KOMPLEMENTTI C3, C4 BORRELIOOSIN DIAGNOSTIIKASSA

[Bb]

Lähettäjä: Soijuv Lähetetty: 28.4.2005 9:38

Shoemaker ym. ovat huomanneet että edellämainittujen proteiinien määrä nousee esim. homesairauksissa. He tutkivat parhaillaan käykö samoin borrelioosiin sairastuneiden kohdalla. He ovat huomanneet aiemmin 12 akuuttia borrelioosia sairastaneen potilaan kohdalla 10 x C3 ja C4 pitoisuuksia. Hoitamattomilla kroonista borrelioosia sairastavilla C4 on ollut koholla, mutta palautunut normaaliksi antibioottihoitojen jälkeen.
Shoemaker ehdottaa akuuttiin borrelioosiin sairastuvia kontrolloimaan C3- ja C4-tasot viimeistään 3 pv puremasta. Antibioottihoitoa tulisi jatkaa niin kauan kuin tasot ovat korkealla.

"C3 ja C4 kuuluvat ns. akuutin faasin proteiineihin, joiden tuotanto lisääntyy tulehduksessa. Määrityksiä käytetään immunokompleksin aiheuttamien tilojen toteamiseen ja hoidon tehon seurantaan sekä komplementtien puutoksen ja lisääntyneen infektioalttiuden selvittelyyn.

http://www.epshp.fi/labnet/ohjekirj/k.h ... %20JA%20C4

Komplementin puutostilaa voi epäillä jos potilaalla on toistuvia infektioita tai hänellä esiintyy autoimmuunisairauksiin liittyviä vaskuliitteja tai yliherkkyysreaktioita."


Shoemaker

"We are preparing a paper on the diagnostic benefits of measuring the activated piece of the third element of complement (C3a) in acute Lyme disease. This protein rises rapidly (less than 4 hours) in acute exposure of HLA susceptible patients to indoor molds, so we wondered if acute Lyme also gave us C3a increases. Of interest, in our 12 patients with acute Lyme from last year, as shown by a ECM rash, seen within two days, all had C3a levels that were quite high, usually 10X greater than control levels. MMP9 blew up in about 75% and VCS was positive in 80%. None of the patients, matched by age and gender with tick bites but no rash and no obvious illness had a blip in C3a. Non-bite controls also had no change in C3a. Because of the role of C3a in both the alternative pathway of complement and the classical pathway, we looked at signs of activation of properdin factor B, finding increased levels of its breakdown product as well, implicating activation of the alternative pathway. Toxin patients usually have activation of C3a, without evidence of activation of the classical pathway.

A marker for activation of the classical pathway, C4a, isn't elevated in non-Lyme toxin patients. Yet in our cohort of acute Lyme, C4a was elevated at 10X control levels. We are looking at patients with a diagnosis of Lyme that isn't supported clinically, and find normal C4a. In our long-term Lyme patients where the diagnosis is secure and antibiotics aren't on board, C4a is high, with conversion to normal after antibiotics. As a general rule, classical pathway requires antigen and antibody, with LPS functioning as an activator, while alternative involves antigen only.

In non-15-6-51 HLA DR genotype Lyme patients, C3a does not show up high, but in 15-6-51 patients, the levels are quite high. Hopefully, we will be able to show that using C4a and C3a can help us predict which Lyme patients have ongoing living organisms requiring antibiotics and which don't, as well as figuring out which Lyme patients have a biotoxin illness.

Quest Baltimore will send the frozen plasma for the complement studies to National Jewish in Denver where Dr. Giclas' lab is running the assays for us. The specimens need to be spun almost immediately-don't wait 15 minutes for the plasma to sit on the lab counter while the tech is doing something else.

We are now working with cultures of Borrelia and will try to establish a mouse model of illness examined from a complement point of view.

For now, my suggestion for all tick bite patients is to grab a C3a and a C4a within 3 days of of bite and treat with antibiotics until the levels come back. Repeat the levels to attempt to assess whether or not the inflammatory response from the innate immune system is abated or not.

Ritch Shoemaker MD