Review article: nonclinical and clinical pharmacology, pharmacokinetics and pharmacodynamics of etrolizumab, an anti-ß7 integrin therapy for inflammatory bowel disease.

BACKGROUND: Novel treatments with superior benefit-risk profiles are needed to improve the long-term prognosis of patients with inflammatory bowel disease (IBD). Etrolizumab-a monoclonal antibody that specifically targets ß7 integrins-is currently under phase III clinical evaluation in IBD. AIM: This review summarises the available pharmacological and pharmacokinetic/pharmacodynamic data for etrolizumab to provide a comprehensive understanding of its mechanism of action (MOA) and pharmacological effects. METHODS: Published and internal unpublished data from nonclinical and clinical studies with etrolizumab are reviewed. RESULTS: Etrolizumab exerts its effect via a unique dual MOA that inhibits both leucocyte trafficking to the intestinal mucosa and retention within the intestinal epithelial layer. The gut-selectivity of etrolizumab results from its specific targeting of the ß7 subunit of α4ß7 and αEß7 integrins. Etrolizumab does not bind to α4ß1 integrin, which mediates lymphocyte trafficking to tissues including the central nervous system, a characteristic underlying its favourable safety with regard to progressive multifocal leucoencephalopathy. Phase I/II studies in patients with ulcerative colitis (UC) showed linear pharmacokinetics when etrolizumab was administered subcutaneously at 100 mg or higher once every 4 weeks. This dose was sufficient to enable full ß7 receptor occupancy in both blood and intestinal tissues of patients with moderate to severe UC. The phase II study results also suggested that patients with elevated intestinal expression of αE integrin may have an increased likelihood of clinical remission in response to etrolizumab treatment. CONCLUSION: Etrolizumab is a gut-selective, anti-ß7 integrin monoclonal antibody that may have therapeutic potential for the treatment of IBD.

A humanized monoclonal antibody targeting the ß7 integrin selectively blocks intestinal homing of T lymphocytes.

BACKGROUND AND PURPOSE: rhuMAb Beta7 is a humanized anti-human ß7 monoclonal antibody currently in phase I in inflammatory bowel disease. rhuMAb Beta7 binds the ß7 subunit of the integrins α4ß7 and αEß7, blocking interaction with their ligands. These integrins play key roles in immune cell homing to and retention in mucosal sites, and are associated with chronic inflammatory diseases of the gastrointestinal tract. The goal of this study was to evaluate the mucosal specificity of rhuMAb Beta7. EXPERIMENTAL APPROACH: We assessed the effect of murine anti-Beta7 on lymphocyte homing in mouse models of autoimmune disease. We also compared the effect of rhuMAb Beta7 on circulating mucosal-homing versus peripheral-homing T cells in naïve non-human primates. KEY RESULTS: In cynomolgus monkeys, occupancy of ß7 integrin receptors by rhuMAb Beta7 correlated with an increase in circulating ß7(+) mucosal-homing lymphocytes, with no apparent effect on levels of circulating ß7(-) peripheral-homing lymphocytes. rhuMAb Beta7 also inhibited lymphocyte homing to the inflamed colons of severe combined immunodeficient mice in CD45RB(high) CD4(+) T-cell transfer models. Consistent with a lack of effect on peripheral homing, in a mouse model of experimental autoimmune encephalomyelitis, anti-ß7 treatment resulted in no amelioration of CNS inflammation. CONCLUSIONS AND IMPLICATIONS: The results presented here suggest that rhuMAb Beta7 selectively blocks lymphocyte homing to the gastrointestinal tract without affecting lymphocyte trafficking to non-mucosal tissues. rhuMAb Beta7 provides a targeted therapeutic approach with the potential for a more attractive benefit:risk ratio than currently available inflammatory bowel disease therapies.

Anti-CD22-MCC-DM1: an antibody-drug conjugate with a stable linker for the treatment of non-Hodgkin's lymphoma.

