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We hypothesized that inhibition of the complement system in the lungs by repeated treatment with nebulized plasma-derived human C1-esterase inhibitor reduces pulmonary complement activation and subsequently attenuates lung injury and lung inflammation. This was investigated in a rat model of severe<jats:italic>Streptococcus pneumoniae<\/jats:italic>pneumonia. Rats were intra\u2013tracheally challenged with<jats:italic>S. pneumoniae<\/jats:italic>to induce pneumonia. Nebulized C1-esterase inhibitor or saline (control animals) was repeatedly administered to rats, 30\u2009min before induction of pneumonia and every 6\u2009h thereafter. Rats were sacrificed 20 or 40\u2009h after inoculation with bacteria. Brochoalveolar lavage fluid and lung tissue were obtained for measuring levels of complement activation (C4b\/c), lung injury and inflammation. Induction of pneumonia was associated with pulmonary complement activation (C4b\/c at 20\u2009h 1.24\u2009% [0.56\u20132.59] and at 40\u2009h 2.08\u2009% [0.98\u20135.12], compared to 0.50\u2009% [0.07\u20130.59] and 0.03\u2009% [0.03\u20130.03] in the healthy control animals). The functional fraction of C1-INH was detectable in BALF, but no effect was found on pulmonary complement activation (C4b\/c at 20\u2009h 0.73\u2009% [0.16\u20131.93] and at 40\u2009h 2.38\u2009% [0.54\u20134.19]). Twenty hours after inoculation, nebulized C1-esterase inhibitor treatment reduced total histology score, but this effect was no longer seen at 40\u2009h. Nebulized C1-esterase inhibitor did not affect other markers of lung injury or lung inflammation. In this negative experimental animal study, severe<jats:italic>S. pneumoniae<\/jats:italic>pneumonia in rats is associated with pulmonary complement activation. Repeated treatment with nebulized C1-esterase inhibitor, although successfully delivered to the lungs, does not affect pulmonary complement activation, lung inflammation or lung injury.<\/jats:p>","DOI":"10.1007\/s12013-016-0766-1","type":"journal-article","created":{"date-parts":[[2016,9,28]],"date-time":"2016-09-28T03:50:59Z","timestamp":1475034659000},"page":"545-552","update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Nebulized C1-Esterase Inhibitor does not Reduce Pulmonary Complement Activation in Rats with Severe Streptococcus Pneumoniae Pneumonia"],"prefix":"10.1007","volume":"74","author":[{"given":"Friso","family":"de Beer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wim","family":"Lagrand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerie J.","family":"Glas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte J. 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