Clinical Use Of Intravenous Immunoglobulin Research Articles

Intravenous Immunoglobulin Therapy of Autoimmune and Systemic Inflammatory Diseases

The proven beneficial effect of intravenous immunoglobulins (IVIg) in certain autoimmune disorders has led to the development of clinical trials in other autoimmune and systemic inflammatory diseases. In parallel, experimental studies are being carried out to better understand the mechanisms of action of IVIg. In this review, we discuss the clinical use of IVIg in autoimmune disorders and the possible mechanisms by which IVIg may be effective in the various diseases. A better understanding of the mechanisms of action of IVIg in autoimmune disease will allow optimization of their use as a therapeutic alternative to conventional immunosuppression.

Immunoglobulines intraveineuses (IVIg) et suppression anti-idiotypique de l'auto-immunité

This review summarizes the clinical use of intravenous immunoglobulins (IVIg) in autoimmune diseases and focuses on the mechanisms by which IVIg suppress autoimmune responses. Evidence is presented of a role of IVIg in modulating the regulatory function of the idiotypic network on the expression of the natural and pathological autoimmune repertoires.

Enhanced Killing of Group B Streptococci In Vitro by Penicillin and Opsonophagocytosis with Intravenous Immunoglobulin

Combined effects of intravenous immunoglobulin (IVIG) and antibiotics in killing bacteria are of interest with broadening clinical use of IVIG. Since the kinetics of killing by these agents differ and each may influence the outcome of the other, it is difficult to evaluate combination effects in vitro. Conditions were developed to measure killing of group B streptococci (GBS), type III strain M732, by an opsonic mixture with IVIG, fresh serum, and human polymorphonuclear leukocytes (PMNL) with or without penicillin. Bacterial killing was observed with the opsonic IVIG mixture, penicillin, and the opsonic IVIG mixture plus penicillin at 1 h. The effect of the combination was greater than the sum of the effects of two separate incubations. The enhanced killing was evident for up to 18 h. By 24 h, the killing by the combination was no greater than that by penicillin alone. A similar pattern of GBS killing was observed with cord blood PMNL, six different GBS type III strains, and pretreatment of GBS with either IVIG or penicillin. These effects suggest that the combination of IVIG and penicillin has potential for use in the treatment of neonatal GBS infections.

Clinical use of intravenous immunoglobulin in blood disorders

The protective effect of passively administered immunoglobulin has been known for many years. Although its accepted use over the last 40 years has been in the prevention and treatment of infection 1 its widest and, arguably, most important application has been in the prevention of Rhesus haemolytic disease of the newborn. However, the development over the last decade of a number of safe and effective immunoglobulin preparations for intravenous use has allowed its more widespread utilisation in clinically appropriate settings. It is now widely accepted that intravenous immunoglobulin (IVIgG) is indicated, on a repeat basis, as treatment of choice as replacement therapy for patients with primary antibody deficiency. 2 It may also be effective, in the non-immune deficient patient, in the management of certain bacterial as well as viral infections. 3 This is particularly the case in the pre-term neonate 4 but may have an application in the infected intensive care patient. The benefit in these patient groups has led to a re-evaluation of the use of immunoglobulin replacement therapy in the severe secondary antibody deficiency states associated with such haematological conditions as multiple myeloma and chronic lymphocytic leukaemia. These are currently the subject of randomised, controlled studies. The observation that the use of IV IgG may be associated with effects other than passive transfer of antibody were first made by Imbach in Switzerland. While treating children with immunodeficiency he noticed that two with a coincident immune thrombocytopenia had a rapid platelet increment in close association with the immunoglobulin infusion. He subsequently confirmed that this was a rapid and predictable form of therapy in childhood idiopathic thrombocytopenic purpura (ITP) 5 and that in some children it appeared to affect the natural history of the disease. Since these initial observations the response has been confirmed in both children and adults 6 and extended to other immune-based haematological disorders. 7

The clinical use of intravenous immunoglobulin in pediatrics

l 'he availability of immunoglobulin preparations produced for intravenous application has opened up a new field for pediatric therapy. Initially prepared for replacement in children with antibody deficiency syndromes, we now realize the potential of immunoglobulins as an adjuvant in the management of infections and as a potent modulator of pathologic immune responses. The purpose of this review is to summarize the biological role of immunoglobulins and our knowledge about their clinical efficacy.