H. Younes^{* *}Correspondence: H. Younes, Department of Biomedical Science, Qatar University, Doha, Qatar, Email:

Author info »

Description

Behring and Kitasato demonstrated that the transfer of immunological sera might confer passive immunity to diphtheria in the late 1890s, leading to the development of the first widely used and successful antimicrobial treatment. Serum transfer was successfully employed to treat a variety of illnesses over the course of the following 50 years, including pneumococcal pneumonia, meningococcal meningitis, and streptococcal infection. With the exception of a small number of toxin- and viral-mediated disorders, which continued to rely on serum therapy since there were no other effective treatments available, serum therapy was mainly abandoned by the late 1940s due to safety concerns and the development of antibiotics. Modern human immunoglobulin preparations are not comparable to the traditional serum therapy. These products use highly reproducible release tests, are highly purified, are processed and filtered to assure viral inactivation and elimination, and are free of the contaminants, resident viruses, and lot variation that have historically plagued Polyclonal Antibodies (Ab). A crucial upsurge in the research and development of antibody-based treatments has resulted from two unsettling trends in infectious illnesses. Second, the recent growth in the number of immunocompromised people worldwide has created an unprotected population from which combinations of complicated illnesses are arising.

The first is the rampant emergence of multi-drug resistance forms of both new and old pathogens. The ideal approach for treating and preventing the current wave of drug-resistant infectious diseases may be to develop new supplementary antibody therapies for every major disease or infection type. Pathogenesis and treatability are related. Infectious organisms can have very complicated pathogenesis. Numerous varieties of inflammatory reactions are the result of the co-evolution of the host and pathogen over time. A delicate balance occurs between protective and overly enthusiastic host responses, either due to deregulation or pathogen subversion. Although many viral, bacterial, fungal, and prion-mediated diseases are treatable with Ab treatments, there are significant distinctions in the pathophysiology and severity of these pathogens. The need for the quick protection offered by antibody therapies is typically greater in illnesses that are both extremely virulent and acute. In addition, early implementation of public health measures may aid in containing the spread of an outbreak when there is no vaccine available, as was the case with SARS. Immunotherapy may offer a form of protection that is preferable to traditional vaccines during periods of drastically increased exposure risk. Passive antibody therapies have a half-life that makes them unnecessary to employ other than in emergency situations.

The most common medicines used now in passive antibody therapy for treating infectious disorders are bulk Intravenous Immune Globulin (IVIG) and immunoglobulin from high titer plasma of immune individuals (poly Ig). Infectious agents are typically foreign to the immune system, allowing the less specific and more widely available polyclonal approach to become the standard in treating infectious disease. This contrasts with the modest antigenic differences between normal and tumour cells that warrant a monospecific approach to treating cancer. Recent reviews have found that IVIG therapy is effective in treating a variety of illnesses, including Kawasaki’s disease, newborn sepsis, rotaviral enterocolitis, and staphylococcal toxic shock syndrome. Anti-tetanus Ig is used to treat tetanus; rabies, hepatitis B, and tetanus donors are typically immunised and CMV, measles, and varicella are typically screened for high titer. Poly Ig is used clinically as a high titer substitute in the prevention of infections caused by CMV, hepatitis A and B viruses (HBV), rabies, In this regard, efficient polyclonal anthrax immune globulin (AIG) for passive therapy has been created by stimulating human donors with vaccinations. HBV and varicella-zoster virus are also prevented from being passed from mother to child using poly Ig. For the prophylactic therapy of an infectious condition, however, only a singlemAb to RSV is currently licenced. Both monoclonal and polyclonal IgG preparations have been used successfully for the prevention of infectious diseases, with purified polyclonal IgG having the most experience.

The need for a shift to the more precise but more expensive to produce mAb-based therapy is driven by advancements in mAb technology. With respect to poly Ig preparations harvesting procedures, the capacity to generate mAb therapies in scalable numbers to fulfil demand marks a key distinction. Even while the likelihood of human poly Ig transmitting an infection is extremely unlikely and modern human IgG preparations have the best safety record of all biologics, there are still some residual concerns. Although the use of mAbs produced by tissue culture or microbial expression systems could alleviate such worries, the cost per dosage of mAbs is much higher and may not justify development for many niche market goods. Since it is not always clear which models are important for evaluating a treatment or which antigens would be protective, poly Ig is frequently used as a less expensive alternative to mAbs. Harvesting poly Ig from endemic places in such situations, where a vaccine is not at least in phase 1 and available, may allay worries about the poor titer of particular IVIG reagents. In order to treat infection, for example, IVIG with a titer against the West Nile virus is obtained from chosen Israeli donors. Additionally, mAbs are often more difficult to extract and optimise than poly Ig or IVIG because they are fragile macromolecules with limited functionality and selectivity.