M860, a Monoclonal Antibody against Human Lactoferrin, Enhances Tumoricidal Activity of Low Dosage Lactoferrin via Granzyme B Induction

Lactoferrin (LF) is a soluble glycoprotein of the transferring family found in most biological fluids, functioning as a major first line defense molecule against infection in mammals. It also shows certain anti-tumor activity, but its clinical application in tumor therapy is limited because high dosage is required. In this study, we demonstrate that M860, a monoclonal antibody against human LF (hLF), could significantly increase the anti-tumor potential of low dosage hLF by forming LF-containing immune complex (IC). Human monocytes primed with LF-IC, but not hLF or M860 alone, or control ICs, showed strong tumoricidal activity on leukemia cell lines Jurkat and Raji through induction of secreted Granzyme B (GzB). LF-IC is able to colligate membrane-bound CD14 (a TLR4 co-receptor) and FcγRIIa (a low affinity activating Fcγ receptor) on the surface of human monocytes, thereby triggering the Syk-PI3K-AKT-mTOR pathway leading to GzB production. Our work identifies a novel pathway for LF-mediated tumoricidal activity and may extend the clinical application of LF in tumor therapy.


Introduction
Lactoferrin (LF), an 80-kDa glycoprotein with iron-binding ability, was discovered in mammary secretions and also in the second granules of neutrophils, and could be extracellularly released under conditions of stress or inflammation [1]. It functions as a major defense molecule against infections, and also exhibits certain anti-tumor potential both in vitro and in vivo [2,3]. It has been reported that down-regulation of LF gene in cells leads to an increase of malignant tumors [4,5]. LF and its derivatives induced apoptosis of tumor cells through both extrinsic and intrinsic pathways [3,6]. LF could also inhibit phosphorylation of AKT thus inducing cell cycle arrest of tumor cells [7,8]. In addition to the direct function of LF on tumor cells, LF could also affect immune cells to evade cancers. Bovine LF could significantly improve the anti-tumor activity of NK cells and macrophages [9,10]. As a multifunctional protein, LF is widely used for various clinical conditions. For instance, it is utilized for treating stomach and intestinal ulcers [11,12]. It is also applied as an antioxidant to protect against infections or tissue damage associated with aging [13][14][15]. However, clinical application of LF in tumor therapy is limited because of fast clearance of LF in vivo and high dosage requirement for effective therapy [16,17].
M860, an anti-human LF (hLF) monoclonal antibody produced in this laboratory, can form immune-complex (IC) with hLF [18]. We have previously demonstrated that LF-IC (M860+hLF) was very potent in inducing pro-inflammatory cytokines including TNFα by human monocytes/macrophages [19]. Freshly purified human monocytes were primed with 30 μg/mL LF-IC. CFSE labeled Jurkat or Raji cells were seeded directly to the culture or were placed in transwell inserts. Cells were acquired and analyzed by Flow Cytometry with Propidium Iodide staining post co-culture for 18 hrs. Specific Lysis were expressed by the percentage of CFSE + PI + cell counts in CFSE + cell counts. * p < 0.05, ** p < 0.01.

The tumoricidal function of LF-IC-primed human monocytes is independent of TNFα production
TNFα is known to trigger apoptosis in tumor cells through blocking NF-κB signaling [28,29], and thus considered a possible mediator of the tumoricidal effect of LF-IC-primed monocytes. However, Etanercept, a blocking mAb against TNFα, did not affect the tumoricidal activity of LF-IC primed monocytes (Figure 2), arguing for the presence of soluble factors other than TNFα responsible for the killing of the tumor cells in these experiments. (C,D) Freshly purified human monocytes were primed with 30 µg/mL LF-IC. CFSE labeled Jurkat or Raji cells were seeded directly to the culture or were placed in transwell inserts. Cells were acquired and analyzed by Flow Cytometry with Propidium Iodide staining post co-culture for 18 h. Specific Lysis were expressed by the percentage of CFSE + PI + cell counts in CFSE + cell counts. * p < 0.05, ** p < 0.01.

