Prognostic Value of Complement Properdin in Cancer

The complement system is readily triggered by the presence of damage-associated molecular patterns on the surface of tumor cells. The complement alternative pathway provides rapid amplification of the molecular stress signal, leading to complement cascade activation to deal with pathogens or malignant cells. Properdin is the only known positive regulator of the alternative pathway. In addition, properdin promotes the phagocytic uptake of apoptotic T cells by macrophages and dendritic cells without activating the complement system, thus, establishing its ability to recognize "altered-self". Dysregulation of properdin has been implicated in substantial tissue damage in the host, and in some cases, chronic unresolved inflammation. A corollary of this may be the development of cancer. Hence, to establish a correlation between properdin presence/levels in normal and cancer tissues, we performed bioinformatics analysis, using Oncomine and UALCAN. Survival analyses were performed using UALCAN and PROGgeneV2 to assess if properdin can serve as a potential prognostic marker for human lung adenocarcinoma (LUAD), liver hepatocellular carcinoma (LIHC), cervical squamous cell carcinoma (CESC), and pancreatic adenocarcinoma (PAAD). We also analyzed levels of tumor-infiltrating immune cells using TIMER, a tool for characterizing immune cell composition in cancers. We found that in LUAD and LIHC, there was a lower expression of properdin in the tumors compared to normal tissues, while no significant difference was observed in CESC and PAAD. Survival analysis demonstrated a positive association between properdin mRNA expression and overall survival in all 4 types of cancers. TIMER analysis revealed that properdin expression correlated negatively with tumor purity and positively with levels of infiltrating B cells, cytotoxic CD8⁺ T cells, CD4⁺ helper T cells, macrophages, neutrophils and dendritic cells in LUAD, CESC and PAAD, and with levels of B cells, CD8⁺ T cells and dendritic cells in LIHC. Immunohistochemical analysis revealed that infiltrating immune cells were the most likely source of properdin in the tumor microenvironment. Thus, complement protein properdin shows promise as a prognostic marker in cancer and warrants further study.

IgA nephropathy: clinicopathology and immunopathology

In a total of 283 biopsies, 100 (35%) were found to be IgA nephropathy. The incidence reached 40% among primary glomerulonephropathies. On the basis of histopathologic changes in glomeruli, these biopsies were classified into 3 groups. The criteria employed correlated well with clinical, laboratory and immunofluorescent findings. Immune complex pathogenesis was discussed in relation to our findings.

C-reactive protein, C3, C4 and properdin during the Jarisch-Herxheimer reaction in early syphilis

The occurrence of plasma CRP during the febrile response after the first injection of penicillin was followed in 10 patients with early syphilis. An increase in CRP was noted after 12 hours, with a maximum after 24 hours. The appearance of this acute phase protein could not be correlated to cutaneous reaction, increased body temperature or leukocytosis, nor were baseline values of CRP correlated to clinical or serological activity of the infection. Patients with high levels of CRP prior to treatment suffered the most intense systemic reactions. No activation of the complement system during the Jarisch-Herxheimer reaction was detected from sequential determinations of C3, C4 and properdin.

Serum amyloid A, properdin, complement 3, and toll-like receptors are expressed locally in human sinonasal tissue

BACKGROUND

There is a growing appreciation of the role that nasal mucosa plays in innate immunity. In this study, the expression of pattern recognition receptors known as toll-like receptors (TLRs) and the effector molecules complement factor 3 (C3), properdin, and serum amyloid A (SAA) were examined in human sinonasal mucosa obtained from control subjects and patients with chronic rhinosinusitis (CRS).

METHODS

Sinonasal mucosal specimens were obtained from 20 patients with CRS and 5 control subjects. Messenger RNA (mRNA) was isolated and tested using Taqman real-time polymerase chain reaction with primer and probe sets for C3, complement factor P, and SAA. Standard polymerase chain reaction was performed for the 10 known TLRs. Immunohistochemistry was performed on the microscopic sections using antibodies against C3.

