Analysis of cytokine profiles in pediatric fulminant myocarditis and acute myocarditis multicenter study

Introduction: Acute myocarditis (AM) is an inflammatory disease of the heart muscle that can progress to fulminant myocarditis (FM), a severe and life-threatening condition. The cytokine profile of myocarditis in children, especially in relation to fulminant myocarditis, is not well understood. This study aims to evaluate the cytokine profiles of acute and fulminant myocarditis in children. Method: Pediatric patients diagnosed with myocarditis were included in the study. Cytokine levels were measured using a multiplexed fluorescent bead-based immunoassay. Statistical analysis was performed to compare patient characteristics and cytokine levels between FM, AM, and healthy control (HC) groups. Principal component analysis (PCA) was applied to cytokine groups that were independent among the FM, AM, and HC groups. Result: The study included twenty-two patients with FM and fourteen with AM patients. We identified 4 cytokines that were significantly higher in the FM group compared to the AM group: IL1-RA (p=0.002), IL-8 (p=0.005), IL-10 (p=0.011), and IL-15 (p=0.005). IL-4 was significantly higher in the AM group compared to FM and HC groups (p=0.006, and 0.0015). PDGF-AA, and VEGF-A were significantly lower in the FM group than in the AM group (p=0.013, and <0.001). Similar results were obtained in PCA. Conclusion: Cytokine profiles might be used to differentiate pediatric FM from AM, stratify severity, and predict prognosis. The targeted therapy that works individual cytokines might provide a potential treatment for reducing the onset of the FM and calming the condition, and further studies are needed.