Molecular mechanism of action of a blood brain barrier shuttle antibody

The transferrin receptor has emerged as a prime target for transcytosis of antibody shuttles from the bloodstream into the brain parenchyma to deliver therapeutic payloads that treat neurological disorders. However, how the transferrin receptor-antibody binding mode impacts avidity, degradation, pH sensitivity and delivery remains underexplored. To address this, we determined the cryo-EM structure of mouse transferrin receptor 1 bound to the model brain shuttle antibody 8D3. In combination with cell binding and localisation studies we show that 8D3 can structurally support small-scale inter-receptor cross-linking, such as in self-contained pairs, that cause avidity but do not induce receptor redistribution or degradation. The structure can also explain pH-dependent binding modes, and we show how some of these antibody variants with graded sensitivities regulate brain penetration in vivo. Overall, our study illuminates how distinct molecular features of antibody binding impact transferrin receptor behaviour and brain delivery to inform on future shuttle design.