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Complement system, consisting of more than 50 proteins present in blood
or anchored on the surfaces of cells, is activated by classical, lectin, or
alternative pathways. All three pathways finally lead to the formation of a
membrane attack complex (MAC), resulting in cell lysis. Current studies suggest
that complement is involved in liver regeneration, and targeting the complement
cascade modulates liver regeneration. In this mini-review, we discuss the role
of complement system and the therapeutic potential of its interventions in
liver regeneration.
Keywords: Complement, liver
regeneration, complements inhibitor.
Abbreviations: MBL: Mannose
Binding Lectin; MAC: Membrane Attack Complex; MCP: Membrane Cofactor Protein;
DAF: Decay Acceleration Factor; CR1: Complement Receptor 1; HDL: High-Density
Lipoprotein; LXR: Liver X Receptor; LPS: Lipopolysaccharides; TLR: Toll-Like
Receptor; IRI: Ischemia/Reperfusion Injury; C1-INH: C1-Esterase Inhibitor; CR2:
Complement Receptor 2; Crry: Complement Receptor 1-Related Protein Y.
INTRODUCTION
Complement
(C) system consists of more than 50 proteins present in blood or anchored on
the surfaces of cells. The primary functions of the complementary system are to
participate in host defense machinery to regulate immunological and
inflammatory processes [1,2]. In addition, complement is now known to be
involved in lipid metabolism, tumorigenesis, stem cell biology, tissue
regeneration and homeostasis [3-5].
The liver, aside from its role in digestion, is critical to protein
synthesis, detoxification of metabolites, and processing of nutrients. Hepatic
blood supply is unique, having hepatic arteries and portal veins, which
increases the liver’s vulnerability to toxins, toxicants, metabolic products,
and circulatory insults. Fortunately, the liver can regenerate without
interventions, and viral or toxic injuries or partial hepatectomy can stimulate
liver regeneration [6]. Data show that complement is involved in hepatic
regeneration, and in this mini-review, we describe the action and intervention
of complement in the process of liver regeneration.
The Components and
Regulation of Complement System
The
complement system is a network of interacting cell surface-bound and
circulating proteins and as many as 50 molecules are involved in the complement
cascade [7]. Signaling from the classical, lectin, or alternative pathways can
activate the complement system [8-10], but each of these three complement
pathways differs with respect to the initial target recognition even though
they all activate component C3. The activated surface binding of the C1 complex
(C1q, C1r, C1s) to antibody or to C-reactive protein initiates the classical
pathway to form C4bC2a (the classical C3 convertase) from C4 and C2, which
subsequently cleaves C3. Similar to the classical pathway, the lectin pathway
is activated by collagen-containing C-type lectins (collectins) such as mannose
binding lectin (MBL). The alternative pathway is different: after C3 is
hydrolyzed spontaneously or C3b is deposited by the above-mentioned two
pathways, C3b directly binds to microbial surfaces and begins activating the
alternative pathway. Once factor B is cleaved, C3b can bind it to form C3bBb,
the alternative C3 convertase. Enzyme complexes C4bC2a or C3bBb must be formed
in all three complement pathways, and they cleave C3 to form C3a and C3b.
Subsequently C5 is cleaved to produce C5a and C5b. Finally, the terminal
pathway is initiated by C5b to form MAC, creating a pore in the cell membrane
and causing cell lysis [11,12].
Complement
activation generates many potent pro-inflammatory mediators like C3a, C4a and
C5a or anaphylatoxins such as C3a and C5a [13]. When responding to
anaphylatoxins, phagocytic cells can increase C3b, iC3b and C3d, which are
recognized by cell surface receptors [14]. To prevent autologous
complement-mediated injury in vivo,
the complement system is precisely controlled by regulating factors that target
convertase which is critical to the complement activating cascade. For example,
factor H is a serum protein regulating the alternative pathway; the C4b binding
protein regulates the classical and lectin pathways; and some proteins can bind
to the membrane, such as decay acceleration factor (DAF), membrane cofactor protein
(MCP), and complement receptor 1 (CR1), which also predominately affects
convertase [15,16]. In addition, when C5b678 deposition induced by complement
activation appeared on host cells, cell-bound CD59 could bind C9 and inhibit
MAC formation [17].
