Immunohistological changes in dilated cardiomyopathy induced by immunoadsorption therapy and subsequent immunoglobulin substitution

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Item Type:	Article
Title:	Immunohistological changes in dilated cardiomyopathy induced by immunoadsorption therapy and subsequent immunoglobulin substitution
Creators Name:	Staudt, A., Schaeper, F., Stangl, V., Plagemann, A., Bohm, M., Merkel, K., Wallukat, G., Wernecke, K.D., Stangl, K., Baumann, G. and Felix, S.B.
Abstract:	Background - Immunoadsorption (IA) and subsequent immunoglobulin (Ig) G substitution represent an additional therapeutic approach in dilated cardiomyopathy (DCM). It remains to be elucidated whether this treatment modulates myocardial inflammation, which is possibly a causal factor of ventricular dysfunction. Methods and Results - From 25 DCM patients (EF <30%), 12 patients were randomized for IA therapy and subsequent IgG substitution at 1-month intervals until month 3. Before (<7 days) and after IA therapy, right ventricular biopsies were obtained from all patients. Biopsies were also obtained at intervals of 3 months from 13 patients without IA/IgG treatment (controls). IA/IgG treatment induced improvement in left ventricular ejection fraction from 21.3±1.7% (±SEM) to 27.0±1.3% (P<0.01 versus baseline/controls) and reduction of the β-receptor autoantibody serum levels (P<0.01 versus baseline/controls). The number of CD3 cells decreased from 5.7±0.8 to 2.9±0.5 cells/mm 2 (P<0.01 versus baseline/controls). This decline was paralleled by a decrease in CD4 (P<0.01 versus baseline/controls) and CD8 (P<0.05 versus baseline/controls) lymphocytes. The number of leukocyte common antigen-positive cells (leukocytes) was reduced from 20.0±3.2 to 9.9±2.8 cells/mm 2 (P<0.01 versus baseline/P<0.05 versus controls). HLA class II expression decreased from 2.1±0.7% to 1.1±0.4% (P<0.05 versus controls/baseline). The number of immunopositive cells and the expression of HLA class II in controls remained stable. In both groups, the degree of fibrosis remained unchanged. Conclusions - IA and subsequent IgG substitution mitigate myocardial inflammation in DCM.
Keywords:	Cardiomyopathy, Immunology
Source:	Circulation
ISSN:	0009-7322
Publisher:	American Heart Association
Volume:	103
Number:	22
Page Range:	2681-2686
Date:	1 January 2001
Official Publication:	http://circ.ahajournals.org/cgi/content/abstract/103/22/2681
PubMed:	View item in PubMed

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