Intravenous immunoglobulin therapy: how does IgG modulate the immune system?

Nat Rev Immunol. 2013 Mar;13(3):176-89. doi: 10.1038/nri3401. Epub 2013 Feb 15.

Abstract

Intravenous immunoglobulin (IVIG) preparations comprise pooled IgG antibodies from the serum of thousands of donors and were initially used as an IgG replacement therapy in immunocompromised patients. Since the discovery, more than 30 years ago, that IVIG therapy can ameliorate immune thrombocytopenia, the use of IVIG preparations has been extended to a wide range of autoimmune and inflammatory diseases. Despite the broad efficacy of IVIG therapy, its modes of action remain unclear. In this Review, we cover the recent insights into the molecular and cellular pathways that are involved in IVIG-mediated immunosuppression, with a particular focus on IVIG as a therapy for IgG-dependent autoimmune diseases.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Autoantibodies / immunology
  • Autoimmune Diseases / immunology
  • Autoimmune Diseases / therapy
  • Cell Adhesion Molecules / immunology
  • Clinical Trials as Topic
  • Disease Models, Animal
  • Glycosylation
  • Histocompatibility Antigens Class I / immunology
  • Humans
  • Immunocompromised Host
  • Immunoglobulin Fc Fragments / immunology
  • Immunoglobulin G / immunology
  • Immunoglobulin G / pharmacology
  • Immunoglobulin G / therapeutic use*
  • Immunoglobulin Variable Region / immunology
  • Immunoglobulins, Intravenous / pharmacology
  • Immunoglobulins, Intravenous / therapeutic use*
  • Immunomodulation / drug effects*
  • Immunomodulation / immunology
  • Immunosuppression*
  • Inflammation / immunology
  • Inflammation / therapy
  • Lectins, C-Type / immunology
  • Lymphocyte Subsets / immunology
  • Mice
  • Models, Molecular
  • N-Acetylneuraminic Acid / immunology
  • Protein Conformation
  • Protein Processing, Post-Translational
  • Receptors, Cell Surface / immunology
  • Receptors, Fc / immunology
  • Receptors, IgG / chemistry
  • Receptors, IgG / classification
  • Receptors, IgG / immunology

Substances

  • Autoantibodies
  • Cell Adhesion Molecules
  • DC-specific ICAM-3 grabbing nonintegrin
  • Histocompatibility Antigens Class I
  • Immunoglobulin Fc Fragments
  • Immunoglobulin G
  • Immunoglobulin Variable Region
  • Immunoglobulins, Intravenous
  • Lectins, C-Type
  • Receptors, Cell Surface
  • Receptors, Fc
  • Receptors, IgG
  • N-Acetylneuraminic Acid
  • Fc receptor, neonatal