Since the highly reactive thioester bond of activated C3 and C4 cannot distinguish between acceptor groups on a host cell from those on the surface of a pathogen, mechanisms have evolved that prevent the small amounts of C3 or C4 molecules deposited on host cells from fully triggering complement activation. We introduced these mechanisms in the context of control of the alternative pathway (see Fig. 2.27), but they are also important regulators of the classical pathway convertase (see Fig. 2.37, second and third rows). Section 2-10 described the proteins that inactivate any C3b or C4b that has bound to host cells. These are the plasma factor I and its cofactors MCP and CR1, which are membrane proteins. Circulating factor I is an active serine protease, but it can cleave C3b and C4b only when they are bound to MCP and CR1. In these circumstances, factor I cleaves C3b, first into iC3b and then further to C3dg, thus permanently inactivating it. C4b is similarly inactivated by cleavage into C4c and C4d. Microbial cell walls lack MCP and CR1 and thus cannot promote the breakdown of C3b and C4b, which instead act as binding sites for factor B and C2, promoting complement activation. The importance of factor I can be seen in people with genetically determined factor I deficiency. Because of uncontrolled complement activation, complement proteins rapidly become depleted and such people suffer repeated bacterial infections, especially with ubiquitous pyogenic bacteria.
There are also plasma proteins with cofactor activity for factor I, most notably C4b-binding protein (C4BP) (see Fig. 2.36). It binds C4b and acts mainly as a regulator of the classical pathway in the fluid phase. Another is factor H, which binds C3b in the fluid phase as well as at cell membranes and helps to distinguish the C3b that is bound to host cells from that bound to microbial surfaces. The higher affinity of factor H for sialic acid residues on host membrane glycoproteins allows it to displace factor B in binding to C3b on host cells. Also, C3b at cell membranes is bound by cofactor proteins DAF and MCP. Factor H, DAF, and MCP effectively compete with factor B for binding to C3b bound to host cells, so that the bound C3b is catabolized by factor I into iC3b and C3dg and complement activation is inhibited. In contrast, factor B is favored for binding C3b on microbial membranes, which do not express DAF or MCP and which lack the sialic acid modifications that attract factor H. The greater amount of factor B on a microbial surface stimulates formation of more C3bBb C3 convertase, and thus complement activation is amplified.
The critical balance between the inhibition and the activation of complement on cell surfaces is illustrated in individuals heterozygous for mutations in any of the regulatory proteins MCP, factor I, or factor H. In such individuals, the concentration of functional regulatory proteins is reduced, and the tipping of the balance toward complement activation leads to a predisposition to atypical hemolytic uremic syndrome, a condition characterized by damage to platelets and red blood cells and by kidney inflammation. Another serious health problem related to complement malfunction is a significantly increased
The complement system and innate immunity.
risk of age-related macular degeneration, the leading cause of blindness in the elderly in developed countries, which has been predominantly linked to single-nucleotide polymorphisms in the factor H gene. Polymorphisms in other complement genes have also been found to be either detrimental or protective for this disease. Thus, even small alterations in the efficiency of either the activation or the regulation of this powerful effector system can contribute to the progression of degenerative or inflammatory disorders.