In this study, we have utilized both traditional and novel in vitro methodologies to assess the activity of a cell depleting anti-KRLG1 antibody on NK cell mediated ADCC, as a method to eliminate autoreactive CD8+ T cells. Utilizing a transfected KLRG1+ CHO cell, we first observed the specificity of this antibody for mediating ADCC exclusively through KLRG1 recognition. Our plate assay confirmed cytotoxicity increases were only observed in the KLRG1+ CHO with the anti-KLRG1 Ab (Fig. 2). Additionally, no significant increase in target cell killing by the anti-KLRRG1 Ab was observed in the absence of NK cells, indicating no direct toxicity by the antibody binding (Fig. 2D). These results were also confirmed by a flow cytometry ADCC assay (Supplemental Fig. 2) as well as via our single-cell droplet platform (Fig. 3). Both plate and single-cell assays displayed a significant increase in cytoxicity in higher E:T ratios. Additionally, we observed a significant increase in effector-target contact in the KLRG1+ CHO with the anti-KLRG1 antibody, but not in the KLRG1− CHO (Supplemental Fig. 1). This is presumably due to the high-affinity binding of CD16 to a-KLRG1 Ab.
We next tested this antibody on KLRG1+ versus KLRG1− CD8+ T cells using our single-cell droplet microfluidic array. We observed specific killing only towards the KLRG1 expressing T cells (Fig. 4), as well as an increase in effector-target contact (Supplemental Fig. 4F). We did not observe and increase in killing with increased E:T ratios, which indicates the 1:1 NK to T cell ratio as the most efficient. This result is promising for clinical application, as ratios of NK cells to KLRG1+ CD8+ T cells in circulation are roughly 1:1 or lower in adults (26–28). As with the CHO cells, the KLRG1− T cells were unaffected by the a-KLRG1 Ab, suggesting no spontaneous toxicity. Additionally, the NK cell viability was also unaffected, indicating the antibody does not induce significant levels of fratricide killing between NK cells (Supplemental Fig. 4E).
After establishing the ability of the a-KLRG1 Ab to elicit ADCC towards KLRG1+ cells, we next developed a protocol to sort NK cells based on response to the a-KLRG1 Ab using our droplet sorting platform. NK cells and a-KLRG1 Ab-bound CHO cells were paired on-chip, and a ratiometric calcium dye was utilized to identify cells with increased intracellular calcium. These cells presumably recognized the anti-KLRG1 Ab through CD16 receptor binding, and would be undergoing the first stages of the ADCC response when sorted, although the short time elapsed between receptor activation and collection of RNA probably permitted identification of only transcripts already present in the responding cells or those most rapidly induced after receptor triggering. We collected the sorted cells and used transcriptomic sequencing to validate this method, and potentially uncover genetic factors influencing anti-KLRG1 Ab recognition. Despite the short time lapse between receptor binding/triggering and sample collection we did observe variation between the calcium positive and calcium negative NK cell populations for expression of genes relevant to NK function (Fig. 5). Many of the most significantly different genes between the two populations tend to have inherently high expression levels in mammalian cells and may fluctuate greatly based on cell cycle (Fig. 5B) (16–19). They included various proteins involved in translation and transcription and may have represented the initial steps in transcription/translation associated with FcgR signaling.
