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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Oncol.</journal-id>
<journal-title>Frontiers in Oncology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Oncol.</abbrev-journal-title>
<issn pub-type="epub">2234-943X</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fonc.2025.1663743</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Oncology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Anti-lipolysis-stimulated lipoprotein receptor antibody-drug conjugate to treat triple-negative breast cancer</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" equal-contrib="yes">
<name>
<surname>Zhou</surname>
<given-names>Zhuoxin &#x201c;Zora&#x201d;</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="author-notes" rid="fn003">
<sup>&#x2020;</sup>
</xref>
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<contrib contrib-type="author" equal-contrib="yes">
<name>
<surname>Ballard</surname>
<given-names>Davis</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="author-notes" rid="fn003">
<sup>&#x2020;</sup>
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<contrib contrib-type="author">
<name>
<surname>Varadkar</surname>
<given-names>Tanvi</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
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<contrib contrib-type="author">
<name>
<surname>Zhang</surname>
<given-names>Jiashuai</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
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<contrib contrib-type="author">
<name>
<surname>Du</surname>
<given-names>Zhantao</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
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<contrib contrib-type="author">
<name>
<surname>George</surname>
<given-names>Ashley</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
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<contrib contrib-type="author">
<name>
<surname>Krabacher</surname>
<given-names>Aaron</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
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<contrib contrib-type="author">
<name>
<surname>Yengo</surname>
<given-names>Rachel</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
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<contrib contrib-type="author">
<name>
<surname>Zhou</surname>
<given-names>Lufang</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
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<contrib contrib-type="author" corresp="yes">
<name>
<surname>Liu</surname>
<given-names>Xiaoguang &#x201c;Margaret&#x201d;</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
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<aff id="aff1">
<sup>1</sup>
<institution>Department of Chemical and Biomolecular Engineering, The Ohio State University</institution>, <addr-line>Columbus, OH</addr-line>,&#xa0;<country>United States</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>Department of Biomedical Engineering, The Ohio State University</institution>, <addr-line>Columbus, OH</addr-line>,&#xa0;<country>United States</country>
</aff>
<aff id="aff3">
<sup>3</sup>
<institution>Comprehensive Cancer Center, The Ohio State University</institution>, <addr-line>Columbus, OH</addr-line>,&#xa0;<country>United States</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/2934142/overview">Xudong Zhu</ext-link>, University of Kentucky, United States</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/232936/overview">Provas Das</ext-link>, University of Oklahoma Health Sciences, United States</p>
<p>
<ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/3140310/overview">Hadir Emara</ext-link>, American University in Cairo, Egypt</p>
<p>
<ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/3145355/overview">Wenjie Liu</ext-link>, Lakehead University, Canada</p>
</fn>
<fn fn-type="corresp" id="fn001">
<p>*Correspondence: Xiaoguang &#x201c;Margaret&#x201d; Liu, <email xlink:href="mailto:liu.482@osu.edu">liu.482@osu.edu</email>
</p>
</fn>
<fn fn-type="equal" id="fn003">
<p>&#x2020;These authors have contributed equally to this work</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>17</day>
<month>09</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="collection">
<year>2025</year>
</pub-date>
<volume>15</volume>
<elocation-id>1663743</elocation-id>
<history>
<date date-type="received">
<day>10</day>
<month>07</month>
<year>2025</year>
</date>
<date date-type="accepted">
<day>03</day>
<month>09</month>
<year>2025</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2025 Zhou, Ballard, Varadkar, Zhang, Du, George, Krabacher, Yengo, Zhou and Liu.</copyright-statement>
<copyright-year>2025</copyright-year>
<copyright-holder>Zhou, Ballard, Varadkar, Zhang, Du, George, Krabacher, Yengo, Zhou and Liu</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 terms.</p>
</license>
</permissions>
<abstract>
<p>Triple-negative breast cancer (TNBC), the most aggressive breast cancer subtype (ER<sup>-</sup>/PR<sup>-</sup>/HER2<sup>-</sup>), is characterized by rapid proliferation, high metastatic rate and frequent recurrence. The development of targeted therapies for TNBC, such as antibody-drug conjugates (ADCs), has been limited by the lack of promising cell surface receptors. Our recent findings revealed that lipolysis-stimulated lipoprotein receptor (LSR) is overexpressed in breast cancer patients. The objective of this study was to develop an anti-LSR monoclonal antibody (mAb) and ADC for TNBC treatment. We observed high transcript and surface expression of LSR across various breast cancer subtypes, with over 63% of TNBC patient tissue samples exhibiting elevated expression. A new mAb targeting the extracellular domain of LSR was developed, engineered, and evaluated <italic>in vitro</italic> and <italic>in vivo</italic>. The ADC, constructed by conjugating LSR mAb with a cytotoxic agent mertansine (DM1), demonstrated potent anti-TNBC cytotoxicity in three cell lines. <italic>In vivo</italic> anti-cancer efficacy was evaluated in two TNBC xenografted mouse models, where a 24 mg/kg-body weight dose of LSR mAb-DM1 reduced tumor burden by 85% in one model and prevented tumor regrowth in the second model. Notably, no off-target effects or systemic toxicity were observed in animal models during or after treatment. This study highlights LSR as a promising therapeutic target and the anti-LSR mAb and ADC as potential targeted therapies for TNBC.</p>
</abstract>
<kwd-group>
<kwd>lipolysis-stimulated lipoprotein receptor (LSR)</kwd>
<kwd>antibody-drug conjugate (ADC)</kwd>
<kwd>triple-negative breast cancer (TNBC)</kwd>
<kwd>targeted therapy</kwd>
<kwd>evaluations</kwd>
</kwd-group>
<contract-num rid="cn001">1R01CA242917-01A1, 1R01CA281980-01, 1R01CA262028-01A1</contract-num>
<contract-sponsor id="cn001">National Institutes of Health<named-content content-type="fundref-id">10.13039/100000002</named-content>
</contract-sponsor>
<counts>
<fig-count count="7"/>
<table-count count="0"/>
<equation-count count="0"/>
<ref-count count="68"/>
<page-count count="14"/>
<word-count count="6120"/>
</counts>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-in-acceptance</meta-name>
