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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Pharmacol.</journal-id>
<journal-title>Frontiers in Pharmacology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Pharmacol.</abbrev-journal-title>
<issn pub-type="epub">1663-9812</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="publisher-id">803059</article-id>
<article-id pub-id-type="doi">10.3389/fphar.2022.803059</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Pharmacology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>IgG-like Bispecific Antibody CD3&#xd7;EpCAM Generated by Split Intein Against Colorectal Cancer</article-title>
<alt-title alt-title-type="left-running-head">Wang et&#x20;al.</alt-title>
<alt-title alt-title-type="right-running-head">CD3&#xd7;EpCAM BsAb Against CRC</alt-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Wang</surname>
<given-names>Lei</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="fn" rid="fn1">
<sup>&#x2020;</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1001199/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Qiao</surname>
<given-names>Yu</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="fn" rid="fn1">
<sup>&#x2020;</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1669993/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Zong</surname>
<given-names>Huifang</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1669934/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Han</surname>
<given-names>Lei</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1670029/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ke</surname>
<given-names>Yong</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1669992/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Pan</surname>
<given-names>ZhiDi</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Chen</surname>
<given-names>Jie</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1669988/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Lu</surname>
<given-names>Jun</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/106672/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Li</surname>
<given-names>Jinyao</given-names>
</name>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/767876/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ying</surname>
<given-names>Tianlei</given-names>
</name>
<xref ref-type="aff" rid="aff6">
<sup>6</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/145138/overview"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Zhang</surname>
<given-names>Baohong</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="corresp" rid="c001">
<sup>&#x2a;</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/768238/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Zhu</surname>
<given-names>Jianwei</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<xref ref-type="aff" rid="aff7">
<sup>7</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/784728/overview"/>
</contrib>
</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>Engineering Research Center of Cell and Therapeutic Antibody, MOE, School of Pharmacy</institution>, <institution>Shanghai Jiao Tong University</institution>, <addr-line>Shanghai</addr-line>, <country>China</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>Jecho Institute, Co. Ltd.</institution>, <addr-line>Shanghai</addr-line>, <country>China</country>
</aff>
<aff id="aff3">
<sup>3</sup>
<institution>Jecho Biopharmaceuticals Co. Ltd.</institution>, <addr-line>Tianjin</addr-line>, <country>China</country>
</aff>
<aff id="aff4">
<sup>4</sup>
<institution>School of Science, and School of Interprofessional Health Studies</institution>, <institution>Faculty of Health and Environmental Sciences</institution>, <institution>Auckland University of Technology</institution>, <addr-line>Auckland</addr-line>, <country>New&#x20;Zealand</country>
</aff>
<aff id="aff5">
<sup>5</sup>
<institution>Xinjiang Key Laboratory of Biological Resources and Genetic Engineering</institution>, <institution>College of Life Science and Technology</institution>, <institution>Xinjiang University</institution>, <addr-line>Urumqi</addr-line>, <country>China</country>
</aff>
<aff id="aff6">
<sup>6</sup>
<institution>Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS)</institution>, <institution>School of Basic Medical Sciences</institution>, <institution>Fudan University</institution>, <addr-line>Shanghai</addr-line>, <country>China</country>
</aff>
<aff id="aff7">
<sup>7</sup>
<institution>Jecho Laboratories, Inc.</institution>, <addr-line>Frederick</addr-line>, <addr-line>MD</addr-line>, <country>United&#x20;States</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>
<bold>Edited by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1013192/overview">Amit Kumar Nayak</ext-link>, Seemanta Institute of Pharmaceutical Sciences (SIPS), India</p>
</fn>
<fn fn-type="edited-by">
<p>
<bold>Reviewed by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1097108/overview">Shahryar Khoshtinat Nikkhoi</ext-link>, Rutgers, The State University of New Jersey, United&#x20;States</p>
<p>
<ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/738420/overview">Christian Klein</ext-link>, Roche Innovation Center Zurich, Switzerland</p>
</fn>
<corresp id="c001">&#x2a;Correspondence: Baohong Zhang, <email>bhzhang@sjtu.edu.cn</email>
</corresp>
<fn fn-type="equal" id="fn1">
<label>
<sup>&#x2020;</sup>
</label>
<p>These authors have contributed equally to this&#x20;work</p>
</fn>
<fn fn-type="other">
<p>This article was submitted to Drug Metabolism and Transport, a section of the journal Frontiers in Pharmacology</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>23</day>
<month>02</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="collection">
<year>2022</year>
</pub-date>
<volume>13</volume>
<elocation-id>803059</elocation-id>
<history>
<date date-type="received">
<day>27</day>
<month>10</month>
<year>2021</year>
</date>
<date date-type="accepted">
<day>31</day>
<month>01</month>
<year>2022</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2022 Wang, Qiao, Zong, Han, Ke, Pan, Chen, Lu, Li, Ying, Zhang and Zhu.</copyright-statement>
<copyright-year>2022</copyright-year>
<copyright-holder>Wang, Qiao, Zong, Han, Ke, Pan, Chen, Lu, Li, Ying, Zhang and Zhu</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these&#x20;terms.</p>
</license>
</permissions>
<abstract>
<p>
<bold>Background:</bold> Colorectal cancer is a commonly diagnosed cancer with high mortality worldwide. Postoperative recidivation and metastasis still are the main challenges in clinical treatments. Thus, it is urgent to develop new therapies against colorectal cancer. Epithelial Cell Adhesion Molecule (EpCAM) is overexpressed in colorectal cancer cells and strongly associated with cancer development. Bispecific antibody (BsAb) is a kind of promising immunotherapy, which could recognize T&#x20;cells and cancer cells simultaneously to achieve the anti-tumor effects.</p>
<p>
<bold>Methods:</bold> A bispecific antibody targeting EpCAM and CD3 with IgG format was genereated by split intein based on the Bispecific Antibody by Protein Splicing&#x201d; platform. <italic>In vitro</italic>, the affinity of CD3&#xd7;EpCAM BsAb was determined by Biolayer interferometry, its cytotoxicity was detected by LDH release assay, T&#x20;cell recruitment and activation was detected by Flow Cytometry. <italic>In vivo</italic>, its pharmacokinetic parameters were detected, and anti-tumor effects were evaluated on the tumor cell xenograft mouse&#x20;model.</p>
<p>
<bold>Results:</bold> The results showed that the CD3&#xd7;EpCAM BsAb could activate and recruit T&#x20;cells via binding colorectal cells and T&#x20;cells, which could lead to more potent cytotoxicity to various colorectal cell lines than its parent EpCAM monoclonal antibody (mAb) <italic>in&#x20;vitro</italic>. The CD3&#xd7;EpCAM BsAb had similar pharmacokinetic parameters with EpCAM mAb and inhibits tumor growth on the SW480 tumor cell xenograft mouse&#x20;model.</p>
<p>
<bold>Conclusion:</bold> The CD3&#xd7;EpCAM BsAb could be a promising candidate for colorectal cancer treatment.</p>
</abstract>
<kwd-group>
<kwd>colorectal cancer</kwd>
<kwd>bispecific antibody</kwd>
<kwd>split intein</kwd>
<kwd>epcam</kwd>
<kwd>CD3</kwd>
</kwd-group>
<contract-sponsor id="cn001">National Natural Science Foundation of China<named-content content-type="fundref-id">10.13039/501100001809</named-content>
</contract-sponsor>
</article-meta>
</front>
<body>
<sec id="s1">
<title>Introduction</title>
<p>Colorectal cancer (CRC) is one of the most common cancers with a low 5-years survival rate worldwide (<xref ref-type="bibr" rid="B41">Siegel et&#x20;al., 2021</xref>; <xref ref-type="bibr" rid="B46">Sung et&#x20;al., 2021</xref>). CRC develops from normal mucosa to an invasive tumor through different stages (<xref ref-type="bibr" rid="B2">Argil&#xe9;s et&#x20;al., 2020</xref>). Even though surgery and chemotherapy are standard treatments, chemotherapy could negatively affect normal tissue (<xref ref-type="bibr" rid="B30">Nordlinger et&#x20;al., 2009</xref>). Meanwhile, patients with metastatic colorectal cancer have a poor prognosis, and tumor recurrence is possible within 5&#xa0;years after surgery (<xref ref-type="bibr" rid="B39">Seo et&#x20;al., 2013</xref>; <xref ref-type="bibr" rid="B47">Van Cutsem et&#x20;al., 2016</xref>). Therefore, a novel therapeutic for colorectal cancer is urgently needed.</p>
<p>In recent years, immunotherapies for CRC have been developed, including bispecific antibodies (BsAb), checkpoint inhibitors, cancer vaccines, and oncolytic virus therapy (<xref ref-type="bibr" rid="B12">Ciardiello et&#x20;al., 2019</xref>). Engineered antibodies are an important part of immunotherapy (<xref ref-type="bibr" rid="B53">Zhu, 2012</xref>). The bispecific antibody is an engineering antibody with two different binding targets or epitopes for multiple applications (<xref ref-type="bibr" rid="B7">Brinkmann and Kontermann, 2021</xref>). It could exhibit a novel action or mechanism that cannot be achieved by combining separate antibodies with the same targets (<xref ref-type="bibr" rid="B23">Labrijn et&#x20;al., 2019</xref>), such as redirecting T&#x20;cells to tumor cells (<xref ref-type="bibr" rid="B4">Bargou et&#x20;al., 2008</xref>), activating or inhibiting two receptors (<xref ref-type="bibr" rid="B36">Schaefer et&#x20;al., 2011</xref>), serving as cofactor mimetic (<xref ref-type="bibr" rid="B34">Sampei et&#x20;al., 2013</xref>), or even delivering a protein across the blood-brain barrier (<xref ref-type="bibr" rid="B51">Yu et&#x20;al., 2011</xref>; <xref ref-type="bibr" rid="B50">Yu et&#x20;al., 2014</xref>). Recruiting effector cells to eliminate tumor cells was the typical application of BsAb in immunotherapies. The European Medicines Agency approved the first commercial bispecific antibody targeting CD3 and EpCAM for malignant ascites, followed by FDA approval of Blinatumomab targeting CD3 and CD19 for acute lymphoblastic leukemia, Emicizumab targeting factors IXa and X for Hemophilia A, and Amiivantamab targeting EGFR and cMet for non-small cell lung cancer (<xref ref-type="bibr" rid="B20">Heiss et&#x20;al., 2010</xref>; <xref ref-type="bibr" rid="B5">Blair, 2019</xref>; <xref ref-type="bibr" rid="B44">Stein et&#x20;al., 2019</xref>; <xref ref-type="bibr" rid="B28">Neijssen et&#x20;al., 2021</xref>). However, compared to the success of hematological malignancies, solid tumor treatment is still complex in clinical trials.</p>
