Pentsuk Nele, van der Laan Jan Willem
Section on Safety of Medicines and Teratology, Centre for Biological Medicines and Medical Technology, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Birth Defects Res B Dev Reprod Toxicol. 2009 Aug;86(4):328-44. doi: 10.1002/bdrb.20201.
There are profound differences in maternofetal transfer of immunoglobulins between species with extensive gestational transfer of maternal immunoglobulins in primates (including humans) via the chorioallantoic placenta as well as in rabbits and guinea pigs via the inverted yolk sac splanchnopleure. In contrast, other neonatal rodents (rats and mice) receive passive immunity predominantly postnatally. This transfer is mediated principally via FcRn receptors. Therapeutic monoclonal antibodies (mAbs) are most commonly of the IgG1 subclass, which is transported most efficiently to the fetus. In all animal species used for testing developmental toxicity, fetal exposure to IgG is very low during organogenesis, but this increases during the latter half of gestation such that the neonate is born with an IgG1 concentration similar to the mother (but not rats and mice). Review of mAb developmental toxicity studies of licensed products reveals Cynomolgus monkey as the species used in the majority of the cases (10 out of 15). Pregnancy outcome data from women gestationally exposed to mAb is limited. In general, the findings are consistent with the expected low exposure during organogenesis. Guinea-pigs and rabbits are potential candidates as "alternatives" to the use of nonhuman primates as the maternofetal transfer in the last part of gestation is at a level similar in humans. Based on the pattern of placental transfer of IgG in humans, study designs that allow detection of both the indirect effects in early gestation plus the effects of direct fetal exposure in mid and late gestation are recommended for developmental toxicity of mAbs.
在不同物种之间,母体免疫球蛋白的母胎转运存在显著差异。在灵长类动物(包括人类)中,母体免疫球蛋白通过绒毛膜尿囊胎盘进行广泛的孕期转运;在兔子和豚鼠中,则通过倒置卵黄囊脏壁进行转运。相比之下,其他新生啮齿动物(大鼠和小鼠)主要在出生后获得被动免疫。这种转运主要通过FcRn受体介导。治疗性单克隆抗体(mAb)最常见的是IgG1亚类,其向胎儿的转运效率最高。在所有用于测试发育毒性的动物物种中,在器官形成期胎儿接触IgG的水平非常低,但在妊娠后半期会增加,以至于新生儿出生时的IgG1浓度与母亲相似(但大鼠和小鼠除外)。对已获许可产品的mAb发育毒性研究的综述表明,食蟹猴是大多数情况下(15例中的10例)所使用的物种。孕期接触mAb的女性的妊娠结局数据有限。总体而言,研究结果与器官形成期预期的低暴露情况一致。豚鼠和兔子有可能作为替代非人类灵长类动物的“备选方案”,因为在妊娠后期它们的母胎转运水平与人类相似。基于人类IgG胎盘转运的模式,对于mAb的发育毒性研究,建议采用能够检测妊娠早期间接影响以及妊娠中期和晚期直接胎儿暴露影响的研究设计。