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Review ArticleReview

C1-Esterase Inhibitor: An Anti-Inflammatory Agent and Its Potential Use in the Treatment of Diseases Other Than Hereditary Angioedema

C. Caliezi, W. A. Wuillemin, S. Zeerleder, M. Redondo, B. Eisele and C. E. Hack
Pharmacological Reviews March 2000, 52 (1) 91-112;
C. Caliezi
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W. A. Wuillemin
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S. Zeerleder
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M. Redondo
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B. Eisele
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Abstract

C1-esterase inhibitor (C1-Inh) therapy was introduced in clinical medicine about 25 years ago as a replacement therapy for patients with hereditary angioedema caused by a deficiency of C1-Inh. There is now accumulating evidence, obtained from studies in animals and observations in patients, that administration of C1-Inh may have a beneficial effect as well in other clinical conditions such as sepsis, cytokine-induced vascular leak syndrome, acute myocardial infarction, or other diseases. Activation of the complement system, the contact activation system, and the coagulation system has been observed in these diseases. A typical feature of the contact and complement system is that on activation they give rise to vasoactive peptides such as bradykinin or the anaphylatoxins, which in part explains the proinflammatory effects of either system. C1-Inh, belonging to the superfamily of serine proteinase inhibitors (serpins), is a major inhibitor of the classical complement pathway, the contact activation system, and the intrinsic pathway of coagulation, respectively. It is, therefore, endowed with anti-inflammatory properties. However, inactivation of C1-Inh occurs locally in inflamed tissues by proteolytic enzymes (e.g., elastase) released from activated neutrophils or bacteria thereby leading to increased local activation of the various host defense systems. Here we will give an overview on the biochemistry and biology of C1-Inh. We will discuss studies addressing therapeutic administration of C1-Inh in experimental and clinical conditions. Finally, we will provide an explanation for the therapeutic benefit of C1-Inh in so many different diseases.

Footnotes

  • ↵1 Address for correspondence: Walter A. Wuillemin, M.D., Ph.D., Division of Haematology, Departement of Internal Medicine, Kantonsspital, 6000 Lucerne 16, Switzerland. E-mail: walter.wuillemin{at}KSL.GSD.LU.ch

  • W.A.W. and S.Z. are supported by a grant from the Swiss National Foundation for Scientific Research (3200-55312.98). C.C. is supported by an unrestricted grant from Centeon Pharma Schweiz AG.

  • The American Society for Pharmacology and Experimental Therapeutics
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Pharmacological Reviews: 52 (1)
Pharmacological Reviews
Vol. 52, Issue 1
1 Mar 2000
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Review ArticleReview

C1-Esterase Inhibitor: An Anti-Inflammatory Agent and Its Potential Use in the Treatment of Diseases Other Than Hereditary Angioedema

C. Caliezi, W. A. Wuillemin, S. Zeerleder, M. Redondo, B. Eisele and C. E. Hack
Pharmacological Reviews March 1, 2000, 52 (1) 91-112;

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Review ArticleReview

C1-Esterase Inhibitor: An Anti-Inflammatory Agent and Its Potential Use in the Treatment of Diseases Other Than Hereditary Angioedema

C. Caliezi, W. A. Wuillemin, S. Zeerleder, M. Redondo, B. Eisele and C. E. Hack
Pharmacological Reviews March 1, 2000, 52 (1) 91-112;
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  • Article
    • Abstract
    • I. Introduction
    • II. Biochemistry and Biology of C1-Inh
    • III. C1-Inh As Inactivator of Plasma Cascade Systems and Leukocytes
    • IV. Potentiation of C1-Inh Activity by Glycosaminoglycans
    • V. C1-Inh Therapy in Animal Models and Clinical Disease
    • VI. CRP-Mediated Complement Activation: A Common Target for C1-Inh Therapy?
    • VII. Summary
    • Acknowledgment
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    • Abbreviations
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