Professorand Chair Department of Pathology University of California-SanFrancisco SanFrancisco,California
Associate Professor of PathologY Harvard Medical School Brigham and Women's HosPital Boston. Massachusetts
Associate Professorof Medicine Harvard Medical School MassachusettsGeneral Hospital Cancer Center Boston, Massachusetts
Illustrations by David L. Baker,MA AlexandraBaker,MS, CNT DNA lllustrations, Inc.
ARAND
TH EDITION
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CELLUIARAND MOLECUI-ARIMMUNoLocY updated 6/E ISBN:978-l-4160-3123-9 InternationalEdition ISBN:978-0-8089-2411-l Copyright @ 2010 by Saunders,an imprinr of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means,electronicor mechanical,including photocopying,recording,or any information storage and retrieval system,without permission in writing from the publisher. !91inpsio_nsmay be sought directly from Elsevier'sHealth sciences Rights Department in Philadelphia,PA,USA:phone: (+l) 2I5239 3804,fax: (+l) 2r5 239 3805,e-mail:
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Notice Neither the Publisher nor the Authors assume any responsibility for any loss or injury and/or qam_age to persons or property arising out of or related to any use of the material contained in this book._ltis the responsibility of the treating practitioner, relying on independent expertise and knowledge of the patient, to determine the best treatment and method of application for the patient. The Publisher Previous-editions copyrighted2007,2o0s,2003,2000,1997,1994,l99l by saunders,an imprint of ElsevierInc. Library of CongressCataloging-in-Publication Data Abbas, Abul K cellular and molecular immunology / Abul K. Abbas,Andrew H. Lichtman, shiv pillai.Updated 6th ed. p. ; cm. Includes bibliographical referencesand index. ISBN978-1-4160-3123-9 l. cellular immunity. 2. Molecular immunology. I. Lichtman, Andrew H. II. pillai, Shiv. III. Title. . [DNLM:1. Immunity,Cellu]ar. 2. AntibodyFormation-immunology. 3. Antigensimmunology. 4. Immune SystemDiseases-immunology. 5. Lymphoiytes-immunology. QW 568Al22c 20101 2010 QRlBs.5.A2s 616.07'97-dc22 20090084r5
ExecutiueEditor: William Schmitt Managing Editor: RebeccaGruliow Publishing SeruicesManager:Joan Sinclair Design Direction: GeneHarris
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nit sixth edition of Cellular and Molecular Immunology includes extensive revisions I of the previous edition, which incorporate new discoveries in immunology and the constantly growing body of knowledge. It is remarkable and fascinating to us that new principles continue to emerge from analysisof the complex systemsthat underlie immune responses.Perhapsone of the most satisfying developrnentsfor students of human disease is that basic principles of immunology are now being used for rational development of new immunological therapies. Examples of areas in which our understanding has grown impressively since the last edition of this book include the recognition of microbial products by cytoplasmic and membrane sensors, the intricate organization of lyrnphoid tissues,the functional heterogeneity of subsetsof dendritic cells and lymphocytes, and the roles of regulatory cells and inhibitory pathways in immune regulation. We have added new information while striving to emphasize important principles, and without increasing the length of the book. We have also changed many sections, when necessary,for increased clarity, accuracy,and completeness. We have retained the design elements that have evolved through the previous editions to make the book easierto read. These include the use of bold italic text to highlight "takehome messages,"presentation of experimental results in bulleted lists distinguishable from the main text, and the use of "In-depth" boxes (including severalnew orres)to present detailed information about experimental approaches, disease entities, and selected molecular or biological processes.We also constantly try to further improve the clarity of illustrations and tables. Many individuals have made invaluable contributions to this edition. Drs. Michael Carroll, Jason Cyster, Moh Daha, and Richard Locklsey have been generous with advice and comments. Our illustrators, David and Alexandra Baker of DNA Illustrations, remain full partners in the book and provide invaluable suggestions for clarity and accuracySeveral members of the Elsevier Science staff have played critical roles. Our editor, Bill Schmitt, has been a source of support and encouragement. Our Developmental Editor, Rebecca Gruliow shepherded the book through its preparation and production. Gene Harris was responsible for the design. Ellen Sklar took charge of the production and has been a constant source of good senseand efficiency. Our students were the original inspiration for the first edition of this book, and we remain continually grateful to them, because from them we learn how to think about the science of immunology, and how to communicate knowledge in the clearest and most meaningful way.
f
Abul K.Abbas Andrew H. Lichtman Shiv Pillai
Dedication To Ann, Jonathan,Rehana Sheila,Eben,Ariella, Amos, Ezra Honorine, Sohini
' l '
j
I Introduction SECTION to the lmmuneSystem 1.
FI M M U NREE S P O N S E S P R O P E R TAIN ED SO V E R V I O EW
2.
INNATE IMMUNITY
3.
IMMUNESYSTEM CELLS ANDTISSUES OFTHEADAPTIVE
1q
Recognition of Antigens 4.
. .S .,...... A N T I B O DAI E NS DA N T I G E N
15
5.
..... COMPLEX THEMAJOR HISTOCOMPATIBILITY
91
6.
. TOT LYMPHOCYTES ANTIGEN PROCESSING ANDPRESENTATION
113
7.
OM FT OS C.Y. .T. .E. .S. , . ANTIGE RN ECEPTORSANDACCESSORY OLLYEM CP UH LE
131
of LymPhocYtes lll Maturation, andRegulation Activation SECTI0N 8.
ANDEXPRESSION ANDTHEREARRANGEMENT LYMPHOCYTE DEVELOPMENT RECEPTOR GENES. . . . OFANTIGEN
t3J
9.
. ACTIVATION OFT LYMPHOCYTES
r89
IO.
PRODUCTION ANDANTIBODY B CELLACTIVATION
215
. .R . ANCE 1 1 . I M M U N O L O G I C A L T O L. E
243
lV Effector Mechanisms of lmmuneResponses SECTI0N 12.
CYTOKINES
261
13.
.., IMMUNITY OFCELL-MEDIATED EFFECTOR MECHANISMS
303
14.
IMMUNITY OFHUMORAL EFFECTOR MECHANISMS
321
in Defense andDisease V ThelmmuneSystem SECTION 15.
OM I C R O B E S IMMUNITY
. IMMUNOLOGY 16. TRANSPLANTATION 1 7.
OT U M O R S I M M U N I TY
351 375 397
vll
Vii.
CONTENTS
1 8 . D I S E A SCEASU S B EY DI M M U NREE S P O NH SY EP SE : RSENSITIVITY A N DA U T O I M M U N I T Y
419
19. IMMEDIATE HYPERSENSITIVITY .
441
2 0 . c O N G E N IATNADA L c O U I RIE MDM U N O D E F I c I E N c I E s
+oJ
Appendix I: GLOSSARY
489
Appendix II: pnrrucrpRl FEATURES 0FsELECTED cDMoLECULES ....
519
Appendix III: LngonRrORY TEcHNIOUES cOMMONLY USED IN IMMUNOLOGY . . . . . . . 525
I nd e x
539
Introduction to the lmmune System he first three chapters of this book introduce the nomenclature of immunology and the components of innate and adaptive immune responses. In Chapter 1, we describe the types of immune responses and their general properties and present an overview of immune responsesto microbes. In Chapter 2, we discuss the early innate immune response to infectious pathogens.Chapter 3 is devoted to a description of the cells and tissues of the adaptive immune system, with an emphasis on their anatomic organization and structure-function relationships. This section sets the stage for more thorough discussion of how the immune system recognizes and respondsto antigens.
RESP Innate and Adaptive lmmunity,4 Types of Adaptive lmmune Responses,6 Gardinal Features of Adaptive lmmune Responses, 9
substancesis called the immune respon$e" The physiologic function of the immufle systen is
Cellular Components of the Adaptive lmmune System, 11 Overview of lmmune Responses to Microbes, 13 T h e E a r l yI n n a t el m m u n eR e s p o n steo Microbes,13 13 The AdaptivelmmuneResponse, The Captureand Displayof Microbial A n t i g e n s1, 3 14 by Lymphocytes, AntigenRecognition lmmunity:Activationof Cell-Mediated T Lymphocytes and Eliminationof Intracellula Mri c r o b e s1, 5 Humorallmmunity:Activationof B Lymphocytes and Eliminationof Microbes,16 Extracellular l m m u n o l o g i c aMl e m o r y ,1 6
disease in some situations. Therefore, a more inclusive definition of the immune response is a reaction to comDonents of microbes as well as to macromolecules, such is prot"ins and polysaccharides, and small chemicals thal are recognized as foreign, regardlessofthe physiologic or pathologic consequence of such a reaction. immunology is the study of immune responses in this broader sense and of the cellular and molecular events that occur after an organism encounters microbes and other foreign macromolecules. Historians often credit Thucydides, in Athens during the fifth century nc, as having first mentioned immunity to an infection that he called "plague" (but that was probably not the bubonic plague we recognize today). The concept of immunity may have existed long before, as suggestedby the ancient Chinese custom of making children resistant to smallpox by having them inhale
Summary, 16
The term immunity is derived from the Latin word immunitas,which referredto the protectionfrom legal prosecution offered to Roman senatorsduring their tenuresin office.Historically,immunity meant protec-
The evolution of immunology as an experimental discipline has depended on our ability to manipulate the function of the immune system under controlled
,
S e c t i o| -n I N T R 0 D U C T 0 I 0TN H ET M M U N SE YSTEM
conditions. Historically, the first clear example of this manipulation, and one that remains among the most dramatic ever recorded, was Edward Jenner'ssuccessful vaccination against smallpox. Jenner, an English physician, noticed that milkmaids who had recovered from co\^'poxnever contracted the more serious smallpox. on the basis of this observation, he injected the material from a cow?ox pustule into the arm of an 8-year-old boy. \.Vhen this boy was later intentionally inoculated with smallpox, the disease did not develop. Jenner's landmark treatise on vaccination (Latin uaccinus,of or from cows) was published in 1798. It led to the widespread acceptance of this method for inducing immunity to infectious diseases,and vaccination remains the most effective method for preventing infections (Table l-1). An eloquent testament to the importance of immunology was the announcement by the World Health Organization in 1gB0that smallpox was the first disease that had been eradicated worldwide by a program of vaccination. Since the 1960s,there has been a remarkable transformation in our understanding of the immune system and its functions. Advances in cell culture techniques (including monoclonal antibody production), immunochemistry, recombinant DNA methodology, x-ray crystallography, and creation of genetically altered animals (especiallytransgenic and knockout mice) have changed immunology from a largely descriptive science into one in which diverse immune phenomena can be explained in structural and biochemical terms. In this chapter, we outline the general features of immune responies and introduce the concepts that form the cornerstones of modern immunology and that recur throughout this book.
lruruRrr ANDADAPnvE lMMUNtry Defense against microbes is mediated by the early reactions of innate immunity and the later responses of adaptive immunity (Fig. l-1 and Table l-2). Innate immunity (also called natural or native immunity) provides the early line of defense against microbes. It consists of cellular and biochemical defense mechanisms that are in place even before infection and are poised to respond rapidly to infections. These mechanisms react only to microbes (and to the products of injured cells), and they respond in essentiallythe same way to repeated infections. The principal components of innate immunity are (1) physical and chemical barriers, such as epithelia and antimicrobial substances produced at epithelial surfaces; (2) phagocltic cells (neutrophils, macrophages) and natural killer (NK) cells; (3) blood proteins, including members of the complement system and other mediators of inflammation; and (4) proteins called cytokines that regulate and coordinate many of the activities of the cells of innate immunity. The mechanisms of innate immunity are specific for structures that are common to groups of related microbes and may not distinguish fine differences between foreign substances. In contrast to innate immunitv there are other immune responses that are stimulaied by exposure ro infectious agents and increase in magnitude and defensive capabilities with each successiveexposure to a particular microbe. Becausethis form of immunity develops as a response to infection and adapts to the infection, it is called adaptive immunity. The defining characteristics of adaptive immunity are exquisite specificity for
Table 1-1. Effectiveness of Vaccinesfor Some Common InfectiousDiseases
Disease
Maximumnumber Numberof Percent of cases(year) cases in 2004 change
Diphtheria
(1921) 206,939
0
-99.99
Measles Mumps Pertussis
894 1 3 4( 1 9 4 1
37
-99.99
152,209(1968)
236
-99.90
265,269 (1934)
18,957
-96.84
Polio(paralytic) 21,269(1952)
0
-100.0
Rubella 5 7 , 6 8 6( 1 9 6 9 ) Tetanus 1,560(1923) -20,000(1984) Haemophilus influenzaetype B Hepatitis B 2 6 , 6 1 1( 1 9 8 5 )
12
-99.98
26
-98.33
16
-99.92
6,632
-75.08
Thistableillustrates the strikingdecreasein the incidenceof selectedinfectious diseases for whicheffectivevaccineshave been developeo. Adaptedfrom orensteinwA, AR Hinman,KJ Bart, and sc Hadler.lmmunization.ln MandellGL, JE Bennett,and R Dolin(eds).Principlesand Practicesof InfectiousDiseases,4th ed. churchill Livingstone,New york, 1995, and Morbidityand Mortality Weekly Report 53:1213-1221,2005.
C h a p t e1r-
EESP0NSES FI M M U N R NS DO V E R V I E0W P R O P E R TAI E X
Microbe
#
Adaptiveimmunity
lnnateimmunity
Antibodies
Phagocytes
,
Fq .s-/
#
Complement
NK cells
Hours 12
Timeafterinfection FIGURE 1-1 Innateand adaptiveimmunity.The mechanismsof innateimmunityprovidethe initialdefenseagainstinfectionsAdaptive immuneresponsesdeveloplaterand consistof activationof lymphocytesThe kineticsof the innateand adaptiveimmuneresponsesare approximations and may vary in differentinfections
Table 1-2. Featuresof Innateand Adaptivelmmunity
Innate
lAdaPtive
6r'rir".t"rirt"t Forantigensof microbesand antigens for nonmicrobial
Specificity
Forstructuressharedby groupsof relatedmicrobes
Diversity
germline-encoded Verylarge;receptorsare Limited; produced by somatic of recombination genesegments
Memory
None
Nonreactivity to self Yes
Yes
I Yes
Components and Cellular chemicalbarriers
Skin,mucosalepithelia; antimicrobial chemicals
in epithelia; Lymphocytes antibodiessecretedat epithelialsurfaces
Bloodproteins
others Complement,
Antibodies
Cells
(macrophages, Lymphocytes Phagocytes neutrophils), naturalkillercells
and componentsof innateand adaptiveimmune This table liststhe majorcharacteristics responses.Innateimmunityis discussedin much more detailin Chapter2.
5
S e c t i o| -n I N T R 0 D U C T 0 I 0TN H ET M M U N SE YSTEM
distinct molecules and an ability to "remember" and respond more vigorously to repeated exposures to the same microbe. The adaptive immune system is able to recognize and react to a large number of microbial and nonmicrobial substances.In addition, it has an extraordinary capacity to distinguish between different, even closely related, microbes and molecules, and for this reason it is also called specific immunity. It is also sometimes called acquired immunity, to emphasize that potent protective responses are "acquired" by experience. The main components of adaptive immunity are cells called lymphocytes and their secreted products, such as antibodies. Foreign substancesthat induce specific immune responses or are the targets of such responsesare called antigens. Innate and adaptive immune responses are components of an integrated system of host defense in which numerous cells and molecules function cooperatively. The mechanisms of innate immunitv orovide an effective initial defense against infections. However, many pathogenic microbes have evolved to resist innate immunity, and their elimination requires the more powerful mechanisms of adaptive immunitv. The innate immune response to microbes also stimuiates adaptive
M e c h a n i s mfso r d e f e n d i n tgh e h o s ta g a i n sm t i c r o b e sa r e p r e s e n itn s o m ef o r m i n a l lm u l t i c e l l u l o a r g a n i s m sT h e s e m e c h a n i s m cs o n s t i t u t ei n n a t ei m m u n i t yT h e m o r e s p e c i a l i z e dd e f e n s e m e c h a n i s m st h a t c o n s t i t u t ea d a p t i v e i m m u n i t ya r e f o u n di n v e r t e b r a t eosn l y V a r i o u sc e l l si n i n v e r t e b r a t er se s p o n dt o m i c r o b e sb y s u r r o u n d i n gt h e s e i n f e c t i o u sa g e n t s a n d d e s t r o y i n g t h e m T h e s er e s p o n d i ncge l l sr e s e m b l ep h a g o c y t easn d h a v eb e e nc a l l e dp h a g o c y t iacm e b o c y t e isn a c e r o m a r e s , h e m o c y t e si n m o l l u s c sa n d a r t h r o p o d sc,o e l o m o c y t eisn a n n e l i d sa,n db l o o dl e u k o c y t eisn t u n i c a t e sI n v e r t e b r a t e s d o n o t c o n t a i na n t i g e n - s p e c i fl yi cm p h o c y t eas n d d o n o t p r o d u c ei m m u n o g l o b u l i(nl g ) m o l e c u l e so r c o m p l e m e n t p r o t e i n sH o w e v e rt,h e yc o n t a i na n u m b e ro f s o l u b l em o l e c u l e st h a t b i n dt o a n d l y s e m i c r o b e sT h e s em o r e c u r e s i n c l u d eI e c t i n - l i kper o t e i n sw , h i c h b i n dt o c a r b o h y d r a t e s o n m i c r o b i a cl e l l w a l l s a n d a g g l u t i n a t et h e m i c r o b e s , a n d n u m e r o u s l y t i c a n d a n t i m i c r o b i afla c t o r s s u c h a s l y s o z y m ew , h i c h i s a l s o p r o d u c e db y n e u t r o p h i l isn h i g h e ro r g a n i s m sP h a g o c y t ei sn s o m ei n v e r t e b r a t emsa y be capable of secretingcytokinesthat resemDte macrophage-derived cytokinesin the vertebrateslmport a n t l y ,a l l m u l t i c e l l u l aorr g a n i s m se x p r e s sc e l l u l a r e c e p tors resembling Toll-like r e c e p t o r st h a t s e n s em t c r o o e s a n di n i t i a t ed e f e n s er e a c t r o nasg a i n stth e m r c r o b e sT h u s , h o s td e f e n s ei n i n v e r t e b r a t ei ssm e d i a t e db y t h e c e l l sa n d m o l e c u l e st h a t r e s e m b l et h e e f f e c t o rm e c h a n i s m so f i n n a t ei m m u n i t yi n h i g h e ro r g a n i s m s M a n y s t u d i e s h a v e s h o w n t h a t i n v e r t e b r a t eas r e c a p a b l eo f r e j e c t i n gf o r e i g nt i s s u et r a n s p l a n t so,r a r r o -
immune responses and influences the nature of the adaptive responses.We will return to a more detailed discussion of the mechanisms and physiologic functions of innate immunity in Chapter 2. Innate immunity is phylogenetically the oldest system of host defense, and the adaptive immune system evolved later (Box l-l). In invertebrates, host defense against foreign invaders is mediated largely by the mechanisms of innate immunity, including phagocytes and circulating molecules that resemble the plasma proteins of innate immunity in vertebrates. Adaptive immunity, consisting of lymphocy'tes and antibodies, first appeared in jawed vertebrates and became increasingly specialized with further evolution.
TypTsOFADAPTIvE IMMUNE RESPONSES There are two types of adaptiue immune responses, called humoral immunity and cell-mediatedimmunity, that are mediated by dffirent components of the immune system and function to eliminate dffirent typesof microbes(Fig.l-2). Humoral immunity is medi-
grafts (ln vertebrates,this processof graft rejectionis d e p e n d e not n a d a p t i v ei m m u n er e s p o n s e)s l f s p o n g e s (Porifera) from two differentcoloniesare parabiosedby b e i n gm e c h a n i c a l hl ye l dt o g e t h e rt,h e y b e c o m en e c r o t i c tn 1 to 2 weeks,whereasspongesfrom the same colony f u s e a n d c o n t i n u et o g r o w E a r t h w o r m s( a n n e l i d sa)n d s t a r f i s h( e c h i n o d e r m sa)l s o r e j e c t t i s s u e g r a f t s f r o m o t h e r s p e c i e so f t h e p h y l a T h e s e r e l e c t i o nr e a c t i o n s a r e m e d i a t e dm a i n l yb y p h a g o c y t e - l i kc e l l s T h e yd i f f e r f rom graft rejection in vertebrates in that specific memoryfor the graftedtissueeitheris not generatedor i s d i f f i c u l t o d e m o n s t r a t eN. e v e r t h e l e s ss,u c h r e s u l t s indrcate that eveninvertebrates must expresscellsurface m o l e c u l e st h a t d i s t i n g u i s sh e l f f r o m n o n s e l f a , nd such s f histocompatibility m o l e c u l e sm a y b e t h e p r e c u r s o r o moleculesin vertebrates.Recently,a familyof polymorp h i c p r o t e i n sb e l o n g i n gt o t h e i m m u n o g l o b u l isnu p e r f a m i l y h a s b e e n i s o l a t e df r o m m a r i n e c h o r d a t e sa n d s h o w n t o b e r e s p o n s i b l ef o r r e j e c t i o no f o r g a n i s m s T h e s ep r o t e i n sm a y b e p r e c u r s o ros f m a m m a l i a nh i s t o c o m p a t i b i l i tmv o l e c u l e s T h e h a l l m a ro kf the vertebrate i m m u n es y s t e mi s t h e expressionof somaticallyrearrangedantigenreceptors Such receptors appearedin jawed fish Even some jawlessfish expresshighlyvariablereceptorsthat differ from one cell to another,but these are not generatedby r e c o m b i n a t i oonf g e n e s e g m e n t s l t i s b e l i e v e dt h a t a t r a n s p o s o cno n t a i n i ntgh e g e n e ( s e) n c o d i n gt h e e n z y m e f o r r e c o m b i n a t i o n( R A G , o r r e c o m b i n a t i o n activating g e n e s ,s e e C h a p t e r8 ) i n v a d e da g e n e t h a t e n c o d e da Continued on following page
t
t6 RESPONSES 0FIMMUNE ANDOVERVIEW 1- PROPERTIES Chapter
p r o t e i nr e s e m b l i nag v a r i a b l e( V )s e g m e n to f a n a n t i b o d y m o l e c u l eT . h i s a l l o w e dV a n d r e l a t e ds e g m e n t st o b e r e c o m b i n e dt o g e n e r a t eh i g h l y d i v e r s e a n d s p e c iifc antigenreceptors.Not only this feature,but most of the c o m p o n e n t so f t h e a d a p t i v ei m m u n es y s t e m ,i n c l u d i n g and T cell receptors,MHC mollymphocytes, antrbodies l y m p h o i dt i s s u e s ( b u t l a c k i n g e c u l e s ,a n d s p e c i a l i z e d q u i t es u d g e r m i n acl e n t e r s )a, l l s e e m t o h a v ea p p e a r e d d e n l ya n d c o o r d i n a t e il n y j a w e dv e r t e b r a t e(se . 9 . s, h a r k s ) (see Table).A more primitive version of rearranged antigenreceptorsexistsin jawlessfish (lampreys)These
Innateimmunity
receptorshave been called"variablelymphocytereceptors," and are apparentlygeneratedby shufflingDNA s e g m e n t si n t h e a b s e n c eo f R A G g e n e sa n d t h e m o r e machinery. advancedsomaticrecombination The immune system has also become increasingly with evolution.For instance,fisheshaveonly specialized one type of antibody,calledlgM; this numberincreases suchas Xenopusandto seven to two typesin amphibians or eighttypes in mammals.The presenceof more types of the of antibodiesincreasesthe functionalcapabilities t m m u n er e s p o n s e -
AdaptiveimmunitY
PhagocytesNKcells Antibodies
T and B lymphocytes
lnvertebrates Yrolozoa
+
Sponges
+
Annelids
+ +
+
Elasmobranchs+ (sharks, skates, rays)
+
+ (lgM only)
+
Teleosts (common fish)
+
+
* (lgM,others?)
+
Amphibians
+
+
+ (2 or 3 classes) +
Reptiles
+
+
* (3 classes)
+
Birds
+
+
* (3 classes)
+
Mammals
+
+
+ (7 or 8 classes) +
Arthropods Veftebrates
-, absent Key:*, present;
ated by molecules in the blood and mucosal secretions, called antibodies, that are produced by cells called B Il.rnphocytes (also called B cells). Antibodies recognize microbial antigens, neutralize the infectivity of the microbes, and target microbes for elimination by various effector mechanisms. Humoral immunity is the principal defense mechanism against extracellular microbes and their toxins because secreted antibodies can bind to these microbes and toxins and assistin their elimination. Antibodies themselves are specialized,and different tlpes of antibodies may activate different effector mechanisms. For example, some types of antibodies promote the ingestion of microbes by host cells (phagocltosis), and other antibodies bind to and trigger the release of inflammatory mediators from cells. Cellmediated immunity, also called cellular immunity, is mediated by T lyrnphocytes (also called T cells). Intracellular microbes, such as viruses and some bacteria, survive and proliferate inside phagocltes and other host
cells,where they are inaccessibleto circulating antibodies. Defense against such infections is a function of cellmediated immunity, which promotes the destruction of microbes residing in phagocytesor the killing of infected cells to eliminate reservoirs of infection. Protective immunity against a microbe may be induced by the host's response to the microbe or by the transfer of antibodies or lymphocltes specific for the
ically inexperienced. Individuals who have responded to a microbial antigen and are protected from subsequent exposuresto that microbe are said to be immune' Immunity can also be conferred on an individual by transferring serum or lymphocytes from a specifically
7
r o nl -
I N T R O D U C TT| 0 T NH ET M M U NSEY S T E M
Cell-mediated immunity
Microbe
l+# Extracellular microbes
Intracellular Phagocytosed microbes (e.9.,viruses) microbes in replicating within macrophage infected cell I r
I
._43
/-.
--il
--t
:-
-l\. netl
tel
!
T lymphocyte
vr
rvrv^rv
-
T lymphocyte
Secreted antibody
Effector mechanism
Transferred by
Functions
.-q Serum (antibodies)
Block infectionsand eliminate extracellular microbes
Cells Cells (T lymphocytes) (T lymphocytes)
Activate macrophages to kill phagocytosed microbes
immunized individual, a process known as adoptive transfer in experimental situations. The recipient ofiuch a transfer becomes immune to the particular antigen without ever having been exposed to or having responded to that antigen. Therefore,this form of immunity is called passive immunity. passive immunization is a useful method for conferring resistance rapidly, without having to wait for an active immune responsero develop. An example of passiveimmunity is the transfer of maternal antibodies to the fetus, which enables newborns to combat infections before they develop the ability to produce antibodies themselves.passiveimmunization against bacterial toxins by the administration of antibodies from immunized animals is a lifesaving treatment for potentially lethal infections, such as tetanus and rabies. The technique of adoptive transfer has also made it possible to define the various cells and molecules that are responsible for mediating specific immunity. In fact, humoral immunity was originally defined as the type of immunity that could be transferred to unimmunized, or naive, individuals by antibody-containing cell-free portions of the blood (i.e., plasma or serum [once called humors]) obtained from previously immunized individuals. Similarlv cell-
secreteantibodiesthat preventinfections by and eliminateextracellular microbes In cell-mediated immunity,helperT lymphocytes activate macrophagesto kill phagocytosedmicrobesor cytotoxicT lymphocytes(CTLs)directlydestroyinfected ceils
mediated immunity was defined as the form of immunity that can be transferred to naive animals with cells (T lymphocy'tes) from immunized animals but not with plasma or serum. The first experimental demonstration of humoral immunity was provided by Emil von Behring and Shibasaburo Kitasato in 1890.They showed that if serum from animals that had recovered from diphtheria infection was transferred to naive animals, the recipients became specifically resistant to diphtheria infection. The active components of the serum were called antitoxins because they neutralized the pathologic effects of the diphtheria toxin. In the early 1900s, Karl Landsteiner and other investigators showed that not only toxins but also nonmicrobial substances could induce humoral immune responses.From such studies arose the more general term antibodies for the serum proteins that mediate humoral immunity. Substances that bound antibodies and generated the production of antibodies were then called antigens. (The properties of antibodies and antigens are described in Chapter 4.) In 1900, Paul Ehrlich provided a theoretical framework for the specificity of antigen-antibody reactions, the experimental proof for which came during the next 50
EESPONSES FI M M U N R NS DO V E R V I EOW Chapter I - P R O P E R TAI E
SpecificityMemory Microbialantioen (vaccineor iniection)
Challenge infection
Daysor WEEKS
Yes
Yes
Yes
No
ffiilF
Serum(antibodies) or cells(T lymphocytes) fromimmune animal Adoptive transfer to naive animal
Challenge infection
*.-.--^.\1.|/
' - . - . $ \
FTGURE1-3 Active and passiveimmunity.Activeimmunityis conferredby a host responseto a mtcrobeor mcrobialantigen,whereas specificfor the microbe Bothforms of immunityprovide passiveimmunityis conferiedby adoptivetiansferof antibodies or T lymphocytes resistance to infectionand are specificfor microbialantigens,but only activeimmuneresponsesgenerateimmunologicmemory
years from the work of Landsteiner and others using simple chemicals as antigens. Ehrlich's theories of the physicochemical complementarity of antigens and antibodies are remarkable for their prescience. This early emphasis on antibodies led to the general acceptanceof the humoral theory of immuniry according to which immunity is mediated by substances present in body fluids. The cellular theory of immunity, which stated that host cells were the principal mediators of immunity, was championed initially by Elie Metchnikoff. His demonstration of phagocytes surrounding a thorn stuck into a translucent starfish larva, published in 1883, was perhaps the first experimental evidence that cells respond to foreign invaders. Sir Almroth Wright's observation in the early 1900sthat factors in immune serum enhanced the phagocyosis of bacteria by coating the bacteria, a process knorm as opsonization, lent support to the belief that antibodies prepared microbes for ingestion by phagocltes. These early "cellularists"were unable to prove that specific immunity to microbes could be mediated by cells. The cellular theory of immunity became firmly established in the 1950s,when George Mackaness showed that resistance to an intracellular bacterium, Listeria monocytogenes,could be adoptively transferred with cells but not with serum. We now know that the specificity of cell-mediated immunity is due to lymphocltes, which often function in concert with other cells, such as phagocytes,to eliminate microbes. In the clinical setting, immunity to a previously encountered microbe is measured indirectly, either by assaying for the presence of products of immune responses (such as serum antibodies specific for microbial antigens) or by administering substances purified
from the microbe and measuring reactions to these substances.A reaction to a microbial antigen is detectable
individual is capable of mounting a protective immune response to the microbe.
OFADAPTIVE CRnoITRIFTRTUNTS
Rrsporusrs lunrtuu All humoral and cell-mediated immune responses to foreign antigens have a number of fundamental properties that reflect the properties of the lymphocytes that mediate these responses(Table 1-3). o Specificity and diuersity. Immune responses are specific for distinct antigens and, in fact, for different portions of a single complex protein, polysaccharide, or other macromolecule (Fig. 1-4). The parts of such antigens that are specifically recognized by individual lyrnphocytes are called determinants or epitopes. This fine specificity exists because individual lymphocltes express membrane receptors that are able io distinguish subtle differences in structure between distinct antigens. Clones of lymphocytes with different specificities are present in unimmunized individuals and are able to recognize and respond to foreign antigens.This concept is the basic tenet of the clonal selection hypothesis, which is discussed in more detail later in this chapter.
9
S e c t i o|n-
10
I N T R 0 D U C TT| 00N T H ET M M U NSEy S T E t V t
Table 1-3. CardinalFeaturesof Adaptive lmmuneResponses
Feature
I Functionalsignificance
Specificity
Ensures thatdistinctantigens elicitspecificresponses
Diversity
Enablesimmunesystemto respond to a largevarietyof antigens
Memory
Leadsto enhanced resoonses to repeated exposures to thesameantigens
Clonal expansion
Increases numberof antigen-specif ic lymphocytes to keeppacewithmicrobes
Specialization Generates responses thatare
optimalfor defenseagainstdifferent typesof microbes
Contraction and Allowsimmunesystemto respond antigens homeostasis to newlyencountered Nonreactivity Preventsinjuryto the hostduring responses to foreignantigens to self The featuresof adaptiveimmuneresponsesare essential for the functionsof the immunesvstem. The total number of antigenic specificities of the lymphocltes in an individual, called the lymphocyte repertoire, is extremely large. It is estimated that the immune system of an individual can discriminate 107 to 1O'ydistinctantigenic determinants. This property
AntiqenX + Antilen Y
A ntigenX
$
@ Memory. Exposure of the immune system to a foreign antigen enhances its ability to respond again to that antigen. Responsesto second and subsequent exposuresto the same antigen, called secondaryimmune responses, are usually more rapid, larger, and often qualitatively different from the first, or primary, immune response to that antigen (see Fig. 1-4). Immunologic memory occurs partly because each exposure to an antigen expands the clone of lymphocltes specific for that antigen. In addition, stimulation of naive ll.rnphocytes by antigens generates long-lived memory cells (discussed in detail in Chapter 3). These memory cells have special characteristics that make them more efficient at responding to and eliminating the antigen than are naive lymphocytes that have not previously been exposed to the antigen. For instance, memory B lymphocltes produce antibodies that bind antigens with higher affinities than do antibodies produced in primary immune responses,and memory T cells react much more rapidly and vigorously to antigen challenge than do naive T cells. @ Clonol expansion. Lymphocltes undergo considerable proliferation following exposure to antigen. The
,f >f
nnti-xB cetl Activated B cells
L
o =
of the lymphoc],te repertoire is called diversity. It is the result of variability in the structures of the antigen-binding sites of lymphoclte receptors for antigens. In other words, there are many different clones of lymphocytes that differ in the structures of their antigen receptors and therefore in their specificity for antigens, contributing to a total repertoire that is extremely diverse.The molecular mechanisms that generate such diverse antigen receptors are discussedin Chapter 8.
Anti-YB cell ,
1)
o _o (U
Activated
B cells
E J L
o U)
Natve trt
lI
Memory B cells Naive B cell
Weeks
.'/'
ponses.AntigensX and Y inducethe productionof differentantibodies(specificity) The secondaryresponseto antigenX is more rapid and larger than the primary response(memory)Antibodylevelsdecline with time aftereachimmunization (contractron, the process that maintainshomeostasis) The same f eatures are seen in cell-mediated immuneresponses
1Chaoter
term clonal expansion refers to an increase in the number of cells that express identical receptors for the antigen and thus belong to a clone. This increase in antigen-specific cells enablesthe adaptive immune responseto keep pace with rapidly dividing infectious pathogens. @ Specialization. As we have already noted, the immune system responds in distinct and specialways to different microbes, maximizing the effectivenessof antimicrobial defense mechanisms. Thus, humoral immunity and cell-mediated immunity are elicited by different classesof microbes or by the same microbe at different stagesofinfection (extracellularand intracellular), and each type of immune responseprotects the host against that class of microbe. Even within humoral or cell-mediated immune responses, the nature of the antibodies or T lymphocytes that are generated may vary from one class of microbe to another. We will return to the mechanisms and functional signiflcance of such specialization in later chapters. @ Contraction and homeostasis. All normal immune responseswane with time after antigen stimulation, thus returning the immune system to its resting basal state, a state that is called homeostasis (seeFig. 1-4). This contraction of immune responsesoccurs largely because responses that are triggered by antigens function to eliminate the antigens, thus eliminating the essential stimulus for lymphocyte survival and activation. Lymphocltes deprived of these stimuli die by apoptosis. The mechanisms of homeostasis are discussedin Chapter 11. 6 Nonreactiuity to sefi One of the most remarkable properties of every normal individual's immune system is its ability to recognize, respond to, and eliminate many foreign (nonself) antigens while not reacting harmfully to that individual's own (self) antigenic substances. Immunological unresponsiveness is also called tolerance. Tolerance to self antigens, or self-tolerance, is maintained by several mechanisms. These include eliminating llrnphocytes that expressreceptors specific for some self antigens and allowing lyrnphocytes to encounter other self antigens in settings that lead to functional inactivation or death of the self-reactive lymphocytes. The mechanisms of self-tolerance and discrimination between self and foreign antigens are discussed in Chapter 11. Abnormalities in the induction or maintenance of self-tolerance lead to immune responses against self antigens (autologous antigens), often resulting in disorders called autoimmune diseases. The development and pathologic consequences of autoimmunity are described in Chapter 18. These features of adaptive immunity are necessary if the immune system is to perform its normal function of host defense (see Table 1-3). Specificity and memory enable the immune system to mount heightened responses to persistent or recurring stimulation with the same antigen and thus to combat infections that
RESP0NSES 0F IMMUNE AND0VERVIEW PROPEBTIES
are prolonged or occur repeatedly. Diversity is essential if the immune system is to defend individuals against the many potential pathogens in the environment. Specialization enables the host to "custom design' responsesto best combat particular types of microbes. Contraction of the response allows the system to return to a state of rest after it eliminates each foreign antigen and to be prepared to respond to other antigens. Selftolerance is vital for preventing harmful reactions against one's own cells and tissues while maintaining a diverse repertoire of lymphocl'tes specific for foreign antigens.
OFTHEADAPTIVE COIvIPOTTruTS Cru.uI-RR
Svsrrrvt lrunnurur
tinct subpopulations of lymphocytes that differ in how
mediated immuniry recognize the antigens of intracellular microbes and function to destroy these microbes or the infected cells. T cells do not produce antibody molecules.Their antigen receptors are membrane molecules distinct from but structurally related to antibodies (see
associated but not soluble antigens (see Chapter 6). T lymphocltes consist of functionally distinct populationi, the best defined of which are helper T cells and
macrophages, and other leukocytes. CTLs kill cells that produie foreign antigens, such as ,cells infected by 'oi.t,set and other intracellular microbes. Some T l1'rn-
against viruses and other intracellular microbes. We will tJtnrtt to a more detailed discussion of the properties of lymphocltes in Chapter 3. Different classesof lymphoiytei cun be distinguished by the expression of surface pioteins that are named "CD molecules" and numbered (Chapter3).
O NI -
I N T R O D U C TTI OTNH EI M M U N S EY S T E M
nition
Effector functions
B lymphocyte
Activationof macrophages Inflammation HelperT lymphocyte
..r =\
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CytotoxicT lymphocyte
(crL)
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i'r :-'€t/t" rl
K i l l i n qof infecteil cell
l'' 1t
expresstng microbial antigen
Regulatory T lymphocyte
. Suppressionof rmmuneresponse
Natural killer
O,I
rv
Killinq of :P.o ! ".-' "d infecteil cell qi,d-'
K) cell Infectedcell
rl
t'1
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Classesol lymphocytes.B lymphocytesrecognizesolubleantigensand developinto antrbody-secreting cells.HelperT lymgnizeantigenson the surfacesof APCsand secretecytokines,which stimulatedlfferent mechanisms of lmmunityand inflamrecognizeantigenson infectedcellsand kill these cells.Regulatory T cellssuppressand preventimmuneresponse,e.g. to NK cellsuse receptorswith more limiteddiversitythan T oiB cell antigenreceptorsto recognize and kill theirtargeis,such ils.
The initiation and development of adaptive immune responses require that antigens be captured and dis_ played to specific lymphocytes. The celis that serve this role are called antigen-presenting cells (ApCs). The most specializedAPCs are dendritic cells, which capture microbial antigens that enter from the external environment, transport these antigens to lymphoid organs, and present the antigens to naive T lymphocytes tb initiate immune responses.Other cell types function as ApCs at
different stages of cell-mediated and humoral immune responses. We will describe the functions of ApCs in Chapter 6. The activation of lymphocytes by antigen leads to the generation of numerous mechanisms that function to eliminate the antigen. Antigen elimination often requires the participation of cells that are called effector cells because they mediate the final effect of the immune response, which is to get rid of the microbe.
C h a o t e1r-
Activated T lymphocltes, mononuclear phagocytes,and other leukocytes function as effector cells in different lmmune responses. Lymphocytes and APCs are concentrated in anatomically discrete lymphoid organs, where they interact with one another to initiate immune responses.Lymphocltes are also present in the blood; from the blood, they can recirculate to lymphoid tissues and to peripheral sites of antigen exposure to eliminate the antigen (see Chapter 3).
RESPoNSES Ovrnvrrw oFIMMUNE TOMICBOBES Now that we have described the major components of the immune system and their properties, it is useful to summarize the principles of immune responses to different types of microbes. Such a summary will be a foundation for the topics that are discussed throughout the book. The immune system has to combat many and diverse microbes. As we shall see shortly, some features of immune responses are common to all infectious pathogens, and others are unique to different classesof these microbes. How these adaptive immune reactions are initiated, orchestrated, and controlled are the fundamental questions of immunology.We start with a discussion of the innate immune response. The Early Innate lmmune to Microbes
Response
The innate immune system blocks the entry of microbes and eliminates or limits the growth of many microbes that are able to colonize tissues.The main sites of interaction between individuals and their environment-the skin, and gastrointestinal and respiratory tracts-are lined by continuous epithelia, which serve as barriers to prevent the entry of microbes from the external environment. If microbes successfully breach the epithelial barriers, they encounter macrophages in the subepithelial tissue. Macrophages (and other phagocytic leukocytes) expresson their surfacesreceptors that bind and ingest microbes, and other receptors that recognize different microbial molecules and activate the cells. Activated macrophages perform several functions that collectively serve to eliminate ingested microbes. These cells produce reactive oxygen speciesand lysosomal enzymes, which destroy microbes that have been ingested. Macrophages secrete cltokines that promote the recruitment of other leukocytes,such as neutrophils, from blood vesselsto the site of infection. Cltokines are secreted proteins that are responsible for many of the cellular responsesof innate and adaptive immuniry and thus function as the "messenger molecules" of the immune system. The local accumulation of leukocytes, and their activation to destroy the microbes, is part of the host response called inflammation. The innate immune response to some infectious pathogens, partic-
EESP0NSES FI M M U N R NS D0 V E R V I E0W P R O P E R TAI E
ularly viruses, consists of the production of anti-viral cytokines called interferons and activation of NK cells, which kill virus-infected cells. Microbes that are able to withstand these defense reactions may enter the blood stream, where they are recognized by the circulating proteins of innate immunity. The most important plasma proteins of innate immunity are the members of the complement system. Complement proteins may be directly activated by microbial surfaces (the alternative pathway of activation), resulting in the generation of cleavage products that stimulate inflammation, coat the microbes for enhanced phagocltosis, and create holes in the microbial cell membranes, leading to their lysis. (As we shall see later, complement can also be activated by antibodies-called the classical pathway, for historical reasons-with the same functional consequences.) The reactions of innate immunity are remarkably effective at controlling, and even eradicating, many infections. However, a hallmark of pathogenic microbes is that they have evolved to resist innate immunity and to successfully invade and replicate in the cells and tissues of the host. Defense against these pathogens requires the more powerful and specializedmechanisms of adaptive immunity. The Adaptive
lmmune
ResPonse
The adaptive immune system uses three main strategies to combat most microbes. o Secreted antibodies bind to extracellular microbes, block their ability to infect host cells, and promote their ingestion and subsequent destruction by phagocltes. o Phagocl'tesingest microbes and kill them, and helper T cells enhance the microbicidal abilities of the phagocltes. o CTLs destroy cells infected by microbes that are inaccessibleto antibodies. The goal of the adaptive response is to activate one or more of these defense mechanisms against diverse microbes that may be in different anatomic locations, such as intestinal lumens, the circulation, or inside cells. A characteristic of the adaptive immune system is that it produces large numbers of lymphocltes during maturaiion and after antigen stimulation, and selects the most useful cells to combat microbes' Such selection maximizes the efficacy of the adaptive immune response. All adaptive immune responses develop in steps, each of which corresponds to particular reactions of lymphocytes (Fig. 1-6). We start this overview of adaptive immunity witlr the first step, which is the recognition of antigens. The Capture and DisPlaY of Microbial Antigens Because the number of naive l1'rnphocytes specific for any antigen is very small (on the order of I in 105 or
14
S e c t i o|n-
I N T R 0 D U C TTt 00N T H ET M M U NSEY S T E M
I Antisen I I recoshition |
lLympho.cyre-l | hCi'rvaiiiiri| ..,
-(,
Contraction I A'1ilsq.I leririiilrition I (homeostasis)
EffectorT
Cell-mediated immunity
Surviving memory 7 cells
Antigen presenting cell phocyte Naive B lymphocyte
14
Daysafterantigenexposure
21
rune Tesponses nsist of distinctphases,the first three beinqthe tion of antigen(th effectorphase).The responsecontracts(declr'nes) tstasis,and the antigen-specific cellsthat surviveare responsible for sponsesThe y-axisrepresentsan arbitrarymeasureof the magnitude ated by B lymphocytes) and cell-mediated immunity(mediatedby T
10" lymphocyres) and the quantity of the available antigen may also be small, special mechanisms are needed to capture microbes, concentrate them in the correct location, and deliver their antigens to specific lymphocytes. Dendritic cells are the ApCs that display microbial peptides to naive CD4* and CD8*T lymphocltes and initiate adaptive immune responses to protein antigens. Dendritic cells located in epithelia and connective tissues capture microbes, digest their proteins into peptides, and expresson their surface these peptides bound
of a lymphocy-te with receptors for an antigen finding that antigen is greatly increased by concentrating the antigen in recognizable form in the correct anatomic location. Dendritic cells also display the peptides of microbes that enter other lymphoid tissues, such as the spleen. Intact microbes or microbial antigens that enter Iymph nodes and spleen are recognized in unprocessed
(native) form by specific B lymphocytes. There are also specializedAPCsthat displayantigens to B lymphocltes. Antigen
Recognition
by Lymphocytes
Lymphocl'tes specific for a large number of antigens exist prior to exposure to the antigen, and when an antigen enters, it selects the specific cells and activates them (Fig. 1-7). This fundamental concept is called the
receptors, which are different from the receptors on the cells of all other clones. It is estimated thit there are >106 different specificities in T and B lymphocytes, so that at least this many antigenic determinants can be recognized by the adaptive immune system. We will return to a more detailed discussion of clonal selection in Chapter 3.
EESP0NSES FI M M U N R NS D0 V E R V I E0W C h a p t e1r- P R O P E R TAI E
Lymphocyte_
Lymphocyte clonesmature in generative organs, lymphoid in theabsence of antigens Clonesof mature lymphocytes specificfor diverse antigensenter tissues lymphoid ic Antigen-specif clonesare activated ("selected") by antigens FlcuRE 1-7 The clonal selection hypothesis. Each antigen(X or Y) selectsa preexistingclone of specrficlymphocytesand and differentiation stimulatesthe proliferation of that clone The diagramshows only B lymphocytes giving rise to antibody-secreting effectorcells,but the same principleapplies to T lymphocytes
Antigen-specific lmm une occur responses
The activation of naive T lymphocytes requires recognition of peptide-MHC complexes presented on dendritic cells. The nature of the antigen that activates T cells (i.e., peptides bound to MHC molecules) ensures that these lymphocyes can interact only with other cells (since MHC molecules are cell surface proteins) and not with free antigen. This, of course, is predictable, because all the functions of T lymphocltes are dependent on their physical interactions with other cells. In order to respond, the T cells need to recognize not only antigens but also other molecules, called costimulators, that are induced on the APCs by microbes. Antigen recognition provides specificity to the immune response, and the need for costimulation ensures that T cells respond to microbes (the inducers of costimulatory molecules) and not to harmless substances. B lymphocytes use their antigen receptors (membrane-bound antibody molecules) to recognize antigens of many different chemical types. Engagement of antigen receptors and other signals trigger lymphocyte proliferation and differentiation. The reactions and functions of T and B lymphocl'tes differ in important ways and are best considered separately. Cell-Mediated lmmunity: Activation T Lymphocytes and Elimination of lntracellular Microbes
of
Activated CD4* helper T lymphocytes proliferate and differentiate into effector cells whose functions are
mediated largely by secreted cytokines. One of the earliest responses of CD4* helper T cells is secretion of the cltokine interleukin-2 (lL-z).IL-z is a growth factor that acts on the antigen-activated lymphocltes and stimulates their proliferation (clonal expansion). Some of the progeny differentiate into effector cells that can secretedifferent sets ofcytokines, and thus perform different functions. These effector cells leave the lymphoid organs where they were generated and migrate io sites of infection and accompanying inflammation. r,Vhen these differentiated effectors again encounter cell-associated microbes, they are activated to perform the functions that are responsible for eliminaiion of the microbes. Some effector T cells of the CD4*
pathogens. Other CD4* effector T cells secretecytokinesihat siimulate the production of a special class of antibody called immunoglobulin E (IgE) and activate leukocytes called eosinophils, which are able to kill parasites that may be too large to be phagocltosed. As we discuss below CD4* helper T cells also stimulate B cell responses. Activated CD8* Iymphoc],tes proliferate and differentiate into CTLs that kill cells harboring microbes in the cytoplasm. These microbes may be viruses that infect
15
16
S e c t i o|n-
I N T R 0 D U C TT| 00N T H ET M M U NSEY S T E M
many cell t],pes, or bacteria that are ingested by macrophages but have learned to escape from phagocytic vesicles into the cltoplasm (where they are inaccessibleto the killing machinery of phagocytes,which is largely confined to vesicles).By destroying the infected cells, CTLs eliminate the reservoirs of infection. Humoral lmmunity: Activation of B Lymphocytes and Elimination of Extracellular Microbes Upon activation, B lymphocyes proliferate and differentiate into cells that secrete different classes of antibodies with distinct functions. Manypolysaccharide and lipid antigens have multiple identical antigenic determinants that are able to engage many antigen receptor molecules on each B cell and initiate the process of B cell activation. The response of B cells to protein antigens requires activating signals ("help") from CD4* T cells (which is the historical reason for calling these T cells "helper" cells). B cells ingest protein antigens, degrade them, and display peptides bound to MHC molecules for recognition by helper T cells, which then activate the B cells. Some of the progeny of the expanded B cell clones differentiate into antibody-secreting plasma cells. Each plasma cell secretes antibodies that have the same antigen binding site as the cell surface antibodies (B cell receptors) that first recognized the antigen. polysaccharides and lipids stimulate secretion mainly of the antibody class called IgM. Prorein antigens, by virtue of helper T cell actions, induce the production of antibodies of different classes (IgG, IgA, IgE). This production of functionally different antibodies, all with the same specificity, is called hear,y chain class switching; it provides plasticity in the antibody response, enabling it to serve many functions. Helper T cells also stimulate the production of antibodies with increased affinity for the antigen. This process,called affinity maturation, improves the quality of the humoral immune response. The humoral immune response combats microbes in
established;this is why eliciting the production of potent antibodies is a key goal of vaccination. IgG antibodies coat microbes and target them for phagocytosis, since phagocytes (neutrophils and macrophages) express receptors for the tails of IgG. IgG and IgM activate the complement system, by the classicalpathway, and complement products promote phagocl,tosis and destruction of microbes. Some antibodies serve special roles at particular anatomic sites. IgA is secreted from mucosal epithelia and neutralizes microbes in the lumens of the respiratory and gastrointestinal tracts (and other mucosal tissues). IgG is actively transported across the placenta, and protects the newborn until the immune system becomes mature. Most antibodies have half-lives
of about 3 weeks. However, some antibody-secreting plasma cells migrate to the bone marrow and live for years, continuing to produce low levels of antibodies. The antibodies that are secreted by these long-lived plasma cells provide immediate protection if the microbe returns to infect the individual. More effective protection is provided by memory cells that are activated by the microbe. lmmunological
Memory
An effective immune response eliminates the microbes that initiated the response. This is followed by a contraction phase, in which the expanded lyrnphocyte clones die and homeostasis is restored. The initial actiuation of lymphocytes generates longlived memory celk, which may suruiue for years afier the infection. Memory cells are more effective in combating microbes than are naive lymphocytes because as mentioned earlier, memory cells represent an expanded pool of antigen-specific lymphocytes (more numerous than naive cells specific for the antigen), and memory cells respond faster and more effectively against the antigen than do naive cells. This is why generating memory responses is the second important goal of vaccination. We will discuss the properties of memory lymphocytes in more detail in Chapter 3. In Sections II, III, and IV we describe in detail the recognition, activation, regulation, and effector phases of adaptive immune responses. The principles introduced in this chapter recur throughout the book.
SUMMARY o Protective immunity against microbes is mediated by the early reactions of innate immunity and the later responses of adaptive immunity. Innate immunity is stimulated by structures shared by groups of microbes. Adaptive immunity is specific for different microbial and nonmicrobial antigens and is increased by repeated exposuresto antigen (immunologic memory). 6 Humoral immunity is mediated by B lymphocltes and their secreted products, antibodies, and functions in defense against extracellular microbes. Cell-mediated immunity is mediated by T l1'rnphocytes and their products, such as cytokines, and is important for defense against intracellular microbes. o Immunity may be acquired by a response to antigen (active immunity) or conferred by transfer of antibodies or cells from an immunized individual (passiveimmunity). o The immune system possessesseveral properties that are of fundamental importance for its normal
RESP0NSES 0F IMMUNE AND0VERVIEW 1 - PROPERTIES Chaoter
functions. These include specificity for different antigens, a diverse repertoire capable ofrecognizing a wide variety of antigens, memory of antigen exposure, the capacity for rapid expansion of clones of antigen-speciflc lymphocytes in response to the antigen, specialized responses to different microbes, maintenance of homeostasis, and the ability to discriminate between foreign antigens and self antigens.
o CD4*helperT lymphocyteshelp macrophagesto eliminate ingested microbes and help B cells to produce antibodies.CD8*CTLskill cellsharboring intracellular pathogens, thus eliminating reservoirs of infection. Antibodies, the products of B lymphocytes,neutralizethe infectivity of microbes and promote the elimination of microbes by phagocytesand by activation of the complement system.
c Ll,rnphocytes are the only cells capable of specifically recognizing antigens and are thus the principal cells of adaptive immunity. The two major subpopulations of lynphocytes are B cells and T cells, and they differ in their antigen receptors and functions. Specialized antigen-presenting cells capture microbial antigens and display these antigens for recognition by lymphocytes. The elimination of antigens often requires the participation of various effector cells.
a The adaptive immune response is initiated by the recognition of foreign antigens by specific lymphocytes. Lymphocytes respond by proliferating and by differentiating into effector cells, whose function is to eliminate the antigen, and into memory cells,which show enhanced responseson subsequent encounters with the antigen. The activation of lymphocytes requires antigen and additional signals that may be provided by microbes or by innate immune responsesto microbes.
Selected Readings Burnet FM. A modification of Jerne'stheory of antibody production using the concept of clonal selection. Australian Journal of Science 20:67-69, 1957. Flainik MB and L du Pasquier. Evolution of innate and adaptive immunity: can we draw a line? Trends in Immunology 25:640-644,2004. Jerne NK. The natural-selection theory of antibody formation. Proceedings of the National Academy of Sciences U S A 4l:849-857, 1955. Litman GW IP Cannon, and LJ Dishaw. Reconstructing immune phylogeny: new perspectives. Nature Reviews Immunology 5:866-879,2005. Silverstein AM. Paul Ehrlichs Receptor Immunology: The Magniflcent Obsession.Academic Press,NewYork, 2001. Silverstein AM. Cellular versus humoral immunology: a century-long dispute. Nature Immunology 4:425-428, 2003. Van den Berg TK, JA Yoder, and GW Litman. On the origins of adaptive immunity: innate immune receptors join the tale. Trends in Immunology 25:lI-16, 2004.
'it
Features of Innate lmmune Recognition, 2O Receptors, 22 CellularPatternRecognition Components of the Innate lmmune System,27 EpithelialBarriers,27 29 Phagocytes and InflammatoryResponses, N a t u r aK l i l l e rC e l l s3, 8 CirculatingProteinsof Innatelmmunity,42 Cytokinesof the InnatelmmuneSystem,44 Role of Innate lmmunity in Stimulating Adaptive lmmune Responses, 44 Summary,45
Innate immunity is the first line of defense against infections. The mechanisms of innate immunity exist before encounter with microbes and are rapidly activated by microbes before the development of adaptive immune responses(seeChapter I, Fig. f-l). Innate immunity is also the phylogenetically oldest mechanism of defense against microbes and co-evolved along with microbes to protect all multicellular organisms, including plants and insects, from infections. Adaptive immunity mediated by T and B lymphocl'tes appeared in jawed vertebrates and is superimposed on innate immunity to improve host defense against microbes. In Chapter 1, we introduced the concept that the adaptive immune response enhances some of the antimicrobial mechanisms of innate immunity and provides both memory of antigen encounter and specialization of effector mechanisms. In this chapter, we describe the components, specificiry and functions of the innate immune system.
' . . ; ; 1 1- ' ,
.:.,. Innate immunity serves two important funations.
intact and functional. We will review examples of sueh studies later in this chapter and in Chapter 15 when we discuss immunity to different types of microbes, Many pathogenic microbes have evolved strategies to resist innate immunity, and these strategies are crucial for the virulence of the microbes, In infection by such microbes, innate immune defensesmaykeep the infection in check until the adaptive immune responsesare activated.Adaptive immune responses' being more potent and specialized, are able to eliminatehicrobes that resist the defense mechanisms of innate immunity.
an infection is present against which a subsequent adaptive immune responsehas to be mounted. Moreover, different components of the innate immune response often react in distinct ways to different miirobes (e.g., bacteria versus viruses) and thereby influence the type of adaptive immune response that develops.We will return to this concept at the end of the chapter. Some components of innate immunity are functioning at all times, even before infection; these components include barriers to microbial entry provided by epitheIial surfaces, such as the skin and lining of the gastrointestinal and respiratory tracts. Other components of innate immunity are normally inactive but poised 19
20
$
Section | - |NTRODUCT|0N TOTHETMMUNE SYSTEM
to respond rapidly to the presence of microbes; these components include phagocltes and the complement system.We begin our discussion of innate immunity by describing, in general terms, how the innate immune system recognizes microbes and then proceed to the individual components of innate immuniw and their functions in host delense.
FrRrunrs0FINNATE lurlrururRrcocrunroru The specificity of the innate immune system for microbial products differs from the specificity of the adaptive immune system in several respects (Table 2-l). O The components of innate immunity recognize structures that are characteristic of microbial pathogens and are not present on mammalian cells. The innate immune system recognizes only a limited number of microbial products, whereas the adaptive immune
system is capable of recognizing a much wider array of foreign substances whether or not they are products of microbes. The microbial substances that stimulate innate immunity are called pathogenassociated molecular patterns (PAMPs), and the receptors that bind these conserved structures are called pattern recognition receptors (Table Z-2).Different classesof microbes (e.g.,viruses, gram-negative bacteria, gram-positive bacteria, fungi) express different PAMPs. These structures include nucleic acids that are unique to microbes, such as doublestranded RNA found in replicating viruses or unmethylated CpG DNA sequencesfound in bacteria; features of proteins that are found in microbes, such as initiation by l/-formylmethionine, which is typical of bacterial proteins; and complex lipids and carbohydrates that are synthesized by microbes but not by mammalian cells, such as lipopolysaccharides (LPS) in gram-negative bacteria, teichoic acids in gram-positive bacteria, and mannose-rich oligosac-
Table 2-1. Specificityof Innateand Adaptive lmmunity
Specificity
Innateimmunity
Adaptiveimmunity
Forstructures sharedbv classesof microbes ("pathogen-adsociated patterns") molecular
Forstructural detailof microbial molecules (antigens); mayrecognize nonmicrobial antigens
Different I microbes I ldentical-_J mannose L receptors
Different. microbes-| I
oistinct/t antibody molecules
Receptors
Encodedin germline; limiteddiversity ("patternrecognition receptors")
F
Encodedby genesproducedby somaticrecombination of gene segments;greaterdiversity
f1,e
tu 1fr* Distribution of receptors
Nonclonal:identicalreceptorson all cellsof the same lineaqe
DiscriminationYes;hostcellsare not recognizedor they thatpreventinnate betweenself mayexpressmolecules andnonself immunereactions
Clonal:clonesof lymphocytes withdistinctspecificities express differentreceptors
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IMMUNITY INNATE
Table 2-2.Examples of RecognitionMoleculesof Innatelmmunity and the MolecularPatternsof M i c r o b e sT h e y R e c o g n i z e
pattern Location Cell-associated receptors recognation Toll-likereceptors
C-typelectins
Specificexamplesand their PAMPligands
andviralmolecules and TLRs1-9:Variousbacterial Plasmamembrane (seeFig.2-2) membranes of endosomal cells,phagocytes, dendritic cells,andmany endothelial othercelltypes with surfacecarbohydrates Microbial Mannosereceptor: Plasmamembranes andfructose terminalmannose of phagocytes Dectin:Glucanspresentin fungalcellwalls
receptors Scavenger
Plasmamembranes of phagocytes
diacYlglYcerides CD36:microbial
NLRs
Cytoplasmof phagocytes and othercells
Nod1,Nod2 and NALP3:bacterialpeptidoglycans
N{ormylMet-Leu-Phe Plasmamembranes of phagocytes receptors
FPR and FPRL1:peptidescontaining residues N-formylmethionyl
Solublerecognition lLocation molecules
Specificexamplesand their PAMPligands phosphorylcholine protein(CRP):Microbial C reactive andphosphatidylethanolamine with lectin(MBL):Carbohydrates Mannose-binding andfructose terminalmannose proteins SP-AandSP-D:Various SurJactant structures microbial and lipoteichoicacid Ficolin:N-acetylglucosamine componentsoi the cell walls of gram-positivebacteria
charides found in microbial but not in mammalian glycoproteins. Becauseof this specificity for microbial structures, the innate immune system is able to distinguish self from nonself, but it does so very differently from the adaptive immune system.The mechanisms of innate immunity have evolved to recognize microbes (nonself) and not mammalian (self) molecules. In system, contrast, in the adaptive immune self/nonself discrimination is based not on inherited specificity for microbes but on the elimination or inactivation of ll,rnphocyes specific for self antigens. In fact, the innate immune response is not known to react against self structures in healthy tissues and is thus even better at discriminating between self and nonself than the adaptive immune system is. As we shall see in Chapter 18, adaptive immune responses can occur against autologous antigens and result in autoimmune diseases, but this problem does not appear to happen with innate immunity.
@ The innate immune system recognizes microbial prod,ucts that are ofien essential for suruiual of the microbes. This host adaptation is important because it ensures that the targets of innate immunity cannot be discarded by microbes in an effort to evade recog-
own survival. An example of a target of innate immunity that is essential for microbes is double-stranded viral RNA, which plays a critical role in the replication of certain viruses. Similarly, LPS and teichoic acid are structural components of bacterial cell walls that are required for bacterial survival and cannot be discarded. @ Pattern recognition molecules of the innate immune systenx include cell-associnted pattern recognition
22 OHNET M M U N i r S e c t i o| -n I N T R O D U CTT0|T SE YSTEM ., -*-"*,1;..,.,"..-. receptors expressed on the surface of or inside uari_ ous cell types, and soluble proteins in the blood and extracellular fluids (see Table 2-2). The cellassociated receptors may perform one or both of two major functions. First, they may transduce signals that activate antimicrobial and proinflam_ matory functions of the cells in which thev are expressed.Second, they may facilitate uptake of the microbes into the cells. Soluble receptors are respon_ sible for facilitating the clearance of microbes from blood and extracellular fluids by enhancing uptake into cells or by activating extracellular killing mecha_ nisms. We will discuss these receptors and their functions in detail below.
lymphocytes, and other cell types also express pattern recognition receptors. These cell-associated pattern recognition receptors are present on the cell surface, in endosomal vesicles,and in the cytoplasm, ready to recognize microbes in any of these locations (Fig. 2-l). Pattern recognition receptors are linked to intracellular signal transduction pathways that activate various cellular responses,including the production of molecules that promote inflammation and defend against microbes. The major classesof these receptors are discussed next.
a The pattern recognition receptors of the innqte immune system are encoded in germline DNA. In contrast, T and B lymphocytes, the principal compo_ nents of adaptive immunity, use somatic gene rearrangement to generate their antigen receptors (seeChapter8). Becausemany fewer receptorscin be encoded in the germline than can be generated through gene rearrangements, the innate immune system has a limited repertoire of specificities. It is estimated that the innate immune system can recog_ nize about 103 molecular patterns of microbes. In contrast, the adaptive immune system is capable of recognizing 107 or more distinci antigens. Furthermore, whereas the adaptive immune system can distinguish between antigens of differeni microbes of the same class and even different antigens of one microbe, innate immunity can distinguish only classesof microbes.
The TLRs are An evolutionarily conserued family of p&ttern recognition receptors expressed on many cell types, which play essential roles in innate immune responses to microbes (Fig. 2-2 and Box 2-l). Toll was originally identified as a Drosophila gene involved in establishing the dorsal-ventral axis during embryogenesis of the fly, but subsequently it was discoveredthat the Toll protein also mediated antimicrobial responses. There are eleven different human TLRs, named TLR t to I l. All these receptors contain a Toll/IL-1 receptor (TIR) homology domain in their cytoplasmic region, which is
6 In
addition
to microbial
products,
Toll-like Receptors (TLRs)
SurfaceTLRs ( T L R - 2 , 45, ) ; Bacteriallipids, Flagellin,etc.
the innate
ssRNAC
f
With this general introduction to innate immunitv, we proceed to a discussion of the major classes of pattern recognition receptors and then the individual components of innate immunity and their functions in host defense. Cellular Pattern Recognition
Receptors
A wide variety of cell types expresspattern recognition receptors and therefore participate in innate immune responses. These include neutrophils, macrophages, dendritic cells, and endothelial Cells, which we in,itt discuss later in this chapter. In addition, epithelial cells,
Gellularlocationsof patternrecognitionmolecules mmunesystem.Somepatternrecognition molecules m i l y ( s e e F i g . 2 - 7 ) ,s u c h a s T L R s2 , 4 , a n d b , a r e expressedon the cell surface,where they may bind extracellular pathogen-associated molecularpatterns.OtherTLRsare expressed on endosomalmembranes, suchas TLRs3, 7, B, and 9, all of which can recognizenucleicacidsof microbesthat have been phagocy_ tosed by cells Cellsalsocontaincytoplasmic sensoTsof miciobiil rnfection(discussedlaterin the chapter),includingthe NLR family of proteins,which recognizebacterialpeptidoglycans, and a subset of CARDfamilyof proteins,which bindviralRNA.
Chapter2-INNATEIMMUN &I T Y2 3
T L R sa r e m e m b r a n es i g n a l i n rge c e p t o r tsh a t p l a ye s s e n t i a l r o l e si n i n n a t ed e f e n s ea g a i n s m t i c r o b e sT. L R g e n e s h a v e b e e n h i g h l yc o n s e r v e dd u r i n ge v o l u t i o na, n d a r e found in Caenorhabditiselegans,Drosophila,and mamn L Rg e n e s( 11 e x p r e s s e d m a l s .T h e r ea r e 1 2 m a m m a l i aT
in humans),all of which aretype I integralmembraneglycooroteinsthat containleucine-richrepeatsflanked by characteristiccysteine-richmotifs in their extracellular c I R h o m o l o g yd o m a i n( s e e r e g i o n sa n d a c y t o p l a s m i T F i g u r e )T I R d o m a i n sa r e a l s o f o u n d i n t h e c y t o p l a s m i c
@rln signaling LPS binding protein Bacterial li otein
LPS
F
I T
TLRl, TLR2, TLR6
?
cD14 MD2
^ruP CpGnn'"$S DNA .s5'o
I . T B K 1I I_-.
MAP kinase cascade
'
I
i
TRI I K E JK I N A S E
Transcriptionof NF'rcB responsivegenes: lL-6,TNF, IL-1, lL-12.E-selectin,MCP-1,lL-8,others
Continued on following Page
24
0H N ET M M U N SE YSTEM $ S e c t i ol -n I N T R O D U CTT0|T
tailsof the receptorsfor the cytokineslL-1and lL-18,and a n d i n f l a m m a t i o nI n r e s t i n g c e l l s , f u n c t i o n a lN F - r B s i m i l a sr i g n a l i npga t h w a y sa r ee n g a g e db y T L R s ,l L - 1, a n d dimersare presentin an inactivestate in the cytoplasm, rL-18. boundto inhibitoryproteinscalledkBs. The activationof T h e T L R b i n d i n gs i t e sf o r m i c r o b i al li g a n d sa r e b e i n g NF-rBis initiatedby the signal-induced degradation of kB studiedby x-raycrystallography and mutationalanalyses. p r o t e i n sb y a n e n z y m a t ic o m p l e xc a l l e dk B k i n a s e( l K K ) . To date,the structuralbasisfor the dlfferentTLR soeci- The same TLRs that lead to NF-rB activatronoften also f i c i t i e sr e m a i n su n k n o w n T . LRsignaling r e q u i r e sd i m e r - leadto activationof anothertranscription factorcalledAPizationof TLR proteins in the cell membrane,which 1 . N F - r B a n d A P - 1a c t i v a t i o n b y T L R s i n v o l v e sa s i g n a l sometimes involveshomodimerization of two identical transductionpathwaythat is dependenton the MyD88 TLR proteinsand sometimesheterodimerization of two adapterprotein(see Figure).All TLRs exceptTLR3 bind differentTLR proteins The repertoireof specificitiesof MyD88, which, in most cases, then interacts with the TLR system is apparentlyextendedby the abilityof membersof the lL-l receptor-associated kinase(IRAK) TLRs to heterodimerize with one another For example, family,and the IRAKproteinsinteractwith and activate dimersof TLR2 and TLB6 are requiredfor responsesto TNF receptor-associated factor 6 (TRAF-6).TRAF-6, peptidoglycanSpecificitiesof the TLRs are also influwhich promotesubiquitination of downstreamsignaling enced by variousnon-TLRaccessorymolecules This is molecules,activatesTGF-p-activated kinase 1 (TAK1 ), most thoroughlyunderstoodfor TLR4and its liqandLpS which in turn initiatesthe mitogen activatedprotein LPSfirst bindsto solubleLPS-binding protein(L-Bp) (MAP) kinaseand inhibitorof NF-rB (kB) kinasecasin tfre blood or extracellular fluid, and this complex serves to cades The MAP kinaseandthe kB kinasecascadeslead f a c i l i t a t eL P S b i n d i n gt o C D 1 4 ,w h i c h e x i s t sa s b o t h a to activationand nuclearlocalization of the AP-1and NFsolubleplasmaproteinand a glycophosphatidylinositol-rB transcription factors,respectively linkedmembraneproteinon most cells exceptendotheTLR4,which respondsto bacterialLPS(seeBox 15-1, l i u m O n c eL P Sb i n d st o C D 1 4 ,L B Pd i s s o c i a t e sa ,n d t h e Chapter15),engagesat leasttwo differentsignalingpathLPS-CD14complexphysicallyassociateswith TLR4 An ways, eachof which utilizesa differentpairof TIR family additionalextracellular accessoryproteincalledMD2 also adapterproteins.In one pathway,MyD88and Mal/TIRAP b i n d st o t h e c o m p l e xw i t h C D 1 4 .L P S ,C D 1 4 ,a n d M D 2 are recruitedand leadto NF-KBactivationvia IRAK,TRAFa r e a l l r e q u i r e df o r e f f i c i e n L t P S - i n d u c esdi g n a l i n gb,u t i t 6, and TAK1. In a second pathway,TRAM and Trif are rs not yet clear if direct phvsicalinteractionof LpS with recruitedand lead to activationof interferonresoonse TLR4 is necessary.Differentcombinationsof accessory factor-3(lRF-3),via TBK1. IRF-3is a transcriptionfactor moleculesin TLR complexesmay serve to broadenthe that enhancesexpressionof type 1 interferongenes(lFNrange of microbial products that can induce innate o a n d I F N - B )T.h e r e f o r eT, L R 4s i g n a l i n cga na l s or e s u l ti n r m m u n er e s p o n s e sF o r e x a m p l e b , o t h C D 1 4a n d M D 2 expressionof a wide varietyof inflammatory and antiviral areassociated with complexesof otherTLRs(e g., TLR2). g e n e s . The detailsof TLR signalingare the focus of active TLR9,which recognizesbacterialand viral unmethyinvestigation, and new informationcontinuesto change lated CpG DNA within endosomes,recruits MyD88, our understandingof the pathways;the following disleadingto activationof lRF7,a transcriptionfactor that, cussion is an overview of current knowledge.Ligand- l i k el R F 3 i, n d u c e st y p e I i n t e r f e r ogne n ee x p r e s s i o n T.L R g i n d u c e d T L R d i m e r i z a t i o np e r m i t s t h e b i n d i n g o f signalingalso activatesNF-rB cytoplasmic adapterproteinsto the TLRcytoplasmic tails, A secondmajordownstreameffectof TLR signalingis via homotypicinteractions of TIR domainsfound in both the activationof IRF-3 and -7, which are transcription the TLR and the adapterprotein.Fourof these adapters factorsrequiredfor expressionof type I interferongenes are MyD88,Mal (MyD88adapter-like)/TlRAp (TlRdomain- (lFN-cr and IFN-B). TLR3,the endosomalreceptorfor viral containingadapter protein),Trif (TlR-domain-containing double-stranded RNA, activatesIRF-3.TLR3 does not adapter inducing interferon-0),and TRAM (Trif-related b i n dM y D 8 8 ,b u t u t i l i z e st h e T R I Fa d a p t e p , hich r r o t e i nw adaptermolecule)Differentcombinations of the adaoters activatesTBKl TTRAFfamily member associatedNF-rB are used by differentTLRs,as discussedbelow,which activatorbindingkinase).TRIF then activatesthe trani s t h e b a s i s f o r c o m m o n a n d u n i q u e d o w n s t r e a m scriptionfactor IRF-3,which stimulatesexpressionof effectsof the TLRs In all cases,the adapterproteinsare type I interferon genes. The type I interferonsare crucialfor the assemblyof signalingcomplexes,which cytokrnesthat block viral replicationin cells.Therefore, i n c l u d ep r o t e i nk i n a s e s( u s u a l l yI R A Kf a m i l y m e m b e r s ) molecularpatternsthat are producedby vrruses(e.g , a n dT R A F double-stranded RNA) engageTLRs that stimulatethe A majordownstreameffectof TLRsignalingrsthe actitranscription of antiviralcytokines.TRAF6is alsorecruited vationof the transcription factorNF-rB,which is required t o t h e s i g n a l i ncgo m p l e xi n d u c e db y T L R 3l i g a n d sl ,e a d i n g for expressionof manygenesrelatedto innateimmunitv to NF-rB activation.
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essentialfor signaling (seeBox 2-l). The major cell types on which TLRs are expressedinclude macrophages,dendritic cells, neutrophils, mucosal epithelial cells, and endothelial cells. MammalianTLRs are involved in responsesto widely d.iuergent types of molecules that are commonly expressed by microbial but not mammalian cells (see Fig.2-2).TLRs are found on the cell surface and on intracellular membranes, and are thus able to recognize microbes in different cellular locations. Some of the microbial products that stimulate TLR signals include gram-negative bacterial LPS, gram-positive bacterial
INNATE IMMUNITY
insidecellson endoplasmicreticulum mainly expressed (ER) and endosomalmembranes,where they detect microbial nucleic acids (see Fig. 2-2)' Although the nucleic acid ligandsrecognizedby theseTLRsare not all uniquelyproducedby microbes,the nucleicacidsmade by host cells are not normally in the endosomallocations of theseTLRs.In other words,TLRs3, 7, 8, and 9
t Gramne Bacterial ' Bacterial triacylatedjpeptidoglycan, lbacterial lipopeptides r lipoprotein, , Fungaln r lipotechoic acid, I Parasitic lPAt\4Prl r Viralenv I andPorins; , Viralhemagglutinin I Hosthea TLR1:TLR2; TLR2 ] TLR4 lReceptorsl I
TLRS
I TLR2:TLR6
tT Plasma membrane
Recruitmentof adapterproteins d
& \1
Recruitmentand activation of proteinkinases Activationof transcriptionfactors Gene transcription Expressionof Inflammatorycytokines(TNF,lL-1,lL-12) (lL-8,MCP-1,RANTES) Chemokines adhedionmolecules(E-selectin) Endothelial Costimulatorymolecules(CD80,CD86) Antiviralcytokines(lFNodp)
Endosomal membrane
and cellularlesponses.Ligandsfor TLRsare showntogether FIGSRE 2-2 MammalianTLRs:specificities,basic signalingmechanisms, (see with dimersof the TLRsthat speciallybind them NotJ that iome TLRsare expressedin endosomesand some on the cell surface signaling the about detarls TLRs Further qrens to all Fia ?-j\ Thp haqic in TLR signaling, illustrated onlyfor TLR2and TLR4,are applicable pathwavsare describedin Box 2-1
i
26
$
S e c t i oln-
I N T R O D U C TTI 0 T NH EI M M U N S EY S T E M
,;Fs#!:'*..,
distinguish self from foreign substancesbased on cellular location of the ligands they bind. In addition to TLRs, there are other intracellular pattern recognition receptors, located in the cytoplasm, that we will discuss later.
followed by recruitment of TIR domain-containing adapter proteins, which facilitate the recruitment and activation of various protein kinases,leading to the activation of different transcription factors. The major transcription factors that are activated by TLR signaling pathways are nuclear factor rB (NF-rB), Ap-1, IRF-3, and IRF-7. NF-rB andi or AP-1 stimulate the expression of genes encoding many of the molecules in the innate immune response, which we will discuss later in the chapter, including inflammatorycltokines (e.g.TNF and IL-l), chemokines (e.g.CCL?),and endothelial adhesion molecules (e.g. E-selectin).IRF-3 and IRF-7 promote expression of interferon (IFN)-cxlFgenes, important for innate immune responses to viruses. The use of different adapter proteins by different TLRs provides some variability in the type of cellular response that is stimulated by distinct microbial products. Other Pattern Recognition
Receptors
Seueral types of plasma membrane and cytoplasmic receptors other than TLRs are expressed on uarious cell types and. recognize microbial molecules (see Table 2-2 and Fig. 2-l). Some of these receptors transmit activating signals, similar to TLRs, that promote inflammatory responsesand enhance killing of microbes. Other receptors mainly participate in the uptake of microbes into phagocytes, as we will discuss in detail later. O C-type lectins are a large family of calciumdependent carbohydrate-binding molecules exoressed on the plasma membranes of macrophages, dendritic cells, and other leukocltes. There are severalty?es of C-type lectins with different specificities, and only partially understood functions. Some of these lectins recognize carbohydrate structures found on the cell walls of microorganisms but not mammalian cells. The best knorrrmis the mannose receptor, which plays a role in phagocytosis of microbes, discussed later. Another C-type lectin called Dectinl, which binds B-1,3-and B-1,6-linkedglucans present in fungal cell walls, generates signals that intersect with TLR signaling pathways. o Scavenger receptors comprise a structurally and functionally diverse group of molecules wiin tne common characteristic of mediating the uptake of oxidized lipoproteins into cells. Some of the major scavengerreceptors that are expressedon phagocytes are CD36, CD68, and SRBI. Scavengerreceptors play pathologic roles in the generation of cholesterol-
laden foam cells in atherosclerosis;they also recognize and mediate the uptake of microbes into phagocltes as part of innate immune responses. @ N-formyl Met-Leu-Phe receptors, including FPR and FPRLI, recognize short peptides containing l/-formylmethionyl residues. FPR and FPRLI are expressedby neutrophils and macrophages, respectively. Because all bacterial proteins and few mammalian proteins (only those synthesized within mitochondria) are initiated by l/-formylmethionine, FPR and FPRL1 ailow phagocytes to detect and respond to bacterial proteins. The ligands that bind these receptors are some of the first identifled and most potent chemoattractants for leukocytes. FPR and FPRLI belong to the seven-transmembrane,guanosine triphosphate (GTP)-binding (G) proteincoupled receptor superfamily. Like chemokine receptors, these receptors initiate intracellular responses through associated trimeric G proteins. In a resting cell, the receptor-associatedG proteins form a stable inactive complex containing guanosine diphosphate (GDP) bound to Ga subunits. Occupancy of the receptor by ligand results in an exchange of GTP for GDP The GTP-bound form of the G protein activates numerous cellular enzyrnes, including an isoform of phosphatidylinositol-specific phospholipase C that functions to increase intracellular calcium and activate protein kinase C. The G proteins also stimulate cltoskeletal changes, resulting in increased cell motility. g NLRs (NACHT-LRRs) are a family of cytoplasmic molecules, defined by the presence of certain conserved domain structures, which serve as intracellular sensorsof bacterial infection. Severalmembers of this family are known to bind specific ligands inside cells and initiate signaling cascades that activate inflammatory responses. One subset of the NLRs is called Nods (Nucleotide-binding oligomerization domain), and another subfamily is called NALPs (NACHT-, LRR- and pyrin domain-containing proteins). Three NLRs, including Nodl, Nod2, and NALP3, recognize derivatives of peptidoglycan, a common component of bacterial cell walls. After recognizing peptidoglycan, they recruit the protein kinase RICK, which links to dor,rmstreamsignaling pathways that lead to activation of NF-rB and AP-I, and production of cltokines and other mediators of innate immunity. It is likely that NLRs bind other microbial products as well. o Caspase activation and recruitment domain (CARD)-containing proteins, including retinoic acid inducible gene-I (RIG-| and melanoma differentiation-associated gene 5 (MDAS), are cytoplasmic receptors that bind viral RNA. Via their CARD domains, RIG-I and MDAS engagesignaling cascades that involve TBKI, similar to the TLR3 signaling pathway discussed earlier. Ultimately these pathways activate the IRF-3 and NF-rB transcription factors, which stimulate the expression of antiviral type I interferons.
