1
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Takei J, Suzuki H, Asano T, Li G, Saito M, Kaneko MK, Kato Y. Epitope Mapping of an Anti-CD20 Monoclonal Antibody (C 20Mab-60) Using Enzyme-Linked Immunosorbent Assay. Monoclon Antib Immunodiagn Immunother 2021; 40:250-254. [PMID: 34958272 DOI: 10.1089/mab.2021.0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
CD20 is a glycosylated transmembrane protein and is expressed on normal B cells and B cell malignancies. Therapeutic antibodies against CD20 are developed and used in clinic. The understanding of antibody-antigen binding by revealing the epitope is essential for future application to antibody technology. Previously, we developed an anti-human CD20 monoclonal antibody, C20Mab-60 (IgG2a, kappa), using the Cell-Based Immunization and Screening (CBIS). C20Mab-60 can be used for flow cytometry, Western blot, and immunohistochemical analyses. In this study, we examined the critical epitope of C20Mab-60 using enzyme-linked immunosorbent assay (ELISA) with synthesized peptides. We performed ELISA with deletion mutants, and C20Mab-60 reacted to the 160-179 amino acids sequence of CD20. Next, we analyzed the reaction to 20 point mutants, and C20Mab-60 did not recognize the alanine-substituted peptides of N171A, P172A, S173A, and E174A. The results indicate that the binding epitope of C20Mab-60, developed by CBIS, includes Asn171, Pro172, Ser173, and Glu174 of CD20.
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Affiliation(s)
- Junko Takei
- Department of Antibody Drug Development and Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroyuki Suzuki
- Department of Molecular Pharmacology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Teizo Asano
- Department of Antibody Drug Development and Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Guanjie Li
- Department of Molecular Pharmacology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masaki Saito
- Department of Molecular Pharmacology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mika K Kaneko
- Department of Antibody Drug Development and Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yukinari Kato
- Department of Antibody Drug Development and Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Molecular Pharmacology, Tohoku University Graduate School of Medicine, Sendai, Japan
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2
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Kikushige Y. Pathogenesis of chronic lymphocytic leukemia and the development of novel therapeutic strategies. J Clin Exp Hematop 2020; 60:146-158. [PMID: 33148933 PMCID: PMC7810248 DOI: 10.3960/jslrt.20036] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is the most common adult leukemia in Western countries
and is characterized by the clonal expansion of mature CD5+ B cells. There have
been substantial advances in the field of CLL research in the last decade, including the
identification of recurrent mutations, and clarification of clonal architectures,
signaling molecules, and the multistep leukemogenic process, providing a comprehensive
understanding of CLL pathogenesis. Furthermore, the development of therapeutic approaches,
especially that of molecular target therapies against CLL, has markedly improved the
standard of care for CLL. This review focuses on the recent insights made in CLL
leukemogenesis and the development of novel therapeutic strategies.
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Affiliation(s)
- Yoshikane Kikushige
- Department of Medicine and Biosystemic Sciences, Kyushu University Graduate School of Medicine, Fukuoka, Japan.,Center for Cellular and Molecular Medicine, Kyushu University Hospital, Fukuoka, Japan
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3
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Kumar A, Planchais C, Fronzes R, Mouquet H, Reyes N. Binding mechanisms of therapeutic antibodies to human CD20. Science 2020; 369:793-799. [DOI: 10.1126/science.abb8008] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/22/2020] [Indexed: 12/25/2022]
Abstract
Monoclonal antibodies (mAbs) targeting human antigen CD20 (cluster of
differentiation 20) constitute important immunotherapies for the treatment
of B cell malignancies and autoimmune diseases. Type I and II therapeutic
mAbs differ in B cell binding properties and cytotoxic effects, reflecting
differential interaction mechanisms with CD20. Here we present 3.7- to
4.7-angstrom cryo–electron microscopy structures of full-length CD20 in
complexes with prototypical type I rituximab and ofatumumab and type II
obinutuzumab. The structures and binding thermodynamics demonstrate that
upon binding to CD20, type II mAbs form terminal complexes that preclude
recruitment of additional mAbs and complement components, whereas type I
complexes act as molecular seeds to increase mAb local concentration for
efficient complement activation. Among type I mAbs, ofatumumab complexes
display optimal geometry for complement recruitment. The uncovered
mechanisms should aid rational design of next-generation immunotherapies
targeting CD20.
