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2008 ; 12
(4
): 1074-84
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The alternative complement pathway revisited
#MMPMID18419792
Harboe M
; Mollnes TE
J Cell Mol Med
2008[Aug]; 12
(4
): 1074-84
PMID18419792
show ga
Alternative pathway amplification plays a major role for the final effect of
initial specific activation of the classical and lectin complement pathways, but
the quantitative role of the amplification is insufficiently investigated. In
experimental models of human diseases in which a direct activation of alternative
pathway has been assumed, this interpretation needs revision placing a greater
role on alternative amplification. We recently documented that the alternative
amplification contributed to 80-90% of C5 activation when the initial activation
was highly specific for the classical pathway. The recent identification of
properdin as a recognition factor directly initiating alternative pathway
activation, like C1q in the classical and mannose-binding lectin in the lectin
pathway initiates a renewed interest in the reaction mechanisms of complement.
Complement and Toll-like receptors, including the CD14 molecule, are two main
upstream recognition systems of innate immunity, contributing to the inflammatory
reaction in a number of conditions including ischemia-reperfusion injury and
sepsis. These systems act as "double-edged swords", being protective against
microbial invasion, but harmful to the host when activated improperly or
uncontrolled. Combined inhibition of complement and Toll-like receptors/CD14
should be explored as a treatment regimen to reduce the overwhelming damaging
inflammatory response during sepsis. The alternative pathway should be
particularly considered in this regard, due to its uncontrolled amplification in
sepsis. The alternative pathway should be regarded as a dual system, namely a
recognition pathway principally similar to the classical and lectin pathways, and
an amplification mechanism, well known, but quantitatively probably more
important than generally recognized.