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IMMUNITY INNATE
Table 2-3. Componentsof Innatelmmunity
Components
PrincipalFunctions
Barriers Epithelial layers
Preventmicrobialentry
icidin Detengins/cathel
M i c r o b i akl i l l i n g
Intraepithelial lymphocytes
killing Microbial
Circulating effectorcells Neutrophils
and killingof microbes Earlyphagocytosis
Macrophages
and killinqof microbes, Efficient ohaoocvtosis secretioriof dvtokinesthatstimulateinflammation
NKcells
of macrophages cells,activation Lysisof infected
Circulating effectorproteins Complement
of microbes, opsonization Killingof microbes, activationof leukocytes
Mannose-binding lectin(collectin)
of complement activation of microbes, Oosonization (lectinpathway)
C-reactiveprotein(pentraxin)
of complement activation of microbes, Opsonization
Cytokines TNF,lL-1,chemokines
Inflammation
IFN-o,-B
to viralinfection Resistance
IFN-y
activation Macrophage
tL-12
IFN-yproductionby NK cells and T cells
lL-15
of NK cells Proliferation
IL.1O, TGF-F
Controlof inflammation
NK,naturalkiller;TGF-B' lL, interleukin; Abbreviations; lFN,interferon; factor growth necrosis tumor factor-p, TNF, transforming
OFTHE INNATE CoruporurruTs
lvrvrurur Svsrrnn The innate immune system consists of epithelial barriers, circulating and tissue cells, and plasma proteins (Table 2-3). The principal effector cells of innate immunity are neutrophils, mononuclear phagocytes, and natural killer (NK) cells.These cells attack microbes that have breached epithelial barriers and entered into tissues or the circulation. Each of these cell types plays a distinct role in the response to microbes. Some of the cells of innate immuniry notably macrophages and NK cells, secrete cltokines that activate phagocyes and stimulate the cellular reaction of innate immunity, called inflammation. Inflammation consists of recruitment of leukocytes and extravasation of several plasma proteins into a site of infection, and activation of the leukocltes and proteins to eliminate the infectious agent. As we shall see later, inflammation can also iniure normal
tissues.If microbes enter the circulation, they are combated by various plasma proteins. The major circulating proteins of innate immunity are the proteins of the complement system and other plasma proteins that recognize microbial structures, such as mannose-binding lectin. In the following sections,we describe the properties and functions of each of these components of innate immunity. Epithelial Barriers Intact epithelial surfaces form physical barriers between microbes in the external enuironment and host tissue(Fig. 2-3). The three main interfaces between the environment and the host are the skin and the mucosal surfaces of the gastrointestinal and respiratory tracts. AII three are protected by continuous epithelia that prevent the entry of microbes, and loss of integrity of these epithelia commonly predisposes to infection.
27
28
l- INTR0DUCT|0N T0THETMMUNE SYSTEM {* Section
Physical barrier to infection Killingof microbes by locallyproduced antibiotics (defensins, cathelicidins) Intraeoithelial
Killingof microbes and infectedcells by intraepithelial lymphocytes FIGURE2-3 Epithelial barriers.Epithetia at the porrats of entry providephysical of microbes produceantimicrobial barriers, substances, andharborintraepitheljal lymphocytes thatarebelieved to killmicrobes andinfected celis Epithelia, as well as some leukocytes, produce peptides that haue antimicrobial properties. TWo structurally distinct families of antimicrobial peptides are the defensins and the cathelicidins. Defensins are small cationic peptides, 29 to 34 amino acids long, that contain three intrachain disulfide bonds. Three families of defensins, named o, B, and e, are distinguished by the location of these bonds. Defensins are produced by epithelial cells of mucosal surfaces and by granulecontaining leukocytes, including neutrophils, NK cells, and c1'totoxic T l}'rnphocytes. The set of defensin molecules produced differs between different cell types. A major producer of s defensins are paneth cells within the cr)?ts of the small bowel. Paneth cell defensins are sometimes called crypticidins and serve to limit the amount of microbes in the lumen. Defensins are also produced elsewherein the bowel, in respiratory mucosal cells, and in the skin. Some defensins are constitutively produced by some cell types, but their secretion may be enhanced by cytokines or microbial products. In other cells, defensins are produced in responses to cltokines and microbial products. The protective actions of the defensins include both direct toxicity to microbes, including bacteria and fungi, and the activation of cells involved in the inflammatory responseto microbes. The mechanisms of direct microbicidal effects are poorly understood. Cathelicidins are expressed by neutrophils and various barrier epithelia, including skin, gastrointestinal mucosal cells, and respiratory mucosal cells. An l8-kD two-domain precursor cathelicidin protein is transcribed and is proteolytically cleaved into two peptides, each with protective functions. Both precursor slmthesis and proteolytic cleavage may be stimulated by inflammatory cytokines and microbial products. The Cterminal fragment, called LL-37 because it has two leucine residues at its N terminus, has multiple functions
that serve to protect against infections. These include direct toxicity to a broad range of microorganisms, and the activation of various responses in leukocytes and other cell types that promote eradication of microbes. In addition, LL-37 can bind and neutralize LPS,which is a toxic component of the outer wall of gram-negative bacteria that is discussedlater in this chapter.The other fragment of the cleavedcathelicidin precursor may also have antimicrobial activities, but these are less well defined. Barrier epithelin and serosal cauities contain certain types of lymphocytes, including intraepithelial T lymphocytes and the B- I subset of B celk, respectiuely, which recognize and respond to commonly encountered microbes. As we will discuss in greater detail in later chapters, most T and B lymphocltes are components of the adaptive immune system and are characterized by a highly diverse repertoire of specificities for different antigens. The diversity of antigen receptors is generated by somatic recombination of germline DNA segments and modification of nucleotide sequences at the junctions between the recombined segments, yielding unique antigen receptor genes in each lyrnphocyte clone (see Chapter 8). However, certain subsets of T and B lymphocltes have very little diversiry because the same DNA segments are recombined in each clone and there is little or no modification of junctional sequences. It appears that these T and B cell subsets recognize structures commonly expressed by many different or commonly encountered microbial species; in other words, they recognize PAMPs. Although these T and B cells are lymphocytes with antigen receptors like other T or B cells, and they perform similar effector functions as do other lymphocytes, the nature of their specificities places them in a special category of l1'rnphocltes that is akin more to effector cells of innate immunity than to cells of adaptive immunity. Intraepithelial T lymphocltes are present in the epidermis of the skin and in mucosal epithelia (see Chapter 3). Various subsets of intraepithelial lymphocltes are present in different proportions, depending on species and tissue location. These subsets are distinguished mainly by the type of T cell antigen receptors (TCRs) they express. Some intraepithelial T lymphocytes express the conventional crBform of TCR, which is present on most T cells in l]..rnphoid tissues.Other T cells in epithelia expressa form of antigen receptor called the y6 receptor that may recognize peptide and nonpeptide antigens. Intraepithelial l1'rnphocytes may function in host defense by secreting cytokines, activating phagocytes, and killing infected cells. The peritoneal cavity contains a population of B lymphocytes, called B-l cells, whose antigen receptors are immunoglobulin molecules, as in other B lyrnphocltes, but have limited diversity, like the antigen receptors of intraepithelial T lymphocytes. Many B-l cells produce immunoglobulin M (IgM) antibodies specific for polysaccharide and lipid antigens, such as phosphorylcholine and LPS, that are shared by many types of bacteria. In fact, normal individuals have circulating antibodies against such bacteria, most of which are present in the intestines, without any evidence of infection. These antibodies are called natural antibodies and they are largely the producr of B-l cells.
Natural antibodies serve as a preformed defense mechanism against microbes that succeed in penetrating epithelial barriers. A third population of cells present under many epithelia and in serosal cavities are mast cells. Mast cells respond directly to microbial products by secreting cytokines and lipid mediators that promote inflammation. We will return to a discussion of mast cells in Chapter 19. Phagocytes
and Inflammatory
Responses
The most numerous effector cells of the innate immune system are bone marrow-derived cells that circulate in the blood and migrate into tissues.These include cells of the myeloid lineage, including neutrophils, mononuclear phagocytes, and dendritic cells, which we will discuss in this section, and cells of the lymphocyte Iineage, including natural killer cells, which will be described later, as well as y6T cells and B-1 B cells,which were described above. Phago cytes, includ.ing neutrophik end macro phage s, are celk whose primary function is to idenffi, ingest, and destroy microbes. The functional responses of phagocytes in host defense consist of sequential steps: active recruitment of the cells to the sites of infection, recognition of microbes, ingestion of the microbes by the process ofphagocltosis, and destruction ofingested microbes. In addition, phagocytes produce cltokines that serve many important roles in innate and adaptive immune responses and tissue repair. These effector functions of phagocytes are important not only in innate immuniry but also in the effector phases of adaptive immune responses. For example, as we will discuss in Chapter 13, in T cell-mediated immunity, antigenstimulated T cells can activate macrophages to become more efflcient at killing phagocytosed microbes. In humoral immuniry antibodies coat, or opsonize, microbes and promote the phagocytosis of the microbes through macrophage surface receptors for antibodies (seeChapter 14). These are examples that illustrate two ways by which adaptive immunity works by enhancing the anti-microbial activities of a cell type of innate immunity (the macrophage). In the following discussion, we will describe the phagocytes that are important in innate immunity.
Neutrophils are produced in the bone marrow and arise from a common lineage with mononuclear phagocytes. Production of neutrophils is stimulated by granulocyte colony-stimulating factor (G-CSF).An adult human produces more than I x 10rt neutrophils per day, each of which circulates in the blood for only about 6 hours. Neutrophils may migrate to sites of infection within a few hours after the entry of microbes. If a circulating neutrophil is not recruited into a site of inflammation withinlhis period, it undergoes apoptosis and is usually phagocytosed by resident macrophages in the liver or spleen. Even after entering tissues, neutrophils function for a few hours and then die. M ononuclear
PhagocYtes
The mononuclear phagocyte systenxconsistsof celk that haue a common lineage whose primary function is phagocytosk, and that play central roles in innate and adaptive immunity. The cells of the mononuclear phagocyte system originate in the bone marrow circuiateln the blood, and mature and become activated in various tissues (Fig. 2-5). The first cell type that enters
may assume different morphologic forms after activation by external stimuli, such as microbes. Some develop abundant cytoplasm and are called epithelioid cells because of their resemblance to epithelial cells of the skin. Activated macrophages can fuse to form multinucleate giant cells. Macrophages in different tissues have been given special names to designate specific locations. For instance, in the central nervous system' they are called microglial cells; when lining the vascular sinusoids of the liver, they are called Kupffer cells; in pulmonary airways, they are called alveolar macrophages;
Neutrophils Neutrophils, also called polymorphonuclear leukocltes, are the most abundant population of circulating white blood cells and mediate the earliest phases of inflammatory responses. Neutrophils circulate as spherical cells about 12 to 15pm in diameter with numerous membranous projections. The nucleus of a neutrophil is segmented into three to flve connected lobules, hence the slmonym polymorphonuclear leukocyte (Fig. 2-Q. The cytoplasm contains granules of two types. The majority, called specific granules, are filled with enzl'rnes such as lysozgne, collagenase,and elastase.These granules do not stain strongly with either basic or acidic dyes (hematoxylin and eosin, respectively), which distin-
of FIGURE 2-4 Morphologyof neutrophils'The light micrograph a bloodneutrophilshowsthe multilobednucleus,becauseof which and the leukocytes, these cells are also calledpolymorphonuclear granules faintcvtoplasmlc
30
! ;
S e c t i ol -n I N T R O D U CTT0|T 0H N ET M M U N SE YSTEM
Bonemarrow
FIGURE 2-5 Maturationof mononucleatphagocytes.Mononuclearphagocytesdevelopin the bone marrow,circulate in the bloodas monocytes,and are residentin all tissuesof the bodyas macrophagesThey may differentiate into specralized forms in particular tissues CNS,centralnervoussystem
and multinucleate phagocytes in bone are called osteoclasts.
plants. Macrophages typically respond to microbes nearly as rapidly as neutrophils do, but macrophages survive much longer at sites of inflammation. Unlike neutrophils, macrophages are not terminally differentiated and can undergo cell division at an inflammatory site. Therefore, macrophages are the dominant effector cells of the later stages of the innate immune response, I or 2 days after infection. Dendritic
Cells
Dendritic cells play important roles in innate responses to infections and in linking innate and adaptive immune responses. They have long membranous projections and phagocytic capabilities, and are widely distributed
in l1'rnphoid tissues, mucosal epithelium, and organ parenchyma. Dendritic cells are derived from bonemarrow precursors, and most are related in lineage to mononuclear phagocytes.They expresspattern recognition receptors and respond to microbes by secreting cy'tokines.One subpopulation of dendritic cells, called plasmacytoid dendritic cells, are specialized early cellular responders to viral infection. They recognize endocltosed viruses and produce type I interferons, which have potent antiviral activities (see Chapter 12). Dendritic cells serve a critical function in adaptive immune responses by capturing and displaying microbial antigens to T lymphocytes. We will discuss dendritic cells in this context in Chapter 6. Recruitment
of Leukocytes to Sites of lnfection
Neutrophik and monocytes are recruited from the blood to sites of infection by binding to adhesion molecules on endothelial celk and by chemoattractants produced in response to the infection. In the absence of infection, these leukocytes circulate in the blood and do not migrate into tissues.Their recruitment to sites of infection is a multistep process involving adherence of the circulating leukocytes to the luminal surface of endothe-
FIGURE 2-6 Morphologyof mononuclearphagocytes. A Lightmicrograph of a monocytein a peripheral btoodsmear.B Electronmrcrographof a peripheral bloodmonocyte (Courtesy bf tjr Noetweidner De-paitment of Pathology, unr"riiiv of Cailfornia, san oiego ) c e rec tron micrograph of an activated-tissue macrophage showingnumeTous phagocytic vacuolesa-ndcytoplasmic organelles(FromFawcett B l o o m & F a w c e t t ' s T e x t b o o kH o fi s t o l o g yl 2, t h e d C h a p m i n & H a l l ,l g g a " w i i r r k i n d p e r m i s s i o n ' o t ' i p r i n g e r S c i e n c e a n d B u s r n DW essMedia)
through Migration endothelium
Integrinactivation by chemokines
Chemokine
W_
e*d ,'., -.1,
infection
Iial cells in postcapillary venules and migration through the vessel wall (FiB. 2-7). Each step is orchestrated by several different tlpes of molecules. l. Selectin-mediated rolling of leukocytes on endothelium. ln response to microbes and cltokines produced by cells (e.g.macrophages) that encounter the microbes, endothelial cells lining postcapillary venules at the site of infection rapidly increase surface expression of proteins called selectins (Box 2-2). C1'tokines are discussed in more detail in Chapter 12; the most important ones for activating the endothelium are tumor necrosis factor (TNF) and interleukin-1 (IL-1). The two t)?es of selectins expressedby endothelial cells are P-selectin,which is stored in cltoplasmic granules and is rapidly redistributed to the surface in responseto microbial products and cytokines, and E-selectin, which is synthesized in response to IL-l and TNF as well as microbial products, and is expressed on the cell surface within I to 2 hours. A third selectin, called Lselectin (CD62L), is expressed on lymphocytes and other leukocltes. It serves as a homing receptor for naive T l).rrnphocytes and dendritic cells to lymph nodes, mediating the binding of T cells to high endothelial venules (see Chapter 3). On neutrophils, it servesto bind these cells to endothelial cells that are activated by cltokines (TNE IL-1, and IFN-T) found at sites of inflammation. Leukocytes express L-selectin
and the carbohydrate ligands for P- and E-selectinsat the tips of their microvilli, facilitating interactions with molecules on the endothelial cell surface. Selectin-selectin ligand interactions are of low-affinity (K -100 mm) with a fast off-rate, and they are eisily disrupted by the shear force of the flowing blood. As a iesult, the leukocytes repetitively detach and bind again and thus roll along the endothelial surface. Thii slowing of leukocl'tes on the endothelium allows the next set of stimuli to act on the leukocltes. 2. Chemokine-medinted increase in affinity of inte-
chemokines is to stimulate chemotaxis of cells ("chemokines" is a contraction of "chemoattractant cytokines"). The chemokines produced at an infection site are transported to the luminal surface of the endothelial cells of post capillary-venules,where they are bound by heparan sulfate glycosaminoglycans, and are displayed at high concentrations. At this location the chemokines bind to specific chemokine receptors on the surface of the rolling leukocytes' Leutocytes express a family of adhesion molecules called integrini (gox 2-3), which are in a low-affinity
T h e s e l e c t i nf a m i l yo f m o l e c u l e sc o n s i s t so f t h r e es e p a rate but closelyrelatedproteinsthat mediateadhesionof l e u k o c y t etso e n d o t h e l i acle l l s( s e eT a b l e )O , nemember o f t h i s f a m i l y o f a d h e s i o nm o l e c u l e sr s e x p r e s s e do n leukocytes,and the other two membersare expressed onendothelia l l l sb ce , u ta l lt h r e ep a r t i c i p a ti en t h e p r o c e s s o f l e u k o c y t e - e n d o t h e l j uam t t a c h m e n t .E a c h o f t h e s e l e c t i nm o l e c u l e si s a s i n g l e - c h a ti n r a n s m e m b r a ngel y coproteiw n i t h a s i m i l am r o d u l asr t r u c t u r eT h ea m i n ot e r m r n u s e, x p r e s s e e d x t r a c e l l u l a rilsyr,e l a t e dt o m a m m a l i a n carbohydrate-binding proteinsknown as C-tvpe lectins. L i k e o t h e r C - t y p el e c t i n s ,l i g a n db i n d i n gb y s e l e c t i n si s c a l c i u md e p e n d e n(t h e n c et h e n a m e C - t v p e )T h e l e c t r n d o m a i ni s f o l l o w e db y d o m a i n sh o m o l o g o u st o t h o s e f o u n d i n e p i d e r m agl r o w t h f a c t o r sa n d o t h e r sf o u n d i n p r o t e i n s o f t h e c o m p l e m e n ts y s t e m , a n d t h e n a h y d r o p h o b i tcr a n s m e m b r a n ree g i o na n d a s h o r t c y t o p l a s m i cc a r b o x y - t e r m i nr e ag l i o nT. h e g e n e sf o r t h e t h r e e s e l e c t i n as r el o c a t e di n t a n d e mo n c h r o m o s o m e 1 inboth m i c e a n d h u m a n s T h e d i f f e r e n c e sa m o n g t h e t h r e e s e l e c t r n ss e r v e t o c o n f e r d i f f e r e n c e sb o t h i n b i n d i n g s p e c i f r c i tay n d i n t i s s u ee x p r e s s i o nH. o w e v e r a , ll three selectinsmediaterapidlow-affinityattachmentof leukoc y t e s t o e n d o t h e l i u ma, n e a r l y a n d i m p o r t a n ts t e p i n l e u k o c y t eh o m i n g L - s e l e c t i (nC D 6 2 Li)s e x p r e s s e do n l y m p h o c y t eas n d o t h e rl e u k o c y t e sl t. s e r v e sa s a h o m i n gr e c e p t ofro r n a i v e T l y m p h o c y t easn d d e n d r i t i c e l l st o l y m p hn o d e s ,m e d i a t i n gt h e b i n d i n go f T c e l l st o H E V s( s e eC h a p t e 3 r ).On n e u t r o p h i l si t, s e r v e st o b i n d t h e s e c e l l st o e n d o t h e l i a l c e l l st h a ta r ea c t i v a t e b d y c y t o k i n e (sT N F - clrL, - 1 .a n d I F N ! f o u n da t s i t e so f i n f l a m m a t i o nL.- s e l e c t iins l o c a t e do n t h e t i p s o f m i c r o v i l l upsr o j e c t t o nosf l e u k o c y t e sf a, c i l i t a t i n g i t s i n t e r a c t i ow n i t h l i g a n d so n e n d o t h e l i u m . A t l e a s t t h r e e e n d o t h e l i acl e l l l i g a n d sc a n b i n d L s e l e c t i n : g l y c a n - b e a r i n gc e l l a d h e s i o n m o l e c u l e - 1 ( G l y C A M - 1a) ,s e c r e t e dp r o t e o g l y c afno u n d o n H E V so f l y m p hn o d e ;M a d C A M -,l e x p r e s s e d o n e n d o t h e l i acle l l s i n g u t - a s s o c i a t el ydm p h o i dt r s s u e sa; n d C D 3 4 ,a p r o t e o _ g l y c a no n e n d o t h e l i ac le l l s( a n db o n em a r r o wc e l l s ) E - s e l e c t i na,l s ok n o w na s e n d o t h e l i al el u k o c y t e adhes i o n m o l e c u l e -(1E L A M - 1o) r C D 6 2 E i,s e x p r e s s e e dxclu_ s i v e l yb y c y t o k i n e - a c t i v a teendd o t h e l i acle l l s ,h e n c et h e designation E . E - s e l e c t i rne c o g n i z ecso m p l e xs i a l y l a t e d carbohydrate groups relatedto the Lewis X or Lewis A f a m i l yf o u n do n v a r i o u ss u r f a c ep r o t e i n so f g r a n u l o c y t e s , monocytes,and some previouslyactivatedeffectorand m e m o r yT c e l l s E - s e l e c t i ins i m p o r t a n itn m i g r a t i o no f
Selectin lSize
l e u k o c y t e si,n c l u d i n gn e u t r o p h i l sa n d o f e f f e c t o r a n d m e m o r yT c e l l st o s o m ep e r i p h e r asli t e so f i n f l a m m a t i o n . O n a s u b s e to f T c e l l s ,t h e c a r b o h y d r a tlei g a n df o r E s e l e c t i ni s c a l l e dC L A - 1 ; t h i s m o l e c u l em e d i a t e sh o m i n g o f t h e T c e l l st o t h e s k i n . (CD62P)was first identifiedin the secretory P-selectin g r a n u l eo s f p l a t e l e t sh,e n c et h e d e s i g n a t i oPn l t h a ss i n c e b e e n f o u n d i n s e c r e t o r yg r a n u l e so f e n d o t h e l i acl e l l s , w h i c ha r ec a l l e dW e i b e l - P a l a db eo d i e sW . h e ne n d o t h e l i a l c e l l so r p l a t e l e tas r es t i m u l a t e dP, - s e l e c t i ns t r a n s l o c a t e d within minutesto the cell surfaceas part of the exocytic s e c r e t o r yp r o c e s s O n r e a c h i n gt h e e n d o t h e l i acl e l l s u r f a c e ,P - s e l e c t i nm e d i a t e sb i n d i n go f n e u t r o p h i l sT, lymphocytes, and monocytes.In mice, P-selectin express i o ni s r e g u l a t e b d y c y t o k i n e ss,i m i l a tro t h e r e g u l a t i oonf E-selectin.The carbohydrateligandsrecognizedby ps e l e c t i na r e s i m i l a rt o t h o s e r e c o g n i z ebdy E - s e l e c t i nA p r o t e i nc a l l e dP - s e l e c t ignl y c o p r o t e ilni g a n d - 1 ( P S G L - 1i s) p o s t t r a n s l a t i o n am l l yo d i ife d i n l e u k o c y t e st o e x p r e s s functionalligands for P-selectin This modification i n v o l v e sb o t hs u l f a t i o na n d f u c o s y l a t i o n T h e s y n t h e s i so f s e l e c t i nl i g a n d si s r e g u l a t e di n d i f ferent ways in differentleukocytes,reflectingvariations in the expressionof glycosyltransferaseenzymesthat attach carbohydratesto the protein backboneof the l i g a n d sF. o re x a m p l en, a i v eT c e l l se x p r e s sv i r t u a l l n y o Ea n d P - s e l e c t ilni g a n d sa, n dT s 1c e l l se x p r e s ss i g n i f i c a n t l y more than do T;,2cells T h e p h y s i o l o g irco l e so f s e l e c t i n sh a v eb e e n d e m o n strated by studies of gene knockoutmice. L-selectind e f i c i e n tm i c e h a v e s m a l l ,p o o r l yf o r m e d l y m p h n o d e s a n d d e f e c t i v ei n d u c t i o no f T c e l l - d e p e n d e nt m t mune r e s p o n s e sa n d i n f l a m m a t o r yr e a c t i o n s M i c e l a c k i n g e i t h e r E - s e l e c t i no r P - s e l e c t i nh a v e o n l y m i l d d e f e c t s in leukocyte recruitment,suggestingthat these two m o l e c u l e sa r e f u n c t i o n a l lrye d u n d a n tD. o u b l ek n o c k o u t mice lackingboth E-selectinand P-selectinhave signific a n t l yi m p a i r e dl e u k o c y t e r e c r u i t m e natn d i n c r e a s esdu s c e p t i b i l i t yt o i n f e c t r o n s S i m i l a r l y ,m i c e l a c k i n g t h e glycosyltransferase enzymes,suchas fucosyltransferaseV l l , w h i c h a r e r e q u i r e dt o s y n t h e s i z e the carbohydrate l i g a n d st h a t b i n dt o s e l e c t i n sh, a v em a r k e dd e f e c t si n T c e l l m r g r a t i o na n d c e l l - m e d i a t e idm m u n e r e s p o n s e s H u m a n sw h o l a c ko n e o f t h e e n z y m e sn e e d e dt o e x p r e s s the carbohydrate ligandsfor E-selectin and P-selectinon n e u t r o p h i l sh a v e s i m i l a rp r o b l e m s ,r e s u l t i n gi n a s y n dromecalledtype 2 leukocyteadhesiondeficiencv(LAD2 ) ( s e eC h a p t e 2 r 0)
lDistribution
Ligand
L-selectin90-110kD (variation Leukocytes(highexpressionon naive Sialyl-Lewis X on GIyCAM-1, CD34, (cD62L) due to glycosylation)T cells,low expressionon activatedeffector MadCAM-1.others and memorycells)
E-selectin1 1 0k D (cD62E)
Endothelium activatedby cytokines ( T N F r, L - 1 )
Sialyl-Lewis X (e.g.,CLA-1)on variousglycoproteins
P-selectin1 4 0k D (cD62P)
Storagegranulesand surfaceof endotheliumand platelets
Sialyl-Lewis X on PSGL-1and otherglycoproteins
C h a p t e2r-
T h e a d h e s i o no f c e l l s t o o t h e r c e l l s o r t o e x t r a c e l l u l a r m a t r i c e si s a b a s i c c o m p o n e n to f c e l l m i g r a t i o na n d r e c o g n i t i o na n d u n d e r l i e sm a n y b i o l o g i c p r o c e s s e s , includine g m b r y o g e n e s itsi s, s u er e p a i ra, n d i m m u n ea n d i n f l a m m a t o r ye s p o n s e sl t. i s t h e r e f o r en o t s u r p r i s i ntgh a t many differentgeneshaveevolvedthat encodeproteins w i t h s p e c i f i ca d h e s i v ef u n c t i o n sT. h e i n t e g r i ns u p e r f a m i l y c o n s i s t so f a b o u t3 0 s t r u c t u r a l lhyo m o l o g o ups r o t e i n s that promote cell-celo l r c e l l - m a t r i xi n t e r a c t i o n s( s e e T a b l e )T. h e n a m eo f t h i s f a m i l vo f p r o t e i n sd e r i v e sf r o m t h e i d e a t h a t t h e y c o o r d i n a t e( i e . , " i n t e g r a t e " s) i g n a l s g e n e r a t e dw h e n t h e y b i n d e x t r a c e l l u l al ri g a n d sw i t h c y t o s k e l e t o n - d e p e n d emn ot t i l i t y , s h a p e c h a n g e , a n d phagocyticresponses. A l l i n t e g r i n sa r e h e t e r o d i m e r icce l l s u r f a c ep r o t e i n s composed of two noncovalentlylinked polypeptide c h a i n so , a n d B T h e u c h a i nv a r i e si n s i z ef r o m 1 2 0 t o 2 0 0 k D ,a n d t h e B c h a i nv a r i e sf r o m 9 0 t o ' l 1 0 k D T h e a m i n ot e r m i n u so f e a c hc h a i nf o r m sa g l o b u l ahr e a dt h a t c o n t r i b u t e st o i n t e r c h a i nl i n k i n ga n d t o l i g a n db i n d i n g . T h e s e g l o b u l a rh e a d s c o n t a i n d i v a l e n tc a t i o n - b i n d i n g d o m a i n sw , h i c h a r e e s s e n t i aflo r i n t e g r i nr e c e p t o fru n c t i o n .S t a l k se x t e n df r o m t h e g l o b u l ahr e a d st o t h e p l a s m a m e m b r a n ef,o l l o w e db y t r a n s m e m b r a nsee g m e n t sa n d c y t o p l a s m itca i l s ,w h i c h a r e u s u a l l yl e s s t h a n 5 0 a m i n o a c i dr e s i d u e sl o n g T h e e x t r a c e l l u l a d ro m a i n so f t h e t w o c h a i n s b i n d t o v a r i o u sl i g a n d s ,i n c l u d i n ge x t r a c e l l u l a r matrix glycoproteins,activated complement compon e n t s .a n do r o t e i n so n t h e s u r f a c e o s f o t h e rc e l l s S e v e r a l i n t e g r i n s b i n d t o A r g - G l y - A s p( R G D ) s e q u e n c e si n f i b r o n e c t i na n d v i t r o n e c t i nm o l e c u l e sT h e c y t o p l a s m i c t i t h c y t o s k e l e t ac lo m d o m a i n so f t h e i n t e g r i n si n t e r a cw p o n e n t s ( i n c l u d i n gv i n c u l i n ,t a l i n , a c t i n , c r - a c t i n i na,n d tropomvosrn) Integrina s r e c l a s s i f l e idn t o s e v e r asl u b f a m i l i ebsa s e d o n t h e B c h a i n si n t h e h e t e r o d i m e r tsh; e m a j o rm e m b e r s o f t h e s es u b f a m i l i easr e l i s t e di n t h e t a b l e . T h e B , - c o n t a i n i ni ngt e g r i n sa r e a l s o c a l l e dV L A m o l e c u l e s ,r e f e r r i n tgo " v e r yl a t ea n t i g e n s "b, e c a u s ec x , 1aBn. 'd o2p1were shownto be expressedon T cells2 to 4 weeks afterrepetitivestimulationin vitro.In fact,otherVLA integ r i n s ,i n c l u d i n gV L A - 4 ,a r e c o n s t i t u t i v e leyx p r e s s e do n s o m e T c e l l sa n d r a p i d l yi n d u c e do n o t h e r s T h e B , i n t e grins are also calledCD49aJCD29,CD49a-freferringto differenta chains(ar to ao) and CD29 referringto the c o m m o nB 1s u b u n i t M o s t o f t h e B 1i n t e g r i n sa r e w i d e l y e x p r e s s e od n l e u k o c y t easn dn o n h e m a t o p o i e ct iecl l sa n d r atrix m e d i a t e a t t a c h m e n to f c e l l s t o e x t r a c e l l u l am a n dV L A - 5a) n dl a m i n i n l i g a n d ss,u c ha s f i b r o n e c t i(nV L A - 4 (VLA-6). is expressedonlyon VLA-4(cr+0r or CD49dCD29) leukocytesand can mediateattachmentof these cellsto with VCAM-I VLA-4is one of endotheliumby interacting t h e p r i n c i p aslu r f a c ep r o t e i n tsh a tm e d i a t eh o m i n go f l y m phocytesand other leukocytesto endotheliumat periphe r a ls i t e so f i n f l a m m a t i o n . , ere T h e B , i n t e g r i n sa,l s ok n o w na s t h e L F A - 1f a m i l yw i d e n t i f i e d b y m o n o c l o n a la n t i b o d i e s t h a t b l o c k e d l ynmt p h o c y t feu n c t i o n s u c ha s k i l l i n g adhesion-depende of targetcells by CTLs LFA-1playsan importantrole in
I N N A TIEM M U N I T Y
s i t h o t h e r c e l l s ,s u c h a s t h e a d h e s i o no f l y m p h o c y t e w A P C sa n dv a s c u l aer n d o t h e l i u mT.h i sf a m i l yi s a l s oc a l l e d 8 ,' 1C D 1 1 r e f e r r i n gt o d i f f e r e n ct c h a i n sa n d CD11a-cCD C D 1 8t o t h e c o m m o nB 2s u b u n i t .L F A - 1i t s e l fi s t e r m e d C D 11 a C D 1 8 .O t h e r m e m b e r s o f t h e f a m i l y i n c l u d e ( p 1 5 0 , 9o5r ) n dC D 11 c C D 1 8 C D 11b C D 1 8( M a c - lo r C R 3 a CR4),both of which havethe same B subunitas LFA-1. C D 11 b C D 1 8a n d C D 11 c C D 1 8b o t h m e d i a t el e u k o c y t e n .n e a t t a c h m e ntto e n d o t h e l i acle l l sa n d t r a n s m i g r a t i o O l i g a n df o r L F A - I( C D 1 1 a C D 1i8s)I C A M - ' (I C D 5 4 )a, m e m braneglycoproteinexpressedon a varietyof hematopoiB a n dT c e l l s , e t i c a n d n o n h e m a t o p o i e tciec l l s ,i n c l u d i n g d e n d r i t i cc e l l s ,m a c r o p h a g e sf i,b r o b l a s t sk,e r a t i n o c y t e s , a n d e n d o t h e l i acl e l l s T w o o t h e r l i g a n d sf o r L F A - 1a r e I C A M - 2 ,w h i c h i s e x p r e s s e do n e n d o t h e l i acl e l l s ,a n d I C A M - 3w , h i c h i s e x p r e s s e do n l y m p h o c y t e sI .C A M - I ,3 y D 11 b C D 1 8 a r em e m b e r so f t h e l g s u p e r f a m i l C 2, and r e c e p t oa r n da s a c o m p l e a l s of u n c t i o n sa s a f i b r i n o g e n m e n t r e c e p t o ro n p h a g o c y t i cc e l l s , b i n d i n gp a r t i c l e s opsonizedwith a productof complementactivationcalled c 3 b ( i c 3 b ) f r a g m e n t( c h a p t e r1 4 ) A n the inactivated , aca u t o s o m a l - r e c e s si nv h e e r i t e dd e f i c i e n c yi n L F A - 1 M ed h e s i o n 1 , a n dp 1 5 0 , 9 5p r o t e i n sc,a l l e dt y p e 1 l e u k o c y t a in a few families d e f i c i e n c (yL A D - 1 )h, a s b e e n i d e n t i f i e d a n d i s c h a r a c t e r i z ebdy r e c u r r e n tb a c t e r i aal n d f u n g a l leukocyteaccuinfections,lack of polymorphonuclear m u l a t i o n sa t s i t e s o f i n f e c t i o na, n d p r o f o u n dd e f e c t si n lymphocytef unctions.The disease adherence-dependent i s a r e s u l to f m u t a t i o n si n t h e C D 1 8g e n e ,w h i c he n c o d e s t h e 0 c h a i no f L F A - 1s u b f a m i l ym o l e c u l e s . A n i m p o r t a n tf e a t u r eo f i n t e g r i n si s t h e i r a b i l i t yt o r e s p o n dt o i n t r a c e l l u l sairg n a l sb y r a p i d l yi n c r e a s i ntgh e i r to as "activation," a v i d i t yf o r t h e i rl i g a n d sT. h i si s r e f e r r e d s i g n a l s g e n e r a t e df r o m r e s p o n s e t o i n and occurs c h e m o k i n eb i n d i n gt o c h e m o k i n er e c e p t o r sa, n d i n l y m d henantlgen p h o c y t e sb y i n t r a c e l l u lsairg n a l sg e n e r a t e w p r o c e s s c h a n g e si n t h e o f T h e r e c e p t o r s a n t i g e n b i n d st o b i n d i n gf u n c t i o n so f t h e e x t r a c e l l u l adro m a i no f i n t e g s irg n a l si s c a l l e d" i n s i d e - o u t r i n s i n d u c e db y i n t r a c e l l u l a a n d antigen-receptor-induced C h e m o k i n e signaling." t uanosine i n s i d e - o usti g n a l i n gi n v o l v e ss e v e r adl i f f e r e n g pathways,eventuallyleadingto triphosphatase-regulated the associationof RAP family moleculesand cytoskeleproteinswith the cytoplasmictails of the tal-interacting integrinproteins.The resultingaviditychangesare a cono f t h e i n t e g r i n si n t h e l e u k o c y t e s e q u e n c eo f c l u s t e r i n g membrane,which increasesthe effective valency of l i g a n db i n d i n ga, n d c o n f o r m a t i o ncahl a n g e si n t h e e x t r a c e l l u l a dr o m a i n st h a t e n h a n c ea f f i n i t yo f b i n d i n g I n t h e domains low affrnitystate,the stalksof the extracellular o f e a c hi n t e g r i ns u b u n i ta p p e a rt o b e b e n t o v e r ,a n d t h e l i g a n d - b i n d ig n lgo b u l ahr e a d sa r ec l o s et o t h e m e m b r a n e I n r e s p o n s et o a l t e r a t i o n isn t h e c y t o p l a s m i ct a i l , t h e fashion,bringingthe globustalksextendin switch-blade l a r h e a d sa w a yf r o m t h e m e m b r a n et o a p o s i t i o nw h e r e thev more effectivelyinteractwith their ligands. U p o n l i g a n db i n d i n gi n t e g r i n sa l s od e l i v e rs t i m u l a t o r y s i g n a l st o c e l l so n w h i c ht h e y a r e e x p r e s s e dT' h e m e c h a n i s mo f s i g n a l i n gi n v o l v e st y r o s i n ep h o s p h o r y l a t i oonf Continuedon followingPage
33
34
i
S e c t i ol -n I N T R O D U CTT0IT0 H N ET M M U N SE YSTEM
Subunits Name
Fr
Fz
Functions
Major Ligands
c[1
VLA-1(CD49aCD29)C ollagens
Cell-matrix adhesion
a2
vLA-2(CD49bCD29) Collagens
Cell-matrix adhesion
c[3
VLA-3(CD49cCD29)Laminin
Cell-matrix adhesion
a4
vLA-4(CD49dCD29) V C A M - 1 ,M a d C A M - 1
Cell-matrixadhesion;homing; T cell costimulation?
c[5
VLA-5(CD49eCD29)F ibronectin
Cell-matrix adhesion
s6
vLA-6(CD49fCD29)L a m i n i n
Cell-matrix adhesion
a7
CD49gCD29
Laminin
Cell-matrix adhesion
08
cD51CD29
Fibronectin
Cell-matrix adhesion
0,y
cDs1CD29
Fibronectin
Cell-matrix adhesion
0L
C D 1 1 a C D 1(8L F A - 1 ) lcAM-1,tcAM-2,|CAM-3
Leukocyte adhesion to endothelium; T cell-APCadhesion; T cellcostimulation?
M A C - 1iC3b, , C[M c D 1 1 b C D 1( 8 fibronectin, FactorX. ICAM-1Leukocyte adhesionand phagocytosis; cell-matrix adhesion
cR3)
cx'x C D 1 1 c C D 1( p81 5 0 , iC3b;fibronectin 95;CRa) 0d
Fe
cD11dCD18
crilb G P l l b / l l l a (cD41CD61)
0v
Leukocyteadhesionand phagocytosis; cell-matrixadhesion
vcAM-1.tcAM-3
Leukocyte adhesionto endothelium
Fibrinogen,von Willebrandfactor, thrombospondin
Plateletadhesionand aggregation
Vitronectin receptor Fibronectin, vitronectin, von Cell-matrix adhesion Willebrand factor,thrombospondin (cD51CD61)
F+
cx,6 cD49fCD104
Laminin
Cell-matrixadhesion
0s
CX,Y
Vitronectin
Cell-matrix adhesion
Fo Fz
clv
Fibronectin
Cell-matrixadhesion
VCAM-1.MadCAM-1
Lymphocyte homingto mucosal lymphoid tissues
E-cadherin
Retentionof intraepithelial T cells
A4
LPAM-1
CT,E H M L - 1
Abbreviations; APC,antigen-presenting cell;iC3b,C3b inactivated; ICAM,intercellular adhesionmolecure; LFA,leukocytefunction-associated antigen;MadCAM-1,mucosaladdressincelladhesionmolecule1. VCAM-1,vascularcelladhesionmolecu-le 1. AdaptedfromHynesRO. Integrins: versatility, modulation, and signaling in celladhesion. Cell69:11-25,1gg2.O Cellpress.
differentsubstrates,inositollipidturnover,elevatedcytop l a s m i cc a l c i u m ,a n d a c t r v a t i o no f g u a n o s i n et r i p h o s phate-bindingproteinsandthe mitogenactivatedprotein ( M A P )k i n a s ec a s c a d eT h e f u n c t i o n acl o n s e q u e n c eosf these rntegrin-mediated signalsvary with cell type In epithelialcells, integrinscooperatewith growth factor receptorsto deliveranchorage-dependent mitoticsignals ln phagocytes,integrinsignalsare linkedto cvtoskeleton
reorganization required for motility and phagocytosis, reactiveoxygenspeciesgeneration,inflammatorygene expression,and apoptosis.In T lymphocytes,ICAM-I bindingto B2integrinsmay providecostimulatory signals t h a t e n h a n c ec y t o k i n eg e n e e x p r e s s i o na, l t h o u g ht h i s activityof integrinsis probablyless importantthan their r o l ei n c e l l - c e al l d h e s i o n .
2Chaoter
state in unactivated cells and ineffective in mediating adhesion interactions. TWo consequences of chemokine receptor signaling are enhanced aff,nity of leukoclte integrins for their ligands, and membrane clustering of the integrins, resulting in increased avidity of integrin-mediated binding of the leukocytes to the endothelial surface. 3. Stable integrin-mediated. adhesion of leukocytes to endothelium. In parallel with the activation of integrins and their conversion to the high-affinity state, cytokines (TNF and IL-l) also enhance endothelial expression of integrin ligands, mainly vascular cell adhesion molecule-l (VCAM-l, the ligand for the VIA-4 integrin) and intercellular adhesion molecule-l (ICAM-l, the ligand for the LFA-1 and Mac-1 integrins) (seeBox 2-3). The net result ofthese changesis that the leukocytes attach firmly to the endothelium, their cltoskeleton is reorganized, and they spread out on the endothelial surface. 4. Transmigration of leukocytes through the endothelium. Chemokines then act on the adherent leukocytes and stimulate the cells to migrate through interendothelial spaces along the chemical concentration gradient (i.e., toward the infection site). Other proteins expressed on the leukocytes and endothelial cells, notably CD31, play a role in this migration through the endothelium. The leukocytes presumably produce enzymes that enable
INNATE IMMUNITY
them to pass through the vessel wall, and they ultimately accumulate in the extravascular tissue around the infectious microbes. Leukoclte accumulation in tissues is a major component of inflammation. It is typically elicited by microbes, but it may be seen in response to a variety of noninfectious stimuli as well. There is some specificity in this process of leukocyte migration based on the expression of distinct combinations of adhesion molecule and chemokine receptors on neutrophils versus monocytes. For example, neutrophil migration relies mainly on LFA-I-ICAM-I interactions in combination with the chemokines receptors CXCR1 and CXCR2 binding the chemokines CXCL8,while monocytes mainly utilize\r[,A4-VCAM-l interactions together with the chemokine CCL2 binding to the chemokine receptor CCR2.Temporally distinct patterns of expression of adhesion molecules and chemokines at infectious sites typically result in early neutrophil recruitment (hours to days) followed later by monocyte recruitment (days to weeks). As we will see in Chapter 3, yet other combinations of adhesion molecules and chemokines control the migration of lymphocytes into l1'rnphoid and nonlymphoid tissues. Phagocytosis
of Microbes
Neutrophik and macrophages ingest bound microbes into uesicles by the process of phagocytosis (Fig. 2-8).
Phagocyte membranezips up aroundmicrobe
Microbesbind to phagocytereceptors Mac-1 integrin
Scavenger receptor
Killingof phagocytosed microbesby ROSand NO
Microbeingested
withingested "nryr"" Fusionof phagosome with lysosome
Activationof phagocyte
Killingof microbesby lysosomal enzymesIn phagolysosomes
FIGURE 2-a Phagocytosisand intracellulardestructionol microbes.Microbesmay be ingestedby differentmembranereceptorsof with phagocytes; some d-ireitlybindmicrobes,and othersbindopsonizedmicrobes.(Notethat the Mac-1 integrinbindsmicrobesopsonized which fuse with lysosomesto form phagolysosomes, lnto phagosomes, complementproteins,not shown.)The microbe are internalized enzymes.NO, nitricoxide;ROS,reactiveoxygen and proteolytic wherethe microbesare killedby reactiveoxygen nd nitrogenintermediates specres
t.1..;Ll.tion
l- lNTRoDUcTl0N T0THETMMUNE sysTEM
Phagocytosisis an active, energy-dependent process of engulfment of large particles (>0.5 pm in diameter). Microbial killing takes place in the vesicles formed by phagocytosis, and in this way, the mechanisms of killing, which could potentially injure the phagocyte, are isolated from the rest of the cell. The first step in phagocytosis is the recognition of the microbe by the phagocyte. Neutrophils and macrophages are constantly exposed to normal cells, which they ignore, but will specifically ingest various microbes and particles. This specificity is due to the fact that neutrophils and macrophages express receptors that specifically recognize microbes, and these receptors are functionally linked to the mechanisms of phagocytosis. Some of these receptors are pattern recognition receptors, including C-type lectins and scavengerreceptors, as we discussed previously. pattern recognition receptors can contribute to phagocytosis only oforganisms that expressparticular molecular patterns, such as mannose. Another group of receptors on phagocytes recognize certain host proteins that coat microbes. These proteins are called opsonins, and include antibodies, complement proteins, and lectins. The process of coating a microbe to target it for phagocytosisis called opsonization. Phagocytes haue high-affinity receptors that specially bind to antibody molecules, complement proteins, and lectins; these receptors Are critical for phagocytosk of many dffirent microbes. One of the most efficient systems for opsonizing microbes is coating them with antibodies. Antibody molecules have antigen-binding sites at one end, and the other end, called the Fc region, the antibody interacts with effector cells and molecules of the innate immune system. There are several types of antibodies, which we will discuss in detail in Chapters 4 and 14. Phagocytes express high-affinity Fc receptors called FcyRI specific for one type of antibody called IgG (see Chapter 14). Thus, if an individual responds to an infection by making IgG antibodies against microbial antigens, the IgG molecules bind to these antigens, the Fc ends of the bound antibodies can interact with FcyRI on phagocytes, and the end result is efficient phagocytosis of the microbes. Because many different antibodies may be produced that bind to many different microbial products, antibody-mediated opsonization contributes to the phagocytosis of a broader range of microbes than do pattern recognition receptors. Although IgG antibodies are essential for etflcient phagocltosis of many organisms, they are really a product of the adaptive immune system (B lymphocytes) that engagesinnate immune system effector cells (phagocytes) to perform their protective functions. Various soluble pattern recognition receptors and effector molecules of the innate immune system, including complement and lectins, are also important opsonins. These opsonins are present in the blood, they bind to microbes, and phagocytes express receptors for these opsonins. We will discuss these soluble effectors of the innate immune system later in this chapter. Once a microbe or particle binds to receptors on a phagoclte, the plasma membrane in the region of the
receptors begins to redistribute, and extends a cupshaped projection around the microbe. When the protruding membrane cup extends beyond the diameter of the particle, the top of the cup closes over, or "zips up," and pinches offthe interior of the cup to form an "insideout" intracellular vesicle (see Fig. 2-B). This vesicle, called a phagosome, contains the ingested foreign particle, and it breaks away from the plasma membrane. The cell surface receptors also deliver activating signals that stimulate the microbicidal activities of phagocytes. Phagocytosedmicrobes are destroyed,as described next; at the same time, peptides are generated from microbial proteins and presented to T l1'rnphocytes to initiate adaptive immune responses(seeChapter 6). Killing
of Phagocytosed
Microbes
Actiuated neutrophils and macrophages kill phagocytosed microbes by the action of microbicidal molecules in phagolysosomes (see Fig. 2-8). Several receptors that recognize microbes, including TLRs, G protein-coupled receptors, antibody Fc and complement C3 receptors, and receptors for cytokines, mainly IFN-y, function cooperatively to activate phagocytes to kill ingested microbes. Fusion of phagocytic vacuoles (phagosomes) with lysosomes results in the formation of phagolysosomes, where most of the microbicidal mechanisms are concentrated; these mechanisms are described next. O Activated neutrophils and macrophages produce several proteolytic enzymes in the phagolysosomes, which function to destroy microbes. One of the important enzyrnes in neutrophils is elastase, a broad-spectrum serine protease knovrrn to be required for killing many types of bacteria. Another important enzyme is cathepsin G. Mouse gene knockout studies have confirmed the essentialrequirement for these enzymes in phagocyte killing of bacteria. O Activated macrophages and neutrophils convert molecular oxygen into reactive oxygen species (ROS), which are highly reactive oxidizing agents that destroy microbes (and other cells). The primary free radical-generating system is the phagoclte oxidase system. Phagocyte oxidase is a multisubunit enz).ryne that is assembled in activated phagocytes mainly in the phagolysosomal membrane. Phagocyte oxidase is induced and activated by many stimuli, including IFN-y and signals from TLRs. The function of this enzyme is to reduce molecular oxygen into ROS such as superoxide radicals, with the reduced form of nicotinamide adenine dinucleotide phosphate (NADPH) acting as a cofactor. Superoxide is enzymatically dismutated into hydrogen peroxide, which is used by the enzyrne myeloperoxidase to convert normally unreactive halide ions into reactive hlpohalous acids that are toxic for bacteria. The process by which ROS are produced is called the respiratory burst. Although the generation of toxic ROS is commonly viewed as the major function of phagoclte oxidase, another function of the enzyme is to produce conditions within phagocytic vacuoles that are nec-
2- -": chapter essaryfor the activity of the proteolltic enzymes discussed earlier. The oxidase acts as an electron pump, generating an electrochemical gradient across the vacuole membrane, which is compensated for by movement of ions into the vacuole. The result is an increase in pH and osmolarity inside the vacuole, which are necessary for elastase and cathepsin G activity. A disease called chronic granulomatous disease is caused by an inherited deficiency of one of the components of phagocyte oxidase; this deficiency compromises the capacity of neutrophils to kill certain species of gram-positive bacteria (see Chapter 20). In addition to ROS, macrophages produce reactive nitrogen intermediates, mainly nitric oxide (NO), by the action of an enzyme called inducible nitric oxide synthase (iNOS). iNOS is a c1'tosolicenzyme that is absent in resting macrophages but can be induced in response to microbial products that activate TLRs, especially in combination with IFN-y. iNOS catalyzes the conversion of arginine to citrulline, and freely diffusible nitric oxide gas is released.Within phagolysosomes, nitric oxide may combine with hydrogen peroxide or superoxide, generated by phagocyte oxidase,to produce highly reactive peroxynitrite radicals that can kill microbes. The cooperative and redundant function of ROSand nitric oxide is demonstrated by the finding that knockout mice lacking
both iNOS and phagoclte oxidase are more susceptible to bacterial infections than single phagocyte oxidase or iNOS knockout animals are. When neutrophils and macrophages are strongly actiuated, they can iniure normalhost tissues by release of lysosomal enzymes, ROS,and NO. The microbicidal products of these cells do not distinguish between self tissues and microbes. As a result, if these products enter the extracellular environment, they are capable of causing tissue injury. Other Functions of Activated
Macrophages
In addition to killing phagocytosed microbes, macrophages serve many other functions in defense against infections (Fig. 2-9). Many of these functions are mediated by cltokines that will be described in more detail in Chapter 12 as the cytokines of innate immunity. We have already referred to the role of TNB IL-l, and chemokines in inducing inflammatory reactions to microbes. In addition to these cytokines, macrophages oroduce IL-12, which stimulates NK cells and T cells to produce IFN-y. High concentrations of LPSinduce a systemic disease characterized by disseminated coagulation, vascular collapse, and metabolic abnormalities, all of which are pathologic effects of high levels of cltokines secreted by LPS-activated macrophages (see Box l5-1, Chapter l5). Activated macrophages also
Fh"s""yt"]@ I oxidase I H
FIGURE 2-9 Effector functions of Macrophages are activated macrophages. by microbialproductssuch as LPS and laterin IFN-y(described by NK cell-derived the chapter)The processof macrophage activationleadsto the actlvationof transcription factors, the transcrrptionof variousgenes,and the synthesisof proteins that mediatethe functionsof these immunity, cells ln adaptivecell-mediated areactivatedby stimulifrom macrophages (CD40ligandand IFN-y) and T lymphocytes the same way (see respondin essentially C h a p t e 1r 3 , F i g 1 3 - 1 4 )
Molecules produced in activated Reactive macrophages oxygen
w
specles (ROS)
Effector functions of activated macrophages
lT*1:),::__g*.":
Nitric oxide
Inflammation, enhanced adaptive immunity
38
1
Section |-
..,..",,""*e"*,*,"..
INTR0DUCT|ON T0 THETMMUNE SYSTEM
produce growth factors for fibroblasts and endothelial cells that participate in the remodeling of tissues after infections and injury. The role of macrophages, in cellmediated immunity is described in Chapter 13.
Removalof phosphates andinhibition
Natural Killer (NK) Cells NK celk are a lineage of cells related to lymphocytes that rgcognize infected andlor stressed cells ond respond by directly killing these celk and by secreting inJlammatory cytokines. NK cells constitute SToto 20Toof the mononuclear cells in the blood and spleen and are rare in other lymphoid organs. The term natural killer derives from the fact that if these cells are isolated from the blood or spleen, they kill various target cells without a need for additional activation. (In contrast, CDB. T lymphocytes need to be activated before they differentiate into cltotoxic T ly.rnphocytes [CTLsl with the ability to kill targets.) In addition to killing infected cells directly, NK cells are a major source of IFN-1, which activates macrophages to kill ingested microbes. NK cells are
Inhibitory receplor classI MHC-self peptidecomplex
Normal
express somatically rearranged, clonally distributed antigen receptors like immunoglobulin or T cell receptors. Their target cells using germline DNA-encoded receptors, discussed below. Recognition of lnfected and Sfressed Natural Killer Cells
NK cell not activated; no cell killing @ lnniOitoryreceptornot engaged
Cells by
NK ceII actiuation is regulated by a balance between signals that are generatedfrom actiuatingreceptors and inhibitory receptors (Fig. 2-10). There are several families of these receptors, which are described in detail in Box 2-4. Most of these receptors are complexes of ligand-binding subunits, which recognize molecules on the surface of other cells, and signaling subunits, which transduce activating or inhibitory signals into the cell. \Mhen an NK cell interacts with another cell, the
and attack of normal cells. Many of these receptors on NK cells recognize class I MHC molecules or proteins that are structurally homologous to class I MHC molecules. Class I MHC molecules display peptides derived from cyoplasmic proteins, including microbial proteins, on the cell surface for recognition by CDg* t cells. We will describe the structure and function of MHC mol-
Virus inhibits class I MHC expressron
cell(classI MHCnegative)
protein (PTK), activate tyrosine kinase whoseactivity rsinhibited by inhibitory receptors thatrecognize classI MHCmolecules andactF vateprotein phosphatase (PTP). tyrosine NKcellsdo notefficiently killclassI MHC-expressing healthy cells B. lf a virusinfectionor otherstressinhibits classI MHCexpression on infected cells,and rnducesexpression of additional activating ligands, the NK cell inhibitory receptor is notengaged andtheactivating receptor functionsunopposed to triggerresponses of NKcells,suchas killinq of targetcellsandcytokine secretlon. Actiuating receptors on NK cells recognize a heterogeneous group of ligands that are expressed,on celk that haue undergone stress, celk that are infected with uiruses or other intracellular microbes, or celk that are malignantlytransformed. One of the better studied activating receptors is called NKG2D (see Box 2-4), which binds a family of structurally related class I MHC-like proteins that are found on virally infected cells and
C h a p t e2r-
I N N A TIEM M U N I T Y
t h a t i s h o m o l o g o utso h u m a nc l a s sI M H C a n d t h a t c a n bindto ILT-2.This may representa decoymechantsmby which the virus engagesan inhibitoryreceptorand prot e c t s i t s c e l l u l ahr o s tf r o m N K c e l l - m e d i a t ekdi l l i n g . The third NK inhibitoryreceptorfamily consists of heterodimerscomposed of the C-type lectin NKG2A covalentlyboundto CD94.NKG2Ahas two lTlMs in its cytoplasmictail The CD94/NKG24receptorsbind HLAMHC class I molecule StableexpresE, a nonclassical sion of HLA-Eon the surfaceof cells dependson the bindingof signalpeptidesderivedfrom HLA-A,-8, -C, or -G. Therefore,the CD94/NKG24inhibitory receptors functionfor the absenceof HLAperforma surveillance M H C ,a n d H L A - Gm o l e c u l e sA. s i s t h e I c l a s s E ,c l a s s i c a l casefor the KIR receptors,some CD94/NKG2receptors do not havecytoplasmiclTlM motifs,and these function receptors,as discussedbelow' as NK-activating The lTlMs in the cytoplasmic tails of inhibitory receptorsare essentialfor the signalingfunctions of these molecules.lTlMs recruit phosphataseenzymes that counteractthe effect of kinasesin the signalingcascades initiatedby activatingreceptors lTlMs are composed of the sequence lle/'/allleu/Ser-x-Tyr-x-x-Leuly'al, w h e r e x d e n o t e sa n y a m i n o a c i d , a n d a r e p r e s e n ti n several different inhibitoryreceptors in the immune s y s t e m U p o n b i n d i n gc l a s s I M H C m o l e c u l e st o t h e regionsof NK inhibitoryreceptors,the tyroextracellular s i n e r e s i d u ei n t h e l T l M s o f t h e c y t o p l a s m i tca i l s a r e phosphorylated, and then phosphatasesare recruited, fall NK receptors Inhibitory INHIBITORYRECEPTORS phosphatasesSHP (SH2i n t ot h r e em a i nf a m i l i e s( s e eF i g u r e )A. c o m m o nf e a t u r e includingthe protein-tyrosine phosphatase)-1 and SHP-2, protein-tyrosine containing o f m e m b e r so f a l l t h r e e f a m i l i e si s t h e p r e s e n c eo f ( S H 2-containing S H I P p h o s p h o l i p i d p h o s p h a t a s e t h e o r motifs inhibition tyrosine-based immunoreceptor SHP-1and SHP-2 S-phosphatase). ( l T l M s )i n t h e i rc y t o p l a s m itca i l s .T h e s i g n a l i n fgu n c t i o n s inositolpolyphosphate proteins, signaling phosphates from several remove of lTlMs are discussedbelow The first familyto be disphosphatidylinositol-3,4,5degrades SHIP (killer whereas family receptor) lg-like named KIR cell the coveredis (Pl-3,4,5-P3). The end resultis reducedsigbecauseits memberscontaintwo or three extracellular trisphosphate which are coupled to receptors, activating by naling t l l e l e so f . h e K l R s r e c o g n i z ed i f f e r e n a l g - l i k ed o m a i n s T subHLA-A, -B, and -C molecules.Structuraland binding kinasesthat add phosphatesto severalintracellular strates studiesindicatethat the sequenceof the peptidesbound of to the IVHCmoleculesis importantfor KIRrecognition ACTIVATINGRECEPTORSThe activatingreceptorson M H C m o l e c u l e sH. L A c l a s sI m o l e c u l eb i n d i n gt o K l R si s NK cells include severalstructurallydistinct groups of by very fast on-ratesand off-rates,which characterized would be consistentwith the abilityof NK cellsto rapidly m o l e c u l e sa, n d o n l y s o m e o f t h e l i g a n d st h e y b i n d a r e "test" for the presenceof MHC expression known.CD16,one of the first activatingreceptorsidention manycells t h, e i n h i b i t o rsyi g n a l sg e n e r - fied on NK cells,is a low-affinitylgG Fc receptorthat assoi n a s h o r tt i m e . F u r t h e r m o r e a t e di n a n N K c e l lb y K I Rr e c o g n i t i oonf a n M H C m o l e c u l e ciateswtth FceRlyand ( proteinsand is responsiblefor cellularcytotoxicNK cell-mediatedantibody-dependent a r e n o t l o n g l i v e d ,a n d t h e s a m e N K c e l l c a n q u i c k l yg o itv.A more recentlydiscoveredgroupof human NK-actitargetcell.Somemembersof on to killan MHC-negative vating receptors,called natural cytotoxicityreceptors, tailswithout lTlMs, the KIRfamilyhaveshortcytoplasmic and these functionas activatingreceptors,as discussed includesNKp46,NKp30,and NKp44.Theseare members in more detail below Mice do not express KlRs, but insteaduse the Ly49 family of C-type lectin proteins, w h i c h h a v es i m i l a cr l a s sI M H C s p e c i f i c i t i easn d l T l M si n their cytoplasmictails A secondfamilyof inhibitoryreceptorsconsistsof lgbindingto activatingNK cell receptorsleadsto cytokine l i k e t r a n s c r i p t (sl L T s () a l s on a m e d L I R o r C D 8 5 ) ,w h i c h a l s oc o n t a i nl g - l i k ed o m a i n sO n e m e m b e ro f t h i s f a m i l y , production,enhancedmigrationto sites of infection,and targetcells. ILT-2,hasa broadspecificityfor manyclassI MHC alleles killingactivityagainstthe ligand-bearing A common featureof NK cell activatingreceptorsls a n d c o n t a i n sf o u r l T l M s i n i t s c y t o p l a s m itca i l . I n t e r e s t t h e o r e s e n c eo f n o n c o v a l e n t llyi n k e d s u b u n i t s( e . 9 . , encodesa moleculecalledUL18 ingly,cytomegalovirus
e n d k i l l i n f e c t e do r m a l i g n a n t ltyr a n s N K c e l l sr e c o g n i z a f o r m e dc e l l s ,b u t t h e y d o n o t u s u a l l yh a r mn o r m a lc e l l s . p o t e n t i a l ld y a n g e r o u st a r g e t s T h i s a b i l i t yt o d i s t i n g u i s h from healthyself is dependenton the expressionof both inhibitoryand activatingreceptors.Inhibitoryreceptorson N Kc e l l sr e c o g n i zcel a s sI M H C m o l e c u l e sw, h i c ha r ec o n stitutivelyexpressedon most healthycells in the body but are often not expressedby cells infectedwith virus or cancercells Activatingreceptorson NK cellsmay recognizestructuresthat are presenton both NK- susceptiof the b l e t a r g e tc e l l sa n d n o r m a cl e l l s ,b u t t h e i n f l u e n c e inhibitorypathwaysdominateswhen classI MHC is recognized In some cases,if the Iigandsfor the activating in infected receptorsare newly inducedor up-regulated or transformedcells, the increaseddensity of these ligandspermitsthe activatingreceptorsto overcomethe actionof the inhibitoryreceptors,therebyenablingthe NK c e l lt o k i l lc e l l se x p r e s s i ncgl a s sI M H C . S o m ea c t i v a t i n g r e c e p t o r sr e c o g n i z ce l a s sI M H C - l i k em o l e c u l e tsh a t a r e expressedonly on stressedor transformedcells.Different familiesof NK cell receptorsexist,and manyof these receptorshave evolved recently,as indicatedby their absence in rodents and their structural divergence b e t w e e nc h i m p a n z e easn d h u m a n s .T h e f o l l o w i n gd i s c u s s i o nf o c u s e so n t h e p r o p e r t i e so f h u m a n N K c e l l inhibitoryand activatingreceptors,with only brief considerationof murineNK receptors.
Continued on following Page
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Section |-
INTR0DUCTt0N T0 THETMMUNE SYSTEM
Cytoplasmic signaling subunits HLA-E
o o CL
o o o
HLA.A,B, C, E,F,G C M VU L 1 8
o .=
p
HLA-C, Bw4,A
.c c
lgGcoated cell
o o CL
o o o ct) c
HLA-C; pathogen encoded ligands?
(E
o
HLA-E; pathogen encoded ligands? MICA,MICB, ULBP
I@E
NK cellmembrane
ITAM YxxM lTlM Examplesof inhibitoryand ac_tiv_ating NK cell receptorsand their ligandsCD16and the naturalcytotoxicreceptors(NCRs)associate with ( chain homodimers,FcRy homodimers,or (-FcRy hetero-dimersThere are multiple different KlRs, with varyingligand specificities
F c e R l l (, , a n d D A P 1 2p r o t e i n s )w, h o s e c y t o p l a s m itca i l s r e c r u i tk i n a s e si n v o l v e di n s i g n a l l n gC D 1 6 a n o s o m e other activatingreceptorsassociatewith subunitsthat c o n t a i n i m m u n o r e c e p t o r t y r o s i n e - b a s e da c t i v a t i o n motifs flTAMs)in theircytoplasmic talls lrAMs are com_ p o s e do f a c o n s e r v e sde q u e n c eo f a m i n oa c i d s r, n c l u d i n g two Tyr-x-x-Leu/lle elements(wherex is anv aminoacid)
s e p a r a t e db y s i x t o e i g h t a m i n o a c i d r e s i d u e s .U p o n ligandbindingto the extracellular portionof these receptors, the tyrosineresiduesin the ITAMs become phosphorylatedby cytoplasmicSrc family kinases,and the phosphorylated ITAMs then bind other proteintyrosine kinases,suchas Syk and ZAP-10,which act on additional s u b s t r a t eisn a s i g n a l i ncga s c a d eT. h e s es i g n a l i negv e n t s Continued on following page
are very similarto those that occur in T and B lymphocytesafterantigenrecognition, and we will discussthem i n m o r e d e t a i li n C h a p t e r s8 a n d 9 . T h e N K G 2 Dr e c e p t o r (whichis onlydistantlyrelatedto NKG2Aor NKG2C)assoc i a t e sw i t h a s i g n a l i n sgu b u n i n t a m e dD A P 1 0 w , h i c hh a s a Tyr-x-x-Met motif in its cytoplasmic domain Uponphosp h o r y l a t i o tnh, i s m o t i fb i n d sp h o s p h a t i d y l i n o s i t ko il n- 3a s e ( P l 3 K )a n d G r b 2 , w h i c h i n i t i a t e sa d i f f e r e n ts i g n a l i n g cascadefrom that initiatedby ITAM phosphorylation. A s m e n t i o n e ds, o m e m e m b e r so f t h e K I Ra n d C D 9 4 / N K G 2f a m i l i e so f M H C - s o e c i f irce c e p t o r sd o n o t c o n t a i n lTlMs but ratherassociatewith ITAM-bearing accessory m o l e c u l e s( s u c ha s D A P 1 2 a ) n dd e l i v e ra c t i v a t i nsgi g n a l s t o N K c e l l s . T h e s e i n c l u d e K l R 2 D S , K l R 3 D S ,a n d Some of these receptorsare known to CD94/NKG2C. r e c o g n i z en o r m a l c l a s s I M H C m o l e c u l e s ,a n d i t i s not clear why these potentiallydangerousreceptors e x i s to n N K c e l l s .T h e s ea c t i v a t i n g r e c e p t o r sb i n dc l a s s I M H C m o l e c u l e s w i t h l o w e r a f fi n i t i e s t h a n t h e structurallyrelatedinhibitoryreceptors,and it is possible that the activatingreceptorsactuallybind MHC-related l nm o l e c u l e ss p e c i f i c a l lays s o c i a t ew co d ith pathologica ditions
tumor cells. Experimental evidence in mice has shown that NKG2 ligands are important for controlling viral infections and growth of tumors. Another type of activating receptor on NK cells, called CD16 (FcTRIIIa),is a low-affinity receptor for the Fc portions of IgGl and IgG3 antibodies. As a result of this recognition, NK cells kill target cells that have been coated with antibody molecules. This process, called antibody-dependent cellmediated cytotoxicity, will be described in more detail in Chapter 14 when we consider the effector mechanisms of humoral immunity. Kinase-dependent signaling cascades are initiated when activating receptors on NK cells bind their ligands, rapidly leading to cytotoxic activity against the target cells bearing the ligands and the production of cytokines. These signaling pathways are similar to those in T lymphocytes (seeChapter 9). The inhibitory receptors on NK celk bind. to class I MHC molecules, which are normally expressedon most healthy, uninfected cells. The binding of these inhibitory receptors to their ligands triggers phosphatasedependent signaling cascades, which counteract the effect of kinases in the signaling cascades initiated by activating receptors. Becauseof specificity of inhibitory receptors for self-classI MHC, normal host cells are protected from NK-mediated killing. Infection of the host cells, especially by some viruses, often leads to reduced expression of class I MHC molecules, and therefore the ligands for the inhibitory NK cell receptors are lost. As a result, the NK cells are releasedfrom their normal state of inhibition. At the same time, ligands for activating receptors are expressed,and thus the infected cells are killed. This unusual specificity of the NK cell inhibitory receptors for normal class I MHC allows the innate immune system to attack virally infected cells that might
N K G 2 Dw . h i c hi s e x p r e s s e od n N K c e l l s ,a s w e l l a s o n T c e l l s ,r e c o g n i z et sh e M I C A ,M I C B ,a n dU L B Pm o l e c u l e s i n h u m a n sa n dt h e R A E - ,1M U L T l, a n d H 6 0 m o l e c u l e isn m i c e A l l t h e s e N K G 2 Dl i g a n d sh a v e d o m a i n sh o m o l o g o u st o c l a s sI M H C c xa n d B d o m a i n sb, u t d o n o t d i s p l a y TheseNKG2 peptidesor associatewith B2-microglobulin. ligandsare not abundantlyexpressedon normalcellsbut by stressor DNA damageand are often are up-regulated f o u n d o n t u m o r c e l l sa n d v i r u s - i n f e c t ecde l l s .T h u s ,N K cells may use these receptorsto eliminatestressed ( i n j u r e dh) o s tc e l l sa n d t u m o r c e l l s Most of the activatingreceptorson NK cells are also expressedon certainsubsets of T cells, includingyDT cellsand CDS*T cells.However,the expressionof these receptorson T cellsis inducedonly afterT cell activation b y a n t i g e nw , h i l e e x p r e s s i oonf t h e r e c e p t oor n N K c e l l s i s c o n s t i t u t i v eT. h i s h i g h l i g h t sa n i m p o r t a n td i s t i n c t i o n between innate and adaptive immunity-the effector c e l l so f i n n a t ei m m u n i t ys, u c h a s N K c e l l s ,a r e f u l l y d i f ferentiatedand readyto respondimmediatelyto infeci m m u n ee f f e c t o cr e l l sa r eg e n e r a t e d t i o n s .w h i l ea d a p t i v e from naiveprecursorsonly after antigenexposure.
be invisible to T cells,which require MHC expressionfor recognition. The largest group of NK inhibitory receptors are the killer cell immunoglobulin-like receptors (KIRs). These are members of the immunoglobulin superfamily, and they bind a variety of class I MHC molecules that otherwise function to present peptide antigens to CD8* T cells (seeBox 2-4). A second important NK inhibitory receptor is CD94/NKG2A, which is a dimer of C-type lectins and recognizes a class I MHC molecule called H[A-E. Interestingly, H[-A.-Edisplays peptides derived from other class I MHC molecules, so in essence, CD94/NKG2 is a surveillance receptor for several different class I MHC molecules. A third family of NK inhibitory receptors, called the leukocyte lg-like receptors (LIRs), are also Ig superfamily members that bind class I MHC molecules, albeit with lower affinity than the KIRs, and are more highly expressedon B cells than on NK cells. The expansion and actiuities of NKcelk are ako stimulated by cytokines, mainly lL-15 and IL-12. IL-15, which is produced by macrophages and many other cell types, is a growth factor for NK cells, and knockout mice lacking IL-15 or its receptor show a profound reduction in the number of NK cells. The macrophage-derived cltokine IL-12 is a powerful inducer of NKcell IFN-yproduction and cytotoxic activity. IL-18 may augment these actions of IL-12. IL-12 and IL-18 also stimulate IFN-y production by T cells (see Chapter 13) and are thus ientral participants in IFN-y production and the subsequent IFN-1-mediated activation of macrophages in both innate and adaptive immunity. The t)?e I IFNs, IFN-cr and IFN-B, also activate the cytotoxic potential of NK cells, perhaps by increasing the expression of IL-12 receptors and therefore responsivenessto IL-12. IL-15,
42
| - INTRODUCT|0N T0THETMMUNE SYSTEM 6 Section
K i l l i n go f stressed cells
NKcell
.-'''----_--'_ _.-*s\
Virus-infected cell
Macrophage with phagocytosed microbes
K i l l i n go f infected cells
K i l l i n go f phagocytosed microbes
the host cells In this way, NK cellseliminatereservorrs of infection as well as dysfunctional cells B NK cellsrespond:rclL-12produced by macrophagesand secrete IFN-1,which activatesthe macrophagesto kill phagocytosed mrcrobes
IL-12, and type I IFNs are produced by macrophages in response to infection, and thus all three cytokines activate NK cells in innate immunity. High concentrations of IL-2 also stimulate the activities of NK cells, and culture in IL-2 is sometimes used to enhance NK cell killing. Effector
Functions of Natural Kitter Cetts
The effector functions of NK celk are to kill infected celk and to actiuate macrophages to destroy phagocytosed microbes (Fig. 2-11). The mechanism of NK cell-mediated cytotoxicity is essentially the same as that of CTLs (described in detail in Chapter 13). NK cells, like CTLs, have granules that contain proteins which mediate killing of target cells. When NK cells are activated, granule exocytosis releases these proteins adjacent to the target cells. One NK cell granule protein, called perforin, facilitates the entry of other granule proteins, called granzymes, into the cytoplasm of target cells.The granzymes are enzyrnes that initiate apoptosis of the target cells. By killing cells infected by viruses and intracellular bacteria, NK cells eliminate reservoirs of infection. Some tumors, especially those of hematopoietic origin, are targets of NK cells, perhaps because the tumor cells do not expressnormal levels or types of class I MHC molecules. NK cell-derived IFN-1 serves to activate macrophages, like IFN-y produced by T cells, and
increases the capacity of macrophages to kill phagocytosed bacteria (seeChapter l3). NK cells play several important roles in defense against intracellular microbes. They kill virally infected cells before antigen-specific CTLs can become fully active, that is, during the first few days after viral infection. Early in the course of a viral infection, NK cells are expanded and activated by cytokines of innate immunity, such as IL-12 and IL-15, and they kill infected cells, especially those that display reduced levels of class I MHC molecules. In addition, the IFN-y secreted by NK cells activates macrophages to destroy phagocytosed microbes. This IFN-y-dependent NK cell-macrophage reaction can control an infection with intracellular bacteria such as Listeria monocytogenes for several days or weeks and thus allow time for T cell-mediated immunity to develop and eradicate the infection. Depletion of NK cells leads to increased susceptibility to infection by some viruses and intracellular bacteria. In mice lacking T cells, the NK cell response may be adequate to keep infection with such microbes in check for some time, but the animals eventually succumb in the absence of T cell-mediated immunity. NK cells may also kill infected cells that attempt to escape CTl-mediated immune attack by reducing expression of class I MHC molecules. BecauseNK cells can kill certain tumor cells in vitro, it has also been proposed that NK cells serve to kill malignant clones in vivo.
Circulating Proteins of Innate lmmunity In addition to cell-associated molecules, several different soluble proteins found in plasma and extracellular fluids also recognize pathogen-associated molecular patterns and serve as effector molecules of the innate immune system. Other soluble molecules serve as opsonins, targeting microbes for phagocytosis by neutrophils or macrophages. The soluble pattern recognition proteins and associated effector molecules are sometimes called the humoral branch of innate immunity, analogous to the humoral branch of adaptive immunity mediated by antibodies. The major components of the humoral innate immune system are the complement system, the collectins, the pentraxins, and the ficolins.
The Complement
System
The complement system conskts of seueral plasma proteins that are actiuated by microbes and promote destruction of the microbes and inflammatio,n. Recognition of microbes by complement occurs in three ways (Fig. 2-I2). The classical pathway, so called because it was discovered first, uses a plasma protein called Cl to detect IgM, IgGf, or IgG3 antibodies bound to the surface of a microbe or other structure. The alternative pathway, which was discovered later but is
C h a p t e2r
I N N A TIEM M U N I T Y
Microbe
fl'fi',l3li*&
Membrane attack complex (MAC)
Antibody
Mannose bindinglectin
f=*"*l
CSa: lnflammation
I lfunctions of the complementsystemmay be initiatedby threedistinctpathways, of complementactivation.The activation FIGURE 2-12 Pathways -production culminatingin the proof C3b (the earlysteps) C3b initiatesthe late steps of complementactivation, all of which leadto the (C5a)and polymerized C9, which forms the membraneattackcomplex,so calledbecause ductionof peptidesthat stimulateinflammation tuncfunctionsof majorproteinsproducedat differentstepsare shown The activation, it createsholesin plasmamembranesThe prlncipal of the complementsystemare discussedin much more detailin Chapter14 tions,and regulation
phylogenetically older than the classical pathway, is triggered by direct recognition of certain microbial surface structures and is thus a component of innate immunity. The lectin pathway is triggered by a plasma protein called mannose-binding lectin (MBL), which recognizesterminal mannose residues on microbial glycoproteins and glycolipids. MBL bound to microbes activates one of the proteins of the classicalpathway, in the absence of antibody, by the action of an associated serine protease. Recognition of microbes by any of these pathways results in sequential recruitment and assembly of additional complement proteins into protease complexes. The central protein of the complement system, C3, is cleaved, and its larger C3b fragment is deposited on the microbial surface where complement is activated. C3b becomes covalently attached to the microbes and serves as an opsonin to promote phagocltosis of the microbes. A smaller fragment, C3a, is released and stimulates inflammation by acting as a chemoattractant for neutrophils. C3b binds other complement proteins to form a protease that cleavesa protein called C5, generating a secreted peptide (C5a) and a larger fragment (C5b) that remains attached to the microbial cell membranes. C5a stimulates the influx of neutrophils to the site of infection as well as the vascular component of acute inflammation. C5b initiates the formation of a complex of the complement proteins C6, C7, C8, and C9, which are assembledinto a membrane pore that causeslysis of the cells where complement is activated. Mammalian cells express several regulatory proteins that block complement activation and thus prevent injury to normal host cells.The complement system will be discussedin more detail in Chapter 14.
Pentraxins Severalplasma proteins that recognize microbial structures and participate in innate immunity belong to the pentraxin family, which is a phylogenetically old group of structurally homologous pentameric proteins. Prominent members of this family include the short pentraxins C-reactive protein (CRP) and serum amyloid P (SAP) and the long pentraxin PTX3. Plasma concentrations of CRP are very low in healthy individuals, but can increase up to 1000-fold during infections and in response to oiher inflammatory stimuli. The increased levels of CRP are a result of increased synthesis by the liver induced by the cytokines IL-6 and IL-l, which are produced by phagocltes as part of the innate immune response.Liver synthesis and plasma levels of several other proteins, including SAP and others unrelated to the pentraxins, also increase in responseto IL-1 and IL-6, and as a group these plasma proteins are called acute-phase reactants. noth CRp and SAP bind to several different species of bacteria and fungi. The molecular ligands recognized by CRP and SAP include phosphorylcholine and phosphatidylethanolamine, respectively, which are phosphoiipid headgroups found on bacterial membranes and on apoptotic cells, but are not exposed on the surface of healthy eukaryotic cells. CRPfunctions as an opsonin by binding Clq and interacting with phagoclte Clq receptors or by binding directly to IgG Fc receptors. CRP may also contribute to complement activation through its attachment to Clq and activation of the classical pathway. PTX3 is produced by several cell types, including dendritic cells, endothelial cells, and macrophages, in response to TLR ligand and the innate immune svstem cvtokine TNE but it is not an acute-phase reac-
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;
Section | - |NTEODUCT|ON T0 THETMMUNE SYSTEM
tant. PTX3 binds to severalligands, including Clq, apoptotic cells, and certain microorganisms. Studies with knockout mice reveal that PTX3 provides protection against some microbes, including the fungusA spergillus fumigatus. Collectins and Ficolins The collectins are a family of proteins that contain a collagen-like tail connected by a neck region to a calcium-dependent (C-type)lectin head. Three members of this family serve as soluble pattern recognition molecules in the innate immune svstem; these include MBL and pulmonary surfactant proteins Sp-A and Sp-D. Mannose-binding lectin, which was mentioned earlier in relation to the complement system, is a plasma protein that functions as an opsonin. plasma MBL, like the macrophage mannose receptor, binds carbohydrates with terminal mannose and fucose, which are typically found in microbial cell surface glycoproteins and glycolipids. Thus, MBL is a soluble pattern recognition receptor that binds to microbial but not mammalian cells.MBL is a hexamer that is structurally similar to the Clq component of the complement system. MBL binds to a macrophage surface receptor that is called the Clq receptor because it also binds Clq. This receptor mediates the phagocytosis of microbes that are opsonized by MBL. Moreover, MBL can activate the complement system, as discussed earlier. The gene encoding MBL is polymorphic, and certain alleles are associated with impaired hexamer formation and reduced blood levels.Low MBL levels are associatedwith increased susceptibility to a variety of infections, especially in combination with other immunodeficiency states. Surfactant protein-A (SP-A) and surfactant-D (Sp-D) are collectins with lipophilic surfactant properties shared by other surfactants, and are found in the alveoli of the lungs. Their major functions appear to be as modulators of innate immune responses in the lung. They bind to various microorganisms and act as opionins, facilitating ingestion by alveolar macrophages.Sp-A and SP-D can directly inhibit bacterial growth, and they also interact with and activate macrophages. Sp-A- and SpD-deficient mice have impaired abilities to resist a variety of pulmonary infections. Ficolins are plasma proteins that are structurally similar to collectins, possessinga collagen-like domain, but instead of a C-type lectin domain, they have a fibrinogen-type carbohydrate recognition domain. Ficolins have been shown to bind several species of bacteria, opsonizing them and activating complement in a manner similar to that of MBL. The molecular ligands of the ficolins include l/-acetylglucosamine and the lipoteichoic acid component of the cell walls of gram-positivebacteria. Cytokines
of the Innate lmmune
System
The cytokines of innate immunity recruit and actiuate Ieukocytes and produce systemic alterations, including
increases in the synthesis of effector cells ond proteins that potentiate antimicrobial responses. In innate immunity, the principal sources of cytokines are macrophages,neutrophils, and NK cells,but endothelial cells and some epithelial cells such as keratinocltes produce many of the same proteins. As in adaptive immunity, cytokines serve to communicate information among inflammatory cells and between inflammatory cells and responsive tissue cells, such as vascular endothelial cells. The cytokines of innate immunity will be described further in Chapter 12. They include cytokines that control viral infections, namely, IFN-cr and IFN-p; cytokines that mediate inflammation, namely, TNE IL-1, and chemokines; cytokines that stimulate the proliferation and activity of NK cells, namely, IL-15 and IL-2; cytokines that activate macrophages, especially NK cell-derived IFN-y and cytokines that serve to limit macrophage activation, especially IL-10. In addition, some cltokines of innate immunity, such as IL-6, increase bone marrow production of neutrophils and the synthesis of various proteins involved in host defense,such as CRP
Rolr or lruruRrr lrumururrv tNSnMULATTNG AoRpnvr lmnrturur Rrsporusrs The innate imnxune responseprouides signals thatfunction in concert with antigen to stimulate the proliferation and dffirentiation of antigen-specific T and B lymphocytes. As the innate immune response is providing the initial defense,it also sets in motion the adaptive immune response. The activation of lyrnphocl.tes requires two distinct signals, the first being antigen and the second being components of innate immune responses to microbes or injured cells (Fig. 2-13). This idea is called the two-signal hypothesis for lymphoclte activation. The requirement for antigen (so-called signal 1) ensuresthat the ensuing immune responseis specific. The requirement for additional stimuli triggered by microbes or innate immune reactions to microbes (signal 2) ensures that adaptive immune responses are induced when there is a dangerous infection and not when lymphocltes recognize harmless antigens, including self antigens.The molecules produced during innate immune reactions that function as second signals for lymphocyte activation include costimulators (for T cells), cltokines (for both T and B cells), and complement breakdor,rmproducts (for B cells).We will return to the nature of second signals for lymphoclte activation in Chapters 9 and 10. The second signals generated during innate immune responses to dffirent microbes not only enhance the magnitude of the subsequent adaptive immune response but ako influence the nature of the adaptiue response.A major function of T cell-mediated immunity is to activate macrophages to kill intracellular microbes. Infectious agents that engage TLRs will tend to stimulate T cell-mediated immune responses.This is becauseTLR
: !
