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Beta-2 glycoprotein 1 autoantigen-drug conjugate (β2GPI-AADC) is a preclinical-stage precision immunotherapy being developed by Johns Hopkins University and Winnow Therapeutics for the treatment of antiphospholipid syndrome (APS). The therapeutic is designed as an autoantigen-drug conjugate (AADC) consisting of a protein scaffold bivalently conjugated to the APS autoantigen beta-2 glycoprotein 1 (β2GPI domains I-V) and covalently linked to the cytotoxic payload monomethyl auristatin E (MMAE) via a cathepsin-cleavable valine-citrulline linker. β2GPI-AADC selectively binds to and crosslinks anti-β2GPI B-cell receptors (BCRs) on autoreactive B cells, triggering receptor-mediated endocytosis and lysosomal delivery. Intracellular cleavage of the linker releases MMAE, which inhibits tubulin polymerization and selectively eliminates pathogenic autoreactive B cells while sparing protective immunity.
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