Inflammation in viral myocarditis: friend or foe?

Viral myocarditis is an important cause of heart failure for which no specific treatments are available. Direct viral injury to cardiac cells provokes an inflammatory response that significantly contributes to cardiac damage and ensuing morbidity. Despite the central pathogenic role of autoimmune injury, broad inhibition of the inflammatory response does not result in patient benefit. Many preclinical studies collectively emphasize that modulating distinct inflammatory signaling pathways may yield effective viral clearance while preserving cardiac structure. This review aims to provide an overview of the sometimes contrasting observations from experimental viral myocarditis models and to translate the lessons learned into opportunities for future investigations and therapies.