Temporal accrual of complement proteins in amyloid plaques in Down's syndrome with Alzheimer's disease

Am J Pathol. 2000 Feb;156(2):489-99. doi: 10.1016/S0002-9440(10)64753-0.


The complement system constitutes a series of enzymatic steps involved in the inflammatory response and is activated in Alzheimer's disease (AD). Using Down's syndrome (DS) brains as a temporal model for the progression of AD, we examined components of the complement cascade and their relationship to other principal events in AD pathology: Abeta42 deposition, neuritic changes, neurofibrillary tangles (NFTs), and gliosis (reactive astrocytes, activated microglia). Adjacent sections of frontal cortex from 24 DS subjects ranging in age from 12 to 73 years were immunohistochemically examined for immunoreactivity (IR) of classical complement proteins (Clq and C3), markers indicating activation of complement (C4d and C5b-9), the complement inhibitor apolipoprotein J (apo J), and markers of AD neuropathology. Abeta42-labeled diffuse plaques were first detected in a 12-year-old DS subject and were not labeled by any of the complement antibodies. Colocalization of Abeta42 with Clq, C3, C4d, and/or apo J was first detected in compacted plaques in the brain of a 15-year-old DS patient with features of mature AD pathology, such as reactive astrocytes, activated microglia, dystrophic neurites, and a few NFTs. IR for C4d and C5b-9 (membrane attack complex, MAC) was observed in small numbers of plaque-associated dystrophic neurites and in focal regions of pyramidal neurons in this 15-year-old. The only other young (</=30 years) DS brain to show extensive complement IR was that of a 29-year-old DS subject who also displayed the full range of AD neuropathological features. All middle-aged and old DS brains showed IR for Clq and C3, primarily in compacted plaques. In these cases, C4d IR was found in a subset of Abeta42 plaques and, along with C5b-9 IR, was localized to dystrophic neurites in a subset of neuritic plaques, neurons, and some NFTs. Our data suggest that in AD and DS, the classical complement cascade is activated after compaction of Abeta42 deposits and, in some instances, can progress to the local neuronal expression of the MAC as a response to Abeta plaque maturation.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Alzheimer Disease / complications*
  • Alzheimer Disease / metabolism*
  • Alzheimer Disease / pathology
  • Brain / metabolism
  • Brain / pathology
  • Child
  • Clusterin
  • Complement C4 / metabolism
  • Complement C4b*
  • Complement Membrane Attack Complex / metabolism
  • Complement System Proteins / metabolism*
  • Disease Progression
  • Down Syndrome / complications*
  • Down Syndrome / metabolism*
  • Down Syndrome / pathology
  • Glycoproteins / metabolism
  • Humans
  • Middle Aged
  • Molecular Chaperones*
  • Peptide Fragments / metabolism
  • Plaque, Amyloid / metabolism*
  • Time Factors


  • CLU protein, human
  • Clusterin
  • Complement C4
  • Complement Membrane Attack Complex
  • Glycoproteins
  • Molecular Chaperones
  • Peptide Fragments
  • Complement C4b
  • complement C4d
  • Complement System Proteins