• antiphospholipid antibodies;
  • antiphospholipid syndrome;
  • complement activation;
  • endothelial cells;
  • thrombosis

Abstract: Recent findings indicate that complement activation—involving specifically C3 and C5—contributes to antiphospholipid (aPL)-mediated thrombosis. Two complement effector pathways are initiated by the cleavage of C5, C5a and C5b, which leads to the formation of the C5b-9 membrane attack complex. To delineate and distinguish the role of C5a from the C5b-9 membrane attack complex seeded by C5b, we examined the in vivo effects (thrombosis) of aPL on C5a receptor-deficient (C5aR−/−) mice. C5aR−/− and C5aR+/+ mice were injected with IgM or with IgG from two different patients with APS (IgM-APS or IgG-APS) or with control IgM or IgG (IgM-NHS or IgG-NHS) twice. Complement fixing activity of the Ig fractions and anticardiolipin activity in the sera of the mice were determined by enzyme-linked immunosorbent assay. Surgical procedures to study thrombus dynamics were performed. IgM-APS but not IgG-APS fixed C1q to cardiolipin-coated plates. IgM-APS significantly enhanced thrombus size in C5aR+/+ mice compared to C5aR+/+ mice treated with IgM-NHS (3198 ± 2361 μm2 versus 585 ± 460 μm2). C5aR−/− mice treated with IgM-APS showed a significant reduction in thrombi size as compared with C5aR+/+ mice (676 ± 690 μm2 versus 3198 ± 2361 μm2; P= 0.001). IgG-APS enhanced thrombus formation significantly in C5aR+/+ when compared to IgG-NHS-treated mice (3507 ± 965 μm2 versus 1321 ± 798 μm2), and these effects were not altered in C5aR−/− mice (3400 ± 1681 μm2). The data indicate that C5aR−/− mice are protected from the thrombogenic effects of some aPL antibodies.