title: Inhibition of biomaterial-induced complement activation attenuates the inflammatory host response to implantation.
abstract: Although complement is a known contributor to biomaterial-induced complications, pathological implications and therapeutic options remain to be explored. Here we investigated the involvement of complement in the inflammatory response to polypropylene meshes commonly used for hernia repair. In vitro assays revealed deposition of complement activation fragments on the mesh after incubation in plasma. Moreover, significant mesh-induced complement and granulocyte activation was observed in plasma and leukocyte preparations, respectively. Pretreatment of plasma with the complement inhibitor compstatin reduced opsonization >2-fold, and compstatin and a C5a receptor antagonist (C5aRa) impaired granulocyte activation by 50 and 67%, respectively. We established a clinically relevant mouse model of implantation and could confirm deposition of C3 activation fragments on mesh implants in vivo using immunofluorescence. In meshes extracted after subcutaneous or peritoneal implantation, the amount of immune cell infiltrate in mice deficient in key complement components (C3, C5aR), or treated with C5aRa, was approximately half of that observed in wild-type littermates or mice treated with inactive C5aRa, respectively. Our data suggest that implantation of a widely used surgical mesh triggers the formation of an inflammatory cell microenvironment at the implant site through complement activation, and indicates a path for the therapeutic modulation of implant-related complications.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Pennsylvania, 422 Curie Blvd., Philadelphia, PA 19104, USA.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kourtzelis
authors.forename: Stavros
authors.initials: S
authors.lastname: Rafail
authors.forename: Robert A
authors.initials: RA
authors.lastname: DeAngelis
authors.forename: Periklis G
authors.initials: PG
authors.lastname: Foukas
authors.forename: Daniel
authors.initials: D
authors.lastname: Ricklin
authors.forename: John D
authors.initials: JD
authors.lastname: Lambris
mesh_terms: D000818:Animals; D001672:Biocompatible Materials / Q000494:pharmacology*; D039481:CD11b Antigen / Q000378:metabolism; D003167:Complement Activation / Q000187:drug effects*; D003176:Complement C3 / Q000235:genetics / Q000378:metabolism; D005434:Flow Cytometry; D006098:Granulocytes / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D020007:Implants, Experimental / Q000009:adverse effects; D007249:Inflammation / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D051379:Mice; D008810:Mice, Inbred C57BL; D018345:Mice, Knockout; D008856:Microscopy, Fluorescence; D009895:Opsonin Proteins / Q000378:metabolism; D010456:Peptides, Cyclic / Q000494:pharmacology; D011126:Polypropylenes / Q000494:pharmacology*; D044087:Receptor, Anaphylatoxin C5a / Q000235:genetics / Q000378:metabolism; D019707:Receptors, Chemokine / Q000378:metabolism
chemical_list: D001672:Biocompatible Materials; D039481:CD11b Antigen; D003176:Complement C3; C503133:Gr-1 protein, mouse; D009895:Opsonin Proteins; D010456:Peptides, Cyclic; D011126:Polypropylenes; D044087:Receptor, Anaphylatoxin C5a; D019707:Receptors, Chemokine; C111828:compstatin
keywords: C3; C5a anaphylatoxin; compstatin; immune cells; polypropylene
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