补体抑制剂在神经系统自身免疫性疾病临床 应用中的研究进展
Research Progress on the Clinical Application of Complement Inhibitors in Autoimmune Diseases of the Nervous System
DOI: 10.12677/acm.2026.162717, PDF,   
作者: 刘超群:济宁医学院临床医学院(附属医院),山东 济宁;王玉忠*:济宁医学院附属医院神经内科,山东 济宁;济宁医学院附属医院医学研究中心,山东 济宁
关键词: 补体系统补体抑制剂神经免疫疾病Complement System Complement Inhibitors Autoimmune Diseases of the Nervous System
摘要: 神经系统自身免疫性疾病是一类由机体免疫系统异常激活,错误攻击自身神经系统组织所导致的疾病。补体系统的异常激活被认为是导致神经元损伤和炎症反应的关键因素,通过特异性抑制补体级联反应可以有效阻断补体激活引起的组织损伤和炎症反应。随着对补体系统的深入研究,补体抑制剂作为一种新兴的治疗策略,逐渐成为研究热点。本文分析补体在神经系统自身免疫性疾病中的作用机制,总结近年来补体抑制剂治疗神经系统自身免疫性疾病的研究进展,旨在为补体抑制剂临床研究及应用提供参考。
Abstract: Autoimmune diseases of the nervous system are a class of disorders caused by the abnormal activation of the body’s immune system, which mistakenly attacks its own nervous system tissues. The abnormal activation of the complement system is considered a key factor leading to neuronal damage and inflammatory responses. Specific inhibition of the complement cascade can effectively block tissue damage and inflammatory responses caused by complement activation. With the in-depth study of the complement system, complement inhibitors have gradually become a research hotspot as an emerging therapeutic strategy. This article analyzes the mechanisms by which complement contributes to autoimmune diseases of the nervous system and summarizes recent research progress on the therapeutic effects of complement inhibitors in these diseases, aiming to provide reference for clinical research and application of complement inhibitors.
文章引用:刘超群, 王玉忠. 补体抑制剂在神经系统自身免疫性疾病临床 应用中的研究进展[J]. 临床医学进展, 2026, 16(2): 3042-3052. https://doi.org/10.12677/acm.2026.162717

参考文献

[1] Conigliaro, P., Triggianese, P., Ballanti, E., Perricone, C., Perricone, R. and Chimenti, M.S. (2019) Complement, Infection, and Autoimmunity. Current Opinion in Rheumatology, 31, 532-541. [Google Scholar] [CrossRef] [PubMed]
[2] Dalakas, M.C., Alexopoulos, H. and Spaeth, P.J. (2020) Complement in Neurological Disorders and Emerging Complement-Targeted Therapeutics. Nature Reviews Neurology, 16, 601-617. [Google Scholar] [CrossRef] [PubMed]
[3] Karnaukhova, E. (2022) C1-Inhibitor: Structure, Functional Diversity and Therapeutic Development. Current Medicinal Chemistry, 29, 467-488. [Google Scholar] [CrossRef] [PubMed]
[4] Loveless, S., Neal, J.W., Howell, O.W., Harding, K.E., Sarkies, P., Evans, R., et al. (2017) Tissue Microarray Methodology Identifies Complement Pathway Activation and Dysregulation in Progressive Multiple Sclerosis. Brain Pathology, 28, 507-520. [Google Scholar] [CrossRef] [PubMed]
[5] Lucchinetti, C., Brück, W., Parisi, J., Scheithauer, B., Rodriguez, M. and Lassmann, H. (2000) Heterogeneity of Multiple Sclerosis Lesions: Implications for the Pathogenesis of Demyelination. Annals of Neurology, 47, 707-717. [Google Scholar] [CrossRef] [PubMed]
[6] Ingram, G., Loveless, S., Howell, O.W., Hakobyan, S., Dancey, B., Harris, C.L., et al. (2014) Complement Activation in Multiple Sclerosis Plaques: An Immunohistochemical Analysis. Acta Neuropathologica Communications, 2, Article No. 53. [Google Scholar] [CrossRef] [PubMed]
