{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T13:23:14Z","timestamp":1783084994854,"version":"3.54.6"},"reference-count":50,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"unspecified","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007949","name":"Reumatikerf\u00f6rbundet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007949","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013964","name":"Stiftelsen Stig och Gunborg Westman","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013964","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008035","name":"Njurfonden","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008035","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007857","name":"Stiftelsen Konung Gustaf V:s 80-\u00e5rsfond","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007857","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Stockholm County Council"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2026,6,11]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The complement system is crucial in antineutrophil cytoplasmic antibody-associated vasculitis (AAV) pathogenesis. Extracellular vesicles (EVs) serve as carriers of bioactive substances, influencing the immune system. We aimed to investigate myeloperoxidase-positive EVs (MPO\n                      <jats:sup>+<\/jats:sup>\n                      EVs) exposing complement components (C3a, C4d), terminal complement complex (TCC) and complement factor B (CFB) in relation to disease activity and kidney involvement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Plasma MPO\n                      <jats:sup>+<\/jats:sup>\n                      EVs carrying complement products, C3a, C4d, TCC or CFB, were analysed by flow cytometry. Clinical data, including kidney biopsy findings, were retrieved. Disease activity was assessed using the Birmingham Vasculitis Activity Score (BVAS).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighty-one patients with AAV with granulomatosis with polyangiitis (n=59) or microscopic polyangiitis (n=22) were included. Active disease was noted in 73 (90.1%) patients and 50 (68.5%) had kidney involvement. Patients with kidney involvement had higher concentrations of MPO\n                      <jats:sup>+<\/jats:sup>\n                      , MPO\n                      <jats:sup>+<\/jats:sup>\n                      C3a\n                      <jats:sup>+<\/jats:sup>\n                      , MPO\n                      <jats:sup>+<\/jats:sup>\n                      C4d\n                      <jats:sup>+<\/jats:sup>\n                      and MPO\n                      <jats:sup>+<\/jats:sup>\n                      TCC\n                      <jats:sup>+<\/jats:sup>\n                      EVs compared to patients without, and concentrations correlated positively with BVAS (p&lt;0.05), respectively. Levels of EVs showed a negative correlation with estimated glomerular filtration rate, and a positive correlation with the proportions of necrosis and crescents in kidney biopsies. ROC curve analysis indicated that MPO\n                      <jats:sup>+<\/jats:sup>\n                      EVs could distinguish patients with kidney involvement from non-renal AAV. A binary multivariable logistic regression confirmed an independent association between levels of EV subsets and kidney involvement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Elevated levels of MPO\n                      <jats:sup>+<\/jats:sup>\n                      EVs exposing complement components in patients with kidney involvement indicate activation of the classical or lectin and common complement pathways in renal AAV. Furthermore, the association between levels of MPO\n                      <jats:sup>+<\/jats:sup>\n                      EVs with the presence of crescents and necrotic lesions in kidney tissue supports a role in renal inflammatory activity.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2025-006468","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T13:11:26Z","timestamp":1783084286000},"page":"e006468","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Extracellular vesicles exposing complement split products are associated with kidney involvement in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV)"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2196-1164","authenticated-orcid":false,"given":"Anna","family":"Juto","sequence":"first","affiliation":[{"name":"Division of Rheumatology, 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