Mechanistic studies have implicated the alternative complement pathway, specifically C5a receptor activation, in the pathogenesis of anti-neutrophil cytoplasmic antibody-associated vasculitis. Results from a phase 2 trial suggest that C5a receptor blockade could enable the reduced use or complete withdrawal of steroids from induction protocols.
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References
Jayne, D. R. et al. Randomized trial of C5a receptor inhibitor avacopan in ANCA-associated vasculitis. J. Am. Soc. Nephrol. http://dx.doi.org/10.1681/ASN.2016111179 (2017).
Xiao, H., Schreiber, A., Heeringa, P., Falk, R. J. & Jennette, J. C. Alternative complement pathway in the pathogenesis of disease mediated by anti-neutrophil cytoplasmic autoantibodies. Am. J. Pathol. 170, 52–64 (2007).
Huugen, D. et al. Inhibition of complement factor C5 protects against anti-myeloperoxidase antibody-mediated glomerulonephritis in mice. Kidney Int. 71, 646–654 (2007).
Schreiber, A. et al. C5a receptor mediates neutrophil activation and ANCA-induced glomerulonephritis. J. Am. Soc. Nephrol. 20, 289–298 (2009).
Xiao, H. et al. C5a receptor (CD88) blockade protects against MPO-ANCA GN. J. Am. Soc. Nephrol. http://dx.doi.org/10.1681/ASN.2013020143 (2013).
Camous, L. et al. Complement alternative pathway acts as a positive feedback amplification of neutrophil activation. Blood 117, 1340–1349 (2011).
Wang, H., Wang, C., Zhao, M. H. & Chen, M. Neutrophil extracellular traps can activate alternative complement pathways. Clin. Exp. Immunol. 181, 518–527 (2015).
Gou, S. J., Yuan, J., Chen, M., Yu, F. & Zhao, M. H. Circulating complement activation in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis. Kidney Int. 83, 129–137 (2013).
Chen, S. F. et al. Plasma complement factor H is associated with disease activity of patients with ANCA-associated vasculitis. Arthritis Res. Ther. 17, 129 (2015).
US National Library of Medicine. ClinicalTrials.govhttps://clinicaltrials.gov/ct2/show/NCT02994927 (2017).
Acknowledgements
R.K. is supported by the DFG grant KE 576/8-1 and an ECRC grant. The Experimental and Clinical Research Center is a joint cooperation between the Max-Delbrück Center for Molecular Medicine and the Charité Medical Faculty, Berlin, Germany.
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Kettritz, R. A CLEAR argument for targeting complement in ANCA vasculitis. Nat Rev Nephrol 13, 448–450 (2017). https://doi.org/10.1038/nrneph.2017.69
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DOI: https://doi.org/10.1038/nrneph.2017.69