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Details

Autor(en) / Beteiligte
Titel
Role of immunoglobulin G3 subclass in dilated cardiomyopathy: Results from protein A immunoadsorption
Ist Teil von
  • The American heart journal, 2005-10, Vol.150 (4), p.729-736
Ort / Verlag
New York, NY: Mosby, Inc
Erscheinungsjahr
2005
Link zum Volltext
Quelle
Elsevier ScienceDirect Journals Complete
Beschreibungen/Notizen
  • Immunoadsorption (IA) by anti-immunoglobulin G (anti-IgG) columns that effectively eliminates total IgG, including IgG3 subclass, represents an additional therapeutic approach in dilated cardiomyopathy (DCM). A recent study revealed that IA with protein A columns does not effectively remove IgG3 and does not induce hemodynamic improvement in DCM. Eighteen patients with DCM (left ventricular ejection fraction ≤30%) were included in this case-control study. In all patients, IA with protein A was performed in 4 courses, at 1-month intervals until month 3. Nine patients underwent protein A IA with an improved treatment regimen for IgG3 elimination. Data of these patients were compared retrospectively to existing findings for 9 comparable patients treated by protein A IA with ineffective IgG3 reduction. In both groups, IA induced a comparable reduction of the total IgG level. However, reduction of the IgG3 level was different in the 2 groups ( P < .001). Hemodynamics did not significantly change throughout the 3 months in the group with ineffective IgG3 reduction. In contrast, the group with improved IgG3 reduction demonstrated during the first IA course an increase in cardiac index from 2.2 ± 0.1 to 2.8 ± 0.2 L min −1 m −2 ( P < .05). After 3 months before the last IA course, cardiac index was 2.2 ± 0.1 L min −1 m −2 in the group with ineffective IgG3 elimination and 2.8 ± 0.2 L min −1 m −2 in the group with improved IgG3 reduction ( P < .01). In the group with ineffective IgG3 reduction, left ventricular ejection fraction increased after 3 months from 21.6 ± 2% to 24.4 ± 2% (NS), and from 24.3 ± 2 to 34.7 ± 4% in the group with improved IgG3 reduction ( P < .05). Autoantibodies belonging to IgG3 may play an important role in cardiac dysfunction of patients with DCM. Protein A IA in conjunction with an improved treatment regimen for IgG3 elimination induces hemodynamic benefit in patients suffering from DCM.

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