C5a receptor antagonists

The anaphylatoxin C5a is an extremely potent proinflammatory peptide produced during activation of the complement system. The structure of C5a includes a core region (N-terminal residues 1-63) consisting of four, antiparallel alpha-helices held together by three disulfide linkages and a structured C-terminal tail (residues 64-74). The C5a receptor belongs to the large class of seven transmembrane, G-protein-linked receptors. C5a appears to interact with its receptor at two sites: the C5a core binds to the receptor s N-terminal extracellular domain while C5a s tail binds the receptor near Arg206, near the membrane surface of transmembrane helix V. C5a receptors are concentrated on blood granulocytes (neutrophils, eosinophils, and basophils) and tissue inflammatory cells (macrophages, mast cells, microglia); thus the main effects of C5a are manifest as inflammation. Additionally, C5a receptors are also present, albeit in lower concentrations, on non-myeloid cells, e.g. endothelial and smooth muscle cells where they may further influence inflammatory reactions such as blood cell emigration and tissue edema. C5a has been implicated in myriad disorders, both acute and chronic; therefore a C5a receptor antagonist is predicted to have utility as a therapeutic agent. Unfortunately, few specific C5a receptor antagonists have been reported, and only two have demonstrated activity in vivo. Furthermore, those reported are peptidic and hence have limited application therapeutically. The current state of C5a receptor antagonists is discussed as well as the potential for their use against various human disorders. A model of C5a receptor dimerization is presented to account for the high potency of the disulfide antagonist C5aRAD.