Treatment options in myocarditis: what we know from experimental data and how it translates to clinical trials.

Although viral myocarditis has been mostly attributed to enterovirus and adenovirus infection until recently, the association with parvovirus B19 in Europe and hepatitis C virus in Asia has lately been noted. Clinical trials of antiviral agents, such as interferons, are in progress. Whereas immunosuppression with corticosteroids or cyclosporine is ineffective, immunosuppressors that do not promote viral replication, such as FTY720, are promising new approaches. The inhibition of nuclear factor-kappaB and angiotensin II effectively suppresses inflammation in experimental viral myocarditis. In the EMCV animal model Pycnogenol inhibits viral replication, suppresses the expression of pro-inflammatory cytokines and mast cell-related mediators, and improves inflammation and myocardial necrosis. Pimobendan, FTY720 and Pycnogenol are promising agents for the treatment of viral myocarditis.