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Duarte AF, Xavier NF, Sales Sanz M, Cruz AAV. Efficiency and Safety of Tocilizumab for the Treatment of Thyroid Eye Disease: A Systematic Review. Ophthalmic Plast Reconstr Surg 2024; 40:367-373. [PMID: 38215463 DOI: 10.1097/iop.0000000000002573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
PURPOSE To review existing literature concerning the effectiveness and safety of tocilizumab (TCZ) for managing thyroid eye disease. METHODS A systematic search was conducted across the PubMed and Embase databases to identify studies on TCZ therapy, from inception to May 2023. The search included the keywords "Graves orbitopathy," "thyroid ophthalmopathy," "thyroid eye disease," "thyroid-associated orbitopathy," "thyroid-associated ophthalmopathy," "Graves ophthalmopathy," "endocrine ophthalmopathy," and "Tocilizumab." Only articles written in English, Spanish, or French were considered. RESULTS Among the 1,013 articles initially screened, a total of 29 fulfilled the eligibility criteria and were selected. Most studies were case reports or case series, and only one randomized clinical trial was found. TCZ has been used mainly in glucocorticoid-resistant or relapsing cases, with a dosage ranging from 4 or 8 mg/kg every 4 weeks when intravenous or a weekly subcutaneous dose of 162 mg. Treatment duration is usually adjusted to the clinical response. TCZ is mostly effective in reducing inflammatory signs during the active phase of thyroid eye disease, with an improvement of at least 3 points in clinical activity score and an overall relapsing rate of 8.2%. Numerous studies have shown marked reductions in proptosis; although the only available randomized controlled trial reported a nonstatistically significant improvement 6 months after treatment, a recent meta-analysis indicated that TCZ seems to be the most effective treatment for reducing proptosis. No severe side effects related to intravenous or subcutaneous TCZ administration were reported. DISCUSSION Despite these promising findings, randomized clinical trials to directly compare the efficacy and safety of TCZ and other currently available therapeutic options are needed.
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Affiliation(s)
- Ana F Duarte
- Department of Ophthalmology, Centro Hospitalar Universitario Lisboa Central, Lisbon, Portugal
- Department of Ophthalmology, Cuf Descobertas Hospital, Lisbon, Portugal
| | - Naiara F Xavier
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Marco Sales Sanz
- Department of Ophthalmology, Hospital Universitario Ramon y Cajal, Madrid, Spain
- IMO Madrid, Grupo Miranza, Madrid, Spain
| | - Antonio A V Cruz
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Takemasa E, Liu S. Production of Neutralizing Antibody. Methods Mol Biol 2024; 2766:93-106. [PMID: 38270870 DOI: 10.1007/978-1-0716-3682-4_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Techniques employing monoclonal antibodies (mAbs) are widely used in the initial development phase of biologics. The usefulness of mAbs in basic RA research has been established based on their characteristics, including specificity of binding, homogeneity, and ability to be produced on a large scale. MAb immunoglobulins are the starting material for the generation of smaller antibody fragments and other engineered immunomodulatory antibodies. In this chapter, the basic hybridoma technique, which is a well-established and feasible method for the production of mAbs involving animal immunization, cell fusion, hybridoma screening, expanding positive hybridomas, and purification, is introduced. Aiming at specific affinity to a membrane protein, synthetic proteoliposomes are used in the immunization and screening steps.
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Affiliation(s)
- Erika Takemasa
- Department of Pharmacology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Shuang Liu
- Department of Pharmacology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
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Zerbo O, Modaressi S, Goddard K, Lewis E, Getahun D, Palmsten KK, Fuller CC, Crane B, Donahue JG, Daley MF, Jackson LA, Wodi AP, McNeil MM, Klein NP. Safety of Live-Attenuated Vaccines in Children Exposed to Biologic Response Modifiers in Utero. Pediatrics 2022; 150:e2021056021. [PMID: 35773517 PMCID: PMC11271740 DOI: 10.1542/peds.2021-056021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives: To estimate the prevalence of biological response modifiers (BRM) use during pregnancy and compare clinical outcomes in infants, live-attenuated immunization coverage and adverse events of special interest (AESI) following immunization. Methods: We conducted a retrospective cohort study among pregnant people between 2006 – 2017 and children born from these pregnancies within the Vaccine Safety Datalink. We estimated the proportion of women who used BRM during pregnancy overall and by year of pregnancy onset. We compared clinical outcomes, live-attenuated vaccination coverage, and AESI occurring in specific risk intervals following immunization in children exposed and unexposed in utero to BRM. Results: Of the 1,205,416 pregnant people, 2,243 used BRM (19/10,000), which increased from 8/10,000 in 2006 to 46/10,000 pregnant people in 2017. The most frequently dispensed or prescribed BRM were etanercept (35.9%), anakinra (23.2%), adalimumab (21.4%) and infliximab (19.9%). Except for pneumonia, clinical outcomes of interest were rare among exposed and unexposed children to BRM. Proportions of clinical outcomes were similar between both groups. A lower proportion of children exposed to BRM receive rotavirus vaccines by age 12 months compared with unexposed children (79.5% vs. 85.4%). AESI with measles-containing vaccines or rotavirus vaccines were rare and proportions of these were similar among exposed and unexposed children. Conclusion: In utero exposure to BRM was not associated with an increased risk of clinically significant infections or adverse events following live-attenuated vaccines. These data provide reassurance that children exposed in utero to BRM can receive live-attenuated vaccines on the same schedule as other children.
