1
|
Serum C3 complement levels predict prognosis and monitor disease activity in Guillain-Barré syndrome. J Neurol Sci 2023; 444:120512. [PMID: 36462224 DOI: 10.1016/j.jns.2022.120512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/27/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Biomarkers are needed to predict prognosis and disease activity in patients with Guillain-Barré syndrome (GBS). The complement system is a key player in the pathogenesis of GBS. This study aimed to assess the potential utility of serum complement proteins as novel biomarkers in GBS. METHODS We reviewed the medical records of 76 GBS patients with C3 and C4 measurements during hospitalization between 2010 and 2021. Clinical outcomes were correlated with baseline serum C3, C4, and seven additional predictors: four existing biomarkers (GM1, albumin, immunoglobulin G, neutrophil-lymphocyte ratio) and three clinical factors from the modified Erasmus GBS outcome score model. Five complement activation products (C3a, C4a, C5a, soluble C5b-9, factor Bb) were measured in 35 patients and were compared with C3 and C4 levels. Longitudinal changes in C3 and C4 levels were compared with the disease course in 12 patients. RESULTS Higher C3, but not C4, was associated with poorer outcomes: lower Medical Research Council sum scores (MRCSS), higher GBS disability score (GBSDS), longer hospitalization, and more frequent treatment-related fluctuations. Age, MRCSS at admission, and baseline serum C3 were significant independent indicators of 1- and 3-month GBSDS. We found that C3 was positively correlated with C3a (r = 0.32) and C5a (r = 0.37), which indicates an activated complement cascade with high C3. Longitudinal change of C3 coincided with clinical severity of the disease course. INTERPRETATION This study highlights the use of serum C3 as a novel mechanistic biomarker in GBS. Larger prospective studies are needed to validate our findings.
Collapse
|
2
|
Segú-Vergés C, Caño S, Calderón-Gómez E, Bartra H, Sardon T, Kaveri S, Terencio J. Systems biology and artificial intelligence analysis highlights the pleiotropic effect of IVIg therapy in autoimmune diseases with a predominant role on B cells and complement system. Front Immunol 2022; 13:901872. [PMID: 36248801 PMCID: PMC9563374 DOI: 10.3389/fimmu.2022.901872] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/31/2022] [Indexed: 11/26/2022] Open
Abstract
Intravenous immunoglobulin (IVIg) is used as treatment for several autoimmune and inflammatory conditions, but its specific mechanisms are not fully understood. Herein, we aimed to evaluate, using systems biology and artificial intelligence techniques, the differences in the pathophysiological pathways of autoimmune and inflammatory conditions that show diverse responses to IVIg treatment. We also intended to determine the targets of IVIg involved in the best treatment response of the evaluated diseases. Our selection and classification of diseases was based on a previously published systematic review, and we performed the disease characterization through manual curation of the literature. Furthermore, we undertook the mechanistic evaluation with artificial neural networks and pathway enrichment analyses. A set of 26 diseases was selected, classified, and compared. Our results indicated that diseases clearly benefiting from IVIg treatment were mainly characterized by deregulated processes in B cells and the complement system. Indeed, our results show that proteins related to B-cell and complement system pathways, which are targeted by IVIg, are involved in the clinical response. In addition, targets related to other immune processes may also play an important role in the IVIg response, supporting its wide range of actions through several mechanisms. Although B-cell responses and complement system have a key role in diseases benefiting from IVIg, protein targets involved in such processes are not necessarily the same in those diseases. Therefore, IVIg appeared to have a pleiotropic effect that may involve the collaborative participation of several proteins. This broad spectrum of targets and 'non-specificity' of IVIg could be key to its efficacy in very different diseases.
Collapse
Affiliation(s)
| | - Silvia Caño
- Grifols Innovation and New Technologies (GIANT) Ltd., Dublin, Ireland
| | | | - Helena Bartra
- Health Department, Anaxomics Biotech, Barcelona, Spain
| | - Teresa Sardon
- Health Department, Anaxomics Biotech, Barcelona, Spain
| | - Srini Kaveri
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, Sorbonne Université, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - José Terencio
- Grifols Innovation and New Technologies (GIANT) Ltd., Dublin, Ireland
| |
Collapse
|
3
|
Watanabe E, Ido N, Saito T, Kato H, Terashi H, Aizawa H. [Posterior reversible encephalopathy syndrome during intravenous immunoglobulin therapy in Guillain-Barré syndrome]. Rinsho Shinkeigaku 2021; 61:12-17. [PMID: 33328417 DOI: 10.5692/clinicalneurol.cn-001461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 63-year-old woman was diagnosed with Guillain-Barré syndrome (GBS), and intravenous immunoglobulin (IVIg) therapy was initiated. On the second day of IVIg therapy, she became less alert (JCS III-200) and had hyponatremia. Brain MRI showed vasogenic edema in bilateral occipital lobes, which disappeared afterwards. Her clinical course and MRI findings were consistent with those of posterior reversible encephalopathy syndrome (PRES). As a result of considering the timing of the onset of GBS and PRES and the degree of hyponatremia and hypertension in some documented patients, the cause of PRES onset in this case is considered to be IVIg therapy itself and IVIg therapy-induced hyponatremia.
Collapse
Affiliation(s)
- Eri Watanabe
- Department of Neurology, Tokyo Medical University
| | - Nobuhiro Ido
- Department of Neurology, Tokyo Medical University
| | - Tomoko Saito
- Department of Neurology, Tokyo Medical University
| | | | | | | |
Collapse
|
4
|
Perricone C, Triggianese P, Bursi R, Cafaro G, Bartoloni E, Chimenti MS, Gerli R, Perricone R. Intravenous Immunoglobulins at the Crossroad of Autoimmunity and Viral Infections. Microorganisms 2021; 9:microorganisms9010121. [PMID: 33430200 PMCID: PMC7825648 DOI: 10.3390/microorganisms9010121] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/24/2020] [Accepted: 01/05/2021] [Indexed: 02/06/2023] Open
Abstract
Intravenous immunoglobulins (IVIG) are blood preparations pooled from the plasma of donors that have been first employed as replacement therapy in immunodeficiency. IVIG interact at multiple levels with the different components of the immune system and exert their activity against infections. Passive immunotherapy includes convalescent plasma from subjects who have recovered from infection, hyperimmune globulin formulations with a high titer of neutralizing antibodies, and monoclonal antibodies (mAbs). IVIG are used for the prevention and treatment of several infections, especially in immunocompromised patients, or in case of a poorly responsive immune system. The evolution of IVIG from a source of passive immunity to a powerful immunomodulatory/anti-inflammatory agent results in extensive applications in autoimmune diseases. IVIG composition depends on the antibodies of the donor population and the alterations of protein structure due to the processing of plasma. The anti-viral and anti-inflammatory activity of IVIG has led us to think that they may represent a useful therapeutic tool even in COVID-19. The human origin of IVIG carries specific criticalities including risks of blood products, supply, and elevated costs. IVIG can be useful in critically ill patients, as well as early empirical treatment. To date, the need for further well-designed studies stating protocols and the efficacy/tolerability profile of IVIG and convalescent plasma in selected situations are awaited.
Collapse
Affiliation(s)
- Carlo Perricone
- Rheumatology, Department of Medicine, University of Perugia, 06129 Perugia, Italy; (C.P.); (R.B.); (G.C.); (E.B.); (R.G.)
| | - Paola Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome, 00133 Rome, Italy; (M.S.C.); (R.P.)
- Correspondence: ; Tel.: +39-062-090-4444; Fax: +39-062-090-3749
| | - Roberto Bursi
- Rheumatology, Department of Medicine, University of Perugia, 06129 Perugia, Italy; (C.P.); (R.B.); (G.C.); (E.B.); (R.G.)
| | - Giacomo Cafaro
- Rheumatology, Department of Medicine, University of Perugia, 06129 Perugia, Italy; (C.P.); (R.B.); (G.C.); (E.B.); (R.G.)
| | - Elena Bartoloni
- Rheumatology, Department of Medicine, University of Perugia, 06129 Perugia, Italy; (C.P.); (R.B.); (G.C.); (E.B.); (R.G.)