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Affiliation(s)
- Anand Kumar
- Membrane Protein Mechanisms Unit, Institut Pasteur, 75015 Paris, France
- Membrane Protein Mechanisms Group, European Institute of Chemistry and Biology, University of Bordeaux, 33607 Pessac, France
- CNRS UMR 5234 Fundamental Microbiology and Pathogenicity, Bordeaux, France
| | - Cyril Planchais
- Laboratory of Humoral Immunology, Department of Immunology, Institut Pasteur, Paris, France
- INSERM U1222, Paris, France
| | - Rémi Fronzes
- CNRS UMR 5234 Fundamental Microbiology and Pathogenicity, Bordeaux, France
- Structure and Function of Bacterial Nanomachines Group, European Institute of Chemistry and Biology, University of Bordeaux, 33607 Pessac, France
| | - Hugo Mouquet
- Laboratory of Humoral Immunology, Department of Immunology, Institut Pasteur, Paris, France
- INSERM U1222, Paris, France
| | - Nicolas Reyes
- Membrane Protein Mechanisms Unit, Institut Pasteur, 75015 Paris, France
- Membrane Protein Mechanisms Group, European Institute of Chemistry and Biology, University of Bordeaux, 33607 Pessac, France
- CNRS UMR 5234 Fundamental Microbiology and Pathogenicity, Bordeaux, France
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4
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Michelis R, Tadmor T, Aviv A, Stemer G, Majdob R, Shvidel L, Shehadeh M, Barhoum M, Braester A. Cell-free IgG-aggregates in plasma of patients with chronic lymphocytic leukemia cause chronic activation of the classical complement pathway. PLoS One 2020; 15:e0230033. [PMID: 32150580 PMCID: PMC7062264 DOI: 10.1371/journal.pone.0230033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/19/2020] [Indexed: 11/18/2022] Open
Abstract
Therapy regimens for Chronic lymphocytic leukemia (CLL) commonly include chemotherapy and immunotherapy, which act through complement-mediated-cytotoxicity (CDC) and other mechanisms. CDC depends on several factors, including the availability and activity of the complement classical pathway (CP). Recently, a significant decrease in CP activity was shown to be associated with an immunoglobulin-C5a complex (Ig-C5a) and other markers of chronic CP activation in 40% of the patients. The study focused on the involvement of IgG-hexamers, an established CP activator, in the mechanism of chronic CP activation in CLL. Sera from 51 naïve CLL patients and 20 normal controls were collected. CP and alternative pathway (AP) activities were followed by the complement activity marker sC5b-9. Serum high molecular weight (HMW) proteins were collected by gel-filtration chromatography and their complement activation capacity was assessed. The levels of IgM, another established CP activator, were measured. Data were associated with the presence of Ig-C5a. Baseline levels of activation markers negatively correlated with CP and the AP activities, supporting chronic complement activation. In patients with Ig-C5a, HMW proteins that are not IgM, activated the complement. HMW proteins were identified as IgG-aggregates by affinity binding assays and Western blot analysis. The data indicate chronic CP activation, mediated by cell-free IgG-hexamers as a cause of decreased CP activity in part of the CLL population. This mechanism may affect immunotherapy outcomes due to compromised CP activity and CDC.
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Affiliation(s)
- Regina Michelis
- The Institute for Medical Research, Galilee Medical Center, Nahariya, Israel
| | - Tamar Tadmor
- Hematology Division, Bnai Zion Medical Center, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ariel Aviv
- Department of Hematology, Emek Medical Center, Afula, Israel
| | - Galia Stemer
- Department of Hematology, Emek Medical Center, Afula, Israel
| | - Rawan Majdob
- The Institute for Medical Research, Galilee Medical Center, Nahariya, Israel
| | - Lev Shvidel
- Hematology Institute, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Mona Shehadeh
- Biochemistry Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Masad Barhoum
- Institute of Hematology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Andrei Braester
- Institute of Hematology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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5
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Al-Samkari H, Grace RF, Connors JM. Ofatumumab for acute treatment and prophylaxis of a patient with multiple relapses of acquired thrombotic thrombocytopenic purpura. J Thromb Thrombolysis 2018; 46:81-83. [PMID: 29564686 DOI: 10.1007/s11239-018-1647-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Acquired thrombotic thrombocytopenic purpura (TTP) is an autoimmune disorder resulting in potentially life-threating systemic thrombotic microangiopathy due to production of antibodies directed against the von Willebrand factor-cleaving protease ADAMTS13. Typically managed with plasma exchange, glucocorticoids, and the first-generation anti-CD20 monoclonal antibody rituximab, patients with multiple relapses or refractory disease present unique management challenges. We describe a case of a young woman with multiple relapses of TTP despite standard therapy who was treated with ofatumumab, a second-generation anti-CD20 monoclonal antibody, after developing a severe hypersensitivity reaction to rituximab precluding its use. Ofatumumab was effective for the treatment of an acute relapse of TTP in combination with plasmapheresis and as a single-agent for prophylaxis. The patient has had no evidence of relapse 2 years after completion of acute treatment and 1 year after completing prophylactic therapy. Hypersensitivity to ofatumumab did not develop.
