Disorders Of Humoral Immunity Research Articles

Inflammation in the pathogenesis of neurodegenerative diseases

INTRODUCTION: Neurodegenerative diseases are common chronic disorders that are associated with progressive damage to the nervous system. The role of the immune system in the development of neurodegenerative diseases was confirmed by data on the activation of microglia, the presence of an imbalance in the composition and phenotype of peripheral immune cells, and the presence of humoral immunity disorders and intestinal microbiota dysbiosis in patients with this pathology. DISCUSSION: Inflammation has been observed to play a key role in the pathogenesis of diseases associated with progressive damage to the nervous system. The article analyzes the mechanisms in the development of “subclinical” chronic inflammation that leads to development of old-age-related diseases, including neurodegenerative pathology. At least three groups of factors associated with old age play a role in the formation of a proinflammatory status: mitochondrial dysfunction, development of an age-related proinflammatory status of the immune system, and chronic stress. Mitochondrial dysfunction is primarily associated with disruption of mitophagy processes: failure of quality control mechanisms as a result of disruption of mitophagy processes leads to the accumulation of terminally damaged mitochondria, which become a threat to cell survival. Inadequate removal of damaged mitochondria leads to hyperactivation of inflammatory signaling pathways and subsequently to chronic systemic inflammation and the development of inflammatory diseases. A high level of deletions in the mitochondrial genetic apparatus that accumulates with age inevitably leads to increased formation of reactive oxygen species, which in turn are assumed as one of the leading activators of the cytosolic NLRP3 protein, the primary component of inflammasomes. Increased inflammasome formation eventually leads to caspase-1-dependent production of proinflammatory interleukins. Age-related inflammatory imbalance is associated with the fact that the immune system, the main protective mechanism characterized by the inflammatory response, copes with constant antigenic attacks. However, over time, upon reaching a certain threshold, the reaction of the immune system becomes excessive, characterized by increased production of coagulation factors, proinflammatory cytokines, acute phase proteins of inflammation, prostaglandins, and leukotrienes. CONCLUSIONS: Immunological changes that develop during chronic (long-term) stress are the result of a disruption of the homeostatic connection between the neuroendocrine and immune systems, leading to the formation of an inflammatory background that complements the “proinflammatory status” that develops as a result of age-related changes in the immune system and disruption of mitophagy mechanisms.

The state of the immune system in patients with functional ovarian cysts

Conducting a qualitative and comprehensive examination of patients with functional ovarian cysts is fundamentally necessary to understand the treatment strategy of this pathological state.
 The objective of the work was to study the features of immune disorders in patients of reproductive age with functional ovarian cysts. 
 Methods. 50 patients of reproductive age with functional ovarian cysts were examined. General clinical, gynecological, ultrasound examination of the pelvic organs, a study of the state of the immune system were carried out.
 Results. In 70% of patients chronic inflammatory processes of the pelvic organs were detected. The findings revealed varying degrees of immune system disorders in women with ovarian cysts with different parity.
 In nulliparous and women who gave birth violations of cell immunity of the I degree were revealed, in the group with infertility - II degree.
 In the group of patients who gave birth and with infertility, the III degree of disorders of humoral immunity was diagnosed, and in nulliparous women - II degree.
 Conclusion. Determining the degree of disorders of the immune system already at the prehospital stage will allow individualizing the choice and dosing regimen of immunomodulatory drugs as part of the complex therapy of functional ovarian cysts.

Characteristics of B cells and immunoglobulin profile in Takayasu's arteritis.