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome, 00133 Rome, Italy; (M.S.C.); (R.P.)
| | - Roberto Gerli
- Rheumatology, Department of Medicine, University of Perugia, 06129 Perugia, Italy; (C.P.); (R.B.); (G.C.); (E.B.); (R.G.)
| | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome, 00133 Rome, Italy; (M.S.C.); (R.P.)
| |
Collapse
|
5
|
Johnston I, Sarkar A, Hayes V, Koma GT, Arepally GM, Chen J, Chung DW, López JA, Cines DB, Rauova L, Poncz M. Recognition of PF4-VWF complexes by heparin-induced thrombocytopenia antibodies contributes to thrombus propagation. Blood 2020; 135:1270-1280. [PMID: 32077913 PMCID: PMC7146020 DOI: 10.1182/blood.2018881607] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/23/2020] [Indexed: 01/19/2023] Open
Abstract
Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder mediated by complexes between platelet factor 4 (PF4) and heparin or other polyanions, but the risk of thrombosis extends beyond exposure to heparin implicating other PF4 partners. We recently reported that peri-thrombus endothelium is targeted by HIT antibodies, but the binding site(s) has not been identified. We now show that PF4 binds at multiple discrete sites along the surface of extended strings of von Willebrand factor (VWF) released from the endothelium following photochemical injury in an endothelialized microfluidic system under flow. The HIT-like monoclonal antibody KKO and HIT patient antibodies recognize PF4-VWF complexes, promoting platelet adhesion and enlargement of thrombi within the microfluidic channels. Platelet adhesion to the PF4-VWF-HIT antibody complexes is inhibited by antibodies that block FcγRIIA or the glycoprotein Ib-IX complex on platelets. Disruption of PF4-VWF-HIT antibody complexes by drugs that prevent or block VWF oligomerization attenuate thrombus formation in a murine model of HIT. Together, these studies demonstrate assembly of HIT immune complexes along VWF strings released by injured endothelium that might propagate the risk of thrombosis in HIT. Disruption of PF4-VWF complex formation may provide a new therapeutic approach to HIT.
Collapse
Affiliation(s)
- Ian Johnston
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pharmacology and
| | - Amrita Sarkar
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Vincent Hayes
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA
- Departments of Pathology and Laboratory Medicine and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Gavin T Koma
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Dominic W Chung
- Bloodworks Northwest, Seattle, WA
- Departments of Medicine and Biochemistry, University of Washington, Seattle, WA; and
| | - José A López
- Bloodworks Northwest, Seattle, WA
- Departments of Medicine and Biochemistry, University of Washington, Seattle, WA; and
| | - Douglas B Cines
- Departments of Pathology and Laboratory Medicine and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lubica Rauova
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mortimer Poncz
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
6
|
Dimeric IgG complexes from IVIg are incapable of inducing in vitro neutrophil degranulation or complement activation. PLoS One 2018; 13:e0195729. [PMID: 29634774 PMCID: PMC5892932 DOI: 10.1371/journal.pone.0195729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/28/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose Intravenous immunoglobulin (IVIg) products contain various amounts of dimeric IgG complexes. Current insights into the possible biological activities of these dimers remain controversial, and both immunemodulating and immune-activating effects have been reported. Here, we analyzed the putative immune-activating effects of dimers isolated from IVIg. Methods Dimers isolated from IVIg were purified by high-performance size-exclusion chromatography (HP-SEC) and tested for the ability to induce neutrophil degranulation in vitro. Results Dimers isolated from IVIg were found to be incapable of inducing in vitro neutrophil degranulation or complement activation, even at concentrations exceeding those expected to be reached upon administration in patients. These results depend on the removal of artefactual activation by using 0.1 micron filtration and the use of poloxamer to prevent adsorption of IgG onto the solid phase. Conclusions The data suggest dimeric IgG found in IVIg may bind to Fc-receptors without causing activation.
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW To review the difficult syndrome of catastrophic antiphospholipid syndrome, emphasizing new developments in the diagnosis, pathogenesis and treatment. RECENT FINDINGS Few recent publications directly address pediatric catastrophic antiphospholipid syndrome (CAPS). Most articles are case reports or are data from adult and pediatric registries. The major factors contributing to most pediatric catastrophic antiphospholipid syndrome include infection and the presence of antiphospholipid antibodies, but complement activation also is important in creating diffuse thrombosis in the microcirculation. Treatment of the acute emergency requires anticoagulation, suppression of the hyperinflammatory state and elimination of the triggering infection. Inhibition of complement activation appears to improve outcome in limited studies, and suppression of antiphospholipid antibody formation may be important in long-term management. SUMMARY CAPS, an antibody-mediated diffuse thrombotic disease of microvasculature, is rare in childhood but has high mortality (33-50%). It requires prompt recognition and aggressive multimodality treatment, including anticoagulation, anti-inflammatory therapy and elimination of inciting infection and pathogenic autoantibodies.
Collapse
|
8
|
Zhou H, Olsen H, So E, Mérigeon E, Rybin D, Owens J, LaRosa G, Block DS, Strome SE, Zhang X. A fully recombinant human IgG1 Fc multimer (GL-2045) inhibits complement-mediated cytotoxicity and induces iC3b. Blood Adv 2017; 1:504-515. [PMID: 29296968 PMCID: PMC5728453 DOI: 10.1182/bloodadvances.2016001917] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/15/2017] [Indexed: 12/16/2022] Open
Abstract
GL-2045 is a recombinant human immunoglobulin G1 (IgG1)-based Fc multimer designed to recapitulate the anti-inflammatory activities of intravenous immunoglobulin (IVIG) on the innate and adaptive immune responses. We used functional in vitro studies to determine if GL-2045 could mimic the modulatory activity of IVIG on complement activation. GL-2045, at log-order lower concentrations than heat-aggregated IgG (HAGG) and IVIG, protected antibody-opsonized cells from complement-dependent cytotoxicity. These protective effects were completely mediated by the higher order multimer fractions of GL-2045 and were partially dependent upon sequestration of C1q. Exposure of serum to GL-2045 and, to a lesser extent, IVIG, resulted in high levels of C4a, limited levels of C3a, and no C5a. In contrast, HAGG induced high levels of C4a, C3a, and C5a. The means by which GL-2045 governed complement activation was dependent on its ability to augment the function of factor H, alone and in combination with factor I, to indirectly limit the alternative form of C3 convertase, with resultant increases in the anti-inflammatory molecule, the "inactive" form of C3b, called iC3b. Although IVIG, like GL-2045, potentiated factor H function, it also directly inhibited the alternative form of C3 convertase. Our findings help elucidate how IVIG, GL-2045, and HAGG regulate complement function. Furthermore, the capacity of GL-2045 to sequester C1q and augment factor H activity, in combination with its ability to generate activation-induced immunomodulatory complement split products, such as iC3b, make it a viable drug candidate for the treatment of diverse complement-mediated diseases.
Collapse
Affiliation(s)
- Hua Zhou
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD
| | | | - Edward So
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD
| | | | | | | | | | | | - Scott E Strome
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Xiaoyu Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
9
|
Triggianese P, Perricone C, Chimenti MS, De Carolis C, Perricone R. Innate Immune System at the Maternal-Fetal Interface: Mechanisms of Disease and Targets of Therapy in Pregnancy Syndromes. Am J Reprod Immunol 2016; 76:245-57. [PMID: 27108670 DOI: 10.1111/aji.12509] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 03/14/2016] [Indexed: 01/01/2023] Open
Abstract
The maternal-fetal interface is an immunologically unique site that allows the tolerance to the allogenic fetus and maintains host defense against possible pathogens. Balanced immune responses are required for the maintenance of successful pregnancy. It has been demonstrated that innate immune disturbances may be responsible for some adverse pregnancy outcomes such as preeclampsia (PE); hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome; intrauterine growth restriction (IUGR); and recurrent spontaneous abortion (RSA). Observational studies suggest that immunomodulatory treatments in pregnancy-specific complications may improve both the hematological/biochemical features in the mother and the perinatal outcomes. The following review will discuss how recent and relevant findings in the field of the innate immunity have advanced our understanding of the role of inflammation and innate immune system in the pathogenesis of pregnancy failure and will discuss the therapeutic outcomes of the existing studies and clinical trials in light of these new insights.
Collapse
Affiliation(s)
- Paola Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of 'Medicina dei Sistemi', University of Rome Tor Vergata, Rome, Italy
| | - Carlo Perricone
- Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy.
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of 'Medicina dei Sistemi', University of Rome Tor Vergata, Rome, Italy
| | - Caterina De Carolis
- Past Head of Obstetrics and Gynecology II, San Giovanni Addolorata Hospital, Rome, Italy
| | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of 'Medicina dei Sistemi', University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
10
|
Pulvirenti F, Granata G, Girelli G, Quinti I. Immunoglobulin-induced hemolysis, splenomegaly and inflammation in patients with antibody deficiencies. Expert Rev Clin Immunol 2016; 12:725-31. [PMID: 26854522 DOI: 10.1586/1744666x.2016.1151787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
IgG replacement for primary antibody deficiencies is a safe treatment administered to prevent recurrent infections and reduce mortality. Recently, several reports described acute hemolytic episodes following IgG administration due to a passive transfer of blood group alloantibodies, including anti-A, anti-B, as well as anti-Rh antibodies. Here, we reviewed and discussed the consequences of passively transferred RBCs antibodies. The chronic passive transfer of alloantibodies might also cause a subclinical condition due to a compensated extravascular chronic hemolysis with poorly understood consequences. This phenomenon might possibly represent an unrecognized cause of splenomegaly and might contribute to inflammation in patients with primary antibody deficiencies.
