SEPSIS AND POLYSPECIFIC INTRAVENOUS IMMUNOGLOBULINS

The treatment of sepsis with i.v. immunoglobulins (IVIG) is currently regarded as not indicated. Several clinical studies, placebo controlle d since 1985, to determine efficacy have failed to prevent fatal outco me, even when IVIG was given at high doses. The prevailing action mech anism put forward by most researchers is the capacity of specific anti bodies contained in IVIG to bind to the infectious organism followed b y opsonophagocytosis. Recently, IVIG preparations have been shown, bot h in vitro and in vivo, to profoundly affect the homeostasis of the cy tokine network, probably in a way which directs this network from dist urbed to regulated functioning. Excessive production and insufficient removal of cytokines due to multiorgan failure of sepsis patients are now known to play a decisive role in progression of sepsis to septic s hock. There are researchers wondering whether the newly discovered inf luence of IVIG on cytokines might not be exploited for the design of i mproved study protocols, including better selection of the dosage, dos age schedule, association to other treatments and selection of patient s. On the side of the IVIG preparations, improvements discussed includ e spiking of polyclonal preparations with monoclonal antibodies, selec tion of appropriate production lots and study of the efficacy not only of IgG but also of IgM isotype containing preparations. (C) 1997 Wile y-Liss, Inc.