1.) Antibody technologies - Biologics as current medicines Flashcards

1
Q

What are the limits of small molecule (sMW) drug discovery?

A
  • Intractable molecular targets (e.g. receptors for large hormones)
  • Restricted ‘classical’ drug action at target (e.g. agonist, antagonist, inhibitors)
  • Traditional drug discovery approaches by ‘big’ pharma becoming less succesful
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2
Q

What is a biologic?

A

Medicinal product whose synthesis, extraction or manufacture involves living sources (human, animal or microbiological).

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3
Q

Name some types of biologics.

A
  • Protein based therapeutics
  • Gene and cellular therapies, stem cells and transplantation
  • Vaccines
  • Blood products for transfusion
  • Diagnostic reagents e.g. allergens for allergy tests
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4
Q

Give examples of protein based therapeutics.

A
  • Peptide and protein hormones, growth factors
  • Antibodies
  • Engineered proteins (eg. receptor binding site domains)
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5
Q

What advances/challenges in developing insulin (1920s, the OG) can be applied to protein-based therapeutics?

A

Applies to all:
- Unmet clinical need, successfully addressed
(no sMW to date can imitate action of insulin at receptor)
- Due to its complex structure, single gene, enzymatic cleavage
»> PK undesirable: protein-nature means it has to be injected rather than PO (applying to all biologics)

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6
Q

What are the advantages of biologics vs sMW?

A
  • Tackle targets resistant to sMW intervention e.g. receptors with large, complex binding sites, orphan diseases/targets with unknown binding sites
  • Potential for higher affinity and selectivity (big surface contact between drug + receptor) e.g.
    allows selection between closely related receptor targets, targeting mutant forms of the target contributing to disease (pharmacogenetics - personalised medicine)
  • Potential for diverse molecular mechanisms of action e.g.
    interaction with messenger molecule than target, immune-directed cytotoxicity
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7
Q

What are the risks and disadvantages of biologics?

A

Lack of efficacy and PK challenges:
- Administration and delivery to target tissue: injection rather than oral, biologic is also large thus tissue access may be an issue (barriers: intestinal lining, BBB, access to solid tumours)

  • Species variation in protein sequences e.g. risk of lack of efficacy with non-human sequences (porcine/bovine insulin less potent, also RISK of immunogenicity

Manufacture:
- Complexity, reproducibility and purity of synthetic process e.g.
> proteins from multi-gene precursors, or matured via enzymatic cleavage
> correct folding and tertiary structure, avoiding aggregation of product
> process dependent variations in proteins: glycosylation state, AA modifications (post-translation mods may decrease efficacy/increase aggregation) such as oxidation, other components within isolated preparation

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8
Q

What are the 5 types of antibodies/immunoglobulins?

A

5-types, distinguished by type of heavy chain:

  • IgA, IgD, IgE, IgG, IgM
  • Subtypes exist (e.g. IgG1, IgG2…)
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9
Q

What is the principle immunoglobulin class/isotype used for biologics development?

A

IgG:

  • Main circulating antibody/Ig in serum
  • Responsible for 2º adaptive response (memory B-cells from initial antigen challenge = rapid Ab production second time)
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10
Q

Describe the basic IgG ‘Y’ domain structure.

A

Fab - antigen-binding fragment domain:

  • Variable regions (Fv) responsible for antigen recognition
  • 2x Fab domains = IgG is bivalent

Fc - constant fragment domain:
- Directs cellular interactions and immunogenic response via interaction with an Fc receptor
- Linker domain to conjugation with drugs
- Different Ig subtypes Fc’s have different receptors
E.g. IgE (inflammation Abs) - Fc interacts with Fc-episilon R on mast cells, in IgG Fc interactions with Fc-gamma on macrophages and neutrophils

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11
Q

What PK properties of the Fc domain (of IgG) are beneficial in biologics development?

A
  • Fc domain also regulates Ig transport (e.g. across placenta)
  • Thus extending plasma half-life of Ig molecules: they are able to be recycled, preventing elimination via endocytosis
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12
Q

Describe IgG structure with a focus on protein architecture.

A

Human IgG - 4 polypeptide chains:
• 2 Heavy chains (H - forms Fc domain as well as inner arm of Fab domain)
• 2 Light chains (L)
- Joined by disulphide bonds (top of the Fab/Y-region)
- Separate H and L chain genes exist

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13
Q

How are the 4 polypeptides of IgG are arranged?

A

Each of the 4 polypeptide chains are arranged in respective immunoglobulin domains (circa 120 AAs):

  • Fc: CH1, CH2, CH3 and CL1 domains (similar/identical domains)
  • Fab: VH, VL domains (highly variable in sequence - identifying antigen)
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14
Q

What are hypervariable regions within IgG protein architecture?

A

Within VH and VL domains of Fab polypeptide chains:

  • 3 hypervariable regions exist on the external surface of the antibody, defining its binding with antigens (AKA complementarity determining regions [CDR])
  • separated by 4 more conserved framework regions [FR]
  • CDR/hypervariable regions vary dramatically between even IgGs: 10^16 distinct IgG molecules possible
  • Determining recognition and interaction with antigens
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15
Q

Describe what form the IgG contact surface usually takes.

