Annual Review of Immunology Volume 16 1998

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Annual Review of Immunology Volume 16, 1998

Annu. Rev. Immunol. 1998.16:1-25. Downloaded from arjournals.annualreviews.org by HINARI on 08/31/07. For personal use only.

CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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EUREKA! AND OTHER PLEASURES Annu. Rev. Immunol. 1998.16:1-25. Downloaded from arjournals.annualreviews.org by HINARI on 08/31/07. For personal use only.

H. Metzger Section on Chemical Immunology, Arthritis and Rheumatism Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland 20892-1820; e-mail: [email protected] KEY WORDS:

philosophy of science, protein chemistry, scientific method

ABSTRACT At first one is very pleased at being invited to write a Prefatory Chapter, but as the delivery deadline draws closer one begins to think, “Oh my God! What on earth can I say that all but family members and few close friends will not find a great bore?” One solution is to write a scientific essay, but I concluded that that was a cop-out. I decided that perhaps the best tack to follow was to try to convey to the reader the personal characteristics I bring to my science and to other aspects of my professional career. The writing of this chapter has certainly convinced me that my particular background influenced what problems I chose to work on and how I approached their solution, but I hope that my results have a more ecumenical significance. There’s been much written recently about how one’s cultural background affects one’s science, but I think that thesis can also be exaggerated. Science is a method of inquiry that by using certain guidelines permits rational individuals to observe Nature in a way that their findings will agree and have permanence. We shouldn’t be diffident about defending that claim of objectivity.

LEIT MOTIF My increasingly sedentary work routine prompted me to take up jogging. I run two to three miles a day either in my neighborhood or to work, and since it is strictly recreational, I do it at a pace that exerts but doesn’t exhaust me. At one point in my neighborhood route, there’s a landmark where I look at my watch to check my pace, and yesterday I passed there at 13.28 min. Today, I did the same course and at the same point my watch read 13.29 min. During the remainder of the run I contemplated that fact. I thought of the number ∗

The US government has the right to retain a nonexclusive, royalty-free license in and to any copyright covering this paper.

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of biochemical reactions that had transpired in each of those two sprints, a number whose vastness I could barely approximate. I won’t see the day when one understands how the critical molecular governors in my mind and muscles achieve such a reproducible output, but I’m convinced that others will.

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EARLY YEARS I was born in March 1932 in Mainz, Germany, into a solid middle-class wellassimilated Jewish family. My father and his oldest brother worked in my grandfather’s hardware store while their other brother was an ophthalmologist; their sister, despite their father’s opposition, also became a physician and ultimately a psychoanalyst. My mother’s father had a stationery supplies business in Wiesbaden in which her brother was also engaged. Pictures from my early years (my father was an avid photographer) give no hint of the terrible political happenings about which I was to learn in later years, and I have no disturbing personal recollections of that period. I learned much later that in the mid-1930s my mother was pressuring my father to leave, but he resisted. Possibly he was ultimately persuaded by his older sister Emy, the psychiatrist, who was the first of the paternal siblings to emigrate to the USA and who visited us in 1936. What I personally recall of her visit was the toy she brought me: a very un-Germanic mechanical cowboy twirling his lasso on a rearing horse. My father’s American relatives (who had emigrated to New York early in the century) must have been unaware of the imminent threat to European Jews. They vouchsafed him for only a single affidavit so that he could first demonstrate that he was capable of earning a living before bringing over the rest of his family. I remember clearly his leaving in February 1937; I was not to see him again until we arrived in New York City 11 months later. Within a year and a half of my own family’s emigration, two other families who had been close friends to my own in Germany came over also, and for many years we rented a large apartment jointly with one family, just one floor below where the other rented. We lived in the Washington Heights district of Manhattan, and except for the 4 years I spent in college, I lived there for almost 20 years. As I think about the influences of nature and nurture on my choice of career and how I pursued it, it is clear that both contributed. Even as a very young child I apparently had a “sunny disposition”; optimism and a reasonable amount of naivete are helpful for the experimental scientist. Also at a very early age I was much engaged by elaborate jigsaw puzzles; I have the vague feeling that my career in the laboratory has been an extension of the mind set that gets pleasure from such games. My father was also an optimist (my mother felt he was to a fault), and many of his other traits left their mark. Above all was his interest in understanding how things work. On Friday evenings, after a joint sabbath

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meal, the three families (for a while, with three generations there might be as many as 15 of us) would sit around and talk over domestic and world events. My father tended not to participate in these discussions; he read virtually not at all and had little interest in cultural or political matters. But when the subject turned on a technical question—e.g. about how the newfangled thing called TV works—everyone would turn to him, and he was in his element. My father taught both my brother and me to work with tools, and even when we were quite young, our projects were judged by high if not harsh standards. But above all it was my psychiatrist aunt who had the most influence on me, and she and I were good pals. (She was unmarried and had no children of her own and I was her “goldfish.”) She was the family member with whom I developed the strongest intellectual ties as this sphere of life became increasingly important to me.

SCHOOLING If nothing else, economic considerations foreclosed any alternative to attending the neighborhood school, but in fact in those years, the public schools in New York City from elementary school to college were considered excellent. As fresh immigrants we knew no English but picked it up spontaneously, and I recall no difficulties with that adjustment; of course the last thing we wanted to do in the years after our arrival was to speak German in public. Our neighborhood was ethnically mixed, though at that time, Blacks (strange—in those years it was used as a derogatory term!) lived largely to the south of us in Harlem. Many in our neighborhood were recent immigrants like ourselves, but there were also more established Americans. Serious racial, ethnic, or religious friction was not part of my daily life, though slurs and jokes about this group or that were commonplace. Discipline in school was firm but not unduly so, and physical punishment was rare although I can recall specific instances. Report cards saved by my parents indicate that my deportment was imperfect, but my other grades were good enough to qualify me to take the entrance examination for the relatively new Bronx High School of Science to which I then went for four years. (The local high school, George Washington, was thought to be inferior, although attending it didn’t stop at least one of the local immigrant boys, Henry Kissinger, from making his way in the world.) I worked reasonably hard at my studies, but the Bronx High School of Science was a special place; a four-year grade average of about 90 nevertheless placed me in only the bottom half of the class! Although the course work was excellent, I disliked the scholastic competitiveness, and a respite from the New York City atmosphere seemed inviting. Both my psychiatrist aunt who knew or knew about several faculty members there, and my school counselor urged me to consider the University of Rochester. The “U of R” had an early-decision

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policy, and being admitted, I never applied elsewhere. At least among my companions, one didn’t even consider visiting various campuses to engage in comparative shopping with or without parents, and I would have been chagrined had my parents accompanied me to help me settle in. I wonder whether parents who lead their children through this process do them a disservice by depriving them of the valuable experience of jumping out of the nest on their own. Heck, many of our forefathers (and mothers!) emigrated from Europe by themselves at even tenderer ages. Leaving home was nothing new for us kids. From the age of nine years, we abandoned the city during the summers, first to various subsidized camps, and starting at age 14, to work as busboys, waiters, farm hands, or camp counselors. Just around the time I entered college, The Saturday Evening Post had characterized the city from which the University took its name as one where on a Saturday night, adult entertainment consisted of listening to one’s children play the violin. Like the city, the University was a solid (I suppose some might say stolid) institution that enjoyed its sports but valued its scholastics. For reasons I’m unclear about, my first year at college did not go well. I didn’t enjoy the course work and my grades were barely passable. Fortunately, my aunt persuaded me to give my pre-med major one more year’s try. The succeeding years went much better, and I particularly enjoyed the biological courses: comparative anatomy, botany, genetics, and especially embryology. The latter was taught by Johannes Holtfreter, a student of one of the fathers of experimental embryology, the Nobel laureate Hans Spemann. Holtfreter’s was also a German emigr´e, and his pronunciation of “extrogastrulation,” an experimental method he had pioneered under Spemann, was unforgettable. We became friends, and I am still reminded of him daily because it was he who taught me how, with the newly invented ballpoint pen, a southpaw like me could write without scrunching my hand around the way most left-handers still do! During my college years, 1949–1953, many World War II veterans were still taking advantage of the GI Bill, and one of them, Peter Carillo, became a close friend with whom I would sometimes study. A Sunday noon meal at his mother-in-law’s home was one of those memorable experiences that was only to be equaled years later on visits to Rome and Naples with professional friends. Peter himself went into dentistry, but his veteran colleagues caused considerable anguish: Because of them the number of well-qualified applicants to medical school far exceeded the number of available slots. Throughout those college years, the question of whether we would be admitted was an almost daily concern for us pre-meds. In the event, by the time our class of ’53 came around, the situation had eased, and I was accepted for admission at Columbia University’s College of

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Physicians and Surgeons (“P&S”). It was situated just a mile south of where I had been raised, and the possibility of living at home was a major economic plus. I have been told that was the year the school dropped its admissions quota on Jews (but not until years later on women).

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MEDICAL SCHOOL In one of my discussions with my confidant Aunt Emy about what it was like for her in Germany before she emigrated, she recalled that what was most upsetting was the ostracism by many of her non-Jewish medical colleagues. She pointed out that physicians perhaps more than other professionals, develop especially close professional relationships because of the shared experiences in dealing with the most profound human joys and tragedies, courage and frailties. The rupture of those relationships during the early 1930s caused her great pain even in remembrance. I mention this because I think this aspect of the medical school experience is indeed special; I feel bonds with many of my former classmates and house officers that have never dissolved despite four decades of inattention to them. These were the years just before the explosion in knowledge about protein structure and biosynthesis and their genetic basis. As medical students we had no inkling of the impending revolution in knowledge, the impact of which on medicine is only beginning to be manifest. It is with sympathetic amusement now that I recall Erwin Chargaff telling us freshman medical students about his finding that regardless of the source of DNA, the ratio of adenine to thymidine was always close to 1 (as was that of cytosine:guanine); he knew it must mean something important but just couldn’t fathom what it could be. It was left to Watson and Crick to explain it to us in their letter to Nature that same year (1). During the second year I was introduced to immunology, and we had our first contact with one of the giants of immunochemistry, Elvin Kabat. His quantitative approach swayed many interested in immunology in those days, and although I never worked with him directly, I count him among those who considerably influenced the way I do my science. Immunology was well represented at Columbia at that time, and during my third year, I chose to spend an elective semester doing research in that discipline. Dr. Beatrice Seegal agreed to have me work on a model of autoimmune nephritis in her laboratory. Dr. Seegal (I don’t think I would have used “Beatrice” at that time) was a much quieter person than her effusive husband David—a prominent figure in American medicine who headed the medical service at Goldwater Memorial Hospital where many of us took clinical rotations—but under her gentle demeanor was a fiercely determined investigator. She was meticulous in her laboratory work, and it was really from her that I learned

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good technique, attention to detail, and basically how to convert a question into a doable experiment. One cannot refer to Beatrice Seegal’s laboratory without mentioning her side-kick Konrad Hsu. A microscopist, he was also a major figure among the Chinese Masons, and to this day I have no idea what all those hushed phone calls he was continuously engaged in were all about. He was a reliable rock of support for us neophytes in the laboratory. In a setting that I suspect did not differ all that much from an old-fashioned “match-making,” I was introduced to my future wife, Deborah, at the end of my third year. Only a few days after that meeting she left for rural Pennsylvania to work on a project with migrant laborers sponsored by the American Friends Service Committee, but as soon as possible after the end of summer and without any further family prompting, I called her up for our first date. Our marriage the following June was in part made practical by my having been offered an internship at Columbia-Presbyterian Hospital, so I could stay in New York City while she completed her senior year at Columbia’s Barnard College.

CLINICAL YEARS Internship and residency in the medical service at Columbia-Presbyterian under the leadership of Robert F Loeb was a special treat. Loeb (the son of Jacques Loeb the renowned physiologist and reductionist) was one of the giants of American medicine; during the second quarter of the twentieth century, he had been among the pioneers who brought rigorous laboratory science to the bedside. Devoted to his profession, he tended to be intolerant of young trainees who didn’t, or didn’t appear to, share the kind of super full-time commitment he had to his discipline. I think that by the time I first met him (starting with my junior year of medical school), the edge of that intolerance was less keen (his manner and hair color earned him the sobriquet “silver fox”), and certainly to his house staff he was intensely loyal and kind. He conducted “sunrise services” with us in his office before the clinical work day started, and the discussions might range broadly over medical fine points or the essays of Montaigne he was reading. He was an extraordinary teacher, and as harsh as he sometimes was with trainees, he was the gentlest of physicians with patients. A major epidemic of influenza occurred during the year of my internship (1957–1958) and that plus the attendant overwork caused perhaps 10 of the 12 of us medical interns to succumb to some illness or another—in some cases for long periods. I escaped that fate, but my new wife spent a rather lonely first year of our marriage. Just two weeks into my residency I came down with a classic case of pneumococcal pneumonia. Even though the internship at Columbia was not considered as strenuous as some others (it was said that it took “iron men” to survive basic training at the Massachusetts General Hospital), still we

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would be on call 36 hours at a time, have 12 hours off, and then begin again. If luck was running against one (we sometimes forgot that of course it was actually running against the patients), one could be up most of every second night and pretty exhausted much of the time. This was still an era before a more egalitarian atmosphere began to invade the medical wards, so even young doctors were treated with considerable respect by patients and nurses. We shaved carefully, wore ties and starched uniforms, and were expected to have shined or well-whitened shoes. At the end of those two years, one really began to feel pretty confident in one’s abilities—a comfortable feeling of competence I would never again enjoy once I went into research! Although I was to enter the arcane world of protein physical chemistry, I have never regretted beginning my professional career with medical school and the years of clinical training that followed. The latter were intense in terms of human interactions, and they contributed to my knowledge of the human organism in ways that the more academic experience alone could not.

FIRST YEARS AT NIH The physicians’ draft initiated during the Korean “police action” was still in effect in the late 1950s. After deferral for two years of clinical training, all male physicians were required to serve in a uniformed service for two years. Pursuing biomedical research at the National Institutes of Health as a member of the Commissioned Corps of the US Public Health Service satisfied the service requirements and was a professional opportunity for which many of us hotly competed. There were so many aspirants that one had to go through a process much like that used to secure the top post-medical school clinical traineeships, and the letter from the NIH bringing the good news was awaited just as expectantly as the postings of the national matching plan for internships. (Although technically at risk for being called up any time of day or night to serve in a national emergency, the only time that affected any substantial number of commissioned officers that I recall was years later when a contingent was sent to the South to monitor the adherence to the new civil rights legislation as it related to hospital facilities.) In July of 1959 Deborah (now six months pregnant) and I took up residence in the Parkside Apartments in northern Bethesda, the first nesting place for many new recruits at the NIH and dubbed “birthesda” in those days. Thus began a marvelous two years working in Harold Edelhoch’s lab within the Clinical Endocrinology Branch of what was then called the National Institute of Arthritis and Metabolic Diseases (NIAMD). Led by JE Rall, the Branch’s research principally focused on the thyroid, and Harold, a protein physical chemist, had been persuaded to stop working on pepsin and to investigate

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thyroglobulin instead. I had landed there not because of a special interest in endocrinology but because I wanted to learn how to work with proteins: Edelhoch was a well-trained protein chemist who was generously willing to take me on despite my lack of credentials in his field. I had never even taken a course in physical chemistry, and eight years had passed since I’d used logarithms, but Beatrice Seegal and others in her department had advised me that if I was interested in pursuing immunological research, learning some protein chemistry would be a worthwhile investment. They pointed to the recent achievements of Lapresle in defining the antigenic sites on albumin (2), and to the powerful technique of ion exchange chromatography of proteins worked out by Sober & Peterson (3) that were being applied by John Fahey to clinical specimens (4). I was Harold’s first postdoctoral fellow, and initially in the laboratory it was just he, Roland Lipoldt—a research associate in the current parlance—and me. I almost literally rubbed elbows with Harold because my desk was right next to his; contact with him was daily and constant. My first assignment graphically underscores how different the research environment was then. He asked me to determine the pKs of the carboxyl and amino groups of glycine and to compare my results with the literature values. Everything had to be prepared by me from scratch. Beginning with a sample of potassium phthalate obtained from the National Bureau of Standards, I had to dry it to constant weight, weigh out some of it to make a solution of accurately known molarity, use that to determine accurately the molarity of a solution of NaOH, and use the latter to determine the molarity of a solution of HCl. With a glass electrode, the base and acid were then used to titrate a carefully prepared solution of glycine in a water-jacketed beaker attached to a thermostated water bath. When it was all done, the values I obtained were compared with those in Cohen & Edsall’s classic text (5). I have no recollection about what accuracy I achieved, but it must have been good enough so that—even though during the exercise I broke several of those precious electrodes that were just then being introduced—Harold ultimately let me graduate to the Model E ultracentrifuge, the Model H electrophoresis apparatus, and similar behemoths of sophisticated hardware that were the stock in trade of protein physical chemists in those days (and which now stand in museums). Years later, I would recall my training and respect for quantitative chemistry in Harold’s laboratory when I became involved in L’affair du chat Cheshire (below). Harold had taped to one of the lab cabinets a New Yorker cartoon showing a sculptor in a studio containing several small abstract pieces; perched on a ladder he is chipping away on a gigantic bust of Abraham Lincoln. He shouts down to his puzzled colleague standing below: “Well, a man has got to making living, doesn’t he?” Confronting the dilemma of how to survive in research, there is no obvious single answer to that plaintive query.

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Beginning in the 1950s, the NIH became a premier training ground for US biomedical scientists and for many non-US professionals as well. The story of what made it so special has only been partly written (6). One factor was the sheer number of talented individuals in one spot pursuing work that was so obviously leading to the unraveling of so many important problems. The atmosphere was generally congenial and unencumbered by the kinds of regulations and restriction under which we now function. Just to mention a few signs of the times: In the auditorium of the huge Clinical Center each of the 550 seats had an ashtray on its back; these were actively used by a large number—possibly the majority—of us during conferences. We routinely mouth pipetted radioactive iodine solutions at the lab bench, and in fact we smoked and ate while doing experiments all the time. When we needed to perform an experiment on animals, we just ordered the requisite number; we didn’t have to explain to a committee what we were going to do, how we would do it, or why. On the professional level, there were very few women and very little diversity of any kind among the trainees and staff—not surprisingly since, as I have already implied, most of us came from medical schools that were no different. An experience during my second year with Harold Edelhoch is useful to mention. Not only had he and I developed a warm teacher/apprentice relationship, but individually and with our families, we had developed friendships also. During the second year, he had allowed me to initiate a project on thyroglobulin with an immunological bent. I thought it would be interesting to test Dan Campbell’s idea that proteins contain “hidden [antigenic] determinants” (7) by studying the reaction of anti-thyroglobulin antibodies with the subunits and tryptic digestion products of thyroglobulin. With a colleague from the National Cancer Institute, Gordon Sharp, we introduced Ouchterlony’s gel diffusion and Pierre Grabar’s immunoelectrophoresis plates into the laboratory—methods as foreign then to a protein chemist like Harold as they are now to contemporary molecular immunologists. Work progressed well, and Gordon and I were beginning to write up a manuscript (8) when, while standing with Harold in the cafeteria lunch line, he asked me whether I was planning to submit the paper as part of the roman numeral numbered series of papers on “The Properties of Thyroglobulin. . .” that he had initiated. Naif that I was, I said, “Well that doesn’t seem right, because all the others have your name on it.” It had never occurred to me that although the work had been carried out in his laboratory with his support and sometimes advice, he would be a co-author! I don’t remember—this is the sort of matter on which one’s memory can be very inaccurate—whether in his mind he actually felt that his contribution had been more substantial than I had judged, or whether he just felt it was his due. Harold was always extremely generous to me, and to all I have ever met who knew him, and I only point it out as an example of how questions of authorship can arise even in the friendliest of circumstances, and are virtually always sensitive subjects.

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HEADING WEST In the early 1960s only a few professional protein chemists were working on the immune system; one of the most prominent was SJ Singer. A product of the Brooklyn Polytech school of polymer chemists, he had trained under Pauling and (what attracted my interest) had coauthored with Dan Campbell of Caltech, one of the great characters in the history of immunochemistry, a series of careful physicochemical analyses of antigen-antibody complexes (e.g. 9). I applied for a postdoctoral position in his laboratory and was delighted to be accepted. However, a little later we learned that it was not to be at his then place of work (the Department of Chemistry at Yale), but at a brand new campus of the University of California that Roger Revelle was organizing in La Jolla. This created a major problem for Deborah, now pregnant with our second child, who had hoped to complete her masters degree in social work at Columbia, commuting from New Haven. Since the closest Social Work School to La Jolla was impractically far away at UCLA, there seemed to be no choice but for her to finish her studies while we were still in Washington, if she was to retain the credits earned during her first year at the New York School for Social Work. At least among our compatriots, in that era the idea that the male member of the family would adjust his career goals in such a situation just didn’t enter our minds. Fortunately, Washington DC’s Catholic University was very supportive of women wishing to combine professional with procreative activities, and Ren´ee Victoria obligingly arrived during intercession! In those days, La Jolla was, as the British would say, less “tarted up” than it is today, and though it had been a watering hole and beach resort for the glamour kings and queens of Hollywood in the 1920s and 1930s, in the 1960s it had a provincial character heavily influenced by the large number of military retirees. The weather was outstanding. In our second year, we counted 360 perfect days. We became used to the regular boom of the Marine Corps jets breaking the sound barrier, and to the occasional small shifts in the tectonic plates. We were less comfortable with the political conservatism of the region where mental health practioners, communists, and supporters of the UN were considered as co-conspirators. Even the advent of the western edition of the New York Times did only a little to temper the feeling of anxiety produced by the Cuban missile crisis and the civil rights marches in the South. In Jon Singer’s laboratory, as in Edelhoch’s, the atmosphere was intimate. Initially, besides myself, there was only one other postdoctoral fellow, Leon Wofsy, and somewhat later a chemist, Margie Adams. I only recall a single time when Jon attempted lab work himself (unsuccessful I believe) but he was always there. Indeed, so much so and always so engaged that both Leon and I would sometimes withhold our latest results from him because of course he

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would immediately come up with the next six logical experiments to do before we had completed our presentation or had ourselves had a chance to figure out what it all meant. Jon’s special skill was to be able to wring out every possible meaning from an experiment. Where Harold Edelhoch had taught me rigor and the importance of not wandering too far outside the small area one’s latest results had illuminated, Jon taught me the excitement of taking the imaginative leap. I feel very lucky to have experienced both types of approaches so intimately with two equally rigorous thinkers. [It would be that combination of rigorous physicochemical insight and a willingness to make the creative jump that years later would lead Jon to come up with the first modern and still largely correct model of biological membranes (10) for which he has been honored by the scientific community, though not I think enough.] Among the special pleasures of those two years was the contact with the numerous outstanding scientists that populated the small but highly prestigious faculty newly assembled at UCSD, and the many visitors that were attracted by Jon’s prestige and by a couple of special conferences in La Jolla as well as by the group Frank Dixon was bringing to the unit he was establishing at the Scripps Clinic. In those days, even as a postdoctoral fellow, one could meet most of the world’s senior workers in a particular field over the course of a couple of years. I was fortunate to be supported then by the Helen Hay Whitney Foundation, and the delightful annual meetings of the Fellows held at the Princeton Inn established lifelong professional friendships. The opportunities to develop such relationships can be an important asset for the young scientist. Just prior to coming to La Jolla I had accepted an offer from Joseph Bunim, the Clinical Director of the NIAMD, to return to an independent position in the Arthritis and Rheumatism Branch, which he also headed in that Institute. Such offers were not uncommon in those years. How different from today! Who now would be offered such an opportunity after such a short probationary period? In the Intramural Research Program of NIH as at Universities, it now requires a minimum of four to six years just to be in the running for a competitive recruitment for a (six-year) tenure-track position. I have worked for 34 years on the same corridor where I opened my laboratory. Although I have occasionally been persuaded to look at other opportunities, I repeatedly decided to follow the admonition of Deborah’s mother that one should only move when one is unhappy, not when things are already going well. It’s a good precept, I think. As is often the case, one chooses as the initial subject for one’s first independent efforts, a project closely but not too closely related to what one has been working on. In my case it was to continue studies on affinity labeling that Wofsy, Singer, and I had pursued in La Jolla (11, 12). I planned to use that approach to examine IgM antibodies, but a number of circumstances soon

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prompted me first of all to learn something more about the structure per se of these “macroglobulins.” By pure luck the protein I chose to work on—a particular IgM from a patient with Waldenstr¨om’s macroglobulinemia (13)—was also to be virtually uniquely suitable for some functional studies many years later (14).

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A SHIFT FROM STRUCTURE TO FUNCTION1 In his truly seminal work, Landsteiner had identified as “the two chief theoretical problems” [in serology], “the specificity of antibodies” and the “formation of antibodies” (16). Leaving aside that today we refer not simply to antibodies but to the whole family of antigen receptors, for many years much of the immunological community has followed Landsteiner’s lead and considered other aspects of immunity less worthy of serious attention. In particular, those working on how the immune response actually accomplishes anything tended to be out of the mainstream. My own interest began to focus on the border where those interests meet. It struck me that although determining how an antibody combining site is generated was certainly an intellectually challenging problem, from a biological point of view, the binding of an antigen to an antibody is only meaningful if the binding accomplished something. That seemed to be left out of Landsteiner’s formulation. I began to address this issue in an essay for the Annual Review of Biochemistry. During this period that Annual Review regularly featured one or more articles in the general area of “immunochemistry,” and Gerald Edelman had written the previous review on what he called “The Antibody Problem” (17); I decided to call mine, “The Antigen Receptor Problem” (18). I treated this subject more comprehensively in a review for the Advances in Immunology (19). Much of the reading and thinking that went into that analysis was done during a sabbatical year at what had become one of the great centers of immunological research, the Medical Research Council facility in the London suburb of Mill Hill. It became clear to me that the focus needed to be on the effect of antigen on antibody, but that speculation about this matter far exceeded experimentation. In 1959, Rodney Porter had shown that the (two) binding sites for antigen were located in what he dubbed the Fab regions (20), whereas it was with their Fc region that antibodies were later shown to interact with a variety of effector systems. Researchers felt that like many enzymes, antibodies were allosteric 1 It was at the important meeting on immunology held at the Cold Spring Harbor Laboratories in 1967, when Neils Jerne wondered whether in the adage attributed to Francis Crick, the emphasis should be, “If you cannot study function, study structure,” or “If you cannot study function, study structure” (15).

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proteins and that a conformational message was transmitted down what was subsequently identified as the heavy chain from the Fab to the Fc region. A variety of structural features common to all antibodies made it seem an unlikely mechanism to me, but the main problem with this proposal was the almost total lack of any relevant experimental data; the little that existed were unconvincing. Having failed to observe such antigen-induced distal alterations in our own studies (21, 22), I began to conclude that working on isolated antibodies was insufficient. I decided to explore a more complete system in which the effect of antigen on antibody in promoting a biological response could be studied directly at the molecular level. There was one system available for such a structural approach—complement fixation—but it was already being mined by several excellent investigators (including by that time, Porter himself; 23) and besides, the challenge of working on cells had begun to intrigue me. As an aside, I admit that I have never found the competitive aspect of scientific research appealing. In choosing a direction for research, I consider whether others are already working productively along it. If so, that’s a strong (albeit not overriding) disincentive for pursuing that path. After some consideration, the IgE-mast cell system seemed more and more attractive. Its phenomenology had a solid experimental foundation (24, 25), but exploration at a molecular level was in its infancy. Mast cells and basophils were capable of being passively “sensitized” with antigen-specific IgE. When antigen was added, the system responded rapidly and required nothing more than a pinch of Ca2+ in the medium; no so-called helper cells such as were required to turn on B cells complicated the phenomenon. The characteristic of persistent sensitization suggested to me that whatever was binding IgE was binding it very tightly and might therefore be extractable by affinity techniques. So the experimental problem I had set for my sabbatical year was to discover a mast cell line that I could use to study that binding entity—presumptively the component that, like C1q of the classical complement pathway, was the first to “sense” that antigen and antibody had interacted. My calculations had convinced me that in order to pursue serious structural work on this hypothetical component, the numbers of cells I would need would be orders of magnitude larger than could practically be obtained from normal sources. In addition, my experience with myeloma proteins had made me less fearful than others in the field that using a tumor analog would lead one astray. I had been working without much success on three candidate lines for their ability to absorb out IgE antibodies when, partly by happenstance, I was introduced to Brian Leonard. A pathologist at ICI Chemicals, he showed me some slides of a rat tumor he had chanced upon during his study of a carcinogen (26). They were beautiful! Here were cells that looked much more like differentiated mast cells than any of those I had worked with at Mill Hill. Leonard had

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maintained the tumor by regularly transferring it to weanling animals, but he had never tried to culture the cells or to freeze them away. I was anxious lest what seemed like a uniquely precious tumor might be lost. It was almost a year later and only after persistent efforts by John Humphrey—the then Director at Mill Hill who had kindly volunteered his good services—that I received a shipment of animals bearing the tumor. Another scientist at Mill Hill whose generosity helped me on my way, was Dr. Bridgett Ogilvie. I would need large amounts of IgE for the studies I contemplated, and Herv´e Bazin had not yet published his extraordinary discovery of IgE “immunocytomas” in rats (27). Ogilvie showed me how to parasitize rats and how to bleed them, and on a sanguinary day I shall never forget, the two of us working without stop managed to harvest from 180 rats over a liter of high-titred serum. I took it with me to Bethesda and from it we isolated our first preparative amounts of IgE (28). Although the initial binding studies we were able to perform were limited (28, 29), they quickly convinced me that we had a useful system, and we have continued to explore it for the last quarter century.

EUREKA! I recall a cartoon by SN Harris that depicts a modern version of the joy expressed by Archimedes. The cartoon shows two scientists doubled over in speechless laughter, pointing to a blackboard covered with equations. A layman may well ask, “So, what’s the joke?” (much as I do more and more often about the cartoons in The New Yorker). The joke is, of course, that scientists immediately understand but lay people do not, that the two professors could be laughing with joy—joy for the sheer delight of discovering something new, especially if it is unusually revealing of some unknown aspect of nature, or for the joy of answering a complex problem by some simple trenchant experiment—what scientists refer to as “elegance” in experimental work. When Archimedes figured out how to solve the problem of whether the King’s crown was pure gold, I think it likely that it was the sublime elegance of how he solved the problem as much as the solution itself that sent Archimedes, straight from his bath and without dressing, streaking through the streets shouting, “I’ve found it!” I have engaged in several long-term projects that required years of preparatory work before each led to the desired result. There is a wonderfully satisfying feeling at the end. Similarly, especially because of my medical background, I am totally committed to having my scientific work ultimately be useful, and there is no question that one gets tremendous satisfaction from finding a cure or a step to a cure. But it’s not those feelings I’m referring to here. Rather, I’m speaking of the feeling of sheer joy (gaiety) at having done something

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clever that has worked. At the risk of tooting my own horn—although that’s not an unprecedented sound emanating from chapters in this prefatory series— I’ll mention a few instances that brought that special delight to me and my colleagues.

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Circular Reasoning Through careful quantitative analysis, Fred Miller (my first postdoctoral fellow) and I had demonstrated that human IgM was a pentamer and not a hexamer as had been previously proposed. [Virtually simultaneously and independently, Parker Small and his postdoctoral fellow Michael Lamm showed the same to be true of rabbit IgM (30).] Fred and I then began trying to determine the way the subunits were hooked together via disulfide bonds; we considered several models (31). Using a thermodynamic argument, we proposed that the structure could well be a circular pentamer. We got that “Eureka!” feeling when a couple of years later Svehag et al published the first electron micrographs that unequivocally demonstrated the circular conformation of IgM (32). (This experience also underscored for me that a picture is even better than a thousand clever predictions.) Our circular reasoning may not have been on a par with Kekul´e’s insight about the ring structure of benzene, or the recognition that E. coli has a circular chromosome, but scaling peaks other than Everest can also be exhilarating.

The Power of Two I have had a long-term interest is precisely how the topological perturbation of clustering proteins, e.g. on the surface of a cell, initiates biochemical changes. As indicated elsewhere (33), the problem of how ligand signals across the membrane is remarkably similar to how antigen transmits information from the Fab to the Fc region. With the so-called multichain immune recognition receptors (34), the mechanism used appears to be the same, i.e. clustering. In the case of the receptor for IgE, we wanted to know what is being clustered and what is the minimal size (multiplicity) of the functional aggregate. We found a facile way to answer the first question. We simply mixed IgEs that had been labeled alternatively with fluorescein and rhodamine, added them to our receptor-bearing tumor cells and then added bivalent anti-fluorescein. This is the sort of situation where one can shout “Eureka!” even before performing the experiment, because regardless of the outcome, one is certain to get a useful result. Because in our case the rhodaminated IgE failed to co-cluster with the fluoresceinated IgE, the answer was that the receptors for IgE must be univalent (35; see also 36). In subsequent studies we had the same thrill (there really is no better word to describe the feeling) when, by using the covalently crosslinked oligomers pioneered by David Segal and a simple passive cutaneous

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anaphylaxis protocol, we demonstrated for the first time unequivocally that it only takes two univalent receptors to generate an active cluster. A colored slide of the “scalp” from the original rat I had personally injected is one of my treasures (Figure 3 in 37), but I am careful about showing it to particular audiences who lack the background to appreciate my trophy pleasurably.

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A Pretty Separation My colleagues and I spent considerable effort in developing the gentle methods that ultimately allowed us to isolate native IgE receptors without having to use the chemical cross-linking methods that originally led to our discovery that the receptor consisted of more than a single α polypeptide (38). So it may be ironic to single out as one that gave us special delight, an experiment we used to dissociate the receptor. We had determined that by paying careful attention to the type and concentration of lipid and detergent, we could isolate the αβγ 2 tetramer in reasonable yield (39). We were just taking the first steps on the long road towards isolating preparative amounts of receptor in order to get peptide sequences and to then make oligonucleotide probes for the genetic sequences. We had made the strategic decision not to take a shortcut by simply going for the more easily isolatable α chain by itself. Conventional ways of separating the β and γ chains from the α hadn’t worked, and we were looking for some other method when C Bordier’s work on Triton X-114 appeared in a rare methodologically oriented paper in the Journal of Biological Chemistry (40). This variant of Triton X has a “cloud point” at around room temperature rather than at the much higher temperatures required by the less hydrophobic Tritons. Bordier showed that when cells were solubilized by Triton X-114 at temperatures below the cloud point and the temperature was then raised, some of the membrane proteins would segregate to an upper detergent-depleted phase, whereas more hydrophobic ones would fractionate with the detergent-rich pellet. We took our chilled solution of radiolabeled intact IgE-receptor complexes, which was yellow because the hapten used to elute the receptors (41) had not been removed, and added TX-114 and a little bromophenol blue. We then raised the temperature briefly and spun the tube in a centrifuge. It was a lovely sight; the yellow-rose aqueous solution of hapten overlay a sharply defined deep purple pellet. The autoradiogram of the gel on which aliquots of the two phases were analyzed was also aesthetically pleasing: The high concentration of detergent had dissociated the receptor and the carbohydrate-rich, and thus hydrophilic α chain (with its bound IgE) was almost perfectly separated in the upper phase from the more hydrophobic β and γ chains in the lower one (42). An aesthetic aspect contributes to the enjoyment of our research more than we sometimes recognize. In the sense that it does not correspond to an everyday

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object seen with the unaided eye, the “picture” is of course almost always abstract, but as is true of other abstract pictures, it can engender an affective response that is highly pleasurable. It is the scientist’s understanding of the object or the process that has generated the visual phenomenon that, it seems to me, adds to the delight. It is a little like the question of whether a poem, or a painting, or a sonata must have an ethical aspect to be beautiful. I don’t think so, but it’s certainly a desirable embellishment.

INTERMEZZO: L’AFFAIR DU CHAT CHESHIRE In April 1987, I was asked to review a paper for Nature that embroiled me in an affair that was both silly and sad. An investigator in Paris had persuaded the Editor of Nature to consider for publication a manuscript that made an extraordinary claim. It asserted that, if appropriately agitated, molecules such as antibodies could confer an accurate impression on water such that the solution would continue to be active even when diluted beyond the point where even a single molecule of the antibody could have remained. The manuscript describing this phenomenon had been sent to me because the principal experimental system used by the discoverers of this phenomenon involved IgE and the degranulation of basophils. I wrote to the Editor that, although I could see nothing in the description of the experimental procedures that was blatantly deficient, the results the authors claimed to have achieved were not believable. The work was so at variance with both scientific and everyday experience that it should not be considered for publication unless it could be repeated by a competent laboratory of the Editor’s choosing. I heard no more about it until the following summer when, while attending the International Congress of Biochemistry in Prague, I learned of the paper’s publication (43). As I had feared, the press had a field day. “Homeopathic enthusiasts are rejoicing while scientists scratch their heads. .” reported the New Scientist; “Homeopathy finds scientific support” reported Newsweek. Upon my return to Bethesda, the then Deputy Director for Intramural Research at NIH (my old boss Ed Rall) persuaded me to repeat the French group’s experiment and to send the results to Nature. Although our cells and assay system were different than those employed by Davenas et al, Stephen Dreskin, a postdoctoral fellow, and I performed an experiment under a double blind protocol. There were no surprises in our unequivocal results. In our communication to the Editor of Nature, “Only the Smile is Left,” we argued that the claims for what we referred to as the Cheshire cat phenomenon should never have been published (44). John Maddox in an editorial referred to us as “toffee-nosed” (an expression not commonly used this side of the Atlantic—I gather he felt we were taking a holier-than-thou attitude) for having made that

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suggestion (45), but I still feel the same. I think that throughout this controversy, two separate issues became confused. It is one thing for someone to propound an idea that is unprecedented or that may even fly against accepted ideas or interpretations. There are many instances of new, radical ideas that eventually turn out to be true and prove the old dogma false. Like the rest of mankind, scientists tend to be conservative and often resist having to change their ideas. But that was not the issue here. In this instance, experimental claims were made that contradicted the daily experience in kitchens, factories, and laboratories throughout the world! The most generous interpretation for the decision to publish is that in attempting to lean over backwards to show that it was not a bulwark of orthodoxy, Nature’s editors gave insufficient weight to the total lack of generalizability of the bizarre findings.2 That this lapse may not have been inadvertent was suggested by Nature’s decision years later to publish still another paper on this matter. In this case, the authors decided to repeat the French group’s experiments using the same methods employed in the original paper. The methods were the same but, needless to say, not the results. Again, my advice was sought and I suggested that it was not worth continuing this silly business by publishing a further refutation, but apparently the journal could not resist promoting still another episode of this thriller (46). Quite a different evaluation of the original work was made by the group that first organized The Journal of Irreproducible Results. They awarded the senior author of the 1988 paper the first Ignobel Prize. There are many instances when individual scientists persist in promoting a notion because they get an id´ee fixe or for some other reasons. Given the marvelous perversity of human nature, I don’t find that surprising. What I find more puzzling is how often even good scientists will temporarily suspend their customary standards of evidence especially in fields outside their own expertise. Of course these little blips have virtually no long-term influence on the progress of science because “unromantic” facts will eventually adjudicate the matter.

EXTRACURRICULAR ACTIVITIES: POLITICS I remember vividly (accurately?) my first lesson in politics. It was in the Fall of 1940 when I had been in the United States for two and a half years and was all of eight and a half years old. I was walking with my father when I spotted a flyer on the sidewalk promoting the candidacy of Wendell Wilkie, the Republican opponent of President Roosevelt in the upcoming election. FDR was the patron saint of everyone with whom I consorted, and either to show my political sophistication or my allegiance to the cause, I walked over and began to 2 I am reminded of the moral from one of James Thurber’s Fables for Our Times:

too far backwards may fall flat on his face.”

“He who leans

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trample on the face of Mr. Wilkie with great energy. I don’t recall whether it was a slap or just a grab, but the response from my father was swift and unequivocal. The message was emphatically (and it seems indelibly) communicated that one doesn’t show such disrespect even to one’s arch political opponent. Reading about what my parents must have witnessed during the 1930s in Germany, I could later appreciate my father’s sensitivity on this matter. Like many of my background, I leaned to the Left, learned many of the Union songs and those from the Spanish Revolution, and only gradually becoming aware of the rot that was destroying what seemed like such an attractive experiment in socialism in the Soviet Union. In college I joined the debating team and enthusiastically supported the nationalization of US basic industry; I helped to organize a student forum that regularly discussed various public policy matters less formally than in a debate, and I wrote several strong political opinion pieces for The Campus, our college paper. But it was all talk, and it wasn’t until I got to know my fellow post-doc, Leon Wofsy, that I met someone who had actually been “in the trenches” in support of leftist causes (and had suffered the consequences) (47). I learned what it is like engaging in political discussions with someone who is really passionately involved in the subject. My problem was (and is) that I have never been able to muster sufficient conviction that my assessment of the issue is so much more correct than the other guy’s. I realize that that’s what is required if one wishes to promote substantive political change, and I’m glad there are those who have the guts for it. It was years later that I participated more actively in a social action initiative that was actually more humanitarian than ideological. The Medical Committee for Human Rights (MCHR) had originally been formed by Bostonian physicians anxious that the civil rights marchers down South (some of whom were their own children) would have access to sympathetic medical care. They organized medical personnel to accompany the marchers, and a similar effort was organized by some of us in Washington DC with respect to the marchers protesting the US pursuit of the war in Vietnam. Many young physicians training at the NIH became familiar with our home, which served as the MCHR headquarters and staging center for a while. The local endeavor had actually been initiated during the riots that erupted in the 14th street corridor of DC following the assassination of Martin Luther King Jr, during which the physician teams we organized visited the many individuals incarcerated during the police sweeps. (We Metzgers still retain the extra phone line we had installed on that occasion; it is now used by Deborah for her small private practice.) Sidney Wolfe, then a Clinical Associate, was a prime mover, and he subsequently went into medical politics with a vengeance, becoming the well-known medical muckraker in the Nader organization, for which he was to receive a MacArthur Fellow award. MCHR’s experiences in providing medical assistance during the riots and DC

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marches were actually recorded in an article in the New England Journal of Medicine (48)—the only clinical article on which I have been a co-author. After the various protest activities ceased, MCHR increasingly focused its energies on activities meant to convince the public that adequate medical care is a basic right of all citizens. Fortunately the country was finally considering moving in that direction, and this proposition soon came to be accepted as a legitimate subject of conventional political discussion. At that point I was no longer convinced that MCHR could meaningfully influence the debate, and so I dropped my participation.

ORGANIZATION MAN Already in high school and possibly earlier, I participated in student government activities, and in college I continued that mode. On returning to NIH as a member of the staff, I quickly became involved in such activities again, particularly with regard to the Assembly of Scientists—the closest thing we had to a faculty Senate. I was never as impatient with committee meetings as many of my professional colleagues and actually enjoyed the process of trying to articulate issues and seek a solution that most could live with. I suppose this tolerance became known to Baruj Benacerraf, who encouraged me to stand for election as Secretary-Treasurer of the American Association of Immunologists (AAI) to replace Sheldon Dray, who was leaving the NIH to head up the Department of Microbiology and Immunology at the University of Chicago. There probably wasn’t another candidate; in any case I was elected and served in that role for 16 years. That experience led to many similar offers to serve with other national and international organizations. To a considerable degree I have enjoyed such participation but feel almost defensive in saying so. It’s as if I were admitting to some bad habit. That scientists, like most individuals engaged in creative activities, have an aversion to organizations and bureaucracies is easy to understand: Organization can easily drift toward regimentation, which is of course anathema to the innovative spirit. However, more than most creative professions, the enterprise of science is wholly dependent on organizations. It is by and large organizations that support the personnel that help to educate us, that publish the textbooks we study from, that fund our research fellowships and later our laboratories, that make and market the equipment and reagents we increasingly purchase, that sponsor and arrange our meetings, that publish our research, that translate that research into useful things, that publicize those advances to the public, and that transform the public appreciation into financial support. In my 35 plus years as a practicing scientist, I have seen a tremendous growth in the organizational aspects of research. Though I understand the down side, I think it is

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quixotic to decry its necessity and uninformed to belittle its contributions. The future is in its wise use, not in its minimization. A peculiar, but not I think coincidental, aspect of those organizations created by professionals themselves is the short terms to which they elect their officers. For domestic organizations it’s usually one year; for international organizations it’s commonly three years, but given the inertia in the latter entities, from a practical point of view, it’s equivalent. Thus, a president has great difficulty in leaving his or her imprimatur by moving the organization into substantial new ventures, and I suspect that that is in fact the raison d’´etre of the brief terms. Occasionally, an executive director who is a respected professional can make up for this weakness, but in most scientific societies, that is discouraged. In the United States, the National Academy of Sciences and the Institute of Medicine are notable exceptions. I leave it to the reader to judge whether this association between organizational vigor and the length of the term of office of the president has some validity.

IN MY OPINION. . . . I felt honored to have been invited to write this preparatory chapter, particularly because as a member of the Editorial Committee of the Annual Review of Immunology for 13 years, I know how many excellent immunologists we listed as candidates to engage in this special privilege but were unable to invite. I therefore considered it virtually my responsibility to take full advantage of this opportunity and to record what I think about a few matters, without benefit of peer review and subject only to the critical eye of the publication’s energetic and discriminating Production Editor, Nancy P Donham. I’ll register just a few more opinions. I think that those scientists who claim that the most important things have been learned and that only the details remain to be uncovered—and there are some great ones who claim this—are showing their age. It’s a feeling typical of the elderly, and it’s as wrong today as it has been in every prior century when similar statements were made. This is a magnificent time to be doing science especially biology, and I think we’re still at a very early stage. Of course the elucidation of protein structures and of the genetic apparatus has been exciting, but that’s dullsville compared to the real fun that’s on the horizon: putting that dynamic jigsaw puzzle together in a quantitatively realistic manner. Is there anyone who doesn’t think that physiology is a lot more exciting than anatomy? Some of my (cellular immunologist) friends may gloat that a protein anatomist like myself should admit this. “Ahah!” they will say, “You see, you should have been one of us all along.” “You miss the point,” I reply, “I have always felt that physiology is more interesting, but that without the requisite

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structural knowledge it’s a bit insubstantial—somewhat akin to transcendental meditation.” I present this mock dialogue not only to give my view on this particular issue, but to introduce a further subject. That is, the importance of supporting multiple approaches when dealing with any complex and multilayered domain of nature, and the need to encourage scientists with very different personalities and mental habits. Both sense and circumstance demand a strategy that deploys our troops simultaneously on all levels. As a community we cannot and should not attempt to move unidirectionaly from a purely reductionist level to higher and higher levels of integration, even though some of us “unromantic” practitioners may prefer that approach in our personal research. In dealing with more complex systems, we must also encourage those who have the fortitude to give up some of the reassuring rigor that is so much more easily applied to experiments that can be conducted in replicate test tubes. But we must also find ways by which such romantic science, whose practitioners can often be so dazzling, is drawn back within the bounds of reality. While I’m on the subject of whose research we should support, I want to raise two other issues. One relates to the appropriate level of elitism we should practice. I have before me a quote from the US President’s Science Advisory Committee’s 1960 report “Scientific Progress, the Universities and the Federal Government”. It states, “In Science, the excellent is not just better than the ordinary, it is almost all that matters.” This could suggest that really the only thing worth supporting is ground-breaking, mind-expanding, paradigmshattering research, and some of our scientific leaders really feel that way. I think that they misread how progress in science is made. It is important that somebody determined the pK of the carboxyl group in glycine! Cathedrals rise not only because of a Bishop’s vision and an architect’s imagination; it takes as well woodsmen to fell trees for the carpenters, and quarriers to service the stone masons. We should not compromise in demanding craftsmanship, but to think that we can advance science simply or even principally by great intellectual leaps is a mistake. The other relates to the virtual disdain some scientists express for research that is “mission oriented” or worse yet, “applied.” I was always impressed by Farrington’s recounting of Greek science (49). His reading of history suggested that some of the greatest contributions made by the Greeks came while science was still linked to practical concerns; that their science became dissociated from reality when increasing disdain for manual labor meant that the thinkers spent all their time in the Academy far from the workplace. The introduction of slavery accentuated this trend, an instructive example of where something morally wrong is also self-defeating in practical terms. It is a political fact that in order to expect continued public support we must convince the lawmakers that we are

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meeting public needs and desires. But working on practical problems can also make for good science. True, great progress is sometimes made serendipitously; but sometimes it is also made from well-planned, directed research. Again it’s a matter of balance. I recall a Public Affairs Committee luncheon at the headquarters of the Federation of American Societies for Experimental Biology at which I sat next to the then head of the National Science Foundation, Guyford Stever. In discussing with me the issue of priority setting, he related how on any particular morning one group of scientists might come to him asking $25 million for a radio telescope and a half hour later another group would be asking for the same $25 million for a solid waste disposal initiative. “How do you choose between discovering galaxies and disposing of garbage?” he asked. He concluded that you can’t; that somehow, you have to find ways of supporting both. In part this is really an issue of choosing between public needs, but I’m also making the point that there is good science to be promoted even in unexpected places. Here and there I have talked and written a bit about the challenge that already confronts us—and which will only be aggravated in the future—in dealing with the complexity of the biological systems with which we are working. I am excited about the fact that the determination of complete genomes is beginning to give us for the first time an accurate glimpse of the true complexity of biological systems. (I do not intend this statement to contradict the point I made in the second paragraph of this section.) Even for simple systems, the complexity is enormous (50), but it is not immeasurable. What this glimpse has demonstrated is that we will need new ways of assimilating, manipulating, and communicating the facts, and I think that in the next decade or so we will see some dramatic changes in this respect. When asked in his old age whether he would like to start all over again, my father-in-law remarked, “No. . ., next time around I might not be so lucky.” I feel the same way. I have been very lucky particularly with respect to the trainees with whom I have worked and who launched their own ships of exploration after leaving my laboratory. A few hit shoals and foundered, a few continue to sail in the same seas I do but have discovered their own lush islands, some have sailed beyond my horizon and now communicate in languages that are strange to my ear. But I am most envious of those just hoisting their sails. I feel certain they will have a fantastic voyage and am confident they will not fall off the edge; not because I think the universe of knowledge is round but because I think it is unbounded.

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Literature Cited 1. Crick F, Watson J. 1953. A structure for deoxyribose nucleic acid. Nature 171: 737–38 2. Lapresle C, Durieux J. 1957. Etude de la d´egradation de la s´erumalbumine humaine par un extrait de rate de lapin. Ann. Inst. Pasteur 92:62–73 3. Sober HA, Peterson EA. 1958. Protein chromatography on ion exchange cellulose. Fed. Proc. 17:1116–26 4. Fahey JL, McCoy PF, Goulian M. 1958. Chromatography of serum proteins in normal and pathologic sera. J. Clin. Invest. 37:272–84 5. Cohn EJ, Edsall JT. 1943. Proteins, Amino Acids and Peptides. New York: Reinhold. 686 pp. 6. Stetten D Jr, Carrigan WT, eds. 1984. NIH: An Account of Research in its Laboratories and Clinics. New York: Academic. 554 pp. 7. Bartel AH, Campbell DH. 1959. Some immunochemical differences between associated and dissociated hemocyanin. Arch. Biochem. Biophys. 82:232–34 8. Metzger H, Sharp GC, Edelhoch H. 1962. The properties of thyroglobulin. VII. The immunologic activity of thyroglobulin fragments. Biochemistry 1:205–14 9. Singer SJ, Campbell DH. 1952. Physical chemical studies of soluble antigenantibody complexes. I. The valence of precipitating rabbit antibody. J. Am. Chem. Soc. 74:1794–802 10. Singer SJ, Nicolson GL. 1972. The fluid mosaic model of the structure of cell membranes. Science 175:720–31 11. Wofsy L, Metzger H, Singer SJ. 1962. Affinity labeling—a general method for labeling the active sites of antibody and enzyme molecules. Biochemistry 1:1031– 39 12. Metzger H, Wofsy L, Singer SJ. 1963. Affinity labeling of the active sites of antibodies to the 2,4-dinitrophenyl hapten. Biochemistry 2:979–88 13. Miller F, Metzger H. 1965. Characterization of a human macroglobulin. I. The molecular weight of its subunit. J. Biol. Chem. 240:3325–33 14. Ashman RF, Metzger H. 1969. A Waldenstr¨om macroglobulin which binds nitrophenyl ligands. J. Biol. Chem. 244:3405– 14 15. Jerne NK. 1968. Summary: Waiting for the end. Cold Spring Harbor Symp. Quant. Biol. 32:591–603 16. Landsteiner K. 1962. The Specificity of

Serological Reactions. New York: Dover 17. Edelman GM, Gall WE. 1969. The antibody problem. Annu. Rev. Biochem. 38: 415–66 18. Metzger H. 1970. The antigen receptor problem. Annu. Rev. Biochem. 39:889– 928 19. Metzger H. 1974. The effect of antigen binding on the properties of antibody. Adv. Immunol. 28:169–207 20. Porter RR. 1959. The hydrolysis of rabbit (gamma)-globulin and antibodies with crystalline papain. Biochem. J. 73:119–27 21. Ashman RF, Kaplan AP, Metzger H. 1971. A search for conformational change on ligand binding in a human M macroglobulin. I. Circular dichroism and hydrogen exchange. Immunochemistry 8:627–41 22. Ashman RF, Metzger H. 1971. A search for conformational change on ligand binding in a human M macroglobulin. II. Susceptibility to proteolysis. Immunochemistry 8:643–56 23. Reid KB, Lowe DM, Porter RR. 1972. Isolation and characterization of C1q, a subcomponent of the first component of complement, from human and rabbit sera. Biochem. J. 130:749–63 24. Osler AG, Lichtenstein LM, Levy DA. 1968. In vitro studies of human reaginic allergy. Adv. Immunol. 8:183–231 25. Ishizaka K, Ishizaka T. 1971. IgE and reaginic hypersensitivity. Ann. NY Acad. Sci. 190:443–56 26. Eccleston E, Leonard BJ, Lowe JS, Welford HJ. 1973. Basophilic leukaemia in the albino rat and a demonstration of the basopoietin. Nature New. Biol. 244:73–76 27. Bazin H, Querinjean P, Beckers A, Heremans JF, Dessy F. 1974. Transplantable immunoglobulin-secreting tumours in rats. IV. Sixty-three IgE-secreting immunocytoma tumours. Immunology 26: 713–23 28. Isersky C, Kulczycki A Jr, Metzger H. 1974. Isolation of IgE from reaginic rat serum. J. Immunol. 112:1909–19 29. Kulczycki A Jr, Isersky C, Metzger H. 1974. The interaction of IgE with rat basophilic leukemia cells. I. Evidence for specific binding of IgE. J. Exp. Med. 139: 600–16 30. Lamm ME, Small PA Jr. 1966. Polypeptide chain structure of rabbit immunoglobulins. II. gamma-M-immunoglobulin. Biochemistry 5:267–76 31. Miller F, Metzger H. 1965. Characteriza-

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tion of a human macroglobulin II. Distribution of the disulfide bonds. J. Biol. Chem. 240:4740–45 Svehag SE, Chesebro B, Bloth B. 1967. Ultrastructure of gamma-M immunoglobulin and alpha macroglobulin: electron-microscopic study. Science 158:933–36 Metzger H. 1992. Transmembrane signaling: the joy of aggregation. J. Immunol. 149:1477–87 Keegan AD, Paul WE. 1992. Multichain immune recognition receptors: similarities in structure and signaling pathways. Immunol. Today 13:63–68 Mendoza GR, Metzger H. 1976. Distribution and valency of receptor for IgE on rodent mast cells and related tumour cells. Nature 264:548–50 Schlessinger J, Webb WW, Elson EL, Metzger H. 1976. Lateral motion and valence of Fc receptors on rat peritoneal mast cells. Nature 264:550–52 Segal DM, Taurog JD, Metzger H. 1977. Dimeric immunoglobulin E serves as a unit signal for mast cell degranulation. Proc. Natl. Acad. Sci. USA 74:2993– 97 Holowka D, Hartmann H, Kanellopoulos J, Metzger H. 1980. Association of the receptor for immunoglobulin E with an endogenous polypeptide on rat basophilic leukemia cells. J. Recept. Res. 1:41–68 Metzger H, Kinet J-P, Perez-Montfort R, Rivnay B, Wank SA. 1983. A tetrameric model for the structure of the mast cell receptor with high affinity for IgE. In Progress in Immunology V, ed. Y Yamamura, T Tada, pp. 493–501. Orlando, FL: Academic Bordier C. 1981. Phase separation of integral membrane proteins in Triton X-114

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solution. J. Biol. Chem. 256:1604–7 41. Kanellopoulos J, Rossi G, Metzger H. 1979. Preparative isolation of the cell receptor for immunoglobulin E. J. Biol. Chem. 254:7691–97 42. Alcaraz G, Kinet J-P, Kumar N, Wank SA, Metzger H. 1984. Phase separation of the receptor for immunoglobulin E and its subunits in Triton X-114. J. Biol. Chem. 259:14922–27 43. Davenas E, Beauvais F, Amara J, Oberbaum M, Robinzon B, Miadonna A, Tedeschi A, Pomeranz B, Fortner P, Belon P, Sainte-Laudy J, Poitevin B, Benveniste J. 1988. Human basophil degranulation triggered by very dilute antiserum against IgE. Nature 333:816–18 44. Metzger H, Dreskin SC. 1988. Only the smile is left. Nature 334:375 45. 1988. When to publish pseudo-science. Nature 334:367 46. Hirst SJ, Hayes NA, Burridge J, Pearce FL, Foreman JC. 1993. Human basophil degranulation is not triggered by very dilute antiserum against human IgE. Nature 366:525–27 47. Wofsy L. 1995. Looking for the Future. Berkeley, CA: IW Rose. 148 pp. 48. Frank A, Roth J, Wolfe S, Metzger H. 1969. Medical problems of civil disorders. Organization of a volunteer group of health professionals to provide medical services in a riot. N. Engl. J. Med. 280:247–53 49. Farrington B. 1961. Greek Science. Baltimore, MD: Penguin. 320 pp. 50. Wofsy C, Torigoe C, Kent UM, Metzger H, Goldstein B. 1997. Exploiting the difference between extrinsic and intrinsic kinases: implications for regulation of signaling by immunoreceptors. J. Immunol. In press

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INTERLEUKIN-1 RECEPTOR ANTAGONIST: Role in Biology William P. Arend, Mark Malyak, Carla J. Guthridge, and Cem Gabay Division of Rheumatology, Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado 80262 KEY WORDS:

cytokines, IL-1 receptor antagonist, macrophages, arthritis, inflammation

ABSTRACT The interleukin-1 receptor antagonist (IL-1Ra) is a member of the IL-1 family that binds to IL-1 receptors but does not induce any intracellular response. Two structural variants of IL-1Ra have previously been described: a 17-kDa form that is secreted from monocytes, macrophages, neutrophils, and other cells (sIL-1Ra) and an 18-kDa form that remains in the cytoplasm of keratinocytes and other epithelial cells, monocytes, and fibroblasts (icIL-1Ra). An additional 16-kDa intracellular isoform of IL-1Ra has recently been described in neutrophils, monocytes, and hepatic cells. Both of the major isoforms of IL-1Ra are transcribed from the same gene through the use of alternative first exons. The two promoters regulating transcription of the secreted and intracellular forms have been cloned, and some of the functional cis-acting DNA regions have been characterized. The production of IL-1Ra is stimulated by many substances including adherent IgG, other cytokines, and bacterial or viral components. The tissue distribution of IL1Ra in mice indicates that sIL-1Ra is found predominantly in peripheral blood cells, lungs, spleen, and liver, while icIL-1Ra is found in large amounts in skin. Studies in transgenic and knockout mice indicate that IL-1Ra is important in host defense against endotoxin-induced injury. IL-1Ra is produced by hepatic cells with the characteristics of an acute phase protein. Endogenous IL-1Ra is produced in numerous experimental animal models of disease as well as in human autoimmune and chronic inflammatory diseases. The use of neutralizing anti-IL1Ra antibodies has demonstrated that endogenous IL-1Ra is an important natural antiinflammatory protein in arthritis, colitis, and granulomatous pulmonary disease. Treatment of human diseases with recombinant human IL-1Ra showed an absence of benefit in sepsis syndrome. However, patients with rheumatoid arthritis treated with IL-1Ra for six months exhibited improvements in clinical parameters and in radiographic evidence of joint damage.

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INTRODUCTION The cytokine network is self-regulating through the action of opposing cytokines, the release of soluble cytokine receptors, and the production of antagonists of cytokine binding to receptors. The interleukin-1 receptor antagonist (IL-1Ra) is the first described naturally occurring specific receptor antagonist of any cytokine or hormone-like molecule. The IL-1-inhibitory biologic activity of this material was first described in the early 1980s, with the cloning and properties of recombinant IL-1Ra described in 1990. Published reviews on IL-1Ra have emphasized the biochemical properties of this unique cytokine, the mechanisms of its production, and the characterization of both in vitro and in vivo effects (1–7). The objectives of this review are to summarize recent information on additional structural variants of IL-1Ra, the role of IL-1Ra in biologic processes, and the effects of endogenous or exogenous IL-1Ra in human diseases.

STRUCTURE AND PRODUCTION The identification of different isoforms of IL-1Ra suggests that this cytokine, and the IL-1 family in general, may play complex roles in biology. Studies on the transcriptional regulation of IL-1Ra, on polymorphisms in the IL-1Ra gene, and on the crystal structure of IL-1Ra are beginning to clarify how this unique cytokine is produced and how it functions. The extensive in vitro investigation of IL-1Ra is now being extended to in vivo studies, allowing a more complete picture to emerge of the regulation and characteristics of this cytokine in a full biologic environment.

Structural Variants of Human IL-1Ra IL-1Ra was originally described as an IL-1-inhibitory activity in the urine of patients with fever and in the supernatants of monocytes cultured on adherent IgG (5). A cDNA coding for a secreted form of the molecule was cloned from a human monocyte library (8). Secretory IL-1Ra (sIL-1Ra) was synthesized as a 177 amino acid protein, with cleavage of a 25 amino acid leader sequence prior to secretion as a variably glycosylated 152 amino acid protein. A second cDNA coding for an intracellular form of IL-1Ra (18-kDa icIL-1Ra, 159 amino acids) was subsequently cloned from a different human monocyte library (9). These two isoforms of IL-1Ra are created by alternative splicing of different first exons; the first exon for icIL-1Ra is located ≈9.4 kb upstream from the first exon for sIL-1Ra (10). The internal splice acceptor site for icIL-1Ra was located within the first exon for sIL-1Ra, near the 30 end of the sequence coding for the signal peptide. Thus, icIL-1Ra lacked a functional leader sequence and remained in the cytoplasm. sIL-1Ra protein is produced by virtually any cell

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that is capable of synthesizing IL-1, possibly with the exception of endothelial cells and hepatocytes. icIL-1Ra is found constitutively in keratinocytes and other epithelial cells but is also a delayed product of stimulated monocytes and macrophages (11, 12). Neutrophils contain only the sIL-1Ra mRNA. Fibroblasts are capable of producing the mRNA and protein for both IL-1Ra isoforms, when appropriately stimulated. Two possible additional intracellular forms of IL-1Ra have been recently described. A cDNA was cloned from a human polymorphonuclear cell library that coded for a 25-kDa form of icIL-1Ra (13). This cDNA contained an inframe 63-bp sequence located within the first intron of the icIL-1Ra gene. This alternatively spliced form of icIL-1Ra possessed the same three NH2-terminal residues as the original form of icIL-1Ra, followed by a unique insert of 21 amino acids. The mRNA for this structural variant of icIL-1Ra was found by RT-PCR in activated fibroblasts, in resting and stimulated monocytes and neutrophils, and constitutively in keratinocytes. The cDNA for this larger form of icIL-1Ra was expressed in COS cells, and the recombinant protein possessed IL-1-inhibitory bioactivity equivalent to that of the original icIL-1Ra. However, these investigators did not describe the presence of an endogenous 25-kDa icIL1Ra protein in any resting or stimulated cell, and our laboratory has failed to find such a protein by Western blot analysis (M Malyak, WP Arend, unpublished observations). Thus, although a mRNA for a larger isoform of icIL-1Ra appears to exist in several cells, it remains unknown whether any corresponding protein is translated. A smaller isoform of intracellular IL-1Ra was recently described by our laboratory (12). This 16-kDa molecule, as detected by Western blot analysis with polyclonal or monoclonal antibodies, was a major cytoplasmic constituent of LPS-stimulated human neutrophils, was found in monocytes, and was also present in the human hepatoma cell line HepG2 (14). This isoform bound less well to IL-1 receptors in comparison to the original two isoforms of IL-1Ra (12). The origin of this low molecular weight form of IL-1Ra appears to be by alternative translational initiation. Thus, IL-1Ra appears to be a family of proteins and is similar to fibroblast growth factor in possessing both secreted and cytoplasmic forms. The possible biologic role of intracellular isoforms of IL-1Ra is discussed below.

Regulation of Transcription The separate 50 regulatory regions for both sIL-1Ra and icIL-1Ra have been isolated, and some of the cis-acting DNA regions involved in regulation of transcription have been characterized. A cloned 1680-bp region of the sIL-1Ra promoter exhibited a pattern of expression and induction identical to that of the endogenous gene (15). Experiments with 50 -truncated promoter constructs

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indicated that >90% of both baseline and LPS-induced activity was regulated by sequences between bases −294 and −148, with the remaining activity lying between −148 and −85. Subsequent studies demonstrated the presence of one inhibitory LPS response element (LRE) within the proximal 294 bp of the sIL-1Ra promoter between bases −250 and −200 (16). In addition, three positive-acting elements for LPS-induced responses were also present, between bases −250 and −200 (LRE3), −200 and −148 (LRE2), and −148 and −31 (LRE1). LRE1 was further identified as an NF-κB binding site located at bases −93 to −84 overlapping with a C/EBP site. The three positive elements in the proximal sIL-1Ra promoter exhibited cooperativity in mediating responses to LPS. A Stat 6 element in LRE3 is responsible for IL-4-induction of IL-1Ra production in macrophages (17). Further studies are in progress to characterize the additional positive LREs and to determine whether any cell type–specific promoter elements can be identified. Similar studies have been carried out to characterize the icIL-1Ra promoter. A proximal 1763-bp region of the icIL-1Ra promoter was cloned and exhibited activity in unstimulated HT-29 epithelial cells and THP-1 monocytic cells (10). However, the activities of this region of the icIL-1Ra promoter differed somewhat from those of the endogenous gene. In further studies by our laboratory, 4.5 kb of the 50 flanking DNA sequence of the icIL-1Ra promoter exhibited characteristics of expression identical to those of the endogenous gene (18). Constitutive activity in epithelial cells was under the control of three positively acting DNA regions located between bases −4525 to −1438, −288 to −156, and −156 to −49. In contrast, regulation of basal icIL-1Ra transcription in the murine macrophage line RAW 264.7 exhibited different characteristics; a weak inhibitory region was located between bases −4525 to −1438, and a strong positive element was present between −156 to −49. LPS-induction of icIL-1Ra promoter activity in RAW 264.7 cells exhibited two strongly positive acting DNA regions between bases −1438 to −909 and −156 to −49. Thus, the proximal region of the icIL-1Ra promoter contains positive cis-acting elements between bases −156 to −149 that are required for expression in both epithelial and monocyte cell lines. However, full control of icIL-1Ra transcription is influenced in both negative and positive manners by other cis-acting elements in a cell type–specific manner. Additional studies on the icIL-1Ra promoter also are in progress.

Polymorphisms in the Human IL-1Ra Gene The human IL-1Ra gene (IL1RN) has been mapped to band q14-q21 in the long arm of chromosome 2 (19, 20). The genes for IL-1α (IL1A), IL-1β (IL1B), and IL-1Ra all map to a restriction fragment of ≈430 kb in chromosome 2: IL1A lies between +0 and +35 kb, IL1B between +70 and +110 kb,

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and IL1RN between +330 and +430 kb (21). It is of interest that the genes for human types I and II IL-1 receptors also are located on the long arm of chromosome 2, although not close to the genes for the three ligands. A polymorphism is present in intron 2 of the human IL-1Ra gene, due to the presence of variable numbers of an 86-bp tandem repeat (22). Five alleles were described, and this allelic region contained three potential protein binding sites, suggesting possible functional significance. The two-repeat allele (IL1RN∗ 2) has been associated with a variety of human diseases including ulcerative colitis (23, 24), alopecia areata (25), lichen sclerosis (26), psoriasis (27), systemic lupus erythematosus skin lesions (28), Graves’ disease (29), and diabetic nephropathy (30). It is of great interest that these are primarily diseases of epithelial cells. The mechanism of IL1RN∗ 2 association with diseases remains unknown. icIL-1Ra mRNA levels were not altered in keratinocytes from individuals possessing different intron 2 alleles, although protein production was not measured in these studies (31). It was hypothesized that IL1RN∗ 2 is a marker for a linked disease-associated locus and may not be a direct diseaseassociated allele.

Crystal Structure and Mechanism of Action The results of studies published through 1992 on the structures of IL-1 and IL-1Ra are summarized in a previous review (5) and include the possible mechanism whereby IL-1Ra binds to IL-1 receptors with avidity nearly equal to the two agonists, yet which fails to activate cells. Both types I and II IL-1 receptors are members of the Ig superfamily and possess three Ig-like domains in the extracellular portions. The extracellular domains were enzymatically cleaved and were present as soluble receptors both in the pericellular environment and in the circulation (32–36). Soluble type II IL-1 receptors bound IL-1β much more avidly than IL-1Ra (33–35) and may function as inhibitors of IL-1 action in vivo. In contrast, soluble type I IL-1 receptors bound IL-1Ra almost selectively (33, 35, 36). Thus, soluble type I IL-1 receptors might bind exogenously produced IL-1Ra in vivo and block or neutralize its natural antiinflammatory actions. The results of early studies indicated that IL-1β and IL-1Ra possess an identical β-pleated sheet structure and that residues in the common open-faced surface of both molecules bind to the same site on the type I IL-1 receptor (5). However, IL-1β interacted with two additional sites on the receptor, a β-bulge between strands 4 and 5 and a region around aspartic acid at residue 145. These interactions were thought to be responsible for the difference in biologic activity between IL-1β and IL-1Ra. The results of more recent sitedirected mutagenesis studies confirm these conclusions. Site A on the side of the β-barrel structure in type I IL-1 receptors bound all three ligands; however,

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site B in the open end of the β-barrel bound both IL-1 α and IL-1β but not IL-1Ra (37–39). The interaction of the two IL-1 agonists with site B is thought to be responsible for induction of biologic responses in target cells. More detailed information on the structure of the IL-1 ligands was obtained using NMR spectroscopy and X-ray crystallography (40–42). The detailed crystal structures of complexes of soluble type I IL-1 receptors and IL-1β (43) or IL-1Ra (44) were recently described. Both ligands bound to the soluble receptor with 1:1 stoichiometry, and the three Ig domains of the receptor were wrapped around both ligands. The receptor binding regions in IL-1β and IL1Ra previously identified by site-directed mutagenesis interacted with all three domains of the receptor. However, in IL-1Ra the charged region corresponding to the IL-1β trigger site (Lys at positions 92-94) did not interact with the third domain of the soluble type I IL-1 receptor. A truncated receptor consisting of domains 1 and 2 bound IL-1 α and IL-1β with low affinity but bound IL-1Ra with high affinity. Thus, domain 3 was necessary to achieve high-affinity binding with the two IL-1 agonists, in addition to generation of agonist activity (44). The identification and characterization of a second subunit of the IL-1 receptor complex, the IL-1 accessory protein (IL-1R AcP), has further clarified the biochemistry and biology of the IL-1 system. The IL-1R AcP is a 570-amino acid protein of the Ig superfamily and possesses limited homology to both types I and II IL-1 receptors (45). The accessory protein formed a complex with either IL-1 α or IL-1β and the type I IL-1 receptor, but IL-1Ra failed to form this complex. The observation that IL-1 α but not IL-1Ra led to an aggregation of the type I IL-1 receptors at the cell surface, which was associated with induction of biologic responses, was due to formation of a complex with the IL-1R AcP (46). Cell lines that did not express the IL-1R AcP failed to demonstrate responses to IL-1 (47); these responses were restored by transfection of the cDNA for the accessory protein (48). Thus, the conformational changes induced in the ligand-receptor complex by tight binding of the IL-1 agonists to domain 3 of the receptor, not seen with IL-1Ra, may allow a secondary interaction of this complex with the IL-1R AcP. Although the IL-1R AcP molecule itself did not bind the IL-1 agonists, association of IL-1R AcP with the ligand-receptor complex led to a fivefold increase in the affinity of binding of IL-1 to the receptor (45). Signal transduction in responding cells appeared to require intact cytoplasmic domains of both the receptor and IL-1R AcP (49).

IL-1Ra in Other Species The cDNA for murine sIL-1Ra was cloned by three separate groups (50–52). Murine and human sIL-1Ra proteins are both 152 amino acids in size and exhibit 77% homology, similar to the degree of identity between murine and human IL1β. The gene coding for murine sIL-1Ra also was cloned, and the first 234 bp of

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the 50 regulatory region possessed 83% identity to the human gene (53, 54). The gene for rat sIL-1Ra also was cloned, and the genes for all three species (human, rat, and mouse) exhibited the same general structure of 4 exons and 3 introns (53). An analysis of sequences and mutation rates for the genes of all three members of the IL-1 family suggested that a gene duplication event occurring ≈350 million years ago may have given rise to a common IL-1 α/β gene and the IL-1Ra gene from a primordial precursor (53). The gene for murine icIL-1Ra also was recently cloned, and the predicted protein sequence was 77% identical to the human (55). In addition, recent studies in our laboratory demonstrated the presence of a smaller molecular weight IL-1Ra species in the murine macrophage line RAW 264.7 and in mouse liver, spleen, and lung extracts (55). This corresponds to the 16-kDa form of intracellular IL-1Ra found in human neutrophils and monocytes (12) and in human hepatoma lines (14). Similar studies were carried out on rabbit IL-1Ra, and the results showed one important difference. Purification of IL-1Ra from rabbit neutrophils obtained from casein-induced peritoneal exudates revealed a protein of 143 amino acids, 9 residues shorter than the comparable protein described in other species (56, 57). However, the cloned cDNA coded for a protein of 177 amino acids, prompting these authors to conclude that the signal peptide for sIL-1Ra in the rabbit was larger than in other studied species. However, the amino terminal sequence for this purified rabbit IL-1Ra protein was MQAFRI, corresponding to the hypothesized amino terminal sequence for the smaller molecular weight species of icIL-1Ra found in human neutrophils (12). Subsequent genomic and cDNA cloning of rabbit IL-1Ra indicated the presence of two species corresponding to 17-kDa sIL-1Ra and 18-kDa icIL-1Ra in the human (58). Thus, all three species of IL-1Ra described in the human appeared to be present in the mouse and rabbit as well: 17-kDa sIL-1Ra (present extracellularly in the human and rabbit as 22–25-kDa variably glycosylated molecules), icIL-1Ra (the 18-kDa intracellular form transcribed from an alternate mRNA), and the 16-kDa intracellular form.

Production of IL-1Ra The induction of IL-1Ra production in different cells is summarized in earlier reviews (1–7). Agents and materials that have been described, in studies published through mid-1997, as stimulating IL-1Ra production in human monocytes and macrophages are summarized in Table 1. The most potent inducing substances in vitro are adherent IgG, LPS, GM-CSF, and IL-4, although other agents may be more effective in vivo. It is of considerable interest that IL1Ra production is induced by a number of other cytokines, viral products, and acute phase proteins, indicating that this cytokine may be readily produced in vivo in numerous chronic inflammatory and infectious diseases. HIV induced

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Cytokines GM-CSF M-CSF G-CSF IL-1 IL-2 IL-3 IL-4 IL-6 IL-10 IL-13 TGF-β IFN-α IFN-γ

Other stimuli Adherent IgG Lipopolysaccharide Acute phase proteins Products of human CMV early genes Soluble CD23 (with IL-1) IgA IgD Human Th2 cells (direct contact) Fibronectin β-glucan

IL-1Ra production over IL-1 indirectly through the stimulation of synthesis of cytokines such as GM-CSF and transforming growth factor (TGF)β (59). Both IL-4 and IL-10 inhibited IL-1 production while enhancing LPS-induced IL-1Ra production by monocytes. In contrast, fibrin enhanced IL-1β and suppressed IL-1Ra production in human monocytes (60), whereas cis platinum inhibited LPS-induced IL-1Ra transcription and translation without affecting IL-1β production (61). The effects of glucocorticoids on IL-1Ra production vary with the cell. Glucocorticoids inhibited LPS-induced sIL-1Ra and IL-1β production by monocytes (62) but enhanced icIL-1Ra synthesis by keratinocytes (63) and sIL-1Ra production by HepG2 cells (14). Lastly, peripheral monocytes from women obtained during the luteal phase of the menstrual cycle produced five- to tenfold more IL-1β and IL-1Ra than did cells from men, and cytokine production was enhanced another two- to threefold in cells from the follicular phase (64). Urinary excretion of IL-1β and IL-1Ra correlated with the levels of in vitro production by monocytes, suggesting that the differential production of these cytokines also occurred in vivo. Thus, regulation of production of cytokines of the IL-1 family may be fundamentally different between males and females, suggesting possible variation between the genders in functional roles in vivo.

ROLE IN BIOLOGY In spite of extensive studies on IL-1 over the past two decades, the important roles that this cytokine may play in normal biology remain unclear (3, 7).

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Furthermore, whether the function of IL-1Ra is solely to regulate the agonist effects of extracellular IL-1 in normal biologic processes or in pathophysiological conditions also is unknown. Studies on the tissue distribution of IL-1Ra and on the functional consequences of overexpression or an absence of expression of IL-1Ra in transgenic or knockout mice, respectively, may clarify some possible roles of this cytokine in normal biology. Lastly, intracellular IL-1Ra may carry out unique biologic functions within the cells that produce it. Annu. Rev. Immunol. 1998.16:27-55. Downloaded from arjournals.annualreviews.org by HINARI on 08/31/07. For personal use only.

Tissue Distribution of IL-1Ra The distribution of IL-1Ra mRNA and protein in tissues has been partially examined in mice and rabbits. The results of early studies indicated that IL1Ra mRNA was found by Northern blot analysis in normal mouse intestine, lung, lymph nodes, spleen, liver, and skin (51). Although these studies did not differentiate between the mRNAs for sIL-1Ra and icIL-1Ra, it appeared that the intracellular isoform was found primarily in the intestine and skin, consistent with the constitutive expression of icIL-1Ra in epithelial cells. Extensive studies on the tissue distribution of the two major isoforms of IL-1Ra in the mouse were recently carried out by our laboratory (55). Using probes specific for the mRNA of each IL-1Ra isoform, icIL-1Ra mRNA was found only in the skin of normal or LPS-injected mice, as determined by ribonuclease protection assay (RPA). In addition, icIL-1Ra protein was present in the skin, as determined by Western blot analysis of skin extracts. In contrast, sIL-1Ra mRNA was not detected by RPA in any tissue of normal mice but was upregulated in the peripheral blood, spleen, lung, and liver in response to intraperitoneal injection of LPS. sIL-1Ra protein also was present in these organs as determined by ELISA and Western blot. Studies are in progress to characterize further the tissue and cellular distribution of IL-1Ra in the mouse and to examine transcriptional regulation in vivo. Recently reported studies in the rabbit described the presence of IL1Ra mRNA in the lung, brain, heart, liver, and spleen, although the species of mRNA was not determined (65).

Studies in Transgenic and Knockout Mice In an effort to investigate the physiological role of endogenous IL-1Ra, mice were generated that lacked production of either isoform of IL-1Ra or that overproduced sIL-1Ra (66). In the latter transgenic mice, IL-1Ra mRNA and protein were produced in proportion to the number of copies of the IL-1Ra gene present in the genome. The IL-1Ra knockout mice were smaller than wildtype controls, although no other overt phenotypic differences were described. Intraperitoneal injection of LPS was more lethal in the IL-1Ra knockout mice than in normal mice and the transgenics, consistent with the known beneficial effects of IL-1Ra in animal models of septic shock. In contrast, the mice lacking

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endogenous IL-1Ra were less susceptible to infection with Listeria monocytogenes than were the normal and transgenic mice, supporting the importance of IL-1 in resistance to infection with intracellular organisms. These initial studies establish that the in vivo balance between endogenous IL-1 and IL-1Ra is important in influencing the host response to infection. Further experiments with the IL-1Ra knockout and transgenic mice will be necessary to examine more fully the in vivo roles of this cytokine in normal physiology and in immune and inflammatory responses.

IL-1Ra as an Acute Phase Protein Results of clinical studies have described elevated IL-1Ra levels in the peripheral blood of patients with sepsis (67), chronic rheumatic diseases (68–71), and following surgical trauma (72, 73). In children with juvenile chronic arthritis, peripheral blood IL-1Ra levels were found to correlate with IL-6 levels (71). Furthermore, injection of humans with IL-1 (74) or IL-6 (75) led to a rapid rise in blood IL-1Ra levels. Since IL-1 and IL-6 are known to regulate the production of acute phase proteins (APP) by the liver, such as C-reactive protein, this observation suggested that IL-1Ra may behave as an APP. Recently published studies from our laboratory showed that IL-1Ra is an acute phase protein (14). Both cultured human hepatocytes and the human hepatoma cell line HepG2 produced sIL-1Ra in response to stimulation with IL-1 and IL-6. This production was increased by dexamethasone, consistent with the enhancing effects of glucorticoids on production of APP. The HepG2 cells contained only the sIL-1Ra mRNA and not the icIL-1Ra mRNA, consistent with the results of earlier studies with a liver cDNA library (76). In addition, transfection studies indicated that only the sIL-1Ra promoter was active in the HepG2 cells (14). Lastly, transfection experiments with the cloned sIL-1Ra promoter indicated that the response to IL-1 and IL-6 in HepG2 cells was mediated by NF-κB and C/EBP (NF-IL-6) elements in the sIL-1Ra promoter, identical to other APP. These results may explain the earlier clinical observations of elevated blood levels of IL-1Ra in various diseases and may indicate a unique role in biology for this cytokine.

Possible Function of Intracellular Variants Regulation of the effects of IL-1 in the cell microenvironment would appear to be the major biologic role of extracellular sIL-1Ra. Although icIL-1Ra may be released from dying or dead cells, the fact that at least two isoforms of intracellular IL-1Ra have been maintained during evolution suggests that they may be involved in additional functions inside cells. The results of cell fractionation studies in our laboratory indicated that intracellular IL-1Ra in both monocytes and neutrophils remained primarily in the cytoplasm (12).

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In addition to its role as an extracellular cytokine, IL-1, presumably IL-1α, likely plays an internal autocrine role as well. IL-1 α binding to plasma membrane type I IL-1 receptors led to internalization of the receptor ligand complex with eventual nuclear localization (77). Intracellular IL-1 α may play a role in cell growth and differentiation as treatment of human endothelial cells with an IL-1 α antisense oligodeoxynucleotide prevented senescence and prolonged the in vitro lifespan (78). Furthermore, mature IL-1 α delivered directly into the cytoplasm of EL4 thymoma cells by transfection was biologically active in induction of IL-2 production, suggesting a possible role for intracellular IL-1 α that did not require the N-terminal propiece or plasma membrane IL-1 receptors (79). The results of recent studies indicated that the constitutive expression of high levels of intracellular IL-1 α in scleroderma fibroblasts was due to enhanced transcription (80) and, most importantly, determined the fibrogenic phenotype of these cells (81). Lastly, the 33-kDa intracellular precursor of IL-1β inhibited Fas-mediated apoptosis by acting as a competitive substrate for IL-1β converting enzymes (ICE) required for apoptosis (82). Whether icIL-1Ra influences any of these purported activities of intracellular IL-1 is not known. Intracellular IL-1Ra reportedly exhibits an intrinsic autocrine role in two different experimental systems. Ovarian cancer cells possessing high levels of icIL-1Ra displayed impaired IL-1-induced IL-8 and GRO mRNA expression in comparison to cells that did not produce icIL-1Ra (83). This effect of icIL1Ra was not secondary to blockade of plasma membrane receptors for IL-1 but appeared to be mediated by destabilization of the chemokine mRNA. In recent studies from our laboratory, high levels of both constitutive and cytokineinduced icIL-1Ra in keratinocyte cell lines and in transfected fibroblasts were associated with decreased plasma membrane expression of ICAM-1 (84). Other responses of these cells were not affected, such as IL-8 production and HLA-DR or Fas expression. Additional studies are necessary to further investigate the mechanisms of these observations. However, these preliminary results support the hypothesis that icIL-1Ra may perform important and unique regulatory roles within cells that synthesize this cytokine.

IL-1RA IN DISEASE Although the role of IL-1Ra in normal physiology remains to be further clarified, the use of specific neutralizing antibodies has demonstrated the importance of endogenous IL-1Ra as a natural antiinflammatory protein in animal models of disease. In addition, the pattern of endogenous IL-1Ra expression in some human diseases has been described, with the clear implication that this molecule may be an important element of host defense in the human as well. The administration of recombinant IL-1Ra has clarified the role of IL-1 in animal models

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of disease and has established a foundation for clinical trials using the recombinant protein in human diseases. Finally, the delivery of IL-1Ra by gene therapy in animal diseases has led to the first trials of gene therapy with the IL-1Ra cDNA in patients with rheumatoid arthritis.

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Role of Endogenous IL-1Ra in Host Defense Studies on the presence of IL-1Ra in animal models of disease and in human diseases have been summarized in earlier reviews (5, 7). Additional publications over the past few years have indicated that although IL-1Ra is produced locally in tissues during active disease and can be measured systemically, the local balance of net biologic function remains in favor of the agonists IL-1α and IL-1β. As an example, evidence regarding the importance of IL-1 and tumor necrosis factor (TNF)-α in rheumatoid arthritis has been recently reviewed (85). Studies on endogenous IL-1Ra in both animal models and human diseases are discussed under each group of diseases. RHEUMATIC DISEASES Elevated blood levels of IL-1Ra have been described in patients with juvenile chronic arthritis (68, 71), polymyositis (69), systemic lupus erythematosus (70, 86), and rheumatoid arthritis (86, 87). The high serum levels in lupus patients were correlated with disease activity and were accompanied by both high IL-1Ra mRNA levels in peripheral monocytes and enhanced IL-1Ra production after culture of these cells on adherent IgG (70). As previously discussed, the liver may be an additional source of circulating IL-1Ra as an APP. Rheumatoid arthritis patients exhibited a lower ratio of IL-1Ra to IL-1β in plasma both at baseline and following surgery in comparison to patients with osteoarthritis or osteomyelitis (87). This observation suggests that IL-1Ra production may be relatively deficient or inadequate in rheumatoid patients. Furthermore, IL-1Ra production was enhanced, and the ratio of IL-1β to IL-1Ra was decreased, in peripheral blood monocytes from patients with rheumatoid arthritis after clinical response to treatment with methotrexate (88, 89) or gold injections (90). IL-1Ra levels also were elevated in the synovial fluids of patients with rheumatoid arthritis (33, 91, 92), although soluble type I IL-1 receptors in these fluids may have obscured accurate measurement of IL-1Ra by ELISA (33). Neutrophils may be the major source of IL-1Ra in rheumatoid synovial fluids (91), even though these cells produced relatively less IL-1Ra and more IL-1β in comparison to peripheral blood neutrophils (92). An important antiinflammatory role of endogenous IL-1Ra was suggested by observations in patients with knee arthritis from Lyme disease. A higher ratio of IL-1Ra to IL-1β was present in the synovial fluids of those patients with acute arthritis who recovered more rapidly than in patients with a more protracted course (93). These results

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suggested either that the synovial fluid IL-1Ra was derived, at least in part, from production by cells in the synovial tissue or that the neutrophil-derived IL-1Ra in the fluid phase was able to penetrate the tissue and dampen the inflammation. IL-1Ra protein and mRNA were localized to macrophages in the sublining and perivascular areas in rheumatoid synovial tissue and were present at lower levels in the intimal lining layer (94). However, culture of rheumatoid synovial tissue cells revealed deficient IL-1Ra production relative to total IL-1 production (95–97). IL-1Ra production by rheumatoid synovial cultures was enhanced by IL-4, IL-10, and IFN-γ , consistent with the known stimulatory effects of these cytokines on IL-1Ra production by macrophages in vitro (97, 98). Thus, although IL-1Ra is found in large amounts in rheumatoid synovial fluids and is produced by synovial tissue from these patients, the amounts of IL-1Ra may not be sufficient to overcome the IL-1 produced locally. Therapeutic modalities that may enhance endogenous IL-1Ra production, such as the administration of recombinant IL-4 or IL-10, are currently being evaluated in patients with rheumatoid arthritis. In both rheumatoid arthritis and osteoarthritis, IL-1 leads to tissue destruction by stimulating neutral proteinase production by cells in the synovium and by chondrocytes in the adjacent articular cartilage. The origin of the IL-1 may be from synovial macrophages or from the chondrocytes, with an autocrine induction of enzyme release in the latter instance (99). Chondrocytes also produce IL-1Ra, but IL-1-induced nitric oxide inhibited IL-1Ra production by these cells (100). Thus, the balance between IL-1 and IL-1Ra may be important in pathophysiologic events in the cartilage in osteoarthritis and in both the cartilage and synovium in rheumatoid arthritis. The importance of endogenous IL-1Ra also has been demonstrated in LPS-induced arthritis in rabbits where intraarticular injection of F(ab0 )2 anti-IL-1Ra antibodies led to enhanced leukocyte infiltration and protein leak into the synovial fluid (101). Numerous examples have been published of the presence and role of endogenous IL-1Ra in infectious diseases, both in animal models and in human disease. High IL-1Ra levels (up to 55 ng/ml) were described in the plasma of acutely ill patients either after surgery (102, 103), with adult sepsis (102, 103), with neonatal sepsis (104), or presenting with fever of unknown origin subsequently proven to be due to infection, neoplasm, or inflammatory disease (105). Interestingly, the in vitro production of IL-1Ra was not upregulated in monocytes or neutrophils from postsurgery patients exhibiting elevated plasma IL-1Ra levels (106). This result suggests that circulating IL-1Ra may be derived not from peripheral blood cells but rather from the liver as an APP or from other organs. Intravenous injection of endotoxin in normal humans led to a rapid rise in plasma IL-1Ra levels, with peak levels of ≈6.4

INFECTIOUS DISEASES

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ng/ml observed at 3–6 h (107–109). The maximal plasma levels of IL-1Ra were ≈100-fold greater than those of IL-1β (108). Infusion of hydrocortisone 6–144 h prior to an injection of endotoxin in normal volunteers led to enhanced IL-1Ra levels over those seen with endotoxin alone, whereas a decrease in IL1Ra levels was observed with the simultaneous administration of both agents (109). This varying response to glucocorticoids further suggests that tissue macrophages may be the primary source of IL-1Ra in the circulation immediately after endotoxin injection, but that the subsequent increase to high levels may be secondary to delayed production in the liver as an APP. An intravenous injection of TNF-α into normal humans led to increased plasma levels of IL-1Ra peaking at ≈100 ng/ml at 3 h (110). In addition, the simultaneous injection of anti-TNF antibodies and endotoxin to chimpanzees markedly reduced the rise in plasma IL-1Ra levels, indicating that TNF may be an intermediate in endotoxininduced IL-1Ra production (110). Lastly, after the intratracheal administration of endotoxin to rats, neutrophils were demonstrated to be the primary source of the large increase in IL-1Ra both in bronchoalveolar lavage fluid (BAL) and in whole lung (111). Elevated plasma IL-1Ra levels also were observed in patients with asymptomatic HIV infection (up to 9.3 ng/ml), whereas AIDS patients exhibited levels no different from controls (1 ng/ml or less) (112). Both TNF and IL-1 were upregulated by HIV infection in vitro or in vivo, and the IL-1-induced expression of HIV in the latently infected human promonocytic cell line U1 was inhibited by IL-1Ra (113). Endogenously produced IL-1Ra may be an important regulator of HIV expression in U1 cells and may be stimulated by autocrine IL-1 (114). Thus, the results from these three studies suggest that the balance between IL-1Ra and IL-1 may be an important factor in host resistance to HIV infection. An analogous situation may exist in Lyme disease where live Borrelia burgdorferi organisms preferentially induced IL-1β synthesis over IL-1Ra in human monocytes (115), supporting an earlier observation that local IL-1 production may be a major contributor to the destructive arthritis seen in Lyme disease (93). The importance of endogenous IL-1Ra also has been shown in granulomatous diseases and hepatitis. High levels of IL-1Ra protein in macrophages were demonstrated in granulomatous lesions from patients with tuberculosis, sarcoidosis, or foreign bodies (116). The administration of anti-IL-1Ra antibodies worsened by 50% the pulmonary granulomatous response in mice induced by schistosome eggs (117, 118). IFN-γ and TNF-α were important inducers of IL-1Ra production in vivo in experimental granulomatous disease in mice (118). IL-1Ra was abundantly produced by hepatocytes in bacteria-induced fulminant hepatitis in mice, and anti-IL-1Ra antibodies markedly worsened the tissue injury (119). Thus, the results of many studies on human disease and

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on animal models of disease clearly establish the importance of endogenous IL-1Ra in host responses to infection and in limiting subsequent organ damage. CENTRAL NERVOUS SYSTEM Many investigators have described the presence of all three members of the IL-1 system in the brain and have explored the role of these cytokines in diseases of the central nervous system (120). IL-1Ra mRNA was localized in the rat brain by in situ hybridization histochemistry to the paraventricular nucleus of the hypothalamus, hippocampus, and cerebellum (121). Chronic intracerebroventricular infusion of IL-1β in rats induced expression of mRNAs for all three ligands of the IL-1 system in the same areas, particularly in cells in close proximity to the microvasculature (122). Cytokine synthesis and release, particularly of TNF-α and IL-1β, are thought to mediate tissue damage in focal cerebral ischemia, probably during the reperfusion phase. IL1Ra is capable of crossing the blood-brain barrier; thus, protein measured in the brain may be of peripheral or local origin (123). Plasma IL-1Ra levels were elevated in stroke patients along with other APP, with a direct relationship to the size of the infarct (124). IL-1Ra mRNA was increased in focal areas in the rat brain after induced ischemia, reaching a maximum at 12 h, somewhat later than the peak presence of IL-1 (125). In addition, in response to systemic inflammation, large amounts of sIL-1Ra mRNA were found only in the anterior pituitary, whereas IL-1β mRNA was present in many other areas of the brain (120). These observations suggest that endogenous IL-1Ra production in the brain may play an important antiinflammatory role in the local response to ischemia as well as in regulation of the neuroendocrine system.

Endogenous IL-1Ra has also been examined in the large intestine of patients with inflammatory bowel disease (IBD). The expression of IL-1Ra mRNA relative to that of IL-1β appeared to be low in the colonic tissue of patients with Crohn’s disease or ulcerative colitis in comparison to that from patients with inflammation secondary to infection (126, 127). In further studies, a reduced ratio of IL-1Ra to IL-1β was observed in colonic tissue from patients with active IBD in comparison to those with self-limited colitis (128, 129). The importance of endogenous IL-1Ra in host responses to colonic inflammation was demonstrated by the observation that anti-IL-1Ra antibodies led to prolonged intestinal inflammation and increased mortality in a rabbit model of colitis induced by formalin and immune complexes (130). These results all indicate that a relative deficiency in local IL-1Ra production may predispose to chronic inflammation in IBD.

LARGE INTESTINE

LUNG IL-1Ra production in the lung also has been implicated in modulating local inflammatory diseases. Tissue homogenates and BAL from patients with idiopathic pulmonary fibrosis demonstrated elevated IL-1Ra levels compared

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with samples from normal controls (131). The IL-1Ra protein was found in hyperplastic type II pneumocytes, macrophages, and fibroblasts, with the latter cells exhibiting an enhanced production of IL-1Ra in vitro in response to TGF-β. Both IL-1β and IL-1Ra were present in the bronchial epithelium of patients with asthma (132), and plasma levels of IL-1Ra increased during acute attacks of asthma (133). The relative amounts of IL-1Ra and IL-1β in BAL were thought to be important in neutrophil-induced airway inflammation in patients with panbronchiolitis (134). Low concentrations of the antiinflammatory cytokines IL-10 and IL-1Ra in the BAL of patients with early acute respiratory distress syndrome were closely associated with a poor prognosis (135). Lastly, IL-1Ra mRNA expression was increased in the lungs of rats with immune complex–induced inflammation, and blocking endogenous IL-1Ra with specific antibodies led to a more severe inflammatory response (136). Again, these observations all indicate that IL-1Ra functions as an intrinsic regulator of lung inflammation in many different diseases. IL-1Ra has also been examined in renal diseases. Studies in normal rats indicated that the kidneys contributed ≈80% to the clearance of infused IL-1Ra, with either extensive reabsorption and/or metabolism occurring after filtration in the glomeruli (137). The highest urinary IL-1Ra levels were found in normal children in comparison to those with acute or recurrent pyelonephritis (138). Elevated plasma levels of IL-1Ra were present in patients with chronic renal failure, reflecting inadequate clearance as well as possibly increased production (139). Glomerular expression of IL-1Ra mRNA was readily detected in rats with antiglomerular basement membrane antibody-mediated glomerulonephritis (140, 141). These observations suggest that the ratio of endogenous IL-1Ra to IL-1β may not be adequate to inhibit inflammation in various forms of acute renal diseases. KIDNEYS

REPRODUCTIVE SYSTEM The IL-1 system also may be involved in normal ovarian function as well as in the uterus during pregnancy and delivery. IL-1Ra mRNA was present in whole ovarian extracts (142). In subsequent studies, IL1Ra was found in both granulosa and thecal cells in developing follicles, with an increase in the levels of IL-1Ra in thecal cells during ovulation (143). High concentrations of IL-1Ra, up to to 70 ng/ml, were detected in human amniotic fluids (144). The highest concentrations were present during the third trimester; the major source is probably fetal urine (145). The amniotic fluid and neonatal urine concentrations of IL-1Ra were higher for female fetuses than for male, and these levels were increased in preterm labor precipitated by intrauterine infection (145). IL-1Ra production by decidual cells was stimulated by IL-4 and TGF-β, with decidual IL-1Ra possibly playing a negative regulatory role in preterm labor precipitated by intrauterine infection (146).

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OTHER ORGANS Endogenous IL-1Ra production has also been described in the normal human cornea, where epithelial cells produced both sIL-1Ra and icIL-1Ra while stromal cells synthesized only icIL-1Ra (147). Interestingly, the lysates of both cell types also contained the low molecular weight 16-kDa form of IL-1Ra that our laboratory has identified in monocytes, macrophages, neutrophils, and hepatocytes (12). The adrenal gland contained the mRNA and protein for all three ligands of the IL-1 system, with IL-1Ra produced primarily by the adrenergic cells in the adrenal medulla (148). High IL-1Ra levels were present in the serum of patients with Hodgkin’s disease (149), with the mRNA found in histiocytes in both Hodgkin’s and non-Hodgkin’s lymphoma tissue (150). IL-1Ra also was produced by bronchogenic carcinoma cells, possibly contributing to the ability of these tumors to escape host defense mechanisms (151). In addition, production of both IL-1β and IL-1Ra was dysregulated in chronic myelogenous leukemia cells (CML), with high IL-1β and low IL-1Ra protein levels present in CML cells from patients with advanced disease (152). IL-1β may be an important autocrine factor stimulating proliferation of CML cells, with endogenous IL-1Ra limiting these effects. In summary, extensive evidence indicates that IL-1Ra is produced by many tissues in the normal human and that its production is upregulated in the host response to infection and acute or chronic inflammation. Experiments with neutralizing anti-IL-1Ra antibodies in animal models of disease clearly demonstrate the antiinflammatory importance of endogenous IL-1Ra. However, studies in both animal and human systems suggest that the levels of production of IL1Ra in many diseased tissues may not be sufficient to completely neutralize the inflammatory effects of the IL-1 agonists. A further understanding of the mechanisms of regulation of IL-1Ra production in vivo may lead to new therapeutic approaches to human disease through upregulation of endogenous IL-1Ra production.

Effect of Treatment in Animal Models of Disease The beneficial effects of administration of recombinant human IL-1Ra in many experimental animal models of disease are summarized in recent reviews (5–7). Table 2 contains an incomplete listing of some animal models where the delivery of exogenous IL-1Ra, usually intravenously, led to at least partial prevention or treatment of disease. A potential limitation to the therapeutic use of IL-1Ra protein is the necessity to administer large amounts. Up to 100- to 1000-fold amounts of IL-1Ra greater than the IL-1 agonists were necessary to inhibit biologic activities (153). This may be required because target cells are sensitive to binding of only a few molecules of IL-1 per cell, and excess receptors are present. In addition, the presence of the biologically inactive type II IL-1 receptor, either on the cell surface or as a soluble form in the cell microenvironment, may compete for the available IL-1Ra. A mutant IL-1Ra molecule that bound

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Table 2 Animal models of disease treated with recombinant IL-1Ra Collagen-induced arthritis in mice Streptococcal cell wall–induced arthritis in rats Immune complex–induced arthritis in mice Antigen-induced arthritis in rabbits Staphylococcal-induced arthritis in rabbits Osteoarthritis in dogs Septic shock in rabbits, baboons, rats and mice Bacterial meningitis in rabbits Ischemic brain injury in rats Experimental allergic encephalomyelitis in rats Streptococcal cell wall–induced colitis in rats Experimental shigellosis in rabbits Immune complex–induced colitis in rabbits Acetic acid–induced colitis in rats Lipopolysaccharide-induced pleurisy in rabbits Monocrotaline-induced pulmonary hypertension in rats Allergen-induced late asthmatic reaction in guinea pigs Antigen-induced airway hyperreactivity in guinea pigs Bleomycin- or silica-induced pulmonary fibrosis in mice Immune complex–induced lung injury in rats Ischemia/reperfusion lung injury in rats Crescentic glomerulonephritis in rats Anti-glomerular basement membrane antibody–induced glomerulonephritis in rats Pre-term delivery in mice induced by IL-1 Osteoclast formation and bone resorption in ovariectomized mice and rats Hepatic fibrosis induced by dimethylnitrosamine in rats Post-cardiac transplant coronary arteriopathy in piglets Graft-versus-host disease in mice Streptozotocin-induced diabetes in mice

more avidly to the type I IL-1 receptor but less avidly to the type II receptor was a more potent antagonist of IL-1 effects in vivo (154). The delivery of IL-1Ra by gene therapy has recently been examined in experimental animal models of arthritis. This approach would lead to a high concentration of IL-1Ra in the synovium without the systemic inhibition of IL-1 effects seen with the use of recombinant protein. An adenoviral vector containing the human IL-1Ra cDNA was directly injected into rabbit knees, and the cDNA was taken up and expressed by synovial lining cells (155, 156). The production of IL-1Ra protein was detected through four weeks, exhibiting biologic activity in vivo as determined by inhibition of IL-1-induced proteoglycan degradation. sIL-1Ra cDNA was also delivered into rabbit knees using an ex vivo approach where cultured synovial cells were transduced with a retroviral vector, then enriched for IL-1Ra production and transplanted back into a

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knee (157). IL-1Ra protein was produced in the knees of autografted animals through five weeks and was biologically active, as determined by inhibition of IL-1-induced neutrophil infiltration, synovial thickening, and degradation of cartilage proteoglycans (157, 158). Furthermore, the recurrence of bacterial cell wall–induced arthritis in rats (159), the severity of antigen-induced arthritis in rabbits (160), and the development of collagen-induced arthritis in mice (161) all were suppressed by the delivery of IL-1Ra into the joints through the ex vivo gene therapy approach. In the rabbit studies, the locally produced IL-1Ra was primarily chondroprotective and only weakly antiinflammatory. IL-1Ra was also chondroprotective in another model system of inflammatory arthritis, where rheumatoid fibroblasts were cultured on normal human cartilage coimplanted into SCID mice. IL-1Ra-transduced fibroblasts induced less chondrocyte-mediated matrix degradation in this system, whereas the invasion of surface fibroblasts into the cartilage was not altered (162). IL-1 also has been implicated in pathophysiologic events in osteoarthritis through inducing the production of neutral metalloproteinases by chondrocytes in the articular cartilage. Studies with IL-1Ra suggest some beneficial effects in this type of arthritis as well. Human chondrocytes transduced in vitro with an adenoviral vector containing the IL-1Ra cDNA continued to produce IL-1Ra protein after seeding onto the surface of osteoarthritis cartilage organ cultures (163). Furthermore, these cartilage slices with enhanced presence of IL-1Ra were resistant to IL-1-induced proteoglycan degradation during 10 days in organ culture. Intraarticular injections of IL-1Ra protein partially protected against the development of cartilage lesions in an experimental dog model of osteoarthritis, possibly through a reduction in collagenase-1 expression (164). The delivery of IL-1Ra into knee joints by transduced synovial cells also reduced the extent of cartilage lesions in this experimental animal model of osteoarthritis (165). In summary, early experiments with gene therapy have indicated some efficacy in animal models of rheumatoid arthritis or osteoarthritis. A clinical trial is underway examining the feasibility of gene therapy with IL-1Ra in patients with rheumatoid arthritis. Gene transfer of IL-1Ra into neuronal cells (166) or hematopoietic stem cells (167) also has been described, opening the possibility of IL-1Ra gene therapy for diseases of the CNS or bone marrow.

Treatment of Human Disease Clinical trials of recombinant human IL-1Ra have been carried out in patients with sepsis syndrome. In an initial phase II, open-label, placebo-controlled, multicenter trial, three different doses of IL-1Ra were infused intravenously over 3 days into patients with sepsis syndrome or septic shock (168). A dosedependent 28-day survival benefit was associated with IL-1Ra treatment in this

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early clinical trial. In a subsequent double-blind, placebo-controlled, multicenter trial, 3 days of IL-1Ra treatment did not lead to any overall increase in survival at 28 days in patients with sepsis syndrome (169). However, a retrospective analysis of the data suggested some possible benefit in patients with organ dysfunction and/or a predicted risk of mortality of 24% or greater. A subsequent clinical trial in more severely ill patients with sepsis syndrome was halted prematurely because of a lack of efficacy. Thus, sepsis syndrome in humans is more complex than in experimental animal models, and interference with the cytokine system may be too late in patients with overwhelming infection and organ dysfunction. In contrast, recombinant IL-1Ra appeared to demonstrate some efficacy in patients with rheumatoid arthritis. In an initial clinical trial, patients with rheumatoid arthritis were treated with three different doses of IL-1Ra protein by subcutaneous injection daily or three times a week for 3 weeks, followed by a 4-week maintenance phase of once weekly injections (170). The treatment was well tolerated, and patients receiving the daily dosing appeared to have some clinical improvement. In a subsequent randomized, double-blind, placebocontrolled, multicenter trial, 472 patients with rheumatoid arthritis received daily subcutaneous injections of placebo or three different doses of IL-1Ra for 24 weeks (171). The group receiving the largest dose (150 mg/injection) demonstrated ≈35% improvement in various clinical parameters in comparison to the placebo group. In addition, the patients in this treatment group demonstrated slowing in the radiographic progression of disease. Further clinical trials of IL-1Ra protein in rheumatoid arthritis are underway to determine whether this treatment leads to clinical and radiographic improvement over longer periods of time. Treatment with recombinant IL-1Ra also has been evaluated in small trials in patients with other diseases including inflammatory bowel disease, asthma, and psoriasis, with preliminary results not yet reported. Steroid-resistant graftversus-host disease (GVHD) was improved by at least one grade in 10 of 16 patients treated with a continuous infusion of IL-1Ra over 7 days (172). The skin and intestinal tract appeared to be the organs most responsive to the effects of IL-1Ra in this study, although the poor overall survival of patients was not changed. Further clinical trials are necessary to evaluate whether prophylactic treatment with IL-1Ra will be of any benefit in patients with GVHD. In addition to a proinflammatory role in various diseases, IL-1 may be important in host defenses, particularly to infections with intracellular organisms. Patients treated sytemically with IL-1Ra need to be followed closely over long periods of time to carefully assess the risk of increased infection. Local delivery of IL-1Ra by gene therapy may be a safer therapeutic approach to chronic diseases.

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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PATHWAYS AND STRATEGIES FOR DEVELOPING A MALARIA ∗ BLOOD-STAGE VACCINE Michael F. Good,∗ David C. Kaslow,+ and Louis H. Miller+

∗ The Cooperative Research Centre for Vaccine Technology, Queensland Institute of Medical Research, Brisbane 4029, Australia; and +The Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892; e-mail: [email protected]

KEY WORDS:

immune mechanisms, MSP-1, pathogenesis

ABSTRACT In the past 10 years, our knowledge of the malaria parasite has increased enormously: identification and analysis of parasite antigens, demonstration of protection of monkeys and mice following immunization with these antigens, and better understanding of the mechanisms of immunity to malaria and the pathogenesis of disease in malaria. Powerful new adjuvants have been developed, some of which—it is hoped—will be suitable for human use. Recently, a successful human trial of a vaccine aimed at sporozoites (the stage inoculated by mosquitoes) was completed. However, it is the red blood cell stage of the parasite that causes disease, and it is against this stage—in which the parasite grows at an exponential rate—that it has proven very difficult to induce a protective immune response by vaccination. This review focuses on recent exciting developments toward a blood-stage vaccine. We analyze the major obstacles to vaccine development and outline a strategy involving public- and industry-funded research that should result in development of a vaccine.

INTRODUCTION Malaria is a disease caused by parasites of the genus Plasmodium, of which four species infect humans: P. falciparum, P. vivax, P. ovale, and P. malariae. ∗

The US government has the right to retain a nonexclusive, royalty-free license in and to any copyright covering this paper.

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WHO estimates that four billion people in approximately 90 different countries are at risk of developing the disease and that up to 500 million cases of malaria occur each year (1). This results in the deaths of 1–2 million people, mainly children under 5 years of age but also a significant number of pregnant women. Most disease and death are due to P. falciparum, although P. vivax is important throughout Asia and Latin America. Over 90% of deaths due to malaria occur on the continent of Africa. In the earlier years of this century, countries in temperate climates (Europe, North America, and Australia) also experienced a significant number of cases, but they have now eradicated malaria. Many factors were responsible, including drainage of marshes, use of DDT, the improvements in the standard of living such as the use of window screens. Currently, insecticides to control mosquitoes and drugs to kill the parasite are not very effective, and the poor economic conditions of many of the countries in which malaria is endemic mean that a further reduction in malaria endemicity without adoption of different strategies is unlikely. One strategy that could prove very effective—but will take some time to come to fruition—is a malaria vaccine. To have a large impact, a vaccine must be cheap, safe, effective, and easy to administer. The slow progress to date is an indication of the magnitude of the task and of the lack of industrial interest in asexual blood-stage vaccines. In the decades after 1950, several dominant ideas set the stage for vaccine research. First, it was argued that antibody was the mechanism of immunity (2), in the face of the view of William Talliaferro, dominant since the 1920s, that the primary mechanism of immunity was cellular. We now recognize that cellular and humoral immunity are tightly bound through cytokines that control the immune response and that antibody and cellular immunity both play critical roles (3). Another major development was the ability to culture the P. falciparum parasite in vitro (4), making malaria research possible in any laboratory in the world. A final period of intense activity centered on the understanding that the pre-erythrocytic stage, the form of the parasite inoculated by the mosquito, could be the target of immune attack (5), an approach recently validated in preliminary vaccine studies in humans (6). The purpose of this review is to summarize the current position of the field, to identify the obstacles in developing malaria vaccines, and to put forward a strategy to overcome these obstacles. Study of the immunology of malaria is providing us with some of these strategies, whereas others will depend on knowledge of expression systems and formulation. The field of malaria vaccines requires intellectual input from many disciplines both in academe and industry. Funding for malaria vaccine research will be largely from the public sector, but it is hoped that this review will also encourage industry to assist wherever possible with technology lacking in the public sector.

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LIFE CYCLE OF MALARIA PARASITES—AN IMMUNOLOGIST’S PERSPECTIVE Malaria parasites are spread by various species of Anopheline mosquitoes (Figure 1). The blood-feeding mosquito takes up gametocytes, contained within red cells. In the mosquito gut, the gametocytes emerge as gametes and fertilize to produce motile ookinetes that burrow into the mosquito’s gut wall to form oocysts. Immature sporozoites form within the oocyst and migrate to the salivary glands where they mature, waiting to be inoculated into the host on which the mosquito is feeding. Once inoculated, sporozoites spend less than 30 min

Figure 1 The parasite life cycle, with emphasis on targets for blood-stage vaccines.

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in the blood before entering hepatocytes or being cleared by other tissues of the body. Specific antibodies can block invasion of hepatocytes. In the hepatocyte, a single sporozoite develops over the next 5–8 days or longer, depending on the species of malaria, into 30,000–40,000 merozoites, each of which, when released, continues the life cycle within red cells. As the sporozoite enters and develops within a hepatocyte, a variety of sporozoite- and liver-stage–specific antigens are synthesized by the parasite and are processed and presented by MHC class I molecules (7). Consistent with this notion is the observation that CD8+ T lymphocytes are critical effectors (see below). One goal of the parasite during the liver-stage part of the life cycle is to complete the transition from mosquito vector to human host. The parasite does so by developing into a form, the merozoite, that can invade red cells and maintain the erythrocytic cycle. As would be expected, given their functional similarity in invading red cells, liver-derived merozoites and red cell–derived merozoites share a number of, if not most, surface and intracellular antigens. These antigens, when presented in the context of the infected hepatocyte, could be expected to drive a MHC class I–restricted response. Although detrimental to the parasite while in the hepatocyte, this type of immune response would be completely ineffective during the erythrocytic cycle—red cells are deficient in MHC class I molecules—and even if they had the surface molecules, they lack the antigen-processing machinery for MHC class I–restricted antigen presentation. Thus, by the time the human immune system has mounted an effective MHC class I–restricted response, the parasite has left the liver and taken up residence inside the most abundant, easily accessible MHC class I–deficient cell in the body, the red cell. The parasite develops inside the red cell over a period of 2 days (P. falciparum, P. vivax, P. ovale) or 3 days (P. malariae). Six to 24 merozoites develop inside each red cell; following the rupture of the cell, each one can continue the life cycle by invading another red cell. Invasion of red cells by malaria parasites is often viewed simply as a process whereby a parasite invades a red cell, uses up the hemoglobin as a food source, and then moves out of the depleted cell to invade a fresh one. All this may be true; however, in addition, the parasite completely reforms the red cell, altering the surface of the cell, creating a network of structures within the cell, and replicating itself. The main target for antibody is the antigen expressed on the red cell surface that is involved in binding to endothelium (8). Each parasite clone contains more than 100 genes encoding this red cell surface molecule, providing an immense potential for antigenic variation. Antibodies to one variant act as a selection pressure for the outgrowth of parasites expressing new variants. To make the transition from the human host to the mosquito vector, the parasite undergoes sexual differentiation into male and female gametocytes.

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Antibodies that recognize parasite proteins on the surface of gametes in the mosquito midgut can block infectivity to mosquitoes, providing a focus for a vaccination strategy (see section, Types of Malaria Vaccines That Might Become Available). All malaria parasites have a similar life cycle, with some exceptions. One exception, relevant to further discussions, is that the rodent malaria parasites spend only 24 h within each red cell; this may in part explain the much higher parasite densities observed in the blood of rodents compared with those in humans. The red cell stage is clearly a phase of exponential growth in the numbers of malaria parasites within the host; however, given that the life cycle starts with so few parasites (typically, <100 sporozoites will be injected, and most will not enter liver cells) and that the number of red cells is so immense, it takes several days of parasite multiplication before sufficient numbers exist to be detected on a microscopic slide. Clinical symptoms of malaria commence at about the same time or just slightly before parasites are readily detected in the peripheral blood by microscopy; however, more sensitive detection methods (e.g., PCR) can now detect parasites in the blood for up to 1 week before they can be detected microscopically (9).

PATHOGENESIS AND VACCINE DEVELOPMENT The asexual blood stage of P. falciparum causes disease and death. The pathology of this disease is reviewed in detail elsewhere (10–12). Distinct patterns are observed in (a) patients in areas of low endemicity such as in Asia and Latin America, (b) in young children in Africa, and (c) in the fetus carried by African mothers during the first or second pregnancy. Disease in areas of low endemicity is caused by high parasitemia and may affect multiple organs in the same patient (cerebral malaria, severe anemia, renal failure, and adult respiratory distress syndrome with interstitial edema of the lung). Three disease patterns are seen in the young African child: cerebral malaria, severe anemia, and respiratory distress/acidosis. The pathogenesis of these conditions is not well understood. Renal failure is rare. Anemia occurs earlier in life than cerebral malaria and may be associated with low-level parasitemia. Although cerebral malaria is associated with high parasitemia (13), it is unclear why many children who have high parasitemia develop little disease. Sequestration of infected red cells within the small vasculature of the brain is associated with acidosis and reduced focal circulation within the brain. Infarction of the brain is uncommon in cerebral malaria; however, 10% of the children with cerebral malaria develop neurological deficits. A cytokine theory for cerebral malaria has been postulated (14). Certainly, tumor necrosis factor (TNF) levels

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are known to be elevated in the serum of individuals who have a poor outcome (15), and a particular polymorphic form of the TNF promoter is associated with susceptibility to cerebral malaria (16). The pathogenesis of the anemia of malaria is also not well understood. Surprisingly, the most severe cases of anemia (Hb < 6 g/dL) typically occur in young children experiencing a low level of parasitemia, whereas in the less severe anemias the parasitemia is often much higher (17). Suppression of hemopoiesis in the marrow and erythrophagocytosis of red cells are thought to contribute significantly to anemia. TNF is thought to be involved with both of these mechanisms (18, 19). While circumstantial evidence suggests that TNF is involved in the pathogenesis of both cerebral malaria and anemia, its source has not been defined. Various cell types produce TNF, but most attention has focused on the role of malaria toxins (thought to be primarily glycophosphatidylinositol molecules) (20) in stimulating macrophages directly to produce TNF. Indeed, a vaccine strategy based on inducing antibodies to malaria toxins has been proposed as an approach to preventing disease (21); however, parasite-activated T cells may also be a source of TNF, either directly or as a result of macrophage activation (22); such T cell–derived TNF has been postulated to be a route to disease (23). Humans develop a repertoire of malaria parasite-reactive CD4+ T cells most likely as a result of exposure to cross-reactive organisms in the environment (24); there is no evidence that malaria parasites contain superantigenic properties. Such T cells are found in high frequency in about 50% of children and in nearly all adults. These cells are capable of responding to parasite stimulation at low density with resultant proliferative activity and secretion of IFN-γ and TNF. As the pathogenesis of the different malarial disease states differs in the nonimmune patient from that in the child in Africa (e.g. cerebral malaria or severe anemia) or in pregnant women, it is not certain whether the same vaccine will protect all groups. Most vaccines are designed to control asexual parasitemia. It is hoped that this will have an impact on all the varied forms of malaria, but it is possible that a vaccine that would reduce the incidence of one type of disease, such as cerebral malaria, could exacerbate another, such as anemia. In the absence of understanding pathogenesis, vaccinated volunteers need to be followed closely for unusual complications. The study of the other area of pathogenesis—the mechanism of invasion of red cells and binding of infected red cells to endothelium—may identify targets for vaccine development. Binding of infected red cells to endothelium through parasite molecules located on knob protrusions on the red cell surface is critical to parasite survival, as it protects the parasite from destruction in the spleen. If we understood precisely the parasite molecules involved in the invasion of

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red cells (reviewed in 25), we might be able to design vaccines containing molecules involved in sequential steps of invasion and so obtain synergism. For example, micronemes, organelles at the invasive end of merozoites, contain receptors for red cell binding (26). Microneme contents may be released only after the parasite forms a junction with the red cell, protecting the parasite ligand from immune attack by antibody. If we could identify the molecule that signals the parasite that it has hit a red cell, then antibodies to that might cause premature release of the contents of the organelles. A second value of research on invasion of erythrocytes and erythrocyte/endothelial interaction is that it may define domains of parasite ligands that bind to red cells (27) and endothelium (28–30). Indeed, a structurally related domain binds both red cells and endothelium (31). The binding domains are often small regions of large molecules, potentially simplifying production of recombinant proteins for vaccine testing. Such research also identifies the mechanism of protection for development of in vitro assays to predict vaccine efficacy.

TYPES OF MALARIA VACCINES THAT MIGHT BECOME AVAILABLE Each stage in the life cycle of the parasite provides an opportunity for a vaccine. A blood-stage vaccine would reduce the number of infected red cells, and this strategy forms the basis for this review; however, it is helpful to consider briefly other malaria vaccine strategies. A pre-erythrocytic vaccine would prevent infection with sporozoites or would eradicate infected liver cells, and a sexual-stage or transmission-blocking vaccine would block the life cycle within the mosquito (by inducing antibodies that the mosquito would ingest along with its blood meal). All these vaccines are “antiparasitic.” A different type of vaccine is one that might not interfere with the parasite density but might prevent the symptoms associated with malaria. Development of such an “antitoxic” vaccine depends on our understanding of disease pathogenesis in malaria. These differing vaccines might be suitable to different groups of people, depending on their circumstances. A blood-stage vaccine might be very effective in reducing mortality if it were able to diminish, even though not necessarily eliminate, infected red cells. Such a vaccine is desperately needed for people living in endemic countries. Naive individuals, immunized with a blood-stage vaccine, could still be at risk for developing symptoms if all parasites were not eliminated, and thus this type of vaccine might not be efficacious for shortterm visitors to endemic countries. An antitoxic vaccine would need to be administered along with some other form of treatment or prevention, since vaccinated individuals, while not experiencing some symptoms of malaria, would still be at risk for pathology associated with high parasitemia and also could

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pass infection on to others. A transmission-blocking vaccine might be most suitable for people living in a somewhat isolated community in which unimmunized infected visitors would not be common. Such visitors could transmit malaria to local mosquitoes and so infect those immunized. This is because a transmission-blocking vaccine would not protect the person vaccinated but would prevent transmission from that person to others. A pre-erythrocytic vaccine, which could completely prevent infection, would be in demand by visitors to, as well as residents of, endemic countries. Human clinical trials have now been conducted with pre-erythrocytic, blood-stage, and transmission-blocking vaccines.

Progress Toward Pre-Erythrocytic Vaccines The most progress has been made thus far toward the development of a vaccine for the pre-erythrocytic stage. Work in the early 1980s identified a sporozoite coat protein—the circumsporozoite protein—that was the target of protective monoclonal antibodies (5). The dominant antibody epitope was the central repetitive domain of the protein, which is conserved within species. Early work was performed in rodent models, but in 1984 the gene for the circumsporozoite protein (CSP) of P. falciparum was cloned (32), which then led to human trials using recombinant (33) and synthetic forms (34) of this antigen. These antigens, delivered in alum, were not highly immunogenic and, possibly as a result of this, the degree of protection from malaria was limited. Recently, using recombinant CSP fused to the S antigen of hepatitis B and new adjuvants based on monophosphoryl lipid A and QS21, Stoute and colleagues have been able to induce high-level antibody responses and protection from sporozoite challenge in most volunteers (6); however, using a different adjuvant, they achieved similar antibody levels but no protection against challenge, while the use of alum resulted in lower antibody titers and no protection. It appears from this and other work that protection requires a high level of antibody, although a high antibody response does not guarantee protection (34a). Research has also focused on the liver stage; CD8+ T lymphocytes were critical effectors (reviewed in 35–37). CSP-specific CD8+ T cells could adoptively transfer protection, and immunization protocols resulting in CSP-specific CD8+ T cells could protect mice (e.g., vaccination with malaria gene-transformed tumor cells) (38). While human CD8+ T cell epitopes could be defined (39–41), few human trials specifically aimed at inducing CD8+ T cells. An attenuated poxvirus encoding seven malaria antigens—including CSP and other liver-stage antigens—has been developed (42) and is currently in human trials. Poxviruses would be expected to induce CD8+ T cells against vectored antigens. For malaria as well as for other diseases, naked DNA is being developed as a

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delivery strategy and may be particularly useful as a means to induce CD8+ T cells. Experiments in mice using different liver-stage antigen DNAs have resulted in protection (43, 44).

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Progress Toward A Transmission-Blocking Vaccine Interventions directed at the mosquito vector or those that reduce the contact between the vector and the human host have been cornerstones in malaria control and eradication programs in the past. For reasons of cost and resistance to insecticide, these previously highly successful measures are now more difficult to use and sustain in developing countries. Novel means of attacking the vector and blocking the parasite’s transmission are being explored, including vaccines directed against the sexual stages of the parasite and mosquito proteins such as trypsin. The deployment of such vaccines and their use may be more limited than for the other malaria vaccines targeted at pre-erythrocytic and asexual blood stages, in part because they are community-based interventions. Geographically isolated regions with seasonal or low-level malaria transmission, for example Sri Lanka, might benefit tremendously from transmissionblocking vaccines used as principal control or eradication interventions. It is doubtful, however, that the same vaccines would be deployed on their own in areas of high transmission or with substantial flux of malaria-infected people, such as in much of sub-Saharan Africa. The contribution of transmission-blocking vaccines in these regions would more likely be as a component of a multistage vaccine. The transmission-blocking component would be included to prevent the spread of mutant parasites resistant to the protective malaria vaccines as well as to reduce the level of transmission to enhance an otherwise partially effective protective component so that it might be highly effective. Likewise, use of transmission-blocking vaccines might be used to control epidemic malaria or the spread of drug-resistant parasites. Seven lead candidate antigens have been identified (45); however, only one, Pfs25, has been manufactured as a recombinant protein in a form that elicits transmission-blocking activity in experimental laboratory animals (46). Human Phase I safety, immunogenicity, and in vitro efficacy trials are now in progress.

RATIONALE FOR THE FOCUS ON ASEXUAL BLOOD-STAGE VACCINES IN THIS REVIEW The focus of this review is on the development of vaccines that will reduce disease in developing countries—especially in Africa, where nine of ten deaths occur. The review focuses on P. falciparum, the chief cause of most disease and death. The concepts derived from the study of P. falciparum may be extended

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to P. vivax, primary cause of disease in Asia and Latin America. As mentioned above, vaccines are currently being produced against all stages in the life cycle, but we believe that an asexual blood-stage vaccine is likely to have the greatest impact on disease. The reasons for this are as follows. First, it is the asexual blood stage that causes disease, not the liver stages or the sexual stages in red cells. The immunity to malaria created by each of the experimental vaccines studied so far is specific to a particular stage of the parasite life cycle. For example, pre-erythrocytic vaccines do not protect against an asexual blood-stage infection. Thus, a partially effective pre-erythrocytic vaccine may allow a few parasites to reach the blood. In the absence of immunity to the asexual blood stage, a fulminant infection could occur. It is possible, however, that a pre-erythrocytic vaccine could reduce disease. It has been argued that reduction in the number of inoculated sporozoites may reduce the number of clones infecting any child.1 Perhaps a pre-erythrocytic vaccine would have a similar effect, reducing the number of infecting clones. The concern regarding a highly effective pre-erythrocytic vaccine that prevents infection for a period of time is that the population might then be at risk for severe disease if protection waned, due to the appearance of mutant parasites or a failure to continue the vaccine program. Such a situation would resemble that in areas where transmission of malaria is sporadic because of marked yearly fluctuations in vector populations. When the vector population returns and transmission again occurs, epidemics appear in a population that is relatively nonimmune. A transmission-blocking vaccine used for eliminating transmission in an African setting would present the same potential risk to the population. The asexual blood-stage vaccine, on the other hand, would not prevent an immune response to blood-stage antigens, even including those not found in the vaccine, and would be safe even if the vaccination program were to be discontinued. The second theoretical advantage of a blood-stage vaccine is the boosting of immunity during infection. Each cycle of asexual parasite replication could boost the immune response to the immunogen. Thus, the immunity may be continuously enhanced by infection and, as a result, limit the proliferation of the parasite. If pre-erythrocytic immunity has waned at the time of infection, the immune response probably cannot be boosted in time to prevent infection from proceeding to the blood stage, where pre-erythrocytic immunity has no effect. 1 This may explain the effects of insecticide-impregnated bednets that reduced death by 50%, although they did not reduce the number of infected children (47). It was speculated that the reduction in disease in the bednet study was the result of reducing the number of P. falciparum clones inoculated into each child.

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ANTIGEN IDENTIFICATION FOR ASEXUAL BLOOD-STAGE VACCINES There are two broad strategies to developing a malaria vaccine. One is to define precisely the mechanism of natural immunity that does develop, albeit after a number of years’ exposure, and to attempt to hasten this natural progression. The other is to induce an immune response that does not normally develop, but one that is protective. The first strategy is essentially restricted to developing live attenuated malaria vaccines, which in various animal models have been highly effective but for which there are many logistical hurdles. By studying the development of natural immunity, we certainly gain important insights that may contribute to subunit vaccine development. An example of this comes from studying the ability of sera from immune adults to passively transfer resistance to malaria to children. Initially carried out nearly four decades ago (2), these experiments have been more recently revisited (48). Passive transfer of immune sera resulted in a temporary (10–15 day) but dramatic (500-fold) reduction in peripheral parasitemia with resulting improvement in the clinical condition. This is associated with a marked increase in spleen size. The antibody did not block red cell invasion by parasites in the volunteers. Instead, immunity correlated with the presence in the donor serum of cytophilic classes of antibody (IgG1/G3) that, in vitro, cooperate with monocytes and malaria antigen via Fc receptor to produce TNFα. This is referred to as antibody-dependent cellular inhibition (ADCI). It is hypothesized that such TNFα can inhibit the ring stages of parasite development. The results in humans were similar to those in earlier studies of malaria in rodents in which Freeman & Parish demonstrated that hyperimmune sera from mice repeatedly infected with P. yoelii could prevent infection and could also rapidly control an existing infection of high parasitemia (49). More recent studies have shown that the protective antibody induced by P. yoelii infections is IgG2a, a cytophilic antibody (50, 51). If this scenario is correct, a lesson from these studies of natural immunity is that we should be attempting to identify the antigens targeted by this system and to induce cytophilic classes of antibody via vaccination. It was proposed that the hyperimmune sera could be used to define new antigenic targets for ADCI (48). The polymorphism in the N-terminal region may present problems for subunit vaccine development. Druihle et al presented preliminary data that one of the antigens seen by ADCI was MSP3/SPAM (48). Ultimately, all strategies based on subunit vaccine candidates fall into the second category, since exposing the immune system to only a single or a limited number of malaria antigens must induce a focused immune response, possibly

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one in which the quantity and quality of antibody and helper T cells induced will differ from what develops following natural exposure. Many candidate antigens have been identified primarily by monoclonal antibodies that block invasion or by protection studies in animal models immunized with parasite proteins affinity purified by monoclonal antibodies. Most such “protective” antigens are expressed on the parasite surface or within apical organelles involved in red cell invasion. These studies require rodent and monkey models to define protective immunogens, the mechanism of immunity, and in vitro correlates of immunity. Prior to the cloning of malaria antigens, it was demonstrated that monkeys could be protected against simian or falciparum malaria parasites by vaccinating the animals with whole parasites or merozoites emulsified in complete Freund’s adjuvant (52, 53). Immunization with P. knowlesi resulted in robust protection against homologous and heterologous parasite strains. These studies led to successful vaccination with parasite fractions (54) and then, after malaria antigens were cloned, to a number of subunit vaccine studies in monkeys and mice. The various antigens and the results of monkey vaccine studies are reviewed in detail elsewhere (55, 56). Here the data relating to two of the most exciting vaccine prospects—merozoite surface protein 1 (MSP-1) and apical membrane antigen 1 (AMA-1)—are discussed. In 1981, a monoclonal antibody was described that reacted with the surface of merozoites of P. yoelii (anti-MSP-1). The affinity-purified protein induced immunity against P. yoelii in mice (57). Homologous proteins between 190 and 230 kDa have now been found on different species of malaria parasites, including P. falciparum (58). The protein has a number of domains (59). The highly conserved 19-kD C-terminal fragment of MSP-1, referred to as MSP-119 , is the only part of the larger molecule to be taken into the red cell during invasion. Recently, Daly & Long (60), Ling et al (61), and Tian et al (62) were able to vaccinate and protect mice against lethal challenge with P. yoelii using E. coli–expressed MSP-119 fusion proteins with glutathione S-transferase. Protection has also been demonstrated in mice following vaccination with a Saccharomyces cerevisiae–expressed His6-tagged protein (63) (Figure 2). By using different immunization protocols in which some mice of a protected strain developed high-titer antibodies and others developed lower titers, a clear association between the titer of antibody and protection was demonstrated (63). T cells may play an important role in protection by providing help for an antibody response, and they may play a minor role as effector cells. Native and recombinant forms of P. falciparum MSP-119 have been demonstrated to protect Aotus monkeys and are currently being tested in human studies. One of two strains of monkeys immunized with a yeast-expressed MSP-119 was protected (64) (Figure 2). Although the number of animals used in that study was small, this result has now been repeated three times. A baculovirus-

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Figure 2 Parasitemia curves of monkeys (top panel) and mice (lower panel) following immunization with MSP-119 and challenge with homologous parasites (P. falciparum and P. yoelii, respectively). In both monkeys and mice, MSP-119 can induce almost complete protection. The mechanism of immunity has been demonstrated in mice to be predominantly antibody dependent.

expressed 42-kD fragment that contains the 19-kD C-terminus also protects monkeys from challenge with a virulent strain of P. falciparum (65). However, in different studies using a GST-fusion protein of P. falciparum MSP-119 and MSP-142 made in bacteria, no protection was observed (64, 66). Although the data from mice strongly suggest that antibody is the means of protection following immunization with MSP-119 , in one of the monkey studies (64) there was no clear association between prechallenge antibody titer

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by ELISA or by immunofluorescence on parasites or between the ability of serum antibodies to inhibit merozoite invasion in vitro and protection. By comparison, in one of the other studies (65), antibodies from protected monkeys could inhibit parasite growth in vitro. These differences highlight the need to develop robust in vitro correlates of protection if we are to quickly screen and identify optimal vaccine candidates. Data from human vaccine trials with MSP-119 are not yet available; however, naturally exposed individuals do have antibodies specific for MSP-119 . Antibodies specific for the entire MSP-1 protein are found in endemic sera (67). Neither human nor animal studies have yet elucidated the mechanism of protection meditated by MSP-119 -specific antibodies. The fact that extremely high titers (>640,000) are associated with protection (63) suggests that MSP-119 specific antibodies operate via simple neutralization of merozoites. Another possibility is that antibodies plus complement destroy the merozoites or that the antibodies opsonize the merozoites, which are then taken up by neutrophils or macrophages. MSP-119 immunization of mice with a yeast-expressed recombinant P. yoelii vaccine induces primarily IgG1 and IgG2b. Both of these isotypes are capable of activating the classical pathway of the complement cascade (68, 69). AMA-1 is an antigen that appears on the surface of merozoites after its release from apical organelles referred to as rhoptries. The homolog in P. knowlesi was discovered by the use of monoclonal antibodies that blocked invasion. Later, AMA-1 was found in all parasites, including P. falciparum. Although some allelic diversity exists in the sequence of AMA-1, some regions are well conserved, even for species widely divergent in evolution (e.g., P. falciparum and P. vivax). In particular, the external amino-terminal domain of AMA-1 contains 16 cysteine residues that are conserved within the genus. Diversity in this protein is the result of point mutations. Purified native—as well as recombinant—AMA-1 proteins protect against malaria infection in simian and rodent systems. Immunization with native protein protected monkeys against homologous challenge (70), and protection appeared to correlate with antibody production. Collins et al (71) obtained partial protection against P. fragile in Saimiri monkeys following immunization with recombinant P. fragile AMA-1. Subsequent challenge with P. falciparum demonstrated cross-protection between P. fragile and P. falciparum but required prior infection with P. fragile. Such studies suggest the idea that regions of AMA-1 that are homologous between species may give cross-protection in animals and perhaps in people who are infected once. Mice immunized with the P. chabaudi adami AMA-1 expressed in E. coli and refolded in vitro displayed high levels of protection against virulent homologous challenge (72), and passive transfer of rabbit

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anti-AMA immune sera into mice demonstrated a reduction in peak parasitemia and mortality due to the homologous strain of P. chabaudi adami (72). However, AMA-1 does not induce protection against a heterologous strain of P. chabaudi adami. Thus, as with MSP-119 , this recombinant subunit vaccine can protect monkeys and mice against malaria via a mechanism that appears to be antibody dependent and gives further hope that a recombinant falciparum subunit vaccine, or combination of subunit vaccines, will also protect humans. A major potential obstacle with both antigens, however, is antigenic polymorphism (see below).

OBSTACLES TO VACCINE DEVELOPMENT AND STRATEGIES TO OVERCOME THEM The most serious obstacles to developing a vaccine include: 1. antigenic diversity and immune evasion; 2. lack of good in vitro correlates of protection; 3. the difficulties of large-scale production of candidate vaccines; 4. lack of proven delivery systems and adjuvants; and 5. difficulty and expense of human trials.

Antigenic Variation, Diversity, and Immune Evasion This represents one of the greatest hurdles to the development of both natural immunity to malaria and an effective subunit vaccine. It is known, for example, that a monoclonal antibody specific for one allelic variant of P. yoelii, MSP-119 , does not recognize other variants (73); that T cells specific for P. falciparum CSP epitopes often do not recognize epitopes from allelic sequences (74); and that antibodies specific for one allele of P. chabaudi, AMA-1, and that can adoptively transfer protection to the homologous strain are ineffective at protecting against a different strain (72). Sequence variation within CSP has been analyzed extensively, and the data clearly demonstrate that the nucleotide mutations that occur are coding for different amino acids in nearly all cases. This, together with the observations that the allelic sequences are usually not immunologically cross-reactive (74), suggests that immunological pressure is responsible for selecting the natural variants. One vaccine strategy to overcome this obstacle would be to combine all the known allelic sequences together in a vaccine. The success of such a strategy would depend on how many epitopes would need to be combined and whether the immunogenicity of the individual epitopes would be preserved when mixed with many other epitopes. Such strategies are being attempted for malaria as well as for other pathogens. DNAs encoding large numbers of minimal CD8+ T cell epitopes from different organisms can be combined in a “polyepitope”encoding vaccinia virus that is capable of inducing cytotoxic T cells to each

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epitope (75) and that can protect mice against the relevant organisms (76). CD8+ T cell epitopes from different liver-stage malaria antigens—and representing different allelic variants of these epitopes—could be similarly encoded in a DNA vaccine or other vector. B cell epitopes can also be combined to make polyvalent immunogens. A strategy to make synthetic polyvalent immunogens was first developed by J Tam and applied to malaria by creating an immunogen [a multiple antigen peptide (MAP)] containing B and T cell epitopes of the CSP (77). A limitation of this technology is that the number of different epitopes that can be combined is very limited, and the entire immunogen is made in one synthesis, rendering it difficult to prepare a highly purified compound. Recent developments in synthetic chemistry may have overcome this problem. Using a polyacrylic backbone, O’Brien-Simpson and colleagues (78) have been able to develop a polyvalent immunogen in which the individual peptide epitopes are prepared separately and individually purified before being polymerized onto the backbone. This creates very large and highly immunogenic compounds that can contain any number of individual epitopes adorning a central core. A different strategy to overcome the hurdles of antigenic polymorphism is to focus on those epitopes that are not polymorphic. This may seem counterintuitive, in that polymorphisms seem to have evolved to counteract an effective immune response and that conserved sequences are either not targeted by the immune system or are recognized only by ineffective antibodies and/or T cells. Immune responses to concealed regions of proteins, however, can often be effective, once induced. However, for some antigens, such as the pocket of influenza hemagglutinin, there is no access to antibodies and so there would be no point in producing an antibody response, even if one could. Another potential problem is that domains of proteins may not be normally immunogenic in the native protein because neighboring regions are more immunogenic. When considering T cell epitopes, this may relate to the manner in which a protein is processed. Sercarz and colleagues (79) have defined epitopes as immunodominant, subdominant, or cryptic. Dominant epitopes are always recognized following vaccination with the native protein. Subdominant epitopes are occasionally recognized, whereas cryptic epitopes are never recognized in the context of the whole immunogen. Because cryptic epitopes are not recognized following exposure to native protein, they are not likely to be under immune pressure from T cells and thus are more likely to be conserved. Surprisingly, while T cells induced by exposure to protein will not respond to cryptic epitopes as peptides, the same is not true in reverse. Helper T cells generated from mice exposed to cryptic epitope peptides derived from CSP are able to recognize the CSP (80). A protective cryptic epitope has been identified on the P. yoelii CSP (81). This provides a potential vaccination strategy to induce

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a rapid antibody response following exposure to the parasite. We have recently defined cryptic epitopes on the AMA-1 protein of P. chabaudi—epitopes that are never recognized following immunization of mice with recAMA-1 (82) but that are, as peptides, highly immunogenic for T cells. If T cells induced by these peptides, but not T cells of irrelevant specificity, are transferred to recipient mice, those mice develop a much quicker antibody response following malaria infection. This more rapid antibody response following infection can make the difference between being able to control the infection and succumbing to it. The parasite protein on the erythrocyte surface (PfEMP1) performs the critical function of binding the parasite to the endothelium to protect the infected erythrocyte from sequestration in the spleen. The protein is exposed on the erythrocyte surface for at least 30 of the 48 h of the parasite’s life within one red cell. There are 150 copies of this protein, so that as antibody develops to one antigenic type—leading to destruction of erythrocytes and the parasites within them—new antigenic types are constantly appearing; to replace these, parasites expressing them become the dominant population in a process known as antigenic variation. This molecule would be valuable for vaccine development only if it contained a component that is conserved but cryptic (see above). It is known, for example, that PfEMP1 binds to CD36, but the domain involved remains to be defined. If there are conserved epitopes involved in endothelial binding, then they become potential targets for vaccine development.

Lack of Good In Vitro Correlates of Immunity Standard subunit vaccine development has frequently depended upon the establishment of in vitro correlates of protection. Typically, such correlates would include in vitro opsonization assays (e.g., for developing a streptococcal vaccine) and toxin neutralization assays. Robust assays enable safe and economical vaccine development, in that vaccines would not enter large Phase III/IV studies until there was reasonable assurance that appropriate mechanisms of immunity had been induced. In the case of the synthetic malaria vaccine candidate, named SPf66, for which significant uncertainty still remains regarding efficacy, no correlate of immunity has been defined (83, 84). This has resulted in a large number of empiric and expensive field trials to determine efficacy. A difficulty with malaria vaccine development is that we have not yet induced good levels of protection with any vaccine candidate in humans and are not sure what type of response is required. Having said that, however, we believe that antibodies will play a critical role in protection and that assays based on antibodies will be required. Furthermore, a number of successful monkey vaccine trials may provide valuable sera for development of serologic assays that correlate with protection. Data from human studies examining naturally

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acquired immunity have suggested that red cell agglutination (85) and ADCI (86), but not merozoite invasion inhibition (87), are associated with immunity. Naturally acquired immunity, however, takes many years to develop, and the hope is that subunit vaccination will induce immunity far more quickly. If so, entirely different types of immune responses may be protective. One commonly used assay is the merozoite invasion inhibition assay. Here, immune sera are mixed with a culture of schizonts and noninfected red cells in vitro; after one or two cycles of parasite multiplication, the number of newly infected red cells is determined, or the growth of parasites is monitored using 3H-hypoxanthine uptake. It is not clear how this assay correlates with protection following immunization with MSP-1. Following immunization of monkeys with MSP-119 or MSP-142 (a larger fragment than MSP-119 that incorporates all of MSP-119 ), substantial protection was described in two separate reports (64, 65); however, in one group of monkeys, immune sera significantly inhibited invasion (65), whereas the other group showed no effect. Slight differences in the ways these assays were conducted may account for the different results. Exchange of reagents and a standardization of this assay are required, because once a robust assay is developed, new antigen constructs and formulations can be quickly tested in relatively inexpensive Phase I studies. Whether assays that correlate with naturally acquired immunity will correlate with vaccine-induced immunity is not known; this will likely depend on the nature of the antigen involved. For example, antigens not expressed on the surface of infected red cells will not be targets for agglutinating antibodies. The ADCI assay, showing promise as a correlate of naturally acquired immunity, may be triggered by antibodies binding to the merozoite surface (86); this remains to be confirmed, and furthermore the assay has been used in only one laboratory.

Bulk Antigen Process Development Currently, a major obstacle in moving asexual blood-stage vaccines down the critical path is our inability to produce adequate amounts of clinical-grade material. The near absence of industrial interest in bringing the full power of biotechnology to bear on this problem makes this step in malaria vaccine development an even more formidable obstacle. Although most pharmaceutical companies have opted not to vigorously pursue malaria vaccine research and development, we have found that the scientists in these companies are eager to assist. The first decision point one encounters in bulk antigen production is which expression/delivery system(s) to explore. Although the process of producing biologically active immunogens is mainly empirical, knowing early on whether the immunogen contains disulfide bonds can help guide the choice of which

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heterologous protein expression system to pursue. If the target epitope is small enough and does not require extensive tertiary structure for biological activity, then synthetic peptides can be rationally pursued. For larger molecules that do lack disulfide bonds and do not undergo posttranslational modifications, bacterial expression systems are often the first choice. If disulfide bonds must be formed or posttranslational modifications are required, eukaryotic expression systems—although more costly to use in manufacturing than bacterial systems—may be necessary. The alternative is vaccine delivery by nonconventional means such as live vectors or naked DNA (see below). For many asexual blood-stage vaccine candidates (e.g., MSP-1 and AMA-1), the more conventional subunit approach involves creating disulfide bond–dependent epitopes. For AMA-1, that meant bacterial-produced products required refolding (72), a process that may be difficult to control at large scale, certainly adds to the expense of production, and requires purification schemes and reagents for separating conformers. Asn-linked glycosylation, which occurs at the sequence Asn-X-Ser/Thr in many eukaryotes, is rare if nonexistent in the malaria parasite epitopes of interest (88). For example, the sequence Asn-Ile-Ser at the amino terminus of MSP-119 is not modified by carbohydrates (89). Heterologous expression systems that tend to hyperglycosylate recombinant proteins might glycosylate this site, destroying a potentially important B cell epitope. Even if glycosylation were frequent in malaria parasite proteins, it would almost assuredly be different from that produced in yeast, insect cells, or mammalian cells. The presence of apical organelles (rhoptries and micronemes) in Plasmodium and their absence in all the commonly used heterologous expression systems present other potential problems: Folding and posttranslational processing that would normally occur in the milieu of these organelles may not occur in the same way, and the signals embedded in the primary amino acid sequences that target the proteins to these organelles in malaria parasites may be misread in heterologous expression systems. A further potential complication encountered in the development of expression constructs is instability or poor levels of transcription and/or translation due, in part, to the aberrantly high A-T content of the malaria parasite genome. Although the remedy—creating a synthetic gene based on the preferred codon usage for a heterologous expression system—is straightforward, it is also quite laborious (46). Even if success in heterologous expression is achieved at the benchtop, crossing the next hurdle—the transition from producing research-grade material for preliminary animal studies to manufacturing clinical-grade material for preclinical and clinical studies—can be expensive and equally problematic. Scale-up from shaker flask to mid-scale fermenter (50–300 L) frequently takes a nonlinear course (90). Development of a controlled, reproducible process, particularly

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product recovery (protein purification), that is both feasible and results in a product suitable for use in humans is often time-consuming and unpredictable. The rule rather than the exception has been a dramatic decrease in biological potency in the transition from production of research-grade to clinical-grade material. A particularly vexing problem in manufacturing clinical-grade asexual bloodstage vaccines is knowing whether a biologically active product has been produced. In the absence of a reliable, predictive in vitro assay of protection, assessing the quality of the manufactured product requires either doing timeconsuming and expensive primate studies or relying on assays that are presumed but not proven to detect biologically active immunogens (e.g., using lengthy and highly variant competition of parasite growth inhibition or ELISAs with immunological reagents, such as monoclonal antibodies that recognize conformationally constrained epitopes). Rapid in-process evaluation of a product would be an extremely useful tool in monitoring and improving the manufacturing process. Such assays would also be important in establishing bulk antigen lot release specifications that could be used to assure reproducibility of biological activity and potency between lots.

Delivery Systems and Adjuvants Until very recently, most if not all vaccines in use were either whole-cell (attenuated or killed) or detoxified toxins. As it is currently not feasible to manufacture large quantities of malaria parasites for use in human vaccines, subunit immunogen approaches are the only avenue available. Although the most powerful adjuvant or optimized delivery schedule cannot overcome a poor selection of immunogen, the proper choice of adjuvants and carriers—designed to augment the immune response to a specific immunogen—is often required to elicit the desired protective response, even for some of the best immunogens. Unfortunately, vaccinology has not progressed to the point where selection of vaccine immunogen, adjuvant, and route and schedule of administration can be made rationally, even if the exact mechanism of immunity has been well defined. Certainly for the development of effective malaria vaccine formulations and delivery systems, the process will be largely empirical for the foreseeable future because of the absence of (a) insights into the exact mechanism(s) of vaccineinduced immunity, (b) any evidence that immune responses and mechanism of immunity in experimental laboratory animal models will extrapolate to humans, (c) enough primates to properly study efficacy in vivo, (d ) an in vitro correlate of protection, and (e) an obvious and suitable replacement for Freund’s complete adjuvant for use in humans. With more than 100 potential immunomodulators of subunit immunogens and a variety of delivery systems identified and tested in animals (for review,

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see 91), how then to best proceed with asexual blood-stage vaccine development? Judicious use of both nonprimate and primate malaria models, we feel, will continue to be essential, as will the use of nonconventional delivery systems. Some that have already been explored in malaria vaccination strategies and have or will soon be tested in humans include: powerful, parenterally delivered subunit delivery systems, most notably the Smith Kline-Beecham oilin-water formulation of a CSP-hepatitis B fusion particle to which QS21 and MPL have been added (6); live vector vaccines, such as NYVAC-Pf7, a highly attenuated vaccinia virus encoding seven malaria parasite genes (42), given in conjunction with a conventional subunit vaccine in a so-called prime-boost strategy; DNA vaccines that include multiple plasmids, most of which encode a variety of malaria parasite genes but some of which encode immunomodulators such as cytokines; and vaccines delivered intranasally or orally, for example MSP-1 delivered intranasally with cholera toxin B (92). As recently shown with the CSP-based vaccines, a large number of human clinical trials may be necessary before a formulation immunogenic in humans is discovered.

Human Trials The contrast between testing pre-erythrocytic vaccines and blood-stage vaccines is twofold. Both relate to the endpoint of the vaccine trials. Pre-erythrocytic vaccines are designed to prevent blood-stage infection. The challenges are safe to perform in nonimmune volunteers. It is even possible to identify vaccine failures by PCR before the infection is detectable on blood smears and to treat vaccine failures to prevent symptoms. Thus, multiple constructs and multiple formulations can be tested. Second, the endpoint of the trial and the endpoint of an effective vaccine are identical: protection of nonimmune individuals. The contrasting problems of trials of blood-stage vaccines are best exemplified by the vaccine trials with SPf66 (83, 84). The trials were expensive because they were done in large populations in areas endemic for malaria. Second, the studies did not measure the desired endpoint, reduced severe disease and death, as this would have greatly increased the cost. Today, there is difference of opinion as to whether SPf66 is effective, including comments in a recent trial that conclude prematurely that SPf66 should be discarded (93). The dual problems of expense and lack of surrogate endpoints are a serious obstacle to the testing of multiple formulations that will be required for vaccine development. A strategy is needed to simplify the testing to overcome the first obstacle. One proposal is to immunize nonimmune volunteers and to follow infection with semiquantitative PCR so as to define vaccine failures before clinical symptoms occur. Volunteers could be challenged by mosquito bite or by infected blood (9). The concern is that blood-stage vaccines are expected not to prevent blood-stage infection, just to modify the course of infection. In

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addition, it may require a level of infection after immunization to boost and induce immunity (Figure 3). Although this approach deserves to be evaluated, it should not be on the critical path, i.e., vaccines should not be discarded because they do not protect in this model. A second approach carries the assumptions that reducing parasitemia will reduce disease and that it may be easier to immunize people who have been repeatedly infected and, as a result, are partially immune than individuals who are not immune. Adults in Western Kenya who have had hundreds of infections per year still become reinfected after drug cure, and many of these are symptomatic (94). A vaccine trial to prevent infection or symptomatic infection in this population may give valuable information. It will also be possible to determine whether variability in the sequence contained within the immunogen is occurring more frequently in the immunized than in the control population as a preliminary indication that antigenic diversity will be a problem for the vaccine. Effective vaccines in adults can then be tested in children and, eventually, in the very young who will be the target population for the vaccine. The assumption of this approach is that reducing parasitemia will reduce all forms of disease, despite differences in pathogenesis. This approach should permit the study of multiple vaccine candidates (different antigens and formulations) before proceeding to the expense of large field trials to measure impact on disease and death.

STRATEGIC PATH TO VACCINES Limited resources necessitate that malaria vaccine development strategies be cost-effective as well as scientifically sound. The resources we currently have to develop malaria vaccines include: rodent and avian models of malaria and cloned antigen homologs of the leading P. falciparum candidates; a limited number of New World monkeys that can be infected multiple times with P. falciparum; and a growing number of adjuvants and delivery systems suitable for use in humans. What we critically lack is validated in vitro correlates of −−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−→ Figure 3 Parasitemia curves in monkeys following vaccination with AMA-1 of P. knowlesi (70). In the top panel, nonvaccinated and vaccinated animals were challenged, whereas in the lower panel, both vaccinated and control monkeys were cured after the first infection and then reinfected. The data demonstrate that infection has the ability to boost the degree of immunity induced by vaccination. If this were translated to humans, malaria vaccines that were not completely effective against the first infection might, nevertheless, be highly effective against subsequent infections. Since people in endemic countries typically experience multiple infections, such a vaccine strategy might be very effective in reducing disease.

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Figure 4 The critical path to malaria blood-stage vaccine development.

protective immunity (see above). With these resources and limitations, we must first overcome the current obstacles to vaccine development outlined above (identifying conserved immunogens, developing processes that yield biologically active immunogens at scale production, and formulating vaccines with novel adjuvants and delivery systems). As these vaccine production problems are solved, we must develop sensible strategies for evaluating safety and efficacy in human trials (Figure 4). One sensible strategy for immunogens that were biologically active as research-grade products would be to reassess the clinical-grade immunogen in the same assay upon which the immunogen was selected as a candidate vaccine. For those immunogens that elicited protective immunity in animal models when produced as research-grade material, clinical-grade bulk antigen would be evaluated in complete Freund’s adjuvant in New World monkeys for the ability of the antigen to protect against lethal challenge with P. falciparum. This would not be an evaluation of the final formulation (since CFA cannot be given to humans) but rather of the potency of the unformulated bulk antigen. It is worth noting that CFA is the only adjuvant that has reliably induced protective immunity in monkeys. Once the clinical grade has been shown to be biologically active, the next step would be to formulate the immunogen with a series of adjuvants suitable for use in humans.

