title: Environmental factors, toxicants and systemic lupus erythematosus.
abstract: Systemic lupus erythematosus (SLE) is an immune-complex-mediated multi-systemic autoimmune condition of multifactorial etiology, which mainly affects young women. It is currently believed that the onset of SLE and lupus flares are triggered by various environmental factors in genetically susceptible individuals. Various environmental agents and toxicants, such as cigarette smoke, alcohol, occupationally- and non-occupationally-related chemicals, ultraviolet light, infections, sex hormones and certain medications and vaccines, have been implicated to induce SLE onset or flares in a number case series, case-control and population-based cohort studies and very few randomized controlled trials. Here, we will describe some of these recognized environmental lupus triggering and perpetuating factors and explain how these factors potentially bias the immune system towards autoimmunity through their interactions with genetic and epigenetic alterations. Further in-depth exploration of how potentially important environmental factors mechanistically interact with the immune system and the genome, which trigger the onset of SLE and lupus flares, will certainly be one of the plausible steps to prevent the onset and to decelerate the progress of the disease.
authors.affiliation: Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block 119228, Singapore. mdcam@nus.edu.sg.
authors.forename: Anselm
authors.initials: A
authors.lastname: Mak
authors.affiliation: Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block 119228, Singapore. sen_hee_tay@nuhs.edu.sg.
authors.forename: Sen Hee
authors.initials: SH
authors.lastname: Tay
mesh_terms: D000428:Alcohol Drinking; D000818:Animals; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology / Q000378:metabolism; D000076123:DNA (Cytosine-5-)-Methyltransferase 1; D004248:DNA (Cytosine-5-)-Methyltransferases / Q000378:metabolism; D004785:Environmental Pollutants / Q000633:toxicity; D057890:Epigenomics; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000209:etiology*; D018384:Oxidative Stress / Q000187:drug effects; D012907:Smoking
chemical_list: D000889:Anti-Arrhythmia Agents; D004785:Environmental Pollutants; D000076123:DNA (Cytosine-5-)-Methyltransferase 1; D004248:DNA (Cytosine-5-)-Methyltransferases