Immunomodulator therapy: Monoclonal antibodies, fusion proteins, cytokines, and immunoglobulins

The immune system consists of a diverse array of immunocompetent cells and inflammatory mediators that exist in complex networks. These components interact through cascades and feedback circuits, maintaining physiologic inflammation (eg, tissue repair) and immunosurveillance. In various autoimmune and allergic diseases, a foreign antigen or autoantigen might upset this fine balance, leading to dysregulated immunity, persistent inflammation, and ultimately pathologic sequelae. In recent years, there has been tremendous progress delineating the specific components of the immune system that contribute to various aspects of normal immunity and specific disease states. With this greater understanding of pathogenesis coupled with advances in biotechnology, many immunomodulatory agents commonly called “biologic agents” have been introduced into the clinic for the treatment of various conditions, including immune globulins and cytokines. The 2 most common classes of approved biologic agents are mAbs and fusion proteins with exquisite specificity. These agents have the potential both to optimize outcomes through more thorough modulation of specific parts of the dysregulated immune response and to minimize toxicity compared with less specific methods of immunosuppression.

Key words: Monoclonal antibodies, fusion proteins, immunoglobulins, cytokines, autoimmunity

Abbreviations used: AS, Ankylosing spondylitis, CHF, Congestive heart failure, CTLA-4, Cytotoxic T lymphocyte–associated antigen 4, DMARD, Disease-modifying antirheumatic drug, FDA, US Food and Drug Administration, ICAM, Intercellular adhesion molecule, IL-1Ra, IL-1 receptor antagonist, IVIG, Intravenous immunoglobulin, LFA, Lymphocyte function–associated antigen, MS, Multiple sclerosis, PML, Progressive multifocal leukoencephalopathy, PsA, Psoriatic arthritis, RA, Rheumatoid arthritis, SCIG, Subcutaneous immunoglobulin, SLE, Systemic lupus erythematosus