Innate immune and non-immune mediators of erythrocyte clearance

Erythrocyte clearance is reviewed in the context of what is known in 2003 on clearance of apoptotic cells in vitro and in vivo. Thus, emphasis is put on the role of the innate immune system comprised of naturally occurring autoantibodies (NAbs) and complement. Oxidative damage, cellular senescence and diffusion-controlled exoplasmic cross-linking appear to generate oligomers of band 3 (anion transport protein) that are a prerequisite for anti-band 3 NAb binding to human red blood cells (RBC). Similar processes seem to be responsible for premature RBC clearance in hemoglobinopathies and membrane protein deficiencies. The review discusses why NAb binding alone is insufficient and how bound NAbs may enhance complement deposition. Clearance of RBC is not only the result of cell-bound opsonins, but is enhanced by the loss of RBC membrane constituents, such as CD47 and sialic acids. As long as these constituents are present on RBC in normal numbers and topologic arrangement, they bind to their respective receptors on macrophages, elicit a negative signal that appears to prevent the macrophage from engulfing bound RBC. Exposure of phosphatidylserine is not a primary signal for RBC removal and where exposed it initiates binding of CRP or of beta-2-glycoprotein I and NAbs.