Disorders of humoral immunity in Takayasu's arteritis (TAK) have not been well explored. This study describes the characteristics of B cells and immunoglobulin (Ig) profile in patients with TAK. Peripheral B cell populations assessed using flow cytometry and serum Ig levels assessed using a biochemical analyser in 98 newly diagnosed patients with TAK were analysed and compared with those of 31 patients with systemic lupus erythematosus (SLE) and 60 healthy controls (HCs). CD19+ B cell and IgG infiltration to the aortic tissue was evaluated by immunohistochemical staining. The proportion of peripheral CD3-CD19+ B cells and levels of serum IgG in TAK were lower than those in SLE, but higher than those in HCs. CD3-CD19+ B cell counts were higher in TAK than in HCs. Serum IgG and IgG1 levels were higher in active TAK than in non-active TAK. In TAK, positive correlations of serum IgG levels with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, Kerr score, and Indian Takayasu Clinical Activity Score (ITAS2010, ITAS-A) were observed before immunotherapy. After 6 months of immunotherapy, serum Ig levels significantly decreased. Positive correlations between the changes in IgG levels and values of ESR, CRP, Kerr score, and ITAS-A were detected. Immunohistochemical staining confirmed CD19+ B cell and IgG infiltration to the aortic wall in patients with TAK. Enhanced B cells might contribute to the pathogenesis of TAK, and serum IgG levels could serve as a simple, useful biomarker to assess disease activity and monitor treatment response in TAK.

The state of humoral immunity in dusty lung diseases

The estimation of diagnostic value of humoral immunity indices in dust lung diseases is given and the tests for determining the individual sensitivity of persons to the effect of industrial aerosols of various fibrogenity degree are chosen. It is established that disorders of humoral immunity and inspecific resistance of the organism in dust lung pathology depend on the disease type and are determining for developing infectious complications. It is recommended to determine the factors of humoral immunity and inspecific resistance in workers being in contact with high concentrations of industrial aerosols and in patients with dust lung diseases for the exact estimation of risk of developing infectious complications.

Specific antibody response of patients with common variable immunodeficiency to BNT162b2 coronavirus disease 2019 vaccination

Specific antibody response of patients with common variable immunodeficiency to BNT162b2 coronavirus disease 2019 vaccination

Analysis of Clinical Related Factors of Neonatal Hand-Foot-Mouth Disease Complicated With Encephalitis.

Objective: To explore the clinical related factors of neonatal hand-foot-mouth disease (HFMD) complicated with encephalitis.Method: The neonatal HFMD complicated with encephalitis treated in our hospital from July 2015 to July 2020 was taken as the object of study. According to the NBNA score at discharge, the patients were divided into normal group and abnormal group. The clinical symptoms, auxiliary examination and prognosis of the two groups were compared.Result: (1) General condition: there was no significant difference in sex, age, duration of fever, treatment time and etiological test between the two groups (P > 0.05). (2) Clinical symptoms and signs: there was significant difference in abnormal consciousness between the two groups (P < 0.05). However, there was no significant difference in skin rash, respiratory system symptoms, digestive system symptoms, signs of high intracranial pressure, increased muscle tone and weakening of primitive reflex (P > 0.05). (3) Auxiliary examination: the number of white blood cells and the level of cytokines (CK-BB, UCH-L1) in cerebrospinal fluid (CSF) in the group with abnormal NBNA score were significantly higher than those in the group with normal NBNA score (P < 0.05). The serum IgM level in the abnormal NBNA score group was higher than that in the normal NBNA score group, and the serum IgG level in the abnormal NBNA score group was lower than that in the normal NBNA score group, and the difference was statistically significant (P < 0.05). The abnormal rate of Craniocerebral MRI in abnormal NBNA score group was higher than that in normal NBNA score group, and there was significant difference between the two groups (P < 0.05). There was no significant difference in the levels of protein, sugar, chloride, lactate dehydrogenase, and MMP-9 in CSF and the abnormal rate of amplitude integrated EEG (aEEG) between the two groups (P > 0.05). (4) The prognoses of patients with normal and abnormal NBNA score are good, and there are not significantly differences in the prognosis between the two groups (P > 0.05).Conclusion: (1) Neonatal HFMD complicated with encephalitis occurs more than 10 days after birth, there is no obvious abnormality in male and female, the vast majority of newborns have febrile symptoms, rash is not its specific manifestation, and most of them are atypical. (2) The positive rate of HFMD-related virus detected in CSF of neonatal HFMD is high. For newborns with abnormal consciousness, CSF examination should be accomplished in time, which has certain clinical significance for early diagnosis and treatment of severe newborns. (3) The increase of white blood cell count and cytokines (CK-BB, UCH-L1) in CSF of neonatal HFMD complicated with encephalitis has a certain clinical reference value for early diagnosis and identification of severe newborns. (4) There is a certain humoral immune disorder in newborns with HFMD complicated with encephalitis, but the overall prognosis is better due to the protective effect of maternal IgG.

