The humble lab mouse is the workhorse for immunology research, especially antibody discovery. Immunizing mice with pathogens or recombinant antigens triggers an antibody response by mouse B cells, which researchers then screen for powerful and potent antibody therapy candidates. This pipeline has allowed quick development of mouse monoclonal antibodies that are now in trials or approved for use in humans.
However, antibodies developed in mice have clear limitations in clinical use: despite impressive similarity to human antibodies, they are still fundamentally mouse proteins. This means that a human immune system can and does reject these proteins.
One notable example of this is therapies for Epstein-Barr virus (EBV). Most known for causing infectious mononucleosis (‘mono’ aka the kissing disease), EBV has also been implicated in the development of several cancers, multiple sclerosis, lupus, rheumatoid arthritis, and long COVID. In immunocompromised patients, the risks from EBV are even higher.
Therefore, using mAbs to protect against EBV is a long sought-after goal. One pilot study in pediatric liver transplant recipients suggested that that neutralizing mAb therapy may be protective against EBV acquisition. However, there was a huge catch: the therapeutic mAb used in the study was a monoclonal antibody originally isolated from a mouse. Due to the fundamental difference between human and mouse proteins, each patient eventually developed an immune response against the drug. One patient developed severe hypersensitivity against the mouse mAb, leading the study authors to discontinue treatment in all patients and recommend against its future therapeutic use.
So, how can we find human monoclonal antibodies that can protect vulnerable patients from EBV? This question was recently tackled by the McGuire Lab in the Vaccine and Infectious Disease Division.
“Monoclonal antibodies (mAbs)…may have utility as therapeutics against EBV-associated diseases, particularly posttransplant lymphoproliferative disease (a deadly EBV-driven B cell lymphoma affecting transplant patients),” explains Dr. Crystal Chhan, who recently defended her PhD in the McGuire Lab. She is the lead author of a recent study in Cell Reports Medicine that details an exciting new discovery pipeline to find new anti-EBV mAbs with therapeutic potential.
Human mAbs have the potential to show the benefits “with minimal anti-drug reactogenicity previously seen with non-human mAbs,” says Dr. Chhan. However, it is challenging to find these drug candidates, especially for a virus as complicated as EBV.
One method to discover human mAbs involves using the antigenic protein as a bait to fish out the antigen-binding, antibody-producing B cells. They then sequence the gene encoding the antibody which allows cloning of a recombinant mAb.
However, a major challenge to EBV antibody discovery is that the virus infects the very B cells that produce antibodies. The virion attaches to B cells via two important glycoproteins: gp350, which binds complement receptors present on B cells, and gp42, which binds human leukocyte antigens (HLA) molecules. Complement receptors and HLA proteins play essential roles in signaling during immune responses, and both are constitutively expressed on B cells. Therefore, screening for B cells that bind gp350 or gp42 will overwhelming produce false positives – B cells that bind the viral proteins via complement or HLA do not necessarily produce antibodies targeting the virus.
To get around this, Chhan and colleagues turned to a humanized mouse model. There are many ways to humanize mice, so the details are important here. The model used in this study is called ATX-GK from Alloy Therapeutics. These mice have a completely murine immune system except for their antibody repertoire, as all murine antibody genes have been completely replaced with human genes.