FcRn Function Research Articles

Differential effects of FcRn antagonists on the subcellular trafficking of FcRn and albumin.

The homeostasis of IgG is maintained by the neonatal Fc receptor, FcRn. Consequently, antagonism of FcRn to reduce endogenous IgG levels is an emerging strategy for treating antibody-mediated autoimmune disorders using either FcRn-specific antibodies or an engineered Fc fragment. For certain FcRn-specific antibodies, this approach has resulted in reductions in the levels of serum albumin, the other major ligand transported by FcRn. Cellular and molecular analyses of a panel of FcRn antagonists have been carried out to elucidate the mechanisms leading to their differential effects on albumin homeostasis. These analyses have identified 2 processes underlying decreases in albumin levels during FcRn blockade: increased degradation of FcRn and competition between antagonist and albumin for FcRn binding. These findings have potential implications for the design of drugs to modulate FcRn function.

Efgartigimod as a novel FcRn inhibitor for autoimmune disease.

Immunoglobulin G (IgG) autoantibodies can lead to the formation of autoimmune diseases through Fab and/or Fc-mediated interactions with host molecules as well as activated T cells. The neonatal Fc receptor (FcRn) binds at acidic pH IgG and albumin, and the mechanism for prolonging serum IgG half-life is making IgG re-entry into circulation by prompting it not to be degraded by lysosomes and back to the cell surface. Given the FcRn receptor's essential role in IgG homeostasis, one of the strategies to promote the quick degradation of endogenous IgG is to suppress the function of FcRn, which is beneficial to the treatment of IgG-driven autoimmune disorders like myasthenia gravis (MG), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), stiff person syndrome, and immune thrombocytopenia (ITP). We elaborately read the literature about efgartigimod and systematically reviewed the research progress and clinical application of this novel FcRn inhibitor in autoimmune diseases. Efgartigimod is the firstly FcRn antagonist developed and was approved on 17 December 2021 by the United States for the therapy of acetylcholine receptor-positive MG. In January 2022, efgartigimod received its second regulatory approval in Japan. In addition, the market authorization application in Europe was submitted and validated in August 2021. China's National Medical Products Administration officially accepted the marketing application of efgartigimod on July 13, 2022. To suppress the function of FcRn, which is beneficial to the treatment of IgG-driven autoimmune disorders like MG, CIDP, ITP, and stiff person syndrome. We review the rationale, clinical evidence, and future perspectives of efgartigimod for the treatment of autoimmune disease.

Identification of Four Mouse FcRn Splice Variants and FcRn-Specific Vesicles.

Research into the neonatal Fc receptor (FcRn) has increased dramatically ever since Simister and Mostov first purified a rat version of the receptor. Over the years, FcRn has been shown to function not only as a receptor that transfers immunity from mother to fetus but also performs an array of different functions that include transport and recycling of immunoglobulins and albumin in the adult. Due to its important cellular roles, several clinical trials have been designed to either inhibit/enhance FcRn function or develop of non-invasive therapeutic delivery system such as fusion of drugs to IgG Fc or albumin to enhance delivery inside the cells. Here, we report the accidental identification of several FcRn alternatively spliced variants in both mouse and human cells. The four new mouse splice variants are capable of binding immunoglobulins' Fc and Fab portions. In addition, we have identified FcRn-specific vesicles in which immunoglobulins and albumin can be stored and that are involved in the endosomal-lysosomal system. The complexity of FcRn functions offers significant potential to design and develop novel and targeted therapeutics.

Binding to the neonatal Fc receptor enhances the pathogenicity of anti-desmoglein-3 antibodies in keratinocytes.

