The capacity of protein aggregates to enhance immune
responses to the monomeric form of the protein has been
known for over a half-century. Despite the clear connection
between protein aggregates and antibody mediated adverse
events in treatment with early therapeutic protein products
such as intravenous immune globulin (IVIG) and human
growth hormone, surprisingly little is known about the nature
of the aggregate species responsible for such effects. This
review focuses on a framework for understanding how aggregate
species potentially interact with the immune system to
enhance immune responses, garnered from basic immunologic
research. Thus, protein antigens presented in a highly
arrayed structure, such as might be found in large nondenatured
aggregate species, are highly potent in inducing antibody
responses even in the absence of T-cell help. Their
potency may relate to the ability of multivalent protein species
to extensively cross-link B-cell receptor, which (1) activates
B cells via Bt kinases to proliferate, and (2) targets
protein to class II major histocompatability complex (MHC)-
loading compartments, effi ciently eliciting T-cell help for
antibody responses. The review further focuses on protein
aggregates as they affect an immunogenicity risk assessment,
the use of animal models and studies in uncovering effects of
protein aggregates, and changes in product manufacture and
packaging that may affect generation of protein aggregates.
The capacity of protein aggregates to enhance immuneresponses to the monomeric form of the protein has beenknown for over a half-century. Despite the clear connectionbetween protein aggregates and antibody mediated adverseevents in treatment with early therapeutic protein productssuch as intravenous immune globulin (IVIG) and humangrowth hormone, surprisingly little is known about the natureof the aggregate species responsible for such effects. Thisreview focuses on a framework for understanding how aggregatespecies potentially interact with the immune system toenhance immune responses, garnered from basic immunologicresearch. Thus, protein antigens presented in a highlyarrayed structure, such as might be found in large nondenaturedaggregate species, are highly potent in inducing antibodyresponses even in the absence of T-cell help. Theirpotency may relate to the ability of multivalent protein speciesto extensively cross-link B-cell receptor, which (1) activatesB cells via Bt kinases to proliferate, and (2) targetsprotein to class II major histocompatability complex (MHC)-loading compartments, effi ciently eliciting T-cell help forantibody responses. The review further focuses on proteinaggregates as they affect an immunogenicity risk assessment,the use of animal models and studies in uncovering effects ofprotein aggregates, and changes in product manufacture andpackaging that may affect generation of protein aggregates.
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