Ecallantide (DX-88), a plasma kallikrein inhibitor for the treatment of hereditary angioedema and the prevention of blood loss in on-pump cardiothoracic surgery.
BACKGROUND
Plasma kallikrein plays a major role in the contact (kallikrein-kinin) cascade producing bradykinin. Bradykinin is a vasodilator, which increases vascular permeability, activates inflammation and produces pain. Plasma kallikrein is also crosslinked to the coagulation system and the complement cascade.


OBJECTIVE
Ecallantide (DX-88) is a potent and specific inhibitor of plasma kallikrein. Ecallantide is a recombinantly produced and engineered small protein based on the first Kunitz domain of human tissue factor pathway inhibitor. It was identified through phage display technology.


METHODS
The search terms 'ecallantide', 'DX-88' and 'hereditary angioedema' were entered into Pubmed/Medline, ClinicalTrials and Google.


CONCLUSIONS
At present, the drug is being studied for two major indications. First, the results for the treatment of hereditary angioedema are promising. Second, a prospective randomised multi-centre trial for the reduction of blood loss during on-pump cardiothoracic surgery will be terminated in October 2008.
Lehmann
Andreas
A
Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Postfach 21 73 52, D-67073 Ludwigshafen, Germany. lehmanna@klilu.de
D054179:Angioedemas, Hereditary / Q000188:drug therapy*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D006801:Humans; D007610:Kallikreins / Q000037:antagonists & inhibitors*; D010455:Peptides / Q000494:pharmacology / Q000627:therapeutic use*; D015842:Serine Proteinase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*
D010455:Peptides; D015842:Serine Proteinase Inhibitors; C511194:ecallantide; D007610:Kallikreins