New insights into the pathogenesis of dilated cardiomyopathy: possible underlying autoimmune mechanisms and therapy

In the present study, autoimmune processes involved in the pathogenesis of dilated cardiomyopathy (DCM) are discussed. Genetic predisposition, persistent viral infection, and molecular mimicry have previously been described as the underlying mechanisms of the disease, and prevalence of autoantibodies (AABs) against several intra- and extracellular cardiotropic targets has been confirmed. These autoantibodies are able to disturb the normal physiological activity of the cardiomyocytes. They also could function as mediators in an activated immune system and direct a great deal of attention to injured tissue via (1) complement activation and (2) genesis of circulatory immunocomplexes (CICs) in association with self-antigens. The number as well as duration of accessible autoantigens or CICs seem to play an important role in activation of the antigen-presenting cells (APCs) and, consequently, promotion of autoimmunity. Since AABs play such a decisive role, their exclusion by immunoadsorption (IA) therapy has been discussed as a new approach in DCM treatment. Hitherto, all performed pilot studies using this approach have shown improvement in cardiac function and quality of life in the vast majority of treated DCM patients. The removal of circulating AABs may downregulate the autoimmune system, moderate the inflammatory signals, and hasten the recovery of the affected tissue.