Complement is Required for Liver Regeneration
Hepatic
regeneration is initiated after liver damage or resection [6] and this is
governed by hormones, growth factors, and immune mediators. During acute liver
injury, the innate immune system coordinates regeneration [18] and complement
is essential for these early events. After the initiation of regeneration, C3
is activated and C3-cleaved products appear in the blood just 2h after carbon
tetrachloride (CCL4) injection. Deposition of C3a peaks within 3h
[19]. Poor hepatic regeneration was observed in C3-deficient or C3aR-deficient
mice treated with CCL4. For C3-/- mice, C3a reconstitution restored
liver regeneration, but C3aR-/- mice did not receive this benefit. The authors
postulated a priming effect of C3a via C3aR in liver regeneration [19].
A recent study proposed a mechanistic relationship
between the activation of C3, acute-phase proteins and cholesterol metabolism
during the priming phase of liver regeneration [20]. Complement activation
increases complement effector proteins, C3a and C5a, which not only are central
to complement-mediated inflammation [21,22], but also bind to the nearby
Kupffer cells to release TNF-α [23], which subsequently binds to receptors on
hepatocytes to initiate the MAPK pathway and its downstream immediate early
genes. This leads to activation of acute-phase proteins that can replace
lipoprotein in high-density lipoprotein (HDL) to form acute-phase HDL. Acute
phase HDL promotes lower cholesterol efflux more than native HDL, which causes
hepatocytes to respond by activating liver X receptor (LXR) through oxysterols
to reduce cholesterol biosynthesis and stabilizing cholesterol. Reduced
cholesterol biosynthesis allows hepatocytes to use cellular resources to meet
other metabolic demands required for prolonged proliferation during liver
regeneration [20]. C3 is needed for normal liver regeneration but how C3
activation participates in this process is unclear [24].When C4-dependent
complement pathway (classical and lectin cascades), factor B dependent
complement pathway (alternative signaling), or all three were disturbed, liver
regeneration was not impaired. In vitro
analysis confirmed that plasmin might be essential to complement activation
[24]. A similar deterioration in hepatic regenerative response appeared in
C5-deficient mice treated with CCL4. Compared to wild-type mice,
C5-deficient mice had more serious hepatic necrosis, apoptosis, and more lipids
after CCL4 injection. C5-deficient mice treated with murine C5 or
C5a had less injury than wild-type mice after CCL4 injection and
regenerative responses were restored [25]. The authors Mastellos D et al.
confirmed that hepatic regeneration was abated in wild type mice when C5aR was
blocked with an antagonist, suggesting that the interaction between C5a and
C5aR was implicated in stimulating liver regeneration [25].
Another report revealed that C5a receptors were
present on regenerating hepatocytes and C5a receptor expression was increased
after liver resection. C5a/C5aR interaction up-regulated hepatocyte growth
factor (HGF) and the HGF receptor c-MET mRNA [26], which are involved in
mitosis and hepatic regeneration [6]. C3 and C5 are individually needed for
liver regeneration and together they may have a synergistic effect on
hepatocyte proliferation. More severe hepatic injury was observed in
double-deficient C3 and C5 mice compared to single-deficient C3 or C5 mice
[27]. The importance of C3a and C5a in liver regeneration has been confirmed
with single (C3 or C5) or double (C3 and C5) restoration in double-deficient C3
and C5 mice after hepatectomy. Hepatic regenerative ability was partly but not
completely restored after a single treatment of C3a or C5a; but when C3a and
C5a were both reconstituted, liver regeneration in C3/C5-/- mice were rescued
[27]. Several studies confirmed that C3a and C5a are involved in early
signaling and the transcriptional network of hepatocyte proliferation mediated
by Kupffer cells [28-30]. Binding of C3a or C5a to their individual receptors
located on Kupffer cell surfaces, Toll-like receptor 4 (TLR4) signaling
stimulate Kupffer cells to release TNF- and IL-6, as well as activate NF-B and STAT3
signaling in hepatocytes. This induces immediate-early genes involved in
hepatocyte regeneration [31-33].
