Diago-Navarro, E. | bioRxiv Science

bioRxiv2020

SERUM ANTIBODY RESPONSES AGAINST CARBAPENEM-RESISTANT KLEBSIELLA PNEUMONIAE IN INFECTED PATIENTS

BackgroundCapsular polysaccharide (CPS) heterogeneity within carbapenem-resistant Klebsiella pneumoniae (CR-Kp) strain ST258 must be considered when developing CPS-based vaccines. We sought to characterize CPS-specific antibody responses elicited by CR-Kp infected patients. MethodPlasma and bacterial isolates were collected from 33 hospital patients with positive CR-Kp culture. Isolates capsule were typed by wzi sequencing. Reactivity and measures of efficacy of patient antibodies were studied against 3 prevalent CR-Kp CPS types (wzi29, 154 and 50). ResultsHigh IgG titers against wzi154 and wzi50 CPS were documented in 79% of infected patients. Patient-derived (PD) IgGs agglutinated CR-Kp and limited growth better than naive IgG, and promoted phagocytosis of strains across the serotype isolated from their donors. Additionally, poly-IgG from wzi50 and wzi154 patients promoted phagocytosis of non-concordant CR-Kp serotypes. Such effects were lost when poly-IgG was depleted of CPS-specific IgG. Additionally, mice infected with wzi50, wzi154, and wzi29 CR-Kp strains pre-opsonized with wzi50 patient-derived IgG exhibited lower lung CFU than controls. Depletion of wzi50 Abs reversed this effect in wzi50 and wzi154 infections, whereas wzi154 Ab depletion reduced Poly-IgG efficacy against wzi29 CR-Kp. ConclusionsWe are first to report cross-reactive properties of CPS-specific Abs from CR-Kp patients through both in-vitro and in-vivo models. ImportanceCarbapenem-resistant Klebsiella pneumoniae is a rapidly emerging public health threat that can cause fatal infections in ~40-50% of immunocompromised patients. Due to its resistance to nearly all antimicrobials, development of alternate therapies like antibodies and vaccines are urgently needed. Capsular polysaccharides are emerging as important immunotargets as they are a crucial for Klebsiella pneumoniae pathogenesis. Studying how hosts immune system protect against specific bacteria such as Klebsiella pneumoiniae, with respect to their specific capsule-type is crucial to develop effective anti-CPS immunotherapies. In this manuscript, we are the first to characterize humoral responses developed in infected patients against carbapenem-resistant Klebsiella pneumoniae expressing different wzi-capsule types. This study is the first to report efficacy of cross-reactive properties of CPS-specific Abs in both in-vitro and in-vivo models.

immunology↗

bioRxiv2020

The Role of IgG Subclass in Antibody-Mediated Protection against Carbapenem-Resistant Klebsiella pneumoniae

Monoclonal antibodies (Abs) have the potential to assist in the battle against multidrug-resistant bacteria such as Carbapenem-Resistant Klebsiella pneumoniae (CR-Kp). However, the characteristics by which these Abs function, such as the role of antibody subclass, must be determined before such modalities can be carried from the bench to the bedside. We performed a subclass switch on anti-capsular monoclonal murine IgG3 (mIgG3) hybridomas and identified and purified a murine IgG1 (mIgG1) hybridoma line through sib selection. We then compared the ability of the mIgG1 and mIgG3 antibodies to control CR-Kp ST258 infection both in vitro and in vivo. We found by ELISA and flow cytometry that mIgG3 has superior binding to CR-Kp CPS and superior agglutinating ability compared to mIgG1. The mIgG3 also predictably had better complement-mediated serum bactericidal activity than the mIgG1 and also promoted neutrophil-mediated killing at concentrations lower than the mIgG1. In contrast, the mIgG1 had marginally better activity in improving macrophage-mediated phagocytosis. Comparing their activities in a pulmonary infection model with wild type as well as neutropenic mice, both antibodies reduced organ burden in a non-lethal challenge, regardless of neutrophil status, with mIgG1 having the highest overall burden reduction in both scenarios. However, at a lethal inoculum, both antibodies showed reduced efficacy in neutropenic mice, with mIgG3 retaining the most activity. These findings suggest the viability of monoclonal Ab adjunctive therapy in neutropenic patients that cannot mount their own immune response, while also providing some insight into the relative contributions of immune mediators in CR-Kp protection. ImportanceCarbapenem-resistant Klebsiella pneumoniae is an urgent public health threat that causes life-threatening infections in immunocompromised hosts. Its resistance to nearly all antibiotics necessitates novel strategies to treat it, including the use of monoclonal antibodies. Monoclonal antibodies are emerging as important adjuncts to traditional pharmaceuticals, and studying how they protect against specific bacteria such as Klebsiella pneumoniae is crucial to their development as effective therapies. Antibody subclass is often overlooked but is a major factor in how an antibody interacts with other mediators of immunity. This paper is the first to examine how the subclass of anti-capsular monoclonal antibodies can affect efficacy against CR-Kp. Additionally, this work sheds light on the viability of monoclonal antibody therapy in neutropenic patients, who are most vulnerable to CR-Kp infection.

immunology↗