In this review it is our intention to outline briefly the relevance of the complement system in systemic lupus erythematosus. Three main issues will be addressed: the role of complement in handling immune complexes (ICs), the association between complement deficiencies and IC diseases, and the value of measuring complement components and their conversion products in monitoring disease activity.
Porcel JM, Vergani D.El sistema del complemento: una fascinante cascada biológica. Med Clin (Barc)1992 (in press).
2.
Abbas AK, Lichtman AH, Pober JSCellular and Molecular Immunology. Philadelphia : W.B. Saunders Company, 1991: 260.
3.
Peakman M., Senaldi G., Vergani D.Assessment of complement activation in clinical immunology laboratories: time for reappraisal ?J Clin Pathol1989; 42: 1018-25.
4.
Dalmasso APComplement in the pathophysiology and diagnosis of human diseases . CRC Crit Rev Clin Lab Sci1986; 24: 123-83.
5.
Abramson SB, Weissmann G.Complement split products and the pathogenesis of SLE. Hosp Pract1988; 23: 45-56.
6.
Abramson SB, Dobro J., Eberle MA et al. Acute reversible hypoxemia in systemic lupus erythematosus. Ann Intern Med1991; 114: 941-7.
7.
Hopkins P., Belmont HM, Buyon J., Philips M., Weissmann G., Abramson SBIncreased levels of plasma anaphylatoxins in systemic lupus erythematosus predict flares of the disease and may elicit vascular injury in lupus cerebritis . Arthritis Rheum1988; 31: 632-41.
8.
Schifferli JA , Taylor RPPhysiological and pathological aspects of circulating immune complexes. Kidney Int1989 ; 35: 993-1003.
9.
Hebert LA, Cosio FG, Birmingham DJ, Mahan JDBiologic significance of the erythrocyte complement receptor: a primate perquisite . J Lab Clin Med1991; 118: 301-8.
10.
Barbosa JE, Harrison RA, Barker PJ, Lachmann PJAn antipeptide antibody that recognizes a neo-antigen in the CR1 stump remaining on erythrocytes after proteolysis. Clin Exp Immunol1992; 87: 144-9.
11.
Inada Y., Kamiyama M., Kanemitsu T., Clark WS, Asai Y.Relationships between C3b receptor (CR1) activity of erythrocytes and positive Coombs' tests. Ann Rheum Dis1986; 45: 367-72.
12.
Fearon DTComplement, C receptors, and immune complex disease. Hosp Pract1988; 22: 63-72.
13.
Tausk F., Gigli I.The human C3b receptor: function and role in human diseases. J Invest Dermatol1990; 94: 141-5S.
14.
Walport MJ, Lachmann PJErythrocyte complement receptor type 1, immune complexes, and the rheumatic diseases. Arthritis Rheum1988; 31: 153-8.
15.
Cohen Jhm, Caudwell V., Levi-Strauss M., Bourgeois P., Kazatchkine MDGenetic analysis of CR expression on erythrocytes of patients with systemic lupus erythematosus. Arthritis Rheum1989; 32: 393-7.
16.
Tausk F., Harpster E., Gigli I.The expression of C3b receptors in the differentiation of discoid lupus erythematosus and systemic lupus erythematosus. Arthritis Rheum1990; 33: 888-92.
17.
Inada Y., Kamiyama M., Kanemitsu T. et al. In vivo binding of circulating immune complexes by C3b receptors (CR1) of transfused erythrocytes. Ann Rheum Dis1989; 48: 287-94.
18.
Vivanco-Martínez F.Déficit de complemento, inmunocomplejos y lupus eritematoso. Rev Clin Esp1987; 180: 264-8.
19.
Morgan BP, Walport MJComplement deficiency and disease. Immunol Today1991; 12: 301-6.
Sturfelt G. , Truedsson L., Johansen P., Jonsson H., Nived O., Sjöholm AGHomozygous C4A deficiency in systemic lupus erythematosus: analysis of patients from a defined population. Clin Genetics1990; 38: 427-33.
25.
Gatenby PAThe role of complement in the aetiopathogenesis of systemic lupus erythematosus . Autoimmunity1991; 11: 61-6.
26.
Gatenby PA, Barbosa JE, Lachmann PJDifferences between C4A and C4B in the handling of immune complexes: the enhancement of CR1 is more important than the inhibition of immunoprecipitation . Clin Exp Immunol1990; 79: 158-63.
27.
Briggs DC, Senaldi G., Isenberg DA, Welsh KI, Vergani D.Influence of C4 null alleles on C4 activation in systemic lupus erythematosus . Ann Rheum Dis1991; 50: 251-4.
28.
Rasmussen JMInherited deficiencies of complement proteins with special reference to congenital deficiency of the regulatory protein factor I. APMIS1991; 99: 5-48.
29.
Agnello V.Lupus diseases associated with hereditary and acquired deficiencies of complement . Springer Semin Immunopathol1986; 9: 161-78.
30.
