FSAP‐mediated nucleosome release from late apoptotic cells is inhibited by autoantibodies present in SLE

Inefficient clearance of apoptotic cells and the subsequent exposure of the immune system to nuclear contents are crucially involved in the pathogenesis of systemic lupus erythematosus (SLE). Factor VII‐activating protease (FSAP) is activated in serum upon contact with dead cells, and releases nucleosomes from late apoptotic cells into the extracellular environment. We investigated whether FSAP‐mediated nucleosome release from late apoptotic cells is affected in SLE patients. Nucleosome release in sera of 27 SLE patients and 30 healthy controls was investigated by incubating late apoptotic Jurkat cells with serum and analyzing the remaining DNA content by flow cytometry. We found that nucleosome release in sera of SLE patients with high disease activity was significantly decreased when compared with that in SLE sera obtained during low disease activity or from healthy individuals. Upon removal of IgG/IgM antibodies from SLE sera, nucleosome release was restored. Similarly, monoclonal antinuclear antibodies inhibited nucleosome release in healthy donor serum or by plasma‐purified FSAP. This inhibition was lost when Fab fragments were used, suggesting that antigen cross‐linking is involved. In conclusion, FSAP‐mediated nucleosome release from late apoptotic cells is greatly impaired in SLE patient sera, possibly hampering the clearance of these cells and thereby propagating inflammation. In healthy individuals, activated FSAP releases nucleosomes from late apoptotic cells into the extracellular environment, which may assist in the clearance of both nucleosomes as well as dead cell remnants. In SLE patients, nucleosome release is inhibited by antinuclear antibodies. These antibodies exert their inhibition through cross‐linking of nuclear antigen.