THE

COMPLEMEN
T SYSTEM
Shebina
Babu
D3
 Introducti
on
The complement system is the major
effector of the humoral branch of
the immune system. It refers to a
system of factors present in normal
serum which is activated by Ag-Ab
interactions and results in
biologically significant consequences.

Research on complement began in

the 1890s,
when Jules Bordet at the Institut
Surprisingly, the ability to lyse the
bacteria was restored to the heated
serum by adding fresh serum that
contained no antibodies directed against
the bacterium and was unable to kill the
bacterium by itself.

Bordet correctly reasoned that

bacteriolytic activity requires two
different substances:
the specific antibacterial antibodies,
which survive the heating process.
 Bordet devised a simple test for the lytic
activity, the easily detected lysis of
antibody-coated red blood cells, called
hemolysis.

Paul Ehrlich in Berlin independently

carried out similar experiments and
coined the term complement, defining it
as the activity of blood serum that
completes the action of antibody.
In ensuing years, researchers discovered
that the action of complement was the
 Complement Components
The proteins and glycoproteins that compose the
complement system are synthesized mainly by
liver hepatocytes
blood monocytes,
tissue macrophages,
epithelial cells of the gastrointestinal and
genitourinary tracts.
These components constitute 5% (by weight)
of the serum globulin fraction. Most circulate in
the serum in functionally inactive forms as
proenzymes, or zymogens, which are inactive
until proteolytic cleavage, which removes an
Complement components are
designated by numerals (C1C9), by
letter symbols (e.g., factor D), or by
trivial names (e.g., homologous
restriction factor).

Peptide fragments formed by

activation of a component are denoted
by small letters. In most cases, the
smaller fragment resulting from
cleavage of a component is designated
a and the largerfragment designated
 The larger fragments bind to the target
near the site of activation, and the smaller
fragments diffuse from the site and can
initiate localized inflammatory responses by
binding to specific receptors.

The complement fragments interact with

one another to form functional complexes.
Those complexes that have enzymatic
activity are designated by a bar over the
number or symbol

(e.gC4b2a,C3bBb).
 Complement Activation
The complement proteins remain in an inactive form in
the blood plasma. They are made active by certain
substances called activating agents which can be
bacteria
Viruses
Aggregated antibodies like IgG,IgA
endotoxins
Yeast etc.
When one component is activated, other components
are triggered in a cascade pattern to bring the
biological activity such as lysis, phagocytosis etc.
When a component is activated, it acquires
the following unique properties:-
The activated complement binds to
biological membrane.
It generates enzyme activity.
It activates the next complement protein.
The early steps, culminating in formation of
C5b, can occur by :-
the classical pathway,
the alternative or properdin pathway,
the lectin pathway.
The final steps that lead to a membrane
attack are the same in all pathways.
The Classical Pathway
Complement activation by the classical
pathway commonly begins with the formation
of soluble antigen-antibody complexes
(immune complexes) or with the binding of
antibody to antigen on a suitable target, such
as a bacterial cell.
IgM and certain subclasses of IgG (human
IgG1, IgG2, and IgG3) can activate the
classical complement pathway. The initial
stage of activation involves C1, C2, C3, and
C4, which are present in plasma in
functionally inactive forms.
Because the components were named in
The formation of Ag-Ab complex induces
conformational changes in the Fc portion of the
IgM molecule that expose a binding site for the
C1 component of the complement system.
The recognition unit of C1 is C1q,which reacts
with the Fc pieceof bound IgM or IgG.
Binding of C1q to Fc binding sites induces a
conformational change in C1r that converts C1r
to an active serine protease enzyme, C1r, which
then cleaves C1s to a similar active enzyme,
C1s. C1s has two substrates, C4 and C2.
C4 is split into C4a and C4b.
C4b in presence of magnesium ions cleaves C2
into C2a,(which remaies linked to cell-bound
C4b),and C4b.
 C3 convertase splits into two fragments C3a
(which is anaphylatoxin) and C3b which
remains bound to C4b2a to form trimolecular
complex C4b2a3b,also called as C5 convertase.

The membrane attack phase of complement

begins at this stage, with C5 convertase
cleaving C5 into C5a and C5b. C5b coninues the
cascade,which attaches to C6 and initiates
formation of the membrane attack complex
(MAC).
Classical Complement
Pathway
C1qrs
C2
C4 C3
antibody
C4b C5

C4a

Bacteria
 C1qrs C2
C4
C3
antibody
C5
C4b
C2b
C4a
C3b
C2a
Bacteria
C3a
 C1qrs C2
C4 C3
antibody
C5
C4b
C2b
C3b C4a

