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Circulating immune complexes in sickle cell anaemia.

Circulating immune complexes were investigated in sera of 100 patients with sickle cell anaemia (SCA) in different clinical stages, using inhibition of complement-dependent rosette formation (EAC rosette inhibition), anticomplementary activity, polyethylene glycol 6000 precipitation, immunoconglutinin titre, total haemolytic complement, C4 and C3d. A high positivity was observed in patients with hepatic crisis (75%) and cases with leg ulcers (43%) compared with painful crisis (12%) and asymptomatic (7%) patients. These results provide evidence for the presence of circulating immune complexes during leg ulcers and hepatic crisis in SCA.

Adolescent↗

Anti-C1q column: ligand specific purification of immune complexes from human serum or plasma. Analysis of the interaction between C1q and immune complexes.

An efficient and reproducible procedure has been developed for the specific isolation of immune complexes. PEG precipitation of EDTA serum or plasma was an essential preliminary step to separate complex-bound from free C1q. PEG had no discernible effect on the molecular weight size of the extracted complexes. Redissolved complexes were incubated with a Sepharose-4B column coated with anti-human C1q antibodies and following removal of unbound material the bound complexes were sequentially eluted with 0.02 M EDTA, 0.5 M NaCl and 1 M propionic acid. Characteristics of the affinity column were established by the purification of 125I-labelled BSA-anti-BSA complexes and heat-aggregated IgG (HAGG) incubated in normal human serum (NHS). EDTA and NaCl eluted complexes were of similar molecular size and contained antigen, specific antibody, as well as human IgM, IgG, albumin, C3, C3c, C3d and C1q. Acid eluted complexes contained the highest yield of specific antigen and antibody and comprised in addition human C1q and C3d. Activation of complement components after C1q made the bond between C1q and immune complexes resistant to 0.5 M NaCl and interfered with the binding between solid phase anti-C1q and complex bound C1q. Using BSA-anti-BSA complexes and HAGG activated in NHS it was apparent that only a minority of the complexed material was isolated via the C1q ligand and this probably applies to the C1q binding assay. Most complexed material could be isolated using an anti-C3 affinity column.

Antigen-Antibody Complex↗

Some immunological and biochemical markers in chronic lymphatic leukemia patients.

The leukemic cells in chronic lymphatic leukemia (CLL) patients have been studied prior to theory with a panel of immunological markers. Cells were assayed for the presence of receptors for sheep erythrocytes (E active and total rosettes), C3d component of complement (EAC rosettes), mouse erythrocytes (M rosettes), some of them also for surface membrane immunoglobulins (SmIg). In vitro 24 h cultures without mitogen (detection of spontaneous DNA synthesis) or 72 h cultures with phytohemagglutinin (PHA) were also performed. These conventional immunological markers and functional lymphocyte characteristics have been correlated with enzyme activities of adenosine deaminase (ADA) and purine nucleoside phosphorylase (PNP). Electrophoretic patterns of radiolabeled proteins under denaturing conditions (SDS-PAGE) have also been determined in some patients of this group. Phenotypic surface characterization of blood elements of all CLL patients studied revealed their B origin, with increased values of EAC rosette forming cells and especially increased values of M rosette forming cells. Significantly decreased values of both, ADA and PNP, were found in all the cases. Electrophoretic patterns of radiolabeled surface proteins from cells of CLL patients were essentially similar within the group with characteristically strongly radiolabeled glycoproteins gp44--HLA heavy chain and glycoproteins gp29, gp35--Ia-like or HLA-DR antigen.

Adenosine Deaminase↗

Relevance of surface markers in chronic lymphocytic leukemia to acute lymphocytic leukemia.

