47
Views
7
CrossRef citations to date
0
Altmetric
Review

Molecular diagnosis of the viral component in cardiomyopathies: pathophysiological, clinical and therapeutic implications

, , , , , & , MD PhD show all
Pages 821-836 | Published online: 13 Jun 2008

Bibiliography

  • Maron BJ, Towbin JA, Thiene G, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation 2006;113(14):1807-16
  • Elliott P, Andersson B, Arbustini E, et al. Classification of the cardiomyopathies: a position statement from the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2008;29(2):270-6
  • Bultmann BD, Klingel K, Nabauer M, et al. High prevalence of viral genomes and inflammation in peripartum cardiomyopathy. Am J Obstet Gynecol 2005;193(2):363-5
  • Frustaci A, Verardo R, Caldarulo M, et al. Myocarditis in hypertrophic cardiomyopathy patients presenting acute clinical deterioration. Eur Heart J 2007;28(6):733-40
  • Maron BJ, Shirani J, Poliac LC, et al. Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles. JAMA 1996;276(3):199-204
  • Kuhl U, Pauschinger M, Schwimmbeck PL, et al. Interferon-β treatment eliminates cardiotropic viruses and improves left ventricular function in patients with myocardial persistence of viral genomes and left ventricular dysfunction. Circulation 2003;107(22):2793-8
  • Frustaci A, Chimenti C, Calabrese F, et al. Immunosuppressive therapy for active lymphocytic myocarditis: virological and immunologic profile of responders versus nonresponders. Circulation 2003;107(6):857-63
  • Meurs KM, Fox PR, Magnon AL, et al. Molecular screening by polymerase chain reaction detects panleukopenia virus DNA in formalin-fixed hearts from cats with idiopathic cardiomyopathy and myocarditis. Cardiovasc Pathol 2000;9(2):119-26
  • Bowles NE, Ni J, Marcus F, Towbin JA. The detection of cardiotropic viruses in the myocardium of patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy. J Am Coll Cardiol 2002;39(5):892-5
  • Maisch B, Portig I, Ristic A, et al. Definition of inflammatory cardiomyopathy (myocarditis): on the way to consensus. A status report. Herz 2000;25(3):200-9
  • Maisch B, Richter A, Sandmoller A, et al. Inflammatory dilated cardiomyopathy (DCMI). Herz 2005;30(6):535-44
  • Kuhl U, Pauschinger M, Noutsias M, et al. High prevalence of viral genomes and multiple viral infections in the myocardium of adults with “idiopathic” left ventricular dysfunction. Circulation 2005;111(7):887-93
  • Kuhl U, Pauschinger M, Bock T, et al. Parvovirus B19 infection mimicking acute myocardial infarction. Circulation 2003;108(8):945-50
  • Bultmann BD, Klingel K, Sotlar K, et al. Fatal parvovirus B19-associated myocarditis clinically mimicking ischemic heart disease: an endothelial cell-mediated disease. Hum Pathol 2003;34(1):92-5
  • Pauschinger M, Doerner A, Kuehl U, et al. Enteroviral RNA replication in the myocardium of patients with left ventricular dysfunction and clinically suspected myocarditis. Circulation 1999;99(7):889-95
  • Calabrese F, Rigo E, Milanesi O, et al. Molecular diagnosis of myocarditis and dilated cardiomyopathy in children: clinicopathologic features and prognostic implications. Diagn Mol Pathol 2002;11(4):212-21
  • Why HJ, Meany BT, Richardson PJ, et al. Clinical and prognostic significance of detection of enteroviral RNA in the myocardium of patients with myocarditis or dilated cardiomyopathy. Circulation 1994;89(6):2582-9
  • Fujioka S, Kitaura Y, Deguchi H, et al. Evidence of viral infection in the myocardium of American and Japanese patients with idiopathic dilated cardiomyopathy. Am J Cardiol 2004;94(5):602-5