<meta-value>Breast Cancer</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro">
<title>Introduction</title>
<p>Triple-negative breast cancer (TNBC) is highly aggressive and metastatic (<xref ref-type="bibr" rid="B1">1</xref>), with the poorest prognosis among all breast cancer subtypes (<xref ref-type="bibr" rid="B2">2</xref>, <xref ref-type="bibr" rid="B3">3</xref>). Standard cytotoxic chemotherapies, such as doxorubicin and paclitaxel, offer limited clinical benefits due to severe side effects, emergence of drug resistance, and high recurrence rates (<xref ref-type="bibr" rid="B4">4</xref>&#x2013;<xref ref-type="bibr" rid="B6">6</xref>). As previously reviewed (<xref ref-type="bibr" rid="B7">7</xref>, <xref ref-type="bibr" rid="B8">8</xref>), clinical trials demonstrate that immune checkpoint inhibitors, such as the anti-PD-1 pembrolizumab and the anti-PD-L1 durvalumab improve progression-free survival and overall survival in patients with TNBC when combined with chemotherapy, whereas monotherapy shows limited therapeutic efficacy. Sacituzumab govitecan-hziy (Trodelvy), a trophoblast cell-surface antigen 2 (Trop-2)-targeted antibody-SN-38 conjugate, has been approved for relapsed or refractory TNBC (<xref ref-type="bibr" rid="B9">9</xref>&#x2013;<xref ref-type="bibr" rid="B12">12</xref>) and other cancers (<xref ref-type="bibr" rid="B13">13</xref>&#x2013;<xref ref-type="bibr" rid="B16">16</xref>) following standard therapies. However, the limited efficacy of existing chemotherapy and immunotherapy options underscores an urgent need for novel targeted therapies for TNBC.</p>
<p>Targeted therapies, such as monoclonal antibodies (mAbs) and antibody-drug conjugates (ADCs), have been developed and applied in clinical settings to treat various cancers while minimizing adverse effects on the healthy tissues in patients (<xref ref-type="bibr" rid="B17">17</xref>&#x2013;<xref ref-type="bibr" rid="B19">19</xref>). ADCs can carry highly potent drugs and specifically target cancer cells <italic>in vivo</italic> to deliver chemotherapy or other therapies. The mAb component of ADCs can also trigger antibody-dependent cell-mediated cytotoxicity, further enhancing their anti-cancer effect. Compared to traditional mAbs and chemotherapies, ADCs offer improved anti-cancer efficacy and reduced adverse effects. For instance, ado-trastuzumab emtansine (T-DM1, Kadcyla) (<xref ref-type="bibr" rid="B20">20</xref>, <xref ref-type="bibr" rid="B21">21</xref>) and fam-trastuzumab deruxtecan-nxki (T-Dax, Enhertu) (<xref ref-type="bibr" rid="B22">22</xref>, <xref ref-type="bibr" rid="B23">23</xref>) have been approved for human epidermal growth factor receptor 2 (HER2)<sup>+</sup> breast cancers. ADCs targeting folate receptor alpha, such as rinatabart sesutecan (NCT05579366), AMT-151 (NCT05498597), and LY4170156 (NCT06400472), as well as those targeting protein tyrosine kinase 7, including LY4175408 (NCT07046923) and DAY301 (NCT06752681), are currently being evaluated in Phase 1 or 1/2 clinical trials for advanced or metastatic TNBC and other cancers (<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/">https://clinicaltrials.gov/</ext-link>). These developments indicate that ADCs represent a promising targeted therapeutic strategy for TNBC patients, provided suitable surface receptors are identified and validated.</p>
<p>The lipolysis-stimulated lipoprotein receptor (LSR) is a promising therapeutic target for TNBC. LSR is expressed in the plasma membrane, cytoplasm and nucleus of cancer cells with metastatic signatures (<xref ref-type="bibr" rid="B24">24</xref>, <xref ref-type="bibr" rid="B25">25</xref>) and is associated with poor disease-free survival in breast cancer patients (<xref ref-type="bibr" rid="B25">25</xref>). LSR supports lipid metabolism, promotes tumor growth, defines cell corners to form tricellular tight junctions in epithelial cells, and contributes to cancer cell proliferation and metastasis (<xref ref-type="bibr" rid="B24">24</xref>, <xref ref-type="bibr" rid="B26">26</xref>). Recent studies have reported that LSR downregulation inhibits cell proliferation and invasion in endometrial cancer (<xref ref-type="bibr" rid="B27">27</xref>, <xref ref-type="bibr" rid="B28">28</xref>), while its overexpression in gastric and breast cancers correlates with increased lipid uptake, cell proliferation, and cancer stem cell-like features (<xref ref-type="bibr" rid="B29">29</xref>, <xref ref-type="bibr" rid="B30">30</xref>). One study using TNBC xenografted mouse models revealed that LSR overexpression has been linked to tumor development (<xref ref-type="bibr" rid="B25">25</xref>). One recent study showed that anti-LSR antibody-monomethyl auristatin E conjugate significantly inhibited ovarian cancer growth at high dose (<xref ref-type="bibr" rid="B31">31</xref>). Our bioinformatics analysis of The Cancer Genome Atlas (TCGA) dataset and histological analysis of over 100 patient tissues confirmed LSR overexpression in most TNBCs and ER<sup>+</sup>/PR<sup>+</sup>/HER2<sup>+</sup> breast cancers. Additionally, the anti-LSR mAb developed in this study effectively targeted and delivered chemotherapy to TNBC cells both <italic>in vitro</italic> and <italic>in vivo</italic>.</p>
<p>This study aimed to develop and evaluate an LSR-targeted ADC to treat TNBC. High expression of LSR was confirmed in TNBC cell lines and patient tissues. Leveraging this, a new anti-LSR mAb was developed, engineered and used to conjugate with mertansine (DM1). The mAb&#x2019;s surface binding, internalization, and tumor-targeting capabilities were validated using flow cytometry, confocal microscopy and <italic>In Vivo</italic> Imaging System (IVIS). The anti-LSR ADC was evaluated <italic>in vitro</italic> through cytotoxicity assays using three TNBC cell lines. Furthermore, its anti-TNBC efficacy was evaluated in two mouse models to assess tumor burden reduction and tumor blockage. Collectively, this study suggests that LSR is a promising therapeutic target for TNBC, and an LSR-targeted ADC may offer a new treatment strategy.</p>
</sec>
<sec id="s2" sec-type="materials|methods">
<title>Materials and methods</title>
<p>Animal studies were conducted according to the Institutional Animal Care and Use Committee (IACUC) Protocol 2022A00000071 that was approved by the university Institutional Biosafety Committee.</p>
<sec id="s2_1">
<title>Cell lines and culture media</title>
<p>The human TNBC cell lines MDA-MB-231, MDA-MB-468, and MDA-MB-231-FLuc (ATCC, Manassas, VA, USA) were cultivated in Dulbecco&#x2019;s Modified Eagle Medium (DMEM) supplemented with 10% fetal bovine serum (FBS, v/v) and 1% penicillin/streptomycin (Pen/Strep, v/v). The mouse TNBC cell lines 4T1 and 4T1-FLuc (ATCC) were maintained in RPMI-1640 medium with 10% FBS and 1% Pen/Strep. The seed train of Expi293F cells for LSR mAb production was maintained in Expi293 Expression Medium containing 4 mM GlutaMAX and 4 g/L glucose. All cell cultures were incubated at 37&#xb0;C in a humidified incubator with 5% CO<sub>2</sub> (Caron, Marietta, OH, USA). Media and supplements were obtained from Fisher Scientific (Waltham, MA, USA) or Millipore Sigma (Burlington, MA, USA) unless otherwise specified.</p>
