ADM antibodies include monoclonal and polyclonal variants, with distinct epitope targets:
Key Insight: N-terminal antibodies (e.g., adrecizumab) increase circulating ADM levels while reducing interstitial vasodilation, enhancing endothelial barrier integrity .
ADM has both protective and harmful roles in sepsis:
Beneficial: Enhances endothelial barrier function via cAMP/PKA pathways, reducing vascular leakage .
ADM antibodies aim to preserve barrier-stabilizing effects while mitigating vasodilation.
Preclinical Data: In cecal ligation and puncture (CLP) models, N-terminal antibodies (e.g., NT-M) improved survival to 50% vs. 0% in controls .
Adrecizumab (a humanized N-terminal antibody) is under investigation for sepsis:
Phase II Trial (NCT03085758): Targets patients with elevated bio-ADM levels.
Mechanism: ↑ Plasma ADM (bound to antibody) → ↑ endothelial barrier stability; ↓ interstitial ADM → ↓ vasodilation .
Safety: Well-tolerated with no severe adverse effects; terminal half-life ~14 days .
ADM antibodies may synergize with ADM’s intrinsic anti-inflammatory properties:
Pathways: cAMP/PKA → ↓ NF-κB → ↓ pro-inflammatory cytokines (e.g., TNFα, IL-6) .
Inflammatory Bowel Disease (IBD): Preclinical studies show reduced colitis severity with ADM therapy .
Complete inhibition (C-terminal antibodies) risks eliminating ADM’s barrier-protective effects, while partial inhibition (N-terminal) may optimize outcomes .
Biomarker-guided therapy (e.g., bio-ADM levels) is critical for targeting patients most likely to benefit from ADM antibodies .
How to resolve contradictions between in vitro potency and in vivo efficacy of ADM antibodies?
Example: NT-M antibodies show low in vitro cAMP inhibition (~25%) but reduce mortality by 73% in murine sepsis . Strategies include:
What methods ensure specificity and reproducibility of ADM antibodies in complex biological matrices?
How to mitigate immunogenicity risks when using ADM antibodies in preclinical models?
| Epitope Region | Affinity Constant (M) | Maximal cAMP Inhibition | In Vivo Survival Benefit (CLP Model) |
|---|---|---|---|
| N-terminal | 25% | 73% reduction in mortality | |
| Midregional | 70% | 40% reduction | |
| C-terminal | 100% | 35% reduction |
How to design a robust sepsis model for testing ADM antibody efficacy?
What are best practices for validating ADM antibody lot-to-lot consistency?