  • Partanen J, Nieminen MS, Krogerus L, et al. Cytomegalovirus myocarditis in transplanted heart verified by endomyocardial biopsy. Clini Cardiol 1991;14(10):847-9
  • Maisch B, Schonian U, Crombach M, et al. Cytomegalovirus associated inflammatory heart muscle disease. Scand J Infect Dis 1993;88:135-48
  • Cossart YE, Field AM, Cant B, Widdows D. Parvovirus-like particles in human sera. Lancet 1975;1(7898):72-3
  • Porter HJ, Quantrill AM, Fleming KA. B19 parvovirus infection of myocardial cells. Lancet 1988;1(8584):535-6
  • Schowengerdt KO, Ni J, Denfield SW, et al. Association of parvovirus B19 genome in children with myocarditis and cardiac allograft rejection: diagnosis using the polymerase chain reaction. Circulation 1997;96(10):3549-54
  • Murry CE, Jerome KR, Reichenbach DD. Fatal parvovirus myocarditis in a 5-year-old girl. Hum Pathol 2001;32(3):342-5
  • Pankuweit S, Ruppert V, Eckhardt H, et al. Pathophysiology and aetiological diagnosis of inflammatory myocardial diseases with a special focus on parvovirus B19. J Vet Med 2005;52(7-8):344-7
  • Tschope C, Bock CT, Kasner M, et al. High prevalence of cardiac parvovirus B19 infection in patients with isolated left ventricular diastolic dysfunction. Circulation 2005;111(7):879-886
  • Alter P, Rupp H, Maisch B. Activated nuclear transcription factor κB in patients with myocarditis and dilated cardiomyopathy–relation to inflammation and cardiac function. Biochem Biophys Res Commun 2006;339(1):180-7
  • Kawai C. From myocarditis to cardiomyopathy: mechanisms of inflammation and cell death: learning from the past for the future. Circulation 1999;99(8):1091-100
  • Seko Y, Tsuchimochi H, Nakamura T, et al. Expression of major histocompatibility complex class I antigen in murine ventricular myocytes infected with Coxsackievirus B3. Circ Res 1990;67(2):360-7
  • Mueller DL, Jenkins MK, Schwartz RH. Clonal expansion versus functional clonal inactivation: a costimulatory signalling pathway determines the outcome of T cell antigen receptor occupancy. Ann Rev Immunol 1989;7:445-80
  • Seko Y, Matsuda H, Kato K, et al. Expression of intercellular adhesion molecule-1 in murine hearts with acute myocarditis caused by coxsackievirus B3. J Clin Invest 1993;91(4):1327-36
  • Goser S, Ottl R, Brodner A, et al. Critical role for monocyte chemoattractant protein-1 and macrophage inflammatory protein-1α in induction of experimental autoimmune myocarditis and effective anti-monocyte chemoattractant protein-1 gene therapy. Circulation 2005;112(22):3400-7
  • O'Donnell SM, Hansberger MW, Connolly JL, et al. Organ-specific roles for transcription factor NF-κB in reovirus-induced apoptosis and disease. J Clin Invest 2005;115(9):2341-50
  • Tomioka N, Kishimoto C, Matsumori A, Kawai C. Effects of prednisolone on acute viral myocarditis in mice. J Am Coll Cardiol 1986;7(4):868-72
  • Mann DL. Inflammatory mediators and the failing heart: past, present, and the foreseeable future. Circ Res 2002;91(11):988-98
  • Knowlton KU, Badorff C. The immune system in viral myocarditis: maintaining the balance. Circ Res 1999;85(6):559-61
  • Kuhl U, Pauschinger M, Seeberg B, et al. Viral persistence in the myocardium is associated with progressive cardiac dysfunction. Circulation 2005;112(13):1965-70
  • Li Y, Heuser JS, Cunningham LC, et al. Mimicry and antibody-mediated cell signaling in autoimmune myocarditis. J Immunol 2006;177(11):8234-40
  • Caforio AL, Calabrese F, Angelini A, et al. A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis. Eur Heart J 2007;28(11):1326-33
  • Lauer B, Schannwell M, Kuhl U, et al. Antimyosin autoantibodies are associated with deterioration of systolic and diastolic left ventricular function in patients with chronic myocarditis. J Am Coll Cardiol 2000;35(1):11-8