</sec>
<sec id="s2_2">
<title>Development, engineering, and production of anti-LSR mAb</title>
<p>First, the anti-human LSR mAb, targeting the Ig-like V-type extracellular domain (Met1-Asp259) of the surface receptor, was developed using the well-established hybridoma technology as previously described (<xref ref-type="bibr" rid="B32">32</xref>&#x2013;<xref ref-type="bibr" rid="B34">34</xref>). Once mAb production was detected in the mice injected with immunogen, the splenocytes were collected and fused with myeloma cells Sp2/0-Ag14 (ATCC) to generate hybridoma cells. Two rounds of single cell cloning were performed to identify the top hybridoma clone with high affinity and mAb titer, quantified via enzyme-linked immunosorbent assay (ELISA) using the extracellular peptide as the coating antigen. Second, the top LSR mAb clone was engineered by fusing its variable region with the Fc region of a human IgG1 for future clinical application.</p>
<p>The engineered LSR mAb was produced from Expi293F cells using transient expression system (Gibco) fed with glucose (6 g/L) and L-GlutaMAX (6 mM). The antibody productions were performed in 2-L stirred-tank bioreactor with process parameters of Temp 37&#xb0;C, agitation 140 rpm, DO 40% and pH 7.2, or in a 3-L shaker flask at Temp 37&#xb0;C, agitation 130 rpm, and 8% CO<sub>2</sub> (<xref ref-type="bibr" rid="B33">33</xref>&#x2013;<xref ref-type="bibr" rid="B36">36</xref>). Purification of LSR mAb was performed utilizing a Next Generation Liquid Chromatography system (Bio-Rad, Hercules, CA, USA) following our previous procedures (<xref ref-type="bibr" rid="B32">32</xref>&#x2013;<xref ref-type="bibr" rid="B35">35</xref>, <xref ref-type="bibr" rid="B37">37</xref>&#x2013;<xref ref-type="bibr" rid="B40">40</xref>). Specifically, the spent medium containing the mAb product was loaded onto 1-mL or 5-mL Bio-Scale Mini UNOsphere SUPrA affinity chromatography cartridges (Bio-Rad) with buffer A comprised of 0.02 M Na<sub>3</sub>PO<sub>4</sub> and 0.02 M Na<sub>3</sub>C<sub>6</sub>H<sub>5</sub>O<sub>7</sub> (pH 7.5). The mAb was eluted with buffer B comprised of 0.1 M NaCl and 0.02 M Na<sub>3</sub>C<sub>6</sub>H<sub>5</sub>O<sub>7</sub> (pH 3.0).</p>
</sec>
<sec id="s2_3">
<title>Construction of LSR mAb-DM1</title>
<p>The LSR mAb-DM1 ADC was constructed using our previously established conjugation platform (<xref ref-type="bibr" rid="B32">32</xref>, <xref ref-type="bibr" rid="B34">34</xref>, <xref ref-type="bibr" rid="B40">40</xref>) with minor modifications. Briefly, the purified LSR mAb was neutralized, desalted via buffer exchange, and concentrated to 5 mg/mL with a 10 kDa MWCO PES concentrator. During the conjugation reaction, 5 mg/mL mAb, 10 mg/mL sulfo-SMCC linker, and 10 mM of DM1 were mixed at a molar ratio of 1:14:18.2. After incubation at 37 &#xb0;C for 2 hours, the constructed ADC was purified using a Protein A column, desalted using a 10 kDa Slide-A-Lyzer dialysis cassette, and further concentrated with a 10 kDa PES concentrator.</p>
</sec>
<sec id="s2_4">
<title>Characterization of ADCs</title>
<p>The purity and drug-antibody ratio (DAR) of the ADC were analyzed using a High-Performance Liquid Chromatography (HPLC) system (Shimadzu, Columbia, MD, USA) equipped with a MAbPac hydrophobic interaction chromatography (HIC)-butyl column (5 &#xb5;m, 4.6x100 mm). Two aqueous mobile phases with flow rates of 1.0 mL/min were utilized: Buffer A, 1.5 M (NH<sub>4</sub>)<sub>2</sub>SO<sub>4</sub> and 50 mM Na<sub>3</sub>PO<sub>4</sub> at pH 7.0 and Buffer B, 50 mM Na<sub>3</sub>PO<sub>4</sub> at pH 7.0. UV/Vis spectroscopy was used to confirm ADC conjugation and mass spectrometry was used to quantitate DAR at University Mass Spectrometry and Proteomics facility.</p>
</sec>
<sec id="s2_5">
<title>
<italic>In vitro</italic> cytotoxicity</title>
<p>The human and mouse TNBC cells were seeded in 96-well plates at densities of 10,000 cells (MDA-MB-468), 1,000 cells (MDA-MB-231), and 500 cells (4T1) per well. The cells in each well were treated with LSR mAb-DM1 or free DM1 at final concentrations of 0, 2, 4, 10, 20, 50, 100, or 200 nM. After a 5-day incubation at 37&#xb0;C and 5% CO<sub>2</sub>, relative viability was tested using the MTT Cell Proliferation Assay Kit. The absorbance at 570 nm was measured using a microplate reader (BioTek, Winooski, VT, USA).</p>
</sec>
<sec id="s2_6">
<title>Flow cytometry analysis</title>
<p>The surface binding of engineered LSR mAb to TNBC MDA-MB-231, MDA-MB-468 and 4T1 cells was tested using flow cytometry as described before (<xref ref-type="bibr" rid="B41">41</xref>&#x2013;<xref ref-type="bibr" rid="B46">46</xref>). Specifically, the anti-LSR mAb was labeled with fluorescent Alexa Fluor&#x2122; 647 kit. Approximately 1&#xd7;10<sup>6</sup> (<xref ref-type="bibr" rid="B6">6</xref>) TNBC cells were stained with 5 &#xb5;g of LSR mAb-AF647 or saline (control) at 37 &#xb0;C for 60 minutes. After washing with PBS three times, the stained cells were analyzed on a BD LSRII flow cytometer (BD Biosciences, San Jose, CA, USA) and data were processed using FlowJo software. The gating was set so that the negative control (i.e. TNBC cells stained with saline) had &lt;0.5% fluorescent population.</p>
</sec>
<sec id="s2_7">
<title>Live-cell confocal microscopy</title>
<p>The internalization of LSR mAb into TNBC cells was assessed using live-cell confocal microscopy. Approximately 10,000 MDA-MB-468 cells were seeded in 35-mm glass-bottom dishes (Cellvis, Mountain View, CA, USA) in 1.5-mL of medium. As described before (<xref ref-type="bibr" rid="B47">47</xref>), the cytoplasm of cells was stained with BacMam GFP Transduction Control, and the nucleus was visualized with NucBlue&#x2122; Live ReadyProbes Reagent following the manufacturer&#x2019;s instructions. The LSR mAb labeled with cyanine-5.5 fluorescent dye (Lumiprobe, Hunt Valley, MD, USA) was added to TNBC cultures at a final concentration of 5 &#xb5;g/mL and incubated for 12 hours. Live-cell images were acquired using an A1R-HD25 confocal microscope (Nikon, Melville, NY, USA).</p>
</sec>
<sec id="s2_8">
<title>
<italic>In vivo</italic> imaging system</title>
<p>The 6-week-old NOD SCID gamma (NSG) female mice (Jackson Lab, Bar Harbor, ME, USA) were subcutaneously (s.c.) injected with 10&#xd7;10<sup>6</sup> MDA-MB-231-FLuc cells to establish TNBC xenograft models. When tumor volumes reached ~100 mm&#xb3;, 80 &#xb5;g of LSR mAb-Cy5.5 was administered intravenously (i.v.) via tail vein. After 24 hours, live-animal imaging was collected at an excitation/emission wavelength of 660/710 nm following intraperitoneal (i.p.) injection of the FLuc substrate luciferin. Mice were then sacrificed to collect major organs, such as brain, heart, lung, spleen, liver and kidneys, for <italic>ex vivo</italic> imaging.</p>
</sec>
<sec id="s2_9">
<title>MDA-MB-231 xenografted models and treatment</title>
