Binding of factor H to tubular epithelial cells limits interstitial complement activation in ischemic injury

摘要

Factor H is a regulator of the alternative pathway of complement. Genetic studies have revealed that patients with factor H mutations are at increased risk for several types of renal disease. Pathogenic activation of the alternative pathway in acquired diseases, such as ischemic acute kidney injury, also suggests that non-mutated factor H also has a limited ability to control the alternative pathway in the kidney. In the current study we examined the ability of circulating factor H to control alternative pathway activation on renal tubular epithelial cells. We found that an absolute deficiency of factor H prevented complement activation on the cells after ischemia/reperfusion, likely because of consumption of alternative pathway proteins in the fluid phase. In contrast, when the fluid phase regulation by factor H was retained but the interaction of factor H with cell surfaces was blocked, complement activation after renal ischemia/reperfusion increased. Finally, a recombinant form of factor H that is specifically targeted to sites of C3 deposition was found to reduce complement activation in the tubulointerstitium after I/R. These studies demonstrate that native factor H provides critical regulation of the alternative pathway in the renal tubulointerstitium after injury, but that this protection is incomplete. An inhibitor that targeted recombinant factor H to the tissue surface prevented alternative pathway activation and attenuated renal injury after I/R.