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von Gunten S, Schneider C, Imamovic L, Gorochov G. Antibody diversity in IVIG: Therapeutic opportunities for novel immunotherapeutic drugs. Front Immunol 2023; 14:1166821. [PMID: 37063852 PMCID: PMC10090664 DOI: 10.3389/fimmu.2023.1166821] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
Significant progress has been made in the elucidation of human antibody repertoires. Furthermore, non-canonical functions of antibodies have been identified that reach beyond classical functions linked to protection from pathogens. Polyclonal immunoglobulin preparations such as IVIG and SCIG represent the IgG repertoire of the donor population and will likely remain the cornerstone of antibody replacement therapy in immunodeficiencies. However, novel evidence suggests that pooled IgA might promote orthobiotic microbial colonization in gut dysbiosis linked to mucosal IgA immunodeficiency. Plasma-derived polyclonal IgG and IgA exhibit immunoregulatory effects by a diversity of different mechanisms, which have inspired the development of novel drugs. Here we highlight recent insights into IgG and IgA repertoires and discuss potential implications for polyclonal immunoglobulin therapy and inspired drugs.
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Affiliation(s)
- Stephan von Gunten
- Institute of Pharmacology, University of Bern, Bern, Switzerland
- *Correspondence: Stephan von Gunten,
| | | | - Lejla Imamovic
- Sorbonne Université, Inserm, Assistance Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Paris, France
| | - Guy Gorochov
- Sorbonne Université, Inserm, Assistance Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Paris, France
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2
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Liu X, Cao W, Li T. High-Dose Intravenous Immunoglobulins in the Treatment of Severe Acute Viral Pneumonia: The Known Mechanisms and Clinical Effects. Front Immunol 2020; 11:1660. [PMID: 32760407 PMCID: PMC7372093 DOI: 10.3389/fimmu.2020.01660] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/22/2020] [Indexed: 12/30/2022] Open
Abstract
The current outbreak of viral pneumonia, caused by novel coronavirus SARS-CoV-2, is the focus of worldwide attention. The WHO declared the COVID-19 outbreak a pandemic event on Mar 12, 2020, and the number of confirmed cases is still on the rise worldwide. While most infected individuals only experience mild symptoms or may even be asymptomatic, some patients rapidly progress to severe acute respiratory failure with substantial mortality, making it imperative to develop an efficient treatment for severe SARS-CoV-2 pneumonia alongside supportive care. So far, the optimal treatment strategy for severe COVID-19 remains unknown. Intravenous immunoglobulin (IVIg) is a blood product pooled from healthy donors with high concentrations of immunoglobulin G (IgG) and has been used in patients with autoimmune and inflammatory diseases for more than 30 years. In this review, we aim to highlight the known mechanisms of immunomodulatory effects of high-dose IVIg therapy, the immunopathological hypothesis of viral pneumonia, and the clinical evidence of IVIg therapy in viral pneumonia. We then make cautious therapeutic inferences about high-dose IVIg therapy in treating severe COVID-19. These inferences may provide relevant and useful insights in order to aid treatment for COVID-19.
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Affiliation(s)
- Xiaosheng Liu
- Tsinghua-Peking Center for Life Sciences, School of Medicine, Tsinghua University, Beijing, China
| | - Wei Cao
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Taisheng Li
- Tsinghua-Peking Center for Life Sciences, School of Medicine, Tsinghua University, Beijing, China
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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3
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Li T. Diagnosis and clinical management of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection: an operational recommendation of Peking Union Medical College Hospital (V2.0). Emerg Microbes Infect 2020; 9:582-585. [PMID: 32172669 PMCID: PMC7103730 DOI: 10.1080/22221751.2020.1735265] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
Since December 2019, China has been experiencing an outbreak of a new infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical features include fever, coughing, shortness of breath, and inflammatory lung infiltration. China rapidly listed SARS-CoV-2-related pneumonia as a statutory infectious disease. To standardize the diagnosis and treatment of this new infectious disease, an operational recommendation for the diagnosis and management of SARS-CoV-2 infection is developed by Peking Union Medical College Hospital.
