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Stikeman E, Bianco D. Use of human intravenous immunoglobulin for the treatment of 12 dogs with newly diagnosed malignant disease and presumed secondary immune-mediated thrombocytopenia. J Small Anim Pract 2024; 65:338-345. [PMID: 38239177 DOI: 10.1111/jsap.13700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/14/2023] [Accepted: 12/18/2023] [Indexed: 04/25/2024]
Abstract
OBJECTIVES To evaluate the safety and efficacy of human intravenous immunoglobulin in dogs with newly diagnosed malignancy and presumed secondary immune-mediated thrombocytopenia. MATERIALS AND METHODS Twelve client-owned dogs with newly diagnosed malignant disease and presumed secondary immune-mediated thrombocytopenia were prospectively enrolled to receive a single infusion of human intravenous immunoglobulin at a dose of 0.5 to 1 mg/kg intravenous over 8 hours. A complete treatment response was defined as a platelet estimation of ≥40,000 platelets/μL within 24 hours and a partial response within 48 hours from the completion of human intravenous immunoglobulin infusion. No treatment response was defined as a platelet estimation remaining <40,000 platelets/μL over 48 hours from the completion of the human intravenous immunoglobulin infusion. This pilot study had a prospective, open-label, uncontrolled design. RESULTS Out of the 12 enrolled dogs, seven completed the study. A complete treatment response to human intravenous immunoglobulin was identified in one lymphoma dog and a partial response was noted in another lymphoma dog. The remaining 10 dogs had no response to human intravenous immunoglobulin. No clinically relevant adverse reactions to human intravenous immunoglobulin occurred in any of the 12 initially enrolled dogs during the infusion and over a 3-month follow-up period for the seven surviving dogs. CLINICAL SIGNIFICANCE The results of this study suggest that the use of human intravenous immunoglobulin in dogs with newly diagnosed malignant disease and presumed secondary immune-mediated thrombocytopenia appears safe, but not effective for the treatment of thrombocytopenia. Larger multi-centre, prospective, double-blinded, placebo-controlled, outcome-based, malignancy-specific studies are needed to further evaluate these preliminary findings.
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Affiliation(s)
- E Stikeman
- Internal Medicine Department, Metropolitan Animal Specialty Hospital, 6565 Santa Monica Boulevard, Los Angeles, CA, 90038, USA
| | - D Bianco
- Internal Medicine Department, Metropolitan Animal Specialty Hospital, 6565 Santa Monica Boulevard, Los Angeles, CA, 90038, USA
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2
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Shrimant B, Kulkarni T, Hasan M, Arnold C, Khan N, Mondal AN, Arges CG. Desalting Plasma Protein Solutions by Membrane Capacitive Deionization. ACS APPLIED MATERIALS & INTERFACES 2024; 16:11206-11216. [PMID: 38391265 DOI: 10.1021/acsami.3c16691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Plasma protein therapies are used by millions of people across the globe to treat a litany of diseases and serious medical conditions. One challenge in the manufacture of plasma protein therapies is the removal of salt ions (e.g., sodium, phosphate, and chloride) from the protein solution. The conventional approach to remove salt ions is the use of diafiltration membranes (e.g., tangential flow filtration) and ion-exchange chromatography. However, the ion-exchange resins within the chromatographic column as well as filtration membranes are subject to fouling by the plasma protein. In this work, we investigate the membrane capacitive deionization (MCDI) as an alternative separation platform for removing ions from plasma protein solutions with negligible protein loss. MCDI has been previously deployed for brackish water desalination, nutrient recovery, mineral recovery, and removal of pollutants from water. However, this is the first time this technique has been applied for removing 28% of ions (sodium, chloride, and phosphate) from human serum albumin solutions with less than 3% protein loss from the process stream. Furthermore, the MCDI experiments utilized highly conductive poly(phenylene alkylene)-based ion exchange membranes (IEMs). These IEMs combined with ionomer-coated nylon meshes in the spacer channel ameliorate Ohmic resistances in MCDI improving the energy efficiency. Overall, we envision MCDI as an effective separation platform in biopharmaceutical manufacturing for deionizing plasma protein solutions and other pharmaceutical formulations without a loss of active pharmaceutical ingredients.
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Affiliation(s)
- Bharat Shrimant
- Department of Chemical Engineering, Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Tanmay Kulkarni
- Department of Chemical Engineering, Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Mahmudul Hasan
- Department of Chemical Engineering, Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | | | | | | | - Christopher G Arges
- Department of Chemical Engineering, Pennsylvania State University, University Park, Pennsylvania 16802, United States
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3
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Esmaeilzadeh H, Askarisarvestani A, Hosseini N, Samimi S, Shafiei A, Mahdaviani SA, Eslami N, Chavoshzadeh Z, Fallahi M, Khakbazanfard N, Shabestari MS, Aleyasin S, Nabavizadeh SH, Cheraghi T, Kalantari A, Ahmadiafshar A, Safari M, Eslamian MH, Molatefi R, Shirkani A, Heidarzadeh Arani M, Tavakol M, Bemanian MH, Arshi S, Nabavi M, Shokri S, Shahhosseini B, Mortazavi N, Nakhaei P, Nazari F, Fallahpour M, Ahanchian H, Moazzen N, Khoshkhui M, Motlagh AV, Aghamohammadi A, Abolhassani H, Yazdani R, Rezaei N. Adverse reactions in a large cohort of patients with inborn errors of immunity receiving intravenous immunoglobulin. Clin Immunol 2021; 230:108826. [PMID: 34418548 DOI: 10.1016/j.clim.2021.108826] [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: 05/18/2021] [Revised: 08/07/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Intravenous immunoglobulins (IVIg) are the major treatment in inborn errors of immunity (IEI) disorders; However, IVIg infusions show some adverse effects. We aimed to assess the adverse reactions of IVIg infusions. METHODS Data of IVIg infusions in IEI patients were collected from 2011 to 2021. Totally, 363 IEI patients received IVIg regularly in Iran entered the study. The adverse reactions are classified regarding their severity and chronicity. RESULTS 22,667 IVIg infusions were performed in the study. 157 patients (43.2%) and 1349 (5.9%) infusions were associated with at least one type of adverse reaction. The highest rates of adverse reactions were seen in severe combined immunodeficiency. Myalgia, chills, headache, fever, and hypotension were the most frequent adverse effects of IVIg. CONCLUSION The reactions affect almost half of the patients mainly in the first infusions which necessitate the close observation of IEI patients receiving IVIg.