The neonatal Fc receptor (FcRn) is important for numerous cellular processes that involve antibody recycling and trafficking. A major function of FcRn is IgG recycling and half-life prolongation, and FcRn blockade results in a reduction of autoantibodies in IgG-mediated autoimmune diseases. In epithelial cells, FcRn functions in processes different from IgG recycling, such as antibody transcytosis in intestinal cells. In pemphigus vulgaris, an autoimmune disease of the epidermis, IgG autoantibodies directed against desmosomal adhesion proteins, especially desmoglein-3 and -1, cause loss of keratinocyte adhesion. We have previously demonstrated that FcRn blockade with efgartigimod, a human Fc fragment with enhanced FcRn binding, significantly reduces the keratinocyte monolayer fragmentation caused by anti-desmoglein-3 antibodies. This points to a direct function of FcRn in keratinocytes, beyond IgG recycling, but the mechanisms have not yet been elucidated in detail. Here, we show that FcRn binding is required for the full pathogenicity of recombinant anti-desmoglein-3 antibodies in keratinocytes, and that antibodies that exhibit enhanced or reduced FcRn affinity due to targeted substitutions in their Fc region, as well as F(ab')2 fragments not binding to FcRn display different degrees of pathogenicity. Blockade of FcRn by efgartigimod only shows a protective effect on keratinocyte adhesion against antibodies capable of binding to FcRn. Furthermore, antibody-induced degradation of desmoglein-3 in keratinocytes does not depend on FcRn, demonstrating that desmoglein-3 degradation and acantholysis are functionally disconnected processes. Our data suggest that the role of FcRn in autoimmune diseases is likely to be versatile and cell-type dependent, thus stressing the importance of further studies on FcRn function in autoimmune diseases.

Targeted inhibition of FcRn reduces NET formation to ameliorate experimental ulcerative colitis by accelerating ANCA clearance.

Dysregulated immune responses have now been recognized as an essential stimulator of ulcerative colitis (UC). Neutrophil extracellular traps (NET) were reported as the potential factor in sustaining mucosal inflammation in UC. NET formation further induces antineutrophil cytoplasm autoantibodies (ANCA) that serve as a biomarker in determining the severity of UC, which have a long half-life due to neonatal Fc receptor (FcRn)-mediated recycling. This study aimed to explore the role of the ANCA-NET cycle in UC and evaluate the potential of targeting FcRn in UC treatment. Dextran sodium sulfate-induced mice and rat models were used in this study. anti-rat FcRn monoclonal antibodies were used to block FcRn function in vivo. Disease activity index (DAI) and histopathological score (HS) were estimated to characterize the inflammation severity of UC. Serum concentrations of IgG, ANCA, TNF-α, IL-1β and CRP were measured using specific ELISA kits. Colonic NET-associated protein (NAP) expression was determined by western blotting. Serum ANCA and colonic NAPs showed a positive correlation that varied with changes in serum inflammation-related indexes (IRI; including TNF-α, IL-1β, and CRP) and DAI and HS in mice with UC. Blockade of FcRn significantly reduced serum ANCA levels and colonic NAP expression and effectively decreased serum IRIs, DAI, and HS in rats with UC. Especially during the inflammation recurrence period, blockade of FcRn exerted even better therapeutic effects in rats with UC than salazosulfapyridine. Our results show that anti-FcRn therapy has benefits in UC treatment through reduced colonic NET formation by accelerating serum ANCA clearance.

Methods for Functional Characterization of FcRn Interactions with Therapeutic Antibodies and Fc-Fusion Proteins.

The neonatal Fc receptor (FcRn) plays a key role in determining the pharmacokinetic behavior of therapeutic monoclonal antibodies (mAbs). FcRn-mediated intracellular trafficking mechanisms extend the half-lives of mAbs by rescuing them from lysosomal degradation and contribute to their transportation from the vascular space to tissue compartments such as placenta and mucosal surfaces. It is important to characterize the FcRn interactions of therapeutic mAbs and Fc-fusion proteins due to its potential impact on their in vivo pharmacokinetic properties such as clearance and half-life. In this chapter, we describe protocols for two cell-based assays that measure the total function of FcRn which involves pH-dependent association and dissociation with IgG-Fc, as well as FcRn-mediated intracellular trafficking parameters. These assays are suitable for characterization of FcRn interactions with therapeutic mAbs and Fc-fusion proteins for the purpose of assessing lot-to-lot consistency and the structural and functional integrity of the Fc domain. In addition, they may serve as cost-effective screening tools for the evaluation of mAb-based drug candidates during lead selection and optimization for desired pharmacokinetic properties.

