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Alternative complement pathway inhibition does not abrogate meningococcal killing by serum of vaccinated individuals
Journal
Front Immunol
Volume
12
Pages / Article-Number
747594
Keywords
Neisseria meningitidis; alternative pathway; complement inhibitor; immunotherapy; vaccination; between Novartis Pharma AG and the Swiss Tropical and Public Health Institute.; The funders initiated study design and decision to implement the SBA assay and; compare activity of the tested drugs. The funders had no role in data collection; and analysis. GP has received a research grant from Novartis Pharma AG. AS, CT,; NZ, TH, and MK are full-time employees of Novartis. The remaining authors declare; that the research was conducted in the absence of any commercial or financial; relationships that could be construed as a potential conflict of interest.
Dysregulation of complement activation causes a number of diseases, including paroxysmal nocturnal hemoglobinuria and atypical hemolytic uremic syndrome. These conditions can be treated with monoclonal antibodies (mAbs) that bind to the complement component C5 and prevent formation of the membrane attack complex (MAC). While MAC is involved in uncontrolled lysis of erythrocytes in these patients, it is also required for serum bactericidal activity (SBA), i.e. clearance of encapsulated bacteria. Therefore, terminal complement blockage in these patients increases the risk of invasive disease by Neisseria meningitidis more than 1000-fold compared to the general population, despite obligatory vaccination. It is assumed that alternative instead of terminal pathway inhibition reduces the risk of meningococcal disease in vaccinated individuals. To address this, we investigated the SBA with alternative pathway inhibitors. Serum was collected from adults before and after vaccination with a meningococcal serogroup A, C, W, Y capsule conjugate vaccine and tested for meningococcal killing in the presence of factor B and D, C3, C5 and MASP-2 inhibitors. B meningococci were not included in this study since the immune response against protein-based vaccines is more complex. Unsurprisingly, inhibition of C5 abrogated killing of meningococci by all sera. In contrast, both factor B and D inhibitors affected meningococcal killing in sera from individuals with low, but not with high bactericidal anti-capsular titers. While the anti-MASP-2 mAb did not impair SBA, inhibition of C3 impeded meningococcal killing in most, but not in all sera. These data provide evidence that vaccination can provide protection against invasive meningococcal disease in patients treated with alternative pathway inhibitors.
