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The Human Complement System in Health and Disease.
  1. Complement Biology Group, University of Wales College of Medicine, Cardiff

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    The Human Complement System in Health and Disease.Edited by John E Volanakis and Michael M Frank. (Pp 656; $225). New York: Marcel Decker, 1998. ISBN 0-8247-9898-8.

    The complement system is a key factor in host defence against infection and also plays important parts in many other biological systems, notably immune complex handling and the generation of an immune response. Complement has also been implicated as a pathogenic factor in many inflammatory and infectious diseases. Despite these numerous physiological and pathological roles, complement, the dreaded “C-word”, remains unloved by most students of immunology and medicine. Perhaps the major problem limiting the appeal of complement is the archaic and illogical terminology that characterises the field, remnants of the historical roots of discovery of complement. Those “in the know” realise that the terminology is a minor inconvenience; the problem lies in convincing those outsiders that complement is worth the effort. Perhaps a renaissance of interest in complement is now beginning. Recent advances towards the development of specific inhibitors of complement have provoked interest from clinicians in many fields and the role of complement in causing hyperacute rejection of xenografts has prompted discussion of the “C-word” in popular magazines and news reports. Several new books on different aspects of complement have appeared in the past year or two. The volume reviewed here is by far the biggest and most expensive of these!

    John Volanakis and Michael Frank, two of the most respected figures in complement, have undertaken the monumental task of editing a volume that seeks to comprehensively review all aspects of complement biology. This they have done superbly well. The volume could well have been titled Everything you ever wanted to know about complement but were afraid to ask. Twenty eight chapters from 44 contributors provide a thorough synthesis of the current state of complement biology. There is a decidedly American look about the list of contributors, with just a few from Europe and a single contribution from Japan. An understandable bias but one that does not fairly reflect the strengths of complement research outside the USA.

    The book is divided into three major sections. The first describes the “nuts and bolts” of complement, the proteins, regulators and receptors that make up the system. The second describes the biology of the complement system, its roles in the handling of pathogens, cell activation, development of the immune response and in reproduction. The third section describes the role of complement in disease, including immune complex disease, renal diseases, and diseases of the nervous system. The contributions in this section should be required reading for all clinicians interested in immunologically mediated diseases, in particular the excellent chapter on the development of new anti-complement agents for treatment. The quality and quantity of illustrations is rather variable; in general a rather poor feature considering the overall quality of the volume. Few, if any, of these illustrations will make it into my slide collection.

    The book fills a gap in the market in that it is the first to provide a comprehensive and in depth coverage of the complement system. The nearest challenger is The Complement System edited by Rother, Till, and Hansch and published by Springer Verlag, the second edition of which has just appeared. This book is smaller (and cheaper) than the volume under review and covers most of the same areas, albeit not in the same depth.

    The Human Complement System in Health and Disease will be essential reading for those working in basic or applied complement research and should be read by all clinical immunologists in training—who knows, it might even persuade this latter group that complement is interesting and important! Will this book be of use to rheumatologists? I think that the answer has to be yes. An hour or two spent browsing will give a useful insight into the system and will no doubt precipitate the reading in depth of some chapters. The chapters on immune complex disease, neuromuscluar disease and hereditary angio-oedema are of obvious relevance. Unfortunately, given its price and size, this is not a book that will find its way into the personal collection of the interested rheumatologist, unless someone else can be persuaded to pay.

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