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Preliminary results in the monkey model suggest that immune responses in naive animals differ markedly from those in previously infected monkeys. Therefore, monkeys previously infected with P. falciparum as well as naive monkeys should be vaccinated with the final formulations and then challenged. In addition, immunized animals that are not protected can be cured and rechallenged. Clues as to which formulation is most potent in eliciting immune responses and protective immunity may emerge from such studies; however, in the absence of a documented demonstration that protection in the monkey model correlates with that in humans and in the absence of an in vitro correlate of protection, no logical alternative exists except to proceed directly with the best final formulations to human Phase I (safety only) studies of previously nonexposed adult volunteers. As it is likely that the immunogenicity in naive human volunteers studied in the initial Phase I studies may not be predictive of that seen in previously infected humans, extreme caution should be exercised in pivotal decisions as to whether to proceed with a vaccine formulation to Phase I testing in malaria-endemic regions. Immune responses in nonexposed adults should be carefully and thoroughly examined; however, only the safety data should be used in the decision to proceed to Phase I studies in malaria-endemic regions. The formulations should be tested for safety and immunogenicity in human Phase I trials in previously infected volunteers before a decision is taken to proceed to Phase II studies in the same population. Besides demonstration of safety, at this point some evidence of an immune response would be a useful criterion for deciding to proceed to the next step—Phase II testing in which adults treated with drugs to eradicate pre-existing parasites would be vaccinated and allowed to be exposed to malaria parasites naturally within a short period of time, as described above. These trials should quickly point to some evidence of an effect on the likelihood and severity of infection. The above strategy is based on the premise that vaccines that don’t work in monkeys (with CFA) will never work in humans. Currently no data support or refute this premise. The alternative at the present stage of malaria vaccine development would be to clone antigens, produce clinical-grade immunogens, and proceed directly to human clinical trials. Such an empirical approach would be far more expensive than the one outlined above but may be an alternative if the antigens shown to be protective in monkeys are subsequently shown not to be protective in humans, or vice versa. At this stage, however, it makes sense to move along the strategic pathway outlined above.

CONCLUSIONS Great optimism presently charges the hope that a vaccine for malaria will be developed. Immunity to malaria is becoming better understood, critical antigens

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have been defined and cloned, and one candidate vaccine has already been extensively field tested (83–85). However, resources are limited, and it is essential that all available resources present in the public research sector and industry be made available for the effort. The success so far of pre-erythrocytic vaccine development (6) has provided enormous impetus to push ahead and develop a blood-stage vaccine. This review has attempted to outline a strategy to help take us to that important result. Annu. Rev. Immunol. 1998.16:57-87. Downloaded from arjournals.annualreviews.org by HINARI on 08/31/07. For personal use only.

ACKNOWLEDGMENTS We thank Barry Bloom, Alan Sher, Steven Hoffman, and Genevi`eve Milon for suggestions on the manuscript. Visit the Annual Reviews home page at http://www.AnnualReviews.org.

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R. Soc. Trop. Med. Hyg. 83:293–303 9. Cheng Q, Lawrence G, Reed C, Stowers A, Ranford-Cartwright L, Creasey A, Carter R, Saul A. 1997. Measurement of Plasmodium falciparum growth rate in vivo: a test of malaria vaccines. Am. J. Trop. Med. Hyg. 57:495–500 10. Warrell DA, Molyneux ME, Beales PF. 1990. Severe and complicated malaria. Trans. R. Soc. Trop. Med. 84 (Suppl. 2):1– 65 11. Miller LH, Good MF, Milon G. 1994. Disease pathogenesis in malaria. Science 264:1878–83 12. Marsh K, Forster D, Waruiru C, Mwangi I, Winstanley M, Marsh V, Newton C, Winstanley P, Warn P, Pasvol G, Snow R. 1995. Indicators of life-threatening malaria in African children. N. Engl. J. Med. 332:1399–1404 13. Molyneux ME, Taylor TE, Wirima JJ, Borgstein A. 1989. Clinical features and prognostic indicators in paediatric cerebral malaria: a study of 131 comatose Malawian children. Q. J. Med. 71:441–59 14. Clark IA, Rockett KA, Cowden WB. 1991. Proposed link between cytokines, nitric oxide and human cerebral malaria. Parasitol. Today 7:205–7 15. Kwiatkowski D, Hill AV, Sambou I, Twumasi P, Castracane J, Manogue KR, Cerami A, Brewster DR, Greenwood BM. 1990. TNF concentrations in fatal cerebral, non-fatal cerebral, and uncomplicated Plasmodium falciparum malaria. Lancet 336:1201–4

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28. Baruch DI, Pasloske BL, Singh HB, Bi X, Ma XC, Feldman M, Teraschi TF, Howard RJ. 1995. Cloning the P. falciparum gene encoding PfEMP1, a malarial variant antigen and adherence receptor on the surface of parasitized human erythrocytes. Cell 82:77–87 29. Su X-Z, Heatwole VM, Wertheimer SP, Guinet F, Herrfeldt JA, Peterson DS, Ravetch JA, Wellems TE. 1995. The large diverse gene family var encodes proteins involved in cytoadherence and antigenic variation of Plasmodium falciparuminfected erythrocytes. Cell 82:89–100 30. Smith JD, Chitnis CE, Craig AG, Roberts DJ, Taylor D, Peterson DS, Pinches R, Newbold CI, Miller LH. 1995. Switches in expression of Plasmodium falciparum var genes correlate with changes in antigenic and cytoadherence phenotypes of infected erythrocytes. Cell 82:101– 10 31. Peterson DS, Miller LH, Wellems TE. 1995. Isolation of multiple sequences from the Plasmodium falciparum genome that encode conserved domains homologous to those in erythrocyte-binding proteins. Proc. Natl. Acad. Sci. USA 92:7100–4 32. Dame JB, Williams JL, McCutchan TF, Weber JL, Wirtz RA, Hockmeyer WT, Maloy WL, Haynes JD, Schneider I, Roberts D, et al. 1984. Structure of the gene encoding the immunodominant surface antigen on the sporozoite of the human malaria parasite Plasmodium falciparum. Science 225:593–99 33. Ballou WR, Hoffman S, Sherwood JA, Hollingdale MR, Neva FA, Hockmeyer WT, Gordon DM, Schneider I, Wirtz RA, Young JF, Wasserman GF, Reeve P, Diggs CL, Chulay JD. 1987. Safety and efficacy of a recombinant DNA Plasmodium falciparum sporozoite vaccine. Lancet 1:1277–81 34. Herrington DA, Clyde DF, Losonsky G, Cortesia M, Murphy JR, Davis J, Baqar S, Felix AM, Heimer EP, Gillessen D, Nardin E, Nussenzweig RS, Nussenzweig V, Hollingdale MR, Levine MM. 1987. Safety and immunogenicity in man of a synthetic peptide malaria vaccine against Plasmodium falciparum sporozoites. Nature 328:257–59 34a. Sinnis P, Nussenzweig V. 1996. Preventing sporozoite invasion of hepatocytes. See Ref. 7, pp. 15–33 35. Good MF, Berzofsky JA, Miller LH. 1988. The T cell response to the malaria circumsporozoite protein: an immunological approach to vaccine development.

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66. Burghaus PA, Wellde BT, Hall T, Richards RL, Egan AF, Riley EM, Ballou WR, Holder AA. 1996. Immunization of Aotus nancymai with recombinant C terminus of Plasmodium falciparum merozoite surface protein 1 in liposomes and alum adjuvant does not induce protection against a challenge infection. Infect. Immun. 64:3614–19 67. Egan AF, Chappel JA, Burghaus PA, Morris JS, McBride JS, Holder AA, Kaslow DC, Riley EM. 1995. Serum antibodies from malaria-exposed people recognize conserved epitopes formed by the two epidermal growth factor motifs of MSP-119, the carboxy-terminal fragment of the major merozoite surface protein of Plasmodium falciparum. Infect. Immun. 63:456– 66 68. Ey PL, Prowse SL, Jenkin CR. 1979. Complement-fixing IgG1 constitutes a new subclass of mouse IgG. Nature 281:492–93 69. Hirayama N, Hirano T, Koehler G, Kurata A, Okumura K, Ovary Z. 1982. Biological activities of anti-trinitrophenyl and anti-dinitrophenyl mouse monoclonal antibodies. Proc. Natl. Acad. Sci. USA 79:613–15 70. Deans JA, Knight AM, Jean WC, Waters AP, Cohen S, Mitchell GH. 1988. Vaccination trials in Rhesus monkeys with a minor, invariant, Plasmodium knowlesi 66 kD merozoite antigen. Parasite Immunol. 10:535–52 71. Collins WE, Pye D, Crewther PE, Vandenberg KL, Galland GG, Sulzer AJ, Kemp DJ, Edwards SJ, Coppel RL, Sullivan JS, Morris CL, Anders RF. 1994. Protective immunity induced in squirrel monkeys with recombinant apical membrane antigen-1 of Plasmodium fragile. Am. J. Trop. Med. Hyg. 51:711– 19 72. Crewther PE, Matthew ML, Flegg RH, Anders RF. 1996. Protective immune responses to apical membrane antigen 1 of Plasmodium chabaudi involve recognition of strain-specific epitopes. Infect. Immun. 64:3310–17 73. Burns JM Jr, Parke LA, Daly TM, Cavacini LA, Weidanz WP, Long CA. 1989. A protective monoclonal antibody recognizes a variant-specific epitope in the precursor of the major merozoite surface antigen of the rodent malarial parasite Plasmodium yoelii. J. Immunol. 142:2835–40 74. Zevering Y, Khamboonruang C, Good MF. 1994. Natural amino acid polymorphisms of the circumsporozoite protein of

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Tanner M. 1994. Randomised trial of efficacy of SPf66 vaccine against Plasmodium falciparum malaria in children in southern Tanzania. Lancet 344:1175– 81 D’Alessandro U, Leach A, Drakeley CJ, Bennett S, Olaleye BO, Fegan GW, Jawara M, Langerock P, George MO, Targett GAT, Greenwood BM. 1995. Efficacy trial of malaria vaccine SPf66 in Gambian infants. Lancet 346:462–67 Marsh K, Howard RJ. 1986. Antigens induced on erythrocytes by P. falciparum: expression of diverse and conserved determinants. Science 231:150–53 Bouharoun-Tayoun H, Attanath P, Sabchareon A, Chongsuphajaisiddhi T, Druilhe P. 1990. Antibodies that protect humans against Plasmodium falciparum blood stages do not on their own inhibit parasite growth and invasion in vitro, but act in cooperation with monocytes. J. Exp. Med. 172:1633–41 Phillips RS, Trigg PL, Scott-Finnigan TJ, Bartholomew RK. 1972. Culture of Plasmodium falciparum in vitro: a subculture technique used for demonstrating antiplasmodial activity in serum from some Gambians, resident in an endemic malarious area. Parasitology 65:525– 35 Dieckmann-Schuppart A, Barnes E, Schwartz RT. 1994. Glycosylation reactions in Plasmodium falciparum, Toxoplasma gondii, and Trypanosoma burcei burcei probed by use of synthetic peptides. Biochim. Biophys. Acta 1199:37– 44 Blackman M, Ling IT, Nicholls SC, Holder AA. 1991. Proteolytic processing of Plasmodium falciparum merozoite produces membrane-bound fragment containing two epidermal growth factor-like domains. Mol. Biochem. Parasitol. 49:29–34 Pisano GP. 1997. The Development Factory. Unlocking the Potential of Process Innovation. Boston: Harvard Univ. Bus. Sch. Press Vogel FR, Powell MF. 1995. A compendium of vaccine adjuvants. In Vaccine Design: The Subunit and Adjuvant Approach, ed. MF Powell, MJ Newman, pp. 141–228. New York: Plenum Hirunpetcharat C, Stanisic D, Qin LX, Vadolas J, Strugnell RA, Miller LH, Kaslow DC, Good MF. 1997. Intranasal immunization with yeast-expressed 19 kD carboxylterminal fragment of Plasmodium yoelii merozoite surface protein1 (yMSP-119) induces protective immu-

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nity to blood-stage malaria infection in mice. Unpublished data 93. Nosten F, Luxemburger C, Kyle DE, Ballou WR, Wittes J, Wah E, Chongsuphajaisiddhi T, Gordon DM, White NJ, Sadoff JC, Heppner DG, Shoklo SPf66 Malaria Vaccine Trial Group. 1996. Randomized double-blind placebo-controlled trial of SPf66 malaria vaccine in chil-

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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Annu. Rev. Immunol. 1998. 16:89–109 c 1998 by Annual Reviews. All rights reserved Copyright

CD81 (TAPA-1): A MOLECULE INVOLVED IN SIGNAL TRANSDUCTION AND CELL ADHESION IN THE IMMUNE SYSTEM Shoshana Levy, Scott C. Todd, and Holden T. Maecker Department of Medicine, Division of Oncology, Stanford University Medical Center, Stanford, California 94305; e-mail: [email protected] KEY WORDS:

tetraspanins, TM4SF, B cell, T cell, adhesion

ABSTRACT CD81 (TAPA-1) is a widely expressed cell-surface protein involved in an astonishing variety of biologic responses. It has been cloned independently several times for different functional effects and is reported to influence adhesion, morphology, activation, proliferation, and differentiation of B, T, and other cells. On B cells CD81 is part of a complex with CD21, CD19, and Leu13. This complex reduces the threshold for B cell activation via the B cell receptor by bridging Ag specific recognition and CD21-mediated complement recognition. Similarly on T cells CD81 associates with CD4 and CD8 and provides a costimulatory signal with CD3. In fetal thymic organ culture, mAb to CD81 block maturation of CD4−CD8− thymocytes, and expression of CD81 on CHO cells endows those cells with the ability to support T cell maturation. However, CD81-deficient mice express normal numbers and subsets of T cells. These mice do exhibit diminished antibody responses to protein antigens. CD81 is also physically and functionally associated with several integrins. Anti-CD81 can activate integrin α 4β1(VLA-4) on B cells, facilitating their adhesion to tonsilar interfollicular stroma. Similarly, anti-CD81 can activate α Lβ2 (LFA-1) on human thymocytes. CD81 can also affect cognate B-T cell interactions because anti-CD81 increases IL-4 synthesis by T cells responding to antigen presented by B cells but not by monocytes. The tetraspanin superfamily (or TM4SF) includes CD81, CD9, CD37, CD53, CD63, CD82, CD151, and an increasing number of additional proteins. Like CD81,

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LEVY ET AL several tetraspanins are involved in cell adhesion, motility, and metastasis, as well as cell activation and signal transduction.

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INTRODUCTION CD81 (TAPA-1) is a 26-kDa surface protein composed of four transmembrane (TM) and two extracellular (EC) domains and an overall topology shared by the superfamily of proteins known as tetraspanins, or the TM4 superfamily (TM4SF) (Figure 1) (1). The tetraspanins are a large family of proteins expressed in evolutionarily diverse organisms such as Schistosoma (sm23, sj23), C. elegans (several ORF identified by the genome project), Drosophila (late bloomer), and mammals (CD9, CD37, CD53, CD63, CD82, CD151, A15/TALLA-1, CO-029 and SAS), suggesting a conserved role for these proteins (2). Most tetraspanins were originally identified as leukocyte antigens; hence many studies aimed at elucidating their function were carried out in lymphoid cells. Although it is becoming evident that tetraspanins in general and CD81 in particular mediate cellular interactions in nonhematolymphoid tissues, this review highlights CD81 in the context of the immune system. Tetraspanins have been shown to influence cell adhesion and migration, to alter cell morphology, and to affect the activation state of a cell. Antibodies to tetraspanins induce intracellular signaling that is required for functional effects such as adhesion. Signal transduction and possibly many of the functional effects induced by anti-CD81 are likely to be mediated by CD81-associated molecules. A common characteristic of tetraspanins, including CD81, is a propensity to physically associate with a variety of other membrane proteins such as integrins, lineage specific molecules, and other tetraspanins. This review summarizes recent progress concerning the structural features of CD81, its known interactions with other cellular proteins, and the effects induced by cross-linking the protein on the cell surface. In addition, comparisons with other tetraspanins are drawn to highlight unique and general features of CD81 in the context of the protein superfamily. −−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−→ Figure 1 Structural model of CD81. Amino acids are shown as circles; specific residues of human CD81 are indicated by single letter designation, bolded circles mark the position of residues that are conserved in the core (CD9, CD37, CD53, CD63, CD81, CD82, CO-029, CD151, A15, SAS, sm23 and late bloomer) tetraspanins (2). Amino acid differences in the various species are indicated by filled squares; differences between monkey and human are indicated by asterisks. Shaded regions indicate coding by odd numbered exons.

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EXPRESSION AND STRUCTURE

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Anti-CD81 mAb Several different anti-human CD81 mAbs have been made in independent laboratories (Table 1). The immunogens were, in general, whole lymphoid cells, and the antibodies were found in screens involving cell binding and a variety of cellular functions such as the induction of homotypic adhesion, the inhibition of cellular proliferation, or the inhibition of viral-induced syncytium formation. Similarly, antibodies to murine CD81 were discovered by employing functional assays. In the mouse, the screen selected for mAbs that inhibit T cell maturation, and in the rat, for an effect on cell growth and altered morphology of astrocytes. The fact that CD81 was discovered in so many different biological assays implies that it is involved in basic cellular functions that are manifested differently in the various cell types. Antibodies against other tetraspanins were discovered independently as well, by assays that involved a variety of different cellular functions. For example, anti-CD9 mAbs were found by adhesion assays, by cell motility assays, by inhibition of cell maturation, and by inhibition of binding to viral and bacterial receptors, reviewed in (2).

CD81 Expression The anti-human CD81 mAbs revealed that the molecule is expressed on most human tissues with the notable exceptions of red blood cells and platelets (3). Likewise, most human hematopoietic cell lines tested do express the antigen, with the exception of U937, a monocyte-like cell line. Similarly, expression of CD81 mRNA was found in all mouse tissues tested (4, 5). The wide expression of CD81 prompted studies on the temporal expression of the molecule during early mammalian development. A sensitive PCR-based assay showed that CD81 mRNA was expressed in mouse oocytes, in fertilized eggs, and in preimplantation early-cleavage embryos as early as the one, two, and four cell stage (6). Though the molecule is widely expressed, its levels within a single tissue vary during development and in response to cellular activation. For example, cat CD81 was cloned by subtractive hybridization from the visual cortex where it is highly expressed in 30-day-old kittens, by comparison to adult visual cortex (7). Rat CD81 is highly increased at the site of injury in cerebral cortex tissue (8). Immunohistochemical studies from our laboratory indicate that the molecule is differentially expressed in various human organs. For instance, in lymphoid tissues it is highly expressed in germinal center B cells. A study aimed at the identification of cell surface proteins associated with physiological activation of eosinophils demonstrated that CD81 is upregulated in eosinophils from helminth-infected patients (9). On the other hand, studies aimed at analyzing expression of CD81 in normal, malignant, and metastatic tissues did not

M38

JKT.M1

AMP1

IgG1

”

IgG1

IgA,κ

”

4TM1

mouse anti-rat

IgG2a

”

JS64 JS81 S5.7

astrocyte membrane proteins

PAM epithelial cell line

membrane fractions from CD4+ T cells

ML3 promyelocytic leukemia hCD81 transfected mouse cell line HIV infected Jurkat

OCI-LY8 B cell line 5A6 aggregated OCI-LY8 Ramos B cell line

anti-proliferative effect

binding to PAM cells

inhibition of HTLV-1 mediated syncytium formation

homotypic adhesion

cell binding

immunoprecipitation

anti-proliferative effect homotypic adhesion

Selection of Hybridoma

altered morphology of astrocytes

inhibition of T cell maturation

morphological changes

homotypic adhesion anti-proliferative effect

Additional Effects of Antibody

(8)

(20)

(1) Schick & Levy, unpublished, (3) (51) (3) (52), personal communication Tedder & Bradbury, unpublished, (3) (14), personal communication (19)

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IgG2a IgG1 IgG1

” ” ”

5A6 1D6

Immunogen

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IgG1 IgG1

mouse anti-human ”

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Table 1 Anti CD81 mAbs

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find alterations of expression in association with malignant transformation. By contrast, several other tetraspanins such as CD63 or CD9 are inversely correlated with the metastatic state of melanoma (10), and the expression of CD82 (KAI1) is silenced in metastatic prostate cancer cells (11).

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CD81 Protein Protein topology studies of CD81 demonstrated that the two long hydrophilic domains of the molecule are extracellular; one domain, EC1, is located between TM1 and TM2 and a second, EC2, is located between TM3 and TM4 (Figure 1) (12). Short hydrophilic regions at the amino and carboxyl termini and between TM2 and TM3 are most likely cytoplasmic, though this has not been formally proven. The region between TM2 and TM3 is the most conserved region in all tetraspanin proteins, as indicated in Figure 2 (TM4SF consensus). CD81 proteins from such diverse species as shark and human share about 60% sequence identity (MG Tomlinson, M Flajnik, AN Barclay, unpublished). CD81 protein from mammalian species studied exhibit complete identity in their cytoplasmic and transmembrane domains, suggesting an evolutionarily conserved function for these regions. Their small extracellular domain, EC1, is also highly conserved. Sequence divergence between species is seen in the large extracellular domain. This region is also the most variable between the tetraspanin family members both in sequence and in length. In CD81, the sequence variability within EC2 is clustered in one hypervariable region, coded for by exon 6. This exon also codes for a short motif, cysteine-cysteine-glycine (CCG at aa 1568) which is conserved in all tetraspanins. It is unknown if a disulfide bond is formed between one of the cysteines in the CCG motif and the conserved cysteine at amino acid 190. If such a bond were indeed formed, it would create two distinct regions within the large hydrophilic domain. This evolutionary hypervariable region, flanked by cysteines (Figures 1 and 2), may be involved in species-specific interactions. The adjacent conserved hydrophilic regions contain a high proportion of basic and acidic charged residues. The extracellular domains of the molecule are extremely sensitive to reduction: Exposure of the protein to reducing agents destroys its ability to bind to all six anti-CD81 antibodies tested in our laboratory. Similarly, other tetraspanins reportedly bind ←−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−− Figure 2 Amino acid sequences of mammalian CD81 proteins. Alignment of CD81 amino acid sequences of human (1), mouse (21), rat (8), monkey (COS cells) (S Levy, unpublished), hamster (S Levy, unpublished), and rabbit (ML Andria, S Levy, unpublished) is shown.“TM4SF consensus” marks conserved amino acids found in at least 10/12 core tetraspanin proteins; completely conserved amino acids are bolded (2). Lines above the sequence represent the transmembrane domains of the proteins.

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their respective antibodies only in an unreduced form (12, 13). The epitope for mAb 5A6 is located in the large extracellular domain, based on reactivity of the antibody with a bacterially expressed soluble fusion protein EC2-GST (ML Andria, S Levy, unpublished). Within this domain, the antibody probably binds to a region located in the hypervariable region coded by exon 6, as it does not bind monkey CD81 (derived from COS cells), which differs only in four amino acids from the human protein (indicated by asterisks in Figure 1). An independent anti-human CD81-mAb, JKT.1, also binds this soluble EC2-GST protein (SL Lin, JE Hildreth, unpublished). The JKT.1 antibody reacts with a CD81 epitope that is expressed on COS cells (14). CD81 is a nonglycosylated protein, and in this respect it differs from other known tetraspanin proteins that are glycosylated in either one of the two extracellular domains. The CD81 protein undergoes posttranslational modification by acylation. Other tetraspanins shown to be acylated are CD9 (15–17) and sm23 (18). Studies on acylation of CD81 were initiated because the protein contains a potential myristoylation site at its amino terminal end. Indeed, our preliminary experiments using 3H-myristic acid to label tissue culture cells indicated that the label was incorporated into the CD81 protein as shown by immunoprecipitation and autoradiography of the SDS-PAGE separated proteins. However, subsequent experiments revealed that the molecule was acylated at a site different from the potential myristoylation site. This was shown by mutating the essential glycine within the consensus myristoylation site to an alanine. In the absence of a myristoylation site, the mutated CD81 mRNA template still promoted incorporation of labeled myristic acid. This result may be explained by conversion of myristic acid to other fatty acids such as palmitic acid, which may be incorporated at different sites. The incorporation of the label indicates that the molecule was acylated by a fatty acid but not necessarily by myristic acid. Future studies should define the nature of the acylation moiety and the location of the acylated site.

CD81 Gene Several groups have independently isolated the CD81 cDNA. In most cases the cDNA libraries were screened with antibodies (Table 1) known to cause a broad spectrum of cellular responses, as described above (1, 8, 19, 20). The gene has also been cloned using subtractive hybridization methodologies (7). Again, other tetraspanins such as CD9, CD63, and CD82 were cloned repetitively using similar approaches (2). CD81 cDNA contains a long 30 untranslated region (1, 21). The genomic 50 region of CD81 is GC rich and contains a high proportion of CG dinucleotides, so-called CpG islands, a feature shared by many housekeeping genes (21). The 50 region also contains putative Sp1 binding sites and a TATA box. The gene has been mapped to chromosome 11p15.5 (21, 22)

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in human and to the syntenic region in chromosome 7 in mouse (21). Mouse CD81 spans a 17-kb region containing 8 exons (21). This overall genomic structure is shared by each of the tetraspanin genes that has been analyzed. They all have a similar number of exons and their exon-intron junctions are conserved, indicating that they arose from a common ancestral gene (5). In general, tetraspanin genes are located on a number of different chromosomes; however, CD151 was recently shown to be located on the same chromosomal segment that encodes CD81, 11p15.5 (23).

MOLECULAR ASSOCIATIONS The myriad effects of CD81 engagement on the surface of diverse cell types may be explained by its multiple molecular associations. Several approaches were used to define the specific association of CD81 with surface proteins. Biochemical approaches used mild detergents to disrupt cells and identified associated proteins that coimmunoprecipitated with CD81. Cellular approaches probed living cells and used fluorochrome-labeled antibodies to monitor molecular associations by comodulation, cocapping, and fluorescent energy transfer (FET) studies. Finally, the existence of molecular complexes is further supported by the fact that individual participants in a complex trigger similar biologic response.

B Cells CD81 associates on the surface of B cells in a molecular complex that includes the B cell–specific molecules CD19 and CD21 and the interferon inducible antigen Leu-13 (24). The existence of the complex was demonstrated by all the approaches mentioned above: coprecipitation, colocalization on living cells, and the ability of antibodies against the individual proteins to induce the same biological effects in whole cells. These effects included induction of cell death, induction of cell adhesion, and ability to costimulate cells when used in conjunction with suboptimal amounts of antibodies to the Ig molecule (25–27). The nature of the association of CD81 with CD19 was studied in detail, using molecular constructs in which truncated CD19 molecules were used to transfect K562 and Daudi cells expressing endogenous CD81 (28, 29). These experiments revealed that the extracellular domain but not the intracellular domain of CD19 was required for CD19/CD81 associations. Replacing the CD19 extracelluar domain with a different one abolished CD19-induced adhesion and demonstrated that the adhesion process was dependent on association with CD81. In B cells CD81 is also found in association with MHC-class II molecules (27) and with proteins from two protein superfamilies, tetraspanins and integrins. Thus, using immunoprecipitation studies, large molecular complexes on Raji B

various mild detergents, colocalization by confocal microscopy

Brij 58 ippt

human B cell (RPMI 8866) human T cell lines

human T cells

FET CHAPS ippt CHAPS ippt, co-capping, transfection of associated molecules into BHK cells transfection of chimeric CD4

(32) (32)

α 4β1 integrin

(34)

CD81 and CD82 role for intracellular CD4 domain in the absence of lck-CD4 association α 4β7 integrin

(31) (35) (19)

(29)

(30) (28)

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transfection of chimeric CD19 constructs into K562 and Daudi cells

CD37, CD53, CD82, MHC class II cytoplasmic domain of CD19 is not required for association with CD81 while transmembrane domain is required extracellular domain of CD19 is required for association with CD81 while cytoplasmic is not required CD20, CD37, CD53, CD82, MHC class II CD4, CD8 CD82

(25) (27) (26)

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human B cell (JY) human thymocytes human T cells

human B cell (Raji) human B cells CD19/CD21 transfectants human B cells CD19 transfectants

Leu-13 HLA-DR CD19/CD21/Leu-13

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cells included the tetraspanins CD37, CD53, CD81, and CD82 (30), and their proximity on the surface of JY B cells was probed using FET studies (31). The latter approach avoids the need to disrupt the cell membrane, thereby preventing possible artifacts that may occur due to the hydrophobic nature of the molecule. These FET studies confirmed the existence of large molecular complexes that include the tetraspanin molecules CD37, CD53, CD81, and CD82. Close proximity of CD81, MHC-class II proteins, and the B cell–specific molecule CD20 were also demonstrated, while other molecules expressed on the JY cells such as CD71, the transferin receptor, were not part of the complex (31). A recent publication reported the association of CD81 with an integrin, α 4β7, in RPMI 8866 cells (32), although a systematic analysis of the association of CD81 with integrins in B cells has not been done. In other cell types, CD81 associated specifically with certain integrins but not with other integrins expressed by the same cells, indicating that the interactions were indeed specific (33).

T Cells Association of CD81 and CD82 was first demonstrated in several human T cell lines (19). These tetraspanins were found to associate with the T cell– specific molecules CD4 and CD8 in HPB-ALL cells and in CD4- but not CD2transfected B cells (34). The association of CD81 with CD4 and CD8 has been confirmed in human thymocytes (35). Subsequent experiments used chimeric constructs of CD4 to define the CD4 domain needed for the association with the tetraspanins. These experiments demonstrated that the cytoplasmic region of CD4 was sufficient for the association with the CD81 molecule. Deleting the lck binding domain encoded by the 31 amino acids at the C-terminus of CD4 did not reduce CD4 and CD81 (or CD82) associations. Likewise, deleting the cytoplasmic CD4 region important for the palmitoylation of CD4 had no effect on CD81 (or CD82) associations. Interestingly, CD4 engaged with lck could not associate with CD81 (or CD82) (34). The α 4β1 integrin coprecipitated with CD81 in the T cell lines Molt 4 and Jurkat (32). This integrin, but not several other β1 family integrins expressed by these cells, also coprecipitated with the tetraspanins CD53, CD63, and CD82. The association was not dependent on the cytoplasmic domain of α 4 integrin and was not dependent on divalent cations. However, associations did not occur when transfectants coding for α 4 integrin adhesion-deficient mutants were used, suggesting that the association is selective and therefore indicative of a functional role (32). In a recent report anti-CD81 mAb-triggered adhesion of human thymocytes could not be inhibited by anti-VLA-4 ( α 4β1 integrin) antibody (35). However, adhesion was blocked by anti LFA-1 and anti-ICAM-1 mAbs, indicating a functional involvement of α Lβ2 integrin in CD81-induced adhesion (35).

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Thus, cross-linking CD81 on various cell types may affect different sets of associated proteins expressed by the cells. Within a given cell type, cross-linking CD81 may influence protein interactions in at least two ways. It may disengage associated proteins, allowing their associations with structural or with signaling proteins. Alternatively, it may increase the avidity of interactions of CD81 with its associated proteins, which could lead to increased interactions with structural proteins or to sustained stimuli for either positive or negative signaling.

BIOLOGICAL EFFECTS OF CROSS-LINKING CD81 CD81 is involved in a broad range of cellular functions, as revealed by the binding of mAbs. Whether the antibodies evoke their effect by mimicking a natural ligand or by altering the interactions between CD81 and its associated proteins is unknown. While the molecule is expressed on most cells, some of the antibody-triggered effects can be seen only in a subset of cells. Also, some cellular responses are mAb-dependent, since mAbs reacting with different CD81 epitopes do not elicit the same response in a given cell line.

Antiproliferative Effects The mAb 5A6 was selected by its ability to inhibit proliferation of a B lymphoma cell line. Further testing indicated that additional B cell lines were sensitive to the antiproliferative effect of the antibody and that most T cells were insensitive. This effect of the antibody was reversible if the antibody was removed within 18 hours, but not if cells were exposed longer (1). The antiproliferative effect of the 5A6 mAb on the sensitive B cells could be completely prevented when cells were grown in the presence of low concentrations of 2-mercaptoethanol (36). Experiments aimed at understanding this phenomenon revealed that compounds that increase intracellular thiol levels protected cells from the antibody, whereas those that decrease intracellular thiol levels made cells more sensitive to the antibody. To determine if protection was dependent on early signaling events, the effect of intracellular thiol levels on activation of tyrosine kinases was analyzed. Cells that contained low thiol levels were triggered and underwent a rapid increase in protein tyrosine phosphorylation. This increase in tyrosine phosphorylation was not seen when the intracellular thiol levels were raised. High intracellular thiol levels did not prevent protein tyrosine phosphorylation triggered by cross-linking surface immunoglobulin expressed on these cells. This indicated that the sensitivity to intracellular thiol levels was specific to cell-triggering via CD81 and that the activation of cell death probably required specific protein tyrosine phosphorylation events (36). MECHANISM OF CELL DEATH To determine if cell death induced by the antiCD81 antibody occurred by apoptosis, cells were analyzed for DNA fragmentation by agarose gel analysis and by terminal deoxynucleotide transferase assays.

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DNA obtained from sensitive cells that were treated with the antibody was not fragmented, nor did the cells display characteristic apoptotic features when analyzed by electron microscopy (VQ Nguyen, S Levy, unpublished). Another approach to address the mechanism of cell death was to determine whether the anti-apoptotic Bcl-2 protein would rescue cells from the antiproliferative effect of the antibody. An inducible bcl-2 construct was transfected into a B lymphoma cell line, DHL-5, that expresses low endogenous levels of Bcl-2 protein. As expected, transfected DHL-5 cells induced to express high Bcl-2 levels were resistant to drugs known to induce apoptosis. These cells were not protected from the antiproliferative effect of the anti-CD81 mAb. Moreover, a survey of Bcl-2 expression in a large number of B lymphoma cell lines revealed that some of the cell lines that were most sensitive to the anti-CD81 antibody expressed the highest levels of Bcl-2, suggesting a cell death mechanism that is not protected by Bcl-2. Taken together these results indicate that cell death occurred not by apoptosis but by a Bcl-2-independent mechanism.

Adhesion Two different anti-CD81 mAbs, 5A6 and 1D6, are strong inducers of homotypic adhesion in hematolymphoid cells. Both B and T cells are comparably induced to aggregate by these antibodies. The other anti-CD81 mAbs from the Fifth International Leukocyte Workshop were less potent in inducing adhesion. The mAbs JS81 and 4TM-2 induced an intermediate response, whereas JS64 and 4TM-1 induced a minimal response. The ability of the tested antibodies to induce adhesion was directly correlated with their ability to induce growth inhibition of B cell lines (LE Bradbury, TF Tedder, personal communication). Nevertheless, adhesion was not affected by an increase in intracellular thiol levels, while this increase prevented cell death as discussed above (36). Thus, homotypic adhesion induced by cross-linking CD81 is not sufficient to induce cell death. An immunoregulatory role for CD81-induced adhesion was recently illustrated in a study aimed at understanding B cell trafficking to lymphoid organs. Using an assay that measured B cell adhesion to frozen tonsil sections and testing a large number of B cell antigens, Behr & Schriever identified two mAbs that induced VLA-4-mediated adhesion of B cells to interfollicular stroma (37). One reacted with the B cell–specific CD19 antigen and the second with the CD81 antigen. Since CD81 was the primary mediator of homotypic adhesion, as discussed above, the tonsil–B cell adhesion assay suggests a pivotal role for the molecule in B cell trafficking. MECHANISM OF ADHESION Studies to analyze the mechanism of adhesion induced by cross-linking CD81 sought conditions that would block the adhesion process. It is generally agreed that adhesion induced by anti-CD81 mAbs is

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an active metabolic process that is halted at 4◦ C (25). The addition of 10 mM sodium azide in the presence of deoxyglucose did not block 5A6-induced adhesion in OCI-LY8 cells (25), whereas it did block that of mAb JKT.1 (14). Aggregation of both T and B cell lines was inhibited by cytochalasin, indicating a requirement for actin polymerization. CD81-induced aggregation of thymocytes is Ca+ + and Mg+ + dependent and is blocked by anti-LFA-1 mAbs but not by anti-VLA-4 mAb (35). This demonstrates a specific activation of LFA-1 by CD81. In contrast, B cell aggregation was Ca+ + and Mg+ + independent and unaffected by anti-LFA-1 treatment (25). Thus, LFA-1 is variably involved. The demonstration that VLA-4 is activated by anti-CD81 on B cells (37) suggests that this integrin may also contribute to aggregation. Therefore, it is conceivable that cross-linking CD81 on the surface of B cells activates more than a single adhesion pathway, and effective blocking of one pathway is insufficient to block adhesion activated through additional pathway(s). As discussed above, several integrins associate with CD81 and are therefore prime candidates for involvement in CD81-mediated adhesion processes. The central lesson of these studies is that the mechanism by which CD81 induces cell adhesion is likely to depend on the cell type.

Change in Cell Morphology In addition to inducing adhesion, the anti-CD81 mAb JKT.1 changed the morphology of C8166 T cells, where the immobilized antibody induced the formation of processes by the cell (14). A similar effect on cell morphology was seen when a soluble anti-CD81 mAb was used to treat rat astrocytes. They responded by increasing the length but not the number of their cell processes (8). Similar changes in morphology were reported for another tetraspanin, CD82. Cross-linking this antigen by an immobilized mAb (4F9) induced the formation of dendritic processes in the human T cell line H9 (38). This effect was inhibited by cytochalasin D and by colchicine, once again indicating involvement of the cytoskeleton (38). It is likely that both CD81 and CD82, which are associated on the surface of T cells, are coactivators of the changes in cell morphology.

Inhibition of Syncytium Formation The anti-CD81 mAb, M38, was found by its ability to inhibit HTLV-induced syncytium formation. M38 was one of two antibodies identified by the screen; interestingly, the second mAb reacted with the tetraspanin CD82 (19, 39). Although it is not known how the virus induces membrane fusion, cross-linking CD81 may prevent fusion by changing cell morphology and adhesion as described above.

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Release of TNF- α The mAbs 5A6 and 1D6 increase TNF- α production in JY, an EBV-positive B cell line (40). A similar effect was seen when an anti-HLA-DR mAb, L243, was used to treat the cells. However, the effect of triggering cells with both antibodies was not additive, indicating that each of the antibodies induced the maximal effect and that the signals transmitted by these two molecules may share a common pathway (40). As discussed above, CD81 associates on the surface of B cells with MHC-class II (27). Both antibodies also induced an increase in tyrosine phosphorylation in this cell line; however, the pattern of the phosphorylated proteins differed considerably, with more proteins being phosphorylated in the 5A6 treated cells.

IMMUNE FUNCTIONS OF CD81 CD81-Mediated Responses in B Cells The preferential antiproliferative effect of anti-CD81 mAb on B cells and the fact that CD81 contains a short intracellular tail lacking signaling motifs led to a search for B cell–specific signaling proteins that may associate with CD81. These and studies that focused on association of proteins with the B cell–specific CD19 and CD21 antigens identified a molecular complex on the surface of B cells, as discussed above (24–28). The CD19/CD21/CD81/Leu-13 B cell complex augments triggering of B cells by reducing the number of engaged B cell receptors necessary to achieve a signaling threshold, defined by cell activation and proliferation. Maximal Ca+ + flux occurred when suboptimal concentrations of anti-IgM antibodies were used together with mAb to individual components in the molecular complex, CD19, CD81, or Leu-13 (28). Likewise, normal B lymphocytes were activated by suboptimal concentrations of anti-IgM antibodies only in the presence of antibodies to either CD19, CD21, CD81, or MHC-class II (41). The involvement of CD21 (CR2) and CD19 has been studied extensively by Fearon et al, who also describe this B cell molecular complex in a recent review (24). In this complex CD21 binds complement, CD19 mediates intracelluar signaling, CD81 is thought to trigger cellular adhesion; and Leu-13, a molecule highly responsive to interferons, could be involved in response to viral attack. The Leu-13 antigen was recently cloned and shown to be identical to the interferon inducible gene 9-27 (42). Fearon and his collaborators have recently demonstrated, in a series of elegant experiments, that the threshold for B cell activation can be reduced several logs by fusing an antigen, HEL, to the C3d complement fragment (43). Such a fusion protein enabled the simultaneous activation of the B cell receptor (by the antigen) and CD21 (by binding C3d). This resulted in an increased response to

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suboptimal concentrations of antigen in vitro and in vivo. In essence this experiment recreated the effect of microrganisms on the immune system. In vivo, the invading microorganisms initiate the alternative pathway of complement activation, thereby inducing the opsonization of antigen by C3d. This permits the dual binding to antigen-specific B cells, where the antigen is bound by the immunoglobulin molecule and the C3d by its receptor, CR2 (CD21), enabling triggering of these cells by suboptimal concentration of antigen. Therefore this complex may be considered as a coreceptor with the B cell receptor for complement opsonized antigen. In addition to augmenting intracelluar signaling by this complex, engagement of CD81 may activate adhesion and promote intercellular interactions.

CD81 in B Cell–T Cell Interactions We have recently shown that treating human lymphocytes with antibodies to CD81 or to HLA-DR can influence the Th-type of the immune response in vitro (44). The experimental system analyzed a recall immune response to specific antigens or allergens in sensitized subjects. When B cells present these antigens in the presence of anti-CD81 or anti-HLA-DR, IL-4 and IL-10 synthesis was enhanced significantly by the responding CD4+ T cells. This Th2-type cytokine profile was not seen when monocytes were substituted for B cells as APC. Neither was the effect seen when isolated B and T cell subpopulations were pretreated separately with the antibodies prior to the coculture. Thus, continuous presence of the mAb was essential for the increased IL-4 synthesis. The enhancement in IL-4 synthesis was correlated with the presence of large cell aggregates. There was no detectable increase in B7-1, B7-2, MHC-class II, LFA-1, or CD40 expression by the treated B cells. These results indicate that triggering CD81 on the surface of B cells can modulate antigen-specific B cell–T cell interactions. Although the mechanism responsible for these interactions is still not known, it is plausible to suggest that integrin activation and increased cell-cell contact may contribute to this response.

CD81-Mediated Responses in T Cells In general, T cell lines are not sensitive to the antiproliferative effect of antiCD81 antibodies (25). Likewise, the proliferation of freshly isolated thymocytes was unaffected by the antibody (35). However, cross-linking CD81 on human thymocytes provided a costimulatory signal to CD3 (35), while treatment with each of the antibodies alone had no proliferative effect. An increase in proliferation was seen when thymocytes were treated with both antibodies, and when each of the costimulating antibodies was immobilized by direct coating to the tissue culture wells, but not when anti-CD3 was cross-linked on plastic and anti-CD81 was cross-linked by a polyclonal antibody. This suggests that

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a physical juxtaposition of the receptors is necessary to deliver the stimulatory signal. The expression of the activation markers CD25 (IL-2R) and CD69 was markedly increased on the surface of the proliferating T cells. This proliferation was IL-2-dependent because antibodies to CD25 were inhibitory. It is of note that the proliferating T cells were mostly of the CD8+CD4− phenotype, a subpopulation previously shown to respond to a costimulatory activation by anti-CD3 mAb and fibronectin or laminin, which bind to β1-family integrins. Interestingly, cross-linking of other tetraspanins on T cells can be costimulatory as well. A mAb that reacts with CD82 had a costimulatory effect on human CD4 cell proliferation when immobilized together with an anti-CD3 mAb (38, 45). Similarly, an anti-mouse CD9 mAb, with suboptimal concentrations of anti-CD3 mAb, was an effective costimulator of T cells (46). Although the magnitude of activation was similar to costimulation by anti-CD28, it was CD28 independent since T cells derived from CD28-deficient mice showed the same degree of costimulation by CD3 and CD9 as did normal mice (46). A striking effect of an anti-mouse CD81 mAb, 2F7, was shown in a fetal thymus organ culture (FTOC) (20). The antibody was identified by its ability to block maturation of CD4−CD8− thymocytes to the CD4+CD8− phenotype . The antibody had a selective blocking effect on the α β T cells while sparing the maturation of γ δ cells. Interestingly, unlike human thymocytes that express CD81, the mouse fetal thymocytes were not stained by the 2F7 mAb. The antibody did bind to the subcapsular region of the fetal thymus. The effect of the antibody was reversible even after treatment of the FTOC for 5 days; upon its removal the cells proceeded to mature to the double positive phenotype. In an independent reaggregation culture assay, mouse CD81 transfected CHO cells were sufficient to promote the maturation of double negative cells to the double positive phenotype (20). These experiments imply that CD81 is necessary and sufficient in T cell maturation by demonstrating not only that the antibody could block cell maturation, but also that a transfected CD81 was sufficient to allow maturation. In addition to influencing maturation of double negative T cells, CD81 was recently shown to act as a coinducer of maturation of single positive T cells in a two step activation suspension culture system. In this system CD81, in conjunction with activated TCR, but in the absence of thymic epithelium, promoted maturation of double positive CD4+CD8+ thymocytes into single positive CD4+ and CD8+ cells (47). CD81 was not unique in its ability to act as a coinducer of thymocyte maturation. Other molecules that shared a costimulatory ability were CD2, CD5, CD24, CD28, CD49d, and TSA-1. Each of these molecules, but not CD45, was able to provide the proper help to the engaged TCR. The mechanism by which the coinducer molecules provide help to the TCR is unclear, but one explanation is based on the ability of such coinducers to

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form microaggregates around the TCR and exclude inhibitory molecules such as CD45 (48). Another tetraspanin involved in T cell maturation is CD53. It is expressed on early CD4−CD8− mouse thymocytes and is downregulated later so that nonselected CD4 +CD8 + cells do not express CD53 (49). The molecule is reexpressed in the process of positive selection, upon engagement of the TcR. In these experiments the authors used TcR transgenic mice that regained CD53 expression on single positive cells only after antigenic stimulation in the context of the appropriate MHC background (49).

CD81-Deficient Mice To better understand the role of this tetraspanin in development and in the immune system, we have recently generated CD81-deficient mice using gene targeting (50). The mice are viable and undergo normal maturation of all lymphoid cells. The mice express normal numbers and subsets of T cells, despite in vitro data suggesting that CD81 is required in thymocyte development (20). The mice express normal numbers of CD5 + and CD5− B cells. Nevertheless, their primary immune response to protein antigens is impaired by comparison to their heterozygous littermates. It is of note that B cells of CD81-deficient mice express lower levels of CD19 than do their normal littermates. This observation suggests that CD81 is necessary for optimal expression of CD19 on the cell surface. The reduced expression of CD19 may or may not be the cause for the impaired antibody response in these mice. These observations support the suggested role of the CD19/CD21/CD81/Leu-13 B cell complex in lowering the threshold for B cell response. Thus, CD81 is not essential for the development of mice and their immune system. However, because of its evolutionary conservation, its ubiquitous expression, and its multiple molecular interactions, it seems to play an important role in cellular interactions. It is conceivable that other tetraspanins such as CD82 are recruited to compensate for the absence of CD81 expression in most lymphoid cells. However, the reduced CD19 expression and the impaired humoral immune responses lead us to believe that its expression cannot be completely substituted for by other proteins. ACKNOWLEDGMENTS We thank Dr. Ronald Levy for his continuous input and support of this work. This research is supported by grant number CA34233 from the US Public Health Service (PHS), National Institutes of Health. SCT is a recipient of the Lymphoma Research Foundation Award and is supported by PHS grant 5T32CA9302 from the National Cancer Institute. HTM is a recipient of a National Research Service Award from the National Institutes of Health.

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Literature Cited 1. Oren R, Takahashi S, Doss C, Levy R, Levy S. 1990. TAPA-1, the target of an antiproliferative antibody, defines a new family of transmembrane proteins. Mol. Cell. Biol. 10:4007–15 2. Maecker HT, Todd SC, Levy S. 1997. The tetraspanin superfamily: molecular facilitators. FASEB J. 11:428–42 3. Engel P, Tedder TF. 1994. New CD from the B cell section of the Fifth International Workshop on Human Leukocyte Differentiation Antigens. Leukocyte Lymphoma 1:61–64 4. Nagira M, Imai T, Ishikawa I, Uwabe KI, Yoshie O. 1994. Mouse homologue of C33 antigen (CD82), a member of the transmembrane 4 superfamily: complementary DNA, genomic structure, and expression. Cell. Immunol. 157:144–57 5. Tomlinson MG, Wright MD. 1996. Characterisation of mouse CD37: cDNA and genomic cloning. Mol. Immunol. 33:867– 72 6. Andria ML, Barsh GS, Levy S. 1992. Expression of TAPA-1 in preimplantation mouse embryos. Biochem. Biophys. Res. Commun. 186:1201–6 7. Prasad SS, Cynader MS. 1994. Identification of cDNA clones expressed selectively during the critical period for visual cortex development by subtractive hybridization. Brain Res. 639:73–84 8. Geisert EE, Yang L, Irwin MH. 1996. Astrocytes growth, reactivity, and the target of antiproliferative antibody, TAPA. J. Neurosci. 16:5478–87 9. Mawhorter SD, Stephany DA, Ottesen EA, Nutman TB. 1996. Identification of surface molecules associated with physiologic activation of eosinophils. Application of whole-blood flow cytometry to eosinophils. J. Immunol. 156:4851–58 10. Radford KJ, Thorne RF, Hersey P. 1996. CD63 associates with transmembrane 4 superfamily members, CD9 and CD81, and with beta 1 integrins in human melanoma. Biochem. Biophys. Res. Commun. 222:13–18 11. Adachi M, Taki T, Ieki Y, Huang CL, Higashiyama M, Miyake M. 1996. Correlation of KAI1/CD82 gene expression with good prognosis in patients with non-small cell lung cancer. Cancer Res. 56:1751–55

12. Levy S, Nguyen VQ, Andria ML, Takahashi S. 1991. Structure and membrane topology of TAPA-1. J. Biol. Chem. 266:14597–602 13. Tomlinson MG, Williams AF, Wright MD. 1993. Epitope mapping of anti-rat CD53 monoclonal antibodies. Implications for the membrane orientation of the transmembrane 4 superfamily. Eur. J. Immunol. 23:136–40 14. Lin SL, Derr D, Hildreth JE. 1992. A monoclonal antibody against a novel 20-kDa protein induces cell adhesion and cytoskeleton-dependent morphologic changes. J. Immunol. 149:2549–59 15. LeBien TW, Pirruccello SJ, McCormack RT, Bradley JG. 1985. p24 and p26, structurally related cell surface molecules identified by monoclonal antibody BA-2. Mol. Immunol. 22:1185–94 16. Seehafer JG, Tang SC, Slupsky JR, Shaw AR. 1988. The functional glycoprotein CD9 is variably acylated: localization of the variably acylated region to a membrane-associated peptide containing the binding site for the agonistic monoclonal antibody 50H.19. Biochim. Biophys. Acta 957:399–410 17. Seehafer JG, Slupsky JR, Tang SC, Shaw AR. 1988. The functional cell surface glycoprotein CD9 is distinguished by being the major fatty acid acylated and a major iodinated cell-surface component of the human platelet. Biochim. Biophys. Acta 952:92–100 18. K¨oster B, Strand M. 1994. Schistosoma mansoni: Sm23 is a transmembrane protein that also contains a glycosylphosphatidylinositol anchor. Arch. Biochem. Biophys. 310:108–17 19. Imai T, Yoshie O. 1993. C33 antigen and M38 antigen recognized by monoclonal antibodies inhibitory to syncytium formation by human T cell leukemia virus type 1 are both members of the transmembrane 4 superfamily and associate with each other and with CD4 or CD8 in T cells. J. Immunol. 151:6470–81 20. Boismenu R, Rhein M, Fischer WH, Havran WL. 1996. A role for CD81 in early T cell development. Science 271:198–200 21. Andria ML, Hsieh CL, Oren R, Francke

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LEVY ET AL U, Levy S. 1991. Genomic organization and chromosomal localization of the TAPA-1 gene. J. Immunol. 147:1030–36 Reid LH, Davies C, Cooper PR, CriderMiller SJ, Sait SNJ, Nowak NJ, Evans G, Stanbridge EJ, de Jong P, Shows TB, Weissman BE, Higgins MJ. 1997. A 1-Mb physical map and PAC contig of the imprinted domain in 11p 15.5 that contains TAPA1 and the BWSCR1/WT2 region. Genomics 43:366–75 Hasegawa H, Kishimoto K, Yanagisawa K, Terasaki H, Shimadzu M, Fujita S. 1997. Assignment of SFA-1 (PETA-3), a member of the transmembrane 4 superfamily, to human chromosome 11p15.5 by fluorescence in situ hybridization. Genomics 40:193–96 Fearon DT, Carter RH. 1995. The CD19/CR2/TAPA-1 complex of B lymphocytes: linking natural to acquired immunity. Annu. Rev. Immunol. 13:127–49 Takahashi S, Doss C, Levy S, Levy R. 1990. TAPA-1, the target of an antiproliferative antibody, is associated on the cell surface with the Leu-13 antigen. J. Immunol. 145:2207–13 Bradbury LE, Kansas GS, Levy S, Evans RL, Tedder TF. 1992. The CD19/CD21 signal transducing complex of human B lymphocytes includes the target of antiproliferative antibody-1 and Leu-13 molecules. J. Immunol. 149:2841–50 Schick MR, Levy S. 1993. The TAPA-1 molecule is associated on the surface of B cells with HLA-DR molecules. J. Immunol. 151:4090–97 Bradbury LE, Goldmacher VS, Tedder TF. 1993. The CD19 signal transduction complex of B lymphocytes. Deletion of the CD19 cytoplasmic domain alters signal transduction but not complex formation with TAPA-1 and Leu 13. J. Immunol. 151:2915–27 Matsumoto AK, Martin DR, Carter RH, Klickstein LB, Ahearn JM, Fearon DT. 1993. Functional dissection of the CD21/CD19/TAPA-1/Leu-13 complex of B lymphocytes. J. Exp. Med. 178:1407– 17 Angelisov´a P, Hilgert I, Horejs´ı V. 1994. Association of four antigens of the tetraspans family (CD37, CD53, TAPA-1, and R2/C33) with MHC class II glycoproteins. Immunogenetics 39:249–56 Sz¨oll´osi J, Horejs´ı V, Bene L, Angelisov´a P, Damjanovich S. 1996. Supramolecular complexes of MHC class I, MHC class II, CD20, and tetraspan molecules (CD53, CD81, and CD82) at the surface of a B cell line JY. J. Immunol. 157:2939–46

32. Mannion BA, Berditchevski F, Kraeft SK, Chen LB, Hemler ME. 1996. Transmembrane-4 superfamily proteins CD81 (TAPA-1), CD82, CD63, and CD53 specifically associated with integrin alpha 4 beta 1 (CD49d/CD29). J. Immunol. 157:2039–47 33. Hemler ME, Mannion BA, Berditchevski F. 1996. Association of TM4SF proteins with integrins: relevance to cancer. Biochim. Biophys. Acta 1287:67–71 34. Imai T, Kakizaki M, Nishimura M, Yoshie O. 1995. Molecular analyses of the association of CD4 with two members of the transmembrane 4 superfamily, CD81 and CD82. J. Immunol. 155:1229–39 35. Todd SC, Lipps SG, Crisa L, Salomon DR, Tsoukas CD. 1996. CD81 expressed on human thymocytes mediates integrin activation and interleukin 2-dependent proliferation. J. Exp. Med. 184:2055–60 36. Schick MR, Nguyen VQ, Levy S. 1993. Anti-TAPA-1 antibodies induce protein tyrosine phosphorylation that is prevented by increasing intracellular thiol levels. J. Immunol. 151:1918–25 37. Behr S, Schriever F. 1995. Engaging CD19 or target of an antiproliferative antibody 1 on human B lymphocytes induces binding of B cells to the interfollicular stroma of human tonsils via integrin alpha 4/beta 1 and fibronectin. J. Exp. Med. 182:1191–99 38. Nojima Y, Hirose T, Tachibana K, Tanaka T, Shi L, Doshen J, Freeman GJ, Schlossman SF, Morimoto C. 1993. The 4F9 antigen is a member of the tetra spans transmembrane protein family and functions as an accessory molecule in T cell activation and adhesion. Cell. Immunol. 152:249–60 39. Imai T, Fukudome K, Takagi S, Nagira M, Furuse M, Fukuhara N, Nishimura M, Hinuma Y, Yoshie O. 1992. C33 antigen recognized by monoclonal antibodies inhibitory to human T cell leukemia virus type 1-induced syncytium formation is a member of a new family of transmembrane proteins including CD9, CD37, CD53, and CD63. J. Immunol. 149:2879–86 40. Altomonte M, Montagner R, Pucillo C, Maio M. 1996. Triggering of target of an antiproliferative antibody-1 (TAPA1/CD81) up-regulates the release of tumour necrosis factor-alpha by the EBV-B lymphoblastoid cell line JY. Scand. J. Immunol. 43:367–73 41. Carter RH, Fearon DT. 1992. CD19: lowering the threshold for antigen receptor stimulation of B lymphocytes. Science 256:105–7

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CD81 (TAPA-1) 42. Deblandre GA, Marinx OP, Evans SS, Majjaj S, Leo O, Caput D, Huez GA, Wathelet MG. 1995. Expression cloning of an interferon-inducible 17-kDa membrane protein implicated in the control of cell growth. J. Biol. Chem. 270:23860– 66 43. Dempsey PW, Allison ME, Akkaraju S, Goodnow CC, Fearon DT. 1996. C3d of complement as a molecular adjuvant: bridging innate and acquired immunity. Science 271:348–50 44. Secrist H, Levy S, DeKruyff RH, Umetsu DT. 1996. Ligation of TAPA-1 (CD81) or major histocompatibility complex class II in co-cultures of human B and T lymphocytes enhances interleukin-4 synthesis by antigen-specific CD4+ T cells. Eur. J. Immunol. 26:1435–42 45. Lebel-Binay S, Lagaudri`ere C, Fradelizi D, Conjeaud H. 1995. CD82, member of the tetra-span-transmembrane protein family, is a costimulatory protein for T cell activation. J. Immunol. 155:101– 10 46. Tai XG, Yashiro Y, Abe R, Toyooka K, Wood CR, Morris J, Long A, Ono S, Kobayashi M, Hamaoka T, Neben S, Fujiwara H. 1996. A role for CD9 molecules in T cell activation. J. Exp. Med. 184:753– 58

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47. Cibotti R, Punt JA, Dash KS, Sharrow SO, Singer A. 1997. Surface molecules that drive T cell development in vitro in the absence of thymic epithelium and in the absence of lineage-specific signals. Immunity 6:245–55 48. Shaw AS, Dustin ML. 1997. Making the T cell receptor go the distance: a topological view of T cell activation. Immunity 6:361–69 49. Tomlinson MG, Hanke T, Hughes DA, Barclay AN, Scholl E, H¨unig T, Wright MD. 1995. Characterization of mouse CD53: epitope mapping, cellular distribution and induction by T cell receptor engagement during repertoire selection. Eur. J. Immunol. 25:2201–5 50. Maecker HT, Levy S. 1997. Normal lymphocyte development but delayed humoral immune response in CD81-null mice. J. Exp. Med. 185:1505–10 51. Pesando JM, Hoffman P, Abed M. 1986. Antibody-induced antigenic modulation is antigen dependent: characterization of 22 proteins on a malignant human B cell line. J. Immunol. 137:3689–95 52. Borst J, Spits H, de Vries J, Pessano S, Rovera G, Terhorst C. 1983. Target antigen of monoclonal reagent S5.7: comparison with T3 antigen. Hybridoma 2:265– 74

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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CD40 AND CD154 IN CELL-MEDIATED IMMUNITY Iqbal S. Grewal and Richard A. Flavell∗ ∗ Howard

Hughes Medical Institute, and Section of Immunobiology, Yale University School of Medicine, New Haven, Connecticut 06520; e-mail: [email protected] KEY WORDS:

CD40L, T cell activation, T cell priming, T cell effector functions, autoimmunity, parasitic infections

ABSTRACT CD40-CD154–mediated contact-dependent signals between B and T cells are required for the generation of thymus dependent (TD) humoral immune responses. CD40-CD154 interactions are however also important in many other cell systems. CD40 is expressed by a large variety of cell types other than B cells, and these include dendritic cells, follicular dendritic cells, monocytes, macrophages, mast cells, fibroblasts, and endothelial cells. CD40- and CD154-knockout mice and antibodies to CD40 and CD154 have helped to elucidate the role of the CD40CD154 system in immune responses. Recently published studies indicate that CD40-CD154 interactions can influence T cell priming and T cell–mediated effector functions; they can also upregulate costimulatory molecules and activate macrophages, NK cells, and endothelia as well as participate in organ-specific autoimmune disease, graft rejection, and even atherosclerosis. This review focuses on the role of the CD40-CD154 system in the regulation of many newly discovered functions important in inflammation and cell-mediated immunity.

INTRODUCTION Cell-to-cell interactions play an important role in the regulation of the immune response. Significant advances have been made in the past few years in our understanding of some of the molecular mechanisms that underlie these interactions; several molecules that provide stable intercellular contacts and costimulatory or apoptotic signals have been identified. The use of antibodies that disrupt interactions between CD40-CD154 has shown that these molecules 111 0732-0582/98/0410-0111$08.00

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mediate interaction between CD40 expressing B and CD154 expressing activated T cells; it has also established the role of this molecular interaction in TD humoral responses (1, 2). Humans that have a mutation in CD154 develop a severe form of immunodeficiency, hyper IgM syndrome (HIGM1), that is characterized by elevated levels of IgM in the majority of patients and low levels of IgA, IgG, and IgE, the absence of germinal centers, and the inability to mount TD humoral response (3, 4). As a result, HIGM1 patients suffer from recurrent pathogenic bacterial infections (5). Studies by means of antibodies in mice that block this interaction have also indicated a primary role of CD40-CD154 interactions in the regulation of B cell proliferation, production of immunoglobulins (Ig), Ig class switching, rescue of B cells from apoptotic death, germinal center formation, and generation of B cell memory (reviewed in 6, 7). The role of CD40-CD154 in the regulation in B cell responses was recently confirmed in CD40- and CD154-deficient mice (8–10). In addition, a novel dual role for CD154 in both clonal expansion and deletion of B cells in vivo was recently demonstrated (11). CD154 expressed on activated T cells in concert with Fas ligand induces clonal expansion of B cells that specifically bind to foreign antigens; such CD154 expression also induces clonal deletion of B cells whose B cell receptors that have been desensitized by chronic stimulation with self-antigens or that have no antigens bound to their B cell receptors. The fact that CD40 is not expressed solely on B cells but is also expressed on all other antigen-presenting cells (APC) and other cell types as indicated in Table 1 (11a, 11b, 12) suggested that CD40-CD154 interactions may be important in T cell–mediated immune responses at both the initiation and effector phases as well as in the development of effector functions of other CD40 expressing cells. Recent studies also indicate expression of CD154 on many cell Table 1 Expression of CD40 Human and mouse B cells Human and mouse dendritic cells Mouse follicular dendritic cells Human and mouse monocytes Human and mouse macrophages Mouse thymic epithelium cells Human hemopoeitic progenitor cells Human carcinomas Human and mouse endothelial cells Human and mouse mast cells Mouse fibroblasts Human smooth muscle cells

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Table 2 Expression of CD154 Activated CD4 T cells from spleen and blood from mice and humans Activated mouse Th1 and Th2 clones Antigen primed lymph node cells in mice Human PMA activated CD8 T cells Mouse CD8 T cell clones Mouse γ δ TCR+ T cell clones Mouse NK cells Mouse and human monocytes Mouse fetal thymocytes Mouse small intestine Human basophils Human mast cells Human eosinophils Activated dendritic cells from humans Human B cells and B cell lines

types (see Table 2), suggesting CD40-CD154-mediated regulation of multiple cell types. Although earlier studies indicated a primary role for CD40-CD154 interactions in humoral immunity, recent work has suggested that these interactions play a much broader role in the immune response (reviewed in 12). Thus, a key role of this interaction has now been demonstrated in the priming and expansion of antigen-specific CD4 T cells, activation of APC to upregulate costimulatory activity and cytokine production, activation of macrophages, and activation of endothelia (11–16). The role of CD40-CD154 in humoral responses has been addressed in a recent excellent review by Clark, Foy & Noelle (6). Thus, the present chapter highlights developments in our understanding of the importance of CD40-CD154 interactions in non–B cell mediated cellular functions.

REGULATION OF APC ACTIVITY Contact-dependent interactions between T cells and APC are required for the initiation of a successful T cell–mediated immune response. A number of different cell types perform APC functions, including B cells, macrophages, and dendritic cells. The interactions between T cells and APC provide bidirectional stimulatory signals that are important in the activation of specific T cells and in the regulation of activation of self-reactive or unwanted bystander cells. The most popular model of T cell activation postulates the requirement of two distinct signals for T cell activation (18, 19). The first signal is believed to be the interaction of the T cell receptor (TCR) with MHC/peptide complex

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on the surface of the APC, and the second signal comes from costimulatory molecules such as CD80 and CD86 on the surface of APC stimulating CD28 on the surface of T cells. However, certain APC, such as resting B cells that express low-level costimulatory molecules constitutively, are not competent APC and require activation first in order to upregulate costimulatory activity and to become competent APC (20). Resting B cells express CD40 and can be activated by CD154-expressing T cells to progress through the cell cycle (21), to upregulate IL-2, IL-4, and IL-5 receptors (22) and costimulatory ligands, and to deliver costimulatory activity (24–27). Evidence for a role of CD40-CD154 interactions in the regulation of costimulatory activity on B cells was provided by in vitro blocking of the T cell–induced upregulation of CD80 and CD86 molecules by anti-CD154 antibodies or by directly inducing these molecules by recombinant CD154 (24–26). This was confirmed by recent studies in which T cells lacking CD154 were unable to activate B cells to induce costimulatory molecules (27). The role of CD40CD154 in regulation of B cell APC functions was further exemplified in an in vivo system, showing that combined administration in mice of anti-CD154 antibodies and allogeneic B cells elicited poor mixed lymphocytes and cytotoxic T cell responses (28). Similarly, when allogeneic B cells were transferred to CD154-deficient mice, as expected, a lack of allogeneic T cell responses was apparent, again suggesting a role of CD40-CD154 in transformation of resting B cells into competent APC (28). Because CD40-CD154 interactions regulate costimulatory molecules on APC, and LPS-activated B cells expressing high levels of B7 molecules could act as competent APC, it is likely that the diminished alloresponses in the above systems were due to the lack of upregulation of costimulatory activity on B cells. Thus, both in vitro and in vivo studies strongly indicate that CD40-CD154 regulate activation of APC functions on B cells. Several recent reports suggest that CD40-CD154 interactions are also important in the induction of costimulatory activity on other types of APC such as dendritic cells and macrophages (11a, 12, 29). This was demonstrated by upregulation of CD58, CD80, and CD86 by human dendritic Langerhans cells, stimulating them through CD40 by CD154-transfected L-cells (30–33), and enhancing CD40-triggered APC functions of human peripheral blood dendritic cells to induce proliferation and IFN-γ production by T cells (30). Furthermore, ligation of CD40 with CD154 on the surface of dendritic cells regulates production of certain cytokines such as IL-8, MIP-1α, TNFα, and IL-12 (30–33). Production of proinflammatory cytokines and chemokines by APC, such as dendritic cells, is important for the induction of inflammation; production of IL-12 by dendritic cells in particular is critical for activation of T cells and in the development of Th1-type T cell responses.

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Although the data presented above illustrate that CD40-CD154 play an important part in the activation of APC functions in B cells and dendritic cells, little is known about the role of CD40-CD154 in activation of APC functions on macrophages or monocytes. However, one recent report suggested a role for CD40-CD154 in activation of human monocytes as APC (34). Stimulation of human peripheral monocytes with soluble CD154-CD8 chimeric protein induces upregulation of several molecules important for APC functions, including CD54, MHC class II, CD86, and CD40. In addition ligation of CD40 on monocytes enhances survival of monocytes. Taken together, these results suggest that CD40-CD154 interactions are important for the activation of all APC, and this interaction may be a critical step in T cell activation.

ROLE OF CD40-CD154 INTERACTION IN T CELL PRIMING Infections by opportunistic pathogens such as Pneumocystis and Cryptosporidium are typically associated with severe T cell immunodeficiency (e.g. in AIDS patients) (5). However, these pathogens infect HIGM1 patients, suggesting that T cell responses are defective in the absence of CD154. Since CD154 stimulates APC to deliver activating signals to T cells, this deficiency could lead to a failure of T cell responses. Recent studies have therefore addressed the role of CD40-CD154 interactions in CD4 T cell priming. We have used CD154knockout mice to investigate the possible role of CD40-CD154 interactions in in vivo T cell priming to protein antigens (13). Studies with these mice demonstrated defects in priming of CD4 T cells to protein antigens (13). T cells harvested from antigen-immunized CD154-deficient mice proliferated poorly and produced little to no IL-4 and IFNγ when challenged with priming antigen in vitro, compared to T cells from antigen immunized wild-type mice. Because CD4 T cells from CD154-deficient mice had no intrinsic defects and they proliferated normally when challenged in vitro with polyclonal activators, a lack of efficient in vivo priming of T cells in CD154-deficient mice was suggested. This defect in in vivo T cell priming was corrected when purified CD4 T cells from wild-type mice were adoptively transferred to CD154-deficient mice prior to immunization with antigen, suggesting that the defect was at the level of the T cell. Studies using an adoptive transfer system suggested that the lack of in vivo T cell priming in CD154-deficient mice was due to the limited expansion of antigen specific T cells. When cytochrome-c (cyt-c)-specific TCR-transgenic T cells that lacked CD154 were transferred to wild-type non-TCR transgenic recipients, no loss of transferred cells was apparent. Even when recipients were challenged with cyt-c, little expansion in T cell frequency was seen, and only a few TCR transgenic T cells entered the cell cycle. The studies suggest that

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CD40-CD154 interactions play a rate-limiting role in antigen-specific CD4 T cell priming and clonal expansion in vivo. A requirement for CD40 signaling in T cell priming to alloantigens was recently demonstrated by Noelle and co-workers (35), who showed a lack of graftvs-host disease (GVHD) when T cells were transferred from CD154-deficient mice to F1 recipients. However, when wild-type T cells were transferred to F1 hosts, severe GVHD was evident, accompanied by profound reduction in splenic cellularity and resulting in death of over 95% of mice within 21 days. These studies suggest that CD40-CD154 interactions are also important in the priming of alloreactive T cells. Similarly, a lack of immune response to autologous tumors in CD154-deficient mice was also demonstrated, thus strongly reinforcing the central role of CD40-CD154 in T cell priming (discussed in 35). In addition, CD4 T cell priming following adenovirus infection was also tested in CD154-deficient mice (15). In contrast to control wild-type mice, T cells harvested from virally infected CD154-deficient mice exhibited reduced IL-4, IL-10, and IFNγ , again suggesting defects in CD4 T cell priming in these mice. Since costimulatory signals are important for activation of T cells, lack of priming and expansion of CD4 T cells to protein antigens and to alloantigens in the absence of CD154 may be explained by inability of the T cells to activate APC. As discussed above, professional APC such as dendritic cells that upregulate costimulatory activity and enhance cytokine production upon CD40 ligation (30, 31) are generally considered to be the key APC for initiation of in vivo antigen-specific T cell responses. Lack of activation of this type of APC may therefore explain defects seen in CD4 T cell priming in the above systems. Although a role of CD40-CD154 in CD4 T cell priming is strongly suggested, whether this interaction is important in the priming of CD8 T cells is not yet clear. However, a limited number of studies have addressed this question by studying the priming of CD8 T cells in viral infection models in CD154-deficient mice (36–39). Results suggest strong activation of primary CD8 cytotoxic T cells (CTLs) following infection of CD154-deficient mice with lymphocytic choriomeningitis virus (LCMV), Pichinde virus (PV), or vesicular stomatitis virus (VSV), suggesting that priming of CD8 T cells is independent of CD40CD154. Interestingly, however, antiviral CD8 CTL memory responses were defective in CD154-deficient mice (36), suggesting a requirement of CD154mediated signal in the establishment or maintenance of CTL memory. Since CD154 is important in CD4 T cell priming as discussed above, a defect in the memory responses in CD154-deficient mice could be due to inefficient CD4 T cell help. Alternatively, since CD8 T cells also express CD154 after activation (40–42), interaction of CTLs with CD40 expressing APC or other cells may be important for generation of CTL memory. However, the precise role of CD154 in CTL memory still remains to be established.

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CD40-CD154 AND CD4 T CELL DIFFERENTIATION AND IMMUNE DEVIATION Strongly polarized CD4 T cell responses can occur in vivo or in vitro, and this polarity is explained by the cytokines that are secreted by the respective T cells (43). Th1 cells produce IFNγ and TNFβ, and activate macrophages and potentiate the inflammatory response, whereas Th2 cells produce IL-4, IL-5, IL-6, IL-10, and IL-13, and they promote antibody production. Factors that influence the differentiation of Th cells into distinct Th1 or Th2 subsets have been reviewed recently (43), and the critical role of cytokines, antigen/MHC affinity, and type of APC have all been implicated in this process. In addition, selective expression of costimulatory molecules on APC and soluble cofactor production such as IL-6 and IL-12 were also suggested to contribute toward the development of Th subsets (45). Because the CD40-CD154 interaction regulates the activation of APC both to upregulate costimulatory activity and to produce cytokines, these interactions are likely important in the polarization of Th cells into subsets. Studies presented in previous sections indicate that CD40-CD154 interactions regulate the production of IL-12 by dendritic cells and macrophages; IL-12 is required for the development of Th1 type response. The role of CD40CD154 in the development of Th2 type response has not yet been studied in detail. However, anti-CD154 antibodies are beneficial in cardiac allotransplantion (44), prolongation of graft survival was accompanied by immune deviation toward Th2 cytokines IL-4 and IL-10. This deviation was also accompanied by specific downregulation of CD80 without any effect on CD86 expression. Similarly, St¨uber et al (46) reported that anti-CD154 antibodies can prevent the Th1 cell type–mediated autoimmune disease, inflammatory colitis, by blocking IL-12 secretion and by slightly upregulating IL-4, although the levels of IL-4 seen were extremely low. A definitive role of CD40-CD154 interaction in immune deviation is yet to be established. However, a recent interesting report (47) proposed a role for CD154 in delivering direct signals to T cells in immune deviation. This study demonstrated that, in an APC-independent system, during costimulation of human T cells by anti-CD3 and anti-CD28, incremental stimulation with anti-CD154 was required for production of Th2 type cytokines IL-4 and IL-10, but not for IFN-γ (47). Recent studies from Gray’s group (48) also suggest that T cells can be activated by triggering CD154 on T cells. This raises the interesting possibility that direct costimulation of T cells through CD154 can cause IL-4 synthesis and mediate Th2 responses as well as directly potentiate T-B collaboration and B cell growth and differentiation. However, this stimulus is unlikely to be absolutely required for Th2 cytokine synthesis. Moreover, the relative role of CD40-CD154-mediated direct signals

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for T cell activation versus effects mediated through the induction of cytokines in antigen-specific systems has not been addressed. In addition, because lack of CD40-CD154 interaction may also lead to failure of production of IL-12 from dendritic cells and macrophages, it is likely that development of Th2 cells in absence of CD154-mediated signals may actually be enhanced; however, experimental data is not yet available to definitely implicate the CD40-CD154 system in immune deviation.

CD40-CD154 AND MONOCYTE/MACROPHAGE EFFECTOR FUNCTIONS Macrophages are central players in many T cell–mediated inflammatory processes: They act to promote the inflammatory response and function as effector cells that mediate tissue damage; they further function as APC to process and present antigens to T cells, as target cells for intracellular parasite replication, and as effector cells to eliminate intracellular parasites. Recently, a requirement for cell-to-cell contact between T cells and macrophages for the activation of macrophages has been reviewed (11a). Since pre-activation of T cells is required for the activation of macrophages, it was suggested that activationinduced T cell surface molecules may be involved in this event. Monocyte and macrophage activation occurs as a result of T cell generated signals (11a, 49), and recently, these signals were determined to include ligation of CD40 on the surface of monocytes. Ligation of CD40 on monocytes is important in stimulating production of IL-1α, IL-1β, TNFα, IL-6, and IL-8, as well as in the rescue of circulating monocytes from apoptotic death (11a, 50–53). Thus, it is likely that CD40-CD154 interactions play a role in monocyte-mediated inflammatory processes by upregulating cytokine production by monocytes and promoting their rescue from death at sites of inflammation. Signals derived from activated CD4 T cells are important for the activation of macrophages to produce IFNγ and nitrite (54, 55); consequently, a role for CD40-CD154 interactions was postulated in the activation of macrophages. Indeed, cell-to-cell contact via CD40-CD154 interactions is required for production of NO and IL-12 by macrophages (11a, 48, 54, 56, 57). Furthermore, studies with T cells from CD154-deficient mice also indicate the requirement of CD40-CD154 interaction in activation of macrophages to produce TNFα and nitric oxide (49). Since IL-12 is required for induction and maintenance of Th1 type cellular immune responses as well as NK cell activation, it is likely that events mediated by CD40-CD154 during macrophage activation could be important in Th1-mediated inflammatory immune response to intracellular parasites. On the other hand, production of active nitrogen mediators by macrophages may be important in delivering effector mechanisms against intracellular parasites.

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ACTIVATION OF NK CELLS VIA CD154 SIGNALS In addition to their more well-known functions in killing a variety of tumors, virus-infected cells, and allogeneic targets (58–61), NK cells induce B cell maturation, immunoglobulin secretion, and isotype switching (62, 63)—the pathways normally regulated by CD40-CD154 interactions (6, 7). Recently, a role for CD40-CD154 in NK cell interactions with other cells was investigated (64). NK cell clones express CD154, and these NK cells were able to kill targets expressing CD40. Because lysis of targets was inhibited by anti-CD40 antibodies, it was suggested that the CD40-CD154 mediated pathway might be functionally involved in the induction of cytotoxicity activity in NK cells. While freshly isolated human NK cells were unable to lyse targets, when activated with rIL-2 they also killed CD40 transfected targets. Furthermore, pre-treatment of resistant targets that expressed FcR with anti-CD154 antibody also resulted in killing of these targets by NK cell clones, suggesting activation of NK cells via CD154 cross-linking. Finally, the effects of negative signals, such as expression of MHC class I on targets, were also investigated in this system. When targets expressing both CD40 and MHC class I were used, a complete inhibition of target lysis was noticed, indicating regulation of CD154-mediated killing by MHC class I. Whether activation of NK cells via CD154 has in vivo significance is not clear at present, but one possibility is that NK cells expressing CD154 may have immunoregulatory functions (64). Since expression of MHC class I on targets can downregulate CD40 triggered killing of NK cells, encounters of NK effector cells with APC might conceivably play a role in regulation of the immune response. Further, regulation of CD40 triggered cytotoxicity by MHC class I may prevent the inappropriate lysis of APC. On the other hand, under certain circumstances, aberrantly activated APC expressing CD40 but lacking MHC class I (for example as a consequence of infection) can be eliminated by NK cells. Thus, regulation of induction of cytotoxicity activity on NK cells may regulate the immune response.

CD40-CD154 AND EXTRAVASATION OF LEUKOCYTES CD40 is expressed on endothelial cells from many vascular locations including spleen, skin, thyroid gland, thymus, and lungs (65), and it can be further upregulated by cytokines (66–69). Thus, CD40-CD154 interactions have been implicated as playing a significant role in the activation of vascular endothelium. Indeed, triggering of CD40 with CD154 was shown to induce CD62E, CD106, and CD54 on human endothelial cells (66, 67). During an inflammatory response, extravasation of leukocytes, which is mediated by CD62E, CD54, CD106 (69–71), and by chemokines such as IL-8, MCP-1, and MIP-1α,

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takes place at sites of inflammation and in secondary lymphoid organs (11a). Since CD40-CD154 interactions mediate upregulation of adhesion molecules and chemokines in endothelial cells, it is possible that CD40-CD154 interactions play an important role in the promotion of extravasation and accumulation of activated T cells at the sites of inflammation. In addition, activated T cells could also activate vascular endothelia at sites of inflammation, which could be important in T cell–mediated inflammatory reactions. These functions can also be performed by inflammatory cytokines such as TNF, IFNγ , etc. The relative importance of the CD154 contact mediated mechanisms and cytokine mechanisms is not yet clear.

CD40-CD154 AND ATHEROSCLEROSIS Increasing evidence has suggested the involvement of activated T cells and macrophages in inflammatory atherosclerotic plaques, and many recent reports have highlighted a role for autoimmunity in atherogenesis (72–77). A significant number of actively proliferating CD4 and CD8 T cells are present in atherosclerotic plaques (72, 73). Interestingly, the majority of CD4 T cells are of the memory phenotype, indicating involvement of antigen specific T cells in atherosclerosis plaques (reviewed in 73). In addition, a reduced incidence of atherosclerosis in IFNγ knockout mice and complete lack of disease in MHC class I knockout mice when crossed with an atherosclerosis-prone strain (Apolipoprotein-E knockout mice) again suggests an immunological component in atherosclerosis (78, 79). Endothelial cells (EC), smooth muscle cells (SMC), and macrophages participate in atherogenesis (72). Human EC are known to express CD40, and ligation of this molecule leads to upregulation of adhesion molecules (see above) (65–68). Since increased levels of adhesion molecules are detected on EC and SMC in atherosclerotic lesions, a role for CD40-CD154 in this disease was recently investigated (77). The results of these studies indicate that cells other than leukocytes expressed functional CD154 during atherogenesis. Furthermore, coexpression of CD154 and CD40 on vascular endothelium and SMC was revealed in atherosclerotic lesions. Thus, expression of CD40 on SMC and CD154 on EC, SMC, and macrophages may be involved in a novel signaling pathway causing cellular activation during atherogenesis (77). Thus, CD154 expressed in both the vascular wall and T cells resident within lesions could ligate CD40 on EC, SMC, or macrophages, which may result in the expression of cytokines, matrix-metalloproteinases, or adhesion molecules, all proteins normally present in human atheroma (72, 77, 80). Hence the CD40 signaling pathway may play two distinct roles during atherogenesis. The first may occur in the regulation of antigen-specific T cell responses. The second may be related to the presence of functional CD154 on non–T cells associated with atherosclerotic lesions, which suggests a novel

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T cell–independent mechanism to induce the inflammatory response, an increasingly recognized component of atherogenesis.

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ROLE OF CD40-CD154 IN AUTOIMMUNITY The role of contact-dependent signaling in the development of autoimmunity has been addressed using anti-CD154 antibodies in many recent reports. A role of CD40-CD154 interactions in many organ-specific T cell–mediated autoimmune diseases such as collagen-induced arthritis, experimental allergic encephalomyelitis (EAE), lupus nephritis, colitis, and oophoritis has been demonstrated in mouse models (46, 81–84). Treatment of mice with anti-CD154 antibodies blocks development of disease in all the above-mentioned animal models; the treatment was accompanied by a reduction or elimination of damage to target tissue or infiltration of leukocytes to target tissues. Although the prevention of development of autoimmunity can be explained by the blockade of priming of self-antigen-specific T cells by anti-CD154, downstream effects of CD154 on effector functions that mediate tissue damage may also be blocked by these antibodies. It is clear that CD154 controls both the initiation of CD4 T cell responses as well as the delivery of effector functions, such as the activation of macrophages. Alternatively, anti-CD154 antibodies may block humoral responses that are believed to play a significant part in some autoimmune disease such as arthritis and oophoritis. A role for CD40-CD154 interactions in the development of EAE was also studied in CD154-deficient mice expressing a myelin basic protein specific (MBP)-TCR transgene, in which over 95% of T cells are specific for a Nterminal peptide fragment of MBP. Even these CD154-deficient transgenic mice do not develop EAE upon challenge with antigen, unlike wild-type MBP-TCR transgenic mice (14), again confirming the important role of CD40-CD154 interactions in the development of autoimmunity. Further studies with these mice indicated that CD4 T cells from autoantigen immunized TCR transgenic mice lacking CD154 were mostly unactivated, produced no effector cytokines, and did not infiltrate or cause damage to the CNS. These studies suggested that lack of development of EAE in CD154-deficient mice was due to a block in the activation rather than the migration of activated T cells to the CNS. EAE could be developed and T cell responses could be restored by adoptive transfer of CD80 expressing APC prior to immunization. These results show that the CD40-CD154 interaction is required for the initiation of a CD4 T cell–mediated autoimmune response at least in part by the upregulation of costimulatory molecules on APC, and a likely candidate APC during a normal immune response may be a dendritic cell in the initiation of this autoimmune response (12, 16). Furthermore, a recent report by Yang & Wilson (15) showed the in vivo requirement for CD40-CD154 interactions

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for activation of APC to upregulate costimulatory molecules for the priming of T cells. This mechanism is consistent with the demonstration that blockade of expression of CD80 prevents clinical relapse and chronicity of EAE (85–87). Although the above-mentioned studies with CD154-deficient mice indicate a requirement of CD40-CD154 interactions for upregulation of costimulatory activities for the induction of the anti-MBP-response in EAE, studies with anti-CD154 antibodies show that these interactions may also be required for the perpetuation of chronic EAE (83); administration of anti-CD154 antibodies during the course of EAE eliminates disease (83). The first possibility to explain this observation is that anti-CD154 antibody may have blocked the migration of autoreactive T cells to CNS. CD40-CD154 interactions are important in inflammatory responses—in regulation of adhesion molecules on epithelial cells, induction of inflammatory cytokines, chemokines, and IL-12 (11a, 14, 65, 66). Alternatively, treatment of mice with anti-CD154 antibody during the course of EAE could possibly block the priming of new T cells that are required for chronic EAE as the immune response spreads to new epitopes following initial damage of CNS tissue (88, 89). Finally, CD40-CD154 interactions may be important in the effector phase of the response; for example, activation of monocyte/macrophage or microglial cells by T cells could cause damage in the CNS, because, as discussed in previous sections, CD40-CD154 interactions are required for activation of cells of these lineages (90). CD40 is expressed in the brains of multiple sclerosis patients and in mice undergoing chronic EAE, again suggesting a possible role for CD40-CD154 interactions at the effector level (83). Taken together, it is probable that CD154 may regulate both the initiation and effector phases of T cell responses as well as transmigration of activated T cells to target tissues.

ROLE OF CD40-CD154 INTERACTIONS IN TRANSPLANTATION Because CD40-CD154 interactions are important in responses to alloantigens (7, 35), their role in transplantation has also been investigated. Parker et al (91) studied the role of CD40-mediated signals in islet transplantation. Mice that were made diabetic by chemical destruction of their own islets were given alloislet transplants. Results from these studies indicate that administration of anti-CD154 antibodies could prevent alloislet graft rejection in 40–50% of the mice. Although islet graft rejection was not completely prevented, these studies highlight the important role of CD40-CD154 interactions in transplantation. For complete prevention of nonvascularized organ allografts such as islets, a more rigorous regimen is required that includes sensitization with appropriate alloantigens along with anti-CD154 antibodies (35, 91). Recently, a role of

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CD40-CD154 interactions in vascularized organ allograft rejection was also demonstrated by Larsen et al (92), who found that both CD40 and CD154 transcripts were induced in acute cardiac rejection. However, when recipients were given anti-CD154 antibody before transplantation, prolonged survival of cardiac allografts occurred. Allografts from mice treated with anti-CD154 antibody also showed decreased expression of transcripts for the macrophage product, inducible nitric oxide synthetase. In addition, antibody responses were also inhibited, but transcripts for T cell–associated cytokines such as IL-2, IL-4, IL-10, and IFNγ were not significantly inhibited. These data suggest that in cardiac allograft rejection, CD40-CD154 interactions mediate effector functions of T cells such as macrophage activation that require cell-to-cell contacts. However, when anti-CD154 antibodies were administered to recipients in combination with CTLA-4-Ig at the time of transplantation, cardiac allografts survived in all recipients for prolonged periods of time. This treatment was accompanied by an inhibition of T cell–associated cytokine transcripts for IL-2, IL-4, IL-10, and IFNγ (93). Because the CD40-CD154 pathway modulates costimulatory activity in vitro and in vivo (14, 25–27) and costimulatory molecules are important in graft rejection (94–98), it is likely that CD40-CD154 interactions also mediate their effects at least in part by regulating in vivo costimulatory activity. In this respect, Hancock et al (44) have addressed the role of the CD40-CD154 interaction in regulation of costimulatory activities in acute allograft rejection. First, they showed that a single injection of anti-CD154 antibodies along with donor-specific transfusion leads to prolonged survival of cardiac allograft in all recipient mice. In contrast to the results obtained by Larsen et al (92), this study showed a marked inhibition of IL-2, IL-12, TNFα, and IFNγ , but an increase in IL-4- and IL-10–expressing cells in sections from grafted tissues. In addition, treatment of recipients at the time of transplantation with anti-CD154 antibody completely abolished the expression of CD80, although the expression of CD86 was not significantly changed. The data presented above suggest that anti-CD154 antibodies prevent graft rejection by inhibiting the induction of CD80 on APC. Taken together, from the above studies and those of Larsen et al (44, 92, 93), it can be concluded that CD40-CD154 interactions affect both the activation of alloreactive T cells by inhibiting expression of costimulatory molecules on APC and at the effector phase by inhibiting the activation of macrophages and other effector cells.

CD40-CD154 IN THE CONTROL OF INFECTION CD40-CD154 interactions are required for a broad spectrum of anti-infective host immune responses induced following infection with bacteria, parasites, or viruses (reviewed in 99). The following section highlights the recent

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developments in our understanding of in vivo functions of CD40-CD154 interactions in cell-mediated immune responses that are important in anti-infective host defense.

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Extracellular Pathogens Since CD4-CD154 interactions are critical for the development of humoral responses, infection with extracellular bacterial pathogens, which is resolved mainly by humoral immune mechanisms (100), may be more severe in the absence of CD40-CD154 interactions. The role of CD40-CD154 interactions was investigated by infecting CD154-deficient mice with Borrelia burgdorferi, the causative agent of Lyme disease. Susceptible C3H mice develop carditis and acute arthritis following infection with Borrelia, which ultimately resolves through an antibody-mediated mechanism (101). Infection of both control and CD154-deficient mice with B. burgdorferi resulted in clearance of pathogens and regression of arthritis, in a similar fashion (102). However, as expected, CD154-deficient mice were defective in humoral responses, but antibodies against B. burgdorferi were generated (including switched isotypes such as IgG2b) that were sufficient to resolve B. burgdorferi infections, even upon adoptive transfer to naive animals. CD40-independent class switching to IgG2b can therefore occur. A likely role of CD40-CD154 is still expected in anti-bacterial immune response when TD antibodies are important, as evident by increased susceptibility of HIGM1 patients to certain bacterial infections, but CD40-CD154 is non-essential when T cell–independent responses are sufficient as for Borrelia. A role for CD40-CD154 interactions in the resolution of infection by multicellular extracellular pathogens that require both humoral and cell-mediated immune responses was investigated recently. The involvement of CD40-mediated signals in type 2 mucosal immune responses was examined by administering anti-CD154 antibodies to mice infected with Heligmosomoides polygyrus. Infection of mice with this parasite results in the development of a type 2 enteric immune response, characterized by elevation of IgG1 and IgE levels, blood eosinophils, intestinal mucosal mast cells, and cytokines such as IL-3, IL-4, IL-5, and IL-9. The data showed that administration of anti-CD154 antibody to mice inhibited H. polygyrus-induced elevation of IgG1 as well as elevation in blood eosinophils and mucosal mast cells (103). CD40-CD154 interactions may regulate proliferation and/or activation of effector cells such as mast cells and eosinophils. Interestingly, mast cells express CD154 and provide help for antibody production (104, 105), further emphasizing that CD154 regulates interaction between multiple cell types. Taken together, CD40-CD154 interactions play a significant role in host responses to extracellular pathogens when both cellular and TD humoral responses are involved but play a rather minimal

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role where CD4 T cell–independent humoral responses are sufficient to contain infections. A critical role for CD40-CD154 in extracellular protozoan infection is emphasized by the observation that HIGM1 patients are susceptible to Pneumocystis carinii infections (106). P. carinii is an opportunistic pathogen of the lungs, and both humoral and cell-mediated immune responses are required for the resolution of this infection. Recent studies have documented the use of anti-CD154 antibodies to determine the role of CD40-CD154 interactions in Pneumocystis infections, in a mouse model. SCID mice reconstituted with splenic cells from wild-type mice before infection with P. carinii completely recovered from Pneumocystis infection, and treatment of these mice with anti-CD154 antibodies completely blocked the recovery. Furthermore, SCID mice reconstituted only with purified CD4 T cells recovered from Pneumocystis infection, and this recovery was blocked by treatment of these mice with anti-CD154, suggesting CD40-CD154 interactions between non-B cells and T cells are important in containing this infection. Since CD40-mediated signals are required for the activation of macrophages to produce TNFα and monocytes to produce IL-1 (11a), and these cytokines are required for resolution of Pneumocystis infections (106), T cell–mediated activation of macrophages may be required for resolution of Pneumocystis infections (105).

Intravesicular Pathogens Pathogens such as Leishmania invade macrophages in vertebrates, and in humans they cause leishmaniasis, a significant cause of morbidity in several geographical areas (107). In murine models of leishmaniasis, resolution and progression of this disease is modulated by preferential activation of Th1 or Th2 CD4 T cell subsets, respectively. As discussed in previous sections, disruption of the CD40-CD154 interaction prevents the development of these effector T cell responses because CD40 signals are important in dendritic cells and macrophage activation and IL-12 production—functions required for the Th1 response. Studies in CD40- and CD154-deficient mice (108–110) demonstrate a critical role for CD40-CD154 interactions in the protective immune response to Leishmania major because control mice remained resistant to L. major promastigote challenge, whereas both CD40- and CD154-deficient mice were unable to control growth of the parasite and developed ulcerating lesions at the site of inoculation. When T cells from infected CD40- or CD154-deficient mice were examined, a lack of IFNγ production was apparent, suggesting that priming of Th1 type cells was impaired in these mice. In addition, when splenic cells from CD154-deficient mice were challenged with Leishmania antigens, IL-12 production by these cells was greatly reduced compared to control mice. A possibility that IL-12 may be critical for protective immunity against L. major

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infection was demonstrated by partial rescue of protective phenotype in CD154deficient mice by administration of IL-12 (108). This result implies that T cells in CD40- and CD154-deficient mice were defective in inducing IL-12 production by macrophages. Indeed, IL-12 production by macrophages is dependent on CD40 stimulation (111, J Suttles, R Stout, unpublished). In parallel to these studies, infection of CD154-deficient mice with another species, Leishmania amazonensis (109), was also investigated. Wild-type control mice are susceptible to infection with this strain, which results in the development of progressive ulcerative lesions that fail to resolve. In contrast to wild-type controls, CD154-deficient mice infected with L. amazonensis showed a much higher incidence of progressive ulcerative lesions and tissue parasite burden, accompanied by the complete absence of IFNγ and LT-TNFα production by T cells. Furthermore, activation of macrophages to produce the inflammatory mediator NO did not take place in CD154-deficient mice. As discussed in previous sections, CD40-mediated signals are required for the production of NO by macrophages (49, 54); taken together these results indicate that CD40-CD154 interactions are required for priming of T cells, the differentiation of Th1 effector cells via IL-12, and thus the production of cytokines required for macrophage activation. Finally this system is required for stimulation of macrophages through CD154 to activate the effector mechanisms that kill intracellular pathogens such as NO.

CD40-CD154 AND INTRACYTOPLASMIC PATHOGENS Role of CD40-CD154 in Host Defense Against Virus Infections CD40-CD154 interactions are important in both humoral and CD4 T cell– mediated immune responses. Thus it is anticipated that CD40-CD154 interactions are important in viral infections where the CD4 T cell response or humoral immune response are required, but probably not for virus infections where CD8 CTL responses are sufficient to control a given pathogen. The role of CD40CD154 interactions in anti-viral immune responses was determined by studying infections of CD154-deficient mice with LCMV, PV, and LSV (36, 37, 39). When CD154-deficient mice were infected with these viruses, they mounted strong primary CTL responses and cleared virus with a time course similar to that for control mice (36, 37, 39); these data indicate that antiviral CTL are sufficient to control infection by these viruses. Such results are broadly consistent with the fact that mice infected with LCMV develop antiviral CD4 T cell, CTL, and antibody response, but only antiviral CTL responses are sufficient for virus clearance (reviewed in 112). However, CD154-deficient mice were

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defective in memory CTL response against these viruses, compared to control animals (36), suggesting that CD40-CD154 interactions may be important in CTL memory responses. In addition when CD154-deficient mice were examined for LCMV-specific humoral immune responses, severely impaired primary responses were seen; however, low levels of anti-LCMV antibodies (IgG2a, 2b, and 3, but not IgG1) were generated (36, 37). As expected, CD154-deficient mice exhibited severely impaired TD immune responses, as indicated by lack of germinal centers, short-lived serum titers of virus-specific antibody, and lack of B cell memory (36, 37, 39). Similarly, a gross defect in TD humoral responses of CD154-deficient mice to PV and LSV was also apparent (36, 39). Finally, a role for CD40-CD154 interactions in viral infections was studied by infecting CD154-deficient mice with an adenoviral vector containing a lac Z reporter gene (15, 38). This infection is controlled by both CTL and humoral immune responses that are dependent on CD4 T cell help (113). In contrast to the LCMV infection, CD154-deficient mice infected with this viral vector resulted in impairment in both anti-viral CTL and TD responses. Thus, CD154deficient mice were unable to mediate virus clearance and were susceptible to superinfection with a second recombinant adenovirus (15, 38), suggesting that CD40-CD154 interactions are of critical importance in this system as well. Finally, limited data also suggest that CD154 may have direct antiviral activity (114). This was demonstrated by rapid clearance of recombinant vaccinia viruses expressing CD154 from a variety of immune-deficient mice such as athymic mice, sublethally irradiated SCID mice, IFN-γ receptor knockout mice, and TNFα-receptor knockout mice. The mechanism of CD154-mediated direct antiviral activity remains unclear; however, the above-mentioned studies suggest that this antiviral activity is independent of other antiviral host defenses.

CD40-CD154 in Listeria monocytogenes The role of CD40-CD154 interactions in the defense against intracellular bacterial infection was determined by infecting CD154-deficient mice with Listeria monocytogenes, a Gram-positive intracellular bacterium that infects the cytosol of macrophages and hepatocytes. Mice develop protective immunity predominantly mediated by CTLs following infection with a sublethal dose of virulent L. monocytogenes (115). Infection of CD154-deficient mice with L. monocytogenes resulted in the development of early protective innate inflammatory responses, independent of T cells, similar to those of control mice (99). In addition, when mice were immunized with a sublethal dose of L. monocytogenes and rechallenged, CD154-deficient mice were equally effective at clearing the infectious challenge. Thus, CTL cell-mediated protective immunity appears to develop normally in mice lacking CD154, suggesting no role for CD40-CD154 interactions in this system. These results are broadly

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consistent with the effective primary antiviral response of these mice discussed above.

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CD40-CD154 REGULATE THE IMMUNE RESPONSE AT MULTIPLE LEVELS Cell-to-cell interactions involving a variety of cell types clearly are required for an effective immune response, and the experiments reviewed here suggest that CD40-CD154 interactions are critical for the development of the CD4 T cell–dependent cell-mediated immune response at multiple levels (see Table 3). How does that happen? A likely scenario using three check points is the following: At the first check point, lack of the CD40-CD154 interaction results in greatly reduced activation of CD4 T cells—inefficient priming and expansion of antigen specific T cells. This step could be mediated by a lack of induction of costimulatory activity on APC, a failure in the activation of APC Table 3 Regulation of cellular functions by CD40-CD154 interactions Interaction

Pathway

Putative major responses

T cell-B cell

B cell proliferation and differentiation Immunoglobulin production/class switching Antigen presentation

Humoral responses Immune deviation

T cell-monocyte/ macrophage

Antigen presentation Activation of monocyte/macrophage to produce effector molecules

T cell priming Macrophage effector functions Parasite removal Rescue of monocytes from apoptosis

T cell-DC

Induction of cytokines Induction of costimulation Antigen presentation

T cell priming Immune deviation

T cell-endothelial cell

Induction of adhesion molecules Induction of cytokines

Extravasation of leukocytes

T cell-SMC

Proliferation of SMC? Induction of adhesion molecules Induction of cytokines

Atherogenesis

Mast cell-B cell

Antibody production IL-4 production

Antibody production Immune regulation

NK cell-Target

Activation of NK cell Cytolysis

Immune regulation Tumor killing Elimination of virally infected cells

T cell-Fibroblast

Proliferation

Inflammation

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to produce cytokines such as IL-12, or both. In addition, polarization of the immune response toward Th2 could also result from a lack of CD40-CD154 interaction that normally yields IL-12. Thus, in this step, absence of CD40CD154 interactions will lead to impairment of many T cell effector functions, such as help for B cells, activation of dendritic cells, activation of monocytes and macrophages to produce cytokines and to kill intracellular pathogens, and activation of autoreactive T cells to mount an autoimmune response. At the second check point, the migration to secondary lymphoid organs as well as to target organs of the residual activated T cells could be blocked by regulation of adhesion molecules by CD40-CD154 interactions on endothelia. At the final check point, CD40-CD154 interactions may be important for the effector stage (for example, activation of inflammatory cells to secrete cytokines); at the site of inflammation, they could be important to upregulate costimulation to amplify the response; and finally they could be important for the secretion of inflammatory mediators. Taken together, the evidence reviewed supports all of the above possibilities and can provide satisfactory explanations as to why interruption of CD40-CD154 interactions by antibodies or by CD154 mutations in mice and humans lead to impaired antigen-specific CD4 T cell priming, failure to mount autoimmune responses, and an ability to contain infection and prevent graft rejection.

CD40-CD154 AS A THERAPEUTIC TARGET Because CD40-CD154 interactions regulate diverse pathways of the immune system, therapeutic strategies designed to modulate this interaction may provide useful additional means to treat autoimmune and cardiovascular diseases, and to prevent graft rejection. These strategies may include the use of antiCD40 or anti-CD154 antibodies, development of small molecule antagonists, and chimeric soluble proteins that can bind CD40 or CD154. Alternatively, strategies could be targeted at the level of intracellular pathways of CD40mediated signaling that include inactivation of recently identified proteins (discussed in 6 and 11b) associated with the CD40 cytoplasmic intracellular tail such as CRAF-1, CAP-1, TRAF1, and TRAF2. Although some of these approaches have been successful in experimental models, potential side effects must be weighed before they are applied to humans. Because CD40 expression is widespread and found notably on APC, targeting of the CD40-CD154 interaction may lead to reduced TD immune responses. If a major contribution of direct signaling through CD154 in the modulation of Th1/Th2 responses is confirmed, then ligands could be developed to polarize the immune response to Th2, which may be beneficial in both autoimmune diseases and in graft rejections. Other approaches might include development of compounds to trigger CD40 on APC in order to upregulate costimulatory

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activity and cytokine secretion, which may be important to fight tumor growth and contain infections.

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CONCLUSIONS It is now evident that CD40-CD154 interactions regulate the activation as well as the differentiation of a number of different cell types into effector cells, but many questions remain unanswered. An as-yet-unexplored area is the role of CD40-CD154 interactions in chronic inflammatory cardiovascular disease. The preliminary evidence on the presence of CD40 and CD154 expressing cells present in atherosclerotic plaques is exciting, while the exact nature of the role of these molecules remains to be explored. Although some evidence supports a role of CD40-CD154 interaction in the polarization of response to Th1 cells, the extent to which this interaction plays a role in the development of Th2 effectors also remains to be further explored. Some interesting data suggest that CD154 may act as a receptor, but how these signals for T cell activation are transmitted is still unclear. CD40-CD154 interactions regulate the activation of endothelia in some cases, but the precise role of these interactions in the inflammatory process is not yet clear. Finally, a remaining puzzle of great interest is the poor CD8 memory T cell response seen in the absence of CD40CD154 interaction. Since CD40-CD154 interactions regulate multiple phases of the immune response, it is likely to remain the subject of intense investigation, particularly in the development of beneficial therapeutic approaches. ACKNOWLEDGMENTS ISG was an associate and RAF is an investigator of the Howard Hughes Medical Institute. ISG is the recipient of a fellowship from the Juvenile Diabetes International Foundation. We thank numerous colleagues for providing reprints and preprints of their work prior to publication. Visit the Annual Reviews home page at http://www.AnnualReviews.org.

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GS, Abe R, June CH, Perrin PJ. 1995. Distinct roles for B7–1 (CD-80) and B7–2 (CD-86) in the initiation of experimental allergic encephalomyelitis. J. Clin. Invest. 96:2195–203 Lehmann PV, Forsthuber T, Miller A, Sercarz EE. 1992. Spreading of T-cell autoimmunity to cryptic determinants of an autoantigen. Nature 358:155–57 McRae BL, Vanderlugt CL, Dal Canto MC, Miller SD. 1995. Functional evidence for epitope spreading in the relapsing pathology of experimental autoimmune encephalomyelitis. J. Exp. Med. 182:75–85 Stout RD, Suttles J. 1997. T cell signaling of macrophage function in inflammatory disease. Frontiers Biosci. 2:197–206 Parker DC, Greiner DL, Phillips NE, Appel MC, Steele AW, Durie FH, Noelle RJ, Mordes JP, Rossini AA. 1995. Survival of mouse pancreatic islet allografts in recipients treated with allogeneic small lymphocytes and antibody to CD40 ligand. Proc. Natl. Acad. Sci. USA 92:9560–64 Larsen CP, Alexander DZ, Hollenbaugh D, Elwood E, Ritchie SC, Aruffo A, Hendrix R, Pearson TC. 1996. CD40-gp39 interactions play a critical role during allograft rejection. Suppression of allograft rejection by blockade of the CD40-gp39 pathway. Transplantation 61:4–9 Larsen CP, Elwood ET, Alexander DZ, Ritchie SC, Hendrix R, Tucker-Burden C, Cho HR, Aruffo A, Hollenbaugh D, Linsley PS, Winn KJ, Pearson TC. 1996. Long-term acceptance of skin and cardiac allografts after blocking CD40 and CD28 pathways. Nature 381:434–38 Lenschow DJ, Zeng Y, Thistlethwaite JR, Montag A, Brady W, Gibson MG, Linsley PS, Bluestone JA. 1992. Long-term survival of xenogeneic pancreatic islet grafts induced by CTLA4lg. Science 257:789– 92 Turka LA, Linsley PS, Lin H, Brady W, Leiden JM, Wei RQ, Gibson ML, Zheng XG, Myrdal S, Gordon D, Bailey T, Bolling SF, Thompson CB. 1992. T-cell activation by the CD28 ligand B7 is required for cardiac allograft rejection in vivo. Proc. Natl. Acad. Sci. USA 89:11,102–5 Lin H, Bolling SF, Linsley PS, Wei RQ, Gordon D, Thompson CB, Turka LA. 1993. Long-term acceptance of major histocompatibility complex mismatched cardiac allografts induced by CTLA4Ig plus donor-specific transfusion. J. Exp. Med. 178:1801–6 Pearson TC, Alexander DZ, Winn KJ,

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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REGULATION OF IMMUNE RESPONSES BY TGF-β ∗ John J. Letterio and Anita B. Roberts Laboratory of Chemoprevention, National Cancer Institute, Bethesda, Maryland 20892-5055; e-mail: [email protected] KEY WORDS:

T cells, B cells, macrophage, dendritic cell, autoimmune disease

ABSTRACT The transforming growth factor β (TGF-β) family of proteins are a set of pleiotropic secreted signaling molecules with unique and potent immunoregulatory properties. TGF-β1 is produced by every leukocyte lineage, including lymphocytes, macrophages, and dendritic cells, and its expression serves in both autocrine and paracrine modes to control the differentiation, proliferation, and state of activation of these immune cells. TGF-β can modulate expression of adhesion molecules, provide a chemotactic gradient for leukocytes and other cells participating in an inflammatory response, and inhibit them once they have become activated. Increased production and activation of latent TGF-β have been linked to immune defects associated with malignancy and autoimmune disorders, to susceptibility to opportunistic infection, and to the fibrotic complications associated with chronic inflammatory conditions. In addition to these roles in disease pathogenesis, TGF-β is now established as a principal mediator of oral tolerance and can be recognized as the sine qua non of a unique subset of effector cells that are induced in this process. The accumulated knowledge gained through extensive in vitro functional analyses and from in vivo animal models, including newly established TGF-β gene knockout and transgenic mice, supports the concept that clinical therapies based on modulation of this cytokine represent an important new approach to the treatment of disorders of immune function.

INTRODUCTION Several established cytokine families are recognized for their roles in regulating the immune response (1). These include the tumor necrosis factor (TNF)-related ∗ The US government has the right to retain a nonexclusive, royalty-free license in and to any copyright covering this paper.

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molecules, the interferons, the chemokines, the interleukins, and the other hematopoietins known to orchestrate the development and function of a variety of immunocompetent cells. Though rarely included under this umbrella of immunoregulatory molecules, the members of the family of transforming growth factors–β (TGF-β) must also be viewed as having a unique and essential role in regulating immune function (2–5). Best known for their roles in development, in epithelial cell growth and differentiation, and in the process of carcinogenesis (6), they are possibly the most pleiotropic, multifunctional secreted peptides known in that they are produced by and act on a wide variety of cell types to regulate endpoints ranging from control of cell growth and differentiation to regulation of cellular function and target gene activity (6). The three isoforms of TGF-β, i.e., TGF-β 1, 2, and 3, signal through the same serine-threonine kinase type I and type II cell surface receptors and have similar if not identical cellular targets, although each isoform is expressed in a distinct pattern under control of a unique promoter (6, 7). These molecules are now recognized to have profound effects on immune cells, including all classes of lymphocytes, macrophages, and dendritic cells. The action of TGF-β on these cells is dependent not only on the cell type and its state of differentiation, but also on the total milieu of cytokines present (8), suggesting that perturbations of the balance of this cytokine array may also alter effects of TGF-β and contribute to immunopathology. The complex and often context-dependent manner in which TGF-β controls immune responses is gaining greater appreciation, largely through recognition of its roles in experimental models of disease and by evaluation of transgenic and knockout mice with altered expression of these ligands or their receptors (9). In this review we focus on the ability of TGF-β to regulate the function and interaction of cells of the immune system in the development of both humoral and cell-mediated immunity and in immune aspects of disease pathogenesis.

TGF-β REGULATES T CELL DEVELOPMENT AND EFFECTOR FUNCTION T lymphocytes are clearly influenced by TGF-β at all stages of development, from their differentiation to their activation and proliferation, and can serve as a paradigm for the pleiotropic nature of this cytokine. As in many systems, the effects of TGF-β on T cells are, in part, a function of their state of differentiation, and such effects often are altered by the nature of the activating signals (10, 11). The earliest studies of the effects of TGF-β on human lymphocyte function revealed that activated T cells themselves synthesize and secrete TGF-β and that exogenous TGF-β typically inhibits IL-2-dependent proliferation (12). Several studies have highlighted these inhibitory effects of

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TGF-β, particularly its ability to interfere with events that occur subsequent to IL-2 production and receptor binding (13) such as the production of various cytokines (14–16) and cytolytic functions (17, 18). In contrast to the many inhibitory effects of TGF-β on T lymphocytes delineated by these early studies, a growing body of literature demonstrates that TGF-β can also enhance the growth of T cells, predominantly of the naive phenotype (19), induce T cell expression of specific cytokines and enhance their capacity to respond to subsequent stimulation, and even promote effector expansion through inhibition of T cell apoptosis (20–22). Though these differential activities appear to be contradictory, they exemplify the common association between cellular differentiation or activation status and effect of TGF-β that exists in most responsive cell types. We expand this discussion below in an overview of the roles of TGF-β in thymocyte development and TH1-TH2 differentiation.

Autocrine and Paracrine Effects of TGF-β During Normal Thymopoiesis Early thymocytes progress through a series of differentiation steps largely defined by their expression of specific receptor molecules (23, 24). These cells undergo extensive proliferation promoted by a number of cytokines, including IL-2, IL-4, and IL-7, and their development from the T cell receptor negative (TCR−), CD4−CD8− (triple negative, TN) thymic precursor into either the CD4+ or the CD8+ single positive (SP) populations is controlled by a variety of cellular interactions. Through in vitro studies of thymopoiesis, roles for both autocrine and paracrine TGF-β have now been defined. TGF-β was first reported to induce CD8 expression in studies designed to determine the influence of various cytokines on the differentiation of murine thymic TN cells to either the CD4+ or the CD8+ SP populations. IL-7 can maintain the viability of IL-2 receptor negative (CD25−) early TN thymocytes, including their capacity to differentiate fully in vitro in a lymphoid-depleted fetal thymus organ culture system (25). TGF-β synergizes with TNF-α to promote or favor the development of thymic precursor cells expressing CD8 (26). Furthermore, these thymic precursors treated with TGF-β and TNF-α retained the capacity to differentiate fully when transferred to fetal thymus organ culture, suggesting that this TGF-β-induced expression of CD8 on CD25+ TN thymocytes represents a normal differentiation step (25). The ability of TGF-β to regulate the expression of CD8 is not restricted to thymic precursors. Inge and colleagues found that TGF-β alone could enhance de novo CD8 expression not only on CD4−CD8− thymocytes, but also on the IL-2-dependent CTLL-2 cytotoxic T cell line (27). The induction of CD8 in CTLL-2 cells was dependent on the continuous presence of TGF-β, was not a consequence of growth arrest, and was in contrast to the ability of TGF-β to

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inhibit IL-2-dependent increases in IL-2Rα, IL-2Rβ, and Granzyme B mRNA levels in these cells. TGF-β IN THE CONTEXT OF CELLULAR INTERACTIONS IN THE THYMUS More recent studies examine the role of specific cellular interactions in these events and point toward both autocrine and paracrine TGF-β activity in normal thymopoiesis. One such study focused on the inhibitory effects of TGF-β on the in vitro proliferation of freshly isolated human triple negative thymocytes in response to IL-2, IL-4, and IL-7 (28). The dramatic inhibitory effect of TGF-β on these proliferative responses was mimicked by the coculture of these thymocytes with autologous irradiated CD8+ T cells, but not their cell free supernatants. Cell fixation studies determined that the thymocytes themselves produce a latent TGF-β1 that could only be activated through the interaction of TN cells with the CD8+ cells, thus identifying TGF-β1 as an autocrine inhibitory factor for early human thymocytes. Studies of murine thymocyte development in fetal organ culture further substantiate the role of TGF-β in early thymopoiesis (29) and also implicate potential paracrine mechanisms involved in this process. The progression of CD4−CD8− thymocytes to CD4−CD8lo, and to the subsequent CD4+CD8+ stages show that differentiation into the double positive state requires progression through at least one cell division, an event that is effectively inhibited by thymic epithelial cells expressing TGF-β (30). The effect is specific for this stage of development in that the generation of CD4−CD8lo cells is unaffected. Thus, it is likely that both paracrine and autocrine mechanisms participate in a complex regulatory loop to control thymopoiesis. This may include the regulation of stromal cell production of stimulatory cytokines, such as IL-7, by TGF-β produced by thymocytes (31, 32). As noted above, TGF-β produced either by thymic precursors or thymic epithelial cells can affect the development of thymocytes, particularly their response to stimulatory cytokines such as IL-7.

A Role for TGF-β in the Development of Specific TH Responses Our understanding of the process of differentiation from a naive, peripheral CD4+ T cell into distinct TH subsets with unique cytokine profiles and functions continues to increase. There are multiple pathways for the initiation of this differentiation into any of these functionally polarized TH subsets, and certain cytokines are clearly established as inducers of either the TH1 (IFN-γ and IL-12), or the TH2 (IL-4) response (reviewed in 33) (see Figure 1). More recent studies have focused on determining not only the cellular origin of these cytokines, but also the mechanisms controlling their production (34, 35). Even though expression of these cytokines remains the hallmark of their respective TH1 or

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Figure 1 The characteristic production of active TGF-β by a specific subset of TH cells is now recognized as an important factor in the establishment of oral tolerance. While this subset produces cytokines characteristic of the TH2 class of effector cells, the secretion of TGF-β is critical to their ability to suppress an inflammatory response. Although the exact requirements for the establishment of these TGF-β-secreting cells remained to be defined, the progress is clearly antagonized by factors that promote differentiation toward a TH1 response.

TH2 subset, the recent identification of differential expression of the β2 chain of the IL-12 receptor on these two cell populations shows this subunit to be a distinct marker of TH1 cells, in both mice (36) and humans (37). While different experimental systems have produced conflicting data regarding the influence of TGF-β on TH differentiation, clearly TGF-β can inhibit the production of and response to cytokines associated with each subset, and the production of TGF-β by antigen-specific T cells may mark a unique subset already referred to as TH3 (38–40). Initial studies of the exposure of naive CD4+ cells to TGF-β during their priming phase suggested that this factor would push differentiation toward a TH1 phenotype, with the primary result being an increase in INF-γ -producing cells and a decrease in IL-4-producing cells (41). This effect has also been observed in a murine IL-2-secreting CD4+

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T cell clone (42), and in cultures of directly alloresponsive human CD4+ T cells when TGF-β is included in a mixed lymphocyte culture (MLC) performed with purified responder T cells (43). However, the significance of these observations has been questioned, particularly since systemic administration of TGF-β in mice infected with L. amazonis or L. brasiliensis leads to increased production of the TH2 cytokine, IL-4, and decreased production of the TH1-associated IFN-γ , and ultimately results in a greater severity of disease (44). Further studies appear to have more clearly aligned TGF-β exposure with TH2 differentiation by virtue of its reciprocal relationship with both IFN-γ and IL-12 (45). For example, exposure of naive murine CD4+ T cells to IL-12 during activation with anti-CD3 monoclonal antibody (mAb), in the absence of accessory cells, not only leads to autocrine production of IFN-γ , but synergizes with IFN-γ to induce TH1 differentiation (46). However, simultaneous exposure to TGF-β strongly inhibits this induction of IFN-γ in response to IL-12 and suppresses IL-12-induced TH1 development, an effect that is enhanced by the addition of anti-IFN-γ neutralizing antibodies (46). This functional interaction between TGF-β and IL-12 has also been observed in human primary allogeneic proliferative and cytotoxic T cell responses (47), in which the effects of TGFβ are mediated through mechanisms associated with the abrogation of IL12 production. This response cannot be reversed even with the addition of exogenous IL-12 or IFN-γ . This antagonistic relationship between IL-12, IFN-γ , and TGF-β may also be a factor in the induction of peripheral tolerance following the oral administration of antigen (48). In several animal models of autoimmunity, and in their respective disease counterparts in humans, the ability to ameliorate disease severity through this mechanism is linked to the establishment of a TH2-like subset that is further distinguished by its ability to secrete bioactive TGF-β (38). This process has been modeled in ovalbumin (OVA)–T cell receptor (TCR) transgenic mice, in which the oral administration of high doses of OVA leads to local T cell expression of IFN-γ in Peyer’s patches, followed by systemic unresponsiveness due primarily to clonal anergy rather than the suppressor cytokine production typically seen with low dose oral antigen (49). This predominance of TH1 cytokines, including IL-12, effectively inhibits the establishment of TGFβ-secreting suppressor T cells. More importantly, the concomitant systemic administration of anti-IL-12 blocking antibodies not only significantly enhances TGF-β production in this model, but this induction is completely independent from any effect on IL-4 production, further distinguishing these suppressor cells as a potentially distinct TH subset (see Figure 1). This conclusion is also supported by models of inflammatory bowel disease in which TGF-β-producing CD45RBlo T cells protect against colitis induced in SCID mice following their reconstitution with CD45RBhi T cells, even when the CD45RBlo cells are from an IL-4−/− donor (50).

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TGF-β INFLUENCES DENDRITIC CELL DEVELOPMENT AND FUNCTION Dendritic cells (DC) are a distinct population of leukocytes that function as the primary antigen-presenting cells in the activation of T lymphocyte responses (51). Several highly specialized populations of dendritic cells, including the Langerhans cells (LC) of the epidermis and the follicular dendritic cell (FDC) of lymph nodes, have been identified, and TGF-β may both regulate their development and mediate their effects.

A Role for TGF-β1 in the Generation of Dendritic Cells The recent discovery of a requirement for TGF-β1 during the in vitro differentiation of functional dendritic cells identified a new role for TGF-β in regulating these specialized antigen presenting cells (52). Though in vitro differentiation of DC from cultures of CD34+ precursor cells is dependent on the presence of specific cytokines, such as TNF-α, SCF, and GM-CSF, it is greatly enhanced by the addition of exogenous TGF-β1, which can effectively substitute for the serum or plasma requirement in this system. Further studies determined that TGF-β protects DC viability, as demonstrated by a reduction of more than 60% in the number of apoptotic cells at 72 h in culture (53). The importance of TGF-β1 in DC development is also emphasized by recent studies in the TGF-β1 knockout mouse, where the complete absence of the epidermal LC is a striking feature of the phenotype (54), which also includes the generalized activation of most immune cell populations and widespread tissue inflammation (55, 56). The loss of epidermal LC is a consistent defect in TGF-β1 null mice whether they are bred onto a variety of immunodeficient backgrounds (SCID, athymic nude, RAG2-null) or maintained on the immunosuppressive agent rapamycin, so it appears unlikely that inflammatory cytokines are effecting migration of LC from the TGF-β1-null epidermis (54). This absence of epidermal LC may reflect an absence of precursor populations or perhaps some defect in their homing to the epidermis. However, transplantation of TGF-β1-null marrow into wild-type, lethally irradiated recipients leads to repopulation of recipient skin with donor-derived LC, implying that normal LC progenitors exist in the TGF-β1 null mouse bone marrow, and that paracrine sources of TGF-β1 are sufficient to support normal LC development and perhaps even their migration into the epidermis (57).

TGF-β and Follicular Dendritic Cells TGF-β may also have an important role in another highly specialized class of antigen-presenting cell, the follicular dendritic cell (FDC). Localization of TGF-β within the FDC of lymphoid follicles (58), combined with its ability to inhibit antigen-induced rescue of germinal center (GC) B cells, suggests

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there is specific function for TGF-β in FDC. While these FDC, which have the capacity to take up antigen and display it on their surface for more than a year, express receptors for several cytokines, TGF-β is the only one they are known to produce (58). The surface of the FDC is the site of primary selection events in B cells that have undergone activation, clonal expansion, and somatic hypermutation of Ig v− region genes (centrocytes). Antigen trapped on the surface of FDC provides an effective survival signal for centrocytes with highaffinity surface membrane immunoglobulin (smIg), and TGF-β is the only factor known to interrupt this signal (59). This effect is specific, in that the survival signals initiated through CD40 are not inhibited by TGF-β; this may represent a regulatory mechanism to prevent the selection of centrocytes with low-affinity receptors bearing autoreactive mutations (60). Finally, the fact that TGF-β1 null mice also lack gp40+ lymph node DC, despite normal numbers of CD11c+ DC, suggests that the loss of TGF-β1 may affect other specialized DC populations participating in extrafollicular immune responses (54).

TGF-β PRODUCTION AND RESPONSIVENESS IN B CELLS A Link Between Activation and TGF-β Expression in B Cells As in most immune cell populations, the synthesis, secretion, and response to TGF-β in B cells are often a consequence of their state of differentiation and the activation signals involved. For example, the activation of human tonsillar B cells with the polyclonal mitogen Staphylococcus aureus Cowan (SAC) only slightly upregulates TGF-β1 mRNA expression, but results in a sevenfold induction of TGF-β1 protein secretion, over 90% of which remains in the latent or inactive form (61). These effects contrast with those of another polyclonal B cell activator, lipopolysaccharide (LPS), which stimulates mouse splenic B cells to produce bioactive TGF-β (62). This autocrine TGF-β is required for the secretion of IgG by B cells in response to LPS in vitro. Activation through antigen receptor by binding a monoclonal anti-IgM antibody to cell surface IgM induces expression of TGF-β1 mRNA in normal human peripheral blood B cells and stimulates murine B-lymphoma cell lines to secrete large amounts of active TGF-β1 (63, 64). Given that TGF-β typically inhibits B cell proliferation and may induce apoptosis in both B cells (59, 65) and in the fully differentiated plasma cells (S Amoroso, N Huong, A Roberts, M Potter, J Letterio, manuscript in preparation), this induction of TGF-β likely serves as an important regulatory feedback loop to limit expansion of an activated population. This autocrine inhibitory loop remains intact in some B lymphoid malignancies and has been

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implicated in their reduced proliferative responses and slow rate of progression (66, 67). However, it is interesting that several murine and human B lymphoid malignancies have been identified that have become insensitive to the growth inhibitory effects of TGF-β and that express substantial amounts of an active form of the molecule (68–70). This association is common in epithelial malignancies and may be important in tumor progression and in suppression of immune surveillance (71).

B Cell Differentiation and Immunoglobulin Production Are Regulated by TGF-β TGF-β controls several aspects of the normal maturation and differentiated functions of B cells, in addition to its effects on B cell proliferation. This includes the regulation of expression of cell surface molecules, including the inhibition of IgM, IgD, IgA, κ and λ chains, CD23 (FcRII) and the transferrin receptor, and the induction of MHC class II expression on both pre-B and mature B cells (reviewed in 72). The ability of TGF-β to direct switch recombination in immunoglobulin isotypes IgA and IgG2b in mouse and IgA in human appears to be due to the induction of transcription from the unrearranged Iα-Cα and Iγ 2b-Cγ 2b gene segments, but the specific events that lead to this switching and whether TGF-β is even essential are not yet known (72). Indeed, although the loss of endogenous TGF-β1 gene expression in the TGF-β1-null mouse results in the production of autoantibodies (predominantly IgG), it does not lead to a diffuse polyclonal hypergammaglobulinemia nor to a predominance of an Ig clonotype (73). While TGF-β is noted for this ability to inhibit immunoglobulin synthesis and the secretion Igs of all classes, here too there can be a dichotomy in the response to TGF-β. Most studies demonstrating this inhibitory effect have investigated the effects of addition of exogenous TGF-β to cultures of activated B cells. In a revealing study by Snapper et al (62), the addition of an anti-TGF-β blocking antibody to LPS-activated cultures led to a significant decrease in the secretion of IgG1, IgG2a, IgG3, and IgE, without an effect on IgM, suggesting that low levels of autocrine TGF-β may actually serve to enhance production and secretion of immunoglobulins under certain conditions.

CONTROL OF MONOCYTE/MACROPHAGE FUNCTION BY TGF-β Cells of the mononuclear phagocyte system function both as accessory antigenpresenting cells in the induction of immune responses and as effector cells in mediation of certain responses. Monocytes/macrophages secrete TGF-β, which can also regulate a broad spectrum of their activities from chemotaxis, to host

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defense, to activation and deactivation as mediated by expression of cytokines and their receptors and small effector molecules such as reactive oxygen species and nitric oxide (for a review, see 74). As such, these cells mediate many of the effects of TGF-β on inflammation (reviewed in 4, 75) and, indirectly, on pathological fibrosis associated with chronic inflammation (reviewed in 76).

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Expression and Activation of TGF-β by Monocytes/Macrophages As is the case for all cell lineages derived from the bone marrow, both circulating monocytes and tissue macrophages secrete TGF-β, predominantly as the type 1 isoform (77, 78). In macrophages, as in lymphocytes, the primary level of control is not in the regulation of expression of TGF-β mRNAs, but in the regulation of both the secretion and activation of latent forms of TGF-β. Thus, treatment of peripheral blood monocytes with bacterial lipopolysaccharide (LPS) or of alveolar macrophages with concanavalin A results in significant increases in secreted active TGF-β1 without changes in the level of TGF-β1 mRNA (77, 78). Activation of the latent forms of TGF-β, which are blocked from receptor binding, is an important posttranscriptional control point in both physiological and pathological actions of TGF-β (79, 80). Specific mechanisms of activation of TGF-β by LPS-treated thioglycollate-elicited peritoneal macrophages include complex cooperativity between the serine proteases plasmin and urokinase (uPA), the uPA receptor, tissue type II transglutaminase, and the mannose6-phosphate receptor (81). Expression of active TGF-β1 by macrophages and other leukocytes plays a central role not only in inflammation, but also in accompanying fibrosis by paracrine stimulation of resident mesenchymal cells to produce excessive extracellular matrix. Thus, in bleomycin-induced pulmonary fibrosis in mice, nearly all of the active TGF-β implicated in pathologic matrix deposition is secreted by alveolar macrophages and is temporally concordant with the deposition of collagen in the lung (82). In these cells, activation of latent TGF-β is dependent both on plasmin and on binding of the latent complex to the cell membrane via thrombospondin-1 (TSP-1) and its receptor, CD36, expressed on the surface of monocytes and macrophages (82–84) (Figure 2). These findings suggest that the mannose-6-phosphate receptor and transglutaminase might also serve to anchor latent TGF-β to the cell surface to optimize proteolysis and activation by plasmin. Studies with human THP-1 macrophage-like cells show that TGF-β itself may contribute to its activation by macrophages. Adherent THP-1 cells respond to TGF-β by upregulation of uPA and its receptors, essential components in the regulation of macrophage plasminogen activation, resulting in a threefold increase in membrane-bound plasmin activity (85). Parasitic infection of macrophages

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Figure 2 Activation of latent TGF-β by macrophages is key to both its physiological and pathological actions on immune cells. Following processing of pre-pro TGF-β to its latent complex, the secreted latent TGF-β is anchored to the macrophage membrane via TSP-1 bound to its receptor, CD36, and activated by cell membrane bound plasmin (84). Macrophages can also activate IgG-TGF-β complexes secreted by plasma cells by binding these complexes to cell membrane Fc receptors (119, 121). Alternatively, certain IgG-TGF-β complexes may be intrinsically active (120). Active TGF-β then signals through its cell surface receptor in an autocrine or paracrine mode.

also results in activation of secreted TGF-β, as discussed in greater detail below, although the particular mechanisms involved have not yet been identified.

Activation of Macrophage Function by TGF-β Similar to the pleiotropic effects of TGF-β on lymphocyte subsets, effects of TGF-β on proliferation of macrophages can be either stimulatory or inhibitory, depending on the other cytokines present and the state of differentiation or tissue origin of the cells (86–88). Femtomolar concentrations of TGF-β induce a chemotactic response in human peripheral blood monocytes, a response that likely plays a critical role in the recruitment of mononuclear cells into sites of injury or inflammation (89–91). Picomolar concentrations of TGF-β activate resting human blood monocytes to express increased levels of mRNAs encoding

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a variety of cytokines including IL-1α and β, TNF-α, PDGF-BB, and bFGF, which indirectly affect various immune processes as well as non-immune targets as in angiogenesis (89–91). Other proinflammatory effects of TGF-β on leukocytes include its ability to increase expression of several integrin receptors on monocytes including LFA-1, which binds ICAM-1 expressed on the surface of endothelial cells; VLA-3 (α 3β 1), which binds collagen, fibronectin, and laminin; and VLA-5 (α 5β 1), which binds fibronectin, thereby increasing both cell-cell and cell-matrix interactions (92, 93). This enhanced expression of adhesion receptors as well as of type IV collagenase by activated monocytes likely enhances their penetration of the basement membrane of vascular endothelium and their subsequent transmigration into tissues (93). As in other responses, IFNγ can antagonize certain of these effects of TGF-β on cellular adhesion, suggesting that the cytokine balance may regulate leukocyte motility within sites of inflammation (94). The phagocytic activity of monocytes/macrophages is also activated by TGF-β. One such mechanism involves its ability to stimulate circulating monocytes to upregulate expression of cell surface Fcγ RIII, which recognizes bound IgG and is thought to play a key role in immunophagocytosis (95). A second mechanism involves a TGF-β–dependent increase in macrophage recognition of phosphatidyl serine, which, though normally localized to the inner membrane, is expressed on the outer membrane leaflet of apoptotic cells (96). Thus TGF-β contributes both to the formation of inflammatory foci by direct effects on chemotaxis and adhesion and to the resolution of acute inflammatory reactions and restoration of homeostasis by increasing the phagocytic activity of macrophages toward inflammatory cells and damaged parenchymal cells.

Deactivation of Monocytes/Macrophages by TGF-β In contrast to the activating effects of TGF-β on peripheral blood monocytes, its actions on tissue macrophages are generally suppressive and contribute to the resolution of an inflammatory response. This has been attributed, in part, to a dramatic difference in the expression pattern of receptors for TGF-β on these two populations of the mononuclear phagocyte system. Resting monocytes express high levels of TGF-β type I and II receptors, whereas receptor levels decline as cells mature and then become activated by agents such as LPS or IFNγ (4). Examples of suppressive effects of TGF-β on activated macrophages are its ability to modulate the profile of activating cyokines as by limiting production of IFNγ (15) or increasing expression of the IL-1 receptor antagonist (97) similar to effects of IL-4, IL-10, and macrophage deactivating factor (MDF) (74). This also parallels the role of TGF-β in resolution of inflammation in models of inflammatory bowel disease, where there is suggested to be a deficiency in elaboration of suppressive cytokines such as IL-1 receptor antagonist, IL-4,

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IL-10, and TGF-β to counterbalance the pro-inflammatory cytokines such as IFNγ and TNFα, which are produced in response to the constant luminal exposure to antigens (45, 98). SUPPRESSION OF NITRIC OXIDE AND REACTIVE OXYGEN INTERMEDIATES Possibly the most important deactivating effect of TGF-β on macrophages is its ability to limit the production of cytotoxic reactive oxygen and nitrogen intermediates by cells activated by either IFNγ or LPS (for reviews, see 74, 99). The enzyme responsible for production of nitric oxide by activated macrophages is an inducible form of nitric oxide synthase (iNOS). Regulation of this enzyme by cytokines including TGF-β is now known to underlie control of the antimicrobial and tumoricidal pathways of macrophages and of immune responses in general (74). TGF-β regulates iNOS at both transcriptional and posttranscriptional levels, resulting in downregulation of iNOS mRNA levels and suppression of both the expression and activity of iNOS protein. The latter effects are still observed even when TGF-β is added to cultures after expression of iNOS is maximal (99). TGF-β also suppresses expression of reactive oxygen intermediates and respiratory burst capacity by both resting blood monocytes (100) and activated macrophages (101), but the mechanisms involved are still unknown. SUPPRESSION OF MACROPHAGE FUNCTION IN PARASITIC INFECTION TGF-β is now recognized as an important immunoregulator and parasite escape mechanism in all forms of human and murine leishmaniasis, a parasitic disease with both tegumentary and visceral effects, depending on the strain. Protozoan parasites such as Trypanosoma cruzi, which infect all nucleated cells (102), and Leishmania, for which macrophages serve as the exclusive cellular host (44, 103), have evolved mechanisms to induce the infected host cell to secrete active TGF-β, which then suppresses the killing activity of macrophages and enhances intracellular proliferation of the pathogen. Fascinating studies with T. cruzi suggest that autocrine signaling of TGF-β is required for parasite entry into cells: Epithelial cells lacking TGF-β receptors are resistant to trypanozome infection and infectivity is restored following transfection of functional TGF-β receptors (104). In vitro experiments demonstrate that the amount of active TGF-β produced by macrophages upon infection with various strains of Leishmania promastigotes correlates roughly with both the strain virulence and the proliferation of parasites within the macrophage (105). Moreover, studies in mice demonstrate a role for endogenous TGF-β in susceptibility to infection in that systemic administration of TGF-β increases the infectivity of relatively avirulent strains of Leishmania and reverts the genetic resistance of certain strains of mice to infection, whereas systemic administration of antibodies to

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TGF-β arrests development of lesions in susceptible mice (44). Similar results are found with T. cruzi infection in mice (106). Both resistance to and recovery from leishmaniasis are related to cell-mediated immune responses. Two mechanisms are proposed to explain the diseaseenhancing effects of TGF-β in leishmaniasis, and each depends on the balance of the cytokine milieu. One involves the ability of TGF-β to decrease cellmediated immunity by suppressing effects of IFNγ or IL-4 on expression of MHC class II antigen on antigen presenting cells (107, 108). The second mechanism is related to the ability of TGF-β to modulate the activity and differentiation of CD4+ and CD8+ T cell subsets. Thus in patients with the destructive mucosal form of leishmaniasis, TGF-β inhibits cytotoxic CD8+ T cells, which are thought to play a role in elimination of infected cells (109). And in mice, a TH2-like response with accompanying increased production of IL-4 and IL-10 is found in regional lymph nodes of susceptible strains, whereas in resistant mice, a TH1-type response predominates with production of IL-2 and IFNγ , which promotes leishmanicidal activity by enhanced production of cytotoxic oxygen and nitrogen radicals (103). As discussed above, TGF-β appears to play a direct role in modulation of these TH cell subsets (see Figure 1). Infection of macrophages with the intracellular bacteria Mycobacterium avium also increases macrophage production of active TGF-β and suppresses their antibacterial activity, suggesting that a variety of infectious agents may have developed similar mechanisms for their survival and proliferation in a mammalian host (110).

ROLE OF TGF-β IN AUTOIMMUNE DISEASES In autoimmune disease, the normal ability to distinguish between self and nonself is disturbed. Many lines of evidence implicate TGF-β in the pathogenesis of autoimmune diseases. Studies of experimental allergic encephalomyelitis (EAE) and collagen-induced arthritis (CIA) in mice and rats demonstrated that systemic administration of TGF-β suppressed the symptoms of the disease, whereas antibodies to TGF-β enhanced the disease process, demonstrating that endogenous TGF-β has a suppressive effect on disease progression (111–114). TGF-β also mediates certain aspects of peripheral immune tolerance induced by oral administration of antigens. Both CD4+ and CD8+ suppressive T cell subsets that secrete active TGF-β1 have been identified following induction of oral tolerance (115), and the protective function of these cells both in vitro and in vivo can be blocked by antibodies to TGF-β (38, 114). Consistent with these observations, mice in which the TGF-β1 gene has been deleted by homologous recombination develop a phenotype characterized by numerous hallmarks of autoimmune disease (for a review, see 116). All of these data support a model

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in which TGF-β actively participates in the development of self-recognition and plays an essential role in the maintenance of self-tolerance, as discussed in greater detail below.

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Mechanisms of Action of TGF-β in Autoimmune Disease STUDIES IN THE MRL/LPR MOUSE Several new insights into pathologic TGF-β activation and trafficking and its regulation of immune cell activity have come from the study of the MRL/lpr mouse, a murine model of systemic autoimmunity. These mice, which uniformly develop systemic autoimmune disease resembling human systemic lupus erythematosis (SLE), have a mutation in the gene encoding Fas that results in defective apoptosis, one of the key mechanisms responsible for deletion of self-reactive lymphocytes (117). Study of the MRL/lpr mice has demonstrated that these mice have elevated levels of circulating plasma TGF-β1 bound to IgG autoantibodies (118–120). Unrelated studies show that mice repeatedly immunized with an antigen carry TGF-β1 on a small fraction of the specific IgG induced, and that this complex suppresses CD8+ CTL responses in mixed lymphocyte cultures, but only in the presence of macrophages (121). The demonstration that this suppression could be blocked by an antibody to Fc receptors suggests a novel regulatory circuit in which antigen-specific IgGs are processed by macrophages to suppress CTL responses to unrelated antigens (see Figure 2). Given the highly pleiotropic nature of TGF-β, it has been proposed that its binding to IgG could restrict or direct its activity to antigenic sites where it plays important roles in the homeostasis of immunity and suppression of autoimmune disease (121). Elevated circulating levels of IgG-bound TGF-β1 are found not only in the MRL/lpr mice, but also in pristane-induced systemic autoimmunity in Balb/c mice and, importantly, in the plasma of some patients with SLE (118–120). Two consequences directly attributable to these increased levels of IgG-bound TGF-β1 in plasma are increased susceptibility to infection by gram-negative and gram-positive bacteria and defects in polymorphonuclear leukocyte (PMN) function as assayed by their inability to extravasate into the thioglycollateinflamed peritoneum and failure to amplify phagocytic function in response to stimulation by phorbol ester or the chemotactic peptide FMLP (118, 120, 122). Importantly, the IgG bound form of TGF-β1 is consistently 10–500-fold more active than uncomplexed recombinant TGF-β1 in mediation of effects on immune cells both in vitro and in vivo, suggesting that targeting of this TGF-β complex to the cell surface, possibly via Fc receptors, may increase its propensity to interact with signaling receptors on immune cells and possibly even modulate its receptor binding in such a way as to augment its effects (120, 121). Whereas total plasma levels of TGF-β1 in MRL/lpr mice are only about double that of congenic control mice, plasma levels of IgG-bound TGF-β1 are

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nearly 150-fold higher than the controls, with about 75% of the total plasma TGF-β1 in MRL/lpr mice bound to IgG (120). Both immunohistochemical data and in vitro assay of culture supernatants of cells purified from MRL/lpr mice identify B cells and plasma cells as the source of the circulating IgG-bound TGF-β1 (120). Notably, greater than 80% of the secreted TGF-β1 complexed to IgG is in the active form, suggesting that the pathogenicity of this complex may derive not only from the specific targeting imparted by the bound IgG, but also from loss of regulation of the activation of latent TGF-β. Many aspects of this important mechanism are still unknown (see Figure 2). For example, whether TGF-β can associate with any other immunoglobulin isotypes is not known, and whether mature or latent TGF-β1 associates with specific IgGs intracellularly prior to secretion (119, 120) or associates with IgG extracellularly (121, 123) is still controversial. Moreover, since TGF-β appears to associate only with IgG autoantibodies and antibodies raised in response to specific immunization (120, 121), it is important to identify the precise determinants of IgGs that mediate the interaction with TGF-β and whether the binding is isoform specific. Thus, the demonstration that glomerulopathic but not tubulopathic monoclonal κ light chains are associated with TGF-β-like effects on mesangial cells, implicating TGF-β in the pathogenesis of light chain deposition disease (124), does not exclude the interpretation that glomerulopathic light chains might actually bind TGF-β and that the variable region of the light chain might be the site of TGF-β binding to IgG. However, studies demonstrating the ability of TGF-β to mimic an IgG-binding factor, thought to be important in negative-feedback inhibition of IgG and IgM antibody production by B cells (123), show that TGF-β can bind insolubilized IgG but not F(ab0 )2 (123). Based on these observations, the possibility that TGF-β might bind to both the variable region and the Fc domain of IgG cannot be excluded. Interesting in this regard, activation of latent TGF-β by binding to TSP-1 involves the bimodal interaction of a WSXW motif with mature TGF-β followed by interaction of another sequence, RFK, with the amino terminus of the latency-associated protein (LAP) (125). Binding of this TSP-1/TGF-β1 complex to macrophages via the CD36 receptor represents another mechanism for targeting TGF-β complexes, though with an additional level of control by plasmin (84). In summary, active TGF-β1/IgG complexes secreted by B cells and plasma cells and interacting, in certain cases, with cellular Fcγ receptors may be found to modulate B cell responses, to mediate immunosuppressive effects on both T cells and neutrophils in a broad spectrum of diseases, and possibly to participate in physiological trafficking of TGF-β1 as proposed for the transfer of maternal TGF-β1 to fetuses and neonates (126). AUTOIMMUNE DISEASE IN THE TGF-β1 NULL MOUSE Mice null for the TGF-β1 gene clearly illustrate that this isoform is a critical regulator of immune cell

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differentiation and function, and further, that loss of this gene is sufficient for development of an autoimmune-like phenotype including enhanced expression of MHC class I and II antigens, circulating SLE-like IgG antibodies to nuclear antigens, pathogenic glomerular IgG deposits, and a progressive infiltration of lymphocytes into multiple organs similar to that seen in human autoimmune syndromes such as Sj¨ogren’s disease (73, 127, 128; for a review, see 116). The inflammatory infiltrates compromise organ function and contribute to the death of these mice at about 3 weeks. Although tissue infiltration can be blocked by systemic administration of fibronectin peptides, which block adhesion of TGFβ1-null leukocytes to endothelium, this treatment does not block the primary autoimmune response (129). In contrast, aberrant expression of the MHC class I and II antigens clearly represents an important mechanism in development of this autoimmune phenotype because backcrosses of the TGF-β1 null mice onto either an MHC class I- or class II–deficient background develop neither circulating autoantibodies nor immune complex deposits (130). TGF-β1 is known to suppress expression of MHC class II antigen (107, 131), consistent with its overexpression in TGF-β1 deficiency. Since MHC class II molecules play a role in the selection and activation of CD4+ T cells, which regulate both humoral and cell-mediated immune responses to antigens, the suppression of the autoimmune phenotype in TGF-β1(−/−)/MHC-II (−/−) mice also derives, in part, from the absence of this T cell subset in the MHC-II-null background (130).

Role of TGF-β in Immunologic Tolerance The term tolerance describes the process whereby the immune system distinguishes self from nonself to prevent pathologic reactivity against self-antigens. Development of autoimmunity is normally prevented by selection processes operative during lymphocyte maturation that result in apoptosis of self-reactive clones and by mechanisms that maintain or establish tolerance in peripheral tissues. Data suggest that TGF-β can contribute to both of these processes. In the thymus, negative selection ordinarily takes place at the CD4+CD8+ “double positive” stage of T cell development and involves recognition of MHC class II molecules (30). Since TGF-β regulates the maturation of these doubly positive cells from their CD4−CD8lo precursors, it is possible that, in the absence of TGF-β1, doubly positive thymocytes are generated too rapidly for their appropriate elimination (30). Dysregulated production of CD4+CD8+ T cells in these mice may be exacerbated by defects in apoptosis of T cell subsets, as suggested by preliminary data (JJ Letterio, unpublished). Mechanisms involved in the maintenance of peripheral tolerance include clonal anergy and a delicate balance of reactive and suppressor T cells and their respective cytokines (see Figure 1). Thus in the EAE model, oral tolerization with myelin basic protein induces peripheral tolerance by generating both a

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population of CD8+ T cells that secretes active TGF-β1 and a regulatory population of CD4+ TH2-like cells producing IL-4, IL-10, and secreting TGF-β1 in an antigen-specific manner (38, 114, 115). Since only a subset of the TH2 clones isolated produced TGF-β1, and since the cytokine profile of these cells is stable on prolonged culture, these cells may constitute a novel T cell subset (TH3) with mucosal T helper function and suppressive activity for TH3 cells (38). The suppression of disease is proposed to be mediated by inhibition of the autoimmune responses by TGF-β1 secreted by these mucosally derived cells at the target organ. Importantly, a similar distinct subset of TH3 cells has been identified in multiple sclerosis patients treated for 2 years with oral antigen (39). Some evidence suggests that the cytokine profile can drive the preponderance of specific TH cell subsets. As shown in Figure 1, antibodies to IL-12 or IFNγ enhance expression of TGF-β, presumably by a TH2-like or possibly TH3 T cell subset (45, 48). Disruption of this tightly controlled cytokine network, as by the loss of TGF-β1, can potentially upset the normal regulation of self-reactivity and contribute to the development of systemic autoimmunity by disturbing the delicate balance between TH1 and TH2 cells (116). Although the direct involvement of such a mechanism remains to be demonstrated for autoimmune disease in humans, in murine models of inflammatory bowel disease there is now substantial data to support antagonistic effects of pro-inflammatory (TH1) and anti-inflammatory (TH2) TH subsets characterized by secretion of IFNγ and IL-12 or IL-4 and TGF-β, respectively (45, 50).

CONCLUSION The multifunctional, context-dependent activities of TGF-β described in this article are by no measure unique to its actions in the immune system, but rather, they exemplify the basic tenet that has defined the function of this molecule, as stated succinctly by MB Sporn: “The function of TGF-β... is not to have an intrinsic action, but to serve as a mechanism for coupling a cell to its environment, so that the cell has the plasticity to respond appropriately to changes in its environment or changes in its own state” (132). Thus, the ability of TGF-β to enhance the induction of an immune response is often accompanied by the increased expression of TGF-β itself, which then often serves to dampen the response or inhibit the activated cell populations. It is significant that each member of the various hematopoietic lineages can be included in the long list of cells responsive to TGF-β. Though we chose to focus on the differentiation and function of just a few highly specialized leukocytes, the expression and function of TGF-β in NK cells, neutrophils and other myeloid lineages, and various hematopoietic progenitors must also be recognized. In each instance, TGF-β clearly provides regulatory signals that

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are shaped by ongoing cellular interactions, by the cytokine context, and by the relative state of differentiation of the responsive cell. As we continue to advance our understanding of the important and essential functions of this cytokine, it is critical that we begin to consider practical and clinically useful approaches to manipulate both the expression of and the response to this cytokine in those disorders where a role for TGF-β has been implicated. Visit the Annual Reviews home page at http://www.AnnualReviews.org.

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LETTERIO & ROBERTS table by interleukin-10 and transforming growth factor-beta. Eur. J. Immunol. 22: 2501–6 Barral-Netto M, Barral A. 1994. Transforming growth factor-beta in tegumentary leishmaniasis. Braz. J. Med. Biol. Res. 27:1–9 Ming M, Ewen ME, Pereira ME. 1995. Trypanosome invasion of mammalian cells requires activation of the TGF-β signaling pathway. Cell 82:287–96 Barral A, Barral-Netto M, Yong EC, Brownell CE, Twardzik DR, Reed SG. 1993. Transforming growth factor beta as a virulence mechanism for Leishmania braziliensis. Proc. Natl. Acad. Sci. USA 90:3442–46 Silva JS, Twardzik DR, Reed SG. 1991. Regulation of Trypanosoma cruzi infections in vitro and in vivo by transforming growth factor beta (TGF-β). J. Exp. Med. 174:539–45 Czarniecki CW, Chiu HH, Wong GH, McCabe SM, Palladino MA. 1988. Transforming growth factor-beta 1 modulates the expression of class II histocompatibility antigens on human cells. J. Immunol. 140:4217–23 Gollnick SO, Cheng HL, Grande CC, Thompson D, Tomasi TB. 1995. Effects of transforming growth factor-beta on bone marrow macrophage Ia expression induced by cytokines. J. Interferon Cytokine Res. 15:485–91 Barral A, Teixeira M, Reis P, Vinhas V, Costa J, Lessa H, Bittencourt AL, Reed S, Carvalho EM, Barral-Netto M. 1995. Transforming growth factor-beta in human cutaneous leishmaniasis. Am. J. Pathol. 147:947–54 Champsi J, Young LS, Bermudez LE. 1995. Production of TNF-alpha, IL-6 and TGF-β, and expression of receptors for TNF-alpha and IL-6, during murine Mycobacterium avium infection. Immunology 84:549–54 Kuruvilla AP, Shah R, Hochwald GM, Liggitt HD, Palladino MA, Thorbecke GJ. 1991. Protective effect of transforming growth factor beta 1 on experimental autoimmune diseases in mice. Proc. Natl. Acad. Sci. USA 88:2918–21 Thorbecke GJ, Shah R, Leu CH, Kuruvilla AP, Hardison AM, Palladino MA. 1992. Involvement of endogenous tumor necrosis factor alpha and transforming growth factor beta during induction of collagen type II arthritis in mice. Proc. Natl. Acad. Sci. USA 89:7375–79 Racke MK, Cannella B, Albert P, Sporn M, Raine CS, McFarlin DE. 1992. Evi-

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dence of endogenous regulatory function of transforming growth factor-beta 1 in experimental allergic encephalomyelitis. Int. Immunol. 4:615–20 Miller A, Lider O, Roberts AB, Sporn MB, Weiner HL. 1992. Suppressor T cells generated by oral tolerization to myelin basic protein suppress both in vitro and in vivo immune responses by the release of transforming growth factor beta after antigen-specific triggering. Proc. Natl. Acad. Sci. USA 89:421–25 Chen Y, Inobe J, Weiner HL. 1995. Induction of oral tolerance to myelin basic protein in CD8-depleted mice: both CD4+ and CD8+ cells mediate active suppression. J. Immunol. 155:910–16 Letterio JJ, Kulkarni AB. 1997. The transforming growth factor-β1 knockout mouse. In Cytokine Knockout Mice, ed. S Durum, K Muegge. Totow, NJ: Humana. In press Steinberg AD. 1994. MRL-lpr/lpr disease: theories meet Fas. Semin. Immunol. 6:55–69 Lowrance JH, O’Sullivan FX, Caver TE, Waegell W, Gresham HD. 1994. Spontaneous elaboration of transforming growth factor beta suppresses host defense against bacterial infection in autoimmune MRL/lpr mice. J. Exp. Med. 180:1693–1703 Rowley DA, Becken ET, Stach RM. 1995. Autoantibodies produced spontaneously by young 1pr mice carry transforming growth factor beta and suppress cytotoxic T lymphocyte responses. J. Exp. Med. 181:1875–80 Caver TE, O’Sullivan FX, Gold LI, Gresham HD. 1996. Intracellular demonstration of active TGF-β1 in B cells and plasma cells of autoimmune mice. IgGbound TGF-β1 suppresses neutrophil function and host defense against Staphylococcus aureus infection. J. Clin. Invest. 98:2496–506 Stach RM, Rowley DA. 1993. A first or dominant immunization. II. Induced immunoglobulin carries transforming growth factor beta and suppresses cytolytic T cell responses to unrelated alloantigens. J. Exp. Med. 178:841–52 Gresham HD, Ray CJ, O’Sullivan FX. 1991. Defective neutrophil function in the autoimmune mouse strain MRL/lpr. Potential role of transforming growth factorbeta. J. Immunol. 146:3911–21 Bouchard C, Galinha A, Tartour E, Fridman WH, Sautes C. 1995. A transforming growth factor beta-like immunosuppressive factor in immunoglobulin G-binding

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TGF-β AND IMMUNE CELLS factor. J. Exp. Med. 182:1717–26 124. Zhu L, Herrera GA, Murphy-Ullrich JE, Huang ZQ, Sanders PW. 1995. Pathogenesis of glomerulosclerosis in light chain deposition disease. Role for transforming growth factor-beta. Am. J. Pathol. 147:375–85 125. Schultz-Cherry S, Chen H, Mosher DF, Misenheimer TM, Krutzsch HC, Roberts DD, Murphy-Ullrich JE. 1995. Regulation of transforming growth factor-beta activation by discrete sequences of thrombospondin 1. J. Biol. Chem. 270:7304–10 126. Letterio JJ, Geiser AG, Kulkarni AB, Roche NS, Sporn MB, Roberts AB. 1994. Maternal rescue of transforming growth factor-beta 1 null mice. Science 264:1936–38 127. Geiser AG, Letterio JJ, Kulkarni AB, Karlsson S, Roberts AB, Sporn MB. 1993. Transforming growth factor beta 1 (TGF-β1) controls expression of major histocompatibility genes in the postnatal mouse: aberrant histocompatibility antigen expression in the pathogenesis of the TGF-β1 null mouse phenotype. Proc. Natl. Acad. Sci. USA 90:9944–48 128. Christ M, McCartney-Francis NL, Kulka-

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rni AB, Ward JM, Mizel DE, Mackall CL, Gress RE, Hines KL, Tian H, Karlsson S. 1994. Immune dysregulation in TGF-β 1deficient mice. J. Immunol. 153:1936–46 Hines KL, Kulkarni AB, McCarthy JB, Tian H, Ward JM, Christ M, McCartneyFrancis NL, Furcht LT, Karlsson S, Wahl SM. 1994. Synthetic fibronectin peptides interrupt inflammatory cell infiltration in transforming growth factor beta 1 knockout mice. Proc. Natl. Acad. Sci. USA 91:5187–91 Letterio JJ, Geiser AG, Kulkarni AB, Dang H, Kong L, Nakabayashi T, Mackall CL, Gress RE, Roberts AB. 1996. Autoimmunity associated with TGF-β1deficiency in mice is dependent on MHC class II antigen expression. J. Clin. Invest. 98:2109–19 Reimold AM, Kara CJ, Rooney JW, Glimcher LH. 1993. Transforming growth factor beta 1 repression of the HLA-DR alpha gene is mediated by conserved proximal promoter elements. J. Immunol. 151:4173–82 Sporn MB, Roberts AB. 1990. TGFβ: problems and prospects. Cell Regul. 1:875–82

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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TRANSCRIPTIONAL REGULATION DURING B CELL DEVELOPMENT Andrew Henderson# and Kathryn Calame∗ ∗ Department

of Microbiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, and # Department of Veterinary Science, Pennsylvania State University, University Park, Pennsylvania 16802; e-mail: [email protected] KEY WORDS:

transcription factor, B cell development, coactivator, primary B lymphopoiesis, antigen-dependent B lymphopoiesis

ABSTRACT Information is increasingly available concerning the molecular events that occur during primary and antigen-dependent stages of B cell development. In this review the roles of transcription factors and coactivators are discussed with respect to changes in expression patterns of various genes during B cell development. Transcriptional regulation is also discussed in the context of developmentally regulated immunoglobulin gene V(D)J recombination, somatic hypermutation, and isotype switch recombination.

