Does IVIg administration yield improved immune function in very premature neonates?

Wynn, James L.; Seed, Patrick C.; Cotten, C. Michael

doi:10.1038/jp.2009.197

Cited by 27 publications

(14 citation statements)

References 72 publications

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“…The failure of these interventions in large randomized trials likely reflects underappreciated differences in the functional capacity of the neonatal host response (32). To successfully modify immune function and improve infection outcomes in human neonates, as has been done in neonatal animal models (27,33,34), consideration of the unique immuno-developmental stage of the neonate must be taken into account.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Developmental Age on the Early Transcriptomic Response of Children with Septic Shock

Wynn

Cvijanovich²,

Allen

et al. 2011

Mol Med

123

109

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Septic shock is a frequent and costly problem among patients in the pediatric intensive care unit (PICU) and is associated with high mortality and devastating survivor morbidity. Genome-wide expression patterns can provide molecular granularity of the host response and offer insight into why large variations in outcomes exist. We derived whole-blood genome-wide expression patterns within 24 h of PICU admission from children with septic shock. We compared the transcriptome between septic shock developmental-age groups defined as neonates (≤28 d, n = 17), infants (1 month to 1 year, n = 62), toddlers (2-5 years, n = 54) and schoolage (≥6 years, n = 47) and age-matched controls. Direct intergroup comparisons demonstrated profound changes in neonates, relative to older children. Neonates with septic shock demonstrated reduced expression of genes representing key pathways of innate and adaptive immunity. In contrast to the largely upregulated transcriptome in all other groups, neonates exhibited a predominantly downregulated transcriptome when compared with controls. Neonates and school-age subjects had the most uniquely regulated genes relative to controls. Age-specific studies of the host response are necessary to identify developmentally relevant translational opportunities that may lead to improved sepsis outcomes.

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Section: Discussionmentioning

confidence: 99%

The Influence of Developmental Age on the Early Transcriptomic Response of Children with Septic Shock

Wynn

Cvijanovich²,

Allen

et al. 2011

Mol Med

123

109

View full text Add to dashboard Cite

show abstract

“…They conclude unmistakable: "Therapy with intravenous immune globulin had no effect on the outcomes of suspected or proven neonatal sepsis". This statement is supported by a number of former and a recent invitro study [5] and a review [6] providing reasons for failure of IVIg due to inhibited immune system components by IVIg. However, IVIg are constituted in sepsis therapy of the adult [7,8] and in preventing infections in primary immunodeficiencies with lack of IgG.…”

mentioning

confidence: 66%

IVIG in Neonatal Sepsis: Alea iacta est?

Umlauf

Gille²,

Orlikowsky³

2012

J Neonatal Biol

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“…Multiple explanations address the limited efficacy of IVIG for the prevention or treatment of neonatal sepsis [44]. Some are based in limitations in study design such as varied inclusion criteria, heterogeneity in dosing, variation in pathogens, the low levels of antibodies to neonate-specific pathogens in IVIG, and use of non-enriched IgM products.…”

Section: Unique Nature Of Neonatal Immunitymentioning

confidence: 98%

Impact of Immunoglobulin Therapy in Pediatric Disease: a Review of Immune Mechanisms

Wong

White

2015

Clinic Rev Allerg Immunol

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Intravenous immunoglobulin (IVIG) provides replacement therapy in immunodeficiency and immunomodulatory therapy in inflammatory and autoimmune diseases. This paper describes the immune mechanisms underlying six major non-primary immunodeficiency pediatric diseases and the diverse immunomodulatory functions of IVIG therapy. In Kawasaki disease, IVIG plays a major, proven, and effective role in decreasing aneurysm formation, which represents an aberrant inflammatory response to an infectious trigger in a genetically predisposed individual. In immune thrombocytopenia, IVIG targets the underlying increased platelet destruction and decreased platelet production. Although theoretically promising, IVIG shows no clear clinical benefit in the prophylaxis and treatment of neonatal sepsis. Limitations in research design combined with the unique neonatal immunologic environment offer explanations for this finding. Inflammation from aberrant immune activation underlies the myelinotoxic effects of Guillain-Barré syndrome. HIV-1 exerts a broad range of immunologic effects and was found to decrease serious bacterial infections in the pre-highly active anti-retroviral therapy (HAART) era, although its practical relevance in the post-HAART era has waned. Clinical and experimental data support the role of immune mechanisms in the pathogenesis of childhood epilepsy. IVIG exerts anti-epileptic effects through targeting upregulated cytokine pathways and antibodies thought to contribute to epilepsy. Applications in six additional pediatric diseases including pediatric asthma, atopic dermatitis, cystic fibrosis, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS), autism, and transplantation will also be briefly reviewed. From autoimmunity to immunodeficiency, a dynamic immunologic basis underlies major pediatric diseases and highlights the broad potential of IVIG therapy.

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Does IVIg administration yield improved immune function in very premature neonates?

Cited by 27 publications

References 72 publications

The Influence of Developmental Age on the Early Transcriptomic Response of Children with Septic Shock

The Influence of Developmental Age on the Early Transcriptomic Response of Children with Septic Shock

IVIG in Neonatal Sepsis: Alea iacta est?

Impact of Immunoglobulin Therapy in Pediatric Disease: a Review of Immune Mechanisms

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