IVIG in GBS

Q: What is the multi-facets mechanism of action of intravenous immunoglobulin (IVIG) in Guillain-Barré syndrome(GBS)? 

 Answer: The precise mechanism of  IVIG in GBS is not entirely clear but probabilities have been described with following actions. The objective of the above question is to emphasize the multi-facet mechanism of action of IVIG instead of using umbrella term of antagonizing the hostile molecules.

1. provide anti-idiotypic antibodies
2. modulate expression and function of Fc receptors
3. interfere with the activation of complement and production of cytokines, and 
4. interfere with the activation and effector functions of T and B cells

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References: 

 1. Buchwald B, Ahangari R, Weishaupt A, Toyka KV. Intravenous immunoglobulins neutralize blocking antibodies in Guillain-Barré syndrome. Ann Neurol 2002; 51:673. 

 2. Dalakas MC. The use of intravenous immunoglobulin in the treatment of autoimmune neuromuscular diseases: evidence-based indications and safety profile. Pharmacol Ther 2004; 102:177.