Plasma samples diluted to 1 1:100 in PBS were added to anti-IgE-coated beads for 30-60 minutes at room temperature, washed with PBST, and stained with labeled ASNase at 1 IU/mL. cells provided complete protection. Combined treatment with either anti-IgE mAb plus a platelet-activating factor receptor antagonist or anti-FcRIII mAb plus a H1 receptor antagonist suppressed asparaginase hypersensitivity. The observations indicate that asparaginase hypersensitivity is mediated by antigen-specific IgG and/or IgE through the immunoglobulin receptors FcRIII and FcRI, respectively. Provided that these results apply to humans, they emphasize the importance of monitoring both IgE- and IgG-mediated asparaginase hypersensitivities in patients receiving this agent. Introduction L-Asparaginase (ASNase) is given repeatedly during treatment regimens for acute lymphoblastic leukemia (ALL). The non-human enzyme is derived from bacteria and inhibits leukemic cell proliferation by depleting asparagine.1 The most common adverse reaction of ASNase in children results from the production of anti-ASNase antibodies (seen in up to 70% of patients) and the onset of clinical hypersensitivity reactions during treatment.2C7 ASNase-mediated hypersensitivity can occur in 30-75% of patients receiving native ASNase3,8C10 and typically manifest as urticaria, angioedema, bronchospasm, dyspnea, and anaphylaxis.11 Typically, if a patient develops SAR156497 a hypersensitivity reaction to first-line PEG-ASNase, a substitution with ASNase is recommended; a subsequent reaction to ASNase may necessitate discontinuing ASNase therapy.12 In addition, the development of anti-ASNase antibodies can increase the risk of relapse by neutralizing ASNase ASNase formulated with 1 mg of aluminum hydroxide adjuvant, on days 0 and 14, as previously described.21 ASNase hypersensitivity reactions were induced in sensitized PTGS2 SAR156497 mice by challenging with a 100 mg IV dose of ASNase on Day 24 of treatment. All experiments with mice were reviewed and conducted under approved protocol by the University of Pittsburgh Institutional Animal Cares and Use Committee. Detection of anti-ASNase IgE by flow cytometry Anti-IgE-biotin (Biolegend, USA) at 1 mg/mL was bound to 3106 streptavidin-coupled 6-8 SAR156497 mm diameter magnetic particles (Spherotech, USA). Plasma samples diluted to 1 1:100 in PBS were added to anti-IgE-coated beads for 30-60 minutes at room temperature, washed with PBST, and stained with labeled ASNase at 1 IU/mL. The stained samples were analyzed by flow cytometry for ASNase fluorescence. Basophilic activation test (BAT) BAT was performed as previously described.22,23 Briefly, 50 mL of blood was incubated for 15 min at 37C and further stimulated with EM-95 at 300 ng/mL, 2.4G2 at 300 ng/mL, ASNase at 1 IU/mL, or medium (as a negative control). Samples were further incubated for 2 h at 37C in 5% CO2, quenched by adding 20 mM EDTA, and incubated on ice for 10 minutes. Cells were blocked with 15% HS in PBS for 30 minutes on ice, washed, and stained with anti-IgE, anti-CD49b, anti-CD200R3, and anti-CD200R1 mAbs for 30-60 minutes at 4C. The cells were then lysed, washed with 1% BSA in PBS, and analyzed by flow cytometry. The percent change in CD200R1 expression is equal to the mean experimental expression of CD200R1 minus that of the mean expression of the sample stimulated with moderate, divided with the mean appearance of the test stimulated with moderate. Likewise, the percent transformation in Compact disc200R3 may be the mean appearance of the test stimulated with moderate without the mean experimental appearance of Compact disc200R3, divided with the mean appearance of the test stimulated with moderate. immune system cell depletion Anti-CD4 mAb or anti-CD19 mAb had been injected IP in mice at 200 mg/mouse three times before every sensitization dosage of ASNase. Cell depletions had been confirmed by stream cytometry, as defined above, where different mAb clones targeting CD19 or CD4 were employed for cell staining and depletion. Mice had been challenged with ASNase on Time 24, as defined above. preventing of ASNase-induced hypersensitivity reactions with anti-IgE or anti-FcRIIB/III mAb To avoid IgE- or IgG-mediated hypersensitivities, an individual 100.