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Altered concentrations of terminal complement complexes, anaphylatoxins, and leukotrienes in the coronary sinus during cardiopulmonary bypass.

The aim of this study was to determine if the hypoperfused heart activates complement with formation of anaphylatoxins, terminal complement complexes (TCC), or leukotrienes during cardiopulmonary bypass. Fifteen patients undergoing elective cardiopulmonary bypass surgery were studied regarding complement and leukotriene activation. Blood samples were drawn serially from the radial artery and coronary sinus. The plasma concentrations of the complement components C1INH, C3, C4, and C5 decreased during the procedure, whereas C3a and TCC increased. Protamine reversal of heparin further increased the plasma levels of C3a and TCC. No significant changes in plasma levels of C5a and leukotriene C4 were observed during cardiopulmonary bypass. The activity of the anaphylatoxin inactivator (AI) decreased in both the radial artery and the coronary sinus. There were no significant differences between the concentrations of complement components and leukotriene C4 in blood from the radial artery and coronary sinus. The levels of C3a and TCC increased and C1INH, C3, C4, C5, and the anaphylatoxin inactivator activity decreased to the same extent in the coronary sinus and the radial artery. Thus, the heart does not appear to be the primary site for the altered concentrations of these endogenous vasoactive substances.

Aged↗

Human complement regulatory proteins protect swine lungs from xenogeneic injury.

BACKGROUND: Pulmonary xenotransplantation is not possible because of hyperacute lung injury, the pathogenesis of which is unknown. This study evaluates complement-dependent pathways of pulmonary injury during heterologous perfusion of swine lungs. METHODS: Lungs from unmodified swine and swine expressing human decay-accelerating factor and human CD59 (hDAF/hCD59 swine) were perfused with either human plasma or baboon blood. Pulmonary vascular resistance and static pulmonary compliance were measured serially, and swine lung tissue were examined by light microscopy. Complement activation was assessed by serial measurements of baboon plasma C3a-desArg concentrations. RESULTS: Perfusion of unmodified swine lungs with human plasma and baboon blood resulted in hyperacute lung injury within minutes of perfusion. However, function was preserved in swine lungs expressing human decay-accelerating factor and human CD59. In both study groups, xenogeneic perfusion with baboon blood resulted in at least a sevenfold increase in plasma C3a-desArg levels suggesting transient activation of complement. CONCLUSIONS: Lungs from swine expressing human decay-accelerating factor and human CD59 were resistant to injury during perfusion with human plasma and baboon blood, indicating that complement mediated some of the features of xenogeneic acute lung injury.

Animals↗

A pilot study to evaluate the effects of C1 esterase inhibitor on the toxicity of high-dose interleukin 2.

In a pilot study six patients received 4 days' treatment with interleukin 2 (IL-2) [cumulative dose (CD) 264 +/- 26 x 10(6) IU m-2] and C1 esterase inhibitor (C1-INH) (loading dose 2,000 U, followed by 500-1,000 U twice daily). Toxicity was compared with that in patients given 4 days' treatment with standard (CD 66 +/- 12 x 10(6) IU m-2) or escalating-dose (CD 99 +/- 8 x 10(6) IU m-2) IL-2. IL-2-induced hypotension was equivalent and complement activation was less after IL-2 + C1-INH (C3a = 10.5 +/- 3.2 nmol l-1) than following standard (14.1 +/- 8.4 nmol l-1) or escalating-dose (18.3 +/- 2.9 nmol l-1) IL-2. This study demonstrates that C1-INH administration during IL-2 treatment is safe and warrants further study to evaluate its ability to ameliorate IL-2-induced toxicity.

Adult↗

Neutrophil lactoferrin release during open heart surgery is unrelated to complement activation.

The relationship between neutrophil activation and complement activation during open heart surgery was evaluated by measuring plasma lactoferrin and C3a des Arg (C3a) in 30 adult patients undergoing coronary artery surgery. Measurements were made before induction of anesthesia, before cardiopulmonary bypass, at the end of bypass, and 10 min after protamine infusion. Changes in the measured parameters thus reflected activation during the three distinct phases of cardiac surgery: pre cardiopulmonary bypass, the bypass phase, and the heparin neutralization phase. A major rise in lactoferrin occurred in the pre bypass period, from 99 +/- 13 (mean +/- SEM) to 647 +/- 48 ng/ml (p < 0.001). During this time, C3a levels did not rise significantly (384 +/- 22 to 439 +/- 36 ng/ml). The bypass procedure resulted in a rise of both lactoferrin and C3a levels, with lactoferrin reaching 1,092 +/- 69 ng/ml and C3a increasing to 1,884 +/- 179 ng/ml after bypass (p < 0.001 for both). In individual patients, however, the changes in lactoferrin during bypass did not correlate with changes in C3a levels (r = -0.06). After protamine infusion, C3a levels reached 3,301 +/- 324 ng/ml, while the plasma lactoferrin levels declined to 522 +/- 57 ng/ml. Thus, during open heart surgery, neutrophil activation, as measured by plasma lactoferrin concentration, does not correlate with complement activation resulting from the bypass procedure or the protamine neutralization of heparin. The potential clinical relevance of the neutrophil granular release of lactoferrin is discussed.

