HITESHA A BAROT

8/7/2019 HITESHA A BAROT

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DEFINATION:- Immunotherapy is a medical termdefined as 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.Immunotherapies designed to reduce, suppress or

more appropriately direct an existing immune

response ,as in cases of autoimmunity or allergy, are

classified as suppression immunotherapies


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The active agents of immunotherapy are collectively

called immunomodulators.

They are a diverse array of recombinant, synthetic

and natural preparations, often cytokines. Some of

these substances, such as granulocyte colony -

stimulating factor (G-CSF), interferons, imiquimod and

cellular membrane fractions from bacterial

microorganisms are already licensed for use in

patients.

Others including IL-12, various chemokines,

cytosine phosphate-guanosine (oligodeoxynucleotides

and glucans are being currently investigated

extensively in clinical and preclinical studies.


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Cell based Immunotherapies are proven to be

effective for cancers, where the immune cells such

as lymphocytes, macrophages, dendritic cells,

natural killer cells (NK Cell), cytotoxic T

lymphocytes (CTL), etc., work together to defend

the body against cancers and attacks by "foreign"

or "non-self" invaders such as bacteria and

viruses.


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Cancer immunotherapy attempts to stimulate the

immune system to reject and destroy tumors.

cancer

Immuno cell therapy for cancer was first introduced

by Rosenberg and his colleagues of NationalInstitute of Health USA. In the late 80s, they

published an article in which they reported a low

tumor regression(2.63.3%) in 1205 patients with

metastatic cancer who underwent different types ofactive specific immunotherapy (ASI), and suggested

that immuno cell therapy with specific chemotherapy

is the future of cancer immunotherapy.


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In the beginning Immunotherapy treatmentsinvolved administration of cytokines such as

Interleukin with an aim of inducing the lymphocytes

to carry on their activity of destroying the tumor

cells.

Thereafter the adverse effects of such

intravenously administered cytokine

lead to the extraction of the lymphocytes from theblood and culture-expanding them in the lab and

then injecting the cells alone to enable them to

destroy the cancer cells.


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Though the concept of this treatment started in

the US in 80s, fully fledged clinical treatments on a

routine basis have been in practice in Japan since

1990. Randomized controlled studies in different

cancers with significant increase in survival and

disease free period have been reported.


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Lung cancer has been demonstrated to potentially

respond to immunotherapy

In many parts of Asia, medicinal mushrooms are

thought to be able to boost the immune system naturally.

Cellular and animal research has shown that Agaricusblazei may stimulate immune system cells and the

production of interferons and interleukins (reviewed by

G. Hetland).

Mushroom isolates like PSK also are used to increase

immune system parameters (reviewed by Kobayashi).


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Autologous Immune Enhancement Therapy (AIET)

In the multipronged approach to treat cancer,one very useful latest weapon would be AIET

which is in clinical practice in Japan since 90s

AIET is a treatment method in which some

immune cells are taken out of a patient's body

which are cultured and processed to be

activated or to acquire additional functions until

their resistance to cancer is strengthened, then

the cells are put back in the body.


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. Researchers have found that the thus activated

immune system might also be able to determine the

difference between healthy cells and cancer cells

eliminate the cancer cells from the body.

In AIE

T, specific type of cells mainly the NK cellsand lymphocytes are isolated from the peripheral

blood of the cancer patients (during remission in

patients who undergo chemotherapy)


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These cells are act against cancer cells and active immuneresponse.

Upon encountering a tumor cell, the activated NK cell attaches

to the membrane of the cancer cell and injects toxic granules

which dissolve the target cell. In less than five minutes, the

cancer cell dies and the NK cell moves on to its next target

cancer cell. A single NK cell can destroy up to 27 cancer cells

before its lifespan. This is the mechanism by which AIET is

effective in Cancer therapy.


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Dendritic cell based immunotherapy

This utilizes dendritic cells to activate a cytotoxic

response towards an antigen.

Dendritic cells, a type of antigen presenting cell ,

are harvested from a patient. These cells are then

either pulsed with an antigen or transfected with a

viral vector. The activated dendritic cells are then

placed back into the patient


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Monoclonal antibody therapy

Antibodies are a key component of the adaptive immune

response playing a central role in both in the recognition of

foreign antigens and the stimulation of an immune response

to them.It is not surprising therefore, that many

immunotherapeutic approaches involve the use of

antibodies.

The advent of monoclonal antibody technology has made it

possible to raise antibodies against specific antigens such as

the unusual antigens that are presented on the surfaces of

tumors.

A number of therapeutic monoclonal antibodies have been

approved for use in humans; approvals mentioned here are

by the U.S.Food and Drug Administration(FDA).


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Cancer immunotherapy:Monoclonal antibodies[1]

Antibody Brand name Approval date Type TargetApproved

treatment(s)

Alemtuzumab Campath 2001 humanized CD52

Chronic

lymphocytic

leukemia

Bevacizumab Avastin 2004 humanized

vascular

endothelial

growth factor

colorectal cancer

Cetuximab Erbitux 2004 chimeric

epidermal

growth factor

receptor

colorectal cancer

Gemtuzumab

ozogamicinMylotarg 2000 humanized CD33

acute

myelogenous

leukemia

calicheamicin

Ibritumomab

tiuxetan Zevalin 2002 murine CD20

non-Hodgkin

lymphomayttrium-90

Panitumumab Vectibix 2006 human

epidermal

growth factor

receptor

colorectal cancer

RituximabRituxan,

Mabthera1997 chimeric CD20

non-Hodgkin

lymphomaTrastuzumab Herceptin 1998 humanized ErbB2 breast cancer

).


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The therapy is indicated for people who are

extremely allergic or who cannot avoid specificallergens.

Immunotherapy is generally not indicated for food

or medicinal allergies. Immunotherapy is typicallyindividually tailored and administered by an allergist

(allergologist)This therapy is particularly useful for

people with allergic rhinitis or asthma.


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Other approaches to immunotherapy

Recent research into the clinical effectiveness of

Whipworm ova (Trichuris suis) and Hookworm

(Necator americanus) for the treatment of certain

immunological diseases and allergies means thatthese organisms must be classified as immuno-

therapeutic agents.

Helminthic therapy is being investigated as apotentially highly effective treatment for the symptoms

and or disease process in disorders such as relapsing

remitting multiple sclerosis Crohn s,

allergies and asthma.


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Cancer Vaccines Back to the Table of Contents As described above,

biological therapy or immunotherapy is now

considered a fourth modality of cancer treatment, and

examples such as interferon and monoclonal

antibodies have become part of standard cancer

treatment.

Vaccines have revolutionized public health by

preventing the development of many important

infectious diseases, including polio, small pox, and

diphtheria. It has been much more difficult to develop

effective vaccines to prevent cancer, or to treat

patients who already have cancer.


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. Attempts to develop such cancer vaccines,

despite many decades of experimental work, haveyet to yield proven results.

Cancer vaccines typically consist of a source of

cancer-associated material (antigen), along withother components, to further stimulate the immune

response


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cancer vaccines have been shown to be capable

of improving the immune response againstparticular antigens.

The result of this immunologic effect is not always

sufficient to reverse the progression of cancer.

However, cancer vaccines have been generally

well tolerated, and they may provide useful

anticancer effects in some situations.


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