New concepts in antibody-mediated immunity.

After stimulating the development of immunology in the early 20th century, the study of the functional aspects of antibody-mediated immunity (AMI) stagnated in the 1960s because the function of antibodies (Abs) was considered understood and available Ab preparations were limited to polyclonal immune sera. Abs in polyclonal sera are heterogeneous, and the uniqueness of each preparation with respect to specificity and isotype posed formidable problems in achieving consistency, reliability, and reproducibility in Ab experimentation. The limitations inherent in studies of AMI with polyclonal sera, combined with the discovery of T cells, an increased interest in cell-mediated immunity, and later a rediscovery of innate immunity, steered immunology research away from studies of AMI. However, by the late 1980s the development of monoclonal antibody (MAb) technology, the discovery of Fc receptors (FcR), and the generation of mice with defined genetic deficiencies made possible studies that rekindled interest in the basic mechanisms of AMI. More than a dozen MAbs are now licensed for clinical use for diverse indications, such as prophylaxis of respiratory syncytial virus disease in neonates, treatment of Crohn’s disease, prevention of coronary artery closure after angioplasty, and therapy of refractory rheumatoid arthritis (65). In addition, the fact that the use of passive Abs is currently the only means to provide immediate immunological protection against biological weapons in immunologically naïve populations has stimulated new interest in AMI (9, 13). The availability of new technologies to study AMI and the need for specific, rapidly acting therapies for new and emerging diseases have led to the discovery of new Ab functions that have broadened the classical views of AMI. This review will focus primarily on insights that have emerged from studies with whole Ab molecules, which are the natural products of B cells. However, many contributions to the field of AMI and promising clinical reagents have also come from studies with Ab fragments and antibody-derived peptides, although to date fewer studies have addressed the mechanisms of efficacy for these reagents. CLASSICAL VIEWS OF AMI