 |
|
Impaired Antigen Presentation in Toxic Epidermal Necrolysis
Martine Bagot, MD, PhD;
Dominique Charue;
Michèle Heslan;
Janine Wechsler, MD;
Jean-Claude Roujeau, MD;
Jean Revuz, MD
Arch Dermatol. 1993;129(6):721-727.
Abstract
| |
• Background and Design.—
The pathophysiology of toxic epidermal necrolysis (TEN) remains largely unknown. Toxic epidermal necrolysis is considered a hypersensitivity reaction to drugs, but direct evidence of an immunologic mechanism is still lacking. Lymphopenia and a decrease in the numbers of circulating CD3- and CD4-positive lymphocytes have been reported in acute phase, but, to our knowledge, no study of cellular immune functions of patients with TEN has been reported so far. Herein, we investigated several T-cell functions in a series of 11 patients with TEN. Peripheral blood mononuclear cells (PBMC) obtained in the acute phase were tested together with PBMC obtained after the patient's recovery and compared with those of age- and sex-matched healthy control subjects.
Results.—
Phytohemagglutinin-induced proliferations and lymphocyte responses in allogeneic mixed lymphocyte reactions were not impaired in the acute phase compared with those after recovery in the same patients and with those in control subjects. In contrast, natural killer cytotoxicity and allogeneic cytotoxic responses were significantly decreased in early TEN. The most striking feature was the significantly impaired ability of acute-phase lymphoid cells to activate allogeneic T cells. Patient PBMC in acute-phase TEN did not inhibit the proliferation induced by patient PBMC after recovery, suggesting that their defect was not related to the presence of radioresistant suppressor cells. The phenotypic expression of HLA-DR, -DQ, and -DP antigens on circulating peripheral blood lymphocytes was then assessed by immunoalkaline phosphatase staining and flow cytometry. Results showed decreased percentages of HLA-DR-positive mononuclear cells and a decreased density of HLA-DR antigens, mainly on monocytes, in acute-phase TEN.
Conclusions.—
These results demonstrate that peripheral blood lymphocytes of patients with TEN have an impaired ability to activate allogeneic T cells. This defective antigen presentation is not secondary to the presence of suppressor lymphocytes, but it is probably related to a decreased expression of HLA-DR antigens on circulating mononuclear cells in acute-phase TEN.
(Arch Dermatol. 1993;129:721-727)
Author Affiliations
From the Departments of Dermatology (Drs Bagot, Roujeau, and Revuz), Pathology (Dr Wechsler), and Research in Immunodermatology (Drs Bagot and Mss Charue and Heslan), Henri Mondor Hospital, Université Paris XII, Créteil, France.
Footnotes
Accepted for publication February 1, 1993.
Reprint requests to Department of Dermatology, Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France (Dr Bagot).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Toxic Epidermal Necrolysis in Children--An Update
Ringheanu and Laude
CLIN PEDIATR 2000;39:687-694.
ABSTRACT
Characteristics of Toxic Epidermal Necrolysis in Patients Undergoing Long-term Glucocorticoid Therapy
Guibal et al.
Arch Dermatol 1995;131:669-672.
ABSTRACT
|
