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Host defense against opportunist microorganisms following trauma. I. Studies to determine the association between changes in humoral components of host defense and septicemia in burned patients.

Total hemolytic complement (CH(50)), conversion of C3 by inulin, and immunochemical levels of Clq, C4, C2, C3, C5, factor B, C3b inactivator (KAF), and properdin were measured in the sera of 15 patients with severe thermal injury during nine weeks postburn. Five of the 15 patients had multiple episodes of septicemia as documented by positive blood cultures and clinical findings. Decrease in CH(50), Clq, C4, C2, C3, and C5 occurred prior to and during septic episodes in these patients. Although conversion of C3 by inulin was often reduced during septic episodes, levels of factor B and KAF were generally normal or elevated. In only one patient did consumption of complement occurring during septicemia decrease the opsonic capacity of the patient's sera for the patient's infecting microorganism, an isolate of E. coli; sera from the same patient opsonized her infecting strain of S. aureus normally. The microorganisms isolated from the other septic patients, which were opsonized normally by the patients' sera despite complement consumption, were also with one exception strains of Staphylococci. In the nonseptic burned patients, decrease in properdin and C3 conversion by inulin, and increase in C3, factor B and KAF were demonstrated as we have previously reported. The results indicate that the classical complement pathway was activated during septicemia in burned patients and that activation of this pathway occurred preferentially due to inhibition of the alternative pathway. In addition, the data show that complement consumption may reduce the opsonic capacity of a patient's sera for certain microorganisms and not for others.

Adolescent↗

Host defense against opportunist microorganisms following trauma. II. Changes in complement and immunoglobulins in patients with abdominal trauma and in septic patients without trauma.

Total hemolytic complement (CH50), conversion of C3 by inulin and cobra venom factor (CoVF), and immunochemical levels of Clq, C4, C2, C3, C5, factor B, properdin, C3b inactivator (KAF), and immunoglobulins (Igs) G, A, and M were measured in the sera of ten patients with abdominal trauma and ten medical patients with septicemia without trauma. Reduction in C3 conversion by CoVF and decrease in the levels of properdin and KAF were demonstrated in the trauma sera. CH50 and the level of C5 were also decreased. Conversion of C3 by inulin and levels of factor B, Clq, C4, C2, and C3 were found to be normal in the patients' sera. Complement levels and activities were found to be normal in the sera of the septic non-trauma patients. A decrease in serum IgM was observed in both patient groups; levels of IgG and IgA were normal. These results indicated that abnormalities of immunoglobulin and of the alternative and classical complement pathways were associated with nonburn trauma. Moreover, the data suggested that consumption of the classical complement pathway associated with septicemia in the thermally injured patient resulted from synergism between the trauma and infection rather than from septicemia per se.

Abdominal Injuries↗

Complement activation in bullous skin diseases.

Pemphigus, bullous pemphigoid, cicatricial pemphigoid, dermatitis herpetiformis, and herpes gestationis are members of the chronic vesiculobullous skin diseases of man. The complement system, including both the classical and alternative pathways, may be important in the pathogenesis of these diseases. In pemphigus, early complement components (C1, C4, and C2) appear to be activated in addition to later components (C3 and C5), suggestive of classical pathway activation. Participation of properdin in addition to early complement components suggests local activation of both complement pathways in bullous pemphigoid and cicatricial pemphigoid. Herpes gestationis and dermatitis herpetiformis may be bullous skin diseases entirely mediated by the alternate or properdin pathway. The specific immunopathologic findings in these diseases are discussed.

Antibody Formation↗

Reversible activation of proactivator (factor B) of the alternative pathway without cleavage of the molecule.

The serum of a patient (M.C.) with chronic glomerulonephritis and renal deposits of IgA, C3, and properdin converted C3 on overnight exposure of 0 degrees C. The cold reaction was dependent on immunoglobulin, initiating factor, Factors B and D, and magnesium but not on properdin. Factor B, the C3-cleaving enzyme in this reaction, was used in zymogen form. After participation in this rection, Factor B zymogen in M.C. serum could be fully activated by cobra venom factor (CVF) at 37 degrees C. That activation without fragmentation was not due to an abnormal form of Factor B was shown by its typical cleavage on incubation of MC. serum with CVF or C3b or after depletion of C3b inactivator. The evidence indicates that in the cold reaction only the initial C3 convertase of the alternative parhway is formed and that this enzyme is responsible for the observed C3 consumption.

Chronic Disease↗

Effects of anesthesia, surgery and inflammation upon host defense mechanisms. I. Effects upon the complement system.

