immune stuff

• MABs

  Medications that end in MAB, derived from human, mouse, or a combination
• Antigen

  Substance introduced into a host that triggers antibody production
• Hybridoma formation

  1. Introduce antigen

  2. Host makes antibodies

  3. Combine antibodies with tumor cells

  4. Divide to make copies

  5. Isolate to make drug
• MABs

  • Work at cell membrane receptors
  • Target specific antigens
  • Activate body's natural immune response
• Therapeutic uses of MABs

  • Cancer
  • Asthma
  • Hemophilia
  • Prevention of migraine headaches
  • RA
• Omalizumab is approved for allergy-related asthma
• Omalizumab

  Works by combining three immunoglobulin E to reduce available IgE
• Decreasing mast cell activation reduces airway bronchospasm and inflammation
• MABs approved for eosinophilic asthma

  • Mepolizumab
  • Benralizumab
  • Reslizumab
  • Dupilumab
• Dupilumab

  Targets IL4 type one and two receptors on mast cells and eosinophils
• Cytokine release syndrome (CRS)

  Occurs when proinflammatory cytokines are released from leukocytes after immunomodulator administration
• Key cytokines involved in CRS

  • Interleukin six
  • Interleukin one
  • Interleukin two
• Common symptoms associated with CRS

  • Fever
  • Nausea
  • Vomiting
  • Diarrhea
  • Rash
• Immunogenicity is an adverse reaction that can occur with immunomodulators
• Production of anti-drug antibodies can lead to anaphylaxis
• Non-acute reactions include delayed hypersensitivity reactions
• Supportive treatment for non-acute reactions includes corticosteroids
• MABs associated with organ toxicity

  • Avelumab
  • Durvalumab
  • Ipilimumab
  • Novolumab
  • Pembrolizumab
• Dermatologic effects of MABs

  • Target epidermal growth factor (EGFR)
  • Can cause skin fissures, acne, rash, keratitis, xerosis
• GI effects are common with MABs
• Common GI side effects of MABs

  • Diarrhea
  • Nausea
  • Vomiting
  • Constipation
• NIBs

  Tyrosine Kinase inhibitors that end in nib
• NIBs mechanism

  Block Tyrosine Kinase that sends growth signals
• Conditions treated with NIBs

  • Hepatocellular carcinoma
  • Differentiated thyroid cancer
  • Renal cell carcinoma
  • Metastatic melanoma
  • Other malignancies
• Common toxicities of NIBs

  • Dermatologic
  • Gastrointestinal
• Erlotinib produces higher grades of rash
• MIBs

  Proteasome inhibitors that work intracellularly
• MIBs mechanism

  Block proteasomes causing unwanted proteins to build up and cause cell death
• Conditions treated with MIBs

  • Multiple myeloma
  • Mantle cell lymphoma
• MIBs are substrates of Cytochrome 450 enzymes
• Common toxicities of MIBs

  • Cardiologic
  • Gastrointestinal
• Common gastrointestinal symptoms with MIBs include nausea, vomiting, diarrhea, and constipation
• Severe toxicity with MIBs can include colitis and colonic ulceration
• Natural immunity

  Innate or native immunity present before exposure to infectious agents
• Factors conferring natural immunity

  • Physical barriers
  • Phagocytic cells
  • Natural killer cells
• Specific acquired immunity

  Occurs after exposure to a foreign substance
• Antigens

  Foreign substances that induce specific immune responses
• Specific immune response becomes more rapid and intense with reexposure to an antigen
• T lymphocytes and B lymphocytes

  Cells that possess receptors recognizing individual antigens
• Types of specific acquired immune responses

  • Cell mediated
  • Humoral