Commercial IVIG preparations contain multiple anti-idiotypic antibodies, such as anti-factor VIII antibodies , anti-DNA autoantibodies [11–13], anti-intrinsic factor antibodies , anti-thyroglobulin (Tg) autoantibodies , anti-neutrophil cytoplasmic antibodies , anti-microsomal antibodies , anti-neuroblastoma antibodies
, anti-phospholipid antibodies , anti-platelet antibodies , anti-Sm idiotype (ID-434)  and anti-GM1 antibody . Therefore, in the last decade, IVIG has been used increasingly as an immunomodulatory agent in the treatment of autoimmune and systemic inflammatory diseases, including systemic lupus erythematosus, dermatomyositis and polymyositis, multiple sclerosis, myasthenia gravis, Guillain–Barré syndrome and anti-phospholipid syndrome [21,22]. Anti-idiotypic antibodies are effective in the treatment or prevention of disease manifestations because they inhibit the binding AZD9291 mouse of the pathogenic autoantibodies to their corresponding antigen, as shown both in vitro[12,13,23,24] and in vivo[17,19,25]. An in vitro study of systemic lupus erythematosus suggested that the value of anti-idiotypic antibodies may also be attributable to their
inhibitory effect on the spontaneous secretion of anti-desmoglein by peripheral B lymphocytes . In addition, IVIG Selleck Ku0059436 may act via the idiotypic network, causing soluble circulating immune complexes to aggregate and become insoluble and, consequently, removable by the reticuloendothelial system. Our previous study demonstrated the efficacy of IVIG in the prevention of blister formation in an experimental model of PV Avelestat (AZD9668) . Recently, our positive findings were confirmed in a large double-blind placebo-controlled clinical trial . The amount of specific anti-idiotypes in commercial IVIG preparations
is extremely low. Therefore, we speculated that the use of isolated anti-idiotypes against pathogenic autoantibodies could yield even better results with a fraction of the amount of IgG, with a lower rate of adverse reactions. To test this theory, we developed a modulated anti-idiotypic preparation using concentrated specific natural polyclonal anti-desmoglein anti-idiotypic antibodies from commercial IVIG. The aim of the present study was to evaluate the effect of treatment with IVIG affinity-purified anti-desmoglein anti-idiotypic antibodies on the immunological and clinical findings in a mouse model of PV. Desmogleins 1 and 3 single-chain variable fragment (scFv) was produced in the Top10F’ strain of Escherichia coli (Invitrogen, Carlsbad, CA, USA) and purified by nickel chelation affinity chromatography, as described previously . Rabbit anti-desmogleins 1 and 3 were derived from rabbits immunized with anti-desmogleins 1 and 3 scFv and used as a source of anti-idiotypic antibodies.