Complement protein levels and C7 hemolytic activity were measured in four individuals following anesthesia and surgery, and in a group of 20 patients with inflammatory diseases. Seven of the eight complement components studied characteristically were elevated, most dramatically C1s and C3PA. Elevation of C1s often was greater than elevation of C1q, displaying an independent variation of C1s and C1q in both postoperative and inflammatory disease patient groupds. The major increases of C components were seen subsequent to the peak C-reactive protein response, as was the occurrence of the 'reactor state', a propensity to formation of C56 which surprisingly was associated with increased levels of C7. Levels of properdin frequently were reduced postoperatively. It is concluded that multiple complement components, with the notable exception of properdin, respond as acute phase reactants which are elevated and changed in proportion postoperatively and during inflammatory disease.

Anesthesia, General↗

Competition for binding sites on C3b by CR1, CR2, MCP, factor B and factor H.

The reaction of radiolabeled C3b-binding proteins with C3b-coated particles has been investigated. CR1 binding was inhibited by factor H and factor B (in the presence of properdin), but not by properdin alone. CR2 and MCP binding were also inhibited by factor H. Therefore factor H, factor B, CR1, CR2 and MCP probably comprise a group of mutually competitive proteins with similar or overlapping binding sites on C3b. These results correlate with their structural homology and suggest that they all evolved from a single C3b-binding molecule. Factor H, CR1 and MCP are also cofactors for the factor-I-mediated cleavage of C3b. A species incompatibility between rat factor I and human CR1 for the cleavage of human C3b suggests the possibility that cofactors may also function by interacting directly with factor I.

Animals↗

The association of respiratory infection, recurrent hematuria, and focal glomerulonephritis with activation of the complement system in the cold.

The study of the activation of C3, C5, and C7 associated with the conversion of C3 in the serum of a 9-yr old girl after incubation at 0 degrees C for 6-8 h without utilization of C1, C4, and C2 is described. The patient has upper respiratory infections associated with recurrent gross hematuria, focal glomerulonephritis, and transient renal insufficiency. Histological lesions demonstrated the presence of B1c globulin IgA and properdin in the glomeruli. The activation of complement (C) in the cold requires the patient's IgA. Removal of IgA from the serum by immunoadsorption prevents activation and conversion of C3. Bactericidal and phagocytic activity is also impaired after incubation. C3 proactivator (C3PA) level is reduced before and after incubation. Properdin level drops after incubation. These findings suggest that the activation of C3 which is demonstrable in vitro may be a continuous process in vivo.

Child↗

Evidence for complement activation via the alternate pathway in skin diseases, I. Herpes gestationis, systemic lupus erythematosus, and bullous pemphigoid.

A patient with herpes gestationis, 6 of 6 patients with bullous pemphigoid, and 5 of 25 patients with systemic lupus erythematosus were found to have properdin deposited along the skin basement membrane.The patient with herpes gestationis demonstrated by immunofluorescence basement membrane deposition of C3 and C5 in the absence of C1q, immunoglobulins, and light chains. A second patient with herpes gestationis had C3 deposition with no demonstrable immunoglobulins or light chains. A thermolabile humoral factor(s) capable of depositing C3 (without C1q or C4) on normal skin basement membrane was found in the sera of both patients with herpes gestationis. No anti-basement membrane antibodies could be demonstrated in the sera of these patients.The patients with systemic lupus erythematosus and bullous pemphigoid who manifested properdin deposition also showed skin basement membrane deposits of C1q, C4, C3, C5, and immunoglobulins. C3 proactivator (C3PA) was also found deposited along the skin basement membrane of three patients with systemic lupus erythematosus and all six bullous pemphigoid patients. This study provides suggestive evidence that activation of complement is occurring via the alternate pathway in herpes gestationis. In systemic lupus erythematosus and bullous pemphigoid, both the classical (antibody) mediated activation of complement as well as the alternate pathway may be operative.

Adult↗

Serum complement levels in infancy: age related changes.

Levels of eight complement components and two control proteins, were determined on cord serum from normal full term neonates and serum from healthy infants aged 1 and 6 months. For all proteins, the levels were below the adult normal at birth and rose toward the adult range by age 6 months. In a second group of 271 patients, ages 1-36 months, serum Clq and properdin levels were measured. For both proteins, the mean values in early infancy were more than two SD below the adult range and did not reach the adult range until 18-21 months of age. The Clq concentration was more variable than that for any other component studied. In infants from 11 months-3 yr of age, Clq levels correlated with serum IgG levels, but properdin levels did not.

Adult↗

Increased levels of acylation-stimulating protein in interleukin-6-deficient (IL-6(-/-)) mice.

