Human immunoglobulin as a treatment for West Nile virus infection

AG Agrawal, LR Petersen - The Journal of infectious diseases, 2003 - academic.oup.com
AG Agrawal, LR Petersen
The Journal of infectious diseases, 2003academic.oup.com
During the West Nile virus outbreak in Israel in 2000, a woman with chronic lymphocytic
leukemia who was comatose as a result of West Nile virus encephalitis recovered after
treatment with intravenous immunoglobulin (IVIG)[1]. Antibody titers against West Nile virus
were 1: 1600 in Israeli IVIG; in contrast, North American IVIG preparations had no detectable
West Nile virus antibody [1, 2]. A second patient, a lung transplant recipient, also recovered
from West Nile virus encephalitis after treatment with Israeli IVIG [3]. Six other subsequently …
During the West Nile virus outbreak in Israel in 2000, a woman with chronic lymphocytic leukemia who was comatose as a result of West Nile virus encephalitis recovered after treatment with intravenous immunoglobulin (IVIG)[1]. Antibody titers against West Nile virus were 1: 1600 in Israeli IVIG; in contrast, North American IVIG preparations had no detectable West Nile virus antibody [1, 2]. A second patient, a lung transplant recipient, also recovered from West Nile virus encephalitis after treatment with Israeli IVIG [3]. Six other subsequently treated patients have had variable outcomes: 2 improved, 2 had no improvement, and 2 eventually died [4](C. Isada, oral communication; R. Babecoff, written communication). These anecdotal reports, although inconclusive, have stimulated interest in the use of passive immunization for treating severe West Nile virus disease. The article on the efficacy of human immunoglobulin in treating West Nile virus infection in mice by Ben-Nathan et al.[5] is provocative, in that it suggests that
IVIG might ameliorate or abort established West Nile virus infection. In the series of experiments described, BALB/c mice were infected intraperitoneally with either 20 or 200 times the LD50 (100 or 1000 pfu). They received 1 of 6 treatments: nonimmune mouse serum, immune mouse serum with ELISA titers against West Nile virus of 1: 3200, Omrix IVIG with ELISA titers of 1: 1600, IVIG from US donors with ELISA titers of 1: 10, pooled plasma from Israeli donors (titers not described but presumed to be less than concentrated immunoglobulin), or pooled plasma from US donors. In protection experiments in which the antibody-containing treatments were given shortly before and after infection, the results were unequivocal—any treatment containing specific antibody produced 100% survival, and treatments without specific anti–West Nile virus antibody provided no protection (100% mortality; table 1).
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