Accessible Requires Authentication Published by De Gruyter May 29, 2018

Complement systems C4, C3 and CH50 not subject to a circadian rhythm

Thomas Lung, Katja Matozan, Martin Risch, Benjamin Sakem, Urs E. Nydegger and Lorenz Risch
From the journal Diagnosis



The circadian fluctuations in the blood levels of selected components of the complement system are ill-defined. Some authors found nadir serum levels of C4 and C3 components, together with C3a at nighttime, while others reported insomnia when pro-inflammatory components exhibited increased serum levels. In this study, we quantitatively estimate the morning and evening daytime serum levels of CH50, C4, C3, put into context with C-reactive protein (CRP), cortisol, parathyroid hormone (PTH) and 25(OH)vitamin D at 07:00 A.M. and at 07:00 P.M.


Seven healthy adult women and 11 men who were voluntary participants agreed to a fasting venipuncture in the morning after having normally eaten through the day and in the evening. The C4 and C3 serum levels were measured on a Cobas (Roche Diagnostics, Switzerland) modular analyzer, CH50 was estimated using the COMPL300 enzyme-linked immunosorbent assay (ELISA) of Wieslab (Malmö, Sweden). CRP, 25(OH)vitamin D, PTH and cortisol concentrations were assessed with electro-chemiluminescence immunoassay (ECLIA) on the Roche Cobas 6000 platform; IgG was measured using nephelometry (Siemens, Germany).


With the exception of higher PTH levels in the evening [3.12–5.46, 95% confidence interval (CI)] compared to the morning (2.93–4.65, 95% CI), the mean and median values of C4, C3, CH50 as well as CRP, PTH and 25(OH)vitamin D fell within the established reference intervals. Cortisol levels were measured as an internal positive control for diurnal fluctuations (morning: 294–522 nmol/L, 95% CI; evening: 106–136 nmol/L, 95% CI).


The concentrations of the assessed complement components C4 and C3 as well as CH50 surrogate assay did not yield significantly different values between early morning and evening. This does not exclude their participation in the circadian metabolome; this pilot study with healthy participants suggests that patients with an autoimmune disease in remission can give their blood samples independently during daytime with or without fasting.

Corresponding author: Prof. em Dr. Med. Urs E. Nydegger, Labormedizinisches Zentrum Dr. Risch, Buchs SG und Liebefeld bei Bern BE, Waldeggstr. 37, 3097 Liebefeld bei Bern, Bern, Switzerland, Phone: +4158 523 3466, Fax: +4158 523 3499


The authors acknowledge the precious secretarial help of Simone Inderbitzin. Madeleine Lehmann helped as study nurse.

  1. Author contributions: TL and UN wrote the first draft. KM and TL introduced the TTC test in our lab. BS and LR did the statistical evaluations. LR and UN applied at Ethical Committee. MR and LR validated the study. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


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Received: 2018-1-26
Accepted: 2018-5-3
Published Online: 2018-5-29
Published in Print: 2018-6-27

©2018 Walter de Gruyter GmbH, Berlin/Boston