Granzyme B Is a Key Mediator of the Tumoricidal Function of LF-IC-Primed Monocytes
Based on our analysis on the differentially expressed genes (DEGs) of RNA-seq data from LF-ICand OVA-IC-primed human monocytes [30], Granzyme B (GzB), a potent cytotoxic protein produced by myeloid cells [31,32], was amongst the most significantly up-regulated genes in LF-IC-primed cells, which was confirmed by q-PCR ( Figure 3A) and ELISA ( Figure 3B) results. Furthermore, concentration of GzB in supernatant of LF-IC-stimulated monocyte cultures reached plateau by 48 h ( Figure 3C). It has also been reported that Z-AAD-CMK could bind to GzB and irreversibly inhibit its cytotoxic activity. Consistently, the tumoricidal activity of LF-IC-primed human monocytes was dose-dependently inhibited by Z-AAD-CMK (Figs. 3D& 3E). Since tumor cells are known to polarize monocytes through secreted soluble factors or exosomes [20], Jurkat or Raji cells might also be able to induce GzB expression by human monocytes. However, concentration of GzB in the supernatant of LF-IC primed monocyte cultures was unaffected by the presence of these tumor cells ( Figure 3F). These results together confirm an indispensable role for GzB in the tumoricidal function of LF-IC-primed monocytes.

Granzyme B is a key mediator of the tumoricidal function of LF-IC-primed monocytes
Based on our analysis on the differentially expressed genes (DEGs) of RNA-seq data from LF-IC-and OVA-IC-primed human monocytes [30], Granzyme B (GzB), a potent cytotoxic protein produced by myeloid cells [31,32], was amongst the most significantly up-regulated genes in LF-ICprimed cells, which was confirmed by q-PCR ( Figure 3A) and ELISA ( Figure 3B) results. Furthermore, concentration of GzB in supernatant of LF-IC-stimulated monocyte cultures reached plateau by 48 h ( Figure 3C). It has also been reported that Z-AAD-CMK could bind to GzB and irreversibly inhibit its cytotoxic activity. Consistently, the tumoricidal activity of LF-IC-primed human monocytes was dose-dependently inhibited by Z-AAD-CMK (Figs. 3D& 3E). Since tumor cells are known to polarize monocytes through secreted soluble factors or exosomes [20], Jurkat or Raji cells might also be able to induce GzB expression by human monocytes. However, concentration of GzB in the supernatant of LF-IC primed monocyte cultures was unaffected by the presence of these tumor cells ( Figure 3F). These results together confirm an indispensable role for GzB in the tumoricidal function of LF-ICprimed monocytes.  The tumoricidal function of LF-IC-primed human monocytes is independent of TNFα secretion. LF-IC primed monocytes were treated by 100 μg/mL Etanercept or left untreated for 24 hrs. CFSE labeled Jurkat (A) or Raji (B) were then added and co-cultured with primed monocytes for 18 hrs. Cells were acquired and analyzed by FACS with PI staining. Results were expressed by the percentage of CFSE + PI + cell counts in CFSE + cell counts. * p < 0.05, ** p < 0.01.

Granzyme B is a key mediator of the tumoricidal function of LF-IC-primed monocytes
Based on our analysis on the differentially expressed genes (DEGs) of RNA-seq data from LF-IC-and OVA-IC-primed human monocytes [30], Granzyme B (GzB), a potent cytotoxic protein produced by myeloid cells [31,32], was amongst the most significantly up-regulated genes in LF-ICprimed cells, which was confirmed by q-PCR ( Figure 3A) and ELISA ( Figure 3B) results. Furthermore, concentration of GzB in supernatant of LF-IC-stimulated monocyte cultures reached plateau by 48 h ( Figure 3C). It has also been reported that Z-AAD-CMK could bind to GzB and irreversibly inhibit its cytotoxic activity. Consistently, the tumoricidal activity of LF-IC-primed human monocytes was dose-dependently inhibited by Z-AAD-CMK (Figs. 3D& 3E). Since tumor cells are known to polarize monocytes through secreted soluble factors or exosomes [20], Jurkat or Raji cells might also be able to induce GzB expression by human monocytes. However, concentration of GzB in the supernatant of LF-IC primed monocyte cultures was unaffected by the presence of these tumor cells ( Figure 3F). These results together confirm an indispensable role for GzB in the tumoricidal function of LF-ICprimed monocytes. Cells were acquired and analyzed by FACS with PI staining. Results were expressed by the percentage of CFSE + PI + cell counts in CFSE + cell counts. (F) Freshly purified human monocytes were primed with 30 µg/mL LF-IC for 24 h. Supernatant were removed and tumor cells were added followed by further incubation for 24 h. In a parallel group, tumor cells were added without supernatant removement. GzB in supernatants was determined by ELISA. * p < 0.05, ** p < 0.01, *** p < 0.001.