Chapter2-INNATEIMMUN ! I T Y4 5 & e,,
Lymphocyte
Microbial antigen
lnnateimmune response to microbe inducedby Molecule innateresponse (e.0.costimulator, dofrplement fragment)
Lymphocyte proliferation and differentiation
Adaptive immuneresponse FIGURE 2-13 Stimulationof adaptiveimmunityby innate provides Antlgenrecognition by lymphocytes immuneresponses, and molecules of the lymphocytes, slgnal1 for the activation to microbes induced on hostcellsduringinnateimmuneresponses provide areB cells,but thelymphocytes slgnal2 Inthisillustration, Thenatureof second applyto T lymphocytes the sameprinciples in laterchapters srgnals differsfor B andT cellsandis described
signaling enhances the ability of antigen-presenting cells to induce the differentiation of T cells into effector cells called Tsl cells.THI cells produce the cytokine IFN1, which can activate macrophages to kill microbes that might otherwise survive within phagocytic vesicles.Tsl cells and cell-mediated immunity are discussedin detail in Chapter 13. In contrast, many extracellular microbes that enter the blood activate the alternative complement pathway, which in turn enhances the production of antibodies by B lymphocltes. This humoral immune response servesto eliminate extracellular microbes. The role of complement in enhancing B cell activation is discussed in Chapter 14. The role of innate immunity in stimulating adaptive immune responses is the basis of the action of adjuvants, which are substances that need to be administered together with protein antigens to elicit maximal T cell-dependent immune responses (see Chapter 6). Adjuvants are useful in experimental immunology and in clinical vaccines.Many adjuvants in experimental use are microbial products, such as killed mycobacteria and LPS, that engage TLRs and elicit strong innate immune responsesat the site of antigen entry.
SUMMARY o The innate immune system provides the first line of host defenseagainst microbes. The mechanisms of innate immunity exist before exposure to
microbes.The componentsof the innate immune system include epithelial barriers, Ieukocytes (neutrophils,macrophages,and NK cells),circulating effector proteins (complement,collectins, pentraxins), and cytokines (e.8., TNE IL-1' chemokines,lL-2,typeI IFNs,and IFN-9. c The innate immune systemuses cell-associated pattern recognitionreceptorsto recognizestrucmolecular pattures called pathogen-associated (PAMPs), microbes,are by shared which are terns not present on mammalian cells, and are often essentialfor survivalof the microbes,thus limiting the capacity of microbes to evade detection by mutating or losingexpressionof thesemolecules. TLRs are the most important family of pattern recognitionreceptors,recognizinga wide variety of ligands, including microbial nucleic acids, sugars,glycolipids,and Proteins. e Neutrophils and macrophagesare phagocytesthat kill ingestedmicrobes by producing ROS,nitric oxide, and enzymes in phagolysosomes. Macrophagesalso produce cytokinesthat stimulate inflammation and promote tissueremodeling at sites of infection. Phagocytesrecognize and respondto microbial products by severaldifferent typesof receptors,includingTLRs,C-typelectins, scavengerreceptors,and N-formyl Met-Leu-Phe receptors. C Neutrophils and monocytes (the precursorsof tissue macrophages)migrate from blood into inflammatory sites during innate immune Cytokines,includingIL- I and TNf; proresponses. duied at thesesitesin responseto microbialproducts induce the expressionof adhesionmolecules on the endothelial cells of local venules.These adhesionmoleculesmediatethe attachmentof the
firmly bound, via interactions of leukocyte integrins binding to Ig-superfamilyligands on the endothelium. Intergrin binding is strengthenedby chemokines,produced at the site of infection, which bind to receptors on the leukocytes. Chemokinesalso stimulate directed migration of the Ieukocltes through the vesselwall into the site of infection. o NK cellsarel1'rnphocltesthat defendagainstintracellular microbesby killing infected cells and providing a source of the macrophage-activating cy'tokineIFN-1.NK cell recognitionof infectedcells ii regulated by a combination of activating and inhibitory receptors.Inhibitory receptorsrecog-
,,.--
_.
46 $
Section | - INTR0DUCT|ON T0THETMMUNE SYSTEM
nize class I MHC molecules, because of which NK cells do not kill normal host cells but do kill cells in which class I MHC expression is reduced, such as virus-infected cells. C The complement system is activated by microbes, and products of complement activation promote phagocytosis and killing of microbes and stimulate inflammation. o The innate immune system includes other soluble pattern recognition and effector molecules found in the plasma, including pentraxins (e.g., CRP), collectins (e.g., MBL), and ficolins. Theie molecules bind microbial ligands and enhance clearance by complement-dependent and -independent mechanisms. o Different cytokines of innate immunityrecruit and activate leukocytes (e.g.,TNf; IL-1, chemokines), enhance the microbicidal activities of phagocytes (IFN-y), and stimulate NK cell and T cell responses (IL-2). In severe infections, excess svstemic cvtokine production is harmful and may ".r"n "ut'rr" death of the host. C Molecules produced during innate immune responsesstimulate adaptive immunity and influence the nature of adaptive immune responses. Macrophages activated by microbes and by IFN-1 produce costimulators that enhance T cell activa-
Selected
Readings
Akira S, and K Takeda.Toll-like receptor signalling.Nature ReviewsImmunology4:499-5II, 2004. AkiraS,S Uematsu,and O Takeuchi.pathogenrecognitionand innateimmuniry.Cell 124:783_801,2006. BuletB R Stocklin,and L Menin.Anti-microbialpeptides:from invertebratesto vertebrates.ImmunologicaLReviewsl9B: t69-t84,2004. ChenG, MH ShawYG Kim, and G Nunez.Nod-likereceptors: role in innate immunity and inflammatorydisease.Annual Reviewol Parhology 4:365-398, 2008. DommettR, M Zilbauer,JT George,and M Bajaj-Elliott.Innate immune defencein the human gastrointestinal tract.Mole_ cularImmunology42:903-9 12,2OOS. Fujita I M Matsushita,and y Endo.The lectin-comolemenr pathway-its role in innate immunity and evolution. ImmunofogicafReviewsl9B:I BS-202,2004.
Garlanda C, B Bottazzi, A Bastone, and A Mantovani. Pentraxins at the crossroads between innate immuniry inflammation, matrix deposition and female fertility. Annual Review of Immunology 23:337-366, 2004. Hotchkiss RS, and IE Karl. The pathophysiology and treatment of sepsis. New England Journal of Medicine 348:138-150, 2003. Inohara N, M Chamaillard, C McDonald, and G Nunez. NODLRR proteins: role in host-microbial interactions and inflammatory disease.Annual Review of Biochemistrv 74:355-383,
200s. faneway CA, and R Medzhitov. Innate immune recognition. Annual Review of Immunology 2O:197-216,2002. Kawai T and S Akira. Innate immune recognition of viral infection. Nature Immunology 7 :l3l-I37, 2006. Klotman ME and TL Chang. Defensins in innate antiviral immunity. Nature Reviews Immunology 6;447-456, 2006. Kopp E, and R Medzhitov. Recognition of microbial infection by Toll-like receptors. Current Opinion in Immunology 15:396-401,2003. KriegA. CpG motifs in bacterial DNA and their immune effects. Annual Review of Immunology 2O:709-760,2002. Lanier LL. NK cell recognition. Annual Review of Immunology 23:225-274,2OO5. Lehrer RI, and T Ganz. Defensins of vertebrate animals. Current Opinion in Immunology 14:96-102, 2002. Ley K, Laudanna C, Cybulsky MI, Nourshargh S. Getring to the site of inflammation: the leukoclte adhesion cascade updated. Nature Reviews Immunolo gy 7 :678-689, 2007. Meylan E, J Tschopp, and M Karin. Intracellular pattern recognition receptors in the host response. Nature 442:39-44, 2006. Nauseef \MM. How human neutrophils kill and degrade microbes: an integrated view Immunological Reviews 219:88-102,2007. Pichlmair A, and C Reis e Sousa.Innate recognition of viruses. Immunity 27:370-383, 2007. Segal AW. How neutrophils kill microbes. Annual Review of Immunology 23:197-223, 2005. Selsted ME, and AI Ouellette. Mammalian defensins in the antimicrobial immune response. Nature Immunology 6:551-557,2005. StroberW PJMurray, A Kitani, and TWatanabe. Signalling pathways and molecular interactions of NODI and NOD2. Nature Reviews Immunology 6:9-20, 2006. Takeda K, T Kaisho, and S Akira. Toll-like receptors. Annual Reviewof Immunology 2l:335-376,2003. Trinchieri G, and A Sher. Cooperation of Toll-like receptor signals in innate immune defence. Nature Reviews Immunology 7:179-190, 2007. Underhill DM, and A Ozinsky.Phagocytosisof microbes: complexity in action. Annual Review of Immunolo gy 20: B2S-852, 2002. Van de Wetering lK, LMG van Golde, and ll Batenburg. Collectins: players of the innate immune system. European Journal of Biochemistry 27 | :229-249, 2004. Vivier E, E Tomasello, M Baratin, TWalzer, and S Ugolini. Functions of natural killer cells. Nature Immunology 9:503-511, 2008.
Cells of the Adaptive lmmune System,48 Lymphocytes,49 Cells,56 Antigen-Presenting Anatomy and Functions of Lymphoid Tissues, 56 Bone Marrow,57 Thymus,58 LymphNodesand the LymphaticSystem,58 S p l e e n6, 1 CutaneouslmmuneSystem,62 MucosallmmuneSystem,63 Pathways and Mechanisms of Lymphocyte Recirculation and Homing,64 Recirculationof NaiveT Lymphocytes BetweenBloodand SecondaryLymphoid Organs,65 Migrationof EffectorT Lymphocytesto Sites 68 of lnflammation, MemoryT CellMigration,69 Homing of B Lymphocytes,69
are of critical importance for the genera resDonses.The immune system faces lenges to generate effective protective infectious pathogens. First, the system respond to small numbers of manY d that may be introduced at any site in
The ability of the irnmune system to meet these chalIenges and to perform its protective functions optimally is dependent on several properties of its cells and tlssues. fi Specialized tissues, called peripheral lymphoid organs, function to concentrate antigens that are iniroduced through the common portak of entry (skin and gastrointestinal and respiratory tracts). The capture of antigen and its transport to l1'rnphoid organs are the first steps in adaptive immune responses.Antigens that are transported to lymphoid orgins are displayed by antigen-presenting cells (APCs)for recognition by specifrc lymphocytes.
Summary,70
The cells of the adaptive immune system are normally present as circulating cells in the blood and lymph, as anatomically defined collections in ll.rnphoid organs, and as scattered cells in virtually all tissues. The anatomic organization of these cells and their ability to circulate and exchangeamong blood, lymph, and tissues
and activation phasesof adaptive immune responses' Effector and memory lymphocyes develop from the progeny of antigen-stimulated naive cells. * Effector and memory lymphocytes circulate in the biood, home to peripheral sites of antigen entry, and are fficiently retained at thesesites.This ensuresthat 47
48 -jl1;!$@*.
| - INTR0DUCT|ON T0THETMMUNE SYSTEM $ Section * immunity is systemic (i.e., that protective mechanisms can act anlvrhere in the body). Adaptive immune responsesdevelop through a series of steps, in each of which the special properties of immune cells and tissues play critical roles. The key phases ofthese responsesand the roles ofdifferent cells and tissues are illustrated schematically in Fig. 3-1. This chapter describes the cells, tissues, and organs of the adaptive immune system and concludes with a discussion of the traffic patterns of lymphocytes throughout the body.
Crus0FTHE AoRpnvr lmruurur Svsrrnrt The celk that are inuolved in adaptiue immune responses are antigen-specific lymphocytes, APCs that display antigens and actiuate lymphocytes, and effictor cells that function to eliminate antigens. These cell types were introduced in Chapter 1 Here we describe the morphology and functional characteristics of lymphocytes and APCs and then explain how these cells are organized in lymphoid tissues.The numbers of some of these cell types in the blood are listed in Table 3-1.
Primary (generative) .Sourceof lymphocyte progenitors lymphoidorgans .Maturation of B lymphocytes .Siteof residence of longlived plasmacells
Bone marrow
Naive lymphocytes
Lymphocyte progenitor
#*
Antigens/ microbes
Antigen presenting cell
,so
Maturation of T lymphocytes
Entryof infectious
agentsandlor Secondary(peripheral) environmental lymphoidorgans antigens
Lymphatic/ blood vessel
Mucosa/skin
Activationof lymphocytes and initiation of adapt rmmuneresponses
Collection of antigensfrom tissuesvia
Effector T lymphocytes and antibodies
Collection of antigens via blood Lymph node Spleen
,-.Antigens/ microbes
Mucosa/skin
Activationof lymphocytes and initiationof adaptive rmmuneresponses
responses in vivo. Lymphocytes maturein the bonemarrow(B cells) and thymus(T cells),and entersecondary(peripheral) lymphoidorgans as "naive" lymphocytesAntigens arecapturedfrom theirsite of entry by dendriticcellsand concentrated in lymph nodes,where they activate naive lymphocytes that migrateto the nodesthroughblood vessels Effector and memory T cellsdevelopin the nodesandenter the circulation,f rom which they may mrgrateto peripheraltissues Antibodiesare produced in lymphoidorgansand enter the circulation, from which they may locate antrgensat any site Memory cells also enter the circulationand may residein lymphoidorgansandother tissues This illustration depictsthe key eventsin an immuneresponse to a protein antigen in a lymph node;responsesin otherperipheral l y m p h o i do r g a n sa r e s i m i l a r
SYSTEMi IMMUNE ANDTISSUES 0FTHEADAPTIVE 3 - CELLS Chapter
T a b l e 3 - 1 . N o r m a l B l o o dC e l l C o u n t s
MeannumberI Normal
permicroliterI range Whitebloodcells 7400 (leukocytes)
4500-11,000
Neutrophils
4400
1800-7700
Eosinophils Basophils Lymphocytes Monocytes
200
0-450
40 2500
0-200 '1000-4800
300
0-800
Although these cells are found in the blood, their responses to antigens are localized to lymphoid and other tissues and are generally not reflected in changes in the total numbers of circulating leukocytes.The cells involved in innate immunity were described in detail in Chapter 2. Lymphocytes Lymphocytes are the only cells in the body capable of specifically recognizing and distinguishing dffirent antigenic d.eterminants and are responsible for the two defining characteristics of the adaptiue immune response, specificity and memory. Several lines of evidence have established the role of lymphocl'tes as the cells that mediate adaptive immunity. Protectiveimmunity to microbes can be adoptively transferred from immunized to naive individuals only by lymphocytesor their secretedproducts. Some congenital and acquired immunodeficiencies are associatedwith reduction of lymphocltes in the peripheral circulation and in lymphoid tissues.Furthermore, depletion of lymphocltes with drugs,irradiation, and cell type-specific antibodies, and by targeted gene disruptions in mice, leads to impaired adaptiveimmune responses. Stimulation of lymphocytes by antigens in culture leads to responsesin vitro that show many of the characteristicsof immune responsesinduced under more physiologicconditions in vivo. Most important, specific receptors for antigens are produced by lymphocltes but not by any other types of cells. Subsefs of Lymphocytes Lymphocytesconsist of dktinct subsetsthat are dffirent in their lunctions and protein products but are morphologically very similnr (Table 3-2). This heterogeneity of l1'rnphocltes was introduced in Chapter I (see Fig.
l-5). B lymphocytes, the cells that produce antibodies, were so called because in birds they were found to mature in an organ called the bursa of Fabricius. In mammals, no anatomic equivalent of the bursa exists, and the early stages of B cell maturation occur in the bone marrow. Thus, "B" lymphocltes refers to bursaderived lymphocltes or bone marrow-derived lymphocytes. T lymphocytes, the mediators of cellular immunity, were named because their precursors, which arise in the bone marrow migrate to and mature in the thymus; "T" lymphocytes refers to thymus-derived lymphocytes. B and T lymphocltes each consist of subsets with distinct phenotypic and functional characteristics. The major subsets of B cells are follicular B cells, marginal zone B cells, and B-1 B cells, each of which is found in distinct anatomic locations within lymphoid tissues. The two major T cell subsets are helper T lymphocytes and cltotoxic T lymphocltes (CTLs), which express an antigen receptor called the aB receptor. CD4* regulatory T cells are now recognized as a third unique subset of T cells expressing the crBreceptor. Another population of T cells called yD T cells expressesa similar but structurally distinct type of antigen receptor. The different functions of these classesof B and T cells will be discussed in later chapters. B and T lymphocytes have clonally distributed antigen receptors, meaning that there are many clones of these cells with different antiSen specificities, and all the members of each clone expressantigen receptors of the same specificity that are different from the receptors of other clones. The genes encoding the antigen receptors of B and T lyrnphocytes are formed by recombinations of DNA segments during the maturation of these cells. There is a random aspect to these somatic recombination events, which results in the generation of millions of different receptor genes and a highly diverse repertoire of antigen speciflcities among different clones of lymphocltes (seeChapter 8). Some subsets of lymphocltes, including T6 T cells, marginal zone B cells, and B- I B cells, are restricted in their use of DNA segments that contribute to their antigen receptor genes, and the repertoires of these lymphocyte subsets are very limited. In addition to B and T cells, there exist other populations of cells that are called lymphocltes based on morphology and certain functional and molecular criteria, but which are not readily categorized as T or B cells. Natural killer (NK) cells, which were described in Chapter 2, have similar effector functions as CTLs, but their receptors are distinct from B or T cell antigen receptors and are not encoded by somatically recombined genes.NKT cells are a numerically small population of lymphocltes that share characteristic of both NK cells and T cells. They express aB antigen receptors that are encoded by somatically recombined genes,but like yb T cells and B-1 B cells, they lack diversity. NKT cells, y6 T cells, and B-1 B cells may all be considered as part of both adaptive and innate immune systems. Membrane proteins may be used a's phenotypic markers to d.istinguish functionally dktinct populations of lymphocyfes (see Table 3-2)' For instance, most
49
50
:l
i
Section | - INTRODUCT|ON T0THETMMUNE SYSTEM
Table 3-2. Lymphocyte Classes
Class
Functions
crBT lymphocytes CD4+helper B cell differentiation T lymphocytes (humoralimmunity) Macrophageactivation (cell-mediated immunity)
Antigen receptorand specificity
Selected markers
Lymph Blood node Spleen
cD3+,CD4+ Diversespecificities cD8-
u,Bheterodimers
a,Bheterodimers cD3+,CD4cD8+ Diversespecificities for peptide-class I MHCcomplexes
Regulatory T cells
aB heterodimers
Suppress function of otherT cells(regulation of rmmuneresponses, maintenance of self-tolerance)
y6T lymphocytesHelperand cytotoxicfunctions (innateimmunity)
B lymphocytes
Antibodyproduction ( h u m o r ailm m u n i t y )
50-60* 50-60
50-60
20:25
15-20
10-15
10
10
for peptide-classll MHC complexes
CD8+cytotoxicKillingof cellinfected T lymphocyteswithmicrobes, killingof tumorcells
Percentof total lymphocytes(human)
cD3+,CD4+, Rare cD25+ (Mostcommon, butother phenotypes as well)
y6 heterodimers cD3+,CD4, Limitedspecificities andCD8 variable for peptideand nonpeptide antigens Surfaceantibody Fc receptors: 1 0 - 1 5 20-25 class ll MHC; Diversespecificities C D 1 9C ; D21 for all typesof molecules
4045
Naturalkillercells Killingof virus-infected
Variousactivating and c D 1 6 inhibitoryreceptors (Fcreceptor Limitedspecificities forlgG) for MHCor MHC-like molecules
NKTcells
oB heterodimers (Limited specificity for glycolipid-CD1 complexes)
or damagedcells (innateimmunity)
Suppressor activate innateandadaotive rmmuneresoonses
10
Rare
10
cD16 10 (Fcreceptor f o rl g G ) ; C D 3
Rare
10
*ln most cases,the ratioof CD4+CD8- to CD8+CD4- cells is about 2:1. Abbreviations;lgG, immunoglobulin G; MHC, major histocompatibility complex
helper T cells express a surface protein called CD4, and most CTLs expressa different surface protein called CD8. Antibodies that are specific for such markers, labeled with probes that can be detected by various methods, are often used to identifv and isolate various ll.rnphocyte populations. (Techniques for detecting labeled antibodies are described in Appendix III.) Many of the surface proteins that were initially recognized as phenotypic markers for various ll.rnphocl'te subpopulations have turned out, on further analysis,to play important roles in the activation and functions of these cells. The accepted nomenclature for lymphoclte markers
uses the CD number designation. CD stands for "cluster of differentiation," a historical term referring to a cluster (or collection) of monoclonal antibodies that are speciflc for a particular marker of lymphocyte differentiation. The CD system provides a uniform way to identi$r cell surface molecules on lymphocytes, APCs, and many other cell types in the immune system (Box 3-l). Examples of some CD proteins are mentioned in Table 3-2, and the biochemistry and functions of the most important ones are described in later chapters.A current list of CD markers for leukocltes that are mentioned in the book is provided in Appendix II.
ChaDter3 - CELLSANDTISSUES0F THEADAPTIVEIMMUNESYSTEM
F r o m t h e t i m e t h a t f u n c t i o n a l ldyi s t i n c tc l a s s e so f l y m phocytes were recognized,immunologistshave att e m p t e dt o d e v e l o pm e t h o d sf o r d i s t i n g u l s h i nt hge m .T h e basic approachwas to produceantibodiesthat would s e l e c t i v e lrye c o g n i z e d i f f e r e n st u b p o p u l a t i o nTsh i sw a s ( is. e .a, n t i b o d i etsh a t i n i t i a l ldy o n eb y r a i s i n ga l l o a n t i b o d i e m i g h tr e c o g n i z a e l l e l i cf o r m s o f c e l l s u r f a c ep r o t e i n sb) y i m m u n i z i nign b r e ds t r a i n so f m i c ew i t h l y m p h o c y t efsr o m o t h e r s t r a i n sS . u c ht e c h n i o u e w s e r e s u c c e s s f ual n d l e d to the developmentof antibodiesthat reacted with m u r i n eT c e l l s ( a n t i - T h ya1n t i b o d i e sa)n d e v e n a g a i n s t functionally differentsubsetsof T lymphocytes(anti-Lyt1 and anti-Lyt2antibodies). The limitationsof this approach are obvious,however,becauseit is usefulonly for cell s u r f a c ep r o t e i n st h a t e x i s t i n d i f f e r e n a t l l e l i cf o r m s .T h e advent of hybridomatechnologygave such analysesa tremendousboost, with the productionof monoclonal antibodiesthat reactedspecificallyand selectivelywith d e f i n e dp o p u l a t i o nosf l y m p h o c y t e sf i,r s t i n h u m a n sa n d s u b s e q u e n t liyn m a n yo t h e rs p e c i e s(. A l l o a n t i b o d iaens d m o n o c l o n aaln t i b o d i easr e d e s c r i b e d i n C h a p t e4r ) Functionally distinctclassesof lymphocytesexpress d i s t i n c tt y p e s o f c e l l s u r f a c ep r o t e i n s l m m u n o l o g i s t s often relyon monoclonal antibodyprobesto detectthese s u r f a c em o l e c u l e sT.h ec e l ls u r f a c em o l e c u l erse c o g n i z e d b y m o n o c l o n aaln t i b o d i eas r e c a l l e d" a n t i g e n s "b e c a u s e a n t i b o d i e sc a n b e r a i s e da g a i n s t h e m , o r " m a r k e r s , " b e c a u s et h e yi d e n t i f ya n dd i s c r i m i n a tbee t w e e n( " m a r k " ) differentcell populationsThesemarkerscan be grouped into severalcategories;some are specificfor cells of a particularlineage or maturationalpathway, and the expressionof othersvariesaccordingto the stateof activ a t i o no r d i f f e r e n t i a t i oonf t h e s a m e c e l l s .B i o c h e m i c a l analysesof cell surfaceproteinsrecognizedby different monoclonalantibodiesdemonstratedthat these antibodi e s ,i n m a n yi n s t a n c e sr ,e c o g n i z etdh e e q u i v a l e nptr o t e i n i n d i f f e r e n st p e c i e s l.n t h e p a s t ,c o n s i d e r a b lceo n f u s i o n was createdbecausethesesurfacemarkerswere initially named accordingto the antibodiesthat reacted with them. To resolvethis, a uniform nomenclaturesystem
Development
of Lymphocytes
Like all blood cells after birth, lymphocytes arise from stem cells in the bone marrow. The origin of lymphocytes from bone marrow progenitorswas first demonstratedby experimentswith radiation-induced bone marrow chimeras.Lymphocytes and their precursorsare radiosensitiveand are killed by high dosesof y-irradiation.If a mouse of one inbred strain is irradiatedand then injectedwith bone marrow cells, or small numbers of hematopoietic stem cells (HSCs),of another strain that can be distinguished from the host, all the lyrnphocytesthat develop subsequently are derived from the bone marrow cells or HSCsof the donor. Such approaches RoshanKetab 02L-6 69 50 639
Accordingto was adopted,initiallyfor humanleukocytes. this system,a surfacemarkerthat identifiesa particular stage,that has a definedstruclineageor differentiation t u r e ,a n dt h a t i s r e c o g n i z ebdy a g r o u p( " c l u s t e r "o) f m o n o c l o n a la n t i b o d i e si s c a l l e da m e m b e r o f a c l u s t e ro f (CD).Thus,all leukocytesurfaceantigens differentiation whose structuresare definedare givena CD designation ( e g , C D 1, C D 2 l .A l t h o u g ht h i s n o m e n c l a t u rwe a s o r i g i nallv used for human leukocyte markers, it is now common practiceto refer to homologousmoleculesin other speciesand on cellsother than leukocytesby the d o n o c l o n aaln t i N.e w l yd e v e l o p e m s a m eC D d e s i g n a t i o n bodies are periodicallyexchangedamong laboratories, a n d t h e a n t i g e n sr e c o g n i z eadr e a s s i g n e dt o e x i s t i n gC D structuresor introducedas new "workshop"candidates (CDw) The classificationof lymphocytesby CD antigen expressionis now widely used in clinicalmedicineand experimentalimmunology For instance,most helperT and most CTLs are lymphocytesare CD3*CD4*CD8-, to idenThis has allowedimmunologists CD3*CD4-CD8* in variousimmune responses, tify the cells participating l yn a l y z et h e i r s p e c i f i c i t i e s , i s o l a t et h e m , a n d i n d i v i d u a l a responsepatterns,and effectorfunctions.Suchantibodles have also been used to definespecificalterationsin that mightbe occurring particular subsetsof lymphocytes i n v a r i o u sd i s e a s e sF. o r e x a m p l e t, h e d e c l i n i n gn u m b e r of blood CD4* T cells is often used to follow the prog r e s s i o no f d i s e a s ea n d r e s p o n s et o t r e a t m e nitn h u m a n virus-infectedpatients.Furtherinvesimmunodeficiency tigationsof the effectsof monoclonalantibodieson lymphocytefunctionhaveshown that these surfaceproteins are not merely phenotypicmarkersbut are themselves involvedin a varietyof lymphocyteresponses.The two most freouentfunctionsattributedto variousCD moleand adheculesare (1) promotionof cell-cellinteractions s i o n a n d ( 2 \ t r a n s d u c t i o no f s i g n a l s t h a t l e a d t o lymphocyteactivation.Examplesof both types of funct h r o u g h o utth i s b o o k . t i o n sa r e d e s c r i b e d
have proved useful for examining the maturation of lyrnphocytesand other blood cells (seeChapter 8). All l1'rnphocytes go through complex maturation stagesduring which they express antigen receptors and acquire the functional and phenotypic characteristics of mature cells (Fig. 3-2). B lyrnphocltes partially mature in the bone marrow enter the circulation, and populate the peripheral lymphoid organs where they complete their maturation. T lymphocltes mature completely in the thymus, then enter the circulation and populate peripheral lymphoid tissues. We will discuss these processes of B and T lymphocyte maturation in much more detail in Chapter 8. These mature B and T cells are called naive lymphocytes. Upon activation by antigen,
52 |,, Section . ..-,,""*-,1.",. ,.,
INTRODUCTI0N T0 THETMMUNE SYSTEM
Generative lymphoid organs
Peripheral lymphoid organs Recirculation
lBb"dl B lymphocytes
'
Thymus
T lymphocytes
Lymphnodes Spleen Mucosal and cutaneous lymphoid tissues Recirculation
FIGURE 3-2 Maturationof lymphocytes. Maturelymphocytes developfrom bone maTTow stem cellsin the generativelymphoidorgans, a n d r m m u n er e s p o n s etso f o r e r g na n t i g e n o s c c u ri n t h e p e r i p h e r al yl m p h o i d tissues
lymphocytes go through sequential changes in phenotlpe and functional capacity. Populations of Lymphocytes Distinguished History of Antigen Exposure
by
In adaptiue immune responses,naiue lymphocytes that emerge from the bone marrow or thymus migrate into secondary lymphoid organs, where they are actiuated by antigens to prolifurate and dffirentiote into effector and memory celk, some of which then migrate into tissues (Fig. 3-3). The activation of lymphocytes follows a series of sequential steps, beginning with the synthesis of new proteins, such as cltokine receptors and cy'tokines, which are required for many of the subsequent changes.The naive cells then undergo proliferation, resulting in increased size of the antigen-specific clones, a process that is called clonal expansion. In some infections, the numbers of microbe-specific T cells may increasemore than 50,000-fold,and the numbers of specific B cells may increasemore than 5000-fold. This rapid clonal expansion of microbe-specific lymphocy.teJ is needed to keep pace with the ability of microbes to rapidly replicate and expand in numbers. Concomitant with clonal expansion, antigen-stimulated lymphocytes differentiate into effector cells, whose function is to eliminate the antigen. Some of the progeny of antigenstimulated B and T lymphocltes differentiate into longlived memory cells, whose function is to mediate rapid and enhanced (i.e.,secondary)responsesto subsequent exposuresto antigens.Therefore, distinct populations of lymphocltes (naive, effector, memory) are always present in various sites throughout the body, and these populations can be distinguished by several functional and phenotypic criteria (Table 3-3). The details of lymphocyte activation and differentiation, as well as the functions of each of these populations, will be addressed later in this book. Here we will summarize the uhenotlpic characteristics of each population.
Naive Lymphocytes. Naive lymphocltes are mature T or B cell emigrants from generative lymphoid organs that have never encountered foreign antigen. They will die after I to 3 months if they do not recognize antigens. Naive and memory lymphocytes, discussed below, are both called resting l1'rnphocytes,because they are not actively dividing, nor are they performing effector functions. Naive (and memory) B and T lymphocytes cannot be readily distinguished morphologically, and are both often called small lymphocytes when observed in blood smears or by flow cltometry (seeAppendix III). A small lymphocyte is 8 to 10 pm in diameter and has a large nucleus with dense heterochromatin and a thin rim of cltoplasm that contains a few mitochondria, ribosomes, and lysosomes,but no visible specializedorganelles (Fig. 3-4). Before antigenic stimulation, naive lymphocltes are in a state of rest, or in the G6 stage of the cell cycle. In response to stimulation, they enter the G, stage of the cell cycle before going on to divide. Activated lymphoc)'tes are larger (10 to 12 pm in diameter), have more cytoplasm and organelles and increased amounts of c$oplasmic RNA, and are called large lymphocltes, or lymphoblasts (see Fig. 3-4). The survival of naive l1'rnphocytes depends on engagement of antigen receptors, presumably by self antigens, and on cytokines. It is postulatedthat naive lymphocytesrecognizevarious self antigens"weakly"-enough to generate survival signals, but without triggering the strongersignalsthat are neededto initiate clonal expansion and differentiation into effectorcells. The need for antigen receptorexpressionto maintain the pool of naively.rnphocy.tes in peripherallyrnphoid organshas been demonstratedby studies in mice in which the immunoglobulin (Ig)genesthat encodethe antigenreceptorsofB cellswereknockedout after the B cellshad matured,or the antigenreceptorsof T cells were knocked out in mature T cells. (The method used is called the cre-lox technique and is described
I SYSTEM$ IMMUNE 0FTHEADAPTIVE ANDTISSUES 3 - CELLS Chapter s
*rl.sF.s@1;i13!@?-,1
Site of infection
i\
-t@-:= 'l:-\cell, [\ Dendritic i '/''\ |} associated assocla o antigen , Free' antigen Connective Naive TandB
Antigentransported via lymphatics into regional Afferent lymphnode
lymphatic vessel Efferent lymphatic vessel
Circulatingnaive lymphocytes migrateinto lymphnode
& Activationof naive lymphocytes:clonal expansionand into differentiation effectorand memorylymphocytes EffectorT lymphocytes EffectorB lymphocytes (plasmacells)
Secreted antibodies
Effector T cells and antibodies entercirculation
Peripheraltissue , , :i ) ' r l , i : . i r t r : : l
Effector T cells and antibodies enter into tissue and eliminate antigen
MemorY lymphocytes take up residence in tissuesand secondarYlYmPhoid organsin preparation for nextinfection
FIGURE 3-3 The anatomyof lymphocyteactivation.NaiveT cells emergingfrom the thymus and naive B cells emergingfrom the they areactivatedby antigens, organs,includinglymphnodesand spleen In these locatrons, lymflnoiO bonemarrowmigrateinto seconOary tissuesitesof into effectorand memorylymphocytesSorie'efiectorand memorylymphocytesmigrateinto peripheral and differentiation infection
53
54
,
S e c t i o|n- I N T R 0 D U C TT| 00N T H ET M M U NSEY S T E M
Table 3-3. Characteristics of Naive,Effector,and Memory Lymphocytes
Naive lymphocytes
T lymphocytes Migration
Activatedor effector I Memory lymphocytes lymphocytes
Preferentially to Preferentially to peripheral lymphoid tissuesinflamed tissues
Frequency of cellsresponsiveVerylow to particular antigen
Preferentially to inflamed tissues, mucosal tissues
High
LOW
Effectorfunctions
None
Cytokine secretion; cytotoxicactivity
None
Ce l l c y c l i n g
No
Yes
+l-
High
Low
Low
Low or variable
High
High
Low
Variable
cD45RO
CD45RO;variable
Large;more cytoplasm
Small
Sudaceproteinexpr,ession High-affinity IL-2 receptor Low Peiipneiitiympn616;.,.l.l' H i g h homingreceptor (L-selectin, CD62L) Adhesionmolecules: Low integrins, CD44 Chemokine receptor: CCRT H i g h MajorCD45isoform CD45RA (humansonly) Morphology Small;scant cytoplasm B lymphocytes Membrane immunoglobulin (lg) isotype
lgMand lgD
Frequently lgG,lgA,lgE
Frequently lgG,lgA,lgE
Affinityof lg produced
Relativelylow
Increases during rmmuneresDonse
Relativelyhigh
Effectorfunction Morphology
None
Antibodysecretion
None
Small;scantcytoplasm
Large;morecytoplasm; S m a l l someareolasmacells
Chemokine receptor: CXCR5 H i g h CD27 Low
Low
?
High
High
Ab b reviations; IL-2, interleukin-2
in Appendix III.) Mature naive lynphocltes that lost their antigen receprsdied within 2 or 3 weeks. Among T cells,there is evidencethat survival of particular clones of naive cells in peripheral ll.rnphoid organs depends on recognition of the same ligands that the clones saw during their maturation in the thymus. In ChapterB,we will discussthe processof T cell maturation and the selectionof T cells by recognition of self antigens in the th).rynus. This selection processensuresthat the cellsthat mature are capable of surviving in peripheral tissuesby recognizingthe selectingself antigens.
If naive lyrnphocytes are transferred into a mouse that does not have any lymphocl'tes of its or.tm,the transferred ly'rnphocytes begin to proliferate and increase in number until they reach roughly the numbers of lyrnphocytes in normal mice. This process is called homeostatic proliferation because it servesto maintain homeostasis(a steady state of cell numbers) in the immune system.This proliferation of naive lymphocytes in the absence of overt exposureto antigen is triggeredby the recognition of self antigens.
SYSTEM IMMUNE 0FTHEADAPTIVE ANDTISSUES 3 - CELLS Chapter
FIGURE 34 Morphology of lymphocytes.A Lightmicrograph of a lymphocytein a peripheral blood smear. B. Electronmicrograph of a small lymphocyte (Courtesyof Dr Noel Weidner, Departmentof Pathology,University of California,San Diego) C Electronmicrograph of a large (From lymphocyte(lymphoblast). Fawcett DW Bloom & Fawcett's Textbookof Histology,12th ed . ithkind & H a l l ,1 9 9 4 W Chapman permissionof SpringerScience and BusinessMedia)
Secreted proteins called cytokines are also essential for the survival of naive lymphocytes, and naive T and B cells constitutively express receptors for these cytokines. Among these cltokines are interleukin-7 (IL-7), which promotes survival and, perhaps, low-level cycling of naive T cells, and B cell activating factor (BAFF), which is required for naive B cell survival. Naive lymphocytes also express surface proteins that are involved in directing migration into lymph nodes, as we will discuss in detail later in this chapter. Effector Cells. After naive lymphocytes are activated, they become larger and proliferate, and are called lymphoblasts. Some of these cells differentiate into effector lymphocytes have the ability to produce molecules capable of eliminating foreign antigens; effector lymphocytes include helper T cells, CTLs, and antibodysecreting B cells. Helper T cells, which are usually CD4*, expresssurface molecules such as CD40ligand (CD154) and secrete cytokines that interact with macrophages and B lymphocytes, leading to their activation. Differentiated CTLs contain cytoplasmic granules containing proteins that kill virus-infected and tumor cells. Both CD4t and CD8* effector T cells usually express surface proteins indicative of recent activation, including CD25 (a component of the receptor for the T cell growth factor IL-2), and class II major histocompatability complex (MHC) molecules (in humans, but not mice). A subset of CD4. T cells called regulatory T cells, which are distinct from and suppress effector T cells, constitutively express CD25 (discussedin Chapter 11). The majority of differentiated effector T lymphocytes are short lived and not self-renewing. Many antibody-secreting B cells are morphologically identifiable as plasma cells. They have characteristic nuclei, abundant cltoplasm containing dense, rough endoplasmic reticulum that is the site where antibodies (and other secreted and membrane proteins) are slmthesized, and distinct perinuclear Golgi complexes where antibody molecules are converted to their flnal forms and packaged for secretion (Fig. 3-5). It is estimated that half or more of the messenger RNA in plasma cells codes for antibody proteins. Plasma cells develop in lymphoid organs and at sites of immune responses and often migrate to the bone marrow where some of them may survive for long periods after the immune response is induced and even after the antigen is eliminated.
although it is still not clear which of these surface proteins are definitive markers of memory populations (see Table 3-3). Memory B lymphocytes express certain classes(isotypes) of membrane Ig, such as IgG, IgE, or IgA, as a result of isotype switching, whereas naive B cells express only IgM and IgD (see Chapters 4 and 10). In humans, CD27 expressionis a good marker for memory B cells. MemoryT cells,like naive but not effectorT cells, expresshigh levels of IL-7 receptors. Memory T cells also express surface molecules that promote their migration inio sites of infection anywhere in the body (discussed later in the chapter). In humans, most naive T cells express a 200-kD isoform of a surface molecule called Ct45 that contains a segment encoded by an exon designated A. This CD45 isoform can be recognized by antibodies specific for the A-encoded segment and is therefore called CD45RA (for "restricted A'). In contrast, most activated and memory T cells express a 180-kD isoform of CD45 in which the A exon RNA has been spliced out; this isoform is called CD45RO' However, this way of distinguishing naive from memory T cells is not peifect, and interconversion between CD45M. and -D+snO. populations has been documented. MemoryT
Roughendoplasmic reticulum Mitochondrion I GolgicomPlex q
1
'?
of FIGURE 3-5 Morphologyof plasmacells. A Lightmicrograph a plasmacell in tissue. B Electronmicrographof a plasmacell' University (Courtesy of Dr NoelWeidner,Departmentof Pathology, ) San Diego,California of California,
56
!
Section | - INTR0DUCT|ON T0THETMMUNE SYSTEM
cells appear to be heterogeneous in many respects. Some, called central memory T cells, migrate preferentially to lymph nodes, where they provide a pool of antigen-specific lymphocytes that can rapidly be activated to proliferate and differentiate into effector cells if the antigen is reintroduced. Others, called effector memory cells, reside in mucosal tissues or circulate in the blood, from where thev mav be recruited to anv site of infection and mount rapih effecto, ,"rponr"! that serve to eliminate the antigen. The migration of memory T cells is discussed later in this chapter, and more details about the generation of memory cells, and the signals for their maintenance, are discussed in Chapters 10 and 13.
Antigen-Presenting
Cells
APCs are cell populations that are specinlized to capture microbial and other antigens, dkplay them to lymryhocytes,and prouide signak that stimulate the proliferation and differentiation of the lymphocytes. By convention, APC usually refers to a cell that displays antigens to T l1'rnphocytes. The major type of ApC that is involved in initiating T cell responsesis the dendritic cell. Macrophages present antigens to T cells during cell-mediated immune responses, and B lymphocytei function as APCs for helper T cells during humoral immune responses.A specialized cell type called the follicular dendritic cell (FDC) displays antigens to B lymphocytes during particular phases of humoral immune responses.APCs link responses of the innate immune system to responses of the adaptive immune system, and therefore they may be considered as components of both systems.In addition to the introduction presented here, APC function will be described in more detail in Chapter 6.
Dendritic
Cells
Dendritic cells play important roles in innate immunity to microbes and in antigen capture and the induction of T lymphocyte responses to protein antigens. Dendritii cells arise from bone marrow precursors, mostly of the mo-noc],'te lineage, and are found in many organs, including epithelial barrier tissues, where they are poised to capture foreign antigens and transport these antigens to peripheral lymphoid organs.They have long cltoplasmic projections, which effectively increasei their surface area, and they actively sample and internalize components of the extracellular tissue environment by pinocltosis and phagocytosis. In addition, dendritic cells expressvarious surface receptors, such as Toll-like receptors (see Chapter 2), that recognize pathogen-associatedmolecular patterns and transduce activating signals into the cell. Once activated, dendritic cells become mobile and migrate to regional lymphoid tissues, where they participate in presenting peptides derived from internalized protein antigens to t lymphocytes.These activated dendritic cells also expressmole-
cules, called costimulators, which function in concert with antigen to stimulate T cells. Mononuclear
Phagocytes
Mononuclear phagocytes function as APCs in T cell-med,iqted ad.aptiue immune responses. We introduced mononuclear phagocltes (monocltes and macrophages) in the context of innate immune responses in Chapter 2. Macrophages containing ingested microbes display microbial antigens to differentiated effector T cells. The effector T cells then activate the macrophages to kill the microbes. This process is a major mechanism of cell-mediated immunity against intracellular microbes (seeChapter 13). Mononuclear phagocytes are also important effector cells in both innate and adaptive immunity. Their effector functions in innate immunity are to phagocytose microbes and to produce cytokines that recruit and activate other inflammatory cells (see Chapter 2). Macrophages serve numerous roles in the effector phases of adaptive immune responses. As mentioned above, in cell-mediated immuniry antigen-stimulated T cells activate macrophages to destroy phagocytosed microbes. In humoral immunity, antibodres coat, or opsonize, microbes and promote the phagocytosis of the microbes through macrophage surface receptors for antibodies (seeChapter l4). Follicular
Dendritic
Cells (FDC)
FDCs are cells with membranous projections, which are present intermingled in specialized collections of activated B cells, called germinal centers, found in the lymphoid follicles of the lymph nodes, spleen, and mucosal lymphoid tissues.FDCs are not derived from precursors in the bone marrow and are unrelated to the dendritic cells that present antigens to T lymphocltes. FDCs trap antigens complexed to antibodies or complement products and display these antigens on their surfaces for recognition by B lymphocytes. This is important for the selection of activated B lgnphocytes whose antigen receptors bind the displayed antigens with high affinity (seeChapter 10).
Arunrouy ANDFUNcTIONS OF
LYrvrplroro Trssurs
To optimize the cellular interactions necessary for the recognition and activation phases of specific immune responses,llmphocytes andAPCs are localized and concentrated in anatomically defined tissues or organs, which are also the sites where foreign antigens are transported and concentrated. Such anatomic compartmentalization is not fixed because, as we will discuss later in this chapter, many lymphocytes recirculate and constantly exchange between the circulation and the tissues. Lymphoid tissues are classified as generatiue organs, ako called primary lymphoid orgarrs, where lympho-
IMMUNE SYSTEM. 0FTHEADAPTIVE ANDTISSUES 3 - CELLS Chapter l
cytesfrrst expressantigen receptorsand etta.in phenotypic and functional maturity, and as peripheral orgnns,also called secondarylymphoid organs, where Iymphocyte responsesto foreign antigens are initiated and deuelop(seeFig. 3-2). Included in the generative lymphoid organs of adult mammals are the bone marrow where all the lymphocytes arise and B cells mature,and the thymus,whereT cellsmature and reach a stage of functional competence.The peripheral ll.rnphoid organs and tissues include the lymph nodes, spleen, cutaneous immune system, and mucosal immune system.In addition, poorly defined aggregatesof ll.rnphocl'tes are found in connective tissue and in virtually all organs except the central nervoussystem. Bone Marrow The bone marrow is the site of generation of all circulnting blood cellsin the adult, including immature lymphocytes, and. is the site of early euents in B cell mqturation. During fetal development,the generation of all blood cells,calledhematopoiesis(FiB.3-6),occurs initially in blood islands of the yolk sac and the paraaortic mesenchymeand later in the liver and spleen. This function is takenovergraduallyby the bone marrow and increasinglyby the marrow of the flat bonesso that, by puberry hematopoiesis occurs mostly in the sternum, vertebrae, iliac bones, and ribs. The red marrow that is found in these bones consists of a
sponge-like reticular framework located between long tiabeculae. The spaces in this framework are filled with fat cells, stromal fibroblasts, and precursors of blood cells. These precursors mature and exit through the dense network ofvascular sinuses to enter the vascular circulation. lVhen the bone marrow is injured or when an exceptional demand for production of new blood cells occurs, the liver and spleen can be recruited as sites of extramedullary hematoPoiesis. All the blood cells originate from a common hematopoietic stem cell that becomes committed to differeniiate along particular lineages (i.e', erythroid, megakaryocytic, granulocytic, monocytic, and lympho cytic) (see Fig. 3-6). Stem cells lack the markers of differentiated blood cells and instead expresstwo proteins called CD34 and stem cell antigen-l (Sca-l). These markers are used to identify and enrich stem cells from suspensions of bone marrow or peripheral blood cells for transplantation to reconstitute the hematopoietic system. The proliferation and maturation of precursor cells in the bone marrow are stimulated by cytokines. Many of these cytokines are called colony-stimulating factors because they were originally assayed by their ability to stimulate the growth and development of various leukocytic or erythroid colonies from marrow cells. These molecules are discussed in Chapter 12. Hematopoietic cytokines are produced by stromal cells and macrophages in the bone marrow thus providing the local environment for hematopoiesis. They are also produced by antigen-stimulated T lymphocytes and
Common
CFU CFU Granulocyte-monocyte CFU Eosinophil ErythroidCFU MegakaryocyteBasophil
&$&@ Erythrocytes Platelets
BasophilsEosinophilsNeutrophilsMonocytes
tree " The roles The development of the differentlineagesof bloodcellsis depictedin this "hematopoietic FIGURE 3{ Hematopoiesis. unit in Chapter12, Figure12-15 CFU,colony-forming are illustrated of cvtokinesin hematoboiesis
57
58 '1!@4(t,
{ !
Section | - INTRODUCT|ON T0THETMMUNE SYSTEM
cytokine-activated or microbe-activated macrophages, providing a mechanism for replenishing leukocytes that may be consumed during immune and inflammatory reactions. In addition to self-renewing stem cells and their differentiating progeny, the marrow contains numerous antibody-secreting plasma cells. These plasma cells are generated in peripheral lymphoid tissues as a consequence of antigenic stimulation of B cells and then migrate to the marroq where they mav live and continue to produce antibodies for many years. Some longlived memory T lymphocytes also migrate to and may reside in the bone marrow.
Thymus Thethymusis thesite ofT cell maturation. Thethymus is a bilobed organ situated in the anterior mediastinum. Each lobe is divided into multiple lobules by fibrous septa, and each lobule consists ofan outer cortex and an inner medulla (Fig. 3-7). The cortex contains a dense
collection of T lymphocytes, and the lighter-staining medulla is more sparsely populated with lymphocytes. Scattered throughout the thymus are nonlymphoid epithelial cells, which have abundant cytoplasm, as well as bone marrow-derived macrophages and dendritic cells. In the medulla are structures called Hassall's corpuscles, which are composed of tightly packed whorls of epithelial cells that may be remnants of degenerating cells. The thymus has a rich vascular supply and efferent lymphatic vessels that drain into mediastinal lymph nodes. The thymus is derived from invaginations of the ectoderm in the developing neck and chest of the embryo, forming structures called branchial clefts. Humanswith DiGeorge slmdrome sufferfromT cell deficiency because of mutations in genes required for thymus development. In the "nude" mouse strain, which has been widely used in immunology research, a mutation in the gene encoding a transcription factor causes a failure of differentiation of certain types of epithelial cells that are required for normal development of the thymus and hair follicles. Consequently, these mice lack T cells and hair (seeChapter 20). The lymphocytes in the thymus, also called thymocytes, are T lymphocytes at various stages of maturation. In general, the most immature cells of the T cell lineage enter the thymic cortex through the blood vessels. Maturation begins in the cortex, and as thl.rnocytes mature, they migrate toward the medulla, so that the medulla contains mostly mature T cells. Only mature T cells exit the thymus and enter the blood and peripheral ll.rnphoid tissues. The details of thymoclte maturation are described in Chapter 8. Lymph
FIGURE 7 Morphologyof the thymus.A. Lightmicrograph of a lobe of t thymus showing the cortex and medulla.The bluestainedcellsare developing T cellscalledthymocvtes.(Courtesv of Dr.JamesGulizia, Departmentof pathology, BrighamandWomen,s Hospital,Boston.)B. Schematicdiagramof the thymus illustrating a portion of a lobe divided into multiple lobulesby fibrous trabeculae.
Nodes and the Lymphatic
System
Antigens are trensported to lymph nodes mainly in Iymphatic uessek.The skin, epithelia, and parenchgnal organs contain numerous lymphatic capillaries that absorb and drain fluid from spacesbetween tissue cells (made of plasma filtrate) (Fig. 3-8). The absorbed interstitial fluid, called lymph, flows through the lymphatic capillaries into convergent, ever larger lymphatic vessels.These vessels merge into afferent lymph vessels that drain into the subcapsular sinuses of lymph nodes. Lymphatic vessels that carry lymph into a lymph node are referred to as afferent, and vessels that drain the ly-ph from the node are called efferent. Because lymph nodes are connected in series along the lymphatics, an efferent lymphatic exiting one node may serve as the afferent vessel for another. The efferent lymph vessel at the end of a lymph node chain joins other lymph vessels, eventually culminating into one large lymphatic vessel called the thoracic duct. Llnnph from the thoracic duct is emptied into the superior vena cava, thus returning the fluid to the blood stream. About 2 L of l1'rnph are normally returned to the circulation each day, and disruption of the lymphatic system may lead to rapid tissue swelling. The function of collecting antigens from their portals of entry and delivering them to lymph nodes is performed largely by the lyrnphatic system. Microbes enter
SYSTEMf IMMUNE 0FTHEADAPTIVE ANDTISSUES 3 - CELLS Chaoter
Thoracic duct
lntercostal vessels
Cisterna chyli Paraaortic nodes
Fig. 3-9B). These conduits are organized around collagen-containing reticular fibers and are delimited by basement membrane-like matrix molecules and a sheath of specialized cells called fibroblastic reticular cells. Dendritic cells that are resident in the lymph node are also closely associated with the conduits. The conduit system serves several functions. It provides a direct route for delivery of lymph-borne chemokines that are produced in inflamed tissues, such as CCL2, to the HEV where they contribute to the regulation of leukocyte recruitment into the lymph node. The specialized lining of the conduit serves as a selective filtration barriel allowing only some molecules of particular size or chemical properties to enter the T cell Zones of the node. The resident dendritic cells lining the conduits sample cell-free protein antigens transported through the conduits, so that these antigens may be processed and presented to T cells in the adjacent
Vessels from intestines Inguinal nodes
FIGURE 3-8 The lymphatic system. The major lymphatic vesselsand collections of lymphnodesare illustratedAntigensare capturedfrom a site of infection,and the draininglymph node to whrch these antigensare transportedand where the immune responseis initiated the body most often through the skin and the gastroin-
testinal and respiratory tracts. All these tissues are lined by epithelia that contain dendritic cells, and all are drained by lymphatic vessels.The dendritic cells capture some microbial antigens and enter li.nnphatic vessels. Other antigens enter the lymphatics in cell-free form. In addition, soluble inflammatory mediators, such as chemokines, produced at sites of infection enter the lyrnphatics. The lyrnph nodes are interposed along lymphatic vessels and act as filters that sample the ll.rnph before it reaches the blood. In this way, antigens captured from the portals of entry are transported to ly'rnph nodes, and molecular signals of inflammation are also delivered to the draining ll,rnph nodes. Lymph enters a lymph node via an afferent lymphatic vessel into the subcapsular sinus, and tissue-derived dendritic cells within the lyrnph then leave the sinus and enter the paracortex. In this new location, the dendritic cells can present antigens derived from the tissue to naive T cells and initiate adaptive immune responses (seeChapter 6). The mechanisms bywhich the dendritic cells gain access to the paracortex are not well understood. Some of the lymph from the subcapsular sinus is channeled through specialized conduits that run through the paracortical T cell zone toward specialized vessels called high endothelial venules (HEV) (see
lymph node consists of an outer cortex and an inner medulla. As described earlier, each lymph node is surrounded by a fibrous capsule that is pierced by numerous afferent lynphatics, which empty the lymph into a subcapsular or marginal sinus (Fig.3-9). The lymph percolates through the cortex into the medullary sinus and Ieaves the node through the efferent lymphatic vessel in the hilum. Beneath the subcapsular sinus, the outer cortex contains aggregatesof cells called follicles. Some follicles contain central areas called germinal centers' which stain lightly with commonly used histologic stains. Follicles without germinal centers are called primary follicles, and those with germinal centers are iecondary follicles. The cortex around the follicles is called the parafollicular cortex or paracortex, and is organized into cords, which are regions containing reticular fibers, lymphocltes, dendritic cells, and mononuclear phagocytes, arranged around l1'rnphatic and vascular sinusoids. Lymphocytes and APCs in these cords are often found near one another, but there is significant movement of these cells relative to one another. Internal to the cortex is the medulla, consisting of medullary cords separated by a labyrinthine arrangement of sinuses that drain into fibroblastic reticular cell conduits, and eventually into a main medullary sinus. These medullary cords are populated by macrophages and plasma cells. Blood is delivered to a lyrnph node by an aitery that enters through the hilum and branches into capillaries in the outer cortex, and it leaves the node by a single vein that exits through the hilum. classes of lymphocytes are sequestered in Dffiient distiict regions of the cortex of lymph nodes (Fig. 3-10) . Follicles are the B cell zones of lymph nodes. Primary follicles contain mostly mature, naive B lymphocltes. Germinal centers develop in responseto antigenic stimulation. They are sites of remarkable B cell proliferation, selection of B cells producing high-affinity antibodies, and generation of memory B cells. The processes of
59
Section I-
INTRODUCTION TOTHEIMMUNE SYSTEM
FDCsinterdigitate to form a densereticular network in the germinal centers. The T lymphocytes are located mainly beneathand more centrallyto the follicles,in the High endothelial paracorticalcords.Most (-70To)of theseT cellsareCD4* B cellzone (follicle) venule(HEV) helper T cells,intermingled with relatively sparseCD8' cells.Theseproportions can changedramaticallyduring the course of an infection. For example,during a viral Subcapsular infection, there may be a marked increasein CD8* T SINUS cells.Dendritic cellsare also concentratedin the paracortexof the lymph nodes. Theanatomic segregationof dffirent classesof lymphocytesin distinct areas of the nod,ek dependenton cytokines (see Fig. 3-10). Naive T and B lymphocytes enter the node through an artery.Thesecells leave the circulation and enter the stroma of the node through specialized vessels called high endothelial venules (HEVs,describedin moredetaillater),which arelocated T cell zone in the center of the cortical cords.The naive T cells expressa receptorcalledCCRTthat bindsthe CCLIgand Germinal Medulla CCL?I chemokinesproduced in the T cell zones of the cenler lymph node. Chemokines (chemoattractantcytokines) include a largefamily of B- to 10-kDaproteinsthat are involved in a wide variety of cell motility functions in development,maintenance of tissue architecture,and immune and inflammatory responses. Chemokines exert their biologic effects by binding to chemokine receptors, which are cell surface, G protein-linked Sinusliningcell receptorsthat are linked to various signal transduction pathways. The general properties of chemokines and chemokinereceptorsare discussedin detail in Chapter 12.CCL19 and CCL?I attracrthe naiveT cells into the T Fibroblastic reticular cell zone.Dendritic cellsalso expressCCR7,and this is cell Subcapsular why they migrate to the same area of the node as do macrophage or naive T cells (see Chapter 6). Naive B cells express dendritic cell Perivenular channel Jrabecular another chemokine receptor,CXCRS,which recognizes a chemokineCXCLI3produced only in follicles.Thus, B cells are attracted into the follicles, which are the B Capsule cell zones of lymph nodes. Another cytokine, called lymphotoxin, plays a role in stimulating CXCLI3 production,especiallyin the follicles.The functionsof variouscytokinesin directing the movementof lymphocytesin lymphoid organsand in the formation of these organshave been establishedby numerous studiesin mice.
tt*@
s Knockoutmice lacking the membraneform of the cytokinelymphotoxin(tjIP) or the llIB receptorshow
Medulla
Parafollicular cortex(T cellzone)
andthe routesof entryof lymphocytes andantigen(showncaptured by a dendriticcell).B. Schematicof the microanatomy of a lymph node depictingthe route of lymph drainagefrom the subcapsular sinus,throughfibroreticular cellconduits,to the perivenular channel aroundthe HEV C. Light micrographof a lymph node illustrating the T cell and B cell zones. (Courtesyof Dr. James Gulizia, Departmentof Pathology, Brighamand Women'sHospital,Boston, Massachusetts )
3Chaoter
T celland Naive B cellsoecific dendritic cell B cell chemokine specific. cnemoKlne
SYSTEM IMMUNE 0FTHEADAPTIVE ANDTISSUES CELLS
CXCR5 knockout mice lack B cell zones in lyrnph nodes and spleen. Similarly, CCRT knockout mice lack T cell zones. The anatomic segregation of T and B cells ensures that each lymphoclte population is in close contact with the appropriate APCs (i.e.,T cellswith dendritic cells and B cells with FDCs). Furthermore, because of this precise
Afferent lymphatic vessel B cell zone
vated B cells migrate into germinal centers and, following differentiation into plasma cells, they may home to the bone marrow. Spleen
T cellzone (parafollicular conex)
B cell (lvmohoid
ftittiite) of B cells andT cells in a lymphnode. FIcURE s-t o Segregation the path by whlch naiveT and A The schematicdiagramillustrates migrateto differentareasof a lymphnode The lymB lymphocytes phocytesenterthroughan arteryand reachan HEV,shownin crossaredrawnto differentareas section,from where naivelymphocytes of the node by chemokinesthat are producedin these areasand to eithercell type Also shown is the migrationof bind selectively dendriticcells,which pick up antigensfrom the sites of antigen entry,enterthroughafferentlymphaticvessels,and migrateto the T cell-richareasof the node B In this sectionof a lymphnode,the locatedin the follicles, arestainedgreen;the T cells, B lymphocytes, cortex,are red The methodusedto stainthese in the parafollicular (see Appendixlll for details) cells is calledimmunofluorescence (Courtesyof Drs KathrynPapeand JenniferWalter,Universityof MinnesotaSchoolof Medicine,Minneapolis ) The anatomicsegregationof T and B cellsis alsoseen in the spleen(seeFig 3-1 1)
absenceof peripherall1'rnphnodesand a marked disorganization of the architecture of the spleen,with loss of the segregationof B and T cells. Overexpressionof lyrnphotoxin or tumor necrosis factor (TNF) in an organ, either as a transgene in experimental animals or in response to chronic inflammation in humans, can lead to the formation in that organ of lpph node-like structures that contain B cell follicles with FDCs and interfollicular T cell-rich areascontaining mature dendritic cells.
The spleen is the maior site of immune responses to blood,-borne antigens. The spleen, an organ weighing about 1509 in adults, is located in the left upper quadrant of the abdomen. It is supplied by a single splenic artery, which pierces the capsule at the hilum and divides into progressively smaller branches that remain surrounded by protective and supporting fibrous trabeculae (Fig. 3-11). The lyrnphocyte-rich regions of the spleen, called the white pulp, are organized around branches of these arteries, called central arteries. The architecture of the white pulp is analogous to the organization of l1'rnph nodes, with segregated T cell and B cell zones. In mouse spleen, the central arteries are surrounded by cuffs of lymphocytes, most of which are T cells. Becauseof their anatomic location, morphologists call these areas periarteriolar lyrnphoid sheaths. Several smaller branches of each central arteriole pass through the periarteriolar lymphoid sheaths and drain into a vascular sinus knor,rmas the marginal sinus. B cell-rich follicles occupy the space between the marginal sinus and the periarteriolar sheath. Outside the marginal sinus is a distinct region called the marginal zone, which forms the outer 6oundary of the white pulp and is populated by B cells and specialized macrophages. The B cells in the marginal zone are functionally distinct from follicuIar B cells and are known as marginal zone B cells. The architecture of the white pulp is more complex in humans than in mice, with both inner and outer marginal zones, and a perifollicular zone. The segregation-of i l1'rnphocltes in the periarteriolar lymphoid sheaths, and B-cells in follicles and marginal zones, is a highly regulated process, dependent on the production of different c1'tokines and chemokines by the stromal cells in these different areas, analogous to the case for lymph nodes. The chemokine CXCL13 and its receptor CXCRS are required for B cell migration into the follicles, and CCLIS and CCL}I and their receptor CCRTare required for naive T cell migration into the periarteriolar sheath. The production of these chemokines by non-lyrnphoid stromal cells is stimulated by the cytokine lymphotoxin.
62
S e c t i o|n-
I N T R 0 D U C TTI 00N T H ET M M U NSEY S T E M
APCs, B cells, and T cells promotes the interactions required for the efficient development of humoral immune responses,as will be discussed in Chapter 10. The spleen is also an important filter for the blood. Some of the arteriolar branches of the splenic artery ultimately end in extensivevascular sinusoids, distinct from T cellzone (periarteriolar the marginal sinuses, scattered among which are large lymphoid numbers of erythrocytes, macrophages, dendritic cells, sheath,PALS) sparse lymphocytes, and plasma cells; these constitute the red pulp. The sinusoids end in venules that drain B cellzone (follicle) into the splenic vein, which carries blood out of the spleen and into the porta-l circulation. Red pulp macrophages clear the blood of microbes, and of damaged red blood cells.The spleen is the major site for the phagocytosis of antibody-coated (opsonized) microbes. Individuals lacking a spleen are highly susceptible to infections with encapsulatedbacteria such as pneumococci and meningococci because such organisms are normally cleared by opsonization and phagocytosis, and this function is defective in the absence of the spleen.
Marginal sinus Follicular arteriole
@
Germinal centerof lymphoid follicle
B c e l lz o n e (lymphoid follicle)
T cell zone (periarteriolar lymphoid sheath)
h r s t o c h e m t cdae m o n s t r a t i oonf T c e l la n dB c e l lz o n e si n t h e s o l e e n . shown in a cross-section of the regionaroundan arteriolei cells i n t h e p e r i a r t e r i o llayrm p h o i ds h e a t ha r e s t a i n e dr e d , a n d B c e l l s in the fo licle are sta ned green. (Courtesyof Drs. Kathrynpape a n d J e n n i f eW r alterU , n i v e r s i toyf M i n n e s o t aS c h o o o l f Medicine, M i n n e a p o l iM s ,i n n e s o t a . ) The function of the white pulp is to promote adaptive immune responses to blood-borne antigens. These antigens are delivered into the marginal sinus by circulating dendritic cells, or are sampled by the macrophages in the marginal zone. The anatomic arrangements of the
Cutaneous
Immune
System
The skin contains a specialized cutaneous immune system consisting of lymphocytes and APCs. The skin is the largest organ in the body and is an important physical barrier between an organism and its external environment. In addition, the skin is an active participant in host defense, with the ability to generate and support local immune and inflammatory reactions. Many foreign antigens gain entry into the body through the skin, and this tissue is the site of many immune responses. The principal cell populations within the epidermis are keratinocl.tes, melanocJ,'tes,epidermal Langerhans cells, and intraepithelial T cells (Fig.3-12). Keratinocytes produce severalcytokines that may contribute to innate immune reactions and cutaneous inflammation. Langerhans cells, located in the suprabasal portion of the epidermis, are the immature dendritic cells of the cutaneous immune system. Langerhans cells form an almost continuous meshwork tlhat enables them to capture antigens that enter through the skin. Vy'hen Langerhans cells encounter microbes, they are activated by engagement of Toll-like receptors (Chapter 2). The cells lose their adhesiveness for the epidermis, enter lymphatic vessels,begin to expressthe CCRTchemokine recepto! and migrate to the T cell zones of draining lymph nodes in response to chemokines produced in that location. The Langerhans cells also mature into efficient APCs. This process is described in more detail in Chapter 6. Intraepidermal lymphocytes constitute only about 2% of skin-associatedlymphocytes (the rest reside in the dermis), and the majority are CD8* T cells. Intraepidermal T cells may expressa more restricted set of antigen receptors than do T lymphocytes in most extracutaneous tissues. In mice (and some other species),many intraepidermal lymphocytes are T cells that express an
SYSTEM! IMMUNE 0FTHEADAPTIVE ANDTISSUES 3- CELLS Chapter { ..',*"e*$a'*e**&xw@*','
I m
Epidermal ttCL Langerhans o cell 3 Intraepidermal o lymphocyte J I T lymphocyte
In the mucosa of the gastrointestinal tract, lyrnphocytes are found in large numbers in three main regions: within the epithelial layer, scattered throughout the lamina propria, and in organized collections in the lamina propria, including Peyer's patches (Fig. 3-13). Cells at each site have distinct phenotypic and functional characteristics. The majority of intraepithelial lymphocytes are T cells. In humans, most of these are CDSa cells. In mice, about 50% of intraepithelial lym-
I
o o
3.
'Macrophage o
and the yD TCR-expressing intraepithelial lymphocytes show limited diversity of antigen receptors. All these findings support the idea that mucosal intraepithelial lymph-ocytes have a limited range of specificity' distinct from that of most T cells and this restricted repertoire of the cutaneousimmune may have evolved to recognize commonly encountered FIGURE 3-12 Gellularcomponents immunesystem of the cutaneous components system.The ma.ior antigens. Langerhans intraluminal include keratinocytes, diagram shownin thisschematic lamina propria contains a mixed popintestinal The lymphocytes, all locatedin the epidermis, cells,andintraepidermal ulation of cells. These include T lymphocytes, most of locatedin the dermis. andmacrophages, andT lymphocytes which are CD4* and have the phenotype of activated (TCR) formed uncommon type of T cell antigen receptor by l and 6 chains instead of the usual o and p chains of the antigen receptors of CD4t and CD8' T cells (see Chapter 7). As we shall discuss shortly, this is also true of intraepithelial lymphocytes in the intestine, raising the possibility that yb T cells, at least in some species, may be uniquely committed to recognizing microbes that are commonly encountered at epithelial surfaces. However, In addition to scattered lymphocytes, the mucosal neither the specificity nor the function of this T cell subsystem contains organized lymphoid tissues, immune population is clearly defined. the most prominent of which are the Peyer's patches of The dermis, which is composed of connective tissue, the smallintestine. like lymphoid follicles in the spleen contains T lyrnphocytes (both CD4* and CD8* cells), preand lymph nodes, the central regions of these mucosal dominantly in a perivascular location, and scattered follicies are B cell-rich areas that often contain germinal macrophages. This is essentially similar to connective phecenters. Peyer's patches also contain small numbers of express tissues in other organs. The T cells usually CD4* T cells, mainly in the interfollicular regions. In adult notypic markers typical of activated or memory cells. It mice, 507o to 70Vo of Peyels patch lymphocytes are B is not clear whether these cells reside permanently cells, and l0% to 3OVoare T cells. Some of the epithelial within the dermis or are merely in transit between blood recircells overlying Peyer's patches are specialized M (memand lymphatic capillaries as part of memoryT cell (described branous) cells. M cells lack microvilli, are actively later). culation and transport macromolecules from the intespinocytic, ^tinal lumen into subepithelial tissue by a mechanism of Mucosal lmmune System transepithelial transport known as transcytosis. They are thought to play an important role in delivering antigens gastrointesthul and respiThe mucosal surfaces of the to Peyer's patches. Follicles similar to Peyer's patches are retory trects ere colnnizzd W lwphocytes and APCs abundant- in the appendix and are found in smaller that are inuolved in immune responses to ingested and numbers in much of the gastrointestinal and respiratory inhaled antigeru. Like the skin, these mucosal epithelia tracts. Pharyngeal tonsils are also mucosal lymphoid folare barriers between the internal and external environlicles analogous to Peyer's patches- Because of the vast of of entry important site an ments and are therefore size of the mucosal tissues, a large portion of the body's microbes. Much of our knowledge of mucosal immunity are normally present in these.tissues. lymphocytes is based on studies of the gastrointestinal tract, and this to oral antigens differ in some responses Immune is emphasized in the discussion that follows. In comfrom responses to antigens respects fundamental in the responses immune parison, little is known about encountered at other sites. The two most strikng differrespiratory mucosa, even though the airways are a major ences are the high levels of IgA antibody production portal of antigen entry. It is likely, however, that the feaassociated with mucosal tissues (seeChapter 14) and the tures of immune responses are similar in all mucosal tendencv of oral immunization with protein antigens lymphoid tissues.
'Dermal dendriticcell
63 l
il
.
Section | - tNTRODUCT|ON T0THETMMUNE SYSTEM
l
Mucosal epithelium Lamina propna Peyer'spatch
to induce T cell tolerance rather than activation (see Chapter I t).
PRTHwRYS ANDMEcHANIsMS OF LyrupHocyTE REcIRcULATION ANDHOMING
lymph nodes, and via lyrnphatics back into the blood stream many times, until they encounter an antigen they recognize within a lyrnph node. This traffic pattern of naive ll.rnphocltes, called lymphocyte recirculation, enables the limited number of naive lymphocytes that are specific for a particular foreign antigen to search for that antigen throughout the body. Lymphocytes that have reacted to that antigen and differentiated into effector and memory cells within secondary lymphoid tissues may move back into the blood stream ind- then
FIGURE 3-13 The mucosal immune system. A. Schematic diagram of the cellularcomponents of the mucosal immune systemin the intestineB Photomicrographof mucosallymphoid tissue in the human intestine Similar aggregatesof lymphoid tissue are found throughoutthe gastrointestinal tract and the resprratorvtract
migrate into sites of infection andi or inflammation in peripheral (nonlymphoid) tissues. Some effector l].'rnphocyte subsetswill preferentially migrate into a particular tissue, such as skin or gut. The process by which particular populations of li,rnphocytes selectively enter lymph nodes or some tissues but not others is called Ii.rnphocyte homing. The existence of different homing patterns ensures that different subsets of lymphocytes are delivered to the tissue microenvironments where they are required for adaptive immune responses and not, wastefully, to places where they would serve no purpose. In the following section, we describe the mechanisms and pathways of lymphocyte recirculation and homing. Our discussion emphasizes T cells because much more is knor,rm about their movement through tissues than is known about B cell recirculation. The mechanisms of l1'rnphocyte migration out of blood vesselsinto the extravascularsites in ly-ph nodes or peripheral tissues are fundamentally similar to the mechanjsms of migration of other leukocytes into inflammatory sites, described in Chapter 2. The adhesion molecules involved include selectins, integrins, and members of the Ig superfamily. The adhesion molecules expressed on lymphocytes are often called
SYSTEM IMMUNE 0FTHEADAPTIVE ANDTISSUES 3 - CELLS Chaoter
Lymphnode withoutantigen Blood VESSEI
Naive T cell Activated T cell
High endothelial venute
site Peripheraltissue nflammation of infection/i Microbes lymphatic vessel--1:
Afferent lymphatic vessel \
Lymphatic P e r i p h e r a l vessel bloodvessel
lymphaticvessel....Thoracic duct
leavethe bloodand enter lymph nodesacrossthe FIGURE 3-14 Pathwaysof T lymphocytelecirculation.NaiveT cells preferentially HEVs Dendriticcellsbearingantigenenterthe lymph nodethroughlymphaticvessels lf the T cellsrecognizeantigen,they are activated, a n d t h e y r e t u r nt o t h e c i r c u l a t i ot nh r o u g ht h e e f f e r e n lt y m p h a t i casn d t h e t h o r a c i cd u c t ,w h i c he m p t i e si n t ot h e s u p e r i ovr e n ac a v a ,t h e n leavethe bloodand enter peripheral rntothe heart,and ultimatelyinto the arterialcirculatlonEffectorand memoryT cells preferentially t r s s u e st h r o u g hv e n u l e sa t s i t e so f i n f l a m m a t l o R n e c i r c u l a t i tohnr o u g hp e r i p h e r al yl m p h o i do r g a n so t h e rt h a n l y m p hn o d e si s n o t s h o w n
homing receptors, and the adhesion molecules that the homing receptors bind to on the endothelial cells are often called addressins.Chemokines influence lymphoclte adhesion to endothelial cells and various aspectsof movement of the lymphocltes through the vessel wall and in the extravascularspace.Chemokines involved in lymphocyte traffic are produced constitutively in secondary lymphoid organs and inducibly at sites of infection. Adhesion to and detachment from extracellular matrix components within tissues determine how long lymphocytes are retained at a particular extravascular site before they return through the lymphatics to the blood.
Recirculation of Naive T LymphocYtes Between Blood and SecondarY Lymphoid Organs Specifichoming of naiue T celk to lymph nodes and mucosal lynphoid tissuesoccurs through specialized postcapillary uenulesand inuoluesseueral dffirent adhesionmoleculesand chemokines.The homing mechanisms are very efficient, resulting in a net flux of l1'rneach phocytesthroughll. nph nodesofup to 25x 10'gcells day (i.e.,eachlymphocytegoesthrough a node once a day on the average).Peripheral tissue inflammation causesa significant increasein T cell infltx into lymph
65
66
I
Section | - INTR0DUCTI0N T0 THEIMMUNE SYSTEM
nodes draining the site of inflammation, while egress of the T cells into efferent ll.rnphatics is transiently reduced. The mechanism of this transient retention involves innate immune system cytokines interferon-q, and -B, which inhibit the function of sphingosine l-phosphate receptor-l (SlPl), described later. The net result is a rapid increase in the number of naive T cells that are retained in a lymph node draining a site of infection or inflammation. Antigens are concentrated in the secondary li..rnphoid organs, including ly-ph nodes, mucosal ll,rnphoid tissues, and spleen, where they are presented by mature dendritic cells, the APCs that are best able to initiate responses of naive T cells. Thus, movement of naive T cells through the secondary lyrnphoid organs maximizes the chances of specific encounter with antigen and initiation of an adaptive immune response. Naive T lymphocytes are delivered to secondary lymphoid tissues via arterial blood flow, and they leave the circulation and migrate into the stroma of lymph nodes through modified postcapillary venules called high endothelial venules that are lined by plump endothelial cells (Fig. 3-15). HEVs are also present in mucosal lymphoid tissues,such as Peyer'spatches in the gut, but not in the spleen. HEVs display certain adhesion molecules and chemokines on their surfaces, discussed below which support the selectivehoming of only certain populations of lymphocytes. The development and maintenance of the morphologic and molecular phenotype of HEVs depend on soluble factors present in lymph. In addition, certain c)'tokines, such as lymphotoxin, are required for HEV development. In fact, HEVs may develop in extralymphoid sites of chronic inflammation where such cytokines are produced for prolonged periods of time. Migration of naiueT celk out of the blood into lymph node parenchyna is a multi-step process consisting of selectin-mediated rolling of the cells, integrin-medinted firm adhesion, and transmigration through the uessel wall. This sequence of events for T lymphocyte homing is similar to migration of other leukocltes into peripheral inflamed tissues discussed in Chapter 2. Different selectins and integrins are involved in the migration of naive and activated lymphocytes to different tissues (Fig. 3-16). The rolling of naive T cells on HEVs in peripheral lyrnphoid organs is mediated by L-selectin on the llzmphocytes binding to its peripheral node addressin (PNAd) on HEVs. (Selectins are described in Box 2-2, Chapter 2.) The carbohydrate groups that bind L-selectin may be attached to different sialomucins on the endothelium in different tissues.For example, on lrrmph n o d e H E V s ,t h e P N A d i s d i s p l a y e db y r w o s i a l o m l c i n s , called GIyCAM-1 (glycan-bearing cell adhesion molecule-l) and CD34. In Peyer's patches in the intestinal wall, the L-selectin ligand is a molecule called MadCAMI (mucosal addressin cell adhesion molecule-I). The subsequent firm adhesion of the T cells to the HEVs is mediated by integrins, mainly LFA-l andVl"\-4 (seeBox 2-3, Chapter 2). The affinity of the integrins is rapidly increased by two chemokines, called CCLl9 and CCL2l, which are produced mainly in lymphoid tissues. CCLI9 is constitutively produced by HEV and is bound to glycosaminoglycanson the cell surface for display to rolling
node @ nrv in tymph
L-selectin ligandon endothelial cells
T cellsbindingto HEV: frozensectionassay
t
T cells HEV
FIGURE 3-rS High endothelialvenules.A Light micrographof an HEVin a lymph node illustrating the tall endothelial cells (Courtesy of Dr Steve Rosen,Departmentof Anatomy,Universityof California,San Francisco ) B Expressionof L-selectinligandon HEVs,stainedwith a specificantibodyby the immunoperoxidase technique(Thelocationof the antibodyis revealedby a brownreaction productof peroxidase, which is coupledto the antibody;see A p p e n d i xl l l f o r d e t a i l s) T h e H E V sa r e a b u n d a nitn t h e T c e l lz o n e of the lymphnode (Courtesyof Drs SteveRosenand Akio Kikuta, Departmentof Anatomy,Universityof California, San Francisco ) C A bindingassayin which lymphocytes are incubatedwith frozen (staineddarkblue)bind sectionsof a lymphnode The lymphocytes selectively to HEVs (Courtesyof Dr SteveRosen,Departmentof Anatomy,University of California, San Francisco ) D Scanningelectron micrograph of an HEVwith lymphocytes attachedto the luminal surfaceof the endothelialcells, (Courtesyof J Emersonand T Yednock,University of California SanFrancisco Schoolof Medicine, San FranciscoFrom RosenSD, and LM Stoolman Potentialrole of cell surfacelectinin lymphocyterecirculation/n Olden K, and J Parent(eds) VertebrateLectins Van NostrandReinhold.New '1 York. 987 )
SYSTEM IMMUNE 0FTHEADAPTIVE ANDTISSUES 3 - CELLS Chapter
tissue Peripheral
Peripheral bloodvessel
Efferent lymphatic vessel
Naive T cell Activated T cell
L-selectin L-selectin
E- or Pselectin
E- or Psetectin
Integrin (LFA-1or VLA-4)
ligand
ccl19/
Endothelium at the siteof infection
of receptor: Function ligandpair NaiveT cells I
L-selectin
V ccnz
L-selectin ligand
Adhesionof naiveT cellsto high endothelialvenule in lymphnode
CCL19or CCL21
Activationof integrinsand chemokinesis
Tl
Activated(effector andmemory)T cells E- and Pselectinligand
E- or Pselectin
n*-n
or J1.1fLFA-1(82-integrin) U[,|VLA-4(81integrin) CXCR3 CCR5
ICAM-1or VCAM-1 CXCL10(others)
Activationof
:CCL4{olhers)
FIGURE 3-16 Migrationof naive and eflectorT lymphocytes.A NaiveT lymphocyteshome to lymph nodesas a resultof L-selectin bindingto its ligand-onHEVs,which are presentonlyin'lymphnodes,and as a resultof bindingchemokines(CCL19and CCL21)displayed tissues,and this mlgraincludingeffectorcells,hometo sitesof infectionin peripheral on the surfaceof the HEV.ActivatedT lymphocytes, bnd integrins,and chlmokinesthat are producedat sites of infection.Additionalchemokinesand tion is medlatedby E- and P-selectins T cell migration.B. The adhesionmolecules,chemokines, chemokinereceptors,besidesthe ones shown,are involvedin effector/memory T cell migrationare described and chemokinereceptorsinvolvedin naiveand effector/memory
6A
$ e c t i o ln- I N T R 0 D U C T 0 |O N ET M M U N TH SE YSTEM
lymphocl'tes. CCL2I is produced by other cell types in the lymph node and displayed by the HEV in the same fashion as CCL19. Both these chemokines bind to the chemokine receptor called CCRZ, which is highly expressed on naive ll,.rnphocytes. This interaction of the chemokines with CCRT ensures that naive T cells increase integrin avidity and are able to adhere firmly to HEVs. The final step of transmigration of the firmly attached lymphocytes through the vesselwall occurs in response to the same CCRT-binding chemokines produced in the lyrnph node, and is presumably assistedby surface molecules such as CD3l on the ly'rnphocytesand the endothelialcells. The important role for L-selectin and chemokines in naive T cell homing to secondary lymphoid tissues is supported by many different experimental observations. ' Lgnphocytes from L-selectin knockout mice do not bind to peripheral lymph node HEVs,and the mice have a marked reduction in the number of lymphoc1.tesin peripheral lymph nodes. Studies indicate that CCLI9 and CCL2I, the two chemokines that bind to CCRTon T cells, are Droduced in T cell zonesof lymph nodes. I
There arevery few naiveT cellsin the lymph nodesof mice with genetic deficienciesin CCLIg and CCL2l, or CCR7,but the B cell and memoryT cell content of theselymph nodes is relativelynormal.
