Rapid and reversible responses to IVIG in autoimmune neuromuscular diseases suggest mechanisms of action involving competition with functionally important autoantibodies

作者: Melvin Berger , Daniel E. McCallus , Cindy Shin‐Yi Lin

DOI: 10.1111/JNS5.12048

关键词:

摘要: Intravenous immunoglobulin (IVIG) is widely used in autoimmune neuromuscular diseases whose pathogenesis undefined. Many different effects of IVIG have been demonstrated vitro, but few studies actually identify the mechanism(s) most important vivo. Doses and treatment intervals are generally chosen empirically. Recent Guillain-Barre syndrome chronic inflammatory demyelinating polyneuropathy show that some readily reversible highly dependent on serum IgG level. This suggests autoantibody-mediated diseases, directly competes with autoantibodies reversibly interfere nerve conduction. Mechanisms action which likely involve direct competition include: neutralization by anti-idiotypes, inhibition complement deposition, increasing catabolism pathologic antibodies saturating FcRn. Indirect immunomodulatory not as to may same reversibility dose-dependency. Pharmacodynamic analyses should be informative regarding relevant well role immunopathogenesis each disease. Better understanding target(s) could lead more efficient use this therapy better patient outcomes.

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