Intravenous immunoglobulin therapy for autoimmune diseases

Abstract

Therapeutic approaches for autoimmune diseases are primarily based on suppressive measures that down regulate an over productive immune system. The increasing availability of modern biological therapies has advanced the ability to target and to neutralize essential components of the immune response without experiencing the hazardous adverse effects caused by the traditional immunosuppressants. One of the noticeable examples of this approach is the increasing use of high-dose intravenous immunoglobulin (IVIg). IVIg mechanisms include modulating function of Fc receptors, interference with complement activation and cytokine network, provision of anti-idiotypic antibodies, regulation of cell growth, and effects on of T and B cells. In this review we gather existing information regarding IVIg mechanisms of action, clinical applications and its effects on various conditions.

Neutralization of mitogenic lectins by intravenous immunoglobulin (IVIg) prevents T cell activation: does IVIg really have a direct effect on T cells?

“…In the early 1980s, infusion of high doses of IVIg was shown to produce therapeutic effects in patients suffering from immune thrombocytopenia (ITP) by attenuating platelet clearance [1]. IVIg is now used commonly to treat a diversity of autoimmune and inflammatory diseases [2][3][4]. However, the mechanisms by which IVIg produces anti-inflammatory effects in such a diversity of diseases are still not well defined and require further investigation [5,6].…”

Therapeutic Effect of IVIG on Inflammatory Arthritis in Mice Is Dependent on the Fc Portion and Independent of Sialylation or Basophils

“…Although primary immunodeficiency represents a significant proportion of IVIG usage, the larger market share for IVIG is used for the treatment of patients with various chronic and acute autoimmune and inflammatory diseases (6). High-dose (1-2 g/kg body weight) IVIG is commonly used for the treatment of immune cytopenia, GuillainBarré syndrome, Kawasaki disease, chronic inflammatory demyelinating polyneuropathy, myasthenia gravis, and several other rare diseases (7)(8)(9)(10)(11). In addition to these accepted uses, several other indications are currently under exploration.…”

Intravenous Immunoglobulin Treatment in Humans Suppresses Dendritic Cell Function via Stimulation of IL-4 and IL-13 Production

“…ntravenous Ig (IVIg) is used for the treatment of several autoimmune and systemic inflammatory diseases caused by autoantibodies and/or derailment of the cellular immune system (1)(2)(3)(4)(5)(6)(7). Importantly, the anti-inflammatory effects of IVIg require treatment with high doses, which exceed those used for replacement therapy in immune deficiencies (3,(8)(9)(10).…”