Walport MJ, Lachmann PJComplement deficiencies and abnormalities of the complement system in systemic lupus erythematosus and related disorders. Curr Opin Rheumatol1990; 2: 661-3.
31.
Steinsson K. , Erlendsson K., Valdimarsson H.Successful plasma infusion treatment of a patient with C2 deficiency and systemic lupus erythematosus: clinical experience over forty-five months. Arthritis Rheum1989 ; 32: 906-13.
32.
Lloyd W., Schur PHImmune complexes, complement, and anti-DNA in exacerbations of systemic lupus erythematosus (SLE). Medicine1981; 60: 208-17.
33.
Valentijn RM , van Overhagen H., Hazevoet HM et al. The value of complement and immune complex determinations in monitoring disease activity in patients with systemic lupus erythematosus. Arthritis Rheum1985; 28: 904-13.
34.
West CDRelative value of serum C3 and C4 levels in predicting relapse in systemic lupus erythematosus. Am J Kidney Dis1991; 18: 686-8.
35.
Swaak Ajg, Groenwold J., Bronsveld W.Predictive value of complement profiles and anti-dsDNA in systemic lupus erythematosus . Ann Rheum Dis1986; 45: 359-66.
36.
Ter Borg EJ , Horst G., Hummel EJ, Limburg PC, Kallenberg Cgm.Measurement of increases in anti-double-stranded DNA antibody levels as a predictor of disease exacerbation in systemic lupus erythematosus. Arthritis Rheum1990; 33: 634-43.
37.
Devoe LD, Loy GLSerum complement levels and perinatal outcome in pregnancies complicated by systemic lupus erythematosus. Obstet Gynecol1984; 63: 796-800.
38.
Shibata S., Sasaki T., Hirabayashi Y. et al. Risk factors in the pregnancy of patients with systemic lupus erythematosus: association of hypocomplementaemia with poor prognosis. Ann Rheum Dis1992; 51: 619-23.
39.
Buyon JP, Cronstein BN, Morris M., Tanner M., Weissmann G.Serum complement values (C3 and C4) to differentiate between systemic lupus activity and pre-eclampsia. Am J Med1986; 81: 194-200.
40.
Ricker DM, Hebert LA, Rohde R. et al. Serum C3 levels are diagnostically more sensitive and specific for systemic lupus erythematosus activity than are serum C4 levels. Am J Kidney Dis1991; 18: 678-85.
41.
Wilson WA, Armatis PE, Pérez MCC4 concentrations and C4 deficiency alleles in systemic lupus erythematosus . Ann Rheum Dis1989; 48: 600-4.
42.
Waldo FB, Forristal J., Beischel L., West CDA circulating inhibitor of fluid-phase amplification C3 convertase formation in systemic lupus erythematosus. J Clin Invest1985; 75: 1786-95.
43.
Morgan BPComplement. Clinical Aspects and Relevance to Disease. London: Academic Press, 1990: 94.
44.
Swaak Ajg, van Rooyen A., Vogelaar C., Pillay M., Hack E.Complement (C3) metabolism in systemic lupus erythematosus in relation to the disease course. Rheumatol Int1986; 6: 221-6.
45.
Porcel JM, Peakman M., Senaldi G., Vergani D.Methods for assessing complement activation in the clinical immunology laboratory . (Submitted for publication)
46.
Porcel JM, Ordi J.Complemento activado en el lupus eritematoso sistémico. Med Clin (Barc)1991; 96: 135-7.
47.
Levy RA, Qamar T., Lockshin MDAlternative complement pathway in hypocomplementemic/normal C1s-C1 inhibitor complex patients with SLE. Clin Exp Rheumatol1990 ; 8: 11-5.
48.
Jenkins JS, Powell RJC3 degradation products (C3d) in normal pregnancy. J Clin Pathol1987; 40: 1362-3.
49.
Hopkinson ND , Powell RJClassical complement activation induced by pregnancy: implications for management of connective tissue diseases . J Clin Pathol1992 ; 45: 66-7.
50.
Buyon JP, Tamerius J., Ordorica S., Young B., Abramson SBActivation of the alternative complement pathway accompanies disease flares in systemic lupus erythematosus during pregnancy. Arthritis Rheum1992; 35: 55-61.
51.
Manzi S., Kelly RH, Carpenter AB, Jagarlapudi SP, Ramsey-Goldman R., Medsger TAUrine complement split product C3d in lupus renal disease. Arthritis Rheum1991; 34: S96 (abstract A183).
52.
Sanders ME, Alexander EL, Koski CL, Frank MM, Joiner KADetection of activated terminal complement (C5b-9) in cerebrospinal fluid from patients with central nervous system involvement of primary Sjögren's syndrome or systemic lupus erythematosus. J Immunol1987 ; 138: 2095-9.
53.
Laitman RS, Glicklich D., Sablay LB, Grayzel AI, Barland P., Bank N.Effect of long-term normalization of serum complement levels on the course of lupus nephritis. Am J Med1989; 87: 132-8.