The effect of a repeated immunoadsorption in patients with dilated cardiomyopathy after recurrence of severe heart failure symptoms

Reinthaler, Markus; Empen, Klaus; Herda, Lars R.; Schwabe, Anna; Ruhl, Michael; Dörr, Marcus; Felix, Stefan B.

doi:10.1002/jca.21364

Cited by 15 publications

(5 citation statements)

References 29 publications

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“…We decided to enroll 40 patients in total assuming radionuclide LVEF was increased by 3.1% according to our preliminary finding . Although previous report defined 5% or more increase in LVEF as a responder , we did not perform responder/nonresponder analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Several autoantibodies found in sera from patients with DCM play a role in mediating cardiac damage and provide arrhythmic substrates , resulting in sudden cardiac death . Immunoapheresis removing these autoantibodies has been developed to treat DCM patients with refractory heart failure . In these preliminary trials except for Müller, et al , intravenous immunoglobulin was replaced after each session of apheresis, because the columns used in these trials nonspecifically removed immunoglobulin.…”

Section: Introductionmentioning

confidence: 99%

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Immunoadsorption therapy for dilated cardiomyopathy using tryptophan column—A prospective, multicenter, randomized, within‐patient and parallel‐group comparative study to evaluate efficacy and safety

Yoshikawa

Baba

Amaki

et al. 2016

J of Clinical Apheresis

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Over the past few decades, several cardiac autoantibodies have been reported in sera from patients with dilated cardiomyopathy (DCM). Immunoadsorption (IA) therapy is one of the therapeutic tools to remove such autoantibodies. The objective of this study was to investigate functional effects of IA therapy using a tryptophan column in severe DCM patients. Of 49 patients enrolled, 44 were randomized from 10 sites in Japan. IA therapy was conducted in 40 patients with DCM (refractory to standard therapy for heart failure, New York Heart Association [NYHA] class III/IV, left ventricular ejection fraction [LVEF] <30%). Mean echocardiographic LVEF was significantly improved (23.8 ± 1.3% to 25.9 ± 1.3%, P = 0.0015). However, mean radionuclide LVEF over 3 months of IA therapy was not significantly improved (20.8 ± 1.1% to 21.9 ± 1%, P = 0.0605). The cardiothoracic ratio was also significantly decreased (P = 0.0010). NYHA functional class (P < 0.0001), subjective symptoms assessed by a quality of life questionnaire (P = 0.0022), maximum oxygen consumption (P = 0.0074), and 6‐minute walk distance (P = 0.0050) were improved after IA therapy. Subgroup analysis revealed improvement of echocardiographic LVEF in patients with higher baseline autoantibody scores but not in those with lower scores. IA therapy improved subjective symptoms and exercise capacity in patients with refractory heart failure resulting from DCM. Favorable effect on cardiac function was noted in patients with higher autoantibody scores. J. Clin. Apheresis 31:535–544, 2016. © 2015 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Immunoadsorption therapy for dilated cardiomyopathy using tryptophan column—A prospective, multicenter, randomized, within‐patient and parallel‐group comparative study to evaluate efficacy and safety

Yoshikawa

Baba

Amaki

et al. 2016

J of Clinical Apheresis

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“…The immunoadsorption is designed to remove antibodies directed to beta-adrenergic receptors which are believed to have a pathogenic role in the disease. Reinthaler (16**) compared immunoadsorption columns for both total immunoglobulin and for selective removal of the IgG3 subclass. Some patients showed surprisingly long-term benefits of this treatment.…”

Section: Introductionmentioning

confidence: 99%

Viral myocarditis

Rose¹

2016

Current Opinion in Rheumatology

127

103

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Purpose of the review This article traces the pathways leading from viral infection of the heart by coxsackievirus B3 to autoimmune myocarditis in its various manifestations. Recent findings Myocarditis can be induced by a number of different infectious agents and represents a significant cause of death especially in young individuals. Following infection patients may develop lymphocytic, eosinophilic, or giant cell/granulomatous myocardial inflammation. It can lead to infectious dilated cardiomyopathy, a disease frequently requiring cardiac transplantation. Although acute viral myocarditis is frequently sub-clinical and recovery may be spontaneous, treatment of chronic myocarditis is presently unsatisfactory. Ongoing disease may be due to persistent virus in the heart or to immunopathic attack. Depending on the etiology, treatment may be antiviral or immunosuppressive. Endomyocardial biopsy is proving of value in determining etiology and deciding future therapy. A great deal of information about the pathogenesis of myocarditis has been gained from experimental models in rodents using heart disease induced by infection using coxsackievirus B3 or by immunization with cardiac myosin. Summary Treatment of myocarditis is still problematic and may depend on etiologic diagnosis to distinguish infectious from immune mediated disease. Both pathogenic mechanisms may co-occur in individual patients. In the future, treatment may depend upon endomyocardial biopsy, immunohistologic testing, improved imaging, and molecular genetic analysis for providing more precise diagnoses.