The surface membrane of the B-lymphocyte of chronic lymphocytic leukemia (CLL) has been subject to detailed investigation over the past decade. Surface immunoglobulin of low density, punctate in distribution, without the tendency to polar cap formation, and clonal with respect to light and heavy chains, is characteristic. Other B-cell properties include the presence of the Ia antigen and the receptor for the C3d portion of complement. The CLL surface membrane lacks such T-cell attributes as the ability to form rosettes with sheep erythrocytes and reactivity with anti-T-cell antisera, although T-cells may be increased early in the disorder. CLL is believed to be a proliferation of a B-lymphocyte of the medullary cord of the lymph node, although the exact place of this cell in lymphocyte development remains to be clarified. Surface markers are useful in distinguishing classical B-cell CLL from other proliferations of small lymphocytes (lymphosarcoma cell leukemia of follicle-center B-cells, T-cell CLL, Sézary syndrome, and reactive lymphocytosis).

B-Lymphocytes↗

Comparisons of pooled polyclonal rabbit anti-human C3d with four monoclonal mouse anti-human C3ds. II. Quantitation of RBC-bound C3d, and characterization of antiglobulin agglutination reactions against RBC from 27 patients with autoimmune hemolytic anemia.

Labelled polyclonal IgG anti-C3d and monoclonal IgM and IgG anti-C3d antibodies (MAs) were employed at increasing antibody excess to measure the number of C3d molecules on human red blood cells (RBC) coated by complement in vitro and in vivo. Values for the number of C3d sites per cell determined with polyclonal anti-C3d were at least 4-fold higher than when MAs were used. The results suggest that the molar combining ratio for polyclonal anti-C3d with a single RBC-bound C3d fragment is more likely greater than 4.0 than 1.0 as previously assumed. Antiglobulin agglutination studies compared polyclonal and monoclonal anti-C3d antibodies against C3d-coated RBC from 27 patients with autoimmune hemolytic anemia. All four MAs showed striking prozones, requiring their use over a 25-fold higher range of dilutions than polyclonal anti-C3d. Polyclonal anti-C3d produced stronger agglutination reactions than any of the IgG MAs. Only the IgM MA produced agglutination as strong as, or stronger than, polyclonal anti-C3d. While IgM MA always gave the strongest MA agglutination reactions, no consistent ranking of the three IgG MAs was observed. Agglutination was not enhanced when all IgG MAs were combined; addition of IgG MAs to IGM MA reduced the strength of agglutination seen with IgM alone, suggesting blocking of IgM binding by competing IgG anti-C3d.

Anemia, Hemolytic, Autoimmune↗

Candida albicans and Candida stellatoidea, in contrast to other Candida species, bind iC3b and C3d but not C3b.

It was demonstrated that complement-coated sheep erythrocytes bind to Candida albicans cells grown in serum-free RPMI 1640 medium. Testing of purified complement components proved that iC3b and C3d were responsible for the reaction, whereas C3b and C3b-H reacted only slightly if at all. Binding occurred only to C. albicans and C. stellatoidea, not to other species pathogenic to humans. There was evidence of a lectinlike nature of the effect.

Animals↗

[Paroxysmal nocturnal hemoglobinuria. Increase in proteins of the alternative complement pathway].

Increased activity of the complement alternative pathway proteins C3, B and H was found in the sera of 16 patients with paroxysmal nocturnal haemoglobinuria (PNH). This increased activity might depend on protein hypersynthesis secondary to in vivo low-grade complement consumption by abnormal erythrocytes in PNH patients, despite the fact that serum levels of C3d were found to be normal. B and H activities were directly related; however, the B/H ratio was higher in patients whose sera had been taken early after an episode of haemoglobinuria. Activation of the alternative pathway, which is known to result in vitro lysis of PNH erythrocytes, only accounts for part of the events leading to chronic haemolysis and haemoglobinuria in vitro.

Adult↗

Interaction of fibronectin with complement component C3.