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Affiliation(s)
- Ousseny Zerbo
- Kaiser Permanente Northern California, Division of Research, Vaccine Study Center, Oakland, California
| | - Sharareh Modaressi
- Kaiser Permanente Northern California, Division of Research, Vaccine Study Center, Oakland, California
| | - Kristin Goddard
- Kaiser Permanente Northern California, Division of Research, Vaccine Study Center, Oakland, California
| | - Edwin Lewis
- Kaiser Permanente Northern California, Division of Research, Vaccine Study Center, Oakland, California
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | - Candace C. Fuller
- Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Bradley Crane
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - James G. Donahue
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Lisa A. Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - A. Patricia Wodi
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael M. McNeil
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicola P. Klein
- Kaiser Permanente Northern California, Division of Research, Vaccine Study Center, Oakland, California
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Kumar AR, Devan AR, Nair B, Vinod BS, Nath LR. Harnessing the immune system against cancer: current immunotherapy approaches and therapeutic targets. Mol Biol Rep 2021; 48:8075-8095. [PMID: 34671902 PMCID: PMC8605995 DOI: 10.1007/s11033-021-06752-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 09/15/2021] [Indexed: 02/08/2023]
Abstract
Cancer immunotherapy is a rapidly evolving concept that has been given the tag "fifth pillar" of cancer therapy while radiation therapy, chemotherapy, surgery and targeted therapy remain the other four pillars. This involves the stimulation of the immune system to control tumor growth and it specifically targets the neoplastic cells rather than the normal cells. Conventional chemotherapy has many limitations which include drug resistance, recurrence of cancer and severe adverse effects. Immunology has made major treatment breakthroughs for several cancers such as colorectal cancer, prostate cancer, breast cancer, lung cancer, liver cancer, kidney cancer, stomach cancer, acute lymphoblastic leukaemia etc. Currently, therapeutic strategies harnessing the immune system involve Checkpoint inhibitors, Chimeric antigen receptor T cells (CAR T cells), Monoclonal antibodies, Cancer vaccines, Cytokines, Radio-immunotherapy and Oncolytic virus therapy. The molecular characterization of several tumor antigens (TA) indicates that these TA can be utilized as promising candidates in cancer immunotherapy strategies. Here in this review, we highlight and summarize the different categories of emerging cancer immunotherapies along with the immunologically recognized tumor antigens involved in the tumor microenvironment.
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Affiliation(s)
- Ayana R Kumar
- Department of Pharmacognosy, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Science Campus, Ponekkara P. O., Kochi, Kerala, 682041, India
| | - Aswathy R Devan
- Department of Pharmacognosy, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Science Campus, Ponekkara P. O., Kochi, Kerala, 682041, India
| | - Bhagyalakshmi Nair
- Department of Pharmacognosy, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Science Campus, Ponekkara P. O., Kochi, Kerala, 682041, India
| | - Balachandran S Vinod
- Department of Biochemistry, Sree Narayana College, Kollam, Kerala, 691001, India.
| | - Lekshmi R Nath
- Department of Pharmacognosy, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Science Campus, Ponekkara P. O., Kochi, Kerala, 682041, India.
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Waldron JL, Schworer SA, Kwan M. Hypersensitivity and Immune-related Adverse Events in Biologic Therapy. Clin Rev Allergy Immunol 2021; 62:413-431. [PMID: 34319562 DOI: 10.1007/s12016-021-08879-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 12/13/2022]
Abstract
Biologic medications are an expanding field of therapeutics for various medical conditions including cancer and inflammatory diseases. Due to their targeted approach to therapy, biologics can be less toxic than traditional systemic medications. However, as use becomes more widespread, adverse effects from biologic administration have also become apparent. Immune-related adverse events are a common mechanism by which biologics can cause on-target immune-related toxicities and both immediate and delayed-type hypersensitivity reactions. Immediate hypersensitivity reactions can be mediated by cytokine release or antibody mediated reactions, while delayed-type hypersensitivity is most often caused by serum sickness-like reactions. Additionally, biologics used for treatment of cancer using checkpoint blockade and rheumatologic disease using cytokine blockade can result in autoimmunity. Finally, when inflammatory cytokines are targeted for treatment of autoimmune or autoinflammatory disease, the host immune defense can be compromised predisposing to secondary immunodeficiency. This review will discuss the mechanisms of these reactions and discuss examples of biologics implicated in each of these adverse events.
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Affiliation(s)
- Jamie L Waldron
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, UNC School of Medicine, Chapel Hill, NC, USA
| | - Stephen A Schworer
- Department of Pediatrics, Division of Allergy & Immunology, UNC School of Medicine, Chapel Hill, NC, USA
| | - Mildred Kwan
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, UNC School of Medicine, Chapel Hill, NC, USA.
