title: Specific immunoadsorption therapy using a tryptophan column in patients with refractory heart failure due to dilated cardiomyopathy.
abstract: BACKGROUND
  Certain cardiac-specific autoantibodies found in patients with dilated cardiomyopathy (DCM) play a role in mediating myocardial damage and fatal ventricular arrhythmias resulting in sudden cardiac death. Immunoadsorption therapy (IA) is one of the therapeutic tools to remove such autoantibodies. Clinical studies from Germany have shown that nonspecific IA using columns loaded by sheep antihuman IgG or protein A improved hemodynamic data and affected favorably cardiac function and survival in patients with heart failure (HF) due to DCM. The goal of this study is to determine if IA therapy using the high-profile tryptophan column, which has high affinity for IgG3 subclass, affects favorably cardiac function in patients with severe HF who are refractory to conventional therapy.
  
  
  RESULTS
  IA therapy was conducted in 16 patients with DCM (age 53 ± 4, male 8, New York Heart Association functional class III/IV, mean ejection fraction 18 ± 2%). Study subjects had autoantibodies directed against either β1-adrenergic or M2-muscarinic receptors. Plasma brain natriuretic peptide levels were significantly decreased after IA (P = 0.016). Plasma inflammatory cytokines including interleukin-6 and tumor necrosis factor-α did not change after each session of IA. Six-minute walk distance was significantly increased after IA (P = 0.01). Left ventricular ejection fraction increased by 3% 3 months after IA (P = 0.039).
  
  
  CONCLUSIONS
  Our initial experience demonstrated safety and short-term efficacy of IA using a new IgG3-specific tryptophan column for patients with advanced HF due to DCM. Long-term follow-up is needed to confirm the effects on cardiac function and morbidity/mortality in such patients.
authors.affiliation: Cardiology Division, Department of Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nagatomo
authors.forename: Akiyasu
authors.initials: A
authors.lastname: Baba
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ito
authors.forename: Kotaro
authors.initials: K
authors.lastname: Naito
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yoshizawa
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kurita
authors.forename: Iwao
authors.initials: I
authors.lastname: Nakamura
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Monkawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsubara
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Wakabayashi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ogawa
authors.forename: Makoto
authors.initials: M
authors.lastname: Akaishi
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yoshikawa
mesh_terms: D000328:Adult; D000368:Aged; D000595:Amino Acid Sequence; D002311:Cardiomyopathy, Dilated / Q000150:complications*; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D007163:Immunosorbent Techniques; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D020097:Natriuretic Peptide, Brain / Q000097:blood; D014364:Tryptophan / Q000378:metabolism*; D016277:Ventricular Function, Left
chemical_list: D007074:Immunoglobulin G; D020097:Natriuretic Peptide, Brain; D014364:Tryptophan