Role of CD32a (FcγRIIa) and Membrane-Bound CD14 in LF-IC Priming of Human Monocytes
Membrane-bound CD14 (mCD14) is a co-receptor of TLR4, they function together as a receptor complex in monocytes for LF [19]. Consistent with our previous finding that LF-IC strongly activates human monocytes through co-ligation of FcγRIIa (but not FcγRI and FcγRIII) and mCD14/TLR4 [19], GzB production by human monocytes under stimulation of LF-IC was significantly inhibited by αCD32a (FcγRIIa), but not αCD64 (FcγRI) or αCD16 (FcγRIII), mAb ( Figure 4A). Additionally, mAb against human CD14 almost completely abolished GzB production by LF-IC-primed monocytes ( Figure 4A). Meanwhile, heparin, a carbohydrate capable of blocking LF-CD14 interaction, dose-dependently inhibited GzB production by human monocytes under LF-IC stimulation ( Figure 4B). CMK) for 18 hrs. Cells were acquired and analyzed by FACS with PI staining. Results were expressed by the percentage of CFSE + PI + cell counts in CFSE + cell counts. (F) Freshly purified human monocytes were primed with 30 μg/mL LF-IC for 24 h. Supernatant were removed and tumor cells were added followed by further incubation for 24 hrs. In a parallel group, tumor cells were added without supernatant removement. GzB in supernatants was determined by ELISA.* p < 0.05, ** p < 0.01, *** p < 0.001.

LF-IC induces GzB expression in human monocytes via the syk-PI3K-AKT pathway
Syk is a predominant kinase essential for signal transduction of immunoreceptor tyrosine-based activation motifs (ITAMs) in the cytoplasmic tail of FcγRs [33]. As shown in Figure 5A, LF-IC strongly induced phosphorylation of Akt, Syk and mTOR in human monocytes as evidenced by Western Blotting Assay ( Figure 5A). Given also that PI3K was also induced in the same experiment ( Figure  5A), it is highly likely that LF-IC elicited GzB production in human monocytes through the PI3K/Akt/mTOR pathway. This is supported by the results that specific inhibitors against Syk (R406), PI3K (LY294002), AKT (GSK690693) and mTOR (rapamycin) significantly decreased GzB expression in LF-IC-primed human monocytes ( Figure 5B-E).

LF-IC Induces GzB Expression in Human Monocytes via the syk-PI3K-AKT Pathway
Syk is a predominant kinase essential for signal transduction of immunoreceptor tyrosine-based activation motifs (ITAMs) in the cytoplasmic tail of FcγRs [33]. As shown in Figure 5A, LF-IC strongly induced phosphorylation of Akt, Syk and mTOR in human monocytes as evidenced by Western Blotting Assay ( Figure 5A). Given also that PI3K was also induced in the same experiment ( Figure 5A), it is highly likely that LF-IC elicited GzB production in human monocytes through the PI3K/Akt/mTOR pathway. This is supported by the results that specific inhibitors against Syk (R406), PI3K (LY294002), AKT (GSK690693) and mTOR (rapamycin) significantly decreased GzB expression in LF-IC-primed human monocytes ( Figure 5B-E).

Unresponsiveness of Murine Monocytes to LF-IC Stimulation
Since mice do not have FcγRIIa homologue, human FcγRIIa transgenic (hFcγRIIa-TG) mice were employed for further investigation on whether LF-IC exhibits anti-tumor effect through augmentation of tumoricidal activity of monocytes/macrophages in vivo. Surprisingly, LF-IC-primed hFcγRIIa TG murine monocytes did not show tumoricidal activity against EL4 cells, a mouse leukemia cell line ( Figure 6A). We also compared hFcγRIIa TG mice treated with, or without, LF-IC, for response to intravenous inoculated viable EL4 cells, no significant difference was observed in terms of time of survival ( Figure 6B).

Unresponsiveness of murine monocytes to LF-IC stimulation
Since mice do not have FcγRIIa homologue, human FcγRIIa transgenic (hFcγRIIa-TG) mice were employed for further investigation on whether LF-IC exhibits anti-tumor effect through augmentation of tumoricidal activity of monocytes/macrophages in vivo. Surprisingly, LF-IC-primed hFcγRIIa TG murine monocytes did not show tumoricidal activity against EL4 cells, a mouse leukemia cell line ( Figure 6A). We also compared hFcγRIIa TG mice treated with, or without, LF-IC, for response to intravenous inoculated viable EL4 cells, no significant difference was observed in terms of time of survival ( Figure 6B).

