title: IVIG-pools: regulatory gifts--transiting from harmony toward harmonious immunoglobulins: why? and why not?
abstract: Based on 'initial conditions' which depend on each donors' exposure to a unique environment, a pooled intravenous immunoglobulin (IVIG) product transfers its immunoglobulin molecule repertoire, unchanged, to the altered host. The relay function of the cell-bound receptors, especially that of the inhibitory Fc(gamma)RIIB, may then allow sufficient amplification to make regulatory activity possible. To the clinician, IVIG may be considered a tool to promote reversal of the dysregulation causing autoimmune disease. Generically, IVIG may be seen as a promoter allowing a progression from harm by an inflammatory/fibrotic reaction, then down-regulating toward restitutio ad integrum. By modifying natural processes, IVIG may play minor roles in promoting defense against spontaneous bleeding and, perhaps, stimulating remyelination. The wide spectrum of IVIG specificities, by reflecting evolutionary epitope selection, may not further destabilize cell/molecule disarray in the affected host. Benefit to the patient by IVIG treatment cannot be predicted nor can potentially severe or even fatal accidents entirely be excluded. Important aspects of IVIG treatment still await clarification including dosage, timing and the isotype form. In the foreseeable future it does not seem that biotechnological advances will match the physiologic harmony of IVIG, leaving antibody characteristics aside.
authors.affiliation: rewald@arnet.com.ar
authors.forename: E
authors.initials: E
authors.lastname: Rewald
authors.forename: M M
authors.initials: MM
authors.lastname: Francischetti
authors.forename: U E
authors.initials: UE
authors.lastname: Nydegger
mesh_terms: D000026:Abortion, Habitual / Q000628:therapy; D058186:Acute Kidney Injury / Q000209:etiology; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000915:Antibody Affinity; D000917:Antibody Formation; D000918:Antibody Specificity; D001327:Autoimmune Diseases / Q000276:immunology / Q000628:therapy; D001771:Blood Banks / Q000592:standards; D001787:Blood Group Incompatibility / Q000276:immunology; D003131:Combined Modality Therapy; D003711:Demyelinating Diseases / Q000628:therapy; D004417:Dyspnea / Q000188:drug therapy / Q000628:therapy; D004899:Erythroblastosis, Fetal / Q000517:prevention & control; D005260:Female; D005355:Fibrosis / Q000628:therapy; D006470:Hemorrhage / Q000628:therapy; D006706:Homeostasis / Q000276:immunology; D006801:Humans; D007128:Immunoglobulin Fragments / Q000276:immunology; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use*; D007249:Inflammation / Q000188:drug therapy / Q000276:immunology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000628:therapy; D010951:Plasma Exchange; D011247:Pregnancy; D018805:Sepsis / Q000628:therapy; D013256:Steroids; D013789:Thalassemia / Q000628:therapy
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D007128:Immunoglobulin Fragments; D016756:Immunoglobulins, Intravenous; D013256:Steroids