  • Felix SB, Staudt A, Dorffel WV, et al. Hemodynamic effects of immunoadsorption and subsequent immunoglobulin substitution in dilated cardiomyopathy: three-month results from a randomized study. J Am Coll Cardiol 2000;35(6):1590-8
  • Koutsilieris M. Skeletal metastases in advanced prostate cancer: cell biology and therapy. Crit Rev Oncol Hematol 1995;18(1):51-64
  • Reyes-Moreno C, Sourla A, Choki I, et al. Osteoblast-derived survival factors protect PC-3 human prostate cancer cells from adriamycin apoptosis. Urology 1998;52(2):341-7
  • Koutsilieris M, Allaire-Michaud L, Fortier M, Lemay A. Mitogen(s) for endometrial-like cells can be detected in human peritoneal fluid. Fertil Steril 1991;56(5):888-93
  • Janvier R, Sourla A, Koutsilieris M, Doillon CJ. Stromal fibroblasts are required for PC-3 human prostate cancer cells to produce capillary-like formation of endothelial cells in a three-dimensional co-culture system. Anticancer Res 1997;17(3A):1551-7
  • Tsigkos S, Koutsilieris M, Papapetropoulos A. Angiopoietins in angiogenesis and beyond. Expert Opin Invest Drugs 2003;12(6):933-41
  • Tolis G, Faure N, Koutsilieris M, et al. Suppression of testicular steroidogenesis by the GnRH agonistic analogue Buserelin (HOE-766) in patients with prostatic cancer: studies in relation to dose and route of administration. J Steroid Biochem 1983;19(1C):995-8
  • Koutsilieris M, Sourla A, Pelletier G, Doillon CJ. Three-dimensional type I collagen gel system for the study of osteoblastic metastases produced by metastatic prostate cancer. J Bone Miner Res 1994;9(11):1823-32
  • Dimitriadou V, Mecheri S, Koutsilieris M, et al. Expression of functional major histocompatibility complex class II molecules on HMC-1 human mast cells. J Leukoc Biol 1998;64(6):791-9
  • Mitsiades CS, Koutsilieris M. Molecular biology and cellular physiology of refractoriness to androgen ablation therapy in advanced prostate cancer. Expert Opin Investig Drugs 2001;10(6):1099-115
  • Koutsilieris M. Pathophysiology of uterine leiomyomas. Biochem Cell Biol 1992;70(5):273-8
  • Sourla A, Doillon C, Koutsilieris M. Three-dimensional type I collagen gel system containing MG-63 osteoblasts-like cells as a model for studying local bone reaction caused by metastatic cancer cells. Anticancer Res 1996;16(5A):2773-80
  • Sourla A, Polychronakos C, Zeng WR, et al. Plasminogen activator inhibitor 1 messenger RNA expression and molecular evidence for del7;(q22) in uterine leiomyomas. Cancer Res 1996;56(13):3123-8
  • Afanasyeva M, Georgakopoulos D, Rose NR. Autoimmune myocarditis: cellular mediators of cardiac dysfunction. Autoimmun Rev 2004;3(7-8):476-86
  • Magnani JW, Dec GW. Myocarditis: current trends in diagnosis and treatment. Circulation 2006;113(6):876-90
  • Cohen CJ, Shieh JT, Pickles RJ, et al. The coxsackievirus and adenovirus receptor is a transmembrane component of the tight junction. Proc Natl Acad Sci USA 2001;98(26):15191-6
  • Asher DR, Cerny AM, Weiler SR, et al. Coxsackievirus and adenovirus receptor is essential for cardiomyocyte development. Genesis 2005;42(2):77-85
  • Chen JW, Zhou B, Yu QC, et al. Cardiomyocyte-specific deletion of the coxsackievirus and adenovirus receptor results in hyperplasia of the embryonic left ventricle and abnormalities of sinuatrial valves. Circ Res 2006:923-30
  • Okegawa T, Pong RC, Li Y, et al. The mechanism of the growth-inhibitory effect of coxsackievirus and adenovirus receptor (CAR) on human bladder cancer: a functional analysis of CAR protein structure. Cancer Res 2001:6592-600
