Anti-TNF-alpha therapies in systemic lupus erythematosus

Tumor necrosis factor (TNF)-alpha is not just a proinflammatory cytokine. It has also been proposed to be an immunoregulatory molecule that can alter the balance of T regulatory cells. Anti-TNF-alpha therapies have been provided clinical benefit to many patients and introduced for treating moderate to severe rheumatoid arthritis, Crohn's disease, and other chronic inflammatory disorders. However, their use also is accompanied by new or aggravated forms of autoimmunity, such as formation of autoantibodies, including antinuclear antibodies (ANAs), antidouble-stranded DNA (dsDNA) antibodies, and anticardiolipin antibodies (ACL). Systemic lupus erythematosus (SLE) is a disease with autoimmune disturbance and inflammatory damage. The role of TNF-alpha in human SLE is controversial. Here we review the role of TNF-alpha in the pathophysiological processes of SLE and the likely effects of blocking TNF-alpha in treatment of SLE.