<p>Important expression characteristics and functional roles contribute to EpCAM (CD326) to an attractive target for immunotherapy (<xref ref-type="bibr" rid="B10">Chaudry et&#x20;al., 2007</xref>; <xref ref-type="bibr" rid="B15">Eyvazi et&#x20;al., 2018</xref>; <xref ref-type="bibr" rid="B43">Song et&#x20;al., 2021</xref>). On the one hand, it is a highly expressed glycoprotein on most carcinomas and slightly expressed on normal tissues. On the other hand, it is crucial for tissue morphogenesis and stable adhesion formation, and it is associated with epithelial cell proliferation, differentiation, and migration (<xref ref-type="bibr" rid="B26">Munz et&#x20;al., 2004</xref>; <xref ref-type="bibr" rid="B48">Went et&#x20;al., 2006</xref>). Compared with the anti-EpCAM monoclonal antibody (<xref ref-type="bibr" rid="B13">de Bono et&#x20;al., 2004</xref>), CD3&#xd7;EpCAM BsAb (Catumaxomab and MT110) exhibited a better efficacy against EpCAM-positive cancer in clinical trials (<xref ref-type="bibr" rid="B20">Heiss et&#x20;al., 2010</xref>; <xref ref-type="bibr" rid="B27">M&#xfc;nz et&#x20;al., 2010</xref>; <xref ref-type="bibr" rid="B21">Kebenko et&#x20;al., 2018</xref>). Nevertheless, while catumaxomab can drive the immune system to kill tumor cells, it also has serious side effects due to its Fc region&#x2019;s off-target binding to Fc&#x3b3;R<sup>&#x2b;</sup> Kuffer cells (<xref ref-type="bibr" rid="B6">Borlak et&#x20;al., 2016</xref>).</p>
<p>The property of the bispecific antibody is deeply affected by the structure and target (<xref ref-type="bibr" rid="B29">Nie et&#x20;al., 2020</xref>). Fragment-based BsAb has intense penetration and epitope accessibility with a short plasma half-life (<xref ref-type="bibr" rid="B16">Fan et&#x20;al., 2015</xref>). For instance, the half-life of Blinatumomab is only 1.25&#x20;&#xb1; 0.63&#xa0;h (<xref ref-type="bibr" rid="B22">Klinger et&#x20;al., 2012</xref>). By contrast, IgG-like BsAb with a natural structure could be flexible&#x20;and desirable for therapeutic clinical application; however, heavy/light chain miss pairing remains an issue. Several alternative strategies were applied to generate bispecific antibodies (<xref ref-type="bibr" rid="B19">Han et&#x20;al., 2019</xref>; <xref ref-type="bibr" rid="B52">Zhou et&#x20;al., 2020</xref>). In our study, the &#x201c;Bispecific Antibody by Protein Trans-Splicing&#x201d; (BAPTS) platform was introduced to maintain the correct pairing of chains for the binding affinity of the Fab domain (<xref ref-type="bibr" rid="B18">Han et&#x20;al., 2017</xref>). Split inteins comprise N-terminal fragment (Intein<sup>N</sup>) and C-terminal fragment (Intein<sup>C</sup>) and are inactive when separated. The <italic>trans</italic>-splicing reaction could be carried out under native conditions, including reconstitution of intein fold, excision of the intein, and ligation of exteins. In the BAPTS platform, the bispecific antibody was divided into two antibody fragments attached with Intein<sup>N</sup> and Intein<sup>C</sup> at the hinge region of the antibody. The <italic>trans</italic>-splicing reaction occurred between two antibody fragments under mild reducing conditions, resulting in a mature bispecific antibody with correct chain pairing. In addition, the bispecific antibody remains an IgG-like format without an extra linker.</p>
<p>In our previous work, CD3&#xd7;HER2, CD3&#xd7;EGFR, HER2&#xd7;EGFR and CD3&#xd7;PRLR BsAbs were produced based on the &#x201c;BAPTS&#x201d; platform (<xref ref-type="bibr" rid="B18">Han et&#x20;al., 2017</xref>; <xref ref-type="bibr" rid="B52">Zhou et&#x20;al., 2020</xref>). The CD3&#xd7;EpCAM BsAb was generated with natural human IgG1 structure with the same technology. The CD3&#xd7;EpCAM BsAb eliminated the tumor cells with high EpCAM expression level, activated T&#x20;cells and induced T&#x20;cells redirected to tumor cells <italic>in&#x20;vitro</italic>. It could inhibit the growth of solid tumors derived from the SW480 cell line and maintain a similar half-life with EpCAM mAb <italic>in&#x20;vivo</italic>.</p>
</sec>
<sec sec-type="materials|methods" id="s2">
<title>Materials and Methods</title>
<sec id="s2-1">
<title>Mice and Cell Culture</title>
<p>Female NOD/SCID mice and Balb/c mice were purchased from Beijing Charles River Laboratories. The experimental protocols were approved by the Institutional Animal Care and Use Committee of Shanghai Jiao Tong University (A2018041). SW480 and Jurkat cells were purchased from the Chinese Type Culture Collection, and Caco-2 and HT-29 cells were purchased from the American Type Culture Collection. All tumor cell lines were cultured according to manufactures&#x2019; instructions.</p>
</sec>
<sec id="s2-2">
<title>Transient Antibody Expression in HEK293E Cells</title>
<p>Anti-CD3 and anti-EpCAM variable heavy chain (VH) and variable light chain (VL) sequences were synthesized and extended with human IgG1 framework with mutations of L234A, L235A, and P329G (LALA-PG), and then cloned into expression vector pM09 separately via One Step Cloning Kit (Vazyme Biotech, Nanjing, China) (30). Fragment A contained anti-CD3 light chain, anti-CD3 heavy chain, and inteinC fused CH2-3 construct, and Fragment B contained anti-EpCAM light chain and anti-EpCAM VH and CH1 in tandem with inteinN construct.</p>
<p>Transient gene expression (TGE) was used to produce antibody fragments and monoclonal antibodies as previously described (<xref ref-type="bibr" rid="B14">Ding et&#x20;al., 2017</xref>). In brief, two antibody fragments conjunct with split intein against CD3 and EpCAM were expressed via the transient transfection system in HEK293E cells. Plasmids were prepared through the TM Endo-free Plasmid Maxi Kit (Omega Bio Tek, Norcross, GA, United&#x20;States). HEK293E&#xa0;cells were seeded at a density of 3&#xd7;10<sup>6</sup> cells/mL on the day before transfection and were centrifuged and adjusted at 6&#xd7;10<sup>6</sup> cells/mL using Freestyle 293 medium (Thermo Fisher Scientific, Shanghai, China) on the day of transfection. Fragment A and B expression vectors were diluted into 40&#xa0;&#x3bc;g/ml using freestyle 293 medium and gently mixed with 25&#xa0;kDa linear-polyethyleneimine (PEI, 1&#xa0;mg/ml, 23966-1, Polysciences, Warrington, PA, United&#x20;States) (DNA: PEI &#x3d; 1:5, <italic>w: w</italic>). Plasmid and PEI complexes were incubated for 10&#x2013;15&#xa0;min and added to the cell medium. After 4&#xa0;h, the transfection system was supplemented with SFM4 HEK293 (Cytiva, Logan, UT, United&#x20;States) medium equal to freestyle 293 medium in volume and valproic acid (VPA, Sigma Aldrich, Shanghai, China) to 3&#xa0;mM; after 24&#xa0;h, 20% Tryptone N1 (Organotechnie, La Courneuve, France) was added into to the culture at 0.5% and anti-clumping agent (Thermo Fisher Scientific, Shanghai, China) to 0.1%. The supernatant was taken for purification when the cell viability was near&#x20;50%.</p>
</sec>
<sec id="s2-3">
<title>Bispecific Antibody Generation and Purification</title>
<p>The CD3 and EpCAM fragments were purified by Capto L chromatography (Cytiva, Uppsala, Sweden) through the Akta150 system (Cytiva, Uppsala, Sweden). The supernatant was centrifuged and flirted through a 0.45&#xa0;&#x3bc;m filter membrane. The column was loaded with binding buffer (20&#xa0;mM sodium phosphate, 150&#xa0;mM NaCl, pH 7.4), supernatants, wash buffer (100&#xa0;mM sodium citrate, pH 5.0), and eluted with elution buffer (100&#xa0;mM sodium citrate, pH 2.8). The elution was neutralized to pH 7.0 with Tris-HCl buffer (1&#xa0;M, pH 8.0). Fragment A and B samples were dialyzed into phosphate buffer (PBS, pH 7.4) followed by splicing reaction catalyzed mediated by split intein.</p>
<p>After dialyzing all of the fragments in PBS buffer and adding 2&#xa0;mM dithiothreitol (DTT, Sigma Aldrich, Shanghai, China), 100&#xa0;mM fragment A was combined with 375&#xa0;mM fragment B and incubated at 37&#xb0;C for 2&#xa0;h. The mixture was dialyzed to PBS to remove DTT, sterilized using a 0.22&#xa0;&#x3bc;m filter (Millipore, Shanghai, China), and the oxidation reaction was carried out at room temperature for 2&#x2013;3&#xa0;days. The CD3&#xd7;EpCAM BsAb was isolated through Protein A affinity chromatography (Cytiva, Uppsala, Sweden). The eluates were adjusted to pH 7.0 using Tris-HCl buffer, dialyzed to PBS, and sterilized through a 0.22&#xa0;&#x3bc;m filter (Millipore, Shanghai, China).</p>
</sec>
<sec id="s2-4">
<title>Affinity Measurement of the CD3&#xd7;EpCAM BsAb</title>
<p>Biolayer light interferometry (BLI, OctectRED96, ForteBio Analytics, Shanghai, China) was used to evaluate CD3&#xd7;EpCAM BsAb affinity to EpCAM. Biotinylated EpCAM antigen (Sino Biological, Beijing, China) immobilized to the pre-hydrated streptavidin (SA, 18&#x2013;5,020, Sartorius) sensors. SA sensors were balanced in PBST &#x2b;0.1%Tween 20 (assay buffer). Then 50&#xa0;nM CD3&#xd7;EpCAM BsAb associated with antigen for 300&#xa0;s and dissociated in 0.1%PBST for 600&#xa0;s. The SA sensors were regenerated by 10&#xa0;mM glycine, pH 3.0 for 10&#xa0;s, and neutralized in assay buffer for 10&#xa0;s, repeated three times. CD3&#xd7;EpCAM BsAb concentration series at 500&#xa0;nM, 300&#xa0;nM, 200&#xa0;nM, 100&#xa0;nM was measured another four times. The shaking speed was 1,000&#xa0;rpm. A 1:1 curve fitting model analyzed the association and dissociation results to fit the association constant (k<sub>on</sub>), dissociation constant (k<sub>dis</sub>), and affinity constant&#x20;(KD).</p>
</sec>
<sec id="s2-5">
<title>
<italic>In Vitro</italic> Cytotoxicity Assays</title>
<p>Tumor cells were seeded in culture medium RPMI 1640 (Thermo Fisher Scientific, Shanghai, China) with 10% FBS (Thermo Fisher Scientific, Shanghai, China) at a density of 1&#xd7;10<sup>4</sup> cells/well on a 96-well flat-bottom cell culture plate (Corning, New York, NY, United&#x20;States) and cultured overnight. In RPMI 1640/2% inactivated FBS, 10-fold serial gradient dilution of CD3&#xd7;EpCAM BsAb was performed starting with a 15&#xa0;&#x3bc;g/ml concentration. Samples were added to corresponding wells at a final volume of 50&#xa0;&#x3bc;l. Peripheral blood mononuclear cells (PBMC) were isolated from health volunteers through Ficoll plus (Cytiva, Logan, UT, United&#x20;States) density centrifugation by standard procedures. In RPMI 1640 with 10% inactivated FBS medium, PBMCs were adjusted to 1&#xd7;10<sup>5</sup> cells/well added into the plate at an effector cell: tumor cell (E: T) ratio of 10:1. The cytotoxicity assay was detected after plates were incubated at 37&#xb0;C for 32&#x2013;48&#xa0;h from supernatant samples using CytoTox 96<sup>&#xae;</sup> Non-Radioactive LDH Kit (Promega, Madison, WI, United&#x20;States). All tests were repeated in triplicate and nonlinear regression analysis to fit dose-response curves and were assayed with GraphPad Prism Version&#x20;8.0.</p>
</sec>
<sec id="s2-6">
<title>Analysis of T-Cell Redirection</title>
<p>CD3<sup>&#x2b;</sup> Jurkat cells were labeled with PKH26 (Sigma Aldrich, Shanghai, China) as model cells, and SW480 cells were labeled with carboxyfluorescein succinimidyl amino ester (CFSE, Invitrogen, Carlsbad, CA, United&#x20;States) as target cells, according to manufactures&#x2019; instructions. The two kinds of labeled cells were incubated at equal ratios and then added with 150&#xa0;ng/ml EpCAM mAb, CD3 mAb, CD3&#xd7;EpCAM BsAb and control antibody for 30&#xa0;min at 4&#xb0;C respectively. CFSE<sup>&#x2b;</sup>/PKH26<sup>&#x2b;</sup> cells were detected by flow cytometry.</p>
</sec>
<sec id="s2-7">
<title>Analysis of T-Cell Activation</title>
