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Immunoglobulin G can inhibit antibody response. The mechanism of immunosuppression by immunoglobulins remains unknown. Recently, we found a new factor of immunoregulation referred to as regulatory rheumatoid factor (regRF). RegRF prevents autoimmunity and reduces experimental autoimmune reactions. RegRF comprises a population of anti-idiotypic antibodies that have a unique paratope specific to the antigen-binding sites of the antibodies, and a shared paratope specific to neoepitopes of IgG Fc fragments. Given the specificity of regRF, we can anticipate that IgG would be able to induce regRF production, and consequently that the immunosuppressive effect of IgG may be mediated by regRF. We found that IgG induces regRF production in a culture of B lymphocytes obtained from the red bone marrow of intact rats. IgG does not expose neoepitopes recognized by the shared paratope of regRF, and does not acquire them in culture. Therefore, the stimulation of regRF production induced by IgG is not a result of the interaction between the shared paratope of regRF and the neoepitopes of IgG. Fc fragments of IgG are unable to stimulate regRF production. Fab fragments inhibit spontaneous regRF production. F(ab´)

Deficient antibody production in patients with common variable immunodeficiency (CVID) is accompanied by an inability to produce free light chains (FLCs), particularly kappa (κ) FLC, due to B-cell dysfunction. We found that intravenous immunoglobulin (IVIg) administration, in a patient with CVID and (κ) FLC deficiency, for o short period of only 6 months, induced after discontinuation of treatment some kind of “long-lasting active immunity”, leading to the secretion of immunoglobulin (κ) FLCs. A remarkable finding of our study is how effectively IVIg therapy led to a calculable (κ/λ) FLCs ratio, within the reference range. IVIg therapy may have functioned as an idiotype vaccine which induced a humoral response. To date, several questions remain open. For instance, from a clinical standpoint, we do not know whether this form of active immunotherapy has the potential to cure or just to control the immunoglobulin (κ) FLC deficiency. Further studies are necessary to confirm these findings.

We report on the design of a phase I, non-randomized, open-label study of idiotypic DNA vaccination in patients with B-cell non-Hodgkin's lymphoma (ISRCTN31090206). The study uses DNA fusion gene vaccination encoding patient-specific single chain variable fragment, or idiotype, linked to an immunostimulatory sequence. Two types of immunostimulatory sequence are being explored: potato virus X coat protein and human chemokine MIP3α. Linear polyethylenimine with low molecular weight (8 kDa) is used as a synthetic vehicle for vaccine delivery. Humoral and T-cellular immune responses to vaccination will be measured by ELISA and ELISPOT, respectively. The primary study endpoints are safety, tolerability and immunogenicity of DNA-PEI vaccination.

The concept that immune responses to self antigens are regulated by anti-idiotypic networks has attracted renewed interest following reports of circulating factors within IgG fractions of serum that impair detection of autoantibodies with autoantigen. Thus, preclearance of sera with bead-immobilised monoclonal autoantibodies to the Type 1 diabetes autoantigen GAD65, or prebinding of serum antibodies to protein A Sepharose prior to addition of antigen, increases immunoreactivity detected in serum samples consistent with the trapping on the beads of anti-idiotypic antibodies that block antibody binding to the autoantigen. The aim of this study was to investigate the presence of anti-idiotypic antibodies to another major target of autoantibodies in Type 1 diabetes, IA-2. As previously observed for GAD65, preadsorption of serum samples with immobilised monoclonal IA-2 autoantibody, or prebinding to protein A Sepharose, resulted in substantial increases in subsequent immunoprecipitation of radiolabeled IA-2 in a proportion of samples. However, control experiments indicated that the increases seen on pre-incubation with immobilized autoantibodies were caused by displacement of the antibody by serum IgG, whereas impaired detection of immunoreactivity in liquid-phase radiobinding assays was the result of formation of insoluble complexes that bind poorly to protein A. The results emphasise the importance of direct demonstration of specific binding of antibodies to the idiotype in the study of idiotypic networks in autoimmunity. Variability between patients in formation of insoluble immune complexes has implications for the design and standardization of autoantibody assays for diabetes prediction.

The idiotype of B-cell non-Hodgkin lymphomas has been intensively investigated for its proven immunogenicity as a promising cancer vaccine. Indeed, available data clearly indicate that these vaccines are able to induce tumor-specific immune responses and molecular remissions in patients with follicular lymphoma. However, only one of the three phase III trials performed so far demonstrated a prolonged disease-free survival in vaccinated patients. The observed failures have been mainly ascribed to defects in the study design and not to the limited efficacy of idiotype vaccines per se. Therefore, innovative and optimized idiotype-based vaccine formulations are being developed in order to overcome current limitations and improve the clinical benefit of this immunotherapeutic strategy. Among the most promising advances, the development of "off-the-shelf" vaccines appears of particular relevance, being potentially able to overcome the limitations related to the complex, time-consuming and expensive production of the individualized idiotypic vaccines currently used. Moreover, there is a pressing need to identify biomarkers suitable for the identification of the subset of patients who are most likely to benefit from vaccination. Recent findings also indicate that idiotypic vaccines may be safely and successfully used in additional clinical settings, including lymphoma patients after high-dose chemotherapy and autologous stem cell transplantation.

