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[A clinical study of complements as a marker of a hepatocellular carcinoma].

Serum complement C3, C4, and C3 proactivator (C3PA) have been evaluated for their diagnostic power in detecting a hepatocellular carcinoma (HCC) in patients with liver cirrhosis (LC). It was found that serum complement levels were lower in LC patients than in HCC patients and that difference of the serum C4 and C3PA levels between LC patients and HCC patients were statistically significant. In addition, serum C3 PA levels were found to correlate significantly with the serum gamma-GTP levels in HCC patients. Thus, using the cutoff values of C4 and C3PA as the mean values for HCC patients, examination of serum complement levels enabled the detection of 38% of the HCC patients with low AFP levels. These findings suggest that the examination of the serum complements may be a useful a tool for the detection of HCCs in LC patients.

Biomarkers, Tumor

Tetanus toxoid-anti-tetanus toxoid complexes: a potential model to study the complement transport system for immune complex in humans.

Complement and its receptor on erythrocytes appears to play a physiological role in the elimination of large immune complexes (IC) in monkeys, and a similar system is likely to work in humans. Here we define a safe IC model which is suitable for clinical investigations. Soluble tetanus toxoid (TT)-human anti-TT (IgG) antibody complexes were prepared in large antibody excess. The size of the complexes was approximately 45 S. When incubated in normal human serum, 50% of the IC increased further in size, but remained soluble, and bound rapidly to human erythrocytes in vitro. This binding was shown to require intact classical pathway function. When injected into normal guinea-pigs a comparable proportion of IC bound immediately to blood cells (mainly to platelets). No platelet binding of IC occurred in C4-deficient guinea-pigs, but this binding was restored when C4 was supplied. Initial immune complex elimination was faster in C4 deficient than in C4-supplemented and normal guinea pigs. Thus classical pathway function appeared to be necessary for the normal processing, transport and elimination of TT-anti-TT complexes.

Animals

Studies of complement activation in ARDS patients treated by long-term extracorporeal CO2 removal.

To investigate the role of complement activation in the adult respiratory distress syndrome (ARDS) and in the complications of extracorporeal circulation (ECC), several parameters (CH50, C3 split products, C3a, C5a, PMN aggregating activity, carboxypeptidase activity) of the complement profiles of 23 ARDS patients were measured. Twenty patients were treated by long-term extracorporeal support. Before connection to ECC, marked leukocytosis (18,250 +/- 5,950) and significantly high plasma C3a levels (p less than 0.005) were observed. After connection, C3a levels increased further, up to values eight times higher than the basal ones. The WBC count transiently decreased to 41% of prebypass levels after 15 minutes of ECC. At the same time C3 split products appeared and PMN aggregating activity was shown in 52% of the patients. C5a levels remained normal during bypass, even in two samples in which PMN aggregating activity was detected. Later decreases in CH50 titers (p less than 0.001) and carboxypeptidase activity (p less than 0.005) were observed. Complement activation was no longer evident after the 24th hour of bypass. We conclude that there is a low-degree complement activation in ARDS, and ECC is a further strong stimulus for complement activation. This phenomenon appears, however, to be self-limited.

Adolescent

Studies on complementation of beta hexosaminidase deficiency in human GM2 gangliosidosis.

Complementation of beta hexosaminidase A (hex A) deficiency was obtained by Sendai virus-mediated somatic cell hybridization of cultured skin fibroblasts from two unrelated patients with Tay-Sachs disease (TSD) and one patient with Sandhoff-Jatzkewitz disease (SJD). The newly formed hex A was identified by its electrophoretic mobility in three different systems, heat lability, and reactivity with an antiserum against the unique antigenic determinant, alpha of hex A. The percentage of heterokaryons obtained by virus treatment of TSD and SJD fibroblast mixtures showed good correlation with the observed percentage of hex A activity. It is concluded that, in these two forms of GM2 gangliosidosis, beta hexosaminidase deficiency results from two different mutations. All of the current models of beta hexosaminidase structure are compatible with the observed complementation. No complementation was detected in 13 Sendai virus-induced fusions of cultured skin fibroblasts from seven unrelated patients with SJD. The enzyme deficiency in these patients may be due to very similar allelic mutations, not capable of undergoing complementation; or to different structural mutations, all coding for unstable beta hexosaminidase molecules.

Acetylglucosaminidase

A study of complement fixation by rheumatoid factor using a haemolytic assay system.

Complement fixation by rheumatoid factor (RF) in sera from rheumatoid arthritis patients has been investigated by means of a haemolytic assay system employing sheep erythrocytes (SRBC) coated with reduced and alkylated rabbit IgG anti-SRBC antibody. Haemolysis was almost invariably detected with RF-positive sera whereas haemolysis was not observed with RF-negative sera; It was evident from a marked increase in haemolysis, obtained following isolation of IgM-RF of high purity from several RF-positive sera, that the full in vitro complement-fixing ability and hence lytic potential of RF in serum is masked. Parallel observations were also made with synovial fluids. The inhibition of haemolysis by RF in sera and synovial fluids commonly involved a reduction in degree of lysis at high concentration of test material as well as a more generalized inhibition in overall percentage lysis. Complete replication of typical RF-positive serum and synovial fluid patterns of lysis on dilution was achieved by addition of heat-aggregated human IgG to isolated IgM-RF preparations and demonstrated that the two inhibitory effects are separable in terms of complement depletion and reduction of free rheumatoid factor antibody activity, respectively.

Arthritis, Rheumatoid

Action of a new non-steroid antiinflammatory drug, nimesulide, on activation of the complement system: an in vitro study.

The complement system has a pivotal role in the antiinflammatory reaction. Furthermore it has been shown that the sequential activation of the complement system may be inhibited at various levels by pharmacological agents such as non-steroidal antiinflammatory drugs. Therefore the eventual anticomplementary action of Nimesulide was assessed in vitro in various experimental models. It was found that it blocks immunohaemolysis in vitro and has a direct effect on serum complement activity. Nimesulide blocks the activation of third complement and this explains why the drug is also inhibitory on the inulin-induced haemolytic reaction.

Animals

Paediatric coeliac disease and dermatitis herpetiformis: differences in complement activation in relation to diet.

We studied complement (C') involvement in paediatric coeliac disease (CD) and dermatitis herpetiformis (DH) in relation to lesions and function of enteric mucosa and to diet. For this purpose, 50 children affected by CD and 42 affected by DH were subdivided in 3 groups: in the first (I) were included subjects in free diet, in the second (II) children during gluten-free diet (GFD) and in the third (III) subjects after gluten reintroduction in diet. Only in CD we found significant modifications of some C' parameters. In fact C3 and C4 levels increase in II group in GFD (respectively p less than 0.02 and p less than 0.03) and result inversely correlated to an arbitrary score for the evaluation of the enteric histological lesions (p less than 0.02 and p less than 0.01). C3d/C3 ratio levels, as catabolic index of C3, result always greater than normal in both diseases, but significantly decrease only in II group of CD children (p less than 0.02), where they result also positively correlated to the histological score (p less than 0.05). Circulating immune complex-like material is higher in DH, but incidence of pathological values decrease in II group only in CD (p less than 0.04). These data suggest probable significant differences in the pathogenetic mechanisms of CD and DH involving C'.

Antigen-Antibody Complex