The activation of the complement component C3 generates C3a and C3b fragments, and the physiological cleavage of C3b further yields C3c and C3d fragments. We studied here by enzyme immunoassay the ability of human plasma fibronectin to interact with native C3 of human sera and with isolated C3c and C3d fragments of C3. C3 from sera of all six individuals tested bound to solid-phase fibronectin. Soluble fibronectin bound to solid-phase C3c and C3d, and fluid-phase C3c and C3d also bound to solid-phase fibronectin. The binding of fibronectin to solid-phase C3c and C3d could be inhibited by fluid-phase C3c and C3d. The results suggest the possibility that soluble fibronectin may attach to C3-coated particles or that C3-coated particles may adhere to fibronectin-containing structures.

Complement Activation↗

Mechanisms of leukocyte regulation by complement-derived factors.

Progress over the past five years has drawn attention to the fact that the anaplylatoxins are important factors in both leukocyte activation and regulation events. The C5 anaphylatoxin has been proposed to play major role in leukocyte aggregation and adherence phenomenon. Influences of C5a on the leukocyte may lead to clinical manifestations such as respiratory distress syndrome after trauma or postpump syndrome after cardiopulmonary bypass, both effects derived from leukocyte sequestration. Many other clinical conditions involving repeated transient sequestration of leukocytes, particularly in the pulmonary vasculature, may eventually be recognized as a complication of systemic complement activation. Dramatic pathologic changes observed in the lungs of animals exposed to either C3a or C5a emphasizes the potential damage that these factors may exert via cellular activation mechanisms (Huey et al., 1983). More recent evidence that the anaphylatoxins are potent immunoregulatory factors under in vitro conditions suggests a physiologic role for these humoral factors in nonspecific modulation of the immune response. It is an attractive hypothesis to suggest that once activated, complement is capable of relaying information to the cellular immune system via the anaphylatoxins. Other components of the complement system have long been known to exert regulatory influences on the immune system, and perhaps molecular description of such entities as the C3d-K fragment will serve to unravel this seemingly more complex effector system. In any case, as our understanding of both the chemical and biologic nature of factors derived from blood complement components advances, it has become apparent that a major function of complement may be to modulate the immune response. We have already demonstrated that these factors are selective both for cell type and for eliciting a variety of cellular responses. From this, one can infer that manipulation of the cellular events will eventually be possible. Hence a therapeutic value may be realized once involvement of these complement factors under in vivo conditions is better characterized.

Anaphylatoxins↗

Clinicopathological study of patients with mesangial isolated C3d deposition in various glomerular diseases.

The clinicopathological findings of isolated mesangial C3d deposition in the absence of other complement components or immunoglobulins are summarized. 55 out of 242 individual human renal biopsies examined by immunoperoxidase microscopy had isolated C3d deposition. This group consisted of 12 patients with chronic glomerulonephritis, 8 with minimal-change nephrotic syndrome, 32 with benign recurrent hematuria, 2 with Bartter's syndrome and 1 with Raynaud's syndrome. None of these patients had a disorder of the renal function and in all the patients the disease took a benign clinical course. Light-microscopic findings indicated injuries ranging from minor glomerular abnormality to mild diffuse mesangial proliferative glomerulonephritis, and there were no other remarkable findings such as cellular crescents, global sclerosis or interstitial infiltration. By immunoperoxidase microscopy, fine granular deposits of C3d were identified only in the mesangium, and arteriolar C3 staining was seen in 31 of the 55 patients. In 38 of the 42 patients examined by electron microscopy, electron-dense deposits were identified in the mesangial matrix. These findings suggest that isolated C3d deposition is a new entity with benign features both clinically and pathologically.

Adolescent↗

Immunohistochemical analysis of C3 cleavage fragments, factor H, and the C5b-9 terminal complex of complement in de novo membranous glomerulonephritis occurring in patients with renal transplant.

