Role of granulocytes in immune complex-induced tissue injuries

Tissue injury of many types may be caused by deposited complexes of antigen and antibody. The circumstances under which the complexes form and deposit often determine the location and type of injury observed: If the complex forms in the circulation, deposition may occur in arterial walls and glomeruli, initiating lesions in those tissues. If the complex forms in the synovial tissues or spaces, then the reaction will develop at that point. Any local source of antigen will initiate these lesions once antibody is formed. If the source of antigen persists, antibody-forming cells soon establish themselves locally as they do in the active Arthus reaction, and injury will become chronic. When the antibody formed is capable of activating complement, polymorphonuclear leukocytes (PMNs, neutrophils) will accumulate, leading to release of injurious constituents. Such is the case in acute glomerulonephritis, arteritis, synovitis, and vasculitis. The ability of complement to attract the PMNs has been demonstrated as an in vitro phenomenon and as a clear possibility in vivo. The requirement of PMNs in the development of the lesions has been demonstrated. The process by which PMNs and other cells (platelets, mast cells, basophils, and macrophages) release injurious constituents is of great interest currently. The exocytosis of their cytoplasmic granules constitutes the major mechanism of release and involves a complicated series of events outlined in this review. The constituents of PMNs capable of injuring tissue in various ways is described, from peptides capable of increasing vascular permeability, to enzymes that indirectly bring more PMNs and other cells into the lesion, to proteolytic enzymes that hydrolyze vital structures in the tissues. These agents were most likely designed to rid the host of invaders; but at times they are unfortunately directed against the host's own tissues.