Intravenous gammaglobulin treatment in patients with hypogammaglobulinaemia.

Intravenous gammaglobulin was compared with the standard British intramuscular preparation in patients with hypogammaglobulinaemia and chronic bronchitis. Five patients were given six months'' treatment with the weekly intramuscular preparation and six months'' treatment with intravenous gammaglobulin given once every 18 days. During the trial they recorded symptoms of infection, absence from work, and sputum volume; lung function tests were performed during the intravenous treatment. The half life of the intravenous IgG and changes in serum IgG and C1q concentrations were also measured in seven other patients who received intravenous gammaglobulin every two weeks for 12 weeks. IgG concentrations, sputum volume, and infection scores were significantly better during intravenous treatment and there were no adverse effects from the intravenous gammaglobulin. These five patients were significantly more healthy when they received an intravenous gammaglobulin preparation, probably because the intravenous preparation increased serum IgG concentrations. Although longer studies are needed, intravenous gammaglobulin should be considered for patients with severe chest disease and those who cannot tolerate intramuscular injections.     

ITP in pregnancy: use of the bleeding time as an indicator for treatment

ITP is a relatively common disorder seen in pregnancy. Current recommendations for management of patient with ITP recommend maintaining the platelet count above 50 x 10(9)/L and the bleeding time less than 20 min. It has been well documented that the bleeding time in ITP is disproportionately shortened in many patients relative to the platelet count. We present a prospective study of 24 ITP patients in whom the bleeding time was used as an indicator for therapeutic intervention in pregnancy. Indications for therapy with prednisone and/or intravenous gammaglobulin were the following: significant clinical hemorrhage due to thrombocytopenia; bleeding time of greater than 20 min at the baseline platelet count; for normalization of hemostasis prior to delivery or surgical procedure. Caesarean section was performed only in cases in which there were obstetrical indications for this mode of delivery or when the fetal platelet count (obtained by fetal scalp vein sample) was less than 50 x 10(9)/L. Of 24 patients with ITP, eight had significant thrombocytopenia (platelet count less than 50 x 10(9)/L) throughout pregnancy. Only two patients required prolonged prednisone therapy. Both suffered side effects of chronic prednisone administration. Four patients were treated with prednisone for a short course (10-14 days) at term to improve hemostasis for delivery. One patient was treated with intravenous gammaglobulin at term in an effort to prevent severe neonatal thrombocytopenia. Seven patients required caesarean section; the remaining 17 patients underwent vaginal delivery. Only one minor bleeding complication was seen - a small wound hematoma post caesarean section. In summary, using the bleeding time as an indicator for therapeutic intervention, treatment of ITP in pregnancy can be minimized. Thus, therapy related toxicity can be avoided.     

Assessment of British Gammaglobulin in Preventing Infectious Hepatitis

A series of 87 controlled trials of the effectiveness of British gammaglobulin in preventing infectious hepatitis in schools and other institutions showed that gammaglobulin is very effective in these circumstances. No protection was given for the first two weeks after injection, probably because it was given during the incubation period of the hepatitis.The risks of developing hepatitis in contacts was found to vary greatly. In day schools there was usually little tendency for the disease to spread among the population, but the pupils in closest contact were at greater risk. In mental hospitals and children''s homes, on the other hand, the tendency for the disease to spread was more pronounced.     

Evaluation of test immunisation in the assessment of antibody deficiency syndromes.

Antibody responses after immunisation with pneumococcal polysaccharide did not correlate with the severity and frequency of infections in 22 patients with severe hypogammaglobulinaemia, when these were measured by a Farr radioimmunoassay. Five "healthy" patients with severe hypogammaglobulinaemia not only failed to make antipneumococcal polysaccharide antibody, when measured by radioimmunoassay, but also had very low or unrecordable antibody responses to Escherichia coli and failed to produce antibody when immunised with tetanus toxoid. Some of these subjects, however, did make small amounts of IgM antipneumococcal polysaccharide antibody when this was measured by an enzyme linked immunosorbent assay, while others retained some ability to produce IgM or IgA or both in their saliva. These findings show that the measurement of serum antibody responses after immunisation, with the possible exception of IgM antibodies to polysaccharides, is unlikely to be helpful in assessing the requirement for gammaglobulin replacement therapy in patients with hypogammaglobulinaemia.     

