Complement in neurological disorders and emerging complement-targeted therapeutics

Nat Rev Neurol. 2020 Nov;16(11):601-617. doi: 10.1038/s41582-020-0400-0. Epub 2020 Oct 1.

Abstract

The complement system consists of a network of plasma and membrane proteins that modulate tissue homeostasis and contribute to immune surveillance by interacting with the innate and adaptive immune systems. Dysregulation, impairment or inadvertent activation of complement components contribute to the pathogenesis of some autoimmune neurological disorders and could even contribute to neurodegenerative diseases. In this Review, we summarize current knowledge about the main functions of the complement pathways and the involvement of complement in neurological disorders. We describe the complex network of complement proteins that target muscle, the neuromuscular junction, peripheral nerves, the spinal cord or the brain and discuss the autoimmune mechanisms of complement-mediated myopathies, myasthenia, peripheral neuropathies, neuromyelitis and other CNS disorders. We also consider the emerging role of complement in some neurodegenerative diseases, such as Alzheimer disease, amyotrophic lateral sclerosis and even schizophrenia. Finally, we provide an overview of the latest complement-targeted immunotherapies including monoclonal antibodies, fusion proteins and peptidomimetics that have been approved, that are undergoing phase I-III clinical trials or that show promise for the treatment of neurological conditions that respond poorly to existing immunotherapies.

Publication types

  • Review

MeSH terms

  • Animals
  • Complement Inactivating Agents / administration & dosage*
  • Complement Inactivator Proteins / administration & dosage
  • Complement Inactivator Proteins / immunology
  • Complement System Proteins / immunology*
  • Complement System Proteins / metabolism
  • Drug Delivery Systems / methods
  • Drug Delivery Systems / trends*
  • Humans
  • Immunoglobulins, Intravenous / administration & dosage
  • Immunoglobulins, Intravenous / immunology
  • Immunotherapy / methods
  • Immunotherapy / trends*
  • Nervous System Diseases / immunology*
  • Nervous System Diseases / therapy*
  • Signal Transduction / drug effects
  • Signal Transduction / immunology
  • Synapses / drug effects
  • Synapses / immunology

Substances

  • Complement Inactivating Agents
  • Complement Inactivator Proteins
  • Immunoglobulins, Intravenous
  • Complement System Proteins