<p>A total of 10x10<sup>6</sup> MDA-MB-231-Flux cells were s.c. injected into 6-week-old female NSG mice (Jackson Lab). Once tumor volumes reached ~50 mm<sup>3</sup>, the mice were randomized into three groups (n = 6) and received i.v. administrations of saline (control), 12 mg/kg ADC, or 24 mg/kg ADC every three or four days (i.e. twice each week). Tumor dimensions were measured with a caliper and volumes were calculated using the formula (length x width <sup>2</sup>)/2. IVIS imaging was also performed to monitor tumor growth. Mouse body weight was measured twice per week. At the end of the study, all tumor tissues and major organs, such as brain, heart, lung, kidneys, liver, and spleen, were collected for further post-treatment analysis.</p>
</sec>
<sec id="s2_10">
<title>4T1 xenografted models and treatment</title>
<p>The 6-week-old BALB/cJ female mice were s.c. implanted with 2x10<sup>6</sup> 4T1-Flux cells per mouse. Tumor growth and body weight were monitored twice each week. When the average tumor volume reached ~50 mm<sup>3</sup>, mice were randomized into two groups (n = 4) and i.v. injected with either saline (control) or 24 mg/kg ADC every three or four days (i.e. twice each week). The study concluded when ulcerations reached 2 mm, after which tumors and organs were collected for further analysis.</p>
</sec>
<sec id="s2_11">
<title>Immunohistochemistry staining</title>
<p>A TNBC patient tissue microarray (TMA, Cat# BR1102, TissueArray, Derwood, MD, USA) and normal organ tissue microarray (Cat# FDA662d, TissueArray) were stained with our engineered anti-LSR mAb following a published IHC staining protocol (<xref ref-type="bibr" rid="B47">47</xref>). The stained TMA slides were scanned with a Lionheart FX automated microscope (BioTek, Winooski, VT, USA). LSR expression was quantified with ImageJ and the score was calculated using the formula ((red/blue)<sub>TNBC</sub>/(red/blue)<sub>positive control</sub>)-1)x100. High, medium, and low or no expression levels were defined as scores of &gt;0.5, 0.5 to -0.5 and &lt;-0.5 respectively, using positive control as baseline. Proliferation and apoptosis in the tumor microenvironment after treatment were evaluated using a similar IHC procedure to stain the tissue slides.</p>
</sec>
<sec id="s2_12">
<title>TCGA transcript analysis</title>
<p>The LSR RNA data for breast cancers (TNBC, ER<sup>+</sup>/PR<sup>+</sup>, HER2<sup>+</sup>) and normal breast tissue were obtained from The Cancer Genome Atlas (TCGA) via the UCSC Xena platform (<ext-link ext-link-type="uri" xlink:href="https://xenabrowser.net/datapages/">https://xenabrowser.net/datapages/</ext-link>). The raw expression data, originally in fragments per kilobase of transcript per million mapped reads (FPKM), were converted to transcripts per million (TPM) for normalization. Student&#x2019;s t-test was conducted to assess the differential expression of LSR between various breast cancer subtypes and normal tissue.</p>
</sec>
<sec id="s2_13">
<title>Western blotting</title>
<p>Lysates of TNBC cells were prepared using RIPA buffer and quantified using the Pierce protein assay kit. After separation on a NuPAGE 4-12% gradient SDS-PAGE gel, host cell proteins were transferred onto a PVDF membrane using a power supply (Bio-Rad Laboratories, CA, USA). The PVDF membrane was blocked in 5% non-fat milk in TBST buffer for 1 hour, stained with primary antibodies, i.e. our engineered LSR mAb (2 &#xb5;g/mL) or anti-&#x3b2;-tubulin antibody (1:1000, Abcam), overnight at 4 &#xb0;C, and washed three times with TBST. Following the washes, PVDF membrane was incubated with anti-human IgG-HRP (1:5000) or anti-rabbit IgG-HRP (1:3000) in 5% non-fat milk for 1 hour at room temperature. After color development, the washed PVDF membrane was imaged with Azure 300 imaging system (Azure Biosystems, Dublin, CA, USA).</p>
</sec>
<sec id="s2_14">
<title>Hematoxylin and eosin staining</title>
<p>Paraffin-embedded tumor and organ slides were dewaxed in xylene, rehydrated using a graded ethanol series (100% &#x2192; 50%) and distilled water, and stained with hematoxylin. After dipping in 1% HCl and 70% ethanol, slides were immersed in 1% NH<sub>4</sub>OH for blue color development, followed by a 30-second eosin stain. Finally, the slides were dehydrated in 95% and 100% ethanol and cleared with xylene. Images of the H&amp;E-stained slides were captured using a Lionheart FX Automated Microscope (BioTek, Winooski, VT, USA).</p>
</sec>
<sec id="s2_15">
<title>Statistical analysis</title>
<p>Experimental data were analyzed and presented as mean &#xb1; standard error of the mean (SEM). Within-animal changes were evaluated using paired t-tests. Tumor growth and body weight were compared among groups using a two-way ANOVA followed by <italic>post-hoc</italic> (Dunnett&#x2019;s) analysis. GraphPad Prism was used for statistical analysis, a significance threshold of <italic>P</italic>-value&lt; 0.05 was used for all tests. All adjusted <italic>P</italic>-values were calculated using the Benjamini-Hochberg method to control the FDR.</p>
</sec>
<sec id="s2_16">
<title>Data and materials availability</title>
<p>All data generated during this study are included in the main text of this article. Most materials used in the study, except the developed and engineered LSR mAb, are commercially available. The commercial NSG (NOD.Cg-Prkdc<sup>scid</sup> Il2rg<sup>tm1Wjl</sup>/SzJ) mice and BALB/cJ mice were purchased from Jackson Laboratory.</p>
</sec>
</sec>
<sec id="s3" sec-type="results">
<title>Results</title>
<sec id="s3_1">
<title>LSR expression in TNBCs</title>
<p>To assess LSR protein expression in TNBCs, we performed IHC staining on a patient-derived tumor microarray (TMA, n = 110) using our developed LSR mAb (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1A</bold>
</xref>). Representative IHC images of tissue cores displaying varying LSR expression levels are shown in <xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1B</bold>
</xref>. High LSR expression was observed in 35 patient samples (32.7%), and moderate expression in 32 samples (29.9%), collectively accounting for 62.6% of TNBC cases (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1B</bold>
</xref>). To complement these findings, LSR transcript expression was analyzed using The Cancer Genome Atlas (TCGA) dataset. As depicted in <xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1C</bold>
</xref>, LSR mRNA levels were significantly elevated in TNBC compared to normal breast tissue. These transcriptomic data align with the TMA protein expression results, suggesting LSR as a promising therapeutic target. In addition to TNBC, the ER<sup>+</sup>/PR<sup>+</sup> patients and HER2<sup>+</sup> patients also showed high counts of LSR transcripts. Therefore, targeting LSR could cover and benefit multiple subtypes of breast cancer. LSR expression was further evaluated in TNBC cell lines, including human MDA-MB-231, human MDA-MB-468 and mouse 4T1. Western blot analysis revealed consistently high LSR expression across these three cell lines (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1D</bold>
