Monoclonal Antibodies: The Magic Bullets For Treating A Host Of Diseases

December 11, 2022 at 8:26 p.m.


Everywhere around us today imperceptibly small “magic bullets” called monoclonal antibodies or Mabs are quietly affecting our lives.

A monoclonal antibody is a type of protein that is made in the laboratory and can bind to certain targets in the body, such as antigens on the surface of cancer cells. They have a number of promising potential therapeutic applications in the treatment of asthma, autoimmune diseases, cancer, poisoning, septicemia, substance abuse, viral infections and other diseases. Monoclonal antibodies (Mabs) are the largest class of biological products in clinical use.  

Background

According to Lara Marks in her book “Lock and Key of Medicine,” at least six out of 10 of the best-selling drugs in the world are Mabs. Mabs are not only successful drugs but also powerful tools for a wide range of medical applications. In industry, they are critical to the purification of drugs.

Elsewhere, they are essential research probes for determining the pathological pathway and the cause of diseases.  They are used on a routine basis in hospitals to type blood and tissue, a process vital to ensuring safe blood transfusion and organ transplantation. On the diagnostic front, Mabs are intrinsic components in home-testing kits for detecting ovulation, pregnancy or menopause. They are used for the analysis of body fluids for medical diagnosis, and to determine whether a heart attack has occurred. They are at the forefront of public health efforts, helping, for example, to identify hospital infections such as methicillin-resistant Staphylococcus aureus (MRSA).

At a global level, governments also depend on Mab-based tests to contain the spread of infectious diseases such as AIDS, Covid and pandemic flu, or to detect the potential release of anthrax or smallpox by bioterrorists. Mabs are indispensable not only to health, but also to many other aspects of modern life: They help identify viruses in animal livestock or plants, prevent food poisoning, and are used to investigate environmental pollution.

Yet, despite their ubiquity and significance, most people have never heard of Mabs or how they have both transformed healthcare and spawned an entire new industry. Produced in the laboratory, Mabs are derived from the billions of tiny antibodies made every day by our immune systems to combat substances, known as antigens, that are regarded as foreign or potentially dangerous.  

Millions of different types of antibodies can be found in the blood of humans and other mammals. Made by white blood cells known as B lymphocytes, each antibody is highly specific, that is, it has the ability to bind to only one particular antigen, which may be derived from bacteria, viruses, fungi, parasites, pollen or nonliving substances such as toxins, chemicals, drugs or foreign particles considered alien to the body. Once antibodies have marked their particular antigen, they and other types of cells produced by the immune system can attack it.

Major Diseases

On the therapeutic front, Mabs have radically altered the treatment of more than 50 major diseases, many considered untreatable before. Mab therapies are used for a broad range of conditions today, including organ transplants, cancer, inflammatory and autoimmune diseases, cardiovascular and infectious diseases, allergies and ophthalmic disorders.

Monoclonal Antibodies —Treatment

As mentioned above, more than 75 monoclonal antibodies have been licensed for use by the Food and Drug Administration.  Muromonab CD3 (Orthoclone OKT) was approved in 1986, and it was the first mAb on the market. Muromonab was used to prevent T-cell mediated kidney transplant rejection. Only three however are used to treat or prevent infectious diseases — respiratory syncytial virus (RSV), anthrax and C. difficile. Two different monoclonal antibody products have been shown to be effective in reducing mortality from Ebola virus disease. One was a combination of three monoclonal antibodies, while the other was a single monoclonal antibody.   

Examples of FDA approved monoclonal antibody drugs include teclistamab for multiple myeloma, nirsevimab for RSV, relatlimab for melanoma, tezepelumab for severe asthma, eptinezumab to prevent migraine headaches and sutimlimab for cold agglutinin disease.  

Generic Names

Many of the generic names for Mabs are often unpronounceable but there is a rationale for them. Monoclonal antibodies are named based on a specific structure developed by the International Nonproprietary Names Working Group, under the direction of the World Health Organization. This structure consists of a prefix, substem A, substem B and suffix.

The prefix does not follow any specific criteria, except that it must distinguish an antibody from other products. Substem A specifies the target of the antibody, such as a tumor or bacterial target, while substem B specifies the sequence from which the monoclonal antibody was derived, so antibodies that were derived from a mouse would contain the substem -o-.  Note that the suffix —mab is a common stem for all monoclonal antibodies.

Final Thoughts

Watch for the suffix “mab” in drug ads in television or in print, you will no doubt be surprised at the number of times you read it.