Antibody-drug conjugates (ADCs) are potent cytotoxic drugs linked to antibodies through chemical linkers, and allow specific targeting of drugs to neoplastic cells. The expression of CD22 is limited to B-cells, and we show that CD22 is expressed on the vast majority of non-Hodgkin's lymphomas (NHLs). An ideal target for an ADC for the treatment of NHL would have limited expression outside the B-cell compartment and be highly effective against NHL. We generated an ADC consisting of a humanized anti-CD22 antibody conjugated to the anti-mitotic agent maytansine with a stable linker (anti-CD22-MCC-DM1). Anti-CD22-MCC-DM1 was broadly effective in in vitro killing assays on NHL B-cell lines. We did not find a strong correlation between in vitro potency and CD22 surface expression, internalization of ADC or sensitivity to free drug. We show that anti-CD22-MCC-DM1 was capable of inducing complete tumor regression in NHL xenograft mouse models. Further, anti-CD22-MCC-DM1 was well tolerated in cynomolgus monkeys and substantially decreased circulating B-cells as well as follicle size and germinal center formation in lymphoid organs. These results suggest that anti-CD22-MCC-DM1 has an efficacy, safety and pharmacodynamic profile that support its use as a treatment for NHL.

Alpha beta T cell response to Toxoplasma gondii in previously unexposed individuals.

The mechanisms by which T cells from previously unexposed hosts respond in vitro to certain intracellular pathogens remain to be fully understood. We report and characterize the in vitro reactivity to Toxoplasma gondii of human alpha beta T cells from T. gondii-seronegative individuals. Resting alpha beta T cells from these individuals proliferated in response to PBMC infected with T. gondii or pulsed with T. gondii lysate Ags. This was accompanied by an increase in the percentage of CD4+ alpha beta T cells. Purified CD4+ alpha beta T cells but not CD8+ alpha beta T cells proliferated in response to these T. gondii preparations. Both CD4+ alpha beta T cells with naive (CD45RA+) and memory (CD45RO+) phenotypes from adults as well as alpha beta T cells from T. gondii-seronegative newborns proliferated after incubation with T. gondii. This alpha beta T cell response to the parasite was inhibited by anti-HLA-DR mAb and to a lesser degree by anti-HLA-DQ mAb. Use of paraformaldehyde-fixed PBMC completely abrogated the proliferation of alpha beta T cells, indicating the need for processing of T. gondii Ags. Analysis of the TCR V beta expression did not show evidence for restriction in TCR V beta usage during T. gondii stimulation of alpha beta T cells. Alpha beta T cells secreted significant amounts of IFN-gamma after incubation with T. gondii-infected monocytes. This rapid and remarkable alpha beta T cell response may play an important role in the early events of the immune response to T. gondii.

Role of CD80 (B7.1) and CD86 (B7.2) in the immune response to an intracellular pathogen.

The costimulatory ligands CD80 and CD86 play a crucial role in the initiation and maintenance of an immune response. We demonstrate that whereas infection of human monocytes with viable tachyzoites of Toxoplasma gondii resulted in rapid induction of expression of CD80 and up-regulation of expression of CD86, incubation with killed organisms failed to alter the levels of expression of these costimulatory ligands. The T. gondii-mediated changes in levels of expression of these molecules are critical to the T cell response to the parasite. Proliferation of resting T cells in response to parasite-infected cells was dependent on both CD80 and CD86. More importantly, early production of IFN-gamma in response to T. gondii by T cells from T. gondii-seronegative individuals occurred only after stimulation with monocytes that exhibited increased expression of CD80 and CD86 (monocytes infected with viable parasites) and was almost completely ablated by the combination of anti-CD80 plus anti-CD86 mAb. Moreover, proliferation and IFN-gamma production by CD4+ CD45RA+ T cells from unexposed individuals were dependent on both CD80 and CD86. These data indicate that pathogen-monocyte interaction influences the ensuing T cell response.