-ximab this and -zumab that! Has the magic bullet arrived in the new millennium of medicine and science?

The Multifaceted Role of Monoclonal Antibodies in Oral Cancer Therapy – A Narrative Overview

Oral cancer, a part of head-and-neck cancer, is associated with a high risk of mortality which necessitates specificity in the cancer therapy. Known as the fourth pillar among various cancer treatment modalities, immunotherapy requires the stimulation of particular immune system components by modulating the counteraction of signals that cause suppression of the immune system. Monoclonal antibodies (mAbs) provide numerous benefits over conventional chemotherapeutic drugs due to their increased target specificity and extended half-life. When delivered, mAbs act as cytotoxic agents with varied pharmacological effects that prove as a potential therapeutic approach for cancer therapy. In the current review, a bibliographic search was done in PubMed and other databases for English articles that were published over the last decade. The aim of this paper is to furnish a substantial review that highlights the immunotherapeutic role of selected mAbs and their mechanisms and clinical applications in the treatment of oral cancers. It also emphasizes the versatile role of antibodies with diverse features which have led to the development of novel therapeutic strategies.

[The importance of biologicals in the treatment of SoJIA]

Systemic onset juvenile idiopathic arthritis (SoJIA) remains difficult to treat. In addition to conventional antirheumatic therapy with non-steroidal antirheumatic drugs (NSARDs), steroids or disease-modifying antirheumatic drugs (DMARDs), biologicals offer a new therapeutic approach for this disease in that they are able to target pathogenically relevant cytokines and effector cells. Some biologicals are already approved for use in children with rheumatic disease.In order to assess the currently available data on the use of biologicals in SoJIA, we performed a Medline search for the period 2005 to March 2010, including the MeSH terms "SoJIA", "systemic juvenile idiopathic arthritis" and"biologicals", as well as an NIH study registry search. At Present there are scant and unconvincing data on the use of Etanercept or Adalimumab for the treatment of SoJIA. No results are published on the use of Infliximab or other new TNF-alpha inhibitors. The inhibition of IL-1 or IL-6 shows promising results. Data on the efficacy of Abatacept is limited due to very low numbers of SoJIA patients in the studies.Further studies on the use of biologicals in SoJIA while taking individual factors into consideration are required. The long-term safety of all biologicals should be investigated in prospective registers.

Adverse drug reactions to biologics

The use of biologics has rapidly expanded since the introduction of the first diagnostic antibodies; they are now widely employed in oncology, autoimmune disorders, inflammatory diseases and transplantation medicine. Their widespread use has resulted in an increase in adverse drug reactions. Adverse effects result from both direct pharmacological actions and immunological actions, as well as through induction of a specific immune response. The nomenclature, particularly of the monoclonal antibodies, identifies the target structure and organ as well as the species of origin, which then helps predict their effects and antigenic properties. Depending on the extent of foreign protein, anti-allotypic or anti-idiotypic antibodies with or without neutralizing properties may be induced. Adverse drug reactions from biologics often depend on the target and may be explained by activation or inhibition of particular cytokine pathways. Adverse drug reactions are classified by their pathomechanism, which enhances understanding of the pathogenesis and facilitates both allergologic diagnostic measures and planning of premedication in future treatments. This review emphasizes immunostimulatory and hypersensitivity reactions.

Off-target activity of TNF-alpha inhibitors characterized by protein biochips

Tumor necrosis factor-alpha inhibitors are widely and successfully used to treat rheumatic diseases. However, significant side effects have been reported. To detect the potential off-target activities of such inhibitors we characterized two therapeutic antibodies (adalimumab, infliximab) and one receptor fusion protein (etanercept) on protein biochips (UNIchip AV-400) containing a printed serial dilution of tumor necrosis factor-alpha and about 384 different human proteins. Etanercept binds to ten proteins (affinity: 20-33% of tumor necrosis factor-alpha recognition), and six of these proteins are related to ribosomal proteins. Interestingly, adalimumab binds to the same six proteins related to ribosomal proteins (affinity: 12-18%) as well as to four proteins crucially involved in ribosomal protein synthesis. Alignment of protein sequences indicates no significant sequence homology between these ten proteins bound by the biological drugs with the highest off-target activities. Taken together, our in vitro results demonstrate that a significant number of proteins are recognized by tumor necrosis factor-alpha inhibitors and are related to ribosome biogenesis.