Collapse
Affiliation(s)
- Federica Pulvirenti
- a Centre for Primary Immune Deficiencies, Department of Molecular Medicine , Sapienza University of Rome , Rome , Italy
| | - Guido Granata
- a Centre for Primary Immune Deficiencies, Department of Molecular Medicine , Sapienza University of Rome , Rome , Italy
| | - Gabriella Girelli
- b Unit of Immunohematology and Transfusion Medicine , Sapienza University of Rome , Rome , Italy
| | - Isabella Quinti
- a Centre for Primary Immune Deficiencies, Department of Molecular Medicine , Sapienza University of Rome , Rome , Italy
| |
Collapse
|
11
|
Management of adverse events in the treatment of patients with immunoglobulin therapy: A review of evidence. Autoimmun Rev 2015; 15:71-81. [PMID: 26384525 DOI: 10.1016/j.autrev.2015.09.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/08/2015] [Indexed: 12/12/2022]
Abstract
Immunoglobulin (IG) therapy is actually used for a broad range of diseases including primary and secondary immunodeficiency disorders, and autoimmune diseases. This therapy is available for intravenous (IV) and subcutaneous (SC) administration. The efficacy of the IG therapy has been demonstrated in numerous studies and across different diseases. Generally, IG infusions are well tolerated; however some well-known adverse reactions, ranging from mild to severe, are associated with the therapy. The most common adverse reactions including headache, nausea, myalgia, fever, chills, chest discomfort, skin and anaphylactic reactions, could arise immediately during or after the infusion. Delayed events could be more severe and include migraine headaches, aseptic meningitis, haemolysis renal impairment and thrombotic events. This paper reviews all the potential adverse events related to IG therapy and establishes a comprehensive guideline for the management of these events. Moreover it resumes the opinions and clinical experience of expert endorsers on the utilization of the treatment. Published data were classified into levels of evidence and the strength of the recommendation was given for each intervention according to the GRADE system.
Collapse
|
12
|
Squaiella-Baptistão CC, Marcelino JR, Ribeiro da Cunha LE, Gutiérrez JM, Tambourgi DV. Anticomplementary activity of horse IgG and F(ab')2 antivenoms. Am J Trop Med Hyg 2014; 90:574-84. [PMID: 24445201 DOI: 10.4269/ajtmh.13-0591] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Envenomation by poisonous animals is a neglected condition according to the World Health Organization (WHO). Antivenoms are included in the WHO Essential Medicines List. It has been assumed that immunoglobulin G (IgG) antivenoms could activate the complement system through Fc and induce early adverse reactions (EARs). However, data in the literature indicate that F(ab')2 fragments can also activate the complement system. Herein, we show that several batches of IgG and F(ab')2 antivenoms from the Butantan, Vital Brazil, and Clodomiro Picado Institutes activated the complement classical pathway and induced the production of C3a; however, only those antivenoms from Clodomiro Picado generated C5a. Different protein profiles (IgG heavy chain, protein contaminants, and aggregates) were observed by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and Western blot analyses. Our results show that various antivenoms from different producers are able to activate the classical pathway of the complement system and generate anaphylatoxins, and these findings suggest that factors, such as composition, contaminant proteins, and aggregates, may influence the anticomplementary activity of antivenoms in vitro. Therefore, there is a need to further improve antivenom production methods to reduce their anticomplementary activity and potential to cause EARs.
Collapse
Affiliation(s)
- Carla Cristina Squaiella-Baptistão
- Laboratório de Imunoquímica, Instituto Butantan, São Paulo, SP, Brazil; Seção de Processamento de Plasmas Hiperimunes, Instituto Butantan, São Paulo, Brazil; Instituto Vital Brazil, Niterói, Brazil; Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | | | | | | | | |
Collapse
|
13
|
Darnige L, Lillo-Le Louët A. [Treatments with immunoglobulin and thrombotic adverse events]. Rev Med Interne 2013; 35:39-44. [PMID: 24011913 DOI: 10.1016/j.revmed.2013.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/24/2013] [Accepted: 07/20/2013] [Indexed: 02/06/2023]
Abstract
Treatments with intravenous or subcutaneous immunoglobulin (Ig) are used in a broad variety of disorders. Tolerance of Ig is usually good but adverse events, including some serious ones, have been reported and may differ among different Ig preparations. Thrombotic complications occur in 0.6 to 13% of cases and can involve arterial or venous circulation, rarely both. Deep venous thrombosis with or without pulmonary embolism, stroke or myocardial infarction remained the most frequent thrombotic complications. Some risk factors have been identified, mainly old age, multiple cardiovascular risk factors, and past history of thrombo-embolic manifestations. Several mechanisms are suggested to explain this increased risk of thrombotic complications. Indeed, Ig treatments increase the plasma viscosity, increase and activate platelets, can trigger the coagulation cascade through the presence of activated factor XI in some Ig preparations, and release vasoactive molecules responsible for vasospasm. Patients have to be carefully monitored and risk factors to be identified as soon as possible. The role of antiplatelets or anticoagulation is not well determined but should probably be proposed to patients with high risk.
Collapse
Affiliation(s)
- L Darnige
- Service d'hématologie biologique, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75908 Paris cedex 15, France.
| | - A Lillo-Le Louët
- Centre régional de pharmacovigilance, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75908 Paris cedex 15, France
| |
Collapse
|
14
|
Wu YW, Champagne J, Toueille M, Gantier R, Burnouf T. Dedicated removal of immunoglobulin (Ig)A, IgM, and Factor (F)XI/activated FXI from human plasma IgG. Transfusion 2013; 54:169-78. [DOI: 10.1111/trf.12243] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 03/30/2013] [Accepted: 03/30/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Yu-Wen Wu
- Institute of Medical Biomaterials and Tissue Engineering, College of Oral Medicine; Taipei Medical University; Taipei Taiwan
- Research and Development, Chromatography Applications; Pall Life Sciences; Cergy France
- Pall Life Sciences; Northborough Massachusetts
- Human Protein Process Sciences (HPPS); Lille France
| | - Jérôme Champagne
- Institute of Medical Biomaterials and Tissue Engineering, College of Oral Medicine; Taipei Medical University; Taipei Taiwan
- Research and Development, Chromatography Applications; Pall Life Sciences; Cergy France
- Pall Life Sciences; Northborough Massachusetts
- Human Protein Process Sciences (HPPS); Lille France
| | - Magali Toueille
- Institute of Medical Biomaterials and Tissue Engineering, College of Oral Medicine; Taipei Medical University; Taipei Taiwan
- Research and Development, Chromatography Applications; Pall Life Sciences; Cergy France
- Pall Life Sciences; Northborough Massachusetts
- Human Protein Process Sciences (HPPS); Lille France
| | - René Gantier
- Institute of Medical Biomaterials and Tissue Engineering, College of Oral Medicine; Taipei Medical University; Taipei Taiwan
- Research and Development, Chromatography Applications; Pall Life Sciences; Cergy France
- Pall Life Sciences; Northborough Massachusetts
- Human Protein Process Sciences (HPPS); Lille France
| | - Thierry Burnouf
- Institute of Medical Biomaterials and Tissue Engineering, College of Oral Medicine; Taipei Medical University; Taipei Taiwan
- Research and Development, Chromatography Applications; Pall Life Sciences; Cergy France
- Pall Life Sciences; Northborough Massachusetts
- Human Protein Process Sciences (HPPS); Lille France
| |
Collapse
|
15
|
Ballanti E, Perricone C, Greco E, Ballanti M, Di Muzio G, Chimenti MS, Perricone R. Complement and autoimmunity. Immunol Res 2013; 56:477-91. [DOI: 10.1007/s12026-013-8422-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
16
|
Al-Riyami AZ, Lee J, Connolly M, Shereck E. Cerebral sinus thrombosis following IV immunoglobulin therapy of immune thrombocytopenia purpura. Pediatr Blood Cancer 2011; 57:157-9. [PMID: 21445949 DOI: 10.1002/pbc.22968] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 11/15/2010] [Indexed: 01/29/2023]
Abstract
We present a pediatric patient treated with high dose intravenous immunoglobulin (IVIG) for acute immune thrombocytopenic purpura (ITP), who developed cerebral sinus thrombosis in the absence of any identifiable hypercoagulable state. This report describes the successful management of this rare complication in this challenging setting. This report shows IVIG induced cerebral sinus thrombosis in ITP.
