18 Production of the regulatory cytokine IL-10 and of pro-inflammatory TNF-α was also measured. Supernatants from 15 proliferation assays were taken for this purpose, nine of which were from days 1 and 7 after antigen stimulation (all antigens), and the remaining six were from days 1 (all antigens), 5 (TG and TT only) and 9 (KLH only). As might be expected with a primary antigen, KLH elicited no appreciable cytokine production during the first day of challenge, apart from a low, though significant, amount of TNF-α (P < 0·05)

(Fig. 2). After 9 days of incubation, TNF-α was still detectable in significant amounts (P < 0·001), and traces of IL-2, IFN-γ and IL-10 were also observed selleck chemical in most culture supernatants. Tetanus toxoid elicited significant early production of IL-2 and IFN-γ (P < 0·0001, for both cytokines) and, to a lesser extent, TNF-α (P < 0·05) (see Fig. 2). Whereas the level of IL-2 declined thereafter, TNF-α and IFN-γ production increased, with TNF-α peaking at day 5 and IFN-γ production persisting through to day 7. This profile indicates the presence of memory T cells, providing a pro-inflammatory cytokine response, in the cultures. Notably, a strong Th2 cytokine response, comprising

IL-4 (P < 0·05) and IL-5 (P < 0·01 and < 0·001, at days 5 and 7, respectively), developed in the latter phase of the incubation (Fig. 2). The predominant cytokine elicited by TG was IL-10, in a prolonged response lasting from day 1 through selleck kinase inhibitor to day 7 (P < 0·0001, < 0·01 and < 0·001, at days 1, 5 and 7) (Fig. 1). Substantial TNF-α production (P < 0·0001) was also seen at day 1 although this response declined sharply thereafter. Significant early production of IL-2 (P < 0.01 at day 1) and a late IL-5 response (P < 0·05 at day 5; P < 0·001 at day 7) were also recorded, although at lower levels than those following

TT stimulation. Interleukin-4 Clomifene exhibited biphasic kinetics with significant production on day 1 (P < 0·0001), falling to near background on day 5 and recovering to the original level (P < 0·01) on day 7 (Fig. 2). Little or no production of IFN-γ was observed for 10 of the 15 donors examined but the remaining five produced amounts of IFN-γ comparable to those seen with TT. To examine more closely the characteristics of the high IFN-γ responders to TG, the panel of nine supernatants tested on day 7 was divided into two subgroups, based on their levels of IFN-γ production. These groups were compared with each other, as well as with the corresponding TT-stimulation supernatants, in terms of proliferation and cytokine profiles (Fig. 3). Apart from displaying a high IFN-γ production, TG-stimulated T cells from high-IFN-γ responders and the TT-stimulated T cells had high proliferation rates (Fig. 3a), and low production of IL-2 and TNF-α, in common (Fig. 3b).

The binding efficiencies of MoPrP under reducing conditions were not significantly different from those under nonreducing conditions click here in the four prion strains and Chandler (Fig. 3a, open and solid columns). The efficiencies of conversion of 79A, ME7, and Obihiro and Chandler under reducing conditions were not significantly different

from those under nonreducing conditions (Fig. 3b, open and solid columns). However, the efficiency of the mBSE strain was about three times greater under reducing conditions (P < 0.01). To determine whether the disulfide bond or thiol groups of MoPrP were involved in binding with PrPSc and conversion into PrPres, binding and conversion assays using Cys-less mutants (C178, 213S) were performed. No significant differences were observed in binding efficiencies under nonreducing conditions among C178, 213S, and MoPrP, although the binding efficiencies of C178, 213S with ME7, and Obihiro PrPSc were about half those of MoPrP

(Fig. 3a, c, open columns). The efficiency of mBSE-seeded conversion of C178, 213S was not different from that of MoPrP, but the efficiencies of the other strains were lower than SB203580 clinical trial that of MoPrP. Furthermore, the difference in the efficiencies of Chandler and 79A were significant (Fig. 3b, d, open columns). Thus, the findings suggested that the effects of Cys to Ser substitutions on binding and conversion were different for each prion strain, and that the presence of Cys or thiol groups was especially important for conversion into PrPres in Chandler and 79A strains. The binding efficiencies of C178, 213S in each prion strain under reducing conditions were not significantly different from those under nonreducing conditions (Fig. 3c, open and solid columns). The conversion efficiencies of C178,