Number of gammaglobulin containing cells after the single local administration of antigen

The number of cells containing gammaglobulin in the regional lymphatic nodes of rabbits during the response to the single local dose of diphtheria toxoid was demonstrated using immunofluorescent technique. Antigen-dependent increase of the number of IgG—containing cells in regional lymph nodes was found. The possible source of the gammaglobulin without demonstrable specificity to the administered antigen is discussed. Dedicated to Academician Ivan Málek on the occasion of his 60th birthday     

Prevention of Rh-haemolytic Disease: Final Results of the “High-risk” Clinical Trial: A COMBINED STUDY FROM CENTRES IN ENGLAND AND BALTIMORE

The final results are reported of a trial of about 1,000 μg of anti-D gammaglobulin given intramuscularly to a selected high-risk group of Rh-negative primiparae just delivered of an ABO-compatible Rh-positive baby, the aim being to prevent them becoming immunized to Rh. Six months after delivery only 1 out of 173 treated mothers had been immunized as against 38 out of 176 controls. The crucial test of the prophylactic therapy depends on the presence or otherwise of anti-D at the end of a second Rh-positive pregnancy. Of 86 treated mothers two had antibodies at this time compared with 20 out of 65 controls.The results show a high degree of protection in this group of mothers.     

Gammaglobulin treatment and anti-IgA antibodies in IgA-deficient patients.

Antibodies to IgA may cause severe anaphylactic reactions during blood transfusions. Tests for anti-IgA antibodies were carried out on six patients with IgA deficiency (five of whom also had hypogammaglobulinaemia) who had received continuous gammaglobullin treatment for chronic or recurrent infections for three to eight years. Three patients had minute amounts of IgA, and three had none (less than 0.01 microgram/ml). Only one patient had anti-IgA. Her antibody titre did not change during treatment. No patient had any untoward effects of treatment, which relieved the symptoms of infection in every case. IgA determinations should be performed by more accurate methods than radial immunodiffusion when evaluating the risks of giving gammaglobulin to patients with hypogammaglobulinaemia and IgA deficiency. Probably the stimulus provided by intramuscular gammaglobulin in such patients is insufficient for the formation of anti-IgA antibody.     

A patient with Graves' disease who developed hypothyroidism associated with thyroid stimulation blocking immunoglobulin during anti-thyroid drug therapy

A girl, 12 years of age, developed Graves' disease compounded with rheumatic fever and idiopathic thrombocytopenic purpura. Thrombocytopenia improved under short-term treatment with steroids and her mitral valvular insufficiency, due to the rheumatic fever, disappeared 4 years later. Initially, she had been treated with propylthiouracil (PTU) for 28 months. She suffered a relapse 9 months after stopping PTU and so she was given further PTU therapy. However, hypothyroidism developed 11 months after the initiation of therapy and continued, though further PTU treatment was discontinued. She now receives 1-thyroxine and maintains a euthyroid state. At the onset of the patient's hyperthyroidism, the TSH-binding inhibitor immunoglobulin (TBII) and the thyroid stimulating antibodies (TSAb) were found to be positive. During the remission period, only the thyroid stimulation blocking immunoglobulin (TSBI) was weakly positive. At relapse, only TBII was mildly positive. When hypothyroidism developed, both TBII and TSBI were positive, and TSAb was negative in all testings of her diluted IgGs. The patient's TBII and thyroid dysfunction were unaffected by high-dose intravenous gammaglobulin therapy or by treatment with prednisolone 0.5 mg/kg/day for 2 weeks. In conclusion, the emergence of TSBI during or after anti-thyroid drug therapy might possibly lead to hypothyroidism in patients with Graves' disease.     

