title: Blister fluid T lymphocytes during toxic epidermal necrolysis are functional cytotoxic cells which express human natural killer (NK) inhibitory receptors.
abstract: Toxic epidermal necrolysis (TEN) is a rare life-threatening adverse drug reaction characterized by a massive destruction of the epidermis. Immunohistological studies of skin biopsies of TEN showed infiltrates of predominantly CD8+ T lymphocytes even though other authors reported a prominent involvement of cells of the monocyte-macrophage lineage. The aim of this study was to characterize phenotypically and functionally the cells present in the cutaneous blister fluid of four patients with TEN. We first determined that lymphocytes were predominant in blister fluid obtained early, while monocytes/macrophages later became the most important population. We then showed that this lymphocyte population, mainly CD3+CD8+, corresponded to a peculiar cell subset as they expressed cutaneous leucocyte antigen, killer inhibitory receptors KIR/KAR and failed to express CD28 molecule. Functionally, we determined that blister T lymphocytes had a cytotoxic T lymphocyte (CTL)- and NK-like cytotoxicity. The role of this cytotoxic lymphocyte population present at the site of lesions during TEN remains to be understood.
authors.affiliation: Department of Dermatology, INSERM U448, Hôpital Henri Mondor, Créteil, France.
authors.forename: L
authors.initials: L
authors.lastname: Le Cleach
authors.forename: S
authors.initials: S
authors.lastname: Delaire
authors.forename: L
authors.initials: L
authors.lastname: Boumsell
authors.forename: M
authors.initials: M
authors.lastname: Bagot
authors.forename: I
authors.initials: I
authors.lastname: Bourgault-Villada
authors.forename: A
authors.initials: A
authors.lastname: Bensussan
authors.forename: J C
authors.initials: JC
authors.lastname: Roujeau
mesh_terms: D000328:Adult; D001768:Blister / Q000276:immunology*; D001826:Body Fluids / Q000276:immunology; D017252:CD3 Complex / Q000378:metabolism; D016827:CD8 Antigens / Q000378:metabolism; D003602:Cytotoxicity, Immunologic; D005260:Female; D006801:Humans; D007694:Killer Cells, Natural / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011971:Receptors, Immunologic / Q000378:metabolism; D054340:Receptors, KIR; D055607:Receptors, Natural Killer Cell; D013262:Stevens-Johnson Syndrome / Q000209:etiology / Q000276:immunology*; D016176:T-Lymphocyte Subsets / Q000276:immunology*; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology
chemical_list: D017252:CD3 Complex; D016827:CD8 Antigens; D011971:Receptors, Immunologic; D054340:Receptors, KIR; D055607:Receptors, Natural Killer Cell