The biology behind the new therapies for SLE.
BACKGROUND
Systemic lupus erythematosus (SLE) is a heterogenous disease with complex pathogenesis.


OBJECTIVE
In this review, we summarise recent progress in the understanding of SLE pathogenesis and discuss implications for the treatment of SLE patients using standard and experimental medications.


CONCLUSIONS
The discovery that Toll-like receptor signalling and interferon-alpha abundance are central elements of the disease process has led to a new appreciation for hydroxychloroquine as an essential baseline medication. Although much needs to be learned, modulation of the immune system via B-cell depletion is entering clinical practice. Mycophenolate mofetil is an effective and safer alternative to cyclophosphamide for many patients with lupus nephritis. Several other therapeutic approaches are at various stages of preclinical and clinical development. These include anticytokine therapies, co-stimulatory blockade, antigen-specific immune modulation and haematopoietic stem cell transplantation.
Ermann
J
J
Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115, USA.
Bermas
B L
BL
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000941:Antigens / Q000276:immunology; D001323:Autoantibodies / Q000502:physiology; D001402:B-Lymphocytes / Q000276:immunology; D016207:Cytokines / Q000037:antagonists & inhibitors; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D007111:Immunity, Cellular; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016898:Interferon-alpha / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000276:immunology; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D009841:Oligonucleotides / Q000627:therapeutic use; D000069283:Rituximab; D051193:Toll-Like Receptors / Q000502:physiology
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000941:Antigens; D001323:Autoantibodies; D016207:Cytokines; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D016898:Interferon-alpha; D009841:Oligonucleotides; D051193:Toll-Like Receptors; D000069283:Rituximab; D006886:Hydroxychloroquine; D009173:Mycophenolic Acid; C094104:abetimus