213S in the Chandler, 79A, ME7, and Obihiro strains under reducing conditions were not significantly Clomifene different from those under nonreducing conditions, although a significant increase in the conversion efficiency of mBSE was observed under reducing conditions (Fig. 3d, open and solid columns). Therefore, the effect of reducing conditions on the binding and conversion of Cys-less mutants was similar to those of MoPrP, suggesting that neither Cys residues nor thiol groups are involved in the acceleration of mBSE-seeded conversion under reducing conditions. Immunohistochemical and HE staining of brain tissue from mice infected with each strain were performed (Fig. 4a). In mice inoculated with Chandler and 79A strains, diffuse synaptic deposits were found throughout the brain, and the PrPSc accumulation patterns of both strains were very similar. In contrast, ME7 and Obihiro strains produced PrPSc accumulation throughout the neuropil in most areas of the brain, although some areas were predictably severely affected. Large numbers of PrP-aggregates were also detected, but these tended to be small and had less obvious amyloid cores.

In this study, the aim was to establish and optimize a method for the detection of NDV-specific memory T cells in the chicken. The assay was then used to determine differences in the

development of NDV-specific T cells Selleck Ribociclib upon ND vaccination in chickens differing in the major histocompatibility complex (MHC). Two animal experiments were performed. Experiment 1 was performed to determine the proliferative capacity of four different MHC haplotypes, while experiment 2 was performed to determine recall proliferation after experimental vaccination in two MHC haplotypes. Experimental chickens for optimization of a method for recall proliferation and for experiment 1.  Offspring from different inbred chicken lines were used: line 2 (B12), line 133 (B13), line 130 (B130) and line 201 (B201), the MHC haplotypes are shown in parentheses. All lines are bred at Aarhus University [11]. The birds were vaccinated through drinking water at 3 and 8 weeks of age with a live attenuated Newcastle disease vaccine (Poulvac NDW; Fort Dodge Animal Health Ltd. Southhampton, UK) and once at 16 weeks of age intramuscularly (IM) with inactivated ND vaccine (Poulvac I-ND; Fort Dodge Animal Health Ltd.), according to Danish legislation. Blood samples were taken in the jugular vein and stabilized with either EDTA or heparin for optimization Selleck SAHA HDAC purposes and with EDTA

only for the MHC screening. Birds for optimization and MHC screening were tested up to 2 years after vaccination. Experimental chickens experiment 2.  For this purpose, animals from two inbred chicken lines that differ immunologically with respect to their peripheral blood CD4/CD8 ratios were chosen. These were line 133 (B13) and

line 130 (B130), the MHC haplotypes are shown in parentheses [11]. Ten birds from each line were vaccinated orally at 4 and 8 weeks of age with 1 dose of live attenuated Newcastle disease vaccine (Poulvac NDW; Fort Dodge Animal Health Ltd.). Recall proliferation was performed 3 weeks after the last vaccination. Blood samples were taken from the jugular vein and stabilized with EDTA. MHC genotyping of chickens for experimental vaccination.  All chickens used in the experiment were produced from MHC-characterized parents. The MHC haplotypes Tacrolimus (FK506) of the offspring were confirmed by genotyping the LEI0258 microsatellite locus [12] by a PCR-based fragment analysis [13]. Genomic DNA was isolated from peripheral blood using the ArchivePure™DNA Blood Kit (5 PRIME GmbH, Hamburg, Germany) according to the manufacturer’s instructions. Amplification by PCR and gel documentation were performed as earlier described [14]. PBMC isolation.  PBMC were purified from heparinized or EDTA-stabilized peripheral blood density gradient centrifugation. One millilitre of blood was diluted with 1 ml of phosphate-buffered saline (PBS) and layered onto an equal volume of Ficoll-Paque™ PLUS (Amersham Biosciences, Uppsala, Sweden) before centrifugation at 400 g for 35 min at 20 °C.