Complement Activation↗

Effects of immune complex formation and complement activation on circulating platelets in the primate.

Primate platelets are different from rodent and rabbit platelets in that they do not express receptors for C3a or C5a or immune adherence receptors. This study assessed the effects of immune complex (IC)-induced complement activation on primate platelets in the circulation. Cynomolgus monkeys (CYN, N = 4) immunized to bovine gamma globulin (BGG) were infused with BGG over 5 min to induce acute intravascular IC formation and complement activation. The studies were carried out under normal complement conditions (N = 12), partial complement inhibition (CAB-2 treated, N = 3), or total complement inhibition (CVF treated, N = 1). Under normal complement conditions, BGG infusion increased C3a levels from undetectable to an average of 11.9 +/- 2.6 micrograms/ml. At this time, decreases occurring in both circulating neutrophils (85 +/- 6%) and monocytes (78 +/- 6%) were significantly greater than decreases in circulating platelets (13 +/- 3%, p < 0.001). Partial complement inhibition had an equivocal effect on the BGG-induced changes in circulating leukocytes, while total complement inhibition abrogated these changes. In contrast, platelet changes were unaffected by complement inhibition. We conclude that, compared to circulating leukocytes, circulating platelets are insensitive to intravascular complement activation induced by IC in the nonhuman primate. These results contrast with previous studies in rodents which demonstrate strong effects of IC-induced intravascular complement activation on both circulating neutrophils and platelets.

Animals↗

Complement and the damaging effects of cardiopulmonary bypass.

Postoperative cardiac, pulmonary, renal and coagulation dysfunction, along with C3a levels, were studied prospectively in 116 consecutive patients undergoing open cardiac operations and 12 patients undergoing closed operations in the same time period. The level of C3a 3 hours after open operation was high (median value 882 ng X ml-1 plasma) and was related to the C3a level before cardiopulmonary bypass (CPB) (p = 0.03), the level at the end of CPB (p less than 0.0001), elapsed time of CPB (p = 0.07), and older age at operation (p less than 0.0001). It was inversely related to the cardiac output as reflected by the strength of the pedal pulses (p = 0.006). In contrast, C3a levels did not rise in patients undergoing closed operations. The probability of postoperative cardiac dysfunction after open operations (present in 27 of 116 patients) was predicted by C3a levels 3 hours after operation (p = 0.02), the CPB time (p = 0.02), and younger age (p less than 0.0001). The same risk factors pertained for postoperative pulmonary dysfunction (present in 41 of the 116 patients); renal dysfunction (present in 24 of the 116 patients) except that CPB time was not a risk factor here; abnormal bleeding (present in 21 of the 116 patients); and important overall morbidity (present in 26 of 116 patients). As regards important overall morbidity, the C3a level effect became evident at about 1,900 ng X ml-1 (a level reached by 9% of patients); the effect of increasing time of CPB became evident at about 90 minutes of CPB time; and the effect of young age became evident as age decreased from 10 to 4 years. This study demonstrates the damaging effects of CPB, relates them in part to complement activation by the foreign surfaces encountered by the blood, and supports the hypothesis that the mechanisms of the damaging effects include a whole-body inflammatory reaction.

Cardiac Surgical Procedures↗

Complement plays an essential role in shock following intestinal ischaemia in rats.

Intestinal ischaemia lasting more than 30 min in rats causes fatal systemic shock. Systemic shock was suppressed by preadministration of cobra venom factor (CVF), which reduced the serum complement to less than 5% of the normal level, indicating that complement is involved in the syndrome. After complement activation, anaphylatoxins such as C3a and C5a are generated, and their activity is restricted by carboxypeptidases which remove C-terminal arginine from such bioactive peptides. As expected, preadministration of a carboxypeptidase inhibitor enhanced the systemic shock induced by the intestinal ischaemia. However, when the complement level was suppressed by CVF treatment, no fatal systemic shock was induced by the intestinal ischaemia even with preadministration of the carboxypeptidase inhibitor. These results indicate that complement plays a crucial role in systemic shock induced by intestinal ischaemia, and that anaphylatoxins generated by the complement activation should be involved in induction of the shock syndrome.