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Affiliation(s)
- Taisheng Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
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4
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Brem MD, Jacobs BC, van Rijs W, Fokkink WJR, Tio-Gillen AP, Walgaard C, van Doorn PA, IJspeert H, van der Burg M, Huizinga R. IVIg-induced plasmablasts in patients with Guillain-Barré syndrome. Ann Clin Transl Neurol 2018; 6:129-143. [PMID: 30656191 PMCID: PMC6331722 DOI: 10.1002/acn3.687] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 01/08/2023] Open
Abstract
Objective The Guillain-Barré syndrome (GBS) is an acute, immune-mediated disease of peripheral nerves. Plasmablasts and plasma cells play a central role in GBS by producing neurotoxic antibodies. The standard treatment for GBS is high-dose intravenous immunoglobulins (IVIg), however the working mechanism is unknown and the response to treatment is highly variable. We aimed to determine whether IVIg changes the frequency of B-cell subsets in patients with GBS. Methods Peripheral blood mononuclear cells were isolated from 67 patients with GBS before and/or 1, 2, 4, and 12 weeks after treatment with high-dose IVIg. B-cell subset frequencies were determined by flow cytometry and related to serum immunoglobulin levels. Immunoglobulin transcripts before and after IVIg treatment were examined by next-generation sequencing. Antiglycolipid antibodies were determined by ELISA. Results Patients treated with IVIg demonstrated a strong increase in plasmablasts, which peaked 1 week after treatment. Flow cytometry identified a relative increase in IgG2 plasmablasts posttreatment. Within IGG sequences, dominant clones were identified which were also IGG2 and had different immunoglobulin sequences compared to pretreatment samples. High plasmablast frequencies after treatment correlated with an increase in serum IgG and IgM, suggesting endogenous production. Patients with a high number of plasmablasts started to improve earlier (P = 0.015) and were treated with a higher dose of IVIg. Interpretation High-dose IVIg treatment alters the distribution of B-cell subsets in the peripheral blood of GBS patients, suggesting de novo (oligo-)clonal B-cell activation. Very high numbers of plasmablasts after IVIg therapy may be a potential biomarker for fast clinical recovery.
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Affiliation(s)
- Maarten D Brem
- Department of Immunology Erasmus MC University Medical Center Dr. Molewaterplein 40 3015 GD Rotterdam The Netherlands
| | - Bart C Jacobs
- Department of Immunology Erasmus MC University Medical Center Dr. Molewaterplein 40 3015 GD Rotterdam The Netherlands.,Department of Neurology Erasmus MC University Medical Center Dr. Molewaterplein 40 3015 GD Rotterdam The Netherlands
| | - Wouter van Rijs
- Department of Immunology Erasmus MC University Medical Center Dr. Molewaterplein 40 3015 GD Rotterdam The Netherlands.,Department of Neurology Erasmus MC University Medical Center Dr. Molewaterplein 40 3015 GD Rotterdam The Netherlands
| | - Willem Jan R Fokkink
- Department of Immunology Erasmus MC University Medical Center Dr. Molewaterplein 40 3015 GD Rotterdam The Netherlands.,Department of Neurology Erasmus MC University Medical Center Dr. Molewaterplein 40 3015 GD Rotterdam The Netherlands
| | - Anne P Tio-Gillen
- Department of Immunology Erasmus MC University Medical Center Dr. Molewaterplein 40 3015 GD Rotterdam The Netherlands.,Department of Neurology Erasmus MC University Medical Center Dr. Molewaterplein 40 3015 GD Rotterdam The Netherlands
| | - Christa Walgaard
- Department of Neurology Erasmus MC University Medical Center Dr. Molewaterplein 40 3015 GD Rotterdam The Netherlands
| | - Pieter A van Doorn
- Department of Neurology Erasmus MC University Medical Center Dr. Molewaterplein 40 3015 GD Rotterdam The Netherlands
| | - Hanna IJspeert
- Department of Immunology Erasmus MC University Medical Center Dr. Molewaterplein 40 3015 GD Rotterdam The Netherlands
| | - Mirjam van der Burg
- Department of Immunology Erasmus MC University Medical Center Dr. Molewaterplein 40 3015 GD Rotterdam The Netherlands
| | - Ruth Huizinga
- Department of Immunology Erasmus MC University Medical Center Dr. Molewaterplein 40 3015 GD Rotterdam The Netherlands
