Novel preparations enriched in IgM may have some promise, but to date results are inconsistent ( 7, 8). However, large randomized clinical trials have failed to show consistent benefit in terms of prevention or outcomes from septic episodes ( 4– 6). Rationally, those infants who are premature or suffer from very low birth weights should benefit from the immune supplementation provided by IVIg. IVIg is commonly used in the prevention or treatment of neonatal sepsis. IVIg is used as a primary treatment for ITP, Kawasaki Syndrome (KS), Guillain–Barré syndrome, myasthenia gravis, chronic inflammatory demyelinating polyneuropathy, systemic lupus erythematosus, and other autoimmune and neurologic disorders ( 3). Since then, there has been a progressive increase in the use of IVIg in patients with a wide variety of autoimmune and inflammatory disorders. ( 2), in the early 1980s, demonstrated that administration of high doses of human polyclonal IgG in children with immune deficiency who concomitantly suffered from immune thrombocytopenic purpura (ITP) had a dramatic increase in platelet counts. IgG has been the standard treatment for primary immunodeficiency diseases since Bruton’s identification of a patient with agammaglobulinemia in the early 1950s ( 1). Intravenous immunoglobulin (IVIg) is prepared from polyclonal immunoglobulin G (IgG) purified from pooled plasma samples of several thousand healthy donors.
In this review, we discuss data on the potential mechanisms contributing to the interaction between IVIg and the regulatory T-cell compartment. The ability of IVIg to influence Treg induction has been shown both in animal models and in human diseases. IVIg alters dendritic cell function, cytokine and chemokine networks, and T lymphocytes, leading to development of regulatory T cells. Recent data indicate that IVIg increases both the number and the suppressive capacity of regulatory T cells, a subpopulation of T cells that are essential for immune homeostasis. The mode of action of IVIg has been investigated in multiple disease states, with various mechanisms described to account for its benefits. Intravenous immunoglobulin (IVIg) is a polyclonal immunoglobulin G preparation with potent immunomodulatory properties. 4Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, QC, Canada.3Infectious Diseases and Immunity in Global Health Program, The Research Institute of the McGill University Health Centre, Montreal, QC, Canada.2Laboratory of Cellular and Molecular Immunology, University of Montreal Hospital Research Centre, Montreal, QC, Canada.1Translational Research in Respiratory Diseases Program, The Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
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