<p>Freshly prepared peripheral blood mononuclear cells (PBMC) were treated with CD3&#xd7;EpCAM BsAb, CD3 mAb, EpCAM mAb and control antibody at 150&#xa0;ng/ml and incubated with or without target cells in 96-well plates. The early activation marker CD69 was detected after 24&#xa0;h and late activation marker CD25 was detected after 90&#xa0;h. The PBMC were collected and stained with CD8-FITC (Sino Biological, Beijing, China), CD4-PE (Sino Biological, Beijing, China), and CD69-APC (BD biosciences, San Jose, CA, United&#x20;States) or CD25-APC (Sino Biological, Beijing, China) by standard flow cytometry.</p>
</sec>
<sec id="s2-8">
<title>Pharmacokinetic Studies</title>
<p>Five male Balb/c mice (6&#x2013;8&#xa0;weeks) per group were intraperitoneally (i.p.) treated with CD3&#xd7;EpCAM BsAb or EpCAM mAb at a dose of 10&#xa0;mg/kg. Blood samples were diluted 2000-fold for the quantitative assay through enzyme-linked immunosorbent assay (ELISA) standard procedure. In brief, goat anti-human IgG kappa chain-specific antibody (Millipore, Shanghai, China) was coated on 96 well high-affinity protein-binding flat-bottom plates overnight. CD3&#xd7;EpCAM BsAb or EpCAM mAb were captured by anti-human IgG kappa antibody and then were detected by goat anti-human Fc HRP antibody (Sigma Aldrich, Shanghai, China) for the measurements by TMB solution over OD450 absorption. PK parameters were assayed with a non-compartmental analysis model using the PK solver software.</p>
</sec>
<sec id="s2-9">
<title>Xenograft Tumor for Pharmacodynamics Studies</title>
<p>Human effector cells were isolated from healthy donors using Ficoll density centrifugation. <italic>In vivo</italic> experiments were performed in female NOD/SCID mice (6&#x2013;8&#xa0;weeks). Thirty mice were divided into five groups for double-blind and randomized treatment. For each mouse, 6&#xd7;10<sup>6</sup> SW480 cells were mixed with 2&#xd7;10<sup>6</sup> inactivated PBMCs in a final volume of 100&#xa0;&#x3bc;l. Each mouse was subcutaneously implanted with PBMC and SW480 cells in an E: T ratio of 1:3 on the right flank. Six mice per group were intraperitoneally injected with CD3&#xd7;EpCAM BsAb, mAb, and PBS as blank control at indicated doses on the second day. All mice were treated once a week by intraperitoneal administration. Tumor sizes were measured using a caliper every three days and calculated according to the formulation.<disp-formula id="equ1">
<mml:math id="m1">
<mml:mrow>
<mml:mi>v</mml:mi>
<mml:mi>o</mml:mi>
<mml:mi>l</mml:mi>
<mml:mi>u</mml:mi>
<mml:mi>m</mml:mi>
<mml:mi>e</mml:mi>
<mml:mi mathvariant="normal">&#x3d;</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mrow>
<mml:mi>l</mml:mi>
<mml:mi>e</mml:mi>
<mml:mi>n</mml:mi>
<mml:mi>g</mml:mi>
<mml:mi>t</mml:mi>
<mml:mi>h</mml:mi>
<mml:mi mathvariant="normal">&#xd7;</mml:mi>
<mml:mi>w</mml:mi>
<mml:mi>i</mml:mi>
<mml:mi>d</mml:mi>
<mml:mi>t</mml:mi>
<mml:msup>
<mml:mi>h</mml:mi>
<mml:mn>2</mml:mn>
</mml:msup>
</mml:mrow>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mi mathvariant="normal">&#xf7;2</mml:mi>
</mml:mrow>
</mml:math>
</disp-formula>
</p>
</sec>
<sec id="s2-10">
<title>Statistical Analysis</title>
<p>The GraphPad was applied to calculate EC<sub>50</sub> values from nonlinear regression analysis. PK solver calculated the pharmacokinetic parameters using noncompartmental analysis.</p>
</sec>
</sec>
<sec sec-type="results" id="s3">
<title>Results</title>
<sec id="s3-1">
<title>Designing of Bispecific Antibody Molecule Assembly</title>
<p>We constructed CD3 and EpCAM fragment expression vectors based on the &#x201c;BAPTS&#x201d; platform (<xref ref-type="fig" rid="F1">Figure&#x20;1</xref>). Two fragments were expressed in mammalian cells separately (CD3 light chain, CD3 heavy chain, and intein<sup>C</sup> for fragment A and EpCAM light chain, EpCAM Intein<sup>N</sup> chain for fragment B. The Antibody-Dependent Cell-mediated Cytotoxicity (ADCC) activity of CD3&#xd7;EpCAM BsAb was silenced, and &#x201c;Knobs-into-Holes&#x201d; were adopted through Fc engineering methods.</p>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption>
<p>Illustration of the CD3&#xd7;EpCAM BsAb bispecific antibody generated by BAPTS platform. <bold>(A)</bold> CD3 variable and constant domains for the CD3 light chain. <bold>(B)</bold> CD3 variable and constant domains for the CD3 heavy chain. <bold>(C)</bold> CH2 and CH3 fused with Intein<sup>C</sup> for Int<sup>c</sup>Fc chain. <bold>(D)</bold> EpCAM variable domain fused with InteinN for HN chain. <bold>(E)</bold> Variable and constant domains for the EpCAM light chain. <bold>(F)</bold> Schematic illustration of CD3&#xd7;EpCAM BsAb generated by BAPTS platform.</p>
</caption>
<graphic xlink:href="fphar-13-803059-g001.tif"/>
</fig>
</sec>
<sec id="s3-2">
<title>Generation of CD3&#xd7;EpCAM BsAb</title>
<p>After being caught by Capto L affinity chromatography, fragment A and B molecular weight were measured by SDS-PAGE at about 170 and 55&#xa0;kDa. Fragment A comprised three peptides, CD3 light chain, CD3 heavy chain, and Int<sup>C</sup>FcH chain (<xref ref-type="fig" rid="F2">Figure&#x20;2A</xref>, <xref ref-type="sec" rid="s11">Supplementary Figure S1A</xref>). Fragment B comprised two peptides, EpCAM light chain and HN chain (<xref ref-type="fig" rid="F2">Figure&#x20;2A</xref>, <xref ref-type="sec" rid="s11">Supplementary Figure S1B</xref>).</p>
<fig id="F2" position="float">
<label>FIGURE 2</label>
<caption>
<p>SDS-PAGE analysis of CD3&#xd7;EpCAM bispecific antibody. <bold>(A)</bold> SDS-PAGE analysis of CD3&#xd7;EpCAM bispecific antibody CD3 fragment A and EpCAM fragment B under non-reduced and reduced conditions. <bold>(B)</bold> <italic>Trans</italic>-splicing reaction between CD3 fragment A and EpCAM fragment B at 37&#xb0;C with 1.5&#xa0;mM DTT for 2&#xa0;h <bold>(C)</bold> CD3&#xd7;EpCAM BsAb under non-reduced and reduced conditions. <bold>(D)</bold> <italic>Trans</italic>-splicing reaction condition optimization between the different fragments A and B ratios with 1.5&#xa0;mM DTT.</p>
</caption>
<graphic xlink:href="fphar-13-803059-g002.tif"/>
</fig>
<p>When two fragments were reduced with 1.5&#xa0;mM DTT, the <italic>trans</italic>-splicing reaction mediated by <italic>Npu</italic> DnaE split intein occurred. A new peptide bond was formed in the flanking extein, and SDS-PAGE analysis showed the heavy chain binding to EpCAM at 55&#xa0;kDa formed (<xref ref-type="fig" rid="F2">Figure&#x20;2B</xref>). Then, the dimeric light chain and extra fragment B were removed through Protein A affinity chromatography (<xref ref-type="fig" rid="F2">Figure&#x20;2C</xref>). Additionally, a 3.75:1 ratio of fragment B to fragment A (<italic>mol: mol</italic>) was optimized for <italic>trans</italic>-splicing reaction. (<xref ref-type="fig" rid="F2">Figure&#x20;2D</xref>). At the same time, an EpCAM parental monoclonal antibody was produced as a control (<xref ref-type="sec" rid="s11">Supplementary Figure S1C</xref>).</p>
</sec>
<sec id="s3-3">
<title>
<italic>In Vitro</italic> Cytotoxicity of CD3&#xd7;EpCAM BsAb</title>
<p>BLI was used to evaluate the affinity of CD3&#xd7;EpCAM BsAb for EpCAM. The biotinylated extracellular domain of EpCAM was loaded on the streptavidin sensor and yielded a k<sub>on</sub> of 2.70 &#xd7; 10<sup>4</sup>&#xa0;M<sup>&#x2212;1</sup>s<sup>&#x2212;1</sup>, a k<sub>dis</sub> of 1.05 &#xd7; 10<sup>&#x2212;3</sup> s<sup>&#x2212;1</sup>, fitting a KD of 3.98 &#xd7; 10<sup>&#x2212;8</sup>&#xa0;M (<xref ref-type="fig" rid="F3">Figure&#x20;3A</xref>, <xref ref-type="sec" rid="s11">Supplementary Figure S2</xref>). In addition, the parental antibody was characterized at a KD of nM (<xref ref-type="table" rid="T1">Table&#x20;1</xref>).</p>
<fig id="F3" position="float">
<label>FIGURE 3</label>
<caption>
<p>Binding activity to EpCAM and <italic>in&#x20;vitro</italic> cytotoxicity analysis of CD3&#xd7;EpCAM BsAb. <bold>(A)</bold> Affinity analysis of CD3&#xd7;EpCAM BsAb to EpCAM detected by BLI. <bold>(B)</bold> Expression of EpCAM on different cell lines detected by flow cytometry. <bold>(C)</bold> <italic>In vitro</italic> cytotoxicity assay of CD3&#xd7;EpCAM bispecific antibody using LDH release assay. The dose-response curve was fitted through Graphpad Prism version 8.0. Data points in the curve represent the mean of three samples; error bars, SD.</p>
</caption>
<graphic xlink:href="fphar-13-803059-g003.tif"/>
</fig>
<table-wrap id="T1" position="float">
<label>TABLE 1</label>
<caption>
<p>Binding kinetics of the CD3&#xd7;EpCAM BsAb and EpCAM mAb using BLI.</p>
</caption>
<table>
<thead valign="top">
<tr>
<th align="left">Antibody</th>
<th align="center">KD. (M)</th>
<th align="center">k<sub>on</sub> (s<sup>&#x2212;1</sup>)</th>
<th align="center">k<sub>dis</sub> (M<sup>&#x2212;1</sup>s<sup>&#x2212;1</sup>)</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left">EpCAM mAb</td>
<td align="center">3.77 &#xd7; 10<sup>&#x2212;12</sup>
</td>
<td align="char" char="&#xd7;">1.09 &#xd7; 10<sup>5</sup>
</td>
<td align="center">4.22 &#xd7; 10<sup>&#x2212;7</sup>
</td>
</tr>
<tr>
<td align="left">CD3&#xd7;EpCAM BsAb</td>
<td align="center">3.98 &#xd7; 10<sup>&#x2212;8</sup>
</td>
<td align="char" char="&#xd7;">2.70 &#xd7; 10<sup>4</sup>
</td>
<td align="center">1.05 &#xd7; 10<sup>&#x2212;3</sup>
</td>
</tr>
</tbody>
</table>
</table-wrap>
<p>Cell surface expression level of EpCAM on our panel of cancer cells was tested using flow cytometry. The highest expression level was Caco-2, followed by HT-29 and SW480. The <italic>in&#x20;vitro</italic> bioactivity of CD3&#xd7;EpCAM BsAb was tested using an LDH-release cytotoxicity assay. As effector cells, PBMCs were obtained from healthy donors, and as target cells, a group of tumor cells with different EpCAM expression levels were chosen (<xref ref-type="fig" rid="F3">Figure&#x20;3B</xref>). The cells could be killed only in the presence of PMCM and an E:T ratio of 10:1 was taken for the cytotoxicity assay (<xref ref-type="sec" rid="s11">Supplementary Figure S3A,B</xref>). A dose-dependent decrease cytotoxicity effect caused by CD3&#xd7;EpCAM BsAb was observed at an E:T ratio of 10:1 (<xref ref-type="fig" rid="F3">Figure&#x20;3C</xref>). The results showed that tumor cells with the high expression level of EpCAM were sensitive to the BsAb but not to parental EpCAM mAb. And EpCAM negative cell line, Jurkat cell, could not be killed by both CD3&#xd7;EpCAM BsAb and EpCAM mAb (<xref ref-type="sec" rid="s11">Supplementary Figure S3C,D</xref>). The maximal killing activity of CD3&#xd7;EpCAM BsAb to different cell lines Caco-2, SW480, and HT-29 were listed (<xref ref-type="table" rid="T2">Table&#x20;2</xref>).</p>
<table-wrap id="T2" position="float">
<label>TABLE 2</label>
<caption>
<p>Cytotoxicity analysis of CD3&#xd7;EpCAM BsAb and EpCAM mAb.</p>
</caption>
<table>
<thead valign="top">
<tr>
<th align="left">Cell line</th>
<th colspan="2" align="center">Caco-2</th>
<th colspan="2" align="center">HT-29</th>
<th colspan="2" align="center">SW480</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left"/>
<td align="center">EpCAM mAb</td>
<td align="center">CD3&#xd7;EpCAM BsAb</td>
<td align="center">EpCAM mAb</td>
<td align="center">CD3&#xd7;EpCAM BsAb</td>
<td align="center">EpCAM mAb</td>
<td align="center">CD3&#xd7;EpCAM BsAb</td>
</tr>
<tr>
<td align="left">Top (%)</td>
<td align="center">2.48</td>
<td align="center">45.49</td>
<td align="center">17.29</td>
<td align="center">36.67</td>
<td align="center">33.97</td>
<td align="center">57.79</td>
</tr>
<tr>
<td align="left">EC<sub>50</sub> (ng/ml)</td>
<td align="center">-</td>
<td align="center">797</td>
<td align="center">-</td>
<td align="center">0.78</td>
<td align="center">9.69</td>
<td align="center">1.88</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="s3-4">
<title>
<italic>In Vitro</italic> T&#x20;Cell Recruitment and Activation Mediated by CD3&#xd7;EpCAM BsAb</title>
