LILRB4 is a transmembrane inhibitory receptor expressed predominantly on myeloid-derived immune cells, including tumor-associated macrophages (TAMs) and dendritic cells (DCs) . Its primary role is to suppress immune responses by modulating cytokine production and promoting tolerance, often contributing to tumor immune evasion . The LILRB4 antibody is engineered to bind specifically to this receptor, blocking its inhibitory signaling and enhancing antitumor immunity.
The LILRB4 antibody disrupts the receptor’s immunosuppressive functions through two primary pathways:
Suppression of Inhibitory Signaling
Modulation of Tumor Microenvironment (TME)
Preclinical studies demonstrate the antibody’s potent antitumor activity across multiple models:
These results highlight LILRB4’s role as a critical checkpoint in solid tumors, particularly in “cold” tumors resistant to conventional therapies .
Potential Applications:
Challenges:
Species-Specific Differences: Human LILRB4 has three ITIMs vs. two in murine counterparts, necessitating further validation in humanized models .
Epitope Heterogeneity: Variability in LILRB4 expression across tumor types may limit universal efficacy .
Combination Therapies: Pairing with checkpoint inhibitors (e.g., anti-PD1) to overcome resistance mechanisms .
Biomarker Development: Identifying LILRB4 expression levels as predictive markers for therapeutic response .
Engineered Antibodies: Next-generation antibodies with optimized affinity and stability for clinical use .
LILRB4 (leukocyte immunoglobulin-like receptor B4) is an inhibitory immune receptor that mediates suppressive immune responses through immunoreceptor tyrosine-based inhibitory motifs (ITIMs). It is also known by several alternative names including ILT3, CD85k, LIR5, ILT-3, LIR-5, and in mice as gp49B. This receptor plays a pivotal role in regulating immune tolerance and has gained considerable attention due to its potent immunosuppressive functions . The human LILRB4 protein has a molecular mass of approximately 49.4 kilodaltons .
The human LILRB4 receptor consists of two extracellular immunoglobulin domains, a transmembrane domain, and three intracellular immunoreceptor tyrosine-based inhibitory motifs (ITIMs). Importantly, while murine LILRB4 also contains two extracellular domains, it differs in having only two intracellular ITIMs compared to the three present in the human version . These ITIMs are critical for the receptor's inhibitory function, as they transmit suppressive signals that downregulate immune responses. The structural elements of LILRB4 enable it to interact with its ligands and mediate its immunoregulatory effects in various physiological and pathological contexts .
Research has identified several potential ligands for LILRB4, with apolipoprotein E (APOE) being one of the most well-established. The interaction between LILRB4 and APOE has been extensively studied and is a target for therapeutic interventions . Additionally, integrin αVβ3 has been suggested as another ligand for LILRB4 . Understanding these ligand interactions is crucial for developing effective LILRB4-targeting strategies, as demonstrated by the development of humanized monoclonal antibodies like h128-3 that specifically block the LILRB4/APOE interaction in a competitive manner . These ligand interactions play essential roles in mediating LILRB4's immunosuppressive functions across various disease contexts.
LILRB4 exhibits a diverse expression pattern across multiple immune cell populations. It is prominently expressed on myeloid lineage cells, including dendritic cells, monocytes, and macrophages, particularly tumor-associated macrophages (TAMs). Beyond myeloid cells, LILRB4 expression has been documented on mast cells, B cells, natural killer (NK) cells, T cells, and osteoclasts . In the context of cancer, LILRB4 expression significantly increases on CD45+ tumor-infiltrating immune cells as tumors progress, with notably higher expression in tumor tissue compared to normal tissue . LILRB4 is also expressed at elevated levels on monocytic acute myeloid leukemia (AML) cells, specifically in the M4 and M5 subtypes, compared to their normal counterparts .