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Friis IS, Kochanek M, Monsef I, Skoetz N, Engert A, Bauer K. Intravenous immunoglobulins for the treatment of infections in patients with haematological cancers. Hippokratia 2016. [DOI: 10.1002/14651858.cd009357.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- In Sook Friis
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Cologne Germany 50924
| | - Matthias Kochanek
- University Hospital of Cologne; Department I of Internal Medicine; Kerpener Straße 62 Cologne Germany 50924
| | - Ina Monsef
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Cologne Germany 50924
| | - Nicole Skoetz
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Cologne Germany 50924
| | - Andreas Engert
- University Hospital of Cologne; Department I of Internal Medicine; Kerpener Straße 62 Cologne Germany 50924
| | - Kathrin Bauer
- Spitzenverband Bund der Krankenkassen; Reinhardtstraße 30 Berlin Germany 10117
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Adachi Y, Hino T, Ohsawa M, Ueki K, Murao T, Li M, Cui Y, Okigaki M, Ito M, Ikehara S. A case of CD10-negative angioimmunoblastic T cell lymphoma with leukemic change and increased plasma cells mimicking plasma cell leukemia: A case report. Oncol Lett 2015; 10:1555-1560. [PMID: 26622708 DOI: 10.3892/ol.2015.3490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 05/22/2015] [Indexed: 11/06/2022] Open
Abstract
Angioimmunoblastic T cell lymphoma (AITL) is a peripheral T cell lymphoma, known to express CD3 and CD4, and, frequently, also CD10 and c-Maf-1. Hypergammaglobulinemia is not particularly rare in patients with AITL. However, AITL in conjunction with plasmacytosis in the peripheral blood is rare. The current report presents a case of CD10-negative AITL demonstrating leukemic change and plasmacytosis in the peripheral blood mimicking plasma cell leukemia. A 78-year-old male was admitted to hospital due to systemic lymph node enlargement, high serum IgG and IgA, and increased counts of plasmacytoid cells and lymphoid cells with atypical nuclei in the peripheral blood. Initially, plasma cell leukemia was suspected, due to the extreme increase in the number of plasma cells in the peripheral blood. However, the plasma cells did not show clonal expansion on examination by flow cytometry. Based on histological analyses, following a biopsy of an enlarged lymph node, the patient was diagnosed with AITL. This case suggests that when hypergammaglobulinemia and increases in B-lineage cells are observed, AITL should be considered in addition to disorders of B-lineage cells.
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Affiliation(s)
- Yasushi Adachi
- Division of Surgical Pathology, Toyooka Hospital, Toyooka City, Hyogo 668-8501, Japan ; Department of Stem Cell Disorders, Kansai Medical University, Hirakata City, Osaka 573-1010, Japan
| | - Takuya Hino
- Department of Internal General Medicine, Toyooka Hospital, Toyooka City, Hyogo 668-8501, Japan
| | - Masahiko Ohsawa
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka City, Osaka 545-0051, Japan
| | - Kazuhito Ueki
- Department of Internal General Medicine, Toyooka Hospital, Toyooka City, Hyogo 668-8501, Japan
| | - Tomoko Murao
- Department of Clinical Laboratory, Toyooka Hospital, Toyooka City, Hyogo 668-8501, Japan
| | - Ming Li
- Department of Stem Cell Disorders, Kansai Medical University, Hirakata City, Osaka 573-1010, Japan
| | - Yunze Cui
- Department of Stem Cell Disorders, Kansai Medical University, Hirakata City, Osaka 573-1010, Japan ; Japan Immunoresearch Laboratories Co. Ltd., Takasaki City, Gunma 370-0021, Japan
| | - Mitsuhiko Okigaki
- Department of Internal Medicine, Otokoyama Hospital, Yawata City, Kyoto 614-8366, Japan
| | - Mitsuhiro Ito
- Division of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe City, Hyogo 650-0017, Japan
| | - Susumu Ikehara
- Department of Stem Cell Disorders, Kansai Medical University, Hirakata City, Osaka 573-1010, Japan
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Molecular and immunological biomarkers to predict IVIg response. Trends Mol Med 2015; 21:145-7. [PMID: 25680699 DOI: 10.1016/j.molmed.2015.01.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 01/10/2023]
Abstract
Some patients with autoimmune and inflammatory diseases treated with intravenous immunoglobulin G (IVIg) as a first line therapy are refractory. Identification of predictive biomarker(s) to segregate responders and non-responders to IVIg therapy remains critical. A number of biomarkers, particularly in Kawasaki disease, have shown potential for predicting response to IVIg.