Most patients with B-cell lymphoma face an often incurable disease, particularly those diagnosed with an indolent subtype. The addition of passive immunotherapy to old and new chemotherapy regimens has improved both response rates and disease-free survival, leading in many cases to an extended overall survival. However, a cure remains elusive in most cases. For this reason, the patient- and tumor-specific idiotype, that is the collection of epitopes exclusively presented by the tumor clone's surface immunoglobulin, has been extensively studied as a privileged target for vaccine therapy, aiming at preventing disease re-occurrence after standard treatment. BiovaxID(®) (Biovest International, FL, USA), the most clinically advanced among such therapeutic vaccines, finds itself at a crucial turning point when it comes to further development. Both clinical trials in which it has been formally employed have shown intriguing results. Independent studies using slightly different versions of a conceptually identical vaccine provided all proofs of principle required to ascertain the vaccine's value - biological and clinical efficacy as well as clinical benefit. However, all these data have failed to bring an idiotype vaccine to the market owing to reasons that often have very little to do with the product itself. In fact, some successful studies were not conceived with this goal in mind, while others simply did not enroll enough patients to convincingly make their case for regulatory approval. It is likely that one or more new clinical trials will have to be successfully completed to reach the ultimate goal - that is, to make BiovaxID available to most patients and to adequately position it in the very crowded therapeutic algorithm of B-cell lymphoma.

Despite having been the first cancer vaccine to provide clear-cut evidence of biological and clinical efficacy as well as of clinical benefit in humans, idiotype vaccines have failed to become the first therapeutic cancer vaccine to be granted regulatory approval. Indeed, idiotypic vaccination is still an experimental therapeutic option for some types of B-cell malignancy over 20 years after its first use in patients with lymphoma. The ultimate reason for this situation lies in the recent failure of three large-scale, independent, randomized trials to achieve their respective main clinical end points. Interestingly, each trial had been designed with intrinsic pitfalls that are likely to have influenced, and perhaps even entirely compromized, all chances each study had to succeed. Therefore, it is difficult to conclude whether any of the different idiotype vaccines employed so far may still represent an ideal candidate for further trials. Meanwhile, other idiotype vaccine formulations are under active investigation.

Recombinant antibodies may be engineered to obtain improved functional properties. Functional mapping of the residues in the binding surfaces is of importance for predicting alterations needed to yield the desired properties. In this investigation, 17 single mutation mutant single-chain variable fragments (scFvs) of the anti-idiotypic antibody anti-TS1 were generated in order to functionally map amino acid residues important for the interaction with its idiotype TS1. Residues in anti-TS1 determined to be very important for the interaction were identified, Y32L, K50L, K33H, and Y52H, and they were distributed adjacent to a centrally located hydrophobic area, and contributed extensively to the interaction energy (≥2.5 kcal/mol) in the interaction. Quantitative ELISA assays, BIAcore technologies and three-dimensional surface analysis by modeling were employed to visualize the consequences of the mutations. The expression levels varied between 2 - 1,800 nM as determined by ELISA. All the 17 scFvs displayed higher dissociation rates (60 - 1,300 times) and all but two of them also faster association rates (1.3 - 56 times). The decrease in affinity was determined to be 1.6 - 12,200 times. Two of the mutants displayed almost identical affinity with the wild type anti-TS1, but with a change in both association and dissociation rates. The present investigation demonstrates that it is possible to generate a large panorama of anti-idiotypic antibodies, and single out a few that might be of potential use for future clearing and pre-targeting purposes of idiotypic-anti-idiotypic interactions.

During the last 2 decades, idiotypic vaccination has provided proof of principle of biological efficacy, clinical efficacy and clinical benefit in small follicular lymphoma trials. However, with the exception of anecdotal reports, most patients have received no more than 10 doses of their customised idiotype (Id) vaccine. Therefore, it is not known whether prolonged usage of idiotypic vaccination is safe. Since 2002, 18 previously treated patients with follicular lymphoma have received extended idiotypic vaccination at our institution outside clinical trials. Vaccination was provided as a compassionate alternative to no further treatment, and was meant to be stopped only upon complete consumption of the available patient- and tumor-specific vaccine [Id-keyhole limpet hemocyanin + granulocyte-macrophage colony-stimulating factor (Id-KLH + GM-CSF)], or in case of disease relapse or any serious non-local toxicity. So far, 18 patients have received an average of 18 doses of Id vaccine (median: 17; mean: 18; range: 10-31). Eleven patients are still actively receiving idiotypic vaccination: some of them are now over more than 6 years. Toxicity has been systematically negligible and mostly local. No patient has abandoned the vaccination program because of toxicity. Prolonged idiotypic vaccination with the soluble protein Id-KLH + GM-CSF formulation is safe and well tolerated.

Recently, immunoglobulin G Fc receptor (FcgammaR) polymorphisms have been found to correlate with the clinical response to rituximab or idiotype vaccine in patients with follicular lymphoma. Two critical questions are whether the FcgammaR polymorphisms correlate with the clinical outcomes after chemotherapy alone in patients with follicular lymphoma and whether they can be explained by linking to underlying biology of follicular lymphoma. This is an important issue because the clinical decisions about the use of antibody therapy may be based on the FcgammaR polymorphisms of these patients. Here, we analyzed the FcgammaRIIIa 158 V/F, FcgammaRIIa 131 H/R, and FcgammaRIIb 232 I/T polymorphisms in a group of 188 patients with follicular lymphoma who were treated with chemotherapy without rituximab initially. In the current study, FcgammaR polymorphisms neither correlated with response rate or time to progression after induction chemotherapy, nor with time to the initial therapy or overall survival after diagnosis. Our results confirm that the correlation between FcgammaR polymorphisms and clinical outcome is specific to immunotherapy such as rituximab and idiotype vaccination, and not due to any effect on the underlying clinical behavior of the disease or chemotherapy response.