Naiue T celk that haue homed into lymph nodes but fail to recognize antigen and become actiuated will euentually return to the blood stream.This return to the blood completes one recirculation loop, and provides the naive T cells another chance to seek out the antigens they can recognize in other lymph nodes. The major route of reentry into the blood is through the efferent lymphatics, perhaps via other lt'rnph nodes in the same chain, and then via the ly.rnphaticvasculature to the thoracic duct, and finally into the superior vena cava. The exit of naive T cells from lymph nodes is dependent on a lipid chemoattractant called sphingosine l-phosphate (Slp), which is present at relatively high concentrations in the lyrnph and blood compared to tissues.Slp binds to a specific G protein-coupled receptor on T cells called SlPl (mentioned earlier), and signals generated by SlPl stimulate directed movement of the naive T cells along an SIP concentration gradient out of the lymph node parenchyma. Circulating naive T cells have very little cell surface SlPl because the high blood concentration of SIP causes internalization of the receptor. Once a naive T cell enters a ll.rnph node, where Slp concentrations are low it may take severalhours for surface SlPl to be re-expressed.This allows time for the naive T cell to interact with APCs before it is directed out of the node toward the SlP gradient. Slp and the Slpl receptor are also required for mature naive T cell egressfrom the thymus. I
A drug called FTY720 functionally inactivates SlPl, blocksT cell egressfrom ll,rnphoid organs,and acts as a potent immunosuppressivedrug for experi-
mental treatment of graft rejectionsand autoimmune diseases. ,-' Genetic ablation of S1Pl in mice results in a failure of T cellsto leavethe th].nnusand populate secondary lymphoid organs.If T cells lacking this receptor are injected into mice, the cells enter l1'rnphnodes but are unable to exit. Following activation, T cells transiently reduce expression of SlPl and stay in the lymph nodes for a few days. Once these cells have differentiated into effector cells, SlPl is re-expressedand the cells are able to leave the lymph nodes and migrate to peripheral tissues. Naive T cell homing into gut-associated lymphoid tissues, including Peyer's patches and mesenteric Iymph nodes, relies on interactions of the T cells with HEVs, which are mediated by selectins, integrins, and chemokines. One particular feature of naive T cell homing to the gut is the contribution of an Ig superfamily molecule called MadCAM-1 (mucosal addressin cell adhesion molecule-1) that is expressedon HEVs in these sites but not typically elsewherein the body. Naive T cells expresstwo ligands that bind to MadCAM-1, L-selectin and an integrin called cr4B7,and both contribute to the rolling step of naive T cell homing into gut-associated lymphoid tissues. Naive T cell migration into the spleen is not as finely regulated as homing into lymph nodes. The spleen does not contain HEVs, and it appears that naive T cells are delivered to the marginal zone and red pulp sinuses by passive mechanisms that do not involve selectins, integrins, or chemokines. However, CCRT-binding chemokines do participate in directing the naive T cells into the white pulp. Even though splenic homing of naive T cells appears to be less tightly regulated than homing into lymph nodes, the rate of lymphoclte passagethrough the spleen is very high, about half the total body lymphocy'te population every 24 hours. Migration of Effector Sites of Inflammation
T Lymphocytes
to
Effector T celk exit lymph nodes and preferentially home to peripheral tissues at sitesof infection, where they are need.edto eliminate microbes during the effector phase of adaptiue immune responses.Afundamental aspect of differentiation of naive T cells into effector cells, which occurs in the peripheral lymphoid organs, is a change in expression of chemokine receptors and adhesion molecules that determine the migratory behavior of these cells. Predictably, the expression of molecules involved in naive T cell homing into lymph nodes, including Lselectin and CCR7, decreases shortlv after antigeninduced activation of the naive T cells. As a result, the effector cells that develop are no longer constrained to stay in the node. L-selectin and CCRT may be reexpressedlater, allowing for some homing of circulating effectorT cells back into lymph nodes. The egressof activated lymphocytes from l1-rnph nodes is also actively driven by the SIP-SIPI receptor pathway (discussed earlier).
ii
IMMUNE SYSTEM * 0FTHEADAPTIVE ANDTISSUES 3 - CELLS Chapter a
Effector T cell migration into inflammatory sites is dependent on a multistep sequence of events at the blood-endothelial interface, similar to the processes described for migration of other leukocytes in Chapter 2 and for naive T cells in this chapter. Homing to these sites involves adhesion to, and transmigration through, the endothelial lining of postcapillary venules in the infected tissue. Effector T cells express adhesion molecules and chemokine receptors, which bind ligands typically present on endothelial cells at peripheral inflammatory sites. The ligands include endothelial adhesion molecules and chemokines whose expression is induced as part of the innate immune response to infections. The adhesion molecules and cytokines that control the migration of effector T cells to inflammatory sites are described in Chapter 13. Some effector cells haue a propensity to migrate to particular tissues. This selective migration capacity is acquired during the differentiation of the T cells. By enabling different subsets of effector cells to migrate to different sites, the adaptive immune system directs cells with specialized effector functions to the locations where they are best suited to deal with particular types of infections. The clearest examples of populations of effector T cells that specifically home to different tissues are skin-homing and gut-homing T cells. Skin-homing effector T cells express a carbohydrate ligand for E(for cutaneous lymphocyte selectin called CIA-l antigen-1), and the CCR4 and CCR10chemokine receptors, which bind CCLf 7 and CCL27,chemokines that are commonly expressed in inflamed skin. Gut-homing effector T cells expressthe o4B7 integrin, which binds to MadCam-t on gut endothelial cells, and CCR9, which binds to CCL25, a chemokine expressed in inflamed bowel. Remarkably,these distinct migratory phenotypes of skin- and gut-homing effector T cells may be induced by distinct signals delivered to naive T cells at the time of antigen presentation by DCs in either subcutaneous lymph nodes or gut associatedlymphoid tissues,respectively. Although the molecular basis for this imprinting of migratory phenotype is not knor,rm,there is evidence that DCs in Peyer'spatches produce retinoic acid, which promotes the expression of u4B7 and CCR9by responding T cells. A different subset of T cells that is found within the intestinal epithelium express an integrin called CDl03 (sEF7) that can bind to E-cadherin molecules on epithelial cells,allowingT cells to maintain residence as intraepithelial lymphocyes. Another example of heterogeneity of the migratory phenotpye of effector T cells are subsetsof CD4* effector T cells, called Thl and Th2 cells; these are discussed in detail in Chapter 13. Memory
T Cell Migration
Memory T cells are heterogeneous in their patterns of expression of adhesion molecules and chemokine receptors and in their propensity to migrate to dffirent tissues. Subsets of memory cells arise from the same clones of T cells that give rise to skin- and gut-homing effector cells described above, and these memorv cells
likely retain the homing properties of their corresponding eft'ectorcell brethren. Becausewe have only imperfect ways of identifying memory T cells, the distinction between effector and memory T cells in experimental studies is often not precise. TWo subsets of memory T cells described earlier in this chapter, namely, central memory and effector memory T cells, were initially defined based on differences in CCRT and L-selectin expression. Central memory T cells were defined as human CD4SRO*blood T cells that expresshigh levels of CCRTand L-selectin, while effector memoryT cells were defined as CD4SRO*blood T cells that expresslow levels of CCRT and L-selectin but express other chemokine receptors that bind inflammatory chemokines. These phenotypes suggestthat central memoryT cells home to secondary lyrnphoid organs, while effector memory T cells home to peripheral tissues. Although central and effector memoryT cell populations can also be detected in mice, experimental homing studies have indicated that CCRT expression is an imperfect marker to distinguish central and effector memory T cells. Nonetheless, it is clear that some memory T cells either remain in, or tend to home to, secondary lymphoid organs, while others migrate into peripheral tissues, especially mucosal tissues. In general, the peripheral tissue homing effector memory T cells respond to antigenic stimulation by rapidly producing effector cltokines, while the lymphoid tissue based central memory cells tend to proliferate more (providing a pool of cells for recall responses), and provide helper functions for B cells.
of B Lymphocytes Homing B celk utilize the same basic mechanisms as do naiueT cells to home to secondary lymphoid. tksues throughout the body, which enhances their likelihood of responding to microbial antigens in dffirent sifes.Immature B cells leave the bone marrow via the blood and enter the red pulp of the spleen from open-ended arterioles at the perimeter of the white pulp. Once in the spleen, the immature B cells mature either into follicular B cells or marginal zone B cells. As the fbllicular B cells mature they migrate, in an integrin-dependent manner, into the white pulp in response to a chemokine called CXCL13, which binds to the chemokine receptor CXCRS,and, to a lesser extent, in response to CCL19 and CCL2l, which bind to CCR7.Once the maturation is completed within the splenic white pulp, naive follicular B cells will reenter the circulation and home to lymph nodes and mucosal lymphoid tissues.Homing of naive B cells from the blood into tymph nodes involves tethering/rolling interactions on HEV chemokine activation of integrins, and stable arrest, as described earlier for naive T cells. Naive B cells expressL-selectin, CCR7, and LFA1,which bind to PNAd, CCL19 and CCL21, and ICAM-1' respectively, on lymph node HEVs. In addition, naive B cells express another chemokine receptor called CXCR4, which binds the chemokine CXCLI2, and this interaction
eS
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Section l-
INTRODUCT|ON TOTHETMMUNE SYSTEM
,,,'*"**;.*, also plays a significant role in naive B cell integrin activation and homing into lymph nodes. Once naive B cells enter the stroma of secondary lymphoid organs, they migrate into follicles, the site where they may encounter antigen and become activated.This migration of naive B cells into follicles is mediated by CXCL13,which is produced in follicles. Homing of naive B cells into peyer,s patches involves CXCRS,and the integrin a4B7, which binds to MadCAMl. During the course of B cell responsesto protein antigens, B cells and helper T cells must directly interact, and this involves highly regulated movements of both B and T cells within the secondary lymphoid organs. These local migratory events, and the chemokines that orchestrate them, will be discussed in detail in Chapter 10. Presumably, naive B cells that have entered secondary lyrnphoid tissues but do not become activated by antigen reenter the circulation, Iike naive T cells do, but how this process is controlled is not clear. Subsets of B celk committed to expressing particular types of antibodies migrate from secondary lymphoid org&ns into specifrc tksues. As we will describe in later chapters, different populations of activated B cells may secrete different types of antibodies, called isotypes, each of which performs a distinct set of effector functions. Many antibody-producing plasma cells migrate to the bone marrow where they secreteantibodies for long periods of time. Most bone marrow-homing plasma cells produce IgG antibodies, which are then distributed throughout the bodyvia the blood stream. B cells within mucosal associated lymphoid tissues usually become committed to expressing the IgA isotype of antibody, and these committed cells may home specifically to epithelial-lined mucosal tissues. This homing pattern combined with the local differentiation within mucosa of B cells into IgA-secreting plasma cells serve to optimize IgA responsesto mucosal infections, becauseIgA is efficiently excretedinto the lumen of mucosal epitheliallined tissues, such as the gut and respiratory tree. The mechanisms by which different B cell populations migrate to different tissues are, not surprisingly, similar to the mechanisms we described for tissuespecific migration of effector T cells, and depend on expression of distinct combinations of adhesion molecules and chemokine receptors on each B cell subset.For example, bone marrow-homing IgG-secreting plasma cells expressVt-A-4and CXCR4,which bind respectively to VCAM-I and CXCLI2 expressed on bone marrow sinusoidal endothelial cells. In contrast, mucosalhoming IgA-secreting plasma cells expresscx4p7,CCR9, and CCR10, which bind respectively to MadCAM-l, CCL25, and CCL2B, expressed on mucosal endothelial cells. IgG-secreting B cells are also recruited to chronic inflammatory sites in various tissues,and this pattern of homing can be attributed to CXCR3and VLA-4 on rhese B cells binding to VCAM-t , CXCL9,and CXCL10,which are often found on the endothelial surface at sites of chronic inflammation.
SUMMARY e The anatomic organization of the cells and tissues of the immune system is of critical importance for the generation of immune responses. This organization permits the small number of lymphocytes specific for any one antigen to locate and respond effectively to that antigen regardless of where in the body the antigen is introduced. B The adaptive immune response depends on antigen-specific lymphocytes, APCs required for lymphocyte activation, and effector cells that eliminate antigens. e B and T lymphocytes express highly diverse and specific antigen receptors and are the cells responsible for the specificity and memory of adaptive immune responses. NK cells are a distinct class of ll.rnphocytes that do not express highly diverse antigen receptors and whose functions are largely in innate immunity. Many surface molecules are differentially expressed on different subsets of lymphocytes, as well as on other leukocytes, and these are named according to the CD nomenclature. € Both B and T lymphocytes arise from a common precursor in the bone marrow. B cell development proceeds in the bone marrow whereas T cell precursors migrate to and mature in the thymus. After maturing, B and T cells leave the bone marrow and thgnus, enter the circulation, and populate peripheral lyrnphoid organs. € Naive B and T cells are mature l1'rnphocytes that have not been stimulated by antigen. When they encounter antigen, they differentiate into effector lyrnphocytes that have functions in protective immune responses. Effector B lymphocytes are antibody-secreting plasma cells. Effector T cells include cytokine-secreting CD4+helper T cells and CDS* CTLs. @ Some of the progeny of antigen-activated B and T lymphocytes differentiate into memory cells that survive for long periods in a quiescent state. These memory cells are responsible for the rapid and enhanced responses to subsequent exposures to antigen. @ APCs function to display antigens for recognition by lymphocytes and to promote the activation of lyrnphocltes. APCs include dendritic cells, mononuclear phagocytes, and FDCs. I
The organs of the immune system may be divided into the generative organs (bone marrow and thyrnus), where lymphocytes mature, and the
SYSTEM IMMUNE 0FTHEADAPTIVE ANDTISSUES 3 - CELLS Chaoter
peripheral organs fiynph nodes and spleen), where naive lymphocytes are activated by antigens. t Bone marrow contains the stem cells for all blood cells, including lymphocytes, and is the site of maturation of all of these cell types except T cells, which mature in the thymus. o The ly-ph nodes are the sites where B and T cells respond to antigens that are collected bythe lymph from peripheral tissues.The spleen is the organ in which lyrnphocytes respond to blood-borne antigens. Both ly-ph nodes and spleen are organized into B cell zones (the follicles) andT cell zones.The T cell areas are also the sites of residence of mature dendritic cells, which are APCs specialized for the activation of naive T cells. FDCs reside in the B cell areas and serve to activate B cells during humoral immune responsesto protein antigens.The development of secondary lymphoid tissue architecture depends on cytokines. s The cutaneous immune system consists of specialized collections of APCs and lyrnphocytes adapted to respond to environmental antigens encountered in the skin. A network of immature dendritic cells called Langerhans cells, present in the epidermis of the skin, serves to trap antigens and then transport them to draining lymph nodes. The mucosal immune system includes specialized collections of lymphocytes and APCs organized to optimize encounters with environmental antigens introduced through the respiratory and gastrointestinal tracts. e Lymphocyte recirculation is the process by which lymphocltes continuously move between sites throughout the body through blood and lymphatic vessels, and it is critical for the initiation and effector phases of immune responses. 6 Naive T cells normally recirculate among the various peripheral lymphoid organs, increasing the likelihood of encounter with antigen displayed by APCs such as mature dendritic cells. Effector T cells more typically are recruited to peripheral sites of inflammation where microbial antigens are located. MemoryT cells may enter either lymphoid organs or peripheral tissues. @ Different populations of Iymphocytes exhibit distinct patterns of homing. Naive T cells migrate preferentiallyto lymph nodes; this process is mediated by binding of L-selectin on the T cells to peripheral lymph node addressin on HEVs in
lymph nodes and by the CCRTreceptor on T cells that binds to chemokines produced in lymph nodes.The effector and memory T cells that are generatedby antigen stimulation of naive T cells exit the lymph node. They have decreased Lselectin and CCRT expression but increased expression of integrins and E-selectin and Pselectin ligands, and these molecules mediate binding to endothelium at peripheral inflammatory sites.Effector and memory lymphocytes also expressreceptors for chemokines that are producedin peripheraltissues.
Selected Readings Bromley SK, TR Mempel, and AD Luster. Orchestrating the orchestrators: chemokines in control of T cell traffic. Nature Immunology 9:970-980,2008. Cyster JG. Chemokines, sphingosine-l-phosphate, and cell migration in secondary lymphoid organs. Annual Review of Immunolo gy 23:127-I59, 2O05. Drayton DL, S Liao, RW Mcunzer, and NH Ruddle. Lymphoid organ development: from ontogeny to neogenesis' Nature Immunology 7 :344-353, 20O6. HartyIT, and\? Badovinac. Shaping and reshaping CDB+T-cell memory. Nature ReviewsImmunology B:107-119'2008' y'W Agace. Generation of gutIohansson-Lindbom B, and \ to the small intestinal localization their and T cells homing mucosa. Immunolgical Reviews 215:226-242, 20O7Kupper TS, and RC Fuhlbrigge. Immune surveillance in the skin: mechanisms and clinical consequences. Nature ReviewsImmunology 4:2lI-222, 2004. Marrack I and I Kappler. Control of T cell viability. Annual Review of Immunology 22;765-7 87, 2004. Mebius RE, and G IGaal. Structure and function of the spleen. Nature ReviewsImmunology 5:606-616,2005. Nagler-Anderson C. Man the barrier! Strategic defences in the intestinal mucosa. Nature Reviews Immunology 1:59-67' 2001. Sallusto B and M Baggiolini. Chemokines and leukocyte traffic' Nature ImmunologY 9:949-952,2008. Schluns KS, and L Lefrancois. Cytokine control of memory Tcell development and survival. Nature Reviews Immunology 3:269-279,2003. Serbina NV T lia, TM Hohl, and EG Pamer. Monocl'te-mediated defense against microbial pathogens. Annual Review of Immunolo gy 26: 421452, 20O8. Sigmundsdottir H, and EC Butcher. Environmental cues, dendritic cells and the programming of tissue-selective lymphocyte trafnckinS. Nature Immunology 9:981-987' 2008. Sprent L IH Cho, O Boyman, and CD Surh. T cell homeostasis' Immunology and Cell Biology 86:312-319,2008' Von Andrian UH, and CR Mackay. T cell function and migration: two sides of the same coin' New England Iournal of Medicine 343:1020-1034, 2000. Von Andrian UH, and TR Mempel. Homing and cellular traffic in lymph nodes. Nature Reviews Immunology 3:867-878, 2003.
Recognition of Antigens daptive immune responsesare initiated by the specific recognition of antigens by lymphocytes. This section is devoted to a discussion of the cellular and molecular basis of antigen recognition and the specificities of B and T lymphocytes. We begin with antibodies, which are the antigen receptors and effector molecules of B lymphocytes, because our understanding of the structural basis of antigen recognition has evolved from studies of these molecules. Chapter 4 describes the structure of antibodies and how these proteins recognize antigens. The next three chapters consider antigen recognition by T lymphocytes, which play a central role in all immune responses to protein antigens. In Chapter 5, we describe the genetics and biochemistry of the major histocompatibility complex (MHC), whose products are integral components of the ligands that T cells specifically recognize. Chapter 6 discussesthe association of foreign peptide antigens with MHC molecules and the cell biology and physiologic significance of antigen presentation. Chapter 7 deals with theT cell antigen receptor and the otherT cell membrane moleculesthat are involved in the recognition of antigens and the responsesof the T cells.
ANTI Natural Distribution and Production of Antibodies, 76 Molecular Structure of Antibodies, 77 GeneralFeaturesof AntibodyStructure,80 StructuralFeaturesof VariableRegionsand Their Relationship to AntigenBinding,84 StructuralFeaturesof ConstantRegionsand 85 TheirRelationship to EffectorFunctions, of lg Assembly,and Expression Synthesis, Molecules, 88 Antibody Binding of Antigens, 89 Featuresof BiologicAntigens,89 Structuraland ChemicalBasisof Antigen B i n d i n g9, 1 Structure-Function Relationships in Antibody Molecules,92 92 FeaturesRelatedto AntigenRecognition, FeaturesRelatedto EffectorFunctions,94 Summary,95
Antibodies are circulating proteins that are produced in vertebrates in responseto exposure to foreign structures knor,rmas antigens.Antibodies are incredibly diverse and specific in their ability to recognize foreign shapes, and are the primary mediators of humoral immunity against all classesof microbes. One of the earliest experimental demonstrations of adaptive immunitywas the findingby von Behring and Kitasato in 1890 that chemically inactivated toxins could induce protective immunity when injected into experimental animals, and that protection could be transferred to other susceptible animals by
injecting serum from their immune counterparts. Based on this discovery, life-threatening human diphtheria infections were successfully treated by the administration of serum from horses immunized with a chemically modified form of the diphtheria toxin. The family of circulating proteins that mediate these protective
were then called antigens. Antibodies, major histocompatibility complex (MHC) molecules (see Chapter 5)' and T cell antigen receptors (seeChapter 7) are the three classesof molecules used in adaptive immunity to recognize antigens (Table 4-l). Of these three, antibodies bind the widest range of antigenic structures, show the greatest ability to discriminate between different antigens, and bind antigens with the greateststrength' Antibodies represent the first of the three types of antigen-binding molecules to be discoveredand characterized. Therefore, we begin our discussion of how the immune system specifically recognizes antigens by describing the structure and the antigen-binding properties of antibodies. Antibodies can exist in two forms: membrane-bound antibodies on the surface of B lymphocytes function as receptors for antigen, and secreted' antibodies that reside in the circulation, tissues,and mucosal sitesbind antigens, neutralize toxins, and preuent the entry and spread of pathogens. The recognition of antigen by membrane-bound antibodies on specific naive B cells activates these lymphoc)'tes and initiates a humoral immune response. Antibodies are also produced in a secretedform by antigen-stimulated B cells. In the effector phase of humoral immunit-v these secreted antibodies bind to antigens and trigger several effector mechanisms that eliminate the antigens. The elimination of antigen often requires interaction of antibody with other components of the immune system, includ-
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S e c t i ol n l- RECOGNTT OTFAONNT | c E N S
T a b l e 4 - 1 . F e a t u r e so f A n t i g e nB i n d i n gb y t h e A n t i g e n - R e c o g n i z i n Mgo l e c u l e so f t h e l m m u n e S y s t e m
Feature
Antigenbindingmolecule T cellreceptor(TCR) MHCmolecules"
Antigen binding site
Madeuo of three CDRsin Vs and threeCDRsin Vg
Madeup of three CDRsin Vs and threeCDRsin Vg
(proteins,Peptide-MHC Natureof antigen Macromolecules thatmaybe bound lipids,polysaccharides) complexes
Peptide-binding cleft madeof a1 and o2 (classl) or a1 and B1(classll) Peptides
andsmallchemicals
Natureof antigenic LinearandconformationalLineardeterminants of Lineardeterminants of determinants peptides; of various only2 or 3 amino peptides; determinants onlysome macromolecules acidresidues of a peptide aminoacidresidues recognized andchemicals
Affinityof antigenbinding
boundto an MHCmoleculeof a peptide
K61Q-z-10-ttM; average K 6 1 Q --s 1 0 - 7M affinityof lgs increases duringimmuneresponse
K 6 1 0 - 6- 1 0 - eM ; extremelystablebinding
.The
structures and functionsof MHC and TCR moleculesare discussedin Chapters5 and 7, respectively Abbreviations:CDR, complementarity-determining region;K6, dissociation consiant;MHC,majorhistocompatibility complex; V6, variabledomainof heavychainlg; V1,variabledomainof lightchainlg
ing molecules such as complement proteins and cells that include phagocytes and eosinophils. Antibodymediated eff'ector functions include neutralization of microbes or toxic microbial products; activation of the complement system; opsonization of pathogens for enhanced phagocl'tosis;antibody-dependent cell-mediated cytotoxiciry by which antibodies target microbes for lysis by cells of the innate immune system; and immediate hypersensitiviry in which antibodies trigger mast cell activation. These effector functions of antibodies are described in detail in Chapter 14. In this chapter, we discuss the structural features of andbodies that underlie their antigen recognition and effector functions.
NRruRRL DrsrRraufl oNANo PnooucrroN oFANTIBoDtEs
antigen receptor. After exposure to an antigen, much of
the initial antibody responseoccurs in lymphoid tissues, mainly the spleen, lymph nodes, and mucosal lymphoid tissues,but long-lived antibody-producing plasma cells may persist in other tissues, especially in the bone marrow (see Chapter l0). Secreted forms of antibodies accumulate in the plasma (the fluid portion of the blood), in mucosal secretions,and in the interstitial fluid oftissues. Secretedantibodies often attach to the surface of other immune effector cells, such as mononuclear phagocltes, natural killer (NK) cells, and mast cells, which have specific receptors for binding antibody molecules (seeChapter l4). \A/hen blood or plasma forms a clot, antibodies remain in the residual fluid, called serum. Any serum sample that contains detectable antibody molecules that bind to a particular antigen is commonly called an antiserum. (The study of antibodies and their reactions with antigens is therefore classically called serology.) The concentration of antibody molecules in serum specific for a particular antigen is often estimated by determining how many serial dilutions of the serum can be made before binding can no longer be observed; sera with a high concentration of antibody molecules specific for a particular antigen are said to have a "high titer." A healthy 70-kg adult human produces about 2g-3g of antibodies every day. Almost two thirds of this is an
ANDANTIGENS 4 - ANTIB0DIES Chapter
Moucur-RR SrRUcruRE 0FANneoores
approach, to deflne antibody structure precisely because serum contains a mixture of different antibodies produced by many clones of B lymphocltes that may respond to different portions (epitopes) of an antigen (so-called polyclonal antibodies)' A major breakthrough providing antibodies whose structures could be elucidated was the discovery that patients with multiple myeloma, a monoclonal tumor of antibodyproducing plasma cells, often have large amounts of biochemically identical antibody molecules (produced by the neoplastic clone) in their blood and urine. Immunologists found that these antibodies could be purified to homogeneity and analyzed. The recognition that myeloma cells make monoclonal immuno-
An understanding of the structure of antibodies has provided important insights regarding antibody function. The analvsis of antibody structure also paved the way to the eventual characterization of the genetic organization of antigen receptor genes in both B and T cells, and the elucidation of the mechanisms of immune diversity, issuesthat will be considered in depth in Chapter B. Early studies of antibody structure relied on antibodies purified from the blood of individuals immunized with various antigens. It was not possible, using this
"hybridomas," each of which secretedindividual monoclonal antibodies of predetermined speciflcity. These antibodies have proved to be of tremendous importance in most avenues of biologic research, and have many practical applications in clinical diagnosis and therapy ( B o x4 - I ) .
antibody called IgA, which is produced by activated B cells and plasma cells in the walls of the gastrointestinal and respiratory tracts and actively transported into the lumens. The large amount of IgA produced reflects the Iarge surface areasofthese organs.Antibodies that enter the circulation have limited half-lives. The most common tlpe of antibody, called IgG, is primarily found in the serum (though IgG antibodies can also be transported to mucosal sites) and has a half-life of about 3 weeks.
T h e a b i l i t yt o p r o d u c ev i r t u a l l yu n l i m i t e dq u a n t i t i e so f i d e n t i c aal n t i b o d ym o l e c u l e s p e c i f i cf o r a p a r t i c u l aarn t i g e n i c d e t e r m i n a nht a s r e v o l u t i o n i z ei m d m u n o l o g ya n d g paco t n r e s e a r c ihn d i v e r s ef i e l d s h a sh a da f a r - r e a c h i ni m l e d i c i n eT h e f i r s t m e t h o df o r p r o a s w e l l a s o n c l i n i c am d u c i n gh o m o g e n e o uosr m o n o c l o n aaln t i b o d i eosf k n o w n s p e c i f i c i tw y a s d e s c r i b e db y G e o r g e sK o h l e ra n d C e s a r M i l s t e i ni n 1 9 7 5 ,a n d t h i s a p p r o a c hr e m a i n st h e m o s t c o m m o n o n e u s e d t o d a y t o g e n e r a t es u c h a n t i b o d i e s T h i st e c h n i q u ei s b a s e do n t h e f a c t t h a t e a c hB l y m p h o c y t e p r o d u c e sa n t i b o d yo f a s i n g l es p e c i f i c i t yB e c a u s e n o r m a l B l y m p h o c y t e sc a n n o t g r o w i n d e f i n i t e l yi t, i s n e c e s s a r yt o i m m o r t a l i z eB c e l l s t h a t p r o d u c e a s p e c i f i ca n t i b o d y T h i s i s a c h i e v e db y c e l l f u s i o n , o r ne , t w e e na n o r m a la n t i b o d y s o m a t i cc e l l h y b r i d i z a t i o b p r o d u c i n gB c e l la n d a m y e l o m ac e l l ,f o l l o w e db y s e l e c t i o n o f f u s e d c e l l st h a t s e c r e t ea n t i b o d yo f t h e d e s i r e d s p e c i f i c i td v e r i v e df r o m t h e n o r m a lB c e l l S u c hf u s i o n d n t i b o d y - p r o d u c icnegl l l i n e s a r e d e r i v e di m m o r t a l i z e a . n d t h e a n t i b o d i etsh e y p r o d u c ea r e c a l l e dh y b r i d o m a s a m o n o c l o n a la n t i b o d i e s . T h e t e c h n i q u eo f p r o d u c i n gh y b r i d o m arse q u i r e sc u l t u r e dm y e l o m ac e l ll i n e st h a t w i l l g r o w i n n o r m a cl u l t u r e medium but not in a defined "selection"medium b e c a u s et h e y l a c k f u n c t i o n agl e n e s r e q u i r e df o r D N A s y n t h e s i si n t h i s s e l e c t i o nm e d i u m F u s i n gn o r m a lc e l l s to these defective myeloma fusion partnersprovides t h e n e c e s s a rgy e n e sf r o m t h e n o r m a cl e l l s ,s o t h a t o n l y t h e s o m a t i c c e l l h y b r i d sw i l l g r o w i n t h e s e l e c t i o n medium Moreover,the uncontrolledgrowth property
o f t h e m y e l o m a c e l l m a k e s s u c h h y b r i d si m m o r t a l . M y e l o m ac e l l l i n e st h a t c a n b e u s e d a s f u s i o np a r t n e r s synthesis a r e c r e a t e db y i n d u c i n gd e f e c t si n n u c l e o t i d e p a t h w a y s N o r m a l a n i m a l c e l l s s y n t h e s i z ep u r i n e nucleotidesand thymidylate,both precursorsof DNA, Antiby a de novo pathway requiringtetrahydrofolate. f o l a t e d r u g s ,s u c h a s a m i n o p t e r i nb, l o c k a c t i v a t i o no f t e t r a h y d r o f o l a t et h, e r e b y i n h i b i t i n gt h e s y n t h e s i so f p u r i n e sa n d t h e r eof r e p r e v e n t i n gD N A s y n t h e s i sb y cells can the de novo palhway Aminopterin-treated u s e a s a l v a g ep a t h w a yi n w h i c h p u r i n ei s s y n t h e s i z e d by the enf r o m e x o g e n o u s l ys u p p l i e dh y p o x a n t h i n e phosphoribosyltransferase zyme hypoxanthine-guanine ( H G P R Ta) ,n d t h y m i d y l a t ies s y n t h e s i z efdr o m t h y m i d i n e b y t h e e n z y m et h y m i d i n ek i n a s e( T K ) T h e r e f o r ec, e l l s g r o w i n t h e p r e s e n c eo f a m i n o p t e r ionn l y i f t h e c u l t u r e d i t h h y p o x a n t h i naen d medium is also supplementew . y e l o m ac e l l l i n e sc a n t h y m i d i n e( c a l l e dH A Tm e d i u m ) M be made defectivein HGPRTor TK by mutagenesisfoll o w e d b y s e l e c t i o ni n m e d i a c o n t a i n i n gs u b s t r a t e sf o r t h e s ee n z y m e st h a ty i e l dl e t h a pl r o d u c t sO. n l yH G P R To-r T K - d e f i c i e nc te l l sw i l l s u r v i v eu n d e rt h e s es e l e c t i o nc o n d i t i o n s S u c h H G P R T -o r T K - n e g a t i v em y e l o m a c e l l s c a n n o tu s e t h e s a l v a g ep a t h w a ya n d w i l l t h e r e f o r ed i e i n H A T m e d i u m l f n o r m a lB c e l l sa r e f u s e dt o H G P R To- r TK-negativecells, the B cells provide the necessary enzymesso that the hybridssynthesizeDNA and grow i n H A Tm e d i u m . To produce a monoclonalantibody specific for a d e f i n e da n t i g e na, m o u s eo r r a t i s i m m u n i z e dw i t h t h a t Continuedon followingPage
77
78 I S e c t i olnl , . ,,..,,.,.*.,,t,,.,.,-.
R E C 0 G N t T t00FNA N T T G E N S
a n t i g e na, n d B c e l l sa r ei s o l a t e d f r o mt h e s p l e e no r l y m p h n o d e so f t h e a n i m a l T . h e s eB c e l l sa r e t h e n f u s e dw i t h a n a p p r o p r i a tiem m o r t a l i z ecde l l l i n e M y e l o m al i n e sa r e t h e b e s tf u s i o np a r t n e r fso r B c e l l sb e c a u s el i k ec e l l st e n d t o f u s e a n d g i v e r i s e t o s t a b l eh y b r i d sm o r e e f f i c i e n t l y
t h a n u n l i k ec e l l s .l n c u r r e n tp r a c t i c et,h e m y e l o m al i n e s t h a ta r e u s e dd o n o t p r o d u c et h e i ro w n l g , a n dc e l lf u s i o n is achievedwith polyethylene glycol Hybridsareselected for growth in HAT medium; under these conditions, unfused HGPRT-or TK-negativemyeloma cells die
AntigenX
lsolatespleen cellsfrommouse immunized withantigenX
Mutantmyelomaline; unableto growin HAT selection medium;does not produceantibody
Mixtureof spleencells,including someproducing anti-Xantibody
lrrfirt,r* "f lfusedand
I
I lunfusedcellsI
Onlyfusedcells (hybridomas) grow
ll
"i:, .i-n
Screensupernatants for presenceof anti-X and expandpositiveclones
Hybridomasproducing monoclonalanti-Xantibody
Continued on following page
C h a p t e4r- A N T I B O D IAENSDA N T I G E N S
because they cannot use the salvage pathway, and u n f u s e dB c e l l s c a n n o ts u r v i v ef o r m o r e t h a n 1 t o 2 weeks becausethey are not immortalized, so that only h y b r i d sw i l l g r o w ( s e e F i g u r e )T. h e f u s e d c e l l sa r e c u l t u r e d a t a c o n c e n t r a t i oant w h i c h e a c h c u l t u r ew e l l i s e x p e c t e di n i t i a l l yt o c o n t a i no n l y o n e h y b r i d o m ac e l l . T h ec u l t u r es u p e r n a t a nf rto m e a c hw e l l i n w h i c hg r o w i n g cellsare detectedis then testedfor the oresenceof antib o d y r e a c t i v ew i t h t h e a n t i g e nu s e d f o r i m m u n i z a t i o n . T h e s c r e e n i n gm e t h o d d e p e n d so n t h e a n t i g e nb e i n g u s e d . F o r s o l u b l e a n t i g e n s ,t h e u s u a l t e c h n i q u ei s r a d i o i m m u n o a s s aoyr e n z y m e - l i n k e di m m u n o s o r b e n t assay; for cell surface antigens,a variety of assays f o r a n t i b o d yb i n d i n gt o v i a b l ec e l l s c a n b e u s e d ( s e e A p p e n d i x l l l : L a b o r a t o r yM e t h o d s U s i n g A n t i b o d i e s ) O n c e p o s i t i v ew e l l s ( i . e . ,w e l l s c o n t a i n i n gh y b r i d o m a s producingthe desiredantibody)are identified,the cells a r e c l o n e di n s e m i s o l i da g a ro r b y l i m i t i n gd i l u t i o na, n d c l o n e sp r o d u c i n gt h e a n t i b o d ya r e i s o l a t e db y a n o t h e r s roduce r o u n do f s c r e e n i n gT h e s e c l o n e dh y b r i d o m a p monoclonalantibodiesof a desiredspecificity.Hybridom a s c a n b e g r o w n i n l a r g ev o l u m e so r a s a s c i t i ct u m o r s in syngeneicmice to producelargequantitiesof monoc l o n aa l ntibodies S o m eo f t h e c o m m o na p p l i c a t i o nosf h y b r i d o m aasn d m o n o c l o n aaln t i b o d i eisn c l u d et h e f o l l o w i n g : . ldentification of phenotypicmarkersuniqueto part i c u l a rc e l lt v o e s .T h e b a s i sf o r t h e m o d e r nc l a s s i f i cationof lymphocytesand other leukocytesis the fio c n o c l o n aal n t i b o d b i n d i n go f p o p u l a t i o n - s p e c im ies Thesehavebeen usedto defineclustersof differentiation(CD markers)for variouscelltvpes (see C h a p t e3 r) . l m m u n o d i a g n o sTi sh. e d i a g n o s iosf m a n yi n f e c t i o u s a n d s y s t e m i cd i s e a s e sr e l i e so n t h e d e t e c t i o no f p a r t i c u l aarn t i g e n so r a n t i b o d i eisn t h e c i r c u l a t i oonr i n t i s s u e s b y u s e o f m o n o c l o n aal n t i b o d i e si n rmmunoassays . T u m o r d i a g n o s i sT. u m o r - s p e c i f m i c o n o c l o n aal n t i bodiesare usedfor detectionof tumors by imaging technrques . T h e r a o vA . n u m b e ro f m o n o c l o n aal n t i b o d i e sa r e u s e dt h e r a p e u t i c a tl loyd a y S o m ee x a m p l e si n c l u d e the use of antibodiesagainsttumor necrosisfactor i n t h e t h e r a p Vo f r h e u m a t o i da r t h r i t i sa, n t i b o d i e s a g a i n sC t D 2 0f o r t h e t r e a t m e not f B c e l lI e u k e m i a s , l rowth a n t i b o d i e sa g a i n s tt h e t y p e 2 e p i d e r m a g factor receptorin patientswith breastcancer,anti, b o d i e sa g a i n svt a s c u l aer n d o t h e l i aglr o w t hf a c t o r a p r o m o t e ro f a n g i o g e n e s i si n, p a t i e n t sw i t h c o l o n c a n c e ra, n d s o o n . . F u n c t i o n a ln a l y s ios f c e l ls u r f a c ea n ds e c r e t e dm o l , o n o c l o n aal n t i e c u l e s I n i m m u n o l o g i rce s e a r c hm b o d i e st h a tb i n dt o c e l ls u r f a c em o l e c u l eas n de i t h e r s t i m u l a t eo r i n h i b i tp a r t i c u l acre l l u l a fru n c t i o n sa r e i n v a l u a b lteo o l sf o r d e f i n i n gt h e f u n c t i o n so f s u r f a c e . ntim o l e c u l e si,n c l u d i n gr e c e p t o r sf o r a n t i g e n s A b o d i e st h a t b i n d a n d n e u t r a l i z cey t o k i n e sa r e r o u tinely used for detecting the presence and
functionalrolesof these proteinhormonesin vitro andin vivo At present,hybridomasare most often producedby mouse myelomaswith B cellsfrom fusingHAT-sensitive immunizedmice, rats,or hamsters.Attempts are being m a d et o g e n e r a t eh u m a nm o n o c l o n aaln t i b o d i e sp,r i m a to patients,by developinghuman rily for administration myelomalinesas fusionpartners.However,it is a general rulethat the stabilityof hybridsis low if cellsfrom species that are far apart in evolutionare fused, and for this reason human B cells do not form hybridomaswith mouse myelomalinesat high efficiency. G e n e t i ce n g i n e e r i ntge c h n i q u e sa r e u s e d t o e x p a n d the usefulnessof monoclonalantibodiesThe complementary DNAs (cDNAs)that encode the polypeptide chainsof a monoclonalantibodycan be isolatedfrom a h y b r i d o m aa, n d t h e s e g e n e s c a n b e m a n i p u l a t e idn vitro. As we shall discuss later in this chapter,only s m a l lp o r t i o n so f t h e a n t i b o d ym o l e c u l ea r e r e s p o n s i b l e r f the antibody f o r b i n d i n gt o a n t i g e n ;t h e r e m a i n d e o m o l e c u l ec a n b e t h o u g h t o f a s a " f r a m e w o r k . "T h i s allowsthe DNA segmentsencodstructuralorganization i t e sf r o m a m u r i n em o n o c l o n a l i n g t h e a n t i g e n - b i n d i ns g a n t i b o d yt o b e " s t i t c h e d "i n t oa c D N Ae n c o d i n ga h u m a n myeloma protein, creating a hybrid gene. When expressed,the resultanthybrid protein,which retains antibody. is referredto as a humanized antigenspecificity, H u m a n i z e da n t i b o d i e sa r e f a r l e s s l i k e l y t o a p p e a r "foreign" in humans and to induce anti-antibody responses(see Box 4-3) that limit the usefulnessof m u r i n em o n o c l o n aal n t i b o d i e sw h e n t h e y a r e a d m i n i s tered to pattents. G e n e t i ce n g i n e e r i nigs a l s ob e i n gu s e dt o c r e a t em o n oclonal antibody-likemoleculesof defined specificity w i t h o u t t h e n e e d f o r p r o d u c i n g h y b r i d o m a s .O n e a p p r o a c hc, a l l e d" p h a g ed i s p l a y , "u s e s r a n d o mc o l l e c j u s tt h e a n t i g e n - b i n d i rnegg i o n s t i o n so f c D N A se n c o d i n g of antibodiesThese cDNAs are generatedfrom mess e n g e r R N A i s o l a t e df r o m t h e s p l e e n so f i r , n m u n i z e d mice, and amplified by polymerase chain reaction technology.The cDNAs are then cloned into bacteriop h a g e st o f o r m p h a g e d i s p l a yl i b r a r i e sA. l t h o u g ht h e a n t i g e n - b i n d i nr e g g i o n so f a n t i b o d i e sa r e f o r m e d f r o m two different polypeptidechains, synthetic antigenbindingsites can be createdby expressingfusion prot e i n s i n w h i c h s e q u e n c e sf r o m t h e t w o c h a l n s a r e . u c hf u s i o np r o t e i n s c o v a l e n t ljyo i n e di n a t a n d e ma r r a y S can be expressedon the surfacesof the bacteriophages, and poolsof phagecan be tested for their abilityto bind t o a p a r t i c u l aarn t i g e nT. h ev i r u st h a t b i n d st o t h e a n t i g e n p r e s u m a b l yc o n t a i n sc D N A e n c o d i n gt h e d e s i r e ds y n site.The cDNAis isolatedfrom that theticantigen-binding D N A e n c o d i n gt h e n o n - a n t i g e n w i t h l i n k e d virus and b i n d i n gp a r t so f a g e n e r i ca n t i b o d ym o l e c u l eT. h e f i n a l constructcanthen be transfectedintoa suitablecelltype, expressedin solubleform, purified,and used.The advantage of phagedisplaytechnologylies in the fact that the number of binding sites that can be screened for the desiredspecificityis three to four ordersof magnitude greaterthan the practicallimit of hybridomasthat can be screened.
79
80
$
S e c t i olnl - R E C O G N t T0t 0FN ANTTGENS
$
The availability of homogeneous populations of antibodies and immortalized antibody-producing plasma cells (myelomas and hybridomas) permitted the complete amino acid sequence determination and molecular cloning of individual antibody molecules. The ready availability of monoclonal immunoglobulins culminated in the x-ray crystallographic determinations of the three-dimensional structure of several antibody molecules and of antibodies bound to antigens. General Features of Antibody
Structure
Plasma or serum proteins are traditionally separated by solubility characteristics into albumins and globulins and may be further separatedby migration in an electric
@ SecretedlgG
field, a process called electrophoresis. Most antibodies are found in the third fastest migrating group of globulins, named gamma globulins for the third letter of the Greek alphabet. Another common name for antibody (Ig), referring to the immunityis immunoglobulin conferring portion of the gamma globulin fraction. The Ierms immunoglobulin and antibody are used interchangeably throughout this book. AII antibody moLecuLesshare the same basic structural characteristics but dkplay remarkable uariability in the regions that bind antigens. This variability of the antigen-binding regions accounts for the capacity of different antibodies to bind a tremendous number of structurally diverse antigens. There are believed to be a million or more different antibody molecules in everv
lgM @ naemUrane
Heavy Light c h a i n chain
D i s u l f i d eb o n d - - - - -
lg domain
c c
Crystalstructureof secretedlgG
Structureof an antibodymolecule.A. Schematic diagram gG molecule.The antigen-binding sitesareformedby the f V1andVs domains.The heavychainC regionsend in tail pieces The locationsof complement-and Fc receptor-binding sites within the heavy chain constant regions are approximationsB Schematicdiagramof a membrane-bound lgM moleculeon the surface of a B lymphocyte. The lgM moleculehasone moreCsdomainthan lgG, and the membraneform of the antibodyhas C-terminal transmembrane and cytoplasmic portionsthat anchorthe moleculein the plasmamembrane.C. Structureof a humanlgG moleculeas revealedby x+ay crystallography. In this ribbondiagramof a secretedlgG molecule,the heavy chainsare coloredblue and red,and the lightchainsare coloredgreen; carbohydrates are shown in gray.(Courtesy of Dr.Alex McPherson,Universityof California, lrvine)
ANDANTIGENS 4 - ANTIB0DIES Chaoter
individual (theoretically the antibody repertoire may include more than 10edifferent antibodies), each with unique amino acid sequencesin their antigen-combining sites, The effector functions and common physicochemical properties of antibodies are associated with the non-antigen-binding portions, which exhibit relatively few variations among different antibodies. An antibody molecule has a symmetric core structure composed.of two id.entiral light chains and two id.enticalheauy chains (seeFig. a-l). Both the light chains and the heavy chains contain a series of repeating, homologous units, each about 110 amino acid residues in Iength, that fold independently in a globular motif that is called an Ig domain. An Ig domain contains two layers of B-pleated sheet, each layer composed of three to five strands of antiparallel polypeptide chain (Fig. a-2). The two layers are held together by a disulfide bridge, and adjacent strands of each p-sheet are connected by short loops. It is the amino acids in some of these loops that are critical for antigen recognition, as discussed below. Many other proteins of importance in the immune system contain domains that use the same folding motif and have amino acid sequences that are similar to Ig amino acid sequences.All molecules that contain this type of domain are said to belong to the Ig superfamily, and all the gene segments encoding the Ig domains of these molecules are believed to have evolved from one ancestral gene (Box 4-2). Both heavy chains and light chains consist of aminoterminal uarinble (V) regions that participate in
antigen recognition and carboxy-terminal constant (C) regions; the C regions of the heauy chains medinte effector functions. In the heavy chains, the V region is composed of one Ig domain and the C region is composed of three or four Ig domains. Each light chain is made up of one V region Ig domain and one C region Ig domain. Variable regions are so named because they contain regions of variability in amino acid sequence that distinguish the antibodies made by one clone of B cells from the antibodies made by other clones. TheV region of one heary chain (Vu) is juxtaposed with the V region of one light chain (VL) to form an antigen-binding site (see Fig. 4-1). Because the core structural unit of each antibody molecule contains two heavy chains and two light chains, it has two antigen-binding sites. The C region domains are separate from the antigen-binding site and do not participate in antigen recognition. The heavy chain C regions interact with other effector molecules and cells of the immune system and therefore mediate most of the biologic functions of antibodies. In addition, the carboxy-terminal ends of one form of the heavy chains anchor membrane-bound antibodies in the plasma membranes of B lymphocytes. The C regions of light chains do not participate in effector functions and are not directly attached to cell membranes. Each light chain is about 24kD, and each heavy chain is 55 to 70kD. Heavy and light chains are covalently Iinked by disulfide bonds formed between cysteine residues in the carboxyl terminus of the light chain and the Csl domain of the heaqr chain. Noncovalent inter-
193
FTGURE Structureof an antibodylight chain. The secondaryand tertiarystructuresof a human lg lightchainare shown schematireprearraysof B-strands fold into lg domains.Eachdomainis composedof two antiparallel cally.The d C regionseachindepende-ntty to form two p-pleatedsheets.In the C domain,there are three and four seniedby the flat ariows,coloredyellow and red, respectively, two sheetsare comFstrandsin the two sheets.In the V domain,which is about 16 aminoacid residueslongerthan the C domain,the posedof five and four strands.The dark blue bars are intrachain disulfidebonds,and the numbersindicatethe positionsof amino acid portionsof manyother residuescountingfrom the amino(N)terminus Similarlg C and V domainstructuresare found in the extracellular membraneproteinsin the immunesystem,as discussedinBox4-2. (Adaptedwith permissionfrom EdmundsonAB, KR Ely,EE Abola,M light chains.Biochemistry Roiationalallomerismand divergentevolutionof domainsin immunoglobulin Schiffer,and N Panagiotopoulos. 1975 Copyright1975AmericanChemicalSociety) 14:3953-3961,
a2
ll - RECOGN|T|0N 0FANTTGENS $ Section
Many of the cell surface and soluble moleculesthat mediaterecognition, adhesion,or bindingfunctionsin the vertebrate immune system share partial amino acid sequencehomologyand tertiarystructuralfeaturesthat w e r e o r i g i n a l liyd e n t i f i e di n l g h e a v ya n d l i g h tc h a i n s I. n a d d i t i o nt,h e s a m ef e a t u r e sa r ef o u n di n m a n ym o l e c u l e s outside the immune system that also perform simrlar
functions.Thesediverseproteinsare membersof the lg superfamily(sometimescalledthe lg supergenefamily). A superfamilyis broadlydefinedas a group of proteins that share a certain degree of sequence homology, usuallyat least 15oloThe conservedsequencesshared by superfamilymembersoften contributeto the formation of compacttertiarystructuresreferredto as domains,
TCR NN
C l a s sI I M H C NN 0 /q'
0zm
cD4
cD2
87-1187-2 CD316,e;
cD8
CD28
N
VI iV
Thy-1
NN
B
V
V
vcAM-1 NHz
rcAM-1 N
iH
HI Fcfill
( Hj
N
Hi
NCAM N
iH
iH
rcAM-2
Hi IL.lR
(typet1 (v.;
iH
Hi Hi
iH
Hi
iH
Hi
iH
Hi
Hi
PDGFR N Hi Hi
Hi
Hi
Continued on following page
ANDANTIGENS 4 - ANTIB0DIES Chaoter
and most often the entiresequenceof a domaincharacteristicof a particularsuperfamilyis encodedby a single exon Membersof a superfamilyare likelyto be derived from a common precursorgene by divergentevolution, a n d m u l t i d o m a ipnr o t e i n sm a y b e l o n gt o m o r et h a n o n e n f a p r o t e i ni n t h e s u p e r f a m i lT y h e c r i t e r i o nf o r i n c l u s i o o l g s u p e r f a m i liys t h e p r e s e n c e o f o n e o r m o r el g d o m a i n s ( a l s oc a l l e dl g h o m o l o g yu n i t s ) w , h i c h a r e r e g i o n so f 7 0 t o 1 1 0 a m i n oa c i dr e s i d u e sh o m o l o g o utso e i t h e rl g v a r i a b l e ( V )o r l g c o n s t a n (t C )d o m a i n sT. h e l g d o m a i nc o n tains conservedresiduesthat permit the polypeptideto a s s u m ea g l o b u l atre r t i a r ys t r u c t u r e c a l l e da n a n t i b o d y( o r lg) fold, composedof a sandwicharrangementof two Bs h e e t s ,e a c h m a d e u p o f t h r e e t o f i v e a n t i p a r a l l eBl s t r a n d so f 5 t o 1 0 a m i n oa c i dr e s i d u e sT h i ss a n d w i c h - l i k e s t r u c t u r ei s s t a b i l i z ebdy h y d r o p h o b ai cm i n oa c i dr e s i d u e s o n t h e p - s t r a n d sp o i n t i n gi n w a r d ,w h i c h a l t e r n a t ew i t h h y d r o p h i l irce s i d u e sp o i n t i n go u t . B e c a u s et h e i n w a r d pointingresiduesare essentialfor the stabilityof the tertiary structure,they are the major contributorsto the regions that are conserved between lg superfamily members.In addition,there are usuallyconservedcysteineresiduesthat contributeto the formationof an intrac h a i n d i s u l f i d e - b o n d el odo p o f 5 5 t o 7 5 a m i n o a c i d s ( - 9 0 k D ) .l g d o m a i n sa r e c l a s s i f i e a d s V - l i k eo r C - l i k eo n t h e b a s i so f c l o s e s th o m o l o g yt o e i t h e r l g V o r l g C d o m a i n sV d o m a i n sa r e f o r m e df r o m a l o n g e rp o l y p e p tide than are C domainsand containtwo extraB-strands w i t h i nt h e p - s h e e st a n d w i c hA. t h i r dt y p e o f l g d o m a i n , c a l l e dC 2 o r H , h a sa l e n g t hs i m i l a tro C d o m a i n sb u t h a s s e q u e n c e tsy p i c aol f b o t hV a n d C d o m a i n s . U s i n gs e v e r acl r i t e r i a o f e v o l u t i o n a r ye l a t e d n e ss u, c h structure,and abilityto as primarysequence,intron-exon , l e c u l abr i o l o g i s ths a v e u n d e r g oD N A r e a r r a n g e m e n tms o p o s t u l a t e ad s c h e m e o the evolu, r f a m i l yt r e e ,d e p i c t i n g t i o no f m e m b e r so f t h e l g s u p e r f a m i l Iyn. t h i s s c h e m ea, n e a r l ye v e n tw a s t h e d u p l i c a t i oonf a g e n ef o r a p r i m o r d i a l surface receptor followed by divergenceof V and C e x o n s .M o d e r nm e m b e r so f t h e s u o e r f a m l lcvo n t a i nd i f f e r e n tn u m b e r so f V o r C d o m a i n sT h e e a r l yd i v e r g e n c e is reflectedby the lackof significantsequencehomology
actions between theVr andVH domains and between the Cr and Csl domains may also contribute to the association of heary and light chains. The two heary chains of each antibody molecule are also covalently linked by disulfide bonds. In IgG antibodies, the flrst class of antibodies to be structurally analyzed, these bonds are formed between cysteine residues in the CsZ regions, close to the region known as the hinge (see below). In other isotypes, the disulfide bonds may be in different locations. Noncovalent interactions (e.9., between the third Cu domains [CH3])may also contribute to heavy chain pairing. The associationsbetween the chains of antibody molecules and the functions of different regions of antibod-
i n l g a n d T C RV a n d C u n i t s ,a l t h o u g ht h e y s h a r es i m i l a r tertiarystructures.A secondearlyevent in the evolution of the abilityto undergo of this familywas the acquisition D N A r e c o m b i n a t i o nw, h i c h h a s r e m a i n e da u n i q u e feature of the antigen receptorgene members of the family. Most identifiedmembersof the lg superfamily(see Figurea ) r e i n t e g r a pl l a s m am e m b r a n ep r o t e i n sw i t h l g d o m a i n si n t h e e x t r a c e l l u l apro r t i o n s ,t r a n s m e m b r a n e d o m a i n sc o m p o s e do f h y d r o p h o b i ca m i n o a c i d s ,a n d w i d e l yd i v e r g e nct y t o p l a s m itca i l s ,u s u a l l yw i t h n o i n t r i n sic enzymaticactivityThereare exceptionsto thesegengrowth eralizationsFor example, the platelet-derived factor receptors have cytoplasmictails with tyrosine kinaseactivity,and the Thy-1moleculehas no cytoplasmic tail but, rather,is anchoredto the membraneby a p h o s p h a t i d y l i n o s li itnokl a g e . One recurrentcharacteristicof the lg superfamily betweenlg domainson difmembersis that interactions ferent polypeptidechainsare essentialfor the functions o f t h e m o l e c u l e sT h e s ei n t e r a c t i o ncsa n b e h o m o p h i l i c , occurring between identical domains on opposing c r o t e i na, s i n t h e c a s e p o l y p e p t i dceh a i n so f a m u l t i m e r i p o f C H : C sp a i r i n gt o f o r m f u n c t i o n aFl c r e g i o n so f l g m o l as occurs they can be heterophilic, ecules Alternatively, i n t h e c a s eo f V H: V r o r V s : V op a i r i n gt o f o r m t h e a n t i g e n Hetbindingsites of lg or TCR molecules,respectively. can alsooccurbetweenlg domatns eroohilicinteractions on entirelydistinctmoleculesexpressedon the surfaces of different cells Such interactionsprovide adhesive forces that stabilizecell-cellinteractionsand initiate s .o re x a m p l et,h e s i g n a l sr e s u l t i n fgr o m s u c hi n t e r a c t i o nF presentation of an antigento a helperT cellby an antigenp r e s e n t i n gc e l l i n v o l v e s h e t e r o p h i l i ci n t e r c e l l u l a lrg betweenseverallg superfamilymoldomaininteractions e c u l e s ,i n c l u d i n gC D 4 : c l a s sl l M H C a n d C D 2 8 : 8 7( s e e C h a p t e r7 ) . N u m e r o u sl g s u p e r f a m i l ym e m b e r s h a v e been identifiedon cells of the developingand mature nervoussystem, consistentwith the functionalimportance of highly regulatedcell-cellinteractionsin these sites.
ies were first deduced from experiments done by Rodney Porter in which rabbit IgG was cleaved by proteolytic enzymes into fragments with distinct structural and functional properties. In IgG molecules, the hinge between the Cnl and Cn2 domains of the hear'y chain is the region most susceptible to proteolytic cleavage. If rabbit IgG is treated with the enzyme papain under conditions of limited proteolysis, the enzyme acts on the hinge region and cleaves the IgG into three separate pieCes Gig. a-3). TWo of the pieces are identical to each other and consist of the complete light chain (Vt and C.) associatedwith a V,,-CHl fragment of the heavy chain. These fragments retain the ability to bind antigen because each contains paired Vt and Vn domains, and
I
,N\
Papain products cleavedby the enzymespapain(A) and pepsin(B)at the sitesindicatedby arrows Papaindigestionallowsseparation of two antigen-bindingregions (the Fab f ragments)from the portionof the lgG molecule that binds to complementand Fc receptors(the Fc fragment) Pepsingenerates a single bivalentantigen-binding fragment,F(ab')z
they are called Fab (fragment, antigen binding). The third piece is composed of two identical, disulfidelinked peptides containing the heavy chain Cg2 and Cs3 domains. This piece of IgG has a propensity to selfassociateand to crystallize into a lattice and is therefore called Fc (fragment, crystallizable). \iVhen pepsin {instead of papain) is used to cleave rabbit IgG under limiting conditions, proteolysis occurs distal to the hinge region, generating an F(ab'), antigen-binding fragment of IgG with the hinge and the interchain disulfide bonds intact (seeFig. a-3). The results of limited papain or pepsin proteolysis of other isotypes besides IgG, or of IgGs of species other than the rabbit, do not always recapitulate the studies with rabbit IgG. However, the basic organization of the Ig molecule that Porter deduced from his experiments is common to all Ig molecules of all isotypes and of all species.In fact, these proteolysis experiments provided the first evidence that the antigen recognition functions and the effector functions of Ig molecules are spatially segregated.
Structural Features of Variable and Their Relationship to Antigen Binding
Regions
Most of the sequence dffirences among dffirent antibodies are confined to three short stretches in the V region of the heavy chain and to three stretches in theV region of the light chain. These diverse stretches are knorrrmas hlpervariable segments, and they correspond to three protruding loops connecting adjacent strands of the B-sheetsthat make up theV domains of Ig heary and light chain proteins (Fig.4-4). The hlpervariable regions are each about 10 amino acid residueslong, and they are held in place by more conserved framework sequences that make up the Ig domain of the V region. The genetic mechanisms leading to amino acid variability are discussed in Chapter 8. In an antibody molecule, the three hlpervariable regions of a Vr domain and the three hypervariable regions of a Vs domain are brought together to form an antigen-binding surface. Because these sequences form a surface that is complementary
ANDANTIGENS 4 - ANTIBODIES Chaoter
CDR3 CDR2 CDRl
i :i
(U
:
, , l , , l l lai l
L
I
50
60
70
80
Residue +
1 0 0 1 1 0t
i
in lg moleculesThe histogramsdepictthe FIGURE ,t-4 Hypervariable regionsin lg molecules.A Kabatwu plot of aminoacidvariability sequencedlg lightchains, in eachaminoacidresidueamongvariousindependently extentof variabiliiy definedas the numberof differences developedby ElvinKabatand Tai plottedagainstaminoacidresiduenumber,measuredfrom the aminoterminus This methodof analysis, regions,coloredin blue,yellow,and red, correTe Wu, indicatesthat the most variableresiduesare clusteredin three "hypervariable" of Dr.E.A.Kabat, regionsarealsopresentin heavychains.(Courtesy Threehypervariable spondingto CDR'1 , CDR2,and CDR3,respectively. view of the hyperand Surgeons,New York.)B. Three-dimensional Departnientof Microbiology, ColumbiaUniversityCollegeof Physicians variableCDR loopsin a lightchainV domain.The V regionof a lightchainis shown with CDR1,CDR2,and CDR3loops,coloredin blue, plot in A Heavychain hypervariable yellow,and red, respectivelyThese loopscorrespondlothe hyplrvariableregionsin the variability iegions(not shown)are also locatedin ihree loops,and all six loopsare juxtafosedin the antibodymoleculeto form the antigen-binding surface(see Fig 4-5)
to the three-dimensional structure of the bound antigen, the hlpervariable regions are also called complemenregions (CDRs). Proceeding from tarity-determining either theVs or theVH amino terminus, these regions are called CDRI, CDR2, and CDR3 (seeFig. 4-4). The CDR3s of both the Vs segment and the VL segment are the most variable of the CDRs. As we will discuss in Chapter 8, there are special genetic mechanisms for generating more sequence diversity in cDR3 than in cDRl and CDR2. Crystallographic analyses of antibodies reveal that the CDRs form extended loops that are exposed on the surface of the antibody and are thus available to interact with antigen (seeFig. 4-4). Sequencedifferences among the CDRs of different antibody molecules contribute to distinct interaction surfaces and, therefore, specificities of individual antibodies. The abiliry of a V region to fold into an Ig domain is mostly determined by the conserved sequencesof the framework regions adjacent to the CDRs. Confining the sequence variability to three short stretches allows the basic structure of all antibodies to be maintained despite the variability among different antibodies. Antigen binding by antibody mol.ecules is primarily a function of the hyperuariable regions of Vs and Vy Crystallographic analyses of antigen-antibody complexes show that the amino acid residues of the hlpervariable regions form multiple contacts with bound antigen (Fig.a-5). The most extensivecontact is with the
third hlpervariable region (CDR3), which is also the most variable of the three CDRs. However, antigen binding is not solely a function of the CDRs, and framework residues may also contact the antigen. Moreover, in the binding of some antigens, one or more of the CDRs may be outside the region of contact with antigen, thus not participating in antigen binding. Structural Features of Constant Regions and Their RelationshiP to Effector Functions Antibody molacules can be diuided' into d'ktinct classes and subclasses on the bask of dffirences in the struc-
Heavy chains are designated by the letter of the Greek alphabet corresponding to the isotype of the antibody:
86
; ll - RECOGNtTt0N 0FANT|cENS $ Section
n antigenby an antibody.A. This model n (henegg lysozyme)boundto an antithe antigen-binding site can accommoes in their native(folded)conformation.
anotherare shown in red.A critrcalglutamineresidueon lysozyme (in magenta)fits into a "cleft" in the antibody.(Thisfigureis based on Figure38 and reprintedwith permissionfrom Amit AG, RA Mariuzza, SE Phillips, and RJ Poljak.Threedimensional structureof an antigen antibodycomplex at 2.BA resolution Science233, 7 47-153,1986. Copyright1986 AAAS.)
designated Cn and numbered sequentially from amino terminus to carboxyl terminus (e.g., Csl, Cs2, and so on). In each isotype, these regions may be designated more specifically (e.g., Cl, C?. in IgG). Antibodies can
tinely used in the clinical and experimental analyses of humoral immune resDonses. Differentisotypes and subtypes of antibodies perform dffirent effector functions. The reason for this is that most of the effector functions of antibodies are mediated by the binding of heavy chain C regions to Fc receptors on different cells, such as phagocytes,NK cells, and mast cells, and to plasma proteins, such as complement proteins. Antibody isotypes and subtypes differ in their C regions and therefore in what they bind to and what effector functions they perform. The effector functions mediated by each antibody isotype are listed in Table 4-2 and are discussedin more detail later in this chapter and in Chapter 14. Antibod.y molecules are flexible, permitting them to bind to different arrays of antigens. Every antibody contains at least two antigen-binding sites, each formed by a pair of V, and V, domains. Many Ig molecules can orient these binding sites so that tvvo antigen molecules on a planar (e.g.,cell) surface may be engaged at once Fig. 4-6). This flexibility is conferred, in large part, by a hinge region located between Csl and Cg2 in certain isotypes. The hinge region varies in length from l0 to more than 60 amino acid residues in different isotypes. Portions of this sequence assume a random and flexible conformation, permitting molecular motion between the Cgl and, Cr2 domains. Some of the greatest differences between the constant regions of the IgG subclasses are concentrated in the hinge. This leads to different overall shapes of the IgG subtypes. In addition, some flexibility of antibody molecules is due to the ability of each V.. domain to rotate with respect to the adjacent Csl domain. There are two classes, or isotypes, of ltght chains, called rcand )"which are dktinguLshedby their carboxyterminal constant (C) regions. Anantibody molecule has either two r light chains or two l, light chains, but never one of each. In humans, about 60% of antibody molecules have r light chains, and about 40To have l" light
'Closely spacedcell surfacedeterminants surfacedeterminants Widelyspacedcell
determinants separatedby varyingdistances.ln A, an lg molecule is depictedbindingto two widely spaceddeterminantson a cell surface,and in B, the sameantibodyis bindingto two determinants that are close together.This flexibilityis mainlydue to the hinge regionslocatedbetweenthe CH'1and Cs2 domains,which permit independent movementof antigen-binding sites relativeto the rest of the molecule
Table 4-2. Human Antibody lsotypes
lsotypeof SubtypesH chain Serum Serum Secretedform antibody concentr.half-life (mg/mL) (days)
Functions
6
lgA (dimer)
Mucosalimmunity
Trace
3
None
NaiveB cell antigenreceptor
0.05
2
Defenseagainst parasites, helminthic immediate hypersensitivity
y(1,2,3 13.5 or 4)
23
Opsonization, complement activation,antibodycelldependent mediatedcytotoxicity, neonatalimmunity, feedbackinhibition of B cells
p
5
lgA
lgA1,2
all or 2) 3.5
lgD
None
6
lgE
None
a
lgG
lgGl-4
lgM
None
1.5
lgM
Cp1
t,t:
NaiveB cellantigen complement receptor, activation
The effectorf unctionsof antibodiesare discussedin detailin Chapter14
chains. Marked changes in this ratio can occur in patients with monoclonal B cell tumors because the neoplastic clone produces antibody molecules with the same light chain. In fact, the ratio of r-bearing cells to l,bearing cells is often used clinically in the diagnosis of B cell lymphomas. In mice, r-containing antibodies are about 10 times more abundant than l"-containing antibodies. Unlike in heavy chain isotypes, there are no kno',nm differences in function between r-containing antibodies and l.-containing antibodies.
antibod'iesdffir and membrane-associated Secreted, in the amino acid.sequenceof the carboxy-terminal end of the heavychain C region.In the secretedform,found in blood and other extracellular fluids, the carboxyterminal portion is hydrophilic.The membrane-bound form of antibody contains a carboxy-terminal stretch that includesa hydrophobics-helical transmembrane anchor region followed by an intracellular juxtamembrane positively charged stretch that helps anchor the protein in the membrane(Fig.4-7).In membraneIgM
88
S e c t i olnl - R E C O G N I T0I 0FN ANTTGENS
Antibody molecules are proteins and can therefore b e i m m u n o g e n i cl m m u n o l o g i s thsa v ee x p l o i t e d t h i sf a c t t o p r o d u c ea n t i b o d i e ss p e c i f i cf o r l g m o l e c u l e st h a t c a n b e u s e d a s r e a g e n t st o a n a l y z et h e s t r u c t u r ea n d f u n c t i o no f t h e l g m o l e c u l e sT o o b t a i na n a n t i - a n t i b o d y r e s p o n s e t, t i s n e c e s s a r yt h a t t h e l g m o l e c u l e su s e d t o r m m u n r z ea n a n i m a lb e r e c o g n i z e di n w h o l e o r i n p a r t a s f o r e i g n T h e s i m p l e s ta p p r o a c hi s t o i m m u n i z e a n a n r m aol f o n e s p e c i e s( e g , r a b b i t w ) ith lg molecules o f a s e c o n d s p e c i e s ( e g , m o u s e ) p o p u l a t i o n so f a n t i b o d i e sg e n e r a t e db y s u c h c r o s s - s p e c i ei m s munizat r o n sa r e l a r g e l ys p e c i f i cf o r e p i t o p e sp r e s e n ti n t h e c o n s t a n t ( C ) r e g i o n so f l i g h t o r h e a v y c h a i n s A n t i s e r a generated r n t h i s w a y c a n b e u s e dt o d e f i n et h e i s o t v p e of an antibody W h e n a n a n i m a l i s i m m u n i z e dw i t h l g m o l e c u l e s d e r i v e df r o m a n o t h e ra n i m a lo f t h e s a m e s p e c i e s t, h e r m m u n er e s p o n s ei s c o n f i n e dt o e p i t o p e so f t h e i m m u n i z i n gl g t h a t a r e a b s e n to r u n c o m m o no n t h e l g m o l e c u l e so f t h e r e s p o n d earn i m a lT, w ot v p e so f d e t e r m r n a n t s h a v eb e e n d e f i n e db y t h i s a p p r o a c hF i r s t ,d e t e r m i n a n t s m a y b e f o r m e db y m i n o rs t r u c t u r adl i f f e r e n c e(sp o l y m o r p h i s m s )i n a m i n o a c i d s e q u e n c e sl o c a t e di n t h e c o n s e r v e dp o r t i o n so f l g m o l e c u l e sc, a l l e da l l o t o p e s .A l l a n t i b o d ym o l e c u l e st h a t s h a r ea p a r t i c u l aar l l o t o p ea r e s a i dt o b e l o n gt o t h e s a m ea l l o t y p e .I n s i m p l et e r m s ,a n a l l o t y p ei s t h e p r o t e i np r o d u c o t f a d i s t i n c at l l e l i cf o r m o f a n l g g e n e D r f f e r e nitn d i v i d u a li sn a s p e c i e sm a y i n h e r i t t w o d i f f e r e n ft o r m s o f a n y l g g e n e M o s t a l l o t o p e sa r e l o c a t e di n t h e C r e g i o n so f l i g h to r h e a v yc h a i n sb, u t s o m e a r e f o u n d i n t h e f r a m e w o r kp o r t i o n so f V r e g i o n sA l l o typic differenceshave been importantin the study of lg g e n e t r c sF o re x a m p l ea, l l o t y p e d s e t e c t e db y a n t i - l ga n t i b o d i e sw e r e i n i t i a l l yu s e d t o l o c a t et h e p o s i t i o no f l g g e n e s b y l i n k a g ea n a l y s i sI n a d d i t i o n t, h e r e m a r k a b l e o b s e r v a t i otnh a t , i n h o m o z y g o u as n i m a l sa, l l t h e h e a v y c h a i n so f a p a r t i c u l ai rs o t y p e( e g , l g M ) s h a r et h e s a m e a l l o t y p ee v e n t h o u g ht h e V r e g i o n so f t h e s e a n t i b o d i e s h a v ed i f f e r e n ta m i n oa c i d s e q u e n c e sp r o v i d e dt h e f i r s t e v i d e n c et h a t t h e C r e g i o n so f a l l l g m o l e c u l e o s f a part i c u l a irs o t y p ea r ee n c o d e db y a s i n g l eg e n es e g m e n t h a t r ss e p a r a t e f r o m t h e g e n es e g m e n t se n c o d i n g V regions and IgD molecules, the cytoplasmic portion of the healy chain is short, only three amino acid residues in length; in membrane IgG and IgE molecules, it is somewhat longer, up to 30 amino acid residues in length, but this includes the positively charged three-amino acid juxtamembrane sequence. SecretedIgG and IgE, and all membrane Ig molecules, regardlessof isotype, are monomeric with respect to the basic antibody structural unit (i.e., they contain two hear,y chains and two light chains). In contrast, the secreted forms of IgM and IgA form multimeric complexes in which two or more of the four-chain core antibody structural units are covalently joined. IgM may be secreted as pentamers and hexamers of the core fourchain structure, while IgA is often secreted as an Ig dimer. These complexes are formed by interactioni
As is discussedin Chapter8, we now know that this surp r i s i n gc o n c l u s i o ins c o r r e c t . The second type of determinanton antibodymolec u l e st h a t c a n b e r e c o g n i z eads f o r e i g nb y o t h e ra n i m a l s of the same speciesis that formed by the hypervariable r e g i o n so f t h e l g v a r i a b l de o m a i n sW h e na h o m o g e n e o u s p o p u l a t i o no f a n t i b o d y m o l e c u l e s( e g , a m y e l o m a p r o t e i no, r a m o n o c l o n aaln t i b o d yi )s u s e da s a n i m m u n o g e n ,a n t i b o d i eas r e p r o d u c e dt h a t r e a c tw i t h t h e u n i q u e hypervariable loopsof that antibody.Thesedeterminants are recognizedas foreign because they are usually p r e s e n ti n v e r y s m a l lq u a n t i t i e isn a n y g i v e na n i m a l( i e , a t t o o l o w a l e v e lt o i n d u c es e l f - t o l e r a n c eT)h. e u n i q u e d e t e r m i n a n tosf i n d i v i d u aaln t i b o d ym o l e c u l e a s recalled i d i o t o p e s ,a n d a l l a n t i b o d ym o l e c u l e st h a t s h a r e a n idiotopeare said to belongto the same idiotype. As is d i s c u s s e di n C h a p t e r8 , h y p e r v a r i a b lsee q u e n c e st h a t form idiotopesariseboth from inheritedgermlinediversity and from somaticevents ldiotopesmay be involved in regulationof B cell functions.The theory of lymphocyte regulationthrough idiotopesof antigenreceptors, c a l l e dt h e n e t w o r kh y p o t h e s i si s, m e n t i o n e di n C h a p t e r 11. I na d d i t i o n t o e x p e r i m e n t a lel yl i c i t e da n t i - l ga n t i b o d i e s , i m m u n o l o g i s thsa v e b e e n i n t e r e s t e di n n a t u r a l l yo c c u r r i n g a n t i b o d i e sr e a c t i v ew i t h s e l f l g m o l e c u l e sA n t i - l g a n t i b o d i e sa r e p a r t i c u l a r lpyr e v a l e n itn a n a u t o l m m u n e d i s e a s ec a l l e dr h e u m a t o i d a r t h r i t i s( s e e C h a p t e r1 8 ) , i n w h i c h s e t t i n g t h e y a r e k n o w n a s r h e u m a t o i df a c t o r R h e u m a t o ifda c t o ri s u s u a l l ya n l g M a n t i b o d yt h a t r e a c t s with the constantregionsof self lgG The significance of r h e u m a t o i df a c t o r i n t h e p a t h o g e n e s ios f r h e u m a t o i d a r t h r i t i sr s u n k n o w n . P a t i e n t st r e a t e dw i t h m o u s e m o n o c l o n aal n t i b o d i e s m a y m a k e a n t i b o d i e sa g a i n s tt h e m o u s e l g , c a l l e da human antr-mouseantibody (HAN/A)response These a n t i - l ga n t i b o d i ees l i m i n a t e t h e i n j e c t e dm o n o c l o n aaln t i b o d y .H u m a n i z eadn t i b o d i ehs a v eb e e nd e v e l o p e tdo c i r c u m v e n tt h i s p r o b l e m ,b u t e v e n h u m a n i z e da n t i b o d i e s containhypervariable regionsderivedfrom the original m o n o c l o n aaln t i b o d ya, n d t h e s ec a n e l i c i ta r e s p o n s ei n treatedpatients.
between regions, called tail pieces,that are located at the carboxy-terminal ends of the secreted forms of prand a hear,y chains (see Table 4-2). Multimeric IgM and IgA molecules also contain an additional 15-kD polypeptide called the joining (I) chain, which is disulfide bonded to the tail pieces and serves to stabilize the multimeric complexes, and to transport multimers across epithelia from the basolateral to the luminal end. Synthesis, Assembly, lg Molecules
and Expression
of
Ig hear,y and light chains, like most secreted and membrane proteins, are synthesized on membrane-bound ribosomes in the rough endoplasmic reticulum. The protein is translocated into the endoplasmic reticulum,
C h a p t e4r- A N T I B O D IAENSDA N T I G E N S
Membrane lgG
Membrane lgM
Secreted lgM
drophobic
drophobic
transmembrane regron
transmembrane regron
tail
tail Cytoplasmic -
p heavychainC region Transmembrane region @
y heavychainC region tail Cytoplasmic
LightchainC region
FIGURE c-7 Membraneand secretedformsof lg heavychains.The membraneforms of the lg heavychains,but not the secretedforms, amongthe aminoacid residuesand cytoplasmicomainsthat differsignificantly regionsmade up of hydro=phobii conrarnrTansmemDrane region portionof ihe membraneform of the p chaincontainsonly residues,whereasthe cytoplasmic differentisotypes.The cytdplasmic of lgG heavychainsconiains20-30 residues.The secretedforms of the antibodiesend in C-t minaltail pieces,which also differamong isotypes:trrhas a longtail piece(21 residues)that is involvedin pentamerformation,whereaslgGshavea shorttail piece(3 residues)
and Ig hear,y chains are N-glycosylated during the translocation process. The proper folding of Ig heaqr chains and their assemblywith Iight chains are regulated by proteins resident in the endoplasmic reticulum called chaperones.These proteins, which include calnexin and a molecule called BiP (binding protein), bind to newly slmthesized Ig polypeptides and ensure that they are retained or targeted for degradation unless they become properly folded and assembled into Ig molecules. The covalent association of hear,yand light chains, stabilized by the formation of disulfide bonds, also occurs in the endoplasmic reticulum. After assembly,the Ig molecules are released from the chaperones and directed into the cisternae of the Golgi complex, where carbohydrates are modified, and the antibodies are then transported to the plasma membrane in vesicles.Antibodies of the membrane form are anchored in the plasma membrane and the secreted form is transported out of the cell. Other proteins that bind to Ig are coordinately regulated. For instance, secreted IgA and IgM antibodies are maintained as multimers by the attached J chains. In plasma cells, transcription of Ig heary and light chain genes is accompanied by coordinate J chain gene transcription and biosynthesis. The maturation of B cellsfrom bone marrow progenitors is accompanied. by specific changes in Ig gene expression, resulting in the production of Ig molecules in dffirent fonzs (Fig. 4-8). The earliest cell in the B lymphocyte lineage that produces Ig polypeptides, called the pre-B cell, synthesizesthe membrane form of the p hear,y chain. These p chains associate with proteins called surrogate light chains to form the pre-B cell receptor, and a small proportion of the synthesized pre-B cell receptor is expressedon the cell surface. Immature and mature B cells produce r or l, light chains, which associate with p proteins to form IgM molecules. Mature B cells expressmembrane forms of IgM and IgD (the p and
5 heavy chains associatedwith r or l" light chains). These membrane Ig receptors serve as cell surface receptors that recognize antigens and initiate the process of B cell activation. The pre-B cell receptor and the B cell antigen receptor are noncovalently associated with two other integral membrane proteins, Igo and IgB, which serve signaling functions and are essential for surface expression of IgM and IgD. The molecular and cellular events in B cell maturation underlying these changes in antibody expression are discussed in detail in Chapter 8' \A{henmature B lymphocytes are activated by antigens and other stimuli, the cells differentiate into antibody-
will be discussedin Chapter 10.The second change is the expressionof Ig heaqz chain isotypes other than IgM and tgD. rnis process, called heary chain isotype (or class) switching, is described later in this chapter and in more detail in Chapter 10,when we discuss B cell activation'
oFANTIGENS Blruoluc ANrtaooY Features of Biologic
Antigens
An antigen is any substance that may be speciflcally bound by an antibody molecule or T cell receptor' Antibodies can recognize as antigens almost every kind of biologic molecule, including simple intermediary metabolites, sugars,lipids, autacoids, and hormones, as well as macromolecules such as complex carbohydrates, phospholipids, nucleic acids, and proteins. This is in Lontrast to T cells,which mainly recognize peptides (see Chapter 6).
89
90
i
S e c t i olnl -
R E C 0 G N t T t00FNA N T T G E N S
r,rl,ri#d-;...
