Systemic Lupus Erythematosus (3rd edn): edited by Robert G. Lahita

Abstract

Academic Press, 1998. $189.95 (xx + 1051 pages)ISBN 0-12-433900-XSystemic lupus erythematosus (SLE) is the prototypic systemic autoimmune disease. This book successfully links basic science with clinical medicine, providing a framework within which to understand this complex disease. Given the rapid pace of basic and clinical research in SLE, regular updating has been required and the book is now in its third edition. As Lahita states in the introduction, ‘The history of discovery is now in the log phase of growth.’ The third edition of Systemic Lupus Erythematosus conveys the excitement and the breadth of this dynamic field.The text begins with three sections focused on mechanisms of disease: Pathogenesis and Predisposition, Animal Models, and Autoantibodies and Antigens. Each unit contains chapters written by investigators from different fields. These authors provide a background for current studies on the pathogenesis of lupus and attempt to foresee future directions of research and implications for therapy. An up-to-date description of the cellular immune defects and the susceptibility genes, as determined from human and murine studies, is clearly and comprehensively presented.Antibodies to nuclear antigens are the hallmark of the autoimmune response in SLE. Linked sets of autoantibodies reactive with many components of the same macromolecular complex reflect multiple mechanisms that ultimately lead to the spread of autoimmunity. To help the reader understand the patterns of autoantibodies found in the sera of patients with SLE, a range of defects are considered, including abnormalities in B-cell and T-cell tolerance, altered antigen processing, and exposure of ‘hidden’ self-antigens as sequelae of apoptosis. The spectrum of autoantibodies and the potential mechanisms of production and pathogenicity of each subset (e.g. anti-DNA, antihistone, anti-nonhistone antigens, anti-cytoplasmic antigens, anti-phospholipid) are carefully discussed, along with the molecular activity of autoantibodies in the context of cell function. For example, a most intriguing section describes the pathogenesis of antibody-induced tissue injury in neonatal lupus, a syndrome characterized by congenital heart block. The author presents evidence for antibody (anti-52 kDa Ro)-mediated conduction abnormalities in human fetal hearts perfused with patient-derived antibodies, inhibition of calcium channel activity in an in vitro human fetal heart cell model, and development of an antibody-specific murine model of maternal autoantibody-mediated heart block.There are four clinical sections in Systemic Lupus Erythematosus. The first provides information on clinical presentation, epidemiology and laboratory evaluation. It also includes an outstanding review of imaging techniques for the diagnosis of lupus and its complications for each organ system. Other sections provide encyclopaedic descriptions of how lupus affects each organ system, and discussions of conventional and experimental therapies.This volume will be an excellent resource for basic and clinical scientists, as well as for students of immunology and rheumatology. The chapters are well-referenced and can be read independently – as befits a reference book. More importantly, Systemic Lupus Erythematosus provides valuable information not only for those in the field, but also to scientists and clinicians interested in up-to-date answers to general and highly specific questions about SLE and related diseases.