<p>The mechanism of CD3&#xd7;EpCAM BsAb mediated cytotoxicity of cancer cells was investigated (<xref ref-type="bibr" rid="B8">Brischwein et&#x20;al., 2007</xref>; <xref ref-type="bibr" rid="B24">Massafra et&#x20;al., 2021</xref>). The binding ability of CD3&#xd7;EpCAM to objected cells was tested through flow cytometry. After incubation with CD3&#xd7;EpCAM BsAb at 100&#xa0;ng/ml, redirected T&#x20;cells around tumor cells were observed (<xref ref-type="fig" rid="F4">Figure&#x20;4A</xref>), and CFSE<sup>&#x2b;</sup>/PKH26<sup>&#x2b;</sup> cells were more efficiently assembled than CD3 mAb or EpCAM mAb groups. Cell aggression was observed, indicating that compared with EpCAM mAb or CD3 mAb, T&#x20;cells were significantly redirected to tumor cells by CD3&#xd7;EpCAM BsAb. (<xref ref-type="fig" rid="F4">Figure&#x20;4B</xref>).</p>
<fig id="F4" position="float">
<label>FIGURE 4</label>
<caption>
<p>T&#x20;cell recruitment mediated by CD3&#xd7;EpCAM BsAb. <bold>(A)</bold> The recruitment of T&#x20;cells to tumor cells mediated by 150&#xa0;ng/ml CD3&#xd7;EpCAM BsAb and EpCAM mAb at an E: T ratio of 10:1 after an incubation of 24&#xa0;h. Images were obtained under 20 &#xd7; magnification, and scale bars 100&#xa0;&#x3bc;m. <bold>(B)</bold> The recruitment analysis of CD3<sup>&#x2b;</sup> cells to tumor cells by CD3&#xd7;EpCAM BsAb by flow cytometry.</p>
</caption>
<graphic xlink:href="fphar-13-803059-g004.tif"/>
</fig>
<p>Meantime, the early activation marker CD69 and late activation marker CD25 of CD8 or CD4 positive T&#x20;cells was also determined by flow cytometry. In the presence of the target cell, activation maker CD69 of T&#x20;cells was upregulated obviously by CD3&#xd7;EpCAM BsAb (<xref ref-type="fig" rid="F5">Figure&#x20;5A</xref>). In comparison to CD3 mAb or EpCAM mAb, CD3&#xd7;EpCAM BsAb efficiently activated T&#x20;cells, resulting in increased CD69 and CD25 expression on CD8<sup>&#x2b;</sup> and CD4<sup>&#x2b;</sup> T&#x20;cells (<xref ref-type="fig" rid="F5">Figures 5B,C</xref>). The results also showed the CD107a could be upregulated by CD3&#xd7;EpCAM BsAb on CD4<sup>&#x2b;</sup> and CD8<sup>&#x2b;</sup> T&#x20;cells (<xref ref-type="sec" rid="s11">Supplementary Figure&#x20;S4</xref>).</p>
<fig id="F5" position="float">
<label>FIGURE 5</label>
<caption>
<p>T&#x20;cell activation analysis mediated by CD3&#xd7;EpCAM BsAb detected by flow cytometry. <bold>(A)</bold> The activation expression level of CD69 on T&#x20;cells was detected after incubation for 24&#xa0;h and CD25 for 90&#xa0;h (E: T &#x3d; 10:1). <bold>(B)</bold> The activation analysis of CD8<sup>&#x2b;</sup> cells to tumor cells by CD3&#xd7;EpCAM BsAb, EpCAM mAb, and CD3 mAb. <bold>(C)</bold> The cell activation analysis of CD4<sup>&#x2b;</sup> cells to tumor cells by CD3&#xd7;EpCAM BsAb, EpCAM mAb, and CD3 mAb.</p>
</caption>
<graphic xlink:href="fphar-13-803059-g005.tif"/>
</fig>
</sec>
<sec id="s3-5">
<title>
<italic>In Vivo</italic> Bioactivity Study</title>
<p>We performed PK and PD experiments to investigate the <italic>in vivo</italic> bioactivity of CD3&#xd7;EpCAM BsAb. Balb/c mice were i. p. treated with a single dose of 10&#xa0;mg/kg CD3&#xd7;EpCAM bispecific antibody or parental EpCAM mAb, respectively. The blood samples were gathered at a series of time points and quantified by Elisa assay (<xref ref-type="fig" rid="F6">Figure&#x20;6A</xref>). CD3&#xd7;EpCAM bispecific antibody parameters were consistent with EpCAM mAb as excepted (<xref ref-type="table" rid="T3">Table&#x20;3</xref>). It is worth noting that the CD3&#xd7;EpCAM bispecific antibody was stable with an <italic>in vivo</italic> half-life of about 14 days. The CD3&#xd7;EpCAM BsAb is lack of cross-reactivity to muEpCAM, so the EpCAM related toxicity and elimination could not be reflected in the mouse&#x20;model.</p>
<fig id="F6" position="float">
<label>FIGURE 6</label>
<caption>
<p>
<italic>In vivo</italic> bioactivity assay of CD3&#xd7;EpCAM BsAb in xenograft NOD/SCID mouse model. <bold>(A)</bold> <italic>In vivo</italic> PK analysis of CD3&#xd7;EpCAM BsAb and EpCAM mAb in Balb/c mice (N &#x3d; 5). <bold>(B)</bold> Tumor growth inhibition efficacy of CD3&#xd7;EpCAM BsAb. Mice were implanted subcutaneously with 6&#xd7;10<sup>6</sup> SW480 cells mixed with 2&#xd7;10<sup>6</sup> unstimulated human PBMC (E: T &#x3d; 1:3). Mice (N &#x3d; 6) were treated through intraperitoneal injection with PBS vehicle control, EpCAM mAb, or CD3&#xd7;EpCAM BsAb at different dosages per mouse per week. <bold>(C)</bold> Excised tumor results showed on double-blind order. <bold>(D)</bold> Weight comparison of different groups. Error bar, SD.</p>
</caption>
<graphic xlink:href="fphar-13-803059-g006.tif"/>
</fig>
<table-wrap id="T3" position="float">
<label>TABLE 3</label>
<caption>
<p>PK parameters of CD3&#xd7;EpCAM BsAb and EpCAM mAb.</p>
</caption>
<table>
<thead valign="top">
<tr>
<th align="left"/>
<th align="center">CD3&#xd7;EpCAM BsAb</th>
<th align="center">EpCAM mAb</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left">CL (mL/day/kg)</td>
<td align="char" char=".">0.032</td>
<td align="char" char=".">0.026</td>
</tr>
<tr>
<td align="left">AUC (day &#xd7; &#x3bc;g/mL)</td>
<td align="char" char=".">229.42</td>
<td align="char" char=".">275.56</td>
</tr>
<tr>
<td align="left">Cmax (&#x3bc;g/ml)</td>
<td align="char" char=".">28.68</td>
<td align="char" char=".">27.31</td>
</tr>
<tr>
<td align="left">Vz (ml/kg)</td>
<td align="char" char=".">0.69</td>
<td align="char" char=".">0.57</td>
</tr>
<tr>
<td align="left">t <sub>1/2</sub> (day)</td>
<td align="char" char=".">14.89</td>
<td align="char" char=".">14.79</td>
</tr>
</tbody>
</table>
</table-wrap>
<p>The anti-tumor bioactivity of CD3&#xd7;EpCAM BsAb was evaluated on xenograft NOD/SCID mouse model. The NOD/SCID mice were implanted subcutaneously with a 3:1 mixture of SW480 cells and unstimulated human PBMCs and treated with CD3&#xd7;EpCAM BsAb or EpCAM mAb through intraperitoneal injection every week. After 66&#xa0;days, the results revealed that the experimental groups could reduce the growth of the SW480 tumor, although there was no dose-dependent inhibition in the 1&#xa0;mg/kg, 5&#xa0;mg/kg, and 10&#xa0;mg/kg groups (<xref ref-type="fig" rid="F6">Figures 6B,C</xref>). Unexpectedly, EpCAM mAb at a dosage of 10&#xa0;mg/kg resulted in considerable tumor elimination. In addition, as a sign of toxicity, there was a weight loss of mice in both CD3&#xd7;EpCAM BsAb and EpCAM mAb groups (<xref ref-type="fig" rid="F6">Figure&#x20;6D</xref>).</p>
</sec>
</sec>
<sec sec-type="discussion" id="s4">
<title>Discussion</title>
<p>Colorectal cancer is still a commonly diagnosed cancer with high mortality (<xref ref-type="bibr" rid="B3">Arnold et&#x20;al., 2017</xref>), and an increasing number of novel therapeutics were explored into the clinical stage. This study generated a kind of IgG format bispecific antibody targeting CD3 and EpCAM without an extra linker based on the &#x201c;BAPTS&#x201d; platform. Furthermore, the CD3&#xd7;EpCAM BsAb characterizations <italic>in&#x20;vitro</italic> and <italic>in vivo</italic> bioactivity, specificity, affinity, and stability were demonstrated.</p>
<p>EpCAM is an attractive target overexpressed on colorectal tumor cells and slightly expressed on normal tissues (<xref ref-type="bibr" rid="B25">Moldenhauer et&#x20;al., 1987</xref>). In order to evaluate the safety, tolerability, pharmacokinetics and pharmacodynamics of solitomab (MT110, AMG 110), a phase I trial in patients with advanced solid tumors was investigated. Diarrhea and transient abnormal liver parameters were dose-limiting toxicities (DLT), leading to a maximum tolerated dose of 48&#xa0;&#x3bc;g/d (<xref ref-type="bibr" rid="B21">Kebenko et&#x20;al., 2018</xref>). It&#x2019;s noticed that EpCAM-related toxicity on non-pathological epithelial tissue, especially like hepatocytes and duodenal, when design an anti-EpCAM-antibody based therapy (<xref ref-type="bibr" rid="B38">Schmelzer and Reid, 2008</xref>). Besides, a half-life-extended bispecific T-cell engager molecule format was developed by Amgen, which possessed of the Fc region and may change the administration method (<xref ref-type="bibr" rid="B17">Giffin et&#x20;al., 2021</xref>). CD3&#xd7;EpCAM BsAb exhibited superior cytotoxicity than EpCAM mAb on colorectal cell lines with different EpCAM expression levels <italic>in&#x20;vitro</italic> (<xref ref-type="fig" rid="F3">Figure&#x20;3B</xref>). For safety reasons, the affinity to EpCAM of CD3&#xd7;EpCAM BsAb was the nM scale in our study (<xref ref-type="fig" rid="F3">Figure&#x20;3A</xref>), which could elicit a robust and toxic immune response when binding to EpCAM positive cells (<xref ref-type="bibr" rid="B33">Ruf et&#x20;al., 2007</xref>). The redirection and activation of T&#x20;cells were confirmed. T&#x20;cells were bridged with tumor cells through the BsAb rather than the parent monoclonal antibody. T&#x20;cells were activated by binding of CD3&#x3b5; without major histocompatibility complex (MHC) restriction, leading to the increased release of granzyme B and perforin (<xref ref-type="bibr" rid="B31">Offner et&#x20;al., 2006</xref>; <xref ref-type="bibr" rid="B4">Bargou et&#x20;al., 2008</xref>). More research could investigate co-simulation or co-inhibitory receptor expression after bispecific antibody treatment to better understand the T activation and cytotoxicity mechanism (<xref ref-type="bibr" rid="B42">Skokos et&#x20;al., 2020</xref>). SW480 xenograft mouse model was established to evaluate the efficacy of CD3&#xd7;EpCAM BsAb (<xref ref-type="bibr" rid="B37">Schlereth et&#x20;al., 2005</xref>). The growth of the tumor in the NOD/SCID model was inhibited under different dosages of CD3&#xd7;EpCAM BsAb (<xref ref-type="fig" rid="F6">Figure&#x20;6B</xref>). The anti-tumor response among different dosages of CD&#xd7;EpCAM BsAb was similar in the early stage, while 10&#xa0;mg/kg CD3&#xd7;EpCAM BsAb group did not show a superior <italic>in vivo</italic> bioactivity. We considered it might be because the extra CD3 fragment blocked the CD3 antigen on human PBMC in the system or T&#x20;cell exhaustion on the early stage of administration (<xref ref-type="bibr" rid="B49">Wherry and Kurachi, 2015</xref>). The NOD/SCID mouse was widely used in the pre-clinical stage of immunotherapy (<xref ref-type="bibr" rid="B1">Amann et&#x20;al., 2009</xref>; <xref ref-type="bibr" rid="B11">Chen et&#x20;al., 2021</xref>; <xref ref-type="bibr" rid="B45">Sun et&#x20;al., 2021</xref>). However, human immune cells with a limited half-life in the treatment cycle might hard to infiltrate into tumor tissues (<xref ref-type="bibr" rid="B40">Shultz et&#x20;al., 2005</xref>). As the bispecific antibody is specific for human EpCAM and could not bind muEpCAM expressed on mouse normal tissues, the toxicity and distribution could not be reflected in the mouse model. It was worth mentioning that the 10&#xa0;mg/kg EpCAM mAb group eliminated the tumor growth on the xenograft mouse model. That might be due to EpCAM mAb with low dissociation constant to EpCAM (kdis &#x3d; 10<sup>&#x2212;7</sup> s<sup>&#x2212;1</sup>) could specifically target tumor cells and then lead to a more prolonged and robust ADCC activity in this model. EpCAM mAb processing bivalent antigen-binding domain could bind to EpCAM more easily than CD3&#xd7;EpCAM BsAb with single binding valency in this model. Thus, bispecific antibodies with bivalent binding domain to tumor antigen might be more potent to eliminate tumors (<xref ref-type="bibr" rid="B35">Santich et&#x20;al., 2020</xref>). Immune checkpoint inhibitors, including cytotoxic T&#x20;cell lymphocyte antigen-4 antibody and programmed death-1 antibody, could block the receptor to down-regulate T&#x20;cells activation and were used to treat colorectal cancer (<xref ref-type="bibr" rid="B9">Chang et&#x20;al., 2017</xref>; <xref ref-type="bibr" rid="B32">Pan et&#x20;al., 2021</xref>). Combination CD3&#xd7;EpCAM BsAb with the immune checkpoint inhibitor with CD3&#xd7;EpCAM BsAb might be more helpful to improve the anti-tumor efficacy in future&#x20;work.</p>
