Apoptosis, clearance mechanisms, and the development of systemic lupus erythematosus

Cell death by apoptosis is an integral part of many biologic processes, including embryonic development, T- and B-cell selection, the elimination of potentially autoreactive lymphocytes in the periphery, and maintenance of lymphocyte homeostasis through activation-induced cell death. There is also increasing evidence that apoptosis may maintain immune tolerance and that it may be the process that generates the self antigens responsible for the initial development of autoimmunity. This review discusses some of the biochemical steps involved in the apoptotic process, how potentially immunogenic self antigens are generated during apoptosis, and the mechanisms by which the products of apoptosis are cleared and processed to avoid breaking immune tolerance.