New insight into the effects of heparinoids on complement inhibition by C1-inhibitor. (13th April 2016)

• Record Type: Journal Article
• Authors: Poppelaars, F; Damman, J; de Vrij, E L; Burgerhof, J G M; Saye, J; Daha, M R; Leuvenink, H G; Uknis, M E; Seelen, M A J
• Is Part Of: Clinical and experimental immunology. Volume 184:Number 3(2016:Jun.)
• Page Start: 378
• Page End: 388
• Publication Date: 2016-04-13
• Subjects: complement -- complement 1-inhibitor -- glycosaminoglycans -- heparinoids -- inhibition; Immunopathology -- Periodicals; 616.079
• DOI: 10.1111/cei.12777
• Languages: English
• ISSNs: 0009-9104

Abstract

Summary: Complement activation is of major importance in numerous pathological conditions. Therefore, targeted complement inhibition is a promising therapeutic strategy. C1-esterase inhibitor (C1-INH) controls activation of the classical pathway (CP) and the lectin pathway (LP). However, conflicting data exist on inhibition of the alternative pathway (AP) by C1-INH. The inhibitory capacity of C1-INH for the CP is potentiated by heparin and other glycosaminoglycans, but no data exist for the LP and AP. The current study investigates the effects of C1-INH in the presence or absence of different clinically used heparinoids on the CP, LP and AP. Furthermore, the combined effects of heparinoids and C1-INH on coagulation were investigated. C1-INH, heparinoids or combinations were analysed in a dose-dependent fashion in the presence of pooled serum. Functional complement activities were measured simultaneously using the Wielisa ® -kit. The activated partial thrombin time was determined using an automated coagulation analyser. The results showed that all three complement pathways were inhibited significantly by C1-INH or heparinoids. Next to their individual effects on complement activation, heparinoids also enhanced the inhibitory capacity of C1-INH significantly on the CP and LP. For the AP, significant potentiation of C1-INH by heparinoids was found; however, this was restricted to certain concentration ranges. At low concentrations the effect on blood coagulation by combining heparinoids with C1-INH was minimal. In conclusion, our study shows significant potentiating effects of heparinoids on the inhibition of all complement pathways by C1-INH. Therefore, their combined use is a promising and a potentially cost-effective treatment option for complement-mediated diseases.