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Lee S, Kim Y, Kim YS, Zhang H, Noh M, Kwon YG. CU06-1004 alleviates vascular hyperpermeability in a murine model of hereditary angioedema by protecting the endothelium. Allergy 2023; 78:1333-1346. [PMID: 36789476 DOI: 10.1111/all.15674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/09/2023] [Accepted: 01/22/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Over-release of the vasoactive peptide bradykinin (BK) due to mutation in the SERPING1 gene is the leading cause of hereditary angioedema (HAE). BK directly activates endothelial cells and increases vascular permeability by disrupting the endothelial barrier, leading to angioedema affecting face, lips, extremities, gastrointestinal tract, and larynx. Although various pharmacological treatment options for HAE became available during the last decade, they are presently limited and pose a major economic burden on patients. To identify additional therapeutic options for HAE, we evaluated the effect of CU06-1004, an endothelial dysfunction blocker, on BK-induced vascular hyperpermeability and the HAE murine model. METHODS To investigate the effect of CU06-1004 on BK-induced vascular hyperpermeability in vivo, we pre-administrated WT mice with the drug and then induced vascular leakage through intravenous injection of BK and observed vascular alternation. Then, SERPING1 deficient mice were used for a HAE murine model. For an in vitro model, the HUVEC monolayer was pre-treated with CU06-1004 and then stimulated with BK. RESULTS Bradykinin disrupted the endothelial barrier and formed interendothelial cell gaps, leading to hyperpermeability in vivo and in vitro. However, CU06-1004 treatment protected the endothelial barrier by suppressing Src and myosin light chain activation via BK and alleviated hyperpermeability. CONCLUSION Our study shows that CU06-1004 oral administration significantly reduced vascular hyperpermeability in the HAE murine model by protecting the endothelial barrier function against BK stimulation. Therefore, protecting endothelium against BK with CU06-1004 could serve as a potential prophylactic/therapeutic approach for HAE patients.
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Affiliation(s)
- Sunghye Lee
- Department of Biochemistry, College of Life Science and Biotechnology, Yonsei University, Seoul, Korea
| | - Yeomyeong Kim
- Department of Biochemistry, College of Life Science and Biotechnology, Yonsei University, Seoul, Korea
| | - Ye-Seul Kim
- Department of Biochemistry, College of Life Science and Biotechnology, Yonsei University, Seoul, Korea
| | | | - Minyoung Noh
- Department of Biochemistry, College of Life Science and Biotechnology, Yonsei University, Seoul, Korea
| | - Young-Guen Kwon
- Department of Biochemistry, College of Life Science and Biotechnology, Yonsei University, Seoul, Korea
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Luo S, Chen Y, Yang L, Gong X, Wu Z. The complement system in retinal detachment with choroidal detachment. Curr Eye Res 2022; 47:809-812. [PMID: 35176953 DOI: 10.1080/02713683.2022.2038634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE This study aims to explore the differences in the levels of complement components and complement regulatory factors in the vitreous humor of patients with retinal detachment with choroidal detachment (RRDCD), patients with rhegmatogenous retinal detachment (RRD). METHODS A prospective case-control study design was used to recruit 20 patients with RRDCD and 20 patients with RRD in consecutive cases who underwent pars plana vitrectomy from March 2019 to January 2020. The control group comprised 15 patients with epiretinal membrane and 5 eyes from cadavers. The concentrations of complement C2, complement C4b, complement C5/C5a, complement C9, complement factor D (CFD), lectin, and complement factor I (CFI) were measured using Multiplex Luminex Assay, and the concentration of soluble decay acceleration factor (sDAF) was measured using ELISA. RESULTS As compared with the RRD and control groups, complement C2, complement C4b, complement C5/C5a, complement C9, CFD, lectin, CFI, and sDAF were significantly increased in the RRDCD group. Additionally, as compared with the control group, the concentrations of complement component C2 and CFD were significantly increased in the vitreous humor of the RRD group. CONCLUSION Components of all three complement pathways were elevated in eyes with RRDCD. Interestingly, while there was evidence of early complement activation in RRD, the final common pathway components were not elevated. In contrast, RRDCD eyes showed significant elevations of the MAC complex components, underscoring a potential pathophysiologic impact of complement activation in this condition.