During the last three decades, idiotypic vaccination has cleared all the hurdles between preclinical studies and randomized clinical trials, assuming the forerunner role among human therapeutic cancer vaccines. However, over the last few months, the very same Phase III clinical trials that were supposed to consecrate idiotype vaccines as the first such products to reach the market have, one after another, begun failing to achieve their main end points. While their negative outcome had been predicted long ago, it must be underlined that most clinical studies on idiotypic vaccination have shown a substantial correlation between induction of an idiotype-specific immune response and improvement of clinical outcome. Failures of late-stage clinical trials were due to severe pitfalls in their study design and not necessarily to idiotypic vaccination itself. Therefore, it is desirable that dedicated scientists and clinicians persevere until confirming ultimately the clinical benefit of a broadly and readily available idiotype vaccine.

The clonal immunoglobulin molecule, idiotype (ID), expressed on the surface of B-cell malignancies can function as a tumor-specific antigen. BiovaxID is a patient-specific therapeutic cancer vaccine composed of the tumor idiotype conjugated to a carrier protein, keyhole limpet hemocyanin (KLH). In a Phase II clinical trial, administration of ID-KLH vaccine together with granulocyte-macrophage colony-stimulating factor to follicular lymphoma patients in complete remission induced tumor-specific cellular and humoral immunity and molecular remissions, and was associated with prolonged disease-free survival. A randomized, double-blind, Phase III clinical trial is ongoing to definitively determine the clinical benefit of BiovaxID plus granulocyte-macrophage colony-stimulating factor vaccination in patients with follicular lymphoma.

Most patients with poor-prognosis myeloma (abnormal metaphase cytogenetics) achieve excellent responses with tandem transplants, but the remissions are not durable. Novel interventions such as immunotherapy may eradicate the residual chemotherapy-resistant disease. Immunotherapy targeting weak antigens such as myeloma idiotype or tumor lysate has failed to produce clinically meaningful responses. We previously reported that the NY-ESO-1 antigen is expressed in >60% of poor-prognosis myeloma at diagnosis. Since NY-ESO-1 is highly immunogenic and is not expressed in most normal tissues, it is an ideal target for anti-myeloma immunotherapy. NY-ESO-1 based therapies are already being tested in clinical trials for a multitude of tumors. This review discusses the potential of NY-ESO-1 immunotherapy to improve outcome for myeloma.

FavId (Favrille, Inc., San Diego, CA, USA) is a personalized therapeutic vaccine product for B cell non-Hodgkin's lymphoma, custom-manufactured from individual patient's tumour cells. This investigational agent consists of recombinant tumour-specific immunoglobulin (idiotype [Id]) chemically conjugated to the highly immunogenic carrier protein keyhole limpet haemocyanin (Id-KLH). The vaccine product is administered by subcutaneous co-injection with the cytokine adjuvant granulocyte-macrophage colony-stimulating factor (GM-CSF) with the goal of stimulating tumour-specific T cell and humoral immunity. Therapeutic Id vaccines have shown promising results in early phase clinical trials in follicular lymphoma, and several Phase III trials are ongoing. FavId's advantages over other Id vaccine formulations include its rapid and efficient manufacturing technology utilising recombinant baculovirus, with a production time of only 8-12 weeks. In Phase II studies, FavId Id-KLH plus GM-CSF vaccines have been found to be safe, immunogenic and clinically active in follicular lymphoma. At present, FavId is being tested in a randomised, placebo-controlled Phase III trial in follicular lymphoma, aimed at improving the time to disease progression when administered following cytoreduction with rituximab. If found to be efficacious in this pivotal trial, FavId would represent a tumour-selective immunotherapy for lymphoma with little toxicity and a novel mechanism of action.

Despite advances in chemotherapy, radiotherapy and combined modality treatment, a significant proportion of non-Hodgkin's lymphomas remain incurable. The disease usually responds well to chemotherapy or radiation, but relapses are observed within months to a few years, with frequent failure of subsequent therapies. High-dose chemotherapy with or without radiation and autologous or allogeneic hematopoietic stem cell transplantation provide higher cure rates and longer remissions in certain patients with aggressive lymphomas. However, the higher treatment-related morbidity and mortality of high-dose chemotherapy has driven a search for new and more tumor-specific treatment modalities, such as immunotherapy. Tumor antigens expressed by B-cell lymphomas, such as the "idiotype antigen", are seen as unique and specific target molecules for direct lymphoma immunotherapy. This review will delineate advances, problems and prospects for approaches to anti-B cell lymphoma immunotherapy where pre-clinical studies and proof of principle have been directly translated to patient care.

Twelve years after the first formal demonstration that it is possible to vaccinate a cancer patient against an antigen derived from his/her own tumor, idiotype vaccines are now well into Phase III clinical trials for the treatment of follicular lymphoma. Meanwhile, their potential has also begun to be explored in other non-Hodgkin's lymphoma settings, such as that of mantle cell lymphoma. Another well known field of potential application for idiotype vaccines is that of multiple myeloma. However, the currently available results, even with the advent of dendritic cells, seem to be less promising than those obtained in lymphoma, to such an extent that idiotype vaccines are currently tested in multiple myeloma patients in the context of more aggressive therapeutic strategies.

Multiple myeloma is still a fatal disease. Despite advances in high-dose chemotherapy supported by autologous transplantations, relapse of the underlying disease remains the primary cause of treatment failure. Strategies for post-transplantation immunomodulation would be desirable for eradication of remaining tumor cells. Toward this end, immunotherapy aimed at inducing myeloma-specific immunity in patients has been exploited. Idiotype protein, secreted by myeloma cells, has been the main target for immunotherapy as it is the best-defined, tumor-specific antigen. The focus of this review article is the use of idiotype as a form of protein antigen to immunize patients, to load dendritic cells, or as part of DNA vaccines. Various strategies of immunotherapy and the outcome of clinical trials are also discussed.

