Chapter 37 - Anti-Idiotypic Therapy in Autoimmunity

Abstract

Idiotypes are the antigenic determinants of immunoglobulin molecules that are located in the variable region of the antibodies. Anti-idiotypic (anti-Id) antibodies are antibodies directed against the idiotypic determinants. Under normal physiological conditions, the idiotypic network has a major role in the regulation of immune responses to external antigens. An autoimmune disease is attributed to the disturbance of this network and anti-Id antibodies is an effective treatment against it. This chapter reviews the therapeutic effect of anti-idiotypic therapy. Anti-idiotypic therapy has not been tried in human autoimmune diseases directly. Administration of anti-idiotypes manipulates immune reactions affecting autoimmune diseases. The chapter lists the methods of in vivo and in vitro modulation of idiotypic network by anti-Id treatment. Other methods by which anti-idiotypes can be employed in the treatment of autoimmune diseases is as specific carriers of toxins and by active immunization with idiotype. The mechanism of suppression of the idiotype antibody response by the anti-idiotypic antibody is unclear. Two entailing possibilities are clonal deletion of B cells and production of suppressor T cells. The chapter discusses the possible mechanisms and therapeutic problems in modulation of the idiotype network with anti-idiotypic therapy.