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8
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May early intervention with intravenous immunoglobulin pose a potentially successful treatment for Ebola virus infection? SCIENCE CHINA LIFE SCIENCES 2015; 58:108-10. [PMID: 25558865 PMCID: PMC7089321 DOI: 10.1007/s11427-014-4794-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 11/22/2014] [Indexed: 11/16/2022]
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Plasmacytosis is a common immune signature in patients with MMN and CIDP and responds to treatment with IVIg. J Neuroimmunol 2015; 278:60-8. [DOI: 10.1016/j.jneuroim.2014.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/08/2014] [Accepted: 11/10/2014] [Indexed: 11/21/2022]
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Rezaei N, Abolhassani H, Aghamohammadi A, Ochs HD. Indications and safety of intravenous and subcutaneous immunoglobulin therapy. Expert Rev Clin Immunol 2014; 7:301-16. [DOI: 10.1586/eci.10.104] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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11
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Buttmann M, Kaveri S, Hartung HP. Polyclonal immunoglobulin G for autoimmune demyelinating nervous system disorders. Trends Pharmacol Sci 2013; 34:445-57. [PMID: 23791035 DOI: 10.1016/j.tips.2013.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 05/08/2013] [Accepted: 05/22/2013] [Indexed: 12/13/2022]
Abstract
Demyelinating diseases with presumed autoimmune pathogenesis are characterised by direct or indirect immune-mediated damage to myelin sheaths, which normally surround nerve fibres to ensure proper electrical nerve conduction. Parenteral administration of polyclonal IgG purified from multi-donor human plasma pools may beneficially modulate these misguided immune reactions via several mechanisms that are outlined in this review. Convincing therapeutic evidence from controlled trials now exists for certain disorders of the peripheral nervous system, including Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy, and multifocal motor neuropathy. In addition, there is evidence for potential therapeutic benefits of IgG in patients with chronic inflammatory demyelinating diseases of the central nervous system, including multiple sclerosis and neuromyelitis optica. This review introduces these disorders, briefly summarises the established treatment options, and discusses therapeutic evidence for the use of polyclonal immunoglobulins with a particular emphasis on recent clinical trials and meta-analyses.
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Affiliation(s)
- Mathias Buttmann
- Department of Neurology, University of Würzburg, Josef-Schneider-Str. 11, D-97080 Würzburg, Germany
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12
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Ahsanuddin AN, Brynes RK, Li S. Peripheral blood polyclonal plasmacytosis mimicking plasma cell leukemia in patients with angioimmunoblastic T-cell lymphoma: report of 3 cases and review of the literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2011; 4:416-420. [PMID: 21577327 PMCID: PMC3093066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 04/12/2011] [Indexed: 05/30/2023]
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a unique type of peripheral T-cell lymphoma. Patients with AITL may have occasional reactive plasma cells present in the peripheral circulation. Prominent peripheral blood polyclonal plasmacytosis mimicking plasma cell leukemia, however, is distinctly uncommon. Here we describe 3 such cases from two large tertiary medical centers and discuss the role of ancillary studies in the differential diagnosis of peripheral blood plasmacytosis.
