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Introduction to immunology. LESSON 6: BIOTECH AND BIOMEDICAL APPLICATIONS Today we will get to know: • A little bit of immunopharmacology and immunotherapy • Some examples of biotech applications of immune system processes 1 Introduction to immunology. Lesson 6 Immunopharmacology – how to suppress or stimulate the immune system Immunopharmacology is a very wide term which we will use here to indicate those drugs that act primary on the immune system. There are two major groups of immunopharmacological drugs: immunosuppressive and immunostimulant drugs. Immunosuppressive drugs Immunostimulant drugs Those drugs that suppress the immune system. Particularly important for transplantation, autoimmune disorders, allergies, and all the cases where immune system is too active. Those drugs that stimulate the immune system. Particularly important for the treatment of infectious diseases, tumors, immunodeficiencies and all the cases where the immune system needs a boost. 2 Introduction to immunology. Lesson 6 Immunopharmacology – how to suppress the immune system Immunosuppression is widely used in clinical practice. But it has some major problems: it works better on primary responses than on secondary (memory) responses, it works best if administered before exposure to the antigen, and shutting down the immune system is always a risk. Glucocorticoids NSAIDs Immunosuppressive drugs Antiallergic drugs T-cell blockers Cytotoxic drugs Cell-based Immunosuppression (experimental) Treg tDCs Antibody reagents Anti-cytokine treatments 3 Introduction to immunology. Lesson 6 Immunosuppressive drugs – the glucocorticoids Glucocorticoids have a very wide range of effects on the immune system, and are thus widely used as immunosuppressive drugs whenever significant inhibition of the immune system is needed. Natural glucocorticoids are not used because of their significant mineralocorticoid activity. Glucocorticoids like prednisone, prednisolone, methylprednisolone etc. suppress both innate and adaptive immune responses, at both the humoral and the cellular level. But, to do so, they need high doses. The bad side is that their suppressive activity lasts long (increased infection risk), they can induce monocytopenia, lymphopenia and eosinopenia, and they have strong systemic side-effects (glucose intolerance, bone dissolution, muscle waste, Cushing’s syndrome) Nature Rev. 2012 4 Introduction to immunology. Lesson 6 Immunosuppressive drugs – the NSAIDs To overcome side-effects of corticosteroids, Non-Steroidal Antinflammatory Drugs (NSAIDs) have been developed. Regardless of their differences, they all inhibit ciclooxygenase (COX)-1 and -2 enzymes, which metabolize arachidonic acid to produce prostaglandins. NSAIDs are not prototypical immunosuppressive, as they target many other cell types. NSAIDs inhibit COX-2, which, under the influence of inflammatory cytokines, produces inflammatory prostaglandins. These, in turn, recruit phagocytes to the inflamed sites, stimulate fever and sensitize neurons to pain. The bad side is that they also inhibit COX-1, which is ubiquitous and has protective roles in the mucosae. Suppression of COX-1 is associated to high liver toxicity, gastric ulcerations and higher frequency of gastric carcinomas. 5 Introduction to immunology. Lesson 6 Immunostimulation and immunotherapy Immunotherapy deals with the idea of boosting an individuals’ immune system, to allow it to destroy microbes and tumors. The boost can be biological (microbial-derived products), pharmacological, or cell-based. Immunostimulant drugs Microbial products and cytokines STRONGER IMMUNE SYSTEM STRONGER DEFENSES Adoptive cell transfer 6 Introduction to immunology. Lesson 6 Immunostimulant drugs – microbial products Many bacterial products are PAMPs, and they strongly stimulate inflammation by triggering cytokine production in APCs. These, in turn, stimulate the adaptive immunity and, overall, increase leukocytes number by boosting hematopoiesis. Brandy Urology, J.H. Hospital The Bacillus Calmette–Guérin (BCG) is an attenuated (less virulent, but still alive) mycobacterium bovis strain. This is able to infect human cells, but not to induce any pathology. Rather, it can stimulate the production of Igs by B-cell and thus behave as a vaccine against mycobacterium tuberculosis. It has a strong inflammatory effect on some tissues, and has thus been also approved as a treatment for bladder cancer. The bad side is that PAMPs can induce massive cytokine production, which can result in fever and shock. This is especially true with cytokines, which can also have direct toxic effects. 