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{{short description|Blood serum containing antibodies; used to spread passive immunity}}
{{about|the applications of antiserum|an explanation of its production|polyclonal antibodies}}
{{cleanup|reason=Dives too deep into monoclonal, which mostly isn’t produced by live humans (or domestic animals) donating their serum, even in "modern use"! Antiserum needs to be serum or derived from it.|date=January 2023}}
In [[immunology]], '''
Antisera are widely used in diagnostic [[virology]] laboratories. The most common use of antiserum in humans is as [[antitoxin]] or [[antivenom]] to treat [[envenomation]].{{cn|date=November 2023}}
'''Serum therapy''', also known as '''serotherapy''', describes the treatment of infectious disease using the serum of animals that have been immunized against the specific organisms or their product, to which the disease is supposedly referable.{{cn|date=November 2023}}
== History ==
In 1890, [[Emil Behring]] and [[Kitasato Shibasaburō]] published their first paper on serum therapy.
It was necessary for Behring to immunize larger animals in order to produce enough serum to protect humans, because the amount of antiserum produced by guinea pigs was too little to be practical. Horses proved to be the best serum producer, as the serum of other large animals is not concentrated enough, and horses were not believed to carry any [[zoonosis|diseases that could be transferred to humans]].
Due to the [[World War I|First World War]], a large number of horses were needed for military purposes. It was difficult for Behring to find enough German horses for his serum facility. He chose to obtain horses from [[Eastern Europe]]an countries, mostly Hungary and Poland. Because of Behring's limited financial resources, most horses he selected had been intended for slaughter; however, the usefulness of the animal to others had no influence on the production of serum. Serum horses were calm, well-mannered, and in good health. Age, breed, height, and color were irrelevant.<ref>{{Cite web|url=
Horses were transported from Poland or Hungary to the Behring facilities in Marburg, in the west-central part of Germany. Most of the horses were transported by rail and treated like any other freight load. During the interminable border crossing, horses were left at the mercy of the weather.<ref>{{Cite book|title=Die Stute Namenlos|last=Kautz|first=Gisela|publisher=Thienemann-Esslinger|year=2004|isbn=978-3522176446|location=Stuttgart}}</ref> Once the horses arrived in [[Marburg]], they had three to four weeks to recover in a quarantine facility, where data on them was recorded. They had to be in perfect medical condition for the immunization, and the quarantine facility ensured that they were free of microbes which could infect the other horses. In the Behring facilities, the horses were viewed as life savers; therefore, they were well treated. A few of the individual horses used for serum production were [[Personal name#Names of pets|named]], and celebrated for their service to medicine, both human and [[veterinary medicine|non-human]].
[[File:Convalescent plasma collected during COVID-19 pandemic.jpg|thumb|right|300px|[[Convalescent plasma]] collected at a blood donor center during the [[COVID-19 pandemic]].]]
At the end of the 19th century, every second child in Germany was infected with diphtheria, the most frequent cause of death in children up to 15 years. In 1891 [[Emil von Behring|Emil Behring]] saved the life of a young girl with diphtheria by injecting antiserum for the first time in history. Serum horses proved to be saviors of diphtheria-infected people. Subsequently, treatment of [[tetanus]], [[rabies]], and [[snake venom]] developed, and proactive protective vaccination against diphtheria and other microbial diseases began.
In 1901, Behring won the first [[Nobel Prize in Physiology or Medicine|Nobel Prize in Medicine]] for his work in the study of [[diphtheria]].
Serum therapy became increasingly prevalent for infectious diseases, and was even used to treat patients during the [[Influenza Pandemic|influenza pandemic in 1918]]. Its uses were then quickly expanded to also treat diseases such as [[polio]], [[measles]], [[pneumococcus]], [[Haemophilus Influenzae|Haemophilus influenza B]], and [[meningococcus]]. In the 1920s, [[Michael Heidelberger]] and [[Oswald Avery]] proved that [[Antibody|antibodies]] were proteins that targeted the capsule of the [[virus]] or [[bacteria]].
The discovery of [[antibiotics]] in the 1940s diminished interest in treating bacterial infections with antiserum, but its use for viral infections continued with the development of [[Cohn process|ethanol fractionation]] of blood plasma (which allowed for purified antibodies), discovered by [[Edwin Joseph Cohn|
In 1984, [[César Milstein|Milstein]] and [[Georges J. F. Köhler|Köhler]] won a Nobel Prize for their paper that described their method for making murine [[monoclonal antibody|monoclonal antibodies]] by immortalizing [[B Cell|
In 1996, the FDA approved the use of RSV-IGIV (Respigam
The past 30 years have seen the transformation of how chronic and autoimmune diseases (e. g. [[cancer]], [[ulcerative colitis]]) are treated, with 30 drugs—28 of which for chronic conditions—with monoclonal antibodies being approved. Monoclonal antibodies are currently being researched to treat viral diseases without vaccines, such as [[HIV]], [[SARS]], and [[MERS]].<ref>{{cite journal |last1=Graham |first1=Barney S. |last2=Ambrosino |first2=Donna M. |title=History of Passive Antibody Administration for Prevention and Treatment of Infectious Diseases |journal=Current Opinion in HIV and AIDS |date=May 2015 |volume=10 |issue=3 |pages=129–134 |doi=10.1097/COH.0000000000000154 |pmid=25760933 |pmc=4437582 |issn=1746-630X}}</ref>
==Modern use==
{{For
▲For a more complete list of monoclonal antibodies visit [[list of therapeutic monoclonal antibodies]].