[7] Rus, H., Cudrici, C. and Niculescu, F. (2005) C5b‐9 Complement Complex in Autoimmune Demyelination and Multiple sclerosis: Dual Role in Neuroinflammation and Neuroprotection. Annals of Medicine, 37, 97-104. [Google Scholar] [CrossRef] [PubMed]
[8] Cooze, B.J., Dickerson, M., Loganathan, R., Watkins, L.M., Grounds, E., Pearson, B.R., et al. (2022) The Association between Neurodegeneration and Local Complement Activation in the Thalamus to Progressive Multiple Sclerosis Outcome. Brain Pathology, 32, e13054. [Google Scholar] [CrossRef] [PubMed]
[9] Oechtering, J., Schaedelin, S.A., Stein, K., Maleska Maceski, A., Melie-Garcia, L., Benkert, P., et al. (2025) Aberrant Complement Activation Is Associated with Structural Brain Damage in Multiple Sclerosis. Neurology Neuroimmunology & Neuroinflammation, 12, e200361. [Google Scholar] [CrossRef] [PubMed]
[10] Piddlesden, S.J., Storch, M.K., Hibbs, M., Freeman, A.M., Lassmann, H. and Morgan, B.P. (1994) Soluble Recombinant Complement Receptor 1 Inhibits Inflammation and Demyelination in Antibody-Mediated Demyelinating Experimental Allergic Encephalomyelitis. The Journal of Immunology, 152, 5477-5484. [Google Scholar] [CrossRef
[11] Werneburg, S., Jung, J., Kunjamma, R.B., Ha, S., Luciano, N.J., Willis, C.M., et al. (2020) Targeted Complement Inhibition at Synapses Prevents Microglial Synaptic Engulfment and Synapse Loss in Demyelinating Disease. Immunity, 52, 167-182.e7. [Google Scholar] [CrossRef] [PubMed]
[12] Pittock, S.J., Berthele, A., Fujihara, K., Kim, H.J., Levy, M., Palace, J., et al. (2019) Eculizumab in Aquaporin-4-Positive Neuromyelitis Optica Spectrum Disorder. New England Journal of Medicine, 381, 614-625. [Google Scholar] [CrossRef] [PubMed]
[13] Soltys, J., Liu, Y., Ritchie, A., Wemlinger, S., Schaller, K., Schumann, H., et al. (2019) Membrane Assembly of Aquaporin-4 Autoantibodies Regulates Classical Complement Activation in Neuromyelitis Optica. Journal of Clinical Investigation, 129, 2000-2013. [Google Scholar] [CrossRef] [PubMed]
[14] Carnero Contentti, E. and Correale, J. (2021) Neuromyelitis Optica Spectrum Disorders: From Pathophysiology to Therapeutic Strategies. Journal of Neuroinflammation, 18, Article No. 208. [Google Scholar] [CrossRef] [PubMed]
[15] Mastellos, D.C., Hajishengallis, G. and Lambris, J.D. (2023) A Guide to Complement Biology, Pathology and Therapeutic Opportunity. Nature Reviews Immunology, 24, 118-141. [Google Scholar] [CrossRef] [PubMed]
[16] Huang, T., Wang, J., Chang, P., Hsu, Y., Lin, C., Lin, K., et al. (2022) Neuromyelitis Optica Spectrum Disorder: From Basic Research to Clinical Perspectives. International Journal of Molecular Sciences, 23, Article 7908. [Google Scholar] [CrossRef] [PubMed]
[17] Pittock, S.J., Lennon, V.A., McKeon, A., Mandrekar, J., Weinshenker, B.G., Lucchinetti, C.F., et al. (2013) Eculizumab in AQP4-IGG-Positive Relapsing Neuromyelitis Optica Spectrum Disorders: An Open-Label Pilot Study. The Lancet Neurology, 12, 554-562. [Google Scholar] [CrossRef] [PubMed]
[18] Duchow, A., Paul, F. and Bellmann-Strobl, J. (2020) Current and Emerging Biologics for the Treatment of Neuromyelitis Optica Spectrum Disorders. Expert Opinion on Biological Therapy, 20, 1061-1072. [Google Scholar] [CrossRef] [PubMed]
[19] 中华医学会神经病学分会神经免疫学组. 中国视神经脊髓炎谱系疾病诊断与治疗指南(2025版) [J]. 中华神经科杂志, 2025, 58(7): 687-703.