</sec>
</body>
<back>
<sec id="s5">
<title>Data Availability Statement</title>
<p>The original contributions presented in the study are included in the article/<xref ref-type="sec" rid="s11">Supplementary Material</xref>, further inquiries can be directed to the corresponding author.</p>
</sec>
<sec id="s6">
<title>Ethics Statement</title>
<p>The animal study was reviewed and approved by Institutional Animal Care and Use Committee of Shanghai Jiao Tong University.</p>
</sec>
<sec id="s7">
<title>Author Contributions</title>
<p>LW and YQ performed the experiments and drafted the manuscript. HZ and LH designed the strategy, developed the methodology and prepared the CD3 fragment. YK, ZP, and JC provided reagents, performed some experiments and discussed data. JuL, TY, and JiL reviewed and revised the manuscript. JZ discussed strategy, reviewed data and revised manuscript. BZ designed the strategy, discussed data, revised the manuscript. All authors read and approved the final manuscript.</p>
</sec>
<sec id="s8">
<title>Funding</title>
<p>This project was supported by the National Natural Science Foundation of China (grant number: 81773621 and 82073751), the National Science and Technology Major Project &#x201c;Key New Drug Creation and Manufacturing Program&#x201d; of China (grant number: 2019ZX09732001-019) and New Zealand Ministry of Education, New Zealand-China Tripartite Partnership Fund (grant number: AUT-13772).</p>
</sec>
<sec sec-type="COI-statement" id="s9">
<title>Conflict of Interest</title>
<p>LH is an employee of Jecho Biopharmaceutical Institute, Shanghai and Jecho Biopharmaceuticals Co., Ltd., Tianjin, China; JZ is an employee of Jecho Biopharmaceuticals Co., Ltd., Tianjin, China; Jecho Laboratories, Inc., Frederick, MD, United States; and Jecho Biopharmaceutical Institute, Shanghai, China.</p>
<p>The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec sec-type="disclaimer" id="s10">
<title>Publisher&#x2019;s Note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors, and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<sec id="s11">
<title>Supplementary Material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fphar.2022.803059/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fphar.2022.803059/full&#x23;supplementary-material</ext-link>
</p>
<supplementary-material>
<label>Supplementary Figure S1</label>
<caption>
<p>
<bold>(A)</bold> CD3 fragment A the EpCAM fragment B under non-reduced and reduced conditions. <bold>(B)</bold> EpCAM fragment B under non-reduced and reduced conditions. <bold>(C)</bold> EpCAM mAb under non-reduced and reduced conditions. Lanes: 1, cell culture supernatant; 2, protein L flow through; 3 to 6, different fractions of protein L elution. Lanes 7 to 12 are the corresponding samples of lanes 1 to 6 analyzed under reduced condition. Lanes 13 to 15, different fractions of protein A elution. Lanes 16 to 17 are the corresponding samples of lanes 13 to 15 analyzed under reduced condition.</p>
</caption>
</supplementary-material>
<supplementary-material>
<label>Supplementary Figure S2</label>
<caption>
<p>Subtracted data process of CD3&#xd7;EpCAM BsAb in the binding test to EpCAM.</p>
</caption>
</supplementary-material>
<supplementary-material>
<label>Supplementary Figure S3</label>
<caption>
<p>
<italic>In vitro</italic> cytotoxicity assay of EpCAM negative cells and optimization. <bold>(A)</bold> <italic>In vitro</italic> cytotoxicity assay in the presence of T cells and target cells. <bold>(B)</bold> <italic>In vitro</italic> cytotoxicity assay of CD3&#xd7;EpCAM BsAb to SW480 cells at a concentration of 1.5&#xa0;mg/ml in different E:T ratio. <bold>(C)</bold> Expression of EpCAM on Jurkat cells detected by flow cytometry. <bold>(D)</bold> <italic>In vitro</italic> cytotoxicity assay of CD3&#xd7;EpCAM BsAb and EpCAM mAb to Jurkat cells detected by LDH release assay.</p>
</caption>
</supplementary-material>
<supplementary-material>
<label>Supplementary Figure S4</label>
<caption>
<p>T cell activation maker CD107a analysis detected by flow cytometry. <bold>(A)</bold> The CD107a detection of CD8<sup>&#x2b;</sup> cells to tumor cells by CD3&#xd7;EpCAM BsAb, EpCAM mAb, and CD3 mAb. <bold>(B)</bold> The CD107a detection of CD4<sup>&#x2b;</sup> cells to tumor cells by CD3&#xd7;EpCAM BsAb, EpCAM mAb, and CD3 mAb.</p>
</caption>
</supplementary-material>
<supplementary-material xlink:href="Image3.tif" id="SM1" mimetype="application/tif" xmlns:xlink="http://www.w3.org/1999/xlink"/>
<supplementary-material xlink:href="Image4.tif" id="SM2" mimetype="application/tif" xmlns:xlink="http://www.w3.org/1999/xlink"/>
<supplementary-material xlink:href="Image2.tif" id="SM3" mimetype="application/tif" xmlns:xlink="http://www.w3.org/1999/xlink"/>
<supplementary-material xlink:href="Image1.pdf" id="SM4" mimetype="application/pdf" xmlns:xlink="http://www.w3.org/1999/xlink"/>
</sec>
<ref-list>
<title>References</title>
<ref id="B1">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Amann</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>D&#x27;Argouges</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Lorenczewski</surname>
<given-names>G.</given-names>
</name>
<name>
<surname>Brischwein</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Kischel</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Lutterbuese</surname>
<given-names>R.</given-names>
</name>
<etal/>
</person-group> (<year>2009</year>). <article-title>Antitumor Activity of an EpCAM/CD3-Bispecific BiTE Antibody during Long-Term Treatment of Mice in the Absence of T-Cell Anergy and Sustained Cytokine Release</article-title>. <source>J.&#x20;Immunother.</source> <volume>32</volume> (<issue>5</issue>), <fpage>452</fpage>&#x2013;<lpage>464</lpage>. <pub-id pub-id-type="doi">10.1097/CJI.0b013e3181a1c097</pub-id> </citation>
</ref>
<ref id="B2">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Argil&#xe9;s</surname>
<given-names>G.</given-names>
</name>
<name>
<surname>Tabernero</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Labianca</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Hochhauser</surname>
<given-names>D.</given-names>
</name>
<name>
<surname>Salazar</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Iveson</surname>
<given-names>T.</given-names>
</name>
<etal/>
</person-group> (<year>2020</year>). <article-title>Localised colon Cancer: ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up</article-title>. <source>Ann. Oncol.</source> <volume>31</volume> (<issue>10</issue>), <fpage>1291</fpage>&#x2013;<lpage>1305</lpage>. <pub-id pub-id-type="doi">10.1016/j.annonc.2020.06.022</pub-id> </citation>
</ref>
<ref id="B3">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Arnold</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Sierra</surname>
<given-names>M. S.</given-names>
</name>
<name>
<surname>Laversanne</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Soerjomataram</surname>
<given-names>I.</given-names>
</name>
<name>
<surname>Jemal</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Bray</surname>
<given-names>F.</given-names>
</name>
</person-group> (<year>2017</year>). <article-title>Global Patterns and Trends in Colorectal Cancer Incidence and Mortality</article-title>. <source>Gut</source> <volume>66</volume> (<issue>4</issue>), <fpage>683</fpage>&#x2013;<lpage>691</lpage>. <pub-id pub-id-type="doi">10.1136/gutjnl-2015-310912</pub-id> </citation>
</ref>
<ref id="B4">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Bargou</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Leo</surname>
<given-names>E.</given-names>
</name>
<name>
<surname>Zugmaier</surname>
<given-names>G.</given-names>
</name>
<name>
<surname>Klinger</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Goebeler</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Knop</surname>
<given-names>S.</given-names>
</name>
<etal/>
</person-group> (<year>2008</year>). <article-title>Tumor Regression in Cancer Patients by Very Low Doses of a T Cell-Engaging Antibody</article-title>. <source>Science</source> <volume>321</volume> (<issue>5891</issue>), <fpage>974</fpage>&#x2013;<lpage>977</lpage>. <pub-id pub-id-type="doi">10.1126/science.1158545</pub-id> </citation>
</ref>
<ref id="B5">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Blair</surname>
<given-names>H. A.</given-names>
</name>
</person-group> (<year>2019</year>). <article-title>Emicizumab: A Review in Haemophilia A</article-title>. <source>Drugs</source> <volume>79</volume> (<issue>15</issue>), <fpage>1697</fpage>&#x2013;<lpage>1707</lpage>. <pub-id pub-id-type="doi">10.1007/s40265-019-01200-2</pub-id> </citation>
</ref>
<ref id="B6">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Borlak</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>L&#xe4;nger</surname>
<given-names>F.</given-names>
</name>
<name>
<surname>Spanel</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Sch&#xf6;ndorfer</surname>
<given-names>G.</given-names>
</name>
<name>
<surname>Dittrich</surname>
<given-names>C.</given-names>
</name>
</person-group> (<year>2016</year>). <article-title>Immune-mediated Liver Injury of the Cancer Therapeutic Antibody Catumaxomab Targeting EpCAM, CD3 and Fc&#x3b3; Receptors</article-title>. <source>Oncotarget</source> <volume>7</volume> (<issue>19</issue>), <fpage>28059</fpage>&#x2013;<lpage>28074</lpage>. <pub-id pub-id-type="doi">10.18632/oncotarget.8574</pub-id> </citation>
</ref>
<ref id="B7">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Brinkmann</surname>
<given-names>U.</given-names>
</name>
<name>
<surname>Kontermann</surname>
<given-names>R. E.</given-names>
</name>
</person-group> (<year>2021</year>). <article-title>Bispecific Antibodies</article-title>. <source>Science</source> <volume>372</volume> (<issue>6545</issue>), <fpage>916</fpage>&#x2013;<lpage>917</lpage>. <pub-id pub-id-type="doi">10.1126/science.abg1209</pub-id> </citation>
</ref>
<ref id="B8">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Brischwein</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Parr</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Pflanz</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Volkland</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Lumsden</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Klinger</surname>
<given-names>M.</given-names>
</name>
<etal/>
</person-group> (<year>2007</year>). <article-title>Strictly Target Cell-dependent Activation of T&#x20;Cells by Bispecific Single-Chain Antibody Constructs of the BiTE Class</article-title>. <source>J.&#x20;Immunother.</source> <volume>30</volume> (<issue>8</issue>), <fpage>798</fpage>&#x2013;<lpage>807</lpage>. <pub-id pub-id-type="doi">10.1097/CJI.0b013e318156750c</pub-id> </citation>
</ref>
<ref id="B9">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Chang</surname>
<given-names>C. H.</given-names>
</name>
<name>
<surname>Wang</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Li</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Rossi</surname>
<given-names>D. L.</given-names>
</name>
<name>
<surname>Liu</surname>
<given-names>D.</given-names>
</name>
<name>
<surname>Rossi</surname>
<given-names>E. A.</given-names>
</name>
<etal/>