7 Introduction to immunology. Lesson 6 Immunotherapy – cytokine therapies Since cytokines control the whole immune system, and mostly stimulate it, it is logical to use them whenever there is the need to boost immune system activity. They are used in clinical practice, but they are burdened by severe side effects. Cytokine therapies Cytokine Effects Used for Side effects IL-2 Proliferation of T cells, differentiation to Th and CTLs, empowers innate immunity Melanoma, metastatic renal cancer Toxic for blood vessels, blood leakage, edema, hemorrhage, mental disorders IFN-a Strong stimulation of innate and adaptive immunity, activation of the antiviral defense state CGD, Kaposi’s sarcoma, hairy cell leukemia, papillomavirus infections, hepatitis C, multiple sclerosis Flu-like syndromes at every injection, pain, diarrhea, anorexia, confusion, depression, suicide 8 Introduction to immunology. Lesson 6 Immunotherapy – active vaccination Active vaccination is the process of injecting individuals with microbial antigens, heat-killed microbes or attenuated living microbes to induce antibody production and memory B-cells formation. Thus, the individual acquires the ability to respond to the microbe he/she has been vaccinated against. To ensure memory B-cells formation, whole microbes (either killed or attenuated) are preferred, as they also trigger fever and inflammation that boost B-cells activation and memory cells formation. Attenuated microbes are those living strains which are still able to infect an individual, but that generate a less-dangerous pathological manifestation, which is generally inflammation/flu. Side-effects are generally low, but sometimes they can be extremely severe. 9 Introduction to immunology. Lesson 6 Immunotherapy – adjuvants for vaccination Injecting individuals with microbial antigens can determine unsufficient responses because natural antigens are often weak. Also, injecting a living microbe can be dangerous, and reducing the amount of microbe to the minimum is mandatory. Here’s the need for adjuvants. Types of adjuvants Inorganic compounds Alum, aluminum hydroxide, aluminum phosphate, calcium phosphate hydroxide Mineral oil Paraffin oil Bacterial products Killed bacteria like B. Pertussis, M. Bovis Organic compounds Squalene Detergents QuilA Cytokines IL-2, IL-1, IL-12, TNF-a Combined Freund’s adjuvant (mineral oil + M. Bovis) Adjuvants are chemical or biological products that can either boost Tcells, activate inflammation or help to stabilize the antigen so that it can stimulate B-cells for a longer time. Adjuvants have been also implicated in clinical side-effects of vaccinations, like the onset of juvenile diabetes in the case of Freund’s adjuvant. 10 Introduction to immunology. Lesson 6 Immunotherapy – passive vaccination In passive vaccination, individuals are injected with preformed immunoglobulins (from donors). Thus, individuals acquire pools of immunoglobulins (good for immunodeficiencies) and the ability to respond to certain microbes. Transfusion of immunoglobulins is called intravenous immunoglobulins (IGV). Generally, IGVs contain IgG and IgA. Anti-microbial IGVs are used against hepatitis B, botulism, diphtheria, tetanus, rabies. It’s generally well-tolerated, but sporadic sideeffects can be extremely severe. 11 Introduction to immunology. Lesson 6 Immunotherapy – adoptive cell transfer Adoptive cell transfer deals with the idea of isolating immune cells from individuals, expand them in culture and then re-infuse them. This is a wonderful strategy to kill tumors. Tumor-infiltrated lymphocytes (TIL) are a heterogeneous population which includes Th and CTLs able to recognize and kill the tumor. The problem is that the cytokines released from the tumor suppress them. Taking these “good cells” out of the tumor mass and re-injecting them upon expansion strongly increases the ability of the immune system to react against tumors. 12 Introduction to immunology. Lesson 6 Immunotherapy – cell-based vaccination Also dendritic cells can be “prepared” in vitro to show tumor antigens, and then re-injected into the patient to stimulate tumor antigens’ recognition and tumor killing. This is currently defined as cell-based vaccination. 5) The DC matures and is infused back to the patient 3) The antigen is given to DC 2) The antigen is purified in the lab 4) The antigen is uptaken by DC 6) The DC displays tumor antigen and activates the T-cells 1) Blood is drawn 7) T-cells attack cancer cells 13 Introduction to immunology. Lesson 6 Biotech applications – hybridomas and monoclonal antibodies Often, antigens are polyclonal (contain different epitopes), thus being able to stimulate the expansion of different B-clones, each producing specific antibodies against a part of the antigenic molecule. Overall, the mixture of antibodies produced is polyclonal. Single epitopes Single B-clones Y Antigen Epitope 2 Epitope 3 Y Y Epitope 1 14 Introduction to immunology. Lesson 6 Biotech applications – hybridomas and monoclonal antibodies But tumors of B-cells (myeloma or plasmacytoma), originating from a single B-clone, can only produce antibodies against a single epitope. Hence, they are monoclonal. Y Y Y Y Neoplastic transformation Y B-cell tumor Single B-clones Y Single epitopes 15 Introduction to immunology. Lesson 6 Biotech applications – hybridomas and monoclonal antibodies This suggested that it was theoretically possible to generate monoclonal B-cells, immortalize them (so they can be cultured in the labs like tumor cells) and use them to produce large