Research Advances on the Pathogenesis of Primary Immune Thrombocytopenia--Review

Abstract Immune thrombocytopenia (ITP) is a complex autoimmune disease characterized by less than 100×109/L platelet count in peripheral blood. The pathogenesis of ITP is complex and has not been fully elucidated. Currently, researches on the pathogenesis of ITP mainly focus on the disorders of humoral immunity and cellular immunity. In recent years, some new progress has been made in the study of this pathogenesis, including the platelet clearance pathway that is not dependent on Fc γ R mediation, the metalloproteinase (ADAM) 10 that can regulate T and B cells, and the abnormal expression of micro RNA in genetic factors. Under the joint action of multiple factors, the imbalance of the immune system in the body leads to the occurrence of ITP. This article reviews the research progress on humoral immunity, cellular immunity and other possible new pathogenesis of ITP in recent years.

The immunomodulatory function of human amniotic fluid stromal cells on B lymphocytes

Current treatments for B cell-mediated disease are mainly based on global B cell depletion, thereby eliminating pathogenic B cells as well as Breg subsets. A more refined modulation of B cell activity could prove beneficial for patient treatment.Objective:To investigate the immunomodulatory function of human amniotic fluid stromal cells (hAFSCs) on different subpopulation of B lymphocytes.Methods:hAFSCs were isolated and cultured and identified by characteristic phenotypic markers. After coculture of B lymphocytes with hAFSCs, the activation, proliferation, differentiation, as well as apoptosis, cell cycle, and expression of the inhibitory costimulatory molecules B7H1, B7H3, and B7H4 of B lymphocytes were examined in vitro.Results:Coculture with hAFSCs significantly decreased the expression of CD80/CD86, Ki-67 and CFSE expression, on activated B lymphocytes. These might be due to the inhibition of B lymphocyte apoptosis and cell cycle arrest. In activated B lymphocytes, coculture with hAFSCs resulted in a reduced proportion of memory B and plasma cells, reduced amounts of immunoglobulins. hAFSCs could balance the B1 to B2 cell subpopulation ratio. hAFSCs could inhibit the expression of the negative co-inhibitory molecule B7H4 and PD-L1 on the activated B lymphocytes.Conclusion:hAFSCs could inhibit B cell activation, proliferation, and subpopulation differentiation. These might be due to their affect on B cell apoptosis, cell cycle and the expression of costimulatory molecules of human B lymphocytes. Our experiment provided the evidence for hAFSCs as ideal seed cells with therapeutic potential for treating humoral immunity disorders, which were mainly mediated by B lymphocytes.

Analysis of differences between total IgG and sum of the IgG subclasses in children with suspected immunodeficiency \u2013 indication of determinants

