Two-thirds of complement C3 glomerulopathy (C3G) recur after transplantation and commonly cause graft loss. There is not a standard treatment protocol for these cases. We present a kidney transplant patient with recurrent C3G who was successfully treated with eculizumab. Nephrotic proteinuria and hematuria occurred and creatinine levels increased after transplantation. A graft biopsy revealed recurrent C3G. The patient was administered 250 mg pulse methylprednisolone for 3 days and had 9 sessions of plasmapheresis. Since elevated creatinine levels and proteinuria persisted, eculizumab was instituted. A complete remission was observed after 9-month maintenance eculizumab treatment. Eculizumab may be a potentially effective option in kidney transplant patients with recurrent C3G unresponsive to other treatment modalities.

complement component 3 glomerulopathy (C3G) defines a group of newly classified disorders that is due to C3 deposition in glomeruli. Very few outbreaks of this disease have been reported in the world. In this study, a 56 year old woman is reported who had complaints of weakness, abdominal pain, and skin petechiae and purpura. Laboratory tests revealed mild anemia and high serum creatinine level. complementary studies were performed and the patient was suspected of having some form of vasculitis, especially PAN and Henoch Schonlein. Negative differential diagnosis of the most common reviews were obtained and due to lack of response to conventional therapy including corticosteroids and endoksan, kidney biopsy was done to detect the diagnosis. The patient was diagnosed with C3G. She had loss of consciousness, severe anemia, and rectorhalgia and transferred to Intensive Care Unit but died despite therapeutic efforts.

complement C3 glomerulopathy refers to a disease process in which abnormal control of complement activation or degradation results in predominant C3 fragment deposition within the glomerulus and causes glomerular damage. Abnormal control of the complement alternative pathway is a well-established risk factor for the occurrence of C3 glomerulonephritis. It is the first reported case in Iran with multiple mutations in complement factor H, with one of these mutations we have expected in hemolytic uremic syndrome rather than C3 glomerulopathy. Genetic analysis showed that the molecular abnormalities of factor H led to complement factor H malfunction that were polymorphous and not restricted to the C-terminal domains of the protein.

Background and Objectives: complement proteins are some of the most important plasma proteins of the innate immune system. Impaired immune function is reported in subjects who are iron deficient, and there are documents that these patients are prone to infection. This study was conducted to show whether serum C3 and C4 complement change in adult nonpregnant female with iron deficient anemia or not.Methods: Forty five normal subjects and 45 iron deficient anemia (hypochrom microcytic) cases were entered in this case and control study by using patients’ clinical history and also results of CBC, Serum ferritin, iron and total iron binding capacity. Serum C3, and C4 were measured in case and control subjects with nephlometry method, finally comparison between result of patients group and control group was done with using suitable statistical test.Results: Mean serum C3 and C4 in patient group was 1.28 ± 0.81 and 0.28 ± 0.23 g/L respectively and for control group was 1.39 ± 0.87 and 0.35 ± 0.25 g/L respectively. Although serum complements were slightly lower in patient groups in compared to control group but this differences was not meaningful with t test.Conclusion: This study showed serum C3 and C4 complements levels were not changed in iron deficiency anemia.

Candidiasis is a type of opportunistic fungal disease with some predisposing factors such as hematologic disorders (e.g. leukemia, lymphoma). Since the complement system plays a major role in its prevention, we investigated and compared the role of C3, C4 and the rate of hemolytic activity of CH5O in two groups: Case group consisted of patients having leukemia and lymphoma as well as candidiasis. Control group consisted of patients having leukernia and lymphoma but not candidiasis. The method of sensitization of sheep blood by embosebtor was employed to assess the rate of activity of the complement, and the mean of C3 and C4 was measured by immunodiffusion method. T-test was used for comparison of the two groups. There was a significant decrease in the mean of C3 complement and CH50 in the case group compared to those of the control group (p<0.05). But there was no significant difference in the mean of C4 between two groups. Therefore a decrease of C3 and CH50 may play a role in producing candidiasis along with leukemia and lymphoma.

