In vivo complement activation by polyanion--polycation complexes: evidence that C5a is generated intravascularly during heparin--protamine interaction.

In vitro studies have established the complement-activating potency of polyanion-polycation interaction. By transferring the heparin-protamine model to an animal (rabbit) system that picks up ongoing intravascular complement activation by documenting acute granulocytopenia due to margination, evidence that intravascular polyanion-polycation complexing leads to instantaneous activation of the C system in vivo that goes beyond C1, C4, and C2, and results in generation of biologically highly reactive products, such as C5a, is provided. Dependence of the phenomenon on an activable complement system is documented by its complete abolishment when animals were complement depleted by cobra venom factor administration. Therefore, activation of the complement system may play a causative role for untoward effects following heparin neutralization by protamine under clinical conditions. Furthermore, these studies suggest an in vivo role of nonimmune generation of inflammatory mediators by interaction of naturally occurring polyions.