RESULTS

Analysis of the sinonasal sample mRNA revealed expression of all 10 TLRs in both CRS samples and in control specimens. Expression of the three effector proteins was detected also, with the levels of mRNA for C3 generally greater than SAA and properdin in CRS patients. No significant differences were found in TLR or innate immune protein expression in normal controls. Immunohistochemical analysis of sinonasal mucosal specimens established C3 staining ranging from 20 to 85% of the epithelium present.

CONCLUSION

These studies indicate that sinonasal mucosa expresses genes involved in innate immunity including the TLRs and proteins involved in complement activation. We hypothesize that local production of complement and acute phase proteins by airway epithelium on stimulation of innate immune receptors may play an important role in host defense in the airway and, potentially, in the pathogenesis of CRS.

Innate immunity of the sinonasal cavity: expression of messenger RNA for complement cascade components and toll-like receptors

OBJECTIVE

To study the expression of important elements of the innate immune responses in human sinonasal tissue to elucidate its potential role in mucosal inflammation.

DESIGN

We studied human sinonasal tissue from patients with chronic rhinosinusitis and an immortalized epithelial cell line to detect the expression of innate immune effectors and the responses of these cells to stimulation with compounds associated with pathogenic organisms.

PATIENTS

Nine individuals undergoing endoscopic sinus surgery for chronic rhinosinusitis.

MAIN OUTCOME MEASURES

Expression of complement components and toll-like receptors.

RESULTS

We found detectable levels of messenger RNA for all toll-like receptors in human sinonasal tissue and in the BEAS-2B epithelial cell line. Expression of several components of the alternate pathway of complement (factors B, H, and I and properdin) was constitutively present in unstimulated BEAS-2B cells and was readily detectable in human sinonasal tissue. Stimulation of BEAS-2B cells with the toll-like receptor 3 ligand double-stranded RNA resulted in increased expression of messenger RNA for factors B and H but not for properdin or factor I.

CONCLUSIONS

Toll-like receptors and the alternate pathway of complement are important components of innate immunity that are expressed in human sinonasal epithelium in vivo and in cultured airway epithelial cells in vitro. The expression of some of these components can be significantly induced by stimulation via toll-like receptors, and epithelial expression of components of innate immunity may play a role in inflammation in chronic rhinosinusitis.

Ontogeny of complement regulatory proteins - concentrations of factor h, factor I, c4b-binding protein, properdin and vitronectin in healthy children of different ages and in adults

Previous studies of human in vivo complement protein levels have only compared data for neonates with that from adult sera. Here, we establish the normal concentration ranges of the following complement regulatory proteins in healthy Brazilian children of different age groups (neonates: 1 month-1 year, 1-6 years and 6-13 years) and in adults: factor H (fH), factor I (fI), C4b-binding protein (C4 BP), properdin and vitronectin. We found that the concentrations of fH, fI, properdin and vitronectin in neonates are significantly lower than in adults. Remarkably, the concentration of C4 BP is below the method resolution (<50 micro g/ml) in 76% of the sera from neonates, while adults presented 199-532 microg/ml of C4 BP in their sera. The concentration of properdin in the sera from neonates and up to 1-year-old children was less than that observed in older children. Adults presented vitronectin levels significantly higher than all the other age groups in the study. No significant sex differences in the concentrations of all the studied regulatory proteins were detected. This study reveals the ontogeny of complement system in greater detail than previously available and may point to the reasons why neonates have higher susceptibility to develop life-threatening pyogenic infections. These reference values will be of use in clinical and laboratory investigations of disorders associated with low levels of these regulatory proteins.

Discordant renal histopathologic findings and complement profiles in membranoproliferative glomerulonephritis type III

Patients with membranoproliferative glomerulonephritis (MPGN) type III and a low serum C3 concentration tend to have evidence for a nephritic factor of the terminal complement pathway (Nft). Complement profiles were studied in three patients with MPGN type III and low serum C3 concentrations. Serum C3 concentrations were 52, 21, and 14 mg/dL (normal range, 83 to 177 mg/dL). Serum Clq, C2, C4, properdin, and C5 concentrations were normal in all patients, whereas two had a slight decrease of C7 or C8. This pattern of complement activation resembles that seen with MPGN type II in which a nephritic factor activates the amplification loop (NFa). We conclude that in patients with MPGN type III the previously reported profile/presence of Nft is not always found, at least in the chronic stage of the disease, despite a low C3 value.

