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2015 ; 4
(ä): 24
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The endothelial deprotection hypothesis for lupus pathogenesis: the dual role of
C1q as a mediator of clearance and regulator of endothelial permeability
#MMPMID25901277
Prechl J
; Czirják L
F1000Res
2015[]; 4
(ä): 24
PMID25901277
show ga
Systemic lupus erythematosus (SLE) is a heterogeneous multifactorial systemic
autoimmune disease affecting several organs. SLE can start relatively early in
life and results in impaired quality of life and shortened life expectancy
because of a gradual disease progression leading to cardiovascular, renal and
neoplastic disease. The basic mechanisms of the pathogenesis of the disease still
remain to be clarified. It is clear that complement proteins play a key and
complex role in the development of SLE. Complement component C1q has been known
to be a fundamental component of lupus development, but most explanations focus
on its role in apoptotic debris removal. Importantly, C1q was recently found to
play a key role in the maintenance of vascular endothelial integrity. We suggest
that apoptotic products, endothelial cells and extracellular matrix components,
which display negatively charged moieties, compete for binding to molecules of
the innate humoral immune response, like C1q. Genetic or acquired factors leading
to an increased load of apoptotic cell debris and decrease or absence of C1q
therefore interfere with the regulation of endothelial permeability and
integrity. Furthermore, we suggest that lupus is the net result of an imbalance
between the two functions of immune clearance and vascular endothelial integrity
maintenance, an imbalance triggered and sustained by autoimmunity, which skews
C1q consumption by IgG-mediated complement classical pathway activation on
autoantigens. In this triangle of innate clearance, autoimmunity and endothelial
integrity, C1q plays a central role. Hence, we interpret the pathogenesis of
lupus by identifying three key components, namely innate immune clearance,
autoimmunity and endothelial integrity and we establish a link between these
components based on the protective role that innate clearance molecules play in
endothelial renewal. By including the vasoprotective role of C1q in the
interpretation of SLE development we attempt to provide novel explanations for
the symptoms, organ damage, diagnostic and therapeutic difficulties of the
disease.