BackgroundDeficits in disorders of humoral immunity associated with a deficit of antibodies are the most common primary immunodeficiency. Total IgG and IgG subclasses measurements are used to diagnose, differentiate and control in patients with primary and secondary immunodeficiencies.MethodsThe purpose of the study was to analyze the structure patients group according to difference between total IgG and sum of the IgG subclasses and to determine factors affecting the level of this difference. This study was based on data collected from 670 children referred to the Department of Clinical Immunology and Pediatrics in order to diagnose the immune disorders. For all children the level of the total of immunoglobulins IgG and of the IgG subclasses (IgG1, IgG2, IgG3, IgG4) were determined. The group of children was divided into subgroups according to gender, age (under 6 years of age, 6.5–12 years, and 12–18 years), and IgG abnormality (below the normal range, normal and above the normal range). In the patients group, the total IgG values were on average higher than sum of the IgG subclasses.ResultsStatistical analysis shown the all parameters under study (age, gender and IgG abnormality) influence statistically significant on the discrepancy between the sum of the IgG subclasses and total IgG. Assessment of IgG and IgG subclasses levels is based on different methods what causes the discrepancy between the sum of the IgG subclasses and total IgG.ConclusionsStandardization in that regard is crucial. In addition, we have shown the reliability of the results obtained. Despite the determination in two different laboratories and on different analyzers, as well as the freezing process does not affect the test results.

Risk factors and peculiarities of clinical course of ulcer disease in employees of antibiotic industry.

A total of 62 patients engaged in antibiotic production (main group) and 59 control subjects were examined. Risk factors of ulcer disease in these patients could be dust inhalation, contact with solvents, shift work, and smoking. Patients of the main group had a more severe disease and higher frequency of complications, larger amounts of Helicobacter pylori in the gastric mucosa, its more pronounced morphological changes, slower disappearance of clinical symptoms of exacerbation, and longer period of ulcer scarring. Also, they underwent more severe disorders of humoral immunity than control subjects which might account for the unfavourable clinical picture of their condition.

Disorders of Humoral Immunity in Children with IgG Subclass Deficiency and Recurrent Respiratory Infections.

Respiratory tract infections in children are one of the most common causes for medical consultations. When the infections are of recurring nature, they are a major reason for the diagnostics for primary immunodeficiency that is in about 65% of cases underlain by disorders of humoral immunity. This study seeks to retrospectively evaluate the history of recurrent respiratory tract infections in children with humoral disorders and the associations among deficiencies in the immune system components. We evaluated 394 children aged 3months to 18years. We found 49.5% (195 cases) of children with IgG deficiencies, all of whom had normal IgE levels. There were 8.4% (33 cases) of IgA deficiency, 7.4% (29 cases) of IgM insufficiency, and 4.1% (16 cases) of CD19+ cells deficiency. The elevated level of CD19+ cells was found in 27.7% (109 out of the 394 children). Immunoglobulin deficiencies often coexisted with a deficiency in another immunoglobulin class above outlined. There was an interdependence between IgA abnormality and IgG, IgG3, and IgG4 abnormalities as well as between IgM abnormality and IgG and IgG1 abnormalities. We conclude that respiratory tract infections in children are often underlain by a convergence of IgG with both IgA and IgM abnormal states. The physiopathological meaning of this convergence for the infection course and resulting functional respiratory changes remains elusive.

OPTIMIZATION OF THERAPEUTIC MEASURES IN PATIENTS WITH NUMMULAR ECZEMA

Constant cellular and humoral immunity disorders promote the development of nummular eczema. Severe refractory cases of eczema represent a complex therapeutic problem. Increasingly eczema resistance to standard methods of therapy forces specialists to use systemic drugs with immunosuppressive action and a high risk of serious complications. Material and methods. The therapeutic possibilities and safety of the new domestic immunoactive agent L-isoleucyl-L-glutamyl-L-tryptophan sodium salt in patients with nummular eczema and its effect on the immune homeostasis were analyzed. The drug was included in complex treatment in 34 patients with nummular eczema. The comparison group composed 20 patients who received standard therapy. The highly sensitive methods for assessing the immune status: the cytokine system, the relative affinity of antibodies and the expression of Toll-like receptors (TLRs) are used. Results. 24 (70.6%) patients had a clinical cure and 9 (26.5%) patients had a significant improvement after L-isoleucyl-L-glutamyl-L-tryptophan sodium salt treatment. Only 1 (2.9%) patient had no effect from the therapy. There were no any side effects and complications in the course of the therapy. In the comparison group, clinical cure was achieved in 11 (55%) patients, the effect of the therapy was not observed in 2 (10%) patients. Conclusion. After the termination of the course of therapy, 15 (44.1%) patients had a clear tendency to normalize the affinity of immunoglobulins, The intensity of TLR4 expression was significantly reduced and did not differ from those in healthy donors. The use of this drug quickly allowed to stop the clinical manifestations of nummular eczema with the preservation of long-term remission, to normalize the processes of interleukin-dependent regulation of the immune response and nonspecific resistance. The advantage of the proposed method of treatment is the possibility of using in outpatient settings.