Collapse
Affiliation(s)
- Arwa Z Al-Riyami
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | |
Collapse
|
17
|
The Role of Intravenous Immunoglobulins in the Management of Acute Complex Autoimmune Conditions. Autoimmune Dis 2011. [DOI: 10.1007/978-0-85729-358-9_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
18
|
Dodel R, Neff F, Noelker C, Pul R, Du Y, Bacher M, Oertel W. Intravenous Immunoglobulins as a Treatment for Alzheimerʼs Disease. Drugs 2010; 70:513-28. [DOI: 10.2165/11533070-000000000-00000] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
19
|
Imbach P, Lazarus AH, Kühne T. Intravenous immunoglobulins induce potentially synergistic immunomodulations in autoimmune disorders. Vox Sang 2009; 98:385-94. [PMID: 19821958 DOI: 10.1111/j.1423-0410.2009.01264.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The increase in platelets in patients with immune thrombocytopenia (ITP) by intravenous administration of human immunoglobulin concentrates (IVIG) reflects a therapeutic immunomodulatory intervention targeted at the disturbed immune response in many inflammatory and autoimmune disorders. These immunoglobulin concentrates contain large numbers of antibodies as well as trace levels of various other immunologically active molecules. Clinical and laboratory studies have documented various mechanisms of action of IVIG. The complex network of immunological reactions resulting from the infusion of IVIG includes changes in several cytokines, interactions with dendritic cells, T- and B- lymphocyte effects, macrophage effects, mediated by distinct Fc-gamma receptors. In addition, effects on complement components and apoptosis have also been observed. Synergism between the different elements of the immune response characterizes the beneficial effects of IVIG in inflammatory and autoimmune disorders. They have immunopathogeneses and clinical manifestations which are difficult to define and therefore IVIG treatment indications remain heterogeneous. Dose finding studies are missing for most of the indications of the drug. In future research, defining the appropriate subgroups of patients should be undertaken. This may be accomplished by prospective registries collecting data on large numbers of patients with long-term follow-up. Controlled clinical and laboratory studies may follow based on new, validated patient selection criteria and focused on mechanisms of action, leading to more evidence-based indications.
Collapse
Affiliation(s)
- P Imbach
- Pediatric Hematology-Oncology, University Children's Hospital, Medical Faculty of University of Basel, Basel, Switzerland.
| | | | | |
Collapse
|
20
|
Arnson Y, Shoenfeld Y, Amital H. Intravenous immunoglobulin therapy for autoimmune diseases. Autoimmunity 2009; 42:553-60. [DOI: 10.1080/08916930902785363] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
21
|
Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossettias G. Recommendations for the use of albumin and immunoglobulins. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2009; 7:216-34. [PMID: 19657486 PMCID: PMC2719274 DOI: 10.2450/2009.0094-09] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Giancarlo Maria Liumbruno
- UU.OO.CC. di Immunoematologia e Medicina Trasfusionale e Patologia Clinica, Ospedale San Giovanni Calibita Fatebenefratelli, Roma, Italy.
| | | | | | | | | |
Collapse
|
22
|
Saland JM, Shneider BL, Bromberg JS, Shi PA, Ward SC, Magid MS, Benchimol C, Seikaly MG, Emre SH, Bresin E, Remuzzi G. Successful split liver-kidney transplant for factor H associated hemolytic uremic syndrome. Clin J Am Soc Nephrol 2008; 4:201-6. [PMID: 19005013 DOI: 10.2215/cjn.02170508] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES A male infant with a family history of thrombotic microangiopathy developed atypical hemolytic uremic syndrome (aHUS). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Case report. RESULTS Genetic analysis demonstrated a heterozygous mutation (S1191L) of CFH, the gene coding complement factor H (CFH). The child suffered many episodes of HUS, each treated with plasma exchange. In time, despite initiation of a prophylactic regimen of plasma exchange, his renal function declined significantly. At the age of 4 yr he received a (split liver) combined liver-kidney transplant (LKT) with preoperative plasma exchange and enoxaparin anticoagulation. Initial function of both grafts was excellent and is maintained for nearly 2 yr. CONCLUSIONS This report adds to the small but growing number of individuals in whom LKT has provided a favorable outcome for aHUS associated with CFH mutation, expands the technique of using a split liver graft, and describes the unique histologic features of subclinical liver disease in HUS.
Collapse
Affiliation(s)
- Jeffrey M Saland
- Department of Pediatrics, The Mount Sinai Medical Center, One Gustave L Levy Place, New York, NY 10029, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
The Mechanisms of Action of Intravenous Immunoglobulin and Polyclonal Anti-D Immunoglobulin in the Amelioration of Immune Thrombocytopenic Purpura: What Do We Really Know? Transfus Med Rev 2008; 22:103-16. [DOI: 10.1016/j.tmrv.2007.12.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
24
|
Davé S, Hagan J. Myocardial infarction during intravenous immunoglobulin infusion in a 65-year-old man with common variable immunodeficiency and subsequent successful repeated administration. Ann Allergy Asthma Immunol 2008; 99:567-70. [PMID: 18219840 DOI: 10.1016/s1081-1206(10)60388-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intravenous immunoglobulin (IVIG) may cause thromboembolic events. Although such events are usually associated with large IVIG doses administered to treat neurologic diseases, thromboembolic events may also occur with standard immunodeficiency doses. OBJECTIVE We describe a 65-year-old man with common variable immunodeficiency (CVID) who experienced angina and myocardial infarction with IVIG infusion. METHODS The patient's electronic medical record was reviewed. RESULTS The patient developed substernal chest pain during a scheduled 40-g (400-mg/kg) infusion. The infusion was discontinued, and a cardiac evaluation was initiated. The patient was found to have elevated troponin T and creatine kinase MB levels, signifying cardiac injury. Heart catheterization revealed severe vessel disease, and surgical revascularization was subsequently performed. Three weeks after revascularization, an IVIG dose of 200 mg/kg was cautiously readministered. This dose was increased in 2 weeks to 300 mg/kg, which was tolerated every 3 to 4 weeks without any adverse thrombotic events in the subsequent 12 months. CONCLUSIONS This case demonstrates not only angina and myocardial infarction associated with IVIG infusion in a patient with CVID but also the successful reinitiation of IVIG infusion after surgical revascularization. This case also underscores the importance of caution with IVIG infusion in patients with CVIDand known coronary artery disease.
Collapse
Affiliation(s)
- Shoban Davé
- Division of Allergic Diseases, Department of Medicine. Mayo Clinic, Rochester, Minnesota 55905, USA.
| | | |
Collapse
|
25
|
Abstract
Intravenous immunoglobulin (IVIg) has been found to have a multitude of uses. However, IVIg is a pooled blood product and as a result a limited resource. At replacement doses (200-400 mg/kg/month) it is of critical utility in the treatment of primary and secondary antibody deficiencies. High-dose immunoglobulin (hdIVIg) given at doses of up to 2 g/kg/day has immunomodulatory action mediated via a number of different effects. First used in the 1980s for the treatment of idiopathic thrombocytopenic purpura, hdIVIg has found uses in a wide range of autoimmune conditions, though for many conditions the evidence base lacks formal randomized controlled trials (RCTs). This article will detail the issues regarding the manufacture and clinical aspects of administration of hdIVIg and its uses, especially with regards to the treatment of autoimmune disease.
Collapse
Affiliation(s)
- Tariq El-Shanawany
- Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff CF14 4XW, Wales, U.K.
| | | |
Collapse
|
26
|
Sibéril S, Elluru S, Graff-Dubois S, Negi VS, Delignat S, Mouthon L, Lacroix-Desmazes S, Kazatchkine MD, Bayry J, Bayary J, Kaveri SV. Intravenous Immunoglobulins in Autoimmune and Inflammatory Diseases: A Mechanistic Perspective. Ann N Y Acad Sci 2007; 1110:497-506. [PMID: 17911465 DOI: 10.1196/annals.1423.052] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Initially used for the treatment of immunodeficiencies, intravenous immunoglobulins (IVIg) have increasingly been used as immunomodulatory agents in autoimmune and inflammatory disorders. The mode of action of IVIg is enigmatic, probably involving Fc-dependent and/or F(ab')2-dependent nonexclusive mechanisms of action. IVIg broadly interacts with the different components of the immune system: cytokines, complement, Fc receptors, and several cell surface immunocompetent molecules. IVIg has also an impact on effector functions of immune cells. These mechanisms of action of IVIg reflect the importance of natural antibodies in the maintenance of immune homeostasis. We discuss here the recent advances in the understanding of immunoregulatory effects of IVIg, and we pointed out the need for new strategies to overcome the predicted increasing worldwide shortage of IVIg.
