Gantenerumab: A Novel Human Anti-Aβ Antibody Demonstrates Sustained Cerebral Amyloid-β Binding and Elicits Cell-Mediated Removal of Human Amyloid-β
Open accessAbstract
The amyloid-β lowering capacity of anti-Aβ antibodies has been demonstrated in transgenic models of Alzheimer's disease (AD) and in AD patients. While the mechanism of immunotherapeutic amyloid-β removal is controversial, antibody-mediated sequestration of peripheral Aβ versus microglial phagocytic activity and disassembly of cerebral amyloid (or a combination thereof) has been proposed. For successful Aβ immunotherapy, we hypothesized that high affinity antibody binding to amyloid-β plaques and recruitment of brain effector cells is required for most efficient amyloid clearance. Here we report the generation of a novel fully human anti-Aβ antibody, gantenerumab, optimized in vitro for binding with sub-nanomolar affinity to a conformational epitope expressed on amyloid-β fibrils using HuCAL(®) phage display technologies. In peptide maps, both N-terminal and central portions of Aβ were recognized by gantenerumab. Remarkably, a novel orientation of N-terminal Aβ bound to the complementarity determining regions was identified by x-ray analysis of a gantenerumab Fab-Aβ(1-11) complex. In functional assays gantenerumab induced cellular phagocytosis of human amyloid-β deposits in AD brain slices when co-cultured with primary human macrophages and neutralized oligomeric Aβ42-mediated inhibitory effects on long-term potentiation in rat brain. In APP751(swedish)xPS2(N141I) transgenic mice, gantenerumab showed sustained binding to cerebral amyloid-β and, upon chronic treatment, significantly reduced small amyloid-β plaques by recruiting microglia and prevented new plaque formation. Unlike other Aβ antibodies, gantenerumab did not alter plasma Aβ suggesting undisturbed systemic clearance of soluble Aβ. These studies demonstrated that gantenerumab preferentially interacts with aggregated Aβ in the brain and lowers amyloid-β by eliciting effector cell-mediated clearance.
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The decrease in amyloid of about 5 centiloids from baseline with 1.0 mg/kg bapineuzumab was very modest and therapeutically irrelevant.
“The decrease in amyloid (~5 CL) from baseline in the 1.0 mg/kg group was very modest and therapeutically irrelevant.”
From The amyloid hypothesis in Alzheimer disease: new insights from new therapeutics (2022) · cites this paper as [61]
Bapineuzumab caused significant ARIA-E but removed very little amyloid.
“For example, bapinezumab caused significant ARIA-E but removed very little amyloid 61 .”
From The amyloid hypothesis in Alzheimer disease: new insights from new therapeutics (2022) · cites this paper as [61]
Bapineuzumab has an incidence of ARIA-E of 9%.
“| Bapineuzumab | 0.3 | ~7 a /12 | 0 | 71 | 0 | 9 | - |”
From The amyloid hypothesis in Alzheimer disease: new insights from new therapeutics (2022) · cites this paper as [61]
Bapineuzumab has a normalized rate of amyloid removal of 0 CL/4 wk/10mg/kg.
“| Bapineuzumab | 0.3 | ~7 a /12 | 0 | 71 | 0 | 9 | - |”
From The amyloid hypothesis in Alzheimer disease: new insights from new therapeutics (2022) · cites this paper as [61]
Bapineuzumab removes approximately 7 centiloids in 12 patients.
“| Bapineuzumab | 0.3 | ~7 a /12 | 0 | 71 | 0 | 9 | - |”
From The amyloid hypothesis in Alzheimer disease: new insights from new therapeutics (2022) · cites this paper as [61]
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“Clinical trials are currently being conducted for the next phase of immunotherapies, which have moved away from linear Aβ epitopes targeting soluble Aβ to those that recognize conformational epitopes on Aβ aggregates; for example SAR228810, Gantenerumab [11], BAN2401, Aducanumab, ACI-24 [64] and Crenezumab [1] (http:/…”
BackgroundStructural and kinetic basis for the selectivity of aducanumab for aggregated forms of amyloid-β
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Two phase 3 trials of gantenerumab in early Alzheimer's disease
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Immunotherapeutic Approaches for Alzheimer’s Disease
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“Another two anti-Aβ mABs are currently in clinical trials—BAN2401, selective for Aβ protofibrils [447,448] and gantenerumab, selective for a specific folded conformation of aggregated Aβ [449].”
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“An advantage of this strategy compared to active immunization is that the proinflammatory T cellmediated immune reactions should not occur.”
BackgroundImmunotherapy for Alzheimer’s disease: targeting β-amyloid and beyond
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“Gantenerumab Gantenerumab (RO4909832) is a human IgG1 monoclonal antibody that binds to aggregated Aβ with high affinity and facilitates Aβ clearance via Fc receptor-mediated phagocytosis [51, 52].”