Complement proteins are present in developing endochondral bone and may mediate cartilage cell death and vascularization

Normal endochondral bone formation follows a temporal sequence: immature or resting chondrocytes move away from the resting zone, proliferate, flatten, become arranged into columns, and finally become hypertrophic, disintegrate, and are replaced by bone. The mechanisms that guide this process are incompletely understood, but they include programmed cell death, a stage important in development and some disease processes. Using immunofluorescence we have studied the distribution of various complement proteins to examine the hypothesis that this sequence of events, particularly cell disintegration and matrix dissolution, are complement mediated. The results of these studies show that complement proteins C3 and Factor B are distributed uniformly in the resting and proliferating zones. Properdin is localized in the resting and hypertrophic zone but not in the proliferating zone. Complement proteins C5 and C9 are localized exclusively in the hypertrophic zones. This anatomically segregated pattern of distribution suggests that complement proteins may be important in cartilage-bone transformation and that the alternate pathway is involved.

Frequency of complement third component (C3) and properdin factor (BF) phenotypes in patients with various clinical manifestations of HBV infection

Four groups of children were tested for the distribution of C3 and BF phenotypes: HBV-infected patients with Gianotti-Crosti syndrome, with CAH and with glomerulonephritis, and healthy children. The frequency of the phenotype C3F was significantly higher in children with Gianotti-Crosti syndrome in comparison with healthy children. The frequency of the phenotype BFS was significantly higher in patients with glomerulonephritis than in individuals with CAH. The difference between the frequency of the BFS phenotype in glomerulonephritis patients and that in healthy subjects neared significance. We suggest that the carriers of these phenotypes are characterized by susceptibility to some immune complex diseases associated with HBV infection.

Glomerulonephritis in Henoch-Schöenlein purpura without mesangial IgA deposition

Ten patients with Henoch-Schöenlein purpura (HSP) were selected for study because their early renal biopsies showed focal and segmental hypercellularity, with IgA present only in deposits at the periphery of the lobules. Mesangial deposits of IgA were absent. All had laboratory evidence of nephrotic syndrome and/or renal compromise. The glomerular hypercellularity was largely the result of the infiltration of monocytes whose cytoplasm often contained tubular lysosomes and wrapping lysosomal membranes, evidence of monocyte activation. Mean levels of C3 were normal but those of C4 and properdin significantly depressed. This complement profile, as well as a glomerular monocytic infiltrate, are also seen in essential cryoglobulinemia in the adult. Of follow-up biopsies in six patients, the glomeruli were normal in three, with no IgA deposition. In the other three, mesangial deposits of IgA typical of HSP were present. The initial focal-segmental glomerulitis of these patients appeared to be the benign first phase of a disease which had the potential to culminate in mesangial IgA deposition. Patients like the three who escaped mesangial IgA would be among those responsible for the observed dissociation between severity of the initial illness and ultimate prognosis.

Serum complement levels before and after the onset of acute post-streptococcal glomerulonephritis. A case report

Low serum C3, properdin, and C5 levels found in the acute stage of acute post-streptococcal glomerulonephritis (APSGN) indicate the presence of aggressive complement activation. We followed serum complement component levels in a child hospitalized with erysipelas who developed APSGN on the 2nd hospital day. Her initial serum sample, obtained prior to the clinical onset of nephritis, had a low properdin level and normal C3 and C5 levels despite the presence of C3 splitting activity. Two days later she developed gross hematuria and subsequent sera contained low C3, properdin, and C5 levels, as is usual in APSGN. These observations suggest that complement activation, predominantly through the alternative pathway, precedes the clinical onset of APSGN.

