CD19, a B cell-restricted receptor critical for B-cell development, is expressed in most B-cell malignancies. The Fc-engineered anti-CD19 antibody, XmAb5574, has enhanced Fc␥ receptor (Fc␥R) binding affinity, leading to improved Fc␥R-dependent effector cell functions and antitumor activity in murine xenografts compared with the non-Fc-engineered anti-CD19 IgG1 analog. Here, we use XmAb5574 and anti-CD19 IgG1 to further dissect effector cell functions in an immune system closely homologous to that of humans, the cynomolgus monkey. XmAb5574 infusion caused an immediate and dose-related B-cell depletion in the blood (to <10% of baseline levels) concomitant with a sustained reduction of natural killer (NK) cells. NK cells had fully recovered by day 15, whereas B-cell recovery was underway by day 57. B cells in secondary lymphoid tissues were depleted (to 34%-61% of vehicle), with involuted germinal centers apparent in the spleen. Anti-CD19 IgG1 had comparable serum exposure to XmAb5574 but demonstrated no B-cell depletion and no sustained NK-cell reduction. Thus, increasing Fc␥R binding affinity dramatically increased B-cell clearing. We propose that effector cell functions, possibly those involving NK cells, mediate XmAb5574 potency in cynomolgus monkeys, and that enhancing these mechanisms should advance the treatment of B-cell malignancies in humans.
IntroductionCD19 is a B cell-restricted signal-transducing cell-surface receptor present on most B cells from the earliest stages of pre-B-cell development until terminal differentiation into plasma cells. 1,2 A critical role for CD19 in B-cell development and activation has been established using CD19-deficient mice. Such mice fail to develop a proper immune response after antigen challenge, exhibit decreased B-cell numbers in the periphery and in lymphoid tissues, lack germinal center (GC) formation, and have decreased serum immunoglobulin (Ig) levels. 1,3,4 Furthermore, anti-CD19 antibodies effectively deplete peripheral B cells in transgenic mice expressing human CD19 and block malignant B-cell growth in murine xenografts. [5][6][7] With the exception of multiple myeloma, 8 CD19 is expressed in nearly all non-Hodgkin lymphomas and many leukemias. 9,10 Several anti-CD19 antibodies have been evaluated in the clinic for the treatment of such diseases, including unconjugated antibodies, 11,12 antibody-drug conjugates, 13,14 and bispecific antibodies targeting CD19 and CD3. 15,16 Despite the attractiveness of CD19 as an immunotherapeutic target for the treatment of B-cell malignancies, the results with patients have been mixed. Thus, the challenge remains to optimize anti-CD19 antibodies to achieve improved clinical outcome.The potency of immunotherapeutics depends on multiple mechanisms of action, including those mediated by effector cells expressing Fc␥ receptors (Fc␥Rs). 17 Fc␥Rs in turn have activating or inhibitory functional roles and differ in their distribution among effector cells. Monocytes, macrophages, and neutrophils express both activating and inhibitor...