New treatment strategies for systemic vasculitis: the role of intravenous immune globulin therapy

• Published in: Clinical and experimental immunology Vol. 104; no. Supplement_1; pp. 77 - 82
• Main Author: Lock Wood, C. M.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Oxford Blackwell 01.05.1996
• Subjects: Applied microbiology; Biological and medical sciences; Fundamental and applied biological sciences. Psychology; Humans; Immunoglobulins, Intravenous - therapeutic use; Immunomodulators; IVIG; Medical sciences; Microbiology; microscopic polyangiitis; Pharmacology. Drug treatments; Vaccines, antisera, therapeutical immunoglobulins and monoclonal antibodies (general aspects); vasculitis; Vasculitis - therapy; Wegener's granulomatosis; Human; Immunoglobulins; Intravenous administration; Antibody; Cardiovascular disease; Wegener granulomatosis; Review; Vascular disease; Immunomodulator; Vasculitis; Treatment; Immunotherapy; Systemic disease
• ISSN: 0009-9104; 1365-2249
• DOI: 10.1111/cei.1996.104.s1.77

Intravenous immune globulin (IVIG) is now under evaluation for the treatment of patients with the forms of systemic vasculitis associated with anti‐neutrophil cytoplasmic antibodies (ANCA). Although IVIG may produce effects by a variety of mechanisms, including control of T‐cell function, interference with cytokine action, and Fe receptor blockade, it is the regulation of autoantibody production by B cells, through idiotypic‐anti‐idiotypic reactions, that makes this treatment attractive for patients with systemic vasculitis. The author and others have shown the importance of ANCA idiotypic‐anti‐idiotypic reactions in vitro and demonstrated that these could be influenced by anti‐idiotypic determinants present in IVIG. Thus F(ab′)2 fragments of IVIG could block ANCA binding to antigen, in a dose‐dependent fashion. The degree of inhibition was variable, ranging up to 100% for the ANCA‐containing sera of certain patients. Similar inhibitory activity could be found in the sera of patients in remission after treatment, as well as in occasional patients whose disease remitted spontaneously, without drugs being used. Thus, IVIG appears to be particularly valuable in the management of vasculitis in the elderly, the very young and for pregnant women, as well as for those at any age who are vulnerable to infection.