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Affiliation(s)
- Hanny Al-Samkari
- Center for Hematology, Massachusetts General Hospital Cancer Center, 55 Fruit St., Boston, MA, 02114, USA.
| | - Rachael F Grace
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, USA
| | - Jean M Connors
- Division of Hematology, Brigham and Women's Hospital, Boston, USA
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6
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Abstract
PURPOSE Cancer remains a significant cause of morbidity and mortality across the globe. A recent report suggests around 14.1 million new cases and 8.2 million cancer-related deaths, which are expected to reach 21.7 million and 13 million by 2030 worldwide, respectively. MATERIALS AND METHODS Because of highly complex mechanisms of cancer progression, it is important to explore and develop new innovative technologies which are more efficient compared with presently available treatment options. RESULTS Currently, chemotherapy, radiation and surgery are the most commonly used cancer treatment methods. In the last decade, nanomedicine emerged as an alternative treatment option that uses specific drug-delivery systems, improves efficacy of drugs and reduces detrimental side effects to normal tissues. CONCLUSION In this review, we have summarized cancer nanomedicines (active and passive drug delivery) available in the market. We have also discussed other nanomedicines that are at different stages of clinical trials.
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Affiliation(s)
- Nasimudeen R Jabir
- a King Fahd Medical Research Center , King Abdulaziz University , Jeddah , Saudi Arabia
| | - Khalid Anwar
- b School of Life Sciences , Jawaharlal Nehru University , New Delhi , India
| | - Chelapram K Firoz
- a King Fahd Medical Research Center , King Abdulaziz University , Jeddah , Saudi Arabia
| | - Mohammad Oves
- c Center of Excellence in Environmental Studies , King Abdulaziz University , Jeddah , Saudi Arabia
| | - Mohammad Amjad Kamal
- a King Fahd Medical Research Center , King Abdulaziz University , Jeddah , Saudi Arabia
| | - Shams Tabrez
- a King Fahd Medical Research Center , King Abdulaziz University , Jeddah , Saudi Arabia
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7
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Thurgood LA, Chataway TK, Lower KM, Kuss BJ. From genome to proteome: Looking beyond DNA and RNA in chronic lymphocytic leukemia. J Proteomics 2017; 155:73-84. [PMID: 28069558 DOI: 10.1016/j.jprot.2017.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/11/2016] [Accepted: 01/03/2017] [Indexed: 02/07/2023]
Abstract
Chronic lymphocytic leukemia (CLL) remains the most common leukemia in the Western world. Whilst its disease course is extremely heterogeneous (ranging from indolent to aggressive), current methods are unable to accurately predict the clinical journey of each patient. There is clearly a pressing need for both improved prognostication and treatment options for patients with this disease. Whilst molecular studies have analyzed both genetic mutations and gene expression profiles of these malignant B-cells, and as a result have shed light on the pathogenesis of CLL, proteomic studies have been largely overlooked to date. This review summarizes our current knowledge of the proteomics of CLL, and discusses some of the issues in CLL proteomic research, such as reproducibility and data interpretation. In addition, we look ahead to how proteomics may significantly help in the development of a successful treatment for this currently incurable disease.
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Affiliation(s)
- Lauren A Thurgood
- Department of Haematology and Genetic Pathology, Flinders University, Adelaide, South Australia, Australia.