Collapse
Affiliation(s)
- Sophie Sibéril
- INSERM UMRS 872, Université René Descartes (Paris-5), Université Pierre et Marie Curie (UPMC Paris-6) 75006 Paris, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Sibéril S, Elluru S, Negi VS, Ephrem A, Misra N, Delignat S, Bayary J, Lacroix-Desmazes S, Kazatchkine MD, Kaveri SV. Intravenous immunoglobulin in autoimmune and inflammatory diseases: More than mere transfer of antibodies. Transfus Apher Sci 2007; 37:103-7. [PMID: 17765663 DOI: 10.1016/j.transci.2007.01.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 01/07/2007] [Indexed: 01/21/2023]
Abstract
Initially used for the treatment of immunodeficiencies, intravenous immunoglobulin (IVIg) has increasingly been used as an immunomodulatory agent in immune thrombocytopenic purpura, autoimmune neuropathies, systemic lupus erythematosus, myasthenia gravis, Guillain-Barré syndrome, and Kawasaki disease. Although IVIg benefits have been reported in many autoimmune and systemic inflammatory diseases, its mechanisms of immunomodulation are not fully understood and probably involve Fc-dependent and/or F(ab')(2)-dependent mutually non-exclusive effects. These mechanisms of action of IVIg reflect the importance of natural antibodies in the maintenance of immune homeostasis. We discuss here the recent advances in the understanding of immunoregulatory effects of IVIg.
Collapse
Affiliation(s)
- Sophie Sibéril
- Centre de Recherche des Cordeliers, Equipe 16- Immunopathology and therapeutic immunointervention, Université Pierre et Marie Curie Paris 6, UMR S 872, 15 rue de l'Ecole de Médicine, Paris, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Graff-Dubois S, Sibéril S, Elluru S, Negi VS, Delignat S, Mouthon L, Lacroix-Desmazes S, Kazatchkine MD, Bayary J, Kaveri SV. Utilisation des immunoglobulines polyclonales intraveineuses dans les pathologies auto-immunes et inflammatoires. Transfus Clin Biol 2007; 14:63-8. [PMID: 17498995 DOI: 10.1016/j.tracli.2007.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Initially used for the treatment of immunodeficiencies, intravenous immunoglobulins (IVIg) have increasingly been used as immunomodulatory agent in autoimmune and inflammatory disorders. The mode of action of IVIg is enigmatic, probably involving Fc-dependent and/or F(ab')2-dependent non-exclusive mechanisms of action. IVIg broadly interacts with the different components of the immune system: cytokines, complement, Fc receptors and several cell surface immunocompetent molecules. IVIg also has an impact on effector functions of immune cells. These mechanisms of action of IVIg reflect the importance of natural antibodies in the maintenance of immune homeostasis. We discuss here the recent advances in the understanding of immunoregulatory effects of IVIg, and we pointed out the need of new strategies to overcome the predicted increasing worldwide shortage of IVIg.
Collapse
Affiliation(s)
- Stéphanie Graff-Dubois
- INSERM U 872, université René-Descartes (Paris-5), université Pierre-et-Marie-Curie (UPMC Paris-6) et équipe 16 (immunopathologie et immunointervention thérapeutique), centre de recherche des Cordeliers, 15 rue de l'Ecole-de-Médecine, 75006 Paris, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Negi VS, Elluru S, Sibéril S, Graff-Dubois S, Mouthon L, Kazatchkine MD, Lacroix-Desmazes S, Bayry J, Kaveri SV. Intravenous immunoglobulin: an update on the clinical use and mechanisms of action. J Clin Immunol 2007; 27:233-45. [PMID: 17351760 DOI: 10.1007/s10875-007-9088-9] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Accepted: 02/21/2007] [Indexed: 01/27/2023]
Abstract
Initially used as a replacement therapy for immunodeficiency diseases, intravenous immunoglobulin (IVIg) is now widely used for a number of autoimmune and inflammatory diseases. Considerable progress has been made in understanding the mechanisms by which IVIg exerts immunomodulatory effects in autoimmune and inflammatory disorders. The mechanisms of action of IVIg are complex, involving modulation of expression and function of Fc receptors, interference with activation of complement and the cytokine network and of idiotype network, regulation of cell growth, and effects on the activation, differentiation, and effector functions of dendritic cells, and T and B cells.
Collapse
Affiliation(s)
- Vir-Singh Negi
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
León G, Rodríguez MA, Rucavado A, Lomonte B, Gutiérrez JM. Anti-human erythrocyte antibodies in horse-derived antivenoms used in the treatment of snakebite envenomations. Biologicals 2007; 35:5-11. [PMID: 16490363 DOI: 10.1016/j.biologicals.2005.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Revised: 11/28/2005] [Accepted: 11/30/2005] [Indexed: 11/17/2022] Open
Abstract
This work examined the presence of antibodies reacting with human erythrocytes in horse-derived antivenoms used in the treatment of snakebite envenomations, and assessed the efficacy of various fractionation protocols in the elimination of agglutinating antibodies. A number of antivenoms produced by various fractionation protocols were tested for direct agglutination of human erythrocytes. Reactions were observed visually and microscopically, and an indirect anti-equine globulin test was also used. In addition, rabbits and mice were injected intravenously with antivenoms to observe possible intravascular hemolysis and erythrocyte sequestration. All tested antivenoms agglutinated human erythrocytes, albeit to different extent, and also gave a positive anti-globulin test. Agglutination was due to IgG(T) subclass of antibodies. Pepsin digestion of horse IgG, to obtain F(ab')(2) fragments, reduced the direct agglutination, but not the indirect anti-globulin test. Ion-exchange chromatography of IgG in a strongly basic quaternary ammonium cellulose membrane abrogated direct agglutination and reduced the indirect anti-globulin test. Binding of antivenom antibodies to erythrocytes in vivo was demonstrated in rabbits, although there was no evidence of intravascular hemolysis or erythrocyte sequestration in rabbits and mice. It is concluded that anti-human erythrocyte antibodies are present in horse-derived antivenoms, and that fractionation of horse plasma by pepsin digestion, and especially by anion-exchange chromatography, reduces the titer of these antibodies. Our in vivo experimental results do not support a role for these antibodies in early adverse reactions occurring after antivenom administration.
Collapse
Affiliation(s)
- Guillermo León
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | | | | | | | | |
Collapse
|
31
|
Coghill J, Comeau T, Shea T, Braddy L, Bandarenko N, Afenyi-Annan A, Harvey D. Acute hemolysis in a patient with cytomegalovirus pneumonitis treated with intravenous immunoglobulin (IVIG). Biol Blood Marrow Transplant 2006; 12:786-8. [PMID: 16785068 DOI: 10.1016/j.bbmt.2006.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Accepted: 03/07/2006] [Indexed: 10/24/2022]
|
32
|
Bayry J, Bayary J, Dasgupta S, Misra N, Ephrem A, Duong Van Huyen JP, Delignat S, Hassan G, Caligiuri G, Nicoletti A, Lacroix-Desmazes S, Kazatchkine MD, Kaveri S. Intravenous immunoglobulin in autoimmune disorders: An insight into the immunoregulatory mechanisms. Int Immunopharmacol 2006; 6:528-34. [PMID: 16504915 DOI: 10.1016/j.intimp.2005.11.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Intravenous immunoglobulin (IGIV) has increasingly been used for the treatment of autoimmune and systemic inflammatory diseases in addition to supportive therapy of immunodeficient patients. IGIV is beneficial in several diseases, including acute and chronic/relapsing diseases, autoimmune diseases and inflammatory disorders. Therapeutic efficacy of IGIV has also been established in a number of dermatologic diseases. Although a considerable progress has been made in understanding the mechanisms by which IGIV exerts immunomodulatory functions in autoimmune diseases, they remain not fully elucidated. The mode of action of IGIV is complex, involving modulation of expression and function of Fc receptors, interference with activation of complement and the cytokine network, modulation of idiotype network, regulation of cell growth, alteration of cellular adhesion process, and effects on the activation differentiation and effector functions of T and B cells and of antigen-presenting cells. The therapeutic effects of IGIV most likely reflect the functions of natural antibodies in maintaining immune homeostasis in healthy people. The ability of IGIV to interact through V regions with complementary V regions of antibodies and antigen receptors as well as with relevant soluble and surface molecules provides the basis for inducing the selection of immune repertoires. Since IGIV is frequently used to treat autoimmune and inflammatory diseases for which evidence of its efficacy is insufficiently documented, controlled trials, particularly of some neurologic and dermatologic diseases, are imperative.