A

AKA the hypervariable region (3 regions of the VH/VL domains of the Fab regions):

  • Forms recognition site
  • IgG contact surface is usually flat or concave
  • Fab region is sequence of beta-pleated sheets
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16
Q

What are the two classes of antibodies that can be raised/generated against an antigen by immunisation?

A
  • Polyclonal antibodies (pAb)

- Monoclonal antibodies (mAb)

17
Q

How do polyclonal and monoclonal antibodies differ?

A

Polyclonal (pAb):
- Many different IgG molecules (many subtypes) with high affinity for antigen which are purified from serum after immunisation
- Taken from rabbit, IgGs are not identical, may recognised different parts of the antigen
»> Not heavily used in medicine

Monoclonal (mAb):

  • IgG producing plasma B cells isolated from immunised mouse, producing identical IgG molecules
  • Liver B cells are cultured, with each cell producing the single antibody desired
  • Current Ab therapeutics are monoclonal, hence -mab suffix (e.g. trastuzumab, infliximab)
18
Q

How do monoclonal antibody therapeutics compare with sMW drug discovery?

A

Monoclonal antibodies technically:

  • Are applicable to any antigen (e.g. microbe, protein, chemical target - inject anything/desired antigen into mouse hypothetically)
  • Do not need structural knowledge of ‘binding site’ - mouse B-cells do the work/recognise antigen, naturally developing high affinity Abs
  • IgGs can be identified by high affinity binding, then molecular properties elucidated.
19
Q

What issues do solely mouse-derived monoclonal IgGs present?

A

PK issues:
- Risk of generating human anti-mouse antibodies (HAMAs); recognise mouse IgGs, leading to rapid degradation of human IgG and short plasma t1/2
»> Also potential immunogenicity (inflammatory response)

  • Mouse Fc domains may also contribute to lack of efficacy
20
Q

How are issues with sole mouse-derived monoclonal IgGs combatted? What are they?

A

Chimeric/humanised Abs are required for clinical IgGs:

Chimeric ( xi )
- Fc domains: human (constant)
- Fab domain: mouse (variable)
E.g. infliXImab

Humanised (zu)
- Fc domains: human (constant)
- Fab domain: human, aside from CDR/hypervariable regions which are mouse
E.g. trastuZUmab (Herceptin)

Human (u)
- Fc domains: human
- Fab domain: human (whole, inc. CDR regions)
E.g. AdalimUmab

21
Q

What new technologies exist to improve cloning and production of human IgG therapeutics?

A
  • In vivo immunisation of transgenic mice, engineered to produce human IgG (majority of fully ‘hUman’ IgGs marketed derived in this manner)
  • Phage display: virus coats engineered to express human IgG domains, allowing screening and selection for target affinity without immunisation. Associated IgGs lack key post-translational modification (e.g. glycosylation - can be a pro or a con)
  • Mammalian cell antibody display systems
22
Q

What different mechanisms of action do IgGs exhibit?

A
  • Receptor antagonism/inhibitors
  • Antagonism of stimulating growth factor/messenger
  • Agonists
  • Ab-directed cell cytotoxicity (ADCC)
23
Q

Describe the mechanism of action of cetuximab (licensed for head & beck, colon and lung cancers).

A

Antagonist for ligand (EGF) binding at the EGF receptor:

  • Thus limiting EGFR dependent proliferation of tumour cells
  • Classical antagonist (blocking EGF reaching receptor site)
24
Q

Describe the mechanism of action of IgGs such as bevacizumab and infliximab.

A

Antagonism of stimulating growth factor/messenger:

  • Bevacizumab: anti-VEGF therapy (growth factor for tumour angiogenesis; coats VEGF growth factor to prevent binding to tyrosine kinase VEGF receptor, turning off the signal)
  • Infliximab: anti-TNFα therapy

> > > Targets messenger, NOT the receptor

25
Q

How are IgGs used as agonists therapeutically?

A

Trial as agonists for death receptors linked to tumour apoptosis:

  • Chemokine ligands (TRAIL) normally bind to ‘death’ receptors (e.g. DR4, 5) on tumour cells, activating pro-apoptotic signalling
  • Bivalent antibodies (e.g. conatumumab) can mimic this activation by cross-linking DR4, 5 receptors - forced dimerisation results in downstream signalling for apoptosis of tumour cells (hijack death receptors)

> > > Not in clinic: not passed PI/II trials yet

26
Q

Describe the IgG mechanism of action for ADCC (antibody directed cell cytotoxicity).

A

‘Immunotherapy’:

  • Fc domains of IgG subtypes (particularly IgG1 and IgG3) recruit macrophages to IgG bound antigens or tumours cells)
  • Leads to destruction by complement/cell mediated mechanisms (T cells)
  • In longer term, response can be reinforced by adaptive immunity to the antigens presented by the macrophages following phagocytosis
27
Q

What is adaptive immunity?

A
  • Immune system/phagocytes ingest tumour cells and then present tumour antigens on their surface
  • Allows targeting from T cells
28
Q

Describe how trastuzumab (herceptin) combines different molecular mechanisms.

A

Trastuzumab targets the EGF-related receptor HER2 in HER2+VE breast cancer:

  • Direct binding and inhibition of HER2 dimers and signalling
  • Prevention of HER2 cleavage to a constitutively active form
  • Endocytosis and degradation of HER2 receptors in cancer cells
  • Antibody dependent cytotoxicity to destroy tumour cells (Fc domains recruiting macrophages etc)