36 Active, passive and adoptive immunotherapy

Question 1

Immunotherapy is divided into four approaches. How are they different?

Active immunotherapy

Active and specific immunotherapy

Answer 1

Active immunotherapy - systemic activation of immune response (non-specific)

Active and specific immunotherapy - systemic activation of immune response, using antigen recognition pathways

Question 2

Immunotherapy is divided into four approaches. How are they different?

Adoptive immunotherapy

Passive immunotherapy

Answer 2

Adoptive immunotherapy - cells with antigen specific effector responses, are expanded in vitro, and given to host

Passive immunotherapy - preformed antibodies given to the host

Question 3

Adoptive immunotherapy.

CAR-T cells can be used in modern treatments for blood cancers.

How do they work?

Answer 3

T-cells of patient separated out

Exposed to antigen (e.g tumour cell)

Express chimaeric antigen receptors on their surface (CAR)

CAR-T cells population expanded in vitro

Administered to patient. CAR-T cells attack tumour/ cancer

Question 4

What are examples of passive immunotherapy?

Immunoglobulin can come from human/ animals .

Antibiotics/ vaccination has reduced need for this

Answer 4

Diptheria - horse
Tetanus - horse
Botulism - horse
VZV
Rabies
HBV
Measles

Convalescent plasma has been trialled in conditions such as ebola/ covid

Question 5

Immunoglobulin administration from animal source, can cause serum sickness.

What is this?

Answer 5

Antibody response to foreign antibodies (hypersensitivity type III)

They bind to each other, and and immune complex deposition in kidney/ skin/ blood vessels. Complement/ neutrophil activation - inflammation/ increased permeability.

Symptoms -

• anaphylaxis
• hypotension
• glomerulonephritis
• rash
• fever

Better to use convalescent human immunoglobulin if possible

Certain drugs can cause serum sickness too

Question 6

What is treatment of serum sickness?

Answer 6

Stop offending drug/ immunoglobulin

Steroids

Anti-histamines

Question 7

Why is human normal immunoglobulin used?

Answer 7

With common infections, it is presumed that most people have reasonable antibody levels to common pathogens.

So can used pooled immunoglobulin to treat common infections e.g measles

Some patients require regular immunoglobulin - e.g hypogammablogulinaemia, CVID

Question 8

What are globulins?

Answer 8

Globulins are a group of proteins within the blood. They are produced by the liver and the immune system. Albumin makes up more than half of the total protein within the blood, and globulins make up the remainder.

Globulins have multiple different functions; the group includes immunoglobulins, enzymes, carrier proteins and complement.

Question 9

What are monoclonal antibodies?

Answer 9

Different to pooled immunoglobulin, as has only one type of antibody present, which targets specific pathogen e.g ebola

Question 10

What is a prebiotic?

What is a probiotic?

Answer 10

Pre-biotic - non-digestible fibres which stimulate bacterial growth

Pro-biotic - live bacteria/ yeast