</person-group> (<year>2017</year>). <article-title>Combination Therapy with Bispecific Antibodies and PD-1 Blockade Enhances the Antitumor Potency of T&#x20;Cells</article-title>. <source>Cancer Res.</source> <volume>77</volume> (<issue>19</issue>), <fpage>5384</fpage>&#x2013;<lpage>5394</lpage>. <pub-id pub-id-type="doi">10.1158/0008-5472.Can-16-3431</pub-id> </citation>
</ref>
<ref id="B10">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Chaudry</surname>
<given-names>M. A.</given-names>
</name>
<name>
<surname>Sales</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Ruf</surname>
<given-names>P.</given-names>
</name>
<name>
<surname>Lindhofer</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>Winslet</surname>
<given-names>M. C.</given-names>
</name>
</person-group> (<year>2007</year>). <article-title>EpCAM an Immunotherapeutic Target for Gastrointestinal Malignancy: Current Experience and Future Challenges</article-title>. <source>Br. J.&#x20;Cancer</source> <volume>96</volume> (<issue>7</issue>), <fpage>1013</fpage>&#x2013;<lpage>1019</lpage>. <pub-id pub-id-type="doi">10.1038/sj.bjc.6603505</pub-id> </citation>
</ref>
<ref id="B11">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Chen</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Pan</surname>
<given-names>Z.</given-names>
</name>
<name>
<surname>Han</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Zhou</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Zong</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>Wang</surname>
<given-names>L.</given-names>
</name>
<etal/>
</person-group> (<year>2021</year>). <article-title>A Novel Bispecific Antibody Targeting CD3 and Lewis Y with Potent Therapeutic Efficacy against Gastric Cancer</article-title>. <source>Biomedicines</source> <volume>9</volume> (<issue>8</issue>), <fpage>1059</fpage>. <pub-id pub-id-type="doi">10.3390/biomedicines9081059</pub-id> </citation>
</ref>
<ref id="B12">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ciardiello</surname>
<given-names>D.</given-names>
</name>
<name>
<surname>Vitiello</surname>
<given-names>P. P.</given-names>
</name>
<name>
<surname>Cardone</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Martini</surname>
<given-names>G.</given-names>
</name>
<name>
<surname>Troiani</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Martinelli</surname>
<given-names>E.</given-names>
</name>
<etal/>
</person-group> (<year>2019</year>). <article-title>Immunotherapy of Colorectal Cancer: Challenges for Therapeutic Efficacy</article-title>. <source>Cancer Treat. Rev.</source> <volume>76</volume>, <fpage>22</fpage>&#x2013;<lpage>32</lpage>. <pub-id pub-id-type="doi">10.1016/j.ctrv.2019.04.003</pub-id> </citation>
</ref>
<ref id="B13">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>de Bono</surname>
<given-names>J.&#x20;S.</given-names>
</name>
<name>
<surname>Tolcher</surname>
<given-names>A. W.</given-names>
</name>
<name>
<surname>Forero</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Vanhove</surname>
<given-names>G. F.</given-names>
</name>
<name>
<surname>Takimoto</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Bauer</surname>
<given-names>R. J.</given-names>
</name>
<etal/>
</person-group> (<year>2004</year>). <article-title>ING-1, a Monoclonal Antibody Targeting Ep-CAM in Patients with Advanced Adenocarcinomas</article-title>. <source>Clin. Cancer Res.</source> <volume>10</volume> (<issue>22</issue>), <fpage>7555</fpage>&#x2013;<lpage>7565</lpage>. <pub-id pub-id-type="doi">10.1158/1078-0432.Ccr-04-0729</pub-id> </citation>
</ref>
<ref id="B14">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ding</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Han</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Zong</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>Chen</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Zhang</surname>
<given-names>B.</given-names>
</name>
<name>
<surname>Zhu</surname>
<given-names>J.</given-names>
</name>
</person-group> (<year>2017</year>). <article-title>Production Process Reproducibility and Product Quality Consistency of Transient Gene Expression in HEK293 Cells with Anti-PD1 Antibody as the Model Protein</article-title>. <source>Appl. Microbiol. Biotechnol.</source> <volume>101</volume> (<issue>5</issue>), <fpage>1889</fpage>&#x2013;<lpage>1898</lpage>. <pub-id pub-id-type="doi">10.1007/s00253-016-7973-y</pub-id> </citation>
</ref>
<ref id="B15">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Eyvazi</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Farajnia</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Dastmalchi</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Kanipour</surname>
<given-names>F.</given-names>
</name>
<name>
<surname>Zarredar</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>Bandehpour</surname>
<given-names>M.</given-names>
</name>
</person-group> (<year>2018</year>). <article-title>Antibody Based EpCAM Targeted Therapy of Cancer, Review and Update</article-title>. <source>Curr. Cancer Drug Targets</source> <volume>18</volume> (<issue>9</issue>), <fpage>857</fpage>&#x2013;<lpage>868</lpage>. <pub-id pub-id-type="doi">10.2174/1568009618666180102102311</pub-id> </citation>
</ref>
<ref id="B16">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Fan</surname>
<given-names>G.</given-names>
</name>
<name>
<surname>Wang</surname>
<given-names>Z.</given-names>
</name>
<name>
<surname>Hao</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Li</surname>
<given-names>J.</given-names>
</name>
</person-group> (<year>2015</year>). <article-title>Bispecific Antibodies and Their Applications</article-title>. <source>J.&#x20;Hematol. Oncol.</source> <volume>8</volume>, <fpage>130</fpage>. <pub-id pub-id-type="doi">10.1186/s13045-015-0227-0</pub-id> </citation>
</ref>
<ref id="B17">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Giffin</surname>
<given-names>M. J.</given-names>
</name>
<name>
<surname>Cooke</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Lobenhofer</surname>
<given-names>E. K.</given-names>
</name>
<name>
<surname>Estrada</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Zhan</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Deegen</surname>
<given-names>P.</given-names>
</name>
<etal/>
</person-group> (<year>2021</year>). <article-title>AMG 757, a Half-Life Extended, DLL3-Targeted Bispecific T-Cell Engager, Shows High Potency and Sensitivity in Preclinical Models of Small-Cell Lung Cancer</article-title>. <source>Clin. Cancer Res.</source> <volume>27</volume> (<issue>5</issue>), <fpage>1526</fpage>&#x2013;<lpage>1537</lpage>. <pub-id pub-id-type="doi">10.1158/1078-0432.Ccr-20-2845</pub-id> </citation>
</ref>
<ref id="B18">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Han</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Chen</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Ding</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Zong</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>Xie</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Jiang</surname>
<given-names>H.</given-names>
</name>
<etal/>
</person-group> (<year>2017</year>). <article-title>Efficient Generation of Bispecific IgG Antibodies by Split Intein Mediated Protein Trans-splicing System</article-title>. <source>Sci. Rep.</source> <volume>7</volume> (<issue>1</issue>), <fpage>8360</fpage>. <pub-id pub-id-type="doi">10.1038/s41598-017-08641-3</pub-id> </citation>
</ref>
<ref id="B19">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Han</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Zong</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>Zhou</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Pan</surname>
<given-names>Z.</given-names>
</name>
<name>
<surname>Chen</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Ding</surname>
<given-names>K.</given-names>
</name>
<etal/>
</person-group> (<year>2019</year>). <article-title>Naturally Split Intein Npu DnaE Mediated Rapid Generation of Bispecific IgG Antibodies</article-title>. <source>Methods</source> <volume>154</volume>, <fpage>32</fpage>&#x2013;<lpage>37</lpage>. <pub-id pub-id-type="doi">10.1016/j.ymeth.2018.10.001</pub-id> </citation>
</ref>
<ref id="B20">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Heiss</surname>
<given-names>M. M.</given-names>
</name>
<name>
<surname>Murawa</surname>
<given-names>P.</given-names>
</name>
<name>
<surname>Koralewski</surname>
<given-names>P.</given-names>
</name>
<name>
<surname>Kutarska</surname>
<given-names>E.</given-names>
</name>
<name>
<surname>Kolesnik</surname>
<given-names>O. O.</given-names>
</name>
<name>
<surname>Ivanchenko</surname>
<given-names>V. V.</given-names>
</name>
<etal/>
</person-group> (<year>2010</year>). <article-title>The Trifunctional Antibody Catumaxomab for the Treatment of Malignant Ascites Due to Epithelial Cancer: Results of a Prospective Randomized Phase II/III Trial</article-title>. <source>Int. J.&#x20;Cancer</source> <volume>127</volume> (<issue>9</issue>), <fpage>2209</fpage>&#x2013;<lpage>2221</lpage>. <pub-id pub-id-type="doi">10.1002/ijc.25423</pub-id> </citation>
</ref>
<ref id="B21">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kebenko</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Goebeler</surname>
<given-names>M. E.</given-names>
</name>
<name>
<surname>Wolf</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Hasenburg</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Seggewiss-Bernhardt</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Ritter</surname>
<given-names>B.</given-names>
</name>
<etal/>
</person-group> (<year>2018</year>). <article-title>A Multicenter Phase 1 Study of Solitomab (MT110, AMG 110), a Bispecific EpCAM/CD3&#x20;T-Cell Engager (BiTE&#xae;) Antibody Construct, in Patients with Refractory Solid Tumors</article-title>. <source>Oncoimmunology</source> <volume>7</volume> (<issue>8</issue>), <fpage>e1450710</fpage>. <pub-id pub-id-type="doi">10.1080/2162402X.2018.1450710</pub-id> </citation>
</ref>
<ref id="B22">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Klinger</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Brandl</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Zugmaier</surname>
<given-names>G.</given-names>
</name>
<name>
<surname>Hijazi</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Bargou</surname>
<given-names>R. C.</given-names>
</name>
<name>
<surname>Topp</surname>
<given-names>M. S.</given-names>
</name>
<etal/>
</person-group> (<year>2012</year>). <article-title>Immunopharmacologic Response of Patients with B-Lineage Acute Lymphoblastic Leukemia to Continuous Infusion of T Cell-Engaging CD19/CD3-Bispecific BiTE Antibody Blinatumomab</article-title>. <source>Blood</source> <volume>119</volume> (<issue>26</issue>), <fpage>6226</fpage>&#x2013;<lpage>6233</lpage>. <pub-id pub-id-type="doi">10.1182/blood-2012-01-400515</pub-id> </citation>
</ref>
<ref id="B23">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Labrijn</surname>
<given-names>A. F.</given-names>
</name>
<name>
<surname>Janmaat</surname>
<given-names>M. L.</given-names>
</name>
<name>
<surname>Reichert</surname>
<given-names>J.&#x20;M.</given-names>
</name>
<name>
<surname>Parren</surname>
<given-names>P. W. H. I.</given-names>
</name>
</person-group> (<year>2019</year>). <article-title>Bispecific Antibodies: a Mechanistic Review of the Pipeline</article-title>. <source>Nat. Rev. Drug Discov.</source> <volume>18</volume> (<issue>8</issue>), <fpage>585</fpage>&#x2013;<lpage>608</lpage>. <pub-id pub-id-type="doi">10.1038/s41573-019-0028-1</pub-id> </citation>
</ref>
<ref id="B24">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Massafra</surname>
<given-names>V.</given-names>
</name>
<name>