Blockade of the Neonatal Fc Receptor (FcRn) Represents an Effective Mechanism for the Removal of Pathogenic Autoantibodies in Primary Immune Thrombocytopenia

Introduction: The neonatal Fc receptor, FcRn is ubiquitously expressed, & is responsible for maintaining the half-life of IgG & albumin, by rescuing these proteins from intracellular lysosomal degradation. Blockade of the interaction of FcRn with IgG would be expected to prevent salvage of both non-pathogenic and pathogenic IgG. Patients with primary immune thrombocytopenia (ITP) have autoantibodies against platelet membrane proteins such as the cell adhesion receptor CD61/CD41 (GPIIb/IIIa). Rozanolixizumab (a high affinity IgG4 monoclonal antibody (mAb) that specifically inhibits IgG binding to FcRn) is currently being evaluated in phase 2 clinical studies in patients with ITP. The aim of the current study was to understand the in vitro properties of rozanolixizumab & to explore the in vivo effects of a surrogate anti-mouse FcRn mAb (murinized “4464”) in a mouse model of ITP.Methods: The affinity of rozanolixizumab for FcRn was tested using surface plasmon resonance technology (Biacore), with the antibody captured by an anti-Fc immobilized on the sensor chip & soluble FcRn in solution, whilst the affinity of fluorescently labelled rozanolixizumab for human FcRn expressed on the surface of Madin-Darby canine kidney (MDCK) cells was measured by flow cytometry. Recycling & transcytosis of human IgG (hIgG) was also assessed in FcRn-transfected MDCK cells. For IgG tracking experiments, endothelial & epithelial cell lines were incubated with an AF647-conjugated IgG for 24 hours in the presence or absence of rozanolixizumab. Prior to imaging, nuclei were labelled using Hoechst at 37°C & cells were then visualized by fluorescence microscopy. Phagocytosis of anti-human MHC I (W6/32)-coated platelets by THP-1 cells was assessed by flow cytometry at 1 hour. The effect of rozanolixizumab on IgG recycling in vivo was assessed in the human FcRn-transgenic (hFcRn-Tg) mouse: hIgG at 500mg/kg was administered IV to mice on day 1 & dosed with antibodies on day 2; serial bleeds were then taken at multiple time points post antibody dosing & levels of hIgG, albumin & rozanolixizumab were quantified using LC-MS/MS. For the induction of ITP in mice, animals received an anti-CD41 antibody (MWReg30), delivered by osmotic minipump (~1µg of antibody delivered every 24 hours) & the anti-mouse FcRn mAb (4464) was administered at 30mg/kg either on days 0, 2 & 4 (prophylactic dosing) or on days 3 & 5 (therapeutic dosing); IVIg (1g/kg) was also evaluated & control mice received either PBS or an isotype-matched control mAb (101.4). Daily blood samples were taken to assess platelet numbers.Results: Rozanolixizumab has a high affinity for FcRn in a protein-protein (Biacore) assay with a KD of ~25pM at both pH6.0 & pH7.4; in the cell-based assay, the affinity was 1nM at both pH's. Rozanolixizumab efficiently inhibited the recycling & transcytosis of IgG in human FcRn-transfected MDCK cells (IC50 0.4nM & 1.1nM, respectively). Confocal microscopy experiments showed that there was an increased accumulation of IgG in cells in the presence of rozanolixizumab, relative to an isotype control mAb, & that the IgG was co-localized in lysosomes where it appeared to be degraded. FcRn has been postulated to play a direct role in phagocytosis, but the phagocytosis of opsonized platelets by THP-1 cells was unaffected by blockade with rozanolixizumab. Treatment with rozanolixizumab resulted in a dose-dependent accelerated clearance of hIgG in the hFcRn-Tg mouse; hIgG levels in all treated groups were significantly lower vs PBS controls from 24 hours post-dosing until the end of the experiment 8 days post dosing (p<0.01). No effect on albumin levels occurred in these mice. In the mouse model of ITP, both prophylactic & therapeutic treatment regimens with 4464 resulted in an increased number of platelets compared to control animals that received either PBS or 101.4. Animals that received 4464 from day 0 had significantly greater platelet numbers than control animals on days 4 & 5 (p<0.05); therapeutic dosing gave a significantly greater platelet number than control animals on day 5 (p<0.05).Conclusion: Rozanolixizumab is a high affinity mAb that inhibits the IgG recycling function of FcRn in vitro &in vivo . An anti-mouse FcRn mAb demonstrated efficacy in a mouse model of ITP. These data support the evaluation of rozanolixizumab in patients with ITP, & a phase 2 clinical study is currently ongoing in this patient population. DisclosuresEddleston:UCB Pharma: Employment. Greenslade:UCB Pharma: Employment. Qureshi:UCB Pharma: Employment. West:UCB Pharma: Employment. Atherfold:UCB Pharma: Employment. Amirkhosravi:UCB Pharma: Research Funding. Desai:UCB Pharma: Research Funding. Rivera-Amaya:UCB Pharma: Research Funding. Smith:UCB Pharma: Consultancy, Equity Ownership. Shock:UCB Pharma: Employment.

