The Fab region of IgG impairs the internalization pathway of FcRn upon Fc engagement.
Brinkhaus, M., Pannecoucke, E., van der Kooi, E.J., Bentlage, A.E.H., Derksen, N.I.L., Andries, J., Balbino, B., Sips, M., Ulrichts, P., Verheesen, P., de Haard, H., Rispens, T., Savvides, S.N., Vidarsson, G.(2022) Nat Commun 13: 6073-6073
- PubMed: 36241613 
- DOI: https://doi.org/10.1038/s41467-022-33764-1
- Primary Citation of Related Structures:  
7Q15, 7Q3P - PubMed Abstract: 
Binding to the neonatal Fc receptor (FcRn) extends serum half-life of IgG, and antagonizing this interaction is a promising therapeutic approach in IgG-mediated autoimmune diseases. Fc-MST-HN, designed for enhanced FcRn binding capacity, has not been evaluated in the context of a full-length antibody, and the structural properties of the attached Fab regions might affect the FcRn-mediated intracellular trafficking pathway. Here we present a comprehensive comparative analysis of the IgG salvage pathway between two full-size IgG1 variants, containing wild type and MST-HN Fc fragments, and their Fc-only counterparts. We find no evidence of Fab-regions affecting FcRn binding in cell-free assays, however, cellular assays show impaired binding of full-size IgG to FcRn, which translates into improved intracellular FcRn occupancy and intracellular accumulation of Fc-MST-HN compared to full size IgG1-MST-HN. The crystal structure of Fc-MST-HN in complex with FcRn provides a plausible explanation why the Fab disrupts the interaction only in the context of membrane-associated FcRn. Importantly, we find that Fc-MST-HN outperforms full-size IgG1-MST-HN in reducing IgG levels in cynomolgus monkeys. Collectively, our findings identify the cellular membrane context as a critical factor in FcRn biology and therapeutic targeting.
Organizational Affiliation: 
Immunoglobulin Research Laboratory, Department of Experimental Immunohematology, Sanquin Research and Landsteiner, Amsterdam UMC, University of Amsterdam, 1066 CX, Amsterdam, The Netherlands.