Manipulation of the Immune Response Chapter 14
Objectives Discuss modes of action of common immunosuppressive drugs Describe uses of monoclonal antibodies in immune disorders and cancer Explain how anti-tumor immune responses are generated Describe characteristics of an effective vaccine
Anti-inflammatory drugs: NSAIDs phospholipids phospholipase A 2 arachidonic acid cyclo-oxygenase (COX)-1 or -2 prostaglandins thromboxane leukotrienes lipoxygenase x NSAIDs inflammation
Anti-inflammatory drugs: steroids Corticosteroids are powerful anti- inflammatory drugs –Prednisone (cortisol analogue) –Used in transplantation, autoimmunity, allergy –Activated steroid receptors act as transcription factors
Anti-inflammatory drugs: steroids
Corticosteroid physiology Corticotropin releasing hormone (CRH) Adrenocorticotropic hormone (ACTH) cortisol STRESS + +
Corticosteroid physiology from P. Stewart, Williams Textbook of Endocrinology, 2003 Many side effects are possible Used in combination with other drugs to limit toxicity
Cytotoxic immunosuppressive drugs Azathioprine, cyclophospamide –Interfere with DNA synthesis –High doses used to eliminate all lymphocytes prior to bone marrow transplantation –Originally developed to treat cancer Cyclosporin A, tacrolimus, rapamycin –Less toxic –Interfere with clonal expansion of activated lymphocytes –Used in transplant recipients
Cytotoxic immunosuppressive drugs
Halloran P. New England Journal of Medicine 351: , Immunosuppression
Antibodies as therapeutics Monoclonal antibodies are used for transplantation, autoimmunity, cancer –Depleting (antibody- mediated cytotoxicity) –Nondepleting (block function of target molecules) –Monoclonal antibodies are traditionally made in mice… problems??? Murine 100% Mouse Protein Chimeric 33% Mouse Protein Humanized 10% Mouse Protein
Anti-CD4 Ab and graft tolerance
Anti-TNF Ab in autoimmune disease
Anti-integrin Ab in multiple sclerosis
Immunomodulation Interfere with costimulation –Soluble CTLA-4 blocks CD28 : B7 interactions Induce regulatory T cells or tolerance??
Cancer immunology
Escape from immune surveillance
mAbs and cancer
Fighting infectious disease: vaccines
Vaccines Antigen sources: –Small doses of the wild type virus or use of a “safe” counterpart (early smallpox vaccines) –Killed/inactivated pathogen –Toxoid –Viral subunits –Live attenuated virus
Making a vaccine
Making a vaccine using molecular biology
DNA vaccines
Other vaccine development strategies Developing better adjuvants –ISCOMs (Immune Stimulatory Complexes) deliver peptides to MHC I processing pathway –Mucosal adjuvants (modified pertussis toxin) Targeting APCs by coadministration of cytokines Developing nasal or oral vaccines