marotta, serena (2017) Novel anti-complement agents for PNH:from eculizumab to complement inhibition 2.0. [Tesi di dottorato]

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Item Type: Tesi di dottorato
Lingua: English
Title: Novel anti-complement agents for PNH:from eculizumab to complement inhibition 2.0
Creators:
CreatorsEmail
marotta, serenamarotta.serena@gmail.com
Date: 7 December 2017
Number of Pages: 33
Institution: Università degli Studi di Napoli Federico II
Department: dep13
Dottorato: phd106
Ciclo di dottorato: 30
Coordinatore del Corso di dottorato:
nomeemail
Di Minno, Giovannigiovanni.diminno@unina.it
Tutor:
nomeemail
Risitano, AntonioUNSPECIFIED
Date: 7 December 2017
Number of Pages: 33
Uncontrolled Keywords: pnh, anti-complement agents, eculizumab
Settori scientifico-disciplinari del MIUR: Area 06 - Scienze mediche > MED/15 - Malattie del sangue
Date Deposited: 21 Dec 2017 08:11
Last Modified: 10 Apr 2019 10:41
URI: http://www.fedoa.unina.it/id/eprint/12066

Abstract

Therapeutic complement inhibition by eculizumab has revolutionized the treatment of paroxysmal nocturnal hemoglobinuria (PNH) with a major impact on its natural history. Nevertheless, emerging unmet clinical needs may benefit from the development of novel complement inhibitors. Novel strategies of complement inhibition exploit different agents targeting C5, as well as compound intercepting the complement cascade at the level of its key component C3, or even upstream at the level of component involved in complement alternative pathway initiation. Many of these agents are already in their clinical development; preliminary data together with a deep understanding of PNH biology may help to anticipate their possible clinical effect. Novel anti-C5 agents include monoclonal antibodies (even long-lasting) as well as other small molecules bioavailable by subcutaneous administration; an anti-C5 small interfering RNA has been developed too. All these anti-C5 agents seem to recapitulate safety and efficacy of current eculizumab treatment; their main improvement pertains to better patient compliance due to longer dosing interval and possible subcutaneous self-administration. The possibility of achieving a deeper C5 inhibition has been shown as well, but its actual clinical meaning remains to be elucidated. Upstream complement inhibitors include the anti-C3 small peptide compstatin (and its derivatives), and small inhibitors of complement factor D or complement factor B. This class of compound anticipates a possible efficacy in prevention of C3-mediated extravascular hemolysis, in addition to inhibition of intravascular hemolysis, possibly leading to improved hematological responses. The availability of all these compounds will result soon in a substantial improvement of PNH management.

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