Morphogenesis and pathogenesis of chronic lung diseases. XX. Effects of repeated hypersensitivity reactions upon experimental immuno-granulomas of the lung

In order to analyse the effects of repeated hypersensitivity reactions upon chronic lung lesions, lung granulomas were experimentally induced in rabbits by an intravenous injection of 1 ml of the complete Freund's adjuvant added with 10 per cent human gammaglobulin. Groups of rabbits with 14- and 21-day-granulomas were intratracheally challenged with 1.000 I.U. human gammaglobulin injected two or three times at 7-9 days interval. The responses of the lung tissue were of the Arthus type with neutrophil granulocytic accumulations and proteasic action; the intensity of cell accumulations was decreasing after the 2nd and 3rd challenge. The lesional evolution after challenge showed intra- and perigranulomatous infiltrations with alkaline-phosphatase positive lymphocytes and plasma cells. The density of the intragranulomatous reticulin network developed after the hypersensitivity reactions increased progressively and was morphometrically assessed as statistically significant. Cellular and fibrillar lesions led to the restructuring of the lung tissue.     

Antibody prophylaxis of varicella in immunosuppressed patients

ZIG prophylaxis was administered to a total of 39 children immunosuppressed under antitumour therapy and presenting a negative varicella history. Varicella developed in only 2 of them. 47 children received a substitutive prophylaxis consisting of ordinary gammaglobulin NORGA. Fourteen of the children fell ill with varicella, two of the cases being complicated. With a few exceptions, the cases represented hospital contacts, because most children with anticancer therapy are in hospital. The difference between the numbers of varicella cases after ZIG and after NORGA was statistically highly significant in the group of seronegative children. On the other hand, the difference between the numbers of cases among preprophylactically seropositive children in both prophylactic groups was not substantial. Varicella was not encountered either among children with a titre of minimally 1:128 at the time of contact with the disease. In contrast, varicella developed in 20-30% of children with a titre of at most 1:64. Four children were serologically followed up for 35-49 days after the injection of ZIG. The degradation of VZV antibodies in these children under immunosuppression was far more rapide than that of known passively transferred IgG in normal individuals. In states of deep immunosuppression a quantitatively or qualitatively different mechanism of passively transferred antibody clearance is probably involved.     

Prophylactic use of human endotoxin-core hyperimmune gammaglobulin to prevent endotoxaemia in colostrum-deprived, gnotobiotic lambs challenged orally with Escherichia coli

Abstract The efficacy of human IgG polyclonal antibody to endotoxin-core in preventing endotoxaemia and subsequent disease was studied in colostrum-deprived gnotobiotic lambs challenged orally at about 5 h old with 10⁹ cfu Escherichia coli . Human endotoxin-core hyperimmune gammaglobulin was given intravenously to 5 lambs at 1.9 g IgG/kg bodyweight prior to challenge. Human albumin was given intravenously to 3 control lambs. Bacteraemia was observed in all lambs, but the incidence was lower ( P < 0.01) and the onset later ( P < 0.05) in gammaglobulin pre-treated lambs. These lambs showed no signs of disease, whereas clinical endotoxaemia, manifesting as watery mouth disease, was diagnosed in 2 of the 3 control lambs which were killed between 18 and 22 h after challenge. Thus, prophylactic treatment of colostrum-deprived lambs with human IgG enriched in endotoxin-core antibodies was effective in reducing the degree of bacteraemia and preventing endotoxaemia, leukopenia and clinical disease following oral challenge with E. coli .     

Local production of antibodies to leptospira pomona in kidneys of chronically infected skunks (Mephitis mephitis)

The kidneys of skunks chronically infected with Leptospira pomona contained a conspicuous number of plasma cells. From comparative studies of overall gammaglobulin content and specific antibody titers in sera and kidney extracts it was concluded that specific antibodies to L. pomona were synthesized in the kidneys of skunks with renal leptospirosis.     

Prevention of hepatitis C in partners of anti-HCV positive subjects by periodic gammaglobulin administration.

Since hepatitis C is sexually transmitted, this poses the problem of protecting the anti-HCV negative partners of anti-HCV positive subjects. Since no specific prophylaxis exists for hepatitis C, I suggest that 4 ml of normal human gammaglobulin should be given to the anti-HCV negative partners intramuscularly every two months until a vaccine against hepatitis C virus is available.     