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Sasnovskaya V, Kumor LM, Stubbings J, Chevalier A. A pharmacist-managed virtual consult service to improve tuberculosis screening. Am J Health Syst Pharm 2021; 79:e41-e49. [PMID: 34170283 DOI: 10.1093/ajhp/zxab257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE To describe a pharmacist-managed virtual consult service practice model to improve medication safety in a population of rheumatology patients and evaluate its initial impact on guideline compliance. SUMMARY Optimal pharmacologic care of patients with rheumatologic conditions often revolves around the use of specialty medications such as self-injectable biologics and infused therapies, including biologic response modifiers (BRMs), nearly all of which carry risks of serious adverse events due to their immune-suppressive properties. Possible adverse events include serious infections such as reactivation of tuberculosis (TB) and viral hepatitis B (HBV). This articles describes a pharmacist-managed virtual consult service introduced by a large university-affiliated health system in 2018 to integrate clinical, specialty pharmacy, and therapeutic infusion services for proactive medication and safety management for patients with rheumatologic conditions requiring specialty or infused medications. During a 4-month evaluation period, 157 referrals were sent to the consult service; of 137 consults included in the analysis, 42% were for self-injectable biologic medications, 28% were for intra-articular injections, 26% were for infusions, and 4% were for oral specialty medications. Forty-one percent of the pharmacy benefit consult orders required an intervention prior to submission of prior authorization requests. Most interventions (61%) were clinical in nature and involved the pharmacists ensuring that necessary laboratory work, clinical disease activity scoring, or radiographic imaging were completed prior to submission of the consult results for insurer approval. CONCLUSION National rates of HBV screening and TB screening for patients prescribed BRMs continue to be suboptimal. The pharmacist-managed virtual consult service is a novel practice model to increase the screening rate to 100% to ensure the safety and appropriate monitoring of patients who are starting or continued on these complex medications.
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Affiliation(s)
| | - Lisa M Kumor
- University of Illinois at Chicago Hospital and Health Sciences System, Chicago, IL
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - JoAnn Stubbings
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Aimee Chevalier
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
- Arthritis and Kidney Center, University of Illinois Hospital and Health Sciences System, Chicago, IL
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Ramirez JA, Musher DM, Evans SE, Dela Cruz C, Crothers KA, Hage CA, Aliberti S, Anzueto A, Arancibia F, Arnold F, Azoulay E, Blasi F, Bordon J, Burdette S, Cao B, Cavallazzi R, Chalmers J, Charles P, Chastre J, Claessens YE, Dean N, Duval X, Fartoukh M, Feldman C, File T, Froes F, Furmanek S, Gnoni M, Lopardo G, Luna C, Maruyama T, Menendez R, Metersky M, Mildvan D, Mortensen E, Niederman MS, Pletz M, Rello J, Restrepo MI, Shindo Y, Torres A, Waterer G, Webb B, Welte T, Witzenrath M, Wunderink R. Treatment of Community-Acquired Pneumonia in Immunocompromised Adults: A Consensus Statement Regarding Initial Strategies. Chest 2020; 158:1896-1911. [PMID: 32561442 PMCID: PMC7297164 DOI: 10.1016/j.chest.2020.05.598] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/03/2020] [Accepted: 05/09/2020] [Indexed: 12/23/2022] Open
Abstract
Background Community-acquired pneumonia (CAP) guidelines have improved the treatment and outcomes of patients with CAP, primarily by standardization of initial empirical therapy. But current society-published guidelines exclude immunocompromised patients. Research Question There is no consensus regarding the initial treatment of immunocompromised patients with suspected CAP. Study Design and Methods This consensus document was created by a multidisciplinary panel of 45 physicians with experience in the treatment of CAP in immunocompromised patients. The Delphi survey methodology was used to reach consensus. Results The panel focused on 21 questions addressing initial management strategies. The panel achieved consensus in defining the population, site of care, likely pathogens, microbiologic workup, general principles of empirical therapy, and empirical therapy for specific pathogens. Interpretation This document offers general suggestions for the initial treatment of the immunocompromised patient who arrives at the hospital with pneumonia.
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Affiliation(s)
- Julio A Ramirez
- Division of Infectious Diseases, University of Louisville, Louisville, KY.
