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Paraproteins and complement depletion: pathogenesis and clinical syndromes.

Various clinical syndromes that associate paraproteinemia and complement depletion have been described in the last three decades. Among these, cryoglobulinemias, acquired Clq deficiency, and acquired deficiencies of the classical pathway of complement can be associated with B-cell lymphoproliferative disorders. Some specific symptoms should alert the clinician to suspect an underlying malignancy. In this report, we review the pathogenesis, symptomatology and therapeutic options of these clinical conditions.

Agammaglobulinemia↗

Multimerin: a bench-to-bedside chronology of a unique platelet and endothelial cell protein--from discovery to function to abnormalities in disease.

In studies conducted about 8 years ago, the author and her colleagues raised a monoclonal antibody that recognized an uncharacterized human platelet protein with a reduced molecular mass of 155 kDa. Investigations of this protein's nonreduced structure yielded surprising findings: in its native state, it exists as massive disulfide-linked multimers millions of daltons in size, making it one of the largest proteins found in the human body. This feature led the author to designate this protein "multimerin." Multimerin is found in endothelial cells as well as in platelets. It originates from a single subunit protein, promultimerin, that undergoes extensive N-glycosylation, proteolytic processing and polymerization during biosynthesis. Recent data from the cloning and sequencing of its complementary DNA indicate that multimerin is a unique protein. Like von Willebrand factor, it has a massive repeating structure, but these proteins are unrelated. Multimerin's sequence contains the adhesive motif Arg-Gly-Asp-Ser, central coiled-coil sequences, several epidermal growth-factor-like motifs, and a globular domain that is similar to a protein-binding domain found in complement C1q and in collagens type VIII and X. Investigations of multimerin's function indicate that it binds the coagulation protein factor V and its activated form, factor Va. In platelets, but not in plasma, all of the biologically active factor V is complexed with multimerin. Multimerin may also have functions as an extracellular matrix or adhesive protein. Recently, members of 2 Canadian families with puzzling autosomal-dominant bleeding disorders were found to have a deficiency of platelet multimerin. Studies of these patients may provide a unique opportunity to evaluate the functions of multimerin.

Amino Acid Sequence↗

The complement-activating capacity of maternal IgG antibodies to blood group A in paired mother/child serum samples.

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate whether IgG antibodies to blood group A bind or activate complement after crossing the placenta. MATERIALS AND METHODS: IgG anti-A concentrations as well as C1-q-binding and the capacity of anti-A to form the C5b-9 membrane attack complex were measured in sera of 61 mother/child pairs. The enzyme-linked immunosorbent assay was used to quantitate anti-A or anti-B in maternal and neonatal serum samples. RESULTS: The concentrations of IgG anti-A in ABO-identical and ABO-compatible children born to type O or B mothers correlated significantly with maternal concentrations (p < 0.05), whereas type A or AB children had strikingly diminished concentrations of IgG anti-A. The IgG anti-A concentrations were analyzed in two different groups: first, 44 mother/child pairs with mothers and children group O or B (group I), and second, 17 pairs with mothers group O or B and children group A or AB (group II). In group I, identical or compatible pairs with regard to IgG anti-A, a significant correlation was found by Spearman's rank analysis, whereas the same analysis revealed no significant correlation in group II. The capacity of anti-A to activate complement was also more marked in newborns who were ABO-identical or ABO-compatible with their mothers, and this capacity was virtually absent in cord blood samples from incompatible babies. CONCLUSIONS: Tests for complement-dependent or complement-independent ABO blood group antibodies must be interpreted in the light of the blood group of the child.

ABO Blood-Group System↗

Repeated renal biopsy in proliferative lupus nephritis--predictive role of serum C1q and albuminuria.

