The therapeutic potential of immune therapy in idiopathic dilated cardiomyopathy

Idiopathic dilated cardiomyopathy (DCM) is a heart muscle disease of unknown origin and the second most common reason for heart transplantation. Genetic factors, viral persistence and the presence of an autoimmune response against myocardial epitopes are believed to play a major pathogenic role in idiopathic DCM. Pathogenic circulating autoantibodies against several cardiac proteins have been detected in sera from idiopathic DCM patients. Accordingly, suppression of autoreactive components of the immune system has been discussed as a prospective therapeutic implement in idiopathic DCM management. Removal of pathophysiologic active autoantibodies by immunoadsorption and subsequent immunoglobulin infusion induces acute and long-term beneficial effects such as improved cardiovascular function and reduced morbidity. Understanding of the amendment in various components of the immune system induced by immunoadsorption therapy may help in elucidating the underlying pathophysiologic mechanisms of the disease. This approach may reveal markers of prognostic value, and new therapeutic approaches could be established.