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Ding L, Zhang MJ, Rao GW. Summary and future of medicine for hereditary angioedema. Drug Discov Today 2024; 29:103890. [PMID: 38246415 DOI: 10.1016/j.drudis.2024.103890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/24/2023] [Accepted: 01/16/2024] [Indexed: 01/23/2024]
Abstract
Hereditary angioedema (HAE) is a rare autosomal genetic disease for which there are currently nine FDA-approved drugs. This review summarizes drug treatments for HAE based on four therapeutic pathways: inhibiting the contact system, inhibiting bradykinin binding to B2 receptors, supplying missing C1 inhibitors, and inhibiting plasminogen conversion. The review generalizes the clinical use, pharmacological effects and mechanisms of HAE drugs, and it also discusses possible development directions and targets to enhance understanding of HAE and help researchers.
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Affiliation(s)
- Lei Ding
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou 310014, PR China; Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, PR China
| | - Meng-Jiao Zhang
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou 310014, PR China; Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, PR China
| | - Guo-Wu Rao
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou 310014, PR China; Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, PR China.
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Yong PFK, Coulter T, El-Shanawany T, Garcez T, Hackett S, Jain R, Kiani-Alikhan S, Manson A, Noorani S, Stroud C, Symons C, Sargur R, Steele C, Alachkar H, Anantharachagan A, Arkwright PD, Bernatoniene J, Bhole M, Brown L, Buckland M, Burns S, Chopra C, Darroch J, Drewe E, Edmonds J, Ekbote A, Elkhalifa S, Goddard S, Grosse-Kreul D, Gurugama P, Hague R, Herriot R, Herwadkar A, Hughes SM, Jones L, Lear S, McDermott E, Kham Murng SH, Price A, Redenbaugh V, Richter A, Riordan A, Shackley F, Stichbury J, Springett D, Tarzi MD, Thomas M, Vijayadurai P, Worth A. A National Survey of Hereditary Angioedema and Acquired C1 Inhibitor Deficiency in the United Kingdom. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2476-2483. [PMID: 37146882 DOI: 10.1016/j.jaip.2023.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 03/30/2023] [Accepted: 04/14/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Detailed demographic data on people with hereditary angioedema (HAE) and acquired C1 inhibitor deficiency in the United Kingdom are relatively limited. Better demographic data would be beneficial in planning service provision, identifying areas of improvement, and improving care. OBJECTIVE To obtain more accurate data on the demographics of HAE and acquired C1 inhibitor deficiency in the United Kingdom, including treatment modalities and services available to patients. METHODS A survey was distributed to all centers in the United Kingdom that look after patients with HAE and acquired C1 inhibitor deficiency to collect these data. RESULTS The survey identified 1152 patients with HAE-1/2 (58% female and 92% type 1), 22 patients with HAE with normal C1 inhibitor, and 91 patients with acquired C1 inhibitor deficiency. Data were provided by 37 centers across the United Kingdom. This gives a minimum prevalence of 1:59,000 for HAE-1/2 and 1:734,000 for acquired C1 inhibitor deficiency in the United Kingdom. A total of 45% of patients with HAE were on long-term prophylaxis (LTP) with the most used medication being danazol (55% of all patients on LTP). Eighty-two percent of patients with HAE had a home supply of acute treatment with C1 inhibitor or icatibant. A total of 45% of patients had a supply of icatibant and 56% had a supply of C1 inhibitor at home. CONCLUSIONS Data obtained from the survey provide useful information about the demographics and treatment modalities used in HAE and acquired C1 inhibitor deficiency in the United Kingdom. These data are useful for planning service provision and improving services for these patients.
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Affiliation(s)
- Patrick F K Yong
- Department of Allergy and Clinical Immunology, Frimley Health NHS Foundation Trust, Frimley, United Kingdom.
