Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
Front Immunol. 2022 Sep 14;13:981375. doi: 10.3389/fimmu.2022.981375. eCollection 2022.
The complement system is part of the innate immune system. The crucial step in activating the complement system is the generation and regulation of C3 convertase complexes, which are needed to generate opsonins that promote phagocytosis, to generate C3a that regulates inflammation, and to initiate the lytic terminal pathway through the generation and activity of C5 convertases. A growing body of evidence has highlighted the interplay between the complement system, coagulation system, platelets, neutrophils, and endothelial cells. The kidneys are highly susceptible to complement-mediated injury in several genetic, infectious, and autoimmune diseases. Atypical hemolytic uremic syndrome (aHUS) and lupus nephritis (LN) are both characterized by thrombosis in the glomerular capillaries of the kidneys. In aHUS, congenital or acquired defects in complement regulators may trigger platelet aggregation and activation, resulting in the formation of platelet-rich thrombi in the kidneys. Because glomerular vasculopathy is usually noted with immunoglobulin and complement accumulation in LN, complement-mediated activation of tissue factors could partly explain the autoimmune mechanism of thrombosis. Thus, kidney glomerular capillary thrombosis is mediated by complement dysregulation and may also be associated with complement overactivation. Further investigation is required to clarify the interaction between these vascular components and develop specific therapeutic approaches.
补体系统是先天免疫系统的一部分。激活补体系统的关键步骤是 C3 转化酶复合物的产生和调节,这些复合物需要产生促进吞噬作用的调理素、产生调节炎症的 C3a 以及通过 C5 转化酶的产生和活性启动裂解终末途径。越来越多的证据强调了补体系统、凝血系统、血小板、中性粒细胞和内皮细胞之间的相互作用。肾脏在几种遗传、感染和自身免疫性疾病中极易受到补体介导的损伤。非典型溶血性尿毒症综合征(aHUS)和狼疮性肾炎(LN)的特征均为肾脏肾小球毛细血管中的血栓形成。在 aHUS 中,补体调节剂的先天性或获得性缺陷可能触发血小板聚集和激活,导致肾脏中富含血小板的血栓形成。由于肾小球血管病通常伴有 LN 中的免疫球蛋白和补体积累,因此组织因子的补体介导激活部分可以解释血栓形成的自身免疫机制。因此,肾脏肾小球毛细血管血栓形成是由补体失调介导的,也可能与补体过度激活有关。需要进一步研究以阐明这些血管成分之间的相互作用,并开发特定的治疗方法。