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Affiliation(s)
- Hossein Esmaeilzadeh
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Division of Allergy and Clinical Immunology, Pediatrics Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Askarisarvestani
- Division of Allergy and Clinical Immunology, Pediatrics Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazanin Hosseini
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Samimi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Alireza Shafiei
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Alireza Mahdaviani
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narges Eslami
- Allergy and Clinical immunology Dept, Mofid Children Hospital, , Shahid Beheshti University of Medical Sciences, Tehran, , Iran
| | - Zahra Chavoshzadeh
- Allergy and Clinical immunology Dept, Mofid Children Hospital, , Shahid Beheshti University of Medical Sciences, Tehran, , Iran
| | - Mazdak Fallahi
- Allergy and Clinical immunology Dept, Mofid Children Hospital, , Shahid Beheshti University of Medical Sciences, Tehran, , Iran
| | - Nasrin Khakbazanfard
- Allergy and Clinical immunology Dept, Mofid Children Hospital, , Shahid Beheshti University of Medical Sciences, Tehran, , Iran
| | | | - Soheila Aleyasin
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Division of Allergy and Clinical Immunology, Pediatrics Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Hesamedin Nabavizadeh
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Division of Allergy and Clinical Immunology, Pediatrics Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Taher Cheraghi
- Department of Pediatrics, 17th Shahrivar Children's Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Arash Kalantari
- Department of Immunology and Allergy, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mojgan Safari
- Department of Pediatrics, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Rasol Molatefi
- Department of Pediatrics, Bo-Ali children's Hospital of Ardabil University of Medical Sciences, Ardabil, Iran
| | - Afshin Shirkani
- Allergy and Clinical Immunology Department, Bushehr University of Medical Science, School of Medicine, Bushehr, Iran
| | | | - Marzieh Tavakol
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammad Hassan Bemanian
- Department of Allergy and Clinical Immunology, Rasool e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Saba Arshi
- Department of Allergy and Clinical Immunology, Rasool e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Nabavi
- Department of Allergy and Clinical Immunology, Rasool e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sima Shokri
- Department of Allergy and Clinical Immunology, Rasool e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Shahhosseini
- Division of Allergy and Clinical Immunology, Pediatrics Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Negar Mortazavi
- Department of Clinical Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pooria Nakhaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Nazari
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Morteza Fallahpour
- Department of Allergy and Clinical Immunology, Rasool e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Ahanchian
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasrin Moazzen
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Khoshkhui
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmad Vosughi Motlagh
- Department of Pediatrics, North Khorasan University of Medical Sciences, Bojnurd. Iran
| | - Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Hassan Abolhassani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Division of Clinical Immunology, Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden; Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden; Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Reza Yazdani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
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4
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Erkan D. Expert Perspective: Management of Microvascular and Catastrophic Antiphospholipid Syndrome. Arthritis Rheumatol 2021; 73:1780-1790. [PMID: 34114366 DOI: 10.1002/art.41891] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/01/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Doruk Erkan
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
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5
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Sánchez-Herrero A, Nieto-Benito L, Rosell-Díaz A, Pulido-Pérez A. False-Positive Serology for Hepatitis B After Intravenous Immunoglobulin Therapy for Toxic Epidermal Necrolysis. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2019.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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6
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Spurlock N, Prittie J. Use of Human Intravenous Immunoglobulin in Veterinary Clinical Practice. Vet Clin North Am Small Anim Pract 2021; 50:1371-1383. [PMID: 32896436 DOI: 10.1016/j.cvsm.2020.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Therapy with human intravenous immunoglobulin (hIVIG) as an immunomodulator in veterinary patients results in effective but transient immunosuppression, and may be viable as part of a multidrug strategy against immune-mediated thrombocytopenia and autoimmune cutaneous disease. Efficacy of hIVIG against other veterinary autoimmune diseases is questionable. Veterinary patients tolerate hIVIG therapy well, with few infusion reactions documented. Veterinary clinical trials of hIVIG are limited, and more work is needed to determine the true efficacy and risk of hIVIG administration in companion animals.
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Affiliation(s)
- Nicole Spurlock
- Animal Specialty Emergency Center, 1535 South Sepulveda, Los Angeles, CA 90025, USA.
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7
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Kaplan A. Preparation, Storage, and Characteristics of Whole Blood, Blood Components, and Plasma Derivatives. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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8
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Saab W, Seshadri S, Huang C, Alsubki L, Sung N, Kwak-Kim J. A systemic review of intravenous immunoglobulin G treatment in women with recurrent implantation failures and recurrent pregnancy losses. Am J Reprod Immunol 2021; 85:e13395. [PMID: 33511656 DOI: 10.1111/aji.13395] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 11/28/2022] Open
Abstract
Over the last few decades, the advancement in reproductive technologies and protocols to improve embryo quality through culture techniques and genetic testing to eliminate chromosomally abnormal embryos resulted in better pregnancy rates and outcomes after fertility treatments. Unfortunately, some patients still struggle with recurrent implantation failures (RIFs) and recurrent pregnancy losses (RPLs). Immune etiologies have been attributed to play an important role in some of those patients. Maintaining a pre-conceptional anti-inflammatory environment for implantation and pregnancy continuation yields superior results. Intravenous immunoglobulin G (IVIG) treatment has been reported to enhance reproductive outcome in patients with RIF and RPL with immune dysregulations. In this systemic review, we analyzed outcomes of IVIG trials for RIF and RPL, its mechanism of action, dosing, administration, side-effects, and evidence for its use in women with RIF and RPL.
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Affiliation(s)
- Wael Saab
- Assisted Conception unit, The Centre for Reproductive and Genetic Health, London, UK
| | - Srividya Seshadri
- Assisted Conception unit, The Centre for Reproductive and Genetic Health, London, UK
| | - Changsheng Huang
- Reproductive Medicine and Immunology, Obstetrics and Gynecology, Clinical Sciences Department, Chicago Medical School, Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA.,Department of Traditional Chinese Medicine Rheumatology, Shenzhen Nanshan People's Hospital and The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Lujain Alsubki
- Reproductive Medicine and Immunology, Obstetrics and Gynecology, Clinical Sciences Department, Chicago Medical School, Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA.,Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Nayoung Sung
- Reproductive Medicine and Immunology, Obstetrics and Gynecology, Clinical Sciences Department, Chicago Medical School, Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA
| | - Joanne Kwak-Kim
- Reproductive Medicine and Immunology, Obstetrics and Gynecology, Clinical Sciences Department, Chicago Medical School, Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA
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9
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False-Positive Serology for Hepatitis B After Intravenous Immunoglobulin Therapy for Toxic Epidermal Necrolysis. ACTAS DERMO-SIFILIOGRAFICAS 2020; 112:476-477. [PMID: 33220309 DOI: 10.1016/j.ad.2019.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/01/2019] [Accepted: 10/04/2019] [Indexed: 11/22/2022] Open
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10
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Borilova Linhartova P, Gachova D, Lipovy B. Responsiveness to i.v. immunoglobulin therapy in patients with toxic epidermal necrolysis: A novel pharmaco-immunogenetic concept. J Dermatol 2020; 47:1236-1248. [PMID: 32935409 DOI: 10.1111/1346-8138.15583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 12/15/2022]
Abstract
Toxic epidermal necrolysis (TEN) represents a rare drug-induced autoimmune reaction with delayed-type hypersensitivity that initiates the process of developing massive keratinocyte apoptosis, dominantly in the dermoepidermal junction. Although the etiopathophysiology has not yet been fully elucidated, the binding of Fas ligand (FasL, CD95L) to the Fas receptor (CD95) was shown to play a key role in the induction of apoptosis in this syndrome. The knowledge of the role of immunoglobulin G (IgG) in inhibition of Fas-mediated apoptosis contributed to the introduction of i.v. Ig (IVIg) in the therapy of TEN patients. Despite great enthusiasm for this therapy at the end of the 1990s, subsequent studies in various populations and meta-analyses could not unequivocally confirm the efficacy of the IVIg-based treatment concept. Today, therefore, we are faced with the dilemmas of how to adjust therapy of TEN patients most effectively, which patients could benefit from IVIg therapy and what dose of the preparation should be administrated. The ground-breaking question is: do the host genetic profiles influence the responsiveness and side-effects of IVIg therapy in TEN patients? Based on recent pharmacological, immunological and genetic findings, we suggest that the variability of IVIg therapy outcomes in TEN patients may be related to functional variants in Fas, FasL and Fc-γ receptor genes. This novel concept could lead to improved quality of care for patients with TEN, facilitating personalized therapy to reduce mortality.