Soluble programmed death-1 and soluble programmed death ligand 1 protein expression and immune status in patients with recurrent aphthous ulcer

This study aims to investigate the possible role and significance of soluble programmed death-1 (sPD-1) /soluble programmed death ligand 1 (sPD-L1) in the immune pathogeneses of recurrent aphthous ulcer (RAU). A total of 30 RAU cases (18 cases of minor RAU, 5 cases of major RAU, and 7 cases of herpetiform ulcers) were enrolled in this study. A total of 18 healthy people served as controls. Lymphocyte subsets (CD3⁺, CD4⁺, CD8⁺, CD19⁺, and CD16⁺+56⁺) were investigated by flow cytometric analysis. Humoral immunity (IgG, IgA, IgM, C3, and C4) was explored by nephelometry immunoassay. The sPD-1 and sPD-L1 protein levels in the sera of RAU patients were investigated by enzyme-linked immunosorbent assay. The correlations of the sPD-1 and sPD-L1 protein levels with the immune status and clinical characteristics of the RAU patients were analyzed by SPSS 19.0. The number of CD4+ T cells decreased and the levels of IgM antibodies increased in the RAU patients relative to those in the normal controls (P<0.05). The sPD-1 and sPD-L1 protein levels in the RAU patients were significantly higher than those in the control group (P<0.05). Meanwhile, the sPD-1 and sPD-L1 protein levels in the patients with minor and major RAU were significantly higher than those in the control group (P<0.05). By contrast, no significant difference was found in the patients with herpetiform RAU (P>0.05). Positive correlations were noted between the sPD-1 protein level and the CD19+ cell frequency or C4 level (r₁=0.389, P₁=0.034; r₂=0.382, P₂=0.037). Cellular immune hypofunction and humoral immunity disorders were found in the RAU patients. The PD-1/PD-L1 signaling pathway, which might be influenced by the involvement of sPD-1 and sPD-L1 proteins to a certain extent, may play some roles in the immune pathogenesis of RAU.

Serum immunoglobulin E levels in children with idiopathic nephrotic syndrome

Background Children with idiopathic nephrotic syndrome (INS)have been known to have T-cell dysfunction and an impairment ofthe cytokine network that may alter glomerular permeability andthe glomerular filtration barrier. This disorder may contribute to thepresence of urinary protein loss in children with INS. The elevationof serum IgE levels has been noted in some cases, but its associa-tion with steroid-responsive nephrotic syndrome has not been fullyelucidated.Objective This study was done to investigate the association be-tween serum IgE levels prior to prednisone treatment in childrenwith INS and the outcome of treatment.Methods A prospective observational study has been conductedon 22 children with INS. Prednisone therapy was given with a doseof 60 mg/m 2 body surface area (BSA) for four weeks followed by asingle dose of 40 mg/m 2 BSA every other day for another fourweeks. This protocol was applied for steroid-responsive INS chil-dren. Children with steroid resistance were given oral cyclophos-phamide 2 mg/kg for eight weeks. IgE level measurements wereperformed prior to prednisone therapy and at remission. Data wereanalyzed using one-way ANOVA and multiple regression.Results Twenty-two children were enrolled in this study. High lev-els of serum IgE were found in 95.5% of children, with a mean of2002.5 (SD 2172.1) IU/ml. The serum IgE levels of INS childrenwith history of allergy were significantly higher than those of neph-rotic children without history of allergy (P&lt;0.05). However, therewas no significant correlation between the serum IgE levels andthe outcome of treatment in children with INS.Conclusion The high serum IgE levels in children with INS seemto be associated with humoral immune disorder and did not haveany association with the outcome of therapy. Even though the se-rum IgE levels were significantly higher in INS children with historyof allergy, other factors that may influence serum IgE levels mustbe considered

