Impact of intravenous infusions of low and high doses of gamma globulins (IVIG) on phagocytic functions in adults with primary humoral immunodeficiency

Abstract

Twelve adult patients with primary humoral immunodeficiency were treated for at least six months with IVIG 200 mg/kg/mo and then crossed over to a high dose of 600 mg/kg/mo. Polymorphonuclear and mononuclear cells of these patients were tested after the third infusion in the low-dose cycle and then after the third infusion in the high-dose cycle, each time a day before, four days after, and 14 days after intravenous infusion. Each time, patients' cells and normal cells were tested using normal sera and patients' sera. IVIG infusions led to a significant increase in the level of circulating IgG, which was much more prominent in the high-dose group. Phagocytosis, phagocytic index, intracellular bactericidal activity and chemotaxis of polymorphonuclear cells (PMNs) were at least as active as in healthy controls. Actually in both cycles patients' PMN's had slightly higher phagocytic activity than normal cells. Patients' serum in the high dose cycle supported chemotaxis better than normal serum. Efficient phagocytic activity was maintained throughout the cycle; however, it was more active (P < 0.0125) in the midcycle in the high-dose cycle. Superoxide generation was normal in all conditions. Monocytic function was also normal in all conditions tested. It may be concluded that as far as cellular phagocytic functions are concerned, the high dose of IVIG does not protect the host more efficiently than the low dose.

Modulatory Effects of Antibody Replacement Therapy to Innate and Adaptive Immune Cells

“…IVIg might modulate PMN activity by a saturating and an activating/inhibiting effect on PMN FcγRs (5). Almost 20 years ago, the first demonstration that IVIg administered at low dosages in patients affected by PAD did not alter neutrophils functions was published (6). Phagocytosis, intracellular bactericidal activity, and chemotaxis of PMN in PAD patients treated at very low dosages (IVIg 200 mg/kg/month) and at replacement dosages (IVIg 600 mg/kg/month) were comparable to those of healthy controls (6).…”

“…Almost 20 years ago, the first demonstration that IVIg administered at low dosages in patients affected by PAD did not alter neutrophils functions was published (6). Phagocytosis, intracellular bactericidal activity, and chemotaxis of PMN in PAD patients treated at very low dosages (IVIg 200 mg/kg/month) and at replacement dosages (IVIg 600 mg/kg/month) were comparable to those of healthy controls (6). We have recently confirmed these data showing that in CVID and XLA patients, PMN were capable in vivo to perform efficient migration, degranulation, phagocytosis, and oxidative burst at baseline and shortly after IVIg administration (7, 8).…”