BackgroundNeurodegenerative Diseases: Regenerative Mechanisms and Novel Therapeutic Approaches
Hussain, R., Zubair, H., Sarah, P., & Shahab, M. (2018) · Brain Sciences · doi:10.3390/brainsci8090177 · Cited by 233 · see citing works
“It binds both N-terminal and central amino acids of Aβ Phase III 225 mg SC [388]”
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A Historical Review of Brain Drug Delivery
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Mouse Models of Alzheimer’s Disease
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“Gantenerumab bound to cerebral Aβ and enhanced the removal of small Aβ plaques by recruiting microglia, and prevented new plaque formation in PS2APP mice (Bohrmann et al., 2012).”
BackgroundKinetic fingerprints differentiate the mechanisms of action of anti-Aβ antibodies
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TREM2 deficiency reduces the efficacy of immunotherapeutic amyloid clearance
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“For in vitro and ex vivo phagocytosis assay, the following antibodies were used: rat monoclonal antibody 2D8 against Ab1–16 (Shirotani et al, 2007), rabbit polyclonal antibody 6687 against cytosolic domain of APP (Capell et al, 2000), mouse IgG2a isotype control (Sigma-Aldrich), and mouse monoclonal mAb11 (IgG2a (Bohr…”
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“In a chronic treatment study in 5- to 6-month-old PS2APP transgenic mice, gantenerumab caused a significant reduction in preexisting small plaques; however, there was an increase in larger plaques [215].”
BackgroundInfluentialTargeting microglia for the treatment of Alzheimer’s Disease
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“…microglia in an ex vivo assay with brain sections from PDAPP mice or AD tissue was dependent on the antibody effector function (Bard et al., 2000b; Bohrmann et al., 2012); (2) in mice, antibody isotypes with high affinity for FcgRs, such as mouse IgG2a, were more efficacious than lower affinity…”
BackgroundAnti-amyloid antibody therapies in Alzheimer's disease
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“2nM) than Aβ monomers (17nM).(45) A 2-year, double-blind, placebo-controlled, phase II/III study (SCarlet RoAD) investigating gantenerumab in 797 Aβ-PET–positive prodromal AD patients was prematurely halted for failure to demonstrate efficacy, despite dose-dependent reductions in brain amyloid (PET) and CSF tau parame…”
BackgroundTargeting Amyloid Aggregation: An Overview of Strategies and Mechanisms
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“Crenezumab Monoclonal antibody Aβ AD [72] Gantenerumab Monoclonal antibody Aβ AD [73] Solanezumab **** Monoclonal antibody Aβ AD [74] Tanshinones Diterpene Aβ AD [75] Dopamine and L-dopa Neurotransmitter Aβ/α-syn/IAPP AD/PD/diabetes [76,77] Methylene Blue Thiazine dye tau/PrP/ Aβ AD [55,78,79]”
BackgroundGrimm, H. P., Schumacher, V. L., Schäfer, M. K.-H., Imhof-Jung, S., Freskgård, P., Brady, K., Hofmann, C., Rüger, P., Schlothauer, T., Göpfert, U., et al. (2023) · mAbs · doi:10.1080/19420862.2023.2261509 · Cited by 173 · see citing works
“Multiple therapeutic antibodies are currently under clinical investigation, which have mechanisms of action (MoAs) involving targeted amyloid-beta (Aβ) binding, recruitment of microglia via the antibody’s wild-type Fc domain binding to Fc gamma receptors, and Fc-mediated antibody – Aβ complex clearance.(9,10) However,…”
BackgroundImmunotherapy for Alzheimer’s disease: hoops and hurdles
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Amyloid‐ß‐directed immunotherapy for Alzheimer's disease
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Passive immunotherapies targeting Aβ and tau in Alzheimer's disease
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Anti-Amyloid Immunotherapies for Alzheimer's Disease: A 2023 Clinical Update
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“Risk factors for ARIA are drug exposure, APOE-e4 allele carriership, and pretreatment microhemorrhages.(24,27,37,38) Regarding drug exposure, the risk of ARIA was”
BackgroundFibrillar Aβ triggers microglial proteome alterations and dysfunction in Alzheimer mouse models
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“…a therapeutic approach since substantial reduction of Aβ burden appears to correlate with cognitive benefits (Bacskai et al., 2001; Bard et al., 2000; Bohrmann et al., 2012; Janus et al., 2000; Lathuiliere et al., 2016; Morgan et al., 2000; Nicoll et al., 2006; Nicoll et al., 2003; Schenk et al.,…”
BackgroundTherapeutic Strategies Targeting Amyloid-β in Alzheimer’s Disease
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Drug development for alzheimer’s disease: Microglia induced neuroinflammation as a target
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Biometals and Their Therapeutic Implications in Alzheimer's Disease
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“Gantenerumab was shown to bind to cerebral Aβ in APP/presenilin 1 (PS1) transgenic mouse model, to reduce amyloid burden in mouse brain, and to prevent the formation of new plaque [19].”