INTRODUCTION Transcriptional regulation plays a critical role during development. With respect to B cells, transcription of genes encoding immunoglobulin (Ig) heavy and light chains, J chain, and class II major histocompatability (MHC) proteins has received sustained attention, leading to identification and characterization of numerous transcription factors and coactivators. Although the number and idiosyncratic nomenclature of these proteins are often confusing, unifying patterns are becoming apparent since most transcription factor families (although not all family members) are probably known, general mechanisms for activation and repression of transcription are increasingly understood, and combinatorial roles of different transcription factors in the context of natural genes are being elucidated. 163 0732-0582/98/0410-0163$08.00

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This review has two goals: The first is simply to summarize recent studies on important transcriptional regulators in B cells; the second and more important is to integrate our understanding of transcriptional regulation with a more general understanding of B cell development. Advances in understanding the functions and characteristics of B cells at specific stages, the mechanisms by which B cells communicate with T cells and dendritic cells, the mechanisms for signal transduction via soluble and cell surface molecules, and the mechanisms for immunoglobulin gene rearrangement need to be integrated into our continuing studies on transcriptional regulation. Since we discuss transcription in this broad developmental context, ample references to more detailed reviews are included to provide more information on particular events.

TRANSCRIPTION DURING PRIMARY B CELL DEVELOPMENT An attractive feature of studying B lymphopoiesis is the abundance of phenotypic and molecular markers that allow the specific stages of B cell development to be defined. These markers are regulated in an orderly fashion and have been especially useful for characterizing the cells and molecular mechanisms involved in antigen-independent B lymphopoiesis. Their tissue-restricted and temporally regulated expression, controlled in part by transcription, indicates these markers serve important functions in the differentiation of B cell progenitors.

Stages of Primary B Cell Development Stages of B cell development are defined by the expression pattern of several B-restricted markers, cell size, growth properties, and rearrangement status of immunoglobulin (Ig) genes. Figure 1A and the discussion below highlight general features of antigen-independent B cell development. More detailed discussions of the markers used to delineate human and mouse B lymphopoiesis have been reviewed (1–3). The first identifiable stage of B cell development is the pro-B cell. These cells express surface B220 (CD45), as do all cells committed to B lymphopoiesis. In addition, they also express CD43. The proB cell population is often fractionated by additional markers and Ig gene status (1, 3). As progenitors progress through the pro-B stage, they express terminal deoxytransferase (TdT), RAG-1, RAG-2, surrogate light-chain genes (λ5, and Vpre-B), CD19, Igα (mb-1), and Igβ (B29), and rearrange their Ig heavy chain (IgH) genes. The pre-B cell stage is marked by a decrease in the expression of CD43, lack of TdT expression, successful rearrangement of the IgH locus, and the appearance of the pre-B cell receptor complex (pBCR) (4). Early large cycling

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Figure 1 Antigen-independent stages of B cell development. The different stages of primary B cell development are shown with characteristic surface markers and expression patterns for genes. Large circles represent cycling cells, whereas small circles represent nondividing cells. Upward arrows represent induction of gene expression, and downward arrows represent repression of gene expression. Genes without an arrow are expressed, but their levels are not altered from the previous stage. Components of the pBCR include surrogate light chains (grey bars), µ (black bars) and Igα/β (squares). Components for BCR are the same except that light chain genes are associated with µ. Abbreviations: germ line (GL), surrogate light chain (SL), sterile µ transcript (µ◦ ). For additional markers and more detailed discussion, see cited reviews (1–3, 10, 11).

pre-B cells are marked by a decrease in RAG-1 and -2 expression (5, 6). As these pre-B cells continue to differentiate, the RAG genes are induced and Ig light chain rearrangements begin. The completion of antigen-independent B cell development is marked by successful rearrangement of the light chain genes and expression of surface IgM. The cells then exit the bone marrow and migrate to the periphery. B220 (CD45) is a phosphotyrosine phosphatase (PTPase), which appears to regulate B cell receptor signaling by dephosphorylating src family tyrosine kinases such as lyn as well as Igα and Igβ (7). It is assumed that CD45 integrates signals during development although it is not required for B lymphopoiesis, suggesting that other PTPases may be functionally redundant (8). CD19 is also thought to be important for B cell signaling and interacts with a number of tyrosine kinases (7). The role of this protein in B cell development is unclear because mice lacking CD19 still generate B cells. However, ectopic expression of CD19 decreases the ability of immature cells to enter the periphery (9). Appropriate expression of the surrogate light chain proteins, µ, Igα, and Igβ, is essential for B cell differentiation. These molecules form the pBCR that appears on the surface of the cell during the pro-B cell stage of development (4, 10, 11). The pBCR associates with nonreceptor tyrosine kinases and provides critical signals for progressing to the pre-B cell stage and establishing IgH allelic exclusion (12). Gene targeting experiments have confirmed that individual components of the pBCR are required for normal B cell differentiation; mice lacking Igβ are blocked at the pro-B cell stage of development (13), λ5 and µ− mice are blocked at the early pre-B cell stage (14, 15), and mice with a nonfunctional Igα have a significant reduction in the number of peripheral

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B cells (16). The role of pBCR signaling in lymphopoiesis may reflect cell fate decisions at the pro/pre-B transition. Consistent with this hypothesis is the finding that bcl-2 and bcl-x, genes involved in protecting cells against apoptosis, are differentially expressed during B cell development (17). Other molecules involved in signaling that have a role in B cell development include JAK3, in which knockout mice lacked B220+ progenitors (18, 19); flk2, a receptor tyrosine kinase that may influence progenitor B cell development (20); syk, a tyrosine kinase that appears to be necessary for generating pre-B cells (21, 22); the src-related kinase lyn, which may affect the maturation of immature B cells (23, 24); and Bruton’s tyrosine kinase (BTK), in which mutations of this gene are associated with mouse X-linked immunodeficiency and human X-linked agammaglobulinemia (7). Additional proteins that display B cell–restricted functions include TdT, which randomly adds nucleotides at the coding joins during IgH recombination, the IL-7 receptor (IL-7R), which is required for pro/pre-B generation, and integrin proteins that are necessary for mediating cell-cell and cell-extracellular matrix interactions (25–27).

Expression and Rearrangement of Immunoglobulin Genes Proper expression of Ig heavy and light chain genes is critical for B lymphopoiesis. The transcriptional regulation and the recombination events that generate these genes have been well studied and discussed extensively (28– 32). In general Ig genes are regulated by an array of tissue-specific cis-acting promoters and enhancers. The transcriptional regulatory elements of the Ig genes include the V gene–associated proximal promoters, the Ig heavy chain gene intronic enhancer (Eµ), the 30 Ig heavy chain enhancer (30 EH), the κ intronic enhancer (iEκ), the 30 κ enhancer (30 Eκ), and the λ light chain enhancers (Eλ) (30). Recently, additional Ig enhancer elements have been identified (30). These cis-elements are regulated by a combinatorial mechanism that involves tissue-specific and ubiquitous transcription factors, which are discussed in detail later in this review and elsewhere (28–31). The tissue specificity of Ig genes is also in part governed by the assembly of Ig genes during B cell differentiation (32). V(D)J recombination occurs at specific times during B lymphopoiesis (29). Recombination begins during the pro-B cell stage in which cells undergo DJH recombination (33). Successful rearrangement of a VH segment to a previously joined DJH results in the expression of cytoplasmic µ, which is a characteristic of a pre-B cell. In the final stages of primary B cell development, the pre-B cell must successfully rearrange V and J elements at one of its light chain loci. V(D)J recombination is regulated by at least two mechanisms that both depend on transcription: expression of the RAG genes and accessibility of the Ig

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genes to recombinase activity (32). Components of the V(D)J recombination machinery include ubiquitously expressed DNA repair proteins such as DNAdependent protein kinase complex and lymphoid-specific component consisting of RAG-1 and RAG-2, which together are sufficient for recognizing recombination signal sequences and mediating cleavage (32, 34–38). Defects in either of these components will result in deficiencies in V(D)J recombination (39, 40). Expression of the RAG genes is primarily restricted to developing lymphocytes that are undergoing rearrangement of their antigen receptor genes; expression is highly regulated during B lymphopoiesis. RAG-1 and RAG-2 mRNA can be first detected in pro-B cells but are downregulated in large pre-B cells upon completion of IgH rearrangements (6, 41). The RAG genes are then transcribed again in small pre-B cells to allow light chain gene rearrangement (6). The promoters and enhancers that regulate RAG transcription are just beginning to be defined (42, 43). Posttranslational regulation is also important for regulating RAG expression. RAG-2 is regulated in a cell cycle–dependent fashion and accumulates at G0/G1. Upon entry into S-phase RAG-2 is phosphorylated and targeted for degradation by a cell cycle–dependent kinase (41, 44). In addition RAG-2 may influence the stability of RAG-1 protein (44). How Ig genes are targeted for recombination is not completely understood; it may involve multiple mechanisms including changes in chromatin structure and methylation patterns (32). A role for transcription in regulating accessibility of Ig loci was suggested by the detection of germ-line transcripts in B cell precursors prior to Ig rearrangements (45). The significance of these transcripts is not clear, and they may merely reflect the accessibility of a locus to transcription factors. However, recent gene targeting experiments have indicated that the transcriptional regulatory elements of the Ig genes are required for V(D)J recombination (32). Deletion of the Eµ, the iEκ enhancer, or the 30 κE all significantly decreased V(D)J recombination (32, 46–48).

Roles of Transcription Proteins PU.1 AND THE ETS PROTEINS The Ets family of transcription factors has at least 35 members, and additional Ets proteins continue to be discovered (49, 50). Ets proteins are related by a conserved 85 amino acid DNA binding motif, which has a novel loop-helix-loop structure that binds purine-specific sequences (50). Ets family members are usually very weak transcriptional activators and require interactions with other factors to activate or repress their target genes (50). Although differential roles and/or binding specificities are not defined for all these proteins, PU.1 and Ets-1 show functional differences. PU.1 is an Ets family protein that is preferentially expressed in monocytic, granulocytic, and lymphoid cells (51). Its importance in the development of these lineages was confirmed by generating mutant PU.1 mice (52, 53). A

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PU.1 knockout is an embryonic lethal, and the mice lack B- and T-progenitors as well as multiple myeloid lineages in their fetal livers (52, 53). Recent studies that examined the ability of PU.1 embryonic stem cells and fetal liver cells to contribute to various hematopoietic lineages in vivo and in vitro confirmed a cell autonomous defect and suggested that PU.1 may be required for the development of a multipotential lymphoid-myeloid progenitor (54). A number of genes expressed in B cells have Ets sites in their transcriptional regulatory elements and can be regulated by PU.1. The list includes genes encoding Ig heavy and light chains, RAG-1, Igα, Igβ, Vpre-B, λ5, BTK, bcl-2, TdT, CD19, and J chain (30, 55–59). However, PU.1 requires interactions with other proteins in order to regulate transcription. This was first demonstrated in studies using the 30 κE. PU.1 was capable of activating transcription on this element only when associated with a second binding activity NF-EM5 (60). Recently, NF-EM5 has been cloned and shown to be Pip, a member of the interferon regulatory factor (IRF) family (61). Phosphorylation of PU.1 appears to be important in regulating its ability to interact with Pip. (62). Furthermore, it has been suggested that a second IRF protein, ICSBP, can associate with PU.1 on λE, but this association appears to repress enhancer function (63). IKAROS The Ikaros gene encodes a set of proteins, generated by alternative mRNA splicing, that contain kruppel-like zinc fingers organized in two functional domains, one for DNA binding and a second for dimerization (64–66). An additional Ikaros-related factor, Aiolos, has been recently cloned (67). Ikaros family proteins can generate homo- and heterodimers, and these interactions influence their ability to bind DNA and activate transcription (68). The Ikaros genes are primarily expressed in hemopoietic tissues, and Ikaros and Aiolos mRNA are present throughout B cell development (66, 67, 69). Ikaros gene expression appears to increase as B cells mature, but the relevance of absolute versus relative levels of Ikaros proteins is not understood (66). Ikaros’ role in lymphopoiesis was demonstrated by gene targeting experiments that introduced an Ikaros-null mutation into mice (70). These animals lack fetal lymphocytes and adult B cells. The B cell developmental block is very early—prior to the pro-B cell stage (70). Mice expressing a dominantnegative version of Ikaros have a more severe phenotype. These mice have a complete block in lymphopoiesis, the development of their erythroid and myeloid cells is altered, and the majority of mice die within 3 weeks (71). This more dramatic phenotype may reflect the existence of other Ikaros-like proteins or cofactors that are titrated away by the dominant-negative activity (66). Ikaros binding sites have been described in the promoters of a number of genes. Genes potentially regulated by Ikaros include RAG-1, IL-2 receptor, Igα, Vpre-B, λ5, and TdT (66). For the latter three genes, the Ikaros binding

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sites overlapped an Ets recognition sequence. At least for the TdT promoter, Ets and Ikaros cannot simultaneously bind and may compete for binding (72). It has been proposed that this competition in part regulates the TdT promoter. E2A/bHLH PROTEINS The E2A gene was identified based on the ability of its alternatively spliced gene products, E47, E12, and E2-5, to recognize µE sites in several Ig transcriptional regulatory elements (73). Additional genes that encode proteins that recognize these elements include E2-2 and HEB (74, 75). These genes are part of a larger family of transcription factors that share homology in their basic DNA binding domain and their helix-loop-helix dimerization motif (bHLH) (73, 76). bHLH proteins bind DNA as homo- or heterodimers and are ubiquitously expressed. Transfection experiments have demonstrated that these proteins are transcriptional activators and that overexpression of E2A in a T cell line can induce µ sterile transcripts and DJH rearrangements (77– 79). These observations suggest that these factors may have an important role in regulating Ig transcription. Recent studies have provided insight into how ubiquitous E2A genes may act as tissue-specific factors. A B cell–specific complex that binds Eµ has been demonstrated to consist of E47 homodimers, whereas in other tissues E47 preferentially forms heterodimers (80, 81). The tendency of E47 to generate homodimers in B cells reflects a B cell–specific phosphorylation pattern (82). Disruption of E2A confirmed that this gene is required for normal B cell development (83, 84). The majority of E2A-minus animals die within a week. These mice are specifically blocked in B lymphopoiesis, fail to initiate DJH rearrangements, and lack B220+CD43+ progenitor B cells (83, 84). Data from transgenic mice expressing E47 or E12 in an E2A-minus background has suggested that E12 is important for committing cells to B cell development and that E47 is required for their differentiation (85). The role of E2-2 and HEB in B cell development is not clear. Gene targeting experiments have indicated that these factors are not required for B cell development, but mice harboring different combinations of HEB, E2-2, and E47 mutations produce fewer pro-B cells than do wild-type mice, implying that the dosage of bHLH proteins may influence normal B cell production (86). E2A proteins may be negatively regulated during primary B cell development by a dominant negative factor, Id (87). Id has a HLH domain but lacks a DNA binding domain, thus inhibiting other family members by forming nonfunctional heterodimers (87). Id is expressed only in pro-B cells and is absent in more differentiated precursors (87). Id transgenic animals have a phenotype that is very similar to the E2A ablated animals, consistent with Id being a negative regulator of E2A proteins (88). A zinc-finger protein, ZEB, has also been implicated in inhibiting E2A function (89).

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EARLY B CELL FACTOR Early B cell factor (EBF) was identified based on its ability to bind and activate the promoter for Igα gene (90, 91). EBF has a novel zinc-binding motif and a carboxyl-terminal bHLH-like motif that are required for DNA binding and homodimerization, respectively (92). EBF is expressed throughout primary B cell development but is not detected in terminally differentiated plasma cells (91). Ablation of EBF results in a block in B cell differentiation at the early pro-B cell stage. These mice do not have cells that progress beyond the B220+CD43+ stage (93). Pro-B cells from these animals lack DJH rearrangements, Igα, Igβ, surrogate light chain, RAG-1, and RAG-2, although they do express IL-7R, TdT, and µ sterile transcripts (93). Therefore, it appears that EBF is a critical factor for the progression of pro-B cells to the pre-B cell stage. BSAP (PAX5) BSAP is a member of the paired-box homeodomain family of transcription factors. BSAP is expressed throughout primary B lymphopoiesis but is absent in mature B cells; it is also expressed in the developing central nervous system (94). Mice in which BSAP was disrupted are runted, have mid-brain defects, and usually die within three weeks after birth (95). In regard to hematopoiesis, these animals lack pre-B, B, and plasma cells (95). Pro-B cells that express c-kit, B220, CD43, and IL-7R and have undergone DJH rearrangements are present in the bone marrow, but cells expressing CD19 are not detected, and VHDJH recombination is significantly reduced (95, 96). The block in B cell development is more severe in the fetal liver, which lacks B220+ progenitor cells, although whether this reflects different functions of BSAP in fetal liver and bone marrow progenitors or the different microenvironments supporting their development is not clear (96). A number of B cell–restricted genes have BSAP sites within their promoters including CD19, λ5, Vpre-B, and Blk; however, with the exception of CD19, all these genes appear to be expressed in normal levels in the knockout mice (96). By interacting with an Ets protein, BSAP may also regulate Igα expression (97). Furthermore, BSAP can act as a negative regulator during primary B lymphopoieis. BSAP negatively regulates 30 Cα enhancer by competing with the Ets-family protein NF-αP for binding. It also silences J chain gene expression in immature B cells (98, 99). NF-κB/REL PROTEINS The NF-κB/rel family of transcription factors has been extensively studied (100–102). Family members are related by the high degree of homology shared in a 300 amino acid rel domain. The rel domain is essential for DNA binding, dimerization between rel proteins, and interactions with other transcription factors. NF-κB/rel proteins are ubiquitously expressed, induced by a number of agents including bacterial and viral pathogens, cytokines and mitogens, and DNA damaging agents, and they appear to regulate a number

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of genes in various cell types. There are at least five rel family members that may be involved in B cell development. These include RelA(p65), Rel-c, RelB, NF-κB1(p105), and NF-κB2(p100). NF-κB1 and NF-κB2 generate precursor proteins that are processed by proteolytic cleavage to generate the p50 and p52 subunits, respectively. These subunits can generate hetero- and homodimers that bind DNA. NF-κB/rel dimers are usually located in the cytoplasm. This is due to the association of the dimers with IκB proteins. IκB proteins as well as p105 and p100 have carboxyl terminal ankyrin repeats that are necessary for their cytoplasmic localization. The interaction between NF-κB and IκB is the primary mechanism that regulates NF-κB activity; NF-κB is sequestered in the cytoplasm until cellular activation leads to IκB phosphorylation and ubiquitin-dependent degradation. Upon its release from IκB, NF-κB translocates to the nucleus (102–105). Recovery of IκB levels is partly controlled by transcriptional activation by NF-κB (104, 105). Therefore, NF-κB may regulate its own activity by maintaining the cytoplasmic pool of its inhibitor IκB (104, 105). Several observations have suggested that rel proteins may be important for primary B cell development. NF-κB was originally characterized as a preB cell inducible transcription factor that could bind the κEi element (106). Furthermore, it is constitutively activated in mature B cells (106). Moreover, studies have suggested a hierarchy of NF-κB dimers during B cell development; pre-B cells primarily have p50/p65 dimers, mature cells have Rel-c/p50 dimers, and plasma cells have p52RelB dimers (107, 108). Although this family was discovered by virtue of their binding to κEi, their role in kappa transcription remains ambiguous. Various NF-κB/rel genes have been ablated, and relatively minor effects on primary B cell development have been observed, possibly reflecting the redundancy of this family of factors (109–111). Embryonic stem cells that are deficient for both p50 and p65 do not contribute to the B cell compartment when transplanted into lethally irradiated mice; however, this defect is not cell autonomous and appears to reflect the lack of an extracellular factor required for B cell maturation (112). Recent experiments in which a dominant-negative, nondegradable form of IκB was overexpresssed in pre-B cells indicated that NF-κB/rel proteins are necessary for B cell differentiation. In this system, inhibition of relA and rel-C led to a decrease in κ transcription and inhibited VκJκ rearrangements (113). Therefore, it appears that p50 and p65 are not required for κ expression because related family members, such as p52 and c-Rel, functionally substitute; however, some form of NF-κB/rel activator is required for kappa expression. HIERARCHY OF FACTORS FOR B CELL DEVELOPMENT Transcription factors that are essential for B cell development appear to block differentiation primarily at two stages; prior to the commitment to B lymphopoiesis and at the pro-B/pre-B

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cell transition when VHDJH recombination is beginning. PU.1 and Ikaros seem to be required prior to the first developmental checkpoint, whereas E2A, EBF, and BSAP appear to act at the second developmental checkpoint (94, 114, 115). It has been suggested that PU.1 is important for the development of multiple hematopoietic lineages (54, 115). Likewise, the lack of T cells and B cells in Ikaros-minus animals indicates that this factor is acting in a lymphoid-restricted progenitor (66). Taken together these observations imply that PU.1 is required for hematopoieis prior to Ikaros (115). However, Ikaros is expressed in PU.1 knockout mice, and it may have a more general function in hematopoieisis (66). It is also formally possible that these genes are required separately for the differentiation of committed progenitors into individual lineages (115). Although both genes are expressed throughout hematopoiesis, it is also not clear what role they play during B cell development since hematopoiesis is blocked in knockout mice prior to lymphopoiesis. Finally, it is unknown whether stochastic or regulated events initiate expression of these factors, or whether these factors trigger the commitment of progenitor cells down a particular developmental pathway. The differentiation of the earliest cell committed to B cell development appears to require E2A genes. This is based upon the absence of µ germline and BSAP expression in E2A-minus mice (84). EBF is also required very early in B development, and its expression pattern appears to overlap E2A although EBFdeficient mice appear to have more mature progenitor B cell populations. BSAP is required in late pro-B/early pre-B cells when cells are actively rearranging IgH genes (85, 96). It is interesting that all three of these factors potentially regulate components of the pBCR complex and that B cells in Igβ and λ5 knockouts are also blocked at a late pro-B/early pre-B stage (14, 15, 55, 115). Furthermore, greater than 80% of pro-B cells are selected against at this stage of B cell development, providing additional support for this as a critical checkpoint (11). Therefore, one function of E2A, EBF, and BSAP may be to coordinate the components of the pBCR and its signal transduction pathways so that progenitor B cells can respond appropriately to growth and differentiation signals. The dependence of B cell development on these signals would be consistent with a regulated model of primary B lymphopoiesis.

TRANSCRIPTION DURING ANTIGEN-DEPENDENT B CELL DEVELOPMENT Stages of Antigen-Dependent Development Developmental events and altered patterns of gene expression that occur after B cells encounter antigen are summarized in Figure 2 and discussed below to

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Figure 2 Antigen-dependent stages of B cell development. Lines from top to bottom indicate the anatomical location, types of B cells, cell cycle status, developmental events, and expression patterns for genes known to increase (arrow up) or decrease (arrow down).

provide a context for the subsequent consideration of transcriptional regulators. Recent reviews of these events have appeared (11, 116–119). INITIAL ACTIVATION BY ANTIGEN The first encounter between a naive B cell and cognate antigen via the BCR activates proliferation, leading to uptake, processing, and presentation of thymus-dependent (TD) antigens and altered patterns of gene expression. Molecules involved in subsequent T cell–B cell interactions are upregulated including: 1. class II major histocompatibility (MHC) proteins (120); 2. B7-1 (CD80) and B7-2 (CD86), which contact CD28 and CTL-A on the T cell (121); and 3. CD40, which contacts CD40L on the T cell (122, 123). As detailed below, the abundance or activity of many transcription factors also changes upon engagement of BCR. T CELL–INDEPENDENT RESPONSES AND B-1 CELLS Multimeric antigens stimulate B cells to proliferate and differentiate into plasma cells (11, 118, 124). Thymus-independent (TI) responses occur predominantly but not exclusively with B-1 cells, which can be distinguished from “conventional” B cells by their surface phenotype and ability to self-replenish (117, 125). Binding of TI-2 antigen induces expression of CD5 (126), and signaling between CD5 and CD72 may mediate interactions between B cells (127). Signal transduction molecules are required for TI responses including lymphotoxin-α (LT-α) and tumor necrosis factor (TNF) (128), IL-5Rα (129), CD19 (130), lyn (23), and HS1 (131). Little is known about transcription factors in TI responses. GERMINAL CENTER FORMATION The complex developmental steps that occur in the germinal center (GC) depend on intimate association of B cells with TH

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cells and with follicular dendritic cells (FDCs); they involve clonal proliferation, somatic hypermutation (SHM), and selection for cells expressing high-affinity antibodies, isotype switch recombination (ISR), and negative selection (116, 132–134). Predictably, gene products involved in B cell–T cell interaction are required for GC formation, including CD28 (135), CD40 (136, 137), CD40L (138–140), CD19 (9, 141), and B7-2 (139). LT-α and TNF receptor type I are required for GC formation (142–144). SOMATIC HYPERMUTATION, RECEPTOR EDITING, AND ISOTYPE SWITCH RECOMBINATION IN THE DARK ZONE Centroblasts that form the dark zone proliferate rapidly and express high levels of c-Myc (145) and, presumably, other gene products required for rapid cell division. SHM takes place in GCs (146) in centroblasts prior to ISR (147–149) although GC formation is not strictly required for SHM (144, 150). SHM may be dependent upon the amount of CD4+ T cell help and B7 signaling because deficient expression of B7-2 on GC B cells and a decrease of SHM occur in aging mice (151). ISR occurs mainly in the GC, but GCs are not required for ISR (136, 137). ISR requires cell cycling, and germline transcripts are produced in the G1-S phase (152, 153). Receptor editing of immunoglobulin light chain genes and expression of RAG-1/2 also occur in the GC centroblasts (154). SELECTION AND APOPTOSIS IN THE LIGHT ZONE Centroblasts migrate to the light zone where they contact antigen bound to FDCs and antigen-specific TH2 cells. They stop dividing and are subjected to selection for high-affinity antibody. Selection against cells that respond to soluble antigen or that do not receive T cell help provides a mechanism for elimination of self-reactive antibodies that may be generated during the SHM process. B cells cycle between the dark and light zones for several rounds of mutation and selection (116, 133, 155). FDCs and T cells signal the B cells by engagement of their surface receptors, including BCR, CD40, B7-1/2, CD20, LFA-1, and VLA-4, and by the action of cytokines produced by T cells and FDCs, including IL-2, IL-4, IL-5, IL-6, IL-10, and LT-α (139, 156–158). Signaling centrocytes via CD40 induces both SHM (116, 149, 155, 159) and ISR (160–162). Centrocytes express low levels of IgM, no IgD (149), and the molecules necessary for costimulatory signals including CD40, B7-1, B7-2, CD23, CD20, LFA-1, and VLA-4. Centrocytes also express “apoptotic” genes including Fas (CD95), c-myc, bax, and p53, but have low levels of bcl-2 expression (163–165). Signaling via CD40/CD40L induces expression of B7, CD23, and other surface molecules in GC cells (166–168). If GC cells fail to receive signals from FDCs or T cells, they undergo spontaneous Fas-dependent death (140, 161, 169, 170). If BCR is engaged by soluble antigen or in the absence of T cell help, the

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cells also undergo apoptosis independent of Fas and CD40L (171–174), which presumably deletes autoreactive B cells (174, 175). EXITING THE GERMINAL CENTER After undergoing successive rounds of SHM, receptor editing, ISR, and selection, GC B cells are signaled to proliferate, exit the GC, and differentiate into either memory cells or plasma cells. These cells lose their “apoptotic” phenotype by downregulating Fas (169) and increasing expression of bcl-2, bcl-xL, and cyclin-dependent kinases 4 and 6 (176). They switch from an autocrine to a paracrine dependence on IL-6 by downregulating IL-6 expression and upregulating IL-6R expression (170). CD40 signaling also induces expression of a number of transcription factors, including jun via JNK (177, 178), NF-κB (179), and NF-AT (180). CD40 signaling is probably required for both memory and plasma cells (164, 181). The timing, strength, and interplay of signals from BCR, CD40, B7-1/2, and cytokines appears to determine cell fate (156 182–185). Little is known about gene expression in memory cells, although human memory cells are CD38-CD20+CD39+ and can be restimulated to proliferate in response to CD40L (182). Plasmablasts exiting the GC are still proliferating, but outside the GC they become nondividing plasma cells (PCs) with a life span of approximately 1 month. IL-6 protects PCs from apoptosis (186), induces immunoglobulin and Oct-2 expression (187), and leads to activation of cyclin-dependent kinase inhibitor p18, which blocks cell division (188). PCs have superabundant levels of Ig and J chain mRNA, and transcription factor Blimp-1 is induced when B cells differentiate into PCs (189). Expression of many genes is decreased in PCs, including CD23 (190), CD22 (191), possibly CD19 (192), class II MHC (193), c-Myc (194), BSAP (99), early B cell factor (EBF) (91), and CIITA (193). Mice deficient for the transcription factors NF-IL-6 and Ets-1 have increased PCs (195, 196), but the biochemical explanation is not currently clear.

Nonclassical Roles of Transcription in B Cell Development SOMATIC HYPERMUTATION Evidence that transcription is important for SHM is increasingly compelling (159, 197–199). Mutations rarely occur 50 of the transcription initiation site of variable genes (200–202), although no mutations are found in CH genes (201). SHM also shows DNA strand bias (203, 204). Use of experimentally manipulable transgenic substrates for SHM has allowed the role of different cis elements to be tested. Ig promoters can be replaced by heterologous promoters (205); however, Ig enhancers are required but interchangeable. Non-Ig sequences can be mutated in place of variable regions (206). Finally, introduction of a Vκ promoter 50 to a Cκ gene conferred mutation on the Cκ region, strongly linking transcription to SHM (207). A current model postulates the existence of a mutator, probably B cell specific, which is

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recruited to the transcription initiation complex by Ig enhancers and functions to cause transcriptional pausing that is accompanied by error-prone transcriptioncoupled repair. Subsequent dissociation of the mutator would explain the lack of mutations in the 30 part of the transcription unit (198, 207). ISOTYPE SWITCH RECOMBINATION Demonstration that cytokines induce both ISR and germline CH transcripts corresponding to the CH gene which subsequently undergoes switching (208, 209), provided evidence that transcription is linked to ISR. Isotype switch (I) region promoters and cytokine response elements in them have been studied and reviewed (210–213), but the exact role of germline transcripts in ISR remains unclear. Gene targeting studies have implicated the 30 Cα enhancer (214). Two other studies showed transcription was necessary but not sufficient for ISR and implicated other features of I regions (215, 216), although another report showed that neither the Iα exon nor the Iα promoter was required for switching to Cα (217). Transcription may provide accessibility of the switch regions to the recombinase machinery, as reviewed recently (213). However, additional or different mechanisms are possible, consistent with reports that germline transcripts can form triplex structures at the switch sites (218) and that the direction of germline transcription is important (219).

Role of Transcription Factor Families in Antigen-Dependent B Cell Development OCTAMER-BINDING PROTEINS AND COACTIVATOR OCA-B/BOB-1/OBF-1 Early studies identified 8 bp, “octamer” regions in all Ig light (220) and heavy (221) chain variable region promoters studied. Functional analyses demonstrated that octamer sites are critical for activity of V gene promoters (222, 223) and can confer B cell specificity in transfections (224). In B cells, two proteins bind octamer sites—Oct-1 which is ubiquitously expressed and Oct-2 which is more limited in its expression pattern, reviewed in (225, 226). Cloning of Oct-2 revealed homology with homeobox proteins which regulate development in drosophila (227, 228). These data led to the hypothesis that octamer sites, via Oct-2, conferred B cell specificity on Ig promoters (226). However, there were difficulties with this simple model (225, 226): 1. Other genes such as snRNA and histone H2B are regulated by octamer sites, 2. levels of Oct-2 do not correspond with levels of Ig expression, and 3. in vitro, Oct-1 activates Ig promoters indistinguishably from Oct-2 (229). This paradox was resolved upon identification (230) and subsequent cloning (231–235) of a B cell–specific coactivater called OCA-B (Bob-1 or OBF-1). OCA-B enhances transcriptional activity of Oct-1 and Oct-2. It associates with the POU domain of octamer proteins, causing a conformational change that

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allows binding to octamer DNA sequences (236). OCA-B alters the binding specificity of the complex so that only a subset of octamer sites are recognized (237). The B cell–specific expression pattern of OCA-B explains how octamer sites in Ig promoters can confer B cell specificity; the ability of OCA-B to alter the recognition specificity of the octamer-binding proteins explains why not all octamer sites confer B cell specificity. Other genes expressed in B cells also depend on octamer sites. Octamer sites are important for class II MHC promoters (238), and OCA-B associates with another coactivator, CIITA, to activate class II promoters (239). Octamer and Ets factors cooperate to activate the PU.1 promoter (240, 241). The CD20 promoter has an octamer site that is important for its expression in mature B cells (242). The promoter for the gene encoding adhesion molecule CD36 is specifically Oct-2 dependent (243). Mice lacking Oct-2 have normal B cell precursors but fewer IgM+ cells. They have a defect in their proliferative response to polyclonal mitogens but respond normally to T cell signals (244, 245). Thus, Oct-2 appears to be important for B cell activation. Since OCA-B associates equally well with Oct-1 and Oct-2 (231), mice deficient in OCA-B provide a different test for the importance of octamer proteins in B cell development (246–248). These mice have normal B1 cells and normal primary follicles. However they have no GCs, poor B cell maturation, reduced circulating B cells, and abnormalities in the level and isotype of serum Ig. The response to both TI and TD antigens is reduced (247). The isotype defect appears to stem from lack of transcription of switched Ig genes rather than inability to undergo ISR (248). Thus, OCA-B and Oct-2 are important for antigen-driven stages of development in B2 cells but do not appear to be important for initial transcription of Ig genes and early B cell development. ETS FAMILY PROTEINS Abundant evidence indicates that the Ets-1 family proteins, which were introduced above, are important for heavy and light chain Ig gene transcription. Ets-1 binds to the µA site in Eµ, whereas PU.1 binds the µB site (28, 30). The region of Eµ containing µA, µE3, and µB sites comprises an enhancer “core” that displays B cell specificity (249). The alignment, spacing, and context of Ets-1, TFE3, and PU.1 bound here is critical for transcriptional activation (250–252). It may also be important that Ets proteins cooperate with C/EBP proteins (253) since there is a C/EBP site in Eµ (30). Ets/AP1 complexes are also recruited to the 30 Cα enhancer following BCR stimulation (254) and CD40 stimulation (255). These Ets complexes are inhibited by BSAP early in B cell development (98). As already discussed, PU.1, in conjunction with Pip, is required for activity of the 30 kappa enhancer. Finally, many VH and Vκ promoters have pyrimidine-rich regions, and a pyrimidine-rich region in a Vκ promoter was recognized by PU.1 (256).

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Other family members can apparently substitute for Ets-1 since Ets-1−/− mice express normal levels of Ig (249). Interestingly, lack of Ets-1 increases T cell death and B cell differentiation (196, 257), leading to the suggestion that Ets-1 is required to regulate entry of lymphocytes into G0. Ets-1 is highly expressed in B cells (49, 50). In addition, two recently described Ets-related proteins, NERF (258) and ERP (259), are also highly expressed in B cells. The phenotype of PU.1-deficient B cells has not been determined, but its high expression suggests an important function (260). Expression of Spi-B (261, 262), which has binding specificity and transcriptional activity indistinguishable from PU.1 (263), increases during B cell differentiation (260). Other genes are expressed during antigen-dependent B cell development that also appear to depend on Ets or PU.1 proteins. PU.1 activates the J chain promoter and autoregulates its own promoter (264, 265). Ets-1 activates the DRA promoter in B cells (266). Elf-1 is important for regulating the B cell–specific TdT promoter (72). Ets proteins associate with histone acetylase coactivators CBP/p300, and Ets/AP-1 complexes compete with STATs, which are activated upon cytokine signaling, for limiting amounts of CBP/p300 (267). Thus, STAT activation could cause decreased transcription of genes dependent upon Ets family proteins. STATS Cytokines, some hormones, and other soluble ligands activate transcription by the Jak/STAT path (268–272). Binding of ligand to cell surface receptors leads to activation of Janus kinases (Jaks), which subsequently phosphorylate signal transducer and activator of transcription (STAT) proteins; phosphorylation of STATs allows them to dimerize and enter the nucleus where they bind regulatory sites on specific genes and activate transcription. Of the four Jaks expressed in B cells, Jaks 1-3 and tyk2, Jak3 is preferentially expressed in hematopoietic cells. Seven STATs (STATs 1-4, 5a, 5b and 6) are activated by Jak signaling. Although many of the important biochemical components of Jak/STAT signaling have been identified, the critical question of how specific ligands cause different arrays of genes to be activated has not been answered (270). Combinatorial effects of both qualitative and quantitative differences in activated STATs, regulation of the response by phosphatases and newly identified inhibitors (273–275), and differential regulatory requirements at different STAT-dependent promoters are likely to play important roles. In WEHI 231 B cells, engagement of BCR leads to an increased abundance of Jak 1 and 2 (276). Stimulation of normal human peripheral blood B cells led to increased levels of Jak 3 (277). BCR occupation causes activation of STAT1 and STAT3 in conventional B cells (278, 279), but STAT3 is constitutively activated in B1 cells (279). BCR occupation also causes activation of STAT5 and 6 (280). Cytokines that signal ISR do so via STAT activation (281), and IL-4 activation

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of STAT6 is the best-studied example (282–286). IL-4 response elements have been identified in the I and Iγ 1 promoters (287, 288). IL-4 treatment leads to binding of STAT6 to a site in the I promoter and activation of I transcription (282, 283, 288–290). Since few target genes have been identified for STATs, the I region promoters provide a good system for studying STAT-dependent activation in the context of important natural promoters. Gene targeting studies are beginning to reveal the relative importance of particular Jaks and STATS in B cell development, although functional redundancy of both Jaks and STATs complicates interpretation. Jak 3 is important for B cell development because Jak3−/− mice have a severe defect at the pre-B stage in BM and also have inefficient IL-4 signaling (19, 291, 292). This is corroborated in an X-SCID patient who lacks Jak 3; B cells from this patient cannot activate STAT6 in response to IL-4 (293). Mice deficient in STAT6 have established the importance of STAT6 in IL-4 signaling. Expression of CD23 and MHC class II in resting B cells was not enhanced in response to IL-4; and IL-4-induced B cell proliferation costimulated by anti-IgM antibody was abolished in these mice (294, 295). Furthermore, STAT6−/− B cells do not produce IgE following in vivo immunization with anti-IgD (285). STAT1-deficient mice have revealed that STAT1 is primarily important for IFNα/β and IFNγ signaling and is necessary for induction of IRF-1 and CIITA by IFNγ , although these genes can still be regulated by other cytokines (296, 297). Targeting experiments have revealed no role for STAT5a (298) or Stat 4 (299) in B cells. NF-κB/REL PROTEINS NF-κB/rel proteins were discussed above with respect to kappa transcription and have been reviewed extensively (100, 101, 103–105). A role of NF-κB/rel proteins in ISR is clearly established. B cells from mice lacking p50 have impaired isotype switching and abnormal mature lymphocyte development (109, 110). Preliminary results suggest that p52 deficient mice have a similar phenotype (100). The biochemical basis for this defect has been determined. CD40 signaling induces both NF-κB (300) and germline γ 1 transcripts that depend on two NF-κB sites in the Iγ 1 promoter (301, 302). The IL-4 inducibility of the I promoter also depends on NF-κB sites (303), which probably cooperate with IL-4-induced STAT6. This biochemistry is also consistent with the finding that B cells from p50-deficient mice fail to respond to CD40L, and the deficient mice have a 40-fold decrease in serum IgE (304). Regulatory elements of other genes expressed in B cells depend on NF-κB, which plays a role in cellular decisions to undergo apoptosis (305). Activation of NF-κB, which follows CD40, IL-1β, or TNFα signaling, is important for transcription of the IL-6 gene (306, 307). NF-κB sites are important for the MHC class II invariant chain promoter (308). Finally, an important NF-κB target gene in B cells is c-myc. In the WEHI 231 model of anti-BCR-mediated

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apoptosis, anti-µ increases p50 dimers, which repress c-myc transcription and cause apoptosis (309, 310). This family of BZIP proteins regulates genes in many cell lineages including B cells (311–313). There are C/EBP sites in Eµ, many VH promoters, I and Iγ 1 promoters, and the intronic kappa enhancer (30). Other genes expressed in B cells that contain C/EBP sites include CD22 (314), Id1 (315), and IL-8 (316). In many of these elements C/EBP proteins synergize with other transcription factors including NF-κB/rel proteins (317–320), STAT6 (287, 288), AP-1 (321), PU.1 (253), AML-1 (322), and Sp1 (323). Various types of regulation are critical for C/EBP proteins. NF-IL-6 activity is regulated by phosphorylation in response to signaling (324–326). In addition, Ig/EBP, LIP, and CHOP are naturally occurring dominant inhibitors of the activator forms C/EBPα, NF-IL-6, and CRP3. Ig/EBP and CHOP are encoded by separate genes (327, 328). Liver inhibitory protein (LIP) is generated by translational initiation at an internal AUG codon in the NF-IL-6 mRNA. Since the ratio of NF-IL-6 to LIP varies in different B cell lines, expression of LIP appears to be a regulated event (329). Finally, during B cell development, levels of different C/EBP mRNAs and proteins change: Ig/EBP is expressed at high levels in pro- and pre-B cells, but NF-IL-6 is induced in mature B cells and following activation of splenic B cells (329). This has led to the suggestion that C/EBP sites function as activator sites only in later stages of B cell development. However, a recent report suggests that expression of the Id1 gene in proB cells depends on C/EBP activators (315). Thus, whether C/EBP sites are transcriptional activator sites in early B cells and whether the effects vary with the context of different binding sites are currently unclear. Gene targeting experiments confirm the general importance of C/EBP negative regulation since Ig/EBP-deficient mice die as embryos (S Akira, personal communication). NF-IL-6-deficient mice have abnormalities in macrophage function (330) but also display B cell abnormalities, which are only partially characterized. They have enlarged spleens and lymph nodes and overexpress IL-6, but Ig serum levels have not been reported (195). It will be important to determine the role of C/EBP inhibitors and activators, especially with respect to Ig genes, at different stages of B cell development.

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C/EBP PROTEINS

TFE3/MYC PROTEINS The TFE3/myc family of proteins are BHLHZip proteins that bind as obligate dimers (30, 31). Differences in their “zipper” domains determine three subfamilies that heterodimerize with each other but not with members of other subfamilies (331). The subfamilies include: 1. TFE3 (332, 333), TFEB (334, 335), TFEC (336) and Mi (337), 2. USF I/II (338, 339), and 3. Myc/max (340, 341).

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TFE3 sites are present in Eµ and in some VH promoters. In a model system, TFE3 bound at a distant site was shown to associate, via the HLHZip domains, with TFE3 bound near the transcription initiation site to mediate activation from a distance, suggesting an important role for TFE3 in enhancer-promoter interactions (342). Recent data also suggest that CD23 is a target for TFE3 because a binding site occurs in the promoter region and the promoter is transactivated by TFE3 (D Conrad, personal communication). Members of all three subfamilies recognize the same DNA sequence, and all except Mi (337) are ubiquitously expressed and present in B cells. Nevertheless, the binding site in Eµ is occupied in a B cell–specific manner (343). It may be that TFE3 family proteins are modified or activated in a B cell–specific manner or that naturally occurring splice forms are regulated in B cell forms (344, 345). Alternatively, it may be that cooperative association with B cell–specific PU.1 (250, 251), bound at the adjacent µB site in Eµ, is sufficient to give B cell–specific occupation of the TFE3 site. Because of the heterogeneity of the family, an important question has been to understand which protein(s) act at functionally important binding sites. The dimerization specificity conferred by different zipper domains allowed the design of subfamily-specific dominant negative proteins (346). Expression of these dominant negatives in a transfection assay showed that the endogenous TFE3/B subfamily played a more important role in Eµ that the USF subfamily. This is consistent with the recently reported phenotype of TFE3-deficient lymphocytes in RAG-2−/− chimeric mice (347). These animals have normal numbers of T and B cells, but serum Ig levels are decreased two- to sixfold, especially for IgG and IgA. Since TFE3-deficient B cells secrete normal levels of different Ig isotypes upon activation in vitro, the data also suggest that absence of TFE3 causes a defect in the ability of B cells to respond to in vivo signals, probably from T cells. TFE3-deficient B cells also have decreased expression of HSA and CD23 on their surface, suggesting that TFE3 may regulate transcription of these genes (347). An interesting complication is that the TFE3 site in the human IgH intronic enhancer is poorly conserved, and a recent study shows that CBF (348, 349) binds and activates this site as well as the site in the murine enhancer (350), suggesting a role for CBF. Targeting studies are not currently helpful for determining the role of CBF in B cell development because mice deficient in either of the two CBF subunits die embryonically and have defective hematopoiesis (351, 352). It will be interesting to learn the phenotype of chimeras in which only the B cells lack CBF. CIITA is the coactivator required for class II MHC gene expression. Bare lymphocyte syndrome (BLS) individuals lack class II expression and fall into

CIITA

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five complementation groups (353). CIITA was isolated by complementation cloning as the defective gene in one BLS complementation group (354). This defined CIITA as a protein required for class II expression. The requirement was confirmed by gene targeting because mice lacking CIITA do not express class II on B cells or dendritic cells (355). CIITA also appears to be required for expression of invariant chain and histocompatibility leukocyte antigen-DM gene transcription (356, 357). CIITA does not bind DNA and appears to associate with and stabilize proteins bound to the X box of the class II promoter (358). CIITA also associates with another coactivator OCA-B (239). Association of CIITA with TAFII32 is responsible for activation of class II genes (359). CIITA regulation may be particularly revealing with respect to later stages of B cell development. CIITA is only expressed in cells expressing class II and is inducible by IFNγ (360). Induction of CIITA by IFNγ is dependent upon STAT1 (361). A promoter for CIITA has been identified that gives B cell expression but not IFNγ induction (362), so some elements remain unidentified. In PCs, class II transcription is shut down, apparently because CIITA is shut down, but the mechanism responsible for lack of CIITA expression is not yet known (193, 363). The Bcl-6 gene was cloned because it is translocated in large diffuse B cell lymphomas and is rearranged in Hodgkins disease (364). It is a zinc finger protein that functions as a transcriptional repressor (365, 366). Bcl-6 is expressed in GCs (367, 368). It is also expressed at high levels in resting T and B cells but decreases upon cellular activation (369). Gene targeting has shown that Bcl-6 plays an important role in germinal center formation and B cell development because Bcl-6−/−mice lack GCs and affinity maturation of antibodies (371, 372). These mice also display inflammation due to increased TH2 cytokine production. Until recently, no target genes for Bcl-6 had been identified. However, recent reports show that Bcl-6 can compete with STATs for binding STAT sites (370) (P Rothman, personal communication). Thus, faulty regulation of STAT-responsive genes may underlie the inflammatory disease in BCL-6-deficient mice and may also participate in lymphoid malignancies.

BCL-6

Blimp-1 was cloned in a subtractive screen for mRNAs that were upregulated when BCL1 B cells were induced to differentiate by IL-5 and IL-2 (189). Blimp-1 expression appeared to be specific to mature B cells and plasmacytomas, and ectopic expression of the protein was sufficient to drive differentiation of BCL1 cells (189). However, further inspection (371) showed that Blimp-1 was the murine homologue of a previously cloned human zinc finger protein, PRDI-BFI (374). PRDI-BFI is a transcriptional repressor of the IFNβ promoter and is induced upon virus infection (372). More recently, an

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important target gene for Blimp-1 has been identified in B cells. Blimp-1 binds to a previously identified repressor site on the c-myc gene (373) and represses c-myc transcription in B cells (194). c-Myc is required for cell proliferation and blocks terminal differentiation (374), so it makes sense that c-myc transcription is repressed by a transcription factor that causes terminal differentiation. Whether Blimp-1 has additional target genes in B cells is unknown. Recent results show that induction of Blimp-1 upon terminal differentiation is not unique to B cells (D Chang, K Calame, unpublished). Blimp-1 is also important in early development because mice lacking the gene die as embryos (M Davis, personal communication).

FINAL CONSIDERATIONS Figure 3 depicts a simplified developmental scheme for B cells, indicating current information about the approximate stages at which particular transcription

Figure 3 Transcription factors in B cell development. Stages of B cell development are represented across the top, and approximate times when particular transcription factors are critical are indicated by the vertical lines. Bars below indicate the approximate expression pattern for various transcription factors. Except for NF-κB, the bars correspond to information on mRNA levels; for NF-κB, bars represent active, nuclear protein. The dark bars represent times when the factors are expressed but do not reflect relative expression among factors. Light grey bars represent lower expression relative to expression of the factor at another stage. Hatched bars represent expression in progenitor cells that has not been demonstrated experimentally but that is implied by expression in other cell lineages.

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factors are expressed and when they function. Expression patterns sometimes, but not always, correlate with the developmental stage when the factor is known to play an important role. It is likely that some of these factors play important roles at many stages of development, and gene targeting has only revealed the first developmental stage at which they are important. PU.1, E2A, and BSAP are probably examples of such proteins because there is strong evidence that they regulate Ig and/or J chain genes in later developmental stages. Alternatively, some transcription factors may be expressed at stages at which they do not play critical roles or when other family members have a redundant function. Oct-2, TFE3, and Ets-1 may be examples of such proteins. It is also likely that certain factors, such as Ets family proteins, require interaction with other transcription factors for activity. Another important point is that abundance does not always reflect activity. Differential splicing, phosphorylation, or altered subcellular localization can regulate activity, and for most of the factors listed such regulation has not been systematically studied. With the exception of NF-κB, where regulation is well-studied, these modifications are not represented in Figure 3. For example, Ikaros (64–66) and TFE3 (344) have differential splice forms with different activities, and the activities of E2A (80) and C/EBPβ (324–326) are regulated by phosphorylation. Another interesting feature is that the abundance of several of the transcriptional regulators such as C/EBPβ, CIITA, and Blimp-1 may be regulated at the transcriptional level. It will be important to understand that regulation. One imagines that posttranscriptional regulation of a few key transcription factors may ultimately initiate developmental decisions. Our understanding of B lymphocyte development has progressed remarkably, and the ability to begin integrating that knowledge with general developmental patterns of transcriptional regulation provides a new dimension to studies on transcriptional regulation. However, much remains to be learned. Additional gene targeting studies will help, but understanding the developmental regulation of various transcription proteins and identifying all of their target genes will also be necessary. ACKNOWLEDGMENTS We are very grateful to many colleagues who provided copies of their recent studies or aided our understanding through discussions. We thank K Dorshkind for critically reading the manuscript. The current literature is vast, and we apologize for omissions made in appropriate citations. This work was supported by PHS-RO1 GM29361 to KC and a Leukemia Society Special Fellowship to AH. Visit the Annual Reviews home page at http://www.AnnualReviews.org.

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TRANSCRIPTIONAL REGULATION 330. Tanaka T, Akira S, Yoshida K, Umemoto M, Yoneda Y, Shirafuji N, Fujiwara H, Suematsu S, Yoshida N, Kishimoto T. 1995. Targeted disruption of the NFIL6 gene discloses its essential role in bacteria killing and tumor cytotoxicity by macrophages. Cell 80:353–61 331. Beckmann H, Kadesch T. 1991. The leucine zipper of TFE3 dictates helixloop-helix dimerization specificity. Genes Dev. 5:1057–66 332. Beckmann H, Su L-K, Kadesch T. 1990. TFE3: a helix-loop-helix protein that activates transcription through the immunoglobulin enhancer uE3 motif. Genes Dev. 4:167–79 333. Roman C, Matera AG, Cooper C, Artandi S, Blain S, Ward DC, Calame K. 1992. mTFE3, an X-linked transcriptional activator containing basic helix-loop-helix and zipper domains, utilizes the zipper to stabilize both DNA binding and multimerization. Mol. Cell. Biol. 12:817–27 334. Fisher D, Carr C, Parent L, Sharp P. 1991. TFEB has DNA-binding and oligomerization properties of a unique helix-loophelix/zipper family. Genes Dev. 5:2342– 52 335. Carr CS, Sharp PA. 1990. A helix-loophelix protein related to the immunoglobulin E box-binding proteins. Mol. Cell. Biol. 10:4384–88 336. Zhao GQ, Zhao Q, Zhou X, Mattei MG, de Crombrugghe B. 1993. TFEC, a basic helix-loop-helix protein, forms heterodimers with TFE3 and inhibits TFE3dependent transcription activation. Mol. Cell. Biol. 13:4505–12 337. Hodgkinson CA, Moore KJ, Nakayama A, Steingrimsson E, Copeland NG, Jenkins NA, Arnheiter H. 1993. Mutations at the mouse microphthalmia locus are associated with defects in a gene encoding a novel basic-helix-loop-helix-zipper protein. Cell 74:395–404 338. Sirito M, Walker S, Lin Q, Kozlowski MT, Klein WH, Sawadogo M. 1992. Members of the USF family of helix-loop-helix proteins bind DNA as homo- as well as heterodimers. Gene Expr. 2:231–40 339. Gregor P, Sawadogo M, Roeder R. 1990. The adenovirus major late transcription factor USF is a member of the helixloop-helix group of regulatory proteins and binds to DNA as a dimer. Genes Dev. 4:1730–40 340. Blackwell TK, Kretzner L, Blackwood EM, Eisenman RN, Weintraub H. 1990. Sequence-specific DNA binding by the cMyc protein. Science 250:1149–51 341. Blackwood EM, Eisenman RN. 1991.

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HENDERSON & CALAME AH, Speck NA. 1996. The CBFbeta subunit is essential for CBFalpha2 (AML1) function in vivo. Cell 87:697–708 Mach B, Steimle V, Martinez-Soria E, Reith W. 1996. Regulation of MHC class II genes: lessons from a disease. Annu. Rev. Immunol. 14:301–31 Steimle V, Otten LA, Zufferey M, Mach B. 1993. Complementation cloning of an MHC class II transactivator mutated in hereditary MHC class II deficiency (or bare lymphocyte syndrome). Cell 75: 135–46 Chang CH, Guerder S, Hong SC, van Ewijk W, Flavell RA. 1996. Mice lacking the MHC class II transactivator (CIITA) show tissue-specific impairment of MHC class II expression. Immunity 4:167–78 Chang CH, Flavell RA. 1995. Class II transactivator regulates the expression of multiple genes involved in antigen presentation. J. Exp. Med. 181:765–67 Kern I, Steimle V, Siegrist CA, Mach B. 1995. The two novel MHC class II transactivators RFX5 and CIITA both control expression of HLA-DM genes. Int. Immunol. 7:1295–99 Riley JL, Westerheide SD, Price JA, Brown JA, Boss JM. 1995. Activation of class II MHC genes requires both the X box region and the class II transactivator (CIITA). Immunity 2:533–43 Fontes J, Jiang B, Peterlin M. 1997. The Class II trans-activator CIITA interacts with the TBP-associated factor TAFII32. Nucleic Acids Res. 25:2522–28 Steimle V, Siegrist CA, Mottet A, Lisowska-Grospierre B, Mach B. 1994. Regulation of MHC class II expression by interferon-gamma mediated by the transactivator gene CIITA. Science 265:106–9 Lee YJ, Benveniste EN. 1996. Stat1 alpha expression is involved in IFN-gamma induction of the class II transactivator and class II MHC genes. J. Immunol. 157:1559–68 Lennon AM, Ottone C, Rigaud G, Deaven LL, Longmire J, Fellous M, Bono R, Alcaide-Loridan C. 1997. Isolation of a B-cell-specific promoter for the human class II transactivator. Immunogenetics 45:266–73 Sartoris S, Tosi G, De Lerma Barbaro A, Cestari T, Accolla RS. 1996. Active

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suppression of the class II transactivatorencoding AIR-1 locus is responsible for the lack of major histocompatibility complex class II gene expression observed during differentiation from B cells to plasma cells. Eur. J. Immunol. 26:2456– 60 Liang R, Chan WP, Chan AC, Ho FC. 1996. Rearrangement of the bcl-6 gene in Hodgkin’s disease, lymphocyte predominant type. Am. J. Hematol. 52:63–64 Chang CC, Ye BH, Chaganti RS, DallaFavera R. 1996. BCL-6, a POZ/zincfinger protein, is a sequence-specific transcriptional repressor. Proc. Natl. Acad. Sci. USA 93:6947–52 Seyfert VL, Allman D, He Y, Staudt LM. 1996. Transcriptional repression by the proto-oncogene BCL-6. Oncogene 12:2331–42 Pittaluga S, Ayoubi TA, Wlodarska I, Stul M, Cassiman JJ, Mecucci C, Van Den Berghe H, Van De Ven WJ, De WolfPeeters C. 1996. BCL-6 expression in reactive lymphoid tissue and in B-cell non-Hodgkin’s lymphomas. J. Pathol. 179:145–50 Cattoretti G, Chang CC, Cechova K, Zhang J, Ye BH, Falini B, Louie DC, Offit K, Chaganti RS, Dalla-Favera R. 1995. BCL-6 protein is expressed in germinalcenter B cells. Blood 86:45–53 Allman D, Jain A, Dent A, Maile RR, Selvaggi T, Kehry MR, Staudt LM. 1996. BCL-6 expression during B-cell activation. Blood 87:5257–68 Dent A, Shaffer A, Yu X, Allman D, Staudt L. 1997. Control of inflammation, cytokine expression, and germinal center formation by BCL-6. Science 276:589– 92 Huang S. 1994. Blimp-1 is the murine homolog of the human transcriptional repressor PRDI-BF1. Cell 78:9 Keller A, Maniatis T. 1991. Identification and characterization of a novel repressor of beta-interferon gene expression. Genes Dev. 5:868–79 Kakkis E, Riggs KJ, Gillespie W, Calame K. 1989. A transcriptional repressor of cmyc. Nature 339:718–21 Marcu KB, Bossone SA, Patel AJ. 1992. myc function and regulation. Annu. Rev. Biochem. 61:809–60

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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T CELL MEMORY Annu. Rev. Immunol. 1998.16:201-223. Downloaded from arjournals.annualreviews.org by HINARI on 08/31/07. For personal use only.

R. W. Dutton1, L. M. Bradley2, and S. L. Swain1 1Trudeau

Institute, PO Box 59, Saranac Lake, New York 12983 and 2The Scripps Research Institute, Torrey Pines Road, La Jolla, California 92037; e-mail: sswain northnet.org

KEY WORDS:

homeostasis, homing, cytokine, phenotype, function

ABSTRACT Immunological memory can be defined as the faster and stronger response of an animal that follows reexposure to the same antigen. By this definition, it is an operational property of the whole animal or the immune system. Memory cells express a different pattern of cell surface markers, and they respond in several ways that are functionally different from those of naive cells. Murine memory cells are CD44 high and low in the expression of activation markers such as CD25 (IL-2R), whereas human memory cells are CD45RA−, CD45RO+. In contrast to naive cells, memory cells secrete a full range of T cell cytokines and can be polarized to secrete particular restricted patterns of secretion for both CD4 and CD8 T cells. The requirements for the activation of memory cells for proliferation and cytokine production are not quite as strict as those of naive cells, but costimulation in the broad sense is required for optimum responses and for responses to suboptimum antigen concentrations. It would appear that memory cells can persist in the absence of antigenic stimulation and persist as nondividing cells. Reencounter with the same antigen can expand the population to a new, stable, higher level and generate a separate population of CD44 high effectors that may be required for protection, while competition from other antigens can drive it down to a lower stable level. It is unclear how or where memory cells arise, but once generated they have different pathways of recirculation and homing.

INTRODUCTION: DEFINING T CELL MEMORY The two defining features of the immune response, antigen specificity and memory, have been recognized in some way for over two thousand years. Antigen specificity, a molecular problem, is now rather well understood in terms of two key features, first, rearranging gene families that give rise to repertoires of lymphocyte receptors for single B cell or T cell epitopes and, second, the 201 0732-0582/98/0410-0201$08.00

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clonal distribution of these receptors in individual lymphocytes. Coming to grips with the biological basis of memory, a systems problem, has proved more challenging. Immunological memory can be defined as the altered response of an animal that follows reexposure to the same antigen. By this definition, it is an operational property of the whole animal or the immune system. In general, the memory response is faster and stronger, and we do not normally include the lower responses seen when anergy or tolerance ensue, although these would fall under the definition just propounded. We are thinking more of enhanced responses that lead to better protection against an invading pathogen. In the case of the humoral response, not only is there a greater frequency of antigen reactive cells specific for the antigen, but the cells themselves and their antibody products are clearly qualitatively different. The pathway to the memory B cell is a complex developmental process that occurs in germinal centers; the memory cell emerges after isotype switching and hypermutation of the immunoglobulin genes. These changes in the memory cells can be clearly identified by a number of experimental procedures so that memory B cells can be readily recognized. The case for a memory T cell is less clear. No special anatomical site has been identified where memory T cells develop; no isotype switching of the T cell receptor genes occurs; and no advantageous somatic mutations selected for higher affinity have been observed. The repertoire of antigen-specific T cells is narrowed following initial encounter with antigen (1), but this fact can be explained as solely the result of selected outgrowth of a subset of the original cells. An increase in the frequency of antigen-reactive T cells appears following immunization, and this increased frequency can be maintained for long periods of time (2–4). This is a quantitative change, and the question remains whether there is also a qualitative change leading to an altered T cell that can be called a “memory” cell and, if there is a memory T cell, how can it be identified. The answer to the first part of the question appears to be “yes” and to the second, “with difficulty.” Memory T cells are different from naive T cells. They express a different pattern of cell surface markers, and they respond in several functionally different ways from naive cells. Here, we have chosen to concentrate on the classic T cell memory, which is long lived, in that it can be recalled long after the initial exposure to antigen and is carried by small resting lymphocytes rather than ones with the characteristics of activated effectors.

CELL SURFACE PHENOTYPE OF MEMORY T CELLS CD45 has been widely used, with the higher molecular weight isoforms defining the pool containing naive cells and the lower molecular weight isoforms,

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the pool in which memory cells reside. In fact, multiple CD45 isoforms are expressed on the cell surface in various combinations (5). This complexity is generally ignored, and the molecule is treated as though it is expressed in either the high molecular weight or the low molecular weight form. Empirically, the presence of any of the three epitopes A, B, or C is often taken as evidence that the high molecular weight, naive form is present (6). Thus, in the human, naive cells are held to be CD45RA positive, CD45RO negative, and memory T cells to be CD45RA negative and CD45RO positive. (The CD45RO antibody identifies an epitope that is present in the absence of A, B, and C.) In the mouse, using different anti-CD45 reagents, the CD45RB isoform has been used by some investigators, with naive cells being RB high and the memory RB low. There is no well-characterized antibody for the murine RO form. The CD45 profile can also change with activation or with cytokine treatment (6), and so most would argue that these phenotypes, in the mouse, are less reliable than in the human, and so most prefer to use the level of expression of the adhesion molecules CD44 and CD62L. Naive T cells are CD44 low, and memory T cells are CD44 high. Here again problems arise because the clear pattern seen in C57BL/6 mice is not seen in BALB/c and other strains (7). Naive cells are also CD62L high and lose expression of antigen on encounter with antigen (8). Naive cells can thus be readily distinguished from effector T cells. Subsequently, some memory cells (especially CD8) appear to regain CD62L expression and again the marker does not provide a definitive identification of the memory cell. In the rat the situation is even more problematic. CD44 is not significantly upregulated in memory T cells that are heterogeneous for CD62L expression, and loss of CD45RC (OX 22) has been used to identify memory cells (6). Clearly, however, some antigen-experienced antigen reactive cells can regain CD45RC, and the marker still poses problems in interpretation (6). The differential expression of adhesion molecules has been used to define naive and memory subsets in sheep (9). Another problem is that activated effector T cells (10) have already downregulated CD62L expression and elevated CD44. This has led to a certain amount of confusion because the pool defined by these changes contains not only memory cells but also activated effector cells. Memory cells are in a pool defined by certain markers; the cells in the pool defined by these markers have certain properties; and therefore it is sometimes erroneously assumed these are the properties of memory cells. Yet further problems are that many studies do not distinguish between changes in the phenotype of CD4 and CD8 T cells, nor do they apply criteria established for CD4 cells to CD8 with adequate caution. The best that can be done is to apply multiple criteria to identify memory cells. Thus, CD44 high memory cells should also be low in the expression of activation markers such as CD25 (IL-2R) and CD69, and this appears, in

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general, to be the case. Murine memory CD8 cells are Ly6C high (11), which distinguishes them from effectors that are Ly6C low (AM Cerwenka, SL Swain, RW Dutton, unpublished). Welsh has shown that Mac-1 (12) and CZ-1 (13) are activation markers that remain high on activated and resting CD8 memory cells. Clearly, differences exist between the phenotype of naive and memory T cells, but in view of these many caveats, the use of these criteria need to be applied with great caution, especially when interpreting the results of the numerous experiments that seek to characterize the nature and behavior of memory T cells defined by phenotype.

MEMORY CELL FUNCTION The salient properties of the memory response are expected to be that it is faster, larger, and more effective than the primary response, and that these properties would be reflected in related properties of the memory cells themselves. One reason memory responses are larger is certainly the increased frequency of antigen-specific CD4 (8) and CD8 (2) T cells present in primed animals. Less clear are the relative contributions of other distinctions between naive and memory cells. Transgenic models allow the visualization of specific T cell populations and head-to-head comparisons of cells with the same TCR at different stages of differentiation. With these, it is now possible to reevaluate which behaviors of memory and naive cells are the same, which are different, and how residual effector populations may contribute to the state of memory. Here we concentrate on those studies that make such direct comparisons, largely ignoring less definitive earlier studies that either relied on phenotypic definitions of memory and/or could have been complicated by differences in frequency or selection for affinity.

Elicitation of Memory Function From polyclonal models, it has been suggested that memory cells are more easily triggered than naive, responding at lower antigen dose (14), without the stringent requirements for costimulation (15) that tightly delimit the response of naive T cells to antigen. Indeed, when resting naive T cell receptor (TCR) transgenic (Tg) CD4 T cells become activated effectors, they are able to proliferate and secrete most cytokines at much lower doses of peptide (16, 17) and in the absence of costimulation from known pathways (10, 17). But are these features retained when the cells become resting memory? Surprisingly little information is available. In the AND (pigeon cytochrome C-specific TCR) Tg model, memory cells isolated after adoptive transfer of effectors (18) are resting cells that show only a marginal decrease, compared to

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naive cells, in the dose of peptide required for elicitation of cytokine production and proliferation (P Rogers, C Dubey, SL Swain, unpublished). Direct comparisons of the costimulation requirements of naive and memory cells in the same model suggest that memory but not naive T cells will respond to high receptor cross-linking, such as is provided by platebound anti-CD3 (19) or anti-Vβ or very high peptide doses even when levels of potential costimulation are low or absent (P Rogers, C Dubey, SL Swain, unpublished). However, optimum response remains dependent on costimulation, defined broadly to include not only interactions between CD28 and its ligands, but also those mediated by integrins such as CD54/CDlla (LFA-1) (20). We hypothesize that the requirement for costimulation is critical for restricting responses of resting T cells such that only infectious agents capable of activating so-called “professional APC” to express costimulatory ligands will be efficient at initiating responses. It seems appropriate that this regulatory mechanism be reinstated with the transition to memory. No direct studies of similar CD8 populations have yet been reported. It has also been suggested that memory cells are more (21) or less (22) sensitive to downregulation or anergy and that signal transduction is altered in memory populations (23). Indeed, it is likely that the differences in cell surface expression of integrins, CD45 isoforms, CD44, and other proteins with known or suspected receptor functions will result in additional signaling events when the ligands are present on the APC, providing possible alternate regulatory mechanisms.

Responses of Memory Cells The majority of studies have focused on models using conventional antigenprimed animals in which the frequency of antigen specific cells and the avidity of the receptors are uncontrolled and in which the presence of contaminating effectors has not been excluded. Memory cells secrete a wider variety of cytokines than do naive cells. Naive CD4 produce only IL-2 and IL-3, and naive CD8 produce only IFNγ , whereas memory cells can be induced to secrete the whole range of T cell cytokines (18; AM Cerwenka, SL Swain, RW Dutton, unpublished). Moreover, populations of polarized effector cells will, upon adoptive transfer, give rise to resting memory cells that retain the polarized pattern (18). Thus, not only do memory cells secrete a potentially broader range of cytokines upon restimulation, they can also be specialized to perform unique functions specified by the patterns of cytokines they secrete. The cytokine production capabilities of memory cells are sure to endow them with a broad spectrum of functions that naive cells cannot perform (at least until they have differentiated into effectors). One such function is B cell help that enables B cells to differentiate into antibody secreting cells. Naive CD4 T cells are very poor at helping B cells, whereas memory CD4 T cells mediate vigorous B cell

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responses (18, 24). Effector cells secrete much higher titers of cytokines than do either naive or memory cells, and they do it with faster kinetics than resting T cell populations (10, 25). There have been no reports of careful studies of whether the kinetics of cytokine production and cell cycle progression might be accelerated in memory CD4 or CD8 cells, compared to naive T cells. In both CD4 and CD8 models the optimal generation of effectors from naive T cells takes 4–5 days, though some select effector functions may be elicited after 1–2 days of stimulation (8, 26, 27). Memory cells also give rise to a second generation of effectors (memory effectors) after restimulation with antigen, and this response seems to peak earlier than the response of naive cells, supporting a further functionally significant difference between naive and memory cells (28). Activated cells and effectors can be induced to undergo rapid apoptosis upon restimulation (29–31), while naive cells respond under the same conditions by secreting cytokines and proliferating (32). The susceptibility to rapid activationinduced cell death (AICD) develops during the generation of effectors (29). The susceptibility to rapid AICD seems to disappear when CD4 cells become memory cells and their response pattern returns to the pattern seen for naive cells (10) (X Zhang, P Rogers, C Dubey, SL Swain unpublished). T cells also exert their functions via the expression of ligands that interact with coreceptors on the APC with which they interact. Thus, the expression of CD40L, ligands for integrins, or members of the TNF family (e.g. FasL) will have profound effects on function. CD40L is rapidly upregulated on naive CD4 T cells (33, 34), while FasL is known to be upregulated only on more activated T cells (29). Whether there are differences in kinetics or the extent of expression between naive and memory cells of CD8 or CD4 lineage remains unexplored. We suggest that the most striking differences in the function of naive and memory T cells are not in their requirements for stimulation but in the great diversity of cytokines that can be produced in different patterns by memory CD4 and CD8 T cells.

HOMING AND MIGRATION OF MEMORY T CELLS The continuous recirculation of lymphocytes from blood into tissue is thought to be a fundamental feature of the biology of the immune system that ensures dissemination of rare cells of particular specificities throughout the body. For memory T cells, the capacity to enter tissues from the blood is thought to be integral to the process of immune surveillance for previously encountered antigen. Analyses of lymphocyte migration both in vivo and in vitro under flow conditions have revealed that carefully orchestrated interactions involving selectins, integrins, chemokines, and cytokines underlie the remarkable ability of cells to leave the blood in the face of tremendous shear forces and migrate through

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endothelium into adjacent tissue (reviewed in 35). While salient features of this process for various types of leukocytes are essentially similar, a remarkable diversity exists in the molecules with the capacity to perform identical functions. This redundancy enables the immune system to use distinct combinations of molecules in different anatomical locations to very specifically target memory T cells to locations where the likelihood of encounter with antigen is substantially elevated.

Recirculation of Memory T Cells Antigen recall responses of resting T cells are demonstrable in PBL as well as in lymphoid tissues as soon as the primary response subsides, indicating that T cells with the capacity for memory arise during the primary response. Memory responses are often demonstrable for extended periods after initial antigen exposure, particularly in the blood and spleen. This general finding has been used as support for the notion that all memory cells are recirculating and engaged in the process of immune surveillance. Studies of the homing of L-selectin− cells, which include most memory CD4 cells and many CD8 memory cells, in the mouse (10, 36–39) indicate that these cells do not migrate into lymphoid tissues where entry is controlled by HEV during recirculation. Because memory cells retain elevated levels of adhesion molecules associated with effector cells, it is thought that memory cells primarily recirculate by migrating into nonlymphoid tissues, draining into lymphoid tissue via the afferent lymphatics, and finally returning to blood in efferent lymph (40). The evidence for this hypothesis is that, in vivo, cells that enter lymph nodes in lymph are exclusively of a memory phenotype (40). However, whether such cells are in the process of recirculation or are cells that have responded to antigen in tissue and have trickled into draining nodes via lymph, but do not then recirculate, is not known. Regardless, the numbers of cells that enter lymph nodes by this process are few compared to the large numbers of naive T cells that recirculate via HEVs. In vitro, resting T cells of a memory phenotype extravasate through both normal and activated endothelium, whereas naive cells do not (41). These data suggest that memory cells can enter nonlymphoid tissues through endothelium but do not reveal whether this is a biologically important process in vivo. Several studies suggest that in vivo, naive cells can also migrate into nonlymphoid tissues via normal or inflamed endothelium (42–46), although in vivo their propensity for this behavior is limited compared to their preferential recirculation via HEV. A conceptual difficulty with the hypothesis that memory cells recirculate exclusively by migration through normal endothelium in the absence of an immune response, is that none of the conditions known to promote leukocyte extravasation from the blood are present. Without inflammation,

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adhesion molecules would not be upregulated on endothelium, and no mediators (chemokines or cytokines) would be present to call cells from the blood into tissue. In support of this contention, recent evidence suggests that the majority of memory cells do not migrate into tissue in the absence of an immune response (47; LM Bradley, unpublished data). These observations support the hypothesis that memory and naive cells do have distinct pathways of recirculation. A surprising and generally overlooked observation is that, following a primary response to antigen in lymph nodes, frequencies of antigen-specific T cells do not remain substantially elevated as they do in the blood (1, 48). This suggests that many memory cells, particularly those that develop in lymph nodes, may leave the sites where they are generated and enter the circulation, but they do not reenter these sites to any appreciable extent. In support of this concept, the numbers of T cells of a memory phenotype increase in the spleen and blood as animals age (49–51). The low frequency of L-selectin− cells in lymph nodes (52) suggests that entry may correlate with expression of this molecule. In its absence, memory T cells have limited access and instead recirculate through sites where other available adhesion molecules can facilitate migration. Our homing studies (10, 53) demonstrate that L-selectin− memory CD4 cells do not enter tissues where migration is through HEV (which include Peyer’s patches as well as peripheral and mesenteric lymph nodes) even after several weeks following transfer to recipients, though they are demonstrable in the blood and spleen (LM Bradley, unpublished data). Thus, many memory T cells recirculate in the blood but do not migrate efficiently into lymph nodes via either HEV or normal endothelium in the absence of an immune response (47). However, when recirculation of naive CD4 cells to sites where entry is controlled by HEV is blocked, a residual memory population is demonstrable (LM Bradley, submitted). This finding combined with the very low rate of entry of memory-like cells from lymphatics (40) suggests that some memory cells may be sessile in a resting animal. At face value, it would seem problematic that few memory cells remain in lymph nodes after a primary response subsides unless antigen persists, particularly as these sites are thought to be important locations for exposure of the immune system to antigen that enter through tissues. Yet maintenance of memory and homeostatic controls may not require more. Studies of naive T cells suggest that large numbers of cells can be rapidly expanded from only a small number precursors (54, 55), and memory T cells may have a greater capacity for proliferation than do naive T cells (14, 56), owing in part to lowered activation requirements (57). Thus, a memory effector T cell population could be quickly generated from a small population of precursors that remains within the tissue following the primary response. Moreover, reintroduction of antigen can cause rapid recruitment of both CD4 and CD8 memory cells from

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the blood into lymph nodes (47; LM Bradley, unpublished data). Exposure to systemic antigen readily induces antigen-recall responses of T cells in the spleen, where memory cells have access to antigen from the blood. Memory T cells, like memory B cells, may be retained to a greater extent in the spleen (47, 58) than in the lymph nodes. Memory effectors that develop in both the spleen and lymph nodes would be expected to be similar to primary effectors in terms of capacities for relocation to additional sites of antigen exposure. Thus, the routes of antigen reexposure may have important effects on the dynamics of memory T cell migration. The ability to retain a few cells at sites where original activation by antigen occurs, combined with the ability to rapidly mobilize memory cells from the blood to sites of antigen reexposure, would be a highly effective strategy for generating efficient memory T cell responses.

Tissue-Specific Migration of Memory T Cells A large body of evidence now supports the concept that adhesion receptors direct the migration of T cells to different anatomical sites. L-selectin (36, 59, 60) and β7 integrin (61) knockout mice as well as numerous blocking studies with Mab to these receptors (52, 62, 63) demonstrate the critical importance of integrins to lymphocyte migration to peripheral lymph nodes and gut-associated tissues, respectively. Studies of both CD4 and CD8 cells indicate that the location of initial antigen exposure determines restricted subsequent homing receptor usage by memory cells (reviewed in 64). The cytokine milieu in which T cells are primed appears to govern the selective upregulation and/or loss of particular integrins as well as other markers such as CD45RB, and L-selectin. Most well characterized in this respect are the α4β1 and α4β7 integrins (9, 64–66). The former, the primary ligand for VCAM-1, which is expressed on follicular dendritic cells and macrophages in addition to inflamed endothelium, is thought to typify recirculating T cells that were primed in peripheral sites such as lymph nodes. In sheep and humans, the α4β1 subset of memory phenotype cells also expresses L-selectin (62, 67). Memory T cells found in peripheral lymph nodes can also express the cutaneous lymphocyte antigen (CLA), a ligand for E-selectin that is thought to direct them to sites of antigen exposure in human skin (67). In contrast, α4β7 expression predominates on memory CD4 cells generated in gut-associated tissues, and such cells show preferential recirculation back to the gut. Recent studies suggest that the distinctions between peripheral and gut mucosal migration extend to other mucosal sites as well. In fact, CD8 cells primed by mucosal routes (e.g. intranasal viral infection) preferentially recirculate through other mucosal sites in the gut and reproductive tracts and are only found to a limited extent in peripheral lymphoid tissues (68). Although much of the data on differential homing receptor usage by memory cells is indirect, the concepts are consistent with largely distinctive peripheral

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and mucosal pathways of recirculation that were initially described two decades ago (69). However, additional complexities are introduced by the presence of subsets of CD4 cells (Th1 and Th2) (70, 71) as well as CD8 cells (Tc1 and Tc2) (72, 73) whose surface phenotypes and differentiation are influenced by cytokines (74) and possibly chemokines (75). It has recently been proposed that differential homing by CD4 memory cells is exclusively a consequence of Th1 versus Th2 development (76), based on studies of in vitro generated subsets (77). While this may occur, particularly with antigens that lead to preferential subset development in certain sites, this can by no means be a universal explanation for apparent tissue-specific migration. Priming conditions that relate to the nature of the antigen, route of exposure, and dose are among the factors that have profound influence of T cell subset development and can in turn affect expression of surface markers and migratory potential. Moreover, under different priming conditions, chemokine-mediated, selective recruitment of Th1 versus Th2 cells has been observed. In inflammatory reactions in the skin and lung where Th1 cells accumulate, RANTES induced in response to Th1 cytokines (78) appears to play a role in the recruitment of activated and memory CD4 cells (79, 80). IL-12, a product of activated macrophages and the primary cytokine to elicit IFN-γ secretion by Th1 cells, has been shown to induce CLA expression on T cells (81), which would facilitate migration of Th1 cells into inflamed skin. In gut mucosal tissues, the predominant responses involve Th2 cells that secrete IL-4, IL-5, IL-6, and IL-10. Transforming growth factor β(TGF-β), which is produced by numerous cells, including CD4 and endothelial cells, promotes development of IgA responses and appears to be a major cytokine that upregulates expression of β7 integrins on T cells (82). Recent evidence suggests that the chemokines MIP-1a and MCP-1 may differentially regulate cytokine production by Th1 and Th2 cells, respectively (75). It is likely that cytokines present in localized sites of inflammation play additional roles in the expansion of particular subsets during the memory T cell response. While it is attractive to envision that memory T cells preferentially recirculate through sites where the potential for exposure to the priming antigen is greatest, with Th1 cells dominating in the peripheral circulation and Th2 responses in the mucosal circulation, it is important to keep in mind that such limitations on memory T cell migration could limit the efficacy of memory responses by compromising the ability for reencounter of antigen when exposure occurs at locations other than the initial route.

GENERATION OF MEMORY CELLS After the effector response has subsided, resting memory T lymphocytes are found. The source of the memory cells is still unclear in the sense that they

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may derive either from effectors themselves or from some cohort of the activated population either precommitted to become memory cells or driven by a stochastic or directive process into the memory cell pool. The factors involved in the transition of activated T cells to resting memory cells are largely unknown because memory has only been generated in vivo. Thus in most cases the requirements for naive T cell activation and proliferation have not been delineated from subsequent requirements that result in generation of memory cells.

Role of Antigen in Memory T Cell Generation Until recently it has been particularly difficult to assess the role of repeated antigenic stimulation in T cell memory generation. The argument is compelling for a strict requirement for antigen reexposure to achieve B cell memory generation from activated B cells in germinal centers to select somatic mutants with high affinity for antigen (e.g. 83). However, the situation for T cells, which do not undergo somatic mutation to any great extent, is not parallel. CD4 T cells do seem to undergo “repertoire selection” (54), although others have suggested that in most cases the memory CD8 repertoire reflects that of the initial responding CD8 cells (3, 84). Transfer of in vitro (18; AM Cerwenka, SL Swain, RW Dutton, unpublished) or in vivo (2, 56) generated effectors, but not antigen-specific naive cells, results in development of a resting memory population in adoptive hosts not restimulated with antigen. This confirms the fact that initial antigen-mediated events are required but suggests that repeated contact with antigen is not necessary for the transition from activated T cells to memory T cells. Others have argued, however, that memory generation could be mediated by cross-reacting antigens or low-avidity interactions with TCR (85). Several observations suggest the alternate hypothesis that cross-reactive antigen is not involved. First interaction of antigen with activated effector cells results in stimulation of progression through cell cycle, in cytokine production, in upregulation of cytokine receptors, maintenance of an activated state, and thus in cell division and potential expansion (86). Activation also leads to AICD (29, 31, 86), both curtailing the response and leading to its exhaustion. Exhaustion of CD8 effector responses to virus are also seen in vivo (87, 88). These fates are incompatible with the generation of small, resting memory cells. In fact it seems most likely that the transition from an activated cell to a resting memory cell depends on lack of antigen stimulation because effectors or in vivo primed resting TcR transgenic memory cells will transfer memory to hosts without further antigen stimulation. Moreover, it seems unlikely that antigens reacting with receptors using endogenous TCRα chains are involved since T cells from TCR Tg mice on a RAG-2 KO background are able to transfer memory (89; SL Swain, G Huston, unpublished). Furthermore, in the AND Tg model, studies

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in aged mice suggest no antigens are present in the environment that react with the Tg TCR (90). Thus, the evidence taken together suggests that antigen is not required for the transition from activated to memory T cell.

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Role of Other Factors in Memory T Cell Generation from Effectors Studies with cytokine knockout mice indicate that T cell produced cytokines including IL-2, IL-4, or IFNγ , do not have a necessary role in T cell memory generation. We have found that transfer of effectors from TCR Tg, cytokine KO mice results in efficient memory CD4 generation (SL Swain, G Huston, unpublished). Several studies report memory generation in the absence of B cells (91, 92), indicating that antigen persistence, mediated by antigen/antibody complexes is not required. We conclude that the transition from activated to resting memory is mediated through pathways not involving antigen recognition. That is not to say that repeated antigen stimulation will not increase the pool of cells that become memory, nor is it unlikely that memory populations may be expanded in adoptive hosts by specific stimulation, although direct demonstrations of these possibilities have not been reported. What other signals favor memory generation from activated cells? It stands to reason that activated cells must escape cell death if they are to go on to be memory. Thus, factors that promote survival of otherwise death-susceptible T cells are candidates for memory factors. IL-2 participates in T cell survival, but it also keeps T cells in an activated state in which they are susceptible to death (29, 31). The cytokine TGFβ both promotes CD4 and CD8 effector survival (86, 93) and also tends to push activated effector cells to a more resting phenotype (X Zhang, L Giangreco, SL Swain, unpublished), provided antigen and IL-2 are not present. Interactions of T cells with fibroblasts (94) or with extracellular matrix components (95) may also provide survival signals in the absence of signals promoting activation, cytokine secretion, and cell cycle progression. Further experiments are needed to identify the signals involved in this critical transition. It remains unclear when T cells become committed to a memory pathway and whether it is a stochastic process or one determined by specific signals. One recent study argued that the memory pathway was induced separately from that for effector generation, based on experiments indicating that CD28:CD80 interactions were essential for in vivo effector generation but not for memory generation (57). Further analyses are needed to see if such experiments can be repeated in an in vitro system where the multiple costimulation pathways can be better separated for study. We conclude that antigen- and T cell–produced cytokines are not required for the generation of resting memory cells from a cohort of activated/effectors cells, but that the factors that do regulate this transition remain unidentified.

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Homeostasis A number of studies have led to the concept that there are two independently regulated T cell compartments, the naive and the memory, that are maintained at a constant size, throughout the greater part of the life of the animal. Effector cells generated during a response represent a third compartment that expands enormously but then disappears rapidly by massive apoptosis. Naive cells are CD62L high, CD44 low and label only very slowly with agents such as BrdU (89, 96–98), or not at all (99, 100), and therefore they enter the pool only from the thymus. Sprent has shown that they divide once after exiting the thymus and then become nondividing (96). This conclusion is predicated on the belief that all CD44 low are naive and have not reverted from effector or memory cells. It also ignores the possibility that there may be appreciable numbers of anergic cells of unidentified phenotype in the normal mouse. More recently, it has been suggested that interaction of the TcR on the naive cell with a ligand may or may not provide a signal according to the specificity of the receptor (89).

Memory Cells Memory cells, as a population, must be long lived by definition, and conceptually this could be achieved either by generating nondividing cells that never die or by generating a dividing population that provides new members by replication as fast as old members are lost by cell death. The first model has the advantage that it requires no external regulatory component; all the cells have to do is survive. The second requires some regulatory mechanism that ensures that the rate of cell death is rather closely balanced by the rate of cell division. The more recent data, coming from many sources noted above, appear to reverse the earlier understanding and suggest that some if not all of the memory cell population is turning over at a steady rate. The rate of labeling is not rapid, being much less than the maximal of cell division observed in responding lymphocytes, and must be regulated by some form of external control. In this context, Rocha and her colleagues have found that memory cells divide slowly, all the time (101): Transferred memory cells expand whether they are transferred into an empty compartment (athymic recipients) or a full compartment (euthymic recipients), and the size of the pool is regulated, at least in part, by the rate of loss by cell death. In addition, memory cells can be serially transferred (101) and show a vast proliferative capacity, limited eventually by Hayflick’s number. Most memory cells have low forward and side scatter on FACS and are low for CD25 and CD69. The exceptions are the small numbers of CD25+ blast cells that are cytolytic ex vivo, described by Selin (102) and other investigators (6). It is not clear whether these should be considered as memory cells or as

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recently reactivated effector cells. Tough & Sprent (96) have also described two types of memory cells, a dividing pool and a resting pool. These conclusions are based on identifying memory cells by CD44 and CD45RB phenotype and showing that not all cells of this phenotype label even after prolonged periods, and by BrdU pulse chase experiments that show that some cells labeled in the pulse fail to lose label in the chase. There is some worry about the long-term labeling studies with BrdU (103, 104), and one could argue that some dividing cells may be unlabeled or that labeled cells fail to lose label because BrdU is inhibitory. BrdU also interferes with transcription and could alter cell surface marker expression (105). It is also possible that not all cells bearing the memory phenotype are functional. It is clear that some memory cells, defined by cell surface marker expression in mouse, sheep (9), and human (106), do divide. Welsh has shown that effective memory, as judged by the presence of CTLp in a limiting dilution assay, resides in at least three populations one year after immunization with LCMV (88). About 60% of the precursors are in an L-selectin high pool and 40% in an L-selectin low. Some of the L-selectin high are large, express IL-2 receptors, are in cycle, and develop into CTL without IL-2. The others are small, lack IL-2R, and require IL-2. The third pool is L-selectin low, small, and requires IL-2 for development. In addition there is a small pool of blasts that are cytolytic in a sensitive 6-h assay immediately ex vivo and the cytolytic activity of which is not blocked by cyclosporin A (102). The design of the experiment does not allow one to determine whether any of the cells are driven by antigen presence but does provide the most accurate picture of the complexity of immune memory in an unmanipulated animal. In our own studies involving the transfer of in vitro generated effectors into adult thymectomized irradiated bone marrow–restored recipients with PCCFspecific TCR Tg CD4 ‘AND’ (10) and with the HA-specific TCR Tg CD8 ‘Clone 4’ (AM Cerwenka, SL Swain, RW Dutton, unpublished), there is a brief initial period of expansion. After this, the memory cells persist and are predominantly in the resting state (IL-2R, CD69 low, small forward scatter and side scatter), and the CD8 cells are Ly6C high, in contrast to effectors that are Ly6C low (AM Cerwenka, SL Swain, RW Dutton, unpublished)

Requirements for the Maintenance of Memory: Antigen A number of questions have been examined by several investigators, often with conflicting conclusions drawn from the data obtained. Is antigen needed for maintenance of memory? This issue has been investigated for at least the past 30 years (107). We do not reexamine the early studies here but note that different antigens have quite different half lives; peptide versus replicating virus represents the extremes, and there are mechanisms to store

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antigen in the iccosomes attached to follicular dendritic cells. More recent experiments continue to yield mixed results. Four studies (47, 108–110) have argued that antigen is needed, while a second four say it is not (2, 10, 56, 92). The reasons for these differences reside most probably in the different protocols used, as discussed below. CD8 memory is subject to exhaustion if exposed to too much antigen (87) or anergy (111).

Technical Issues and Caveats A number of technical considerations influence the outcome in different experimental models. Many of the more recent studies on the factors that control the maintenance of memory involve transfer of TCR Tg cells (rather than polyclonal populations), which can be followed in the recipient by some form of TCR marker and by reactivity to antigen (see below). The use of the transgene allows one to follow antigen-driven events and the availability of pure naive cells, especially if RAG −/− are used. It also ensures that the effects of background environmental stimulation are less likely to directly affect the outcome of the experiment. The transferred memory cells can be transferred into empty space (nudes, SCIDs ATXBM, or irradiated recipients), in which case they may be subject to homeostatic forces that are working to ensure that the empty space becomes full (increase in proliferation and/or reduction of cell death). Or memory cells may be transferred into normal mice, in which case the death rate may increase to compensate for the increase due to added cells and the transferred cells must compete with recipient cells. Differences between these two models may account for some of the differences observed. It has been claimed (112) that many experimental protocols commonly used in surgery are sufficient to deplete from 50% to 90% of cells from primary and secondary lymphoid organs, as a result of stress. This suggestion has been ignored in later discussions. Cultured cells may take up antigens from fetal calf serum that could markedly affect the host response in adoptive transfer models. It is not clear how far either of these two potentially critical issues has affected the results. Memory cells can proliferate while naive cells cannot. Hence upon transfer of naive cells from a TcR transgenic mouse into T-depleted recipients, the Tg+ naive cells that do not divide get diluted out by memory cells using endogenous TCRα which expand. A number of investigators have used RAG-2 −/− to obviate this problem by ensuring that there are no, or at least fewer, memory cells in the inoculum. Finally, memory has been measured in a number of different ways. CD8 memory can be determined by the limiting dilution assay of CTLp, or it can be

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measured by the ability to provide protection against challenge by the pathogen. CD4 memory can be, although rarely is, measured by limiting dilution of cells able to produce helper cytokines, or it can be measured by bulk help to B cells. Persistence of transferred cells can be followed also by any donor-specific marker. We conclude that the issue of whether antigen is required for the persistence of memory is still undecided; the conclusion depends on the criterion of memory used and is perhaps unresolvable experimentally. Antigen, in current terms, is a peptide on class 1 or class 11 MHC. The same peptide could come from anywhere, including self, and analog peptides or even unrelated peptides could bind the receptor. The use of memory TCR Tg cells transferred into recipients limits the possibilities for encountering ligands, especially if TCR Tg crossed onto RAG-2 −/− is used, but one cannot completely refute the possibility that a ligand, capable of interacting with the TCR, is present in the recipient. One can show, in some cases, that operationally the hypothetical ligand does not elicit a primary response or a secondary response. Thus, in aged AND (pigeon cytochrome c-specific) mice all of the cells that are still Vβ3 high, Vα11 high, carry the naive phenotype, i.e., are CD44 low, while cells expressing endogenous α are CD44 high (90). But one cannot rule out hypothetical ligand (89) that does not elicit primary or secondary response but does interact with the TCR enough to keep the cell ticking over. This argument is by no means implausible because such a ligand had to exist in the mouse to positively select the cell with the transgene TCR in the thymus, in the first place. Our conclusion is that, once generated, memory cells to a particular epitope (peptide-MHC complex) can persist in the absence of antigenic stimulation and persist as nondividing cells. Reencounter with the same antigen can expand the population to a new stable higher level and generate a separate population of CD44 high effectors that may be required for protection, whereas competition from other antigens can diminish it to a lower stable level. States intermediate between resting and effector would also seem to exist.

Factors Other Than Specific Antigen In addition to the question of the role of antigen are the questions about whether cell interactions between lineages are required for the maintenance for memory. Some of the motivation for considering these questions is based on the concept that memory T cells do need antigen that B cells present or, in the case of CD8 cells, that they need help from CD4 T cells that need B cells. Alternatively, CD4, CD8, and B cells need to be in some sort of balance to maintain the equilibrium of all parties at a constant status quo. Di Rosa & Matzinger (92) have found that CD8 memory cells do not require CD4 T cells to persist, as do our own studies (AM Cerwenka, SL Swain,

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RW Dutton, unpublished), while in other studies it does not seem to be so clear (113, 114). It seems to be generally agreed that CD8 memory do not require B cells, (91, 92, 115). A recent paper by Tanchot and colleagues (116) suggests that interactions of the TCR with various elements of class 1 MHC may affect the survival of naive and memory cells. The issue of whether responses to heterologous or unrelated antigen expand memory is more contentious. Sprent and his colleagues (11) claim that unrelated viral infections stimulate type 1 IFN, which causes proliferation of unrelated memory cells, and that this is important in maintaining memory cell populations. Zinkernagel and colleagues (117), however, found no evidence that type 1 IFN could cause enhanced CTL activity in vitro or that viral infections could enhance memory in vivo. Rather they found that high concentrations of IL-2 alone could induce CTL activity in naive cells. The reasons for these differences are not clear. Selin and her colleagues found that each new response to an unrelated antigen dilutes the old memory pool (3). A more recent paper by the same group (118) provides evidence that only cross-reacting cells are involved in the type of responses reported by Tough et al and that cells of truly unrelated specificity are not involved. Under this model, cross-reacting antigens would help to maintain and non-cross-reacting antigens would diminish immunological memory.

CONCLUSIONS We have chosen to concentrate on the T cell memory that is provided by longlived populations of antigen-specific resting cells that develop as a consequence of antigen stimulation. This population has a characteristic if not unique phenotype, combining changes wrought by antigen exposure (upregulation of CD44 and integrins, downregulation of CD62L and high molecular weight CD45 isoforms) with indications of reversion to a resting state (small size, lack of expression of receptors for IL-2, or transferrin or activation markers such as CD69). None of these criteria is sufficiently stable to be used confidently to identify memory cells. The most dramatic differences between naive and memory cells are functional. Particularly important is the ability of memory cells to secrete the full range of T cell cytokines and to be polarized to secrete particular restricted patterns. The requirements for the activation of memory cells for proliferation and cytokine production are not quite so strict as those of naive cells, but costimulation in the broad sense is required for optimum responses and for responses to suboptimum antigen concentrations. The memory population is very long lived, and lymphocytes within the population may divide occasionally at a rate controlled, at least in part, by homeostasis. Memory T cells do not recirculate continuously via extravasation through

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HEV, and some may actually be nonrecirculating and be maintained indefinitely in specific lymphoid sites. The dramatically enhanced memory response of T cells observed in primed animals is likely to be the result of these differences in response, combined with the increased frequency of precursors to specific antigen within the pool. The requirements for the generation and maintenance of memory are still largely unclear. Reexposure to specific antigen does not seem to be needed to generate memory T cells from a previously antigen-activated population. Indeed, we have argued that the transition to resting memory depends on lack of TCR triggering. Several cytokines critical in T cell proliferation (IL-2) and polarization (IL-4, IFNγ ) are not required for memory cell transition. The identification of additional factors involved in memory T cell generation and persistence is an important goal for future studies. ACKNOWLEDGMENT The studies on immunological memory in the author’s laboratories are supported by NIH grant AI37935. Visit the Annual Reviews home page at http://www.AnnualReviews.org.

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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Annu. Rev. Immunol. 1998. 16:225–60 c 1998 by Annual Reviews. All rights reserved Copyright

NF-κ B AND REL PROTEINS: Evolutionarily Conserved Mediators of Immune Responses Sankar Ghosh, Michael J. May, and Elizabeth B. Kopp Section of Immunobiology and Department of Molecular Biophysics and Biochemistry, Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, Connecticut 06520; e-mail: [email protected] KEY WORDS:

NF-κB, IκB, signal transduction, transcription, gene expression

ABSTRACT The transcription factor NF-κB, more than a decade after its discovery, remains an exciting and active area of study. The involvement of NF-κB in the expression of numerous cytokines and adhesion molecules has supported its role as an evolutionarily conserved coordinating element in the organism’s response to situations of infection, stress, and injury. Recently, significant advances have been made in elucidating the details of the pathways through which signals are transmitted to the NF-κB:IκB complex in the cytosol. The field now awaits the discovery and characterization of the kinase responsible for the inducible phosphorylation of IκB proteins. Another exciting development has been the demonstration that in certain situations NF-κB acts as an anti-apoptotic protein; therefore, elucidation of the mechanism by which NF-κB protects against cell death is an important goal. Finally, the generation of knockouts of members of the NF-κB/IκB family has allowed the study of the roles of these proteins in normal development and physiology. In this review, we discuss some of these recent findings and their implications for the study of NF-κB.

INTRODUCTION The immune system responds to enormous diversity when mounting a defense. It is surprising therefore that relatively few signaling systems have been identified that directly perform the complicated task of communicating states of injury and infection. One way in which such signaling is accomplished is via 225 0732-0582/98/0410-0225$08.00

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inducible messengers such as cytokines, soluble molecules that are generally produced by and act on immune cells. Some cytokines induce the proliferation and differentiation of specific cells, for example, the effect of IL-2 on T cells and of GM-CSF and G-CSF on macrophages and granulocytes. Other cytokines (e.g. IL-1, IL-6, IL-8, and TNFα) induce the acute phase response in inflammation or protect uninfected cells from viral infection (interferon-β). Cytokine signaling to B cells results in their differentiation into plasma cells that then produce antibodies. It is therefore intriguing that in each of these different systems one common transcriptional activator, known as NF-κB, is targeted as an integral messenger in the enhancement of the response. NF-κB is a eucaryotic transcription factor that exists in virtually all cell types. It was first described in 1986 as a nuclear factor necessary for immunoglobulin kappa light chain transcription in B cells (hence the name, nuclear factor-κ B) (1). In mature B cells and plasma cells, NF-κB is localized to the nucleus where it binds a 10 base-pair region of the kappa intronic enhancer and activates transcription. It was originally thought that NF-κB was not produced in other cells, including pre-B cells, because it could not be detected in these cell types by a sensitive gel-shift assay using the Igκ DNA-binding site. Subsequently however, it was found that the DNA-binding ability of NF-κB in these cells was masked by the presence of an inhibitor (2, 3). It is now known that NF-κB preexists in the cytoplasm of most cells in an inactive form bound to the inhibitor, IκB. Upon receipt of an appropriate signal, NF-κB is released from IκB and translocates to the nucleus where it can upregulate transcription of specific genes. It is critical to note that NF-κB’s ability to respond to a signal makes it an inducible factor, and the fact that NF-κB activity does not require new protein synthesis allows the signal to be transmitted quickly. Furthermore, NF-κB communicates with both the cytoplasm and the nucleus and is therefore able to carry messages directly to their nuclear targets. Since the discovery of NF-κB, its responsive sites (κB sites) have been characterized in the promoters and enhancers of numerous genes, making NF-κB an important component in the inducible expression of many proteins, including cytokines, acute phase response proteins, and cell adhesion molecules (4, 5). A closer inspection of these genes reveals a common purpose, namely, enhancement of the immune response. In addition to these inducible genes, NF-κB has been found in an active, nuclear form in mature B cells, plasma cells, macrophages, and some neurons. Because differentiation of cells is defined by the production of cell-type specific proteins, the constitutive activation of NF-κB probably allows some cells to maintain a differentiated phenotype. In this review we describe the known members of the NF-κB family of transcription factors, recent knowledge about the signaling pathways leading to their activation, and their potential role as central coordinators of the innate immune response.

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THE NF-κB/REL AND IκB PROTEINS

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The NF-κB Signaling System Is Evolutionarily Conserved Nature has not overlooked the elegance of the NF-κB signaling system. Indeed, this system has been conserved to operate on divergent genes in many different species (6). In Drosophila three NF-κB molecules have now been described— dorsal, dif, and relish (7–9). The first Drosophila rel protein described was the dorsal/ventral morphogen, Dorsal, which delineates polarity by specifically activating genes on one side of the Drosophila embryo and repressing genes on the other (10). The signal activating Dorsal passes through a transmembrane protein called Toll, which bears a remarkable likeness to the cytoplasmic domain of the type I IL-1 receptor (11) and passes through a serine/threonine protein kinase, pelle, which is also homologous to IRAK (IL-1 receptor-associated kinase) from mammalian cells (12, 13). Dorsal, like NF-κB, is retained in the cytoplasm by an inhibitory protein called cactus (14, 15). The release of Dorsal from cactus (16) requires the kinase pelle, and although the exact sequence of events has not been determined, Dorsal itself is also phosphorylated (12, 17, 18). Interestingly, a κB-dependent mouse enhancer can operate successfully in transgenic flies to direct transcription of the Dorsal-responsive gene, rhomboid, an experiment that succinctly illustrates the versatility of the entire Dorsal/NF-κB transcription system, which has been adapted for use on a variety of genes (6). A more striking similarity in function is observed in the case of the the second rel protein described in Drosophila, known as dif (8). Dif appears to be the fly equivalent of the inducible form of NF-κB because it is active only under certain circumstances and upregulates transcription of insect immunity genes. Dif preexists in the fat body of insects, an organ that is thought to be the ancestral equivalent of the liver in vertebrates (19). Interestingly, the liver is the center for production of the acute phase proteins in the acute phase response to inflammation, a condition partly regulated by NF-κB (20). Dif becomes activated as a result of infection; the dif-activated response is therefore part of a primitive innate immune system controlled by rel proteins (19). Although NF-κB sites have been found in the promoters of many of the insect antibacterial and antifungal genes, including cecropin, attacin, defensin, diptericin, drosocin, and drosomycin, a recent report suggests that not all the genes are regulated by Dorsal or Dif (21). The gene most dependent on Dorsal and Dif was that encoding the antifungal protein drosomycin, while the genes encoding the antibacterial proteins cecropin, attacin, and defensin were only partly dependent. These results suggested an additional signaling pathway in insects that is involved in responses to microbial infection (21). The third known member of the Rel-family in Drosophila is Relish, which appears to be the homolog of the mammalian p105 and p100 proteins (9), with the exception that it has

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a serine-rich region in the place of the glycine-rich region (see below). This protein was reported recently, and as yet very little is known about its regulation except that it is highly upregulated upon bacterial infection. Nevertheless, its similarity to p105 and p100 once again reinforces the striking evolutionary conservation of the Rel/NF-κB family. An intriguing parallel to the Toll/Dorsal/Dif system exists in plants. The product of the plant N gene is homologous to Toll and the IL-1R (22). This gene encodes a transmembrane receptor that confers resistance to tobacco mosaic virus infection probably by signaling the upregulation of the pathogenesis resistance proteins. Although an NF-κB-like protein has not been described in plants, the N protein may ultimately communicate with a similar transcription factor enabling the plant to activate an innate type of immune system. Recently, however, the gene encoding the NIM1 (noninducible immunity) gene in Arabidopsis, which plays a critical role in systemic acquired resistance and disease resistance in plants, has been cloned and found to be homologous to IκB (23). The signaling system of Toll and Dorsal/Dif also led to the search for an equivalent system in mammals. It is gratifying that a mammalian Toll homolog has now been identified, that appears to be able to induce the expression of cytokines and genes known to play an important role in innate and adaptive immunity (24). Therefore, Toll appears to function in vertebrates as a nonclonal receptor that modulates the immune response by activating NF-κB. These findings also further strengthen the notion that signaling in disease resistance responses from flies to mammals utilizes an ancient, evolutionarily conserved, and ubiquitous pathway that involves the Toll/NF-κB/IκB family of proteins.

Structure of NF-κB NF-κB is a dimer of members of the rel family of proteins (reviewed in 4, 5, 25). Each family member contains an N-terminal 300 amino acid conserved region known as the rel homology domain (RHD). This region is responsible for DNA-binding, dimerization, and interaction with IκB family members. It also contains a nuclear localization sequence. The first NF-κB molecule described was a heterodimer of p50 and p65 subunits (5, 25). This protein is still what is commonly referred to as NF-κB despite the diversity of other members now known. Because the two rel proteins making up the complex each contact one half of the DNA binding site, the slight variations possible in the 10 base pair consensus sequence, 50 GGGGYNNCCY30 , confer a preference for selected rel combinations (26). Other rel members include Dif, Dorsal, and Relish (Drosophila, see above), v-rel (chicken oncogene), c-rel, p52, and rel-B (see Figure 1) (reviewed in 4, 5, 25). The transcription factor NFAT (nuclear factor of activated T cells) is also homologous in the Rel-homology domain and is therefore sometimes considered to be a member of the Rel-family of proteins (27). In addition to showing specificity for DNA binding sites, each combination of

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Figure 1 The Rel/NF-κB/IκB family of proteins. Members of the NF-κB/rel and I-κB families of proteins are shown. The number of amino acids in each protein is shown on the right. The arrows point to the endoproteolytic cleavage sites of p100/p52 and p105/p50: RHD, rel homology domain; TD, transactivation domain; LZ, leucine zipper domain of rel-B; GRR, glycine-rich region; SRR, serine-rich region in Relish. IκB- has been proposed to be translated from either the first methionine or from an internal methionine at position 140 (69).

rel proteins also has its own transactivating potential (25). Although most of the NF-κB proteins are transcriptionally active, some combinations are thought to act as inactive or repressive complexes. Thus, p50/p65, p50/c-rel, p65/p65, and p65/c-rel are all transcriptionally active, whereas p50 homodimer and p52 homodimer are transcriptionally repressive (28–32). Because p50 and p52 lack a variable C-terminal domain found in the activating rel proteins, this domain is most likely responsible for transactivation of NF-κB-responsive genes.

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The first glimpse of how proteins of the Rel-family bind to DNA came from the crystal structure of p50 homodimers bound to a κB site (33, 34). Each p50 molecule is comprised of two domains joined by a flexible link. The core of these domains is made up of β-strands that fold in a pattern similar to immunoglobulin domains, although the significance of this similarity is unknown. Dimerization occurs exclusively via the C-terminal domains where a set of hydrophobic side chains interdigitate, clamping these regions together. In both immunoglobulin-like domains, β-strands are connected by loops that are responsible for an unusual DNA-contact interface. Both N- and C-terminal regions are involved in DNA binding, and the dimerization and DNA-binding contacts of the C-terminal domain form a novel continuous interface that essentially “locks” NF-κB to the major groove. This DNA-binding method is also noteworthy in the extensive number of contacts made by the loops to both the sugar-phosphate backbone and the bases. Mutational analysis has confirmed the importance of the bases involved in these interactions (35–37). The overall structure of the p50 dimer forms a molecule likened to a butterfly with the DNA binding site gripped tightly at its center and the immunoglobulin-like domains forming “wings” at the periphery (33, 38). The structure of the p65 RHD bound to DNA has also been solved recently (39). Although the overall architecture of the complex is quite similar to that of p50, the p65-DNA complex reveals a few novel features. Unlike the p50 homodimer, p65 subunits are not symmetrically arranged on the DNA target. While one of the subunits binds a four base-pair DNA half site with sequence specificity, the other subunit displays a remarkably different mode of DNA recognition, retaining only partial specificity for the other half site. This novel mode of DNA recognition exhibited by p65 probably helps to explain the wide range of DNA sequences recognized by NF-κB. Finally, the solution structure of the NFAT DNA-binding domain has also been determined (40). Unlike the other Rel-proteins NFAT-binds to DNA with the AP-1 transcription factor, and the structure of the NFAT-RHD reveals how this interaction might occur. The insert region in NFATc most probably interacts with c-jun in the NFAT-AP-1 complex, and in keeping with this model, mutations in the insert region reduce cooperativity between NFAT and AP-1 without affecting DNA binding by NFATc (40). The structure of NF-κB p50 and p65 has also helped in understanding how NF-κB interacts with other regulatory proteins. In particular, the structure of p50 bound to DNA explains how NF-κB interacts with the HMG-I(Y) protein, in the transcription factor complex formed on the enhancer of the β-interferon gene (41). One of the sites for HMG-I(Y) is in the middle of a NF-κB binding site where the HMG-I(Y) protein contacts DNA from the side of the minor groove (41). The NF-κB p50 dimer approaches the DNA from the side of the major groove, and the structure of the p50-DNA complexes shows that the side

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of the minor groove is empty (33, 34). Therefore, the binding site for HMG-I(Y) remains accessible from the minor groove. The two helices in the N-terminal domain of p50 are close to this region and hence affect the accessibility to the minor groove. Since the sequence corresponding to these helices is variable in different Rel-members and is significantly shorter in p65, it is possible that the binding of HMG-I(Y) could be facilitated when κB sites are bound by other combinations of Rel proteins, such as p50:p65.

Biogenesis of NF-κB p50 and p52 The mRNA retrieved from the cloning of p50, surprisingly, was found to encode for a much larger protein of approximately 105 kDa (42, 43). Likewise, the mRNA for p52 also encodes a protein of 100 kDa (44–46). The N-terminal regions of p105 and p100 are identical to the p50 and p52 proteins, respectively (see Figure 1). Inspection of the C-terminal portion of these molecules revealed several ankyrin repeats, reminiscent of the ankyrin repeats found in the NF-κB inhibitor molecule, IκB (discussed below). Later it was demonstrated that p100 and p105 are posttranslationally cleaved to produce the smaller p50 and p52 products (47–50). This processing is ATP-dependent and requires polyubiquitination in vitro (48, 51). Furthermore, because cytosolic fractions enriched with proteasomes support the processing of p105 in vitro, and proteasome inhibitors block processing in vitro and in vivo, the proteasome complex is implicated in the degradation of the C-terminal region of p105 (51, 52). The exact reason for translation of the larger product is unknown; however, the processing event probably represents a further level of control of the activation of NF-κB. The longer p105 and p100 proteins are exclusively cytosolic because of the masking of the nuclear localization signals on p50 and p52 by the C-terminal ankyrinrepeat region (53). Stimulation of cells with agents that activate NF-κB causes an increase in the rate of degradation of the C-terminal region of these proteins, and consequently increased amounts of p50 and p52, complexed with p65, are produced (54). The complete model of the generation of p50 is, however, far from complete. Recent work suggests that there may be two pathways for the processing of p105: a signal-dependent pathway and a signal-independent pathway (55). The processing described above may be relevant for p105 bound to p65 in the context of a signal-dependent event; that is, upon stimulation, degradation of the C-terminal region of p105 increases, allowing this “pool” of NF-κB to translocate to the nucleus. Indeed, a phosphorylation event on the C-terminal of p105 is thought to be required for this processing (56). However, a preexisting pool of p50 is also associated with p65 and IκBα, which is generated constitutively in the absence of signal (see below). The processing event for the generation of this p50 appears to be regulated by a fascinating novel mechanism

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(55). A 23–amino acid glycine-rich region (GRR) within the N-terminal of p105 is necessary and sufficient for directing the cleavage of p105 a short distance downstream from this region. Mutation or deletion of the C-terminal region (the target for the phosphorylation and degradation of p105 in the signal-dependent pathway) appears to have no effect on the generation of p50 in both unstimulated transfected COS cells and in vitro. Furthermore, cleavage also occurs when this glycine-rich sequence is inserted into a heterologous protein. The proteolytic event only occurs C-terminal to the GRR; however, the exact cleavage site is not determined by a specific linear distance from the glycine-rich region. Studies carried out on p100 indicate that a corresponding GRR also plays an analogous role in directing its cleavage. However, the p100 GRR has not been extensively characterized (57). Although it is not yet clear whether a specific GRR-protease exists, current evidence already hints at a fascinating process whereby the presumed “GRR-protease” recognizes the GRR but cleaves downstream of its binding site in a sequence-independent manner. In some ways, this process is similar to that observed in case of Type III–restriction endonucleases (e.g. Fok I) (58). Clearly, however, determination of the mechanism by which GRR-mediated cleavage of p105 is followed by the rapid degradation of the C-terminal fragment, presumably by the proteasome, will be crucial to reaching a fuller understanding of how p105 and p100 are processed.

IκB Proteins: Inhibitors of NF-κB Activity Activation of NF-κB is regulated by its cytoplasmic inhibitor, IκB. IκB binds NF-κB and masks its nuclear localization signal, thus retaining it in the cytoplasm (25, 59). Like NF-κB, IκB is a member of a larger family of inhibitory molecules that includes IκBα, IκBβ, IκB, IκBγ , and Bcl-3 in higher vertebrate cells and cactus in Drosophila (see Figure 1). All of these inhibitors contain multiple regions of homology known as the ankyrin-repeat motifs. The ankyrin repeats are regions of protein/protein interaction, and the specific interaction between ankyrin repeats and rel-homology domains appears to be a crucial, evolutionarily conserved feature of the regulation of NF-κB proteins. Each IκB differs in the number of ankyrin repeats, and this number appears to influence the specificity with which IκB pairs with a rel dimer. As mentioned above, p100 and p105 also contain ankyrin repeats and are sometimes included in the IκB family. The best-characterized IκB is IκBα, mainly because it was the first member of this family to be cloned (60, 61). IκBα is a 37-kDa protein that has a tripartite organization also seen in IκBβ: an N-terminal domain that is phosphorylated in response to signals, a central ankyrin repeat domain, and a C-terminal PEST domain that is involved in the basal turnover of the protein (25). As is discussed later, most of the current knowledge about signaling through NF-κB derives

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from studies carried out on this protein. Physiologically the defining characteristic of IκBα is its ability to regulate rapid but transient induction of NF-κB activity, owing to the participation of IκBα in an autoregulatory feedback loop; that is, the activation of NF-κB causes the upregulation of transcription of IκBα, which serves to shut off the signal (62–65). This upregulation occurs owing to the presence of κB sites in the IκBα promoter (66, 67). Thus IκBα is thought to maintain the transient effect of inducing agents on the transcription of NF-κ B responsive genes. The continuing presence of certain inducing agents (for example, LPS) however causes NF-κB to be maintained in the nucleus despite the upregulation of IκBα mRNA synthesis, and this persistent activation of NF-κB is regulated by IκBβ (68). IκBβ is a 45-kDa molecule that was cloned later and hence is less well characterized than IκBα (68). Both the biochemical purification and immunoprecipitation studies indicate that the majority of p50:p65 and p50:c-Rel complexes are regulated by IκBα and IκBβ (68, 69). It was originally anticipated that IκBβ would prefer different combinations of rel proteins than IκBα allowing a divergence in the signal transduction pathway (70). Surprisingly, IκBβ binds the same rel subunits as IκBα; the divergence appears to be at the level of the incoming signal and at the timing of the onset and duration of the response (68). Both IκBα and IκBβ are rapidly degraded after cells are treated with the inducing agents IL-1 and LPS; however, IκBα is retranscribed as a result of NF-κB activation, whereas IκBβ is not. Thus, IκBβ levels remain low until the NF-κB activating signal is attenuated. The process for IκBβ degradation is less well understood and, as discussed later, appears to be more complex than that for IκBα. The most recent member of the IκB family to be described is IκB. Unlike IκBα and IκBβ, which were identified and characterized during purification of NF-κB:IκB complexes from cells, IκB was identified as a protein that specifically interacted with p52 in a yeast two-hybrid assay (69). Surprisingly, subsequent characterization of the protein revealed that it was unable to interact with either p50 or p52; instead it appeared to be a specific inhibitor of p65 and c-Rel complexes. Immunoprecipitation experiments revealed that in vivo IκB was associated exclusively with p65:p65 and p65:c-Rel complexes (69). IκB can be degraded with slow kinetics upon stimulation of cells with the majority of inducers of NF-κB, and as with the other IκBs, this degradation requires two N-terminal serine residues. At present it seems that IκB acts as a specific inhibitor of a subset of Rel complexes, and it therefore probably regulates the expression of specific genes, e.g. IL-8, whose promoters bind preferentially to p65 and c-Rel complexes (71). Bcl-3 is the most unusual member of the IκB family. It was first identified by cloning a t(14:19) chromosomal breakpoint from a B cell chronic lymphocytic

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leukemia (72). Structurally, Bcl-3 is very much like the other IκB family members in that its predicted protein structure contains 7 ankyrin repeats. However, unlike IκBα and IκBβ which are located in the cytoplasm, Bcl-3 appears to be located in the nucleus and has a binding specificity for p50 and p52 homodimers (73–77). Although Bcl-3 may function as a transactivator by removing these inhibitory NF-κB complexes from κB sites, p52:Bcl-3 complexes can also directly bind to κB sites and activate transcription (78). Thus, Bcl-3 is apparently unique among the IκB proteins in that its binding to rel proteins leads to transcriptional activation rather than repression. How Bcl-3 fits into the scheme of rel protein regulation remains to be defined, although the recent knockout of Bcl-3 will probably help in this regard (see below). Finally, very little is known about the IκB family member IκBγ , which is a 70-kDa molecule detected only in lymphoid cells (79). Its sequence is identical to the IκB-like C-terminal region of p105, and indeed IκBγ is the product of an alternate promoter usage that produces an mRNA encoding the C-terminal portion of p105. Although the initial report of IκBγ suggested that it functioned as a trans-inhibitor of Rel-proteins, similar to the other IκB proteins (79), subsequent studies have suggested that IκBγ probably plays a more limited role, probably inhibiting only p50 or p52 homodimers (80). The very narrow cell type distribution of this protein, namely, only in mature B cell lines from mice (42, 79), also hints at a very specialized function. The precise role of IκBγ in regulating Rel-proteins remains to be elucidated.

INDUCIBLE ACTIVATION OF NF-κB NF-κB Is Induced by Many Different Inducers and Affects Many Different Genes One of the most interesting aspects of NF-κB is the variety and the nature of the inducers that lead to its activation. As mentioned above, the activation of NF-κB is achieved primarily through the degradation of IκB proteins. Many agents when added to cells will induce the activation of NF-κB (see Figure 2). Each signals to the cell that damage (reactive oxygen intermediates, uv light) or infection (LPS, viral transactivating proteins, double-stranded RNA) has occurred. Some inducers are themselves by-products of a signal transduction cascade (IL-1, TNFα, sphingomyelin, products of membrane turnover, and calcium ionophores) (reviewed in 4, 5). Ultimately the signal is passed on to an IκB kinase (see below), which phosphorylates IκB and leads to its degradation. NF-κB is also responsive to reactive oxygen intermediates (ROIs). Since ROIs are sometimes released and produced during the inflammatory response, this pathway for NF-κB activation may be physiologically relevant. The activation of NF-κB by ROIs, the tax protein, and other known inducers can be

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inhibited by reducing agents and ROI scavengers, including dithiocarbamates and N-acetyl-L-cysteine (81). These data suggest that the redox state of the cell may be a general mechanism for upregulating NF-κB responsive gene transcription. The nature of the signals that lead to the activation of NF-κB strongly suggests that NF-κB plays a critical role in innate immune responses (5). NF-κB plays such a role in the activation of immune cells by upregulating the expression of many cytokines essential to the immune response [for an extensive list, see Kopp & Ghosh (5) and see Figure 2]. In particular, NF-κB stimulates the production of IL-1, IL-6, TNFα, lymphotoxin, and IFN-γ . Furthermore, some of these cytokines, e.g. IL-1 and TNFα, activate NF-κB themselves, thus initiating an autoregulatory feedback loop. All of these cytokines have multiple effects that contribute to inflammation (82). NF-κB is an important protein in the regulation of the acute phase response of inflammation, which is the systemic defense established to restore homeostastis after infection or injury. The clinical hallmark of this response is the rapid production of acute phase response proteins by the liver, a response that can be measured in the bloodstream. Many of the acute phase proteins have κB sites in their promoters or enhancers and are produced as a result of exposure of cells to the inflammatory cytokines IL-1 and IL-6. These include serum amyloid A protein 1, α1 acid glycoprotein, angiotensinogen, complement factor B (Bf), and the C3 component of complement (4, 5). It is interesting to note that anti-inflammatory drugs such as the salicylates and the corticosteroid dexamethasone inhibit NF-κB activation in cultured cells, suggesting that NF-κB may be a good target for potential therapies against chronic inflammatory diseases (83–86). Understanding the mechanism by which inducers of NF-κB transduce their signals to the cytosolic NF-κB:IκB complex is a major area of investigation at present. Below we summarize some of the recent advances in this area.

Signal-Induced Degradation of IκBα Two lines of evidence pointed toward phosphorylation of IκBα as a means of activating NF-κB. First, the phorbol ester PMA, which is known to act through the kinase PKC, could activate NF-κB in intact cells (87, 88). Second, in vitro, IκBα responds to treatment with various kinases (PKC, PKA, and HRI) by releasing NF-κB (89). Subsequently, it was demonstrated that in vivo degradation of IκBα was required for the appearance of NF-κB in the nucleus (49, 62, 90–92). In addition, some investigators were able to demonstrate a slower migrating form of IκBα by immunoblot analysis in extracts from stimulated cells treated with protease inhibitors (49, 51, 93, 94). This slower moving IκBα could be abolished by treatment with phosphatase, which also implied that IκBα is phosphorylated before degradation. The question remained whether

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the phosphorylated IκB was degraded while it was still part of the NF-κB:IκB complex or whether it first dissociated from NF-κB? This was answered by co-immunoprecipitating rel proteins with IκBα, from stimulated cells treated with proteasome inhibitors to block the degradation of phosphorylated IκBα, which demonstrated that IκBα undergoes proteasome-mediated degradation after phosphorylation but before dissociation (90, 93–95). Protein degradation within cells is a very tightly regulated multistep process, believed to be initiated by site-directed ubiquitination of target proteins. Initially it was thought that ubiquitination-dependent protein degradation was used exclusively for turnover of misfolded or defective proteins (96, 97). However, subsequent studies demonstrated that modulation of the level of some regulatory proteins, such as the periodic degradation of cyclins, was mediated through this mechanism. The actual degradation of ubiquitinated proteins is carried out by the multicatalytic ATP-dependent proteasome complex. The first evidence that inducible degradation of IκBα might be dependent on ubiquitination was provided by experiments using peptide aldehyde inhibitors of the proteasome such as calpain inhibitor I (ALLN), PSI, and MG-132 (Z-LLF-CHO) (51, 93– 95). Treatment of cells with these inhibitors blocked the degradation of IκBα after stimulation with NF-κB inducers, and phosphorylated IκBα accumulated in the cytoplasm. It was determined by several groups that inducible phosphorylation on IκBα occurs on two N-terminal serines positioned at residues 32 and 36 (98–101). Mutation of these residues by site-directed mutagenesis blocked phosphorylation of IκBα in response to activating signals and thereby prevented subsequent degradation of the protein. The use of proteasome inhibitors also allowed the direct mapping of the phosphorylation sites on ser-32 and 36 of IκBα (102). Similar approaches also led to identification of ubiquitinated IκBα, and −−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−→ Figure 2 Proposed mechanism for induction of NF-κB proteins. NF-κB molecules exist in the cytoplasm of most cells in an inert, non-DNA-binding form. Some NF-κB homo- and heterodimers are retained in the cytosol by the inhibitory molecules, IκBα, IκBβ, and IκB. The NF-κB precursor proteins p105 and p100 are also retained in the cytoplasm as heterodimers with other rel proteins by virtue of their IκB-like C-terminal regions (54, 171). Presumably the ankyrin repeats in the C-terminal regions of p105 and p100 fold back to mask the nuclear localization sequence of p65. Extracellular inducers creating stress or indicating infection cause the activation of IκB kinase(s) through poorly defined pathway(s). This process can be blocked by antioxidants (e.g PDTC) and salicylates. Activation of NF-κB occurs predominantly through the phosphorylation and degradation of IκB proteins. Phosphorylation of IκB proteins is followed by polyubiquitination, and they are degraded as part of their respective ternary complexes. This degradation can be inhibited by inhibitors of the proteasome (ALLN, Z-LLF, lactacystin). “Free” NF-κB translocates to the nucleus, where it upregulates expression from many genes involved in the immune and inflammatory responses.

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multiple ubiquitin molecules were found to covalently conjugate to two neighboring N-terminal lysine residues at positions 21 and 22 (95, 103). Taken together, these experiments revealed the following order of events required for NF-κB activation: 1. stimulation of cells with inducers of NF-κB results in phosphorylation of IκBα at positions ser-32 and ser-36; 2. phosphorylated IκBα is then ubiquitinated on lys-21 and lys-22; and 3. this triggers the rapid degradation of the protein by the 26S proteasome. Neither phosphorylation nor ubiquitination alone is sufficient to dissociate the NF-κB:IκBα complex; hence, free NF-κB is only released after degradation of IκBα. Intriguingly, a structural motif similar to that required for IκB phosphorylation and ubiquitination has been identified in the adhesion complex protein β-catenin (104). Mutagenesis experiments have demonstrated that this motif is involved in the phosphorylation and degradation of β-catenin and is therefore required for the regulation of the steady-state levels of the protein (104). Therefore, these findings indicate that the multistep mechanism of phosphorylation, ubiquitination, and degradation may also be used for the regulation of other proteins.

The IκB Kinase Identification of the critical role played by specific phosphorylation of serines 32 and 36 in the initiation of IκBα degradation has prompted a concentrated search for the so-called IκBα kinase. A number of different kinases, including PKC-ζ , PKA, raf-1, double-stranded RNA dependent kinase (PKR), and p90ribosomal S6 protein kinase (p90-RSK), have been suggested to fulfill this role, and most of these have been shown to cause dissociation of the NF-κB:IκBα complex in vitro (89, 105–108). However, besides p90-RSK, which appears to phosphorylate only Ser 32 (108), none of these kinases is able to specifically phosphorylate both of the N-terminal serine residues of IκBα required for activation in vivo. Mutational studies have revealed that substitution of the serine residues with threonines also prevents inducible phosphorylation of IκBα, suggesting that a completely novel, exquisitely serine-specific kinase is required (102). Furthermore, single amino acid substitution of either of these serines is sufficient to prevent NF-κB activation in response to numerous signals, including LPS, TNFα, and IL-1, demonstrating a critical requirement of the kinase for an intact substrate sequence (99, 102). Since most of the known inducers of NF-κB transmit their intracellular signals through distinct pathways, there must be a convergence point where all these pathways intersect. One likely candidate for this convergence point is therefore the kinase responsible for phosphorylating IκB and initiating its degradation. Intense effort is currently underway in many laboratories to clone and characterize this putative IκB kinase, which until recently remained elusive. However, two recent reports have described the partial purification and characterization

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of a high molecular weight (approximately 700 kDa) kinase complex from cytosolic extracts, which apparently specifically phosphorylates ser-32 and ser-36 of IκBα (109, 110). One unprecedented and entirely unexpected property of this kinase, besides its large size, is its apparent dependence on ubiquitination for activity (109). This conclusion is based upon observations made during the purification process, which suggested that separation of certain ubiquitinconjugating molecules (e.g. Ubc4/Ubc5) from kinase-containing fractions inhibited its activity. Surprisingly ubiquitination does not appear to cause degradation of the kinase; instead it seems that the modification induces its activation by an as-yet-uncharacterized mechanism. Initially, it was reported that the kinase could be extracted in an active form from uninduced cells; however, it was later suggested that activation of the kinase was a consequence of stresses applied during preparation of the extracts (110). In keeping with this concept, when the kinase was extracted from cells by a rapid lysis procedure, it was found to be inactive, and its activity could be induced by ubiquitination (110). This ability to isolate the IκBα kinase in an inactive form allowed investigation of potential upstream regulators of the kinase in addition to ubiquitination (110). Very little is known about the signals directly proximal to NF-κB activation, although several studies had previously demonstrated that TNFα-induced NF-κB activity could be mediated by activation of the protein kinase MEKK (mitogen-activated protein kinase/extracellular signal-regulated kinase kinase)1 which lies in the signaling pathway leading from TNFα to activation of the mitogen-activated protein kinase JNK (c-jun N-terminal protein kinase) (111– 113). Furthermore, the MEKK-1 to JNK signaling cascade can be activated by other known inducers of NF-κB such as UV irradiation and LPS, and upstream activators of MEKK-1 such as the small GTPases CDC42 and Rac-1 have also been shown to activate NF-κB (114). Together, these results suggest that MEKK-1 lies at the juncture of the pathways leading to JNK and NF-κB. Investigation of the role of MEKK-1 in this process revealed that a truncated form of the kinase could activate IκB kinase activity, although this activation differed slightly from that induced by ubiquitination. This difference was only manifested during an anion exchange chromatography stage of kinase purification in which the MEKK-1-activated IκB kinase eluted in a broader peak than the ubiquitination-activated complex. Hence it is possible that two similar but subtly different populations of the IκB kinase exist: one that is responsive to MEKK-1 and another that is activated by ubiquitination (110). Curiously, another recent study has suggested that MEKK-1 does not play a role in NF-κB activation, a result clearly inconsistent with those described above (115). It is unclear why these different observations have been made; however, the recent identification of a MEKK-1-related kinase, termed NIK (NF-κB inducing kinase), which interacts with the TNF-receptor associated

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factor (TRAF)-2 and stimulates IκBα degradation, supports the hypothesis that a MEKK-1-related kinase, rather than MEKK-1 itself, plays an important role in NF-κB activation (116). Indeed, a separate MEKK family member named MEKK-3 activates NF-κB, and although the mechanism of activation by MEKK-3 is unknown, it most likely functions in a manner analogous to MEKK-1, i.e. upstream of the IκB kinase (117). Interestingly, mutant forms of NIK block signaling from both TNF and IL-1 receptors, suggesting that the convergence of signaling pathways induced by these cytokines leading to NF-κB activation might occur upstream of the IκB kinase (116). However, these issues can be addressed only after molecular cloning and a full characterization of the IκB kinase. A number of questions exist that can only be answered following thorough characterization of the IκB kinase. Principal of these is the issue of how different signaling pathways, whose known components are discrete, are able to activate the IκB kinase. A number of upstream activators of NF-κB have been identified, including members of the TRAF family of molecules (TRAF-2, -5, and -6) which can associate with several of the TNF receptor family of proteins (e.g. TNF-receptors type I and II, CD30, CD40, CD95, LT-β (118–124) and the IL-1 type I receptor (TRAF-6 only) (125). Furthermore, IL-1–induced NF-κB activation requires the accessory protein IL-1RAcP (IL-1 receptor-associated protein) (126, 127) as well as recruitment of a ser/thr kinase named IRAK (IL-1 receptor-associated kinase) (13). However, the convergence point for these signals is not yet known. If there is a single IκB kinase, then is it regulated by activator proteins that act as the end points of the various signaling pathways? Or do the different pathways merge further upstream before they activate the IκB kinase by, for example, activation of a kinase such as NIK, described above? The apparent complexity of the IκB kinase itself poses a number of questions. Is this assembly of many proteins used only to activate NF-κB, or does it target other intracellular substrates? One possibility is that some of the subunits of the kinase are signaling and/or adapter molecules that can also serve distinct functions in separate systems. In this scenario, different subunits of the kinase complex might associate to allow interaction with different signaling pathways, and thus the kinase itself may be capable of responding directly to the many activating signals. It is therefore possible that the different subunits are targets for separate signaling cascades. For example, some may be the substrates for upstream kinases (e.g. MEKK-1), whereas others may be activated by ubiquitination or by association with small GTPases such as RhoA (114). More intriguing still is the possibility that the IκB kinase complex responds to incoming signals by generating an internal signaling cascade involving kinase and substrate subunits, which leads ultimately to activation of the IκB phosphorylating kinase.

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Finally, a fascinating issue that remains unanswered is why this kinase was not recovered in the genetic screens in Drosophila? Several of the components of the pathway leading from the IL-1 receptor to NF-κB activation have Drosophila counterparts, e.g. Toll (IL-1 receptor), pelle (IRAK, mouse pelle-like kinase), Dorsal (NF-κB), and cactus (IκB), and therefore the absence of mutants of the IκB kinase seems surprising (128). However, this result would be expected if mutation in the kinase resulted in a lethal phenotype, suggesting that the kinase might be involved in regulating critical developmental processes. Cloning of the mammalian kinase will undoubtedly lead to identification of the Drosophila homolog and will provide answers to these questions. Another major area of current interest is the mechanism by which phosphorylated and ubiquitinated IκB proteins are selectively degraded by the proteasome (96, 97). The current model hypothesizes that phosphorylation of the N-terminal serine residues of IκB in some way alters the conformation of the protein and exposes the lysine-containing sequences that are targeted by the ubiquitination machinery (25, 54, 59). One possible mechanism regulating selectivity for IκB molecules might be the existence of a specific ubiquitin ligase that recognizes defined substrate sequences present only in N-terminally phosphorylated IκB (96, 97). Attempting to identify an IκB-specific ligase is a major research objective for many laboratories. Lysine residues that are believed to be the sites of ubiquitination are conserved between the different IκB isoforms; however, mutation of these residues does not lead to a complete block of IκB degradation (69). The most likely explanation for this is that alternative lysines can be used for ubiquitination if the original sites are absent, although this has yet to be demonstrated. Phosphorylation and ubiquitination result in the IκB proteins adopting a conformation that is selectively recognized by the proteasome; it is possible that additional modifications such as phosphorylation of tyr-42 (see below) inhibit this recognition (129). Recent studies on the three-dimensional structure of the 20S proteasome from yeast have indicated that proteins destined for degradation must enter the structure through small openings (130). This suggests that IκB proteins are not degraded while in contact with NF-κB, but they are somehow stripped from NF-κB and threaded into the proteasome. However, identification of this mechanism must await three-dimensional structural analysis of the process.

Phosphorylation of IκBα at Other Amino Acid Residues In addition to ser-32 and ser-36, IκBα is also phosphorylated at a number of other amino acid residues. The precise role of these phosphorylations is unclear at the moment, although we know phosphorylation of serines and/or threonines within the C-terminal PEST domain of IκBα affects the intrinsic stability of the protein (131, 132). The kinase responsible for this phosphorylation

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has been identified as casein kinase II (CKII), which reportedly preferentially phosphorylates the serine residue at position 293 (131–134). CKII-mediated phosphorylation is constitutive and appears to be required for the turn-over of free IκBα but is not involved in the inducible degradation of IκBα in response to extracellular stimuli. The mechanism of this basal degradation has not yet been determined, nor has its precise role in NF-κB:IκB homeostasis, although answers to these questions will surely be forthcoming. It is interesting to note that the recently cloned IκB lacks a PEST domain, suggesting that this may underlay differences in function between this and the other PEST-containing IκB isoforms (69). Attention is also being paid to the potential role of tyrosine phosphorylation in the functional regulation of IκBα, and although two recent reports have addressed this issue, the results of these studies are somewhat conflicting (129, 135). In the first of these reports treatment of Jurkat-T cells with the potent tyrosine phosphatase inhibitor pervanadate (PV) led to tyrosine phosphorylation of IκBα coupled with activation of NF-κB (129). The site of this phosphorylation was tyr-42, and use of p56lck–deficient Jurkat variants suggested that this kinase was responsible for the phosphorylation. More interesting, however, was the observation that tyr-42 phosphorylation resulted in dissociation of IκBα from NF-κB but not in its subsequent degradation. The conclusion drawn from this result was that tyrosine-phosphorylated IκBα is not recognized by the proteasome, and interaction with an SH2 domain-containing protein may be responsible for removal of IκBα from NF-κB. The subsequent report verified both the phosphorylation of tyr-42 and the lack of IκBα degradation in response to PV; however consistent with their prior observations, no accompanying activation of NF-κB was observed (135). In contrast, tyrosine phosphorylation of IκBα blocked NF-κB activation in response to TNF and this occurred via inhibition of the induced serine phosphorylation of IκBα. This finding suggests that phosphorylation of tyr-42 prevents phosphorylation of ser-32 and -36 by the IκB kinase, perhaps by altering the substrate structure required for recognition by the kinase. The reason for the conflicting data from these two studies is not clear at present, although differences between the cell types used in each may be a factor. Nevertheless, both reports indicate a crucial role for tyr-42 in IκBα regulation and suggest that either constitutive or induced control of this phosphorylation by kinases or phosphatases is fundamental to the function of IκBα. The lack of analogous tyrosine residues in either IκBβ or IκB may contribute to differences in the regulation of these three IκB molecules, but further study of the role of tyr-42 is certainly required.

Differential Regulation of IκBα and IκBβ The different IκB isoforms target different combinations of Rel-proteins; for example, IκBα and IκBβ associate predominantly with p50:p65 and p50:c-Rel

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heterodimers, whereas IκB interacts only with p65 and c-Rel hetero- and homodimers, and bcl-3 interacts with p50 and p52 homodimers (68, 69, 75). Different combinations of Rel-protein dimers preferentially bind to distinct DNA sequences (termed κB sites) and as such can differentially regulate gene expression (26). It is therefore relatively easy to understand how the regulation of separate IκB isoforms could differentially activate distinct Rel-protein dimers and control expression of individual genes. However, since the interaction specificity of IκBα and IκBβ appears to be indistinguishable, they are unlikely to function as differential activators of Rel protein dimers (68). Functional differences between the two isoforms only become apparent upon examination of the degradation of the proteins in stimulated cells. All known inducers of NF-κB cause degradation IκBα. In contrast, in some cell types, IκBβ is only affected by a subset of inducers, e.g. LPS, IL-1, or the HTLV-1 tax protein, which cause a persistent activation of NF-κB varying in magnitude in a cell-type–specific manner (68, 136). This initially suggested fundamental differences in the regulation of IκBα and IκBβ; they were targeted by separate kinases induced by the distinct signaling pathways or ubiquitinated by distinct ubiquitin ligases. However, two N-terminal serine residues at positions 19 and 23 in IκBβ resembled Ser 32 and 36 in IκBα that are known to be critical for signal-induced degradation. Mutational studies indicated that Ser 19 and 23 in IκBβ were required for inducible degradation by inducers such as IL-1, LPS, and HTLV-1 tax (102, 136). In addition, other amino acids positioned close to these serines are also conserved between the two IκB isoforms. These data suggest that both IκBs are targeted by the same or very similar serine-specific IκB kinases and that the differences in their regulation patterns lie elsewhere. Degradation of IκBβ occurs with slower kinetics than does IκBα, and this may be due to a slower rate of phosphorylation of IκBβ, which may be a less efficient substrate for the IκB kinase (102). Therefore, inducers that only weakly activate the kinase may not provide a sufficient signal for IκBβ phosphorylation. Resolution of the nature of individual signals upstream of the IκB kinase will be required to test this hypothesis. Despite the current consensus that both IκBα and IκBβ are targeted by the same or similar kinases, a few reports suggest that the regulation of IκBβ may differ more substantially from IκBα. The initial characterization of IκBβ suggested this isoform was unresponsive to TNF and PMA, but it now appears that the response of IκBβ to different inducers is dependent on the cell type used (137, 138). For example TNF leads to the degradation of IκBβ in human umbilical vein endothelial cells (HUVEC), whereas PMA can cause IκBβ degradation in certain 70Z/3 murine pre-B cell lines. These results strongly suggest that there does exist a distinct IκBβ kinase and that HUVECs and sublines of 70Z/3 differ from other cell lines such that the IκBβ kinase can be activated by TNF or PMA. However the fundamental assumption that IκBβ

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is phosphorylated prior to degradation has been challenged in a recent report, which failed to detect changes in the phosphorylation status of IκBβ in stimulated vs unstimulated cells (138). Instead it appeared that serines 19 and 23 of IκBβ were constitutively phosphorylated even in the absence of any stimulus. Since Ser 32 and 36 of IκBα in these same cells are inducibly phosphorylated, the most likely explanation is that a single IκB kinase is constitutively active and continuously phosphorylates both IκB. The serines 32 and 36 of IκBα are kept in an unphosphorylated state by an IκBα-specific phosphatase in unstimulated cells, and inactivation of this phosphatase leads to phosphorylation and degradation of IκBα. However, the inducible degradation of IκBβ cannot be accounted for by such a model. The ability of phosphatase inhibitors such as okadaic acid and calyculin A to induce IκBβ degradation (139) does raise the possibility that a phosphatase is also involved in regulating the phosphorylation of IκBβ. Recent work on IκBβ has focused on discerning the mechanism by which it mediates persistent activation of NF-κB. After activation, NF-κB causes upregulation of IκBα mRNA levels by binding to NF-κB sites in the IκBα promoter (25, 59). Newly synthesized IκBα then migrates to the cytoplasm where it can bind to and inactivate free NF-κB. However, during persistent NF-κB activation, some NF-κB is resistant to resequestration and retains the ability to enter the nucleus and initiate transcription. Following degradation of the initial pool of IκBβ, newly synthesized IκBβ, which is not basally phosphorylated, can complex with free NF-κB and prevent it from interacting with IκBα (140). Furthermore, unlike basally phosphorylated IκBβ, unphosphorylated IκBβ is not able to mask the NLS or DNA-binding domains of NF-κB (140). In this state IκBβ-bound NF-κB can still enter the nucleus and remain transcriptionally active (140, 141). Therefore, newly synthesized and unphosphorylated IκBβ appears to act as a chaperone for NF-κB and maintains its activity long after production of IκBα. A recent report has also examined the differential regulation of NF-κB by IκBα and IκBβ from a different perspective. In this study the ability of the two IκBs to act as post-induction inhibitors of promoter-bound NF-κB was tested (141). While IκBα was a potent inhibitor of DNA-bound NF-κB, IκBβ was effective only in certain situations, e.g. when HMG-I(Y) was a part of the promoter complex. In addition this study demonstrated that, in a manner similar to LPS-induced pre-B cells, the persistently induced NF-κB in virus infected cells is a ternary complex with DNA and IκBβ (141). Determining the mechanism by which unphosphorylated IκBβ is generated in persistently stimulated cells is crucial for further deciphering the regulation of IκBβ. During stimulation the appearance of the hypophosphorylated IκBβ can be blocked by cycloheximide, indicating that only newly synthesized IκBβ can become hypophosphorylated, and the phosphorylation status of the

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already basally phosphorylated IκBβ is not affected (138, 140). The possible explanations for this would be either (i) the kinase responsible for basally phosphorylating IκBβ is inactivated in stimulated cells, or (ii) a phosphatase specific for IκBβ is activated or synthesized in stimulated cells. The recent identification of the sites of basal phosphorylation in the PEST-domain of IκBβ is therefore an important first step. Two serine residues at positions 313 and 315 are the critical residues whose phosphorylation status determines the ability of IκBβ to inhibit the DNA-binding activity of NF-κB (142). The kinase reponsible for phosphorylating these residues is casein kinase II, which is also responsible for basally phosphorylating IκBα (see above). Since the basal phosphorylation status of IκBα is not altered in stimulated cells, the most feasible hypothesis would involve an IκBβ-specific phosphatase that is either activated or newly synthesized in cells persistently stimulated with inducers of NF-κB activity.

Regulation of NF-κB Activation by PKA The activity of NF-κB is primarily regulated by its sequestration in the cytosol through anchoring to the IκB proteins. Therefore, mechanisms leading to the disruption of the NF-κB:IκB complex and the subsequent translocation of NF-κB to the nucleus have received most attention. Nearly all other inducible transcription factors, including those that translocate from the cytoplasm to the nucleus, are themselves subjected to posttranslational modifications, which helps to regulate their activity. Recent studies indicate that the activity of NFκB is also regulated by posttranslational modification, but the exact manner by which this occurs is unusual and involves cyclic-AMP (cAMP)-independent activation of PKA (143). During purification of IκBβ from rabbit lung cytosol, it was noticed that a 42-kDa protein co-purified with IκBβ. This protein was subsequently identified as the catalytic subunit of PKA (PKAc), which is normally complexed with the regulatory subunit PKAr and requires cAMP for activation. However, PKAr was not found associated with the co-purified PKAc. Instead the PKAc could associate with the NF-κB:IκB complex via a bivalent interaction where the ATPbinding domain of PKAc interacts with either IκBα or IκBβ, while the substrate binding domain remains bound to the NF-κB p65 subunit. The association with NF-κB:IκB inhibits the PKAc catalytic activity, which can be induced upon stimulation of NF-κB activity via degradation of IκBα and -β. Activation of PKA by this mechanism does not therefore require cAMP and represents an entirely novel mode of activation for this kinase. But does this PKA influence the activity of NF-κB? Examination of the amino acid sequence of the p65 subunit of NF-κB reveals that it contains a consensus PKA phosphorylation site, and mutation of this sequence (at ser-276) inhibits the transcriptional activity

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of NF-κB. Study of the possible targets of PKA-mediated regulation of NF-κB has demonstrated that catalytically active PKA does not significantly affect the dissociation of NF-κB:IκB complexes, the nuclear translocation of NF-κB, or the binding of NF-κB to DNA. Instead, PKA phosphorylation increases the transactivating activity of DNA-bound NF-κB. An important issue raised by these studies is determining the mechanism by which phosphorylation by PKA alters the transcriptional activity of NF-κB. Recent results have demonstrated that cAMP response element binding protein (CREB)-binding protein (CBP) and the closely related factor p300 can interact with p65 and potentiate its transactivating ability (144, 145). Co-immunoprecipitation studies reveal that CBP/p300 can form a molecular bridge between DNA-bound p65, other transcription factors such as ATF-2 or c-jun, and the basal transcriptional apparatus (e.g. TFIIB) that may be required for full transcriptional activation. Furthermore, RNA polymerase II constitutively associates with CBP/p300 and, as such, interaction with p65 may recruit the polymerase to the gene promoter. The interaction of CBP/p300 with CREB is dependent upon phosphorylation of CREB by PKA, and therefore the interaction of CBP with p65 may also be modulated by PKA. Interestingly, the three-dimensional structure of p65 indicates that ser-276 is in a loop in the dimerization domain, which is exposed to the surface (39). Hence phosphorylated p65 can provide an excellent binding surface for coactivators such as CBP/p300. However, evidence demonstrating that PKA phosphorylation modulates the interaction between CBP and p65 is yet to be provided.

KNOCKOUTS OF NF-κB AND IκB PROTEINS: WHAT DO THEY TELL US ABOUT THEIR PHYSIOLOGICAL ROLES? Knockouts of NF-κB/Rel Proteins The presence of different rel family members in most cell types poses a challenge in understanding the distinct biological role of each family member. Therefore, to further delineate the exact role of each rel protein in vivo, targeted gene disruption in mice has been performed. Several groups have independently knocked out many of the rel proteins including p50, p52, c-rel, p65 (Rel A), and Rel B (146–151). Because p50 is a shared component of most NF-κB complexes that regulate genes involved in immune function and immune cell development, it was anticipated that a p50 knockout would be lethal. Remarkably, the absence of p50 does not cause developmental abnormalities or lethality by itself. These mice have normal levels of B cells and normal ratios of κ and λ light chain

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usage (150). However, B cells isolated from these mice cannot be induced to differentiate in response to the mitogen LPS, and no NF-κB activation was observed. In contrast, cross-linking IgM with appropriate antibodies does induce NF-κB (p65 and c-Rel, but not p50) and B cell proliferation (150). This result strongly suggests that these two stimuli use distinct signaling pathways. Interestingly, p50 also seems to play a crucial role in isotype switching since the levels of serum IgA, IgE, and IgG1 in knockout mice were significantly lower than in control littermates. Not surprisingly, these mice had dramatically greater susceptibility to bacterial infection but remarkably enhanced resistance to viral infection. This latter effect was due to an upregulation of the antiviral cytokine IFN-β. NF-κB is thought to upregulate the levels of this protein, but this result indicates that p50 mediates a repressive effect in this particular system, probably acting as p50 homodimers. Therefore, it appears that p50 plays a very important role in immune responses to acute inflammation but not in the overall development of the mouse. It remains possible, however, that since p50 is a member of a larger family of proteins, another rel protein may be compensating for its loss in the p50 knockout mice. Expression of c-rel is generally restricted to hemopoietic cells (152). Specifically, it is found in the greatest amount in T and B cells and appears to be a major component of NF-κB found in the nucleus of B cells. Nevertheless, the absence of c-rel, like that of p50, has few consequences on the development of hemopoietic cells (149). The number of these cells appears to be equivalent to that of normal littermates, and cell surface markers such as Igκ and the IL-2Rα chain are expressed at normal levels. C-Rel appears instead to have an effect on the inducible response of B cells and T cells to mitogen stimulation (149). Thus, the proliferative and humoral response of both B and T cells is reduced in c-rel−/− mice as is the level of IL-2. Interestingly, the composition of nuclear NF-κB dimers from B cells differs in c-rel−/− mice relative to normal mice. More specifically, the absence of c-rel appears to be compensated by the presence of more p65 in the nucleus. This compensation however is obviously not functional because c-rel-deficient mice have profound lymphocyte activation defects. In contrast to p50, p65 has a critical role in development: Mice lacking this gene die at day 16 of gestation (146, 148). The livers from the resulting embryos undergo massive degeneration as a result of apoptosis. It is unclear whether the absence of p65 mediates apoptosis of hepatocytes directly, or whether p65 regulates expression of an additional factor that is necessary for survival. Obviously, there is no functional complementation effect here, suggesting that this particular developmental parameter is specific to p65. Two groups have inactivated the RelB gene (147, 151). Unlike p50 and p65, which are expressed in virtually all cell types, RelB expression is largely

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restricted to lymphoid tissue. Interestingly, the effects of this knockout are biphasic, since the mice develop normally until about day 10 after birth. However, after this time the mice begin to express a severe and complex phenotype including thymic atrophy, splenomegaly, hyperplasia in the bone marrow, and a dysfunctional immune response; in extreme cases this leads to premature death (151). Burkly and colleagues have further suggested that Rel B plays a critical role in development of dendritic cells in the bone marrow and UEA-1+ medullary epithelial cells in the thymus; they conclude that RelB could be a candidate gene for committing precursor cells to a particular lineage within the immune system (147). RelB appears to have little effect on lymphoid development, although there is evidence to suggest that it may be important in T cell–mediated immunity. Interestingly the multiorgan inflammation and myeloid hyperplasia observed in RelB-deficient mice are dependent on T cells, since crossing the knockout mice with Nur 77/N10 transgenic mice lacking T cells blocks the development of disease symptoms (153). The phenotypes of these knockout mice lacking individual Rel-proteins demonstrate the importance of proteins in this family in different cellular processes. It is clear that the different members serve unique functions that cannot be fully complemented by other Rel-proteins. However, the possibility remains that complementation by family members masked some phenotypes and hence prevented the complete elucidation of the physiological roles of the Reltranscription factors. Recent studies have attempted to address such possibilities by generating knockouts of multiple Rel-family members. The first study examined the effect of generating p50/Rel B double knockout mice (154). The inflammatory phenotype observed in the relB−/− mice was greatly exacerbated in the double knockout mice and led to death of the mice within four weeks. Therefore, it appeared that the lack of RelB is in fact compensated by other p50 containing complexes, but the inflammatory phenotype is not due to the p50:p65 NF-κB. The second double knockout removed both p50 and p65 (155). The knockout of p65 alone resulted in an embryonic lethal phenotype that prevented examination of the possible role of p65 in lymphocyte development. To overcome this difficulty, two groups transplanted fetal liver stem cells from p65−/− mice into either lethally irradiated or SCID mice (148, 155). Surprisingly stem cells lacking p65 developed normally and reconstituted hematopoetic lineages in a manner similar to that seen when fetal liver cells from wild-type or heterozygous animals were used. To determine whether deletion of p50 along with p65 might reveal a greater effect, Horwitz et al generated p50−/−, p65−/− mice through crosses (155). These double knockout mice were also embryonic lethals with massive apoptosis of liver cells. However, the onset of apoptosis was at embryonic day 12 instead of day 16 in case of p65−/− mice. When

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fetal liver cells from day 12 of these mice were used to complement lethally irradiated animals, there was no observable development of lymphocytes (155). This dramatic block in lymphocyte development of the p50/p65 double knockout cells could be rescued if bone marrow cells from wild-type animals were co-injected into the recipient animals. The only logical conclusion from this result is that NF-κB plays a critical role in lymphocyte development. However, this role is manifested not in the developing lymphocytes but in surrounding cells. These surrounding cells probably produce a critical growth factor whose expression is dependent on NF-κB. These results are highly intriguing, and further study will be necessary to elucidate the relationship between NF-κB and lymphocyte development. In summary, the results of the different knockouts reveal that individual members of the Rel-family play distinct and unique roles that cannot be replaced by other members of the Rel-family. Thus, p50 and c-rel appear to be more important in mediating acute immune responses than in overall development. p65 and RelB, on the other hand, have crucial roles in the development of the liver and the haematopoietic system, respectively, and their absence may not be compensated for by other rel family members. Enhancement of the observed phenotypes in the double knockouts (154, 155) suggests that there is some functional complementation, and the degree to which this occurs may differ among the different family members as well as in different tissue or cell types. Efforts are underway to generate more knockouts, and it is likely that through this approach we will have a far better understanding of the physiological role of Rel-proteins in the near future.

