We previously described the antigenic structure of both the VEEV E1 and E2 glycoproteins using mMAbs, as well as identifying viral epitopes most important in the murine protective response (
Mathews and Roehrig, 1982;
Mathews et al., 1985;
Roehrig and Mathews, 1985;
Roehrig et al.,1982). More recently, we mapped the VEEV epitopes recognized by hMAbs (
Hunt et al., 2010) and selected hMAb F5 nIgG, which has significant neutralizing ability and is specific for a unique E2 protein epitope, AA 115–119, for evaluation of its potential to provide either pre- or post-exposure protection from both SC and aerosol challenge with virulent VEEV TrD in a murine model.
The association of
in vitro neutralizing activity with
in vivo protection using anti-VEEV mMAbs or humanized mMAbs is well-documented (
Hunt et al., 2006;
Mathews and Roehrig, 1982;
Phillpotts, 2006;
Phillpotts et al., 2002). F5 nIgG had a VEEV TC-83 70% plaque-reduction neutralization endpoint of 12.5 ng/ml, which compares favorably to average endpoints of 29 and 100 ng/ml for humanized Hy4 IgG and mMAb 3B4C-4, respectively (
Hunt et al., 2006,
2010). Prophylactic administration of 100 µg or 500 µg of Hy4 resulted in significant protection from IP or IN VEEV challenge, respectively (
Hunt et al., 2006); thus, we expected F5 nIgG to provide prophylactic protection from SC or aerosol challenge with VEEV TrD in a similar manner. We found that prophylactic administration of 50 µg of F5 nIgG resulted in similar levels of protection from aerosol challenge as 500 µg of Hy4 IgG provided against IN VEEV challenge (
Hunt et al., 2006; ). As little as 100 ng of either Hy4 or F5 protected 90–100% of mice from lethal IP or SC challenge, and survivor sera contained significant murine anti-VEEV titers but little to no residual human antibody (
Hunt et al., 2006; ). Administration of 50 µg of prophylactic F5 nIgG resulted in complete protection and almost complete sterilizing immunity in mice that survived subsequent challenge with aerosolized VEEV, as evidenced by both the lack of a murine anti-VEEV humoral response in challenge survivors and the inability to detect infectious virus in most serum and brain samples collected on days 1 to 5 post-challenge (,). These data support results of previous studies with anti-VEEV neutralizing MAbs 1A4A-1, 1A3A-9, 1A3B-7 and 3B2A-9, which documented the protective capacity of mMAbs from SC and aerosol VEEV challenge (
Phillpotts, 2006;
Phillpotts et al., 2002).
We found that a dose of 500 µg F5 nIgG was effective in protecting mice 24 h after either SC or aerosol infection with VEEV TrD (). In our study, murine anti-VEEV titers in mice treated after SC virus infection were significantly higher than in mice infected by the aerosol route; no hIgG could be detected after 14 days in mice that survived SC challenge ().
Phillpotts et al. (2002) reported that 100 µg mMAb 1A3A-9 provided significant post-exposure protection to mice when administered 2 or 24 h, but not 72 h, following aerosol VEEV infection. They also showed that 24 h-post-exposure treatment of VEEV-infected mice with mMAb led to significant reductions in virus titers in peripheral organs for 5 days PI, but not in brains of about half of treated mice. This finding led the investigators to suggest that although MAb given prophylactically could prevent virus replication in the brain, therapeutic activity depended on both rapid clearance from the periphery and prevention of virus infection of the brain, and that treatment would have little effect once a CNS infection was established. We followed VEEV titers in tissue and serum samples from F5 nIgG-therapeutically treated and untreated mice for 6 days after aerosol infection and also found that infectious virus replication was controlled in the periphery, but not in the brain (). Demonstration of similar intensity and cell specificity of virus antigen expression in the brains of hMAb-treated and untreated mice was confirmed by detection of virus antigen in neurons by IHC (). Subsequently, we followed hMAb-treated mice for 28 days PI and found that infectious virus as well as viral RNA was cleared from brains by 14–28 days PI (). Despite initial high titers of virus in brains, none of the mice euthanized on days 7, 14, or 28 following infection showed any clinical signs of disease.
We have not yet investigated a possible increase in pharmacologic potency by administering a mixture of MAbs Hy4 IgG and F5 nIgG. Mixing of mMAbs 1A4A-1 and 1A3A-9 demonstrated no enhanced efficacy when used for treatment (
Phillpotts et al., 2002). Because F5 and Hy4 bind to different regions on the E2 protein it is feasible that this mixture might show enhanced efficacy. Additionally, cocktails of therapeutically relevant antibodies could reduce the probability of selecting resistant strains or neutralization-escape variants
in vivo (
Sanna et al., 2000).