BackgroundImmunotherapy for neurodegenerative diseases: Focus on α-synucleinopathies
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“The most probable mechanism of the effects of this antibody seems to be the binding to small plaques and stimulation of a phagocytic response by microglia [247].”
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Structure of Crenezumab Complex with Aβ Shows Loss of β-Hairpin
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Leveraging preclinical models for the development of Alzheimer disease therapeutics
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Donanemab (LY3002813) dose‐escalation study in Alzheimer's disease
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Immunotherapy with Aducanumab Restores Calcium Homeostasis in Tg2576 Mice
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“However, studies with anti-A immunotherapy have led to conflicting results, with effects on parenchymal A often accompanied by no or very minor reversal of memory deficits (Arendash et al., 2001, Austin et al., 2003, Adolfsson et al., 2012, Bohrmann et al., 2012).”
ResultCentral nervous system myeloid cells as drug targets: current status and translational challenges
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Self-citationSpecific Uptake of an Amyloid-β Protofibril-Binding Antibody-Tracer in AβPP Transgenic Mouse Brain
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“The antibody recognises both N-terminal and central regions of the peptide and induces its removal by Fc receptor-mediated microglial phagocytosis [59,60].”
BackgroundPassive anti-amyloid immunotherapy in Alzheimer's disease: What are the most promising targets?
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Amyloid-Related Imaging Abnormalities: An Update
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Is there still any hope for amyloid-based immunotherapy for Alzheimer's disease?
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“In transgenic mice, gantenerumab significantly reduced the amyloid plaque burden by recruiting microglia and preventing new senile plaque formation without altering plasma Ab [74].”
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“(Bohrmann et al., 2012) was significantly enhanced by combination treatment.”
BackgroundMethodInfluentialSelf-citationMolecular basis for mid-region amyloid-β capture by leading Alzheimer's disease immunotherapies
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Advances in Alzheimer’s Disease Drug Development
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Treatment of Alzheimer’s Disease: Beyond Symptomatic Therapies
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Amyloid-related Imaging Abnormalities in Alzheimer Disease Treated with Anti–Amyloid-β Therapy
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Open questions for Alzheimer’s disease immunotherapy
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“Pittsburgh Compound B) scans [33,34].”
Alzheimer’s Disease: A Brief History of Immunotherapies Targeting Amyloid β
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Amyloid Hypothesis: Is There a Role for Antiamyloid Treatment in Late-Life Depression?
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“Gantenerumab induced cellular phagocytosis of human amyloid-β deposits in AD brain (70).”
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Islet amyloid polypeptide: Another key molecule in Alzheimer’s pathogenesis?
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“…clinical trials since 2000 including both active vaccinations (e.g. CAD 106 and Affitope AD02) (Farlow et al., 2015; Schneeberger et al., 2010, 2009; Winblad et al., 2012) and passive vaccinations (e.g. solanezumab and gantenerumab) (Bohrmann et al., 2012; Farlow et al., 2012; Uenaka et al., 2012).”
BackgroundBiomarkers in Amyloid-β Immunotherapy Trials in Alzheimer’s Disease
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- Authors
- Bohrmann, B., Baumann, K., Benz, J., Gerber, F., Huber, W., Knoflach, F., Messer, J., Oroszlan, K., Rauchenberger, R., Richter, W. F., Rothe, C., Urban, M., Bardroff, M., Winter, M., Nordstedt, C., & Loetscher, H.
- Affiliations
- F. Hoffmann-La Roche AG (CH)
- F. Hoffmann-La Roche Ltd., pRED, Basel, Switzerland
- MorphoSys (Germany) (DE)
- Corresponding author
- Bohrmann, Bernd
- Venue
- Journal of Alzheimer's Disease
- Publisher
- SAGE Publications
- Published
- 2012-01-12
- Volume
- 28
- Issue
- 1
- Pages
- 49-69
- ISSN
- 1387-2877 (ISSN-L)
- 1875-8908
- OpenAlex
- W1927066019
- Cited by
- 448
- References
- 61
- Citations by year
- 2026: 21 · 2025: 32 · 2024: 49 · 2023: 43 · 2022: 43 · 2021: 26 · 2020: 45 · 2019: 29 · 2018: 29 · 2017: 23 · 2016: 31 · 2015: 21 · 2014: 31 · 2013: 19 · 2012: 5
- FWCI
- 16.30
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Alzheimer s Disease (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DORA PSI (Paul Scherrer Institute) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- gantenerumab, anti-amyloid beta antibodies
- MeSH terms
- Amino Acid Sequence, Animals, Antibodies, Monoclonal, Cerebral Cortex, Cricetulus, Female, Cricetinae, Humans, Male, Mice, Inbred C57BL, Mice, Transgenic, Molecular Sequence Data, Phagocytosis, Protein Binding, Amyloid beta-Peptides, CHO Cells, Rats, Sprague-Dawley, Protein Structure, Tertiary, Crystallography, X-Ray, Excitatory Postsynaptic Potentials, Mice, Rats, Antibodies, Monoclonal, Humanized
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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