amounts of the desired antibody. In 1975, G. Kohler and C. Milstein described the method to generate antibodies with a single specificity (monoclonal), by fusing normal Bcells from immunized lab animals with myeloma cells. The chimera formed, being a cell able to produce antibodies and to survive in culture like a tumor, was called hybridoma. Antibodies produced by this approach only recognize a single epitope and they are all identical. Georges Kohler MONOCLONAL ANTIBODIES Cesar Milstein 16 Introduction to immunology. Lesson 6 Biotech applications – hybridomas and monoclonal antibodies To make a hybridoma, we need the following: Y A well-purified antigen (even better, just a single epitope) to inject into lab animals along with adjuvants B-cells isolated from the spleen of laboratory animals immunized (injected) with the antigen of interest Commercially available myeloma/plasmacytoma cell lines. These cells have to fundamental features: • They do not produce Ig of their own • They have a mutation in the purines biosynthetic pathway. 17 Introduction to immunology. Lesson 6 Biotech applications – hybridomas and monoclonal antibodies Purine synthesis occurs trough 2 pathways De Novo Salvage Aminopterin blocks tetrahydrofolate production Tetrahydrofolate needed Myeloma cells used for hybridomas do not produce HGPRT, so they use the de novo pathway. HypoxanthineGuanine Phosphorybosiltransferase (HGPRT) enzyme needed 18 Introduction to immunology. Lesson 6 Biotech applications – hybridomas and monoclonal antibodies In a medium containing aminopterin, HGPRT-null myeloma cells are condemned to death because both the purine pathways are blocked. + Y B-cells can rescue these cells, because they express HGPRT and can thus produce purines from hypoxanthine and thymidine, in the absence of tetrahydrofolate. Y = Hybridomas (fused cells) can survive in a medium with Hypoxanthine, Aminopterin and Thymidine HAT medium 19 Introduction to immunology. Lesson 6 Biotech applications – hybridomas and monoclonal antibodies Monoclonal antibodies have thousands of applications: • Research of tumor antigens • Research of specific cell-types markers • Identification of soluble molecules and markers from biological samples Abbas et al. • Diagnosis • Therapy • Etc. 20 Introduction to immunology. Lesson 6 Biotech applications – applications of monoclonal antibodies: ELISA Antibodies are very useful to “detect” soluble molecules in a liquid phase. A technique which exploits this ability is called Enzyme-Linked Immunosorbent Assay (ELISA). 1 Antigens of interest can either be adsorbed to the bottom of a culture plate (indirect ELISA) or captured by an antibody adsorbed to the bottom of a culture plate (sandwich or direct ELISA). 2 Another antibody is added to the mixture, which binds to the antigen (detection antibody). 3 A final, modified antibody (secondary antibody) is added to the mixture. This antibody binds to the detection antibody and is covalently linked to a fluorochrome or to an enzyme (typically HRP). 4 A chemical substrate is provided to the complex, and metabolized by HRP to generate a colored product. The more the color means the more the antibodies bound and, hence, the more the quantity of the antigen! 21 Introduction to immunology. Lesson 6 Biotech applications – applications of monoclonal antibodies: fluorescence Antibodies are also very specific. So, you can use them to identify your cells of interest in a mixture of different cells. The easiest way to identify these cells is to add a fluorescent moiety to the antibody, and then look under a fluorescence microscope. 22 Introduction to immunology. Lesson 6 Biotech applications – applications of monoclonal antibodies: humanized antibodies It is not so difficult to generate antibodies against some markers (i.e., a tumor antigen) in lab animals. But, if these antibodies are injected straightforward into humans, human B-cells will recognize animal antibodies as non-self and produce antibodies against them (human antimouse antibodies, HAMAs), making them useless. Antibodies for therapy must be humanized. Murine Humanized Chimeric Human Humanizations consists in cloning the 3 CDR regions of a mouse antibody against the antigen of interest into a human Ig plasmid. As a result, a new antibody is produced which has the whole frame of a human immunoglobulin but has the CDR (hence, the antigen specificity) of the mouse antibody. Another possibility is to clone the whole VL and VH region of a murine antibody into a human antibody, creating a chimeric antibody. 23 Introduction to immunology. Lesson 6 Biotech applications – applications of monoclonal antibodies: humanized antibodies Once humanized, antibodies can be used for therapy. Examples of monoclonal antibodies for human therapy Target Effect Disease CD20 Depletion of B-cells Rheumatoid arthritis, multiple sclerosis, other autoimmune diseases VEGF Blockade of tumor neo- Breast cancer, angiogenesis carcinoma HER2/Neu Depletion of cells which Breast cancer show HER2 amplification TNF Inhibition inflammation Colon of Rheumatoid arthritis, Crohn’s disease 24