==== Reference: Usmani SS, Bedi G, Samuel JS, Singh S, Kalra S, Kumar P, et al. (2017) THPdb: Database of FDA-approved peptide and protein therapeutics. PLoS ONE 12(7) e0181748.====

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1831 details
Primary information
ThPP IDTh1221
Therapeutic Peptide/Protein NameC1 Esterase Inhibitor (Recombinant)
SequenceNA view full sequnce in fasta
Functional ClassificationIIa
Molecular Weight67000
Chemical FormulaNA
Isoelectric PointNA
HydrophobicityNA
Melting Point (℃)NA
Half Life2.4-2.7 hr
DescriptionC1 Esterase Inhibitor (Recombinant) is a recombinant analogue of endogenous complement component-1 esterase inhibitor (rhC1INH), purified from the milk of transgenic rabbits. The primary function of endogenous C1INH is to regulate the activation of the complement and contact system pathways. It does this through inhibition of several target proteases within these pathways including activated C1s, kallikrein, factor XIIa and factor XIa. C1 esterase inhibitor has also been shown to inhibit the action of thrombin within the coagulation pathway, and tPA and plasmin within the fibrinolytic pathway. Deficiency of C1-inhibitor permits plasma kallikrein activation, which leads to the production of the vasoactive peptide bradykinin. Additionally, C4 and C2 cleavage goes unchecked, resulting in auto-activation of the complement system. Down-stream effects of the lack of enzyme inhibition by C1 esterase inhibitor results in swelling due to leakage of fluid from blood vessels into connective tissue and consequently the presentation of hereditary angioedema (HAE). Marketed as the product Ruconest (FDA), this drug is indicated for the treatment of acute attacks of hereditary angioedema (HAE) due to C1 esterase inhibitor deficiency in adults. Intravenous replacement of C1 esterase inhibitor results in reversal of acute symptoms of HAE.
Indication/DiseaseFor the treatment of acute attacks of hereditary angioedema (HAE) due to C1 esterase inhibitor deficiency in adults.
PharmacodynamicsA dose of 50 U/kg of Ruconest increases plasma C1INH activity levels to greater than 0.7 U/mL (the lower limit of normal) in HAE patients.
Mechanism of ActionThe primary function of endogenous C1INH is to regulate the activation of the complement and contact system pathways. It does this through inhibition of several target proteases within these pathways including activated C1s, kallikrein, factor XIIa and factor XIa. C1 esterase inhibitor has also been shown to inhibit the action of thrombin within the coagulation pathway, and tPA and plasmin within the fibrinolytic pathway. Deficiency of C1-inhibitor permits plasma kallikrein activation, which leads to the production of the vasoactive peptide bradykinin. Additionally, C4 and C2 cleavage goes unchecked, resulting in auto-activation of the complement system. Down-stream effects of the lack of enzyme inhibition by C1 esterase inhibitor results in swelling due to leakage of fluid from blood vessels into connective tissue and consequently the presentation of hereditary angioedema (HAE). Replacement of C1 esterase inhibitor results in a reversal of these effects.
ToxicityThe common adverse reactions (≥ 2%) reported in clinical trials were headache, nausea, and diarrhea. Serious arterial and venous thromboembolic (TE) events have been reported at the recommended dose of plasma derived C1 esterase inhibitor products in patients with risk factors. Risk factors may include the presence of an indwelling venous catheter/access device, prior history of thrombosis, underlying atherosclerosis, use of oral contraceptives or certain androgens, morbid obesity, and immobility. Monitor patients with known risk factors for TE events during and after administration.
MetabolismNA
AbsorptionMean Cmax was found to be 1.2 U/mL and Tmax was 0.31 ± 0.10 hr following administration of 50 U/kg.
Volume of DistributionNA
ClearanceClearance was found to be 1207 ± 414 mL/hr following administration of 50 U/kg.
CategoriesBlood and Blood Forming Organs
Patents NumberNA
Date of IssueNA
Date of ExpiryNA
Drug InteractionAllylestrenol, Altrenogest, Bazedoxifene, Chlorotrianisene, Conjugated Equine Estrogens, Desogestrel, Dienestrol, Dienogest, Diethylstilbestrol, Dihydrotestosterone may increase the thrombogenic activities of C1 Esterase Inhibitor (Recombinant).
TargetComplement C1r subcomponent, Complement C1s subcomponent, Plasma kallikrein, Coagulation factor XII, Prothrombin, Coagulation factor XI, Tissue-type plasminogen activator
Information of corresponding available drug in the market
Brand NameRuconest
CompanyTjoapack Netherlands Bv
Brand DiscriptionRuconest (conestat alfa) is a recombinant human C1 esterase inhibitor approved for the treatment of angioedema attacks in patients with HAE in the USA, Israel, all 28 EU countries plus Norway, Iceland and Liechtenstein
Prescribed forIndicated for treatment of acute attacks in adult and adolescent patients with hereditary angioedema (HAE)
Chemical NameNA
FormulationNA
Physcial AppearncePowder and liquid for solution
Route of AdministrationIntravenous
Recommended Dosage<84 kg: 50 IU/kg infused over 5 minutes; not to exceed 4200 IU/dose
ContraindicationHistory of life-threatening immediate hypersensitivity reactions to C1 esterase inhibitor preparations, including anaphylaxis
Side EffectsSevere hypersensitivity reactions may occur during or after injection; signs and symptoms include hives, generalized urticaria, tightness of the chest, wheezing, hypotension, and/or anaphylaxis
Useful Linkhttps://www.fda.gov/downloads/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/LicensedProductsBLAs/FractionatedPlasmaProducts/UCM405634.pdf , http://reference.medscape.com/drug/ruconest-c1-esterase-inhibitor-recombinant-999953#5
PubMed ID16267649, 123251, 13734157, 6184384, 6725552, 11460008, 3756141
3-D StructureN.A.