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Prevention of Anti-HMGCR Immune-Mediated Necrotising Myopathy by C5 Complement Inhibition in a Humanised Mouse Model
oleh: Sarah Julien, Douangsone Vadysirisack, Camil Sayegh, Sharan Ragunathan, Yalan Tang, Emma Briand, Marion Carrette, Laetitia Jean, Rachid Zoubairi, Henri Gondé, Olivier Benveniste, Yves Allenbach, Laurent Drouot, Olivier Boyer
Format: | Article |
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Diterbitkan: | MDPI AG 2022-08-01 |
Deskripsi
<b>Introduction</b>: immune-mediated necrotising myopathy (IMNM) is associated with pathogenic anti-signal recognition particle (SRP) or 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) antibodies, at least partly through activation of the classical pathway of the complement. We evaluated zilucoplan, an investigational drug, and a macrocyclic peptide inhibitor of complement component 5 (C5), in humanized mouse models of IMNM. <b>Methods</b>: purified immunoglobulin G (IgG) from an anti-HMGCR<sup>+</sup> IMNM patient was co-injected intraperitoneally with human complement in C57BL/6, C5-deficient B10 (C5<sup>def</sup>) and Rag2 deficient (Rag2<sup>−/−</sup>) mice. Zilucoplan was administered subcutaneously in a preventive or interventional paradigm, either injected daily throughout the duration of the experiment in C57BL/6 and C5<sup>def</sup> mice or 8 days after disease induction in Rag2<sup>−/−</sup> mice. <b>Results</b>: prophylactic administration of zilucoplan prevented muscle strength loss in C5<sup>def</sup> mice (anti-HMGCR<sup>+</sup> vs. anti-HMGCR<sup>+</sup> + zilucoplan: <i>p</i> = 0.0289; control vs. anti-HMGCR<sup>+</sup> + zilucoplan: <i>p</i> = 0.4634) and wild-type C57BL/6 (anti-HMGCR<sup>+</sup> vs. anti-HMGCR<sup>+</sup> + zilucoplan: <i>p</i> = 0.0002; control vs. anti-HMGCR<sup>+</sup> + zilucoplan: <i>p</i> = 0.0939) with corresponding reduction in C5b-9 deposits on myofibres and number of regenerated myofibres. Interventional treatment of zilucoplan after disease induction reduced the complement deposits and number of regenerated myofibres in muscles of Rag2<sup>−/−</sup> mice, although to a lesser extent. In this latter setting, C5 inhibition did not significantly ameliorate muscle strength. <b>Conclusion</b>: Early administration of zilucoplan prevents the onset of myopathy at the clinical and histological level in a humanized mouse model of IMNM.