| | - Tim K Chataway
- Department of Physiology, Flinders University, Adelaide, South Australia, Australia
| | - Karen M Lower
- Department of Haematology and Genetic Pathology, Flinders University, Adelaide, South Australia, Australia
| | - Bryone J Kuss
- Department of Haematology and Genetic Pathology, Flinders University, Adelaide, South Australia, Australia
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8
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Papadantonakis N, Advani AS. Recent advances and novel treatment paradigms in acute lymphocytic leukemia. Ther Adv Hematol 2016; 7:252-269. [PMID: 27695616 PMCID: PMC5026289 DOI: 10.1177/2040620716652289] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This is an exciting time in the treatment of acute lymphoblastic leukemia (ALL) given the advances in the relapsed/refractory setting. The development of antibody treatments (including antibody drug conjugates with toxins) offers a different treatment approach compared with conventional chemotherapy regimens. Moreover, the use of bispecific T-cell-engager antibodies (BiTEs) such as blinatumomab harness the cytotoxic activity of T cells against CD19-positive lymphoblasts. Another strategy involves the use of chimeric antigen receptor (CAR) T cells. CAR T cells have demonstrated promising results in the relapsed/refractory setting. However, the use of BiTEs and CAR T cells is also associated with a distinct set of adverse reactions that must be taken into account by the treating physician. Apart from the above strategies, the use of other targeted therapies has attracted interest. Namely, the discovery of the Philadelphia (Ph)-like signature in children and young adults with ALL has led to the use of tyrosine kinase inhibitors (TKI) in these patients. The different drugs and strategies that are being tested in the relapsed/refractory ALL setting pose a unique challenge in identifying the optimum sequence of treatment and determining which approaches should be considered for frontline treatment.
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Affiliation(s)
| | - Anjali S. Advani
- Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, OH 44120, USA
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9
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Korycka-Wołowiec A, Wołowiec D, Robak T. Ofatumumab for treating chronic lymphocytic leukemia: a safety profile. Expert Opin Drug Saf 2015; 14:1945-59. [DOI: 10.1517/14740338.2015.1113253] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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10
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Okroj M, Eriksson I, Österborg A, Blom AM. Killing of CLL and NHL cells by rituximab and ofatumumab under limited availability of complement. Med Oncol 2013; 30:759. [DOI: 10.1007/s12032-013-0759-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 10/24/2013] [Indexed: 01/26/2023]
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11
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Okroj M, Österborg A, Blom AM. Effector mechanisms of anti-CD20 monoclonal antibodies in B cell malignancies. Cancer Treat Rev 2013; 39:632-9. [DOI: 10.1016/j.ctrv.2012.10.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 10/01/2012] [Accepted: 10/16/2012] [Indexed: 11/25/2022]
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12
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Gupta IV, Jewell RC. Ofatumumab, the first human anti-CD20 monoclonal antibody for the treatment of B cell hematologic malignancies. Ann N Y Acad Sci 2012; 1263:43-56. [PMID: 22830942 DOI: 10.1111/j.1749-6632.2012.06661.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ofatumumab is the first human anti-CD20 monoclonal antibody to be approved for patients in the United States and the European Union. Ofatumumab received accelerated approval from the U.S. Food and Drug Administration in October 2009 and was granted a conditional marketing authorization by the European Medicines Agency in April 2010 for the treatment of patients with chronic lymphocytic leukemia (CLL) refractory to fludarabine and alemtuzumab, based on interim results of a pivotal phase 2 trial. Preliminary positive results for ofatumumab in combination with chemotherapy in patients with CLL are currently being confirmed in larger randomized trials in both the frontline setting and the relapsed/refractory setting. Ofatumumab has also shown potential in treating B cell non-Hodgkin's lymphoma, such as follicular lymphoma (FL), diffuse large B cell lymphoma (DLBCL), and Waldenström's macroglobulinemia. Additional trials are ongoing to confirm activity of ofatumumab as monotherapy and in combination with chemotherapy in patients with FL or DLBCL.
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Affiliation(s)
- Ira V Gupta
- GlaxoSmithKline, Collegeville, Pennsylvania 19426, USA.
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13
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Zhou Y, Zhao L, Marks JD. Selection and characterization of cell binding and internalizing phage antibodies. Arch Biochem Biophys 2012; 526:107-13. [PMID: 22627065 DOI: 10.1016/j.abb.2012.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 05/09/2012] [Accepted: 05/13/2012] [Indexed: 12/25/2022]
Abstract
Many therapeutic targets are cell surface receptors, which can be challenging antigens for antibody generation. For many therapeutic applications, one needs antibodies that not only bind the cell surface receptor but also are internalized into the cell. This allows use of the antibody to deliver various payloads into the cell to achieve a therapeutic effect. Phage antibody technology has proven a powerful tool for the generation and optimization of human antibodies to any antigen. While applied to the generation of antibodies to purified proteins, it is possible to directly select cell binding and internalizing antibodies on cells. Potential advantages of this approach include: cell surface receptors are in native conformation on intact cells while this might not be so for recombinant proteins; antibodies can be selected for both cell binding and internalization properties; the antibodies can be used to identify their tumor associated antigens; and such antibodies can be used for human treatment directly since they are human in sequence. This review will discuss the factors that impact the successful selection of cell binding and internalizing antibodies. These factors include the cell types used for selection, the impact of different phage antibody library formats, and the specific selection protocols used.
