Bongoni Anjan K, Kiss Bence, McRae Jennifer L, Salvaris Evelyn J, Fisicaro Nella, Muntz Fenella, Németh Bálint Zoltán, Nagy Zoltán Attila, Kocsis Andrea, Gál Péter, Cowan Peter J, Pál Gábor
Immunology Research Centre, St. Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia.
Department of Biochemistry, Eötvös Loránd University, Budapest H-1117, Hungary.
Proc Natl Acad Sci U S A. 2025 Apr 22;122(16):e2424754122. doi: 10.1073/pnas.2424754122. Epub 2025 Apr 14.
Renal ischemia-reperfusion injury (IRI) is a common complication in several clinical scenarios including kidney transplantation. Mannan-binding lectin-associated serine proteinase (MASP)-2 is essential for activation of the complement lectin pathway, which has been implicated in the pathogenesis of renal IRI and therefore represents a potential therapeutic target. We developed a new, affinity-enhanced MASP-2 inhibitor, EVO24, by directed evolution of the D2 domain of human tissue factor pathway inhibitor. EVO24 was fused with a human IgG1-Fc to create the homodimer EVO24L, which potently and selectively inhibited the lectin pathway in human and mouse serum in vitro. EVO24L was tested in a mouse model of unilateral warm renal IRI. EVO24L administered before and after ischemia significantly protected against IRI, with improved renal function as well as reduced tubular injury and inflammatory cell infiltration at 24 h compared to vehicle-treated mice. Immunofluorescence analyses showed reduced deposition of complement components (C3d, C4d, and C9) and reduced expression of VCAM-1, indicating a decrease in complement activation and endothelial cell activation. Additionally, EVO24L treatment lowered plasma levels of complement C5a, hyaluronan (a marker of endothelial glycocalyx shedding), and the proinflammatory cytokines IL-6 and TNF-α. Our findings indicate that EVO24L inhibits acute inflammatory responses in renal IRI by blocking the lectin pathway, confirming the important role of this pathway in acute ischemic kidney injury and warranting further investigation of EVO24L in clinical settings.
肾缺血再灌注损伤(IRI)是包括肾移植在内的多种临床情况下常见的并发症。甘露聚糖结合凝集素相关丝氨酸蛋白酶(MASP)-2对于补体凝集素途径的激活至关重要,该途径已被认为与肾IRI的发病机制有关,因此是一个潜在的治疗靶点。我们通过对人组织因子途径抑制剂的D2结构域进行定向进化,开发了一种新型的、亲和力增强的MASP-2抑制剂EVO24。EVO24与人IgG1-Fc融合,产生同型二聚体EVO24L,其在体外能有效且选择性地抑制人和小鼠血清中的凝集素途径。EVO24L在单侧温缺血性肾IRI小鼠模型中进行了测试。与载体处理的小鼠相比,在缺血前后给予EVO24L能显著保护肾脏免受IRI损伤,在24小时时肾功能得到改善,肾小管损伤减轻,炎症细胞浸润减少。免疫荧光分析显示补体成分(C3d、C4d和C9)的沉积减少,血管细胞黏附分子-1(VCAM-1)的表达降低,表明补体激活和内皮细胞激活减少。此外,EVO24L治疗降低了血浆中补体C5a、透明质酸(内皮糖萼脱落的标志物)以及促炎细胞因子白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的水平。我们的研究结果表明,EVO24L通过阻断凝集素途径抑制肾IRI中的急性炎症反应,证实了该途径在急性缺血性肾损伤中的重要作用,并值得在临床环境中对EVO24L进行进一步研究。
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