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Affiliation(s)
- Petra Borilova Linhartova
- Institute of Medical Genetics, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Clinic of Stomatology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Molecular Pharmacy, Faculty of Pharmacy, Masaryk University, Brno, Czech Republic.,Clinic of Maxillofacial Surgery, Institution shared with University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Daniela Gachova
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Bretislav Lipovy
- Department of Burns and Plastic Surgery, Institution shared with University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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11
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Yazdanbakhsh K, Zhong H. IVIg and hemolytic anemia risk: dump the anti-A/B already! Transfusion 2020; 60:1337-1339. [PMID: 32681818 DOI: 10.1111/trf.15939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 06/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Karina Yazdanbakhsh
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| | - Hui Zhong
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
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12
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Abbas A, Rajabally YA. Complications of Immunoglobulin Therapy and Implications for Treatment of Inflammatory Neuropathy: A Review. Curr Drug Saf 2019; 14:3-13. [PMID: 30332974 DOI: 10.2174/1574886313666181017121139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Intravenous Immunoglobulin (IVIg) forms a cornerstone of effective treatment for acute and chronic inflammatory neuropathies, with a class I evidence base in Guillain-Barré Syndrome (GBS), Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and multifocal motor neuropathy (MMN). It is generally considered to be a safe therapy however there are several recognised complications which are reviewed in this article. DISCUSSION AND CONCLUSION Most adverse events are immediate and mild such as headache, fever and nausea although more serious immediate reactions such as anaphylaxis may rarely occur. Delayed complications are rare but may be serious, including thromboembolic events and acute kidney injury, and these and associated risk factors are also discussed. We emphasise the importance of safe IVIg administration and highlight practical measures to minimise complications of this therapy.
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Affiliation(s)
- Ahmed Abbas
- Department of Neurophysiology, Queen Elizabeth Hospital, University Hospital of Birmingham, Birmingham, United Kingdom
| | - Yusuf A Rajabally
- Department of Neurophysiology, Queen Elizabeth Hospital, University Hospital of Birmingham, Birmingham, United Kingdom.,Department of Neurology, Queen Elizabeth Hospital, University Hospital of Birmingham, Birmingham, United Kingdom.,Department of Aston Brain Centre, Aston University, Birmingham, United Kingdom
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13
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Long-Term Follow-Up after Intravenous Immunoglobulin Therapy in Patients with Severe Ocular Mucous Membrane Pemphigoid Unresponsive to Conventional Therapy. J Ophthalmol 2018; 2018:8372146. [PMID: 30327726 PMCID: PMC6169236 DOI: 10.1155/2018/8372146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/12/2018] [Indexed: 12/12/2022] Open
Abstract
Mucous membrane pemphigoid (MMP) is a heterogeneous group of rare, systemic, autoimmune subepidermal inflammatory disease that affects mucous membranes and the eye. In its most severe forms, this disease needs systemic therapy, usually based on steroids and immunosuppressant agents. In unresponsive cases or in the presence of contraindications or severe side effects due to conventional systemic corticosteroid and/or immunosuppressant therapy, a therapy shift to high-dose intravenous immunoglobulins (IVIg) has been recommended in other reports. This new therapy has proven to be effective in stopping ocular pemphigoid, but the data regarding the long-term effect on the disease activity or reactivation are extremely scarce, so the novel scientific aim of this study was to evaluate the clinical outcomes after a 9-year follow-up in 12 eyes (6 patients) affected by MMP with ocular involvement, successfully treated with IVIg therapy, as previously described in our report published in 2008. The evaluation of ocular and extraocular disease progression was performed at the end of IVIg therapy and at the end of the follow-up period. After 9 years, all the eyes enrolled showed a long-lasting remission of ocular and oral symptoms with a significant steroid-sparing effect. In conclusion, the IVIg has to be considered as a safe and successful alternative therapy in patients with severe ocular mucous membrane pemphigoid; furthermore, this kind of therapy seems to be effective in maintaining the clinical remission by the time.
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14
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Guo Y, Tian X, Wang X, Xiao Z. Adverse Effects of Immunoglobulin Therapy. Front Immunol 2018; 9:1299. [PMID: 29951056 PMCID: PMC6008653 DOI: 10.3389/fimmu.2018.01299] [Citation(s) in RCA: 186] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/24/2018] [Indexed: 01/09/2023] Open
Abstract
Immunoglobulin has been widely used in a variety of diseases, including primary and secondary immunodeficiency diseases, neuromuscular diseases, and Kawasaki disease. Although a large number of clinical trials have demonstrated that immunoglobulin is effective and well tolerated, various adverse effects have been reported. The majority of these events, such as flushing, headache, malaise, fever, chills, fatigue and lethargy, are transient and mild. However, some rare side effects, including renal impairment, thrombosis, arrhythmia, aseptic meningitis, hemolytic anemia, and transfusion-related acute lung injury (TRALI), are serious. These adverse effects are associated with specific immunoglobulin preparations and individual differences. Performing an early assessment of risk factors, infusing at a slow rate, premedicating, and switching from intravenous immunoglobulin (IVIG) to subcutaneous immunoglobulin (SCIG) can minimize these adverse effects. Adverse effects are rarely disabling or fatal, treatment mainly involves supportive measures, and the majority of affected patients have a good prognosis.
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Affiliation(s)
- Yi Guo
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
| | - Xin Tian
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
| | - Xuefeng Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
| | - Zheng Xiao
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
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15
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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.
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Benwell N, Boan P, Raby E, McGettigan B. False positive hepatitis B virus core and surface antibodies due to intravenous immunoglobulin. Intern Med J 2017; 47:119-120. [PMID: 28076916 DOI: 10.1111/imj.13314] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 05/15/2016] [Accepted: 05/22/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Nicola Benwell
- Department of Immunology, Fiona Stanley Hospital and Pathwest Laboratory Medicine, Perth, Western Australia, Australia
| | - Peter Boan
- Departments of Infectious Disease and Microbiology, Fiona Stanley Hospital and Pathwest Laboratory Medicine, Perth, Western Australia, Australia
| | - Edward Raby
- Departments of Infectious Disease and Microbiology, Fiona Stanley Hospital and Pathwest Laboratory Medicine, Perth, Western Australia, Australia
| | - Ben McGettigan
- Department of Immunology, Fiona Stanley Hospital and Pathwest Laboratory Medicine, Perth, Western Australia, Australia
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Immune Gamma Globulin Therapeutic Indications in Immune Deficiency and Autoimmunity. Curr Allergy Asthma Rep 2017; 16:55. [PMID: 27401913 DOI: 10.1007/s11882-016-0632-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Immune gamma globulin (IgG) has a long history in the treatment of both primary immune deficiency and autoimmune disorders. Disease indications continue to expand and new-generation products increase the versatility of delivery. This review encompasses a historical perspective as well as current and future implications of human immune globulin for the treatment of immune-mediated illness.
