Any idea why IVIG or PEX might work?

[Buster]

Anyone have an idea of why IVIG, PEX and Azithromycin seem all to affect PANDAS?

 

I'd be particularly interested if Dr. K has offered any explanation.

 

I've been wondering whether the similar factor is the supression of an antibody. Yes, I know that Swedo's theory was that PANDAS was an auto-immune disorder but it didn't make sense to me that both PEX and IVIG both worked -- because PEX removes antibodies and IVIG adds antibodies.

 

However, I just ran across a very interesting paper by Kawikova at Yale:

"Decreased numbers of regulatory T cells suggest impaired immune tolerance in children with tourette syndrome: a preliminary study." http://www.ncbi.nlm.nih.gov/pubmed/16996487

 

and then Matsushita paper at Duke in Sept 2008, found the elusive regulatory/suppressor B cells:

http://content.jci.org/articles/view/36030

 

and Tedder's paper on regulatory B cell effect http://www.biochemsoctrans.org/bst/030/0807/0300807.pdf

 

So perhaps the problem is that PANDAS kids are just missing the regulatory B cells (i.e., the suppressor B antibodies) that get rid of antibodies that would otherwise attach to host cells/cause inflamation. Could it be this simple?

• PEX removes the generated antibody that attacks self.
  
• IVIG adds a suppressor antibody (a suppressor stops antibodies that attack self)
  
• and Azithromycin shifts the Thelper response, thereby acting as an anti-inflammatory and immunomodulator/suppressor.
  

I'd be very interested if anyone has any other collaborating or contradicting documentation on this.

 

If this is really the key, then Azithromycin would be a temporary suppression (like Prednisone) because

a ) the underlying self-attacking antibody is still there and

b ) there is no long term suppressive agent to prevent replication of the antibody

 

I've gone to look at Kirvan's paper again on GlcNAc but was wondering if anyone had heard from one of the IVIG folks why IVIG is supposed to work. I'm now thinking these regulatory B cells are very likely the missing culprit.

 

Regards,

 

Buster