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(Circulation. 2002;106:2448.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Potential Role of Autoantibodies Belonging to the Immunoglobulin G-3 Subclass in Cardiac Dysfunction Among Patients With Dilated Cardiomyopathy

Alexander Staudt, MD; Marko Böhm, MD; Fabian Knebel, MD; Yvonne Grosse, MD; Claudia Bischoff, MD; Astrid Hummel, MD; Johannes B. Dahm, MD; Adrian Borges, MD; Nicoline Jochmann, MD; Klaus D. Wernecke, PhD; Gerd Wallukat, PhD; Gert Baumann, MD; Stephan B. Felix, MD

From Klinik für Innere Medizin B, Ernst-Moritz-Arndt-Universität (A.S., Y.G., C.B., A.H., J.B.D., S.B.F.), Greifswald, Germany; Medizinische Klinik I, Charité, Humboldt-Universität (M.B., F.K., A.B., N.J., G.B.), Berlin, Germany; Institut für Medizinische Biometrie, Charité, Humboldt-Universität (K.D.W.), Berlin, Germany; and Max-Delbrück-Zentrum für Molekulare Medizin (G.W.), Berlin, Germany.

Correspondence to Stephan B. Felix, MD, Klinik für Innere Medizin B, Ernst-Moritz-Arndt-Universität, Friedrich-Loefflerstraße 23a, 17487 Greifswald, Germany. E-mail felix{at}mail.uni-greifswald.de

Background— Immunoadsorption capable of removing circulating autoantibodies represents an additional therapeutic approach in dilated cardiomyopathy (DCM). The role played by autoantibodies belonging to the immunoglobulin (Ig) subclass G-3 in cardiac dysfunction remains to be elucidated.

Methods and Results— Patients with DCM (left ventricular ejection fraction <30%) participated in this case-control study. Nine patients underwent immunoadsorption with protein A (low affinity to IgG-3), and 9 patients were treated with anti-IgG, which removes all IgG subclasses. Immunoadsorption was performed in 4 courses at 1-month intervals until month 3. In the 2 groups, immunoadsorption induced comparable reduction of total IgG (>80%). IgG-3 was effectively eliminated only by anti-IgG adsorption (eg, during the first immunoadsorption course; protein A, -37±4%; anti-IgG, -89±3%; P<0.001 versus protein A). The ß₁-receptor autoantibody was effectively reduced only by anti-IgG (P<0.01 versus protein A). Hemodynamics did not change in the protein A group. In the anti-IgG group during the first immunoadsorption course, cardiac index increased from 2.3±0.1 to 3.0±0.1 L · min^-1 · m^-2 (P<0.01 versus protein A). After 3 months, before the last immunoadsorption course, cardiac index was 2.2±0.1 L · min^-1 · m^-2 in the protein A group and 3.0±0.2 L · min^-1 · m^-2 in the anti-IgG group (P<0.01 versus protein A). Left ventricular ejection fraction increased only in the anti-IgG group (P<0.05 versus protein A).

Conclusions— Autoantibodies belonging to IgG-3 may play an important role in cardiac dysfunction of DCM. The removal of antibodies of the IgG-3 subclass may represent an essential mechanism of immunoadsorption in DCM.

Key Words: cardiomyopathy • immunoadsorption • antibodies

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