Hydroxy polyethylene glycol: a solution to evade human pre-existing anti-PEG antibodies for efficient delivery

Polyethylene glycol (PEG) has been extensively utilized in food, cosmetics, and pharmaceutical fields, especially in the realm of nanomedicines, where it serves as a pivotal excipient for extending the nanoparticles circulation half-life. Contrary to its historical perception as non-immunogenic, pre-existing anti-PEG antibodies have been widely detected in human who even have never been exposed to PEGylated therapeutics, which considered to be associated with serious side effects of PEGylated nanomedicines including infusion reactions and other hypersensitive reactions. Herein, we elucidated the prevalence and distribution characteristics of pre-existing anti-PEG antibodies in 2074 human blood samples, and investigated its binding with PEG. Pre-existing anti-PEG antibodies were found to primarily recognize the PEG terminus, especially methoxy, which is the only PEG terminus contained in currently marketed PEGylated nanomedicines. While hydroxy PEG (OH-PEG) significantly evaded binding with pre-existing anti-PEG antibodies among most clinical samples. Noteworthily, substituting OH-PEG for MeO-PEG significantly mitigated complement activation of lipid nanoparticle (LNP) caused by pre-existing anti-PEG antibodies, thereby markedly enhancing stability and reducing mRNA leakage in human serum. Additionally, LNP modified with OH-PEG exhibited reduced immunogenicity, which was crucial for repeated drug administrations. The present work elucidated the crucial role of OH-PEG in evading human pre-existing anti-PEG antibodies, and discovered that the current pre-clinical studies inadequately simulated the biological effects of clinical pre-existing anti-PEG antibodies on such formulations through interspecies study, which had a profound impact on clinical translation of PEGylated nanomedicines.