OBJECTIVE: Proliferative (WHO III/IV) nephritis in systemic lupus erythematosus (SLE) is a severe disease manifestation for which treatment with cyclophosphamide and high dose corticosteroids is generally recommended. We investigated the effect of this standard treatment on renal histopathology and clinical and serological findings to determine if the therapeutic response could be predicted by these variables. METHODS: We studied 18 patients with SLE and proliferative nephritis in whom repeated renal biopsy was performed after termination of induction therapy with cyclophosphamide and corticosteroids. At the time of renal biopsy, renal function and albuminuria were determined and analyses of anti-dsDNA, anti-C1q, and the complement factors C1q, C3 and C4 were performed. RESULTS: At repeated biopsy, 6/18 patients still had renal biopsy findings of WHO III/IV, 3 had transformed to WHO V, while 9 exhibited histopathological remission (WHO I/II). In the 9 patients with WHO III-V at the repeat biopsy, all but one patient had low C1q levels at the time of first biopsy and 5/9 at the repeat biopsy. In the 9 patients with WHO I/II at repeated biopsy, 4/9 had low C1q at first biopsy and none at the repeated biopsy (p = 0.0054 and p = 0.017 vs WHO III-V at repeat and first biopsy, respectively). Albuminuria > or = 0.5 g/day combined with low C1q levels at repeat biopsy predicted persistent histopathological activity (WHO III-V). CONCLUSION: Despite aggressive immunosuppressive therapy, 9/18 patients still had active proliferative or membranous nephritis at a second renal biopsy. Serum C1q levels at both first and repeated renal biopsies were found to be a predictive marker of the histopathological outcome.

Adolescent↗

Activation of the complement classical pathway (C1q binding) by mesophilic Aeromonas hydrophila outer membrane protein.

The mechanism of killing of Aeromonas hydrophila serum-sensitive strains in nonimmune serum by the complement classical pathway has been studied. The bacterial cell surface component that binds C1q more efficiently was identified as a major outer membrane protein of 39 kDa, presumably the porin II described by D. Jeanteur, N. Gletsu, F. Pattus, and J. T. Buckley (Mol. Microbiol. 6:3355-3363, 1992), of these microorganisms. We have demonstrated that the purified form of porin II binds C1q and activates the classical pathway in an antibody-independent manner, with the subsequent consumption of C4 and reduction of the serum total hemolytic activity. Activation of the classical pathway has been observed in human nonimmune serum and agammaglobulinemic serum (both depleted of factor D). Binding of C1q to other components of the bacterial outer membrane, in particular to rough lipopolysaccharide, could not be demonstrated. Activation of the classical pathway by this lipopolysaccharide was also much less efficient than activation by the outer membrane protein. The strains possessing O-antigen lipopolysaccharide bind less C1q than the serum-sensitive strains, because the outer membrane protein is less accessible, and are resistant to complement-mediated killing. Finally, a similar or identical outer membrane protein (presumably porin II) that binds C1q was shown to be present in strains from the most common mesophilic Aeromonas O serogroups.

Aeromonas hydrophila↗

Fc-dependent effector functions of idiotype-anti-idiotype immune complexes.

Some effector functions of antigen-antibody and antibody-antibody (idiotype-anti-idiotype) complexes were analyzed. As a model system a monoclonal IgM antibody specific for the hapten NP (antibody B1-8) was reacted either with hapten and hapten-carrier conjugates or with monoclonal anti-idiotope antibodies with specificity for B1-8 idiotopes. The precipitating, C1q-binding, complement-activating and Fc receptor binding properties of these complexes were compared. Binding of both hapten-carrier conjugates and anti-idiotope antibodies to B1-8 results in formation of complexes which depending on the B1-8:ligand ratio precipitate, activate complement, bind C1q and exhibit increased avidity for Fc mu and Fc gamma receptors of mouse spleen cells. In both types of complexes cross-linking of IgM molecules is essential for triggering these Fc-dependent functions, and a functional heterogeneity if idiotype-anti-idiotope complexes based on different idiotype-anti-idiotope ratios could also be observed. The functional similarity of B1-8-hapten-carrier and B1-8-anti-idiotope complexes suggests that regulatory functions so far assigned to antigen-antibody complexes could be carried out also by idiotype-anti-idiotope complexes.

Animals↗

On the reactivity of corneal collagen and subcomponent C1q of the complement system with human platelets and IgG-coated latex particles.