</xref>), corroborating the TMA protein and TCGA transcript analyses. This study used MDA-MB-231 and 4T1 cell lines for <italic>in vitro</italic> anti-cancer cytotoxicity assays and <italic>in vivo</italic> anti-TNBC efficacy evaluations. Collectively, these results underscore LSR as a promising therapeutic target for TNBC and potentially other breast cancer subtypes.</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>Evaluations of LSR surface receptor in TNBCs. <bold>(A)</bold> IHC staining of TNBC patient tissue microarray (TMA) with our engineered anti-LSR antibody. n = 110. <bold>(B)</bold> Representative images of normal breast and TNBC tissues with low, medium and high levels of LSR expression. <bold>(C)</bold> TCGA transcript analysis of LSR expression of normal breast and breast cancers. <bold>(D)</bold> Western blotting of TNBC cell lines (MDA-MB-231, MDA-MB-468, 4T1) and normal breast epithelial cell (184B5).</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fonc-15-1663743-g001.tif">
<alt-text content-type="machine-generated">Panel A shows a tissue microarray with labeled rows A to J and columns 1 to 11. Panel B presents four microscopy images comparing normal breast tissue with varying LSR expression levels: C9 low, A11 medium, and C2 high. Each image includes a scale bar indicating 20 micrometres. Panel C is a box plot illustrating LSR transcript levels across four categories: Normal, ER+/PR+, HER2+, and TNBC, with statistical significance marked by asterisks. Panel D displays Western blot results for LSR and &#x3b2;-tubulin across different cell lines: 184B5, MDA-MB-468, MDA-MB-231, and 4T1, marked by molecular weight.</alt-text>
</graphic>
</fig>
</sec>
<sec id="s3_2">
<title>Development, engineering and production of anti-LSR mAb</title>
<p>We developed a new mAb to target the extracellular domain (Met1-Asp259) of human LSR (UniProtKB A0A8Z5ABK9). The top hybridoma clone 3C4A7, which had high titer and binding affinity for the extracellular domain of CTYQMTSTPTQPIV, was identified (<xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2A</bold>
</xref>). After sequencing, the top clone was further engineered by fusing its variable region with the Fc region of a human IgG1 (<xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2B</bold>
</xref>). The engineered LSR mAb was produced in fed-batch suspension culture using transient expression system. As shown in <xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2C</bold>
</xref>, 41.6 mg/L of mAb was produced from a 9-day culture with maximum viable cell density (VCD) of 4.9x10<sup>6</sup> cells/mL. Glucose (4 g/L) and GlutaMAX (4 mM) were added to the production culture on Days 3 and 5. Purified mAb was generated from affinity purification using liquid chromatography system (<xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2D</bold>
</xref>).</p>
<fig id="f2" position="float">
<label>Figure&#xa0;2</label>
<caption>
<p>Development, engineering and production of LSR mAb. <bold>(A)</bold> Clone ranking of murine anti-human LSR mAb. <bold>(B)</bold> Engineering of LSR mAb by fusing the variable region of the murine anti-human LSR mAb with the constant region of human IgG. <bold>(C)</bold> Transient production of engineered LSR mAb using HEK293 cells. <bold>(D)</bold> Purification of engineered LSR mAb using protein A column with liquid chromatography.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fonc-15-1663743-g002.tif">
<alt-text content-type="machine-generated">(A) Bar graph showing optical density values for various clones, highlighting Clone 3C4A7. (B) Diagram of murine and chimeric anti-human LSR monoclonal antibodies. (C) Line and bar graph depicting viable cell density (VCD), viability, and monoclonal antibody (mAb) titer over time, with VCD plotted on the left and titer on the right. (D) Chromatogram illustrating the elution profile of LSR mAb with A280 absorbance against column volume.</alt-text>
</graphic>
</fig>
</sec>
<sec id="s3_3">
<title>TNBC targeting and cross-species reactivity of LSR mAb</title>
<p>To evaluate the surface binding of our engineered anti-LSR mAb to TNBC cells, we performed flow cytometry on human TNBC cell lines (MDA-MB-231 and MDA-MB-468) and a murine TNBC cell line (4T1) (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3A</bold>
</xref>). The mAb exhibited high surface binding, with rates of 100% in MDA-MB-468, 95.6% in MDA-MB-231, and 73.3% in 4T1. The extracellular domain (residues 89-259) of human LSR (UniProt: Q86X29), used as the immunogen, shares 91% amino acid sequence similarity with the corresponding extracellular region (residues 1-171) of mouse LSR (UniProt: Q99KG5). This high homology accounts for the cross-species reactivity of our anti-human LSR mAb, though binding to murine TNBC cells was comparatively lower. The ability to target both human and murine LSR supports the use of mouse models for future preclinical studies. Additionally, IHC staining of TNBC patient tissues (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1A</bold>
</xref>) confirmed the specificity of our chimeric anti-LSR mAb for human TNBC.</p>
<fig id="f3" position="float">
<label>Figure&#xa0;3</label>
<caption>
<p>Evaluations of TNBC surface binding, internalization and specificity of anti-LSR mAb. <bold>(A)</bold> Flow cytometry analysis of LSR mAb surface binding to TNBC cells. <bold>(B)</bold> Confocal microscope showing internalization of mAb (Cy5.5, red) in MDA-MB-468 cells (GFP, green). <bold>(C)</bold> IVIS imaging of MDA-MB-231 xenografted NSG mice with administration of LSR mAb-Cy5.5. About 80 &#xb5;g of mAb was injected via tail vein. <bold>(D)</bold> <italic>Ex vivo</italic> imaging with IVIS to validate TNBC specificity.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fonc-15-1663743-g003.tif">
<alt-text content-type="machine-generated">Panel A shows flow cytometry histograms for MDA-MB-468, MDA-MB-231, and 4T1 cell lines. Panel B displays four images: MDA-MB-468 stained cells, DAPI staining, LSR mAb-Cy5.5 staining, and a merged image. Panel C includes images of a mouse showing bioluminescence and fluorescence highlighting MDA-MB-231-FLuc and LSR mAb-Cy5.5. Panel D presents fluorescence images of dissected organs: tumor, heart, liver, spleen, lung, kidneys, and brain. Color scales indicate signal intensity.</alt-text>
</graphic>
</fig>
<p>Next, mAb internalization in TNBC cells was investigated using live-cell confocal microscopy. As presented in <xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3B</bold>
</xref>, the Cy5.5 labelled LSR mAb (displayed as red color) was detected in the cytoplasm of MDA-MB-468 cells expressing GFP (green color) 12 hours after incubation. As previously reported (<xref ref-type="bibr" rid="B33">33</xref>, <xref ref-type="bibr" rid="B40">40</xref>, <xref ref-type="bibr" rid="B47">47</xref>), the mAb is internalized via receptor-mediated endocytosis and trafficked to late endosomes for lysosomal degradation, which releases the conjugated cytotoxic drugs into the cytoplasm, causing cell death (<xref ref-type="bibr" rid="B48">48</xref>).</p>
<p>Finally, the MDA-MB-231-FLuc xenografted mouse models were established to assess the <italic>in vivo</italic> TNBC-specific targeting and biodistribution of the LSR mAb. Live-animal IVIS imaging displayed colocalization of the Cy5.5 fluorescence signal (mAb) with the FLuc bioluminescence signal (TNBC tumor) 24 hours after tail vein injection (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3C</bold>
