**6. References**

362 Myocarditis

**P40225** Thrombopoietin IHELLN\*GTRGLFPGPSRRM 250-267

**P07996** Thrombospondin 1 VVN\*STTGPGEHLRH,M 1065-1077 **P04004** Vitronectin NN\*ATVHEQVGGPSLTSDLQAQSKM 85-107

**P02766** Transthyretin ALGISPFHEHAEVVFTA**N**\*DSGPRH 101-123 Table 3. LC/MSMS analysis for the identification of glycosylation sites, H indicates peptides

In biomedical applications, a comparative approach is usually employed to identify proteins that are up and down regulated in a disease specific manner for use as diagnostic markers or therapeutic targets. This report represents an overview of the investigation at molecular

Serum proteins (including the N-glycosylation sites profiling) and glycoproteins and free peptides occurring in human sera from healthy donors were compared to the ones from myocarditis patients. This procedure, allowed the identification of several N-glycosylation sites by a single-step proteomic approach, contemporarily probing an entire complex sample by LC-MS/MS. Thanks to the depletion of the serum most abundant proteins, we could detect some of the very weakly represented free peptides, whose presence is connected to the pathology itself. The high resolution, the sensitivity and the reproducibility of the used techniques led to the identification of some up regulated proteins in the serum from a myocarditis affected patient, all these proteins are connected to inflammatory events and one in particular (hemopexin) opens the way to new speculations

 Finally, this proteomic approach represents a new opportunity for therapeutics and early diagnostics, for the screening of proteic biomarkers in pathological status. Finding a biomarker molecule that precisely indicates certain kind of pathology, is something quite difficult to achieve since it requires a huge background in many different fields of clinical investigation. Here we contribute with putative diagnostic species that could really be

This work was supported by grants from the INBB, Ministero dell'Universita` e della Ricerca Scientifica (Progetti di Rilevante Interesse Nazionale 2002, 2003, 2005, 2006; FIRB 2001). Support from the National Center of Excellence in Molecular Medicine (MIUR - Rome) and from the Regional Center of Competence (CRdC ATIBB, Regione Campania – Naples) is gratefully acknowledged. The authors declare that this paper is novel and does

deriving from healthy serum and M indicates the ones from myocarditis serum.

**P02787** Serotransferrin

**P25311** Zinc-alpha-2-

level of myocarditis by using a proteomic approach .

in serum proteins as a specific marker for pathologic state.

helpful for an early diagnosis myocarditis event.

not overlap with any already published articles.

**5. Acknowledgments** 

**4. Conclusions** 

**Protein Sequence Peptide** 

glycoprotein DIVEYYN\*DSN\*GSHVLQGRH,M 100-117

QQQHLFGSN\*VTDCSGNFCLFRH,M CGLVPVLAENYN\*KSDNCEDTPEAGY FAVAVVKM

622-642 421-452


**18** 

*Rome, Italy* 

**Myocarditis Presenting with Ventricular Arrhythmias: Role of Electroanatomical** 

**Mapping-Guided Endomyocardial Biopsy** 

Myocarditis is defined as a disease characterized by myocardial inflammation associated with myocyte necrosis. It can be caused by infections, autoimmune response primarily affecting the myocardium or by systemic autoimmune or inflammatory disorders (Aretz et al., 1986). Viral infections are the most frequent cause and account for the vast majority of

Cardiac symptoms that develop during myocarditis may follow after a delay of days to weeks from the beginning of the pathological process; they are quite unspecific and include fatigue, dyspnoea, palpitations, malaise and atypical chest discomfort. Even the clinical cardiac signs may be vague in many patients and generally include cardiac murmurs, gallop rhythms and other signs of heart failure and sometimes pericardial rubs when the pericardium is also involved in the inflammatory process. Myocarditis is often associated with various types of ECG abnormalities (including bundle branch blocks, Q waves resembling those related to myocardial infarction, repolarization abnormalities and QRS prolongation) and rhythm disturbance such as atrio-ventricular blocks, supraventricular tachycardias and ventricular ectopies and tachycardias. Echocardiography may reveal overt systolic dysfunction or a reduction of peak systolic velocities at TDI; moreover, regional wall motion abnormalities and diastolic dysfunction may be found (Cooper, 2009; Feldman et al. 2000). Therefore, this disease should always be considered in patients who present with rapidly progressive cardiomyopathy, chest pain with ECG anomalies that mimic an acute coronary syndrome but with normal coronary arteries or idiopathic ventricular arrhythmias. Furthermore, in young people myocarditis may be frequently responsible for sudden cardiac death, particularly after strenuous physical exertion (Doolan et al., 2004; Corrado D et al. 2001). With this regard it should be highlighted that the recognition of myocarditis in patients presenting with aborted sudden death or major ventricular arrhythmias is actually challenging in everyday clinical practice, as the diagnosis may be difficult and may require the use of invasive procedures. Nevertheless, the detection of myocarditis in patients presenting with ventricular arrhythmias may have a pivotal importance, because the

**1. Introduction** 

cases in North America and Europe (Cooper, 2009).

Maurizio Pieroni, Costantino Smaldone and Fulvio Bellocci *Cardiology Department, Catholic University of the Sacred Heart,* 

**in Differential Diagnosis** 

A central role for free heme in the pathogenesis of severe sepsis. Sci Transl Med. 2010 Sep 29;2(51):51.