Targeting the neonatal Fc receptor (FcRn) to treat autoimmune diseases and maternal-fetal immune cytopenias.

FcRn, a non-classical Fc gamma (γ) receptor (FcγR) with near ubiquitous expression, plays key roles in disease pathogenesis and progression though immunoglobulin G (IgG) transport, IgG recycling, and IgG-immune complex clearance. FcRn function can be inhibited using IgG-based and non-IgG-based antagonists, by exploiting the pH-dependent binding affinity of FcRn for the IgG Fc region. FcRn therapeutics have shown promise in murine models and human clinical trials for autoimmune diseases and maternal-fetal immune cytopenias; they appear safe, well-tolerated, and reduce circulating IgG levels. Compared to traditional therapeutics, inhibiting FcRn has fewer adverse side effects and represents a new approach that is less invasive, time-consuming, and costly.

Antagonism of the Neonatal Fc Receptor as an Emerging Treatment for Myasthenia Gravis.

Myasthenia gravis is an autoimmune disease in which immunoglobulin G (IgG) autoantibodies are formed against the nicotinic acetylcholine receptor (AChR) or other components of the neuromuscular junction. Though effective treatments are currently available, many commonly used therapies have important limitations and alternative therapeutic options are needed for patients. A novel treatment approach currently in clinical trials for myasthenia gravis targets the neonatal Fc receptor (FcRn). This receptor plays a central role in prolonging the half–life of IgG molecules. The primary function of FcRn is salvage of IgG and albumin from lysosomal degradation through the recycling and transcytosis of IgG within cells. Antagonism of this receptor causes IgG catabolism, resulting in reduced overall IgG and pathogenic autoantibody levels. This treatment approach is particularly intriguing as it does not result in widespread immune suppression, in contrast to many therapies in routine clinical use. Experience with plasma exchange and emerging phase 2 clinical trial data of FcRn antagonists provide proof of concept for IgG lowering in myasthenia gravis. Here we review the IgG lifecycle and the relevance of IgG lowering to myasthenia gravis treatment and summarize the available data on FcRn targeted therapeutics in clinical trials for myasthenia gravis.