Normal human serum depleted of C1q, factor D and properdin: its use in studies of complement activation

Normal human sera were depleted of C1q, factor D (D) and properdin (P) by a simple and reproducible procedure providing reagents for analysis of complement-dependent functions. Classical pathway activity was restored with purified C1q, and alternative pathway activity with purified D and P. Since both activation pathways were abolished, antibodies and other components could be removed without loss of complement activity during immunoabsorption procedures. Synergism between the two pathways during haemolysis of rabbit erythrocytes was clearly demonstrated, and was also found on analysis of C3 cleavage in serum incubated with other alternative pathway activators such as zymosan and inulin. Experiments with a Neisseria meningitidis serogroup W-135 strain isolated from a patient with inherited P deficiency showed that both pathways were capable of supporting antibody-dependent killing of the bacteria in serum. The alternative pathway was possibly more efficient than the classical pathway in the assay system. In C1q,D,P-depleted serum with high concentrations of anticapsular IgG antibodies, the addition of D alone resulted in efficient alternative pathway-mediated killing. The alternative pathway was equally efficient in a C1q,D,P-depleted serum with low concentrations of anticapsular antibody, but in this case the reaction required both D and P.

Immunoglobulin and complement studies in children with Schönlein-Henoch Syndrome and other vasculitic diseases

In 35 children with Schönlein-Henoch Syndrome (SHS) serum IgG, IgM, and IgA concentrations were increased in 15%, 21%, and 44% of cases, respectively. Seven children with other vasculitic syndromes (VS) had normal serum Ig concentrations. Serum concentration of IgG subclass IgG1 was increased in 72% of children with SHS and 57% with VS. In SHS this was related to the presence of arthritis, but inversely related to nephritic symptoms. Only a few children had IgG subclasses IgG2, IgG3, or IgG4 concentrations outside the normal ranges. Platelet associated Ig (PAIg) was found in 75% of children with SHS or VS. In SHS the identification of increased amounts of PAIgG was related to the presence of nephritis. The serum concentration of properdin, a component of the alternative complement system, was reduced in 21% of children with SHS. This was related to the presence of abdominal symptoms or nephritis. No cases of retinal vasculitis was observed, but 4 of 22 children with SHS had punctuate retinal haemorrhages. SHS and VS may be clinical variations of the same syndrome. The immunological aspects indicate a close relationship with autoimmune diseases.

[The dynamics of the basic factors of nonspecific resistance in North Asian tick-borne typhus]

At the acute period of tick-borne typhus an increase in the activities of the main nonspecific resistance factors of the body, and particularly lysozyme, betalysins, complement and properdin, is observed. During convalescence the concentration of lysozyme normalizes and the content of betalysins remains sufficiently high, this indicating that, even in the absence of clinical sings of the disease, the disturbances in homeostasis persist. A decrease in the levels of complement and properdin during convalescence is seemingly linked with their consumption for the formation of immune complexes, eliminated from the body.

Renal manifestation of pustulosis palmaris et plantaris

Diffuse proliferative glomerulonephritis without IgA deposits (DPGN) in patients with pustulosis palmaris et plantaris (PPP) is described. This association has not been previously reported. Although PPP was resolved transiently after tonsillectomy, it was worsened coincidently at the time of exacerbation of DPGN. Improvement of proteinuria and PPP was observed after antiplatelet therapy. It was suggested that the renal manifestation and the development of PPP were associated.

[Various non-specific immunity proteins in the blood serum of workers in the coke-processing industry]

The concentrations of certain proteins related to non-specific immunity were determined in the serum of cokery workers and in a matched control group. No changes were found in the concentrations of the main proteins of the properdin system, that is properdin and third fraction of complement. However, the level of transferrin was higher in cokery workers. It seems that the harmful effects of the working environment were not changing the function of the properdin system. Raised transferrin level seems to be only a biochemical trace of exposure without essential importance.