"-.;-',-
Stageof maturation
Patternof immunoglobulin production
Stem cell
None
Pre-B cell
lmmature B cell
Mature B cell
Activated B cell
Cytoplasmic Lowrate u heavv lg secretion; inain ano MemDrane Membrane heavychainisotype lgM lgM,lgD ore-B switching; rdceptor affinitymaturation
Antibodysecretingcell Highrate lg secretion; reduced membrane lg
FIGURE 4-8 lg_expression during B lymphocytematuration.Stagesin B lymphocytematurationare shown with associated changesrn the.productionof lg heavyand light chains lgM heavychainsare shown in red, lgD heavychainsin blue,and lightchainsin green"The m o l e c u l aerv e n t sa c c o m p a n y i nt hge s ec h a n g e sa r ed i s c u s s e idn c h a p t e r sB a n d 1 0
Although all antigens are recognized by specific tymphocytes or by antibodies, only some antigens are capable of actiuetinglymphocytes. Molecules that stimulate immune responses are called immunogens. Only macromolecules are capable of stimulating B lymphocytes to initiate humoral immune responses,because B cell activation requires either the bringing together (cross-linking) of multiple antigen receptors, or requires protein antigens to elicit T cell help. Small chemicals, such as dinitrophenol, may bind to antibodies, and are therefore antigens, but cannot activate B cells on their oum (i.e., they are not immunogenic). To generate antibodies specific for such small chemicals, immunologists commonly attach them to a protein before immunization. In these cases, the small chemical is called a hapten, and the protein to which it is conjugated is called a carrier. The hapten-carrier complex, uniike free hapten, can act as an immunogen (see Chapter l0). A second approach to make a hapten immunogenic is to render it multivalent, as discussed below often bv attaching a number of hapten molecules to a single molecule of a polysaccharide. Macromolecules, such as proteins, polysaccharides, and nucleic acids, are usually much bigger than the antigen-bindingregion of an antibodymolecule (seeFig. 4-5). Therefore, any antibody binds to only a portion of the macromolecule, which is called a determinant or an epitope. These two words are svnonvmous and are used interchangeably throughout this book. Macromolecules typically contain multiple determinants, some of which may be repeated, and each of which, by definition, can be bound by an antibody. The presence of multiple identical determinants in an antigen is referred to as pol1rualency or multivalency. Most globular proteins do not contain multiple identical epitopes and are not pol),valent,, unless they are in aggregates.In the case of polysaccharides and nucleic acids, many identical epitopes may be regularly spaced, and the molecules are said to be polyvalent. Cell surfaces, including microbes, often display polyvalent arrays of protein or carbohydrate antigenic determinants. Polyvalent antigens can induce
clustering of the B cell receptor and thus initiate the process of B cell activation. The spatial arrangement of dffirent epitopes on a single protein molecule may influence the binding of antibodies in seueral ways.When determinants are well separated, tvvo or more antibody molecules can be bound to the same protein antigen without influencing each other; such determinants are said to be nonoverlapping. \Mhen two determinants are close to one another, the binding of antibody to the first determinant may cause steric interference with the binding of antibody to the second; such determinants are said to be overlapping. In rarer cases,binding of one antibody may cause a conformational change in the structure of the antigen, positively or negatively influencing the binding of a second antibody at another site on the protein by means other than steric hindrance. Such interactions are called allosteric effects. Any auailable shape or surface on a molecule that may be recognized by an antibody constitutes an antigenic determinant or epitope. Antigenic determinants may be delineated on any type of compound, including but not restricted to carbohydrates,proteins, lipids, and nucleic acids. In the case of proteins, the formation of some determinants depends only on the primary structure, and the formation of other determinants reflects tertiary structure (Fig. -9). Epitopes formed by several adjacent amino acid residues are called linear determinants. The antigen-binding site of an antibody can usually accommodate a linear determinant made up of about six amino acids. If linear determinants appear on the external surface or in a region of extended confbrmation in the native folded protein, they may be accessible to antibodies. More often, linear determinants may be inaccessible in the native conformation and appear only when the protein is denatured. In contrast, conformational determinants are formed by amino acid residues that are not in a sequencebut become spatially juxtaposed in the folded protein. Antibodies specific for certain linear determinants and antibodies specific for conformational determinants can be used to ascertain
SDA N T I G E N S C h a p t e4r- A N T I B O D IAEN
determinant Neoantigenic (createdby proteolysis)
Conformational determinant I I I I I I
Inaccessible determinant
I I
t l
Denaturation,', \Denaturation
N I
:i
I I I I I I I I I I I I I I
lost Determinant by denaturation
lg bindsto in determinant denatured proteinonly
lg binds to determinantin both native and denatured protein
I I I I I I I
Determinantnear site of proteolysis
(shownin orange,red,and blue)may dependon proteinfoldFIGURE rS-9 The natureof antigenicdeterminants, Antigenicdeterminants (A), are accessiblein nativeproteinsand are lost on denaturation ing (conformation) as well as on primarystructure Some determinants such as peptidebond modifications arisefrom postsynthetic *iereas othersare exposedonly on proteinunfolding(B) Neodeterminants cleavage(C)
whether a protein is denatured or in its native conformation, respectively.Proteins may be subjected to modifications such as glycosylation, phosphorylation, or proteolysis. These modifications, by altering the structure of the protein, can produce new epitopes. Such epitopes are called neoantigenic determinants, and they too may be recognized by specific antibodies.
Structural and Chemical Antigen Binding
Basis of
The antigen-binding sitesof most antibodies are planar surfaces that can accommodate conformational epitopes of macromolecul.es, allowing the antibodies to bind large macromolecules (seeFig. 4-5) . As is discussed in Chapter 5, this is a key difference between the antigen-binding sites of antibody molecules and those of certain other antigen-binding molecules of the immune system, namely, MHC molecules, which contain antigen-binding clefts that bind small peptides but not native globular proteins (seeTable 4-1). In some instances, such as antibodies specific for small carbohydrates, the antigen is bound in a cleft betweenVl andVn domains. The recognition ofantigen by antibody inuolues noncovalent, reversible binding. Various types of noncova-
lent interactions may contribute to antibody binding of antigen, including electrostatic forces, hydrogen bonds, van derWaals forces, and hydrophobic interactions. The relative importance of each of these depends on the structures of the binding site of the individual antibody and of the antigenic determinant. The strength of the binding between a single combining site of an antibody and an epitope of an antigen is called the affinity of the antibody. The affrnity is commonly represented by a dissociation constant (IQ), which indicates how easy it is to separate an antigen-antibody complex into its constituents. A smaller IQ indicates a stronger or higheraffinity interaction because a lower concentration of antigen and of antibody is required for complex formation. The IQ of antibodies produced in typical humoral immune responses usually varies from about l0-7M to 10-1tM. Serum from an immunized individual will contain a mixture of antibodies with different afflnities for the antigen, depending primarily on the amino acid sequencesof the CDRs. Because the hinge region of antibodies gives them flexibility, a single antibody may attach to a single multivalent antigen by more than one binding site. For IgG or IgE, this attachment can involve, at most, two binding sites, one on each Fab. For pentameric IgM, however, a single antibody may bind at up to 10 different sites (Fig. 4-10). Polyvalent antigens will have more than one copy
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of a particular determinant. Although the affinity of any one antigen-binding site will be the same for each epitope of a polyvalent antigen, the strength of attachment of the antibody to the antigen must take into account binding of all the sites to all the available epitopes. This overall strength of attachment is called the avidity and is much greater than the affinity of any one antigen-binding site. Thus, a low-affinity IgM molecule can still bind tightly to a polyvalent antigen because many low-affinity interactions (up to l0 per IgM molecule) can produce a single high-avidity interaction. Polyvalent antigens are important from the viewpoint ofB cell activation, as discussedearlier. Polyvalent interactions between antigen and antibody are also of biologic significance because many effector functions of antibodies are triggered optimally when two or more antibody molecules are brought close together by binding to a polyvalent antigen. If a polyvalent antigen is mixed with a specific antibody in a test tube, the two interact to form immune complexes (Fig. a-ll). At the correct concentration, called a zone of equivalence, antibody and antigen form an extensively cross-linked network of attached molecules such that most or all of the antigen and antibody molecules are complexed into large masses. Immtrne complexes may be dissociated into smaller aggregateseither by increasing the concentration of antigen so that free antigen molecules will dis-
place antigen bound to the antibody (zone of antigen excess) or by increasing antibody so that free antibody molecules will displace bound antibody from antigen determinants (zone of antibody excess). If a zone of equivalence is reached in vivo, large immune complexes can form in the circulation. Immune complexes that are trapped or formed in tissues can initiate an inflammatory reaction, resulting in immune complex diseases (seeChapter l8).
SrRucrunr-Furucrroru RrmnorusHtps tN ANrreoov Molrcuus Many structural features of antibodies are critical for their ability to recognize antigens and for their effector functions. In the following section, we summarize how the structure of antibodies contributes to their functions.
Features Related to Antigen
Recognition
Antibodies are able to specifically recognize a wide variety of antigens with varying affinities. AII the features ofantigen recognition reflect the properties ofantibody V regions.
lv"t"*y "il l-A"idity "f II linteractionl I interaction
ffi
antigens,or epitopesspacedfar aparton cell surfaces,will interactwith a singlebinding site of one antibodymoleculeAlthoughthe affinityof this interactionmay be high,the overallaviditymay be relativelylow When repeateddeterminants on a cell surfaceare closeenough,both the antrgen-binding sites o f a s i n g l el g G m o l e c u l ec a n b i n d ,l e a d i n g to a higher-avidity bivalentinteractionThe hingeregionof the lgc motecuteaccommodatesthe shapechangeneededfor simultaneous engagementof both binding sites. lgM moleculeshave '10 identicalantigenbinding sites that can theoreticallybind simultaneously with 10 repeatingdeterminantson a cell surface,resultingin a polyvalent,high-avidity interaction
ANDANTIGENSI 4 - ANTIBODIES Chaoter
Zone ol Zone of Zone of antigenexcess equivalence antibodyexcess (smallcomplexes) (largecomplexes) (smallcomplexes)
a n t i g e no r a n t i b o d e y xcess a r e s n a l l e r; n r e l a t i v e
Specificity Antibodies can be remarkably specific for antigens, distinguishing between small differencesin chemical structure. Classicexperiments performed by Karl Landsteiner in the 1930s demonstrated that antibodies made in response to an aminobenzene hapten with a metasubstituted sulfbnate group would bind strongly to this hapten but weakly or not at all to ortho- or parasubstituted isorners. These antigens are structurally similar and differ only in the location of the sulfonate group on the benzene ring. The fine specifrcity of antibodies applies to the recognition of all classesof molecules. For exarnple, arltibodies can distinguish between tvvo linear protein deterrninants differing by only a single conservative amino acid substitution that has little effect on secondary structure. Because the biochemical constituents of all living organisms are fundamentally similar, this high degree of specificity is necessaryso that antibodies generated in response to the antigens of one microbe usually do not react with structurally similar self molecules or with the antigens of other microbes. However, some antibodies produced against one antigen may bind to a different but structurally related antigen. This is referred to as a cross-reaction. Antibodies that are produced in response to a microbial antigen sometimes cross-reactwith self antigens, and this may be the basis of certain immunologic diseases(see Chapter 18). Diversity As we discussed earlier in this chapter, an individual is capable of making a tremendous number of structurally distinct antibodies, perhaps up to 10s,each with a distinct specificity.T'he ability of antibodies in atty individual to specifically bind a large number of ditTerent antigens is a reflection of antibody diversity, and the total collection of antibodies with different specificities represents the antibody repertoire. The genetic mecha-
nisms that generate such a large antibody repertoire occur exclusivelyin lyrnphoc)'tes.They are based on the random recombination of a limited set of inherited germline DNA sequences into functional genes that encode the v regions of heaqr and light chains as well as on the addition of nucleotide sequences during the recombination process. These mechanisms are discussed in detail in Chapter 8. The millions of resulting variations in structure are concentrated in the hlpervariable regions of both hear,y and light chains and thereby deterrnine specificity for antigens'
Affinity
Maturation
The ability of antibodies to neutralize toxins and int'ectious microbes is dependent on tight binding of the antibodies. As we have discussed,tight binding is achieved by high-affinity and high-avidity interactions. A mechanism for the generation of high-affinity antibodies involves subtle changes in the structure of the V regions of antibodies duringT cell-dependent humoral immune responses to protein antigens. These changes come about by a process of somatic mutation in antigenstimulated B lymphocyes that generatesnewV domain structures, sotne of which bind the antigen with greater affinity than did the original V domains (Fig. 4-L2). Those B cells producing higher-affinity antibodies pref'erentially bind to the antigen and, as a result of ielection, become the dominant B cells with each subsequent exposure to the antigen. This process, called affinity maturation, results in an increase in the average binding affinity of antibodies for an antigen as a humoral imrnune respollse evolves. Thus, an antibody produced during a primary immune response to a 7 p.utein antigen often has a IQ in the range of 10 to increases, 1tt*M; in secondary responses, the aflinity with a IQ of 10-ttM or even less. The mechanisrns of somatic mutation and affinity maturation are discussed in Chapter 10.
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RECOGNIT|ON 0FANTTGENS
Changesin antibodystructure
Functional significance: Antiqen Effector recoghition functions
Affinity maturation Increased (somatic aflinity mutationsin variableregion)
No change
.''. ,ttt
Switchfrom membraneto secretedform
No chanqe '
Changefrom B cell receptor function to effectorfunction
No chanqe '
Eachisotype servesa differentset of effectorfunctions
j9€qlil :#;lalitJc"g€€€e
--
V region
*€r$tsJ{"###tgekboa*5
Ghangesin antibody stlucture during humoral immune responses.The illustrationdepictsthe changesin the structureof may be producedby the progenyof activatedB cells(oneclbne)and the relatedchangesin functionlDuringaffinitymatules in fine specificitywithoutchangesin C region-dependent effector rbrane-bound antibodiescontainingtransmembrane and cvtoplasmic how V gene mutations(i e , secretionof antibodies occursbeforeano indicatedby colorchangefrom blueto orange)withoutchangesin the nd and secretedantibodiesThe molecularbasisfor these chanqesis
Features Related to Effector
Functions
Many of the efiectorfunctions of immunoglobulins are mediated by the Fc portions of the molecules, and anti-
antigen-complexed IgG molecule is able to bind, through its Fc region, to t heavy chain-specific Fc receptors (FcRs) that are expressed on neutrophils and macrophages. In contrast, IgE binds to mast cells and triggers their degranulation because mast cells express IgE-specific FcRs. Another Fc-dependent effector mechanism of humoral immuniW is activation of the classical pathway of the co*pi"-ert system. The system generates inflammatory mediators and pro-
motes microbial phagocytosis and lysis. It is initiated by the binding of a complement protein called Clq to the Fc portions of antigen-complexed IgG or IgM. The FcRand complement-binding sites of antibodies are found within the heavy chain C domains of the different isotypes (seeFig.4-l). The structure and functions of FcRs and complement proteins are discussed in detail in Chapter 14. The effectorfunctiorts of antibodies are initiated only hy antibodies that haue bound antigens and not by free 1g.The reason that only antibodies with bound antigens activate effector mechanisms is that two or more adjacent antibody Fc portions are needed to bind to and trigger various effector systems, such as complement proteins and FcRs ofphagocytes (see Chapter f4). This requirement for adjacent antibody molecules ensures that the effector functions are targeted specifically toward eliminating antigens that are recognized by the antibody and that circulating free antibodies do not wastefully trigger effector responses.
Changes in the isotypes of antibodies during humoral immune responses influence how and where the responses work to eradicate antigen. After stimulation by an antigen, a single clone of B cells may produce antibodies with different isotypes yet identical V domains, and therefore identical antigen specificity. Naive B cells, for example, simultaneously produce IgM and IgD that function as membrane receptors for antigens.\Mhen these B cells are activated by an antigen such as a microbe, they may undergo a process called isotype switching in which the type of Cs region, and therefore the antibody isotype, produced by the B cell changes, but the V regions and the specificity do not (see Fig. 4-12). As a result of isotlpe switching, different progeny of the original IgM- and lgD-expressing B cell may produce isotypes and subrypesthat are best able to eliminate the antigen. For example, the antibody responseto many bacteria and viruses is dominated by IgG antibodies, which promote phagocytosis of the microbes, and the response to helminths consists mainly of IgE, which aids in the destruction of the parasites.The mechanisms and functional significance of isotype switching are discussed in Chapter 10. The heauy chain C regions of antibodies ako determine the tissue distribution of antibody molecules. As we mentioned earlier, after B cells are activated, they gradually lose expression of the membrane-bound antibody and express more of it as a secreted protein (see Fig. 4-12). IgA can be secreted efficiently through mucosal epithelia and is the major class of antibody in mucosal secretions and milk. Neonates are protected from infections by IgG antibodies they acquire from their mothers during gestation and early after birth. This transfer of maternal IgG is mediated by a special type of Fc receptor that is expressed in the placenta (through which antibodies enter the fetal circulation) and in the intestine. This receptor also protects IgG molecules from intracellular degradation and thus contributes to the long half-life of this antibody isotype.
SUMMARY e Antibodies, or immunoglobulins, are a family of structurally related glycoproteins produced in membrane-bound or secreted form by B lymphocytes. Membrane-bound antibodies serve as receptors that mediate the antigen-triggered activation of B cells. Secreted antibodies function as mediators of specific humoral immunity by engaging various effector mechanisms that serve to eliminate the bound antigens. c The antigen-binding regions of antibody molecules are highly variable, and any one indMdual has the potential to produce up to 10e different antibodies, each with distinct antigen specificity. e All antibodies have a common s1'rnmetric core structure of two identical covalently linked heavy
chains and two identical light chains, each linked to one of the heavychains.Eachchain consistsof two or more independently folded Ig domains of about 110 amino acids containing conserved sequencesand intrachain disulflde bonds. D The N-terminal domains of heavyand light chains form the V regions of antibody molecules,which differ among antibodies of different specificities. The V regions of heavy and light chains each contain three separate hypervariable regions of about 10 amino acidsthat are spatially assembled to form the antigen-combiningsite of the antibody molecule. I Antibodiesareclassifiedinto different isotypesand subtypeson the basis of differencesin the heavy chain C regions,which consistof three or four Ig C domains,and these classesand subclasseshave different functional properties. The antibody classesarecalledIgM, IgD, IgG,IgE,and IgA' Both Iight chainsof a singleIg molecule are of the same light chain isotype, either r or 1.,which differ in their singleC domains. o Most of the effector functions of antibodies are mediatedby the C regionsof the heavychains,but these functions are triggered by binding of antigensto the spatially distant combining site in the V region. O Antigens are substances specifically bound by antibodies or T lymphocyte antigen receptors. Antigensthat bind to antibodiesare a wide variety of biologicmolecules,includingsugars,lipids,carbohydrates,proteins, and nucleic acids.This is in contrast to T cell antigen receptors,which recognize only peptide antigens. e Macromolecular antigens contain multiple epitopes, or determinants,each of which may be recognized by an antibody. Linear epitopes of protein antigens consist of a sequence of adjacent amino acids, and conformational determinants are formed by folding of a polypeptide chain. o The affinity of the interaction between the combining site of a single antibody molecule and a single epitope is generallymeasuredas a IQ. Polyvalent antigenscontain multiple identical epitopes to which identical antibody molecules can bind. Antibodies can bind to two or, in the caseof IgM, up to 10identical epitopessimultaneously,leading to enhancedavidity of the antibody-antigeninteraction. The relative concentrations of polyvalent antigensand antibodies may favor the formation of immune complexesthat may deposit in tissues and causedamage.
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o Antibody binding to antigencan be highly specific, distinguishingsmall differencesin chemicalstructures,but cross-reactions may alsooccurin which two or more antigensmay be bound by the same antibody. o Several changes in the structure of antibodies made by one clone of B cells may occur in the course of an immune response.B cells initially produce only membrane-boundIg, but in activatedB cellsand plasmacells,slmthesisis induced of solubleIg with the sameantigen-bindingspecificiry asthe originalmembrane-boundIg receptor. Changesin the use of C region gene segments without changesin V regions are the basis of isotypeswitching,which leadsto changesin effector function without a changein specificity.point mutationsin the V regionsof an antibodyspecific for an antigen lead to increasedaffinity for that antigen (affinity maturation).
Selected
Readings
FagarasanS. Evolution, development,mechanism and function of IgA in the gut. Current Opinion in Immunology 2O:170-177,2008. HarrisLJ,SBLarsen,and A McPherson.Comparisonof intact antibody structuresand the implications for effector functions.Advancesin Immunology72:19l-208,1999. Krihler G, and C Milstein. Continuous cultures of fused cells secreting antibody of predefined speciflcity. Nature 256: 495-497,1975. Law M, and L Hengartner.Antibodiesagainstviruses:passive and active immunization. Current Opinion in Immunology 2O:486-492,2008. Lonberg N. Fully human antibodies from transgenic mouse and phagedisplayplatforms. Current Opinion in Immunology 20:450459,2008. SchaedelO, and Y Reiter.Antibodies and their fragments as anti-canceragents.CurrentPharmaceutical Design12:363378,2006. StanfleldRL,and IAWilson. Structuralstudiesof human HIV-l V3 antibodies.HumanAntibodiesl4:73-80,2005.
MAJ COMP Discovery of the MHC and lts Role in lmmune Responses,93 Discoveryof the MouseMHC,98 Discoveryof the HumanMHC,100 Properties of MHC Genes,101 Structure of MHC Molecules, 1O2 Properties of MHC Molecules,102 C l a s sI M H CM o l e c u l e s1.0 2 C l a s sl l M H CM o l e c u l e s1,0 4 Binding of Peptides to MHC Molecules, 1O4 of Peptide-MHC Characteristics Interactions, 105 StructuralBasisof PeptideBindingto MHC M o l e c u l e s1,0 6 Genomic Organization of the MHC, 1O7 Expression of MHC Molecules, 1O9 Summary, 11O
The principal functions of T lymphoc)'tes are defense against intracellular microbes and activation of other cells, such as macrophages and B lymphocltes. All these functions require that T lymphocltes interact with other cells, which may be infected host cells, dendritic cells, macrophages,and B lymphocytes. The antigen receptors ofT cells can only recognize antigens that are displayed on other cells.This specificity of T lymphocytes is in contrast to that of B lymphocytes and their secreted prod-
that determine the outcome of tissue transplants, We now know that the physiologic function of MHC molecules is the presentation of peptides to T cells. In faet, MHC molecules are integral components of the ligands that most T cells recognize because the antigen receptors of T cells are actually specific for complexes of foreign peptide antigens and self MHC molecules (schematically illustrated in Fig. 5-1). There are two main tlpes of MHC gene products, called class I MHC molecules and class II MHC molecules, which sample different pools of protein antigens, cltosolic (most commonly endogenously synthesized) antigens, and extracellular antigens endocytosed into vesicles,respectively. Class I MHC molecules present peptides to CD8* cytotoxic T ly'rnphocltes (CTLs),and classII MHC molecules to CD4* helper T cells. Thus, knowledge of the structure and biosynthesis of MHC molecules and the association of peptide antigens with MHC molecules is fundamental to understanding how T cells recognize antigens' We begin our discussion of antigen recognition by T cells with a description of the structure of MHC molecules, the biochemistry of peptide binding to MHC molecules, and the genetics of the MHC. In Chapter 6, we will discuss in more detail the presentation of antigens to T lymphocytes, the roles of class I and class II MHC molecules in this process, and the physiologic significance of MHC-associated antigen presentation. The structure of T cell antigen receptors is described in Chapter 7. The role of MHC molecules in graft rejection is described in Chapter 16. The terminology and 97
98
lt - RECOGNIT|ON 0FANTTGENS $ Section *
T cellcontact residueof peptide Polymorphic residueof MHC
Anchor residue of peptide "Pocket" of MHC tion of a peptide-MHG complex. This a n M H Cm o l e c u lbei n d i n a g n dd i s -
:i:":J:' :?'"" ?:ili%':i if:'[Tfi:' molecules' andr cell
receptors aredescribed I. chffi|"[?'NIHC
genetics of the MHC are best understood from a historical perspective, and we begin with a description of how the MHC was discovered.
DlscovrnY OFTHEMHCANDITSRou IIrI
luruurur Rrsporusrs Discovery
of the Mouse MHG
The MHC was discouered as the genetic locus whose
species (exceptfor relatively rare mutations); such genes are said to be nonpolymorphic, and the normal, or wildt]4)e, gene sequence is usually present on both chromosomes of a pair in every member of the species. By contrast, alternate forms, or variants, of other genes are present at stable frequencies in different members of the pooulation. Such genes are said to be poll'rnorphic, and each common variant of a polymorphic gene is called an allele. For polymorphic genes, an individual can have the same allele at that genetic locus on both chromosomes of the pair and would be said to be homozygous, or an individual can have two different alleles, one on each chromosome, and would be termed heterozygous. In the I940s, George Snell and his colleagues used genetic techniques to analyze the rejection of transplanted tumors and other tissues grafted between
mice are homozygous at every genetic locus, and every mouse of an inbred strain is genetically identical (syngeneic) to every other mouse of the same strain. In the
case ofpolyrnorphic genes, each inbred strain, because it is homozygous, expressesa single allele from the original population. Different strains may express different alleles and are said to be allogeneic to one another. \A/hen a tissue or an organ, such as a patch of skin, is grafted from one animal to another, two possible outcomes may ensue. In some cases,the grafted skin survives and functions as normal skin. In other cases, the immune system destroys the graft, a process called rejection. (We will discuss graft rejection in more detail in Chapter 16.) Skin grafting experiments showed that grafts exchanged between animals of one inbred strain are accepted, whereas grafts exchanged between animals of different inbred strains (or between outbred animals) are rejected (Fig. 5-2A). Therefore, the recognition of a graft as self or foreign is an inherited trait. The genes responsible for causing a grafted tissue to be perceived as similar to or different from one's or,rmtissues were called histocompatibility genes (genes that determine tissue compatibility between individuals), and the differences between self and foreign were attributed to polymorphisms among different histocompatibility gene alleles. The tools of genetics, namely, breeding and analysis of the offspring, were then applied to identiSr the relevant genes (Box 5-1). The critical strategy in this effort was the breeding of congenic mouse strains; in two congenic strains, the mice are identical at all loci except the one at which they are selected to be different. Analyses of congenic mice that were selected for their ability to reject grafts from one another indicated that a single genetic region is primarily responsible for rapid graft rejection, and this region was called the major histocompatibility locus. The particular locus that was identified in mice by Snell's group was linked to a gene on chromosome 17 encoding a blood group antigen called antigen II, and therefore this region was named histocompatibility-2, or simply H-2. Initially, this locus was thought to contain a single gene that controlled tissue compatibility. However, occasional recombination events occurred within the H-2 locus during interbreeding of different strains, indicating that it actually contained several different but closely linked genes, each involved in graft rejection. The genetic region that controlled graft rejection and contained several linked geneswas named the major histocompatibility complex. Genes that determine the fate of grafted tissues are present in all mammalian species, are homologous to the H-2 genes first identified in mice, and are all called MHC genes (Fig. 5-3). Other genes that contribute to graft rejection to a lesser degree are called minor histocompatibility genes; we will return to these in Chapter 16, when we discuss transplantation immunology. The nomenclature of mouse MHC genes is described in Box 5-1. MHC genescontrolimmune responsiuenessto protein antigens. For almost 20 years after the MHC was discovered, its only documented role was in graft rejection. This was apuzzle to immunologists because transplantation is not a normal phenomenon, and there was no obvious reason why a set of genes should be preserved
C0MPLEX HISTOC0IVIPATIBILITY 5 - THElVlAJ0R Chapter
lmmunization
Transplantation
(R) I I
, I
, I I I
ilt 1
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qruftIt [s*t-.r l-J'_
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response Yes Antibody for X specific
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Thetwo strainsof mlceshownare identicalexceptfor theirMHC FIGUBE 5-2 MHCgenescontrolglaft rejectionand immuneresponses. with a model alleles(referredto as a and b) Thesestrainsreiectskin qraftsfrom eachother (A)and responddifferentlyto immunization ( B) ) p r o t e i na n t i g e n( u s u a l lay s i m p l ep o l y p e p t i d e
through evolution if the only function of the genes was to control the rejection of foreign tissue grafts. In the 1960sand 1970s,it was discovered that MHC genes are of fundamental importance for all immune responsesto protein antigens. Baruj Benacerraf, Hugh McDevitt, and their colleaguesfound that inbred strains of guinea pigs
and mice differed in their ability to make antibodies against simple synthetic polypeptides, and responsiveness was inherited as a dominant mendelian trait (Fig. 5-28).The relevant geneswere called immune response (Ir) genes, and they were all found to map to the MHC. We now know that Ir genes are, in fact, MHC genes that
" C l a s sl l l "
ffi
I MHClocuso-'1 tta locus-1 Classll MHClocus ;rClass ;d I L--.-J
l
I FIGURE 5-3 Schematicmaps of human and of the mouseMHC loci. The basicorganization g e n e si n t h e M H C l o c u si s s l m i l airn h u m a n sa n d mice Sizesof genesand interveningDNA segments are not shown to scale Classll loci are shown as singleblocksbut each locusconsists of severalgenes Classlll MHC locusrefersto genesthat encodemoleculesotherthanpeptidedisplavmolecules;this term is not used comm a p o f t h e h u m a nM H C m o n l y A m o r ed e t a i l e d is in Figure5-9
Cytokines:
LTB,TNF.a,LT 8ffi?,l".lsll FactorB, C2
\
\
I-E JL ct"r, t l MHC locus C l ass I M H CI O C U S
MHC locus
MHC locus
99
100
S e c t i olnl -
R E C 0 G N I T I00FNA N T T G E N S
O u r k n o w l e d g eo f t h e o r g a n i z a t i oonf t h e M H C l o c u si s I n l a r g ep a r tt h e r e s u l to f m o u s eb r e e d i n gs t u d i e sA . key d e v e l o p m e nitn t h e s e s t u d i e sw a s t h e c r e a t i o no f c o n g e n r cm o u s es t r a i n st h a t d i f f e ro n l yi n t h e g e n e sr e s p o n s i b l e f o r g r a f t r e j e c t i o nM i c e o f a c o n g e n i cs t r a i na r e r d e n t i c at ol t h e p a r e n st t r a i na t e v e r yg e n e t i cl o c u se x c e p t t h e o n e f o r w h i c h t h e y a r e s e l e c t e dt o d i f f e r .T h e s t r a t e g y f o r d e r i v i n gc o n g e n i cm i c e i s b a s e do n b r e e d i n ga n d s e l e c t r o nf o r a p a r t i c u l atrr a i t I n t h e i r o r i g i n a le x p e r i m e n t s ,S n e l a l n dc o l l e a g u euss e da c c e p t a n coer r e j e c t i o n o f t r a n s p l a n t a btluem o r sa s t h e i ra s s a yf o r h i s t o c o m p a t i b i l i t y ,b u t t h i s i s m o r e e a s i l yd o n e w i t h s k i n g r a f t s F o r i n s t a n c ea, c r o s sb e t w e e ni n b r e ds t r a i n sA a n d B g e n e r a t e s ( A x B ) F ,o f f s p r i n g( F ,f o r f i r s tf i l i a lg e n e r a t i o nT) h e offspringare repeatedlybackcrossed to parentalstrainA, a n d a t e a c hs t a g et h e m i c e t h a t a r e s e l e c t e df o r b r e e d i n g a r e t h o s e t h a t a c c e p ta s k i n g r a f tf r o m s t r a i nB B y t h i s m e t h o d ,o n e c a n g e n e r a t em i c et h a t a r e g e n e t i c a l l y i d e n t i c at o l s t r a i nA e x c e p t h a tt h e y h a v et h e M H C l o c u s o f s t r a i nB I n o t h e rw o r d s ,m i c e w i t h t h e s t r a i nB M H C d o n o t r e c o g n i z es t r a i n B t i s s u e sa s f o r e i g na n d w i l l a c c e p ts t r a i nB g r a f t s ,e v e nt h o u g ha l l o t h e rg e n e t i cl o c i a r e f r o m s t r a i nA S u c hm i c e a r e s a i dt o b e c o n g e n i ct o s t r a i nA a n d t o h a v et h e " B M H C o n a n A b a c k g r o u n"d S u c hc o n g e n i cs t r a i n sh a v eb e e nu s e dt o s t u d yt h e f u n c t i o no f t h e M H C g e n e sa n dt o p r o d u c ea n t i b o d i easg a i n s t M H C - e n c o d epdr o t e i n s I n m i c e ,t h e N / l H C a l l e l e so f p a r t i c u l ai nr b r e ds t r a i n sa r e designatedby lowercaseletters(e g , a, b, c) The indiv i d u a lg e n e sw i t h i n t h e M H C a r e n a m e df o r t h e M H C t y p e o f m o u s es t r a i ni n w h i c h t h e y w e r e f i r s t i d e n t i f i e d . T h et w o r n d e p e n d e nMt H C l o c ik n o w nt o b e m o s rr m o o r t a n t f o r g r a f tr e j e c t i o ni n m i c e e n c o d ec l a s sI M H C m o l eculesand are calledH-2K and H-2D The K qene was f i r s t d i s c o v e r e idn a s t r a i nw h o s e M H C h a d b J e n o e s r g n a t e dk , a n d t h e D g e n ew a s f i r s t d i s c o v e r e idn a s t r a i n w h o s e M H C h a d b e e nd e s i g n a t e d I n t h e p a r l a n c e of m o u s eg e n e t i c i s t st h, e a l l e l eo f I h e H - 2 K q e n ei n a s t r a i n
encode MHC molecules thar differ in their ability to bind and display peptides derived from various protein antigens. Responder strains inherit MHC alleles whose products do bind such peptides,forming peptide-MHC complexes that can be recognized by helper T cells. These T cells then help B cells to produce antibodies. Nonresponder strains express MHC molecules that are not capable of binding peprides derived from the pollpeptide antigen, and therefore these strains cannot generate helper T cells or antibodies specific for the antigen. The first explanation for the role of MHC molecules in T cell antigen recognition came with the discovery of the phenomenon of MHC restriction of T cells,which we will describe in Chapter 6 when we consider the characteristics of the ligands that T cells recognize.
with the k-type MHC is called K (pronouncedK of k), whereasthe alleleof lhe H-2Kgenein a strainof MHC d i s c a l l e dK d( K o f d ) A t h i r dl o c u ss i m i l a rt o K a n d D w a s d i s c o v e r e lda t e ra n d c a l l e dL Severalothergeneswere subsequently mappedto the regionbetweenthe K and D genes responsible for skin rejection For example,S genes were found that coded for polymorphicserum proteins,now known to be componentsof the complementsystem Most important,the polymorphiclr genesdescribedin the text were assigned to a regionwithin the MHC called/ (the letter,not the R o m a nn u m e r a l )T.h e / r e g i o ni,n t u r n ,w a s f u r t h e rs u b d i vided into LA and fE subregionson the basisof recombination events during breeding between congenic strainsThe / regionwas alsofoundto codefor certaincell surfaceantigensagainstwhich antibodiescould be producedby interstrainimmunizationsTheseantigenswere c a l l e dI r e g i o n - a s s o c i a tm ed o l e c u l e so,r l a m o l e c u l e sa,n d a r et h e m u r i n ec l a s sl l M H C m o l e c u l e sT.h eg e n e so f t h e l-A and /-Eloci,which were discoveredas lr genes,code f o r l a a n t i g e n sw , h i c h a r e c a l l e dl - A a n d l - E m o l e c u l e s , r e s p e c t i v e lTyh e l - A m o l e c u l ef o u n di n t h e i n b r e dm o u s e s t r a i nw i t h t h e K ka n d D ka l l e l e si s c a l l e dl - A k( p r o n o u n c e d I A o f k ) S i m i l a tre r m i n o l o g iys u s e d f o r l - E m o r e c u r e s A n a l y s i so f t h e m o u s ec l a s sl l r e g i o nr e v e a l e d s o m es u r prisesthat were not anticipated genetics.For by classical i n s t a n c et ,h e / - As u b r e g i o no,r i g i n a l ldye f i n e db y r e c o m b i nationsduringinterbreeding of inbredstrains,codes for t h e a a n d 0 c h a i n so f t h e l - A m o l e c u l ea s w e l l a s f o r t h e c c h a i no f t h e l - E m o l e c u l eT. h e l F h i g h l yp o l y m o r p h iB s u b r e g i o ind e n t i f i efdr o m b r e e d i n cg o d e so n l yf o r t h e l e s s p o l y m o r p h isc c h a i no f t h e l - Em o l e c u l e T h e n o m e n c l a t u roef t h e H L Al o c u st a k e si n t oa c c o u n t t h e e n o r m o u sp o l y m o r p h i s m i d e n t r f i eb dy s e r o l o g i a c nd m o l e c u l am r e t h o d sT h u s ,i n d i v i d u a l l e l e sm a v b e c a l l e d H L A - A " 0 2 0 1r,e f e r r i n gt o t h e 0 1 s u b t y p eo f H L A - A 2o, r H L A - D R B"10 4 0 1 ,r e f e r r i n tgo t h e 0 1 s u b t y p eo f t h e H L A D R B 4a l l e l ea, n ds o o n
Discovery
of the Human MHC
Human MHC molecules are called human leukocyte antigens (HLA) and are equiuaLent to the H-2 molecules of mice. The kinds of experiments used to discover and define MHC genes in mice, requiring inbreeding, obviously cannot be performed in humans. However, the development of blood transfusion and especially organ transplantation as methods of treatment in clinical medicine provided a strong impetus to detect and define genes that control rejection reactions in humans. Jean Dausset,Jan van Rood, and their colleaguesfirst showed that individuals who reject kidneys or have transfusion reactions to white blood cells often contain circulating antibodies reactive with antigens on the white blood cells ofthe blood or organ donor. Serathat react against
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CoMPLEX$ HlsTocoMPATlBlLlTY 5 - THEMAJ0R chapter p ..
the cells of other, allogeneic individuals are called alloantisera and are said to contain alloantibodies, whose molecular targets are called alloantigens. It was presumed that these alloantigens are the products of poll'rnorphic genes that distinguish foreign tissues from self tissues. Panels of alloantisera were collected from alloantigen-immunized donors, including multiparous women (who are immunized by paternal alloantigens expressed by the fetus during pregnancy), actively immunized volunteers, and transfusion or transplant recipients. These sera were compared for their ability to bind to and lyse lymphocytes from different donors. Efforts at international workshops, involving exchanges of reagents among laboratories, led to the identification of severalpolymorphic genetic loci, clustered together in a single Iocus on chromosome 6, whose products are recognizedby alloantibodies. Becausethese alloantigens are expressed on human leukocytes, they were called human leukocyte antigens (HLAs). Family studies were then used to construct the map of the HLA locus (seeFig. 5-3). The first three genes defined by serologic approaches were called HLA-A, HIA.-B, and HIA-C. The use of antibodies to study alloantigenic differences between donors and recipients was complemented by the mixed leukoclte reaction (MLR), a test for T cell recognition of allogeneic cells.The MLR is also an in uitro model for allograft rejection and will be discussed more fully in the context of transplantation (see Chapter 16). It was found that T lymphocltes from one individual would proliferate in responseto leukocytes of another individual, and this assay was used to map the genes that elicited allogeneic T cell reactions. The first gene to be identified from these studies of cellular responsesmapped to a region adjacent to the serologically defined HIA locus and was therefore called HIAD. The protein encoded by the HLA-D locus was later detected by alloantibodies and was called the H[A-Drelated, or HLA-DR, molecule. TWoadditional genesthat mapped adjacent to HLA-D were found to encode proteins structurally similar to HIA-DR and also were found to contribute to MLRs; these geneswere called HI-4-DQ and HIA-DE with Q and P chosen for their proximity in the alphabet to R. We now know that differences in HLA alleles between individuals are important determinants of the rejection of grafts from one individual to another (seeChapter 16). Thus, the HLA Iocus of humans is functionally equivalent to the H-2 locus of mice defined by transplantation experiments. As we shall see later, MHC molecules in all mammals have essentially the same structure and function. The accepted nomenclature of MHC genes and their encoded proteins is based on sequence and structural homologies and is applicable to all vertebrate species (see Fig- 5-3). The genes identified as determinants of graft rejection in mice (H-2K, H-2D, and H-2L) are homologous to the serologically defined human Hl.A genes (HLA-A, HI-4-8, and HLA-Q, and all of these are grouped as class I MHC genes. The Ir genes of mice (1-A and 1-E) are homologous to the human genes identified by lyrnphocyte responses in the MLR (HIA-
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DR,HLA-DB and HI'A-DQ) and are grouped as classII MHC genes.There are many other genes contained withinlhe MHC; we will return to these later in this 02L-66950639 chapter.RoshanKetab Propefties of MHG Genes Severalimportant characteristicsof MHC genes and their productswere deducedfrom classicalgeneticand biochemicalanalysesdone in mice and humans. @ Thetwo ffies of polymorphic MHC genes,namely,the classI and, classII MHC genes,encod'etwo groups of structurally distinct but homologousproteins' ClassI MHC moleculespresentpeptidesto and are recognized by CD8*T cells,and classII MHC molecules presentPePtidesto CD4*T cells.
studieswere conductedon outbred human populations. A remarkable feature to emerge from the studies of the human MHC genesis the unprecedented and unanticipatedextent of their polymorphism. For some HLA loci (HI"q'-B),as many as 25O Molull"l"t havebeen identifiedby serologicassays. serologisingle a that has shor'rm sequencing ecular cally defined HI-A. allele may actually consist of muitiple variants that differ slightly. Therefore,the polymorphism is even greater than that predicted from serologicstudies. o MHC genesare cod'ominantlyexpressedin eachindiuiauit. In other words, for a given MHC gene,each individual expressesthe alleles that are inherited from each of ihe two parents.For the individual, this maximizesthe number of MHC molecules available to bind peptidesfor presentationto T cells' The set of MHC allelespresenton eachchromosome is calledan MHC haplotype. In humans,eachHIA allele is given a numerical designation.For instance, an HI-A traptotype of an individual could be HIA-A2, HIA-BS, HI-A.-DRS,and so on. All heterozygousindividuals, of
disequilibrium. The discoveriesof the phenomenaof MHC-linked
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SrRucruRr oFMHCMolrculrs The elucidation of the biochemistrv of MHC molecules has been one of the most important accomplishments of modern immunology. The key advance in this field was the solution of the crystal structures for the extra_ cellular portions of human class I and class II molecules by DonMley, JackStrominger, and their colleagues.Subsequently, many MHC molecules with bound peptides have been crystallized and analyzed in detail. On the basis of this knowledge, we now understand how MHC molecules function to display peptides. In this section of the chapter, we first summarize the biochemical features that are common to class I and class II MHC molecules and that are most important for the function of these molecules. We then describe the structures of class I and class II proteins, pointing out their important similarities and differenceJ(Table S_tt. Properties of MHC Molecules All MHC molecules share certain structural characteristics that are critical for their role in peptide display and antigen recognition by T ly.rnphocytes. o Each MHC molecule consists of an extracellular peptide-binding cleft, or grooue, followed by immunoglobulin (Ig)-like domains and transmem_ brane and cytoplasmic domains.As we shall seelater, class I molecules are composed of one polypeptide chain encoded in the MHC and a second,non-MHC_ encoded chain, whereas class II molecules are made up of two MHC-encoded polypeptide chains. Despite this difference, the overall three-dimensional struc_ tures of class I and class II molecules are similar. o The polymorphic amino acid residues of MHC mole_ cules are located in and ad,jacent to the peptide_ binding cleft. This cleft is formed by the folding'of the
amino termini of the MHC-encoded proteins and is composed of paired s-helices resting on a floor made up of an eight-stranded B-pleated sheet. The polymorphic residues, which are the amino acids that vary among different MHC alleles, are located in and around this cleft. This portion of the MHC molecule
a discussion of peptide binding by MHC molecules later in this chapter. @ The nonpolymorphic lg-like domains of MHC molecules contain binding sitesfor the T celt molecules CD4 andCDS. CD4 and CD8 are expressedon distinct subpopulations of mature T lyrnphocltes and participate, together with antigen receptors, in the recognition of antigen; that is, CD4 and CDg are T cell "coreceptors" (see Chapter Z). CD4 binds selectively to class II MHC molecules, and CD8 binds to classi molecules. This is why CD4. T cells recognize only peptides displayed by class II molecules, and CDg. i cells recognize peptides presented by class I molecules. Most CD4* T cells function as helper cells, and most CD8* cells are CTLs.
Class I MHC Molecules Class I molecules consist of two noncovalently linked polypeptide chains: an MHC-encoded 44-47kD achain (or heavy chain) and a non-MHC-encoded 12 kD subunit called pr-microglobulin (Fig. 5-4). Each a chain is oriented so that about three quarters of the complete polypeptide extends into the extracellular milieu, a short
Table5-1. Featuresof ClassI and Classll MHC Molecules
Feature
C l a ssIMHC
Classll MHC
Polypeptidechains
u (44-47 kD) B 2 - M i c r o g l o b u(l 1 i n2 k D )
cr(32-34kD) B (2e-32kD)
Locationsof s1 andcr2domains cr1and B1domains polymorphic residues Binding sitefor a3 regionbindsCD8 B2regionbindsCD4 T cellcoreceptor Sizeof Accommodates peptides Accommodates peptides peptide-binding of 10-30residues cleft of 8-11residues or more Nomenclature Human HLAIA,HLA-B,HLA-C HLA:DR,HLA-D-Q:HLA-DP Mouse H.zK,H-2D.H-2L t-A,t-E A.bbreviations; HLA,humanleukocyteantigen;MHC,major histocompatibility complex
C0MPLEX 5 - THEMAJ0RHISTOCOMPATIBILITY Chaoter
ClassI MHC
Peptide-binding \
Transmembrane
leaflet of the lipid bilayer and anchor the MHC molecule in the plasma membrane. The light chain of classI molecules,which is encoded by a gene outside the MHC, is called B2-microglobulin for iti electrophoretic mobility (pr), size (micro), and solubility (globulin). p2-microglobulininteracts noncovalently with the s3 domain of the o chain. Like the s3 segment, B2-microglobulinis structurally homologous to an Ig domain and is invariant among all class I molecules. Thefully assembledclassI mol'eculek a heterotrimer consising of an a chain, p2-microglobulin,and a bound
C l a s sI M H C
Disulfidebond lg domain FIGURE 5-4 Structule of a class I MHC molecule.The schematic the differentregionsof the MHC molecule diagramf/eftlillustrates (not drawn to scale) ClassI moleculesare composedof a polyp1 attachedto the nonpolymorphic morphico chainnoncovalently microglobulin(02m) The cr chain is glycosylated;carbohydrate residuesare not shown The ribbondiagram/rghtl shows the strucportionof the HLA-B27moleculewith a ture of the extracellular (Courtesy of Dr P boundpeptide,resolvedby x+aycrystallography. Pasadena, California Instituteof Technology, ) Bjorkman,California
hydrophobic segment spans the cell membrane, and the carboxy-terminal residues are located in the cytoplasm. The amino-terminal (N-terminal) ol and cr2segments of the cr chain, each approximately 90 residues long, interact to form a platform of an eight-stranded, antiparallel p-pleated sheet supporting two parallel strands of crhelix. This forms the peptide-binding cleft of classI molecules. Its size is large enough (-254 x 10A x I lA) to bind peptides of 8 to ll amino acids in a flexible, extended conformation. The ends of the class I peptide-binding cleft are closed so that larger peptides cannot be accommodated. Therefore, native globular proteins have to be "processed" to generate fragments that are small enough to bind to MHC molecules and to be recognized by T cells (seeChapter 6). The polyrnorphic residues of class I molecules are confined to the crl and a2 domains, where they contribute to variations among different class I alleles in peptide binding and T cell recognition (Fig. 5-5). The a3 segment of the cr chain folds into an Ig domain whose amino acid sequence is conserved among all class I molecules. This segment contains the binding site for CD8. At the carboxy-terminal end of the cr3 segment is a stretch of approximately 25 hydrophobic amino acids that traverses the lipid bilayer of the plasma membrane. Immediately following this are approximately 30 residues located in the cytoplasm, included in which is a cluster of basic amino acids that interact with phospholipid head groups of the inner
Topview
Class ll MHC
Top view
Polymorphicresiduesof MHC molecules.The polyes of classI and classll MHC molecules(shownas clefts and the s-helices locatedin the peptide-binding aroundthe clefts In the class ll moleculeshown (HLA-DR),essenis in the p chain.However,otherclassll tiallyall the polymorphism moleculesin humansand mice show varyingdegreesof polymorohism in the a chainand usuallymuch more in the p chain'(Couriesy of Dr. J. McCluskey, University of Melbourne, Parkville, Australia.)
104 .:.iqs@,....
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ll - RECOGN|T|0N 0FANTIGENS ! Section * antigenic peptide, and stable expression of classI molecules on cell surfaces requires the presence of all three components of the heterotrimer. The reason for this is
only useful peptide-loaded MHC molecules are expressed on cell surfaces.The process of assembly of stable peptide-loaded class I molecules will be detailed in Chapter 6. Most individuals are heterozygous for MHC genes and therefore express six different class I molecules on every cell, containing cr chains encoded by the two inherited alleles of HLA-A, HLA-&, and HIA-C genes. Class ll MHC Molecules Class II MHC molecules are composed of two noncovalently associated polypeptide chains, a 32 to 34 kD a chain and a 29 to 32 kD P chain (Fig. 5-6). Unlike class I molecules, the genes encoding both chains of class II molecules are polymorphic. The amino-terminal al and Bl segments of the class II chains interact to form the peptide-binding cleft, which is structurally similar to the cleft of class i molecules. Four strands ofthe floor ofthe cleft and one ofthe cr-helical walls are formed by the al segment, and the
Classll MHC
Transmembrane
other four strands of the floor and the second wall are formed by the Bt segment.The polyrnorphic residuesare located in the al and Bl segments, in and around the peptide-binding cleft, as in class I molecules (see Fig. 5-5). In human class II molecules, most of the polyrnorphism is in the B chain. In class II molecules, the ends of the peptide-binding cleft are open, so that peptides of 30 residues or more can fit. The a2 and p2 segments of class II molecules, like class I a3 and Br-microglobulin, are folded into Ig domains and are nonpolymorphic amongvarious alleles of a particular class II gene. The p2 segment of class II molecules contains the binding site for CD4, similar to the binding site for CD8 in the a3 segment of the class I heavy chain. In general, cr chains of one class II MHC locus (e.9.,DR) most often pair with B chains of the same locus and less commonlywith p chains of other loci (e.g., DQ, DP). The carboxy-terminal ends of the a2 andB2 segments continue into short connecting regions followed by approximately 25-amino acid stretches of hydrophobic transmembrane residues. In both chains, the transmembrane regions end with clusters of basic amino acid residues, followed by short, hydrophilic cytoplasmic tails. The fully assembled class II moLecul.e is a heterotrimer consisting of an a chain, a p chain, and a bound antigenic peptide, and stable expression of class II molecules on cell surfaces requires the presence of all three components of the heterotrimer. As in class I molecules,this ensuresthat the MHC molecules that end up on the cell surface are the molecules that are serving their normal function of peptide display. Humans inherit, from each parent, one DpBl and one DPAI gene encoding, respectively, the p and a chains of an HI-A-DP molecule; one DQAI and one DeBI gene; and one DRAI gene, a DRBI gene, and a separateduplicated DRB gene that may encode the alleles DRB3, 4, or 5. Thus, each heterozygous individual inherits six or eight classII MHC alleles,three or four from each parent (one set each of DP and DQ, and one or two of DR). Typically, there is not much recombination between genes of different loci (i.e.,DRcrwith DQF, and so on), and each haplotype tends to be inherited as a single unit. However, because some haplotypes contain extra DRB loci that produce B chains that assemblewith DRa, and some DQcrmolecules encoded on one chromosome can associatewith DQB molecules encoded from the other chromosome, the total number of expressed class II molecules may be considerably more than 6.
Disulfide bond -----,
rsdomain
C
FIGURE5-6 Structureof a class ll MHGmolecule.Theschematic diagram(/eftlillustrates the differentregionsof the MHC molecule (not drawn to scale).Classll moleculesare composedof a poly_ morphica chainnoncovalently attachedto a polymorphicB chain. Bothchainsareglycosylated; carbohydrate reslduesare not shown. The ribbondiagram(nglhtlshows the structureof the extracellular portionof the HLA-DR1moleculewith a boundpeptide,resolvedby x-ray crystallography. (Courtesyof Dr. p Bjorkman,CaliforniaInsti_ tute of Technology, Pasadena, California.)
Blrrrotruc 0FPEplDEs r0 MHCMomcuus With the realization rhat MHC molecules are the peptide display molecules of the adaptive immune sysrem, considerable effort has been devoted to elucidating the molecular basis of peptide-MHC interactions and the characteristics of peptides that allow them to bind to MHC molecules. These issuesare important not only for understanding the biology of T cell antigen recognition but also for defining the properties of a protein that
C0MPLEX 5 - THEMAJ0RHIST0COMPATIBILITY Chaoter
make it immunogenic. All proteins that are immunogenic in an individual must generate peptides that can bind to the MHC molecules of that individual. Information about peptide-MHC interactions may be used to design vaccines, by inserting MHC-binding amino acid sequences into antigens used for immunization. In the section that follows, we summarize the key features of the interactions between peptides and class I or class II MHC molecules. Several analytical methods have been used to study peptide-MHC interactions: r' The earliest studies relied on functional assaysof helper T cells and CTLs responding to antigenpresenting cells that were incubated with different peptides. By determining which types of peptides derived from complex protein antigens could activate T cellsfrom animals immunized with theseantigens, it was possibleto define the featuresof peptides that allowed them to be presentedby antigen-presenting cells. Lr After MHC moleculeswere purified, it was possibleto study their interactionswith radioactivelyor fluorescently labeled peptides in solution by methods such as equilibrium dialysis and gel filtration to quantitate bound and free peptides. {:} The nature of MHC-binding peptides generatedfrom intact proteins has been analyzedby exposingantigenpresentingcellsto a protein antigenfor varioustimes, purifying the MHC moleculesfrom thesecellsby affinity chromatography, and eluting the bound peptides for amino acid sequencingby mass spectroscopy.The sameapproachmay be usedto definethe endogenous peptides that are displayedby antigen-presentingcells isolated from animals or humans.
bind many different peptides was established by several lines of experimental evidence. If a T cell specific for one peptide is stimulated by antigen-presentingcells presentingthat peptide, the responseis inhibited by the addition of an excessof other,structurallysimilar peptides (Fig.5-7). In these experiments, the MHC molecule bound different peptides,but the T cell recognizedonly one of these peptidespresentedby the MHC molecule. Direct binding studieswith purified MHC molecules in solution definitively established that a single MHC molecule can bind multiple different peptides (albeit only one at a time) and that multiple peptides compete with one another for binding to the single binding site of each MHC molecule. , The analysesof peptideseluted from MHC molecules purified from antigen-presentingcells showed that many different peptides can be eluted from any one type of MHC molecule. The solution of the crystal structures of class I and class II MHC molecules confirmed the presence of a single peptide-binding cleft in these molecules (see Figs. 5-4 and 5-6). It is not surprising that a single MHC molecule can bind multiple peptides because each individual contains only a few different MHC molecules (6 class I and as many as 10 to 20 class II molecules in a heterozygous individual), and these must be able to present peptides from the enormous number of protein antigens that one is likely to encounter.
il X-ray crystallographic analysis of peptide-MHC complexeshas provided valuable information about how peptides sit in the clefts of MHC moleculesand about the residues of each that participate in this binding. On the basis of such studies, we now understand the physicochemical characteristics of peptide-MHC interactions in considerable detail. It has also become apparent that the binding of peptides to MHC molecules is fundamentally different from the binding of antigens to the antigen receptors of B and T lymphocytes (see Chapter 4, Table 4-1). Characteristics lnteractions
of Peptide-MHC
MHC molecules show a broad specificity for peptide binding, in contrast to the fine specificity of antigen recognition of the antigen receptors of T lymphocytes. There are several important features of the interactions of MHC molecules and antigenic peptides. o Each class I or class II MHC molecule has a single peptide-binding clefr that bind.s one peptide at a time, but each MHC molecule can bind. many d'ffirent peptid.es. This ability of any MHC molecule to
Excessof different
MHC-bindingpeptide Antigencompetitionfor T cells' A T cell recognizes ented by one MHC molecule.An excessof a differat binds to the same MHC moleculecompetitively tationof the peptidethat the T cell recognizesAPC, cell antigen-presenting
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FANN T T G E N S $ S e c t i ol ln- R E C 0 G N t TOt 0
3
@ The peptides that bind to MHC molecules share structural features that promote this interaction. One of these features is the size of the peptide-class I molecules can accommodate peptides that are 8 to ll residues long, and class II molecules bind peptides that may be 10 to 30 residues long or longer, the optimal length being 12 to 16 residues. In addition, peptides that bind to a particular allelic form of an MHC molecule contain amino acid residues that allow complementary interactions between the peptide and that allelic MHC molecule. The residues of a peptide that bind to MHC molecules are distinct from those that are recognized byT cells. @ The association of antigenic peptides and MHC molecules is a saturable interaction with a uery slow off-rate. In a cell, several chaperones and enzl'rnes facilitate the binding of peptides to MHC molecules (see Chapter 6). Once formed, most peptide-MHC complexes are stable, and kinetic dissociation constants are indicative of long half-lives that range from hours to many days.This extraordinarily slow off-rate of peptide dissociation from MHC molecules allows peptide-MHC complexes to persist long enough on the surfaces of antigen-presenting cells that the antigen can be found by T cells. This feature of antigen display enables the few T cells that are specific for the antigen to locate the antigen as the cells circulate through tissues, and thus to generate effective immune responsesagainst the antigen. o The MHC molecules of an indiuidual do not discriminate between foreign peptides (e.g., those deriued ftom microbial proteins) and peptid,es derived from the proteins of that indiuidual (self antigens). Thus, MHC molecules display both self peptides and foreign peptides, and T cells survey these displaved peptides for the presence of foreign antigen;. This process is central to the surveillance function of T cells. However, the inability of MHC molecules to discriminate between self antigens and foreign antigens raises two questions. First, because MHC molecules are continuously exposed to, and presumably occupied by, abundant self peptides, how can their peptide-binding sites ever be available to bind and
assembly,in the specificity of T cells,and in the exquisite sensitivity of these cells to small amounts of peptide-MHC complexes. We will return to these questions in more detail in Chapter 6. Structural Basis of Peptide Binding to MHC Molecules The binding of peptides to MHC molecules k q noncoualent interaction mediated bv residues both in the peptides and in the ctefrs oi the MHC molecules. Protein antigens are proteol),'tically cleaved in antigen-
presenting cells to generate the peptides that will be bound and displayed by MHC molecules (see Chapter 6). These peptides bind to the clefts of MHC molecules in an extended conformation. Once bound, the peptides and their associated water molecules fill the clefts, making extensive contacts with the amino acid residues that form the B-strands of the floor and the cr-helicesof the walls of the cleft (Fig. 5-8). In most MHC molecules, the B-strands in the floor of the cleft contain "pockets." The amino acid residues of a peptide may contain side chains that fit into these pockets and bind to complementary amino acids in the MHC molecule, often through hydrophobic interactions. Such residues of the peptide are called anchor residues because they contribute most of the favorable interactions of the binding (i.e., they anchor the peptide in the cleft of the MHC molecule). The anchor residues of peptides may be located in the middle or at the ends of the peptide. Each MHC-binding peptide usually contains only one or tvvo anchor residues, and this presumably allows greater variability in the other residues of the peptide, which are the residues that are recognized by specific T cells. Not all peptides use anchor residues to bind to MHC molecules, especially to classII molecules. Specific interactions of peptides with the cr-helicalsides of the MHC cleft also contribute to peptide binding by forming hydrogen bonds or charge interactions (salt bridges). Class I-binding peptides usually contain hydrophobic or basic amino acids at their carboxyl termini that also contribute to the interaction. Because many of the residues in and around the peptide-binding cleft of MHC molecules are polymorphic (i.e., they differ among various MHC alleles), different alleles favor the binding of different peptides. This is the structural basis of the function of MHC genes as "immune response genes"; only animals that express MHC alleles that can bind a particular peptide and display it to T cells can respond to that peptide. The antigen receptors of T cells recognizn both the antigenic peptide and the MHC molecules, with the peptide being responsible for the fine specificity of antigen recognition and the MHC residues accounting for the MHC restriction of the T celk. A portion of the bound peptide is exposed from the open top of the cleft of the MHC molecule, and the amino acid side chains of this portion of the peptide are recognizedbythe antigen receptors of specific T cells. The same T cell receptor also interacts with polymorphic residues of the a,-helicesof the MHC molecule itself (seeFig. 5-l). predictably, variations in either the peptide antigen or the peptide-binding cleft of the MHC molecule will alter presentation of that peptide or its recognition by T cells. In fact, one can enhance the immunogenicity of a peptide by incorporating into it a residue that strengthens its binding to commonly inherited MHC molecules in a population. By introducing mutations in an immunogenic peptide, it is possible to identif,i residues involved in binding to MHC molecules and those that are critical for T cell recognition.This approachhas been applied
COMPLEX Chaoter 5 - THEMAJ0RHIST0C0MPATIBILITY
to many peptide antigens,using T cells to measure responsesto thesepeptides(seeFig.5-8C). The realization that the polymorphic residues of MHC molecules determine the speciflcity of peptide binding and T cell antigen recognition has led to the question of why MHC genes are poll'rnorphic. One possibility is that the presence of multiple MHC alleles in a population provides an evolutionary advantage because it will ensure that virtually all peptides derived from microbial antigens will be recognized by the immune system of at least some individuals. At the population level, this will increase the range of microbial peptides that may be presented to T cells and reduce the likelihood that a single pathogen can evade host defensesin all the individuals in a given species.
Peptide
Grruourc 0ncnrurzRnoN oFTHE MHC In humans, the MHC is located on the short arm of chromosome 6, and Br-microglobulin is encoded by a gene on chromosome 15. The human MHC occupies a large segment of DNA, extending about 3500 kilobases (kb). (For comparison, a large human gene may extend up to 50 to 100kb, andthe size of the entire genome of the bacteriurr' Escherichiacoliis approximately 4500kb.) In classical genetic terms, the MHC locus extends about 4 centimorgans, meaning that crossovers within the MHC occur with a frequency of about 4Vo at each meiosis. A molecular map of the human MHC is shown in Figure 5-9. Many of the proteins inuolued. in the processing of protein antigens and. the presentation of peptides to T celk are encoded by genes located within the MHC.ln other words, this genetic locus contains much of the information needed for the machinery of antigen presentation. The class I genes, HLA-A, HLA-B, and HIA-C, are in the most telomeric portion of the HIA locus, and the class II genes are the most centromeric in the HLA locus. Within the class II locus are genes that encode several proteins that play critical roles in antigen processing. One of these proteins, called the transporter associated with antigen processing (TAP), is a heterodimer that transports peptides from the cytosol into the endoplasmic reticulum, where the peptides can associatewith newly synthesized class I molecules. The two subunits of the TAP dimer are encoded by two genes within the class II region. Other genes in this cluster encode subunits of a cytosolic protease complex, called the proteasome, that degrades cytosolic proteins into peptides that are subsequently presented by classI MHC molecules. Another pair of genes, called HLA-DMA and HLA-DMB, encodes a nonpolymorphic heterodimeric class Il-like molecule, called HIA-DM (or H-2M in mice), that is involved in peptide binding to classII molecules. The functions of these proteins in antigen presentation are discussed in Chapter 6. Between the classI and classII gene clusters are genes that code for several components of the complement svstem; for three structurallv related cytokines, tumor
residue of peptide
P4 FIGURE S-8 Peptidebindingto MHG molecules.A Thesetop views of the crystalstructuresof MHC moleculesshow how pepclefts.The class I moleculeshown tides lie in the peptide-binding is HLA-A2,and the class ll moleculeis HLA-DR1The cleft of the classI moleculeis closed,whereasthat of the classll moleculeis open.As a result,classll moleculesaccommodatelongerpeptldes with permissionof Macmillan than do classI molecules,(Reprinted PublishersLtd from BjorkmanPJ, MA Saper,B Samraoui,WS and DC Wiley Structureof the humanclass Bennett,JL Strominger, antigenHLA-A2.Nature329:506-512,1987;and I histocompatibility structureof the human class ll Brown J et al. Three-dimensional antigenHLA-DR1.Nature364:33-39,1993.)B. histocompatibility The sideview of a cut-outof a peptideboundto a classll MHC molecule shows how anchor residuesof the pepttdehold it in the pocketsin the cleftof the MHC molecule.(FromScottCA, PAPeterson, L Teyton,and lA Wilson. Crystalstructuresof two 1-40-peptide complexesrevealthat high affinitycan be achievedwithout large anchorresidues.lmmunity8:319-329,1998.Copyright1998'with permission C. Differentresiduesof a peptide from ElsevierScience.) byT cells.The immunbindto MHC moleculesand are recognized odominantepitopeof the proteinhen egg lysozyme(HEL)in H-2" mice is a peptidecomposedof residues52-62 fhe ribbondiagram modeledaftercrystalstructuresshows the surfaceof the peptidebindingcleftof the l-Akclassll moleculeandthe boundHELpeptide with aminoacid residues(P1-Pg)indicatedas spheres.Mutational analysisof the peptidehas shown that the residuesinvolvedin bindingto MHC moleculesare P'1(Asp52),P4 (lle55),P6 (Gln57), thesearethe residuesthat projectdown P7 (lle58).and P9 (Ser60); cleft The residuesinvolvedin recogandf it intothe peptide-binding P5 (Leu56),and P8 (Asn59);these nitionby T cellsare P2 (Tyr53), to T cells (FromFremont residuesprojectupwardand are available and ER Unanue DH, D Monnale,CA Nelson,WA Hendrickson, epitopeof Crystalstructureof l-A in complexwith a dominant '1 lysozyme.lmmunity8:305-317,1998. Copyright 998, with permissionfrom ElsevierScience)
1Oa,_
S e c t i olnl -
R E C 0 G N I T t00FNA N T t c E N S
-
Classll Region Proteasome oenes DP DM TAP2 8 1A 1 A B TAPl DOB A2
Tapasin
A
I
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!
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800
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Class:u Regisn TNF-a
MICB
LTFr | ,/Lr /
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I't'
I
I
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HLA-B HLA-C
tn I
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I
I
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Class I Region HLA-A
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tl
rl
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FlgU^RE5-9 Map of the humanMHC.This map s simplifiedto excludemany genesthat are of unknownfunction HLA-E,HLA-F,and H L A - Ga, n d t h e M I C g e n e sa r e c l a s sl - l i k em o l e c u l e sm, a n yo f w h o s e p r o d u c t s- r e r e c o g n i z ebdy N K c e l l s ;C 4 . C 2 , a n d f a c t o rB g e n e s encodecomplementproteins;tapasin,DlV, DO, TAP,and proteasomeencodeproteinsinvolvedin antrgenprocessing;LTA,B, and TNF encodecytokrnesMany pseudogenes and geneswhose rolesin immuneresponsesare not established are locatedin the HLA complex but are not shown
necrosis factor (TNF), lymphotoxin-c (LI-c), and LI-p; and for some heat shock proteins. The genes within the MHC that encode these diverse oroteins have been called class III MHC genes. Between HLA-C and HLA-A, and telomeric to HIA-A, are many genes that are called class I-like because they resemble class I genes but exhibit little or no polymorphism. Some of these encode proteins that are expressed in association with Brmicroglobulin and are called class IB molecules, to distinguish them from the classical polymorphic class I molecules. Among the class IB molecules is HIA-G, which may play a role in antigen recognition by natural killer (NK) cells, and HIA-H, which appears to be involved in iron metabolism and has no known function in the immune system. Many of the class I-like sequencesare pseudogenes.The functions of most of these classI-like genesand pseudogenesare not knor,m. One role may be that during evolution, these DNA sequencesserveas repositoriesof ccldingsequencesthat are used for generating polymorphic sequencesin conventional class I and class II MHC molecules by the processof gene conversion.In this process,a portion of the sequence of one gene is replaced with a portion of another gene without a reciprocal recombination event. Gene conversion is a more efficient mechanism than
point mutation for producing genetic variation without loss of function because several changes can be introduced at once, and amino acids necessaryfor maintaining protein structure can remain unchanged if identical amino acids at those positions are encoded by both of the genes involved in the conversion event. It is clear from population studies that the extraordinary polymorphism of MHC molecules has been generated by gene conversion and not by point mutations. The mouse MHC, located on chromosome 17, occupies about 2000kb ofDNA, and the genes are organized in an order slightly different from the human MHC gene. One of the mouse class I genes (H-2p is centromeric to the class II region, but the other class I genes and the nonpolymorphic classIB genesare telomeric to the class II region. As in the human, Br-microglobulin is encoded not by the MHC but by a gene located on a separate chromosome (chromosome 2). There are Br-microglobulin-associatedproteins other than class I MHC molecules that may serve important functions in the immune system. These include the neonatal Fc receptor (seeChapter 14), and the CDI molecules,which are involved in presenting lipid and other nonpeptide antigens to unusual populations of T cells. These proteins are homologous to the class I MHC cr
COMPLEX 5 - THEMAJ0RHIST0C0MPATIBILITY Chaoter
chain but are encodedoutside the MHC, on different chromosomes.
ExpRrssroN oFMHCMouculrs Because MHC molecules are required to present antigens to T lymphocltes, the expression of these proteins in a cell determines whether foreign (e.g., microbial) antigens in that cell will be recognized by T cells. There are several important features of the expression of MHC molecules. C CJassI moLeculesare constitutiuely expressedon uirtually all nucleated celk, whereas class II molecules are normally expressed.on only d.endritic celk, B lymphocytes, macrophages, and a few other cell types, This pattern of MHC expression is linked to the functions of class I-restricted and class Il-restricted T cells. The effector function of class I-restricted CD8* T cells is to kill cells infected with intracellular microbes, such as viruses. Becauseviruses can infect virtually any nucleated cell, the ligands that CD8* T cells recognize need to be displayed on all nucleated cells. The expression of class I MHC molecules on nucleated cells servesprecisely this purpose, providing a display system for viral antigens. In contrast, class Il-restricted CD4. helper T lymphocytes have a set of functions that require recognizing antigen presented by a more limited number of cell types. In particular, naive CD4'T cells need to recognize antigens that are presented by dendritic cells in peripheral Iyrnphoid organs. Differentiated CD4. helper T lymphocytes function mainly to activate (or help) macrophages to eliminate extracellular microbes that have been phagocytosed and to activate B lymphocltes to make antibodies that also eliminate extracelIular microbes. Class II molecules are expressed mainly on these cell types and provide a system for displaying peptides derived from extracellular microbes and proteins. o The expression of MHC molecules is increased by cytokines produced duringboth innate and adaptiue immune responses(Fig. 5-10). On most cell qpes, the interferons IFN-c, IFN-8, and IFN-1increase the level of expressionof classI molecules, andTNF and LI can have the same effect. (The properties and biologic activities of cltokines are discussed in Chapter 12.) The interferons are produced during the early innate immune response to many viruses (see Chapter 2), and TNF and LI are produced in response to many microbial infections. Thus, innate immune responses to microbes increase the expressionof the MHC molecules that display microbial antigens to microbespecific T cells. This is one of the mechanisms by which innate immunity stimulates adaptive immune responses. The expression of class II molecules is also reguIated by cytokines and other signals in different cells. IFN-y is the principal cltokine involved in stimulating expression of class II molecules in antigen-pre-
RestingAPC (lowMH.C. expresslon)
Cytokineclassll mediated expression onAPCS Enhanced antigen presentation
Activated APC (high
MHCexpression)
Enhanced T cellresponse by of class ll MHG expression FIGUBE 5-1o Enhancement by NK cellsand othercell typesduring IFN-1.IFN-y,produced or by T cellsduringadaptive to microbes, innateimmunereactions on antigenclassll MHCexpression stimulates immunereactions, of CD4* the activation andthusenhances presenting cells(APCs) of classI MHC effecton the expression hasa similar T cells.IFN-^y of CDB*T cells andthe activation molecules
senting cells such as dendritic cells and macrophages (see Fig. 5-f0). The IFN-1may be produced by NK cells during innate immune reactions, and by antigen-activated T cells during adaptive immune reactions. The ability of IFN-y to increase class II expression on antigen-presenting cells is an ampliflcation mechanism in adaptive immunity. In dendritic cells, the expression of class II molecules also increasesin response to signals from Toll-like receptors responding to microbial components, thus promoting the display of microbial antigens (Chapter 6). B l1'rnphocltes constitutively express class II molecules and can increase expression in response to antigen recognition and cytokines produced by helperT cells,thus enhancing antigen presentation to helper cells (Chapter 10). Vascular endothelial cells, like macrophages, increase class II expression in response to IFN-y the significance of this phenomenon is unclear. Most nonimmune cell types express few if any, class II MHC molecules unless exposed to high levels of IFN-1. These cells are unlikely to present antigens to CD4'T cells except in unusual circum-
11O
AN NTTGENS $ S e c t i ol ln R E C 0 G N t T0tFO stances.Some cells, such as neurons, never appear to expressclass II molecules. Human, but not mouse, T cells express class II molecules after activation; howeve! no cltokine has been identified in this response,and its functional significance is unknown. g The rate of transcription is the major determinant of the leuel of MHC molecule synthesis and expression on the cell surface. Cytokines enhance MHC expression by stimulating the rate of transcription of class I and class II genes in a wide variety of cell types. These effects are mediated by rhe binding of cytokineactivated transcription factors to regulatory DNA sequences in the promoter regions of MHC genes. Several transcription factors may be assembled and bind a protein called the class II transcription activator (CIITA), and the entire complex binds to the class II promoter and promotes efficient transcription. By keeping the complex of transcription factors together, CIITA functions as a master regulator of class II gene expression.CIITA is slrlthesized in response to IFN-1, explaining how this cytokine can increase expression of class II MHC molecules. Mutations in several of these transcription factors have been identified as the cause of human immunodeficiency diseasesassociated with defective expression of MHC molecules. The best studied of these disorders is the bare lrrmphocyte syndrome (see Chapter 20). Knockout mice lacking CIITA also show an absence of class II expression on dendritic cells and B lymphocytes and an inability of IFN-y to induce class II on macrophages. The expression of many of the proteins involved in antigen processing and presentation is coordinately regulated. For instance, IFN-y increases the transcription not only of class I and class II genes but also of Brmicroglobulin, of the genes that encode two of the subunits of the proteasome, and of the genes encoding the subunits of the TAP heterodimer.
SUMMARY c The MHC is a large genetic region coding for class I and class II MHC molecules as well as for other proteins. MHC genes are highly poll'rnorphic, with more than 250 allelesfor some of these genesin the population. c The function of MHC-encoded class I and class II molecules is to bind peptide antigens and display them for recognition by antigen-specific T lymphocytes. Peptide antigens associatedwith class I molecules are recognized by CD8* CTLs, whereas classll-associated peptide antigens are recognized by CD4. (mostly helper) T cells. MHC molecules were originally recognized for their role in triggering T cell responses that caused the rejection of transplanted tissue. O Class I MHC molecules are composed of an a (or heavy) chain in a noncovalent complex with a non-
poll.rnorphic pollpeptide called B2-microglobulin. The classII moleculescontaintwo MHC-encoded polymorphic chains, an a chain and a B chain. Both classesof MHC moleculesare structurally similar and consist of an extracellular peptidebinding cleft, a nonpolymorphic lg-like region, a transmembraneregion,and a cytoplasmicregion. The peptide-bindingcleft of MHC moleculeshas a-helical sidesand an eight-strandedantiparallel B-pleatedsheetfloor.The peptide-bindingcleft of classI moleculesis formed by the crl and o2 segmentsof the a chain,and that of classII molecules by the crl and pl segmentsof the two chains.The Ig-like domains of classI and classII molecules containthe binding sitesfor the T cell coreceptors CD8 and CD4,respectively. c MHC moleculesbind only one peptide at a time, and all the peptidesthat bind to a particularMHC moleculesharecommon structural motifs. Peptide binding is saturable,and the off-rate is very slow, so that complexes,once formed,persistfor a sufficiently long time to be recognizedby T cells. Every MHC molecule has a broad specificity for peptidesand can bind multiple peptidesthat have common structural features, such as anchor residues. C The peptide-bindingcleft of classI moleculescan accommodatepeptidesthat are8 to ll amino acid residueslong, whereasthe cleft of classII molecules allows larger peptides (up to 30 amino acid residuesin lengh or more)to bind. The polymorphic residuesof MHC moleculesare localizedto the peptide-bindingdomain. Somepolymorphic MHC residuesdeterminethe binding specificities for peptidesby forming structures,calledpockets, that interact with complementary residuesof the bound peptide, called anchor residues. Other polymorphicMHC residuesand someresiduesof the peptide are not involved in binding to MHC molecules but instead form the structure recognized byT cells. O In addition to the polymorphicclassI and classII genes,the MHC containsgenesencodingcomplement proteins, cytokines, nonpolymorphic class I-like molecules,and severalproteins involved in antigenprocessing. c ClassI moleculesare expressedon all nucleated cells, whereas class II molecules are expressed mainly on specialized antigen-presenting cells, such as dendritic cells, macrophages,and B lymphocytes, and a few other cell types, including endothelial cells and thymic epithelial cells. The expressionof MHC geneproductsis enhancedby inflammatory and immune stimuli, particularly cytokines like IFN-^7,which stimulate the transcriptionof MHC genes.
Chaoter5-THEMAJ0R
Selected Readings Bjorkman PL MA Saper, B Samraoui, WS Bennett, JL StromingeSand DCWiley.Structureof the human classI histocompatibility antigenHLA-A2.Nature 329:506-512,1987. Horton R, L Wilming, V Rand,et al. Genemap of the extended human MHC. Nature ReviewsGenetics5:BB9-899, 2004. KelleyL L Walter, and J Trowsdale.Comparativegenomicsof major histocompatibility complexes.Immunogenetics 56: 683-695,2005. I(ein L and A Sato.The HtA system.New EnglandJournalof Medicine 343:702-7 09 and 782-786,2000. Mach B. The bare lymphocyte slmdromeand the regulationof MHC expression.Annual Reviewof Immunology 19:331-373, 2001,
Madden DR.The three dimensionalstructureof peptide-MHC complexes.Annual Reviewof Immunology 13587422, 1995. Marrack B JP Scott-Browne,S Dai, L Gapin, and IW Kappler. Evolutionarilyconservedamino acidsthat control TCR-MHC interaction. Annual Review of Immunology 26:17I-203, 2008. Mazza C, and B Malissen.What guides MHC-restrictedTCR recognition?Seminarsin Immunology 19:225-235,2007. ReithW, S Leibundgut-Landmann,and JM Waldburger.Regulation of MHC classII geneexpressionby the classII transactivator.Nature ReviewsImmunology 5:793-806'2005.
T LYM
Properties of Antigens Recognized by T Lymphocytes, 114 Antigen-Presenting Cells, 1 16 Cellsand Discoveryof Antigen-Presenting T h e i rR o l ei n l m m u n eR e s p o n s e 1 s ,1 6 AntigenPresentation to NaiveT Lymphocytes: c e l l si n I n i t i a t i n T g Cell R o l eo f D e n d r i t i C 117 Responses, Antigen Presentation to DifferentiatedEffector T Lymphocytes,122 Cell Biology of Antigen Processing, 122 Antigensfor Class Processing of Endocytosed Presentation, 123 ll MHC-Associated Processing of CytosolicAntigensfor ClassI 129 MHC-Associated Presentation, Physiologic Significance of MHCAssociated Antigen Presentation, 132 T CellSurveillance for ForeignAntigens,132 132 Natureof T CellResponses, lmmunogenicity of ProteinAntigens,133 Presentation of Lipid Antigens by CDl Molecules, 134 Summary, 135
nity, CD4* helperT cells interact with ts lymphocytes and stimulate the prolif'eration and differentiation of these B cells. Both the induction phase and the effector phase of
ity conrplex (MHC) (see Fig. 5-1). The cells that display MHC-associated peptides are called antigen-presenting cells (APCs).Certain APCs present antigens to naive T cells during the recognition phase of immune responses to initiate these responses,and sorne APCs present antigens to difTerentiatedT cells during the effector phase to trigger the mechanistns that eliminate the antigens. In Chapter 5, we focused on the structures and functions of MHC molecules. In this chapter, we continue the discussion of the ligands that T cells recognize by focusing orr the generation of peptide-MHC complexes on APCs. Specifically,we describe the characteristics of the APCs that fbrm and display these peptide-MHC complexes and how protein antigens are converted by APCs to peptides that ass
o
Foreign antigens
v
signals to both B and T lymphocytes that have properly rearranged both chains oftheir antigen receptors. Negative selection is the process that eliminates or alters developing lymphocltes whose antigen receptors bind strongly to self antigens present in the generative lymphoid organs. Both developing B cells and developing T cells are susceptible to negative selection during a short period after antigen receptors are first expressed. Developing T cells with a high affinity for self-antigens are eliminated by apoptosis, a phenomenon knor,vn as clonal deletion. Strongly self-reactive immature B cells may be induced to make further Ig gene rearrangements and thus evade self-reactivity. This phenomenon is called receptor editing. Negative selection of developing lyrnphocytes is an important mechanism for maintaining tolerance to many self antigens; this is called central tolerance (seeChapter 11).
Expansionand differentiation
The Generation
of l-ymphocyte
Subsets
Another important feature of lymphocyte development that appears to be mechanistically linked to positive selection is the generation of functionally distinct subsets in both the T and the B lineages (see Fig' B-4).
into either CD4* class II MHC-restricted T cells or CD8* class I MHC-restricted T cells. The CD4t cells that leave the thymus can be activated by antigens to differentiate into helper T cells whose effector functions are mediated by specific membrane proteins and by the oroduction of cwokines. The CD8* cells can differentiate
157
158
!
Section lll - MATURAT|0N, ACT|VAT|0N, ANDREGULATTON 0FLyMPH0CYTES
,ii1i:..l!'il:,q',!l!#;;r
into cytotoxic T lymphocytes whose major effector function is to kill infected target cells.A similar lineage commitment process during positive selection of B cells drives the development of these cells into distinct peripheral B cell subsets. Bone marrow-derived developing B cells may differentiate into follicular B cells that recirculate and mediate T cell-dependent immune responses in secondary lymphoid organs, or marginal zone B cells that reside in the vicinity of the marginal sinus in the spleen and mediate largely T cell-independent responsesto blood-borne antigens. With this introduction, we proceed to a more detailed discussion of lyrnphocyte maturation, starting with the key event in maturation, the rearrangement and expression of antigen receptor genes.
RTRRRRITICEMENT OFANTIGEN RECEPTOR
Grrurs tNB AND T LyvrpHocyrEs The genes that encode diuerse antigen receptors ofB and T lymphocytes are generated. W the re&rrangement in indiuidual lymphocytes of dffirent uariable (V) region gene segments with diversity (D) andlor joining (D gene segments. A novel rearranged exon for each antigen receptor gene is generated by fusing a specific distant upstream V gene segment to a dor,r,nstreamsegment on the same chromosome. This specialized process of sitespecific gene rearrangement is called V(D)I recombination. (The terms recombination and rearrangement are used interchangeably.)Elucidation of the mechanisms of antigen receptor gene rearrangement, and therefore of the underlying basis for the generation of immune diversiry represents one of the landmark achievements of modern immunology.