These results demonstrate the beneficial role of Emodin in attenuating the LPS-induced

microcirculatory disturbance, and support the use of Emodin for patients with endotoxemia. “
“Please cite this paper as: Correa D, Segal SS(2012). Neurovascular Akt inhibitor proximity in the diaphragm muscle of adult mice. Microcirculation 19: 306–315, 2012. Objective:  Regional blood flow to the diaphragm muscle varies with the workload of inspiration. To provide anatomical insight into coupling between muscle fiber recruitment and oxygen supply, we tested whether arterioles are physically associated with motor nerve branches of the diaphragm. Methods:  Following vascular casting, intact diaphragm muscles of C57BL/6 and CD-1 mice were stained for motor innervation. Arteriolar networks and nerve networks were mapped (∼2 μm resolution) to evaluate their physical proximity. Results:  Neurovascular proximity was similar between muscle regions and mouse strains. Of total mapped

nerve lengths (C57BL/6, 70 ± 15 mm; CD-1, 87 ± 13 mm), 80 ± 14% and 67 ± 10% were ≤250 μm from the nearest arteriole and associated predominantly with arterioles ≤45 μm in diameter. Distances to the nearest arteriole encompassing 50% of total nerve length (D50) were consistently within 200 μm. With nerve networks repositioned randomly within muscle borders, D50 values nearly doubled (p < 0.05). Reference lines within anatomical boundaries reduced proximity to arterioles (p < 0.05) as they deviated from the original location of motor nerves. Conclusion:  Across selleck compound two strains of mice, motor nerves and arterioles of the diaphragm muscle are more closely associated than can be explained by chance. We hypothesize that neurovascular proximity facilitates local perfusion very upon muscle fiber recruitment. “
“The mechanical forces acting on SMC in the vascular wall are known to regulate processes such as vascular remodeling and contractile differentiation. However,

investigations to elucidate the underlying mechanisms of mechanotransduction in smooth muscle have been hampered by technical limitations associated with mechanical studies on pressurized small arteries, due primarily to the small amount of available tissue. The murine portal vein is a relatively large vessel showing myogenic tone that in many respects recapitulates the properties of small resistance vessels. Studies on stretched portal veins to elucidate mechanisms of mechanotransduction in the vascular wall have shown that stretch-sensitive regulation of contractile differentiation is mediated via Rho-activation and actin polymerization, while stretch-induced growth is regulated by the MAPK pathway. In this review, we have summarized findings on mechanotransduction in the portal vein with focus on stretch-induced contractile differentiation and the role of calcium, actin polymerization and miRNAs in this response.

Here we show that the LPS stimulus induced a stronger homogeneous maturation

effect, while the hypoxia stimulus showed a diverse degree of response. It is well known that in activating innate immunity, LPS induces DC maturation by ligand-driven Toll-like receptor (TLR) activation [25]. Our current results show that LPS and hypoxia induced mean fluorescence of mature phenotype DC markers differently from non-stimulated iDCs, but examining these markers individually to compare the two stimuli we found a down-regulation of CD86 for only hypoxia DC. Also, only CD40 and CD83 were expressed to the same degree for both hypoxia and LPS stimulation, whereas for the other surface markers (CD80, CD86, CD54 and HLA-DR) LPS induced PI3K inhibitor a significant up-regulation learn more at least two times greater than did hypoxia. Recently, Jantsch et al. [26] described similar

results with an increase in CD80, CD86 and major histocompatibility complex (MHC)-II expression in DCs treated with LPS together with hypoxia, compared to cells treated only with LPS. In contrast, CD80 and CD86 expression decreased slightly under hypoxia alone, whereas MHC-II expression remained unchanged. Sekar et al. [27] generated plasmacytoid-like DC, attenuated IFN-γ production and decreased CD86 as well as MHC-I surface exposure under hypoxia. These findings suggest that LPS probably promotes a more conventional DC profile, while hypoxia appears to create an imbalance in plasmacytoid-like DC phenotypes [28, 29]. ABC transporters 5-Fluoracil datasheet are described fully in nephrotoxicity models in kidney transplantation, modulating the pharmacokinetics of many immunosuppressors. It is also known that P-glycoprotein is involved in DC maturation. Pendse et al. [12] defined a novel role for Pgp in DC maturation, identifying this transporter as a potential novel therapeutic target in allotransplantation. Schroeijers et al. [30] showed that human monocyte-derived DCs express Pgp at all maturation stages, and that they are up-regulated during DC maturation. Randolph et al. [31] found that Langerhans cells express Pgp and observed that their blockade

inhibited migration of these cells. Although there is some consistent literature in this field, the precise role of Pgp and MRP1 in DC migration and maturation is, as yet, not known precisely, especially under hypoxia [32]. Concerning our results, the immunofluorescence staining that revealed higher expression of Pgp and MRP1 in DC LAMP-positive mDCs versus iDCs suggested initially that Pgp plays a role in the maturation of iDCs under hypoxia. To explore further the mechanisms involved in DC maturation under hypoxia, and taking into account the potential role of ABC transporters in this process, we were tempted to analyse the role of the ABC transporters. The addition of three specific inhibitors shifted the ratio of mature and immature DCs achieved after hypoxia or LPS stimuli.