Several sophisticated techniques can be employed to measure the binding affinity of LILRB4 antibodies:
Bio-Layer Interferometry (BLI): This label-free technique measures binding kinetics in real-time. For LILRB4 antibody analysis, protein G biosensors are loaded with the antibody (typically at 30 μg/mL), followed by exposure to varying concentrations of recombinant LILRB4 protein (range: 0.1-200 nM). Association and dissociation rates are measured, with data fitted to a 1:1 binding model to calculate the dissociation constant (Kd = koff/kon) .
Chimeric Receptor Reporter Assay: This cellular system tests both binding and functional activity. The assay uses cells expressing a chimeric receptor with the extracellular domain (ECD) of LILRB4 fused to the intracellular signaling domain of paired immunoglobulin-like receptor (PILR) β, which signals through DAP-12 to activate an NFAT-GFP reporter. Antibody binding and its agonistic or antagonistic effects are measured by changes in GFP expression. For competition assays, APOE protein (10 μg/ml) is precoated on plates, followed by addition of the test antibody and reporter cells .
Both methods provide complementary information about antibody-LILRB4 interactions, with BLI offering precise kinetic parameters and the reporter assay providing functional insights.
Multiple complementary approaches can be used to rigorously quantify LILRB4 expression in tumor samples:
Flow Cytometry: This technique allows for cell-specific quantification of LILRB4 protein expression. Research protocols have successfully used flow cytometry to analyze LILRB4 expression on tumor-infiltrating immune cells at different stages of tumor development, revealing that LILRB4 expression increases on CD45+ cells as tumors progress (comparing day 14 versus day 21 tumors in B16/F10 melanoma models) .
Mass Cytometry (CyTOF): This high-dimensional approach enables simultaneous analysis of multiple markers alongside LILRB4, providing insights into co-expression patterns with other immune receptors. Studies have demonstrated high correlation between LILRB4 expression and other inhibitory receptors using CyTOF analysis .
Single-cell RNA Sequencing (scRNA-seq): This method provides transcriptome-wide expression data at single-cell resolution, enabling identification of cell populations expressing LILRB4 and correlation with other genes.
RNA NanoString Analysis: This hybridization-based technique allows for precise quantification of LILRB4 mRNA in tumor samples without amplification, reducing quantification bias .
For comprehensive characterization, researchers should combine protein-level (flow cytometry, CyTOF) and transcript-level (scRNA-seq, NanoString) approaches to gain complete insights into LILRB4 expression patterns within the tumor microenvironment.
LILRB4 plays a multifaceted role in facilitating tumor immune evasion through several mechanisms:
Suppression of T Cell Activity: LILRB4 significantly inhibits T cell responses in the tumor microenvironment (TME). Studies have shown that LILRB4-deficient T cells exhibit increased IFN-γ production and enhanced cytotoxicity compared to their wild-type counterparts .
Modulation of Tumor-Associated Macrophages (TAMs): LILRB4 is prominently expressed on TAMs and promotes their immunosuppressive phenotype. Blocking LILRB4 shifts TAMs toward a less suppressive state, thereby reducing their tumor-promoting functions .
Regulation of T Cell Differentiation: LILRB4 influences the balance between effector T cells (Teff) and regulatory T cells (Treg). LILRB4 blockade increases the Teff to Treg ratio, promoting anti-tumor immunity .
Induction of T Cell Exhaustion: Expression of LILRB4 correlates with T cell exhaustion markers. LILRB4 blockade reduces exhaustion phenotypes in CD8+ T cells, facilitating more effective anti-tumor responses .
Soluble LILRB4 Effects: Soluble forms of LILRB4 have been detected in the serum of patients with various cancers, including pancreatic carcinoma, colorectal carcinoma, and melanoma, suggesting systemic immunosuppressive effects beyond the tumor microenvironment .
These combined mechanisms establish LILRB4 as a critical immunosuppressive checkpoint that tumors exploit to evade immune surveillance and maintain a favorable microenvironment for growth and progression.
Substantial preclinical evidence supports LILRB4 as a promising therapeutic target:
Genetic Deletion Studies: LILRB4-/- mice challenged with tumors demonstrate significantly reduced tumor burden and increased survival compared to wild-type controls, providing strong genetic evidence for LILRB4's role in tumor progression .