[20] Pittock, S.J., Barnett, M., Bennett, J.L., Berthele, A., de Sèze, J., Levy, M., et al. (2023) Ravulizumab in Aquaporin‐4-Positive Neuromyelitis Optica Spectrum Disorder. Annals of Neurology, 93, 1053-1068. [Google Scholar] [CrossRef] [PubMed]
[21] Levy, M. and Mealy, M.A. (2014) Purified Human C1-Esterase Inhibitor Is Safe in Acute Relapses of Neuromyelitis Optica. Neurology Neuroimmunology & Neuroinflammation, 1, e5. [Google Scholar] [CrossRef] [PubMed]
[22] Tradtrantip, L., Asavapanumas, N., Phuan, P. and Verkman, A.S. (2014) Potential Therapeutic Benefit of C1-Esterase Inhibitor in Neuromyelitis Optica Evaluated in Vitro and in an Experimental Rat Model. PLOS ONE, 9, e106824. [Google Scholar] [CrossRef] [PubMed]
[23] Sinnathamby, E.S., Issa, P.P., Roberts, L., Norwood, H., Malone, K., Vemulapalli, H., et al. (2023) Hereditary Angioedema: Diagnosis, Clinical Implications, and Pathophysiology. Advances in Therapy, 40, 814-827. [Google Scholar] [CrossRef] [PubMed]
[24] Huda, S., Woodhall, M.R., Vincent, A. and Heckmann, J.M. (2016) Characteristics of Acetylcholine‐Receptor‐Antibody-Negative Myasthenia Gravis in a South African Cohort. Muscle & Nerve, 54, 1023-1029. [Google Scholar] [CrossRef] [PubMed]
[25] Frischauf, N., Strasser, J., Borg, E.G.F., Labrijn, A.F., Beurskens, F.J. and Preiner, J. (2024) Complement Activation by Igg Subclasses Is Governed by Their Ability to Oligomerize Upon Antigen Binding. Proceedings of the National Academy of Sciences, 121, e2406192121. [Google Scholar] [CrossRef] [PubMed]
[26] Cetin, H. and Vincent, A. (2018) Pathogenic Mechanisms and Clinical Correlations in Autoimmune Myasthenic Syndromes. Seminars in Neurology, 38, 344-354. [Google Scholar] [CrossRef] [PubMed]
[27] Engel, A.G., Sahashi, K. and Fumagalli, G. (1981) The Immunopathology of Acquired My Asthenia Gravis. Annals of the New York Academy of Sciences, 377, 158-174. [Google Scholar] [CrossRef] [PubMed]
[28] Romi, F., Kristoffersen, E.K., Aarli, J.A. and Gilhus, N.E. (2005) The Role of Complement in Myasthenia Gravis: Serological Evidence of Complement Consumption in Vivo. Journal of Neuroimmunology, 158, 191-194. [Google Scholar] [CrossRef] [PubMed]
[29] Liu, A., Lin, H., Liu, Y., Cao, X., Wang, X. and Li, Z. (2009) Correlation of C3 Level with Severity of Generalized Myasthenia Gravis. Muscle & Nerve, 40, 801-808. [Google Scholar] [CrossRef] [PubMed]
[30] Lennon, V.A., Seybold, M.E., Lindstrom, J.M., Cochrane, C. and Ulevitch, R. (1978) Role of Complement in the Pathogenesis of Experimental Autoimmune Myasthenia Gravis. The Journal of Experimental Medicine, 147, 973-983. [Google Scholar] [CrossRef] [PubMed]
[31] Morgan, B.P., Chamberlain-Banoub, J., Neal, J.W., Song, W., Mizuno, M. and Harris, C.L. (2006) The Membrane Attack Pathway of Complement Drives Pathology in Passively Induced Experimental Autoimmune Myasthenia Gravis in Mice. Clinical and Experimental Immunology, 146, 294-302. [Google Scholar] [CrossRef] [PubMed]
