Anti-neutrophil cytoplasmic antibodies engage and activate human neutrophils via FcγRIIa

The presence of anti-neutrophil cytoplasmic Abs (ANCA) in many patients with systemic vasculitis suggests that ANCA may play a role in disease pathogenesis. Neutrophils from patients with Wegener's granulomatosis often express ANCA target Ags (myeloperoxidase (MPO) and proteinase 3 (PR3)) on their surface, making these intracellular primary granule enzymes accessible to these autoantibodies. Similarly, normal neutrophils can be induced to translocate MPO and PR3 to the cell surface in vitro, and we demonstrate that murine mAb ANCA IgG; but not IgM, binds to the ANCA target and engages the FcγRIIa ligand-binding site on the surface of human neutrophils. In contrast to ANCA IgM, ANCA IgG also induces an oxidative burst in neutrophils (oxidation of dihydrorhodamine = 91 ± 15 fluorescence units with anti-PR3 IgG vs 17 ± 2 with anti-PR3 IgM, p < 0.001). Blockade of the ligand-binding site of FcγRIIa with an antibinding site mAb Fab significantly reduces this ANCA IgG-triggered production of reactive oxygen species (p < 0.01). Similarly, human ANCA bind the ANCA target, engage FcγRIIa, and induce an oxidative burst in neutrophils. The allelic phenotype of FcγRIIa strongly influences the Fcγ receptor engagement by ligand, and FcγRIIa homozygous donors differ by more than threefold in the quantitative production of reactive oxygen intermediates (ROI) (p < 0.01). Thus, engagement of FcγRIIa by the Fc region of ANCA is one mechanism by which these autoantibodies activate receptor-mediated signal transduction systems in human neutrophils to initiate programs of inflammation and tissue injury. Fcγ receptor alleles may represent heritable disease risk factors influencing the magnitude of such a process.