Knockouts of IκB Proteins; IκBα and Bcl-3 Recently mice lacking the IκBα gene have been generated, and although the pups are born normally (i.e. there are no developmental defects), they die within 9 days of birth (156, 157). Typically, the animals show rapid physiological degeneration including atrophy of the spleen and thymus, severe runting, and the development of many skin abnormalities (which may result from enhanced granulopoiesis). In addition the levels of constitutive NF-κB activity are greatly enhanced in haematopoietic organs (156). It remains unclear whether the enhancement of NF-κB activity in lymphoid tissue is the result of the loss of anchoring function of IκBα or whether it is due to the inability of IκBα −/− mice to terminate NF-κB activation in these cells. To determine whether the enhanced NF-κB activity is responsible for this lethal phenotype, a chimeric IκBα −/−p50−/− mouse has been generated (156). Here, constitutive NF-κB levels are lower than in the IκBα −/− mouse, and the onset of the lethal phenotype is delayed until the third week after birth. The absence of p50 therefore

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suppresses but does not eliminate the effects of NF-κB overexpression and suggests that constitutive activation of the Rel proteins is a primary cause of neonatal lethality in the IκBα −/− mouse. These results also begin to illuminate the interplay between IκBα and IκBβ in regulating NF-κB expression (156, 157). The most obvious conclusion from these studies is that IκBβ is incapable of inhibiting the constitutive expression of NF-κB and thus cannot substitute for IκBα; this suggests that there are IκBα- and IκBβ-sensitive pools of NF-κB within cells that may be targeted by different signal transduction pathways. Furthermore in embryonic fibroblasts, constitutive NF-κB activity is low, but in the presence of TNF-α, significant NF-κB is activated (156, 157). Suppression of this inducible activation appears to require IκBα because the levels of NF-κB remain high in these cells after removal of the activating signal. By contrast, in similar experiments in wildtype cells, the levels of NF-κB rapidly returned to the basal level due to the sequestering of NF-κB from the nucleus by IκBα. The source for NF-κB in these TNF-stimulated fibroblasts appears somewhat controversial; Beg et al (156) suggest that it is due to the degradation of IκBβ, whereas Klement et al (157) do not observe any changes in IκBβ levels. More recently it has been proposed that IκBβ levels are highly upregulated in IκBα −/− mice and that the source of induced NF-κB in TNF-stimulated fibroblasts may be cytoplasmic IκB complexes (69). It is however fair to conclude that the phenotype of the IκBα −/− mice supports the data from cell lines, which suggests that IκBα is more important in regulating inducible responses, whereas IκBβ is involved in the persistent activation of NF-κB. Generation of mice lacking IκBβ will be necessary to conclusively test the validity of this model. Two groups have recently reported the generation of mice lacking the bcl-3 gene (158, 159). The paradoxical nature of Bcl-3, which resembles IκB proteins but activates NF-κB activity, and its low level of expression had prevented meaningful analysis of its in vivo function. In addition, expression of bcl-3 in thymocytes of transgenic mice indicated that instead of blocking, overexpressed Bcl-3 augmented DNA binding by p50 dimers (160). The knockout mice did not reveal any differences in the expression of NF-κB and IκB proteins, induction of NF-κB activity, or composition of the NF-κB complexes detected in these animals. No defects in development appeared either in the animals or in the immune system. Instead they display selective defects in the response to immunogenic challenge from pathogens such as L. monocytogenes, S. pneumoniae, or T. gondii. Some of these defects could be due to the fact that these mice lack germinal centers and display altered microarchitecture in the spleen and lymph nodes. None of the observed phenotypes shed any light on the basis of the oncogenic potential of bcl-3, although the somewhat reduced numbers of B cells in these mice may reflect a role of bcl-3 in the survival of B cells.

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Interestingly, mice lacking the p52 protein, the presumed partner for nuclear complexes with Bcl-3, display defects similar to that of Bcl-3, namely, lack of germinal centers and inability to respond to certain pathogens (161, 162). Currently only one cytosolic anchor of NF-κB activity, namely IκBα, has been knocked out. Whereas lack of certain Rel-members (p65) leads to lethality, paradoxically, the targeted deletion of IκBα also promotes neonatal lethality as a result of an overexpression of the Rel proteins. It is therefore evident that precise regulation of NF-κB expression both temporally and spatially is necessary to ensure normal development and subsequently to achieve an effective immune response against antigenic challenge.

NF-κB and Apoptosis The role of Rel-proteins in oncogenic transformation is quite well established (see Gilmore & White 1996 for a recent comprehensive review on this area) (163). Transforming forms of Rel-proteins include v-Rel, lyt-10, and truncated forms of c-Rel. The mechanism underlying Rel-mediated transformation remains unclear despite years of study, particularly because evidence connecting Rel-function with growth regulatory mechanisms has not been forthcoming. The phenotype of the p65−/− mice, which die during embryonic development through massive apoptosis of hepatocytes, suggested that instead of promoting growth of cells, NF-κB might play an important role in protecting cells from apoptosis (146, 148). Hence the transforming effect of Rel-proteins may be the consequence of their anti-apoptotic function, not unlike the tumors induced by oncogene Bcl-2. Strong support for a protective role for NF-κB in apoptosis came from four recent reports that examined the effects of TNF on cell killing (115, 164–166). The cytokine TNF was initially characterized by its ability to kill tumor cells. However subsequent analysis indicated that its ability to kill cells was highly cell-type dependent. The recent reports indicate that inhibiting NF-κB activity in cells, either in cell lines lacking p65 or those expressing a dominant negative form of IκBα, made cells that were otherwise insensitive to TNF-mediated killing exquisitely susceptible to apoptosis. Interestingly, this protective function of NF-κB was apparent not only against TNF but also on cells treated with ionizing radiation or chemotherapeutic agents, thus suggesting that NF-κB may play an anti-apoptotic role in many systems (166). There is also evidence that inhibition of the constitutive NF-κB activity in WEHI 231 cells prevents their apoptosis (167). Because in most cases the enhancement of apoptosis can also be manifested by blocking protein synthesis using cycloheximide, it appears that NF-κB probably serves to upregulate the synthesis of one or many antiapoptotic gene products, e.g A20 (168). Identification of such NF-κB regulated genes therefore is an important objective for the near future.

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As discussed above, the phenotype of the double knockouts indicates some functional complementation between members of the Rel-family, thus keeping alive the possibility that the only way to generate a mouse lacking all NF-κB activity would be to create one with all the members missing. Although this might soon be possible, a few reports present an alternate strategy. In these papers, a dominant negative form of IκBα, lacking the N-terminal signal-responsive domain, is expressed in a tissue-specific fashion to inactivate all NF-κB activity. Studies carried out in cell lines clearly establish the validity of this approach (165, 166, 169), and a recent report extends such studies to examine the regulation of NF-κB in T lymphocytes in transgenic mice (170). The dominant negative IκBα was expressed in thymocytes using a 30 lck promoter (with cointegrated CD2 promoter) and led to a surprising result. The ratio of single positive T cells was altered in these mice with a significant loss of CD8 cells. The reason behind this alteration in the profile of single-positive T cells remains unclear; however, the loss of CD8 cells without a corresponding increase in CD4 cells suggests that defect is not at the stage of commitment to the CD4 or CD8 lineages. Instead the observed results probably derive from a selective apoptosis of CD8 cells, an explanation that would reinforce the possible role of NF-κB as an anti-apoptotic gene. Further use of this approach should help uncover other systems where NF-κB might play similar roles.

SUMMARY The study of the regulation of transcription factors of the Rel family appears poised to achieve significant breakthroughs in the near future. Particularly interesting will be the identification and characterization of the putative IκB kinase. Events that follow the signal-induced phosphorylation of IκBs, namely the ubiquitination and degradation of the protein, also appear to be an important area of future study. Finally, the role of NF-κB in modulating the expression of so many different cytokines and lymphokines strongly supports its proposed role as a co-ordinating element in the body’s response to situations of stress, infection, or inflammation. Therefore, development of specific inhibitors of its function should lead to novel therapeutics, which may serve to effectively treat situations such as inflammation. ACKNOWLEDGMENTS We would like to acknowledge the help of Dr. Dola Sengupta and Dr. Roderick Phillips in the preparation of this manuscript. The authors’ own research was supported by grants from National Institutes of Health and the Howard Hughes Medical Institute.

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NOTE ADDED IN PROOF Following submission of this review, two groups reported the identification and characterization of the IKKα kinase that displays many of the expected properties for a bona fide IκB kinase (172, 173). The sequence of the cDNA encoding this kinase revealed that it was the same as a previously cloned kinase (CHUK) of unknown physiological function. The kinase NIK, which appears to be a component in the pathways originating from inducers such as TNF-α and IL-1, was found to associate with IKKα, but the significance of this association is not completely clear. Interestingly, IKKα appears to be a phosphoprotein, and treatment with protein phosphatase 2a (PP2a) leads to a loss of activity, a result in agreement with the capacity of okadaic acid to activate NF-κB in intact cells. The purified kinase complex, which includes IKKα, is ≈900 kDa in size, and hence the characterization of other components of the kinase complex is an important question that remains to be solved. Visit the Annual Reviews home page at http://www.AnnualReviews.org.

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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Annu. Rev. Immunol. 1998. 16:261–92 c 1998 by Annual Reviews. All rights reserved Copyright

GENETIC SUSCEPTIBILITY TO SYSTEMIC LUPUS ERYTHEMATOSUS T. J. Vyse and B. L. Kotzin Division of Basic Sciences, National Jewish Medical and Research Center, 1400 Jackson Street, Denver, Colorado 80206; e-mail: [email protected] KEY WORDS:

autoimmune disease, autoantibodies, genetic linkage, gene mapping, murine lupus

ABSTRACT Considerable evidence suggests that the development of systemic lupus erythematosus (SLE) has a strong genetic basis. Recent studies have emphasized that this disease, like other autoimmune diseases, is a complex genetic trait with contributions from major histocompatibility complex (MHC) genes and multiple non-MHC genes. Etiologic genes in these disorders determine susceptibility, and no particular gene is necessary or sufficient for disease expression. Studies of murine models of lupus have provided important insight into the immunopathogenesis of IgG autoantibody production and lupus nephritis, and genetic analyses of these mice overcome certain obstacles encountered when studying patients. Genome-wide linkage studies of different crosses have mapped the position of at least 12 non-MHC disease-susceptibility loci in the New Zealand hybrid model of lupus. Although the identity of the actual genes is currently unknown, recent studies have begun to characterize how these genetic contributions may function in the autoimmune process, especially in terms of their role in autoantibody production. Studies of MHC gene contributions in New Zealand mice have shown that heterozygosity for particular haplotypes greatly increases pathogenic autoantibody production and the incidence of severe nephritis. The mechanism for this effect appears to be genetically complex. Studies in human SLE have mostly focused on the association of disease with alleles of immunologically relevant genes, especially in the MHC. Associations with various complement component deficiencies and an allele of a particular Fcγ receptor gene (FCGR2A) also have been described. In a diversion from previous association studies, a recent directed linkage analysis of sibpairs with SLE was based on mapping studies in murine lupus and may be an important step toward identifying a new disease-susceptibility gene in patients. Since the genes that predispose to autoimmunity are probably

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related to key events in pathogenesis, their identification in patients and murine models will almost certainly provide important insight into the breakdown of immunological self-tolerance and the cause of autoimmune disease.

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INTRODUCTION Systemic lupus erythematosus (SLE) is considered to be the prototypic systemic autoimmune disease (reviewed in 1, 2). Unlike organ-specific autoimmune diseases such as multiple sclerosis and type 1 diabetes mellitus, SLE has the potential to involve multiple organ systems directly, and its clinical manifestations are extremely diverse and variable. Although SLE can occur at nearly any age, women in their childbearing years are primarily affected. Autoantibody production is the major pathogenic mediator in SLE, and a hallmark of the disease is elevated serum levels of IgG antinuclear antibodies. The heterogeneous clinical manifestations appear to be associated with the production of different pathogenic autoantibodies. The mechanism by which many autoantibodies in SLE mediate pathology is variable. Some specificities, for example, IgG antibodies to double-stranded (ds) DNA, can form immune complexes and result in an immune-complex glomerulonephritis. Immune complexes may also be responsible for other disease manifestations such as arthritis, rashes, serositis, and vasculitis. A separate group of autoantibodies are directed to cell surface determinants and may cause problems such as hemolytic anemia, thrombocytopenia (platelet destruction), or central nervous system damage. How other autoantibodies cause disease manifestations in SLE is mostly unknown. Although T cells do not play a direct role in tissue damage in SLE, CD4+ T cells seem to be required for the production of pathogenic IgG autoantibodies (1). As discussed below, considerable evidence indicates that the development of SLE has a strong genetic basis. Since disease appears to involve the emergence and activation of both autoreactive T cells and B cells, it seems likely that susceptibility genes will influence this breakdown of immunological tolerance in either or both lymphocyte populations. Multiple abnormalities of both B cell and T cell phenotype and function have been described in SLE and murine models of lupus (2), but most of these defects probably reflect secondary events in the disease process. It is unclear which if any of the lymphocyte abnormalities described to date are primary checkpoints in the pathogenesis of disease. This issue can be addressed through genetic analysis, since a number of the genes that predispose to lupus will be related to key immunologic events in the disease process. The identification of lupus susceptibility genes will therefore almost certainly provide important insight into the development of autoimmunity and the cause of autoimmune disease.

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SLE is a complex genetic trait with contributions from major histocompatibility complex (MHC) genes and multiple non-MHC genes. It is therefore similar to other autoimmune diseases such as type I diabetes and multiple sclerosis. Etiologic genes in these disorders determine susceptibility, and no particular gene is necessary or sufficient for disease expression. Genetic complexity in these polygenic diseases is mostly related to the low penetrance of each contributing gene, that is the small increase in probability of disease expression given a particular allele. Even in the presence of a full complement of susceptibility alleles at multiple loci, overt disease does not always result (this is termed incomplete penetrance). Genetic complexity in SLE is also related to genetic heterogeneity, in which the same phenotype is the result of the combined effect of different genes and/or alleles. For example, the same disease manifestation in different SLE patients and in different murine models may be determined by a different set of contributing genes. The study of the genetic basis of lupus is made additionally difficult by the fact that the alleles that predispose to autoimmune disease appear to be common in the general population. There has been no selection against the genetic alleles that contribute to polygenic disorders, unlike the selection against the causal mutations in monogenic disease, which are usually serious function alterations or knockouts of a gene. Finally, in polygenic disease, the complexity of the genetic analysis is further increased by the fact that susceptibility alleles may interact with one another [termed epistasis (3)] or act independently [termed additivity or heterogeneity (4)] to result in the phenotype being studied. As is evident in the discussion below, the investigation of the genetic basis of SLE is challenging. Most genetic studies in human SLE conducted to date have focused on the association of particular alleles with disease, and the MHC and other immunologically relevant genes have been the main target for intensive scrutiny. Association studies are, however, potentially subject to inherent biases such that spurious associations are revealed owing to the lack of appropriate controls. The interpretation of associations may be further complicated by the presence of linkage disequilibrium with the actual etiological allele. The association of SLE with particular MHC haplotypes (discussed below) exemplifies this difficulty. Association studies also require an a priori hypothesis that a particular candidate gene is involved in the disease process, and therefore such studies are not suitable to investigate the many unknown non-MHC genetic contributions in SLE. Over the last several years, the availability of easy-to-use maps of genetic markers that cover the entire mouse and human genomes (5, 6) has revolutionized the study of genetic predisposition, especially the study of non-MHC genes in complex genetic traits. These markers (microsatellites) are short repeated sequences (for example, repeats of the same dinucleotide), which are scattered

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fairly randomly throughout eukaryotic genomes at a relatively high frequency. The unique flanking sequences for each microsatellite are used to PCR-amplify the segment for analysis and to position the marker in the genome. Among different individuals or inbred mouse strains, microsatellites exhibit frequent polymorphism in the length of the repeat sequence. Polymorphism of this length can be used to determine the parental origin of alleles at a particular chromosomal position in an analysis of families, and similarly in the mouse, in an analysis of backcross or intercross progeny. These markers therefore can be used to map the chromosomal positions of genetic loci linked with a disease, identifying regions of the genome that contain disease-susceptibility genes. In these linkage analyses, the positions of contributing genes are isolated on the basis of location and not on the basis of any known function. Genome-wide scans have been reported for loci linked with type I diabetes (reviewed in 7) and multiple sclerosis (reviewed in 8). Linkage in these and other similarly designed genetic analyses is established by demonstrating a disproportionate frequency of sharing of alleles at a particular locus in affected (i.e. diseased) sibpairs. To conduct a genome-wide scan in humans, several hundred affected sibpairs are frequently necessary to document linkage for many of the contributing loci. This is due to the low penetrance of most disease-susceptibility genes in these disorders. The complex phenotypes of human SLE, and its lower prevalence than type I diabetes, have delayed the completion of a genome-wide analysis of SLE, although several studies are under way. A recent study in SLE patients (discussed below) has used allele sharing and microsatellite mapping to investigate linkage in a selected region of the human genome. In contrast, genome-wide scans have been used to analyze a number of crosses involving murine models of lupus. The basic approach to mapping loci in mice is relatively straightforward. In essence, two strains, A and B for example, are mated. The two strains are chosen such that one exhibits high expression and the other low expression of the disease phenotype to be mapped. In the first instance, the phenotype of the (A × B)F1 progeny is studied. Genetic diversity is created by backcrossing the F1 animals to one of the parents (usually the parent that differs most from the F1 phenotype) or by intercrossing the F1 animals. The frequency of an allele is then compared in affected and nonaffected progeny or analyzed as a quantitative trait locus (QTL) for a continuous trait.

GENETIC LOCI IMPLICATED IN MURINE LUPUS Animal Models of SLE Several murine models of spontaneous lupus-like disease have been described (9). The most well characterized are: the New Zealand hybrid model, in which

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the F1 hybrid of the New Zealand black (NZB) and New Zealand white (NZW) develops lupus-like disease; the MRL mouse, an admixture of LG/J, AKR/J, and C3H/Di backgrounds; and the BXSB/MpJ (BXSB) mouse, a recombinant inbred of C57BL/6J (B6) and SB/Le strains. The MRL and BXSB mice most frequently studied also carry single gene mutations that accelerate lupus-like disease. MRL-lpr/lpr mice are homozygous for the lymphoproliferation (lpr) mutation in the Fas gene, and male BXSB mice carry the Y-linked Yaa gene. Both of these are discussed in more detail below. The (NZB × NZW)F1, MRL-lpr/lpr, and BXSB mice all develop a progressive severe glomerulonephritis and are primarily models of diffuse proliferative lupus nephritis. As in human SLE, all these mice develop high levels of IgG autoantibodies to nuclear antigens, including dsDNA. These autoantibodies mediate nephritis, probably as a result of in situ immune complex formation in the glomerulus (reviewed in 2). Lupus-prone strains produce antibodies to another self-antigen, the endogenous xenotropic viral glycoprotein, gp70, and these autoantibodies have also been implicated in the pathogenesis of murine lupus nephritis (10–12). Extra-renal disease manifestations variably occur in these models and include lymphoproliferation with both splenomegaly and lymphadenopathy, hemolytic anemia, autoimmune thrombocytopenia, vasculitis, thrombosis, and arthritis. All of these lupus-prone strains also exhibit premature thymic atrophy, the significance of which is unknown. Several backcross and intercross studies have been published, mapping loci linked with nephritis and/or autoantibody production in New Zealand hybrid models. Limited data are available with respect to MRL-lpr/lpr and BXSB mice.

Contributions from MHC Genes to Murine Lupus The mouse MHC (H2) influences lupus-like disease in (NZB × NZW)F1, BXSB, and MRL-lpr/lpr mice. (NZB × NZW)F1 MICE In multiple studies of the genetic contributions to disease in this F1 model, genes encoded within or closely linked to the MHC have been shown to be pivotal for maximal production of pathogenic autoantibodies and the development of severe lupus nephritis. The F1 mice are heterozygous at H2 (i.e. H2d/z), inherited from the NZB (H2d) and NZW (H2z) parents. Several groups analyzing both backcross and congenic mice have shown that H2d/z heterozygosity is associated with an increased frequency of fatal lupus nephritis compared with either H2d/d or H2z/z (12–17). This is associated with enhanced production of pathogenic IgG autoantibodies to dsDNA, chromatin, and/or gp70 (12, 14–16). In different studies, separate strong contributions from both the H2d and H2z haplotypes can be demonstrated. Interestingly, heterozygosity

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involving other MHC haplotypes (in the context of H2z or H2d) also enhances disease expression. For example, in an analysis of (NZM × B6)F1 × NZM backcross mice (18), in which NZM is an H2z-positive recombinant inbred strain of NZB and NZW, inheritance of H2b from the B6 strain (i.e. H2b/z versus H2z/z) was linked with the production of autoantibodies and the development of nephritis. In a study of (NZB × SM/J)F1 × NZW backcross mice, there was no linkage of the MHC with nephritis (19). However, since (NZB × SM/J)F1 × NZW backcross mice are either H2d/z or H2v/z, these data imply that heterozygosity for H2d or H2v (in the context of H2z) confers an equivalent increased risk for disease. Recent backcross studies from our laboratory also have shown that H2b/d (H2b inherited from B6 or B10 strains) is strongly linked with nephritis and autoantibody production in preference to H2d/d (TJ Vyse, SJ Rozzo, BL Kotzin, manuscript submitted). Heterozygosity at H2 has also been linked with nephritis in a related model of lupus, (NZB × SWR)F1 mice (20). Together, the above studies are remarkably consistent in their demonstration of the disease-enhancing effect of MHC heterozygosity compared to a double-dose of H2d or H2z haplotypes in the New Zealand murine model of lupus. The genes encoded within H2 that account for the genetic contribution to lupus in New Zealand hybrid mice are not known. Because the production of pathogenic IgG autoantibodies and development of lupus nephritis in this model is dependent on CD4+ T cells (21) and class II MHC molecules (22), it has been hypothesized that class II MHC genes, either H2A or H2E, are likely candidates. This hypothesis may be further supported by studies of NZB mice congenic for either H2b or H2bm12. Although the difference in the MHC haplotypes of these strains is limited to three amino acids in the I-Aβ molecules, one study showed that NZB. H2bm12 mice developed severe disease similar to (NZB × NZW)F1 mice, whereas NZB.H2b mice were similar to NZB (H2d) mice and did not develop severe lupus nephritis (23). These studies of NZB.H2bm12 mice are, however, difficult to reconcile with other studies of NZB mice congenic for H2z and NZB mice heterozygous for H2d/z, which did not express a higher frequency of lupus nephritis compared to NZB (H2d) mice (24). In addition, preliminary studies of New Zealand mice transgenic for various class II H2z genes have not demonstrated a positive role for these class II molecules in expression of disease (25; TJ Vyse, SJ Rozzo, BL Kotzin, unpublished results). No generally accepted mechanism or model can explain how H2 heterozygosity contributes to murine lupus. Some investigators have suggested that mixed haplotype class II molecules such as Aα dAβ z, or Eα dEβ z, or possibly mixed isotype class II molecules such as Eα dAβ z may underlie the enhancing effect on disease (25–28). Some evidence supports the cell surface expression and T cell recognition of I-A mixed molecules (27, 28). However, a recent attempt

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to show disease influence with an Abz transgene in (NZB × NZW.H2d)F1 mice was unsuccessful (25). More important, it seems unlikely that the diseaseenhancing effect of heterozygosity for H2d/z, H2v/z, H2b/z, and H2b/d could all be explained by increased self-antigen presentation involving mixed class II molecules. A number of studies have shown that increased I-E expression can suppress different types of autoimmune processes (29–32), including IgG autoantibody production and nephritis in murine lupus models (33–35). In New Zealand hybrid mice, analysis of intra-MHC recombinant congenic strains suggested that the E-region of H2d (NZB) was also likely to contain a locus (or loci) that suppressed lupus-like disease (35). The neutralization of a suppressive H2-E region locus within H2d does not, however, explain all of the data regarding the enhancing effect of heterozygosity, notably the increased risk of H2d/z compared with H2z/z, and the equivalence of H2v/z and H2d/z. In addition, in at least two studies, the enhancing effect of H2d/z versus H2z/z appeared to be more selective for gp70 autoantibodies, compared to antinuclear autoantibodies (11, 12). In contrast, in studies of murine lupus, the E-region effect has not been specific for one autoantibody or a subset of autoantibodies (36) but appears to involve downregulation of autoantibody production in general. Competition by I-Eα-derived peptides resulting in decreased self-peptide presentation on I-A molecules has been suggested as a possible mechanism (37). It has also been proposed that a polymorphism within the Tnfa locus of the MHC may account for the linkage of H2 with murine lupus (38, 39). Increased TNF-α production and TNF-α injections decrease lupus-like disease in New Zealand mice, whereas decreased TNF (i.e., anti-TNF treatment) resulted in increased disease (38). A Tnfa polymorphism in the H2z haplotype was associated with reduced production of TNF-α in NZW mice. However, it is difficult to conceive how such a polymorphism contributes maximally as a single-copy (i.e. heterozygous) contribution, and functionally significant Tnfa polymorphisms do not correlate with the contributions from other H2 haplotypes to New Zealand hybrid disease. Overall, it seems unlikely that polymorphism in one MHC gene will account for the consistent linkage of various H2 heterozygous states with disease. Although cytokine genes may be one component, at this time, it seems reasonable to predict that the H2 contribution to New Zealand disease will involve multiple genes and multiple mechanisms. BXSB MICE Fewer crosses have analyzed the contribution of MHC in the BXSB model, compared with New Zealand mice. BXSB (H2b) mice have been made congenic for H2d, and male H2d/d mice had significantly delayed development of disease compared to H2b/d and H2b/b mice (40). Similar results were obtained in (BXSB × NZB)F1 mice (41). Since the H2b haplotype does not encode an I-E

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molecule (due to a failure to express Eα), it seemed possible that the suppressive effect of H2d was I-E related. This was further examined by introduction of an Eα d transgene into BXSB mice (34, 37). Comparison of multiple transgenic lines revealed that disease suppression correlated with increased Eα d transgene copy number, Eα mRNA levels, and with presentation of I-Eα d peptides by I-A (37). As discussed above, these authors favor a model of autoimmunity prevention based on competition for antigen presentation, in which excessive generation of I-Eα peptides prevents, because of their high affinity for I-A molecules, activation of autoreactive T and B cells. MRL-lpr/lpr MICE In an (MRL-lpr/lpr × CAST/Ei)F1 × MRL-lpr/lpr backcross analysis, no evidence for linkage of H2 with nephritis was apparent (42). However, IgG autoantibody production was reduced in a general fashion by breeding H2d onto B6-lpr/lpr mice (36). This inhibitory effect of H2d prompted the investigation of the effect of the Eα d transgene (33), and as with studies of other lupus-prone mice, suppression of autoantibody production was associated with the expression of I-E. In cell-transfer studies, autoantibody production was made preferentially by I-E negative versus I-E positive B cells, a result consistent with models described above suggesting that I-Eα-derived peptides might negatively influence self-peptide presentation by I-A.

Non-MHC Loci Mapped in Murine Lupus The majority of data relating to non-MHC loci linked with murine lupus has been obtained from the New Zealand hybrid model. (NZB × NZW)F1 MICE

Since neither NZB nor NZW mice develop severe lupuslike renal disease, genes from both parents must be involved in the full expression of F1 disease. Loci from either the NZB or NZW strains that have been linked with lupus-like traits are shown in Figure 1. Only loci meeting criteria for probable or confirmed linkage have been given names in Figure 1, as recommended (43). Unfortunately, at this time there is no agreed upon nomenclature for loci linked with SLE-like traits, in contrast to studies of insulin-dependent diabetes mellitus and the NOD murine model of that disease (44). Also shown in Figure 1 are a few candidate genes in the region of mapped intervals that may be pathogenetically relevant. Overall, about 12 loci from NZB or NZW strains, in addition to their MHC, have been shown to be in suggestive, probable, or confirmed linkage with lupus traits (Figure 1). The most consistent regions of linkage with respect to nephritis are on chromosome 4, distal chromosome 1, and chromosome 7. These three regions are discussed in more detail. Lupus-susceptibility loci mapped to chromosome 4 A locus (Nba1; New Zealand black autoimmunity 1) on distal chromosome 4 was initially

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identified in (NZB × NZW)F1 × NZW backcross mice with maximal linkage at D4Mit48 (≈69 cM from the centromere) (12, 45). An NZB locus close to this position has also been mapped by other investigators in a similarly designed backcross (46). In the latter paper, this locus was also found linked with IgM production (46) and Mott cell formation (47). The Mott cell is a form of plasma cell that contains excess intracellular immunoglobulin due to increased production. Interestingly, Nba1 is close to Aia1 (≈75 cM), which was described over 20 years ago to be linked with autoimmune hemolytic anemia in NZB mice (48). Studies of three additional crosses have mapped loci on chromosome 4 with maximal linkages proximal to Nba1 (17, 18, 49). One locus, designated Lbw4 (≈56 cM), was mapped in (NZB × NZW)F2 intercross mice (17); a second locus, Sle2 (≈44 cM), was mapped in (NZM × B6)F1 × NZM backcross mice (18). The NZM is a recombinant inbred strain derived from NZB and NZW, and this strain therefore comprises regions of both NZB and NZW genomes. Evidence for linkage of D4Mit28 (48 cM) with nephritis was also found in (BALB.H2z × NZB)F1 × NZB backcross mice (49). Sle2 has been further studied by breeding an NZM interval containing Sle2 onto a B6 background (50, 51). The interval was described to be about 15 cM in length with both NZW and NZB contributions. The congenic mice, termed B6.NZMc4, demonstrated increased serum levels of IgM (compared to B6 mice) but did not produce antinuclear autoantibodies or develop nephritis (50). A more detailed analysis of the phenotype of B6.NZMc4 mice revealed that there was an early increase in the population of splenic CD23low B cells (51), and older mice showed progressively elevated numbers of peritoneal and splenic B1 cells. With age, congenic mice demonstrated increasing serum levels of polyclonal IgM, and their B cells showed evidence of activation by surface phenotype and a hyper-responsiveness to a variety of stimuli including lipopolysaccharide (LPS), BCR cross-linking, and CD40 ligation (51). A number of problematic issues pertain to the disease-susceptibility loci and B cell traits mapped to chromosome 4. For example, extensive serological investigation of an (NZB × NZW)F1 × NZW backcross failed to show evidence that Nba1 is linked with the production of any known pathogenic IgG autoantibodies (12) or with total IgG, IgG2a, and IgG3 levels (TJ Vyse, BL Kotzin, unpublished data). Furthermore, an analysis of (NZB × B6.H2z)F1 × NZB backcross mice showed no detectable linkage of nephritis or IgG autoantibody production with a chromosome 4 locus (49). Yet, there was a contribution from this NZB region to serum IgM levels (TJ Vyse, SJ Rozzo, BL Kotzin, unpublished results). In light of these data, the relationship between the B cell abnormalities associated with the Sle2 congenic interval and the development of lupus nephritis needs to be clarified. How a locus linked with increased IgM production might promote murine lupus nephritis without also promulgating

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pathogenic IgG autoantibody production is unclear. An alternative explanation for the IgM linkage with chromosome 4 is that it is due to a separate gene from the nephritis-susceptibility NZB gene. It therefore will be important in future studies to show that a narrowed interval on NZM chromosome 4 contains a nephritis-enhancing gene as well as a gene that influences B cell phenotype and function. It is also possible that there is more than one disease-susceptibility gene on chromosome 4. The peak linkage of Sle2 was positioned ≈25 cM proximal to that of Nba1. Although this may represent the inherent inaccuracies of mapping loci in experimental crosses, it is possible that the two loci are different. It should also be emphasized that Sle2 was mapped in a backcross with B6 mice, whereas Nba1 was mapped in a cross of NZB and NZW backgrounds. Other studies have shown that contributions from disease-susceptibility loci may vary markedly depending on the genetic backgrounds used in a backcross analysis (see below). ←−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−− Figure 1 A schematic of 14 murine autosomes on which the positions of 16 non-MHC loci mapped in murine lupus are shown. The number of each chromosome is given above its centromere, and the distance in cM from the centromere is shown to the left of each chromosome. The degree of statistical support for these loci is also indicated. Loci shown in bold type have been mapped at p < 1 × 10−4 or have been confirmed at p < 0.01 in at least two separate crosses. Loci linked with nephritis that satisfy these criteria are: Sle1-Sle3 (18); Lbw2 and Lbw5 (17); Nba1 (12, 45); Nba2 (19, 49, 52). Some of these loci were also linked with autoantibody production. Loci that have been separately linked with autoantibody production with similar statistical support are: Lbw7 and Lbw8, which are NZB loci (17); and Nwa1 and Nwa2, which are NZW loci (54). An NZB locus on chromosome 7 (Nba3 at D7Mit7) was linked with IgG autoantibody production (12) and showed a trend for linkage with nephritis ( p < 0.01) in another cross (19). The BALB/c locus on chromosome 9, Baa1, was linked to IgM autoantibody production (54); another BALB/c locus on chromosome 1 was in suggestive linkage with the same trait (54). Other non-MHC loci in suggestive linkage with nephritis and/or autoantibodies (0.003 < p < 1 × 10−4) are shown, underlined. These include the NZW loci, Lbw3 and Lbw6, on chromosomes 5 and 18, respectively (17), and an NZB locus on chromosome 13 (at D13Mit150) (19). Data from a (BALB.H2z × NZB)F1 × NZB backcross showed two NZB loci on chromosomes 11 and 14 in suggestive linkage with nephritis (49). An NZW locus on chromosome 14 at the T cell receptor alpha locus (Tcra) was found in suggestive linkage with autoantibody production (12, 54). Loci in linkage with lupus-related traits at 0.01 < p < 0.003 are shown in plain text. Although some of these loci may represent false-positive results, they are included for completeness as linkage may yet be confirmed in future genetic analyses. The locus Aia1 was mapped on chromosome 4 to be linked with autoimmune hemolytic anemia in NZB mice (48). Two loci mapped in the MRL model of SLE, on chromosomes 7 and 12, were linked with nephritis and are depicted, Mrl (42). The positions of some candidate genes are shown by horizontal bars. These include Cfh, complement factor H; Fasl, Fas ligand; Fcgr2, Fc receptor, IgG, low affinity II; Crp, C-reactive protein; Sap, serum amyloid P protein; Crry, complement receptor related protein; Cr2, complement receptor 2; C1q, complement protein 1, q subcomponent; Tnfr2, tumor necrosis factor receptor II; Cd30, Cd30 antigen; Cd22, Cd22 antigen; Rt6, rat T lymphocyte differentiation marker RT6 homologue; Cd3d/e/g, CD3 antigen, delta, epsilon, and gamma polypeptides; Igh, immunoglobulin heavy chain; and Fas, Fas antigen.

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Lupus-susceptibility loci mapped to chromosome 1 As shown in Figures 1 and 2, several different crosses have identified colocalizing loci on chromosome 1 (17–19, 49). An NZB locus, termed Nba2, was initially mapped in an analysis of nephritis-susceptibility loci in (NZB × SM/J)F1 × NZW backcross mice (19). An NZB locus at a similar position on chromosome 1 was linked with nephritis in (B6.H2z × NZB)F1 × NZB and in (BALB.H2z × NZB)F1 × NZB backcross mice (49). Nba2 was the only non-MHC locus from the NZB strain that showed consistent linkage with nephritis in the context of different nonautoimmune backgrounds. Subsequently, this locus was linked with the production of multiple different autoantibodies and with elevated serum IgG in two separate backcrosses (52). Based on the serological traits linked with Nba2, this locus was proposed to act as an immune response gene, that is, promoting the immune response in general rather than as a selective self-tolerance defect. If Nba2 simply resulted in a tolerance defect and only affected autoantibody levels, it would not be expected to exhibit linkage with total IgG levels. It was also argued that Nba2 is unlikely to be acting as a polyclonal activator because its linkage with autoantibodies was considerably stronger than with total immunoglobulin levels. Morel et al (18) mapped a locus, Sle1, in (B6 × NZM)F1 × NZM backcross mice. Sle1 was situated at a position on distal chromosome 1 similar to that on Nba2 but was contained within an NZW interval in the NZM genome. As discussed above, Nba2 (New Zealand black autoimmunity 2) is a contribution from the NZB strain. The function of Sle1 was further investigated by selectively breeding B6 congenic mice containing the Sle1 interval. In these congenic mice, Sle1 alone was associated with selective loss of tolerance to a limited range of subnucleosomal antigens and a minimal degree of histological nephritis (50). This phenotype was therefore very different from the traits linked −−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−→ Figure 2 A map of the distal end of mouse chromosome 1 showing the positions of peak linkage for loci linked with murine lupus, Nba2, Sle1 and Lbw7. The distance from the centromere in cM is shown at the left side of the Figure. The position of the following candidate genes are also depicted: Fasl, Fas ligand; Sele, E-selectin; Sell, L-selectin; Selp, P-selectin; Cd3z, Cd3 antigen, zeta polypeptide; Fcgr2, Fc receptor, IgG, low affinity 2; Fcgr3, Fc receptor, IgG, low affinity 3; Ctl1, cytotoxic T lymphocyte response 1; Fcer1g, Fc receptor, IgE, high affinity 1, gamma; Cd48, Cd48 antigen; Ly9, lymphocyte antigen 9; Fcer1a, Fc receptor, IgE, high affinity 1, alpha; Crp, C-reactive protein; Sap, serum amyloid P-component; Ifi201-4, interferon inducible proteins 201–4; Adprp, ADP ribosyl transferase; Hlx, H2.0-like homeobox; Tg f b2, transforming growth factor, beta 2; Cr1, complement receptor-related protein Y; Cr2, complement receptor 2; and Cd34, membrane cofactor protein. Shown on the right side of the figure is a syntenic interval of human chromosome 1. In a linkage analysis of SLE patients this interval was found to possibly contain a lupus-susceptibility locus (134). Three human homologues of candidate genes within this interval are depicted.

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to Nba2, although the latter was determined in the context of other NZB loci in backcross analyses and not in a congenic analysis. However, the consistent phenotype linked with Nba2 in the context of different backcrosses suggests that the function of Nba2 differs from Sle1. In a separate study, a locus on distal chromosome 1 (NZB-derived) was linked with IgG anti-chromatin antibody production but not nephritis in an (NZB × NZW)F2 intercross (17). Together, these results from different laboratories suggest that there may be contributions from both NZB and NZW strains on distal chromosome 1. It remains to be determined whether these NZB and NZW genes are different alleles of the same gene or are different genes. Attractive candidate genes in this region include Fcgr2 and Fcgr3 (see below). Lupus-susceptibility loci mapped to chromosome 7 A third genomic region of particular interest is on chromosome 7, which also may contain more than one contributing gene (Figure 1). One locus, Lbw7 (23 cM), is of note because disease was linked more strongly with heterozygosity than homozygosity for NZB or NZW alleles in (NZB × NZW)F2 intercross mice (17). This is likely to reflect some form of epistasis, and other evidence indicates contributions from both NZB and NZW loci. An NZB locus, Nba3, was linked with nephritis in (NZB × SM/J)F1 × NZW mice (19) and with autoantibody production in (NZB × NZW)F1 × NZW backcross mice (12) with peak linkage at ≈50 cM. Similarly, an NZW locus more proximal on chromosome 7 was linked with autoantibody production in (NZB × NZW)F1 × NZB backcross mice (TJ Vyse, RK Halterman, BL Kotzin, unpublished results). These data appear to support the hypothesis that heterozygosity for certain alleles on chromosome 7 is linked with disease more strongly than either NZB or NZW homozygosity. A locus, Sle3, was linked with nephritis in (B6 × NZM)F1 × NZM mice with peak linkage ≈20 cM proximal to Nba3 (18). It was subsequently shown to be NZW in origin (53). This locus has been examined in isolation as a congenic interval on a B6 background (50). In these congenic mice, Sle3 was associated with mild glomerulonephritis and fluctuating antinuclear autoantibody levels. In view of their respective differences in position and strain of origin, Sle3 and Nba3 are likely to be distinct susceptibility genes. Other loci mapped in New Zealand hybrid mice As shown in Figure 1, loci on chromosomes 5, 6, 11, 13, 14, 16, 18, and 19 also have been mapped as susceptibility loci in the New Zealand hybrid model. Most of these loci require confirmation in additional experimental crosses; however, many are likely to be validated, indicating the genetic complexity of murine lupus. This is a situation analogous to the NOD model of type I diabetes in which at least 15 non-MHC Idd loci have been linked with disease (44). The roles of some of these additional loci linked with murine lupus can be inferred from subphenotype analyses. For example, the NZW loci, Nwa1 and Nwa2 on chromosomes 16 and 19,

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respectively, were linked with class-switching the autoantibody response from IgM to IgG in (NZW × BALB/c)F1 × NZW backcross mice (54). Alleles from strains not themselves displaying a significant autoimmune phenotype have been linked with autoimmune traits and diseases in analyses of crosses with New Zealand mice. For example, loci from nonautoimmune SM/J mice were linked with accelerated nephritis and autoantibody production in an analysis of backcross mice and in NZB × SM/J (NXSM) recombinant inbred strains (19; TJ Vyse, BL Kotzin, unpublished data). In a separate backcross study of NZW contributions, BALB/c loci on chromosomes 1 and 9 were linked with increased production of IgM antinuclear autoantibodies, although BALB/c mice themselves do not demonstrate these autoimmune traits (54). Such results emphasize that the lupus-prone strains being studied in these backcross and intercross analyses only harbor a subset of disease-susceptibility loci, and that other strains, including nonautoimmune strains, may show contributions to disease that may be relevant to human SLE. Contributions to diabetes susceptibility from the nonautoimmune B6 strain have also been found in studies of NOD mice (55). These contributions to autoimmunity may not be surprising when one considers that multiple loci control related traits in nonautoimmune strains, such as the magnitude of the immune response. For example, loci from the A.SW/snJ strain (in a backcross with SJL/snJ) on chromosomes 1, 5, 7, 13, 16, and 19 were linked with increased IgG antibody production to a test antigen, rhodopsin (56). Interestingly, these quantitative trait loci appear to colocalize with lupus-susceptibility loci mapped to the corresponding chromosomes (56; and see Figure 1). The effect of genetic background on loci mapped in (NZB × NZW)F1 mice Different genetic backgrounds are known to influence the phenotype of transgenic and knockout mice. Hence, in a complex trait, it would be anticipated that the contributions from disease-susceptibility loci could be modified by genetic background. As described above, the usual approach used to map loci linked with murine disease is to cross an affected strain to a second strain that does not exhibit the disease phenotype. The influence of this second strain on the contributions of disease-susceptibility loci from the diseased strain has been subject to limited investigation. In studies of NOD mice, Idd loci mapped in a NOD cross with MHC-congenic NON mice were compared retrospectively to loci mapped in crosses with C57BL/10 (B10) mice (57). Background genetic influences from NON versus B10 were apparent, although these findings were undoubtedly influenced by the relatedness of the NON and NOD strains. In one study of NZB loci linked with lupus nephritis, the role of background genes was directly addressed by comparing NZB contributions in (B6.H2z × NZB)F1 × NZB backcross mice and (BALB.H2z × NZB)F1 × NZB backcross mice (49). In (B6.H2z × NZB)F1 × NZB backcross mice, contributions from H2z

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on chromosome 17 and Nba2 on chromosome 1 accounted for the majority of the nephritis observed. In contrast, in (BALB.H2z × NZB)F1 × NZB backcross mice, H2z showed no linkage with disease, and Nba2 was only weakly linked with nephritis, whereas other NZB loci on chromosomes 4, 11, and 14 showed evidence for linkage with nephritis. Thus, the contributions from disease-susceptibility loci, including MHC, varied markedly depending on the nonautoimmune strain used in the backcross analysis. The mechanism for this influence appeared to be complex. In the case of MHC, the influence of nonautoimmune background must have been related to gene(s) at a distance from the MHC. These studies provide insight into variables that affect genetic heterogeneity and point to another important dimension of complexity to be considered in linkage analyses of human SLE. BXSB MICE No genome-wide linkage studies have been published to date documenting non-MHC loci in this strain. It would be interesting to note if any colocalized with loci mapped in New Zealand mice, particularly in view of the disease potentiation described in hybrids between the two model strains (9, 41, 58). BXSB mice carry the Yaa (Y chromosome-linked autoimmune acceleration) gene, which results in a more rapid and severe lupus-like disease in male versus female BXSB mice. In contrast, (NZB × NZW)F1 mice are more akin to humans in that they show earlier and more severe disease in females, related to the influence of sex hormones (reviewed in 2). Although the molecular basis of the Yaa contribution is unknown, studies have suggested possible mechanisms by which Yaa may accelerate lupus. For example, the Yaa locus has been associated with augmenting the antibody response to exogenous antigens (59) and has been shown to bias the IgG autoantibody subclass response from IgG1 to IgG2a and IgG3 (60). The latter two subclasses appear to be more pathogenic in relation to autoantibody-mediated nephritis than the IgG1 subclass of autoantibody (61). MRL MICE AND THE LPR AND GLD MUTATIONS Homozygosity for the lpr and gld mutations results in the acceleration of lupus-like autoimmunity as well as massive accumulation of CD4− CD8− (double negative) T cells (reviewed in 9, 62). Full expression of lupus-like disease, such as in MRL-lpr/lpr mice, is dependent on complex genetic contributions from other non-MHC genes. Figure 1 shows the position of the lpr (Fas) and gld (Fas ligand) genes and two additional loci (designated Mrl) on proximal chromosome 7 and mid chromosome 12 mapped in a backcross analysis of MRL-lpr/lpr mice (42). None of these genes or loci appears to overlap with any of the New Zealand disease loci mapped thus far.

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Lpr, identified as a spontaneous mutation of Fas (CD95), and gld, identified as a mutation of Fas ligand, have been the subject of intense research in terms of their role in cellular apoptosis and the mechanism by which they contribute to various aspects of immunobiology, including autoimmunity. We do not attempt to review this extensive literature at this time and instead refer interested readers to some of the many recent reviews of this subject (reviewed in 62–66). Although the mechanism by which mutations in Fas lead to accelerated autoimmunity is unknown, the strongest hypothesis is that self-reactive T and B cells arise when they fail to undergo normal apoptosis. Studies have shown that both T cells and B cells must carry the lpr mutation for maximal autoantibody production to occur in lpr mice. Fas does not appear to be essential for positive or negative selection during intrathymic T cell development in the thymus (67–69), although some influence on negative selection has been reported (70), and several lines of evidence support the contention that peripheral T cell tolerance mechanisms are primarily affected by the lpr mutation (68, 69). Studies suggest that central B cell tolerance also may be relatively independent of Fas, and surface expression of Fas on B cells may be most important in preventing inappropriate CD4+ T cell-dependent expansion of autoreactive B cells in the peripheral lymphoid tissues (65, 71–73). It is worth emphasizing that there is really no counterpart to the lpr and gld phenotype in human SLE, and studies have not provided evidence of defects in the FAS and FASL homologous genes in human SLE patients. Fas mutations, however, have been identified in a few families with lymphoproliferative syndromes and evidence of autoimmunity primarily affecting the hematologic system (74–76). It will be interesting to see if other genes involved in apoptosis and related cell signaling pathways will be shown to be involved in the emergence of autoreactive lymphocytes and genetic susceptibility in human SLE.

Selected Knockout and Transgene Models of Systemic Autoimmunity The investigation of molecules potentially relevant to lupus-like disease has involved the generation of mice in which the gene encoding the molecule is deliberately knocked out or the generation of transgenic mice that have altered patterns or levels of expression. Some of these genetically engineered mouse strains have demonstrated evidence of systemic autoimmunity, and a few examples of this phenomenon are briefly described. B CELL LYMPHOMA PROTEIN 2, (BCL-2) The Bcl-2 protein is expressed intracellularly and protects lymphocytes against apoptosis induced by a variety of stimuli (reviewed in 77). Transgenic mice that overexpress Bcl-2 in lymphocytes showed prolonged survival of both B and T cells (78). In one study

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most of the transgenic mice produced antinuclear autoantibodies, including antibodies to DNA and histones, and developed a lupus-like immune complex glomerulonephritis (78). TUMOR NECROSIS FACTOR (TNF) RECEPTORS The TNF receptors (TNF-RI and TNF-RII) belong to the same gene family as Fas (79) and both are involved in apoptosis. TNF-RI and Fas share the same cytoplasmic domain sequence that is responsible for delivering the death signal after receptor ligation (80). Although both Fas and TNF receptors mediate apoptosis, it has become clear that they utilize different signaling pathways (81, 82). In contrast to MRL-lpr/lpr mice, neither Tnfr1 nor Tnfr2 knockout mice appeared to be predisposed to autoimmunity (83). However, when Tnfr1 knockout mice were crossed with lpr mice, the double knockout strain developed markedly accelerated lymphadenopathy, autoantibody production, and systemic autoimmunity with a high mortality (83). LYN The Src family tyrosine kinase, Lyn, associates physically with the BCR complex and may play an important role in BCR-mediated signaling. Studies in Lyn knockout mice showed decreases in B cell numbers and function (84, 85). Despite the impairment of B cell function, these knockout mice demonstrated antinuclear autoantibody production, elevated serum Ig, and immune complex glomerulonephritis. In contrast to SLE and spontaneous murine lupus, the autoantibody production was predominantly IgM, although some IgG was apparent in the kidneys. TRANSFORMING GROWTH FACTOR BETA (TGF-β) This 25-kDa protein has pleiotropic actions within the immune and inflammatory processes. It may act in a stimulatory or inhibitory fashion, depending on its concentration and the cytokine milieu in which it operates. Mice made deficient in TGF-β1 (Tg f b1 knockout), after about two weeks of age, develop marked mononuclear cell infiltration of multiple organs (86, 87). The salivary gland infiltration resembled that seen in Sj¨ogren’s syndrome, and the fatal lymphoproliferative syndrome was associated with lupus-like antinuclear antibody production and immune complex formation in the glomeruli (88). Interestingly, increased production of TGF-β1, in mice transgenic for Tg f b1, also demonstrated progressive glomerulonephritis and renal failure (89).

IL-2 is considered a pivotal cytokine in the proliferation and differentiation of T cells. Il2 (90) and Il2rb (Il-2 receptor beta chain) knockout (91) mice developed increased Ig levels and antinuclear autoantibodies together with antierythrocyte antibodies. The majority of animals exhibit a severe hemolytic anemia in early life. INTERLEUKIN-2 (IL-2)

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SHP-1 PROTEIN TYROSINE PHOSPHATASE Two strains of mice with similar phenotypes have resulted from mutations in the same gene in B6 mice. These mice develop lupus-like autoimmune phenomena and are termed motheaten (me/me) and motheaten viable (mev/mev) strains. Although these mutations were spontaneous, they are described in this section because their molecular basis has been determined and they are relevant to other knockout models. Each strain carries a mutation in the gene encoding the SHP-1 protein tyrosine kinase, formerly referred to as tyrosine phosphatase PTP1C or hematopoietic cell phosphatase, HCP (92, 93). This tyrosine phosphatase associates with CD22 (94, 95) and Fcγ RIIb1 (96), and by doing so, SHP-1 mediates the dephosphorylation of the Igα component of the BCR complex (96). The phosphatase appears to play a role in downregulating antigen-induced B cell activation (96, 97). This may be the mechanism by which SHP-1 deficiency leads to some of the autoimmune traits displayed by motheaten mice, including elevated levels of CD5+ B cells, increased autoantibody production (predominantly IgM), and a small amount of glomerular immune complex formation. The major pathology of this animal, however, appears to be separate from lupus-like disease (98). The immunologic consequences of SHP-1 deficiency may also be relevant to the hypothesis that polymorphism of Fcgr2 may be a contribution to susceptibility from NZB mice. Consistent with its role in negative regulation of BCR signaling, Fcgr2 knockout mice demonstrate augmented B cell responses and increased immunoglobulin levels (99). As discussed above, in several backcross analyses, Nba2 was mapped to a position on chromosome 1 with peak linkage close to Fcgr2. Importantly, its associated phenotype was consistent with B cell hyperactivity and increased antibody responses to both self and exogenous antigens (52). In preliminary studies, we have shown that the NZB Fcgr2 allele includes a promoter region deletion that decreases gene expression (CG Drake, TJ Vyse, BL Kotzin, unpublished observations).

HUMAN STUDIES Genetic Epidemiology of SLE Studies of genetic epidemiology are designed to determine whether there is familial clustering of disease. The degree of disease clustering can be expressed as a ratio of the prevalence in families in which there is an affected member to the prevalence of disease within the population as a whole. The risk ratio of affected sib pair to population prevalence, λs, quantifies sibpair familial clustering (100). If this ratio is close to 1.0, then there is no evidence of familial clustering or evidence for genetic factors in susceptibility. In contrast, the λs value for SLE is estimated to be 10–20, which is similar to that in type I diabetes and multiple sclerosis (44).

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A second epidemiological approach to examine the genetic contribution to a disease uses twins: The prevalence of a disease in pairs of identical or monozygotic twins is compared with that in nonidentical or dizygotic twins. These data are usually expressed as concordance rates, the fraction of the twin pairs that share disease expression. The most recent studies in SLE found concordance rates of 24% versus 2% in monozygotic versus dizygotic twins, respectively (101). These rates are not dissimilar from those found in studies of type 1 diabetes and multiple sclerosis, and they lend further support for a genetic component to disease.

Association of MHC Alleles with SLE The first descriptions of the association of class II MHC alleles with SLE were made about twenty years ago (102, 103). These observations have been subsequently confirmed and indicate that HLA-DR2 and HLA-DR3 separately confer twofold to threefold relative risks for the development of SLE in Caucasians. Even these low increased risks are remarkable considering the heterogeneous types of autoantibodies and disease manifestations in the patient groups analyzed in these studies. In African-American patients (in which HLA-DR3 is uncommon), HLA-DR2 and HLA-DR7 have been associated with SLE. At the molecular level this association is largely accounted for by the DRB1∗1501 subtype in linkage disequilibrium with DRB5∗0101 and DQB1∗0602 (104). These findings have also been made in Japanese patients (105). Other investigators have attempted to examine the relation between the MHC and clinical subtypes of SLE based on autoantibody production (106, 107). In general, this form of analysis has revealed strong associations between the production of specific autoantibodies and various HLA-DQ alleles. For example, one group of investigators showed that the heterozygous combination of DQw2.1/DQw6 was closely correlated with the production of autoantibodies to Ro/SS-A and La/SS-B in both SLE and Sj¨ogren’s syndrome (108, 109). Importantly, this association was present in both Caucasian and African-American populations with increased relative risks approaching 10 in both populations (107–110). Although the majority of SLE patients producing anti-Ro and anti-La did not carry DQw2.1/DQw6 alleles, sequence analysis of these and other DQ α- and β-chains expressed in these patients prompted the authors to conclude that a glutamine residue at position 34 of the α-chain and a leucine residue at position 26 of the β-chain were important for the production of these autoantibodies (110). Related to these findings, the production of low levels of anti-Ro (in the absence of anti-La) in Caucasians was associated with DR2 and DQw6, which are in linkage disequilibrium (107). In addition, in a study of SLE patients in Germany, DR3 (and DQw2.1) were more specifically associated with anti-La production (111). It is emphasized that

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the B8-DR3-DQw2.1 haplotype also contains a null complement C4A gene (see below). African-American lupus patients tend to have a higher preponderance of antibodies to the spliceosome complex (anti-U1 RNP and anti-Sm). In this population, production of anti-Sm was associated with DR2-DQw6, whereas the presence of anti-RNP antibodies (in the absence of anti-Sm) was associated with DQw5 (DQw1.1) (112). At the molecular level the associations were strongest with particular DQ alleles; DQA1∗0102-DQB1∗0602 was associated with anti-Sm, and DQA1∗0101-DQB1∗0501 was associated with anti-RNP. Both of these allelic associations have been described in Caucasians too. HLA-DQ allelic associations have also been reported for antiphospholipid antibodies (i.e. anticardiolipin antibodies and/or the lupus anticoagulant), anti-dsDNA antibodies, and in a subset of patients with lupus nephritis (107, 113–115). Together, these results suggest that the contribution of class II MHC genes in SLE is predominantly at the level of production of specific autoantibodies. The B8-DR3-DQw2.1 extended haplotype associated with SLE in Caucasians contains a complement C4A null allele as a result of a large genomic deletion. The human C4 locus comprises two C4 genes per haplotype, C4A and C4B. The B8-DR3-DQw2.1 haplotype also contains a number of class III complement gene alleles in linkage disequilibrium designated [SC01]: the S allele of factor B (Bf), the C allele C2, the null allele of C4A (C4A∗Q0), and the 1 allele of C4B. The B8-[SC01]-DR3-DQw2.1 haplotype is relatively common in Caucasian populations with a frequency of ≈0.25. Since other classical pathway complement protein deficiencies predispose to SLE, and probably some functional differences exist between C4A and C4B (116, 117), it has been proposed that C4A∗Q0 predisposes to SLE. Complete C4 deficiency (absence of gene product from all four C4 genes) is a rarity, but most individuals with this deficiency develop a lupus-like syndrome (118, 119). In order to determine whether deficiency of a single gene, namely C4A∗Q0, has an etiological role in SLE, various groups have determined the association of C4A null alleles in SLE in different ethnic populations in an attempt to dissociate the C4A null alleles from the B8-DR3 extended haplotype. The results thus far have been inconclusive in part because of the inherent biases in association studies as well as methodological problems of ascertaining the presence of C4 null alleles. If C4A null alleles do enhance disease susceptibility, they appear to exert a weak effect, and other genes within the MHC haplotypes carrying C4 null alleles also contribute to disease susceptibility. A polymorphic variant of the class III gene encoding tumor necrosis factor (TNF)-α has been postulated to be a disease susceptibility allele in SLE. One allele (TNF∗B) is in linkage disequilibrium with DR2-DQw6 and correlates with low production of TNF-α in vitro (120). Thus, it was suggested that

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reduced TNF-α production accounted for the risk of lupus nephritis associated with DR2-DQw6. As discussed above, these findings are relevant to studies of the MHC contribution and role of TNF-α in New Zealand hybrid mice.

Non-MHC Genes Implicated in SLE by Association

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With the exception of complete deficiencies of classical pathway complement proteins, the association of SLE with other non-MHC genes or loci remains for the most part work in progress. COMPLEMENT GENES Deficiencies of complement components C1q, C1r, C1s are each associated with SLE, lupus nephritis, and anti-dsDNA autoantibody production (121, 122). Complete deficiencies of C2, C4, and C3 are associated with a milder form of lupus (119, 122). The validity of the associations is strengthened because the genes encoding these proteins are not all linked (although C1r and C1s are linked on chromosome 12, and C2 and C4 are in the MHC), and the molecular lesions underlying the different complement deficiencies are diverse. Thus, the relationship between these deficiency states and SLE is likely to be an etiological one. The mechanism of causality remains to be established. Classical complement deficiencies may impede appropriate handling of immune complexes leading to greater tissue deposition. Other investigators have postulated defects in the clearance of infectious particles or immune complexes, leading to enhanced autoantibody production. Alternatively, prolonged or excessive generation of C3 fragments (which bind CR2) may alter B cell activation via signaling through the coreceptor CR2(CD21)/CD19/CD81/Leu-13 complex (123). SLE is also associated with reduced levels of tissue complement CR1(CD35) receptors. However, CR1 deficiency is an acquired defect in SLE, and hence it is not genetically determined (124). A protein related to C1q, both structurally and functionally, is mannose-binding protein (or lectin). A null allele of the MBL gene (on chromosome 10q) also has been associated with SLE in Caucasians (125), although this allele is relatively common in controls (frequency = 0.3). FC RECEPTOR AND OTHER GENES Polymorphisms in a variety of genes encoding molecules with relevant immunological functions have been examined for association with SLE. Examples include allotypes of the immunoglobulin heavy chains (111, 126), deletions within the immunoglobulin complexes (127), and polymorphisms in T cell receptor (TCR) α- and β-chain gene complexes (128, 129). None of these loci has been conclusively associated with SLE. In contrast, two groups have recently shown an association between SLE and alleles of the FCGR2A gene (130, 131), which encodes an Fcγ receptor (CD32) expressed on monocytes-macrophages and neutrophils. These associations have been found in African-American patients (130) and also in Caucasians (131)

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with lupus nephritis. The FCGR2A gene encodes two alleles, Fcγ RIIa-H131 and Fcγ RIIa-R131, which differ substantially in their ability to bind human IgG2. The Fcγ RIIa-H131 is the only human Fcγ R that recognizes IgG2 efficiently, and optimal handling of IgG2-bearing immune complexes occurs in the homozygous state. The inefficient binding of IgG2 complexes by Fcγ RIIaR131 is additionally important because IgG2 is an IgG subclass that does not activate complement-dependent clearance mechanisms (132). The above association studies found a decrease in the prevalence of the Fcγ RIIa-H131 allele in SLE, particularly in patients with lupus nephritis. These findings in SLE patients are of additional interest in view of the fact that loci linked with nephritis in New Zealand hybrid mice (Nba2/Sle1) map to a region on distal murine chromosome 1 that includes the mouse homologue of FCGR2A, Fcgr2. It should, however, be noted that one published report did not find an association of SLE with FCGR2A alleles (133).

Linkage Studies in SLE To date, only one published paper has examined linkage in human SLE (134). In this report 52 affected sibpairs from 43 families were investigated. A whole genome scan was not described; instead the study examined a single region of the long arm of human chromosome 1 (from 1q31 to 1q42). This region was selected because it is syntenic (encodes homologous genes) with a region on distal mouse chromosome 1 containing loci linked with murine lupus (encompassing Nba2/Sle1/Lbw7; see Figures 1 and 2 and section on non-MHC loci mapped in New Zealand mice). Seven microsatellite markers spanning ≈27 cM from 1q31 to 1q42 were screened in the sibpairs and other family members. Evidence for excess allele sharing (p < 0.01) was found with markers D1S229, D1S213, and D1S225 (encompassed within 1q41–42). A trend for linkage (p < 0.05) was also observed between this locus and serum IgG anti-chromatin antibody levels. The statistical support for linkage was remarkable, especially when one considers the small number of sibpairs studied, the racial heterogeneity of the families, and that no attempt was made to subset the analysis based on phenotype (i.e. individuals were counted as affected if they met ACR criteria for classification of SLE). It is interesting to note that a trend for excess allele sharing was found in Caucasians, Asians, and African-Americans, although the numbers in each of these three groups were small. Despite the directed nature of this study, it is perplexing to note that the region on human chromosome 1 mapped may be 5 to 10 cM distal (on the mouse chromosome) to the syntenic interval containing Nba2 and Sle1 (see Figure 2). Especially in view of the small number of sibpairs examined in this study, analysis of a separate group of lupus families will be necessary to confirm whether there is a disease-susceptibility locus at 1q41–42. It also remains to be determined

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whether linkage with human SLE will be established in the murine syntenic interval or whether the finding in human SLE was fortuitous.

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COMPARISON OF HUMAN AND MURINE GENETIC DATA As a guide to the investigation of genetic predisposition in human disease, the results from genetic analyses in animal models could be useful in two major ways. First, a mouse chromosomal region containing a disease-susceptibility locus will generally have a syntenic region in the human genome, which could be examined for linkage. Thus, a linkage analysis in patients could be directed to particular genomic regions rather than involve several hundred markers to complete a genome-wide screen. This approach was used in the study described above by Tsao et al (134), which linked a locus on human 1q41–1q42 to SLE. Two other examples of syntenic loci in murine models are being exploited to examine linkage in autoimmune diseases other than SLE. The NOD locus Idd5 on proximal murine chromosome 1 is syntenic with a region on human chromosome 2q. In fact, two human IDDM loci have been mapped to human chromosome 2 using transmission disequilibrium testing: IDDM7 was mapped to 2q31 (135); and a polymorphism in the CTLA4 gene (at 2q33 and designated IDDM12) was linked with diabetes in Spanish/Italian and Belgian families (136). In studies of patients with multiple sclerosis, the Eae2 locus on mouse chromosome 15, mapped in one EAE model (137), was also used as a guide in mapping a disease-susceptibility locus in a Finnish population (138). However, there is also reason to be cautious about the syntenic approach. Despite genomewide scans that have mapped at least 15 non-MHC Idd loci in the NOD model and about 10 IDDM loci in human type 1 diabetes, to date, only this one Idd locus on murine proximal chromosome 1 may correspond in the mouse and human diseases. Second, the results from genetic analyses from animal models could be useful once an actual gene is identified. Not only could the same gene be examined for linkage and/or association with the human disease, but other genes encoding molecules in the same or related biological pathways could be tested for linkage and/or association with human SLE. However, although multiple loci have been mapped in linkage analyses of murine lupus, no non-MHC susceptibility genes have been identified to date.

CONCLUSION From the above discussion, it is evident that SLE, like other autoimmune diseases, is a complex genetic trait with contributions from MHC and multiple

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non-MHC genes. This complexity is retained even when disease subphenotypes such as specific IgG autoantibody production or lupus nephritis are analyzed separately. Essentially all of the elements that determine genetic complexity seem to be operative in this disease. For example, of the multiple different non-MHC loci mapped in linkage analyses in New Zealand hybrid mice, each appears to confer a small increased risk to disease susceptibility. Because they are unlikely to represent knockout mutations or mutations with marked functional alterations, the etiologic alleles are also likely to be relatively common in the general population. Genetic heterogeneity also has been apparent in studies of both human disease and mouse models. Even different and variable gene combinations from the same lupus-prone strain can result in the same autoimmune phenotype, and background genetic influences from nonautoimmune parents in genetic crosses can affect the genes that contribute to disease in their offspring. Although not discussed in detail in this chapter, epistasis (interaction) among contributing genes, with both disease-enhancing and diseasesuppressing effects, has been inferred with near certainty. However, prior to identification of the actual genes, the nature of such interactions is unknown. It is emphasized that the development of murine lupus in various crosses appears to be a probability function solely based on the susceptibility genes inherited. Environmental influences, not addressed in this chapter, may add further to the complex non-Mendelian inheritance of disease in SLE patients. In the last few years, a great advance in genetic susceptibility research has been the development of techniques to map the position of disease-susceptibility loci in genome-wide screens. The positions of contributing genes are isolated on the basis of chromosomal location and not on the basis of any a priori hypothesis regarding the function of a gene. Although multiple loci have now been positioned in murine lupus, the intervals containing the etiologic alleles remain large, and this markedly decreases the chance of correctly identifying a candidate gene. Importantly, of the non-MHC loci mapped, none of the susceptibility genes at these loci has yet been identified. Ongoing studies in murine lupus, mainly using congenic mice, are focused on reducing the chromosomal intervals containing the susceptibility genes so that candidate gene approaches will be more likely to succeed and/or positional cloning techniques can be used to identify the etiologic allele. Similar goals will follow successful linkage studies in human SLE, although the strategies employed to accomplish this work, such as transmission disequilibrium testing, will be quite different compared to those used in the murine disease. Identification of the genes that predispose to SLE will almost certainly provide important insight into the development of autoimmunity and the cause of autoimmune disease.

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ACKNOWLEDGMENT This work was supported by Grant AR37070 from the National Institues of Health. Visit the Annual Reviews home page at http://www.AnnualReviews.org.

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VYSE & KOTZIN tation in mice causes excessive inflammatory response and early death. Proc. Natl. Acad. Sci. USA 90:770–74 Dang H, Geiser AG, Letterio JJ, Nakabayashi T, Kong L, Fernandes G, Talal N. 1995. SLE-like autoantibodies and Sj¨ogren’s syndrome-like lymphoproliferation in TGF-β knockout mice. J. Immunol. 155:3205–12 Sanderson N, Factor V, Nagy P, Kopp J, Kondaiah P, Wakefield L, Roberts AB, Sporn MB, Thorgeirsson SS. 1995. Hepatic expression of mature transforming growth factor β1 in transgenic mice. Proc. Natl. Acad. Sci. USA 92:2572–76 Horak I, L¨ohler J, Ma A, Smith KA. 1995. Interleukin-2 deficient mice: a new model to study autoimmunity and self-tolerance. Immunol. Rev. 148:35–44 Suzuki H, K¨undig TM, Furlonger C, Wakeham A, Timms E, Matsuyama T, Schmits R, Simard JJL, Ohashi PS, Griesser H, Taniguchi T, Paige CJ, Mak TW. 1995. Deregulated T cell activation and autoimmunity in mice lacking interleukin-2 receptor β. Science 268: 1472–76 Tsui H-W, Siminovitch KA, de Souza L, Tsui FWL. 1993. Motheaten and viable motheaten mice have mutations in the hematopoietic cell phosphatase gene. Nature Genet. 4:124–29 Shultz LD, Schweitzer PA, Rajan TV, Yi T, Ihle JN, Matthews RJ, Thomas ML, Beier DR. 1993. Mutations at the murine motheaten locus are within the hematopoietic cell protein-tyrosine phosphatase (Hcph) gene. Cell 73:1445–54 Lankester AC, van Schijndel GM, van Lier RA. 1995. Haematopoietic cell phosphatase is recruited to CD22 following B cell antigen receptor ligation. J. Biol. Chem. 270:20, 305–8 Doody GM, Justement LB, Delibrias CC, Matthews RJ, Lin J, Thomas ML, Fearon DT. 1995. A role in B cell activation for CD22 and the protein tyrosine kinase phosphatase SHP. Science 269:242–44 D’Ambrosio D, Hippen KL, Minskoff SA, Mellman I, Pani G, Siminovitch KA, Cambier JC. 1995. Recruitment and activation of PTP1C in negative regulation of antigen receptor signaling by Fcγ RIIB1. Science 268:293–97 Cyster JG, Goodnow CC. 1995. Protein tyrosine phosphatase 1C negatively regulates antigen receptor signaling in B lymphocytes and determines thresholds for negative selection. Immunity 2:13–24 Yu CCK, Tsui H-W, Ngan BY, Shulman MJ, Wu GE, Tsui FWL. 1996. B and T

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temic lupus erythematosus. Relationships between histocompatibility antigens, autoantibodies, and lymphopenia or renal disease. Arthritis Rheum. 32:826–36 Reveille JD, MacLeod MJ, Whittington K, Arnett FC. 1991. Specific amino acid residues in the second hypervariability region of HLA-DQA1 and DQB1 chain genes promote the Ro (SS-A)/LA (SS-B) autoantibody responses. J. Immunol. 146: 3871–76 Hartung K, Coldewey R, Rother E, Pirner K, Specker C, Schendel D, Stangel W, Stannet-Kiessling S, de Lange GG. 1991. Immunoglobulin allotypes are not associated with HLA-antigens, autoantibodies and clinical symptoms in systemic lupus erythematosus. Members of the SLE Study Group. Rheumatol. Int. 11:179–82 Olsen ML, Arnett FC, Reveille JD. 1993. Contrasting molecular patterns of MHC class II alleles associated with the anti-Sm and anti-RNP precipitin autoantibodies in systemic lupus erythematosus. Arthritis Rheum. 36:94–104 Arnett FC, Olsen ML, Anderson KL, Reveille JD. 1991. Molecular analysis of major histocompatibility complex alleles associated with the lupus anticoagulant. J. Clin. Invest. 87:1490–95 Arnett FC. 1992. Genetic aspects of human lupus. Clin. Immunol. Immunopathol. 63:4–6 Fronek Z, Timmerman LA, Alper CA, Hahn BH, Kalunian K, Peterlin BM, McDevitt HO. 1990. Major histocompatibility complex genes and susceptibility to systemic lupus erythematosus. Arthritis Rheum. 33:1542–53 Schifferli JA, Hauptmann G, Paccaud J-P. 1987. Complement-mediated adherence of immune complexes to human erythrocytes: differences in requirements for C4A and C4B. FEBS Lett. 213:415–18 Briggs DC, Senaldi G, Isenberg DA, Welsh KI, Vergani D. 1991. Influence of C4 null alleles on C4 activation in systemic lupus erythematosus. Ann. Rheum. Dis. 50:251–54 Hauptmann G, Tappeiner G, Schifferli JA. 1988. Inherited deficiency of the fourth component of human complement. Immunodef. Rev. 1:3–22 Atkinson JP. 1992. Genetic susceptibility and class III complement genes. In Systemic Lupus Erythematosus, ed. RG Lahita, 87–102. New York: Churchill Livingstone Jacob CO, Fronek Z, Lewis GD, Koo M, Hansen JA, McDevitt HO. 1990. Heritable major histocompatibility complex

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class II-associated differences in production of tumor necrosis factor α: relevance to genetic predisposition to systemic lupus erythematosus. Proc. Natl. Acad. Sci. USA 87:1233–37 Walport MJ, Lachmann PJ. 1990. Complement deficiencies and abnormalities of the complement system in systemic lupus erythematosus and related disorders. Curr. Opin. Rheumatol. 2:661–63 Bowness P, Davies KA, Norsworthy PJ, Athanassiou P, Taylor-Wiedeman J, Borysiewicz LK, Meyer PAR, Walport MJ. 1994. Hereditary C1q deficiency and systemic lupus erythematosus. Q. J. Med. 87:455–64 Tedder TF, Inaoki M, Sato S. 1997. The CD19-CD21 complex regulates signal transduction thresholds governing humoral immunity and autoimmunity. Immunity 6:107–18 Moldenhauer F, David J, Fielder AH, Lachmann PJ, Walport MJ. 1987. Inherited deficiency of erythrocyte complement receptor type 1 does not cause susceptibility to systemic lupus erythematosus. Arthritis Rheum. 30:961–66 Davies EJ, Snowden N, Hillarby MC, Carthy D, Grennan DM, Thomson W, Ollier WER. 1995. Mannose-binding protein gene polymorphism in systemic lupus erythematosus. Arthritis Rheum. 38:110– 14 Hoffman RW, Sharp GC, Irvin WS, Anderson SK, Hewett JE, Pandey JP. 1991. Association of immunoglobulin Km and Gm allotypes with specific antinuclear antibodies and disease susceptibility among connective tissue disease patients. Arthritis Rheum. 34:453–58 Olee T, Yang PM, Siminovitch KA, Olsen NJ, Hillson J, Wu J, Kozin F, Carson DA, Chen PP. 1991. Molecular basis of an autoantibody-associated restriction fragment length polymorphism that confers susceptibility to autoimmune diseases. J. Clin. Invest. 88:193–203 Tebib JG, Alcocer-Varela J, AlarconSegovia D, Schur PH. 1990. Association between a T cell receptor restriction fragment length polymorphism and systemic lupus erythematosus. J. Clin. Invest. 86:1961–67 Wong DW, Bentwich Z, MartinezTarquino C, Seidman JG, Duby AD, Quertermous T, Schur PH. 1988. Nonlinkage of the T cell receptor alpha, beta, and gamma genes to systemic lupus erythematosus in multiplex families. Arthritis Rheum. 31:1371–76 Salmon JE, Millard S, Schachter LA,

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VYSE & KOTZIN Arnett FC, Ginzler EM, Gourley MF, Ramsey-Goldman R, Peterson MGE, Kimberley RP. 1996. Fcγ RIIA alleles are heritable risk factors for lupus nephritis in African Americans. J. Clin. Invest. 97:1348–54 Duits AJ, Bootsma H, Derksen RHWM, Spronk PE, Kater L, Kallenberg CGM, Capel PJA, Westerdall NAC, Spierenberg GTh, Gmelig-Meyling FHJ, van der Winkel JGJ. 1995. Skewed distribution of IgG Fc receptor IIa (CD32) polymorphism is associated with renal disease in systemic lupus erythematosus patients. Arthritis Rheum. 39:1832–36 Van de Winkel JGJ, Capel PJA. 1993. Human IgG Fc receptor heterogeneity: molecular aspects and clinical implications. Immunol. Today 14:215–21 Botto M, Theodoridis E, Thompson EM, Beynon HLC, Briggs D, Isenberg DA, Walport MJ, Davies KA. 1996. Fcγ RIIa polymorphism in systemic lupus erythematosus (SLE): no association with disease. Clin. Exp. Immunol. 104:264– 68 Tsao BP, Cantor RM, Kalunian KC, Chen S-L, Badsha H, Singh R, Wallace DJ, Kitridou RC, Song YW, Isenberg DA, Yu C-L, Hahn BH, Rotter JI. 1997. Evidence for linkage of a candidate chromosome 1 region to human systemic lupus erythe-

matosus. J. Clin. Invest. 99:725–31 135. Copeman JB, Cucca F, Hearne CM, Cornall RJ, Reed PW, Rnningen KS, ˆ L, Buzzetti R, Tosi Undlien DE, NisticU R, Pociot F, Nerup J, Corn´elius F, Barnett AH, Bain SC, Todd JA. 1995. Linkage disequilibrium mapping of a type I diabetes susceptibility gene (IDDM7) to chromosome 2q31-q33. Nature Genet. 9:80–85 136. Nistic´o L, Buzzetti R, Pritchard LE, Van der Auwera B, Giovannini C, Bosi E, Larrad MTM, Rios MS, Chow CC, Cockram CS, Jacobs K, Mijovic C, Bain SC, Barnett AH, Vandewalle CL, Schuit F, Gorus FK, Registry BD, Tosi R, Pozzilli P, Todd JA. 1996. The CTLA-4 gene region of chromosome 2q33 is linked to, and associated with, type 1 diabetes. Hum. Mol. Genet. 5:1075–80 137. Sundvall M, Jirholt J, Yang HT, Jansson L, Engstr¨om A, Pettersson U, Holmdahl R. 1995. Identification of murine loci associated with susceptibility to chronic experimental encephalomyelitis. Nature Genet. 10:313–17 138. Kuokkanen S, Sundvall M, Terwilliger JD, Tienari PJ, Wikstr¨om J, Holmdahl R, Pettersson U, Peltonen L. 1996. A putative vulnerability locus to multiple sclerosis maps to 5p14-p12 in a region syntenic to the murine locus Eae2. Nature Genet. 13:477–80

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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JAKS AND STATS: Biological Implications∗ Warren J. Leonard1 and John J. O’Shea2 1Laboratory

of Molecular Immunology, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-1674; and 2Arthritis and Rheumatism Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland 20892-1674; e-mail: [email protected]; [email protected] KEY WORDS:

cytokines, interferons, signaling, transcriptional activation, tyrosine phosphorylation

ABSTRACT Cytokines and interferons are molecules that play central roles in the regulation of a wide array of cellular functions in the lympho-hematopoietic system. These factors stimulate proliferation, differentiation, and survival signals, as well as specialized functions in host resistance to pathogens. Although cytokines are known to activate multiple signaling pathways that together mediate these important functions, one of these pathways, the Jak-STAT pathway, is the focus of this chapter. This pathway is triggered by both cytokines and interferons, and it very rapidly allows the transduction of an extracellular signal into the nucleus. The pathway uses a novel mechanism in which cytosolic latent transcription factors, known as signal transducers and activators of transcription (STATs), are tyrosine phosphorylated by Janus family tyrosine kinases (Jaks), allowing STAT protein dimerization and nuclear translocation. STATs then can modulate the expression of target genes. The basic biology of this system, including the range of known Jaks and STATs, is discussed, as are the defects in animals and humans lacking some of these signaling molecules.

OVERVIEW Cytokines and interferons are intercellular messengers that induce many important biological responses in target cells (1). Over the past five years, an ∗ The US government has the right to retain a nonexclusive, royalty-free license in and to any copyright covering this paper.

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extraordinarily exciting new signaling pathway has been elucidated. This pathway involves families of proteins, denoted as Jaks (Janus family tyrosine kinases) and STATs (signal transducers and activators of transcription) (2–7). This pathway has proved to be integral to both type I (IFNα/β) and type II (IFNγ ) interferons (collectively also known as type II cytokines) and to all cytokines whose receptors are members of the cytokine receptor superfamily, also known as type I cytokine receptors. These type I cytokines include the short-chain cytokines, IL-2, IL-3, IL-4, IL-5, GM-CSF, IL-7, IL-9, IL-13, and IL-15 and the long-chain cytokines, IL-6, IL-11, OSM, CNTF, CT-1, growth hormone, prolactin, erythropoietin, and thrombopoietin. These cytokines form a family based on sharing a similar four-α-helical bundle structure (reviewed in 1, 8). The Jak-STAT pathway represents an extremely rapid membrane-tonucleus signaling system and clarifies at least part of the basis for the specificity of signals that are induced by different cytokines.

JANUS KINASES AND CYTOKINE SIGNAL TRANSDUCTION Discovery of the Jaks Four mammalian Jaks have been identified: Jak1, Jak2, Jak3, and Tyk2. This new class of kinases was discovered by two approaches. Tyk2 was first identified by low-stringency hybridization screening of a T cell cDNA library with the c-fms catalytic domain (9), whereas the remainder of the Jaks (Jak1, Jak2, and Jak3) were cloned with a PCR-based strategy using primers corresponding to conserved motifs within the catalytic domain of tyrosine kinases (10–16). Carp and zebrafish Jak1 have also been cloned (17, 18). A Drosophila Jak was identified in the analysis of mutant flies with defects in the expression patterns of the pair-rule genes and segment-polarity genes, giving the gene its name, hopscotch (19).

Characteristics of Jaks Jaks are relatively large kinases of approximately 1150 amino acids with apparent molecular weights of about 120–130 kDa. Their mRNA transcripts range from 4.4 to 5.4 kb in length. Jak2 has two transcripts, and multiple spliced forms of Jak3 have been identified, including a variant that lacks a segment of the catalytic domain (12, 16, 20). The functional significance of these variant transcripts is not understood, but it is intriguing to speculate that a naturally occurring dominant negative form of Jak3 may have regulatory function. In contrast to the relatively ubiquitous expression of Jak1, Jak2, and Tyk2, Jak3 has more restricted and regulated tissue expression. It is expressed constitutively at high levels in NK cells and thymocytes and is inducible in T cells,

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B cells, and myeloid cells (14, 16, 21–23). In addition to its expression in hematopoietic cells, Jak3 is also expressed in vascular smooth muscle cells and endothelium (24). The mechanisms by which Jak3 expression is regulated have not been well studied, but it is notable that the putative Jak3 promoter found in the mouse gene contains consensus binding sites for a variety of transcription factors, which may explain the inducibility of the Jak3 gene (25).

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Genomic Organization and Chromosomal Localization The intron/exon organization of the murine Jaks, human Jak3, and carp Jak1 has been determined (17, 25–28). The genomic organization is conserved among murine genes for different Jaks, but the intron/exon organization of the Jaks does not conform to the defined Jak homology domains of the polypeptides. As is later discussed, a unique feature of the Jaks is the presence of a pseudokinase domain in conjunction with the bona fide catalytic domain. The organization of the kinase and pseudokinase domains is not conserved, suggesting distinct evolutionary origins. In humans, the Jak1 gene resides on chromosome 1p31.3 and Jak2 at 9p24 (reviewed in 3). Interestingly, Jak3 and Tyk2 are nearby on chromosome 19; Jak3 maps to 19p13.1 and Tyk2 maps to 19p13.2 (26, 27, 29). The murine genes reside on chromosomes 4 (Jak1), 19 (Jak2), and 8 (Jak3) (30).

STRUCTURE OF JANUS KINASES The hallmark of the Jak family of PTKs is the existence of tandem kinase and pseudokinase domains, a feature that also gives the Janus kinases their name (Figure 1). Like the Roman god of gates and doorways, the Janus kinases are “two-faced.” In addition, several other segments of homology were recognized among the Jaks, and hence Jak homology (JH) domains were defined using nomenclature analogous to that of the Src homology (SH) domains of Src family PTKs (10, 11). Seven JH regions (JH1-JH7) are described, but it is important to emphasize that, with the exception of the JH1 or catalytic domain, the function of these regions remains poorly understood. Moreover, which JH regions are, in fact, independent structural domains remains unclear.

The JH1 or Catalytic Domain The JH1 domain has all of the features of a typical tyrosine kinase domain and, as with other tyrosine kinases, mutation of the conserved Lys residue in subdomain II that binds ATP abrogates kinase activity (16, 31–35). Tyrosine residues in the activation loop of PTKs typically play an important role in regulating catalytic activity (36). Structural studies support a model in which, prior to phosphorylation, the activation loop impedes substrate access

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Figure 1 Structure of Jaks and STATs. Jaks are structurally unique in having tandem kinase and kinase-like domains. The C-terminal kinase domain is the catalytic domain, and the precise function of the kinase-like domain has yet to be determined. Regions of homology shared by Jaks have been termed Jak homology (JH) domains. Like Src homology (SH) domains, they are named in a C-terminal–to–N-terminal direction. The JH1 domain is the kinase domain and the kinase-like domain is the JH2 domain. The remainder of the homology domains are indicated, though their functions are not well understood. The N-terminus of the Jaks, however, appears to be important for association with cytokine receptor subunits. STATs have a conserved tyrosine whose phosphorylation allows STAT dimerization, an SH2 domain that mediates the dimerization, and an N-terminal region known to play a role in the dimerization of STAT dimers. Interacting proteins bind at both the N-terminal and C-terminal regions of STATs. In some STATs, a serine phosphorylation site has been identified C-terminal to the conserved tyrosine.

to the active site of the enzyme, whereas phosphorylation of tyrosine residue(s) within the loop facilitates substrate accessibility. Consistent with this model, mutation of such residues (e.g. Tyr 1162 of the insulin receptor kinase) reduces kinase activity. Multiple autophosphorylated sites have been identified in Jak kinases, including sites within the activation loop (33–35). Mutation of Tyr residues in the activation loop of the Jaks, though, has variable effects on catalytic activity. For Jak2, mutation of Tyr 1007 to Phe abrogated kinase activity and the ability to transmit cytokine-mediated signals (34). However, mutation of the corresponding Tyr residues in Tyk2 (Tyr 1054 and Tyr 1055) blocked ligand-dependent tyrosine phosphorylation of Tyk2 but did not abolish its kinase activity (33). Indeed, mutations either in the activation loop or in the ATP binding site reduced but did not abrogate signaling, while mutations at both sites abolished signaling. Like Tyk2, mutation of Y980 in Jak3 inhibited but did not abolish kinase activity. In contrast, mutation of Y981 augmented kinase activity (35). Mutation of the corresponding Tyr residue in Jak2, however, did not enhance catalytic activity. Thus, surprisingly, there may be substantial differences in the regulation of catalytic activity of the different Jaks. The

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consequence of the mutation of individual Tyr residues in the activation loop of Tyk2 has not yet been reported.

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The Pseudokinase or JH2 Domain Among metazoan PTKs, only the Jaks have a pseudokinase domain, and the function of this region has not yet been determined. The pseudokinase domain has all of the subdomains that correspond to those in bona fide tyrosine kinase catalytic domains, but they are altered from the typical motifs. For example, JH2 domain lacks the third Gly of the canonical GXGXXG motif (subdomain I). Also lacking is a nearly invariant aspartic acid residue that is present in both tyrosine and serine kinases in the catalytic loop (subdomain VIb) that serves as the proton acceptor in the phosphotransfer reaction. The JH2 domain also lacks a conserved Phe residue (in the motif Asp-Phe-Glu in subdomain VII) that is important for binding the adenine ring of ATP. The lack of these key residues suggested that the pseudokinase domain would not have catalytic activity, and this has been confirmed (10, 16, 37, 38). However, several lines of evidence indicate a role for JH2 domains in regulating Jak catalytic function. In the context of a growth hormone receptor/Jak chimera, deletion of the JH2 domain led to more robust signaling, leading the authors to speculate that the JH2 domain serves to inhibit Jak kinase activity (39). Consistent with this possibility, a gain-of-function mutation has been found in the JH2 domain of the Drosophila Hopscotch Jak kinase (40), and a similar mutation in Jak2 is also activating. One can envision a structural model in which the JH2 domain impedes access to the kinase domain; activation would entail relief of this inhibition. However, other data suggest other possible roles for the JH2 domain. For Tyk2, removal of the pseudokinase domain abrogated kinase activity and IFNα/β-induced signaling. In addition, several patients with nonfunctional Jak3 (see below) have mutations in this domain (41). Thus, at present the precise functions of the JH2 domain remain unclear. Clearly, structural information pertaining to the interactions of the JH1 and JH2 domains will be of great interest. Another potential function of JH2 is a docking site for other signaling molecules. Indeed, the JH2 domain associates with STATs (42). Dictyostelium PTKs (DPYK3 and DPYK4) have been cloned that have tandem kinase domains (43), but overall they are not highly homologous Jaks, even though a Dictyostelium STAT has been identified (44).

The Jak N-Terminus: Role In Cytokine Receptor Binding Though a complete understanding of the function of the relatively divergent N-termini of the Jaks is presently lacking, one function that has been defined is the ability of this segment to bind to cytokine receptors (38, 39, 45–47). Whereas deletion of kinase and kinase-like domains, in general, has little effect

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on binding, deletion of the N-terminal region eliminates binding. For Jak3, the JH7 and JH6 domains are necessary and sufficient for binding to its cognate cytokine receptor subunit, γc. Studies using chimeric Jak constructs (46, 47) support the importance of the Jak N-terminus in binding to cytokine receptors, though the understanding of the basis of Jak/cytokine receptor interactions is far from complete. The region of cytokine receptors that bind the Jaks has been better characterized. The relatively conserved membrane proximal domain of cytokine receptors is the region that interacts with Jaks and is essential for signal transduction (reviewed in 3). Although this segment is better characterized than the corresponding region of the Jaks, we still do not understand the rules by which a given cytokine receptor recruits a given Jak. Interestingly, the Jaks have an SH2-like segment in the JH4 domain that has a conserved Arg residue corresponding to the phosphotyrosine binding pocket of other SH2 domains (11). Whether this domain is capable of binding phosphotyrosine has not been demonstrated, however. Moreover, this residue has been mutated with no clear effect on signaling (46).

JANUS KINASES AND CYTOKINE SIGNAL TRANSDUCTION Shortly after the discovery of the Jaks, their essential function in cytokine signaling was established in a series of experiments using mutagenized cell lines that were resistant to the effects of IFNs. Signaling was reconstituted by transfection of the cells with different Jaks found to be lacking in the cells. Specifically, IFNα/β signaling required Jak1 and Tyk2, whereas IFNγ required Jak1 and Jak2 (2, 48–51). Subsequently, growth hormone and erythropoietin were shown to activate Jak2 (52, 53), whereas IL-6 activated Jak1, Jak2, and Tyk2 (54). In contrast, Jak3 was activated only by cytokines whose receptors contain γc (IL-2, IL-4, IL-7, IL-9, and IL-15) and in cells lacking Jak3, IL-2 and IL-4 signaling is compromised (15, 55–60). In subsequent studies, all of the type I cytokines examined activated Jaks (1, 3, 61). These studies are summarized in Table 1. That Jaks and cytokine receptors associate was shown first by the interaction of Jak2 with the erythropoietin and growth hormone receptors (52, 53). Jak2 also associates with β c, a shared subunit of the IL-3, IL-5, GM-CSF receptors (62). The gp130 subunit of the IL-6 family of receptors is bound somewhat indiscriminately by Jak1, Jak2, and Tyk2 (54). In contrast, Jak3 specifically associates with γc (56, 63, 64), whereas the unique receptor subunits of this subfamily of cytokines (e.g. IL-2Rβ) associate with Jak1 (56). Similarly, for the IFNα/β receptor, the α subunit, also termed IFNAR-1, is associated with

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Table 1 Jaks and STATs that are activated by cytokines Type I Cytokines Cytokines whose receptors share γc IL-2, IL-7, IL-9, IL-15 IL-4 IL-13∗

Jak1, Jak3 Jak1, Jak3 Jak1, Jak2, Tyk2

Stat5a, Stat5b, Stat3 Stat6 Stat6

Cytokines whose receptors share βc IL-3, IL-5, GM-CSF

Jak2

Stat5a, Stat5b

Jak1, Jak2, Tyk2 Jak2, Tyk2

Stat3 Stat4 Stat3

Cytokines with homodimeric receptors Growth hormone Prolactin Erythropoietin Thrombopoietin

Jak2 Jak2 Jak2 Jak2

Stat5a, Stat5b, Stat3 Stat5a, Stat5b Stat5a, Stat5b Stat5a, Stat5b

Type II Cytokines Interferons IFNα, IFNβ IFNγ IL-10‡

Jak1, Tyk2 Jak1, Jak2 Jak1, Tyk2

Stat1, Stat2 Stat1 Stat3

Cytokines whose receptors share gp130 IL-6, IL-11, OSM, CNTF, LIF, CT-1 IL-12+ Leptin+

∗

Jaks

STATs

IL-13 does not share γ c but uses IL-4Rα. IL-12 and leptin do not share gp130, but their receptors are related to gp130. IL-10 is not an interferon, but its receptor is a type II cytokine receptor.

+ ‡

Tyk2, and the β subunit (IFNAR-2) is associated with Jak1 (65–67). By comparision, the IFNγ Rα subunit (IFNGR-1) associates with Jak1 and IFNγ Rβ (IFNGR-2) associates with Jak2 (reviewed in 5). For the IL-12R, the β1 subunit associates with Tyk2, while the β2 subunit associates with Jak2 (68). Importantly, although specific Jaks are recruited to different cytokine receptors, this is not an important mechanism by which specificity in cytokine signaling is imparted. First, Jak usage is too degenerate to provide such specificity (e.g. many different cytokines activate Jak1 and Jak2; see Table 1). Second, experiments have shown that artificially recruiting a different Jak to a receptor does not alter signaling (69). Finally, although Jaks are constitutively associated with receptors, a ligand-inducible augmentation is seen in several receptor systems; the mechanism underlying this augmentation has not been identified. Jaks therefore satisfy two key criteria that would be demanded of a proximal signal transducing unit used by cytokine receptors: They physically associate with receptor subunits, and they are essential components for signaling.

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Models of Jak Activation Cytokine receptors form homo- or heterodimers following ligand binding, and the dimerization of cytokine receptor subunits is sufficient to initiate signaling (70–73). Because the Jaks are associated with receptors, they likely become activated by being brought into proximity by receptor hetero- or homodimerization. For cytokine receptors that homodimerize (e.g., growth hormone and erythropoietin receptors), this effectively results in homodimerization of Jak2. Similarly, for receptors that form heterodimers (i.e., most of the interleukin and the interferon receptors), presumably heterodimerization of different Jaks occurs. In these cases, the data have been interpreted to indicate that Jaks are interdependent in their activation. Support for this model comes from studies in which the absence of a given Jak results in the failure of the other Jak to become activated following ligand stimulation. For example, in cells lacking Jak1, no phosphorylation of Tyk2 or Jak2 was observed upon stimulation with IFNα or IFNγ , respectively (50). Conversely, no phosphorylation of Jak1 was seen in cells lacking Tyk2 or Jak2. Similar results have been obtained with IL-2 signaling in Jak3-deficient cells; in the absence of Jak3, no phosphorylation of Jak1 occurred in response to IL-2 (59). Consistent with this model, reconstitution of Jak1-deficient cells with catalytically inactive Jak1 did not support signaling or IFNα-induced gene expression (32). Accordingly, reconstitution of Jak2-deficient cells with a catalytically inactive form of Jak2 did not permit IFNγ -induced phosphorylation of Jak1 or Jak2. Surprisingly, however, reconstitution of Tyk2-deficient cells with kinasedead Tyk2 did permit IFNα/β-induced phosphorylation of Tyk2 and suboptimal signaling (33). Similarly, in Jak1-deficient cells reconstituted with kinasedead Jak1, IFNγ could still induce suboptimal Jak2 phosphorylation, low-level receptor phosphorylation, STAT activation, and ligand-induced gene expression. The model proposed for IFNγ signaling is that Jak2 phosphorylates itself and Jak1. Jak1 is principally responsible for receptor phosphorylation, Stat1 is recruited to the receptor, and Jak2 then phosphorylates Stat1 (32). IL-6 signaling is unusual in that three different Jaks (Jak1, Jak2, and Tyk2) are activated. Interestingly, however, the absence of any one Jak does not interfere with the activation of the others, but the absence of Jak1 inhibited IL-6-induced expression of the IRF-1 gene and phosphorylation of gp130, Stat1, and Stat3 (31). Thus, although the Jaks are to an extent interdependent, they are not functionally symmetrical. Given the aforementioned differences emerging in the catalytic regulation of the Jaks, the non-equivalence of the Jaks is not surprising. The data also argue for a structural role of Jaks beyond an enzymatic role.

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Attenuation of Jak Signaling Reversible Jak activation is quite evident following cytokine stimulation; however, the mechanisms by which the termination of Jak signaling is accomplished are poorly understood. The SH2-containing tyrosine phosphatase, Shp-1, associates with some cytokine receptors and regulates Jak phosphorylation (74, 75). Whether other cytokine receptors and Jaks are regulated similarly has not been documented. Jaks are also associated with Shp-2 (76), but in general Shp-2 positively regulates signaling (see below) and does not attenuate it (77). Interestingly, an inhibitor of Jak catalytic activity has recently been identified (78–80). This protein, variably termed SOCS-1 (suppressor of cytokine signal-1), JAB (Jak-binding protein), and SSI-1 (STAT-induced STAT inhibitor1), is related to originally identified family member CIS (cytokine inducible SH2-containing protein) (81); a total of seven members of this family have now been identified, although the biological actions of each are still being clarified (182). Unquestionably, the mechanisms by which Jak signaling is turned off form an area that deserves more attention.

JAKS AND DEVELOPMENT Jak3 and Severe Combined Immunodeficiency While the analysis of mutant cell lines established the essential function of Jaks in cytokine signaling, the significance to the organism of a given Jak has been less well characterized. Thus far, we only have information on organisms deficient in one mammalian Jak, Jak3 (Table 2). Mutation of γc, which specifically associates with Jak3, is the molecular basis of X-linked severe combined immunodeficiency (X-SCID). Its intimate association with Jak3 suggested that mutations of the latter might also cause SCID (56, 82, 83). Consequently, the initial patients with autosomal recessive SCID due to Jak3 mutations were identified (58, 84). Subsequently, other patients, including patients with missense mutations, have also been identified (41). Jak3 knockout mice have been generated, and they too are immunodeficient (85–87). Thus, the essential role of Jak3 in lymphoid development is seen in both humans and mice with deficiency of Jak3, although the phenotypes of the immunodeficiency are somewhat different. Whereas Jak3- and γc-deficient humans have profoundly decreased numbers of T cells with normal or increased numbers of B cells, Jak3- and γc-deficient mice accumulate somewhat larger numbers of peripheral T cells but essentially lack conventional B cells (88, 89). The block in lymphocyte development in Jak3and γc-deficiency presumably relates, at least in part, to the absence of IL-7

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Jaks Jak1: Jak2: Jak3: Tyk2:

Not yet reported Not yet reported Severe Combined Immunodeficiency similar to X-linked SCID Not yet reported

STATS Stat1: Stat2: Stat3: Stat4:

Defective signaling in response to type I and type II IFNs Not yet reported Fetal lethal. Implantation occurs, but fetal growth is blunted Defective Th1 development, consistent with the role of IL-12 in activating Stat4 and promoting Th1 development Stat5a: Defective lobuloalveolar development in the breast Stat5b: Required for sexual dimorphism of body growth rates, similar to Laron-type dwarfism, a human disease due to growth hormone resistance. Defective GM-CSF signaling in bone marrow–derived macrophages. Defective IL-2-induced IL-2Rα expression in splenic T cells Stat6: Defective Th2 development, consistent with the role of IL-4 for Stat6 and Th2 development

signaling. The difference in B cell development between mice and humans is presumably indicative of an essential role for IL-7 as a pre-B cell growth factor in mice but not humans. The T cells produced in γc- and Jak3-deficient mice are abnormal in that they express activation markers, i.e. high levels of CD44 and low levels of CD62L (90–92). lmpaired negative thymic selection has been reported in Jak3-deficient mice (92), but a complete explanation of the abnormal T cell phenotype in Jak3and γc-deficient mice has not yet been provided. It will be important to more rigorously compare and contrast the effects of γc deficiency and Jak3 deficiency in terms of the T cell defect. If γc-deficient mice do not have the same defects as Jak3-deficient mice, that would argue that Jak3 has other functions unrelated to γc-mediated signaling. For instance, it has been reported that Jak3 associates with CD40, but a specific role for Jak3 in this pathway has yet to be demonstrated (93). Interestingly, the clinical presentation of one patient with a Jak3 missense mutation differed from others in that T cell production occurred over time. The T cells were not normal, however, in that they expressed activation markers, as do Jak3-deficient mice (41). It is pertinent to note that although Jak3 is inducible in activated monocytes, Jak3-deficient individuals do not have abnormalities attributable to defects in myeloid function; their defects are limited to lymphoid cells (28). The fact that the defects seen in Jak3-deficient individuals are restricted to the immune system has suggested that targeting Jak3 (58, 84) or the interaction between Jak3 and

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γc might be a useful strategy to generate a novel class of immunosuppressant drugs (56).

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Jak1 and Teleost Embryonic Development Although, Jak3 is the only Jak for which knockout mice have been reported, zebrafish Jak1 was recently cloned and shown to play an important role in early vertebrate development (18). It is maternally encoded, stored in unfertilized eggs, and essential for proper embryogenesis. Injection of RNA-encoding a dominant-negative Jak1 allele interfered with anterior structure formation. These data suggest that Jaks are likely to have important developmental functions in mammal.

Hopscotch and Drosophila Development Another system that graphically demonstrates the importance of the Jaks in development is the analysis of the function of the Drosophila Jak, Hopscotch (Hop) (94). Mutation of the hop gene results in lethal segmentation defects through both maternal and zygotic effects with stripe-specific defects in the expression patterns of pair-rule genes (even-skipped, runt, and fushi tarazu) and segment-polarity genes (engrailed and wingless) (19). It will be important in the future to define Drosophila cytokines, cytokine receptors, and other Jaks if they exist; dissection of these pathways in Drosophila should provide considerable insight into the vertebrate pathways.

JAKS AND TRANSFORMATION Studies in Drosophila provide clear evidence of the essential function of the Jaks in normal growth and development. Interestingly, this system also provides evidence that dysregulation of Jaks can lead to cancer. These mutations, known as Tum-l or tumorous lethal, result in leukemia in the flies (95–97). This is characterized by formation of melanotic tumors and hypertrophy of larval lymph glands, the hematopoietic organs. Interestingly, overexpression of wild-type hop also leads to the formation of tumors. There are a number of circumstances in which constitutive activation of Jaks has been seen in association with malignant transformation in mammalian cells. This was first demonstrated in HTLV-I–transformed T cells (98). Subsequently, constitutive Jak activation has been found in other settings including: Sezary’s syndrome (99), v-abl-transformed cells (100) and acute lymphoblastic leukemia (ALL) (101). Moreover, a translocation in a patient with T-cell ALL resulted in a Jak2 fusion protein with constitutive kinase activity, and this was transforming in vitro (183). It will be important to understand the mechanism of activation of Jaks in these circumstances and to determine if Jak activation is an essential part of malignant transformation in these cells.

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JAKS AND THEIR SUBSTRATES Presently, our understanding of the relevant Jak substrates is quite limited. The paradigm emerging is that one class of substrate, aside from the kinases themselves, is cytokine receptors. As is discussed shortly, tyrosine phosphorylation of receptors forms docking sites for proteins with phosphotyrosine binding domains, which in turn are also Jak substrates. The STAT family of transcription factors is one example, and the adaptor molecule Shc is another. Other proteins that reportedly interact with Jaks include Grb2, SHP-2, Vav, and STAM (76, 102–104). In summary, in the short time since their discovery, Janus kinases have been shown to have essential functions in cytokine signaling and development. In humans, the absence of one Jak, Jak3, results in profound immunologic disease. In Teleosts and Drosophila, Jaks clearly have essential roles in early development. A role for Jaks in oncogenesis is also apparent. Jaks are, however, only part of the story. The discovery of the STATs provides important insights as to how extracellular signals effect gene expression.

STATS The seven known mammalian STAT proteins are denoted Stat1, Stat2, Stat3, Stat4, Stat5a, Stat5b, and Stat6 (105–117). Most of the STATs are approximately 750 to 800 amino acids in length, whereas Stat2 and Stat6 are approximately 850 amino acids in length. The STATs exist as clusters on chromosomes, with Stat1 and Stat4 on mouse chromosome 1, Stat2 and Stat6 on mouse chromosome 10, and Stat3, Stat5a, and Stat5b on mouse chromosome 11 (118). Stat5a and Stat5b are closely positioned on human chromosome 17 (116). The clustering similarities on human and murine chromosomes are consistent with a common ancestral gene that was initially duplicated, followed by subsequent duplication events. The facts that Stat2 and Stat6 are both of the longer STAT form and that they colocalize are consistent with this hypothesis.

Mechanism of Activation of STATs Following the binding of cytokines or interferons to their receptors, STAT proteins can be activated. The basic scheme of STAT protein activation is summarized in Figure 2 and has been reviewed previously (2–7). The binding of a cytokine to its cognate receptor rapidly induces the tyrosine phosphorylation of the receptor by Jak kinases. Such phosphorylated tyrosines provide docking sites for STATs. The STATs themselves are phosphorylated, released from the receptor, and then can dimerize. The dimeric form can then translocate into the nucleus, where it modulates expression of target genes. A remarkable feature of this system is that newly induced STAT DNA binding activity can be detected in the nucleus within minutes of cytokine binding. Thus, in accord with the

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Figure 2 A model for cytokine signal transduction. In this model of the IL-2 and IL-15 receptors, there are three receptor subunits, two of which interact with Jak kinases. The addition of the cytokines activates the Jaks, The Jaks in turn phosphorylate tyrosine-based docking sites on the receptor. STATs then bind via their SH2 domains. The STATs are then phosphorylated, form homo- or heterodimers, and then translocate to the nucleus, where they bind target sequences. Shown is a γ -IFN activated sequence motif (see text). In at least some cases, GAS motifs can be multimers, and STAT dimers can associate with adjacent STAT dimers to allow higher affinity binding. Transcriptional activation of genes may also require accessory transcription factors.

urgency of an emergency “STAT” order in clinical medicine, STATs have an appropriate acronym that accurately reflects the rapidity of their activation and abilities to exert biological actions. As indicated above, STATs have six essential functional requirements. These are the abilities (a) to bind phosphorylated tyrosines, (b) to themselves become tyrosine phosphorylated, (c) to dimerize, (d ) to translocate into the nucleus, (e) to bind DNA, and ( f ) to modulate gene expression.

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Docking of STATs on Receptor Molecules The bases for some of these functions are well understood. As shown in Figure 1, STAT proteins have a conserved SH2 domain (typically between residues 600 and 700) that mediates the first function. One mechanism for specificity derives from the fact that the SH2 domains of different STATs differ sufficiently so that they recognize different phosphorylated motifs. For example, Stat6 binds to phosphotyrosine docking sites on the IL-4 receptor α chain (117), whereas Stat5a and Stat5b bind to related but distinct docking sites on the IL-2 receptor β chain (IL-2Rβ) and IL-7 receptor α chain (IL-7Rα) (119). The STATs that are activated by various cytokines are summarized in Table 1. In some situations, docking may not be on a receptor chain. Indeed, in the case of IFNα/β stimulation, it is believed that while Stat2 docks on the receptor, Stat1 docks on Stat2 following the tyrosine phosphorylation of Stat2 (120). In addition to docking on receptor chains and other STATs, Jak kinases also provide docking sites. Indeed, STAT5 proteins can coprecipitate with JAK3, suggesting that a direct interaction can occur (42, 98).

Phosphorylation and Dimerization of STATs Each of the STATs has a conserved tyrosine residue approximately 700 residues from the N-terminus, slightly distal to the end of SH2 domain, that is a substrate for phosphorylation (6). Following its tyrosine phosphorylation, the STAT can form homodimers or heterodimers based on the interaction between the SH2 domain on one STAT molecule and the phosphorylated tyrosine on another. Indeed, as each STAT has both an SH2 domain and a phosphorylated tyrosine, these dimers are stabilized by bivalent interactions. The bivalent nature of these interactions helps to explain why dimerization of STATs is favored over the monovalent interaction of the STAT SH2 with a phosphorylated receptor. Some cytokine receptor chains, such as the IFNGR-1 (also denoted the IFNγ Rα chain) (121) and IL-7Rα (119), have single STAT docking sites. Others, such as IL-2Rβ (119, 122), IL-4Rα (117), and gp130 (a common receptor chain shared by the receptors for IL-6, IL-11, OSM, CNTF, LIF, and CT-1 (123), have more than one. The presence of more than one docking site allows for the possibility that two STAT molecules might simultaneously be activated (i.e., phosphorylated) in close proximity to each other, thereby potentially facilitating their dimerization. Whether homodimerization or heterodimerization occurs is based on the specificity of the SH2 domain and the microenvironment of the phosphorylated tyrosine. Thus, some heterodimerization events such as Stat1 with either Stat2 or Stat3 (6) and Stat5a with Stat5b (113), can occur, whereas others do not occur. Furthermore, Stat2 is so far known to exist as a heterodimer with Stat1, but not as a homodimer.

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As indicated above, for IFN and type I cytokine receptors, the kinases that phosphorylate the STATs appear to be Jak kinases. However, certain growth factors, such as epidermal growth factor and platelet-derived growth factor, bind to receptors with intrinsic tyrosine kinase domains and can activate STATs. Thus, other kinases besides Jaks may also be able to mediate the activation of STATs.

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Nuclear Translocation and DNA Binding of STATs Although the dimerization presumably unmasks a nuclear localization signal (NLS), the residues comprising the STAT NLS are not well defined. It is therefore also unclear whether the STATs enter the nucleus alone or in the context of chaperonin molecules, and whether their nuclear localization requires the release of a cytosolic anchoring protein (e.g., a functional analog of IκB whose association with NF-κB retains NF-κB in the cytosol, discussed below). Once in the nucleus, in general, the STAT homodimers or heterodimers can directly bind to DNA. However, this is not the case for the signaling complex activated by type I interferons (IFNα and IFNβ). Type I interferons activate a Stat1-Stat2 heterodimer that requires a DNA binding protein, p48, to bind DNA (6). p48 is a member of the IRF family of proteins. Perhaps not surprisingly, then, this Stat1-Stat2-p48 complex recognizes a relatively nonpalindromic, interferonstimulated response element (ISRE) motif, AGTTTNCNTTTCC (6), whereas the other STAT complexes tend to bind semipalindromic motifs, TTCNNNGAA or TTCNNNNGAA, although some variation is allowed even in the TTC/GAA flanking sequences. These semipalindromic motifs are known as GAS motifs, for IFNγ -activated sequences, based on their original identification for the sequences recognized by IFNγ -induced Stat1 homodimers; however, it is now clear that such sequences can be recognized by multiple other STATs as well. The number of nucleotides in the central core of the motifs depends on the particular STAT combination. This is determined by a 180-amino-acid-long DNA binding domain centrally located within STATs (124, 125). The DNA binding domains were delineated by using chimeric constructs that created fusions between different STAT proteins with different specificities so that it could be determined when one specificity was lost and another gained.

Transcriptional Activation by STATs The sixth function of STATs listed above was the ability to modulate gene expression. In principle, depending on the context, individual transcription factors can either activate or repress the transcription of target genes; however, at least so far, STATs have been identified only in the setting of gene activation and augmented transcription. For some STATs, such as Stat1 (6), Stat2 (126), and

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Stat5 (127), C-terminal transcriptional activation domains (distal to the conserved phosphorylated tyrosine) have been delineated. For Stat1 and Stat3, it is known that the C-terminal regions contains a serine residue (at residue 727 for both Stat1 and Stat3) whose phosphorylation is important for potent activity (128, 129). Stat4 has an analogous serine residue. IL-12-induced serine phosphorylation of Stat4 is important for transcriptional activation, although the site of phosphorylation has not been mapped (130). The kinase that mediates the phosphorylation has not yet been identified, but the motif surrounding serine 727 suggests that it will be an enzyme with a specificity similar to that of MAP kinases (131). Stat5 is also reportedly a target for serine phosphorylation, but it lacks the putative MAPK phosphorylation site (132). For STATs containing a serine that is phosphorylated, it is unclear whether this residue alone is important or whether other sequences also contribute to the transcriptional activation domain. Interestingly, Stat2 contains an acidic C-terminal transcriptional activation domain but Stat2 is not a target for serine phosphorylation (126). Thus, it is clear that serine phosphorylation is not the only important feature of the C-terminal region. Indeed, as noted below, the C-terminal region of Stat2 can bind the p300/CBP transactivator proteins (133–135). In addition to whatever intrinsic transcriptional activation activity the STATs might have, at least some STATs have been demonstrated to associate physically and functionally with coactivator proteins. First, Stat1 has been reported to associate with the transcriptional activator Sp1 in the context of the ICAM-1 promoter, where binding sites for each of these proteins have been found (136). Second, a truncated version of Stat3, denoted Stat3β, was shown to associate with c-Jun; this interaction was discovered by the use of a yeast two-hybrid screen (137). Third, the potent transcriptional activators CBP (cAMP response element binding protein, or CREB binding protein)/p300 have been shown to interact with Stat1 and Stat2 (133–135). Interestingly, p300 interacts with the N-terminal region of Stat1 via its CREB-binding domain (residues 571–687) and to the C-terminal region of Stat1 via the E1A binding region (residues 1680–1891, the region of CBP/p300 capable of binding the E1A protein of adenovirus) (134). Finally, Stat5a reportedly interacts with the glucocorticoid receptor (138). These types of findings provide a basis for the recruitment of transcriptional activators. In addition to the observation that STAT proteins cooperate with other proteins, it is striking that functional STAT binding sites (GAS motifs) are often found in close proximity to each other, as for example in the promoters for IFNγ (139) and the IL-2 receptor α chain (IL-2Rα promoter) (140–142). It is therefore interesting that the N-terminal region of Stat1, and perhaps the N-termini of other STAT proteins as well, can mediate the dimerization of STAT dimers (139, 143). Thus, a promoter with adjacent GAS motifs can recruit

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two STAT dimers which can physically interact, thereby forming a tetrameric structure, and can bind to the promoter with higher affinity. In some cases, one of the GAS motifs is imperfect and a poor STAT binding site (139–141); nevertheless, in conjunction with another site, such imperfect GAS motifs are important. This mechanism of cooperative binding presumably provides the ability to achieve much higher STAT binding affinity and specificity by bringing together the proper dimers. Interestingly, DNA binding activity is not detected to the IL-2 response element in the IL-2Rα promoter when either the consensus or the nonconsensus GAS motif is mutated (141). In this element, it is striking that binding of an Ets family protein, Elf-1, is also vital for promoter activity (140, 141), suggesting a functional cooperation of Elf-1 for Stat5-mediated activation of the IL-2Rα promoter. It is possible that more than one cooperating factor can associate with the same STAT, providing a mechanism by which that same STAT can be involved in the activation of different genes (with binding sites for different cooperating factors) in different cell types or activation states, depending on which cooperating factor is expressed.

CONTRIBUTION OF STATS TO SPECIFICITY OF CYTOKINE SIGNALING All interferons and type I cytokines can activate one or more STATs. Given only seven known STATs and so many cytokines, it is clear that each cytokine cannot have its own STAT. Nevertheless, it is interesting that cytokines fall into groups and there is considerable specificity to the various STATs (see Table 1). This has been confirmed by the analysis of mice in which various STATs have been deleted by homologous recombination (Table 2). For example, Stat1-deficient mice exhibit a selective defect signaling in response to both type I and type II IFNs (144, 145). Although Stat1 has been reported to be activated by a number of other cytokines and growth factors, including growth hormone, IL-2, EGF, etc, the phenotype of the Stat1-knockout mice indicates either that the role of Stat1 for other cytokines is not physiologically important, or that Stat1 plays roles in functions redundantly served by other STATs or non-STAT proteins. Although we cannot yet distinguish between these possibilities, it may be relevant that many reports of the activation of STATs by certain cytokines/growth factors have used cell lines rather than primary cells and have used extremely high concentrations of the cytokines/growth factors, suggesting the need for caution in interpreting these types of experiments. Corresponding to the role of IL-12 and IL-4 in Th1 and Th2 cell development, mice lacking Stat4 (146, 147) or Stat6 (148–150) exhibit defective Th1 or Th2 cell development, respectively. Mice lacking expression of Stat5a exhibit defective lobulo-alveolar development and milk production in the mammary

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gland, consistent with the importance of Stat5a for prolactin signaling (151), whereas mice lacking Stat5b exhibit defective growth similar to that found in Laron-type dwarfism, a disease resulting from defects in the growth hormone receptor (179). Mice lacking Stat5a have also been shown to have lymphohematopoietic defects (180, 181). Bone marrow–derived macrophages from Stat5a-deficient mice exhibit defective responsiveness to GM-CSF (180), and Stat5a-deficient T cells exhibit defective IL-2-induced receptor α chain expression (180), consistent with the Stat5 dependence of the IL-2Rα IL-2 response element described above. It is interesting that murine embryos lacking Stat3 can implant, but fetal growth and development are then greatly compromised, resulting in very early death (149), earlier than is seen in mice lacking gp130, indicating another role for Stat3 in addition to its activation in response to the IL-6 family of cytokines. Overall, the effects that have been seen in the various knockout mice are consistent with very selective defects in signaling by different cytokines. Thus, STATs seem to provide important selectivity. Nevertheless it is clear that STATs activated by many cytokines (e.g., Stat3, Stat5a, and Stat5b) cannot by themselves determine the unique actions of a diverse set of cytokines; specificity may depend on these STATs acting in conjunction with the proper combination of other transcription factors and signaling molecules.

STATS IN PROLIFERATION AND TRANSFORMATION Considerable controversy has surrounded the range of biological actions of STATs including their roles in mediating proliferative responses. IFNs are antiproliferative, and signaling is associated with differentiation to achieve the antiviral state. As a result, Stat1 and Stat2 have been assumed to play a role related to differentiation. However, most of the type I cytokines are mitogenic, so it would make sense that some STATs may contribute directly or indirectly to mitogenic responses (1, 4). Indeed, a variety of data support this hypothesis. First, in some biological systems STAT proteins are constitutively activated following viral or oncogene-mediated transformation; this has been observed following infection of cells with human T-cell lymphotropic virus, type I (HTLV-I) (98), v-Abl (100), raf/myc or abl/myc viruses (152), spleen focus forming virus (153), and v-Src (154). Second, for some receptors such as IL-2 receptor β chain, mutagenesis of the tyrosines whose phosphorylation creates docking sites for Stat5 results in diminished proliferation (122, 155). In the case of the erythropoietin receptor, one group concluded that mutation of Stat5 docking sites had no effect on proliferation (156), but another group found a significant effect (157). Third, a dominant negative Stat5 construct significantly inhibited IL-3-induced proliferation (158). Fourth, mice lacking Stat4 and Stat6 expression exhibit diminished proliferation in response to IL-12

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and IL-4, respectively (146–150). Finally, studies in Drosophila also support a role of STATs in mediating proliferation (94). Specifically, a reduction in the amount of STAT92E gene activity suppressed the transforming ability of hopTum-l, a gain-of-function Jak mutation (159–160). Thus, there are compelling data to support a role for STATs in proliferation. However, it is important to recognize that the role may not be direct. For example, in the case of the Stat6 knockout mouse, expression of the IL-4 receptor α chain is diminished (150), consistent with a role for IL-4 and Stat6 in regulating IL-4Rα expression, making it impossible to determine whether the effect on proliferation was “direct” or instead a result of diminished receptor numbers. In Stat5a-deficient mice, there is defective IL-2-induced proliferation at standard levels of IL-2. However, this results from defective IL-2-induced IL-2Rα expression (and hence diminished high-affinity receptors) rather than an intrinsic defect in proliferation, because maximal proliferation is still achieved at concentrations of IL-2 sufficient to titrate the IL-2Rβ-γc intermediate-affinity IL-2 receptors (181). In contrast to mitogenic cytokines, IFNs can exert antiproliferative actions. It is therefore interesting that Stat1 can induce the expression of p21WAF1 (161), a cyclin-dependent kinase (cdk) inhibitor. Indeed, this role for Stat1 may be of pathophysiological relevance in thanatrophoric dysplasia type II dwarfism (162).

OTHER ROLES FOR STATS In addition to their role in modulating transcription, another type of role for STATs has been suggested by the ability of Stat3 to serve as a mechanism for recruitment of PI 3-K to the IFNAR-I component of type I IFN receptors (163). Thus, the existence of a receptor-associated STAT protein could represent a basis for the recruitment of other signaling molecules. Stat1 also mediates constitutive expression of caspases apparently independent of interferons and Stat1 dimerization (184).

NEGATIVE REGULATION OF STATS The activation of STATs has been described above. How are STATs turned off? A number of different potential mechanisms exist. First, dephosphorylation of the critical tyrosine in the vicinity of amino acid 700 of STATs would result in the loss of dimerization and inactivation of DNA binding. Indeed, it has been reported that this is a mechanism (164). For STATs where serine phosphorylation is vital for action, dephosphorylation of a regulatory serine (e.g., serine 727 of Stat1 or Stat3) would also shut off a signal. In this regard, the N-terminal region of Stat1 has been implicated in the binding of a phosphatase (165), and mutation of this region can lead to constitutive activation. Second, degradation of STATs

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would be a logical mechanism. In this regard, it has been demonstrated that Stat1 is a target of ubiquitin/proteasome-mediated degradation (166). Stat1 is also known to undergo alternative splicing, resulting in both 84- and 91-kDa forms of Stat1, where only the longer form is active (167). Stat5 proteins are well known to exist in multiple forms, resulting from degradation (168) and alternative splicing (116, 169). Interestingly, one alternatively spliced form of Stat5b is missing much of the DNA binding domain (116), whereas another form, analogous to Stat1, is missing the C-terminal region (169). Third, the CIS/SOCS/JAB/SSSI family of proteins can inhibit STAT-dependent signaling (78–81, 182). Thus, in addition to direct inactivation of STATs by dephosphorylation or degradation, these other proteins have the ability to serve in a more classical negative feedback loop to regulate cytokine signaling. Finally, there is now an example of another class of protein that can compete for a STAT binding site. Specifically, BCL-6 is able to compete with Stat6 for binding to target sites, thus perhaps explaining the important role played by BCL-6 in germinal center formation (170).

GENES ACTIVATED BY STATS STATs were originally discovered based on studies of IFN-inducible genes (6). Thus, a potential family of STAT-regulated genes was known even before STATs were well studied, and much is known about the roles of IFNα/β-induced Stat1Stat2-p48 complexes and IFNγ -induced Stat1 homodimers. However, for the four-helical bundle type I cytokines, much less is known regarding the range of genes activated by induced STAT complexes. Stat5a was originally discovered in the context of prolactin signaling as a mammary gland factor. As a result, it was assumed to regulate the β-casein gene. However, in the Stat5a knockout mice, β-casein expression is essentially unaffected (151), whereas expression of the whey acidic protein (WAP) gene is clearly regulated by Stat5a. Other genes known to be regulated by Stat5 proteins include the CIS (171), oncostatin M (172), and IL-2Rα genes (140–142, 173, 181). Stat6 regulated genes include MHC class II, CD23, and IL-4Rα. There is still much to learn regarding the range of genes controlled by STATs, including whether particular genes are regulated by particular STAT homodimers or heterodimers, or whether more than one STAT complex is capable of regulating particular genes. Even for those genes analyzed, the degree of redundancy of different STAT complexes generally remains unclear.

STATS IN EVOLUTION The basic mechanism of activation of STATs is extremely appealing as a rapid means of signaling from the membrane to the nucleus. As such, it is not

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surprising that this mechanism is a very old one. Indeed, Drosophila have a STAT, denoted D-STAT or STAT92E, indicating the role in invertebrates (159, 160, 174). Moreover, a STAT-like protein has now been discovered in Dictyostelium (44). This protein has a related DNA binding site, and its activation is based on an SH2 domain. This indicates that the use of tyrosine phosphorylation as a mechanism of activating transcription factors is quite old from a phylogenetic perspective.

OTHER TYPES OF CYTOPLASMIC-TO-NUCLEAR SIGNALING Two other examples of rapid cytoplasmic-to-nuclear signaling exist, namely the induction of NF-κB (nuclear factor-κB, which is induced by many agents, including certain cytokines, and can regulate the expression of a broad range of genes) (175), and NF-AT (nuclear factor of activated T cells, which is activated by T cell receptor signaling) (176, 177). Whereas activation of a STAT requires its own tyrosine phosphorylation, NF-κB activation involves either serine phosphorylation or ubiquitin-mediated degradation of the inhibitory molecule, IκB (178), and NF-AT activation involves calcineurin-mediated dephosphorylation of NF-AT family proteins. Thus, these three systems each act in a different context, but each uses a phosphorylation-based level of control to effect rapid cytoplasmic-to-nuclear translocation.

CONCLUSIONS STATs and Jaks together constitute a signaling system of tremendous importance about which much information has been gathered in the past few years. However, much remains to be learned. The regulation of the Jaks and the function of the various JH domains need clarification. In addition, it will be important to clarify the range of substrates, beyond STATs, that are targets of Jak family kinases. Solution of the three-dimensional structure of the Jaks and STATs is eagerly anticipated. Moreover, as indicated above, the negative regulation of both the Jaks and STATs is an area in need of further clarification, both in terms of the roles of phosphatases and regulated degradation. The region between the DNA binding domain and SH2 domain, although originally suggested to have homology to SH3 domains, in fact, has not been demonstrated to bind proline-rich regions. Nevertheless, this region and others are conserved, suggesting that they may have important functions that still remain to be elucidated. The range of genes activated by STATs and the protein-protein interactions that mediate these phenomena are extremely important areas for future studies. A major challenge that remains is to understand the mechanisms by which specificity in signaling is achieved. Presently, the STATs have provided a number of

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clues as to how this occurs, but transcriptional regulation of genes typically is achieved by the coordinated effect of multiple factors, making it necessary to understand how STATs integrate into the overall program of gene activation. Finally, it is clear that cytokines can also activate many other pathways, including those that couple to Ras/Raf/MAPK, insulin receptor substrate-1 and -2, phosphatidylinositol 3-kinase, Akt, and p70 S6 kinase, to name a few. It is the cytokine-specific interaction of multiple pathways that ultimately integrates a complex array of signals into specific cellular functions such as proliferation, differentiation, and the inhibition of apoptosis. Understanding the contribution of Jaks and STATs to these pathways and the crosstalk among the pathways will be essential to our understanding of the molecular basis of cytokine action. Visit the Annual Reviews home page at http://www.AnnualReviews.org.

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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Annu. Rev. Immunol. 1998. 16:323–58 c 1998 by Annual Reviews. All rights reserved Copyright

MECHANISMS OF MHC CLASS I–RESTRICTED ANTIGEN PROCESSING Eric Pamer∗ and Peter Cresswell

∗ Department of Internal Medicine and Section of Immunobiology, Yale University School of Medicine, Howard Hughes Medical Institute, New Haven, CT 06510; e-mail: [email protected], [email protected]

KEY WORDS:

HLA, proteasome, antigen processing, chaperone

ABSTRACT Classical class I molecules assemble in the endoplasmic reticulum (ER) with peptides mostly generated from cytosolic proteins by the proteasome. The activity of the proteasome can be modulated by a variety of accessory protein complexes. A subset of the proteasome β-subunits (LMP2, LMP7, and MECL-1) and one of the accessory complexes, PA28, are upregulated by γ -interferon and affect the generation of peptides to promote more efficient antigen recognition. The peptides are translocated into the ER by the transporter associated with antigen processing (TAP). A transient complex containing a class I heavy chain–β 2 microglobulin (β 2m) dimer is assembled onto the TAP molecule by successive interactions with the ER chaperones calnexin and calreticulin and a specialized molecule, tapasin. Peptide binding releases the class I–β 2m dimer for transport to the cell surface, while lack of binding results in proteasome-mediated degradation. The products of certain nonclassical MHC-linked class I genes bind peptides in a similar way. A homologous set of β 2m-associated membrane glycoproteins, the CD1 molecules, appears to bind lipid-based ligands within the endocytic pathway.

INTRODUCTION In higher organisms, MHC class I molecules are expressed on the surface of virtually all nucleated cells, where they serve as the target antigens for CD8positive T cells. They consist of a membrane-integrated glycoprotein, which is the polymorphic product of one of the MHC class I genes, a small soluble protein, β 2 microglobulin (β 2m), and a short peptide usually of 8–10 amino 323 0732-0582/98/0410-0323$08.00

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acids. Numerous examples of class I–peptide complexes have been successfully crystallized and their three-dimensional structures determined (1). The characteristic feature of the molecule is the peptide binding site, which consists of two antiparallel α-helices overlaying a platform of antiparallel β-strands. The peptide lies in the groove so formed, with its N- and C-termini and a subset of its amino acid side chains interacting with the binding groove to produce an extremely stable, high-affinity interaction. The substitution of different amino acid residues in positions lining the binding groove limits the range of peptides that bind to the products of particular MHC class I alleles. Usually two or three positions (anchor residues) in the bound peptide are restricted to a very narrow subset of amino acids, leading to a particular “binding motif” for each allele (2). Such anchor residues fit into pockets formed by the variable residues in the peptide binding groove. The T cell receptor (TcR) recognizes the complex by binding to the surface formed by exposed residues of the bound peptide and accessible elements of the two α-helices. The interaction of the TcR with class I is very similar in the two examples of TcR-class I complexes currently structurally characterized, with a diagonal orientation of the Vα and Vβ domains of the TcR imposed by two “peaks” at the amino terminal ends of the α-helices of the class I molecules (3, 4). Proper assembly of the MHC class I peptide complexes is required for stable surface expression of class I molecules. Assembly occurs in the endoplasmic reticulum (ER), where newly synthesized MHC class I heavy chains and β 2m form dimers. Peptides associated with class I molecules are predominantly generated in the cytosol by degradation of cytosolic proteins. The dominant responsible protease is the proteasome, a multisubunit ATP-dependent protease that plays the major role in normal turnover of proteins in the cytosol. The peptides generated are translocated into the ER by the transporter associated with antigen processing (TAP), a heterodimeric member of the ATP-binding cassette (ABC) family of transporters. MHC class I–β 2m dimers, physically associated with TAP, bind a subset of the translocated peptides, are released from TAP, and are transported to the cell surface. This is a constitutive process, and the normal complement of class I–associated peptides is derived from cytosolic and nuclear proteins. When a virus, intracellular bacterium, or protozoan parasite infects a cell, newly synthesized pathogen-encoded proteins contribute new peptides to the class I–associated pool. This review covers our current understanding of these processes, which together constitute MHC class I–restricted antigen processing.

ANTIGEN DEGRADATION Degradation of cytosolic antigens is an essential step in the generation of most MHC class I–presented epitopes. Cytosolic protein degradation is highly

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specific and tightly regulated to prevent nonspecific destruction of essential selfproteins. Following infection, the protein degradation machinery of the host cell faces several formidable challenges. First, foreign antigens, whether viral, bacterial, fungal, or protozoal, must be recognized and degraded by proteases in a way that generates peptides of the appropriate length for TAP transport and binding by MHC class I molecules. An extra level of complexity is generated by the distinct peptide preferences of different MHC class I molecules. Thus, the protein degradation machinery, which is conserved between different individuals, must generate peptides for MHC class I molecules which, because of their polymorphism, are likely to bind different peptides in different individuals. Some intracellular pathogens replicate quickly, whereas others replicate slowly and produce only scant amounts of antigen. Degradation of cytosolic antigens and generation of MHC class I–associated epitopes, therefore, should be rapid, to detect rapidly replicating pathogens, and efficient, to present sufficient numbers of epitopes from small amounts of antigen. While efficient peptide generation is desirable, the protein degradation pathway must remain sufficiently general to accommodate a plethora of foreign antigens. Finally, constitutive, highly efficient antigen degradation and peptide generation may be detrimental to the host, either because of the energy involved or because of the potential for inducing autoimmunity. Therefore, the ability to induce higher rates and efficiencies of antigen degradation during times of infection may be desirable. The work of many laboratories is beginning to show us how the protein degradation pathways confront many of these challenges.

Cytosolic Recognition of Foreign Antigens How antigens are funneled into protein degradative pathways remains an important question. In the case of viral infections, there is even controversy about whether whole viral proteins or partial proteins that result from aberrant translation products are the major sources of MHC class I–associated epitopes. According to proponents of the DRiP (defective ribosomal products) hypothesis, ribosomes are error prone, and defective translation products may be an important source of peptides for MHC class I molecules (5). This hypothesis originated with the findings of Boon et al (6), who described the generation of CTL epitopes following the transcription and translation of promotorless, and even out-of-frame, fragments of DNA (6). Subsequent studies have confirmed this original finding (7). The quantitative contribution of the DRiP pathway to general MHC class I antigen processing and presentation, however, remains unmeasured. Degradation of endogenous proteins is modulated in various ways. Some proteins are rapidly degraded because they contain PEST sequences, which are rich in proline, glutamine, serine, and threonine (8). Other proteins contain

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sequences referred to as destruction boxes that confer cell cycle–specific degradation (9). Another factor that influences the stability of cytosolic proteins is the identity of their N-terminal amino acids (10). The most clearly understood and apparently most general entrance to the cytosolic protein degradation pathway involves the conjugation of ubiquitin to internal lysine residues of targeted proteins (11, 12). The mechanisms involved in ubiquitination are complex and involve three enzymatic activities mediated by proteins called E1, E2, and E3 (11, 12). These enzymes work in series, first activating ubiquitin and then covalently linking it to specific lysine residues in the target protein. Polyubiquitin chains are generated by conjugating additional ubiquitin moieties to lysine residues of already conjugated ubiquitin molecules (12). Polyubiquitin chains may serve two major purposes: one, to unfold the target protein, and two, as recognition elements for cytosolic proteasome complexes (see below). Although it remains unclear how ubiquitination destabilizes proteins, once a target protein is ubiquitinated, its degradation is rapid.

Ubiquitination and Antigen Processing The role of ubiquitination in MHC class I antigen processing remains controversial. The earliest study of the potential role of ubiquitination was performed by Carbone, Bevan, and colleagues (13). These investigators, having previously shown that ovalbumin osmotically loaded into cell cytosol was effectively processed into MHC class I–associated peptides (14), repeated this experiment after first methylating (and rendering nonubiquitinatable) all of the lysine residues in ovalbumin. Target cells osmotically labeled with methylated ovalbumin presented the MHC class I–associated, ovalbumin-derived peptide efficiently, indicating that ovalbumin did not require ubiquitination for efficient epitope generation. Subsequent studies used cell lines that have temperature-sensitive E1 enzymes and thus do not ubiquinate proteins at nonpermissive temperatures; these studies provide conflicting results. One study demonstrated ubiquitindependent degradation of ovalbumin (15), whereas the other found that antigen processing occurred similarly at permissive and nonpermissive temperatures (16). Further studies have confirmed that ovalbumin processing can occur independently of ubiquitination (17). Thus, ubiquitination may not be a general feature of CTL epitope generation. While it appears that ubiquitination is not essential for all MHC class I antigen processing, it is likely that some antigens will require ubiquitination for degradation and generation of MHC class I–associated epitopes.

The N-End Rule and MHC Class I Antigen Processing Townsend and colleagues were the first to show the correlation between the N-terminal amino acid of an antigen, its degradation rate, and the efficiency of

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epitope presentation to CTL (18). These investigators altered the N-terminus of the influenza nucleoprotein and showed that arginine (destabilizing) at the N-terminus enhanced presentation, while methionine (stabilizing) diminished presentation to NP-specific CTL. This finding was subsequently confirmed with mutant forms of β-galactosidase (19). Forms of β-galactosidase that contained destabilizing N-terminal residues were presented more effectively to T cells than were slowly degraded forms. Studies of the bacterially secreted p60 protein also demonstrated that the identity of the N-terminal amino acid could influence the rate of its degradation, and quantitative extraction of CTL epitopes from infected cells demonstrated the direct correlation between antigen degradation rates and the generation of epitopes (20). In contrast to these studies, the work of Shastri and colleagues has recently demonstrated that while the N-terminal amino acid dramatically influenced the rate of recombinant antigen degradation, the number of epitopes generated in infected cells did not correlate with the rate of degradation (21). Although this finding is difficult to reconcile with all of the preceding studies, it is possible that in Shastri’s system epitopes are not generated from whole protein but rather from DRiPs (5), in which case protein stability may not enter into the picture.

Proteasomes and Peptide Generation Rock, Goldberg, and their colleagues were the first to demonstrate that proteasomes mediated the majority of endogenous cytoplasmic protein degradation (22). Using peptide aldehyde inhibitors, they demonstrated that proteasomes degrade short-lived and long-lived proteins, and that, in the absence of proteasome-mediated protein degradation, MHC class I molecules remain in the ER, starved for peptides. MHC class I molecules in cells treated with peptide aldehyde proteasome inhibitors remain associated with TAP for prolonged periods because of the absence of peptides (23). In cells infected with the cytosolic bacterium Listeria monocytogenes, peptide aldehyde inhibitors prevent the degradation of bacterially secreted proteins and the generation of MHC class I–associated epitopes, demonstrating that antigen degradation and epitope generation are tightly linked (24). Subsequent studies with the more specific proteasome inhibitor lactacystin (25) have confirmed the important role of proteasomes in the generation of MHC class I–associated peptides. Proteasomes, also referred to as multicatalytic proteases, contain a barrelshaped 20S core particle that is proteolytically active and can degrade proteins in an ATP-independent fashion. In vitro incubation of 20S proteasomes with either peptide or protein antigens can result in the generation of peptides known to associate with MHC class I molecules (26, 27). Most intracellular protein degradation, however, appears to be mediated by a larger protein complex that consists of the 20S core decorated by additional complexes, thereby creating

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a larger 26S particle. Multiple proteins and complexes that associate with and modulate proteasome activity have been identified in the last several years and are discussed in the following sections.

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Three-Dimensional Structure of 20S Proteasomes One of the most exciting advances in the proteasome field was the structure determination of the Thermoplasma acidophilum proteasome (28). The crystal structure of the T. acidophilum proteasome revealed a stack of four rings, each containing either seven α or seven β subunits. The rings were arranged in the order αββα, and protease inhibitor–binding studies indicated that the inner β subunits contained the proteolytic sites. This study also demonstrated the sequestration of the protease active sites on the inner surface of the barrel, indicating that protein substrates must feed into the proteasome to be degraded. An advantage of this is that surrounding cellular proteins are less likely to be nonspecifically degraded. The far more complex structure of the yeast 20S proteasome was recently solved (29). The yeast proteasome also consists of four rings consisting of either seven α or β subunits. A major difference from T. acidophilum, however, is that each of the α and β subunits in the seven-member ring is distinct from the others, and their order of appearance in the rings and within the proteasome is conserved between proteasomes. An interesting aspect of β subunits of 20S proteasomes is that they fall into a family called the Ntn (N-terminal nucleophile) hydrolases (30). The C terminus of precursor forms of proteasome β subunits must be cleaved to reveal a threonine residue that participates in peptide bond cleavage. The crystal structure of the yeast proteasome reveals that only three of the seven β subunits are cleaved in this manner and thus are proteolytically active. An additional surprising feature of the yeast 20S proteasome is the finding that the central cavity is poorly accessible. It is believed that the additional subunits that make up 26S proteasomes may enable substrate access to the inside of the 20S core particle.

LMP2, LMP7, and MECL-1 Subunits of 20S Proteasomes The proteasomes of higher eukaryotes appear to be even more complex than the yeast proteasome. It came as a surprise several years ago when it was discovered that two subunits of proteasomes are encoded in the mammalian MHC (31–34). These two proteasome subunits belong to the β subunit family and are called LMP2 and LMP7. The level of expression of these two subunits varies between tissues (35, 36) and is induced by γ -interferon (34). Exposure of cells to γ -interferon results in 20S proteasomes in which the constitutive proteasome subunits X (MB1) and Y (δ) are replaced with LMP7 and LMP2 (37, 38). Recently, a third proteasome subunit, MECL-1 (LMP10), has been found to be induced by γ -interferon and to replace proteasome subunit Z (39, 40).

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What impact do the γ -interferon-inducible subunits have on proteasome specificity, antigen processing, and T cell–mediated immunity? A number of studies have approached these questions and provided some interesting, and at times conflicting, answers. Early experiments with cell lines lacking LMP2 and LMP7 indicated that antigen presentation can occur in the absence of these two proteasome subunits (41). Subsequent studies, however, showed that presentation of some antigens was attenuated in cells lacking LMP2 and LMP7 and could be rescued by transfection of the gene for LMP7 (42). In vitro comparisons of proteasomes purified from γ -interferon stimulated or unstimulated cells, or proteasomes purified from cell lines containing or lacking LMP2 and LMP7, demonstrated that these two subunits can alter the specificity of proteasomes (43, 44). Specifically, these subunits appeared to enhance cleavage after hydrophobic and basic residues, while inhibiting cleavage after acidic residues. Subsequent studies showed that transfection of lymphoblast or HeLa cells with the gene for LMP7 generated proteasomes with increased capacity to cleave after hydrophobic or basic residues, whereas transfection with LMP2 resulted in proteasomes with a diminished capacity to cleave after acidic residues (45). Reciprocally, overexpression of proteasome subunit X diminished proteasomemediated cleavage after hydrophobic amino acids, while proteasome subunit Y enhanced the cleavage following acidic amino acids (46). Other investigators studying the effects of γ -interferon stimulation and LMP2 and LMP7 on proteasome specificity have obtained different results, however. For example, investigations comparing proteasomes purified from γ -interferon treated and untreated mouse fibroblasts demonstrated downregulation of the chymotrypsin-like activity in proteasomes derived from γ -interferontreated cells (47). In this and subsequent studies these investigators, using a 25mer peptide as a substrate, found that LMP2 and LMP7 dramatically changed the spectrum of smaller peptides formed by proteasome digestion (48, 49). Another group, studying proteasomes purified from lymphoblastoid cell lines that either express LMP2/LMP7 or lack the genes for these subunits, found that LMP2 and LMP7 increased cleavage after hydrophobic residues modestly (50), but that this effect was markedly influenced by amino acid residues preceding the P1 residue (51). Most recently, Orlowski and colleagues compared the specificity of proteasomes isolated from bovine spleen, which contain LMP2, LMP7, and MECL1, to proteasomes isolated from bovine pituitary, which lack these γ -interferon-inducible subunits (35). These investigators previously characterized five different peptidase specificities in pituitary proteasomes: 1. chymotrypsin-like (ChT-L); 2. trypsin-like (T-L); 3. peptidylglutamylpeptide hydrolyzing (PGPH); 4. branched chain amino acid preferring (BrAAP); and 5. small neutral amino acid preferring (SNAAP) (52). In the recent study, spleen-derived proteasomes (containing LMP2/LMP7) had decreased ChT-L

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activity and PGPH activity compared to pituitary-derived proteasomes (lacking LMP2/LMP7). Interestingly, the BrAAP activity was increased in spleenderived proteasomes, thereby increasing cleavage after branched chain and aromatic amino acids (35). The preceding studies have used proteasomes purified by a variety of methods from a variety of cell types and tissues of murine, human, and bovine origin. Furthermore, purified proteasomes were assayed under a variety of conditions with different substrates. Thus, these different studies have provided variable, at times distinct, results, and while some controversy still exists about the precise specificity changes induced by the incorporation of LMP2 and LMP7 into 20S proteasomes, there is little doubt that the specificity is altered. What might be the advantage of enhanced cleavage after hydrophobic or basic residues to the antigen processing pathway? Perhaps the most compelling explanation is that MHC class I molecules typically bind peptides that have hydrophobic residues at the C-terminus. Thus, induction of LMP2 and LMP7 and their incorporation into proteasomes could enhance the production of peptides capable of associating with MHC class I molecules. An alternative hypothesis proposed by Monaco and colleagues is that LMP7, LMP2, and MECL-1 replacement of proteasome subunits X, Y, and Z may be only partial, resulting in a range of proteasomes that contain various proportions of constitutive and γ -interferon-induced subunits. Increasing the diversity of proteasomes might, therefore, increase the variety of peptides that can be produced within a cell (39). The importance of LMP2 and LMP7 in MHC class I antigen processing received support from analyses of mice lacking the genes for these subunits. Mice lacking LMP2 have fewer mature CD8 T cells and also have a diminished CTL response to influenza virus infection (53). Thus, LMP2 appears to play a role in both thymic selection of MHC class I–restricted T cells and in the presentation of peptides to mature T cells during the immune response to viral infection. Similarly, mice lacking LMP7 have diminished cell surface expression of MHC class I and present the H-Y antigen poorly (54).

Role of PA28 in Antigen Processing While γ -interferon can alter the subunit composition of 20S proteasomes, it also increases the expression of the PA28 activator (also referred to as the 11S regulator). PA28 was first purified from bovine (55) and human red blood cells (56) and was found to dramatically increase the peptidolytic activity of 20S proteasomes. It did not, however, enable 20S proteasomes to degrade denatured or ubiquitinated whole proteins (55, 56). The PA28 activator consists of six subunits that form a ring that can attach as a cap to both ends of 20S proteasomes (57). Two different subunits, called PA28α and PA28β, are present in roughly equal proportions in the PA28 activator rings (58). The cDNAs for

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the PA28α and β subunits have been cloned and revealed 50% identity between these two proteins and dramatic induction of both subunits upon cell exposure to γ -interferon (59, 60). Cross-linking studies suggest that the PA28 activator consists of a hexamer of alternating αβ subunits. Carboxypeptidase digestion indicates that the C-terminus of the α subunit attaches the activator to the 20S proteasome (61). Does association of PA28 with the 20S proteasome affect antigen processing? Using a 25-mer peptide as a substrate, the PA28 activator was found to increase the spectrum of peptides produced by 20S proteasomes, regardless of whether they contained LMP2/LMP7 (49). Using smaller, hydrophobic peptides as substrates, another study indicated that PA28 and LMP2/LMP7 synergized to enhance cleavage after hydrophobic amino acids (51). An enhancing role for PA28 in the processing of antigens by infected cells was demonstrated in a study in which fibroblasts were transfected with the PA28α subunit gene (62). Such fibroblasts expressing the MCMV pp89 proteins were more sensitive to lysis by pp89-specific CTL than were untransfected fibroblasts. Interestingly, the presence or absence of transfected PA28α did not affect either the amount or stability of pp89 in transfected fibroblasts, suggesting that PA28α did not simply increase the degradation rate of antigen. PA28α transfection did not alter expression levels of MHC class I in fibroblasts, either, but did increase the presentation of influenza virus antigens to specific CTL (62). Although these studies demonstrated that PA28α increases the sensitivity of target cells to CTL lysis, they did not measure an actual increase in antigen-processing efficiency. Furthermore, the role of PA28β, which markedly enhances proteasome activity when added together with PA28α (61), was not determined. The mechanism by which PA28 enhances antigen-processing efficiency was investigated with several 19 to 25 amino acid long peptides (63). Mass spectrometric analysis of peptide digests with 20S proteasomes in the absence of PA28 indicated that most peptide products resulted from a single cleavage event during short incubations. In contrast, 20S proteasome in the presence of PA28 (presumably containing both αβ subunits) rapidly generated many peptide products that resulted from double peptide cleavage (63). Additionally, PA28 markedly enhanced the generation by 20S proteasomes of MCMV pp89 CTL epitope from the middle of a larger peptide during in vitro incubation. Importantly, by testing proteasome activity on a range of substrate concentrations, these investigators determined that double cleavages by proteasomes in the presence of PA28 occurred simultaneously rather than sequentially. This suggests that PA28 does not simply increase the overall kinetics of proteasome mediated peptide cleavage, but rather that it alters the conformation of the substrate peptide in the 20S proteasome to render it concurrently accessible to two different protease sites (63). Taken together, these studies indicate that the PA28 regulator plays a positive role in antigen processing.

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Association of Proteasomes with PA700 In addition to PA28, the 20S core proteasome can associate with other subunits that alter its size and activity. It has been known for many years that the 26S proteasome, which contains the 20S core particle and additional subunits that increase its mass, can degrade whole proteins and ubiquitinated substrates in an ATP-dependent manner (12). A 19S ATPase complex has been characterized that, when associated with the 20S core proteasome, increases its activity (64). (To avoid confusion, we use the designation “19S complex” rather than “20S complex” preferred by Rechsteiner and colleagues) (64). The 19S ATPase and its multiple subunits are clearly distinct from PA28, and concurrent binding of these complexes to 20S proteasomes cannot be detected (64). Other investigators have purified and characterized a 700-kDa complex composed of about 16 polypeptides called PA700 (65). Purified PA700 has ATPase activity and contains multiple subunits with consensus sequences for ATP binding (66). More recently, the same group has identified an additional modulator that enhances the activation of the 20S proteasome by PA700 (67). This modulator, which also contains proteins of the ATP-binding family, enhances the activation of 20S proteasomes by PA700 by a factor of 8. Although it has not yet been demonstrated, it is likely that PA700 and additional regulators of proteasomes will be found to play a role in MHC class I antigen processing. One possible role for PA700 and other modulators may be to assist in the unfolding of potential degradation substrates. Another role for the additional subunits is to associate with multiubiquitin sidechains. Exciting progress has been made in the last several years on the mechanism of 26S proteasome association with ubiquitinated substrates. First, a 50-kDa subunit of the 26S proteasome was identified that specifically bound ubiquitin-lysozyme conjugates and polyubiquitin chains (68). The gene for this subunit, named S5a, has been cloned, and the recombinant protein binds to multiubiquitin chains through repeating hydrophobic patches (69, 70). A plant proteasome subunit named MBP1 has also been identified in Arabidopsis that binds to polyubiquitinated substrates and, interestingly, can inhibit the ubiquitin-dependent degradation by reticulocyte lysates (71, 72). The potential utility is clear of a specific inhibitor of ubiquitin binding by 26S proteasomes for studies of antigen processing.

Proteasomes and CTL Epitope Generation The important role of proteasomes in the generation of MHC class I–presented peptides is incontrovertible. It has been suggested that the hierarchy of T cell responses to different epitopes is influenced by the relative efficiency of epitope generation by proteasome-mediated proteolysis (73). Single amino acid substitutions that prevent proteasome-mediated peptide cleavage prevent

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antigen presentation (74). Indeed, some proteins derived from pathogens may contain sequences that prevent antigenicity, perhaps by preventing proteasomemediated degradation (75). However, proteases other than proteasomes may be involved in the generation of MHC class I–associated peptides. For example, peptides of 17 amino acids expressed endogenously could be processed for presentation by MHC class I molecules in the presence of proteasome inhibitors, implying that other proteases are involved in the generation of the CTL epitopes (76). Since TAP can transport peptides that are larger than most MHC-associated peptides (see below), it is possible that additional “trimming” proteases are present in the endoplasmic reticulum. Evidence for such proteases comes from experiments using TAP-deficient cells in which antigenic peptides are transported into the ER behind a conventional signal sequence (77). Interestingly, epitopes with N-terminal extensions are processed efficiently in the ER while peptides with C-terminal extensions are processed poorly, suggesting the presence of an aminopeptidase (78). Although the identity of ER proteases that might be involved with peptide trimming is not known, studies of signal sequences that are bound and presented by HLA-A2 in a TAP-independent fashion demonstrated that at least one ER peptidase is inhibitable by peptide aldehyde inhibitors (23).

PEPTIDE TRANSPORT INTO THE ER The TAP Transporter TAP is a heterodimer with both subunits, TAP.1 and TAP.2, encoded by genes in the MHC closely linked to the LMP2 and LMP7 genes encoding γ -interferoninducible proteasome subunits (79). Each TAP subunit has an N-terminal hydrophobic region with multiple predicted transmembrane domains, and a cytosolic C-terminal ATP-binding domain. Numerous in vitro studies have demonstrated the ability of TAP to translocate peptides across the ER membrane (80–82). Radiolabeled photoactivatable derivatives of peptides have been used in attempts to identify the peptide binding site. Expression of both TAP.1 and TAP.2 is required to get efficient binding, and certain peptides bind preferentially to TAP.1 while others bind to TAP.2 (83–86). Competition experiments indicate a single binding site, and together the data argue that it is combinatorial, requiring the juxtaposition of cytosolic regions of TAP.1 and TAP.2 (84–86). More precise definition of the binding site has been obtained by determining the regions of the TAP subunits to which the photoactivatable peptides bind. This approach involves proteolysis of the TAP proteins following covalent peptide binding and immunoprecipitation using antisera against hydrophilic regions separating putative transmembrane domains (85, 86). The data suggest that the binding site is comprised of regions of TAP.1 and TAP.2 at the C-terminal

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end of the hydrophobic segment, adjacent to the cytosolic hydrophilic domain. Consistent with this is the finding that a polymorphism in the rat TAP.2 gene, which affects the nature of the transported peptides (87, 88), maps to a similar region (89). Peptide binding is ATP-independent, while translocation is ATP-dependent (82, 83). The precise topology of the N-terminal domains of TAP.1 and TAP.2 is currently unclear. Up to eight hydrophobic regions potentially constituting transmembrane domains can be identified, and data obtained using truncation mutants of TAP.1 expressed in prokaryotic cells suggest that each can span the membrane (90). A major difficulty with this analysis is that it predicts that the region identified as part of the peptide binding site using photoactivatable peptides (85) is in the ER lumen. This seems highly unlikely. Further definition of the topology by expressing similar mutants in eukaryotic cells will probably be required to resolve this issue. Understanding the topology and structure of the hydrophobic segments is essential to determine how ATP-hydrolysis is coupled to translocation, which is ill-understood for any member of the ABC transporter family. The specificity of the TAP peptide-binding site has been studied using in vitro translocation assays with either permeabilized cells (83, 91–93) or microsomes (80), or direct binding assays using human TAP molecules expressed in insect cells (94, 95). The data from a number of laboratories are largely in agreement that the peptide-binding site of human TAP is more promiscuous in terms of sequences acceptable for binding and transport than is mouse TAP. Mouse TAP has a strong preference for peptides with hydrophobic C-terminal amino acids, while human TAP also binds peptides with basic C-termini. The two rat TAP.2 alleles form TAP dimers similar in specificity to mouse TAP (TAP.2u) or human TAP (TAP.2a), with the difference in binding related to sequence differences at the C-terminal end of the hydrophobic domain, as described above (88). The polymorphism of mouse and human TAP genes appears to be more limited (96, 97) and has little or no effect on the specificity of peptide translocation (97, 98). In spite of its relative promiscuity, human TAP exhibits a large range in binding affinity depending on the peptide sequence, perhaps as great as three orders of magnitude (99). For nonamer peptides, the three N-terminal residues and the C-terminal residue have significant effects on binding (94, 99). Using combinatorial peptide libraries, Tamp´e and coworkers (99) confirmed that acidic C-terminal residues in a nonamer dramatically decrease the affinity, and they found that acidic residues at the first and third positions are also disfavored. Basic residues, particularly arginine, in the first three positions enhanced binding. A proline residue in the second position very significantly impaired binding. Residues 4 through 8 had little effect, and earlier studies showed that acetylation of the N-terminal amino group or conversion of the C-terminal

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carboxyl group to an amide impaired binding (98). Thus, TAP appears to concern itself, roughly speaking, with the ends of the peptide. Substitution of D-amino acid residues at position 1 to 3 and position 9 also affected binding, while D-amino acids had little effect when introduced at positions 4 to 8 (99). This leads to a model suggesting that peptide backbone as well as side chain interactions at positions 1 to 3 and 9 are predominantly involved in the binding of a nonameric peptide to TAP. A similar mode of binding, with N- and C-terminal interactions and “looping” of the central regions of the peptide, could explain the ability of TAP to translocate longer peptides as well as covalently modified peptides. Peptides of 8-13 residues bind well (83, 98), and peptides of up to 40 residues (100) have been shown to transport, as have peptides with large side chains consisting of up to 8 lysine residues polymerized by linking their -amino groups to their carboxyl residues (≈70˚a ) (101). How relevant is the in vitro data on the specificity of peptide binding and translocation by TAP to the in vivo generation of class I peptide complexes? There are examples of peptides that form CTL epitopes but translocate poorly or not at all in in vitro assays (83, 102). Human class I alleles that have a preference for basic C-terminal residues in their peptide binding motifs, such as HLA-A3, function well in mouse cells even though mouse TAP has a strong preference for C-terminal hydrophobic residues. In fact, HLA-A3 molecules isolated from transfected mouse cells predominantly contain peptides with Cterminal lysine residues (103). These situations may reflect the existence of a specialized mechanism for transferring peptides from proteasomes to TAP, which would make the simple binding affinity of peptides for TAP less relevant. For example, cytosolic heat shock proteins may bind peptides prior to translocation (2). Hsp70 molecules isolated from virus-infected cells, presumably with bound antigenic peptides, elicit CTL responses in mice (see below, 104). Those peptides that preferentially bind to heat shock proteins may have a higher probability of surviving peptidases in the cytosol and ultimately being translocated. Additional experiments have shown that, in some cell lines at least, photoactivatable peptides that are TAP substrates can bind covalently to an unidentified protein of 100 kDa on the cytoplasmic side of the ER (96). However, an intermediary molecule acting between the proteasome and TAP remains to be conclusively identified. An alternative explanation for the existence of class I complexes with peptides that are poor substrates for TAP is that the peptides actually translocated may be extended at the N- or C-terminus. The ability of TAP to bind and translocate peptides longer than those usually found in association with class I molecules has often been used to argue that trimming by exopeptidases may occur in the ER. As described above, evidence in favor of this has been obtained in TAP-negative cells where peptides are introduced into the ER by an N-terminal

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signal sequence (77, 78, 105). Bennink, Yewdell and their coworkers have also shown that epitopes expressed as fusion proteins at the C-terminus of an unusual type II ER membrane protein, JAW1, can serve as TAP-independent class I– restricted epitopes (106). By eliminating N-linked glycans and thus enhancing its ER degradation rate, intact influenza nucleoprotein expressed in the ER can also be presented to T cells in a class I–restricted fashion (T Elliott, personal communication). This indicates that even endopeptidases in the ER can play a role. In addition, Neefjes and coworkers (107) have provided evidence that peptides can be “retrotranslocated” from the ER to the cytosol, where further trimming may occur followed by retranslocation by TAP. Whether ER trimming reactions are significant in epitope generation in normal circumstances, i.e., in TAP-positive cells, has been called into question (88), but they seem likely to play at least some role.