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Affiliation(s)
- Shasha Luo
- Department of Ophthalmology, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi, Jiangsu Province, People's Republic of China.,Department of Ophthalmology, Affiliated Wuxi Clinical College of Nantong University, Wuxi, Jiangsu Province, People's Republic of China
| | - Yanghao Chen
- Department of Ophthalmology, Anqing No.2 People's Hospital, Anqing, Anhui Province, People's Republic of China
| | - Lufei Yang
- Department of Ophthalmology, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi, Jiangsu Province, People's Republic of China
| | - Xuechun Gong
- Department of Ophthalmology, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi, Jiangsu Province, People's Republic of China
| | - Zhifeng Wu
- Department of Ophthalmology, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi, Jiangsu Province, People's Republic of China.,Department of Ophthalmology, Affiliated Wuxi Clinical College of Nantong University, Wuxi, Jiangsu Province, People's Republic of China
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Cui Q, Xu Q, Yang Y, Li W, Huang N, Chen H, Ma D, Zhang S, Yang L, Zhu R. The prevalence of hereditary angioedema in a Chinese cohort with decreased complement 4 levels. World Allergy Organ J 2022; 15:100620. [PMID: 34992711 PMCID: PMC8693024 DOI: 10.1016/j.waojou.2021.100620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 11/21/2022] Open
Abstract
Objective Hereditary angioedema (HAE) is a rare, life-threatening autosomal dominant disorder. We aimed to investigate the prevalence of HAE in a Chinese population with a decreased Complement 4 (C4) level. Methods All the patients present in Tongji Hospital with C4 below lower normal range were included from January 2019 to June 2020. The individual data were extracted from the database and categorized by diagnosis. Patients suspected of HAE were further evaluated by C1 inhibitor level and function test to confirm the HAE diagnosis. Results A total of 8226 patients were enrolled in our study, among whom 18 had symptoms similar to HAE and received C1 inhibitor level and function tests. Two (1 male and 1 female) of the 18 patients were identified as HAE patients. This means the prevalence of HAE was 2.43/10 000 among the C4-decreased population and 10.1/10 000 in the C4-decreased population with etiology undetermined. The 2 HAE patients had experienced skin and oropharynx edema attack and received tracheotomy. The female patient had a family history. Laboratory tests showed significant decrease of C4 and C1 inhibitor levels in the 2 patients, both of whom were diagnosed as type 1 HAE. Conclusion The prevalence of HAE is low in C4-decreased patients. In a large cohort, C4 level can serve as a practical indicator to screen the HAE patients, but further testing of C1 inhibitor activity and levels is needed to confirm the diagnosis of HAE.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Rongfei Zhu
- Corresponding author. Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Yu Y, Liu A, Dhawan G, Mei H, Zhang W, Izawa K, Soloshonok VA, Han J. Fluorine-containing pharmaceuticals approved by the FDA in 2020: Synthesis and biological activity. CHINESE CHEM LETT 2021. [DOI: 10.1016/j.cclet.2021.05.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Rex DAB, Arun Kumar ST, Modi PK, Keshava Prasad TS. Broadening COVID-19 Interventions to Drug Innovation: Neprilysin Pathway as a Friend, Foe, or Promising Molecular Target? OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2021; 25:408-416. [PMID: 34191617 DOI: 10.1089/omi.2021.0080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is anticipated to transition to an endemic state as vaccines are providing relief in some, but not all, countries. Drug discovery for COVID-19 can offer another tool in the fight against the pandemic. Additionally, COVID-19 impacts multiple organs that call for a systems medicine approach to planetary health and therapeutics innovation. In this context, innovation for drugs that prevent and treat COVID-19 is timely and much needed. As the virus variants emerge under different ecological conditions and contexts in the long haul, a broad array of vaccine and drug options will be necessary. This expert review article argues for a need to expand the COVID-19 interventions, including and beyond vaccines, to stimulate discovery and development of novel medicines against SARS-CoV-2 infection. The Renin-Angiotensin-Aldosterone System (RAAS) is known to play a major role in SARS-CoV-2 infection. Neprilysin (NEP) and angiotensin-converting enzyme (ACE) have emerged as the pharmaceutical targets of interest in the search for therapeutic interventions against COVID-19. While the NEP/ACE inhibitors offer promise for repurposing against COVID-19, they may display a multitude of effects in different organ systems, some beneficial, and others adverse, in modulating the inflammation responses in the course of COVID-19. This expert review offers an analysis and discussion to deepen our present understanding of the pathophysiological function of neprilysin in multiple organs, and the possible effects of NEP inhibitor-induced inflammatory responses in COVID-19-infected patients.
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Affiliation(s)
- Devasahayam Arokia Balaya Rex
- Center for Systems Biology and Molecular Medicine, Yenepoya Research Center, Yenepoya (Deemed to be University), Mangalore, India
| | - Sumaithangi Thattai Arun Kumar
- Center for Systems Biology and Molecular Medicine, Yenepoya Research Center, Yenepoya (Deemed to be University), Mangalore, India
| | - Prashant Kumar Modi
- Center for Systems Biology and Molecular Medicine, Yenepoya Research Center, Yenepoya (Deemed to be University), Mangalore, India
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Tanaka H, Tanaka K, Enomoto N, Takakura S, Magawa S, Maki S, Nii M, Toriyabe K, Katsuragi S, Ikeda T. Reference range for C1-esterase inhibitor (C1 INH) in the third trimester of pregnancy. J Perinat Med 2021; 49:166-169. [PMID: 32887189 DOI: 10.1515/jpm-2020-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 08/21/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objectives of this study were to (i) establish the reference range and mean value for normal levels of C1-esterase inhibitor (C1 INH) during pregnancy, and (ii) investigate the association between C1 INH and uterine atony, as measured by blood loss at delivery. METHODS We prospectively studied 200 healthy pregnant women who were registered. We studied C1 INH levels in 188 women at 34 and 35 gestational weeks of pregnancy. The reference range for C1 INH during the third trimester of pregnancy was calculated using the value of C1 INH that was determined at registration. RESULTS The mean value of C1 INH was determined to be 70.3% (95% confidence interval, 68.7-71.9). While the C1 INH levels in four women were determined to be 40% lower than the calculated mean value, amniotic fluid embolism (AFE) did not occur in any of the women studied. CONCLUSIONS This study successfully demonstrated that a reference value for C1 INH activity can be established using the methods described herein. Further research is needed to determine whether C1 INH is involved in obstetric coagulopathy syndrome such as amniotic fluid embolism.
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Affiliation(s)
- Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
| | - Kayo Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
| | - Naosuke Enomoto
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
| | - Sho Takakura
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
| | - Shoichi Magawa
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
| | - Shintaro Maki
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
| | - Kuniaki Toriyabe
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
| | - Shinji Katsuragi
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
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Hassan K. Urticaria and angioedema as a prodromal cutaneous manifestation of SARS-CoV-2 (COVID-19) infection. BMJ Case Rep 2020; 13:e236981. [PMID: 32641443 PMCID: PMC7342472 DOI: 10.1136/bcr-2020-236981] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2020] [Indexed: 12/17/2022] Open
Abstract
This is a case of a patient who presented with an urticarial rash 48 hours before developing symptoms of fever and a continuous cough. She subsequently developed angioedema of her lips and hands before testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Urticarial rashes occurring 48 hours before other symptoms of COVID-19 infection have been documented. This case demonstrates the importance of heightened awareness that not all urticarial rashes represent spontaneous urticaria and as a consequence, this may result in misdiagnosis and ultimately delayed diagnosis. This is the first reported case in the literature of urticaria with angioedema as a prodromal phenomenon of COVID-19.