Unresponsiveness of murine monocytes to LF-IC stimulation
Since mice do not have FcγRIIa homologue, human FcγRIIa transgenic (hFcγRIIa-TG) mice were employed for further investigation on whether LF-IC exhibits anti-tumor effect through augmentation of tumoricidal activity of monocytes/macrophages in vivo. Surprisingly, LF-IC-primed hFcγRIIa TG murine monocytes did not show tumoricidal activity against EL4 cells, a mouse leukemia cell line ( Figure 6A). We also compared hFcγRIIa TG mice treated with, or without, LF-IC, for response to intravenous inoculated viable EL4 cells, no significant difference was observed in terms of time of survival ( Figure 6B).

Discussion
Tumorigenesis is a failure of immune surveillance towards malignant cells, therefore improving immune response is expected to have beneficial effect against cancers. LF exhibits functions of immunoregulation and anti-tumor protection [2,3]. However, its therapeutic efficacy is quite low, which has to be compensated by high dosage [8]. In this study, we demonstrate that combination of human LF and M860, a mouse monoclonal IgG1 antibody against human LF, renders human monocytes potent tumoricidal activity through FcγRIIa-CD14/TLR4 co-ligation and induction of GzB. This strategy allows LF to achieve anti-tumor effect at significantly lower concentration. The Fc proportion of mouse IgG1 is able to bind human FcγRIIa [34], which is a low affinity receptor for IgG in ICs. Humanized M860 with increased binding affinity for hFcγRIIa may further enhance the efficiency in facilitating the anti-tumor potential of low dose hLF in vivo.
Mouse monocytes transgenic for hFcγRIIa did not respond to LF-IC in the same way as human monocytes ( Figure 6). Our recent data indicate that CD14/TLR4 complex on the surface of murine monocytic cells is also capable of binding hLF (not shown), thereby excluding the possibility that the unresponsiveness of hFcγRIIa-TG mouse monocytes to LF-IC was due to lack of binding with mouse CD14/TLR4. An important consideration here is that FcγRs expressed on the surface of mouse myeloid cells differ considerably from those of human monocytes. For instance, FcγRIIb, an inhibitory FcγR, is expressed at a high level in mouse monocytes, but at a low level in human monocytes [35,36]. This could be a main reason for the poor response of mouse monocytes to LF-IC priming. Humanized mouse models would be needed for future investigation on anti-tumor effects of hLF in combination with M860 in vivo.
Among the cytokines released by LF-IC-primed human monocytes, TNFα could induce cell death of tumor cells. However, TNFα in LF-IC primed monocyte cultures was insufficient to induce cellular death of Jurkat and Raji cells. It has previously been documented that Jurkat cells were insensitive to TNFα or TRAIL [37]. Another possibility is that the amount of TNFα produced by LF-IC-primed monocytes was not large enough to achieve significant tumoricidal effects. Granzymes, a family of serine proteases expressed by cytotoxic cells, play important roles in protection against viral infection and cellular transformation. GzB is the most powerful member of the granzyme family. Our work identifies GzB as the major soluble mediator of the tumoricidal activity of LF-IC-primed monocytes. It has been shown that TLR8 agonist could boost antibody-dependent cell death (ADCC) through the induction of GzB [38]. Our data further emphasize that the interaction of TLRs with FcγRs could be beneficial for conditioning innate immune cells such as monocytes and macrophages for tumoricidal activity. Though cytotoxicity of GzB is not tumor-specific, receptors for LF, such as LRP, are well characterized tumor-associated antigens, which may help effective targeting of the LF-IC-primed monocytes [39,40]. In conclusion, our results on the tumoricidal activity of LF-IC-primed monocytes will expand the clinical cancer therapeutic application of LF and provide new research areas of tumor therapy.

Peripheral Blood Monocyte Isolation and Cell Culture
Peripheral blood monocytes (PBMs) were obtained from healthy individuals after informed consent in accordance with procedures approved by the human ethics committee of Soochow University. Monocytes were sorted from PBMCs using human αCD14 magnetic-labeled beads (MACS; Miltenyi Biotec) according to the manufacturer's instructions. The purity of monocytes obtained was around 95%, as determined by flow cytometer with αCD14 mAb. Purified monocytes were cultured in RPMI-1640 medium supplemented with 10% (v/v) autologous serum, penicillin/streptomycin (100 U/mL), at 37 • C and 5% CO 2 . Human T-cell leukemia Jurkat cells. B-cell leukemia Raji cells and mouse leukemia EL4 cells were originally obtained from the American Type Culture Collection (ATCC). All cells were cultured in RPMI-1640 (Hyclone) supplemented with 10% FBS (BI), penicillin/streptomycin (100 U/mL) at 37 • C with 5% CO 2 .