ASSEMBLY OF THE MHC CLASS I–PEPTIDE COMPLEX Cell lines, or mice, that lack β 2m fail to express MHC class I molecules on the cell surface (108, 109). This is an example of the “quality control” function of the ER, which ensures that misfolded proteins are not transported and are in fact degraded (110). Quality control is mediated by a set of chaperones that reversibly bind to misfolded proteins, allowing multiple attempts at achieving a native conformation. Once such a conformation is attained, the proteins can leave the ER, whereas failure, after a certain period, leads to degradation of the protein. β 2m is an obligate subunit of class I molecules, and its absence leads to misfolding and degradation of the heavy chain. Similarly, in cell lines that lack expression of either or both of the TAP genes, MHC class I molecules are poorly expressed on the cell surface (111, 112). Such cell lines form heavy chain-β 2m dimers in the ER, but ultimately the class I molecules are degraded. This indicates that the bound peptide is an essential component of a class I molecule, and that peptide association as well as β 2m is required for the formation of a native conformation that can satisfy ER quality control processes. Incubation at reduced temperatures (26◦ C) can lead to quite high levels of expression of H-2 class I–β 2m dimers on the cell surface in TAPnegative mouse RMA-S cells (113), and mouse H-2 alleles transfected into human TAP-negative T2 cells are well expressed even at 37◦ C (114). This appears to be an intrinsic property of the heavy chain because human class I molecules are poorly expressed on the surface of RMA-S cells at reduced temperatures even when human β 2m is present (115). The difference between HLA and H-2 class I alleles remains unexplained, and it is unclear whether the surface-expressed H-2 molecules in TAP-negative cells are genuinely “empty,” or whether they contain TAP-independent, low-affinity peptides.

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The Role of Chaperones in Assembly A major chaperone involved in MHC class I assembly is calnexin. Calnexin is an ER-retained transmembrane protein that shares with a homologous soluble ER protein, calreticulin, the property of binding to monoglucosylated N-linked glycans (110). This interaction may play a major role in the folding of glycoproteins in the ER. N-linked glycans, when first added to newly synthesized proteins, contain three terminal glucose residues, two of which are removed enzymatically to generate the monoglucosylated ligand to which calnexin and calreticulin bind. Further deglucosylation, followed by reglucosylation by the enzyme UDP-glucose glycoprotein glucosyltransferase, an enzyme that accepts only nonnative proteins as a substrate (116), is believed to provide the molecular basis for the dissociation-association cycle for calnexin and calreticulin. In the murine system, calnexin associates with newly synthesized free MHC class I heavy chains and newly assembled class I heavy chain–β 2m dimers (117). Furthermore, the transport of heavy chain-β 2m dimers to the surface of insect cells, which lack TAP, is reduced by coexpression of calnexin (118, 119). This is consistent with an important role for calnexin in the ER retention of heavy chain-β 2m dimers prior to peptide binding. In human cells, while association of calnexin with free class I heavy chains has proven easy to demonstrate (120–122), interaction with heavy chain-β 2m dimers has not. One report shows that HLA-B27–β 2m dimers associate with calnexin (123). This uses a particularly sensitive approach involving immunoprecipitation with β 2m-dependent class I monoclonal antibodies, followed by Western blotting with anticalnexin antibodies. It is conceivable that such an interaction occurs with additional human class I–β 2m dimers, but that the association does not survive detergent solubilization. Alternatively, HLA-B27 may be exceptional. Whatever the precise role calnexin normally plays in HLA class I assembly, clearly it is not essential. Normal assembly, transport, and surface expression of both human and mouse class I molecules has been observed in a mutant human cell line, CEM.NKR, which lacks calnexin expression (124, 125). Normal peptide loading also occurs, as is shown by recognition of influenza virus–infected H-2Db–expressing CEM.NKR cells by specific Db-restricted CTL (125). It seems likely that there is redundancy in the ER and that additional chaperones can perform the same function as calnexin. The ER chaperone BiP binds free human class I heavy chains and is an obvious candidate (122). A number of years ago anti-TAP antibodies were observed to coprecipitate newly synthesized class I–β 2m dimers from detergent extracts of cells (121, 126). Class I–TAP association was observed only in certain detergents such as digitonin and CHAPS. Free class I heavy chains, for example in β 2mnegative cell lines, failed to associate with TAP. Because human heavy chainβ 2m dimers could not readily be shown to bind to calnexin, a step-wise assembly

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pathway was proposed in which free heavy chains first bound calnexin, then after β 2m association, the class I molecules bound to TAP. Peptide binding had previously been shown to liberate class I molecules from TAP (121, 126), and this was proposed to complete the assembly. An alternative pathway was proposed in the mouse system, in which calnexin–class I association was retained throughout the assembly process (117, 127). In fact, convincing data were presented indicating that calnexin remains transiently associated with class I molecules even after peptide loading and dissociation from TAP (127). This dichotomy remains unresolved and may represent a real difference between the human and mouse class I assembly processes. Calreticulin is involved in MHC class I assembly. Immunoprecipitation of digitonin extracts of pulse-labeled human B cell lines with anti-calreticulin antibodies revealed that both newly synthesized class I heavy chains and β 2m were associated with calreticulin (128). In the β 2m-negative cell line Daudi, no association of free class I heavy chains with calreticulin was observed. Expression of β 2m in this cell line by transfection restored the class I–calreticulin interaction. Further complicating the situation was the finding that an additional 48-kDa protein, first observed in association with TAP (121), was also associated with calreticulin in normal B cell lines. Like class I molecules the novel protein, now called tapasin, was not associated with calreticulin in the absence of β 2m (128). Tapasin was, however, associated with TAP in the absence of β 2m. In TAP-negative cells, both tapasin and class I–β 2m dimers were associated with calreticulin. These findings suggested that in normal cells a complex containing calreticulin, class I heavy chain, and β 2m might be bridged to TAP by the tapasin molecule (128). Prior evidence that a novel species might be required for the physical association of class I molecules with TAP came from a mutant human B cell line defective in cell surface expression of the products of transfected class I genes (129, 130). This cell line, .220, was generated by DeMars and coworkers by multiple rounds of γ -irradiation and selection with a variety of anti–class I monoclonal antibodies (131). Spies and coworkers demonstrated that in the .220 cell line, class I–TAP association was absent, and they also showed that the class I–β 2m dimers formed in the cell appeared to lack associated peptides (130). In addition, .220 cells expressing HLA-A1 or B8, when infected with a recombinant Vaccinia virus expressing a cytomegalovirus protein or with influenza virus, respectively, failed to be recognized by class I–restricted, virusspecific cytotoxic T cells (132). Analysis of .220 cells showed that they lacked tapasin expression (128), consistent with the hypothesis that tapasin forms a bridge between calreticulin-associated assembled class I–β 2m dimers and TAP. Expression of tapasin in .220 by transfection restored class I–TAP association and recognition by virus-specific CTL (132).

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Thus, a current model for the assembly of MHC class I–peptide complexes suggests that newly synthesized class I heavy chains bind calnexin, and that when β 2m binds, calnexin is exchanged for calreticulin. Association of the class I–β 2m-calreticulin complex with TAP is then mediated by tapasin. It has been suggested that β 2m may interact with tapasin/TAP in the absence of class I heavy chains (123, 133). These data derive from a second mutant cell line, .221, which does not express HLA-A, B, or C molecules (131). However, it does express HLA-E and probably HLA-F, which calls this conclusion into question. Peptide translocation by TAP eventually results in the formation of a class I–peptide complex, which dissociates from tapasin and calreticulin and is transported from the ER through the Golgi apparatus to the plasma membrane. This model fits well with the data for human cells, and data consistent with it have been generated in the mouse system by Kearse and coworkers (134), who also found sequential interaction of class I heavy chains and class I–β 2m dimers with calnexin and calreticulin. This differential binding of calnexin and calreticulin implies that the N-linked glycan specificity of the two chaperones cannot by itself explain their binding capacity. There must be an element of protein-specific recognition involved in the calnexin and calreticulin interactions. The transmembrane domain of the mouse H-2Kb molecule has been proposed to play a role in the calnexin interaction (135), although contradictory results have also been reported (136). The N-linked glycan plays some role, however, because castanospermine, which inhibits the glucosidase involved in N-glycan modification, has a significant effect on the calreticulin–class I interaction as well as on the class I–TAP interaction (128). Its effect on the calnexin interaction with free class I heavy chains is less. While in a β 2m-negative cell, the folding and disulfide bond formation in free heavy chains is slowed by castanospermine (137), the rate of formation of heavy chain-β 2m dimers in wild-type cells is relatively unaffected (128, 138). As mentioned earlier, other data obtained in mouse cells argue that calnexin interaction is maintained throughout the assembly process (127), and this issue remains to be resolved.

Tapasin and the MHC Class I–TAP Complex Tapasin is a proline-rich, type 1 transmembrane glycoprotein of 428 amino acids with a single N-linked glycan (132). It is a member of the immunoglobulin superfamily with a membrane proximal domain homologous to Ig constant region domains. The hydrophobic region forming the putative transmembrane domain contains a lysine residue that may be involved in the interaction with other proteins, for example TAP. Interactions involving charged residues occur within the transmembrane regions of TcR α- and β-chains and associated CD3 components (139). There is a short cytoplasmic tail, putatively 11 amino acids, with lysine residues at −3, −4, and −5 that probably constitute an ER retention

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signal. Such signals usually consist of lysine residues at −3 and −4 or −3 and −5 (140). The gene encoding tapasin is closely linked to the MHC approximately 200-kb centromeric of the HLA-DP loci and within 500 kb of the TAP.1 and TAP.2 genes (141). Homologous genes occupy syntenic positions in the mouse and rat (141). The exon-intron structure of the tapasin gene is not like that of most Ig superfamily members except that the Ig C-domain homologue is encoded by a separate exon, and the majority of the tapasin sequence is also quite different from other Ig superfamily members (132). Thus, it does not appear as if tapasin arose from an immediate common ancestor of the class I genes themselves. Analysis of TAP-tapasin complexes purified from Daudi cells, and TAPtapasin-class I-calreticulin complexes from a β 2m-positive human B cell line indicated that multiple tapasin molecules, probably four, associate with a single TAP.1-TAP.2 heterodimer (132). A number of class I–β 2m dimers equal to the number of associated tapasin molecules were found in the complex from the β 2m-positive B cell line. This was a surprising finding, and it remains unclear exactly how this complicated structure is organized. Cells expressing TAP.1 but not TAP.2 have been used to show that class I and tapasin can associate with TAP.1 alone (84, 126; B Ortmann, unpublished results). Similar experiments failed to find a class I association with TAP.2, but TAP.2 may misfold in the absence of TAP.1 and not bind tapasin because of this. Thus, tapasin could form tetramers that associate with TAP.1, or dimers or monomers that independently associate with the TAP.1 and TAP.2 subunits. It seems clear, however, that each tapasin molecule in the complex can bind a single class I–β 2m dimer, and probably an associated calreticulin molecule (132). The multimeric interaction of tapasin class I–β 2m complexes with TAP may play a role in enhancing the probability that a single translocated peptide may bind to a TAP-associated class I molecule. TAP is much less selective than class I molecules in the peptides with which it will interact. If the reason for the tapasin-mediated association of class I molecules with TAP is to facilitate peptide loading by simple proximity, it has always seemed to provide a minimal advantage since the majority of peptides translocated by an individual TAP complex would not bind to the associated class I molecule. In an HLA heterozygous individual, having four molecules to choose from may at least increase the probability that a peptide will encounter a class I molecule to which it can bind. The precise role of tapasin in the MHC class I assembly process remains unclear. Class I–β 2m dimers are less stable in the ER of the TAP-negative cell line .174 than they are in the tapasin-negative cell line .220 (142). In neither case do they efficiently load with peptides, and these findings suggest that tapasin may have a specific chaperone-like function, protecting class I–β 2m dimers from degradation. Tapasin also increases the rate of peptide translocation by

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TAP when expressed in .220 cells as measured in in vitro transport assays with permeabilized cells (P Lehner, P Cresswell, unpublished results). Thus, it may serve to coordinate peptide translocation and MHC class I–TAP association in some fashion. Certain HLA class I alleles, particularly a subset of HLAB alleles, have been found to associate poorly with TAP (143). Sequence comparisons suggested that residues 116 and 156, which reside in the floor and α2-helical region of the binding groove, respectively, might play a role in the association. This could be consistent with a tapasin interaction with the binding groove. It is unclear at the moment whether lack of association between functional class I molecules and tapasin-TAP following detergent solubilization reflects a genuine lack of association in vivo. A mutant HLA-A2 molecule nonfunctional in terms of its antigen-presenting capacity also fails to interact with the TAP complex (144, 145). This mutant has an alteration at residue 134. Findings such as these again cast doubt on the possibility that β 2m binds to the TAP complex (123, 133), because β 2m does associate with the HLA-A2 mutant. It remains possible that proximity of “empty” class I molecules to the source of peptides, i.e., TAP, is not essential for peptide loading. ER chaperones, particularly the soluble molecule gp96 (also known as grp94), may serve as intermediates in the delivery of peptides to class I molecules (104, 146). Gp96, as well as Hsp70, purified from tumor cells or virally infected cells can induce tumor- or virus-specific CD8-positive CTL when injected into mice (see below, 104, 147). Macrophages have been suggested to be the cell type able to take up gp96 or Hsp70 complexed with specific peptides and to generate MHC class I complexes with these peptides (or “trimmed” versions of them), which can then elicit CD8 responses (148). The mechanism by which this occurs is unclear, although it does appear to be TAP-dependent, arguing for cytosolic delivery of the peptides (148). However, because gp96-peptide complexes can lead to the formation of class I–peptide complexes when presented exogenously, it has been suggested that they can perform the same function in the ER (147). Circumstantial evidence for this idea came from experiments showing that a peptide corresponding precisely to an octameric H-2Kb-restricted epitope derived from vesicular stomatitis virus (VSV) glycoprotein could be isolated from gp96 purified from VSV-infected cells (149). Photoactivatable peptides translocated by TAP have also been found to bind to gp96 (150). However, although the model is attractive, to date no convincing evidence has been presented showing that gp96, or any other ER chaperone, serves a genuine intermediary function in class I peptide loading in the ER.

The Fate of Unassembled MHC Class I Molecules When MHC class I heavy chains are expressed in β 2m-negative cells, they are degraded, and class I heavy chain-β 2m dimers in TAP-negative cells, or cells

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in which peptide generation or TAP transport is inhibited, suffer the same fate (151). This is the common outcome when single chains of heteromultimeric complexes or mutant proteins are introduced into the ER (152). Proteolysis in such situations has generally been called ER-associated degradation. Recent data suggest that such degradation is actually mediated in the cytosol by the proteasome. Evidence that ER-associated degradation of unassembled MHC class I molecules is mediated by the proteasome first came from studies of human cytomegalovirus (CMV). CMV possesses a number of genes that inhibit the surface expression of class I molecules. This is probably responsible for the ability of the virus to persist in vivo, avoiding an effective CD8 T cell response (153– 155). One gene (US3) encodes a protein that binds class I molecules and retains them in the ER (156, 157). A second (US6) encodes a transmembrane protein that inhibits peptide translocation by TAP (158–160). Two other genes (US2 and US11) independently induce the disappearance of newly synthesized class I molecules from the ER (161, 162). In the presence of proteasome inhibitors, such as lactacystin, the class I molecules accumulate in the cytosol. The cytosolic molecules are deglycosylated, and the evidence indicates that the asparagine acceptor for the N-linked glycan is converted into an aspartic acid (162). This is consistent with deglycosylation by an N-glycanase activity previously assigned to the cytosol of mammalian cells (163). In the presence of proteasome inhibitors, both US2 protein and deglycosylated class I molecules were found in association with the Sec61p translocation channel (161) and with the proteasome. These data led Wiertz, Ploegh and their coworkers to suggest that the route of access to the cytosol was the Sec61p complex (161, 162), the same pore used for the signal sequence dependent translocation of soluble and transmembrane proteins into the ER during synthesis on membrane-associated ribosomes (164). Compelling genetic data, generated using yeast Sec61 temperature-sensitive mutants and examining the degradation of soluble mutant proteins such as a deglycosylated pre-pro-α-factor, have provided very strong evidence that Sec61p is indeed the route of access to the cytosol for ER proteins destined for degradation (165). Following the lead provided by the CMV data, further experiments have shown that class I heavy chains in β 2m-negative and TAP-negative cell lines are also degraded by the proteasome following translocation into the cytosol (151, 161). Furthermore, in wild-type cell lines a variable fraction of class I heavy chains initially assemble with β 2m but ultimately are degraded in the cytosol (151, 161). This suggests that peptide may be the limiting component in MHC class I assembly. It may be important, should a cell become infected by a virus or other intracellular pathogens, to have excess class I molecules that can deal with new peptides derived from the pathogen proteins that enter the cytoplasmic pool.

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EFFICIENCY OF MHC CLASS I ANTIGEN PROCESSING How efficiently does the MHC class I antigen-processing pathway generate CTL epitopes from pathogen-derived antigens? Several studies have explored the efficiency of antigen processing. Studies of the influenza virus HA have shown that residues internal to the epitope are of primary importance for efficient presentation of epitopes (166). Since anchor residues are essential for MHC class I binding (167), it is not surprising that internal residues play a major role in the presentation of epitopes. Several other studies have shown that flanking amino acids influence antigen presentation. In one case, an epitope derived from murine CMV was placed in different regions of HBeAg, a heterologous protein (168). Epitopes placed near the N terminus of HBeAg were not processed, and this processing defect could be corrected by inserting penta-alanine flanking residues on either side of the epitope. In another study, influenza virus NP was poorly processed if flanked only by 12 amino acids on either side, but that processing was markedly enhanced if the epitope was surrounded by the whole NP (169). Shuffling epitopes that are processed with known efficiencies within an antigen revealed that the efficiency of epitope generation is unique for each epitope, and each site within an antigen (170). Taken together, these studies show that intra-epitope, flanking, and remote residues influence the efficiency of antigen processing. To determine how efficiently cells can generate CTL epitopes from antigen, it is necessary to quantify both the amount of antigen that is degraded within the cell and the number of epitopes that are produced by the cell. Determining the number of epitopes generated by infected cells can be accomplished by acid eluting, HPLC fractionating, and quantifying peptides from infected cells (171, 172). Determining the amount of antigen degraded within an infected cell is more difficult. This challenge, however, was approached with cells infected with the bacterium L. monocytogenes, which infects the cytosol of macrophages, where it secretes proteins that are processed into nonamer peptides that are bound by MHC class I molecules (172, 173). One of the major CTL antigens of L. monocytogenes is p60, a constitutively secreted murine hydrolase that mediates bacterial septation (174). By determining the rate of p60 secretion and degradation in the cytosol of infected cells, it was possible to determine the percentage of degraded p60 molecules that give rise to an MHC class I–bound peptide (170, 175). Surprisingly, approximately 3% of degraded p60 molecules gave rise to the nonamer peptide p60 217-225, while roughly 30% of degraded p60 gave rise to p60 449-457. Further studies with another secreted L. monocytogenes antigen, listeriolysin O (LLO), indicated that roughly 5% to 10% of degraded LLO molecules give rise to the CTL epitope LLO 91-99 (176). Thus, although the hurdles an epitope must surmount prior to association with MHC class I molecules are formidable, the overall

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efficiency of MHC class I processing, at least for three bacterially derived CTL epitopes, is remarkable. How can cells process antigens this efficiently? While this question remains unanswered, a recent study with J774 macrophage-like cells showed that MHC class I molecules retained in the ER with brefeldin A (BFA) have a prolonged capacity to bind newly generated peptides (177). This finding indicates that the availability of receptive MHC class I grooves is not limiting in infected macrophages, consistent with the data referred to above indicating that in normal human B cell lines a fraction of newly synthesized class I molecules may be degraded because peptide is limiting (151). The efficiency of the MHC class I antigen-processing pathway is likely to be of great importance in the CTL response to many pathogens that do not generate large amounts of antigen in their hosts. Indeed, the immunodominant CTL response in mice infected with L. monocytogenes is directed to an antigen that is virtually undetectable within infected cells (178).

CROSS-PRIMING AND ALTERNATIVE MHC CLASS I ANTIGEN-PROCESSING PATHWAYS Over twenty years ago Bevan observed priming of host MHC class I–restricted CTL for minor antigens following immunization with cells that lacked the cognate MHC class I molecules (179). This result, termed cross-priming, suggested that minor antigens could be transferred to host cells for presentation by host MHC class I molecules. Cross-priming was more difficult to understand when it became clear that MHC class I–restricted CTL were primed by peptides derived from endogenously synthesized proteins and not from exogenously administered antigens. The cross-priming paradox, therefore, led to the prediction that lymphoid tissues contain specialized cells that take up exogenous antigens and prime CTL (180). The first hint that cross-priming may involve a novel antigenprocessing pathway came from a study in which mice were immunized with soluble ovalbumin or with spleen cells that had been mixed with soluble ovalbumin prior to inoculation. As expected, immunization with soluble ovalbumin did not prime CTL, but surprisingly, immunization with spleen cell–associated ovalbumin did prime specific CTL (181). These initial findings were extended by Rock and colleagues when they discovered that macrophages, which do not present soluble ovalbumin, efficiently presented ovalbumin conjugated to particulate beads to MHC class I–restricted CTL (182). Furthermore, immunization of mice with ovalbumin conjugated to beads primed specific CTL (182). Subsequent studies with cloned, transformed macrophages and dendritic-like cells confirmed this finding (183, 184). Surprisingly, MHC class I–restricted presentation of particulate antigens was TAP-dependent and abrogated with proteasome inhibitors (185). This indicates that the particulate antigen and conventional MHC class I antigen-processing

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pathways overlap and that phagosomal antigen must gain access to the APC cytosol. Although it has been proposed that particles may rupture occasional phagosomes, liberating antigen into the cytosol (186), the precise mechanism for antigen translocation remains unknown. Micropinocytosis of high concentrations of antigen by macrophages results in translocation of antigen to the cytosol in a fraction of cells, suggesting that macrophages may have a distinct pathway for moving the contents from a range of vacuoles (phagosomes and micropinosomes) into the cytosol (187). A TAP- and proteasome-independent pathway for the presentation of particulate antigens has also been identified (188). Macrophages that were fed recombinant bacteria expressing a CTL epitope presented the epitope to MHC class I–restricted T cells. Furthermore, peptides generated from processed bacteria could be “regurgitated” and transferred to neighboring cells (188). Subsequent studies with antigen coupled to latex beads have confirmed the regurgitant pathway (189), which is not sensitive to proteasome inhibitors and appears to be TAP-independent (190), indicating that the pathway is distinct from the other alternative MHC class I antigen-processing pathway. Immunization with particle-associated antigen can prime CTL responses that eliminate tumors expressing the immunizing antigen (191). Immunization with certain tumors also elicits protective, tumor-specific CTL. It was surprising, however, to find that CTL were primed directly not by the tumor cells but rather by macrophages presenting tumor-derived antigens to naive T cells (192). This finding was extended by studying cross-priming in bone marrow–chimeric mice reconstituted with normal or TAP −/− bone marrow (193). In this system, all cross-priming was TAP dependent, suggesting that, in vivo, the tumor-associated antigen required cytosolic degradation and TAP transport for adequate presentation by APCs. Alternatively, the absence of TAP may decrease the number of peptide-receptive, surface MHC class I molecules on APCs, resulting in subthreshold levels of antigen presentation (190, 194). What occurs at the subcellular level during cross-priming? As described above, two concurrent studies demonstrated that in vivo immunization with peptides complexed with gp96 primed MHC class I–restricted CTL (148, 195). This led to the proposal that gp96 shuttles peptides into the cytosol of APCs. The mechanisms macrophages use to internalize and transport exogenous gp96 have not been identified.

ANTIGEN PRESENTATION BY MHC CLASS Ib MOLECULES AND CD1 MHC class Ib molecules are encoded in the major histocompatibility complex and are characterized by their structural similarity to MHC class Ia molecules, their association with β 2-microglobulin, and their relative lack of polymorphism

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(196). Thus, it is far more likely that different individuals will share identical MHC class Ib molecules (such as HLA-E, F, or G) than MHC class Ia molecules (such as HLA-A, B, or C). CD1 molecules, on the other hand, are not encoded in the MHC but share structural features with MHC class I molecules and also associate with β 2-microglobulin (197). In the following paragraphs we summarize recent studies of the antigens presented by these molecules and their mechanisms of processing.

Presentation by Murine MHC Class Ib Molecules One of the best understood murine MHC class Ib molecules is H2-M3. This molecule was identified because it presents mitochondrial peptides to CTL, specifically, peptides that contain N-formyl methionine at the N-terminus (198). The molecular basis for the binding of N-formyl peptides by H2-M3 was determined by X-ray crystallography of H2-M3 complexed with the peptide fMYFINILTL (199). This structure demonstrated that the H2-M3 B pocket accommodates the N-formylmethionine instead of the A pocket, as is usual for nonformylated peptides bound by MHC class Ia molecules. A consequence of this shift is that H2-M3 binds peptides that are shorter than those usually bound by MHC class Ia molecules, a characteristic of H2-M3 that had been noticed previously (200, 201). An interesting aspect of the selectivity of H2-M3 for peptides initiating with N-formyl methionine is that under normal circumstances endogenous, mitochondrial-derived peptides are insufficient to maximize surface expression of H2-M3 (201). This suggests that most H2-M3 molecules are available for association with foreign, most likely bacterial, peptides. While the ability of H2-M3 to present L. monocytogenes–derived peptides had been shown previously (200, 202), the identity of the bacterial peptides was only determined recently. The first peptide to be identified was fMIGWIIA, an L. monocytogenes–derived peptide that forms the amino terminus of the LemA protein (203). This protein contains multiple, putative transmembrane regions and is of unknown function. Another L. monocytogenes–derived peptide presented by H2-M3 is f-MIVIL, a pentapeptide that was identified and sequenced from bacterial cultures by tandem ion mass spectrometry (204). Both of these peptides can be generated by macrophages from heat-killed Listeria, even in the absence of TAP (203, 205). This suggests that the two Listeria epitopes, in contrast to mitochondrial peptides presented by H2-M3 (206), do not follow the conventional MHC class I antigen-processing pathway on their way to the cell surface. Another murine MHC class Ib molecule, Qa-1, presents a peptide derived from the signal sequence of the H2-Dk MHC class I molecule (207). Interestingly, although the peptide presented derives from the signal sequence, peptide association with Qa-1 is TAP dependent. This result is unexpected because

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binding of signal sequence–derived peptides by HLA-A2 is TAP independent (208). Remarkably, Qa-1 appears to bind a very limited array of peptides of which the leader-derived peptide is the predominant member (209). A human nonclassical class I molecule, HLA-E, has also recently been found to bind signal sequence–derived peptides (210). Although the restriction is less extreme, Qa-2, another murine MHC class Ib molecule, has also been described as binding a more limited range of peptides than do conventional MHC class Ia molecules (211).

Presentation by HL A-G MHC Class Ib Molecules HLA-G is a conserved MHC class Ib molecule expressed on placental cytotrophoblast cells (196) and also on γ -interferon–induced macrophages (212). Several recent studies have begun to characterize the peptides bound by HLA-G molecules. An interesting aspect of HLA-G expression is the finding that a soluble form of HLA-G is expressed naturally (213). Membrane-bound HLA-G associates detectably with TAP, whereas soluble HLA-G does not. However, the spectrum of peptides bound by both forms of HLA-G is similar (214). Mass spectrometric analysis and sequencing of peptides eluted from HLA-G revealed a motif of proline in the third position and leucine at the C-terminus (214), a finding that was confirmed by pool sequencing of HLA-G extracted peptides (215).

Antigen Presentation by CD1 Molecules Although mouse and human CD1 molecules share structural similarities with MHC molecules, they are encoded outside of the major histocompatibility complex (197). The potential importance of CD1 molecules in the defense against infection became apparent when it was found that human CD1b presents a mycobacterial antigen to T cells (216). More recent studies indicate that human CD1c can also present mycobacterial antigens to T cells (217). CD1b molecules present mycolic acid (218) and lipoarabinomannan (LAM) rather than peptides to T lymphocytes (219), a characteristic that distinguishes them from conventional MHC molecules. The antigen-processing mechanisms involved in glycolipid presentation by CD1 molecules certainly differ from the conventional MHC class I pathway, and the mechanisms appear to have more in common with the MHC–class II pathway. Like MHC class I molecules, murine CD1 requires β 2-microglobulin for transport to the cell surface. However, unlike most MHC class I molecules, CD1 transport appears to be TAP independent (220, 221). CD1 is targeted to the MIIC, the compartment associated with MHC class II antigen processing (222). Unlike MHC class II molecules, which are targeted to MIICs by their association with the invariant chain, targeting of CD1 is mediated by its cytoplasmic domain. A recent

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study demonstrated that the macrophage mannose receptor binds LAM on the cell surface and delivers it to late endosomes, where CD1 molecules intersect with and presumably bind LAM (223). Transport of LAM from early endosomal compartments to late endosomes or MIICs is inhibited by the proton pump antagonist concanamycin A, explaining the inhibition of CD1-mediated presentation of LAM to T cells by this agent (219, 223). Because the CD1 antigen-processing pathway only partially overlaps with the MHC class I and class II antigen pathways, and because antigens presented by CD1 are distinct from those presented by either MHC class I or class II molecules, it is becoming conventional to think of CD1-mediated antigen presentation as a novel third antigen-processing pathway (197). ACKNOWLEDGMENTS We wish to thank the many colleagues who supplied us with numerous preprints prior to publication, and we apologize to those whose work we failed almost certainly to cite because of the overwhelming amount of literature in this field. We would also like to thank Nancy Dometios for her painstaking efforts in preparing the manuscript. Work cited from our own laboratories was supported by NIH grant RO1-AI39031 (E.P.) and the Howard Hughes Medical Institute (P.C.). Visit the Annual Reviews home page at http://www.AnnualReviews.org.

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215. Diehl M, Munz C, Keilholz W, Stevanovic S, Holmes N, Loke YW, Rammensee HG. 1996. Nonclassical HLA-G molecules are classical peptide presenters. Curr. Biol. 6:305–14 216. Porcelli SA, Morita CT, Brenner MB. 1992. CD1b restricts the response of human CD4−8− T lymphocytes to a microbial antigen. Nature 360:593–97 217. Beckman EM, Melian A, Behar SM, Sieling PA, Chatterjee D, Furlong ST, Matsumoto R, Rosat JP, Modlin RL, Porcelli SA. 1996. CD1c restricts responses of mycobacteria-specific T cells. Evidence for antigen presentation by a second member of the CD1 family. J. Immunol. 157:2795–803 218. Beckman EM, Porcelli SA, Morita CT, Behar SM, Furlong ST, Brenner MB. 1994. Recognition of a lipid antigen by CD1-restricted alpha/beta T cells. Nature 372:691–94 219. Sieling PA, Chatterjee D, Porcelli SA, Prigozy TI, Mazzaccaro RJ, Soriano T, Bloom BR, Brenner MB, Kronenberg M, Brennan PJ, Modlin RL. 1995. CD1-

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restricted T cell recognition of microbial lipoglycan antigens. Science 269:227–30 Brutkiewicz RR, Bennink JR, Yewdell JW, Bendelac A. 1995. TAP-independent, beta 2-microglobulin-dependent surface expression of functional mouse CD1.1. J. Exp. Med. 182:1913–19 Teitell M, Holcombe HR, Brossay L, Hagenbaugh A, Jackson MJ, Pond L, Balk SP, Terhorst C, Peterson PA, Kronenberg M. 1997. Nonclassical behaviour of the mouse CD1 class I-like molecule. J. Immunol. 158:2143–49 Sugita M, Jackman RM, Donselaar Ev, Behar SM, Rogers RA, Peters PJ, Brenner MB, Porcelli SA. 1996. Cytoplasmic taildependent localization of CD1b antigenpresenting molecules to MIICs. Science 273:349–52 Prigozy TI, Sieling PA, Clemens D, Stewart PL, Behar DM, Porcelli SA, Brenner MB, Modlin RL, Kronenberg M. 1997. The mannose receptor delivers lipoglycan antigens to endosomes for presentation to T cells by CD1b molecules. Immunity 6:187–97

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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NK CELL RECEPTORS Lewis L. Lanier DNAX Research Institute of Molecular and Cellular Biology, 901 California Avenue, Palo Alto, California 94304; e-mail: [email protected] KEY WORDS:

NK cells, MHC class I, KIR, Ly49, tyrosine phosphatase

ABSTRACT NK cells are regulated by opposing signals from receptors that activate and inhibit effector function. While positive stimulation may be initiated by an array of costimulatory receptors, specificity is provided by inhibitory signals transduced by receptors for MHC class I. Three distinct receptor families, Ly49, CD94/NKG2, and KIR, are involved in NK cell recognition of polymorphic MHC class I molecules. A common pathway of inhibitory signaling is provided by ITIM sequences in the cytoplasmic domains of these otherwise structurally diverse receptors. Upon ligand binding and activation, the inhibitory NK cell receptors become tyrosine phosphorylated and recruit tyrosine phosphatases, SHP-1 and possibly SHP-2, resulting in inhibition of NK cell–mediated cytotoxicity and cytokine expression. Recent studies suggest these inhibitory NK cell receptors are members of a larger superfamily containing ITIM sequences, the inhibitory receptor superfamily (IRS).

INTRODUCTION NK cells are bone marrow–derived lymphocytes that share a common progenitor with T cells (reviewed in 1). Unlike T or B cells, NK cells develop normally in scid mice (2) or mice with disrupted RAG-1 or RAG-2 genes (3, 4), indicating that gene rearrangement is not required for their differentiation or function. NK cells are instrumental in innate immune responses, in particular providing for the early production of γ -interferon and possibly other cytokines necessary to control certain bacterial, parasitic, and viral infections (reviewed in 5, 6). The factors responsible for activation of NK cells during infection have remained elusive but likely involve soluble factors such as the α/β interferons, cytokines (e.g. TNFα, IL-12, IL-15, etc), and chemokines, as well as the presence of 359 0732-0582/98/0410-0359$08.00

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certain membrane-bound molecules on surrounding tissues. Although positive stimuli are required to activate NK cell migration, blastogenesis, and effector function (cytotoxicity and cytokine production), the process is tightly regulated by inhibitory receptors and cytokines that limit and potentially terminate the response.

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MEMBRANE RECEPTORS ACTIVATING NK CELL–MEDIATED CYTOTOXICITY CD16 (Fcγ RIII) The most extensively studied membrane receptor on NK cells is the lowaffinity receptor for IgG, CD16 (Fcγ RIII) (reviewed in 7). The transmembraneanchored CD16 isoform is an ≈70-kDa glycoprotein of the Ig superfamily (8, 9) expressed on the majority of, but not all, human and mouse NK cells (10, 11), as well as on activated monocytes (12, 13) and a subset of T cells (14). CD16 is noncovalently associated with the γ subunit of the high-affinity IgE receptor (FcRI-γ ) in mouse NK cells and with FcRI-γ or the ζ subunit of T cell antigen receptor (TcR) complex in human NK cells (8, 15–17). Upon ligation of CD16 receptors, activated src-family tyrosine kinases (e.g. lck) (18) bind to and phosphorylate tyrosine residues contained within the immunoreceptor tyrosine– based activation motifs (ITAM) in the cytoplasmic domains of FcRI-γ (19) and ζ (20, 21). Subsequently, there is recruitment and phosphorylation of ZAP70 (22), activation of phospholipase Cγ 1 and Cγ 2 (23–25), stimulation of phosphatidylinositol 3-kinase (26, 27) and MAP kinase (28), p21 ras activation (29), and translocation of NFATp and NFATc (30). Upon CD16-mediated activation, NK cells secrete cytokines (31, 32), mediate antibody-dependent cellular cytotoxicity (33), and may undergo apoptosis (34, 35) as a consequence of Fas ligand–induced cell death (36). The signal transduction pathways and the effector functions induced by activation of CD16 on NK cells are remarkably similar to the events triggered by engagement of the TcR on T lymphocytes (reviewed in 37). While CD16 is responsible and necessary for ADCC, this receptor has not been implicated in other modes of NK cell–mediated cytotoxicity.

CD2 CD2 is an ≈50-kDa membrane glycoprotein of the Ig superfamily (38) expressed on T and NK cells. Monoclonal antibodies (mAb) against particular epitopes on CD2 activate NK cell–mediated cytotoxicity (39–41). The biochemical events accompanying CD2 activation are similar to those initiated by CD16 ligation. In particular, CD2 stimulation of NK cells results in the activation of src-family kinases (42) and the generation of inositol trisphosphates (40). Moreover, there is evidence that CD2 activation of NK cells involves

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phosphorylation of ζ (43, 44). The predominant ligand of human CD2 is another membrane glycoprotein, CD58 (LFA-3) (45). Transfection of CD58 into murine cell lines augments the lysis of these target cells by some, but not all, human CD2+ NK cell clones (46). However, expression of CD58 alone is insufficient to confer cells sensitive to NK cell–mediated lysis (46), suggesting that CD2 may serve as a costimulatory receptor that augments, but does not initiate, the primary activation of NK cells. Consistent with this interpretation, NK cell development and function is normal in mice with disrupted CD2 genes (47; J Ryan, personal communication).

NKR-P1 The rat NKR-P1 cDNA (48) was cloned by using a mAb selected for its ability to activate rat NK cells (49). The prototype mouse NK cell antigen, NK1.1 (50), is encoded by a murine homology of the rat NKR-P1 gene (51). Three highly related genes, NKR-P1A, NKR-P1B, and NKR-P1C, have been identified in mice and rats (48, 51–55). So far, only a single human NKR-P1 homolog has been found (56). The NKR-P1 antigens are type II membrane glycoproteins of the C-type lectin superfamily (57) that are expressed as disulfide-bonded dimers on the surface of most NK cells and a subset of T cells (48, 49, 51, 55, 56, 58–60). The NKR-P1 genes are on mouse chromosome 6 (61), human chromosome 12p12-p13 (56, 62), and rat chromosome 4 (63) in a region designated the “NK gene complex” (55). mAbs against mouse and rat NKR-P1 stimulate phosphoinositide turnover (64) and arachidonic acid generation (65), induce a rise in intracellular Ca++ levels (64), and trigger NK cell–mediated cytotoxicity and cytokine production (49, 66, 67). The functional consequences of treating human NK cells with anti-NKR-P1 mAb are more complex, resulting in no effect, activation, or inhibition, depending on the NK cell population studied (56, 68). These diverse responses elicited by anti-NKR-P1 mAb suggest that additional, functionally distinct, isoforms of NKR-P1 may exist in humans. In this regard, it is interesting to note the structural diversity of the cytoplasmic domains of the different NKR-P1 genes in rodents (Figure 1). All rodent NKRP1 proteins express the C × CP motif, also found in the cytoplasmic domains of CD4 and CD8, that interacts with phosphorylated p56lck (69). Campbell & Giorda (70) have demonstrated a direct association between rat NKR-P1 and p56lck. Interestingly, human NKR-P1A lacks this motif. Another remarkable feature is the presence of an immunoreceptor tyrosine-based inhibition motif (ITIM) (71) in the cytoplasmic domain of rat and mouse NKR-P1B, but not in other NKR-P1 isoforms. The existence of NKR-P1 receptors containing ITIM suggests that certain isoforms of this family may inhibit rather than activate NK cell–effector function.

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Figure 1 Alignment of the amino acid sequences in the cytoplasmic domain of the rat, mouse, and human NKR-P1 proteins. ITIM sequences (I/VxYxxL/V) are underlined and the C × CP motifs implicated in lck binding are bold. Sequences were obtained from GenBank. Two different sequences have been designated as rat “NKR-P1B.” The sequence labeled NKR-P1B is GenBank U56936, and the sequence labeled NKR-P1B∗ is GenBank X97477.

Although the biological function of NKR-P1 is presently unknown, clues come from the studies of Ryan et al (72), who have shown that loss of NKRP1 expression by the rat RNK-16 NK leukemia cell line correlates with the inability to kill certain mouse tumor cell targets. Transfection of the RNK-16 loss mutant with NKR-P1 cDNA restores cytotoxicity against these targets. In addition, anti-NKR-P1 mAb can inhibit the killing of parental lymphoblasts by NK cells from (C57BL/6 × Balb/C)F1 mice, suggesting a role for NKR-P1 in target cell recognition (73). However, it should be appreciated that certain mouse strains (e.g. Balb/c and others) that possess normal NK cells apparently do not transcribe any of the known NKR-P1 genes (54), indicating that NKRP1 is not essential for NK cell development or function. While recombinant NKR-P1 proteins bind certain synthetic carbohydrates (74, 75), physiological ligands of NKR-P1 have not as yet been identified.

CD28 The CD28 receptor/B7 ligand system is the dominant costimulatory pathway affecting T cell immune responses. The CD28 glycoprotein is a disulfide-linked homodimer that binds to the CD80 (B7.1) and CD86 (B7.2) ligands, resulting in T cell activation, cytokine production and proliferation (reviewed in 76). Although CD28 is expressed on human fetal NK cells (77), it is lost upon maturation and is absent on peripheral blood NK cells in adults. YT, an immature NK cell line established from a child with an acute lymphoblastic lymphoma, expresses CD28 and kills target cells expressing either CD80 or CD86 (78, 79), indicating that CD28 may serve as a signaling receptor in NK cells. Murine splenic NK cells express CD28, and ligation of CD28 with mAb or B7 ligands

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augments NK cell proliferation (80), production of γ -interferon (81), and tumor cell lysis (82–84). Treatment of scid mice infected with Toxoplasma gondii with CTLA4-Ig (to block interactions between CD28 and B7) resulted in an increase in parasite burden, suggesting that CD28+ NK cells are important in the control of this infection (81). Chambers et al (85) have recently observed that NK cells from mice with disrupted CD28 genes can still recognize and kill target cells expressing CD80, thus predicting the existence of other receptors for CD80 that can activate NK cell effector function.

Other Membrane Receptors Activating NK Cell–Mediated Cytotoxicity Several other membrane receptors have been implicated in NK cell activation based on the ability of mAb against these molecules to permit lysis of Fc receptor–bearing target cells (mAb redirected cytotoxicity assay). Structures implicated by this criteria include: murine Ly6 (66), mouse and human CD69 (66, 86), mouse 2B4 (87), human DNAM-1 (88), and human CD44 (89–91). Additionally, a recent report indicates that activated NK cells express CD40 ligand and demonstrate augmented lysis of target cells bearing CD40 (92).

NK CELL RECEPTORS INVOLVED IN MHC–CLASS I RECOGNITION Based on the ability of NK cells to kill preferentially mouse tumor cells that lacked expression of MHC class I molecules (93, 94), Karre & Ljunggren (95, 96) proposed the existence of a mechanism of immune surveillance to eliminate cells with aberrant MHC expression. Subsequently, human NK cell recognition of MHC class I was demonstrated by the observation that human NK cells lysed MHC class I–deficient EBV-transformed B lymphoblastoid cell lines, but NK cells were unable to kill these targets after transfection with certain HLA-B and HLA-C genes (97, 98). A molecular basis for this activity was provided by the identification and cloning of membrane receptors on NK cells that bind MHC class I molecules on potential target cells and inhibit NK cell–mediated cytotoxicity (99–102). Thus, NK-cell function appears to be regulated by a balance between positive-signaling receptors that initiate, and inhibitory receptors that suppress, cell activation.

C-Type Lectin Superfamily Receptors—“The NK Complex” The Ly49 family of NK cell receptors are responsible for the recognition of polymorphic H-2 class-I molecules on potential target cells and the subsequent inhibition of NK cell–mediated cytotoxicity (99, 103, 104). The Ly49 family is composed of at least nine highly related genes (Ly49A-Ly49I) (55, 61,

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Figure 2 Diagrammatic representation of the mouse and human NK gene complex. The relative location of mouse CD94 and mouse NKG2D is not yet determined.

103–110) present on mouse chromosome 6 in the “NK gene complex” (Figure 2). Ly49 homologs have been identified on rat chromosome 4 in the “NK gene complex” (63). The Ly49 genes are members of the C-type lectin superfamily (57, 111) and encode type II membrane glycoproteins that are expressed as disulfide-linked homodimers (103, 104, 107, 109). As yet, disulfide-linked heterodimers between different Ly49 glycoproteins have not been observed (112), but the possibility should not be excluded. Diversity within the Ly49 gene family is provided by alternative mRNA splicing and allelic polymorphism (106, 107, 109, 110, 113–115). Different Ly49 genes are expressed in overlapping subsets within the total NK cell population, providing for a diverse repertoire of Ly49 receptors (103, 106, 116). Each allele at a Ly49 loci may be expressed independently, by an as-yet-unknown process (117). The Ly49 genes differ both in their extracellular and cytoplasmic domains, implying diversity in ligand binding and signal transduction functions, respectively. As yet, human homologs of the Ly49 genes have not been identified. However, the CD94/NKG2 receptors expressed on human NK cells and a subset of T cells (118–120) are members of the C-type lectin superfamily (121– 123) and have been implicated in the recognition of polymorphic HLA class I molecules (121–126). Unlike the Ly49 molecules, the CD94/NKG2 receptors are disulfide-bonded heterodimers, composed of an invariant common subunit, CD94, that is linked to a distinct glycoprotein encoded by a gene of the NKG2 family (121–123). Whereas CD94 is a single gene with limited or no allelic polymorphism (127), the NKG2 family comprises four genes, designated

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NKG2A, NKG2C, NKG2E, and NKG2D/F (128–132). CD94 and the four NKG2 genes are all closely linked on human chromosome 12p12.3-p13.1 in the human “NK gene complex” (62, 127, 128, 131, 132) (Figure 2). The extracellular and cytoplasmic domains of the NKG2A, NKG2C, and NKG2E molecules are structurally diverse, suggesting differences in ligand recognition and signal transduction (128–132). CD94 essentially lacks a cytoplasmic domain, thus lacking intrinsic signal transduction capacity (127). NKG2D/F is an unusual gene, demonstrating homology with the other NKG2 genes only in the 50 region (128–130, 132). While we have been able to force the expression of NKG2A/B glycoproteins on the cell surface by transfection using strong promoters (LL Lanier, unpublished observation), it appears that the NKG2 glycoproteins are usually unable to be expressed on the cell membrane unless they are disulfide-bonded to a CD94 glycoprotein (121–123). Thus, CD94 may primarily function as a chaperone to permit transport of the NKG2 receptors to the cell surface. There is evidence that the NKG2A, NKG2B (produced as a splice variant of the NKG2A gene), NKG2C, and NKG2E glycoproteins can associate with CD94 (121). In addition to forming disulfide-bonded heterodimers with NKG2 subunits, CD94 glycoproteins are readily expressed on the cell surface as disulfide-bonded homodimers, at least on transfected cell lines (121, 125, 127). Due to the lack of appropriate serological reagents, it has not been possible to discriminate whether NK cells express CD94 homodimers as well as CD94/NKG2 heterodimers on the cell surface. Biochemical studies have demonstrated that the ≈70-kDa CD94/NKG2A heterodimer is composed of an ≈30-kDa CD94 glycoprotein disulfide-bonded to an ≈43-kDa NKG2A glycoprotein (121–123, 125). The ≈43-kDa NKG2A glycoprotein is efficiently labeled by 125I, whereas the CD94 glycoprotein does not label with 125I, presumably due to a lack of accessible tyrosine residues (121). Consequently, CD94 was originally named “Kp43” because of the apparent molecular weight of the glycoprotein visualized on SDS-PAGE gels that were immunoprecipitated from 125I-labeled NK cells with an anti-CD94 mAb (118, 119). In fact, CD94 was not visible, and the protein detected was an 125I-labeled NKG2 protein (previously referred to as a CD94-associated protein (125)) that was disulfide-bonded to CD94 and thus immunoprecipitated with the anti-CD94 mAb (121, 125). Because human CD94/NKG2 and mouse Ly49 both are involved in MHC class-I recognition and both are C-type lectins encoded by genes in the “NK gene complex,” it was initially thought that CD94/NKG2 may be the human homolog of the mouse Ly49 receptor system. However, this now seems quite unlikely. Dissen et al have cloned the rat homolog of human CD94 (133) and a rat homolog of human NKG2D (designated NKR-P2) (63). These genes are preferentially expressed on NK cells and are present on rat chromosome 4 in

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the “NK gene complex.” Moreover, murine homologs of the human CD94 and NKG2 genes have recently been identified (LL Lanier et al, unpublished observation).

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Ig Superfamily Receptors—The KIRs In humans, the killer cell–inhibitory cell receptor (KIR) genes encode glycoproteins of the Ig superfamily (100–102) that bind HLA class-I ligands and inhibit NK cell–mediated cytotoxicity (134). The KIR genes are located on human chromosome 19q13.4 (135–138). The precise number of KIR loci is unknown but is estimated to be about 12 genes based on analysis of the existing cDNA sequences. Two subfamilies of KIR can be identified based on the number of Ig-like domains in the extracellular regions of the molecules. The KIR3D subfamily contains three Ig-like domains, whereas the KIR2D structures contain two Ig-like domains (Figure 3). In general, the two Ig-like domains of the KIR2D family are most similar to Ig-domains two and three of the KIR3D molecules (where Ig-domain 1 is the most amino terminal in the KIR3D proteins) (100–102, 134). However, the KIR2D protein designated KIR103 contains two Ig-domains that most resemble Ig-domain 1 of the KIR3D subfamily and Ig-domain three of the KIR2D group (139). Within both the KIR2D and KIR3D subfamilies, there is diversity throughout the extracellular, transmembrane, and intracellular domains. A remarkable feature of both KIR2D and KIR3D is the heterogeneity in the length of the cytoplasmic

Figure 3 Inhibitory NK cell receptors for MHC class I. All family members (except CD94) contain ITIM (I/VxYxxL/V) sequences in the cytoplasmic domain. KIR are members of the Ig-superfamily and contain either two or three Ig-domains in the extracellular region. CD94, NKG2, and Ly49 are members of the C-type lectin superfamily and possess carbohydrate recognition domains in the extracellular region.

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domains. KIR with long cytoplasmic domains (i.e. KIR2DL, also called p58 and KIR3DL, also called p70) contain two ITIM sequences that are responsible for the inhibitory function of these molecules (140–146). KIR containing short cytoplasmic domains (KIR2DS, also called p50 and KIR3DS) lack ITIM sequences, but all possess a charged amino acid in the transmembrane domain that is not present in the KIR2DL and KIR3DL molecules (100, 147). The KIR2DS and KIR3DS molecules potentially activate, rather than inhibit, NK cell function (147–151). KIR are expressed on the cell surface as monomeric glycoproteins, with the exception of the KIR3DL-NKAT4 glycoprotein that may potentially be expressed as either a monomer or a disulfide-linked homodimer (152, 153). Diversity within the KIR family is also increased by alternative mRNA splicing and allelic polymorphism (102, 137, 138, 154, 155). While KIR gene homologs have been identified in primates (156), rat or mouse KIR homologs that recognize H-2 have not as yet been found. Like Ly49, the KIR genes are expressed on overlapping subsets of human NK cells and a subset of T cells (151–153, 157–164).

MHC Class I Specificity of NK Receptors The murine Ly49, human CD94/NKG2A, and human KIR molecules have all been implicated in NK cell recognition of polymorphic MHC class I ligands. Mapping studies have indicated that the Ly49A receptor interacts with a site on the α1 and/or α2 domain of the MHC class I heavy chain (99, 165) and requires the association of β2-microglobulin (165). The composition of the peptides present in the H-2Dd peptide-binding groove does not appear to substantially affect recognition by Ly49A (165, 166). The H-2 specificity of several Ly49 receptors has been identified by using cell binding or functional assays. The Ly49A receptor has been implicated in the recognition of H-2Dd and H-2Dk (99, 167, 168), Ly49G2 recognizes H-2Dd and H-2Ld (103), and Ly49C may recognize several ligands, including H-2b, H-2k, H-2b, and H-2s (104, 106, 112, 116, 169). Carbohydrates on H-2 may influence the affinity or avidity of the interactions with the Ly49 receptors but are unlikely to substantially affect the specificity of these receptors (170, 171). Ligand recognition appears to involve both the carbohydrate recognition domain (CRD) and the stalk region in the extracellular domain of Ly49 (112). The HLA class I specificity of the KIR molecules has been inferred from studies with neutralizing mAbs (152, 153, 158–160, 172, 173), demonstrated by physical binding experiments (134, 153, 174–178), and confirmed by direct genetic transfer (134, 179). The KIR2D molecules predominantly recognize HLA-C ligands. All of the HLA-C alleles may be distinguished either by possessing an N at amino acid 77 and K at amino acid 80 (N77, K80) in the α1 domain or by S at residue 77 and N at residue 80 (S77, N80). This polymorphism

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Figure 4 Human NK Cell receptors for MHC class I–ligand specificity. HP-3E4, EB6, GL183, DX9, DX27, and DX31 are mAb that react with KIR isoforms of the indicated HLA specificity. NKAT4 is a KIR3DL cDNA.

is recognized by NK cells (180, 181) using different members of the KIR2D family. The KIR2D molecules (designated CD158a), detected by mAb HP3E4 (160, 182) or EB6 (157, 158), recognize the HLA-C molecules with N77 and K80, whereas KIR2D (designated CD158b) reactive with mAb GL183 (157, 158) or DX27 (46) recognize HLA-C with S77, N80 (Figure 4). A single amino acid at position 44 in the first Ig domain of the KIR2DL molecules determines the HLA-C specificity of these receptors for HLA-Cw∗ 0401 (N77, K80) and HLA-Cw∗ 0304 (S77, N80) (183). Although controversy remains about the relative contribution of HLA-C residues 77 and 80 to KIR2D recognition (184, 185), it appears that residues 76, 73, and 90 in the α1 domain of the HLA-C heavy chain contribute to the HLA-C specificity of the KIR2D molecules (186). Carbohydrates on the KIR2D or the HLA-C proteins are not required for receptor/ligand binding (174). KIR2D are not strictly specific for HLA-C, because KIR2D receptors reactive with the HP-3E4 or EB6 mAb can also recognize HLA-B∗ 4601, an HLA-B gene that represents an interlocus recombinant inserting residues 66–76 of HLA-Cw∗ 0102 into the HLA-B∗ 1501 gene (187). Pazmany et al (188) reported that the KIR2D recognized by mAb HP-3E4 or GL183 are responsible for recognition of HLA-G; however, extensive studies by other laboratories have failed to support this conclusion (189–191). NK cells also possess receptors that recognize the serologically defined HLA-Bw4 allotype (172, 173, 192). Functional and direct binding assays have

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established that the KIR3DL molecules identified by the DX9 mAb react with HLA-B allotypes possessing the Bw4 motif at residues 77–83 in the α1 domain of the HLA-B heavy chain (159, 172, 176, 193) (Figure 4). There is evidence that NK cells might be able to discriminate between certain Bw4 alleles based on the presence of I or T at residue 80 (192, 194); however, this has not been observed in other studies (173). These discrepant results may be due to the particular KIR3DL isoforms expressed by the NK cell clones evaluated. Similarly, we have seen variable effects of the DX9 mAb on KIR3DL+ NK cell clones that recognize HLA-A allotypes containing the Bw4 epitope (172, 173; JP Phillips, LL Lanier, unpublished observations). As with HLA-C, there is no requirement for carbohydrates on the HLA-Bw4 proteins for functional recognition by the KIR3DL molecules (172). It has been proposed that KIR3DL molecules encoded by the NKAT4 and related cDNAs recognize HLA-A3 (152, 153); however, using a mAb specific for the KIR3DL-NKAT4 glycoprotein, we have been unable to confirm these observations (JH Phillips, LL Lanier, unpublished observation). In general, the KIR family of molecules appears to be biased toward recognition of HLA-C and HLA-Bw4 allotypes. Many HLA-A and HLA-Bw6 allotypes apparently do not have a corresponding KIR (JH Philips, LL Lanier, unpublished observations), indicating that the KIR repertoire is not all-inclusive for human class I allotypes. Recognition of polymorphic HLA-B and HLA-C by the KIR3D and KIR2D molecules, respectively, may be influenced by the composition of the peptides bound in the groove of the MHC class I complex (178, 179, 195–198). In particular, the amino acids at position 7 or 8 in the peptide may disrupt interactions between the MHC class I complex and the KIR, potentially rendering the target cell susceptible to NK cell–mediated cytotoxicity (196, 197). While it has been convincingly demonstrated that the peptide can affect KIR recognition, the biological significance of this is uncertain. First, there is no inherent difference at position 7 or 8 between peptides derived from normal, self-proteins versus peptides derived from viruses or other foreign proteins. In addition, KIR2D and KIR3D cross-react with many different HLA-C and HLA-B allotypes, respectively, that are known to present different arrays of bound peptides. Finally, disruption of KIR binding to an MHC class I ligand because of the presence of a nonpermissive peptide in the cleft would require this nonpermissive peptide to represent the majority of all peptides in the available pool. Collectively, these argue that the major role of peptide in KIR recognition may be simply to stabilize the MHC class I molecule. Regarding the human C-type lectin receptors, whereas antibodies against either CD94 or the CD94/NKG2A heterodimer have been shown to interfere with NK cell recognition of HLA class I molecules on potential target cells (124– 126), there are as yet no direct experiments to demonstrate physical binding of CD94/NKG2 glycoproteins to HLA class I molecules. However, results from

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cytotoxicity assays using anti-CD94 or anti-CD94/NKG2A antibodies implicate this receptor in the recognition of several HLA-A, -B, -C, and -G ligands (121, 125, 126, 189–191) (Figure 4). CD94/NKG2A receptors can recognize certain HLA-C allotypes, independent of the amino acid residues at positions 77 and 80 that affect KIR2D specificity (125). Furthermore, CD94/NKG2A receptors are unable to discriminate between Bw4 and Bw6 allotypes (125). Thus, the CD94/NKG2A receptor is rather promiscuous in ligand binding. CD94/NKG2A receptors can functionally recognize HLA-B and HLA-C mutant molecules that lack sites for N-glycosylation; however, preliminary studies suggest that the carbohydrate may influence the affinity of these interactions (A D’Andrea, LL Lanier, unpublished observations). We have been unable to demonstrate direct binding of recombinant CD94, NKG2A, or CD94/NKG2A to HLA-A, -B, or -C class I molecules; therefore, the relative contribution of the subunits to HLA class I recognition is unknown (LL Lanier, unpublished observation). Finally, it should be appreciated that the CD94/NKG2A receptors apparently recognize several HLA-C allotypes that are also ligands for the KIR2D molecules (125). In situations where an NK cell expresses both a KIR2D and CD94/NKG2A receptor for HLA-C, the receptors function independently and it is necessary to inactivate both inhibitory receptors to permit target cell lysis (125).

Mechanism of Inhibition Despite the structural differences between the human KIR, human CD94/NKG2A, and mouse Ly49 receptors, all of these inhibitory receptors appear to use a common strategy to inhibit NK and T cell activation. The unifying characteristic is the presence of ITIM sequences in the cytoplasmic domain of these receptors that upon tyrosine phosphorylation are able to recruit SHP-1, and possibly SHP-2, to mediate the inhibitory function (140–146, 149, 199–202). The precise sequence of biochemical events that results in the negative signal is as yet only partially defined, and the mechanism may depend on the particular positive signaling receptor that is being affected. KIR, Ly49, and CD94/NKG2A receptors regulate not only cytotoxicity but can also inhibit cytokine production by T and NK cells (203–206). NK cell stimulation induced by exposure to NK-sensitive target cells or by ADCC via CD16 results in the immediate activation of tyrosine kinases, PLC-γ induced generation of phosphoinositides, and increases in intracellular Ca++ levels (207). If KIR are engaged either by their natural class I ligands on the potential target cells or by agonistic anti-KIR mAb, the tyrosine residues in the ITIM (I/VxYxxL/V) are phosphorylated, possibly by src family kinases, and SHP-1 is recruited to the receptor complex (reviewed in 207, 208). In NK cell– mediated cytotoxicity against EBV-transformed B lymphoblastoid cell lines,

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Valiante et al (146) have shown that recognition of an appropriate HLA allotype on the target cells prevents the generation of inositol 1,4,5-trisphosphate and intracellular Ca++ elevations. However, KIR ligation did not affect phosphorylation of PLC-γ 1 or PLC-γ 2 but apparently inhibited activation by preventing the association of an adapter protein, pp36, with PLC-γ or Grb2. In this experimental system, pp36 might be the critical substrate for activated SHP-1 that is recruited by the phosphorylated ITIM in the KIR cytoplasmic domain. By contrast, when NK cells are stimulated via CD16 to trigger ADCC, activation of KIR or the CD94/NKG2A receptor inhibits phosphorylation of PLC-γ , ζ chain, and the protein tyrosine kinase ZAP70 (142, 209). Nonetheless, the critical event in all of these pathways is the recruitment and enzymatic activity of the tyrosine phosphatase, SHP-1. NK cells transfected with a dominantnegative (enzymatically inactive) SHP-1 mutant are unable to transmit negative signals via KIR (140, 142). Similarly, SHP-1 mutant motheaten mice demonstrate defects in Ly49A receptor signaling, although inhibitory function is not completely absent, suggesting a potential role for other phosphatases, possibly SHP-2 (201). SHIP, a polyphosphate inositol 5-phosphatase implicated in the inhibitory function of Fcγ RIIB (210), does not appear to participate in KIR-induced negative signaling (199, 202). When the KIR, CD94/NKG2, or Ly49 receptors interact with relevant class I ligands on potential target cells, the inhibitory signals are delivered in a directional and transient manner. There is no evidence that engagement of an NK cell–inhibitory receptor leads to deletion of the cell or long-lived anergy. Because NK cells are constantly surrounded by normal tissues expressing abundant levels of self-MHC class I (and the NK cells themselves express class I), deletion or anergy induction by these inhibitory receptors would not be beneficial. In experiments where KIR3DL-NKB1+NK cell clones were exposed to unlabeled 721.221 B lymphoblastoid cells transfected with an HLA-Bw4 gene (an KIR3DL-NKB1 ligand) before the addition of 51Cr labeled HLA class I– negative 721.221 targets, killing of the class I–deficient targets was not affected by prior exposure to the same cell line bearing the protective HLA-Bw4 ligand (A D’Andrea, LL Lanier, unpublished observations). In another model system using RBL-2H3 rat mast cells transfected with human KIR molecules, Bl´ery et al (149) showed that signaling by the high-affinity IgE Fc receptor on the RBL2H3 cells is only prevented when the KIR and IgE Fc receptors are coligated on the same cell and in near proximity. The requirement for simultaneous coligation of both an activating and inhibitory receptor in a proximal location explains the ability of NK cells to discriminate between class I positive and class I negative target cells in the same tissue and provides for directional cytolytic function. Finally, the inhibitory activity of the KIR, CD94/NKG2A, and Ly49 receptors is not absolute. Rather, the final outcome results from a balance between

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the activating and inhibitory receptors and is influenced by both qualitative and quantitative aspects. Recently, in an experimental model using agonist mAbs against several activating NK cell receptors (e.g. CD2, CD16, CD69, and DNAM-1) and agonist mAbs against human KIR, we demonstrated that the negative signals transduced via KIR can be overcome, provided that several positive receptors are simultaneously engaged (46). Other studies have shown that expression of HLA-Bw4 on exquisitely NK-sensitive targets (e.g. K562 and Jurkat) failed to provide protection against NK cell–mediated cytotoxicity (211). Certain signal transduction pathways initiating NK cell–mediated cytotoxicity may not be regulated by SHP-1 (and thus may be immune to the inhibitory function of the KIR and Ly49 receptors). Alternatively, these very NK-sensitive targets may simply provide strong positive signals that overcome the action of the inhibitory receptors.

Noninhibitory NK Cell Receptors for MHC Class I The existence of NK cell receptors for MHC that activate, rather than inhibit, cytotoxicity was predicted by the observation that rat NK cells kill MHCmismatched hematopoietic cells by a process that is inherited as a genetically dominant characteristic (212–214, reviewed in 215). Similarly, NK cells in B6 (H-2b) mice reject bone marrow grafts from B6 mice expressing an H-2Dd transgene, consistent with an activating NK cell receptor against H-2Dd (216). While the precise receptors responsible for alloantigen recognition in these mouse and rat models have not been identified, recent evidence demonstrates that mouse Ly49D, an isoform lacking ITIM, can activate NK cell–mediated cytotoxicity when the receptor is ligated by anti-Ly49D mAb (217) (Figure 5). Mouse Ly49H (116) and two isoforms of rat Ly49 (63) also lack ITIM in the cytoplasmic domain and may transmit positive signals. In humans, the NKG2C and NKG2E receptors lack ITIM (130) (Figure 5). A chimeric receptor expressing the cytoplasmic domain of NKG2C linked with the extracellular domain of mouse NKR-P1C was able to activate cytolytic activity in rat NK cells transfected with this molecule, when the receptor was cross-linked with an antibody against mouse NK1.1 (200). With certain human NK cell clones, anti-CD94 mAb has been shown to induce activation of protein tyrosine kinase activity, PLC-γ , and generate inositol phosphates as well as initiate cell-mediated cytotoxicity. Presumably these clones express either a CD94/NKG2C or CD94/NKG2E receptor complex (203, 209), although the presence of NKG2C or NKG2E was not directly demonstrated. While it is likely that NKG2C and NKG2E may function as MHC class I receptors, this has not as yet been proven. By contrast, it has been suggested that NKG2C is the receptor for an uncharacterized ligand on the MHC class I negative cell line K562 (218); however, this has not as yet been verified.

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Figure 5 Noninhibitory NK cell receptors of the Ly49, CD94/NKG2, and KIR families. Note the lack of ITIM in the cytoplasmic domains and the presence of charged amino acids in the transmembrane domains of Ly49D, Ly49H, KIR2DS, KIR3DS, NKG2C, E and CD94.

As mentioned previously, certain members of the KIR2D and KIR3D families lack ITIM and have been proposed as activating NK-cell receptors for MHC class I (147, 148, 151) (Figure 5). In certain NK cell clones, antiKIR mAbs flux Ca++ levels and induce cell-mediated cytotoxicity against Fc-receptor bearing targets, consistent with activation rather than inhibitory signaling (147, 148, 151). In addition, KIR2DS have been detected in some T cell clones and shown to augment TcR-dependent proliferation induced by suboptimal concentrations of bacterial superantigens (219). Activation correlates with the presence of KIR2DS transcripts in these NK and T cell clones (147, 151, 219). Analysis of the cytoplasmic domains of these KIR2DS isoforms does not reveal any sequence motifs implicated in positive signal transduction. In addition, KIR2DS molecules expressed by transfection into the rat RBL-2H3 mast cells are unable to activate these cells when the transfected receptors are cross-linked with anti-KIR mAbs (149). Human Jurkat cells transfected with a KIR2DS were also unable to activate a Ca++ flux or augment superantigen-induced cytokine production, either when the KIR2DS was cross-linked with anti-KIR mAb or when superantigen was presented by an antigen-presenting cell expressing a putative HLA class I ligand of the KIR2DS (C Leong, LL Lanier, unpublished observation). However, the inability of KIR2DS to function in these transfected cells may be explained by the recent observation that KIR2DS proteins noncovalently associate with a novel 12-kDa dimer in NK cells (150). Thus, the KIR2DS molecules apparently lack intrinsic

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signaling capability and likely require an associated protein to function, similar to the requirement of ζ or FcRI-γ in CD16 or TcR signal transduction. The charged amino acids in the transmembrane of the KIR2DS and KIR3DS molecules (as well as in CD94, NKG2C, NKG2E, Ly49D, and Ly49H) are likely interaction sites for association with p12. A 12-kDa dimer has also been identified in the mouse pre-TcR cell receptor complex (220), making it a likely candidate for association with these NK cell receptors. The biological purpose of activating MHC class I receptors on NK cells is an enigma. Presently, it is unknown whether these potentially activating isoforms of the Ly49, KIR, and NKG2 families are expressed in individuals bearing relevant self-ligands, or if they are biased toward recognition of alloantigens. Likewise, does an individual NK cell clone express both activating and inhibitory receptors specific for the same MHC class I molecule or different class I ligands? The answers to these questions are essential in order to develop a testable hypothesis and model. If the activating receptor binds to the same MHC class I molecule as the inhibiting receptor in a given clone, the activating receptor may function to recruit the tyrosine kinases required to phosphorylate the ITIM in the inhibitory receptor. Alternatively, if the activating and inhibitory receptors see different self–class I molecules, the preferential loss of the ligand for the inhibitory receptor on potential target cells could permit stimulation via the activating receptor. If the activating receptors are against non-self MHC class I (or other as yet unidentified molecules), do they cross react with ligands carried by pathogens? Finally, a role for activating MHC class I receptors might be envisioned during NK cell development, where recognition of self–class I may be required for positive selection, permitting NK cell differentiation.

THE REPERTOIRE OF INHIBITORY NK CELL RECEPTORS: MODULATION, CALIBRATION, AND EDUCATION The mechanism that generates and selects for NK cell receptor gene expression is not yet defined. In understanding this process, several unique features need to be accounted for: 1. Most mouse NK cells simultaneously express two or more Ly49 receptors (103, 104, 116, 117, 169, 217, 221). Likewise, most human NK cell clones simultaneously express two or more KIR and/or CD94/NKG2 receptors (125, 146, 148, 151, 152, 157, 160). 2. If an NK cell clone expresses multiple inhibitory NK cell receptors, they are able to function independently (125, 160, 222, 223).

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3. While each NK cell expresses one inhibitory NK receptor for a self-MHC class I ligand, they often express receptors that apparently have no MHC class I ligand in the host (99, 146, 224).

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4. In mice, the MHC class I haplotype of the host can influence the repertoire and level of the NK-cell receptors expressed (115, 221, 225–235). Collectively, these observations suggest that the creation of an NK-cell receptor repertoire may involve a stochastic process regulating gene expression that is fine-tuned by the host MHC class I haplotype. The ability of NK cells to discriminate between MHC class I positive and class I negative normal nontransformed cells was first appreciated by studies of mice with disrupted β2-microglobulin genes (236, 237). NK cells from wild-type mice were able to reject bone marrow grafts from syngeneic β2-microglobulin −/− mice and to kill T lymphoblasts from the mutant mice in vitro (236, 237). Interestingly, NK cells in the β2-microglobulin −/− mice develop normally and express Ly49 receptors (236, 237). The NK cells from these mutant mice do not kill autologous β2-microglobulin −/− lymphoblasts, so they must be educated by their development in a host lacking normal MHC class I expression (234, 236, 237). A similar phenotype is observed in mice with disrupted Tap-1 genes, which also prevents normal expression of MHC class I on the cell surface (238). The host MHC haplotype can have a profound influence on the expression of NK cell receptors for MHC class I. For example, the levels of Ly49A on NK cells from B10.D2 or B6 mice expressing an H-2Dd transgene are ≈10-fold lower than on the NK cells of congenic B10 or B6 mice that lack the H-2Dd ligand for Ly49A (229, 230). Similarly, in bone marrow chimeric mice, H-2 molecules expressed by either hematopoietic or nonhematopoietic tissues can influence the expression of Ly49A on the NK cells in these animals (233). The effect of MHC class I on Ly49A expression appears to be regulated by modulation or internalization of these receptors in the presence of an appropriate ligand. Transcriptional control of Ly49A by the presence of ligand has been excluded, based on the observation that mice expressing a Ly49A transgene using a heterologous promoter also demonstrate Ly49A receptor modulation in mice bearing H-2Dd (227). Expression of a Ly49A transgene in the entire NK cell population does not completely prevent expression of the endogenous Ly49 genes (226). However, the Ly49A transgene does alter the frequency of NK cells expressing other H-2Dd-specific Ly49 receptors (e.g. Ly49G2) in animals that express H-2Dd, but not in mice lacking the ligand (226). Based on a comparison of Ly49 expression in mice of different MHC haplotypes, Raulet and colleagues (221, 239) have proposed that the system may be rigged to ensure the presence of at least one self-reactive Ly49 on each NK cell, but

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to limit expression of too many self-specific Ly49 receptors. Simultaneous expression of too many inhibitory receptors for self-MHC class I molecules may be disadvantageous because it would diminish the ability of NK cells to detect subtle alterations in MHC class I expression. The mechanism whereby NK cells are tolerant to self is not understood. However, this does not occur by deletion of potentially autoreactive NK cells and may be regulated by active suppression. For example, in B6 mice that express an H-2Dd transgene on only a fraction of the host cells, transgene-negative NK cells in these animals do not kill H-2Dd lymphoblasts or reject B6 bone marrow allografts (228). However, if these H-2Dd negative NK cells from mosaic transgenic mice are isolated and cultured in vitro for 4 days in the presence of IL-2, they acquire the ability to kill H-2Dd lymphoblasts. Further evidence for active tolerance in the NK cell population comes from studies of mice receiving bone marrow grafts containing mixtures of stem cells from class I–deficient and wildtype donors (234). Normal NK cells were rendered tolerant to class I–deficient cells by development in this environment. Human NK cell clones can kill autologous PHA-stimulated lymphoblasts, provided class I on the lymphoblasts is masked by an anti-MHC class I mAb (240). These studies demonstrate that NK cells can recognize and potentially kill normal, nontransformed autologous cells. While the antigens on normal, activated lymphoblasts that stimulate NK cell function have not been identified, these experiments imply the existence of stimulating ligands for NK cells that are self-antigens. KIR specific for HLA-Bw4 are expressed in humans lacking the ligand, i.e. HLA-Bw6 homozygous individuals (224). Unlike the situation with Ly49, there is no evidence for modulation or diminished levels of the KIR specific for HLA-Bw4 in individuals expressing the ligand (HLA-Bw4 homozygotes or heterozygotes) (224). In addition, analysis of families with identical twins and other non-twin siblings demonstrates that KIR expression is genetically determined (224). These conclusions are supported by a recent study of transgenic mice expressing a human KIR2DL reactive with HLA-Cw3 (241). When crossed to mice expressing a HLA-Cw3 transgene, the amount of KIR on the cell surface was not modulated (241). How humans generate an NK cell repertoire tailored to self is not understood. However, a useful experimental model to study this process involves the in vitro culture of human NK precursor cells in IL-15 (242). NK cells derived from these cultures express CD94/NKG2A receptors that provide for self-protection (242). Receptors of the KIR family were not induced using these conditions, suggesting different requirements for expression of these genes.

Why Multiple NK Cell–Receptor Families? The existence of both the KIR and CD94/NKG2 families in humans and both CD94/NKG2 and Ly49 receptor families in rodents was unexpected. One

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possibility is that the CD94/NKG2 system evolved first. These receptors are likely of low affinity and react with a broad array of MHC class I ligands. NK cells expressing CD94/NKG2 receptors may detect cells as abnormal only if they lose expression of class I at several loci. This mechanism could be useful to eliminate cells infected with viruses like CMV or adenovirus that totally disrupt MHC class I synthesis (243). However, it would not be advantageous for detection of subtle changes, for example loss of expression by a single allele at one MHC loci. Therefore, as a refinement on the theme, the Ly49 receptors in mouse and KIR molecules in humans may have evolved to provide more specificity and sensitivity.

THE FUNCTION OF NK CELL RECEPTORS IN VIVO Bone Marrow Transplantation, Maternal-Fetal Interactions, Defense against Pathogens and Tumors The classical rules of transplantation biology are inadequate to accommodate the observed rejection of parental bone marrow grafts by F1 animals [known as the hybrid histocompatibility (Hh) phenomenon]. This can now be explained by the presence of NK cells in the F1 host that recognize and eliminate the parental bone marrow cells as foreign because a subset of NK cells in the recipient lacks inhibitory receptors for the parental H-2 antigens (169, 244). As bone marrow transplantation becomes more widely used, the potential exists for NK cell–mediated Hh rejection in humans. The placenta is a more common site of exposure to alloantigens. Interestingly, decidual tissues contain large numbers of maternal NK cells, exceeding the number of T cells in this site (245–248). The populations of NK cells in the decidual tissues differ from those in circulation with respect to the repertoire of NK cell receptors on these cells (191, 249). The biological role for NK cells in the placenta is an intriguing issue. Do they protect the mother from the invading fetus? Protect the fetus from infection? Inadvertently migrate to the decidua in response to chemotactic factors released by the placenta? Much attention has been generated by the expression of HLA-G by trophoblasts. While NK cells in circulation and in decidual tissues can recognize HLA-G in experimental models (250–252), predominantly using the CD94/NKG2A receptors (189– 191), the physiological significance of this with respect to interactions between NK cells and trophoblasts has not been established. The existence of NK cell receptors for MHC class I molecules and the surveillance for “missing self” were predicted based on the observation that NK cells preferentially killed tumors lacking H-2 (93, 94, 96). Genetic reconstitution of cell surface H-2 expression in these murine tumors conferred protection against NK cell–mediated cytotoxicity and restored their tumorigenicity (253– 255). Ikeda et al (256) have shown that CTL may also be regulated by inhibitory

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MHC class I receptors. An HLA-A24-restricted antigen-specific CTL generated from a melanoma patient was able to kill a metastatic variant of the autologous tumor but was unable to lyse the parental melanoma. HLA typing of the melanoma demonstrated that the parental tumor expressed HLA-Cw7; however, the metastatic tumor lost HLA-Cw7, yet both parental and metastatic melanoma expressed HLA-A24. The inability of the CTL to kill the parental melanoma was caused by expression of a KIR2DL molecule on the CTL that inhibited lysis of melanoma cells bearing HLA-Cw7. The tumor antigen, PRAME, recognized by this CTL is a normal, unmutated self-antigen that was overexpressed in the melanoma. One wonders whether the KIR on this CTL normally functions to prevent autoimmunity against normal tissues expressing the self-antigen. Recent studies of T cells in HIV-infected patients indicate that inhibitory MHC class I receptors may also regulate the function of virus-specific CTL (257). Finally, the most important role of NK cells in host defense may be in antiviral immunity (reviewed in 6, 258). The ability of certain viruses to downregulate MHC class I provides a clever strategy to evade host T cell immunity (243). However, loss of MHC class I would potentially make the virus-infected cells targets for NK cell attack. Although there is as yet no direct evidence for the role of inhibitory MHC class I receptors in viral defense in vivo, it is interesting that disease resistance genes for mouse CMV and the poxvirus ectromelia (259) map within the mouse NK gene complex (61, 105, 260, 261). Moreover, NK cells participate in the innate immune response against CMV (6, 258, 262, 263). Mouse (264, 265) and human (264, 265) CMV encode an MHC class I–like protein that has been proposed to suppress NK cell activity against CMV-infected cells (266, 267). However, the ability of these CMV class I–like proteins to be expressed and directly to inhibit NK cell–mediated cytotoxicity in vitro is controversial.

NK CELL RECEPTORS ARE MEMBERS OF AN INHIBITORY RECEPTOR SUPERFAMILY—THE “IRS” It is becoming apparent that the immune system may be constantly poised to attack but is actively held in check. Thus, a balance is achieved to permit elimination of pathogens but avoid autoimmunity. The potential for self-aggression is dramatically illustrated by the phenotype of mice with disrupted CTLA-4 genes. In these animals, CD28 stimulation via CD80 or CD86 (268) in the absence of negative regulation by CTLA4 (269, 270) leads to a T cell lymphoproliferative disease that results in death. SHP-2 has been implicated in the mechanism of CTLA4 inhibitory function (271). Similarly, motheaten mice, possessing mutations in SHP-1, suffer from autoimmunity that results in death (272, 273).

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The discovery of new receptors possessing the consensus ITIM sequence is an exploding field of research. The NK cell receptors represent only a minor branch of the inhibitory receptor superfamily that now includes genes expressed on T cells, B cells, NK cells, monocytes, dendritic cells, mast cells, and granulocytes. For example, CD22 (274), LAIR-1 (275), gp49 (276–279), LIR1 (280), gp91/PIR (281, 282), ILT1/2 (283), and ILT3 (284) are all Iglike genes of the IRS expressed on human chromosome 19q13.4 or the syntenic region on mouse chromosome 7. A related family of 15 Ig-like genes of the IRS, designated SIRP, have been identified on fibroblasts and can regulate growth factor receptor signal transduction (285). Inhibitory receptors are not just for lymphocytes anymore; they represent a general theme in biological regulation. ACKNOWLEDGMENTS Thanks to Drs. Eric Long, David Raulet, Wayne Yokoyama, John Ortaldo, Eric Vivier, Lorenzo Moretta, Bo Dupont, Erik Dissen, Sigbjorn Fossum, Petter Hoglund, and Miguel Lopez-Botet for providing preprints. Thanks also to Ms Jo Ann Katheiser for excellent graphic and administrative support. DNAX Research Institute is supported by Schering Plough Corporation. Visit the Annual Reviews home page at http://www.AnnualReviews.org.

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LANIER Physical and functional independency of p70 and p58 NK cell receptors for HLAclass I. Their role in definition of different groups of alloreactive NK cell clones. Proc. Natl. Acad. Sci. USA 93:1453– 57 Vitale M, Sivo S, Pende D, Moretta L, Moretta A. 1995. Coexpression of two functionally independent p58 inhibitory receptors in human natural killer cell clones results in the inability to kill all normal allogeneic target cells. Proc. Natl. Acad. Sci. USA 92:3536–40 Gumperz JE, Valiante NM, Parham P, Lanier LL, Tyan D. 1996. Heterogeneous phenotypes of expression of the NKB1 natural killer cell class I receptor among individuals of different HLA types appear genetically regulated, but not linked to MHC haplotype. J. Exp. Med. 183:1817– 27 Dorfman JR, Raulet DH. 1996. Major histocompatibility complex genes determine natural killer cell tolerance. Eur. J. Immunol. 26:151–55 Held W, Raulet DH. 1997. Ly49A transgenic mice provide evidence for a major histocompatibility complexdependent education process in natural killer cell development. J. Exp. Med. 185:2079–88 Held W, Cado D, Raulet DH. 1996. Transgenic expression of the Ly49A natural killer cell receptor confers class I major histocompatibility complex (MHC)specific inhibition and prevents bone marrow allograft rejection. J. Exp. Med. 184:2037–41 Johansson MH, Bieberich C, Jay G, Karre K, Hoglund P. 1997. Natural killer cell tolerance in mice with mosaic expression of major histocompatibility complex class I transgene. J. Exp. Med. 186: In press Karlhofer FM, Hunziker R, Reichlin A, Margulies DH, Yokoyama WM. 1994. Host MHC class I molecules modulate in vivo expression of a NK cell receptor. J. Immunol. 153:2407–16 Olsson MY, Karre K, Sentman CL. 1995. Altered phenotype and function of natural killer cells expressing the major histocompatibility complex receptor Ly-49 in mice transgenic for its ligand. Proc. Natl. Acad. Sci. USA 92:1649–53 Salcedo M, Diehl AD, Olsson-Alheim MY, Sundback J, van Kaer L, Karre K, Ljunggren H-G. 1997. Altered expression of Ly49 inhibitory receptors on natural killer cells from MHC class I-deficient mice. J. Immunol. 158:3174–80 Sentman CL, Olsson-Alheim MY,

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inhibitory receptor (CD158b). Proc. Natl. Acad. Sci. USA 94:8088–92 Mingari MC, Vitale C, Cantoni C, Bellomo R, Ponte M, Schiavetti F, Bertone S, Moretta A, Moretta L. 1997. Interleukin15-induced maturation of human natural killer cells from early thymic precursors: selective expression of CD94/NKG2A as the only HLA class I-specific inhibitory receptor. Eur. J. Immunol. 27:1374–80 Wiertz EJHJ, Mukherjee S, Ploegh HL. 1997. Viruses use stealth technology to escape from the host immune system. Mol. Med. Today 3:116–23 Bennett M, Yu YYL, Stoneman E, Rembecki RM, Mathew PA, Lindahl KF, Kumar V. 1995. Hybrid resistance: ‘Negative’ and ‘positive’ signaling of murine natural killer cells. Semin. Immunol. 7:121–27 King A, Balendran H, Wooding P, Carter NP, Loke YW. 1991. CD3 leucocytes present in the human uterus during early placentation: phenotypic and morphological characterization of the CD56++ population. Dev. Immunol. 1:169–90 King A, Loke YW. 1991. On the nature and function of human uterine granular lymphocytes. Immunol. Today 12:432–35 King A, Jokhi PP, Burrows TD, Gardner L, Sharkey AM, Loke YW. 1996. Functions of human decidual NK cells. Am J. Reprod. Immunol. 35:258–60 King A, Loke YW, Chaouat G. 1997. NK cells and reproduction. Immunol. Today 18:64–66 Verma S, King A, Loke YW. 1997. Expression of killer cell inhibitory receptors on human uterine natural killer cells. Eur. J. Immunol. 27:979–83 Deniz G, Christmas SE, Brew R, Johnson PM. 1994. Phenotypic and functional cellular differences between human CD3decidual and peripheral blood leukocytes. J. Immunol. 152:4253–61 Chumbley G, King A, Robertson K, Holmes N, Loke YW. 1994. Resistance of HLA-G and HLA-A2 transfectants to lysis by decidual NK cells. Cell. Immunol. 155:312–22 Rouas-Freiss N, Marchal RE, Kirszenbaum M, Dausset J, Carosella ED. 1997. The a1 domain of HLA-G1 and HLA-G2 inhibits cytotoxicity induced by natural killer cells: Is HLA-G the public ligand for natural killer cell inhibitory receptors? Proc. Natl. Acad. Sci. USA 94:5249–54 Glas R, Sturmhofel K, Hammerling GJ, Karre K, Ljunggren H-G. 1992. Restoration of a tumorigenic phenotype by β2microglobulin transfection to EL-4 mu-

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tant cells. J. Exp. Med. 175:843–46 254. Franksson L, George E, Powis S, Butcher G, Howard J, Karre K. 1993. Tumorigenicity conferred to lymphoma mutant by major histocompatibility complexencoded transporter gene. J. Exp. Med. 177:201–5 255. Glas R, Waldenstrom M, Hoglund P, Klein G, Karre K, Ljunggren H-G. 1995. Rejection of tumors in mice with severe combined immunodeficiency syndrome determined by the major histocompatibility complex. Class I expression on the graft. Cancer Res. 55:1911–16 256. Ikeda H, Leth´e B, Lehmann F, Van Baren N, Baurain J-F, De Smet C, Chambost H, Vitale M, Moretta A, Boon T, Coulie PG. 1997. Characterization of an antigen that is recognized on a melanoma showing partial HLA loss by CTL expressing an NK inhibitory receptor. Immunity 6:199– 208 257. De Maria A, Ferraris A, Guastella M, Pilia S, Cantoni C, Polero L, Mingari MC, Bassetti D, Fauci AS, Moretta L. 1997. Expression of HLA class I-specific inhibitory natural killer cell receptors in HIV-specific cytolytic T lymphocytes. Impairment of specific cytolytic functions. Proc. Natl. Acad. Sci. USA 94: In press 258. Welsh RM, Vargas-Cortes M. 1992. Natural killer cells in viral infection. In The Natural Killer Cell, ed. CE Lewis, JOD McGee. Oxford, UK: IRL Press 259. Delano ML, Brownstein DG. 1995. Innate resistance to lethal mousepox is genetically linked to the NK gene complex on chromosome 6 and correlates with early restriction of virus-replication by cells with an NK phenotype. J. Virol. 69:5875– 77 260. Scalzo AA, Fitzgerald NA, Wallace CR, Gibbons AE, Smart YC, Burton RC, Shellam GR. 1992. The effect of the Cmv1 resistance gene, which is linked to the natural killer cell gene complex, is mediated by natural killer cells. J. Immunol. 149:581–89 261. Scalzo AA, Shellam GR, Fitzgerald NA, Wallace CR, Lyons PA, Yokoyama WM. 1992. The Cmv-1 resistance gene is closely linked to loci residing in the NKC region on mouse chromosome 6. FASEB J. 6:A2053 262. Welsh RM, Burbaker JO, Vargas-Cortes M, O’Donnell CL. 1991. Natural killer (NK) cell response to virus infections in mice with severe combined immunodeficiency. The stimulation of NK cells and the NK cell-dependent control of virus

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LANIER infections occur independently of T and B cell functions. J. Exp. Med. 173:1053– 63 Bukowski JF, Warner JF, Dennert G, Welsh RM. 1985. Adoptive transfer studies demonstrating the antiviral effect of natural killer cells in vivo. J. Exp. Med. 161:40–52 Beck S, Barrell BG. 1988. Human cytomegalovirus encodes a glycoprotein homologous to MHC class-I antigens. Nature 331:269–72 Fahnestock ML, Johnson JL, Feldman RMR, Neveu JM, Lane WS, Bjorkman PJ. 1995. The MHC class I homolog encoded by human cytomegalovirus binds endogenous peptides. Immunity 3:583–90 Farrell HE, Vally Y, Lynch DM, Fleming P, Shellam GR, Scalzo AA, DavisPoynter NJ. 1997. Inhibition of natural killer cells by a cytomegalovirus MHC class I homologue in vivo. Nature 386:510–14 Reyburn HT, Mandelbolm O, ValesGomez M, Davis DM, Pazmany L, Strominger JL. 1997. The class I MHC homologue of human cytomegalovirus inhibits attack by natural killer cells. Nature 386:514–17 Tivol EA, Boyd SD, McKean S, Borriello F, Nickerson P, Strom TB, Sharpe AH. 1997. CTLA4Ig prevents lymphoproliferation and fetal multiorgan tissue destruction in CTLA-4-deficient mice. J. Immunol. 158:5091–94 Waterhouse P, Penninger JM, Timms E, Wakeham A, Shahinian A, Lee KP, Thompson CB, Griesser H, Mak TW. 1995. Lymphoproliferative disorders with early lethality in mice deficient in Ctla-4. Science 270:985–88 Tivol EA, Borriello F, Schweitzer AN, Lynch WP, Bluestone JA, Sharpe AH. 1995. Loss of CTLA-4 leads to massive lymphoproliferation and fatal multiorgan tissue destruction, revealing a critical negative regulatory role of CTLA-4. Immunity 3:541–47 Marengere LEM, Waterhouse P, Duncan GS, Mittrucker H-W, Feng G-S, Mak TW. 1996. Regulation of T cell receptor signaling by tyrosine phosphatase SYP association with CTLA-4. Nature 272:1170– 73 Kozlowski M, Mlinaric-Rascan I, Feng G-S, Shen R, Pawson T, Siminovitch KA. 1993. Expression and catalytic activity of the tyrosine phosphatase PTP1C is severely impaired in motheaten and viable motheaten mice. J. Exp. Med. 178:2157– 63

273. Shultz LD, Schweitzer PA, Rajan TV, Yi T, Ihle JN, Matthews RJ, Thomas ML, Beier DR. 1993. Mutations at the murine motheaten locus are within the hematopoietic cell protein-tyrosine phosphatase (Hcph) gene. Cell 73:1445– 54 274. Law C-L, Sidorenko SP, Chandran KA, Zhao Z, Shen S-H, Fischer EH, Clark EA. 1996. CD22 associates with protein tyrosine phosphatase 1C, Syk, and phospholipase Cγ 1 upon B cell activation. J. Exp. Med. 184:547–60 275. Meyaard L, Adema GJ, Chang C, Woollatt E, Sutherland GR, Lanier LL, Phillips JH. 1997. LAIR-1, A novel inhibitory receptor expressed on human mononuclear leukocytes. Immunity 7:283–90 276. Katz HR, Vivier E, Castells MC, McCormick MJ, Chambers JM, Austen KF. 1996. Mouse mast cell gp49B1 contains two immunoreceptor tyrosine-based inhibition motifs and suppresses mast cell activation when coligated with the highaffinity Fc receptor for IgE. Proc. Natl. Acad. Sci. USA 93:10809–14 277. Rojo S, Burshtyn DN, Long EO, Wagtmann N. 1997. Type I transmembrane receptor with inhibitory function in mouse mast cells and NK cells. J. Immunol. 158:9–12 278. Wagtmann N, Rojo S, Eichler E, Mohrenweiser H, Long EO. 1997. A new human gene complex encodes the killer cell inhibitory receptors and a related family of monocyte/macrophage receptors. Curr. Biol. 7:615–18 279. Wang LL, Mehta IK, LeBlanc PA, Yokoyama WM. 1997. Mouse natural killer cells express gp49B1, a structural homologue of human killer inhibitory receptors. J. Immunology 158:13–17 280. Cosman D, Fanger N, Borges L, Kibin M, Chin W, Peterson L, Hus M-L. 1997. A novel immunoglobuolin superfamily receptor for cellular and viral MHC class I molecules. Immunity 7:273–82 281. Hayami K, Fukuta D, Nishikawa Y, Yamashita Y, Inui M, Ohyama Y, Hikida M, Ohmori H, Takai T. 1997. Molecular cloning of a novel murine cellsurface glycoprotein homologous to killer cell inhibitory receptors. J. Biol. Chem. 272:7320–27 282. Kubagawa H, Burrows PD, Cooper MD. 1997. A novel pair of immunoglobulinlike receptors expressed by B cells and myeloid cells. Proc. Natl. Acad. Sci. USA 94:5261–66 283. Samaridis J, Colonna M. 1997. Cloning of novel immunoglobulin superfamily

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receptors expressed on human myeloid and lymphoid cells: structural evidence for new stimulatory and inhibitory pathways. Eur. J. Immunol. 27:660–65 284. Cella M, Dohring C, Samaridis J, Dessing M, Brockhaus M, Lanzavecchia A, Colonna M. 1997. A novel inhibitory receptor (ILT3) expressed on monocytes,

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macrophages, and dendritic cells involving antigen processing. J. Exp. Med. 185:1743–51 285. Kharitonenkov A, Chen Z, Sures I, Wang H, Schilling J, Ullrich A. 1997. A family of proteins that inhibit signalling through tyrosine kinase receptors. Nature 386:181–86

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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BCL-2 FAMILY: Regulators of Cell Death Debra T. Chao and Stanley J. Korsmeyer Howard Hughes Medical Institute, Division of Molecular Oncology, Departments of Medicine and Pathology, Washington University School of Medicine, St. Louis, Missouri 63110; e-mail: [email protected] KEY WORDS:

apoptosis, lymphocyte development, BAX, BCL-X, BCL-2

ABSTRACT An expanding family of BCL-2 related proteins share homology, clustered within four conserved regions, namely BCL-2 homology (BH1-4) domains, which control the ability of these proteins to dimerize and function as regulators of apoptosis. Moreover, BCL-XL, BCL-2, and BAX can form ion-conductive pores in artificial membranes. The BCL-2 family, comprised of both pro-apoptotic and anti-apoptotic members, acts as a checkpoint upstream of CASPASES and mitochondrial dysfunction. BID and BAD possess the minimal death domain BH3, and the phosphorylation of BAD connects proximal survival signals to the BCL-2 family. BCL-2 and BCL-XL display a reciprocal pattern of expression during lymphocyte development. Gain- and loss-of-function models revealed stagespecific roles for BCL-2 and BCL-XL. BCL-2 can rescue maturation at several points of lymphocyte development. The BCL-2 family also reveals evidence for a cell-autonomous coordination between the opposing pathways of proliferation and cell death.

INTRODUCTION Programmed cell death plays an indispensable role in the development and maintenance of homeostasis within all multicellular organisms (1). Genetic and molecular analysis from nematodes to humans has indicated that the pathway of cellular suicide is highly conserved (2–4). Although the capacity to carry out apoptosis appears to be inherent in all cells, the susceptibility to apoptosis varies markedly and is influenced by external and cell-autonomous events. 395 0732-0582/98/0410-0395$08.00

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Considerable progress has been made in identifying the molecules that regulate the apoptotic pathway at each level. Of note, both positive and negative regulators, often encoded within the same family of proteins, characterize the extracellular, cell-surface, and intracellular steps (5).

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BCL-2 Initiates a New Category of Oncogenes: Regulators of Cell Death The BCL-2 family of proteins constitutes a critical intracellular checkpoint of apoptosis within a distal common cell death pathway. The founding member of this family, BCL-2, first presented at the interchromosomal breakpoint of the t(14;18), the molecular hallmark of follicular B cell lymphoma (6–8). The discovery that BCL-2, unlike oncogenes studied previously, functions in preventing programmed cell death (PCD) instead of promoting proliferation established a new class of oncogenes (9–12). The overexpression of BCL-2 increased the viability of certain cytokinedependent cells upon cytokine withdrawal. In interleukin-3 (IL-3)-dependent pro-B-cell lines and promyeloid cell lines, BCL-2 overexpression prolonged cell survival upon IL-3 withdrawal and maintained the cells in G0 (9, 11, 12). The observation was extended to IL-4 and granulocyte macrophage colonystimulating factor (GM-CSF)-dependent cells (13) and in certain IL-2-dependent (14) and IL-6-dependent (15) cells. BCL-2 was also capable of protecting T cells against a variety of apoptotic signals, including glucocorticoids, γ -irradiation, phorbol esters, ionomycin, and cross-linking of cell surface molecules by anti-CD3 antibody. The protective effects were observed in T cell hybridomas transfected with BCL-2 and in thymocytes and peripheral T cells from transgenic mice (16, 17). The in vivo effects of BCL-2 were initially investigated using transgenic mice with BCL-2 overexpression targeted to B cells or to T cells. Transgenic mice bearing a BCL-2-Ig minigene harbor an expanded B cell compartment (10). When the BCL-2 transgene is expressed in B lymphocytes, the mice develop follicular hyperplasia; some progress to high-grade monoclonal lymphomas (10, 18–20). When expression is directed to T cells, fully one third of the mice develop peripheral T cell lymphomas (21). A long latency and progression from polyclonal hyperplasia to monoclonal malignancy are consistent with the hypothesis that further oncogenic events in addition to BCL-2 are necessary for tumor formation. In lymphomas arising in BCL-2-Ig transgenic mice, a common second hit is translocation of the Myc oncogene (18). Double transgenic mice expressing both BCL-2 and Myc exhibited hyperproliferation of pre-B cells and developed tumors of a hematolymphoid cell type at a markedly increased rate (20, 22). Synergy between these oncogenes of two different classes results in more potent transformation than either oncogene alone.

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Inappropriate c-Myc expression under conditions such as heat shock in Chinese hamster ovary (CHO) cells or serum deprivation of Rat-1 fibroblasts leads to rapid onset of apoptosis (23, 24). Inducible MYC-constructs in serumdeprived fibroblasts showed that expression of MYC activated both proliferation and apoptosis and that the survival of the cell was dependent on factors (25) such as IGF-1 or BCL-2 that suppress the inherent apoptotic program. The transgenic mice experiments illustrated that cell death is normally a well-regulated process in lymphoid development and that lack of cell death is tumorigenic. Deleterious mutations that would have resulted in cell death can be retained when apoptosis is inhibited. The progression to lymphoma in BCL-2 transgenic mice constitutes in vivo evidence that the t(14;18) and BCL-2 overexpression can play a primary role in oncogenesis.

An Expanded BCL-2 Family of Proteins The identification of multiple BCL-2 homologs many of which form homoor heterodimers suggests that these molecules function at least in part through protein-protein interactions. The first pro-apoptotic homolog, BAX, was identified by coimmunoprecipitation with BCL-2 protein. BAX is a 21-kDa protein that shares homology with BCL-2 clustered in conserved regions including BH1 and BH2 (Figure 1). BAX heterodimerizes with BCL-2 and homodimerizes

Figure 1 Summary of anti-apoptotic and pro-apoptotic BCL-2 family members. BCL-2 homology regions are indicated with similar shaded boxes (BH1-BH4).

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with itself (26). When BAX was overexpressed in cells, apoptotic death in response to a death signal was accelerated, earning its designation as a death agonist. When BCL-2 was overexpressed, it heterodimerized with BAX and death was repressed (26). Thus, the ratio of BCL-2 to BAX is important in determining susceptibility to apoptosis (Figure 2). BAX protein contains a hydrophobic carboxy terminus similar to BCL-2 and has been colocalized like BCL-2 to intracellular membranes including mitochondria (unpublished observations). BAX is widely expressed in tissues, including a number of sites in which cells die during normal maturation (26, 27). Moreover, the BCL-2-toBAX ratio varies during the developmental history of a given lineage. The family has further expanded to include the death antagonists BCL-2, BCL-XL, MCL-1, and A1 as well as the pro-apoptotic molecules BAX, BCLXS, BAK, and BAD. The overall ratio of the death agonists to antagonists determines the susceptibility to a death stimulus. Conserved domains BH1, BH2, and BH3 participate in the formation of various dimer pairs as well as the regulation of cell death (28, 29). The BCL-2 family also has homologs in DNA viruses. Adenovirus possesses the E1B-19k gene, and the BHRF1 gene of EBV that is expressed early in lytic and some latent infections is also homologous to BCL-2 in the BH1 and BH2 domains (30, 31) (Figure 1). An open reading frame (ORF16) in the T lymphotropic herpesvirus saimiri (HVS) was reported as a novel member of the BCL-2 family (32). The African swine fever virus encodes a homologous gene, LMW5-HL (Figure 1), which is also expressed early in infection of mononuclear phagocytes (33). Most recently the virus felt to be responsible for Kaposi’s sarcoma has also been shown to encode a BCL-2-like product (34–36). The function of these viral homologs may be to maintain host cell viability while infection is being established.

Dimerizations of the BCL-2 Family Mutational analysis of BCL-2 and BCL-XL identified key residues within BH1 and BH2 domains required for both heterodimerization with BAX and repression of cell death (37). However, other BCL-XL mutants lost heterodimerization with BAX but still retained some death-repressor activity, suggesting that these two functions were separable (38). An additional domain, BH3, had also been noted in BCL-2 proteins and proved essential for BAK’s pro-apoptotic function (39, 40). Recently the multidimensional NMR and X-ray crystallographic structure of a BCL-XL monomer indicated that BH1–4 domains corresponded to α-helices 1–7. The α-helices of BH1–3 are closely juxtaposed to form a hydrophobic pocket (41). A detailed NMR analysis of wild-type and mutant peptides of the BH3 amphipathic α2-helix of BAK indicated it formed critical interactions with BCL-XL through both hydrophobic and electrostatic interactions (42). Several more distantly related pro-apoptotic molecules—BIK, BID,

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Figure 2 Schematic model of mammalian cell death pathway. Major check points in a common pathway of programmed cell death (PCD) include the ratio of pro-apoptotic (BAX) to anti-apoptotic (BCL-2) members and the activation of Caspases.

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HARAKIRI, BIM and perhaps BAD, principally—share only the amphipathic BH3 α-helix (43–47; S Cory, personal communication). Mutagenesis of BID and BAD has indicated that the BH3 domain is critical for both binding to the pocket of antagonists BCL-2 and BCL-XL, and also their death agonist activity (45, 48). These observations provide support for the argument that BH3 represents the critical death domain within these molecules. Besides BH1, BH2, and BH3 domains, a fourth N-terminal α-helical domain entitled BH4 is also found in certain family members and is vital for the death repression by BCL-2 and BCL-XL and may be involved in further protein interactions (40, 49, 50).

Genetic Ordering of Agonists and Antagonists While the majority of mutagenesis studies favored the functional importance of protein/protein interaction in regulating BCL-2 family function, they proved inconclusive in determining whether death agonists or antagonists were dominant in regulating apoptosis. A genetic approach to this question utilized gain and loss of function mouse models to assess whether the death agonist (Bax) or death antagonist (Bcl-2) resides upstream or downstream in a genetic pathway of apoptosis. Three generalized models might account for BCL-2 and BAX activity (Figure 3). If BCL-2 is a dominant molecule that suppresses apoptosis, BAX could represent an upstream inert handcuff that inhibits or sequesters BCL-2 (Model A, Figure 3). Alternatively, if BAX is a downstream activator of death, BCL-2 might be an upstream inhibitor of BAX (Model B, Figure 3). Finally, despite the capacity of these molecules to form heterodimers, they could each be capable of independent regulation of a common apoptotic pathway (Model C, Figure 3). Crosses of knockout mice revealed that the apoptosis and thymic hypoplasia characteristics of Bcl-2-deficient mice were predominantly corrected in mice also deficient for Bax. Moreover, a single copy of Bax promoted apoptosis in the absence of Bcl-2. However, a Bcl-2 transgene

Figure 3 Models for the order of BAX and BCL-2 function. (A) BAX is upstream of BCL-2. (B) BAX is downstream of BCL-2. (C ) BAX and BCL-2 independently regulate a common apoptotic pathway.

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still suppressed apoptosis in the absence of Bax. Thus, despite the in vivo competition between these molecules, BCL-2 and BAX, each is capable of regulating apoptosis independently of the other molecule (Model C, Figure 3) (51). Model C is also consistent with observations that in certain cell lines BCL-2 and BAX are localized to different compartments (52). Although a genetic approach does not directly assess whether monomers, dimers, or highorder structures are active, it does indicate that BCL-2/BAX heterodimers are not solely required. Furthermore, while this is a multigene family, it did not appear that other members were being substituted for the missing BCL-2 or BAX molecule.

BCL-2 Family in Nonlymphoid Development and Homeostasis The normal developmental role of Bcl-2 family members has been addressed by gene disruption. BCL-2 is initially widely expressed during embryogenesis. However, in the nervous system, BCL-2 expression decreases and becomes much more restricted postnatally (53). Newborn Bcl-2-/- knockout mice are viable, but the majority die at a few weeks of age. They develop polycystic kidney disease with marked dilatation of proximal and distal tubules and collecting ducts, resulting in renal failure (54–56). In the normal fetal kidney, detection of strong BCL-2 expression in the developing subcapsular condensations of mesenchymal cells destined to differentiate into proximal nephrons suggested that BCL-2 may be important in maintaining cell survival during inductive interactions between epithelium and mesenchyme (57, 58). Comparisons of embryonic kidneys from Bcl-2+/+ and Bcl-2-/- mice showed that Bcl-2-/- kidneys contain many fewer nephrons and greatly increased apoptosis within metanephric blastemas of metanephroi at embryonic day 12. Growth and development of Bcl-2-/- embryonic metanephroi are also reduced in culture, indicating that the abnormality in Bcl-2-/- kidneys is cell autonomous (59). Bcl-2-/- mice turn gray at 5 to 6 weeks of age, at the time of the second hair follicle cycle (54–56). The hypopigmentation in the Bcl-2-/- mice reflects decreased melanocyte survival. While the absence of BCL-2 allows viable pups to be born, the absence of BCL-X results in embryonic lethality. Bcl-x-/- mice are dead around embryonic day 13 (E13) (60). Extensive cell death appears throughout the brain and spinal cord in regions of postmitotic, differentiating neurons, in which BCLX is normally highly expressed. In contrast to BCL-2, BCL-X appears to be essential for brain development. In the hematopoietic system, massive cell death is observed in the developing liver. Bax-deficient mice represent the first knockout of a death-promoting family member (61). Bax-/- mice appear healthy, indicating that BAX is not essential for development of the organism. However, male Bax-/- mice are infertile,

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and Bax-/- testes exhibited a marked increase in cell death clustered in germ cells. The seminiferous tubules were abnormal, and multinucleated giant cells and pyknotic cells were present. The complete cessation of mature sperm cell production appears to follow an expansion of the premeiotic 2N cell population, suggesting a role for BAX in their homeostasis. Bax-/- ovaries display an accumulation of atrophic granulosa cells and 1◦ follicles that presumably failed to undergo apoptosis. Bax-/- sympathetic neurons are independent of NGF for survival, and motor neurons survive disconnection from their targets by axotomy. These trophic factor–independent neurons show reduced neurite outgrowth and have atrophic somas. Yet, Bax-/- neurons respond to addition of trophic factor with enhanced neurite outgrowth and soma hypertrophy. Furthermore, developmental sympathetic and motor neuronal death is reduced in Bax-/- mice. Thus, the Bax-deficient mice have separated the survival from anabolic action of neurotrophic factors. Despite the presence of multiple BCL-2 family members within these neurons, their death by trophic factor deprivation was singularly dependent upon BAX (62).

Pro-Apoptotic BAX as a Tumor Suppressor Prolonged cell survival with resistance to apoptosis can be a primary oncogenic event. Evidence has emerged that a principal contribution from the loss of p53 function is the elimination of a death pathway (63, 64). In select settings stimuli that induce p53 result in the expression of Bax (65). Experimental models utilizing Bax-deficient mice argue that approximately half of certain p53-dependent cell deaths require BAX. For example, chemotherapeutic agents induce apoptosis in embryonic fibroblasts in a p53-dependent manner. Elimination of BAX blocks approximately half of this chemotherapy-induced death (66). A transgenic model, TGT121 expresses a truncated T antigen in the choroid plexus that inhibits Rb but leaves p53 intact, resulting in cell proliferation with counterbalancing cell death. The introduction of Bax deficiency into this model markedly decreased the apoptosis induced by truncated T antigen, a p53-dependent death. Moreover, the TGT121 transgenic mice displayed a markedly accelerated progression to malignancy on a Bax-deficient background (67). These experimental models argue that Bax can also be considered a tumor suppressor and that loss of this pro-apoptotic molecule promotes tumorigenesis. Recently, mutation in BAX was noted in approximately 20% of human hematopoietic malignancy lines studied (68). Approximately half were frameshifts confined to a single mononucleotide (G)8 tract (nt 114–121) that results in a stop codon and the loss of BAX protein. The others represent point mutations within conserved BH1 and BH3 domains and alter dimerization and eliminate pro-apoptotic activity. Rampino et al described the presence of frameshift mutations in the identical (G)8 tract of BAX in about 50% of human colon

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adenocarcinomas with the microsatellite mutator phenotype (MMP) (69). Some sporadic cancers and almost all cancers associated with the hereditary nonpolyposis colorectal cancer syndrome (HNPCC) accumulate mutations in microsatellites of nucleotide repeats due to defects in human DNA mismatch repair genes including hMSH2, hMLH1, hPMS1, hPMS2 (70). This raises the possibility that a subset of acute lymphoblastic leukemia may also have a mutator phenotype. Mutations of the pro-apoptotic BAX molecule within human malignancies support the role of BAX as a tumor suppressor.

BCL-2 and BAX as an Active Checkpoint Upstream of CASPASES and Mitochondrial Dysfunction Important contributions to the understanding of programmed cell death have come from the genetic studies of the nematode C. elegans. In the development of that worm, 131 of the 1090 somatic cells undergo programmed cell death using a common genetic pathway. Two genes, ced-3 and ced-4, are required for cell death to occur. A third gene, ced-9, represses the death pathway and protects cells (71). In C. elegans, the phenotype of ced-3, ced-9 double mutants is the same as ced-3 single mutants, i.e., cells live. This indicates that ced-9 is not downstream of ced-3, but ced-9 could be an upstream negative regulator of ced-3 and ced-4. Epistasis mapping has also established that ced-4 is upstream of ced-3. ced-9 is a regulator of cell death, whereas ced-3 and maybe ced-4 encode effector molecules of cell death. CED-9 shows significant structural and functional homology to BCL-2. Cloning of the C. elegans ced-3 gene revealed the protein is homologous to the mammalian enzyme ICE (72). ICE is a cysteine protease that cleaves the 33-kDa pro-IL-1β at an aspartic acid residue into the biologically active 17.5-kDa IL-1β. Active ICE is composed of two subunits p10 and p20, which associate to form a heterotetramer. Indeed, overexpression of ICE causes Rat-1 fibroblasts to undergo apoptosis, which can be inhibited by BCL-2 and crmA (73), a cowpox virus protein that inhibits ICE-like cysteine proteases. ICE itself has not been fully established as an enzyme normally found in the cell death pathway. However, there are more than 10 ICE-like proteases, now termed CASPASES (cysteine proteases which cleave after aspartic acid) (74). CASPASES utilize a cysteinyl residue as the active nucleophile and recognize a cleavage site with an aspartic acid residue at the P1 position. The CASPASES can be divided into at least three subgroups based on homology and their tetrapeptide specificities, which may alter substrate specificities. CASPASES themselves are activated by cleavage of inactive zymogens at aspartic acid residues to generate active heterotetrameric proteases. Caspase-8 (FLICE/MACH) is activated by FAS/FASL engagement and appears to activate downstream CASPASES in a protease cascade.

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Examination of CASPASES in mammalian cells indicated that the presence of BCL-2 blocked activation of Caspase-3 (75–78). Thus, the BCL-2 decision point appears to operate upstream of most CASPASES and proximal to irreversible damage to cellular constituents (Figure 2). While the ratio of BCL-2/ BAX determines the response to an apoptotic signal, a question remained as to whether this was a passive checkpoint requiring an additional apoptotic signal or whether BAX itself could initiate death and if so, how. Transient transfection and inducible expression systems for BAX or BAK proved sufficient to induce apoptosis without an additional stimulus (79, 80). BAX-induced death included the activation of CASPASES and the cleavage of endogenous substrates in the nucleus (PARP) and cytosol (D4-GDI). However, while the inhibitor zVADfmk successfully blocked this protease activity and could prevent a FAS-induced death, it did not block BAX-induced death. While the cleavage of substrates and the final degradation of DNA was prevented, mitochondrial dysfunction still occurred. A BAX-induced fall in mitochondrial membrane potential, production of reactive oxygen species (ROS), cytoplasmic vacuolation, and plasma membrane permeability apparently occurred despite the inhibition of measurable CASPASES (79) (Figure 4). With the production of ROS and extreme vacuolation, it is possible that BAX induces characteristics of necrotic as well as apoptotic death. However, a drop in mitochondrial membrane potential, production of ROS, and permeability transition resulting in mitochondrial swelling have all been noted when cells are committed to apoptosis (81). These findings suggest that the localization of BAX at mitochondrial membranes may initiate a death program involving this organelle. Another mitochondrial component implicated in apoptotic cell death is the release of cytochrome c from the inter membrane space. Release of cytochrome c into the cytosol is a strong activator of CASPASES (82–84). When BCL-2 blocked apoptosis, cytochrome c was not released. Evidence in some systems suggests that cytochrome c release may precede a fall in mitochondrial membrane potential. Further study will focus upon whether the release of cytochrome c is a proximal decisional step in a genetic pathway of cell death or whether it helps insure the demise of cells with already injured mitochondria. How might BCL-2 and BAX alter mitochondrial function? The recent structure for a BCL-XL monomer (41) proved similar to the ion pore forming bacterial toxins of colicin and diphtheria toxin B fragment. This observation has prompted a series of electrophysiologic studies which have revealed the capacity of both anti-apoptotic BCL-XL, BCL-2 as well as pro-apoptotic BAX to form distinct ion conductive channels in artificial lipid membranes. BCL-XL, BCL-2 and BAX displayed pH dependent insertion into lipid vesicle with macroscopic efflux of KCl. Fusion of BCL-XL, BCL-2 or BAX into planar lipid bilayers and single channel recordings revealed distinct channels for each (85–87). The

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Figure 4 Schematic model of BAX-induced apoptosis. BAX activation may include the membrane insertion of internal α-helices to create an ion-conductive pore. Downstream effects include the activation of CASPASES and a program of mitochondrial dysfunction.

minimal channel conductance for BAX of 30 pS evolved to well-formed channel currents with at least three subconductance levels. The final, apparently stable, BAX channel was mildly chloride anion selective and characteristically open (87). In contrast, BCL-2 or BCL-XL formed mildly K+ cation selective channels with the most prominent initial conductance of 80 pS (85–87). Over time, either channel progressed to a maximum conductance of 1nS (87). How might ion-conductive pores regulate apoptosis? While the difference in selectivity is mild, the BCL-2 and BAX channels do display different characteristics. BCL-2 or BAX might regulate an electrochemical gradient, alter critical substrates or product residing in the intermembrane space. Because BCL-2 tends to cluster at contact points between the inner and outer membrane, it also becomes a candidate for regulating or being a component of the permeability transition pore (PTP) that enables colloidosmotic swelling of mitochondria that accompanies apoptosis. Alternatively, the BCL-2 family could modify other ion channels or transport other molecules not yet examined. Perhaps the strongest argument for a role of pore-forming activity for the BCL-2 family members is a teleologic

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one, in that bacterial toxins, perforin, and complement are all pore-forming protein that kills cells. Recently, it has also been demonstrated that ced-9 can bind ced-4 and that ced-9, ced-4, and ced-3 can be found at times in a shared complex (88, 89). Since anti-apoptotic BCL-XL and BCL-2 but not pro-apoptotic BAX appear to bind Ced-4, this suggests a displacent model in which anti-apoptotic BCL-2 members would prevent ced-4 equivalents from activating CASPASES (Figure 4). In summation, these data suggest a model in which the activation of BAX may reside at a branchpoint in the cell death pathway (Figure 4). One path is clearly the activation of CASPASES, which may utilize a membrane templateassociated protein interaction cascade. The ion pore–forming activity may prove to be more related to the mitochondrial dysfunction program that ensues (Figure 4).

Extracellular Survival Factors Can Reset the BCL-2 Checkpoint Through Posttranslational Mechanisms The pro-apoptotic molecules BAD and BID possess critical amphipathic BH3 domains, but lack the hydrophobic C-terminal signal/anchor sequence typical of other membrane-based family members. These molecules translocate between cytosol and membrane based partners such as BCL-2 or BCL-XL, and as such might be envisioned as “death ligands” that bind to membrane-based “receptors.” These characteristics make BID and BAD candidates that may reside upstream in the pathway linking the BCL-2 checkpoint to proximal signal transduction events. Support for this thesis comes from the recognition that BAD is rapidly phosphorylated on two serine residues in response to a survival factor, IL-3 (90). These serines represent canonical 14-3-3 binding sites, and phosphorylated BAD appears to be the inactive form incapable of binding BCL-XL and sequestered in the cytosol bound to 14-3-3 (Figure 5). Consistent with this model, substitution of the serine phosphorylation sites eliminated binding to 14-3-3 and further enhanced BAD’s death-promoting activity. A substantial component of extracellular survival factor’s effects are through posttranslational mechanisms. BAD represents one such link that connects extracellular cues with a resetting of the BCL-2 checkpoint within the common apoptotic pathway. Phosphorylation also appears to be involved in the regulation of other BCL-2 family members (91). BCL-2 is phosphorylated on serine residues that reside in the unstructured loop region between the α-1 and α-2 helices, and is an attractive mechanism for altering the conformation of the molecule. This occurs in a variety of settings including response to microtubule inhibitors such as Taxol (92, 93). Overall, most of these phosphorylation events appear to be inactivating and thus would promote cell death.

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Figure 5 Dual impact of IL-3-induced phosphorylation of BAD. The phosphorylated BAD is sequestered with 14-3-3 in the cytosol and felt to be the inactive form which releases BCL-XL to promote survival. Only the nonphosphorylated BAD can heterodimerize with membrane-bound BCL-XL, which is felt to actively inhibit BCL-XL.

The Role of BCL-2 and BCL-XL in Lymphocyte Development During development, lymphocytes are subjected to highly selective processes that save cells bearing functional antigen receptors, and remove cells that are potentially autoreactive. Because the assembly of immunoglobulin (Ig) receptors and T cell receptors (TCR) depends largely on random gene rearrangement, many receptors will be nonfunctional. It is estimated that as many as 95% of lymphoid precursors die during development mostly because of incorrectly rearranged and nonselected immunoglobulin and TCR receptors (94). Consequently, tightly regulated programmed cell death is an essential component for generating a functional lymphoid system.

Reciprocal Expression Pattern of BCL-2 and BCL-XL in Lymphocytes Within the thymus, BCL-2 is expressed uniformly in mature thymocytes in the medulla but is present only in scattered cells in the cortex (95). Flow cytometry confirms that BCL-2 is expressed in nearly all CD4+ and CD8+ single positive (SP) cells, but in only a few CD4+8+ double positive (DP) thymocytes undergoing selection. In addition, BCL-2 expression is high in mature peripheral T cells in spleen, lymph nodes, and blood (96, 97). Conversely, BCL-XL is highly expressed in the immature DP cells but absent from mature SP thymocytes (98, 99). BCL-XL is highly induced upon activation in the peripheral T cells while BCL-2 expression remains unchanged (100, 101) (Figure 6A). Similarly, BCL-2 and BCL-XL have a reciprocal pattern of expression in B cell compartments. In the bone marrow, BCL-2 is high in pro-B cells

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Figure 6 Reciprocal expression pattern of BCL-2 and BCL-XL in lymphocytes. (A) T cells. (B) B cells.

(B220loCD43+) and mature (IgM+IgD+) B cells, but low in pre-B cells (B220lo CD43−IgM−) undergoing Ig gene rearrangement and in immature (IgM+IgD−) B cells (102). In contrast, BCL-XL expression is low in pro-B, high in pre-B cells, and downregulated in the immature B population (103, 104). BCL-XL is undetectable in mature B cells but rapidly induced upon stimulation with surface IgM, CD40 ligand, or LPS in the peripheral B cells (103) (Figure 6B). The reciprocal expression patterns of BCL-2 and BCL-XL indicates their tight regulation is likely critical for lymphocyte development. Endogenous BCL-2 was downregulated in animals bearing the Bcl-2 transgenes, most likely due to a feedback regulation (105, 106). Of note, in both the thymocytes and spleen T cells of Lck-Bcl-xL mice, the endogenous BCL-2 protein expression was also downregulated. In parallel, endogenous BCL-XL was decreased in Bcl-2 transgenic animals (106). These results suggest a shared feedback regulatory pathway for BCL-2 and BCL-XL expression.

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Gene-Deficient Animals Revealed Stage-Specific Roles for BCL-2 and BCL-XL in Lymphocyte Development One way to address distinct physiological roles of the BCL-2 family members is to generate gene-deficient animal models. Although Bcl-2-deficient mice demonstrate normal differentiation of both B and T lineages, they are unable to maintain homeostasis in the immune system. Both the thymus and spleen undergo massive apoptosis within a few weeks after birth (54, 55). While disruption of Bcl-2 allows lymphocyte differentiation, disruption of Bcl-x results in embryonic lethality due to massive death in immature hematopoietic cells and neurons (60). Chimeric animals generated with Bcl-x-deficient ES cells have been used to study the function of BCL-X in the lymphocyte compartments (60, 99). While maturation of T cells is unaffected, the number of mature B cells is significantly reduced. Mature SP thymocytes and peripheral T cells derived from Bcl-x-deficient ES cells do not exhibit decreased survival (99). However, the survival of Bcl-x-deficient CD4+8+ DP thymocytes and B220+BM cells is significantly reduced (60, 99). BCL-XL seems to be important in the survival of immature lymphocytes, whereas BCL-2 is more important in the maintenance of a mature population. The death repressor molecules BCL-2 and BCL-XL appear to sequentially regulate cell death at serial stages in lymphocyte development. If BCL-2 and BCL-XL function at distinct stages of lymphocyte development, how is the endogenous expression regulated to ensure proper development? Evidence suggests that expression of BCL-2 and BCL-XL may be coupled to TCRmediated signals. BCL-2 expression is upregulated during positive selection and persists in mature T cells in the periphery (107, 108). However, BCL-XL is downregulated by either a positive or a negative selection signal (109). Since BCL-XL is essential for the survival of DP thymocytes, these results indicate a principal role for BCL-XL in DP cells prior to selection signals. Presumably, CD4+8+ DP cells downregulate BCL-XL expression to ensure vulnerability to apoptosis and enable selective deaths after receiving a TCR-mediated selection signal. Cells that receive a positive selection signal upregulate BCL-2 to restore their resistance to apoptosis, which enables maturation and emigration from the thymus. Thus, T cell maturation may utilize coordinate expression of BCL-XL and BCL-2 at serial stages to ensure proper selection.

BCL-2 and BCL-XL Repress Cell Death Through a Common Pathway Using either the Eµ or Lck proximal promoter, BCL-2 or BCL-XL was constitutively expressed in T cells (16, 17, 98, 106). Thymocyte maturation in both LckPr-Bcl-2 and LckPr-Bcl-xL mice was altered, resulting in increased CD3int/hi, CD4−8+ SP thymocytes, and peripheral T cells (16, 106). Thymocytes and peripheral T cells that overexpressed BCL-2 or BCL-XL had increased survival in

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culture. BCL-2 and BCL-XL both protected thymocytes from a variety of apoptotic stimuli, including γ irradiation, glucocorticoid and anti-CD3 treatments (16, 17, 98, 106). Similarly, transgenic mice overexpressing either BCL-2 or BCL-XL within the B cell lineage displayed comparable phenotype. Accumulation of peripheral B cells in lymphoid organs and enhanced survival of developing and mature B cells were observed in both BCL-2 and BCL-XL transgenic mice (10, 103). Overall, the phenotypes of Bcl-2 and Bcl-xL transgenic mice were indistinguishable. The observation that the Bcl-2 and Bcl-xL gain-of-function transgenics displayed similar phenotypes suggested a functional redundancy. Consequently, LckPr-Bcl-xL transgenic animals were mated to Bcl-2-deficient mice to determine if selective expression of BCL-XL would reverse the apoptotic loss of T cells in Bcl-2-null mice. In this genetic test of redundancy, BCL-XL rescued total spleen T cell numbers in Bcl-2-deficient mice. Moreover, the survival and resistance to apoptotic stimuli were restored by BCL-XL in Bcl-2-deficient cells (106). These studies indicate that BCL-XL and BCL-2 can repress cell death through a common pathway.

BCL-2 Promote Maturation But Cannot Fully Rescue Lymphocyte Development Without Antigen Receptors Both Rag-deficient and scid mutant mice lack the ability to successfully complete V(D)J recombination. Lymphocytes from these mutants are unable to develop further without antigen receptor and thus die at the pro-B or CD4−8− DN stage. Consequently, these mice have a profound reduction in the absolute number of lymphocytes (110). To examine whether expression of BCL-2 or BCL-XL could replace the necessary signal from the antigen receptor and rescue lymphoid development, various transgenic Bcl-2 and Bcl-xL mice have been mated to either Rag-deficient or scid mice. Bcl-2 or Bcl-xL transgene driven by the Lck proximal promoter can promote thymocytes to mature from DN to DP stage in Rag-deficient animals (107, 109) (A Strasser, unpublished data). Neither BCL-2 nor BCL-XL was able to fully restore the number of thymocytes to the wild-type level. Of note, BCL-XL was unable to promote DP thymocyte maturation in scid mice (109). These results suggest a fundamental difference between Rag-/- and scid mutant thymocytes that may be attributed to p53 activation in the former but not latter mouse model (111). Mice expressing the Bcl-2 transgene in the B cell lineage had increased numbers of pro-B cells but did not promote maturation in Rag-deficient mice (112). Another line of Bcl-2 transgenic mice that expressed the transgene in both lineages was mated to scid mice to determine if BCL-2 can rescue lymphopoiesis (113). Strikingly, the Bcl-2 transgene allowed significantly increased numbers of B lymphocytes to develop. These B cells do not display

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surface immunoglobulin but some express markers of maturity, including CD21 and CD23. In contrast, T cell development remains blocked in these Bcl-2/scid mice (113). In conclusion, BCL-2 and BCL-XL seem to play a role in the survival of early lymphocyte development. However, the effect of BCL-2 on maturation may vary depending on the level and timing of expression. Although BCL-2 can enhance survival of immature lymphocytes, it cannot completely replace the selecting signals through the antigen receptors.

BCL-2 Rescues T Lymphocyte Development in IL-7R-Deficient Mice IL-7 is an essential cytokine for both T cell and B cell development (114, 115). The major role of the IL-7/IL-7R interaction has been considered to be the expansion of DN thymic precursors because both IL-7- and IL-7R-deficient mice are severely lymphopenic due to decreased precursors (114, 115). However, it is unclear whether the role of IL-7/IL-7R is to trigger cell division, promote differentiation, or prevent apoptosis. A recent study has shown that BCL-2 is induced upon IL-7R engagement during T cell maturation (116). Moreover, enforced expression of BCL-2 restores T cell development in IL-7R-deficient mice (116, 117). BCL-2 also restored cellularity in the thymus of the IL-7R null mouse (116, 117). The data suggest that upregulation of BCL-2, or its homologue, is the essential signal induced by IL-7/IL-7R during T cell development. Since BCL-2 does not promote cell proliferation (9, 10), the principal role of IL-7R signaling is likely to maintain viability although other studies have suggested a role for BCL-2 in promoting differentiation (16, 107).

BCL-2 and Thymocyte Selection Since both BCL-2 and BCL-XL protect thymocytes from anti-CD3 treatment in vivo (15, 16, 98, 106), it seems plausible that BCL-2 or BCL-XL could block negative selection. One form of clonal deletion can be tested with self-reactive T cells that bear endogenous superantigen. In several studies, neither BCL-2 nor BCL-XL is able to fully block clonal deletion induced by endogenous superantigen (16, 17, 98). Overexpression of BCL-2 or BCL-XL in TCR transgenic mice provided another way to test its ability to abrogate negative selection. Both H-Y TCR and AND TCR transgenic mice were used to test this hypothesis. Although BCL-2 and BCL-XL increase total cell number in the thymus, they do not allow functional self-reactive T cells to appear in the periphery (98, 108, 109). Thus, both BCL-2 and BCL-XL are unable to completely block negative selection. Several TCR transgenic mouse models have been used to assess the role of BCL-2 in positive selection in the thymus (107, 108, 118). Recently, the role of

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BCL-XL-regulated apoptosis in thymocyte selections has been examined using a similar approach (98, 109). Expression of a Bcl-2 transgene in H-Y TCR mice on a positive or a nonselecting background resulted in significant increase in the total thymocyte number (108, 118). Most of the increase was CD4−8+ SP cells that expressed endogenous TCR α-chain rather than the transgenic TCR α-chain (108). To avoid the complication due to endogenous rearrangements, a scid background was used in one study (118). The data show that BCL-2 expression could enhance the survival of DP thymocytes in the absence of a positive signal from the TCR. Whether TCR transgenes are restricted by either MHC class I (H-Y) or class II (AND), BCL-2 and BCL-XL preferentially affect the development of the CD8 lineage (107–109). The mechanism of lineage commitment has been a highly debated topic in T cell development, and many models have been proposed to explain various experimental observations (119). The observation that BCL-2 family preferentially affects CD8 lineage maturation favors an asymmetric model for CD4 vs CD8 lineage commitment (120–123). Of note, the preferential impact of BCL-2 is dependent on the presence of MHC, suggesting that it acts downstream of the TCR/MHC signal (107). Presumably, BCL-2 and BCL-XL may regulate mechanisms downstream of TCR signaling and give the necessary signal for CD8 lineage commitment.

BCL-2 FAMILY AND CELL CYCLE REGULATION Homeostasis of cell numbers requires a careful balance between input (proliferation) and output (cell death) processes. Neoplasm results when the balance is offset by an aberration in either process. The question remains as to how these two processes are coordinated to achieve a balance within each lineage. One hypothesis is that two independent genetic pathways exist to regulate cell division and cell death; and the regulation would be at the level of extracellular signals. For example, only a defined number of neurons survive in development because they have to compete for the limited amount of trophic factor in the environment (124). An alternative hypothesis is that each cell autonomously coordinates two processes and makes the decision to divide or to die. In support of this hypothesis, Rat-1 fibroblasts overexpressing Myc are unable to arrest growth in the absence of serum and progress to apoptosis (24). The apoptotic attribute of c-Myc is inseparable from its mitogenic property, and dimerization with Max is necessary for both functions (125). The evidence argues that proliferation and apoptosis are coupled through downstream targets of Myc. Consequently, improper activation and aberrant cell cycle progression will prompt individual cells to initiate suicide. Bcl-2 defines a new class of proto-oncogenes that block cell death without promoting cell proliferation (12). However, studies have indicated an additional

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role of BCL-2 in regulation of cell cycle progression (126–129). Bcl-2-deficient T cells demonstrate accelerated cell cycle progression and increased apoptosis following activation (126). In contrast, thymocytes from LckPr-Bcl-2 display a decreased level of proliferation; and BCL-2 overexpressing peripheral T cells exhibit delayed entry to S phase and diminished IL-2 production upon activation (126–128). Since a CASPASE inhibitor that also blocks apoptosis has no substantial effect, the effect of BCL-2 is likely independent of its function in survival (126). Moreover, NFAT nuclear translocation and NFAT-mediated transactivation are impaired in the BCL-2 overexpressing T cells (126). One recent study provides evidence that the effect of BCL-2 on NFAT translocation may be through its interaction and regulation of calcineurin (130). In addition, another study has suggested that BCL-2 overexpression in myeloid cells promotes withdrawal into G0 in response to a differentiation-inducing signal (129). Another BCL-2 family member, BCL-XL, has a similar inhibitory effect on cell cycle entry in activated T cells and fibroblasts (DT Chao, SJ Korsmeyer, unpublished data) (128). Curiously, thymocytes in Lck-Bax transgenic mice have increased percentage of cells in S/G2/M phase (CM Knudson, DT Chao, SJ Korsmeyer, unpublished data). Thus, a role in cell cycle regulation may be not unique to BCL-2 but a common feature of the family. It is conceivable that BCL-2 family helps to coordinate the opposing pathways of proliferation and death in a cell autonomous manner. ACKNOWLEDGMENTS We thank Mary Pichler for her assistance in preparing the manuscript. Visit the Annual Reviews home page at http://www.AnnualReviews.org.

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CHAO & KORSMEYER ity to cell death in B lymphocytes. EMBO J. 13:683–91 Grillot DA, Merino R, Pena JC, Fanslow WC, Finkelman FD, Thompson CB, Nunez G. 1996. bcl-x exhibits regulated expression during B cell development and activation and modulates lymphocyte survival in transgenic mice. J. Exp. Med. 183:381–91 Fang W, Mueller DL, Pennell CA, Rivard JJ, Li Y-S, Hardy RR, Schlissel M, Behrens TW. 1996. Frequent aberrant immunoglobulin gene rearrangement in ProB cells revealed by a bcl-xL transgene. Immunity 4:291–99 McDonnell TJ, Nunez G, Platt FM, Hockenberry D, London L, McKearn JP, Korsmeyer SJ. 1990. Deregulated Bcl2-immunoglobulin transgene expands a resting but responsive immunoglobulin M and D-expressing B-cell population. Mol. Cell Biol. 10:1901–7 Chao DT, Linette GP, Boise LH, White LS, Thompson CB, Korsmeyer SJ. 1995. Bcl-xL and Bcl-2 repress a common pathway of cell death. J. Exp. Med. 182:821– 28 Linette GP, Grusby MJ, Hedrick SM, Hansen TH, Glimcher LH, Korsmeyer SJ. 1994. Bcl-2 is upregulated at the CD4+CD8+ stage during positive selection and promotes thymocyte differentiation at several control points. Immunity 1:197–205 Tao W, Teh SJ, Melhado I, Jirik F, Korsmeyer SJ, Teh HS. 1994. The T cell receptor repertoire of CD4–8+ thymocytes is altered by overexpression of the BCL2 protooncogene in the thymus. J. Exp. Med. 179:145–53 Chao DT, Korsmeyer SJ. 1997. The role of Bcl-XL regulated apoptosis in T cell development. Int. Immunol. 9:1375–84 Mombaerts P, Iacomini J, Johnson RS, Herrup K, Tonegawa S, Papaioannou VE. 1992. Rag-1-deficient mice have no mature B and T lymphocytes. Cell 68:869– 77 Guidos CJ, Williams CJ, Grandal I, Knowles G, Huang MT, Danska JS. 1996. V(D)J recombination activates a p53dependent DNA damage checkpoint in scid lymphocyte precursors. Genes Dev. 10:2038–54 Young F, Mizoguchi M, Bhan AK, Alt FW. 1997. Constitutive Bcl-2 expression during immunoglobin heavy chainpromoted B cell differentiation expands novel precursor B cells. Immunity 6:23– 33

113. Strasser A, Harris AW, Corcoran LM, Cory S. 1994. Bcl-2 expression promotes B- but not T-lymphoid development in scid mice. Nature 368:457–60 114. Peschon JJ, Morrissey J, Grabstein KH, Ramsdell F, Maraskovsky E, Gliniak BC, Park LS, Williams DE. 1994. Early lymphocyte expansion is severely impaired in interleukin 7 receptor-deficient mice. J. Exp. Med. 180:1955–60 115. von Freeden-Jeffry U, Vieria P, Lucian LA, McNeil T, Burdach SE, Murray R. 1995. Lymphopenia in interleukin (IL)7 gene-deleted mice identifies IL-7 as a nonreductant cytokine. J. Exp. Med. 181:1519–26 116. Akashi K, Kondo M, von Freeden-Jeffry U, Murray R, Weissman IL. 1997. Bcl2 rescue T lymphopoiesis in interleukin7 receptor-deficient mice. Cell 89:1033– 41 117. Susin SA, Zamzami N, Castedo M, Hirsch T, Marchetti P, Macho A, Daugas E, Geuskens M, Kroemer G. 1996. Bcl2 inhibits the mitochondrial release of an apoptogenic protease. J. Exp. Med. 184:1331–41 118. Strasser A, Harris AW, von Boehmer H, Cory S. 1994. Positive and negative selection of T cells in T cell receptor transgenic mice expressing a bcl-2 transgene. Proc. Natl. Acad. Sci. USA 91:1376–80 119. von Boehmer H. 1996. CD4/CD8 lineage commitment: back to instruction? J. Exp. Med. 183:713–15 120. Suzuki H, Punt JA, Granger LG, Singer A. 1995. Asymmetric signaling requirements for thymocyte commitment to the CD4+ versus CD8+ T cell lineages: a new perspective on thymic commitment and selection. Immunity 2:413–25 121. Lundberg K, Heath W, Kontgen F, Carbone FR, Shortman K. 1995. Intermediate steps in positive selection: differentiation of CD4+8∫ TCR∫ thymocytes into CD4–8+TCRhi thymocytes. J. Exp. Med. 181:1643–51 122. Veillette A, Bookman MA, Horak EM, Bolen JB. 1988. The CD4 and CD8 T cell surface antigen are associated with the internal membrane tyrosine-protein kinase p56lck. Cell 55:301–9 123. Goldrath AW, Hogguist KA, Bevan MJ. 1997. CD8 lineage commitment in the absence of CD8. Immunity 6:633–42 124. Oppenheim RW. 1991. Cell death during development of the nervous system. Annu. Rev. Neurosci. 14:453–501 125. Harrington EA, Fanidi A, Evan GI. 1994. Oncogenes and cell death. [Review] [112

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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Annu. Rev. Immunol. 1998. 16:421–32 c 1998 by Annual Reviews. All rights reserved Copyright

DIVERGENT ROLES FOR FC RECEPTORS AND COMPLEMENT IN VIVO Jeffrey V. Ravetch and Raphael A. Clynes Laboratory of Molecular Genetics and Immunology, Rockefeller University, 1230 York Avenue, New York, NY 10021; e-mail: [email protected] KEY WORDS:

immune complex, inflammation, anaphylaxis, glomerulonephritis, innate immunity

ABSTRACT Recent results obtained in mice deficient in either FcRs or complement have revealed distinct functions for these two classes of molecules. While each is capable of interacting with antibodies or immune complexes, the two systems mediate distinct biological effector responses. Complement-deficient mice are unable to mediate innate immune responses to several bacterial pathogens and bacterial toxins, yet respond normally to the presence of cytotoxic antibodies and pathogenic immune complexes. In contrast, FcR-deficient mice display no defects in innate immunity or susceptibility to a variety of pathogens, yet they are unable to mediate inflammatory responses to cytotoxic IgG antibodies or IgG immune complexes, despite the presence of a normal complement system. These results lead to the surprising conclusion that these two systems have evolved distinct functions in host immunity, with complement and its receptors mediating the interaction of natural antibodies (IgM) with pathogens to effect protection, while FcRs couple the interaction of IgG antibodies to effector cells to trigger inflammatory sequelae. These results necessitate a fundamental revision of the role of these antibody-binding systems in the immune response.

INTRODUCTION A variety of systems are known that can interact with antibody molecules. Three general classes of molecules have been described: 1. The complement components, 2. the Fc receptors, and 3. the immunoglobulin transporters. Structural 421 0732-0582/98/0410-0421$08.00

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characterization of all of these systems has recently been reviewed in a variety of recent publications (1–8), and distinct features of each system have been revealed. Thus, the complement components interact with IgM and IgG immune complexes initiated by the binding of C1q, thereby triggering the well-known “classical pathway” of complement activation, resulting in the generation of C3 and its proteolytic components (1). In contrast, Fc receptors are a diverse multigene family of the immunoglobulin supergene class that either activate or inhibit cellular responses (2–6). The activatory receptors are members of the ITAM family (9, 10), which includes TCR and BCR; they are composed of a ligand binding α chain, which confers ligand specificity and affinity, and an associated γ chain (11–14), which bears the ITAM sequence required for the recruitment and activation of src and syk family protein tyrosine kinases (15). In contrast, the inhibitory receptors are single-chain polypeptides in which the extracellular domain is highly homologous with its activatory counterpart, and its cytoplasmic domain contains the inhibitory sequence of the LxYxxL class (16–18). Upon coligation of the inhibitory FcR to an ITAM containing FcR, cell activation is inhibited by the recruitment of an inositol polyphosphate phosphatase, SHIP, which mediates the inhibition of calcium influx (19, 20). Finally, the immunoglobulin transporters include the poly IgR and FcRn. Both are members of the Ig superfamily, the former specific for polymeric IgA and IgM (21, 22), while the latter bind IgG (23–25) and effect transcytosis across epithelial membranes. FcRn is a homologue of the MHC class I molecule composed of an α chain associated with β2 microglobulin and functions not only in trancytosis of IgG but as the protective receptor postulated by Brambell (26, 27) to account for the long half-life of IgG1 in serum (28–30). Given this redundancy of molecules with the capability of binding to immunoglobulin, assigning discrete biological functions to each class of receptors has resulted in a considerable degree of confusion and suggestions of biological overlap. However, the recent generation of specific mouse strains deficient in individual components of each class has revealed a striking result—each class has specific biological roles in antibody-mediated effector responses, acting autonomously and independently of the remaining classes. Thus, as is described in detail below, the role of each system in antibody-triggered inflammation is nonoverlapping, thus illustrating that complement activation is not involved in immune complex–triggered inflammation but is essential in mediating protection through natural antibody in innate responses. Conversely, FcRs do couple cytotoxic and immune complex IgG to effector cells and initiate the inflammatory cascade, thereby playing the dominant role in autoantibody-triggered autoimmune diseases. However, FcR-deficient mice appear to be as equally susceptible as their wild-type littermates to infection by a variety of bacterial, fungal, protozoan, or helminthic pathogens.

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Activation Receptor Knockouts Mice possess a single gene for the α subunit of the high-affinity IgE receptor FcRI (31, 32) and single genes for the IgG FcRs, Fcγ RI, Fcγ RIIB, and Fcγ RIII (33–36). The common γ subunit is required for the surface expression and signal transduction of the high-affinity IgE receptor, FcRI, the highaffinity IgG receptor Fcγ RI, and the low-affinity activation receptor, Fcγ RIII (11–14). Mice with targeted insertion into this subunit thus fail to express these three FcRs. Expression of the inhibitory receptor Fcγ RIIB is retained. Initial characterization of γ chain–deficient mice revealed a defect in IgE-triggered passive anaphylaxis, either cutaneous or sytemic, due to the absence of FcRI on mast cells and basophils (37). Similarly, disruption of the FcRI α subunit resulted in an identical phenotype (38), indicating that this receptor is the only molecule capable of initiating the effector response to IgE cross-linking. The situation changed, however, when active anaphylaxis was compared in γ chain or FcRIα chain–deficient mice. Immunization with DNA in Bordatella pertussis and Alum resulted in IgE anti-DNP titers twofold to threefold over background. However, when these sensitized mice were challenged with antigen and systemic anaphylaxis was measured by changes in core body temperature, heart rate, or blood pressure, only the common γ chain–deficient mice were protected (39). Paradoxically, FcRIα-deficient mice demonstrated an exacerbation of the anaphylactic response. Characterization of these animals revealed that the IgG-mediated pathways were the significant ones in mediating active anaphylaxis, and the increased susceptibility of FcRIα-deficient mice resulted from an increased expression of Fcγ RIII, indicating that γ chain was limiting and competition between these two receptors for assembly determined the surface expression levels (40). Hence, decreased FcRIα expression relieved this competition and resulted in more Fcγ RIII on mast cells, with a correspondingly enhanced systemic anaphylactic response. Thus, despite the presence of antigen-specific IgE bound to mast cells and the availability of antigen to crosslink these receptors, the contribution of this pathway is minimal when compared to the IgG component binding to Fcγ RIII on its effector cells, which includes mast cells, neutrophils, macrophages, and NK cells in evoking an anaphylactic response. These data are compatible with studies in IgE-deficient mice, where active anaphylaxis was unimpaired, again illustrating the importance of IgG and Fcγ RIII in murine models of anaphylaxis (41). The situation for IgG-mediated inflammatory responses, as seen for cytotoxic antibodies or immune complexes has been greatly clarified by the availability of complement C3-, C4-, or FcR-deficient mice. Several models of cytotoxic antibody–triggered inflammation have been studied in these animals. Rabbit

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IgG raised against murine red blood cells mediated an acute anemia when injected into wild-type mice (42). Injection of these antibodies into FcR γ chain, C3- or C4-deficient mice demonstrated that complement-deficient mice are equally susceptible to the effects of these antibodies, while γ chain–deficient mice are protected (43). Examination of the livers of these animals revealed that IgG opsonized RBCs are cleared by Kupfer cell erythrophagocytosis, which is absent in FcR γ chain–deficient animals. A similar situation was found to exist for a murine monoclonal antibody directed against mouse platelets (42, 43). Injection of this antibody resulted in rapid clearance of platelets in wild-type, C3- or C4-deficient mice and in protection in FcR γ chain–deficient animals, indicating that the effector pathways initiated by Fcγ RI and III are responsible for the thrombocytopenia induced by this antibody. A particularly striking example of the role of FcR-mediated pathways in cytotoxic antibody responses is seen in a murine model of metastatic melanoma, for which a protective mAb has been described (44). This IgG2a antibody (TA99) is directed against the melanosome protein gp75, the product of the brown locus. Injection of B16 melanoma cells i.v. results in the appearance of diffuse metastatic disease in the lungs of B6 mice. Passive administration of TA99 beginning at the time of introduction of the tumor cells and continuing for the two-week period results in significant reduction in the number of tumor nodules in the lung when compared to treatment with an isotype-matched control (250 vs 50). If the B6 recipients have a disruption in the FcR γ chain gene, the number of nodules in the lung are the same with TA99 treatment or with an isotype-matched control (250 vs 250). Thus, the ability of TA99 to inhibit metastatic tumor implantation depends upon the functioning of Fcγ RI and/or III (R Clynes, Y Takechi, Y Moroi, A Houghton, JV Ravetch, submitted). Depletion studies have shown that NK cells as well as monocytes contribute to this tumor clearance (44, 45), suggesting Fcγ RIII as the primary receptor responsible for the ADCC mediated by TA99. An alternative approach has been taken to evaluate the role of FcRs in tumor immunity by using recombinant gp75 to immunize either B6 or B6/FcR γ -deficient mice (46). The polyclonal response generated by this immunization results in a similar degree of protection as seen for TA99, in the case of B6 wild-type mice, but such response is unable to offer protection in the FcR γ -deficient animals (R Clynes, Y Takechi, Y Moroi, A Houghton, JV Ravetch, submitted). These studies convincingly demonstrate the dominant role of FcRs and IgG antibodies in the effector stage of a heterologous response. The interaction of IgG immune complexes with C1q is a well-established observation and underlies the central role attributed to complement in mediating the effector responses seen in autoimmune diseases such as lupus and rheumatoid arthritis. The cutaneous model for immune complex disease, the

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Arthus reaction, results from the deposition of immune complexes in the skin after injection of antigen (47). Edema, hemorrhage, and neutrophil infiltration are characteristic inflammatory changes seen in this reaction, attributed to the generation of C3b. It was thus unexpected that C3- (or C4-)-deficient mice would mount a normal Arthus reaction (43), while FcR γ - or FcRIIIα-deficient mice lack the ability to mount the Arthus reaction (48, 49). Further characterization of this model revealed that mast cell–deficient mice are attenuated for the Arthus reaction, which can be reconstituted with mast cells derived from wild-type (50) but not FcR γ -deficient mice (51). Thus, the conclusion of these studies is that the Arthus reaction requires Fcγ RIII on mast cells and is independent of complement components to mediate its inflammatory sequelae. The Arthus reaction is thus comparable to the type I hypersensitivity reaction in which antibody (IgE) binds to a cognate receptor (FcRI) on mast cells to trigger the inflammatory cascade. Type III inflammation thus involves the binding of IgG immune complexes to Fcγ RIII on mast cells, triggering a similar activation profile. It is notable that Arthus, in describing his observations in 1903, equates the reaction he described to an anaphylactic reaction in rabbits to horse serum (using the term anaphylaxis as described by Richet and Portier for immediate hypersensitivity). The prediction of studies on the Arthus reaction in FcR-deficient or complement-deficient mice would be that systemic models of immune complex injury, as seen in autoimmune models of glomerulonephritis, for example, would be attenuated by disruption of FcR but not complement genes. Such studies have recently been reported. In an induced model of glomerulonephritis (in which rabbit antimouse glomerular basement membrane antibodies are injected into mice presensitized to rabbit IgG), proteinuria and glomerular changes of mesangial thickening, sclerosis, and inflammatory cell infiltrate are attenuated in FcR γ chain–deficient mice (Y Suzuki, I Shirato, Y Tomin, K Okomura, T Takai, C Ra, submitted). Complement depletion with cobra venom factor did not influence the incidence or progression of disease in this model. The NZB/NZW model is a well-characterized murine model of lupus, demonstrating many of the characteristics of the human disease (52, 53). Thus, F1 animals develop autoantibodies and immune complex deposition in glomeruli, leading to glomerulonephritis and a mean survival of six months. The FcR γ chain–disrupted allele was backcrossed onto the NZB and NZW parent for eight generations, and the intercrossed F1 monitored for the appearance of autoantibodies, immune complexes, proteinuria, and glomerulonephritis. Mice heterozygous for the FcR γ chain had a disease course indistinguishable from that of the parental strains, while the homozygous, disrupted FcR γ -bearing NZB/NZW F1 had autoantibodies, circulating immune complexes, and immune complex deposition in the glomeruli, with complement C3 deposition, yet no histological evidence

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of disease or proteinuria at six months (when heterozygote littermates were in a premorbid state) and a mean survival in excess of 10 months and ongoing (R Clynes, C Dumitru, JV Ravetch, submitted). Thus, despite the presence of immune complexes in the kidney, with C3 deposition, the absence of Fcγ RI and III prevented the initiation of an inflammatory reaction and attenuated disease in this spontaneous model of autoimmune glomerulonephritis. In contrast, crossing the complement deficiency onto an B6/lpr model of autoimmune glomerulonephritis resulted in exacerbation of disease (M Carroll, personal communication), consistent with the conclusion that FcRs and not complement are the mediators of immune complex activation of effector responses in vivo. Finally, several studies have begun to address the role of FcRs in immunity to pathogens, focusing on the role of IgE and its receptor in the clearance of helminthic infections and the role of IgG FcRs in immunity to microbial pathogens like streptococcus (R Clynes, B Diamond, JV Ravetch, unpublished data) and cryptococcus (R Yuan, R Clynes, J Oh, JV Ravetch, MD Scharff, submitted). The results of those studies suggest that susceptibility to infection by these pathogens is not influenced by the presence or absence of FcR genes, with knockout mice and their heterozygous littermates showing identical susceptibility. Models in which mice are protected by passive immunization with IgG antibodies reveal the now-expected result that protective IgG1, 2a, and 2b antibodies require the presence of an intact FcR system to mediate their responses. IgG3 antibodies, by virtue of their interaction with a distinct IgG3 FcR, have separable biological properties not affected by FcRI, II, or III. Unexpectedly, S. mansoni-induced granulomas are influenced by the presence of antibody and FcRs. Infection of FcR-deficient or B cell–deficient animals with this trematode results in augmented granuloma formation during the initial stages of infection (D Jankovic, A Cheever, M Kullberg, T Wynn, G Yap, P Casper, F Lewis, R Clynes, J Ravetch, A Sher, submitted; 72). Additionally, the modulation of granuloma formation, which occurs at late stages of infection in wild-type mice, is not observed in B cell- and FcR-deficient mice, indicating a role for immune complex–triggered effector responses in this classical T cell–mediated reaction.

INHIBITORY RECEPTOR KNOCKOUTS Balancing the activation properties of FcRs is the inhibitory receptor Fcγ RIIB. This single chain transmembrane protein binds immune complexes with low affinity; it is structurally homologous to Fcγ RIII and indeed binds ligand in an indistinguishable manner. It is the most widely expressed of FcRs and is present on all hematopoietic lineages with the exception of red blood cells and NK cells (2–6). The receptor does not trigger cellular responses to ligand cross-linking,

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unless the ligand is able to bridge both activation and inhibitory receptors. Thus, on B cells, Fcγ RIIB inhibits BCR-triggered lymphocyte proliferation, antibody secretion, and lymphokine release (54–56), while on mast cells, macrophages and neutrophils studies have shown that Fcγ RIIB is co-ligated to Fcγ RIII, thereby inhibiting cellular activation (57, 58; T Takai, R Clynes, M Ono, JV Ravetch, unpublished data). It follows that modulation of FcRIIB would determine the activation state of the cell and indeed has been observed for mast cells and macrophages. Disruption of FcRIIB would be expected to have proinflammatory effects. Antibody responses to antigen are 5–10-fold elevated in RIIB-deficient mice, as compared to wild-type (58), and peripheral cutaneous anaphylaxis (PCA) to IgG complexes results in enhanced mast cells activation by a similar factor (58). Models of inflammatory disease have begun to be studied in these mice, and they reveal that induced glomerulonephritis is exacerbated in RIIB-deficient animals (Y Suzuki, I Shirato, Y Tomin, K Okomura, T Takai, C Ra, submitted). Clearly, as additional models of inflammation are applied to these mice, the range of this receptor in setting thresholds for immune complex stimulation will become apparent.

