Potential Use of Intravenous Immune Globulin for Group B Streptococcal Infection

Baker, Carol J.; Noya, Francisco

doi:10.1093/clinids/12.supplement_4.s476

Cited by 18 publications

(8 citation statements)

References 15 publications

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“…However, meta-analyses of IVIG for treating cases of suspected or proven neonatal sepsis have revealed conflicting results, although these studies did not specifically target GBS sepsis (2627). Moreover, several studies have revealed that, compared to IVIG preparations from adults who were immunized with GBS (hyperimmune IVIG), standard IVIG preparations contain only modest levels of antibodies to GBS (28), exhibit dose- and preparation-dependent variations in their in vitro opsonophagocytosis, and are significantly less protective in experimental infection models. Baker et al (29) have reviewed the studies regarding IVIG in human neonates and reported inconclusive findings, which were related to the small numbers of included infants, the lack of suitable controls, the use of a clinical definition for sepsis (vs. a strict microbiological definition), and single-center study designs.…”

Section: Discussionmentioning

confidence: 99%

Opsonophagocytic Antibodies to Serotype Ia, Ib, and III Group BStreptococcusamong Korean Infants and in Intravenous Immunoglobulin Products

et al. 2017

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Group B streptococcus (GBS) infection is a leading cause of sepsis and meningitis among infants, and is associated with high rates of morbidity and mortality in many countries. Protection against GBS typically involves antibody-mediated opsonization by phagocytes and complement components. The present study evaluated serotype-specific functional antibodies to GBS among Korean infants and in intravenous immunoglobulin (IVIG) products. An opsonophagocytic killing assay (OPA) was used to calculate the opsonization indices (OIs) of functional antibodies to serotypes Ia, Ib, and III in 19 IVIG products from 5 international manufacturers and among 98 Korean infants (age: 0–11 months). The GBS Ia, Ib, and III serotypes were selected because they are included in a trivalent GBS vaccine formulation that is being developed. The OI values for the IVIG products were 635–5,706 (serotype Ia), 488–1,421 (serotype Ib), and 962–3,315 (serotype III), and none of the IVIG lots exhibited undetectable OI values (< 4). The geometric mean OI values were similar for all 3 serotypes when we compared the Korean manufacturers. The seropositive rate among infants was significantly lower for serotype Ia (18.4%), compared to serotype Ib and serotype III (both, 38.8%). Infant age of ≥ 3 months was positively correlated with the seropositive rates for each serotype. Therefore, only a limited proportion of infants exhibited protective immunity against serotype Ia, Ib, and III GBS infections. IVIG products that exhibit high antibody titers may be a useful therapeutic or preventive measure for infants. Further studies are needed to evaluate additional serotypes and age groups.

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Section: Discussionmentioning

confidence: 99%

Opsonophagocytic Antibodies to Serotype Ia, Ib, and III Group BStreptococcusamong Korean Infants and in Intravenous Immunoglobulin Products

et al. 2017

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“…The serum factors necessary for optimal phagocytosis also include the immunoglobulins and complement components [15]. Different studies have demonstrated that IVIG preparations containing intact IgG lead to increased opsonophagocytosis [7][8][9][10][11][12]. Binding of leukocytic receptors to Fc-expressing particles initiates phagocytosis and also stimulates the release of L-arginine products [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

“…Prophylactic and therapeutic use of IVIG preparations containing intact IgG lead to increased opsonophagocytosis in vivo and in vitro [8][9][10][11][12], and this response may cause the release of toxic oxygen and L-arginine products [13][14][15]. Nitric oxide (NO) is a product of L-arginine, which is a potent endogenous vasodilator normally produced in the endothelium from L-arginine by a metabolic pathway that requires enzymes called NO synthases [16,17].…”

Section: Introductionmentioning

confidence: 99%

Urinary Nitrite Excretion after Prophylactic Intravenous Immunoglobulin in Premature Infants

Özkan¹,

Uzuner²,

Ören³

et al. 2000

Neonatology

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Aims: To investigate the correlation between the prophylactic administration of intravenous immunoglobulin (IVIG) to preterm infants and urinary nitrite levels, which can be utilized as an index of endogenous nitric oxide (NO) formation, and to determine if NO formation plays a role in both therapeutic and adverse effects of IVIG. Methods: 28 healthy preterm infants were included in this prospective study. They had a mean gestational age of 29.4 ± 2.2 weeks and weight of 1,387 ± 371 g. Prophylactic IVIG infusion at a dose of 0.5 g/kg/day was administered when they were 3–10 days old. Urine samples of the neonates were obtained for analysis on days 1, 2 and 3 after IVIG administration as well as 1 day before. Urinary nitrite levels obtained in the subjects were normalized for urinary creatinine concentrations. Results: The mean urinary nitrite levels were: 2.77 ± 1.66 μmol/mmol creatinine before IVIG administration; 4.33 ± 3.88 μmol/mmol creatinine on the 1st day of IVIG; 3.77 ± 2.73 μmol/mmol creatinine on the 2nd day, and 3.64 ± 3.28 μmol/mmol creatinine on the 3rd day. There was a significant increase in urinary nitrite levels between before and after IVIG administration. There was no statistical difference in urinary nitrate levels between days 1, 2 and 3 after IVIG administration. Conclusion: We demonstrated that urinary nitrite excretion is significantly elevated in preterm infants after prophylactic IVIG administration and this result suggests that endogenous NO formation may play an important role in both the therapeutic and adverse effects of IVIG.

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“…Human immunoglobulin modified for intravenous use could provide specific antibodies to enhance opsonization and phagocytosis of GBS [587][588][589][590][591][592][593]. IVIG has been shown in experimental models [594] and septic neonates [595] to improve complement activation and chemotaxis by neonatal sera and to hasten resolution of neutropenia.…”

Section: Adjunctive Therapiesmentioning

confidence: 99%

“…Administration of sufficient human type-specific antibodies against CPS to animals before lethal challenge with GBS of the homologous serotype is protective [350,[587][588][589][590][591]. Despite this sound theoretical rationale, commercial preparations of IVIG contain relatively low concentrations of antibodies to group B streptococcal polysaccharides [590][591][592][593][595][596][597][598][599][600], suggesting that prohibitively large doses would be required and raising concern for reticuloendothelial blockade [589,592]. In addition, functional activity of licensed IVIG preparations can vary by manufacturer and lot [588,589,[595][596][597][598][599][600][601], and any increase in antibodies after infusion would be transient only [596,602].…”

Section: Adjunctive Therapiesmentioning

confidence: 99%

Group B Streptococcal Infections

Edwards¹,

Nizet²,

Baker³

2011

Infectious Diseases of the Fetus and Newborn

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118

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Potential Use of Intravenous Immune Globulin for Group B Streptococcal Infection

Cited by 18 publications

References 15 publications

Opsonophagocytic Antibodies to Serotype Ia, Ib, and III Group BStreptococcusamong Korean Infants and in Intravenous Immunoglobulin Products

Opsonophagocytic Antibodies to Serotype Ia, Ib, and III Group BStreptococcusamong Korean Infants and in Intravenous Immunoglobulin Products

Urinary Nitrite Excretion after Prophylactic Intravenous Immunoglobulin in Premature Infants

Group B Streptococcal Infections

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