In vitro assessment of recombinant, mutant immunoglobulin G anti-D devoid of hemolytic activity for treatment of ongoing hemolytic disease of the fetus and newborn

BACKGROUND: A specific treatment for ongoing hemolytic disease of the fetus and newborn (HDFN) due to anti-D would be very attractive. One approach could be administration to the mother of nonhemolytic anti-D, which by crossing the placenta can block the binding of hemolytic maternal anti-D. STUDY DESIGN AND METHODS: Two anti-D immunoglobulin G3 (IgG3) heavy-chain mutants were expressed in Chinese hamster ovary cells. To investigate whether these anti-D IgG3 mutants could inhibit the red blood cell-destructive activity of recombinant human (rHu)IgG1 with identical antigen-binding region as well as polyclonal anti-D having multiple D epitope specificities, two assays were used, antibody-dependent cell-mediated cytotoxicity (ADCC) and a chemiluminescence (CL)-based method for detection of respiratory burst in peripheral blood monocytes. RESULTS: The two IgG3 anti-D heavy-chain mutants inhibited the ADCC and CL responses mediated by a rHuIgG1 anti-D with identical antigen-binding region as the mutant antibodies, as well as the destructive activity mediated by a polyclonal anti-D. CONCLUSION: The use of nonhemolytic anti-D may be an effective countermeasure against hemolysis in HDFN due to anti-D.