IL-6-deficient (IL-6(-/-)) mice develop obesity at 6-7 months of age. To elucidate the mechanisms of this mature-onset obesity, global gene expression profiles of 3-month-old preobese IL-6(-/-) were compared with those of IL-6(+/+) mice using DNA arrays. Genes that were up-regulated in IL-6(-/-) mice included the factors transthyretin and properdin in white adipose tissue and adipsin in muscle. These factors have been shown to influence the formation of acylation-stimulating protein (ASP), a cleavage product of complement C3. ASP stimulates the synthesis of triacylglycerol in adipocytes, and ASP-deficient mice are resistant to diet-induced obesity. In line with the increases in transthyretin, properdin, and adipsin, ASP levels in serum were increased by 31-54% in IL-6(-/-) compared with IL-6(+/+) mice. Furthermore, IL-6 replacement treatment in IL-6(-/-) mice decreased ASP levels significantly by 25-60%. In conclusion, ASP levels are increased in preobese IL-6(-/-) mice. This increase may result in increased triacylglycerol formation and uptake in IL-6(-/-) adipocytes and thereby contribute to the development of obesity in IL-6(-/-) mice.

Adipocytes↗

Immunopathology of periodontal disease. II. Immunofluorescent studies on the localized immune response in periodontitis and juvenile periodontitis.

Local immunologic responses were studied in eleven patients with periodontitis, ten patients with juvenile periodontitis, and ten control subjects by performing immunofluorescence on gingival biopsies. F(ab')2 monospecific conjugates to human IgG, IgM, IgA, IgD, and kappa and lambda light chains were used as well as monospecific conjugates to human IgE and properdin. Biopsies from patients with juvenile periodontitis displayed a more intensified immunologic response as evidenced by increases of (I) positive cells stained with a F(ab')2 antihuman immunoglobulin conjugate; (2) IgG, IgM, and kappa and lambda containing cells; (3) extracellular fluorescence of IgG, IgM, IgA, and kappa and lambda light chains; and (4) properdin deposition. Neither IgD nor IgE conjugates reacted significantly with biopsies from the three patient groups. These findings support our previous conclusion that immunologic responses in periodontitis and juvenile periodontitis appear qualitatively similar, but that patients with juvenile periodontitis exhibit a more intense immune response.

Fluorescent Antibody Technique↗

Correlation among complement activation, protease inhibitors, and clinical course in acute pancreatitis in man.

Changes in complement levels and protease inhibitors were measured in plasma/serum and peritoneal fluid during 15 attacks of acute pancreatitis. The abnormalities found in the complement system and the protease inhibitors were most pronounced in severe attacks, especially in the peritoneal fluid. Depressed levels of C1q, C3, properdin, and factor I were found in blood on admission in severe attacks. A decrease during the first days of illness was found for C1q, C3, C4, properdin, factor I, and factor H levels in blood. There was a discrepancy between the low C1q and the high C1r and C1s levels in blood. Complexes of C1r-C1s-C1 inactivator and factor B conversion products were found, especially in the peritoneal fluid, denoting an activation of the complement system. High levels of trypsin in complex with alpha 1-protease inhibitor were found, both in blood and in peritoneal fluid, denoting the liberation of active trypsin in acute pancreatitis. The levels of the functional alpha 2-macroglobulin were low, especially in the peritoneal fluid. It is concluded that both classical and alternative complement activation take place in acute pancreatitis, starting in the peritoneal cavity. The magnitude of activation depends on the severity of the disease. Trypsin-induced activation of complement components may explain some of these changes.

Acute Disease↗

Allergic interstitial nephritis: report of a case with activation of complement by the alternate pathway.

An eighteen year old woman developed a streptococcal pharyngitis documented by throat culture. After two days of treatment with penicillin she developed arthritis and abdominal pain and within a week became anuric. Her renal biopsy revealed extensive interstitial nephritis without proliferative glomerular changes. Serum properdin levels were significantly reduced and immunofluorescence studies demonstrated properdin deposition within the glomeruli, C1, C4 and C2 were not depressed nor were they demonstrable within the glomeruli. These results support activation of complement apparently only by the alternate pathway, a finding heretofore noted only in membranoproliferative glomerulonephritis.

Adolescent↗

[The dynamics of the basic factors of nonspecific resistance in North Asian tick-borne typhus].

At the acute period of tick-borne typhus an increase in the activities of the main nonspecific resistance factors of the body, and particularly lysozyme, betalysins, complement and properdin, is observed. During convalescence the concentration of lysozyme normalizes and the content of betalysins remains sufficiently high, this indicating that, even in the absence of clinical sings of the disease, the disturbances in homeostasis persist. A decrease in the levels of complement and properdin during convalescence is seemingly linked with their consumption for the formation of immune complexes, eliminated from the body.

