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Immunopathogenesis and Novel Therapeutic Strategies for Systemic Lupus Erythematosus: Third Edition

A special issue of International Journal of Molecular Sciences (ISSN 1422-0067). This special issue belongs to the section "Molecular Immunology".

Deadline for manuscript submissions: closed (20 April 2026) | Viewed by 1642

Special Issue Editors


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Guest Editor
Department of Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
Interests: rheumatology; internal diseases; systemic lupus erythematosus; arthritis; systemic sclerosis; idiopathic inflammatory myopathies; preconception and pregnancy in chronic diseases
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Guest Editor
Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland
Interests: systemic lupus erythematosus; rheumatic diseases; internal medicine; connective tissue disease in pregnancy

Special Issue Information

Dear Colleagues,

Systemic lupus erythematosus (SLE) is a connective tissue disease that may serve as a prototype for almost all autoimmune diseases. Its diverse clinical presentations and involvement in all vitally important internal organs is challenging for treating physicians. Moreover, despite enormous progress in rheumatology and clinical immunology, the pathophysiological background of the disease is still not completely understood. From a clinical point of view, corticosteroids and immunosuppressants are still the gold standard for the treatment of SLE. The main reason for this is the continued lack of new treatment strategies that are safe and efficacious for SLE. Therefore, understanding SLE’s pathogenic background and disease-driving mechanisms will contribute to the development of novel therapeutic strategies.

SLE pathogenesis is complex and, obviously, no single pathological mechanisms will be responsible for all SLE presentations. Moreover, the existence of many pathological theories suggests quite convincingly that none of these mechanisms are universal or explain the disease satisfactorily. In the course of SLE, several immunological phenomena may be observed, such as the loss of tolerance to self-antigens, autoreactive T- and B-cell activation, the synthesis of autoantibodies, and the activation of interferon. In recent years, advances in immunology have translated into the identification of several molecular and cellular targets, the modulation of which may exert therapeutic potential in the disease.

This Special Issue is designed as a platform to provide recent research advantages that focus on understanding the immuno-pathological mechanisms, biomarkers, and novel therapeutic strategies for SLE. Both review and research papers are welcomed. Please note that pure clinical or model studies are unsuitable for this journal, but clinical submissions with biomolecular studies are welcome. Topics include, but are not limited to, the following:

  • The genetic background of SLE;
  • The epigenetic regulation of lupus;
  • Cellular and molecular mechanisms in lupus;
  • The role of cytokine networks in lupus progression;
  • Innate and adaptive immunity in SLE;
  • The role of immunocompetent cells in lupus pathogenesis and disease mechanisms;
  • The role of interferon and interferon signatures in lupus pathogenesis;
  • Novel lupus biomarkers in SLE diagnosis and monitoring disease activity;
  • Novel therapeutics and new treatment strategies for lupus.

Prof. Dr. Marzena Olesińska
Dr. Hanna Przepiera-Bȩdzak
Guest Editors

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Keywords

  • systemic lupus erythematosus
  • SLE pathogenesis
  • the epigenetic regulation of lupus
  • the genetic background of SLE
  • interferon
  • cytokine networks
  • innate immunity
  • adaptive immunity

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Related Special Issue

Published Papers (2 papers)