| | - Daniel M Musher
- Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX
| | - Scott E Evans
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles Dela Cruz
- Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT
| | - Kristina A Crothers
- Veterans Puget Sound Health Care System, University of Washington, Seattle WA
| | - Chadi A Hage
- Thoracic Transplant Program, Indiana University, Indianapolis, IN
| | - Stefano Aliberti
- Department of Pathophysiology and Transplantation, University of Milan, and Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
| | - Antonio Anzueto
- South Texas Veterans Health Care System, Audie L. Murphy Memorial Veterans Hospital, and University of Texas Health, San Antonio, TX
| | - Francisco Arancibia
- Pneumology Service, Instituto Nacional del Tórax and Clínica Santa María, Santiago de Chile, Chile
| | - Forest Arnold
- Division of Infectious Diseases, University of Louisville, Louisville, KY
| | - Elie Azoulay
- Medical ICU, Saint-Louis Teaching Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, and Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
| | - Jose Bordon
- Section of Infectious Diseases, Providence Health Center, Washington, DC
| | - Steven Burdette
- Wright State University Boonshoft School of Medicine, Dayton, OH
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care, and Sleep Disorders Medicine, University of Louisville, Louisville, KY
| | - James Chalmers
- Scottish Centre for Respiratory Research, School of Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Patrick Charles
- Department of Infectious Diseases, Austin Health and Department of Medicine, University of Melbourne, Australia
| | - Jean Chastre
- Service de Médecine Intensive-Réanimation, Hôpital La Pitié-Salpêtrière, Sorbonne Université, APHP, Paris, France
| | | | - Nathan Dean
- Intermountain Medical Center and the University of Utah, Salt Lake City, UT
| | - Xavier Duval
- UMR 1137, IAME, INSERM, and CIC 1425, Hôpital Bichat-Claude Bernard, APHP, Paris, France
| | - Muriel Fartoukh
- Service de Médecine Intensive Réanimation, Hôpital Tenon, APHP, and APHP, Sorbonne Université, Faculté de Médecine Sorbonne Université, Paris, France
| | - Charles Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Thomas File
- Infectious Disease Section, Northeast Ohio Medical University and Infectious Disease Division, Summa Health, Akron, OH
| | - Filipe Froes
- ICU, Chest Department, Hospital Pulido Valente-Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Stephen Furmanek
- Division of Infectious Diseases, University of Louisville, Louisville, KY
| | - Martin Gnoni
- Division of Infectious Diseases, University of Louisville, Louisville, KY
| | - Gustavo Lopardo
- Fundación del Centro de Estudios Infectológicos, Buenos Aires, Argentina
| | - Carlos Luna
- Pulmonary Diseases Division, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Takaya Maruyama
- Department of Respiratory Medicine, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Rosario Menendez
- Pneumology Department, La Fe University and Polytechnic Hospital, La Fe Health Research Institute, Valencia, Spain
| | - Mark Metersky
- Division of Pulmonary, Critical Care and Sleep Medicine and Center for Bronchiectasis Care, University of Connecticut Health, Farmington, CT
| | - Donna Mildvan
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Eric Mortensen
- Department of Medicine, University of Connecticut Health Center, Farmington, CT
| | - Michael S Niederman
- Pulmonary and Critical Care, New York Presbyterian/Weill Cornell Medical Center and Weill Cornell Medical College, New York, NY
| | - Mathias Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Jordi Rello
- Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, and Infections Area, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Marcos I Restrepo
- South Texas Veterans Health Care System, Audie L. Murphy Memorial Veterans Hospital, and University of Texas Health, San Antonio, TX
| | - Yuichiro Shindo
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Antoni Torres
- Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona. Barcelona, CIBERES, Spain
| | - Grant Waterer
- School of Medicine, University of Western Australia, Perth, Australia
| | - Brandon Webb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT and Division of Infectious Diseases and Geographic Medicine, Stanford Medicine, Palo Alto, CA
| | - Tobias Welte
- German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) Clinic of Pneumology, Hannover Medical School, Hannover, Germany
| | - Martin Witzenrath
- Division of Pulmonary Inflammation and Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Richard Wunderink
- Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL
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Bavaro DF, Fiordelisi D, Angarano G, Monno L, Saracino A. Targeted therapies for autoimmune/idiopathic nonmalignant diseases: risk and management of opportunistic infections. Expert Opin Drug Saf 2020; 19:817-842. [PMID: 32394759 DOI: 10.1080/14740338.2020.1767585] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The management of patients affected by autoimmune/idiopathic diseases has been revolutionized by the development of targeted therapies (TT). However, the use of TT is complicated by several adverse events, like opportunistic infections (OIs). The potential of TT to predispose to OIs mainly depends on the site of action; nevertheless, such associations are far from being deterministic, because many factors could increase the infection risk. AREAS COVERED The impact on the infective risk of different TT used for autoimmune/idiopathic diseases is far from being completely understood. Indeed, many post-marketing reports documented severe or unexpected infections in patients treated with TT that did not emerge during registrative trials. In this review, the authors attempt to provide an easy and practical update about the 'infectious' safety of TT and examine the management strategies of OIs and other infections more frequently observed in the course of treatment with TT. EXPERT OPINION The authors suggest to precisely schedule the clinical management of these subjects, both to prevent and eventually treat promptly the TT-related infectious complications. A coordinated approach should be implemented from different medical specialties to improve the overall understanding of safety of TT and, in general, the management of opportunistic infections in immune-compromised hosts.
