Complete elimination of cardiodepressant IgG3 autoantibodies by immunoadsorption in patients with severe heart failure.
BACKGROUND
Cardiodepressant IgG3 autoantibodies (CD-Abs) can be targeted by apheresis. Using blinded measurements of CD-Abs before and after immunoadsorption (IA), the cardiac function of patients who did or did not achieve complete CD-Abs elimination was compared.


RESULTS
Autoantibodies were completely removed from 18 patients with heart failure (New York Heart Association class 3 or 4, left ventricular ejection fraction (LVEF) <30%) using a selective IgG3 adsorption column. All patients had anti-beta1-adrenergic and/or M2-muscarinic autoantibodies before IA, and all LVEF were measured on radionuclide ventriculography. CD-Abs were measured before and after IA, and patient status was blinded until all measurements were collected. Treatment was defined as complete when CD-Abs status changed from positive to negative after IA. Other instances were defined as incomplete. Six-min walk test results and brain natriuretic peptide levels improved significantly after IA (P<0.01). The increase in LVEF 3 months after IA was significantly greater after complete treatment in comparison to the incomplete treatment group (19+/-8-29+/-9% vs 18+/-9-17+/-8%, P<0.01). Cardiac insufficiency events were also more frequent in the incomplete treatment group.


CONCLUSIONS
Complete elimination of CD-Abs with apheresis may be related to improved cardiac function in the treatment of heart failure.
Baba
Akiyasu
A
Department of Cardiology, Kitasato Institute Hospital, Kitasato University School of Medicine, Tokyo, Japan. ababa68@insti.kitasato-u.ac.jp
Akaishi
Makoto
M
Shimada
Megumi
M
Monkawa
Toshiaki
T
Wakabayashi
Yasuhisa
Y
Takahashi
Michiko
M
Nagatomo
Yuji
Y
Yoshikawa
Tsutomu
T
D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000276:immunology / Q000302:isolation & purification*; D001781:Blood Component Removal; D005260:Female; D006333:Heart Failure / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D007163:Immunosorbent Techniques; D008297:Male; D008875:Middle Aged; D043585:Receptor, Muscarinic M2 / Q000276:immunology; D011943:Receptors, Adrenergic, beta / Q000276:immunology; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D055815:Young Adult
D001323:Autoantibodies; D007074:Immunoglobulin G; D043585:Receptor, Muscarinic M2; D011943:Receptors, Adrenergic, beta