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Affiliation(s)
- Khalid Hassan
- Loch Lomond Surgery, 75 Bank Street, Alexandria, Scotland
- Department of Dermatology, Vale of Leven Hospital, Alexandria, Scotland
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Lepelley M, Bernardeau C, Defendi F, Crochet J, Mallaret M, Bouillet L. Update on bradykinin-mediated angioedema in 2020. Therapie 2020; 75:195-205. [DOI: 10.1016/j.therap.2020.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/15/2019] [Indexed: 12/11/2022]
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9
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Karadža-Lapić L, Barešić M, Vrsalović R, Ivković-Jureković I, Sršen S, Prkačin I, Rijavec M, Cikojević D. HEREDITARY ANGIOEDEMA DUE TO C1-INHIBITOR DEFICIENCY IN PEDIATRIC PATIENTS IN CROATIA - FIRST NATIONAL STUDY, DIAGNOSTIC AND PROPHYLACTIC CHALLENGES. Acta Clin Croat 2019; 58:139-146. [PMID: 31363336 PMCID: PMC6629194 DOI: 10.20471/acc.2019.58.01.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Hereditary angioedema (HAE) is a rare autosomal dominant disease with deficiency (type I) or dysfunction (type II) of C1 inhibitor, caused by mutations in the C1-INH gene, characterized by recurrent submucosal or subcutaneous edemas including skin swelling, abdominal pain and life-threatening episodes of upper airway obstruction. The aim of this study was to investigate healthcare experiences in children with HAE due to C1 inhibitor deficiency (C1-INH-HAE) in Croatia in order to estimate the number of affected children and to recommend management protocols for diagnosis, short-term prophylaxis and acute treatment. Patients were recruited during a 4-year period at five hospitals in Croatia. Complement testing was performed in patients with a positive family history. This pilot study revealed nine pediatric patients positive for C1-INH- HAE type I, aged 1-16 years, four of them asymptomatic. Before the age of one year, C1-INH levels may be lower than in adults; it is advisable to confirm C1-INH-HAE after the age of one year. Plasma-derived C1-INH is recommended as acute and short-term prophylactic treatment. Recombinant C1-INH and icatibant are licensed for the acute treatment of pediatric patients. In Croatia, HAE is still underdiagnosed in pediatric population.
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Affiliation(s)
| | - Marko Barešić
- 1Department of Otorhinolaryngology, Šibenik General Hospital, Šibenik, Croatia; 2Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4Zagreb Children's Hospital, Zagreb, Croatia; Pediatric Department, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Pediatrics, Split University Hospital Centre, Split, Croatia; 6Department of Internal Medicine, School of Medicine, University of Zagreb, Merkur University Hospital, Zagreb, Croatia; 7Golnik University Clinic of Pulmonary and Allergic Diseases, Golnik, Slovenia; 8Department of Otorhinolaryngology, Split University Hospital Centre, Split, Croatia
| | - Renata Vrsalović
- 1Department of Otorhinolaryngology, Šibenik General Hospital, Šibenik, Croatia; 2Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4Zagreb Children's Hospital, Zagreb, Croatia; Pediatric Department, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Pediatrics, Split University Hospital Centre, Split, Croatia; 6Department of Internal Medicine, School of Medicine, University of Zagreb, Merkur University Hospital, Zagreb, Croatia; 7Golnik University Clinic of Pulmonary and Allergic Diseases, Golnik, Slovenia; 8Department of Otorhinolaryngology, Split University Hospital Centre, Split, Croatia
| | - Irena Ivković-Jureković
- 1Department of Otorhinolaryngology, Šibenik General Hospital, Šibenik, Croatia; 2Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4Zagreb Children's Hospital, Zagreb, Croatia; Pediatric Department, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Pediatrics, Split University Hospital Centre, Split, Croatia; 6Department of Internal Medicine, School of Medicine, University of Zagreb, Merkur University Hospital, Zagreb, Croatia; 7Golnik University Clinic of Pulmonary and Allergic Diseases, Golnik, Slovenia; 8Department of Otorhinolaryngology, Split University Hospital Centre, Split, Croatia
| | - Saša Sršen
- 1Department of Otorhinolaryngology, Šibenik General Hospital, Šibenik, Croatia; 2Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4Zagreb Children's Hospital, Zagreb, Croatia; Pediatric Department, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Pediatrics, Split University Hospital Centre, Split, Croatia; 6Department of Internal Medicine, School of Medicine, University of Zagreb, Merkur University Hospital, Zagreb, Croatia; 7Golnik University Clinic of Pulmonary and Allergic Diseases, Golnik, Slovenia; 8Department of Otorhinolaryngology, Split University Hospital Centre, Split, Croatia
| | - Ingrid Prkačin
- 1Department of Otorhinolaryngology, Šibenik General Hospital, Šibenik, Croatia; 2Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4Zagreb Children's Hospital, Zagreb, Croatia; Pediatric Department, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Pediatrics, Split University Hospital Centre, Split, Croatia; 6Department of Internal Medicine, School of Medicine, University of Zagreb, Merkur University Hospital, Zagreb, Croatia; 7Golnik University Clinic of Pulmonary and Allergic Diseases, Golnik, Slovenia; 8Department of Otorhinolaryngology, Split University Hospital Centre, Split, Croatia