Monoclonal antibodies are used to treat both [[acute (medicine)|acute]] and [[chronic condition|chronic]] conditions. Acute conditions may include, but are not limited to Ebola virus, envenomation (e. g. snake bites), and [[anthrax]] infection. Chronic conditions may include, but are not limited to [[rheumatoid arthritis]], [[ulcerative colitis]], and [[lupus]].<ref name="scicomvisuals" />
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There are four main types of monoclonal antibodies. They are murine, chimeric, humanized, and human.
Murine monoclonal antibodies are identified with the suffix "-omab". They originate from
During the early stages of the [[COVID-19 pandemic]], reliable treatment options had not yet been found or approved. In reaction, convalescent blood plasma was considered as a possibility and is used as a treatment option at least for severe cases.<ref>{{Cite web|url=https://ec.europa.eu/health/blood_tissues_organs/covid-19_en|title=COVID-19 Convalescent Plasma Transfusion|date=8 April 2020}}</ref><ref>{{Cite web|url=https://www.pei.de/EN/newsroom/press-releases/year/2020/07-pei-approves-first-covid-19-therapy-study-with-convalescent-plasma.html|title = Paul-Ehrlich-Institut - Press Releases - Paul-Ehrlich-Institut Approves First COVID-19 Therapy Study with Convalescent Plasma}}</ref><ref>{{Cite web |title=Convalescent Plasma COVID-19 Emergency Use Authorization |url=https://www.uscovidplasma.org/ |access-date=2023-02-20 |website=Convalescent Plasma COVID-19 Emergency Use Authorization |language=en}}</ref> In May 2021, India was one of the first major country to remove plasma from its national COVID-19 guidelines. This was after public criticism of the lack of plasma's effectiveness, criticism of health systems, and persuasion by leading Indian scientists including Shahid Jameel, [[Soumyadeep Bhaumik]], Gagandeep Kang, [[Soumitra Pathare]], and others.<ref>{{Cite web|last=Livemint|date=2021-05-11|title=Call off plasma therapy for patients of covid-19|url=https://www.livemint.com/opinion/online-views/call-off-plasma-therapy-for-patients-of-covid19-11620752200055.html|access-date=2022-02-04|website=mint|language=en}}</ref><ref>{{Cite web|date=2021-05-10|title=Plasma therapy for Covid 'irrational, non-scientific', change guidelines, experts ask govt|url=https://theprint.in/health/plasma-therapy-for-covid-irrational-non-scientific-change-guidelines-experts-ask-govt/656058/|access-date=2022-02-04|website=ThePrint|language=en-US}}</ref><ref>{{Cite web|last=Staff|first=The Wire|title=COVID: Public Health Experts Pen Concerns About Plasma to PSA VijayRaghavan – The Wire Science|url=https://science.thewire.in/health/covid-public-health-experts-pen-concerns-about-plasma-to-psa-vijayraghavan/|access-date=2022-02-04|language=en-GB}}</ref><ref>{{Cite web|last=Buckshee|first=Devina|date=2021-05-18|title=Plasma Dropped from COVID Guidelines: What About HCQ, Ivermectin?|url=https://fit.thequint.com/coronavirus/plasma-dropped-from-covid-guidelines-what-about-hcq-ivermectin|access-date=2022-02-04|website=TheQuint|language=en}}</ref> The World Health Organization recommended against use of plasma in COVID-19 in December 2021.<ref>{{Cite web|title=WHO recommends against the use of convalescent plasma to treat COVID-19|url=https://www.who.int/news/item/07-12-2021-who-recommends-against-the-use-of-convalescent-plasma-to-treat-covid-19|access-date=2022-02-04|website=www.who.int|language=en}}</ref>
▲Human monoclonal antibodies are identified with the suffix "-umab". They originate from a human.<ref name="miller" /> An example of a human monoclonal antibody is [[Ustekinumab]], which treats [[psoriasis]].<ref name="scicomvisuals" />
On June 7, 2021, the FDA approved [[
==How it works==
Antibodies in the antiserum bind the infectious agent or [[antigen]].<ref>{{cite journal |last1=de Andrade |first1=Fábio Goulart |last2=Eto |first2=Silas Fernandes |last3=Navarro dos Santos Ferraro |first3=Ana Carolina |last4=Gonzales Marioto |first4=Denise Turini |last5=Vieira |first5=Narciso Júnior |last6=Cheirubim |first6=Ana Paula |last7=de Paula Ramos |first7=Solange |last8=Venâncio |first8=Emerson José |title=The production and characterization of anti-bothropic and anti-crotalic IgY antibodies in laying hens: A long term experiment |journal=Toxicon |date=May 2013 |volume=66 |pages=18–24 |doi=10.1016/j.toxicon.2013.01.018|pmid=23416799 }}</ref> The [[immune system]] then recognizes foreign agents bound to antibodies and triggers a more robust [[immune response]]. The use of antiserum is particularly effective against pathogens which are capable of evading the immune system in their unstimulated state but are not robust enough to evade the stimulated immune system. The existence of antibodies to the agent depends on an initial survivor whose immune system, by chance, discovered a counteragent to the pathogen or a host species which carries the pathogen but does not
Horses that were infected by a pathogen were vaccinated thrice in increasing sizes of the dose. The time between each vaccination varied from each horse and its health condition. Normally the horses needed a few weeks to produce the serum in the blood after the last vaccination. Even though they tried to empower the immune system of the horses during this immunization with painstaking care, most of the horses
The highest immunization risk for horses was the production of antiserum for snake venom.
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