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Affiliation(s)
- Davide Fiore Bavaro
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro" , Bari, Italy
| | - Deborah Fiordelisi
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro" , Bari, Italy
| | - Gioacchino Angarano
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro" , Bari, Italy
| | - Laura Monno
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro" , Bari, Italy
| | - Annalisa Saracino
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro" , Bari, Italy
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Allergic Immune Diseases and the Risk of Mortality Among Patients Hospitalized for Acute Infection. Crit Care Med 2020; 47:1735-1742. [PMID: 31599813 DOI: 10.1097/ccm.0000000000004020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The immune response during sepsis remains poorly understood and is likely influenced by the host's preexisting immunologic comorbidities. Although more than 20% of the U.S. population has an allergic-atopic disease, the type 2 immune response that is overactive in these diseases can also mediate beneficial pro-resolving, tissue-repair functions. Thus, the presence of allergic immunologic comorbidities may be advantageous for patients suffering from sepsis. The objective of this study was to test the hypothesis that comorbid type 2 immune diseases confer protection against morbidity and mortality due to acute infection. DESIGN Retrospective cohort study of patients hospitalized with an acute infection between November 2008 and January 2016 using electronic health record data. SETTING Single tertiary-care academic medical center. PATIENTS Admissions to the hospital through the emergency department with likely infection at the time of admission who may or may not have had a type 2 immune-mediated disease, defined as asthma, allergic rhinitis, atopic dermatitis, or food allergy, as determined by International Classification of Diseases, 9th Revision, Clinical Modification codes. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 10,789 admissions for infection, 2,578 (24%) had a type 2 disease; these patients were more likely to be female, black, and younger than patients without type 2 diseases. In unadjusted analyses, type 2 patients had decreased odds of dying during the hospitalization (0.47; 95% CI, 0.38-0.59, p < 0.001), while having more than one type 2 disease conferred a dose-dependent reduction in the risk of mortality (p < 0.001). When adjusting for demographics, medications, types of infection, and illness severity, the presence of a type 2 disease remained protective (odds ratio, 0.55; 95% CI, 0.43-0.70; p < 0.001). Similar results were found using a propensity score analysis (odds ratio, 0.57; 95% CI, 0.45-0.71; p < 0.001). CONCLUSIONS Patients with type 2 diseases admitted with acute infections have reduced mortality, implying that the type 2 immune response is protective in sepsis.
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Niehues T, Özgür TT. The Efficacy and Evidence-Based Use of Biologics in Children and Adolescents: Using Monoclonal Antibodies and Fusion Proteins as Treatments. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:703-710. [PMID: 31711560 PMCID: PMC6891884 DOI: 10.3238/arztebl.2019.0703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 12/27/2018] [Accepted: 07/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Monoclonal antibodies (mAb) and fusion proteins (FP) are increasingly being used in children and adolescents. In this review, we analyze the evidence for their safety and efficacy in the treatment of the most common chronic inflammatory diseases. METHODS We systematically searched PubMed, AWMF.org, and other databases for high-quality trials (i.e., randomized controlled trials with clinical primary endpoints) and guidelines published at any time up to 10 December 2018 that dealt with mAb and FP that are approved for pediatric use. The search term was "monoclonal anti- body/fusion protein [e. g. adalimumab] AND children." RESULTS The 620 hits included 25 high-quality trials (20 of them manufacturer- sponsored) on 9 mAb/FP (omalizumab, adalimumab, etanercept, ustekinumab, infliximab, golimumab, anakinra, canakinumab, tocilizumab, and abatacept), as well as 6 guidelines (3 each of levels S3 and S2k) on the treatment of bronchial asthma, psoriasis, juvenile idopathic arthritis, and chronic inflammatory bowel diseases. For none of these conditions are mAb and FP the drugs of first choice. Adverse drug effects are rare but sometimes severe (infection, immune dysregulation, tumors). CONCLUSION The retrieved trials have deficiencies that make it difficult to reliably evaluate the efficacy, safety, and utility of mAb/FP for children and adolescents with chronic inflammatory diseases. mAb/FP nonetheless represent a treatment option to be considered in case conventional immune-modulating drugs are ineffective. Researcher-initiated, high-quality trials and manufacturer-independent, systematic long-term evaluations of adverse effects (e.g., tumors) are sorely needed.
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Affiliation(s)
- Tim Niehues
- Department of Pediatrics and Adolescent Medicine, HELIOS Klinikum Krefeld
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11
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Sager R, Frei P, Steiner UC, Fink D, Betschart C. Genital Dysplasia and Immunosuppression: Why Organ-Specific Therapy Is Important. Inflamm Intest Dis 2019; 4:154-160. [PMID: 31768388 PMCID: PMC6873019 DOI: 10.1159/000502687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 08/12/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Young patients with Crohn's disease (CD) show a high prevalence of human papillomavirus (HPV) which is the main cause of high-grade squamous intraepithelial lesions (HSIL). A major complication for patients undergoing immunocompromising therapy is the development of genital dysplasia. METHODS We report the case of a 32-year-old patient with recurrent genital dysplasia under long-term therapy for CD with a focus on different drug-related, immunosuppressive mechanisms. RESULTS Gynecological examination and biopsy revealed high-grade vulvar intraepithelial neoplasia (VIN) positive for HPV 16 treated with laser vaporization. Due to the combination of HPV positivity, intraoperative multilocularity, and CD, follow-up examinations were performed every 6 months. One year later, the patient showed a VIN at a new location and additionally, a cervical intraepithelial neoplasia (CIN), which were surgically treated. Catch-up HPV vaccination was applied accessorily. After the switch from a TNF-α blocker to vedolizumab, which acts as a gut-selective anti-integrin, the subsequent PAP smear, vulvoscopy, and colposcopy showed no more evidence of dysplasia. CONCLUSIONS This case report highlights that gut-selective immunosuppression with vedolizumab might be favorable in young HPV-positive patients due to a good side effect profile. Regular screening and HPV vaccination are a mainstay of dysplasia prevention and control. The risk for HPV-associated dysplasia in immunosuppressed patients is highly dependent on the choice of immunosuppressive therapy.
