Accumulating evidence indicates that epigenetic alterations contribute to exacerbated activation or deregulation of the mechanisms that maintain tolerance to self-antigens in patients with lupus, a systemic autoimmune disease that can be triggered by medications taken to treat a variety of conditions. Here, we tested the effect of hydralazine, an antihypertensive drug that triggers lupus, on receptor editing, a chief mechanism of B lymphocyte tolerance to self-antigens. Using mice expressing transgenic human Igs, we found that hydralazine impairs up-regulation of RAG-2 gene expression and reduces secondary Ig gene rearrangements. Receptor editing was also partially abolished in a dose-dependent manner by a specific inhibitor of MEK1/2. Adoptive transfer of bone marrow B cells pretreated with hydralazine or with a MEK inhibitor to naïve syngeneic mice resulted in autoantibody production. We conclude that, by disrupting receptor editing, hydralazine subverts B lymphocyte tolerance to self and contributes to generation of pathogenic autoreactivity. We also postulate that inhibition of the Erk signaling pathway contributes to the pathogenesis of hydralazine-induced lupus and idiopathic human lupus.autoimmune disease ͉ receptor editing D rug-induced lupus (DIL) is a systemic autoimmune disease that can be induced by over 40 medications, including the antihypertensive drug hydralazine and the antiarrhythmic drug procainamide (1). In the patient, the drug reaches a steady-state concentration within a few hours, but the symptoms require several months to develop and fade with therapy discontinuation. Intriguingly, there is no apparent common chemical structure or pharmacologic property among the various medications that trigger similar laboratory and clinical features, and the disease is clinically indistinguishable from idiopathic lupus. Likewise, the mechanisms underlying the induction of DIL remain unclear.The ability of the immune system to distinguish self from non-self is central to its capacity to protect against pathogens and, at the same time, maintains tolerance to its own components. This seminal property is established at discrete nodes, both during early development and adulthood. In the B lymphocyte compartment, several mechanisms have been identified (2). They include clonal deletion of autoreactive lymphocytes, clonal anergy, which converts autoreactive cells to a state that precludes them from becoming activated, and receptor editing, a mechanism that modifies self-reactive B cells and renders them nonautoreactive (3, 4). This latter process can extinguish autoreactivity by displacing a productively rearranged Ig heavy (H)-or light (L)-chain gene by secondary gene rearrangements, forming edited antigen (Ag) receptors with no, or reduced autoreactivity. Importantly, it also represents a powerful mechanism by which autoreactive cells can be generated or fail to be eliminated (5, 6). Editing depends on the products of recombinase activator genes (RAG-1 and RAG-2), and uses the same recombination machinery ...