COMPLEMENT-DEFICIENT MICE C3 and C4 Deficiencies Strains with targeted disruptions of C3 or C4 have been constructed and tested in vivo for their contributions to innate and adaptive immunity. Since C4 is activated via the “classical pathway” and C3 can be activated through either the classical or alternative pathway, the use of these two strains of mice reveals the contributions of each arm of the complement activation system. As summarized above, C3- or C4-deficient mice have a normal Arthus reaction, and their ability to mediate type II (cytotoxic antibody) triggered inflammation appears unaffected in a variety of model systems, including immune hemolytic anemia and immune thrombocytopenia. Thus, neither the classical or alternative pathway is required for the inflammatory response initiated by IgG immune complexes or IgG cytotoxic antibodies. In contrast, C3- or C4-deficient mice are highly susceptible to a variety of bacterial pathogens, such as Group B streptococcus (59), S. typhimurium endotoxemia (60), and acute septic peritonitis (61). Thus, in a murine GBS model, C3- or C4-deficient mice demonstrated an LD50 50- and 25-fold lower than wild-type littermates (59). C3- or C4-deficient mice were highly sensitive to i.p. injection of LPS isolated from S. typhimurium, with a significantly reduced survival rate relative to wild-type controls (60). RAG2- or Btk-deficient mice also had an increased sensitivity to LPS, which could be reversed by the introduction of pooled normal mouse serum or purified IgM to the deficient recipients

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(62). Finally, in a model of septic peritonitis, cecal ligation and puncture (CLP), which is known to require mast cells and TNF-α, C3- or C4-deficient mice were dramatically more sensitive than wild-type controls (61). Thus, activation of peritoneal mast cells in the CLP model is complement dependent. Preliminary results suggest that recognition of enteric bacteria and activation of classical pathway complement are mediated by natural antibody (R Reid, A Prodeus, M Carroll, unpublished results). In each case complement is essential in innate immunity to bacterial pathogens. Complement is thought to participate in host defense against bacterial infection at several stages, including the direct lysis of bacteria by the C5bC9 membrane attack complex, opsonization of bacteria by C3b and iC3b ligands, and activation and chemotaxis of neutrophils via C3a and C5a peptides (63, 64, 65). These present studies extend these roles to the interaction of natural IgM antibodies with bacteria and the activation of complement-mediated clearance pathways.

FUTURE DIRECTIONS The in vivo studies described above have revealed an unexpected dichotomy in the mechanisms by which antibodies trigger effector responses. The classical pathway of complement activation by immune complexes turns out to be significant for IgM antibodies, and in particular natural antibodies, in the innate response to pathogens. Despite the potent interaction of IgG immune complexes with complement components in vitro, the in vivo action of complement in these reactions does not appear to play a major role. Future studies will need to focus on extending the observations in the model systems described to additional tissues (66, 67) and organisms, to determine if the conclusions based on the murine models of cutaneous or glomerular inflammation are generalizable to other tissue compartments and to other species. A significant area of ambiguity still remains in the role of FcRs, complement, and FcRns in clearance of IgG immune complexes. The murine strains now exist to test the contribution of each system to clearance and determine the relative significance of each. Ample evidence exists to suggest that complement deficiencies in humans contribute to autoimmune disease (68, 69). Does this reflect a defect in clearance of immune complexes or in the regulation of the antibody response, a pathway clearly dependent on complement (70, 71). The answer to this question is central to our understanding of the mechanisms of antibody homeostasis in the intact organism. There is little doubt that the unexpected results obtained in the deficient strains represent only the beginning of a dissection of the interaction of antibodies with effector cells and the generation of the inflammatory response. More surprises certainly await.

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Table 1 Inflammatory responses and innate immunity in FcR and complement gene-targeted mice

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Targeted genes

Type I

Type II

Type III

Innate

Fcγ RI,III

Attenuated passive, active (39)

Attenuated in induced anemia, thrombocytopenia, ADCC (42)

Attenuated Arthus (48), B/W glomerulonephritis,b GBM nephritisc

No effect in Strepd, Cryptococcuse, increased granuloma in Shistof

Fcγ RIIIα

n.d.

n.d.

Attenuated Arthus (49)

n.d.

Fcγ RII

Enhanced passive to IgG (58)

Enhanced phagocytosis, ADCCa

Enhanced GBM nephritisc

n.d.

FcRIα

Attenuated passive to IgE (38), enhanced active (40)

n.d.

No effect

Increased granuloma in Shisto (72)

C3

No effect

No effect (43)

No effect in Arthus (43), Autoimmune GNb, GBM nephritisc

Enhanced sensitivity to Strep (59), LPS (60), enterococci (CLP) (61)

C4

No effect

No effect (43)

No effect in Arthus (43)

Enhanced sensitivity (59, 60, 61)

a

T Takei, R Clynes, M Ono, J V Ravetch. (unpublished data) R Clynes, C Dumitru, J V Ravetch. (submitted) c Y Suzuki, I Shirato, Y Tomin, K Okomura, T Takai, C Ra. (submitted) d R Clynes, B Diamond, J V Ravetch. (unpublished data) e R Yuan, R Clynes, J Oh, J V Ravetch, M D Scharff. (submitted) f D Jankovic, A Cheever, M Kullberg, T Wynn. G Yap, P Casper, F Lewis, R Clynes, J Ravetch, A Sher. (submitted) b

ACKNOWLEDGMENTS The authors wish to acknowledge the support of the National Institutes of Health and our colleagues who generously shared their unpublished observations. We are grateful to Michael Carroll for critically reading this manuscript and to the members of the Ravetch laboratory for helpful discussions. Visit the Annual Reviews home page at http://www.AnnualReviews.org.

Literature Cited 1. Liszewski MK, Farries TC, Lublin DM., Rooney IA, Atkinson JP. 1996. Control of the complement system. Adv. Immunol. 61:201–83 2. Ravetch JV. 1997. Fc receptors. Curr. Opin. Immunol. 9:121–25 3. Daeron M. 1997. Fc receptor biology. Annu. Rev. Immunol. 15:203–34 4. Ravetch JV. 1994. Fc receptors: rubor redux. Cell 78:553–60 5. Hulett MD, Hogarth PM. 1994. Molecu-

lar basis of Fc receptor function. Adv. Immunol. 57:1–127 6. Ravetch JV, Kinet JP. 1991. Fc receptors. Annu. Rev. Immunol. 9:457–92 7. Simister N, Story C. 1996. Fcγ receptors in human placenta. In Human IgG Fc Receptors, ed. J van de Winkle, P Capel, 1:25–38. New York: Chapman & Hall 8. Mostov KE. 1994. Transepithelial transport of immunoglobulins. Annu. Rev. Immunol. 12:63–84

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9. Reth M. 1989. Antigen receptor tail clue. Nature 338:383–84 10. Cambier JC. 1995. New nomenclature for the Reth motif (or ARH1/TAM/ARAM/ YXXL). Immunol. Today 16:110 11. Ernst LK, van der Winkle JG, Chiu IM, Anderson CL. 1993. Association of the high affinity receptor for IgG (Fcγ RI) with the γ subunit of the IgE receptor. Proc. Natl. Acad. Sci. USA 90:6023–27 12. Kurosaki T, Ravetch JV. 1989. A single amino acid in glycosylphosphotidylinositol attachment domain determines the membrane topology of Fcγ RIII. Nature 326:292–95 13. Lanier LL, Yu G, Phillips JH. 1989. Co-association of CD3ζ with a receptor (CD16) for IgG on human natural killer cells. Nature 341:803–6 14. Ra C, Jouvin M-H, Blank U, Kinet J-P. 1989. A macrophage Fcγ receptor and the mast cell receptor for immunoglobulin E share an identical subunit. Nature 341:752– 54 15. Weiss A, Littman DR. 1994. Signal transduction by lymphocyte antigen receptors. Cell 76:263–74 16. Muta T, Kurosaki T, Misulovin Z, Sanchez M, Nussenzweig MC, Ravetch JV. 1994. A 13-amino-acid motif in the cytoplasmic domain of Fc gamma RIIB modulates B-cell receptor signaling. Nature 368:70–73 17. Amigorena S, Bonnerot C, Drake JR, Choquet D, Hunziker W, Guillet JG, Webster P, Sautes C, Mellman I, Fridman WH. 1992. Cytoplasmic domain heterogeneity and functions of IgG Fc receptors in B lymphocytes. Science 256:1808–12 18. Daeron M, Latour S, Malbec O, Espinosa E, Pina P, Pasmans S, Fridman WH. 1995. The same tyrosine-based inhibition motif, in the intracytoplasmic domain of Fc gamma RIIB, regulates negative BCR-, TCR- and FcR-dependent cell activation. Immunity 3:635–46 19. Ono M, Bolland S, Tempst P, Ravetch JV. 1996. Role of the inositol phosphatase SHIP in negative regulation of the immune system by the receptor Fc(gamma)RIIB. Nature 383:263–66 20. Ono M, Okada H, Bolland S, Yanagi S, Kurosaki T, Ravetch JV. 1997. Deletion of SHIP or SHP-1 reveals two distinct pathways for inhibitory signalling. Cell 90:293–301 21. Piskurich JF, Blanchard MH, Youngman KR, France JA, Kaetzel CS. 1995. Molecular cloning of the mouse polymeric Ig receptor. Functional regions of the molecule are conserved among five mammalian species. J. Immunol. 154:1735–47

22. Mostov KE, Friedlander M, Blobel G. 1984. The receptor for transepithelial transport of IgA and IgM contains multiple immunoglobulin-like domains. Nature 308:37–43 23. Simister NE, Story CM, Chen HL, Hunt JS. 1996. An IgG-transporting Fc receptor expressed in the syncytiotrophoblast of human placenta. Eur. J. Immunol. 26:1527– 31 24. Leach JL, Sedmak DD, Osborne JM, Rahill B, Lairmore MD, Anderson CL. 1996. Isolation from human placenta of the IgG transporter, FcRn, and localization to the syncytiotrophoblast: implications for maternal-fetal antibody transport. J. Immunol. 157:3317–22 25. Israel EJ, Patel VK, Taylor SF, MarshakRothstein A, Simister NE. 1995. Requirement for a beta 2-microglobulin-associated Fc receptor for acquisition of maternal IgG by fetal and neonatal mice. J. Immunol. 154:6246–51 26. Brambell FWR, Hemmings WA, Morris IG. 1964. A theoretical model of γ globulin catabolism. Nature 203:1352– 58 27. Junghans RP. 1997. Finally: the Brambell receptor (FcRB). Mediator of transmission of immunity and protection from catabolism for IgG. Immunol. Res. 16:29– 57 28. Ghetie V, Hubbard JG, Kim JK, Tsen MF, Lee Y, Ward ES. 1996. Abnormally short serum half-lives of IgG in beta 2microglobulin-deficient mice. Eur. J. Immunol. 26:690–96 29. Junghans RP, Anderson CL. 1996. The protection receptor for IgG catabolism is the beta 2-microglobulin-containing neonatal intestinal transport receptor. Proc. Natl. Acad. Sci. USA 93:5512–16 30. Israel EJ, Wilsker DF, Hayes KC, Schoenfeld D, Simister NE. 1996. Increased clearance of IgG in mice that lack beta(2)microglobulin—possible protective role of FcRn. Immunology 89:573–78 31. Kinet JP, Metzger H, Hakimi J, Kochan J. 1987. A cDNA presumptively coding for the alpha subunit of the receptor with high affinity for immunoglobulin E. Biochemistry 26:4605–10 32. Shimizu A, Tepler I, Benfey PN, Berenstein EH. Siraganian RP, Leder P. 1988. Human and rat mast cell high-affinity immunoglobulin E receptors: characterization of putative alpha-chain gene products. Proc. Natl. Acad. Sci. USA 85:1907–11 33. Sears DW, Osman N, Tate B, McKenzie IF, Hogarth PM. 1990. Molecular cloning and expression of the mouse high affinity

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45. Takechi Y, Hara I, Naftzger C, Xu Y, Houghton AN. 1996. A melanosomal membrane protein is a cell surface target for melanoma therapy. Clin. Cancer Res. 2:1837–42 46. Naftzger C, Takechi Y, Kohda H, Hara I, Vijayasaradhi S, Houghton AN. 1996. Immune response to a differentiation antigen induced by altered antigen: a study of tumor rejection and autoimmunity. Proc. Natl. Acad. Sci. USA 93:14809–14 47. Arthus M. 1903. Injections repetees de serum de cheval cuez le lapin. CR Soc. Biol. 55:817–20 48. Sylvestre DL, Ravetch JV. 1994. Fc receptors initiate the Arthus reaction: redefining the inflammatory cascade. Science 265:1095–98 49. Hazenbos WL, Gessner JE, Hofuis FM, Kuipers H, Meyer D, Heijnen IA, Schmidt RE, Sandor M, Capel PJ, Daeron M, van de Winkle JG, Verbeek JS. 1996. Impaired IgG dependent anaphylaxis and Arthur reaction in Fc gamma RIII (CD16) deficient mice. Immunity 5:181–88 50. Zhang Y, Ramos BF, Jakschik BA. 1991. Augmentation of reverse Arthus reaction by mast cells in mice. J. Clin. Invest. 88:841–46 51. Sylvestre DL, Ravetch JV. 1996. A dominant role for mast cell Fc receptors in the Arthus reaction. Immunity 5:387–90 52. Andrews BS, Eisenberg RA, Theofilopoulos AN, Izui S, Wilson CB, McConahey PJ, Murphy ED, Roths JB, Dixon FJ. 1978. Spontaneous murine lupus-like syndromes. Clinical and immunopathological manifestations in several strains. J. Exp. Med. 148:1198–215 53. Theofilopoulos A, Dixon FJ. 1985. Murine models of systemic lupus erythrematosus. Adv. Immunol. 37:269–390 54. O’Rourke L, Tooze R, Fearon DT. 1997. Co-receptors of B lymphocytes. Curr. Opin. Immunol. 9:324–29 55. Phillips NE, Parker DC. 1983. Fcdependent inhibition of mouse B cell activation by whole anti-mu antibodies. J. Immunol. 130:602–6 56. Phillips NE, Parker DC. 1984. Crosslinking of B lymphocyte Fc gamma receptors and membrane immunoglobulin inhibits anti-immunoglobulin-induced blastogenesis. J. Immunol. 132:627–32 57. Daeron M, Malbec O, Latour S, Arock M, Fridman WH. 1995. Regulation of highaffinity IgE receptor-mediated mast cell activation by murine low-affinity IgG receptors. J. Clin. Invest. 95:577–85 58. Takai T, Ono M, Hikida M, Ohmori H, Ravetch JV. 1996. Augmented humoral and

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65. Hopken UE, Lu B, Gerard NP, Gerard C. 1997. The C5a chemoattractant receptor mediates mucosal defence to infection. Nature 383:86–89 66. Bozic CR, Lu B, Hopken UE, Gerard C, Gerard NP. 1996. Neurogenic amplification of immune complex inflammation. Science 273:1722–25 67. Hopken UE, Lu B, Gerard NP, Gerard C. 1997. Impaired inflammatory responses in the reverse arthus reaction through genetic deletion of the C5a receptor. J. Exp. Med. 186:749–56 68. Davies KA. 1996. Complement, immune complexes and systemic lupus erythematosus. Br. J. Rheumatol. 35:3–23 69. Wolpert MJ, Davies KA, Morley BJ, Botto M. 1997. Complement deficiency and autoimmunity. Ann. N.Y. Acad. Sci. 815:267– 81 70. Carroll MC, Fischer MB. 1996. Complement and the immune response. Curr. Opin. Immunol. 9:64–69 71. Heyman B. 1996. Complement and Fc receptors in regulation of the antibody response. Immunol. Letts. 54:195–99 72. Jankovic D, Kullberg MC, Dombrowicz D, Barbieri S, Caspar P, Wynn TA, Paul WE, Cheever AW, Kinet JP, Sher A. 1997. Fc epsilonRI-deficient mice infected with Schistosoma mansoni mount normal Th2type responses while displaying enhanced liver pathology. J. Immunol. 159:1868–75

Annual Review of Immunology Volume 16, 1998

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

1 27 57 89 111 137 163

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XENOGENEIC TRANSPLANTATION Annu. Rev. Immunol. 1998.16:433-470. Downloaded from arjournals.annualreviews.org by HINARI on 08/31/07. For personal use only.

Hugh Auchincloss, Jr. and David H. Sachs Transplant Unit and Transplantation Biology Research Center, Surgical Services, Massachusetts General Hospital, Boston, Massachusetts 02114 KEY WORDS:

xenotransplants, humoral antibody rejection, tolerance, accommodation, pigs, hyperacute rejection

ABSTRACT This review summarizes the clinical history and rationale for xenotransplantation; recent progress in understanding the physiologic, immunologic, and infectious obstacles to the procedure’s success; and some of the strategies being pursued to overcome these obstacles. The problems of xenotransplantation are complex, and a combination of approaches is required. The earliest and most striking immunologic obstacle, that of hyperacute rejection, appears to be the closest to being solved. This phenomenon depends on the binding of natural antibody to the vascular endothelium, fixation of complement by that antibody, and finally, activation of the endothelium and initiation of coagulation. Therefore, these three pathways have been targeted as sites for intervention in the process. The mechanisms responsible for the next immunologic barrier, that of delayed xenograft/acute vascular rejection, remain to be fully elucidated. They probably also involve multiple pathways, including antibody and/or immune cell binding and endothelial cell activation. The final immunologic barrier, that of the cellular immune response, involves mechanisms that are similar to those involved in allograft rejection. However, the strength of the cellular immune response to xenografts is so great that it is unlikely to be controlled by the types of nonspecific immunosuppression used routinely to prevent allograft rejection. For this reason, it may be essential to induce specific immunologic unresponsiveness to at least some of the most antigenic xenogeneic molecules.

INTRODUCTION Xenotransplantation is defined as the transplantation of organs or tissues between members of different species.1 Clinical interest in xenotransplantation 1 Xenotransplantation was formerly called heterologous transplantation, and this term is still used by Index Medicus and Medline.

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and scientific research in this field have increased enormously in recent years. This review summarizes the clinical history and rationale for xenotransplantation; the progress that has been made in understanding the physiologic, immunologic, and potential infectious barriers to its success; and some of the strategies being persued to overcome these obstacles (see also 1–6). An effort has been made to identify the features that distinguish xenogeneic from allogeneic transplantation. In addition, we have tried to indicate how the study of xenotransplantation contributes to an understanding of regulatory mechanisms in immunology. Many other reviews of the subject have been written in recent years that will provide readers with a different perspective from this one (1–6).

CLINICAL HISTORY AND RATIONALE FOR XENOTRANSPLANTATION Early clinical efforts to accomplish xenotransplantation were first reported by Reemtsma beginning in 1963 and involved several chimpanzee-to-human kidney transplants (7–9). One transplant patient suffered a rejection episode, which was reversed by steroid therapy, and another survived for nine months with normal renal function before dying from the side effects of immunosuppression. These achievements indicated that long-term survival and function of a xenograft can be achieved in humans, even with the relatively ineffective immunosuppression available at that time. Following these reports, Hitchcock indicated that he had performed an unsuccessful baboon-to-human heart transplant one year earlier (10). Subsequently, Starzl performed a series of baboonto-human kidney and liver transplants (11, 12). Others attempted cardiac xenotransplantation from several different species to human patients. None of these early efforts achieved one-year patient or graft survival, although some of the roughly 50 patients treated for liver failure with ex vivo perfusion of animal livers survived after their own liver function improved (13, 14). These early clinical efforts at xenotransplantation were driven both by the mortality of end-stage organ failure unless organ transplantation was performed and by a relative lack of human organs for that purpose. These factors changed in the later part of the 1960s with the greater availability of hemodialysis and the acceptance of the concept of brain death. At the same time, investigators became more aware of the importance of preformed antibodies in transplant rejection, a factor that was recognized to be especially relevant when using xenogeneic donors. Thus, interest in xenogeneic transplantation diminished over the next 15 years. Eventually, the increasing success of allogeneic transplantation and the resulting growth of clinical transplantation led to renewed interest in xenotransplantation. First for pediatric candidates, and eventually for almost all groups of

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patients waiting for organ transplantation, the supply of human organs became inadequate for the increasing number of patients thought likely to benefit from transplantation. Over the past eight years the number of transplants performed annually has increased about 30% while the number of candidates waiting for organ transplantation has increased almost 100%. This increase would probably be even larger if more organs were available, but there are still more than five times as many people currently waiting for organ transplants as will actually receive them each year. The beginning of the renewed effort at clinical xenotransplantation started in 1984 with the pediatric baboon heart transplant performed for the patient known as Baby Fae (15). Since then, surgeons in Pittsburgh have attempted two additional baboon-to-human liver transplants, several institutions have resumed ex vivo perfusion through animal livers (16), and one group has attempted a temporary pig-to-human liver transplant (17). In addition, investigators in Sweden have attempted several fetal pig–to–human islet transplants for diabetic patients and achieved prolonged detection of pig C-peptide and documented survival of porcine cells in at least one patient (18). However, none of these patients achieved a significant reduction in exogenous insulin requirement. Baboon bone marrow has also been transplanted into one patient with AIDS but without evidence of graft survival (19). Finally, fetal pig neural cells have been transplanted into more than a dozen patients with Parkinson’s or Huntington’s disease, and survival of pig tissue was documented in one patient when he died of a pulmonary embolus eight months after the procedure (20). This last effort is the only currently active trial of clinical xenotransplantation. More efforts are likely in the future. Associated with renewed clinical efforts, scientific investigation in the field has increased enormously. Over the past 50 years the number of papers published on xenografting has increased from about 10 per year to about 250 per year. Enormous progress has been made on the basis of this research, both in defining more accurately the barriers to successful xenotransplantation and in suggesting possible solutions to these problems.

TYPES OF XENOTRANSPLANTS AND THEIR SPECIAL FEATURES Xenotransplantation is often thought of in terms of the transplantation of primarily vascularized organs such as the heart or kidney. In these cases, the immediate exposure of donor vascular endothelium to the recipient’s circulation determines the character of the initial immune response. The liver is unusual in this regard because it is unusually resistant to hyperacute rejection although not entirely so (21).

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The other potential application of xenotransplantation is for tissues that are not immediately revascularized such as islets or cell transplants including bone marrow, neural cells, hepatocytes (22, 23), and many others. Because donor endothelium is not involved in these cases, several of the immunologic responses to xenografts discussed below do not occur. However, the use of cellular transplants for xenografting raises a number of special issues.

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Antibody-Mediated Resistance to Cell Transplant Engraftment Although hyperacute rejection does not occur for cellular xenografts, there has been considerable uncertainty about whether preformed or induced antibodies might contribute to rejection of cellular transplants by different mechanisms. The data at this point indicate that while some types of cells may not express the critical α-gal determinant (such as fresh adult β cells from pigs), this epitope is expressed by other cells in pancreatic islets and by other types of cells such as hepatocytes (24, 25). The α-gal determinant is expressed on fetal islets and can be induced in adult islets in in vitro culture and probably by other stimuli. Evidence also indicates that preformed natural antibodies are toxic to islets in vitro both with and without complement (26, 27). Furthermore, strong antibody responses occur following islet and other types of cellular xenotransplants, including responses to the α-gal determinant (28, 29). However, prolonged islet survival can occur in the presence of antibodies directed against them (30), and xenogeneic islet rejection occurs equally rapidly in the absence of an antibody response (31). Bone marrow engraftment can also be achieved in the presence of an antibody response, although in this case more donor cells appear to be required than in allogeneic combinations (32). These results suggest that both preformed and induced antibodies can often bind to xenogeneic cellular transplants and contribute to the resistance to their engraftment. However, since the mechanisms of resistance do not involve the vascular events of hyperacute rejection, the humoral resistance to xenogeneic cellular transplants can probably be overwhelmed by the transplantation of larger numbers of cells.

Privileged Sites Another feature of cell transplantation is that the grafts can be placed in sites that are less apt to generate an immune response. Some of these so-called privileged sites, such as the testis and the thymus, have been used successfully to achieve improved survival of xenogeneic cellular transplants (33). However, this improved survival has been consistently less than that seen in the same sites for allotransplants, indicating that the protection they provide is only a matter of degree. Nonetheless, the survival of pig cells in the brain of a human patient for eight months in a clinical trial, using only cyclosporine for immunosuppression, suggests that the blood-brain barrier provides meaningful protection for xenogeneic cellular transplantation (20).

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Encapsulation Another way of protecting transplanted cells from rejection is to separate them from the immune system by a variety of physical barriers. These devices have been constructed such that neither cells nor antibodies of the immune system can gain access to the transplanted cells but that diffusion of nutrients and critical functional molecules (such as insulin) can still occur (34). Prolonged survival of both allogeneic and xenogeneic cell transplants has been achieved using encapsulation techniques (35), but often survival has been limited eventually by a fibrotic reaction encompassing the encapsulation devise (36, 37). This response has been especially common when transplanting xenogeneic tissues and has been prevented by the use of anti-CD4 therapy (38, 39). These results suggest that a particularly powerful indirect immune response initiates the fibrotic reaction, stimulated by peptides of xenogeneic antigens escaping from the encapsulated tissue.

BARRIERS TO XENOTRANSPLANTATION Physiologic Function of Xenogeneic Organs Perhaps the most important potential barrier to successful xenotransplantation is that some types of organs from disparate species may not function adequately in a new environment. This issue is particularly difficult to evaluate, especially in humans, because so few xenotransplants have survived for prolonged periods. It is known already that chimpanzee kidneys can support human life and that porcine insulin can regulate blood sugar levels in humans. However, there are reports that primates surviving with pig kidney transplants develop marked anemia, raising the possibility that pig erythropoietin may not function properly in primates. In addition, the human recipients of baboon livers have had lower levels of serum cholesterol (consistent with the levels in baboons) and remarkably low levels of serum uric acid (since the baboon liver does not produce uric acid as the human liver does) (16). Also, xenogeneic stem cell engraftment is diminished by the lack of appropriate stem cell growth factors in some species combinations (40–42). These examples indicate that some physiologic functions of xenogeneic organs will remain intact but that others may not. While it seems reasonable to expect that appropriately sized hearts may function adequately in widely disparate species combinations, and that kidneys from pigs may be sufficient to support the renal function required by humans, it is also reasonable to expect that significant deficiencies may exist if metabolically more complex organs, such as the liver, are used for transplantation. Molecular incompatibilities revealed by xenogeneic organ transplantation will be extremely useful in teaching us about the normal physiology of organ function. In addition, the understanding that molecular incompatibilities

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between species may cause a loss of physiologic regulation is important in understanding the nature of the immune response to xenografts. Since the immune system is subject to complex regulatory controls, disorders of these regulatory processes may be a distinguishing feature of xenogeneic graft rejection.

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Hyperacute Rejection Experimental studies during the 1960s established that primarily vascularized xenografts between widely disparate species suffered immediate destruction by hyperacute rejection. The histology of this type of rejection is marked by extensive intravascular thrombosis and extravascular hemorrhage. Because this rejection was similar to that being recognized at the time in ABO-incompatible allografts (and in other patients with preformed alloantibodies), the idea emerged that it was primarily an antibody-mediated lesion. Furthermore, studies of xenotransplantation in numerous species combinations indicated that hyperacute rejection occurred whenever the species disparity was large enough. Calne tried to capture this observation by suggesting the terms concordant, to describe species combinations in which hyperacute rejection did not occur, and discordant, to describe combinations in which it did (43). His terminology has generally been used slightly differently to distinguish species combinations without detectable levels of preformed natural antibodies from those in which they are easily identified. During the 1990s, experimental studies of hyperacute rejection identified several important features of the process. First, a critical mediator of the lesion is complement activation. This usually occurs as a result of preformed antibody binding, but in some species combinations (such as guinea pig–to–rat or pigto-dog) complement activation can occur through the alternative pathway, even in the absence of preformed antibodies (44). Second, the binding of preformed natural antibodies depends on the expression of different endothelial carbohydrate determinants in different species. For example, in the pig-to-human combination, the loss of a functional α-galactosyl transferase enzyme in higher primates made the expression of the α-gal determinant on pig endothelium a novel determinant for humans (45). Third, complement regulatory proteins play a critical role in determining the intensity of hyperacute rejection. These regulatory proteins include DAF (CD56), MCP (CD46), and CD59, which ordinarily diminish or prevent inappropriate complement activation. However, to the extent that these proteins are restricted to homologous target molecules, they do not regulate the function of complement proteins from other species (46). COMPONENTS OF HYPERACUTE REJECTION IN PIG-TO-HUMAN TRANSPLANTATION Antigens that bind natural antibodies An important finding in the past

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several years is that pig endothelium expresses a single dominant epitope that is responsible for binding a large portion of preformed human natural antibodies (47). This gal α(1,3) gal determinant is formed by the action of an α-galactosyl transferase enzyme, which glycosylates N-acetyllactosamine. Humans and all higher order primates after the New World monkeys do not have a functional gene for this transferase and instead use α(1,2) fucosyl transferase to form the H substance from the same substrate. Depending on the blood group of individual human, additional sugars are added to this carbohydrate backbone to form blood groups A or B. Thus, in essence, pigs express a novel blood group antigen relative to all humans. Although the α-gal determinant appears to bind the majority of preformed human natural antibodies and removal of these α-gal binding natural antibodies is sufficient to prevent hyperacute rejection, α-gal is not the only pig determinant that binds human natural antibodies (48). These additional determinants may become important after organ transplantation, since recipient antibody levels rise in response to the antigenic stimulus. The glycoproteins on pig endothelium that express the α-gal determinant include several adhesion molecules and probably other cell surface glycoproteins as well (49–51). Although there is now considerable interest in the biochemistry of carbohydrate expression on these proteins, their physiologic function has not been determined. There is no apparent survival advantage to humans of different blood groups, and genetically altered animals that do not express the α-gal determinant or that do express new transferase enzymes do not have detectable abnormalities associated with these genetic changes. Antibodies that bind the α-gal determinant As with other natural antibodies that bind blood group antigens, those that bind to the α-gal determinant in humans do not exist at birth and probably arise as a result of exposure to environmental bacteria that express the same carbohydrate determinants. The majority of these antibodies are IgM. IgG3 and IgA natural antibodies also exist, along with still lower levels of other isotypes. The level of IgM natural antibodies in individual humans may represent as much as 4% of the total IgM antibodies and does not appear to correlate with environmental exposure to animal products (52). The human natural anti-gal antibodies are part of a larger pool of antibodies formed by the self-renewing population of T-independent B-1 B cells. The antibodies produced by this population include many of the autoreactive antibodies that bind such molecules as thyroglobulin and DNA. These natural antibodies may have a physiologic function in clearing damaged cells from the body. However, the function of the α-gal natural antibodies is more likely to involve defense against bacterial pathogens. Loss of the galactosyl transferase

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gene during evolution may have provided a survival advantage by allowing the formation of anti-gal antibodies and thus defense against an important environmental pathogen. Evolutionary loss of the galactosyl transferase also may have provided protection against interspecies transfer of viruses that can also express these carbohydrate determinants (53). As with other blood group antibodies, the binding affinity of natural antibodies to the gal epitope is relatively low, in the range of 10−4 (6). As a result, factors that increase the overall avidity of binding are important in the function of these antibodies, including the density of expression of the gal epitope on glycoprotein molecules and duplication of receptors on IgM compared to IgG antibodies. However, the weak affinity makes it relatively difficult to inhibit these antibodies by soluble gal α(1,3) gal disaccharides (54). Uncertainty exists regarding the degree of heterogeneity of the preformed anti-gal antibodies in humans. Sequences derived from monoclonal anti-gal IgM antibodies have shown a relatively conserved configuration from a small number of germ-line genes (55, 56). In addition, anti-idiotype antibodies have been generated that appear to block a substantial portion of natural antibody binding to the gal determinant (57). However, it is unclear whether the degree of natural antibody homogeneity is sufficient to make anti-idiotypic therapy clinically applicable. Although there are several isotypes among the human natural antibodies, only IgM natural antibodies cause hyperacute rejection (58, 59). This is probably because they have a sufficiently high binding avidity to trigger complement activation. The presence of IgG natural antibodies may actually inhibit IgM antibody binding sufficiently to diminish the tendency for hyperacute rejection (60). In addition to preformed natural antibodies, antibodies to protein determinants can also exist in potential transplant recipients as a result of prior exposure to foreign antigens. However, the preformed IgG antibodies against allogeneic MHC molecules are not an important factor in xenogeneic transplantation (61, 62). COMPLEMENT AND COMPLEMENT REGULATORY PROTEINS IN HYPERACUTE REJECTION Complement activation is the critical mediator of hyperacute re-

jection for primarily vascularized xenografts. The full manifestation of hyperacute rejection requires formation of the membrane attach complex at the end of the complement cascade (63, 64). However, inflammatory mediators such as C3b, generated earlier in the sequence, undoubtedly contribute to the process. In some species combinations, notably the guinea pig–to–rat combination, complement activation through the alternative pathway is sufficient to generate hyperacute rejection even in the absence of preformed antibody (65). This may

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occur because of stimulation by unusual glycolipid determinants on the vascular endothelium or because there is unrestrained constitutive activation of the alternative pathway if complement regulatory molecules do not function well across species differences. In pig-to-primate transplants, removal of preformed natural antibodies is sufficient to prevent hyperacute rejection, indicating that alternative pathway activation in this species combination is not sufficient to initiate the process (66). As with most physiologic activation pathways in biology, the complement cascade is ordinarily closely regulated, in this case by a series of endothelial proteins including Decay Accelerating Factor (DAF, CD55), Membrane Cofactor Protein (MCP, CD46), and CD59, which act as inhibitors at various points along the cascade. As originally suggested by Dalmasso et al, these regulatory proteins often show homologous restriction, functioning effectively only with the complement proteins of their own species (46). This feature explains why hyperacute rejection of blood-group-mismatched allogeneic organs is a relatively weak and inconsistent reaction (occurring in only about 25% of cases), whereas hyperacute rejection of pig organs by primates is an explosive and nearly universal event. Endothelial activation during hyperacute rejection The target of hyperacute rejection is the vascular endothelium. Although one potential consequence of the binding of the membrane attack complex of complement would be lysis of endothelial cells, the onset of hyperacute rejection occurs before death of the endothelium can occur and involves instead endothelial cell activation (67). This type of activation occurs too quickly to involve upregulation of gene expression or new protein synthesis. It has been referred to as Type I endothelial activation and is manifested both by the separation of endothelial cells from one another (allowing the extravasation of fluid or red blood cells) and by the loss from endothelial cells of heparan sulfate (giving rise to procoagulant changes on the endothelial surface) (68). Thus, Type I endothelial activation is responsible for the most obvious manifestations of hyperacute rejection including intravascular thrombosis and extravascular hemorrhage and edema. Efforts to modify hyperacute rejection The most exciting recent progress in xenotransplantation has been the development of approaches to prevent hyperacute rejection. Some of these approaches have involved systemic therapy of the recipient, but the most interesting have involved genetic engineering of the donor to eliminate the two key features that distinguish xenograft from allograft rejection. In the case of hyperacute rejection, these features include the expression of α(1,3) αgal as a new foreign antigen and the loss of physiologic complement regulation owing to the homologous restriction of pig complement regulatory proteins. Thus, genetic engineering efforts have attempted to reduce

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the expression of the new antigen and to restore physiologic, or even supraphysiologic, regulation by achieving new expression of the appropriate regulatory molecules. These general principles, developed in the effort to prevent hyperacute xenograft rejection, have guided the development of genetic engineering strategies for the other forms of xenograft as well. Removing preformed antibodies Numerous approaches have been reported for removing preformed natural antibodies either specifically or more generally (48, 66, 69–72, 72a). The general principles that have emerged from these studies are (a) that several techniques can reduce the level of preformed natural antibodies below the threshold level required to trigger hyperacute rejection, (b) that this reduction is always transient and is often followed by a rebound within several days to levels of antibody that are higher than baseline, and (c) that no known drug or combination of drugs is capable of preventing the rapid return of these antibodies. These results have made it possible to accomplish pig-to-primate organ transplantation without hyperacute rejection by antibody depletion, but only by an extraordinarily determined and sustained effort. Therefore, more recent efforts to deplete the recipient’s natural antibodies have begun to concentrate on attempts to deplete the B-1 population of B cells entirely or to induce tolerance in this population for the gal α(1,3) gal determinant (73). Removing the α-gal determinant Since expression of the gal α(1,3) gal determinant depends on the expression of the galactosyl transferase enzyme, one approach to removing this determinant has been to eliminate the galactosyl transferase gene by homologous recombination (74, 75). Knock-out mice lacking this gene have been produced by at least two groups (76, 77). The technology for this approach is not yet available in other species. Furthermore, removal of the gal determinant exposes a new carbohydrate determinant, against which humans have a low level of preformed antibodies (78). Although homologous recombination is not available, it is possible to insert transgenes into the pig genome. Sandrin et al suggested the idea of competing with the α-galactosyl transferase in pigs by expressing the α–1,3 fucosyl transferase (or H-transferase) gene that humans use to form the blood group O antigen (75, 79). In vitro experiments confirmed that this strategy reduces expression of the α-gal determinant to a remarkable degree, and transgenic mice as well as pigs have been generated expressing the H-transferase gene (80, 81). In vivo experiments using these transgenic pigs have not been reported. Because the H-transferase strategy is based on the competition of two enzymes for a common substrate, some remaining expression of the α-gal determinant is likely. A further modification of the H-transferase approach is to introduce a second gene encoding a galactosidase enzyme. Experiments testing the effectiveness of this combined approach are in progress.

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Complement regulation Systemic treatment to control complement activation has included administration of cobra venom factor and of other drugs or giving a soluble form of complement receptor 1 (82–86). Genetic engineering to inhibit complement activation has been accomplished by creating transgenic donors expressing human complement regulatory proteins (46, 87–96). Several issues are important in the development of this approach, including (a) which regulatory proteins or which combination of proteins will most effectively prevent complement activation, (b) what level of expression will be required, and (c) whether expression of transgenic complement regulatory proteins will simply diminish the intensity of hyperacute rejection to a similar level as encountered with allogeneic blood group incompatibles or whether it will prevent hyperacute rejection altogether. None of these issues has been resolved fully, but studies have indicated that even relatively low levels of transgenic expression of either CD55 (DAF) or CD59 can have a profound effect on hyperacute rejection, converting the time of pig organ rejection from minutes to days in unmodified primate recipients (90). With vigorous immunosuppression, transgenic pig organs have survived in primates for up to 60 days without evidence of rejection (97). Ongoing research is testing the value of combining several different transgenes for complement regulatory proteins or of combining transgenes for complement regulation with those that would alter the expression of the gal determinant. Part of this effort has included studies to determine which promotors will give the highest level of endothelial transgene expression. The ICAM-2 promotor has been identified as a promising candidate for this purpose (98). In addition, the likely need for multiple transgenes has led to efforts to see how many new genes can be inserted with a single genetic construct. Refining the use of transgenic technology to prevent hyperacute rejection will likely take some years, but the key elements needed to eliminate the problem of hyperacute xenograft rejection probably have already been identified and thus will be in place for potential clinical application in the foreseeable future.

Delayed Xenograft Rejection/Acute Vascular Rejection For discordant species combinations it is now possible to prevent hyperacute rejection in a number of ways; and for concordant combinations, hyperacute rejection does not occur at all. In both cases, however, vigorous rejection typically occurs within two to three days, much faster than for most forms of allogeneic transplantation. The histology of this type of rejection is different from hyperacute rejection, with less hemorrhage although with significant intravascular thrombosis. As in hyperacute rejection, this type of rejection typically involves little cellular infiltrate, and the fibrinoid necrosis often seen again suggests that the vascular endothelium is the target. Less is known about this second type of rejection mechanism than about hyperacute rejection. There is even disagreement about what to call it. Some

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have referred to it as delayed xenograft rejection, emphasizing its timing in relation to hyperacute rejection. Others have called it acute vascular rejection, emphasizing its vascular target. Still others have called it accelerated vascular rejection, in contrast to acute cell-mediated rejection, which may also involve the vascular endothelium. In this review it is referred to as DXR/AVR. Like hyperacute rejection, the central element in the pathophysiology of DXR/AVR is endothelial activation. In contrast, however, this activation does not require complement, and it occurs more slowly, allowing time for new gene transcription and protein synthesis by the endothelium. This delayed endothelial activation has been called Type II activation, in contrast to the Type I activation associated with hyperacute rejection. Thus, DXR/AVR is not simply a slower form of hyperacute rejection, but rather it is a distinctly different process. In very general terms, hyperacute rejection is what happens to the endothelium when complement is activated, while DXR/AVR is what happens in the face of an early antibody response. MODELS FOR STUDYING DXR/AVR Judged by the timing of onset, almost any form of xenogeneic transplantation that does not generate hyperacute rejection can be used to study DXR/AVR in vivo, since early rejection almost always occurs before the end of the first week. Thus, concordant species combinations such as monkey-baboon (99), hamster-rat (100), and rat-mouse combinations (101) all provide ways of studying this type of rejection. However, in these cases, complement as well as antibodies are available to mediate the rejection process, making it difficult to determine for research purposes which features truly represent the unique aspects of DXR/AVR as opposed to those reflecting the delayed onset of a process that is more like hyperacute rejection. Therefore, it has been more common to study DXR/AVR, even in concordant combinations, using complement inhibitors such as cobra venom factor. Some investigators have sensitized small animal recipients (such as rats) prior to organ transplantation, which has then been performed in the presence of complement inhibition (102–104). Large animal studies of DXR/AVR have been performed in discordant combinations using pig donors and primate recipients with complement inhibition either by transgenic modification of the pigs or by systemic treatment with cobra venom factor or sCR1 (see above). In vitro studies that are thought to reflect the process of DXR/AVR have used endothelial cells from the donor species cultured with cells or antibodies from the recipient in the absence of complement. FACTORS THAT CAUSE TYPE II ENDOTHELIAL ACTIVATION Antibody binding is thought to be the most important factor responsible for Type II endothelial activation. The evidence for this conclusion comes largely from the striking correlation between the timing of appearance of anti-donor antibodies in

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concordant combinations and the onset of rejection. Furthermore, immunosuppressive agents that delay or prevent this antibody response tend to achieve a corresponding delay in the onset of rejection (105–109). In addition, the sparse cellular infiltrate is consistent with a humoral mediator for this lesion. In vitro studies also indicate that antibody binding can lead to Type II endothelial activation (110). Antibodies can also activate endothelial cells through an antibody-dependent cell-mediated cytotoxicity (ADCC) mechanism involving NK cells (111, 112). Furthermore, in vitro studies show that NK cells alone can activate endothelium in some species combinations (113, 114) and that monocytes and macrophages may also be able to do so (115–117). In vitro studies without antibodies raise the question of whether antibody responses are essential in causing DXR/AVR or are simply the most obvious factor. Experiments using B cell–deficient mice as recipients of rat or hamster heart transplants are difficult to perform and have not been reported; however, such studies would not necessarily prove whether DXR/AVR would occur in primate recipients of pig organs in the complete absence of an antibody response. ANTIBODIES AND ANTIGENS RESPONSIBLE FOR DXR/AVR In contrast to hyperacute rejection, some isotypes of IgG antibodies are as effective as IgM antibodies in causing DXR/AVR (118). In pig-to-primate combinations these IgG antibodies are already present at the time of transplantation, primarily directed at the α-gal determinant (119, 120). Following exposure to pig tissues, however, the level of these IgG anti-gal antibodies increases rapidly. In concordant combinations, anti-donor antibodies also appear within several days after transplantation. Their appearance seems to be T cell–independent, and although their specificity is not yet well characterized, the current view is that they represent increased levels of preformed natural antibodies that exist even in concordant combinations but at a level too low for easy detection and too low to trigger hyperacute rejection. An important implication of this view is that there may not be a single predominant antibody specificity responsible for DXR/AVR, as there appears to be for hyperacute rejection, since even minor populations of preformed antidonor antibodies may increase rapidly after xenogeneic transplantation. Thus, as in hyperacute rejection, one of the principle features responsible for the difference between allografts and xenografts in DXR/AVR is the presence of more donor antigens. In this case, however, there are probably many new antigens that have not yet been characterized. PHYSIOLOGIC CONSEQUENCES OF TYPE II ENDOTHELIAL ACTIVATION Two primary effects follow delayed endothelial activation, both of which are thought to be the consequence of transcriptional activation mediated by NF-κB (115).

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The first effect involves endothelial cell synthesis and expression of many proinflammatory molecules, including ICAM-1, E-selectin, and IL-1. The second effect involves the generation of a procoagulant environment by the increased expression of tissue factor and other regulators of thrombosis and the loss of thrombomodulin (121–123). These two effects are well correlated with the pathologic findings associated with DXR/AVR, including the sparse inflammatory infiltrate composed predominantly of NK cells and macrophages and the presence of intravascular thrombosis and fibrin deposition. As with other activation sequences in biology, Type II endothelial activation is associated with physiologic regulation of the activation events. One of these regulatory events is the expression of tissue factor pathway inhibitor (TFPI), which tends to inhibit intravascular coagulation. The finding that TFPI of pig endothelial cells fails to interact appropriately with human Factor Xa (its target molecule) suggests that physiologic dysregulation of Type II endothelial activation in xenogeneic combinations may be an important feature in the strength of this type of rejection, just as physiologic dysregulation contributes to the strength of hyperacute xenograft rejection (124). One possibility that arises from this finding is that DXR/AVR might occur in some species combinations (including the pig-to-human combination) in the absence of anti-donor antibody, NK cells, or monocytes, but simply by the poorly controlled tendency toward intravascular coagulation (125, 126). It has not been possible so far to answer this question in a scientifically rigorous way. THERAPY FOR DXR/AVR Because of the importance of induced antibody responses in triggering DXR/AVR, therapies directed at this immunologic barrier have often included agents or treatments aimed at B cell responses. For example, splenectomy with or without drugs such as cyclophosphamide, methotrexate, leflunomide, brequinar, and 15-deoxyspergualin have all been tried and found effective in varying degrees (106–107). In addition, therapies have been examined that are directed at preventing endothelial activation by inhibiting NF-κB (127). The longest graft survival has been achieved using cyclophosphamide. In large animal studies involving pig-to-primate transplantation, this drug has led to survival for six to eight weeks without evidence of DXR/AVR when used in association with complement inhibition and anti–T cell therapy (97). However, high doses of cyclophosphamide have been required to accomplish these results, and they have produced substantial toxicity and mortality. Although small animal studies have suggested that high-dose cyclophosphamide is not required after an initial, short period of time, the use of lower doses of the drug in the large animals has not produced equally long survival.

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The effectiveness of cyclophosphamide alone in preventing DXR/AVR has suggested to some that control of B cell responses is sufficient to prevent this type of rejection and that intrinsic disorders of thromboregulation and activation by NK cells or monocytes are not important in this process. However, highdose cyclophosphamide may directly inhibit Type II endothelial activation or its secondary consequences in addition to its effects on B cells. This view is supported by the finding that some of the monkey recipients of pig transplants that achieved prolonged survival showed periodic elevations of their anti-donor antibody levels, despite the cyclophosphamide therapy, but still did not develop DXR/AVR. ACCOMMODATION The most promising feature of DXR/AVR is that the tendency to develop this type of rejection appears to diminish over time. In allogeneic transplantation, a number of ABO-mismatched kidney transplants have survived after initial plasmapheresis despite the subsequent return of measurable anti–blood group antibodies. The phenomenon has been called accommodation, and several small animal studies have suggested that it can occur in xenogeneic combinations as well. The mechanisms of accommodation have been studied in vitro and in vivo, using the same models ordinarily associated with DXR/AVR but with modifications to prevent initial endothelial activation and rejection. A key feature in the development of accommodation is the low-level stimulation of endothelial cells with small amounts of antibody that are not sufficient to trigger Type II endothelial activation (110, 128). Endothelial cells that have undergone accommodation have increased expression of several anti-apoptotic genes, including bcl-xL, bcl-2, A20, and hemoxygenase (129). In addition to their anti-apoptotic effects, these same genes are also capable of inhibiting transcriptional activation through NF-κB. In addition to changes in the donor endothelium, there also appear to be changes in the character of the recipient’s immune response after accommodation has occurred. For example, there is an increase in Th2 cytokine production by graft-infiltrating cells and a tendency toward production of the IgG isotypes associated with Th2 responses. Retransplantation experiments have shown that accommodated grafts can survive in new recipients and that fresh transplants can survive in a previously accommodated recipient (104, 130). Thus, accommodation can involve changes in both the donor graft and the recipient. Based on these findings, genetic modifications of donor animals might be used to diminish the tendency for Type II endothelial activation and to promote the induction of accommodation by transgenic expression of inhibitors of NFκB (127) or by overexpression of the anti-apoptotic genes (131). As with the study of hyperacute rejection, these efforts are increasing our understanding

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of fundamental endothelial biology as well as providing potential therapeutic value in xenotransplantation.

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Cell-Mediated Immunity The mechanisms of cell-mediated xenograft rejection have been less intensively studied than those of humoral rejection. This discrepancy is mainly due to the strength and immediacy of humoral xenograft rejection, which until recently, have made it difficult to keep discordant xenografts alive long enough to study cell-mediated immune mechanisms. In addition, early studies of in vitro xenogeneic reactions in the mouse gave the mistaken impression that cellular immunity might be less of a barrier to discordant xenografts than it is to allografts and concordant xenografts. This impression was caused by the failure of several mouse accessory molecules to interact properly with their corresponding ligands on the cells of the discordant species used in those studies (human and pig). In contrast, in the most relevant species combination for potential clinical xenografting (i.e. pig to primate) these interactions appear to be intact, and the cellular responses measured in vitro are as great or greater than the corresponding allogeneic responses (132). Indeed, the strength of cellular immune responses to xenografts is so great that it is not likely to be controlled by the types of nonspecific immunosuppression used routinely to prevent allograft rejection. For this reason, many investigators consider it essential that specific immunologic unresponsiveness be induced to at least some of the most antigenic xenogeneic molecules in order for xenografting to become a clinical reality. This aspect of cellular immunity to xenografts is covered in the Induction of Tolerance section. Most studies in large animal species have indicated that mechanisms of cellmediated immunity to discordant xenografts are fundamentally similar to those involved in allograft rejection but stronger. Although these similarities between the two types of responses are probably what is most important, we highlight some of the differences between them. SPECIAL FEATURES OF CELL-MEDIATED XENOGRAFT REJECTION At least six features of cell-mediated xenograft rejection have emerged as potentially distinct from allograft rejection.

CD4+ T cells Adoptive transfer studies and in vivo depletion experiments in rodents have consistently indicated that CD4+ T cells are necessary for the rejection of xenogeneic skin and islet transplants and that they can cause rejection in the absence of CD8+ T cells, NK cells, and B cells (25, 133–135). Although these results have often been presented as distinct from allograft rejection, the circumstances in which that is true have generally involved special cases, and CD4+ cells are also necessary and sufficient for most cases of allograft rejection.

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Thus, the conclusion that CD4+ T cells are especially important in xenograft rejection is one of degree. The indirect pathway Early studies of cell-mediated xenogeneic immunity in mice showed a striking disparity between the rapid rejection of skin grafts from widely disparate species and the extremely weak direct cell-mediated immune response measured in vitro to stimulators from these donors. After graft rejection, however, there was a strong T cell response in vitro that was dependent on the presence of APCs from the recipient species (136). These results suggested that cell-mediated xenograft rejection might be especially dependent on T cell stimulation occurring through the indirect pathway. Numerous studies since that time have indicated that cell-mediated xenograft rejection can be initiated through indirect recognition, and evidence in mice indicates that the strength of cell-mediated xenograft rejection becomes weaker than for allograft rejection when the indirect pathway is not available (137–139). To date, this observation has been made only for discordant skin xenografts on mice, and it may depend on selective failure of molecular interactions in this species combination. Nevertheless, these results indicate that indirect recognition may be especially important in cell-mediated xenograft rejections. There are additional caveats to this conclusion. First, even in the species combinations in which the importance of an indirect response has been demonstrated most clearly, that is, in human-to-mouse transplantation, prolonged graft survival has been achieved using reagents such as anti-B7 antibodies, which bind only to cells of the donor species (140). Thus, direct recognition of donor cells may also be involved in these cases even when the indirect pathway appears to be especially important. Second, the finding that indirect responses play a key role in xenograft rejection does not necessarily distinguish cell-mediated xenograft from allograft rejection. Substantial evidence has accumulated in recent years that indirect responses can initiate allograft rejection and that they may in some cases be as important as direct recognition (141). Thus, the emphasis on indirect recognition in xenograft rejection may also be a matter of degree. Th2 cytokine responses Several studies of cell-mediated rejection of xenogeneic skin and islet transplants have indicated that the cytokines produced by infiltrating T cells tend more toward production of Th2 cytokines than they do in cases of allograft rejection (142, 143). Studies using various cytokine knock-out mice have not identified any particular Th2 cytokine that is essential for xenograft rejection, and there is no clear explanation for the difference in cytokine production. NK cell activation In several species combinations, including the pig-tohuman combination, evidence from in vitro studies indicates that NK cells can

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lyse xenogeneic cells (144). Some studies suggest that carbohydrate determinants, such as the α-gal determinant, are responsible for NK cell stimulation (145, 146). Additional evidence indicates that a failure of NK inhibitory receptors (KIRs) to bind xenogeneic MHC class I molecules allows the activation of NK cells to proceed, whereas they are generally inhibited in allogeneic combinations (147). Many in vivo studies also suggest that NK cells may participate in xenogeneic organ rejection. These cells have been found with unusual frequency in the cellular infiltrates associated with xenograft rejection (148). In addition, slight additional prolongation of xenograft survival has been achieved in a small number of studies by the additional depletion of NK cells along with other forms of immunosuppression (149). In most small animal studies, however, CD4+ T cell depletion without NK depletion has led to prolonged xenograft survival, and additional depletion of NK cells has had no effect (139, 150). Thus, IL-2 produced by T cells may be necessary to activate NK cells so that they can participate in xenograft rejection. There is good evidence that NK cells play an especially important role in resistance to xenogeneic bone marrow engraftment, since allogeneic engraftment can be achieved with T cell–depleting nonmyeloablative conditioning, whereas xenogeneic bone marrow engraftment requires additional anti-NK cell therapy (151). Additional types of effector mechanisms of rejection Another special feature of cell-mediated xenograft rejection is that xenografts appear to be more susceptible to nonspecific inflammatory processes of graft destruction than are allografts. T cells are often quite sparse in the actual area of destruction of cellular xenografts, tending instead to accumulate around the periphery of the infiltrate, while macrophages are the predominant cell in the area of tissue destruction (152, 153). In addition, eosinophils have been identified with unusually high frequency, probably reflecting the Th2 cytokine predominance associated with xenograft rejection (138). However, although there is evidence that activated macrophages may be able to transfer accelerated xenograft rejection, the predominance of eosinophils is not essential for xenograft destruction (154). Studies using the MHC knock-out mice as donors have also suggested that indirect inflammatory mechanisms are more apt to cause xenograft rejection. Some types of allografts from these mice show prolonged survival, whereas xenografts lacking MHC antigens have been rapidly rejected in every study reported so far (155). Despite the higher proportion of nonspecific inflammatory cells observed during xenograft rejection, there is evidence that T cells of the recipient are required to initiate these reactions (139). These data are most consistent with a nonspecific inflammatory reaction dependent on cytokines released by T cells and, therefore, essentially representing an augmentation of the T cell immune response.

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Strength of cell-mediated xenograft rejection The early studies indicating that direct T cell responses to xenogeneic stimulators were weak in some species combinations suggested that cell-mediated xenograft rejection might also be weaker than allograft rejection. However, substantial evidence indicates that this prediction was wrong. Dozens of studies have tested the ability of a variety of immunosuppressive agents and strategies to prolong xenograft survival, and in almost every case xenograft survival is not as good as allograft survival (1). The few exceptions have generally occurred only when CD4+ cells of the recipient have been depleted or when they lack the capacity to respond through the indirect pathway (133). Thus, the CD4-mediated indirect response to xenografts appears to be the primary source of the unusually powerful cellmediated xenograft rejection. EXPLANATIONS FOR THE SPECIAL FEATURES OF CELL-MEDIATED XENOGRAFT REJECTION As in hyperacute rejection and DXR/AVR, there are two funda-

mental explanations for the differences between cell-mediated xenograft and allograft rejection: (a) Cell-mediated xenograft rejection involves more antigens, and (b) molecular incompatibilities between species cause disordered physiologic regulation of cell-mediated responses to xenografts. The additional antigens available to stimulate T cell responses in xenogeneic combinations are the large number of cellular proteins with amino acid sequences that differ from those of the recipient. These proteins can presumably generate a large number of novel peptides for presentation by the recipients’ APCs. Thus, some researchers have suggested that xenografts can be thought of as minordisparate allografts with the response amplified enormously. In addition to the new protein antigens, there may also be novel carbohydrate determinants that stimulate NK cells, although the importance of such positive signals for NK cell activation compared to the absence of negative signals is unclear (146). The best example of a molecular incompatibility across species differences that leads to stronger cell-mediated responses is the failure of pig MHC class I molecules to interact with human NK inhibitory receptors, thereby allowing the activation of NK cells by xenogeneic stimulators (147). A second example of disordered physiologic regulation in xenogeneic cellular immunity is the failure of T cells from mice to respond directly to widely disparate xenogeneic stimulators in vitro. Originally this was thought to reflect a failure of T cell receptors, positively selected on self-MHC molecules, to recognize xenogeneic (and, therefore, potentially quite different) MHC antigens. However, this hypothesis has turned out to be wrong. Instead, the polymorphic regions of xenogeneic MHC molecules may be as similar to self MHC molecules as are the polymorphic regions of allogeneic molecules (156). In addition, experiments using target cells of the same species transfected with xenogeneic MHC molecules have indicated that direct recognition of xeno-MHC antigens can occur if all

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of the accessory molecules involved in T cell activation are functioning normally (157). However, these accessory molecular interactions sometimes do not function normally across species differences. The molecular incompatibilities identified have included CD4 or CD8 binding to xenogeneic class II or class I molecules, cytokine interactions with xenogeneic cytokine receptors, and cell surface adhesion and co-stimulatory molecules with their ligands on xenogeneic T cells, depending on the species combination involved (157, 158). However, the key words in this statement are “depending on the species combination,” since the molecular incompatibilities in one species combination may not be an issue in another. The molecular incompatibilities accounting for weaker direct recognition of xenogeneic stimulators do not explain why CD4-mediated xenograft rejection, initiated through the indirect pathway, should be stronger than for allografts. The strength of this response may depend entirely on the larger number of peptides available for presentation by recipient APCs, but it is not obvious that going from a large number of foreign peptides to a huge number would give rise to what seems like a qualitatively different cell-mediated rejection mechanism. Another plausible explanation is that incompatibilities of molecular interactions that ordinarily downregulate cell-mediated immunity are responsible for the strength of cell-mediated xenograft destruction. However, no such molecular incompatibilities have been identified. Relatively little is known about the elements that inhibit cellular immunity in vivo, even in allogeneic combinations, but the possibility is being explored that inhibitory cytokines, Fas-FasL interactions, or CTLA4-B7 interactions might fail during xenograft rejection, leading to a stronger response. This is another area where studies of xenogeneic transplantation are both benefiting from and contributing to more basic studies of immunology. HUMAN ANTI-PIG CELLULAR IMMUNITY As emphasized above, the special features that distinguish cell-mediated xenograft rejection from allograft rejection vary in importance depending on the species combination involved. Thus, for clinical purposes it is important to investigate human anti-pig immunity in particular. Most of what is known about this response has come from in vitro assays. These experiments have emphasized two primary conclusions: (a) that human anti-pig T cell responses are remarkably similar to human allogeneic responses, although they are stronger, and (b) that the one special feature of cellular immunity in this species combination is the ability of NK cells to cause lysis of pig targets, especially when activated by IL-2 (144, 147). Studies of T cell immunity have shown that both direct and indirect responses can occur in vitro, that CD4+ T cells can proliferate and generate cytotoxicity

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in response to pig class II stimulation, and that CD8+ T cells can generate cytotoxicity after stimulation with pig class I antigens (132, 144, 159–167). A potentially significant difference from allogeneic T cell immunity is that the helper function and IL-2 production of CD8+ human T cells appear to be less after pig class I than after allogeneic class I stimulation. However, xenogeneic MLR reactions in human anti-pig combinations are stronger than allogeneic MLR reactions of the same human responder cells. The presence of direct responses by human T cells against pig cells implies that many of the molecular interactions involved in T cell function are intact in this species combination. Additional studies demonstrated that most of the key molecular interactions are functional, including CD4/class II, CD8/class I, CD2/LFA-3, CD28/B7, LFA-1/ICAM, VLA-4/VCAM, and Fas/FasL (166– 170). The only exceptions are the failure of pig class I molecules to inhibit human NK cells and their weaker ability to stimulate IL2 production by human CD8+ cells (147). The striking similarity between the human T cell response to pig cells in vitro and that of human allogeneic responses raises the question of whether any of the special features of cell-mediated xenogeneic immunity described above apply to this clinically relevant species combination other than the unusual NK response. Therefore, some investigators have suggested that if humoral and NK responses to pig organs were abrogated, the remaining T cell response of humans to pig organs could be controlled adequately using the immunosuppressive drugs that have been successful in allogeneic transplantation. Although this possibility has not been tested formerly, evidence does not support it. The likelihood that indirect responses are important in causing allograft as well as xenograft rejection, especially chronic rejection, and the likelihood that xenotransplantation will cause stronger indirect responses, suggest that human T cell–mediated rejection of pig organs will be hard to control with standard immunosuppression. Furthermore, every experiment attempting to control cellmediated xenograft rejection with immunosuppressive drugs, even in the most closely related species combinations, has indicated that these drugs work less well for xenografts than for allografts. The opposite point of view suggests that the special features of cell-mediated xenograft rejection reflect quantitatively stronger and possibly qualitatively different mechanisms of xenograft destruction. According to this view, a better understanding of this unique mechanism will be required in order to develop appropriate specific therapies. TREATMENT FOR CELL-MEDIATED XENOGRAFT REJECTION Immunosuppressive drugs Essentially every known immunosuppressive agent has been tested for its ability to prolong xenograft survival. None has been shown to be as effective in xenogeneic combinations as in allogeneic transplantation, even when

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using closely related species. However, there are several examples of prolonged xenograft survival, both in small and large animal studies, achieved by the use of exogenous immunosuppression alone (171–173). These studies have demonstrated that it is physiologically possible for a xenograft to survive and that this can be accomplished with standard forms of immunosuppression. However, the doses and combinations of immunosuppressive drugs needed to achieve survival generally have been extremely toxic. Thus, the therapeutic index for exogenous immunosuppressive drugs appears to be even smaller for xenogeneic than for allogeneic transplantation. Genetic engineering of donor animals to prevent cell-mediated rejection The general principles of genetic engineering to promote xenotransplantation are to reduce the expression of the additional antigens and to correct the molecular incompatibilities responsible for physiologic dysregulation of the immune response. In the case of cell-mediated immunity, reducing the number of antigens is unlikely to be either possible or effective. Even if an embryonal stem cell line for large animals were to become available, the large number of xenogeneic proteins generating novel peptides for indirect presentation makes it inconceivable that these antigens can be reduced significantly by homologous recombination. Furthermore, small animal experiments have shown that grafts from MHC knock-out donors are always rejected rapidly, even in closely related xenogeneic combinations, although these same grafts may show prolonged survival in allogeneic recipients (155). Thus, even the reduction of MHC antigen expression is not likely to affect cell-mediated xenograft rejection significantly. Therefore, the focus of genetic engineering to alter cell-mediated xenograft rejection has been on the insertion of new genes that might downregulate the immune response. Since the one important molecular incompatibility affecting cellular immunity that has been identified is the inability of pig class I molecules to bind human NK cell inhibitory receptors, genetic engineering to correct this incompatibility is being tested. While the approach is somewhat counterintuitive, given the benefit of MHC antigen matching in allotransplantation, the concept is to introduce genes encoding human MHC antigens into pigs in order to inhibit NK cell activation. Although this approach will almost certainly indroduce new alloantigens, the inhibition of NK cell activation may be worth this price. Furthermore, evidence suggests that a relatively large portion of NK cells may be inactivated by the insertion of genes encoding relatively nonpolymorphic human antigens such as HLA-G (174). In the absence of a better understanding of the molecular interactions that downregulate graft rejection or of evidence that any of these interactions are defective in the pig-to-human combination, alternative efforts at genetic engineering to prevent cell-mediated rejection have not been as well focused as they are

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in hyperacute rejection and DXR/AVR. Even in the absence of known molecular incompatibilities, it may be possible to achieve supra-physiologic downregulation of rejection by local expression in the donor graft of inhibitory cytokines, soluble CTLA-4, other inhibitors of receptor-ligand pairs, or FasLigand. Only a small number of experiments have tested these possibilities, but there will likely be more in the near future. Induction of tolerance—modifying the response of the recipient As described above, cellular immune responses to xenografts are considerably stronger than comparable responses to allografts. In addition, no matter how successful efforts may be at modifying the donor through genetic engineering, the antigenic disparities between discordant xenogeneic species will remain far greater than those between allogeneic members of the same species. Since even for allografts, the titration of immunosuppressive drugs places the transplant patient on the border between rejection and infection, one might expect the amount of nonspecific immunosuppression required to avoid xenograft rejection to be so great that too many patients would succumb to infectious complications. For this reason, the success of clinical xenografting will likely depend, at least in part, on finding ways of inducing specific hyporesponsiveness, or tolerance, across xenogeneic barriers rather than relying entirely on nonspecific immunosuppressive agents. The application of tolerance-inducing approaches to xenotransplantation is particularly attractive, since the use of xenogeneic donors provides the opportunity for inducing tolerance by first using donor antigens and then following the induction regimen with a xenograft tissue or organ from the same donor. The potential for generating fully inbred animals, such as inbred miniature swine, as xenograft donors (175) would provide a virtually unlimited source of genetically identical donor tissue for induction and maintenance of the tolerant state. Furthermore, such donors could be modified by genetic engineering, as discussed above, to decrease the immunologic barriers to be overcome. As described earlier, T cell reactivity between xenogeneic species is generally very similar to allogeneic reactivity. Therefore, many of the methodologies being explored for inducing tolerance to allografts are also being applied to xenografts. These include attempts to utilize anergic (176–178), suppressive (179–181), and deletional (182–184) mechanisms of tolerance induction. However, for the clinically relevant pig-to-primate species combination, the only approach toward induction of specific tolerance reported to date involves attempts to induce mixed chimerism through bone marrow transplantation (reviewed in 72a). The intent of these studies is to specifically eliminate much of the immune response to the transplant without diminishing immune responses to other antigens. Because an understanding of the principles of mixed chimerism is essential to

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understanding this approach, we describe briefly the basics of this avenue of tolerance induction and its application to xenotransplantation. Mixed chimerism in allogeneic and concordant xenogeneic systems When bone marrow transplantation is carried out clinically as a treatment for hematologic malignancy, all host lymphohematopoietic elements must be ablated, to assure that the leukemia is eliminated. Numerous studies, both in animals and in patients, have demonstrated that such bone marrow transplantation also induces transplantation tolerance to the bone marrow donor and that this tolerance extends to any other organ or tissue from the same donor (185, 186). However, when bone marrow transplantation is utilized for the induction of transplantation tolerance, rather than for treatment of a hematologic malignancy, it is neither necessary nor desirable to completely ablate the recipient’s lymphohematopoietic system. In fact, it is advantageous to leave as much of the host’s lymphohematopoietic system intact as possible, assuring only that sufficient bone marrow elements from the donor survive to maintain tolerance in the reconstituted recipient. The level of chimerism needed for this purpose can be very low, and although it is not clear exactly which cells must survive or where they must reside, a very strong correlation has been established between presence of donor dendritic cells in the thymus and the induction of tolerance to allogeneic skin grafts peripherally in allogeneic mixed chimeric animals (187). In addition, such dendritic cells are capable of negative selection of newly arising thymic T cells (187). Mixed lymphohematopoietic chimerism provides an effective means of inducing long-term tolerance for skin grafts across full MHC barriers in mice (188, 189) and also for kidney allografts in cynomolgus monkeys (190). The procedure for inducing mixed chimerism for this purpose involves T cell depletion in vivo with anti–T cell antibodies, low-dose whole-body irradiation, and administration of allogeneic bone marrow prior to or at the same time as the tissue or organ allograft. A similar procedure is effective in producing longterm specific hypo-responsiveness to concordant xenogeneic rat-to-mouse skin grafts (151, 191), and to concordant xenogeneic baboon-to-cynomolgus monkey renal xenografts (192). Mixed chimerism in discordant species On the basis of the successes in allogeneic and concordant xenogeneic systems, the principle of mixed xenogeneic chimerism has been explored as an approach to discordant renal xenotransplantation. The protocol for attempting to induce tolerance parallels very closely one for inducing long-term graft acceptance in allogeneic mouse combinations (151), concordant rat-to-mouse xenogeneic combinations (192), and fully MHC mismatched allogeneic nonhuman primates (190). One main difference from previous protocols involved the need to deal with the problem of hyperacute

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rejection. This was accomplished in the short term by an absorption technique, involving perfusion of the monkey’s blood through either an isolated pig liver or solid matrix columns bearing appropriate α1,3 galactose sugar linkages (72a). Sublethal irradiation consisting of three fractions of whole body irradiation, 1.0 Gy each, were administered on days −6 and −5 and 7.0 Gy of thymic irradiation was administered on day −1. Because no monoclonal antibodies to remove mature T cells from monkeys were available, ATG (Upjohn) was used for this purpose on days −2, −1, and 0 (50 mg/kg, iv). Since this treatment did not produce complete T cell depletion, a postoperative course of immunosuppression with Cyclosporin A (15 mg/kg per day, im or iv) was also administered to further suppress T cell function in the immediate posttransplant period. On day 0, the recipient received a pig kidney followed by bone marrow from the same donor (approximately 5 × 108 cells/kg). After the transplant the animals received the pig recombinant cytokines IL-3 and SCF daily for two weeks in an attempt to aid engraftment of pig bone marrow. They also received a drug (DSG or Brequinar) in an attempt to diminish antibody responses. This procedure was successful in avoiding hyperacute rejection, and some kidney grafts functioned normally for up to 15 days (72a). However, in all of the animals the renal transplants subsequently succumbed to a vascular form of rejection, and there were no long-term kidney survivals. Recent data indicate that this rejection coincided with the return of natural antibodies, consistent with one of the likely causes of DXR/AVR (see above). However, there was significant evidence that the tolerizing procedure led to specifically diminished T cell responses to the xenograft in these studies (193), despite the fact that pig cell chimerism was observed only in the peripheral blood at very low levels (<5%) and only transiently (194). Thus, unlike unmodified recipients, which produce both IgM and IgG anti-pig antibodies in response to pig xenografts, and in which the posttransplant antibodies react with both α1,3-Gal and additional non-α1,3-Gal determinants, the antibodies returning in these animals reacted almost entirely with anti-α1,3-Gal, indicating a return of natural antibodies rather than a T cell–dependent immune response to the transplant. Additional data suggesting a specific decrease in T cell reactivity to the xenogeneic donor included a diminished MLR to pig stimulator cells (193). Studies in allogeneic systems have demonstrated that persistent mixed chimerism is a requirement for achieving lasting transplantation tolerance by this methodology (177). Current efforts are focusing on increasing the engraftment of pig bone marrow cells in monkey recipients and mobilizing them to sites important for tolerance induction, such as the thymus. Use of the pig recombinant cytokines IL-3 and SCF in the postoperative period have led to engraftment of pig cells, as evidenced by the detection of pig CFU in bone marrow aspirates of recipient nonhuman primates as late as 300 days posttransplant

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(193; T Sablinski, DW Emery, R Monroy, R Hawhey, Y Xu, P Gianello, T Lorf, T Kozlowski, M Bailin, DKC Cooper, AB Cosimi, D Sachs, manuscript in preparation). Further proliferation of those cells and mobilization to the thymus have not been achieved. Another way of achieving central deletion of developing T cells with anti-pig reactivity may be to bring the pig thymus stroma to the recipient rather than the mobilizing donor cells to the recipient’s thymus. Studies doing just that have been reported for mice in which fetal pig thymic tissue was engrafted under the kidney capsule (183, 195). These animals regained immunocompetence and were specifically tolerant to skin grafts from the father of the fetuses from which the fetal thymus tissue grafts had been taken. These results suggest that combined approaches to control both the humoral and cellular xenograft responses will eventually permit long-term acceptance of discordant xenografts in the pig-to-primate combination, making clinical xenografting a reality.

Infectious Risks of Xenotransplantation An increasingly important barrier to xenotransplantation is public concern that transplantation of organs or tissues from animals to humans might expose the human population to unacceptable risks of infectious complications. This concern has spawned a rapidly expanding field of xenozoonosis, which means the transplantation of infections by xenotransplantation. The term grew out of the word zoonosis, which refers to the more general issue of infections transferred between members of different species. A large number of pathogens have been recognized that reside primarily in animals but can infect humans. In general, these are the least worrisome potential pathogens, since if the organisms are known, potential animal donors can be screened to avoid their presence (196). In practical terms, however, this is not easy to accomplish for potential nonhuman primate donors, since the number of suitable baboon donors is not enormous and the number of potentially important pathogens that are widely prevalent is quite large. Furthermore, there is no agreement on which infectious agents in nonhuman primates are of potential pathogenic significance in humans, especially among the known exogenous retroviruses (197). It is likely to be far easier to obtain organs from pigs that have been bred to avoid the presence of known pathogens for human recipients. Despite the presence of many potential pathogens among different donor species, there will almost certainly be less transmission of known infections by xenotransplantation than by allotransplantation. This is because of the years available to screen animals and to raise them in relative isolation in comparison to the hours available to screen potential cadaver human donors (196). As a result of the short time available, it is not uncommon during allotransplantation to transmit pathogens from donors to recipients. In addition,

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many known pathogens, such as cytomegalovirus, are considered acceptable for human donors even though they are known to cause frequent infection and morbidity in transplant recipients. However, cytomegalovirus and the various hepatitis viruses are species restricted; thus, the risk of transmitting these common pathogens will be less in xenotransplantation than in allotransplantation. Furthermore, the risk of recurrence of some important recipient infections (such as hepatitis C) will be less in xenotransplantation. The important infectious barrier to xenotransplantation involves the risk from unknown potential pathogens. This has become of particular concern because of the widespread belief that the appearance of the AIDS epidemic occurred when a previously unknown and nonpathogenic retrovirus was transferred from nonhuman primates to human beings, where it became a pathogenic and transmissible virus. In addition to the SIV viruses, several other known exogenous retroviruses are frequently found in the nonhuman primates, raising concern that these might also become pathogenic if transferred to humans and that other unknown retroviruses might later be identified as clinically significant (198). Thus, part of the debate on the infectious risks of xenotransplantation is over what type of screening, if any, would identify a suitable nonhuman primate donor (199). Pigs carry no known infectious retroviruses, but there are retroviral sequences in the pig genome. Co-culture of pig cells and human cells in vitro allows transfer of these retroviral sequences into the human cells (200). These results suggest that successful clinical xenotransplantation quite possibly will allow new retroviral genetic sequences to be incorporated into the DNA of human recipients. There is no evidence at this time that this event is in any way pathogenic or that it leads to the formation of infectious viruses. To do so, the transferred retroviral sequence would presumably have to recombine with endogenous human retroviruses or proviruses. Recombined, these retroviral sequences could conceivably generate a new virus that is both pathogenic and infectious for human beings. Most investigators believe that xenotransplantation is exceedingly unlikely to lead to the generation of new pathogens. For example, the physical proximity of humans to pigs would seem to have allowed such an event to occur already if it were likely to do so. Thus, the risk of this infectious complication for the individual recipient of a xenotransplant is trivial relative to the much more significant identifiable risks associated with any form of transplantation. Therefore, the debate about the infectious risks of xenotransplantation are not about the risk-benefit calculations for the patient receiving the transplant but about the risks for society as a whole. Since xenotransplantation provides no significant benefit to nonrecipients of the transplant, even a small risk of a serious threat to the public health

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becomes a reasonable concern (201). This risk is primarily the possibility that xenotransplantation would uniquely establish the circumstances in which a retroviral sequence from another species could recombine with a human retrovirus to generate a previously unknown pathogenic and infectious agent for the human population as a whole (198). Establishing reasonable public policies to deal with this risk is especially difficult because so little data is available on its true magnitude. Therefore, it is important to begin gathering more information both from experimental studies of xenotransplantation and from ongoing clinical trials.

CONCLUSION In the face of an increasing need for additional organs for transplantation, interest, research, and even clinical trials in xenotransplantation have also been increasing. Although significant barriers to xenotransplantation have been identified from recent research, better scientific understanding has generated potential solutions almost as quickly. Fundamentally, xenotransplantation differs from allotransplantation because of the larger number of foreign antigens in xenogeneic donors and because of the loss of physiologic functions due to molecular incompatibilities in some species combinations. Solutions to overcome the barriers to xenotransplantation have included genetic engineering approaches to diminish the expression of the additional antigens and to restore the physiologic regulation of the immune responses. Ultimately, tolerance induction is likely to be necessary to eliminate the anti-donor immune response and thus to achieve widespread clinical application of xenotransplantation. Visit the Annual Reviews home page at http://www.AnnualReviews.org.

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AUCHINCLOSS & SACHS FK506, cyclophosphamide, organ perfusion, and complement inhibition. Transplantation 59:1183–88 Dorling A, Stocker C, Tsao T, Haskard DO, Lechler RI. 1996. In vitro accommodation of immortalized porcine endothelial cells: resistance to complement mediated lysis and down-regulation of VCAM expression induced by low concentrations of polyclonal human IgG antipig antibodies. Transplantation 62:1127–36 Schaapherder AFM, Daha MR, te Bulte M-J, van der Woude FJ, Gooszen HG. 1994. Antibody-dependent cell-mediated cytotoxicity against porcine endothelium induced by a majority of human sera. Transplantation 57:1376–82 Watier H, Gullaumin JM, Vallee I, Thibault G, Gruel Y, Lebranchu Y, Bardos P. 1996. Human NK cell-mediated direct and IgG-dependent cytotoxicity against xenogeneic porcine endothelial cells. Transplant. Immunol. 4:293–99 Goodman DJ, von Albertini M, Willson A, Millan MT, Bach FH. 1996. Direct activation of porcine endothelial cells by human natural killer cells. Transplantation 61:763–71 Malyguine AM, Saadi S, Platt JL, Dawson JR. 1996. Human natural killer cells induce morphologic changes in porcine endothelial cell monolayers. Transplantation 61:161–64 Millan MT, Geczy C, Stuhlmeier KM, Goodman DJ, Ferran C, Bach FH. 1997. Human monocytes activate porcine endothelial cells, resulting in increased E-selectin, interleukin-8, monocyte chemotactic protein-1, and plasminogen activator inhibitor-type-1 expression. Transplantation 63:421–29 Fryer JP, Chen S, Johnson E, Simone P, Sun LH, Goswitz JJ, Matas AJ. 1997. The role of monocytes and macrophages in delayed xenograft rejection. Xenotransplantation 4:40–48 Fryer JP, Leventhal JR, Dalmasso AP, Chen S, Simone PA, Goswitz JJ, Reinsmoen NL, Matas AJ. 1995. Beyond hyperacute rejection: accelerated rejection in a discordant xenograft model by adoptive transfer of specific cell subsets. Transplantation 59:171–76 Minanov OP, Itescu S, Neethling FA, Morgenthau AS, Kwiatkowski P, Cooper DKC, Michler RE. 1997. Anti-Gal IgG antibodies in sera of newborn humans and baboons and its significance in pig xenotransplantation. Transplantation 63:182– 86 Satake M, Kawagishi N, Rydberg L,

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Samuelsson BE, Tibell A, Groth CG, Moller E. 1994. Limited specificity of xenoantibodies in diabetic patients transplanted with fetal porcine islet cell clusters. Main antibody reactivity against α-linked galactose-containing epitopes. Xenotransplantation 1:89–101 Cotterell AH, Collins BH, Parker W, Harland RC, Platt JL. 1995. The humoral immune response in humans following cross-perfusion of porcine organs. Transplantation 60:861–68 Grey ST, Hancock WW. 1996. A physiologic anti-inflammatory pathway based on thrombomodulin expression and generation of activated protein C by human mononuclear phagocytes. J. Immunol. 156:2256–63 Robson SC, Siegel JB, Lesnikoski BA, Kopp C, Candinas D, Ryan U, Bach FH. 1996. Aggregation of human platelets induced by porcine endothelial cells is dependent upon both activation of complement and thrombin generation. Xenotransplantation 3:24–34 Robson SC, Kaczmarek E, Siegel JB, Candinas D, Koziak K, Millan M, Hancock WW, Bach FH. 1997. Loss of ATP diphosphohydrolase activity with endothelial cell activation. J. Exp. Med. 185:153–63 Kopp CW, Siegel JB, Hancock WW, Anrather J, Winkler H, Geczy CL, Kaczmarek E, Bach FH, Robson SC. 1997. Effect of porcine endothelial tissue factor pathway inhibitor on human coagulation factors. Transplantation 63:749–58 Bach FH. 1994. Discordant xenografts: problems beyond antibodies and complement? Xeno 2:57–59 Jurd KM, Gibbs RV, Hunt BJ. 1996. Activation of human prothrombin by porcine aortic endothelial cells—a potential barrier to pig to human xenotransplantation. Blood Coagul. Fibrinolysis 7:336–43 Goodman DJ, von Albertini MA, McShea A, Wrighton CJ, Bach FH. 1996. Adenoviral-mediated overexpression of IκBα in endothelial cells inhibits natural killer cell-mediated endothelial cell activation. Transplantation 62:967–72 Dalmasso AP, He T, Benson BA. 1996. Human IgM xenoreactive natural antibodies can induce resistance of porcine endothelial cells to complement-mediated injury. Xenotransplantation 3:54–62 Bach FH, Ferran C, Hechenleitner P, Mark W, Koyamada N, Miyatake T, Winkler H, Badrichani A, Candinas D, Hancock WW. 1997. Accommodation of vascularized xenografts: expression of

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“protective genes” by donor endothelial cells in a host Th2 cytokine environment. Nat. Med. 3:196–204 Johnsson C, Andersson A, Bersztel A, Karlsson-Parra A, Gannedahl G, Tufveson G. 1997. Successful retransplantation of mouse-to-rat cardiac xenografts under immunosuppressive monotherapy with cyclosporine. Transplantation 63:652– 56 Stroka DM, Cooper JT, Brostjan C, Millan MT, Goodman DJ, Wrighton CJ, Bach FH, Ferran C. 1997. Expression of a negative dominant mutant of human P55 tumor necrosis factor-receptor inhibits TNF and monocyte-induced activation in porcine aortic endothelial cells. Transplant. Proc. 29:882 Yamada K, Sachs DH, DerSimonian H. 1995. Human anti-porcine xenogeneic T cell response: evidence for allelic specificity of mixed leukocyte reaction and for both direct and indirect pathways of recognition. J. Immunol. 155:5249–56 Pierson RN, Winn HJ, Russell PS, Auchincloss HJ. 1989. Xenogeneic skin graft rejection is especially dependent on CD4+ T cells. J. Exp. Med. 170:991–96 Simeonovic CJ, Ceredig R, Wilson JD. 1990. Effect of GK1.5 monoclonal antibody dosage on survival of pig proislet xenografts in CD4+ T cell-depleted mice. Transplantation 49:849–56 Wecker H, Winn HJ, Auchincloss HJ. 1994. CD4+ T cells, without CD8+ or B lymphocytes, can reject xenogeneic skin grafts. Xenotransplantation 1:8–16 Moses RD, Pierson RNI, Winn HJ, Auchincloss HJ. 1990. Xenogeneic proliferation and lymphokine production are dependent on CD4+ helper T cells and self antigen-presenting cells in the mouse. J. Exp. Med. 172:567–75 Restifo AC, Ivis-Woodward MA, Tran HM, Nickerson PW, Lehnert AM, Strom TB, Chapman JR, O’Connell PJ. 1996. The potential role of xenogeneic antigenpresenting cells in T-cell co-stimulation. Xenotransplantation 3:141–48 Mandel TE, Kovarik J, Koulmanda M, Georgiou HM. 1997. Cellular rejection of fetal pancreas grafts: differences between allo- and xenograft rejection. Xenotransplantation 4:2–10 Korsgren O. 1997. Acute cellular xenograft rejection. Xenotransplantation 4: 11–19 Lenschow DJ, Zeng Y, Thistlethwaite JR, Montag A, Brady W, Gibson MG, Linsley PS, Bluestone JA. 1992. Long-term survival of xenogeneic pancreatic islet grafts

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induced by CTLA4Ig. Science 257:789– 92 Auchincloss H Jr, Lee R, Shea S, Markowitz JS, Grusby MJ, Glimcher LH. 1993. The role of “indirect” recognition in initiating rejection of skin grafts from major histocompatibility complex class IIdeficient mice. Proc. Natl. Acad. Sci. USA 90:3373–77 Wren SM, Wang SC, Thai NL, Conrad B, Hoffman RA, Fung JJ, Simmons RL, Ildstad ST. 1993. Evidence for early Th 2 T cell predominance in xenoreactivity. Transplantation 56:905–11 Morris CF, Simeonovic CJ, Fung M-C, Wilson JD, Hapel AJ. 1995. Intragraft expression of cytokine transcripts during pig proislet xenograft rejection and tolerance in mice. J. Immunol. 154:2470–82 Chan DV, Auchincloss H Jr. 1996. Human anti-pig cell-mediated cytotoxicity in vitro involves non-T as well as T cell components. Xenotransplantation 3:158– 65 Bezouska K, Yuen C, O’Brian J, Childs RA, Chai W, Lawson AM, Drbal K, Fiserova A, Pospisil M, Feizi T. 1994. Oligosaccharide ligands for NKR-P1 protein activate NK cells and cytotoxicity. Nature 372:150–57 Ballas ZK, Rasmussen WL, Krieg AM. 1996. Induction of NK activity in murine and human cells by CpG motifs in oligodeoxynucleotides and bacterial DNA. J. Immunol. 157:1840–45 Seebach JD, Yamada K, McMorrow IM, Sachs DH, DerSimonian H. 1996. Xenogeneic human anti-pig cytotoxicity mediated by activated natural killer cells. Xenotransplantation 3:188–97 Inverardi L, Samaja M, Motterlini R, Mangili F, Bender JR, Pardi R. 1992. Early recognition of a discordant xenogeneic organ by human circulating lymphocytes. J. Immunol. 149:1416–23 Umesue M, Mayumi H, Nishimura Y, Kong Y-Y, Omoto K, Murakami Y, Nomoto K. 1996. Donor-specific prolongation of rat skin graft survival induced by rat-donor cells and cyclophosphamide under coadministration of monoclonal antibodies against T cell receptor αβ and natural killer cells in mice. Transplantation 61:116–24 Karlsson-Parra A, Ridderstad A, Wallgren AC, Moller E, Ljunggren HG, Korsgren O. 1996. Xenograft rejection of porcine islet-like cell clusters in normal and natural killer cell-depleted mice. Transplantation 61:1313–20 Sharabi Y, Aksentijevich I, Sundt TM III,

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AUCHINCLOSS & SACHS Sachs DH, Sykes M. 1990. Specific tolerance induction across a xenogeneic barrier: production of mixed rat/mouse lymphohematopoietic chimeras using a nonlethal preparative regimen. J. Exp. Med. 172:195–202 Wallgren AC, Karlsson-Parra A, Korsgren O. 1995. The main infiltrating cell in xenograft rejection is a CD4+ macrophage and not a T lymphocyte. Transplantation 60:594–601 Satake M, Korsgren O, Ridderstad A, Karlsson-Parra A, Wallgren AC, Moller E. 1994. Immunological characteristics of islet cell transplantation in humans and rodents. Immunol. Rev. 141:191–211 Simeonovic CJ, Townsend MJ, Wilson JD, McKenzie KUS, Ramsay AJ, Matthaei KI, Mann DA, Young IG. 1997. Eosinophils are not required for the rejection of neovascularized fetal pig proislet xenografts in mice. J. Immunol. 158:2490–99 Markmann JF, Campos L, Bhandoola A, Kim JI, Desai NM, Bassiri H, Claytor BR, Barker CF. 1994. Genetically engineered grafts to study xenoimmunity: a role for indirect antigen presentation in the destruction of major histocompatibility complex antigen deficient xenografts. Surgery 116:242–49 Gustafsson K, Germana S, Hirsch F, Pratt K, LeGuern C, Sachs DH. 1990. Structure of miniature swine class II DRB genes: conservation of hypervariable amino acid residues between distantly related mammalian species. Proc. Natl. Acad. Sci. USA 87:9798–802 Moses RD, Winn HJ, Auchincloss HJ. 1992. Evidence that multiple defects in cell-surface molecule interactions across species differences are responsible for diminished xenogeneic T cell responses. Transplantation 53:203–9 Alter B, Bach FH. 1990. Cellular basis of the proliferative response of human T cells to mouse xenoantigens. J. Exp. Med. 171:333–38 Satake M, Kawagishi N, Moller E. 1996. Direct activation of human responder T cells by porcine stimulator cells leads to T cell proliferation and cytotoxic T cell development. Xenotransplantation 3:198– 206 Dorling A, Binns R, Lechler RI. 1996. Cellular xenoresponses: Although vigorous, direct human T cell anti-pig primary xenoresponses are significantly weaker than equivalent alloresponses. Xenotransplantation 3:149–57 Dorling A, Binns R, Lechler RI. 1996.

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Cellular xenoresponses: observation of significant primary indirect human T cell anti-pig xenoresponses using costimulator-deficient or SLA class IInegative porcine stimulators. Xenotransplantation 3:112–19 Yamada K, Seebach JD, DerSimonian H, Sachs DH. 1996. Human anti-pig T-cell mediated cytotoxicity. Xenotransplantation 3:179–87 Bravery CA, Batten P, Yacoub MH, Rose ML. 1995. Direct recognition of SLA- and HLA-like class II antigens on porcine endothelium by human T cells results in T cell activation and release of interleukin2. Transplantation 60:1024–33 Kirk AD, Li RA, Kinch MS, Abernethy KA, Doyle C, Bollinger RR. 1993. The human antiporcine cellular repertoire: in vitro studies of acquired and innate cellular responsiveness. Transplantation 55:924–31 Kumagai-Braesch M, Satake M, Korsgren O, Andersson A, Moller E. 1993. Characterization of cellular human anti-porcine xenoreactivity. Clin. Transplant. 7:273– 80 Murray AG, Khodadoust MM, Pober JS, Bothwell ALM. 1994. Porcine aortic endothelial cells activate human T cells: direct presentation of MHC antigens and costimulation by ligands for human CD2 and CD28. Immunity 1:57–63 Rollins SA, Kennedy SP, Chodera AJ, Elliott EA, Zavoico GB, Matis LA. 1994. Evidence that activation of human T cells by porcine endothelium involves direct recognition of porcine SLA and costimulation by porcine ligands for LFA-1 and CD2. Transplantation 57:1709–16 Birmele B, Thibault G, Nivet H, Gruel Y, Bardos P, Lebranchu Y. 1996. Human lymphocyte adhesion to xenogeneic porcine endothelial cells: modulation by human TNF-α and involvement of VLA4 and LFA-1. Transpl. Immunol. 4:265– 70 Herrlinger KR, Eckstein V, MullerRuchholtz W, Ulrichs K. 1996. Human Tcell activation is mediated predominantly by direct recognition of porcine SLA and involves accessory molecule interaction of ICAM1/LFA1 and CD2/LFA3. Transplant. Proc. 28:650 Maher SE, Karmann K, Min W, Hughes CCW, Pober JS, Bothwell ALM. 1996. Porcine endothelial CD86 is a major costimulator of xenogeneic human T cells: cloning, sequencing, and functional expression in human endothelial cells. J. Immunol. 157:3838–44

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XENOTRANSPLANTATION 171. Kawauchi M, Gundry SR, de Begona JA, Razzouk AJ, Bouchart F, Fukushima N, Hauck AJ, Weeks DA, NehlsenCannarella S, Bailey LL. 1993. Prolonged survival of orthotopically transplanted heart xenograft in infant baboons. J. Thorac. Cardiovasc. Surg. 106(5):779–86 172. Matsumiya G, Gundry SR, Fukushima N, Kawauchi M, Zuppan CW, Bailey LL. 1996. Pediatric cardiac xenograft growth in a rhesus monkey-to-baboon transplantation model. Xenotransplantation 3:76– 80 173. Zhong R, Tucker J, Grant D, Wall W, Garcia B, Asfar S, Zhang Z, Sharpe M, Gelb A, Stiller C. 1996. Long-term survival and functional tolerance of baboon to monkey kidney and liver transplantation: a preliminary report. Trans. Proc. 28:762 174. Munz C, Holmes N, King A, Loke YW, Colonna M, Schild H, Rammensee H-G. 1997. Human histocompatibility leukocyte antigen (HLA)-G molecules inhibit NKAT3 expressing natural killer cells. J. Exp. Med. 185:385–91 175. Sachs DH. 1994. The pig as a potential xenograft donor. Vet. Immunol. Immunopathol. 43:185–91 176. Sayegh MH, Perico N, Gallon L, Imberti O, Hancock WW, Remuzzi G, Carpenter CB. 1994. Mechanisms of acquired thymic unresponsiveness to renal allografts. Thymic recognition of immunodominant allo-MHC peptides induces peripheral T cell energy. Transplantation 58:125–32 177. Tomita Y, Khan A, Sykes M. 1994. Role of intrathymic clonal deletion and peripheral energy in transplantation tolerance induced by bone marrow transplantation in mice conditioned with a non-myeloablative regimen. J. Immunol. 153:1087–98 178. Wood KJ. 1993. The induction of tolerance to alloantigens using MHC class I molecules. Curr. Opin. Immunol. 5:759– 62 179. Waldmann H, Cobbold S. 1993. The use of monoclonal antibodies to achieve immunological tolerance. Immunol. Today 14:247–51 180. Hutchings PR, Cooke A, Dawe K, Waldmann H, Roitt IM. 1993. Active suppression induced by anti-CD4. Eur. J. Immunol. 23:965–68 181. Sayegh MH, Akalin E, Hancock WW, Russell ME, Carpenter CB, Linsley PS, Turka LA. 1995. CD28-B7 blockade after alloantigenic challenge in vivo inhibits Th1 cytokines but spares Th2. J. Exp. Med. 181:1869–74

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182. Khan A, Sergio JJ, Zhao Y, Pearson DA, Sachs DH, Sykes M. 1997. Discordant xenogeneic neonatal thymic transplantation can induce donor-specific tolerance. Transplantation 63:124–31 183. Zhao Y, Swenson K, Sergio JJ, Arn JS, Sachs DH, Sykes M. 1996. Skin graft tolerance across a discordant xenogeneic barrier. Nat. Med. 2:1211–16 184. Dono K, Wood ML, Ozato H, Otsu I, Gottschalk R, Maki T, Monaco AP. 1995. Marked prolongation of rat skin xenografts induced by intrathymic injection of xenogeneic splenocytes and a short course of rapamycin in antilymphocyte serum-treated mice. Transplantation 59:929–32 185. Helg C, Chapuis B, Bolle J-F, Morel P, Salomon D, Roux E, Antonioli V, Jeannet M, Leski M. 1994. Renal transplantation without immunosuppression in a host with tolerance induced by allogeneic bone marrow transplantation. Transplantation 58:1420–22 186. Sayegh MH, Fine NA, Smith JL, Rennke HG, Milford EL, Tilney NL. 1991. Immunologic tolerance to renal allografts after bone marrow transplants from the same donors. Ann. Intern. Med. 114:954– 55 187. Tomita Y, Khan A, Sykes M. 1996. Mechanism by which additional monoclonal antibody injections overcome the requirement for thymic irradiation to achieve mixed chimerism in mice receiving bone marrow transplantation after conditioning with anti-T cell mAbs and 3 Gy whole body irradiation. Transplantation 61:477–85 188. Ildstad ST, Sachs DH. 1984. Reconstitution with syngeneic plus allogeneic or xenogeneic bone marrow leads to specific acceptance of allografts or xenografts. Nature 307(5947):168–70 189. Sharabi Y, Sachs DH. 1989. Mixed chimerism and permanent specific transplantation tolerance induced by a nonlethal preparative regimen. J. Exp. Med. 169:493–502 190. Kawai T, Cosimi AB, Colvin RB, Powelson J, Eason J, Kozlowski T, Sykes M, Monroy R, Tanaka M, Sachs DH. 1995. Mixed allogeneic chimerism and renal allograft tolerance in cynomolgus monkeys. Transplantation 59:256–62 191. Sykes M, Lee LA, Sachs DH. 1994. Xenograft tolerance. Immunol. Rev. 141: 245–76 192. Bartholomew AM, Cosimi AB, Sachs DH, Bailin M, Boskovic S, Colvin R, Hong H, Johnson M, Kimikawa M,

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AUCHINCLOSS & SACHS LeGuern A, Meehan S, Sablinski T, Wee SL, Powelson J. 1997. A study of tolerance in a concordant xenograft model. Transplant. Proc. 29:923–24 Sachs DH, Sykes M, Greenstein JL, Cosimi AB. 1995. Tolerance and xenograft survival. Nat. Med. 1:969 Tanaka M, Latinne D, Gianello P, Sablinksi T, Lorf T, Bailin M, Nickeleit V, Colvin R, Lebowitz E, Sykes M, Cosimi AB, Sachs DH. 1994. Xenotransplantation from pig to cynomolgus monkey: the potential for overcoming xenograft rejection through induction of chimerism. Transplant. Proc. 26:1326–27 Zhao Y, Fishman JA, Sergio JJ, Oliverso JL, Pearson DA, Szot GL, Wilkinson RA, Arn JS, Sachs DH, Sykes M. 1997. Immune restoration by fetal pig thymus grafts in T cell-depleted, thymectomized mice. J. Immunol. 158:1641–49 Fishman JA. 1994. Miniature swine as organ donors for man: strategies for pre-

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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Annu. Rev. Immunol. 1998. 16:471–93 c 1998 by Annual Reviews. All rights reserved Copyright

THE ORIGIN OF HODGKIN AND REED/STERNBERG CELLS IN HODGKIN’S DISEASE Ralf K¨uppers and Klaus Rajewsky Institute for Genetics, University of Cologne, Weyertal 121, D-50931 Cologne, Germany; e-mail: [email protected] KEY WORDS:

germinal center, Epstein-Barr virus, clonality, somatic hypermutation, single cell studies

ABSTRACT One of the characteristic features of Hodgkin’s disease (HD) is the presence of a small population of often bizarre-looking large mono- or multinucleated Hodgkin and Reed-Sternberg (HRS) cells within the affected tissue. Recent cytogenetic investigations, studies of Epstein-Barr virus (EBV) genomes present in HRS cells, and analyses of Ig gene rearrangements amplified from single, micromanipulated HRS cells show that these cells largely represent clonal populations. The finding of Ig gene rearrangements in HRS cells in most cases of HD identifies B cells as the precursors of HRS cells in most if not all cases. Furthermore, the presence and pattern of somatic mutations within the rearranged Ig genes show that HRS cells in classical (i.e. nodular sclerosis, mixed cellularity, and lymphocyte depletion HD) as well as lymphocyte predominant (LP) HD originate from germinal center (GC) B cells. Ongoing somatic mutation and evidence for selection link HRS cells from LP HD to a mutating, antigen-selected GC B cell. In classical HD, the finding of “crippling” mutations and lack of stringent selection for antigen receptor expression suggests that in this case HRS cells are derived from a compartment of GC B cells that were destined to die but escaped apoptosis by some transforming event. One candidate for the latter is EBV infection.

INTRODUCTION In 1832 Thomas Hodgkin published a paper entitled “On some morbid appearances of the absorbant glands and spleen” in which he described seven 471 0732-0582/98/0410-0471$08.00

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cases of tumors in lymph nodes and spleen (1). About 60 years later the histological picture of the disease—now called Hodgkin’s disease (HD)—was further characterized by Dorothy Reed and Carl Sternberg (2, 3). One characteristic feature of HD, which is the most common malignant lymphoma in the Western world, is the presence of small numbers of peculiar, large cells in the tumor tissue. These cells are called Hodgkin cells if they are mononucleated and Reed/Sternberg cells in case of multinuclearity. Usually, Hodgkin and Reed/Sternberg (HRS) cells account for less than 1% of the cells in the tumor (4). They are surrounded by a major population of apparently nonmalignant T cells, B cells, histiocytes, eosinophils, neutrophils, and plasma cells (5). Based on the cellular composition and the histological picture of the tumor, HD is grouped into four subtypes: nodular sclerosis (NS), mixed cellularity (MC), lymphocyte predominant (LP), and lymphocyte depleted (LD) (5, 6). NS HD, which accounts for about 60% of cases of HD is characterized by extensive sclerosis. In NS, as well as in MC HD, T lymphocytes are the predominant lymphocyte population in the tumor (5). This contrasts with LP HD where B cells account for a major fraction of the cellular infiltrate. In NS, MC, and LD HD, the HRS cells usually express the activation markers CD30 and CD15 and lack B lineage markers like CD20 (see also below). In LP HD the situation is reversed. Since HRS cells in LP HD also express other B cell markers, which again are usually not found on HRS cells of the three other subtypes, LP HD is now considered a distinct entity of HD and is discriminated from the three other types of “classical” HD (7). Although HD has been known for a long time, the nature of the HRS cells has until recently been unclear and a matter of much controversy. In particular, two questions have been difficult to answer: (a) Do HRS cells represent a clonal population of tumor cells? And (b) from which cell type do HRS cells derive? Several features of HD account for the difficulties in answering these questions. First, with the exception of HRS cells in LP HD, which regularly express B cell markers, HRS cells of the other subtypes of the disease often lack expression of typical lymphoid markers (4). Furthermore, expression of genes of various hematopoietic lineages was reported in an analysis of gene expression in single HRS cells (8). Second, the scarcity of HRS cells in the tumor poses problems to the application of standard molecular biological techniques like Southern blot hybridization and polymerase chain reaction (PCR) using whole tissue DNA. Using these methods, other lymphomas can in general be analyzed for the presence of clonal immunoglobulin (Ig) or T cell receptor (TCR) gene rearrangements. As Ig and TCR gene rearrangements are highly variable and specific for individual B and T cells, respectively, these methods have been successfully applied in the study of non-Hodgkin lymphomas to reveal the clonal nature and the lineage derivation of the tumor cells in these malignancies (9).

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However, in HD the frequency of HRS cells is too low to allow their detection by Southern blot hybridization and whole tissue DNA PCR. Furthermore, when TCR or Ig gene rearrangements were detected in rare cases by these methods, it was not possible to assign the rearrangements directly to the HRS cells. A third problem in the study of HRS cells has been encountered in attempts to establish cell lines from those cells. Only 15 cell lines have been reported in the literature (10–12), and for only one of these lines are molecular markers available that demonstrate its derivation from an HRS cell in the patient (see below; 13). Despite these difficulties, the results of three types of studies now indicate that HRS cells represent clonal populations: cytogenetic investigations for chromosomal abnormalities, studies of Epstein-Barr virus (EBV) genomes in a fraction of cases of classical HD, and single cell analyses of Ig gene rearrangements. The latter also revealed that HRS cells are derived from germinal center (GC) B cells.

HD IS CHARACTERIZED BY CLONAL POPULATIONS OF HRS CELLS Cytogenetic Studies Karyotype analysis of tumor cells is not only useful in the search for recurrent chromosomal abnormalities, but also reveals the clonal nature of a putative malignant population. However, the low frequency of HRS cells in HD hampered classical cytogenetic investigations of this lymphoma. If mitoses with aberrant karyotypes are detected, it is unclear whether they are derived from HRS or bystander cells. Indeed, it has been reported that cells other than HRS cells with aberrant karyotypes can be detected in HD patients (14, 15). Several attempts have been made to overcome this problem. In a study reported in 1975, cells isolated from pleural effusions from two patients with HD were grown in diffusion chambers implanted into mice (16). The cells growing in the diffusion chambers had the typical morphology of HRS cells, and all carried marker chromosomes that were also detected in primary effusion cells. This finding suggested that HRS cells present in the pleural effusion represented a clonal population. Teerenhovi and colleagues applied a method in which karyotype analysis was combined with immunohistochemistry (17). In two cases of HD they could show that a clonal, abnormal karyotype was consistently present in and restricted to CD30 and CD15 positive large—and thus most likely HRS—cells. In a different approach, Poppema et al (18) analyzed lymph node touch preparations by in situ hybridization for numerical chromosome abnormalities in HRS cells. In four informative cases, the same numerical

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alterations were found in all mononucleated Hodgkin cells of the respective case (multinucleated RS cells often had additional copies of the numerically abnormal chromosomes), suggesting again clonality of the HRS cell population. Inghirami et al obtained evidence for clonality of HRS cells in several cases of HD by DNA index analysis and fluorescence in situ hybridization for numerical chromosome alterations on lymph node touch preparations (19). In this study multiple biopsies were available for all patients. The same DNA indices and numerical alterations were detected in all tissue samples of a given patient, biopsied from different lymphoid organs either at the same time or during initial presentation and relapse. This indicates that the same HRS cell clone was present in all disease-affected lymph nodes of a patient and that relapse of HD was most likely caused by the HRS cell clone present in primary presentation. Finally, in a recent study combining fluorescence in situ hybridization and immunophenotyping, clonal numerical chromosome alterations were detected in each of 30 cases of HD analyzed (20). In those studies that rely on the detection of numerical chromosomal abnormalities, some variation in the number of marker chromosomes in individual HRS cells was regularly observed (18–20). Although this might be taken as an indication for some degree of polyclonality in rare cases of HD, some variation in the number of marker chromosomes is more likely due either to technical matters and/or genetic instability of HRS cells. The latter is supported by the grossly abnormal karyotypes observed in HRS cells (12, 18). Taken together, cytogenetic studies combined with morphological and/or immunohistochemical analysis of the cells carrying abnormal genotypes strongly suggest that HRS cells in HD generally represent a clonal population of tumor cells.

Studies of Clonal EBV Genomes in HRS Cells EBV is a human herpesvirus that can infect human B cells, T cells, and epithelial cells (21). More than 90% of the population in the Western world is latently infected by the virus. In healthy EBV carriers, about 1 in 105 to 1 in 106 B cells harbor the virus (22). EBV is present in several human neoplasms, including endemic Burkitt’s lymphoma, posttransplantation B cell lymphomas, nasopharyngeal carcinoma, and certain T cell lymphomas (23). In addition, in about 50% of cases of classical HD in Europe and North America, EBV is detectable in the HRS cells (24). The prevalence of HD with EBV-positive HRS cells is even higher in other geographic locations, with 96% positive cases in Peru and 100% positive cases of children with HD in Honduras (24). Upon latent infection of a cell, the linear genome of EBV is circularized and stably propagated in the infected cell as an episome. Since the linear genome harbors variable numbers of a 500 bp tandem repeat sequence at both ends, the number of repeats in the episome can be used as a clonal marker

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for EBV-infected cells (25). By combining Southern blot hybridization for the terminal repeat region with in situ hybridization for the identification of EBV-infected cells in the tissue of several cases of HD, it became clear that a clonal population of EBV-infected cells was present in the biopsies and that EBV was largely restricted to HRS cells (26–28). Thus, in those cases, EBV infection had occurred most likely in the progenitor cell that gave rise to a clonal population of HRS cells. In two cases of EBV-positive HD in AIDS patients, it could furthermore be shown that the same clonal EBV genome was present in several biopsies taken from different HD-involved tissues of the two patients, respectively (29). This indicates that the HRS cells present in the various disease-affected tissues were all members of the same malignant clone. There is evidence that this also holds true for primary HD and relapse, at least in a fraction of cases. Brousset et al demonstrated that the same terminal repeat structure was detectable in a case of HD in primary presentation and at relapse several years later, showing that relapse was caused by residual tumor cells of the original HRS clone (30).

Detection of Clonal Ig Gene Rearrangements in HRS Cells The diversity of antibody molecules expressed by B cells is generated during B cell differentiation by a series of gene rearrangements that join three gene segments for the heavy chain (VH, DH, and JH) and two such segments (VL and JL) for κ and λ light chains to create the antibody variable region gene. Since multiple gene segments are available for the recombination processes, and since additional variability arises at the recombination breakpoints by the removal and/or untemplated addition of nucleotides, an enormous diversity of antibody V regions is generated in this way. Since a given V(D)J gene rearrangement is specific for a B cell and its progeny, sequence analysis of V gene rearrangements carried by B cells is ideally suited to study the clonality of B cell populations. To study HD for a potential B lineage derivation and clonality, single HRS cells were isolated by various approaches and analyzed for rearranged V region genes (31–35). Roth et al isolated HRS cells from cell suspensions of fresh lymph nodes and did not detect VH gene rearrangements in any of 12 cases of classical HD and one case of LP HD (32). Delabie et al used formalin-fixed tissues for their studies (34). By enzymatic disaggregation, single cell suspensions were prepared from immunostained tissue sections and used for the isolation of HRS cells. In their analysis of four cases of LP HD, polyclonal VH gene rearrangements were amplified from HRS cells of each of the cases (34). In a later study of this group six cases of NS HD were studied using the same approach (36). Whereas three cases were negative in the analysis, HRS cells of the other three cases, in which the HRS cells expressed the B lineage marker CD20, gave rise to polyclonal VH gene rearrangements, only a single sequence

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was obtained twice. Hummel et al isolated HRS cells by micromanipulation from frozen tissue sections (33), using an approach that we had originally established (37). Twelve cases of classical HD with CD20-positive HRS cells were investigated. VH gene rearrangements were amplified from HRS cells in all cases. Three different patterns were obtained: Six cases harbored only polyclonal V region genes, three cases harbored a clonal rearrangement in addition to polyclonal sequences, and the remaining three cases were monoclonal. A further approach for the study of HRS cells was recently published by Ohshima and colleagues (35). Single putative HRS cells of nine cases of classical HD were isolated by flow cytometry and analyzed for TCRγ as well as Ig heavy chain rearrangements. Whereas TCRγ gene rearrangements were rarely amplified from HRS cells, polyclonal Ig heavy chain gene rearrangements were amplified from all nine cases. In evaluating these various studies one has to take into account that both the failure to detect Ig gene rearrangements and the identification of polyclonal rearrangements are typical potential artifacts of the single cell approach (see also 38): 1. In three of the studies, cases of HD negative for Ig gene rearrangements were encountered—one of 19 cases in our own series (see below), three of six in the analysis of NS HD by Delabie et al (36), and all 13 cases investigated by Roth et al (32). A possible reason for these negative results of course is that a fraction of HD cases is derived from non-B, e.g. T cells (further discussed below). However, we consider it likely that the failure to amplify Ig gene rearrangements from these cases is often or always due to technical problems. As is discussed below, HRS cells of all informative cases of HD in our own series harbored somatically mutated V region genes. If mutations are located at sites where the primers used in the PCR analysis bind, then amplification of the corresponding rearrangement can be prevented. In light of the high mutation load observed in several of the cases (see below), it is indeed expected that some cases—although B cell-derived—will remain negative in the analysis. In addition, negative PCR results may also be due to a general “inaccessibility,” perhaps degradation of the DNA in the cells of the tissue samples. Indeed, a further analysis of the case of HD in our series for which no rearranged Ig genes were amplified revealed that several other genes could also not be amplified from the cells (M Montesinos-Rongen, A Roers, R K¨uppers, K Rajewsky, ML Hansmann, unpublished observation). While these findings may explain why some cases of B cell–derived HD remain negative in an analysis for Ig gene rearrangements, it is still puzzling why all of the cases analyzed by Roth et al (isolating HRS cells from cell suspensions; 32) were negative for VH gene rearrangements. To address the question whether the failure to detect V gene rearrangements in HRS cells isolated from cell suspensions is somehow due to

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the isolation procedure, we recently isolated HRS cellls from tissue sections as well as from cell suspensions (J Itsch, S Nitsch, R K¨uppers, K Rajewsky, A Radbruch, unpublished data). V gene rearrangements were amplified from micromanipulated HRS cells of two cases. The same clonal V gene rearrangements were also amplified from HRS cells enriched by magnetic cell separation, showing that cell suspensions of HRS cells are suitable for V gene studies. 2. In three of the single cell studies, HRS cells were described as polyclonal populations of cells in the majority of the cases (33–36). An important aspect in evaluating these results is that cellular contamination by B cells in the cell isolation procedure—not easy to avoid given the cellular heterogeneity of the diseased tissue—either will generate a polyclonal pattern of V gene sequences when a clonal V gene rearrangement harbored by HRS cells is not successfully amplified or will produce “mixed” results if clonally unrelated V region genes are amplified in addition to a clonal Ig gene rearrangement. In contrast, contamination like DNA from previous amplifications that will cause “monoclonality” can be easily controlled because this kind of contamination will most likely also give rise to PCR products in control reactions (see also 38, 39). Significantly, the initial reports by two groups of a high frequency of polyclonal cases of HD (33, 34) have been questioned by further studies of the same groups. In a reinvestigation of four of their “polyclonal” cases, Hummel et al obtained only clonal V gene rearrangements in two instances (including one case which we analyzed in parallel; 38–40). The same group has also recently claimed monoclonality for HRS cells in each of 11 cases of LP HD (41). Furthermore, in a recent continuation of their work, Chan’s group (which in their first analysis of LP HD reported polyclonality; 34) now report that four of five cases of LP HD are characterized by clonal populations of HRS cells (42). 3. In two studies reporting polyclonality of HRS cells in classical HD, HRS cells expressed the CD20 antigen (33, 36). Since CD20 is expressed by HRS cells only in a small fraction of cases of classical HD (about 10–15%; 4), those cases may represent a separate, minor subset of HD. However, two findings support another possibility to explain the polyclonal results obtained in the CD20-positive cases: (a) In “CD20-positive” HD cases often only a fraction of HRS cells expresses CD20 (33, 36), and (b) EBV-harboring CD20-positive B cells can express CD30 and acquire the phenotype of HRS cells (e.g., in infectious mononucleosis and immunosuppreessed posttransplantation patients) (43–45). Thus, polyclonal V gene rearrangements in “CD20-positive” cases may be derived from EBV-harboring HRS-like B cells, unrelated to the HRS tumor clone. Given this confusing situation, we conclude that there is presently no convincing evidence for cases of HD with polyclonal HRS cells (see also further below).

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In our own studies we used a method that we had previously established and successfully applied to the study of B cell differentiation within human lymph node germinal centers (GC) (37, 46): Single HRS cells were micromanipulated from immunostained histological sections of frozen biopsy specimens and analyzed by PCR for VH as well as Vκ gene rearrangements. In a first experiment, three cases of HD were analyzed, one each of NS, MC, and LP HD. Clonal Ig gene rearrangements were amplified from each of the cases (31). A fourth case that we studied was of particular interest because a permanentely growing cell line was established in V Diehl’s group from peripheral blood of the patient (12). We demonstrated that identical VH and Vκ gene rearrangements were present in the cell line as well as in the HRS cells isolated from a bone marrow biopsy of that patient (13). This is the first and only cell line for which a derivation from the HRS cells of the HD patient was formally proven. Furthermore, the analysis showed that HRS cells can be found in peripheral blood of advanced stage HD patients (12). More recently, we analyzed ten further cases of primary classical HD and five cases of LP HD. In nine cases of classical HD and all five cases of LP HD, we detected clonal VH and/or VL gene rearrangements (47, 48). One case was negative in the analysis. In some cases rare or unique V gene sequences were amplified (13, 31, 47, 48). However, since from some micromanipulated T cells, V gene rearrangements were also obtained with a comparable frequency, these unique V gene rearrangements are most likely due to cellular contamination in the isolation procedure. In addition, some of the micromanipulated cells with a morphology of HRS cells may represent EBV-harboring B lymphocytes unrelated to the tumor population (as discussed above). Thus, overall, in 18 of 19 cases clonality of HRS cells could be demonstrated. Taken together, there is ample evidence that HRS cells in classical as well as LP HD regularly represent a clonal population. The occurrence of polyclonal populations of HRS cells, e.g., at an early stage of the disease (33), may be an interesting speculation, but is not so far supported by convincing evidence.

HRS CELLS IN CLASSICAL AND LP HD ARE DERIVED FROM SEPARATE SUBSETS OF GC B CELLS The Germinal Center Reaction Upon antigen-dependent activation in secondary lymphoid tissues, activated B cells enter primary follicles and establish germinal centers (GCs) (49, 50). Within these structures B cells proliferate and activate the process of somatic hypermutation, which introduces mutations (mainly point mutations) into rearranged variable region genes (37, 51). Antibody variants generated by somatic

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hypermutation are then selected for high-affinity binding to the immunizing antigen (49, 50, 52). Most likely, GC T cells and follicular dendritic cells play an important role in the selection process (49, 50). Only cells producing antibody with increased affinity to the immunizing antigen survive in the GC, whereas cells that do not acquire favorable mutations or that lose the ability to produce antibody at all are efficiently and quickly eliminated by apoptosis (50, 53). Indeed, it appears that B cells upon entering the GC activate the “death program” by default and can survive only if they receive positively selecting signals (54). It is believed that GC B cells go through several rounds of proliferation, mutation, and selection, leading to the generation of B cells that express high-affinity antigen receptors in a short time (55). Two types of descendents leave the GC: long-lived memory B cells and precursors of plasma cells (50). Because human naive B cells carry unmutated V region genes, and because there is no evidence for a structure besides the GC where the hypermutation machinery is active, distinct stages of B cell development can be identified by sequence analysis of rearranged V genes: Whereas immature and naive B cells carry unmutated V genes, GC B cells accumulate somatic mutations and show ongoing somatic mutation (37, 51, 56, 57). In GC-derived memory B cells, on the other hand, the somatic hypermutation machinery is inactive. These cells carry somatically mutated V region genes with evidence for antigen selection (56, 58, 59).

HRS Cells in Classical HD Appear To Be Derived from Crippled GC B Cells Sequence analysis of Ig heavy and light chain gene rearrangements amplified from HRS cells of 13 cases of classical HD revealed that the cells invariably harbor somatically mutated V region genes (13, 31, 47). The average mutation frequency (about 10%) was considerably higher than frequencies usually detected in IgM-positive and class-switched memory B cells (2% and 4%, respectively; 56, 57, 60). As discussed above, the finding of somatic mutation within the rearranged Ig genes identifies a GC B cell or a memory B cell as the precursor of the HRS cells in those cases. Interestingly, mutations generating stop codons within in-frame, potentially functional, V region genes were detected in four cases (31, 47). Mutations creating stop codons are expected to occur in mutating GC B cells (about 5% of random point mutations giving rise to a stop codon; 59). However, GC B cells are stringently selected for the expression of high-affinity antibodies (discussed above). Only cells fulfilling this criterion are allowed to leave the GC and enter the pool of memory B cells. Thus, B cells carrying “crippling” mutations like those causing translational stop occur only within the GC and not in the memory B cell pool. Although we detected apparent crippling mutations in only 4 of 12 cases, it is likely on

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that basis that indeed most if not all cases of classical HD are derived from crippled GC B cells for the following reason: To preserve the antibody V domain structure, replacement mutations within the framework regions (FRs) of potentially functional V region genes are usually counterselected, resulting in replacement/silent (R/S) values below the ones expected, assuming random mutagenesis (58). Whereas low R/S values within FRs were consistently detected in memory B cells (59), the values determined for the potentially functional V region genes amplified from cases of classical HD were intermediate, indicating that mutations in the V region genes of these cases accumulated at least in part in the absence of selection for antigen receptor expression (59). Given the frequently high load of somatic mutation, we speculate that these V region genes accumulated amino acid replacement mutations that are “crippling” in that they reduce affinity for the immunizing antigen, which would, in the absence of cellular transformation, result in apoptosis of the respective GC B cell. It should also be pointed out that crippling mutations like stop codons or defective splice sites may have remained undetected in those cases in which only heavy or light chain genes were successfully amplified and/or not the entire V region genes were sequenced. In summary, both the frequent occurrence of crippling mutations and the high R/S value within the FRs indicate that HRS cells in classical HD derive from GC B cells that lost their dependence on antigen receptor expression and antigenic selection. In light of these findings, it should be mentioned that binding of peanut agglutinin (which is a GC B cell marker; 61) by HRS cells was reported 15 years ago (62, 63).

HRS Cells in LP HD Are Derived from Antigen-Selected GC B Cells A relationship of HRS cells in LP HD to GC B cells was earlier suspected on the basis of immunohistochemical findings. Follicular dendritic and CD57positive T cells, which are both characteristic constituents of normal GCs, are present in LP HD–affected lymph nodes (64–66). In addition, HRS cells in LP HD strongly express the BCL-6 protein, known to be predominantly expressed by GC B cells (67). As in classical HD, somatic mutations in Ig gene rearrangements were detected in all cases of LP HD so far analyzed (31, 41, 42, 48). However, important differences appear in the mutation pattern between LP and classical HD. Thus, in four of six cases of LP HD that we analyzed, ongoing mutation was detectable within the clonal Ig gene rearrangements (31, 48). Intraclonal diversity was also reported for 6 of 11 cases studied by Marafioti et al (41) and three of four cases analyzed by Ohno et al (42). In the remaining cases, it may be due to the limited sequence information available that no intraclonal diversity

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Table 1 Molecular features of HRS cells

Classical HD LP HD

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∗

Clonal lg gene rearrangements

Somatically mutated V genes

Crippling mutations

Counterselection of R mutations in FRs

Ongoing mutation

Yes Yes

Yes Yes

Yes No

Partial Yes

No Yes∗

: at least in a large fraction of cases.

was observed. Somatic hypermutation may thus be ongoing in HRS cells of LP HD as a rule. The occurrence of ongoing mutation identifies a mutating GC B cell as the precursor of HRS cells in LP HD and discriminates LP HD from classical HD, where ongoing mutation was not detected (Table 1). In agreement with this view, the analysis of mutations within FRs revealed that low R/S values, as they are characteristic for antigen-selected normal memory B cells, are typical for HRS cells of LP HD (48). Thus, in contradistinction to classical HD, in LP HD the precursor of the tumor clone shows evidence of selection for expression of a functional antigen receptor (48). This is further supported by the counterselection of mutations causing stop codons in the corresponding sequences (48). Indeed, the detection of mRNA for κ or λ light chains by in situ hybridization (41, 68–70) in HRS cells of a large fraction of cases of LP (but not classical) HD suggests that antibody is expressed by the HRS cells in LP HD. A recent investigation by Marafioti et al (41) appears to contradict the scenario proposed here for the derivation of HRS cells in classical as opposed to LP HD, because 1 of 11 cases of LP HD was reported to be characterized by an HRS clone that lost the coding capacity for immunoglobulin by somatic mutation. However, this conclusion is based on a misinterpretation of the respective V gene sequence, which represents not a crippled, previously functional VH gene rearrangement, but a nonfunctional out-of-frame rearrangement, as they are present also in many normal B cells in addition to a functional rearrangement (analysis available on request). However, it may well be that in some cases (e.g. after acquiring additional transforming events) HRS cells lose their dependence on antibody expression at later stages of the disease. An example of such a case (in which a fraction of the HRS cells had accumulated a crippling mutation within a potentially functional V region gene) is indeed contained in the case collection of Marafioti et al (41).

T Cell–Derived HRS Cells? Although evidence is overwhelming that in the great majority of cases HD originates from a transformed B cell, it is still possible that in a subset of cases the HRS cells are derived from other lineages. In particular, the occasional

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finding of the T cell marker CD3, the cytotoxic T and natural killer cell-specific proteins granzyme B and TIA1, and mRNA for perforin in HRS cells in classical HD (4, 71–74) suggests that in these instances the HRS cells may be T cell derived. Single cell analysis of such and also other HRS cells for TCR gene rearrangements is needed to clarify this issue. However, two recent analyses of a total of 22 cases of HD for TCRγ gene rearrangements did not reveal a single positive case (35, 75). Thus, HD may only rarely (or indeed never) originate from the malignant transformation of a T cell.

GENERATION OF HRS CELL PROGENITORS: A SCENARIO As discussed above, “crippled” GC B cells are usually eliminated by apoptosis within the GC microenvironment. Therefore, the presence of crippling mutations identified GC B cells as the precursor of the HRS cell clone, at least in some cases of classical HD (47). In these cases some transforming event must thus have rescued the HRS cell progenitor from apoptosis and allowed its survival, independent of antigen receptor expression. What might this transforming event be? An interesting possibility is EBV infection, as EBV is present in HRS cells of classical HD in about 50% of cases (24). EBV-harboring HRS cells express the three latent genes, LMP1, EBNA1, and LMP2 (24, 76). LMP1 is known for its transforming capacity, although recent experiments indicate that it mainly influences cell survival and has little effect on B cell proliferation (77). LMP1 also engages signaling proteins for the tumor necrosis factor receptor family (78). One of the mechanisms by which LMP1 may prevent apoptosis and prolong cell survival is through induction of the A20 gene (79), a potent inhibitor of apoptosis (80). The EBNA1 gene has long been thought to be important only for the maintenance of the viral episome. However, a B cell–transforming capacity of EBNA1 is indicated by the recent finding that EBNA1 transgenic mice frequently develop B cell lymphomas (81). The expression of LMP2 by HRS cells may be essential for stabilization of the latent state of EBV infection (82, 83). Taking the functions of LMP1 and EBNA1 into consideration, one can envision that an EBV-harboring GC B cell that has lost the ability to be selected by antigen is rescued from apoptosis due to expression of LMP1 and/or EBNA1 (Figure 1). Thus, because of the B cell–transforming capacity of EBV, EBV-harboring GC B cells may become independent of survival signals usually mediated through their antigen receptor. In addition, the vigorous clonal expansion and the activity of the hypermutation machinery may put these cells at an increased risk to acquire additional (so far unknown) transforming events, finally leading to generation of an HRS tumor clone. In this scenario, it is an open question whether EBV was already present within the prospective

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Figure 1 Scenario for HRS progenitor generation.

progenitor entering a GC, or whether EBV infection took place within the GC. In particular in the first instance, it is likely that further transforming events took place in the HRS precursor, because the lack of intraclonal diversity within the HRS cells in classical HD indicates that only one of the cells of an expanded GC B cell clone gave rise to the HRS clone. It remains to be resolved which transforming events prevented apoptosis of the HRS cell progenitor in the EBV-negative cases of classical HD. Other, so far unknown, viruses or oncogene mutations may be involved in this situation. However, the recent finding of chromosomally integrated fragments of the EBV genome in some cases of “EBV-negative” sporadic Burkitt’s lymphoma (84) lends support to the speculation that in some EBV-negative cases of HD, EBV may also have been present initially in the tumor clone, but was lost at later stages of the disease. It has been speculated that the first phase of HD is caused by a dysregulated immune response in which the immune system unsuccessfully attempts to eliminate antigen-presenting cells expressing some target antigen, e.g. LMP1 in EBV-positive cases (85). Subsequently, a gradual transformation—due to an inherited genetic instability and/or mutagenic events—occurs within this population and finally causes the outgrowth of a single or a few clones of malignant

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HRS cells. This scenario differs from the one proposed above. Although antigenic stimulation of a B cell is a critical event in the development of the disease in both scenarios, we speculate that in classical HD, the initial step in tumorigenesis is a transforming event rescuing a GC B cell from apoptosis. Thus, in the scenario proposed here, it is a single GC B from which the disease originates, not a polyclonal population of cells expressing a viral or cellular target antigen. Like in classical HD, it is likely that also in LP HD the disease initates in a GC B cell. However, as opposed to classical HD, in LP HD EBV does not seem to play a role in this process, because HRS cells in LP HD are usually EBVnegative (86). Furthermore, whereas HRS cells in classical HD appear to derive from “crippled” GC B cells that lost their dependence on antigenic stimulation, the mutation pattern in V genes of HRS cells in LP HD (see above) indicates that transformation of the tumor precursor in LP HD does not render the HRS clone independent of antibody expression. This further supports that other transforming events are involved in the generation of the HRS tumor clones in classical compared to LP HD. It is an intriguing possibility that a potential dependence of the HRS clone by some localized antigenic stimulation is one of the factors causing the indolent clinical behavior and lesser tendency of metastatic tumor spread in LP HD (7).

THE PUZZLE OF THE HRS CELL PHENOTYPE: HRS CELLS IN OTHER DISEASES A puzzling feature of HRS cells is their peculiar phenotype. The reasons for the inconsistent expression of typical B lymphocyte markers as well as factors causing the unusual morphology of HRS cells are poorly understood. Interestingly, HRS-like cells have also been described in several other diseases. For example, EBV-harboring cells of this kind are regularly seen in infectious mononucleosis (43, 44, 87). A potential relationship between this disease and HD is indicated by the finding that individuals with a history of infectious mononucleosis have an up to fivefold increased risk of developing HD, as compared to control populations (86). HRS-like cells have also been described in some rare cases of B-CLL (88). In this disease, rare HRS-like cells are found intermingled with the B-CLL cells, in the absence of infiltration of the affected lymph nodes by other cells as is typical for HD (88). A molecular analysis of HRS cells in these diseases may help to reveal defining features of the HRS cell phenotype. For the characterization of HRS-like cells in infectious mononucleosis, we micromanipulated single CD30-positive HRS-like cells and LMP1-expressing B cells from an affected tonsil and analyzed the cells for Ig gene rearrangements (J Kurth, ML Hansmann, JG Strickler, R K¨uppers, K Rajewsky, unpublished data). Sequence analysis of rearranged V region genes revealed that the

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HRS-like cells represent an oligoclonal population of B lineage cells. Detection of somatic point mutations in most of the rearranged V region genes carried by the cells showed that also in this disease HRS cells were derived from B cells that had participated in a GC reaction. However, in contradistinction to HRS cells in classical HD, no crippling mutations were found, and the V genes showed evidence of selection for antigen receptor expression. V region genes clonally related to the ones amplified from HRS-like cells were also obtained from LMP1-positive B cells. This indicates that members of expanded EBVharboring B cell clones can have either the phenotype of B or of HRS cells and that the EBV-carrying B cell population in this case is largely restricted to antigen-selected GC or memory B cells. More patients will have to be analyzed to reveal whether these findings can be generalized. In two cases of B-CLL with HRS cells, we found the HRS-like cells to represent clonal populations of B cells harboring somatically mutated V region genes (H Kanzler, R K¨uppers, K Rajewsky, HH Wacker, ML Hansmann, unpublished data). Interestingly, in one of the cases a potentially functional V gene rearrangement was rendered nonfunctional because of a somatic mutation creating a stop codon. In this case, the HRS cell clone was unrelated to the B-CLL tumor clone. This shows that HRS cells can derive from crippled GC B cells also in diseases other than classical HD. It remains presently unclear, however, whether the HRS cells in this case represent a tumor clone that developed alongside the B-CLL. Alternatively, a nonmalignant (EBV-positive?) B cell might have clonally expanded in the T cell–deprived microenvironment of the CLL-affected lymph node and acquired the HRS cell phenotype, comparable to what has been described in immunosuppressed patients (45). In the second case, HRS and B-CLL cells belonged to the same clone. However, a point mutation shared by all HRS cells and missing from the B-CLL cells shows that the HRS cells represent a subclone of the B-CLL tumor clone. This indicates that the acquisition of the HRS phenotype was not a random event in multiple B-CLL cells, but that the HRS clone and the B-CLL tumor population developed from two distinct members of a (pre?) malignant B cell clone. In rare cases, HD appears to be associated with a non-Hodgkin’s lymphoma in the same patient (89). In one case of these “composite” lymphomas, in which a Hodgkin’s lymphoma and a follicular lymphoma were found in the same lymph node, the HRS cells and the follicular lymphoma harbored the same somatically mutated clonal Ig heavy and light chain gene rearrangements (R K¨uppers, K Rajewsky, JG Strickler, ML Hansmann, unpublished data). However, several nucleotide differences were observed between the tumor B cells of the two lymphomas, showing that they are derived from two distinct members of a GC B cell clone. In addition, ongoing somatic mutation of V region genes was evident within the tumor cells of the follicular lymphoma, but absent from the

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HRS cells. A more detailed study of this and related cases may reveal which transforming events and differentiation processes cause the development of HD as opposed to other B cell lymphomas. Taking these findings together, HRS cells isolated from infectious mononuclosis, B-CLL with HRS cells and a composite lymphoma invariably carried somatically mutated V region genes, similar to what had been found in HD. Thus, one may speculate that the phenotye of these cells is in some way related to events taking place within the GC. Since it is now clear that most and perhaps all cases of HD are derived from GC B cells, it is puzzling that HRS cells in classical HD usually lack expression of typical B lineage markers. Several factors may account for this. As HRS cells in at least a fraction of classical HD are unable to express immunoglobulin, this could potentially cause a concomitant downregulation of Ig-associated molecules (90). Furthermore, compared to EBV-negative HRS cells, EBV-infected HRS cells show several changes in surface marker expression, like downregulation of CD20 (91, 92). Thus, in EBV-harboring HRS cells, the phenotype of the cells may also be influenced by the virus. Finally, based on the derivation of HRS cells in classical HD from pre-apoptotic GC B cells, one may speculate that in such “dying cells that do not die” the normal gene expression pattern is disturbed, leading, for example, to the downregulation of several typical B lineage markers and/or the expression of molecules not normally produced by B cells. Indeed, one may learn about apoptotic processes by studying HRS cells.

COMPARISON OF HD TO FOLLICULAR AND BURKITT’S LYMPHOMA Ongoing mutation as detected in LP HD is also well known for follicular center lymphoma, which is regarded as a typical GC B cell lymphoma (93, 94). It appears that ongoing mutation is more prominent in follicular lymphoma than in LP HD (48), and clear histological distinctions exist between these lymphomas (95). Nevertheless, both diseases originate from a mutating GC B cell, and the presence of follicular dendritic cells and GC-type T cells is characteristic of follicular lymphoma as well as of LP HD (6, 65, 95). Because of the similarities between the two diseases, it is likely not the differentiation stage of the tumor precursor or the microenvironment in the tissue that determines which of the two lymphomas arises, but rather the transforming events that caused malignant transformation. In agreement with this concept, translocations involving the bcl-2 protooncogene and Ig loci that are typical for follicular lymhpoma (96) have not so far been detected in LP HD. As discussed above, EBV may play a role in rescuing the precursor of the HRS clone in a large fraction of classical HD from apoptosis within the GC.

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In endemic Burkitt’s lymphoma, which is characterized by the presence of EBV and a chromosomal translocation involving the c-myc oncogene and one of the Ig loci (97), the role of EBV in B cell transformation appears to be different. Like HD, endemic Burkitt’s lymphoma presumably derives from a transformed GC B cell, as indicated by (a) the high load of somatic mutation within V region genes expressed by Burkitt’s lymphoma cells, (b) evidence for ongoing mutation of rearranged Ig genes in some cases, and (c) expression of GC-specific surface markers like CD77 (98–101). However, the tumor B cells in Burkitt’s lymphoma regularly express surface Ig (97), indicating that, despite the presence of EBV and the c-myc translocation, Ig expression is still needed in the malignant B cells. How does this relate to the role of EBV in classical HD? One answer may be that EBV transformation alone does not render a B cell independent of survival signals mediated through the antigen receptor, and that a second (unknown) event taking place in an EBV-harboring GC B may allow this cell to survive and give rise to HD. Alternatively, one may speculate that the expression pattern of EBV genes in an EBV-harboring GC B cell has a decisive role in determining the type of lymphoma that may result upon malignant transformation: If expression of only EBNA1 in a GC B cell does not allow the survival of cells that acquired crippling mutations, after further transforming events an antibody-expressing Burkitt’s lymphoma (in which EBNA1 is the only expressed EBV gene; 97) may arise. In contrast, a GC B cell expressing the EBV gene pattern typical for HRS cells (which includes expression of the LMP1 gene in addition to EBNA1) may become independent of antigen receptor expression. Upon malignant transformation, such cells would give rise to HD.

CONCLUDING REMARKS Overall, solid evidence now indicates that classical as well as LP HD is characterized by monoclonal populations of HRS cells, for which the V region genes carried by the cells represent clonal markers. These markers can be used to study various other aspects of the disease (see also 102). For example, other compartments of the body can be screened for the presence of HRS cells, biopsies from patients in remission can be investigated for residual tumor cells, and composite lymphomas consisting of a non-Hodgkin’s lymphoma, and HD can be studied for a potential relationship between the two diseases (see above). The finding of somatically mutated V region genes and the characteristic features of those mutations in HRS cells identified distinct types of GC B cells as the precursors of the tumor in classical and LP HD, respectively (Figure 1). Whereas HRS cells in classical HD appear to derive from crippled GC B cells, in LP HD the precursor of the tumor clone is a mutating, presumably selected

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GC B cell. Since it is now evident that classical and LP HD differ not only in their clinical course and the immunophenotype of the HRS cells but also in the differentiation stage of the precursor of the HRS clone, it should be reconsidered whether the two diseases should be classified as two subtypes of the same disease. Although the clonality of HRS cells and their derivation seem largely established, many questions of key importance for an understanding of HD remain to be resolved: (a) Besides EBV, which transforming events cause the development of a malignant clone of HRS cells? (b) In EBV-positive cases, why is there no effective immune response against LMP1 and 2 expressing HRS cells? A local suppression of cytotoxic T cells in HD-involved lymph nodes has been reported (103). The production of interleukin 10 by HRS cells may play a role in suppression of cellular immunity (104). In addition, HRS cells may escape elimination by cytotoxic T cells because of downregulation of HLA class I expression (105), although this finding is controversial (106). In a more general way, one may speculate that the derivation of HRS cells in classical HD from cells that escaped apoptosis in the GC is directly connected to the acquisition of resistance to apoptosis. (c) By which means are the lymphocytes, eosinophils, plasma cells, and other cell types that constitute the major cellular population attracted to an HD-involved lymph node, and how do they interact with the HRS cells? Most likely, expression of cytokines and chemokines by HRS cells plays an important role in the cellular interactions between HRS and surrounding cells. In a recent single cell analysis of T cells located around HRS cells from three cases of HD, no evidence for a clonal restriction of the T cells was observed, supporting the view that T cells are attracted by HRS cells in an antigen-independent way (A Roers, R K¨uppers, K Rajewsky, ML Hansmann, unpublished observation). In light of the derivation of HRS cells in classical HD from pre-apoptotic GC B cells, one may speculate that the attraction of nontransformed cells into the tumor reflects a so-far-unrecognized property of apoptotic cells that is preserved by the HRS cells. The different histological pictures observed in classical compared to LP HD may thus reflect the distinct origins of the HRS cells in these diseases. ACKNOWLEDGMENTS We are indebted to ML Hansmann, V Diehl, and the other members of the “Hodgkin group” for stimulating discussions over the last years. We thank the Deutsche Forschungsgemeinschaft for support (Di184, SFB502, SFB243).

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¨ KUPPERS & RAJEWSKY subtype and stage in lymphocyte predominance type Hodgkin’s disease. J. Cancer Res. Clin. Oncol. 114:405–10 Falini B, Bigerna B, Pasqualucci L, Fizzotti M, Martelli MF, Pileri S, Pinto A, Carbone A, Venturi S, Pacini R, Cattoretti G, Pescarmona E, Lo Coco F, Pelicci PG, Anagnostopoulos I, Dalla-Favera R, Flenghi L. 1996. Distinctive expression pattern of the BCL-6 protein in nodular lymphocyte predominance Hodgkin’s disease. Blood 87:465–71 Hell K, Pringle JH, Hansmann ML, Lorenzen J, Colloby P, Lauder I, Fischer R. 1993. Demonstration of light-chain mRNA in Hodgkin’s disease. J. Pathol. 171:137–43 Stoler MH, Nichols GE, Symbula M, Weiss LM. 1995. Lymphocyte predominance Hodgkin’s disease. Evidence for a κ light chain-restricted monotypic B-cell neoplasm. Am. J. Pathol. 146:812–18 van Wasielewski R, Wilkens L, Nolte M, Werner M, Georgii A. 1996. Lightchain mRNA in lymphocyte-predominant and mixed-cellularity Hodgkin’s disease. Mod. Pathol. 9:334–38 Oudejans JJ, Kummer JA, Jiwa M, van der Valk P, Ossenkoppele GJ, Kluin PM, Kluin-Nelemans JC, Meijer CJLM. 1996. Granzyme B expression in ReedSternberg cells of Hodgkin’s disease. Am. J. Pathol. 148:233–40 Foss HD, Anagnostopoulos I, Araujo I, Assaf C, Demel G, Kummer JA, Hummel M, Stein H. 1996. Anaplastic large-cell lymphomas of T-cell and null-cell phenotype express cytotoxic molecules. Blood 88:4005–11 Krenacs L, Wellmann A, Sorbara L, Himmelmann AW, Bagdi E, Jaffe ES, Raffeld M. 1997. Cytotoxic cell antigen expression in anaplastic large cell lymphomas of T- and null-cell type and Hodgkin’s disease: evidence for distinct cellular origin. Blood 89:980–89 Felgar RE, Macon WR, Kinney MC, Roberts S, Pasha T, Salhany KE. 1997. TIA-1 expression in lymphoid neoplasms. Am. J. Pathol. 150:1893–900 Daus H, Tr¨umper L, Roth J, von Bonin F, M¨oller P, Gause A, Pfreundschuh M. 1995. Hodgkin and Reed-Sternberg cells do not carry T-cell receptor γ gene rearrangements: evidence from single-cell polymerase chain reaction examination. Blood 85:1590–95 Niedobitek G, Kremmer E, Herbst H, Whitehead L, Dawson CW, Niedobitek E, von Ostau C, Rooney N, Gr¨asser FA, Young LS. 1997. Immunohisto-

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chemical detection of the Epstein-Barr virus-encoded latent membrane protein 2A in Hodgkin’s disease and infectious mononucleosis. Blood 90:1664–72 Zimber-Strobl U, Kempkes B, Marschall G, Zeidler R, van Kooten C, Banchereau J, Bornkamm GW, Hammerschmidt W. 1996. Epstein-Barr virus latent protein (LMP1) is not sufficient to maintain proliferation of B cells but it and activated CD40 can prolong their survival. EMBO J. 15:7070–78 Mosialos G, Birkenbach M, Yalamanchili R, VanArsdale T, Ware C, Kieff E. 1995. The Epstein-Barr virus transforming protein LMP1 engages signaling proteins for the tumor necrosis factor receptor family. Cell 80:389–99 Laherty CD, Hu HM, Opipari AW, Wang F, Dixit VM. 1992. The Epstein-Barr virus LMP1 gene product induces A20 zinc finger protein expression by activating nuclear factor κB. J. Biol. Chem. 267:24,157–60 Sarma V, Lin Z, Clark L, Rust BM, Tewari M, Noelle RJ, Dixit VM. 1995. Activation of the B-cell surface receptor CD40 induces A20, a novel zinc finger protein that inhibits apoptosis. J. Biol. Chem. 270:12,343–46 Wilson JB, Bell JL, Levine AJ. 1996. Expression of Epstein-Barr virus nuclear antigen-1 induces B cell neoplasia in transgenic mice. EMBO J. 15:3117–26 Miller CL, Lee JH, Kieff E, Longnecker R. 1994. An integral membrane protein (LMP2) blocks reactivation of EpsteinBarr virus from latency following surface immunoglobulin cross-linking. Proc. Natl. Acad. Sci. USA 91:772–76 Miller CL, Burkhard AL, Lee JH, Stealey B, Longnecker R, Bolen JB, Kieff E. 1995. Integral membrane protein 2 of Epstein-Barr virus regulates reactivation from latency through dominant negative effects on protein tyrosine kinases. Immunity 2:155–66 Razzouk BI, Srinivas S, Sample CE, Singh V, Sixbey JW. 1996. Epstein-Barr virus DNA recombination and loss in sporadic Burkitt’s lymphoma. J. Infect. Dis. 173:529–35 Wolf J, Diehl V. 1994. Is Hodgkin’s disease an infectious disease? Ann. Oncol. 5:S105-S111 (Suppl. 1) Haluska FG, Brufsky AM, Canellos GP. 1994. The cellular biology of the ReedSternberg cell. Blood 84:1005–19 Niedobitek G, Hamilton-Dutoit S, Herbst H, Finn T, Vetner M, Pallesen G, Stein H. 1989. Identification of Epstein-Barr

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virus-infected cells in tonsils of acute infectious mononucleosis by in situ hybridization. Hum. Pathol. 20:796–99 Momose H, Jaffe ES, Shin SS, Chen YY, Weiss LM. 1992. Chronic lymphocytic leukemia/small lymphocytic lymphoma with Reed-Sternberg-like cells and possible transformation to Hodgkin’s disease. Am. J. Surg. Pathol. 16:859–67 Jaffe ES, Zarate-Osorno A, Kingma DW, Raffeld M, Medeiros LJ. 1994. The interrelationship between Hodgkin’s disease and non-Hodgkin’s lymphomas. Ann. Oncol. 5:S7-S11 (Suppl. 1) Korkolopoulou P, Cordell J, Jones M, Kakaminis L, Tsenga A, Gatter KC, Mason DY. 1994. The expression of the Bcell marker mb-1 (CD79a) in Hodgkin’s disease. Histopathology 24:511–15 Bai MC, Jiwa NM, Horstman A, Vos W, Kluin PH, van der Valk P, Mullink H, Walboomers JMM, Meijer CJLM. 1994. Decreased marker expression of cellular markers in Epstein-Barr virus-positive Hodgkin’s disease. J. Pathol. 174:49–55 Herbst H, Raff T, Stein H. 1996. Phenotypic modulation of Hodgkin and ReedSternberg cells by Epstein-Barr virus. J. Pathol. 179:54–59 Cleary ML, Meeker TC, Levy S, Lee E, Trela M, Sklar J, Levy R. 1986. Clustering of extensive somatic mutations in the variable region of an immunoglobulin heavy chain gene from a human B cell lymphoma. Cell 44:97–106 Bahler DW, Levy R. 1992. Clonal evolution of a follicular lymphoma: evidence for antigen selection. Proc. Natl. Acad. Sci. USA 89:6770–74 Poppema S, Kaleta J, Hugh J, Visser L. 1992. Neoplastic changes involving follicles: morphological, immunophenotypic and genetic diversity of lymphoproliferations derived from germinal center and mantle zone. Immunol. Rev. 126:163–78 Cotter FE. 1990. The role of the bcl-2 gene in lymphoma. Br. J. Haematol. 75:449–53 Magrath I. 1990. The pathogenesis of Burkitt’s lymphoma. Adv. Cancer Res. 55:133–260 Gregory CD, Tursz T, Edards CF, Tetaud C, Talbot M, Caillou B, Rickinson AB, Lipinski M. 1987. Identification of a sub-

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set of normal B cells with a Burkitt’s lymphoma (BL-)-like phenotype. J. Immunol. 139:313–18 Ling NR, Hardie D, Lowe J, Johnson GD, Khan M, MacLennan ICM. 1989. A phenotypic study of cells from Burkitt’s lymphoma and EBV-B-lymphoblastoid lines and their relationship to cells in normal lymphoid tissue. Int. J. Cancer 43:112– 18 Klein U, Klein G, Ehlin-Henriksson B, Rajewsky K, K¨uppers R. 1995. Burkitt’s lymphoma is a malignancy of mature B cells expressing somatically mutated V region genes. Mol. Med. 1:495–505 Chapman CJ, Mockridge CI, Rowe M, Rickinson AB, Stevenson FK. 1995. Analysis of VH genes used by neoplastic B cells in endemic Burkitt’s lymphoma show somatic hypermutation and intraclonal heterogeneity. Blood 85:2176–81 K¨uppers R, Hansmann ML, Diehl V, Rajewsky K. 1995. Molecular single-cell analysis of Hodgkin and Reed-Sternberg cells. Mol. Med. Today 1:26–30 Frisan T, Sj¨oberg J, Dolcetti R, Boiocchi M, De Re V, Carbone A, Brautbar C, Battat S, Biberfeld P, Eckman M, ¨ A, Christensson B, Sundstr¨om C, Ost Bj¨orkholm M, Pisa P, Masucci MG. 1995. Local suppression of Epstein-Barr virus (EBV)-specific cytotoxicity in biopsies of EBV-positive Hodgkin’s disease. Blood 86:1493–1501 Herbst H, Foss HD, Samol J, Araujo I, Klotzbach H, Krause H, Agathanggleou A, Niedobitek G, Stein H. 1996. Frequent expression of interleukin-10 by Epstein-Barr virus-harboring tumor cells of Hodgkin’s disease. Blood 87:2918– 29 Poppema S, Visser L. 1994. Absence of HLA class I expression by ReedSternberg cells. Am. J. Pathol. 145:37–41 Oudejans JJ, Jiwa NM, Kummer JA, Horstman A, Vos W, Baak JPA, Kluin PM, van der Valk P, Walboomers JMM, Meijer CJLM. 1996. Analysis of major histocompatibility complex class I expression on Reed-Sternberg cells in relation to the cytotoxic T-cell response in Epstein-Barr virus-positive and -negative Hodgkin’s disease. Blood 87:3844–51

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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Annu. Rev. Immunol. 1998. 16:495–521 c 1998 by Annual Reviews. All rights reserved Copyright

THE INTERLEUKIN-12/ INTERLEUKIN-12-RECEPTOR SYSTEM: Role in Normal and Pathologic Immune Responses Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini∗ , Ueli Gubler, and David H. Presky Department of Inflammation/Autoimmune Diseases, Hoffmann-La Roche Inc., Nutley, New Jersey 07110, and ∗ Roche Milano Ricerche, Via Olgettina 58, 20132 Milano, Italy; e-mail: [email protected] KEY WORDS:

autoimmune diseases, cytokine, IL-12, IL-12 receptor, Th subsets

ABSTRACT Interleukin-12 (IL-12) is a heterodimeric cytokine that plays a central role in promoting type 1 T helper cell (Th1) responses and, hence, cell-mediated immunity. Its activities are mediated through a high-affinity receptor composed of two subunits, designated β1 and β2. Of these two subunits, β2 is more restricted in its distribution, and regulation of its expression is likely a central mechanism by which IL-12 responsiveness is controlled. Studies with neutralizing anti-IL-12 antibodies and IL-12-deficient mice have suggested that endogenous IL-12 plays an important role in the normal host defense against infection by a variety of intracellular pathogens. However, IL-12 appears also to play a central role in the genesis of some forms of immunopathology. Inhibition of IL-12 synthesis or activity may be beneficial in diseases associated with pathologic Th1 responses, such as multiple sclerosis or Crohn’s disease. On the other hand, administration of recombinant IL-12 may have utility in the treatment of diseases associated with pathologic Th2 responses such as allergic disorders and asthma.

INTRODUCTION Interleukin-12 (IL-12) is a heterodimeric cytokine that is produced primarily by antigen-presenting cells and exerts immunoregulatory effects on T and natural 495 0732-0582/98/0410-0495$08.00

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killer (NK) cells (1–4). IL-12 is most noted for its ability to regulate the balance between type 1 and type 2 helper T cells. As is discussed below, endogenous IL-12 appears to be requisite for generating optimal Th1 responses in many experimental settings and appears to play a pivotal role in promoting cell-mediated immunity against predominantly intracellular microbial pathogens (5–8). In addition, recombinant IL-12 (rIL-12) has striking therapeutic effects in a number of mouse tumor models (9–11) and mouse models of infectious diseases (12–15) and airway inflammation (16, 17). Based on these results, clinical trials investigating the potential therapeutic effects of IL-12 have been initiated in human cancer patients, HIV-infected patients, and patients with chronic viral hepatitis. IL-12 may also have utility as a vaccine adjuvant (18, 19). In this review, we focus on more recent information on the structure and function of the IL-12 receptor (IL-12R) and the role of endogenous IL-12 in both normal and pathologic immune responses. Reviews discussing the therapeutic potential of IL-12 can be found in (20–22) and more general reviews of IL-12 biology in (23–28).

STRUCTURE OF IL-12 Among the family of interleukin proteins characterized to date, IL-12 has a novel structure. It is a heterodimeric protein comprised of two disulfide-linked subunits designated p35 and p40 (representing their approximate molecular weights), which are encoded by unrelated genes (1–4, 29, 30). The genes for the IL-12 subunits p35 and p40 reside at independent loci in the human genome on chromosomes 3p12–3q13.2 and 5q31–33, respectively (31). The genes encoding the mouse IL-12 p35 and p40 subunits have been localized to chromosomes 3 and 11, respectively (32–34). No sequence homology exists between the IL-12 p35 and p40 subunits. However, the 35-kDa subunit of IL-12 shares homology with IL-6, G-CSF, and chicken myelomonocytic growth factor (35) and has, similar to many other cytokines, an α-helix-rich structure. Interestingly, the 40-kDa subunit is not homologous to other cytokines, but belongs to the hemopoietin receptor family, and most resembles the extracellular domain of the IL-6 receptor α-subunit and the ciliary neurotrophic factor receptor (30, 36). However, no evidence has appeared for the existence of membrane-associated forms of IL-12 or either of its subunits. A three-dimensional model of the IL-12 molecule has been constructed (37). Neither IL-12 subunit alone was found to display significant biologic activity over a large range of concentrations (3, 4), although a p40 homodimer ((p40)2) may function as an IL-12 antagonist that binds to the IL-12R but does not mediate a biologic response (38–40). Production of IL-12 both by cell lines

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Figure 1 Production of p40 monomer and dimer by activated mouse macrophages (Mφ). Thioglycollate elicited, adherent peritoneal Mφ from wild-type C57BL/6 or IL-12 p35 deficient (p35−/−) mice were cultured in the presence or absence of formalinized Staphylococcus aureus plus 200 U/ml mouse IFN-γ . Culture supernatants were harvested after 24 h and analyzed for IL-12 p40 by Western blotting using a rat anti-mouse p40 mAb 10F6. Contents of lanes: 1. mouse rp40 monomer; 2. mouse r(p40)2; 3. mouse rIL-12; 4. supernatant from unactivated p35−/− Mφ, volume equal to that applied in lane 6; 5. supernatant from activated wild-type Mφ, 2 ng p40 added to gel; 6. supernatant from activated p35−/− Mφ, 2 ng p40 added to gel. By ELISA, amounts of p40 and IL-12 heterodimer in the supernatants were as follows: control p35−/− Mφ: no p40 or heterodimer detectable; activated wild-type Mφ: 140 ng/ml p40 + 4 ng/ml heterodimer; activated p35−/− Mφ: 275 ng/ml p40 but no detectable heterodimer.

and by normal monocytes results in the secretion of a 5- to 500-fold excess of p40 relative to the IL-12 heterodimer (29, 41). The excess p40 produced in vitro by activated mouse adherent peritoneal exudate cells contains 5% to 30% (p40)2, and this excess p40 possesses IL-12-antagonist activity (Figure 1 and R Warrier, F Podlaski, A Stern, M Gately, unpublished results). Likewise, approximately 20% to 40% of the p40 in the serum of normal and endotoxintreated mice is in the form of (p40)2 (42). These results suggest that (p40)2 may act as a physiologic regulator of IL-12 activity in mice, but this possibility remains to be demonstrated experimentally. Moreover, (p40)2 was recently reported to stimulate, rather than inhibit, the differentiation of CD8+ Th1 cells in vitro (43). In addition, Th1 development was enhanced in allografted IL-12 p35-deficient mice that were shown in other experiments to produce normal amounts of p40 monomer and dimer (Figure 1), as compared to allografted

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IL-12 p40-deficient mice. This enhancement was eliminated by administration of anti-IL-12 p40 mAb (JR Piccotti, K Li, SY Chan, J Ferrante, J Magram, EJ Eichwald, DK Bishop, manuscript submitted for publication). Thus, (p40)2 may play a previously unsuspected role in facilitating some immune responses that involve production of IFN-γ by CD8+ T cells.