Human cytomegalovirus evades antibody-mediated immunity through endoplasmic reticulum-associated degradation of the FcRn receptor

Human cytomegalovirus (HCMV) can persistently infect humans, but how HCMV avoids humoral immunity is not clear. The neonatal Fc receptor (FcRn) controls IgG transport from the mother to the fetus and prolongs IgG half-life. Here we show that US11 inhibits the assembly of FcRn with β2m and retains FcRn in the endoplasmic reticulum (ER), consequently blocking FcRn trafficking to the endosome. Furthermore, US11 recruits the ubiquitin enzymes Derlin-1, TMEM129 and UbE2J2 to engage FcRn, consequently initiating the dislocation of FcRn from the ER to the cytosol and facilitating its degradation. Importantly, US11 inhibits IgG-FcRn binding, resulting in a reduction of IgG transcytosis across intestinal or placental epithelial cells and IgG degradation in endothelial cells. Hence, these results identify the mechanism by which HCMV infection exploits an ER-associated degradation pathway through US11 to disable FcRn functions. These results have implications for vaccine development and immune surveillance.

The neonatal Fc receptor: Key to homeostasic control of IgG and IgG-related biopharmaceuticals.

IgG and albumin are the most abundant proteins in the circulation and have the longest half-lives. These properties are due to a unique receptor, the neonatal Fc receptor (FcRn). Although FcRn is named for its function of transferring IgG across the placenta from maternal to fetal circulation, FcRn functions throughout life to maintain IgG and albumin concentrations. FcRn protects IgG and albumin from intracellular degradation and recycles them back into the circulation. Clinical trials have confirmed that pathogenic antibodies can be depleted by blocking this homeostatic function of FcRn. Moreover, understanding the molecular interactions between IgG and FcRn has resulted in the design of therapeutic monoclonal antibodies with more efficacious pharmacokinetics. As a result of genetic engineering these monoclonals can be delivered at lower doses and at longer intervals. More recent findings have demonstrated that FcRn enhances phagocytosis by neutrophils, immune complex clearance by podocytes and antigen presentation by dendritic cells, macrophages, and B cells. This minireview highlights the relevance of FcRn to transplantation.

FcRn-Dependent Transcytosis of Monoclonal Antibody in Human Nasal Epithelial Cells In Vitro: A Prerequisite for a New Delivery Route for Therapy?

Monoclonal antibodies (mAbs) are promising therapies to treat airway chronic inflammatory disease (asthma or nasal polyps). To date, no study has specifically assessed, in vitro, the potential function of neonatal Fc receptor (FcRn) in IgG transcytosis through the human nasal airway epithelium. The objective of this study was to report the in vitro expression and function of FcRn in nasal human epithelium. FcRn expression was studied in an air–liquid interface (ALI) primary culture model of human nasal epithelial cells (HNEC) from polyps. FcRn expression was characterized by quantitative RT-PCR, western blot, and immunolabeling. The ability of HNECs to support mAb transcytosis via FcRn was assessed by transcytosis assay. This study demonstrates the expression of FcRn mRNA and protein in HNEC. We report a high expression of FcRn in the cytosol of ciliated, mucus, and basal cells by immunohistochemistry with a higher level of FcRn proteins in differentiated HNEC. We also proved in vitro transepithelial delivery of an IgG1 therapeutic mAb with a dose–response curve. This is the first time that FcRn expression and mAb transcytosis has been shown in a model of human nasal respiratory epithelium in vitro. This study is a prerequisite for FcRn-dependent nasal administration of mAbs.

Hepatic function of FcRn revealed: Implications for overcoming drug-mediated hepatotoxicity.

Hepatic function of FcRn revealed: Implications for overcoming drug-mediated hepatotoxicity.

Characterization of the interactions of rabbit neonatal Fc receptor (FcRn) with rabbit and human IgG isotypes.

