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In vivo evidence for apoptosis in the bone marrow in systemic lupus erythematosus
  1. Alastair L Hepburn1,*,
  2. Irvin A Lampert2,*,
  3. Joseph J Boyle2,
  4. Donna Horncastle2,
  5. W Fai Ng1,
  6. Mark Layton3,
  7. Timothy J Vyse1,
  8. Marina Botto1,
  9. Justin C Mason1
  1. 1Department of Rheumatology, Imperial College London, Hammersmith Hospital, London W12 0HS, UK
  2. 2Department of Histopathology, Imperial College London, Hammersmith Hospital, London W12 0HS, UK
  3. 3Department of Haematology, Imperial College London, Hammersmith Hospital, London W12 0HS, UK
  1. Correspondence to:
    Dr A L Hepburn
    Department of Rheumatology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK; alnhepburn{at}


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.

  • ANA, antinuclear antibodies
  • BM, bone marrow
  • ESR, Erythrocyte Sedimentation Rate
  • MCV, Mean Corpuscular Volume
  • SLE, systemic lupus erythematosus
  • SLEDAI, SLE disease activity index
  • apoptosis
  • bone marrow
  • pancytopenia
  • SLE

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  • * ALH and IAL contributed equally to this study.

  • Conflicts of interest: None declared.

  • Published Online First 2 February 2007