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Open Access

HLA class I-drug-T-cell receptor interactions in SJS/TEN

  • Craig Rive1,
  • Rebecca Pavlos1,
  • David Ostrov2,
  • Pablo Plasencia2,
  • Shien-Iu Hung3,
  • WenHung Chung4,
  • Bjoern Peters5,
  • Soren Buus6,
  • Simon Mallal7, 8 and
  • Elizabeth Phillips7, 8
Clinical and Translational Allergy20144(Suppl 3):P2

Published: 18 July 2014


CDR3 SequenceCutaneous Drug ReactionExposed MannerQX100 DropletVersus Subtype


Carbamazepine (CBZ) is associated with the severe cutaneous drug reaction Stevens-Johnson Syndrome/toxic epidermal necrolysis (SJS/TEN). CBZ-SJS/TEN has been associated with HLA-B*15:02 carriage and specific T-cell clonotypes. We aimed to characterize the interactions between specific T-cell receptor (TCR) clonotypes, HLA-B*15:02 and CBZ.


Peripheral blood mononuclear cells (PBMCs) were isolated from patients with CBZ-SJS/TEN and healthy controls, stimulated with 10ug/mL CBZ (Sigma, cat. no. C4024-5G) and cultured over a 9-14 day period. RNA was isolated at various time points and TCR V subtypes were assessed using digital droplet PCR (Bio-Rad QX100 droplet digital PCR system). Drug specific T-cell INF and granulysin responses were assessed by ELISpot and ICS. In silico modelling was used to examine the interaction between the known specific TCR V and V chains, CBZ and HLA-B*15:02.


CBZ specific T-cell INF and granulysin responses were detected many years following the original SJS/TEN reaction. Expansion of specific TCR CDR3 sequences was confirmed in CBZ SJS/TEN patient cultures. In silico modelling of the CBZ-HLA-B*15:02-TCR interaction suggests that CBZ binds non-covalently in the P4 binding pocket of the HLA-B*15:02 antigen binding cleft in a site that is typically occupied with bound peptide.


These findings raise two non-mutually exclusive possibilities: 1) CBZ may block peptide binding and be presented by HLA-B*15:02 in a solvent exposed manner available for direct recognition by the TCR, 2) CBZ binding the central portion of the HLA-B*15:02 antigen binding cleft may permit long peptides to bind conventionally at the peptide termini (in the A and F pockets) and bulge over the drug in the central residues to permit indirect recognition of CBZ (peptide mediated TCR contact).

Authors’ Affiliations

Institute for Immunology and Infectious Diseases, Murdoch University, Australia
University of Florida, College of Medicine, USA
Institute of Pharmacology, School of Medicine, Genome Research Centre, National Yang-Ming University, Taiwan
Department of Dermatology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taiwan
La Jolla Institute for Allergy and Immunology, La Jolla, USA
Laboratory of Experimental Immunology, University of Copenhagen, Denmark
Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Australia
Vanderbilt University Medical Centre, USA


© Rive et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.