Targeting
Complement Cascade Could Regulate Liver Regeneration
Complement is necessary for normal liver
regeneration. Rat liver ischemia and reperfusion injury (IRI) experiments
indicate that controlling complement activation with CR1 reduces liver injury
[34-36]; however, products and MAC from complement activation have detrimental
effects on liver tissues and cause neutrophil accumulation, microvascular
dysfunction and cell death [37,38]. A damaged liver’s regenerative ability and
hepatic dysfunction is related to the degree of IRI and there may be a balance
between liver injury and regeneration, all of which are mediated by the
complement signaling pathway.
Several studies confirmed that liver regeneration
could be ameliorated with complement inhibitors. For example, the protease
inhibitor, C1-esterase inhibitor (C1-INH), is a serpin superfamily member that
can inhibit the classical and lectin complement pathways and the purpose of
this is to activate complement spontaneously [39-41]. Administration of C1-INH
(human) can promote liver regeneration in mice, and 400 IU/kg is the most
effective dose that causes the least elevation of hepatic function enzymes and
IL-6 and offers best histology scores. Even so, there was no apparent dose-dependent
effect of C1-INH on liver regeneration [42].
Similar results were found with another complement
inhibitor, CR2-Crry (complement receptor 2 (CR2)-complement receptor 1-related
protein y (Crry)) [43]. CR2 is a C3 binding protein family member and matured B
cells and follicular dendritic cells express CR2 [44]. iC3b, C3dg, C3d, and
cell-bound products cleaved from C3 are present at complement activating sites
and are natural ligands targeting the CR2 moiety [45]. As a structural and
functional orthologue of human soluble CR1, soluble Crry is a murine protein
that inhibits the activation of C3. The effect and characteristics of CR2-Crry
were first tested in a mouse intestine IRI model, and tissue localization of
CR2-Crry was at the activating sites of complement. CR2-Crry was more effective
in complement inhibition compared to Crry-Ig, which is used as a counterpart
systemically [46]. In a complicated model combined with IRI and hepatectomy,
CR2-Crry at a lower dose could prevent liver damage and enhance liver
proliferation and this involved IL-6, STAT3, and Akt signaling. However,
CR2-Crry at higher doses or C3 knock out resulted in steatosis, liver injury,
and more death [43]; thus, complement must be balanced for liver health.
MAC is the last step of complement activation. CD59
is a MAC inhibitor, and soluble CD59 is a poor inhibitor but can function
effectively if positioned where complement was activated and MAC was formed
[47]. The fusion protein of CR2-CD59 is a mouse-specific inhibitor targeting
MAC production, which is the terminal signaling event in the activated
complement system. However, unlike CR2-Crry, CR2-CD59 is a specific inhibitor
targeting cells opsonized by C3 and reduces MAC production. It has no or little
effect on C3 activation, so CR2-CD59 is more specific to the complement system
[48], it does not affect C3a and C5a production, which are essential for liver
regeneration. Furthermore, CR2-CD59 significantly reduces hepatic IRI and
enhances liver regeneration by multiple mechanisms that involve elevation of
TNF and IL-6, activation of STAT3 and AKT signaling pathways, blockade of
mitochondrial depolarization, and restoration of ATP [48].
CONCLUSION
Complement is involved in inflammatory injury and
regenerative response, excessive activation of complement aggravates hepatic
IRI and deteriorates hepatic regeneration. Inhibitors used in the complement
system may be clinically beneficial for augmenting liver regeneration by
modulating excessive of complement activation and may represent a promising
targeted strategy for balancing hepatic inflammatory responses and cellular
regeneration.
ACKNOWLEDGMENTS
The present study was supported in part by the
“Sphingolipids and Related Diseases” Program for Innovative Research Team of
Guilin Medical University, and Hundred Talents Program under the Introduction
of Overseas High-Level Talents in Colleges and Universities in Guangxi. This
research was also supported by Guangxi Distinguished Experts Special Fund.
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