Role of immunoglobulin G3 subclass in dilated cardiomyopathy: Results from protein A immunoadsorption

Staudt, Alexander; Dörr, Marcus; Staudt, Yvonne; Böhm, M; Probst, M.; Empen, Klaus; Plötz, Sebastian; Maschke, Hans E.; Hummel, Astrid; Baumann, Gert; Felix, Stephan B.

doi:10.1016/j.ahj.2004.11.002

Cited by 72 publications

(53 citation statements)

References 31 publications

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“…As cardiodepressant antibodies belong to the IgG3 subgroup, previous studies have underlined the importance of adequate IgG3 reduction [32]. Despite application of a therapeutic protocol for optimized IgG3 reduction [5], in this pilot study, an IgG3 reduction of 58.5% was obtained, which is slightly lower compared to the previously described IgG3 reduction of 61-70% [33][34][35]. As recently published study data disclosed that protein A IA with ineffective IgG-3 reduction shows no beneficial hemodynamic effects [34], the slightly lower rate of IgG3 reduction might contribute to the lower than expected results of the current study.…”

Section: Discussioncontrasting

confidence: 72%

Effects of protein A immunoadsorption in patients with advanced chronic dilated cardiomyopathy

Doesch

Konstandin

Celik

et al. 2009

J of Clinical Apheresis

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In this study, on severely limited heart failure patients with nonfamilial DCM, IA therapy moderately improved markers of heart failure severity in a limited subgroup of patients. This may be due to the selected study population with end-stage heart failure patients and the lower reduction of IgG3 compared to previous studies. Future blinded multicenter studies are necessary to identify those patients that benefit most.

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Section: Discussioncontrasting

confidence: 72%

Effects of protein A immunoadsorption in patients with advanced chronic dilated cardiomyopathy

Doesch

Konstandin

Celik

et al. 2009

J of Clinical Apheresis

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“…Because of the application of a therapeutic protocol for optimized IgG3 reduction [5], an IgG3 reduction of 66.7% was obtained, which is higher than observed in previous pilot studies [10] and is in line with previously described IgG3 reduction of 61-70% [29][30][31]. In support of the role of the IgG3 subclass it was reported that protein A IA with ineffective IgG3 reduction did not show beneficial hemodynamic effects [30].…”

Section: Discussionsupporting

confidence: 84%

Effects of protein A immunoadsorption in patients with chronic dilated cardiomyopathy

Doesch

Mueller

Konstandin

et al. 2010

J of Clinical Apheresis

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In this study, on heart failure patients with nonfamilial DCM, IA therapy significantly improved clinical and humoral markers of heart failure severity. These promising results may be due to the selected study population, with a shorter disease duration and the higher amount of IgG 3 reduction. Future blinded prospective multicenter studies are necessary to identify those patients that benefit most.

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“…Similarly, in patients suffering from DCM, Trimpert et al [25] detected a significant improvement in left ventricular function due to a reduction in cardiotropic AAB (AAB against sarcolemmal and mitochondrial proteins, surface receptors [β 1 -adrenoreceptor and M 1 muscarinic receptor], and heat shock proteins) and therefore an increase in contractility of the left ventricle. Several earlier studies have detected that IA combined with subsequent IgG substitution (IA/IgG) improves the left ventricular ejection fraction, enhances the CI and NYHA class [26][27][28] , reduces inflammation [29] , and decreases plasma levels of the prognostic heart failure markers nt-BNP and 270 nt-ANP [30] in patients suffering from DCM. An improvement in right ventricular myocardial function after IA could therefore be a possible explanation for the increase in CI in our IPAH patients and should be targeted by further studies.…”

Section: Hemodynamic Changes and Aab Levelsmentioning

confidence: 99%

Safety and Efficacy of Immunoadsorption as an Add-On to Medical Treatment in Patients with Severe Idiopathic Pulmonary Arterial Hypertension

Nagel¹,

Ewert²,

Egenlauf³

et al. 2017

Respiration

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Background: Despite optimized medical therapy, severe idiopathic pulmonary arterial hypertension (IPAH) is a devastating disease with a poor outcome. Autoantibodies have been detected in IPAH that can contribute to worsening of the disease. Objectives: The objective of this prospective, open-label, single-arm, multicenter trial was to evaluate the safety and efficacy of immunoadsorption (IA) as an add-on to optimized medical treatment for patients with IPAH. Methods: A total of 10 IPAH patients received IA over 5 days. Their clinical parameters, including hemodynamics measured by right heart catheter, were assessed at baseline and after 3 and 6 months. The primary endpoint was the change in pulmonary vascular resistance (PVR). Secondary endpoints included the change in 6-min walking distance, quality of life, safety, and plasma levels of IgG and autoantibodies. Results: The evaluation of the 10 IPAH patients (75% female; 51 ± 12 years; 166 ± 10 cm; WHO functional class III; 53% on combination therapy) revealed that IA was a safe procedure that efficiently removed IgG and autoantibodies from the circulation. After 3 months, the mean PVR improved significantly by 13.2% (p = 0.03) and the cardiac index improved by 13.1%, but no significant changes were found in 6-min walking distance. The quality of life physical functioning subscale score significantly improved after 6 months. The serious adverse events in 3 patients were possibly related to IA and included pneumonia, temporary disturbance in attention, and thrombocytopenia. Conclusions: IA as an add-on to targeted medical treatment for IPAH is a safe procedure with beneficial effects on hemodynamics, especially in patients with high levels of autoantibodies. Larger-scale controlled studies are needed to assess its efficacy in IPAH and to identify responders.

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Role of immunoglobulin G3 subclass in dilated cardiomyopathy: Results from protein A immunoadsorption

Cited by 72 publications

References 31 publications

Effects of protein A immunoadsorption in patients with advanced chronic dilated cardiomyopathy

Effects of protein A immunoadsorption in patients with advanced chronic dilated cardiomyopathy

Effects of protein A immunoadsorption in patients with chronic dilated cardiomyopathy

Safety and Efficacy of Immunoadsorption as an Add-On to Medical Treatment in Patients with Severe Idiopathic Pulmonary Arterial Hypertension

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