Editorial

Abstract

In this issue of the European Journal of Immunology (EJI), the News and EFIS forum serves as a platform for the discussion of a hot topic in clinical immunology; a topic for which a scientific immunological viewpoint makes the difference, and which matters for the care and benefit of patients. What would be better suited for such a theme than a discussion regarding immunoglobulin (Ig)-based therapies? About a year ago, a group of clinical experts met in Wildbad Kreuth for a workshop on the optimal use of clotting factors and Igs. In spite of its seemingly dry title, the meeting covered a range of aspects associated with one of the oldest and most successful immunological therapies to date, starting from passive immunization with Igs as introduced by Emil von Behring in the 19th century, to the use of Igs to provide general humoral protection and regulate inflammation, and including the use of Igs and clotting factors for long-term substitution in patients suffering from hypogammaglobulinaemia. Given that the resources for such therapies are limited and sometimes difficult to standardize, treatments are expensive and patients may have to be prioritized according to the relevant national guidelines, if established; however, for some of the Ig-based therapies, the mechanisms of action are only now slowly beginning to emerge and thus reveal the potentially novel approaches for the optimization of Ig-based therapeutic products. Obviously covering the spectrum of issues related to Ig therapy is a lot to discuss when you aim for a consensus among 36 Council of Europe states. A resume of this meeting, as well as the six recommendations for the optimal use of Ig therapy that the working group agreed upon, is published in this issue of EJI, as a News & EFIS article entitled “European consensus proposal for Ig therapies” 1. The authors have explicitly asked that the readership of EJI – i.e. the international community of immunologists – openly discuss their proposal and communicate the outcome of their discussions to the community by way e.g. of a Letter to the Editor to EJI, although this is just one public route;. I personally find this a very important step in reaching any consensus: a transparent discussion of the initial proposal, opening it for improvement and amendments, and adding new perspectives. I hope that in the end the document matures from a proposal to a consensus that it not just “European” but “International”, reflecting the expertise of immunologists from all over the world. I also hope that, after open discussion among the community, this consensus does not follow the statement of Abba Eban (1915–2002): “A consensus means that everyone agrees to say collectively what no one believes individually.” For the discussion of consensus protocols in clinical immunology, EJI is a prime choice. At EJI, basic and clinical immunology are of equal importance, what matters is the quality of the science. Interestingly, several papers recently published in EJI shed light on the mechanism of action of therapeutic Igs 2-8, some of which highlightthe role of glycosylation in determining the regulatory potential of Igs 2-4. It will be interesting to see whether and how the profound basic expertise demonstrated in these articles influences or shapes the consensus discussion. If the aim was to to unite basic and clinical immunology, we should remember Marcus Tullius Cicero (106–43 B.C.), who stated, albeit in a different context: “Not cohabitation but consensus constitutes marriage.”