Idiotypic determinants are potential patient-specific tumor antigens in multiple myeloma (MM). In this study, we have determined the DNA sequence of the variable region of the tumor immunoglobulin (Ig) in 6 patients with MM. We then selected high affinity class I-restricted T-cell peptide epitopes in tumor Ig using two different internet-based epitope prediction programs. High affinity binding peptides were identified by at least one program in 4 out of 6 patients. Of these 35 peptides, only 3 scored high by both analyses. Given that all 6 patients had expanded T-cell clones with a cytotoxic (CD57+CD8+CD28-perforin+) phenotype, known to be associated with a longer survival and postulated to recognise tumor epitopes, this analysis indicates that such clones are unlikely to be exclusively directed towards tumor immuoglobulin, and suggests the need to expand the scope of the search for tumor epitopes with the ability to stimulate cytotoxic T cells in vivo.

A peptide based on the complementarity determining region (CDR) 3 of a pathogenic anti-DNA monoclonal antibody that bears the 16/6 idiotype (Id) was shown previously to be a dominant T-cell epitope in experimental SLE, and to be capable of inhibiting SLE-associated responses. When injected, concomitant with active immunization with the pathogenic human anti-DNA, 16/6 Id+ mAb, pCDR3 inhibited the proliferation of LN-derived T cells stimulated in vitro with the 16/6 Id mAb. The inhibition of the specific proliferative responses could be reversed by the addition of exogenous IL-2 to the cultures. Analysis of secreted cytokine profile in supernatants of these cultures demonstrated that pCDR3 treatment reduced significantly the levels of both IL-2 and IFN-gamma that were elevated further in cells of the 16/6 Id-immunized mice. The CDR3-based peptide was shown here to immunomodulate in vivo experimental SLE, induced by the human anti-DNA 16/6 Id+ antibody. The beneficial effects of pCDR3 on the clinical manifestations of SLE were associated with downregulation of the Th1-type (IL-2, IFN-gamma) and proinflammatory (TNF-alpha) cytokines, whereas the immunosuppressive cytokine TGF-beta was up regulated.

Idiotypic structures expressed on the myeloma immunoglobulin (Ig) protein (M-component) might be regarded as tumor-specific antigens. Naturally occurring, idiotype-specific type I T-cell immunity has been observed preferentially in patients with early stage myeloma. The idiotypic structures on the clonal myeloma B-cells (B lymphocytes and plasma cells) may serve as targets for active immunization. Vaccination using the autologous monoclonal Ig as a vaccine has conferred resistance to tumor cell challenge in murine myeloma. The autologous myeloma Ig protein was used for immunization in patients with progressive stage I and early stage II multiple myeloma. When the idiotype (emulsified in aluminium phosphate) was used alone for immunization, a weak and transient idiotype-specific T-cell response was observed with no clinical effects. In our second series, the idiotype (in alum) was combined with GM-CSF. In all five patients, a specific T-cell response was induced consisting preferentially of MHC class I restricted (CD8+) T-cells. Ig-specific CD4+ T-cells were also induced. A clinical response (50% reduction of the M-component concentration) was observed in one patient. These results indicate that idiotype-specific T-cell immunity may be induced or enhanced by idiotype Ig vaccination in patients with early stage multiple myeloma, in which the tumor load is relatively low and the immune system is functionally less compromized than in patients with chemotherapy-treated, advanced stages of the disease. The use of GM-CSF seems to be mandatory for the frequency and magnitude of the induced T-cell response. The optimal route, schedule and cytokine combination for idiotype immunization remains to be established.

Mycloma cells secrete monoclonal immunoglobulin (Ig), called myeloma protein. The variable (V) regions of myeloma proteins are unique to each plasma cell tumor, and therefore contain highly tumor-specific antigenic determinants called idiotopes (Id). T cells with specificity for Id are thought to be of importance in eradication of multiple myeloma. In ongoing clinical trials, myeloma patients are vaccinated against the Id of their own myeloma protein, with the aim of inducing Id-specific T cells. However, this strategy will only succeed if Id-specific T cells are present in patients, and are able to respond. In an experimental animal model, we have shown that [d-specific T cells become progressively deleted as the myeloma protein serum concentration exceeds 50 microg/ml. This indicates that the ability of multiple myeloma patients to respond to Id-vaccination might be seriously handicapped. We suggest that Id-vaccination should be reserved for eradication of minimal residual disease, e.g. after high-dose chemotherapy and stem-cell transplantation.

There's still plenty "missing" from attempts to immunize against cancer and other pesky pathogens. Conjugation of weakly-immunogenic tumor-derived proteins or other pathogen-associated antigens to highly-immunogenic carrier proteins has long been utilized as a tool for improving immune responses. Such vaccines have recently been tested in phase 3 clinical trials targeting non-Hodgkin's B cell lymphoma. However, these vaccines, composed of tumor-specific immunoglobulin ("idiotype") protein linked to keyhole limpet hemocyanin using glutaraldehyde, largely failed to show efficacy. Yet substituting a sulfhydryl-based linker cleavable in lysosomes markedly augments the efficacy of these vaccines, offering heightened antibody and CTL responses. Could such conjugation strategies be the "missing link" needed in vaccines against pathogens requiring both antibodies and T cells for protection?

We screened a 10 amino acid peptide display library in filamentous phage with B'20, a monoclonal high affinity IgM rheumatoid factor (RF) expressing the VkIIIa-dependent 4C9 idiotype. Using direct and indirect selection techniques, 12 B'20 reactive peptides were identified, 9 of which belonged to one of two motifs. Binding of B'20 to phage-bearing peptides was inhibited by both IgG and 4C9 antiidiotype. Synthetic peptides corresponding to the two motifs inhibited the Fc binding of a low avidity IgA B'20 construct. Purified IgM from 6/8 RF-positive RA patients and 8/11 monoclonal RFs with VkIII-encoded light chains bound to the phage, whereas none of the four monoclonal RFs with VkI or VkII encoded light chains bound. Phage binding appeared to be RF specific. Three 4C9 positive/RF negative cell lines from RA patients did not bind to phage nor did three B'20 mutants that had lost RF specificity, whereas two mutants that retained RF specificity also retained phage binding. We propose that there is a common epitope(s) recognized by VkIII encoded RFs that is mimicked by the structure of these peptides. Such mimotopes might be exploited to design novel agents that interfere with autoantibody binding.