[32] Chamberlain-Banoub, J., Neal, J.W., Mizuno, M., Harris, C.L. and Morgan, B.P. (2006) Complement Membrane Attack Is Required for Endplate Damage and Clinical Disease in Passive Experimental Myasthenia Gravis in Lewis Rats. Clinical and Experimental Immunology, 146, 278-286. [Google Scholar] [CrossRef] [PubMed]
[33] Howard, J.F., Utsugisawa, K., Benatar, M., Murai, H., Barohn, R.J., Illa, I., et al. (2017) Safety and Efficacy of Eculizumab in Anti-Acetylcholine Receptor Antibody-Positive Refractory Generalised Myasthenia Gravis (REGAIN): A Phase 3, Randomised, Double-Blind, Placebo-Controlled, Multicentre Study. The Lancet Neurology, 16, 976-986. [Google Scholar] [CrossRef] [PubMed]
[34] Muppidi, S., Utsugisawa, K., Benatar, M., Murai, H., Barohn, R.J., Illa, I., et al. (2019) Long‐term Safety and Efficacy of Eculizumab in Generalized Myasthenia Gravis. Muscle & Nerve, 60, 14-24. [Google Scholar] [CrossRef] [PubMed]
[35] Vu, T., Meisel, A., Mantegazza, R., Annane, D., Katsuno, M., Aguzzi, R., et al. (2023) Summary of Research: Terminal Complement Inhibitor Ravulizumab in Generalized Myasthenia Gravis. Neurology and Therapy, 12, 1435-1438. [Google Scholar] [CrossRef] [PubMed]
[36] Meisel, A., Annane, D., Vu, T., Mantegazza, R., Katsuno, M., Aguzzi, R., et al. (2023) Long-Term Efficacy and Safety of Ravulizumab in Adults with Anti-Acetylcholine Receptor Antibody-Positive Generalized Myasthenia Gravis: Results from the Phase 3 CHAMPION MG Open-Label Extension. Journal of Neurology, 270, 3862-3875. [Google Scholar] [CrossRef] [PubMed]
[37] Howard, J.F., Bresch, S., Genge, A., Hewamadduma, C., Hinton, J., Hussain, Y., et al. (2023) Safety and Efficacy of Zilucoplan in Patients with Generalised Myasthenia Gravis (RAISE): A Randomised, Double-Blind, Placebo-Controlled, Phase 3 Study. The Lancet Neurology, 22, 395-406. [Google Scholar] [CrossRef] [PubMed]
[38] Howard, J.F., Bresch, S., Farmakidis, C., Freimer, M., Genge, A., Hewamadduma, C., et al. (2024) Long-Term Safety and Efficacy of Zilucoplan in Patients with Generalized Myasthenia Gravis: Interim Analysis of the RAISE-XT Open-Label Extension Study. Therapeutic Advances in Neurological Disorders, 17, 1-16. [Google Scholar] [CrossRef] [PubMed]
[39] Blanchard, O., Bresch, S., Freimer, M., Hewamadduma, C., Leite, M., Maniaol, A., et al. (2025) P.107 Early and Sustained Response over Time with Zilucoplan in Generalised Myasthenia Gravis: 120-Week Post Hoc Analysis of Raise-XT. Canadian Journal of Neurological Sciences/Journal Canadien des Sciences Neurologiques, 52, S40-S40. [Google Scholar] [CrossRef
[40] Freimer, M., Desai, U., Govindarajan, R., Kang, M.K., Khan, S., Khatri, B., et al. (2025) Switching to Subcutaneous Zilucoplan from Intravenous Complement Component 5 Inhibitors in Generalised Myasthenia Gravis: A Phase IIIB, Open-Label Study. Therapeutic Advances in Neurological Disorders, 18, 1-15. [Google Scholar] [CrossRef] [PubMed]
