Effector mechanisms activated by human IgG subclass antibodies: clinical and molecular aspects. Review article

Secondary systemic immune responses are predominantly of the IgG class and passive administration of intravenous IgG, from pooled normal serum, is an effective prophylactic and/or therapeutic treatment for patients with defined immunodeficiencies. However, the proportions of each IgG subclass present within a specific antibody response may differ dramatically from that of the total IgG pool. For some antigens the response may be essentially restricted to a single subclass and it may be presumed that the antibody isotype produced has an optimal protective role. The clinical consequences of selective IgG subclass deficiency appears to validate this presumption. In this review we emphasize the differences in effector functions activated by the IgG subclasses and hence the mechanisms responsible for the removal and destruction of antigen/antibody complexes. These studies are relevant to diagnosis and treatment of patients with recurrent infection; the IgG isotype of monoclonal antibodies selected for passive in vivo therapy; the generation of customized antibodies having a pre-determined profile of effector functions and 'immuno-direction' with new vaccines to provoke an antibody response having an isotype profile optimal for the proposed application.