Treatment of cartilage–hair hypoplasia with recombinant human growth hormone

Cartilage-hair hypoplasia (CHH) is an autosomal recessive disorder characterized by short stature, hypoplastic hair and humoral immunity disorders. It is a mutation in the RMRP gene, located on chromosome 9p13.3, that leads to CHH. There is no special treatment for short stature in CHH. The efficacy and safety of recombinant human growth hormone (rhGH) therapy in CHH is still under discussion. The present study describes the case of a girl with CHH who was treated with rhGH. The rhGH treatment had a significant effect on the height gain: the height SD score was changed from -4. to -2.98 after 4 years 7 months of treatment. rhGH therapy should be considered as a treatment modality for CHH, and insulin-like growth factor (IGF)-1 and IGF-binding protein 3 concentrations should be closely monitored, particularly because of the increased cancer risk that is a characteristic feature of CHH.

Efficiency of immune-regulating therapy in patients with chronic obstructive pulmonary disease

The study was aimed to evaluate efficiency of Inferon in treatment of patients with chronic obstructive pulmonary disease (COPD). The study included 45 patients with COPD aged 59.7 ± 1.07 yrs in average. Of them, 23 patients received standard treatment and Inferon was administrated to 22 patients with COPD. In COPD patients, T-cell and humoral immunity disorders have been observed. Blood neutrophile activity and serum interferon-γ level were significantly reduced. Immune disorders and symptoms of disease persisted in the patients received the standard treatment. Therapy with Inferon improved immunity and the overall efficiency of the treatment. The results allow inclusion of Inferon in therapy of COPD patients.

Manifestations immunes associées aux syndromes myélodysplasiques. Étude prospective de 40 patients

The association of myelodysplastic syndromes (MDS) with auto-immune diseases and humoral disorders have already been reported. In this prospective study we tried to estimate type and the frequency of immunological associated diseases among patients affected by MDS. In this prospective study, auto-immune disease and humoral immunity disorders were systematically searched during MDS and conversely MDS searched during cytopenia. All MDS secondary to chemotherapy and the children's MDS were excluded. The MDS diagnosis was established according to FAB criteria and patients were classified in two groups A or B according to presence (group A) or not (group B) of dysimmune manifestations. Forty patients(19 males and 21 females, mean age of 56,6 years) with MDS have been enrolled during this period (group A: 20 patients). Associated diseases are following: systemic lupus erythematosus (three), lupus-like syndrome(one), sarcoidisis(one), Sjogrën syndrome(one), polyarthritis (two), chronic liver diseases (three), autoimmune thyroid diseases (two), pyoderma gangrenosum (one), Crohn's disease(one), haemolytic anaemia (one), and pericardial effusion(one). A wide spectrum of auto-immune manifestations is frequently reported in myelodysplastic syndromes. Further studies are necessary for discuss the current physiopathological hypothesis with their therapeutic relevance.

