Immunoadsorption in patients with dilated cardiomyopathy

Abstract

Dilated cardiomyopathy (DCM) is characterized by ventricular enlargement and progressive systolic and diastolic dysfunction. Disturbances of the cellular and humoral immune system are frequently observed in DCM. Circulating antibodies of the IgG class against diverse myocardial antigens have been identified and are thought to play a causative role in the pathogenesis of DCM. Possible mechanisms include the promotion of chronic inflammation, activation of the β1-adrenoreceptor and activation of Fc(γ)-receptors. Various clinical studies suggest a positive effect of immunoadsorption (IA) using protein A columns, with or without subsequent IgG substitution (IA/IgG) on symptoms, myocardial function and the hemodynamic situation of these patients. Decreased myocardial inflammation was also observed in DCM patients treated with IA/IgG. In addition to conservative medical treatment, IA/IgG may therefore represent a new therapeutic option for patients with heart failure due to DCM.