Intravenous immunoglobulin treatment in Multiple Sclerosis and experimental autoimmune encephalomyelitis - the Israeli experience

Intravenous immunoglobulin (IVIg) has been shown to be beneficial in the treatment of several autoimmune disorders both in humans and in animal models. IVIg has been applied for the treatment of multiple sclerosis (MS). One of the major advantages of IVIg treatment in MS is that it can affect several mechanisms that have been proposed to be involved in the pathogenesis of the disease, including: suppression of T-cell activation, Fc receptor blockade, modulation of cytokine production, T-cell receptor blockade and masked recognition of class II MHC (D/DR).(1-4) In addition to its immunological effects, IVIg can penetrate the blood-brain barrier,(5) and produce a direct effect on myelin formation.(6,7) This is of major importance in MS, wherein myelin breakdown and destruction at the edges of expanding plaques leads to accumulating neurological disability. The possibility of IVIg to influence several mechanisms involved in the disease process is advantageous because the treatment might have different effects in different stages of the disease, and even in the same patient influencing several simultaneously ongoing processes. In the present review the clinical and experimental data related to experience gained by the Israeli MS Study Group with IVIg treatment in MS and EAE will be summarized.