Immunoadsorption as treatment option in dilated cardiomyopathy.

Abnormalities of the cellular and humoral immune system have been described in patients with dilated cardiomyopathy (DCM). Various circulating cardiac autoantibodies have been detected among DCM patients. Circulating antibodies are extractable by immunoadsorption (IA). Recent open controlled pilot studies have consequently 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 cardiodepressive antibodies play an important role in cardiac dysfunction of DCM patients; removal of these antibodies may accordingly represent the essential mechanism of IA in DCM. Furthermore, detection of cardiodepressive antibodies predicts hemodynamic benefits during IA. These antibodies belong to immunoglobulin G subclass 3. Recent data indicate that newly detected sarcolemmal Fc(gamma) receptors IIa are involved in the functional effects of cardiac autoantibodies.