| | - Matija Rijavec
- 1Department of Otorhinolaryngology, Šibenik General Hospital, Šibenik, Croatia; 2Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4Zagreb Children's Hospital, Zagreb, Croatia; Pediatric Department, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Pediatrics, Split University Hospital Centre, Split, Croatia; 6Department of Internal Medicine, School of Medicine, University of Zagreb, Merkur University Hospital, Zagreb, Croatia; 7Golnik University Clinic of Pulmonary and Allergic Diseases, Golnik, Slovenia; 8Department of Otorhinolaryngology, Split University Hospital Centre, Split, Croatia
| | - Draško Cikojević
- 1Department of Otorhinolaryngology, Šibenik General Hospital, Šibenik, Croatia; 2Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4Zagreb Children's Hospital, Zagreb, Croatia; Pediatric Department, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Pediatrics, Split University Hospital Centre, Split, Croatia; 6Department of Internal Medicine, School of Medicine, University of Zagreb, Merkur University Hospital, Zagreb, Croatia; 7Golnik University Clinic of Pulmonary and Allergic Diseases, Golnik, Slovenia; 8Department of Otorhinolaryngology, Split University Hospital Centre, Split, Croatia
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De Maat S, Hofman ZLM, Maas C. Hereditary angioedema: the plasma contact system out of control: reply. J Thromb Haemost 2018; 16:2349-2351. [PMID: 30129108 DOI: 10.1111/jth.14269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- S De Maat
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Z L M Hofman
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - C Maas
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Castellano G, Divella C, Sallustio F, Montinaro V, Curci C, Zanichelli A, Bonanni E, Suffritti C, Caccia S, Bossi F, Gallone A, Schena FP, Gesualdo L, Cicardi M. A transcriptomics study of hereditary angioedema attacks. J Allergy Clin Immunol 2018; 142:883-891. [DOI: 10.1016/j.jaci.2018.03.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 02/20/2018] [Accepted: 03/28/2018] [Indexed: 01/21/2023]
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CRYSTAL RONALDG, PAGOVICH ODELYAE. THE JEREMIAH METZGER LECTURE NOVEL THERAPEUTIC STRATEGIES OF ALLERGIC AND IMMUNOLOGIC DISORDERS. TRANSACTIONS OF THE AMERICAN CLINICAL AND CLIMATOLOGICAL ASSOCIATION 2018; 129:250-265. [PMID: 30166721 PMCID: PMC6116601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Advances in understanding the immunological basis and mechanisms underlying allergic and immunologic disorders have led to effective but costly long-term and repetitive biologic therapies. Gene therapy is a rapidly advancing technology, in which a single administration of an adeno-associated virus encoding the therapeutic protein or monoclonal antibody may provide effective long-term therapy for allergic and immunologic disorders. In this review, we summarize the recent studies from our laboratory developing gene therapy strategies to treat hereditary angioedema and peanut allergy. The unraveling of the pathogenesis of immune-based disorders, including hereditary deficiencies of components of the immune system and allergic disorders, has led to the development of therapies using parenteral administration of recombinant proteins or monoclonal antibodies (1). While many of these therapies are highly effective, they are limited by the half-life of the therapeutic protein or antibody, requiring repetitive administration of days to weeks (2-15). The focus of recent work in our laboratory has been to solve this problem by substituting protein/monoclonal antibody administration with gene therapy, where current technology allows for a single administration of the gene coding for a protein or antibody to provide persistent expression of effective levels of the therapeutic protein or antibody. Gene therapy is a drug delivery platform which uses genetic material, usually in the form of coding exons of the therapeutic gene, to correct, compensate for, or prevent the development of an abnormal phenotype (16). Originally conceptualized as a strategy to treat rare hereditary disorders, gene therapy is being developed for a wide range of human disorders, including common acquired conditions (17-20). In this review, we will describe how we have adopted gene therapy technology to develop therapies for immune-related disorders, using as examples hereditary angioedema, an inherited autosomal dominant disorder, and peanut allergy, a common acquired allergic disorder.
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Li Z, Partridge J, Silva-Garcia A, Rademacher P, Betz A, Xu Q, Sham H, Hu Y, Shan Y, Liu B, Zhang Y, Shi H, Xu Q, Ma X, Zhang L. Structure-Guided Design of Novel, Potent, and Selective Macrocyclic Plasma Kallikrein Inhibitors. ACS Med Chem Lett 2017; 8:185-190. [PMID: 28197309 DOI: 10.1021/acsmedchemlett.6b00384] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 12/06/2016] [Indexed: 11/28/2022] Open
Abstract
A series of macrocyclic analogues were designed and synthesized based on the cocrystal structure of small molecule plasma kallikrein (pKal) inhibitor, 2, with the pKal protease domain. This led to the discovery of a potent macrocyclic pKal inhibitor 29, with an IC50 of 2 nM for one olefinic isomer and 42.3 nM for the other olefinic isomer.
