Methicillin-resistant Staphylococcus aureus (MRSA) colonize the nasopharynx and GI tract of healthy individuals and of patients admitted to hospitals. Colonization is the key risk factor for community-acquired and hospital-acquired MRSA invasive diseases. MRSA infection is associated with treatment failure, increased morbidity, and increased mortality. Prior attempts to develop vaccines or immune therapeutics that can prevent MRSA colonization or invasive disease or that improve the outcome of MRSA infections have failed. Infected individuals cannot develop protective antibody responses (immunity), which enables MRSA to persist within host tissues and to cause recurrent disease. MRSA immune escape is based on immunoglobulinbinding proteins, specifically staphylococcal protein A (SpA) and staphylococcal binder of immunoglobulin (Sbi). SpA and Sbi block effector functions of human IgG by binding to the Fc? domain of antibodies. SpA also binds to the variant heavy chains of VH3-idiotypic immunoglobulin and crosslinks IgM B cell receptors, thereby activating B cell proliferation and the secretion of VH3-clonal antibodies that fail to recognize MRSA. This B cell superantigen activity (BCSA) of SpA is essential for the diversion of antibody responses during MRSA colonization and invasive disease. Here we describe a monoclonal antibody, MAb 3F6, that binds and neutralizes SpA and Sbi. We show that MAb 3F6 galactosylation at Fc? promotes C1q binding, MAb 3F6- dependent opsonophagocytic killing (OPK) of MRSA and protection of mice against MRSA bloodstream infection. Further, we isolated amino acid substitutions in Fc? that abolish SpA and Sbi binding and enhance the OPK activity of variant MAb 3F6. We also report that SpA is essential for suppression of antibody responses (BCSA) against bacterial colonization factors, thereby enabling S. aureus persistence in the nasopharynx and GI tract. Intravenous administration of MAb 3F6 into mice neutralizes circulating SpA and blocks its BCSA, thereby promoting antibody responses against bacterial surface antigens and the removal of S. aureus from the nasopharynx and GI tract. Here, we will test the hypotheses that intravenous administration of glyco- and Fc?-engineered human 3F6-IgG1 in preclinical models a) elicits broad spectrum antibody responses against S. aureus, b) promotes decolonization of MSSA and MRSA, c) induces immunity to prevent re-colonization as well as invasive MSSA and MRSA disease, and d) improves the outcome of MRSA bloodstream infections. Glyco- and Fc?engineered 3F6 antibodies that achieve such product profile can be developed further for clinical testing to prevent and treat MRSA infections in American hospitals.

Public Health Relevance

Antibiotic-resistant Staphylococcus aureus (MRSA) persistently colonize humans, which represents the key risk factor for community- and hospital-acquired infections with poor clinical outcomes. Capitalizing on new insights into S. aureus immune evasion, this proposal combines the skills of three investigators to generate human monoclonal antibodies that neutralize staphylococcal protein A (SpA), resist bacterial interference with antibody effector functions and promote opsonophagocytic killing of MRSA. Preclinical testing will identify antibodies with product profiles of 1) promoting broad spectrum antibody responses against MRSA, 2) clearing S. aureus from colonized individuals, 3) inducing persistent immunity to colonization and invasive disease, and 4) improving the outcome of MRSA bloodstream infections.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Research Project (R01)
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Immunity and Host Defense (IHD)
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Xu, Zuoyu
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University of Chicago
Schools of Medicine
United States
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