Incidence of anti-human Ig with restricted specificity in Japanese, Kuwaiti, and Swedish patients with rheumatoid arthritis

Rheumatoid factor autoantibody repertoire profiling reveals distinct binding epitopes in health and autoimmunity

BACKGROUND

Rheumatoid factors (RF) are one of the hallmark autoantibodies characteristic of rheumatoid arthritis (RA), and are frequently observed in other diseases and in healthy individuals. RFs comprise multiple subtypes with different specificities towards the constant region of human IgG. Studies indicate that these patterns differ between naturally occurring RFs and RFs associated with disease. However, individual specificities characteristic of either have not been clearly defined.

METHODS

In this study, we developed an extended set of engineered IgG-fragment crystallisable (Fc) targets with preferential RF binding to specific (conformational) epitopes, which was subsequently used for profiling of RF binding patterns in a compiled exploration cohort, consisting of sera from healthy donors with measurable RF and patients with RA, primary Sjögren's syndrome (pSS) and seropositive arthralgia.

RESULTS

We identified an epitope that is strongly associated with RA, which was targeted by both IgM-RF and IgA-RF. We also identified an epitope that is preferentially targeted by healthy donor (IgM) RFs. IgM-RFs derived from healthy donors and patients with RA and pSS all target distinct regions on the IgG-Fc, whereas overall, the IgA-RF repertoire is largely restricted to pathology-associated specificities. Using monoclonal RFs with different specificities, we furthermore demonstrate that the capacity to activate complement or even inhibit IgG-mediated complement activation varies according to the epitopes to which RFs bind.

CONCLUSIONS

Our results demonstrate both the need and feasibility to redefine 'RF' into pathological and physiological autoantibody subtypes.

IgG3 reactive rheumatoid factor in rheumatoid arthritis: etiologic and pathogenic considerations

Rheumatoid factor (RF) is a polyclonal autoantibody directed against the Fc portion of IgG. Although the role of RF in patients with rheumatoid arthritis (RA) is unclear, immune complexes that form between RF and IgG can activate the classical complement (C) pathway, leading to pathogenic outcomes involving inflammatory events and tissue damage. The specificity of serum RF and RF produced by rheumatoid synovial cells (RSC) is different. Serum RF has specificity for rabbit IgG and human IgG subclasses IgG1, 2, and 4, but binds poorly to IgG3. The affinity of serum RF for IgG Fc is low, having an association constant of 10(4)-10(5) M-1. RSC RF, however, has specificity for human IgG and high avidity for IgG3. Because of this greater specificity and avidity for IgG3, and because RSC RF may be pathogenically more important than serum RF, an important role for IgG3-reactive RF in RA may exist. Binding of RF to IgG may be dependent on the allotype and glycosylation of IgG. Infectious agents present in RA patients may directly or indirectly induce the production of certain RF. In this communication, we review and expand on several observations examining the role of IgG3-reactive RF in RA including: 1) binding differences between RF derived from RSC and serum; 2) glycosylation characteristics of IgG and its interaction with RF; 3) apparent allotype dependent binding of IgG3-reactive RF; and 4) possible relationship between infectious agents and the production of IgG3-reactive RF. Taken together, these observations suggest an important role for IgG3-reactive RF in better understanding the etiology and pathogenesis of RA.

Conformational dependency of human IgG heavy chain-associated Gm allotypes

Human IgG allotypic markers Gm(a)[Glm(1)], Gm(x)[Glm(2)]; Gm(f)[Glm(4)], Gm(b)[G3m(5) and (11)] and Gm(g)[G3m(21)] were studied after chemical modification of IgG histidines by diethylpyrocarbonate, tyrosines by N-acetylimidazole and lysines by formaldehyde and sodium borohydride. Degrees of substitution were estimated by trinitrobenzenesulfonic acid assay. IgG of known Gm phenotype isolated from serum of hyperimmune anti-tetanus toxoid donors was studied. Histidyl modification resulted in virtually complete loss of Gm(a) and Gm(g) antigenicity but preservation of Gm(x), Gm(b) and Gm(f). Reconstitution of the histidyl residues using hydroxylamine resulted in virtually complete restoration of Gm(a) and Gm(g) antigenicity. Histidine modification resulted in no significant decrease in ELISA anti-tetanus antibody activity. Alteration of tyrosyl residues using N-acetylimidazole considerably diminished Gm(a) and Gm(f) expression. This effect was reversed by hydroxylamine treatment. Moreover, chemical alteration of tyrosyl residues produced a complete loss of Gm(g) antigenicity which was only partially restored after deacylation. A urinary H chain fragment containing the VH region directly linked to C gamma 3 which contained the Gm(a) specific and Gm(x) specific amino acid residues was positive for Gm(a) but negative for Gm(x). Another urinary H chain fragment containing only the C gamma 3 domain was negative for both Gm(a) and (x). These findings indicate that Gm allotypic markers may depend on conformational determinants in which strongest expression for Gm(a) and (x) depends on structures expressed by C gamma 3 linked to C gamma 2 domains. Although RFs react with the region encompassing the C gamma 2-C gamma 3 interface, Gm-specificities of such reactions are affected allosterically through single or double amino acid substitutions at a relatively distant site.