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Affiliation(s)
- Raphael Sager
- Department of Gynecology, University Hospital of Zurich, Zurich, Switzerland
| | - Pascal Frei
- Gastroenterology, Clinic Bethanien, Zurich, Switzerland
| | - Urs C. Steiner
- Department of Immunology, University Hospital of Zurich, Zurich, Switzerland
| | - Daniel Fink
- Department of Gynecology, University Hospital of Zurich, Zurich, Switzerland
| | - Cornelia Betschart
- Department of Gynecology, University Hospital of Zurich, Zurich, Switzerland
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12
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Sun X, Dong S, Li X, Yu K, Sun F, Lee RJ, Li Y, Teng L. Delivery of siRNA using folate receptor-targeted pH-sensitive polymeric nanoparticles for rheumatoid arthritis therapy. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2019; 20:102017. [PMID: 31128293 DOI: 10.1016/j.nano.2019.102017] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 05/01/2019] [Accepted: 05/10/2019] [Indexed: 02/06/2023]
Abstract
Systemic delivery of siRNA to target tissues is difficult to achieve owing to its limited cellular uptake and poor serum stability. Herein, polymeric nanoparticles were developed for systemic administration of siRNA to inflamed tissues. The polymeric nanoparticles were composed of PK3 as a pH-sensitive polymer, folate-polyethyleneglycol-poly(lactide-co-glycolide) as a targeting ligand, and a DOTAP/siRNA core. The polymeric nanoparticles had a mean particle size of 142.6 ± 0.61 nm and a zeta potential of 3.6 ± 0.43 mV. In vitro studies indicated pH-dependent siRNA release from polymeric nanoparticles, with accelerated release at pH 5.0. Cellular uptake was efficient and gene silencing was confirmed by Western blot. In vivo, polymeric nanoparticles were shown to have inflammation-targeting activity and potent therapeutic effects in an adjuvant-induced arthritis rat model. These results suggest that pH-sensitive and folate receptor-targeted nanoparticles are a promising drug carrier for siRNA delivery for rheumatoid arthritis.
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Affiliation(s)
- Xiangshi Sun
- School of Life Sciences, Jilin University, Changchun, China
| | - Shiyan Dong
- School of Life Sciences, Jilin University, Changchun, China
| | - Xiangyu Li
- School of Life Sciences, Jilin University, Changchun, China
| | - Kongtong Yu
- School of Life Sciences, Jilin University, Changchun, China
| | - Fengying Sun
- School of Life Sciences, Jilin University, Changchun, China
| | - Robert J Lee
- School of Life Sciences, Jilin University, Changchun, China; Division of Pharmaceutics and Pharmaceutical Chemistry, The Ohio State University, Columbus, OH, USA
| | - Youxin Li
- School of Life Sciences, Jilin University, Changchun, China.
| | - Lesheng Teng
- School of Life Sciences, Jilin University, Changchun, China.
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13
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Lacoma A, Mateo L, Blanco I, Méndez MJ, Rodrigo C, Latorre I, Villar-Hernandez R, Domínguez J, Prat C. Impact of Host Genetics and Biological Response Modifiers on Respiratory Tract Infections. Front Immunol 2019; 10:1013. [PMID: 31134083 PMCID: PMC6513887 DOI: 10.3389/fimmu.2019.01013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 04/23/2019] [Indexed: 12/26/2022] Open
Abstract
Host susceptibility to respiratory tract infections (RTI) is dependent on both genetic and acquired risk factors. Repeated bacterial and viral RTI, such as pneumonia from encapsulated microorganisms, respiratory tract infections related to respiratory syncytial virus or influenza, and even the development of bronchiectasis and asthma, are often reported as the first symptom of primary immunodeficiencies. In the same way, neutropenia is a well-known risk factor for invasive aspergillosis, as well as lymphopenia for Pneumocystis, and mycobacterial infections. However, in the last decades a better knowledge of immune signaling networks and the introduction of next generation sequencing have increased the number and diversity of known inborn errors of immunity. On the other hand, the use of monoclonal antibodies targeting cytokines, such as tumor necrosis factor alpha has revealed new risk groups for infections, such as tuberculosis. The use of biological response modifiers has spread to almost all medical specialties, including inflammatory diseases and neoplasia, and are being used to target different signaling networks that may mirror some of the known immune deficiencies. From a clinical perspective, the individual contribution of genetics, and/or targeted treatments, to immune dysregulation is difficult to assess. The aim of this article is to review the known and newly described mechanisms of impaired immune signaling that predispose to RTI, including new insights into host genetics and the impact of biological response modifiers, and to summarize clinical recommendations regarding vaccines and prophylactic treatments in order to prevent infections.
