Table 3.

Advantages and disadvantages of antibody-based drugs in cerebral ischemia.

	Pros	Cons
1	Monoclonal antibodies are extremely sensitive and specific for antigens.	Injection-related reactions (IRRs). They occur most frequently in a period of 10 min to 4 h after the start of antibody administration. However, anaphylactic reactions are not expected to occur during the first mAbs infusion, except in the rare case that pre-existing immunoglobulins E (IgEs) cross-react with the infused mAb.
2	Without alteration, nanobodies such as VHH can cross the blood–brain barrier.	Cytokine release syndrome (CRS) depends largely on the cell type targeted by the mAb rather than its allergenic properties. mAbs that activate T cells are most likely to cause CRS, when large amounts of proinflammatory cytokines are released by activated astrocytes and white blood cells, including B cells, T cells, natural killer cells, macrophages, dendritic cells, and monocytes.
3	Antibodies are stable, especially nanobodies in extreme conditions such as temperature and pH.	The more immunogenic the mAbs, the more likely they are to produce anti-drug antibodies (ADA). This explains why ADAs are more likely to be produced against chimeric than human mAbs, and ADA production can lead to neutralization of mAbs, rapid elimination, and loss of efficacy.
4	Nanobodies can penetrate hard-to-reach epitopes.	Opportunistic infections occur when mAbs affect immune function by depleting cell populations (e.g., ocrelizumab) or blocking immune cell migration through endothelial barriers; dizziness.
5	Bispecific antibodies (BsAbs) can facilitate transport across the BBB. They are designed to contain one arm with specificity against a BBB RMT receptor that drives their migration across the BBB and a second arm with a therapeutic function that produces the pharmacological effect when the BsAb encounters the target.	MAb-associated malignancy. In a phase III study of the treatment of primary progressive multiple sclerosis with ocrelizumab, an anti-CD20, B-cell-depleting mAb, 11 cases of malignancy were reported in the active treatment group, 4 of which were adenocarcinomas of the breast [57]; back pain; diarrhea.
6	Antibodies can be easily cleared from the system without causing damage to the tissues as compared to chemotherapy.	Autoimmune disorders; nasopharyngitis