Based on extensive studies with SINV, as well as VEEV, the complex association of the immune response in CNS disease pathogenesis and recovery is well established (
Griffin, 2010). Unlike SINV, VEEV is directly cytopathic for cells of the CNS in the absence of an immune response (
Charles et al., 2001). Although T cells and their related cytokines, especially IFN-γ, have a prominent role in clearing virus from the CNS, mice deficient in mature B cells are not able to clear virus from the brain or prevent persistent virus replication (
Griffin, 2010). For protection by passive antibody transfer, viral clearance is dependent on the amount and specificity of antibody transferred; antibody to the E2 protein is most effective (
Johnston and Peters, 1996). In the current study the amount of IP-administered anti-E2 F5 nIgG required for effective prophylaxis was as little as 100 ng for subsequent SC VEEV challenge and 50 µg for aerosol challenge (). The effective dose of post-exposure F5 nIgG, delivered 24 h PI, was 500 µg for SC VEEV infection or 50 µg for aerosol infection (). Local production of antibody in the CNS or nasal mucosa may also play a role in protection and continued suppression of viral replication due to persistant viral RNA (
Charles et al., 1997;
Elvin et al., 2002;
Griffin, 2010). Although SINV RNA was detected by RT-PCR for 12 months after infection in mice effectively treated with passive antibody (
Levine and Griffin, 1992;
Levine et al., 1991), we found no detectable viral RNA 14–28 days PI in brain tissue from mice infected by aerosolized VEEV and treated 24 h PI with 50 µg F5 nIgG. The mechanism of antibody suppression of intracellular virus replication is not completely understood, but appears to require bivalent antibody and is independent of IgG isotype (
Ubol et al., 1995).
Human exposure to VEEV in nature is usually mosquito-transmitted and related to the occurrence of epizootic disease in equines and can probably be best controlled by routine vaccination of equine populations (
Johnson and Martin, 1974). In addition, humans can be occupationally (laboratorians, veterinarians or field workers) exposed to VEEV via injection or aerosol routes (
Slepushkin, 1959;
Zarate et al., 1968) or through an act of bioterrorism (intentional release). Because no FDA-licensed, human vaccine or specific antiviral drugs are currently available, an antiviral, protective hMAb for passive immunization has a number of advantages: 1) provides a state of immediate immunity and can be used prophylactically, 2) is highly specific and 3) has minimal toxicity or reactogenicity for the human host. Technological developments in antibody engineering and recombinant DNA technology, as well as antibiotic resistance, have created more interest in passive antibody immunization for prevention and treatment of infectious diseases (
Casadevall, 2002;
Casadevall et al., 2004;
Krause et al., 1997;
Weltzin and Monath, 1999;
Zeitlin et al., 1999). Several antibody-based therapies are being developed for viral encephalitides. A phase I clinical study of the safety, pharmacokinetics, and immunogenicity of a neutralizing, recombinant humanized mMAb (MGAWN1) targeting the E glycoprotein of the encephalitogenic flavivirus West Nile virus has recently been reported (
Beigel et al., 2010). A hMAb cocktail that neutralizes rabies virus has been evaluated in phase I studies as an alternative strategy to human and equine rabies immunoglobulin for post-exposure prophylaxis in humans (
Bakker et al., 2008).
Although the mouse model for VEEV disease is considered to closely reflect the disease process in humans, studies in different immunocompetent inbred mouse strains (Balb/c, C3H/HeN, A/J) have revealed some variability in response to vaccines or passive antibody immunization (
Elvin et al., 2002;
Hart et al., 2000;
Kinney et al., 1988;
Phillpotts et al., 2002). We have used outbred mice (ICR or Swiss Webster) in our evaluations of the protective capacity of human or humanized anti-VEEV E2 MAbs in an effort to assess an overall species response (
Hunt et al., 2006). Our results suggest that hMAb F5 nIgG is a valuable antiviral, capable of providing both pre- and post-exposure protection from peripheral and aerosol VEEV challenge, if used at appropriate doses. It is also effective in reducing or eliminating persistent viral RNA replication. Since passively-administered humanized antibody titer in mouse serum was fairly stable over a two-week period, prophylactic protection for a similar period is theoretically possible (
Hunt et al., 2006); however, therapeutic doses must be given within 24 h of infection for significant survival rates since the average survival time of VEEV-infected mice is only about six days. The VEEV-infected, passively immunized mouse model will also provide a good platform for future studies of the contributions of other components of the immune response to disease or survival of animals. In addition, further evaluation of the potential of anti-VEEV passive human antibody is needed in nonhuman primates.