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Accession NumberDB06681

Belatacept is a soluble fusion protein, which links the extracellular domain of human cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) to the modified Fc (hinge, CH2, and CH3 domains) portion of human immunoglobulin G1 (IgG1). Structurally, abatacept is a glycosylated fusion protein with a MALDI-MS molecular weight of 92,300 Da and it is a homodimer of two homologous polypeptide chains of 357 amino acids each. It is produced through recombinant DNA technology in mammalian CHO cells. The drug has activity as a selective co-stimulation modulator with inhibitory activity on T lymphocytes. It is approved for the treatment of rheumatoid arthritis. Belatacept selectively blocks the process of T-cell activation. It was developed by Bristol-Myers-Squibb. It differs from abatacept (Orencia) by only 2 amino acids. FDA approved on June 15, 2011.

Protein structureNo structure small
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Protein chemical formulaC3508H5440N922O1096S32
Protein average weight92300.0 Da (with glycosylation)
> sequence for belatacept
Download FASTA Format
CD152 antigen
External Identifiers
  • BMS-224818
Approved Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing End
Nulojixinjection, powder, lyophilized, for solution250 mg/1intravenousE.R. Squibb & Sons, L.L.C.2011-06-15Not applicableUs
Approved Generic Prescription ProductsNot Available
Approved Over the Counter ProductsNot Available
Unapproved/Other Products Not Available
International BrandsNot Available
Brand mixturesNot Available
SaltsNot Available
CAS number706808-37-9
DescriptionNot Available
KingdomOrganic Compounds
Super ClassOrganic Acids
ClassCarboxylic Acids and Derivatives
Sub ClassAmino Acids, Peptides, and Analogues
Direct ParentPeptides
Alternative ParentsNot Available
SubstituentsNot Available
Molecular FrameworkNot Available
External DescriptorsNot Available
IndicationFor prophylaxis of organ rejection. It is also used concomitantly with basiliximumab for induction therapy, mycophenolate, and corticosteriods in kidney transplant recepients that are seropositive for the Epstein-Barr virus.
PharmacodynamicsBelatacept binds to CD86 with a 4-fold higher affinity than abatacept. It also binds to CD80 with a 2-fold higher affinity than abatacept. It was observed in non-human primates that belatacept prolongs graft survival due to a decrease in antibody production against the donor organ. Furthermore, belatacept also inhibits the primary humoral immune response which is indicated by the decrease in post-transplant levels of IgG, IgM, and IgA. The magnitude of this effect is more significant in belatacept than it is in cyclosporine.
Mechanism of actionBelatacept is a fusion protein in which the Fc portion of human IgG1 is attached onto the extracellular portion of human CTLA-4 (CD152). Belatacept specifically binds to CD80 and CD86 receptors that are found on the antigen-presenting cell (B cells, macrophages, dendritic cells) to block selective T-cell lymphocyte costimulation. CD80 and CD86 would normally act as the ligands to the CD28 receptor T-cells in which this interaction triggers the activation of T lymphocytes. However in the presence of belatacept, because the extracellular CTLA-4 component binds to CD28 with higher affinity than CD80 or CD86, T lymphyocyte anergy, a state of antigen specific tolerance, occurs instead. The T cell is also no longer able to respond to their antigen.
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AbsorptionFollowing multiple intravenous doses of an initial 10 mg/kg dose and followed by a maintenance dose of 5 mg/kg in kidney transplant recipients, these are the following pharmacokinetic parameters: Cmax, 10 mg/kg = 247 µg/mL; Cmax, 5 mg/kg = 139 µg/mL; AUC, 10 mg/kg = 22,252 µg · h/mL; AUC, 5 mg/kg = 14,090 µg · h/mL; Belatacept had linear and dose-dependent pharmacokinetic profile.
Volume of distribution

Vd, steady state, transplant patients, 10 mg/kg = 0.11 L/kg;
Vd, steady state, transplant patients, 5 mg/kg = 0.12 L/kg

Protein bindingNot Available

The cytochrome P450 enzyme system or uridine diphosphate-glucuronosyltransferases are not expected to be involved with the metabolism of belatacept. Because the drug is a protein, belatacept is degraded into smaller peptides and amino acids by proteolytic enzymes.

