title: Evidence of autoantibodies against cardiac troponin I and sarcomeric myosin in peripartum cardiomyopathy.
abstract: Peripartum cardiomyopathy (PPCM) is a major cause of pregnancy-related maternal heart failure that develops towards the end of pregnancy or in the months following delivery. In small retrospective case series, autoimmune responses in the pathogenesis of PPCM have been proposed upon identification of autoantibodies (AABs) to cardiac antigens. However, their clinical and prognostic relevance still remain unclear. In this study, we evaluated the presence of circulating AABs against cardiac sarcomeric myosin (MHC) and troponin I (TnI) in the sera of PPCM patients and in relation to clinical presentation. In this case-control study, 70 patients diagnosed with PPCM and 50 pregnancy-matched healthy women with normal cardiac function were enrolled. Clinical assessment, echocardiography and blood tests were performed at baseline and at 6 ± 2 months follow-up. The presence of serum AABs against MHC (anti-MHC) and TnI (anti-TnI) was determined with a custom-made enzyme-linked immunosorbent assay (ELISA). The seropositivity for these AABs was correlated with the severity of LV dysfunction and the occurrence of pericardial effusion indicative of perimyocardial inflammation at baseline. Potential impact of these AABs on disease progression was evaluated with regard to functional (left ventricular ejection fraction) and clinical improvement at follow-up. Either anti-MHC or anti-TnI or both AABs were detected in the serum of 46 % of PPCM patients and in 8 % of healthy controls. In PPCM the presence of either one of these AABs was associated with significantly lower baseline LVEF and lower rate of full cardiac recovery at follow-up. Patients who were seropositive for anti-TnI AABs showed more frequently pericardial effusion indicative of a more pronounced immune response of the peri-/myocardium in these patients. Further studies are required to clarify cellular and molecular circuits leading to elevated levels of AABs and their pathophysiological relevance for disease initiation and progression in PPCM.
authors.affiliation: Department of Cardiology and Angiology, Hannover Medial School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. haghikia.arash@mh-hannover.de.
authors.forename: Arash
authors.initials: A
authors.lastname: Haghikia
authors.affiliation: Department of Cardiology, Pulmonology, and Vascular Medicine, University of Heidelberg, Heidelberg, Germany.
authors.forename: Ziya
authors.initials: Z
authors.lastname: Kaya
authors.affiliation: Department of Cardiology, General Hospital Nuernberg, Paracelsus Medical University, Nuernberg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Schwab
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Westenfeld
authors.affiliation: Department of Cardiology, Pulmonology, and Vascular Medicine, University of Heidelberg, Heidelberg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Ehlermann
authors.affiliation: Department of Internal Medicine III, University Hospital of Saarland, Homburg/Saar, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Bachelier
authors.affiliation: Department of Cardiology, Pulmonology, and Vascular Medicine, University of Heidelberg, Heidelberg, Germany.
authors.forename: Renate
authors.initials: R
authors.lastname: Oettl
authors.affiliation: Department of Gynecology and Prenatal Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Constantin S
authors.initials: CS
authors.lastname: von Kaisenberg
authors.affiliation: Department of Cardiology, Pulmonology, and Vascular Medicine, University of Heidelberg, Heidelberg, Germany.
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
authors.affiliation: Department of Cardiology and Angiology, Hannover Medial School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Johann
authors.initials: J
authors.lastname: Bauersachs
authors.affiliation: Department of Cardiology and Angiology, Hannover Medial School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. hilfiker.denise@mh-hannover.de.
authors.forename: Denise
authors.initials: D
authors.lastname: Hilfiker-Kleiner
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D009202:Cardiomyopathies / Q000276:immunology*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D018995:Myosin Heavy Chains / Q000276:immunology*; D010641:Phenotype; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000276:immunology*; D011446:Prospective Studies; D019210:Troponin I / Q000276:immunology*
chemical_list: D001323:Autoantibodies; D019210:Troponin I; D018995:Myosin Heavy Chains
keywords: Autoantibodies; Biomarker; Peripartum cardiomyopathy