  • Ruppert V, Meyer T, Pankuweit S, et al. Activation of STAT1 transcription factor precedes up-regulation of coxsackievirus-adenovirus receptor during viral myocarditis. Cardiovasc Pathol 2008;17(2):81-92
  • D'Ambrosio A, Patti G, Manzoli A, et al. The fate of acute myocarditis between spontaneous improvement and evolution to dilated cardiomyopathy: a review. Heart (British Cardiac Society) 2001;85(5):499-504
  • Abdel-Aty H, Boye P, Zagrosek A, et al. Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. J Am Coll Cardiol 2005;45(11):1815-22
  • Brown M, Petric M. Evaluation of cell line 293 for virus isolation in routine viral diagnosis. J Clin microbiol 1986;23(4):704-8
  • Fujioka S, Kitaura Y, Ukimura A, et al. Evaluation of viral infection in the myocardium of patients with idiopathic dilated cardiomyopathy. J Am Coll Cardiol 2000;36(6):1920-6
  • Muir P, Nicholson F, Banatvala JE, Bingley PJ. Coxsackie B virus and postviral fatigue syndrome. BMJ 1991;302(6777):658-9
  • Modrow S, Dorsch S. Antibody responses in parvovirus B19 infected patients. Pathol Biol 2002;50(5):326-31
  • Henle W, Henle G, Andersson J, et al. Antibody responses to Epstein-Barr virus-determined nuclear antigen (EBNA)-1 and EBNA-2 in acute and chronic Epstein-Barr virus infection. Proc Natl Acad Sci USA 1987;84(2):570-4
  • Grangeot-Keros L, Cointe D. Diagnosis and prognostic markers of HCMV infection. J Clin Virol 2001;21(3):213-21
  • Vohringer M, Mahrholdt H, Yilmaz A, Sechtem U. Significance of late gadolinium enhancement in cardiovascular magnetic resonance imaging (CMR). Herz 2007;32(2):129-37
  • Laissy JP, Hyafil F, Feldman LJ, et al. Differentiating acute myocardial infarction from myocarditis: diagnostic value of early- and delayed-perfusion cardiac MR imaging. Radiology 2005;237(1):75-82
  • Mahrholdt H, Wagner A, Deluigi CC, et al. Presentation, patterns of myocardial damage, and clinical course of viral myocarditis. Circulation 2006;114(15):1581-90
  • Cooper LT, Baughman KL, Feldman AM, et al. The role of endomyocardial biopsy in the management of cardiovascular disease: A Scientific Statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. Eur Heart J 2007;28(24):3076-93
  • Friedrich MG, Strohm O, Schulz-Menger J, et al. Contrast media-enhanced magnetic resonance imaging visualizes myocardial changes in the course of viral myocarditis. Circulation 1998;97(18):1802-9
  • Kubo N, Morimoto S, Hiramitsu S, et al. Feasibility of diagnosing chronic myocarditis by endomyocardial biopsy. Heart Vessels 1997;12(4):167-70
  • Hauck AJ, Kearney DL, Edwards WD. Evaluation of postmortem endomyocardial biopsy specimens from 38 patients with lymphocytic myocarditis: implications for role of sampling error. Mayo Clin Proc 1989;64(10):1235-45
  • Aretz HT, Billingham ME, Edwards WD, et al. Myocarditis. A histopathologic definition and classification. Am J Cardiovascular Pathol 1987;1(1):3-14
  • Schultheiss HP, Kuhl U. Overview on chronic viral cardiomyopathy/chronic myocarditis. Ernst Schering Res Found Workshop 2006;(55):3-18
  • Corradi D, Vaglio A, Maestri R, et al. Eosinophilic myocarditis in a patient with idiopathic hypereosinophilic syndrome: insights into mechanisms of myocardial cell death. Hum Pathol 2004;35(9):1160-3
  • Bowles NE, Richardson PJ, Olsen EG, Archard LC. Detection of Coxsackie-B-virus-specific RNA sequences in myocardial biopsy samples from patients with myocarditis and dilated cardiomyopathy. Lancet 1986;1(8490):1120-3
  • Pauschinger M, Kallwellis-Opara A. Frontiers in viral diagnostics. Ernst Schering Res Found Workshop 2006;(55):39-54
