Enhanced delivery of antibodies across the blood-brain barrier via TEMs with inherent receptor-mediated phagocytosis

Med (N Y). 2022 Dec 9;3(12):860-882.e15. doi: 10.1016/j.medj.2022.09.007. Epub 2022 Oct 17.


Background: The near impermeability of the blood-brain barrier (BBB) and the unique neuroimmune environment of the CNS prevents the effective use of antibodies in neurological diseases. Delivery of biotherapeutics to the brain can be enabled through receptor-mediated transcytosis via proteins such as the transferrin receptor, although limitations such as the ability to use Fc-mediated effector function to clear pathogenic targets can introduce safety liabilities. Hence, novel delivery approaches with alternative clearance mechanisms are warranted.

Methods: Binders that optimized transport across the BBB, known as transcytosis-enabling modules (TEMs), were identified using a combination of antibody discovery techniques and pharmacokinetic analyses. Functional activity of TEMs were subsequently evaluated by imaging for the ability of myeloid cells to phagocytose target proteins and cells.

Findings: We demonstrated significantly enhanced brain exposure of therapeutic antibodies using optimal transferrin receptor or CD98 TEMs. We found that these modules also mediated efficient clearance of tau aggregates and HER2+ tumor cells via a non-classical phagocytosis mechanism through direct engagement of myeloid cells. This mode of clearance potentially avoids the known drawbacks of FcγR-mediated antibody mechanisms in the brain such as the neurotoxic release of proinflammatory cytokines and immune cell exhaustion.

Conclusions: Our study reports a new brain delivery platform that harnesses receptor-mediated transcytosis to maximize brain uptake and uses a non-classical phagocytosis mechanism to efficiently clear pathologic proteins and cells. We believe these findings will transform therapeutic approaches to treat CNS diseases.

Funding: This research was funded by Janssen, Pharmaceutical Companies of Johnson & Johnson.

Keywords: Alzheimer's disease; CD98; Pre-clinical research; TfR; antibody exposure in brain; blood-brain barrier; brain metastasis; her2; phagocytosis; receptor-mediated transcytosis; tau.

MeSH terms

  • Antibodies
  • Biological Transport / physiology
  • Blood-Brain Barrier* / metabolism
  • Receptors, Transferrin
  • Transcytosis* / physiology


  • Receptors, Transferrin
  • Antibodies