The influence of genetic and nongenetic factors on abnormalities of the immune response in systemic lupus erythematosus (SLE) was studied in 9 sets of twins in which one or both twins had SLE. Particular emphasis was placed on contrasting the results between the sibs of 3 monozygotic pairs discordant for clinical SLE. Depression of cell-mediated immunity, determined by lymphocyte blastogenic response to mitogens, was associated with the clinical expression of illness. In contrast, autoreactive antilymphocyte antibodies and lymphocyte tubu- loreticular structures were found in both clinically affected and unaffected subjects and were more prominently associated with the presence of other serologic abnormalities. No evidence of antigens or cell surface determinants unique to affected sibs was encountered.
Genetic, immune, and viral factors have been implicated in the pathogenesis of systemic lupus erythematosus (SLE).A genetic influence has been suggested by studies demonstrating an increased prevalence of SLE in first degree relatives of SLE patients and multiple occurrences of SLE within single faGilies (1,2). Extremely high concordances of clinical SLE and serologic abnormalities between monozygotic twins have recently been reported (3). Evidence for abnormal immune function in SLE is well known, including "autoantibodies," which have been related to tissue injury (4). Studies have demonstrated a substantially increased prevalence of certain of these serologic abnormalities in relatives of SLE patients, a finding suggesting that genetic factors are important in their production (5). Impaired cell-mediated immunity in SLE (6) has been related either to intrinsic cellular deficiencies (7) or to inhibiting serum factors, particularly antilymphocyte antibodies (8), or to both (9-1 1). It also has been postulated that a deficiency of "suppressor" T cells may result in heightened humoral responses (1 2).In the SLE-like and leukemic illnesses of New Zealand mice, in which the presence of genetic and