Chronic heart failure remains to be one of most important causes for morbidity and mortality and has very high frequency for readmission to hospitalization，one of most important reasons is that the present heart failure management is aimed mostly at restoration of neurohormonal balance， rather than targeting primary causes of the disease.

炎症是CHF的生物标志还是治疗靶点？
Inflammation in CHF: biomarker or target?

 Circulating markers of inflammation，have been used in establishing the diagnosis and gauging prognosis in patients with heart failure in the younger. In addition， inflammatory cytokines have been investigated as targets of heart failure therapy. Results from clinical trials directed against specific cytokine have thus far been disappointing， the role of adiponectin in cardiovascular system seems paradoxical. Whereas the relationship between low adiponectin level and an increased risk of coronary arterial disease (CAD) or myocardial infarction seems to be robust， the role of plasma adiponectin in CHF appears to be more complex. 

心脏G蛋白偶联受体自身抗体的作用与临床意义
G-protein coupled cardiac receptor autoantibody as both player and biomarker

Many investigations showing distinct autoantibodies or other immune factors in heterogeneous subsets of DCM. There is increasing evidence showing that this autoantibody is causative to DCM. Many studies demonstrating that β1-adrenergic receptor is not only a potent and responsible autoanti?gen  but also causative to cardiomyopathy by both passive transfer and active immunization in diverse animal models. Recently， clinical follow-up study demonstrated that presence of stimulating anti–β1-AR autoantibodies is independently associated with an about 3-fold increase in all-cause and cardiovascular mortality in DCM.

There is an accumulation of evidence showing that anti-M2 autoantibodies are of pathogenic importance in DCM. We recently studied whether the presence of M2 autoantibodies is also associated with AF that often occurs in DCM. The presence of the M2-autoantibody was found to be the strongest independent predictor of AF development.

自身抗体损伤心脏结构及功能的潜在机制
Underlying mechanisms for autoantibody-induced impairment in cardiac structure and function

There are many players in the cascade from antibody induction to myocardial damage and gradually developing into DCM. Sustain stimulation in chronotropic effect is harmful for both cardiac structure and function. Recently it is reported that antibody –induced impairment of cardiac function may be through Fc(gamma) receptor.  However， underlying mechanism from autoantibody to DCM is still largely unknown， in particular how autoimmunity interacts with inflammation， neurohormonal regulation and extracellular matrix proteins.

免疫吸附开始用于充血性心力衰竭的治疗
Immunoadsorption as emerging therapy in CHF

Immunoadsorptions have been conducted last decade in a number of small scale studies. Recently Staudt et al demonstrated that immunoadsorption in one course is equally effective as repetitions at monthly intervals. Removal of autoantibodies is believed to be an important part of it but certainly not the whole truth. The specific immunoadsorption of anti-β1-adrenoceptor autoantibodies is effective in improving cardiac performance in patients with dilated cardiomyopathy. The main mechanism for immunoadsorption is probably through modulating inflammation beyond antibody elimination. In our study， immunoabsorption was shown to improve cardiac structure and function. At the electron microscopic level， there was less prominent intracellular edema and accumulation of hypercontraction bands after immunoabsorption，  LV mass/body weight ratio was decreased， cardiac function was increased.

未来与挑战
Future and challenges
Better understanding of pathophysiological role and clinical relevance of cytokines in CHF，  may lead to better management of this disease state. We have to exhaustively study fundamental mechanism for autoimmune initiation and its interplay with inflammation. In this context we are still standing at the beginning of our race. As autoimmunity is often complicated with individual genetic susceptibility and environmental factors etc， it is anticipated that different individuals may have different autoimmune- and genetic spectrums so that the future immune therapy should be tailored from individual perspective.