English

Abstract

Treatment of disorders through immune manipulation of the host has come a long way in the last decades and has broadened its applications from infectious diseases to control of allograft rejection, induction of tolerance for the treatment of autoimmunity and break of tolerance to induce cancer rejection. Immunotherapy, biological response modifier therapy or biotherapy uses the immune system to fight disease like cancer. The potentials of immunotherapy are many. The objective of this review article is to increase awareness of contemporary immunologic therapies and recent advances in immunotherapy. Keywords - Immunotherapy, Adjuvant, Interleukin, Monoclonal antibody, Interferon, Autoimmunity Immunotherapy Introduction Immunotherapy uses the immune system to fight disorders and immune based therapies are to harness the sensitivity, specificity and self- regulation of the immune system to eradicate any and all tumor cells (1). Biological response modifiers (BRMs) change the route the body's defenses interact with infected cells and produced in a laboratory and given to patients to enhance immune system. BRMs include nonspecific immunomodulating agents, interferons, interleukins, colony-stimulating factors, monoclonal antibodies, cytokine therapy, and vaccines. Monoclonal antibodies are agents, produced in the laboratories that bind to infected cells. Examples of monoclonal antibody therapy include trastuzumab for breast cancer and rituximab for lymphoma. Chronic disorders including malignant, infectious and autoimmune conditions are difficult to treat and often require the use of multiple agents, alone or in combination. The latter approach is already being attempted in some cancer patients. Herceptin, which targets cell proliferation mediated by HER2 and bevacizumab, which targets tumor angiogenesis mediated by VEGF, are being used in combination in breast cancer patients (2). Research has been undertaken to provide an explanation on how a relatively limited number of antibodies can protect against a vast and almost infinite number of invading antigens (3). Proposed potential explanations include the notion that one antibody may be capable of binding more than one antigen through the selection of specific binding sites on pre-existing antibody conformations, and in this manner antibodies with multiple specificities can be achieved. It has been suggested that multispecificity may evolve and play a role in the efficient antibody repertoire for immune protection with one antibody performing more than one task (4). Autoimmune beneficial from the use of two-in-one antibodies and autoimmune disorders, particularly rheumatoid arthritis and systemic lupus erythematosus, are being treated with single biologic agents directed at specific pathogenic pathways, but one may envision the use of two-in-one antibodies directed at multiple targets in the not too distant future (5). Cytokine therapy is used with advanced melanoma and with adjuvant therapy and reaches all parts of the body to kill infected cells and prevent tumors from growing. Vaccine therapy involves use of vaccines produced in Escherichia coli , yeast or insect cells. Plant- based vaccines are also advantageous in terms of their scalability, no cold chain required, stability, safety, cost-effectiveness and needle- free administration (6). Peptide immunotherapy using dominant T-cell epitopes derived from allergens represents another approach to developing safer treatment, because regions involved in allergenicity i.e., responsible for reactivity with IgE, can be completely removed while retaining immunogenicity (7). Antigen- specific immunotherapy strategies include administration of: proteins/peptides with or without adjuvant; dendritic cells (DCs; transfected with DNA- or RNA-encoding tumor antigens, or loaded with peptides, whole proteins or tumor lysates); recombinant viruses encoding tumor antigens; and autologous or allogeneic tumor cells (8). Future of immune therapy for cancer holds promise with novel combined approaches that simultaneously target cancer-initiating stem cells, restore APC immune-stimulating activity, expand tumor-reactive T cells and down regulate suppressor pathways to generate effective therapy.(9) Immune therapy for lung cancer has high potential. Identification of the cell type capable of sustaining neoplastic growth and directing immune therapy to cells that possess