Purified decay-accelerating factor (DAF), from the stroma of normal human erythrocytes, was incorporated into the membranes of erythrocytes of patients with paroxysmal nocturnal hemoglobinuria (PNH), and its effect on the complement sensitivity of the cells was investigated. Reconstitution with exogenous DAF restored the ability of the affected PNH cells to resist assembly of the homologous C3 convertase, C4b2a, on their surfaces, and decreased the susceptibility of the cells to lysis in acidified serum. Conversely, treatment of normal erythrocytes with monoclonal or polyclonal anti-DAF antibodies abrogated the capacity of the normal cells to circumvent C4b2a assembly and rendered the cells sensitive to acid lysis. These findings show that the previously reported association of DAF deficiency with PNH is causally related to the lytic abnormalities of the cells and clarify the molecular basis for restriction of autologous convertase formation on normal human erythrocytes. Recently, a 70-kilodalton membrane component (DAF; decay-accelerating factor) that can inhibit C3 activation (2) was purified from the stroma of normal human erythrocytes (3). The isolated protein resembled the complement receptor type 1 (CR1) in that it could promote dissociation by decay of preformed C3 convertases of both the classical and alternative complement pathways (3). Two groups of investigators (4-6) found that DAF was deficient or absent in cells of patients with PNH, and they suggested that this defect was involved in the heightened sensitivity of the PNH cells to lysis.In our laboratory, we examined the respective roles of CR1 and DAF in the regulation of bound C3b and C4b fragments (7)(8)(9)) and compared the function of purified DAF and of DAF incorporated within cell membranes. We found that membrane-associated DAF acts primarily to block the uptake of C2 and factor B by deposited C4b or C3b fragments rather than to regulate preformed convertases. Moreover, in contrast to CR1, which interacts extrinsically with convertases on targets, DAF acts only within the surface of the same cells-i.e., it is strictly an intrinsic membrane inhibitor. Since, in its native environment, DAF effectively inhibits the assembly of all amplifying enzymes of the cascade (C3 and C5 convertases), we suggested that it might play a central role in vivo in preventing complement-mediated damage of autologous cells.A key observation permitting the above analyses was that purified DAF could be incorporated into erythrocyte membranes and retain its functional properties (8,10). In the present study, we took advantage of this phenomenon to determine whether the DAF deficiency of the PNH erythrocytes is causally related to their increased sensitivity to complement-mediated lysis. We found that reconstitution of PNH erythrocytes with DAF restores the ability of the cells to inhibit assembly of the classical pathway C3 convertase (C4b2a) on their surfaces and markedly reduces the susceptibility of the erythrocytes to the alternative pathway-mediated lysi...