Systemic lupus erythematosus (SLE) is a prototype inflammatory autoimmune disease resulting from autoimmune responses against nuclear autoantigens. During apoptosis many lupus autoantigens congregate inside the cells and are susceptible to modifications. Modified nuclear constituents are considered foreign and dangerous. Therefore, apoptotic cells have to has to be efficiently removed to avoid the accumulation of apoptotic debris and the subsequently development of autoimmune responses. Hence, apoptosis and clearance of apoptotic cells/material are considered key processes in the aetiology of SLE. Clearance deficiencies may account for the development of autoimmunity by inducing a loss of tolerance in lymphoid tissues. Furthermore, phagocytosis of apoptotic cells may lead to a pro-inflammatory response in the presence of autoantibodies. This may sustain inflammatory conditions and the pathology found in overt lupus.

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The binding of anti-double-stranded DNA (anti-dsDNA) autoantibodies to the glomerular basement membrane (GBM) in lupus nephritis can be explained by two mechanisms: (1) direct crossreactive binding to intrinsic glomerular antigens; (2) nucleosome-mediated binding to heparan sulfate in the GBM. Kalaaji et al. demonstrated using novel techniques that glomerular in vivo-bound antoantibodies bind to nucleosomes/dsDNA derived from apoptotic cells and not to intrinsic glomerular structures.

The SmD1(83-119) peptide is able to bind dsDNA and nucleosomes, and dsDNA or nucleosomes in applied reagents lead to an apparent reactivity of anti-dsDNA, anti-histone or nucleosome-specific antibodies with the SmD1(83-119) peptide in ELISA.