Introduction: Regulatory T cells (Tregs) are crucial for maintaining immune tolerance and their dysfunction contributes to inflammatory and autoimmune conditions, such as graft versus host disease (GVHD). IL-2 is a pleiotropic cytokine that activates both immunosuppressive Tregs and inflammatory cells, including NK cells, cytotoxic T cells, and helper T cells. Although low dose IL-2 therapy effectively expands Tregs, this intervention is limited by coincident stimulation of conventional T cells and natural killer cells. Investigational therapeutics derived from directed mutagenesis of native IL-2 sequences have resulted in some improvements in Treg selectivity. To optimize the magnitude and selectivity of Treg expansion, we utilized de novo protein design technology to fine-tune the individual receptor interfaces of IL-2 mimetic proteins targeted to Tregs with CD25 antibodies. We found decoupling receptor agonism and targeting is an effective means of improving Treg stimulation and corresponding therapeutic candidates elicit robust expansion of Treg populations in vivo without detectable stimulation of inflammatory immune cells. Methods: We designed a series of de novo IL-2Ra independent agonists of the IL-2 receptor that demonstrate reduced binding affinity to CD122 and CD132, the beta and gamma chains of the IL-2 receptor complex, by up to 5 logs when compared to IL-2. These non-alpha IL-2 mimetic variants were fused to a humanized anti-CD25 mAb that lacks effector function for cis-targeting to Tregs. Candidate molecules were screened on primary human T cells to assess pSTAT5 signaling. Treg-specific molecules were administered to humanized NSG mice weekly (four times) and peripheral blood was collected for immune cell profiling via flow cytometry. Results: Screening of TRA candidates in primary human T cells identified several highly selective Treg agonists, including NEO-TRA1 (Fig1). At all concentrations, CD8+ and CD4+ non-Tregs showed low or negligible levels of pSTAT5 signaling upon treatment with NEO-TRA1. Nevertheless, CD4+CD25highCD127low Tregs show increasing pSTAT5 signaling at a wide range of concentrations starting at 20pM, and demonstrate preferential signaling in Tregs by NEO-TRA1. To establish the ability of our TRA to expand Treg in vivo, NSG mice engrafted with human hematopoietic stem cells to create a humanized immune system received weekly injections of NEO-TRA1, vehicle control, or a previously described Treg selective IL-2 mutein (IL-2v-Fc). Characterization of Day 13 CD4+CD25+Foxp3+ Treg percentages in peripheral blood mononuclear cells show that the Treg population expanded to ~30% of total CD4+ cells in mice receiving NEO-TRA1, while Treg percentages reached ~22% in mice receiving IL-2v-Fc (Fig2). Despite a slight decrease at Day 20, the Treg percentages remained higher in NEO-TRA1-treated cohorts than in control groups throughout the study. Conclusions: NEO-TRA1 exhibits potent expansion of Treg populations within primary human samples and in humanized mouse models. The observed profile of STAT5 phosphorylation demonstrates selective activation of Tregs over other lymphocyte populations. NEO-TRA1 is the first Treg agonist based on de novo protein design. NEO-TRA1 is both specific and potent and has high therapeutic potential for the treatment of GVHD and other autoimmune or inflammation diseases. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Antibody-drug conjugates (ADC) leverage the specificity of antibodies to direct the delivery of potent cytotoxic agents to cancer cells. To fully leverage this specificity, targets with significant differential tumor versus normal tissue expression are ideal for ADC development. Placental alkaline phosphatases, ALPP and ALPPL2, are proteins present during fetal development but are found in several tumor types, making them an attractive ADC target. These cell membrane-attached phosphatases form homo- and heterodimers and play key roles in nucleotide recycling. SGN-ALPV is a novel investigational vedotin ADC comprised of a humanized IgG1 monoclonal antibody conjugated to the microtubule disrupting agent monomethyl auristatin E (MMAE) via a protease-cleavable peptide linker that has been clinically validated in multiple ADC programs. Here we characterize the target antigens, ALPP and ALPPL2, and evaluate SGN-ALPV antitumor activity in preclinical models. Immunohistochemistry and genomic data mining showed that ALPP and ALPPL2 have a highly restricted normal tissue expression yet high expression in several solid tumor types including ovarian, endometrial, germ cell, non-small cell lung and gastric carcinomas. Importantly, normal tissue expression is restricted to placenta and reproductive tissue, with low levels in lung tissue. SGN-ALPV utilizes a humanized antibody, h12F3, that is highly specific for