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Affiliation(s)
- Zhe Li
- Global Blood Therapeutics, South San Francisco, California 94080, United States
| | - James Partridge
- Global Blood Therapeutics, South San Francisco, California 94080, United States
| | - Abel Silva-Garcia
- Global Blood Therapeutics, South San Francisco, California 94080, United States
| | - Peter Rademacher
- Global Blood Therapeutics, South San Francisco, California 94080, United States
| | - Andreas Betz
- Global Blood Therapeutics, South San Francisco, California 94080, United States
| | - Qing Xu
- Global Blood Therapeutics, South San Francisco, California 94080, United States
| | - Hing Sham
- Global Blood Therapeutics, South San Francisco, California 94080, United States
| | - Yunjin Hu
- Pharmaron Xi’an Co., Xi’an, Shaanxi 710018, China
| | - Yuqing Shan
- Pharmaron Xi’an Co., Xi’an, Shaanxi 710018, China
| | - Bin Liu
- Pharmaron Xi’an Co., Xi’an, Shaanxi 710018, China
| | - Ying Zhang
- Pharmaron Xi’an Co., Xi’an, Shaanxi 710018, China
| | - Haijuan Shi
- Pharmaron Xi’an Co., Xi’an, Shaanxi 710018, China
| | - Qiong Xu
- Pharmaron Xi’an Co., Xi’an, Shaanxi 710018, China
| | - Xubo Ma
- Pharmaron Xi’an Co., Xi’an, Shaanxi 710018, China
| | - Li Zhang
- Pharmaron Xi’an Co., Xi’an, Shaanxi 710018, China
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Farkas H, Martinez-Saguer I, Bork K, Bowen T, Craig T, Frank M, Germenis AE, Grumach AS, Luczay A, Varga L, Zanichelli A. International consensus on the diagnosis and management of pediatric patients with hereditary angioedema with C1 inhibitor deficiency. Allergy 2017; 72:300-313. [PMID: 27503784 PMCID: PMC5248622 DOI: 10.1111/all.13001] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2016] [Indexed: 01/01/2023]
Abstract
Background The consensus documents published to date on hereditary angioedema with C1 inhibitor deficiency (C1‐INH‐HAE) have focused on adult patients. Many of the previous recommendations have not been adapted to pediatric patients. We intended to produce consensus recommendations for the diagnosis and management of pediatric patients with C1‐INH‐HAE. Methods During an expert panel meeting that took place during the 9th C1 Inhibitor Deficiency Workshop in Budapest, 2015 (www.haenet.hu), pediatric data were presented and discussed and a consensus was developed by voting. Results The symptoms of C1‐INH‐HAE often present in childhood. Differential diagnosis can be difficult as abdominal pain is common in pediatric C1‐INH‐HAE, but also commonly occurs in the general pediatric population. The early onset of symptoms may predict a more severe subsequent course of the disease. Before the age of 1 year, C1‐INH levels may be lower than in adults; therefore, it is advisable to confirm the diagnosis after the age of one year. All neonates/infants with an affected C1‐INH‐HAE family member should be screened for C1‐INH deficiency. Pediatric patients should always carry a C1‐INH‐HAE information card and medicine for emergency use. The regulatory approval status of the drugs for prophylaxis and for acute treatment is different in each country. Plasma‐derived C1‐INH, recombinant C1‐INH, and ecallantide are the only agents licensed for the acute treatment of pediatric patients. Clinical trials are underway with additional drugs. It is recommended to follow up patients in an HAE comprehensive care center. Conclusions The pediatric‐focused international consensus for the diagnosis and management of C1‐INH‐HAE patients was created.
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Affiliation(s)
- H. Farkas
- 3rd Department of Internal Medicine; Hungarian Angioedema Center; Semmelweis University; Budapest Hungary
| | | | - K. Bork
- Department of Dermatology; University Medical Center Mainz; Mainz Germany
| | - T. Bowen
- Departments of Medicine and Paediatrics; University of Calgary; Calgary AB Canada
| | - T. Craig
- Department of Medicine, Pediatrics and Graduate Studies; Penn State University; Hershey PA USA
| | - M. Frank
- Department of Pediatrics; Duke University Medical Center; Durham NC USA
| | - A. E. Germenis
- Department of Immunology and Histocompatibility; School of Health Sciences; Faculty of Medicine; University of Thessaly; Larissa Greece
| | - A. S. Grumach
- Outpatient Group of Recurrent Infections; Faculty of Medicine ABC; Santo Andre SP Brazil
| | - A. Luczay
- 1st Department of Pediatrics; Semmelweis University; Budapest Hungary
| | - L. Varga
- 3rd Department of Internal Medicine; Hungarian Angioedema Center; Semmelweis University; Budapest Hungary
| | - A. Zanichelli
- Department of Biomedical and Clinical Sciences “Luigi Sacco”; University of Milan, ASST Fatebenefratelli Sacco; Milan Italy
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15
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Farkas H. Icatibant as acute treatment for hereditary angioedema in adults. Expert Rev Clin Pharmacol 2016; 9:779-88. [DOI: 10.1080/17512433.2016.1182425] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Henriette Farkas
- Hungarian Angioedema Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
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16
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Nygren A, Nordenfelt P, Lindfors A, Mallbris L, Björkander J, Wahlgren CF. Swedish children with hereditary angioedema report good overall health and quality of life despite symptoms. Acta Paediatr 2016; 105:529-34. [PMID: 26821285 DOI: 10.1111/apa.13345] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 11/08/2015] [Accepted: 01/22/2016] [Indexed: 11/29/2022]
Abstract
AIM Few studies have been published on children with hereditary angioedema (HAE), an autosomal dominant disease caused by mutations on chromosome 11. This study explored various aspects of the disease in the Swedish paediatric population. METHODS A retrospective questionnaire was sent to all 36 Swedish children known to have HAE, and a physician carried out follow-up telephone interviews. RESULTS Most of the questionnaires were completed by the parents of 31 (86%) children with HAE, with or without their input, at a median age of nine years (range 1-17), and the physician also interviewed 29. HAE symptoms were experienced by 23 children, including abdominal attacks (96%), skin swelling (78%) and swelling in the mouth and/or upper airways (52%). Psychological stress was the most common trigger for abdominal attacks and trauma and sports triggered skin swelling. The majority (n = 19) had access to complement-1 esterase inhibitor concentrate at home. Current health and quality of life were generally rated as good, independent of whether the child had experienced HAE symptoms or not. CONCLUSION Most children with HAE had experienced abdominal attacks and skin swelling, but their overall health and quality of life were generally perceived to be good.