A modified fast micro method for spectrotypic/clonotypic analysis of human IgG1-4 antibodies against bacterial virulence antigens of polysaccharide or protein nature is described. Serum samples of as small volumes as 0.5 microliter were isoelectrically focused in micro agarose gels made in plexiglass matrices and blotted using immunoaffinity-mediated capillary blotting onto nitrocellulose membranes previously coated with antigen. The bands of the antigen-specific antibodies were identified with respect to isotypes, light chain types, allotypes or idiotypes by incubating the nitrocellulose membranes with mouse monoclonal anti-human IgG subclass antisera and then with alkaline phosphatase-conjugated rabbit anti-mouse immunoglobulins. The method was applied for characterization of human monoclonals against tetanus toxoid (TT) and for the analysis of variable patterns of clonotypes in IgG subclass-deficient patients. The usefulness of the technique was also demonstrated by comparing the variable specificity and reactivity of different commercial monoclonals against human IgG subclasses. This method is fast, specific, sensitive, uses little material, is simple and reproducible.

134 cationic human IgG myeloma proteins were studied for expression of anti-DNA Idiotypic markers. 64 were studied for 16/6, F4, 3I, and 8.12, and 70 for expression of F4 and 3I. 31.3% showed at least one anti-DNA Id marker and many cationic myelomas were also positive for anti-DNA ELISA reactivity as well as anti-F(ab')2. Five M-components showed anti-nucleosome reactivity and one without detectable anti-DNA Id markers showed very strong anti-nucleosome antibody which was also inhibited by DNA and Sm antigens. Anti-idiotypic antisera produced either against Id(+) anti-DNA reactive M components or F(ab')2 fragments of affinity purified SLE IgG anti-DNA showed preferential cross-reactive idiotype reactivity between Id(+) anti-DNA reactive M components. Our findings indicate that human IgG monoclonal proteins positive for several common anti-DNA Ids and possessing anti-DNA ELISA reactivity, can serve as models for SLE Id marker antigens and as a source to prepare anti-Ids from IVIG.

In previous studies, we demonstrated that anti-human thyroglobulin (hTg) autoantibodies in patients with thyroid disorders exhibit a restricted epitopic specificity towards antigenic region II defined by its reactivity with four murine monoclonal antibodies (mAb 3, 6, 10, 15). To analyze the relationships between epitopic specificity and idiotypic expression of these mAb, two polyclonal anti-idiotypic sera were generated in rabbits by immunization with F(ab')2 fragments of mAb 3 and mAb 10. These anti-idiotypic preparations (AI 3 and AI 10) were tested against a panel of hTg-mAb produced in different strains of mice (HR BIOZZI and BALB/c). The idiotypic analysis showed that AI 3 and AI 10 specifically recognized framework-associated idiotopes as well as paratope-associated idiotopes shared by region II mAb. These results demonstrate that specificity for region II was strongly associated with a restricted idiotype suggesting a high sequence homology between V regions. In addition, naïve BALB/c mice immunized with AI 3 or AI 10 produced anti-hTg (Ab3) antibodies that recognize region II epitopes. These latter findings reveal that anti-Id contain a population of Ab2 beta carrying the internal image of region II epitopes.

BEG-2 is a monoclonal antibody produced by the human-human hybridoma technique from a 12 weeks old human fetus. A polyclonal antiserum was raised in an (NZW x Half-lop hybrid) rabbit against BEG-2 and the anti-BEG-2 anti-idiotype was purified and characterised. Using this rabbit reagent the expression of the BEG-2 beta idiotype was analysed in 12 patients with active rheumatoid arthritis and their close family members (n = 54). Twenty five sera from healthy controls were analysed to establish a normal range. Ten of 12 patients (83%) with rheumatoid arthritis expressed the BEG-2 idiotype as well as 11 of 54 healthy unaffected relatives (20%).

Heavy and light chain variable region nucleotide sequences were derived from 6 human hybridoma antibodies which bear characteristics of antibodies associated with the phospholipid antibody syndrome. All antibodies originated from non-autoimmune individuals and were polyspecific. Four of these reacted with cardiolipin (and other antigens) and three carried the H3 idiotype which is expressed on a high percentage of disease-associated anti-cardiolipin antibodies. This idiotype was localized to the lambda light chain of the H3 monoclonal antibody and found on two other antibodies which like H3 expressed Vλ4 or the related Vλ3 subgroup light chains. The H3 idiotype however did not define these subgroups nor was it required or sufficient for anti-cardiolipin activity. Anticardiolipin binding was found in VH1, VH3 and VH4 heavy chain families and in a Vk1 light chain. The D region was diverse in both length and gene usage. Although all cardiolipin binding antibodies showed little deviation from germline variable (V) gene sequences, where mutations occurred they tended to be replacement mutations and clustered in complementarity determining regions (CDR) suggesting these B cells were derived from antigen-driven responses. These results from our panel of hybridomas and their comparison to other human antibodies provide extensive information on the diversity of genetic elements which can be used by cardiolipin-binding antibodies. We also show gene sequences which encode the disease-associated H3 idiotype and its location on lambda light chains, which imply that some labda light chains may be preferentially utilized in auto-reactive hybridomas. © 1995 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.