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STRUCTURE AND FUNCTION OF IL-12R IL-12R are primarily expressed on activated T and NK cells (44). Using radiolabeled rIL-12 and human PHA-activated lymphoblasts, high-affinity (Kd = 5–20 pM, 100–1000 sites per cell) and low-affinity (Kd = 2–6 nM, 1000–5000 sites per cell) IL-12 binding sites have been detected. A third, medium-affinity site (Kd = 50–200 pM, 200–1000 sites per cell) has also been described (45). The cDNAs for two IL-12R subunits have been cloned from human and mouse T cells and designated as IL-12Rβ1 (46, 47) and IL-12Rβ2 (48). Both of these subunits belong to the gp130 subgroup of the cytokine receptor superfamily. They are type I transmembrane glycoproteins, with molecular sizes of about 100 kDa (IL-12Rβ1) and 130 kDa (IL-12Rβ2). On the cell surface, each of the two recombinant IL-12R subunits occurs as dimers/oligomers. The formation of these higher order structures is ligand independent. When expressed in recombinant form on COS cells, each human subunit binds labeled IL-12 with only low (nM) affinity. Coexpression of IL-12Rβ1 and IL-12Rβ2 is required for the generation of human high-affinity (pM) IL-12 binding sites (48). Detailed comparison of the binding characteristics of the mouse and human IL-12R subunits demonstrated that although the proteins exhibit significant structural homology (47, 48), the mouse IL-12R subunits exhibit differences in their IL-12 binding characteristics as compared to their human counterparts (46–49). When expressed in the mouse IL-3-dependent pro-B cell line Ba/F3, human IL-12Rβ1 mediates only very low affinity (Kd > 50 nM) binding of human IL-12, whereas mouse IL-12Rβ1 mediates both low (Kd about 2 nM) and high (Kd about 100 pM) affinity binding of mouse IL-12. In contrast, human IL-12Rβ2 expressed in Ba/F3 cells binds human IL-12 with low affinity (Kd about 3 nM), whereas mouse IL-12Rβ2 binds mouse IL-12 with an affinity too low to quantitate (Kd > 50 nM). Therefore, the contributions of the two IL-12R subunits to high-affinity IL-12 binding differ significantly between mouse and human. For both species the IL-12Rβ2 subunit appears to function as the signal transducing component of the high-affinity receptor complex (48, 50). This is suggested by the absence of tyrosine residues in the cytoplasmic domain of human IL-12Rβ1 and the presence of conserved tyrosine residues in the cytoplasmic portion of IL-12Rβ2. Ba/F3 cells expressing human IL-12Rβ2 alone proliferate in response to human IL-12, although at higher concentrations

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of IL-12 than are required for Ba/F3 cells expressing both the β1 and β2 subunits (48). In contrast, Ba/F3 cells expressing only mouse IL-12Rβ2 cannot grow in IL-12-containing medium, probably due to the very low affinity binding of mouse IL-12 to the mouse IL-12Rβ2 subunit (49). In addition, Ba/F3 cells expressing only mouse IL-12Rβ1, which bind mouse IL-12 with both high and low affinity, do not grow in the presence of mouse IL-12 (49). Therefore, for the mouse system, the β1 subunit appears to provide most of the binding energy, whereas the β2 subunit is necessary for signal transduction. In contrast, in the human system both the β1 and β2 subunits contribute IL-12 binding energy, while the β2 subunit functions as the primary signal transducing component. Using flow cytometric techniques, IL-12 has been shown to bind to activated human B cells and the B cell lymphoma SKW6.4 (51; C Wu, M Gately, unpublished results). In contrast, resting human PBMC, activated human B cells, and SKW6.4 cells express IL-12Rβ1 mRNA and protein but fail to bind detectable 125I-labeled human IL-12 (52, 53). The reasons for the discrepancy between these reported results are not clear but may involve either the level of B cell activation or the possibility that flow cytometric studies, in which cells are incubated with very high concentrations of IL-12 (50–500 nM), may be measuring IL-12 binding of very low affinity not detectable by the radiolabeled IL-12 binding studies. The latter is suggested by our observations that binding of IL-12 to SKW6.4 cells was detected by FACS analysis but not by radiolabeled IL-12 binding studies (C Wu, M Gately, unpublished results). In contrast to the situation for human B cells, IL-12 binding to mouse B cells is less controversial. Both high- and low-affinity binding of mouse IL-12 to activated mouse B cells have been measured using 125I-labeled mouse IL-12 (C Wu, M Gately, unpublished results), and flow cytometric techniques have detected mouse IL-12 binding to activated mouse B cells (51). The differences in IL-12 binding to mouse and human B cells may be explained by the likelihood that B cells do not express IL-12Rβ2, and therefore the observed differences in IL-12 binding may simply reflect the differences in the IL-12 binding characteristics of mouse and human IL-12Rβ1 described above. Recent evidence suggests that expression of both the human and mouse IL-12Rβ2 proteins may be confined to Th1 cells and that IL-12Rβ2 expression correlates with IL-12 responsiveness in these cells (54, 55). Following differentiation, Th2 cells, like activated B cells, express IL-12Rβ1 but not IL-12Rβ2 (54, 55). Likewise, in comparison to expression of IL-12Rβ1, expression of the IL-12Rβ2 subunit appears to be more highly regulated by cytokines such as IL-10 and TGF-β (56). Thus, control of IL-12Rβ2 expression may constitute a pivotal mechanism for regulating IL-12 responsiveness. Upregulation of IL-12Rβ1 on activated B and Th2 cells in the absence of IL-12Rβ2 suggests

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that this receptor subunit may serve some as-yet-to-be-identified function, in addition to its role as an essential component of the high-affinity IL-12R.

BIOLOGIC ACTIVITIES OF IL-12 The following is a brief overview of the biologic activities mediated by IL-12. For more detailed reviews, see references (23–28). Annu. Rev. Immunol. 1998.16:495-521. Downloaded from arjournals.annualreviews.org by HINARI on 08/31/07. For personal use only.

Regulation of Th1/ Th2 Responses by IL-12 The most distinctive, and perhaps the most important, of IL-12’s activities is its ability to regulate the balance between Th1 and Th2 cells. Th1 cells secrete IL-2 and IFN-γ , thus promoting cell-mediated immunity; whereas Th2 cells produce IL-4, -5, -6, -10, and -13, thereby facilitating humoral immunity (57, 58). In vitro studies in both human (59–61) and murine (62–64) systems and in vivo studies in mice (5, 6, 12, 13, 65) have shown that IL-12 promotes Th1 responses. IL-12 does this in three ways: (a) it promotes the differentiation of naive T cells, during initial encounter with an antigen, into a population of Th1-cells capable of producing large amounts of IFN-γ following activation (60, 62–64), (b) it serves as a costimulus required for maximum secretion of IFN-γ by differentiated Th1 cells responding to specific antigen (66, 67), and (c) it stimulates the development of IFN-γ -producing Th1 cells from populations of resting memory T cells interacting with an antigen to which they have been previously exposed (59, 61, 67). IL-12 does not appear to play a significant role in regulating IL-2 production (5, 62), although IL-2, like IFN-γ , is typically considered to be a type 1 cytokine. In some (62–64, 68) but not all (59, 63, 68) models, the Th1-promoting effects of IL-12 could be inhibited by anti-IFN-γ ; however, IFN-γ by itself could not substitute for IL-12 (62–64, 68). The role of IFN-γ as a costimulus to IL-12-dependent Th1 responses could reflect a role as a cofactor needed for optimal IL-12 secretion (69) (under circumstances where the Th1 response is driven by endogenous, rather than added, IL-12) and/or to its ability to promote expression of the β2 subunit of the IL-12 receptor and, hence, IL-12 responsiveness (55, 68). Although IL-12 has been most commonly found to promote Th1 responses while suppressing Th2 responses, under some experimental conditions IL-12 was observed to enhance Th2 responses (70–73). Whether IL-12 suppresses or enhances Th2 responses appears to depend both on the cytokine milieu and on the maturational state of the T cells. It has also been recently reported that priming human T cells in vitro in the presence of IL-12 can lead to production of high levels of IL-10, as well as of IFN-γ , following subsequent activation (74, 75).

Induction of Cytokine Secretion by IL-12 One of the most important properties of IL-12 is its ability to induce the production of large amounts of IFN-γ from resting and activated T and NK cells

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(1, 14, 76–79). This activity of IL-12 is central to many of the effects seen when IL-12 is administered in vivo (10–12, 14–16, 65) and provides a mechanism whereby IL-12 plays an important role in innate, as well as adaptive, immunity. In eliciting the production of IFN-γ by T and/or NK cells, IL-12 synergizes with a variety of cytokines and other lymphocyte-activating agents, including TNF-α, IL-1, and IL-2; on the other hand, IL-12-induced IFN-γ production has been reported to be down-regulated by IL-4, IL-10, and TGF-β (1, 60, 76, 77, 79–82; reviewed in references 23–27). IL-12 induces the production of several cytokines in low amounts, including TNF-α (10, 77, 83, 84), GM-CSF (77, 85), IL-2 (83), and IL-8 (85). Surprisingly, IL-12 induces IL-10 production in vivo when administered to mice (65) and acts as a costimulus to IL-10 secretion by activated human T cells in vitro (86–88). Since IL-10 can inhibit the synthesis and, to a lesser extent, the action of IL-12 (79, 80), the ability of IL-12 to induce IL-10 production may represent a negative feedback mechanism by which IL-12 limits its own effects. On the other hand, IL-12 is reported to suppress the production of TGF-β via a mechanism that is at least partially IFN-γ dependent (89, 90).

Effects of IL-12 on Antibody Responses IL-12 can either enhance or inhibit humoral immunity, depending on the Ig isotype and the stimulus to antibody formation. Administration of IL-12 to mice can result in enhancement of IgG2a, IgG2b, and IgG3 antibody responses to protein antigens by as much as 10- to 1000-fold (91, 92). These isotypes are associated with Th1 responses in mice (93), so this result is not surprising. On the other hand, IL-12 suppressed IgG1 antibody responses, which are Th2-associated, when antibody levels were measured following primary immunization (92, 94), but modestly enhanced (2- to 5-fold) IgG1 responses in mice that had been primed and boosted several times (91, 92). IL-12 has been shown to cause dramatic inhibition of IgE responses in a variety of experimental models both in vitro (81, 95) and in vivo (65, 91, 96–98). However, under some circumstances IL-12 can actually enhance IgE responses (72, 98), consistent with its ability to enhance IL-4 production in some experimental settings, as noted above (70–73). In most models, the effects of IL-12 on antibody responses were at least partially mediated via IFN-γ (65, 81, 91, 92, 95–97), but direct effects of IL-12 on B cells cannot be excluded (99).

Other Activities of IL-12 IL-12 can enhance the lytic activity of NK and lymphokine-activated killer cells (1, 2, 84, 100–102), promote specific cytolytic T lymphocyte (CTL) responses (101–103), act as a short-term growth factor for activated T and NK cells (1–4, 83, 100, 104), and synergize with stem cell factor and, to a lesser extent, with some of the other colony stimulating factors to induce the proliferation and

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differentiation of hematopoietic stem cells (105–107). For further discussion of these activities, see references 23–28. IL-12 inhibits activation-induced apoptosis of human peripheral blood T cells from normal or HIV-infected individuals (108, 109) or of cloned human Th1 cells (110). In one report, IL-12 suppressed apoptosis of both activated CD4+ and activated CD8+ T cells (108), whereas in a second report CD4+, but not CD8+, T cells were protected by IL-12 (109). This discrepancy may relate to differences in the conditions used for activation. In contrast to these results, preincubation of human peripheral blood NK cells with either IL-2 or IL-12 primed them so that they underwent apoptosis in response to subsequent crosslinking of CD16 in the absence of added cytokines (111). The discrepancy between the enhancing effects of IL-12 on apoptosis of NK cells in this study (111) and the inhibitory effects of IL-12 on T cell death in the previous studies (108–110) could reflect differences in the cell type examined or differences in the timing of exposure to IL-12 relative to the timing of addition of the apoptosis-inducing stimulus.

ROLE OF ENDOGENOUS IL-12 IN NORMAL IMMUNITY AND HOST DEFENSE The generation of Th1 responses and IFN-γ production are important in promoting immunity to a number of infectious pathogens, playing a critical role in resistance to these pathogens. Studies in IL-12 deficient mice have demonstrated an essential role for endogenous IL-12 in promoting the generation of Th1 responses leading to optimal IFN-γ production (5). Consistent with this, there is a large body of literature documenting the role of IL-12 in resistance to a variety of predominantly intracellular pathogens, including bacteria, fungi, and protozoans (reviewed in 25). The present review focuses primarily on the role of endogenous IL-12 using the analysis of mice made deficient in IL-12 production by introduction of a mutation into one of the IL-12 subunit genes (5, 6) or through the use of neutralizing monoclonal antibodies (mAbs). Infection of mice with Leishmania major provides a valuable model for the study of Th1 responses in parasitic infection (112). The genetic background of the mice dictates their ability to mount an effective immune response against the infection. C57BL/6 mice, as well as 129/SvEv and C3H mice, selectively initiate a Th1 response upon infection with Leishmania major and are able to resolve the infection. In contrast, BALB/c mice respond to Leishmania major infection by generation of a predominant Th2 response and subsequently succumb to the infection. IL-12 is critical for the protective Th1 response because elimination of IL-12 in otherwise genetically resistant mice results

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in failure to generate a Th1 response and, consequently, in susceptibility to Leishmania major. This was shown by the use of anti-IL-12 mAbs (113, 114) and confirmed with IL-12 deficient mice (6). Mutation of either the p40 or the p35 subunit conferred susceptibility (6). Endogenous IL-12 is required for resistance to infection with Toxoplasma gondii (7, 14, 115–117); however, this resistance is mediated by both IL-12dependent and IL-12-independent events (7). Furthermore, the IL-12-dependent events critical to resistance occur early during the infection since administration of anti-IL-12 antibodies during the acute phase of infection, but not during the chronic phase, resulted in death (117). IL-12 also appears to contribute to the ability to control infection by Mycobacterium avium (118) or by Mycobacterium tuberculosis (119), since neutralization of IL-12 with mAbs suppressed resistance to infection with these pathogens. Recent data using IL-12-deficient mice further demonstrate the requirement for IL-12 in protective immunity to Mycobacterium tuberculosis (8). Resistance to a Listeria monocytogenes infection involves both IL-12-mediated and IL-12-independent responses. Although neutralization of IL-12 during the primary response resulted in an increased susceptibility to Listeria monocytogenes infection (120, 121), neutralization during the secondary response had significantly less effect (121). Experiments using IL-12 p40– or IL-12 p35–deficient mice seemed to substantiate the requirement for IL-12 in resistance to Listeria monocytogenes because IL-12-deficient mice died at normally sublethal doses of Listeria (F Brombacher, J Magram, J Ferrante, WJ Dai, G K¨ohler, A Wunderlin, K Palmer, FJ Podlaski, MK Gately, G Alber, manuscript in preparation). However, in contrast to the susceptibility of IL-12 p40–deficient mice, IL-12 p35–deficient mice were able to respond to intermediate doses of Listeria by sterile elimination of the bacteria despite the mouse’s inability to produce biologically active IL-12. Interestingly, these IL-12 p35– deficient mice produce normal levels of IL-12 p40 dimer and monomer (Figure 1), suggesting that IL-12 (p40)2 or IL-12 p40 monomer, alone or associated with a polypeptide distinct from IL-12 p35, can play a pivotal role in the elimination of Listeria. This is intriguing in light of the recent data demonstrating agonistic activity of IL-12 (p40)2 in a cardiac allograft model (43). However, in contrast to the IFN-γ inducing activity observed on CD8+ T cells in the transplantation studies, no such effect on CD8+ T cells was observed in these experiments (F Brombacher, J Magram, J Ferrante, WJ Dai, G K¨ohler, A Wunderlin, K Palmer, FJ Podlaski, MK Gately, G Alber, manuscript in preparation). IL-12-deficient mice infected with Cryptococcus neoformans were also differentially susceptible to infection depending on which subunit of IL-12 was

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mutated (K Decken, G K¨ohler, J Magram, J Ferrante, K Palmer, A Wunderlin, F Mattner, MK Gately, G Alber, manuscript in preparation). Similar to infection with Listeria, IL-12 p40 deficient mice died significantly earlier than either IL-12 p35 deficient mice or wild-type control mice. These results are consistent with a previously unidentified agonistic role for IL-12 p40 or (p40)2 and warrant further investigation into the mechanism of action of this ligand.

ROLE OF ENDOGENOUS IL-12 IN IMMUNOPATHOLOGY Endotoxin-Induced Shock Severe gram-negative bacterial infections can lead to development of endotoxic shock, which is mediated through the release of cytokines such as TNF-α, IL-1, IL-6, and IFN-γ (122). Elevated serum IL-12 levels following endotoxin administration have been demonstrated in both mice (123, 124) and baboons (125). The role of endogenous IL-12 in contributing to endotoxin-induced mortality has been studied in several murine models (124, 126). The generalized Schwartzman reaction is a model of endotoxin-induced shock in which mice are primed with a low dose of endotoxin in the footpad, followed one day later by a lethal challenge dose of endotoxin given i.v. Administration of antibodies to IL12 or IFN-γ prior to the priming dose of endotoxin prevented mortality (126). In addition, 10 ng of IL-12 could substitute for endotoxin in priming mice for a lethal response to the endotoxin challenge, and the priming effect of IL-12 could also be blocked by treatment with anti-IFN-γ (126). The results suggest that in this model the priming dose of endotoxin induces production of IL-12 which, in turn, stimulates the secretion of IFN-γ , resulting in priming of macrophages and other cell types for a lethal response to the endotoxin challenge. In other studies, injection of anti-IL-12 antibodies caused significant reductions in the levels of serum IFN-γ seen in endotoxin-treated, BCG-primed (124) or unprimed (123) mice and prevented mortality (124, 126a). Thus, IL-12 produced in response to endotoxin appears to upregulate the production of IFN-γ , a cytokine believed to play an important role in endotoxin-induced pathology. However, the rapid kinetics and high serum levels of IFN-γ seen following endotoxin administration cannot be accounted for on the basis of IL-12 alone (102, 123, 124) and likely reflect synergistic interactions between IL-12 and other cytokines, including TNF-α (124). In contrast to these results, IL-12 blockade did not reduce mortality in mice given endotoxin in combination with D-galactosamine, whereas blockade of TNF-α was protective in this model (126a). Thus, mechanisms of endotoxin-induced mortality appear to be heterogeneous, including both IL-12-dependent and IL-12-independent pathways.

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Experimental Autoimmune Encephalomyelitis and Multiple Sclerosis Much of the knowledge and evidence regarding a potential role for IL-12 in multiple sclerosis has been obtained in animal models of experimental autoimmune encephalomyelitis (EAE), a Th1-mediated, demyelinating inflammation of the CNS. In a rat model of monophasic EAE, IL-12 mRNA expression was found elevated immediately prior to the onset of clinical symptoms (127). The systemic administration of rIL-12 to rats immunized with guinea pig myelin basic protein exacerbated the clinical symptoms of EAE and induced relapse when administered to animals who had recovered from the initial episode of disease (128). Likewise, rIL-12 treatment increased the severity of EAE induced by adoptive transfer of proteolipid protein (PLP)-immune lymph node cells in mice (129). We have found in a murine model of relapsing, remitting EAE that treatment with an antibody to IL-12, starting either at one day after immunization with PLP or during the onset of clinical symptoms, prevented the induction or progression of disease (Figure 2). Similar results were obtained using the IL-12 antagonist, IL-12 (p40)2 (N Lad, D Bradshaw, L Renzetti, M Gately, unpublished results). These results are consistent with those obtained by Leonard et al (129) and provide evidence to support an involvement of IL-12 in inflammation of the CNS. However, the role played by endogenous IL-12 in promoting EAE is not entirely clear. The most dramatic deficit demonstrated in IL-12-deficient mice was a deficit in IFN-γ production (5). However, studies using IFN-γ deficient mice indicate that IFN-γ is not essential for the development of EAE (130). Other possible results of IL-12 blockade that could produce therapeutic effects in EAE include increased production of TGF-β and increased apoptosis of antigen-specific T cells (89). In addition to the evidence implicating IL-12 in the pathogenesis of EAE in various animal models, recent studies suggest the involvement of IL-12 in human multiple sclerosis (MS). Using semiquantitative RT-PCR, increased expression of IL-12 p40 mRNA was detected in acute MS plaques, but not in inflammatory lesions due to CNS infarcts (131). In addition, increased IL-12 production was observed when antigen-presenting cells were stimulated with T cells isolated from MS patients as compared to control T cells (132). Anti-CD40 ligand (CD40L) antibodies blocked this T cell–stimulated IL-12 production, and activated T cells from MS patients exhibited a higher level of CD40L expression (132). Consistent with this, CD40-expressing cells of monocytic lineage and CD40L+ T cells were shown to be co-localized in active lesions from MS patient brain sections, whereas CD40L+ cells were not observed in brain sections from normal controls or from Alzheimer patients (133). CD40/CD40L interactions are a potent stimulus to IL-12 production (134, 135). These studies suggest that

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Figure 2 Anti-IL-12 inhibits the induction and progression of EAE. EAE was induced in female SJL mice by footpad inoculation on day 0 of 100 µg PLP (p139–151) in complete Freund’s adjuvant (CFA) containing 4 mg/ml M. tuberculosis. The animals received pertussis toxin, 200 ng i.v., on days 0 and 2 and either goat anti-mouse IL 12 IgG or control IgG, 300 µg ip, 3 times per week beginning at day 1 (open symbols) or 8 (closed symbols). Clinical symptoms were scored on a scale of 1 to 5 using standard criteria: 0.5, loss of tail tone; 1.0, flaccid tail or ataxia; 2.0, paralysis in one hind paw; 3.0, paralysis in both hind paws; 4.0, paraplegia/moribund; and 5.0, death. Body weights were measured at the time of clinical scoring. Numbers in parentheses refer to the number of animals in each group that developed clinical symptoms. Results are means for 8–10 animals/group. ∗ p < 0.05.

IL-12 is produced at the site of acute MS lesions. In addition, elevated IL-12 levels were found in the serum of secondary progressive MS patients, but not in the serum of patients with other neurological diseases (136). IL-12 has also been shown to enhance the ability of PLP-reactive T cell clones isolated from MS patients to present and respond to antigen in the absence of additional antigen presenting cells (137). This may provide a mechanism by which IL-12 can take part in the progression of MS from an acute to a secondary progressive clinical phase.

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Collagen-Induced Arthritis and Rheumatoid Arthritis Collagen-induced arthritis (CIA), a mouse model of rheumatoid arithritis, is induced by immunization of genetically susceptible DBA/1 mice with type II collagen in adjuvant. This immunization regimen results in inflammation of multiple joints with lesions resembling those observed in human rheumatoid arthritis (reviewed in 138). As in other models of Th1-mediated autoimmune diseases, IL-12 appears to play a critical role in this disease model. IL-12 deficient mice on the DBA/1 background were demonstrated to have a reduced incidence and severity of CIA as measured by paw swelling, cellular infiltrate, collagen-specific antibodies and collagen-induced IFN-γ secretion (139). There were, however, a few IL-12-deficient mice that developed severe arthritis in a single paw, indicating that the requirement for IL-12 was not absolute. Similar results were seen in wild-type DBA/1 mice immunized with collagen and treated chronically with anti-IL-12 antibodies starting on the day of immunization (A-M Malfait, DM Butler, DH Presky, RN Maini, FM Brennan, M Feldmann, manuscript submitted for publication). Recent studies report that DBA/1 mice lacking IFN-γ receptors develop CIA with comparable or greater severity than wild-type DBA/1 mice despite reduced levels of anti-collagen antibodies (140, 141); these reports create the same questions regarding the mechanism by which IL-12 blockade suppresses the development of CIA as were discussed for EAE above. In one study, synovial fluids from human patients with rheumatoid arthritis (RA) were reported to contain significantly higher levels of IL-12 heterodimer than serum from RA patients or healthy controls (142). However, this was not confirmed in a second study (143). Thus the role played by IL-12 in human RA, if any, remains to be defined.

Insulin-Dependent Diabetes Mellitus Two lines of evidence suggested the possible involvement of IL-12 in the pathogenesis of insulin-dependent diabetes mellitus (IDDM) in rodent models. First, IL-12 p40 mRNA was upregulated in the pancreata of cyclophosphamidetreated NOD mice (144) and of diabetes-prone BB rats (145) prior to and during the onset of autoimmune diabetes. Second, rIL-12 administration to NOD mice, which are genetically predisposed to the development of IDDM, greatly accelerated the onset of disease, correlating with increased Th1 cytokine production by islet-infiltrating mononuclear cells (146). More direct evidence for involvement of IL-12 in the pathogenesis of IDDM has come from experiments in which NOD mice were treated with mouse IL-12 (p40)2 (147, 148), a potent IL-12 antagonist (39, 40). Administration of (p40)2 to NOD mice starting at 3 weeks of age, before the onset of insulitis, resulted in deviation of pancreas-infiltrating CD4+ T cells to the Th2 phenotype and in a reduction in the incidence of both spontaneous and cyclophosphamide-accelerated IDDM

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(147). On the other hand, treating NOD mice with (p40)2 from 9 weeks of age, when insulitis is florid, caused a slight decrease in the incidence of spontaneous diabetes, but no reduction in cyclophosphamide-accelerated diabetes (147). Such treatment of the older mice caused a reduction in the pancreasinfiltrating Th1 cells but little induction of Th2 cells. These results indicate that IL-12 plays an important role early in the pathogenesis of IDDM in NOD mice and suggest that induction of Th2 cells within the pancreatic infiltrate protects from disease. A role for IL-12 in the pathogenesis of autoimmune diabetes mellitus in humans has not yet been established.

Inflammatory Bowel Disease Inflammatory bowel disease encompasses two disease entities, Crohn’s disease and ulcerative colitis. The cytokine secretion profile of T cells from the lamina propria (LP) of patients with Crohn’s disease is Th1-like in that elevated IFN-γ secretion was observed, together with decreased secretion of IL-4, IL-5, and, paradoxically, IL-2 in comparison to control LP T cells (149). On the other hand, LP T cells from ulcerative colitis patients were found to secrete increased amounts of IL-5 with decreased IL-4 and normal IL-2 and IFN-γ (149). Studies in a mouse model of granulomatous colitis with histologic similarities to Crohn’s disease indicated that IL-12 plays an essential role in disease pathogenesis in this model (150, 151). Colitis was induced in this model by rectal application of low doses of trinitrobenzene sulfonic acid (TNBS), and LP T cells isolated from inflamed bowel displayed increased secretion of IFN-γ and decreased secretion of IL-4 (150). Treatment with anti-IL-12 mAb starting at day 5 after TNBS application or as late as day 20, when the disease was fully established, resulted in striking improvement in the clinical symptoms and histologic evidence of disease and frequently abrogated the colitis completely (150). IL-12 could be demonstrated in the inflamed bowel by immunohistochemistry and appeared to be produced as a result of CD40-CD40L interactions (151). In a second mouse model, colitis was induced by immunization of IL-2-deficient mice with an antigen such as TNP-KLH in CFA (152). In this model also, IL-12 could be demonstrated by immunohistochemistry in the inflamed colon, and anti-IL-12 treatment prevented colitis (152). Mice with a targeted mutation in the G protein subunit Gαi2 develop an inflammatory bowel disease that was thought to be clinically and pathologically similar to ulcerative colitis in humans (153). These mice displayed increased IL-12 p40 mRNA in inflamed colons, but the effect of treatment with anti-IL-12 antibody was not examined (153). Immunohistochemical analysis of tissue sections from the colons of human patients with Crohn’s disease revealed an abundance of IL-12-expressing macrophages and IFN-γ -expressing T cells (154). Such cells were rare or

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absent in colon sections from patients with noninflammatory bowel disorders. Immunohistochemistry studies on tissue samples from ulcerative colitis patients were not reported. Demonstration of IL-12 at the site of disease in patients with Crohn’s disease, together with the data from the mouse models described above, suggests that IL-12 blockade should be of therapeutic benefit in this disorder.

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Transplantation /Graft-versus-Host Disease The predominance of the Th1 response in transplant rejection was presumed to imply that a shift toward a Th2 response would be therapeutic (155). However, this was recently disproved by experiments in which IL-12 was antagonized by neutralizing anti-IL-12 antibodies, IL-12 (p40)2, or the use of IL-12 p40 deficient mice in a model of cardiac allograft rejection (156). A Th2 response was preferentially induced as measured by enhanced expression of IL-4 and IL-10, but not IL-5, mRNA within the graft; nonetheless, antagonism of IL-12 resulted in exacerbation of graft rejection, rather than protection. Furthermore, IFN-γ production did not decrease as a result of IL-12 antagonism in this model (156). Failure of IL-12 antagonism to prevent development of alloantigeninduced Th1 cells was confirmed in subsequent studies in vitro, in which the IFN-γ -producing T cells generated in the presence of an IL-12 antagonist were shown to be predominantly CD8+ (43). Enhanced cardiac allograft survival was observed in mice treated with a combination of IL-12 (p40)2 and in vivo depletion of CD8+ T cells, although neither of these treatments, by itself, prolonged graft survival (43). These results suggest a multiplicity of mechanisms, including both IL-12-dependent and IL-12-independent mechanisms, by which cardiac allografts can be rejected so that blockade of IL-12 alone is not effective in prolonging graft survival. In studies on the survival of mouse allogeneic skin grafts following portal venous immunization with cultured dendritic cells, treatment with anti-IL-12 mAb or with rIL-13 alone had little or no effect; however, anti-IL-12 mAb and rIL-13 synergized to prolong skin graft survival (157). In contrast to these results in which IL-12 blockade alone did not improve allograft survival, transduction of a murine myoblast cell line with a retroviral vector carrying the mouse IL-12 p40 gene resulted in prolonged survival of the transduced cell line following transplantation into allogeneic recipients, as compared to survival of myoblasts transduced with vector lacking the p40 gene (158). This was correlated with decreased production of IL-2 and IFN-γ and impaired induction of CTL. IL-12-dependent Th1 development appears to be pivotal to the development of acute graft-vs-host disease (GVHD) (97, 159, 160). In vivo neutralization of IL-12 resulted in amelioration of acute GVHD (159, 160), and administration of rIL-12 both exacerbated the acute disease and converted chronic GVHD to

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severe acute GVHD (97, 159). Furthermore, expression of IL-12 p40 mRNA by primed macrophages correlated with the occurrence of acute GVHD in mice (161). Nonetheless, other investigators have not been able to prevent mortality due to acute GVHD by use of anti-IL-12 antibodies or IL-12-deficient mice (162; B Desai, CS Via, J Magram, unpublished results). Paradoxically, treatment with a single injection of rIL-12 on the day of bone marrow transplantation prevented acute GVHD in a fully MHC plus multiple minor antigen-mismatched bone marrow transplantation model (163).

Asthma Asthma is a chronic inflammatory disease of the human airways, which may be mediated by activated Th2-type lymphocytes (164). Recent evidence suggests that asthmatic patients have increased Th2 responses with reduced Th1 responses (165). The possibility that this may reflect a deficiency in IL-12 production was suggested by the observations that (a) expression of IL-12 mRNA was significantly lower in bronchial biopsies from allergic asthmatic patients as compared to those from normal controls (166) and (b) production of IL-12 in whole blood cultures from patients with allergic asthma was selectively and signficantly reduced in comparison to nonatopic controls, but production of IFN-γ in response to IL-12 was normal (167). We therefore examined the physiological importance of IL-12 in regulating allergic airway inflammation using IL-12 p40-deficient (IL-12p40−/−) mice. Immunization of IL-12p40−/− mice with ovalbumin (OA) on day 1 followed by challenge with OA-containing aerosol on days 14–20 resulted in a pronounced eosinophilic airway inflammation (Figure 3). This response was associated with enhanced levels of IL-4 and TNF-α in the bronchoalveolar lavage fluid and IgE in the serum (Figure 3). Interestingly, no difference appeared in the level of IL-5 or IFN-γ in the airways of IL-12p40−/− mice compared to wild-type mice (data not shown). The excess eosinophil accumulation in IL-12p40−/− mice was inhibited (p < 0.05) by an antibody to IL-4 or by a TNF receptor fusion protein (data not shown). These results suggest that IL-12 plays an important role in curtailing the allergic response in the airways, possibly by regulating IL-4 and TNF-α. The anti-inflammatory/anti-allergic activity of exogenous IL-12 has been demonstrated in murine models of allergic lung inflammation. The systemic administration of rIL-12 inhibits both allergen-induced airway hyperreactivity (AHR) and eosinophil accumulation in the lung (16, 17). As an extension to these observations, we have found that the administration of rIL-12 as a nebulized aerosol also abrogates AHR and airway eosinophilia in mice (L Renzetti, S Tannu, unpublished results). These results suggest that the local delivery of rIL-12 to the lung would provide efficacy equivalent to systemic treatment. The

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Figure 3 Enhanced allergic airway inflammation in IL-12 p40−/− (KO) mice as compared to wild-type (WT) controls. Mice were immunized with a single injection of 10 µg OA + 1 mg of Al(OH)3 gel i.p. on day 1 and then exposed to a 1% OA aerosol for 30 min/day on days 14–20. One hour after the final OA exposure, bronchoalveolar lavage was performed, and blood samples were obtained for measurement of serum IgE by ELISA. Total and differential cell counts were determined on lavage fluids, and the levels of IL-4 and TNF-α were measured in the lavage fluid supernatants by ELISA. Results represent the mean ± standard error for 8–10 animals/group. ∗ p < 0.05.

anti-inflammatory effects of rIL-12 may be attributed to a reduction in IL-4 and IL-5 levels in the airways (16). We examined the therapeutic potential of rIL-12 for the treatment of chronic asthma using a nonhuman primate model described by Turner et al (168). Wildcaught cynomolgus monkeys with a natural airway reactivity to Ascaris suum antigen exhibit AHR to methacholine (MCh) and airway eosinophilia following challenge with inhaled Ascaris. Treatment with rIL-12 abolished AHR and eosinophilia in atopic monkeys (Figure 4). The ability of rIL-12 to abolish AHR and eosinophilia in a model of established airway disease suggests that rIL-12 may represent a novel therapeutic for the treatment of chronic asthma.

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Figure 4 Human rIL-12 abolishes AHR and eosinophilia in a nonhuman primate model of atopic asthma. Baseline airway responses to inhaled MCh were obtained in male cynomolgus monkeys that exhibited a natural airway response to inhaled Ascaris suum antigen extract on day 1. On days 3, 5, and 8 the animals were challenged with Ascaris antigen by aerosol. The airway response to MCh then was repeated on day 10. AHR was assessed by determining the difference in log PC100 (concentration of MCh that increased airway resistance by 100%). Bronchoalveolar lavage was performed after the second MCh challenge for determination of numbers of eosinophils in the lavage fluid. Separate groups of animals received either 2 µg/kg human rIL-12 or an equivalent volume of vehicle solution s.c. on each of days 1–8. The results represent the mean ± standard error for four animals/group. ∗ p < 0.05.

CONCLUSIONS It is clear that IL-12 plays an essential role in the optimal generation of IFN-γ secreting Th1 cells under many experimental conditions. Through this action, and through its ability to induce directly IFN-γ secretion from both T and NK cells, IL-12 plays a central role in both innate and adaptive immunity important to host defense against predominantly intracellular pathogens. However, studies on the generation of IFN-γ -secreting Th1 cells in response to allogeneic stimuli (43, 156) suggest the existence of other pathways for promoting Th1 responses and even the possibility that IL-12 (p40)2, which had been previously shown to be a potent IL-12 antagonist (39, 40), may have agonist activity in enhancing the generation of CD8+ Th1 (43). Moreover, differences in the abilities of IL-12 p40 deficient mice and IL-12 p35 deficient mice to resist

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infection with Listeria monocytogenes or Cryptococcus neoformans also suggest a previously unsuspected agonistic role for IL-12 p40 in host defense. Data from a number of animal models suggest that IL-12 may play a central role in the pathogenesis of a variety of forms of immunopathology. Thus, inhibitors of IL-12 or IL-12 synthesis may be beneficial in Th1-dependent diseases, such as multiple sclerosis or Crohn’s disease (169). On the other hand, rIL-12 may have utility in the treatment of diseases associated with pathologic Th2 responses such as allergic disorders and asthma. Clinical trials with rIL-12 are already in progress. The generation of IL-12 antagonists or inhibitors suitable for clinical testing remains to be accomplished. Visit the Annual Reviews home page at http://www.AnnualReviews.org.

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103. Chouaib S, Chehimi J, Bani L, Genetet N, Tursz T, Gay F, Trinchieri G, Mami-Chouaib F. 1994. Interleukin 12 induces the differentiation of major histocompatibility complex class Iprimed cytotoxic T-lymphocyte precursors into allospecific cytotoxic effectors. Proc. Natl. Acad. Sci. USA 91:12659– 63 104. Gately MK, Desai BB, Wolitzky AG, Quinn PM, Dwyer CM, Podlaski FJ, Familletti PC, Sinigaglia F, Chizzonite R, Gubler U, Stern AS. 1991. Regulation of human lymphocyte proliferation by a heterodimeric cytokine, IL-12 (cytotoxic lymphocyte maturation factor). J. Immunol. 147:874–82 105. Jacobsen SEW, Veiby OP, Smeland EB. 1993. Cytotoxic lymphocyte maturation factor (interleukin 12) is a synergistic growth factor for hematopoietic stem cells. J. Exp. Med. 178:413–18 106. Hirayama F, Katayama N, Neben S, Donaldson D, Nickbarg EB, Clark SC, Ogawa M. 1994. Synergistic interaction between interleukin-12 and steel factor in support of proliferation of murine lymphohematopoietic progenitors in culture. Blood 83:92–98 107. Bellone G, Trinchieri G. 1994. Dual stimulatory and inhibitory effect of NK cell stimulatory factor/IL-12 on human hematopoiesis. J. Immunol. 153:930–37 108. Clerici M, Sarin A, Coffman RL, Wynn TA, Blatt SP, Hendrix CW, Wolf SF, Shearer GM, Henkart PA. 1994. Type 1/type 2 cytokine modulation of T-cell programmed cell death as a model for human immunodeficiency virus pathogenesis. Proc. Natl. Acad. Sci. USA 91:11811–15 109. Estaquier J, Idziorek T, Zou W, Emilie D, Farber C-M, Bourez J-M, Ameisen JC. 1995. T helper type 1/T helper type 2 cytokines and T cell death: preventive effect of interleukin 12 on activation-induced and CD95 (FAS/APO-1)-mediated apoptosis of CD4+ T cells from human immunodeficiency virus-infected persons. J. Exp. Med. 182:1759–67 110. Radrizzani M, Accornero P, Amidei A, Aiello A, Delia D, Kurrle R, Colombo MP. 1995. IL-12 inhibits apoptosis induced in a human Th1 clone by gp 120/CD4 cross-linking and CD3/TCR activation or by IL-2 deprivation. Cell. Immunol. 161:14–21 111. Ortaldo JR, Mason AT, O’Shea JJ. 1995. Receptor-induced death in human natural killer cells: involvement of

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INTERLEUKIN-12 AND ITS RECEPTOR CD16. J. Exp. Med. 181:339–44 112. Reiner SL, Locksley RM. 1995. The regulation of immunity to Leishmania major. Annu. Rev. Immunol. 13:151–77 113. Scharton-Kerston T, Afonso LC, Wysocka M, Trinchieri G, Scott P. 1995. IL-12 is required for natural killer cell activation and subsequent T helper 1 cell development in experimental Leishmaniasis. J. Immunol. 154:5320–30 114. Heinzel FP, Rerko RM, Ahmed F, Pearlman E. 1995. Endogenous IL-12 is required for control of Th2 cytokine responses capable of exacerbating leishmaniasis in normally resistant mice. J. Immunol. 155:730–39 115. Hunter CA, Candolfi E, Subauste C, Van Cleave V, Remington JS. 1995. Studies on the role on interleukin-12 in acute murine toxoplasmosis. Immunology. 84:16–20 116. Scharton-Kersten T, Caspar P, Sher A, Denkers EY. 1996. Toxoplasma gondii: evidence for interleukin-12-dependent and -independent pathways of interferon-γ production induced by an attenuated parasite strain. Exp. Parasit. 84:102– 14 117. Gazzinelli RT, Wysocka M, Hayashi S, Denkers EY, Hieny S, Caspar P, Trinchieri G, Sher A. 1994. Parasiteinduced IL-12 stimulates early IFN-γ synthesis and resistance during acute infection with Toxoplasma gondii. J. Immunol. 153:2533–43 118. Castro AG, Silva RA, Appelberg R. 1995. Endogenously produced IL-12 is required for the induction of protective T cells during Mycobacterium avium infections in mice. J. Immunol. 155:2013– 19 119. Cooper AM, Roberts AD, Rhoades ER, Callahan JE, Getzy DM, Orme IM. 1995. The role of interleukin-12 in acquired immunity to Mycobacterium tuberculosis. Immunology 84:423–32 120. Tripp CS, Gately MK, Hakimi J, Ling P, Unanue ER. 1994. Neutralization of IL-12 decreases resistance to Listeria in SCID and C.B.-17 mice. Reversal by IFN-γ . J. Immunol. 152:1883–87 121. Tripp CS, Kanagawa O, Unanue ER. 1995. Secondary response to Listeria infection requires IFN-γ but is partially independent of IL-12. J. Immunol. 155:3427–32 122. Cerami A, Beutler B. 1988. The role of cachectin/TNF in endotoxic shock and cachexia. Immunol. Today 9:28–31 123. Heinzel FP, Rerko RM, Ling P, Hakimi J, Schoenhaut DS. 1994. Interleukin 12

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GATELY ET AL (CD86), and interleukin 12 cytokine in multiple sclerosis lesions. J. Exp. Med. 182:1985–96. Balashov KE, Smith DR, Khoury SJ, Hafler DA, Weiner HL. 1997. Increased interleukin 12 production in progressive multiple sclerosis: induction by activated CD4+ T cells via CD40 ligand. Proc. Natl. Acad. Sci. USA 94:599–603 Gerritse K, Laman JD, Noelle RJ, Aruffo A, Ledbetter JA, Boersma WJA, Claassen E. 1996. CD40-CD40 ligand interactions in experimental allergic encephalomyelitis and multiple sclerosis. Proc. Natl. Acad. Sci. USA 93:2499– 2504 Shu U, Kiniwa M, Wu CY, Maliszewski C, Vezzio N, Hakimi J, Gately M, Delespesse G. 1995. Activated T cells induce interleukin-12 production by monocytes via CD40-CD40 ligand interaction. Eur. J. Immunol. 25:1125–28 Cella M, Scheidegger D, PalmerLehmann K, Lane P, Lanzavecchia A, Alber G. 1996. Ligation of CD40 on dendritic cells triggers production of high levels of interleukin-12 and enhances T cell stimulatory capacity: T-T help via APC activation. J. Exp. Med. 184:747– 52 Nicoletti F, Patti F, Cocuzza C, Zaccone P, Nicoletti A, Di Marco R, Reggio A. 1996. Elevated serum levels of interleukin-12 in chronic progressive multiple sclerosis. J. Neuroimmunol. 70:87–90 Correale J, McMillan M, Li S, McCarthy K, Le T, Weiner LP. 1997. Antigen presentation by autoreactive proteolipid protein peptide-specific T cell clones from chronic progressive multiple sclerosis patients: roles of co-stimulatory B7 molecules and IL-12. J. Neuroimmunol. 72:27–43 Feldmann M, Brennan FM, Maini RN. 1996. Rheumatoid arthritis. Cell 85:307–10 McIntyre KW, Shuster DJ, Gillooly KM, Warrier RR, Connaughton SE, Hall LB, Arp LH, Gately MK, Magram J. 1996. Reduced incidence and severity of collagen-induced arthritis in interleukin12 deficient mice. Eur. J. Immunol. 26:2933–38 Manoury-Schwartz B, Chiocchia G, Bessis N, Abehsira-Amar O, Batteux F, Muller S, Huang S, Boissier M-C, Fournier C. 1997. High susceptibilitiy to collagen-induced arthritis in mice lacking IFN-γ receptors. J. Immunol. 158:5501–6

141. Vermeire K, Heremans H, Vandeputte M, Huang S, Billiau A, Matthys P. 1997. Accelerated collagen-induced arthritis in IFN-γ receptor-deficient mice. J. Immunol. 158:5507–13 142. Bucht A, Larsson P, Weisbrot L, Thorne ˆ C, Pisa P, SmedegArd G, Keystone EC, Gr¨onberg A. 1996. Expression of interferon-gamma (IFN-γ ), IL-10, IL12 and transforming growth factor-beta (TGF-β) mRNA in synovial fluid cells from patients in the early and late phases of rheumatoid arthritis (RA). Clin. Exp. Immunol. 103:357–67 143. Wang F, Sengupta TK, Zhong Z, Ivashkiv LB. 1995. Regulation of the balance of cytokine production and the signal transducer and activator of transcription (STAT) transcription factor activity by cytokines and inflammatory synovial fluids. J. Exp. Med. 182:1825– 31 144. Rothe H, Burkart V, Faust A, Kolb H. 1996. Interleukin-12 gene expression is associated with rapid development of diabetes mellitus in non-obese diabetic mice. Diabetologia 39:119–22 145. Zipris D, Greiner DL, Malkani S, Whalen B, Mordes JP, Rossini AA. 1996. Cytokine gene expression in islets and thyroids of BB rats. IFN-γ and IL-12p40 mRNA increase with age in both diabetic and insulin-treated nondiabetic BB rats. J. Immunol. 156:1315– 21 146. Trembleau S, Penna G, Bosi E, Mortara A, Gately MK, Adorini L. 1995. Interleukin 12 administration induces T helper type 1 cells and accelerates autoimmune diabetes in NOD mice. J. Exp. Med. 181:817–21 147. Trembleau S, Penna G, Gregori S, Gately MK, Adorini L. 1997. Deviation of pancreas-infiltrating cells to Th2 by IL-12 antagonist administration inhibits autoimmune diabetes. Eur. J. Immunol. 27:2330–39 148. Rothe H, O’Hara RM Jr, Martin S, Kolb H. 1997. Suppression of cyclophosphamide induced diabetes development and pancreatic Th1 reactivity in NOD mice treated with the interleukin (IL)12 antagonist IL-12(p40)2. Diabetologia 40:641–46 149. Fuss IJ, Neurath M, Boirivant M, Klein JS, de la Motte C, Strong SA, Fiocchi C, Strober W. 1996. Disparate CD4+ lamina propria (LP) lymphokine secretion profiles in inflammatory bowel disease. J. Immunol. 157:1261–70 150. Neurath MF, Fuss I, Kelsall BL, St¨uber

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E, Strober W. 1995. Antibodies to interleukin 12 abrogate established experimental colitis in mice. J. Exp. Med. 182:1281–90 St¨uber E, Strober W, Neurath M. 1996. Blocking the CD40L-CD40 interaction in vivo specifically prevents the priming of T helper 1 cells through the inhibition of interleukin 12 secretion. J. Exp. Med. 183:693–98 Ehrhardt RO, Ludviksson BR, Gray B, Neurath M, Strober W. 1997. Induction and prevention of colonic inflammation in IL-2-deficient mice. J. Immunol. 158:566–73 H¨ornquist CE, Lu X, Rogers-Fani PM, Rudolph U, Shappell S, Birnbaumer L, Harriman GR. 1997. Gαi2-deficient mice with colitis exhibit a local increase in memory CD4+ T cells and proinflammatory Th1-type cytokines. J. Immunol. 158:1068–77 Parronchi P, Romagnani P, Annunziato F, Sampognaro S, Becchio A, Gianninarini L, Maggi E, Pupilli C, Tonelli F, Romagnani S. 1997. Type 1 T-helper cell predominance and interleukin-12 expression in the gut of patients with Crohn’s disease. Am. J. Pathol. 150:823– 32 Charlton B, Auchincloss H Jr, Fathman CG. 1994. Mechanisms of transplantation tolerance. Annu. Rev. Immunol. 12:707–34 Piccotti JR, Chan SY, Goodman RE, Magram J, Eichwald EJ, Bishop DK. 1996. IL-12 antagonism induces T helper 2 responses, yet exacerbates cardiac allograft rejection. Evidence against a dominant protective role for T helper 2 cytokines in alloimmunity. J. Immunol. 157:1951–57 Gorcynski RM, Cohen Z, Fu X-M, Hua Z, Sun Y, Chen Z. 1996. Interleukin-13, in combination with anti-interleukin-12, increases graft prolongation after portal venous immunization with cultured allogeneic bone marrow-derived dendritic cells. Transplantation 62:1592– 1600 Kato K, Shimozato O, Hoshi K, Wakimoto H, Hamada H, Yagita H, Okumura K. 1996. Local production of the p40 subunit of interleukin 12 suppresses T-helper 1-mediated immune responses and prevents allogeneic myoblast rejection. Proc. Natl. Acad. Sci. USA 93:9085–89

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159. Williamson E, Garside P, Bradley JA, Mowat AM. 1996. IL-12 is a central mediator of acute graft-vs-host disease in mice. J. Immunol. 157:689–99 160. Nishimura T, Sadata A, Yahagi C, Santa K, Otsuki K, Watanabe K, Yahata T, Habu S. 1996. The therapeutic effect of interleukin-12 or its antagonist in transplantation immunity. Ann. N.Y. Acad. Sci. 795:375–78 161. Kichian K, Nestel FP, Kim D, Ponka P, Lapp WS. 1996. IL-12 p40 messenger RNA expression in target organs during acute graft-versus-host disease. Possible involvement of IFN-γ . J. Immunol. 157:2851–56 162. Saito K, Yagita H, Hashimoto H, Okumura K, Azuma M. 1996. Effect of CD80 and CD86 blockade and antiinterleukin-12 treatment on mouse acute graft-versus-host disease. Eur. J. Immunol. 26:3098–3106 163. Sykes M, Szot GL, Nguyen PL, Pearson DA. 1995. Interleukin-12 inhibits murine graft-versus-host disease. Blood 86:2429–38 164. Robinson DR, Hamid Q, Ying S, Tsicopoulos A, Barkans J, Bentley AM, Corrigan C, Durham SR, Kay AB. 1992. Predominant Th2-like bronchoalveolar T-lymphocyte population in atopic asthma. N. Engl. J. Med. 326:298–304 165. Shirakawa T, Enomoto T, Shimazu S, Hopkin JM. 1997. The inverse association between tuberculin responses and atopic disorder. Science 275:77–79 166. Naseer T, Minshall EM, Leung DYM, Laberge S, Ernst P, Martin RJ, Hamid Q. 1997. Expression of IL-12 and IL13 mRNA in asthma and their modulation in response to steroid therapy. Am. J. Respir. Crit. Care Med. 155:845–51 167. van der Pouw Kraan RCTM, Boeije LCM, de Groot ER, Stapel SO, Snijders A, Kapsenberg ML, van der Zee JS, Aarden LA. 1997. Reduced production of IL-12 and IL-12-dependent IFN-γ release in patients with allergic asthma. J. Immunol. 158:5560–65 168. Turner CR, Andersen CJ, Smith WB, Watson JW. 1996. Characterization of a primate model of asthma using anti-allergy/anti-asthma agents. Inflamm. Res. 45:239–45 169. Trembleau S, Germann T, Gately MK, Adorini L. 1995. The role of IL-12 in the induction of organ-specific autoimmune diseases. Immunol. Today 16:383–86

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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LIGAND RECOGNITION BY αβ T CELL RECEPTORS Mark M. Davis∗ , J. Jay Boniface#, Ziv Reich∗ , Daniel Lyons#, Johannes Hampl#, Bernhard Arden∗ , and Yueh-hsiu Chien#

Howard Hughes Medical Institute∗ , and the Department of Microbiology and Immmunology#, Stanford University School of Medicine, Stanford, California 94305; Paul Ehrlich Institut, Langen, Germany; e-mail: [email protected] KEY WORDS:

structure, repertoire, oligomerization, binding

ABSTRACT While still incomplete, the first data concerning the biochemistry of T cell receptor–ligand interactions in cell-free systems seem to have considerable predictive value regarding whether a T cell response is strong or weak or suppressive. This data will help considerably in elucidating the mechanisms behind T cell responsiveness. Also of great interest are the first structures of T cell receptor molecules and, particularly, TCR-ligand complexes. These appear to confirm earlier suggestions of a fixed orientation for TCR engagement with peptide/MHC and should form the basis for understanding higher oligomers, evidence for which has also just emerged. We conclude with an analysis of the highly diverse CDR3 loops found in all antigen receptor molecules and suggest that such regions form the core of both TCR and antibody specificity.

INTRODUCTION The last few years have seen the study of T cell recognition enter an exciting new phase. We now have enough biochemical and structural data to begin putting together some of the essential pieces in the first stages of this process and to correlate these with some of the cellular outcomes that have been observed. The recent X-ray crystal structures of T cell receptors and TCR-ligand complexes have shown that while αβ TCRs are fundamentally immunoglobulin-like in their structure, some significant differences exist both in the details of some domains (Cα in particular) but most importantly in the strong indications that 523 0732-0582/98/0410-0523$08.00

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they have a uniform angle with which they bind peptide/MHC or superantigen/MHC complexes. This uniformity of approach may in turn help to explain how clusters of TCRs and coreceptors might form to trigger the internal signaling machinery. Understanding the dynamics of this process—that is, how the TCR-CD3s and other important cell surface molecules act in concert to produce a biological result in the periphery or in the thymus—would seem to be the next major challenge in this area. Another interesting aspect of work in T cell recognition is that it has raised anew the question of why antigen receptor molecules are so different in some respects, yet retain certain universal features, such as a highly diverse CDR3 region on at least one chain of a given heterodimer. The riddle of this last feature in particular may point toward a general mechanism of TCR and Ig binding as well as a better understanding of what constitutes the immune repertoire.

BIOCHEMICAL ASPECTS OF TCR-LIGAND INTERACTIONS Cellular and organismal decisions ultimately can be traced back to genetic programs and specific molecular interactions. Thus, it has been very important for the study of T cell recognition to have data on direct binding between specific TCRs and their ligands, both peptide/MHC complexes and superantigen/MHC complexes. While we have deduced from classical cellular studies and from the primary structure of TCR polypeptides that this is likely to occur, this supposition needed to be confirmed and the actual kinetic and affinity data obtained before one could even consider how higher order events might be organized. Luckily, we now have enough data to make some generalizations and some definitive statements. The actual measurements have been difficult, partly in the first case because the membrane-bound nature of MHC molecules and TCRs required the engineering of soluble forms and, secondly, because most of the affinities are very low and only measurable with technology available in the last few years. The first problem, expressing active soluble forms of TCR, is also a key to structural studies (see next section) and has been solved in a variety of ways, including replacing the transmembrane regions with signal sequences for glycolipid linkage (1), deleting the transmembrane regions (2, 3), cysteine mutagenesis and Escherichia coli expression (4), or other methods. Unfortunately, no one method seems to work for all TCRs. On the MHC side, the production of soluble forms has a much larger history, starting with the enzymatic cleavage protocol of Parham et al (5), and in general is more reproducible from molecule to molecule than with the TCR methods. Recent recombinant methods that have been successful are gpi-linkage, for

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mouse class II MHC molecules (6), E. coli expression, and folding for both class I (7) and class II MHC (8), insect cell expression of truncated molecules (9, 10) with the addition of a covalent peptide for some class II molecules being necessary for stability (11). Once soluble forms of TCR and MHC are available, another important consideration is the stability of the relevant peptide or superantigen-MHC complex. Luckily, in many systems, the peptide binds to the MHC very stably, and the complex can be stored for months at 4◦ C. With superantigens and some peptides, however, dissociation is very rapid, and thus measuring TCR binding can become a three-body problem. This can be mitigated by keeping the MHC in a large excess of peptide or superantigen. The first measurements of TCR affinities for peptide/MHC complexes were made by Matsui et al (12) and Weber et al (13). Matsui and colleagues used a high concentration of soluble peptide/MHC to block the binding of a labeled anti-TCR Fab fragment to T cells specific for those complexes, obtaining a Kd value of ≈50 µM for several different T cells and two different cytochrome peptide/I-Ek complexes (as shown in Table 1). Weber and colleagues used a soluble TCR to inhibit the recognition of a flu peptide/I-Ed complex by a T cell, and they obtained a KD value of ≈l0 µM. Later experiments by Sukylev et al (14) using the antibody competition approach obtained a significantly higher affinity (KD of 0.1 µM) in an alloreactive peptide/class I MHC system. It may be significant that in this last system, the alloreactive peptide is very unstably associated with the class I molecule (Ld), perhaps selecting a higher than usual affinity TCR. While an important start in TCR biochemistry, these studies still have significant drawbacks: They give no information about the kinetics of TCR-ligand interactions, and they have not isolated TCR binding in a cell-free system. Thus, the development of surface plasmon resonance instruments, particularly the BIAcoreTM (Pharmacia Biosensor) with its remarkable sensitivity to weak macromolecular interactions, has allowed rapid progress in this area, and the BIAcoreTM is now the instrument of choice. The earlier cell-based measurements are still useful, however, in that, at least in the cytochrome c/I-EK system, the BIAcoreTM (15) results match very closely (Table 1) with previous results, and thus we can be sure that the rigors of the expression system have not harmed the TCR and MHC molecules in any significant way with respect to recognition. In addition to confirming some of the previous affinity measurements (15–22), the surface plasmon resonance studies have thus far been the only means of measuring the kinetics of TCR binding to peptide/MHC or to superantigens. In many ways this is more biologically relevant than affinity measurements, which require an equilibrium state that seldom occurs in biological processes. The one exception to this is the classical labeled ligand approach of Sykulev et al (23), which has worked for some higher affinity TCRs (see Table 1). As shown in Table 1, these measurements indicate that, whereas the on-rates

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Table 1 T cell receptor-ligand binding

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TH cells

Ligand

KD (µM)

kon (M−1 s−1)

koff (s−1)

Method

Reference (12) (12) (15)

(13) (22) (17) (17)

5C.C7 2B4 2B4

MCC/Ek MCC/Ek MCC/Ek

50 50 30

— — —

— — —

2B4 228.5

MCC/Ek MCC 99E/Ek

90 50

600 —

0.057 —

14.3.d 14.3.d HA1.7 HA1.7

Flu H1N1/Ed SEC1,2,3 HA/DR1 SEB

∼10 5.4–18.2 >25 0.82

— >100,000 — 13000

— >0.1 — 0.001

Anti-TCR comp. Anti-TCR comp. Anti-P/MHC comp. BIA 1 Anti-P/MHC comp. Sol. TCR BIA1 BIA1 BIA1

TH cells

Ligand

KD (µM)

kon (M−1 s−1)

koff (s−1)

Method

Reference

0.5 0.1 0.065 0.65 6.5 3.3 23.4 2.0

11000 210000 53000 22000 3135 8300 6200 5100

0.0055 0.026 0.003 0.02 0.02 0.027 0.145 0.01

Anti-TCR comp. BIA1 Labeled MHC Labeled MHC BIA4 BIA1 BIA1 BIA1

(14) (16) (23) (23) (20) (18) (18) (18)

0.32

12000

0.0038

BIA1

(18)

2C 2C 2C 4G3 42.12 2C HY HY 2C

p2Ca/Ld p2Ca/Ld QL9/Ld pOV/Lb OVA/Kb p2Ca/Ld M80/Db CD8 α/β+ M80/Db CD8 α/β+ p2/Ca/Lb

(15) (15)

Note: BIA1, TCR amine coupled; BIA2, TCR cysteine coupled; BIA3, MHC/peptide amine coupled in competition experiment; and BIA4, TCR coupled using H57 and MHC coupled via amine chemistry.

of TCRs binding to peptide/MHC molecules vary from very slow (1,000) to moderately fast (200,000), their off-rates fall in a relatively narrow range (0.5– .01) or a t1/2 of 12–30 sec at 25◦ C, similar to other membrane-bound receptors that recognize membrane molecules on other cells (24, 25). In the case of the class I MHC-restricted TCR, 2C, this relatively fast off-rate is significantly stabilized (10 times) if soluble CD8 is introduced (18). Similar experiments using soluble CD4 have not produced comparable results (J Hampl, J Boniface, unpublished results), but it may be that the conformation or valency of the recombinant soluble molecule is not equivalent to that of the native form on the cell surface. While all the measurements cited above were performed at

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25–20◦ C, due to instrument limitations the off-rates are likely to be at least two times faster at physiologic temperatures. Using a photo-activated cross-linker as part of the peptide ligand, Luescher and colleagues have developed a novel cell-based assay for TCR binding, and they observe a marked decrease in TCR binding to cells assayed at 37◦ C versus 18◦ C (26). Perhaps the most important finding using the surface plasmon resonance technique, however (apart from the demonstration that isolated TCR molecules actually can bind to peptide/MHC or superantigen), is the striking correlation (in most cases) of the TCR affinity, and particularly the dissociation rate, with biological outcome. A correlation with affinity was first noted by Sykulev et al (14), and a correlation with dissociation rate was noted by Matsui et al (15), who found that a series of three agonist peptides in the cytochrome c/I-EK system seem to illustrate a trend in which increasing offrate correlated with decreasing agonist activity. They suggested that antagonist peptides might be even less stable, and this is supported by the data of Lyons et al (19), who showed that, whereas antagonist peptide might differ only slightly in affinity compared with the weakest agonist, their dissociation rates differ by tenfold or more (see Table 2). This paper also significantly expanded the ability of the BIAcoreTM instrument to measure affinities by developing a sensor-chip based competition assay.

Table 2 Weak agonist/antagonist binding

T cell

Ligand

Type

2B4

MCC/Ek

Strong agonist

2B4 2B4 2B4 2B4

PCC/Ek MCC 102S/Ek MCC 102N/Ek MCC 99R/Ek

Agonist Weak agonist Weak agonist Antagonist

2B4

MCC 102G/Ek

Antagonist

2B4 42.12 42.12 42.12 42.12 42.12

MCC 99Q/Ek OVA/Kb OVA E1/Kb V-OVA/Kb OVA R4/Kb OVA K4/Kb

Weak antagonist Strong agonist Weak agonist Antagonist Antagonist Null

See Table 1 for explanation of BIAcore methods.

KD (µM)

koff (s−1)

t1/2 (sec)

90 0.057 12 40 0.063 11 80 0.09 8.0 240 0.36 2.0 320 0.44 1.6 500 4.8 0.15 330 — — 1500 5.1 0.14 900–1200 — — 2100 — — 6.5 0.02 24.5 22.6 0.068 7.3 29.8 0.039 12.9 57.1 0.146 3.4 >360 >0.2 <2.5

Method

Reference

BIA1 BIA2 BIA1 BIA2 BIA2 BIA2 BIA3 BIA2 BIA3 BIA3 BIA4 BIA4 BIA4 BIA4 BIA4

(15) (19) (15) (19) (19) (19) (19) (19) (19) (19) (20) (20) (20) (20) (20)

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In this assay, native class II MHC loaded with agonist peptide is placed on the sensor chip, and then soluble TCR in solution is allowed to bind. Varying concentrations of soluble peptide/MHC complexes are mixed in, and a competition curve established. In this fashion, affinities as low as 2 mM could be measured (although, unfortunately, on-rates and off-rates cannot). This data in a Th system is largely supported by the BIAcoreTM studies of Alam et al (20), who also see a drop-off in affinities and an increase in off-rates (with one exception as noted in Table 2) with antagonist versus agonist ligands. Al Ramadi et al (21) also saw one outlier in a grouping of peptide/MHCs, and thus there may be other properties that can contribute (or interfere with) agonist or antagonist affects. In general, though, lower affinities and faster off-rates characterize the progression from strong agonists all the way to weak antagonist ligands, and thus no conformational models need to be invoked. How might the differences between agonist and antagonist ligands summarized in Tables 1 and 2 cause such different outcomes as agonism or antagonism? As McKeithan (27) and Rabinowitz (28) have noted, any multistep system such as T cell recognition has an inherent ability to amplify small differences in signals that are received on the cell surface to much larger differences at the end of the chain, in this case the nucleus; thus antagonism may occur at one threshold and an agonist response at another. Alternatively, an antagonist ligand may traverse the activation pathway just far enough to use up some critical substrate, as is proposed by Lyons et al (19). Yet another possibility is that some antagonists may act even earlier, by blocking TCR clustering (29), a possibility discussed later in this review. Another recent controversy that bears on this data is the serial engagement model of Lanzavecchia and colleagues (30, 31), which proposes that one way in which a small number of peptide/MHC complexes can cause activation is by transiently binding many TCRs and effecting their downregulation. While the dissociation rates reviewed here show that such a scenario is likely, they do not in fact support the statement that more interactions are better. This is because, thus far, all improvements in TCR-peptide/MHC stability within any one system result in a more robust T cell response rather than exhibiting a normal distribution around some optimum value.

ROLE OF CD4 AND CD8 What is the role of CD4 and CD8 with respect to the T cell response to agonist and antagonist peptides? With respect to the former, the literature is quite clear, particularly in the case of Th cells, where CD4 greatly augments the amount of cytokine produced or determines whether there is a response at

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all (as reviewed in 32). Much of this effect of CD4 seems to be due to the recruitment of lck to the resulting complexes, but as there is a significant positive effect when CD4 molecules lacking a cytoplasmic tail are introduced, probably some effect on binding occurs as well (32). CD8 also greatly augments the response of class I MHC-specific T cells (33), and recently Garcia et al (18) and Luescher et al (26) have reported that CD8 stabilizes TCR peptide/MHC complexes by approximately tenfold (Table 1). Overall it seems likely that each molecule has two roles: to stabilize TCR-ligand interactions physically, and to aid in signaling by recruiting lck. With respect to antagonism, previous data have shown several instances in which the presence of CD4 converts an antagonist peptide into a weak agonist (34–36), consistent with the roles suggested above. Recent data in the cytochrome system by Hampl et al (37) put a new twist on this by showing that while weak agonist peptides are made almost as potent as the best peptides by the presence of CD4, little or no effect is seen on antagonism. This is illustrated in Figure 1, where part A shows the effects of titrating an αCD4 antibody on an agonist response to cytochrome c with the characteristic shift in the dose response curve due to progressively more CD4 being removed from the interaction (see also Madrenas et al; 38). In contrast part B shows the percentage inhibition obtained when antagonism is measured under the same conditions. Here the inhibition of CD4 has no effect on the titration curve, indicating that in this case CD4 plays no role either in physically stabilizing the interaction or in recruiting signaling molecules. We interpret these results to mean that CD4 engagement is not automatic and simultaneous with TCR binding, but rather, it is recruited later into preexisting TCR-peptide/MHC complexes (or oligomers) as suggested by Germain (39). In some cases antagonist/MHC complexes will be stable long enough for CD4 to have an effect, in which case the T cell could be stimulated, but in the experiments of Hampl et al, the TCR-ligand association does not last long enough for that to happen. This would seem to be the strongest evidence to date that CD4 binding follows TCR-ligand engagement, if only by a few seconds.

TOPOLOGY OF TCR-LIGAND INTERACTIONS Analysis of TCR sequence diversity has shown that the vast majority of amino acid variation resides in the region between the V and J region gene segments, which corresponds to the CDR3 regions of antibodies (40). This has suggested models in which the CDR3 loops of Vα and Vβ would line up directly above a peptide bound to the MHC groove (40–42). Support for such a model has come from the mutagenesis studies of Hedrick and colleagues (43, 44), and particularly from the variant peptide immunization data of Jorgensen et al (45, 46);

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more recently it has come from Sant’Angelo et al (47). In these last two studies, involving two different peptide/class II MHC Th recognition systems, single amino acid changes at positions that affect T cell recognition but not MHC binding are made in a given peptide. These variant peptides are then used to immunize mice that express either the α or the β chain of a TCR that recognizes the original peptide, and the responding T cells are analyzed. Using TCR α or β transgenes serves to keep one half of the receptor constant, while allowing considerable variation to occur in the chain that pairs with it. The results from these studies are similar in that every mutation at a TCR-sensitive residue triggered a change in the CDR3 sequence of Vα, Vβ, or both, and in some cases a change in the Vα or Vβ gene segment as well (as summarized in Figure 2). One of the more striking examples of a CDR3-peptide interaction occurred in the cytochrome system, where a Lys −→ Glu change in the central TCR determinant on the peptide triggered a Glu −→ Lys charge reversal in the Vα CDR3 loop, arguing for a direct Lys −→ GIu contact between the two molecules (45). Another interesting finding was that the same order of Vα −→ Vβ preference ran from the N-terminal to the C-terminal residues. Additional data from MHC mutations led Sant’Angelo et al to propose an orientation of the TCR in which the CDR3 loops are perpendicular to the peptide bound to the MHC versus the more linear model of Jorgensen et al. They also developed intriguing data suggesting an interaction between the CDR1 of Vα and an N-terminal residue of the peptide. Another mutagenesis study of a different sort was performed on a class I MHC molecule, H-2D, by Nathenson and colleagues (Figure 3). Here they compiled numerous mutations that affected T cell recognition and found that they indicate a roughly diagonal footprint (48), roughly splitting the difference between the two previous studies cited above. Early mutagenesis studies on α-helical residues in the class II MHC molecule, I-EK, show a very different pattern of T cell sensitivity however (49). After considerable efforts the beginning of a resolution of this controversy has appeared in the works of Garcia et al (2) and Garboczi et al (4) who, nearly ←−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−− Figure 1 α-CD4 antibody titration affects agonist but not antagonist activity (from 37). (A) A CD4+ variant of a T cell hybridoma, 2B4 was stimulated by peptide-pulsed, antigen-presenting cells in the presence of varying concentrations of an anti-CD4 antibody Fab1 fragment (GK1.5). IL-2 production was monitored by ELISA assay. (B) Antagonism was measured using the same clone and α-CD4 Fab1 material. APCs were first pulsed with a limiting dose of peptide agonist, then washed and used to stimulate 2B4 cells in the presence of varying concentrations of the antagonist MCC (99R) and the α-CD4 Fab1. IL-2 was assayed as above.

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Figure 2 Variant peptide immunization experiments reveal similar topology of peptide-TCR interactions (adopted from references 45–47). This figure summarizes the results of Jorgensen et al (45, 46), and Sant’Angelo et al (47) who analyzed moth cytochrome I-EK, and concanavalin A/IAk recognition, respectively, as described in the text. Residues that greatly influence T cell recognition are indicated by upward arrows, and above each arrow is an indication of whether a change at that position triggered a change in either a CDR3 sequence or a V region or both. It will be seen from this summary that alterations in all TCR sensitive residues in each peptide caused changes in one or both CDR3s of the TCR, and in some cases changes in the Vα or Vβ used as well.

simultaneously, solved the crystal structures of two different types of TCRpeptide/class I MHC complexes. Building on earlier successes with fragments of TCRs by Mariuzza and colleagues (50–52), these studies show a TCR binding surface much like an antibody fitting down between the two opposite high points of the class I MHC α helices, roughly in the diagonal configuration suggested by Nathenson et al (48). In these structures, one of which is shown in Figure 4, the CDR2 loops are centrally located over the peptide, but the Vα CDR1 and the Vβ CDR1 are also in a position to contact the N-terminal and C-terminal peptide residues, respectively. Such a contact between Vα CDR1 and an Nterminal residue was seen in the Garboczi structure whereas that of Garcia et al has insufficient resolution at this point. While more structures are needed (with a third complete TCR just being reported; 53), especially of TCRs in complex with class II MHC-peptide complexes, the results are sufficiently consistent with the results of the peptide-immunization and mutation experiments cited previously to suspect that all TCR-peptide/MHC complexes will have roughly the same topology. This may be critically important both for thymic selection

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Figure 3 H-2Kb mutants that affect T cell reactivity. Above is the data of Sun et al (48) showing a diagonal pattern of mutants that impair T cell recognition of this class I molecule, presaging the structural data of Garcia et al (2) and Garboczi et al (4).

and for the intercalation of CD4/CD8 molecules during activation. In the later regard, the recent structure of a class I MHC-CD8 complex is a beginning glimpse of how this may occur (54). Progress has also been made in elucidating the topology of TCR–super Ag– MHC complexes, largely by structural determination (55–56) and thus far only for the staph enterotoxins. Here it appears that different superantigens can bind to class II MHCs in remarkably different ways but that they interact with TCRs somewhat similarly and in ways that were accurately predicted by mutagenesis (57–59) and loop swapping studies (60). That is, they bind to the CDR4 (D −→ E loop) of the Vβ chain as well as to CDR1 and CDR2 (52). Overall the combination of MHC-SAg-TCR holds the TCR in a completely different orientation over the MHC than in the TCR-peptide-MHC structures described above and most but not all contact of the TCR with the peptide/MHC (in the SAg complex) may be avoided (52)—as suggested previously (61), given the

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Figure 4 The structure of a TCR-peptide/MHC complex (adapted from 2) above showing the complex, together with its CDR footprint on the peptide/MHC. CDR1, 2, 3 are indicated as α1, α2, etc.

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requirement that superantigens ligate TCRs to MHCs irrespective of the bound peptide.

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EVIDENCE FOR TCR OLIGOMER FORMATION IN T CELL ACTIVATION For many years now, cross-linking of surface Ig in B cells has been known to induce activation, and in the early 1980s similar effects could be shown with anti-TCR antibodies either in solution or bound to a solid substrate (62–64). In the case of the TCR, antibody cross-linking of chimeric membrane proteins only containing CD3ζ could also provoke activation (65, 66). Thus, it has long seemed likely that multimerization of TCR/CD3 complexes in a ligandspecific fashion may be an important feature of T cell activation, although there are dissenting views. Recent data from our laboratory (29, 67) has provided support for oligomerization of TCRs upon ligand contact and also speaks to the minimal number of receptors that need to be engaged. In the first study, Reich et al (29) used quasi-elastic light scattering to investigate the association of a soluble TCR. In this technique the relaxation time of scattered laser light was used to estimate the radius of a given molecule or collection of molecules in solution. Figure 5A shows a typical pattern for a mixture of TCR and peptide/MHC at 6 µm, well below the KD (60 µM). At 30 µM, significant binding of the TCR to its ligand occurs, producing a higher molecular weight species. The peak coincides with two MHC molecules tethered together by a linked peptide, which has a predicted radius close to that of a TCR-peptideMHC complex. At higher concentrations larger and larger oligomers appear, corresponding to a dimer of heterodimers and then one that appears to have six TCRs together with six peptide-MHCs at the highest concentration (114 µM). These data suggest that once a TCR binds to a peptide/MHC the resulting ternary complexes have an intrinsic ability to self-assemble into multimeric entities. This may be because of some conformational changes in the TCR or the MHC, or both, or it may be just that a larger binding surface is available and in the right orientation compared to unbound molecules. This principle of self-assembly has a number of important implications for models of T cell recognition and activation. In particular it suggests an explanation for how oligomerization might be accomplished even when very small numbers of peptide are present. Here the problem has been that if only 10–100 peptides/MHCs are needed to activate a T cell, then the random formation of MHC dimers or trimers that all have the same peptide would be extremely rare (>1 per cell) as reviewed in (68). If TCR-peptide/MHCs can self-associate, however, the problem becomes less acute, in part because of a large excess of TCRs on the T cell side, more than

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Figure 5 Oligomerization of TCR-peptide/MHC complex (adapted from Reich et al, Ref. 29). As described in the text, this figure shows the progressive increase in molecular weight of the predominant species in mixtures of a soluble 2B4 TCR, and its cognate peptide/MHC (MCC/ I-Ek). These oligomers do not form if the incorrect peptide is bound to the MHC.

1000 times in some cases; thus, every correct peptide/MHCs at the interface will be bound by a TCR. As they are bound, they will self-associate regardless of what other MHCs surround them. This congregation of TCR peptide/MHC complexes into microclusters might then allow TCR/CD3 complexes to come into much closer proximity, equivalent to the effects of antibody cross-linking and presumably driven by bringing tyrosine kinases such as lck or syk into contact with CD3 substrates. A second important finding of this work is that self-association does not stop at dimerization, as had been speculated previously (69), but instead seems to extend into higher order oligomers. This is also consistent with the peptide array simulation results of Dintzis and colleagues (70) and the recent work of Metzger et al on IgE receptor signaling (70a). If these higher order clusters are important for activation (as will be proposed based on data presented later in this section), then one possible mechanism of antagonism would be

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the premature termination of oligomerization by the incorporation of unstable TCR-peptide/MHC complexes, as originally suggested from first principles by McKeithan (27). While this would only explain the data for antagonists that work in large molar excess (100–1000 times) over agonist peptides, these are by far the vast majority of those described, and the only ones for which kinetic data are available. Another important question to ask regarding the relationship of TCR oligomerization to activation is: How many molecules are required to initiate a signal? While much attention has focused on dimerization as a key event, we took advantage of a method developed by Altman et al (71) to make a set of reagents having from one to four agonist peptide/MHC complexes on a streptavidin backbone. Where there are less than four agonist/MHC complexes, additional MHCs containing a null peptide (MCC 99A) are added to bring the number of MHCs to four per streptavidin. T cell activation of short-term T cell lines was monitored by acidification of the media using a microphysiometer instrument (Molecular Devices). These results from Boniface et al (67) are shown in Figure 6, where we find that tetramers and trimers of MCC/Ek can stimulate specific T cells, but dimers and monomers cannot. As strepavidin has a tetrahedral symmetry it is likely that only three peptide/MHCs can engage TCRs on the surface of a T cell at any one time. Thus the difference that we see in activation between trimers and tetramers is probably due to the fact that all possible combinations of three peptide/MHCs are active on a tetramer whereas only one is on a trimer. Thus the data argue strongly that dimerization of TCRs on a T cell surface is insufficient to initiate activation and that at least three TCRs must be brought together. In the literature, Kourilsky and colleagues (72) have described experiments in which a dimer of class I MHC/peptide could stimulate cytokine production by a CTL, whereas a monomer could not. This may be a difference between CD4 and CD8 cells, but as these use the same types of TCR, there seems to be no reason to postulate a fundamental difference in their signaling mechanism, nor has one been detected in receptor cross-linking experiments. Another possibility is that this may be a difference in TCR affinity or off-rate between the two systems, but we think this is unlikely because even with a large excess of dimer we are unable to trigger significant T cell activation, thus occupancy effects are eliminated. Instead we would suggest that cytokine and seratonin release assays, which must of necessity be carried out over one or more hours, may lend themselves to aggregation effects, either in solution or on the cell surface. These effects are much less of a problem in the short-term assays that we employed in this study, which are completed in minutes. Nonetheless, even with the tetramer/trimer activation, we do not see a robust calcium elevation in the T cells, but rather a series of spikes of varying amplitude, a phenotype

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Figure 6 Three or more TCRs need to be engaged to initiate T cell activation (from Boniface et al; 67) A. Shows schematic of peptide/MHC tetramers with mixtures of a null peptide, MCC (99A) versus the strong agonist, MCC. Complexes of the appropriate stoichiometry are first made with the null peptide/MHC. B. This experiment shows the stimulation of a 2B4 T cell line with tetramers and trimers of MCC/Ek, but not monomers and dimers, using the acidification of the media as an early activation assay.

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that we associate with incomplete activation (73). Thus, more than three TCRs may need to be engaged to produce the stable elevation of calcium that can be achieved with a supported lipid bilayer loaded with peptide/MHC for example. Despite this new evidence that TCR oligomerization can occur and that it undoubtedly plays a role in T cell activation, some indications suggest that it is not the only molecular interaction on the cell surface. In particular the data of W¨ulfing et al (74) show that while there is a time-lag between T cell contact and activation at limiting doses of antigen, this onset delay is not as sensitive to peptide concentration as would be predicted if TCR oligomerization was the rate-limiting step, indicating that some other process is. It is also clear that accessory receptors such as LFA-1, CD2, etc often play an important role in whether a T cell becomes activated or not (75, 76).

CDR3 DIVERSIFICATION: A GENERAL STRATEGY FOR TCR AND IG COMPLEMENTARITY TO ANTIGENS? One striking feature about the gene rearrangements that create both T cell receptor and immunoglobulins is how strongly skewed the sequence diversity is toward the CDR3 loop in one or both of the chains making up a given heterodimer. In the case of αβ TCRs, this concentration of diversity occurs in both Vα and Vβ CDR3 loops. Recent structural data has confirmed that these loops sit largely over the center of the antigenic peptide (see previous section). For immunoglobulins, however, diversity is also strongest in the CDR3 region of VH, and, while not as pronounced as in most of the TCR genes, it is still considerable. Recent work on human Ig genes has found that there are only about 50 functional VH gene segments, and a similar number of VLs, (77, 78), thus limiting the naive repertoire to 50 CDR1s and CDR2s of each type. In contrast to this, the CDR3 of heavy chain is composed of the c-terminal part of VH, parts or all of a D region and the N-terminal part of a JH. In between V and D and J can be N- or P-element insertions of up to 10 nucleotides. Thus, a conservative estimate of the number of possible amino acid sequences that could be encoded would be 107. Lacking N-region diversification and a D region, the diversity of the light chain CDR3 is relatively modest—≈102. It has never been explained why there should be such a dichotomy between the VH CDR3 and all the other CDR loops involved in antigen-binding. Even more of a problem is TCRδ, which has the most CDR3 diversity of any antigen receptor by far (≈1013; 79), and yet recent data shows that γ δ TCRs can recognize ligands in an antibodylike manner (80–82). Clearly some chemical or structural logic must lie behind this phenomenon. A clue as to what this might be comes from the elegant

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studies of Wells and his colleagues who systematically mutated all the amino acids on either side of the interface of human growth hormone and its receptor (83, 84) as determined by X-ray crystallography. Interestingly only a quarter of the 30 or so alanine scans on either side had any effect on the binding affinity, even in cases where the X-ray structure showed an amino acid side chain of one molecule buried in the other. This study illustrates the fact that X-ray structures indicate what amino acids might be important in a given interaction, but that most may be effectively neutral. This is presumably because the fit at that position is not precise enough to add binding energy to the interaction. In any event the fact that some contacts might be more equal than others suggests an explanation for the failure of antibody-antigen structures with their many contacts between most of the CDR3 loops and an antigen to account for the very skewed genetics illustrated in Figure 7. In this context we have proposed a new model (M Davis, Y Chien, B Arden, submitted; 85) in which the principle antigen specificity of an Ig or TCR is derived from its most diverse CDR3 loops. In the case of antibodies, we imagine that most of the specific contacts (and hence free energy) with antigen are made by the VH CDR3 and

Figure 7 Skewing of diversity in human immunoglobulin genes. Shown in the figure is a schematic of human IgH and IgK diversity in the CDR1, 2, and 3 regions. Below the CDR1 and −2 regions are numbers representing the approximate number of germ-line genes (≈50 in each case from references 77 and 78) and thus an upper limit on the sequence diversity available at that position. For the CDR3 region, the estimates are based on random combinations of junctional N-region (in IgH) and D- and J-derived diversity (following the methods outlined in references 40 and 79), with the number representing the approximate number of amino acid sequences that could be generated.

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that the other CDRs provide opportunistic contacts that contribute to the energy of binding and specificity, but in a relatively minor way. Once antigen has been encountered and clonal selection anoints particular B cells, somatic mutation would then improve the binding of the CDR1s and −2s to convert the typically low-affinity antibodies to the higher-affinity models, as observed by Berek & Milstein (86) and most recently by Patten et al (87). This model predicts that a single VH might be able to accommodate most antigens, provided that full CDR3 diversity was possible, as has apparently been observed by Taylor et al (88) and in our own recent experiments (JL Xu, MM Davis, unpublished). While direct tests of this hypothesis are just beginning, it would seem to hold considerable promise as a general mechanism for antigen receptor specificity and as an answer to an intriguing molecular genetic puzzle.

CONCLUSION In many cases the work discussed above is based on just one or a few examples, and clearly we need many more to see the full scope of the possibilities. Still some theses seem to have emerged, and we have discussed them reasonably fairly, we hope. We think that the culmination of the biochemical and structural phase of this area will be in studies of the dynamics of TCRs and the ligands, together with the other important molecules on the surfaces of T cells and on antigen-presenting cells. This study of the whole ensemble of molecules, especially in the peculiar environment of a cell surface, will be extremely interesting. ACKNOWLEDGMENTS We wish to thank Chris Garcia, Luc Teyton and Ian Wilson for being so helpful with the TCR-Ag-MHC structure figure, and we thank the Howard Hughes Medical Institute and the National Institutes of Health for financial support. We also thank Stephanie Wheaton for assistance with the manuscript. Visit the Annual Reviews home page at http://www.AnnualReviews.org.

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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Annu. Rev. Immunol. 1998. 16:545–68 c 1998 by Annual Reviews. All rights reserved Copyright

THE ROLE OF COMPLEMENT AND COMPLEMENT RECEPTORS IN INDUCTION AND REGULATION OF IMMUNITY Michael C. Carroll Department of Pathology, Harvard University Medical School, Boston, Massachusetts 02115; e-mail: [email protected] KEY WORDS:

complement receptors, B cell coreceptor, clonal selection, innate immunity, B-1 lymphocytes, germinal centers, follicular dendritic cells

ABSTRACT Covalent attachment of activated complement C3 (C3d) to antigen links innate and adaptive immunity by targeting antigen to follicular dendritic cells (FDC) and B cells via specific receptors CD21 and CD35. Recent characterization of knockout mice deficient in complement components C3, C4, or the receptors CD21 and CD35 as well as biochemical studies of the CD21/CD19/ Tapa-1 coreceptor on B cells have helped to elucidate the mechanism of complement regulation of both B-1 and B-2 lymphocytes. Interestingly, natural antibody of the adaptive immune system provides a major recognition role in activation of the complement system, which in turn enhances activation of antigen-specific B cells. Enhancement of the primary and secondary immune response to T-dependent antigens is mediated by coligation of the coreceptor and the B cell antigen receptor, which dramatically increases follicular retention and B cell survival within the germinal center. Most recent evidence suggests that complement also regulates elimination of self-reactive B cells, as breeding of mice that are deficient in C4 or CD21/CD35 with the lupus-prone strain of lpr mice demonstrates an exacerbation of disease due to an increase in autoantibodies.

INTRODUCTION Participation of the complement system in regulation of B cell responses is a relatively old idea that was first proposed based on the finding of complement 545 0732-0582/98/0410-0545$08.00

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receptors on murine lymphocytes by Lay and Nussenzweig (1, 2). Subsequently, Pepys found that transient depletion of the third component (C3) resulted in an impaired humoral response to T-dependent and T-independent antigens (3). Complement was found to be essential for localization of immune aggregates to the follicular region of the secondary lymphoid compartment, and this suggested a mechanism for its enhancing effect (4, 5). Studies with guinea pigs deficient in C3 or components involved in its activation such as C2 and C4 confirmed the importance of complement in formation of a primary and secondary immune response to protein antigens (reviewed in 6). However, the absence of well-defined reagents for dissecting the humoral response limited more detailed analyses in these animal models. In mice, follicular dendritic cells (FDC) and B cells bear two distinct receptors, i.e. CD21 (l50 kDa) (7–9) and CD35 (l90 kDa) (10) for activated products of C3 and C4 (Figure 1). They are encoded at a single locus (Cr2) on chromosome 1 (8). The two receptors are assembled from multiple repeating structures referred to as short consensus repeats (SCRS) that consist of conserved units of 60–70 amino acids. CD21 is assembled from 15 SCRS, a transmembrane region, and a 35 amino acid cytoplasmic tail, whereas CD35 includes all of CD21 and an additional six SCRs on its N-terminal region. The two receptors differ in their ligand-binding specificity as CD21 binds iC3b, C3d,g, C3d, and C4d; and CD35 includes additional binding sites for C3b and C4b in the N-terminal region (11–13). CD35 has an additional function as a cofactor to factor I in the conversion of C3b to iC3b and C3d,g (10, 13). Human FDC and B cells also coexpress CD21 and CD35; however, the two genes are encoded at separate loci (14, 15) and appear to have distinct functions. Biochemical characterization of human complement receptor CD21 led to the novel finding that CD21 forms either a complex with CD35 (16) or CD19, TAPA-1, and Leu-13 on B lymphocytes (17–19). Coligation of the CD21/CD19 receptor complex with the B cell receptor (BCR) enhances signal transduction and effectively reduces the amount of antigen required by 10–100-fold (20, 21). Thus, CD21/CD19 participates as a coreceptor on human B cells much as does CD4 on T cells (22) and so effectively lowers the threshold for BCR signal transduction (23, 24). Since a ligand for CD19 has not been reported, it is assumed that CD21 binding of its ligands, i.e. iC3b, C3d,g, C3d, provides the primary recognition site for the coreceptor. This finding led to an alternative hypothesis to explain the enhancing role of C3 in humoral immunity. The involvement of CD21 in the humoral response to T-dependent antigens was confirmed in vivo by the demonstration that pretreatment of mice with either a CD21/CD35 specific-monoclonal antibody (mab) (25, 26) or a fusion protein of CD21-IgG (sCR2) (27) blocked the secondary humoral response. However, because both FDC and B cells express CD21, these studies could not distinguish between the two proposed hypotheses. Although not mutually

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Figure 1 Structure and binding sites of murine complement receptors CR1 and CR2. Murine CR1 (MCR1, CD35) and murine CR2 (MCR2, CD21), alternative transcripts of the Cr2 gene, are cell surface glycoproteins that specifically recognize proteolytic fragments of complement components C3 and C4. MCR1 (Mr 190,000) is expressed by B cells, FDCs, peritoneal macrophages, and activated granulocytes; it serves to bind C3b, iC3b, C3d, and C4b. MCR2 (Mr 150,000) is expressed by B cells and FDCs and serves to bind iC3b and C3d. MCR2 has an extracellular domain composed entirely of 15 SCRS, a 27 amino acid transmembrane region, and a 35 amino acid cytoplasmic tail. The structure of MCR1 is identical to that of MCR2, except for the presence of an additional six SCRs at the amino terminus that contains a binding domain for C3b, C4b, and mAB 8CI2. SCR-1 and SCR-2 of MCR2, which are common to both receptors, mediate binding of iC3b, C3d, and mAB 7G6, which blocks binding of both ligands to the receptors (72).

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Figure 2 Covalent attachment of activated C3 (C3d) to antigen targets the complex to follicular dendritic cells (FDC) and B cells within the lymphoid compartment via CD21 and CD35. Model illustrating the dual role of CD21 and CD35 in binding of C3d-antigen to FDC and B cell. Retention of C3d-antigen complex on FDC is important for presentation of antigen to follicular B cells and for providing a CD21L survival signal to the B cell. Coligation of the CD21/CD19/Tapa-1 coreceptor and the B cell antigen receptor lowers the threshold for signal transduction and delivers a survival signal.

exclusive, whether complement enhances humoral immunity by lowering the threshold of B cell signal transduction via the coreceptor or by increasing the efficiency of antigen trapping and retention on FDC via CD21/CD35 (Figure 2) remains a question. In this review, I discuss recent studies that address the mechanism for complement regulation of B cell development within the secondary lymphoid compartment. Furthermore, I attempt to combine results from studies of complement in both inflammation and the humoral response. This rather broad approach has led to our current model that complement activated principally by natural antibody modulates the selection and specific response of both B-1 and B-2 lymphocytes via the CD21/CD19 coreceptor. Thus, innate immunity regulates adaptive immune responses and natural antibody, which is the product of B-1 cells and is important in activation of the classical complement pathway. Finally, I speculate that complement is an important factor in setting the threshold for negative selection of B cells.

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HOW IS COMPLEMENT ACTIVATED IN THE IMMUNE RESPONSE? Models explaining an enhancing role for complement are based on the assumption that C3 becomes activated and binds covalently to protein antigens in vivo as it does in vitro (28). Thus, in order either to coligate CD21/CD19 coreceptor and BCR or to trap antigen on FDC, the CD21 ligand C3d must first become attached to antigen. Definitive evidence that direct attachment of C3d to antigen results in an enhanced humoral response was demonstrated by Dempsey et al (29). They found that fusion proteins of C3d and lysozyme were highly immunogenic. Thus, coupling two and three copies of C3d to the N-terminus of lysozyme reduced the amount of antigen required to induce an optimal secondary antibody response by two and three orders of magnitude, respectively. Given the importance of C3 binding, it is worth considering how C3 is activated following immunization or infection and becomes attached to antigen in vivo.

Recognition Molecules of Innate Immunity The innate immune system has evolved highly specific recognition proteins that activate complement following binding of their ligand (30) such as mannan binding lectin (MBL) (31, 32), C-reactive protein (33), complement system (34, 35), and natural antibody. For example, MBL has evolved highly specific structures (carbohydrate recognition domains) that bind carbohydrates common to pathogens. The classical pathway of the complement system can be activated directly by the binding of C1q to pathogens such as human immune deficiency virus (36). In the alternative pathway of complement, the spontaneous activation of C3b and covalent attachment to non-self surfaces, which are not protected by sialic acid or regulators of complement, lead to amplification of C3 activation and attachment of C3b (37).

Natural Antibody Is a Major Recognition Molecule of Innate Immunity Serum immuoglobulin is one of the most abundant proteins in the blood (approximately 10 mg/ml). Natural antibodies account for a large part of circulating Ig; however, despite their abundance, their functional importance remains controversial. The primary source of natural antibody in the mouse is the peritoneal B-1 cell (38). This CD5+ subset of B cells is self-replenishing and is not thought to produce hypermutated antibodies. The repertoire of B-1 cells appears to be biased toward germline-encoded antibodies that react with structures common to pathogens, such as levan, LPS, and phosphatidyl choline (PtC), with a wide range of binding affinities (39–41). For example, 10–20% of the B-1 cell repertoire recognizes PtC, LPS, and epitopes on bromelain-treated

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red blood cells (42, 43). The heavy and light chain genes represent germline products of two heavy and light chain V region subfamilies, i.e. VH11Vk9 and VH12Vk4 (39, 42). CD5+B cells also are a source of polyreactive IgM natural antibodies, which react with self-antigens (44). Natural antibody also binds to exogenous antigens such as keyhole limpet hemocyanin (KLH) and activates complement (45). Given the specificity of many of the products of B-1 cells, it is probable that the repertoire evolved to provide immediate protection against pathogens. As such, natural antibody is an important recognition molecule of innate immunity. Mice deficient in immunoglobulin are highly sensitive to bacterial infection. Reconstitution of Ig-deficient mice (X-linked immunodeficiency, or Xid) with the PtC-specific IgM is protective against infection with streptococcus (46). Protection is probably mediated via the classical pathway as mice deficient in C4 also have an increased sensitivity to infection with group B streptococcus (47). The recent finding that mice deficient in classical pathway complement were more susceptible to endotoxemia than WT controls (48) led to the observation that natural antibody is essential in intravascular clearance and protection against high doses of endotoxin (49). The source of the antibody was identified to be peritoneal B-1 cells as mice with a disruption of the gene encoding Bruton’s tyrosine kinase (Btk−/−), the enzyme deficiency that results in Xid, are nearly as sensitive to endotoxin shock as those totally deficient in Ig, i.e. recombinase activation gene 2 deficient (RAG-2−/−) (49). Btk-deficient mice express negligible levels of IgM and IgG3 but a normal range of the other subclasses of IgG (50). IgM is the major protective isotype, as reconstitution of the IgM/IgG3 deficient mice with pooled IgM is protective against endotoxin shock. In vitro binding experiments confirmed that the IgM fraction of pooled serum rather than IgG contained natural antibody that bound the LPS moiety expressed by Salmonella (49). Natural antibody not only recognizes pathogenic organisms but can recognize self-antigens and initiate autoimmune injury. One such example comes from recent studies on ischemia reperfusion injury. Reperfusion of hypoxic tissue following occlusion of blood supply results in a local inflammatory response leading to irreversible injury of both endothelium and skeletal muscle. Injury is mediated in part by the complement system as pretreatment of animals with a soluble form of the CR1 receptor (which inactivates C3 convertase) reduces injury substantially (51, 52). The first evidence that reperfusion injury was initiated by natural antibody came from the two findings: that inflammation was mediated by the classical pathway of complement and that deposits of IgM and C3 colocalized at the site of inflammation following reperfusion (53). This hypothesis was confirmed with antibody-deficient mice (RAG-2−/−) that were protected against injury; this protection was abrogated by reconstitution

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with either fresh mouse serum (53) or pooled IgM (54). A model that would explain these observations is that neoepitopes are expressed on hypoxic venular endothelium and that circulating natural antibody recognize the altered surface and bind. This results in activation of the classical pathway of complement and initiation of an inflammatory response. These findings are relevant to this review as they provide an insight into the antibody repertoire of B-1 lymphocytes, discussed in the next section.

ROLE OF COMPLEMENT IN CLONAL SELECTION OF B-1 CELLS One of the phenotypes identified in mice bearing a targeted disruption of the Cr2 locus (Cr2−/−) is a selective reduction in the B-1a (CD5+, IgM+, CD11b/CD18+) subset of peritoneal B-1 cells (55). Thus, while the B-1b (IgM+, CD11b/CD18+) subset of B-1 cells appears normal, the B-la population is reduced by approximately 50%. Despite this reduction in cell number, the level of IgM in the serum of Cr2−/− mice is normal. Interestingly, mice deficient in CD19 (CD19−/− ) have an even greater reduction in B-1 cells with a corresponding decrease in serum IgM (56, 57). The more severe phenotype of the CD19-deficient mice could reflect an inherent role for CD19 signaling independent of CD21. B-1 cells represent a self-replenishing population of B lymphocytes that are thought to be maintained or expanded by contact with antigen such as enteric bacteria. The finding that mice deficient in the CD21/CD19 coreceptor have a reduced number of peritoneal B-1 cells suggests an essential role for complement in selection of this population of lymphocytes. Thus, contact of B-1 cells with C3d-coated antigen might enhance cell signaling and clonal selection via coligation of the coreceptor with BCR, in a manner similar to that proposed for enhancement of B-2 lymphocyte signaling (24; Figure 2). A prediction of this hypothesis would be that the repertoire of natural antibody in Cr2−/− mice is reduced or altered compared to WT mice. To test this hypothesis, Cr2−/− mice were examined in the natural antibody-dependent ischemia reperfusion model (53, 54). Interestingly, they are equally protected in the mucosal ischemia reperfusion model as mice deficient in either C4 (C4−/− ) or Ig (RAG-2−/− ) (A Prodeus, RR Reid, H Hechtman, FD Moore, MC Carroll unpublished results). Protection is due to an absence of specific IgM, as reconstitution of Cr2−/− mice with pooled IgM abrogates protection. Thus, even though the CD21/CD35-deficient mice have normal circulating levels of IgM, they lack the natural antibody/antibodies that mediate reperfusion injury; and consequently they are protected in the IgM-dependent reperfusion model. The source of specific IgM is the B-1 lymphocyte because engraftment of Cr2−/− mice with

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Figure 3 CD21 coreceptor is essential for clonal selection and expansion of B-1 lymphocytes. Model illustrating that clonal expansion and maintenance of peritoneal CD5+ B-1 cells are dependent on coligation of the CD21/CD19 coreceptor and BCR on binding of C3d-coated antigen. While the specific antigens are not known, they likely include enteric bacteria based on the specificity of the B-1 cell repertoire, i.e. LPS and phosphatidyl choline.

peritoneal B-1 cells harvested from WT mice restores normal inflammation in the mucosal reperfusion injury model (A Prodeus, RR Reid, H Hechtman, FD Moore, MC Carroll, unpublished results). The results support the hypothesis that B-la cells require antigen stimulation for survival and expansion and that selection is CD21 dependent (Figure 3).

Source of C3 The complement system consists of over 20 serum proteins that interact in a series of proteolytic events leading to release of proinflammatory peptides (C3a and C5a), covalent attachment of opsonins (C3b, iC3b, C3d, C4b, C4d) to surfaces and formation of the membrane attack complex (C5b-9) (34, 35). C3 protein is a major component of blood and is found at a concentration of approximately 1 mg/ml. While the primary site of synthesis is the liver (58), extra-hepatic synthesis is common and a number of cell types such as macrophages (59), keratinocytes (60), kidney tubular epithelial cells (61), and endothelial cells (62) synthesize C3 protein. Synthesis is regulated by inflammatory cytokines such as IL-lα (61), IL-6 (63), and interferon-gamma (IFN-γ ) (64) that are known to upregulate acute phase proteins.

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Results from our early studies with mice bearing heterozygous deficiency in C3 demonstrated a gene dosage effect as the mice responded to T-dependent antigens with a response intermediate between that of wild-type controls (WT) and animals totally deficient in C3 (C3−/− ) (MB Fischer, M Ma, MC Carroll, unpublished results). This was something of a surprise given the relatively high level of C3 in blood, and it suggested that its concentration within the tissues may be a limiting factor in enhancement of humoral immunity. To test the importance of locally synthesized C3 in the humoral response, C3-deficient mice that have an impaired response to T-dependent antigens (discussed in more detail below) (65) were reconstituted with bone marrow (BM) from WT mice. Interestingly, engraftment of the deficient mice with WT BM rescued their impaired humoral response to (4-hydroxy-3-nitrophenyl) acetyl keyhole limet hemocyanin (NP-KLH) despite nearly undetectable levels of C3 in their blood (66). In situ hybridization and immunohistochemical analyses of cryosections of the spleens of immunized WT mice and BM chimeras, localized C3 synthesis to the white pulp region. The cellular source of C3 protein and mRNA was further identified as MOMA-2+ macrophages by immunohistochemical staining and by reversetranscriptase-PCR analysis of RNA isolated from purified MOMA-2+ cells, respectively (66). This population of macrophage is located primarily within the T and B cell zones of the secondary lymphoid compartment (67). Thus, in the case of the BM chimeras, a sufficient level of C3 protein is synthesized within the lymphoid compartment by WT donor macrophages to provide enhancement of the humoral response and efficient trapping of antigen on FDC. Local synthesis appears to be tightly regulated as C3 mRNA expression is not detectable in the lymphoid compartment in nonimmune WT mice. However, within 24 h following immunization C3mRNA is expressed by MOMA2+ macrophages within the spleen and lymph nodes and persists for 3 to 5 days or up to 2 weeks following primary and secondary immunizations, respectively (66). While the molecular events regulating C3 expression have not been identified, it seems most likely that inflammatory cytokines such as IL-la, IL-6, and IFN-γ as discussed above are involved (Figure 4).

REGULATION OF ADAPTIVE IMMUNITY BY CD21/CD35 A distinct role for classical pathway complement in enhancement of the humoral response was confirmed in mice genetically deficient in C3 or C4 (65). Comparison of the primary and secondary immune response of these mice with WT mice following challenge with T-dependent antigen (bacteriophage (φX 174) demonstrated that while their T-cell response was normal, their B cell response was impaired (65) (Figure 5). Phage antigen was selected as a model

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Figure 4 Upregulation of local C3 synthesis in the lymphoid compartment during an immune response enhances activation and covalent attachment to antigen. (a) Presentation of antigen within the splenic periarteriolar lymphoid sheath (PALS) zone by dendritic cells to T cells results in (b) T cell activation and release of IFN-γ , (c) which induces C3 synthesis (and synthesis of other early components of classical pathway not shown in the figure) by macrophages in the lymphoid compartment. (d ) Specific antibodies released by primed B cells bind antigen and activate locally synthesized complement, leading to (e) covalent attachment of C3 to antigen, which enhances B cell activation and antigen uptake by FDCS (64–69, 67a).

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Figure 5 C3- and C4-deficient mice fail to make an IgG response to the TD antigen bacteriophage φX174. C3−/− (open triangles), C4−/− (open square), and wild-type littermates (closed circles) were injected i.v. with 3 × 107 φX174 on days 0 and 21 (as indicated by arrows) and bled at the time indicated. Levels of anti-phage φX174 Abs were determined in a neutralization assay. IgM and IgG were distinguished based on the sensitivity of the former to 2-ME. All results are presented as means plus or minus SD. Asterisk indicate statistical significance with p value of <0.05 (65).

T-dependent antigen because of the sensitive plaque forming unit (PFU) assay for detecting antibody and it was used in previous studies in guinea pigs deficient in C3 or C4 (68, 69). As expected, splenic B cells of C3 and C4 deficient mice respond normally in proliferation assays in vitro when stimulated via their BCR (crosslinking IgM receptor) or CD40. Likewise, no difference in the response to LPS was observed among B cells isolated from WT or the deficient mice. It was not unexpected that B cells in C3 deficient mice would respond normally in vitro as these assays did not involve complement ligands. The immune-enhancing role of complement has been proposed as mediated by the CD21 receptor based on blocking experiments [anti-CD21 antibody (26) and sCR2 (27)] and biochemical studies (23, 24) as discussed above. The

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recent availability of mice deficient in CD21 and CD35 (Cr2−/− ) has provided a mouse model not only for confirming the critical role for this receptor/receptors in humoral immunity but for dissection of the mechanism. As predicted, the Cr2−/− mice have an impaired humoral response to T-dependent antigens (T-D) characterized by a reduction in the secondary antibody (55, 70). In general, the phenotype of the Cr2−/− mice is very similar to that of mice deficient in C3 or C4 because they have a reduced number and size of germinal centers and a corresponding reduction in serum levels of the switched isotypes of Ig, i.e. IgG2a, IgG2b, and IgG3 (55). Interestingly, some GC do form in response to immunization with soluble T-D antigen, but their mean size is approximately 10-fold less than that found with WT mice; and this is discussed in more detail below. In the absence of complement in in vitro assays, splenic B cells isolated from Cr2−/− mice appear to transduce signals normally following cross-linking of BCR or CD40 or by stimulation with LPS (55).

B Cell Signal Transduction vs Antigen Trapping The availability of embryonic stem (es) cells bearing a disrupted Cr2 locus provided an opportunity to examine the mechanism of complement enhancement of humoral immunity, i.e. B cell signal transduction vs antigen trapping. Using the model of blastocyst complementation in RAG-2−/− mice (71), Croix et al constructed chimeric mice that expressed normal levels of CD21/CD35 on their FDC, but their B cells (which were totally derived from the Cr2−/− es cells) were negative (72). Thus, the differential expression of CD21/CD35 on FDC and B cells provided a model for testing the importance of the coreceptor expression on B cells without apparent altering of complement-mediated uptake of antigen by FDC. Despite expression of normal levels of CD21/CD35 on their FDC, the Cr2−/− chimeric mice had an impaired humoral response to the T-D antigen NP-KLH. Therefore, it was concluded that CD21/CD35 expression by B cells is essential in the formation of a normal secondary response. It should be noted that splenic B cells in the RAG-2 mice reconstituted with Cr2−/− es cells expressed normal levels of CD19 in the absence of CD21/CD35, thus confirming that CD19 expression alone was not sufficient for the proposed coreceptor enhancement. While these results suggested strongly that complement-regulation of the B cell response was mediated by the coreceptor, a combined requirement for trapping of antigen on FDC and B cell response could not be ruled out. Alternatively, Cr2+ B cells might be required for efficient transport of antigen to the FDC. These experiments also demonstrated that FDC in RAG2−/− mice are not inherently defective and appear to be normal following reconstitution with mature B and T cells. These results add to the growing evidence of the interdependency of B cells and FDC.

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To examine further the importance of B cell coreceptor expression in humoral immunity, Fischer et al constructed BM chimeras between Cr2+ and Cr2− MHC-matched mice to obtain differential expression of CD21/CD35 on B cells and FDC (55). Reconstitution of lethally irradiated Cr2−/− mice with WT BM provided chimeric mice in which their B cells were derived from the donor (Cr2+), but the radio-resistant splenic FDC were of recipient origin (Cr2−/− ). This phenotype, i.e. CD21/CD35+ B cells and CD21/CD35− FDC, was confirmed by immunohistochemical analysis and flow cytometry. Comparison of the immune response of chimeric mice (WT into Cr2−/− ) with Cr2−/− and WT controls demonstrated that expression of CD21/CD35 on B cells was sufficient for an apparently normal secondary response to T-dependent antigens. However, it remains to be determined if the affinity of the antibody is the same as in WT mice. Despite an apparently normal GC reaction in immune chimeric mice, the level of antigen retained on CD21/CD35- FDC was dramatically reduced (MB Fischer, MC Carroll, unpublished results). Thus, it would not be unexpected to find that the long-term memory response of the chimeric mice is relatively weak.

Two Stages of B Cell Enhancement The finding that coligation of the CD21/CD19 coreceptor complex with the BCR enhanced B cell signal transduction led to the “threshold hypothesis” (23, 24). According to this hypothesis, the coreceptor is important for initial activation of naive or virgin B cells bearing low-affinity surface IgM. Thus, the coreceptor serves to lower the threshold such that antigens that bind with low affinity to the BCR can induce sufficient signal to activate the B cell. In the spleen, naive B cells encounter T-dependent antigens within the white pulp and migrate into the periarteriolar lymphoid sheath region (PALS) or T cell zone where they interact with cognate helper T cells (73, 74). The outcome of efficient activation of the B cell is development along two pathways, i.e. antibody forming cells (AFC) within the PALS; and entry into the follicles and initiation of a GC reaction. It is not clear if progenitors of the same B cell clone can do both. Formation of the AFC foci requires CD40L stimulation as treatment with anti-CD40L at time of immunization blocks both AFC and GC response (75). According to the threshold hypothesis, both pathways of B cell development might be affected by absence of coreceptor signaling. The primary antibody response to bacteriophage φX 174 is impaired in both guinea pigs (68) and mice deficient in C3 or C4 (65). In addition, Cr2−/− mice have an impaired primary response to bacteriophage (55). In contrast, Molina et al. reported a normal primary response to sheep red blood cell antigen (SRBC) in Cr2−/− mice (70). It is probable that the structure of the antigen and the affinity of preexisting B cells determine the necessity for complement in the AFC foci response.

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In an attempt to define at what stage/stages the coreceptor was involved in the early activation of B cells, the Cr2−/− and control mice were bred with mice (strain MD4) bearing the hen egg lysozyme (HEL)-specific immunoglobulin (Ig) heavy and light chain transgene (tg) (76). By varying the form of avian lysozyme used to activate the tg B cells in an adoptive transfer model, this system could be used to test the threshold hypothesis. Thus, this model could be used to determine directly if the affinity of the antigen affected the requirement for coreceptor expression. Two forms of lysozyme were selected that differ in relative binding affinity by at least 2000 fold, i.e. duck egg lysozyme (DEL) and turkey (TEL) that bind with relative affinities of 1 × 107 vs 2 × 1010 M−, respectively (77). As expected, Cr2+ and Cr2− HEL-specific tg B cells respond similarly to DEL and TEL antigens in vitro; however, approximately 100-fold less TEL (high affinity antigen) than DEL (lower affinity antigen) is required to induce expression of activation markers CD86 (B7–2) and CD54 (ICAM-2) or to induce B cell proliferation in vitro (78). These in vitro experiments established that Cr2+ and Cr2− tg B cells respond similarly following antigen activation in the absence of complement ligand. However, a very different result is observed in vivo when complement is involved, as discussed below. To examine the requirement of the coreceptor in vivo for antigens that bind with a relative lower affinity, Cr2+ and Cr2− tg B cells were mixed with DEL antigen and adoptively transferred into WT mice that had been immunized 7 days previously with the antigen. The advantage of this model is that the two groups of transgenic B cells can be compared in an ongoing humoral immune response in which the conditions of T help, antigen concentration, and FDC trapping are constant. In this model, WT mice were injected intravenously with 50 µg of soluble DEL without adjuvant 7 days prior to adoptive transfer and were not irradiated, so that the tg B cells were competing with endogenous B cells for antigen and T help. Although these conditions induce a less vigorous reaction than that found with adjuvants, this approach favors the requirement for natural immunity. Spleens were harvested 1–5 days following adoptive transfer and were analyzed by flow cytometry and immunohistochemistry. Day 1 following transfer, a similar number of Cr2+ and Cr2− tg B cells were identified within the splenic white pulp (both follicular and PALS regions). However, by day 5, very few, i.e. less than 2%, of the follicles included Cr2− tg B cells. In contrast, 65% of the follicles included Cr2+ tg B cells at the same time period. The level of surface expression of B cell activation markers CD54 and CD86 on day 1 after transfer was consistent with negligible activation of the Cr2− tg B cells. The impaired follicular retention of the Cr2− tg B cells and their low level of activation in vivo were consistent with the threshold hypothesis. Thus, in the absence of a functional coreceptor signaling, the Cr2− tg B cells were

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not sufficiently activated to compete with the endogenous B cells for limiting antigen and T help. The relatively rapid loss of Cr2− HEL-specific tg B cells from the lymphoid compartment raises the question of whether they were eliminated or simply returned to circulation. If the Cr2− tg B cells simply failed to become activated on binding antigen, it might be reasoned they would remain within the follicles as they are when transferred into nonimmune recipients, i.e. approximately 50% of follicles include Cr2+ or Cr2− tg B cells 5 days after transfer (78). Thus, the lack of retention of Cr2− tg B cells within the follicles following transfer into DEL-immune recipients suggests that they are specifically eliminated from the lymphoid compartment. These results extend the threshold hypothesis and suggest that the coreceptor provides an essential survival signal following antigen binding that allows the antigen-specific B cell to continue along either the AFC pathway or entry into the follicular zone for initiation of the GC reaction (Figure 6a). Coreceptor-dependent retention within the follicular compartment can be overridden by very high affinity antigens. In contrast to that observed with DEL antigen, adoptive transfer of Cr2− HEL-specific tg B cells into TEL (highaffinity antigen) immune recipients leads to relatively high rates of occupancy of the follicles, i.e. approximately 65%. The increased survival of the Cr2− tg B cells within the follicles was not explained by a difference in the amount of T help or antigen trapping in the WT immune recipients because the immune response to DEL and TEL is similar in WT recipients. WT mice make a similar secondary response to the two forms of lysozyme as evidenced by secondary antibody titer, the number of splenic GC formed, and degree of T cell activation in an in vitro proliferation assay. The increased survival and follicular localization of the Cr2− tg B cells in the TEL vs the DEL immune recipients correlates with the findings in vitro that 100-fold less high-affinity than low-affinity antigen is required for B cell activation in vitro.

CD21 Ligand Promotes GC Survival Examination of the survival of Cr2+ and Cr2− HEL-specific tg B cells following transfer into WT mice immunized with the high-affinity antigen TEL demonstrated a striking difference in the number of tg B cells identified within the GC regions, i.e. 6% vs 54% of GC occupied by Cr2− vs Cr2+ tg B cells, respectively. Despite retention within the follicles, Cr2− tg B cells failed to compete with endogenous B cells for space within the GC. Two possible explanations for this observation are that either the Cr2− tg cells failed to enter the GC or they entered but failed to survive. The former possibility seems unlikely since Cr2− mice (as well as C3- and C4-deficient mice) can initiate a GC, albeit at a reduced rate. Moreover, their size is approximately 10-fold less than that of WT

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controls, and this suggests limited survival of the GC B cell. Thus, irrespective of the affinity of the antigen, B cell expression of CD21/CD35 is required for survival within the GC. This finding was not predicted by the threshold hypothesis and suggests that coligation of CD21/CD19 coreceptor and BCR not only has an enhancing effect but provides a qualitative signal. The clonal selection hypothesis proposes that memory B cells are selected by antigen and only those that bind with the highest affinity survive (79, 80). Intense competition for antigen occurs within the specialized microenvironment of the GC. Here, B cells rapidly divide and acquire somatic mutations within their VH and VL region of rearranged Ig genes. Mutants that bind antigen with greater affinity are selected for entrance into the pool of memory cells. Although competition of GC B cells is antigen-dependent, additional signals are required for survival (81, 82). Soluble antigen alone is not sufficient to ensure survival and in fact can be deleterious. Flooding the GC with specific soluble antigen during the period of peak GC activity can result in a rapid elimination of the GC B cells some of which undergo apoptosis and others traffic to the PALS zone (83–85). Shokat & Goodnow proposed that B cell survival within the GC not only is antigen dependent but requires contact with the FDC surface, and this provides a survival signal (81, 84). Following FDC contact, GC B cells acquire antigen from the FDC and present it to the cognate T cell resulting in continued development into a memory cell. The requirement for T cell help was confirmed by the demonstration that blocking of CD40 ligand at the critical GC period has an effect similar to that of soluble antigen (75), i.e. elimination of GC. Thus, at least three signals are required for B cell survival within the GC: (a) antigen, (b) T help, and (c) FDC contact. Antigen is retained on FDC via Fcγ R and complement receptors (5, 86). Immune complexes are putatively transported to the FDC in a mechanism that is ←−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−− Figure 6 Expression of CD21 by B cells is critical in at least two stages of B cell follicular development. (a) Early activation within the inner PALS zone and (b) survival within the germinal center. (a) On binding of antigen naive B cells migrate into PALS zone (step 1) and encounter T cell help (step 2). Attachment of an activated fragment of C3d to antigen lowers the threshold for B cell activation (step 2) (and probably delivers a survival signal) and is mediated by coligation of the CD21/CD19/Tapa-1 coreceptor with the B cell antigen receptor. Interaction with cognate T helper cell leads to formation of the PALS foci and release of specific antibody (step 3). Arrow sizes in the figure reflect the level of B cell activation. (b) A subset of antigen specific cells migrate out of the PALS zone into the follicle and initiate the germinal center reaction. Rapidly dividing B cells (centroblasts) undergo somatic hypermutation (step 1). Newly formed B cells (centrocytes) require contact with antigen bound to FDC to prevent a death signal (step 2). CD21 expression is critical for firm contact with C3d-coated antigen retained on FDCs primarily via CD21 receptor. Encounter with cognate T cell help is also required to prevent apoptosis and to promote memory B cell formation (step 3) (67a).

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B cell dependent (81). Complement is important in antigen deposition and possibly transport because mice transiently depleted of C3 fail to efficiently retain aggregated IgG on their FDC (4, 5). CD21 and CD35 receptors are the major complement receptors on FDC, and deficiency in these receptors results in a dramatic reduction in the retention of antigen in immune animals (MB Fischer, S Goerg, M Ma, MC Carroll, unpublished results). A hypothesis that would explain the role of complement in the GC response is that the B cell coreceptor is essential for FDC contact and delivery of a survival signal (Figure 6b). Support for this hypothesis comes not only from the adoptive transfer experiments discussed above but from the finding that FDC coated with C3d and immune complexes support long-term survival of B cells activated by either LPS or antigen plus T help in vitro (87). Interestingly, in the in vitro assay, the survival effect of FDC can be blocked by addition of sCR2 or anti-CD21 antibody or when either the B cell or FDC are deficient in CD21/CD35 (87). Thus, long-term survival of activated B cells in this in vitro model depends on contact between the CD21 ligand on the FDC and CD21 receptor on the B cell. A prediction of this model is that injecting immune mice with sCR2 or C3d at the optimal GC period would eliminate the GC in a manner similar to that observed with soluble antigen (83–85) or anti-CD40 ligand treatment (75). Using human tonsiler B cells bearing a GC phenotype (CD38hi, CD20hi, CD10+, CD21+CD19+, CD23lo, sIgMlo, IgD−, and CD14−), Bonnefoy et al find that a subset of CD21specific antibodies can rescue greater than 40% of the cells from apoptosis in vitro (88). However, they argue that the important CD21 ligand is CD23 because soluble CD23 can also block apoptosis. The role of human CD23 appears to differ between mice and humans as mice deficient in CD23 have normal GC responses and mouse CD23 does not appear to bind to mouse CD21. In summary, adoptive transfer experiments not only confirm the threshold hypothesis in vivo but extend it to demonstrate that the coreceptor provides a critical survival signal for naive B cells on encounter of low-affinity antigen. Further, they demonstrate that CD21-CD21 ligand interaction provides an essential survival signal for GC B cells in vivo irrespective of the affinity of the antigen.

Setting the Threshold for B Cell Tolerance An important component of the clonal selection theory of Burnet is that autoreactive clones of lymphocytes are eliminated on encounter with self-antigens (79). Strength of BCR signal is a major factor in induction of B cell tolerance in the peripheral lymphoid compartment just as it is in B cell activation (reviewed in 89). The study of the anti-HEL/soluble HEL double tg mice has led to the hypothesis that strength of BCR signal determines whether self-reactive B cells are deleted, anergized, or ignored. Expression of a membrane form of HEL leads to clonal deletion of HEL-specific B cells within BM, whereas expression of a soluble form of HEL (sHEL) leads to clonal anergy in the

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periphery. Thus, by varying the serum concentration of sHEL and the affinity of the HEL-specific BCR, it was determined that induction of peripheral tolerance was dependent on the overall strength of the BCR signal. A link between complement and autoimmunity is suggested by the observation that a major risk factor for systemic lupus erythematosus (SLE) in humans is genetic deficiency in the early components of the classical pathway of complement, i.e. Clq, Clr, Cls, C2, or C4A and C4B (90). In addition, partial deficiency in C4, i.e. null allele for C4A isotype, is an apparent risk factor for SLE (91). Given the role of complement in clearance of immune complexes, one explanation for the increased risk of SLE among complement-deficient individuals is increased accumulation of immune complexes that in turn enhance the pathology of autoimmune disease. However, this explanation does not account for the initiation of autoantibody formation. An alternative explanation is a corollary to the threshold hypothesis. Accordingly, signaling via the BCR is enhanced by the coreceptor irrespective of whether the antigen is foreign or self as long as the antigen is coated with C3d. Thus, it is speculated that a subset of self-antigens (as proposed for environmental antigens) are recognized by natural antibody resulting in attachment of C3d (as found in reperfusion injury). The encounter of naive self-reactive B cells with selfantigen coupled to C3d (or C4d) ligand cross-links the coreceptor and BCR delivering an enhanced tolerogenic signal (in the absence of T-help). Thus, in the case of complement-deficient individuals, self-reactive B cells encountering specific antigen in the peripheral lymphoid compartment receive a subthreshold signal in the absence of coreceptor cross-linking, and the clone remains in circulation. A secondary event resulting in T help and release of sufficient levels of self-antigen to overcome the increased threshold in activation would activate the self-reactive clones, resulting in release of autoantibody. Thus, it is proposed that deficiency in early complement components would result in both a reduction in the efficiency of targeting of self-antigens to the lymphoid compartment and an absence of CD21 ligand for coreceptor enhancement of signaling and therefore lead to an accumulation of self-reactive B cell clones. To test this hypothesis, Goerg et al have bred Cr2−/− or C4−/− mice with the B6 lpr/lpr congenic strain (92). The latter develop a mild form of lupuslike disease characterized by late-onset of lymphadenopathy and autoantibodies against nuclear antigens (ANA), double-strand DNA (dsDNA), and IgG rheumatoid factor (Rh factor). It was predicted that deficiency in either the coreceptor (Cr2−/− /lpr/lpr) or its ligand (C4−/− /lpr/lpr) would exacerbate autoimmune disease as elimination of self-reactive B cells would be impaired to even a greater extent than in the fas-defective mice (B6 lpr/lpr). As predicted, deficiency in either CD21 or C4 in combination with lpr/lpr leads to more severe autoimmune disease. CD21−/− lpr/lpr mice have significantly higher autoantibody titers (ANA, anti-dsDNA and Rh factor) and autoimmunity occurs at

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an earlier age than in the WT/lpr/lpr controls (92). These results support the hypothesis that regulation of self-reactive B cells is altered by the absence of CD21/CD35 expression. Similarly, ANA autoantibody titers appear sooner (by 10 weeks of age) and are significantly higher in C4-lpr/lpr than in C4+lpr/lpr controls. Interestingly, both groups of deficient mice, i.e. CD21−/− and C4−/− , mice clear IgG immune complexes from the vasculature similar to that of normal mice. Thus, impairment of immune clearance of IgG containing complexes would not explain the increased susceptibility to lupus-like disease in complement-deficient mice. It will be important to examine the complementdeficient mice in more defined Ig transgenic models such as anti-HEL/sHEL (93) or anti-DNA tg mice (94).

CONCLUDING REMARKS While the focus of the review has been on the importance of CD21 as a coreceptor on B cells, its role in antigen retention on FDCs should not be overlooked. Studies in vitro of the interaction between B cells and FDC confirm the importance of C3d ligand for functional contact and delivery of a survival signal to the B cell (87). The model that is developing is that B cells like T cells recognize antigen that is bound to an accessory cell (FDC in case of B cell), and this contact provides a signal through the antigen receptor and the coreceptor (Figure 2). Finally, new results suggesting a role for complement in regulation of selfreactive B cells and clonal selection of B-1 cells support a broader participation of complement in adaptive immunity than was previously held. It will be important to examine the repertoire of the complement-deficient strains to look for alterations in their preimmune B cell repertoire that would explain their predisposition to autoimmunity and absence of specific natural antibodies. ACKNOWLEDGMENTS I would like to thank my collaborators Joe Ahearn, Stephen Galli, Chris Goodnow, Herb Hechtman, Garnett Kelsoe, Francis Moore, Jr., and John Tew who participated in many of the experiments discussed in the review. I would also like to thank the members of my laboratory who contributed to the experiments and in construction of the knockout mice: Michael B. Fischer, Siegfried Goerg, Minghe Ma, Andrey Prodeus, Russell Reid, Li-Ming Shen, Junrong Xia, and Xiaoning Zhou. Michael Carroll is supported by grants from the National Institutes of Health, the Lupus Foundation, and Cambridge Antibodies Technology. Visit the Annual Reviews home page at http://www.AnnualReviews.org.

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Smith KG, Nossal GJ. 1995. Soluble antigen can cause enhanced apoptosis of germinal-centre B cells. Nature 375:331– 34 Shokat K, Goodnow C. 1995. Antigeninduced B-cell death and elimination during germinal-centre immune response. Nature 375:334–38 Han S, Zheng B, Dal Porto J, Kelsoe G. 1995. In situ studies of the primary immune response to (4-hydroxy3-nitrophenyl). IV. Affinity-dependent, antigen-driven B cell apoptosis in germinal centers as a mechanism for maintaining self-tolerance. J. Exp. Med. 182:1635–44 Tew JG, Kosco NM, Burton GF, Szakal AK. 1990. Follicular dendritic cells as accessory cells. Immunol. Rev. 117:185–211 Qin D, Wu J, Carroll MC, Burton GF, Szakal AK, Tew JG. 1997. Antibody production and B cell-FDC communication via CD21-CD21 ligand. Submitted Bonnefoy J-Y, Henchoz S, Hardie D, Holder MJ, Gordon J. 1993. A subset of anti-CD21 antibodies promote the rescue of germinal center B cells from apoptosis. Eur. J. Immunol. 23:969–72 Goodnow CC. 1996. Balancing immunity and tolerance: Deleting and tuning lymphocyte repertoires. Proc. Natl. Acad. Sci. USA 93:2264–71 Agnello V. 1978. Association of systemic lupus erythematosus and SLE-like syndromes with hereditary and acquired complement deficiency states. Arthritis Rheum. 21:146–52 Hauptmann G, Goetz X, Uring-Lambert B, Grossehans E. 1986. Complement deficiencies. 2. The fourth component. Prog. Allergy 39:232–49 Goerg S, Chu L, Prodeus A, Zhou X, Carroll MC. 1997. Deficiency in CD21 and CD35 increases autoimmune disease in lpr mice. Submitted Hartley SB, Crosbie J, Brink R, Kantor AB, Basten A, Goodnow CC. 1991. Elimination from peripheral lymphoid tissues of self-reactive B lymphocytes recognizing membrane-bound antigens. Nature 353:765–69 Erikson J, Radic MZ, Camper SA, Hardy RR, Carmack C, Weigert M. 1991. Expression of anti-DNA immunoglobulin transgenes in non-immune mice. Nature 349:331–34

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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Annu. Rev. Immunol. 1998. 16:569–92 c 1998 by Annual Reviews. All rights reserved Copyright

DIMERIZATION AS A REGULATORY MECHANISM IN SIGNAL TRANSDUCTION Juli D. Klemm1, Stuart L. Schreiber 2, and Gerald R. Crabtree1 1Howard Hughes Medical Institute, Departments of Developmental Biology and Pathology, Stanford University Medical School, Stanford, California 94305; e-mail: [email protected] 2Howard Hughes Medical Institute, Department of Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, Massachusetts 02138

KEY WORDS:

DNA-binding proteins, proximity, cell surface receptors, dominant negative, oligomerization

ABSTRACT Dynamic protein-protein interactions are a key component of biological regulatory networks. Dimerization events—physical interactions between related proteins—represent an important subset of protein-protein interactions and are frequently employed in transducing signals from the cell surface to the nucleus. Importantly, dimerization between different members of a protein family can generate considerable functional diversity when different protein combinations have distinct regulatory properties. A survey of processes known to be controlled by dimerization illustrates the diverse physical and biological outcomes achieved through this regulatory mechanism. These include: facilitated proximity and orientation; differential regulation by heterodimerization; generation of temporal and spatial boundaries; enhancement of specificity; and regulated monomer-todimer transitions. Elucidation of these mechanisms has led to the design of new approaches to study and to manipulate signal transduction pathways.

INTRODUCTION Specific protein-protein interactions are essential for almost all biological processes. Many of these interactions are highly stable, such as the interaction between the subunits of hemoglobin or between trypsin inhibitor and trypsin. 569 0732-0582/98/0410-0569$08.00

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Others interactions are dynamic, including recognition events that lead to phosphorylation, nucleotide exchange, and proteolysis. A subset of protein-protein interactions is dimerization, which can be defined as a protein-protein complex composed of two related subunits (1). Dimerization is a common theme in the regulation of signal transduction, and this review focuses on events in eukaryotic signal transduction processes that involve dimerization. We limit our discussion to dynamic dimerization—those situations where the dimerization event itself is part of a decision point in the signaling process. Thus, we do not include in our discussion proteins such as the antibody molecule, which is an obligate disulfide-bonded (covalent) dimer. While dimer formation is key to antibody function, the dimerization event is not the interpretation of a particular signal. We begin by discussing the functional consequences of dimerization, and then we describe specific molecules that homodimerize or heterodimerize in response to a given signal. We conclude with examples of how elucidation of dimerization events in biology has led to the design of new ways for researchers to study and to manipulate signal transduction.

FUNCTIONAL CONSEQUENCES OF DIMERIZATION Dimerization represents a powerful and flexible regulatory mechanism that can achieve a variety of consequences. Below are discussed broad categories of regulatory strategies achieved through dimerization; these are outlined in Table 1. The reader should note that these strategies are not mutually exclusive within a given system. Table 1 Underlying strategies in protein dimerization Physical and physiologic outcomes of dimerization

Possible examples

Proximity and orientation

Single transmembrane cell surface receptors

Differential regulation by heterodimerization Temporal and spatial thresholds

Myc/Mad/Max Bcl-2 family Id Emc

Enhanced specificity Enlarged surface area

Many DNA-binding proteins, DCoH Growth factor-receptor interactions

Regulated monomer-to-dimer transitions Imposition of a kinetic barrier

STAT proteins Smad proteins E-cadherin Synaptotagmin

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Proximity and Orientation When proteins dimerize, they are brought into proximity with one another; for enzymes, this may allow them to act in trans on one another. The most common example of this strategy is the dimerization of cell surface receptors, such as the TGF-β receptor or the EGF receptor, which activate intracellular signaling pathways. These receptors often posses intracellular kinase domains that phosphorylate the dimer partner when brought into proximity by binding ligand via their extracellular domains (2). Moreover, ligand-induced dimerization of cell-surface receptors can bring into proximity proteins associated with these receptors. For example, the cytokine receptors have kinases noncovalently bound to their cytoplasmic domains, and these transphosphorylate upon receptor dimerization. The role of proximity in a cell is probably more important than generally appreciated. In solution, the probability of an interaction between any two molecules, such as an enzyme and its substrate, is a third order function of the distance between them. This factor makes the enhancement by proximity a powerful regulatory influence. The proximity effect is also enhanced by the viscosity of the cell interior, which limits rates of diffusion over even short distances. These two physical characteristics mean that reactions within a cell can be very slow if the interactions between two proteins depend on simple diffusion. Therefore, a mechanism that brings two partners together can effectively activate them. It should be noted that in addition to bringing molecules closer together, dimerization may further enhance reaction rates by placing substrates and active sites in favorable orientations. Examples of this aspect of reaction kinetics are common in chemistry, where the concept of effective molarity originated to describe this phenomenon. A biological example of the importance of orientation is activation of signaling by the insulin receptor, which is a disulfide-bonded dimer on the cell membrane and may require reorientation by ligand binding to initiate signaling. Prior to ligand binding, the two chains of the insulin receptor have a high local concentration relative to one another; however, they likely have a low effective molarity and hence do not signal until ligand is bound. Thus, the increase in catalysis rates associated with many dimerization events may reflect changes in both local concentration and orientation.

Differential Regulation by Heterodimerization Dimeric proteins often belong to extended families whose members are capable of cross-dimerization. When a protein subunit has multiple dimeric partners, the different dimeric species may have distinct functions. In this case, the relative concentration of these proteins in the cell and the relative strengths of their interactions determine the major dimeric species and thus the biological

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outcome (3). This response to protein levels can also generate a timing mechanism, as dimerization can create a sharp temporal response to changes in protein concentration. As the total protein accumulates as a linear function, the oligomer concentration increases as a geometric function, which depends on the order of the oligomerization. As a result of this threshold effect, the activity of a protein can rapidly respond to subtle changes in protein concentration. One specific category of differential regulation by dimerization involves “poison subunit” or “dominant negative” partners. These terms refer to dimerization partners that retain the dimerization domain but are missing a key functional domain. Hence, while these proteins are functionally neutral as monomers, they can form nonproductive complexes with partners containing the functional domains, thereby acting as negative regulators. The result of introducing a functionally inactive but dimer-competent protein partner within a cell will depend on the ratio of the dimerization affinities to the concentration of the inactive partner. A well-characterized poison subunit is the protein Id, a negative regulator of the transcription factor MyoD. Id contains the necessary dimerization domains to interact with MyoD; however, it lacks a functional DNA-binding domain (4). Therefore, Id:MyoD oligomers cannot bind DNA. Similarly, the Drosophila protein Extramacrochaetae (Emc) antagonizes the activities of the Achaete and Scute transcription factors in a dose-dependent manner by the formation of inactive heterodimers. The mutant phenotype and expression pattern of the emc gene strongly suggest that it plays an essential early role in defining territories of bristle-forming potential by controlling the function of the Achaete Scute complex (5, 6). Thus, the regulated expression of inactive dimerization partners can be employed to create sharp temporal and spatial boundaries, similar to those described above.

Enhanced Specificity Dimerization of a protein generally results in the formation of an enlarged interaction surface, relative to the monomer. The enlarged surface area of the dimer provides increased potential for protein-protein or protein-DNA interactions. Additionally, different heteromeric species may have distinct binding specificities. For example, transcription factors that dimerize achieve a higher DNA binding affinity and specificity as twice as many base pairs can be recognized relative to binding of a single subunit. Furthermore, different heterodimers may have distinct DNA-binding specificities. Thus, a Fos-Jun heterodimer has distinct binding site preferences compared to an ATF-Jun heterodimer (7). Dimerization is a more efficient means of increasing specificity than increasing the size of the protein monomer; this conclusion is best illustrated by protein-DNA interactions. Simply doubling the size of a transcription factor

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to increase the number of contacts made with the DNA not only would lead to increased affinity for the specific binding site, but also would lead to increased affinity for nonspecific sites. This would result in a kinetic barrier to specific binding (8). However, cooperative DNA binding by protein dimers allows the size of the DNA recognition element to be doubled without paying a kinetic price. Dimerization between DNA binding proteins results in cooperative DNA binding, provided that the dimerization constant exceeds the DNA-binding equilibrium constant. Cooperative binding is manifested as a sigmoidal binding curve since the free oligomer remains largely dissociated at protein concentrations at which DNA binding occurs.

Regulated Monomer-to-Dimer Transitions The monomer-to-dimer transition itself can be a regulated process that is the rate-limiting step for activation. For instance, there are proteins that, in response to a change in calcium levels, undergo significant conformational changes and dimerize to form an active complex. These include E-cadherin, a cell matrix protein, and synaptotagmin, a vesicular protein. For the STAT proteins and the SMAD proteins, it appears that phosphorylation regulates their oligomeric state. In all of these examples, the monomeric form of the protein is inactive but becomes active immediately upon dimerization (these are discussed in further detail below).

EXAMPLES OF DIMERIZATION IN SIGNAL TRANSDUCTION To illustrate the strategies in protein dimerization that have been outlined, specific examples of dimerization in signal transduction are presented below. As a comprehensive discussion of all known regulatory dimerization events is beyond the scope of this review, this discussion is limited to some of the more prominent or instructive examples in higher eukaryotes, specifically focusing on how dimerization plays an important role in their regulation.

Cell Surface Receptors Cell surface receptors anchored in the membrane with a single transmembrane domain appear to be primarily activated by ligand-induced dimerization or oligomerization. These molecules do not readily dimerize on their own but are brought into close proximity through mutual interactions with an extracellular ligand. This class of receptors for extracellular signaling molecules typically consists of a ligand-binding extracellular domain, a single transmembrane domain, and

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a cytoplasmic domain that either possesses kinase activity itself or is associated with a protein kinase. Three general lines of evidence suggest that these receptors are activated by a monomer-to-dimer transition. Perhaps the best evidence for a dimerization mechanism of activation is that ligand binding leads to receptor dimerization. A second compelling line of evidence is that dimerization artificially induced (by antibodies or other means) or resulting from naturally occurring mutations, recapitulates signaling in the absence of the physiological ligand (9, 10). Finally, oligomerizing the intracellular regions of receptors with cell-permeable synthetic ligands can lead to signaling (11). The outcome of dimer formation is protein phosphorylation—very often cross-phosphorylation of the linked receptors—which leads to downstream signaling events. Ligands can induce receptor dimerization by a variety of mechanisms. Several of the extracellular ligands are themselves dimers and thus contain two surfaces for receptor binding. For example, PDGF is a disulfide-bonded dimer with three different isoforms: A chain homodimers, B chain homodimers, and AB chain heterodimers. The A chain binds α receptors with high affinity, while the B chain can bind both α and β receptors with equal affinity. Thus, AA produces α-α receptor homodimers, AB produces α-α homodimers and α-β heterodimers, and BB produces all possible combinations (12). In contrast, monomeric hGH uses two different sites on its surface to contact two receptor molecules, thus forming a 1:2 ligand:receptor complex (13). Another interesting case is that of acidic fibroblast growth factor (aFGF). aFGF is itself a monomer and incapable of inducing dimerization of its receptor, but forms a multivalent complex with heparin sulfate proteoglycans that can in turn bind two or more receptors (14). TNF-β is a trimeric ligand, and the crystal structure contains three TNF receptor molecules bound symmetrically to one TNFβ trimer (15). In some cases, dimerization is further stabilized by ligand-independent receptor-receptor interactions. For example, biophysical studies of stem cell factor1 (SCF-1) did not detect an intermediate complex with a single Kit receptor bound, arguing that receptor-receptor interactions may participate in Kit dimerization to some extent (16). Likewise, the crystal structure of the human growth hormone receptor:hGH complex also revealed extensive receptor-receptor interactions in addition to ligand-mediated interactions (17). Alternatively, the crystal structure of the IFNγ -receptor complex shows that the dimer is solely stabilized through ligand-mediated interactions—the two receptor molecules do not interact with one another and are separated by 27 a˚ at their closest point (18). Below we discuss categories of receptors that require dimerization or oligomerization for activation. These include protein tyrosine kinase receptors, cytokine receptors, TNF family receptors, TGF-β family receptors, and antigen receptors. Specific examples from each of these families are described below to illustrate the varied use of dimerization in receptor activation.

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The tyrosine kinase receptors are comprised of an extracellular ligand-binding domain, a single transmembrane domain, and an intracellular, cytosolic kinase domain. Subfamilies within this group include the PDGF receptor family, the EGF receptor family, and the FGF receptor family. Dimerization induced by binding an extracellular ligand brings two kinase domains in close proximity, allowing one receptor in the dimer to phosphorylate the other. Of the two types of phosphorylation sites characterized, one type, phosphorylation, occurs on a tyrosine inside the catalytic domain. This leads to an increase in the kinase activity and preceeds phosphorylation of other sites in the receptor or subsites. For the other type, phosphorylation occurs on sites localized outside the kinase domains and serves as docking sites for downstream signal transduction molecules containing SH2 domains (2). Although the first studies of ligand-mediated receptor dimerization involved homodimerization of protein tyrosine kinase receptors, subsequent studies have indicated that heterodimerization is also very common. Often when receptors heterodimerize, one partner has low kinase activity and serves as an important substrate for the more active member of the dimer (19). For example, the receptor ErbB3 has low kinase activity and cannot transduce signals as a homodimer; however, it can form heterodimers with other receptors in the EGF family to generate a strong ligand-induced response (20).

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TYR KINASE RECEPTORS

CYTOKINE RECEPTORS The cytokine receptors are distinguished from the protein tyrosine kinase receptors by the fact that they do not themselves contain kinase domains and share only limited stretches of sequence homology in their cytoplasmic domains. Rather, they have a kinase associated with the intracellular, cytoplasmic domain. These are referred to as the Janus kinases (JAKs). To date, the JAK family consists of four members, JAKs 1-3, and TYK2. For this class of receptors, ligand binding and subsequent dimerization bring these associated kinases into proximity, resulting in cross-phosphorylation of the kinases (as well as the receptor components) (21). This phosphorylation increases the activity of the JAKs which subsequently phosphorylate members of a family of transcription factors known as the STATs (signal transducers and activators of transcription). The ligand induced dimerization appears to have two purposes: to bring the JAKs into proximity and allow transphosphorylation, and to form a scaffold for the binding of STAT proteins. Cytokine receptors commonly have a ligand-binding subunit that forms a heterodimer with a nonbinding subunit that has signaling capabilities. For example, IL-6, IL-11, leukemia inhibitory factor, oncstatin M, and ciliary neurotrophic factor all share gp130 as a signal-transducing receptor component (22). Likewise, the GM-CSF, IL-3, and IL-5 share a common βc subunit, while IL-2, IL-4, IL-7, IL-9, and IL-15 share a common γ c subunit (22). The

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presence of shared subunits suggests that signal transduction through these receptors will proceed, at least in part, through the activation of common JAK family members (23). There are also examples of cytokine receptors in which each subunit binds ligand and that are activated by homodimerization. These include the receptors for human growth hormone, erythropoietin, prolactin, and granulocyte colonystimulating factor. TGF-β FAMILY The TGF-β family of cytokines and the related activins and bone morphogenic proteins are disulfide-linked dimers that signal by simultaneously contacting two transmembrane serine/threonine kinases known as the type I and type II receptors (24). The type II receptor contains a constitutively active kinase. This receptor first binds TGFb, and this receptor-ligand complex subsequently recruits the type I receptor, forming an oligomeric complex that is likely a heterotetramer. The type I receptor is then serine and threonine phosphorylated, thus activating its kinase activity and leading to the initiation of cytoplasmic signaling events (25). Since the type II receptors are required before the type I receptors, one may think of these components as primary receptors and transducers, respectively. This sequential activation mechanism allows for the generation of combinatorial diversity: Different type II receptors can pair with different type I receptors, so that a given ligand is capable of generating varied responses (24). The downstream targets of the TGF-β-family receptors are the recently identified Smad proteins, which themselves undergo dimerization upon phosphorylation by the receptor (discussed below). TNF RECEPTOR FAMILY The TNF receptor subfamily of cytokine receptors includes among its members TNFR-1, TNFR-2, Fas, CD40, and the NGF receptor. Like the cytokine receptors described above, these receptors do not possess intrinsic kinase activity, but they have signal-transducing proteins associated with their cytoplasmic domains (26). The ligands for these receptors are noncovalent trimers, and the x-ray structure of the TNF-β trimer complexed with TNFR-1 confirmed that this cytokine binds a trimeric receptor (15). It has not been determined whether receptor dimerization would be sufficient for activation or whether trimerization is required. Support for a requirement for trimerization comes from the observation that monoclonal antibodies against the receptor do not lead to receptor activation, while activation does occur after stimulation by two monoclonal antibodies directed against different epitopes (27). On the other hand, another member of this family, Fas, was discovered by a systematic search for monoclonal antibodies that would rapidly kill cells (28). There is some evidence that these receptors are dimeric when uncomplexed, in a conformation that would inhibit signaling in the absence of ligand (29).

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The mechanism by which receptor aggregation leads to transduction of downstream signals remains unclear. Several proteins associated with the cytoplasmic domains of these receptors have recently been identified; however, their functions are still under investigation. TRAF-1, -2, and -3 are associated with TNFR-2 and form homo- and heterodimers (30, 31). Both a heteromeric complex composed of TRAF-1 and TRAF-2 as well as TRAF-2 homodimers can associate with the C-terminal signal transducing component of TNFR-2; although TRAF-1 is also capable of forming homodimers, association with TNFR-2 appears to be mediated by TRAF-2 (30). Since these proteins have distinct expression patterns, it is possible that tissue-specific combinations of TRAF proteins exist and have specific functions (26). ANTIGEN RECEPTOR SIGNALING The B cell and T cell antigen receptors are multisubunit complexes containing distinct antigen binding and signal transduction subunits and appear to signal by similar mechanisms; for the purpose of this review, we discuss signaling by the T cell receptor (TCR). The TCR contains variable, disulfide-linked α and β chains that have large extracellular domains responsible for antigen recognition but have minimal intracellular domains. These are noncovalently associated with invariant CD3γ , CD3δ, and ζ -chain dimers, which have larger cytoplasmic domains (than the antigen recognition subunit) that couple the receptor to the intracellular signaling machinery (32). The TCR recognizes foreign antigens in the form of peptides bound to MHC molecules on the surface of antigen presenting cells. The signal transducing function of the invariant chains of the TCR complex was initially revealed by studies with chimeric receptors in which their cytoplasmic domains were linked to the extracellular and transmembrane domains of other proteins. Cross-linking of such chimeric proteins induced early and late signal transduction events, independent of the antigen recognition chains (33, 34), indicating that the TCR is activated by oligomerization. Later studies provided further evidence that oligomerization but not dimerization of the intracellular regions of the TCRz chain was required for signaling, suggesting that the fundamental activating event provided by antigen interactions was receptor oligomerization (11, 35). Recent biophysical studies of TCR/MHCpeptide complexes reveal that these complexes oligomerize in solution to form supramolecular structures at concentrations near the dissociation constant of the binding reaction (36). This effect is specific, as neither molecule forms oligomers by itself, nor are oligomers observed unless the correct peptide is bound to the MHC. The peptide-specific oligomerization observed in these studies suggest that slightly different antigens could produce large differences in the extent and character of a T cell response, if the formation of larger receptor aggregates generates stronger downstream signals.

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Aggregation of the TCR complexes may also be enhanced by the CD4 and CD8 co-receptors, which interact with nonpolymorphic regions of MHC class II or MHC class I (respectively) and the TCR, and increase the avidity of association of the TCR/MHC complex (32). Recent structural studies reveal that the CD4 extracellular domain forms a dimer at high concentrations, suggesting that this molecule may enhance the formation of a network of TCR/MHC complexes (37). Indeed, when the many point mutations in CD4 that affect interaction with MHC are mapped onto its three-dimensional surface, it appears that each CD4 molecule must interact with two different MHC molecules (37). Another role fulfilled by CD4 is to recruit the Lck tyrosine kinase to the MHC/TCR complex, by virtue of Lck’s association with the CD4 cytoplasmic tail. Lck phosphorylates tyrosines in the cytoplasmic domain of the CD3 chains, and these phosphorylated tyrosines become substrates for binding of the two SH2 domains of the ZAP70 tyrosine kinase, which propagates the signal from the TCR. This level of activation is reminiscent of cytokine receptor activation, in which a receptor-associated kinase is recruited to phosphorylate another receptor in the complex that in turn recruits a downstream signaling molecule.

Bcl-2 Family Dimerization The physiological cell death pathway is regulated by a delicate balance of proteins that either induce or inhibit cell death (38). The Bcl-2 family of proteins plays a central role in the regulation of apoptotic cell death induced by a wide variety of stimuli. Heterodimerization between members of the Bcl-2 family of proteins is a key event in the regulation of programmed cell death. Bcl-2 was first identified via chromosomal translocations found in lymphomas characterized by abnormal cell survival rather than proliferation. These translocations result in deregulation of Bcl-2 gene expression and cause inappropriately high levels of Bcl-2 protein production, suggesting a role for Bcl-2 in preventing apoptosis. Following the initial characterization of Bcl-2, a related protein, termed Bax, was identified and shown to heterodimerize with Bcl-2, while homodimerizing in the absence of Bcl-2 (39). Overexpression of Bax was shown to accelerate apoptotic cell death induced by cytokine depravation and to counter the activity of Bcl-2 (39). This data suggested a model in which the ratio of Bcl-2 to Bax determines survival or death following apoptotic stimuli (39). In this model, Bax-Bax homodimers promote apoptotic cell death, and the disruption of these homodimers by Bcl-2 prevents apoptosis. Experiments in yeast support this hypothesis: Overexpression of Bax in yeast confers a lethal phenotype, which can be neutralized by Bcl-2 (40). Furthermore, mutations in Bcl-2 that disrupt Bcl-2-Bax heterodimerization but not Bcl-2 homodimerization are not permissive for Bax neutralization by Bcl-2, further suggesting that Bcl-2 operates like a dominant negative by inhibiting a pro-death function of Bax.

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Subsequently, a number of other mammalian Bcl-2 family members were identified, including Bcl-X (whose gene generates two alternatively spliced forms, Bcl-XL and Bcl-XS), Mcl-1, A1, Bad, Bak, and Bik. These related proteins share conserved BH1 and BH2 domains, and sometimes a BH3 domain, that are required for dimerization. Some of these proteins function as promoters of cell death, while others function as suppressers of cell death. Sedlak et al (41) used a yeast two-hybrid analysis to rank the order of dimerization among Bcl-2 family members. Their study demonstrated that the Bax-Bax homodimer is more stable than the Bcl-2-Bax heterodimer. Bax can dimerize with multiple partners, including Bcl-XL, Mcl-1, and A1, consistent with the observation that these are all proteins that are, like Bcl-2, suppressors of cell death. Bcl-XS, an alternatively spliced form of Bcl-XL that counters the protection from cell death by Bcl-2, lacks the BH1 and BH2 domains and selectively interacts with Bcl-2 and Bcl-XL. Although there are tissue-specific patterns of expression for some Bcl-2 family members, certain cells express multiple family members. In this case, the susceptibility to death would reflect a complex setpoint determined by competing protein-protein interactions of varying affinity. The solution structure of Bcl-XL complexed with a peptide from Bak, a Bcl-2 family member that promotes apoptosis, reveals the molecular basis for heterodimer formation (42). This Bak peptide corresponds to a portion of the BH3 region that is necessary and sufficient for promoting cell death and binding to Bcl-XL. This same region from Bax and Bik also promotes apoptosis and interacts with Bcl-XL. The structure shows that this peptide adopts an α-helical conformation and binds in a hydrophobic cleft formed by the BH1, BH2, and BH3 regions of Bcl-XL. Structural studies also revealed that the Bcl-2 family proteins bear a striking similarity to the pore-forming domains of certain bacterial toxins that act as channels for either ions or proteins (43). Indeed, there is direct evidence that Bcl-2, Bcl-XL, and Bax have ion-channel activity when incorporated into synthetic lipid membranes (44–46) and that Bcl-2 can interfere with the ability of Bax to form channels (46). However, the biochemical basis for the pro-apoptotic and apoptotic actions of these proteins remains uncertain.

Smad-Family Dimerization The recently identified Smad-related family proteins have provided a greater understanding of signal transduction by the TGF-β family molecules, and their function appears to be regulated by dimerization. Available data suggest that the functional dimer complex is comprised of a “pathway-restricted” subunit (Smads 1, 2, 5, and 5) and a “common” subunit (Smad4). These associations occur upon receptor-mediated phosphorylation of the pathway-restricted SMADs. In the case of TGF-β, the activated receptor phosphorylates Smad2 and perhaps

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Smad3 on C-terminal serine residues, allowing these proteins to associate with Smad4 and translocate to the nucleus where they bind DNA and activate transcription of target genes in association with other proteins (47, 48). Similarly, for bone morphogenic proteins, the activated receptor phosphorylates Smad1 and perhaps Smad5, which associate with Smad4. The recent crystal structure of the C-terminus of Smad4 reveals that the individual family members are actually trimeric and that an exposed surface loop likely mediates formation of a dimer of trimers between family members (49). Biochemical evidence suggests that the association event is probably regulated by an intramolecular interaction between the N- and C-termini that is interrupted by phosphorylation by the receptor, thus allowing hetero-oligomerization between the Smads (50). Thus, it appears that a regulated monomer-to-dimer transition may control the activity of Smad family proteins.

