From the first attempts at passive immunization with heterologous serum, carried out by von Behring about 100 years ago, the administration of human for prophylactic and therapeutic purposes has gradually become more widespread and it has presently gained acceptance as one of the best known methods of replacement immunotherapy for the primary and secondary immunodeficiency syndromes. Standard Ig preparations still retain their value, their main limitation being the relatively small volume that can be injected intramuscularly. Recently, other preparations have been made available (enriched with IgA or IgM, specific or hyperimmune Ig) which have a greater specificity although sharing the same limitations as the former preparations. A decisive advance has been made by procedures that modify the Ig preparations so that they can be given intravenously, thus allowing the ad- ministration of large quantities of Ig in a short time. Discussion is still open on the indications and optimum dosages for Ig therapy. These appear to be clear and unquestionable in cases of definite deficiencies in humoral immu• nity, but are debatable in severe acute infections (especially if of undetermined etiology) and in recurrent infections of the upper respiratory tract in patients with an apparently normal immune system. The uncertainty in these cases arises from the difficulty of carrying out controlled clinical studies because of the usual delay (and sometimes because of the lack) in the identification of a definite etiology for each individual case, as well as for the general lack of information about the antibody titre of the various preparations. As regards trends and aims for the future, efforts should be directed to the development of preparations that approach as nearly as possible to the following 'ideal' characteristics, namely: a. structural and functional integrity of the Ig molecules; b. a high content of IgM; c. absence of macromolecular aggregates; d. inability to activate complement spontaneously; e. normal survival in vivo; f high antibody titres. Finally, it may be envisaged that, with the increasing development of hybridoma techniques, human monoclonal antibodies will Shortly become available and these will have a useful therapeutic effect in controlling infections of known etiology as well as in regulating the immune response of the patient.
Human immunoglobulins in therapy. Rational basis and clinical applications
Perosa Federico
;
1983-01-01
Abstract
From the first attempts at passive immunization with heterologous serum, carried out by von Behring about 100 years ago, the administration of human for prophylactic and therapeutic purposes has gradually become more widespread and it has presently gained acceptance as one of the best known methods of replacement immunotherapy for the primary and secondary immunodeficiency syndromes. Standard Ig preparations still retain their value, their main limitation being the relatively small volume that can be injected intramuscularly. Recently, other preparations have been made available (enriched with IgA or IgM, specific or hyperimmune Ig) which have a greater specificity although sharing the same limitations as the former preparations. A decisive advance has been made by procedures that modify the Ig preparations so that they can be given intravenously, thus allowing the ad- ministration of large quantities of Ig in a short time. Discussion is still open on the indications and optimum dosages for Ig therapy. These appear to be clear and unquestionable in cases of definite deficiencies in humoral immu• nity, but are debatable in severe acute infections (especially if of undetermined etiology) and in recurrent infections of the upper respiratory tract in patients with an apparently normal immune system. The uncertainty in these cases arises from the difficulty of carrying out controlled clinical studies because of the usual delay (and sometimes because of the lack) in the identification of a definite etiology for each individual case, as well as for the general lack of information about the antibody titre of the various preparations. As regards trends and aims for the future, efforts should be directed to the development of preparations that approach as nearly as possible to the following 'ideal' characteristics, namely: a. structural and functional integrity of the Ig molecules; b. a high content of IgM; c. absence of macromolecular aggregates; d. inability to activate complement spontaneously; e. normal survival in vivo; f high antibody titres. Finally, it may be envisaged that, with the increasing development of hybridoma techniques, human monoclonal antibodies will Shortly become available and these will have a useful therapeutic effect in controlling infections of known etiology as well as in regulating the immune response of the patient.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
