On the etiology and pathogenesis of systemic lupus erythematosus with special reference to environmental factors

Research output: ThesisDoctoral Thesis (compilation)


Systemic lupus erythematosus (SLE) is a complex autoimmune disease in which environmental factors interact with genetic factors in the development of the disease process and evolution of clinical manifestations. In this thesis both exogenous factors and host factors were investigated, as well as important immunopathological aspects including involvement of immune complex (IC), the complement system and interferon-alpha (IFN-α). Both exogenous retrovirus and human endogenous retrovirus (HERV) have been implicated in the etiology of SLE. To identify endogenous retroviral antigens of importance in SLE, IgG antibody reactivity against a panel of synthetic peptides derived from HERV sequences were investigated. Increased immune reactivity against a restricted set of HERV derived synthetic peptides was observed. Retroviral immune reactivity was not associated with serum levels of the anti-viral and immunomodulating cytokine IFN-α in SLE patients. However, increased IFN-α was detected in most patients with active disease, and a close relation between SLE disease activity, disease course and serum levels of IFN-α was observed. Furthermore, it was demonstrated that sera from SLE patients, especially with active disease, contained soluble factors that induced the production of IFN-α in PBMC from healthy donors. A decrease of nucleosomal DNA containing circulating IC (IC-DNA) in patients who developed hypocomplementemia with low C1q levels, was also observed. This probably reflects tissue deposition of IC-DNA, a main pathogenic pathway in IC mediated SLE manifestations. Human parvovirus B19 has been suggested as an environmental trigger of SLE. Exposure to this virus, measured as IgG and IgM anti-parvovirus antibodies, was not increased in SLE patients compared to controls. Instead, a significantly low parvovirus B19 IgG seroprevalence was observed in the SLE patients most likely because of impaired antibody production. To identify exogenous and endogenous risk factors of importance in the development of SLE, a case-control study was performed. Using a multivariate model, smoking, a history of hypertension, drug allergy, constitutional skin-type as determined by sun-reactivity, and a family history of SLE were all associated with increased risk for developing SLE, whereas consumption of alcohol was inversely associated with SLE risk.


Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Rheumatology and Autoimmunity


  • muscle system, rheumatology locomotion, Skelett, muskelsystem, reumatologi, Skeleton, Risk factors, Human parvovirus B19, Immune complex, Disease activity, Interferon-alpha, SLE, Retrovirus
Original languageEnglish
Awarding Institution
Supervisors/Assistant supervisor
  • [unknown], [unknown], Supervisor, External person
Award date2000 Dec 19
  • Anders Bengtsson, Dept of Rheumatology, University Hospital, S-221 85 Lund, Sweden,
Publication statusPublished - 2002
Publication categoryResearch

Bibliographic note

Defence details Date: 2000-12-19 Time: 09:00 Place: Reumatologiska klinikens föreläsningssal, Universitetssjukhuset i Lund External reviewer(s) Name: Isenberg, David Title: Professor Affiliation: Bloomsbury Rheumatology Unit, Arthur Stanley House, Middlesex Hospital, London, UK --- Article: (I) Bengtsson A, Blomberg J, Nived O, Pipkorn R, Toth L, Sturfelt G. Selective antibody reactivity with peptides from human endogenous retroviruses and nonviral poly (amino acids) in patients with systemic lupus erythematosus. Arthritis Rheum 1996; 39(10):1654-1663.(II) Bengtsson A, Sturfelt G, Truedsson L, Blomberg J, Alm G, Vallin H, Rönnblom L. Activation of type I interferon system in systemic lupus erythematosus correlates with disease activity but not with antiretroviral antibodies. In press, Lupus.(III) Bengtsson A, Nezlin R, Shoenfeld Y, Sturfelt G. DNA levels in circulating immune complexes decrease at severe SLE flares-correlation with complement component C1q. J Autoimmun 1999; 13(1):111-119.(IV) Bengtsson A, Widell A, Elmstahl S, Sturfelt G. No serological indications that systemic lupus erythematosus is linked with exposure to human parvovirus B19. Ann Rheum Dis 2000; 59(1):64-66.(V) Bengtsson A, Rylander L, Hagmar L, Nived O, Sturfelt G. Risk factors for developing systemic lupus erytheamtosus (SLE) – A case-control study in southern Sweden. Submitted.