Characterization of Drug-Specific CD4<sup>+</sup> T-Cells Reveals Possible Roles of HLA Class II in the Pathogenesis of Carbamazepine Hypersensitivity Reactions
Issued Date
2022-01-01
Resource Type
ISSN
0893228X
eISSN
15205010
Scopus ID
2-s2.0-85154063554
Pubmed ID
37074725
Journal Title
Chemical Research in Toxicology
Rights Holder(s)
SCOPUS
Bibliographic Citation
Chemical Research in Toxicology (2022)
Suggested Citation
Jaruthamsophon K., Thomson P.J., Hammond S., Zhang E., Alfirevic A., Sukasem C., Naisbitt D.J., Pirmohamed M. Characterization of Drug-Specific CD4<sup>+</sup> T-Cells Reveals Possible Roles of HLA Class II in the Pathogenesis of Carbamazepine Hypersensitivity Reactions. Chemical Research in Toxicology (2022). doi:10.1021/acs.chemrestox.2c00414 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/86886
Title
Characterization of Drug-Specific CD4<sup>+</sup> T-Cells Reveals Possible Roles of HLA Class II in the Pathogenesis of Carbamazepine Hypersensitivity Reactions
Other Contributor(s)
Abstract
Carbamazepine (CBZ) is an aromatic anticonvulsant known to cause drug hypersensitivity reactions, which range in severity from relatively mild maculopapular exanthema to potentially fatal Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS-TEN). These reactions are known to be associated with human leukocyte antigen (HLA) class I alleles, and CBZ interacts preferentially with the related HLA proteins to activate CD8+ T-cells. This study aimed to evaluate the contribution of HLA class II in the effector mechanism(s) of CBZ hypersensitivity. CBZ-specific T-cells clones were generated from two healthy donors and two hypersensitive patients with high-risk HLA class I markers. Phenotype, function, HLA allele restriction, response pathways, and cross-reactivity of CBZ-specific T-cells were assessed using flow cytometry, proliferation analysis, enzyme-linked immunosorbent spot, and enzyme-linked immunosorbent assay. The association between HLA class II allele restriction and CBZ hypersensitivity was reviewed using Allele Frequency Net Database. Forty-four polyclonal CD4+ CBZ-specific T-cell clones were generated and found to be restricted to HLA-DR, particularly HLA-DRB1*07:01. This CD4+-mediated response proceeded through a direct pharmacological interaction between CBZ and HLA-DR molecules. Similar to the CD8+ response, CBZ-stimulated CD4+ clones secreted granulysin, a key mediator of SJS-TEN. Our database review revealed an association between HLA-DRB1*07:01 and CBZ-induced SJS-TEN. These findings implicate HLA class II antigen presentation as an additional pathogenic factor for CBZ hypersensitivity reactions. Both HLA class II molecules and drug-responsive CD4+ T-cells should be evaluated further to gain better insights into the pathogenesis of drug hypersensitivity reactions.