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And yet most biologics are designed without ever
consulting that logic.

They are injected. Infused. Escalated. Shielded with
immunosuppressants. And when the immune system
predictably resists, we escalate again or switch to the next
molecule. We’ve built an entire infrastructure around
working against the immune system, instead of with it.

It’s time to redesign that relationship. To shift from
confrontation to cooperation.

This chapter explores what biologics might look like if we
started with immune compatibility as a first principle.
What would change in how we design, manufacture, and
deliver them?
What technologies are already emerging that challenge the
status quo?
And what would it mean—for patients, for payers, and for
the future of medicine—if our most advanced therapies
were not just effective, but welcome?

The immune system isn’t the obstacle.
It’s the missing partner.

Now, let’s build the therapies that speak its language.

3.1 – The Biology of Tolerance

To understand how to build biologics that are accepted—
not just effective—we need to first understand how the
immune system defines safety.

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