Abstract
AIMS: Evidence for a pathophysiologic relevance of autoimmunity in
human heart disease has substantially increased over the past years.
Conformational autoantibodies stimulating the cardiac beta1-adrenoceptor
(beta1-aabs) are considered of importance in heart failure development
and clinical pilot studies have shown their prognostic significance
in human 'idiopathic' cardiomyopathy. METHODS: We recently developed
a novel highly sensitive fluorescence-based functional assay to detect
stimulating beta1-aabs. We will use this method to assess Etiology,
Titre-Course, and effect on Survival (ETiCS) of beta1-aabs in a prospective
multicentre study with serial follow-up of patients after a first
acute myocarditis or myocardial infarction. Several European core
laboratories will jointly study the hypothesis that both disorders
may trigger autoimmune reactions leading to the generation of beta1-aabs
and/or other heart-directed aabs. Further, sera from healthy controls
and well-characterized patient cohorts with dilated, ischaemic, or
hypertensive cardiomyopathy will be analysed retrospectively for
beta1-aab prevalence, incidence, persistence, and/or clearance. CONCLUSION:
ETiCS is so far the largest clinical diagnostic study projected to
address cardiac autoimmunity. It attempts to unravel the pathophysiology
of cardiac autoantibody formation and persistence/clearance. ETiCS
will enhance current knowledge on autoimmunity in human heart disease
and promote endeavours to develop novel therapies targeting cardiac
aabs.
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