Blood human mAbs

A number of chimerized, humanized, and one human mAb have now been approved for therapeutic use in humans in the treatment of autoimmunity, malignancy, infection and cardiovascular disease (Table 1). Some of the currently licensed mAb will be discussed here. A much larger number of mAb are currently being evaluated in Phase I, II and III trials. In general, chimeric, humanized and human mAb are very well tolerated with few side effects. Chimeric or humanized mAb still have the potential to evoke host immune response to the variable domains or CDRs of the antibody so-called HACA (human anti-chimeric antibody) or HAHA (human anti-human antibody) responses, although these responses are uncommon. Short-lived and occasionally severe infusion-related acute hypersensitivity reactions such as fever, skin itching, shivering, respiratory compromise and low blood pressure sometimes occur-. Such effects may... 

Apart from the spleen, other lymphoid tissues, such as tonsils and the mesenteric or popliteal lymph nodes, can be used as a source of lymphocytes. In the preparation of MABs of human or veterinary origins it is often not possible to obtain lymphoid tissue, and there have been many reports of the successful use of lymphocytes separated from peripheral blood. In some cases, for ethical or practical reasons, it is not possible to immunize the lymphocyte donor, as when human MABs are required, or acutely toxic antigens are used. Also, antigen is not always available in sufficient quantities to perform a successful immunization in vivo. In these circumstances, it may be possible to perform the boosting stage or, indeed, the entire immunization procedure on the lymphocytes in vitro. 

Clinical studies have confirmed that chimeric and humanized mAbs are less immunogenic. However, the half time for clearance of these molecules from the blood pool in humans is much slower than their murine counterparts due to the fact that they have human Fc regions. This feature must be considered in selecting the optimal radionuclide—mAb combination for radioimmunotherapy. Indeed, the ideal radionuclide for labeling a particular mAb maybe different depending upon whether the protein is in murine, chimeric, or humanized form. 

Permeation of mAbs across the cells or tissues is accomplished by transcellular or paracellular transport, involving the processes of diffusion, convection, and cellular uptake. Due to their physico-chemical properties, the extent of passive diffusion of classical mAbs across cell membranes in transcellular transport is minimal. Convection as the transport of molecules within a fluid movement is the major means of paracellular passage. The driving forces of the moving fluid containing mAbs from (1) the blood to the interstitial space of tissue or (2) the interstitial space to the blood via the lymphatic system, are gradients in hydrostatic pressure and/or osmotic pressure. In addition, the size and nature of the paracellular pores determine the rate and extent of paracellular transport. The pores of the lymphatic system are larger than those in the vascular endothelium. Convection is also affected by tortuosity, which is a measure of hindrance posed to the diffusion process, and defined as the additional distance a molecule must travel in a particular human fluid (i. e., in vivo) compared to an aqueous solution (i. e., in vitro). 

Generally, the estimated volumes of distribution are small and relatively homogeneous (Table 3.5). mAbs initially distribute into a restricted central volume (Vc) of 3-5 L, which in humans approximates the serum volume. In order to evaluate the value in patients with respect to physiology, it must be kept in mind that, especially in tumor patients, the cellular fraction in blood and the hematocrit may be decreased and hence the serum volume will be increased. 

---