Besides genetic susceptibility and infections with cardiotropic viruses, autoimmune responses against heart tissue play a major role in the pathogenesis of dilated cardiomopathy, the most common cause of heart failure in young patients. Recent findings suggest that the combination of tissue damage resulting in release of self-antigens, together with non-specific activation of the innate immune system triggers various responses that are crucial for the development of heart-specific autoimmunity. Understanding these mechanisms is critical for the design and development of novel treatment strategies against devastating heart diseases in the future. (C) 2004 Elsevier Ltd. All rights reserved.