both human and cynomolgus monkey ALPP and ALPPL2 proteins, but not other related phosphatases. In vitro, upon binding to SGN APLV, the antigens, ALPP and ALPPL2, are internalized to lysosomal vesicles releasing the MMAE payload, whose cytotoxic features drive mitotic arrest, apoptosis, and the induction of immunogenic cell death. Additionally, SGN-ALPV mediates antibody dependent cellular cytotoxicity (ADCC) and antibody-dependent cellular phagocytosis (ADCP) in vitro but lacks complement-dependent cytotoxicity. In preclinical studies, SGN-ALPV exhibits robust antitumor activity in cell line- and patient-derived xenograft models of ovarian, lung, pancreatic, and gastric carcinoma including models with both homogenous and heterogeneous expression of ALPP and ALPPL2, consistent with robust bystander activity of vedotin ADCs. Although, the contribution of ADCC and ADCP in vivo is currently unknown, it is expected that the antitumor activity of SGN-ALPV is mediated by MMAE cytotoxicity. SGN-ALPV was well tolerated in non-human primates (NHP) and exhibited linear pharmacokinetic characteristics, with a toxicity profile consistent with other vedotin-based ADCs. In summary, differential expression of ALPP and ALPPL2 in the tumor versus normal tissue, antibody specificity, antitumor activity, and tolerability of SGN-ALPV provide a strong rationale for the initiation of a planned first-in-human Phase 1 clinical study. Citation Format: Sarah Anderson, Nanna Hansen, Robert Lawrence, Aroon T. Chande, David Ortiz, Christopher Carosino, Esther Trueblood, Nicole Stevens, Kerry Klussman, Angela Epp, Bill Arthur, Shyra Gardai, Hector Rincon. SGN-ALPV a novel, investigational vedotin ADC demonstrates highly effective targeting of oncofetal phosphatases ALPP and ALPPL2 in preclinical models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1766.

Abstract Targeting glyco-epitopes with antibody-drug conjugates (ADCs) provides a unique advantage as multiple cell surface proteins expressing the same carbohydrate can be harnessed to deliver drug. Sialyl-Thomsen nouveau (STn) is a tumor associated carbohydrate antigen that has historically been difficult to target with specificity. Using glycan array screening, h2G12 was identified as a highly specific human IgG1 antibody, that exclusively binds the STn glyco-epitope independent of protein backbone. Here we introduce SGN-STNV, an investigational antibody-drug conjugate (ADC) targeting monomethyl auristatin E (MMAE) to STn expressing tumor cells with the clinically validated vedotin linker technology. STn has restricted normal tissue expression and is expressed on various solid tumors including ovarian, non-small cell lung, gastric, and endometrial carcinomas. Our work shows correlation of enzyme ST6GALNAC1 expression with STn expression on tumors. Given the frequent O-glycosylation of mucins, we also confirmed high STn expression in mucinous subtypes of ovarian, pancreatic, colorectal, and lung adenocarcinomas. Previous reports have confirmed STn is found on mucins MUC1, MUC5A, and MUC16 (CA-125), as well as cell surface receptors CD44 and integrin β1. These proteins are known to play functional roles in tumor progression and, importantly for ADC delivery, they internalize well to deliver cytotoxic payload. We sought to identify other proteins that may contribute to cytotoxic activity of SGN-STNV and determined that additional surface receptors are tagged with STn. These receptors are internalized and likely contribute to SGN-STNV activity. After binding to STn, SGN-STNV is internalized into cells and releases the microtubule inhibitor MMAE to drive mitotic arrest, apoptosis, and to induce immunogenic cell death. SGN-STNV further mediates anti-tumor response through Fc-mediated effector functions, including antibody-dependent cellular cytotoxicity (ADCC) and antibody-dependent cellular phagocytosis (ADCP). In preclinical xenograft studies, SGN-STNV monotherapy treatment leveraged h2G12 specificity and ability to target STn on multiple tumor associated proteins to drive durable tumor regressions. SGN-STNV was well tolerated in non-human primates (NHP), with no concerning target-mediated toxicities and a maximum tolerated dose similar to other vedotin-platform ADCs. In summary, the antibody specificity, unique mechanism of targeting a carbohydrate, anti-tumor activity, and tolerability provide a strong rationale for initiation of a phase I study to investigate the therapeutic potential of SGN-STNV. Citation Format: Alyssa Schwartz, Hector Rincon, Nanna Hansen, Robert Lawrence, Sarah Anderson, Nicole Blesie, Kerry Klussman, Angela Epp, Shyra Gardai, William Arthur. Targeting Sialyl-Thomsen nouveau (STn) antigen with the SGN-STNV antibody-drug conjugate is effective in preclinical studies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 50.