{"doi":"10.3389/fcvm.2022.983617","title":"A decline of protective apolipoprotein J and complement factor H concomitant with increase in C5a 3 months after cardiac surgery—Evidence of long-term complement perturbations","abstract":"Background Heart surgery results in complement activation with the potential for collateral end-organ damage, especially if the protective elements (complement factor H, Apolipoprotein J) are inadequate. Here, we have investigated if peri-operative stress results in an imbalance between complement activation and its protective mechanisms up to 3 months after heart surgery. Methods 101 patients scheduled for non-emergent cardiac surgery donated blood before the procedure (t baseline ), and 24 h (t 24 h ), 7 days (t 7 d ) and 3 months (t 3 m ) after. Complement activation was measured as a serum level of soluble activated component 5 (sC5a) and soluble terminal complement complex (sTCC). Simultaneously, protective complement factor H (CfH), and apolipoprotein J (ApoJ) were measured. Inflammatory responses were quantified using C-reactive protein (CRP) and interleukin-6 (IL-6). Details regarding anesthesia, intensive care unit (ICU) stay, pre-existing conditions, the incidence of postoperative complications, and mortality were collected from medical records. Results C5a declined at t 24 h to rebound at t 7 d and t 3 m . sTCC was significantly depressed at t 24 h and returned to baseline at later time points. In contrast, CfH and ApoJ were depressed at t 3 m . Milieu of complement factors aligned along two longitudinal patterns:cluster#1 (C5a/sTTC continuously increasing and CfH/ApoJ preserved at t baseline ) and cluster#2 (transient sC5a/sTTC increase and progressive decline of CfH). Most patients belonged to cluster #1 at t 24 h (68%), t 7d (74%) and t 3m (72%). sTCC correlated with APACHE 1 h ( r 2 =−0.25; p < 0.031) and APACHE 24 h ( r 2 = 0.27; p < 0.049). IL-6 correlated with C5a ( r 2 =−0.28; p < 0.042) and sTTC ( r 2 =−0.28; p < 0.015). Peri-operative administration of acetaminophen and aspirin altered the complement elements. Prolonged hospital stay correlated with elevated C5a [ t (78) = 2.03; p = 0.048] and sTTC serum levels [ U (73) = 2.07; p = 0.037]. Patients with stroke had a decreased serum level of C5a at t 7d and t 3m . Conclusion There is a significant decrease in complement protective factors 3 months after cardiac surgery, while C5a seems to be slightly elevated, suggesting that cardiac surgery affects complement milieu long into recovery.","journal":"Frontiers in Cardiovascular Medicine","year":2022,"id":313791,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9538,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":890323,"name":"Da Liu","orcid":"0000-0003-3994-2786","position":1,"is_corresponding":false},{"id":937883,"name":"Damodar Gullipalli","orcid":"0000-0002-6226-0807","position":2,"is_corresponding":false},{"id":445823,"name":"Wen‐Chao Song","orcid":"0009-0004-1740-843X","position":3,"is_corresponding":false},{"id":688907,"name":"Tony Okeke","orcid":"0000-0002-4829-7726","position":4,"is_corresponding":false},{"id":881533,"name":"Wilson Y. Szeto","orcid":null,"position":5,"is_corresponding":false},{"id":688905,"name":"Krzysztof Laudański","orcid":"0000-0002-7373-0851","position":0,"is_corresponding":true}],"reference_count":40,"raw_metadata":null,"created_at":"2026-07-19T00:33:48.490749Z","pmid":"36606279","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}