Broadly effective metabolic and immune recovery with C5 inhibition in CHAPLE disease

Ahmet Ozen; Nurhan Kasap; Ivan Vujkovic-Cvijin; Richard Apps; Foo Cheung; Elif Karakoc-Aydiner; Bilge Akkelle; Sinan Sari; Engin Tutar; Figen Ozcay; Dilara Kocacik Uygun; Ali Islek; Gamze Akgun; Merve Selcuk; Oya Balci Sezer; Yu Zhang; Gunsel Kutluk; Erdem Topal; Ersin Sayar; Cigdem Celikel; Roderick H J Houwen; Aysen Bingol; Ismail Ogulur; Sevgi Bilgic Eltan; Andrew L Snow; Camille Lake; Giovanna Fantoni; Camille Alba; Brian Sellers; Samuel D Chauvin; Clifton L Dalgard; Olivier Harari; Yan G Ni; Ming-Dauh Wang; Kishor Devalaraja-Narashimha; Poorani Subramanian; Rabia Ergelen; Reha Artan; Sukru Nail Guner; Buket Dalgic; John Tsang; Yasmine Belkaid; Deniz Ertem; Safa Baris; Michael J Lenardo

doi:10.1038/s41590-020-00830-z

Broadly effective metabolic and immune recovery with C5 inhibition in CHAPLE disease

Nat Immunol. 2021 Feb;22(2):128-139. doi: 10.1038/s41590-020-00830-z. Epub 2021 Jan 4.

Authors

Ahmet Ozen^{1

2

3}, Nurhan Kasap^{4

5

6}, Ivan Vujkovic-Cvijin⁷, Richard Apps⁸, Foo Cheung⁸, Elif Karakoc-Aydiner^{4

5

6}, Bilge Akkelle⁹, Sinan Sari¹⁰, Engin Tutar⁹, Figen Ozcay¹¹, Dilara Kocacik Uygun¹², Ali Islek¹³, Gamze Akgun^{5

6

14}, Merve Selcuk¹⁵, Oya Balci Sezer¹¹, Yu Zhang^{16

17}, Gunsel Kutluk¹⁸, Erdem Topal¹⁹, Ersin Sayar²⁰, Cigdem Celikel²¹, Roderick H J Houwen²², Aysen Bingol¹², Ismail Ogulur^{4

5

6}, Sevgi Bilgic Eltan^{5

6

14}, Andrew L Snow²³, Camille Lake²³, Giovanna Fantoni⁸, Camille Alba²⁴, Brian Sellers⁸, Samuel D Chauvin^{17

25}, Clifton L Dalgard²⁶, Olivier Harari²⁷, Yan G Ni²⁷, Ming-Dauh Wang²⁷, Kishor Devalaraja-Narashimha²⁷, Poorani Subramanian²⁸, Rabia Ergelen²⁹, Reha Artan³⁰, Sukru Nail Guner³¹, Buket Dalgic¹⁰, John Tsang⁸, Yasmine Belkaid^{7

