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Beta lactam hypersensitivities

Background

Allergic reactions to drugs are often unpredictable and can lead to serious side effects such as anaphylactic shock. According to the hapten hypothesis, any drug with a molecular weight lower than 1000 daltons cannot induce an immune response by itself and must be bound to a protein. Antigen presenting cells, such as dendritic cells (DC), internalize hapten-protein conjugates and digest them into peptides bound with the drug. The latter are then presented on HLA molecules to drug-specific T cells inducing specific-drug immune response. Knowing that drugs provoke IgE mediated hypersensitivity reactions in treated patients, the CD4+ T-cell response to benzylpenicillin (BP) was investigated. The objectives of this study were to evaluate the frequency of naïve CD4+ T cells specific to BP and to identify BP-haptenized peptides responsible for T lymphocyte activation.

Method

Since BP is known to bind covalently to proteins, such as Human Serum Albumin (HSA), HSA-BP bio-conjugates were synthesized at basic pH (pH=10.8). Seventeen BP binding-sites on HSA were then identified using mass-spectrometry, and 12 BP-haptenized peptides of 15 mer long potentially presented to T-cells via HLA class II molecules were identified and synthetized. Naïve CD4+ T cells from non-allergic donors were stimulated once a week with autologous DC loaded with HSA-BP or with peptide-BP to amplify respectively HSA-BP- or peptide-BP-specific T cells. Activation of specific CD4+ T cells was detected using interferon- EliSpot and their frequency was calculated using the Poisson distribution law.

Results

The results of the CD4+ T-cell response to BP were as follows:

- Detection of HSA-BP-specific CD4+ T cells in 12 out of 13 tested donors with a mean frequency of 0.26 cells/million of circulating CD4+ T cells

- Identification of 17 binding sites of BP on HSA

- Specific naïve CD4+ T cells recognized at least 3 specific peptides, from HSA, haptenized by BP.

Conclusion

This study showed the capacity of HSA-BP to be recognized by naïve T-cells from multiple healthy donors irrespective of their HLA typing and the possibility to identify BP-haptenized peptides involved in the allergic reaction to BP.

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Correspondence to Marie Eliane* Azoury.

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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 (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Azoury, M.E., Scornet, N., Delluc, S. et al. Beta lactam hypersensitivities. Clin Transl Allergy 4, P65 (2014). https://doi.org/10.1186/2045-7022-4-S3-P65

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Keywords

  • Dendritic Cell
  • Human Serum Albumin
  • Allergic Reaction
  • Benzylpenicillin
  • Lactam