Anti-cocaine Monoclonal Antibodies

Abstract

The use of an anti-cocaine monoclonal antibody (mAb) is similar to the concept of cocaine vaccines, discussed elsewhere in this book. Although vaccines have many advantages as an immunotherapy for cocaine abuse, the use of anti-cocaine mAbs addresses the limitations of cocaine vaccines: the polyclonal response that produces between-patient variability of affinities of the antibodies raised, the amount of antibodies raised, and the delay in the production of antibodies. Directly injecting therapeutically relevant doses of antibodies with known high affinity and selectivity avoids the between-patient variability in response to active immunization. Anti-cocaine mAbs could be used as a stand-alone treatment or as a supplement to patients treated with cocaine vaccines who do not produce adequate levels of high-affinity antibodies. Additionally, the antibodies are active immediately upon injection, whereas vaccines require time to elicit an immune response. Therefore, mAbs are better suited to mitigating relapse upon release from rehabilitation facilities and to overdose rescue than are the vaccines. Clearly, the active and passive immunotherapy approaches could be used together in individual patients. As there appears to be a minimum concentration of high-affinity anti-cocaine antibodies in order to be effective in relapse prevention, in those patients that produce sub-therapeutic concentrations the anti-cocaine mAb would augment their cocaine binding capacity to above therapeutic concentrations.