A review of intravenous immunoglobulin in the treatment of neuroimmune conditions, acute COVID-19 infection, and post-acute sequelae of COVID-19 Syndrome

IF 8.8 2区 医学 Q1 IMMUNOLOGY
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引用次数: 0

Abstract

Intravenous immunoglobulin (IVIG) is an immunomodulatory therapy that has been studied in several neuroimmune conditions, such as Guillain-Barré Syndrome, chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy, and multiple sclerosis. It has also been proposed as a potential treatment option for acute COVID-19 infection and post-acute sequelae of SARS-CoV-2 infection (PASC). IVIG is thought to function by providing the recipient with a pool of antibodies, which can, in turn, modulate immune responses through multiple mechanisms including neutralization of cytokines and autoantibodies, saturation of neonatal fragment crystallizable receptors, inhibition of complement activation, and regulation of T and B cell mediated inflammation. In acute COVID-19, studies have shown that early administration of IVIG and plasmapheresis in severe cases can reduce the need for mechanical ventilation, shorten ICU and hospital stays, and lower mortality. Similarly, in PASC, while research is still in early stages, IVIG has been shown to alleviate persistent symptoms in small patient cohorts. Furthermore, IVIG has shown benefits in another condition which has symptomatic overlap with PASC, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), though studies have yielded mixed results. It is important to note that IVIG can be associated with several potential adverse effects, such as anaphylaxis, headaches, thrombosis, liver enzyme elevations and renal complications. In addition, the high cost of IVIG can be a deterrent for payers and patients. This review provides a comprehensive update on the use of IVIG in multiple neuroimmune conditions, ME/CFS, acute COVID-19, and PASC, as well as covers its history, production, pricing, and mechanisms of action. We also identify key areas of future research, including the need to optimize the use of Ig product dosing, timing, and patient selection across conditions, particularly in the context of COVID-19 and PASC.
静脉注射免疫球蛋白治疗神经免疫疾病、COVID-19 急性感染和 COVID-19 综合征急性后遗症的综述。
静脉注射免疫球蛋白(IVIG)是一种免疫调节疗法,已在吉兰-巴雷综合征、慢性炎症性脱髓鞘性多发性神经病、多灶性运动神经病和多发性硬化症等多种神经免疫疾病中进行过研究。此外,它还被建议作为治疗 COVID-19 急性感染和 SARS-CoV-2 感染急性后遗症(PASC)的潜在疗法。人们认为,IVIG 的功能是为受体提供抗体池,进而通过多种机制调节免疫反应,包括中和细胞因子和自身抗体、饱和新生儿片段可结晶受体、抑制补体活化以及调节 T 细胞和 B 细胞介导的炎症。对于急性 COVID-19,研究表明,在严重病例中尽早使用 IVIG 和血浆置换可减少机械通气的需要,缩短重症监护室和住院时间,并降低死亡率。同样,尽管对 PASC 的研究仍处于早期阶段,但在小规模患者群体中,IVIG 已被证明可减轻持续症状。此外,IVIG 对另一种与 PASC 症状重叠的疾病--肌痛性脑脊髓炎/慢性疲劳综合征(ME/CFS)也有疗效,但研究结果不一。值得注意的是,IVIG 可能会带来一些潜在的不良反应,如过敏性休克、头痛、血栓形成、肝酶升高和肾脏并发症。此外,IVIG 的高昂费用也会让付款人和患者望而却步。本综述全面介绍了 IVIG 在多种神经免疫疾病、ME/CFS、急性 COVID-19 和 PASC 中的最新应用,并涵盖了其历史、生产、定价和作用机制。我们还确定了未来研究的关键领域,包括需要优化 Ig 产品在不同病症中的使用剂量、时机和患者选择,尤其是在 COVID-19 和 PASC 的情况下。
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来源期刊
CiteScore
29.60
自引率
2.00%
发文量
290
审稿时长
28 days
期刊介绍: Established in 1987, Brain, Behavior, and Immunity proudly serves as the official journal of the Psychoneuroimmunology Research Society (PNIRS). This pioneering journal is dedicated to publishing peer-reviewed basic, experimental, and clinical studies that explore the intricate interactions among behavioral, neural, endocrine, and immune systems in both humans and animals. As an international and interdisciplinary platform, Brain, Behavior, and Immunity focuses on original research spanning neuroscience, immunology, integrative physiology, behavioral biology, psychiatry, psychology, and clinical medicine. The journal is inclusive of research conducted at various levels, including molecular, cellular, social, and whole organism perspectives. With a commitment to efficiency, the journal facilitates online submission and review, ensuring timely publication of experimental results. Manuscripts typically undergo peer review and are returned to authors within 30 days of submission. It's worth noting that Brain, Behavior, and Immunity, published eight times a year, does not impose submission fees or page charges, fostering an open and accessible platform for scientific discourse.
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