Extended AbstractBackground and Aim: There is evidence that components of the innate immune system, particularly the complement system, play a role in multiple sclerosis (MS) (1, 2). The complement system, a key element of innate immunity (1), consists of blood proteins involved in inflammation and host defense. C3 and C4 are potential diagnostic markers for autoimmune inflammatory demyelinating diseases of the central nervous system (CNS). Their activation is central to the complement system and contributes to neurodegeneration in MS (4, 7). Studies have shown that plasma levels of C3 and C4 are elevated in MS patients compared to healthy controls (2). In addition to pharmacological treatments, lifestyle modifications, such as physical activity, can effectively modulate the complement system without adverse effects. Therefore, the aim of this study was to investigate the effects of combined physical C3 and C4, the C3/C4 ratio and motor function in women with multiple sclerosis.Materials and Methods: The present study employed a pretest-posttest design involving 30 patients aged 30 to 40 years who were diagnosed with multiple sclerosis (MS) according to the McDonald 2010 criteria. Participants were randomly assigned to two groups: an experimental group (n=15) that participated in an exercise program and a control group (n=15) that went about their normal daily activities. The inclusion criteria required an Expanded Disability Status Scale (EDSS) score of less than five, as determined by a neurological examination by a physician (20). Participants had to be able to move independently and voluntarily consent to participate in the study. Exclusion criteria included inflammatory conditions such as metabolic syndrome, cardiovascular problems (including hypertension), kidney problems, asthma, potential neuropathic pain in the lower extremities, severe cognitive impairment, visual impairment, drug dependence (alcohol or smoking), comorbidities that could interfere with participation, recent MS relapses within the last eight weeks, pregnancy or regular exercise in the last six months (21). Blood samples and motor function assessments were taken 72 hours before and after the training protocol in a fasting state. C3 and C4 levels were measured using the turbidometry method. Motor function was assessed with the timed up and test (TUG) and the balance test (FTSST). The exercises protocol followed the American College of Sports Medicine (ACSM) guidelines for patients with MS (26). The program lasted 12 weeks, with sessions taking place three days a week and lasting approximately one hour each. It included: a) aerobic exercise at 40-60% of maximum heart rate (MHR), b) resistance exercises with a yellow band consisting of three sets of eight to fifteen repetitions, c) balance exercises in standing and dynamic positions, and d) seated stretching exercises with controlled breathing, based on methods from previous studies. The data were analyzed using analysis of covariance with the significance level of p<0.05.Findings: At baseline, an independent t-test showed that the initial characteristics of weight (experimental group: 65.41±11.70 kg; control group: 58.58±12.68 kg; p=0.72) and MS history (experimental group: 51.75±3.30 years; control group: 21.83±6.30 years; p=0.66) were similar in both groups. After 12 weeks of combined training, the experimental group showed a significant reduction in serum levels of complement C3 compared to the control group (p=0.01). However, there were no significant differences between the groups in complement C4 levels or the C3/C4 ratio (p>0.05). In addition, the experimental group showed significant improvements in motor performance, (fall risk and balance), as well as a significant reduction in walking times compared to the control group (p<0.05) (Table 1).Conclusion: The current evidence on the effects of exercise on complement components C3 and C4 in individuals with MS remains limited and somewhat conflicting. One review found that the C3 and C4 family proteins are the best studied. complement proteins were found to be transiently activated immediately after acute exercise and remain elevated for up to 72 hours after strength training and ultra-endurance running. Conversely, prolonged exercise and higher cardiorespiratory fitness levels are associated with a decrease in C3 family proteins (32). The response of complement proteins depends on the type of exercise. Endurance exercise tends to decrease C3 and increase C4, while anaerobic (fast) exercise reduces C4(12). The observed decrease in C3 following combined training may be due to a reduction in inflammatory mediators that activate the complement cascade. Combined training (strength and endurance training) has been shown to improve motor function and reduce inflammation in women with MS (36). In contrast to acute exercise, exercise reduces inflammatory proteins that activate the complement system, such as C-reactive protein (CRP), as well as cells such as monocytes that secrete these proteins (32). In this study, combined exercises were more effective in improving balance. Conversely, in studies that did not show significant improvements in balance, balance exercises alone were found to be insufficient (30). As for the effects of breathing exercises on the immune system, research in psychoneuroimmunology suggests that these exercises may alter immune markers and promote health by modulating the adrenocorticotropin-cortisol immune pathway (40). Overall, the combination of resistance, aerobic, balance, and breathing exercises appears to enhance both immunological and functional outcomes in individuals with MS. These findings support the recommendation of such multifaceted exercise programs as a beneficial non-pharmacological intervention for this population.Ethical considerations: Before starting the protocol, a consent form was signed by the subjects and an ethics ID number IR.AZARUNIV.REC.1402.014 was obtained.Conflict of interest: There are no conflicts of interest.

Introduction: Fasting during Ramadan can be useful for healthy person. Ramadan fasting has spiritual, physical, psychological, and social benefits. The extensive studies about low calorie diet effects on rodents have shown that its profound effect is on longevity and safety of immune system development. Since a basic aspect of fasting that forbids eating from dawn to dusk can cause low calorie intake and due to the relationship between the immune system and central nerves, endocrine glands and its interference pathogeneses of most diseases, we decided to study the effects of Ramadan fasting on some parameters of immune system on complement components of C3 and C4, which are the major components of complement activity in classic pathway in innate immune response. Material and methods: In this study, fifty normal and healthy male and female students aged 20-25 were selected, blood samples were obtained and analyzed for immunological studies such as C3 and C4 in the method of SRID and CH50 test in the method of veronal in two different occasion, the fourth week of Ramadan and one month later.Findings: Comparing the results of the fourth week and one month after Ramadan, using paired t-test, it was known that fasting had no effect on C3 and C4 concentration and CH50 activity and there was no significant change in the above factors either.Conclusion: According to the results, it seems that Ramadan fasting has no effect on increasing innate immunity including components.

