Five drugs associated with systemic lupus erythematosus were studied for their effect on the salt-induced right-handed (B) to left-handed (Z) transition of poly (dG-me5dC) . poly(dG-me5dC). Using circular dichroism spectroscopy, procainamide and hydralazine were found to reduce the midpoint of B to Z transition from 0.8M NaCl to 0.5M NaCl and to increase the rate of this transition at 1M NaCI. Isoniazid and D-penicillamine had less effect on the midpoint of transition and practically no effect on the kinetics. N-acetyl procainamide (a structurally related control for procainamide) and L-canavanine had no effect. Procainamide caused slight reduction in the helix-coil transition (melting) temperature of calf thymus DNA. At a concentration of 1 : 1 (DNA phosphate : drug ratio), procainamide and hydralazine also caused the aggregation of calf thymus DNA. Since altered DNA conformations, such as Z-DNA, are more immunogenic, these results suggest that the induction or stabilization of Z-DNA by these drugs might be important in the pathogenesis of at least some cases of systemic lupus erythematosus.The presence of a variety of antibodies showing differing degrees of specificity to nuclear components-DNA, RNA, histones-is the hallmark of idio- pathic and drug-induced systemic lupus erythematosus (SLE) ( 1 4 ) . In addition to antibodies against right-handed (B) DNA and single-stranded (ss) DNA, recent reports indicate the presence of antibodies to left-handed (Z) DNA in SLE patient sera (5,6). Antibodies raised from the autoimmune MRL/lpr-lpr mouse strain also show specificity for different forms of Z-DNA (7). Z-DNA is an effective antigen, as demonstrated by Lafer et a1 (8), who produced anti-Z-DNA antibodies by exogenous administration of brominated poly(dG-dC) . poly(dG-dC) in mice and rabbits. Using these antibodies, the presence of segments of Z-DNA has been revealed in some native genomes, such a s the interband region of the Drosophila polytene chromosome (9).The DNA sequences which are capable of converting to the Z form in the presence of salts, alcohols, and polyamines are mainly constituted of alternating purine-pyrimidines: specifically, dG-dC and its derivatives (10). However, DNA sequences consisting of (dT-dG), . (dC-dA), also undergo the right-handed to left-handed transition upon covalent modification with drugs such as acetylaminofluorene (1 1). These potential Z-DNA-forming sequences are widely dispersed in the human genome (12) and other native DNAs (13). Van Helden (14) recently reported that DNA fragments isolated from the serum of an SLE patient were rich in these potentially Z-DNA-forming regions. Similarly , Sano and Morimoto (1 5,16) reported that DNA fragments isolated from DNA-anti-DNA immune complexes contained a higher percentage of guaninecytosine (G-C) sequences compared with the average percentage of such sequences in total human DNA (5040% versus 38%). In addition, SLE sera show a high binding affinity for DNA fragments containing elevated G-C content or Z-form conformation (17).