{:en}A Human Monoclonal Antibody with Mature Affinity Targeting the Dengue Virus Epitope Fusion Loop with Therapeutic Potential{:}{:id}Sebuah Human Monoclonal Antibody dengan Afinitas yang Matang dan Menargetkan Fusion Loop Epitope Virus Dengue dengan Potensi Terapetik{:}
{:en} Several viruses that are transmitted through mosquitoes include Dengue virus (DENV), Japanese encephalitis virus (JEV), West Nile virus (WNV), and Zika virus (ZIKV) belonging to the Flavivirus genus and family Flaviviridae. Among them, DENV causes the most serious health problems in the world, in terms of the number of patients and the fatality rate. Infections caused by one of the DENV serotypes (1-4) cause Dengue fever (DF), Dengue hemorrhagic fever (DHF) or Dengue shock syndrome (DSS). Every year, at least 390 million dengue infections are recorded with 100 million people showing symptoms and 21,000 deaths worldwide. One of the hypothesized mechanisms of the risk of an increase in severity due to DENV infection is antibody-dependent enhancement (ADE), which is where DENV antibodies that are already present in a person’s body both caused by primary infection and due to vaccination will facilitate Fc-receptor positive cells such as macrophages when further dengue infection. Thus, DENV antibodies can play two conflicting activities, namely neutralization and ADE. Neutralization suppresses viremia resulting in a defense against DENV infection. While ADE increases viremia, which is associated with an increase in the severity of dengue infection. This phenomenon is likely to increase the risk of increasing severity in the event of Dengue infection in seronegative persons who have received the CYD-TDV vaccination, as the only currently licensed Dengue vaccine. In addition, ZIKV antibodies were also reported to be proven to increase dengue infection in vitro and vice versa. The presence of ADE complicates the pathogenesis of Dengue, a problem in itself for the development of an effective Dengue vaccine, as well as for the manufacture of prophylactic or therapeutic antibodies. The dengue virus genome encodes three structural proteins namely capsid [C], premembrane/membrane [prM/M], and envelope [E] as well as seven non-structural proteins). Viral particles accumulate in the lumen of the endoplasmic reticulum, where the nucleocapsid (viral RNA complexes with protein C) is incorporated into a lipid bilayer containing the proteins prM and E. Due to the traffic of immature virus particles through the trans-Golgi network, a serine protease (furin) from the host cleaves the prM protein of the immature virus resulting in maturity. This maturation stage is sometimes incomplete, resulting in a mixture of virus particles with different stages of maturity. Virus particles exhibit conformational dynamics known as viral respiration. Virion maturation and respiration have an impact on antibody recognition so that it affects neutralization and enchancing activities. Protein E is the main target for neutralizing antibodies, due to its location on the virion surface of a DENV. There are three domains, namely domains I (DI), II (DII) and III (DIII) in the E protein structure. Each DENV particle contains 180 E protein monomers that make up 90 E-dimers. The neutralizing and ADE activity of the antibody was determined by the viral epitope. Antibodies targeting the fusion loop epitope (FLE) or bc loop in DII generally provide low neutralization, high ADE and have cross-reactivity to other flaviviruses. Antibodies like this are widely formed during secondary infection with DENV, because the epitope between flaviviruses is highly conserved. Antibodies bound to the E dimer, the epitope of the quaternary structure, or the hine region of DI-DIII provide high neutralization ability by inhibiting viral conformational changes and membrane fusion. Antibodies that recognize the epitope complex play a major role in the neutralizing activity that occurs in the patient’s serum in the convalescent phase. However, some of these antibodies are specific to certain serotypes. Antibodies targeting domain III are serotype specific and exhibit higher neutralizing activity when compared to antibodies targeting domains I-II, however, antibodies targeting domain III are not widely produced in the human body. Human monoclonal antibody (HuMAb) can be a useful tool to elucidate the mechanism of neutralization and ADE, as information needed in vaccine development. In addition, HuMAb can also be used for prophylactic and therapeutic purposes. Several researchers have succeeded in developing HuMAb by various methods. However, therapeutic agents against flavivirus infection are not yet available. Seeing the success of antibody therapy against syncytium virus in the respiratory tract, Ebola virus and SARS-CoV-2 virus, antibody therapy against Dengue virus is promising. Using the newly developed cell technology, SPYMEG, we have succeeded in developing eight anti-DENV HuMAb clones from an acute-phase patient with secondary infection in Indonesia. HuMAbs in this study have potential as therapeutic agents against dengue virus, especially against viral strains circulating in Southeast Asia, including Indonesia, as one of the largest dengue endemic countries in the world. In general, HuMAbs with high neutralizing ability against Dengue virus are serotype-specific, bind to E-dimers or epitope quaternary structures, and inhibit at the pre- and post-adjacent stages of virus attachment to the host. On the other hand, HuMAbs with low neutralization ability were highly cross-reactive against all dengue virus serotypes, bound to the monomer E FLEs, and only inhibited at the pre-adhesion stage of the virus. Although the HuMAbs produced in this study were HuMAbs type with low neutralization ability, all HuMAbs showed low NT50 values, especially against DENV-2. mOf the eight HuMAbs produced in our study, 3G9 showed superior properties over the others, namely: 1. Capable of inhibiting DENV-2 with an NT50 value of 100 times lower than 4G2 (a low neutralizing antibody bound to FLE). These results underline the potential use of 3G9 as a neutralizing antibody against Dengue virus. The presence of HuMAb with a high neutralization potential, particularly against DENV-2, is very advantageous. This is because the Dengue vaccine (CYD-TDV), as the only Dengue vaccine currently accepted for use, provides a low level of protection against DENV-2. In studies of people who have received CYD-TDV vaccination, it was reported that neutralizing cross-reactive antibodies play an important role in establishing protection against DENV-2, whereas serotype-specific neutralization is the key to protection against other DENV serotypes. Thus, the HuMAb generated in our study (3G9) would be able to make up for the shortage of currently available Dengue vaccines. 2. Not only against DENV, HuMAb 3G9 produced in this study was also able to