Computer localization of some Gm markers on the surface of the Fc region of human immunoglobulin G

The surface localization of some Gm markers on the Fc fragment of IgG has been identified from previously published amino acid sequences associated with known Gm markers using the atomic coordinates described by Deisenhofer, INSIGHT software and a Digital VAX 11/785 computer, which together permit a study of the three-dimensional structure of the Fc fragment. The G1m(x)-associated amino acid residue 431, the G3m(s)- and G3m(u)-associated residue 435 and the nG4m (a)- and (b)-associated residue 309 are all localized in the interface between the CH2 and CH3 domains. Furthermore, it is postulated that the G1m(a)-associated residue 356 (Asp, Glu) influences the interface formation through an ion pair interaction to Lys 439. Finally, G3m(b) and G3m(g) are associated with the interface via residues 435 and 436. The data explain why sera from patients with rheumatoid arthritis are useful tools for the detection of some Gm markers and support the view that rheumatoid factors from these patients are internal images of microbial Fc-binding proteins.

Possible role of microbial IgG Fc-binding proteins in rheumatoid arthritis

IgG Fc binding substances (receptors) are widespread among pathogenic microorganisms. The receptors from Staphylococcus aureus, streptococci of group A, C and G as well as Herpes-infected cells bind to the interface between the CH2 and CH3 domains i.e. to His 435, Tyr 436 and possibly also His 433 and/or 310. Most rheumatoid factors (RF) from patients with rheumatoid arthritis show a similar binding pattern. Hence, it has been shown that antibodies to microbial IgG Fc receptors (S. aureus and group A streptococci type M15) and RF are idiotypic-anti-idiotypic antibody "partners" i.e. that RF are the "internal images" of microbial IgG Fc binding proteins. Group A streptococci possessing IgG Fc receptors elicit higher titres of RF when injected in rabbits as compared to group A streptococci without IgG Fc receptors. The streptococcal IgG Fc receptors exhibit a diversity of preferences for subclasses of human IgG, some of them showing allotype preferences. Such allotypes are also recognized by certain RF. IgG RF are able to self-associate thereby forming immune complexes which can activate the complement cascade as well as stimulate release of prostaglandins and (probably) interleukin-1. Since these factors have been assigned an important pathogenic role in rheumatoid arthritis, self-aggregating IgG RF, proposed to be induced by microbial IgG Fc receptors might be an important pathogenic factor in rheumatoid arthritis because rheumatoid arthritis is the only known condition where synthesis of RF takes place in the synovia.

The Gm system. Anti-Gm's: characteristics in rheumatoid arthritis; experimental induction without resort to allotype; frequent occurrence in mononucleosis

Gm system: Some RFs specifically detect Mendelian markers of human Ig, originally proving that Ig production is gene controlled. The genetic marker systems of human Ig with 17 Gm, 2 Am, 3 Km and 1 Em markers are briefly described. Examples of the usefulness of the Gm system in medicine, immunology and molecular biology are mentioned.

CONCLUSIONS

1. Some RFs have been essential tools in elucidating genetic control mechanisms in Ig production. 2. Knowledge of the Gm system is extensive. Anti-Gm's: High-titered anti-Gm's are common in R.A. The anti-allotypes in R.A. are markedly restricted as to their specificity. They are usually not directed against the individuals own Gm markers. Anti-human-immunoglobulins were observed in 12 of 18 sera from patients with mononucleosis. The majority of these anti-immunoglobulins were inhibitable by native human Ig and showed restricted specificity.

CONCLUSIONS

1. There is a strong stimulus for production of particular anti-Gm's in a majority of R.A. cases. 2. Notions of an autoimmune origin for many anti-Gm's in R.A. are not in obvious agreement with experimental observations. 3. Anti-human-Ig's with restricted specificity are commonly induced in mononucleosis.