The pathogenesis of the axonal degeneration in acquired or hereditary amylo
idosis is unknown. In this immunohistochemistry study, we examined 20 sural
nerve biopsies from individuals with amyloid neuropathy (14 acquired and 6
hereditary) for evidence of complement activation. Complement activation p
roducts were detected on and around amyloid deposits within peripheral nerv
es. We found no difference in the extent, location or pattern of complement
activation products between the 2 forms of amyloidosis. The presence of ea
rly classical pathway activation markers in the absence of antibody in here
ditary cases suggests an antibody-independent activation of the classical p
athway through binding of C1q. The lack of Factor Bb-suggested alternative
pathway activation was not significant in these cases. The detection of C5b
-9 neoantigen on amyloid deposits demonstrated that the full complement cas
cade was activated. Complement activation on amyloid deposits and the gener
ation of C5b-9 in vivo may contribute to bystander injury of axons in the v
icinity of amyloid deposits.