<surname>Tundo</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Dietzig</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Ducret</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Jost</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Klein</surname>
<given-names>C.</given-names>
</name>
<etal/>
</person-group> (<year>2021</year>). <article-title>Proteolysis-Targeting Chimeras Enhance T&#x20;Cell Bispecific Antibody-Driven T&#x20;Cell Activation and Effector Function through Increased MHC Class I Antigen Presentation in Cancer Cells</article-title>. <source>J.&#x20;Immunol.</source> <volume>207</volume> (<issue>2</issue>), <fpage>493</fpage>&#x2013;<lpage>504</lpage>. <pub-id pub-id-type="doi">10.4049/jimmunol.2000252</pub-id> </citation>
</ref>
<ref id="B25">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Moldenhauer</surname>
<given-names>G.</given-names>
</name>
<name>
<surname>Momburg</surname>
<given-names>F.</given-names>
</name>
<name>
<surname>M&#xf6;ller</surname>
<given-names>P.</given-names>
</name>
<name>
<surname>Schwartz</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>H&#xe4;mmerling</surname>
<given-names>G. J.</given-names>
</name>
</person-group> (<year>1987</year>). <article-title>Epithelium-specific Surface Glycoprotein of Mr 34,000 Is a Widely Distributed Human Carcinoma Marker</article-title>. <source>Br. J.&#x20;Cancer</source> <volume>56</volume> (<issue>6</issue>), <fpage>714</fpage>&#x2013;<lpage>721</lpage>. <pub-id pub-id-type="doi">10.1038/bjc.1987.276</pub-id> </citation>
</ref>
<ref id="B26">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>M&#xfc;nz</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Kieu</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Mack</surname>
<given-names>B.</given-names>
</name>
<name>
<surname>Schmitt</surname>
<given-names>B.</given-names>
</name>
<name>
<surname>Zeidler</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Gires</surname>
<given-names>O.</given-names>
</name>
</person-group> (<year>2004</year>). <article-title>The Carcinoma-Associated Antigen EpCAM Upregulates C-Myc and Induces Cell Proliferation</article-title>. <source>Oncogene</source> <volume>23</volume> (<issue>34</issue>), <fpage>5748</fpage>&#x2013;<lpage>5758</lpage>. <pub-id pub-id-type="doi">10.1038/sj.onc.1207610</pub-id> </citation>
</ref>
<ref id="B27">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>M&#xfc;nz</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Murr</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Kvesic</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Rau</surname>
<given-names>D.</given-names>
</name>
<name>
<surname>Mangold</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Pflanz</surname>
<given-names>S.</given-names>
</name>
<etal/>
</person-group> (<year>2010</year>). <article-title>Side-by-side Analysis of Five Clinically Tested Anti-EpCAM Monoclonal Antibodies</article-title>. <source>Cancer Cel Int</source> <volume>10</volume>, <fpage>44</fpage>. <pub-id pub-id-type="doi">10.1186/1475-2867-10-44</pub-id> </citation>
</ref>
<ref id="B28">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Neijssen</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Cardoso</surname>
<given-names>R. M. F.</given-names>
</name>
<name>
<surname>Chevalier</surname>
<given-names>K. M.</given-names>
</name>
<name>
<surname>Wiegman</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Valerius</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Anderson</surname>
<given-names>G. M.</given-names>
</name>
<etal/>
</person-group> (<year>2021</year>). <article-title>Discovery of Amivantamab (JNJ-61186372), a Bispecific Antibody Targeting EGFR and MET</article-title>. <source>J.&#x20;Biol. Chem.</source> <volume>296</volume>, <fpage>100641</fpage>. <pub-id pub-id-type="doi">10.1016/j.jbc.2021.100641</pub-id> </citation>
</ref>
<ref id="B29">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Nie</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Wang</surname>
<given-names>Z.</given-names>
</name>
<name>
<surname>Moscoso-Castro</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>D&#x27;Souza</surname>
<given-names>P.</given-names>
</name>
<name>
<surname>Lei</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Xu</surname>
<given-names>J.</given-names>
</name>
<etal/>
</person-group> (<year>2020</year>). <article-title>Biology Drives the Discovery of Bispecific Antibodies as Innovative Therapeutics</article-title>. <source>Antib Ther.</source> <volume>3</volume> (<issue>1</issue>), <fpage>18</fpage>&#x2013;<lpage>62</lpage>. <pub-id pub-id-type="doi">10.1093/abt/tbaa003</pub-id> </citation>
</ref>
<ref id="B30">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Nordlinger</surname>
<given-names>B.</given-names>
</name>
<name>
<surname>Van Cutsem</surname>
<given-names>E.</given-names>
</name>
<name>
<surname>Gruenberger</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Glimelius</surname>
<given-names>B.</given-names>
</name>
<name>
<surname>Poston</surname>
<given-names>G.</given-names>
</name>
<name>
<surname>Rougier</surname>
<given-names>P.</given-names>
</name>
<etal/>
</person-group> (<year>2009</year>). <article-title>Combination of Surgery and Chemotherapy and the Role of Targeted Agents in the Treatment of Patients with Colorectal Liver Metastases: Recommendations from an Expert Panel</article-title>. <source>Ann. Oncol.</source> <volume>20</volume> (<issue>6</issue>), <fpage>985</fpage>&#x2013;<lpage>992</lpage>. <pub-id pub-id-type="doi">10.1093/annonc/mdn735</pub-id> </citation>
</ref>
<ref id="B31">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Offner</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Hofmeister</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Romaniuk</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Kufer</surname>
<given-names>P.</given-names>
</name>
<name>
<surname>Baeuerle</surname>
<given-names>P. A.</given-names>
</name>
</person-group> (<year>2006</year>). <article-title>Induction of Regular Cytolytic T&#x20;Cell Synapses by Bispecific Single-Chain Antibody Constructs on MHC Class I-Negative Tumor Cells</article-title>. <source>Mol. Immunol.</source> <volume>43</volume> (<issue>6</issue>), <fpage>763</fpage>&#x2013;<lpage>771</lpage>. <pub-id pub-id-type="doi">10.1016/j.molimm.2005.03.007</pub-id> </citation>
</ref>
<ref id="B32">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Pan</surname>
<given-names>Z.</given-names>
</name>
<name>
<surname>Chen</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Xiao</surname>
<given-names>X.</given-names>
</name>
<name>
<surname>Xie</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Jiang</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>Zhang</surname>
<given-names>B.</given-names>
</name>
<etal/>
</person-group> (<year>2021</year>). <article-title>Characterization of a Novel Bispecific Antibody Targeting Tissue Factor-Positive Tumors with T&#x20;Cell Engagement</article-title>. <source>Acta Pharm. Sinica B</source>. <pub-id pub-id-type="doi">10.1016/j.apsb.2021.10.028</pub-id> </citation>
</ref>
<ref id="B33">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ruf</surname>
<given-names>P.</given-names>
</name>
<name>
<surname>Gires</surname>
<given-names>O.</given-names>
</name>
<name>
<surname>J&#xe4;ger</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Fellinger</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Atz</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Lindhofer</surname>
<given-names>H.</given-names>
</name>
</person-group> (<year>2007</year>). <article-title>Characterisation of the New EpCAM-specific Antibody HO-3: Implications for Trifunctional Antibody Immunotherapy of Cancer</article-title>. <source>Br. J.&#x20;Cancer</source> <volume>97</volume> (<issue>3</issue>), <fpage>315</fpage>&#x2013;<lpage>321</lpage>. <pub-id pub-id-type="doi">10.1038/sj.bjc.6603881</pub-id> </citation>
</ref>
<ref id="B34">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sampei</surname>
<given-names>Z.</given-names>
</name>
<name>
<surname>Igawa</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Soeda</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Okuyama-Nishida</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Moriyama</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Wakabayashi</surname>
<given-names>T.</given-names>
</name>
<etal/>
</person-group> (<year>2013</year>). <article-title>Identification and Multidimensional Optimization of an Asymmetric Bispecific IgG Antibody Mimicking the Function of Factor VIII Cofactor Activity</article-title>. <source>PLoS One</source> <volume>8</volume> (<issue>2</issue>), <fpage>e57479</fpage>. <pub-id pub-id-type="doi">10.1371/journal.pone.0057479</pub-id> </citation>
</ref>
<ref id="B35">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Santich</surname>
<given-names>B. H.</given-names>
</name>
<name>
<surname>Park</surname>
<given-names>J.&#x20;A.</given-names>
</name>
<name>
<surname>Tran</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>Guo</surname>
<given-names>H. F.</given-names>
</name>
<name>
<surname>Huse</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Cheung</surname>
<given-names>N. V.</given-names>
</name>
</person-group> (<year>2020</year>). <article-title>Interdomain Spacing and Spatial Configuration Drive the Potency of IgG-[L]-scFv T&#x20;Cell Bispecific Antibodies</article-title>. <source>Sci. Transl Med.</source> <volume>12</volume> (<issue>534</issue>), <fpage>eaax1315</fpage>. <pub-id pub-id-type="doi">10.1126/scitranslmed.aax1315</pub-id> </citation>
</ref>
<ref id="B36">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Schaefer</surname>
<given-names>G.</given-names>
</name>
<name>
<surname>Haber</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Crocker</surname>
<given-names>L. M.</given-names>
</name>
<name>
<surname>Shia</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Shao</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Dowbenko</surname>
<given-names>D.</given-names>
</name>
<etal/>
</person-group> (<year>2011</year>). <article-title>A Two-In-One Antibody against HER3 and EGFR Has superior Inhibitory Activity Compared with Monospecific Antibodies</article-title>. <source>Cancer Cell</source> <volume>20</volume> (<issue>4</issue>), <fpage>472</fpage>&#x2013;<lpage>486</lpage>. <pub-id pub-id-type="doi">10.1016/j.ccr.2011.09.003</pub-id> </citation>
</ref>
<ref id="B37">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Schlereth</surname>
<given-names>B.</given-names>
</name>
<name>
<surname>Fichtner</surname>
<given-names>I.</given-names>
</name>
<name>
<surname>Lorenczewski</surname>
<given-names>G.</given-names>
</name>
<name>
<surname>Kleindienst</surname>
<given-names>P.</given-names>
</name>
<name>
<surname>Brischwein</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>da Silva</surname>
<given-names>A.</given-names>
</name>
<etal/>
</person-group> (<year>2005</year>). <article-title>Eradication of Tumors from a Human colon Cancer Cell Line and from Ovarian Cancer Metastases in Immunodeficient Mice by a Single-Chain Ep-CAM-/cd3-Bispecific Antibody Construct</article-title>. <source>Cancer Res.</source> <volume>65</volume> (<issue>7</issue>), <fpage>2882</fpage>&#x2013;<lpage>2889</lpage>. <pub-id pub-id-type="doi">10.1158/0008-5472.Can-04-2637</pub-id> </citation>
</ref>
<ref id="B38">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Schmelzer</surname>
<given-names>E.</given-names>
</name>
<name>
<surname>Reid</surname>
<given-names>L. M.</given-names>
</name>