To further elucidate the differences between populations, we looked at several genes related to NK cell functionality and calcium signaling (Fig. 6).For the genes related to NK cell functionality, our findings supported droplet sorter’s capability to isolate NK cells based on CD16 activity (Fig. 6A). As expected, the calcium-positive NK cells had higher levels of CD16 (FCGR3A). Lower expression of FCGR3A (CD16) and higher expression of NCAM1 (CD56) in the calcium negative population also suggest that the NK cells that did not recognize anti-KRLG1 antibody seem to possess an immature phenotype (Fig. 6B). Lower expression of HAVCR2 (TIM3) further supports this observation, suggesting either an immature or downregulated phenotype (29, 30). Higher expression of CD244 and CD69 (Fig. 5B) also support a more active phenotype in the calcium positive NK group (20, 21). Of the genes associated with the calcium cascade (Fig. 6A), ZAP70 and SYK had the most significant increase in expression in the calcium positive NK. Zap70 and Syk levels have been found to be highly correlated to NK cell activity and are triggered after CD16 activation (22, 23, 31, 32). Coinciding with this, Lck, which also had higher expression in the calcium positive cells, promotes Zap70 signaling, further reinforcing the importance of this pathway in the response of these NK cells to a-KLRG1 Ab binding (33). The integral membrane proteins FcεR1γ and CD247 are also important for NK cell calcium signaling, as they bind to CD16 and stabilize its activation (34). Higher expression of FCER1G in the calcium positive cells and minimal difference in CD247 expression indicate FcεR1γ, associated with NK cells with strong cytotoxic effector function is also a key factor in the response to anti-KLRG1 antibody (35). ADAM17, S100A4 and Calmodulin are more highly expressed in the calcium negative NK population Calmodulin acts downstream of calcium signaling, responding to calcium concentrations to mediate further downstream signaling (36). S100A4 has been shown to attenuate signaling by binding CD16, and ADAM17 induces shedding of the CD16 receptor from the plasma membrane (24, 32). Therefore, the increased expression of these factors provides logical mechanisms reducing the NK cell response to the a-KLRG1 Ab in this population. This finding provides three potential characteristics of NK cells that will not respond to monoclonal antibody treatments through ADCC. In addition to observing genes that may influence the ability of an NK cell to respond to the a-KLRG1 Ab, we also observed variation in the expression of several genes related to cytotoxicity (Fig. 6B). Higher expression of GZMA, GZMB and PRF1 suggest the calcium positive NK cells will be highly cytotoxic after CD16 activation (24, 37). Additionally, increased expression of the CD16-independent apoptosis-inducing ligands FASLG (Fas ligand) and TNFSF10 (TRAIL) in the calcium positive NK cell population suggest they may have additional mechanisms available to kill target cells, promoted by the increased contact duration observed with anti-KLRG1 Ab treatment (Supplemental Figs. 2, 4).
To summarize, we observed consistent specificity of the anti-KLRG1 Ab for mediating elimination of target cells based on KLRG1 expression, with no direct toxicity in the absence of NK cells. We noted more significant effects in our single-cell platform than in a traditional plate assay, which correlates more accurately to the clinical expectations of Ulviprubart (10–12). These findings support the use of our single-cell droplet observation platform for sensitive and accurate analysis of treatment efficacy. We additionally developed a method for screening NK cells based on their ability to respond to antibody therapies by implementing our fluorescence-assisted droplet sorting platform with a fluorescent calcium assay, to sort NK cells based on activation of the CD16 receptor. Traditional cell-sorting approaches, such as flow cytometry-based sorting, are unable to sort based cells based on their functional interactions on another cell type. Droplets provide an optimal alternative due to their ability to encapsulate two cell types, and sort them based on fluorescent signal of either cell. Additionally, calcium release rapidly peaks and dissipates in a cell, requiring a platform that can both combine and sort to isolate cells based on calcium signaling (14, 38). This same methodology could be used to screen cells based on activation of other immune receptors, such as T cell receptors and chimeric antigen receptors (39, 40). Utilizing transcriptomic sequencing, the results reinforced the accuracy of this novel calcium-based droplet sorting assay by displaying functionally relevant phenotypic differences between sorted NK cell populations. We also presented several transcriptomic variations between the two populations suggesting potential genes influencing the CD16 response to this antibody. This study supports the efficacy of an anti-KLRG1 antibody for suppression of autoreactive CD8+ T cells with unique observations through our combined platform and presents a methodology for detailed in vitro screening of antibody treatments and other immunotherapies.