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Affiliation(s)
- Alicia Lacoma
- Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - Lourdes Mateo
- Servei de Reumatologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ignacio Blanco
- Clinical Genetics and Genetic Counseling Program, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Barcelona, Spain
| | - Maria J Méndez
- Servei de Pediatria, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació GermansTrias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Rodrigo
- Servei de Pediatria, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Facultat de Medicina, Unitat Docent Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irene Latorre
- Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - Raquel Villar-Hernandez
- Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - Jose Domínguez
- Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - Cristina Prat
- Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBER Enfermedades Respiratorias, Barcelona, Spain
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14
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Affiliation(s)
- Ivan K Chinn
- Department of Pediatrics, Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, TX.,Center for Human Immunobiology, Texas Children's Hospital, Houston, TX
| | - Jordan S Orange
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY.,New York Presbyterian Morgan Stanley Children's Hospital, New York, NY
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15
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Mishra RK, Kumar VB, Monteran L, Sredni B, Gedanken A. AS101-Loaded PLGA–PEG Nanoparticles for Autoimmune Regulation and Chemosensitization. ACS APPLIED BIO MATERIALS 2019; 2:2246-2251. [DOI: 10.1021/acsabm.9b00200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Rahul Kumar Mishra
- Bar-Ilan Institute for Nanotechnology and Advanced Materials, Department of Chemistry, Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - Vijay Bhooshan Kumar
- Bar-Ilan Institute for Nanotechnology and Advanced Materials, Department of Chemistry, Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - Lea Monteran
- Bar Ilan Institute for Nanotechnology and Advanced Materials, Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - Benjamin Sredni
- Bar Ilan Institute for Nanotechnology and Advanced Materials, Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - Aharon Gedanken
- Bar-Ilan Institute for Nanotechnology and Advanced Materials, Department of Chemistry, Bar-Ilan University, Ramat-Gan 5290002, Israel
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Grimaux X, Leducq S, Goupille P, Aubourg A, Miquelestorena-Standley E, Samimi M. Ulcérations buccales aphtoïdes inaugurales d’une maladie inflammatoire chronique de l’intestin induite par le sécukinumab. Ann Dermatol Venereol 2018; 145:676-682. [DOI: 10.1016/j.annder.2018.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 01/22/2018] [Accepted: 07/13/2018] [Indexed: 01/27/2023]
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Abstract
Medications to treat children with rheumatic disease include disease-modifying antirheumatic drugs, glucocorticosteroids, and biologic response modifiers that target mediators and cells involved in autoimmunity and inflammation. Although usually well-tolerated, such medications have many possible side effects, of which primary care and emergency providers should be aware. Both disease and immunosuppression contribute to susceptibility to unusual and opportunistic infections, in addition to usual childhood infections for which these children should receive all applicable nonlive vaccines. Close coordination between the rheumatologist and other medical care providers is essential, because medication side effects, infections, and disease flares are difficult to distinguish, and may occur together.
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Affiliation(s)
- Gloria C Higgins
- Pediatric Rheumatology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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18
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Depmeier C, Günthard HF, Steiner UC. [Infections during Immunosuppression]. PRAXIS 2018; 107:689-698. [PMID: 29921180 DOI: 10.1024/1661-8157/a003003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Infections during Immunosuppression Abstract. Immunomodulating and immunosuppressive therapies are being used more and more frequently. Depending on the mechanism of action and the underlying disease, there is an increased risk of infection with these therapies. In everyday clinical practice, the individual risk of infection depends on a large number of patients, and environmental as well as pathogen-specific factors. Elderly and multimorbid patients are at particular risk of infection. Classical bacterial infections with possible atypical manifestation, hepatitis B virus, herpes viruses, mycobacteria and other granulomatous infections are prevalent. Typical clinical signs of infections may be missing and laboratory chemical parameters may fail as diagnostic tools. Systematic screening for latent or chronic infections prior to initiation and close monitoring of patients during immunomodulatory or immunosuppressive therapy are necessary to reduce morbidity and mortality.
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Affiliation(s)
- Carsten Depmeier
- 1 Klinik für Infektionskrankheiten und Spitalhygiene, Universitätsspital Zürich
| | - Huldrych F Günthard
- 1 Klinik für Infektionskrankheiten und Spitalhygiene, Universitätsspital Zürich
- 2 Institut für Medizinische Virologie, Universität Zürich
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19
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Wieder T, Eigentler T, Brenner E, Röcken M. Immune checkpoint blockade therapy. J Allergy Clin Immunol 2018; 142:1403-1414. [PMID: 29596939 DOI: 10.1016/j.jaci.2018.02.042] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 02/09/2018] [Accepted: 02/27/2018] [Indexed: 12/30/2022]
Abstract
Immune checkpoints are accessory molecules that either promote or inhibit T-cell activation. Two inhibitory molecules, cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death protein 1 (PD-1), got high attention, as inhibition of CTLA-4 or PD-1 signaling provides the first immune therapy that significantly improves the survival of patients with metastatic solid cancers. Inhibition of CTLA-4 or PD-1 was first studied in and approved for patients with metastatic melanoma. Blocking immune checkpoints is also efficient in non-small-cell lung cancer, renal cell cancers, hypermutated gastrointestinal cancers, and others. Immune responses, whether directed against infections or against tumors, are divided into 2 phases: an initiation phase and an activation phase, where the immune system recognizes a danger signal and becomes activated by innate signals to fight the danger. This reaction is fundamental for the control of infections and cancer, but needs to be turned off once the danger is controlled, because persistence of this activation ultimately causes severe tissue damage. Therefore, each activation of the immune system is followed by a termination phase, where endogenous immune suppressor molecules arrest immune responses to prevent harmful damage. In the case of cancer immune therapies, therapeutic approaches classically enhanced the initiation and activation of immune responses to increase the emergence and the efficacy of cytotoxic T lymphocytes (CTL) against cancers. In sharp contrast, immune checkpoint blockade focuses on the termination of immune responses by inhibiting immune suppressor molecules. It thus prevents the termination of immune responses or even awakes those CTLs that became exhausted during an immune response. Therefore, blocking negatively regulating immune checkpoints restores the capacity of exhausted CTL to kill the cancer they infiltrate. In addition, they drive surviving cancer cells into a still poorly defined state of dormancy. As the therapy also awakes self-reactive CTL, one downside of the therapy is the induction of organ-specific autoimmune diseases. The second downside is the exorbitant drug price that withdraws patients in need from a therapy that was developed by academic research, which impairs further academic treatment development and financially charges the public health system.