Collagen was isolated from bovine cornea and tested for reactivity towards platelets and IgG-coated polystyrene latex particles. The corneal collagen caused a dose- and temperature-dependent platelet aggregation in all human platelet-rich plasmas studied. As little as 0 . 31 micrograms of purified corneal collagen could trigger platelet activation. Human C1q, a subcomponent of the first complement component (C1), which shares extensive chemical-structural similarities with collagen, was able to inhibit the platelet aggregation provoked by corneal collagen. This blocking effect could be, however, overcome by increasing collagen doses. In a slide method or in aggregometry both corneal collagen and C1q agglutinated IgG-coated latex particles in a dose-dependent manner. Addition of such latex particles to platelet-rich plasmas or preincubation of the particles with collagen reduced or prevented the platelet action of collagen, suggesting that due to their reactivity with collagen immune complexes may play an inhibitory role in collagen-caused platelet aggregation. The results are discussed in relation to pathological events that lead to collagenolysis and also with respect to wound healing in the injured cornea.

Amino Acids↗

Surfactant protein A binds to IgG and enhances phagocytosis of IgG-opsonized erythrocytes.

Surfactant protein (SP)-A and SP-D, immunoglobulins, and complement all modulate inflammation within the lung by regulating pathogen clearance. For example, SP-A binds to and opsonizes a variety of bacteria and viruses, thereby enhancing their phagocytosis by innate immune cells such as alveolar macrophages. Immunoglobulins, which bind to antigen and facilitate Fc receptor-mediated phagocytosis, can also activate complement, a family of soluble proteins with multiple host defense functions. Previous studies showed that SP-A and complement protein C1q interact. Since complement protein C1q binds to IgG and IgM immune complexes, the hypothesis tested in this study was that SP-A, which is structurally homologous to C1q, also binds to IgG and affects its functions. SP-A binds to the Fc, rather than the Fab, region of IgG. Binding is calcium dependent but not inhibited by saccharides known to bind to SP-A's carbohydrate recognition domain. The binding of SP-A does not inhibit the formation of immune complexes or the binding of IgG to C1q. In contrast, SP-A enhances the uptake of IgG-coated erythrocytes, suggesting that SP-A might be influencing Fc receptor-mediated uptake. In summary, this study shows a novel interaction between SP-A and IgG and a functional consequence of the binding.

Animals↗

The complete complement of C1q-domain-containing proteins in Homo sapiens.

The C-terminal domains of the A, B, C chains of C1q subcomponent of C1 complex represent a common structural motif, the C1q domain, that is found in a diverse range of proteins. We analyzed the human genome for the complete complement of this family and have identified a total of 31 independent gene sequences. The predominant organization of C1q-domain-containing (C1qDC) proteins includes a leading signal peptide, a collagen-like region of variable length, and a C-terminal C1q domain. There are 15 highly conserved residues within the C1q domain, among which 8 are invariant within the human gene set and these are predicted to cluster within the hydrophobic core of the protein. We suggest a 3-subfamily classification based on sequence homology. For some C1qDC-encoding genes, strict orthology has been retained throughout vertebrate evolution and these examples suggest a highly specific functional role for C1qDC proteins that has been under significant selective pressure. Alternatively, individual species have co-opted C1qDC proteins for roles that are highly specific to their biology, suggesting an evolutionary strategy of gene duplication and functional diversification. A more extensive analysis of the evolutionary relationship of C1qDC proteins reveals an ancient rooting, with clear members found in eubacterial species. Curiously, we have been unable to identify C1qDC-encoding genes in many eukaryotic genomcs, such as Sacchromyces cerivisae and C. elegans, suggesting that the retention or loss of this gene family throughout evolution has been sporadic.

Amino Acid Sequence↗

Deposition of C3b/iC3b leads to the concealment of antigens, immunoglobulins and bound C1q in complement-activating immune complexes.