Transcription Factor Dimerization Most extracellular signals are eventually transduced to the nucleus to elicit changes in gene expression. One of the most common dimerization events in signal transduction is the dimerization of transcription factors. As discussed above, dimerization of DNA-binding proteins increases sequence specificity since twice as many DNA contacts can be made by a dimer as by a monomer of the same protein. Some of the largest families of transcription factors that bind DNA as dimers include the nuclear hormone receptors, the STATs, the bZIP proteins, and the bHLH proteins. NUCLEAR HORMONE RECEPTORS Lipophilic hormones such as steroids, retinoic acid, thyroid hormone, and vitamin D3 function by interacting with ligandactivated transcription factors that comprise the steroid/nuclear receptor superfamily. These include the receptors for the steroids estrogen (ER), progesterone (PR), mineralocorticoid (MR), and androgen (AR). Also included are receptors for thyroid hormone (TR), vitamin D (VDR), retinoid acid (RAR), and 9-cis retinoic acid (RXR). Additionally, a number of “orphan” receptors have been isolated for which ligands have not been defined. This family of transcription factors provides perhaps the most intricate examples of how cross-family dimerization can lead to desired changes in gene expression. The nuclear hormone receptors bind to bipartite response elements as homodimers or heterodimers through a small, highly conserved DNA-binding domain containing two zinc-binding subdomains (51). The DNA sequences responsive to steroid hormones have been termed hormone response elements (HREs), and they generally contain two hexameric half-sites. Three features characterize these response elements: the nucleotide sequence of the half-site, the relative orientations of the half-sites, and the number of base pairs separating

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the two half-sites (52, 53). While GR, PR, ER, AR, and MR bind to DNA as homodimers and recognize a palindromic response element, other receptors including TR, RAR, VDR, and RXR can recognize direct repeat response elements (52, 53). This latter group of receptors can form heterodimers with each other. TR, RAR, and VDR bind to their cognate DNA responsive elements with higher affinity as heterodimers with RXR than as homodimers, and it has been predicted that the heterodimer is the major functional complex for these receptors (51). The observation that TR, RAR, VDR, COUP-TF, PPAR, and RXR all bind to direct repeats of AGGTCA raised the question of how they discriminate their binding sites. Biochemical studies revealed that RARs activate transcription preferentially through direct repeats spaced by two or five nucleotides, whereas VDR and TR activate through direct repeats spaced by three and four nucleotides, respectively (52, 53). RXR-PPAR heterodimers as well as RXR homodimers activate through direct repeats spaced by one nucleotide; thus, all spacing options from one to five nucleotides are used by distinct dimeric complexes (54). The nuclear hormone receptors contain at least two dimerization interfaces: one in the DNA-binding domain and one in the ligand-binding domain. The three-dimensional structures of three receptor-DNA complexes have been solved, revealing the molecular nature of the DNA-binding domain dimerization interface. Crystal structures of receptors bound to both dyad-symmetric [ER (55) and GR (56) homodimers] as well as asymmetric direct repeats [TR + RXR heterodimer (57)] have been solved, showing the distinct strategies for bringing different regions of the proteins to the dimerization interface. These domains are monomeric in the absence of DNA, and the structures show how a dimerization interface forms to fit precisely to a half-site orientation and spacing. The dimerization properties of the ligand-binding domain appear to function in stabilizing the receptor-DNA complexes but have no selective power for response element recognition (58). An orphan nuclear hormone receptor termed SHP lacks the DNA binding domain but can still dimerize with other receptors via its ligand-binding domain and in this way appears to function as a negative regulator of receptor-dependent signaling pathways (59). STAT DIMERIZATION A few years ago the STAT family of transcription factors was described; these proteins form dimers and mediate the action of many cytokines. As discussed above, cytokine-induced dimerization of their receptor components leads to the activation of JAKs, which are constitutively associated with the cytoplasmic domains of the respective receptors. One substrate of the activated JAKs is the receptor itself. Upon phosphorylating specific tyrosine residues of the cytoplasmic tail of the receptor, STAT factors are recruited to the receptor via their SH2 domain, where they are tyrosine phosphorylated by

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the JAKs. Upon phosphorylation, the STATs dissociate from the receptor, form homo- or heterodimers, and translocate to the nucleus to bind enhancer elements of target genes. Considerable evidence indicates that tyrosine phosphorylation of STATs leads to dimerization through the intermolecular interaction of the SH2 domains and the sites of tyrosine phosphorylation (60). This dimerization is essential for DNA binding and may also control nuclear localization. Interestingly, there exists a naturally occurring splice variant of STAT1, termed STAT1b, that lacks the 38 carboxyl amino acids required for transcriptional activation. When recruited to the receptor complex, STAT1b becomes phosphorylated and binds DNA, but fails to activate gene transcription (2). This protein thus acts as a dominant negative. In response to cytokines, specific subsets of STAT proteins are activated. This specificity is apparently not controlled by the JAKs, but by the ability of individual receptors to recruit specific STATs. Formation of a paired set of STAT binding sites in a receptor complex, however, is not required for STAT factor dimerization. Instead, available data suggest that a phosphorylated STAT monomer already bound to the tyrosine phosphorylated receptor binds a second STAT factor, which then becomes phosphorylated, and a stable dimer is formed (61). The highly conserved DNA-binding domains of the seven known STATs bear no similarity to other known DNA-binding domains. STATs generally bind to very similar, symmetric sequences, raising the question of how STATs activate specific target genes when they have similar DNA binding preferences. A study by Xu et al (62) provided one clue toward resolving this dilemma. This group demonstrated that a conserved amino terminal domain in the STAT proteins mediates cooperative DNA binding interactions between STAT dimers on naturally occurring multimerized binding sites, and that these cooperative interactions enable the STAT proteins to recognize variations of the consensus site. Thus, the STATs form dimers in solution and then form higher order oligomeric complexes on DNA. BASIC HELIX-LOOP-HELIX PROTEINS The basic region/helix-loop-helix (bHLH) family of transcription factors play important roles in the generation of celltype specific gene expression. This motif was originally identified by sequence comparisons of the eukaryotic transcription factors E12 and E47 (which bind to immunoglobulin enhancers) and the eukaryotic transcription factors MayoD, Myc, Daughterless, and Achaete-scute (63). These proteins contain a highly conserved basic region required for DNA binding, adjacent to the HLH motif, which mediates dimerization. These proteins are characterized by their ability to bind to the E-box enhancer sequence, CANNTG. Crystal structures of four bHLH-DNA complexes have been determined, revealing the overall conformation of the bHLH motif and how it interacts with the E-box (64–67). These

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structures show that the two helices of each monomer cross each other at the loop region and interact with the other monomer to form a left-handed parallel fourhelix bundle (68). The basic region forms a helix that is continuous with helix 1 of the HLH and lies in the major groove of the DNA. Two subclasses of the bHLH family contain additional regions that contribute to the dimerization interface. One class, which includes Max and upstream stimulatory factor (USF), have a leucine zipper immediately C-terminal to the second helix of the HLH. Another more recently identified class, which includes the dioxin receptor and its partner Arnt, contains a PAS domain juxtaposed to their bHLH domains (69). Extensive genetic and biochemical studies of bHLH transcription factors have revealed a hierarchy of regulatory heterodimerization events among the subfamilies of these proteins. One of the first identified and best characterized bHLH proteins is MyoD. The myoD gene is expressed exclusively in skeletal muscle, and expression of a myoD cDNA will induce a variety of differentiated cell lines to exhibit many of the characteristics of muscle cells (70). The 68 amino acid bHLH of MyoD is necessary and sufficient for this activity (71). Although MyoD is capable of binding to DNA as a homodimer, the E47MyoD heterodimer has a tenfold greater affinity for the target sequence. A negative regulator of MyoD named Id was subsequently identified that contains the HLH dimerization domain but lacks a basic region. This protein can form oligomers with MyoD, E12, and E47, but these complexes fail to bind DNA (4). Interestingly, in proliferating myoblasts, Id levels are high, suggesting that Id prevents MyoD and/or E47 from activating muscle-specific genes in myoblasts. Another well-studied bHLH regulatory system involves the Myc, Max, and Mad bHLH-LZ proteins. The c-Myc oncoprotein does not homodimerize or bind DNA on its own but can heterodimerize with Max to mediate its functions as a transcriptional activator and a transforming protein (72). Although Max preferentially dimerizes with Myc, it can also form homodimers that bind DNA and thereby repress transcription and inhibit transformation by Myc. Max can also heterodimerize with two other bHLH-LZ proteins, Mad (73) and Mxi1 (74). Like Myc, these proteins do not homodimerize or bind DNA on their own, but preferentially heterodimerize with Max to recognize the same CACGTG E-box as Myc-Max homodimers. These proteins appear to modulate transcriptional activation by Max. In a transient transfection reporter assay, Myc-Max heterodimers activate transcription, and this activation is suppressed by addition of increasing amounts of Mad (73). A functional correlate of these observations has been demonstrated by Ayer & Eisenman (75), who have shown that, in the undifferentiated U937 monocyte cell line, Max was complexed with Myc but not Mad. Mad-Max complexes began to accumulate as early as 2 h after induction of macrophage differentiation with TPA and, by 48 h following treatment, only Mad-Max complexes were detectable. These

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data show that differentiation is accompanied by a change in the composition of Max heterodimers and, therefore, a change in gene expression. The leucine zipper is one of the simplest of dimerization interfaces, yet it can mediate highly selective and avid protein associations. It was first identified as a sequence motif in C/EBP and GCN4 (76, 77) and has been recognized as an interaction surface in many transcription factors (78). It derives its name from the ≈35 amino acid region containing a leucine every seven residues and an alternate hydrophobic residue at the fourth position after each leucine. The crystal structures of two bZIP-DNA complexes have been solved: a homodimeric complex of the yeast GCN4 bZIP domain (79) and a heterodimeric complex of c-Fos and c-Jun (80). These structures, as well as the earlier structure of the isolated GCN4 leucine zipper (81), revealed that leucine zipper dimers form a parallel, coiled-coil in which the 4,3 hydrophobic repeat is buried in the dimerization interface between the helices. Charged and polar side chains on the outside of the coiled-coil form inter- and intrahelical interactions that mediate the specificity of complex formation (82). The N-terminal basic regions, which make all of the DNA contacts, form helices that are continuous with the leucine zipper helices. Two general types of DNA elements are recognized by these proteins: the AP-1/TRE and the ATF/CRE sequence motifs. The AP-1/TRE element contains the consensus sequence TGACTCA, which has pseudo-dyad symmetry. The binding proteins for this site include the Fos and Jun families, which are induced by mitogenic, differentiation-inducing, and neuronal-specific stimuli. The ATF/CRE element contains the consensus sequence TGACGTCA, which has perfect dyad symmetry. The binding proteins for this site have been implicated in cAMP-, calcium-, and virus-induced alterations in transcription (7). Biochemical studies have shown that members of the Fos/Jun family can sometimes cross-dimerize with members of the ATF/CREB family to form heterodimers that have different DNA binding activities than their parental homodimers (7). AP-1 is perhaps the best-characterized bZIP transcription factor and is a heterodimer of members of the jun and fos families. Based on its kinetics of transcriptional activation by growth factors and its location in the nucleus, the c-Fos protein was expected to be directly involved in the regulation of growth factor inducible genes. However, no DNA binding by c-Fos could be demonstrated prior to the identification of c-Jun (83). Cotransfection of c-Fos with c-Jun gave higher expression of an AP-1-driven indicator gene than c-Jun alone, while c-fos alone gives no activation. This synergism appears to be related to the fact that c-Fos and c-Jun form more stable dimers that c-Jun alone, and that c-Fos does not dimerize with itself at all (84–86). These associations extend to other members of these families, including JunB, JunD,

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THE BZIP FAMILY

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FosB, Fra1, and Fra2 (83). Transcription of both c-Jun and c-Fos is induced by TPA and other activators of PKC. The Fos protein and mRNA have shorter half-lives than the Jun protein and mRNA (87–89); therefore, the composition of the complex changes from predominantly Jun homodimers before induction, to mostly Jun-Fos heterodimers immediately after induction. The formation of this heterodimeric complex appears to be a critical regulatory step during cell signaling and cellular transformation.

Calcium-Mediated Dimerization Intracellular calcium levels undergo dramatic changes in response to environmental changes. In turn, these changes in calcium concentration play an essential role in a wide variety of events, including fertilization, synaptic vesicle fusion, and lymphocyte activation. Calcium mediates conformational changes in a number of proteins, and in some cases, these conformational changes lead to dimerization. Thus, certain calcium-regulated biological responses are transmitted via protein dimerization. The synaptic vesicle protein synaptotagmin serves as the major calcium sensor for regulated exocytosis from neurons. Synaptotagmin is an integral membrane protein, containing a short amino-terminal intravesicular domain and a large cytoplasmic domain. Disruption of this gene abolishes the fast component of calcium-dependent exocytosis. In vitro studies of this protein revealed that the cytoplasmic domain undergoes a dramatic calcium-dependent conformational change which leads to dimer formation (90). Thus, it appears that the calcium-induced homodimerization of synaptotagmin is important for the efficient regulation of exocytosis by calcium. Another important calcium-regulated dimerization event is that of E-cadherin. The cadherins mediate cell adhesion and play a fundamental role in normal development (91). Cadherins depend on calcium for their function and, in the case of E-cadherin, calcium induces a dramatic reversible conformational change in the entire extracellular region to its functional form. The crystal structure of E-cadherin in the presence of calcium has revealed that the calcium ions act not only to linearize and rigidify the molecule, but also to promote dimerization between two monomers (92). The dimerization of E-cadherin in the presence of calcium may at least in part explain the requirement for calcium for the maintenance of cell junctions (92).

MIMICKING DIMERIZATION: LESSONS LEARNED FROM BIOLOGY Elucidation of biological regulatory mechanisms can lead to the design of new approaches for manipulating systems in order to better understand their function and to achieve new outcomes. Some of the dimerization paradigms outlined at

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the beginning of this review have been employed by researchers in efforts to further dissect some pathways as well as to activate or inhibit other pathways.

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Design of Dominant Negative Dimerization Partners Landano & Doolittle (93) first demonstrated that multimeric proteins can be negatively regulated through interaction with variants or fragments lacking key functional domains. As described above, there are many naturally occurring examples of such “dominant negatives.” Researchers have used this approach to design dominant negative dimerization partners. For example, variant cell surface receptors have been produced that retain the ligand-binding and transmembrane domains but lack or have mutations in the cytoplasmic domain. When such a variant of the FGF receptor was expressed in Xenopus embryos, it disrupted mesoderm formation (94), revealing the important role the FGF signaling pathway plays in early embryogenesis. Likewise, polypeptides complementary to the leucine zipper of CREB have been coexpressed in cells and can be used to interfere with expression of a reporter gene driven by a CREcontaining promoter (95). A wide variety of such “poison subunit” experiments are possible and a great deal of information has been accumulated through use of this strategy. As with natural inhibitors, the effect of expressing these subunits is dictated by the concentration of the dimeric subunits and the level of the native complex required for a biologic action.

Regulating Biological Responses Using Small Synthetic Ligands that Promote Protein Association The concept of promoting protein association as a means of regulation has inspired the design of a system to inducibly associate proteins. These methods take advantage of the observation that many proteins can be activated by bringing them in proximity with one another or by recruiting them to the plasma membrane where they may interact with similarly localized proteins. In this technique, low-molecular-weight organic molecules that permeate cells are used to induce the “dimerization” of two protein targets, thus earning them the name “chemical inducer of dimerization” or CIDs (11, 96). By analogy to extracellular growth factors or cytokines, these CIDs are equipped with two binding surfaces that recognize specific protein modules that have been fused to target proteins. Addition of the CID to cells containing these chimeric proteins induces their association (96). Furthermore, dimerization can be rapidly reversed with a CID having only one of the two binding surfaces. Many of the forms of dimerization-dependent regulatory events described in this review can be mimicked with this simple strategy. The first use of CIDs in the regulation of signal transduction was oligomerization of cell surface receptors that lacked their transmembrane and extracellular

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DIMERIZATION IN SIGNAL TRANSDUCTION Table 2 CID-induced protein association

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Biological target

Regulatory strategy

T cell receptor B cell receptor Fas receptor Exchange factor (SOS)

Oligomerization Oligomerization Dimerization Membrane recruitment

Src-like kinases Non-receptor tyrosine kinases, ZAP70 c-raf Transcription factors

Outcome

Reference (11, 35) (11) (97, 98) (99)

Membrane recruitment Membrane recruitment

Signal transduction Signal transduction Cell death Activation of the ras pathway Signal transduction Signal transduction

Dimerization Recruitment of activation domain to DNA

Signal transduction Transcriptional activation

(102, 103) (104–106)

(100) (101)

regions but contained intracellular signaling domains. A protein chimera containing a TCR ζ -chain cytoplasmic domain with a myristilation signal for membrane localization, and a CID-interaction module, was introduced into cells, and treatment of these cells with the appropriate CID resulted the activation of a TCR-responsive reporter gene (11). Subsequently, CIDs have been used to activate other pathways using related strategies (Table 2). Together, these examples demonstrate how the inducible control of protein proximity is a powerful tool to regulate a desired biological response in a reversible fashion.

CONCLUSIONS Regulated dimerization events play multiple roles in nearly all signal transduction pathways, beginning at the cell surface and continuing to the nucleus. We have tried to catalogue and to provide a rationale for some of the better-studied regulatory mechanisms controlled by protein dimerization. The purpose of this exposition was to provoke thought and provide examples that might be subject to experimental manipulation in informative ways. The recent development of ways of rapidly and reversibly altering dimerization and, more broadly, protein associations, will hopefully facilitate a synthesis of biochemical and genetic approaches to mammalian biology. ACKNOWLEDGMENTS We thank Stephen Biggar, Michael Brodsky, and Sang Ho Kim for their comments on the manuscript. Visit the Annual Reviews home page at http://www.AnnualReviews.org.

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Proximity and presentation underlie signaling by the non-receptor tyrosine kinase ZAP70. EMBO J. In press 102. Farrar MA, Alberola-Ila J, Perlmutter RM. 1996. Activation of the Raf-1 kinase cascade by coumermycin-induced dimerization. Nature 383:178–81 103. Luo Z, Tzivion G, Belshaw PJ, Vavvas D, Marshall M, Avruch J. 1996. Oligomerization activates c-Raf1 through a Ras-dependent mechanism. Nature 383:181–85 104. Ho SN, Biggar SR, Spencer DM, Schreiber SL, Crabtree GR. 1996. Dimeric ligands define a role for tran-

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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Annu. Rev. Immunol. 1998. 16:593–617 c 1998 by Annual Reviews. All rights reserved Copyright

THE IMMUNOGENETICS OF HUMAN INFECTIOUS DISEASES Adrian V. S. Hill Wellcome Trust Centre for Human Genetics, University of Oxford, Windmill Road, Oxford OX3 7BN, United Kingdom; e-mail: [email protected] KEY WORDS:

malaria, HIV, tuberculosis, hepatitis, genetic linkage

ABSTRACT Twin and adoptee studies have indicated that host genetic factors are major determinants of susceptibility to infectious diseases in humans. Twin studies have also found high heritabilities for many humoral and cellular immune responses to pathogen antigens, with most of the genetic component mapping outside of the major histocompatibility complex. Candidate gene studies have implicated several immunogenetic polymorphisms in human infectious diseases. HLA variation has been associated with susceptibility or resistance to malaria, tuberculosis, leprosy, AIDS, and hepatitis virus persistence. Variation in the tumor necrosis factor gene promoter has also been associated with several infectious diseases. Chemokine receptor polymorphism affects both susceptibility to HIV-1 infection and the rate of progression to AIDS. Inactivating mutations of the γ -interferon receptor lead to increased susceptibility to atypical mycobacteria and disseminated BCG infection in homozygous children. The active form of vitamin D has immunomodulatory effects, and allelic variants of the vitamin D receptor appear to be associated with differential susceptibility to several infectious diseases. NRAMP1, a macrophage gene identified by positional cloning of its murine homologue, has been implicated in susceptibility to tuberculosis in Africans. Whole genome linkage analysis of multi-case families is now being used to map and identify new loci affecting susceptibility to infectious diseases. It is likely that susceptibility to most microorganisms is determined by a large number of polymorphic genes, and identification of these should provide insights into protective and pathogenic mechanisms in infectious diseases.

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INTRODUCTION Over that last five years human infectious disease immunogenetics has developed from a subdivision of HLA disease-association studies to a diverse field exploiting new methodologies in taking a genome-wide approach to identifying a large number of diverse immune response genes. Although genetic technology and approaches have developed, the key questions remain the same. What immunogenetic polymorphisms affect differential susceptibility to infectious diseases in humans? Does variation in these or other genes account for the striking heterogeneity in immune responses observed following certain infections or immunizations? Can the identification of new genes modulating immune responses to infection identify molecules or pathways that are targets for immunomodulatory or pharmacological interventions? And, from an evolutionary perspective, to what extent has selection by particular infectious diseases given rise to observed polymorphism in genes determining immune responsiveness? The increasing popularity of infectious disease immunogenetic studies in humans reflects two developments: the availability of a large array of new polymorphic candidate genes and the capacity to take a genome-wide approach to mapping and subsequently identifying new resistance or susceptibility genes. New candidate genes have been suggested by a variety of approaches. The continuing identification of genes for new immune mediators such as cytokines, chemokines, and their receptors is one source. Analysis of susceptibility to certain infectious diseases in mice has led to the mapping and identification of some candidate genes for human studies. Also, the analysis of susceptibility phenotypes of “knockout” mice with targeted gene deletions has encouraged searches for functional variation in the human homologues. Although the major histocompatibility complex continues to be the focus of many infectious disease studies, interest is increasing in the mapping and identification of other susceptibility loci using whole genome linkage analyses. Although this area is still in its infancy, the potential of an approach is attracting considerable effort for particular diseases. As outlined below, an underlying complementarity exists between these association and linkage approaches to infectious disease genetics. I briefly review some of the evidence on the nature and extent of the host genetic contribution to infectious disease susceptibility before considering recent association studies of particular candidate genes and then family linkage studies. Finally, I summarize recent work on particular infectious diseases before concluding with some general remarks on strategy for future work.

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EXTENT OF THE GENETIC COMPONENT Various approaches may be taken to estimate the extent of the host genetic contribution to variation in susceptibility to infectious diseases. There is evidence of familial clustering for many infectious diseases. In the literature on polygenic diseases this is frequently expressed as a λs value. This describes the increase in risk of disease found in a sibling of a case compared to the general population risk. In autoimmune diseases such as type I diabetes and multiple sclerosis, this is of the order of 15–20 (1). Estimates of the λs in infectious diseases somewhat overestimate the importance of the host genetics because of the increased risk of exposure to infection in family members compared to the general population. Such λs estimates may be made from epidemiological surveys or from twin studies and are of value in providing an upper limit on the likely genetic contribution. For most infectious diseases λs values appear to be lie between one and ten. Estimates of the host genetic contribution that are relatively independent of environmental effects may be obtained from studies of adoptees or of twins. Sorensen et al (2) reported a large study of causes of premature death in 960 families with children adopted early in life. The risk of these adoptees dying from specific groups of causes before the age of 58 was assessed. Adoptees with a biological parent who had died before the age of 50 from an infectious cause had an increase in relative risk of 5.8 of dying from an infectious disease. In contrast, the death of an adoptive parent from an infectious cause had no significant effect on the adoptee’s risk of such a death. In the same study there was also a strong but less marked genetic influence on cardiovascular death, but a much greater environmental than genetic influence on deaths from cancer. Although a variety of infectious diseases were included in this study of deaths in northern Europeans during the middle of this century, respiratory infections were prominent. Numerous comparisons have been made of concordance for particular infectious diseases in identical and nonidentical twins. Tuberculosis has been frequently studied, and much higher concordance rates were found in monozygotic than dizygotic twins (3). A large study of leprosy also found higher disease concordance rates in monozygotic twins, but the large number of monozygotic twins ascertained may have led to an overestimate of the genetic component (4). The older literature on twin studies of infectious disease has been reviewed by Vogel & Motulsky (5). More recently twin studies of hepatitis B virus and Helicobacter pylori infection and malaria have been reported. In Chinese twins higher rates of concordance for hepatitis B virus persistence were found in identical than nonidentical twins (6). Although the number of pairs analyzed was

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small, this finding is consistent with data on candidate genes affecting susceptibility to viral persistence (see below). However, no difference in concordance rates for HBV infection was found. Malaty et al (7) assessed H. pylori status in 269 Swedish twin pairs and found a significantly higher concordance for infection with this bacterium in monozygotic than dizygotic twin pairs, yielding a heritability estimate of 0.57. Jepson et al (8) have reported the first twin study of malaria infection and disease. They performed a longitudinal study of 257 Gambian twins. Among these children, concordance rates for infection by malaria parasites were actually higher in the dizygotic than the monozygotic twin pairs, arguing against a significant genetic influence on risk of infection. However, concordance rates for fever caused by malaria were significantly higher among the identical twins, providing evidence that host genetic factors affect risk of malarial disease rather than infection. Twin studies are increasingly being used to estimate the extent of genetic determination of various immune responses to infectious pathogens. Jepson et al (9) have reported a comparison of immune responses to a panel of malarial antigens and to mycobacterial purified protein derivative (PPD) among adult Gambian twins of different zygosity. The deduced heritabilities provide an estimate of the extent of host genetic determination of these immune responses in a population where essentially all adults have been infected by mycobacteria and malarial parasites. However, marked qualitative and quantitative differences are observed in both humoral and cellular immune responses to antigens from these pathogens (10, 11). High heritabilities for both antibody and proliferative responses were found for immune responses to most of the malaria antigens and to PPD (9). HLA typing of the twins allowed the extent of the genetic contribution to be apportioned between HLA-linked and nonMHC genes. Interestingly, although MHC effects were detectable for most of these immune responses, the greater part of the overall genetic effect for both humoral (12) and cellular immune responses was attributable to nonMHC genes. The nature of these nonMHC genes is unclear. In addition to family, adoptee, and twin studies, interpopulation differences in disease prevalence may suggest a role for genetic factors in disease. Because of the many environmental factors and pathogen strain differences that may also underlie such geographic differences in infectious disease prevalence and manifestations, such evidence should be interpreted with caution. However, a recent study of sympatric ethnic groups in Burkina Faso has provided strong evidence of ethnic differences in response to malaria infection (13; see below). In addition to providing information of the extent of genetic determination of susceptibility to infectious disease, family studies can also suggest the pattern of inheritance of susceptibility genes utilizing complex segregation analysis. Typically, the transmission pattern of disease within families is compared to a

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variety of transmission models using estimates of the number of genes involved, their allele frequencies, and whether they are dominant, recessive, or codominant. An early leprosy study was performed in the Caribbean island Desirade (14), and more recently, pedigrees from Vietnam and Brazil have been analyzed (15, 16). Similar analyses have been undertaken for infection with schistosomiasis and also for IL-5 responses to this helminthic infection in Brazil (17, 18), for leishmaniasis in Peru, and for malaria parasite densities in Cameroon and Burkina Faso (19, 20). The CD4:CD8 ration of T cells in peripheral blood has also been studied (21). Most of these analyses have found evidence of a major single gene affecting susceptibility to the disease or phenotype in the pedigrees studied, usually recessive or codominant and sometimes with a modifier locus. These results fit uneasily with accumulating evidence that susceptibility to most infectious diseases appears to be highly polygenic. One explanation might be that there are one or two predominant loci affecting susceptibility with many minor modifying loci. However, it is unclear to what extent the best fit found with single gene models in these analyses might not be equally or better modeled with a somewhat larger number of susceptibility genes. The major single gene proposal could be retested for temporally varying phenotypes such as malaria parasite density by resampling of the same population. However, current wholegenome searches for major susceptibility genes should allow direct testing of some of the predictions of complex segregation analysis models.

ASSOCIATION STUDIES OF CANDIDATE GENES The number of association studies of candidate genes in infectious diseases has increased rapidly as more polymorphisms are identified in genes considered to have important roles in pathogenesis or protection. These candidate genes have been identified in several ways. Most are suggested by studies of immune mechanisms in infectious diseases, such as MHC genes and an increasing number of cytokine and chemokine genes and their receptors. There are now a few examples of genes identified in mice (22, 23) that affect susceptibility to infectious pathogens, so that their human homologues become candidates for affecting susceptibility to the disease in humans. The geographical distribution of some genetic variants provided early clues to candidate genes for malaria susceptibility but such geographic and racial correlations are of less use for other infectious disease. Finally, the positional candidate gene approach is beginning to be used as genes affecting susceptibility to infections are mapped through linkage analysis (see below). Interpretation of the literature on genetic associations with infectious diseases is complicated by apparent inconsistencies between different populations for many associations. It is clear that some of this population heterogeneity is

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genuine, but some of it probably results from poor study design. A general problem is that most published association studies have been too small to detect convincing allelic associations with odds ratios that are less than 2 or greater than 0.5. Yet the majority of genetic associations with infectious disease are probably of this magnitude. This lack of power is particularly problematic with HLA studies where there is a requirement to make statistical correction for comparisons of multiple alleles. HLA studies with just a hundred or so cases and similar numbers of controls are still undertaken but can only demonstrate extremely strong associations convincingly. Performing two sequential studies, with the results from the first raising a small number of specific hypotheses for testing in the second, is a relatively efficient means of dealing with extensive allelic and haplotypic diversity in HLA studies. Another general problem in design is that of adequately matching a control group to the cases. This is generally easier in rural populations in developing countries than in admixed urban populations of modern cities. For ethnically heterogeneous populations, this problem can be overcome, with increased effort in sample collection, by using family-based controls as described in several recent theoretical studies (24, 25). This approach requiring recruitment of both parents may be well suited to studies of pediatric infectious diseases.

HLA Studies NONVIRAL PATHOGENS The bacterial diseases leprosy and tuberculosis were frequently studied in the 1970s and 1980s. Various class I antigen associations were suggested, but no clear or consistent associations were identified. However, the class II antigen HLA-DR2 was frequently but not invariably associated with susceptibility to both leprosy and tuberculosis, particularly in Asian populations (Table 1) (26–31). The HLA-DR2 association with leprosy in India has been reconfirmed and shown to encompass several DRB1∗ 1501, DRB1∗ 1502 Table 1 Some HLA allelic associations described with infectious disease. The population (country) in which the study was performed is shown. ↑ indicates a susceptibility allele; ↓ indicates a protective allele Some HLA associations with infectious diseases Disease

HLA allele(s)

Population

References

Malaria Tuberculosis Leprosy HIV progression Hepatitis B persistence Hepatitis C persistence

DRB1∗ 1302↓

Gambia India, Russia, Indonesia India USA, Europe Gambia, Germany Italy, UK

57 27, 29–31 26, 28, 32 47–54 39, 40 43–46

B53↓ DR2↑ DR2↑ B35↑ A1-B8-DR3↑ B27↓ DRB1∗ 1302↓ DR5↓

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subtypes and appears to apply to both lepromatous and tuberculoid leprosy (32). A possible HLA-A∗ 6802 association with trachoma scarring caused by Chlamydia trachomatis has been identified in West African Gambians (33). The largest HLA association studies of an infectious disease have been of malaria. In The Gambia HLA-B∗ 5301 and HLA-DRB1∗ 1302 were independently associated with a reduced risk of severe malaria in childhood (34). The HLA-B∗ 5301 association was most marked in very young children (35) and more marked for severe malaria than other manifestations of malaria infection. This was independent of numerous flanking polymorphisms and may relate to the activity of CD8+ T cells against malaria liver-stage antigen epitopes (36). In a more recent and similar case-control study of severe malaria in Kenya, a protective association with HLA-DRB1∗ 0101 but not HLA-B∗ 5301 and HLADRB1∗ 1302 was found (37). The large sample sizes in these two studies allowed demonstration of statistically significant heterogeneity in HLA association between the populations. Whether such heterogeneity relates to known differences in malaria parasite allele frequencies between these locations or to other factors such as transmission intensity differences (35) is unclear. Recently, the potential interaction of polymorphism in the malaria parasite and HLA type has been addressed directly in the same Gambian population. The distribution of variants of cytotoxic T lymphocyte epitopes for HLA-B∗ 3501 was found to differ significantly between individuals with and without this class I type (38). Malaria parasites undergo frequent genetic recombination, and this association was evident only by typing the parasites for the genetic variants that specify an epitope for this HLA type, suggesting that further such HLA associations might be discovered by subdividing infections according to the relevant polymorphic epitopes in other pathogens. VIRAL INFECTIONS Several associations have been identified with manifestation of hepatitis virus infections. In The Gambia, HLA-DRB1∗ 1302 was associated with clearance of hepatitis B virus (HBV) infection; individuals with this HLA type were less likely to become persistent carriers who are at high risk of chronic liver disease (39). Two smaller studies of Europeans have found that this allele (40) or its supertype HLA-DR6 (41) is protective against chronic hepatitis associated with HBV persistence. In a study of Quatari patients with persistent HBV, HLA-DR2 was associated with viral clearance and HLA-DR7 with viral persistence. However, the sample size in the second stage of this two-stage study was very small (42). These associations with HBV infection are of particular interest in relation to the analysis of the mechanisms of HLA associations, as the small size of the HBV genome (about 3000 base pairs) should allow functional analysis of all of the potential epitopes for these HLA alleles. There also appear to be HLA class II associations with outcome

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of hepatitis C virus infection. Peano et al (43) and Zavaglia et al (44) both found a lower frequency of HLA-DR5 in Italian HCV-infected individuals with chronic liver disease than those with asymptomatic infection or in healthy controls. Minton et al (45) found that HLA-DRB1∗ 1101, which is the main DR5 allele in Europeans, was associated with clearance of HCV infection in England. A protective association with HLA-DQB1∗ 0301 in this study was consistent with another smaller study of English HCV-infected individuals (46). A large number of studies of HLA genes and various manifestations of HIV infection have now been reported. No strong and consistent associations with particular class I or II alleles have emerged, but several associations have been found in more than one study. For example, the HLA-B35 antigen (47–51) and the HLA-A1-B8-DR3 haplotype have been associated several times with more rapid disease progression (52, 53), and HLA-B27 may be associated with slower progression (53, 54). The lack of consistency in these associations may reflect extensive polymorphism in this virus and a high rate of intra-host diversification, even though most studies have been performed in populations where clade B viruses are predominant. The clearest evidence that some genes within the MHC affect the rate of disease progression comes from a study of 95 affected sibling pairs of HIV-infected hemophiliac brothers that found significant concordance for rates of CD4 T cell decline and AIDS status in sibling pairs sharing one or two but not zero MHC haplotypes (55). Kaslow et al (54) have presented interesting evidence that particular combinations of HLA class I and II alleles together with variants of the transporter associated with antigen-processing (TAP) genes, which are located between the HLA-DQ and -DP genes, may be associated with altered disease progression. An HLA profile of combinations associated with particular levels of risk developed in one study was predictive of the rate of disease progression in a second cohort. Early studies of HLA associations with other viral pathogens, measles, polio, and dengue and more recent studies of HLA-DQ associations with human papilloma virus infection (56) have been reviewed recently (57). The association of HLA-DR15 and -DR13 alleles with papilloma virus–related cervical carcinoma is of interest in that the associations were specific for the viral type HPV-16 (58), suggesting that dividing infectious diseases by the sequence type of the infectious pathogen may yield stronger HLA associations. In general, infectious disease associations appear to be found more frequently with HLA class II than class I antigens, but this may in part reflect the earlier development of molecular typing methods for class II genes. When Zinkernagel and Doherty discovered MHC restriction of the T cell response to infectious pathogens, they noted that this offered a potential mechanism for the selective maintenance of MHC polymorphism through heterozygote advantage (59). Such heterozygote advantage has not been evident in

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infectious disease studies (34), but most would have lacked power to detect this. However, in The Gambia, HLA class II heterozygotes were recently found to be less likely to develop persistent HBV infection than were homozygotes, in keeping with this hypothesis (60).

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Cytokine Genes and Receptors Analysis of the course of infection in gene knockout mice has provided numerous examples of the potential relevance to infectious disease susceptibility of polymorphism in cytokine and cytokine receptor genes in humans. Newport et al (61) studied a Maltese family with recessive susceptibility to atypical mycobacterial species, M. fortuitum, M. chelonei, and M. avium. The interferon-γ receptor was absent on leukocytes, and a point mutation was found at nucleotide 395 of the interferon-γ -receptor 1 gene that introduced a stop codon leading to a truncated protein that lacks transmembrane and cytoplasmic domains. Subsequently, a different mutation was identified in a child with fatal disseminated BCG infection (62). Interestingly, susceptibility to infectious pathogens appears more selective in children with a γ -interferon receptor gene knockout than in mice with a similar genetic defect. For example, it is unclear whether these children are susceptible to the pathogenic species M. tuberculosis and M. leprae, and they do not appear particularly susceptible to other bacteria and viruses. It will be of interest to establish the prevalence of heterozygosity for defects of this receptor gene in human populations and to know whether heterozygosity has any phenotypic effects. Numerous association studies have now been done of polymorphisms in and near to the tumor necrosis factor (TNF) gene located in the class III region of the MHC. McGuire et al (63) found an increased prevalence of homozygotes for a single base change at position −308 of the TNF promoter in children with cerebral malaria in The Gambia. This condition is associated with markedly elevated serum levels of TNF, and Wilson et al (64) have reported that this promoter variant is a stronger transcriptional activator than the common allele in reporter gene assays using human B cell lines. This −308 variant has also been associated with mucocutaneous leishmaniasis (65) and with lepromatous leprosy (66), both diseases with high serum TNF levels. These genetic associations support the view that the high TNF levels seen in these diseases are causally involved in pathogenesis rather than just a marker of an ongoing pathological process. The same TNF promoter variant has also recently been associated with scarring trachoma (67), persistent hepatitis B virus infection (68), mortality from meningococcal meningitis (69) as well as with asthma (70). A high heritability for whole blood TNF production probably mainly related to nonMHC genes was found in a Dutch twin study, and children with first-degree relatives who had low TNF and high IL-10 production were more likely to die of meningococcal

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disease (71). In a small study of HIV and disease progression, an allele of a microsatellite close to the TNF gene was associated with slow disease progression (72). In several but not all of these studies, HLA class I and II alleles were also typed, allowing an independent effect of the TNF gene region to be assessed. These TNF promoter associations have encouraged ongoing infectious disease studies of other cytokine genes with known polymorphisms such as IL-4, IL-10, and IL-1. Recent studies of chemokine receptor variants are discussed below.

Mannose-Binding Lectin Mannose-binding lectin (MBL), also known as mannose-binding protein, is a serum lectin that plays an important role in innate immunity (73). MBL activates complement via a specific protease and acts directly as an opsonin using the C1q receptor on macrophages. Functionally deficient variants of this collectin are remarkably common in most human populations. Mutations are found at codons 52, 54, and 57 that lead to low and near absent serum MBL levels in heterozygotes and homozygotes, respectively. Further variation is found in the promoter region associated with lesser degrees of variation in MBL levels. Anecdotal reports of mannose binding protein (MBP) defects in immunodeficient children and adults (74, 75) were followed by some small case-control studies suggesting associations of genotypes specifying MBL deficiency (homozygotes or compound heterozygotes) with unexplained immunodeficiency and HIV infection (76, 77). However, these two studies showed a surprisingly low frequency of such functional mutant homozygotes in the controls (78). Similarly, the suggestion of an association with persistent hepatitis B virus infection in Europeans (79) may reflect small sample size. However, a recent larger study of MBL genotypes in children attending a London hospital found a doubling in frequency of MBL mutations in children with a variety of infections compared to children with noninfectious diagnoses (80). Unless this association has arisen because of unknown population stratification, this study would appear to indicate that such variants are associated with susceptibility to a broad range of infections. This is surprising in view of the global prevalences of these MBL deficiency alleles; a selective advantage for these deficiency alleles should exist, but none has been clearly demonstrated. In large studies of malaria, HBV persistence and tuberculosis in The Gambia (81) and in a study of HIV infection in Uganda (S Ali, J Whitworth, AVS Hill, unpublished data), no evidence was found of MBL variants predisposing to any of these infectious diseases.

Vitamin D Receptor In 1994, Morrison et al (82) reported an association between polymorphisms at the 30 end of the vitamin D receptor (VDR) gene and osteoporosis. Over 30

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studies since then have reexamined this association, with about half confirming and the remainder failing to confirm the association (83). The same polymorphism has also been associated with hyperparathyroidism and risk of prostatic carcinoma (84, 85), supporting the functionality of this or very closely linked variation. The active form of vitamin D, 1,25 dihydrocholecalciferol (1,25 D3) is an immunomodulatory hormone and is one of the few mediators shown to impair growth of M. tuberculosis in macrophages (86). Therefore, Bellamy et al (87) examined the VDR polymorphism in tuberculosis cases in The Gambia and found that the tt genotype, frequently associated with lower bone mineral density (82, 83), was found less frequently in cases of pulmonary TB. In the same population, the tt genotype was also found to be negatively associated with persistent hepatitis B virus infection (87). In a subsequent Indian study, Roy et al (88) have found the tt genotype to be associated with tuberculoid leprosy, whereas the opposite TT genotype was associated with lepromatous leprosy. Interestingly, D’Ambrosio et al (89) have found that 1,25D3, in addition to several other immunomodulatory effects, downregulates IL-12 expression in macrophages and may thus be involved in the putative TH1-Th2 switch in human T cells. Lepromatous leprosy has been associated with a TH2 type immune response and tuberculoid leprosy with a TH1 type immune response (90). Finally, in a large case-control study of HIV infection in Uganda, heterozygotes for the same VDR polymorphism were found to be at reduced risk of HIV-1 infection (91). This may relate to the observed effects of 1,25D3 on HIV infection of, and expression in, human macrophages (91). This series of observations on the VDR polymorphism and infectious diseases suggest that this might represent a more general immune response gene in humans, and further studies are warranted.

Natural Resistance–Associated Macrophage Protein Studies of acute susceptibility of mice to infection with Leishmania donovani and Salmonella typhimurium led to the mapping of a major gene denoted Lsh or Ity on mouse chromosome 1 (93–96) that was subsequently found to affect susceptibility to some strains of BCG (97). This gene is expressed in macrophages and appears to influence macrophage activation. It was positionally cloned by Vidal et al (23) and designated Nramp1, for natural resistanceassociated macrophage protein 1. Mice with a knockout of this gene are susceptible to all three types of pathogen (98). Naturally susceptible strains of inbred mice all have a single-point mutation in the fourth transmembrane domain of the Nramp1 gene. The Nramp1 protein localizes to the phagosome membrane (99) and may act as a divalent cation transporter. Several polymorphisms in the human homologue NRAMP1 have been defined, but the mutation found in susceptible mice is absent (100, 101). Only very small-scale genetic linkage

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and association studies of tuberculosis and leprosy have been reported that could have detected very strong effects (100). Recently, Bellamy et al (102) have identified variants in the NRAMP1 gene that are associated with a significantly increased risk of pulmonary tuberculosis in West Africans. Although the effect of this polymorphism in humans appears more modest than that observed in mice, this evidence that there is some functional variation in the human NRAMP1 gene should encourage larger studies of its relevance to other infectious diseases and to human immune responses.

GENETIC LINKAGE AND WHOLE-GENOME ANALYSIS Despite the success of the candidate gene approach in identifying many genetic variants affecting susceptibility to infectious diseases in humans, there are limitations to this method. One is the requirement for prior identification of the gene and its function to suggest a possible role in pathogenesis or protection. Thus, major genes affecting susceptibility to infectious diseases may be missed because they remain unidentified. With the completion of genetic and physical maps of the human genome, it has become possible to adopt a genome-wide genetic linkage approach to mapping and identifying susceptibility genes for complex disease (103). Genetic linkage studies analyze the segregation of genetic markers in families with more than one individual affected by the disease. Classical genetic linkage studies analyzed the segregation of genetic markers and a disease in large multigenerational pedigrees. For infectious and other multifactorial diseases, simpler pedigrees consisting of two or more affected siblings and their parents are preferred (104). Thus, by analyzing allele-sharing only in affected-sibling pairs, the problem of classifying healthy family members as either resistant or simply unexposed to the infectious agent is avoided. Linkage between the MHC and susceptibility to leprosy was demonstrated in this way as early as 1976 (105). Using about 300 highly informative microsatellite markers, it is now possible to scan the entire human genome in segments of about 10 centimorgans or 10 megabases. In multifactorial disease where the pattern of inheritance is unknown it is safest to perform nonparametric analyses of affected sib pairs in which no model of the type of inheritance is assumed. This requires large numbers of families with affected sib-pairs. Typically, 70–100 are studied in a first-round genome scan, and possible linkages are confirmed in a similar number of further families. Such an approach has been used to map several genes in noninfectious complex diseases such as diabetes, asthma, and inflammatory bowel disease. Such whole-genome scans are been undertaken for pulmonary tuberculosis (R Bellamy, unpublished) in African families and for leprosy in South Indian

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families (S Meisner, R Siddiqui, unpublished). In the first round screen for tuberculosis, possible linkages have been identified on chromosome 3, 6, 8, and 15, and these are being reassessed in further families. Where there is information on the likely pattern of inheritance of a major gene, a parametric or model-based genetic linkage approach may be used. Previous complex segregation analysis of Brazilian pedigrees had suggested a major gene affecting intensity of Schistosoma mansoni infection (17). Marquet et al (106) performed a genome-wide linkage study of just 142 individuals in 11 families and found strong evidence of linkage to one region on chromosome 5q31–33. Interestingly, this region contains several immunologically important genes in the so-called TH2 cytokine cluster, including IL-4, IL-5, and IL-13, and in some studies this region has been linked to manifestations of asthma. Identification of the relevant gene or genes should permit assessment of whether natural selection for resistance to helminths has increased the prevalence of an asthma-susceptibility gene on chromosome 5. A great deal of effort is often required to map more finely regions of linkage and then to identify the relevant gene after confirmation of the initial linkage result. Typically, the first step is to search for evidence of linkage and association within the identified region using a series of microsatellite markers and the transmission disequilibrium test (TDT) (107). This tests whether in heterozygous individuals a particular allele is transmitted from a parent to an affected child at more than the expected frequency of 50%. Interestingly this observation was made for the HLA-DR2 allele in families with both leprosy and tuberculosis before the more recent popularization of this test (26, 27). Once a positive TDT result is found, a detailed analysis of neighboring genes is undertaken. However, the linkage result in schistosomiasis and the existence of numerous candidate genes suggest that a shorter route involving linkage analysis combined with a positional candidate gene approach will often be rewarding for infectious disease–susceptibility studies in humans. This involves assessment of the candidacy of genes known to map to the region of genetic linkage in association studies. A striking example of this was provided by the study of a Maltese family with atypical mycobacterial disease, referred to above. Assuming that the four affected Maltese children were homozygous for a single mutation introduced by a common ancestor, Newport et al (61) searched for regions of the genome in which all affected family members were homozygous. One of these was a fairly large segment of the long arm of chromosome 6, but this contained the interferon-γ -receptor 1 gene, and a causative mutation in this gene was rapidly identified. The main limitations of the genetic linkage approach are its lower power than association studies (108) and the requirement for multi-case families, which are often difficult to recruit, particularly for acute infectious diseases. However,

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for many diseases the linkage and candidate gene approaches are highly complementary and may be used in parallel.

SPECIFIC DISEASES

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Although results on several diseases have been discussed above, I summarize here recent immunogenetic results on the infectious diseases that have been most frequently studied.

Malaria Although many malaria resistance genes show marked allele frequency differences between populations, it has been difficult to compare susceptibility directly in different ethnic groups. An epidemiological study in Burkina Faso, West Africa, provided an opportunity to contrast rates of infection, malaria morbidity, and antibody levels in three distinct ethnic groups living in the same area of hyperendemic transmission (13). The Fulani ethnic group showed consistently lower prevalences of malaria parasites, and fewer clinical episodes than the other two. Interestingly, the Fulani also showed markedly stronger antibody responses to all three malaria antigens tested. This ethnic difference could not be accounted for by differences in hemoglobin S or HLA-B53 frequencies, and the authors suggest that the observed interethnic differences have some other immunogenetic basis. In certain areas of West Africa, the Fulani have an increased prevalence of the hyperreactive malarious splenomegaly syndrome, a severe manifestation of hyperresponsiveness to malarial infection. Although malaria resistance genes (Table 2) (109) have been well defined through case-control studies, genetic linkage studies of malaria in families have been lacking. Recently, Jepson et al (110) reported a small affected-sib pair study of Gambian families where two dizygotic twins had clinical malaria during a defined surveillance period. Using microsatellite markers within the Table 2 Genes implicated in resistance or susceptibility to malaria α-Globin β-Globin Glucose-6-phosphate dehydrogenase Spectrin Erythrocyte band 3 Glycophorin A Glycophorin B

HLA-B HLA-DRB1 TNF ABO blood group Duffy chemokine receptor ICAM-1 Complement receptor-1

The HLA genes (34), TNF (63), ICAM-1 (112), the complement receptor-1 (113) and α thalassemia (α-globin; 111) are discussed in the text. The others are from (109).

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MHC, linkage was demonstrated using just 23 sibling pairs. These data support previous work identifying class I, II, and III genes that are associated with altered susceptibility to severe malaria (34, 63). However, these previous association studies had not shown clear associations with mild clinical malaria, which was the phenotype in the linkage study. This may suggest that the MHC as a whole has a greater effect on malaria susceptibility than is evident from the effects of defined resistance alleles at the HLA-B, HLA-DRB1, and TNF loci. Another more exacting approach to defining the role of candidate genes in malaria susceptibility is to undertake a prospective cohort study rather than a hospital-based case-control study. Williams et al (111) followed Melanesian children in Vanuatu and found that children homozygous for the common mild single-gene deletion forms of α thalassaemia were at increased risk of developing clinical malaria. Protection against malaria caused by both P. falciparum and P. vivax was observed. This was not surprising as all previous case-control studies of other hemoglobinopathies had demonstrated protection against malaria. The authors suggested that an immunological mechanism might be involved, whereby increased susceptibility to mild malaria during early childhood would prime protective immunity so that homozygotes for α thalassaemia would be more protected against severe life-threatening forms of malaria. It will be important to confirm this observation on malaria susceptibility in a larger group of children with homozygous α thalassaemia as well as investigating the immunological hypothesis. Two new malaria resistance/susceptibility genes have recently been proposed. A new variant of ICAM-1 with a point mutation in the N-terminal domain has been identified in Africans that appears to be very rare in other populations (112). In a case-control study in Kenya, this variant, surprisingly, was found at a higher frequency in cases of malaria than in controls. Complement-receptor 1 (CR1) plays a role in the phenomenon of rosetting in which parasitized erythrocytes bind to uninfected erythrocytes (113). Rosetting has been associated with severe malaria, and Rowe et al have suggested that a common African variant of CR1 encoding the Sl(a-) antigen may protect against severe malaria (113).

HIV There has recently been substantial interest in the relevance of newly discovered chemokine receptor genes to HIV infection and disease progression to AIDS. One of these, the CC chemokine receptor gene-5 (CCR-5), is a co-receptor for the entry of macrophage-tropic strains of HIV-1 into cells. An inactivating 32-bp deletion of this gene is found at high frequencies (0.1) in populations of

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European origin. Homozygotes thus comprise 1% of the population and are very, but not completely (114), resistant to HIV-1 infection. In large studies, heterozygotes show slower rates of disease progression to AIDS but are not protected from HIV infection (115–118). This mutation is rare or absent in Asia and has not been found in populations of sub-Saharan African origin (119). It is unclear why this deletion has reached high frequencies in Europeans as there has not been enough time or mortality for HIV-1 to have been the selective agent. No obvious selective agents appear among known present-day pathogens, but candidates can probably be assessed using in vitro assays as well as case-control studies. Recently, an association between a variant in the CCR2 gene and rate of disease progression has been described (120). As described above, in a study of rural Ugandans in whom chemokine receptor defects were not found, Ali et al have identified an association between vitamin D receptor genotype and risk of HIV infection (91). It will be of interest to determine whether this gene may also be associated with altered rates of disease progression. In a study of female commercial sex workers in West Africa, an association between nonsecretor status and resistance to HIV-1 infection has been identified (S Ali, N Kiviat, AVS Hill, unpublished data) similar to the findings in a small study of heterosexual HIV transmission in the United Kingdom (121).

Hepatitis Viruses As described above, associations between hepatitis B virus persistence and several genetic variants have been reported from particular populations. In The Gambia HLA-DRB1∗ 1302, TNF promoter genotype, heterozygosity in the HLA-DR-DQ region, and a vitamin D receptor genotype have been associated with HBV clearance (39, 60, 68, 86). In Europeans, mannose-binding protein deficiency may increase the risk of HBV persistence, but this was not observed in Asians nor in Africans (78, 80). Clearance of HCV infection has been associated with both HLA-DR and HLA-DQ variants in Europeans (43–46). The haptoglobin 1-1 phenotype has been recently associated with chronic hepatitis C virus infection (122). It is likely that other loci also affect the immune response to these viruses, and it may be possible to map and identify some of these though family linkage studies. Other genes have been implicated in the progression of HBV persistent infection to hepatocellular carcinoma. McGlynn et al (123) studied polymorphisms in the liver detoxification enzymes, epoxide hydrolase, and glutathione S-transferase M1. These metabolize aflatoxin, a cofactor with persistent hepatitis B virus infection for risk of hepatocellular carcinoma. A marked synergistic interaction between the environmental risk factors and genetic risk factors was found. Once multiple common genetic risk factors are identified in the same population for this and other infectious

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diseases, it will be of interest to determine whether they interact additively, multiplicatively, or negatively. However, very large study populations will be required to define such interactions.

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Mycobacterial Diseases Genetic factors in leprosy and tuberculosis have been frequently studied, perhaps because patient recruitment is more straightforward in these chronic infections. Early studies of the role of HLA types have now been succeeded by a variety of candidate gene and genetic linkage studies. The evidence that HLADR2 is a susceptibility allele for tuberculosis and both types of leprosy in some Asian populations is compelling. Results on the vitamin D receptor and Nramp1 are described above. Several reports in the Russian literature have described associations between tuberculosis and the haptoglobin 2-2 phenotype (e.g. 124), but this was not found in a study in Indonesia (125). It remains to be determined whether variation in the interferon-γ -receptor 1 that has been clearly associated with disseminated BCG infection and disease caused by atypical mycobacteria (61, 62) are also associated with susceptibility to leprosy or tuberculosis.

PERSPECTIVE Over the last few years interest has increased in both MHC and nonMHC genes that are important in the immunogenetics of human infectious diseases. This in part reflects an increasing appreciation of the relative importance of nonMHC genes and in part new molecular and statistical techniques available to identify these. For some years it has been clear that the genetic determination of variable malaria susceptibility in humans is highly polygenic, and it appear likely that this will be a general finding for most infectious diseases. If susceptibility is mainly determined by a large or very large number of polymorphic host genes, each contributing a relatively small effect, this makes each individual contributor more difficult to identify in genetic linkage studies. Therefore largescale studies will be essential to demonstrate these convincingly. However, there are two advantages to this pattern of polygenic determination. First, it increases the probability that any given candidate gene plays a significant role in disease susceptibility, and candidate genes studies in infectious disease have been relatively successful compared to some other multifactorial diseases. Second, and more important, this diversity of genetic disease modifiers increases the potential of genetic analysis to provided useful insights into protective and pathogenic mechanisms in these diseases. As inspection of the list of malaria resistance genes demonstrates, some but not all loci will provide insights into disease mechanisms and may suggest new approaches for prophylactic or therapeutic interventions.

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The first infectious disease resistance genes to be demonstrated convincingly were mainly disease specific, such as the role of the hemoglobinopathies and glucose-6-phosphate dehydrogenase deficiency in malaria. Increasingly, with better knowledge of mechanisms of immunity, variants are being found that are likely to affect resistance to many infectious pathogens, such as the TNF −308 promoter polymorphism. Indeed, data associating variants with altered susceptibility to several infectious diseases may provide supportive evidence of the validity of an association prior to the understanding of an underlying mechanism. The success of nonparametric linkage approaches in mapping genes in other multifactorial disease has encouraged the adoption of a similar approach to many infectious diseases. However, recruitment of families with acute infectious diseases is more difficult than for many chronic noninfectious diseases, and the numbers of families available for analysis are likely to be less. Thus, if the genetic component is not very strong and this is shared among many genes, it may be possible to map only genes having very marked effects. Although complex segregation analyses have suggested that such major genes exist for many infectious disease, this remains to be confirmed. An alternative genomewide strategy has been outlined by Risch & Merikangas (108) that may be particularly applicable to infectious disease genetics. They compare the relative efficiency of screening the genome by linkage with a few hundred markers to screening by association with many thousands. They find that the greater power of association studies than of linkage analysis more than compensates for the requirement to correct for a larger number of comparisons in the former approach. However, genome-wide association studies require a substantially larger number of genotypings than linkage approaches and are probably still beyond the capacity of current centers. However, with technological developments in high-throughput genotyping, such large-scale association studies should become feasible. For diseases with multiple genes exerting small-tomoderate effects, where multicase families are difficult to recruit, this strategy may be preferable. Another issue that is only beginning to be addressed is the extent of interpopulation heterogeneity in infectious disease resistance alleles. There are striking differences in the prevalences of some malaria-resistance alleles in different populations (109). HLA associations also show some geographic variation. It seem likely that the same evolutionary selection pressures that have given rise to frequent polymorphisms in genes involved in resisting infectious pathogens have contributed to marked allele frequency differences at the same loci. When geographic variation in pathogen polymorphism is superimposed on this host genetic heterogeneity, considerable potential appears for variation in detectable allelic associations. Gene-environment interactions are likely to

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introduce another layer of complexity. For example, variation in calcium intake may affect the strength of vitamin D receptor allelic associations with infectious and noninfectious disease (126). Finally, if epistatic effects are of importance (127), another unknown, then this is likely to compound interpopulation differences. Against this background of complexity, the safest course would appear to be to attempt to identify and confirm genes of major to moderate effect in a single population with large sample sizes and then determine whether a similar effect is found elsewhere. Studies performed so far have likely only scratched the surface of a substantial amount of immunogenetic diversity that affects resistance to infectious disease. It is too early to estimate the extent to which allelic variants implicated in the autoimmune diseases of urbanized societies have been selected by the epidemics of the past. However, genes involved in defense against infectious pathogens evolve more rapidly than others (128), and much polymorphism in the human genome may result from selection pressures by infectious diseases. It follows that identifying genes selected in this way and investigating their molecular interactions with the relevant infectious pathogen should reveal mechanisms that have generated a significant amount of human genetic diversity. ACKNOWLEDGMENTS I thank the numerous colleagues and collaborators in Oxford and elsewhere in the United Kingdom and in The Gambia, Thailand, Vietnam, Uganda, and South Africa, whose ideas and data have contributed to this review. The author is a Wellcome Trust Principal Research Fellow. Visit the Annual Reviews home page at http://www.AnnualReviews.org.

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INFECTIOUS DISEASE IMMUNOGENETICS 118. Huang Y, Paxton WA, Wolinsky SM, Neumann AU, Zhang L, He T, Kang S, Ceradini D, Jin Z, Yazdanbakhsh, K, Kunstman K, Erickson D, Dragon E, Landau NR, Phair J, Ho DD, Koup RA. 1996. The role of a mutant CCR5 allele in HIV1 transmission and disease progression. Nat. Med. 2:1240–43 119. Martinson JJ, Chapman NH, Rees DC, Liu YT, Clegg JB. 1997. Global distribution of the CCR5 gene 32 basepair deletion. Nat. Genet. 16:100–3 120. Smith MW, Dean M, Carrington M, Winkler C, Huttley GA, Lomb DA, Goedert JJ, O’Brien TR, Jacobson LP, Kaslow R, Buchbinder S, Vittinghoff E, Vlahov D, Hoots K, Hilgartner MW, O’Brien SJ. 1997. Contrasting genetic influence of CCR2 and CCR5 variants on HIV-1 infection and disease progression. Hemophilia Growth and Development Study (HGDS), Multicenter AIDS Cohort Study (MACS), Multicenter Hemophilia Cohort Study (MJCS), San Francisco City Cohort (SFCC), ALIVE Study. Science 277:959–65 121. Blackwell CC, James VS, Davidson S, Wyld R, Brettle RP, Robertson RJ, Weir DM. 1991. Secretor status and heterosexual transmission of HIV. Br. Med. J. 303:825–26 122. Louagie HK, Brouwer JT, Delanghe JR, De Buyzere ML, Leroux Roels GG. 1996.

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Haptoglobin polymorphism and chronic hepatitis C. J. Hepatol. 25:10–14 McGlynn KA, Rosvold EA, Lustbader ED, Hu Y, Clapper ML, Zhou T, Wild CP, Xia XL, Baffoe Bonnie A, Ofori Adjei D, et al. 1995. Susceptibility to hepatocellular carcinoma is associated with genetic variation in the enzymatic detoxification of aflatoxin B1. Proc. Natl. Acad. Sci. USA 92:2384–87 Kharakter ZZ, Mazhak KD, Pavlenko AV. 1990. The role of genetically determined haptoglobin phenotypes in patients with destructive pulmonary tuberculosis. Probl. Tuberk. 7:50–52 Grange JM, Kardjito T, Beck JS, Ebeid O, Kohler W, Prokop O. 1985. Haptoglobin: an immunoregulatory role in tuberculosis? Tubercle 66:41–47 Kiel DP, Myers RH, Cupples LA, Kong XF, Zhu XH, Ordovas J, Schaefer EJ, Felson DT, Rush D, Wilson PW, Eisman JA, Holick MF. 1997. The BsmI vitamin D receptor restriction fragment length polymorphism (bb) influences the effect of calcium intake on bone mineral density. J. Bone Miner. Res. 12:1049–57 Frankel WN, Schork NJ. 1996. Who’s afraid of epistasis? Nat. Genet 14:371– 3 Murphy PM. 1993. Molecular mimicry and the generation of host defense protein diversity. Cell 72:823–26

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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Annu. Rev. Immunol. 1998. 16:619–44 c 1998 by Annual Reviews. All rights reserved Copyright

HOW DO MONOCLONAL ANTIBODIES INDUCE TOLERANCE? A Role for Infectious Tolerance? Herman Waldmann and Stephen Cobbold Sir William Dunn School of Pathology, South Parks Road, Oxford OX1 3RE, United Kingdom KEY WORDS:

CD4 suppression, transplantation, immune regulation

ABSTRACT One of the major goals in therapeutic immunosuppression has been to achieve long-term benefit from short-term therapy. The discovery in the mid-1980s that CD4 antibodies can induce immunological tolerance without depleting CD4+ T cells has reawakened interest in the use of nondepleting monoclonal antibodies for reprogramming the immune system in autoimmunity and in transplantation. Since that time, antibodies to CD11a, CD4OL, CD25, CD3, and CTLA4-Ig have all been shown capable of facilitating tolerance. In order to apply the principle of reprogramming in the clinic, we have sought to understand the mechanisms that are involved in its induction and its maintenance. In a number of allogeneic transplant models (heart, skin, bone marrow) anti-CD4 (±CD8) antibodies can be shown to block the rejection process while selectively promoting the development of CD4+ regulatory T cells responsible for a dominant tolerance that is reflected in findings of linked suppression and infectious tolerance. In these models, T cells that have never been exposed to CD4 antibodies become tolerant to grafted antigens by experiencing antigen in the microenvironment of regulatory T cells. Dominant tolerance is not the only mechanism that can be facilitated by CD4 Mab therapy. If allogeneic marrow is given at high cell doses under the umbrella of CD4 and CD8 antibodies, then tolerance can be achieved through clonal deletion. The mechanism by which regulatory CD4+ T cells suppress is not yet defined but could be active or passive. We have proposed the “civil service model” to explain how tolerant T cells might interfere with the responses of competent T cells in such a way as to render them tolerant.

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The application of dominant infectious tolerance and linked suppression to clinical immunosuppression should not be underestimated because it suggests that tolerance acquired (through therapy) to a limited set of antigens can spread to embrace all others in the tissues under attack.

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INTRODUCTION The immune system has evolved to protect against infectious microbes through a wide range of different effector mechanisms. In fulfilling this function the immune system is constrained by the need to avoid any destructive responses directly targeted to self-antigens and to prevent irreversible bystander damage within the tissues where the immune reactions are occurring. Most immune responses have a limited life and are curtailed by regulatory mechanisms that prevent overreaction. The processes by which the immune system avoids destructive self-reactivity are embraced by the term self-tolerance. In large part lymphocytes reactive with ubiquitous self-antigens are deleted within the primary lymphoid organs as part of central tolerance. For less abundant antigens or antigens confined to distinct geographical sites, a number of other mechanisms exist to prevent autoaggression. These have been the focus of much recent research into peripheral tolerance. Diverse experimental systems have implicated deletion, anergy, receptor downregulation, and ignorance as mechanisms, the contribution of each depending on the particular model studied. These observations apply to both T and B lymphocytes, although T cells are critical to all immune responses. (Figure 1 summarizes the above overview). These are also clear examples of self-tolerance mechanisms which involve active regulation or suppression by T cells (1–3). It is remarkable how “experts” in the subject of self-tolerance vary in the extent to which they accept some but not all proposed mechanisms. More often than not, those who wish to understate the importance of regulatory mechanisms do so either because of some private intuition that they are irrelevant or because their views of tolerance depend on unique model systems such as TCR transgenics in which complex but natural population effects may be minimized by the very nature of the system they select and by the enthusiasm to extrapolate conclusions about long-term tolerance from short-term readouts. One of the great hopes of understanding self-tolerance has been the possibility that this knowledge could be exploited for therapeutic purposes. Currently, autoimmune diseases, allergies, and transplant reactions run third (behind cancer and cardiovascular disease) in terms of the demand on health service resources in the Western World. These disorders are largely treated with anti-inflammatory

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Figure 1 Mechanisms of self-tolerance in the thymus and periphery. T cells develop in the thymus, and as a result of random rearrangements of their antigen receptor genes, they mature into thymocytes expressing both CD4 and CD8 on their surface (DP thymocytes). In order to proceed to the single CD4 or CD8 positive (SP) mature thymocyte, the T cell receptor must interact with selfpeptides (Ag) bound in the clefts of the major histocompatibility complex (MHC) molecules on the surface of antigen-presenting cells (APC). A high-avidity (and therefore potentially autoimmune) interaction with self-Ag/MHC/APC will lead to central thymic tolerance, mainly by clonal deletion, whereas a low-avidity interaction leads to positive selection and export into the periphery as a naive T cell. Immune responses in the periphery (spleen, lymph nodes, peyers patches, etc) are also subject to control mechanisms that include clonal deletion and anergy as well as regulation and suppression. These mechanisms are important both to maintain tolerance to self-antigens that were not expressed in the thymus during negative selection and might be recognized by the emerging naive T cells, as well as to limit responses to foreign antigens by primed T cells once the invading pathogen has been eliminated by the immune response. The aim in using therapeutic agents such as monoclonal antibodies that block CD4 and CD8 molecules in vivo is to harness and amplify these natural tolerance and regulatory mechanisms to control responses to foreign tissues following transplantation or self-tissues in autoimmune disease.

and immunosuppressive drugs, most of which were discovered empirically, and virtually all of which tending to penalize the whole of the immune system rather than the small minority of lymphocytes involved. In most cases the therapeutic agents are given long-term and pose risks of unwanted side effects; their benefit is lost if the drug is withdrawn. There is a growing sense that exploitation of tolerance processes may soon change the face of therapeutic immunosuppression, so as to ensure long-term therapeutic benefit from short-term, low-impact therapy. This clinical need for low-impact treatments will determine which tolerance mechanisms come to be most useful for therapeutic purposes. It seems likely that achieving and maintaining therapeutic tolerance solely through central (deletion) mechanisms might incur unacceptable risks at the induction stage. On the other hand, the

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harnessing of regulatory or active suppressive mechanisms may require less aggressive therapy and be more appropriate, especially if microbial immunity and hemopoiesis remained unimpeded long-term. This introduction provides the background to the present article, which aims to review recent information on how certain biological agents such as monoclonal antibodies, used short-term, can reprogram the immune system to become tolerant to transplanted tissues and to self-antigens in autoimmune disease. Our pursuit of mechanism has revealed a hitherto unsuspected and immensely powerful form of dominant tolerance that seems eminently exploitable for therapeutic purposes.

TOLERANCE WITH CD4 ANTIBODIES THE INITIAL OBSERVATIONS In 1986 two groups (ours and that of David Wofsy) (4–6) reported that a short course of treatment with depleting CD4 antibodies resulted in long-term tolerance to foreign immunoglobulins. Simultaneously Fathman and colleagues (7) described a long-term impairment in the response to sperm whale myoglobin following CD4 antibody therapy, which in retrospect was probably also a result of tolerance induction. It soon became apparent that depletion of CD4 T cells was not essential for tolerance. F(ab0 )2 fragments (8–10), nondepleting isotypes (11), or sublytic doses of synergistic pairs of CD4 antibodies (12) could also induce tolerance to foreign immunoglobulins without T cell depletion. The possibility that tolerance with CD4 antibodies may also apply to transplanted tissues came from studies where short-term CD4 antibody treatment contributed to long-term graft acceptance of skin (13) and islet (14) allografts, well beyond the time by which immunocompetence had returned. In those early studies, tolerance was not tested by challenging with second donor grafts, but this was established by subsequent work which showed that transplantation tolerance could be induced by these antibody protocols.

Evidence for Peripheral Mechanisms Determining Tolerance to HGG We analyzed the cellular basis of tolerance to HGG and demonstrated tolerance in the T helper population, but not in B cells (10). Antibody ablation studies showed that CD8+ T cells were not required for either induction or maintenance of tolerance (10, 15). Tolerance with nondepleting antibodies could be elicited in adult-thymectomized (ATx) mice (12), showing that it too involves peripheral mechanisms. In ATx mice, tolerance could be demonstrated 200 days after its induction, in the absence of further antigen challenge. In contrast, longterm tolerance in euthymic animals required repeated injections of antigen to reinforce the tolerant state (10). This suggested that loss of tolerance to HGG

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in euthymic mice given no further antigen depends on repopulation of the periphery with naive T cells. Tolerance could also be induced in animals that had been previously primed to HGG (15), suggesting at that time it might be possible to reinstate tolerance in autoimmunity. Perhaps the most revealing of the early findings was that tolerance, once induced, could not be broken by infusion of naive splenocytes, although in that example it could be broken by primed cells. Antibody ablation of host CD4+ T cells removed this resistance (15), suggesting that host CD4+ T cells were responsible for this form of dominant tolerance.

Tolerance Induction to Allogeneic Marrow: Classical Transplantation Tolerance in the Adult From these initial studies with HGG, we reasoned that if tolerance could be induced to transplants or reinduced in autoimmune disease, then no additional booster (reinforcing doses) of antigen would be needed from without to maintain it. Both the transplanted tissue and particular self-tissue should provide such a permanent source of tolerance-reinforcing antigen from within. We tested this idea by trying to achieve tolerance to a foreign bone marrow (16): CBA/Ca mice could be tolerized to the multiple minor antigens of B10.BR and AKR donors by injection of donor bone marrow under the cover of CD4 and CD8 antibodies. Mice that became chimeric with donor marrow went on to accept donor skin, while retaining the capacity to reject a third party. Again, depletion of CD4+ T cells was not essential as chimerism and tolerance to skin grafts could be obtained with either depleting or nondepleting CD4 antibodies. Peripheral mechanisms were sufficient as this could all be done in ATx mice. Although tolerance could also be obtained across an MHC class I minors difference (16), it proved harder to tolerize to bone marrow mismatched for both minors and the whole MHC, without incorporating some additional immunosuppressive/myeloablative agents (17). In our attempts to use CD4/CD8 antibodies to tolerize BALB/c (H-2d) mice to B10.BR (H-2k) marrow, we observed no prolongation of B10.BR skin, yet to our surprise we saw extended survival (MST 56 days) of B10.D2 (H-2d) skin. This suggests that donor “black” minors must have been presented on host (H-2d) APCs, and that antibody therapy was tolerizing to these. A direct demonstration that peripheral T cells also become tolerant to reprocessed minors from skin grafts came from studies where (CBA × BALB/c)F1 recipients (H-2k × H-2d) were tolerized to either B10.D2 (H-2d black minors) or B10.BR (H-2k + black minors) skin grafts (18). Animals tolerating a B10.D2 graft were shown to be tolerant to B10.BR and vice versa. In 1986, we had shown that adult transplantation tolerance could be induced by an infusion of donor marrow fully mismatched for MHC and minors (19, 20) if given under the umbrella of with CD4 and CD8 antibodies and a nonlethal

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dose of irradiation (600 rads). Tolerance in this situation involved substantive donor chimerism. Subsequently, we determined that much of the effect of irradiation was related to host myeloablation, as myeloablative, relatively nonimmunosuppressive doses of the alkylating agent dimethylmyeleran (DMM) wholly replaced the need for irradiation (17). We concluded that the role of DMM was to create further hemopoietic space so that more donor stem cells could engraft and in so doing overwhelm residual host resistance mechanisms. In assessing the level of recipient whole body irradiation required to guarantee tolerance to MHC mismatched marrow, we observed that as little as 300 rads was sufficient , but only if we increased the level of antibody immunosuppression by adding anti-LFA-1 antibodies to the CD4 and CD8 antibody cocktail (21) . Sachs, Sykes, and coworkers (22, 23) adapted the basic protocol involving CD4 and CD8 antibodies, and they observed that robust tolerance to MHC mismatched grafts could be achieved using the antibodies combined with irradiation: 300 rads whole body supplemented with 700 rads applied to the thymus. Recently, they too have accepted that thymic irradiation is unnecessary if a more substantive course of antibody therapy is given (24).

Tolerance Induction to Skin Grafts Transplanted under Cover of Antibody Therapy We then asked whether tolerance could be induced directly to the transplanted tissue without the need for prior marrow transplantation. This proved straightforward with skin grafts mismatched for multiple minor antigens (11). [B10.BR; AKR and BALB/k transplanted onto CBA/Ca recipients—(11).] The outcome was similar in both euthymic and ATx mice, showing that peripheral tolerance mechanisms were involved. In most cases CD4 antibody alone was insufficient to ensure permanent graft acceptance, but the addition of a nondepleting CD8 antibody to the therapeutic protocol resulted in permanent graft acceptance and tolerance. Unlike the situation for HGG, tolerance once induced was not lost in euthymic mice. A role for graft antigens in reinforcing tolerance could be demonstrated by parking tolerant cells in T cell–depleted recipients that carried no donor antigens (25). Tolerance was eventually lost, whereas reintroduction of antigen (skin) early resulted in long-term graft maintenance (25). The role of antigen could be either to maintain T cells in a reversible “impotent” state or to ensure the sustained dominance of regulators over any residual competent T cells. These ideas are not mutually exclusive; evidence for the existence of dominant tolerance and suppression soon emerged. THERAPEUTIC TOLERANCE TAKES TIME TO DEVELOP We wished to determine at which stage in the induction process the T cell population became tolerant (25). This could be examined by transferring T cells into T cell–depleted

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Figure 2 Tolerance induction under CD4 plus CD8 antibody cover takes time to develop. CBA mice could be made tolerant of multiple minor antigen different (B10.BR) skin grafts by treating them with CD4 plus CD8 antibodies that saturate the T cell surface for more than 4 weeks. Tolerance after this time could be confirmed by transferring spleen cells into “empty” adult mice that had previously been thymectomized and T cell depleted with rat IgG2b (depleting) CD4 plus CD8 antibodies and given a fresh B10.BR skin graft. However, if the spleen cells were removed from the original CD4 plus CD8 antibody saturated mouse before 4 weeks, they caused rapid rejection of the B10.BR graft upon transfer into the “empty” recipient, showing that they had not yet become fully tolerant.

hosts given fresh skin grafts (Figure 2). Surprisingly, T cells transferred at the end of the therapeutic antibody course were still competent to reject grafts. It took some four weeks from the end of the course for the T cell population to behave as if tolerant. This suggests that in the first few weeks following antibody administration the therapeutic antibodies were selectively blindfolding the immune system, allowing the tolerance processes time to evolve over the ensuing weeks (Figure 3). Certainly, we can exclude the notion that CD4 crosslinking by antibodies was causing an immediate widespread deletion in the antigen reactive population. By extending the period of antibody treatment, we found that tolerance could occur even under conditions where the T cells were bathed in saturating levels of CD4 antibodies. Antigen recognition leading to tolerance must have occurred in T cells that had modulated their CD4 and had much of the remaining cell-surface CD4 occupied by antibody.

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Figure 3 An ideal therapeutic CD4 antibody should block rejection yet allow regulation. The T cell response to a foreign antigen or a skin graft is often thought of only in terms of the initiation of the immune response, such that activation leads to inevitable expansion, effector function, and memory. However, there must be processes that limit or terminate that response once the antigen has been eliminated or the graft rejected, especially if there is any risk that some of the response could be maintained on cross-reacting environmental or self antigens. There is increasing evidence that T cell responses to both self and foreign antigens are subject to separate, regulatory T cell responses. The ideal therapeutic antibody for inducing transplantation tolerance would be one that blocked the rejection response but still allowed the natural evolution of the regulatory response.

EVIDENCE FOR DOMINANT TOLERANCE AND T CELL–MEDIATED SUPPRESSION Tolerance to skin grafts showed all the features of dominant tolerance, as

it could not be broken by further priming with donor antigens nor with infusions of large numbers of naive recipient-type splenocytes (11, 25). This was quite unlike the situation where mice were tolerized centrally (by allowing T cells to develop in donor type thymus lobes) where the infused naive cells retained their capacity to reject grafts (25). Dominant tolerance was dependent on host T cells, as their prior removal with ablative antibodies (Thy 1.2) enabled adoptively transferred naive Thy1.1 T cells to reject donor grafts (25). We examined whether tolerant T cells could prevent naive T cells from rejecting grafts when both were adoptively transferred to T cell–depleted recipients (26, 27). Indeed, at appropriate ratios the tolerant population could completely prevent naive cells from rejecting minormismatched grafts. Ablation of the CD4+, but not the CD8+ subset from the tolerant population, resulted in loss of suppression, showing the regulators to be CD4+ (26). The same conclusion was also reached by Yin & Fathman (28).

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Figure 4 Tolerance is associated with linked suppression of third-party antigens. CBA mice that have been made tolerant of B10.BR skin under cover of a short course of nondepleting CD4 plus CD8 monoclonal antibodies will accept fresh B10.BR grafts given at any time. Tolerant mice will reject third-party grafts that do not share any of the tolerated antigens, in this case skin from a CBA mouse transgenic for the MHC-I antigen Kb, even if this is given side by side with a fresh B10.BR graft. However, if the third-party Kb is expressed on the same graft (and therefore same APC) as the tolerated B10.BR antigens (using an F1 cross), the rejection is delayed and about half the mice accept the combination indefinitely. Those mice that accepted the (B10.BR × CBK)F1 graft became truly tolerant of Kb because they later accepted entirely third-party CBK skin.

How might tolerant CD4+ T cells prevent naive T cells from rejecting grafts? One possibility is that the reinforcing antigen focuses them to the site of antigen presentation where they come into close proximity with naive T cells. We tested this hypothesis by looking for evidence of linked suppression (18) (Figure 4). CBA/Ca mice tolerized to B10.BR were grafted with a third-party graft from CBK mice (CBA/Ca mice transgenic for Kb). Such grafts were rejected promptly as expected. In contrast (B10.BR × CBK)F1 grafts were not rejected in 50% of mice, and in the others their rejection time was delayed. Mice that had accepted (B10.BR × CBK)F1 skin later accepted CBK skin, showing that they had actually become tolerant to the third party. Clearly, the demonstration of linked suppression allows us to conclude that regulation must operate in a local microenvironment where antigen acts to focus naive antigen-specific T cells into the vicinity of tolerant or regulatory CD4+ T cells. However, life-long tolerance by regulation would require either that the

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Figure 5 Infectious tolerance. CBA mice carrying a transgenic human CD2 gene (as a marker in all T cells) were made tolerant of B10.BR skin using nondepleting CD4 and CD8 antibody treatment. A number of weeks later they were infused with 50 million naive spleen cells from a nontransgenic littermate. These recipient mice could be demonstrated as chimeric because the human CD2 marker was now expressed on only a proportion of their T cells. Despite the presence of the originally naive donor T cells, the grafts were not rejected, demonstrating that tolerance was dominant. Finally, the original tolerant population was eliminated using an efficient anti-human CD2 antibody, and yet the mice remained tolerant of B10.BR skin even if challenged with a fresh graft. The tolerant state could therefore be passed from one population of T cells to another, as if infectious.

first cohort of regulators survived indefinitely, or that their function could be continuously acquired by new T cells exported from the thymus. We tested this idea by looking to see if naive T cells could acquire tolerance by cohabitation with (marked) tolerant T cells in the presence of the graft antigens. Not only was this shown to be the case, but this second cohort of tolerant T cells had also gained the property of dominant tolerance (Figure 5), as a further cohort of naive T cells could again not break tolerance when infused into the primary host (26). We termed this phenomenon “infectious tolerance,” rejuvenating a term first used by the late Richard Gershon. The original use of the term had not really distinguished suppression from the process by which the same trait is conferred on a new cohort of T cells. In that sense, our use of the term is meant to reflect that both phenomena, i.e. tolerance and suppression, are infectious.

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Tolerance in a Primed Immune System It came as some surprise to us that one could tolerize mice previously primed to multiple minor antigens, even in the course of the rejection process (29, 30). Dominant tolerance could again be demonstrated. The evidence for this was: (a) that tolerance, once established, could be broken by depletion of the CD4+ subset resulting in graft rejection by the remaining CD8+ T cells (30, 31), and (b) that tolerant (primed) CD4 T cells could be shown to suppress primed CD4+ and CD8+ T cells from rejecting grafts. This did, however, require a higher ratio of tolerant to normal cells than that observed for suppression of naive T cells (30). These findings make the clear point that there should be no barrier to tolerizing T cells involved in autoimmune disease if one can ensure dominance by regulatory cells.

Tolerance to Transplanted Organ Grafts Differing Across Full MHC and Minor Barriers While it is possible to induce tolerance to MHC mismatched skin with nondepleting antibodies (29), some level of T cell depletion is often required to make this reliable (31). Despite permanent acceptance of the tolerizing, and subsequent challenge grafts, T cells from tolerized mice were still able to proliferate, generate CTLs, and secrete Th1 cytokines, making it difficult to find an in vitro correlate of in vivo tolerance (31, 32). It has, however, been extremely easy to induce tolerance to heart grafts mismatched for MHC (33, 34) and even between species in a concordant system (rat to mouse). Tolerance in this situation follows all the rules outlined above for minors, with the rather remarkable new finding that tolerance can be imposed on naive recipients by the simple process of transferring spleen cells from tolerant animals (35, 36) (Figure 6). Ablation studies showed that suppression was wholly accounted for as a function of the tolerant CD4+ T cell subset, but not the CD8+s. The process of transferring tolerance to naive mice could be repeated sequentially over at least 10 generations of animals, suggesting a major amplification factor for the regulatory component (36). This involved infectious tolerance as Thy1.2 cells transferred into Thy1.1 mice given a heart graft, enabled the Thy1.1 population to become tolerant if the two cell populations had an opportunity to co-exist (36). T cells from CBA/Ca mice (H-2k) that had accepted a B10 H-2b heart were able on transfer to suppress new CBA/Ca recipients from rejecting a (B10 × BALB/c)F1 i.e. (H-2b × H-2d)F1 heart. T cells from mice that had accepted the F1 heart were enabled to suppress naive CBA/Ca mice from rejecting a BALB/c heart. In other words, infectious tolerance can also act through linked suppression, eventually generating tolerance to the third-party antigens (36).

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Figure 6 Infectious tolerance and linked suppression in vascularized, MHC-mismatched heart grafts. CBA mice were made tolerant to allogenic C57/B10 or BALB/c vascularized heart grafts under cover of nondepleting CD4 and CD8 antibodies. After 100 days, 50 million spleen cells from these tolerant mice were sufficient to completely suppress, upon transfer, the rejection of donor-type hearts in fully immune competent secondary recipients. After a further 100 days, 50 million of these tolerant spleen cells would similarly suppress donor-specific rejection in a tertiary normal recipient, and this process could be repeated for more than nine sequential transfers. As this represented a dilution from the original antibody treated mice of >1 million, it could only be due to amplification or elicitation of a normal mechanism by the process of infectious tolerance. This was confirmed by using the Thy-1 allotype marker to allow depletion of transfered tolerant cells, but only after a necessary co-habitation with the recipients cells for two weeks. Finally, this infectious tolerance elicited by transfer could be shown to act on third-party graft antigens if they were expressed on skin from an F1 with the tolerated strain, i.e. linked suppression.

Classical Transplantation Tolerance Revisited THE FINDING OF ANERGIC T CELLS IN TOLERIZED ANIMALS Where we had transplanted AKR marrow (Mls-1a) into CBA/Ca (Mls-1b) recipients, we could examine the fate of Vβ6+ T cells in the lymph nodes in animals that had been stably tolerant for some months (16). Despite tolerance and chimerism, the percentage of Vβ6+ cells was similar to that of normal controls. However, in vitro proliferative responses were significantly reduced, suggesting that Vβ6+ cells were anergic. Later studies using nondepleting protocols (11, 37) showed that although all mice that were tolerant demonstrated chimerism, and had reduced proliferative responses to Mls-1a, some of the mice contained T cells that could still proliferate when cross-linked by anti-Vβ6 antibodies, suggesting that tolerized/anergized cells may have raised their thresholds of triggering to varying degrees (37). Fathman and coworkers have also reported anergic cells in models of islet transplantation (38–40).

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Figure 7 Low-dose bone marrow transplantation induces infectious tolerance and linked suppression. Euthymic CBA mice were given a low dose of T cell–depleted AKR (Mls-1a plus minors different) bone marrow cells under cover of nondepleting CD4 (plus depleting CD8) antibodies and, after waiting for antibody to clear, were grafted with AKR skin to demonstrate tolerance. After a further 10 weeks they were shown to accept third-party (B10.BR × AKR)F1 skin (but not B10.BR), indicating that bone marrow could be used to elicit linked suppression. More surprisingly, if the tolerant mice were boosted with fresh donor bone marrow, spleen cells taken 3 days later could suppress the rejection of AKR skin grafts in otherwise unmanipulated secondary recipients. This transfer depended on CD4+ cells and acted through an infectious mechanism (using Thy-1 allotype depletion).

The abundance of evidence from skin and heart graft models that T cell suppression and infectious tolerance were responsible for maintenance of the long-term tolerant state led us to reinvestigate mechanisms involved in tolerance to bone marrow grafts. A recent study by Bemelman and coworkers has shed some light on the mechanisms involved (41) (Figure 7). By transplanting AKR marrow under cover of nondepleting CD4 and CD8 antibodies, we sought evidence for linked suppression, transferable suppression, or infectious tolerance. We observed that low doses of bone marrow–induced tolerance that was nondeletional (i.e. there was no loss of Vβ6+ T cells from the blood). However, mice so tolerized could accept skin grafts not only from AKR donors, but also from (AKR ×CBA/Ca)F1, demonstrating clearly that linked suppression was operating. A further boost of AKR marrow given to tolerant recipients endowed the spleen of tolerant animals with the capacity to transfer suppression to naive animals, such as to prevent these from rejecting AKR skin. Co-existence of tolerant cells with those of the naive recipient resulted in the latter becoming tolerant in their own right,

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and now these animals became unable to reject (B10.Br × B10.BR × AKR) F1 skin. In other words, even the tolerance generated through linked suppression proved to be infectious. In contrast, tolerance induced with high doses of marrow resulted in deletion of Vβ6+ cells, both in the periphery and in the thymus. This was accompanied by a high level of donor chimerism, with no evidence of linked or transferable suppression (41). In short, this suggests that the tolerance mechanisms in these circumstances involved inactivation and/or death of peripheral T cells, and central tolerance (deletion) of any alloreactive T cells that might arise later. We also investigated mechanisms underlying tolerance induced to a Kb difference by transfusing CBA/Ca mice with CBK bone marrow under antibody cover (42) (Figure 8). We used CBA/Ca mice that were transgenic for an antiKb TCR (Desir´e), where the bulk of the CD8+ cells carried that clonotype. By combining DMM with a nondepleting CD8 antibody we could tolerize these mice with bone marrow so that they could subsequently accept CBK skin grafts. Tolerance was associated with donor chimerism, and deletion of the Desir´e+ CD8+ cells within 2 weeks of marrow administration. Remarkably, depletion of the CD4+ population prevented tolerance, and subsequent deletion of the Desir´e+ CD8+ T cells. We speculated that as these mice had some CD4+ TCR repertoire from expression of endogenous Vα chains, then some of these might have developed the capacity to recognize processed Kb, so as to be able to regulate the CD8+ population. A combination of antibodies to IL-4 and IL-10 also abrogated the CD4+ suppressive effect. This suggested to us that a short burst of these Th2 cytokines might have acted in concert with the blockading CD8 antibody to prevent Desir´e+ T cells from becoming effector cells competent to reject the infused CBK marrow. With marrow engraftment, and expansion of donor hemopoiesis, the load of donor antigen may have become large enough to bring about deletion of the Desir´e+ CD8+ T cells, and consequently tolerance to CBK skin grafts. THE BLOOD TRANSFUSION EFFECT The CD4 and CD8 antibodies described above have been extensively used by the group of Katherine Wood to examine mechanisms and feasibility of using donor blood transfusions given under the cover of CD4 antibodies to elicit tolerance to subsequent transplants of donor tissue (43–46). This group has also shown that transfectants expressing MHC class I or MHC class II molecules can be used in conjunction with therapeutic antibodies to induce tolerance. They have made the striking observation that tolerance to single MHC molecules enables recipients to subsequently accept vascularized heart grafts from donors mismatched for other MHC loci in addition to the tolerated antigen. This is an impressive demonstration of how effective linked-suppression can be, and it has interesting implications for gene therapy.

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Figure 8 CD4+ T cells and Th2 cytokines can influence tolerance in the CD8+ T cell compartment. CBA mice transgenic for the Desir´e anti-Kb TCR were treated with a myeloablative dose of Dimethyl-myeleran (DMM) 24 h before giving transgenic Kb expressing bone marrow (from CBK mice) under the cover of a nondepleting (aglycosyl hIgG1) anti-mouse CD8α antibody. Under these conditions, recipient mice became chimeric and tolerant of Kb, and would later accept CBK skin grafts indefinitely, due to deletion of the Desir´e clonotype+ CD8+ T cells. The requirement to give bone marrow showed that the nondepleting CD8 antibody alone was insufficiently immunosuppressive in this TCR transgenic model. However, deletion and tolerance were no longer achieved if monoclonal CD4 antibodies were given at the time of marrow infusion. This loss of tolerance induction was also observed if antibodies were given that neutralized the Th2 cytokines IL-4 and IL-10. In all cases, there was an absolute association between tolerance and deletion of the Desir´e+CD8+ T cells, which took place under cover of a saturating amount of CD8 antibody, suggesting that CD4+ T cells and Th2 cytokines could act to enhance the immunosuppression and tolerance induction achieved by the CD8 antibody alone.

This group has also investigated the mechanisms underlying tolerance combined with the blood transfusion effect (47–49), and has confirmed our findings described above that tolerance is dominant, involving suppression by CD4+ T cells, and can be transferred to naive recipients.

Tolerance Induced by CD4 Antibodies in Other Systems The groups of Hall (personal communication) and of Kupiec-Weglinski (50, 51) have also shown that short-term CD4 antibody therapy can also elicit tolerance

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to vascularized heart grafts in rats. In both cases, tolerance can be transferred to partially immunocompromized recipients by transfer of CD4+ T cells. Many reports also describe extended remissions or tolerance to auto-antigens induced by treatment with CD4 antibodies, indicating that mechanistic and therapeutic principles defined in the transplant models are probably also applicable in autoimmunity (52–56).

Tolerance Induction and Long-Term Graft Survival with Other Biologicals Prolonged graft survival and tolerance have also been well documented following administration of a wide range of other antibodies. It is a fair generalization that the “weaker” the antigenic system, the lower is the impact of therapy required. Skin and marrow grafts are the most demanding compared to islet or vascularized and neonatal heart or kidney grafts. Tolerance has been demonstrated with LFA-1 antibodies alone (10) or in synergy with anti-ICAM1 (57, 58); with anti-CD2 (59, 60), anti-CD3 (61), CTLA4-Ig (62–69), and others. An important observation of Chatenoud, Bach, and coworkers is that an antiCD3 antibody, even in the form of F(ab0 )2 fragments, is capable of reversing overt NOD mouse diabetes if given at the onset of hyperglycemia (61). That reversal is permanent and undoubtedly a result of tolerance to islet antigens, as fresh islet grafts function normally. In a well-publicized report (70), a combination of CTLA4-Ig and anti-CD40L antibodies synergized to enable long-term survival of MHC mismatched skin grafts. It is not clear whether this result is really due to tolerance or prolonged graft survival based on some other mechanism, as the outcome of secondchallenge transplants from the same donor were not reported. Very few independent studies have emphatically looked for evidence of the stage at which the T cells become tolerant under antibody cover, whether there is linked suppression, and whether indeed tolerance is dominant. Work of Hall and coworkers (personal communication) suggests that tolerance induced by both CD4 and CD3 antibodies results in emergence of CD4+ T cells that can transfer suppression on adoptive transfer. Nickerson, Strom, and coworkers (personal communication) have recent evidence that tolerance induced with CTLA4-Ig may also be dominant.

Is There a Unifying Explanation for How So Many Different Antibodies Can Give Rise to Tolerance? Assumptions: Let us start by considering the factors that might normally be expected to contribute toward tolerance induction. 1. Helplessness It is a long-standing dogma in immunology that most immune responses involve cooperation between lymphocytes: T cells help

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B cells, and T cells help each other. That cooperation could be by direct paracrine influence of T cell products such as IL-2, or it could be a consequence of a T cell activating a dendritic cell, so that it is better able to stimulate the next T cell, and so on. The corollary of their idea can be embraced as tolerance through helplessness and is supported by a substantive literature (e.g. 71) (Figure 9). Depletion or blockade of T cells by antibodies might therefore facilitate tolerance by limiting opportunities for T cell help (discussed further in 72, 73). 2. Costimulation Naive T cells require stimulation by “professional” antigenpresenting cells (dendritic cells) in order for them to respond to antigen. The professionalism of the dendritic cell depends upon its ability to be activated so as to provide adequate costimulation to the participating T cells. Failure to provide such activation through lack of so-called danger signals (74) could render the APC incapable of stimulating T cells appropriately. The T cell might in turn become impotent (i.e. incapable of developing damaging effector function) or might even die. Blockade of adhesion receptors and co-stimulatory molecules on T cells might result in T cells getting inadequate stimulation—this could either leave them “ignorant” or it could mean that they become impotent (a term preferable to anergy as it carries no special implication other than that the cell is compromised from reaching its final, potentially destructive, effector status). (For further discussion see References 31, 32, 74). 3. Immune deviation T cells are sensitive to their microenvironment and in their first encounters with APC may be polarized toward different forms of behavior. The local cytokine microenvironment appears critical in determining the decision of Th0 cells to differentiate to either Th1 or Th2 and perhaps further types. It is also possible that inadequate stimulation through the TCR may result in T cells adopting alternative functions that may affect the response of other T cells. Blocking antibodies may create the circumstances of incomplete signaling that might bias the direction in which T cells get polarized.

Hypothesis (Figure 10) 1. All antibodies that induce tolerance are capable of ensuring a ceasefire (i.e. can prevent the immune system from damaging the tissue and implicitly can eliminate the “danger-potentiating” inflammatory response). This gives time for the tolerance induction processes to go to completion (75). 2. During the ceasefire T cells are still able to acknowledge antigens. In other words, the ceasefire does not preclude antigen recognition. Over time, the

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interaction with antigen could lead to any of deletion, anergy, or regulation, depending on the context of antigen availability. As a corollary, any drug that interfered with T cell perception of antigen would also prevent the tolerance processes and might even antagonize the tolerogenic effects of antibodies. 3. If tolerance is to remain long-term, then either it will depend on the development of powerful regulatory processes (infectious tolerance), or will require a complete silencing or deletion of potentially reactive cells ab initio. If sufficient antigen is available to tolerize all relevant T cells both centrally and peripherally, then that tolerance is likely to be robust and to need no policing. This would be the case for high-dose tolerance with marrow (51). 4. Dominant tolerance is not so demanding. It is conceivable that regulatory T cells might be preoccupied with a limited set of antigens, and this would suffice (because of linked suppression) to maintain quiescence of all potentially antigen-reactive T cells. This is perhaps why depletion of the CD4+ subset freed up CD8+ T cells to reject grafts (30). Over the course of time, tolerance could spread to the remaining T cells through helplessness, and lack of costimulation (i.e. through failed encounters with APC), but this would not be essential for the animal to remain operationally tolerant. 5. There are no data yet available to prove that the regulation or suppression associated with dominant tolerance is an active process involving products that have paracrine activities or that downregulate APCs. Although the literature varies in the extent to which evidence implicates a Th1/Th2 switch, circumstantial evidence exists, but no convincing proof, that this type of immune deviation is necessary (e.g. compare References 18, 32, 36, 42, 52, 60, 69, 76). ←−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−− Figure 9 Tolerance induction and maintenance through helplessness—the Civil Service model. The essence of this hypothesis is that isolated single T cells can become activated to respond to antigen only by collaboration with other helpful T cells (upper left panel ), and that in the absence of help the default pathway is to switch off or become tolerant. It is proposed that both depleting (upper right panel) and nondepleting (blocking) CD4 antibodies (lower left panel ) act by removing the source of help and isolating CD4+ T cells from each other. It is further proposed that in the absence of help the T cells do not die but are maintained in a functionally impotent state (which may be related to classical anergy but for this hypothesis has only to fail to provide help). These impotent cells are then able to compete at sites of antigen presentation such that they will further isolate any emerging, undecided T cells and reinforce the tolerant state (lower right panel ). It can be seen that nondepleting CD4 antibodies would have a potential therapeutic advantage as they maintain the very T cells that are likely to become impotent regulators. Tolerance can then be seen as analogous to the popular view of a government civil service where the status quo is maintained by increasing meaningless activity to block positive action.

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Figure 10 Two steps are required for tolerance therapy: a ceasefire followed by policing. In order for a short therapeutic intervention to generate lifelong tolerance, it is necessary to consider both the induction and maintenance phases. During tolerance induction, it is necessary that the therapeutic, such as a CD4 monoclonal antibody, creates an immune ceasefire by blocking effector function. This need not be in an antigen-specific fashion as long as regulation is still allowed to develop that is antigen specific. Therefore, it is essential that tolerance-inducing regimens do not compromise the generation of CD4 antibody-resistant T cells that can later act to suppress or police any naive T cells that might emerge from the thymus during the maintenance phase. Because tolerance is maintained by antigen-specific suppression generated during the brief induction phase, responses to pathogens such as viruses and immunological memory should remain intact.

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We have proposed a general model termed the “Civil Service Model” (73) that argues a role for the impotent (anergized) T cell (see also Figure 9). The model suggests that impotent T cells can still be attracted to sites of antigen presentation where they effectively compete for access to antigen on the surface of APC. Being impotent, they may lack the ability to provide necessary help for competent T cells that are drawn to the same site. The consequence might be both helplessness and a failure to properly activate the APC. The outcome would be that the potentially competent naive T cell would itself become impotent. The process could then become self-sustaining and infectious. In this model the impotent cell is considered to interfere in a passive manner, although this is not crucial to the idea. For example, if impotent cells produced any biologically active products such as IL-10 or TGFβ, then these too would influence the local microenvironment and the outcome of encounter with antigen. Some support for this idea comes from Lechler, Lombardi, and their coworkers (77), who have done elegant studies with anergic clones suggesting that these may interfere with antigen presentation to competent T cells in vitro.

CONCLUDING REMARKS We have summarized what we know of the mechanisms determining tolerance facilitated by CD4 antibodies. In most of the examples, the complete identity of all antigens to which the immune system was tolerant was irrelevant. Therapy with anti-CD4 (±CD8) antibodies simply changes some aspect of the way the immune system perceives the antigen to which it is reacting. In that sense we are reprogramming the system. The attraction of dominant and infectious tolerance is that one does not have to guarantee tolerance to every single antigenic peptide from the outset. Rather, if one could establish a dominant regulatory mechanism, then antigen would serve to localize regulatory cells into the vicinity of potentially competent cells, thus compromising their competence to damage by linked suppression. Over the course of time, tolerance would spread as a result of all T cells eventually interacting with antigen in lymphoid organs draining the tolerizing tissue. A potential hazard of exploiting linked suppression in therapy is the possibility that the regulatory T cells would interact with all APCs carrying the tolerated antigen. How then could those APCs present viral antigens for adequate immunity? The reality is that only a subset of APCs would be so compromised, and these would be restricted to the lymphoid tissue subtending the transplanted or diseased tissue. Adequate immunity would be guaranteed by competent APCs elsewhere in the body.

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The question arises as to whether linked suppression and dominant tolerance are features unique to antibody therapy, or rather are natural mechanisms exposed and amplified by our experimental procedures. Strong evidence from Y-Chi Kong (3) and Mason, Powrie, and co-workers in particular (1, 2) suggests that CD4+ T regulatory cells exist naturally and without external provocation because they are necessary to ensure peripheral tolerance. Models of oral tolerance have also highlighted CD4+ T cell–mediated regulatory mechanisms with potent bystander effects (78). Whether all these models reflect one type of regulatory mechanism or whether there is diversity remains to be seen. Whatever the answer, dominant tolerance is likely to be eminently exploitable for therapeutic purposes. Ultimately, the clinician will be looking for ways to monitor the evolution of tolerance before withdrawing immunosuppressive drugs. If we had markers of regulatory cells or knew of their unique products, then these would be very helpful diagnostically. Tolerance without regulation could not be so monitored and could only be confirmed following judicious withdrawal of immunosuppression. For this reason, and because tolerance need not require inactivation of absolutely all antigen reactive T cells, we anticipate that the harnessing of regulatory mechanisms will prove to be the most attractive target for immunosuppression in the next millenium. ACKNOWLEDGMENTS This work was supported by the Medical Research Council of Great Britain. Visit the Annual Reviews home page at http://www.AnnualReviews.org.

Literature Cited 1. Powrie F, Mason D. 1990. Ox-22 high CD4+ T-cells induce wasting disease with multiple organ pathology: prevention by OX-22lo subset. J. Exp. Med. 172:1701–8 2. Fowell D, Mason D. 1993. Evidence that the T-cell repertoire of normal rats contains cells with the potential to cause diabetes. Characterisation of the CD4 T-cell subset that inhibits this autoimmune potential. J. Exp. Med. 177:627–36 3. Kong YM, Giraldo AA, Waldmann H, Cobbold SP, Fuller B. 1989. Resistance to experimental autoimmune thyroiditis: L3T4+ cells as mediators of both thyroglobulin-activated and TSHinduced suppression. Clin. Immunol. Immunopathol. 51:38–54 4. Benjamin RJ, Waldmann H. 1986. Induc-

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20. Cobbold SP, Martin G, Qin S, Waldmann H. 1986. Monoclonal antibodies to promote marrow engraftment and tissue graft tolerance. Nature 323:164–66 21. Waldmann H, Hale G, Cobbold S, Clark M, Qin S, Benjamin R, Dyer MJS. 1990. Monoclonal antibody therapy for the prevention of graft-vs.-host disease. Hematology 12:277–93 22. Sharabi Y, Sachs DH. 1989. Mixed chimerism and permanent specific transplantation tolerance induced by a nonlethal preparative regimen. J. Exp. Med. 169(2):493 23. Sharabi Y, Abraham VS, Sykes M, Sachs DH. 1992. Mixed allogeneic chimeras prepared by a non-myeloablative regimen: requirement for chimerism to maintain tolerance. Bone Marrow Transplant. 9(3):191 24. Tomita Y, Sachs DH, Khan A, Sykes M. 1996. Additional monoclonal antibody (mAB) injections can replace thymic irradiation to allow induction of mixed chimerism and tolerance in mice receiving bone marrow transplantation after conditioning with anti-T cell mABs and 3-Gy whole body irradiation. Transplantation 61(3):469 25. Scully R, Qin S, Cobbold SP, Waldmann H. 1994. Mechanisms in CD4 antibodymediated transplantation tolerance: kinetics of induction, antigen dependency and role of regulatory T cells. Eur. J. Immunol. 24:2383–92 26. Qin S, Cobbold SP, Pope H, Elliott J, Kioussis D, Waldmann H. 1993. Infectious transplantation tolerance. Science 12(259):974–77 27. Davies JD, Martin G, Phillips J, Marshall SE, Cobbold SP, Waldmann H. 1996. T cell regulation in adult transplantation tolerance. J. Immunol. 157:529–33 28. Yin D, Fathman GD. 1995. CD4+ suppressor cells block allotransplant rejection. J. Immunol. 154:6339–45 29. Cobbold SP, Martin G, Waldmann H. 1990. The induction of skin graft tolerance in MHC-mismatched or primed recipients: primed T-cells can be tolerized in the periphery with CD4 and CD8 antibodies. Eur. J. Immunol. 20:2747–55 30. Marshall SE, Cobbold SP, Davies JD, Martin GM, Phillips JM, Waldmann H. 1996. Tolerance and suppression in a primed immune system. Transplantation 62:1614–21 31. Cobbold SP, Adams E, Marshall SE, Davies JD, Waldmann H. 1995. Mechanisms of peripheral tolerance and suppression induced by monoclonal anti-

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WALDMANN & COBBOLD bodies to CD4 and CD8. Immunol. Rev. 148:1–29 Cobbold SP, Qin S, Leong LYW, Martin G, Waldmann H. 1992. Reprogramming the immune system for peripheral tolerance with CD4 and CD8 monoclonal antibodies. Immunol. Rev. 129:165– 201 Chen Z, Cobbold SP, Metcalfe S, Waldmann H. 1992. Tolerance in the mouse to MHC mismatched heart allografts, and to rat heart xenografts, using monoclonal antibodies to CD4 and CD8. Eur. J. Immunol. 22:805–10 Chen Z, Cobbold SP, Waldmann H, Metcalfe SM. 1994. Tolerance induction in concordant heart-xenografted mice by CD4 and CD8 monoclonal antibodies. Transplant Proc. 26(3):1199–1200 Chen Z, Cobbold SP, Waldmann H, Metcalfe SM. 1994. Tolerance induction in concordant heart-xenografted mice by CD4 and CD8 monoclonal antibodies. Transplant Proc. 26(3):1199–200 Chen ZK, Cobbold SP, Waldmann H, Metcalfe S. 1996. Amplification of natural regulatory immune mechanisms for transplantation tolerance. Transplantation 62:1200–6 Waldmann H, Cobbold SP, Qin S, Benjamin RJ, Wise M. 1989. Tolerance induction in the adult using monoclonal antibodies to CD4, CD8 and CD11a (LFA-1). Symp. Quant. Biol.: Immunol. Recog. 54th, Cold Spring Harbor, ME: Cold Spring Harbor Lab. Press. LIV, 885– 892 Alters SE, Song HK, Fathman CG. 1993. Evidence that clonal anergy is induced in thymic migrant cells after antiCD4-mediated transplantation tolerance. Transplantation 56(3):633 Alters SE, Shizuru JA, Ackerman J, Grossman D, Seydel KB, Fathman CG. 1991. Anti-CD4 mediates clonal anergy during transplantation tolerance induction. J. Exp. Med. 173(2):491–94 Shizuru JA, Alters SE, Fathman CG. 1992. Anti-CD4 monoclonal antibodies in therapy: creation of nonclassical tolerance in the adult. Immunol. Rev. 129: 105 Bemelman F, Honey K, Adams L, Cobbold SP, Waldmann H. 1998. Bone marrow transplantation induces either clonal deletion or infectious disease tolerance depending on the dose. J. Immunol. In press Scully R, Cobbold SP, Mellor AL, Wissing M, Arnold B, Waldmann H. 1998. A role for Th2 cytokines in the suppression

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of CD8+ T-cell mediated graft rejection. Eur. J. Immunol. In press Pearson TC, Madsen JC, Larsen CP, Morris PJ, Wood KJ. 1992. Induction of transplantation tolerance in adults using donor antigen and anti-CD4 monoclonal antibody. Transplantation 54(3):475 Wood KJ. 1993. The induction of tolerance to alloantigens using MHC class I molecules. Curr. Opin. Immunol. 5(5):759 Bushell A, Morris PJ, Wood KJ. 1994. Induction of operational tolerance by random blood transfusion combined with anti-CD4 antibody therapy. A protocol with significant clinical potential. Transplantation 58(2):133 Pearson TC, Darby CR, Bushell AR, West LJ, Morris PJ, Wood KJ. 1993. The assessment of transplantation tolerance induced by anti-CD4 monoclonal antibody in the murine model. Transplantation 55(2):361 Bushell A, Morris PJ, Wood KJ. 1995. Transplantation tolerance induced by antigen pretreatment and depleting antiCD4 antibody depends on CD4+ T cell regulation during the induction phase of the response. Eur. J. Immunol. 25(9): 2643 Saitovitch D, Morris PJ, Wood KJ. 1996. Recipient cells expressing single donor MHC locus products can substitute for donor-specific transfusion in the induction of transplantation tolerance when retreatment is combined with anti-Cd4 monoclonal antibody. Evidence for a vital role of CD4+ T cells in the induction of tolerance to class I molecules. Transplantation 61(10):1532 Saitovitch D, Bushell A, Mabbs DW, Morris PJ, Wood KJ. 1996. Kinetics of induction of transplantation tolerance with a nondepleting anti-CD4 monoclonal antibody and donor-specific transfusion before transplantation. A critical period of time is required for development of immunological unresponsiveness. Transplantation 61(11):1642–47 Ondera K, Lehmann M, Akalin E, Volk HD, Sayegh MH, Kupiec-Weglinksi JW. 1996. Induction of infectious tolerance to MHC incompatible cardiac allografts in CD4 monoclonal antibody-treated sensitized rat recipients. J. Immunol. 157: 1944–50 Onodera K, Hancock W, Graser E, Lehmann M, Sayegh M, Strom T, Voiak H-D, Kupiec-Weglinski JW. 1997. Type 2 helper T-cell-type cytokines and the development of “infectious” tolerance in rat

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cardiac allograft recipients. J. Immunol. 158:1572–81 Hayward AR, Shriber M, Cooke A, Waldmann H. 1993. Prevention of diabetes but not insulitis in NOD mice injected with antibody to CD4. J. Autoimmun. 6:301– 10 Hutchings P, O’Reilly L, Parish NM, Waldmann H, Cooke A. 1992. The use of a non-depleting anti-CD4 monoclonal antibody to re-establish tolerance to β cells in NOD mice. Eur. J. Immunol. 22:1913– 18 Parish NM, Hutchings PR, Waldmann H, Cooke A. 1993. Tolerance to IDDM induced by CD4 antibodies in nonobese diabetic mice is reversed by cyclophosphamide. Diabetes 42(11):1601–5 Hutchings PR, Cooke A, Dawe K, Waldmann H, Roitt IM. 1993. Active suppression induced by anti-CD4. Eur. J. Immunol. 23(4):965–68 Billingham MEJ, Hicks C, Carney S. 1990. Monoclonal antibodies and arthritis. Agents Actions 29:77–87 Isobe M, Yagita H, Okumura K, Ihara A. 1992. Specific acceptance of cardiac allograft after treatment with antibodies to ICAM-1 and LFA-1. Science 255(5048):1125–27 Isobe M, Suzuki J, Yamazaki S, Sekiguchi M. 1996. Acceptance of primary skin graft after treatment with anti-intercellular adhesion molecule-1 and anti-leukocyte function-associated antigen-1 monoclonal antibodies in mice. Transplantation 62(3):411–13 Chavin KD, Qin L, Lin J, Yagita H, Bromberg JS. 1993. Combined anti-CD2 and anti-CD3 receptor monoclonal antibodies induce donor-specific tolerance in a cardiac transplant model. J. Immunol. 151(12):7249–59 Krieger NR, Most D, Bromberg JS, Holm B, Huie P, Sibley RK, Dafoe DC, Alfrey EJ. 1996. Coexistence of Th1- and Th2type cytokine profiles in anti-CD2 monoclonal antibody-induced tolerance. Transplantation 62(9):1285–92 Chatenoud L, Thervett E, Primo J, Bach JF. 1994. Anti-CD3 antibody induces long-term remission of overt autoimmunity in non-obese diabetic mice. Proc. Natl. Acad. Sci. USA 91:123–27 Lenschow DJ, Zeng Y, Thistlethwaite JR, Montag A, Brady W, Gibson MG, Linsley PS, Bluestone JA. 1992. Longterm survival of xenogeneic pancreatic islet grafts induced by CTLA4-Ig. Science 257(5071):789 Pearson TC, Alexander DZ, Winn

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KJ, Linsley PS, Lowry RP, Larsen CP. 1994. Transplantation tolerance induced by CTLA4-Ig. Transplantation 27 57(12):1701 Pearson TC, Alexander DZ, Winn KJ, Linsley PS, Lowry RP, Larsen CP. 1994. Transplantation tolerance induced by CTLA4-Ig. Transplantation 57(12):1701 Steurer W, Nickerson PW, Steele AW, Steiger J, Zheng XX, Strom TB. 1995. Ex vivo coating of islet cell allografts with murine CTLA4/Fc promotes graft tolerance. J. Immunol. 155(3):1165 Bolling SF, Lin H, Wei RQ, Turka LA. 1996. Preventing allograft rejection with CTLA4-Ig: effect of donor-specific transfusion route or timing. J. Heart Lung Transplant. 15(9):928 Judge TA, Tang A, Spain LM, DeansGratiot J, Sayegh MH, Turka LA. 1996. The in vivo mechanism of action of CTLA-4Ig. J. Immunol. 156(6):2294 Pearson TC, Alexander DZ, Hendrix R, Elwood ET, Linsley PS, Winn KJ, Larsen CP. 1996. CTLA4-Ig plus bone marrow induces long-term allograft survival and donor specific unresponsiveness in the murine model. Evidence for hematopoietic chimerism. Transplantation 61(7):997 Lakkis FG, Konieczny BT, Saleem S, Baddoura FK, Linsley PS, Alexander DZ, Lowry RP, Pearson TC, Larsen CP. 1997. Blocking the CD28-B7 T cell costimulation pathway induces long term cardiac allograft acceptance in the absence of IL4. J. Immunol. 158(5):2443 Larsen CP, Elwood ET, Alexander DZ, Ritchie SC, Hendrix R, Tucker-Burden C, Cho HR, Aruffo A, Hollenbaugh D, Linsley PS, Winn KJ, Pearson TC. 1996. Long-term acceptance of skin and cardiac allografts after blocking CD40 and CD28 pathways. Nature 381(6581):434–37 Guerder S, Matzinger P. 1989. Activation vs tolerance. A decision made by T-helper cells. Cold Spring Harbour Symp. Quant. Biol. 54:799 Waldmann H, Cobbold S, Benjamin R, Qin S. 1988. A theoretical framework for self-tolerance and its relevance to therapy of auto-immune disease. J. Autoimmun. 1:623–29 Waldmann H, Qin S, Cobbold S. 1992. Monoclonal antibodies as agents to reinduce tolerance in immunity. J. Autoimmun. 5(Suppl A):93–102 Matzinger P. 1994. Tolerance, danger, and the extended family. Annu. Rev. Immunol. 12:991–1015 Waldmann H, Cobbold S. 1996. How

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may immunosuppression lead to tolerance? The war analogy. In Immune Tolerance, ed. J Banchereau, B Dodet, R Schwartz, E Trannoy, pp. 221–27. Paris: Elsevier 76. Nickerson P, Steurer W, Steiger J, Zheng X, Steel A, Strom TB. 1994. Cytokines and the Th1/Th2 paradigm in transplantation. Curr. Opin. Immunol. 6: 757–64 77. Lombardi G, Sidhu S, Batchelor R, Lechler R. 1994. Anergic T-cells acts as

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suppressors in-vitro. Science 264(5165): 1587–89 78. Weiner HL, Friedmandein A, Miller A, Khoury SJ, Al-Sabbagh A, Santos L, Sayegh M, Nussenblatt RB, Trentham DE, Hafler DL. 1994. Oral tolerance: immunologic mechanisms and treatment of animal and human organ-specific autoimmune diseases by oral administration of autoantigen. Annu. Rev. Immunol. 12:809–37

NOTE ADDED IN PROOF:

The personal communication referred to on page 634 is now published: Tran HM, Nickerson PW, Restif AC, Iris-Woodward MA, Patel A, Allen RD, Strom TB, O’Connell PJ. 1997. Distinct mechanisms for the induction and maintenance of allograft tolerance with CTLA-4 Fc treatment. J. Immunol. 159:2232– 39

Annual Review of Immunology Volume 16, 1998

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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Annu. Rev. Immunol. 1998. 16:645–70 c 1998 by Annual Reviews Inc. All rights reserved Copyright

POSITIVE VERSUS NEGATIVE SIGNALING BY LYMPHOCYTE ANTIGEN RECEPTORS James I. Healy Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California 94305; e-mail: [email protected]

Christopher C. Goodnow Australian Cancer Research Foundation Genetics Laboratory, and Medical Genome Centre, John Curtin School of Medical Research, Mills Road, PO Box 334, Australian National University, Canberra 2601, Australia; e-mail: [email protected] KEY WORDS:

autoimmunity, tolerance, calcium signal, NFκB, NFAT, JNK, ERK, Fas/CD95, SHP-1, partial activation

ABSTRACT Antigen receptors on lymphocytes play a central role in immune regulation by transmitting signals that positively or negatively regulate lymphocyte survival, migration, growth, and differentiation. This review focuses on how opposing positive or negative cellular responses are brought about by antigen receptor signaling. Four types of extracellular inputs shape the response to antigen: (a) the concentration of antigen; (b) the avidity with which antigen is bound; (c) the timing and duration of antigen encounter; and (d) the association of antigen with costimuli from pathogens, the innate immune system, or other lymphocytes. Intracellular signaling by antigen receptors is not an all-or-none event, and these external variables alter both the quantity and quality of signaling. Recent findings in B lymphocytes have clearly illustrated that these external inputs affect the magnitude and duration of the intracellular calcium response, which in turn contributes to differential triggering of the transcriptional regulators NFκB, JNK, NFAT, and ERK. The regulation of calcium responses involves a network of tyrosine kinases (e.g. lyn, syk), tyrosine or lipid phosphatases (CD45, SHP-1, SHIP), and accessory molecules (CD21/CD19, CD22, FcRγ 2b). Understanding the biochemistry and logic behind these integrative processes will allow development of more selective and efficient pharmaceuticals that suppress, modify, or

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augment immune responses in autoimmunity, transplantation, allergy, vaccines, and cancer.

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INTRODUCTION Antigen receptors on lymphocytes have a dual potential to transmit crucial activating signals for initiating immune responses or to discharge equally potent inactivating signals to abort or inhibit self-reactive clones. The notion that lymphocytes distinguish foreign antigens from self-antigens by responding positively and negatively to antigen receptor ligation is a central theme around which immunology has developed (1–9). Many events impact on this fundamental decision-making process in lymphocytes, and one of the great challenges for modern immunology is to decipher the molecular wiring that integrates and converts these extrinsic and intrinsic variables into positive or negative cellular responses.

External and Intrinsic Modulators of Positive and Negative Responses Positive and negative lymphocyte responses to antigen are regulated by four types of inputs: the physical properties of the antigen such as its concentration and avidity of binding, the timing of antigen encounter, and the association of antigen with costimuli (Figure 1). Antigen concentration refers simply to the amount of soluble or membrane-bound ligand that can bind the B cell receptor or the concentration of specific peptide/MHC complexes available to bind the T cell receptor. The avidity of binding encompasses the intrinsic affinity of the antigen receptor for a single epitope as well as the valency or ability of the antigen to cluster multiple receptors. Timing denotes either the developmental stage during which antigen is encountered or the actual duration of the encounter. Finally, the association of antigenic stimuli with costimuli from three possible sources can alter cellular responses. Costimuli can be derived from pathogens such as bacterial lipopolysaccharide, from the innate immune system such as the C3d fragment of complement or costimulatory molecules on macrophages and dendritic cells, or from other lymphocytes such as the cytokines produced by helper T cells or specific immunoglobulin that are secreted by plasma cells and modify responses. When considering the effect these four variables have on lymphocyte responses, it is important to distinguish two fundamentally different situations in which opposite responses are brought about by antigen receptors of the same specificity. In the first situation, negative and positive responses are triggered

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Figure 1 The four chief inputs shaping the decision between positive and negative responses to antigen.

at different stages of lymphocyte development, and in the second, negative or positive responses are triggered at the same stage of lymphocyte maturity as a result of variations in costimulation or in the antigen concentration, avidity, or duration.

DEVELOPMENTAL SWITCHES FROM NEGATIVE TO POSITIVE RESPONSES The first observations that opposite responses to antigen occur at different stages in development were dependent on immature animal models and neonatal antigen exposure (2, 10–12). Refinement of this developmental timing concept refocused attention from the maturity of the animal to the maturation state of each lymphocyte (3). The difference between the responses of immature and of mature B cells to antigen receptor ligation was the first example, and perhaps best example, of the role development plays in governing lymphocyte responses. Cross-linking B cell receptors on immature B cells aborts B cell development in vivo (13) and transmits a signal that is sensitive to metabolic inhibitors and that preferentially inactivates immature B cells in vitro (6, 14–21). Stimulation

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of mature B cells with anti-IgM antibodies triggers a mitogenic response (22) that is affected by the degree of cross-linking and the presence of costimuli (see below). More recent experiments tracking antigen-specific monoclonal B cells in transgenic mice have reinforced the notion of different responses to the same antigen by immature and mature B cells (23–26). A parallel situation exists in T cells, where extensive receptor cross-linking by anti-CD3, superantigens, alloantigens, or viral antigens triggers apoptotic deletion of immature thymocytes but triggers proliferation of mature T cells (27–34). The ability of myeloid dendritic cells to potently stimulate proliferation and effector functions in mature T cells, but inactivate immature T cells (35–39), further emphasizes the importance of lymphocyte maturation in determining whether the cellular response to receptor ligation will be positive or negative.

DYNAMIC SWITCHES FROM NEGATIVE TO POSITIVE SIGNALING While the negative versus positive responses described above may reflect developmental changes in the hardwiring of antigen receptor signaling in the cytoplasm or in the transcriptional machinery in the nucleus, there are situations where negative or positive signaling occurs at a single stage of maturation. These opposite responses in developmentally matched populations highlight the remarkable plasticity of antigen receptor signaling. Whole-animal experiments have long indicated that mature B cells can either be activated or inactivated by antigens (40, 41). Perhaps the best-studied example is the immunogenic versus tolerogenic effect of aggregated and deaggregated human gamma globulin, respectively (42, 43). Negative and positive responses to antigen in mature B cells were subsequently shown to depend on antigen avidity, in particular, on whether an optimal number of antigen receptors (10–15) are clustered together in a positive signaling “immunon” (44–46). Negative versus positive signaling and responses also depend on the absence or presence of immunogenic costimuli from pathogens such as bacterial endotoxin (47–49), from the innate immune responses such as complement (50–54) or from the helper T cells (4, 55–61). In contrast to immunogenic antigens, which induce positive responses when administered as single pulses (62), experiments with organ explants (63) or other tolerogenic antigens have demonstrated that persistent antigen exposure is necessary to induce or reinforce negative responses (19, 64–66). These data suggested that self-antigens induced a potentially reversible tolerant state, but the significance of these findings has only recently been appreciated explicitly with studies on the biochemical signaling that occurs during positive and negative responses, discussed below.

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A striking example of the plasticity of signaling by B cell antigen receptors is the ability of soluble hen egg lysozyme (HEL) antigen to promote or inhibit maturation and survival of mature HEL-binding B cells after their emigration from the bone marrow (67–70). In this case mutations in different tyrosine phosphatases either exaggerate negative signaling or convert signaling from negative to positive, independent of costimuli or the degree of receptor clustering. Likewise, HEL antigen can either promote mitogenesis or promote Fas-mediated apoptosis in mature B cells depending on the timing of HEL antigen relative to encounter with helper T cells (71). Along the same lines, antigen can also either trigger apoptosis (72–74) or promote survival and memory cell formation (75) in germinal center B cells, depending perhaps on costimuli such as complement. The T cell antigen receptor shows a comparable ability to signal negative or positive responses. Thus, different peptide ligands for the TCR, or different amounts of these ligands, can trigger negative or positive selection of doublepositive thymocytes (reviewed by 76 and 77). In T cell clones and primary T cells, differences in peptide/MHC quality and amount can trigger either a positive Th1 cytokine production, partial activation followed by anergy, or deviation to secrete only Th2 cytokines (78).

MODELS FOR NEGATIVE VERSUS POSITIVE RESPONSES Negative Versus Positive Response Genes The decision between negative versus positive responses to antigen involves differences in gene expression. In general terms, negative responses and positive responses could reflect either induction or repression of completely nonoverlapping sets of genes or partially overlapping sets, or one response could involve only a subset of the genes that are regulated in the opposite response (Figure 2). Little information is currently available regarding negative and positive response genes. The key general issue is how different sets of genes can be regulated by the same receptor to bring about negative versus positive responses. There are three basic possibilities (Figure 3) as described below.

Nuclear Quality Model: Differences in Transcription Factor Expression or Chromatin Structure One of the simplest ways to explain a developmental switch from negative to positive responses between immature and mature lymphocytes is to assume that antigen receptor signals are either on or off like a binary ignition switch and use the same intracellular pathways to the nucleus at all times (Figure 3A). In this model, differences in the nucleus would interpret the same signal in

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Figure 2 Positive versus negative responses to antigen may reflect induction/repression of entirely separate sets of genes, partially overlapping sets of genes, or one response may involve a subset of the genes that are induced/repressed in the other.

alternate ways. Developmental changes in transcription factor expression or chromatin structure that exist prior to antigen encounter could allow the same cytosolic signals to regulate different sets of genes in the nuclei of immature versus mature lymphocytes. Dynamic changes in transcription factor expression between naive, anergic, and memory B or T cells could similarly explain positive or negative responses occurring at a single stage of maturation.

Signal Quantity Model: Differences in the Amount of Cytosolic Signaling As opposed to all-or-none cytosolic signaling, a purely quantitative signaling model could also explain negative versus positive responses to antigen by assuming that lymphocyte antigen receptors function like an electric rheostat, uniformly increasing or decreasing the flow of signals via all pathways to the nucleus, depending on antigen concentration, avidity, timing, and costimuli (Figure 3B). In the nucleus, response genes with a low signal threshold would be activated at trace levels of signaling. These low-level response genes would then regulate cellular responses that are most sensitive to the antigen receptor. At higher signaling levels, additional response genes would be induced and thereby generate different cell fates. A quantitative model would imply that low-level response genes can be activated independently of higher threshold response genes. Tolerogenic stimuli could thus induce a subset of the genes that are induced by immunogenic stimuli (or vice versa) (Figures 2 and 3B), and the fate of the lymphocyte would depend on the amplitude of signal current passing from the receptor to the nucleus (Figure 3B).

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Figure 3 Three models to explain how antigen receptors may trigger positive and negative responses. In (A), pre-existing differences in the set of transcription factors (Q,R,S vs X,Y,Z) and chromatin pattern cause the same pattern of signaling to operate different sets of genes. In (B), intense signaling through all pathways (A, B, C) activates genes with a high or low signal threshold, while low-level signaling through the same pathways activates only a subset of genes with low signal thresholds. In the diagram, negative responses are shown as resulting from lower signal magnitude and positive from high, but the reverse scenario is equally plausible. In (C ), antigen activates a different set of signaling pathways during positive versus negative responses. Signals for negative responses could be a subset of those required for positive responses, as shown, or vice versa, or unique sets of signals could be involved.

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Signal Quality Model: Selective Triggering of Different Cytosolic Signals A qualitative signaling model, on the other hand, would predict that lymphocyte antigen receptors can function as a switchboard, allowing distinct nuclear signaling pathways to be turned on or off independently of one another (Figure 3C ). In this model, negative responses could result from an inability to trigger key pathways required for positive immune responses and/or from activation of pathways that repress or abort immune responses. The expression of response genes in a signal quality model would depend on the combination of active signaling pathways. Tolerogenic and immunogenic stimuli could thus induce either nonoverlapping sets of genes or partially overlapping sets of genes, or a negative response could involve a subset of the genes induced in a positive response (or vice versa) (Figure 2). The fate of the lymphocyte would depend on which set of signaling pathways was connected to the “receptor switchboard” under a given set of circumstances.

Technical Limitations Any of these three models may function alone or in combination to regulate positive and negative responses. Two technical criteria must be met in order to examine these signaling models and determine how cellular responses are influenced by antigen concentration, avidity, timing, and costimuli. First, each of the inputs (Figure 1) must be able to be varied independently of one another. Second, relatively large numbers of purified lymphocytes with uniform antigen specificity are needed to perform biochemical analysis during positive versus negative responses. Transgenic mouse models, by allowing genetic control over these variables in vivo, and T cell clones, by enabling in vitro manipulation, have met these criteria best.

EXAMPLES OF SIGNAL QUALITY DIFFERENCES Responses in Naive Versus Tolerant Mature B Cells Transgenic mice expressing a well-defined HEL-specific receptor on most B cells (IgHEL transgenic mice) in combination with mice expressing HEL as a self-antigen (HEL-transgenic mice) provide a well-controlled model to analyze positive versus negative signaling. In IgHEL transgenic mice, B cells expressing the HEL-specific B cell receptor (BCR) mature in the bone marrow, travel through the blood, and migrate into secondary lymphoid organs as mature, naive B cells (Figure 4, top). During this preimmune phase of maturation, the BCRs on these cells have not been exposed to HEL. Acute ligation of the BCR on these naive cells with foreign HEL antigen rapidly induces expression

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Figure 4 Diagram illustrating the differences in timing and costimuli that typically distinguish foreign antigens from self-antigens. Foreign antigens are typically encountered late in lymphocyte development as an acute antigenic signal in the draining lymphoid organ and are accompanied by costimuli (shown here for B cells as coming from helper T cells). Self-antigens are often encountered early in lymphocyte maturation and stimulate the cells in a chronic fashion. This chronic negative signal is not usually accompanied by costimuli, and when costimuli such as helper T cells become present, the nature and response to these costimuli is reversed so that they trigger elimination rather than activation.

of the costimulatory molecule CD86/B7.2, promotes c-myc induction and cell cycle progression, and renders the cells resistant to Fas/CD95-dependent elimination by CD4 T cells (71, 79). When these acute, positive BCR signals are accompanied or shortly followed by costimuli from antigen-specific T cells or bacterial endotoxin, the combination of inputs results in T cell–dependent or T cell–independent clonal expansion and antibody production (68, 79, 80). By contrast, in HEL/IgHEL double-transgenic mice, which express soluble HEL as a circulating self-antigen, the concentration and avidity of antigen and the maturation state of the cells are the same, but the timing of B cell encounter with HEL and costimulation are different (Figure 4, bottom). In this case, binding of soluble HEL begins as soon as BCRs are expressed on immature B cells in the bone marrow (81) and continues chronically as the cells mature and migrate from primary to secondary lymphoid organs. During the early initial encounter in the bone marrow and during the chronic exposure

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in the periphery, no positive responses occur such as high-level CD86/B7.2 expression, cell enlargement, c-myc-induction, or cell cycle progression (79, 80; and unpublished observations). Once the cells have become tolerant, they are no longer able to mount a T-dependent antibody response (23, 81) but instead are eliminated by CD4 cells through a FasL-Fas-mediated process (71, 82). Similarly, the tolerant B cells no longer exhibit synergistic signaling between the BCR and LPS or interleukin 4 (79). The loss of positive responses to antigen in tolerant B cells is not due to their having become globally refractory to antigen, because the chronic binding of self-HEL is still very efficient at inducing negative responses in the B cells that reinforce tolerance in the periphery. Continued exposure to HEL inhibits the migration of tolerant B cells into primary follicles and marginal zones, trapping them in the T cell zones and preventing their recirculation to other secondary lymphoid organs, and interferes with their survival (67, 68, 83, 84). While tolerant B cells have lost the synergistic proliferative response to LPS and HEL antigen that occurs in naive cells, HEL antigen is still very efficient at inhibiting LPS-induced differentiation of tolerant B cells into antibody-secreting plasma cells (80; JI Healy unpublished data). Tolerant B cells thus still respond to HEL antigen, but their response is exclusively negative. SIGNALING IN NAIVE AND TOLERANT B CELLS Comparison of signaling in these matched cell populations that have an identical specificity and maturation state reveals biochemical differences consistent with the signal quality model outlined in Figure 3C (85). Prior to HEL antigen exposure, naive cells have a stable, low intracellular calcium concentration (<100 nM), little active ERK, RSK, or JNK MAP kinases, and the transcription factors NFATc, NFATp, and NFκB p65 and c-rel are all predominantly in the cytosol. Upon acute HEL exposure, naive B cells exhibit a large biphasic calcium response with an initial spike above 1 µM Ca2+ and a sustained phase above 500 nM. NFATc, NFATp, NFκB p65 and c-rel are translocated to the nucleus within 1–15 min, the c-myc gene is induced within 30 min, JNK and ERK are activated and phosphorylate ATF2 and RSK within 2–10 min, and the ERK/RSK responsive gene egr-1 is induced within 30–60 min (85). B7.2 and CD69 proteins are induced and begin to increase on the cell surface within 2 h after acute HEL exposure (86 and unpublished data). Tolerant B cells, on the other hand, exhibit chronic low calcium oscillations in the 200–300 nM range, continuous shuttling of NFATc and NFATp to the nucleus, activation of the ERK and RSK MAP kinases, and induction of the ERK responsive gene egr-1 (85). This signaling is due to chronic binding of self-HEL antigen to the B cell receptor because it reverts to naive levels when tolerant B cells are transferred to mice that do not express HEL antigen, and

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Figure 5 Summary of differences in BCR signal quality and quantity that accompany different responses to sHEL antigen in mature IgHEL B cells. A high-calcium response and all of the signaling pathways shown are activated by acute BCR stimulation of naive cells, whereas only a low-calcium response and a subset of BCR signals are activated in tolerant cells that have already been stimulated chronically. In the absence of CD45, none of these BCR signaling pathways is detectably activated by chronic self-HEL exposure, but an unknown signal is apparently transmitted that promotes maturation and survival of the B cells in secondary lymphoid tissues. When CD45-deficient B cells are not exposed to HEL, they fail to persist or complete their maturation after leaving the bone marrow.

it is not present in B cells lacking the BCR-associated tyrosine phosphatase CD45. In contrast to naive cells, neither NFκB nor JNK are activated (85), nor is c-myc, B7.2, or CD69 induced (79, and unpublished data). Thus, the negative response to chronic self-HEL triggers only a subset of the signals and response genes that are active in the acute positive response made by naive B cells (Figures 2 and 5). Further study is required to determine if there are any genes uniquely active in tolerant cells, or whether the negative response involves simply a subset of the signals and genes needed for a positive response. The latter view is consistent with the behavior of naive B cells when they are transferred into HEL-expressing mice and exposed to HEL chronically without T cell help, because after an initial activation phase their response becomes more like that of tolerant cells. Thus, the naive cells are also prevented from migrating into follicles and recirculating; they lose B7.2 expression after 1–2 days (JC Rathmell, CC Goodnow, unpublished observations) and lose the capacity to collaborate with helper T cells (87); they begin to die after a 20 h delay (68). Similarly,

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while antigen and LPS show synergistic signaling for proliferation only in naive B cells, persistent but not transient HEL antigen treatment inhibits LPSinduced plasma cell differentiation in both naive and tolerant B cells (80; JI Healy manuscript in preparation). It is not yet known if BCR signaling is altered to the pattern seen in tolerant cells in naive cells that are chronically exposed to HEL after they have matured. HOW DOES CHRONIC ANTIGEN EXPOSURE ALTER SIGNAL QUALITY? The different magnitude of the calcium signal elicited by HEL antigen in naive versus tolerant B cells is in turn sufficient to explain the selective activation of NFAT but not NFκB or JNK. Thus, while all three of these signaling pathways are activated by the BCR through a calcium responsive/cyclosporin A-sensitive intermediate (85), NFAT is activated at lower calcium concentrations (200 nM), whereas NFκB and JNK require higher calcium for activation (>500 nM) (88). The 250-nM calcium oscillations occurring in tolerant cells are both sufficient and necessary for NFATc and NFATp translocation to the nucleus (85), but insufficient for activating NFκB or JNK. The sensitivity to cyclosporin A implies a role for calcineurin in activation of all three pathways. The faster kinetics of activation and higher calcium sensitivity of NFAT imply that calcineurin’s effect on NFAT is immediate, possibly through direct intramolecular binding (89). Local calcium gradients and additional calcium-sensitive enzymes may be involved in NFκB/JNK activation. The different calcium thresholds could mean that calcium/calcineurin activation of NFAT occurs near the source of calcium, whereas NFκB/JNK is more distant, or the higher calcium requirement for the latter could be needed to activate another enzyme that has a higher calcium threshold. Regardless of the mechanism, these distinct calcium thresholds allow the BCR to function as a switchboard, connecting to all three signaling pathways during the high-calcium acute response, but linking only to NFAT during the chronic response in tolerant cells. Unlike NFAT, which is activated by calcium alone (90), BCR-induced activation of NFκB and JNK also depends on a calcium-independent pathway that can be mimicked by phorbol ester stimulation and may normally involve the small G-protein rac (91–93). It is possible that this pathway is also differentially activated during the acute versus chronic antigen response, because ionomycin can restore a high-calcium response in tolerant cells, but this is insufficient to trigger NFκB or JNK. The combination of phorbol ester and ionomycin activates NFκB and JNK equally in naive and tolerant cells at all doses tested, indicating that downstream inhibitors of these pathways such as JNK-phosphatases are unlikely to be preferentially active in tolerant cells (85, JI Healy, data not shown). The different magnitude of calcium signaling in naive and tolerant B cells is likely to reflect deficits in proximal signaling intermediates in tolerant cells.

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Little tyrosine phosphorylation of pp72syk occurs in tolerant cells exposed to HEL, in contrast to the acute phosphorylation induced in naive cells (79; M Cooke, B Weintraub, unpublished data). This deficit is sufficient to account for the depressed elevation of intracellular calcium in tolerant cells, because syk is required for phosphorylation of phospholipase C-γ and elevation of calcium in B lymphoma cells (94) and for calcium elevation in HEL-specific immature marrow B cells (R Cornall, A Cheng, T Pawson, CC Goodnow, manuscript in preparation). HEL also induces little increase in tyrosine phosphorylation of CD79/Igα and β in tolerant cells (79; M Cooke, B Weintraub, unpublished data). This deficit could either be a cause or an effect of poor syk activation. The low calcium oscillations and ERK activation that are stimulated by HEL in tolerant cells appear to depend on one or more src kinases because both of these signaling events are absent in tolerant B cells lacking CD45 (85). LINKING SIGNALS TO RESPONSES The different sets of signaling pathways triggered in naive and tolerant B cells help to illuminate the basis for some of the positive versus negative responses in this setting. Failure to translocate NFκB c-rel to the nucleus is likely to explain the lack of mitogenic responses to antigen in tolerant B cells because B cells lacking one or both copies of the c-rel gene have reduced or absent proliferative responses to acute BCR clustering (95). Failure to activate high level B7.2 expression in tolerant cells appears to be central to their inability to make a T cell–dependent antibody response and Fas-mediated elimination by HEL-specific helper T cells. When B7.2 expression is artificially restored on tolerant B cells using a constitutive B7.2 transgene, this is sufficient to convert the outcome of collaboration with T cells from Fas-mediated elimination to clonal expansion and high-level autoantibody production (J Rathmell, S Fournier, B Weintraub, J Allison, CC Goodnow, submitted). It will be important in future work to define the signaling pathways that trigger B7.2 expression on naive cells, as components of this pathway are likely candidates for genetic susceptibility to autoimmunity. By contrast, persistent ERK activation in naive and tolerant B cells may mediate the inhibition of LPS-induced plasma cell differentiation in these cells. Like ERK activation, this effect of antigen is calcium independent and cyclosporin resistant, is mimicked by low concentrations of phorbol ester, and can be inhibited by a dominant negative ras transgene. This negative signal blocks expression of the plasma cell transcription factor, BLIMP, and of plasma cell genes syndecan-1 and J chain, as well as preventing the characteristic decrease in Pax5 and CD72 expression that normally occurs upon plasma cell differentiation (JI Healy, manuscript in preparation). It will be important to resolve whether chronic activation of NFAT, ERK, or another signaling pathway mediates other negative responses such as the restriction of B cell migration to the T zones and inhibition of B cell recirculation

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and survival. Comparable negative responses have been described in other transgenic models in B cells chronically exposed to deaggregated human gamma globulin (96), and autoreactive B cells in MRL-lpr mice are concentrated in the T zones (97), confirming that this peripheral tolerance process is of broad significance.

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Responses in Naive Versus Tolerant T Cells Comparison of responses in naive or anergic primary T cells and T cell clones has also revealed signaling differences consistent with the signal quality model outlined in Figure 3C. These models have primarily contrasted naive T cells with T cells that have previously been stimulated in vitro with peptide/MHC complexes or anti-TCR antibody in the absence of costimuli such as CD28 (78, 98). For in vivo studies, anergic T cells that have been chronically stimulated with exogenous superantigens can be obtained from mice in sufficient numbers after passing through an acute proliferative phase (99–103). Alternatively, anergic T cells that have been chronically exposed to self-superantigens during their maturation from the thymus to the periphery can be obtained in reasonable numbers from mice that do not cause the deletion of these T cells in the thymus (104–106). The different functional responses to antigen made by anergic and naive T cell clones are not strictly a negative versus positive reaction, but rather anergic cells become restricted to making only a subset of the responses made by naive T cells. For example, anergic TH0 clones produce normal amounts of IL-4 but no longer synthesize IL-2 (107–109); anergic Th2 clones secrete IL-4 but become unable to respond to IL-4 for autocrine mitogenesis (110); and anergic Th1 and CD8 cells are still induced to kill targets through FasL but lose IL-2 secretion (78, 111–114), CD40L expression (115), and helper functions (116, 117). These partial activation responses may nevertheless exert a negative regulatory effect on immune responses in vivo, for example by eliminating selfreactive B cells through selective FasL expression or by inhibiting γ -interferon production through preferential synthesis of IL-4. Analysis of TCR-induced signaling in normal and anergic TH1 cells has shown that only a subset of signaling pathways are activated in anergic cells. Thus, naive and anergic TH1 cells exhibit a comparable calcium response (78) and translocate and activate the transcription factors NFAT and NFIL2A (118–120). By contrast, anergic TH1 cells fail to activate ras, ERK, or JNK (119, 121) and consequently fail to activate AP-1 transactivating factors (118). These deficits could account for the lack of IL-2 production in anergic TH1 cells because activation of the IL-2 promoter depends on collaboration between the NFAT and AP-1 signaling pathways (122); MEKK1, an activator of JNK, synergizes with NFAT in activating the IL-2 promoter (JI Healy, L Holsinger,

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G Crabtree, CC Goodnow, manuscript in preparation). The continued production of FasL or other genes that are induced in anergic T cells, on the other hand, may require NFAT or NFIL2A without AP-1. A clear change in TCR signal quality also appears to occur in anergic CD4 T cells in vivo (103). Again, TCR stimulation induces nuclear NFAT in both naive and anergic CD4 T cells, but induction of nuclear NFκB p50/p65 heterodimers is selectively deficient in the anergic T cells. Since NFκB can regulate the IL-2 promoter (123–126) and is important for mitosis (127, 128), this apparent signaling change may also contribute to reduced IL-2 production and blunted mitogenesis. No change in NFκB was found in anergic TH1 clones, by contrast (118), but in the latter cells NFκB is constitutively expressed and not induced by TCR signaling. It is interesting that Th2 cells (and anergized Th0 cells) have an elevated intracellular calcium in the 200–300 nM range and little further induction of calcium upon TCR stimulation (108, 129), similar to tolerant B cells (85). Given that NFAT is activated at these low calcium concentrations, whereas NFκB and JNK are not (88), it is interesting that the IL-4 promoter is activated in TH2 cells by NFAT elements that do not require NFκB or JNK (130). By contrast, proinflammatory cytokines made by naive TH1 cells such as IL-2, IFN-γ , and GM-CSF do contain important NFκB and AP-1 elements in the promoters of their genes, and naive TH1 cells usually make a large calcium response to antigen that would activate the full spectrum of cytosolic signals and transcription from these promoters.

EXAMPLES OF SIGNAL QUALITY OR SIGNAL QUANTITY DIFFERENCES Positive Versus Negative Selection of Immature B Cells Developmentally regulated negative responses may reflect either differences in nuclear responses or expression of proteins in the cytoplasm that qualitatively or quantitatively modify B cell receptor signaling. In immature IgM+ B cells maturing and emigrating from the bone marrow, BCR signaling can induce three distinct responses: 1. BCR signaling promotes maturation and survival of IgM+/IgD+ B cells (70, 131–133). 2. BCR signaling triggers functional inactivation of maturing cells (6, 81); or 3. BCR signaling reversibly blocks B cell maturation at the immature IgD−CD21− stage, resulting in either clonal deletion within 1 day (25) or receptor editing through secondary light chain gene rearrangements (26). It is not yet clear whether these different responses reflect differences in BCR signal quality or quantity. The notion that differences in BCR signal quantity might be important in determining positive versus negative responses at this stage of development is

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consistent with the effects of variations in antigen avidity and intracellular regulators that appear to control the gain in the “BCR rheostat.” The most extreme negative response, arrested development of immature B cells followed by deletion or editing, is triggered by a variety of high-avidity self-antigens such as membrane bound H-2 Kb (24, 134), membrane bound HEL (135), erythrocyte surface antigens (136), and double-stranded DNA (137, 138). By contrast, soluble monomeric HEL (sHEL) induces functional inactivation in immature B cells but does not trigger developmental arrest even at receptor-saturating concentrations (81), despite the fact that soluble and membrane-bound HEL (mHEL) bind at the same developmental stage and with the same intrinsic affinity. Soluble HEL can trigger developmental arrest in immature B cells under two circumstances: (a) when it is expressed as a covalent dimer that can crosslink BCRs more efficiently (S Akkaraju, JI Healy, CC Goodnow, manuscript in preparation); (b) when BCR signaling is exaggerated by loss of function mutations in the protein tyrosine phosphatase, SHP-1 (69), or the protein tyrosine kinase, lyn (R Cornall, J Cyster, M Hibbs, A Dunn, CC Goodnow, in preparation). It will be important to determine if soluble multimeric ligands induce signals that are quantitatively or qualitatively different from monovalent ligands. Similarly, absence of SHP-1 or lyn greatly increases the intracellular calcium responses to HEL in immature cells, but it is not known if all or only a subset of signaling pathways is exaggerated. As quantitative differences in calcium can differentially trigger nuclear signals through NFAT, NFκB, and JNK (88), the threshold triggering of developmental arrest and editing or abortion may require either a particular quantity of all nuclear signals, as in Figure 3B, or a particular quality of nuclear signals, as in Figure 3C. In contrast to the exaggerated negative response to sHEL when SHP-1 is deficient, the absence of CD45, which dephosphorylates the inhibitory phosphate on src kinases (139), causes immature HEL-specific B cells to make a positive response under circumstances that would otherwise result in negative responses. Thus, HEL-specific B cells lacking CD45 fail to complete their maturation or survive after leaving the bone marrow in the absence of HEL, but their maturation and survival are restored if they are chronically exposed to sHEL autoantigen (70). The chronic activation of ERK and of calcium, which is normally induced by sHEL, are both undetectable in CD45-deficient cells (85), consistent with the notion that a quantitative lowering of signaling through these pathways may cause the response to change from negative to positive. It is equally possible, however, that the BCR links to a distinct signaling pathway in the absence of CD45, so that HEL switches to promoting maturation and survival through a signal quality model as in Figure 3C. Surprisingly, the blunted ERK and calcium responses are not the result of a global block in tyrosine phosphorylation (JI Healy, J Cyster, data not shown) but likely reflect a selective failure in shc and phospholipase C phosphorylation, respectively (140). This residual

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Positive Versus Negative Selection of Immature T Cells TCR engagement with different peptide/MHC ligands triggers opposite responses in double-positive thymocytes: The positive selection response is characterized by inhibition of further TCRα gene rearrangements, maturation to single positive status, and survival; and the negative response is characterized by rapid apoptosis. Peptide/MHC concentration and avidity of binding are implicated in determining which response is made, because in fetal thymic organ cultures, high doses of strongly agonistic peptide ligands trigger negative response, whereas low doses or weak partial agonist ligands can trigger positive selection (143–147). Analysis of proximal TCR signaling events triggered by these different ligands in T cell clones has shown that partial agonists induce a different pattern of tyrosine phosphorylation and/or less phosphorylation of the TCR zeta subunit, and little activation of ZAP-70 kinase (148). Little IP3 production can be detected in response to the partial agonists, but a persistent lower calcium response ensures (149). Low calcium elevations with little IP3 production have also been described in thymocytes undergoing negative selection in vitro (150), and low calcium elevations are also detectable in thymocytes undergoing negative but not positive selection in vivo (151). Pharmacological and genetic analysis suggests that distinct signaling pathways mediate negative and positive selection of thymocytes. Thus, negative selection of autoreactive T cells in vitro requires a calcium signal that may act through a calcium-regulated isoform of PKC (150). The role calcineurin plays in lymphocyte selection is controversial (152–154). Similarly, positive selection but not negative selection is inhibited by dominant negative mutations in the ras/MEK/ERK signaling pathway (155, 156). Whether these signaling pathways are differentially activated during positive versus negative selection of thymocytes or whether quantitative differences in their activation result in the different fates is not yet known.

Inhibitory Versus Stimulatory Costimuli via Coreceptors Two co-receptors on B cells, the CD21 receptor, which binds the complement protein C3d, and the FcRγ 2b receptor for IgG immune complexes, modulate the quantity and probably the quality of signaling (157). Binding of HEL antigen that is covalently bound to C3d induces a much greater intracellular calcium response than antigen alone (54). This effect is due to coclustering of the CD21/CD19 complex with the BCR, allowing phosphorylation of CD19 and recruitment and phosphorylation of vav and PI3 kinase (157). Phosphorylated vav is an activating GTP exchange factor for rac (158), and rac is an upstream activator of the MEKK1/JNK pathway (91–93) and of NFκB (JI Healy,

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L Holsinger, manuscript in preparation). As the C3d/CD21/CD19 complex increases the magnitude of the calcium response and can activate rac, it is likely that stimulation of B cells through the combination of BCR and CD21 changes the quality of signals to the nucleus. The positive effect the CD19/CD21 complex has on B cell responses is evidenced by the blunted proliferative response, germinal center formation and antibody responses in mice lacking CD19, and hyperresponsiveness in mice overexpressing CD19 (159, 160). Coclustering of the FcRγ 2b with the BCR on mature B cells that bind antigens complexed with secreted IgG converts the normally positive mitogenic response into a negative apoptotic response (161). This change in the response is associated with reduced IP3 production (162), a blunted intracellular calcium response (163, 164), and reduced ras activation (165). Recruitment of the inositol-5-phosphatase, SHIP, to the FcR appears to mediate these effects (166–168), although recruitment of the protein tyrosine phosphatase, SHP-1, may also play a role (169). SHIP recruitment and activity is likely to alter the quality of BCR signals to the nucleus in two ways. First, the lower calcium magnitude and duration would allow differential triggering of NFAT, NFκB, and JNK (88). Second, the selective removal of 5-phosphates from PI3,4,5P3 would oppose some of the effects of PI3 kinase such as PIP3-mediated recruitment of btk to the membrane (170).

EXAMPLES OF DIFFERENCES IN THE NUCLEUS AS WELL AS SIGNAL QUALITY AND QUANTITY Response of Immature Versus Mature B or T Cells Monroe and colleagues have compared signaling in immature and mature B cells, with a view to understanding why positive mitogenic responses to BCR clustering are made in the latter, whereas only negative tolerogenic responses are made by immature cells. BCR-induced increases in intracellular calcium are comparable in mature B cells and immature B cells from neonatal mouse spleen, but IP3 production and induction of the Ras/ERK responsive Egr-1 and c-fos genes were only detectable in mature B cells (171). Based on the calcium response, it is likely that NFAT translocation would still occur in immature B cells, suggesting that selective activation of NFAT but not ERK signaling pathways may occur in these cells. Failure to activate egr-1 in immature B cells may also reflect developmentally regulated methylation of this gene (172), consistent with the nuclear quality model outlined in Figure 3A. As immature B cells express different NFκB subunits compared with mature cells (173) and immature B cells lack CD21 and have lower levels of CD45 and CD22, it is likely that their varying response to antigen compared with mature

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cells is a combination of preexisting differences in the nucleus and differences in the quantity and quality of signals activated by the BCR. Quantitative differences in TCR signaling between double positive thymocytes and mature T cells have also been shown. Thus, a lower calcium response accompanied by IP3 production occurs in immature T cells compared with mature T cells (150, 174, 175). Again, it is reasonable to expect that both signaling and nuclear interpretation may differ between these stages of lymphocyte development.

IMPLICATIONS In this article we have outlined the ways that antigen receptors can trigger positive or negative responses in lymphocytes at the same or different stages of development. The weight of data indicates that antigen receptors achieve this by functioning as switchboards, linking to different signaling pathways during negative versus positive responses. This ability to regulate distinct pathways independently geometrically increases the number of possible signaling modes and responses. Quantitative and qualitative differences in second messengers such as calcium help make these different connections, and preexisting or induced differences in nuclear transcription factors are also likely to guide different responses, particularly when these are linked to development stage. We have discussed the role played by the phosphatases, kinases, and coreceptors that regulate the balance between positive and negative signaling, and we have speculated on which signals mediate negative signaling in self-reactive lymphocytes to reinforce tolerance and prevent autoimmunity. Defining the precise functional relevance of different combinations of signaling pathways, and the molecular links used to differentially trigger them, will illuminate drug targets and approaches to better regulate immune responses either for immunosuppression in autoimmunity, transplantation, and allergy, or for augmentation in vaccines, chronic infections, and cancer. Visit the Annual Reviews home page at http://www.AnnualReviews.org.

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Annual Review of Immunology Volume 16, 1998

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CONTENTS Eureka! And Other Pleasures, H. Metzger Interleukin-1 Receptor Antagonist: Role in Biology, William P. Arend, Mark Malyak, Carla J. Guthridge, Cem Gabay Pathways and Strategies for Developing a Malaria Blood-Stage Vaccine, Michael F. Good, David C. Kaslow, Louis H. Miller CD81 (TAPA-1): A Molecule Involved in Signal Transduction and Cell Adhesion in the Immune System, Shoshana Levy, Scott C. Todd, Holden T. Maecker CD40 and CD154 in Cell-Mediated Immunity, Iqbal S. Grewal, Richard A. Flavell Regulation of Immune Responses by TGF-beta, John J. Letterio, Anita B. Roberts Transcriptional Regulation During B Cell Development, Andrew Henderson, Kathryn Calame T CELL MEMORY, R. W. Dutton, L. M. Bradley, S. L. Swain NF-Kappa B and Rel Proteins: Evolutionarily Conserved Mediators of Immune Responses, Sankar Ghosh, Michael J. May, Elizabeth B. Kopp Genetic Susceptibility to Systemic Lupus Erythematosus, T. J. Vyse, B. L. Kotzin Jaks and STATS: Biological Implications, Warren J. Leonard, John J. O'Shea Mechanisms of MHC Class I-Restricted Antigen Processing, Eric Pamer, Peter Cresswell NK Cell Receptors, Lewis L. Lanier BCL-2 Family: Regulators of Cell Death, Debra T. Chao, Stanley J. Korsmeyer Divergent Roles for Fc Receptors and Complement In Vivo, Jeffrey V. Ravetch, Raphael A. Clynes Xenogeneic Transplantation, Hugh Auchincloss Jr., David H. Sachs The Origin of Hodgkin and Reed/Sternberg Cells in Hodgkin's Disease, Ralf Küppers, Klaus Rajewsky Interleukin-12/Interleukin-12 Receptor System: Role in Normal and Pathologic Immune Responses, Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky Ligand Recognition by alpha-beta T Cell Receptors, Mark M. Davis, J. Jay Boniface, Ziv Reich, Daniel Lyons, Johannes Hampl, Bernhard Arden, Yueh-hsiu Chien The Role of Complement and Complement Receptors in Induction and Regulation of Immunity, Michael C. Carroll Dimerization as a Regulatory Mechanism in Signaling Transduction, Juli D. Klemm, Stuart L. Schreiber, Gerald R. Crabtree The Immunogenetics of Human Infectious Diseases, Adrian V. S. Hill How Do Monoclonal Antibodies Induce Tolerance? A Role for Infectious Tolerance? Herman Waldmann, Stephen Cobbold Positive versus Negative Signaling by Lymphocyte Antigen Receptors, James I. Healy, Christopher C. Goodnow

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523 545 569 593 619 645