Researchers have discovered the first biomarker for myocarditis, a condition that's frequently misinterpreted as a heart attack. Despite this, diagnosing myocarditis in clinical practice remains to be difficult. The present biomarkers can play an important role in early management strategies.

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According to a recent study, the human homolog of micro RNA miR721 might be utilised to identify individuals with myocarditis from those with myocardial infarction.

The study's authors noted:

"We've discovered the first biomarker for myocarditis, a condition that's frequently misinterpreted as a heart attack. Despite this, diagnosing myocarditis in clinical practice remains to be difficult."

The study's findings appeared in the New England Journal of Medicine. Dr Valentn Fuster, CNIC General Director, underlines the significance of these findings, which create the first verified blood marker for myocarditis with excellent sensitivity and specificity (>90%). This will help doctors identify this condition from other cardiomyopathies such as acute myocardial infarction, myocardial infarction with nonobstructive coronary arteries (MINOCA), and other autoimmune-related inflammatory illnesses.

Dr. Martn, whose study is supported by a Beca Leonardo Grant from the Fundación BBVA quoted:

"Our discovery has enormous promise as a significant clinical aid for the exact and noninvasive detection of myocarditis from little droplets of blood."

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Difficulty in the diagnosis of myocarditis

Myocarditis is difficult to diagnose, and the availability of a sensitive and specific marker of acute myocardial inflammation might have a significant clinical impact, increasing myocarditis diagnosis in general and particularly in the early stages. An inflammatory condition that affects the heart.

Causes of myocarditis

 Myocarditis is an inflammatory illness of the heart. If left untreated, myocarditis can proceed to dilated cardiomyopathy, which can be deadly and necessitate a heart transplant. Following are the causes of myocarditis:

• Infection
• Chemicals
• Medications
• Autoimmune diseases 

Because it is sometimes difficult to obtain a verified diagnosis, the prevalence of Myocarditis is unknown.

MRI diagnosis

1. After coronary angiography or computed tomography scans have ruled out coronary artery disease, magnetic resonance imaging is used to confirm the diagnosis (MRI).
2. However, not all locations have access to MRI equipment, and endomyocardial biopsy, an invasive technique reserved for severe patients, is the current gold standard for myocarditis diagnosis. The development of trustworthy and accessible methods for the early identification of acute myocarditis is thus a major clinical necessity.

Immune checkpoint inhibitors

1. According to Raquel SánchezDaz, "Myocarditis is an uncommon but potentially significant adverse effect in cancer patients taking immunotherapy medications known as "immune checkpoint inhibitors."
2. There are presently no precise indicators for identifying people who are at risk of myocarditis as a result of cancer treatment.

miR721

1. According to Rafael BlancoDomnguez, "this miRNA is generated by autoimmune Th17 cells that identify cardiac antigens generated from proteins like alpha myosin."
2. "These cells target the myocardium, and are in large part responsible for the pathophysiology of the illness," says research co-first author Raquel SánchezDaz.
3. The researchers then went on to find, clone, and confirm miR721's previously unknown human homolog.
4. This study found that this miRNA is generated in the Th17 cells of myocarditis patients and that its expression is only seen in their plasma.

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Biomarker study

The researchers are presently working on studies to assess the biomarker's ability as a determinant of short- and long-term risk, myocardial inflammation persistence, and the risk of relapse, clinical progression, and unfavourable ventricular remodelling.

The CNIC has the exclusive patent on the biomarker and its application to the diagnosis of myocarditis. The CNIC is currently looking into licence arrangements with industry partners to help develop and commercialise this technology so that it may be used in clinical settings.

According to Dr. Fuster:

"This study is a brilliant example of how the CNIC's fundamental research contributes to social health through the translation of information generated in the center's laboratories to clinical practise."

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Implications for India 

The growing CVD burden and its devastating effects on people, families, and populations demand an immediate response. To arrest the advancement of the CVD pandemic in India's resource-poor settings, novel measures are required.

More resources should be dedicated to implementing current knowledge to combat the CVD pandemic in policy, programming, capacity development, and research sectors to address the socioeconomic disparities in disease burden and healthcare requirements of Indians. The present biomarkers can play important role in the early management strategies.

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Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

The author is a practising super specialist from New Delhi.