Functional Anti‐CD94/NKG2A and Anti‐CD94/NKG2C Autoantibodies in Patients With Systemic Lupus Erythematosus

Objective Recently we serendipitously identified a patient with systemic lupus erythematosus (SLE) who was positive for autoantibodies to CD94/natural killer receptor group 2A (NKG2A). The present study was undertaken to investigate the occurrence and function of autoantibodies targeting lectin‐like NK cell receptors in SLE. Methods Sera from 203 SLE patients and 90 healthy individuals were analyzed, by flow cytometry, for Ig binding to Ba/F3 cells transfected with CD94/NKG2A, CD94/NKG2C, or NKG2D. Autoantibodies identified were characterized with regard to interference with HLA–E binding, effect on NK cell activation in response to HLA–E‐transfected K562 cells, and capacity to facilitate antibody‐dependent cell‐mediated cytotoxicity (ADCC). Levels of autoantibodies were determined in longitudinally sampled sera, and correlations with disease activity (SLE Disease Activity Index 2000) and severity (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) were investigated. Results Anti‐CD94/NKG2A autoantibodies were identified in 7 SLE patients. The autoantibodies from 6 patients inhibited binding of HLA–E to CD94/NKG2A, whereas those from the seventh patient augmented this binding. Autoantibodies from 2 patients also reacted with the activating receptor CD94/NKG2C, with inhibition of the binding of HLA–E to CD94/NKG2C observed in 1 case and enhancement of this binding in the other. None of the sera contained anti‐NKG2D autoantibodies. The levels of anti‐CD94/NKG2A and anti‐CD94/NKG2C autoantibodies correlated with disease activity and with a more severe SLE phenotype. Mechanistically, anti‐CD94/NKG2A and anti‐CD94/NKG2C autoantibodies both interfered with HLA–E‐mediated regulation of NK cell activation and facilitated the elimination of target cells expressing CD94/NKG2A or CD94/NKG2C through ADCC. Conclusion Anti‐CD94/NKG2A and anti‐CD94/NKG2C autoantibodies occur in a subset of patients with clinically active SLE. Given their capacity to deplete certain NK cell subsets and interfere with particular NK cell function, such autoantibodies may promote the pathogenesis of SLE.