</xref>). The <italic>ex vivo</italic> IVIS analysis confirmed strong accumulation of LSR mAb (Cy5.5) in the tumor, with no detectable signal in the brain, heart, lung, spleen, liver, and kidneys (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3D</bold>
</xref>). These results demonstrate that our engineered LSR mAb selectively targets TNBC <italic>in vivo</italic> with minimal off-target effects, highlighting its potential to effectively deliver therapeutic payloads for cancer treatment.</p>
</sec>
<sec id="s3_4">
<title>
<italic>In vitro</italic> cytotoxicity of LSR-targeting ADC</title>
<p>The LSR-targeting ADC was constructed by conjugating the LSR mAb with DM1 via sulfo-SMCC linker (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4A</bold>
</xref>). HPLC characterization of ADC confirmed the homogenous conjugation of mAb and chemotherapy with a conversion rate of ~100% (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4B</bold>
</xref>). SDS-PAGE analysis verified the structural integrity of the LSR ADC (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4C</bold>
</xref>). The anti-TNBC cytotoxicity of free DM1 and LSR mAb-DM1 ADC was assessed in human and mouse TNBC cell lines. The mass spectrometry analysis showed that the drug to antibody ratio (DAR) of LSR ADC was 3.91 (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4D</bold>
</xref>). As presented in <xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4E</bold>
</xref>, free DM1 exhibited IC<sub>50</sub> values of 6.6 nM (4T1), 10.7 nM (MDA-MB-231) and 25.5 nM (MDA-MB-468). The IC<sub>50</sub> values for LSR mAb-DM1 ADC were 46.0 nM (4T1), 43.1 nM (MDA-MB-231) and 35.5 nM (MDA-MB-468) (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4F</bold>
</xref>). These cytotoxicity results illustrate that LSR-DM1 ADC can effectively kill TNBC cells <italic>in vitro</italic>. The ADC has lower cytotoxicity to TNBC cells than free drug at low concentrations of 10&#x2013;40 nM, which can be explained by the multi-step (receptor binding, internalization, and drug release) targeted drug delivery process.</p>
<fig id="f4" position="float">
<label>Figure&#xa0;4</label>
<caption>
<p>Construction, characterization and <italic>in vitro</italic> cytotoxicity of LSR ADC. <bold>(A)</bold> Structure of LSR mAb-DM1. <bold>(B)</bold> HPLC analysis to confirm conjugation of mAb and drug. <bold>(C)</bold> SDS-PAGE analysis of ADC integrity. M: Marker; 1: LSR mAb; 2: LSR mAb-DM1. <bold>(D)</bold> DAR (3.91) analysis of ADC using mass spectrometry. <bold>(E)</bold> Cytotoxicity of free DM1 in TNBC 4T1, MDA-MB-231 and MDA-MB-468. n = 3. <bold>(F)</bold> Cytotoxicity of LSR mAb-DM1 in three TNBC cell lines. n = 3.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fonc-15-1663743-g004.tif">
<alt-text content-type="machine-generated">Diagram illustrating antibody-drug conjugate (ADC) synthesis and efficacy. A shows the ADC structure with Sulfo-SMCC linking the antibody to DM1. B is an analysis graph of mAb and ADC by retention time. C shows gel electrophoresis lanes. D has a mass spectrometry chart of ADCs. E and F display dose-response curves for DM1 and ADC on three cell lines, indicating IC50 values.</alt-text>
</graphic>
</fig>
</sec>
<sec id="s3_5">
<title>Anti-TNBC efficacy in MDA-MB-231 xenograft models</title>
<p>The anti-tumor efficacy study was first conducted in human MDA-MB-231-FLuc xenografted NSG mice. As described in <xref ref-type="fig" rid="f5">
<bold>Figure&#xa0;5A</bold>
</xref>, the TNBC tumor volumes reached 612.2 mm<sup>3</sup> (saline), 435.8 mm<sup>3</sup> (12 mg/kg-BW LSR mAb), 212.4 mm<sup>3</sup> (12 mg/kg LSR mAb-DM1 ADC), and 95.7 mm<sup>3</sup> (24 mg/kg ADC) on Day 32. Compared to the saline group, LSR mAb reduced tumor burden by 29%, which could be attributed to the inhibition of lipid uptake or synthesis by the mAb. The ADC at 12 and 24 mg/kg reduced tumor burden by 65% and 85%, respectively, demonstrating dose-dependent tumor growth inhibition. TNBC tumor volume, assessed via FLuc flux at the end of treatment, corroborated that the 24 mg/kg ADC dose effectively suppressed TNBC growth (<xref ref-type="fig" rid="f5">
<bold>Figure&#xa0;5B</bold>
</xref>). The IVIS images, collected before treatment and on Day 31, also confirmed the ADC&#x2019;s inhibitory effect on tumor growth (<xref ref-type="fig" rid="f5">
<bold>Figure&#xa0;5C</bold>
</xref>). H&amp;E staining of paraffin-embedded tumor tissue sections revealed reduction of tumor intensity in ADC treatment groups, with no evident cancer cell death in the saline group (<xref ref-type="fig" rid="f5">
<bold>Figure&#xa0;5D</bold>
</xref>). IHC staining with anti-Ki67 antibody confirmed that ADC treatment significantly inhibited TNBC cell proliferation (<xref ref-type="fig" rid="f5">
<bold>Figure&#xa0;5E</bold>
</xref>).</p>
<fig id="f5" position="float">
<label>Figure&#xa0;5</label>
<caption>
<p>
<italic>In vivo</italic> anti-TNBC efficacy of LSR ADC in MDA-MB-231-FLuc xenograft mouse models. <bold>(A)</bold> Tumor volume profile as indicated by black arrow. n = 6. Data were presented as mean &#xb1; SEM, <italic>n</italic> = 6. *<italic>P</italic>&lt;0.05 <italic>vs</italic>. saline using ANOVA followed by Dunnett&#x2019;s <italic>t</italic>-test. <bold>(B)</bold> Tumor fluorescence flux measured with IVIS. <bold>(C)</bold> IVIS imaging of mice on Days 9 and 31. <bold>(D)</bold> H&amp;E staining of harvested tumors. Scale bar equals 20 &#xb5;m. <bold>(E)</bold> IHC staining of tumor tissues with Ki67 antibody. Scale bar equals 20 &#xb5;m.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fonc-15-1663743-g005.tif">
<alt-text content-type="machine-generated">Panel A shows a line graph of tumor volume over time for various treatments: saline, mAb 12 mg/kg, ADC 12 mg/kg, and ADC 24 mg/kg, with the highest growth in the saline group. Panel B displays a bar graph of tumor fluorescent flux at days 9 and 31, with reduced flux in ADC-treated groups. Panel C contains images of mice showing tumor imaging on days 9 and 31, with reduced tumor visibility in ADC groups. Panel D presents microscopic images of tumor cell histology with less cellular density in ADC 24 mg/kg. Panel E shows Ki67 staining indicating reduced proliferation in ADC 24 mg/kg treatment.</alt-text>
</graphic>
</fig>
</sec>
<sec id="s3_6">
<title>Anti-TNBC efficacy in 4T1 xenograft models</title>
<p>The anti-TNBC efficacy of the LSR mAb-DM1 ADC was validated in immunocompetent BALB/cJ mice bearing 4T1 xenografts. Treatment with 24 mg/kg ADC significantly reduced tumor volume and caused tumor shrinkage (<xref ref-type="fig" rid="f6">
<bold>Figure&#xa0;6A</bold>
</xref>), without affecting mouse body weight, suggesting minimal systemic toxicity (<xref ref-type="fig" rid="f6">
<bold>Figure&#xa0;6B</bold>
</xref>). Live-animal IVIS imaging confirmed the effectiveness of ADC treatment (<xref ref-type="fig" rid="f6">
<bold>Figure&#xa0;6C</bold>
</xref>), as indicated by the undetectable or weak FLuc signal in the treatment group. H&amp;E staining of tumor tissues harvested at the end of the study revealed severe tumor cell death in the treatment group (<xref ref-type="fig" rid="f6">
<bold>Figure&#xa0;6D</bold>
</xref>). The tumor volume slightly increased on Days 18&#x2013;20 in <xref ref-type="fig" rid="f6">
