Chmel H
Department of Internal Medicine, College of Medicine, University of South Florida, Tampa.
Am J Hosp Pharm. 1990 Nov;47(11 Suppl 3):S11-5.
The past, present, and emerging roles of immunotherapy, including the use of monoclonal antibodies for diagnosis and treatment, are discussed. Although immunotherapy has been used for more than 100 years, it became less important when antimicrobial agents came into widespread use. In the 1970s investigators began to re-examine immunotherapy for potential use in gram-negative infections. Polyclonal antiserum against the J5 mutant of Escherichia coli (gram-negative lipid A) has been shown to be effective in treating patients with bacteremia and septic shock. The discovery of monoclonal antibodies and the creation of hybridoma technology by the fusion of immortal cells with antibody-producing cells have resulted in the production of large amounts of monoclonal antibodies of desired specificities. More recently, murine monoclonal antibodies have been used clinically for immunosuppression in renal-transplant patients (OKT3 antibody) and for prevention of septic complications in patients with suspected gram-negative infection and evidence of systemic response (E5 IgM antibody). E5 antibody directed against gram-negative bacterial endotoxin has been reported to significantly reduce morbidity and mortality from gram-negative sepsis and to be well tolerated. The application of new treatment modalities such as monoclonal antibodies is expected to enhance the therapeutic options available to treat infectious diseases.
本文讨论了免疫疗法过去、现在以及新出现的作用，包括单克隆抗体在诊断和治疗中的应用。尽管免疫疗法已应用了100多年，但在抗菌药物广泛使用后其重要性有所降低。20世纪70年代，研究人员开始重新审视免疫疗法在革兰氏阴性菌感染中的潜在用途。针对大肠杆菌J5突变体（革兰氏阴性菌脂多糖）的多克隆抗血清已被证明可有效治疗菌血症和感染性休克患者。单克隆抗体的发现以及通过将永生细胞与产生抗体的细胞融合而创建的杂交瘤技术，使得能够大量生产具有所需特异性的单克隆抗体。最近，鼠源单克隆抗体已在临床上用于肾移植患者的免疫抑制（OKT3抗体），以及预防疑似革兰氏阴性菌感染且有全身反应证据的患者发生感染性并发症（E5 IgM抗体）。据报道，针对革兰氏阴性菌内毒素的E5抗体可显著降低革兰氏阴性菌败血症的发病率和死亡率，且耐受性良好。预计单克隆抗体等新治疗方式的应用将增加治疗传染病的可用治疗选择。
