Published online May 6, 2015. doi: 10.5527/wjn.v4.i2.169
Peer-review started: August 30, 2014
First decision: December 2, 2014
Revised: December 22, 2014
Accepted: January 15, 2015
Article in press: January 19, 2015
Published online: May 6, 2015
Complement cascade is involved in several renal diseases and in renal transplantation. The different components of the complement cascade might represent an optimal target for innovative therapies. In the first section of the paper the authors review the physiopathology of complement involvement in renal diseases and transplantation. In some cases this led to a reclassification of renal diseases moving from a histopathological to a physiopathological classification. The principal issues afforded are: renal diseases with complement over activation, renal diseases with complement dysregulation, progression of renal diseases and renal transplantation. In the second section the authors discuss the several complement components that could represent a therapeutic target. Even if only the anti C5 monoclonal antibody is on the market, many targets as C1, C3, C5a and C5aR are the object of national or international trials. In addition, many molecules proved to be effective in vitro or in preclinical trials and are waiting to move to human trials in the future.
Core tip: Our therapeutical armamentarium is to date limited in many kidney diseases and in several aspects of renal transplantation. The findings that complement cascade is involved in many kidney diseases and in renal transplantation offer the availability of new therapeutical targets basing on the pathogenesis. The anti C5 monoclonal antibody, eculizumab, is now used to treat the atypical hemolytic uremic syndrome (aHUS), but 24 trials are ongoing in different renal diseases and in renal transplantation. Other targets as C1, C3, C5a, and C5aR are innovative treatments for diseases as aHUS, membranoproliferative glomerulonephritis, ischemia-reperfusion injury, and objects of ongoing trials.