The clinical significance of anti-beta-1 adrenergic receptor autoantibodies in cardiac disease.

Autoimmune response against myocardial antigens is evident in numerous heart diseases. Both the induction of an autoimmune response and the pathogenesis of autoimmune heart diseases are not fully understood. The humoral immune response may play an important role via induction of cardiomyocyte apoptosis, alteration of myocardial mechanical and electrophysiological functions, and activation of the complement system and cell-mediated cytotoxicity. Anti-β-1 adrenergic receptor antibodies appear to contribute to the pathogenesis of dilated cardiomyopathy, heart failure, and Chagas disease. Herein, we review the current knowledge relating to anti-β-1 adrenergic receptor antibodies: their potential role in heart diseases and the potential benefits of a targeted therapy against their apparently destructive effects. Patients with dilated cardiomyopathy with circulating stimulatory anti-β-1 adrenergic receptor autoantibodies are probably at a higher risk for adverse outcome and should be treated with adrenergic receptor antagonists, and possibly with immunotherapy. Further research is required to determine which patients will gain additional clinical benefits from anti-autoantibody-targeted therapy.