The drug or a reactive product reacts with a self-protein or peptide which results in formation of a novel drug conjugate or adduct. This undergoes antigen processing to generate a small, but novel HLA ligand that is loaded onto the HLA and transported to the cell surface, where it can interact with antigen-specific T cells. This process requires a metabilically active antigen presenting cell and time. once generated, the HLA drug-peptide complex is stable and ligand removal requires peptide exchange or peptide stripping from tha HLA groove.
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