This study was undertaken to determine whether the expression of 17.109, 6B6.6 and 4C9 rheumatoid factor (RF) idiotypes is predictive of the development of rheumatoid arthritis (RA) and whether the RF response is idiotypically restricted in an inbred population of Pima Indians who have a genetic predisposition for the disease. Serial sera were obtained from 25 subjects who developed RA and 25 RF-positive subjects who did not develop RA over the course of a longitudinal community health survey. RF titers and titers of the RF-associated idiotypes 17.109, 6B6.6 and 4C9 were determined by ELISA, and the relationship between 6B6.6 and 4C9 was analyzed by cross-absorption studies. Expression of the three RF-associated idiotypes was found in both the subjects who developed RA and those who did not. The amount of idiotype expressed was variable, but a few subjects in both groups had high levels indicative of an oligoclonal RF response. Reactivity with 6B6.6 and 4C9 antiidiotypes overlapped, with 4C9 appearing to mark a broader spectrum of RF than 6B6.6. Thus, even in an inbred and genetically predisposed population, the RF-associated antiidiotypes studied here did not identify a dominant idiotypic response and were no better markers for the development of RA than was RF itself.

We previously reported that rheumatoid factors (RFs) might bear the internal image of Fc gamma-binding proteins (FcBPs) of herpes family viruses, suggesting the possibility that some RFs may be produced as antiidiotypic antibodies to anti-viral FcBP antibodies. Since human cytomegalovirus (HCMV) has been implicated in the pathogenesis of RA, we made an attempt to detect antibodies to 65 KD major HCMV FcBP in sera and synovial fluid from patients with RA. Western blotting was performed using HCMV-infected MRC-5 cell lysate as the antigen. Eleven of 23 patients with RA possessed strong serum antibodies to HCMV-65 KD protein, whereas such antibodies were found in only 2 of 23 normal controls. In the synovial fluid, 10 of 19 RA patients showed anti-HCMV 65 KD reactivity. Pepsin-digested IgG retained anti-65 KD reactivity, indicating that false-positive reaction due to the presence of IgG Fc portion and/or RF was unlikely. 65 KD protein was shown to be different from human heat shock proteins (hsps) using monoclonal antibodies against human hsps. Patients' IgG F(ab')2 also reacted with the 65 KD protein of purified HCMV virion itself. These results support the possibility that some RFs could be produced as antiidiotypic antibodies to anti-viral FcBP antibodies.

(1993). T Cell Regulatory Circuitry: Antigen-Specific and TCR-Idiopeptide-Specific T Cell Interactions in EAE. International Reviews of Immunology: Vol. 9, No. 4, pp. 287-297.

Antibodies against double stranded DNA (dsDNA) are characteristic of systemic lupus erythematosus (SLE) and have been implicated in disease pathogenesis. Up to one third of an SLE patient's anti-dsDNA antibodies can express the lambda L chain idiotype 8.12. Serum titers of this idiotype are elevated in 50% of SLE patients, and idiotypic antibodies are present in glomerular immune deposits associated with lupus nephritis. Two EBV transformed B cell lines, KS3 from a patient with SLE and SD6 from an individual without autoimmune disease, secrete 8.12+ IgG antibodies that bind dsDNA. The 8.12+ lambda L chains of these anti-DNA antibodies are encoded by members of the V lambda II gene family; the KS3 heavy chain is encoded by a VH4-DM1-DQ52-JH6b-C gamma 1 gene rearrangement and the SD6 heavy chain is encoded by a VH3-D21/9-JH6b-C gamma 1 rearrangement. Both of these monoclonal antibodies are somatically mutated: the KS3 antibody displays mutations in complementarity determining regions (CDRs) and the SD6 antibody in framework regions (FRs). The significance of these different patterns of mutation in two potentially pathogenic anti-DNA antibodies is discussed.

We have recently identified in SLE sera antibodies against phosphotyrosine. They were also detected in normal sera and gammaglobulin preparations, suggesting that they belong to natural autoantibodies. In this paper, the occurrence of anti-idiotypic antibodies against anti-phosphotyrosine antibodies, in the above mentioned samples, is investigated. In order to identify these anti-idiotypic antibodies ELISA, immunoprecipitation and immunoblotting are performed. Our data demonstrate the presence of anti-idiotypic antibodies specific to anti-phosphotyrosine antibodies in SLE sera as well as in normal sera, suggesting that these anti-idiotypic antibodies are also auto-anti-idiotypic antibodies. The densitometry of immunoblots reveals significantly higher levels of anti-idiotypic antibodies in SLE sera. Based on the competition inhibition studies we conclude that some of these anti-idiotypic antibodies belong to beta/gamma type.

A simple, rapid and reproducible flow microsphere inhibition immunoassay (FMII) has been developed to detect the ability of paratope specific anti-idiotypic antibody (anti-Id or AB2) to inhibit antigen binding to the corresponding paratope of the Id (AB1). To evaluate the FMII as a measurement of paratope binding anti-Id, an avian model was used to produce Id and anti-Id antibodies for the study. Both antibody to bovine serum albumin (BSA Id) and anti-BSA Id were produced in white leghorn chickens and affinity isolated from egg yolks. The anti-BSA Id samples were incubated with BSA Id coated microspheres, then without rinsing, fluoresceinated BSA (BSA-FITC) was added for a short incubation period and the resulting decrease in fluorescent intensity was used to calculate the extent of inhibition. For validation, statistical comparisons of the line equations generated by BSA dilution curves and anti-BSA Id dilution curves were performed. Replications within each ligand were not significantly different which indicated the assay was reproducible for determining the presence of paratope reactive anti-BSA Id used in this model.