<bold>Figure&#xa0;6A</bold>
</xref>, but the dead cells in H&amp;E staining indicated that this increase could be caused by non-cellular factors (e.g., inflammation, vascular formation, necrosis) instead of tumor growth recurrence. IHC staining of tumor sections showed that the ADC induced apoptosis, as indicated by the upregulation of cleaved caspase 3, and inhibited cancer cell proliferation, as displayed by the downregulation of Ki67 (<xref ref-type="fig" rid="f6">
<bold>Figure&#xa0;6E</bold>
</xref>). Live-cell confocal microscopy demonstrated that anti-LSR mAb reduced lipid uptake (green fluorescence) in MDA-MB-231 cells (<xref ref-type="fig" rid="f6">
<bold>Figure&#xa0;6F</bold>
</xref>), consistent with literature reports that LSR promotes lipid uptake and fatty acid oxidation in gastric cancer (<xref ref-type="bibr" rid="B29">29</xref>, <xref ref-type="bibr" rid="B49">49</xref>).</p>
<fig id="f6" position="float">
<label>Figure&#xa0;6</label>
<caption>
<p>
<italic>In vivo</italic> anti-TNBC efficacy of LSR ADC in 4T1-Fluc xenograft mouse models. <bold>(A)</bold> Tumor volume profiles. Black arrow indicating i.v. injection. n = 4. Data were presented as mean &#xb1; SEM, <italic>n</italic> = 6. *<italic>P</italic>&lt;0.05 <italic>vs</italic>. saline using ANOVA followed by Dunnett&#x2019;s <italic>t</italic>-test. <bold>(B)</bold> Body weight. <bold>(C)</bold> IVIS imaging of mice on Day 17. <bold>(D)</bold> H&amp;E staining of tumor tissue indicating apoptosis and cell death of TNBC in treatment group. Scale bar equals 20 &#xb5;m. <bold>(E)</bold> IHC staining of tumor tissues with Ki67 (cell proliferation inhibition) and CCasp3 (apoptosis) antibodies. Scale bar equals 20 &#xb5;m. <bold>(F)</bold> LSR mAb reduce lipid droplets (green) in MDA-MB-231 cells.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fonc-15-1663743-g006.tif">
<alt-text content-type="machine-generated">Graphs and images compare the effects of Saline and ADC treatments. Chart A shows tumor volume over time, with ADC reducing growth. Chart B shows stable body weight in both treatments. Section C includes thermal images of mice, indicating tumor effects. Section D shows histological samples, contrasting cell conditions. Section E displays immunohistochemistry for CCasp3 and Ki67, highlighting differences in cell activity. Section F shows fluorescence in Saline and LSR mAb treatments, indicating varied cell presence.</alt-text>
</graphic>
</fig>
</sec>
<sec id="s3_7">
<title>Evaluation of toxicity</title>
<p>In animal studies, ADC treatment at 12 and 24 mg/kg did not cause body weight loss (<xref ref-type="fig" rid="f7">
<bold>Figure&#xa0;7A</bold>
</xref>), indicating low systemic toxicity. H&amp;E staining of major organs (heart, brain, lung, liver, kidney, spleen) showed no signs of inflammation, apoptosis, necrosis, or damage in the mAb or ADC groups (<xref ref-type="fig" rid="f7">
<bold>Figure&#xa0;7B</bold>
</xref>). IHC staining of 33 normal human tissues (n = 2) with the engineered LSR mAb revealed no significant off-target binding, as confirmed by whole-slide scanning (<xref ref-type="fig" rid="f7">
<bold>Figure&#xa0;7C</bold>
</xref>). High-resolution images of heart, brain, lung, liver, kidney, and spleen showed no significant mAb binding (<xref ref-type="fig" rid="f7">
<bold>Figure&#xa0;7D</bold>
</xref>). These findings suggest that the LSR mAb selectively targets LSR-overexpressing TNBC cells with minimal off-target effects on normal tissues.</p>
<fig id="f7" position="float">
<label>Figure&#xa0;7</label>
<caption>
<p>Evaluation of off-target and toxicity of LSR ADC. <bold>(A)</bold> Body weight of mice. n = 6. <bold>(B)</bold> H&amp;E staining of major organs (heart, liver, spleen, lung, kidney, and brain). Scale bar equals 20 &#xb5;m. <bold>(C)</bold> IHC staining of 33 human normal organs, including cerebrum, cerebellum, peripheral nerve, adrenal gland, thyroid gland, spleen, thymus, bone marrow, lymph node, tonsil, pancreas, liver, esophagus, stomach, small intestine, colon, lung, salivary, pharynx, kidney, bladder, testis, prostate, penis, ovary, uterine tube, breast, endometrium, cervix, cardiac muscle, skeletal muscle, mesothelium and skin. n = 2. <bold>(D)</bold> Representative IHC images of major organs. Scale bar equals 20 &#xb5;m.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fonc-15-1663743-g007.tif">
<alt-text content-type="machine-generated">Graph A displays body weight over time for different treatments: saline, mAb 12 mg/kg, ADC 12 mg/kg, and ADC 24 mg/kg. Panel B shows histological images of various organs (heart, liver, spleen, lung, kidney, brain) under saline and ADC 24 mg/kg treatments. Panel C displays circular tissue samples. Panel D presents histology of brain, heart, lung, liver, spleen, and kidney tissues, all labeled with 20 micrometer scale bars.</alt-text>
</graphic>
</fig>
</sec>
</sec>
<sec id="s4" sec-type="discussion">
<title>Discussion</title>
<p>The absence of effective cell surface receptors in TNBCs has hindered the development of new targeted therapies. Recently, Trop-2 and CD276 (<xref ref-type="bibr" rid="B47">47</xref>, <xref ref-type="bibr" rid="B50">50</xref>&#x2013;<xref ref-type="bibr" rid="B53">53</xref>) have emerged as promising therapeutic targets for TNBC and other cancers. Trop-2-targeting sacituzumab govitecan (<xref ref-type="bibr" rid="B54">54</xref>&#x2013;<xref ref-type="bibr" rid="B56">56</xref>) and datopotamab deruxtecan (<xref ref-type="bibr" rid="B57">57</xref>&#x2013;<xref ref-type="bibr" rid="B59">59</xref>) have been employed to treat breast and other malignancies, but their clinical efficacy remains limited in recurrent and metastatic settings. Recent clinical trials of GSK5764227 (HS-20093) and Ifinatamab deruxtecan (NCT06203210, NCT04145622) (<xref ref-type="bibr" rid="B50">50</xref>, <xref ref-type="bibr" rid="B60">60</xref>) have evaluated their potential for treating prostate cancer and small cell lung cancer treatment, but trials in TNBC patients has not yet begun. Importantly, the extreme heterogeneity of TNBCs necessitates the exploration of additional surface markers to ensure broader therapeutic coverage. This study identifies LSR as an alternative surface receptor. Our future study will evaluate dual targeting strategies, such as incorporating LSR together with Trop-2 or CD276. The efficacy of LSR-targeted therapy was validated in TNBC mouse models, confirming its therapeutic potential. Beyond TNBC, LSR exhibits high transcript expressions in ER<sup>+</sup>/PR<sup>+</sup> and HER2<sup>+</sup> breast cancer subtypes, suggesting its therapeutic potential across multiple breast cancer types.</p>
