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Rheumatology Advance Access originally published online on November 29, 2006
Rheumatology 2007 46(2):200-208; doi:10.1093/rheumatology/kel379
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

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Chimerism in systemic lupus erythematosus—three hypotheses

I. C. L. Kremer Hovinga, M. Koopmans, E. de Heer, J. A. Bruijn and I. M. Bajema

Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.

Correspondence to: Idske C. L. Kremer Hovinga, Leiden University Medical Center, Department of Pathology, P0-14, PO Box 9600, 2300 RC Leiden, The Netherlands. E-mail: i.c.l.kremer-hovinga{at}lumc.nl


  Abstract

Systemic lupus erythematosus (SLE) is an immune-mediated disease characterized by the presence of autoantibodies and a wide array of clinical symptoms. Despite intensive research, the aetiology of SLE is still unknown and is probably multifactorial. Both genetic and environmental factors have been associated with SLE, but these factors alone are insufficient to explain the onset of SLE.

Recently, it has been suggested that chimerism plays a role in the pathogenesis of autoimmune diseases, including SLE. Chimerism indicates the presence of cells from one individual in another individual. In an experimental mouse model, the injection of chimeric cells induces a lupus-like disease. In addition, chimerism is found more often in kidneys of women with SLE than in healthy controls.

There are several mechanisms by which chimeric cells could be involved in the pathogenesis of SLE. In this review, three hypotheses on the role of chimerism in SLE are discussed. The first two hypotheses describe the possibilities that chimeric cells induce either a graft-vs-host reaction in the host (comparable with reactions seen after bone marrow transplantation) or a host-vs-graft reaction (comparable with reactions seen after solid organ transplantation). The third hypothesis discusses the possible beneficial role chimeric cells may play in repair mechanisms due to their stem cell-like properties. This review provides insights into the mechanisms by which chimerism may be involved in SLE and proposes several lines of inquiry to further investigate chimerism in SLE.

KEY WORDS: Chimerism, SLE, Lupus nephritis, Pregnancy, Graft-vs-host reaction, Host-vs-graft reaction, Repair mechanism

Submitted 9 May 2006; revised version accepted 18 September 2006.
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