scholarly journals Effect of immunoglobulin G (IgG) interchain disulfide bond cleavage on efficacy of intravenous immunoglobulin for immune thrombocytopenic purpura (ITP)

2010 ◽  
Vol 162 (3) ◽  
pp. 415-424 ◽  
Author(s):  
Y. Machino ◽  
H. Ohta ◽  
E. Suzuki ◽  
S. Higurashi ◽  
T. Tezuka ◽  
...  
Keyword(s):  
Intravenous Immunoglobulin ◽  
Disulfide Bond ◽  
Immunoglobulin G ◽  
Immune Thrombocytopenic Purpura ◽  
Bond Cleavage ◽  
Thrombocytopenic Purpura ◽  
Interchain Disulfide Bond

Response to Intravenous Immunoglobulin Predicts Splenectomy Response in Children With Immune Thrombocytopenic Purpura

PEDIATRICS ◽  
2003 ◽  
Vol 111 (1) ◽  
pp. 87-90
Author(s):  
Derick Holt ◽  
Justin Brown ◽  
Kelly Terrill ◽  
Robert Goldsby ◽  
Rebecka L. Meyers ◽  
...  
Keyword(s):  
Intravenous Immunoglobulin ◽  
Immune Thrombocytopenic Purpura ◽  
Predictive Value ◽  
Chart Review ◽  
Objective Response ◽  
Retrospective Chart Review ◽  
Poor Response ◽  
Thrombocytopenic Purpura ◽  
Excellent Response ◽  
Chronic Itp

Objective. Response to intravenous immunoglobulin (IVIG) has been shown to predict response to splenectomy in adults with immune thrombocytopenic purpura (ITP). However, reports in children have been inconsistent. We sought to determine whether response to IVIG is predictive of response to splenectomy in children. Methods. Thirty-two assessable children were identified by a retrospective chart review. Response was graded according to previously published criteria as follows: “excellent” (platelets >150 000 within 1 week), “good” (platelets between 50 000 and 150 000), and “poor” (platelets <50 000). “Response” refers to both splenectomy and IVIG, and response to splenectomy was counted only when it was durable. Results. Twenty-one of 23 patients who had a good or excellent response to IVIG also had an excellent response to splenectomy. Six of 9 patients who had a poor response to IVIG also had a poor response to splenectomy. Response to IVIG was a sensitive predictor of response to splenectomy in 88% of patients. Response to IVIG had a specificity of 75%, a positive predictive value of 91%, and a negative predictive value of 67%. Response to prednisone and length of time to splenectomy were not correlated with splenectomy response. Conclusions. These results suggest that response to IVIG is predictive of response to splenectomy in children with chronic ITP. This correlation may be of value in deciding whether a splenectomy should be performed in children with chronic ITP.

Relative efficacy of intravenous immunoglobulin G in ameliorating thrombocytopenia induced by antiplatelet GPIIbIIIa versus GPIbα antibodies

Blood ◽  
2006 ◽  
Vol 108 (3) ◽  
pp. 943-946 ◽  
Author(s):  
Michelle Lee Webster ◽  
Ebrahim Sayeh ◽  
Min Crow ◽  
Pingguo Chen ◽  
Bernhard Nieswandt ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Intravenous Immunoglobulin ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Immunoglobulin G ◽  
Ivig Treatment ◽  
Relative Efficacy ◽  
Thrombocytopenic Purpura ◽  
Antiplatelet Antibodies ◽  
Intravenous Immunoglobulin G

Abstract Intravenous immunoglobulin G (IVIG) is used to treat idiopathic thrombocytopenic purpura (ITP). Although many patients benefit from IVIG, some are refractory to this therapy. ITP is characterized by platelet clearance mediated primarily by antiplatelet antibodies against GPIIbIIIa and/or the GPIbα complex. These 2 groups of antibodies may induce ITP through different mechanisms. We tested the hypothesis that IVIG may not be equally effective in preventing ITP caused by anti-GPIIbIIIa versus anti-GPIbα antibodies in mice. Thrombocytopenia was induced in BALB/c mice using monoclonal antibodies against either mouse GPIIbIIIa (JON1, JON2, and JON3) or GPIbα (p0p3, p0p4, p0p5, p0p9, and p0p11). Pretreatment with IVIG significantly ameliorated ITP in all anti-GPIIbIIIa–injected animals. Conversely, IVIG failed to prevent ITP in all anti-GPIbα–treated mice, except for p0p4. These results were repeated in C57BL/6 mice, and with different IVIG preparations. These data in mice suggest that patients with ITP mediated by anti-GPIbα antibodies may be less responsive to IVIG treatment.

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