Accelerated blood clearance and hypersensitivity by PEGylated liposomes containing TLR agonists

Systemic administration of toll-like receptor (TLR) agonists have demonstrated impressive preclinical results as an anti-cancer therapy due to their potent innate immune-stimulatory properties. The clinical advancement has, however, been hindered by severe adverse effects due to systemic activation of the immune system. Liposomal drug delivery systems may modify biodistribution, cellular uptake, and extend blood circulation, and thus, potentially enable systemic administration of TLR agonists at therapeutic doses. In this study, we investigated potential barriers for the administration of TLR agonists formulated in polyethylene glycosylated (PEGylated) liposomes with regards to liposome formulation, TLR agonist, administration route, administration schedule, biodistribution, blood clearance, and anti-PEG antibodies. We found that administration of TLR agonists formulated in PEGylated liposomes led to high anti-PEG antibody titers, which upon multiple intravenous administrations, resulted in accelerated blood clearance and acute hypersensitivity reactions. The latter was found to be associated with anti-PEG IgG antibody and not anti-PEG IgM antibody opsonization. This study highlights the need to carefully design and evaluate nanoparticle delivery systems for immunotherapy as anti-nanoparticle immune responses may challenge the therapeutic application. Created with BioRender.com . • TLR agonists formulated in PEGylated liposomes induce anti-PEG antibodies. • Repeated dosing leads to accelerated blood clearance and hypersensivity reactions. • The accelerated blood clearance cannot be avoided by increasing liposome dose. • The severe hypersensitivity reactions appear 5–15 min after the third dose. • The hypersensitivity reaction may be caused by anti-PEG IgG antibodies.