Oxidative stress as a potential causal factor for autoimmune hemolytic anemia and systemic lupus erythematosus

Figure 2 Hypothetical role of oxidative stress in triggering the autoimmune reaction against red blood cells in New Zealand Black mice. Elevated ROS trigger oxidative modification of RBC components and result in the production of oxidatively modified compounds such as 4-hydroxy 2-nonenal and acrolein that are highly antigenic. During aging, the oxidation of susceptible molecules and the production of antibodies recognizing them occurs repeatedly, which results in an accumulation of epitopes and autoantibodies. The elevated levels of autoantibodies ultimately trigger AIHA in aged NZB mice. RBCs: Red blood cells; AIHA: Autoimmune hemolytic anemia; MetHb: Methemoglobin; NZB: New Zealand Black; ROS: Reactive oxygen species.