[41] Hagen, K.M. and Ousman, S.S. (2021) The Neuroimmunology of Guillain-Barré Syndrome and the Potential Role of an Aging Immune System. Frontiers in Aging Neuroscience, 12, Article ID: 613628. [Google Scholar] [CrossRef] [PubMed]
[42] van den Berg, B., Walgaard, C., Drenthen, J., Fokke, C., Jacobs, B.C. and van Doorn, P.A. (2014) Guillain-Barré Syndrome: Pathogenesis, Diagnosis, Treatment and Prognosis. Nature Reviews Neurology, 10, 469-482. [Google Scholar] [CrossRef] [PubMed]
[43] Halstead, S.K., Kalna, G., Islam, M.B., Jahan, I., Mohammad, Q.D., Jacobs, B.C., et al. (2016) Microarray Screening of Guillain-Barré Syndrome Sera for Antibodies to Glycolipid Complexes. Neurology Neuroimmunology & Neuroinflammation, 3, e284. [Google Scholar] [CrossRef] [PubMed]
[44] Rinaldi, S., Brennan, K.M., Kalna, G., Walgaard, C., van Doorn, P., Jacobs, B.C., et al. (2013) Antibodies to Heteromeric Glycolipid Complexes in Guillain-Barré Syndrome. PLOS ONE, 8, e82337. [Google Scholar] [CrossRef] [PubMed]
[45] Thomma, R.C.M., Halstead, S.K., de Koning, L.C., Wiegers, E.J.A., Gourlay, D.S., Tio-Gillen, A.P., et al. (2025) Large-scale Profiling of Antibody Reactivity to Glycolipids in Patients with Guillain-Barré Syndrome. Brain, 148, 4000-4015. [Google Scholar] [CrossRef] [PubMed]
[46] Koski, C.L., Sanders, M.E., Swoveland, P.T., Lawley, T.J., Shin, M.L., Frank, M.M., et al. (1987) Activation of Terminal Components of Complement in Patients with Guillain-Barré Syndrome and Other Demyelinating Neuropathies. Journal of Clinical Investigation, 80, 1492-1497. [Google Scholar] [CrossRef] [PubMed]
[47] Hartung, H., Schwenke, C., Bitter-Suermann, D. and Toyka, K.V. (1987) Guillain‐Barré Syndrome: Activated Complement Components C3a and C5a in CSF. Neurology, 37, 1006-1006. [Google Scholar] [CrossRef] [PubMed]
[48] Hafer‐Macko, C.E., Sheikh, K.A., Li, C.Y., Ho, T.W., Cornblath, D.R., McKhann, G.M., et al. (1996) Immune Attack on the Schwann Cell Surface in Acute Inflammatory Demyelinating Polyneuropathy. Annals of Neurology, 39, 625-635. [Google Scholar] [CrossRef] [PubMed]
[49] Hafer‐Macko, C., Hsieh, S., Ho, T.W., Sheikh, K., Cornblath, D.R., Li, C.Y., et al. (1996) Acute Motor Axonal Neuropathy: An Antibody‐Mediated Attack on Axolemma. Annals of Neurology, 40, 635-644. [Google Scholar] [CrossRef] [PubMed]
[50] Ang, C., Laman, J., Willison, H., Wagner, E., Endtz, H., De Klerk, M., et al. (2002) Structure of Campylobacter Jejuni Lipopolysaccharides Determines Antiganglioside Specificity and Clinical Features of Guillain‐Barre, and Miller Fisher Patients. Journal of the Peripheral Nervous System, 7, 206-206. [Google Scholar] [CrossRef
[51] O’Hanlon, G.M., Plomp, J.J., Chakrabarti, M., Morrison, I., Wagner, E.R., Goodyear, C.S. et al. (2001) Anti-GQ1b Ganglioside Antibodies Mediate Complement-Dependent Destruction of the Motor Nerve Terminal. Brain, 124, 893-906. [Google Scholar] [CrossRef] [PubMed]
[52] Jacobs, B.C., O’Hanlon, G.M., Bullens, R.W., Veitch, J., Plomp, J.J. and Willison, H.J. (2003) Immunoglobulins Inhibit Pathophysiological Effects of Anti-Gq1b-Positive Sera at Motor Nerve Terminals through Inhibition of Antibody Binding. Brain, 126, 2220-2234. [Google Scholar] [CrossRef] [PubMed]