The first insights into how millions of different antigen receptors could be generated from a limited amount of coding DNA in the genome came from analyses of the amino acid sequences of Ig molecules. These analyses showed that the pollpeptide chains of many different antibodies of the same isotype shared identical sequences at their C-terminal ends (corresponding to the constant domains of antibody heavy and light chains) but differed considerably in the sequences at their N-terminal ends that correspond to the variable domains of immunoglobulins (see Chapter 4). Contrary to one of the central tenets of molecular genetics, enunciated as the "one gene-one polypeptide hypothesis" by Beadle and Tatum in 1941, Dreyer and Bennett postulated in 1965 that each antibody chain is actually encoded by at least two genes,one variable and the other constant, and that the tvvo are physically combined at the level of DNA or of messenger RNA (mRNA) to eventually give rise to functional Ig proteins. Formal proof of this hypothesis came more than a decade later when Susumu Tonegawa demonstrated that the structure of Ig genes in the cells of an antibodyproducing tumor, called a myeloma or plasmacytoma, is different from that in embryonic tissues or in nonl),rynphoid tissuesnot committed to Ig production. These differences arise because during B cell development, there is a recombination of DNA sequences within the loci encoding Ig heavy and light chains. Furthermore, similar rearrangements occur during T cell development in the Ioci encoding the pollpeptide chains of TCRs.Antigen receptor gene rearrangement is best understood by flrst describing the unrearranged, or germline, organization of Ig and TCR genesand then describing their rearrangement during lymphocyte maturation.
H chainlocus(1250kb;chromosome 14 L Vpl
( n= - 1 0 0 ) L Vsn Ds (n = 23) enh
K chainlocus(1820kb; chromosome 2) (n = -35) L VK1 L V*n 5' enn
3' enn
enn
heavy chain, K light chain, and l, light chain loci are shown Only functional genes are shown; pseudogeneshave been omitted for simplicityExonsand tntronsare not drawnto scale EachCs geneis shown as a singlebox but is composed of severalexons, as illustrated for C, Gene segmentsare indicated as follows: L, leader {often called signal sequence);V, variable;D, diversity;J, joining;C, constant;enh, enhancer,
GENES I RECEPTOR 0FANTIGEN ANDEXPRESSIoN ANDTHEREABRANGEMENT DEVELoIMENT chapterI - LyMpHocyrE i*:w;}gfu*-.,
Germline Organizationof lg and TGR Genes The germline organizations of Ig and. TCR genetic loci are fundamentally similar and are characterized by spatial segregation of sequences that must be ioined together to produce functional genes cod.ingfor antigen receptor proteins. We first describe the Ig loci and then discussthe TCR loci in comparison.
Organization
of Ig Gene Loci
Three separateloci encode, respectively,all the Ig heavy chains, the Ig r light chain, and the Ig l.light chain. Each locus is on a different chromosome. The organization of human Ig genes is illustrated in Figure B-5, and the relationship of gene segments after rearrangement to the domains of the Ig heavy and light chain proteins is shown in Figure 8-6A. Ig genes are organized in essentially the same way in all mammals, although their chromosomal locations and the number and sequence of different gene segments in each locus may vary. Each germline Ig locus is made up of multiple copies of at least two different types of gene segments, the V and J segments that lie upstream of constant (c) region exons. In addition, the Ig heaqz chain locus has diversity (D) segments. Within each locus, the sets of each rype of
gene segment are separated from one another by stretches of noncoding DNA. At the 5' end of each of the Ig loci, there is a cluster of V gene segments' eachV gene in the cluster being about 300 base pairs long. The numbers of V gene segments vary considerably among the different Ig loci and among different species. For example, there are about 35V genes in the human r light chain locus and about 100 functional genes in the human healy chain locus, whereas the mouse )' light chain locus has only two V genesand the mouse healy chain locus has more than 1000V genes. The V gene segments for each locus are spaced over large stretchesof DNA, up to 2000 kilobases long. Located 5' of each V segment is a leader exon that encodes the 20 to 30 N-terminal residues of the translated protein. These residues are moderately hydrophobic and make up the leader (or signal) peptide. Signal sequences are found in all newly slmthesized secreted and transmembrane proteins and are involved in guiding nascent polypeptides being generated on memb.ane-bo.rttd ribosomes into the lumen of the endoplasmic reticulum (ER). Here, the signal sequences are iapidly cleaved, and they are not present in the mature proteins. Upstream of each leader exon is aV gene promoter at which transcription can be initiated, but this occurs most efficiently, as discussed below after rearrangement.
C Region
V Region
(A -lg
I
lq heavv NHz G) cnaih (membrane form)
lg lightchain
Cu2 Y
DHJH
Cn3
TM CYT
cooH
NHz vL
@ - ---
Cn
TCR
TM CYT
TCR B chain
NHz
cooH
TCR crchain
NHz
cooH VG
c(,
and Domainsof lg and TGRproteins.The domainsof lg heavyand lightchainsare shown in A, and the domainsof TCR o polypepbetweenthe lg andTCRgenesegmentiandthe domainstructureof the antigenreceptor own in B. The-relatlonships and by differentgene segments.The locationsof intrachain lr" The V and C regionsof eachp6lypeptide rndicated. ln regions "n.od"d (complementarity-determining) hypervariable the are (S-S) boxes Areasin ihe dashed lfidebonds are approximate. (CYT)domainsare encodedby separateexons (TM)and cytoplasmic the lg p chainand the TCRo and p chains,transmembrane
159
160
i
section lll- MATURAT|0N, AclvATt0N, ANDREGULATT0N 0FLyMpH0cyrES
At varying distances 3' of the V genes are several I segments that are closely linked to downstream constant region exons. I segments are typically 30 to 50 base pairs long, separated by noncoding sequences. Between the V and I segments in the IgH locus there are additional segments know as D segments. In the human
composed of a single exon that encodes the entire C domain of the light chains. In contrast, each Cs gene is composed of five or six exons.Three or four exons (each similar in size to aV gene segment) encode the complete C region of each heavy chain isotype, and two smaller exons code for the carbory-terminal ends of the membrane form of each Ig heavy chain, including the transmembrane and cytoplasmic domains of the heavy chains (seeFig. 8-6A). In an Ig light chain protein (r or l,), the V domain is
Organization
of TCB Gene Loci
The genes encoding the TCR o chain, the TCR B chain, and the TCR y chain map to three separate loci, and the TCR 6 chain locus is contained within the TCR crrlocus (Fig. 8-7). Each germline TCR locus includes V L and C gene segments. In addition, TCR 0 and TCR 6 loci also have D segmenrs, like the Ig heavy chain locus. At the 5' end of each of the TCR loci, there is a cluster of several V gene segments, arranged in a very similar way to the Ig V gene segments.Upstream of each TCR V gene is an exon that encodes a leader peptide, and upstream of each leader exon is a promoter for each V gene. At varying distances 3' of the TCR V genes are the C region genes. There are two C genes in each of the human TCR p (Ce)and TCR y (Cr) loci and only one C gene in each of the TCR s (C") and TCR 6 (CJ loci. Each TCR C region gene is composed of four exons encoding the extracellular C region, a short hinge region, the transmembrane segment, and the cltoplasmic tail. I segments are found immediately upstream of the C genes in all the TCR loci, and D segments are found only in the TCR B and TCR 6 chain loci (which resemble the Ig heavy chain locus). Each human TCR C gene has its or,rmassociated5' cluster of ] segments.In the TCR cr or 7 chains (analogous to Ig light chains), the V domain is encoded by the V and I exons, and in the TCR B and 5 proteins, the V domain is encoded by the ! D, and J gene segments. The relationship of the TCR gene segments and the corresponding portions of TCR proteins that they encode is shor,rmin Figure 8-68. As in Ig molecules, the TCR V and C domains assume an Ig fold tertiary structure, and thus the TCR is a member of the Ig superfamily of proteins.
V(D)J Recombination The germline organization of Ig and TCR loci described in the preceding section exists in all cell types in the body. Germline genes cannot be transcribed into mRNA that gives rise to antigen receptor proteins. Functional
_Noncoding sequences in the Ig loci play important roles in recombination and gene expiession. As we shall see later, sequences that dictate recombination of different gene segments are found adjacent to each coding segment in Ig genes. Also present are V gene promoters, and other cis-acting regulatory ele_ ments, such as locus control regions, enhancers, and silencers, which regulate gene expression at the level of transcription.
matin must be opened in specific regions of the antigen receptor chromosome in order to make randomly selected gene segments accessible to the recombinational machinery. Recombination involves bringing together the appropriate gene segments across vast chromosomal distances. Double-strand breaks are then introduced at the ends of these segments, nucleotides are added or removed at the broken ends, and finally the processed ends are ligated to produce clonally unique but diverse antigen receptor genes that can be effrciently transcribed.
Chapter 8-
RECEPT0R GENES : 0FANTIGEN ANDEXPRESSI0N ANDTHEREARRANGEMENT LYMPH0CYTE DEVEL0PMENT
7) HumanTCRB chainlocus(620kb;chromosome
L Vp1
(n= -oz)
L Vpn
Dp1
JP1
5',
14 HumanTCRcx,6 chainlocus(1000kb;chromosome -s+) = (n -61) L Vo1
Jo(n=
L Von
Co
S'3 u ellll
Vo2
7 HumanTCRy chainlocus(200kb;chromosome (n= -14)
L vy1
i vrn
Jy1
cy1
Jv2
cv2 3'
5'
Exonsand introns F of humanTCRloci. The humanTCRp, o, y, and5 chainlociareshown,as indicated. Germlineorganization pseudogenes are not shown.EachC gene is shown as a singlebox but is composedof several to scale,and-nonfunctlonal a V, variable;D, diversity;J, tratedfor Cp.Gener"grn"nis are indicatedas follows:L, leader(usuallycalledsignalsequence); e joining;C, constant;enh, enhancer;sil, silencer(sequences that regulateTCRgenetranscription)
The recombination of antigen receptor genescan be demonstrated by a technique called Southern blot hybridization, which is used to examine the sizesof DNA fragments produced by restriction enzJ,'rne digestionof genomic DNA. By this method, it can be shor,,r,nthat the enz).rne-generatedDNA fragments containing Ig or TCR gene segmentsare a different sizewhen the DNA is from cellsthat make antibodies or TCRs,respectively,than when the DNA is from cells that do not make these antigen receptors (Fig. B-B). The explanationfor thesedifferent sizesis thatV and C regions of antigen receptor chains are encoded by different gene segmentsthat are located far apart in embryonic and nonlymphoid cellsand brought close together in cells committed to antibody or TCR sgrthesis (i.e.,in B or T llrrnphocytes). The process of V(D)I recombination at any Ig or TCR locus involves selecting one V gene, one I segment, and one D segment (when present) in each lymphocyte and rearranging these gene segments together to form a singleV(D)I exon that will code for the variable region of an antigen receptor protein. The C regions lie dor,r,nstream of theV(D)I exon separatedby the same germline J-C intron in the rearranged DNA as well as in the primary RNA transcript. RNA splicing brings together the leader exon, theV(D)J exon, and the C region exons, forming an nRNA that can be translated on membranebound ribosomes to produce one of the chains of the
antigen receptor. Different clones of l1'rnphocl'tes use different combinations of V D, and J gene segments at each relevant locus to generate functional receptor chains (Fig. 8-9). In addition, duringV(D)J recombination, nucleotides are added to or removed from the junctions. As we will discuss in more detail latel these processes contribute to the tremendous diversity of intigen receptors.The details and unique features ofthe processes of Ig and TCR gene rearrangement will be described when we consider the maturation of B and T lymphocytes, respectivelY.
Mechanisms
of V(D)J Recomhination
Rearrangement of Ig andTCR genes represents a speci,al kind of nonhomologous DNA recombination euent, mediated, by the coord,inated actiuities of seueral enzymes, some of which are found' only in deueloping lymphocytes while others are ubiquitous DNA doublestrand break repair (DSBR) enzymes. Critical lympho-
located adjacent to the coding sequence' followed by
161
16,2
i
Section lll - MATURAT|0N, ACT|VAT|ON, ANDREGULATT0N 0F LYMPH0CYTES
i
lg DNAin uncommitted (embryonic)cell, nonlymphoid cell
a spacer of exactly L2 or 23 nonconserved nucleotides, followed by a highly conserved AT-rich stretch of Southern 9 nucleotides, called the nonamer. The 12- and blot 23-nucleotide spacersroughly correspond to one or tvvo turns of a DNA helix respectively, and they presumably bring two distinct heptamers into positions that are simultaneously accessible to the enzymes that catalyze the recombination process. A specific enzyme (described below) introduces double-strand breaks in the DNA, cleaving between the heptamer of the RSSand the adjacentV D, or J coding sequence.In Ig light chain V-to-f recombination, for example, breaks will be made 3' of aV segment and 5' of a J segment. The intervening double-stranded DNA, containing signal ends (the ends 6kb that contain the heptamer and the rest of the RSS),is removed in the form of a circle, and this is accompanied 2.5 kb by the joining of the V and I coding ends (Fig. 8-t0B). lg DNAin SomeV genes,especiallyin the Ig r locus, are in the same committed cells orientation as the J segments, such that the RSSslinked of B lymphocyte to these V segments and J segments do not "face" each ilneaoe other. In these cases, the intervening DNA is inverted and theV and I exons are properly aligned and the fused RSSsare not deleted but retained in the chromosome (Fig. 8-l0C). Most Ig and TCR gene rearrangements occur by deletion; rearrangement by inversion occurs in up to 507oof rearrangements in the Ig r locus. Recombination occurs between two segments only if one of the segments is flanked by a l2-nucleotide spacer and the F &a Antigen receptor gene rearlangements,Southern other is flanked by a 23-nucleotide spacer; this is called b sis of DNA from nonlymphoid cellsand from two monoclonal populationsof B lymphocytelineageorigin (e,g., B cell the I2123 rule. A "one-turn" coding segment therefore tumors)is shown in schematicfashion.The DNA is digestedwith always recombines with a "tvvo-turn" segment. The type a restrctionenzyme,different-sized fragmentsare separatedby of the flanking RSSs(one turn or two turn) ensures that electrophoresis, andthe fragmentsareblottedontoa f ilter.Thesites the appropriate gene segments will recombine. For example, in the Ig healy chain locus, both V and I segments have 23-nucleotide spacers and therefore cannot join directly; D-to-l recombination occurs first, followed byV-to-Dl recombination, and this is possible because DNA This indicatesthat the specificsites where the restriction the D segments are flanked on both sides by 12enzymecuts the DNA are in a differentpositionin the genomeof nucleotide spacers,allowing D-I and then V-DI joining. the B cellscomparedwrth the non-Bcells.Thus,a rearrangement The recombination signal sequencesdescribed here are of the germlineDNA sequencein the lg r locushasoccurredin the unique to Ig and TCR genes.Therefore,V(D)I recombiB cells.Note that the f ragmentfrom the rearranged DNA may be nation is relevant for antigen receptor genes but not for largeror smallerthanthe fragmentfrom the germlineDNA,dependother genes. ing on the locationof the stteswhere the restrictionenzymecuts
the DNA
V1 V2
Vn
D1-n
J1-n
c
Somaticrecombination(V-D-Jjoining),additionof N and P nucleotides,transcriptionand RNAprocessing in threeB cell clones
D3J5
N/Pnucleotides
N/Pnucleotides
D2J2
N/Pnucleotides
FIGURE 8-9 Diversityof antigen receptor genes. From the same germline DNA, it is possible to generate recombined DNA sequencesand mRNAs that differ in their V-D-J junctions In the example shown, three distinct antigen receptormRNAs are produced f rom the same germline DNA by the use of differentgene segments and the addition of nucleotides to the junctions
Chapter8 -
GENES 0F ANTIGENRECEPT0R AND EXPRESSI0N LYMPH0CYTE DEVELOPMENT AND THEBEARRANGEMENT
3'
GTGTCAC lt-ll , l
TGTTTTTGG 3'
5'
23
3'
3'
5'
3'
+
in the lg gene lociare depictedThe The DNA sequencesand mechanismsinvolvedin recombination FIGURE 8-1o V(D)Jrecombination. in the TCR loci.A. Conservedheptamer(7bp)and nonamer(9bp) sequences' same sequencesano mecnanismsapplyto recombinations ,"parat"dby12-or23-bpspacers,areiocatedadjacenttoVandJexons(forrandlloci)ortoVD,andJexons{intheHchainloc of V andJ exons signalsequencesand bringsthe exonstogether.B. Recombination recognizes theserecombination The V(D)Jrecombinase by tnverDNA and ligationof ihe V and J segmentsor, C, if the V gene is in the oppositeorientation, may occurby deletionof int6rvening prior germline are cleaved sequences where sites indicate the gene Red arrows segments. DNA followed by ligation of adlacent sionof the to their ligationto other lg or TCRgene segments.
164
!
Section lll - MATURAT|0N, ACT|VAT|0N, ANDREGULATT0N OFLYMPH0CYTES
The process of V(D)I recombination can be divided into four distinct events that flow sequentially into each other (Fig.8-11): l. Synapsis:Portions of the antigen receptor chromosome are made accessible to the recombination machinery, and two selected coding segments and their adjacent RSSsare brought together by a chromosomal looping event and held in position for subsequent cleavage,processing, and joining.
Unrearranged locus
Quynapsrs
2. Cleauage:Double-strand breaks are enzymatically generated at RSS-codingsequencejunctions using machinery that is lgnphoid specific. 3. Coding end processing: The broken coding ends (but not the signal/RSSends) are modified by the addition or removal of bases, and thus greater diversity is generated. 4. Joining: The broken coding ends as well as the signal ends are brought together and ligated by a double-strand break repair process found in all cells that is called non-homolgous end joining. TWo proteins encoded by lymphoid-specific genes called recombination-actiuating gene 1 and recombination-actiuating gene 2 (Rag-l and Rag-2) form a tetrameric complex that plays a major role in V(D)I recombination. The Rag-1 protein, in a manner similar to a restriction endonuclease, recognizes the DNA sequenceat the junction between a hepatamer and a coding segment, and cleavesit, but it is enzymatically active onlywhen complexed with the Rag-2protein. The Rag-I / Rag-2complex is also known as the V(D) I recombinase. The Rag-2 protein may help link the Rag-l/Rag2 tetramer to other proteins, including accessibility factors that bring these proteins to specific "open" receptor gene loci at specific times and in defined stages of ll.rnphocyte development. Rag-l and Rag-2 contribute to holding together gene segments during the process of chromosomal folding or synapsis. Rag-l then makes a nick (on one strand) between the coding end and the heptamer. The released 3'OH of the coding end then attacks the other strand forming a covalent hiirpin. The signal end (including the heptamer and the rest of the RSS)does not form a hairpin and is generated as a blunt double-stranded DNA terminus that unoergoes no further processing. This double-stranded break results in a closed hairpin of one coding segment being held in apposition to the closed hairpin of the other coding end and two blunt signal ends being placed next to each other. Rag-l and Rag-2, apart from generating the double-stranded breaks, also hold the hairpin ends and the blunt ends together prior to the modification of the coding ends and the process of ligation.
r Sequentialevents during V(DU recombination. cleavageof DNA at the heptamer/coding segment ediatedby Rag-1and Rag-2.The codingend hairpin the Artemis endonucleaseand broken ends are repairedby the NHEJmachinerv.
Rag-1/ Rag-2
Rag-1/ Rag-2
@cteavage
44
I
I
tl 5' ffi. Hairpinopening and'endprocessing / ,7n
ffi:;'
//
t
5'
.F.
t-
ArtemisiDNA-PK, exonucleases, TdT
@ Repair/ligation
Ku70/Ku80/DNA-PK XRCC4iDNA LigaselV 5'
NandP nucleotides
GENES RECEPToR 0FANTIGEN ANDEXPRESSIoN ANDTHEREARRANGEMENT DEVELOPMENT chapter8 - LyMpHocyTE
After the formation of double-stranded breaks, hairpins must be resolved (opened up) at the coding junctions, bases may be added to or removed from the coding ends to ensure even greater diversification, and then all the broken ends must be appropriately joined, coding end to coding end and signal end to signal end. The importance of the Rag genes is illustrated by the finding that knockout mice lacking either RagI or Rag2 fail to produce Ig and TCR proteins and lack mature B and T lymphocytes. The Rag-l and Rag-2 proteins exhibit several important properties. First, Rag-I and Rag-2 are cell type specific, being produced only in cells of the B and T l1'rnphoclte lineages. Second, the Rag genes are expressed only in immature lymphocltes. Therefore,V(D)I recombination is active in immature B and T lymphocytes but not in mature cells, explaining why Ig and TCR gene rearrangements do not continue in cells that expressfunctional antigen receptors.Third, Rag genes are expressed mainly in the Go and Gr stagesof the cell cycle and are silenced in proliferating cells. It is thought that limiting DNA cleavage and recombination to nondividing cells minimizes the risk of generating inappropriate DNA breaks during DNA replication or during mitosis. The same recombinase mediates rearrangement at both Ig and TCR loci. Because complete functional rearrangement of Ig genes normally occurs only in immature B cells and rearrangement of TCR genes normally occurs only in developing T cells, some other mechanism, other than the recombinase itself, must control the cell tlpe specificity and the differentiation stage specificity of recombination. It is likely that the accessibility of the Ig and TCR loci to the recombinase is differentially regulated in developing B and T cells by severalmechanisms, including alterations in chromatin structure, DNA methylation, and basal transcriptional activity in the unrearranged loci. One other lymphoid-specific enz].rynethat functions do'urmstreamof the Rag proteins is terminal deoxynucleotidyl transferase (TdT), discussed below. All the
165 $
that are crucial forV(D)I recombination other enz1rynes are involved in the process of non-homologous end joining that mediates double-strand break repair during V(D)J recombination. Their role in Ig and TCR gene recombination is to repair the double-stranded breaks introduced by the recombinase. Ku70 and Ku80 are DNA end binding proteins that bind to the breaks and recruit the catalytic subunit of DNA-dependent protein kinase (DNA-PK), a double-stranded DNA repair enzyme. This enzyme is defective in mice carrying the severe combined immunodeficiencY 6cid) mutation (see Chapter
and B cells cannot be generated. Mutations in Artemis result in the absence of T and B cells (Chapter 20). Ligation of the processed broken ends is mediated by DNA ligase IV One of the consequences of V(D)J recombination is that the process brings promoters located immediately 5' of V genes in close proximity to downstream enhancers that are located in the J-C introns, and also 3' of the C region genes (Fig. 8-12). These enhancers maximize the transcriptional activity of the V gene promoters and are thus important for high-level transcription of rearrangedV genes in lymphocytes. Because Ig and TCR genes are sites for multiple DNA recombination events in B and T cells, and because these sites become transcriptionally active after recombination, genes from other loci can be
(Box 8-l).
recombination
FtcURE &12 Transcriptionalregulation of lg genes. V-D-J recombination brings promoter sequences(shown as P) close to the enhancer (enh) The enhancerpromotestranscriptionof the V gene(V2,whoseactivepromoteris indirearranged catedby a bold greenarrow)
FBft-T"'l
Fl - -t4-
ur rl
p{Transcription
I
RNAI
V J V
166
Section lll - MATURATI0N, ACT|VAT|0N, ANDREGULATT0N 0F LyMpH0CYTES
Cytogeneticistsf irst noted reciprocal chromosomal t r a n s l o c a t i o ni nsl y m p h o m aas n d l e u k e m i aisn t h e 1 9 6 0 s , b u t t h e i rs i g n i f i c a n cree m a i n e du n k n o w nu n t i la l m o s t2 0 y e a r sl a t e rA . t t h i st i m e ,s e q u e n c i nogf s w i t c hr e g i o n so f l g H g e n e si n t w o d i f f e r e n B t c e l lt u m o r sb e a r i n gt r a n s l o c a t i o n s h, u m a nB u r k i t t ' sl y m p h o m aa n d m u r i n ep l a s m a c y t o m a ,r e v e a l e dt h e p r e s e n c eo f D N A s e g m e n t st h a t w e r e n o t d e r i v e df r o m l g g e n e s T h e " f o r e i g n "D N Aw a s identifiedas a portion oI |he C-MYC proto-oncogene, w h i c h n o r m a l l yr e s i d e so n c h r o m o s o m e8 i n h u m a n s P r o t o - o n c o g e n easr e n o r m a lc e l l u l a rg e n e s t h a t o f t e n c o d ef o r p r o t e i n si n v o l v e di n t h e r e g u l a t i oonf c e l l u l apr r o l i f e r a t i o nd, i f f e r e n t i a t i o n a ,n d s u r v i v a ls, u c h a s g r o w t h factors, receptorsfor growth factors, or transcriptiona c t i v a t i nfga c t o r s I n n o r m a cl e l l s ,t h e i rf u n c t i o ni s t i g h t l y r e g u l a t e dW h e n t h e s eg e n e sa r e a l t e r e db y m u r a t r o n s , i n a p p r o p r i a t eel xy p r e s s e do, r i n c o r p o r a t ei dn t o a n d r e i n t r o d u c e di n c e l l sb y r e t r o v i r u s e tsh, e y c a n e x h i b i te i t h e r e n h a n c e do r a b e r r a n ta c t i v i t i e sa n d f u n c t i o na s o n c o g e n e s . D y s fu n c t i o n o f o n c o g e n e si s o n e i m p o r t a n t mechanism l e a d i n gt o i n c r e a s ecde l l u l agr r o w t ha n d ,u l t i m a t e l y ,n e o p l a s t i ct r a n s f o r m a t i o nT h e m o s t c o m m o n t r a n s l o c a t i oinn B u r k i t t ' sl y m p h o m ai s t ( 8 ; 1 4 ) i, n v o l v i n g t h e l g h e a v yc h a i nl o c u so n c h r o m o s o m ej 4 . ,l e s s c o m m o n l y t, ( 2 ; 8 )o r ! 8 ; 2 2 1t r a n s l o c a t r oanrse f o u n d ,i n v o l v i n g t h e r o r ) . l i g h t c h a i nl o c i , r e s p e c t i v e l vI n a l l c a s e so f
Burkitt'slymphoma,C-MYCis translocatedfrom chrom o s o m e8 t o o n e o f t h e l g l o c i ,p r o d u c i n tgh e r e c i p r o c a l 8 ; 1 4 ,2 : 8 , o r 8 ; 2 2 t r a n s l o c a t i o nf osu n d i n t h e s e t u m o r s The C-MYCgene productis a basichelix-loop-helix transcription f a c t o ra, n dt r a n s l o c a t i oonf t h e g e n eI e a d st o i t s dysregulatedexpression C-MYCfunctionis still incompletelyunderstood,but it activatesthe expressionof a l a r g en u m b e ro f g e n e st h a t c o n t r o lm e t a b o l i s mp, r o t e i n s y n t h e s i sa, n d r i b o s o m eb i o g e n e s i sa, n d t h e r e b vp r o m o t e sc e l lg r o w t ha n d d i v i s i o n . B e c a u s ea n t i g e nr e c e p t o rg e n e s n o r m a l l yu n d e r g o severalgeneticrearrangements duringlymphocytematu r a t i o nt,h e y a r e l i k e l ys i t e sf o r a c c i d e n t at rl a n s l o c a t i o n s o f d i s t a n tg e n e s D N A s e q u e n c i n g o f a n t i g e nr e c e p t o r g e n e si n v o l v e di n c h r o m o s o m at rl a n s l o c a t i o nssu g g e s t s t h a tt h e s em i s t a k e so c c u ra t t h e t i m e o f a t t e m p t e dV ( D ) J r e a r r a n g e m e ni nt p r e - Ba n d p r e - Tc e l l s ,d u r i n gs w i t c h r e c o m b i n a t i oinn g e r m i n a cl e n t e r B c e l l s ,a n d p o s s i b l v d u r i n gt h e p r o c e s so f s o m a t i ch y p e r m u t a t i o (na l s oi n g e r m i n acl e n t e rB c e l l s ) O f i n t e r e s th, u m a nl y m p h o m a s d e r i v e df r o m g e r m i n acl e n t e rB c e l l s ,w h i c h r e l yo n r e g u l a t e dg e n o m i ci n s t a b i l i ttyo d i v e r s i f yt h e i rl g g e n e s ,a r e c o m m o n a n d o f t e n h a v e c h r o m o s o m atlr a n s l o c a t i o n s i n v o l v i n tgh e l g g e n e s .I n c o n t r a s tt,u m o r sd e r i v e df r o m m a t u r eT c e l l s( w h i c ha r e g e n o m i c a l lsyt a b l e )a r e i n f r e q u e n t a n d o n l y r a r e l yh a v et r a n s l o c a t i o ni ns v o l v i n gt h e
B Cell derived
au*1t!s lvmohoma
t(8;14)(q24.1;q32.3)most common
C-MYC, tgH
Acutelymphoblastic leukemia (pre-B-ALL)
t(12;21)(p13;q22)(25%ot childhoodcases)
TEL|,AML|
Pre-B-ALL; alsochronic t(9;22)(q3a;q11) (25L of aduttALL, myelogenous ALL) leukemia 3%of childhood
BCR,ABL (Philadelphia chromosome)
Follicularlymphon'ra
BCL-2, lgH
t ( 1 4 ; 1 8 ) ( q 3 2 . 3 ; q32) 1
DiffuseB celllymphoma t(3;1a)(q27;q32.3) largecelltype
8CL-6 (DNA-bindingprotein),/9H
Mantlecelllymphoma
CCND| (CYCL|NDl),lgH
t ( 11; 1 4 ) ( q 1 3 ; q 3 2 . 3 )
T Cell derived 5 )e .o f c a s e s ) : t ( 1 ; 1 4 ) ( p 3 2 ; q 1( 1 Pre-Tcellacute lymphoblastic leu,kemra del(1p32)(20%of cases)
TAL|, TCRa; TALI, SCL
T cell lymphoma, t(2;s)(p23;q35) anaplasticlargg celf type
ALK(tyrosinekinase), NPM (unknownfunction)
I n e s e a r e s o m e e x a m p l e s f c h r o m o s o m at rl a n s l o c a t i o nt hsa t h a v eb e e n m o l e c u l a r lcyl o n e di n h u m a nl y m p h o i d tumors Eachtranslocation i indicatedby the lettert. The first pairof numbersrefersto the chromosomesinvolved, for example,(8;14),and the econdpairto the bandsof eachihromosome,for example, \q24 1; q323) The normar chromosomal locationsof antigenreceptorgenes(indicated in bold)are lgH, 14q323: lgr, 2plZ; lg)\,22q112; TCRo6, 1 4 q 1 12 , T C R p 7 , q 3 4 ;a n dT C R y , 7 p 1 b
Continuedon followingpage
GENES 0F ANTIGENRECEPTOR AND EXPRESSI0N Chaoter8 - LYMPHOCYTE DEVEL0PMENT ANDTHEREARRANGEMENT
TCRgenes.In some translocations associatedwith lymphoid tumors, DNA breakage near proto-oncogenes occurs at sites that resembleheptamerand nonamer sequences,suggestingthat they are causedby an aberrant V(D)J recombinaseactivitv. However, in most , o r eg e n e r a l l yi n, a l lt r a n s l o c a t i o n i n s t a n c e(sa n d m f osu n d i n n o n l y m p h o itdu m o r s )s, u c hs e q u e n c eas r e l a c k i n ga n d the causeof DNA breakagewithin or adjacentto protoo n c o g e n e si s u n c e r t a i n . in B cell Sincethe discoveryof C-MYCtranslocations l y m p h o m a st h, e g e n e si n v o l v e di n t r a n s l o c a t i o ni nsm a n y o t h e r l y m p h o i d( a n d n o n l y m p h o i dt )u m o r s h a v e b e e n identified(seeTable).In most cases,thesetranslocations resultin dysregulation of transcription factors,cellsurvival proteins, or signal-transducing molecules such as kinases.One gene that has proved to be particularly i m p o r t a nitn a c u t ep r e - Bc e l la n da c u t em y e l o i dl e u k e m i a s i s A M L I , a g e n e o n c h r o m o s o m e2 1 t h a t e n c o d e sa member of the Runt family of transcriptionfactors About 25% of childhoodacute pre-Bcell lymphoblastic l e u k e m i ah s a v ea b a l a n c e d 1 1 2 ; 2 1t r) a n s l o c a t i ot hn a t p r o d u c e sa f u s i o ng e n ee n c o d i n g t h e D N A - b i n d i npgo r t i o no f A M L l a n d t h e d i m e r z a t i o nd o m a i no f T E L 1 ,a m e m b e r factors.Similarly, of the Ets familyof transcription about 20o/oof acute myelogenousleukemiashave a balanced ( 8 ; 2 1 )t r a n s l o c a t i o inn v o l v i n ga d i f f e r e n tE t s - l i k et r a n scriptionfactor,ETO,and AMLl . In both instances,the oncogeniA c M L l f u s i o np r o t e i n sa p p e a rt o h a v e " d o m i -
nantnegative"activitythat inhibitsnormalAMLl function This impliesthat and resultsin a block in differentiation. the normalrole of AMLl is to promotethe terminaldifwhich is supported ferentiationof bloodcell progenitors, by the observationthat arnl7 knockoutmice die during embryogenesisbecauseof a failure to produce blood cells.The most frequentchromosomalrearrangements in acute pre-T cell leukemiascause the inappropriate expressionof TALI, a gene encodinga basichelix-loopfactorthat appearsto interferewith T helixtranscription chromosome,found The Philadelphia cell differentiation. in chronicmyelogenousleukemiaand some acute lymphoblasticleukemias,is created by a balancedt(9;221 fusion gene that This yieldsa BCR/C-ABL translocation. encodesa constitutivelyactivetyrosinekinase.Diffuse largeB cell lymphoma,the most common lymphomaof adults,is often associatedwith chromosomaltranslocations that dysregulatethe expressionof BCLC which factorthat is requiredfor germiencodesa transcription expression Inappropriate B cell development. nal center of BCL6is believedto block B cell developmentbeyond the germinalcenter stage and to inhibitthe functionof genes (suchas p53 that respondto DNA damage.The ( 1 4 ; 1 8 )t r a n s l o c a t i o fno u n d i n g r e a t e r t h a n 8 5 % o f a n o t h e rc o m m o nB c e l l l y m p h o m af,o l l i c u l alry m p h o m a , of a survivalgene,BCL2,andthe leadsto overexpression preventionof programmedcell death.
Brigham& Women'sHospitaland Harvard This box was writtenwith the assistance of Dr Jon Aster,Departmentof Pathology, MedicalSchool,Boston
Generation
of Diversity
in B and T Gells
The enormous diuersity of the mature B and.T cell repertoires k generated. primarily by the rearr&ngernent of Ig and TCR genes. Several genetic mechanisms contribute to this diversity, and the relative importance of each mechanism varies among the different antigen receptor loci (Table 8-l). Not discussed here is somatic hlpermutation, a receptor diversification mechanism unique to the B cell lineage, which will be considered in Chapter 10. o Combinatorial diversity.V(D)J recombination events involve multiple germline gene segments that may combine randomly, and different combinations produce different antigen receptors. The maximum possible number of combinations of these gene segments is the product of the numbers of V J, and (if present) D gene segments at each antigen receptor locus. Therefore, the amount of combinatorial diversity that can be generated at each locus reflects the number of germline! J, and D gene segments at that Iocus.After somatic recombination and expressionof antigen receptor chains, combinatorial diversity is further enhanced by the juxtaposition of two different, randomly generated V regions (i.e.,Vu and Vr in Ig molecules andV" andVp in TCR molecules). Therefore, the total combinatorial diversity is theoretically
the product of the combinatorial diversity of each of the two associating chains. The actual degree of combinatorial diversity in the expressed Ig and TCR repertoires in any individual is likely to be considerably less than the theoretical maximum. This is because not all recombinations of Sene segments are equally Iikely to occur, and not dl pairings of Ig heavy and light chains or TCR cr and B chains may form functional antigen receptors. Importantly, since the numbers of V J, and D segments in each locus are limited (see Table 8-l), the maximum possible numbers of combinations are on the order of thousands. This is, of course, much less than the actual diversity of antigen receptors in mature lymphocytes. @ Iunctional diversity. The largest contribution to the diversity of antigen receptors is made by the removal or addition of nucleotides betweenV and D, D and L or V and I segments at the time of joining. These processes result in variability at the junctions of V D, and I gene segments, called junctional diversity. One way this can occur is if endonucleases remove nucleotides from the germline sequences at the ends of the recombining gene segments. In addition, new nucleotide sequences, not present in the germline, may be added at junctions' Coding segments (e.g.,V and J gene segments) that are cleaved by Rag-l form hairpin loops whose ends are often
168
i
Section lll- MATURAT|ON, ACT|VAT|ON, ANDREGULATT0N 0FLYMPHOCYTES
Table8-1. Contributionsof DifferentMechanismsto the Generationof Diversityin lg and TCR Genes
lmmunoglobulinTCRgB Heavychaini r c[ rB
Mechanism
Mechanism Variable(V)segments 85 (D)segments 27 Diversity D segments readin all Rare threereadingframes N regiondiversification V-D, D-J Joining(J)segments 6 Totalpotentialrepertoire withjunctionaldiversity
35
54
0
O
67
t2
TCR yD y :6 14
0
i Often
20-30
r3 : Often
None V-J V.D,D-J v-Ji v-D1,D1-D2, D1-J 5
61 :4
-1011
- 1016
5
4 -1018
The potentialnumber of antigenreceptorswith junctionaldiversityis much greaterthan the number that can be generatedonly by combinationsof V D, and J gene segments.Note that althoughthe upper limit on the numbersof lg and TCR proteinsthat may be expressedis very large, it is estimatedthat each individualcontainson the order of 107clones of B and T cells with distinctspecificitiesand receptors;in other words, only a fractionof the potentialrepertoiremay actuallybe expressed.
cleaved asymmetrically by Artemis so that one DNA strand is longer than the other (Fig.8-13). The shorrer strand has to be extended with nucleotides complementary to the longer strand before the ligation of the two segments.The short lengths of added nucleotides
are called P nucleotides, and their templated addition introduces new sequences at the V-D-I junctions. Another mechanism of junctional diversity is the random addition of up to 20 non-template-encoded nucleotides called N nucleotides (see Fig. 8-13). N
Site of hairpincleavage..\
ffi
w i$] 991
w \Sites of N, nucleotide \ addition P nucleotides
P nucleotides
P nucleotides N nucleotides
P nucleotides
FIGURE &13 Junctional diversity. Duringthe joiningof differentgene segments, addition or removal of nucleotidesmay leadto the generation of novel nucleotideand amino acid sequences at the junction Nucleotides(P sequences)may be added to asymmetricallycleaved hairpins in a templated manner (N regions)may be Othernucleotides addedto the sites of VD, VJ, or DJ junctronsin a nontemplatedmanner by the action of the enzyme TdT. These additions generate new sequences that arenot presentin the germline
GENES 0F ANTIGENRECEPT0R AND EXPRESSI0N DEVEL0PMENT ANDTHEREARRANGEMENT Chaoter8 - LYMPH0CYTE
region diversification is more common in Ig heavy chains and in TCR B and y chains than in Ig rc or l, chains. This addition of new nucleotides is mediated by the enzyrne TdT (terminal deoxynucleotidyl transferase). In mice rendered deficient in TdT by gene knockout, the diversity of B and T cell repertoires is substantially less than in normal mice. The addition of P nucleotides and N nucleotides at the recombination sites may introduce frameshifts, theoretically generating termination codons in two of every three joining events.Such inefficiency is a price that is paid for generating diversity. Because of junctional diuersity, antibod.y and TCR molecules show the greatest uariability at the junctions ofV and C regions that form the third hyperuariable region, or CDR3. The CDR3 regions of Ig and TCR molecules, which are formed at the sites of V(D)I recombination (seeFig. 8-6), are also the most important portions of these molecules for determining the specificity of antigen binding (seeChapters 4 and 7). In fact, because of junctional diversity, the numbers of different amino acid sequencesthat are present in the CDR3 regions of Ig and TCR molecules are much greater than the numbers that can be encoded by germline gene segments. Thus, the greatest diversity in antigen receptors is concentrated in the regions of the receptors that are the most important for antigen binding. Although the theoretical limit of the number of Ig and TCR proteins that can be produced is enormous (see Table 8-l), the actual number of Ig and TCR genes expressed in each individual is probably only on the order of 107.This perhaps reflects the fact that most receptors, which are generated randomly, do not pass the selection processesneeded for maturation. A practical application of our knowledge of junctional diversity is the determination of the clonality of lymphoid tumors that have arisen from B or T cells. Because every lymphoclte clone expresses a unique antigen receptor CDR3 region, the sequenceof nucleotides at the V(D)J recombination site servesas a specific marker for each clone. Thus, by sequencing the junctional regions of Ig orTCR genesin different B orT cell tumors, even from the same patient, one can establish whether these tumors arose from a single clone or independently from different clones. Furthermore, polymerase chain reaction-mediated amplification of these clone-specific sequencesmay be used as a sensitive detection method for small numbers of tumor cells in the blood or tissues. Regulation Transcriptional B Gell Development
of Early T and
As discussed earlier in this chapter, all lymphocytes develop from CLPs that in turn are derived from hematopoietic stem cells (see Fig. 8-2). CLPs in the bone marrow primarily give rise to B cells, and CLP-like cells that migrate to the thymus give rise to T cells. Commitment to the B and T lineages is orchestrated by different sets of transcription factors (Fig. 8-la). The Notch family of proteins are cell surfacemolecules that are proteolytically cleaved when they interact with specific
ligands on neighboring cells. The cleaved intracellular portions of Notch proteins migrate to the nucleus and modulate the expression of specific target genes. Notch-l, a member of the Notch family, is activated in progenitor cells and collaborates with a transcription factor called GATA-3 to commit developing lymphocltes to the T lineage. These transcriptional regulators contribute to the induction of a number of genes that are required for the further development of crB T cells. Do'vrmstream target genes include components of the pre-T cell receptor and of the machinery for V(D)I recombination. In B cells the EBF and E2A transcription factors contribute to the induction of another transcription factor called Pax-S,and these three nuclear proteins collaborate to induce the process of commitment to the B lineage by facilitating the expression of a number of genes. These genes include those encoding the Rag-1 and Rag-2 proteins, surrogate light chains, and the Iga and IgB proteins that contribute to signaling via the preB cell receptor and the B cell receptor.
degradation of various target mRNAs'
DEVETOPMENT B LyIvIPHOCYTE
Drecursors in the fetal liver; after birth, B cells are generited i.r the bone marrow. The majority of B lymphocltes arise from adult bone marrow progenitors that are initially Ig negative, develop into immature B cells that express membrane-bound IgM molecules, and then leave the bone marrow to mature further primarily in the spleen,where B cellsof the follicular B cell lineageexpress tgM and IgD on the cell surface. It is in the spleen that these cells acquire the ability to recirculate and populate all peripheral lymphoid organs. Recirculating follicular B cells home to ly'rnphoid follicles and have the ability to recognize foreign antigens and to respond to them. The development of a mature B cell from a l1'rnphoid progenitor is estimated to take 2 to 3 days in humans. Stages of B Lymphocyte
Development
called a pro-B cell. Pro-B cells do not produce Ig, but they can be distinguished from other immature cells by the expression of B lineage-restricted surface molecules such ai CD19 and CD10. Rag proteins are first expressed
17O
zi
Section lll - MATURAT|ON, ACT|VAT|ON, ANDREGULATT0N 0F LYMPH0CYTES
riptional regulatorsdrive commitmmitmentto the T lineagedepends domainmedi, whose intracellular atestranscriptional activation genesin collaboration of T lrneage with other transcription factorssuch as GATA-3.Commitmentto the B lineageis mediatedinitially by the EBFand E2Atranscription factors, and subsequentlyby Pax-5.These transcriptionfactors work togetherto inducethe transcription genesand of of B cell-specific genesof the recombination machinerv.
at this stage, and the first recombination of Ig genes occurs at the healy chain locus. This recombination brings together one D and one I gene segment, with deletion of the intervening DNA (Fig. 8-l6A). The D segments that are 5' of the rearranged D segment, and the I segments that are 3'of the rearranged J segment, are not affected by this recombination (e.g.,Dl and J2 to 16 in Fig. 8-16A.).After the D-I recombination event, one of the many 5'V genes is joined to the DI unit, giving rise to a rearranged VDI exon. At this stage, all V and D segments between the rearranged V and D genes are also deleted. V-to-DI recombination at the Ig H chain locus occurs only in committed B lyrnphocyte precursors and is a critical event in Ig expression because only the rearrangedV gene is subsequently transcribed. The TdT enzyrne, which catalyzes the nontemplated addition of junctional N nucleotides, is expressedmost abundantly during the pro-B stagewhenVDJ recombination occuri at the IgH locus, and levels of TdT decreasebefore light chain gene V-I recombination is complete. Therefore, junctional diversity attributed to N nucleotides is more abundant in rearranged hear,y chain genes than in light chain genes. The healy chain C region exons remiin
separated from theVDI complex by DNA containing the distal I segments and the J-C intron. The rearranged Ig heavy chain gene is transcribed to produce a primary transcript that includes the rearrangedVDl complex and the Cp exons. Multiple adenine nucleotides, called polyA tails, are added to the 3' end of the Cp RNA after it is cleaved downstream of one of two consensus polyadenylation sites.The nuclear RNA undergoes splicing, an RNA processing event in which the introns are removed and exons joined together. In the case of the p RNA, introns between the leader exon and theVDf exon, between the VDI exon and the first exon of the Culocus, and between each of the subsequent constant region exons of Cp are removed, thus giving rise to a spliced mRNA for the p heavy chain. If the mRNA is derived from an Ig locus at which rearrangement was productive (see below), translation of the rearranged p heavy chain mRNA leads to synthesis of the p prorein. In order for a rearrangement to be productive (in the correct reading frame), basesmust be added or removed at junctions in multiples of three. This ensures that the rearranged Ig gene will be able to correctly encode an Ig protein. Approximately one in three pro-B cells make productive rearrangements at the IgH locus and can thus go on to synthesize the p heavy chain protein. Only cells that make productive rearrangements survive and differentiate further. Once a productive Igp rearrangement is made, a cell ceasesto be called a pro-B cell and has differentiated into the pre-B stage. Pre-B cells are developing B lineage cells that express the Igp protein but have yet to rearrange their light chain loci. The p heavy chain associateswith the 1,5and VpreB proteins, also called surrogate light chains, which are structurally homologous to r and l" light chains but are invariant (i.e., they are identical in all pre-B cells) and are only slrrthesized in pro-B and pre-B cells (Fig.8-17A). Complexes of p, surrogate light chains, and signal transducing proteins called Iga and IgB form the pre-antigen receptor of the B lineage, known as the pre-B cell receptor (preBCR).Iga and IgB also form part ofthe B cell receptor in mature B cells (seeChapter 10). In cells that have made proper in-frame rearrangements at the IgH locus, the pre-BCR drives the pro-B to pre-B transition. This happens, as explained above, in approximately a third of pro-B cells that have completed VDJ rearrangement at the IgH locus, and pre-BCR signaling is responsible for the largest developmental expansion of B lineage cells in the bone marrow. ', The importance of pre-BCRsis illustrated by studies of knockout mice and rare casesof human deficiencies of these receptors.For instance,in mice, knockout of the gene encoding the p chain or one of the surrogate light chains, called 1"5,results in markedly reduced numbers of mature B cells.This suggeststhat the p-1,5complex delivers signals required for B cell maturation and that if either gene is disrupted, maturation does not proceed. It is not knor,r,n what the pre-BCR recognizes, but the consensus view at present is that this receptor functions in a ligand-independent manner, and when it
RECEPTOR GENES i 0F ANTIGEN ANDEXPRESSION Chapter 8 - LYMPHOCYTE DEVELOPMENT ANDTHEBEARRANGEMENT r*,r?4r+#,$rese'*::t;i
*--*-*it5-"
stage of maturation
stem cell
Pro-B
Pre-B L ::,,_
B lmmature
MatureB
RecombinedH
splicing Alternative of VDJ-CRNA (primary to transcript), form Cprand C6 mRNA
l
Ragexpression TdT expression Unrecombined Unrecombined Recombined chain gene (VDJ), (gelmline) (gelmline) H chaingene lg DNA, RNA genes (VJ); (VDJ);tr mRNA rp or l. l" mRNA DNA DNA or K or
lg expression Surface markers Anatomic site Response to antigen
None
None
cD43+
cD43+ cD19+ cD10+
p and MembranelgM (p+ Cytoplasmic pre-Breceptor- r or l" lightchain) p associated B2zoto cD43+
Bonemarrow None
None
lgD* lgM* cD23+
lglYto
cD43,
None
Membrane lgMandlgD
PeriPherY
Negativeselection (deletion), receptor editing
Activation (proliferation and differentiation)
to eachstageof B cell maturationfrom a bone marrowstem cell to a FIGURE 8-tS Stagesof B cell maturation.Eventscorresponding matureB lymphocyteare illustratedSeveralsurfacemarkersin additionto thoseshown havebeenusedto definedistinctstagesof B cell maIUralron
is assembled it is in the "on" conformation. Numerous signaling molecules linked to both the pre-BCR and the BCR are required for cells to successfully negotiate the pre-BCR-mediated checkpoint at the pro-B to pre-B cell transition. A kinase called Bruton's tyrosine kinase (Btk) is activated downstream of the pre-BCR and is required for delivering signals from this receptor that mediate survival, proliferation, and maturation at and beyond the pre-B cell stage.In humans, mutations in the BTK gene result in the disease called X-linked agammaglobulinemia (XLA), which is characterized by a failure of B cell maturation (see Chapter 20). In mice, mutations in brk result in a less severe B cell defect in a mouse strain called Xid (for X-linked immunodeficiency). The defect is less severe than in XLA because murine pre-B cells express a second Btk-like kinase called Tec that compensates for the defective Btk. The pre-BCR regulates further rearrangement of Ig genes in two ways. First, if a p protein is produced from the recombined heavy chain locus on one chromosome and forms a pre-BCR,this receptor signals to irreversibly inhibit rearrangement of the Ig heavy chain locus on the other chromosome. If the first rearrangement is nonproductive, the hear,y chain allele on the other chromosome can completeVDl rearrangement at the IgH locus.
Thus, in any B cell clone, one heavy chain allele is productively rearranged and expressed, and the other is in the germline configuration or is nonproductively rearranged. As a result, an individual B cell can express Ig healy chain proteins encoded by only one of the two inherited alleles. This phenomenon is called allelic exclusion, and it helps ensure that every B cell will expressa single receptor, thus maintaining clonal specificity. If both alleles undergo nonproductive IgH gene rearrangements, the developing cell cannot produce Ig heary chains, cannot generate a pre-BCR-dependent survival signal, and thus undergoes programmed cell death. This occurs frequently and in part explains why only a small fraction of the cells arising from B cell progenitors develop into mature B lymphocytes (see Fig. 8-3). Ig heaqr chain allelic exclusion involves changes in chromatin structure in the heavy chain locus that limit accessibility to the V(D)J recombinase. The second way the pre-BCR regulatesV(D)J recombination is by stimulating light chain gene rearrangement. However, p chain expression is not absolutely required for light chain gene recombination, as sholtryt byihe finding that knockout mice lacking the p gene do initiate light chain gene rearrangements in some developing B cells (which, of course, cannot express func-
171
172
$
Section lll- MATURATION, ACT|VAT|0N, ANDREGULATTON 0FLyMPH0CYTES
@ p Heavychain Germline DNA
LV1 LVn
D1-23
@ r Lightchain J1-6
C,,
C6
L V 1L V 2 L V n
J 1-5
cK
D-J joining
V-Jjoining
Rearranged DNA
LV2..rt
CK
5'
PrimaryRNA transcript
3',
nrunprocessing
RNAprocessing
$ Messenger RNA(mRNA)
LV?t/1c-
LV2J1CK
AAA
AAA Translation LV
C
Nascent polypeptide
Mature
Processino of protein VC
polypeptide
Assembled lg molecule
FIGURE&16 lg heavyandlightchaingenerecombination andexpression. Thesequence of DNArecombination andgeneexpression eventsis shownfor the lg p heavychain(A)andthe lg r lightchain(B) In the example shownin A, theV regionof thef,.heavy'charn rs encoded by theexonsVl, D2,andJ1, In the example shownin B, theV regionof the r chainis encoded bv the exonsV1 andJ'1
RECEPToR GENES 0FANTIGEN ANDEXPRESSI0N DEVELopMENT ANDTHEREARRANGEMENT chapter8 - LyMpH0cyTE
Pre-T cell receptor
Pre-Bcell receptor I I I I I I
FIGURE &17 Pre-B cell and pre-f cell receptols.The pre-Bcel' receptor(A)and the pre-Tcell receptor (B) are expressedduring the pre-Band pre-Tcell stagesof maturation,respectively, and both receptors share similar structures and functions The pre-Bcell receptoris composedof the p heavychainand surrogatelightchain The an invariant surrogatelightchainrs composedof two proteins, the VpreB protein, which is homologousto a lightchain V domain.and a 1"5Droteinthat is covalentlyattachedto the p heavy chainby a disulfidebond The pre-T cell receptor(B) is composedof the pre-Tcr TCRB chainand the invariant chain The pre-Bcellreceptoris associatedwith the lgo and lgp signaling moleculesthat are part of the BCR complex in mature B cells {see Chaniar Q l e n d i h a n r a - T c e r rr e c e p r.tor associateswith the CD3 and ( proteinsthat are part of the TCR complex in mature T cells (see Chaoter7)
I I I I I i I I I I I I I I I I _i
. Survivaland proliferation of pre-B cells .l n h i b i tionof H chain (allelic recombination exclusion) . Stimulation of r lightchain recombination . Shut off of surrogatelight chaintranscription
tional antigen receptors and proceed to maturity). The pre-BCR also contributes to the inactivation of surrogate light chain gene expression as pre-B cells mature. At the next stage in its maturation, each developing B cell also rearranges a K or a l" light chain gene and produces a light chain protein, which associateswith the previously synthesized p chain to produce a complete IgM protein. The IgM-expressing B cell is called the immature B cell. DNA recombination in the r or l, light chain locus occurs in a similar manner as in the Ig heavy chain locus (see Fig. 8-168). There are no D segments in the light chain loci, and therefore recombination involves only the joining of one V segment to one J segment, forming aVJ exon. This\T exon remains separated from the C region by an intron, and this separation is retained in the primary RNA transcript. Splicing of the primary transcript results in the removal of the intron between the\T and C exons and generatesan mRNAthat is translated to produce the r or I protein. In the l, locus, alternative RNA splicing may lead to the use of any one of the four functional C1 gen€s, but there is no knoltm functional difference between the resulting types of l' light chains. The rc locus rearranges after heavy chain rearrangement and before l, gene rearrangement. Production of r light chains inhibits rearrangement of the L locus, and the l" locus will undergo recombination only if a r light chain cannot be produced, or if induced to rearrange during the phenomenon of receptor editing described below when a self-reactive previously rearranged light chain is deleted. Therefore, an individual B cell clone can produce only one of the two types of
. Survivaland proliferationof pre-T cells .Inhibitionof B chaing ene recombination . Stimulation of crchain recombination . Expressionof CD4and CD8 . Shutoff of pTcrtranscription
light chains during its life; this is called light chain isotypeexclusion.As in the heavychain locus,production of r or l. is allelically excludedand is initiated from only one of the two parental chromosomes.Also, as for heavy chains, if one allele undergoes nonfunctional rearrangement,DNA recombinationcan occur on the other allele; however, if both alleles of both r and l, chains are nonfunctional in a developing B cell, that cell dies. The light chain that is produced complexeswith the previously synthesizedp heavy chain, and_theassembtea fgu moleculesare expressedon the cell surfacein associationwith Iga and IgB,wherethey function asspecific receptorsfor antigens.ImmatureB cellsdo not proIiferateand differentiatein responseto antigens'In fact, their encounter in the bone marrow with high avidity antigens,such as multivalent self antigens,may lead to the induction of receptorediting, cell death, or functional unresponsivenessrather than activation. This property is important for the negativeselectionof B cells ihat are specific for self antigens present in the bone marrow (discussedlater). Immature B cells leave the bone marrow and complete their maturation in the spleen before migrating to other peripheral lymphoid or8ans. -Distinct subsetsof B celk deuelopfrom dffirent progenitors (Fig.8-18). Fetal liver-derivedHSCsare the precursorsof B-l B cells,describedbelow.Bonemarrowderived HSCsgive rise to the majority of B cells,which are sometimescalled B-2 B cells.These cells rapidly passthrough tlvo transitional stagesand can commit to
174
i
Section lll - MATURAT|0N, ACT|VAT|ON, ANDREGULATTON 0FLyMPH0CYTES
Fetalliver
aFL\
:9
Pro-B
Pre-B
lmmature B
B-1B cell
@ lgM
Bonemarrow Spleen
6"\
t'y
Pro-B
Pre-B
lmmature B
B-2B cell CD21I cR2
FIGURE 8-18 B lymphocytesubsets.A Most B cellsthat developfrom fetal liver-derived stem cetlsdifferentiate into rhe B-1 lineage B B lymphocytesthat arisefrom bone marrowprecursors after birthgive riseto the B-2 lineageTwo majorsubsetsof B lymphocyteiare derivedfrom B-2 B cellprecursorsFollicular B cellsare recirculating lymphocytes, while margirial zoneB cbllsresideprimarilyi; the'spteen Thesedevelopmental pathwayshavebeen best definedin mice
develop either into marginal zone B cells, also described below, or into follicular B cells. Most mature B cells are follicular B cells.They coexpresstrrand Dheavy chains in association with the r< or l" light chain and therefore produce both membrane IgM and membrane IgD. Both classesof membrane Ig utilize the same \rDJ exon and associate with identical light chains and therefore exhibit the same antigen specificity. Simultaneous expression in a single B cell of the same rearrangedVDf exon on two transcripts, one including Cuexons and the other C6 exons, is achieved by alternative RNA splicing (Fig. 8-19). A long primary RNA transcript is produced containing the rearrangedVDI unit as well as the Cuand C6genes.If the introns are spliced out such that the VDI exon is contiguous with Cpexons, this results in the generation of a p mRNA. If, however, theVDI complex is not linked to Cu exons but is spliced to C6exons, a A mnNR is produced. Subsequent translation results in the syrrthesis of a complete p or 5 heavy chain protein. Thus, alternative splicing allows a B cell to simultaneously produce mature mRNAs and proteins of two different healy chain isotypes.The precise mechanisms that regulate the choice of polyadenylation or splice acceptor sites by which the rearranged VDJ is joined to either Cu or C6are poorlyunderstood, as are the signalsthat deter-
IgD is the essential activating receptor of mature B cells. However, there is no evidence for a functional difference between membrane IgM and membrane IgD. Moreover, knockout of the 6 gene in mice does not have a significant impact on the maturation or antigen-induced responses of B cells. Follicular B cells are also often called recirculating B cells, since they migrate from one lymphoid organ to the next, residing in specialized niches knor,rmas B cell follicles. In these niches these B cells are maintained, in part, by signals delivered by a trophic ligand of the tumor necrosis factor (TNF) cytokine family called BAFF or BlyS (Chapter tO;.
heavv *{F u chain RN N pro pro .----,L:!/
denYlation denYlation sites
't\\ - \ - : ----.
/
\
C6
i------:
IT
444{> u},ff,""t correlation between expressionof IgD and acquisition of functional competence has led to the suggestion that
FIGURE 8-19 Coexplession of lgM and lgD.Alternative processing of a primaryRNAtranscriptresultsin the formationof a u or 6 mRNA Dashedlinesindicatethe H chainsegmentsthat arejoined b y R N As p l i c i n g
Chapter8 -
GENES 0F ANTIGENRECEPTOR LYMPH0CYTE AND EXPRESSI0N DEVELOPMENT ANDTHEREARRANGEMENT
Mature, naive B cells are responsive to antigens, and unless the cells encounter antigens that they recognize with high affinity and respond to, they die in a few months. In Chapter 10, we will discuss how these cells respond to antigens and how the pattern of Ig gene expression changes during antigen-induced B cell differentiation. Selection
of the Mature
B Gell Repertoire
The repertoire of mature B cells is positively selected from the pool of immature B cells. As we shall see later, positive selection is well defined in T lyrnphocytes and is responsible for preserving self MHC-restricted CD4* and CD8* T cells from the much larger pool of unselected, immature T cells.There is no comparable restriction for B cell antigen recognition. Nevertheless,positive selection appearsto be a general phenomenon gearedto identifying lymphocytes that have completed their rearrangement program successfully and possibly facilitating lineage commitment to T or B cell subsets. It is believed that only B cells that express functional membrane Ig molecules receive constitutive BCRderived survival signals. Self antigens appear to influence the strength of the BCR signal and thereby the subsequent choice of peripheral B cell lineage during B cell maturation. Immature B cells that recognize self antigens with high avidity may be induced to change their specificities by a process called receptor editing. In this process, antigen recognition leads to reactivation of Rag genes, additional light chain V-I recombination events, and production of a new Ig light chain, allowing the cell to express a different B cell receptor that is not selfreactive. Receptor editing generally is targeted at selfreactive r light chain genes. VJ* exons encoding the variable domains of autoreactive light chains are deleted and replaced by new VJ* exons or by l, light chain rearrangements.The new\{}* exon may be generated by the rearrangement of a V gene upstream of the original V gene that produced an autoreactive light chain, to a J segment downstream of the originally rearranged J segment.As many as 25% of mature B cells in mice show evidence of rcchain editing. Immature B cells that expresshigh-affinity receptors for self antigens and encounter these antigens in the bone marrow may also die or fail to mature further if they are not edited. Deletion is generally called negative selection, and it is partly responsible for maintaining B cell tolerance to self antigens that are present in the bone marrow (seeChapter Il). The antigens mediating negative selection-usually abundant or polyvalent (e.9., membrane-bound) self antigens-deliver strong signals to IgM-expressingimmature B lymphocytes that happen to express receptors specific for these self antigens. Antigen recognition leads to apoptotic death of immature B cells, probably only when editing fails. Once the transition is made to the IgD*IgM+ mature B cell stage, antigen recognition leads to proliferation and differentiation, not to apoptosis or receptor editing. As a result, mature B cells that recognize antigens with high affinity
in peripheral lymphoid tissues are activated, and this process leads to humoral immune responses (see Chapter10).
B-1 and Marginal Zone Subsets of B Lymphocytes A subsetof B lymphocytes,call.edB- 1 B cells,dffirs from the majority of B lymphocytesand deuelopsin a unique manner, These cells develop from fetal liver-derived hematopoieticstem cells.Many B-1 cells expressthe CDs (Ly-l) molecule.In the adult, large numbers of B-1 cellsare found as a self-renewingpopulationin the peritoneumand mucosalsites.B-l cellsdevelopearlier during ontogenythan do conventionalB cells,and they expressa relativelylimited repertoireof V genesand exhibit far lessjunctional diversity than conventional B in the fetalliver).B-1cells, cellsdo (TdTis not expressed as well as marginalzone B cells,spontaneouslysecrete IgM antibodiesthat often reactwith microbial polysaccharides and lipids. These antibodies are sometimes called natural antibodies becausethey are present in individuals without overt immunization, although it is possiblethat microbialflora in the gut are the sourceof antigens that stimulate their production. B-l cells provide a sourceof rapid antibody production against microbesin particularsites,such asthe peritoneum.At mucosalsites B-1 cells may differentiateinto perhaps half the lgA-secretingcells in the lamina propria. B-1 cells are analogousto yDT cellsin that they both have limited antigenreceptorrepertoires,and they are both presumedto respondto commonlyencounteredmicrobial antigensearlyin immune responses. Marginal zone B cells are lncated primarily in the uicinity of the marginal sinus in the spLeenand' are in some wayssimilar to B-1 cells in terms of their limited diuersity,and their ability to respondto polysaccharide antigens and to generatenatural antibod'ies.Marginal zone B cells expressIgM and the surfacemarker CDZI. Theyrespondvery rapidlyto blood-bornemicrobesand differentiateinto short-livedlgM-secretingplasmacells. Although they generally mediate T cell-independent immune responsesto circulatingpathogens,marginal zone B cells also appearcapableof mediating someT cell-dependentimmune responses.
oFT LvtvtPHocvtrs MRruRRnoN The maturation of T lymphocytesfrom com'miftedprogenitors inuolues the sequential rearrangement and expressionof TCR genes,cell proliferation, antigenind.uced selection,and the acquisition of lunctional capabilities (Fig.8-20). In many ways, this is similar to B cell maturation. However,T cell maturation has some unique featuresthat reflect the specificity of T lymphopeptideantigensand the cytesfor selfMHC-associated need for a specialmicroenvironmentfor selectingcells with this speciflcity.
176
Section lll -
MATURATI0N, ACTIVATI0N, ANDREGULATT0N 0F LYMPH0CYTES
Stageof maturation
Stemcell
Pro-T
Double positive
Pre-T
Single positive Naive (immature matureT cell T cell)
---t
Proliferation Ragexpression
l-.,___l
TdT expression TCRDNA, RNA TCR expression Surface markers
(germline) DNA
Recombined B chaingene
(germline) tv(D)J-cl; DNA BchainmRNA
None
None
c-kit+ CD44+ cD25-
c-kit+ cD44+ cD25+
cD44cD25+
None
None
None
c-kit +
Membrane oBTCR
Membrane op TCR
Membrane up TCR
cD4+cD8+ TCR/CD3ro
CD4+CD8or cD4-CD8+ TCR/CD3hi
CD4+CD8or cD4-CD8+ TCR/CD3NI
Anatomic site Response to antigen
Positiveand negative selection
Activation r r (proliferation and I differentiation)
FIGURE 8-2O Stagesof T cell maturation.Eventscorresponding to eachstageof T cell maturationfrom a bone marrowstem cell to a matureT lymphocyteare illustratedSeverasurfacemarkersin additionto those shown havebeen usedto definedistinctstaqesof T cell maluraton
Role of the Thymus
in T Cell Maturation
The thymus is the major site of maturation of T cells. This function of the thymus was first suspectedbecause of immunologic deficiencies associatedwith the lack of a thymus. If the thymus is removedfrom a neonatalmouse,this animal fails to developmature T cells. The congenital absenceof the thymus, as occurs in the DiGeorge syndrome in humans or in the nude mouse strain, is characterizedby low numbers of mature T cells in the circulation and oerioheral lrrmp h o i d t i s s u e sa n d s e v e r ed e f i c i e n i i e si n T i e l l mediated immunity (seeChapter 20). The thymus involutes with age and is virtually undetectable in postpubertal humans, but some maturation of T cells continues throughout adult life, as indicated by the successful reconstitution of the immune system in adult recipients of bone marrow transplants. It may be that the remnant of the involuted thymus is adequate for some T cell maturation. Becausememory T cells have a
long life span (perhaps longer than 20 years in humans) and accumulate with age, the need to generate new T cells decreasesas individuals age. T lymphocytes originate from precursors that arke in the fetal liuer and ad.ult bone marrow and seed the thymus. In mice, immature lymphocytes are first detected in the thymus on the I lth day of the normal 21day gestation. This corresponds to about week 7 or 8 of gestation in humans. Developing T cells in the thymus are called thymocytes. The most immature thymocytes do not expressthe TCR or CD4 and CD8 coreceptors (see Fig. B-20). They are found in the subcapsular sinus and outer cortical region of the thymus. From here, the thymocytes migrate into and through the cortex, where most of the subsequent maturation events occur. It is in the cortex that the thymocl,'tes first express y6 and aB TCRs,and the crBT cells begin to mature into CD4* class II MHC-restricted or CDB*classI MHC-restricted T cells. As these thymocytes undergo the final stagesof maturation, they migrate from the cortex to the medulla and then exit the thymus through the circulation. In the following sections we discuss the maturation of oB T cells; y6 T cells are discussedlater in the chapter.
Chapter8 -
GENES LYMPH0CYTE AND EXPRESSI0N 0F ANTIGENRECEPT0R DEVEL0PMENT ANDTHEREARRANGEMENT
The thymic enuironment prouides stimuli that are required for the proliferatinn and maturation of thymocytes. Many of these stimuli come from thymic cells other than the maturing T cells. These include thlrnic epithelial cells and bone marrow-derived macrophages and dendritic cells (see Chapter 3, Fig. 3-7). Within the cortex, the epithelial cells form a meshwork of long cytoplasmic processes,around which thymocltes must pass to reach the medulla. Epithelial cells are also present in the medulla. Bone marrow-derived dendritic cells are present at the corticomedullary junction and within the medulla, and macrophages are present primarily within the medulla. The migration of thymocytes through this anatomic arrangement allows physical interactions between the thymocl'tes and these other cells, which are necessary for the maturation of the T lyrnphocytes. TWo types of molecules produced by the nonlymphoid thl.rnic cells are important for T cell maturation. The first are class I and class II MHC molecules, which are expressedon epithelial cells and dendritic cells in the thymus. The interactions of maturing thymocytes with these MHC molecules within the thymus are essential for the selection of the mature T cell repertoire, as we will discuss later. Second, thymic stromal cells, including epithelial cells, secrete c1'tokines and chemokines, which respectively stimulate the proliferation of immature T cells and orchestrate the cortical to medullary transit of developing cB lineage thymocltes. The best defined of these cytokines is IL-7, which was mentioned earlier as a critical lymphopoietic growth factor. Chemokines such as CCL2I and CCL19, which are recognized by the CCRT chemokine receptor on thymoc1tes, mediate the guided movement of developing T cells in the thymus. The rates of cell proliferation and apoptotic death are extremely high in cortical thymocytes. A single precursor gives rise to many progeny, and 95% of these cells die by apoptosis before reaching the medulla. The cell death is due to a combination of failure to productively rearrange the TCR B chain gene and to thus negotiate the preTCR/B selection checkpoint described below failure to be positively selectedby MHC molecules in the thymus, and self antigen-induced negative selection (seeFigs. B-3 and 8-4). Cortical thl.rnocytes are also sensitive to irradiation and glucocorticoids. In uiuo, high doses of glucocorticoids induce apoptotic death of cortical thymocytes. Stages of T Cell Maturation During T cell maturation, there is a precise order in which TCR genes are re&rranged and. in which the TCR and, CD4 and CD8 coreceptors are expressed (Figs. 8-20 and 8-21). In the mouse, surface expressionof the y6TCR occurs first, 3 to 4 days after precursor cells first arrive in the thymus, and the aB TCR is expressed 2 or 3 days later. In human fetal th),rynuses,y6 T cell receptor expression begins at about 9 weeks of gestation, followed by expression of the ap TCR at l0 weeks. The most immature cortical thymocytes, which are recent arrivals from the bone marrow contain TCR genesin their germline configuration and do not express
TCR, CD3 or ( chains, or CD4 or CD8; these cells are called double-negative thymocytes. This is also knor,rm as the pro-T cell stage of maturation. The majority (>90%) of the double-negative thymocytes will ultimately give rise to cB TCR-expressing,MHC-restricted CD4* and CD8. T cells. Rag-I and Rag-2proteins are first expressed at this stage, and are required for the rearrangement of TCR genes.DB-to-IBrearrangements at the TCR B chain locus occur firsU these involve either joining of the Dpl gene segment to one of the six Jpl segments or joining of the Dp2 segment to one of the six Jp2 segments (Fig. 8-22A). Vp-to-DIp rearrangements occur at the transition between the pro-T stage and the subsequent pre-T stage during aB T cell development. The DNA sequences between the segments undergoing rearrangement, including D, L and possibly CBI genes (if Ds2 and Is2 segments are used), are deleted during this rearrangement process.The primary nuclear transcripts of the TCR B genes contain the intron between the recombinedVDIB exon and the relevant Cp gene. Poly-A tails are added following cleavage of the primary transcript dolrmstream of consensus polyadenylation sites located 3' of the C9 region, and the sequencesbetween the VDI exon and Ce are spliced out to form a mature mRNA in which VDI segments are jrxtaposed to either of the two Cpgenes (depending on which I segment was selected during the rearrangement process).Translation of this mRNA gives rise to a full-length Cp protein. The two C9genes appear to be functionally interchangeable, and there is no evidence that an individual T cell ever switches from one C gene to another. Furthermore, the use of either Cp gene segment does not influence the function or specificity of the TCR. The promoters in the 5' flanking regions of Vp genes function together with a powerful enhancer that is located 3'of the Cp2gene once V genes are brought close to the C gene byV(D)I recombination. This proximity of the promoter to the enhancer is responsible for high-level T cell-specific transcription of the rearranged TCR B chain gene, If a productive (i.e., in-frame) rearrangement of the TCR 0 chain gene occurs in a given pro-T cell, the TCR B chain protein is expressedon the cell surface in association with an invariant protein called pre-Tcr and with CD3 and ( proteins to form the pre-T cell receptor (preTCR; seeFig. 8-178). The pre-TCR mediates the selection of the roughly one-in-three developing pre-T cells that productively rearrange the B chain of the TCR (roughly two thirds of developing T cells add or remove bases at rearrangement junctions that are not multiples of three, and therefore these rearrangements fail to encode a TCR B protein). The function of the pre-TCR complex in T cell development is similar to that of the surrogate light chain-containing pre-BCR in B cell development. Signals from the pre-TCR mediate the survival of pre-T cells and contribute to the largest proliferative expansion during T cell development. Pre-TCRsignals also initiate recombination at the TCR a chain locus and drive the transition from the double-negative to the doublepositive stage of thymocyte development (discussed below). These signals also inhibit further rearrangement of the TCR p chain locus largely by limiting accessibility
t.l*-:..
i
lll - MATURATION, ACTIVATI0N, ANDREGULATI0N 0FLYMPHOCYTES ,.Section
Bonemarr fetalliver
Thymus Cortex Medulla cD4+ cD8TCRaB+
CD4+
cD8CD4- tr,
cD8TCR-
CD4+helper T lymphocyte cD4cD8+
TCRaB+ TCRoplow
cD4cD8TCRy6+
cD4cD8+ TCRaB+
CD8+cytotoxic T lymphocyte CD4cD8TCRy6+ CD4. cD8TCRy6+
FIGURE 8-21 Matulationof T cells in the thymus.Precursors of T cellstravelf rom the bone maTrowthroughthe bloodto the thymus In the thymiccortex.progenitors of ap T cellsexpressTCRsand CD4 and CDBcoreceptorsSelectionprocesseseliminateself-reactive thymocytesand promotesurvivalof thymocyteswhose TCRsbind self MHC moleculeswith low affinity Functional and phenotypicdifferentiationinto CD4.CDBor CDB.CD4T cellsoccursin the medulla,and matureT cellsare releasedintothe circulationTheyb TCR-exoTessrnq T cellsare alsoderivedfrom bone marrowprecursors and maturein the thymusas a separatelineage
of the other allele to the recombination machinery. This results in B chain allelic exclusion (i.e., mature T cells express only one of the two inherited B chain alleles). As in pre-B cells, it is not knornrnwhat, if any, ligand the pre-TCR recognizes.Pre-TCRsignaling, like pre-BCR signaling, is generally believed to be initiated in a ligandindependent manner, dependent on the successful assembly of the pre-TCR complex. Pre-TCR signaling is mediated by a number of cytosolic kinases and adapter proteins that are knonm to also be linked to TCR signaling (Chapter 9). The essentialfunction of the pre-TCR in T cell maturation has been demonstrated by numerous studies with genetically mutated mice. In Rag-I - or Rag-2-deficientmice, thymocytescannot rearrangeeither cxor B chain genesand fail to mature past the double-negative stage. If a functionally rearrangedB chain gene is introduced into the Ragdeficient mice as a transgene,the expressedB chain associateswith pre-Tcrto form the pre-TCR,and maturation proceedsto the double-positivestage.An a chain transgenealone does not relieve the maturation block becausethe B chain is required for formation of the pre-TCR.
Knockout mice lacking any component of the preTCRcomplex (i.e.,the TCRB chain, pre-Tcr,CD3, (, or Lck) show a block in the maturation of T cells at the double-negativestage. At the next stage of T cell maturation, thymocltes express both CD4 and CD8 and are called doublepositive thymocytes. Double-positive T cells also induce the expression of the CCR 7 chemokine receptor, which guides these cells from the cortex toward the medulla, where chemokines specific for this receptor are secreted by stromal cells. The expression of CD4 and CD8 is essential for subsequent selection events, discussed later. The rearrangement of the TCR cr chain genes and the expression of TCR crB heterodimers occur in the CD4*CD8* double-positive population, just before or during migration of the thymocytes from the cortex to the medulla (seeFigs. B-20 and 8-21). A second wave of Rag gene expression late in the pre-T stage promotes TCR a gene recombination. Once o chain rearrangement commences, it proceeds for 3 or 4 days (in mice) until the expression of the Rag- I and Rag-2 genes is turned off by signals from the crBTCR during positive selection (discussedlater). The steps involved in TCR cx
GENES OFANTIGENRECEPTOR AND EXPRESSION ChAOtET 8 - LYMPHOCYTE DEVELOPMENT ANDTHEREARBANGEMENT
@ rcn Bchain
@ rCn s chain
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n
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and gene expressioneventsis FIGURE A-22 TCRa and p chain gene recombinationand expression.The sequenceof recombination TCR B chain shown for the TCR p chainiA) and tlie TCR cr chain(B).In the eiample shown in A, the variable(V)regionof the rearranged rncludesthe VD1 , and Dp'1gene segments,and the thirdJ segmentin the Jp1cluster.The constant(C)regionrs encodedby the Cp1.exon Note that at the TCRpiharn locus,rearrangement beginswith D-to-Jjoiningfollowedby V-to-DJjoining,14 JFsegmentshavebeen identified in humans,and not all are shown in the figure.In the exampleshown in B, the V regionof the TCRcr,chainincludesthe Vo1geneand the secondJ segmentin the J" cluster(thlsclusteris made up of at least61 Jo segmentsin humans;not all are shown here)
chain gene rearrangement are broadly similar to those that occur during TCR B chain gene rearrangement (Fig. 8-228). Because there are no D segments in the TCR u locus, rearrangement consistssolely of the joining of V and J segments. The large number of J" segments permits multiple attempts at productive V-J joining on each chromosome, thereby increasing the probability that a functional uB TCR will be produced. In contrast to the TCR B chain locus, where production of the protein
and formation of the pre-TCR suppress further rearrangement, there is little or no allelic exclusion in the u chain locus. Therefore, productive TCR o( rearrangements may occur on both chromosomes, and if this happens, the T cell will expresstwo s chains' In fact, up to 30% of mature peripheral T cells do express two different TCRs, with different cx chains but the same B chain. The functional consequence of this dual receptor expression is unknown. Because only one TCR is
179
180
;
Section lll -
MATURAT|0N, ACT|VAT|ON, ANDREGULATT0N 0F LyMPHOCYTES
required for positive selection, it is possible that the second TCR may not have any affinity for self MHC, and therefore it would have no function. Tianscriptional regulation of the q, chain gene occurs in a broadly similar manner to that of the B chain. There are promoters 5' of eachV" gene that have low-level activity and are responsible for high-level T cell-specific transcription when brought close to an s chain enhancer located 3'ofthe C" gene. The inability to successfully rearrange the TCR cr chain on either chromosome leads to a failure of positive selection (discussedbelow). The thvmocyte that has failed to make a productive rearrangement will die by apoptosis. TCR s gene expression early in the double-positive stage leads to the formation of the complete oB TCR, which is expressedon the cell surface in associationwith CD3 and ( proteins. The coordinate expression of CD3 and ( proteins and the assembly of intact TCR complexes are required for surface expression. Rearrangement of the TCR cxgene results in deletion of the TCR 6 locus that lies between V segments (common to both a and 6loci) and J* segments (seeFig. 8-7). As a result this T cell is no longer capable of becoming a yDT cell. The expression of Rag genes and further TCR gene recombination ceaseafter this stageof maturation. The first cells to expressTCRs are in the thymic cortex, and expression is low compared with mature T cells. By virtue of their expressionof complete TCR complexes, double-positive cells become responsiveto antigens and are subjected to positive and negative selection. Cells that successfully undergo these selection processes go on to mature into CD4* or CD8* T cells, which are called single-positive thymocytes. Thus, the
self MHC molecules. (Recall that there are many alleles of MHC molecules in the population, and every individual inherits one allele of each MHC gene from each parent. These inherited alleles encode "self MHC" for that individual.) Also, in every individual, T cells that recognize self antigens with high avidity are potentially dangerous because such recognition may trigger autoimmunity. Selection processesact on the immature T cell repertoire to ensure that only the useful cells complete the process of maturation. \fhen double-positive thyrnocytes first express oB TCRs, these receptors encounter self peptides (the only peptides normally present in the th).'rnus) displayed by self MHC molecules (the only MHC molecules available to display peptides) mainly on thymic epithelial cells in the cortex, but also on dendritic cells in this location. Positive selection is the process in which thymocl'tes whose TCRs bind with low avidity (i.e., weakly) to self peptide-self MHC complexes are stimulated to survive (see Fig. 8-24A). Thymocltes whose receptors do not recognize self MHC molecules are permitted to die by a default pathway of apoptosis (see Fig. 8-248). This ensures that the T cells that mature are self MHC restricted. Positive selection also fixes the class I or class II MHC restriction of T cell subsets, ensuring that CD8. T cells are specific for peptides displayed by classI MHC molecules and CD4* T cells for class ll-associated peptides. Negative selection is the process in which thymocytes whose TCRs bind strongly to self peptide antigens in association with self MHC molecules are deleted (see
Single-positive CD4+cells
Double-positive CD4+CD8+ cells
as CD40 ligand) that "help" B lymphocltes and macrophages, whereas CDS* cells become capable of producing molecules that kill other cells. Mature singlepositive thymocltes enter the thymic medulla and then leave the thymus to populate peripheral lymphoid tissues. Selection Processes in the Maturation MHc-Restricted cp T Cells
of
The selection ofdeuelopingT cells is dependent on recognition of antigen (peptide-MHC complexes) in the thymus and is responsible for preseruing useful celk and eliminating potentially harmful ones (Fig.8-24). The immature, or unselected, repertoire of T lyrnphocytes consists of cells whose receptors may recognize any peptide antigen (self or foreign) displayed by any MHC molecule (also self or foreign). In addition, receptors may be expressed that do not recognize any peptideMHC molecule complex. In every individual, the only useful T cells are the ones specific for foreign peptides presented by that individual's MHC molecules, that is,
Single-positive CD8+cells
+ FIGURE 8-23 CD4and CD8expressionon thymocytes.The maturationof thymocytescan be followedby changesin expression of the CD4 and CDB coreceptorsA two-colorflow cytometric analysisof thymocytesusing anti-CD4and anti-CDBantibodies, each taggedwith a differentfluorochrome, is illustratedThe percentagesof all thymocytescontributedby each major population are shown in the four quadrantsThe least maturesubset is the CD4 CDB (double-negative) cells Arrowslndicatethe sequenceof maturation
BECEPT0R GENES 0FANTIGEN Chapter ANDEXPRESSI0N 8 - LYMPH0CYTE DEVELOPMENT ANDTHEREARRANGEMENT
Fig. B-ZaC). This eliminates developing T cells that are strongly autoreactive against self antigens that are present at high concentrations in the th1'rnus.The net result of these selection processesis that the repertoire of mature T cells that leaves the thymus is self MHC restricted and tolerant to many self antigens. In the folIowing sections, we discuss the details of positive and negative selection.
