Abstract 1362: IOMX-0675, a LILRB1 and LILRB2 cross-specific antibody, effectively repolarizes immunosuppressive myeloid cells and activates T cells leading to potent tumor cell killing
Authors: Hartl Christina , Zantow Jonas , Maser Ilona-Petra , Stebegg-Wagner Marisa , Friedrich Simone , Schilz Jonas , Kaden Stefan , Milde Ronny , Korotkova Eugenia , Maraslis Michail , Langer Bettina , Swiat Michal , Ginzel Carmen , Ammerhauser Carmen , Albert Lucille , Majunke Leonie , Huth Alina , Sudan Kritika , Yule Murray , Rothe Christine , Loferer Hannes , Aigner Maximilian , Marziale Alexander N. , Bissinger Stefan 
Published: March 2024

Abstract
Recently, myeloid checkpoints in the tumor microenvironment have gained increased attention in the context of tumor immune evasion. LILRB1 (ILT2) and LILRB2 (ILT4) are immunosuppressive receptors of the leukocyte immunoglobulin-like receptor (LILR) family that recognize both classical and non-classical MHC-I molecules (e.g., HLA-G). While tumor-infiltrating myeloid cells express both LILRB1 and LILRB2, lymphoid cells are restricted to LILRB1 expression. LILRB1 and LILRB2 are frequently co-expressed with immune-activating LILR family members LILRA1 and LILRA3 in several tumor indications and upregulated in patients non-responsive to T cell checkpoint blockade. Furthermore, the non-classical MHC-I molecule HLA-G, a major ligand of LILRB1 and LILRB2 in the tumor environment, is overexpressed and associated with poor prognosis in multiple solid cancer types.
IOMX-0675, a fully human, Fc-silenced, monoclonal immunoglobulin G1 (IgG1) antibody with a highly differentiated binding profile, that binds selectively with high affinity to the inhibitory receptors LILRB1 and LILRB2, while binding only weakly to the closely related immune-activating LILR family members LILRA1 and LILRA3, was identified from iOmx’ proprietary phage display library. A high-resolution Fab-based Octet assay was established to monitor the IOMX-0675-mediated blocking of LILRB1 or LILRB2 binding to HLA-G. The LILRB1/2 cross-specific antibody promotes phagocytic and pro-inflammatory activity of various macrophage subtypes, which was monitored by flow cytometry and cytokine profiling. In co-cultures of monocyte-derived macrophages with autologous T cells, IOMX-0675 shows high potential to reprogram dose-dependently immunosuppressive macrophage, to further activate pro-inflammatory macrophage subtypes and thereby rescues the activity of the lymphoid immune compartment. Even in environments dominated by LILRA1/A3, IOMX-0675 shows a strong binding capacity to the immunosuppressive LILRB1/B2 receptors and significantly repolarizes the immune environment.
In summary, we discovered IOMX-0675, a cross-specific antibody antagonizing both LILRB1 and LILRB2 with high selectivity, that exhibits potent reprogramming of the immunosuppressive myeloid compartment and restores cytotoxic T cell activity in the tumor microenvironment. Negligible binding to immune-activating LILR family members by IOMX-0675 could unleash full anti-tumor activity. The differential binding profile of IOMX-0675 provides best-in-class potential and may maximize anti-tumor efficacy for the benefit of patients with high-unmet medical need, who are resistant to T cell checkpoint blockade.
Citation Format: Christina Hartl, Jonas Zantow, Ilona-Petra Maser, Marisa Stebegg-Wagner, Simone Friedrich, Jonas Schilz, Stefan Kaden, Ronny Milde, Eugenia Korotkova, Michail Maraslis, Bettina Langer, Michal Swiat, Carmen Ginzel, Carmen Ammerhauser, Lucille Albert, Leonie Majunke, Alina Huth, Kritika Sudan, Murray Yule, Christine Rothe, Hannes Loferer, Maximilian Aigner, Alexander N. Marziale, Stefan Bissinger. IOMX-0675, a LILRB1 and LILRB2 cross-specific antibody, effectively repolarizes immunosuppressive myeloid cells and activates T cells leading to potent tumor cell killing [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1362.