2A and B). Thus, each dose of α-GalCer

adjuvant delivered by the intranasal route resulted in the activation and expansion of NKT cells with IFN-γ producing potential along with an increase in activated DCs. On the other hand, a second dose of α-GalCer administered by the intravenous route resulted in only a slight increase in NKT cell proliferation, with no concurrent increase in IFN-γ production by NKT cells and no increase in activated DCs. Finally, the significant increase in the activation and reactivation of NKT cells and DCs from the booster immunization by the intranasal route with α-GalCer+OVA also translated into significant increases in antigen-specific cytotoxic T lymphocyte (CTL) activity and IFN-γ-producing cells after the booster dose, which was not observed after the intravenous booster immunization (Fig. 2C and D respectively). Since the primary immunization with α-GalCer+OVA resulted in the expansion Maraviroc purchase of NKT cells that peaked at day 5 in the lung and did not decrease to base-line levels even at day 10 post-immunization (Fig. 1D),

we evaluated whether the second increase in NKT cells is a consequence of the continued effect of the priming dose of α-GalCer or the effectiveness of the second dose delivered on day 5. For this, we delayed the booster immunization until day 23 post-priming and characterized NKT cells and DCs in different tissues on days 24, 26, and 28 (i.e. days 1, 3, and 5 respectively, click here relative to the booster dose, Fig. 3A). Significant increases in the percentages of IFN-γ-producing NKT cells were observed in the spleen and lung of mice immunized with the booster dose of α-GalCer+OVA at day 24 (i.e. day 1 after the booster immunization, Fig. 3B) and furthermore, significant expansion of NKT cells was observed in the lung between days 1 and 5 after the booster immunization (Fig.

3D) compared with that in either the OVA only control group of mice or those that received only the priming dose of α-GalCer+OVA. We also found CD11c+ DCs expressing Rucaparib concentration slightly increased levels of the CD86 activation marker on day 24 (i.e. day 1 after the booster dose), when compared with the DCs from mice in the OVA control group (Fig. 3F). These results from mice that received the priming and boosting doses of α-GalCer+OVA by the intranasal route 23 days apart (the longer immunization scheme) were similar to those observed when the two doses were delivered 5 days apart (the shorter immunization scheme). Thus, regardless of the timing of the second dose, α-GalCer administration by the intranasal route leads to repeated activation of NKT cells, primarily in the lung. These results employing α-GalCer as an adjuvant delivered by the intranasal route are in contrast to those where primary and booster immunizations of α-GalCer+OVA delivered by the intravenous route 23 days apart.

In summary, the present study demonstrates that Notch signalling is engaged in collagen-specific MK-8669 Th1- and Th17-type expansion involving Notch3 and Delta-like1. Selective inhibition of Notch signalling transduced by Notch3

or Delta-like1 may offer a new strategy for the treatment of RA. This study was supported by grants from the Natural Science Foundation of China (30872335), Society Development Foundation of Zhenjiang (SH2008035) and Medical Science and Technology Development Foundation of Jiangsu Province Department of Health (H200950). The authors wish to thank Drs L.W. Lu and L.J. Xin for their helpful suggestions, discussions and excellent technical assistance. The authors declare that they have no conflict of interest. “
“Methicillin-resistant Staphylococcus aureus (MRSA) not only causes disease in hospitals, but also in the community. The characteristics of MRSA transmission in the environment remain uncertain. In this study, MRSA were isolated from public transport in Tokyo and Niigata, Japan. Of 349 trains examined, eight (2.3%) were positive for MRSA. The MRSA isolated belonged to sequence types (STs) 5, 8, 88, and 89,

and included community infection-associated ST8 MRSA (with novel type IV staphylococcal cassette chromosome mec) and the ST5 New York/Japan hospital clone. The data indicate that public transport could contribute to the spread of community-acquired MRSA, and awareness Selleckchem SAHA HDAC of this mode of transmission is necessary. The spread of MRSA, which carries SCCmec, is not only a threat to individual health in hospitals, but also in the community (1, 2). In hospitals, MRSA infections occur most frequently among patients, for example

