Immunoadsorption in dilated cardiomyopathy: long-term reduction of cardiodepressant antibodies

Autor:	Carina Müller, Susanne Pohle, Christiane Trimpert, Martin Landsberger, Stephan B. Felix, Alexander Staudt, Lars R. Herda, Lars G. Eckerle
Rok vydání:	2010
Předmět:	Inotrope Cardiac function curve medicine.medical_specialty Ejection fraction business.industry Clinical Biochemistry Cardiomyopathy Dilated cardiomyopathy General Medicine medicine.disease Biochemistry Contractility Endocrinology Internal medicine Humoral immunity medicine Immunoadsorption business
Zdroj:	European Journal of Clinical Investigation. 40:685-691
ISSN:	1365-2362 0014-2972
DOI:	10.1111/j.1365-2362.2010.02314.x
Popis:	BACKGROUND: Disturbances of humoral immunity have been described in dilated cardiomyopathy (DCM), and a number of antibodies against cardiac cell proteins have been identified. Previous studies showed that immunoadsorption therapy with subsequent IgG substitution (IA/IgG) enhances cardiac function, and that removal of cardiodepressant antibodies may represent one essential mechanism of this therapy. The long-term effect of IA/IgG on the level of cardiodepressant antibodies remains to be elucidated. METHODS: A total of 17 patients with DCM were observed up to 12 months after IA/IgG. Echocardiographic measurements were performed at baseline, 3, 6 and 12 months after therapy. Cardiodepressant antibodies were detected by incubation of rat cardiomyocytes with purified patients' IgG and recording of contractility and Ca(2+) ratio. RESULTS: In contrast to patients without cardiodepressant antibodies before IA/IgG, patients with negative inotropic antibodies showed an improvement of left ventricular ejection fraction (LVEF) from 33.8 +/- 1.7% to 44.7 +/- 2.7%; 44.5 +/- 2.3% and 51.8 +/- 1.7% after 3, 6 and 12 months (P < 0.001 vs. baseline, P < 0.05 vs. LVEF of non-cardiodepressant group). Immediately after IA/IgG therapy, no cardiodepressant effects of patients' IgG on isolated cardiomyocytes were detectable, and this effect remained diminished until 6 months after IA/IgG (P < 0.001 for contractility and Ca(2+) ratio). Compared with the levels after 3 and 6 months, cardiodepressant antibodies reoccured after 12 months (P = 0.067 for contractility, P < 0.05 for Ca(2+) ratio vs. 6 months after IA/IgG). However, the negative inotropic reaction is still diminished compared with the reaction before IA/IgG. CONCLUSION: IA/IgG therapy induces long-term reduction of negative inotropic antibodies. After 12 months, however, re-increase of negative inotropic antibodies cannot be excluded.
Databáze:	OpenAIRE
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