Hinge-deleted IgG4 blocker therapy for acetylcholine receptor myasthenia gravis in rhesus monkeys

Sci Rep. 2017 Apr 20;7(1):992. doi: 10.1038/s41598-017-01019-5.

Abstract

Autoantibodies against ion channels are the cause of numerous neurologic autoimmune disorders. Frequently, such pathogenic autoantibodies have a restricted epitope-specificity. In such cases, competing antibody formats devoid of pathogenic effector functions (blocker antibodies) have the potential to treat disease by displacing autoantibodies from their target. Here, we have used a model of the neuromuscular autoimmune disease myasthenia gravis in rhesus monkeys (Macaca mulatta) to test the therapeutic potential of a new blocker antibody: MG was induced by passive transfer of pathogenic acetylcholine receptor-specific monoclonal antibody IgG1-637. The effect of the blocker antibody (IgG4Δhinge-637, the hinge-deleted IgG4 version of IgG1-637) was assessed using decrement measurements and single-fiber electromyography. Three daily doses of 1.7 mg/kg IgG1-637 (cumulative dose 5 mg/kg) induced impairment of neuromuscular transmission, as demonstrated by significantly increased jitter, synaptic transmission failures (blockings) and a decrease in the amplitude of the compound muscle action potentials during repeated stimulations (decrement), without showing overt symptoms of muscle weakness. Treatment with three daily doses of 10 mg/kg IgG4Δhinge-637 significantly reduced the IgG1-637-induced increase in jitter, blockings and decrement. Together, these results represent proof-of principle data for therapy of acetylcholine receptor-myasthenia gravis with a monovalent antibody format that blocks binding of pathogenic autoantibodies.

MeSH terms

  • Animals
  • Autoantibodies / metabolism*
  • CHO Cells
  • Cholinergic Antagonists
  • Cricetulus
  • Disease Models, Animal
  • Gene Expression Regulation / drug effects
  • HEK293 Cells
  • Hinge Exons
  • Humans
  • Immunoglobulin G / administration & dosage*
  • Immunoglobulin G / pharmacology
  • Macaca mulatta
  • Myasthenia Gravis / drug therapy*
  • Myasthenia Gravis / immunology
  • Myasthenia Gravis / metabolism
  • Receptors, Cholinergic / metabolism*
  • Synaptic Transmission / drug effects
  • Treatment Outcome

Substances

  • Autoantibodies
  • Cholinergic Antagonists
  • Immunoglobulin G
  • Receptors, Cholinergic