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

Division of Allergy and Immunology, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Turkey. ahmet.ozen@marmara.edu.tr. Istanbul Jeffrey Modell Diagnostic Center for Primary Immunodeficiency Diseases, Istanbul, Turkey. ahmet.ozen@marmara.edu.tr. The Isil Berat Barlan Center for Translational Medicine, Istanbul, Turkey. ahmet.ozen@marmara.edu.tr. Division of Allergy and Immunology, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Turkey. Istanbul Jeffrey Modell Diagnostic Center for Primary Immunodeficiency Diseases, Istanbul, Turkey. The Isil Berat Barlan Center for Translational Medicine, Istanbul, Turkey. Metaorganism Immunity Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA. Trans-NIH Center for Human Immunology, Autoimmunity, and Inflammation, NIH, Bethesda, MD, USA. Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Turkey. Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Gazi University, Ankara, Turkey. Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Baskent University Hospital, Ankara, Turkey. Division of Allergy and Immunology, Department of Pediatrics, School of Medicine, Akdeniz University, Antalya, Turkey. Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Ataturk University, Erzurum, Turkey. Division of Allergy and Immunology, Department of Pediatrics, Ministry of Health, Marmara University, Istanbul, Turkey. Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Turkey. Human Immunological Diseases Section, Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD, USA. Clinical Genomics Program, NIAID, NIH, Bethesda, MD, USA. Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Kanuni Sultan Süleyman Training and Research Hospital, Health Sciences University, Istanbul, Turkey. Division of Allergy and Immunology, Department of Pediatrics, School of Medicine, Inonu University, Malatya, Turkey. Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Alanya Alaaddin Keykubat University, Alanya, Turkey. Department of Pathology, School of Medicine, Marmara University, Istanbul, Turkey. Department of Pediatric Gastroenterology, University Medical Center-Wilhelmina Children's Hospital, Utrecht, the Netherlands. Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. The American Genome Center, Henry Jackson Foundation, Uniformed Services University of Health Sciences, Bethesda, MD, USA. Molecular Development of the Immune System Section and NIAID Clinical Genomics Program, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA. Department of Anatomy, Physiology and Genetics, The American Genome Center, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. Regeneron Pharmaceuticals, Inc, Tarrytown, NY, USA. Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, NIAID, NIH, Bethesda, MD, USA. Department of Radiology, School of Medicine, Marmara University, Istanbul, Turkey. Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Akdeniz University, Antalya, Turkey. Division of Pediatric Allergy and Immunology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey. Clinical Genomics Program, NIAID, NIH, Bethesda, MD, USA. lenardo@nih.gov. Molecular Development of the Immune System Section and NIAID Clinical Genomics Program, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA. lenardo@nih.gov.

Nature immunology. 2021;(2):128-139

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.

Methodological quality

Publication Type : Observational Study

Metadata