The alternative complement pathway revisited

M Harboe, TE Mollnes - Journal of cellular and molecular …, 2008 - Wiley Online Library
M Harboe, TE Mollnes
Journal of cellular and molecular medicine, 2008Wiley Online Library
• Introduction• Methods to study and modify the alternative pathway‐Inhibition by
monoclonal antibodies‐Knockout models• Influence of AP amplification on the effect of
specific activation of the other initial pathways‐Direct activation versus amplification‐
Mechanisms of amplification• Properdin‐Control protein in the AP amplification loop‐
Recognition molecule in AP• Influence of AP in deficiency states‐Factor H deficiency and
variants‐C2 bypass in CP and LP‐Properdin deficiency• Complement in sepsis• Concluding …
  • • 
    Introduction
  • • 
    Methods to study and modify the alternative pathway
    • ‐ 
      Inhibition by monoclonal antibodies
    • ‐ 
      Knockout models
  • • 
    Influence of AP amplification on the effect of specific activation of the other initial pathways
    • ‐ 
      Direct activation versus amplification
    • ‐ 
      Mechanisms of amplification
  • • 
    Properdin
    • ‐ 
      Control protein in the AP amplification loop
    • ‐ 
      Recognition molecule in AP
  • • 
    Influence of AP in deficiency states
    • ‐ 
      Factor H deficiency and variants
    • ‐ 
      C2 bypass in CP and LP
    • ‐ 
      Properdin deficiency
  • • 
    Complement in sepsis
  • • 
    Concluding remarks
Abstract
Alternative pathway amplification plays a major role for the final effect of initial specific activation of the classical and lectin complement pathways, but the quantitative role of the amplification is insufficiently investigated. In experimental models of human diseases in which a direct activation of alternative pathway has been assumed, this interpretation needs revision placing a greater role on alternative amplification. We recently documented that the alternative amplification contributed to 80–90% of C5 activation when the initial activation was highly specific for the classical pathway. The recent identification of properdin as a recognition factor directly initiating alternative pathway activation, like C1q in the classical and mannose‐binding lectin in the lectin pathway, initiates a renewed interest in the reaction mechanisms of complement. Complement and Toll‐like receptors, including the CD14 molecule, are two main upstream recognition systems of innate immunity, contributing to the inflammatory reaction in a number of conditions including ischaemia‐reperfusion injury and sepsis. These systems act as ‘double‐edged swords’, being protective against microbial invasion, but harmful to the host when activated improperly or uncontrolled. Combined inhibition of complement and Toll‐like receptors/CD14 should be explored as a treatment regimen to reduce the overwhelming damaging inflammatory response during sepsis. The alternative pathway should be particularly considered in this regard, due to its uncontrolled amplification in sepsis. The alternative pathway should be regarded as a dual system, namely a recognition pathway principally similar to the classical and lectin pathways, and an amplification mechanism, well known, but quantitatively probably more important than generally recognized.
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