How the immune system responds to therapeutic biological agents.
Biological agents target disease mechanisms and have modified the natural history of several immune-mediated disorders. Biological agents are structurally immunogenic, and therefore usually elicit a minor, subclinical and transient phenomenon. Occasionally, however, these drugs induce complete cellular and humoral immune responses, with the main clinical consequences being hypersensitivity reactions or loss of treatment response. This article considers the relative pathogenic mechanisms influencing immunogenicity in biological agents and discusses mechanisms of tolerance and adaptive immune response, including adaptive T-regulatory cell induction and immune response induction. Methods of determining cellular and humoral immune response to biological agents are identified and examined. Assays to detect antidrug antibodies and their isotypes can assist in monitoring immunogenicity and in preventing adverse events. Such strategies also enable resource conservation and may provide regulatory authorities with new insights that can be useful during the process of approving new biological or biosimilar agents.
Centre of Excellence Denothe and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Alessandra
A
Vultaggio
Department of Biomedicine, Immunoallergology Section, AOU Careggi, University of Florence, Florence, Italy.
Giulia
G
Petroni
Department of Biomedicine, Immunoallergology Section, AOU Careggi, University of Florence, Florence, Italy.
Sara
S
Pratesi
Department of Biomedicine, Immunoallergology Section, AOU Careggi, University of Florence, Florence, Italy.
Francesca
F
Nencini
Department of Biomedicine, Immunoallergology Section, AOU Careggi, University of Florence, Florence, Italy.
Daniele
D
Cammelli
Centre of Excellence Denothe and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Andrea
A
Ferraro
Department of Biomedicine, Immunoallergology Section, AOU Careggi, University of Florence, Florence, Italy enrico.maggi@unifi.it.
Enrico
E
Maggi
Department of Biomedicine, Immunoallergology Section, AOU Careggi, University of Florence, Florence, Italy.
Andrea
A
Matucci
Adaptive response; antidrug antibodies; biologicals; humoral response; immune response; immunogenicity; tolerance
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