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Review

16 pages, 517 KB  
Review
Redefining Difficult-to-Treat Systemic Lupus Erythematosus: Biomarkers of Molecular Refractoriness Beyond Clinical Failure
by Agata Matusiewicz, Alicja Paś, Sylwia Wiktorzak and Marzena Olesińska
Int. J. Mol. Sci. 2026, 27(9), 4026; https://doi.org/10.3390/ijms27094026 - 30 Apr 2026
Abstract
Difficult-to-treat systemic lupus erythematosus (D2T-SLE) remains a major unmet challenge in contemporary lupus care, yet it continues to be defined predominantly by clinical non-response rather than underlying biology. Current biomarkers largely quantify inflammatory burden, immune complex activity, or organ damage and do not [...] Read more.
Difficult-to-treat systemic lupus erythematosus (D2T-SLE) remains a major unmet challenge in contemporary lupus care, yet it continues to be defined predominantly by clinical non-response rather than underlying biology. Current biomarkers largely quantify inflammatory burden, immune complex activity, or organ damage and do not reliably capture persistent activation of pathogenic pathways under therapy. Emerging multi-omics, single-cell, and longitudinal studies suggest that, in a subset of patients, apparent treatment failure may reflect incomplete attenuation of dominant immune circuits rather than uniformly elevated inflammation. We propose molecular refractoriness in systemic lupus erythematosus (SLE) as sustained, pathway-level immune activity despite apparently adequate, mechanism-directed therapy. We outline the major immune programs implicated in this process—including interferon-enriched, B-cell/plasmablast-associated, neutrophil extracellular trap (NET)-related, cytotoxic T-cell, and cytokine-associated states—and discuss their relevance for biomarker development and precision trial design. Importantly, we emphasize that interferon gene signatures (IGS) should be interpreted as context-dependent and non-specific markers of interferon responsiveness, reflecting combined activity of type I, II, and III interferons, and functioning primarily as predictive rather than mechanistic biomarkers. We further highlight critical limitations of a purely endotype-based model, including the need to distinguish true molecular refractoriness from damage-dominant and pseudo-refractory states, as well as the emerging role of immune-reset strategies such as cluster of differentiation 19 (CD19)-directed chimeric antigen receptor T-cell (CAR-T) therapy, which may overcome refractoriness independently of specific pathway dominance. These observations suggest that difficult-to-treat SLE encompasses biologically heterogeneous states that may not be fully captured by pathway-resolved stratification alone. Reframing D2T-SLE as a biologically heterogeneous state of incomplete immune attenuation may help bridge the gap between clinical treatment failure and mechanism-informed precision medicine in systemic lupus erythematosus. Full article
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21 pages, 307 KB  
Review
Systemic Lupus Erythematosus: Ophthalmological Safety Considerations of Emerging and Conventional Therapeutic Agents
by Wojciech Luboń, Małgorzata Luboń, Anna Agaś-Lange and Mariola Dorecka
Int. J. Mol. Sci. 2025, 26(23), 11744; https://doi.org/10.3390/ijms262311744 - 4 Dec 2025
Cited by 1 | Viewed by 1190
Abstract
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disorder in which ocular involvement represents a clinically significant yet frequently underrecognized contributor to morbidity. Ocular manifestations in SLE may arise from disease activity itself, but also as adverse effects of long-term pharmacological therapy. [...] Read more.
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disorder in which ocular involvement represents a clinically significant yet frequently underrecognized contributor to morbidity. Ocular manifestations in SLE may arise from disease activity itself, but also as adverse effects of long-term pharmacological therapy. With the advent of targeted immunomodulatory agents, the therapeutic landscape of SLE has expanded beyond conventional drugs such as hydroxychloroquine and corticosteroids toward biologics and small molecules designed to interfere with specific immunological pathways. These advances have improved systemic disease control and survival; however, their ophthalmological safety profiles remain only partially defined. This review synthesizes current evidence on ocular adverse events associated with both traditional and emerging SLE therapies. Established agents, particularly hydroxychloroquine and corticosteroids, are consistently linked to complications including retinopathy, posterior subcapsular cataracts, steroid-induced glaucoma, and central serous chorioretinopathy. In contrast, recently approved or investigational therapies—such as belimumab, anifrolumab, voclosporin, dual BAFF/APRIL inhibitors, rituximab, JAK inhibitors, CD40/CD40L blockade, CD38 inhibition, and mesenchymal stromal cell-based strategies—have limited but evolving safety data, with potential ocular adverse events spanning inflammatory, vascular, neuro-ophthalmic, and structural domains. Although ocular complications appear infrequent in clinical trials, underdetection in real-world practice and insufficient long-term monitoring may underestimate their true incidence. These findings highlight the need for systematic ophthalmological surveillance in patients receiving immunomodulatory therapies for SLE. Early recognition and timely management of ocular toxicity are crucial to safeguarding visual function and optimizing long-term therapeutic outcomes in this vulnerable patient population. Full article
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