Immunotherapy is the use of drugs (e.g., immunosuppressors), biologicals (e.g., cytokines, monoclonal antibodies, and antisera), vitamins and minerals (e.g., zinc, vitamin C, and vitamin B6), transplantation (e.g., bone marrow) and immunizations (e.g., prophylactic and therapeutic vaccines) to control immune responses in diverse direction. For example, immunotherapy is used to upregulate or downregulate the immune system to achieve a therapeutic effect in immunological mediated disorders including immunodeficiencies, hypersensitivity reactions, autoimmune diseases, tissue and organ transplantations, malignancies, inflammatory disorders, infectious diseases, and any other disease, where immunotherapy can improve the quality and life expectancy.
Clinicians describe the use of immunotherapy in some essential disorders of the immune system. The use of immunoglobulins, transfer factor, immunosuppressors, monoclonal antibodies, cytokines, nutritional supplements, transplantation, among other therapies is listed below.
Use of Transfer Factor (Dialysable Leukocyte Extract)
Use of Immunosuppressors
Bone marrow transplant
Use of Cytokines in the Immunotherapy of Advanced Malignancies
Use of Nutritional Supplements (Vitamins A, C, E and B6, Iron, Zinc, Selenium, and Copper)
Phase III Clinical Trials of the Bruton's Tyrosine Kinase (BTK) Inhibitor Ibrutinib
Use of Interferon Gamma
Immune checkpoint inhibitors
Intravenous Immunoglobulins (IVIG)
IVIG is a product made from fractionation of pools of thousands of plasma donations collected in blood transfusion services. Traces of IgM and IgA, and cytokines are present in IVIG. IVIGs have several mechanisms of actions that have been proposed to achieve their therapeutic effects including:
IVIG has been used with some success to improve the symptoms and clinical signs of immune thrombocytopenic purpura (ITP), Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy, Systemic lupus erythematosus (SLE), idiopathic inflammatory myopathies, ANCA-associated vasculitis, multiple motor neuropathy, multiple sclerosis, Myasthenia gravis, Kawasaki disease, autoimmune uveitis, dermatomyositis, systemic sclerosis, Sjogren syndrome, antiphospholipid antibody syndrome, Still's disease, acute disseminated encephalomyelitis, diabetic neuropathy, Lambert-Eaton myasthenic syndrome, Opsoclonus-myoclonus, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, polymyositis, Rasmussen's encephalitis, Stiff person syndrome, primary immunodeficiency disorders, secondary immunodeficiency disorder, chronic lymphocytic leukemia, bone marrow transplantation, Treatment-induced neutropenia and thrombocytopenia, AIDS, autoimmune thyroiditis, inclusion-body myositis, graft versus host disease, recurrent pregnancy loss, cancer, severe infections, toxic epidermal necrolysis, Stevens-Johnson syndrome, and neonatal hemochromatosis.
It is a dialysable extract of leukocytes and can transfer cell-mediated immunity from one individual to another. It may use in several pathologies including immunodeficiencies, viral infections, malignancies and recurrent fungal infections. Some patients with type I hypersensitivity disorders have reacted to this product.
Steroids inhibit cytokine synthesis, affect cell migration and inhibit the production of leukocytes. Cyclophosphamide acts by covalent alkylation, together with chlorambucil exert an immunomodulatory effect. They inhibit strand separation of DNA during replication. Methotrexate is an analog of folic acid and blocks pathways essential for DNA synthesis. Azathioprine is a drug that can convert to 6-mercaptopurine, and its effect is incorporation into DNA as a fraudulent base.
It is a promising solution for many rare diseases that can manifest as primary immunodeficiencies including severe-combined immunodeficiency disorder (SCID), DiGeorge syndrome, Wiskott-Aldrich syndrome, and X-linked agammaglobulinemia.
Several Immunotherapy Modalities Used in Cancer Treatment
The use of monoclonal antibodies can use in the cancer immunotherapy, for example, immune checkpoint inhibitors (ICIs) including pembrolizumab and atezolizumab. These ICI unlock the immune system, which is then able to recognize tumors and kill them.The use of cytokines to successfully treat certain malignancies is a reality, for example, the use of IL-2 in combination with interferon-gamma for renal carcinoma; use of interferon alpha and beta for hairy leukemia; and TNF-alpha used in various tumors caused a notable reduction of the mass. These cytokines upregulated the immune system through stimulation of T cell and NK cell activation and increased MHC class I expression.
IVIG can administer intravenously in the dosage of 0.4g/kg for 5 days to treat Guillain–Barre Syndrome, but the dose varies depending on the pathology. Cyclophosphamide low dose has had a more significant impact on cell-mediated immunity. In humans, a low-dose bolus 600 mg/m B cells decrease more than T cells, and among T cells the CD8 subset diminishes more than CD4 cells.
Patients with T-cell deficiencies including SCID should not vaccinate with the live-attenuated vaccine, because there is a danger that the antigen reverses its pathogenicity and causes physical illness. Patients with IgA deficiency should not be given IgG preparations that are not highly purified, because there is a danger of a hypersensitivity reaction, If the immune system does not recognize the IgA in the preparation, this can be life-threatening. Patients with DiGeorge syndrome should not be transplanted with a thymus older than 14 weeks, because a graft-versus-host reaction may occur. The donor can be one of the siblings or a parent if genetic compatibility exists. Blood group compatibility for major antigens such as ABO system and Rh system must match.