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Complement factors as biomarkers in ANCA-associated vasculitis in remission

Trattner, Rebecca LU ; Iordanou, Maria LU ; Ohlsson, Sophie LU orcid ; Martin, Myriam LU ; Segelmark, Mårten LU orcid and Blom, Anna M. LU orcid (2025) In Clinical and Experimental Immunology 219(1).
Abstract

Background Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of rare, autoimmune diseases causing inflammation in the vessel wall. Many organs can be affected, and kidney involvement is a common and serious manifestation. Complement activation is important in disease development and has also been detected in patients in remission. The reason for increased complement activation also without active disease is not understood. Methods In this study, 65 AAV patients in remission, contributing with a total of 147 plasma samples, were included. Biomarkers of complement activation such as C4d (classical and lectin pathways), C3bBbP (alternative pathway), and soluble terminal complement complex (sTCC) (common... (More)

Background Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of rare, autoimmune diseases causing inflammation in the vessel wall. Many organs can be affected, and kidney involvement is a common and serious manifestation. Complement activation is important in disease development and has also been detected in patients in remission. The reason for increased complement activation also without active disease is not understood. Methods In this study, 65 AAV patients in remission, contributing with a total of 147 plasma samples, were included. Biomarkers of complement activation such as C4d (classical and lectin pathways), C3bBbP (alternative pathway), and soluble terminal complement complex (sTCC) (common terminal pathway) were measured with ELISA. For C4d measurement, an improved assay with an antibody targeting a cleavage neoepitope solely exposed during complement activation was used. Results Our first hypothesis was that patients prone to recurrent flares might have an increased complement activation even when beeing in remission. However, we found no significant difference between those who did and did not develop flares during follow-up, nor any correlation between the total number of flares and any of the complement biomarkers. Interestingly, higher sTCC levels in remission correlated significantly to kidney involvement at the time of diagnosis and plasma creatinine levels at the time of sampling. Also, the diagnosis of microscopic polyangiitis (MPA), compared to granulomatosis with polyangiitis (GPA), yielded higher sTCC levels, and plasma C-reactive protein levels correlated significantly to sTCC. Conclusion These findings suggest that persistent complement activation during remission in AAV may reflect underlying disease severity and organ involvement rather than predicting future flares.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis AAV, biomarkers, complement, remission
in
Clinical and Experimental Immunology
volume
219
issue
1
article number
uxaf037
publisher
Oxford University Press
external identifiers
  • pmid:40440129
  • scopus:105009061502
ISSN
0009-9104
DOI
10.1093/cei/uxaf037
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s).
id
c1a591ec-48c3-4e7f-898f-818ed6abda43
date added to LUP
2025-07-07 14:19:56
date last changed
2025-07-09 03:14:39
@article{c1a591ec-48c3-4e7f-898f-818ed6abda43,
  abstract     = {{<p>Background Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of rare, autoimmune diseases causing inflammation in the vessel wall. Many organs can be affected, and kidney involvement is a common and serious manifestation. Complement activation is important in disease development and has also been detected in patients in remission. The reason for increased complement activation also without active disease is not understood. Methods In this study, 65 AAV patients in remission, contributing with a total of 147 plasma samples, were included. Biomarkers of complement activation such as C4d (classical and lectin pathways), C3bBbP (alternative pathway), and soluble terminal complement complex (sTCC) (common terminal pathway) were measured with ELISA. For C4d measurement, an improved assay with an antibody targeting a cleavage neoepitope solely exposed during complement activation was used. Results Our first hypothesis was that patients prone to recurrent flares might have an increased complement activation even when beeing in remission. However, we found no significant difference between those who did and did not develop flares during follow-up, nor any correlation between the total number of flares and any of the complement biomarkers. Interestingly, higher sTCC levels in remission correlated significantly to kidney involvement at the time of diagnosis and plasma creatinine levels at the time of sampling. Also, the diagnosis of microscopic polyangiitis (MPA), compared to granulomatosis with polyangiitis (GPA), yielded higher sTCC levels, and plasma C-reactive protein levels correlated significantly to sTCC. Conclusion These findings suggest that persistent complement activation during remission in AAV may reflect underlying disease severity and organ involvement rather than predicting future flares.</p>}},
  author       = {{Trattner, Rebecca and Iordanou, Maria and Ohlsson, Sophie and Martin, Myriam and Segelmark, Mårten and Blom, Anna M.}},
  issn         = {{0009-9104}},
  keywords     = {{anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis AAV; biomarkers; complement; remission}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{Oxford University Press}},
  series       = {{Clinical and Experimental Immunology}},
  title        = {{Complement factors as biomarkers in ANCA-associated vasculitis in remission}},
  url          = {{http://dx.doi.org/10.1093/cei/uxaf037}},
  doi          = {{10.1093/cei/uxaf037}},
  volume       = {{219}},
  year         = {{2025}},
}