Objective. Accumulation of apoptotic cells may lead to the development of systemic lupus erythematosus (SLE) through a breakdown in immune tolerance. Altered neutrophil apoptosis may contribute to nuclear autoantigen exposure, ultimately leading to autoantibody generation. This study aimed to determine whether neutrophil apoptosis is altered in patients with juvenileonset SLE as compared with controls.Methods. Apoptosis was measured in neutrophils from patients with juvenile-onset SLE (n ؍ 12), adultonset SLE (n ؍ 6), and pediatric patients with inflammatory (n ؍ 12) and noninflammatory (n ؍ 12) conditions. Annexin V staining and flow cytometry were used to determine neutrophil apoptosis. Proapoptotic and antiapoptotic proteins were measured in sera and in neutrophil cell lysates.Results. Neutrophil apoptosis was significantly increased in patients with juvenile-onset SLE as compared with the noninflammatory controls at time 0. Incubation of neutrophils with sera from patients with juvenile-onset SLE further increased neutrophil apoptosis as compared with incubation with sera from pediatric controls. Concentrations of TRAIL and FasL were significantly increased in sera from patients with juvenile-onset SLE, whereas interleukin-6, tumor necrosis factor ␣, and granulocyte-macrophage colonystimulating factor (GM-CSF) were significantly decreased. Addition of GM-CSF to sera from patients with juvenile-onset SLE significantly decreased neutrophil apoptosis as compared with juvenile-onset SLE sera alone. The expression of proapoptotic proteins (caspase 3, Fas, and FADD) was elevated in juvenile-onset SLE neutrophils, whereas the expression of antiapoptotic proteins (cellular inhibitor of apoptosis 1 and 2 and X-linked inhibitor of apoptosis) was decreased. Neutrophil apoptosis correlated with biomarkers of disease activity (erythrocyte sedimentation rate and doublestranded DNA concentration) and the British Isles Lupus Assessment Group disease activity score.Conclusion. Our data demonstrate an imbalance in proapoptotic and antiapoptotic factors in both neutrophils and sera from patients with juvenile-onset SLE. This imbalance results in increased neutrophil apoptosis in these patients. Correlations with markers of disease activity indicate that altered neutrophil apoptosis in juvenile-onset SLE patients may play a pathogenic role in this condition.Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with a wide spectrum of clinical and immunologic abnormalities (1) that is characterized by hyperactive B cells that produce a range of autoantibodies. Although the cause of SLE remains unknown, a complex interplay between genetic and environmental factors appears to contribute to its immunopathogenesis. Autoantigens typical of SLE (e.g., Ro, La, double-stranded DNA [dsDNA], RNP, etc.) are clustered in blebs on the surface of apoptotic cells (2). Adult patients with SLE show increased apoptosis and defective clearance of monocytes and lymphocytes (3), as well as increased neutrophil apoptosis (4)....