Chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) represent a
significant health burden worldwide and are a major unmet medical need. Asthma affects over 300 million people and
leads to 250,000 deaths per year, with an increasing prevalence particularly in developing countries. Although a large
proportion of asthmatics are maintained on beta agonists and corticosteroids, there still remains a group of patients where
these medicines fail to modulate symptoms and who may therefore benefit from monoclonal antibody based drugs that are
aimed at controlling the disease. COPD is a cigarette smoke-driven chronic inflammatory airway disease with an
increasing global prevalence. Given that current therapies fail to prevent disease progression or mortality, this patient
population is also a focus for the development of monoclonal antibody therapies.
At present anti-IgE (omalizumab, Xolair®) is the only monoclonal antibody based drug approved in the respiratory space
for the treatment of asthma. However, an increasing number of antibodies targeting key mediators/pathways of disease are
in clinical development for both asthma and COPD, including targeting the Th2 pathway for asthma (anti-IL-4/5/13) and
the pro-inflammatory cytokine IL-1 for COPD. This review will examine the antibody engineering approaches used to
develop the next generation of antibodies, with a focus on respiratory disease.