CB2 cannabinoid receptor-specific therapeutic antibody agonists for treatment of chemotherapy-induced peripheral neuropathy

Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating complication of cancer treatment. CB2 cannabinoid receptor activation reduces inflammation and is an attractive therapeutic target. Antibodies targeting G protein-coupled receptors (GPCRs), like CB2, offer high specificity and peripheral-restriction, thereby minimizing off-target activity. Here, we investigated the efficacy of first-in-class CB2-specific antibody agonists (AB110 and AB120) and an isotype control (AB100) on mechanical and cold hypersensitivity induced by paclitaxel in both tumor-free and mammary (4T1) tumor-bearing female mice. These CB2 antibody agonists exhibit biased G- signaling and also reduce macrophage markers and pro-inflammatory cytokines in vitro. Paclitaxel produced behavioral hypersensitivities to mechanical and cold stimulation, which were reduced by AB110 and AB120 for approximately 48 hours post-injection in female mice. Repeated daily dosing did not lead to tolerance to the anti-allodynic effects. Prophylactic treatment with AB110 and AB120 during paclitaxel treatment delayed, but did not prevent, the development of paclitaxel-induced behavioral hypersensitivities after termination of dosing with antibody agonists. AB100 had no effect under any conditions. The anti-allodynic effects of AB120 were absent in CB2 knockout mice, confirming pharmacological specificity via CB2 receptors. Furthermore, AB120 remained effective in paclitaxel-treated tumor-bearing mice. Neither AB110 nor AB120 affected locomotor activity in otherwise naive mice. The cytotoxic activity of paclitaxel on 4T1 tumor cell line was maintained in the presence of CB2 antibody agonists in vitro. Overall, our results suggest that CB2-specific antibody agonists are promising candidates for treating CIPN, providing lasting pain relief without tolerance, off target effects or unwanted CB1-mediated motor side effects.