C5b C2a
Bacteria
C3a
C5a
 C1qrs
antibody

C4b C6
C2b
C3b C7
C5b C8
C6
C7 C9
C8
Bacteria C9 C9
C9 C9
C9 C9
The Alternative
Pathway
The alternative pathway generates bound C5b, the
same
product that the classical pathway generates, but it
does so without the need for antigen-antibody
complexes for initiation.
Because no antibody is required, the alternative
pathway
is a component of the innate immune system. This
major pathway of complement activation involves four
serum proteins: C3, factor B, factor D, and properdin.
The alternative pathway is initiated in most cases by
cell-surface constituents that are foreign to the host.
 C3, is subjected to hydrolysis to yield
C3a and C3b. The C3b component can
bind to foreign surface antigens (such as
those on bacterial cells or viral particles)
or even to the hosts own cells .
The C3b present on the surface of the
foreign cells can bind another serum
protein called factor B to form a complex
stabilized by Mg2.
Binding to C3b exposes a site on factor B
that serves as the substrate for an
enzymatically active serum protein called
factor D.
Factor D cleaves the C3b-bound factor B,
releasing a small
The C3 convertase activity of C3bBb has
a half-life of only 5 minutes unless the
serum protein properdin(Factor P) binds
to it, stabilizing it and extending the half-
life of this convertase activity to 30
minutes.
The C3 convertase activity of C3bBb
generates the C3bBb3b complex, which
exhibits C5 convertase activity, analogous to
the C4b2a3b complex in the classical pathway.
The nonenzymatic C3b component binds C5,
and the Bb component subsequently
hydrolyzes the bound C5 to generate C5a and
C5b, leading to further steps in the cascade.
Alternative Complement
Pathway
C3
B
C5
C3b
C3a
Bacteria
Alternative Complement
Pathway
C3
B
C5

C3b
Bb
C3a
Bacteria
Alternative Complement
Pathway
C3
B
C5

C3b
Bb
C5b C3a
Bacteria C5a

Animation complete
 C6
C3b C7
Bb
C5b C8
C6 C9
C7
C8
C9
Bacteria C9 C9
C9 C9
C9 C9

Animation complete
 The Lectin Pathway
Lectins are proteins that recognize and bind to
specific carbohydrate targets. (Because the lectin that
activates complement binds to mannose residues, it is
also called the MBLectin pathway or mannan-binding
lectin pathway.)
The lectin pathway, like the alternative pathway, does
not depend
on antibody for its activation.However, the mechanism
is more like that of the classical pathway, because
after initiation, it proceeds, through the action of C4
and C2, to produce a C5 convertase.
The lectin pathway is activated by the binding of
mannose- binding lectin (MBL) to mannose residues on
glycoproteins or carbohydrates on the surface of
microorganisms including certain Salmonella, Listeria,
and Neisseria strains, as well as Cryptococcus
 After MBL binds to the surface of a cell or
pathogen, MBL-associated serine proteases,MASP-1
and MASP-2, bind to MBL. The active complex formed
by this association causes cleavage and activation of
C4 and C2.
The MASP-1 and -2 proteins have structural
similarity to C1r and C1s and mimic their activities.
This means of activating the C2C4 components to
form a C5 convertase without need for specific
antibody
binding represents an important innate defense
mechanism
comparable to the alternative pathway, but utilizing
the elements of the classical pathway except for the
C1 proteins.
The Three Complement Pathways Converge at the
Membrane-Attack Complex.
The terminal sequence of complement activation
involves C5b, C6, C7, C8, and C9, which interact
sequentially to form a macromolecular structure called
the membrane-attack complex (MAC). This complex
forms a large channel through the membrane of the
target cell, enabling ions and small molecules to diffuse
freely across the membrane.

The end result of activating the classical, alternative, or

lectin pathways is production of an active C5
convertase.This enzyme cleaves C5.

After binding of C5 to the C3b component of the

convertase, the amino terminus of the chain is cleaved.
The C5b component is extremely labile
and becomes inactive within 2 minutes unless
C6 binds
to it and stabilizes its activity.
Up to this point, all the complement
reactions take place
on the hydrophilic surface of membranes or
on immune
complexes in the fluid phase.
As C5b6 binds to C7, the resulting complex
undergoes a hydrophilic-amphiphilic structural
transition that exposes hydrophobic regions,
which serve as binding sites for membrane
phospholipids. If the reaction occurs on a
Binding of C8 to membrane-bound C5b67 induces a
conformational change in C8, so that it too undergoes a
hydrophilic-amphiphilic structural transition, exposing a
hydrophobic region, which interacts with the plasma
membrane.
the MAC is the binding and polymerization of C9, a
perforin-like molecule, to the C5b678 complex.
As many as 1017 molecules of C9 can be bound
and polymerized by a single C5b678 complex. After
polymerization, it can also insert into the
membrane. The completed MAC, which has a
tubular form and functional pore size of 70100
Since ions and small molecules can diffuse freely
through the central channel of the MAC, the cell
cannot maintain its osmotic stability and is killed by
an influx of water and loss of electrolytes.
Biological Consequences
of Complement
Activation
The MembraneAttack Complex Can Lyse a
Broad Spectrum of Cells
The membrane-attack complex formed by
complement activation can lyse gram-negative
bacteria, parasites, viruses, erythrocytes, and
nucleated cells.

