Fig. 1.

Schematic diagram depicting some of the potential mechanisms of action of IVIg in the treatment of SCI as discussed in the text. Following the neuronal necrosis and axonal destruction and demyelination, the immune system gets activated and leukocytes get recruited in the spinal cord, starting with neutrophils. IVIg may interfere with several steps of the cellular immune response (numbered 1–5). It has been shown to reduce cytokine and chemokine levels, as well as neutrophil recruitment, which may be due to increased leukocyte apoptosis or decreased rolling and adhesion and therefore extravasation. In addition, IVIg has been suggested to interfere with phagocytosis and antigen presentation. Finally, it may interfere with the adaptive immune response by neutralizing CNS antigens, auto-antibodies and auto-reactive lymphocytes