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But the challenge is our inability to demonstrate infectious viral particles during clinical presentations, partly because by that point, the viruses would have damaged the tissues and be cleared by the immune system. Therefore, viral signatures such as viral nucleic acids and virus\u2010reactive antibodies may be the only readouts pointing to viruses as potential primary triggers of DCM. Thus, it becomes hard to explain persistent inflammatory infiltrates that might occur in individuals affected with chronic myocarditis\/DCM manifesting myocardial dysfunctions. In these circumstances, autoimmunity is suspected, and antibodies to various autoantigens have been demonstrated, suggesting that immune therapies to suppress the autoimmune responses may be necessary. From this perspective, we endeavoured to determine whether or not the known viral causes are associated with development of autoimmune responses to cardiac antigens that include both cardiotropic and non\u2010cardiotropic viruses. If so, what their nature and significance are in developing chronic myocarditis resulting from viruses as primary triggers.<\/jats:p>","DOI":"10.1002\/rmv.2478","type":"journal-article","created":{"date-parts":[[2023,9,2]],"date-time":"2023-09-02T10:23:57Z","timestamp":1693650237000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["The knowns and unknowns of cardiac autoimmunity in viral myocarditis"],"prefix":"10.1002","volume":"33","author":[{"given":"Kiruthiga","family":"Mone","sequence":"first","affiliation":[{"name":"School of Veterinary Medicine and Biomedical Sciences University of Nebraska\u2010Lincoln  Lincoln Nebraska USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4082-9254","authenticated-orcid":false,"given":"Jay","family":"Reddy","sequence":"additional","affiliation":[{"name":"School of Veterinary Medicine and Biomedical Sciences University of 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