Complement activation by bound IgG in serum at physiological concentrations is reflected in the deposition of C3b/iC3b in the absence of antigenic expression of the IgG or of any bound C1q on the target. The aim of this study was to investigate the functional requirements for this phenomenon and to establish its relationship to a release or concealment of the antigens. Microtiter wells coated with IgG by direct adsorption or by binding of IgG antibodies to pre-adsorbed homologous antigen were incubated with serum or serum reagents at 37 degrees C. The complement reaction was analyzed by ELISA to quantitate bound or released reaction products, and the release of IgG from the coated microtiter wells was gauged radiometrically. In the presence of serum, rapid binding of C1q and C3b occurred and was soon followed by a rapid loss of C1q expression; C3b binding remained high. Loss of IgG paralleled that of C1q. The functional requirement for the reaction was restricted to the activation and deposition of C3b/iC3b but was dependent of the combined function of the classical and alternative complement pathways. The loss of the IgG antigen was solely the result of antigen concealment, whereas the loss of C1q was only partly so. In biological terms, the concealment of bound IgG and C1q may reflect mechanisms by which complement down-regulates leukocyte responses stimulated by ligand-cell membrane receptor interactions.

Antigen-Antibody Complex↗

Effect of EDTA and citrate on the functional activity of the first component of complement, C1, and the C1q subcomponent.

The first component of complement, C1, is a calcium-dependent complex of the three distinct subcomponents, C1q, C1r, and C1s. Earlier observations revealed that treatment of C1 with EDTA led to a loss of hemolytic C1 activity even after recalcification. Therefore, it was of interest to study whether EDTA has an additional effect on C1 and its subcomponents, beside its chelating capacity. The chelating effect of EDTA was compared to that of citrate. It was found that treatment of C1 or C1 with EDTA followed by addition of Ca++ led to a loss of hemolytic activity up to 90%, depending on EDTA concentration. Even pretreatment of EDTA with varying amounts of Ca++ did not prevent the inactivation of C1 or C1. In contrast, after dissociation of C1 or C1 by citrate, 100% of the original C1q activity is recoverable on addition of C1q deficient serum as source of C1r and C1s. EDTA-treated serum, however, showed a concentration-dependent loss of hemolytic C1q activity, indicating an inhibitory effect of EDTA on C1q. EDTA-treated C1q, fluid phase or bound to EA, was no longer able to form an hemolytically active C1 complex by interaction with C1r and C1s.

Calcium↗

Specific inhibition of the classical complement pathway by C1q-binding peptides.

Undesired activation of the complement system is a major pathogenic factor contributing to various immune complex diseases and conditions such as hyperacute xenograft rejection. We aim for prevention of complement-mediated damage by specific inhibition of the classical complement pathway, thus not affecting the antimicrobial functions of the complement system via the alternative pathway and the lectin pathway. Therefore, 42 peptides previously selected from phage-displayed peptide libraries on basis of C1q binding were synthesized and examined for their ability to inhibit the function of C1q. From seven peptides that showed inhibition of C1q hemolytic activity but no inhibition of the alternative complement pathway, one peptide (2J) was selected and further studied. Peptide 2J inhibited the hemolytic activity of C1q from human, chimpanzee, rhesus monkey, rat, and mouse origin, all with a similar dose-response relationship (IC(50) 2-6 microM). Binding of C1q to peptide 2J involved the globular head domain of C1q. In line with this interaction, peptide 2J dose-dependently inhibited the binding of C1q to IgG and blocked activation of C4 and C3 and formation of C5b-9 induced via classical pathway activation, as assessed by ELISA. Furthermore, the peptide strongly inhibited the deposition of C4 and C3 on pig cells following their exposure to human xenoreactive Abs and complement. We conclude that peptide 2J is a promising reagent for the development of a therapeutic inhibitor of the earliest step of the classical complement pathway, i.e., the binding of C1q to its target.

Amino Acid Sequence↗

Direct binding of C1q to apoptotic cells and cell blebs induces complement activation.

