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HMGB1 Box A is a recombinant protein therapeutic consisting of the A box domain of the High Mobility Group Box 1 (HMGB1) protein. It functions as a competitive antagonist of full-length HMGB1, a nuclear protein that acts as a potent pro-inflammatory alarmin when released into the extracellular space. HMGB1 Box A binds to HMGB1 receptors, including the **Receptor for Advanced Glycation End-products (RAGE)** and **Toll-like Receptor 4 (TLR4)**, without initiating pro-inflammatory signaling cascades. By displacing or preventing the binding of the pro-inflammatory B box domain of HMGB1, Box A effectively inhibits the inflammatory response and prevents the cellular internalization of HMGB1/LPS complexes. Preclinical studies have demonstrated its efficacy in treating sepsis and other HMGB1-driven inflammatory conditions, notably showing a wide therapeutic window with beneficial effects even when administered up to 24 hours after the onset of sepsis.
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