<p>The anti-LSR mAb developed in this study shows significant promise as a targeted delivery vehicle for potent payloads. The mAb demonstrated high surface binding to TNBC cells <italic>in vitro</italic> and selective tumor targeting <italic>in vivo</italic>, with minimal off-target effects in normal human and mouse organs, making it an ideal candidate to target TNBC. The engineering and construction of the chimeric LSR mAb further enhance its future clinical value, with the expectation of improved circulation stability. Additionally, the anti-LSR ADC conjugated with a standard cytotoxic microtubule inhibitor DM1 significantly reduced tumor burden in two TNBC xenografted mouse models. No body weight loss or detectable systematic toxicity was observed, suggesting manageable side effects in future clinical applications. Notably, the mAb exhibited minimal binding to 33 normal human organs, with only weak signals in human liver and pancreas tissues, despite reported high physiological LSR expression in hepatocytes (<xref ref-type="bibr" rid="B61">61</xref>, <xref ref-type="bibr" rid="B62">62</xref>). This selectivity may stem from differences in post-translational modifications (PTMs) between tumors and normal cells, which could affect mAb binding efficacy. Further analysis of PTMs and their impact on antibody binding are needed in future study to elucidate the mechanism underlying this cancer-specific targeting. Moreover, the anti-LSR mAb demonstrated modest therapeutic potential as a standalone agent, slightly reducing tumor growth and inhibiting lipid uptake and synthesis.</p>
<p>The LSR-targeted ADC significantly inhibited TNBC tumor growth in two xenograft mouse models. However, while tumor growth was completely suppressed in syngeneic models, 15% residual tumor volume persisted in immunocompromised models. Several factors may contribute to this partial efficacy, including suboptimal dosing, reliance on a single payload (DM1), or relapse of surface receptor expression in some tumor cells. Recent studies suggest LSR suppresses CD8<sup>+</sup> T-cell activity in the tumor microenvironment (<xref ref-type="bibr" rid="B63">63</xref>), which may explain the enhanced efficacy in syngeneic models, where the ADC&#x2019;s cytotoxic effects (via DM1) synergize with LSR mAb-mediated immune activation. Nevertheless, comprehensive mechanistic studies are essential in future research to validate this hypothesis. For example, advanced immunocompetent models, such as patient-derived xenografts, could elucidate these synergistic anti-cancer mechanisms.</p>
<p>To overcome these challenges and enhance TNBC treatment effectiveness, the following strategies could be implemented. First, the optimal dose and treatment schedule of LSR ADC can be identified from pharmacokinetics studies. Second, a dual-payload ADC platform, conjugating synergistic anti-cancer agents (e.g., cytotoxic and immune-enhancing payloads), could improve the anti-cancer efficacy. Dual targeting of receptors like CD276 and LSR may expand patient coverage and mitigate receptor relapse-driven resistance. Additionally, advanced cleavable linkers with high plasma stability and cancer-specific payload release could enhance drug delivery efficiency. Finally, combining LSR ADC with synergistic therapies, such as immunotherapy or gene therapy, could improve tumor clearance and reduce resistance risk.</p>
<p>High LSR expression correlates with poor prognosis in gastric (<xref ref-type="bibr" rid="B49">49</xref>, <xref ref-type="bibr" rid="B64">64</xref>), epithelial ovarian (<xref ref-type="bibr" rid="B65">65</xref>), and endometrial cancers (<xref ref-type="bibr" rid="B66">66</xref>), suggesting the anti-LSR mAb and ADC may have broader applications across multiple cancer types. While LSR&#x2019;s role in cancer remains incompletely understood, our anti-LSR mAb offers a valuable tool to investigate its contributions to tumorigenesis, metabolic reprogramming (<xref ref-type="bibr" rid="B67">67</xref>), and immune regulation (<xref ref-type="bibr" rid="B63">63</xref>, <xref ref-type="bibr" rid="B68">68</xref>) in future studies. Combining LSR-targeted ADC with existing therapeutic regimens could yield synergistic effects.</p>
<p>Moving forward, we aim to develop dual-payload ADCs using our engineered LSR mAb, combining chemotherapy and immunotherapy for enhanced anti-TNBC efficacy, stability, and functionality. Dual-receptor targeting will be explored to broaden treatment coverage. The anti-LSR ADC will also be evaluated in clinically relevant models, such as patient-derived xenografts in humanized mice, non-human primates, or organ-on-chip systems, to generate preclinical data for future clinical trials.</p>
</sec>
</body>
<back>
<sec id="s5" sec-type="data-availability">
<title>Data availability statement</title>
<p>The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.</p>
</sec>
<sec id="s6" sec-type="ethics-statement">
<title>Ethics statement</title>
<p>The animal study was approved by The Ohio State University Institutional Animal Care and Use Committee (IACUC) Committee. The study was conducted in accordance with the local legislation and institutional requirements.</p>
</sec>
<sec id="s7" sec-type="author-contributions">
<title>Author contributions</title>
<p>ZZ: Data curation, Formal Analysis, Methodology, Validation, Writing &#x2013; original draft. DB: Formal Analysis, Methodology, Validation, Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. TV: Formal Analysis, Methodology, Resources, Visualization, Writing &#x2013; review &amp; editing. JZ: Data curation, Methodology, Resources, Writing &#x2013; review &amp; editing. ZD: Methodology, Writing &#x2013; review &amp; editing. AG: Data curation, Writing &#x2013; review &amp; editing. AK: Data curation, Writing &#x2013; review &amp; editing. RY: Data curation, Writing &#x2013; review &amp; editing. LZ: Conceptualization, Formal Analysis, Funding acquisition, Investigation, Resources, Supervision, Visualization, Writing &#x2013; review &amp; editing. XL: Conceptualization, Formal Analysis, Funding acquisition, Investigation, Project administration, Resources, Supervision, Writing &#x2013; review &amp; editing.</p>
</sec>
<sec id="s8" sec-type="funding-information">
<title>Funding</title>
<p>The author(s) declare financial support was received for the research and/or publication of this article. This work is supported by NIH NCI 1R01CA242917-01A1 and 1R01CA281980-01 (XL) and 1R01CA262028-01A1 (XL and LZ).</p>
</sec>
<ack>
<title>Acknowledgments</title>
<p>The authors thank Mass Spectrometry and Proteomics Facility (MSPF), Comparative Pathology and Digital Imaging Shared Resource (CPDISR), Clinical and Translational Science Shared Resource (CTSSR), Genomics Shared Resource (GSR), Small Animal Imaging Shared Resource (SAISR), Flow Cytometry Shared Resource, and Campus Microscopy &amp; Imaging Facility (CMIF) at the Ohio State University.</p>
</ack>
<sec id="s9" sec-type="COI-statement">
<title>Conflict of interest</title>
<p>The 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>
<p>Patents in protection of the engineered anti-LSR monoclonal antibody and ADC conjugation have been filed by The Ohio State University Provisional Patent Serial No. 63/801,350 &#x201c;Methods and Antibody Compositions for The Treatment of Cancer&#x201d;.</p>
</sec>
<sec id="s10" sec-type="ai-statement">
<title>Generative AI statement</title>
<p>The author(s) declare that no Generative AI was used in the creation of this manuscript.</p>
<p>Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.</p>
</sec>
<sec id="s11" sec-type="disclaimer">
<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>
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