Human antibody to the Haemophilus influenzae capsular polysaccharide (Hib CP) is restricted in diversity in the individual and the population with a limited number of variable region genes encoding antibody. Antibody to the Hib CP shows restricted isoelectric focusing gel patterns and light chain usage with frequent restriction to use of only kappa light chains. Shared cross-reactive idiotypes are expressed on antibody. The heavy chain of antibody to the Hib CP is predominantly encoded by two members of the VH3 family--LSG 6.1/M85-like and VH26/30P1-like. In VH the CDR1, based on complete identity in LSG 6.1/M85-like antibodies, CDR2, based on the suggestion of mutation in this region, and CDR3, based on conserved CDR3 usage in unrelated individuals, may be important for antigen binding. Six or more different VL gene families encode antibody. The predominant antibody of the majority of individuals uses the A2-V kappa II gene in germline or near germline configuration, which encodes an idiotype designated HibId-1. Antibody can also be encoded by V kappa I, non-A2 V kappa II, V kappa III, V kappa IV, V lambda II, and V lambda VII genes. Although different VL genes can be used, unrelated individuals appear to use the same V kappa III (A27), V lambda II (V lambda 2.1 and V lambda VII (4A) genes. The VL diversity accounts for differences in fine binding specificity, with A2-V kappa II genes not encoding E. coli K100 CP cross-reactive antibodies and V lambda VII genes and some of the non-A2 V kappa genes encoding cross-reactive antibodies. The arginine in CDR3 of both antibody kappa and lambda light chains and the asparagine in CDR2 of VL sequences and in CDR1 of LSG6.1-M85 VH sequences of antibody appear to be important residues for antigen binding. A relatively limited degree of somatic mutation has occurred in the non-A2 VL genes, V lambda VII, and the VH genes. Further studies comparing the polymorphism of germline V genes to antibody-encoding V genes are needed to clarify this issue. Research comparing this repertoire to repertoires directed to other bacterial CP and to self antigens and defining structure-antigen binding relationships is in progress.

This paper describes the idiotypic specificities of eight murine monoclonal antibodies directed to three independent epitopes on retinal S-antigen. The antigenic sites recognised by these monoclonal antibodies have previously been localised to a small region near the C-terminal of bovine S-antigen. Xenogeneic, site-related anti-idiotypes prepared against each of the monoclonal antibodies recognised common idiotypes only amongst those monoclonal antibodies which reacted with the same epitope on S-antigen. Two of the three idiotypes were detected in the sera of BALB/c mice but not in two strains of rat immunised with xenogeneic S-antigen and none could be detected in the sera of patients with anti-photoreceptor autoantibodies. Our results demonstrate that the idiotypes of murine monoclonal antibodies to retinal S-antigen exhibit restricted epitope specificity but are species-restricted and imply that the S-antigen lacks a dominant antigenic epitope.

CD4 has an important role in T cell activation events that depend on its binding to non-polymorphic MHC class II determinants on antigen-presenting cells. Here, we provide evidence that CD4 also interacts with immunoglobulins (Ig). The Ig-binding region lies within residues 21-49 of VI domain of CD4. Immunochemical studies suggest that this property of CD4 does not depend on the three-dimensional folding of the CD4 molecule. Synthetic peptides (/)) encompassing amino acid residues 16-49 and 21-49 of CD4 bind immunoglobulins in comparable way to the intact molecule. In vitro p 16-49 enhances significantly idiotype/anti-idiotype and some weak antigen-antibody interactions. Antigen antibody complexes formed in antigen excess bind CD4 peptides with much higher avidity then non-complexed antibodies. The possible role of the CD4/Ig interaction in T-B cell cooperation is discussed.

The anti-idiotype therapy approach has been tested and has shown to be effective in several animal models including the L1210/GZL tumor system in DBA/2 mice. Very recently, anti-idiotype antibodies (Ab2) have also been used in human trials. In this review, the generation and characterization of Ab2s which can be used as potential vaccine candidates for two human tumor systems--leukemia/lymphona and gastrointestinal carcinoma have been discussed. We have generated syngeneic monoclonal idiotypic cascades for two different human tumor-associated antigens (TAA) gp37 and carcinoembryonic antigen (CEA). In both cascades we have produced TAA mimicking monoclonal Ab2s and monoclonal anti-anti-idiotypes (Ab3) which bind to the original TAA. Modulation of immune responses in cancer patients by Ab2 immunization will be an important consideration in future studies.

Marked fluctuations in the levels of a common DNA-antibody idiotype, PR4-Id have been found on IgM and IgA antibodies in particular and to a lesser extent on IgG in serial bleeds of 14 lupus patients. Few clear cut examples were found of the PR4-Id levels reflecting disease activity. However, the idiotype expression was not simply related to total immunoglobulin levels and the controlling mechanisms of idiotype expression on different isotypes remain a matter of conjecture.

Anti-topoisomerase I autoantibodies (anti-topo I) are associated with proximal scleroderma and are of prognostic significance in patients with Raynaud's phenomenon. Polyclonal anti-idiotypic sera were raised against affinity-purified anti-topo I from 2 patients with scleroderma (EM, SG) and 1 healthy individual (NM). All 3 anti-topo I preparations expressed immunodominant private Ids in or near the antigen binding site of the autoantibody. Further analysis of Id-EM showed isotypic restriction to IgG and a stable Id-expression over the course of 9 years. Id-SG and Id-NM were expressed on IgG and on IgA. The idiotypic character of anti-topo I closely resembles that of anti-centromere autoantibodies which are associated with the CREST syndrome of scleroderma. The data suggest an antigen-driven process in the origin of autoantibodies in scleroderma.

