Peptide inhibitors of C3 activation as a novel strategy of complement inhibition for the treatment of paroxysmal nocturnal hemoglobinuria.
Paroxysmal nocturnal hemoglobinuria (PNH) is characterized by complement-mediated intravascular hemolysis due to the lack of CD55 and CD59 on affected erythrocytes. The anti-C5 antibody eculizumab has proven clinically effective, but uncontrolled C3 activation due to CD55 absence may result in opsonization of erythrocytes, possibly leading to clinically meaningful extravascular hemolysis. We investigated the effect of the peptidic C3 inhibitor, compstatin Cp40, and its long-acting form (polyethylene glycol [PEG]-Cp40) on hemolysis and opsonization of PNH erythrocytes in an established in vitro system. Both compounds demonstrated dose-dependent inhibition of hemolysis with IC50 ∼4 µM and full inhibition at 6 µM. Protective levels of either Cp40 or PEG-Cp40 also efficiently prevented deposition of C3 fragments on PNH erythrocytes. We further explored the potential of both inhibitors for systemic administration and performed pharmacokinetic evaluation in nonhuman primates. A single intravenous injection of PEG-Cp40 resulted in a prolonged elimination half-life of >5 days but may potentially affect the plasma levels of C3. Despite faster elimination kinetics, saturating inhibitor concentration could be reached with unmodified Cp40 through repetitive subcutaneous administration. In conclusion, peptide inhibitors of C3 activation effectively prevent hemolysis and C3 opsonization of PNH erythrocytes, and are excellent, and potentially cost-effective, candidates for further clinical investigation.
Hematology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy;
Antonio M
AM
Risitano
Daniel
D
Ricklin
Yijun
Y
Huang
Edimara S
ES
Reis
Hui
H
Chen
Patrizia
P
Ricci
Zhuoer
Z
Lin
Caterina
C
Pascariello
Maddalena
M
Raia
Michela
M
Sica
Luigi
L
Del Vecchio
Fabrizio
F
Pane
Florea
F
Lupu
Rosario
R
Notaro
Ranillo R G
RR
Resuello
Robert A
RA
DeAngelis
John D
JD
Lambris
D000818:Animals; D003167:Complement Activation / Q000187:drug effects*; D003176:Complement C3 / Q000037:antagonists & inhibitors*; D015195:Drug Design; D004912:Erythrocytes / Q000187:drug effects / Q000502:physiology; D006207:Half-Life; D006457:Hemoglobinuria, Paroxysmal / Q000188:drug therapy* / Q000378:metabolism; D006461:Hemolysis / Q000187:drug effects; D006801:Humans; D008252:Macaca fascicularis; D010446:Peptide Fragments / Q000737:chemistry / Q000627:therapeutic use; D010456:Peptides, Cyclic / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use*; D011092:Polyethylene Glycols / Q000494:pharmacology / Q000627:therapeutic use
D003176:Complement C3; D010446:Peptide Fragments; D010456:Peptides, Cyclic; C111828:compstatin; D011092:Polyethylene Glycols