Another Swedish family with complete properdin deficiency: association with fulminant meningococcal disease in one male family member

Inherited deficiency of the complement component properdin is described in a Swedish family without any previous history of meningococcal infections. The properdin-deficient index patient died from a fulminant infection caused by Neisseria meningitidis serogroup Y. Family investigation revealed properdin deficiency in the patient's half-brother and in the maternal grandfather. The half-brother had a history of pneumococcal pneumonia and meningitis probably caused by Borrelia burgdorferi. Opsonic and bactericidal functions of serum were examined in the half-brother after immunization with tetravalent meningococcal vaccine. Vaccination promoted opsonization of N. meningitidis serogroups C and Y but not of serogroups A and W-135. The serum bactericidal activity increased against serogroup C and to some extent against serogroup W-135. This report emphasizes the importance of investigating the complement system even in families with single cases of fulminant meningococcal disease. Individuals with properdin deficiency might be protected from infection by immunization.

[Status of nonspecific defense factors in patients with traumatic endophthalmitis]

Nonspecific defense factors, i. e. phagocytosis, lysozyme, properdin, immunoglobulin levels are unchanged in traumatic endophthalmitis, vs. those in cases uncomplicated with traumas. The complement activity is significantly elevated already at the early stages of a purulent infection, being 0.042 +/- 0.019 U of 100% hemolysis, vs. the control value of 0.058 +/- 0.017 U of 100% hemolysis; the difference is statistically significant. Measurement of the blood serum complement activity may be regarded as an auxiliary test in the early diagnosis of endophthalmitis.

Concentrations of C1q, factor B, factor D and properdin in healthy children, and the age-related presence of circulating C1r-C1s complexes

The concentrations of C1q, factor B, factor D and properdin were determined in healthy children belonging to various age groups of one through five years of age. All concentrations were found to be age-dependent, though they varied from one component to another with regard to ontogenetic pattern. Thus, the concentrations of factor B were high, and those of factor D low throughout the age range studied. C1q and properdin levels were lowest in the younger children, who also showed a fairly high incidence of C1r-C1s complexes in excess of C1q. Since the concentrations of C1q are influenced by those of IgG, the presence of C1r-C1s complexes might partly have reflected maturation of immunoglobulin synthesis during ontogeny.

A sandwich ELISA for properdin in clinical specimens

We have developed a symmetrical sandwich ELISA for measuring human properdin (P) in serum by using the globulin fraction from a commercial antiserum as the capture antibody adsorbed on the plastic. The detecting reagent was a glutaraldehyde conjugate of this Ig fraction with alkaline phosphatase. Two types of inhibition were observed in this study. First, inhibition was observed when greater than 2.5 micrograms/ml of the globulin fraction was used to coat the plates. A second type of inhibition was observed for serum dilutions less than 1/400; it was independent of the concentration of capture Ab and did not occur when purified P was assayed. The data generated with this assay could be fitted in log-log mode by a quadratic equation. The coefficient of the linear term in this equation was found to be the same for serum and purified P, within the limits of experimental error. The results for different samples run on the same plate were expressed in terms of the relative concentration of each sample required to produce an OD405 = 0.2. A sample of pooled normal human serum was run on each plate as a reference; it was assigned a titer of 100 ELISA units/ml (EU/ml). The titers of the unknown samples were expressed in terms of EU/ml by reference to this standard. For purified P, the assay could readily detect 10 ng/ml. By comparing purified P with our reference serum pool, we found that 1 EU equals 0.57 microgram. Day-to-day variation for a group of nine normal sera showed a mean difference of -0.85 EU/ml, SD 5.85 EU/ml. The mean titer for these normal sera was 78.9 EU/ml, SD 15.7 EU/ml. In three recovery experiments in which purified P was mixed with pooled normal serum, the recoveries ranged from 96 to 117%. We conclude that the sandwich ELISA constitutes an adequate immunochemical assay for human P in serum specimens.

Suboptimal C3b/C3bi deposition and defective yeast opsonization. II. Partial purification and preliminary characterization of an opsonic co-factor able to correct sera with the defect

Using a correction assay a factor essential for normal deposition of C3 fragments on zymosan was identified in fractions of serum obtained by Sephacryl S-300 gel filtration (eluting between IgG and albumin), preparative Pevikon block electrophoresis (eluting in the beta-region) and DEAE-ion-exchange chromatography (eluting immediately post IgG). Active material was also identified in a commercial preparation of transferrin. A combination of DEAE-ion-exchange chromatography and gel filtration was used to partially purify the co-factor. The factor has an approximate relative molecular mass of 70,000-80,000.

