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Letter


Nature Medicine 14, 1343 - 1350 (2008)
Published online: 23 November 2008 | doi:10.1038/nm.1884

Granulysin is a key mediator for disseminated keratinocyte death in Stevens-Johnson syndrome and toxic epidermal necrolysis

Wen-Hung Chung1,2,3,9, Shuen-Iu Hung2,4,9, Jui-Yung Yang5, Shih-Chi Su2, Shien-Ping Huang2, Chun-Yu Wei2, See-Wen Chin4, Chien-Chun Chiou1, Sung-Chao Chu6, Hsin-Chun Ho1, Chih-Hsun Yang1, Chi-Fang Lu7, Jer-Yuarn Wu2, You-Di Liao2 & Yuan-Tsong Chen2,8


Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening adverse drug reactions characterized by massive epidermal necrosis, in which the specific danger signals involved remain unclear. Here we show that blister cells from skin lesions of SJS-TEN primarily consist of cytotoxic T lymphocytes (CTLs) and natural killer (NK) cells, and both blister fluids and cells were cytotoxic. Gene expression profiling identified granulysin as the most highly expressed cytotoxic molecule, confirmed by quantitative PCR and immunohistochemistry. Granulysin concentrations in the blister fluids were two to four orders of magnitude higher than perforin, granzyme B or soluble Fas ligand concentrations, and depleting granulysin reduced the cytotoxicity. Granulysin in the blister fluids was a 15-kDa secretory form, and injection of it into mouse skin resulted in features mimicking SJS-TEN. Our findings demonstrate that secretory granulysin is a key molecule responsible for the disseminated keratinocyte death in SJS-TEN and highlight a mechanism for CTL- or NK cell—mediated cytotoxicity that does not require direct cellular contact.


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