Antibody Blockade Effects: Treatment with anti-LILRB4 antibodies shows therapeutic efficacy across multiple tumor models. LILRB4 blockade increases tumor immune infiltrates, improves the effector T cell to regulatory T cell ratio, and modulates phenotypes of tumor-associated macrophages toward less suppressive states .
Expression Correlation with Disease: LILRB4 expression progressively increases during tumor development and shows high correlation with other immune inhibitory receptors. Analysis of human melanoma samples has confirmed elevated LILRB4 expression compared to normal tissue .
Leukemia-Specific Applications: LILRB4 is expressed at significantly higher levels on monocytic acute myeloid leukemia (AML) cells (subtypes M4 and M5) than on normal counterparts, providing a selective therapeutic window. Anti-LILRB4 antibody-drug conjugates have demonstrated remarkable therapeutic effects without significant toxicity in xenograft mouse models of human AML .
Mechanism of Action: LILRB4 blockade modulates CD4+ T cells toward Th1 effector phenotypes and reduces exhaustion markers in CD8+ T cells, demonstrating clear immunomodulatory mechanisms underlying therapeutic effects .
This convergent evidence from genetic models, antibody studies, expression analyses, and mechanistic investigations strongly positions LILRB4 as a compelling target for cancer immunotherapy development.
LILRB4 expression shows significant correlation patterns with other immune checkpoint molecules, suggesting coordinated immunoregulatory networks:
Correlation in Tumor-Infiltrating Lymphocytes: Analysis of tumor-infiltrating T cells by both mass cytometry (CyTOF) and flow cytometry has demonstrated high correlation between LILRB4 expression and other inhibitory receptors in both murine tumors and human cancer patient samples . This correlation pattern suggests coordinated upregulation of multiple immunosuppressive pathways.
Expression in Human Melanoma: Comparative analysis of checkpoint molecule expression in human melanoma samples has revealed significant correlation between LILRB4 and other immune inhibitory receptors. This finding indicates potential synergistic effects between multiple checkpoint pathways in mediating tumor immune evasion .
Progressive Co-expression During Tumor Development: Studies tracking LILRB4 expression at different stages of tumor development have shown that its expression increases alongside other inhibitory molecules as tumors progress, particularly on CD45+ cells. This temporal correlation further supports the concept of coordinated checkpoint expression as a tumor adaptation mechanism .
The strong correlation between LILRB4 and other immune checkpoint molecules suggests potential benefits for combination therapeutic approaches targeting multiple checkpoint pathways simultaneously to overcome tumor immune evasion mechanisms.
Several sophisticated strategies have been employed to develop effective anti-LILRB4 therapeutic antibodies:
Mechanism-Based Antibody Design: Development of antibodies specifically designed to block LILRB4-ligand interactions. The humanized monoclonal antibody h128-3 exemplifies this approach, as it was designed to competitively block the LILRB4/APOE interaction, a key mechanism of LILRB4-mediated immunosuppression .
Antibody-Drug Conjugates (ADCs): For targeted therapy against LILRB4-expressing malignancies, particularly in acute myeloid leukemia (AML), researchers have developed ADCs combining anti-LILRB4 antibodies with cytotoxic payloads. Using the antimitotic agent monomethyl auristatin F, these ADCs demonstrate selective killing of LILRB4-positive AML cells while sparing normal progenitor cells .
Homogeneous Conjugation Technology: Advanced ADC linker technology platforms have been employed to generate homogeneous anti-LILRB4 ADCs with defined drug-to-antibody ratios, ensuring consistent pharmacological properties. These conjugates demonstrate LILRB4-mediated internalization, suitable physicochemical properties, and high cell-killing potency against LILRB4-positive cells .
Functional Screening Approaches: Chimeric receptor reporter assays have been developed to screen candidate antibodies for their ability to block LILRB4 function. This system allows identification of antibodies that not only bind LILRB4 but also effectively inhibit its signaling functions .