  • Baboonian C, Treasure T. Meta-analysis of the association of enteroviruses with human heart disease. Heart 1997;78(6):539-43
  • Koutsilieris M, Lembessis P, Luu-The V, Sourla A. Repetitive and site-specific molecular staging of prostate cancer using nested reverse transcriptase polymerase chain reaction for prostate specific antigen and prostate specific membrane antigen. Clin Exp Metastasis 1999;17(10):823-30
  • Sourla A, Lembessis P, Mitsiades C, et al. Conversion of nested reverse-transcriptase polymerase chain reaction from positive to negative status at peripheral blood during androgen ablation therapy is associated with long progression-free survival in stage D2 prostate cancer patients. Anticancer Res 2001;21(5):3565-70
  • Mitsiades CS, Lembessis P, Sourla A, et al. Molecular staging by RT-pCR analysis for PSA and PSMA in peripheral blood and bone marrow samples is an independent predictor of time to biochemical failure following radical prostatectomy for clinically localized prostate cancer. Clin Exp Metastasis 2004;21(6):495-505
  • Mitropapas G, Nezos A, Halapas A, et al. Molecular detection of tyrosinase transcripts in peripheral blood from patients with malignant melanoma: correlation of PCR sensitivity threshold with clinical and pathologic disease characteristics. Clin Chem Lab Med 2006;44(12):1403-9
  • Lembessis P, Msaouel P, Halapas A, et al. Combined androgen blockade therapy can convert RT-PCR detection of prostate-specific antigen (PSA) and prostate-specific membrane antigen (PSMA) transcripts from positive to negative in the peripheral blood of patients with clinically localized prostate cancer and increase biochemical failure-free survival after curative therapy. Clin Chem Lab Med 2007;45(11):1488-94
  • Kuethe F, Sigusch HH, Hilbig K, et al. Detection of viral genome in the myocardium: lack of prognostic and functional relevance in patients with acute dilated cardiomyopathy. Am Heart J 2007;153(5):850-8
  • Dec GW Jr, Palacios IF, Fallon JT, et al. Active myocarditis in the spectrum of acute dilated cardiomyopathies. Clinical features, histologic correlates, and clinical outcome. N Engl J Med 1985;312(14):885-90
  • McCarthy RE 3rd, Boehmer JP, Hruban RH, et al. Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. N Engl J Med 2000;342(10):690-5
  • Pauschinger M, Rutschow S, Chandrasekharan K, et al. Carvedilol improves left ventricular function in murine coxsackievirus-induced acute myocarditis. Association with reduced myocardial interleukin-1β and MMP-8 expression and a modulated immune response. Eur J Heart Fail 2005;7(4):444-52
  • Maisch B, Richter A, Koelsch S, et al. Management of patients with suspected (peri-)myocarditis and inflammatory dilated cardiomyopathy. Herz 2006;31(9):881-90
  • Mason JW, O'Connell JB, Herskowitz A, et al. A clinical trial of immunosuppressive therapy for myocarditis. The Myocarditis Treatment Trial Investigators. N Engl J Med 1995;333(5):269-75
  • Parrillo JE, Cunnion RE, Epstein SE, et al. A prospective, randomized, controlled trial of prednisone for dilated cardiomyopathy. N Engl J Med 1989;321(16):1061-8
  • Wojnicz R, Nowalany-Kozielska E, Wojciechowska C, et al. Randomized, placebo-controlled study for immunosuppressive treatment of inflammatory dilated cardiomyopathy: two-year follow-up results. Circulation 2001;104(1):39-45
  • Feldman AM, McNamara D. Myocarditis. N Engl J Med 2000;343(19):1388-98
  • Noutsias M, Pauschinger M, Gross U, et al. Giant-cell myocarditis in a patient presenting with dilated cardiomyopathy and ventricular tachycardias treated by immunosuppression: a case report. Int J Cardiol 2007
