Protection of Newborn Macaques by Plant-Derived HIV Broadly Neutralizing Antibodies: a Model for Passive Immunotherapy during Breastfeeding.

Abstract

Preventing human immunodeficiency virus (HIV) infection in newborns by vertical transmission remains an important unmet medical need in resource-poor areas where antiretroviral therapy (ART) is not available and mothers and infants cannot be treated prepartum or during the breastfeeding period. In the present study, the protective efficacy of the potent HIV-neutralizing antibodies PGT121 and VRC07-523, both produced in plants, were assessed in a multiple-SHIV (simian-human immunodeficiency virus)-challenge breastfeeding macaque model. Newborn macaques received either six weekly subcutaneous injections with PGT121 alone or as a cocktail of PGT121-LS plus VRC07-523-LS injected three times every 2 weeks. Viral challenge with SHIVSF162P3 was twice weekly over 5.5 weeks using 11 exposures. Despite the transient presence of plasma viral RNA either immediately after the first challenge or as single-point blips, the antibodies prevented a productive infection in all babies with no sustained plasma viremia, compared to viral loads ranging from 103 to 5 × 108 virions/ml in four untreated controls. No virus was detected in peripheral blood mononuclear cells (PBMCs), and only 3 of 159 tissue samples were weakly positive in the treated babies. Newborn macaques proved to be immunocompetent, producing transient anti-Env antibodies and anti-drug antibody (ADA), which were maintained in the circulation after passive broadly neutralizing antibody clearance. ADA responses were directed to the IgG1 Fc CH2-CH3 domains, which has not been observed to date in adult monkeys passively treated with PGT121 or VRC01. In addition, high levels of VRC07-523 anti-idiotypic antibodies in the circulation of one newborn was concomitant with the rapid elimination of VRC07. Plant-expressed antibodies show promise as passive immunoprophylaxis in a breastfeeding model in newborns. IMPORTANCE Plant-produced human neutralizing antibody prophylaxis is highly effective in preventing infection in newborn monkeys during repeated oral exposure, modeling virus in breastmilk, and offers advantages in cost of production and safety. These findings raise the possibility that anti-Env antibodies may contribute to the control of viral replication in this newborn model and that the observed immune responsiveness may be driven by the long-lived presence of immune complexes.

• Authors: Yvonne J Rosenberg, Xiaoming Jiang, Tracy Cheever, Felicity J Coulter, Shilpi Pandey, Markus Sack, Lingjun Mao, Lori Urban, Jonathan Lees, Miranda Fischer, Jeremy Smedley, Heather Sidener, Jeffrey Stanton, Nancy L Haigwood
• Journal: Journal of virology (J Virol) Vol. 95 Issue 18 Pg. e0026821 (08 25 2021) ISSN: 1098-5514 [Electronic] United States
• PMID: 34190597 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Broadly Neutralizing Antibodies

Topics

• Animals
• Animals, Newborn
• Breast Feeding
• Broadly Neutralizing Antibodies (immunology)
• Female
• HIV Infections (immunology, therapy, virology)
• HIV-1 (physiology)
• Immunization, Passive (methods)
• Leukocytes, Mononuclear (immunology, virology)
• Macaca mulatta
• Male
• Simian Acquired Immunodeficiency Syndrome (immunology, therapy, virology)
• Simian Immunodeficiency Virus (immunology)
• Tobacco (immunology, virology)
• Viremia (immunology, therapy, virology)