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Affiliation(s)
- Yu Zhou
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
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14
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Van Herle K, Behne JM, Van Herle A, Blaschke TF, Smith TJ, Yeaman MR. Integrative continuum: accelerating therapeutic advances in rare autoimmune diseases. Annu Rev Pharmacol Toxicol 2012; 52:523-47. [PMID: 22235861 DOI: 10.1146/annurev-pharmtox-010611-134628] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Autoimmune diseases are chronic, life threatening, and of burgeoning public health concern. They rank among the 10 most common causes of death in women, and some have incidence rates surpassing those of heart disease and cancer. Emerging information regarding molecular and cellular mechanisms affords opportunities for the discovery of novel therapeutic strategies or the repurposing of FDA-approved pharmacologic agents. Yet, obstacles to drug development amplify as an inverse function of the incidence of rare autoimmune disease; challenges include heterogeneous clinical presentation, paucity of definitive biomarkers, and poorly validated measures of therapeutic response. An integrative continuum model to address these challenges is being applied to neuromyelitis optica (NMO)-a potentially devastating neurodegenerative process that has had limited therapeutic options. This model links target discovery with pharmacologic application to accelerate improved clinical efficacy. The application of such innovative strategies may help researchers overcome barriers to therapeutic advances in NMO and other rare autoimmune diseases.
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Affiliation(s)
- Katja Van Herle
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90024, USA.
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15
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Masood A, Sher T, Paulus A, Miller KC, Chitta KS, Chanan-Khan A. Targeted treatment for chronic lymphocytic leukemia. Onco Targets Ther 2011; 4:169-83. [PMID: 22162923 PMCID: PMC3233276 DOI: 10.2147/ott.s7173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The treatment of chronic lymphocytic leukemia (CLL) has evolved over the last few decades. Recognition has increased of several key components of CLL biology currently manipulated for therapeutics. A milestone in the treatment of CLL was reached with the incorporation of immunotherapy with conventional chemotherapy. The fludarabine/cyclophosphamide/rituximab combination has demonstrated survival advantage for the first time in the treatment of CLL. Several other biological compounds are being explored with the hope of improving responses, impacting survival, and ultimately curing CLL. Important agents being tested are targeted on CLL surface molecules and their ligands, signal transduction protein and oncogenes. This review provides a brief summary of the recent advances made in preclinical and clinical investigation of selected promising therapeutic agents, which lead the target-directed therapeutic approach.
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Affiliation(s)
- Aisha Masood
- The Tisch Cancer Institute, Bone Marrow Transplant Unit, Mount Sinai School of Medicine, New York, NY
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16
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Wiernik PH, Adiga GU. Single-agent rituximab in treatment-refractory or poor prognosis patients with chronic lymphocytic leukemia. Curr Med Res Opin 2011; 27:1987-93. [PMID: 21905969 DOI: 10.1185/03007995.2011.615307] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Rituximab in combination with fludarabine and cyclophosphamide has significantly improved outcomes for patients with chronic lymphocytic leukemia (CLL) and an improvement in overall survival has recently been shown for the first time in the history of CLL treatment. However, the chemotherapy portion of this regimen may be unsuitable for elderly patients or those with significant comorbidities. We investigated the safety and tolerability of single-agent rituximab in 23 consecutive patients presenting with CLL at a single institution. RESEARCH DESIGN AND METHODS Patients received eight cycles of weekly rituximab (375 mg/m(2) initially). Patients progressing on rituximab treatment could receive up to five further courses of single-agent rituximab in escalating doses up to 3 gm/m(2) per dose. Previously untreated and previously treated patients, including those refractory to fludarabine, were eligible for the study. RESULTS Single-agent rituximab was efficacious, even in patients with treatment-refractory or poor-prognosis CLL. The overall response rate was 90.9% with a CR rate of 63.6%. The median PFS was 28.5 months, and median duration of response was 26 months. Responses were seen regardless of prior treatment including in patients refractory to fludarabine. Especially encouraging results were seen in patients receiving rituximab maintenance therapy who had a median duration of response substantially longer than those who did not receive maintenance (35 months vs. 14 months, respectively). CONCLUSIONS Rituximab was well tolerated with no unexpected adverse events even at the highest dose. These results indicate that single-agent rituximab is effective and has a place in the treatment of CLL.
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MESH Headings
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Male
- Middle Aged
- Rituximab
- Survival Rate
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Affiliation(s)
- Peter H Wiernik
- St. Lukes-Roosevelt Hospital Center, New York, NY 10019, USA.
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