Collapse
Affiliation(s)
- Jagadeesh Bayry
- INSERM, U681, Université Pierre et Marie Curie (UPMC-Paris 6), France
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Ghielmetti M, Bellis M, Spycher MO, Miescher S, Vergères G. Gene expression profiling of the effects of intravenous immunoglobulin in human whole blood. Mol Immunol 2006; 43:939-49. [PMID: 16045989 DOI: 10.1016/j.molimm.2005.06.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2005] [Indexed: 12/31/2022]
Abstract
Intravenous immunoglobulin (IVIG) is involved in many complex mechanisms that act in synergy including expression and function of Fc receptors, complement activation, the cytokine network, interaction with the anti-idiotypic network and modulation of B and T cell activation. To gain insight into the early effects of IVIG on this broad range of activities at the gene level we performed DNA microarray analysis. Human whole blood was incubated in vitro for 4 h followed by extraction of RNA which was hybridized to a chip containing 8793 genes. About 75 upregulated genes and 21 downregulated genes were identified using a cut off for the false discovery rate of 5%. These genes are associated with a wide range of cellular immune functions in line with the broad mechanism of action of IVIG. A striking upregulation of a series of genes coding for chemokines was measured. This finding was confirmed at the protein level as pharmacologically relevant concentrations of CXCL9 and CXCL10 were measured in serum. Interestingly, IVIG shows a partial overlap of its gene expression program with lipopolysaccharide. Our data suggests multiple hypotheses regarding the pharmacology of IVIG that must be validated by complementary studies.
Collapse
|
34
|
Perricone R, Di Muzio G, Perricone C, Giacomelli R, De Nardo D, Fontana L, De Carolis C. High Levels of Peripheral Blood NK Cells in Women Suffering from Recurrent Spontaneous Abortion are Reverted from High-Dose Intravenous Immunoglobulins. Am J Reprod Immunol 2006; 55:232-9. [PMID: 16451358 DOI: 10.1111/j.1600-0897.2005.00356.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PROBLEM To determine the levels of peripheral blood natural killer (NK) cells in healthy women and recurrent aborters, and the effect of intravenous immunoglobulins (IVIGs) on these levels. METHOD OF STUDY A total of 659 women were evaluated for NK cells by means of flow cytofluorimetry: 42 non-pregnant healthy women, 394 non-pregnant recurrent spontaneous abortion (RSA) women, 36 pregnant healthy women and 187 pregnant RSA women. Fifty-four of the pregnant RSA women were treated with IVIG; in 18 of them NK cells were measured immediately before and after the very first IVIG infusion (0.5 g/kg body weight). RESULTS Blood NK cell results were increased in RSA pregnant/non-pregnant women, and significantly reduced by IVIG, even after the very first infusion. In RSA pregnant women treated by means of IVIG therapy, 92.3% success rate was observed. CONCLUSIONS High levels of NK cells are detected in women affected by RSA. IVIGs are capable of decreasing them with a short- and long-term efficacy, allowing having a very high success rate of pregnancies in RSA women.
Collapse
Affiliation(s)
- Roberto Perricone
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy.
| | | | | | | | | | | | | |
Collapse
|
35
|
Persson L, Borén J, Nicoletti A, Hansson GK, Pekna M. Immunoglobulin treatment reduces atherosclerosis in apolipoprotein E-/- low-density lipoprotein receptor-/- mice via the complement system. Clin Exp Immunol 2006; 142:441-5. [PMID: 16297155 PMCID: PMC1809548 DOI: 10.1111/j.1365-2249.2005.02954.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Atherosclerosis is associated with activation of the immune system. Intravenously applied normal polyclonal immunoglobulins (IVIg) have broad therapeutic applications in the treatment of autoimmune and systemic inflammatory diseases. Recently, IVIg have been shown to inhibit atherogenesis in experimental animal models. To investigate the role of the complement system in this process, we used third complement component-deficient (C3(-/-)) and control atherosclerosis-prone apolipoprotein E (ApoE) and low-density lipoprotein receptor (LDLR) double knock-out mice fed a normal diet. IVIg treatment reduced lesion fraction area in the aortic root of complement-sufficient mice whereas the lesion fraction area of C3(-/-) mice was not affected. Thus, complement activation plays a role in the anti-atherosclerotic effects of IVIg, possibly by C3-derived fragments generated through Fc-dependent complement activation.
Collapse
Affiliation(s)
- L Persson
- Department of Medical Biochemistry, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
| | | | | | | | | |
Collapse
|
36
|
Affiliation(s)
- S Jolles
- Department of Clinical Immunology, Royal Free Hospital London, UK.
| | | | | |
Collapse
|
37
|
Misra N, Bayry J, Ephrem A, Dasgupta S, Delignat S, Duong Van Huyen JP, Prost F, Lacroix-Desmazes S, Nicoletti A, Kazatchkine MD, Kaveri SV. Intravenous immunoglobulin in neurological disorders: a mechanistic perspective. J Neurol 2005; 252 Suppl 1:I1-6. [PMID: 15959666 DOI: 10.1007/s00415-005-1102-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Intravenous immunoglobulin (IVIg) has been used in the treatment of primary and secondary antibody deficiencies for over 25 years. It is a safe preparation with no long-term side effects. IVIg was first demonstrated to be effective in autoimmune disorders, two decades ago, in the treatment of acute immune thrombocytopenia. Since then, the therapeutic efficacy of IVIg has been established in Guillain Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), myasthenia gravis (MG), dermatomyositis (DM), Kawasaki syndrome and the prevention of graft-versus-host disease in recipients of allogeneic bone marrow transplants and reported in a large number of other autoimmune and systemic inflammatory conditions.
Collapse
Affiliation(s)
- Namita Misra
- INSERM U681, Université Pierre et Marie Curie Institut des Cordeliers, 15 rue de l'Ecole de Médecine, Paris, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Alexandrescu DT, Dutcher JP, Hughes JT, Kaplan J, Wiernik PH. Strokes after intravenous gamma globulin: thrombotic phenomenon in patients with risk factors or just coincidence? Am J Hematol 2005; 78:216-20. [PMID: 15726606 DOI: 10.1002/ajh.20287] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report the case of an 82-year-old woman with a diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) for more than 10 years, who developed an ischemic stroke during infusion of immunoglobulin (IVIG). She had received IVIG intermittently for several years, and the previous 86 doses were well tolerated. Thromboembolism was suspected based on magnetic resonance angiogram and on further extension of the deficit after 4 days of evolution. Strokes were associated with the use of IVIG in different clinical circumstances. Pre-existing thrombogenic risk factors should be carefully considered for patients undergoing treatment with IVIG. Clinical evaluation, with attention to history, a focused vascular work-up, and looking for markers of dehydration, can identify the high-risk patient for whom a careful analysis of the risk/benefit ratio is warranted.
Collapse
Affiliation(s)
- Doru T Alexandrescu
- Comprehensive Cancer Center, New York Medical College, Our Lady of Mercy Medical Center, Bronx, New York 10466, USA.
| | | | | | | | | |
Collapse
|
39
|
Siragam V, Brinc D, Crow AR, Song S, Freedman J, Lazarus AH. Can antibodies with specificity for soluble antigens mimic the therapeutic effects of intravenous IgG in the treatment of autoimmune disease? J Clin Invest 2005; 115:155-60. [PMID: 15630455 PMCID: PMC539200 DOI: 10.1172/jci22753] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2004] [Accepted: 11/02/2004] [Indexed: 12/21/2022] Open
Abstract
Intravenous Ig (IVIg) mediates protection from the effects of immune thrombocytopenic purpura (ITP) as well as numerous other autoimmune states; however, the active antibodies within IVIg are unknown. There is some evidence that antibodies specific for a cell-associated antigen on erythrocytes are responsible, at least in part, for the therapeutic effect of IVIg in ITP. Yet whether an IVIg directed to a soluble antigen can likewise be beneficial in ITP or other autoimmune diseases is also unknown. A murine model of ITP was used to determine the effectiveness of IgG specific to soluble antigens in treating immune thrombocytopenic purpura. Mice experimentally treated with soluble OVA + anti-OVA versus mice treated with OVA conjugated to rbcs (OVA-rbcs) + anti-OVA were compared. In both situations, mice were protected from ITP. Both these experimental therapeutic regimes acted in a complement-independent fashion and both also blocked reticuloendothelial function. In contrast to OVA-rbcs + anti-OVA, soluble OVA + anti-OVA (as well as IVIg) did not have any effect on thrombocytopenia in mice lacking the inhibitory receptor FcgammaRIIB (FcgammaRIIB(-/-) mice). Similarly, antibodies reactive with the endogenous soluble antigens albumin and transferrin also ameliorated ITP in an FcgammaRIIB-dependent manner. Finally, broadening the significance of these experiments was the finding that anti-albumin was protective in a K/BxN serum-induced arthritis model. We conclude that IgG antibodies directed to soluble antigens ameliorated 2 disparate IVIg-treatable autoimmune diseases.
