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Infection and Immunity, June 2006, p. 3682-3683, Vol. 74, No. 6
0019-9567/06/$08.00+0 doi:10.1128/IAI.01731-05
Copyright © 2006, American Society for Microbiology. All Rights Reserved.
Isolation of a Human Monoclonal Antibody with Strong Neutralizing Activity against Diphtheria Toxin
Mai Kakita,1
Tsuyoshi Takahashi,2
Takako Komiya,3
Yoshitaka Iba,4
Takao Tsuji,2
Yoshikazu Kurosawa,4* and
Motohide Takahashi3
Institute for Antibodies Ltd.,1
Department of Microbiology,2
School of Medicine, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Aichi 470-1192,4
National Institute of Infectious Diseases, Musashimurayama, Tokyo 208-0011, Japan3
Received 21 October 2005/
Returned for modification 1 November 2005/
Accepted 29 March 2006

ABSTRACT
We isolated a human monoclonal antibody against diphtheria toxin
(DT). It bound to fragment B with a binding activity (
Kd) of
3.01 nM. The neutralizing activity assayed by the rabbit skin
test was estimated to be 73,600 IU/g. This could be used as
a therapeutic drug against DT in place of the traditional equine
sera.

TEXT
Antisera prepared from hyperimmune horse blood are still used
as drugs against diphtheria toxin (DT) in emergency situations.
Since equine antisera could induce serious side effects such
as serum sickness, there is a strong need to develop a human
monoclonal antibody (Ab) against DT. DT excreted by
Corynebacterium diphtheriae has been well characterized (
12). It is a single
polypeptide chain (
Mr, 58,000) composed of two structurally
distinct regions with three functional domains and contains
a protease-sensitive site. The nicked toxin produced upon limited
proteolysis consists of two polypeptides that are held together
by a disulfide bond. The NH
2-terminal region, fragment A, catalyzes
the transfer of the ADP-ribose moiety from NAD to elongation
factor 2 and thus blocks protein synthesis (
4). The COOH-terminal
region, fragment B, binds to a specific receptor on the cell
surface and mediates transfer of fragment A to the cytoplasm
(
6,
11,
14). DT is lethal for susceptible animals, including
humans, in doses of 100 ng/kg or less (
12). Mass immunization
of children has been performed on a worldwide scale since the
1940s. The degree of immunity to DT in the serum of each person
should be critical for determination of susceptibility to diphtheria.
There is a good correlation between clinical protection and
the presence of serum antitoxin, whether this results from disease
or immunization. According to internationally accepted definitions,
an antitoxin concentration of less than 0.01 IU/ml indicates
susceptibility, 0.01 to 0.09 IU/ml indicates basic protection,
and >0.1 IU/ml indicates full protection (
2). Once the symptoms
of this disease start to appear, the antiserum should be given
to the patient as soon as possible. The amount of Abs required
for curing is much larger than that required to prevent infection.
It ranges from 5,000 to 50,000 IU, depending on the degree of
disease progress (
2).
A human Ab library was screened with DT and diphtheria toxoid (DTD) as the antigen (Ag) by the panning method (3, 5). DT and DTD were kindly given to us by Kunio Ohkuma (Kaketsuken, Kumamoto, Japan). DTD is inactivated toxin that is used for vaccination. It has been prepared by treatment with formaldehyde (13). The Abs were initially prepared in the form of an Ab fused with truncated cp3 (Fab-cp3) and converted to immunoglobulin G1 (IgG1) (3). In this paper, we report data obtained with IgG. Fifty-five different clones were isolated. Four of them, DTD4, DTD8, DTD10, and DTD76, distinctively showed neutralizing activities. The amino acid sequences of these four clones are shown in Fig. 1. Western blotting with separated fragments A and B indicated that DTD4 and DTD76 bound to fragment B and DTD8 and DTD10 bound to fragment A. The rate constants, and thus the binding constants, of these four clones against DTD and DT were measured with the BIAcore instrument (5) (Table 1). Abs were coupled to the sensor chip, and Ags were injected to avoid the influence of divalency. Clones DTD4, DTD8, and DTD10 bound to DT more strongly than to DTD, whereas DTD76 bound to DTD more strongly than to DT.
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TABLE 1. Rate constants (ka, kd) and dissociation constant (Kd) of IgG form of Abs with DTD and DT assayed by the BIAcore instrument
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In vitro DT-neutralizing activities were estimated by the pH
color change method (
9,
10). When the cells were metabolically
active, the color of the medium changed to yellow. When cellular
metabolism was stopped by toxin action, it remained red. Thus,
the titration endpoint for anti-DT neutralizing activity was
taken at the highest dilution of anti-DT Ab to be tested in
the well in which the color of the medium was orange. The results
are indicated in the left column of values in Table
2. The antitoxin
titers are expressed in international units by comparison with
the result obtained with equine sera. The in vivo neutralizing
activities of Abs against DT were determined by the rabbit skin
test as described previously (
1,
7). In brief, DT mixed with
serially diluted Abs was injected into rabbit back skin. The
diameter of local erythema was measured at the site of injection
at 48 h postinjection. The results are shown in the rightmost
column of Table
2. The antitoxin titers are expressed in international
units as relative potency with respect to the result obtained
with the standard antitoxin. The neutralizing activities of
Abs assayed by the pH color change method and by the rabbit
skin test were similar to each other in four cases, indicating
a good correlation between the two systems (
10).
In the case of DTD4, which showed the strongest neutralizing
activity of the four clones, it was estimated to be 73,600 IU/g
by the in vivo assay. The binding activity (
Kd) with DT was
3.01 nM. On the other hand, while DTD76 bound to DTD with strong
affinity, it showed very weak neutralizing activity. Although
both clones bound to fragment B, they should recognize completely
different epitopes. It is possible that clone DTD4 corresponded
to the Ab that had matured in vivo by immunization with vaccine
against DT. We propose that DTD4 be clinically tested for therapeutic
use.
Nucleotide sequence accession numbers.
The nucleotide sequences of the eight genes described in Fig. 1 have been registered in GenBank under accession numbers AB063724 (DTDH4), AB063723 (DTDH8), AB063729 (DTDH10), AB063743 (DTDH76), AB063937 (DTDL4), AB064049 (DTDL76), AB063977 (DTDL8), and AB064205 (DTDL10).

ACKNOWLEDGMENTS
We thank Kunio Ohkuma and Eisuke Mekada for providing materials.
We also thank Atsuko Suzuoki for preparation of the manuscript.
This study was supported in part by a grant for Research on Pharmaceutical and Medical Safety from the Ministry of Health, Labor, and Welfare of Japan.

FOOTNOTES
* Corresponding author. Mailing address: Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Aichi 470-1192, Japan. Phone: 81-562-93-9387. Fax: 82-562-93-8835. E-mail:
kurosawa{at}fujita-hu.ac.jp.

Editor: J. B. Bliska

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Infection and Immunity, June 2006, p. 3682-3683, Vol. 74, No. 6
0019-9567/06/$08.00+0 doi:10.1128/IAI.01731-05
Copyright © 2006, American Society for Microbiology. All Rights Reserved.