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Role of circulating immune complexes in renal diseases.

The elimination of a foreign antigen is a function of the antibody, complement and phagocyte systems. When an immune complex is formed in the circulation, clearance is effected by cells of the reticuloendothelial system. Macrophages and polymorphonuclear cells have both IgG Fc and C3b complement receptors so that opsonisation by either the classical or the alternative pathway of complement activation facilitates antigen elimination. This system normally provides a most efficient protection against disease, since man is continually challenged by a variety of inhaled and ingested antigens. Why then does a normally protective system become self-damaging, resulting in immune complex disease? It is unlikely that most immune complex diseases are due to rare or as yet unidentified antigens. It is much more likely that host variation in immune response to a common antigen resuits in effective clearance and health in one individual, but persistent circulating antigen and immune complex disease in another. Increased concentrations of circulating soluble immune complexes are found in a variety of diseases; these include systemic lupus erythematosus, various forms of glomerulonephritis, rheumatoid arthritis, and chronic inflammatory bowel diseases.' High concentrations of immune complexes are also found in many forms of disseminated malignancy2 where it is thought that they may have an enhancing effect on tumour growth, by preventing the host from mounting an effective immune response to his own tumour.3 Paradoxically, immune complexes are also found, in low concentrations, in the sera of apparently healthy people, particularly after food;4 they have also been described in normal pregnancy,5 and in pre-eclampsia.6 The finding of immune complexes in so many different diseases as well as in normal biological states raises the question whether they do indeed play a crucial role in pathological processes.