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Colpo A, Tison T, Gervasi MT, Vio C, Vicarioto M, De Silvestro G, Marson P. Personalized treatment with immunoadsorption and intravenous immunoglobulin in a case of severe Rh alloimmunization during pregnancy unresponsive to plasma – exchange. Transfus Apher Sci 2017. [DOI: 10.1016/j.transci.2017.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Prise en charge des événements indésirables chez les patients sous traitement par immunoglobulines : recommandations pour la pratique clinique. Rev Med Interne 2017; 38:312-319. [DOI: 10.1016/j.revmed.2016.10.390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/25/2016] [Accepted: 10/20/2016] [Indexed: 12/29/2022]
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Limonier F, Van Steendam K, Waeterloos G, Brusselmans K, Sneyers M, Deforce D. An application of mass spectrometry for quality control of biologicals: Highly sensitive profiling of plasma residuals in human plasma-derived immunoglobulin. J Proteomics 2017; 152:312-320. [DOI: 10.1016/j.jprot.2016.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/04/2016] [Accepted: 11/10/2016] [Indexed: 01/02/2023]
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21
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Moon JW, Lee SH, Oh YK, Choi DY, Yu ST. Autoimmune Hemolytic Anemia after Intravenous Immunoglobulin Therapy in a Child with Kawasaki Disease. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2016. [DOI: 10.15264/cpho.2016.23.2.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Joung Whan Moon
- Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Korea
| | - Seung Hyun Lee
- Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Korea
| | - Yeon Kyun Oh
- Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Korea
| | - Du Young Choi
- Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Korea
| | - Seung Taek Yu
- Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Korea
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Chuluundorj D, Harding SA, Abernethy D, La Flamme AC. Glatiramer acetate treatment normalized the monocyte activation profile in MS patients to that of healthy controls. Immunol Cell Biol 2016; 95:297-305. [PMID: 27694998 DOI: 10.1038/icb.2016.99] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 01/16/2023]
Abstract
Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system, and monocytes contribute to MS-associated neuroinflammation. While classically activated monocytes promote inflammation, type II-activated monocytes improve the course of MS. This study investigated type II activation of monocytes and their two main subsets, namely CD14+ (CD14++CD16- subset) and CD16+ monocytes (CD14+CD16+ subset), by glatiramer acetate (GA) or intravenous immunoglobulin-associated immune complexes (IC), both of which are known MS treatments. Total monocytes and subsets were isolated from peripheral blood mononuclear cells (PBMC) of healthy controls, untreated MS patients (MS) and GA-treated MS patients (GA-MS). In contrast to the more activated ex vivo profile of monocytes from the MS group, monocytes from the GA-MS group resembled those from healthy controls. In vitro type II activation with GA primarily reduced CD40, CD86 and IL-12p40 whereas type II activation with IC consistently reduced CD40 but increased interleukin-10 (IL-10), suggesting that the GA and IC activation pathways are distinct. Moreover, while GA treatment reduced IL-12p40 by both CD14+ and CD16+ subsets, IC treatment only enhanced IL-10 by the CD16+ subset. Further analysis of the CD16+ subset revealed that MS patients had a greatly expanded CD14+CD16int population while both CD14+CD16int and CD14lowCD16high monocyte populations were expanded in GA-MS patients. Finally, a global analysis of the ex vivo monocyte data indicated that GA treatment distinctly altered the monocyte profile of MS patients, further supporting the idea that GA directly targets monocytes.
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Affiliation(s)
| | - Scott A Harding
- School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand.,Cardiology Department, Wellington Regional Hospital, Wellington, New Zealand
| | - David Abernethy
- Cardiology Department, Wellington Regional Hospital, Wellington, New Zealand
| | - Anne Camille La Flamme
- School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand.,Malaghan Institute of Medical Research, Wellington, New Zealand
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23
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Preparation, Storage, and Characteristics of Blood Components and Plasma Derivatives. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Catastrophic antiphospholipid syndrome is a rapidly progressive life-threatening disease that causes multiple organ thromboses and dysfunction in the presence of antiphospholipid antibodies. A high index of clinical suspicion and careful investigation are required to make an early diagnosis so that treatment with anticoagulation and corticosteroids can be initiated; plasma exchange and/or intravenous immunoglobulins can be added if the life-threatening condition persists. Despite aggressive treatment and intensive care unit management, patients with catastrophic antiphospholipid syndrome have a 48% mortality rate, primarily attributable to cardiopulmonary failure. This article reviews the current information on the etiopathogenesis, clinical manifestations, diagnosis, management, and prognosis of catastrophic antiphospholipid syndrome.
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Affiliation(s)
- Setu K Vora
- Pulmonary Physicians of Norwich, Norwich, Connecticut, USA
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25
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Ballow M, Pinciaro PJ, Craig T, Kleiner G, Moy J, Ochs HD, Sleasman J, Smits W. Flebogamma(®) 5 % DIF Intravenous Immunoglobulin for Replacement Therapy in Children with Primary Immunodeficiency Diseases. J Clin Immunol 2016; 36:583-9. [PMID: 27279130 DOI: 10.1007/s10875-016-0303-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/23/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The previous studies with Flebogamma(®) 5 % DIF intravenous immunoglobulin (IVIG) contained insufficient numbers of pediatric subjects to fully warrant a pediatric indication by the FDA. The objective of this study was to evaluate the efficacy, safety, and pharmacokinetics of Flebogamma® 5 % DIF for replacement therapy in children (age 2-16) with primary immunodeficiency diseases (PIDD). METHODS IVIG was administered at eight clinical sites to 24 subjects with well-defined PIDD at a dose of 300-800 mg/kg every 21-28 days for 12 months. The pharmacokinetics endpoint in this study was the dose-adjusted increment of the serum IgG trough levels. RESULTS The calculated serious bacterial infection rate was 0.05/subject/year. The incidence of adverse events considered potentially related to IVIG during or within 72 h after completing an infusion was within the FDA guidance threshold of <40 % at each time point. Dose-adjusted incremental IgG levels remained approximately equal to or slightly greater than pre-study IgG levels (between 800 and 1000 mg/dL throughout) when the subjects were treated with IVIG therapy other than Flebogamma(®) DIF 5 % indicating no evidence of a different pharmacokinetic profile in this pediatric population if compared to those profiles in previous Flebogamma studies in predominately adult populations. CONCLUSIONS Flebogamma(®) 5 % DIF is efficacious and safe, has adequate pharmacokinetic properties, is well-tolerated, and maintains the profile of Flebogamma(®) 5 % for the treatment of children with primary humoral immunodeficiency diseases.
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Affiliation(s)
- Mark Ballow
- The Children's Hospital of Buffalo, Buffalo, NY, USA.
