[Interactions between cardiomyocytes and extracellular matrix in the failing human heart].

Numerous morphological changes can be observed in human myocardium failing because of dilated cardiomyopathy. These can be observed by electron microscopy and by immunofluorescence microscopy using monoclonal antibodies. These changes include: 1) the occurrence of hypertrophied and atrophied myocytes as well as cells of normal size, 2) degenerative changes in myocytes; these consist of nuclei of varying size and shape, lack of contractile material, disorganization of the cytoskeleton, and sequestration of cellular particles into the extracellular space and 3) an enlarged extracellular space, that is, fibrosis, which contains increased amounts of the different matrix proteins such as fibronectin and laminin, the various collagens, and chondroitin sulfate, in addition to cellular debris and numerous macrophages and fibroblasts. On the basis of these findings it is hypothetized that there exists an interaction between myocytes and the extracellular matrix. The cells of the latter may be stimulated to higher rates of proteins synthesis by the presence of cellular debris. This process, in turn, may be harmful for the structural integrity of myocytes which consequently sequester more cellular particles. In this manner, a vicious circle may be started that leads to further structural and functional deterioration of the myocardium, finally resulting in failure.