those who have undergone invasive medical procedures, whereas in the community many of these infections occur through skin-to-skin contact in healthy individuals, especially children and adolescents, and are associated mainly with SSTIs such as Protirelin bullous impetigo, but occasionally with invasive infections (1, 2). Distinctly different MRSA clones are distributed in hospitals and the community; these are called HA-MRSA and CA-MRSA, respectively (1, 2). HA-MRSA, which is selected by high usage of antimicrobial agent in hospitals, generally possesses SCCmec type I, II, or III and is multi-drug-resistant (1–3). By contrast, CA-MRSA generally carries SCCmec type IV or V, is resistant to β-lactam agents only or to some agents in restricted classes, and often produces PVL (1–3). Moreover, although MRSA is resistant to all β-lactams, as proposed by the CLSI (4), many HA-MRSA strains exhibit high MICs to oxacillin and imipenem, while many CA-MRSA strains exhibit low MICs to oxacillin and imipenem, providing bacteriological means for distinguishing the two classes of MRSA (5).

Analysis of secreted cytokines by multi-analyte profiling showed that secreted levels of interferon-γ correlated well with cell proliferation and this effect on inhibition of T cell proliferation observed in either the plate-immobilized or beads-based format could be reversed with excess soluble mBTLA-Fc (data not shown). We were interested to test the effect of the anti-BTLA regents that inhibited in vitro T cell proliferation in selleck chemicals a mechanistically relevant in vivo model of inflammation. The most strongly indicated for

T cell antagonism was judged to be the DO11.10 T cells syngeneic transfer with in vivo trapping of IL-2 (see later discussion). Figure 4 shows that a large dynamic range for trapped IL-2 was generated in this model and that this was unaffected by an isotype control antibody and that the IL-2 signal was normalized completely by dosing with recombinant mCTLA4-hFc. None of the anti-BTLA mAbs that had inhibited in vitro T cell proliferation had a significant effect on the levels of trapped IL-2 in this model, even with Atezolizumab relatively high dosing of 15 mg/kg. In an effort to determine any additive or synergistic effects of CTLA4-Fc and anti-BTLA reagents in this experimental system, we titrated the effect of CTLA4-Fc

and have found that it is extremely effective at a wide range of concentrations, providing almost complete quenching of the signal even at a very low dose of 8 µg per mouse (approximately 0·2 mg/kg) (see Fig. S4). In our experience, this profound suppression of the disease-associated readout leaves an insufficient dynamic range for any additive or synergistic combination studies in this model. In this study we have elucidated further the mechanism of how BTLA acts to affect lymphocyte proliferation. We found that HVEM and a panel of different

monoclonal antibodies bound murine BTLA specifically on both B and T cells and that some of the antibodies inhibited anti-CD3ε-induced T cell proliferation in vitro. None of these antibodies, or the HVEM molecule, had any significant effect on in vitro B Adenylyl cyclase cell proliferation. Although some of the anti-BTLA reagents potently inhibited in vitro T cell proliferation, this effect occurred only when the BTLA ligand or the antibodies were in the appropriate format, i.e. putatively cross-linked with a reagent specific for the Fc region of the test agents. Despite the extensive use of this approach in many laboratories, the exact nature of the molecular interaction between the cross-linking reagent, the test agents and the target cells is still unclear. We elucidated further the requirements for inhibition of in vitro T cell proliferation using a beads-based system to immobilize the stimulus and the test agent. This system offers the advantage of either separating or locally clustering these two separate elements that interact with the cell.

3A) and LACK-specific intracellular cytokine release (Fig. 3B) as published previously 10, 15. As in the case of 16.2β-derived cultures, LACK-specific cells were markedly enriched in frequency (Fig. 3A and B) and total number (Fig. 3C and D) following IL-7-driven cultures. In addition to IL-7, IL-2 supported the significant accumulation of LACK-specific cells as well, when compared with IL-15 or IL-6 (Fig. 3C–F). Again, IL-2+ (not depicted) and IFN-γ+ LACK-specific T cells were mainly found among fast dividing CFSEdim www.selleckchem.com/products/MG132.html cells

in IL-7- and also IL-2-driven cultures (Fig. 3G), suggesting that cytokine-driven proliferation of tumour-sensitized LACK-specific T cells contributes to their selective in vitro accumulation. Notably, we found that Ag-driven stimulation elicited the expansion of tumour Ag-sensitized LACK-specific CD4+ T cells, but only when provided in minute amounts (Supporting Information Fig. 1), suggesting that currently used expansion methods, heavily relying on efficient Ag-driven stimulation, might not be optimal for the in vitro expansion of recently primed T cells. We next investigated the role of IL-7-driven cell survival. Cell recovery was first analyzed. IL-7, but not IL-2 supported a significant higher recovery of both CD4+ (Fig. 4A), and CD4+ CFSEdim dividing cells (Fig. AZD1208 4B) when compared

