Harnessing the immune system via FcγR function in immune therapy: a pathway to next-gen mAbs

Abstract

The human fragment crystallizable (Fc)γ receptor (R) interacts with antigen-complexed immunoglobulin (Ig)G ligands to both activate and modulate a powerful network of inflammatory host-protective effector functions that are key to the normal physiology of immune resistance to pathogens. More than 100 therapeutic monoclonal antibodies (mAbs) are approved or in late stage clinical trials, many of which harness the potent FcγR-mediated effector systems to varying degrees. This is most evident for antibodies targeting cancer cells inducing antibody-dependent killing or phagocytosis but is also true to some degree for the mAbs that neutralize or remove small macromolecules such as cytokines or other Igs. The use of mAb therapeutics has also revealed a "scaffolding" role for FcγR which, in different contexts, may either underpin the therapeutic mAb action such as immune agonism or trigger catastrophic adverse effects. The still unmet therapeutic need in many cancers, inflammatory diseases or emerging infections such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires increased effort on the development of improved and novel mAbs. A more mature appreciation of the immunobiology of individual FcγR function and the complexity of the relationships between FcγRs and antibodies is fueling efforts to develop more potent "next-gen" therapeutic antibodies. Such development strategies now include focused glycan or protein engineering of the Fc to increase affinity and/or tailor specificity for selective engagement of individual activating FcγRs or the inhibitory FcγRIIb or alternatively, for the ablation of FcγR interaction altogether. This review touches on recent aspects of FcγR and IgG immunobiology and its relationship with the present and future actions of therapeutic mAbs.

Keywords: ADCC; Fc receptors; SARS-CoV-2; immune therapy; monoclonal antibodies; phagocytosis.

Figure 1

Graphical representation of the FcγR effector functions. (a) Natural killer cell antibody‐dependent cell‐mediated cytotoxicity via FcγRIIIa. (b) Antibody‐dependent cell‐mediated phagocytosis, and/or trogocytosis of large immune complexes, by professional phagocytes via activating FcγR such as FcγRIIIa and FcγRIIa. Biological sequelae include the destruction of the ingested complexes which may also feed antigen into antigen‐presentation pathways of antigen‐presenting cells (APCs). (c) Inhibition of cell activation by FcγRIIb. The immunoreceptor tyrosine activation motif (ITAM)‐mediated signaling of B‐cell antigen receptors (left) or of activating FcγR (right) on innate immune cells such as macrophages and basophils is inhibited by IgG Fc‐mediated co‐cross‐linking of these activating receptors with the inhibitory FcγRIIb. This leads to phosphorylation of the FcγRIIb immunoreceptor tyrosine‐based inhibitory motif (ITIM) and consequently recruits the phosphatases that modulate the ITAM‐driven signaling responses leading to diminished cell responses. (d) Sweeping or internalization of small immune complexes leading to their removal and, in APC, to enhanced immune responses. (e) Scaffolding in which the FcγRs play a passive role. Typically involving FcγRIIb, no signal is generated in the effector cell but “super‐cross‐linking” of the opsonizing antibody by the FcγR on one cell generates a signal in the conjugated target cell, for example, induction of apoptosis or activation in agonistic expansion of cells and/or their secretion of cytokines. In extreme cases, this leads to life‐threatening cytokine storm. ADCC, antibody‐dependent cell‐mediated cytotoxicity; Ag, antigen; BCR, B‐cell receptor; Ig, immunoglobulin; NK, natural killer.