An enhanced effect of hCG and Toll-like receptor-7 (TLR-7)/TLR-9 agonist combinations on the up-modulation of co-stimulatory markers on B cells, as well as on the secretion of lupus-associated cytokines and autoantibodies, has also been described (12), an observation of significance since TLR signaling has been linked with lupus progression (13, 14, 67). This evidence concerns the gene TLR9 and systemic lupus erythematosus.