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The complement system in intestinal inflammation and cancer
Carsten Krieg, Silvia Guglietta
Carsten Krieg, Silvia Guglietta
Published October 1, 2025
Citation Information: J Clin Invest. 2025;135(19):e188348. https://doi.org/10.1172/JCI188348.
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Review Series

The complement system in intestinal inflammation and cancer

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Abstract

The complement system has emerged as a critical regulator of intestinal homeostasis, inflammation, and cancer. In this Review, we explore the multifaceted roles of complement in the gastrointestinal tract, highlighting its canonical and noncanonical functions across intestinal epithelial and immune cells. Under homeostatic conditions, intestinal cells produce complement that maintains barrier integrity and modulates local immune responses, but complement dysregulation contributes to intestinal inflammation and promotes colon cancer. We discuss recent clinical and preclinical studies to provide a cohesive overview of how complement-mediated modulation of immune and nonimmune cell functions can protect or exacerbate inflammation and colon cancer development. The complement system plays a dual role in the intestine, with certain components supporting tissue protection and repair and others exacerbating inflammation. Intriguingly, distinct complement pathways modulate colon cancer progression and response to therapy, with novel findings suggesting that the C3a/C3aR axis constrains early tumor development but may limit antitumor immunity. The recent discovery of intracellular complement activation and tissue-specific complement remains vastly underexplored in the context of intestinal inflammation and colon cancer. Collectively, complement functions are context- and cell-type-dependent, acting both as a shield and a sword in intestinal diseases. Future studies dissecting the temporal and spatial dynamics of complement are essential for leveraging its potential as a biomarker and therapeutic in colon cancer.

Authors

Carsten Krieg, Silvia Guglietta

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Figure 1

The composition of the intestinal barrier.

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The composition of the intestinal barrier.
The intestinal mucus creates ...
The intestinal mucus creates a physical and chemical barrier that prevents direct contact between the luminal microbiota and the intestinal epithelium. Along the small intestine (SI), the mucus layer is relatively porous to different bacteria and thin. The colon (C) is equipped with a double mucus layer: the outer layer is relatively penetrable to bacteria; the inner layer is highly impenetrable to the microbiome (120–123). The intestinal epithelium comprises a single layer of heterogenous and highly specialized cell subtypes arising from common stem cell progenitors (Lgr5+ cells) at the bottom of the crypts. Intestinal epithelial cells (IECs) are tightly held together via strong cell adhesion proteins, forming a physical barrier that separates the contents of the intestinal lumen from the underlying lamina propria (124). Along with providing a physical barrier, cells within the intestinal epithelium produce and secrete molecules that help maintain intestinal homeostasis via a chemical barrier (124). Enterocytes (SI) and colonocytes (C) are the most abundant IECs. These cells recognize pathogen-associated molecular patterns via TLRs and NLRs (125–128). Enterocytes also express polymeric IgA receptors (pIgR) basolaterally, limiting intestinal permeability and susceptibility to intestinal inflammation and infections. Additional IEC types are goblet cells, which are responsible for the formation of the mucus layer through secretion of Muc2 mucin as well as other proteins; Paneth cells, which are found in the base of crypts within the SI that secrete antimicrobial peptides (AMP); tuft cells, which provide defense against helminth infections; and enteroendocrine cells, which secrete hormones. Intraepithelial lymphocytes (IELs) such as CD8+ T and γδ T cells are also found in the intestinal epithelium. Most immune cells are located in the lamina propria underneath the epithelial layer and in the gut-associated lymphoid tissues, which represent the key antigen sampling and adaptive immune inductive sites within the intestinal wall.

Copyright © 2025 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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