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida, 601 4th Street South, Saint Petersburg, FL, 3370, USA.
| | | | - Timothy Craig
- Penn State University Hershey Medical Center, Hershey, PA, USA
| | - Gary Kleiner
- Jeffrey Modell Diagnostic Center for Primary Immunodeficiencies, University of Miami, Miami, FL, USA
| | - James Moy
- Allergy and Immunology, Rush University Medical Center, Chicago, IL, USA
| | - Hans D Ochs
- Seattle Children's Research Institute and University of Washington, Seattle, WA, USA
| | - John Sleasman
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida, 601 4th Street South, Saint Petersburg, FL, 3370, USA
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Telcharova-Mihaylovska A, Stefanov S, Nikolova I. Kawasaki disease and acute haemolytic anaemia after two IVIG infusions. BIOTECHNOL BIOTEC EQ 2016. [DOI: 10.1080/13102818.2016.1159529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Albena Telcharova-Mihaylovska
- Clinic of Rheumatology, Pediatric University Hospital SBALDB “Prof. Ivan Mitev”, Medical University of Sofia, Sofia, Bulgaria
| | - Stefan Stefanov
- Clinic of Rheumatology, Pediatric University Hospital SBALDB “Prof. Ivan Mitev”, Medical University of Sofia, Sofia, Bulgaria
| | - Irina Nikolova
- Department of Pharmacology, Pharmacotherapy and Toxicology, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
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Barahona Afonso AF, João CMP. The Production Processes and Biological Effects of Intravenous Immunoglobulin. Biomolecules 2016; 6:15. [PMID: 27005671 PMCID: PMC4808809 DOI: 10.3390/biom6010015] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 12/17/2022] Open
Abstract
Immunoglobulin is a highly diverse autologous molecule able to influence immunity in different physiological and diseased situations. Its effect may be visible both in terms of development and function of B and T lymphocytes. Polyclonal immunoglobulin may be used as therapy in many diseases in different circumstances such as primary and secondary hypogammaglobulinemia, recurrent infections, polyneuropathies, cancer, after allogeneic transplantation in the presence of infections and/or GVHD. However, recent studies have broadened the possible uses of polyclonal immunoglobulin showing that it can stimulate certain sub-populations of T cells with effects on T cell proliferation, survival and function in situations of lymphopenia. These results present a novel and considerable impact of intravenous immunoglobulin (IVIg) treatment in situations of severe lymphopenia, a situation that can occur in cancer patients after chemo and radiotherapy treatments. In this review paper the established and experimental role of polyclonal immunoglobulin will be presented and discussed as well as the manufacturing processes involved in their production.
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Affiliation(s)
- Ana Filipa Barahona Afonso
- Department of Chemistry, Universidade de Évora, Colégio Luís António Verney, Rua Romão Ramalho 59, 7000-671 Évora, Portugal.
| | - Cristina Maria Pires João
- Hematology Department, Champalimaud Center for the Unknown, Av. Brasília, 1400-038 Lisboa, Portugal.
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Aitken SL, Tichy EM. Rh(O)D immune globulin products for prevention of alloimmunization during pregnancy. Am J Health Syst Pharm 2015; 72:267-76. [PMID: 25631833 DOI: 10.2146/ajhp140288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The pharmacologic properties of Rhesus (Rh) immune globulin (RhIG) and clinical data on its effectiveness in preventing Rh-antigen alloimmunization in pregnant women are reviewed. SUMMARY RhIG is a human plasma derivative that targets red blood cells (RBCs) positive for Rh(O) antigen (also called D antigen). In the United States and other countries, the widespread use of RhIG has markedly reduced the occurrence of hemolytic disease of the fetus and newborn (HDFN), a devastating condition caused by D-antigen sensitization of a pregnant woman via exposure to fetal RBCs (usually during detachment of the placenta in labor) that results in a maternal immune response leading to severe hemolysis in the fetus. Routine administration of RhIG at 26-30 weeks' gestation and again within 72 hours of delivery has been shown to be highly effective in preventing maternal Rh alloimmunization, with very low rates of D-antigen sensitization (in the range of 0-2.2%) reported in multiple studies of at-risk women. The four RhIG products currently available in the United States have common clinical indications but differ in certain attributes. Pharmacists can play an important role in guiding other clinicians on the rationale for the use of RhIG, important differences between products, and appropriate timing of RhIG therapy. CONCLUSION Routine administration of RhIG to women at risk for Rh alloimmunization is clinically effective and has made HDFN a rare clinical event. The available RhIG products are not the same and should be carefully reviewed to ensure that they are administered safely.
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Affiliation(s)
- Samuel L Aitken
- Samuel L. Aitken, Pharm.D., BCPS, is Clinical Pharmacy Specialist in Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston. Eric M. Tichy, Pharm.D., FCCP, BCPS, is Senior Clinical Pharmacy Specialist, Solid Organ Transplantation, and Director, Postgraduate Year 2 Residency, Department of Pharmacy Services, Yale-New Haven Hospital, New Haven, CT
| | - Eric M Tichy
- Samuel L. Aitken, Pharm.D., BCPS, is Clinical Pharmacy Specialist in Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston. Eric M. Tichy, Pharm.D., FCCP, BCPS, is Senior Clinical Pharmacy Specialist, Solid Organ Transplantation, and Director, Postgraduate Year 2 Residency, Department of Pharmacy Services, Yale-New Haven Hospital, New Haven, CT.
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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.
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30
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Abolhassani H, Asgardoon MH, Rezaei N, Hammarstrom L, Aghamohammadi A. Different brands of intravenous immunoglobulin for primary immunodeficiencies: how to choose the best option for the patient? Expert Rev Clin Immunol 2015; 11:1229-43. [DOI: 10.1586/1744666x.2015.1079485] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Use of Intravenous Immunoglobulin for Patients with Inflammatory Bowel Disease with Contraindications or Who Are Unresponsive to Conventional Treatments. Inflamm Bowel Dis 2015; 21:1854-9. [PMID: 25993689 DOI: 10.1097/mib.0000000000000456] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Managing patients with IBD who are refractory or have contraindications to standard therapies is challenging. Many will lose response, become intolerant to treatment, or develop infections with contraindication for immunosuppression. Therefore, alternative therapies, such as the use of intravenous immunoglobulin (IVIg), could be used to manage patients in these difficult cases. METHODS Data were extracted retrospectively from the electronic medical records at Vanderbilt University on patients with IBD who received IVIg (February 2011-June 2013). Patients were treated with IVIg 0.4 g·kg·d for 3 consecutive days and then 0.4 g/kg once monthly. The dose was increased to 0.4 g/kg biweekly for loss of response or partial response. Clinical response was defined as decreasing the Harvey-Bradshaw Index ≥3 points or improvement in C-reactive protein >25%. Clinical remission was defined as Harvey-Bradshaw Index score <5, no hospitalizations or surgeries after IVIg, or symptom resolution. Statistical analysis was performed using Wilcoxon signed-rank test. RESULTS Twenty-four patients with IBD received IVIg. Seventeen patients received IVIg for failure of standard treatment. Six patients received IVIg during active infection. Two patients had histoplasmosis, 1 patient had tuberculosis, and 2 patients had pulmonary fungal infections. One patient with ulcerative colitis was given IVIg for recurrent Clostridium difficile. Nine patients required dose escalation after median 153 days (30-360). Ninteen patients (79%) had a response or remission. Sixteen (67%) had a response and 3 (12.5%) obtained remission with IVIg. C-reactive protein decreased significantly after treatment (19 mg/dL [0.1-77] to 7.5 [0.2-20]), P < 0.05. Harvey-Bradshaw Index scores improved (8 [0-19] to 6 [0-17]), P = not significant. Of note, 62.5% had endoscopic improvement after treatment. CONCLUSIONS IVIg is safe and effective in the short-term management of patients with IBD when standard therapies are contraindicated.
