Intravenous Immunoglobulin
(IVIg)
Presentation by Sydney Santos
Peer-reviewed by Athira Eruthodi & Navya Tanniru
Introduction:
As a treatment, immunoglobulin (gammaglobin, or IgG) comes in an intravenous form (IVIg) and contains the polyspecific IgG of several thousand plasma donors. Its benefits come from how it targets detrimental inflammatory responses (Hartung et al., 2009). While the majority of IVIg research has historically focused on its autoimmune effects, more recent studies have been focusing on neurological ailments of the nervous system. It is especially promising for treating CNS injuries through its ability to access the Blood-Brain Barrier, as well as increasing its long-term durability (St-Amour et al., 2013). Using IVIg to treat Guillain-Barre Syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) has been FDA-approved (Lünemann et al., 2016). IvIg is very effective in reducing associated symptoms (Liu et al., 2018). IVIg has been found to help acute brain injuries from trauma or strokes as well (Thom et al., 2017). Myasthenia gravis, multifocal motor neuropathy, dermatomyositis, Post-polio syndrome also have the potential to be treated by IVIg, although more research needs to be done (Patwa et al., 2012). IVIg therapy is delivered intravenously and has minimal side effects if administered in a low-dose over an extended period of time.
Future Research
Further investigate the mechanisms of IVIg, specifically how its different parts interact with each other.
Study how IVIg interacts with the blood-brain barrier, on a short and long-term basis.
Continue research on other neurodegenerative diseases that show promise after treatment with IVIg, especially acute brain injury.
References
Gorson, K. C. (2012). An update on the management of chronic inflammatory demyelinating polyneuropathy. Therapeutic Advances in Neurological Disorders, 5(6), 359–373. https://doi.org/10.1177/1756285612457215
Guo, Y., Tian, X., Wang, X., & Xiao, Z. (2018). Adverse effects of immunoglobulin therapy. Frontiers in Immunology, 9(JUN), 1–13. https://doi.org/10.3389/fimmu.2018.01299
Hartung, H. P., Mouthon, L., Ahmed, R., Jordan, S., Laupland, K. B., & Jolles, S. (2009). Clinical applications of intravenous immunoglobulins (IVIg) - Beyond immunodeficiencies and neurology. Clinical and Experimental Immunology, 158(SUPPL. 1), 23–33. https://doi.org/10.1111/j.1365-2249.2009.04024.x
Katz, U., Achiron, A., Sherer, Y., & Shoenfeld, Y. (2007). Safety of intravenous immunoglobulin (IVIG) therapy. Autoimmunity Reviews, 6(4), 257–259. https://doi.org/10.1016/j.autrev.2006.08.011
Liu, S., Dong, C., & Ekamereno, E. (2018). syndrome Immunotherapy of Guillain-Barr e. 14(11), 2568–2579.
Lünemann, J. D., Quast, I., & Dalakas, M. C. (2016). Efficacy of Intravenous Immunoglobulin in Neurological Diseases. Neurotherapeutics, 13(1), 34–46. https://doi.org/10.1007/s13311-015-0391-5
Patwa, H. S., Chaudhry, V., Katzberg, H., So, Y. T., Rae-Grant, a D., & So, Y. T. (2012). Evidence-based guideline : Intravenous immunoglobulin in the treatment of neuromuscular disorders. Neurology, 78, 1009–1015. https://doi.org/10.1212/WNL.0b013e31824de293
St-Amour, I., Paré, I., Alata, W., Coulombe, K., Ringuette-Goulet, C., Drouin-Ouellet, J., Vandal, M., Soulet, D., Bazin, R., & Calon, F. (2013). Brain bioavailability of human intravenous immunoglobulin and its transport through the murine blood-brain barrier. Journal of Cerebral Blood Flow and Metabolism, 33(12), 1983–1992. https://doi.org/10.1038/jcbfm.2013.160
Thom, V., Arumugam, T. V., Magnus, T., & Gelderblom, M. (2017). Therapeutic potential of intravenous immunoglobulin in acute brain injury. Frontiers in Immunology, 8(JUL), 1–15. https://doi.org/10.3389/fimmu.2017.00875
van Doorn, P. A. (2013). Diagnosis, Treatment, and Prognosis of Guillain-Barre Syndrome (GBS). Presse Medicale, 42(6 Pt 2), e193–e201. https://doi.org/10.1016/j.lpm.2013.02.328
Images: https://emedicine.medscape.com/article/210367-overview