Route of eliminationNot Available
Half lifeMean terminal elimination half-life: 10 mg/kg, kidney transplant recipients= 9.8 days; 5 mg/kg, kidney transplant recipient = 8.2 days

Increased body weight may increase the clearance rate of belatacept.
Mean systemic clearance:
10 mg/kg, kidney transplant recipients= 0.49 mL/h/kg;
5 mg/kg, kidney transplant recipient = 0.51 mL/h/kg.

ToxicityNot Available
Affected organisms
  • Humans and other mammals
PathwaysNot Available
SNP Mediated EffectsNot Available
SNP Mediated Adverse Drug ReactionsNot Available
ManufacturersNot Available
PackagersNot Available
Dosage forms
Injection, powder, lyophilized, for solutionintravenous250 mg/1
PricesNot Available
PatentsNot Available
Experimental PropertiesNot Available
Synthesis ReferenceNot Available
General References
  1. Wekerle T, Grinyo JM: Belatacept: from rational design to clinical application. Transpl Int. 2012 Feb;25(2):139-50. doi: 10.1111/j.1432-2277.2011.01386.x. Epub 2011 Dec 7. [PubMed:22151353 ]
  2. Garnock-Jones KP: Belatacept: in adult kidney transplant recipients. BioDrugs. 2012 Dec 1;26(6):413-24. doi: 10.2165/11208900-000000000-00000. [PubMed:22928660 ]
External Links
ATC CodesL04AA28
AHFS Codes
  • 92:44
PDB EntriesNot Available
FDA labelDownload (582 KB)
MSDSDownload (479 KB)
Drug Interactions
BelimumabThe risk or severity of adverse effects can be increased when Belatacept is combined with Belimumab.
DenosumabThe risk or severity of adverse effects can be increased when Denosumab is combined with Belatacept.
LeflunomideThe risk or severity of adverse effects can be increased when Belatacept is combined with Leflunomide.
NatalizumabThe risk or severity of adverse effects can be increased when Belatacept is combined with Natalizumab.
PimecrolimusThe risk or severity of adverse effects can be increased when Pimecrolimus is combined with Belatacept.
RoflumilastRoflumilast may increase the immunosuppressive activities of Belatacept.
Sipuleucel-TThe therapeutic efficacy of Sipuleucel-T can be decreased when used in combination with Belatacept.
TacrolimusThe risk or severity of adverse effects can be increased when Tacrolimus is combined with Belatacept.
TofacitinibBelatacept may increase the immunosuppressive activities of Tofacitinib.
TrastuzumabTrastuzumab may increase the neutropenic activities of Belatacept.
Food InteractionsNot Available


Pharmacological action
General Function:
Virus receptor activity
Specific Function:
Receptor involved in the costimulatory signal essential for T-lymphocyte proliferation and interleukin-2 production, by binding CD28 or CTLA-4. May play a critical role in the early events of T-cell activation and costimulation of naive T-cells, such as deciding between immunity and anergy that is made by T-cells within 24 hours after activation. Isoform 2 interferes with the formation of CD86 ...
Gene Name:
Uniprot ID:
Molecular Weight:
37681.97 Da
  1. Vincenti F: Costimulation blockade in autoimmunity and transplantation. J Allergy Clin Immunol. 2008 Feb;121(2):299-306; quiz 307-8. doi: 10.1016/j.jaci.2008.01.002. [PubMed:18269922 ]
Pharmacological action
General Function:
Virus receptor activity
Specific Function:
Involved in the costimulatory signal essential for T-lymphocyte activation. T-cell proliferation and cytokine production is induced by the binding of CD28, binding to CTLA-4 has opposite effects and inhibits T-cell activation.(Microbial infection) Acts as a receptor for adenovirus subgroup B.
Gene Name:
Uniprot ID:
Molecular Weight:
33047.625 Da
  1. Yabu JM, Vincenti F: Novel immunosuppression: small molecules and biologics. Semin Nephrol. 2007 Jul;27(4):479-86. [PubMed:17616278 ]
  2. Tedesco Silva H Jr, Pinheiro Machado P, Rosso Felipe C, Medina Pestana JO: Immunotherapy for De Novo renal transplantation: what's in the pipeline? Drugs. 2006;66(13):1665-84. [PubMed:16978033 ]
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Drug created on March 19, 2008 10:48 / Updated on August 17, 2016 12:24