  • Yuan Z, Liu Y, Liu Y, et al. Cardioprotective effects of peroxisome proliferator activated receptor γ activators on acute myocarditis: anti-inflammatory actions associated with nuclear factor κB blockade. Heart (British Cardiac Society) 2005;91(9):1203-8
  • Sliwa K, Skudicky D, Bergemann A, et al. Peripartum cardiomyopathy: analysis of clinical outcome, left ventricular function, plasma levels of cytokines and Fas/APO-1. J Am Coll Cardiol 2000;35(3):701-5
  • Sliwa K, Forster O, Libhaber E, et al. Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients. Eur Heart J 2006;27(4):441-6
  • Skudicky D, Bergemann A, Sliwa K, et al. Beneficial effects of pentoxifylline in patients with idiopathic dilated cardiomyopathy treated with angiotensin-converting enzyme inhibitors and carvedilol: results of a randomized study. Circulation 2001;103(8):1083-8
  • Bozkurt B, Villaneuva FS, Holubkov R, et al. Intravenous immune globulin in the therapy of peripartum cardiomyopathy. J Am Coll Cardiol 1999;34(1):177-80
  • Miric M, Vasiljevic J, Bojic M, et al. Long-term follow up of patients with dilated heart muscle disease treated with human leucocytic interferon alpha or thymic hormones initial results. Heart (British Cardiac Society) 1996;75(6):596-601
  • Obeyesekere I, Hermon Y. Myocarditis and cardiomyopathy after arbovirus infections (dengue and chikungunya fever). Br Heart J 1972;34(8):821-7
  • Thiede WH. Cardiac involvement in lymphocytic choriomeningitis. Arch Intern Med 1962;109:50-4
  • Russell SJ, Bell EJ. Echoviruses and carditis. Lancet 1970;1(7650):784-5
  • Grist NR, Bell EJ. Coxsackie viruses and the heart. Am Heart J 1969;77(3):295-300
  • Weinstein L, Shelokov A. Cardiovascular manifestations in acute poliomyelitis. N Engl J Med 1951;244:281-5
  • Okabe M, Fukuda K, Arakawa K, Kikuchi M. Chronic variant of myocarditis associated with hepatitis c virus infection. Circulwation 1997;96:22-4
  • Beschorner WE, Baughman K, Turnicky RP, et al. HIV-associated myocarditis. Pathology and immunopathology. Am J Pathol 1990;137(6):1365-71
  • Adams CW. Postviral myopericarditis associated with the influenza virus; report of eight cases. Am J Cardiol 1959;4(1):56-67
  • Roberts WC, Fox SM III. Mumps of the heart: clinical and pathologic features. Circulation 1965;32:342-5
  • Akhtar N, Ni J, Stromberg D, et al. Tracheal aspirate as a substrate for polymerase chain reaction detection of viral genome in childhood pneumonia and myocarditis. Circulation 1999;99:2011-8
  • Ross E, Armentrout SA. Myocarditis associated with rabies. Report of a case. N Engl J Med 1962;24(266):1087-9
  • Henson D, Mufson MA. Myocarditis and pneumonitis with type 21 adenovirus infection. Association with fatal myocarditis and pneumonitis. Am J Dis Child 1971;121(4):334-6
  • Bodey GP, Wertlake PT, Douglas G, Levin RH. Cytomegalic inclusion disease in patients with acute leukaemia. Ann Intern Med 1965;62:899-906
  • Frishman W, Kraus ME, Zabkar J, et al. Infectious mononucleosis and fatal myocarditis. Chest 1977;72:535-8
  • Lowry PJ, Edwards CW, Nagle RE. Herpes-like virus particles in myocardium of patient progressing to congestive cardiomyopathy. Br Heart J 1982;48(5):501-3
  • Beghetti M, Gervaix A, Haenggeli CA, et al. Myocarditis associated with parvovirus B19 infection in two siblings with merosin-deficient congenital muscular dystrophy. Eur J Pediatr 2000;159(1-2):135-6
  • Anderson T, Foulis MA, Grist NR, Landsman JB. Clinical and laboratory observations in a small pox outbreak. Lancet 1951;1(6667):1248-52
  • Dalgaard JB. Fatal myocarditis following smallpox vaccination. Am Heart J 1957;54(1):156-7

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.