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“…Improvement of ejection fraction was shown in 10, improved functional class in 7, and reduced natriuretic peptides in 5 (Table 3). 3,37,38,[43][44][45][46][47][48][49][50][51] Reinthaler et al 52 suggested that initial responders to therapy, who subsequently had a recurrence of autoantibodies, seemed to benefit from repeat immunoadsorption. All of these studies were small and with one exception were not randomized or blinded.…”

Section: Proof Of Concept Immunoadsorptionmentioning

confidence: 99%

β ₁ -Adrenoreceptor Autoantibodies in Heart Failure

Düngen

Đorđević

Felix

et al. 2020

Circ: Heart Failure

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Antibodies that activate the β 1 -AR (β 1 -adrenoreceptor) can induce heart failure in animal models. These antibodies are often found in patients with heart failure secondary to varying etiologies. Their binding to the β 1 receptor leads to prolonged receptor activation with subsequent induction of cellular dysfunction, apoptosis, and arrhythmias. β-blocker therapy while highly effective for heart failure, may not be sufficient treatment for patients who have β 1 receptor autoantibodies. Removal of these autoantibodies by immunoadsorption has been shown to improve heart failure in small studies. However, immunoadsorption is costly, time consuming, and carries potential risks. An alternative to immunoadsorption is neutralization of autoantibodies through the intravenous application of small soluble molecules, such as peptides or aptamers, which specifically target and neutralize β 1 -AR autoantibodies. Peptides may induce immunogenicity. Animal as well as early phase human studies with aptamers have not shown safety concerns to date and have demonstrated effectiveness in reducing autoantibody levels. Novel aptamers have the potential advantage of having a wide spectrum of action, neutralizing a variety of known circulating G-protein coupled receptor autoantibodies. These aptamers, therefore, have the potential to be novel therapeutic option for patients with heart failure who have positive for β 1 -AR autoantibodies. However, clinical outcomes trials are needed to assess the clinical utility of this novel approach to treat heart failure.

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The effect of a repeated immunoadsorption in patients with dilated cardiomyopathy after recurrence of severe heart failure symptoms

Abstract: In DCM patients, who experience a significant improvement of LVEF and heart failure symptoms after IA/IgG but a subsequent relapse during follow up, repeated IA/IgG may be considered.

Cited by 15 publications

References 29 publications

Immunoadsorption therapy for dilated cardiomyopathy using tryptophan column—A prospective, multicenter, randomized, within‐patient and parallel‐group comparative study to evaluate efficacy and safety

Immunoadsorption therapy for dilated cardiomyopathy using tryptophan column—A prospective, multicenter, randomized, within‐patient and parallel‐group comparative study to evaluate efficacy and safety

Viral myocarditis

β ₁ -Adrenoreceptor Autoantibodies in Heart Failure

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The effect of a repeated immunoadsorption in patients with dilated cardiomyopathy after recurrence of severe heart failure symptoms

Abstract: In DCM patients, who experience a significant improvement of LVEF and heart failure symptoms after IA/IgG but a subsequent relapse during follow up, repeated IA/IgG may be considered.

Cited by 15 publications

References 29 publications

Immunoadsorption therapy for dilated cardiomyopathy using tryptophan column—A prospective, multicenter, randomized, within‐patient and parallel‐group comparative study to evaluate efficacy and safety

Immunoadsorption therapy for dilated cardiomyopathy using tryptophan column—A prospective, multicenter, randomized, within‐patient and parallel‐group comparative study to evaluate efficacy and safety

Viral myocarditis

β 1 -Adrenoreceptor Autoantibodies in Heart Failure

Contact Info

Product

Resources

About

β ₁ -Adrenoreceptor Autoantibodies in Heart Failure