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Yu CF, Hou JF, Shen LZ, Gao K, Rao CM, Yang PY, Fu ZH, Wang QZ, Li YH, Wang L, Liu F, Zhang L, Qu Z, Shen Q, Li B, Li XG, Wang JZ. Acute pulmonary embolism caused by highly aggregated intravenous immunoglobulin. Vox Sang 2015. [PMID: 26198276 DOI: 10.1111/vox.12307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Six patients died and one patient survived following infusion of a specific lot of intravenous immunoglobulin (IVIG) within half an hour in May 2008. This study elucidated the underlying pathogenesis. MATERIALS AND METHODS A variety of protein fractionation and identification approaches were employed to determine the abnormal components in IVIG products obtained from the hospital where the patients were treated. Animal studies using mice and monkeys were conducted to elucidate the pathophysiological mechanisms. In animal experiments, the effect and distribution of immunoglobulin was investigated using HE staining and immunohistochemistry (IHC) separately, while platelets and fibrinogen depletion were utilized to determine a possible link between thromboembolism formation in animals and the lethal effect of the IVIG. The size and distribution of the protein aggregates were determined with Coulter Counter Multisizer-3 after the dilution of the IVIG with plasma, and the lethal effect of the protein aggregates was simulated with artificial microparticles. RESULTS The IVIG retrieved from the hospital was found to have striking similarities to the heat-treated IVIG in terms of protein aggregation profiles and lethal effects. Post-mortem examination indicated that immunoglobulin aggregates were mainly found in the lung of the animals, while depletion of platelets and fibrinogen from the IVIG preparations failed to prevent the death of the animals. Similar amount of artificial microparticles caused animal death in similar fashion. CONCLUSIONS Our findings indicate that the retrieved IVIG exerted its lethal effects by blocking the pulmonary circulation without markedly altering the coagulation cascade or immunological events.
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Affiliation(s)
- C F Yu
- National Institutes for Food and Drug Control, Beijing, China
| | - J F Hou
- National Institutes for Food and Drug Control, Beijing, China
| | - L Z Shen
- National Institutes for Food and Drug Control, Beijing, China
| | - K Gao
- National Institutes for Food and Drug Control, Beijing, China
| | - C M Rao
- National Institutes for Food and Drug Control, Beijing, China
| | - P Y Yang
- National Institutes for Food and Drug Control, Beijing, China
| | - Z H Fu
- National Institutes for Food and Drug Control, Beijing, China
| | - Q Z Wang
- National Institutes for Food and Drug Control, Beijing, China
| | - Y H Li
- National Institutes for Food and Drug Control, Beijing, China
| | - L Wang
- National Institutes for Food and Drug Control, Beijing, China
| | - F Liu
- National Institutes for Food and Drug Control, Beijing, China
| | - L Zhang
- National Institutes for Food and Drug Control, Beijing, China
| | - Z Qu
- National Institutes for Food and Drug Control, Beijing, China
| | - Q Shen
- National Institutes for Food and Drug Control, Beijing, China
| | - B Li
- National Institutes for Food and Drug Control, Beijing, China
| | - X G Li
- Centre for Vaccine Evaluation, Biologics and Genetic Therapies Directorate, HPFB, Health Canada, Ottawa, ON, Canada
| | - J Z Wang
- National Institutes for Food and Drug Control, Beijing, China
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The role of intravenous immunoglobulins in the treatment of rheumatoid arthritis. Autoimmun Rev 2015; 14:651-8. [PMID: 25870941 DOI: 10.1016/j.autrev.2015.04.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 04/02/2015] [Indexed: 12/11/2022]
Abstract
Intravenous immunoglobulins (IVIGs) are beneficial and safe for various diseases other than primary immunodeficiencies. Over the years, IVIG has been given for autoimmune diseases as an off-label adjunct therapy. While other biologic agents are indicated for rheumatoid arthritis (RA), IVIG may have a role for specific subgroups of RA patients where anti-cytokine blockers or rituximab may be unwarranted. Such subgroups may include patients with vasculitis, overlap rhupus syndrome, severe infections with active disease, and pregnancy. In addition, IVIG may be considered for juvenile chronic arthritis (JCA) and adult Still's disease. We review the literature for IVIG treatment in RA patients and for these subgroups.
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Buehler AM, Flato UP, Ferri CP, Fernandes JG. Is there evidence for recommending specific intravenous immunoglobulin formulations? A systematic review of head-to-head randomized controlled trials. Eur J Pharmacol 2015; 747:96-104. [DOI: 10.1016/j.ejphar.2014.11.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 11/27/2022]
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Zülfikar B, Koç B. Use of intravenous immunoglobulin in pediatric practice. TURK PEDIATRI ARSIVI 2014; 49:282-8. [PMID: 26078679 PMCID: PMC4462316 DOI: 10.5152/tpa.2014.2212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 09/24/2014] [Indexed: 12/13/2022]
Abstract
In recent years, human-driven intravenous immunoglobulins (IVIG) administered intravenously have been widely used in treatment of many diseases. Intravenous immunoglobulin is obtained from human-driven plasma pools as in other plasma-driven products and IVIG preperations contain structurally and functionally intact immunoglobulin. Intravenous immunoglobulin was approved by FDA (Food and Drug Administration) in USA in 1981 for the first time and was started to be primarily used in patients with immune deficiency with hypogammaglobulinemia. The effects of intravenous immunoglobulin include complex mechanisms, but it exerts its essential action by eliminating the non-specific Fc receptors found in the mononuclear phagocytic system or by inhibiting binding of immune complexes to Fc receptors in the cells. Their areas of usage include conditions where their anti-inflammatory and immunomudulator effects are utilized in addition to replacement of deficient immunoglobulin. Although the definite indications are limited, it has been shown that it is useful in many diseases in clinical practice. Its side effects include fever, sweating, nausea, tachycardia, eczematous reactions, aseptic meningitis, renal failure and hematological-thromboembolic events. In this article, use of IVIG, its mechanisms of action, indications and side effects were discussed.
