Radioimmunotherapy for the treatment of infectious diseases: a comprehensive update

ABSTRACT

Introduction

Corona Virus Disease of 2019 (COVID-19) pandemic has renewed interest in monoclonal antibodies for treating infectious diseases. During last two decades experimental data has been accumulated showing the potential of radioimmunotherapy (RIT) of infectious diseases. In addition, COVID-19 pandemic has created a novel landscape for opportunistic fungal infections in post-COVID-19 patients resulting from severe immune suppression.

Areas covered

We analyze recent results on targeting “pan-antigens” shared by fungal pathogens in mouse models and in healthy dogs; on developing RIT of prosthetic joint infections (PJI); examine RIT as potential human immunodeficiency virus (HIV) cure strategy and analyze its mechanisms and safety. Literature review was performed using PubMed and Google Scholar and includes relevant articles from 2000 to 2022.

Expert opinion

Some of the RIT of infection applications can, hopefully, be moved into the clinic earlier than others after preclinical development: (1) RIT of opportunistic fungal infections might contribute to saving lives as current antifungal drugs do not work in severely immunocompromised patients; (2) RIT of patients with PJI. Success of RIT in these patients will allow to expand the application of RIT to other similarly vulnerable patients’ populations such as cancer patients with weakened immune system and organ transplant recipients.

KEYWORDS:

• radioimmunotherapy
• infectious diseases
• fungal infections
• bacterial infection
• HIV
• COVID-19
• prosthetic joint infections

Article highlights

• Corona Virus Disease of 2019 (COVID-19) pandemic has renewed interest in monoclonal antibodies for treating infectious diseases. During last two decades experimental data has been accumulated showing the potential of radioimmunotherapy (RIT) of infectious diseases.

• RIT of opportunistic fungal infections showed encouraging results targeting 1,3-beta-glucans in a mouse model of B. dermatitidis and proved to be safe in beagle dogs.

• RIT of bacterial infections demonstrated promise in killing S. aureus associated with the prosthetic joints infections (PJI).

• RIT was successful in eliminating HIV-infected PBMCs and monocytes in vitro with an antibody to gp41 labeled with long lived radionuclides alpha-emitter ²²⁵Ac and beta-emitter ¹⁷⁷Lu.

• The mechanistic and safety aspects of RIT of infections have a lot in common with RIT of cancer which is already in the clinic.

Declaration of interest

E Dadachova discloses research funding for cancer related work from Actinium Pharmaceuticals. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14787210.2023.2184345

Additional information

Funding

The work was funded by the Fedoruk Center for Nuclear Innovation grant # FC2019-8 (to E.D.)