Introduction: Recurrent miscarriage is the most common pregnancy problem and is often defined as two or more recurrent miscarriages before the twentieth week of pregnancy. The complement system with the mechanism of lysis of bacteria and extracellular pathogens focuses on the elimination of these foreign agents and can be effective in regulating normal pregnancy and preserving or rejecting the semiallogeneic fetus. The aim of this study was the evaluation of the function of the complement system and the levels of C3 and C4 in patients with recurrent miscarriage. Material & Methods: In this case-control study, two groups were referred to Sarem women's Hospital in Tehran during the period of 2020 to 2021. The referred patients were 77 females with a history of at least three recurrent spontaneous abortions as the case group and 37 healthy women without a history of abortion with at least one live child as the control group. Patients were evaluated for karyotype, anti-phospholipid antibody, anti-cardiolipin, ANA, anti-thyroid antibody, recurrent abortion-related infections, anatomical abnormalities, and hormonal disorders. To measure the activity of the complement system, CH50 test was performed using SRID method and the levels of C3 and C4 were detected by nephelometry method. The measured values were analyzed by SPSS software version 22. Results: The present study showed that the levels of complement proteins, C3 and C4, were significantly reduced in women with recurrent miscarriage compared to the control group. Also, the comparison of complement activity in these two groups showed less serum complement activity in patients with a history of recurrent miscarriage. Conclusion: Considering the possible involvement of complement proteins in recurrent spontaneous abortion, examining the level of major complement proteins such as C3 and C4 and measurement of the serum complement activity of these patients can be useful in diagnosing abortions due to immunological causes.

Introduction: lichen planus and lichenoid reactions are cutaneous-mocusal lesions that their prevalence is higher among adult and women. The mentioned diseases are not distinguishable from their clinical and histological features. Although, the etiology for lichen planus lesions is not determined, there are many different etiological reasons for lichenoid lesions. Both mentioned lesions are in immunological group. The main goal of this research was to determine the amount of complement components such as (C3, C4) as a criterion for distinguishing these two lesions.Materials & Methods: The method of this research was descriptive and analytic. The research population were included the patients who referred to one of the expertise clinic of oral, facial and Jaw in Isfahan city. The statistical samples were included 2 groups of 25 patients who had lichen planus or lichenoid reactions lesions.10cc of serum was taken from two groups of patients and measured their C3 and C4.Results: The results of this study indicated that the mean of C3 in the lichen planus group was 1.270 while in the oral lichenoid reactions was 1.332. Examining differences between means of two groups, t-test indicated that the mean of C3 between two groups did not have significant differences (P=0.31). The mean of C4 in the lichen planus group was 0.285 and in the lichenoid reactions group was 0.328. t -test indicated that the mean of C4 two groups did not have any significant differences (P=0.31). In other words, there was not any relation between C3, C4 and the kind of diseases (lichen planus and lichenoid reactions).Conclusion: results indicated, there were not differences among two groups of patients in terms of their rate of C3 and C4. Therefore, measuring C3 and C4 could not be used as a precise criterion for distinguishing these mentioned diseases. For this reason, we should use other immunologic criteria for distinguishing between these two groups of lesions. For determining the diagnosis and distinguishing criteria, more research should be done with different groups and in different phases of disease such as exacerbation and remission phases.

The purpose of this study was to consider the effect of a 6-week camp preparation on a few pro-inflammatory acute phase proteins (complement C3, C4) in young professional karate ka. For this purpose, 10 professional karate athletes (mean+SD weight 68±5 kg; age 20.8±2 years; height 175±4 cm and body fat 7.6±2%) were invited to the camp. Blood samples were gathered 24 hours before the camp began (Time 1), at the end of the third week (T2) and the end of the sixth week (T3). Data were analyzed by one-way repeated measures analysis of variance (ANOVA) and a Tukey post hoc test. Results showed that C3 concentration was located within the normal domain at the three stages. C3 concentration decreased during the first 3 weeks (2.56%) and returned to the normal domain during the second 3 weeks (T3), however, the variations were non-significant (P=0.712). Before the camp began, C4 concentration was within the normal domain, significantly increased after 3 weeks of camp attending (18%) and at the end of the camp, it returned to the normal domain (P=0.02). Finally, the results of this study suggested that 6 weeks of camp preparation changes the parameters of complement system (C3, C4). The results seem to be questionable in relation to the type and intensity of karate training in the camp, so further studies are necessary to discover more facts about them.