The role of complement and complement regulators in peripheral nerve and neuromuscular disorders

This thesis describes the evaluation of the role of Complement (C) and C regulators (CRegs) in experimental models of peripheral neuropathy and neuromuscular disease. Although a role for C in mediating peripheral neuropathy has previously been demonstrated in Guillain-Barre Syndrome (GBS) and its well characterised animal model Experimnetal Autoimmune Neuritis (EAN), evaluation of the role of individual components is lacking. C activation has also been widely implicated in the pathology seen in myasthenia gravis (MG) and its associated animal model Experimental Autoimmune Myasthenia Gravis (EAMG), although the precise effectors are uncertain. Evaluation of the extent of protection conferred by CRegs in the peripheral nervous system (PNS), and the ability of the myelin-producing Schwann cell to synthesize C components was a vital first step in determining the susceptibility of the system to C attack, and for providing a method of targeting key C-related molecules for further study in vivo. This work demonstrated that the PNS is well protected from membrane attack complex (MAC) attack, with high expression of the terminal pathway regulator, CD59. Crry was also highly expressed, while CD55 had a limited expression, suggesting a possible alternative role for this protein. CD46 was not expressed in the PNS. Testing the susceptibility of C and CReg deficient and knockout animals to induction of EAN and EAMG would enable further clarification of the role of individual C components to disease pathogenesis. For EAN, various antigens derived from myelin protein zero (PO) were generated to induce disease in rodents. Using this panel of antigens, specific, reproducible EAN was not achieved, and the possible reasons for this are discussed. C activation at the neuromuscular junction (NMJ) contributes to pathology in MG, although the precise role of the MAC is undear. EAMG was used to test the susceptibility of wikHype rats versus rats deficient in the terminal pathway component C6, to disease induction. Wildtype rats demonstrated severe weakness following induction of passively transferred EAMG, while C6 deficient rats were completely protected, demonstrated by protection against clinical disease, reduction in acetylcholine receptor (nAChR) loss, absence of inflammatory infiltrates and lack of C9 deposition. Reconstitution of human C6 to the C6 deficient rats resulted in increased disease. Soluble and fusion protein forms of CRegs, and a novel C5 inhibitor were also tested for their ability to abrogate disease in this model. Preliminary studies of EAMG induction in CReg knockout mice revealed that a lack of CD55 and CD59 markedly enhanced disease, although this remains to be confirmed. In conclusion, this work demonstrates: 1 The potential susceptibility of the PNS to C-mediated pathology 2 The difficulties in inducing EAN in rodents using published protocols 3 That MAC is the major drive to NMJ destruction in EAMG CRegs tested in EAMG hold promise for treatment of inflammatory disease, and analysis of the role of CRegs in EAMG in the mouse may shed new light on the precise effectors mediating disease pathogenesis

Prevention of experimental autoimmune myasthenia gravis by rat Crry-Ig: A model agent for long-term complement inhibition in vivo

Despite its vital role in innate immunity, complement is involved in a number of inflammatory pathologies and has therefore become a therapeutic target. Most agents generated for anti-complement therapy have short half-lives in plasma, or have been of mouse or human origin, thereby limiting their use either to murine models of disease or to short-term therapy. Here we describe the generation of a long-acting rat therapeutic agent based on the rat complement inhibitor, Crry. Characterisation of various soluble forms of Crry demonstrated that the amino-terminal four short-consensus repeat domains were required for full regulatory and C3b-binding activities. Fusion of these domains to rat IgG2a Fc generated an effective complement inhibitor (rCrry-Ig) with a circulating half-life prolonged from 7 min for Crry alone to 53 h for rCrry-Ig. Systemic administration of rCrry-Ig over 5 weeks generated a weak immune response to the recombinant agent, however this was predominantly IgM in nature and did not neutralise Crry function or cause clearance of the agent from plasma. Administration of rCrry-Ig completely abrogated clinical disease in a rat model of myasthenia gravis whereas soluble Crry lacking the immunoglobulin Fc domain caused a partial response. rCrry-Ig not only ablated clinical disease, but also prevented C3 and C9 deposition at the neuromuscular junction and inhibited cellular infiltration at this site. The long half-life and low immunogenicity of this agent will be useful for therapy in chronic models of inflammatory disease in the rat