Deficiency of early components of the classical pathway of complement, particularly C1q, predisposes to the development of systemic lupus erythematosus. Several studies have suggested an association between the classical complement pathway and the clearance of apoptotic cells. Mice with a targeted deletion of the C1q gene develop a lupus-like renal disease, which is associated with the presence of multiple apoptotic bodies in the kidney. In the present study we demonstrate that highly purified C1q binds to apoptotic cells and isolated blebs derived from these apoptotic cells. Binding of C1q to apoptotic cells occurs via the globular heads of C1q and induces activation of the classical complement pathway, as shown by the deposition of C4 and C3 on the surface of these cells and on cell-derived blebs. In addition, for the first time, we demonstrate that surface-bound C1q is present on a subpopulation of microparticles isolated from human plasma. Taken together, these observations demonstrate that C1q binds directly to apoptotic cells and blebs derived therefrom and support a role for C1q, possibly in concert with C4 and C3, in the clearance of apoptotic cells and blebs by the phagocytic system.

Apoptosis↗

Localization and cell association of C1q in Alzheimer's disease brain.

The complement protein, C1q, has been shown to bind to fibrillar beta-amyloid, resulting in the activation of the classical complement pathway. C1q has also been found associated with most but not all amyloid deposits in brain. To determine whether C1q is exclusively associated with plaques containing the fibrillar form of beta-amyloid, normal and Alzheimer brain were immunohistochemically double labeled using thioflavine, which specifically stains beta-amyloid in a beta-sheet conformation, and an affinity- purified antibody to human C1q. C1q immunostaining was colocalized with nearly all thioflavine-positive plaques, while C1q was not detected in beta-amyloid immunopositive plaques which were thioflavine-negative. Beta-amyloid plaques in nondemented controls (which are typically thioflavine-negative) were also negative for C1q. Microglia and astrocytes of reactive morphology were also associated with C1q-positive plaques and neurons. Interestingly, many neuronal cells in the AD brain, but not microglia or astrocytes, stained prominently with anti-C1q. Neurons in control brain were not C1q positive. Our data suggest that some of these C1q-positive structures were neurofibrillary tangles immunoreactive for hyperphosphorylated tau, which may be binding extracellular C1q. However, a large number of the C1q-positive neurons had intact cell morphology; suggesting that these cells may be synthesizing this critical complement component. Since the presence of C1q suggests the activation of complement and/or the activation of proinflammatory events, and the specific class of plaques that contain C1q are the type that corresponds to observed clinical dementia, these findings further support the hypothesis that complement plays a role in the pathogenesis of AD.

Alzheimer Disease↗

Biological responses differ considerably between endovascular and conventional aortic aneurysm surgery.

OBJECTIVES: To determine the inflammatory responses in endovascular abdominal aortic aneurysm (AAA) repair and their relation to clinical findings. DESIGN: Prospective non-randomised study. SETTING: University Hospital, Department of Surgery. PATIENTS AND METHODS: Seven patients treated with an endoluminal procedure (AAA-E) and seven patients undergoing conventional surgery (AAA-C) were included. Inflammatory parameters were assessed by measurements of the cytokines interleukin (IL)-1 beta, IL-6, IL-8 and Tumour Necrosis Factor-alpha (TNF-alpha); analyses of complement proteins C1q, C4, C3, C5a and Terminal Complement Complexes (TCC); haematologic parameters and determination of C-reactive protein (CRP). RESULTS: In six of seven patients in the AAA-E group blood pressure decreases were recorded during introduction of the device. IL-6 and CRP levels were found to be significantly higher in AAA-C patients compared to the AAA-E group. On the other hand, high TNF-alpha levels were recorded in the AAA-E group. Less consumption of the complement proteins C1q, C4 and C3 was observed in AAA-E compared to AAA-C patients. Increased C5a levels were recorded in the AAA-C group, whereas only slight fluctuations were noticed in the AAA-E group. TCC levels were unchanged in both groups. CONCLUSION: Endovascular aortic aneurysm repair induced a significant inflammatory response, mainly involving TNF-alpha and differing from the findings during open AAA repair. These inflammatory responses were probably related to blood pressure decreases during the procedures. On the other hand, conventional repair induced responses related to the more extensive surgical trauma and reperfusion injury.

Aged↗