Max Sherman is a medical writer and pharmacist retired from the medical device industry.  His new book “Science Snippets” is available from Amazon and other book sellers. It contains a number of previously published columns.  He can be reached by email at  [email protected]

Everywhere around us today imperceptibly small “magic bullets” called monoclonal antibodies or Mabs are quietly affecting our lives.

A monoclonal antibody is a type of protein that is made in the laboratory and can bind to certain targets in the body, such as antigens on the surface of cancer cells. They have a number of promising potential therapeutic applications in the treatment of asthma, autoimmune diseases, cancer, poisoning, septicemia, substance abuse, viral infections and other diseases. Monoclonal antibodies (Mabs) are the largest class of biological products in clinical use.  

Background

According to Lara Marks in her book “Lock and Key of Medicine,” at least six out of 10 of the best-selling drugs in the world are Mabs. Mabs are not only successful drugs but also powerful tools for a wide range of medical applications. In industry, they are critical to the purification of drugs.

Elsewhere, they are essential research probes for determining the pathological pathway and the cause of diseases.  They are used on a routine basis in hospitals to type blood and tissue, a process vital to ensuring safe blood transfusion and organ transplantation. On the diagnostic front, Mabs are intrinsic components in home-testing kits for detecting ovulation, pregnancy or menopause. They are used for the analysis of body fluids for medical diagnosis, and to determine whether a heart attack has occurred. They are at the forefront of public health efforts, helping, for example, to identify hospital infections such as methicillin-resistant Staphylococcus aureus (MRSA).

At a global level, governments also depend on Mab-based tests to contain the spread of infectious diseases such as AIDS, Covid and pandemic flu, or to detect the potential release of anthrax or smallpox by bioterrorists. Mabs are indispensable not only to health, but also to many other aspects of modern life: They help identify viruses in animal livestock or plants, prevent food poisoning, and are used to investigate environmental pollution.

Yet, despite their ubiquity and significance, most people have never heard of Mabs or how they have both transformed healthcare and spawned an entire new industry. Produced in the laboratory, Mabs are derived from the billions of tiny antibodies made every day by our immune systems to combat substances, known as antigens, that are regarded as foreign or potentially dangerous.  

Millions of different types of antibodies can be found in the blood of humans and other mammals. Made by white blood cells known as B lymphocytes, each antibody is highly specific, that is, it has the ability to bind to only one particular antigen, which may be derived from bacteria, viruses, fungi, parasites, pollen or nonliving substances such as toxins, chemicals, drugs or foreign particles considered alien to the body. Once antibodies have marked their particular antigen, they and other types of cells produced by the immune system can attack it.

Major Diseases

On the therapeutic front, Mabs have radically altered the treatment of more than 50 major diseases, many considered untreatable before. Mab therapies are used for a broad range of conditions today, including organ transplants, cancer, inflammatory and autoimmune diseases, cardiovascular and infectious diseases, allergies and ophthalmic disorders.

Monoclonal Antibodies —Treatment

As mentioned above, more than 75 monoclonal antibodies have been licensed for use by the Food and Drug Administration.  Muromonab CD3 (Orthoclone OKT) was approved in 1986, and it was the first mAb on the market. Muromonab was used to prevent T-cell mediated kidney transplant rejection. Only three however are used to treat or prevent infectious diseases — respiratory syncytial virus (RSV), anthrax and C. difficile. Two different monoclonal antibody products have been shown to be effective in reducing mortality from Ebola virus disease. One was a combination of three monoclonal antibodies, while the other was a single monoclonal antibody.   

Examples of FDA approved monoclonal antibody drugs include teclistamab for multiple myeloma, nirsevimab for RSV, relatlimab for melanoma, tezepelumab for severe asthma, eptinezumab to prevent migraine headaches and sutimlimab for cold agglutinin disease.  

Generic Names

Many of the generic names for Mabs are often unpronounceable but there is a rationale for them. Monoclonal antibodies are named based on a specific structure developed by the International Nonproprietary Names Working Group, under the direction of the World Health Organization. This structure consists of a prefix, substem A, substem B and suffix.

The prefix does not follow any specific criteria, except that it must distinguish an antibody from other products. Substem A specifies the target of the antibody, such as a tumor or bacterial target, while substem B specifies the sequence from which the monoclonal antibody was derived, so antibodies that were derived from a mouse would contain the substem -o-.  Note that the suffix —mab is a common stem for all monoclonal antibodies.

Final Thoughts

Watch for the suffix “mab” in drug ads in television or in print, you will no doubt be surprised at the number of times you read it.

Max Sherman is a medical writer and pharmacist retired from the medical device industry.  His new book “Science Snippets” is available from Amazon and other book sellers. It contains a number of previously published columns.  He can be reached by email at  [email protected]

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