Polyarthritis in adults with hypogammaglobulinaemia and its rapid response to immunoglobulin treatment.

Five patients with primary hypogammaglobulinaemia developed a severe polyarthritis that had some features in common with rheumatoid arthritis. Their joint disease could be distinguished from rheumatoid arthritis, however, by the dramatic improvement after gammaglobulin treatment. The arthritis of hypogammaglobulinaemia can, therefore, be included among the few potentially curable polyarthritides.     

Treatment of Neonatally Aleutian Disease Virus (ADV) Infected Mink Kits with Gammaglobulin Containing Antibodies to ADV Reduces the Death Rate of Mink Kits

Aleutian disease virus (ADV) can cause pneumonitis in newborn kits up to 3 weeks old. In many cases the pneumonitis is fatal, but can be reduced by treatment with antibodies to ADV. The present report describes antibody therapy in both experimentally infected mink kits and in mink kits from a farm, where an ADV epidemic developed during the whelping period in the spring of 1987. In both cases the antibody treatment was found to have a beneficial effect on the survival rate of the mink kits. One hundred percent survival rate was found for the experimentally infected mink kits. The most pronounced effect for the naturally infected mink was found in the wildtype mink kits, where the death rate was 9.6 % for the antibody treated group versus 16.9 % for the untreated group (p < 0.001). In general the success rate of the gammaglobulin treatment seemed to correlate with the ADV-infection level in the mink sheds. The highest success rate was found in the sheds with the highest ADV-infection level (the standard and wildtype mink), while no effect whatsoever was found for the pearl mink, which were placed in a shed with a low ADV-infection level.     

Hematochemical parameters in sheep and goats of Sardinian breeds. I) Electrophoretic picture of plasma proteins

It has been studied the electrophoretic picture of plasma proteins of lactating and dry sheep and goats of Sardinian-breed. The values of the single fractions obtained for the four different groups of subjects have been compared with the "t of Student". The statistically significant differences between values of albumin and gammaglobulin fractions obtained comparing sheep and goats can probably derive from genetic factors. In general significant differences in values of several fractions associated with lactation have not been noticed.     

A heat polyethylene glycol procedure as an alternative method for plasmafractionation

Polyethylenglycol 4000 was used in a combined process of fractionation at normal temperature for preparing gammaglobulin and albumin in a heat denaturation process. Albumin can be gained from human plasma with a high yield and purity by using a heat procedure at the presence of polyethylglycol 4000 and sodium octanate at 75 degrees C. The concentration of polyethylglycol 4000 varies during this heat procedures from 3-10% W/V.     

Prevention of Rh-haemolytic Disease: Results of the Liverpool “Low-risk” Clinical Trial

A clinical trial is reported in which Rh-negative primiparae, just delivered of an Rh-positive ABO-compatible infant and in whom fetal cell counts after delivery suggested less than 0·2 ml of circulating fetal blood, were treated with about 200 μg of anti-D gammaglobulin. Three (0·36%) out of 844 women thus treated developed anti-D in the subsequent six months; this is 10% of the incidence in untreated controls. Three (1·8%) out of 171 treated mothers had anti-D at the end of the second Rh-positive pregnancy, and this is 18% of the incidence in controls.Possible reasons for the occasional failure of the treatment are discussed and the results of this trial are compared with those of a previous trial in which 1,000 μg or more of anti-D was given to a different group of mothers. The combined results of the two trials lead to the conclusion that the passive administration of anti-D gammaglobulin after delivery affords in this population of Rh-negative women a 95% protection rate in the postdelivery period and an 89% protection rate by the end of the subsequent pregnancy.     

Quantitative behavior of B-lymphocytes in infection susceptible children following a single therapeutic substitution with human gamma globulin]

In 15 children with a lowered gammaglobulin level a single substitution with HGG was made, with the impact of this substitution on the number of B-cells in the peripheral blood being examined by means of the direct fluorescence antibody technique. In 9 from 15 children the substitution had no influence on the number of B-cells. However, a significant increase of the number of B-cells could be observed in 6 from 15 children. 14 days after the substitution the number of B-cells lay within the normal range again.