Previous studies indicate a pivotal role for complement in mediating both local and remote injury following ischemia and reperfusion of the intestine. Here, we report on the use of a mouse model of intestinal ischemia/ reperfusion injury to investigate the strategy of targeting complement inhibition to sites of complement activation by linking an iC3b/C3dg-binding fragment of mouse complement receptor 2 (CR2) to a mouse complement-inhibitory protein, Crry. We show that the novel CR2-Crry fusion protein targets sites of local and remote (lung) complement activation following intestinal ischemia and reperfusion injury and that CR2-Crry requires a 10-fold lower dose than its systemic counterpart, Crry-Ig, to provide equivalent protection from both local and remote injury. CR2-Crry has a significantly shorter serum half-life than Crry-Ig and, unlike Crry-Ig, had no significant effect on serum complement activity at minimum effective therapeutic doses. Furthermore, the minimum effective dose of Crry-Ig significantly enhanced susceptibility to infection in a mouse model of acute septic peritonitis, whereas the effect of CR2-Crry on susceptibility to infection was indistinguishable from that of PBS control. Thus, compared with systemic inhibition, CR2-mediated targeting of a complement inhibitor of activation improved bioavailability, significantly enhanced efficacy, and maintained host resistance to infection.
IntroductionIntestinal ischemia/reperfusion injury (IRI) is a major complication associated with abdominal surgery, cardiopulmonary bypass, ruptured abdominal aneurysm, and cardiac arrest (1-5). Reduction of abdominal blood flow as a result of hemorrhagic shock also causes intestinal IRI, which commonly leads to bacterial translocation and sepsis. Intestinal IRI causes gut dysfunction that is characterized by impaired gut motility, increased intestinal permeability, and mucosal wall injury, all of which are thought to be mediated at least in part by complement activation and the infiltration of neutrophils (6-8). Complement activation products and tissue injury result in the induction of a systemic inflammatory response with the release of cytokines and chemokines, the upregulation of adhesion molecules, and the activation of leukocytes. The activation of a systemic proinflammatory state results in remote organ damage to which the lung is particularly susceptible (9-12).Many studies have utilized rodent models of intestinal IRI to investigate the underlying pathophysiological mechanisms of IRI and to test potential therapeutic strategies. The pathogenesis of IRI is complex, but a series of elegant studies have shown that preexisting clonally specific IgM antibodies bind to neoantigens exposed by the ischemic insult and, following reperfusion, activate