Perricone Carlo, Triggianese Paola, Bursi Roberto, Cafaro Giacomo, Bartoloni Elena, Chimenti Maria Sole, Gerli Roberto, Perricone Roberto
Rheumatology, Department of Medicine, University of Perugia, 06129 Perugia, Italy.
Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome, 00133 Rome, Italy.
Microorganisms. 2021 Jan 7;9(1):121. doi: 10.3390/microorganisms9010121.
Intravenous immunoglobulins (IVIG) are blood preparations pooled from the plasma of donors that have been first employed as replacement therapy in immunodeficiency. IVIG interact at multiple levels with the different components of the immune system and exert their activity against infections. Passive immunotherapy includes convalescent plasma from subjects who have recovered from infection, hyperimmune globulin formulations with a high titer of neutralizing antibodies, and monoclonal antibodies (mAbs). IVIG are used for the prevention and treatment of several infections, especially in immunocompromised patients, or in case of a poorly responsive immune system. The evolution of IVIG from a source of passive immunity to a powerful immunomodulatory/anti-inflammatory agent results in extensive applications in autoimmune diseases. IVIG composition depends on the antibodies of the donor population and the alterations of protein structure due to the processing of plasma. The anti-viral and anti-inflammatory activity of IVIG has led us to think that they may represent a useful therapeutic tool even in COVID-19. The human origin of IVIG carries specific criticalities including risks of blood products, supply, and elevated costs. IVIG can be useful in critically ill patients, as well as early empirical treatment. To date, the need for further well-designed studies stating protocols and the efficacy/tolerability profile of IVIG and convalescent plasma in selected situations are awaited.
静脉注射免疫球蛋白（IVIG）是从供体血浆中提取的血液制品，最初被用作免疫缺陷的替代疗法。IVIG在多个层面与免疫系统的不同成分相互作用，并发挥其抗感染活性。被动免疫疗法包括感染康复者的恢复期血浆、具有高滴度中和抗体的高效免疫球蛋白制剂以及单克隆抗体（mAb）。IVIG用于预防和治疗多种感染，特别是在免疫功能低下的患者中，或在免疫系统反应不佳的情况下。IVIG从被动免疫源演变为强大的免疫调节/抗炎剂，导致其在自身免疫性疾病中得到广泛应用。IVIG的组成取决于供体群体的抗体以及血浆加工导致的蛋白质结构改变。IVIG的抗病毒和抗炎活性使我们认为它们甚至在COVID-19中可能是一种有用的治疗工具。IVIG的人源特性带来了特定的关键问题，包括血液制品风险、供应和成本高昂。IVIG对重症患者可能有用，也可用于早期经验性治疗。迄今为止，人们期待进一步设计良好的研究，阐明IVIG和恢复期血浆在特定情况下的方案以及疗效/耐受性概况。
