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2015 ; 125
(21
): 3253-62
Nephropedia Template TP
gab.com Text
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Eculizumab reduces complement activation, inflammation, endothelial damage,
thrombosis, and renal injury markers in aHUS
#MMPMID25833956
Cofiell R
; Kukreja A
; Bedard K
; Yan Y
; Mickle AP
; Ogawa M
; Bedrosian CL
; Faas SJ
Blood
2015[May]; 125
(21
): 3253-62
PMID25833956
show ga
Atypical hemolytic uremic syndrome (aHUS) is a genetic, life-threatening disease
characterized by uncontrolled complement activation, systemic thrombotic
microangiopathy (TMA), and vital organ damage. We evaluated the effect of
terminal complement blockade with the anti-C5 monoclonal antibody eculizumab on
biomarkers of cellular processes involved in TMA in patients with aHUS
longitudinally, during up to 1 year of treatment, compared with in healthy
volunteers. Biomarker levels were elevated at baseline in most patients,
regardless of mutational status, plasma exchange/infusion use, platelet count, or
lactate dehydrogenase or haptoglobin levels. Eculizumab reduced terminal
complement activation (C5a and sC5b-9) and renal injury markers (clusterin,
cystatin-C, ?2-microglobulin, and liver fatty acid binding protein-1) to healthy
volunteer levels and reduced inflammation (soluble tumor necrosis factor
receptor-1), coagulation (prothrombin fragment F1+2 and d-dimer), and endothelial
damage (thrombomodulin) markers to near-normal levels. Alternative pathway
activation (Ba) and endothelial activation markers (soluble vascular cell
adhesion molecule-1) decreased but remained elevated, reflecting ongoing
complement activation in aHUS despite complete terminal complement blockade.
These results highlight links between terminal complement activation and
inflammation, endothelial damage, thrombosis, and renal injury and underscore
ongoing risk for systemic TMA and progression to organ damage. Further research
regarding underlying complement dysregulation is warranted. This trial was
registered at www.clinicaltrials.gov as #NCT01194973.
|Acute Kidney Injury/drug therapy/etiology
[MESH]
|Adult
[MESH]
|Antibodies, Monoclonal, Humanized/*therapeutic use
[MESH]