Flashcards in Immunosuppressive Antibodies, Monoclonal Antibodies and Immunostimulants Deck (19):
Moving on to the immunosuppressive antibodies. First up are the polyclonal antibodies. They are antilymphocyte and antithymocyte antibodies. What is their MOA?
Antilymphocyte globulin (ALG)
Antithymocyte globulin (ATG)
--produced in horses and sheep by immunization against human thymus cells. Antibodies in these preparations bind to T cells involved in antigen recognition and initiate their destruction by serum complement
Used to prevent graft vs host reaction
The other polyclonal antibodies used are Rho Immune Globulin. What is the MOA?
Preparation of human IgG containing antibodies against the Rho antigen of the red cell
Explain hemolytic disease of the newborn in relation to Rho antigen -antibody
Rh negative women will be sensitized to the RH antigen at the time of birth of a Rho positive infant
--when fetal RBCs leak into the mother's bloodstream, the immune response will make antibodies to the Rh antigen
--when mother gets pregnant again, maternal antibody against Rh positive cells is transferred to the fetus during the 3rd trimester and this is life threatening
What are uses of Rho immune globulin?
Prevention of Rh hemolytic disease of the newborn
--given to Rh negative mothers, the immune response will be blocked to foreign cells
The next immunosuppressive antibodies are monoclonal antibodies. First up is TNF-alpha inhibitors, what are some features?
TNF alpha effects are mediated by TNF receptors (TNF1 and TNF2)
--blocking the binding to receptors on inflammatory cells results in suppression of downstream cytokines and adhesion molecules involved in leukocyte activation
An increased risk of what is associated with TNF alpha inhibitors?
Infection or Reactivation of M tuberculosis, hep B virus and invasive systemic fungi
Next monoclonal antibody is Infliximab, what are some features?
Binds with high affinity and specificity to human TNF-alpha
--decreases formation of interleukins and adhesion molecules involved in leukocyte activation
--RA, psoriatic arthritis, UC and Crohns
Third monoclonal antibody is Adalimumab, what are some features?
Human IgG1 anti-TNF monoclonal antibody
--complexes with TNF-alpha and prevents interaction with its receptors
RA, Psoriatic arthritis, UC and Crohns
Fourth monoclonal antibody is Etanercept, what are some features?
Contains the ligand binding portion of a human TNF-alpha receptor fused to the Fc portion of human IgG1
--Etanercept bind to TNF-alpha and prevents it from interacting with its receptors
RA, Plaque Psoriasis and Psoriatic Arthritis
What are some effects of the Anti-TNF alpha drugs.
2. Bacterial sepsis and TB (reactivation)
3. Do not give in patients with active infection
4. Screening for latent TB needs to be done
5. Increase the risk for invasion and disseminated infections caused by viral and fungal pathogens
6. Increased risk for malignancies including lymphomas.
There are three other monoclonal antibodies. The first is Omalizumab, what are some features?
Anti-IgE recombinant Humanized Monoclonal Antibody
--binds to IgE and prevents IgE from binding to mast cells and basophils, so prevents the release of inflammatory mediators after allergen exposure
kids over 12 with asthma refractory to inhaled corticoids
The second other monoclonal antibody is Basiliximab, what are some features?
Human-mouse IgG that binds to IL-2 receptor on activated lymphocytes
prevent renal transplant rejection
The third monoclonal antibody is Rituximab, what are some features?
Murine-human monoclonal antibody that binds to the CD20 molecule on B lymphocytes and depletes circulating B cells
non-hodgkins lymphoma and CLL
Finally there are two other biological immunosuppressive agents, the first is Anakinra. What are some features?
IL-1 receptor antagonist
--recombinant version of the naturally occurring human IL-1RA that prevents IL-1 from binding to its receptor
Moderate to severe R arthritis
The last immunosuppressive agent is Abatacept, what are some features?
Fusion protein that interferes with T cell activation
moderate to severe RA
moderate to severe polyarticular juvenile idiopathic arthritis
There is a chart of immunosuppressive agents
The last set of drugs are the immunostimulants, what are these agents?
Used for tx of immune deficiency diseases and chronic infectious diseases and cancer
The first immunostimulant drug is Aldesleukin, what are some features?
--endogenous lymphokine that promotes the production of cytotoxic T lymphocytes and activates NK cells
--adjunctive treatment of renal cell carcinoma and malignant melanoma