3-Mercaptopropionic Acid↗

Is platelet-activating factor produced during hemodialysis with AN-69 polyacrylonitrile membrane?

BACKGROUND: Platelet-activating factor (PAF) production during hemodialysis (HD) with cuprophane (CU) membrane has previously been demonstrated, while the results regarding PAF production during HD with AN-69 polyacrylonitrile membrane are dubious. In this study an attempt is made to show that PAF is produced during HD using AN-69 membrane while comparing this production with the corresponding one from HD with CU. Since previous studies have indicated that PAF, like the complement system, could also be implicated in HD-related leukopenia and thrombocytopenia (especially when CU membrane is used), the circulating leukocyte and platelet counts as well as the C3a-desArg and SC5b-9 (soluble, nonlytic form of the terminal complement complex) levels were measured. METHODS: Ten hemodialyzed patients were subjected to HD with CU and AN-69 membranes for 2 consecutive weeks (first week with CU and second with AN-69). During the third HD session of each week and at different times (0, 2, 5, 15, 30, 60, 180 and 240 min), the PAF levels in the blood as well as the leukocyte and platelet counts were measured, while the circulating levels of the C3a-desArg and SC5b-9 were measured at 0, 5, 15, 60 and 240 min. PAF was detected by ethanol extraction, followed by purification by column chromatography and high-pressure liquid chromatography and finally quantified by bioassay. The C3a-desArg and SC5b-9 fractions of the complement were measured by immunoassay while an autoanalyzer gave the leukocyte and platelet counts. RESULTS: Circulating PAF levels were detected at all time intervals during HD with AN-69 (PAF(AN-69)) and CU (PAF(CU)) membranes. At all time intervals PAF(AN-69) < PAF(CU), however, statistically significant differences (s) between the two membranes existed only at 15, 30, 60, 180 and 240 min. The highest PAF(AN-69) and PAF(CU) occurred at 5 and 15 min into dialysis, respectively. The same observations were made for circulating C3a-desArg levels (s existed additionally at 5 min as well). The reduction of the circulating leukocytes had almost a mirror image with the C3a-desArg as well as PAF levels while the maximal reduction of platelets was observed after 2 min into dialysis with both membranes (i.e., simultaneously with the first increase in PAF secretion). CONCLUSIONS: PAF is indeed produced during HD with AN-69 membrane, as it is during HD with CU. At all time intervals during the HD procedure, PAF(AN-69) < PAF(CU). PAF seems to contribute to HD-related leukopenia and thrombocytopenia with both membranes.

Acrylic Resins↗

Heparin-coated circuits reduce the inflammatory response to cardiopulmonary bypass.

Cardiopulmonary bypass generates a systemic inflammatory response including the activation of the complement cascade and leukocytes contributing to postoperative morbidity. To evaluate whether the use of heparin-coated extracorporeal circuits could reduce these activation processes, we performed a study on 30 patients undergoing coronary artery bypass grafting who were randomly perfused with a heparin-coated circuit (Duraflo II, n = 15) or with a similar noncoated circuit (control, n = 15). Standardized systemic heparinization was applied for every patient before cardiopulmonary bypass. The use of heparin-coated circuits resulted in a reduction of systemic leukocyte activation during cardiopulmonary bypass reflected by reduced elastase release (p < 0.05) and tumor necrosis factor generation (p < 0.05) manifest after release of the aortic cross-clamp. In addition, blood samples taken from both the right and left atria after reperfusion revealed that the elastase release from the pulmonary microcirculation was absent in the Duraflo II group in contrast to the control group (p < 0.05). The pattern of complement activation, likely initiating this inflammatory reaction, was modified by heparin coating in two different aspects. There was a significant reduction of C3a generation after protamine administration in patients perfused with heparin-coated circuits, and there was a decrease of complement hemolytic capacity in pooled human serum incubated with heparin-coated tubing. These observations suggest that heparin coating might bind some of the complement components from the classic pathway, thereby reducing the inflammatory response to cardiopulmonary bypass.

Aged↗

Involvement of C3a and C5a in interleukin-8 secretion by human polymorphonuclear cells in response to capsular material of Cryptococcus neoformans.