Single mutation in the cystic fibrosis transmembrane regulatory gene in patients with chronic sinusitis and hypogammaglobulinemia: A novel immunodeficiency

Rationale Chronic sinusitis causes significant morbidity. Atopy and immunodeficiency, particularly humoral immunodeficiency, are predisposing risk factors to this condition. Multiple studies have shown a linkage exists between patients with chronic sinusitis and a single cystic fibrosis (CF) gene mutation, who do not meet diagnostic criteria for CF. This mutation occurs in the CFTR gene. Methods We present a series of five patients (3M&2F), age 1-18, with a combined single mutation of the CF gene, humoral immunodeficiency and sinusitis with a positive sinus CT. Of these patients, all failed repeated antibiotic treatments; two had multiple sinus surgeries. Results We found single copy of F508 CF mutation in 3 patients, W1282X, in one and R117H in one. While all of the patients failed to respond to pneumococcal Ab, three had low response to tetanus, H. Flu, polio and isohemmaglutinin, as well. IgG levels were below the standards for their age in three of the patients (mean 510+44); IgG3 was decreased (mean 25+18) and IgA was absent (less than 10) in two; IgM was borderline low in three patients (mean 32-20). As a result of our findings, we treated three of the patients with IVIG (600 mg/kg). A significant improvement in their incidence of sinusitis was noted. Conclusion Based on our findings, we propose the existence of a new humoral immunodeficiency which presents with a single CF mutation and humoral immune disorder, which has a clinical presentation of chronic sinusitis. Given these results, we suggest that IVIG be considered a therapeutic treatment option for these patients.

Incidence of toxoplasmosis in patients with cirrhosis.

It is known that toxoplasmosis rarely leads to various liver pathologies, most common of which is granulomatose hepatitis in patients having normal immune systems. Patients who have cirrhosis of the liver are subject to a variety of cellular as well as humoral immunity disorders. Therefore, it may be considered that toxoplasmosis can cause more frequent and more severe diseases in patients with cirrhosis and is capable of changing the course of the disease. The aim of this study was to investigate the frequency of toxoplasmosis in patients with cirrhosis. Serum samples were taken from 108 patients with cirrhosis under observation in the Hepatology Polyclinic of the Gastroenterology Clinic, and a control group made up of 50 healthy blood donors. IFAT and ELISA methods were used to investigate the IgG and IgM antibodies, which had developed from these sera. Toxoplasma IgG and IgM antibody positivity was found in 74 (68.5%) of the 108 cirrhotic patients and 24 (48%) of the 50 people in the control group. The difference between them was significant (P<0.05). In conclusion, it was found that the toxoplasma sero-prevalence in the cirrhotic patients in this study was higher. Cirrhotic patients are likely to form a toxoplasma risk group. More detailed studies are needed on this subject.

Rapid infusion of Sandoglobulin in patients with primary humoral immunodeficiency

We studied 16 patients with primary disorders of humoral immunity to determine the practicality of infusing intravenous gamma globulin at rates of infusion and concentrations higher than the 4 mg/kg/min and 6% currently recommended. In the first portion of the study, the concentration of Sandoglobulin was increased from 6% to 12%. In the second portion, the flow rate was increased to 5 mg/kg/min, and if no reactions occurred, the time of each successive infusion was decreased by 10 minutes until infusions were completed in 15 to 20 minutes or vasomotor reactions occurred. Thirteen of the 16 patients completed the study; six patients achieved reaction-free rates >15 mg/kg/min, and the other patients achieved rates ranging from 7.1 to 12 mg/kg/min. Seven patients had infusion times <30 minutes, with four patients completing infusions in 15 minutes. In the 13 patients who completed the study, there were 14 reactions in 159 infusions, mostly fever and chills, and often at the end or after the infusion. Only one infusion could not be completed because of an adverse reaction. Three patients were not able to complete the study because of adverse reactions; there were seven reactions in 11 infusions in these three patients, although none of the reactions were considered serious. Overall, in this study, most immunodeficient patients ( 13 16 ) were able to tolerate infusion rates of Sandoglobulin two to 10 times higher than the standard rates now recommended. The maximal rate of infusion must be individualized, but for carefully selected patients, infusions of 400 mg/kg can be completed in 1 hour or less. Such short infusion times could greatly decrease the amount of time lost from work or school and thus improve compliance.