P166 Optimizing PD-1 agonist signaling with membrane proximal binding of rosnilimab, a clinical stage PD-1 agonist IgG1 antibody

Abstract Background Checkpoint agonism represents a promising class of therapies for the treatment of autoimmune and inflammatory diseases, including ulcerative colitis (UC), where unmet needs persist despite available therapies. Binding to membrane proximal regions of checkpoint receptors, together with Fc interactions with receptors on opposing cells, can contribute to tight immune synapse formation between the immune cell and antigen presenting cell. This has been proposed to improve potency of agonistic signaling by excluding phosphatases such as CD45 from the immune synapse and promoting receptor clustering. Optimization of these characteristics results in improved agonism and depletion, with the potential for restoration of immune balance and broader clinical outcomes. Rosnilimab was engineered to leverage these important characteristics. It is a PD-1 agonist IgG1 antibody designed to optimize inhibitory signaling through the PD-1 receptor and to deplete PD-1high pathogenic T cells. Rosnilimab is in Phase 2 clinical development for UC and rheumatoid arthritis. Methods Mutations to surface exposed regions of the PD-1 extracellular domain were made and surface plasmon resonance was used to infer the epitopes of PD-1 agonist molecules from resulting changes to binding. Membrane proximal and distal binding antibodies were studied in in vitro functional assays to assess T cell proliferation and antibody-dependent cellular toxicity. Results Epitopes of agonistic antibodies were mapped to locations on the PD-1 receptor. The membrane proximal binding epitope of rosnilimab was confirmed and binding epitopes for other reference antibodies (ref) were identified. Rosnilimab and a membrane distally binding antibody (ref 1) were selected for comparison in functional assays. Rosnilimab demonstrated greater reduction of T cell proliferation and depletion of PD-1+ T cells compared to ref 1, consistent with the hypothesis that membrane proximal binding improves agonistic activity and target cell depletion. Conclusion By targeting and leveraging inhibitory immune regulatory mechanisms to modulate the pathogenic T cells driving disease, there is an opportunity to dampen the inflammatory cycle and restore immune balance via agonism. Rosnilimab binds to a membrane proximal region of the PD-1 receptor, resulting in potent reduction of T cell proliferation and depletion of PD-1high T cells. These mechanistic data, translational in vivo and in vitro data, robust Phase 1 healthy volunteer data, and unmet needs in UC provide rationale for an ongoing global Phase 2 study of rosnilimab in UC (NCT06127043).