Immunoadsorption in a 40 year old man with dilated cardiomyopathy and underlying active myocarditis

Successful treatment of thromboangiitis obliterans (Buerger's disease) with immunoadsorption: results of a pilot study

BACKGROUND

No established therapy is available for patients with thromboangiitis obliterans (TAO) and critical limb ischemia. Since abnormalities of the immune system appear to be involved in the pathogenesis, we investigated in this pilot study the efficiency of Ig immunoadsorption (IA) therapy.

METHODS

Ten patients with advanced TAO underwent a single IA course over five consecutive days. Before IA angiography was performed. In addition, the following were conducted prior to IA, directly after, as well as 1, 3, and 6 months after IA: clinical examination, pain scale (0-10), treadmill test for evaluation of maximum walking distances, and several angiological methods for evaluation of disease extent: photoplethysmography, ultrasound Doppler, and transcutaneous assessment of partial carbon dioxide (tcPCO(2)) and oxygen (tcPCO(2)) pressure.

RESULTS

Immunoadsorption treatment was tolerated without side effects. Pain intensity decreased rapidly from 7.7 ± 0.8 (mean ± SEM) before treatment to 2.0 ± 1.2 at the second day of IA. One month after IA, all patients were without pain. This functional amelioration persisted over the follow-up period of 6 months. Correspondingly, maximum walking distances significantly increased from 301.7 ± 191.4 to 727.0 ± 192.7 m immediately after IA, and further continuously up to 1,811.0 ± 223.7 at 6 months after IA. Healing of ischemic ulcerations was observed in all patients during follow-up. (tcPCO(2)) and (tcPCO(2)) values as well as photopletysmographic data that were severely compromised before IA reflecting reduced tissue oxygenation and perfusion showed rapid amelioration reaching normal values at 1 month.

CONCLUSION

Anti-Ig IA appears to be an effective therapeutic option for patients with advanced TAO.

Autoimmunity and heart diseases: pathogenesis and diagnostic criteria

Autoimmunity may evolve in predisposed individuals following an exogenous trigger. Autoimmunity is affected by genetic, immune, hormonal, and environmental factors. Immune mechanisms in heart diseases are complex and often not completely understood. Several cardiac disorders are believed to be mediated by an immune reaction. Both humoral and cellular immunity are associated with the development of myocarditis, dilated cardiomyopathy, heart failure, rheumatic fever, and atherosclerosis. Here the diagnostic criteria and autoimmune aspects of autoimmune-mediated cardiac disorders are reviewed. New diagnostic criteria for "autoimmune dilated cardiomyopathy" were recently suggested by the authors. They presume that establishing a dominant autoimmune etiology in some patients will have clinical significance because these patients will potentially gain the greatest benefit from immunosuppressive and immunomodulating treatments.