In a previous paper we demonstrated that human polymorphonuclear cells (PMN) in the presence of normal human serum (NHS) secrete proinflammatory cytokines in response to Cryptococcus neoformans or its major capsular component, glucuronoxylomannan (GXM). The hypothesis that activation of the complement system could be responsible for the observed phenomenon is supported by the fact that encapsulated and acapsular C. neoformans isolates are activators of the complement system and, in particular, large encapsulated isolates are powerful activators. In the present study we demonstrate that (i) interleukin-8 (IL-8) release in response to acapsular or encapsulated strains of C. neoformans is significantly reduced in the presence of heat-inactivated serum rather than NHS and is completely abrogated in the absence of human serum; (ii) GXM-induced IL-8 release is strictly dependent on the presence of NHS, is inhibited by specific antibodies to either C3a and C5 complement components, and is completely abrogated by the combined use of these antibodies; (iii) the addition of purified C3a and C5a directly stimulates IL-8 release by PMN; and (iv) monoclonal antibody to GXM in combination with GXM or encapsulated C. neoformans potentiates IL-8 release by PMN. These data shed light on the mechanism involved in GXM-induced IL-8 secretion by PMN, provide an additional potential role for complement in the control of C. neoformans infections, and suggest a complex interplay between the complement system, humoral immunity, and cytokine regulation.

Cells, Cultured↗

[In vitro study of C3a des Arg produced by plasma incubation with blood purification materials].

This study was performed to evaluate the degree of complement C3 activation of five biomedical polymers (cellulose acetate (CA), polymethylmethacrylate (PMMA), polysulphone (PS), polyethersulphone (PES), sulphonated polyethersulphone(PES-SO3) which are used to make hemofilters. The concentration of the activation derivative C3a des Arg was measured by radioimmunoassay (RIA) in human plasma after incubation with these five polymers for 30, 60, 90 and 120 minutes. The experimental results indicated that the presence of polymers caused an increase in C3a des Arg. The potential to activate complement C3 decreased in sequence of CA, PMMA, PES, PS and PES-SO3. CA activated the most complement C3. PES-SO3 activated the least complement C3, and the concentration of C3a des Arg decreased with the increase in sulphonation degree. The investigation demonstrates that with good biocompatibility PES is a promising material to make biocompatible hemofilters. Furthermore, it indicates that PES containing sulphonate groups can achieve a marked reduction in complement activation and supports the sulphonation as a means of improving the biocompatibility of PES for blood purification application. RIA is a reliable and precise quantitative determination of human C3a des Arg and is suitable for testing the activation of complement of various synthetic materials that are utilized or to be utilized in the medical field.

Complement Activation↗

Complement activation in amyloid plaques in Alzheimer's dementia.

Amyloid plaques in Alzheimer's dementia contain complement factors C1q, C4 and C3. In the present study we demonstrate complement activation in amyloid plaques using immunoenzymatical techniques and specific antibodies against subunits of individual complement components and activated complement products. Amyloid plaques contain C1q and activated C3 fragments (C3c and C3d, g) but no C1s and C3a. These findings demonstrate that the complement components are not passively bound to the amyloid plaque structures but are the result of an activation process. The role of complement activation in the genesis of senile plaques is discussed.

Aged↗

Complement anaphylatoxins activity in middle ear effusion.

There are various theories on the causes of otitis media with effusion. The exact pathogenesis, however, still remains unknown, while the causes have been so far elucidated and studied by many researchers. This disease occurs frequently in children, showing an increasing trend, often causes subsequent deafness, and its treatment takes a long time causing social hardships. Therefore it is urgent to elucidate the pathogenesis of this disease. In this study the C3a and C5a fragments of complements from middle ear fluids, most closely related to the inflammatory reaction, were measured. The subjects were patients with otitis media with effusion consisting of 5 children and 9 adults. All cases showed retraction in the tympanic membrane findings, B type in the tympanogram classification, and serous type in the properties of middle ear fluids. CRP, alpha-1, alpha-2, beta-, gamma-globulin, neutrocytes, and lymphocytes in serum were normal when examined, and C3, C4, C3a, C5a, and CH50 were normal as well. Extremely high values of C3a and C5a in middle ear fluids were observed. The values of C3a were 18,000 ng/ml at maximum, 5,800 ng/ml at minimum, and 9,293 ng/ml on average. The values of C5a were 86, 20, and 55 ng/ml, respectively. No difference between childhood and adult cases was observed, in spite of differences in the underlying diseases among them. The above results revealed that an extremely intensive inflammatory reaction may take place in the middle ear, and that anaphylatoxin might play an important role as a delayed factor in otitis media with effusion.

