Journal article
Protein therapeutics and their lessons: Expect the unexpected when inhibiting the multi-protein cascade of the complement system
Immunological reviews, Vol.313(1), pp.376-401
01/2023
DOI: 10.1111/imr.13164
PMCID: PMC9852015
PMID: 36398537
Abstract
Over a century after the discovery of the complement system, the first complement therapeutic was approved for the treatment of paroxysmal nocturnal hemoglobinuria (PNH). It was a long-acting monoclonal antibody (aka 5G1-1, 5G1.1, h5G1.1, and now known as eculizumab) that targets C5, specifically preventing the generation of C5a, a potent anaphylatoxin, and C5b, the first step in the eventual formation of membrane attack complex. The enormous clinical and financial success of eculizumab across four diseases (PNH, atypical hemolytic uremic syndrome (aHUS), myasthenia gravis (MG), and anti-aquaporin-4 (AQP4) antibody-positive neuromyelitis optica spectrum disorder (NMOSD)) has fueled a surge in complement therapeutics, especially targeting diseases with an underlying complement pathophysiology for which anti-C5 therapy is ineffective. Intensive research has also uncovered challenges that arise from C5 blockade. For example, PNH patients can still face extravascular hemolysis or pharmacodynamic breakthrough of complement suppression during complement-amplifying conditions. These “side” effects of a stoichiometric inhibitor like eculizumab were unexpected and are incompatible with some of our accepted knowledge of the complement cascade. And they are not unique to C5 inhibition. Indeed, “exceptions” to the rules of complement biology abound and have led to unprecedented and surprising insights. In this review, we will describe initial, present and future aspects of protein inhibitors of the complement cascade, highlighting unexpected findings that are redefining some of the mechanistic foundations upon which the complement cascade is organized.
Details
- Title: Subtitle
- Protein therapeutics and their lessons: Expect the unexpected when inhibiting the multi-protein cascade of the complement system
- Creators
- Christoph Q SchmidtRichard J H Smith
- Resource Type
- Journal article
- Publication Details
- Immunological reviews, Vol.313(1), pp.376-401
- DOI
- 10.1111/imr.13164
- PMID
- 36398537
- PMCID
- PMC9852015
- NLM abbreviation
- Immunol Rev
- ISSN
- 0105-2896
- eISSN
- 1600-065X
- Grant note
- DOI: 10.13039/501100001659, name: Deutsche Forschungsgemeinschaft, award: DFG.4372, DFG.5696, DFG.6821; DOI: 10.13039/100000002, name: National Institutes of Health, award: NIDDK R01 110023
- Language
- English
- Electronic publication date
- 11/18/2022
- Date published
- 01/2023
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Molecular Physiology and Biophysics; Anatomy and Cell Biology; Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Otolaryngology; Internal Medicine
- Record Identifier
- 9984320059902771
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