Because the alternative and lectin pathways of

activation generally occur without an initial antigen-
antibody interaction, these pathways serve as
important innate immune defenses against infectious
microorganisms.
 Cleavage Products of Complement
Components Mediate Inflammation
The smaller fragments resulting from
complement cleavage, C3a, C4a, and C5a,
called anaphylatoxins, bind to receptors on
mast cells and blood basophils and induce
degranulation, with release of histamine and
other pharmacologically active mediators.
The anaphylatoxins also induce smooth-muscle
contraction and increased vascular
permeability.
Activation of the complement system thus
results in influxes of fluid that carries antibody
and phagocytic cells to the site of antigen entry.
C3b and C4b Binding Facilitates
Opsonization
Complement facilitates the uptake and destruction of
pathogens by phagoctic cells. This opsonic effect is
based on the presence of complement receptors or
CRs on the surface of phagocytic cells (macrophages,
monocytes, neutrophils etc.)
Many receptors have been identified such as
CR1,2,3,4 and C1q.
Eg:- CR2 receptor on B cells acts as a receptor for the
Epstein-Barr virus (EBV).
C3b can target the antigen directly to the phagocyte,
enhancing the initiation of antigen processing and
accelerating specific antibody production.
The Complement System
Also
Neutralizes Viral
Infectivity
For most viruses, the binding of serum
antibody to the repeating subunits of the viral
structural proteins creates particulate immune
complexes ideally suited for complement
activation by the classical pathway.

Some viruses (e.g., retroviruses, Epstein-Barr

virus, Newcastle disease virus, and rubella
virus) can activate the alternative, lectin, or
even the classical pathway in the absence of
antibody.
The Complement System Clears
Immune Complexes from
Circulation
The importance of the complement system in
clearing immune complexes is seen in patients
with the autoimmune diseases- systemic lupus
erythematosus (SLE) and rheumatoid
arthritis.These individuals produce large
quantities of immune complexes and suffer
tissue damage.
C3b plays a critical role in solubilization and
clearance of immune complexes. RBCs help in
bindingC3b-coated immune complexes and
carrying these complexes to the liver and
spleen. In these organs, immune complexes are
Complement Fixation Test
The complement fixation test (CFT) was extensively used in
syphilis serology after being introduced by Wasserman in 1909.
The property of Ag-Ab complex to fix complement is used in
CFT for the identification of specific antibodies.
TEST SYSTEM
Antigen:It may be soluble or particulate
Antibody:Human serum(may or maynot contain Ab)
Complement:It is pooled serum obtined from 4 to 5 guniea
pigs.It should be fresh or specially preserved as the
complement activity is heat liable (stored at -30 C in small
fractions).its activity should be initially standardised before
using in the test.
INDICATOR SYSTEM
Erythrocytes:sheep RBC
Amboceptor(hemolysins): rabbit antibody to sheep Red cells
prepared by inoculating sheep erythrocytes into rabbit under
standard immunization protocol.
Procedure
Ag mixed with test serum to be assayed for Ab
Standard amount of complement is added
Erythrocytes coated withAbs is added
Amount of erythryocyte lysis is determined
Positive TEST
Ag+Test serum+ complement 37 C complement
fixed
1 hour
Fixed complement +hemolytic system No
hemolysis

Negative test
Ag+test serum+ complement 37 C complement
not fixed
1 hour
Complement Deficiencies
Deficiency Syndrome

C1 inhibitor Hereditary angioneurotic edema

(angioedema of subcutaneous tissue
or mucosa of respiratory and
alimentary tracts.)

Early components of classical SLE(systemic lupus erythematosus,)

pathways C1,C2,C3 glomerulonephritis, and vasculitis.

C3 and C3b infections by pyogenic (pusforming)

bacteria such as streptococci and
staphylococci.

C5 and C8 Bacteremia,mainly with gram

negative diplococci

the components develop recurrent meningococcal

involved in the MAC formation and gonococcal infections caused
by Neisseria species.
CONCLUSION
The complement system comprises a group of serum
proteins,
many of which exist in inactive forms.
Complement activation occurs by the classical,
alternative,
or lectin pathways, each of which is initiated differently.
The three pathways converge in a common sequence of
events that leads to generation of a molecular complex
that
causes cell lysis.
The classical pathway is initiated by antibody binding to
a
cell target; reactions of IgM and certain IgG subclasses
activate
this pathway.
 Activation of the alternative and lectin
pathways is antibody-
independent. These pathways are initiated by
reaction
of complement proteins with surface molecules
of microorganisms.
In addition to its key role in cell lysis, the
complement system mediates opsonization of
bacteria, activation of inflammation, and
clearance of immune complexes.
Interactions of complement proteins and
protein fragments with receptors on cells of the
immune system control both innate and
acquired immune responses.
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