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Affiliation(s)
- Bülent Zülfikar
- Division of Pediatric Hematology-Oncology, İstanbul University, Cerrahpaşa Medical Faculty and Oncology Institute, İstanbul, Turkey
| | - Başak Koç
- Division of Pediatric Hematology-Oncology, İstanbul University, Cerrahpaşa Medical Faculty and Oncology Institute, İstanbul, Turkey
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36
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The demand for polyvalent immunoglobulins in Italy. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 11 Suppl 4:s45-54. [PMID: 24333313 DOI: 10.2450/2013.009s] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bellone M, Boctor FN. Therapeutic plasma exchange and intravenous immunoglobulin as primary therapy for D alloimmunization in pregnancy precludes the need for intrauterine transfusion. Transfusion 2014; 54:2118-21. [DOI: 10.1111/trf.12633] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/23/2014] [Accepted: 01/28/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Michael Bellone
- Division of Transfusion Medicine; Department of Pathology; North Shore University Hospital and Hofstra North Shore-LIJ School of Medicine; Manhasset New York
| | - Fouad N. Boctor
- Division of Transfusion Medicine; Department of Pathology; North Shore University Hospital and Hofstra North Shore-LIJ School of Medicine; Manhasset New York
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Ishii Y, Murakami J, Sasaki K, Tsukahara M, Wakamatsu K. Efficient folding/assembly in Chinese hamster ovary cells is critical for high quality (low aggregate content) of secreted trastuzumab as well as for high production: stepwise multivariate regression analyses. J Biosci Bioeng 2014; 118:223-30. [PMID: 24635945 DOI: 10.1016/j.jbiosc.2014.01.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/27/2014] [Accepted: 01/27/2014] [Indexed: 01/05/2023]
Abstract
When developing cell culture processes for therapeutic antibodies, the low content of aggregated proteins is the most critical because administering aggregated antibody molecules might result in adverse effects such as immunogenicity. To characterize cells with high productivity and quality, we determined factors that are closely related to antibody titer, which is a productivity indicator, and the area percentage of high molecular weight species in cultivated media, which is equivalent to aggregate content and is used as a quality indicator. We examined the factors influencing antibody titer and aggregate content using various data from 28 cell lines throughout their culture periods from growth to death phases. Our study using correlation analysis revealed that statistically significant correlations between factors and indicators changes with sampling points, hence we thought that various factors would influence each indicator simultaneously. To understand the relationship between these factors and titer/aggregates contents, we performed stepwise multiple linear regression analyses and deduced a multiple linear model for each indicator. The titer was found to positively associate with specific growth rate and specific production rate and negatively with intracellular heavy chain content. The aggregate content was found to positively associate with protein disulfide isomerase mRNA level and negatively with light chain secreted into culture media, specific production rate, intracellular light chain content, and specific growth rate. Our observations suggest that correct and efficient assembling and/or folding of an antibody molecule in an endoplasmic reticulum are important for high titer and low aggregates contents.
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Affiliation(s)
- Yoichi Ishii
- Bio-process Research and Development Laboratories, Kyowa Hakko Kirin Co., Ltd., 100-1 Hagiwara-machi, Takasaki-shi, Gunma 370-0013, Japan; Graduate School of Engineering, Gunma University, 1-5-1 Tenjin-cho, Kiryu-shi, Gunma 376-8515, Japan.
| | - Junko Murakami
- Bio-process Research and Development Laboratories, Kyowa Hakko Kirin Co., Ltd., 100-1 Hagiwara-machi, Takasaki-shi, Gunma 370-0013, Japan
| | - Kazue Sasaki
- Bio-process Research and Development Laboratories, Kyowa Hakko Kirin Co., Ltd., 100-1 Hagiwara-machi, Takasaki-shi, Gunma 370-0013, Japan
| | - Masayoshi Tsukahara
- Kyowa Hakko Kirin Co., Ltd., 1-6-1 Ohte-machi, Chiyoda-ku, Tokyo 100-8185, Japan
| | - Kaori Wakamatsu
- Graduate School of Engineering, Gunma University, 1-5-1 Tenjin-cho, Kiryu-shi, Gunma 376-8515, Japan
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Sun A, Teschner W, Yel L. Improving patient tolerability in immunoglobulin treatment: focus on stabilizer effects. Expert Rev Clin Immunol 2014; 9:577-87. [DOI: 10.1586/eci.13.39] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
The drugs used to treat hematologic disorders constitute an extraordinary array of agents and include therapy for anemias, bleeding diatheses, thromboembolism and hematologic malignancies. Within many of these categories, hematologic therapies represent molecular understanding of the disease pathophysiology and a treatment targeted precisely at the known aberration. In this chapter we discuss these treatments, with greater emphasis on the most commonly used agents and the latest advances in the specific field. The chapter includes discussion on old (cyclooxygenase inhibitors) and new antiplatelet agents (ADP receptor P2Y12 inhibitors), newly described oral thrombin inhibitors such as dabigatran, treatment targeted at the bcr-abl tyrosine kinase in chronic myeloid leukemia and demethylating agents in myelodysplasia. The discussion is also oriented towards neurologic implications, both therapeutic and toxic, for each therapy or therapeutic group.
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41
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Ririe MR, Blaylock RC, Morris SE, Jung JY. Intravenous immune globulin therapy for Stevens-Johnson syndrome/toxic epidermal necrolysis complicated by hemolysis leading to pigment nephropathy and hemodialysis. J Am Acad Dermatol 2013; 69:221-5. [DOI: 10.1016/j.jaad.2013.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 03/28/2013] [Accepted: 04/02/2013] [Indexed: 11/25/2022]
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Abstract
Treatment of immune-mediated disease in dogs and cats continues to evolve as new therapies are introduced or adapted from human medicine. Glucocorticoids remain the first-line therapy for many of the immune-mediated or inflammatory diseases of cats and dogs. The focus of this article is to provide an update on some of the common immunosuppressive therapies used in small animal veterinary medicine. The goals of therapy are to induce disease remission through the inhibition of inflammation and the modulation of lymphocyte function.
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Affiliation(s)
- Katrina R Viviano
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, USA.
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Seifner A, Beck G, Bayer P, Eichmeir S, Lackner F, Rögelsperger O, Weber K, Wollein G. Assessment of immunoglobulin concentrates on thrombogenic activity by thrombin generation assay, prekallikrein activator assay, and size-exclusion chromatography. Transfusion 2013; 54:376-83. [DOI: 10.1111/trf.12280] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/19/2013] [Accepted: 04/21/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Alexandra Seifner
- Austrian Medicines and Medical Devices Agency; AGES-Austrian Agency for Health and Food Safety; Vienna; Austria
| | - Gerhard Beck
- Austrian Medicines and Medical Devices Agency; AGES-Austrian Agency for Health and Food Safety; Vienna; Austria
| | - Patrick Bayer
- Austrian Medicines and Medical Devices Agency; AGES-Austrian Agency for Health and Food Safety; Vienna; Austria
| | - Stephanie Eichmeir
- Austrian Medicines and Medical Devices Agency; AGES-Austrian Agency for Health and Food Safety; Vienna; Austria
| | - Friedrich Lackner
- Austrian Medicines and Medical Devices Agency; AGES-Austrian Agency for Health and Food Safety; Vienna; Austria
| | - Olga Rögelsperger
- Austrian Medicines and Medical Devices Agency; AGES-Austrian Agency for Health and Food Safety; Vienna; Austria
| | - Katharina Weber
- Austrian Medicines and Medical Devices Agency; AGES-Austrian Agency for Health and Food Safety; Vienna; Austria
| | - Gabriele Wollein
- Austrian Medicines and Medical Devices Agency; AGES-Austrian Agency for Health and Food Safety; Vienna; Austria
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Gunther M, Saxinger L, Gray M, LeGatt D. Two Suspected Cases of Immunoglobulin-Mediated Interference Causing Falsely Low Vancomycin Concentrations with the Beckman PETINIA Method. Ann Pharmacother 2013; 47:e19. [DOI: 10.1345/aph.1r566] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To describe 2 recent cases of suspected immunoglobulin-mediated interference with the Beckman Coulter particle–enhanced turbidimetric inhibition immunoassay (PETINIA) used to measure vancomycin serum or plasma concentrations and to review the existing literature. CASE SUMMARY A 64-year-old woman with a history of multiple immune-related comorbidities received vancomycin for treatment of a prosthetic joint infection growing coagulase-negative Staphylococcus spp. A 33-year-old man with a history of Felty syndrome received vancomycin for the treatment of methicillin-resistant Staphylococcus aureus pneumonia. Both patients had multiple vancomycin trough concentrations determined using the Beckman Coulter PETINIA method and had measured concentrations reported as less than 4 mg/L despite appropriate vancomycin dosing for their size, age, and organ function. The patients' serum was then tested by alternative methods, which reported vancomycin concentrations consistent with those expected with the patients' dosing regimens. DISCUSSION Immunoglobulins are well known for interfering with chemistry assays. It is suspected that high levels of immunoglobulins in these 2 patients interfered with the accurate measurement of serum vancomycin concentrations. An objective causality assessment supported the interactions as being definite and probable, respectively. Two other cases of suspected immunoglobulin interference with vancomycin measurement have been reported in the literature when vancomycin concentrations were initially measured using the Beckman Coulter PETINIA method. In vitro studies support the hypothesis that immunoglobulin interference with vancomycin measurement by this method occurs and is a graded phenome non. CONCLUSIONS These cases suggest a high likelihood of immunoglobulin-mediated interference with the Beckman Coulter PETINIA method, which results in the reporting of falsely low vancomycin serum concentrations. When vancomycin concentrations do not correlate with what would be expected clinically, clinicians should have a high index of suspicion for potential assay interference.
