The complement system consists of both plasma and membrane proteins. The former influence the inflammatory response, immune modulation, and host defense. The latter are complement receptors, which mediate the cellular effects of complement activation, and regulatory proteins, which protect host cells from complement-mediated injury. Complement activation occurs via either the classical or the alternative pathway, which converge at the level of C3 and share a sequence of terminal components. Four aspects of the complement cascade are critical to its function and regulation: (i) activation of the classical pathway, (ii) activation of the alternative pathway, (iii) C3 convertase formation and C3 deposition, and (iv) membrane attack complex assembly and insertion. In general, mechanisms evolved by pathogenic microbes to resist the effects of complement are targeted to these four steps. Because individual complement proteins subserve unique functional activities and are activated in a sequential manner, complement deficiency states are associated with predictable defects in complement-dependent functions. These deficiency states can be grouped by which of the above four mechanisms they disrupt. They are distinguished by unique epidemiologic, clinical, and microbiologic features and are most prevalent in patients with certain rheumatologic and infectious diseases. Ethnic background and the incidence of infection are important cofactors determining this prevalence. Although complement undoubtedly plays a role in host defense against many microbial pathogens, it appears most important in protection against encapsulated bacteria, especially Neisseria meningitidis but also Streptococcus pneumoniae, Haemophilus influenzae, and, to a lesser extent, Neisseria gonorrhoeae. The availability of effective polysaccharide vaccines and antibiotics provides an immunologic and chemotherapeutic rationale for preventing and treating infection in patients with these deficiencies.

Infectious diseases associated with complement deficiencies.

Cell-killing mechanisms are essential components of host defense against infectious agents, parasites, and malignant cells. We distinguish humoral and cellular killing mechanisms. Complement utilizes specific proteins to assemble its killer molecule. Macrophages generate active oxygen radicals that injure target membranes. Lymphocytes, like complement, use protein molecules as tools in the cellular cytotoxicity reaction. As will be suggested at the conclusion of this chapter, considerable similarity between the structure of the cytolytic apparatus of complement and that of lymphocytes has recently come to light. An in-depth knowledge of the structure and function of the killer molecule of complement may therefore facilitate elucidation of the cell-killing mechanism of lymphocytes. Complement encompasses 20 proteins, not including the various cell­ surface complement receptors and regulatory proteins. Only 5 of these 20 proteins participate directly in cell killing-C5, C6, C7, C8, and C9-and none has enzymatic activity, proteolytic or lipolytic. Upon activation of C5, the 5 proteins interact in a sequential manner and fuse into a macromo­ lecular organization, called the membrarie attack complex or MAC. Fusion brings forth hydrophobic sites through which the complex inserts itself into the hydrocarbon core of lipid membranes. There it forms transmembrane channels, the largest of which constitutes tubular poly C9. Activation of C5 is accomplished by a highly specific serine protease, C5 convertase, itself an assembly of three protein molecules. Thus, formation of the MAC is initiated enzymatically, but this enzyme does not participate in actual membrane attack, which is entirely a physicochemical process.

The membrane attack complex of complement.

The observation that type III erythrocytes of paroxysmal nocturnal hemoglobinuria (PNH) are susceptible to hemolysis initiated by activated cobra venom factor complexes (CoFBb), whereas normal erythrocytes are resistant, implies that the PNH III cells are deficient in a membrane constituent that regulates this process. To isolate the inhibitory factor from normal erythrocytes, membrane proteins were first extracted with butanol and then subjected to sequential anion exchange, hydroxylapatite, and hydrophobic chromatography. Analysis by SDS-PAGE and silver stain of the inhibitory fractions showed a single band corresponding to a protein with an apparent Mr of 18 kD. PNH erythrocytes were incubated with incremental concentrations of the radiolabeled protein and then washed. In a dose-dependent fashion, the protein incorporated into the cell membrane and inhibited CoFBb-initiated lysis. This protein inhibitor functioned by restricting the assembly of the membrane attack complex at the level of C7 and C8 incorporation. By using a monospecific antibody to block the function of the inhibitor, it was shown that normal erythrocytes are rendered susceptible to CoFBb-initiated hemolysis. Analysis by Western blot of membrane proteins revealed that PNH III erythrocytes are deficient in the 18-kD protein. By virtue of its molecular weight and inhibitory activity, the 18-kD protein appears to be discrete from other previously described erythrocyte membrane proteins that regulate complement. These studies also indicate that the susceptibility of PNH III erythrocytes to reactive lysis is causally related to a deficiency of the 18-kD membrane inhibitor.

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Isolation and characterization of a membrane protein from normal human erythrocytes that inhibits reactive lysis of the erythrocytes of paroxysmal nocturnal hemoglobinuria.

The purpose of this review is to dispel these misconceptions by describing the effects of complement membrane attack on metabolically active nucleated cells. The mechanisms by which these cells escape lysis by the MAC and the effects of non-lethal attack will be described, and a role for these events in the pathogenesis of inflammatory diseases postulated

Complement membrane attack on nucleated cells: resistance, recovery and non-lethal effects

Perforin (P1) is a cytolytic protein with similarity to complement component C9. P1 has been described as a unique component of murine cytolytic T-cell and rat natural killer cell granules Previous studies indicated that human granules and P1 differed from murine granules and P1 in that they appeared to be cytolytically less active and lacked the haemolytic activity characteristic of P1. It has been suggested that P1, like C9, is under the control of the homologous restriction factor. Here we determine the primary structure of human P1, re-examine its functional properties, and address the question of homologous restriction.

Structure and function of human perforin.

The cytolytic efficiency of the terminal complement protein complex, C5b-9, varies with the species of origin of C8 and C9. In the present study, we explored the susceptibility of erythrocytes from various species to lysis by C5b6,7 plus C8 and C9 from different species. EC5b6,7 intermediates were prepared on human, guinea pig, rabbit, mouse, and rat erythrocytes with human C5b6 and guinea pig C7. The degree of lysis of these intermediates by C8 and C9 was found to vary widely depending on the species of the proteins and the target cells. In all cases, lysis was least efficient when C8 and C9 were homologous with respect to the target cell species. This effect was mostly attributable to C9. The inefficient lysis in a homologous system is not due to a failure of C9 binding. Rather, the poor lysis in the homologous system may be attributable to inefficient insertion or channel formation.

P Vanguri

Papers

Homologous species restriction in lysis of erythrocytes by terminal complement proteins