Despite the increasing importance of rabbit as an animal model in pharmacological studies like investigating placental transfer of therapeutic IgGs, little is known about the molecular interaction of the rabbit neonatal Fc receptor (FcRn) with rabbit and human IgG molecules. We analyzed the interactions of the rabbit and human FcRn with rabbit and human IgG isotypes using surface plasmon resonance assay. Similar to FcRn of other species, rabbit FcRn functions in pH-dependent manner, as it binds IgGs at pH 6.0, but no binding occurs at pH 7.4. We also showed that rabbit FcRn binds rabbit IgG and human IgG1 with nearly identical affinity, whereas it has stronger interactions with the other human IgG isotypes. The similar affinity of rabbit IgG and human IgG1 for rabbit FcRn was confirmed by in vitro FcRn-mediated recycling assay. These data verify that rabbit is an appropriate animal model for analyzing the pharmacokinetics of human therapeutic monoclonal antibodies.

Hepatic FcRn regulates albumin homeostasis and susceptibility to liver injury

The neonatal crystallizable fragment receptor (FcRn) is responsible for maintaining the long half-life and high levels of the two most abundant circulating proteins, albumin and IgG. In the latter case, the protective mechanism derives from FcRn binding to IgG in the weakly acidic environment contained within endosomes of hematopoietic and parenchymal cells, whereupon IgG is diverted from degradation in lysosomes and is recycled. The cellular location and mechanism by which FcRn protects albumin are partially understood. Here we demonstrate that mice with global or liver-specific FcRn deletion exhibit hypoalbuminemia, albumin loss into the bile, and increased albumin levels in the hepatocyte. In vitro models with polarized cells illustrate that FcRn mediates basal recycling and bidirectional transcytosis of albumin and uniquely determines the physiologic release of newly synthesized albumin into the basal milieu. These properties allow hepatic FcRn to mediate albumin delivery and maintenance in the circulation, but they also enhance sensitivity to the albumin-bound hepatotoxin, acetaminophen (APAP). As such, global or liver-specific deletion of FcRn results in resistance to APAP-induced liver injury through increased albumin loss into the bile and increased intracellular albumin scavenging of reactive oxygen species. Further, protection from injury is achieved by pharmacologic blockade of FcRn-albumin interactions with monoclonal antibodies or peptide mimetics, which cause hypoalbuminemia, biliary loss of albumin, and increased intracellular accumulation of albumin in the hepatocyte. Together, these studies demonstrate that the main function of hepatic FcRn is to direct albumin into the circulation, thereby also increasing hepatocyte sensitivity to toxicity.

The expression and function of the neonatal Fc receptor in thyrocytes of Hashimoto's thyroiditis

ObjectiveThyroglobulin (Tg) and thyroid peroxidase (TPO) antibodies (TgAb and TPOAb), which are primarily of the immunoglobulin G (IgG) class, can mediate antibody-dependent cell-mediated cytotoxicity in vitro. However, it is unclear whether any thyrocyte molecules can facilitate the transport and elimination of TgAb and TPOAb. The IgG transport receptor neonatal Fc receptor (FcRn) is a candidate mediator of these processes. In this study, we aimed to evaluate FcRn expression and function in normal and Hashimoto's thyroiditis (HT) thyrocytes. MethodsFcRn expression in primary thyrocyte cultures (four normal and four HT groups) was examined by polymerase chain reaction (PCR) and Western blotting. Localization of FcRn was demonstrated by immunoelectron microscopy. A double immunofluorescence staining method was adopted to detect FcRn and internalized human TgAb IgG. Stimulation experiments were performed to assess the regulation of FcRn expression by T helper cell 1 (Th1) (IFN-γ and TNF-α) and Th2 cytokines (IL-10 and IL-4). ResultsFcRn expression was lower in HT thyrocytes than in normal thyrocytes. FcRn was located in the cytoplasm, membranes, mitochondria and transport vesicles of thyrocytes. Both human IgG and TgAb IgG were internalized by thyrocytes in a pH-dependent manner and co-localized with FcRn in thyrocytes. FcRn expression was downregulated by Th1 and Th2 cytokines in both normal and HT thyrocytes in a dose-dependent manner. ConclusionsOur results suggest that FcRn may be associated with the transport and metabolism of IgG in thyrocytes and that transport is independent of IgG type. FcRn may be involved in HT pathogenesis.

