Sultan Y, Rossi F, Kazatchkine M
Centre des Hémophiles, Hôpital Cochin, Paris, France.
Folia Haematol Int Mag Klin Morphol Blutforsch. 1990;117(4):539-43.
Therapeutic immunoglobulins from commercial origin were administered to patients with allo and auto antibodies to factor VIII. The protocol used was similar to the prescription suggested for ITP, 0.4 g/kg body weight for five consecutive days. In patients with auto antibodies two kinds of effects were observed: A direct interaction between IVIg and the factor VIII inhibitor and long term interaction on antibody synthesis. The direct interaction observed in vivo was demonstrated to be mediated through Fab'2 fragments of both idiotypic interaction. This was also demonstrated using binding experiments and affinity chromatography experiments: Fab'2 fragments of IVIg were coupled to sepharose and Fab'2 fragments of patients IgG with allo and auto antibodies to Factor VIII were circulated through the column. The recovery of anti Factor VIII antibodies after elution was possible in 2 cases of allo antibodies out of 3 tested and 3 cases of auto antibodies out of 4. The question of anti idiotypes against factor VIII inhibitors in single individuals was investigated. IgG and Fab'2 fragments from single blood donors were isolated and tested for their inhibitory capacity against Fab'2 fragments of three different auto antibodies. The results did not show statistical differences between males and females however in the group of male blood donors, aging was a positive parameter for the presence of anti idiotypic antibodies against factor VIII inhibitors. Anti idiotypic antibodies against factor VIII inhibitors were present in 17.2% of the blood donor tested.
将来自商业来源的治疗性免疫球蛋白给予患有抗凝血因子 VIII 同种抗体和自身抗体的患者。所采用的方案与针对免疫性血小板减少性紫癜（ITP）建议的处方相似，即连续五天给予 0.4 g/kg 体重。在患有自身抗体的患者中观察到了两种效应：静脉注射免疫球蛋白（IVIg）与因子 VIII 抑制剂之间的直接相互作用以及对抗体合成的长期相互作用。体内观察到的直接相互作用被证明是通过两种独特型相互作用的 Fab'2 片段介导的。这也通过结合实验和亲和层析实验得到了证实：将 IVIg 的 Fab'2 片段偶联到琼脂糖上，使患有针对因子 VIII 的同种抗体和自身抗体的患者 IgG 的 Fab'2 片段通过该柱循环。在 3 例接受测试的同种抗体患者中有 2 例、4 例自身抗体患者中有 3 例在洗脱后能够回收抗因子 VIII 抗体。研究了个体中针对因子 VIII 抑制剂的抗独特型问题。从单一献血者中分离出 IgG 和 Fab'2 片段，并测试它们对三种不同自身抗体的 Fab'2 片段的抑制能力。结果显示男性和女性之间没有统计学差异，然而在男性献血者组中，年龄是存在针对因子 VIII 抑制剂的抗独特型抗体的一个正向参数。在所测试的献血者中，17.2%存在针对因子 VIII 抑制剂的抗独特型抗体。
