title: Off-target platelet activation in macaques unique to a therapeutic monoclonal antibody.
abstract: AMG X, a human neutralizing monoclonal antibody (mAb) against a soluble human protein, caused thrombocytopenia, platelet activation, reduced mean arterial pressure, and transient loss of consciousness in cynomolgus monkeys after first intravenous administration. In vitro, AMG X induced activation in platelets from macaque species but not from humans or baboons. Other similar mAbs against the same pharmacological target failed to induce these in vivo and in vitro effects. In addition, the target protein was known to not be expressed on platelets, suggesting that platelet activation occurred through an off-target mechanism. AMG X bound directly to cynomolgus platelets and required both the Fab and Fc portion of the mAb for platelet activation. Binding to platelets was inhibited by preincubation of AMG X with its pharmacological target or with anti-human Fc antibodies or by preincubation of platelets with AMG X F(ab')(2) or human immunoglobulin (IVIG). AMG X F(ab')(2) did not activate platelets. Thus, platelet activation required both recognition/binding of a platelet ligand with the Fab domain and interaction of platelet Fc receptors (i.e., FcγRIIa) with the Fc domain. These findings reflect the complexity of the mechanism of action of mAbs and the increasing awareness of potential for unintended effects in preclinical species.
authors.affiliation: Comparative Biology and Safety Sciences, Toxicology Sciences, Amgen Inc., Seattle, Washington 98119-3105, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Santostefano
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Kirchner
authors.forename: Christine
authors.initials: C
authors.lastname: Vissinga
authors.forename: Madeline
authors.initials: M
authors.lastname: Fort
authors.forename: Sean
authors.initials: S
authors.lastname: Lear
authors.forename: Wei-Jian
authors.initials: WJ
authors.lastname: Pan
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Prince
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Hensley
authors.forename: Duc
authors.initials: D
authors.lastname: Tran
authors.forename: Dan
authors.initials: D
authors.lastname: Rock
authors.forename: Hugo M
authors.initials: HM
authors.lastname: Vargas
authors.forename: Padma
authors.initials: P
authors.lastname: Narayanan
authors.forename: Remi
authors.initials: R
authors.lastname: Jawando
authors.forename: William
authors.initials: W
authors.lastname: Rees
authors.forename: James F
authors.initials: JF
authors.lastname: Reindel
authors.forename: Kai
authors.initials: K
authors.lastname: Reynhardt
authors.forename: Nancy
authors.initials: N
authors.lastname: Everds
mesh_terms: D061605:Administration, Intravenous; D000818:Animals; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000378:metabolism / Q000493:pharmacokinetics / Q000633:toxicity*; D001792:Blood Platelets / Q000187:drug effects* / Q000378:metabolism; D006801:Humans; D007022:Hypotension / Q000097:blood / Q000139:chemically induced; D007140:Immunoglobulin Fab Fragments / Q000378:metabolism; D007141:Immunoglobulin Fc Fragments / Q000378:metabolism; D008252:Macaca fascicularis; D008297:Male; D010215:Papio; D015539:Platelet Activation / Q000187:drug effects*; D010974:Platelet Aggregation / Q000187:drug effects; D011485:Protein Binding; D012701:Serotonin / Q000378:metabolism; D013575:Syncope / Q000097:blood / Q000139:chemically induced; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced; D013929:Thromboxane B2 / Q000378:metabolism
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D007141:Immunoglobulin Fc Fragments; D012701:Serotonin; D013929:Thromboxane B2