Argx-113, a Novel Fc-Based Approach for Antibody-Induced Pathologies Such As Primary Immune Thrombocytopenia

The neonatal Fc Receptor (FcRn) is a key player in the maintenance of high serum levels of immunoglobulin G (IgG) antibodies. IgGs enter cells by pinocytic uptake and bind FcRn in acidic endosomal compartments. FcRn then recycles IgGs back to the cell surface where they are released into circulation at physiological pH. This half-life prolonging salvage pathway has obvious advantages in IgG-mediated pathogen clearance, but also leads to persistence of disease-causing autoantibodies present in various autoimmune indications like immune thrombocytopenia (ITP). Indeed, the principal characteristic of ITP is autoantibody-mediated peripheral platelet destruction and impaired platelet production in bone marrow which leads to an increased risk of bleeding. Functional inhibition of the FcRn receptor could therefore be a novel therapeutic modality in the treatment of ITP as standard treatment options, like immunomodulatory drugs, typically suffer from a high risk of comorbidities.ARGX-113 is a proprietary antibody Fc-fragment based on argenx’ ABDEG™ technology. ABDEG™ mutations dramatically increase the Fc/FcRn binding both at neutral and acidic pH. This results in constitutive blockage of FcRn function by ARGX-113, and concomitantly leads to fast clearance of pathogenic antibodies in an autoimmune setting.The ABDEG™ concept was validated in various mouse models for IgG-induced autoimmune indications. In all models, a significant reduction of disease severity is observed upon ARGX-113 administration, which parallels with markedly reduced disease-causing antibody levels. Follow-up studies in cynomolgus monkeys demonstrated a highly effective and rapid elimination of immunoglobulins, which outperformed by far the pharmacodynamic effects of a 50-fold higher dose of intravenous immunoglobulin (IVIg), a standard-of-care therapy in many IgG-driven autoimmune indications.A first-in-human Phase I study was initiated to evaluate safety, tolerability, efficacy (reduction in IgG levels), pharmacokinetics and immunogenicity of ARGX-113 following single or multiple intravenous administration(s). Up to 68 healthy volunteers will be enrolled in this double-blind placebo-controlled study (48 active, 20 placebo). At present, the compound showed favorable safety and tolerability across multiple doses and dosing regimens with promising pharmacodynamics effects relating to speed, depth and duration of IgG reduction. Upon multiple dosing, IgG reduction of up to 85% is observed and IgG levels slowly return to baseline when dosing is terminated. Full study results, covering all planned doses and dosing regimens, will be presented focusing on safety, PK/PD relationship, IgG subset response, anti-drug antibody formation and dose/dosing regimen selection for future studies.In addition, the study design and outcome measures of a Phase II study evaluating safety, tolerability and efficacy of ARGX-113 in an ITP setting is being prepared and will be presented. DisclosuresUlrichts:argenx: Employment. Cousin:argenx: Employment. Dreier:argenx: Employment. de Haard:argenx: Employment. Leupin:argenx: Employment.

A comprehensive review of the neonatal Fc receptor and its application in drug delivery.

Advances in the understanding of neonatal Fc receptor (FcRn) biology and function have demonstrated that this receptor, primarily identified for the transfer of passive immunity from mother infant, is involved in several biological and immunological processes. In fact, FcRn is responsible for the long half-life of IgG and albumin in the serum, by creating an intracellular protein reservoir, which is protected from lysosomal degradation and, importantly, trafficked across the cell. Such discovery has led researchers to hypothesize the role for this unique receptor in the controlled delivery of therapeutic agents. A great amount of FcRn-based strategies are already under extensive investigation, in which FcRn reveals to have profound impact on the biodistribution and half-life extension of therapeutic agents. This review summarizes the main findings on FcRn biology, function and distribution throughout different tissues, together with the main advances on the FcRn-based therapeutic opportunities and model systems, which indicate that this receptor is a potential target for therapeutic regimen modification.

