ArticleCancer science2026
Pathophysiological and Molecular Features of DXd ADC-Related Interstitial Pneumonitis in Cynomolgus Monkeys.
Article in Cancer science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Interstitial lung disease (ILD) is an important adverse event related to deruxtecan-based antibody-drug conjugates (DXd ADCs). Understanding mechanisms and translationally relevant preclinical models remain incompletely defined. Here, we established a reproducible cynomolgus monkey model of DXd ADC-related ILD and performed the first integration of bronchoalveolar lavage fluid (BALF) extracellular vesicle (EV) proteomics with lung single-cell RNA sequencing (scRNA-seq). Weekly intravenous administration of a target-nonbinding human IgG1 DXd ADC to cynomolgus monkeys for 12 weeks consistently induced interstitial pneumonitis in all animals, with radiologic abnormalities emerging by Week 6 and progressing thereafter. Longitudinal SomaScan-based proteomic analyses revealed a pronounced and selective increase in differentially expressed proteins (DEPs) in BALF-derived EVs from Week 6 onward, exceeding changes observed in plasma or bulk BALF. Gene Ontology analysis showed enrichment of inflammatory, wound repair/regeneration, and extracellular matrix remodeling pathways within the BALF EV compartment. Integration of BALF EV proteomics with lung scRNA-seq demonstrated strong concordance between EV-associated signatures and transcriptional programs in alveolar epithelial, mesenchymal, and immune cell populations. Core injury-associated genes, including FN1, TIMP1, and COL3A1, were broadly upregulated across cell types, along with cell-type-restricted signatures including AT1 cells (BMP4, HMOX2), AT2 cells (CXCL2, SIRPA), fibroblasts (TNC, IGF1), endothelial cells (LCP1, CXCL12), neutrophils (ADAM17), and macrophages (CD84, HAVCR2, CXCL10). Together, this study defines a robust cynomolgus monkey model of DXd ADC-related ILD and identifies BALF EVs as a sensitive, lung-localized molecular readout and a promising translational source of mechanistic insights.
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