The complement system is crucial for defence against pathogens, removal of unwanted materials such as dying cells or immune complexes as well as for development of adaptive immune responses. Genetically determined deficiencies of components of the complement system are usually relatively rare but they result in many severe diseases such as an increased susceptibility to recurrent, severe infections, autoimmune disorders (systemic lupus erythematosus), glomerulonephritis including membranoproliferative glomerulonephritis type II, paroxysmal nocturnal haemoglobinuria or angioedema. Recently, mutations and polymorphisms in complement proteins, particularly complement inhibitors, have been associated with atypical haemolytic uremic syndrome and age‐related macular degeneration. The elucidation of the pathophysiological basis for the different clinical presentations of complement‐deficient individuals has contributed to a better understanding of the physiological role of complement in normal individuals as well as to the development of emerging therapies.
Key Concepts
The majority of complement deficiencies are rare but cause severe diseases.
Deficiencies of the early components of the classical pathway (C1q/r/s, C4, C2) predispose to systemic lupus erythematosus.
The majority of complement deficiencies predispose to infections either with
Neisseria
species (deficiency of Factor D, Properdin, C5, C6, C7, C8, C9) or Gram‐positive bacteria (C1q/r/s, mannose‐binding lectin, C2, C4, C3, factor I).
Mutations in C1q/r/s, C2, C4, C3 and factor I can cause glomerulonephritis.
Paroxysmal nocturnal haemoglobinuria is caused by deficiency of complement inhibitors CD55 and CD59.
Hereditary angioedema is found in patients with dysfunctional C1‐inhibitor.
Atypical haemolytic uremic syndrome is mainly associated with mutations and polymorphisms in complement inhibitors.
Age‐related macular degeneration is associated with polymorphisms in complement inhibitor factor H.