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Affiliation(s)
- Thomas Wieder
- Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Thomas Eigentler
- Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Ellen Brenner
- Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Martin Röcken
- Department of Dermatology, Eberhard Karls University, Tübingen, Germany.
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20
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Abstract
Techniques employing monoclonal antibodies (mAbs) are widely used in the initial development phase of biologics. The usefulness of mAbs in basic RA research has been established based on their characteristics, including specificity of binding, homogeneity, and ability to be produced on a large scale. MAb immunoglobulins are the starting material for the generation of smaller antibody fragments and other engineered immunomodulatory antibodies. In this chapter, the basic hybridoma technique, which is a well-established and feasible method for the production of mAbs involving animal immunization, cell fusion, hybridoma screening, expanding positive hybridomas, and purification, is introduced. Aiming at specific affinity to a membrane protein, synthetic proteoliposomes are used in the immunization and screening steps.
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Affiliation(s)
- Erika Takemasa
- Department of Pharmacology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Shuang Liu
- Department of Pharmacology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
| | - Hitoshi Hasegawa
- Department of Hematology, Clinical Immunology, and Infection Diseases, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
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21
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Urbano PCM, Aguirre-Gamboa R, Ashikov A, van Heeswijk B, Krippner-Heidenreich A, Tijssen H, Li Y, Azevedo VF, Smits LJT, Hoentjen F, Joosten I, Koenen HJPM. TNF-α-induced protein 3 (TNFAIP3)/A20 acts as a master switch in TNF-α blockade-driven IL-17A expression. J Allergy Clin Immunol 2017; 142:517-529. [PMID: 29248493 DOI: 10.1016/j.jaci.2017.11.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/21/2017] [Accepted: 11/06/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Anti-TNF inhibitors successfully improve the quality of life of patients with inflammatory disease. Unfortunately, not all patients respond to anti-TNF therapy, and some patients show paradoxical immune side effects, which are poorly understood. Surprisingly, anti-TNF agents were shown to promote IL-17A production with as yet unknown clinical implications. OBJECTIVE We sought to investigate the molecular mechanism underlying anti-TNF-driven IL-17A expression and the clinical implications of this phenomenon. METHODS Fluorescence-activated cell sorting, RNA sequencing, quantitative real-time PCR, Western blotting, small interfering RNA interference, and kinase inhibitors were used to study the molecular mechanisms in isolated human CD4+ T cells from healthy donors. The clinical implication was studied in blood samples of patients with inflammatory bowel disease (IBD) receiving anti-TNF therapy. RESULTS Here we show that anti-TNF treatment results in inhibition of the anti-inflammatory molecule TNF-α-induced protein 3 (TNFAIP3)/A20 in memory CD4+ T cells. We found an inverse relationship between TNFAIP3/A20 expression levels and IL-17A production. Inhibition of TNFAIP3/A20 promotes kinase activity of p38 mitogen-activated protein kinase and protein kinase C, which drives IL-17A expression. Regulation of TNFAIP3/A20 expression and cognate IL-17A production in T cells are specifically mediated through TNF receptor 2 signaling. Ex vivo, in patients with IBD treated with anti-TNF, we found further evidence for an inverse relationship between TNFAIP3/A20 expression levels and IL-17A-producing T cells. CONCLUSION Anti-TNF treatment interferes in the TNFAIP3/A20-mediated anti-inflammatory feedback loop in CD4+ T cells and promotes kinase activity. This puts TNFAIP3/A20, combined with IL-17A expression, on the map as a potential tool for predicting therapy responsiveness or side effects of anti-TNF therapy. Moreover, it provides novel targets related to TNFAIP3/A20 activity for superior therapeutic regimens in patients with IBD.
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Affiliation(s)
- Paulo C M Urbano
- Department of Laboratory Medicine, Laboratory of Medical Immunology (LMI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Raúl Aguirre-Gamboa
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Angel Ashikov
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bennie van Heeswijk
- Department of Laboratory Medicine, Laboratory of Medical Immunology (LMI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anja Krippner-Heidenreich
- Newcastle University, Northern Institute for Cancer Research, Wolfson Childhood Cancer Research Centre, Newcastle upon Tyne, United Kingdom
| | - Henk Tijssen
- Department of Laboratory Medicine, Laboratory of Medical Immunology (LMI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yang Li
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Valderilio F Azevedo
- Departamento de Medicina Interna, Universidade Federal do Parana, Hospital de Clinicas de Curitiba, Curitiba, Brazil
| | - Lisa J T Smits
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank Hoentjen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Irma Joosten
- Department of Laboratory Medicine, Laboratory of Medical Immunology (LMI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans J P M Koenen
- Department of Laboratory Medicine, Laboratory of Medical Immunology (LMI), Radboud University Medical Center, Nijmegen, The Netherlands.
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