cells Review Unlocking the Non-IgE-Mediated Pseudo-Allergic Reaction Puzzle with Mas-Related G-Protein Coupled Receptor Member X2 (MRGPRX2) Mukesh Kumar, Karthi Duraisamy and Billy-Kwok-Chong Chow * School of Biological Sciences, The University of Hong Kong, Pokfulam Road, Hong Kong, China;
[email protected] (M.K.);
[email protected] (K.D.) * Correspondence:
[email protected]; Tel.: +852-2299-0850; Fax: +852-2559-9114 Abstract: Mas-related G-protein coupled receptor member X2 (MRGPRX2) is a class A GPCR ex- pressed on mast cells. Mast cells are granulated tissue-resident cells known for host cell response, allergic response, and vascular homeostasis. Immunoglobulin E receptor (Fc"RI)-mediated mast cell activation is a well-studied and recognized mechanism of allergy and hypersensitivity reac- tions. However, non-IgE-mediated mast cell activation is less explored and is not well recognized. After decades of uncertainty, MRGPRX2 was discovered as the receptor responsible for non-IgE- mediated mast cells activation. The puzzle of non-IgE-mediated pseudo-allergic reaction is unlocked by MRGPRX2, evidenced by a plethora of reported endogenous and exogenous MRGPRX2 ag- onists. MRGPRX2 is exclusively expressed on mast cells and exhibits varying affinity for many molecules such as antimicrobial host defense peptides, neuropeptides, and even US Food and Drug Administration-approved drugs. The discovery of MRGPRX2 has changed our understanding of mast cell biology and filled the missing link of the underlying mechanism of drug-induced MC degranulation and pseudo-allergic reactions. These non-canonical characteristics render MRGPRX2 Citation: Kumar, M.; Duraisamy, K.; Chow, B.-K.-C.