Sergei A Grando
University of California Irvine, United States
Abstract Title: Intravenous immunoglobulin in dermatology
Biography: Sergei A. Grando, M.D., Ph.D., D.Sci. (Med), is Distinguished Professor of Dermatology at the University of California Irvine. He graduated from Kyiv Medical Institute in 1980, obtained his Ph.D. in 1984 and in 1989, the Doctor of Science in medicine (D.Sci.) degree for studies of pemphigus and pemphigoid. From 1991 to 1996 he was at University of Minnesota, from 1996 to 2007 at University of California Davis, and then joined UC Irvine. He is certified by the American Board of Dermatology. He has published 292 papers and obtained over $12 million research funding from NIH and other funding agencies in the USA.
Research Interest: Intravenous immunoglobulin (IVIg) represents polyclonal natural antibodies pooled from sera of healthy donors. Historically, it was used to treat primary and secondary immune deficiencies. Today, it is being increasingly utilized as off-label therapy for a variety of autoimmune and inflammatory conditions. IVIg is a safe and effective drug to rapidly induce and maintain a prolonged clinical remission in a large variety of dermatological conditions unresponsive to conventional therapy, producing a distinct corticosteroid-sparing effect. Autoimmune blistering diseases and connective tissue diseases are the main diseases treated with IVIg after failure of standard immunosuppressive therapy. Its early use is of significant benefit in patients who may experience life-threatening complications from corticosteroids and immunosuppression. High efficacy of IVIg is not hampered by severe side-effects seen with other treatment regimens, such as systemic corticosteroids. The known mechanisms of therapeutic action of IVIg include selective elimination of pathogenic antibodies due to blocking (saturation) of FcRn that protects IgG molecules from lysosomal degradation, anti-inflammatory action of sialylated IgG species that upregulate expression of the inhibitory FcγRIIB receptor on immune cells, inactivation of pathogenic antibodies by the anti-idiotypic antibodies, activation of anergic/apoptotic program in B cells, increase of B cells producing the immunosuppressive cytokine IL-10 as well as anti-apoptotic and anti-oncotic effects on keratinocytes. However, IVIg is underutilized by dermatologists. The problem stems from lack of knowledge about its mechanisms of action, administration protocol, specific dermatological indications, expected efficacy and cost-effectiveness, unwarranted concerns about its unsafely and difficulties with approval by insurance companies.