ABSTRACT
Introduction Endomyocardial brosis or simply EMF is a restrictive cardiomyopathy known to aect persons of dened geographical locales and socioeconomic status [1], [2]. First described at the Department of Pathology-Makerere University, Uganda by the Pathologist J.N.P Davies in 1948[3], the important features of this diseasenamely, geographical distribution, cardiac specicity and preference for the socioeconomically poor, have evaded a complete scientic explanation despite the intense scientic scrutiny to which the disease has been subjected[4], [5]. Although
the pathological lesions in EMF have been clearly found to comprise brosis and calcication, possibly resulting from long standing inammatory responses, no natural insult is evidenced to cause such pathology [5], [6]. Specically, in as much as several potential insults have been proposed as the primary cause for EMF, including Infection (Toxoplasmosis, Rheumatic fever, Malaria, Myocarditis and Helminthes [7]), allergy (Autoimmunity and Eosinophilia [8]), malnutrition (Protein or Magnesium deciency[5], [7]) and toxic agents(Cassava, other plant toxins, Arsenic[9], Cerium, orium, Serotonin, or Vitamin D[5]); no single one is proven[5], [10]. Existing evidence for an ethnic predisposition points to a possible genetic idiosyncrasy [11], [12]. Largely because of the above lack of evidence for a particular causative insult, the disease remains unpreventable [5]. Recent studies indicate that there might indeed be a decline in the incidence of EMF paralleled to improvement in the socioeconomic welfare of high risk populations [4]. Until now, the only evidenced benet for drug use in EMF-deterring progression of the inammatory pathology, has revolved around steroids [13], with the list of trial drugs expanding to include, more lately, serotonin receptor inhibitors [14], [15]. Surgery, mainly that involving cardiomyoectomy of pathological lesions (plus reconstruction of the heart architecture), has a role despite its infrequent use due to poor state of heart surgery available in regions where EMF is similarly prevalent [15]. Ideally, all EMF patients with stage III and IV heart failure would benet from a heart transplant [15]. e foregoing picture underlines the need to devise novel, cheap and yet still eective medical interventions against EMF.