Fifteen renal biopsies from 13 transplanted patients with de novo membranous nephropathy (DNMN) were investigated by immunofluorescence for the presence of C5b-9 neoantigens of the terminal sequence of complement and for antigens expressed by C3 cleavage fragments. DNMN lesions were classified as stage I, II or III upon light and electron microscopy examination. Seven biopsies were classified as stage I DNMN and 8 stage II-III. All patients were proteinuric. In six biopsies with stage I DNMN, staining for C5b-9 neoantigens was restricted to a fine granular labeling in mesangial areas which was analogous to that seen in normal kidneys in contrast with extensive parietal labeling for IgG, C3d and factor H antigens. In eight biopsies with stage II-III DNMN, the pattern of staining with anti-C5b-9 neoantigens antibodies was similar to that obtained with anti-IgG, anti-C3d and anti-factor H antibodies. These results suggest that in situ activation of the whole complement sequence throughout C5b-9 only occurs on large immune deposits (stage II-III DNMN).

Adolescent↗

Analysis of the complement C3 fragments associated with hemodialysis membranes.

During hemodialysis with cuprophan membranes, bioactive peptides are generated because the alternative pathway of complement is activated. When cellulose acetate membranes are employed, complement activation is attenuated. The molecular basis for this improved biocompatibility is unknown. It has been postulated, however, that the complement activating potential of dialysis membranes is influenced by the availability of free hydroxyl groups which would provide an acceptor site for activated C3. To investigate this hypothesis, the forms of C3 associated with cellulose acetate and cuprophan membranes have been analyzed. By Western blot, the predominant form of C3 present on both types of membranes is C3c, a degradation product of C3 that lacks the thiolester necessary for covalent bonding. Minimal amounts of C3d (the region of C3 which contains the thiolester) were observed on both membranes; however, by ELISA, there was no difference in the amount bound to cellulose acetate compared to cuprophan. Further, membrane-associated C3d could be removed by urea, suggesting that it was not bound covalently. These studies indicate that the complement activating potential of dialysis membranes is not determined primarily by the availability of potential covalent binding sites for activated C3b.

Blotting, Western↗

Activation of the complement system in human immunodeficiency virus infection: relevance of the classical pathway to pathogenesis and disease severity.

In vitro studies implicate classical and alternative complement pathway activation in the pathogenesis of human immunodeficiency virus (HIV) infection. To ascertain their importance in vivo, activation fragments of the classical (C4d), alternative (Ba), and common (C3d) pathways were measured and fragment to parent molecule ratios derived in 74 HIV-infected individuals and related to circulating immune complex (CIC) levels, Centers for Disease Control (CDC) stage, and beta 2-microglobulin, neopterin, and CD4-positive (CD4+) lymphocyte levels. All fragments and ratios were significantly higher in patients (P less than .01) than controls. C4 conversion indices (C4d and C4d to C4) increased linearly with increasing CDC stage (P less than .001), while CD4+ lymphocytes decreased linearly (P less than .001). C4d, C3d, C4d to C4, and C3d to C3 correlated with increasing CIC and beta 2-microglobulin, and C4d and C4d to C4 correlated with decreasing CD4+ lymphocytes (P less than .05). The relationship of classical complement pathway activation to disease progression and CD4+ lymphocytes suggests its involvement in the pathogenesis of HIV infection.

Adult↗

Complement activation in neonatal infection.

To investigate the usefulness of indices of complement activation in the diagnosis of infections in the neonatal period, activation products C4d, Ba, and C3d were measured in 42 babies with a putative diagnosis of infection based on clinical/laboratory criteria, and compared with conventional clinical and haematological criteria of infection and with C reactive protein. The diagnosis of sepsis was confirmed by culture and identification of organisms in 17. Fourteen babies in whom infection was not suspected formed the control group. In babies with proved infection, concentrations of the fragments C4d, Ba, and C3d were higher than in babies with suspected infection in whom microbiological tests were negative, and concentrations of Ba and C3d were higher than in controls. C reactive protein and the platelet count were not significantly different in babies with proved infection and those with negative microbiological tests, but in the latter, C reactive protein concentrations were higher than in controls. Of the indices studied, high concentrations of Ba predicted microbiologically proved infection with the highest sensitivity (47.1%) and specificity (92.0%). Ba thus seems to be useful as an early indicator of infection in the neonatal period.

