Potential role of humoral immunity in cardiac dysfunction of patients suffering from dilated cardiomyopathy

Abstract

In the majority of DCM patients, disturbances of humoral immunity with production of cardiodepressant antibodies may play a functional role in cardiac dysfunction. Evidence of cardiodepressant antibodies predicts hemodynamic benefits during IA.

Immunoadsorption and subsequent immunoglobulin substitution decreases myocardial gene expression of desmin in dilated cardiomyopathy

“…These antibodies induce a negative inotropic effect in isolated rat cardiomyocytes through depression of calcium transients; they are furthermore detectable in the majority of DCM patients [15,17]. Recent in vitro data indicate that these antibodies belong to the IgG-3 subclass [16].…”

“…Recent in vitro data indicate that these antibodies belong to the IgG-3 subclass [16]. Elimination of antibodies by IA results in hemodynamic improvement and a reduction in myocardial inflammation [12][13][14][15][16][17]. The IgG, which was substituted for safety reasons after IA [13] may additionally influence the immune system through various mechanisms [33]-and can possibly have beneficial effects in patients with heart failure [34].…”

“…Animal models have shown that DCM can be triggered by autoantibodies [8][9][10][11]. Recent clinical studies indicate that cardiac antibodies may play an active role in the pathogenesis and progression of the disease in humans: removal of antibodies by immunoadsorption (IA) induces hemodynamic improvement and ameliorates myocardial inflammation in patients with DCM [12][13][14][15][16][17]. Elimination of cardiodepressant antibodies may be one explanation for the beneficial hemodynamic effects of IA in patients with DCM [15][16][17].…”

Complete Elimination of Cardiodepressant IgG3 Autoantibodies by Immunoadsorption in Patients With Severe Heart Failure

“…Cardiodepressant IgG3 autoantibodies (CD-Abs) directed against myosin, sarcolemmal proteins, and G-protein-coupled receptors have been identified, 6,7 and studies of treatment outcome conducted in Germany have demonstrated that approximately half of patients with detectable levels of those autoantibodies show an improvement in cardiac function after undergoing immunoadsorption (IA) therapy to remove them. 8, 9 A recent clinical follow-up report further showed that apheresis treatment can increase the survival rate of DCM from 60% to 80% over 2 years. 10 No prospective studies, however, have been conducted to date to further evaluate this phenomenon.…”

Detection of viral genomes from endomyocardial biopsy samples in dilated cardiomyopathy in hungary

“…Following pentaglobin treatment, the inflammatory phenomena were reduced by 70%, and the control biopsies indicated that eradication was successful in 40% of the cases. Staudt et al [17] found that there is a possibility for elimination of the cardiotoxic antibodies (antiactin, antimyosin, anti-beta-1 receptor, etc. antibodies) with the aid of apheresis (plasma immunoadsorption).…”