MEDICAL UPDATE: Passive Immunotherapy

MEDICAL UPDATE: Passive Immunotherapy

Being Alive Newsletter; July 1992
Dr. Robert Schooley and reported by Walt Senterfitt

The passive immunoglobulin approach is undergoing a community based clinical trial here in Los Angeles. The approach is also being tested to try to prevent vertical transmission from infected mother to child and to prevent transmission to exposed workers or patients in health care settings. One of the problems with this approach is that it is not clear that humoral immunity is pivotal in preventing disease progression. There are certainly neutralizing antibodies present both early and late in disease, but one of the things we don't know is whether or not loss of these antibodies is associated with loss of control of the virus in infected individuals.

Perhaps the biggest problem is the genetic diversity of the virus. We think that neutralizing antibodies work against the envelope (outer coating) of the virus, and particularly one region of the protein which makes up this envelope. This region, however, is the most variable part of the virus (it's known as the "V3 loop"), changing considerably as different strains evolve. The danger is that neutralizing antibodies used therapeutically will be too narrow or restricted to block all the different strains present in an individual. Some researchers are working on ways around this, such as a "cocktail" of different antibodies or cloned antibodies directed at a different part of the envelope, but there are clearly going to be major problems.

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