The interaction of terminal complement proteins (C5-C9) with normal erythrocytes and type m paroxysmal nocturnal hemoglobinuria erythrocytes (PNH-E) has been compared in terms of binding of the C5-9 complex, C9 polymerization, and C9 insertion into membranes. Complement components C5, C7, and C8 bind equally well to both types of erythrocytes, whereas the binding of C9 to PNH-E is 5-6 times greater than that to normal erythrocytes. The kinetics of C9 binding was compared with the kinetics of lysis for both types of cells under conditions leading to 100% lysis. There was a noticeable lag time between C9 binding and lysis of normal erythrocytes, but the lysis of PNH-E proceeded without a lag and the kinetics oflysis more closely paralleled C9 binding. The efficiency of C9 insertion was similar for both types ofcells, but C9 polymerization was significantly enhanced on PNH-E. These data indicate that the enhanced susceptibility of type Im PNH-E toward lysis by C5-9 can be correlated with abnormally high C9 binding and increased formation of poly(C9).Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired disease characterized by an intermittent hemolytic anemia resulting from erythrocytes that are abnormally sensitive to lysis by autologous complement (1-4). PNH erythrocytes (PNH-E) can be distinguished, on the basis of the degree of their abnormal sensitivity to lysis by complement, as highly sensitive (type III PNH-E) and moderately sensitive (type II PNH-E) (5). Both types of PNH-E have abnormal amounts of C3b (a cleavage fragment of the third component of complement, C3) deposited on their surface after complement activation (6). The supranormal levels of C3b can be correlated directly with a deficiency in a membrane protein, the decay-accelerating factor, which inhibits the formation as well as accelerates the decay of the C3/C5 convertases of the alternative and classical complement pathways (7-9). However, the type III PNH-E have an additional defect, that of enhanced susceptibility to lysis by the terminal complement components, C5-9 (10). The molecular basis for the greater sensitivity oftype III PNH-E to reactive lysis by complement is unknown. Recently, Rosenfeld et al. (11) reported that enhanced reactive lysis of type III PNH-E by C5-9 does not involve increased C7 binding or cell-bound C3b, implying that the defect could be in the mode of interaction of C8 and/or C9 with the C5-7 complex or with the membrane itself. The latter result conflicted with earlier studies by Jones et al. (12), which suggested that cell-bound C3b enhanced the assembly of the reactive lysis components on type III PNH-E, effectively increasing the number of active lesions per cell rather than the hemolytic efficiency of a given membrane-bound C5-9 complex.Here we show that C8 binding (in addition to C5-7 binding) is not affected on type III PNH-E and investigate the role of C9 in the enhanced lysis by C5-9. Normal erythrocytes and type III PNH-E were compared with respect to C9 binding, C9-insertion efficiency, and te...