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Therapie mit monoklonalen Antikörpern in der Gastroenterologie

Therapeutic regimens using monoclonal antibodies in gastroenterology

  • Schwerpunkt: Monoklonale Antikörper
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Zusammenfassung

Monoklonale Antikörper finden im klinischen Alltag vielfältigen Einsatz in der Therapie verschiedener gastroenterologischer onkologischer und infektiologischer Erkrankungen des Gastrointestinaltrakts. Die Hauptindikationen liegen in der Behandlung chronisch-entzündlicher Darmerkrankungen und in der Onkologie. Ein neues Einsatzgebiet in der Infektiologie ist die Therapie der rekurrierenden Clostridium-difficile-Kolitis. In der Nomenklatur der monoklonalen Antikörper weisen die Endungen der Substanzen auf die Herstellung bzw. den Grad der „Humanisierung“ der jeweiligen Antikörper hin („umab“: vollhumaner, rekombinanter Antikörper; „ximab“: chimärer Antikörper mit variabler muriner Domäne). Monoklonale therapeutische Antikörper sind in der Therapie der chronisch-entzündlichen Darmerkrankungen vor allem gegen Ziele der inflammatorischen Kaskade (Tumor-Nekrose-Faktor‑α, Interleukin-12 und -23; α4β7-Integrine) sowie in der Onkologie gegen integrale Bestandteile von Signalwegen der Proliferation und/oder Neovaskularisation gerichtet (unter anderem gegen den „vascular endothelial growth factor“ [VEGF], VEGF-Rezeptor, „epidermal growth factor receptor“ und HER2/neu). Der vorliegende Übersichtsbeitrag soll einen umfassenden Überblick über die therapeutischen Einsatzmöglichkeiten monoklonaler Antikörper bei gastroenterologischen Erkrankungen geben.

Abstract

Therapeutic regimens using monoclonal antibodies have been implemented in clinical daily practice for various gastroenterological diseases, for therapeutic strategies in gastrointestinal (GI) oncology, and infectious diseases of the gastrointestinal tract. The main indications remain the therapy of chronic inflammatory bowel disease and in GI oncology. A new field has opened for targeted therapy with monoclonal antibodies of recurrent Clostridium difficile infection. In the nomenclature of monoclonal antibodies, the endings of the substances indicate the production or degree of “humanization” of the respective antibodies (“umab”: fully human, recombinant antibody; “ximab”: chimeric antibody with variable murine domain). For chronic inflammatory bowel disease, monoclonal antibodies has been developed to interfere with molecular targets of the inflammatory cascade in the underlying pathogenesis (tumor necrosis factor‑α, interleukin-12 and -23; α4β7-integrins). The development of targeted therapies in the treatment of GI malignancies, monoclonal antibodies has been developed to interfere with substantial pathways of proliferation and apoptosis as well as neoplastic vascularization and neovascularization (e.g., vascular endothelial growth factor [VEGF] and VEGF receptor antibodies, epidermal growth factor receptor antibodies, HER2/neu antibodies). In the current review, we provide a summary of the current applications of monoclonal antibodies in the therapeutic treatment of gastroenterological diseases.

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  1. Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    Philipp Dobsch, Bernhard Michels,  Martina Müller-Schilling &  Arne Kandulski

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Dobsch, P., Michels, B., Müller-Schilling, M. et al. Therapie mit monoklonalen Antikörpern in der Gastroenterologie. Internist 60, 1043–1058 (2019). https://doi.org/10.1007/s00108-019-00682-2

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