Synapses are well known as the main structures responsible for transmitting information
through the release and recognition of neurotransmitters by pre- and post-synaptic neurons. These
structures are widely formed and eliminated throughout the whole lifespan via processes termed
synaptogenesis and synaptic pruning, respectively. Whilst the first process is needed for ensuring
proper connectivity between brain regions and also with the periphery, the second phenomenon is
important for their refinement by eliminating weaker and unnecessary synapses and, at the same
time, maintaining and favoring the stronger ones, thus ensuring proper synaptic transmission. It is
well-known that synaptic elimination is modulated by neuronal activity. However, only recently the
role of the classical complement cascade in promoting this phenomenon has been demonstrated.
Specifically, microglial cells recognize activated complement component 3 (C3) bound to synapses
targeted for elimination, triggering their engulfment. As this is a highly relevant process for adequate
neuronal functioning, disruptions or exacerbations in synaptic pruning could lead to severe
circuitry alterations that could underlie neuropathological alterations typical of neurological and
neuropsychiatric disorders. In this review, we focus on discussing the possible involvement of excessive
synaptic elimination in Alzheimer’s disease, as it has already been reported dendritic spine
loss in post-synaptic neurons, increased association of complement proteins with its synapses and,
hence, augmented microglia-mediated pruning in animal models of this disorder. In addition, we
briefly discuss how this phenomenon could be related to other neurological disorders, including
multiple sclerosis and schizophrenia.