Possible Relationship between Bacterial or Viral Fcγ-Binding Proteins and Rheumatoid Factor

Bacterial Fc-binding proteins (FcBPs) such as staphylococcal protein A and streptococcal protein G possess IgG fine specificity strikingly similar to that of rheumatoid factors (RFs) derived from patients with rheumatoid arthritis (RA). They were shown to bind to the C_H2-C_H3 interface region of IgG. It has also been shown that peripheral blood lymphocytes can be selectively induced to produce RF by protein A. Several hypotheses, including idiotypic mimicry, have been proposed to explain the relationship of RF and bacterial FcBPs. Although convincing evidence for the involvement of bacterial infection in the etiology of RA has not been available, viral infection has frequently been strongly suspected as the agent possibly triggering RA. Herpes family viruses possess FcBPs reacting with the same C_H2-C_H3 interface region of IgG. Fab fragments of monoclonal antibodies (II-481, 88-S) to the IgG-bindlng site of glycoprotein E (gE), the FcBP glycoprotein of herpes simplex viruses, showed strong binding to RF. The epitope on gE reacting with mAb II-481 showed significant overlap with the IgG Fc-binding site. Antibodies to cytomegalovirus FcBP have been detected in a substantial proportion of sera from patients with RA. These observations may imply that some RFs may be produced as anti-idiotype antibodies to anti-viral FcBP antibodies. Thus, bacterial or viral FcBP could provide a link between RF production and a possible infectious etiology of RA.