On the cover
Several strategies of therapeutic complement inhibition are currently being evaluated in the prevention and treatment of transplant rejection. The humanized monoclonal antibody BIVV009 interferes with the classical pathway of complement by targeting C1 subcomponent C1s. Extracorporeal treatment with membrane filtration (MF) in addition to immunoadsorption (IA) markedly enhances the elimination of C1q (and IgM). Purified C1 inhibitor (C1-INH) disassembles the C1 complex and, in addition, interferes with components of the lectin and alternative pathways. Finally, terminal complement blockade using anti-C5 monoclonal antibody eculizumab prevents the formation of C5a, a strong anaphylatoxin, and C5b, the initial trigger of membrane attack complex (MAC) assembly.
Georg A. Böhmig1, Markus Wahrmann1, Farsad Eskandary1, Lionel Rostaing2
1Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
2Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation, Centre Hospitalier Universitaire Grenoble-Alpes, La Tronche, France.