Introduction

Endothelial cells (ECs) are attractive therapeutic targets because they play an active role in a diverse array of diseases and are directly accessible to intravascular treatments1,2. Despite this potential, there are currently no EC-specific therapies in clinical use3, a fact driven by the challenge of treating ECs without affecting other cell types. Endothelial-targeted nanoparticles (NPs) are a promising solution, as they have the potential to deliver a concentrated dose of various therapeutics (e.g. small molecule, nucleic acid, protein) directly to targeted ECs. In addition, NPs can protect the encapsulated therapeutic from degradation by the environment, facilitate its transport across ECs membranes and sustain its release once inside the cells to prolong the duration of treatment4. Thus, effective targeting of NPs to the vascular endothelium within an organ of interest would create many new treatment possibilities across a variety of diseases.

The first hurdle to achieving EC-specific therapies is to localize the NPs to the tissue to be treated while avoiding losing NPs to the phagocytes of the liver and spleen5,6. In the field of organ transplant, we can circumvent this challenge by delivery in isolated organs during ex vivo normothermic machine perfusion (EVNMP). EVNMP is already in clinical use as a method to assess, preserve and potentially revive marginal organs with the goal of expanding access to organ transplantation7. The risk of dysfunctional inflammation is greater in marginal organs—organs from older and less healthy donors—and contributes to these organs being declined for transplant more frequently due to higher risk of post-transplant complications. Following organ recovery and preservation, ECs play a critical role in post-transplant pathologies associated with the dysfunctional inflammation. A single dose of therapeutics delivered in the forms of vascular-targeted NPs during EVNMP has the potential to reduce the immunogenicity of the graft and to provide several weeks of protection against dysfunctional inflammation during the post-transplant period when the organ is in its most vulnerable state8. Reduced endothelial activation has been demonstrated by treatment with anti-inflammatory molecules that inhibit NF-κB9,10,11, mTOR12, and complement13,14,

Fig. 6: Summary schematic of targeting strategy using the monobody adapter.
figure 6

PACE Poly(amine-co-ester), PVA Poly(vinyl alcohol), VS vinyl sulfone.

In the work shown here, we have utilized FCM101 which is specific for the mouse IgG1 isotype. Mouse IgG1 antibodies against human antigens are readily available, making this an ideal design to develop and demonstrate the approach. To minimize immune-reactions in humans, we envision the use of human or humanized Abs and a Mb adapter specific to human IgG Fc. Just as human Abs can be developed using many modern technologies, Mbs to human Fc can be developed following the well-established pipeline26,28. Furthermore, we envision that the potential problem of Ab displacement with endogenous Abs can be eliminated with a monobody adapter specific to a mutant Fc of human IgG (e.g. the so-called LALA variant that is commonly used for therapeutic antibodies42). We expect Mb adapters to minimally contribute to the overall immunogenicity of NPs based on clinical trials with a related molecule (PEGylated Adnectin) (NCT02515669, NCT03984812)43,44.

Ab-Mb-NPs also resulted in excellent vascular area coverage when perfused in human kidneys during EVNMP. This result is encouraging for future applications of therapeutic delivery to marginal organs, such as the kidneys enrolled in this study. Targeted NPs to treat marginal organs prior to transplant could reduce the risk of dysfunctional endothelial cell inflammation and associated recruitment of immune cells, rendering those organs safer to transplant and thereby increasing the number of transplantable organs. Management of peri-operative graft injuries, e.g., due to ischemia/reperfusion or to binding of graft-reactive alloantibodies in pre-sensitized recipients, with therapeutic NPs likely will require that a critical number of ECs are exposed to enough NPs to reach an effective therapeutic dose. In the context of EVNMP, this is only possible if NP binding efficiency is strong in complex 3D environments involving flow. In fact, develo** NPs in this setting will not only enable clinical translation in the context of ex vivo repair of marginal organs for transplant, but can also provide new insights relevant to intra-arterial or systemic delivery in the context of native kidney disease. Recent advances in EVNMP make it possible to sustain human organs outside the body for as long as 1 week45, which may allow us to evaluate safety and efficacy of vascular-targeted nanomedicines in a human context prior to exposing patients to risk in human clinical trials.

Ab-Mb-NPs have shown strong cellular binding and possess modularity to support rapidly develo** applications and their progression through experimental platforms. The Ab-Mb-NPs have the potential for almost immediate application in organ transplantation, and we are optimistic that this technology can be further developed for systemic delivery in a wide array of disease indications.