Collapse
MESH Headings
- Animals
- Antibodies/immunology
- Antibody Specificity
- Antigens/chemistry
- Antigens/immunology
- Antigens, CD/genetics
- Antigens, CD/immunology
- Antigens, CD/metabolism
- Arthritis/immunology
- Immunoglobulin G/administration & dosage
- Immunoglobulin G/immunology
- Immunoglobulin G/therapeutic use
- Immunoglobulins, Intravenous/immunology
- Immunoglobulins, Intravenous/therapeutic use
- Immunotherapy
- Inflammation/immunology
- Mice
- Mice, Knockout
- Ovalbumin/pharmacology
- Purpura, Thrombocytopenic, Idiopathic/chemically induced
- Purpura, Thrombocytopenic, Idiopathic/immunology
- Purpura, Thrombocytopenic, Idiopathic/therapy
- Receptors, IgG/deficiency
- Receptors, IgG/genetics
- Receptors, IgG/immunology
- Receptors, IgG/metabolism
- Solubility
Collapse
Affiliation(s)
- Vinayakumar Siragam
- Transfusion Medicine Research and the Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
40
|
Siragam V, Brinc D, Crow AR, Song S, Freedman J, Lazarus AH. Can antibodies with specificity for soluble antigens mimic the therapeutic effects of intravenous IgG in the treatment of autoimmune disease? J Clin Invest 2005. [DOI: 10.1172/jci200522753] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
41
|
León G, Lomonte B, Gutiérrez JM. Anticomplementary activity of equine whole IgG antivenoms: comparison of three fractionation protocols. Toxicon 2005; 45:123-8. [PMID: 15581691 DOI: 10.1016/j.toxicon.2004.07.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Accepted: 07/26/2004] [Indexed: 11/23/2022]
Abstract
Early adverse reactions occur in a number of patients treated with heterologous antivenoms and have been associated with anticomplementary activity (ACA). In order to reduce the ACA of equine whole IgG antivenoms produced by caprylic acid fractionation, three different fractionation protocols were compared: (a) routine caprylic acid fractionation; (b) caprylic acid fractionation followed by beta-propiolactone treatment; and (c) caprylic acid fractionation followed by ion-exchange chromatography using a quaternary ammonium membrane. The three protocols yielded products with similar physicochemical characteristics and anti-Bothrops asper venom antibody titers, except that ion-exchange purified antivenom had a lower protein concentration. Antivenoms fractionated by using beta-propiolactone or filtration through quaternary ammonium membrane had a significantly reduced in vitro ACA. A preparation of caprylic acid-fractionated antivenom was heated in order to induce the formation of protein aggregates; however, its ACA was similar to non-heated antivenom. None of the antivenoms affected the hemolytic activity of serum complement in rabbits after a bolus intravenous administration. It is concluded that (a) beta-propiolactone and quaternary ammonium membranes significantly reduce in vitro ACA of caprylic acid-fractionated equine antivenom, and (b) the validity of in vitro ACA as a predictor of EAR needs to be reexamined in clinical and experimental studies, since it may not adequately predict in vivo complement activation by antivenoms.
Collapse
Affiliation(s)
- Guillermo León
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | | | | |
Collapse
|
42
|
Walpen AJ, Laumonier T, Aebi C, Mohacsi PJ, Rieben R. Immunoglobulin M-enriched intravenous immunoglobulin inhibits classical pathway complement activation, but not bactericidal activity of human serum. Xenotransplantation 2004; 11:141-8. [PMID: 14962276 DOI: 10.1046/j.1399-3089.2003.00098.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Acute or even hyperacute humoral graft rejection, mediated by classical pathway complement activation, occurs in allo- and xenotransplantation due to preformed anti-graft antibodies. Intravenous immunoglobulin (IVIg) preparations can prevent complement-mediated tissue injury and delay hyperacute xenograft rejection. It is known that IgM-enriched IVIg (IVIgM) has a higher capacity to block complement than IVIgG. Different IVIgs were therefore tested for specificity of complement inhibition and effect on anti-bacterial activity of human serum. IVIgM-I (Pentaglobin), 12% IgM), IVIgM-II (IgM-fraction of IVIgM-I, 60% IgM), and three different IVIgG (all >95% IgG) were used. The known complement inhibitor dextran sulfate was used as control. Hemolytic assays were performed to analyze pathway-specificity of complement inhibition. Effects of IVIg on complement deposition on pig cells and Escherichia coli were assessed by flow cytometry and cytotoxicity as well as bactericidal assays. Complement inhibition by IVIgM was specific for the classical pathway, with IC50 values of 0.8 mg/ml for IVIgM-II and 1.7 mg/ml for IVIgM-I in the CH50 assay. Only minimal inhibition of the lectin pathway was seen with IVIgM-II (IC50 15.5 mg/ml); no alternative pathway inhibition was observed. IVIgG did not inhibit complement in any hemolytic assay. Classical pathway complement inhibition by IVIgM was confirmed in an in vitro xenotransplantation model with PK15 cells. In contrast, IVIgM did not inhibit (mainly alternative pathway mediated) killing of E. coli by human serum. In conclusion, IgM-enriched IVIg is a specific inhibitor of the classical complement pathway, leaving the alternative pathway intact, which is an important natural anti-bacterial defense, especially for immunosuppressed patients.
Collapse
|
43
|
Lhotta K, Würzner R, Rumpelt HJ, Eder P, Mayer G. Membranous nephropathy in a patient with hereditary complete complement C4 deficiency. Nephrol Dial Transplant 2004; 19:990-3. [PMID: 15031363 DOI: 10.1093/ndt/gfh008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Karl Lhotta
- Division of Clinical Nephrology, Department of Internal Medicine, Innsbruck University Hospital, Anichstrasse 35, A-6020 Innsbruck, Austria.
| | | | | | | | | |
Collapse
|
44
|
Lutz HU, Stammler P, Bianchi V, Trüeb RM, Hunziker T, Burger R, Jelezarova E, Späth PJ. Intravenously applied IgG stimulates complement attenuation in a complement-dependent autoimmune disease at the amplifying C3 convertase level. Blood 2004; 103:465-72. [PMID: 14512320 DOI: 10.1182/blood-2003-05-1530] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractIntravenously applied normal human immunoglobulin G (IgG) has anti-inflammatory effects in the treatment of autoimmune diseases. Systemic inflammation can originate from an overreacting amplification loop of the complement system. In blood, C3b2-containing complexes maintain complement amplification much better than the extremely short-lived C3b. Therefore, in patients with the complement-dependent autoimmune disease, dermatomyositis, we studied whether intravenously applied normal human IgG (IVIG) stimulated in vivo inactivation of these complexes. In the course of IVIG treatment, clinically effective in 6 of 8 patients, the concentration of C3b2-containing complexes dropped to 37% ± 14% (n = 6) of the pretreatment level when having infused 0.5 g IgG/kg body weight, increased marginally and in parallel to factor Bb thereafter until full-dose IgG was infused. By day 14 following infusion of 2 g IgG/kg body weight the concentration of C3b2-containing complexes was 66% ± 19%. The plasma concentration of C3 remained constant in myopathic or increased by 15% to 20% in amyopathic patients. In contrast to this, IVIG infusion was associated with consumption of up to 40% of plasma C4 at day 1 to 2 after completion of IVIG infusion. Thus, IVIG had an immediate and long-lasting attenuating effect on complement amplification in vivo, despite the fact that it induced classical complement pathway activation.
Collapse
Affiliation(s)
- Hans U Lutz
- Institute of Biochemistry, Swiss Federal Institute of Technology, ETH-Hönggerberg HPM D 14.1, CH 8093 Zurich, Switzerland.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Affiliation(s)
- Irina Knezevic-Maramica
- Division of Laboratory and Transfusion Medicine, Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA
| | | |
Collapse
|
46
|
Perricone R, De Carolis C, Giacomelli R, Guarino MD, De Sanctis G, Fontana L. GM-CSF and Pregnancy: Evidence of Significantly Reduced Blood Concentrations in Unexplained Recurrent Abortion Efficiently Reverted by Intravenous Immunoglobulin Treatment. Am J Reprod Immunol 2003; 50:232-7. [PMID: 14629028 DOI: 10.1034/j.1600-0897.2003.00083.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PROBLEM Certain Th-2 cytokines and granulocyte-macrophage colony-stimulating factor (GM-CSF) are propitious for the success of pregnancy and recurrent spontaneous abortion (RSA) is often characterized by a failure of Th-2 type responses. These considerations as well as the use of intravenous immunoglobulin (IVIg) in RSA induced us to evaluate the levels of GM-CSF in normal pregnancies, in pregnant women affected with unexplained RSA and the effects of IVIg treatment. METHOD OF STUDY Peripheral blood free GM-CSF was measured by means of a sandwich enzyme immunoassay in 39 healthy women (13 non-pregnant, 26 pregnant) and in 53 RSA patients (11 non-pregnant, 42 pregnant). In 14 pregnant RSA patients GM-CSF was studied also after the very first IVIg infusion (0.5 g/kg body weight). RESULTS In healthy women we found a significant increase of GM-CSF during pregnancy, in pregnant RSA patients such an increase was not detected. After IVIg, GM-CSF concentrations were almost doubled. CONCLUSIONS GM-CSF is found increased in normal pregnancy and is very low during pregnancy in RSA. IVIg infusions are capable of increasing GM-CSF in pregnant recurrent aborters.
