The requirements for a present-day IVIG preparation are outlined. These are mainly: fully preserved activities of the recognition and effector functions of the IgG molecule, a normal subclass distribution, and a normal half-life after infusion. The therapeutic uses of IVIG preparations are discussed as follows: Antibody substitution in cases of generalized or partial antibody deficiency in immune-compromised patients. These include the following diseases: hypogammaglobulinemia (congenital and acquired, including the neonates); drug-induced and viral immunosuppression. Antibody substitution in cases of selective antibody deficiency in otherwise immune-competent patients. These include acute cases of consumptive antibody deficiencies of the Jarisch-Herxheimer reaction type; in particular, chronic inflammations which apparently involve ineffective immune responses in which the organism is unable to build up sufficient amounts of antibodies with the required partial specificity, which is indispensable for overcoming the disease. Modulation of the immune system by Ig-Ig interactions (mainly idiotype-anti-idiotype interactions) and Ig-Fc-receptor interactions, as it is known from the RES blockade during IVIG treatment of idiopathic thrombocytopenic purpura.
Summary Precipitating antisera against human serum albumin, α2‐macro‐globulin, siderophilin and gammaglobulin were tested against the sera of different mammals (rhesus monkey, horse, cow, cat, dog, sheep, pig, guinea pig, mouse, hedgehog), using Ouchterlony's agar diffusion method. Based on the heterologous precipitin reactions it is possible to conclude that human serum albumin must contain at least 11, α2‐macroglobulin at least 8, siderophilin at least 4 and gamma‐globulin at least 6 different antigenic determinants. The proteins of the rhesus monkey contain at least one such determinant group less than the corresponding human proteins. The corresponding proteins of the other mammals tested contain determinant groups in common with the human serum proteins in varying number and distribution. These results suggest that immune sera against protein antigens consist of numerous different antibodies, each one directed against a specific determinant group of the antigen. Résumé Des immunsérums précipitants anti‐albumine sérique, anti‐α2‐macroglobuline, anti‐sidérophiline et anti‐γ‐globuline humaine ont été testés par la méthode de précipitation dans l'agar selon Oucherlony avec des sérums de différents mammifères (singe Rhésus, cheval, bovidé, chat, chien, mouton, porc, cobaye, souris et hérisson). Ces précipitations hétérologues ont montré que chez l'homme l'albumine sérique contient au moins 11, l'α2‐macroglobuline au moins 8, la sidérophiline au moins 4 et la γ‐globuline au minimum 6 déterminants antigéniques. Chez le singe Rhésus ces mêmes 4 protéines sériques contiennent au moins un déterminant antigénique commun de moins que chez l'homme. Chez les autres mammifères le nombre de la répartition des déterminants communs aux protéines de l'homme est variable. Ces expériences montrent qu'un immunsérum antiprotidique contient de nombreux anticorps différents, réagissant chacun spécifiquement avec le déterminant antigénique donné. Zusammenfassung Präzipitierende Immunseren gegen menschliches Serumalbumin, α2‐Makroglobulin, Siderophilin und γ‐Globulin wurden im Agar‐diffusionstest nach Ouchterlony gegen verschiedene Säugetierseren (Rhesusaffe, Pferd, Rind, Katze, Hund, Schaf, Schwein, Meerschweinchen, Maus, Igel) angesetzt. Anhand der heterologen Präzipitations‐reaktionen gelang es zu zeigen, daß das menschliche Serumalbumin mindestens 11, das α2‐Makroglobulin mindestens 8, das Siderophilin mindestens 4 und das γ‐Globulin mindestens 6 differente Antigen‐determinanten aufweisen. Die entsprechenden Proteine des Rhesus‐affenserums enthalten mindestens eine gemeinsame Determinante weniger als die menschlichen Proteine. In den entsprechenden Proteinen der übrigen Säugetiere sind die restlichen im menschlichen Serumprotein vorkommenden Determinanten in wechselnder Zahl und Verteilung vorhanden. Auf Grund dieser Untersuchungen ist anzunehmen, daß Immunseren gegen Proteine zahlreiche Antikörper enthalten, die mit den betreffenden Determinanten des Antigens spezifisch reagieren.
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