Adult↗

[Intensification of the interaction of IgG with C1q in the presence of melittin as a possible reason for anaphylaxis under the effect of bee venom].

The hydrophilic head of melittin (peptide from bee venom) has the amino acid sequence which is very close to the amino acid sequence of C1q-binding site of the IgG molecule. It was shown, that melittin caused the multiple growth of the interaction of C1q with IgG monoclonal antibody. We assume, that the appearance of melittin in blood causes the spontaneous antigen-independent aggregation of IgG and C1q with the following triggering of the classical pathway of the complement cascade and origin of C3a and C5a components. This can be one of the mechanisms of anaphylaxis as an answer to bee venom.

Anaphylaxis↗

Amino acid sequence of guinea pig C3a anaphylatoxin.

The anaphylatoxin peptide, C3a, was isolated in its inactive des-arginine form from complement-activated guinea pig serum and the complete amino acid sequence was determined. The peptide was isolated using a modification of previously described methods for anaphylatoxin purification and yielded 18 mg of guinea C3ades Arg judged homogeneous by cellulose acetate electrophoresis, high performance liquid chromatography, amino acid composition, and sequence analyses. The complete amino acid sequence of the molecule was determined by automated Edman degradation of intact C3ades Arg following performic acid oxidation, and of four peptides obtained from CNBr, endoproteinase Lys-C, or endoproteinase Glu-C (V8 protease) digests of reduced and alkylated C3ades Arg. The sequence is as follows: Guinea pig C3ades Arg has approximately 70% overall sequence identity with human, porcine, rat and mouse anaphylatoxins. As with C3a's from other species, the guinea pig molecule has an invariant C-terminal tetrapeptide sequence, LGLA, and six invariant cysteinyl residues at positions 23, 24, 37, 50, 57, and 58.

Amino Acid Sequence↗

A phase I trial of aprinocarsen (ISIS 3521/LY900003), an antisense inhibitor of protein kinase C-alpha administered as a 24-hour weekly infusion schedule in patients with advanced cancer.

PURPOSE: A phase I study was performed to determine the maximum tolerated dose (MTD), safety profile and pharmacology of aprinocarsen (ISIS 3521), an antisense oligonucleotide to protein kinase C-alpha, in patients with refractory solid tumors. EXPERIMENTAL DESIGN: Fourteen patients were treated in sequential cohorts of aprinocarsen by 24-hour continuous infusion (CIV), weekly, at doses of 6, 12, 18 and 24 mg/kg. RESULTS: One grade 4 toxicity was observed, transient grade 4 neutropenia at 18 mg/kg. Grade 3 toxicities included neutropenia at 12 mg/kg, fever and hemorrhage at 18 mg/kg, and neutropenia, nausea, and chills at 24 mg/kg. Grade 2 toxicities included thrombocytopenia myalgias, chills, headache, fatigue, fever and nausea/vomiting. Mean prothrombin times and activated partial thromboplastin times (aPTT) increased by 10% and 29% from baseline (p = 0.006 and 0.005). Mean complement split products (Bb and C3a) increased 1.6-fold and 3.6-fold (from p = 0.014 and 0.004, respectively). These changes correlated with dose and were transient with recovery to baseline by day 7. Steady state plasma concentrations (Css) of aprinocarsen were achieved within four hours. Css better described changes in aPTT than dose. Clinical evidence of complement activation was not observed. CONCLUSIONS: In contrast to 21-day protracted infusion schedules, delivery of aprinocarsen over a 24-hour infusion schedule showed concentration-dependent effects on coagulation and complement, which are consistent with nonclinical toxicology studies performed in the phosphorothioate DNA antisense drug class. These coagulation and complement changes resulted in a maximum tolerated dose 24 mg/kg.

Adult↗

Diving decompression fails to activate complement.

The present study evaluated complement activation during decompression after air dives in a hyperbaric chamber. Intravascular bubbles were quantified by Doppler ultrasound scoring. Eighteen subjects completed 92 dives, of which 74 produced bubbles. Complement activation was assessed by plasma C3a des Arg and red-cell-bound C3d before and after each dive. These parameters of in vivo complement activation failed to show significant activation. In vitro complement activation susceptibility tests on pre-dive sera were performed to explore their association with in vivo complement activation and intravascular bubbles. Such tests failed to identify a distinct complement-sensitive group and did not correlate with in vivo complement activation during the dives and/or intravascular bubble appearance. Two subjects developed decompression sickness but were not different from the rest of the group regarding in vitro complement sensitivity or complement activation during dives.

Adult↗