Despite the success of anti-CD20 monoclonal antibody (mAb) in the treatment of lymphoma, there remains considerable uncertainty about their mechanism(s) of action. Here, we show that certain of these reagents (rituximab and 1F5), which redistribute CD20 into membrane rafts, are bound efficiently by C1q, deposit C3b, and result in complement-dependent cytotoxicity (CDC). This activity is important in vivo, because complement depletion using cobra venom factor (CVF) markedly reduced the efficacy of rituximab and 1F5 in 2 lymphoma xenograft models. However, complement depletion had no effect on the potent therapeutic activity of B1, a mAb that does not redistribute CD20 into membrane rafts, bind C1q, or cause efficient CDC. Equivalent immunotherapy also occurred in the presence or absence of natural killer (NK) cells. Perhaps most surprising was the observation that F(ab) 2 fragments of B1 but not 1F5 were able to provide substantial immunotherapy, indicating that non-Fc-dependent mechanisms are involved with B1. In accordance with this, B1 was shown to induce much higher levels of apoptosis than rituximab and 1F5. Thus, although complement is important for the action of rituximab and 1F5, this is not so for B1, which more likely functions through its ability to signal apoptosis. (
IntroductionPrevious studies have suggested that several mechanisms might be involved in providing therapeutic efficacy through anti-CD20 reagents, including antibody-dependent cellular cytotoxicity (ADCC), complement-dependent cytotoxicity (CDC), and the induction of growth arrest or apoptosis. Currently, the bulk of the experimental evidence indicates that rituximab operates through conventional effector mechanisms measured by CDC and ADCC assays, the most conclusive data coming from work in primates showing that an immunoglobulin G4 (IgG4) variant of rituximab, unlike the chimeric IgG1 monoclonal antibody (mAb), was unable to deplete normal B cells. 1 The evidence that ADCC and Fc␥R are important in the therapeutic activity of rituximab comes from several sources, both clinical and experimental. In the former, it has been shown that patients with non-Hodgkin lymphoma (NHL) expressing the high-affinity 158V variant of the Fc␥RIIIa gene have better response rates after rituximab treatment than those carrying the low-affinity allotype. 2 Similar results have now been shown for the depletion of B cells with rituximab in systemic lupus erythematosus (SLE). 3 The importance of Fc␥R in vivo is also supported by elegant work from Clynes et al 4 that used Fc␥R-deficient mice, which indicated that Fc␥R on macrophages are critical to the ability of mAb to control subcutaneous B-cell lymphoma. Thus, there are clearly data to support a role for Fc␥R-bearing effectors in mediating the activity of anti-CD20 mAb. Although these experiments seem to indicate the importance of Fc␥R-expressing cells as cytotoxic effectors, the possible role of these cells in enhancing mAb and receptor cross-linking should not be ignored, as in vitro experiments show tha...