Antibody Discovery, Optimization, and Application: Translational Protein Engineering for Precision Medicine

Next-generation, “omics-based”, translational research is rapidly characterizing genetically determined pathophysiology at an unprecedented depth. Through the application of high-throughput sequencing technologies and advanced immune engineering methods new insights into adaptive immunity has been generated at an extraordinary rate. However, despite rapid accumulation of new scientific insight, critical gaps in our scientific understanding of antibody-mediated molecular immunity limit the number of novel antibody-based medical interventions that translate past basic scientific discovery andinto clinical application. Here, this original work directly addresses outstanding gaps in our scientific knowledge of molecular humoral immunity through the discovery, optimization, enhancement, and biophysical characterization of monoclonal antibody proteins to inform the development of new precision medicines. Experimental monoclonal antibody genes, structure, and functions are assessed using a suite of immune engineering technologies, including: natively-paired antibody heavy:light chain complementary DNA libraries, in vitro mutagenesis, recombinant DNA vectors, functional yeast-surface display, fluorescence activated cell screening, high-throughput single-cell next-generation sequencing, and advanced biophysical characterization assays to translate basic research findings into new, clinically relevant, insights. Experimental application of these technologies using functional antibody:antigen screening methods produced the discovery of a novel SARS-CoV-2 neutralizing monoclonal antibody 910-30, and delineated antibody paired heavy:light chain sequence-structure-function signatures contributing to potent SARS-CoV-2 neutralization in public antibody responses. These findings have important applications for understanding communal immunity and developing effective intervention strategies during an acute global pandemic outbreak. This work also describes translational antibody protein engineering methods used to define precise, functionally optimized, genetic sequences from template monoclonal antibodies CIS43 and VRC34.01, which target the clinically relevant pathogens plasmodium falciparum and viral HIV-1, respectively. The antibody insights gained from functional optimization experiments were used to produce improved biomolecular blueprints defining structural mechanisms and forward pathways for highly protective humoral immunity against P. falciparum and HIV-1, respectively. Altogether, the scientific outcomes from this research have immediate clinical applications for the development of therapeutic, prophylactic, diagnostic and research reagents for COVID-19, HIV/AIDS, and malaria, as well as broad impact for the development of precision medicines against diseases of clinical relevance

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Antibody screening at reduced pH enables preferential selection of potently neutralizing antibodies targeting SARS‐CoV ‐2

Antiviral monoclonal antibody (mAb) discovery enables the development of antibody-based antiviral therapeutics. Traditional antiviral mAb discovery relies on affinity between antibody and a viral antigen to discover potent neutralizing antibodies, but these approaches are inefficient because many high affinity mAbs have no neutralizing activity. We sought to determine whether screening for anti-SARS-CoV-2 mAbs at reduced pH could provide more efficient neutralizing antibody discovery. We mined the antibody response of a convalescent COVID-19 patient at both physiological pH (7.4) and reduced pH (4.5), revealing that SARS-CoV-2 neutralizing antibodies were preferentially enriched in pH 4.5 yeast display sorts. Structural analysis revealed that a potent new antibody called LP5 targets the SARS-CoV-2 N-terminal domain supersite via a unique binding recognition mode. Our data combine with evidence from prior studies to support antibody screening at pH 4.5 to accelerate antiviral neutralizing antibody discovery

Antibody-directed evolution reveals a mechanism for enhanced neutralization at the HIV-1 fusion peptide site

Abstract The HIV-1 fusion peptide (FP) represents a promising vaccine target, but global FP sequence diversity among circulating strains has limited anti-FP antibodies to ~60% neutralization breadth. Here we evolve the FP-targeting antibody VRC34.01 in vitro to enhance FP-neutralization using site saturation mutagenesis and yeast display. Successive rounds of directed evolution by iterative selection of antibodies for binding to resistant HIV-1 strains establish a variant, VRC34.01_mm28, as a best-in-class antibody with 10-fold enhanced potency compared to the template antibody and ~80% breadth on a cross-clade 208-strain neutralization panel. Structural analyses demonstrate that the improved paratope expands the FP binding groove to accommodate diverse FP sequences of different lengths while also recognizing the HIV-1 Env backbone. These data reveal critical antibody features for enhanced neutralization breadth and potency against the FP site of vulnerability and accelerate clinical development of broad HIV-1 FP-targeting vaccines and therapeutics

Highly protective antimalarial antibodies via precision library generation and yeast display screening

The monoclonal antibody CIS43 targets the Plasmodium falciparum circumsporozoite protein (PfCSP) and prevents malaria infection in humans for up to 9 mo following a single intravenous administration. To enhance the potency and clinical utility of CIS43, we used iterative site-saturation mutagenesis and DNA shuffling to screen precise gene-variant yeast display libraries for improved PfCSP antigen recognition. We identified several mutations that improved recognition, predominately in framework regions, and combined these to produce a panel of antibody variants. The most improved antibody, CIS43_Var10, had three mutations and showed approximately sixfold enhanced protective potency in vivo compared to CIS43. Co-crystal and cryo-electron microscopy structures of CIS43_Var10 with the peptide epitope or with PfCSP, respectively, revealed functional roles for each of these mutations. The unbiased site-directed mutagenesis and screening pipeline described here represent a powerful approach to enhance protective potency and to enable broader clinical use of antimalarial antibodies.</jats:p