HLA haplotype determines hapten or p-i T cell reactivity to flucloxacillin

J Immunol. 2013 May 15;190(10):4956-64. doi: 10.4049/jimmunol.1202949. Epub 2013 Apr 17.

Abstract

Drug-induced liver injury (DILI) is a main cause of drug withdrawal. A particularly interesting example is flucloxacillin (FLUX)-DILI, which is associated with the HLA-B*57:01 allele. At present, the mechanism of FLUX-DILI is not understood, but the HLA association suggests a role for activated T cells in the pathomechanism of liver damage. To understand the interaction among FLUX, HLA molecules, and T cells, we generated FLUX-reacting T cells from FLUX-naive HLA-B*57:01(+) and HLA-B*57:01(-) healthy donors and investigated the mechanism of T cell stimulation. We found that FLUX stimulates CD8(+) T cells in two distinct manners. On one hand, FLUX was stably presented on various HLA molecules, resistant to extensive washing and dependent on proteasomal processing, suggesting a hapten mechanism. On the other hand, in HLA-B*57:01(+) individuals, we observed a pharmacological interaction with immune receptors (p-i)-based T cell reactivity. FLUX was presented in a labile manner that was further characterized by independence of proteasomal processing and immediate T cell clone activation upon stimulation with FLUX in solution. This p-i-based T cell stimulation was restricted to the HLA-B*57:01 allele. We conclude that the presence of HLA-B*57:01 drives CD8(+) T cell responses to the penicillin-derivative FLUX toward nonhapten mechanism.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • CD8-Positive T-Lymphocytes / immunology*
  • Cells, Cultured
  • Chemical and Drug Induced Liver Injury / metabolism*
  • Floxacillin / pharmacology*
  • HLA-B Antigens / genetics
  • HLA-B Antigens / immunology*
  • Haplotypes
  • Haptens
  • Humans
  • Liver / immunology
  • Liver / pathology
  • Lymphocyte Activation / immunology

Substances

  • HLA-B Antigens
  • HLA-B*57:01 antigen
  • Haptens
  • Floxacillin