Collapse
Affiliation(s)
- Roberto Perricone
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy.
| | | | | | | | | | | |
Collapse
|
47
|
Song S, Crow AR, Freedman J, Lazarus AH. Monoclonal IgG can ameliorate immune thrombocytopenia in a murine model of ITP: an alternative to IVIG. Blood 2003; 101:3708-13. [PMID: 12506021 DOI: 10.1182/blood-2002-10-3078] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Intravenous immunoglobulin (IVIG) is used to treat immune thrombocytopenia resulting from a variety of autoimmune and nonautoimmune diseases such as idiopathic thrombocytopenic purpura (ITP), heparin-induced thrombocytopenia, and posttransfusion purpura. IVIG is a limited resource and although considered safe, may nevertheless carry some risk of transferring disease. Its high cost makes monoclonal antibodies, capable of mimicking the clinical effects of IVIG, highly desirable. We show here, using a murine model of ITP, that selected monoclonal antibodies can protect against thrombocytopenia. SCID mice were pretreated with 1 of 21 monoclonal antibodies before induction of thrombocytopenia by antiplatelet antibody. Four antibodies reacted with the CD24 antigen on erythrocytes. Two antibodies were of the IgM class, and although one IgM antibody caused a minimal degree of anemia (P <.05), neither antibody ameliorated immune thrombocytopenia. One of 2 anti-CD24 antibodies of the IgG class ameliorated immune thrombocytopenia and blocked reticuloendothelial system function at the same doses that protected against thrombocytopenia. Some antibodies reactive with other circulating cell types also protected against immune-mediated thrombocytopenia while no antibody without a distinct target antigen in the mice was protective. Protective monoclonal antibodies significantly prevented thrombocytopenia at down to a 1000-fold lower dose (200 microg/kg) as compared with standard IVIG treatment (2 g/kg). It is concluded that monoclonal IgG with specificity for a circulating cellular target antigen may provide an alternative therapeutic approach to treating immune thrombocytopenia.
Collapse
MESH Headings
- Animals
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/therapeutic use
- Antibody Specificity
- Antigens, CD/immunology
- Autoimmune Diseases/prevention & control
- Autoimmune Diseases/therapy
- Blood Platelets/immunology
- CD24 Antigen
- Disease Models, Animal
- Drug Evaluation, Preclinical
- Erythrocytes/immunology
- Female
- Germ-Free Life
- Hyaluronan Receptors/immunology
- Immunoglobulin G/immunology
- Immunoglobulin G/therapeutic use
- Immunoglobulins, Intravenous/therapeutic use
- Isoantibodies/toxicity
- Membrane Glycoproteins
- Mice
- Mice, Inbred BALB C
- Mice, SCID
- Mononuclear Phagocyte System/drug effects
- Mononuclear Phagocyte System/immunology
- Purpura, Thrombocytopenic, Idiopathic/prevention & control
- Purpura, Thrombocytopenic, Idiopathic/therapy
- Receptors, IgG/immunology
Collapse
Affiliation(s)
- Seng Song
- Transfusion Medicine Research and the Department of Laboratory Medicine and Pathobiology, St Michael's Hospital, Toronto, ON, Canada
| | | | | | | |
Collapse
|
48
|
Abstract
IVIG is prepared from large pools of plasma from healthy donors and the IgG is present predominantly in monomeric form. It was first reported in 1981 by Dr. Paul Imbach that high doses of IVIG promote fast recovery of ITP in children. Despite extensive clinical use in a variety of autoimmune and inflammatory states, the mechanism of action of IVIG remains as yet incompletely understood. Several theories have been proposed to explain how administration of IVIG to individuals with ITP increases the platelet count. Following is an overview of some of the major theories.
Collapse
Affiliation(s)
- Alan H Lazarus
- Canadian Blood Services, and The Toronto Platelet Immunobiology Group, Toronto, Ontario, Canada.
| |
Collapse
|
49
|
Aukrust P, Gullestad L, Lappegård KT, Ueland T, Aass H, Wikeby L, Simonsen S, Frøland SS, Mollnes TE. Complement activation in patients with congestive heart failure: effect of high-dose intravenous immunoglobulin treatment. Circulation 2001; 104:1494-500. [PMID: 11571242 DOI: 10.1161/hc3801.096353] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Increasing evidence implicates innate immunity in the pathogenesis of congestive heart failure (CHF). In the present study, we examined the possible role of complement, an important part of innate immunity, in CHF. METHODS AND RESULTS Complement activation was analyzed in systemic and coronary circulation in 39 patients with CHF and 20 healthy control subjects. In a double-blind, placebo-controlled study, we have recently reported that high-dose intravenous immunoglobulin (IVIG) improves left ventricular ejection fraction (LVEF) in these patients. To examine if this improvement was related to IVIG-induced effects on complement, we also examined complement activation during induction (first week) and maintenance therapy (6 months) with IVIG or placebo. Our main findings were: (1) We found enhanced systemic complement activation involving classic, alternative, as well as terminal pathway in patients with CHF compared with healthy control subjects. (2) Particularly enhanced complement activation was found in coronary sinus, representing venous drainage from the heart. (3) The systemic complement activation was further enhanced during IVIG but not during placebo therapy, particularly during induction therapy. (4) Although IVIG improved LVEF in patients with CHF, the degree of IVIG-mediated complement activation was negatively correlated with this improvement of LVEF. CONCLUSIONS This study further supports the involvement of innate immunity in the pathogenesis of CHF. Our findings suggest that complement may be added to the list of possible therapeutic targets in CHF and that future studies with specific complement inhibitors may be of interest in this disorder.
Collapse
Affiliation(s)
- P Aukrust
- Section of Clinical Immunology and Infectious Diseases, Research Institute for Internal Medicine, Rikshospitalet, University of Oslo, Norway.
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
León G, Monge M, Rojas E, Lomonte B, Gutiérrez JM. Comparison between IgG and F(ab')(2) polyvalent antivenoms: neutralization of systemic effects induced by Bothrops asper venom in mice, extravasation to muscle tissue, and potential for induction of adverse reactions. Toxicon 2001; 39:793-801. [PMID: 11137538 DOI: 10.1016/s0041-0101(00)00209-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Whole IgG and F(ab')(2) equine-derived polyvalent (Crotalinae) antivenoms, prepared from the same batch of hyperimmune plasma, were compared in terms of neutralization of the lethal and defibrinating activities induced by Bothrops asper venom, their ability to reach the muscle tissue compartment in envenomated mice, and their potential for the induction of adverse reactions. Both preparations were adjusted to the same potency against the lethal effect of B. asper venom in experiments involving preincubation of venom and antivenom. Then, "rescue" experiments were performed, i.e. antivenom was administered either intravenously or intramuscularly at various times after envenomation. IgG and F(ab')(2) antivenoms were equally effective in the neutralization of lethality, both being more effective when administered i.v. than after i.m. injection. Neutralization decreased as the time lapse between envenomation and treatment increased. No significant differences were observed in the ability of antivenoms to neutralize defibrinating activity of B. asper venom in experiments involving independent injection of venom and antivenoms. There was a much higher accumulation of equine antibodies in muscle tissue that had been injected with B. asper venom than in non-envenomated tissue, indicating that venom-induced microvessel damage probably favors a prominent and similar extravasation of both IgG and F(ab')(2) antibodies. This may explain the similar effectiveness of both types of antivenom in previously reported studies on the neutralization of venom-induced local tissue damage. Both IgG and F(ab')(2) antivenoms activate human complement in vitro and induce an anti-equine immunoglobulin response in mice, indicating that Fc removal per se does not eliminate the potential for inducing adverse reactions. However, IgG antivenom had higher anticomplementary activity and induced a stronger anti-immunoglobulin response than F(ab')(2) antivenom.
Collapse
Affiliation(s)
- G León
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | | | | | | | | |
Collapse
|