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Affiliation(s)
- Anders Nygren
- Dermatology Unit; Department of Medicine Solna; Karolinska Institutet and Karolinska University Hospital; Stockholm Sweden
| | - Patrik Nordenfelt
- Department of Clinical and Experimental Medicine; University of Linköping; Linköping Sweden
- Department of Internal Medicine; County Hospital of Ryhov; Jönköping Sweden
| | - Anders Lindfors
- Department of Paediatrics; Astrid Lindgren Children's Hospital; Karolinska University Hospital; Stockholm Sweden
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Lotus Mallbris
- Dermatology Unit; Department of Medicine Solna; Karolinska Institutet and Karolinska University Hospital; Stockholm Sweden
| | - Janne Björkander
- Department of Clinical and Experimental Medicine; University of Linköping; Linköping Sweden
- Futurum - Academy for Health and Care; Region Jönköping County; Jönköping Sweden
| | - Carl-Fredrik Wahlgren
- Dermatology Unit; Department of Medicine Solna; Karolinska Institutet and Karolinska University Hospital; Stockholm Sweden
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17
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Farkas H. Conestat alfa: an orphan drug for the treatment of hereditary angioedema. Expert Opin Orphan Drugs 2016. [DOI: 10.1517/21678707.2016.1153965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Veszeli N, Csuka D, Zotter Z, Imreh É, Józsi M, Benedek S, Varga L, Farkas H. Neutrophil activation during attacks in patients with hereditary angioedema due to C1-inhibitor deficiency. Orphanet J Rare Dis 2015; 10:156. [PMID: 26654922 PMCID: PMC4674948 DOI: 10.1186/s13023-015-0374-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/02/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Earlier studies have shown that the absolute number of neutrophil granulocytes (NGs) may increase during attack of hereditary angioedema due to C1-inhibitor deficiency (C1-INH-HAE). Whether NGs undergo activation during attack has not yet been investigated. However, as neutrophil elastase (NE) can cleave and inactivate C1-INH which may contribute to the dysregulation of the kallikrein-kinin system and hence, to edema formation. Our aim was to investigate the possible activation of NGs during attacks. METHODS We studied blood samples obtained from 26 patients with C1-INH-HAE during symptom-free periods and during attacks, along with samples from 26 healthy volunteers. NG count (NGC), NE, myeloperoxidase (MPO), pentraxin 3 (PTX3), CRP, C5a, factor H, IL-8, and TNF-α levels were measured. RESULTS NGC was higher during attacks than during symptom-free periods (p = 0.0132), and the same was observed for NE (p = 0.0026), MPO (p = 0.0008), and PTX3 levels (p = 0.0409). There was a strong positive correlation between NE and MPO levels during attacks (p < 0.0001, R = 0.709). Furthermore, IL-8 (p = 0.0061) and TNF-α (p = 0.0186) levels were also elevated during attacks, compared with symptom-free periods. By contrast, C5a and factor H levels were similar in samples obtained during attacks or in symptom-free periods. CONCLUSION Increased NGC was associated with elevated NE and MPO levels - this suggests neutrophil activation during attacks. The strong positive correlation between NE and MPO levels, together with the elevated PTX3 concentration, may indicate the expression of neutrophil extracellular traps. All these processes may contribute to the activation of kallikrein-kinin system, which leads to the onset of an edematous episode.
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Affiliation(s)
- Nóra Veszeli
- Hungarian Angioedema Center, 3rd Department of Internal Medicine, Semmelweis University, Kútvölgyi út 4, H-1125, Budapest, Hungary.
| | - Dorottya Csuka
- Hungarian Angioedema Center, 3rd Department of Internal Medicine, Semmelweis University, Kútvölgyi út 4, H-1125, Budapest, Hungary.
| | - Zsuzsanna Zotter
- Hungarian Angioedema Center, 3rd Department of Internal Medicine, Semmelweis University, Kútvölgyi út 4, H-1125, Budapest, Hungary. .,Urology Department, Medical Center, Hungarian Defence Forces, Budapest, Hungary.
| | - Éva Imreh
- Central Laboratory, Kútvölgyi Clinical Block, Budapest, Hungary.
| | - Mihály Józsi
- MTA-ELTE "Lendület" Complement Research Group, Department of Immunology, Eötvös Loránd University, Budapest, Hungary.
| | - Szabolcs Benedek
- Haematology Unit, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
| | - Lilian Varga
- Hungarian Angioedema Center, 3rd Department of Internal Medicine, Semmelweis University, Kútvölgyi út 4, H-1125, Budapest, Hungary.
| | - Henriette Farkas
- Hungarian Angioedema Center, 3rd Department of Internal Medicine, Semmelweis University, Kútvölgyi út 4, H-1125, Budapest, Hungary.
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19
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Speletas M, Szilágyi Á, Csuka D, Koutsostathis N, Psarros F, Moldovan D, Magerl M, Kompoti M, Varga L, Maurer M, Farkas H, Germenis AE. F12-46C/T polymorphism as modifier of the clinical phenotype of hereditary angioedema. Allergy 2015; 70:1661-4. [PMID: 26248961 DOI: 10.1111/all.12714] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2015] [Indexed: 11/29/2022]
Abstract
The factors influencing the heterogeneous clinical manifestation of hereditary angioedema due to C1-INH deficiency (C1-INH-HAE) represent one of the oldest unsolved problems of the disease. Considering that factor XII (FXII) levels may affect bradykinin production, we investigated the contribution of the functional promoter polymorphism F12-46C/T in disease phenotype. We studied 258 C1-INH-HAE patients from 113 European families, and we explored possible associations of F12-46C/T with clinical features and the SERPING1 mutational status. Given that our cohort consisted of related subjects, we implemented generalized estimating equations (GEEs), an extension of the generalized linear model accounting for the within-subject correlation. F12-46C/T carriers exhibited a significantly delayed disease onset (P < 0.001) and did not need long-term treatment (P = 0.02). In a GEE linear regression model, the presence of F12-46C/T was significantly associated with a 7-year delay in disease onset (P < 0.0001) regardless of SERPING1 mutational status. It is concluded that F12-46C/T carriage acts as an independent modifier of C1-INH-HAE severity.
