Targeting the Myocardial Microenvironment: Novel Antiviral Strategies and Therapeutic Perspectives for Coxsackievirus B-Induced Myocarditis.

Coxsackievirus B3 is a primary cause of viral myocarditis, with ≈20% of cases progressing to dilated cardiomyopathy. Despite its clinical significance, therapeutic strategies remain limited. The pathogenesis of coxsackievirus B3-induced myocarditis is complex, centered on the virus's ability to hijack the myocardial microenvironment, which is composed of various cell types and their interactions, influencing disease progression and outcomes. This review comprehensively summarizes the changes in fibroblasts, endothelial cells, mast cells, monocytes/macrophages, neutrophils, dendritic cells, natural killer cells, and lymphocytes within the myocardial microenvironment during coxsackievirus B3 infection, highlighting their critical roles in disease development. Additionally, it provides an overview of recent findings on potential therapeutic approaches targeting the myocardial microenvironment. Targeted regulation of cellular functions, key molecular pathway intervention, intelligent delivery system development, and noninvasive biomarker identification, combined with organoid and artificial intelligence technologies, pave the way for precision therapy and diagnosis centered on myocardial microenvironment remodeling.