Positive Selection of Thymocytes: Development of the Self MHC-Restricted T Cell Repertoire Positiue selection works by promoting the selectiue suruiual and expansion of thymocytes with self MHC-restricted TCRs (Fig. B-24A). Double-positive thymocltes are produced without antigenic stimulation and begin to express crBTCRs with randomly generated specificities. In the th].'rnic cortex, these immature cells encounter epithelial cells that are displaying a variety of self peptides bound to class I and class
II MHC molecules. If the TCR on a cell recognizes peptide-loaded class I MHC molecules, and at the same time CD8 interacts with the class I MHC molecules, that T cell receives signals that prevent its death and promote its continued maturation. To proceed along the maturation pathway, the T cell must continue to expressthe TCR and CD8 but can lose expression of CD4. The result is the development of a class I MHCrestricted CDB* T cell. An entirely analogous process leads to the development of class II MHC-restricted CD4* T cells. Any T cell that expressesa TCR that does not recognize a peptide-loaded MHC molecule in the thymus will die and be lost. The essentialroles of MHC molecules and TCR specificity in positive selection have been established by a variety of experiments. If a th].rynusfrom one inbred strain is transplanted into chimeric animals of another strain, the T cells that mature are restricted by the MHC type of the thymus. The transplanted thymuses may be irradiated or treated with c)'totoxic drugs (such
cD4+CD8+
Rescuefrom programmed cell death; conversionto singlepositive
lassll Low-affi nity/avidity recognition of peptide-MHC complexon thymic epithelialcell Thymic epithelial cell
cD4+CD8+
|r-k"rl positive
I I lselection I
MHC
High-avidityrecognitionof peptide-MHC complexeson thymic antigen-presenting cell (someantigensinducedby AIRE in thymic medullaryepithelialcells) witha interaction ina low-affinity TCRengages ptocesses lf thethymocyte inthethymus. A Positive selection, FIGURE 8-24 Selection
self MHC moleculeon a thymicepithelial cell.rt is rescuedfrom programmedcelldeathand continuesto mature B Lackof positiveselecmoleculecomplexeson thymicepithelialcells,it will die with peptide-MHC tion. lf the thymocyteTCRdoes not engagein any interactions complexeson a thymic by a defaultpathwayof programmedcell death.C Negativeselection.lf the thymocyteTCR bindspeptide-MHC cellwith highaffinityor avidity,it is inducedto undergoapoptoticcell death. antigen-presenting
142
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Section lll - MATURATI0N, ACTIVAT|0N, ANDREGULATTON 0F LYMPHOCYTES
as deoxyguanosine) to kill all resident bone marrow-derived macrophages,dendritic cells, and lyrnphoid cells, leaving only the resistant thymic epithelialcells.Again, mature T cellsdevelopin these thymuses, and their ability to recognize antigen is restricted by MHC gene products expressedon the transplantedthymic epithelialcellsand not necessarily by MHC gene products expressedon extrathymic cells.Therefore,the thymic epithelium is the critical host element for positive selection(i.e.,the development of the MHC restriction patterns of T cells).
TCRsthat can bind self MHC moleculesto be positively selected.As we shall seelater,the same experimental system has been used to study negative selection. During the transition from double-positive to singlepositive cells, thymocytes with class I-restricted TCRs become CDB*CD4-, and cells with class Il-restricted TCRsbecome CD4.CD8-.CD4 and CDB function as coreceptors with TCRs during positive selection and recognize the MHC molecules when the TCRs are recognizing peptide-MHC complexes. Signalsfrom the TCR complex and the coreceptors function together to promote survival of thyrnocytes. This function of CD4 and CD8 is similar to their role in the activation of mature T cells (see Chapter 9). At this stage in maturation, there may be a random loss of either CD4 or CD8 gene, and only cells expressing the "correct" coreceptor (i.e., CD4 on a class Il-restricted T cell or CDB on a class I-restricted T cell) will continue to mature. It is also possible that the expression of the wrong coreceptor is actively suppressed,although how this is accomplished is unknor,rm.
If a transgenicoB TCRwith a known MHC restriction is expressedin a mouse strain that also expressesthe MHC allele for which the TCR is specific,T cells will mature and populate peripheral llnnphoid tissue. If the mouse is of another MHC haplotypeand doesnot expressthe MHC molecule that the transgenicTCR recognizes,there are normal numbers of CD4*CDB* thymocyes but very few mature transgenic TCRexpressingT cells (Fig. B-25). This result demonstratesthat double-positivethymocltes must express
H-2Db
H-Y-soecific H-2Do-restricted ClonedTCRgenes T c e l ll i n e
-.=i),UU {t
PeptideH-Y
Male H-2Db
i\ "iYi \:1 Female H-2Db
Female H-2Dk
Transgenic mice Developing T cells (allexpress transgenic TCR)
ThymicAPC MHCtype H-Y antigen
H-2Db
H-2Db
H.2DK
Yes
No
No
process Selection Positive selection
Yes
No
Negative selection
Yes
No
Functional T cells expressing transgenic TCRandCD8
F|GURE 8-25 T cell maturation and selection in a TGRtransgenic mouse model. In the experimentdepicted,a transgenicmouseexpressesa TCRspecific for an H-2Do-associated H-Y (malespecific)antigen,which is, in effect, a foreignantigenfor a female mouse In femalemice expressing the Db MHC allele, mature T cells expressingthe transgenic TCRdo developbecausethey are positivelyselectedby the self MHC molecules The T cells recognizeself MHC, presumablyweakly and with some self antigen (not H-Y) These T cellsdo not maturein maleH-Y-expressing mice becausethey are negatively selectedby strongH-Yantigenrecognition in the thymus Furthermore, mature T cells do not developin female mice that expressD' but do not expressthe Db allelebecauseof a lack of positive selection of the Db-restrictedTCRexpressing T cells APC, antigenpresentingcell
183 A N T I G ERNE C E P TG OERN E S i E X P R E S S I00FN C h a p t eBr- L Y M P H 0 C YDTEEV E L 0 P M EAN NTDT H ER E A R R A N G E MAENNDT --***"*L***....
Knockout mice that lack class I MHC expressionin thymic epithelial cells do not developmature CDB*T cells but do develop CD4*CDB*thymocytes and mature CD4. T cells. Conversely,classII MHC-deficient mice do not developCD4*T cellsbut do develop CDB* cells. These results demonstrate that thymic epithelial cells must expressclassI or classII MHC moleculesto positively selectthymoc)-testo become CDB*or CD4* single-positivecells,respectively. In transgenic mice expressing a class II MHCrestricted TCR, the mature T cells that develop are almost exclusively CD4*, even though there are normal numbers of CD4.CDB* thymocl'tes. Conversely,if the transgenicTCR is classI restricted,the T cellsthat mature are CDB*.Thus,the coreceptorand the MHC specificityof the TCR must match if a thymoc)'te is to developinto a mature T cell. Peptides bound to MHC molecules on thynxic epithelial cells pla.y a.n essential role in positiue selection. ln Chapters 5 and 6, we described how cell surface class I and class II molecules always contain bound peptides. These MHC-associated peptides on thymic antigenpresenting cells probably serve two roles in positive selection-first, they promote stable cell surface expression of MHC molecules, and second, they may influence the specificities of the T cells that are selected.Obviously, the thymus cannot contain the foreign antigens to which an individual can respond. Therefore, foreign peptides cannot be involved in the positive selection of T cells that ultimately may recognize these peptides. Self peptides are required for positive selection, however, and exactly what role they play in this process has been the subject of numerous studies using a variety of experimental systems.
To addressthe role of peptides in T cell selection, it was necessaryto developsystemsin which the array of peptides presented to developing thymocl'tes was limited and could be manipulated experimentally. For classI MHC-dependent positive selection, this was accomplishedwith use of TAP-l-deficient or B2-microglobulin-deficientmice. In these mice, the class I molecules are not loaded with cytosolic peptides and are unstable, but they can readily be loaded with exogenously added peptides. If thymuses from such mice are cultured without added peptides, few mature T cells develop (Fig' 8-26). The addition of peptides dramatically increasesthe developmentof single-positiveCDB*T cells,indicating effectivepositiveselectionof thymocytesexpressing class I MHC-restricted TCRs.A key finding in these experiments was that one or a few peptides induced the positive selectionof a large repertoireof CDB*T cells that could potentially recognizemany different unrelated peptides. However, no single peptide was sufficient to generatea normal number (or repertoire) of mature T cells. Furthermore, complex mixtures of peptides induced the maturation of more CDB*T cellsthan did singlepeptides'We do not know if the specificities of the T cells that mature are relatedto the peptidesthat induced their maturation. The conclusion drawn from such experiments is that peptides bound to MHC molecules are required for positive selection of T cells and that some peptides are better than others in supporting this process.The finding that peptides differ in the repertoires of T cells they select suggeststhat specific antigen recognition, and not just MHC recognition, has some role in positive selec-
Fetalthymic organ culture
FIGURE &26 Roleof peptidesin positiveselection.In from fetal the experimentshown,thvmusesare Temoved mice and culturedin vitro\felalthymicorgancultures)lf the thymusesare removedearly enough in gestation, they containonlyimmaturethymocytesthat havenot yet undergonepositiveselection,and thereforesubsequent maturationeventscan be followedundervaryingln vitro conditions In thymusesfrom wildtype (normal)mice, both CD4.CDBand CDB.CD4-T cellswill develop TAPI MHC commice cannotform oeotide-class 1-deficient plexeson thymicepithelial cells(seeChapter5),andthere is littledevelopment of CDB.CD4T cellsin the thymuses from these mice becauseof a lackof positiveselection of class l-restrictedthymocytes However,the addition of peptides to the culture medium surroundingthe thymuses permits the formation of TAP-1-deficient peptide-class I MHC complexeson the surfaceof thymic of CD8*CD4 cells,and this restoresmaturation epithelial T cells
Antigenpresentation to double-positive thymocytes
Wild-type(normal)
TAP-deficient Add
TAP-deficient
184
!
g
Section lll - MATURATION, ACT|VAT|0N, ANDREGULATT0N 0FLyMPHOCYTES
tion. Weak, or low-avidity, recognition of peptides in the th)..rnus protects immature T cells from a default pathway of apoptotic death and allows the cells to complete their maturation. We do not know what signals generated by weak antigen recognition protect immature T cells from death and how these signals differ from those generated by antigen recognition in mature, single-positive T cells. One consequence of self peptide-induced positive selection is that the T cells that mature have some capacity to recognize self peptides. We mentioned in Chapter 3 that the survival of naive lymphocytes before encounter with foreign antigens requires survival signals that are apparently generated by recognition of self antigens in peripheral l1'rnphoid organs. The same self peptides that mediate positive selection of double-positive thgnocltes in the thymus may be involved in keeping naive, mature (single-positive) T cells alive in peripheral organs, such as the lymph nodes and spleen. This model of positive selection based on weak recognition of self antigens raises a fundamental question: How does positive selection driven by self antigens produce a repertoire of mature T cells specific for foreign antigens? The likely answer is that positive selection allows many different T cell clones to survive and differentiate, and many of theseT cells that recognizeself peptides with low atfinity will, after maturing, fortuitously recognize foreign peptides with a high enough affinity to be activated and to generate immune responses. As we discuss next, strong recognition of self antigens in the thymus results in negative selection of developingT cells. Negative Selection of Thymocytes: Central Tolerance Negatiue selection of thymocytes worlcs by inducing apoptotic death of celk whose receptors recognize peptide-MHC complexes in the thymus with high auidity (see Fig. 8-24C). Among the double-positive T cells that are generated in the th1.rnus,some may expressTCRs that recognize self antigens with high affinity. The peptides present in the thymus are self peptides derived from widely expressed protein antigens as well as from some proteins believed to be restricted to particular tissues (see below). In immature T cells, the consequence of highavidity antigen recognition is the triggering of apoptosis, leading to death, or deletion, of the cells. Therefore, the immature thyrnocytes that express high-affinity receptors for self antigens in the th1nnus are eliminated, resulting in negative selection of the T cell repertoire. This process eliminates the potentially most harmful selfreactive T cells and is one of the mechanisms ensuring that the immune system does not respond to many self antigens, a property called self-tolerance. Tolerance induced in immature ll.rnphocytes by recognition of self antigens in the generative (or central) ly.rnpf,oid organs is also called central tolerance, to be contrasted with peripheral tolerance induced in mature lymphocltes by self antigens in peripheral tissues. We will discuss the mechanisms and physiologic importance of immunologic tolerance in more detail in Chapter ll.
Formal proof for deletion of T cell clones reactive with antigens in the thymus (also called clonal deletion) has come from several experimental approaches that allowed investigators to observe the effects of self antigen recognition by a large number of developing T cells. {li \Mhen TCR-transgenic mice are exposed to the peptide for which the TCR is specific,a large amount of cell death is induced in the th).rynusand a block occurs in the development of mature transgenic TCRexpressing T cells. In one such study, a transgenic mouse line was createdthat expresseda classI MHCrestricted TCR specific for the Y chromosomeencoded antigen H-Y,which is expressedby many cell types in male mice but not in female mice (seeFig. 8-25). Female mice with this transgenic TCR have normal numbers of thymocytes in the thymic medulla and large numbers of CDB* T cells in the periphery because they do not express the H-Y antigen that may induce negative selection. In contrast, male transgenic mice have fewTCR-expressing, single-positive thymocytes in the medulla and few mature peripheral CD8*T cellsbecauseof deletion of the H-Y-specificthymocytesinduced by H-Y antigen in the th).nnus. {:r Similar deletion of immature T cells is seen if transgenic mice expressing a TCR specific for a known peptide antigen are bred with mice expressing that antigen or if the mice are injected with large dosesof the antigen. This can also be mimicked in uitroby cuIturing intact thymuses from TCR-transgenic mice with high concentrationsof the peptide for which the TCR is specific. In all these examples,there is a block of T cell maturation after the cortical double-positive stage, presumably because immature thymocytes expressthe transgenicTCR,recognizethe antigen on thymic antigen-presenting cells, and are deleted before they can mature into single-positive cells. The deletion of immature self-reactive T cells occurs when the TCR on a CD4*CD8* thgnocyte binds strongly to a self peptide presented by another thymic cell. Negative selection may occur both at the doublepositive stage in the cortex and in newly generated single-positive T cells in the medulla. The thymic antigen presenting cells that mediate negative selection are primarily dendritic cells and thymic medullary epithelial cells, whereas cortical epithelial cells are especially (and perhaps uniquely) effective at inducing positive selection. Double-positive T cells are drawn to the thymic medulla by the CCRT specific chemokines, CCL?I and CCL19. In the medulla, thymic medullary epithelial cells express a nuclear protein called AIRE (autoimmune regulator) that induces the expression of a number of tissue-specific genes in the thymus, thus making a host of tissue-specific peptides available for presentation in the thymus to double-positive and single-positive T cells during the process of negative selection.As will be discussedin Chapter I l, a mutation in the gene that encodesAIRE results in an autoimmune
185
RECEPToR GENES ; 0FANTIGEN ANDEXPRESSIoN ANDTHEREARBANGEMENT DEVELOPMENT chapter8 - LyMpHocyTE ',!
polyendocrine slmdrome, underscoring the importance of AIRE in mediating central tolerance to tissue-specific antigens. The key factor determining the choice between positiue and negative sel.ection is the strength of antigen recognition, with low-aui.d.ity recognition leading to positiue selection and high-auidity recognition inducing negatiue selectinn. CD4 and CD8 molecules probably play a role in negative selection, as they do in positive selection,becausethese coreceptorsparticipate in recognition of MHC molecules presenting self peptides. The cellular basis of negative selection in the thymus is the induction of death by apoptosis.Unlike the phenomenon of death by default (or neglect), which occurs in the absence of positive selection, in negative selection, active death-promoting signals are generatedwhen the TCR of immature th].rynocytesbinds with high affinity to antigen. The induction by TCR signaling of a pro-apoptotic protein called Bim probably plays a crucial role in the induction of mitochondrial leakiness and thymocl'te apoptosis during negative selection (Chapter ll). Recognition of self antigens in the thymus can also generate a population of regulatory T cells, which function to prevent autoimmune reactions (seeChapter 1l). It is not clear how a self antigen causesdeletion of some immature T cells and the development of regulatory T cells from other immature thvmocytes of the same specificity.
16 T Lymphocytes TCR ap- and y\-expressing thymocytes are separate lineages with a common precursor. In fetal thymuses, the first TCR gene rearrangements involve the y and 6 loci. Recombination of TCR yand 6loci proceeds in a fashion similar to that of other antigen receptor gene rearrangements, although the order of rearrangement appears to be less rigid than in other loci. T cells that expressfunctional y and 6 chains do not express cxBTCRs and vice versa. The independence of these lineages is indicated by several lines of evidence. Mature oB-expressingT cells often contain out-offrame rearrangementsof 6 genes, indicating that these cells could never have expressedy6 receptors. TCR 6 geneknockout mice developnormal numbers of crBT cells,and TCR B geneknockout mice develop normal numbers of y6 T cells. The diversity of the y6 T cell repertoire is theoretically even greater than that of the crBT cell repertoire, in part because the heptamer-nonamer recognition sequences adjacent to D segmentspermit D-to-D joining. Paradoxically, however, the actual diversity of expressed 16 TCRs is limited because only a few of the available V D, and I segments are used in mature y6 T cells, for unknown reasons. This limited diversity is reminiscent of the limited diversity of the g- t subset of B lymphocytes and is in keeping with the concept that y6 T cells serve as an early defense against a limited number of commonly encountered microbes at epithelial barriers.
.:rL$*i,
NK-T Cells In Chapter 7, we also mentioned another small subset of T cells knor.tm as NK-T cells, which are not MHC restricted and do not recognize peptides displayed by antigen-presenting cells. These NK-T cells express-aB fCni that are CDI restricted, and also bear a surface marker found on NK cells, hence their name. The TCRs of NK-T cells recognize lipid antigens bound to the groove of CDI molecules. CDI molecules are MHC class i-like molecules made up of a heavy chain and Br-
unique and stereot)?ic TCR s chain gene rearrangement event. NK-T cells secrete cytokines and participate in host defense,but may also be of relevance from a reguIatory standpoint in the context of autoimmunity and
T cells do not express CCR7, and therefore do not migrate toward the medulla like other conventional crB T cells. Instead, they receive instructions to exit the th)rmus and home to a number of peripheral sites, the most prominent being the liver.
SUMMARY o B and T lymphocytesarisefrom a common bone marrow-derivedprecursorthat becomescommitted to the lymphocyte lineage.B cell maturation proceedsin the bone marrow whereasearlyT cell progenitorsmigrateto and completetheir maturaiion in the thymus. Early maturation is characterized by cell proliferation induced by cytokines, mainly IL-7, Ieading to marked increasesin the numbers of immature lYmPhocYtes. 6 B and T cell maturation involves the somatic rearrangementof antigen receptor genesegments and the initial expressionof Ig heavy chain proteinsin B cell precursorsand TCRB moleculesin T cell precursors.The expressionof pre-antigen receptorsand antigenreceptorsis essentialfor survival and maturation of developing lymphocytes and for selectionprocessesthat lead to a diverse repertoireof usefulantigenspecificities. I The antigen receptorsof B and T cells are encoded by genesformed by the somatic rearrangementof a limited number of gene segmentsthat are spatially segregatedin the germline antigen receptor loci. there are separateloci encodingthe Ig heavy chain, Ig r light chain,Ig i" light chain,TCRp chain,
t
.,
186 ,
,: Section lll - MATUBAT|0N, ACT|VAT|0N, ANDREGULATT0N OFLyMPH0CYTES
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TCR a and 6 chains, and TCR y chain. These loci contain ! L and, in the Ig heavy chain and TCR B and 6loci only, D gene segments.These segments lie upstream of exons encoding constant domains. Somatic rearrangement of both Ig and TCR loci involves the joining of D and I segments in the loci that contain D segments,followed by the joining of the V segment to the recombined DJ segments in these loci, or direct V-to-I joining in the other loci. This process of somatic gene recombination is mediated by a recombinase enzyme complex that includes the lymphoclte-specific components Rag-1and Rag-2. € The diversity of the antibody and TCR repertoires is generated by the combinatorial associations of multiple germline ! D, and I genes and junctional diversity generated by the addition or removal of random nucleotides at the sites of recombination. These mechanisms generate the most diversity at the junctions of the segments that form the third hlpervariable regions of both antibodv and TCR pollpeptides. 6 B cell maturation occurs in stagescharacterized by different patterns of Ig gene rearrangement and expression. In the earliest B cell precursors, called pro-B cells, Ig genes are initially in the germline configuration. At the pro-B to pre-B cell transition,
proliferation signals and also signals to inhibit rearrangement on the other heavy chain allele (allelic exclusion). At the immature b cell stage,Vf recombination occurs in the r and l, loci, and light chain proteins are expressed.Heavy and light chains are then assembled into intact IgM molecules and expressedon the cell surface. Immature B cells leave the bone marrow to populate peripheral lymphoid tissues, where they complete their maturation. At the mature B cell stage, synthesis of both p and 6 healy chains occurs in the same B cells mediated by alternative splicing of primary heavy chain RNA transcripts, and membrine IgM and IgD are expressed. a During B ll.rnphoclte maturation, immature B cells that express high-affinity antigen receptors specific for self antigens present in the bone marrow are either induced to edit their receptor genes or these cells are eliminated.
O T cell maturation in the thymus also progresses in stagesdistinguished by expressionof antigen receptor genes,CD4 and CD8 coreceptormolecules, and location in the thymus. The earliestT lineage immigrants to the thymus do not express TCRsor CD4 or CD8 molecules.The developing T cells within the thymus, called thymocytes, initially populate the outer cortex, where they undergo proliferation, rearrangement of TCR genes,and surfaceexpressionof CD3,TCR,CD4, and CD8 molecules.As the cells mature, thev migrate from the cortex to the medulla. @ The least mature thymocytes,called pro-T cells, are CD4 CD8- (double negative),and the TCR genesarein the germline conflguration.At the preT stage,th1'rnocytesremain double negative,butVD-I recombinationis completedat the TCRp chain locus. Primary B chain transcriptsare expressed and processedto bring a C9segmentadjacentto the VDI complex, and B chain polypeptides are produced.The B chain associates with the invariant pre-Toproteinto form a pre-TCR.Thepre-TCR transducessignalsthat inhibit rearrangementon the other B chain allele (allelic exclusion) and promotes CD4 and CD8 expressionand further proliferation of immature thymocytes. At the CD4*CD8*(double-positive)stageof T cell development, V-I recombinationoccurs at the TCR cr locus,crchainpolypeptidesareproduced,and low levelsof the TCRare expressedon the cell surface. I Selection processesdrive maturation of TCRexpressing,double-positivethymocytesand shape the T cell repertoire toward self MHC restriction and self-tolerance. Positiveselectionof CD4*CDg* TCRcB th1'rnocytesrequires low-avidity recognition of peptide-MHCcomplexeson rhynic epithelial cells, leading to a rescue of the cells from programmed death. Negative selection of CD4*CD8* TCRoB double-positive thyrnocytes occurs when these cells recognize, with high avidiry antigens that are present in the thymus. This processis responsiblefor toleranceto many self antigens.Most of the cortical thymocytes do not survivetheseselectionprocesses. As the surviving TCRaBthymocytesmature, they move into the medulla and become either CD4.CDg- or CD8*CD4-. Medullary thymocytes acquire the ability to differentiate into either helper or cytotoxic effector cells and finally emigrateto peripheral lyrnphoid tissues.
Selected Readings BoehmT. Thymus development and function. Current Opinion in Immunology 20:t7 B-L84, 2008. Busslinger M. Transcriptional control of early B cell development. Annual Review of Immunology 22:55-79,2004.
! GENES RECEPT0R 0FANTIGEN ANDEXPRESSION Chapter 8 - LYMPH0CYTE DEVEL0PMENT ANDTHEREARRANGEMENT t Germain RN. T cell development and the CD4-CDB lineage decision. Nature Reviews Immunolo gy 2:309-322, 2002. Hardy RR, and K Hayakawa. B cell development pathways. Annual Review of Immunology 19:595-622,2001. Hoeflg KII and V Heissmeyer. MicroRNAs grow up in the immune system. Current Opinion in Immunology 20:28I-287,2008. Jenkinson EL \,\'E lenkinson, SW Rossi, and G Anderson. The thymus and T-cell commitment: the right choice for Notch? Nature Reviews Immunology 6:551-555,2006. fung D, C Giallourakis, R Mostoslavsky, and FWAlt. Mechanism and control of V(D)l recombination at the immunoglobulin heary chain locus. Annual Review of Immunology 24:541-570,2006. Kuppers R, and R Dalla-Favera.Mechanisms of chromosomal translocations in B cell lyrnphomas. Oncogene 20:55805594,2001. Kyewski B and L ICein. A central role for central tolerance. Annual Review of Immunology 24:57I-6O6,2O06. Lodish HE B Zhou, G Liu, and CZ Chen. Micromanagement of the immune system by microRNAs. Nature Reviews Immunology B:120-130,2008. Maillard I, T Fang, andWS Pear. Regulation of lymphoid development, differentiation, and function by the Notch pathway. Annual Review of Immunology 23:945-974,2005. Meffre E, R Casellas,and MC Nussenzweig. Antibody regulation of B cell development. Nature Immunology l:379-385, 2000. Nemazee D. Receptor editing in lyrnphocyte development and central tolerance. Nature Reviews Immunology 6:728-740, 2006.
Palmer E. Negative selection-clearing out the bad apples from the T cell repertoire. Nature Reviews Immunology 3:383-391' 2003. Rodewald HR: Thl'rnus organogenesis. Annual Review of Immunology 26:355-388,2008. Rolink AG, C Schaniel,I Andersson, and F Melchers. Selection events operating at various stages in B cell development. Current Opinion in Immunology 13:202-207, 2001. Rothenberg EV IE Moore, and MA Yui. Launching the T-cellNature Reviews programme. lineage developmental Immunology 8:9-21, 2008. Schatz DG, and E Spanopoulou. Biochemistry ofV(D)J recombination. Current Topics in Microbiology and Immunology 290:49-85,2005. Schlissel MS. Regulating antiSen-receptor gene assembly. Nature Reviews Immunology 3:890-899,2003. Singer A, SAdoro, and IH Park. Lineage fate and intense debate: myths, models and mechanisms of CD4 versus CDB lineage choice. Nature ReviewsImmunology B:7BB-801,2008. Singh H, KL Medina, and JM Pongubala. Contingent gene regulatory networks and B cell fate specification. Proceedings of the National Academy of Science U S A 102:4949-4953' 2005. von Boehmer H, I Aifantis, F Gounari, O Azugui, L Haughn' I Apostolou, E Jaeckel, F Grassi, and L Klein. Th)'rnic selection revisited: how essential is it? Immunological Reviews 19I:62-78,2003. Xiao C and K Rajewsky. MicroRNA control in the immune system: Basic principles. Cell 136:26-36,2009.
187
PH 'f he activation atrd eft'ectorphases of cell-mediated adaptive inrtnutre resl)ollsesare triggered by antigen rccognitiort b-v T lyrrrllhocvtes.trr (lhapter 6, we de'f scribcd the specificitv of cclls fbr peptide fragments, clcrivedfr.ornpr oteirl antigells,that are displayedbound to self major histocompatibility complex{FIHC} rnolecules. In Chapter 7, we described the antigen rceeptors and accessory rnolectiles of I cells that are involved 'I in the activation of cells by antigens. In this chapter, we describe the biological and biochernical basis of T cell activation by antigens and by additional signals provicled by antigen-presenting cells (APCs).We begin with a brief overview of T cell activation, consider the biology of CD4' and CDS* T cell responses' discuss the role of costimulators in T cell activation, and then proceed to a discttssion of the biochemical mechanisrns of T cell receptor (TCR) signaling. Finally 'I we discussthe regulation -\g
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of Formation C5 convertase pathwayis activated mplementactivationby the alternativeand classicalpathways.The alternative srrfaces,such as microbialcell walls, the classicalpathwayis initiatedby C1 bindingto antigenthway is activatedby bindlngof a plasmalectinto microbes.The C3b that is generatedby the_actron (C5 icrobialcell surfaceor the aitrbodyand becomesa componentof the enzymethat cleavesC5 The latestepsof all three pathwaysare the same (notshown here),and s of complementactivation. comolementactivatedbv all three pathwaysservesthe same functions
cells. Properdin is the only known positive regulator of complement. Some of the C3b molecules generated by the alternative pathway C3 convertasebind to the convertase itself. This results in the formation of a complex containing one Bb moiety and two molecules of C3b, which functions as the alternative pathway C5 convertase that will cleave C5 and initiate the late steps of complement activation.
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undergoesslow spontaneoushydrolysisof its internalthioesterbond,which leadsto the formation of a fluid-phaseC3 convertase(not shown)and the generationof C3b lf the C3b is depositedon the surfacesof microbes,it binds factor B and forms the alternativepathwayC3 convertase This convertasecleaves C3 to producemore C3b,which bindsto the microbial surfaceand participates in the formationof a Cb convertaseThe C5 convertasecleavesCb to generateC5b, the initiatingevent in the late stepsof complementactivation
Table 14-3. Proteinsof the Alternativepathway of Complement
Protein Structure
C3
Serum Function concentration (pg/mL)
185-kD (a-subunit,1000-1200 p-subunit, 11O-kD; 75-kD)
C3b bindsto the surfaceof the microbe,where it functionsas an opsoninand as a component of C3 and C5 convertases C3a stimulatesinflammation (anaphylatoxin)
FactorB
93-kDmonomer
200
Bb is a serineprotease andthe activeenzymeof the C3 and C5 convertases
FactorD
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Plasmaserineprotease,cleaves factorB when it is boundto C3b
ProperdinComposedof up to 25 four 56-kDsubunits
Stabilizes C3 convertases (C3bBb) on microbial surfaces
0 FSH U M 0 R AI M L MUNITY ECHANISM 0R C h a p t e1r4- E F F E C TM
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to microbe, Attachment cellsurfaceprotein, or polysaccharide
FIGURE 14-7 Internal thioester bonds of C3 molecules. A s c h e m a t i cv i e w o f t h e i n t e r n a l t h i o e s t egr r o u p si n C 3 a n dt h e i rr o l e t n f o r m r n g c o v a l e n tb o n d s w i t h other moleculesis shown Proteolyticcleavageof the cr chainoJ C3 form in convertsrt intoa metastable w h i c h t h e i n t e r n atlh i o e s t e rb o n d s to are e\posed and sJScept,ble n u c ' e o P h i l ,act t a c t b Y o x Y g e n( a s shown) or nitrogen atoms The result is the formationof covalent bonds with proteins or carbohydrates on the ce I surfaces C4 rs structurallyhomologousto C3 and l i o e s t egr r o u p h a sa n i d e n t i c at h
c3b Cellassociated
c3b lnactive
c3b
In fluid phase, C3b is inactivated by hydrolysis
subunits;Clq binds to the antibody,and Clr and Cls are proteases.The C1q subunit is made up of an umbrellalike radial array of six chains, each of which has a globular head connected by a collagen-like arm to a central stalk (Fig. l4-9). This hexamer performs the recognition function of the molecule and binds specifically to the Fc regions of p and some y heavy chains. Each Ig Fc region has a single Clq-binding site, and each Clq molecule must bind to at least two Ig hear,ychains to be activated. This requirement explains why antibodies bound to antigens, and not free circulating antibodies, can initiate classical pathway activation (Fig. la-10). Because each IgG molecule has only one Fc region, multiple IgG molecules must be brought close together before Clq can bind, and multiple IgG antibodies are brought together only when they bind to a multivalent antigen. Even though free (circulating) IgM is pentameric, it does not bind Clq, because the Fc regions of free IgM are in a planar configuration that is inaccessibleto Clq. Binding of the IgM to an antigen induces a conformational change into a "staple" form that exposesthe Clq binding sites in the Fc regions and allows Clq to bind. Because of its pentameric structure, a single molecule of IgM can bind two Clq molecules, and this is one reason that IgM is a more efficient complement-binding (also called complement-fixing) antibody than IgG is.
Govalentattachmentof C3b to proteinor polysaccharide by thioesterlinkage
Clr and C1s are serine proteasesthat form a tetramer containing two molecules of each protein' Binding of tvvo or more of the globular heads of Clq to the Fc regions of IgG or IgM leads to enzymatic activation of the associatedC1r, which cleavesand activates C1s (seeFig. 14-B). Activated Cls cleaves the next protein in the cascade,C4, to generate C4b. (The smaller C4a fragment is released and has biologic activities that are described later.) C4 is homologous to C3, and C4b contains an internal thioester bond, similar to that in C3b, that forms covalent amide or ester linkages with the antigenantibody complex or with the adjacent surface of a cell to which the antibody is bound. This attachment of C4b ensures that classical pathway activation proceeds on a cell surface or immune complex. The next complement protein, C2, then complexes with the cell surface-bound C4b and is cleaved by a nearby Cls molecule to generate a soluble C2a fragment of unknown importance and a larger C2b fragment that remains physically associated with'C4b on the cell surface. (Note that in older texts, the smaller fragment is called C2b and the larger one is called CZa for historical reasons') The resulting Cab2b complex is the classical pathway C3 convertase; it has the ability to bind to and proteolytically cleave C3. Binding of this enzyme complex to C3 is mediated by the C4b component, and proteolysis is catalyzed by the C2b
333
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FIGURE14-9 Structure of Cl. C1qconsists of six identical subunitsarranged to forma centralcoreandsym etrically projecting r a d i aalr m sT. h eg l o b u l ahre a d a s t t h ee n do f e h a r m ,d e s i g n a t e d H ,a r et h ec o n t a cr te g i o nfso ri m m u n o g l o b uCl r1nra n dC 1 sf o r ma tetramer composed of two C1randtwo C1smolecules Theends o f C 1 ra n dC ' 1 cs o n t a itnh ec a t a l y tdi co m a i nosf t h e s ep r o t e i nO s ne
C3 convenase
component. Cleavageof C3 results in the removal of the small C3a fragment, and C3b can form covalent bonds with cell surfaces or with the antibody where complement activation was initiated. Once C3b is deposited, it can bind factor B and generate more C3 convertase by UJ the alternative pathway, as discussed before. The net convertase effect of the multiple enzl'rnatic steps and amplification Cleavageof C3 by is that a single molecule of C3 convertase can lead to the C3 convefiase ..l"47 deposition of hundreds or thousands of molecules of C3b on the cell surface where complement is activated. The key early steps of the alternative and classicalpathways are analogous: C3 in the alternative pathway is homologous to C4 in the classicalpathway, and factor B Binding of C3b is homologous to C2. to antigenic Some of the C3b molecules generated by the classical surfaceandto pathway C3 convertase bind to the convertase (as in the C4b2bcomplex c5 alternative pathway) and form aC4b2b3b complex. This convertase complex functions as the classical pathway C5 converCleavage of C5; tase; it cleavesC5 and initiates the late steps of compleinitiation of ment activation. latestepsof An unusual antibody-independent variant form of complement the classicalpathway has been described in the context activation of pneumococcal infections. Splenic marginal zone macrophages express a cell surface C-type lectin called SIGN-Rf that can recognize the pneumococcal polysaccharide and that can also bind Clq. Multivalent binding of whole bacteria or the polysaccharide to SIGN-Rl activates the classical pathway and permits the eventual surfaceswhere the antibodywas deposited The Cb convertase coating, in a C4-dependent manner, of the pneumococcleavesC5 to beginthe late stepsof complementactivation cal polysaccharide with C3b. This is an example of a cell
C h a p t e1r4-
IM 0 FSH U M O R A L M U N I T Y, E F F E C TM OEBC H A N I S M
Table 14-4. Proteinsof the ClassicalPathwayof Complement
Protein Structure
Function Serum concentration (pg/mL)
c1
750-kD
pathway theclassical Initiates
c1q
460-kD;hexamer75-150 of threeoairs of chains(22, 23,24-kD\
C1r
85-kDdimer
50
Bindsto the Fc porlionof thathasboundantigen, antibody to apoptoticcells,andto cationic surfaces cleavesC1sto Serineprotease, makeit an activeprotease
C1s
85-kDdimer
50
Serineprotease,cleavesC4 andC2
C4
210-kD, trimer ot 97-,75-,and 33-kDchains
300-600
C4b covalentlybindsto the surfaceof a microbeor cell,where antibodyis boundand comPlement is activated
(Cl qrzsz)
C4b bindsC2 for cleavagebY Cl s C4a stimulatesinflammation (anaphylatoxin)
C2
102-kD monomer20
C3
See Table14-3
surface lectin that mediates activation of the classical pathway but in an antibody-independent manner. The Lectin Pathway The lectin pathway of complement activation is triggered in the absence of antibody by the binding of microbial polysaccharides to circulating lectins, such as plasma mannose (or mannan)-binding lectin (MBL), or to l[-acety'glucosamine recognizing lectins known as ficolins. These soluble lectins are members of the collectin family and structurally resemble Clq (seeChapter 2). MBL binds to mannose residues on polysaccharides, and also binds to MBl-associated serine proteases (MASPs)such as MASP-1,MASP-Z,and MASP-3.Higherorder oligomers of MBL typically associatewith MASP-2 and MASP-3. These two proteases form a tetrameric complex similar to the one formed by Clr and Cls, and MASP-Z cleaves C4 and C2. Subsequent events in this pathway are identical to those that occur in the classical pathway. Late Steps of Complement
Activation
C5 conuertasesgenerated by the alternatiue, classical, or lectin pathway initiate actiuation of the late compo-
and C2bis a serineProtease of as theactiveenzYme functions to cleave C3 and C5 conveftases C3 andC5
nents of the complement systenx, which culminates in formation of the cytocid,al membrane attack complex (MAC) (Table 14-5 and Fig. 14-1f). C5 convertases cleave C5 into a small C5a fragment that is releasedand a two-chain C5b fragment that remains bound to the complement proteins deposited on the cell surface. C5a has potent biologic effects on several cells that are discussed later in this chapter. The remaining components of the complement cascade, C6, C7, C8, and C9, are structurally related proteins without enzymatic activity. C5b transiently maintains a conformation capable of binding the next proteins in the cascade,C6 and C7. The C7 component of the resulting CSb,6,7 complex is hydrophobic, and it inserts into the lipid bilayer of cell membranes, where it becomes a high-affinity receptor for the C8 molecule. The C8 protein is a trimer comoosed of three distinct chains, one of which binds to the C5b,6,7complex and forms a covalent heterodimer with a second chain; the third chain inserts into the lipid bilayer of the membrane. This stably inserted C5b,6,7,8 complex (C5b-8) has a limited ability to lyse cells. The formation of a fully active MAC is accomplished by the binding of C9, the final component of the complement cascades,to the CSb-B complex. C9 is a serum protein that polymerizes at the site of the bound C5b-8 to form pores in plasma membranes. These pores are about
335
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l00Ain diameter, and theyform channels that allowfree movement of water and ions (Fig. Ia-I2). The entry of water results in osmotic swelling and rupture of the cells on whose surface the MAC is deposited. The pores formed by polymerized Cg are similar to the membrane pores formed by perforin, the cytol],tic granule protein found in cytotoxic T lymphocltes (CTLs) and NK cells (see Chapter l3), and C9 is structurally homologous to perforin.
SolublelgM(planarform)
t'][- l
Itlo
\
f!"r 6|- -'l:'.,,.Antigen-bound rg[,tGi"pLi-rl
Receptors Tissue antrgen
Yes
:c" S o l u b l el g G ( Fc portions not adjacent)
No
Yes
FIGURE 14m u s t b i n dt o c a s c a d eT. h e s r b l eL oC1 i A r soes a shape S o l u be l g G m h a so n l yo n e F a d l a c e n tg G F
bindingto the Fc portionsof lgM and lgG.C1 m o r e F c p o r t i o n st o i n i t i a t et h e c o m p t e m e n l i o n so f s o u b l ep e n t a m e r ilcq M a r e n o t a c c e s l g V o . n d st o s u r t a c e - b o u inndt i o e n s i 1r r n d e r ".;i;.u; hangethar p",-r rt-Cl-oir;Uil ;;l e c u l e sw i l l a J s on o t a c t i v a t eC 1 b e c a u s ee a c hl g G , u t a f t e rb i n d i n gt o c e l ls u r f a c ea n t i g e n s , r e g i o n( C ) b p o r t i o n sc a n b i n da n d a c t i v a t e C1 (D).
for Complement
Proteins
Many of thebiologic actiuities of the complement system are mediated by the binding of complement fragments to membrane receptors expressed on uarious cell types. The best characterized ofthese receptors are specific for fragments of C3 and are described here (Table t4-6). Other receptors include those for C3a, C4a, and C5a, which stimulate inflammation, and some that regulate complement activation. The type 1 complement receptor (CRL,or CDSS)functions mainly to promote phagocytosis of CSb- and C4b-coated particles and clearance of immune complexes from the circuLation. CRI is a high-affinity receptor for C3b and C4b. It is expressed mainly on blood cells, including er1'throcytes,neutrophils, monoc].tes, eosinophils, and T and B lymphocytes; it is also found on follicular dendritic cells in the follicles of peripheral lymphoid organs. Phagoc).tesuse this receptor to bind and internalize particles opsonized with C3b or C4b. The binding of C3b- or C4b-coatedparticles to CRI also transduces signals that activate the microbicidal mechanisms of the phagocytes, especially when the Fcy receptor is simultaneously engaged by antibodycoated particles. CRI on erlthrocl'tes binds circulating immune complexes with attached C3b and C4b and transports the complexes to the liver and spleen. Here, the immune complexes are removed from the erythro-
,1i. I CR
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;
i
aa lvu
/
COand C7 bind sequentially, and the Csb,6,7complexbecomesdirectlyinsertedinto the lipidbilayerof the plasmamembrane,followed by stableinsertionof B Up to l5 C9 moleculesmay then polymerize aroundthe compiexto form the MAC, which createsporesin the membraneand induc cell lysis.CSareleasedon proteolysis of C5 stimulatesinflammation
IMMUNITY 0FHUMORAL MECHANISMS 14- EFFECT0R Chapter $
Table 14-5. Proteinsof the Late Steps of ComplementActivation
Protein Structure
c5
Function Serum concentration (pg/mL)
1 9 0 - k Dd i m e ro f 1 1 5 - 80 and 75- kD chains
assemblY C5binitiates of the membrane attackcomplex inflammation C5astimulates (anaphylatoxin)
c6
11O-kD monomer
45
of the MAc: bindsto component CSband acceptsC7
C7
100-kD monomer
90
Comoonentof the MAC: bindsto C5b,6and inseftsinto liPid membranes
c8
155-kDtrimerof 64-,64-,22-kD chains
60
of the MAC:bindsto Component the binding C5b,6,7andinitiates of Cg andpolymerization
c9
79-kDmonomer
60
of the MAC:bindsto Component to andpolymerizes Csb,6,7,8 pores formmembrane
FIGURE 14-12 Structureof the MAC in cell membranes.A Complement lesions in erythrocyte membranesare shown in this electron micrographThe lesionsconsist of holes approximately100A in diarneterthat areformedby poly-C9 tubularcomplexes B For comparison, membranelesionsinducedon a targetcell by a clonedCTL lineare shown in this electronmicrograph The lesionsappearmorphologically similar to complement-mediated leslons,exceptfor a largerinternal diameter (160A) CTL- and NK c e l l - i n d u c em d e m b r a n el e s i o n sa r e formed bv tubularcomolexesof a polymerized protein (perforin), which is homologousto C9 (see Chapter 13) C A model of the of the MAC is subunitarrangement region shown The transmembrane c o n s i s t so I 1 2 t o 1 5 C 9 m o l e c u l e s arrangedas a tubule,in additionto s i n ge m o l e c u l e os f C 6 , C 7 , a n d C 8 crandychains The C5bcr,CSbB,and that CBBchalnsform an appendage projectsabove the transmembrane pore (From PodackER Molecular of cytolysisby complemechanisms ment and cytolytic lymphocytes J o u r n a l o f C e l l u l a rB i o c h e m i s t r y 3 0 : 1 3 3 - 1 7 01, 9 B OC o p y r i g h 1t 9 8 6 Wiley-LissReprintedby permission of Wiley-Liss,Inc , a subsidiaryof J o h nW i l e v& S o n s ,I n c)
B
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Table 1't-6. Receptorsfor Fragmentsof C3
Receptor
Structure
160-250 kD; Type1 complement multiple CCPRs receptor ( c R 1 ,C D 3 5 )
145-kD; Type2 complement multiple CCPRs receptor (c R 2 ,C D 2 1 )
Ligands
Celldistribution
Function
c 3 b > c 4 b > i c 3 b Mononuclear Phagocytosis phagocytes, neutrophils, Clearance of immune B andT cells, erythrocytes, eosinophils,comprexes FDCs Promotes dissociation of C3 conveftases by actingas cofactor for cleavage of C3b,C4b C3d, C3dg > iC3b B lymphocytes, FDCs, Coreceptor for B cell nasopharyngeal activation epithelium Trapping of antigens in germinal centers
Receptorfor EBV Integrin, with i O 3 b .I C A M - 1 a : l s o Mononuclear phagocytes,Phagocytosis 165-kD cxchain neutrophils, NKcells bindsmicrobes Leukocyte adhesion and95-kDB2chain to endothelium (viaICAM-1)
Type3 complement receptor (C R 3M , a c - 1, c D 1 1b / C D 1 8 ) Integrin, with ic3b Type4 complement 150-kDa chain and95-kD82 chain receptor (CR4,p150/95, C D 1 1 c / C D 18 )
phagocytes,Phagocytosis, Mononuclear neutrophils, NK cells celladhesion?
Abbreviations; CCPR,complement controlproteinrepeat;FDC,follicular dendritic cell; ICAM-1 adhesion molecule-1 . , intercellular
cyte surface by phagocl,tes, and the erythrocltes continue to circulate. CRI is also a regulator of complement activation (seenext section). The type 2 complement receptor (CR2,or CD2l) functions to stimulate humoral immune responses by enhancing B cell actiuation by antigen and by promoting the trapping of antigen-antibody complexes in germinal centers. CR2 is present on B lymphocytes, follicular dendritic cells, and some epithelial cells. It specifically binds the cleavage products of C3b, called C3d, C3dg, and iC3b (i referring to inactive), which are generated by factor l-mediated proteolysis (discussed later). On B cells, CR2 is expressedas part of a trimolecular complex that includes two other noncovalently attached proteins called CDlg and target of antiproliferative antibody-l (TAPA-l, or CDBI). This complex delivers signals to B cells that enhance the responsesof B cells to antigen (seeChapter 10, Fig. l0-5). On follicular dendritic cells, CR2 serves to trap iC3b- and C3dgcoated antigen-antibody complexes in germinal centers. The functions of complement in B cell activation are described later. In humans, CR2 is the cell surface receptor for Epstein-Barr virus, a herpesvirus that causes infectious mononucleosis and is also linked to several human malignant tumors (see Chapter 17, Box l7-2). EpsteinBarr virus infects B cells and can remain latent for life.
The type 3 compl.ement receptor, ako called Mac-I (CRs, CDIlbCDl9), is an integrin that functions as a receptor for the iC3b fragment generated by proteolysk of CSb.Mac-1 is expressedon neutrophils, mononuclear phagocytes, mast cells, and NK cells. It is a member of the integrin family of cell surface receptors (seeChapter 2,Box 2-3) and consistsof an s chain (CDllb) noncovalently linked to a B chain (CD18) that is identical to the B chains of two closely related integrin molecules, leukocyte function-associated antigen-1 (LFA-1)and p150,95. Mac-1 on neutrophils and monocytes promotes phagocytosis of microbes opsonized with iC3b. In addition, Mac-1 may directly recognize bacteria for phagocltosis by binding to some unknorun microbial molecules (see Chapter 2). It also binds to intercellular adhesion molecule-1 (ICAM-1) on endothelial cells and promotes stable attachment of the leukocltes to endothelium, even without complement activation. This binding leads to the recruitment of leukocytes to sites of infection and tissue injury. The type 4 complement receptor (CR4, p150,95, CD1lcCD18) is another integrin with a different s chain (CDllc) and the same p chain as Mac-l. It also binds iC3b, and the function of this receptor is probably similar to that of Mac-l. CDllc is also abundantly expressedon dendritic cells and is used as a marker for this cell type.
C h a p t e1r4-
The complement receptor of the immunoglobulin family (CRIg) is expressed on the surface of macrophages in the liver known as Kupffer cells. CRIg is an integral membrane protein with an extracellular region made up of Ig domains. It binds the complement fragments C3b and iC3b, and is a mal'or receptor for the clearance of opsonized bacteria and other blood-borne pathogens. SIGN-RI, discussed earlier, is a cell surface C-type lectin on marginal zone macrophages that recognizes pneumococcal polysaccharides and can also bind Clq, thus mediating the efficient activation of the classical complement pathway in an antibody-independent manner. It contributes in a major way to the opsonizat i o n a n d c l e a r a n c eo f p n e u m o c o c c i .
Regulation
of Complement
Aetivation
Actiuation of the complement cascade and the stability of actiue complement proteins are tightly regulated to
IM L MUNITY 0 FSH U M O R A E F F E C TM OERC H A N I S M
preuent complement actiuation on nor*)';-:r; and tolimitthe d.uration of compLementactiuation euen on microbial cells and antigen-antibody complexes. Regulation of complement is mediated by several circuIating and cell membrane proteins (Table 14-7). Many of these proteins, as well as severalproteins of the classical and alternative pathways, belong to a family called regulators of complement activity (RCA) and are encoded by homologous genes that are located adjacent to one another in the genome. Complement activation needs to be regulated for two reasons. First, low-level complement activation goes on spontaneously, and if such activation is allowed to proceed, the result can be damage to normal cells and tissues. Second, even when complement is activated where needed, such as on microbial cells or antigenantibody complexes, it needs to be controlled because degradation products of complement proteins can diffuse to adjacent cells and injure them. Different regulatory mechanisms inhibit the formation of C3 convertases in the early steps of complement activation, break
Table14-7. Regulatorsof ComplementActivation
Receptor
Structure Distribution lnteracts Function with , 1s Plasmaprotein; C 1 r C conc.200pg/mL
Serineproteaseinhibitor; b i n d st o C 1 r a n d C 1 s and dissociatesthem f r o mC 1 o
Factor I
88-kD dimer Plasmaprotein; c4b,c3b of 50- and 38- conc.35 pg/ml kD subunits
Serineprotease;cleaves C3bandC4bby using factorH, MCP,C4BP or CR1as cofactors
FactorH
150-kD; multiple CCPRS
C1 inhibitor 104-kD
( c 1r N H )
c3b
BindsC3band Bb disolaces Cofactorfor factorlmediatedcleavageof c3b
C4-binding 570kD; multiple protein CCPRs (c4BP)
Plasmaprotein; c4b conc. 300 pg/ml
Membrane 45-70 kD; four CCPRs cofactor for protein (MCPCD46)
Leukocvtes. epithelialcells endothelialcells
BindsC4band C2 displaces Cofactorfor factorlmediatedcleavageof c4b Cofactorfor factorlmediatedcleavageof C3bandC4b
70 kD;GPI Decayacceleratinglinked,four factor(DAF) CCPRS
c4b2b, Bloodcells, cells, c3bBb endothelial epithelialcells
Displaces C2bfromC4b andBb fromC3b (dissociation of C3 convefiases)
C7, C8 Bloodcells, endothelialcells, epithelialcells
BlocksC9 bindingand preventsformationof the MAC
CD59
'18 kD;GPl linked
Plasmaprotein; conc.480 pg/mL
c3b,c4b
controlproteinrepeat;conc.,concentration; Abbreviations; CCPR,complement attackcomplex. MAC,membrane GPl,glycophosphatidylinositol;
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C 1I N H preventsClrzsz frombecoming proteolytical ly active
c1r2s2
c1 INH
F I G U R Et + - t 3 R e g u l a t i oonf C l a c t i v i t b y y C l l N H .C 1t N Hd i s p l a c eC s 1 r r sf 2 r o mC 1 qa n dt e r m i n a t e c lsa s s i cpaal t h w aayc l v a u o n
down and inactivate C3 and C5 convertases,and inhibit formation of the MAC in the late steps of the complement pathway. The proteolytic actiuity of Clr and CIs is inhibited by a plasma protein called Ct inhibitor (Ct INH). Ct INH is a serine protease inhibitor (serpin) that mimics the normal substratesof Clr and CIs. If Ciq binds to an antibody and begins the process of complement activation, C1 INH becomes a target of the enzymatic activity of the bound Clrr-Clsr. Cl INH is cleaved by and becomes covalently attached to these complement proteins, and as a result, the Clrr-C1s2tetramer dissociates from Clq, thus stopping activation by the classical pathway (Fig. 1 -i3). In this way, Cl INH prevents the accumulation of enzymatically active Clr2-Cls, in the plasma and limits the time for which active CLrr-Cls2is available to activate subsequent steps in the complement cascade. An autosomal-dominant inherited diseasecalled hereditary angioneurotic edema is due to a deficiency of Cl INH. Clinical manifestations of the disease include intermittent acute accumulation of edema fluid in the skin and mucosa, which causes abdominal pain, vomiting, diarrhea, and potentially lifethreatening airway obstruction. In these patients, the plasma levels of C1 INH protein are sufficiently reduced ( DAF > MCB and this hierarchy may reflect the relative abundance of these proteins on cell surfaces. The function of regulatory proteins may be ouerwhelmed by excessiueactivation of complement path-
for MCP(andCR1)actas cofactors proteolytic cleavage l-mediated Factor iC3b of C3b,producing c3,c
,/@
Proteolysis of c3b
**+>
ways. We have emphasized the importance of these regulatory proteins in preventing complement activation on normal cells. However, complement-mediated phagocyosis and damage to normal cells are important pathogenetic mechanisms in many immunologic diseases(seeChapter 18). In these diseases,large amounts of antibodies may be deposited on host cells, generating enough active complement proteins that the regulatory molecules are overwhelmed and unable to control complement activation. Functions
of ComPlement
products of complement activation facilitate the activation of B lymphocltes and the production of antibodies. Phagocytosis,inflammation, and stimulation of humoral immunity are all mediated by the binding of proteolytic fragments of complement proteins to 'uariouscell surface receptors, whereas cell lysis is mediated by the MAC. In the following section, we describe each of these functions of the complement system and their role in host defense. Opsonization
and PhagocYtosis
Microbes onwhich complement is actiuatedby the alternatiue or classical pathway become coated with C3b, iC3b, or C4b and are phagocytosed' by the binding of these proteinsto specifr'creceptors on macrophages and neutrophils (Fig. I4-l7A). As discussed previously, activation of complement leads to the generation of C3b and iC3b covalently bound to cell surfaces. Both C3b and iC3b act as opsonins by virtue of the fact that they specifically bind to receptors on neutrophils and macrophages. C3b and C4b (the latter generated by the classical pathway only) bind to CRl, and iC3b binds to CR3 (Mac-l) and CR4. By itself, CRl is inefficient at
341
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Section lV
EFFECT0R MECHANTSMS 0F TMMUNE RESP0NSES
Activation of latecomponents of complements
CD59inhibits poly-C9 assembly
S proteininhibits membrane insefiionof c5b-c7
protein
is formed on cell surfacesas an end resultof complementactivation The membrane p.otein CD59and S protelnin the plasma inhibitformationof the MAC
iC3b-dependent phagocytosis of microorganisms is a major defense mechanism against infections in innate and adaptive immunity. One example of the importance of complement is host defense against bacteria with polysaccharide-rich capsules,such as pneumococci and meningococci, which is mediated entirely by humoral immunity. IgM antibodies against capsular polysaccharides bind to the bacteria, activate the classicalpathway of complement, and cause phagocy'tic clearance of the
pneumococcal and meningococcal septicemia. C3deficient humans and mice are extremelv susceptible to lethal bacterial infections. Sti m u Iatio n of Infl a m m atory
Responses
The proteolytic complement fragments CSa, C4a, and CSa induce acute inflammation by actiuatingmast cells
and neutrophik (Fig.I4-t7B).All three peptides bind to mast cells and induce degranulation, with the releaseof vasoactive mediators such as histamine. These peptides are also called anaphylatoxins because the mast cell reactions they trigger are characteristic of anaphylaxis (seeChapter l9). In neutrophils, C5a stimulates motility, firm adhesion to endothelial cells, and, at high doses, stimulation of the respiratory burst and production of reactive oxygen intermediates. In addition, C5a may act directly on vascular endothelial cells and induce increased vascular permeability and the expressionof pselectin, which promotes neutrophil binding. This combination of C5a actions on mast cells, neutrophils, and endothelial cells contributes to inflammation at sites of complement activation. C5a is the most potent mediator of mast cell degranulation, C3a is about 20-fold less potent, and C4a is about 2500-fold less.The proinflammatory effects of CSa, C4a, and C3a are mediated by binding of the peptides to speciflc receptors on various cell t1pes. The C5a receptor is the most thoroughly characterized. It is a member of the seven q,-helical transmembrane G-protein coupled receptor family. The C5a receptor is expressed on many cell typea,
14Chapter
IMMUNITY ; 0F HUMORAL MECHANISMS EFFECTOR i..,,!-i::d1ll4j'!:,x!;9*!}g,t'iel!rJ:r
@
op"on,rationand phagocytosis
of boundC3b Bindingof C3b(orC4b) Recoonition phigocyteC3b recePtor to microbe(opsonization)by
Phagocytosis of microbe
Stimulationof inflammatoryreactions
Bindingof C3bto microbe, releaseof C3a;proteolysis C5a of C5,releasing
Destruction and Recruitment of microbes activationof leukocytesby CSa,C3a by leukocytes
cytolysis Complement-mediated 14-17 Functions of FtcuRE complement.The major functions of the complementsvstemin host C3b defenseareshown Cell-bound is an opsoninthat promotesphagocytosisof coatedcells(A);the proteolvtic products C5a, C3a, and (to a lesserextent)C4a stimulate leukocyterecruitmentand inflammation(B);andthe MAC lysescells
(c)
Bindingof C3bto microbe, activation of latecomponents of comolement
including neutrophils, eosinophils, basophils, monocltes, macrophages, mast cells, endothelial cells, smooth muscle cells, epithelial cells, and astrocytes.The C3a receptor is also a member of the G protein-coupled receptor family.
of Formation attack the membrane complex(MAC)
lation when an individual mounts a vigorous antibody response to a circulating antigen. If the immune compleies accumulate in the blood, they may be deposited in vessel walls and lead to inflammatory reactions that
Co m pl em e nt- M edi ated Cyto lysi s Complement-mediated lysis of foreign organisms is mediated by the MAC (Fig. l4-l7c). Most pathogens have evolved thick cell walls or capsules that impede accessof the MAC to their cell membranes. Complement mediated lysis appears to be critical for defense against only a few pathogens that are unable to resist MAC insertion. Thus, genetic defects in MAC components result in increased susceptibility only to infections by bacteria of the genus Neisseria, all of which have very thin cell walls. Other Functions of the Complement
System
By binding to antigen-antibody complexes, complement proteirus promote the solubilization of these complexes and. their clearance by phagocytes. Small numbers of immune complexes are frequently formed in the circu-
of the immune complexes. In addition, as discussed before, immune complexes with attached C3b are bound to CRI on erythrocytes, and the complexes are cleared by phagocytes in the liver. The C3d protein generated ftom C3 binds to CR2 on
results in the covalent attachment of C3b and its cleavage product C3d to the antigen. B ll. nphocyes can bind the antigen through their Ig receptors and simultaneously bind the attached C3d through CR2, the coreceptor for the B cell antigen receptor' thus enhancing
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T h e c o m p l e m e n ts y s t e m m a y b e i n v o l v e di n h u m a n d i s e a s ei n t w o g e n e r aw l a y s .F i r s t ,d e f i c i e n c i ei sn a n y o f t h e p r o t e i nc o m p o n e n t sm a y l e a dt o a b n o r m apl a t t e r n s o f c o m p l e m e nat c t i v a t i o nT h e a b s e n c eo f a c o m p o n e n t o f t h e c l a s s i c aol r a l t e r n a t i vpea t h w a yo r a b s e n c eo f t h e l a t es t e p sm a y r e s u l ti n d e f i c i e nct o m p l e m e nat c t i v a t i o n l f r e g u l a t o rcyo m p o n e n t a s r e a b s e n t t, o o m u c h c o m p l e m e n t a c t t v a t i om n a y o c c u ra t t h e w r o n g t i m e o r w r o n g s i t e , l e a d i n gt o e x c e s si n f l a m m a t i oann d c e l l l y s i s ,a n d m a y a l s oc a u s ea d e f i c i e n c iyn p l a s m ac o m p l e m e npt r o t e r n s b e c a u s eo f e x c e s s i v ec o n s u m p t i o nS e c o n d ,a n i n t a c t ,n o r m a l l yf u n c t i o n i n cgo m p l e m e nst y s t e mm a y o e a c t i v a t e di n r e s p o n s et o a b n o r m asl t i m u l is u c h a s p e r s i s t e n t m i c r o b e s ,a n t i b o d i e sa g a i n s ts e l f a n t i g e n s ,o r i m m u n ec o m p l e x e sd e p o s i t e di n t i s s u e s I n t h e s ei n f e c t r o u sa n d a u t o t m m u n ed i s e a s e st,h e i n f l a m m a t o rayn d l y t i ce f f e c t so f c o m p l e m e nm t a y s i g n i f i c a n t cl yo n t r i b u t e t o t h e p a t h o l o g icch a n g e so f t h e d i s e a s e C O M P L E M E N TD E F I C I E N C | E S I n. h e r i t e da n d s p o n t a n e o u sd e f i c i e n c i eisn m a n yo f t h e c o m p l e m e npt r o t e i n s h a v eb e e nd e s c r i b e di n h u m a n s Genetic deficienciesin classicalpathway compon e n t s , i n c l u d i n gC 1 q , C 1 r ,C 4 , C 2 , a n d C 3 , h a v e o e e n d e s c r i b e dC; 2 d e f i c i e n ciys t h e m o s tc o m m o n l yi d e n t i f i e d h u m a nc o m p l e m e ndt e f i c i e n c yA d i s e a s et h a t r e s e m o t e s t h e a u t o i m m u n ed i s e a s es y s t e m i cl u p u se r v t h e m a t o s u s d e v e l o p si n m o r e t h a n 5 0 % o f p a t i e n t sw i t h C 2 a n d C 4 d e f i c i e n c i eT s h e r e a s o nf o r t h i s a s s o c i a t i oins u n k n o w n , b u t d e f e c t si n c o m p l e m e nat c t i v a t i o m n a y l e a dt o f a r l u r e t o c l e a rc i r c u l a t i nigm m u n ec o m p l e x e sl f n o r m a r rgy e n e r a t e dt m m u n ec o m p l e x e sa r e n o t c l e a r e df r o m t h e c i r c u l a t i o nt ,h e ym a y b e d e p o s i t e d i n b l o o dv e s s e w l a l l sa n d tissues, where they activate leukocytesby Fc recept o r - d e p e n d e npta t h w a y sa n dp r o d u c el o c a li n f l a m m a t r o n C o m p l e m e nm t a y p l a ya n i m p o r t a nrto l ei n t h e c l e a r a n c e o f f r a g m e n t e dD N A c o n t a i n i n a g p o p t o t i cb o d i e s T h e s e a p o p t o t i cb o d i e sa r e n o w c o n s i d e r etdo b e k e y i m m u n o g e n si n l u p u s I n a d d i t i o nc, o m p l e m e npt r o t e i n sr e g u r a r e a n t i g e n - m e d i a t esdi g n a l sr e c e i v e db y B c e l l s ; i n t h e i r a b s e n c es, e l f a n t i g e n sm a y n o t i n d u c eB c e l l t o l e r a n c e , a n da u t o i m m u n i trye s u l t sS o m e w h ast u r p r i s i n g lC y ,2 a n d C 4 d e f i c i e n c i easr e n o t u s u a l l ya s s o c i a t ew di t h i n c r e a s e d s u s c e p t i b i l ittoy i n f e c t i o n sw, h i c hs u g g e s t st h a tt h e a l t e r natrvepathwayand Fc receptor-mediated effectormecha n r s m sa r e a d e q u a t ef o r h o s t d e f e n s e a g a i n s tm o s t m i c r o b e sD e f i c i e n c o y f C 3 i s a s s o c i a t ew d ith frequent s e r i o u sp y o g e n i cb a c t e r i ailn f e c t i o n st h a t m a y b e f a t a l , i l l u s t r a t i ntgh e c e n t r a lr o l e o f C 3 a n d i t s i m p o r t a n c ei n o p s o n i z a t i oenn, h a n c e dp h a g o c y t o s iasn, d d e s t r u c t i oonf t h e s eo r g a n i s m s Deficiencies in components of the alternative p a t h w a y , i n c l u d i n gp r o p e r d i na n d f a c t o r D , r e s u r rr n I n c r e a s esdu s c e p t i b i l ittoy i n f e c t i o nw i t h p y o g e n r b cacter i a C 3 d e f i c i e n c iys m e n t i o n e da b o v e . Mutation of the gene encoding the mannoseb i n d i n gl e c t i n( M B L )c o n t r i b u t etso i m m u n o d e f i c i e nicnv s o m e p a t i e n t st;h i s i s d i s c u s s e di n C h a p t e 2 r0
Deficienciesin the terminal complement compon e n t s ,i n c l u d i n C g 5 , C 6 , C 7 , C 8 , a n d C 9 , h a v ea r s oD e e n d e s c r i b e d I n t e r e s t i n g l yt,h e o n l y c o n s i s t e n tc l i n i c a l p r o b l e mi n t h e s e p a t i e n t si s a p r o p e n s i t yf o r d i s s e m i nated infectionsby lVeisseria bacteria,includingrVeisseria meningitidis and Neisseria gonorrhoeae,indicating t h a t c o m p l e m e n t - m e d i a tbeadc t e r i ally s i s i s p a r t i c u l a r l y i m p o r t a nfto r d e f e n s ea g a i n stth e s eo r g a n i s m s Deficienciesin complement regulatory proteins a r ea s s o c i a t ew d i t h a b n o r m acl o m p l e m e nat c t i v a t i oann d a v a r i e t yo f r e l a t e dc l i n i c aal b n o r m a l i t i eD s .e f i c i e n c i ei sn C 1 i n h i b i t oar n d d e c a y - a c c e l e r a tfi an cgt o ra r e m e n t i o n e d in the text. In patientswith factor I deficiency, plasmaC3 i s d e p l e t e da s a r e s u l to f t h e u n r e g u l a t efdo r m a t i o no f f l u i d - p h a s eC 3 c o n v e r t a s e( b y t h e n o r m a l " t i c k o v e r " m e c h a n i s mT) .h e c l i n i c acl o n s e q u e n cies i n c r e a s eidn f e c tions with pyogenicbacteria.FactorH deficiencyis rare and is characterizedby excess alternativepathwaV a c t r v a t i o nc,o n s u m p t i o no f C 3 , a n d g l o m e r u l o n e p h r i t i s c a u s e db y i n a d e q u a t cel e a r a n c e o f i m m u n ec o m p l e x e s a n dr e n a d l e p o s i t i oonf c o m p l e m e nbt y - p r o d u c t S s pecific allelic variants of factor H are strongly associated with age-relatedmacular degeneration The effects of a lack of factor I or factor H are similarto the effects o f a n a u t o a n t i b o dcya l l e dC 3 n e p h r i t i cf a c t o r ( C 3 N e F ) , which is specificfor alternativepathwayC3 convertase ( C 3 b B b ) .C 3 N e F s t a b i l i z e sC 3 b B b a n d p r o t e c t s t h e complex from factor H-mediated dissociation,which r e s u l t si n u n r e g u l a t ecdo n s u m p t i o o n f C 3 . P a t i e n t sw i t h t h i s a n t i b o d yo f t e n h a v e g l o m e r u l o n e p h r i t ipso, s s i b l y c a u s e db y i n a d e q u a t ec l e a r i n go f c i r c u l a t i n gi m m u n e complexes Deficienciesin complement receptors includethe a b s e n c eo f C R 3a n d C R 4 ,b o t h r e s u l t i n g f r o m r a r em u t a t i o n s i n t h e B c h a i n ( C D 1 8 )g e n e c o m m o n t o t h e C D 1 1 C D 1f8a m i l yo f i n t e g r i n m o l e c u l e sT h e c o n g e n i t a l d i s e a s ec a u s e db y t h i s g e n e d e f e c t i s c a l l e dl e u k o c v t e a d h e s i o nd e f i c i e n c y( s e e C h a p t e r2 0 ) . T h i s d i s o r d e ri s characterizedby recurrentpyogenic infectionsand is c a u s e d b y i n a d e q u a t ea d h e r e n c eo f n e u t r o p h i l st o endothelium a t t i s s u es i t e so f i n f e c t i o na n d p e r h a p sb y impairediC3b-dependent phagocytosis of bacterra. PATHOLOGICEFFECTS OF A NORMAL COMPLEMENT SYSTEM.Evenwhen it is properlyregulatedand appropriatelyactivated,the complement svstem can c a u s es i g n i f i c a nt its s u ed a m a g eS . o m eo f t h e p a t h o l o g i c effects associatedwith bacterialinfectionsmay oe oue to complement-mediated acute inflammatoryresponses t o i n f e c t i o uos r g a n i s m sI n s o m es i t u a t i o n sc,o m p l e m e n t activationis associated with intravascular thrombosisand c a n l e a d t o i s c h e m i ci n j u r yt o t i s s u e s .F o r i n s t a n c e , a n t i e n d o t h e l i aaln t i b o d i e sa g a i n s t v a s c u l a r i z e d organ t r a n s p l a n t sa n d t h e i m m u n e c o m p l e x e sp r o d u c e di n autoimmune d i s e a s e sm a y b i n dt o v a s c u l aer n d o t h e l i u m a n d a c t i v a t ec o m p l e m e n tt,h e r e b yl e a d i n gt o r n f l a m m a tion and generationof the IVIACwith damage to the e n d o t h e l i aslu r f a c e w , h i c h f a v o r sc o a g u l a t i o nT h e r e i s
IMMUNITYi 0FHUMORAL MECHANISMS 14- EFFECT0R Chapter
a l s oe v i d e n c e t h a ts o m eo f t h e l a t ec o m p l e m e npt r o t e i n s m a y a c t i v a t ep r o t h r o m b i n a s e i nst h e c i r c u l a t i otnh a t i n i t i ate thrombosisindependentof MAC-mediateddamage to endothelium It has long been believedthat the clearestexampleof c o m p l e m e n t - m e d i a t epda t h o l o g yi s i m m u n e c o m p l e x d i s e a s e . S y s t e m i c v a s c u l i t i sa n d i m m u n e c o m p l e x g l o m e r u l o n e p h r irtei ss u l tf r o m t h e d e p o s i t i o o nf a n t i g e n a n t i b o d yc o m p l e x e si n t h e w a l l s o f v e s s e l sa n d k i d n e y g l o m e r u l(is e eC h a p t e 1 r 8 ) C o m p l e m e nat c t i v a t e b dythe
antigen-induced signaling in B cells (seeChapter 10,Fig. 10-5). Opsonized antigens are also bound by follicular dendritic cells in the germinal centers of lymphoid organs. Follicular dendritic cells display antigens to B cells in the germinal centers, and this process is important for the selection of high-affinity B cells (seeChapter 10, Fig. 10-12). The importance of complement in humoral immune responses is illustrated by the severe impairment in antibodyproduction and germinal center formation seen in knockout mice lacking C3 or C4 or the CR2 protein. Although our discussion has emphasized the physiologic functions of complement as an effector mechanism of host defense, the complement system is also involved in several pathologic conditions (Box 14-2). Some autoimmune diseasesare associatedwith the production of autoantibodies specific for self proteins expressedon cell surfaces (see Chapter 18). Binding of these antibodies results in complement-dependent lysis and phagocytosis of the cells. In other diseases,immune complexes deposit in tissues and induce inflammation by complement-mediated recruitment and activation of leukocytes. Genetic deficiencies of complement proteins and regulatory proteins are the causes of various human diseases. The similarities in the roles of complement and Fc receptors in phagocl,tosis and inflammation raise the question of which is the more important effector mechanism of humoral immunity. Surprisingly, knockout mice lacking C3 or C4 show virtually no defects in IgG antibody-mediated phagocytosis of opsonized erythrocltes or in immune complex-mediated vasculitis. Both these reactions are abolished in knockout mice lacking the high-affinity Fcy receptor. These results suggest that in IgG antibody-mediated phagocytosis and inflammation, Fc receptor-dependent reactions may be more important than complement-mediated reactions. \Mhether this phenomenon is true in humans remains to be established.Also, IgM antibody-mediated protective immunity and pathologic reactions are dependent only on the complement system because IgM is an efflcient activator of complement but does not bind to leukoclte Fc receptors.
i m m u n o g l o b u l i n t h e s e d e p o s i t e di m m u n ec o m p l e x e s initiatesthe acute inflammatoryresponsesthat destroy t h e v e s s e lw a l l s o r g l o m e r u l ai n d l e a d t o t h r o m b o s i s , ischemicdamageto tissues,and scarring However,as t i c el a c k i n g i n t h e t e x t ,s t u d i e sw i t h k n o c k o um mentioned the complementproteinsC3 or C4 or lackingFcy recepleukocyteactivators suggestthat Fc receptor-mediated t i o n m a y c a u s ei n f l a m m a t i oann dt i s s u ei n j u r ya s a r e s u l t o f l g G d e p o s i t i o ne v e n i n t h e a b s e n c eo f c o m p l e m e n t actrvat|on.
Evasion of Complement
by Microbes
Pathogens have evolved diverse mechanisms for evading the complement system. Some microbes express thick cell walls that prevent the binding of complement proteins, such as the MAC. Gram-positive bacteria and some fungi are examples of microbes that use this relatively non-specific evasion strategy. A few of the more specific mechanisms employed by a small subset of pathogens will be considered here. These evasion mechanisms may be divided into three Sroups. @ Microbes can euade the compl.ement system by recruiting host compl.ement regulatory proteins. Many pathogens express sialic acids which can inhibit the alternative pathway of complement by recruiting factor H, which displaces C3b from Bb' Some pathogens, like schistosomes,Neisseriagonorrheae, and certain Hemophilus species, scavenge sialic acids from the host and enzymatically transfer the sugar to their cell surfaces. Others, including Escherichia coli Kl and some meningococci, have evolved special bioslnthetic routes for sialic acid generation. Some microbes synthesize proteins that can recruit the regulatory protein factor H to the cell surface. Gp41 on HIV can bind to factor H, and this property of the virus is believed to contribute to virion protection. Many other pathogens have evolved proteins that facilitate the recruitment of factor H to their cell walls. These include bacteria such as Streptococccus pyogenes, Borrelia burgdorferi (the causative agent of Ly.rnedisease), Neisseria gonorrhea, Neisseria meningitides, the fungal pathogen Candida albicans, and nematodes such as Echinococcus granulosus. Other microbes, such as HIV incorporate multiple host regulatory proteins into their envelopes. For instance, HIV incorporates the GPl-anchored complement regulatory proteins DAF and CD59 when it buds from an infected cell. @ A number of pathogens prod.uce specific proteins that mimic human complenxent regulatory proteins. Escherichiacoll makes a C1q binding protein (ClqBP) that inhibits the formation of a complexbetween Clq
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and Clr and Cls. Staphylococcusaureus makes a protein called SCIN (Staphylococcal complement inhibitor) that binds to and stably inhibits both the classical and alternative pathway C3 convertases and thus inhibits all three complement pathways. Glycoprotein C- I of the Herpes simplex viruses destabilizes the alternative pathway convertase by preventing its C3b component from binding to properdin. GPl60, a membrane protein on Trypanosoma cruzi, the causative agent ofChagas'disease, binds to C3b and prevents the formation of the C3 convertase,and also accelerates its decay.VCP-1 (vaccinia virus complement inhibitory protein-l), a protein made by the vaccinia virus, structurally resembles human C4bp, but can bind to both C+b and C3b and acceleratethe decay ofboth C3 and C5 convertases. a Complement-mediated inflammation can also be inhibited by microbial gene products. Staphylococcal aureus slmthesizes a protein called CHIPS (Chemokine Inhibitory Protein of Staphylococci),which is an antagonist of the C5a anaphylatoxin. These examples illustrate how microbes have acquired the ability to evade the complement system, presumably contributing to their pathogenicity.
FurucrIorus OFANTIBODIES AT SprcrRl AruRroulc Slrrs So far, we have described the effector functions of antibodies that are systemic and do not show any particular features related to location. Antibodies seive special defense functions as a result of active transport into two anatomic compartments, the lumens of mucosal organs and the developing fetus. In these sites, the principal mechanism of protective immunity against microbes is antibody-mediated neutralization becauselyrnphocytes and other effector cells do not pass through mucosal epithelia or the placenta. Mucosal
lmmunity
IgA is the major class of antibody that is produced, in the mucosal immune system. The gastrointestinal and respiratory tracts are two of the most common portals of entry of microbes. Defense against microbes that enter by these routes is provided by antibody, Iargely IgA, that is produced in mucosal lymphoid tissues and secreted through the mucosal epithelium into the Iumens of the organs. In mucosal secretions, IgA binds to microbes and toxins present in the lumen and neutralizes them by blocking their entry into the host (see Fig. 14-2). Secretoryimmunity is the mechanism of protective immunity induced by oral vaccines such as the polio vaccine. The mucosal immune system is a collection of lymphoc)'tes and other cell types, often organized into discrete anatomic structures with definable lymphoid follicles that are located underneath the epithelia of the gastrointestinal and respiratory tracts (see Chapter 3). IgA is produced in larger amounts than any other antibody isotlpe, mainly because of the size of the mucosal
immune system. It is estimated that a normal 70-kg adult secretesabout 2g of IgA per day, which accounts for 60Toto 70Voof the total output of antibodies. Because IgA synthesis occurs mainly in mucosal lymphoid tissue and transport into the mucosal lumen is efficient, this isotype constitutes less than one quarter of the antibody in plasma and is a minor component of systemic humoral immunity compared with IgG and IgM. Antibody responsesto antigens encountered by ingestion or inhalation are typically dominated by IgA. In antigenstimulated B cells, switching to the IgA isotype is stimulated by transforming growth factor-B (which may be produced by T cells as well as by nonlymphoid stromal cells) and cltokines of the TNF family, including BAFF (seeChapter l0). The reason why larger amounts of IgA are produced in the mucosal immune system than in other tissues is that isotlpe switching to IgA occurs most efficiently in mucosal lymphoid tissue, particularly in Peyer'spatches and mesenteric lymph nodes, and classswitched IgA plasmablasts have a special propensity to home to the lamina propria of the intestine and to other mucosal sites. Secreted IgA is transported through epithelial celk into the intestinal lumen by an lgA-specific Fc receptor called. the poly-Ig receptor. IgA is produced by plasma cells in the lamina propria and secreted in the form of a dimer that is held together by the coordinately produced J chain. (In contrast, serum IgA is usually a monomer lacking the J chain.) From the lamina propria, the IgA must be transported across the epithelium into the lumen, by a process kno'nrmas transcltosis, and this function is mediated by the poly-Ig receptor. This receptor is slmthesized by mucosal epithelial cells and expressed on their basal and lateral surfaces. It is an integral membrane glycoprotein with five extracellular domains homologous to Ig domains and is thus a member of the Ig superfamily. The secreted,dimeric IgA containing the J chain binds to the poly-Ig receptor on mucosal epithelial cells (Fig. 14-f8). This complex is endocytosed into the epithelial cell and actively transported in vesicles to the luminal surface. Here the polyIg receptor is proteolytically cleaved, its transmembrane and ci,toplasmic domains are left attached to the epithelial cell, and the extracellular domain of the receptor, which carries the IgA molecule, is releasedinto the intestinal lumen. The soluble IgA-associated component of the receptor is called the secretory component. The poly-Ig receptor is also responsible for the secretion of IgA into bile, milk, sputum, saliva, and sweat. Although its ability to transport IgA has been studied most extensively, the receptor is capable of transporting IgM into intestinal secretions as well. (Note that secreted IgM is also a polymer associatedwith the J chain.) This is whv this receptor is called the poly-Ig receptor. Neonatal lmmunity Neonatal mammals ere protected ftom infection by maternally produced antibodies transported across the placenta into the fetal circulation and by antibodies in ingested milk transported across the gut epithelium of newborns by a specialized process known as transcyto-
14Chapter
lrrmon h r r n r ^ + a ^ l \ / + i ^ ._l a. _ , 3vage ,.,_ Thc nrnccqs nf transnnrt 29.9gg the ce l, from the basolatera to t l e l u m i l a l s u r { a c e; n t r i s c a s e , i s calledtranscytosis
',,
cell epithelial Mucosal
Laminapropria FIGUHE t4-18 Transport of lgA acrossepithelialcells. lgArs producedby plasmace ls in the la.ninapropriao' mucosaltissue a n d b i n d st o t h e p o l y - l gr e c e p t o r a t t h e b a s eo r a n e p i t i e l i a cl e l t The complex is transported a c r o s st h e e p i t h e l i acle l l ,a n dt h e b o u n d l g A i s r e l e a s e di n t o t h e
IMMUNITY 0F HUMORAL MECHANISMS EFFECT0R
Poly-lgreceptor withboundlgA J chain
:tt:::. :i:::::
:::it::l i:rt::::
Dimeric lgA complexof poly-lg
sis. Neonates lack the ability to mount effective immune responsesagainst microbes, and for severalmonths after birth, their major defense against infection is passive immunity provided by maternal antibodies. Maternal IgG is transported acrossthe placenta, and maternal IgA and IgG in breast milk are ingested by the nursing infant. Ingested IgA and IgG can neutralize pathogenic organisms that attempt to colonize the infant's gut, and ingested IgG antibodies are also transported across the gut epithelium into the circulation of the newborn. Thus, a newborn contains essentially the same IgG antibodies as the mother. Transport of maternal IgG across the placenta and acrossthe neonatal intestinal epithelium is mediated by an IgG-speciflc Fc receptor called the neonatal Fc receptor (FcRn). The FcRn is unique among Fc receptors in that it resembles a class I major histocompatibility complex (MHC) molecule containing a transmembrane heary chain that is noncovalently associated with Brmicroglobulin. However, the interaction of IgG with FcRn does not involve the portion of the molecule analogous to the peptide-binding cleft used by class I MHC molecules to display peptides for T cell recognition. Adults also expressthe FcRn in the endothelium and in many epithelial tissues. In the post-neonatal period, this receptor functions to protect plasma IgG antibodies from catabolism. It binds circulating IgG, promotes endocltosis of the IgG complexes with the receptor in a form that protects the internalized antibody from intracellular degradation, and recyclesthe bound antibody to the cell surface before releasing it back into the circulation. This process of repeated sequestering and release of IgG contributes to its enhanced half-life. Knockout mice lacking B,-microglobulin have 10-fold lower levels of serum IgG than normal mice do because of increased catabolism of antibodies resulting from the failure to express this protective B,-microglobulin-associated Fc receptor. The contribution of the Fc portion of IgG to enhancing the half-life of antibodies has been utilized to generate therapeutically useful fusion proteins that include the Fc portion of human IgG, and consequently survive for extended periods of time in the circulation. One such example of a long-lived fusion protein is a
Proteolytic creavage
chimeric protein that contains the extracellular domains of the TNF receptor fused to the Fc portion of human IgG. This protein competitively inhibits TNF-TNFR interactions and is used to treat patients with rheumatoid arthritis and Crohn disease. The FcRn contributes to the long half-life of all IgG molecules including pathogenic autoantibodies' \Alhile the efficacy of IMG in autoimmune diseases may depend on inhibitory signals derived from FcyRIIB (see above), large amounts of infused exogenous IgG antibodies might compete with endogenous and pathogenic IgG autoantibodies for recognition by the FcRn and thus attenuate the half-lives of disease-associatedantibodies'
SUMMARY s Humoral immunity is mediated by antibodies and is the effector arm of the adaptive immune system responsible for defense against extracellular microbes and microbial toxins. The antibodies that provide protection against infection may be produced by long-lived antibody-secreting cells generated by the first exposure to microbial antigen or by reactivation of memory B cells by the antigen. @ The effector functions of antibodies include neutralization of antigens, Fc receptor-dependent phagocltosis of opsonized particles, and activation of the complement system. ffi Antibodies block, or neutralize, the infectivity of microbes by binding to the microbes and sterically hindering interactions of the microbes with cellular receptors.Antibodies similarly block the pathologic actions of toxins by preventing binding of the toxins to host cells. e Antibody-coated (opsonized) particles are phagocytosed by binding of the Fc portions of the antibodies to phagocyte Fc receptors.There are several
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.. types of Fc receptors specific for different subclassesofIgG and for IgA and IgE antibodies, and different Fc receptors bind the antibodies with varying affinities. Attachment of antigencomplexed Ig to phagoclte Fc receptors also delivers signals that stimulate the microbicidal activities of phagocltes.
