Semin Thromb Hemost 2010; 36(6): 660-668
DOI: 10.1055/s-0030-1262888
© Thieme Medical Publishers

Therapeutic Complement Inhibition: New Developments

Woodruff Emlen1 , Wenhan Li2 , Michael Kirschfink2
  • 1Taligen Therapeutics, Cambridge, Massachusetts
  • 2Institute of Immunology, University of Heidelberg, Germany
Further Information

Publication History

Publication Date:
23 September 2010 (online)

ABSTRACT

Activation of the complement system significantly contributes to the pathogenesis of various acute and chronic inflammatory diseases. Current strategies to inhibit complement include the replacement or substitution of endogenous soluble complement inhibitors (e.g., C1 inhibitor [C1 inh], recombinant soluble complement receptor 1, TP10), the administration of antibodies to block key proteins of the cascade reaction (e.g., C5) or to neutralize the action of the complement-derived anaphylatoxins, or blockade of complement receptors (e.g., C5aR, CD88). The recent approvals of anti-C5 for the treatment of paroxysmal nocturnal hemoglobinuria as well as of C1 inh for the treatment of hereditary angioedema beyond European countries have provided a resurgence of interest in the potential of complement therapeutics for the treatment of disease.

REFERENCES

  • 1 Walport M J. Complement. First of two parts.  N Engl J Med. 2001;  344(14) 1058-1066
  • 2 Walport M J. Complement. Second of two parts.  N Engl J Med. 2001;  344(15) 1140-1144
  • 3 Sjöberg A P, Trouw L A, Blom A M. Complement activation and inhibition: a delicate balance.  Trends Immunol. 2009;  30(2) 83-90
  • 4 Markiewski M M, Lambris J D. The role of complement in inflammatory diseases from behind the scenes into the spotlight.  Am J Pathol. 2007;  171(3) 715-727
  • 5 Holers V M. The spectrum of complement alternative pathway-mediated diseases.  Immunol Rev. 2008;  223 300-316
  • 6 Nussenblatt R B, Liu B, Li Z. Age-related macular degeneration: an immunologically driven disease.  Curr Opin Investig Drugs. 2009;  10(5) 434-442
  • 7 Ricklin D, Lambris J D. Complement-targeted therapeutics.  Nat Biotechnol. 2007;  25(11) 1265-1275
  • 8 Mollnes T E, Kirschfink M. Strategies of therapeutic complement inhibition.  Mol Immunol. 2006;  43(1-2) 107-121
  • 9 Davis III A E. The pathophysiology of hereditary angioedema.  Clin Immunol. 2005;  114(1) 3-9
  • 10 Cugno M, Zanichelli A, Foieni F, Caccia S, Cicardi M. C1-inhibitor deficiency and angioedema: molecular mechanisms and clinical progress.  Trends Mol Med. 2009;  15(2) 69-78
  • 11 Kirschfink M, Mollnes T E. C1-inhibitor: an anti-inflammatory reagent with therapeutic potential.  Expert Opin Pharmacother. 2001;  2(7) 1073-1083
  • 12 Beinrohr L, Dobó J, Závodszky P, Gál P. C1, MBL-MASPs and C1-inhibitor: novel approaches for targeting complement-mediated inflammation.  Trends Mol Med. 2008;  14(12) 511-521
  • 13 Müller-Eberhard H J. Molecular organization and function of the complement system.  Annu Rev Biochem. 1988;  57 321-347
  • 14 Kavanagh D, Richards A, Atkinson J. Complement regulatory genes and hemolytic uremic syndromes.  Annu Rev Med. 2008;  59 293-309
  • 15 Taylor P R, Carugati A, Fadok V A et al. A hierarchical role for classical pathway complement proteins in the clearance of apoptotic cells in vivo.  J Exp Med. 2000;  192(3) 359-366
  • 16 Botto M, Kirschfink M, Macor P, Pickering M C, Würzner R, Tedesco F. Complement in human diseases: lessons from complement deficiencies.  Mol Immunol. 2009;  46(14) 2774-2783
  • 17 Thiel S, Gadjeva M. Humoral pattern recognition molecules: mannan-binding lectin and ficolins.  Adv Exp Med Biol. 2009;  653 58-73
  • 18 Undar A, Fraser Jr C D. Anti-factor D monoclonal antibody, pulsatile flow and cardiotomy suction during cardiopulmonary bypass.  Eur J Cardiothorac Surg. 2002;  22(2) 330-331 discussion 331
  • 19 Taube C, Thurman J M, Takeda K et al. Factor B of the alternative complement pathway regulates development of airway hyperresponsiveness and inflammation.  Proc Natl Acad Sci U S A. 2006;  103(21) 8084-8089
  • 20 Kemper C, Hourcade D E. Properdin: new roles in pattern recognition and target clearance.  Mol Immunol. 2008;  45(16) 4048-4056
  • 21 Hourcade D E. Properdin and complement activation: a fresh perspective.  Curr Drug Targets. 2008;  9(2) 158-164
  • 22 Gupta-Bansal R, Parent J B, Brunden K R. Inhibition of complement alternative pathway function with anti-properdin monoclonal antibodies.  Mol Immunol. 2000;  37(5) 191-201
  • 23 Ricklin D, Lambris J D. Compstatin: a complement inhibitor on its way to clinical application.  Adv Exp Med Biol. 2008;  632 273-292
  • 24 Sahu A, Morikis D, Lambris J D. Compstatin, a peptide inhibitor of complement, exhibits species-specific binding to complement component C3.  Mol Immunol. 2003;  39(10) 557-566