These complementary strategies represent the cutting edge of anti-LILRB4 therapeutic development, with approaches tailored to specific disease contexts and therapeutic goals.
Comprehensive evaluation of anti-LILRB4 antibodies requires a multi-parameter assessment approach:
Tumor Challenge Models:
Solid Tumors: Researchers can measure tumor volume/weight and survival in mice treated with anti-LILRB4 antibodies versus controls. LILRB4-/- mice or antibody-treated mice have demonstrated reduced tumor burden and increased survival across multiple tumor models .
Leukemia: For anti-LILRB4 ADCs in AML, xenograft models of disseminated human AML provide crucial efficacy data. These models have shown remarkable therapeutic effects without significant toxicity .
Immune Cell Phenotyping:
Functional Assays:
Toxicity Assessments:
Pharmacokinetic Studies:
This multi-faceted approach provides comprehensive insights into both the efficacy and safety of anti-LILRB4 therapeutic approaches, informing clinical translation decisions.
Development of effective LILRB4-targeting ADCs requires careful consideration of several critical factors:
Target Selectivity and Expression Profile:
Antibody Optimization:
Payload Selection:
Conjugation Chemistry:
Internalization Efficiency:
Safety Profile:
Therapeutic Window Evaluation:
These considerations have guided the successful development of anti-LILRB4 ADCs that demonstrate remarkable therapeutic effects against AML in preclinical models without significant toxicity.
LILRB4 expression exhibits distinct patterns across cancer types:
Hematological Malignancies:
Solid Tumors:
Melanoma: LILRB4 protein expression has been detected on tumor-infiltrating CD45+ cells in both murine B16/F10 melanoma models and human melanoma patient samples. Expression analyses show that LILRB4 is upregulated in human melanoma compared to normal tissue .
Pancreatic Carcinoma: Soluble forms of LILRB4 have been found in the serum of pancreatic carcinoma patients, suggesting potential systemic effects of this immunoregulatory molecule .
Colorectal Carcinoma: Similar to pancreatic cancer, colorectal carcinoma patients exhibit detectable levels of soluble LILRB4 in their serum .
Temporal Expression Patterns:
Progressive Increase: Studies examining LILRB4 expression at different stages of tumor development have observed that LILRB4 expression increases on CD45+ cells as tumors progress (e.g., day 14 versus day 21 in B16/F10 tumor models) .
Compartmental Differences: LILRB4 expression is significantly higher in tumor-infiltrating immune cells compared to those in peripheral lymphoid organs like the spleen, indicating tumor microenvironment-specific upregulation .
This variable expression across cancer types, with particularly high expression in specific leukemia subtypes and tumor-infiltrating immune cells of solid tumors, informs therapeutic strategies targeting LILRB4 in different oncological contexts.
Several promising combination approaches could enhance anti-LILRB4 antibody efficacy:
Combination with PD-1/PD-L1 Blockade:
Rationale: LILRB4 expression shows high correlation with other immune inhibitory receptors, including PD-1/PD-L1. The PD-1/PD-L1 axis is a well-established immunotherapy target with FDA-approved agents .
Potential Benefit: Dual blockade could overcome complementary immunosuppressive mechanisms, enhancing T cell activation and cytotoxicity against tumor cells.
Combination with CTLA-4 Inhibitors:
Rationale: Anti-CTLA-4 therapy (ipilimumab) works through distinct mechanisms from LILRB4 blockade, with CTLA-4 primarily affecting T cell priming while LILRB4 modulates myeloid cell function and T cell activity within the tumor microenvironment .
Potential Benefit: This combination could enhance both the initial T cell activation phase and the effector phase of anti-tumor immunity.
Integration with Myeloid-Targeted Therapies:
Rationale: Since LILRB4 is prominently expressed on tumor-associated macrophages (TAMs), combining anti-LILRB4 antibodies with other myeloid-targeting approaches could yield synergistic effects.
