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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 2

Complement activation and regulation.

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Complement activation and regulation.
Binding of C1q to IgG or IgM antib...
Binding of C1q to IgG or IgM antibody–opsonized pathogens or altered host cells initiates the classical pathway, whereas binding of MBL to sugar motifs on the surface of bacteria initiates the lectin pathway. The alternative pathway is initiated via spontaneous cleavage of the complement protein C3 into C3a and C3b. All three pathways converge onto the complement protein C3, which is cleaved into C3a and C3b by the C3 convertases (C4b2a and C3bCBb). The generation of C3 convertases amplifies the complement cascade through continued cleavage of C3. C3b opsonizes microbes and targets them for destruction by phagocytes. C3b combines with other complement proteins to generate the C5 convertases (C4b2a3b and C3bBb3b), which cleave C5 into C5a and C5b (14, 129). C3a and C5a are complement anaphylatoxins that bind to their respective cell surface receptors, C3aR and C5aR, and promote migration to and activation of immune cells at sites of infection or damage (130, 131). C5b binds to complement proteins C6, C7, C8, and C9 to generate the MAC, which forms a pore in the cell membrane and induces lysis of bacterial or complement-targeted host cells (11). CD55 is a membrane-bound complement regulator that disassembles C3 and C5 convertases to prevent amplification of the cascade and the generation of the MAC (12). CD46, also known as membrane cofactor protein (MCP), works with serum factor I to prevent C3 convertase reassembly and amplification of the cascade. CD46 functions are well characterized in humans but a functional mouse homolog has not yet been identified (132). CD59 is a complement regulator that blocks MAC formation. The complement regulator CR1, which exists in a soluble (sCR1) and membrane-bound form, acts as a receptor for C3b and C4b, thereby destabilizing and enhancing decay of the classical and alternative pathway C3 and C5 convertases (133).

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

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