  • 25 Nilsson B, Larsson R, Hong J et al. Compstatin inhibits complement and cellular activation in whole blood in two models of extracorporeal circulation.  Blood. 1998;  92(5) 1661-1667
  • 26 Lazar H L, Keilani T, Fitzgerald C A TP10 Cardiac Surgery Study Group et al. Beneficial effects of complement inhibition with soluble complement receptor 1 (TP10) during cardiac surgery: is there a gender difference?.  Circulation. 2007;  116(11, Suppl) I83-I88
  • 27 Hillmen P, Muus P, Dührsen U et al. Effect of the complement inhibitor eculizumab on thromboembolism in patients with paroxysmal nocturnal hemoglobinuria.  Blood. 2007;  110(12) 4123-4128
  • 28 Dubois E A, Cohen A F. Eculizumab.  Br J Clin Pharmacol. 2009;  68(3) 318-319
  • 29 Lappegård K T, Christiansen D, Pharo A et al. Human genetic deficiencies reveal the roles of complement in the inflammatory network: lessons from nature.  Proc Natl Acad Sci U S A. 2009;  106(37) 15861-15866
  • 30 Risitano A M, Notaro R, Marando L et al. Complement fraction 3 binding on erythrocytes as additional mechanism of disease in paroxysmal nocturnal hemoglobinuria patients treated by eculizumab.  Blood. 2009;  113(17) 4094-4100
  • 31 Patel S. Combination therapy for age-related macular degeneration.  Retina. 2009;  29(6, Suppl) S45-S48
  • 32 Monk P N, Scola A M, Madala P, Fairlie D P. Function, structure and therapeutic potential of complement C5a receptors.  Br J Pharmacol. 2007;  152(4) 429-448
  • 33 Wills-Karp M. Complement activation pathways: a bridge between innate and adaptive immune responses in asthma.  Proc Natl Acad Sci U S A. 2007;  4(3) 247-251
  • 34 Sheerin N S, Risley P, Abe K et al. Synthesis of complement protein C3 in the kidney is an important mediator of local tissue injury.  FASEB J. 2008;  22(4) 1065-1072
  • 35 Smith R A. Targeting anticomplement agents.  Biochem Soc Trans. 2002;  30(Pt 6) 1037-1041
  • 36 Souza D G, Esser D, Bradford R, Vieira A T, Teixeira M M. APT070 (Mirococept), a membrane-localised complement inhibitor, inhibits inflammatory responses that follow intestinal ischaemia and reperfusion injury.  Br J Pharmacol. 2005;  145(8) 1027-1034
  • 37 Banz Y, Hess O M, Robson S C et al. Attenuation of myocardial reperfusion injury in pigs by Mirococept, a membrane-targeted complement inhibitor derived from human CR1.  Cardiovasc Res. 2007;  76(3) 482-493
  • 38 Szakonyi G, Guthridge J M, Li D, Young K, Holers V M, Chen X S. Structure of complement receptor 2 in complex with its C3d ligand.  Science. 2001;  292(5522) 1725-1728
  • 39 Huang Y, Qiao F, Atkinson C, Holers V M, Tomlinson S. A novel targeted inhibitor of the alternative pathway of complement and its therapeutic application in ischemia/reperfusion injury.  J Immunol. 2008;  181(11) 8068-8076
  • 40 Atkinson C, Qiao F, Song H, Gilkeson G S, Tomlinson S. Low-dose targeted complement inhibition protects against renal disease and other manifestations of autoimmune disease in MRL/lpr mice.  J Immunol. 2008;  180(2) 1231-1238
  • 41 Song H, Qiao F, Atkinson C, Holers V M, Tomlinson S. A complement C3 inhibitor specifically targeted to sites of complement activation effectively ameliorates collagen-induced arthritis in DBA/1J mice.  J Immunol. 2007;  179(11) 7860-7867
  • 42 Rohrer B, Long Q, Coughlin B et al. A targeted inhibitor of the alternative complement pathway reduces angiogenesis in a mouse model of age-related macular degeneration.  Invest Ophthalmol Vis Sci. 2009;  50(7) 3056-3064
  • 43 Qiao F, Atkinson C, Song H, Pannu R, Singh I, Tomlinson S. Complement plays an important role in spinal cord injury and represents a therapeutic target for improving recovery following trauma.  Am J Pathol. 2006;  169(3) 1039-1047
  • 44 Atkinson C, Song H, Lu B et al. Targeted complement inhibition by C3d recognition ameliorates tissue injury without apparent increase in susceptibility to infection.  J Clin Invest. 2005;  115(9) 2444-2453
  • 45 Seelen M A, Roos A, Wieslander J et al. Functional analysis of the classical, alternative, and MBL pathways of the complement system: standardization and validation of a simple ELISA.  J Immunol Methods. 2005;  296(1–2) 187-198
  • 46 Banda N K, Levitt B, Glogowska M J et al. Targeted inhibition of the complement alternative pathway with complement receptor 2 and factor H attenuates collagen antibody-induced arthritis in mice.  J Immunol. 2009;  183(9) 5928-5937

Michael KirschfinkD.V.M. Ph.D. 

Institute of Immunology, University of Heidelberg

Im Neuenheimer Feld 305, 69120 Heidelberg, Germany

Email: kirschfink@uni-hd.de

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