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Immunohistochemistry and New Treatments For Old Diseases by Day
Immunohistochemistry is a diagnostic test. It uses antibodies previously marked with a substance that can be seen under the microscope. The antibodies are specific to an antigen that the test is able to detect. These antibodies have high affinity to their antigens so the test has high specificity, not necessarily high sensitivity which depends on other factors. It is widely used to detect and classify canc
er cells Antibodies can be polyclonal or monoclonal. How can this test affect treatment options for a given disease? I will explain this through an example: Cells, cancer or not, have, different antigens (markers) on their membranes, such as receptors, glycoproteins, etc. This markers define populations of cells like CD4 and CD8 T-lymphocytes and B-lymphocytes (CD-20 + or -). This markers, when they are unique to a specific type of cell, can help not only to differentiate them, but also to target them with specific antibodies. These antibodies can be used for tests and also as treatments. I will explain this through an example: A patient comes to the office with a biopsy of his pleura, and it reports "Diffuse large B-cell lymphoma". The immunoperoxidase shows CD20 (+) (a B cell marker) and Bcl-6 (a marker of its origin from the germinal center). If this patient didn't have a CD20 (+) report then he wouldn't be eligible for Rituximab therapy and the prognosis would be far more somber. Rituximab is a genetically engineered chimeric murine/human monoclonal antibody that targets CD20 receptors that are present in certain B-cell non-Hodgkin lymphomas. Once it reaches its intended target, it activates other immune cells and the complement system to destroy the b-cell. It is part of the new therapies that are being used in Hemato-oncology. Before Rituximab, the standard therapy for B-cell lymphoma was CHOP therapy. This therapy had a success rate of 40% to 50%. (3-year event-free rate) When Rituximab is used in conjunction with CHOP chemotherapy, it has shown a success rate of up to 99% (when used in early stages). Now you see the difference. However this new therapies are not exempt of potentially hazardous effects, and this page is not intended as an advertisement of Rituximab, but to show an example of the application of antibodies in different settings (diagnostic and therapeutic.
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