with control (Nil) cultures in several independent experiments. Furthermore, while up to 72% of CFSEdim cells remained viable in IL-7-driven cultures (as determined by exclusion of TO-PRO-3, a dye which labels dead cells, Fig. 4C), only 40% of proliferating cells were viable in IL-2-driven cultures (Fig. 4C). Finally, while the vast majority (82.5%) of IL-7 cultured CD4+ T cells upregulated Bcl-2 expression with respect to medium-cultured cells (Fig.

4D, left, compare thick line to shaded histograms), suboptimal Bcl-2 levels were found in IL-2 cultured cells (Fig. 4D, right). It is worth noting that IL-7 better than IL-2 Chlormezanone preserved CD62Lhigh cells (Fig. 4E), while IL-2 mostly enriched cultures cells of CD44high lymphocytes (Fig. 4F). No significant differences were observed in FOXP3+ T-cell representation (not depicted), or CD25, and CD132 expression (Fig. 4F), while CD127 was specifically down-regulated in response to IL-7 (Fig. 4F), as expected 45. Together, these findings indicate that while both IL-7 and IL-2 sustain the accumulation of in vivo primed T cells, IL-7 best preserves lymphocyte viability in vitro, and in vivo survival (Bcl-2) and LN-homing (CD62L) potential. IL-2 and/or IL-2-expanded CD8+ CTL have been previously used in ACT with various degree of success 1. Having found that IL-7-cultured CD4+ T cells qualitatively differ from those cultured in IL-2, we compared their in vivo potential. First we investigated prophylactic settings. CD4+ T cells were purified from IL-7- or IL-2-driven T-dLN culture and adoptively transferred in syngenic mice (5×105per mouse).

Current dosing of IVIg for neurological disorders has been extrapolated from earlier studies with small numbers of patients. A study of immunomodulation with IVIg described seven paediatric patients with idiopathic thrombocytopenic purpura [2]. The patients received an initial dose of 0·4 g/kg for 5 consecutive days, followed by maintenance therapy of 0·4 g/kg every 1–6 weeks. Two small-scale trials published in 1984 demonstrated that IVIg treatment was effective in myasthenia gravis (MG) patients at

doses of six infusions of 20 g for 2 weeks [3] or 1–2 g/kg for 5 days [4]. In nine CIDP patients initial treatment was with 0·4 g/kg/day for 5 consecutive days [5]. Thereafter, the patients were treated with the lowest effective dose at the longest Selleckchem Imatinib possible intervals.

This study may represent one of the first attempts at optimizing IVIg therapy. Current practice is to use a broad range of dosages for these chronic neurological conditions. Autophagy high throughput screening The same is true in primary immunodeficiencies in terms of the wide variations in dosage, treatment interval and target trough levels, as demonstrated in a 2012 survey of immunologists [6]. The selection of appropriate IVIg dose and dosing interval has far wider implications, including the impact on economic considerations (including the cost of IVIg), the limited supply of Ig, convenience to the patient, possible adverse effects and, of course, optimizing maintenance therapy in order to prevent long-term disability in these patients. Although most neurologists will treat with initiation therapy, typically

0·4 g/kg for 5 days, followed by maintenance therapy of 1–2 g/kg/month, other therapeutic regimens have been utilized in different neurological disorders. A study in 2005 compared Thiamet G 1 g/kg with 2 g/kg dosing in MG patients, and found no significant difference between the two doses for the primary and secondary end-points [7]. A similar study in Guillain-Barré syndrome (GBS) patients compared 0·4 g/kg/day for 3 days versus the same dose for 6 days, and found no significant difference between the two regimens on time to walking with assistance [8]; however, there was a significant difference between the two groups when studying the subset of patients on mechanical ventilation, indicating that variable dosing may be of benefit for patients with more severe disease. Guidelines have been published to review indications for neurological disorders [9], and in 2010 the European Federation of Neurological Societies published guidelines for the management of CIDP and multifocal motor neuropathy (MMN), respectively, which suggest individualized assessment and treatment with IVIg [10, 11]. When contemplating the appropriate use of a limited resource, a convenient solution is to consider reducing the IVIg dose or discontinuing treatment if the patient no longer requires it, or if treatment is ineffective.