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Affiliation(s)
- M. Speletas
- Department of Immunology & Histocompatibility; School of Health Sciences; Faculty of Medicine; University of Thessaly; Larissa Greece
| | - Á. Szilágyi
- 3rd Department of Internal Medicine; Hungarian Angioedema Center; Semmelweis University; Budapest Hungary
| | - D. Csuka
- 3rd Department of Internal Medicine; Hungarian Angioedema Center; Semmelweis University; Budapest Hungary
| | - N. Koutsostathis
- Department of Immunology & Histocompatibility; School of Health Sciences; Faculty of Medicine; University of Thessaly; Larissa Greece
| | - F. Psarros
- Department of Allergology; Navy Hospital; Athens Greece
| | - D. Moldovan
- Department of Allergy-Immunology; University of Medicine and Pharmacy; Mures County Hospital; Tîrgu Mureș Romania
| | - M. Magerl
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Kompoti
- Department of Immunology & Histocompatibility; School of Health Sciences; Faculty of Medicine; University of Thessaly; Larissa Greece
| | - L. Varga
- 3rd Department of Internal Medicine; Hungarian Angioedema Center; Semmelweis University; Budapest Hungary
| | - M. Maurer
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - H. Farkas
- 3rd Department of Internal Medicine; Hungarian Angioedema Center; Semmelweis University; Budapest Hungary
| | - A. E. Germenis
- Department of Immunology & Histocompatibility; School of Health Sciences; Faculty of Medicine; University of Thessaly; Larissa Greece
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20
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Merle NS, Church SE, Fremeaux-Bacchi V, Roumenina LT. Complement System Part I - Molecular Mechanisms of Activation and Regulation. Front Immunol 2015; 6:262. [PMID: 26082779 PMCID: PMC4451739 DOI: 10.3389/fimmu.2015.00262] [Citation(s) in RCA: 1011] [Impact Index Per Article: 112.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/11/2015] [Indexed: 12/12/2022] Open
Abstract
Complement is a complex innate immune surveillance system, playing a key role in defense against pathogens and in host homeostasis. The complement system is initiated by conformational changes in recognition molecular complexes upon sensing danger signals. The subsequent cascade of enzymatic reactions is tightly regulated to assure that complement is activated only at specific locations requiring defense against pathogens, thus avoiding host tissue damage. Here, we discuss the recent advances describing the molecular and structural basis of activation and regulation of the complement pathways and their implication on physiology and pathology. This article will review the mechanisms of activation of alternative, classical, and lectin pathways, the formation of C3 and C5 convertases, the action of anaphylatoxins, and the membrane-attack-complex. We will also discuss the importance of structure-function relationships using the example of atypical hemolytic uremic syndrome. Lastly, we will discuss the development and benefits of therapies using complement inhibitors.
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Affiliation(s)
- Nicolas S Merle
- UMR_S 1138, Cordeliers Research Center, Complement and Diseases Team, INSERM , Paris , France ; UMR_S 1138, Centre de Recherche des Cordeliers, Sorbonne Paris Cité, Université Paris Descartes , Paris , France ; UMR_S 1138, Centre de Recherche des Cordeliers, Sorbonne Universités, Université Pierre et Marie Curie-Paris , Paris , France
| | - Sarah Elizabeth Church
- UMR_S 1138, Centre de Recherche des Cordeliers, Sorbonne Paris Cité, Université Paris Descartes , Paris , France ; UMR_S 1138, Centre de Recherche des Cordeliers, Sorbonne Universités, Université Pierre et Marie Curie-Paris , Paris , France ; UMR_S 1138, Cordeliers Research Center, Integrative Cancer Immunology Team, INSERM , Paris , France
| | - Veronique Fremeaux-Bacchi
- UMR_S 1138, Cordeliers Research Center, Complement and Diseases Team, INSERM , Paris , France ; UMR_S 1138, Centre de Recherche des Cordeliers, Sorbonne Paris Cité, Université Paris Descartes , Paris , France ; UMR_S 1138, Centre de Recherche des Cordeliers, Sorbonne Universités, Université Pierre et Marie Curie-Paris , Paris , France ; Service d'Immunologie Biologique, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou , Paris , France
| | - Lubka T Roumenina
- UMR_S 1138, Cordeliers Research Center, Complement and Diseases Team, INSERM , Paris , France ; UMR_S 1138, Centre de Recherche des Cordeliers, Sorbonne Paris Cité, Université Paris Descartes , Paris , France ; UMR_S 1138, Centre de Recherche des Cordeliers, Sorbonne Universités, Université Pierre et Marie Curie-Paris , Paris , France
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21
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Ferrer M, Bartra J, Giménez-Arnau A, Jauregui I, Labrador-Horrillo M, Ortiz de Frutos J, Silvestre JF, Sastre J, Velasco M, Valero A. Management of urticaria: not too complicated, not too simple. Clin Exp Allergy 2015; 45:731-43. [PMID: 25429900 PMCID: PMC4403957 DOI: 10.1111/cea.12465] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2014] [Indexed: 11/27/2022]
Abstract
In spite of being an old disease and apparently easy to diagnose, chronic spontaneous urticaria (CSU) is still perceived as an uncontrollable and difficult to manage disease. The perception of the patient is that his/her condition is not well understood and that is suffering from a disorder with hidden causes that doctors are not able to tackle. Sometimes patients go through a number of clinicians until they found some CSU expert who is familiar with the disease. It is surprising that myths and believes with no scientific support still persist. Guidelines are not widely implemented, and recent tools to assess severity are infrequently used. European and American recent guidelines do not agree in several key points related to diagnosis and treatment, which further contributes to confusion. With the aim to clarify some aspects of the CSU picture, a group of allergists and dermatologists from the Spanish Dermatology and Allergy societies developed a Frequent Asked Questions leaflet that could facilitate physicians work in daily practice and contribute to a better knowledge of common clinical scenarios related to patients with CSU.
