Novartis Pharma AG, Basel, Switzerland.
Neurological Clinic and Policlinic, University Hospital Basel, Basel, Switzerland.
Front Immunol. 2019 Jun 20;10:1340. doi: 10.3389/fimmu.2019.01340. eCollection 2019.
Ofatumumab is the first, fully human, anti-CD20 monoclonal antibody in Phase 3 development for multiple sclerosis (MS). The study focused on changes in lymphocyte subsets in blood and lymphoid tissues and on potential novel biomarkers as a result of anti-CD20 antibody action in Cynomolgus monkeys treated with human equivalent doses of subcutaneous (s.c.) ofatumumab on Days 0, 7, and 14. Axillary lymph nodes (LNs) and blood samples were collected at various time points until Day 90. Lymphocyte subsets were quantified by flow cytometry, while morphological and immune cell changes were assessed by imaging mass cytometry (IMC), immunohistochemistry (IHC), in situ hybridization (ISH), and transcriptome analyses using single-cell methodology. Ofatumumab treatment resulted in a potent and rapid reduction of B cells along with a simultaneous drop in CD20 T cell counts. At Day 21, IHC revealed B-cell depletion in the perifollicular and interfollicular area of axillary LNs, while only the core of the germinal center was depleted of CD20CD21 cells. By Day 62, the perifollicular and interfollicular areas were abundantly infiltrated by CD21 B cells and this distribution returned to the baseline cytoarchitecture by Day 90. By IMC CD20CD3CD8 cells could be identified at the margin of the follicles, with a similar pattern of distribution at Day 21 and 90. Single-cell transcriptomics analysis showed that ofatumumab induced reversible changes in t-distributed stochastic neighbor embedding (t-SNE) defined B-cell subsets that may serve as biomarkers for drug action. In summary, low dose s.c. ofatumumab potently depletes both B cells and CD20 T cells but apparently spares marginal zone (MZ) B cells in the spleen and LN. These findings add to our molecular and tissue-architectural understanding of ofatumumab treatment effects on B-cell subsets.
奥法妥木单抗是首款处于 III 期开发阶段的用于多发性硬化症(MS)的全人源抗 CD20 单克隆抗体。该研究主要关注接受皮下给予相当于人体剂量的奥法妥木单抗(在第 0、7 和 14 天给药)的食蟹猴血液和淋巴组织中淋巴细胞亚群的变化,以及作为抗 CD20 抗体作用的结果出现的潜在新型生物标志物。在第 0、7、14、21、28、42、56、62、84 和 90 天采集腋窝淋巴结(LN)和血液样本。通过流式细胞术定量分析淋巴细胞亚群,通过成像质谱流式细胞术(IMC)、免疫组织化学(IHC)、原位杂交(ISH)和单细胞方法进行转录组分析,评估形态和免疫细胞变化。奥法妥木单抗治疗导致 B 细胞迅速且大量减少,同时 CD20 T 细胞计数也下降。在第 21 天,IHC 显示在腋窝 LN 的滤泡周围和滤泡间区出现 B 细胞耗竭,而只有生发中心的核心耗尽了 CD20CD21 细胞。在第 62 天,滤泡周围和滤泡间区大量浸润 CD21 B 细胞,到第 90 天,该分布恢复到基线细胞结构。通过 IMC 可以在滤泡边缘鉴定出 CD20CD3CD8 细胞,在第 21 天和第 90 天具有相似的分布模式。单细胞转录组学分析显示,奥法妥木单抗诱导 t 分布随机邻嵌入(t-SNE)定义的 B 细胞亚群的可逆变化,这些变化可能作为药物作用的生物标志物。总之,皮下给予低剂量的奥法妥木单抗可有效地耗竭 B 细胞和 CD20 T 细胞,但显然在脾脏和 LN 中保留了边缘区(MZ)B 细胞。这些发现增加了我们对奥法妥木单抗治疗对 B 细胞亚群作用的分子和组织结构理解。
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