Plasma infusions in immunologic deficiency states: metabolic and therapeutic studies.

C URRENT THERAPY for agammaglobulinemia consists of periodic intramuscular injection of commercial y-globulin ( Cohn fraction II ), a preparation containing y0-globulin alone. Agammaglobulinemic patients, deficient in all 3 immune globulins, as well as patients with isolated deficiencies of Ynor -yA-globulin ( dysgammaglobulinemia, ataxia telangiectasia, the Aldrich syndrome’5 ) might be expected to benefit maximally by replacement therapy with a preparation containing the 3 immune globulins. The functional diversity of the immune globulins provides theoretical support for this concept.#{176} Whereas the yG-globulins account for most antibacterial, antiviral and antitoxic antibodies, other antibodies, such as natural isoagglutinins and typhoid 0 agglutinins, are mainly yM-globulins, and still others, such as reagins, are primarily yA-globulins. Furthermore, antibodies with the same specificity but belonging to different classes of immune globulin may vary in their ability to hemolyze cells,7’5 fix complement,5 and inhibit antibody formation.#{176} Finally, the distribution of these proteins is known to vary. yG-globulins are distributed equally between the circulation and the tissues,’#{176}’2 y 1-globulins are localized primarily in the intravascular compartment,1 and ‘yA-globuins seem to be associated chiefly with tissues and exocrine gland secretions.’4” It seems likely, therefore, that each of the 3 immune globulin classes provides certain unique defense mechanisms.