Abstract
Dr Michael Madaio has raised a critical issue regarding the relative importance of the nucleosomal histone epitopes in lupus, which is a complex and heterogeneous disease manifesting many different autoimmune specificities. Nucleosomes are routinely released from apoptotic cells, and this event by itself is not unique to lupus.1,2 Indeed, the normal immune system avoids reacting to products of apoptosis,3,4 unless the latter are seen in an inflammatory context5,6 or there is an excessive burden of apoptotic material that cannot be cleared easily.
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