Immunoadsorption in a 40 year old man with dilated cardiomyopathy and underlying active myocarditis

Excerpt

Sirs: Patients with dilated cardiomyopathy often present elevated levels of potentially harmful autoantibodies directed against various cardiac antigens, including mitochondrial proteins (e.g., adenine nucleotide translocator), sarcolemmal proteins (e.g., actin, laminin, myosin, troponin), and membrane proteins (e.g., cell surface adrenergic or muscarinergic receptors) [5]. Stimulating anti beta1-adrenergic receptor antibodies are thought to induce and/or worsen dilated cardiomyopathy [4], assumingly also via the induction of cardiomyocyte apoptosis [6]. Recently, it has been shown that patients with progressive dilated cardiomyopathy, who are positive for functional anti beta1-adrenergic receptor antibodies, have an about three-fold increased cardiovascular mortality risk [12] and, thus, may probably benefit from immunoadsorption therapy, particularly, if the levels of IgG3 can be reduced substantially [2, 3, 8]. …