Differences in potency of intravenous polyspecific immunoglobulin G against streptococcal and staphylococcal superantigens: implications for therapy of toxic shock syndrome

Clin Infect Dis. 2004 Mar 15;38(6):836-42. doi: 10.1086/381979. Epub 2004 Mar 1.

Abstract

Administration of intravenous polyspecific immunoglobulin G (IVIG) has been proposed as adjunctive therapy for toxic shock syndrome caused by Streptococcus pyogenes or Staphylococcus aureus. We investigated whether superantigen-containing culture supernatants prepared from streptococcal isolates (n=21) and staphylococcal isolates (n=20) from cases of severe sepsis were inhibited to an equal extent by IVIG in proliferation experiments that used human peripheral blood mononuclear cells. All 3 IVIG preparations tested were highly efficient in neutralizing the superantigens, and most supernatants were completely inhibited at concentrations ranging from 0.05 to 2.5 mg IVIG/mL. An important finding was that culture supernatants from S. pyogenes isolates were consistently inhibited to a greater extent than those of S. aureus isolates (P<.01). The findings demonstrate that staphylococcal superantigens are not inhibited as efficiently as streptococcal superantigens by IVIG, and, hence, a higher dose of IVIG may be required for therapy of staphylococcal toxic shock syndrome in order to achieve protective titers and clinical efficacy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Humans
  • Immunoglobulins, Intravenous / immunology
  • Immunoglobulins, Intravenous / therapeutic use*
  • Serotyping
  • Shock, Septic / immunology
  • Shock, Septic / microbiology
  • Shock, Septic / therapy*
  • Staphylococcus aureus / classification
  • Staphylococcus aureus / immunology
  • Streptococcal Infections / immunology
  • Streptococcal Infections / therapy*
  • Streptococcus pyogenes / classification
  • Streptococcus pyogenes / immunology
  • Superantigens / immunology*

Substances

  • Immunoglobulins, Intravenous
  • Superantigens