Immunoglobulins in autoimmunity: history and mechanisms of action

The search for preparations of human gammaglobulin that could be administered safely intravenously was driven by the need to better manage immune deficiency states. However, when suitable formulations were developed, it was soon realised that large infusions of immunoglobulin could be used to manipulate the immune system. The production of autoantibodies was minimised or their effects neutralised; T cell effector and regulatory function could be manipulated and cytokine release modified. More than fifty human disease states, many until now lacking safe and effective therapies, can be improved by the administration of intravenous immunoglobulin. Better understanding of the mechanisms involved will not only improve therapy but will provide a better understanding of the immunopathogenic mechanisms responsible.