BACKGROUND: Cardiodepressant IgG3 autoantibodies (CD-Abs) can be targeted by apheresis. Using blinded measurements of CD-Abs before and after immunoadsorption (IA), the cardiac function of patients who did or did not achieve complete CD-Abs elimination was compared. METHODS AND RESULTS: Autoantibodies were completely removed from 18 patients with heart failure (New York Heart Association class 3 or 4, left ventricular ejection fraction (LVEF) <30%) using a selective IgG3 adsorption column. All patients had anti-beta1-adrenergic and/or M2-muscarinic autoantibodies before IA, and all LVEF were measured on radionuclide ventriculography. CD-Abs were measured before and after IA, and patient status was blinded until all measurements were collected. Treatment was defined as complete when CD-Abs status changed from positive to negative after IA. Other instances were defined as incomplete. Six-min walk test results and brain natriuretic peptide levels improved significantly after IA (P<0.01). The increase in LVEF 3 months after IA was significantly greater after complete treatment in comparison to the incomplete treatment group (19+/-8-29+/-9% vs 18+/-9-17+/-8%, P<0.01). Cardiac insufficiency events were also more frequent in the incomplete treatment group. CONCLUSIONS: Complete elimination of CD-Abs with apheresis may be related to improved cardiac function in the treatment of heart failure.
BACKGROUND: Cardiodepressant IgG3 autoantibodies (CD-Abs) can be targeted by apheresis. Using blinded measurements of CD-Abs before and after immunoadsorption (IA), the cardiac function of patients who did or did not achieve complete CD-Abs elimination was compared. METHODS AND RESULTS: Autoantibodies were completely removed from 18 patients with heart failure (New York Heart Association class 3 or 4, left ventricular ejection fraction (LVEF) <30%) using a selective IgG3 adsorption column. All patients had anti-beta1-adrenergic and/or M2-muscarinic autoantibodies before IA, and all LVEF were measured on radionuclide ventriculography. CD-Abs were measured before and after IA, and patient status was blinded until all measurements were collected. Treatment was defined as complete when CD-Abs status changed from positive to negative after IA. Other instances were defined as incomplete. Six-min walk test results and brain natriuretic peptide levels improved significantly after IA (P<0.01). The increase in LVEF 3 months after IA was significantly greater after complete treatment in comparison to the incomplete treatment group (19+/-8-29+/-9% vs 18+/-9-17+/-8%, P<0.01). Cardiac insufficiency events were also more frequent in the incomplete treatment group. CONCLUSIONS: Complete elimination of CD-Abs with apheresis may be related to improved cardiac function in the treatment of heart failure.
Authors: H Kawano; H Tanaka; T Yamashita; K-I Hirata; S Ishii; T Suzuki; K Wakahashi; Y Kawano; A Sada; K Minagawa; F Kawakami; T Itoh; A Baba; T Matsui; Y Katayama Journal: Bone Marrow Transplant Date: 2015-03-23 Impact factor: 5.483
Authors: Yuji Nagatomo; Dennis M McNamara; Jeffrey D Alexis; Leslie T Cooper; G William Dec; Daniel F Pauly; Richard Sheppard; Randall C Starling; W H Wilson Tang Journal: J Am Coll Cardiol Date: 2017-02-28 Impact factor: 24.094
Authors: Yuji Nagatomo; Daniel Li; Jennifer Kirsop; Alan Borowski; Akanksha Thakur; W H Wilson Tang Journal: J Card Fail Date: 2016-03-17 Impact factor: 5.712