Apoptotic cells as immunogen and antigen in the antiphospholipid syndrome

Apoptotic cell antigens have been increasingly recognized as the targets of autoantibodies across a broad spectrum of autoimmune diseases, including systemic lupus erythematosus (SLE) and the antiphospholipid (aPL) syndrome. In this review, we will focus on one set of apoptotic antigens, namely, those targeted in the aPL syndrome. Here we discuss the biology of aPL autoantibodies and recent work from our and other laboratories demonstrating that apoptotic cells express unique antigen(s) that serve(s) as both immunogen and antigen for aPL autoantibodies. Specific features or events occurring at the surface of apoptotic cells, which may influence immunogenicity and/or antigenicity, will also be discussed. Finally, we will speculate on the broader implications of these findings for the development of systemic autoimmunity as seen in SLE.