Adolescent↗

CR2 is a complement activator and the covalent binding site for C3 during alternative pathway activation by Raji cells.

Antibody-independent activation of the alternative C pathway by human lymphoblastoid cell lines latently infected with EBV has been recognized for some time, although the mechanisms involved and the specific cell surface molecule(s) recognized by the C system have not been identified. The present studies, carried out with the purified proteins of the alternative pathway have addressed these questions. Activation of the purified proteins of the alternative pathway by Raji lymphoblastoid cells was found to be antibody independent, confirming earlier findings with serum. Surprisingly, activation was highly dependent on properdin. In other models properdin has been found to augment alternative pathway activation and to be required for lysis of virus infected cells. Molecules which activate the alternative pathway provide binding sites on which C3 breakdown by regulatory proteins is impeded; therefore intact C3b accumulates on the activator. Immunoprecipitation studies with either anti-CR2 or anti-C3 have identified CR2, the R for C3d,g and EBV, as a major covalent and noncovalent binding site for C3 deposition on Raji cells during alternative pathway activation. Covalently bound C3b was dissociated from CR2 by hydroxylamine, indicating attachment via an ester bond. C3b binding after activation was not reduced by an anti-CR2 mAb which blocks CR2 R function, indicating that it was probably not mediated by C3d,g R epitopes on CR2. Direct confirmation of the ability of CR2 to trigger the alternative pathway came from studies with purified CR2 which was found to activate the alternative C pathway in serum or in mixtures of the purified proteins of the pathway. This work provides conclusive evidence that CR2 is a C activator and functions in this capacity on Raji cells.

Burkitt Lymphoma↗

Activation of the alternative complement pathway by EBV and the viral envelope glycoprotein, gp350.

The EBV-producing B lymphoblastoid cell line B95-8 was found to efficiently activate the alternative C pathway whether assessed with Mg-EGTA-treated human serum or with mixtures of the purified proteins of the pathway (PAP). The ability of the cells to activate was markedly increased after stimulation of EBV replication by treatment of the cells with a phorbol ester, and decreased by treatment of the cells with a viral polymerase inhibitor. Alternative pathway activation was dependent on the presence of either properdin or EBV-immune IgG; the addition of either alone to the PAP led to the deposition of 200,000 C3 molecules/cell. The addition of both properdin and immune IgG to the PAP markedly increased C3 binding to a level of 800,000 molecules/cell. Several lines of evidence indicate that the major external glycoprotein of EBV, gp350, mediates alternative pathway activation by B95-8 cells. First, the ability to activate C positively correlated with gp350 expression on the surface of the EBV-producing cells and gp350- cells failed to activate; second, the anti-EBV antibody in immune human sera which enhanced activation specifically immunoprecipitated gp350 from membranes of B95-8 cells; third, a significant proportion of the C3 which became bound to the cells during activation was attached either to gp350 or to the anti-gp350 antibody found in immune human sera; and fourth, purified gp350, as well as EBV, efficiently activated the alternative pathway. These results indicate that gp350, an EBV envelope glycoprotein, is an efficient alternative pathway activator and its expression on cell membranes is associated with the ability to activate C.

Animals↗

Immunologic phenomena in herpes gestationis.

Immunofluorescence studies were performed in 12 cases of herpes gestations. Direct IF staining (performed in 10 of them) revealed a highly characteristic pattern, notably 1) Constantly BMZ deposits of complement component C3, 2) In most biopsy specimens also C4 and C5, 3) Deposits of C4, C5, properdin and IgG variable in different specimens of given patients. About half of the specimens examined contained properdin and about one third stained for IgG, 4) Findings of IgM, IgA, IgD and IgE were consistently negative, 5) Serum findings of BMZ antibodies in given cases were variable. In two cases circulating BMZ antibodies were detected in one of the samples examined. On the base of these findings it seems that HG is related to BP.

Autoimmune Diseases↗

Complement alterations in inflammatory bowel disease.

A prospective evaluation of the activity of the complement system was undertaken in 32 patients at the time of diagnosis of inflammatory bowel disease, before the onset of therapy. Serum classical pathway components and function were normal, while significant abnormalities of the alternative pathway were found. Depressions of serum properdin and properdin convertase were noted in association with diminished consumption of C3--C9 after reaction with cobra venom. These abnormalities of alternative pathway integrity were most significant in regional enteritis and in ulcerative colitis with extraintestinal complications. Sequential studies extending into clinical remission revealed resolution of all significant abnormalities.

Adolescent↗