Mouse Monocyte Isolation
Bone marrow cells from WT and hFcγRIIa TG mice were treated with red blood cell lysis buffer and resuspended in PBS at a density of 10 8 /mL. Monocytes were enriched using EasySep TM Mouse Monocyte Isolation Kit (StemCell Technology, Vancouver, Canada). In brief, cell suspension incubated with selection cocktail including biotin labeled anti-CD3e, CD45R, Ly-6G, NK1.1, CD117 and Siglec F, followed by incubation with streptavidin coupled beads. The monocytes were purified using magnet depleting other cell population in bone marrow.

Anti-Tumor Effects
Freshly purified human monocytes or mouse monocytes were seeded at a density of 10 5 cells per well in a 96 well plate and primed with stimulators for 24 h. 2 × 10 4 CFSE labeled Jurkat or Raji were later added and co-cultured with primed human monocytes for 18 h. 2 × 10 4 CFSE labeled EL4 cells were added and co-cultured with freshly purified mouse monocytes for 18 h. Cells were acquired and analyzed by FACS with PI (Propidium Iodide) staining. Results were expressed by the percentage of CFSE + PI + cell counts in CFSE + cell counts.

ELISA
The concentration of human Granzyme B in the culture supernatant was determined using ELISA kits (Minneapolis, R&D, USA). Cell supernatants were collected and centrifuged at 10,000 g to clear cellular debris. ELISAs were performed according to the respective manufacturer protocols.

Real-Time RT-PCR
RNA was isolated from cells with the Total RNA Kit II (OMEGA, Norcross, GA, USA) and subsequently reversely transcribed into cDNA using an oligo (dT) primer (Takara, JP). For mRNA-level analysis, cells were lysed at the indicated time points, after which mRNA extraction was performed. Q-PCR (Life Technology, USA) was performed using SYRB green (Takara, JP) and primer pairs as listed in Table 1.

Tumor Models
WT or hFcγRIIa TG mice were obtained from Jackson Laboratory (Bar Harbor, ME, USA) and bred with C57/BL6 mice for more than 10 generations. WT and hFcγRIIa TG (n = 12) were inoculated with 10 6 EL4 intravenously. Mice were treated with 100 µg LF-IC or PBS i.p. at the day before inoculation and 1, 3 days post inoculation. Survival of the animals were monitored for 20 days post inoculation.

Western Blotting Analysis
Cells were lysed in lysis buffer. After centrifugation at 12,000 g for 15 min at 4 • C, the supernatant was collected, and its protein concentration was determined using BCA Protein Assay Kit (Pierce, Rockford, IL, USA). 30 µg proteins for each sample, were separated on 10% SDS-PAGE and transferred onto polyvinylidene difluorid (PVDF) membranes (Millipore, Bedford, MA, USA), followed by being blocked with 5% bovine serum albumin in PBST (0.1% Tween-20 in PBS) for 1 h. The membranes were incubated with anti-p-Syk, p-PI3K, p-Akt, p-mTOR and β-actin (Cell signaling technology, Danvers, MA, USA) at 4 • C overnight followed by incubation with horseradish peroxidase-conjugated secondary antibody for 1 h at room temperature. The blots were developed by enhance chemiluminscence detection regents (Pierce, Rockford, IL, USA).

Study Approval
This study was approved by the Ethics Committees of Soochow University, Suzhou, China. The methods were carried out in accordance with the guidelines of Soochow University. Written informed consent was obtained from all participants prior to inclusion in the study.

Statistical Analysis
Data were expressed as the mean ± SEM of at least three independent experiments. The student's t-test was used to compare differences among groups by using GraphPad Prism 5.0 software and values at p < 0.05 were considered significant.

Conclusions
Data presented here demonstrate that IC between hLF and M860, an anti-hLF mAb, renders human monocytes tumoricidal activiy via induction of secreted GzB. LF-IC is able to colligate CD14/TLR4 and FcγRIIa on the surface of human monocytes, thereby triggering the Syk-PI3K-AKT-mTOR pathway leading to GzB production. Our results may help to expand cancer therapeutic application of low dosage LF.