Analysis of Variance↗

Immunological studies in placentas with villitis of unknown etiology: complement components and immunoglobulins in chorionic villi.

Villitis of unknown etiology (VUE) is a common placental lesion and complement-fixing immune complexes is one of the mechanisms proposed for its development. We examined 16 placentas with VUE and 16 without VUE by immunofluorescence in order to compare the distribution and amount of C1q, C3d, IgG and IgM in the chorionic villi between the two groups. We found both in cases with and without VUE a distribution of the complement components and immunoglobulins similar to that described in normal placentas. The amount of deposit was also not significantly different in the two groups. Only the inflamed villi showed an abnormal distribution of C1q which was present diffusely in the stroma of these villi.

Chorionic Villi↗

Activation of fibrinolysis during xenoperfusion.

Ten rabbit kidneys were perfused at 80 mm Hg, 37 degrees C, with oxygenated recirculating heparinized human blood. These experiments were compared to another ten perfusion experiments where 1 unit/ml porcine plasmin was added to the human blood one hour before the perfusion, at which time the fibrinolytic activity was significant and the fibrinogen concentration under the detection limit. Rejection, determined as time until blood flow decreased to 2 ml/min, was not significantly delayed by addition of plasmin. At the end of the experiments, the fibrinolytic activity in the control experiment had increased above the activity in the plasmin added experiments, although the fibrinogen concentration was almost unchanged. Histological examinations demonstrated a decreased platelet deposition and the fall in platelet count was smaller in the plasmin experiments. C3d determinations revealed a slight activation of complement upon addition of plasmin, but the activation by xenoperfusion was much more pronounced and, at the end of the experiment, the C3d concentration was the same in the two groups.

Animals↗

High levels of complement breakdown products in tuberculous pleural effusions.

Pleural fluids from 10 patients with tuberculous pleural effusions contained high levels of small molecular weight breakdown products of C3 (C3d) and of properdin factor B (Ba) when compared to 16 patients with effusions of neoplastic origin (P less than 0.001). The same fluids exhibited overlapping values of haemolytic factor B, classical or alternative pathway-mediated haemolytic activity and native C3. A significant correlation between Ba and lysozyme levels was found in all effusions tested (P less than 0.05). These findings suggest that activation of the complement system is an important aspect of the extensive inflammation and tissue destruction characteristic of human tuberculosis.

Complement Activation↗

Complement levels and C3 breakdown products in open-heart surgery: association of C3 conversion with the postpericardiotomy syndrome.

The role of the complement system in the pathogenesis of the post-pericardiotomy syndrome (PPS) was evaluated in a prospective study by measuring the levels of complement (C) components, total haemolytic complement activity and circulating C3 breakdown products in serial plasma and serum samples of 45 patients undergoing open-heart surgery. A consistent reduction in the levels of C3 and C4 but not of factor B was seen on the second post-operative day. During the second post-operative week the antigenic levels of each C component increased significantly. At this time six patients developed the post-pericardiotomy syndrome. Circulating C3 conversion products (C3bi and C3c) were demonstrated in the plasma samples from five of these patients by the immunofixation technique, the mean conversion percentage being 14.3 +/- 10.6. The samples from 15 of the 39 other patients also showed C3 conversion, but the mean percentage was significantly lower (4.5 +/- 6.1%, P less than 0.05). Before the second post-operative week C3 conversion was rare in both groups. The C3d levels of plasma samples, as detected by rocket immunoelectrophoresis, followed a similar pattern. Reduced total haemolytic complement activity was found in three patients suffering from the PPS. These results suggest a role for complement in the non-infectious, inflammatory response during the late post-operative period after open heart surgery, and especially in the post-pericardiotomy syndrome.

Adolescent↗