Abstract
Abnormalities of the cellular and humoral immune system have been described in patients with dilated cardiomyopathy (DCM). Various circulating cardiac autoantibodies have been detected in DCM patients. Circulating antibodies are extractable by immunoadsorption (IA). Recent open controlled pilot studies have shown that removal of circulating antibodies by IA induces improvement of cardiac function in DCM. IA, furthermore, decreases myocardial inflammation. In vitro data indicate that removal of negative inotropic antibodies may represent the essential mechanism of IA in DCM. These antibodies belong to immunoglobulin G subclass 3 and may play an important role in cardiac dysfunction of DCM patients. Recent data indicate that the Fc fragments of the immunoglobulins that bind to newly detected sarcolemma-specific Fcg receptors IIa are involved in the functional effects of cardiac autoantibodies. Removal of various cardiac antibodies through unspecific IA could therefore offer a hopeful treatment approach in DCM for intervention into this autoimmune process.
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