# A PBD-dimer containing antibody drug conjugate targeting CCRL2 for high-risk MDS/AML

## TL;DR

A new antibody-drug conjugate targeting CCRL2 shows strong effectiveness against high-risk MDS/AML, especially in TP53-mutated cases.

## Contribution

Development of a novel anti-CCRL2 ADC with superior cytotoxicity and efficacy in TP53-mutated MDS/AML models.

## Key findings

- The anti-CCRL2 ADC showed stronger cytotoxicity than existing ADCs in TP53-mutated MDS/AML cell lines.
- The ADC suppressed leukemic growth in xenograft models without harming healthy hematopoietic cells.
- TP53-mutated MDS/AML and AML with erythroid features exhibited the highest CCRL2 expression.

## Abstract

Patients with myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) with high-risk features including TP53 mutations have poor outcomes due to lack of effective therapies. The atypical chemokine surface receptor C-C motif chemokine receptor-like 2 (CCRL2) is overexpressed in MDS and secondary AML (sAML) compared to healthy hematopoietic cells and we recently found that TP53-mutated MDS/AML and AML with erythroid features express the highest levels of this receptor across MDS/AML subtypes. To illustrate the therapeutic potential of CCRL2 as a therapeutic target, we developed an anti-CCRL2 antibody-drug conjugate (ADC) by conjugating an anti-CCRL2 antibody with the cytotoxic drug pyrrolobenzodiazepine (PBD), which causes DNA double-strand breaks leading to cancer cell death. The anti-CCRL2 ADC demonstrated strong CCRL2-selective cytotoxicity against cell lines derived from MDS/AML patients with TP53 mutations and erythroid features, surpassing the cytotoxic effects observed with gemtuzumab and PBD-conjugated anti-CD33 and anti-CD123 ADCs. It also induced apoptosis and suppressed the clonogenicity of primary MDS/AML bone marrow samples without affecting the survival, differentiation and clonogenicity of healthy hematopoietic stem and progenitor cells. This agent also suppressed the leukemic growth of TP53-mutated MDS/AML cell line xenografts, improving mice survival and decreasing the leukemic burden in patient-derived TP53-mutated MDS/AML xenografts. In conclusion, our study introduces CCRL2 as a potential new therapeutic target in high-risk MDS/AML.