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Affiliation(s)
- Mary Gunther
- Mary Gunther BScPharm, Clinical Pharmacist, Pharmacy Services, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Lynora Saxinger
- Lynora Saxinger MD, Associate Professor, Division of Infectious Diseases, Departments of Medicine and Medical Microbiology and Immunology, University of Alberta
| | - Margaret Gray
- Margaret Gray BSP, Clinical Practice Leader–Infectious Diseases, Pharmacy Services, Alberta Health Services
| | - Donald LeGatt
- Donald LeGatt PhD, Clinical Biochemist ad Clinical Professor, Department of Laboratory Medicine and Pathology, University of Alberta Hospital
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45
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Direct Medical Costs of Liquid Intravenous Immunoglobulins in Children, Adolescents, and Adults in Spain. J Clin Pharmacol 2013; 52:566-75. [DOI: 10.1177/0091270011399575] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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46
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Padet L, Bazin R. IVIg prevents the in vitro activation of T cells by neutralizing the T cell activators. Immunol Lett 2013; 150:54-60. [PMID: 23295311 DOI: 10.1016/j.imlet.2012.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 12/14/2012] [Accepted: 12/27/2012] [Indexed: 11/26/2022]
Abstract
Clinical observations in patients treated with IVIg revealed significant modulations in T cell populations and functions. However, it is unclear whether IVIg acts directly on activated T cells to suppress their functions. To clarify the exact mechanism of IVIg action, we studied its effect on T cells activated using anti-CD3/CD28 microbeads to mimic stimulatory signals provided by accessory cells. We report here that IVIg reduces T cell proliferation and cytokine secretion by interfering with the ability of anti-CD3/CD28 microbeads to deliver activating signals to T cells. We further show that the interference occurs between IVIg and anti-CD3/CD28 microbeads and does not involve T cells. In conclusion, our work suggests that T cells are not a direct target of IVIg and that the modulation of T cell populations and functions observed in treated patients is the indirect consequence of a direct effect of IVIg on accessory cells.
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Affiliation(s)
- Lauriane Padet
- Department of Research and Development, Héma-Québec, Québec, Canada.
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47
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Kumru OS, Liu J, Ji JA, Cheng W, Wang YJ, Wang T, Joshi SB, Middaugh CR, Volkin DB. Compatibility, Physical Stability, and Characterization of an IgG4 Monoclonal Antibody After Dilution into Different Intravenous Administration Bags. J Pharm Sci 2012; 101:3636-50. [DOI: 10.1002/jps.23224] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 04/12/2012] [Accepted: 05/11/2012] [Indexed: 12/11/2022]
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48
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Spurlock NK, Prittie JE. A review of current indications, adverse effects, and administration recommendations for intravenous immunoglobulin. J Vet Emerg Crit Care (San Antonio) 2012; 21:471-83. [PMID: 22316195 DOI: 10.1111/j.1476-4431.2011.00676.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To review and summarize the body of literature regarding human intravenous immunoglobulin (hIVIG) therapy in veterinary medicine. Mechanism of action, usage in human medicine, adverse effects of therapy, implications for veterinary use, and administration recommendations are discussed. DATA SOURCES Current human and veterinary peer-reviewed medical literature including original research articles and scientific reviews. HUMAN DATA SYNTHESIS There are currently 6 labeled uses for hIVIG in human medicine, but preparations are used off-label to successfully treat multiple immune-mediated conditions. To maximize the potential of hIVIG use in animals and identify areas deficient in research, a review of the current literature is warranted. VETERINARY DATA SYNTHESIS Investigation of hIVIG therapy in veterinary patients has been limited to the subjects of immune-mediated hemolytic anemia (IMHA), immune-mediated thrombocytopenia (ITP), Evan's syndrome, cutaneous disease, myasthenia gravis (MG), and sudden acquired retinal degeneration (SARDS). Proponents of veterinary hIVIG use believe administration may reduce transfusion requirements and decrease hospitalization time. CONCLUSION Immunoglobulin (Ig) has not been shown to decrease transfusion requirements in IMHA patients, but shows great promise for treatment of ITP and dermatological diseases. Although serial transfusion of hIVIG is employed in human medicine, repeated transfusion is not recommended in animals due to risk of severe allergic reaction. Other potential adverse effects of transfusion include delayed hypersensitivity reactions, thromboembolism, renal failure, hypotension, and aseptic meningitis.
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Affiliation(s)
- Nicole K Spurlock
- Department of Emergency and Critical Care, The Animal Medical Center, New York, NY 10065, USA.
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49
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Tremblay T, Paré I, Bazin R. Immunoglobulin G dimers and immune complexes are dispensable for the therapeutic efficacy of intravenous immune globulin in murine immune thrombocytopenia. Transfusion 2012; 53:261-9. [DOI: 10.1111/j.1537-2995.2012.03725.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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50
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Doessegger L, Mahler HC, Szczesny P, Rockstroh H, Kallmeyer G, Langenkamp A, Herrmann J, Famulare J. The potential clinical relevance of visible particles in parenteral drugs. J Pharm Sci 2012; 101:2635-44. [PMID: 22628244 DOI: 10.1002/jps.23217] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 05/03/2012] [Accepted: 05/08/2012] [Indexed: 01/16/2023]
Abstract
Visible particulates (VP) are one subclass of defects seen during the final visual inspection of parenteral products and are currently one of the top ten reasons for recalls 1,2. The risk posed by particles is still unclear with limited experience reported in humans but remains an important consideration during the manufacture and use of parenteral products. From the experimental and clinical knowledge of the distribution of particulate matter in the body, clinical complications would include events occurring around parenteral administration e.g., as a result of mechanical pulmonary artery obstruction and injection site reaction, or sub-acute or chronic events e.g., granuloma. The challenge is to better understand the implication for patients of single vials with VP and align the risk with the probabilistic detection process used by manufacturers for accept/reject decisions of individual units of product.
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Affiliation(s)
- Lucette Doessegger
- Pharma Development Safety Risk Management, F. Hoffmann-La Roche AG, Basel, Switzerland.
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