Cautions
Recent research has led to the discovery that unstable hinged monospecific antibodies may engage in a process leading to a decrease in their apparent avidity/affinity. This process, termed Fab arm exchange, has led to theories about the dissemination of viral infections in patients given monospecific IgG4 therapeutic antibodies. Evidence is suggestive that this process is linked to the dissemination of PML in patients given Tysabri for MS. Following dosing unpredictability still reigns and mutations in the hinge of the antibody which may prevent Fab-arm exchange in-vivo should be considered when designing therapeutic antibodies. (Nat Biotechnol. 2009 Aug;27(8):767-71. Epub 2009 Jul 20)
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