HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) All Versions of this Article: ard.2006.065003v1 66/8/1106    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hepburn, A. L Articles by Mason, J. C Search for Related Content PubMed PubMed Citation Articles by Hepburn, A. L Articles by Mason, J. C

In vivo evidence for apoptosis in the bone marrow in systemic lupus erythematosus

¹ Department of Rheumatology, Imperial College London, Hammersmith Hospital, London W12 0HS, UK
² Department of Histopathology, Imperial College London, Hammersmith Hospital, London W12 0HS, UK
³ Department of Haematology, Imperial College London, Hammersmith Hospital, London W12 0HS, UK

Correspondence to:
Correspondence to:
Dr A L Hepburn
Department of Rheumatology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK; alnhepburn{at}doctors.org.uk

ABSTRACT
An increase in leucocyte apoptosis and impaired clearance of apoptotic cells has been observed in patients with systemic lupus erythematosus (SLE). Apoptotic cells are likely to be a key source of autoantigens in SLE as they express many of the nuclear autoantigens (in surface blebs and apoptotic bodies) that are relevant to this disease. The clearance of apoptotic cells is usually a rapid process, such that few cells are usually seen in the extracellular environment in vivo. We report a case in which multiple apoptotic bodies were observed in the bone marrow of a patient with SLE that was complicated by an immune-mediated pancytopenia. We have subsequently examined the frequency of apoptotic cells, identified morphologically, and by caspase-3 staining in bone-marrow trephine samples taken from patients with SLE over a 10-year period of follow-up. A high proportion of bone marrows contained apoptotic debris. The novel demonstration of apoptotic bodies in vivo in patients with SLE is unusual and supports the notion that the marrow may be a target organ in the disease. Their abundance is also consistent with the hypothesis that normal clearance mechanisms are defective and/or overwhelmed in SLE.

Abbreviations: ANA, antinuclear antibodies; BM, bone marrow; ESR, Erythrocyte Sedimentation Rate; MCV, Mean Corpuscular Volume; SLE, systemic lupus erythematosus; SLEDAI, SLE disease activity index

Keywords: apoptosis; bone marrow; pancytopenia; SLE