Structure and humanization of a rat monoclonal Fab to human interleukin-5

Biologic targeted therapy in allergic asthma

OBJECTIVE

To review the structure, function, clinical utility, and safety of current biologic targeted therapies being used for the treatment of asthma.

DATA SOURCES

Medical literature obtained from PubMed and OVID searches from June to November 2013.

STUDY SELECTIONS

Studies were selected based on article impact, relevance, and clinical significance. Particular emphasis was placed on articles discussing therapies targeted at IgE, interleukin (IL)-4, IL-4 receptor, IL-5, IL-13, tumor necrosis factor-α, CRTh2, and toll-like receptors 7 and 9.

RESULTS

Since the approval of omalizumab in 2003, the development of biologic asthma therapies has grown at a remarkable pace. With approximately 30 drugs currently in clinical trials and dozens more in development, the future of asthma biologic therapies is promising. Despite several well-publicized setbacks, researchers remain focused on elucidating the complex pathophysiology of asthma. The hope is that asthma biologic therapies will eventually be tailored to an individual's asthma phenotype. With more than 300 million people worldwide affected by asthma and with roughly 5% to 10% of this population living with severe, uncontrolled asthma, the need for new biologic therapies is great.

CONCLUSION

The introduction of each new biologic therapy into clinical trials has been associated with great anticipation, but the outcome of these trials, in many cases, has led to disappointment. Given the lack of overwhelming positive responses, these results have emphasized that asthma is a complex clinical syndrome with multiple underlying genotypes and clinical phenotypes. It has become abundantly clear that it is very unlikely that there is one "magic bullet" to cure all patients with asthma.

Profile of reslizumab in eosinophilic disease and its potential in the treatment of poorly controlled eosinophilic asthma

Eosinophils are important proinflammatory cells that make a major contribution to the inflammation seen in allergic diseases including asthma. Interleukin-5 is central to eosinophil maturation, release from the bone marrow, and subsequent accumulation, activation, and persistence in the tissues. Reslizumab (Cinquil™) is a humanized monoclonal antibody with potent interleukin-5 neutralizing effects, which represents a potential treatment for poorly controlled eosinophilic asthma. This review will consider the current status of the clinical development of reslizumab for asthma and in other inflammatory diseases with a marked eosinophilic component.

Reslizumab for pediatric eosinophilic esophagitis

Pediatric eosinophilic esophagitis is an inflammatory condition associated with marked eosinophil accumulation in the mucosal tissues of the esophagus. Eosinophils are major proinflammatory cells thought to make a major contribution to allergic diseases that affect the upper and lower airways, skin and GI tract. IL-5 is central to eosinophil maturation and release from the bone marrow, and their subsequent accumulation, activation and persistence in the tissues. Reslizumab (Cinquil, Ception Therapeutics Inc., PA, USA) is a humanized monoclonal antibody with potent IL-5 neutralizing effects that represents a potential treatment for eosinophilic diseases. This article considers the current status of the clinical development of reslizumab for pediatric eosinophilic esophagitis.

Mapping and characterization of the epitope(s) of Sch 55700, a humanized mAb, that inhibits human IL-5

mAb against human IL-5 inhibit pulmonary eosinophilia, tissue damage and airway hyper-reactivity in allergic animal models. Sch 55700 is a humanized, neutralizing anti-IL-5 antibody. To better understand the molecular mechanism by which Sch 55700 blocks IL-5 bioactivity, we have mapped its epitope by scanning IL-5 with synthetic peptides. Those peptides containing a region, ERRRV, corresponding to amino acids 89-93 of IL-5 specifically interact with both Sch 55700 and its parental rat IgG, 39D10. Among the five residues of this region, all three arginine residues were particularly critical for interaction of these peptides with Sch 55700. We further characterized this region by alanine scanning using site-directed mutagenesis. Examination of COS-expressed IL-5 mutants by Western blot showed that single mutations of E(89), R(90), R(91) or R(92) to alanine caused a loss of IL-5 binding to both Sch 55700 and 39D10. We further demonstrated in surface plasmon resonance studies using a BIAcore biosenosor that E(89), R(90) or R(91) are involved in the interaction between IL-5 and its receptor alpha subunit. Based upon the findings here and previously reported structures of the IL-5 and 39D10 variable region, we propose a model suggesting that the molecular interactions between the IL-5 and Sch 55700 mainly involve several ion pair interactions. We conclude that Sch 55700 occupies a region, ERRR, on IL-5 that is essential for its interaction with the receptor and thereby blocks IL-5 bioactivity.