Components of the alternative pathway of complement in otitis media with effusion

An evaluation of the alternative pathway of complement was undertaken in patients with otitis media with effusion (OME). Middle ear fluid (MEF) and serum specimens were obtained from 34 patients at the time of elective myringotomy for OME. Bacterial, viral, and mycoplasma cultures were made for all specimens of the fluids. Immunochemical determinations by radial immunodiffusion were performed for C3, C5, factor B, properdin, factor H, factor I, and albumin. Each patient's recent clinical course and past history were reviewed. The results of all viral and mycoplasma cultures were negative. Three of 55 bacterial cultures were positive for type B Haemophilus influenzae. All components of the alternative pathway measured were found to be present in varying amounts in MEF. When the levels of the complement components were compared to the clinical factors studied, there were no observable differences. These data suggest that components of the alternative pathway of complement are present in OME and are not useful in predicting the clinical course or outcome of this disorder.

Correlation among complement activation, protease inhibitors, and clinical course in acute pancreatitis in man

Changes in complement levels and protease inhibitors were measured in plasma/serum and peritoneal fluid during 15 attacks of acute pancreatitis. The abnormalities found in the complement system and the protease inhibitors were most pronounced in severe attacks, especially in the peritoneal fluid. Depressed levels of C1q, C3, properdin, and factor I were found in blood on admission in severe attacks. A decrease during the first days of illness was found for C1q, C3, C4, properdin, factor I, and factor H levels in blood. There was a discrepancy between the low C1q and the high C1r and C1s levels in blood. Complexes of C1r-C1s-C1 inactivator and factor B conversion products were found, especially in the peritoneal fluid, denoting an activation of the complement system. High levels of trypsin in complex with alpha 1-protease inhibitor were found, both in blood and in peritoneal fluid, denoting the liberation of active trypsin in acute pancreatitis. The levels of the functional alpha 2-macroglobulin were low, especially in the peritoneal fluid. It is concluded that both classical and alternative complement activation take place in acute pancreatitis, starting in the peritoneal cavity. The magnitude of activation depends on the severity of the disease. Trypsin-induced activation of complement components may explain some of these changes.

Immunological aspects of humidifier fever

An epidemiological investigation was made of eight employees working in a defined section of an office building who complained of febrile reactions accompanied by respiratory tract symptoms and fatigue. Culture of the water from the humidifier for their section yielded strains of Pseudomonas acidovorans and an unidentified Pseudomonas species. In vitro studies showed that these strains activated the alternative pathway of the complement system in Mg-EGTA supplemented serum, as evidenced by properdin depletion and conversion of C3-proactivator (Factor B) and C3. Whereas the employees with symptoms had significantly reduced properdin values during the symptomatic phase, a slight C3 conversion and antibodies to Pseudomonas spp., staff working in another part of the building with a different ventilation system did not. It was concluded that staff with humidifier fever symptoms had been exposed to Pseudomonas spp. through the faulty ventilation system, and their symptoms were most likely a result of complement activation.

[Immunologic changes in the acute period of slight craniocerebral trauma]

The authors discuss the results of a dynamic study of the characteristics of nonspecific immune responsiveness (properdin, total protein and globulin fractions in blood plasma, C-reactive protein, and immunoglobulins G, A, and M) as well as of the index of water metabolism of the brain matter--the antidiuretic hormone (ADH) in plasma, in 259 patients with the nosological forms of a mild craniocerebral injury 145 of whom had concussion of the brain and 105 had mild contusion of the brain. Congruence of the clinical manifestations of the injury and the level of plasma ADH was recorded. The participation of the factors of nonspecific immune responsiveness in the body compensatory posttraumatic reactions and the genesis of the clinical manifestations of a mild craniocerebral injury is emphasized.

