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Cutaneous T-Cell Recruitment in Toxic Epidermal Necrolysis: Further Evidence of CD8+ Lymphocyte Involvement

Cutaneous T-Cell Recruitment in Toxic Epidermal Necrolysis: Further Evidence of CD8+ Lymphocyte... Abstract • Background.— Toxic epidermal necrolysis (TEN) is a life-threatening disease with severe mucocutaneous shedding. Although it is widely accepted that immune mechanisms are at play, the pathophysiology of TEN is still unknown. We studied the blister fluid inflammatory cells in three drugrelated cases to further define the suspected T-cell involvement in TEN. Observations.— A peripheral blood lymphopenia, especially of CD4+ T lymphocytes, was associated with a high lymphocytic cellularity of the blister fluid. In two cases, immunophenotyping of blister fluid lymphocytes showed a predominance of the CD8 phenotype. Furthermore, using two-color flow cytometry in one patient, we could show the predominance of CD8+ CD29+ lymphocytes and CD45RAnegative cells. Conclusions.— Our findings point to a cutaneous recruitment of antigen-primed and cytotoxic T cells in TEN, further supporting the involvement of CD8+ lymphocytes in TEN pathogenesis and its immune mediation.(Arch Dermatol. 1993;129:466-468) References 1. Roujeau JC, Chosidow 0, Saiag P, Guillaume JC. Toxic epidermal necrolysis (Lyell syndrome) . J Am Acad Dermatol. 1990;23: 1039-1058.Crossref 2. Avakian R, Flowers FP, Araujo OE, Ramos-Caro FA. Toxic epidermal necrolysis: a review . J Am Acad Dermatol. 1991;25:69-79.Crossref 3. Merot Y, Gravallese E, Guillén FJ, Murphy GF. Lymphocyte subsets and Langerhans' cells in toxic epidermal necrolysis: report of a case . Arch Dermatol. 1986;122:455-458.Crossref 4. Miyauchi H, Hosokawa H, Akaeda T, Iba H, Asada Y. T-cell subsets in drug-induced toxic epidermal necrolysis: possible pathogenic mechanism induced by CD8-positive T cells . Arch Dermatol. 1991;127:851-855.Crossref 5. Villada G, Roujeau JC, Clérici T, Bourgault I, Revuz J. Immunopathology of toxic epidermal necrolysis: keratinocytes, HLA-DR expression, Langherans' cells, and mononuclear cells: an immunopathologic study of five cases . Arch Dermatol. 1992;128:50-53.Crossref 6. Akbar AN, Salmon M, Janossy G. The synergy between naive and memory T cells during activation . Immunol Today. 1991;12:184-188.Crossref 7. Mackay CR. T-cell memory: the connection between function, phenotype and migration pathways . Immunol Today . 1991;12:189-192.Crossref 8. Bos JD, Zonneveld I, Pranab KD, Krieg SR, Van der Loos CM, Kapsenberg ML. The skin immune system (SIS): distribution and immunophenotype of lymphocyte subpopulations in normal human skin . J Invest Dermatol. 1987;88:569-573.Crossref 9. Picker W, Kishimoto TK, Smith CW, Warnock RA, Butcher EC. ELAM-1 is an adhesion molecule for skin-homing T cells . Nature . 1991;349:796-799Crossref 10. Davis LS, Oppenheimer-Marks N, Bednarczyk JL, McIntyre BW, Lipsky PE. Fibronectin promotes proliferation of naive and memory T cells by signaling through both the VLA-4 and VLA-5 integrin molecules . J Immunol. 1990;145:785-793. 11. Sohen S, Rothstein DM, Tallman T, Gaudette D, Schlossman F, Morimoto C. The functional heterogeneity of CD8+ cells defined by anti-CD45RA (2H4) and anti-CD29(4B4) antibodies . Cell Immunol. 1990;128:314-328.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Cutaneous T-Cell Recruitment in Toxic Epidermal Necrolysis: Further Evidence of CD8+ Lymphocyte Involvement

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Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1993.01680250078010
Publisher site
See Article on Publisher Site

Abstract

Abstract • Background.— Toxic epidermal necrolysis (TEN) is a life-threatening disease with severe mucocutaneous shedding. Although it is widely accepted that immune mechanisms are at play, the pathophysiology of TEN is still unknown. We studied the blister fluid inflammatory cells in three drugrelated cases to further define the suspected T-cell involvement in TEN. Observations.— A peripheral blood lymphopenia, especially of CD4+ T lymphocytes, was associated with a high lymphocytic cellularity of the blister fluid. In two cases, immunophenotyping of blister fluid lymphocytes showed a predominance of the CD8 phenotype. Furthermore, using two-color flow cytometry in one patient, we could show the predominance of CD8+ CD29+ lymphocytes and CD45RAnegative cells. Conclusions.— Our findings point to a cutaneous recruitment of antigen-primed and cytotoxic T cells in TEN, further supporting the involvement of CD8+ lymphocytes in TEN pathogenesis and its immune mediation.(Arch Dermatol. 1993;129:466-468) References 1. Roujeau JC, Chosidow 0, Saiag P, Guillaume JC. Toxic epidermal necrolysis (Lyell syndrome) . J Am Acad Dermatol. 1990;23: 1039-1058.Crossref 2. Avakian R, Flowers FP, Araujo OE, Ramos-Caro FA. Toxic epidermal necrolysis: a review . J Am Acad Dermatol. 1991;25:69-79.Crossref 3. Merot Y, Gravallese E, Guillén FJ, Murphy GF. Lymphocyte subsets and Langerhans' cells in toxic epidermal necrolysis: report of a case . Arch Dermatol. 1986;122:455-458.Crossref 4. Miyauchi H, Hosokawa H, Akaeda T, Iba H, Asada Y. T-cell subsets in drug-induced toxic epidermal necrolysis: possible pathogenic mechanism induced by CD8-positive T cells . Arch Dermatol. 1991;127:851-855.Crossref 5. Villada G, Roujeau JC, Clérici T, Bourgault I, Revuz J. Immunopathology of toxic epidermal necrolysis: keratinocytes, HLA-DR expression, Langherans' cells, and mononuclear cells: an immunopathologic study of five cases . Arch Dermatol. 1992;128:50-53.Crossref 6. Akbar AN, Salmon M, Janossy G. The synergy between naive and memory T cells during activation . Immunol Today. 1991;12:184-188.Crossref 7. Mackay CR. T-cell memory: the connection between function, phenotype and migration pathways . Immunol Today . 1991;12:189-192.Crossref 8. Bos JD, Zonneveld I, Pranab KD, Krieg SR, Van der Loos CM, Kapsenberg ML. The skin immune system (SIS): distribution and immunophenotype of lymphocyte subpopulations in normal human skin . J Invest Dermatol. 1987;88:569-573.Crossref 9. Picker W, Kishimoto TK, Smith CW, Warnock RA, Butcher EC. ELAM-1 is an adhesion molecule for skin-homing T cells . Nature . 1991;349:796-799Crossref 10. Davis LS, Oppenheimer-Marks N, Bednarczyk JL, McIntyre BW, Lipsky PE. Fibronectin promotes proliferation of naive and memory T cells by signaling through both the VLA-4 and VLA-5 integrin molecules . J Immunol. 1990;145:785-793. 11. Sohen S, Rothstein DM, Tallman T, Gaudette D, Schlossman F, Morimoto C. The functional heterogeneity of CD8+ cells defined by anti-CD45RA (2H4) and anti-CD29(4B4) antibodies . Cell Immunol. 1990;128:314-328.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Apr 1, 1993

References