[53] Halstead, S.K., Humphreys, P.D., Zitman, F.M.P., Hamer, J., Plomp, J.J. and Willison, H.J. (2008) C5 Inhibitor Rev576 Protects against Neural Injury in an in Vitro mouse Model of Miller Fisher Syndrome. Journal of the Peripheral Nervous System, 13, 228-235. [Google Scholar] [CrossRef] [PubMed]
[54] Mohammad, Q.D., Islam, Z., Papri, N., Hayat, S., Jahan, I., Azad, K.A.K., et al. (2025) Results from a Phase 1 Study Evaluating the Safety, Tolerability, Pharmacokinetics, Pharmacodynamics, and Efficacy of anx005, a C1q Inhibitor, in Patients with Guillain-Barré Syndrome. Journal of the Peripheral Nervous System, 30, e70009. [Google Scholar] [CrossRef] [PubMed]
[55] Kuwabara, S., Kusunoki, S., Kuwahara, M., Yamano, Y., Nishida, Y., Ishida, H., et al. (2024) Efficacy and Safety of Eculizumab in Guillain‐Barré Syndrome: A Phase 3, Multicenter, Double‐blind, Randomized, Placebo‐controlled Clinical Trial. Journal of the Peripheral Nervous System, 29, 339-349. [Google Scholar] [CrossRef] [PubMed]
[56] Dalakas, M.C. and Engel, W.K. (1980) Immunoglobulin and Complement Deposits in Nerves of Patients with Chronic Relapsing Polyneuropathy. Archives of Neurology, 37, 637-640. [Google Scholar] [CrossRef] [PubMed]
[57] Koike, H., Ikeda, S., Fukami, Y., Nishi, R., Kawagashira, Y., Iijima, M., et al. (2020) Complement Deposition and Macrophage-Induced Demyelination in CIDP with Anti-LM1 Antibodies. Journal of the Neurological Sciences, 408, Article 116509. [Google Scholar] [CrossRef] [PubMed]
[58] Quast, I., Keller, C.W., Hiepe, F., Tackenberg, B. and Lünemann, J.D. (2016) Terminal Complement Activation Is Increased and Associated with Disease Severity in CIDP. Annals of Clinical and Translational Neurology, 3, 730-735. [Google Scholar] [CrossRef] [PubMed]
[59] Rumsey, J.W., Lorance, C., Jackson, M., Sasserath, T., McAleer, C.W., Long, C.J., et al. (2022) Classical Complement Pathway Inhibition in a “Human‐on‐a‐Chip” Model of Autoimmune Demyelinating Neuropathies. Advanced Therapeutics, 5, Article 2200030. [Google Scholar] [CrossRef] [PubMed]
[60] Uncini, A. and Vallat, J. (2017) Autoimmune Nodo-Paranodopathies of Peripheral Nerve: The Concept Is Gaining Ground. Journal of Neurology, Neurosurgery & Psychiatry, 89, 627-635. [Google Scholar] [CrossRef] [PubMed]
[61] Schilke, E.D., Cereda, D., Fusco, M.L., Stanzani, L., Marzorati, L., Ripolone, M., et al. (2025) Eculizumab as a Disease‐modifying Therapy in Chronic Inflammatory Demyelinating Polyneuropathy (CIDP): A Case Report. Journal of the Peripheral Nervous System, 30, e70010. [Google Scholar] [CrossRef] [PubMed]
[62] Querol, L., Lewis, R.A., Hartung, H., van Doorn, P.A., Wallstroem, E., Auwarter, K., et al. (2025) Phase 2 Efficacy and Safety of Riliprubart, a C1s-Complement Inhibitor, in Chronic Inflammatory Demyelinating Polyneuropathy (S16.009). Neurology, 104, Article No. 2478. [Google Scholar] [CrossRef