A disease-specific fraction isolated from IVIG is essential for the immunosuppressive effect of IVIG in experimental autoimmune myasthenia gravis.

Intravenous immunoglobulin (IVIG) treatment is beneficially used in autoimmune disorders including myasthenia gravis (MG) although its mode of action and active components are still not fully identified. In an attempt to isolate from IVIG a disease-specific suppressive fraction, IVIG was passed on columns of IgG from rats with experimental autoimmune MG (EAMG) or from MG patients. These chromatographies resulted in depletion of the suppressive activity of IVIG on rat EAMG whereas the minute amounts of IgG fractions eluted from the EAMG- or MG-specific columns retained the immunosuppressive activity of IVIG. These results demonstrate that a minor disease-specific immunoglobulin fraction present in IVIG is essential for its suppressive activity.

[Nummular headache: 21 new cases and therapeutic results].

OBJECTIVE: To evaluate the clinical feature of nummular headache and the efficiency of treatment in China. METHOD: The data of 21 NH patients treated from February 2006 to February 2008, were analyzed. RESULTS: They were 9 men, 12 women, aged 37 +/- 12 (18 - 63) years. Headache history ranged from 7 days to 30 years. 13 patients reported head pain confined to a circular area of 0.6 to 5 centimeter, and the other 8 patients had pain in an elliptical area of 1 - 2 centimeter x 1.5 - 3 centimeter. The symptomatic area was located in the parietal (n = 7), occipital(n = 8), temporal (n = 6), or border regions between temporal and parietal (n = 1). The right side was affected in 10 patients and the left side in the 9 patients, the middle of occipital and parietal areas were affected in 1 patient, respectively. Seven patients had mild pain, 8 patients had moderate pain and 6 patients had severe pain. The characteristics of headache included stabbing pain (n = 6), sharp pain (n = 3), pulsating apin (n = 3), grinding pain (n = 1), exploding pain (n = 5), included light-dull apin (n = 3). Three patients were treated by local nerve block with lidocaine plus dexamethasone phosphate/acetate and one of them got some 30 hours of prominent pain relief, no relief was obtained for other two patients. One patient obtained pain remission by acupuncture after amitriptyline, paroxetine had been tried ineffectively. One patient, woman, 38 years old, was treated by carbamazepine (tegretol) and amitriptyline for 3 months and pain relief was obtained gradually and the head pain disappeared finally. 8 patients were treated effectively by amitriptyline combining indomethacium, ibuprofen or carbamazepine. One patient was treated effectively by nimodipine. 2 patients were treated ineffectively by amitriptyline combining indomethacium. 4 patients were not treated. 3 patients were lost to follow-up. CONCLUSION: NH is not very rare and some of NH patients may be treated effectively by acupuncture or amitriptyline combining indomethacium, ibuprofen or carbamazepine.

Suppression of experimental autoimmune myasthenia gravis by intravenous immunoglobulin and isolation of a disease-specific IgG fraction.

Intravenous immunoglobulin (IVIG) administration has been beneficially used for the treatment of a variety of autoimmune diseases including myasthenia gravis (MG). We have demonstrated that IVIG administration in experimental autoimmune MG (EAMG) results in suppression of disease that is accompanied by decreased Th1 cell and B cell proliferation. Chromatography of pooled human immunoglobulins (IVIGs) on immobilized IgG, isolated from rats with EAMG, results in a complete depletion of the suppressive activity of the IVIG. Moreover, the eluate from this EAMG-specific antibody column retains the immunosuppressive activity of IVIG. This study supports the notion that the therapeutic effect of IVIGs is mediated by an antigen-specific anti-immunoglobulin (anti-idiotypic) activity that is essential for its suppressive activity.

Intravenous immunoglobulin suppresses experimental myasthenia gravis: immunological mechanisms.

Intravenous immunoglobulin (IVIG) administration has been beneficially used in the treatment of several autoimmune disorders including myasthenia gravis (MG), although its mechanism of action is still not clear. To study the optimal conditions of IVIG treatment and delineate its mechanism of action we established a suitable model in rat experimental autoimmune MG (EAMG). We show that IVIG has a suppressive effect on the clinical symptoms of ongoing EAMG that is associated with decreased AChR-specific cellular and humoral immune reactivity. Costimulatory factors and cytokine profile analyses suggest that IVIG immunomodulation in EAMG involves suppression of B and Th1-type T cell responses with no generation of T-regulatory cells. Our data contribute to the understanding of the immunological mechanisms underlying IVIG treatment in MG and in other autoimmune disorders.