| | - Tanya Coulter
- Regional Immunology Service, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Tariq El-Shanawany
- Department of Immunology, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Tomaz Garcez
- Department of Immunology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Scott Hackett
- Department of Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Rashmi Jain
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Ania Manson
- Department of Clinical Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Sadia Noorani
- Department of Immunology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Catherine Stroud
- Regional Department of Immunology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Christine Symons
- Department of Clinical Immunology and Allergy, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Ravishankar Sargur
- Department of Clinical Immunology and Allergy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Cathal Steele
- Department of Clinical Immunology, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom
| | - Hana Alachkar
- Department of Immunology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Ariharan Anantharachagan
- Department of Immunology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Peter D Arkwright
- Department of Paediatric Allergy and Immunology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Jolanta Bernatoniene
- Department of Paediatric Immunology, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Malini Bhole
- Department of Immunology, The Dudley Group NHS Foundation Trust, Dudley, United Kingdom
| | - Lindsay Brown
- Department of Immunology and infectious Diseases, Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, United Kingdom
| | - Matthew Buckland
- Department of Immunology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Siobhan Burns
- Department of Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Charu Chopra
- Department of Clinical Immunology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - James Darroch
- Department of Immunology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Elizabeth Drewe
- Department of Clinical Immunology and Allergy, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Jillian Edmonds
- Department of Clinical Immunology, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom
| | - Anjali Ekbote
- Department of Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Shuayb Elkhalifa
- Department of Clinical Immunology, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Sarah Goddard
- Department of Clinical Immunology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Dorothea Grosse-Kreul
- Department of Clinical Immunology and Allergy, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Padmalal Gurugama
- Department of Clinical Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Rosie Hague
- Department of Paediatric Immunology and Infectious Diseases, Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - Richard Herriot
- Department of Immunology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Archana Herwadkar
- Department of Clinical Immunology, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Stephen M Hughes
- Department of Paediatric Allergy and Immunology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Laura Jones
- Department of Immunology and infectious Diseases, Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, United Kingdom
| | - Sara Lear
- Department of Clinical Immunology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Elizabeth McDermott
- Department of Clinical Immunology and Allergy, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Sai Hurng Kham Murng
- Department of Clinical Immunology, Epsom and St Helier University Hospitals NHS Trust, Epsom, United Kingdom
| | - Arthur Price
- Department of Clinical Immunology and Allergy, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Vyanka Redenbaugh
- Regional Immunology Service, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Alex Richter
- Department of Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew Riordan
- Department of Paediatric Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Fiona Shackley
- Department of Immunology and Infectious Diseases, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Julia Stichbury
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Debbie Springett
- Department of Clinical Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Michael D Tarzi
- Department of Immunology, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Moira Thomas
- Department of Clinical Immunology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Pavaladurai Vijayadurai
- Department of Immunology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Austen Worth
- Department of Immunology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Marceau F, Bachelard H, Bouthillier J, Fortin JP, Morissette G, Bawolak MT, Charest-Morin X, Gera L. Bradykinin receptors: Agonists, antagonists, expression, signaling, and adaptation to sustained stimulation. Int Immunopharmacol 2020; 82:106305. [PMID: 32106060 DOI: 10.1016/j.intimp.2020.106305] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 02/10/2020] [Indexed: 01/23/2023]
Abstract
Bradykinin-related peptides, the kinins, are blood-derived peptides that stimulate 2 G protein-coupled receptors, the B1 and B2 receptors (B1R, B2R). The pharmacologic and molecular identities of these 2 receptor subtypes will be succinctly reviewed herein, with emphasis on drug development, receptor expression, signaling, and adaptation to persistent stimulation. Peptide and non-peptide antagonists and fluorescent ligands have been produced for each receptor. The B2R is widely and constitutively expressed in mammalian tissues, whereas the B1R is mostly inducible under the effect of cytokines during infection and immunopathology. The B2R is temporarily desensitized by a cycle of phosphorylation/endocytosis followed by recycling, whereas the nonphosphorylable B1R is relatively resistant to desensitization and translocated to caveolae on activation. Both receptor subtypes, mainly coupled to protein G Gq, phospholipase C and calcium signaling, mediate the vascular aspects of inflammation (vasodilation, edema formation). On this basis, icatibant, a peptide antagonist of the B2R, is approved in the management of hereditary angioedema attacks. This disease is the therapeutic showcase of the kallikrein-kinin system, with an orally bioavailable B2R antagonist under development, as well as other agents that inhibit the kinin forming protease, plasma kallikrein. Other clinical applications are still elusive despite the maturity of the medicinal chemistry efforts applied to kinin receptors.
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Affiliation(s)
- François Marceau
- Division of Infectious Disease and Immunity, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC, Canada.
| | - Hélène Bachelard
- Division of Endocrinology and Nephrology, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - Johanne Bouthillier
- Division of Infectious Disease and Immunity, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - Jean-Philippe Fortin
- Division of Infectious Disease and Immunity, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - Guillaume Morissette
- Division of Infectious Disease and Immunity, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - Marie-Thérèse Bawolak
- Division of Infectious Disease and Immunity, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - Xavier Charest-Morin
- Division of Infectious Disease and Immunity, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - Lajos Gera
- Department of Biochemistry, University of Colorado Denver, Aurora, CO, USA
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