Autoimmunity significantly contributes to the pathogenesis of myocarditis, underscored by its increased frequency in autoimmune diseases such as systemic lupus erythematosus and polymyositis. Even in cases of myocarditis caused by viral infections, dysregulated immune responses contribute to pathogenesis. However, whether triggered by existing autoimmune conditions or viral infections, the precise antigens and immunologic pathways driving myocarditis remain incompletely understood. The emergence of myocarditis associated with immune checkpoint inhibitor therapy, commonly used for treating cancer, has afforded an opportunity to understand autoimmune mechanisms in myocarditis, with autoreactive T cells specific for cardiac myosin playing a pivotal role. Despite their self-antigen recognition, cardiac myosin-specific T cells can be present in healthy individuals due to bypassing the thymic selection stage. In recent studies, novel modalities in suppressing the activity of pathogenic T cells including cardiac myosin-specific T cells have proven effective in treating autoimmune myocarditis. This review offers an overview of the current understanding of heart antigens, autoantibodies, and immune cells as the autoimmune mechanisms underlying various forms of myocarditis, along with the latest updates on clinical management and prospects for future research.

中文翻译：

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自身免疫性心肌炎，老狗和新把戏。


自身免疫在心肌炎的发病机制中发挥着重要作用，其在系统性红斑狼疮和多发性肌炎等自身免疫性疾病中的发病率增加凸显了这一点。即使是由病毒感染引起的心肌炎，免疫反应失调也会导致发病。然而，无论是由现有的自身免疫性疾病还是病毒感染引发，导致心肌炎的确切抗原和免疫途径仍不完全清楚。与常用于治疗癌症的免疫检查点抑制剂疗法相关的心肌炎的出现，为了解心肌炎中的自身免疫机制提供了机会，其中心肌肌球蛋白特异性的自身反应性 T 细胞发挥着关键作用。尽管心肌肌球蛋白特异性 T 细胞能够识别自身抗原，但由于绕过了胸腺选择阶段，它们仍可存在于健康个体中。最近的研究表明，抑制致病性 T 细胞（包括心肌肌球蛋白特异性 T 细胞）活性的新方法已被证明可有效治疗自身免疫性心肌炎。这篇综述概述了目前对心脏抗原、自身抗体和免疫细胞作为各种形式心肌炎的自身免疫机制的认识，以及临床管理的最新进展和未来研究的前景。