Extra-corporal blood purification filters damaging auto-antibodies out of the blood — Promising results from the first clinical trial with this therapy for chronic heart muscle disease

More than 280,000 people in Germany alone suffer from
chronic dilated cardiomyopathy (DCM). In this disease, the pumping capability
of the heart is reduced, and the heart muscle becomes enlarged (dilation –
expansion) to compensate for the reduction in efficiency. Those affected by the
disease are considerably restricted in their physical capability. Up to now
this disease has been treated with drugs which have provided only short-term
benefits. In the most severe cases, patients may require a heart transplant or
the insertion of a pump.

It is not clear yet whether these auto-antibodies play a
crucial role in the onset of this serious heart disease in humans, Dr.
Wallukat, Dr. Müller and Professor Hetzer point out in their report. However,
this is the case in animals. The causes of this serious heart disease are
varied and many. In some cases the cause is genetic, i.e. familial. 

In about 80 percent of patients with dilated cardiomyopathy,
Dr. Wallukat was able to detect auto-antibodies which attack the
beta1-adrenergic (beta1-AR) receptors of heart muscle cells. It is unclear,
however, why the body’s own immune system is no longer able to distinguish
between ​„foreign” and ​„self”. Via beta-adrenergic receptors, the messengers
(hormones) noradrenaline and adrenaline regulate the heart rate and pump
function (contractibility). ​„The auto-antibodies activate beta1-adrenergic
receptors, interfering with the calcium regulation of the cells, thereby
altering their function,“ explains the cell biologist. Building on these
fundamental investigations at the MDC, Dr. Wallukat and Dr. Müller, together
with medical technologists of the biotech company Affina Immuntechnik GmbH
(Berlin), have developed an adsorber which filters these specific
auto-antibodies targeted at beta1-adrenergic receptors out of the blood of the
patients. 

In addition, there is a second form of this treatment,
which has also been recently developed, but which removes non-specific
auto-antibodies by filtration. However, according to Dr. Müller, ​„in
non-specific immune adsorption side effects can arise in individual cases,
leading to a premature termination of treatment”. To date, more than 100
patients suffering from chronic heart muscle disease have been treated at the
German Heart Institute Berlin with these two techniques. The first positive
results are now to be investigated further in multi-center studies in a larger
number of patients.

Recently, Dr. Wallukat and Dr. Müller were awarded the
​„Apheresis Innovation Prize of the German Working Group for Clinical
Nephrology“ for their development of this novel blood purification therapy to
treat chronic heart muscle disease.