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The clinical symptoms of HAE arise from excess bradykinin generation due to dysregulation of the plasma kallikrein-kinin system (KKS). A quantitative systems pharmacology (QSP) model that mechanistically describes the KKS and its role in HAE pathophysiology was developed based on HAE attacks being triggered by autoactivation of factor XII (FXII) to activated FXII (FXIIa), resulting in kallikrein production from prekallikrein. A base pharmacodynamic model was constructed and parameterized from literature data and ex vivo assays measuring inhibition of kallikrein activity in plasma of HAE patients or healthy volunteers who received lanadelumab. HAE attacks were simulated using a virtual patient population, with attacks recorded when systemic bradykinin levels exceeded 20\u00a0pM. The model was validated by comparing the simulations to observations from lanadelumab and plasma-derived C1-inhibitor clinical trials. The model was then applied to analyze the impact of nonadherence to a daily oral preventive therapy; simulations showed a correlation between the number of missed doses per month and reduced drug effectiveness. The impact of reducing lanadelumab dosing frequency from 300\u00a0mg every 2\u00a0weeks (Q2W) to every 4\u00a0weeks (Q4W) was also examined and showed that while attack rates with Q4W dosing were substantially reduced, the extent of reduction was greater with Q2W dosing. Overall, the QSP model showed good agreement with clinical data and could be used for hypothesis testing and outcome predictions.<\/jats:p>","DOI":"10.1007\/s10928-024-09919-6","type":"journal-article","created":{"date-parts":[[2024,5,11]],"date-time":"2024-05-11T16:01:36Z","timestamp":1715443296000},"page":"721-734","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A quantitative systems pharmacology model of plasma kallikrein-kinin system dysregulation in hereditary angioedema"],"prefix":"10.1007","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8224-1753","authenticated-orcid":false,"given":"Dan","family":"Sexton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoa Q.","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salom\u00e9","family":"Juethner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haobin","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4544-9559","authenticated-orcid":false,"given":"Zhiwei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Jasper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andy Z. 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Juethner and A. Z. X. Zhu are full-time employees of Takeda and hold stocks\/options in Takeda. D. Sexton and H. Q. Nguyen were employees of Takeda at the time of this analysis. H. Luo, Z. Zhang, and P. Jasper are full-time employees of the RES Group, which was contracted by Takeda to develop the QSP HAE model.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}