Chagasic cardiopathy. Immunopathologic and morphologic studies in myocardial biopsies

Immunopathologic and morphologic studies at the light and transmission electron microscope levels were carried out in myocardial biopsies of 4 chagasic individuals with circulating antibodies reacting with plasma membrane of striated muscle and endothelial cells (EVI antibody). Two cases did not present clinical evidences of heart involvement, and 2 cases showed chronic heart disease. In viv deposits of immunoglobulins were found at the plasma membrane of working myocardial cells and endothelial cells. The cytologic location of the in vivo bound gamma-globulin was coincident with the specificity of the EVI antibody. Ultrastructural studies showed intracellular alterations compatible with hypoxia of the fibers; these lesions, although they were more severe in the 2 cases with heart disease, were also present in the asymptomatic individuals. These results are congruent with a possible pathogenic effect of the EVI antibody. In 2 patients with Chagas' heart disease, foci of mononuclear infiltrates were examined by transmission electron microscopy. At that level, a close relationship between lymphoctes and muscle cells was observed, with imbrication of the plasma membranes and disappearance of the basal laminae. In the neighborhood of the lymphocytes, definite muscle cell abnormalities were found. These observations are also congruent with the recently suggested possibility that a lymphocyte-mediated immune response against heart tissue may participate in some of the pathogenetic mechanisms of chronic chagasic cardiopathy.