Immuno therapy~

very new and upcoming for treatment purpose

1. ~ Immuno Therapy ~ Dr. Arifa Akram MD Student Virology Department Bangabandhu Sheikh Mujib Medical University, Dhaka

2. Immunotherapy Immunotherapy is a medical term defined as the "treatment of disease by inducing, enhancing, or suppressing an immune response". Immunotherapies designed to elicit or amplify an immune response are classified as activation immunotherapies , while immunotherapies that reduce or suppress are classified as suppression immunotherapies .

3. `Types of Immunotherapy 1. Active immunotherapy The basic idea is to give the proper mission objectives to the T helper cells of the immune system so that they attack the cancer and continue to attack it until it is completely destroyed. This is called active immunotherapy, because the treatment given to the patient has a direct interaction with the body's immune system. Active immunotherapy can be achieved by administering cytokines, such as interferons (IFNs ) and interleukins (IL-2), which triggers non-specific stimulation of numerous immune cells . It divides into: Non-Specific Active Immunotherapy : Specific Active Immunotherapy .

4. 2. Passive immunotherapy The other method of immunotherapy is to develop new ways to "create" antibodies and other types of cells that mimic the immune system of the human body. These synthesized cells are usually designed to attack cancer cells directly through the use of toxins and radioactive materials without interacting with the body's natural immune system. Due to its lack of interaction with the immune system, this is referred to as passive immunotherapy .Administering monoclonal antibodies ( mAbs ) is a form of passive immunotherapy.

5. 3 . Non-Specific Immunotherapies There are other forms of immunotherapies that do not attack a specific antigen or tumor cell. Instead, a non-specific immunotherapy is designed to boost the performance of the immune system to make the cells that travel throughout the body more powerful and efficient . “ Immunomodulators “ The active agents of immunotherapy are collectively called immunomodulators . They are a diverse array of recombinant, synthetic and natural preparations, often cytokines. Immunomodulatory regimens offer an attractive approach as they often have fewer side effects than existing drugs, including less potential for creating resistance in microbial diseases .

6. Agent Example Interleukins IL-2 , IL-7 , IL-12 Cytokines Interferons , G-CSF , Imiquimod Chemokines CCL3 , CCL26 , CXCL7 Other cytosine phosphate- guanosine , oligodeoxynucleotides , glucans

7. `Activation immunotherapies ` 1)Cancer : Cancer immunotherapy attempts to stimulate the immune system to reject and destroy tumors. BCG immunotherapy .Topical immunotherapy in skin cancer & Injection immunotherapy uses mumps, candida the HPV vaccine. 2) Autologous Immune Enhancement Therapy: Autologous immune enhancement therapy (AIET) is a treatment method in which immune cells are taken out from the patient's body which are cultured and processed to activate them until their resistance to cancer is strengthened and then the cells are put back in the body.

8. 3)T-cell adoptive transfer This can be achieved by taking T cells that are found with the tumor of the patient, which are trained to attack the cancerous cells. These T cells are referred to as tumor-infiltrating lymphocytes (TIL) are then encouraged to multiply in vitro using high concentrations of IL-2 , anti-CD3 and allo -reactive feeder cells. These T cells are then transferred back into the patient along with exogenous administration of IL-2 to further boost their anti-cancer activity.

9. 4)Immune recovery The potential use of immunotherapy to restore the immune system of patients with immune deficiencies as result of infection or chemotherapy. For example cytokines have been tested in clinical trials interleukin-7 has been in clinical trials for HIV and cancer patients. In addition, interleukin-2 has also been tested in HIV patients. 5)Vaccination /Immunization Anti-microbial immunotherapy, which includes vaccination, involves activating the immune system to respond to an infectious agent. Immunization may be active or passive.

10. ` Suppression immunotherapies ` Immune suppression dampens an abnormal immune response in autoimmune diseases or reduces a normal immune response to prevent rejection of transplanted organs or cells. 1)Immunosuppressive drugs Immunosuppressive drugs are important tools in the management of organ transplantation and autoimmune disease . cytotoxic drugs are immunosuppressive. 2)Immune tolerance Immune tolerance is the process by which the body naturally does not launch an immune system attack on its own tissues. Immune tolerance therapies seeks to reset the immune system so that the body stops mistakenly attacking its own organs or cells in autoimmune disease or accepts foreign tissue in organ transplantation.

11. 3)Allergies The Allergen immunotherapy is indicated for people who are extremely allergic or who cannot avoid specific allergens. For example, they may not be able to live a normal life and completely avoid pollen, dust mites, mold spores, pet dander, insect venom, and certain other common triggers of allergic reactions. Immunotherapy is generally not indicated for food or medicinal allergies. This therapy is particularly useful for people with allergic rhinitis or asthma . Sublingual immunotherapy involves putting drops or tablets of allergen extracts under the tongue of a patient with allergic reactions and then swallowing the extracts. It allows the organism to become tolerant to the allergen by absorbing the allergen through the stomach lining . Subcutaneous immunotherapy is the historical route of administration and consists of allergen extract injections. Subcutaneous immunotherapy can only be performed with a medical observation. Although efficacy of subcutaneous immunotherapy has been demonstrated by several studies, subcutaneous immunotherapy entails the risk of systemic anaphylactic reactions.

12. `Application of Immune Therapy` 1. Helminthic therapies in case of relapsing remitting multiple sclerosis,Crohn’s , allergies and asthma . 2.Radioimmunotherapy in case of Lymphoma. 3 . Immunotherapy to Attack Cancer( Monoclonal antibody therapy ). Advantages over ordinary monoclonal antibodies : Cancer immunotherapy with ordinary monoclonal antibodies does not activate T-lymphocytes because this type of cell does not possess Fc receptors, so the Fc region cannot bind to them, and the Fab regions are already used for binding the tumour cells. Bispecific antibodies have a higher cytotoxic potential.

13. Antibody Brand name Approval date Type Target Approved treatment(s) Alemtuzumab Campath 2001 humanized CD52 Chronic lymphocytic leukemia Bevacizumab Avastin 2004 humanized vascular endothelial growth factor colorectal cancer Brentuximab vedotin Adcetris 2011 chimeric CD30 Hodgkin lymphoma , Anaplastic large-cell lymphoma Cetuximab Erbitux 2004 chimeric epidermal growth factor receptor colorectal cancer EG:- Cancer immunotherapy:Monoclonal antibodies

14. Gemtuzumab ozogamicin Mylotarg 2000 humanized CD33 acute myelogenous leukemia (with calicheamicin ) Ibritumomab tiuxetan Zevalin 2002 murine CD20 non-Hodgkin lymphoma (with yttrium-90 or indium-111 ) Panitumumab Vectibix 2006 human epidermal growth factor receptor colorectal cancer Rituximab Rituxan, Mabthera 1997 chimeric CD20 non-Hodgkin lymphoma Trastuzumab Herceptin 1998 humanized ErbB2 breast cancer

15. 4.Immune Therapies for Infertility. 5.In Allergic Rhinitis & Asthma . 6.Topical immunotherapy agents in skin cancer 7 .Vaccination. Conclusion: Immunotherapy is a type of biological therapy that utilizes a person's natural immune defense system to fight disease . Today scientists are discovering ways in which immunotherapy can be used as a stand-alone treatment for cancer and a adjuvant (supplemental) treatment to make current cancer treatments more effective .