Potential Benefit: This approach could more effectively reprogram the immunosuppressive tumor microenvironment.
Combination with Conventional Therapies:
Rationale: Conventional cancer treatments can release tumor antigens and promote immunogenic cell death.
Potential Benefit: Sequencing anti-LILRB4 antibodies with chemotherapy, radiation, or targeted therapies could enhance immune recognition and elimination of tumor cells.
APOE-Targeting Approaches:
Rationale: Since APOE is a key ligand for LILRB4, combining anti-LILRB4 antibodies with strategies targeting APOE or the LILRB4-APOE interaction could provide enhanced blockade of this immunosuppressive pathway .
Potential Benefit: This dual-targeting approach could provide more complete pathway inhibition than single-agent approaches.
These combination strategies represent promising directions for enhancing the efficacy of anti-LILRB4 therapeutic approaches across various cancer types.
Several potential biomarkers could help predict response to anti-LILRB4 therapy:
LILRB4 Expression Levels:
Ligand Expression Profiles:
Immune Cell Infiltration Patterns:
Correlation with Other Checkpoint Molecules:
Soluble LILRB4 Levels:
Genetic and Molecular Features:
Tumor mutational burden and neoantigen load, which affect potential for immune recognition
Specific oncogenic pathways that might influence immune regulation via LILRB4-dependent mechanisms
Functional Immune Assessments:
Ex vivo testing of patient-derived immune cells' response to LILRB4 blockade
Cytokine production profiles (especially IFN-γ) following stimulation
These biomarkers could help identify patients most likely to benefit from anti-LILRB4 therapy and inform rational combination strategies for personalized treatment approaches.
Several significant technical challenges exist in developing effective LILRB4-targeted therapies:
Specificity Engineering:
Varied Expression Patterns:
Species Differences:
Complex Ligand Interactions:
ADC Development Challenges:
Biomarker Development:
Identifying reliable predictive biomarkers for patient selection
Developing standardized assays for LILRB4 expression that correlate with clinical response
Resistance Mechanisms:
Understanding and overcoming potential resistance mechanisms to LILRB4-targeted therapies
Identifying compensatory immunosuppressive pathways that may emerge following LILRB4 blockade
Addressing these technical challenges will be essential for successful clinical translation of LILRB4-targeted therapeutic approaches.
LILRB4's immunoregulatory functions extend to several domains beyond cancer:
Autoimmune Disease Regulation:
LILRB4's role in promoting immune tolerance suggests therapeutic potential in autoimmune conditions
By mediating suppressive immune responses through ITIMs, LILRB4 activation could potentially dampen pathological immune responses in autoimmunity
LILRB4's ability to induce effector T cell dysfunction and promote T suppressor cell differentiation could be leveraged to modulate excessive immune responses in conditions like rheumatoid arthritis, multiple sclerosis, or systemic lupus erythematosus
Transplant Tolerance:
LILRB4 may play a significant role in inducing and maintaining transplant tolerance
As a tolerance receptor, LILRB4-targeted approaches could help prevent rejection of transplanted organs or tissues
Potential strategies include enhancing LILRB4 signaling in the transplant setting, contrasting with the blocking approaches used in cancer immunotherapy
Inflammatory Disorders:
LILRB4's expression on various myeloid cells suggests involvement in regulating inflammatory processes
Modulating LILRB4 function could provide therapeutic benefits in chronic inflammatory conditions
Infectious Disease Responses:
Hematopoietic Development:
LILRB4 expression on osteoclasts suggests potential roles in bone homeostasis
Further investigation of LILRB4 in hematopoietic development could reveal additional functions beyond immune regulation
These diverse roles position LILRB4 as a multifaceted immunoregulatory molecule with therapeutic potential across numerous medical fields beyond oncology.
