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Infect Immun, May 1998, p. 2279-2283, Vol. 66, No. 5
Research Service, Veterans Affairs Medical
Center, Memphis, Tennessee 381041;
Departments of Surgery and of Microbiology and Immunology,
University of Tennessee, Memphis, Tennessee
381632;
Department of Microbiology,
Mount Sinai Hospital, and the University of Toronto, Toronto, Ontario,
Canada3; and
Centers for Disease
Control and Prevention, Atlanta, Georgia 303334
Received 10 October 1997/Returned for modification 15 December
1997/Accepted 2 February 1998
The surface M protein of group A streptococci (GAS) is one of the
major virulence factors for this pathogen. Antibodies to the M protein
can facilitate opsonophagocytosis by phagocytic cells present in human
blood. We investigated whether pooled normal immunoglobulin G (IVIG)
contains antibodies that can opsonize and enhance the phagocytosis of
type M1 strains of GAS and whether the levels of these antibodies vary
for different IVIG preparations. We focused on the presence of anti-M1
antibodies because the M1T1 serotype accounts for the majority of
recent invasive GAS clinical isolates in our surveillance studies. The
level of anti-M1 antibodies in three commercial IVIG preparations was
determined by enzyme-linked immunosorbent assay (ELISA), and the
opsonic activity of these antibodies was determined by
neutrophil-mediated opsonophagocytosis of a representative M1T1
isolate. High levels of opsonic anti-M1 antibodies were found in all
IVIG preparations tested, and there was a good correlation between
ELISA titers and opsonophagocytic activity. However, there was no
significant difference in the levels of opsonic anti-M1 antibodies
among the various IVIG preparations or lots tested. Adsorption of IVIG
with M1T1 bacteria removed the anti-M1 opsonic activity, while the
level of anti-M3 opsonophagocytosis was unchanged. Plasma was obtained
from seven patients with streptococcal toxic shock syndrome who
received IVIG therapy, and the level of anti-M1 antibodies was assessed
before and after IVIG administration. A significant increase in the
level of type M1-specific antibodies was found in the plasma of all
patients who received IVIG therapy (P < 0.006). The
results reveal another potential mechanism by which IVIG can ameliorate
severe invasive group A streptococcal infections.
0019-9567/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
Opsonic Antibodies to the Surface M Protein of
Group A Streptococci in Pooled Normal Immunoglobulins (IVIG): Potential
Impact on the Clinical Efficacy of IVIG Therapy for Severe Invasive
Group A Streptococcal Infections
*
Corresponding author. Mailing address: VA Medical
Center, Research Service 151, 1030 Jefferson Ave., Memphis, TN 38104. Phone: (901) 448-7247. Fax: (901) 448-7208. E-mail:
mkotb{at}utmem1.utmem.edu.
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