Protein-A and anti-IgG columns are licensed for IA. Anti-IgG sepharose effectively eliminates all IgG subclasses, including IgG-3. Protein A binds to the Fc part of human IgG-1, -2, -4. However, the affinity of protein A to IgG-3 is low. IgG-3 removal can be markedly increased by protein-A, through the use of an optimized treatment regime, by prolonging the IA course to 4 - 5 sessions, and by reducing the loading volume of the protein columns with plasma. In use of this adsorption regime for IgG-3 elimination, protein-A IA induces significant acute and prolonged haemodynamic improvement of DCM patients. Furthermore, IA treatment with protein A adsorption performed in 1 course on 5 consecutive days induces improvement of the left ventricular function of DCM patients over a period of 6 months, with results comparable to those received by IA treatment repeated in 4 courses at monthly intervals. Despite optimized medical treatment, the prognosis of DCM is still poor. For most patients, heart transplantation will represent the only palliative treatment option. Alternative therapeutic strategies for treatment of DCM are consequently of essential interest.