PubMed · 7118285
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F Keller, G Schultze, G Offermann, M Molzahn. 1982. Plasma exchange--how does it work?. https://pubmed.ncbi.nlm.nih.gov/7118285/
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Intravenous immunoglobulins (IVIG) were found to contain anti-idiotypic antibodies against autoantibodies of various autoimmune diseases. We examined commercial IVIG preparations, from three different manufactures, for the presence of autoantibodies and anti-idiotypic antibodies of two rare autoimmune diseases--primary biliary cirrhosis [anti-pyruvate dehydrogenase (PDH) antibodies] and Goodpasture's syndrome (anti-NC1 antibodies). We used ELISA studies as well as immunoblotting and anti-PDH enzyme activity for the detection of anti-PDH antibodies. ELISA and immunofluorescence studies were used for the detection of anti-NC1 antibodies. The presence of anti-idiotypic activity against anti-PDH fragments on Sepharose-bound IVIG [F(ab)2]. Anti-anti-NC1 activity was evaluated employing inhibition ELISA and immunofluorescence studies. The commercial IVIG preparations that were examined did not contain anti-PDH or anti-NC1 antibodies nor anti-idiotypic activity against these autoantibodies. We conclude that commercial IVIG may lack anti-idiotypic activity against rare autoantibodies.
The pulmonary-renal syndrome is defined by the association of alveolar hemorrhage and rapidly progressive glomerulonephritis. Goodpasture syndrome and necrotizing vasculitides are the most frequent causes. New serologic markers are currently more rapidly available (anti-glomerular basement membrane--anti-GBM--and antineutrophil cytoplasmic antibodies -ANCA), allowing clinicians to identify and distinguish these 2 entities, and to hasten the initiation of a pulse therapy, now well standardized, which improves the outcome of patients. However, these 2 serologic markers have limitations so that clinical assessment and renal biopsy remains essential in the diagnosis of pulmonary-renal syndrome. The authors propose an algorithmic approach for those confronted with such a condition.