The alternative pathway (AP) of the
complement system is a key
contributor to the pathogenesis of several human diseases including
age-related macular degeneration, paroxysmal nocturnal hemoglobinuria
(PNH), atypical hemolytic uremic syndrome (aHUS), and various glomerular
diseases. The serine protease factor B (FB) is a key node in the AP
and is integral to the formation of C3 and C5 convertase. Despite
the prominent role of FB in the AP, selective orally bioavailable
inhibitors, beyond our own efforts, have not been reported previously.
Herein we describe in more detail our efforts to identify FB inhibitors
by high-throughput screening (HTS) and leveraging insights from several
X-ray cocrystal structures during optimization efforts. This work
culminated in the discovery of LNP023 (41), which is
currently being evaluated clinically in several diverse AP mediated
indications.