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MESH Headings
- Adult
- Aged
- Blood Cell Count
- Diagnosis, Differential
- Erythrocyte Aggregation
- Female
- Flow Cytometry
- Humans
- Immunoblastic Lymphadenopathy/blood
- Immunoblastic Lymphadenopathy/immunology
- Immunoblastic Lymphadenopathy/pathology
- Immunophenotyping/methods
- Leukemia, Plasma Cell/blood
- Leukemia, Plasma Cell/immunology
- Leukemia, Plasma Cell/pathology
- Lymphoma, T-Cell, Peripheral/blood
- Lymphoma, T-Cell, Peripheral/immunology
- Lymphoma, T-Cell, Peripheral/pathology
- Male
- Middle Aged
- Plasma Cells/immunology
- Plasma Cells/pathology
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Affiliation(s)
- Arshad N Ahsanuddin
- Department of Pathology and Laboratory Medicine, Emory University School of MedicineAtlanta, GA
| | - Russell K Brynes
- Department of Pathology, Keck School of Medicine, University of Southern CaliforniaLos Angeles, CA
| | - Shiyong Li
- Department of Pathology and Laboratory Medicine, Emory University School of MedicineAtlanta, GA
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13
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Walgaard C, Jacobs BC, van Doorn PA. Emerging drugs for Guillain-Barré syndrome. Expert Opin Emerg Drugs 2011; 16:105-20. [DOI: 10.1517/14728214.2011.531699] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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Kuitwaard K, de Gelder J, Tio-Gillen AP, Hop WCJ, van Gelder T, van Toorenenbergen AW, van Doorn PA, Jacobs BC. Pharmacokinetics of intravenous immunoglobulin and outcome in Guillain-Barré syndrome. Ann Neurol 2009; 66:597-603. [DOI: 10.1002/ana.21737] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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15
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Néron S, Boire G, Dussault N, Racine C, de Brum-Fernandes AJ, Côté S, Jacques A. CD40-activated B cells from patients with systemic lupus erythematosus can be modulated by therapeutic immunoglobulins in vitro. Arch Immunol Ther Exp (Warsz) 2009; 57:447-58. [DOI: 10.1007/s00005-009-0048-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 04/29/2009] [Indexed: 01/19/2023]
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Dussault N, Ducas E, Racine C, Jacques A, Paré I, Côté S, Néron S. Immunomodulation of human B cells following treatment with intravenous immunoglobulins involves increased phosphorylation of extracellular signal-regulated kinases 1 and 2. Int Immunol 2008; 20:1369-79. [PMID: 18689724 DOI: 10.1093/intimm/dxn090] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
In the treatment of autoimmune diseases, intravenous Igs (IVIg) are assumed to modulate immune cells through the binding of surface receptors. IVIg act upon definite human B cell populations to modulate Ig repertoire, and such modulation might proceed through intracellular signaling. However, the heterogeneity of human B cell populations complicates investigations of the intracellular pathways involved in IVIg-induced B cell modulation. The aim of this study was to establish a model allowing the screening of IVIg signal transduction in human B cell lines and to attempt transposing observations made in cell lines to normal human B lymphocytes. Nine human B cell lines were treated with IVIg with the goal of selecting the most suitable model for human B lymphocytes. The IgG(+) DB cell line, whose response was similar to that of human B lymphocytes, showed reduced IVIg modulation following addition of PD98059, an inhibitor of extracellular signal-regulated protein kinase 1/2 (ERK1/2). The IVIg-induced ERK1/2 phosphorylation was indeed proportional to the dosage of monomeric IVIg used when tested on DB cells as well as Pfeiffer cells, another IgG(+) cell line. In addition, two other intermediates, Grb2-associated binder 1 (Gab1) and Akt, showed increased phosphorylation in IVIg-treated DB cells. IVIg induction of ERK1/2 phosphorylation was finally observed in peripheral human B lymphocytes, specifically within the IgG(+) B cell population. In conclusion, IVIg immunomodulation of human B cells can thus be linked to intracellular transduction pathways involving the phosphorylation of ERK1/2, which in combination with Gab1 and Akt, may be related to B cell antigen receptor signaling.
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Affiliation(s)
- Nathalie Dussault
- Héma-Québec, Ingénierie cellulaire, Recherche et développement, Sainte-Foy, Québec, Canada
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