Hemodynamic effects of immunoadsorption and subsequent immunoglobulin substitution in dilated cardiomyopathy

Abstract

Immunoadsorption and subsequent IgG substitution improves cardiovascular function in DCM.

Immunoadsorption and subsequent immunoglobulin substitution decreases myocardial gene expression of desmin in dilated cardiomyopathy

“…Elimination of antibodies by IA results in hemodynamic improvement and a reduction in myocardial inflammation [12][13][14][15][16][17]. The IgG, which was substituted for safety reasons after IA [13] may additionally influence the immune system through various mechanisms [33]-and can possibly have beneficial effects in patients with heart failure [34].…”

“…In a case-control study, DCM patients (n=6) were treated with Ig-Therasorb (PlasmaSelect, Teterow, Germany), an anti-IgG immunoadsorber, at monthly intervals until month 3, as described previously [13]. After every final IA session, the patients received 0.5 g/kg polyclonal IgG (Venimmun-N®) for safety reasons to restore IgG plasma levels and to reduce the risk of infection after immunoglobulin depletion.…”

“…Animal models have shown that DCM can be triggered by autoantibodies [8][9][10][11]. Recent clinical studies indicate that cardiac antibodies may play an active role in the pathogenesis and progression of the disease in humans: removal of antibodies by immunoadsorption (IA) induces hemodynamic improvement and ameliorates myocardial inflammation in patients with DCM [12][13][14][15][16][17]. Elimination of cardiodepressant antibodies may be one explanation for the beneficial hemodynamic effects of IA in patients with DCM [15][16][17].…”

Defective circulating CD4+LAP+ regulatory T cells in patients with dilated cardiomyopathy

“…These autoantibodies belong to IgG3 and are independent predictors of disease development within 5 years among healthy relatives of DCM patients [42]. Moreover, immunoadsorption to eliminate IgG or IgG3 with subsequent IgG substitution (IA/IgG) results in the improvement of LVEF and represents a novel, therapeutic approach in the treatment of DCM [11][12][13][14][15][16]. Consistent with previous studies [43][44][45] + LAP + T regs and B cells from controls (n = 4) were purified by FACS sorting and cocultured alone or at a 1:1 ratio for suppression and proliferation assay.…”

“…These autoantibodies belong to the IgG3 [9] and play an important role in the pathogenesis of DCM by initiating the disease process [10] or contributing to the progression of contractile dysfunction [6]. Several studies indicate that the use of immunoadsorption to eliminate IgG or IgG3 significantly improves cardiac performance and clinical status in heart-failure patients [11][12][13][14][15]. T regs are a subgroup of T cells that play a vital role in maintaining peripheral tolerance, preventing autoimmune diseases, and restraining chronic inflammatory diseases [16].…”