Complement factor H supplementation rather than complete C3 knockout provides therapeutic benefits in IgA nephropathy

Abstract IgA nephropathy (IgAN), the most common primary glomerulonephritis worldwide, is characterized by mesangial IgA deposition, which triggers complement activation, primarily through the alternative pathway. While complement dysregulation contributes to kidney injury and adverse outcomes, complement may also facilitate clearance of pathogenic immune complexes. Here, we compared complete complement component 3 (C3) deficiency with supplementation of complement factor H (Cfh), the principal regulator of alternative pathway, in murine IgAN models. C3 deficiency prevented complement activation but paradoxically increased glomerular IgA deposition and macrophage infiltration, resulting in complicated inflammatory response. In contrast, Cfh supplementation reduced glomerular IgA and C3 deposition, decreased inflammatory cytokine expression, attenuated macrophage infiltration, lessened glomerular area and ameliorated proteinuria while enhancing macrophage-mediated phagocytosis of circulating IgA immune complexes. Accordingly, IgAN patients with higher plasma CFH levels exhibited reduced mesangial IgA and C3 deposition alongside elevated circulating C3 levels, supporting CFH’s protective role in regulating complement activation and promoting immune complex clearance. Our results reveal complement’s dual role in IgAN: promoting inflammatory kidney injury while facilitating clearance of pathogenic IgA deposits. Targeted complement regulation via complement factor H supplementation, rather than complete complement inhibition via global complement component 3 knockout, achieves superior therapeutic effects by simultaneously controlling complement activation, enhancing immune complex clearance, suppressing inflammation, and reducing proteinuria. These findings identify complement factor H as a novel and promising therapeutic strategy for IgA nephropathy through targeted complement regulation.