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Nagatomo et al. [(1)][1] demonstrated that autoantibodies (AAbs) targeting β1-adrenoceptors (β1ARs), which are detectable in the immunoglobulin-G3 (IgG3) subclass (IgG3-β1AR-AAbs) versus non−IgG3-β1AR-AAbs, predicted better outcome when patients were treated contemporarily, including

80 percent of patients with non-ischemic heart failure (HF) and reduced ejection fraction have autoantibodies against β1-adrenoceptos (β1-AAB), which cause and/or sustain HF. The removal of β1-AAB by immunoadsorption (IA) leads to an improvement of cardiac function and significantly reduced

Objectives Distinguishing the patterns of autoantibodies (AAB) against G-protein–coupled receptors in Chagas' cardiomyopathy and megacolon and the discovery of such a pattern in patients who are as yet asymptomatic could help to identify patients at high risk of developing the life-threatening complications of Chagas' disease. Background Such AAB against receptors as beta 1 (beta1-AAB), beta 2 (beta2-AAB), and muscarinergic 2 (M2-AAB) are thought to be involved in the pathogenesis of Chagas' cardiomyopathy and megacolon, the predominant manifestations of Chagas' disease, which is the most serious parasitic disease in Latin America. Methods Beta1-AAB, beta2-AAB, and M2-AAB were measured in the serum of asymptomatic Chagas' patients and in those with cardiomyopathy and/or megacolon. Results Nearly all Chagas' patients with cardiomyopathy and/or megacolon had AAB. Predominance of beta1-AAB combined with M2-AAB in Chagas' cardiomyopathy and beta2-AAB with M2-AAB in megacolon was found. Such patterns were also found in 34% of the asymptomatic patients, of whom 85% possessed a beta1-AAB level typical for Chagas' cardiomyopathy. Conclusions The percentage of asymptomatic Chagas' patients who had a specific AAB pattern and had a beta1-AAB level above a defined cutoff point mirrors very well the epidemiological situation, which showed that clinical manifestations develop in nearly 30% of Chagas' patients and cardiomyopathy in nearly 90% of them. We hypothesize that beta1-, beta2-, and M2-AAB measurement might be a useful tool for risk assessment in the indeterminate state of Chagas' disease to select patients for earlier involvement in care programs. However, prospective studies are needed to further evaluate this hypothesis.

OBJECTIVES In a substudy to a recently reported investigation that demonstrated the benefit of immunoglobulin adsorption (immunoadsorption) for patients with idiopathic dilated cardiomyopathy (IDC), we tested whether this benefit is associated with a reduction of oxidative stress. BACKGROUND The progression of cardiomyopathy is believed to be related to the increase of oxidative stress. Therefore, reduction of oxidative stress could be one of the effects of immunoadsorption for improvement of cardiac performance and clinical status. METHODS Plasma markers for oxidative stress—thiobarbituric acid-reactive substances (TBARS), lipid peroxides (LPO), anti-oxidized low-density lipoprotein-autoantibodies (anti-oxLDL-AB), thiol groups and vitamin E—were compared in 31 patients, of whom 16 underwent immunoadsorption and 15 received conventional treatment (controls). All patients received a daily supplement of vitamins, minerals and trace elements. RESULTS After one year, TBARS (p = 0.026), LPO (p = 0.026) and anti-oxLDL-AB (p = 0.044) were decreased in the immunoadsorption group but not in the controls. Thiols were unchanged in the immunoadsorption group but were decreased in the controls (p = 0.001). Vitamin E accumulated in both groups (immunoadsorption: p = 0.001; controls: p = 0.031) with a trend for stronger accumulation after immunoadsorption (p = 0.09). Prior to the study, the anti-oxLDL-AB to left ventricular ejection fraction (LVEF) (p = 0.05) were inversely correlated. After one year, correlations with borderline significance were calculated for TBARS to New York Heart Association functional class (p = 0.081) and inversely for LPO to LVEF (p = 0.083). CONCLUSIONS Effective therapy in patients with IDC, such as immunoadsorption which improved cardiac performance and clinical status, is associated with a reduction of oxidative stress.

Distinguishing the patterns of autoantibodies (AAB) against G-protein-coupled receptors in Chagas' cardiomyopathy and megacolon and the discovery of such a pattern in patients who are as yet asymptomatic could help to identify patients at high risk of developing the life-threatening complications of Chagas' disease.Such AAB against receptors as beta 1 (beta1-AAB), beta 2 (beta2-AAB), and muscarinergic 2 (M2-AAB) are thought to be involved in the pathogenesis of Chagas' cardiomyopathy and megacolon, the predominant manifestations of Chagas' disease, which is the most serious parasitic disease in Latin America.Beta1-AAB, beta2-AAB, and M2-AAB were measured in the serum of asymptomatic Chagas' patients and in those with cardiomyopathy and/or megacolon.Nearly all Chagas' patients with cardiomyopathy and/or megacolon had AAB. Predominance of beta1-AAB combined with M2-AAB in Chagas' cardiomyopathy and beta2-AAB with M2-AAB in megacolon was found. Such patterns were also found in 34% of the asymptomatic patients, of whom 85% possessed a beta1-AAB level typical for Chagas' cardiomyopathy.The percentage of asymptomatic Chagas' patients who had a specific AAB pattern and had a beta1-AAB level above a defined cutoff point mirrors very well the epidemiological situation, which showed that clinical manifestations develop in nearly 30% of Chagas' patients and cardiomyopathy in nearly 90% of them. We hypothesize that beta1-, beta2-, and M2-AAB measurement might be a useful tool for risk assessment in the indeterminate state of Chagas' disease to select patients for earlier involvement in care programs. However, prospective studies are needed to further evaluate this hypothesis.

We read the state-of-the-art paper by Nunes et al. [(1)][1], which presents the current knowledge on Chagas disease. For counteracting Chagas heart disease, the most life-threatening complication in chronic Chagas patients, the authors stated that “…management… followed… recommendations for