A geochemical basis for endomyocardial fibrosis

Valiathan, Manna; Cc, Kartha; Panday, V.K.; Dang, H.S.; Sunta, C.M.

doi:10.1093/cvr/20.9.679

Cited by 35 publications

(18 citation statements)

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“…The etiology of the disease is unknown, however it has been associated with a number of factors including tropical climate, helminthic infections and eosinophilia, certain cardiotropic viruses, ingestion of certain foods like cassava, combination of magnesium deficiency and high levels of cerium in the body [8][9][10][11]. No such factors were found in our patient.…”

Section: Discussionmentioning

confidence: 63%

Isolated right ventricular endomyocardial fibrosis in a young male with chronic myeloid leukemia (RCD code: III-3F.2)

Sultan

Hasan

2017

Journal of Rare Cardiovascular Diseases

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Endomyocardial fibrosis (EMF) is a rare disease of unknown etiology which is more prevalent in tropical countries. EMF is associated with fibrosis of endomyocardium, involving one or both ventricles. It usually presents with heart failure and has a poor prognosis. The diagnosis is usually made on echocardiogram, however cardiac magnetic resonance (CMR) is ideal for the diagnosis of EMF. We report a rare case of right ventricular endomyocardial fibrosis in a young male with chronic myeloid leukemia but no eosinophilia. Right ventricular EMF was diagnosed on the basis of classic findings on CMR. JRCD 2017; 3 (3): 98-100

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Section: Discussionmentioning

confidence: 63%

Isolated right ventricular endomyocardial fibrosis in a young male with chronic myeloid leukemia (RCD code: III-3F.2)

Sultan

Hasan

2017

Journal of Rare Cardiovascular Diseases

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“…A clustering of EMF in the coastal region of Kerala led to an hypothesis that exposure to geochemical substances may affect EMF. In support of this, cerium, a rare earth element, was found in the hearts of EMF patients in greater abundance than controls (Valiathan et al 1986), a finding that requires confirmation.…”

Section: Discussionmentioning

confidence: 88%

“…Another peak appears around age 30, favouring women 2 : 1 over men (Connor et al 1967(Connor et al , 1968Sezi 1993). EMF is prevalent in Kerala State, India, and in Uganda, where more detailed studies have been done (Connor et al 1967(Connor et al , 1968Valiathan et al 1993). In Kerala, EMF clusters along the coastal area, and in Uganda the condition is most prevalent in the south central districts of Mukono and Luwero (formerly East Mengo).…”

Section: Introductionmentioning

confidence: 99%

Poverty and eosinophilia are risk factors for endomyocardial fibrosis (EMF) in Uganda

Rutakingirwa¹,

Ziegler²,

Newton³

et al. 1999

Tropical Med Int Health

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Summaryobjective To determine the relative risks of socio-demographic, dietary, and environmental factors for endomyocardial fibrosis (EMF) in Uganda.method Unmatched case control study in Mulago Hospital, Kampala. Cases (n ϭ 61) were sequential patients hospitalized with an echocardiographic diagnosis of EMF from June 1995 to March 1996. Controls (n ϭ 120) were concurrent patients with other forms of heart disease (heart controls, n ϭ 59) and subjects admitted for trauma or elective surgery (hospital controls, n ϭ 61). All consenting subjects answered a structured questionnaire administered by trained interviewers. Complete blood counts, malaria films and stool examination for ova and parasites were performed. Questionnaires elicited information on home address, economic circumstances, variables concerned with environmental exposures and usual diet before becoming ill.results After adjustment for age and sex, cases were significantly more likely than controls to have Rwanda/Burundi ethnic origins (P ϭ 0.008). Compared with controls, cases had a lower level of education (P Ͻ 0.001 for heart controls and P ϭ 0.07 for hospital controls), were more likely to be peasants (P Ͻ 0.001), and to come from Luwero or Mukono Districts (P ϭ 0.003). After further adjustment for peasant occupation, cases were more likely than controls to walk barefoot (P ϭ 0.015), consume cassava as their staple food (P Ͻ 0.001) and to lack fish or meat in dietary sauces (P ϭ 0.02). Cases were more likely to exhibit absolute eosinophilia (P ϭ 0.006). The effect of cassava diet was more marked in the younger age group, while the effect of eosinophilia was greater in adults. Socio-economic disadvantage is a risk for EMF. Absolute eosinophilia is a putative cause of EMF, a finding not explained by parasitism.conclusion Data indicate that relative poverty and environmental factors triggering eosinophilia appear to act in a geographically restricted region of Uganda in the aetiology of EMF. keywords endomyocardial fibrosis, cassava, eosinophilia correspondence Prof. J. L. Ziegler,

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“…As with industrial exposure, environmental contact with lanthanoid dusts is associated fibrotic tissue injury. Of interest, environmental exposure to cerium is linked to fibrotic cardiomyopathy rather than to lung fibrosis [46–48]. The underlying mechanism of this is not known, but it has been demonstrated that cardiac fibroblasts respond to challenge with a greater proliferative response than do lung fibroblasts [49,50].…”

Section: Discussionmentioning

confidence: 99%

Stimulation of Fibroblast Proliferation by Insoluble Gadolinium Salts

Bleavins

Perone

Naik

et al. 2011

Biol Trace Elem Res

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The purpose of this study was to assess insoluble salts containing gadolinium (Gd3+) for effects on human dermal fibroblasts. Responses to insoluble Gd3+ salts were compared to responses seen with Gd3+ solubilized with organic chelators, as in the Gd3+-based contrast agents (GBCAs) used for magnetic resonance imaging. Insoluble particles of either Gd3+-phosphate or Gd3+-carbonate rapidly attached to the fibroblast cell surface and stimulated proliferation. Growth was observed at Gd3+ concentrations between 12.5 and 125 μM, with toxicity at higher concentrations. Such a narrow window did not characterize GBCA stimulation. Proliferation induced by insoluble Gd3+ salts was inhibited in the presence of antagonists of mitogen-activated protein kinase and phosphatidylinositol 3-kinase signaling pathways (similar to chelated Gd3+) but was not blocked by an antibody to the platelet-derived growth factor receptor (different from chelated-Gd3+). Finally, high concentrations of the insoluble Gd3+ salts failed to prevent fibroblast lysis under low-Ca2+ conditions while similar concentrations of chelated-Gd3+ were effective. In conclusion, while insoluble Gd3+ salts are capable of stimulating fibroblast proliferation, one should be cautious in assuming that GBCA dechelation must occur in vivo to produce the profibrotic changes seen in association with GBCA exposure in the subset of renal failure patients that develop nephrogenic systemic fibrosis.

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A geochemical basis for endomyocardial fibrosis

Cited by 35 publications

References 0 publications

Isolated right ventricular endomyocardial fibrosis in a young male with chronic myeloid leukemia (RCD code: III-3F.2)

Isolated right ventricular endomyocardial fibrosis in a young male with chronic myeloid leukemia (RCD code: III-3F.2)

Poverty and eosinophilia are risk factors for endomyocardial fibrosis (EMF) in Uganda

Stimulation of Fibroblast Proliferation by Insoluble Gadolinium Salts

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