On the mechanism of high-dose intravenous immunoglobulin treatment of patients with chronic inflammatory demyelinating polyneuropathy.
A proportion of patients with a chronic inflammatory demyelinating polyneuropathy (CIDP) improves after polyvalent intravenous immunoglobulin (IVIg) treatment. When anti-neuroblastoma cell line (NBL) antibodies are present, they decrease or disappear after IVIg treatment. Purified IgM anti-NBL antibodies from a CIDP patient were inhibited by F(ab')2 of IVIg and by F(ab')2 of a patient recovered from Guillain-Barré syndrome (GBS). Inhibition of anti-NBL antibodies was also found among sera from normal individuals. This suggests that the self-limiting character of GBS and the therapeutic effect of IVIg in CIDP are dependent on suppression of auto-antibodies. This suppression may be mediated by anti-idiotypes present in recovered GBS patients and in the normal donor population contributing to IVIg.
Department of Neurology, University Hospital Dijkzigt, Rotterdam, The Netherlands.
P A
PA
van Doorn
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F
Rossi
A
A
Brand
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van Lint
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Vermeulen
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MD
Kazatchkine
D000293:Adolescent; D000328:Adult; D000888:Antibodies, Anti-Idiotypic / Q000096:biosynthesis; D000912:Antibodies, Neoplasm / Q000276:immunology; D001323:Autoantibodies / Q000096:biosynthesis; D002908:Chronic Disease; D003711:Demyelinating Diseases / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007116:Immunization, Passive; D007140:Immunoglobulin Fab Fragments / Q000276:immunology; D008297:Male; D009447:Neuroblastoma / Q000276:immunology; D011129:Polyradiculoneuropathy / Q000276:immunology / Q000628:therapy*
D000888:Antibodies, Anti-Idiotypic; D000912:Antibodies, Neoplasm; D001323:Autoantibodies; D007140:Immunoglobulin Fab Fragments