Idiopathic thrombocytopenic purpura (ITP): immunomodulation by intravenous immunoglobulin (IVIg).
ITP is a destructive thrombocytopenia. Platelets are coated with antibodies and these opsonized platelets are rapidly removed by phagocytes. On the other hand, therapeutic application of antibody concentrates (IVIg) rapidly raise platelet counts, and in some patients, sustained platelet recovery has been observed. The mechanism of action of IVIg is far from being clear. Several possible mechanism of action of IVIg treatment have been described. The immediate effect of IVIg seems to be a decrease in (unspecific) Fc mediated mononuclear phagocytosis, the long term effect might be a change in the complex network of the regulatory function of the immune response. Both types of interactions seem to play a keyrole in the immunomodulation. The various possible modes of actions evoke investigation of IVIg in a wide range of diseases with similar ineffective immune response. Controlled clinical studies have to be done to prove or disapprove the use of IVIg in other indications.
Imbach
P
P
Inselspital, Bern, Switzerland.
Morell
A
A
D001327:Autoimmune Diseases / Q000276:immunology / Q000628:therapy*; D001792:Blood Platelets / Q000276:immunology; D002648:Child; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000494:pharmacology / Q000627:therapeutic use*; D007153:Immunologic Deficiency Syndromes / Q000628:therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007231:Infant, Newborn; D008297:Male; D018448:Models, Immunological; D015337:Multicenter Studies as Topic; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000276:immunology / Q000628:therapy*; D013156:Splenectomy; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents