Prolactin: a new therapeutic target in peripartum cardiomyopathy

Peripartum/postpartum cardiomyopathy (PPCM) is a potentially life-threatening disease of uncertain aetiology in previously healthy women. Clinical and experimental data suggested inflammation, autoimmune processes, apoptosis and endothelial dysfunction as typical pathophysiological features of PPCM. Recent data discovered that unbalanced peri/postpartum oxidative stress linked to proteolytic cleavage of the nursing hormone prolactin into a potent anti-angiogenic, pro-apoptotic and pro-inflammatory 16-kDa subform as a potential pathomechanism for the development of PPCM. Consistent with these idea, blockade of prolactin by bromocriptine, a dopamine D2 receptor agonist, prevented the onset of disease in an experimental model of PPCM and appeared successful in small pilot trials with respect to prevention or treatment of PPCM in patients. Here we highlight the current state of knowledge on diagnosis of PPCM, provide novel insights into the pathophysiology behind the disease and outline potential consequences for the clinical management and treatment options for patients at risk for or with PPCM.