Abstract 4026: Immunoadsorption Therapy Reduces Oxidative Stress in Patients With Dilated Cardiomyopathy
Introduction: Although the mechanisms responsible for the development and progression of left ventricular failure in DCM have not yet been fully elucidated, a variety of experimental studies suggest that alterations of the immune system are involved. Indeed, several literatures reported that the elimination of anti-β1-adrenoreceptor (AR) autoantibodies with immunoad-sorption (IA) therapy induced in short- and long-term improvements of LVEF, cardiac output, and NYHA functional class in patients with DCM. We assessed the hypothesis that the reduction of reactive oxygen species (ROS) is also related to the mechanism of left ventricular functional benefit from IA.
Methods: Seven patients (NYHA functional class III/IV, LVEF <30%, cardiac index <2.2 l/min/m2) with DCM were enrolled in this study. Removal of β1-AR autoantibodies with IA was achieved by passing a patient’s plasma over columns; a plasma filter (Plasmaflo OP®) for plasmapheresis and a tryptophan column (Immusorba TR®) for immunoglobulin extraction. The level of anti-β1-AR autoantibodies was measured by ELISA. As a marker for oxidative stress, we determined the level of diacron-reactive oxygen metabolite (d-ROM).
Results: During IA, the values of IgG3 and β1-AR autoantibodies of all patients decreased significantly from 63.5±15.0 to 14.6±2.9 mg/dl and from 27.8±5.0 to 18.7±5.5 U/ml (p<0.01), respectively. Simultaneously, the IA induced hemodynamic improvement: cardiac index increased from 1.71±0.40 to 1.97±0.41 l/min/m2 and LVEF increased from 22.8±6.1 to 29.1±9.1% (p<0.05). The level of d-ROM was decreased significantly from 392.7±17.03 to 314.1±22.03 U.CARR (p<0.05), and the reduction rate of d-ROM was associated with the reduction rate of β1-AR antibodies (p<0.01). In cardiac parameters, best correlations were found for d-ROM to PCWP (r=0.668, p<0.05), and inversely for d-ROM to LVEF (r=−0.601, p<0.05).
Conclusions: The reduction of oxidative stress could be one of the mechanisms of beneficial effect of IA therapy in patients with DCM.