Abstract
Immunopathological events in acute appendicitis are poorly understood. It is well known that activation of the complement system plays an important role in mediating inflammatory reactions. Using monoclonal and polyclonal antisera we have investigated the role of complement activation in the pathophysiology of appendicitis in children. Frozen and paraffin embedded tissue specimens were examined immunohistochemically with anti C3, C4, Factor B and a monoclonal antibody (AE11) to a neoantigen on C9 in 20 inflamed suppurative appendices, 6 gangrenous appendicies, 8 perforated appendices and 10 normal appendices. Deposits of C9 of the terminal complement complex (TCC) were uniquely present at subendothelial sites in submucosal arteries in inflamed appendices. In addition complement activation products were present in germinal centres of 72% of inflamed appendices. A strong correlation was seen between the number of C9 positive arterioles and clinical degree of disease activity based on histology (p<0.01). These results indicate a previously unrecognised important role of complement activation in the pathogenesis of appendicitis.
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