IS LEUKOCYTAPHERESIS THERAPY APPLICABLE FOR THE TREATMENT OF DILATED CARDIOMYOPATHY (DCM)?

Abstract

Purpose: Autoimmunity concerning abnormal lymphocytes has been suspected to be one of the main causes of Dilated Cardiomyopathy (DCM). The deterioration factors of DCM are considered to be autoimmune antibodies, cytokines, and neurohormones. Leukocytapheresis (LCAP) therapy has been used for treating various types of autoimmune and inflamatory diseases. LCAP using a leukocyte removal filter (Cellsorba, Asahikasei Medical, Japan) can remove the white cells. LCAP will remove the lymphocytes with the abnormality of programmed cell death-1(PD-1) immuno-regulatory receptor, which is one of the causes of DCM, and the B-lymphocytes which produce autoimmune antibodies. Since TNF-α is mainly produced by the monocyte and macrophage, LCAP will also reduce TNF-α levels in the blood. The purpose of this study was to examine the effect of LCAP for reducing TNF-α during an in vitro study. Method: TNF-α was induced into the human blood by Lipoteichoic acid. TNF-α and IL-6 were measured and compared before and after LCAP with Cellsorba fibers. Results: The number of monocytes decreased, and the blood TNF-α and IL-6 levels decreased after LCAP. Conclusion: Since the conduction of monocytes and lymphocytes from bone marrow to blood appear in the patients, the number of monocytes and lymphocytes are maintained after LCAP. However, the abnormal lymphocytes proportion decreased by LCAP. Immunomodulatory and anti-inflammatory effects of LCAP therapy will be effective for the treatment of DCM.