Intralipid Presentation by Jeffrey Braverman and Darren Ritsick

Last Friday while I was hanging out in Woodbury, Long Island (because that’s how I roll), I had a nice chat with Dr. Braverman about the cocktail of drugs he has prescribed for me, how they work, why I care, and why in his view “everything” on the Internet about reproductive immunology is “wrong” (because that’s how he rolls).

I harbour no illusions about the fact that if he were aware of my blog and he and/or his team read my attempts to understand and convey that understanding I would fall squarely into the “wrong” camp of misinformation on the world wide web. Since he has effectively admonished not only me but everybody with medical degrees and knowledge far more comprehensive than mine will ever be, I reckon I’m in good company. I also figure that there is no point in trying to perfect my lay-person (read “for Dummies”) posts if they are destined to be “all wrong” in any event. As I’ve said before, I am NOT an MD and I am NOT offering any medical advice here.

With those caveats out of the way, I offer an unsponsored invitation to those of you currently prescribed (or past users of) Intralipid to read the presentation slides to which Dr. Braverman referred me during our fireside chat. Okay, there was no fire. But there was music, thanks to the good doctor (seriously, he turned on the music). He mentioned having given a presentation at the American Society for Reproductive Immunology conference that he chaired (of course he did ;-)) this past June about Intralipid and that it was posted on his clinic’s website. I had not read it previously.

Other than the information I’ve read on medical research sites and compliments of Evil Dr. Google, my only prior experience with Intralipid was when my mother was hospitalized for colon cancer and received the treatment when she could not consume foods by mouth. They had a PICC line in her upper chest and my most vivid memory is her visible pain and distress while having that line installed (I spent every moment I wasn’t in law school at the hospital when my Mom was first diagnosed. I learned and saw things I wish I could erase from my memory. Life is cruel sometimes). When the PICC was inserted, I almost puked. As is true for most of us, it was much harder to watch someone I love suffer than it is to endure my own pain.

Skulking around, I found the presentation to which Dr. Braverman had referred. Apart from the above trip down memory lane, I am here now to share the wealth. I believe the article is written by Dr. Braverman and his Director of Research, Dr. Darren Ritsick (who is very nice and shared some research when I had neupogen questions previously – a shout out to him). The introduction recognizes both authors although the Power Point only includes Dr. Braverman’s name, as he was presenting (to my understanding, which could be “all wrong”).

Before I post the link, I want to add some editorial comments, per the it’s my blog and I’ll cry (or sing) if I want to principle.

First, I am very curious about the discussion at the end of future research directions, eincluding the interaction between Lovenox and IL and gender and IL. I hope by the time that research is reported my interest is a purely academic one and not one borne of personal necessity and a heart broken more times than I care to think about.

Second, I know some of you will not take the time to read the actual Power Point slides. I have worked with human beings in high-stakes ventures long enough to know that not everyone will do the heavy lifting even if they know it may be in their best interests. On that basis, I will also mention an important point I drew from the presentation. Intralipids are NOT a discount substitute for IVIg. Levels not believed at this time to be corrected by Intralipids, according to these authors, include:

* Elevated intracellular cytokines
* Elevated serum cytokines
* Elevated autoantibodies/alloantibodies

See slide 35 for more on the IVIg / IL discussion. Of course, if I could afford IVIg, I would be asking Dr. Braverman about that as an alternative for me given that I hit the first two of those three targets. Alas, money is a live issue and I have not done so. He did say it may be something to consider if attempt #1 with the Intralipid IV and the rest of the cocktail does not work. I am not going there right now.

The presentation also includes some interesting (to me, confessed nerd) discussion about using other oils in the emulsions, such as fish oil or even olive oils, which on the spectrum are less pro-inflammatory than the current/previous formulations that use soybean and safflower oil. See slide 36 for an illustration of this.

Even more fascinating (again, to me) is the possibility that Intralipid may have angiogenic (formation of new blood vessels from existing ones) effects. I’m no doctor but it seems to me that this could be a big deal for women whose placentas are not forming properly for immunological or other reasons.

In short, it seems to me that if Intralipid is an iceberg, reproductive immunology has only explored the tip at this point. How exciting (to me)! To me, it is also a little unfortunate in that I would love to be able to leapfrog ahead to the day when Dr. Braverman and his awesome team could offer a more certain outcome in my case (and yours, fellow immune-affected readers). Alas, the resources of Mr. Peabody and Sherman are not available to me (or you) yet, so onward I march.

Without further ado, the link to presentation can be found here. Further instructions for Dummies (present company included): Click on the blue line that reads “Click here to view Dr. Braverman’s Intralipid PowerPoint Presentation”.

Enjoy, friends and fellow RI and other science/medicine/reproductive health nerds!

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10 thoughts on “Intralipid Presentation by Jeffrey Braverman and Darren Ritsick

  1. Wow… Kudos to you for this and trying to understand things behind what you’re doing. I would’ve been overwhelmed from the very beginning, probably because I am not a science or reproductive health nerd. 🙂 I know that reproductive immunology is very controversial but I do see that it helps so many women to have successful pregnancies. I really hope that Dr. B’s cocktail drugs will be the answer to your pregnancy and baby. ❤

    • I have Arts and Law degrees, this is not second nature to me, trust me. I think the controversy is fabricated and unwarranted in most respects and if one looks back a couple of decades we’d be reminded how controversial IVF was. Now it’s up there with you know what and apple pie.

      Thank you for adding your hope to mine. I hope your binky moongee quest ends well soon-ish, too.

  2. This just seems like so much frustration and uncertainty and guess work, and you’re one of so few test cases. It’s just frustrating to have so few answers. Then again, that was true for all of this 25 years ago, and now IVF is standard big business. It’s pretty amazing that you could be part of helping more women not so long from now, not that this theoretical future altruism is helpful to you now, facing what you are now. You are so strong, and you are clearly willing to try whatever you can. I’ll be rooting for you.

    • Thank you. IL has been used in reproductive medicine for quite a while yet it still is a tip of the iceberg thing as best I can tell (I’m going to run that analogy past Dr. B next time I see him if I can remember and ask if he’d agree). I don’t know that I’m strong so much as tenacious, like a terrier. Comes with being a dog in the chinese zodiac, maybe? 😉

  3. I am so thankful for you!! One, because you are amazing. 🙂
    Two, because you are few months further ahead into this reproductive immunology then I am, and every time you post something like this, you provide me with an insight into what I expect to be learning more about in the coming weeks/months as we visit Dr. B and potentially head down the same road.
    As always, I am so hopeful for you that this will work! Wishing you peace as you travel down this road and sending you love!

  4. This is all so interesting! I have a ton to do today, but will definitely be checking out that Powerpoint presentation when I have a bit of time. It really gives me so much hope for the future or RPL research! Praying it becomes only academic interest for you too and you do not need to try the other methods!

  5. Thank you for sharing. I know what I’ll be doing tomorrow! Read, google, keep head from spinning, repeat.

    I’m also concerned about not being able to afford IVIg treatments given that it’s the common protocol for my cruddy TNFa immunophenotypes. The more I read about IVIg success rates with TNF, the further I fall down the rabbit hole. But, like you said, not going there now.

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