Papers

International journal
Jun 30, 2021

Neutrophils initiate and exacerbate Stevens-Johnson syndrome and toxic epidermal necrolysis.

Science translational medicine
  • Manao Kinoshita
  • Youichi Ogawa
  • Natsumi Hama
  • Inkin Ujiie
  • Akito Hasegawa
  • Saeko Nakajima
  • Takashi Nomura
  • Jun Adachi
  • Takuya Sato
  • Schuichi Koizumi
  • Shinji Shimada
  • Yasuyuki Fujita
  • Hayato Takahashi
  • Yoshiko Mizukawa
  • Takeshi Tomonaga
  • Keisuke Nagao
  • Riichiro Abe
  • Tatsuyoshi Kawamura
  • Display all

Volume
13
Number
600
Language
English
Publishing type
Research paper (scientific journal)
DOI
10.1126/scitranslmed.aax2398

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening mucocutaneous adverse drug reactions characterized by massive epidermal detachment. Cytotoxic T cells and associated effector molecules are known to drive SJS/TEN pathophysiology, but the contribution of innate immune responses is not well understood. We describe a mechanism by which neutrophils triggered inflammation during early phases of SJS/TEN. Skin-infiltrating CD8+ T cells produced lipocalin-2 in a drug-specific manner, which triggered the formation of neutrophil extracellular traps (NETs) in early lesional skin. Neutrophils undergoing NETosis released LL-37, an antimicrobial peptide, which induced formyl peptide receptor 1 (FPR1) expression by keratinocytes. FPR1 expression caused keratinocytes to be vulnerable to necroptosis that caused further release of LL-37 by necroptotic keratinocytes and induced FPR1 expression on surrounding keratinocytes, which likely amplified the necroptotic response. The NETs-necroptosis axis was not observed in less severe cutaneous adverse drug reactions, autoimmune diseases, or neutrophil-associated disorders, suggesting that this was a process specific to SJS/TEN. Initiation and progression of SJS/TEN keratinocyte necroptosis appear to involve a cascade of events mediated by innate and adaptive immune responses, and understanding these responses may contribute to the identification of diagnostic markers or therapeutic targets for these adverse drug reactions.

Link information
DOI
https://doi.org/10.1126/scitranslmed.aax2398
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/34193610
PubMed Central
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9392155
ID information
  • DOI : 10.1126/scitranslmed.aax2398
  • Pubmed ID : 34193610
  • Pubmed Central ID : PMC9392155

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