1. Factor H preserves alternative complement function during ARDS linked to improved survival
- Author
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William Bain, Mohammadreza Tabary, Sara R. Moore, Xiaojing An, Georgios D. Kitsios, Bryan J. McVerry, Prabir Ray, Anuradha Ray, Rama K. Mallampalli, Viviana P. Ferreira, Janet S. Lee, and S. Mehdi Nouraie
- Subjects
Pulmonary and Respiratory Medicine - Abstract
BackgroundEffective regulation of complement activation may be crucial to preserving complement function during ARDS. Factor H (FH) is the primary negative regulator of the alternative pathway (AP) of complement. We hypothesized that preserved FH levels are associated with decreased complement activation and reduced mortality during ARDS.MethodsTotal AP function was measured by serum hemolytic assay (AH50) using available samples from the ARDSnet LARMA trial (N=218). Factor B (FB) and FH levels were quantified by ELISA using samples from the ARDSnet LARMA and SAILS (N=224) trials. Meta-analyses included previously quantified AH50, FB, and FH values from an observational registry (ALIR). Complement C3, and complement activation products C3a and Ba plasma levels were measured in SAILS.ResultsAH50>median was associated with reduced mortality in meta-analysis of LARMA and ALIR [hazard ratio (HR)=0.66, 95% confidence interval (CI) 0.45–0.96]. In contrast, patients in the lowest AH50 quartile demonstrated relative deficiency of both FB and FH. Relative deficiency of FB [HR 1.99, CI 1.44–2.75], or FH [HR 1.52, CI 1.09–2.11], were associated with increased mortality in meta-analysis of LARMA, SAILS, and ALIR. Relative FH deficiency was associated with increased factor consumption as evidenced by lower FB and C3 levels and higher Ba:FB and C3a:C3 ratios. Higher FH levels associated with lower inflammatory markers.ConclusionsRelative FH deficiency, higher Ba:FB and C3a:C3 ratios, and lower FB and C3 levels suggest a subset of ARDS with complement factor exhaustion, impaired AP function, and increased mortality that may be amenable to therapeutic targeting.
- Published
- 2023
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