Impact de la thérapie immunoglobuline dans la maladie pédiatrique: une revue des mécanismes immunitaires
Traduction: G.M.
- 1Department of Allergy-Immunology, Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA, priscilla.wong@us.af.mil
Abstract
Intravenous immunoglobulin (IVIG) provides replacement therapy in immunodeficiency and immunomodulatory therapy in inflammatory and autoimmune diseases. This paper describes the immune mechanisms underlying six major non-primary immunodeficiency pediatric diseases and the diverse immunomodulatory functions of IVIG therapy.
Les immunoglobulines intraveineuses (IgIV) offrent une thérapie de remplacement de l'immunodéficience et le traitement immunomodulateur dans les maladies inflammatoires et auto-immunes. Ce document décrit les mécanismes immunitaires sous-jacents à six principales maladies pédiatriques immunodéficience non-primaire et les diverses fonctions immunomodulatrices de la thérapie IgIV.
In Kawasaki disease, IVIG plays a major, proven, and effective role in decreasing aneurysm formation, which represents an aberrant inflammatory response to an infectious trigger in a genetically predisposed individual. In immune thrombocytopenia, IVIG targets the underlying increased platelet destruction and decreased platelet production. Although theoretically promising, IVIG shows no clear clinical benefit in the prophylaxis and treatment of neonatal sepsis. Limitations in research design combined with the unique neonatal immunologic environment offer explanations for this finding. Inflammation from aberrant immune activation underlies the myelinotoxic effects of Guillain-Barré syndrome. HIV-1 exerts a broad range of immunologic effects and was found to decrease serious bacterial infections in the pre-highly active anti-retroviral therapy (HAART) era, although its practical relevance in the post-HAART era has waned.
Clinical and experimental data support the role of immune mechanisms in the pathogenesis of childhood epilepsy. IVIG exerts anti-epileptic effects through targeting upregulated cytokine pathways and antibodies thought to contribute to epilepsy. Applications in six additional pediatric diseases including pediatric asthma, atopic dermatitis, cystic fibrosis, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS), autism, and transplantation will also be briefly reviewed. From autoimmunity to immunodeficiency, a dynamic immunologic basis underlies major pediatric diseases and highlights the broad potential of IVIG therapy.
Les données cliniques et expérimentales supportent le rôle des mécanismes immunitaires dans la pathogenèse de l'épilepsie chez les enfants. L'IVIG exerce des effets anti-épileptiques en ciblant des voies et des anticorps de cytokines régulées à la hausse dont on pense qu'elles contribuent à l'épilepsie.
Les applications dans six maladies pédiatriques supplémentaires, y compris l'asthme pédiatrique, la dermatite atopique, la fibrose kystique, les troubles neuropsychiatriques auto-immunes pédiatriques associées à l'infection streptococcique (PANDAS), l'autisme et la transplantation seront également examinés brièvement. De l'auto-immunité à l'immunodéficience, une base immunologique dynamique sous-tend les principales maladies pédiatriques et met en évidence le large potentiel de la thérapie IGIV.
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