Tight skin (TSK) mice develop cutaneous hyperplasia accompanied by histopathological alterations of skin and collagen metabolism similar to those described in human scleroderma. Diffuse scleroderma, the most severe form of progressive systemic sclerosis, is associated with the production of autoantibodies specific for Scleroderma 70 antigen (topoisomerase I). Our studies show that there is an increase in the level of serum anti-topoisomerase I (topo I) autoantibodies in aged TSK mice. The monoclonal antibodies isolated from TSK mice bind to epitopes which interact with autoantibodies from scleroderma patients. A significant number of TSK monoclonal anti-topo I antibodies and serum immunoglobulin (Ig) from aged TSK mice bear a cross reactive idiotype (Id) recognized by a syngeneic monoclonal anti-Id antibody obtained from a 2 month-old TSK mouse. Analysis of V gene usage by monoclonal anti-topo I antibodies showed that the majority of these antibodies are encoded by VH genes derived from VHJ558 family pairing with VK genes from various families in a stochastic manner.

Approximately thirty common DNA antibody idiotypes have been described on hybridoma derived or affinity purified DNA-binding antibodies. There are associations between some idiotypes and the clinical manifestations of systemic lupus erythematosus although none are sufficiently firm to be clinically useful in identifying subsets of SLE or in assessing disease activity in individual patients. The expression of these idiotypes is not confined to DNA antibodies in SLE. They may be found in the serum from patients with a range of autoimmune rheumatic disorders, infectious diseases and blood dyscrasias. In most cases the antigen binding specificity of the antibody bearing the idiotype is unknown. The precise relationship between the various idiotypes is becoming better understood with increasing availability of genetic and structural data. DNA antibody idiotype manipulation may provide a potential new therapeutic modality in SLE.

We have adopted an idiotypic approach to study the double stranded DNA (dsDNA) binding antibodies of systemic lupus erythematosus (SLE). Three anti-idiotypic reagents, 8.12, 3I, and F4, identify cross reactive idiotypes that are each expressed on anti-dsDNA antibodies in the sera of many patients with SLE. These idiotypic antibodies are implicated in the pathogenesis of SLE as they are present in immune complex deposits in the kidneys of patients with SLE glomerulonephritis. The autoantibody associated idiotypes are also expressed on antibodies that do not bind DNA. We are investigating the origin of the pathogenic anti-dsDNA antibodies of SLE by comparing the autoantibodies, the antibodies to foreign antigens, and the myeloma proteins that express each SLE associated idiotype. In conjunction with serological analysis of these idiotypic systems, molecular genetic studies indicate that both the 8.12 and the 3I autoantibody associated idiotypes may be germline encoded, while the F4 idiotype is generated by somatic mutation. The data further suggest that the antigenic specificity of the pathogenic anti-DNA antibodies of SLE is acquired through somatic mutation of germline immunoglobulin genes. By studying the regulation of genes capable of encoding pathogenic autoantibodies, in both SLE patients and non-autoimmune individuals, we may be able to elucidate the pathogenesis of autoimmune disease and begin to design more effective therapeutic interventions.

Idiotypes (Id) are antigenic determinants expressed on the variable (V) region of the immunoglobulin molecule. Id-bearing antibodies, or Ab-1, are produced upon stimulation with a given antigen. Ab-1 may elicit the production of anti-idiotypic antibodies (anti-Id) or Ab-2. The anti-Id also expresses Id determinants and may in turn elicit the production of anii-anti-Id or Ab-3. The production of Ab-1, Ab-2, and Ab-3 responses resulting from stimulation with the antigen is representative of components within an Id cascade. The existence of this Id cascade is the basis for the development of Id based strategies for controlling the immune response to infectious agents and tumors. In this review we will focus on several aspects regarding the Id cascades that may be operational during the immune response to the human immunodeficiency virus (HIV). In light of several studies which suggest the existence of Id-anti-Id interactions operating during the course of HIV infection, we will discuss the potential applicat...

(1989). The Role of the A48 Regulatory Idiotype in Inducing Tumor-Specific Immunity. International Reviews of Immunology: Vol. 4, No. 4, pp. 321-336.

In three distinct chronic Ig-specific suppression systems in which suppression was initiated by injection of mice with anti-idiotype (Id) or anti-allotype sera, evidence has been presented by others that the differentiation of B cells bearing surface Ig with a target marker (Id or allotype) need not be totally disrupted. Normally "silent" Id+ B cells from Id-suppressed mice could be revealed by certain procedures, one of these being to make use of the powerful stimulatory properties of bacterial lipopolysaccharide. We have employed a similar strategy to determine whether cryptic CRIA+ B cells exist in significant numbers in hyperimmune, CRI-suppressed (HIS) A/J mice. Thus, following T cell removal, the Ar-specific B cell repertoire from HIS mice was probed using Ar- Brucella abortus as a T-independent Ag. No evidence for "silent" CRIA+ B cells was found. The results, taken in conjunction with those of others, suggests that there may exist multiple forms of long-term Ig-specific suppression.

We have developed an in vitro model of granuloma formation for the purpose of studying the immunological components of granulomatous hypersensitivity in patients infected with S. mansoni. Our previous studies have shown that 1) granulomatous hypersensitivity can be studied by examining the cellular reactivity manifested as multiple cell layers surrounding antigen-conjugated polyacrylamide beads; and 2) this reactivity is a CD4 T cell dependent, macrophage dependent, B cell independent response which is antigenically specific for parasite egg antigens. We report here on idiotype - anti-idiotype receptor interactions involved in the regulation of granulomatous hypersensitivity in patients and former patients infected with S. mansoni. Five human monoclonal antibodies specific for parasite egg antigens were used to activate CD4 and CD8 T cell subsets. These activated anti-idiotypic T cells were then assayed for regulatory effector functions in an autologous in vitro granuloma model.