8}, Deniz Ertem⁹, Safa Baris^{4

5

6}, Michael J Lenardo^{32

33}

Affiliations

¹ Division of Allergy and Immunology, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Turkey. [email protected].
² Istanbul Jeffrey Modell Diagnostic Center for Primary Immunodeficiency Diseases, Istanbul, Turkey. [email protected].
³ The Isil Berat Barlan Center for Translational Medicine, Istanbul, Turkey. [email protected].
⁴ Division of Allergy and Immunology, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Turkey.
⁵ Istanbul Jeffrey Modell Diagnostic Center for Primary Immunodeficiency Diseases, Istanbul, Turkey.
⁶ The Isil Berat Barlan Center for Translational Medicine, Istanbul, Turkey.
⁷ Metaorganism Immunity Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA.
⁸ Trans-NIH Center for Human Immunology, Autoimmunity, and Inflammation, NIH, Bethesda, MD, USA.
⁹ Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Turkey.
¹⁰ Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Gazi University, Ankara, Turkey.
¹¹ Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Baskent University Hospital, Ankara, Turkey.
¹² Division of Allergy and Immunology, Department of Pediatrics, School of Medicine, Akdeniz University, Antalya, Turkey.
¹³ Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Ataturk University, Erzurum, Turkey.
¹⁴ Division of Allergy and Immunology, Department of Pediatrics, Ministry of Health, Marmara University, Istanbul, Turkey.
¹⁵ Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Turkey.
¹⁶ Human Immunological Diseases Section, Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD, USA.
¹⁷ Clinical Genomics Program, NIAID, NIH, Bethesda, MD, USA.
¹⁸ Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Kanuni Sultan Süleyman Training and Research Hospital, Health Sciences University, Istanbul, Turkey.
¹⁹ Division of Allergy and Immunology, Department of Pediatrics, School of Medicine, Inonu University, Malatya, Turkey.
²⁰ Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Alanya Alaaddin Keykubat University, Alanya, Turkey.
²¹ Department of Pathology, School of Medicine, Marmara University, Istanbul, Turkey.
²² Department of Pediatric Gastroenterology, University Medical Center-Wilhelmina Children's Hospital, Utrecht, the Netherlands.
²³ Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
²⁴ The American Genome Center, Henry Jackson Foundation, Uniformed Services University of Health Sciences, Bethesda, MD, USA.
²⁵ Molecular Development of the Immune System Section and NIAID Clinical Genomics Program, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA.
²⁶ Department of Anatomy, Physiology and Genetics, The American Genome Center, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
²⁷ Regeneron Pharmaceuticals, Inc, Tarrytown, NY, USA.
²⁸ Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, NIAID, NIH, Bethesda, MD, USA.
²⁹ Department of Radiology, School of Medicine, Marmara University, Istanbul, Turkey.
³⁰ Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Akdeniz University, Antalya, Turkey.
³¹ Division of Pediatric Allergy and Immunology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey.
³² Clinical Genomics Program, NIAID, NIH, Bethesda, MD, USA. [email protected].
³³ Molecular Development of the Immune System Section and NIAID Clinical Genomics Program, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA. [email protected].

Abstract

Complement hyperactivation, angiopathic thrombosis and protein-losing enteropathy (CHAPLE disease) is a lethal disease caused by genetic loss of the complement regulatory protein CD55, leading to overactivation of complement and innate immunity together with immunodeficiency due to immunoglobulin wasting in the intestine. We report in vivo human data accumulated using the complement C5 inhibitor eculizumab for the medical treatment of patients with CHAPLE disease. We observed cessation of gastrointestinal pathology together with restoration of normal immunity and metabolism. We found that patients rapidly renormalized immunoglobulin concentrations and other serum proteins as revealed by aptamer profiling, re-established a healthy gut microbiome, discontinued immunoglobulin replacement and other treatments and exhibited catch-up growth. Thus, we show that blockade of C5 by eculizumab effectively re-establishes regulation of the innate immune complement system to substantially reduce the pathophysiological manifestations of CD55 deficiency in humans.

Publication types

Observational Study
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't

MeSH terms

Antibodies, Monoclonal, Humanized / adverse effects
Antibodies, Monoclonal, Humanized / pharmacokinetics
Antibodies, Monoclonal, Humanized / therapeutic use*
Biomarkers / blood
CD55 Antigens / deficiency
CD55 Antigens / genetics
Complement Activation / drug effects*
Complement C5 / antagonists & inhibitors*
Complement C5 / metabolism
Complement Inactivating Agents / adverse effects
Complement Inactivating Agents / pharmacokinetics
Complement Inactivating Agents / therapeutic use*
Energy Metabolism / drug effects*
Genetic Predisposition to Disease
Humans
Hypoproteinemia / drug therapy*
Hypoproteinemia / genetics
Hypoproteinemia / immunology
Hypoproteinemia / metabolism
Immunity, Innate / drug effects*
Mutation
Phenotype
Protein-Losing Enteropathies / drug therapy*
Protein-Losing Enteropathies / genetics
Protein-Losing Enteropathies / immunology
Protein-Losing Enteropathies / metabolism
Treatment Outcome

Substances

Antibodies, Monoclonal, Humanized
Biomarkers
CD55 Antigens
Complement C5
Complement Inactivating Agents
eculizumab

Abstract

Publication types

MeSH terms

Substances

Grants and funding