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In the setting of de novo TMA after kidney transplantation, the implication of a dysregulation in the alternative complement pathway may be underestimated as suggested by one series of de novo TMA after kidney transplantation published by le Quintrec et al.
In the alternative complement pathway, C3b reacts with the proteins factor B, adipsin, and properdin to compose C3 convertase.
Complement factor H (CFH), complement factor I (CFI), membrane cofactor protein (MCP or CD46) and thrombomodulin (THBD) which are regulatory proteins of the alternative complement pathway and C3 and complement factor B (CFB) which are C3 convertase proteins are involved in the pathogenesis of the disease (6).
Cordeiro et al., "Alternative complement pathway deregulation is correlated with dengue severity," PLoS ONE, vol.
The liposome coating with the monosialoganglioside GM1 (Figure 2), a brain-tissue-derived monosialoganglioside, was found to inhibit the alternative complement pathway by promoting the association of factor H to C3b factor on the vesicle surface [66].
Meanwhile, dimeric IgA has been assumed to contribute to activate the alternative complement pathway to produce some biologically active complement fragments, and complement components such as C3 and C4 are known to be produced by the epithelial cells of the intestinal tract (Michael et al., 1999; Andoh, 1993).
It is well established that dysregulation of the alternative complement pathway is involved in 60-70% of all cases with loss-of-function mutations in complement regulators such as factor H, factor I, and membrane cofactor protein (MCP/CD46), or gain-of-function mutations in C3 or factor B [2].
Thanks to its mechanism of action and high target specificity, TNT009 selectively inhibits disease processes in the Classical Complement pathway cascade and keeps the vital immune surveillance provided by the Alternative Complement Pathway and Lectin Complement Pathway.

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