</person-group> (<year>2008</year>). <article-title>EpCAM Expression in normal, Non-pathological Tissues</article-title>. <source>Front. Biosci.</source> <volume>13</volume>, <fpage>3096</fpage>&#x2013;<lpage>3100</lpage>. <pub-id pub-id-type="doi">10.2741/2911</pub-id> </citation>
</ref>
<ref id="B39">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Seo</surname>
<given-names>S. I.</given-names>
</name>
<name>
<surname>Lim</surname>
<given-names>S. B.</given-names>
</name>
<name>
<surname>Yoon</surname>
<given-names>Y. S.</given-names>
</name>
<name>
<surname>Kim</surname>
<given-names>C. W.</given-names>
</name>
<name>
<surname>Yu</surname>
<given-names>C. S.</given-names>
</name>
<name>
<surname>Kim</surname>
<given-names>T. W.</given-names>
</name>
<etal/>
</person-group> (<year>2013</year>). <article-title>Comparison of Recurrence Patterns between &#x2264;5&#x20;Years and &#x3e;5&#x20;Years after Curative Operations in Colorectal Cancer Patients</article-title>. <source>J.&#x20;Surg. Oncol.</source> <volume>108</volume> (<issue>1</issue>), <fpage>9</fpage>&#x2013;<lpage>13</lpage>. <pub-id pub-id-type="doi">10.1002/jso.23349</pub-id> </citation>
</ref>
<ref id="B40">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Shultz</surname>
<given-names>L. D.</given-names>
</name>
<name>
<surname>Lyons</surname>
<given-names>B. L.</given-names>
</name>
<name>
<surname>Burzenski</surname>
<given-names>L. M.</given-names>
</name>
<name>
<surname>Gott</surname>
<given-names>B.</given-names>
</name>
<name>
<surname>Chen</surname>
<given-names>X.</given-names>
</name>
<name>
<surname>Chaleff</surname>
<given-names>S.</given-names>
</name>
<etal/>
</person-group> (<year>2005</year>). <article-title>Human Lymphoid and Myeloid Cell Development in NOD/LtSz-scid IL2R Gamma Null Mice Engrafted with Mobilized Human Hemopoietic Stem Cells</article-title>. <source>J.&#x20;Immunol.</source> <volume>174</volume> (<issue>10</issue>), <fpage>6477</fpage>&#x2013;<lpage>6489</lpage>. <pub-id pub-id-type="doi">10.4049/jimmunol.174.10.6477</pub-id> </citation>
</ref>
<ref id="B41">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Siegel</surname>
<given-names>R. L.</given-names>
</name>
<name>
<surname>Miller</surname>
<given-names>K. D.</given-names>
</name>
<name>
<surname>Fuchs</surname>
<given-names>H. E.</given-names>
</name>
<name>
<surname>Jemal</surname>
<given-names>A.</given-names>
</name>
</person-group> (<year>2021</year>). <article-title>Cancer Statistics, 2021</article-title>. <source>CA A. Cancer J.&#x20;Clin.</source> <volume>71</volume> (<issue>1</issue>), <fpage>7</fpage>&#x2013;<lpage>33</lpage>. <pub-id pub-id-type="doi">10.3322/caac.21654</pub-id> </citation>
</ref>
<ref id="B42">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Skokos</surname>
<given-names>D.</given-names>
</name>
<name>
<surname>Waite</surname>
<given-names>J.&#x20;C.</given-names>
</name>
<name>
<surname>Haber</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Crawford</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Hermann</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Ullman</surname>
<given-names>E.</given-names>
</name>
<etal/>
</person-group> (<year>2020</year>). <article-title>A Class of Costimulatory CD28-Bispecific Antibodies that Enhance the Antitumor Activity of CD3-Bispecific Antibodies</article-title>. <source>Sci. Transl Med.</source> <volume>12</volume> (<issue>525</issue>), <fpage>eaaw7888</fpage>. <pub-id pub-id-type="doi">10.1126/scitranslmed.aaw7888</pub-id> </citation>
</ref>
<ref id="B43">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Song</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Xue</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Zhang</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Li</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Liu</surname>
<given-names>D.</given-names>
</name>
<name>
<surname>Zhou</surname>
<given-names>T.</given-names>
</name>
</person-group> (<year>2021</year>). <article-title>Mechanistic Prediction of First-In-Human Dose for Bispecific CD3/EpCAM T-Cell Engager Antibody M701, Using an Integrated PK/PD Modeling Method</article-title>. <source>Eur. J.&#x20;Pharm. Sci.</source> <volume>158</volume>, <fpage>105584</fpage>. <pub-id pub-id-type="doi">10.1016/j.ejps.2020.105584</pub-id> </citation>
</ref>
<ref id="B44">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Stein</surname>
<given-names>A. S.</given-names>
</name>
<name>
<surname>Kantarjian</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>G&#xf6;kbuget</surname>
<given-names>N.</given-names>
</name>
<name>
<surname>Bargou</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Litzow</surname>
<given-names>M. R.</given-names>
</name>
<name>
<surname>Rambaldi</surname>
<given-names>A.</given-names>
</name>
<etal/>
</person-group> (<year>2019</year>). <article-title>Blinatumomab for Acute Lymphoblastic Leukemia Relapse after Allogeneic Hematopoietic Stem Cell Transplantation</article-title>. <source>Biol. Blood Marrow Transpl.</source> <volume>25</volume> (<issue>8</issue>), <fpage>1498</fpage>&#x2013;<lpage>1504</lpage>. <pub-id pub-id-type="doi">10.1016/j.bbmt.2019.04.010</pub-id> </citation>
</ref>
<ref id="B45">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sun</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Zhou</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Han</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Pan</surname>
<given-names>Z.</given-names>
</name>
<name>
<surname>Chen</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Zong</surname>
<given-names>H.</given-names>
</name>
<etal/>
</person-group> (<year>2021</year>). <article-title>A Rational Designed Novel Bispecific Antibody for the Treatment of GBM</article-title>. <source>Biomedicines</source> <volume>9</volume> (<issue>6</issue>), <fpage>640</fpage>. <pub-id pub-id-type="doi">10.3390/biomedicines9060640</pub-id> </citation>
</ref>
<ref id="B46">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sung</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>Ferlay</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Siegel</surname>
<given-names>R. L.</given-names>
</name>
<name>
<surname>Laversanne</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Soerjomataram</surname>
<given-names>I.</given-names>
</name>
<name>
<surname>Jemal</surname>
<given-names>A.</given-names>
</name>
<etal/>
</person-group> (<year>2021</year>). <article-title>Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries</article-title>. <source>CA Cancer J.&#x20;Clin.</source> <volume>71</volume> (<issue>3</issue>), <fpage>209</fpage>&#x2013;<lpage>249</lpage>. <pub-id pub-id-type="doi">10.3322/caac.21660</pub-id> </citation>
</ref>
<ref id="B47">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Van Cutsem</surname>
<given-names>E.</given-names>
</name>
<name>
<surname>Cervantes</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Adam</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Sobrero</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Van Krieken</surname>
<given-names>J.&#x20;H.</given-names>
</name>
<name>
<surname>Aderka</surname>
<given-names>D.</given-names>
</name>
<etal/>
</person-group> (<year>2016</year>). <article-title>ESMO Consensus Guidelines for the Management of Patients with Metastatic Colorectal Cancer</article-title>. <source>Ann. Oncol.</source> <volume>27</volume> (<issue>8</issue>), <fpage>1386</fpage>&#x2013;<lpage>1422</lpage>. <pub-id pub-id-type="doi">10.1093/annonc/mdw235</pub-id> </citation>
</ref>
<ref id="B48">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Went</surname>
<given-names>P.</given-names>
</name>
<name>
<surname>Vasei</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Bubendorf</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Terracciano</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Tornillo</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Riede</surname>
<given-names>U.</given-names>
</name>
<etal/>
</person-group> (<year>2006</year>). <article-title>Frequent High-Level Expression of the Immunotherapeutic Target Ep-CAM in colon, Stomach, Prostate and Lung Cancers</article-title>. <source>Br. J.&#x20;Cancer</source> <volume>94</volume> (<issue>1</issue>), <fpage>128</fpage>&#x2013;<lpage>135</lpage>. <pub-id pub-id-type="doi">10.1038/sj.bjc.6602924</pub-id> </citation>
</ref>
<ref id="B49">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wherry</surname>
<given-names>E. J.</given-names>
</name>
<name>
<surname>Kurachi</surname>
<given-names>M.</given-names>
</name>
</person-group> (<year>2015</year>). <article-title>Molecular and Cellular Insights into T&#x20;Cell Exhaustion</article-title>. <source>Nat. Rev. Immunol.</source> <volume>15</volume> (<issue>8</issue>), <fpage>486</fpage>&#x2013;<lpage>499</lpage>. <pub-id pub-id-type="doi">10.1038/nri3862</pub-id> </citation>
</ref>
<ref id="B50">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yu</surname>
<given-names>Y. J.</given-names>
</name>
<name>
<surname>Atwal</surname>
<given-names>J.&#x20;K.</given-names>
</name>
<name>
<surname>Zhang</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Tong</surname>
<given-names>R. K.</given-names>
</name>
<name>
<surname>Wildsmith</surname>
<given-names>K. R.</given-names>
</name>
<name>
<surname>Tan</surname>
<given-names>C.</given-names>
</name>
<etal/>
</person-group> (<year>2014</year>). <article-title>Therapeutic Bispecific Antibodies Cross the Blood-Brain Barrier in Nonhuman Primates</article-title>. <source>Sci. Transl Med.</source> <volume>6</volume> (<issue>261</issue>), <fpage>261ra154</fpage>. <pub-id pub-id-type="doi">10.1126/scitranslmed.3009835</pub-id> </citation>
</ref>
<ref id="B51">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yu</surname>
<given-names>Y. J.</given-names>
</name>
<name>
<surname>Zhang</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Kenrick</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Hoyte</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Luk</surname>
<given-names>W.</given-names>
</name>
<name>
<surname>Lu</surname>
<given-names>Y.</given-names>
</name>
<etal/>
</person-group> (<year>2011</year>). <article-title>Boosting Brain Uptake of a Therapeutic Antibody by Reducing its Affinity for a Transcytosis Target</article-title>. <source>Sci. Transl Med.</source> <volume>3</volume> (<issue>84</issue>), <fpage>84ra44</fpage>. <pub-id pub-id-type="doi">10.1126/scitranslmed.3002230</pub-id> </citation>
</ref>
<ref id="B52">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Zhou</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Zong</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>Han</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Xie</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Jiang</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>Gilly</surname>
<given-names>J.</given-names>
</name>
<etal/>
</person-group> (<year>2020</year>). <article-title>A Novel Bispecific Antibody Targeting CD3 and Prolactin Receptor (PRLR) against PRLR-Expression Breast Cancer</article-title>. <source>J.&#x20;Exp. Clin. Cancer Res.</source> <volume>39</volume> (<issue>1</issue>), <fpage>87</fpage>. <pub-id pub-id-type="doi">10.1186/s13046-020-01564-4</pub-id> </citation>
</ref>
<ref id="B53">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Zhu</surname>
<given-names>J.</given-names>
</name>
</person-group> (<year>2012</year>). <article-title>Mammalian Cell Protein Expression for Biopharmaceutical Production</article-title>. <source>Biotechnol. Adv.</source> <volume>30</volume> (<issue>5</issue>), <fpage>1158</fpage>&#x2013;<lpage>1170</lpage>. <pub-id pub-id-type="doi">10.1016/j.biotechadv.2011.08.022</pub-id> </citation>
</ref>
</ref-list>
</back>
</article>