Several innovative strategies could advance the next generation of LILRB4-targeting approaches:
Bispecific Antibody Development:
Design of bispecific antibodies targeting both LILRB4 and a second immune checkpoint (e.g., PD-1, CTLA-4) could enhance efficacy
Bispecific formats linking LILRB4 blockade with T cell engagement could promote more effective anti-tumor responses
Structure-Guided Antibody Engineering:
Detailed structural understanding of the LILRB4-ligand interface could enable development of antibodies with enhanced blocking potency
Structure-based optimization of antibody binding epitopes could improve specificity for LILRB4 over related family members
Conditional Activation Systems:
Development of context-dependent antibodies that preferentially activate in the tumor microenvironment
Protease-activated antibodies that become fully functional only in tumor tissues could reduce systemic side effects
Advanced ADC Technologies:
Combination with Emerging Modalities:
Integration with nucleic acid-based therapeutics (siRNA, mRNA) for synergistic targeting of the LILRB4 pathway
Combination with cell therapies, such as engineered CAR-T cells resistant to LILRB4-mediated suppression
Target Expression Modulation:
Strategies to temporarily increase LILRB4 expression on target cells to enhance therapeutic window
Approaches to reduce LILRB4 expression on critical normal immune cells to minimize adverse effects
Affinity-Optimized Variants:
Development of antibodies with precisely tuned affinity profiles to achieve optimal tumor targeting while minimizing off-target effects
Exploration of pH-dependent binding to enhance tumor specificity and reduce systemic impact
These innovative approaches represent promising frontiers for enhancing the specificity, efficacy, and safety of LILRB4-targeted therapeutic strategies.
Several well-characterized research models support investigations of LILRB4 biology:
Genetic Models:
Cellular Systems:
Chimeric receptor reporter cell systems have been established for functional studies
These systems incorporate the extracellular domain of LILRB4 fused to signaling domains like PILR-β, which activates NFAT-driven reporters upon ligand binding
Such systems enable testing of antibodies for agonist or antagonist activity
Tumor Models:
Murine B16/F10 melanoma models have been validated for LILRB4 research, showing increased LILRB4 expression as tumors progress
These models demonstrate the efficacy of LILRB4 blockade in enhancing anti-tumor immunity
Xenograft models of human AML have been established for testing LILRB4-targeted therapies, particularly antibody-drug conjugates
Protein Interaction Assays:
Human Sample Collections:
These diverse research models enable comprehensive investigation of LILRB4 biology across multiple experimental contexts, from molecular interactions to in vivo therapeutic efficacy.
Comprehensive quality control is essential when working with LILRB4 antibodies:
Specificity Validation:
Binding Affinity Characterization:
Functional Validation:
Application-Specific Validation:
Batch Consistency:
Lot-to-lot comparisons to ensure consistent performance
Stability testing under various storage conditions to establish shelf-life and handling guidelines
Purity Assessment:
Endotoxin Testing:
For in vivo applications, verification that antibody preparations are endotoxin-free to prevent confounding inflammatory effects
Implementation of these quality control measures ensures reliable and reproducible results when working with LILRB4 antibodies across research and therapeutic applications.
Several strategies can mitigate experimental artifacts when working with LILRB4 antibodies:
Multiple Antibody Validation:
Appropriate Controls:
Complementary Detection Methods:
Careful Sample Preparation:
Standardized protocols for tissue dissociation to avoid selective loss of LILRB4-expressing cells
Consistent fixation and permeabilization conditions for intracellular staining
Fresh sample processing where possible to avoid antigen degradation
Signal Amplification Considerations:
Careful titration of secondary detection reagents to optimize signal-to-noise ratios
Use of direct conjugates where possible to minimize non-specific binding
Appropriate blocking to reduce background signal
Fc Receptor Blocking:
Pre-incubation with Fc receptor blocking reagents to prevent non-specific antibody binding to Fc receptors on immune cells
This is particularly important when studying myeloid cells, which express high levels of Fc receptors
Data Normalization and Analysis:
Appropriate gating strategies in flow cytometry to account for autofluorescence
Consistent quantification methods across experiments
Statistical approaches that account for technical and biological variation