Reduction of phagocyte adherence by nephritic sera: relation to complement activation

Phagocytes isolated from either normal donors or from patients with poststreptococcal (P-SGN), lupus erythematosus (SLE-GN), or membranoproliferative (MPGN) glomerulonephritis showed normal adherence to glass (PAg) after incubation in normal human serum (NHS), but was reduced after incubation in patient serum. Low PAg was the consequence of incubation of normal phagocytes with the earliest available sera from all 22 P-SGN patients, 28 of 37 SLE-GN patients, 19 of 25 patients with MPGN type I, all 10 with types II and III, and all 5 with nephritis associated with chronic bacteremia. Low C3 and decreased PAg were related by regression analysis in sera from patients with P-SGN (P less than 0.001), SLE-GN (P less than 0.005), and MPGN (P less than 0.001) type I. In patients with P-SGN and one patient with nephritis associated with chronic bacteremia, complement levels and PAg returned to normal in parallel with clinical improvement. In vitro, PAg was reduced by NHS treated with either zymosan or bovine serum albumin (BSA)-anti-BSA complexes but neither BSA-anti-BSA complexes or zymosan, previously incubated in NHS, reduced PAg. PAg was normal in serum deficient in C4 or C5 unless treated with zymosan.

Type III membranoproliferative glomerulonephritis: long-term clinical and morphologic evaluation

Seventeen patients with Type III membranoproliferative glomerulonephritis (MPGN) have been followed for more than two years; 16 were treated with alternate day prednisone. Clinical deterioration correlated with nephrotic syndrome (NS) at diagnosis: 3 of 7 patients with NS at diagnosis developed end-stage disease. Serial biopsies in the others showed progressive disease in one, improvement in one and no change in two. Of 10 patients without NS at diagnosis, 6 have improved clinically, 2 are unchanged and 2 are worse. In serial biopsies, 6 showed improved morphology and 4 were unchanged. The results indicate that Type III MPGN will stabilize or improve in most treated patients. The absence of ultrastructural transition of a Type III glomerular lesion to another type and the presence of distinctive immunofluorescent findings and complement abnormalities confirm that Type III is a unique form of MPGN.

The clinical utility of the lupus band test

In order to determine the clinical utility of the lupus band test, the presence of dermal-epidermal junction (DEJ) deposits of IgG, IgM, IgA, C3, C4, Clq, and properdin were studied in biopsies of clinically normal deltoid area skin from 102 patients with systemic lupus erythematosus (SLE) and 151 patients with other rheumatic diseases. One or more proteins were detected at the DEJ in 72.6% (74 of 102) of patients with SLE and in 36.4% (55 of 151) of the other patients, yielding a specificity of 64% and a predictive value of 57%. The predictive value for the diagnosis of SLE was greatest with C4 (100%), properdin (91.3%), and IgA (86.2%) and lowest with IgM (59%). Specificity and predictive value increased with the number of proteins detected at the DEJ. The results suggest that more rigid criteria are required before diagnostic significance is attached to a positive result on the lupus band test.

[Evaluation of the efficiency of the immune system after immunostimulation in patients with breast cancer]

67 patients with mammary carcinoma were submitted to an immunological control examination. This control comprised 14 tests which determined the efficacy of the immune systems, among others: activity of complement, properdin, lysozyme, and beta-lysin, the rate of immunoglobulins, and the behavior of leucergy, rosette tests, NBT, BLT, and tuberculin test. The thoroughly executed examinations did not show any significant difference between patients with active neoplasms and patients in remission stage. The analysis of the results achieved for patients in an advanced stage (TNM) only showed a significant increase (p less than 0.05) of IgG in stage III/IV. The patients were treated with CVF, levamisole (Decaris), and BCG. The observation period was twelve months. The results achieved were discussed in detail.

Complement aberrations in serum from children with otitis due to S. pneumoniae or H. influenzae

Complement components C1q, C1s, C3, C4, factor B and properdin were measured, together with C1 subcomponent complexes and Cq binding substances in acute and convalescent samples from patients with relapsing and non-relapsing otitis media due to S. pneumoniae and H. influenzae. Analysis of C1 subcomponent complexes together with the finding of low C1q levels gave evidence of a disturbed C1 function in acute OME. Furthermore, complement activation by the classical and by the alternative pathways was demonstrated. Complement aberrations were more pronounced in relapsing otitis than in non-relapsing otitis. C1q binding substances that might possibly cause the complement aberrations found were present in most of the patients.

