Which Antibody is Really Being Detected?

Posted By Braverman IVF & Reproductive Immunology || 29-May-2012

The LAD test as has been performed for years still leaves tremendous ambiguity as to which antibody is being "detected". As the antibody reacts to paternal T and B cells, these can only be the anti HLA antibodies (the ones that WILL attack the embryo). Hence, the idea that lacking them is a problem is not well founded and may, actually, be a good thing.

The LAD test takes one major assumption to accept. That is you can only make the protective antibodies if you make the pathologic ones (the ones that WILL attack the pregnancy first). The assumption of the LAD is that finding the pathologic ones is a fairly good predictor that the patient has then gone on to make the protective ones (anti idiotypic). The possibility exists that if a patient did not make the protective (anti idiotypic) antibodies in response to the pathologic (anti HLA antibodies)thepresence of these antibodies (i.e. anti HLA antiboides) on the LAD test is actually a poor prognostic indicator for a successful pregnancy. And yes, in a recent study, this was actually found to be the case!

It certainly makes sense to just test directly for the presence of the protective (anti idiotypic) antibodies and, yes, we are currently underway with this testing and will make it available soon.

It will be useful to decide who really needs LIT, and also on the success of LIT therapy. In fact patients in whom LIT therapy fails to produce this protective antibody, would do well just having it transfused into them hence the beauty of IVIG therapy.

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