The role of Fc-receptors in the uptake and transport of therapeutic antibodies in the retinal pigment epithelium

In the ophthalmological clinic, intravitreally applied antibodies or Fc-containing fusion proteins are frequently used, but the biology and pharmacokinetics of these therapeutics in the retina are not well understood. We have previously shown intracellular uptake of Fc-containing molecules in RPE cells. In this study, we investigated the involvement of Fc-receptors, both Fcγ-receptors and the neonatal Fc-receptor (FcRn) in the uptake and intracellular trafficking of the VEGF-antagonists bevacizumab, aflibercept and the anti-CD20 antibody rituximab in three different model systems, primary porcine RPE cells, ARPE-19 cells and porcine RPE/choroid explants.The expression of Fcγ-receptors was tested in primary porcine RPE cells, and the expression of Fcγ-receptors I and II could be shown in RT-PCR and qRT-PCR, while the expression of FcRn was additionally confirmed in Western blot and immunocytochemistry. All three compounds, bevacizumab, rituximab and aflibercept, were taken up into the cells and displayed a characteristic time-dependent pattern, as shown in Western blot and immunohistochemistry. The uptake was not altered by the inhibition of Fcγ-receptors using different inhibitors (TruStain FcX, genistein, R406). However, the inhibition of FcRn with an antagonistic antibody reduced intracellular IgG in porcine RPE cells (rituximab) and ARPE-19 cells (bevacizumab, rituximab). Colocalisations between the tested compounds and myosin7a could be found. In addition, limited colocalization with FcRn and the tested compounds, as well as triple localization between compound, FcRn and myosin7a could be detected, indicating a role of myosin7a in FcRn mediated transport. However, the colocalizations are restricted to small fractions of the Fc-containing compounds. Furthermore, the FcRn is mainly found in the membrane section, where only minute amounts of the Fc-containing compounds are seen, suggesting a limited interaction. An apical to choroidal transport of IgG through the RPE/choroid can be found in RPE/choroid explants. Inhibition of FcRn increases the amount of bevacizumab found on the choroidal side, suggesting a role of FcRn in the recycling of bevacizumab.In conclusion, our data indicate a role for FcRn, but not Fcγ-receptors, in the uptake and transport of Fc-containing molecules in the RPE and indicate a recycling function of FcRn in the retina.

Gestation age dependent transfer of human immunoglobulins across placenta in timed-pregnant guinea pigs

IntroductionWhen administered during pregnancy, antibodies and other biologic drugs that contain the Fc part of the IgG molecule can traverse the placenta. Although it is generally accepted that the FcRn receptor mediates this process, gaps remain in our understanding of underlying details in humans and in common laboratory animal species. MethodsWe expanded our previous studies in timed-pregnant guinea pigs to both measure the transport of human (h) IgG at earlier gestation ages in vivo and evaluate FcRn function in vitro using Surface Plasmon Resonance (SPR) and Madin–Darby canine kidney cells (MDCK) that express guinea pig (gp) FcRn. ResultsIn timed-pregnant guinea pigs both the average concentration of hIgG in the fetus and its ratio to maternal hIgG concentration increase exponentially with gestation age. Thus, hIgG fetal:maternal concentration ratios increase from an average of 1% to 3%, 17%, and 76% on GD ∼26, 35, 46, and 54, respectively. In vitro, gpFcRn immobilized on a solid surface can bind hIgG and gpIgG preparations in a similar manner. All engineered human Fc isotype-specific constructs were internalized by MDCK-gpFcRn cells at significant levels. While not significant, their recycling and hIgG transcytosis by this cell line also trend higher than background controls. DiscussionPregnant guinea pigs exhibit similarities with humans in the degree and timing of transplacental transfer as well as the ability of their FcRn to bind and internalize hIgG in vitro. Further studies are needed to guide building appropriate systems for the evaluation of FcRn mediated function of human immunoglobulin therapies.