Activation of the alternative complement pathway in ascitic fluid during spontaneous bacterial peritonitis

We studied complement and immunoglobulin profiles on the serum and ascitic fluid of a patient before and during gram-negative spontaneous bacterial peritonitis (SBP). During the infection, activation of the alternative complement pathway in ascitic fluid was manifested by a 35% reduction in functional activity and depression of both properdin and factor B concentrations to nondetectable levels. Activation of the complement cascade was also demonstrated by a 50% reduction in the C3 concentration and depression of total hemolytic complement. There was no evidence of complement activation of a functionally intact complement system in the ascitic fluid of cirrhotic patients. Complement consumption in ascitic fluid may predispose the cirrhotic to SBP.

Immunopathology of periodontal disease. II. Immunofluorescent studies on the localized immune response in periodontitis and juvenile periodontitis

Local immunologic responses were studied in eleven patients with periodontitis, ten patients with juvenile periodontitis, and ten control subjects by performing immunofluorescence on gingival biopsies. F(ab')2 monospecific conjugates to human IgG, IgM, IgA, IgD, and kappa and lambda light chains were used as well as monospecific conjugates to human IgE and properdin. Biopsies from patients with juvenile periodontitis displayed a more intensified immunologic response as evidenced by increases of (I) positive cells stained with a F(ab')2 antihuman immunoglobulin conjugate; (2) IgG, IgM, and kappa and lambda containing cells; (3) extracellular fluorescence of IgG, IgM, IgA, and kappa and lambda light chains; and (4) properdin deposition. Neither IgD nor IgE conjugates reacted significantly with biopsies from the three patient groups. These findings support our previous conclusion that immunologic responses in periodontitis and juvenile periodontitis appear qualitatively similar, but that patients with juvenile periodontitis exhibit a more intense immune response.

In vitro complement activation by intercellular antibodies

By in vitro complement immunofluorescence, 6 sera from pemphigus with intercellular antibodies were tested for their capability to fix C1q, C4, C3, and properdin. All 6 serum samples yielded positive reaction for C3 staining. Three serum samples gave positive staining for C1q, 5 serum samples for C4, and 3 serum samples for properdin, respectively. Substitution of C2 deficient serum as a complement source inhibited C3 and properdin staining but not positive C1q and C4 staining. These results are best explained by the concept that complement activation in vitro by intercellular antibodies occurs via the classical pathway followed by assembly of the C3 amplification mechanism.

In vitro alternative pathway activation of complement by the brush border of proximal tubules of normal rat kidney

The purpose of this study was to investigate which structures of the nephron, if any, are capable of directly activating the complement (C) system. To this end, two sets of experiments were performed. First, activation of C was assessed on sections of frozen kidney tissue, using the indirect immunofluorescence technique for the demonstration of C fixation. Second, glomerular or tubular fractions of kidney were incubated with normal fresh serum, and subsequent C consumption was measured. The data obtained support the interpretation that the brush border of proximal tubules activates the alternative pathway of the C system. This phenomenon may have pathogenic significance in conditions of aselective proteinuria.

Aluminum-containing dense deposits of the glomerular basement membrane: identification by energy dispersive X-ray analysis

Heavy metals, including gold, mercury, lead, bismuth, and cadmium, have the potential to cause renal disease. With the development of X-ray microanalysis, these heavy metals can now be identified in tissue deposits. This report describes a case of renal failure, probably related to dysproteinemia, in which granular, electron-opaque dense deposits were present in the glomerular basement membranes. Energy dispersive X-ray analysis demonstrated that these dense deposits contained aluminum. An analysis of this patient's history in relation to the current knowledge of aluminum metabolism suggests that the aluminum deposition occurred secondary to previous glomerular injury. This case emphasizes the need to utilize heavy metal identification technology whenever granular, electron-opaque dense deposits are identified and represents, to our knowledge, the first study to document aluminum deposits within the glomerular basement membrane of humans.