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The Complement System
Complement activation and effector functions - Robbins & Kumar Basic Pathology
What Is It?
The complement system is a collection of more than 20 plasma proteins (numbered C1-C9, plus regulatory and accessory proteins) that function as a key effector arm of both innate and adaptive immunity. In their resting state, these proteins circulate as inactive zymogens. Upon activation, they undergo sequential proteolytic cleavage - a cascade that amplifies enormously at each step, depositing millions of active fragments on a microbial surface within 2-3 minutes.
The name itself comes from Jules Bordet's 19th-century observation that fresh serum could lyse bacteria, but heating it to 56°C destroyed that capacity even though antibody function remained intact. He concluded a separate heat-labile factor must "complement" the antibody - and so the system was named. - Cellular and Molecular Immunology
Three Activation Pathways
All three converge on the same critical step: cleavage of C3 by a C3 convertase.
1. Classical Pathway
- Triggered by C1q binding to IgM or IgG antibodies already bound to antigen on a microbial surface
- Two associated serine proteases (C1r and C1s) become active and initiate the proteolytic cascade
- Also activated by pentraxins (e.g., C-reactive protein), which bind C1q directly
- This is the major effector of adaptive humoral immunity
2. Alternative Pathway
- Phylogenetically the oldest pathway
- C3 undergoes spontaneous low-level hydrolysis in plasma at all times ("tick-over"), depositing C3b randomly on surfaces
- On host cells, regulatory proteins (DAF, CD59, Factor H) rapidly inactivate this C3b
- Microbial surfaces lack these regulators, so C3b is amplified instead - the system distinguishes self from non-self by the presence or absence of regulatory proteins
- Triggered by LPS, fungal cell walls, and other microbial surface molecules without requiring antibody
3. Lectin Pathway
- Mannose-binding lectin (MBL), a collectin with a hexameric structure similar to C1q, binds terminal mannose residues on microbial glycoproteins
- MASP1 and MASP2 (mannose-associated serine proteases) associate with MBL and initiate the same downstream steps as C1r/C1s in the classical pathway
- Also antibody-independent; part of innate immunity
The Central Event: C3 Cleavage
All three pathways generate a C3 convertase that cleaves C3 into:
| Fragment | Fate | Function |
|---|
| C3b (large) | Covalently attaches to microbial surface | Opsonin; also feeds C5 convertase formation |
| C3a (small) | Released into fluid phase | Anaphylatoxin - recruits neutrophils, degranulates mast cells, increases vascular permeability |
C3b then combines with C3 convertase to form C5 convertase, which cleaves C5:
| Fragment | Function |
|---|
| C5a | Most potent anaphylatoxin - chemoattractant for neutrophils, mast cell degranulation, vasodilation |
| C5b | Anchors to microbial membrane; nucleates MAC assembly |
Three Effector Functions
1. Inflammation (C3a, C4a, C5a - "Anaphylatoxins")
These small fragments recruit and activate leukocytes, induce histamine release from mast cells, increase vascular permeability, and cause vasodilation. C5a is the most potent. They are called anaphylatoxins because their effects mimic anaphylaxis mediators.
2. Opsonization and Phagocytosis (C3b, iC3b)
C3b covalently coats the microbial surface. Neutrophils and macrophages carry complement receptors (CR1, CR3) that recognize C3b and its inactive cleavage product iC3b, dramatically enhancing phagocytosis.
3. Cell Lysis - Membrane Attack Complex (MAC)
C5b recruits C6, C7, C8, and multiple copies of C9, which polymerize to form a transmembrane pore. This MAC punches holes in the membrane, allowing water and ions to flood in, lysing the cell. This is particularly effective against thin-walled gram-negative bacteria - notably Neisseria species (meningococci, gonococci). Individuals with terminal complement deficiencies (C5-C9) or who receive complement inhibitors (e.g., eculizumab) are at high risk of disseminated Neisseria infections.
Regulation
Complement activation is tightly controlled to prevent host tissue damage:
| Regulator | Mechanism |
|---|
| DAF (CD55) | Accelerates decay of C3 convertase on host cell surfaces |
| CD59 (protectin) | Blocks MAC assembly on host cells |
| Factor H | Inhibits alternative pathway C3 convertase in fluid phase |
| C1 inhibitor (C1-INH) | Blocks C1r and C1s; also inhibits kallikrein (deficiency causes hereditary angioedema) |
| Carboxypeptidase N | Inactivates C3a and C5a in plasma |
Microbes lack most of these regulators - which is exactly why complement can attack them but not normal host cells. - Cellular and Molecular Immunology
Clinical Relevance
| Deficiency | Consequence |
|---|
| C1q, C2, C4 (classical) | Increased susceptibility to SLE (impaired immune complex clearance) |
| C3 | Severe, recurrent pyogenic infections; most critical single complement component |
| C5-C9 (terminal) | Recurrent Neisseria infections specifically |
| C1-INH | Hereditary angioedema (bradykinin accumulates, not histamine-mediated) |
| DAF/CD59 | Paroxysmal nocturnal hemoglobinuria (PNH) - complement attacks host RBCs |
Sources: Cellular and Molecular Immunology (Abbas et al.); Robbins & Kumar Basic Pathology