Concluding remarks: current trends and future directions

Article Abstract:

In the past decade, there has been enormous growth in research of intravenous immunoglobulin (IVIG) therapy. Immunoglobulins, or antibodies, are purified from pooled donor blood and may be used in the treatment of patients with immune deficiency as well as in patients with specific autoimmune disorders. In the United States, seven commercial preparations of IVIG have been approved for use. All seven have been approved for primary immunodeficiency disorders, five have been approved for the treatment of immune thrombocytopenic purpura, and only one has been approved for the prevention of recurrent bacterial infections among patients suffering from chronic lymphocytic leukemia. Any other uses for IVIG therapy remain, at present, experimental. Experimental uses include the prevention of graft-versus-host disease and cytomegalovirus pneumonia among bone marrow transplant recipients. Unfortunately, research in IVIG therapy is hampered by many factors. Since the IVIG preparations are purified from donor blood, variability from batch to batch and from manufacturer to manufacturer remains a problem. However, little is understood about how IVIG actually works. Consequently, researchers do not know how any particular IVIG preparation may be analyzed in the laboratory to determine its effectiveness. The variability among individual lots of IVIG also make it difficult to compare the results obtained by different medical centers. In the future, it may be necessary to evaluate IVIG preparations for the presence of specific antibodies against specific common bacteria. Analyses might also be performed to detect antibodies against idiotypes (specific individual immunoglobulin structures) and cell receptor components. At present, monoclonal antibody technology is most successful at preparing mouse antibodies for analytical use in the lab. However, in the future it may be possible to prepare monoclonal human antibodies with specific desirable characteristics. These monoclonal antibodies could then be used to supplement intravenous immunoglobulin preparations for the treatment of specific disorders. (Consumer Summary produced by Reliance Medical Information, Inc.)

Monoclonal antibodies

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Use of intravenous immunoglobulin in acquired immune deficiency syndrome

Article Abstract:

The hallmark of AIDS is the progressive depletion of cells of the immune system, specifically CD4-positive lymphocytes, also called T helper-inducer cells. However, AIDS patients suffer other immunologic abnormalities as well. Among these abnormalities is a decrease in antibodies circulating in the blood. AIDS patients are therefore potential candidates for the therapeutic supplementation of these antibodies, more precisely called immunoglobulins. Immunoglobulins are now available for intravenous injection; these antibodies are prepared from pooled donor blood, and therefore provide protection against many of the common infections to which people are regularly exposed. During one study involving children with AIDS, 16 percent of the children receiving experimental treatment with intravenous immunoglobulins (IVIG) died. In contrast, 83 percent of the control children with AIDS died during the same period. Other studies have found similar beneficial effects of IVIG on children with AIDS. There is no evidence, however, that the IVIG had any effect on the children's cellular immune system and its progressive decimation by the AIDS virus. Therefore, there is not yet any reason to begin IVIG treatment of HIV-infected children who are not yet symptomatic and who have not yet begun to suffer the ravages of recurrent bacterial infections. Adults with AIDS suffer a different array of infections than do children with this disease. Recurrent bacterial infections are less important in the overall clinical picture of adult AIDS. IVIG is unlikely to protect against many of the viral, fungal and protozoal infections that torment the adult AIDS patient, and there is not yet any evidence to indicate a clear benefit for IVIG therapy in adult patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Drug therapy, AIDS (Disease), Opportunistic infections, AIDS (Disease) in children, Pediatric AIDS (Disease)

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Immunoglobulin subclasses and prophylactic use of immunoglobulin in immunoglobulin G subclass deficiency

Article Abstract:

Immunoglobulins (Ig), or antibody molecules, exist in several classes, called A, D, E, G, and M. Most antibodies circulating in the blood are G class, or IgG. However, IgG molecules have subclasses of their own, IgG1, IgG2, IgG3, and IgG4. Some patients suffering from increased susceptibility to infection have been found to have a deficiency not of a class of antibodies, but only of antibodies of a particular subclass. The role of this deficiency is not completely understood, however, since healthy individuals have been identified in whom an IgG subclass is completely absent. The use of intravenous immunoglobulin therapy is an obvious potential treatment for patients who suffer from frequent infections and a subclass deficiency. The therapeutic immunoglobulin preparation is made from the pooled blood of many donors, and therefore contains a broad range of antibody specificities, as well as all subtypes. In an experimental study of 43 patients with subclass deficiency, weekly intramuscular injections of immunoglobulins were found to significantly reduce the number of days of infection. Subsequent studies have suggested that higher doses of immunoglobulins are more effective. Improvements in the methods of purification of immunoglobulins from donor blood have made it possible to inject immunoglobulins intravenously rather than rely on intramuscular injections. This will permit the more practical use of higher doses of antibodies and will likely improve the success of treatment of patients with immunoglobulin subclass deficiency. (Consumer Summary produced by Reliance Medical Information, Inc.)

Immunodeficiency

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