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Affiliation(s)
- M Ferrer
- Department of Allergy and Clinical Immunology, Clínica Universidad de NavarraPamplona, Spain
| | - J Bartra
- Allergy Unit, Pneumology Department, Hospital Clinic, University of BarcelonaBarcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Barcelona, Spain
| | - A Giménez-Arnau
- Dermatology Department, Hospital del Mar, Parc de Salut Mar, Universitat Autonoma BarcelonaBarcelona, Spain
| | - I Jauregui
- Allergy Department, Hospital Universitario BasurtoBilbao, Spain
| | - M Labrador-Horrillo
- Allergy Section, Medicine Department, Hospital Vall d'Hebron, Universitat Autònoma de BarcelonaBarcelona, Spain
| | - J Ortiz de Frutos
- Dermatology Department, Hospital Universitario 12 de OctubreMadrid, Spain
| | - J F Silvestre
- Dermatology Department, Hospital General Universitario de AlicanteAlicante, Spain
| | - J Sastre
- Allergy Department, Fundación Jiménez DiazMadrid, Spain
| | - M Velasco
- Dermatology Department, Hospital Arnau de VilanovaValencia, Spain
| | - A Valero
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Barcelona, Spain
- Allergy Unit, Pneumology and Respiratory Department, Hospital Clínic (ICT), University of BarcelonaBarcelona, Spain
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22
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Campos RA, Valle SOR, França AT, Cordeiro E, Serpa FS, Mello YF, Malheiros T, Toledo E, Mansour E, Fusaro G, Grumach AS. Icatibant, an inhibitor of bradykinin receptor 2, for hereditary angioedema attacks: prospective experimental single-cohort study. SAO PAULO MED J 2014; 132:261-5. [PMID: 25054967 PMCID: PMC10496749 DOI: 10.1590/1516-3180.2014.1325652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 09/19/2013] [Accepted: 09/25/2013] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE Hereditary angioedema (HAE) with C1 inhibitor deficiency manifests as recurrent episodes of edema involving the skin, upper respiratory tract and gastrointestinal tract. It can be lethal due to asphyxia. The aim here was to evaluate the response to therapy for these attacks using icatibant, an inhibitor of the bradykinin receptor, which was recently introduced into Brazil. DESIGN AND SETTING Prospective experimental single-cohort study on the efficacy and safety of icatibant for HAE patients. METHODS Patients with a confirmed HAE diagnosis were enrolled according to symptoms and regardless of the time since onset of the attack. Icatibant was administered in accordance with the protocol that has been approved in Brazil. Symptom severity was assessed continuously and adverse events were monitored. RESULTS 24 attacks in 20 HAE patients were treated (female/male 19:1; 19-55 years; median 29 years of age). The symptoms were: subcutaneous edema (22/24); abdominal pain (15/24) and upper airway obstruction (10/24). The time taken until onset of relief was: 5-10 minutes (5/24; 20.8%); 10-20 (5/24; 20.8%); 20-30 (8/24; 33.4%); 30-60 (5/24; 20.8%); and 2 hours (1/24; 4.3%). The time taken for complete resolution of symptoms ranged from 4.3 to 33.4 hours. Adverse effects were only reported at injection sites. Mild to moderate erythema and/or feelings of burning were reported by 15/24 patients, itching by 3 and no adverse effects in 6. CONCLUSION HAE type I patients who received icatibant responded promptly; most achieved improved symptom severity within 30 minutes. Local adverse events occurred in 75% of the patients.
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Affiliation(s)
- Regis Albuquerque Campos
- MD, PhD. Associate Professor in the Discipline of Allergy and Immunology, Faculdade de Medicina, Universidade Federal da Bahia (UFB), Salvador, Bahia, Brazil
| | - Solange Oliveira Rodrigues Valle
- MD, PhD. Attending Physician in the Allergy Outpatient Group, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Alfeu Tavares França
- MD, PhD. Attending Physician in the Allergy Outpatient Group, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Elisabete Cordeiro
- MD. Attending Physician in the Recurrent Infections Outpatient Group, Faculdade de Medicina do ABC (FMABC), Santo André, São Paulo, Brazil
| | - Faradiba Sarquis Serpa
- MD, MSc. Assistant Professor in the Department of Internal Medicine, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória, Espírito Santo, Brazil
| | - Yara Ferreira Mello
- MD. Attending Physician in the Allergy Service, Hospital Edmundo Vasconcelos, São Paulo, São Paulo, Brazil
| | - Teresinha Malheiros
- MD. Attending Physician in the Allergy Service, Hospital Edmundo Vasconcelos, São Paulo, São Paulo, Brazil
| | - Eliana Toledo
- MD, PhD. Associate Professor in the Department of Pediatrics, Faculdade de Medicina da Universidade de São José do Rio Preto (Famerp), São José do Rio Preto, São Paulo, Brazil
| | - Elie Mansour
- MD. Associate Professor in the Department of Pediatrics, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Gustavo Fusaro
- MD. Attending Physician in the Department of Pediatrics, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Anete Sevciovic Grumach
- MD, PhD. Professor, Attending Physician in the Recurrent Infections Outpatient Group and Responsible for Clinical Immunology Laboratory, Faculdade de Medicina do ABC (FMABC), Santo André, São Paulo, Brazil
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Floccard B, Hautin E, Bouillet L, Coppere B, Allaouchiche B. An evidence-based review of the potential role of icatibant in the treatment of acute attacks in hereditary angioedema type I and II. CORE EVIDENCE 2012; 7:105-14. [PMID: 23055948 PMCID: PMC3467996 DOI: 10.2147/ce.s24743] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Icatibant, a first-in-class B2 bradykinin receptor antagonist, appears to have a favorable efficacy and safety profile for the treatment of acute attacks of hereditary angioedema in adults. AIMS To update the evidence and provide an overview of the available data on icatibant. EVIDENCE REVIEW Peer reviewed articles published and listed in Medline Search and published updated guidelines for the treatment of acute attacks in hereditary angioedema type I and II in adults were reviewed. The validity and quality of evidence were evaluated. PLACE IN THERAPY Clinical evidence for the treatment of acute hereditary angioedema attacks with icatibant is strong. Approximately 10% of the patients require a second dose. No serious adverse reactions have been reported. The only significant side effects consistently registered by 90% of patients are transient local pain, swelling, and erythema at the local injection site. CONCLUSION Subcutaneously administered 30 mg icatibant has been shown to be a safe and efficacious treatment in clinical trials. It is the only specific treatment authorized for self-administration by the subcutaneous route offering increased patient independence.
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Affiliation(s)
- Bernard Floccard
- Département d'Anesthésie Réanimation, Centre de Référence des Angioedèmes à Bradykinine, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon
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