HUMAN INTRAVENOUS IMMUNOGLOBULIN: CURRENT INDICATIONS IN SMALL ANIMAL MEDICINE

摘要

Human intravenous immunoglobulin (hIVIg) is prepared from pooled plasma of a large number of healthy blood donors. It consists mainly of intact immunoglobulin G (IgG) molecules, and trace of IgA, IgM, soluble CD4, CD8, human leukocyte antigen molecules, and certain cytokines.1'2 The proposed immunodulatory effects of hIVIg are not completely understood and include: fucose (Fc) receptor-mediated effects, modulation of complement, modulation of cytokine production, superantigen neutralization, neutralization antibodies by idiotype network, increased catabolism of IgG, and possible role in apopotosis. Binding of hIVIg to Fc receptors has also been demonstrated to in canine lymphocytes and monocytes in vitro.4 It has been recently demonstrated that mostof the hIVIg properties are associated with a small fraction of Fc fragment-sialylated IgG, which offered the possibility of creating more clinically effective solutions by increasing the Fc-sialylated IgG fraction. The half-life of hIVIg is 21-33 daysin humans and 7-9 days in dogs. Currently, there are only six conditions approved by the United States Food and Drug Administration for "on-label" use of hIVIg, including primary immunoglobulin deficiency, idiopathic thrombocytopenic purpura (ITP), Kawasaki disease, human immunodeficiency virus infection in children, B-cell chronic lymphocytic leukemia, and bone marrow transplantation. In human medicine, hIVIg is administered for "off-label" use in more than 50% of cases, including many hematologic, neurologic, and dermatologic conditions; furthermore, hIVIg is often used in patients with sepsis, septic shock, and nosocomial infections.