6 The complement system consists of serum and membrane proteins that interact in a highly regulated manner to produce biologically active protein products. The three major pathways of complement activation are the alternative pathway, which is activated on microbial surfaces in the absence of antibody, the classical pathway, which is activated by antigen-antibody complexes, and the lectin pathway, initiated by collectins binding to antigens. These pathways generate enz).rnes that cleave the C3 protein, and cleaved products of C3 become covalently attached to microbial surfaces or antibodies, so subsequent steps of complement activation are limited to these sites. All pathways converge on a common pathway that involves the formation of a membrane pore following the proteol)'ric cleavage of C5. 6 Complement activation is regulated by various plasma and cell membrane proteins that inhibit different steps in the cascades. 6 The biologic functions of the complement system include opsonization of organisms and immune complexes by proteolytic fragments of C3, followed bybinding to phagocyte receptors for complement fragments and phagocytic clearance, activation of inflammatory cells by proteolytic fragments of complement proteins called anaphylatoxins (C3a, C4a, C5a), cytolysis mediated by MAC formation on cell surfaces, solubilization and clearance of immune complexes,and enhancement of humoral lmmune responses. € Defense against microbes and toxins in the lumens of mucosal organs is provided by IgA antibody
that is producedin mucosallymphoid tissueand actively transported through epithelial cells into the lumen. 6 Protective immunity in neonates is a form of passiveimmunity provided by maternal antibodiestransportedacrossthe placentaor ingestedand transportedacrossgut epitheliumby a specialized neonatalFc receptor.
Selected Readings Carroll MC. The complement system in regulation of adaptive immunity. Nature Immunology 5:9Bl-986, 2004. Fagarasan S. Evolution, development, mechanism and function of IgA in the gut. Current Opinion in Immunology 20:17O-177,2008. Gould HL and BJ Sutton. IgE in allergy and asthma today. Nature Reviews Immunology 8:205-217, 2008. Gros B FJ Milder, and BJ Janssen.Complement driven by conformational changes. Nature Reviews Immunology 8:48-58, 2008. Lencer \M, and RS Blumberg. A passionate kiss, then run: exocltosis and recycling of IgG by FcRn. Trends in Cell Biology 15:5-9,2005. Manderson AII M Botto, and MJ Walport. The role of complement in the development of systemic lupus erythematosus. Annual Review of Immunology 22:431-456,2004. Nimmerjahn Fj,Ravetch fV Fcgamma receptors as regulators of immune responses.Nature ReviewsImmunology B:34-47, 2008. Parren PW, and DR Burton. The antiviral activity of antibodies in vitro and in vivo. Advances in Immunology 77:195-262, 200L Petersen SV S Thiel, and JC Iensenius. The mannan-binding lectin pathway of complement activation: biology and disease association. Molecular Immunology 38:133-149, 200t. Roozendaal R, and MC Carroll. Emerging patterns in complement- mediated patho gen reco gnitio n. Cell 125:29-32, 2006. Smith GII and RA Smith. Membrane-targeted complement inhibitors. Molecular Immunology 38:249-255, 2OOl. Walport Mf. Complement. New England Journal of Medicine 344:l05B-1066, Il4l-r144, 2001.
in Defense lmmunity andDisease n this final section of the book, we apply our knowledge of the basic mechanisms of innate and adaptive immunity to understanding immunological defenses against microbes and tumors, reactions against transplants, and diseases caused by abnormal immune responses. Chapter 15 is an overview of the mechanisms of innate and adaptive immunity against different types of microbes, and the interplay between microbes and the immune system. Chapter 16 is devoted to the immunology of tissue transplantation, a promising therapy for a variety of diseaseswhose successis limited in large part by the immunologic rejection response. Chapter 17 describes immune responses to tumors and immunological approaches for cancer therapy. Chapter lB deals with the mechanisms of diseases caused by aberrant immune responses,so-called hlpersensitivity diseases,and emphasizes the pathogenesisof autoimmune disorders.In Chapter 19 we describeimmediate hlpersensitivity and allergy, the most common group of diseasescaused by immune responses.In Chapter 20 we discussthe cellular and molecular bases of congenital and acquired immunodeficiencies, including the acquired immunodefi ciency syndrome.
I
I
General Features of lmmune Responses to Microbes, 352 f mmunity to Extracellular Bacteria, 352 Innatelmmunityto Extracellular Bacteria, 354 Adaptivelmmunityto Extracellular Bacteria, 354 354 InjuriousEffectsof lmmuneResponses, lmmuneEvasionby Extracellular Bacteria, 355 lmmunity to Intracellular Bacteria, 355 Bacteria, 358 lnnatelmmunityto Intracellular Intracellular Bacteria, Adaptivelmmunityto 358 Bacteria, 362 lmmuneEvasionby Intracellular lmmunity to Fungi, 362 Innateand Adaptivelmmunityto Fungi,362 lmmunity to Viruses, 362 Innatelmmunityto Viruses,363 Adaptivelmmunity to Viruses,363 lmmuneEvasionby Viruses,364 lmmunity to Parasites, 365 365 Innatelmmunityto Parasites, Adaptivelmmunity to Parasites,367 368 lmmuneEvasionby Parasites, Strategies for Vaccine Development, 37O Bacterialand Viral Attenuatedand Inactivated Vaccines,370 371 PurifiedAntigen(Subunit)Vaccines, Antigen Vaccines, 371 Synthetic
Live Viral Vectors,371 DNA Vaccines,372 372 Adjuvantsand lmmunomodulators, 2 n, 37 Passivelmmunizatio Summary,372
In the preceding chapters, we have described the components of the immune system and the generation and functions of immune responses.In this chapter' we inte-
tures of immunity to different types of pathogenic microorganisms and how microbes try to resist the mechanisms of host defense. The development of an infectious diseasein an individual involves complex interactions between the microbe and the host. The key events during infection include entry of the microbe, invasion and colonization of host tissues, evasion of host immunity, and tissue injury or functional impairment. Microbes produce diseaseby killing host cells or by liberating toxins, even without extensive colonization of host tissues, and in some infections the host response is the culprit, being the main cause of tissue damage and disease'Many features of microorganisms determine their virulence, and many diverse mechanisms contribute to the pathogenesis of infectious diseases.The topic of microbial pathogenesisis beyond the scope of this book and will not be discussed in detail. Rather, our discussion focuses on host immune responsesto pathogenic microorganisms.
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S e c t i oVn- l M M U N t trN y D E F E NASNEDD T S E A S E
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GrrurnRl FrRrunrs oFIMMUNE Rrsporusrs ro MtcRoBEs Although antimicrobial host defense reactions are numerous and varied, there are several important general features of immunity to microbes. @ Defense against microbes is mediated W the effector mechanisms of innate and adaptiue immunity. The innate immune system provides early defense, and the adaptive immune system provides a more sustained and stronger response. Many pathogenic microbes have evolved to resist innate defense mechanisms, and protection against such microbes is critically dependent on adaptive immune responses. Adaptive immune responses are generally more potent than innate immunity for several reasons, including expansion of the pool of antigen-specific lymphocy.tesand specialization (seebelow). Adaptive immune responsesto microbes induce effector cells that eliminate the microbes and memory cells that protect the individual from subsequent infections. @ The immune system responds in distinct and specialized ways to dffirent types of microbes to most effectiuely combat these infectious agents. Because microbes differ greatly in patterns of host invasion and colonization, their elimination requires diverse effector systems. The specialization of adaptive immunity allows the host to respond optimally to each type of microbe. Q The suruiual and pathogenicity of microbes in a host are critically influenced by the ability of the microbes to euade or resist the effector mechanisms of immunity. lnfectious microbes and their hosts are engaged in a constant struggle for survival, and the balance
between host immune responses and microbial strategiesfor resisting immunity often determines the outcome of infections. As we shall see later in this chapter, microorganisms have developed a variety of mechanisms for surviving in the face of powerful immunologic defenses. @ In many infections, tissue injury and disease may be caused by the host response to the microbe and its prod,ucts rather than by the microbe dfsefi Immunity, like many other defensemechanisms, is necessaryfor host survival but also has the potential for causing injury to the host. This chapter considers five categories of pathogenic microorganisms that illustrate the main features of immunity to microbes: extracellular bacteria, intracellular bacteria, fungi, viruses, and protozoan and multicellular parasites (Table 15-1). Our discussion of the immune responses to these microbes illustrates the diversity of antimicrobial immunity and the physiologic significance of the effector functions of lymphocytes discussed in earlier chapters.
Iluvturury r0 ExrRAcEtturAR BRcrrntR Extracellular bacteria are capable of replicating outside host cells, for example, in the circulation, in connective tissues, and in tissue spaces such as the lumens of the airways and gastrointestinal tract. Many different species of extracellular bacteria are pathogenic, and disease is caused by two principal mechanisms. First, these bacteria induce inflammation, which results in tissue destruction at the site of infection. This is how pyogenic (pus-forming) cocci cause a large number of suppurative infections in humans. Second, manv of
Table 15-1. Examplesof PathogenicMicrobes
Extracel Iularbacteria Staphylococcus Skinandsofttissue infections, lungabscess; aureus
systemic: toxicshock syndrome, foodpoisoning
Streptococcus pyogenes(groupA)
Skininfections; acuteinflammation inducedbv toxins;celldeathcausedby pore-forming toxiirs Systemic: ("superantigen")-induced enterotoxin production cytokine by T cellscausingskin necrosis, shock.diarrhea
Pharyngitis
impetiso, ervsipelas; |j,li,,lill""'"'s: Systemic: scarletfever
Sfrepfococcus , pyogenes (pneumococcus)
Pneumonia, meningitis
Escherichiacoli
Urinarytractinfections, gastroenteritis, Toxinsact on intestinalepitheliumand cause seoticshock increasedchlorideand water secretion;
Acuteinflammation inducedbv cellwall pneumolysin constituents; is sjmilarto streptolysin O
endotoxin(LPS)stimulatescvtokinesecretion by macrophages
C h a o t e1r5-
I M M U N I TTY0 M I C R 0 B E S
Table 15-1. Continued
Microbe
Examplesof humandiseases I Mechanis@ G proteinsubunit, CholeratoxinADPribosylates cyclicAMPin intestinal whichleadsto increased secretion cellsandresultsin chloride epithelial andwaterloss
(cholera) Diarrhea
at toxinbindsto the motorend-plate I Tetanus junctions andcausesirreversible neuromuscular musclecontraction
Tetanus
Acute inflammationand systemicdisease causedby potentendotoxin
Meningitis Diphtheria
toxinADP ribosylateselongation Diphtheria rtr rvilq urPr
l
I
Intracellular bacteria Mycobacteria
factor-2andinhibitsproteinsynthesis
Tuberculosis, leprosy
in resulting activation Macrophage andtissue inflammation granulomatous destruction
Listeriosis
damagescell membranes Listeriolysin
Legionnaires'disease
lysescellsandcauseslunginjuryand Cytotoxin inflammation
monocytogenes Legionella pneumophila Fungi Candidiasis -.-,.,.-,--.4-
Aspergillosis Histoplasmosis
l
of bloodvesselscausing andthrombosis I Invasion andcellinjury necrosis I ischemic causedby granulomatous i Lunginfection inflammation
Viruses Poliomyelitis
pneumonia Influenza Rabiesenceohalitis
(tropism for hostcellproteinsynthesis Inhibits motorneuronsin theanteriorhornof thespinal cord) (tropism for hostcellproteinsynthesis Inhibits
cells) _-_ 9!Li1!-""{gni[glial
(tropism for hostcellproteinsynthesis Inhibits nerves) 1 peripheral
(skin, Variousherpesinfections systemic) Viralhepatitis
B cell Infectious mononucleosis; proliferation, lymphomas
{or B celllysis(tropism Acuteinfection: lymphocytes) stimulatesB cellproliferation Latentinfection:
syndrome Multiple:killingof CD4+T cells,functional- Acquiredimmunodeficiency impairmentofimmune cells (see Chapter20) (AIDS) *-... **-.-": CTL, cytotoxicT lymphocyte;i AMP,adenosinemonophosphate; ADP,adenosinediphosphate; iAbbreviations; : LPS, lipopolvsaccaride. -----,.'-.r
,.,_,..,'._' .,.'-..*"1"-.*.--.
oi tissue mechanisms microbesof differentclassesare listed,withbriefsummariesoi knownor postulated Examplesof pathogenic parasites 15-4 in Table Examples of are injury and disease t't''istable was compiledwith ihe assistanceof Dr ArleneSharpe,Departmentof Pathology,HarvardMedicalSchooland Brigham and Women'sHospital.Boston.Massachusetts
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Section V-
IMMUNITY tN DEFENSE ANDDTSEASE
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these bacteria produce toxins, which have diverse pathologic effects. Such toxins may be endotoxins, which are components of bacterial cell walls, or exotoxins, which are activelv secreted bv the bacteria. The endotoxin of gram-negative bacteria, also called lipopolysaccharide (LPS),has been mentioned in earlier chapters as a potent activator of macrophages. Many exotoxins are cytotoxic, and they'exotoxins kill cells by various biochemical mechanisms. Other interfere with normal cellular functions without killing cells, and yet other exotoxins stimulate the production of cytokines that cause disease. Innate lmmunity
to Extracellular
Bacteria
The principal mechanisms of innate immunity to extracellular bacteria are complement actiuation, phagocytosis, and the inflammatory response. Gram-positive bacteria contain a peptidoglycan in their cell walls that activates the alternative pathway of complement by promoting formation of the alternative pathway C3 convertase (see Chapter I4). LpS in the cell walls of gram-negative bacteria also activates the alternative complement pathway in the absence of antibody. Bacteria that express mannose on their surface may bind mannose-binding lectin, thereby leading to complement activation by the lectin pathway. One result of complement activation is opsonization and enhanced phagocytosis of the bacteria. In addition, the membrane attack complex lyses bacteria, especially Neisseria species,and complement by-products stimulate inflammatory responses by recruiting and activating leukocltes. Phagocltes use various surface receptors, including mannose receptors and scavenger receptors, to recognize extracellular bacteria, and use Fc receptors and complement receptors to recognize appropriately opsonized bacteria. Toll-like receptors (TLRs) of phagocytes participate in the activation of the phagocytes as a result of encounter with microbes. These various receptors promote the phagocytosis of the microbes and stimulate the microbicidal activities of the phagocytes (see Chapter 2). In addition, activated phagocytes secrete cytokines, which induce leukocWe infiltration into sites of infection (inflammation). Injury to normal tissue is a pathologic side effect of inflammation. Cr,tokines also induce the systemic manifestations of infeition, including fever and the slmthesis of acute-phase proteins. Adaptive
lmmunity
to Extracellular
Bacteria
Humoral immunity is the principal protectiue immune response ag&inst extracellular bacteria, and it Iunctions to block infection, eliminate the microbes, and neutralize their toxins (Fig. l5-l). Antibody responses against extracellular bacteria are directed against cell wall antigens and secretedand cell-associatedtoxins, which may be polysaccharides or proteins. The polysaccharides are prototypic thyrnus-independent antigens, and a major function of humoral immunity is defense against polysaccharide-rich encapsulated bacteria. The effector mechanisms used by antibodies to combat these infections include neutralization, opsonization and phagocytosis, and activation of complement by the classical
pathway (seeChapter 14). Neutralization is mediated by high-affinity immunoglobulin G (IgG) and IgA isotypes, opsonization by some subclassesof IgG, and complement activation by IgM and subclasses of IgG. The protein antigens of extracellular bacteria also activate CD4* helper T cells, which produce cytokines that stimulate antibody production, induce local inflammation, and enhance the phagocltic and microbicidal activities of macrophages and neutrophils (see Fig. 15-1). Interferon-y (IFN-y) is the T cell cytokine responsible for macrophage activation, and tumor necrosis factor (TNF) and lymphotoxin trigger inflammation. Recent work, done mainly in mice, has shornmthat IL-17 produced by "THl7" cells is responsible for neutrophil-rich inflammation and defense against some bacterial infections. Injurious
Effects
of lmmune
Responses
The principal injurious consequences ofhost responses to extracellular bacteria are inflammation and septic shock. The same reactions of neutrophils and macrophages that function to eradicate the infection also cause tissue damage by local production of reactive oxygen species and lysosomal enzymes. These inflammatory reactions are usually self-limited and controlled. Septic shock is a severe pathologic consequence of disseminated infection by gram-negative and some gram-positive bacteria. It is a slrrdrome characterized by circulatory collapse and disseminated intravascular coagulation (Box 15-l). The early phase of septic shock is caused by cytokines produced by macrophages that are activated by microbial components, particularly LpS. TNF is the principal cytokine mediator of septic shock, but IFN-y and interleukin-l2 (lL-12) may also contribute. In fact, serum levels of TNF are predictive of the outcome of severe gram-negative bacterial infections. This early burst of deadly amounts of cytokines is sometimes called a "cyokine storm." There is some evidence that the progression of septic shock is associated with defective immune responses, perhaps related to depletion of T cells, resulting in unchecked microbial spread. Certain bacterial toxins stimulate all the T cells in an individual that express a particular family of Vp T cell receptor genes. Such toxins are called superantigens (Box 15-2). Their importance lies in their ability to activate manyT cells,with the subsequent production of large amounts of cytokines that also cause septic shock. A late complication of the humoral immune response to bacterial infection may be the generation of diseaseproducing antibodies. The best deflned examples are two rare sequelae of streptococcal infections of the throat or skin that are manifested weeks or even months after the infections are controlled. Rheumatic fever is a sequel to pharyngeal infection with some serologic types of B-hemolytic streptococci. Infection leads to the production of antibodies against a bacterial cell wall protein (M protein). Some of these antibodies cross-react with myocardial sarcolemmal proteins and myosin and are deposited in the heart and subsequently cause inflammation (carditis). Poststreptococcalglomerulonephritis is a sequel to infection of the skin or throat with other
C h a p t e1r5-
I M I V I U N ITT0YM I C R 0 B E S
Neutralization Opsonizationand Fc receptormediated phagocytosis Phagocytosis of C3b-coated bacteria
Helper T cells (forprotein orotein antigens)
lnflammation
Bacteriallysis
Macrophage activation Phagocytosisand bacterialkilling
N Presentation of proteinantigens
F1
lrrur|
-: -i'r
Inflammation
microbes,suchas bacFIGURE 15-1 Adaptiveimmuneresponsesto extracellularmicrobes.AdaptiveimmuneTesponses to extracellular and eliminatemicrobes teria,and their toxinsconsistof antibodyproductionand the activatron of CD4. helperT cells Antibodiesneutralize and inflamactivation, and toxinsby severalmechanismsHelperT cells producecytokinesthat stimulateB cell responses,macrophage mation APC,antigen-presenting cell
serotypes of B-hemolytic streptococci. Antibodies produced against these bacteria form complexes with bacterial antigen, which may be deposited in kidney glomeruli and cause nephritis. lmmune
Evasion by Extracellular
Bacteria
The virulence of extracellular bacteria has been linked to a number of mechanisms that resist innate immunity (Table l5-2), including antiphagocltic mechanisms and inhibition of complement or inactivation of complement products. Bacteria with polysaccharide-rich capsules resist phagocytosis and are therefore much more virulent than homologous strains lacking a capsule.The capsulesof many gram-positive and gram-negative bacteria contain sialic acid residues that inhibit complement activation by the alternative pathway. The major mechanism used by bacteria to evade humoral immunity is genetic variation of surface antigens. Some surface antigens of bacteria such as gonococci and Escherichia coli are contained in their pili, which are the structures responsible for bacterial adhesion to host cells. The major antigen of the pili is a
protein called pilin. The pilin genes of gonococci undergo extensive gene conversion, because of which the progeny of one organism can produce up to 106antigenically distinct pilin molecules. This ability to alter antigens helps the bacteria evade attack by pilin-specific antibodies, although its principal significance for the bacteria may be to select for pili that are more adherent to host cells so that the bacteria are more virulent. In other bacteria, such as Haemophilus influenzae, changes in the production of glycosidaseslead to chemical alterations in surface LPS and other polysaccharides, which enable the bacteria to evade humoral immune responsesagainst these antigens.
BNCTTRIR IuuuruIrYTOINTRACELLULAR A characteristic of facultative intracellular bacteria is their ability to survive and even replicate within phagocy'tes.Because these microbes are able to find a niche where they are inaccessible to circulating antibodies, their elimination requires the mechanisms of cellmediated immunity (Fig. 15-2). As we shall discusslater
355
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I M M U N I Tl N Y D E F E NA SN E DD I S E A S E
B a c t e r i aLlP S( o re n d o t o x i ni s) a p r o d u cot f g r a m - n e g a t i v e b a c t e r i a ,a n d a p o t e n t s t i m u l a t o ro f i n n a t e i m m u n e r e s p o n s e sL P Si s p r e s e n it n t h e o u t e rc e l lw a l l so f g r a m negative b a c t e r i a n dc o n t a i n sb o t hl i p i dc o m p o n e n tas n d p o l y s a c c h a r i dmeo i e t i e sT h e p o l y s a c c h a r i d ge r o u p sc a n b e h r g h l yv a r i a b l ea n d a r e t h e m a j o ra n t i g e n so f g r a m n e g a t i v eb a c t e r i ar e c o g n i z e db y t h e a d a p t i v ei m m u n e system The liprdmoiety,by contrast,is highlyconserved a n d i s a n e x a m p l eo f a m o l e c u l apr a t t e r nr e c o g n i z ebdy t h e i n n a t ei m m u n es y s t e m LPSis a potentactivatorof macrophagesLPSbindsto ) n dt h e c o m p l e xt h e n a p l a s m aL P S - b i n d i npgr o t e i n( L B P a b i n d st o C D 1 4o n m a c r o p h a g easn d d e n d r i t i c e l l s T h e L P Sm o i e t yi s t h e n r e c o g n i z ebdy T L R 4( s e eC h a p t e 2 r) M a c r o p h a g e sw,h i c h s y n t h e s i zaen d e x p r e s sC D 1 4 ,c a n r e s p o n dt o m i n u t eq u a n t i t i eosf L P S ,a s l i t t l ea s 1 0p g / m L , a n d c e l l st h a t l a c k C D ' 41 a r e g e n e r a l l yu n r e s p o n s i vteo LPS The genes that are inducedby LPS encode c y t o k i n e sc,o s t i m u l a t o ras n , d e n z y m e so f t h e r e s p i r a t o r y b u r s t T h e f u n c t i o n so f t h e s ep r o t e r n isn i n n a t ei m m u n i t y a r ed e s c r i b e d i n C h a p t e2r T h e s y s t e m i cc h a n g e so b s e r v e di n p a t i e n t sw h o h a v e d i s s e m i n a t ebda c t e r i ai ln f e c t i o n ss,o m e t i m e sc a l l e dt h e s y s t e m i ci n f l a m m a t o r rye s p o n s es y n d r o m e( S I R S )a, r e r e a c t i o ntso c y t o k i n e w s h o s ep r o d u c t i o ins s t i m u l a t e b dy LPS In mildlyaffectedpatients,the responseconsistsof n e u t r o p h i l ifae,v e r ,a n d a r i s ei n a c u t e - p h a sree a c t a n t isn the plasma Neutrophilia i s a r e s p o n s eo f t h e b o n e m a r r o wt o c i r c u l a t i ncgy t o k i n e se, s p e c i a l lG y - C S Fr ,e s u l t i n g i n i n c r e a s ep d r o d u c t i o an n d r e l e a s eo f n e u t r o p h i ltso r e p l a c et h o s e c o n s u m e dd u r i n gi n f l a m m a t i o nA n e l e v a t e dc i r c u l a t i nnge u t r o p hci lo u n t ,e s p e c i a l loyn e a c c o m panied by the presence of immature neutrophils p r e m a t u r e lrye l e a s e d f r o m t h e b o n em a r r o w ,i s a c l i n i c a l s i g n o f i n f e c t i o nF e v e ri s p r o d u c e di n r e s p o n s et o s u b s t a n c e sc a l l e dp y r o g e n st h a t a c t t o e l e v a t ep r o s t a g l a n d i n s y n t h e s i si n t h e v a s c u l a a r n d p e r i v a s c u l acre l l s o f t h e h y p o t h a l a m u sB. a c t e r i apl r o d u c t ss u c h a s L P S ( c a l l e d e x o g e n o u sp y r o g e n s s) t i m u l a t el e u k o c y t e st o r e l e a s e c y t o k i n e s u c ha s l L - 1a n dT N F( c a l l e d e n d o g e n o upsy r o g e n s )t h a t i n c r e a s et h e e n z y m ec a l l e dc y c l o o x y g e n a s e t h a t c o n v e r t sa r a c h i d o n a i cc i di n t o p r o s t a g l a n d i nNso n s t e r o i d aal n t i - i n f l a m m a t odrryu g s ,i n c l u d i n ag s p i r i nr,e d u c e f e v e r b y r n h i b i t i n cgy c l o o x y g e n a s ea- n 2d t h u s b l o c k i n g p r o s t a g l a n d si ny n t h e s i sA n e l e v a t e db o d y t e m p e r a t u r e h a s b e e n s h o w n t o h e l p a m p h i b i a nw s ard off microbial i n f e c t i o n sa, n d i t i s a s s u m e dt h a t f e v e r d o e s t h e s a m e f o r m a m m a l s ,a l t h o u g ht h e m e c h a n i s mi s u n k n o w n Acute-phasereactantsare plasmaproteins,mostly synt h e s i z e di n t h e l i v e r , w h o s e p l a s m a c o n c e n t r a t i o n s i n c r e a s ae s p a r to f t h e r e s p o n s e t o L P S T h r e eo f t h e b e s t k n o w ne x a m p l e so f t h e s ep r o t e i n sa r ec - r e a c t i vper o t e i n ,
( C R P f) i b r i n o g e na, n d s e r u ma m y l o i dA p r o t e i n S y n t h e sis of these moleculesby hepatocytesis up-regulated by c y t o k i n e se, s p e c i a l l yl L - 6 ( f o r C R P a n d f i b r i n o g e na) n d l L - 1o r T N F ( f o rs e r u ma m y l o i dA p r o t e i n )T h e r i s ei n f i b r i n o g e nc a u s e se r y t h r o c y t e tso f o r m s t a c k s( r o u l e a u x ) t h a t s e d i m e n tm o r e r a p i d l ya t u n i t g r a v i t yt h a n d o i n d i v i d u a le r y t h r o c y t e sT h i s i s t h e b a s i sf o r m e a s u r i n g eryrate as a simpletest for the t h r o c y t es e d i m e n t a t i o n s y s t e m i ci n f l a m m a t o rrye s p o n s ed u e t o a n y n u m b e ro f s t i m u l ii,n c l u d i nLgP S . W h e n a s e v e r eb a c t e r i ai ln f e c t i o nl e a d st o t h e p r e s e n c e o f o r g a n i s m sa n d L P S i n t h e b l o o d ,a c o n d i t i o n c a l l e ds e p s i sc, i r c u l a t i ncgy t o k i n el e v e l si n c r e a s e a n dt h e f o r m o f t h e h o s t r e s p o n s ec h a n g e s H i g h l e v e l s o f c y t o k i n e sp r o d u c e di n r e s p o n s et o L P Sc a n r e s u l ti n d i s s e m i n a t e di n t r a v a s c u l acro a g u l a t i o n( D l C ) ,c a u s e d b y i n c r e a s e de x p r e s s i o no f p r o - c o a g u l a nptr o t e i n s ( e . 9 . t i s s u ef a c t o r )a n d r e d u c e da n t i - c o a g u l aanct t i v i t yo n T N F a c t i v a t e de n d o t h e l i acle l l s M u l t i p l eo r g a n ss h o w i n f l a m m a t i o na n d i n t r a v a s c u ltahrr o m b o s i sw, h i c h c a n p r o d u c e o r g a nf a i l u r el i s s u e i n j u r yi n r e s p o n s et o L P Sc a n a l s o resultfrom the activationof neutrophilsbeforethey exit t h e v a s c u l a t u r teh, u s c a u s i n gd a m a g et o e n d o t h e l i ac le l l s a n d r e d u c e db l o o df l o w T h e l u n g sa n d l i v e ra r e p a r t i c u l a r l ys u s c e p t i b lteo i n j u r yb y n e u t r o p h i l sL u n gd a m a g ei n t h e S I R Si s c o m m o n l yc a l l e dt h e a d u l tr e s p i r a t o rdyi s t r e s s s y n d r o m e( A R D Sa) n d r e s u l t sw h e n n e u t r o p h i l - m e d i a t e d e n d o t h e l i ai nl j u r ya l l o w sf l u i d t o e s c a p ef r o m t h e b l o o d i n t ot h e a i r s p a c eL i v e ri n j u r ya n d i m p a i r e dl i v e rf u n c t i o n r e s u l ti n a f a i l u r et o m a i n t a i n o r m a b l l o o dg l u c o s el e v e l s d u e t o a l a c ko f g l u c o n e o g e n e sf irso m s t o r e dg l y c o g e n . T h e k i d n e ya n d t h e b o w e l a r e a l s o i n j u r e d l,a r g e l ya s a r e s u l t o f r e d u c e dp e r f u s i o n O v e r p r o d u c t i oonf n i t r i c oxide by cytokine-activated cardiacmyocytesand vascul a rs m o o t hm u s c l ec e l l sl e a d st o h e a r tf a i l u r ea n d l o s so f perfusionpressure,respectively,resultingin hemodyn a m i cs h o c k .T h e c l i n i c atlr i a do f D l C ,h y p o g l y c e m ia n, d c a r d i o v a s c u lfaari l u r ei s d e s c r i b e da s s e p t i cs h o c k .T h i s c o n d i t i o ni s o f t e nf a t a l TNF produced by LPS-activated macrophagesis a m a j o r m e d i a t o ro f L P S - i n d u c eidn j u r y T h i s i s k n o w n becausemanyof the effectsof LPScan be mimickedby T N F ,a n d i n m i c e , a n t i - T N Fa n t i b o d i e so r s o l u b l eT N F receptorscanattenuateor completelyblockresponsesto L P S .l L - 1 2a n d I F N - y a l scoo n t r i b u t teo L P S - | n d u c ei ndj u r y b e c a u s el L - 1 2s t i m u l a t e sI F N - yp r o d u c t i o nb y N K c e l l s a n d T c e l l s ,a n d I F N - 1i n c r e a s e T s N F s e c r e t i o nb y L P S activated macrophagesand synergizeswith TNF in e f f e c t s o n e n d o t h e l i u mC. l i n i c atlr i a l so f T N F a n d l L - ' 1 a n t a g o n i s t isn s e p t i cs h o c k h a v e n o t b e e n s u c c e s s f u l , p e r h a p sb e c a u s es e v e r acl y t o k i n e m s a yc o n t r i b u t teo t h i s disorder
C h a p t e1r5-
I I V I M U N ITT0YM I C R 0 B E S
enterotoxib n i n d st o c l a s sl l m o l e c u l e so f d i f f e r e n t S o m em i c r o b i at lo x i n sa r e c a l l e ds u p e r a n t i g e nbse c a u s e t h e y s t i m u l a t el a r g en u m b e r so f T c e l l s( m o r et h a n c o n a l l e l e s ,i n d i c a t i n gt h a t t h e p o l y m o r p h i s mo f t h e M H C d o e sn o t i n f l u e n c teh e b i n d i n go f t h e s et o x i n s v e n t i o n aaln t i g e n s b ) ,u t n o ta l lT c e l l s( w h i c hd i s t i n g u i s h e s Each staphylococcalenterotoxin molecule posthem from polyclonalactivators)Staphylococcal enterotoxins are exotoxins produced by the gram-positive s e s s e st w o b i n d i n gs i t e s f o r c l a s s l l M H C m o l e i cl l o w s e a c h e n t e r o t o x i n c u l e s T h i s c h a r a c t e r i s ta bacterium Staphvlococcus aureus and consist of five m o l e c u l et o c r o s s - l i n kM H C m o l e c u l e so n A P C s , s e r o l o g i c a ldl yi s t i n c g t r o u p so f p r o t e i n sS: E A ,S E B ,S E C , m o l e c u l ed i m e r m a y S E D ,a n dS E E T h e s et o x i n sa r et h e m o s tc o m m o nc a u s e and the enterotoxin-MHC o f f o o d p o i s o n i n gi n h u m a n s ,A r e l a t e dt o x i n , T S S T , cross-linktwo antigenreceptorson eachT cell and t h u s i n i t i a t eT c e l l r e s P o n s e s c a u s e sa d i s e a s ec a l l e dt o x i c s h o c k s y n d r o m e( T S S ) , w h i c h h a sb e e na s s o c i a t ew d i t h t a m p o nu s ea n ds u r g i c a l Staphvlococcalenterotoxinsare among the most wounds Pyrogenicexotoxinsof streptococciand exop o t e n tn a t u r a l l o y c c u r r i n gT c e l l m i t o g e n sk n o w n T h e y t o x i n sp r o d u c e db y m y c o p l a s m am s a y b e s t r u c t u r a l al yn d of naiveT lymare capableof stimulatingthe proliferation f u n c t i o n a l lrye l a t e dt o t h e s ee n t e r o t o x i n s e M o r l e s s .A s m a n ya s 1 0 o f a t c o n c e n t r a t i o n s ohocvtes Thc nntenr.v nf qrrnerantioens as T cell activators iS o n e i n f i v e T c e l l si n m o u s e l y m p h o i dt i s s u eo r h u m a n relatedto the way these moleculesinteractwith APCs p e r i p h e r abll o o dm a y r e s p o n dt o a p a r t i c u l aern t e r o t o x i n . a n d w i t h T c e l l s l m p o r t a n t l ym, o s t s u p e r a n t i g e nwso r k The high frequency of staphylococcalenterotoxlnby bringing T c e l l sa n dA P C si n t od i r e c tc o n t a c tb, y s i m u l T c e l l s ,p a r t i c u l a r lCy D 4 * c e l l s ,h a s s e v e r a l responding t a n e o u s l yb i n d i n gt o b o t h M H C m o l e c u l e sa n d T c e l l f u n c t i o n ailm p l i c a t i o n sA c u t e l y ,e x p o s u r et o h i g h c o n receptors(TCRs) centrationsof enterotoxinleads to systemic reactions r E n t e r o t o x i nbsi n dt o t h e V pr e g i o no f T C R s a, n de a c h i n t r a v a s c u l acro a g u l a t i o n , s u c h a s f e v e r ,d i s s e m i n a t e d t o x i ns t i m u l a t e T s c e l l st h a t e x p r e s sa n t i g e nr e c e p - a n d c a r d i o v a s c u lsahr o c k T h e s ea b n o r m a l i t i easr e p r o b ably mediated by cytokines,such as TNF, produced t o r s w h o s e V p r e g i o n sa r e e n c o d e db y a s i n g l eV p that are actig e n eo r g e n ef a m i l y I n o t h e rw o r d s ,t h e s p e c i f i c i t y directlyby the T cells or by macrophages v a t e db y t h e T c e l l s .T h e s er e a c t i o n rse s e m b l es y s t e m i c o f T c e l l sf o r d i f f e r e net n t e r o t o x i ni s e n c o d e di n t h e r e a c t i o n tso e n d o t o x i n( L P S )a, s i n s e p t i cs h o c k ,w h i c h V s r e g i o na n d i s n o t r e l a t e dt o o t h e rc o m p o n e n t o sf t h e T C R ,s u c ha s t h e V " ,J , o r D s e g m e n t sb, e c a u s e a r ea l s om e d i a t e db y c y t o k i n e (ss e eB o x 1 5 - 1) P r o l o n g e d a d m i n i s t r a t i oonf e n t e r o t o x i nt so m l c er e s u l t si n w a s t i n g , e n t e r o t o x i n bs i n d d i r e c t l yt o t h e B c h a i n so f T C R m o l e c u l e sc l o s et o b u t o u t s i d et h e a n t i g e n - b i n d i n g t h y m i c a t r o p h y ,a n d p r o f o u n di m m u n o d e f i c i e n cayl,s o ( c o m p l e m e n t a r i t y - d e t e r m i n ri neg )i o n s D i f f e r e n t p r o b a b l ys e c o n d a rtyo c h r o n i ch i g hl e v e l so f T N F . S t a o h v l o c o c ceanl t e r o t o x i nasr e u s e f u lt o o l s f o r a n a e n t e r o t o x i nsst i m u l a t eT c e l l se x p r e s s i nV g sgenes and tolerance activation, lyzingT lymphocytematuration, f r o m d i f f e r e nfta m i l i e s( s e eT a b l e )T, h e s p e c i f i c i toyf A d m i n i s t r a t i o no f S E B t o n e o n a t a l m i c e l e a d s t o e n t e r o t o x i nfso r V pr e g i o n se x p l a i n w s hy theystimi n t r a t h y m idc e l e t i o no f a l l i m m a t u r eT c e l l st h a t e x p r e s s u l a t em a n yb u t n o t a l l T c e l l s t h e V p 3a n d V p 8T C R g e n e s .T h i s d e l e t i o nm i m i c ss e l f o E n t e r o t o x i nbs i n d t o c l a s s l l M H C m o l e c u l e so n o f s e l f - r e a c t i vTec e l l s a n t i g e n - i n d u c ne ed g a t i v es e l e c t i o n A P C s a t a s i t e d i s t l n c tf r o m t h e p e p t i d e - b i n d i n g . u p e r a n t i g e nasl s o i n d u c e d u r i n g t h y m i c m a t u r a t i o nS cleft Enterotoxins do not need to undergointracela p o p t o t i cd e a t ho f m a t u r eC D 4 *a n d C D 8 *T c e l l s .T h i s l u l a r p r o c e s s i n ga, s d o c o n v e n t i o n apl r o t e i na n t i tvpe of cell deathis postulatedto be a modelof deletion g e n s ,t o b i n d t o t h e s e M H C m o l e c u l e sT h e s a m e o f m a t u r eT c e l l st h a t a r e e x p o s e dt o s e l f a n t i g e n s . V i r a lg e n e p r o d u c t sm a y a l s o f u n c t i o na s s u p e r a n t i t ouse g e n s I n c e r t a i ni n b r e ds t r a i n so f m i c e ,d i f f e r e n m i n c o r porated g e n e s h a v e b e c o m e v i r u s t u m o r mammary i n t ot h e g e n o m e V i r a la n t i g e n sp r o d u c e db y t h e c e l l so f Enterotoxin lMice lHumans one strainare capableof activatingT lymphocytesfrom 1 8 Y SEB V p 7 ,B 3 , 1 7 p3,12,14,15,17 o t h e rs t r a i n st h a t e x p r e s sp a r t i c u l aVr ps e Q m e n t isn t h e i r ,20 antigenreceptors The result is a form of "mixed lymV 912,13,14,15,17 ,20 Vp8.2,10 SEC2 o h o c v t er e a c t i o n "t h a t i s n o t c a u s e db y M H C d i s p a r i t y T h i sw a s d i s c o v e r eldo n gb e f o r ev i r a ls u p e r a n t i g e nwse r e Vp11,15,17 V95.1,6.1-6.3,8,18 SEE s e r e a t t r i b u t e tdo i d e n t i f i e da,n dt h e i n t e r s t r a irne a c t i o nw Vn2 TSST-1 Vp15,16 n gl s )l o c i W e n o w k n o w m i n o r l y m p h o c y t e - s t i m u l a t(i M t h a t M l s " l o c i " a r e a c t u a l l yd i f f e r e n rt e t r o v i r aslu p e r a n t i n t ot h e g e n o m e g e n g e n e st h a t a r e s t a b l yI n c o r p o r a t ei d s t r a i n s . i n b r e d a n d i n h e r i t e di n d i f f e r e n t
357
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S e c t i oVn-
I M M U N I Tl N Y DEFENS AE N DD T S E A S E
T a b l e1 5 - 2 .M e c h a n i s m so f l m m u n e E v a s i o n by Bacteria
Mechanism of immuneevasion
lExamples
Extracellular bacteria Nelsserlagonorrhoeae, Antigenic variation Escherichiacoli, Salmonel la typhimurium
Manv bacteria Inhibition of complementactivation
Pneumococcus Resistance to phagocytosis -... Scavenging of reactive Catalase-positive oxygenintermediates staphylococci Intracellular bacteria Mycobacterium Inhibition of tuberculosis, phagolysosome Legionella p neumop hiIa formation lnactivation of reactive Mycobacterium leprae oxygenand nitrogen ( p h e n o l i gc l y c o l i p i d ) sp,eoles Disruption of Listeria monocytogenes phagosome membrane,(hemolysinprotein) €€@pe,,into c)4oplasm
in this section, the pathologic consequencesof infection by many intracellular bacteria are due to the host response to these microbes. Innate lmmr.lnity
to Intracellular
Bacteria
The innate immune response to intracellular bacteria is mainly med,iated lry of phagocytes and natural killer (NK) celk. Phagocytes, initially neutrophils and later macrophages, ingest and attempt to destroy these microbes, but pathogenic intracellular bacteria are resistant to degradation within phagocl,tes.Intracellular bacteria activate NK cells by inducing expression of NK cell-activating ligands on infected cells or by stimulating dendritic cell and macrophage production of IL-12, a powerful NK cell-activating cltokine. The NK cells produce IFN-y, which in turn activates macrophages and promotes killing of the phagocytosed bacteria. Thus, NK cells provide an early defense against these microbes, before the development of adaptive immunity. In fact, mice with severecombined immunodeficiency, which lack T and B cells, are able to transiently control infection with the intracellular bacterium Listeria monocytogenesby NK cell-derived IFN-y production. However, innate immunity usually fails to eradicate these infections, and eradication requires adaptive cell-mediated immunity. Adaptive
lmmunity
to Intracellular
Bacteria
The major protectiue immune response against intracellular bacteriq is T cell-mediated immunity. lndividuals with deficient cell-mediated immunity, such as patients with acquired immunodeficiency syndrome
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z Days after infection FIGURE 15-2 Innateand adaptiveimmunityto intracellularbacteria.The innateimmuneresponseto intracellular bacteriaconsistsof phagocytesand NK cells,interactions amongwhich are mediatedby cytokines(lL-l2 and IFN-y). The typicaladaptiveimmuneresponseto thesemicrobesis cell-mediated immunity,in whichT cel s activatephagocytes to eliminatethe'microbes. Innateimmunitymay controlbacterialgrowth,but elimination of the bacteriarequiresadaptiveimmunity.Theseprinciples are basedlargelyon analysisof Listeria monocytogenesinfectionin mice;the numbersof viablebacteriashown on the y-axisare relativevaluesof bicterialcoloniesthat can be grown from the ttssuesof infectedmice (FromUnanueER Studiesin listeriosis show the strongsymbiosisbetweenthe innatecellularslstem and the T-cellresponselmmunological Reviews1SB.11-25,lggl I
15Chapter
(AIDS), are extremely susceptible to infections with intracellular bacteria (and viruses). Cell-mediated immunity was first identifled by George Mackaness in the 1950s as protection against the intracellular bacterium L. monocytogenes. This form of immunity could be adoptively transferred to naive animals with lymphoid cells but not with serum from infected or immunized animals (seeChapter 13, Fig. l3-2). As we discussed in Chapter 13, cell-mediated immunity consists of two types of reactions: macrophage activation by the T cell-derived signals CD40 ligand and IFN-1,which results in killing of phagocytosed microbes, and lysis of infected cells by cytotoxic T lymphocltes (CTLs). Both CD4* T cells and CD8* T cells respond to protein antigens of phagocytosed microbes, which are displayed as peptides associatedwith classII and class I major histocompatibility complex (MHC) molecules, respectively. CD4. T cells differentiate into Tsl effectors under the influence of IL-12, which is produced by macrophages and dendritic cells. The T cells express CD40 ligand and secrete IFN-1, and these two stimuli activate macrophages to produce several microbicidal substances, including reactive oxygen species, nitric oxide, and lysosomal enzyrnes.IFN-1also stimulates the production of antibody isotypes (e.g., IgG2a in mice) that activate complement and opsonize bacteria for phagocytosis, thus aiding the effector functions of macrophages.
T0 MICROBES IMMUNITY
The importance of lL-I2 and IFN-y in immunity to intracellular bacteria has been demonstrated in several experimental models. For instance, knockout mice lacking either of these cytokines are extremely susceptible to infection with intracellular bacteria such as Mycobacterium tuberculoslsand l. monocytogenes (Fig. I5-3). Phagocytosed bacteria stimulate CD8* T cell responses if bacterial antigens are transported from phagosomes into the cytosol or if the bacteria escape from phagosomes and enter the cytoplasm of infected cells. In the cytoplasm, the microbes are no longer susceptible to the microbicidal mechanisms of phagocytes, and the infection is eradicated by the killing of infected cells by CTLs.Thus, the effectors of cell-mediated immunity, namely, CD4*T cells that activate macrophages and CD8t CTLs, function cooperatively in defense against intracellular bacteria (Fig. 15-4). iJ The role of different T cell populations in defense against intracellular bacteria has been anallzed by adoptively transferring T cells from I. monocytogenes-infectedmice to normal mice and chal-
Wildtype(normal) mice lL-12(p40)knockout IFN-yknockout
cD4+
=6 (!
o -oc
54 -J
0204060 Time(days)postinfection indefense against anintra15-3 Roleol ll-l2 andIFN-1 FIGURE
cellular bacterial infection.In this experiment,wild-type(normal control)mice and knockoutmice lackingthe p40 subunitof lL-12or IFN-ywereinfectedwith the intracellular bacteriumM tuberculosis by aerosol Lungswere examinedat differenttimes after infectton for the numberof bacteriacapableof formingcoloniesin culture Normalmice controlbacterialgrowth, mice lackinglL-12 have a reducedabilityto controlthe infection(anddie by day 60),and IFNy knockoutmice are incapable of limitingbacterialgrowth (anddie bv day 30 to 35) Asterisksindicatethe time of death.(DatacourColorado tesy of Dr AndreaCooper,Departmentof Microbiology, FortCollins) StateUniversitv,
Killingof bacteriain phagolysosome Gooperationol GD4*and GDF T cells in defense bacteriasuch as L. llulal microbes. Intracellular are phagocytosed by macrophages and may and escapeintothe cytoplasmCD4*T cells survivein phagosomes peptideantigensderivedfrom respondto classll MHC-associated bacteria.These T cells produce IFN-y,which the intravesicular to destroythe microbesin phagosomes activatesmacrophages CDB*T cells respondto class l-associatedpeptidesderivedfrom cytosolicantigensand killthe infectedcells.
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I M M U N I Tl N Y D E F E NA SN E DD t S E A S E
lenging the recipientswith the bacteria.By depleting particular cell types,it is possibleto determine which effector population is responsible for protection. Such experimentshave shor.rmthat both CD4*T cells and CDB*T cells function cooperativelyto eliminate infection by wild-type L. monocytogenes. The CD4* cells produce large amounts of IFN-1, which activates macrophagesto kill phagocl.tosedmicrobes. However,L. monocytogerzes producesa protein called listeriolysin that allows bacteria to escapefrom the phagolysosomesof macrophagesinto the cy'toplasm. In their cy'toplasmichaven,the bacteriaare protected from the microbicidal mechanismsof macrophages, such as reactiveoxygenspecies,which are produced mainly within phagolysosomes. CDB*T cells are then activated and function by killing any macrophages that may be harboring bacteria in their cltoplasm. A mutant of L. monocytogenesthat lacks listeriolysin remains confined to phagolysosomes.Such mutant bacteria can be completely eradicated by CD4. T cell-derived IFN-y production and macrophage activation. The macrophage actiuation that occurs in response to intracellular microbes is also capable of causing tissue injury. This injury may be the resulr of delayed-type hypersensitivity (DTH) reactions to microbial protein antigens (seeChapter 13). Becauseintracellular bacteria have evolved to resist killing within phagocltes, they often persist for long periods and cause chronic antigenic stimulation and T cell and macrophage activation, which may result in the formation of granulomas surrounding the microbes (seeChapter 13, Fig. l3-12). The histologic hallmark of infection with some intracellular bacteria is granulomatous inflammation. This type of inflammatory reaction may serve to localize and prevent
spread of the microbes, but it is also associated with severefunctional impairment caused by tissue necrosis and fibrosis. The concept that protective immunity and pathologic hlpersensitivity may coexist becausethey are manifestations of the same q,?e of adaptive immune response is clearly exemplified in mycobacterial infections (Box l5-3). Dffirences among indiuiduals in the patterns of T cell responses to intracellular microbes are important determinq.nts of disease progression ond clinical outcome (Fig. 15-5). An example of this relationship between the type of T cell response and disease outcome is leprosy, which is caused by Mycobacterium leprae. There are two polar forms of leprosy, the lepromatous and tuberculoid forms, although many patients fall into less clear intermediate groups. In lepromatous leprosy, patients have high specific antibody titers but weak cell-mediated responses to M. leprae antigens. Mycobacteria proliferate within macrophages and are detectable in large numbers. The bacterial growth and persistent, but inadequate, macrophage activation result in destructive lesions in the skin and underlying tissue. In contrast, patients with tuberculoid leprosy have strong cell-mediated immunity but low antibody levels.This pattern of immunity is reflected in granulomas that form around nerves and produce peripheral sensory nerve defects and secondary traumatic skin lesions but less tissue destruction and a paucity of bacteria in the lesions. One possible reason for the differences in these two forms of diseasecaused by the same organism may be that there are different patterns of T cell differentiation and cytokine production in individuals. Some studies indicate that patients with the tuberculoid form of the disease produce IFN-1 and lL-2 in lesions (indicative of Tpl cell activation), whereas patients with lepromatous leprosy produce less IFN-y
Tn1 Naive cD4+ T cell
',:
Macrophage activation: Inhibits microbicidal cell-mediated immunity function of macrophages -:ffiq>ltlroJLTl
T62cell
Infection
Response
Outcome
Leishmania major
Most mousestrains:Tg1
) Recovery
BALB/c mice: Tr-r2
) Disseminatedinfection
Mycobacterium Somepatients:Txl leprae Some patients:Defective T61 or dominantTs2
) Tuberculoidleprosy
) Lepromatous leprosy (highbacterialcount)
-5 Roleof T cells and cytokines ng outcomeof infections.Naive CD4*T lymphocytes may differentrate intoTH1 cells, which activate phagocytes to kill ingested m i c r o b e sa,n dT n 2c e l l s w , h i c hi n h i b i t macrophage activationThe balancebetween thesetwo subsetsmay influencethe outcome of infections,as illustratedby Leishmanra infectionin mice and leprosyin humans
C h a p t e1r5
Mycobacteria are slow-growing, aerobic,facultativeintracellulab r a c i l lw i h o s e c e l l w a l l s c o n t a i nh i g h c o n c e n t r a t i o n s o f l i p i d s T h e s e l i p i d s a r e r e s p o n s i b l ef o r t h e a c i d - r e s i s t a sntta i n i n go f t h e b a c t e r i aw i t h t h e r e d d y e c a r b o l f u c h s i n , b e c a u s eo f w h i c h t h e s e o r g a n i s m s a r e a l s o c a l l e da c i d - f a s b t acilli Two common human pathogensin this class of bacteriaare Mvcobacterium tuberculosis and Mycobacterium Ieprae; in addition, atypical mycobacteriasuch as Mycobacteriumaviumintracellulare cause oooortunisticinfectionsin immunod e f i c i e n th o s t s ( e 9 . , A I D S p a t i e n t s ) .M y c o b a c t e r i u m b o v i si n f e c t sc a t t l ea n d m a v i n f e c th u m a n s a. n d b a c i l l u s C a l m e t t e - G u 6 r i(nB C G ) i s a n a t t e n u a t e d ,n o n v i r u l e n t s t r a i n o f M b o v r st h a t i s u s e d a s a v a c c i n ea q a i n s t tuberculosis. T u b e r c u l o s i s a n e x a m p l eo f a n i n f e c t i o nw i t h a n intracellulb aa r c t e r l u mi n w h i c h p r o t e c t i v ei m m u n i t ya n d p a t h o l o g i ch y p e r s e n s i t i v ict yo e x i s t ,a n d t h e l e s r o n sa r e caused mainly by the host response M. tuberculosis does not produce any known exotoxin or endotoxin I n f e c t i o nu s u a l l yo c c u r sb y t h e r e s p i r a t o rryo u t ea n d i s t r a n s m i t t e df r o m p e r s o nt o p e r s o n l t i s e s t i m a t e dt h a t a l m o s t2 b i l l i o np e o o l ew o r l d w i d ea r e i n f e c t e dw t l h M tuberculosis. In a primaryinfection,bacillimultiplyslowly i n t h e l u n g sa n dc a u s eo n l ym i l di n f l a m m a t i o T n heinfect r o n i s c o n t a i n e db y a l v e o l am r a c r o p h a g e(sa n dp r o b a b l y d e n d r i t i cc e l l s ) M o r e t h a n 9 0 % o f i n f e c t e dp a t i e n t s r e m a i n a s y m p t o m a t i cb, u t b a c t e r i as u r v i v e i n l u n g s , m a i n l yi n m a c r o p h a g e sB.y 6 t o 8 w e e k sa f t e ri n f e c t i o n , t h e m a c r o p h a g ehs a v e t r a v e l e dt o t h e d r a i n i n gl y m p h n o d e s ,a n d C D 4 *T c e l l sa r e a c t i v a t e dC; D 8 *T c e l l sm a y a l s ob e a c t i v a t e lda t e rT h e s eT c e l l sp r o d u c eI F N - yw, h i c h a c t i v a t e sm a c r o p h a g easn d e n h a n c e st h e i ra b i l i t yt o k i l l p h a g o c y t o s e db a c i l l i .T N F p r o d u c e db y T c e l l s a n d m a c r o p h a g easl s op l a y sa r o l e i n l o c a li n f l a m m a t i oann d m a c r o p h a gaec t i v a t i o na,n dT N F r e c e p t o kr n o c k o um t ice a r e h i g h l ys u s c e p t i b l e t o m y c o b a c t e r i ai nl f e c t i o n sT h e T cell reactionis adequateto control bacterialspread However, M. tuberculosis is capable of surviving within macrophageb s e c a u s ec o m p o n e n t so f i t s c e l l w a l l i n h i b i t t h e f u s i o n o f p h a g o c y t i cv a c u o l e sw i t h lysosomes C o n t i n u i nT g c e l la c t i v a t i o n l e a d st o t h e f o r m a t i o no f g r a n u l o m a sw, h i c h a t t e m p tt o w a l l o f f t h e b a c t e r i aa, n d a r eo f t e na s s o c i a t ewdi t h c e n t r anl e c r o s i sc,a l l e dc a s e o u s n e c r o s i st ,h a t i s c a u s e db y m a c r o p h a gper o d u c t s u c ha s l y s o s o m ael n z y m e sa n d r e a c t i v eo x y g e ns p e c i e sG . ranul o m a t o u si n f l a m m a t i oins a f o r m o f D T H r e a c t i o nt o t h e b a c i l l il t i s p o s t u l a t e d t h a t n e c r o s i ss e r v e st o e l i m i n a t e i n f e c t e dm a c r o p h a g easn d p r o v i d e sa n a n o x i ce n v i r o n m e n t i n w h i c h t h e b a c i l lci a n n o td i v i d e .T h u s ,e v e n t h e t i s s u ei n j u r ym a y s e r v ea p r o t e c t i v e f u n c t i o nC , aseating g r a n u l o m aasn d t h e f i b r o s i s( s c a r r i n gt h) a t a c c o m p a n i e s
I I V I M U N ITT0YI V I I C R 0 B E S
g r a n u l o m a t o ui n s f l a m m a t i oanr e t h e p r i n c i p acl a u s e so f t i s s u e i n j u r ya n d c l i n i c adl i s e a s ei n t u b e r c u l o s i sP r e v i ouslyinfectedpersonsshow cutaneousDTH reactionsto e i t h a b a c t e r i aal n t i g e np r e p a r a t i o(np u r i s k i nc h a l l e n g w i a y s u r v i v ef o r f i e d p r o t e i nd e r i v a t i v eo, r P P D ) ,B a c i l l m m a n y y e a r s a n d a r e c o n t a i n e dw i t h o u t a n y p a t h o l o g i c c o n s e q u e n c ebs u , t m a y b e r e a c t i v a t eadt a n yt i m e ,e s p e c i a l l yi f t h e i m m u n er e s p o n s eb e c o m e su n a b l et o c o n t r o l t h e i n f e c t i o nA l t h o u g ht h e p r e v a l e n coef t u b e r c u l o s ihsa s b e e n g r e a t l yr e d u c e dw i t h t h e u s e o f a n t i b i o t i c st ,h e i n c i d e n c eo f t h e d i s e a s eh a s r e c e n t l yb e e n i n c r e a s i n g . T h i s i s m a i n l yb e c a u s eo f t h e e m e r g e n c eo f a n t i b i o t i c resistant strains and the increasedincidence of i m m u n o d e f i c i e nc a y u s e db y H I V i n f e c t i o na n d i m m u n o t h e r a p i e s I n i m m u n o d e f i c i e ni nt d i v i d u a l s , suppressive l e s i o n s m a y r e s u l t f r o m c o n t i n u e d ,a n d i n a d e q u a t e , macrophageactivationand are typicallynot associated w i t h w e l l { o r m e dg r a n u l o m a sT.h e e f f i c a c yo f B C Ga s a p r o p h y l a c tvi ca c c i n er e m a i n sc o n t r o v e r s i aI nl r a r ec a s e s , M tuberculosismay cause lesions in extrapulmonary s i t e s I n c h r o n i ct u b e r c u l o s i ss,u s t a i n e dp r o d u c t i o no f TNF leadsto cachexia Differentinbredstrainsof mice vary in their susceptibility to infectionwith M tuberculosis(and with other microbes,such as the protozoanL ma1ol. intracellular or resistanceto M. tuberculoslshas been Susceptibility m a p p e dt o a g e n e o r i g i n a l l cy a l l e db c A o r / s h t h a t h a s b e e n i d e n t i f i e da s a p o l y m o r p h i cN R A M P I ( N R A M B n a t u r arl e s i s t a n c e - a s s o c i amt eadc r o p h a gper o t e i ng) e n e ae l m b r a n e isn N R A M P li s e x p r e s s eodn p h a g o l y s o s o mm m a c r o p h a g easn d i s i n v o l v e di n d i v a l e nct a t i o nt r a n s p o r t that NRAMPl contributesto microbial lt is hvpothesized k i l l i n gb y d e p l e t i n gt h e p h a g o s o m eo f d i v a l e n ct a t i o n s , a n da l l e l i cv a r i a n t so f N R A M P l a r ed e f e c t i v ei n t h i sf u n c t i o n S t u d i e si n h u m a n sa l s os u g g e s t h a t s o m e v a r t a n t s oI NRAMP! are associatedwith increasedsusceptibilitv infection to mycobacterial of stimulatesunusualpopulations M tuberculosisalso y 6 c e l l sa n d N K - Tc e l l s T h e y 6 T c e l l s T c e l l s ,i n c l u d i n g may be reacting to mycobacterialantigens that are homologousto heat shock proteins NK-Tcells respond t o b a c t e r i alli p i da n t i g e n sd i s p l a y e db y t h e C D 1 c l a s sI M H C - l i k em o l e c u l el.t i s p o s t u l a t etdh a t t h e r e s p o n s eo f u n c o n v e n t i o nTa cl e l l si s a p r i m i t i v ed e f e n s em e c h a n i s m and other microbes.However,the againstmycobacteria e f f e c t o rf u n c t i o n so f t h e s e c e l l sa n d t h e i r r o l e si n p r o t e c t i v e i m m u n i t ya g a i n s tm y c o b a c t e r iaar e n o t c l e a r l y established M. lepraeis the causeof leprosy.The natureof the T the types of cytokinesprocell responseand specifically ducedby activatedT cellsare importantdeterminantsof the lesionsand clinicalcourseof M lepraeinfection(see text)
361
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IMMUNITY lN DEFENSE ANDDISEASE
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and perhaps more IL-4 and IL-10 (Wpical of TH2 cells). In lepromatous leprosy,both the deficiency of IFN-y and the macrophage-suppressiveeffects of IL-10 and possibly IL- may result in weak cell-mediated immunity and failure to control bacterial spread. The role of T,,1- and Ts2-derived c1'tokines in determining the outcome of infection has been most clearly demonstrated in infection by the protozoan parasite Leishmania major in different strains of inbred mice (discussed later in this chapter). lmmune
Evasion by Intracellular
Bacteria
Different intracellular bacteria have developed various strategiesto resist elimination by phagocltes (seeTable 15-2). These include inhibiting phagolysosomefusion or escaping into the c1'tosol,thus hiding from the microbicidal mechanisms of lysosomes,and directly scavenging or inactivating microbicidal substancessuch as reactive oxygen species. The outcome of infection by these organisms often depends on whether the T cell-stimulated antimicrobial mechanisms of macrophages or microbial resistance to killing gains the upper hand. Resistance to phagocyte-mediated elimination is also the reason that such bacteria tend to cause chronic infections that may last for years,often recur after apparent cure, and are difficult to eradicate.
lvrlrulrrry ro FUNGI Fungal infections, aiso called mycoses, are important causes of morbidity and mortality in humans. Some fungal infections are endemic, and these infections are usually caused by fungi that are present in the environment and whose spores are inhaled by humans. Other fungal infections are said to be opportunistic because the causative agents cause mild or no diseasein healthy individuals but may infect and cause severe disease in immunodeficient persons. Compromised immunity is the most important predisposing factor for clinically significant fungal infections. Neutrophil deficiency as a result of bone marrow suppression or damage is frequently associated with such infections. A recent increase has been noted in opportunistic fungal infections secondary to an increase in immunodeficiencies caused mainly byAIDS and by therapy for disseminated cancer and transplant rejection, which inhibits bone marrow function and suppressesimmune responses.A dreaded opportunistic fungal infection associatedwith AIDS is Pneumocystis jiroueci pneumonia, but many others contribute to the morbidity and mortality caused by immune deficiencies. Different fungi infect humans and may live in extracellular tissues and within phagocytes. Therefore, the immune responsesto these microbes are often combinations of the responses to extracellular and intracellular bacteria. However, much less is known about antifungal immunity than about immunity against bacteria and viruses. This lack of knowledge is partly due to the paucity of animal models for mycoses and partly
due to the fact that these infections typically occur in individuals who are incapable of mounting effective lmmune responses. Innate and Adaptive
lmmunity
to Fungi
The principal mediators of innate immunity against fungi are neutrophils and macrophages. Patients with neutropenia are extremely susceptible to opportunistic fungal infections. Neutrophils presumably liberate fungicidal substances, such as reactive oxygen intermediates and lysosomal enzyrnes,and phagocytose fungi for intracellular killing. Virulent strains of Cryptococcus neoformans inhibit the production of cytokines such as TNF and lL-12 by macrophages and stimulate production of IL-10, thus inhibiting macrophage activation. Cell-mediated immunity is the major mechanism of adaptive immunity against fungal infections. Histoplasma capsulatum, a facultative intracellular parasite that lives in macrophages,is eliminated by the same cellular mechanisms that are effective against intracellular bacteria. CD4* and CD8* T cells cooperate to eliminate the yeast forms of C. neoformans, which tend to colonize the lungs and brain in immunodeficient hosts. Candida infections often start at mucosal surfaces, and cellmediated immunity is believed to prevent spread of the fungi into tissues. In many of these situations, Trl responses are protective and Ts2 responses are detrimental to the host. Not surprisingly, granulomatous inflammation is an important cause of host tissue injury in some intracellular fungal infections, such as histoplasmosis. Fungi often elicit specific antibody responses that are of protective value. Antibody-dependent cellular cytotoxicity, mediated via Fc receptors, plays a role in clearing some fungi, such as C. neoformans.
IrvrrvrulrtrY ToVrRusES Viruses are obligatory intracellular microorganisms that replicate within cells, using components of the nucleic acid and protein synthetic machinery of the host. Viruses typically infect a wide variety of cell populations by using normal cell surface molecules as receptors to enter the cells. After entering cells, viruses can cause tissue injury and diseaseby any of several mechanisms. Viral replication interferes with normal cellular protein synthesis and function and leads to injury and ultimately death of the infected cell. This result is one type of cytopathic effect of viruses, and the infection is said to be "lytic" because the infected cell is lysed. Viruses may also cause latent infections, during which viral DNA persists in host cells and produces proteins that may or may not alter cellular functions. Latency is often a state of balance between persistent infection and an immune responsethat can control the infection but not eradicate it. Predictably, some of these latent infections become widespread and even lltic if the immune response is compromised. Innate and adaptive immune responses to viruses are aimed at blocking infection and eliminating infected cells (Fig. 15-6).
15Chaoter
Innateimmunity
IMMUNITY T0 MICROBES
Adaptiveimmunity
OType I
o rFN
Antibod
d adapagainst
Antiviral state
VITUSES
functionsto preventinfectionano to eradicate established infection Innateimmunityis mediatedby type I lFNs,which preventinfect i o n , a n d N K c e l l s ,w h i c h e l i m i nate infected cells Adaptive immunity is mediated by antibodies and CTLs, which also block infectionand kill infected cells,respectively
Innate lmmunity
NK cell
Infecte cell
Killingof infected cell
to Viruses
The principal mechanisms of innate immunity against uiruses a.re inhibition of infectionby type I IFNs and NK cell-mediated killing of infected cells.Infection by many viruses is associated with production of tlpe I IFN by infected cells, especially dendritic cells of the plasmacytoid type (see Box 6-1, Chapter 6). Severalbiochemical pathways trigger IFN production (see Chapters 2 and 12).These include recognition of viral RNA and DNA by endosomal Toll-like receptors (TLRs), and activation of cytoplasmic kinases by viral RNA. Ci,toplasmic sensors of viruses provide TlR-independent pathways of IFN production. These sensors include RNA helicases,such as RIG-I (retinoid-inducible gene-I) and MDA-S, that recognize RNAs produced in virus-infected cells. The TLR- and cytoplasmic sensor-initiated pathways converge on the activation of protein kinases, which in turn activate transcription factors that stimulate IFN gene transcription. Type I IFNs function to inhibit viral replication in both infected and uninfected cells by inducing an "antiviral state" (seeChapter 12). One of the key molecules induced by IFNs is PKR, a protein kinase that must bind dsRNA in order to be activated, and is therefore functional only in virus-infected cells. Active PKR shuts off protein slmthesis,causing infected cells to die. NK cells kill cells infected with a variety of viruses and are an important mechanism of immunity against viruses early in the course of infection, before adaptive immune responseshave developed. NK cells also recognize infected cells in which the virus has shut off class I MHC expression (discussedlater) because the absence of class I releasesNK cells from a normal state of inhibition (seeChapter 2, Fig.2-10).
Adaptive
lmmunity
to Viruses
Adaptiue immunity against uiral infections is mediated by antibod.ies, which block uirus binding and entry into
Protection against infection
Neutralization
Eradication of established infection Killingof infected cell
host celk, and by CTLs, which eliminate the infection by killing infected. celk (see Fig. 15-6). Antibodies are produced and are effective against viruses only during the extracellular stage of the lives of these microbes. Viruses may be extracellular early in the course of infection, before they enter host cells, or when they are released from infected cells by virus budding or if the cells are killed. Antiviral antibodies function mainly as neutralizing antibodies to prevent virus attachment and entry into host cells. These neutralizing antibodies bind to viral envelope or capsid antigens. Secretedantibodies of the IgA isotype are important for neutralizing viruses that enter through the respiratory and intestinal mucosa. Oral immunization against poliomyelitis works by inducing mucosal immunity. In addition to neutralization, antibodies may opsonize viral particles and promote their clearance by phagocytes. Complement activation may also participate in antibodymediated viral immuniry mainly by promoting phagocytosis and possibly by direct lysis of viruses with lipid envelopes. The importance of humoral immuniry in defense against viral infections is supported by the observation that resistance to a particular virus, induced by either infection or vaccination, is often specific for the serologic (antibody-defined) type of the virus. An example is influenza virus, in which exposure to one serologic type does not confer resistanceto other serotypesofthe virus. Neutralizing antibodies block viral infection of cells and spread of viruses from cell to cell, but once the viruses enter cells and begin to replicate intracellularly, they are inaccessible to antibodies. Therefore, humoral immunity induced by previous infection or vaccination is able to protect individuals from viral infection but cannot by itself eradicate established infection. Elimination of uiruses that reside within cells is mediated by CTLs, which kill the infected cells. As we have mentioned in previous chapters, the principal physiologic function of CTLs is surveillance against viral
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S e c t i oVn-
I M M U N I Tl N Y DEFENS AE N DD I S E A S E
" ..,,, infection. Most virus-specific CTLs are CD8- T cells that recognize cytosolic, usually endogenously synthesized, viral antigens in association with classI MHC molecules on any nucleated cell. If the infected cell is a tissue cell and not a professional antigen-presenting cell (APC),the infected cell may be phagocltosed by a professional APC, such as a dendritic cell, which processesthe viral antigens and presents them to naive CDB* T cells. This p r o c e s s o f c r o s s - p r e s e n t a t i o no, r c r o s s - p r i m i n g ,w a s described in Chapter 9 (seeFig. 9-3). Full differentiation of CD8* CTLs requires innate immunity or cytokines produced by CD4* helper cells or costimulators expressed on infected cells (Chapter 9). Cltopathic viruses, especially RNA viruses, tend to stimulate strong innate immune responses and are able to induce CTLs without T cell help, whereas noncytopathic latent infections, often by DNA viruses, usually elicit CTL responses only in the presence of CD4* helper T cells.As discussed in Chapters 9 and 13, CDB*T cells undergo massive proliferation during viral infection, and most of the proliferating cells are specific for a few viral peptides. Some of the activated T cells differentiate into effector CTLs, which can kill any infected nucleated cell. The antiviral effects of CTLs are mainly due to killing of infected cells, but other mechanisms include activation of nucleases within infected cells that degrade viral genomes, and secretion of cltokines such as IFN-y, which has some antiviral activity. The importance of CTLs in defense againstviral infection is demonstrated by the increased susceptibility to such infections seen in patients and animals that are deficient in T lymphoc).tes, and by the experimental observation that mice can be protected against some virus infections by adoptive transfer of virus-specific, class I-restricted CTLs. Furthermore, manv viruses are able to alter their surface antigens, such as envelope glycoproteins, and thus escape attack by antibodies. However, infected cells produce viral proteins that are often invariant, so that CTL-mediated defense remains effectiveagainstsuch viruses. In some uiral infections, especially with nonq/topathic uiruses, tissue injury may be caused by CTLs. An experimental model of a diseasein which the pathology is due to the host immune response is lymphocytic choriomeningitis virus (LCMV) infection in mice, which induces inflammation of the spinal cord meninges. LCMV infects meningeal cells, but it is noncytopathic and does not injure the infected cells directly. The virus stimulates the development of virus-specific CTLs that kill infected meningeal cells during a physiologic attempt to eradicate the infection. Therefore, T celldeficient mice infected with LCMV become chronic carriers of the virus, but pathologic lesions do not develop, whereas in normal mice, meningitis develops. This observation appears to contradict the usual situation, in which immunodeficient individuals are more susceptible to infectious diseasesthan normal individuals are. Hepatitis B virus infection in humans shows some similarities to murine LCMV in that immunodeficient persons who become infected do not develop the diseasebut become carriers who can transmit the infec-
tion to otherwise healthy persons. The livers of patients with acute and chronic active hepatitis contain large numbers of CDB* T cells, and hepatitis virus-specific, class I MHC-restricted CTLs can be isolated from liver biopsy specimens and propagated in vitro. Immune responses to viral infections may be involved in producing disease in other ways. A consequence of persistent infection with some viruses, such as hepatitis B, is the formation of circulating immune complexes composed of viral antigens and specific antibodies (seeChapter 18).Thesecomplexesare deposited in blood vessels and lead to systemic vasculitis. Some viral proteins contain amino acid sequencesthat are also present in some self antigens.It has been postulated that because of this "molecular mimicry," antiviral immunity can lead to immune responsesagainst self antigens. lmmune
Evasion by Viruses
Viruses have evolved numerous mechanisms for evading host immunity (Table 15-3). a Viruses can alter their antigens and are thus no Ionger tergets of immune responses. The antigens affected are most commonly surface glycoproteins that are recognized by antibodies, but T cell epitopes may also undergo variation. The principal mechanisms of antigenic variation are point mutations and
Table 15-3. Mechanisms of lmmune Evasion
by Viruses
Mechanism of immune evasron variation Antigenic
lExamples Influenza, r h i n o v i r u sH, I V
Inhibition of antigenprocessing Blockade of TAPtransporterHerpessimplex Removalof class I moleculesfromthe ER
Production of cytokine receptorhomologs
Cytomegalovirus Vaccinia, poxvrruses ( l L - 1 ,I F N - y ) Cytomegalovirus (chemokine)
Productionof immunosuppressive cytokine
Epstein-Barr virus (rL-10)
Infection of immunocompetent cells
HIV
Abbreviations: ER,endoplasmic reticulum; HlV, humanimmunodeficiency virus;TAP,transporter withantigenprocessing. associated Representative examplesof differentmechanismsused : by virusesto resisthostimmunityare listed.
C h a o t el 5r -
reassortment of RNA genomes (in RNA viruses). Because of antigenic variation, a virus may become resistant to immunity generated in the population by previous infections. The influenza pandemics that occurred in 1918, 1957, and 1968 were due to different strains of the virus, and subtler variants arise more frequently. There are so many serotypes of rhinovirus that specific immunization against the common cold may not be a feasible preventive strategy. Human immunodeficiency virus I (HIV-l), the virus that causesAIDS, is also capable of tremendous antigenic variation (see Chapter 20). In these situations, prophylactic vaccination may have to be directed against invariant viral proteins.
o
Some uiruses inhibit class I MHC-associated presentation of cytosolic protein antigens. Several mechanisms that inhibit antigen presentation have been described with different viruses (Box i5-4). Inhibition of antigen processing and presentation blocks the assembly and expression of stable class I MHC molecules and the display of viral peptides. As a result, cells infected by such viruses cannot be recognized or killed by CD8* CTLs. NK cells may have evolved as an adaptation to this viral evasion strategy because NK cells are activated by infected cells, especially in the absence of class I MHC molecules.
o Some uiruses produce molecules that inhibit the immune response.Poxvirusesencode molecules that are secreted by infected cells and bind to several cytokines, including IFN-y, TNfl IL-l, IL-18, and chemokines. The secreted cytokine-binding proteins may function as competitive antagonists of the cytokines. Some cytomegalovirusesproduce a molecule that is homologous to class I MHC proteins and may compete for binding and presentation of peptide antigens. Epstein-Barr virus produces a protein that is homologous to the cltokine IL-10, which inhibits activation of macrophages and dendritic cells and may thus suppress cell-mediated immunity. These examples probably represent a small fraction of immunosuppressive viral molecules. Identifi cation of these molecules raises the intriguing possibility that viruses have acquired genes encoding endogenous inhibitors of immune responsesduring their passage through human hosts and have thus evolved to infect and colonize humans. @
Some chronic uiral infections are associated with failure of CTL responses, which allows viral persistence. Studies of a chronic infection with lymphocl'tic choriomeningitis in mice have sholtm that this tlpe of immune deficit may result from activation of inhibitoryT cell pathways, such as the PD-1 pathway, which normally functions to maintain T cell tolerance to self antigens (see Chapter l1). Reduced T cell responses resulting from HIV infection may also be partly because of PD-l-mediated T cell unresponsiveness.Thus, viruses may have learned to exploit normal mechanisms of immune regulation and to activate these pathways in T cells.
I M M U N I TTY0 M I C R 0 B E S
o Viruses may infect and either kill or inactiuate immunocompetentcells.The obviousexampleis HIV which survivesby infecting and eliminating CD4. T cells, the key inducers of immune responsesto protein antigens.
ro PARASITES lmnauurv In infectious disease terminology, parasitic infection refers to infection with animal parasites such as protozoa, helminths, and ectoparasites (e.9.,ticks and mites). Such parasites currently account for greater morbidity and mortality than any other class of infectious organisms, particularly in developing countries. It is estimated that about 30% of the world's population suffers from parasitic infestations. Malaria alone affects more than 100 million people worldwide and is responsible for about I million deaths annually. The magnitude of this public health problem is the principal reason for the great interest in immunity to parasites and for the development of immunoparasitology as a distinct branch of immunology. Most parasites go through complex life cycles,part of which occurs in humans (or other vertebrates) and part of which occurs in intermediate hosts, such as flies, ticks, and snails. Humans are usually infected by bites from infected intermediate hosts or by sharing a particular habitat with an intermediate host. For instance, malaria and trlpanosomiasis are transmitted by insect bites, and schistosomiasisis transmitted by exposure to water in which infected snails reside. Most parasitic infections are chronic because of weak innate immunity and the ability of parasites to evade or resist elimination by adaptive immune responses. Furthermore, many antiparasite antibiotics are not effective at killing the organisms. Individuals living in endemic areas require repeated chemotherapy because of continued exposure, and such treatment is often not possible because of expense and logistic problems. Therefore, the development of prophylactic vaccines for parasites has long been considered an important goal for developing countries. Innate lmmunity
to Parasites
Although different protozoan and helminthic parasites have been shornm to activate different mechanisms of innate immunity, these organisms are often able to survive and replicate in their hosts because they are well adapted to resisting host defenses.The principal innate immune responseto protozoa is phagocltosis, but many of these parasites are resistant to phagocytic killing and may even replicate within macrophages. Some protozoa may express surface molecules that are recognized by TLRs and activate phagocytes. Phagocltes also attack helminthic parasites and secrete microbicidal substances to kill organisms that are too large to be phagoc1.tosed. Many helminths have thick teguments that make them resistant to the cytocidal mechanisms of neutrophils and macrophages. Some helminths may
As viruseshave co-evolvedwith their hosts,they have developed m a n ys t r a t e g i etso e v a d ei m m u n er e s p o n s e s S e v e r avl i r a lg e n e sh a v eb e e ni d e n t i f i e tdh a t e n c o d ep r o t e i n s t h a t m o d u l a t eh o s t i m m u n e r e s p o n s e sS. o m e o f t h e s ev i r a lp r o t e i n si n h i b i t h e p r e s e n t a t i oonf v i r a la n t i g e n st o T c e l l s C D 8 *c l a s sI M H C - r e s t r i c t eCdT L sa r et h e m a j o rm e c h a n i s mos f d e f e n s ea g a i n svt i r a li n f e c t i o n o sf c e l l s l f a v i r u sc o u l di n h i b i t h e c l a s sl - r e s t r i c t e ad n t i g e n p r e s e n t a t r opna t h w a yt,h a t v i r u sw o u l d b e c o m ei n v i s i b l e t o C T L sa n d w o u l d b e a b l et o r e p l i c a t ei n i n f e c t e dc e l l s . I n C h a p t e r6 , w e d e s c r i b e dt h e s t e p s i n t h e p r o c e s s i n g o f c y t o s o l i ca n t i g e n sa n d t h e p r e s e n t a t i oonf a n t i g e n i c p e p t i d e sb o u n dt o c l a s sI m o l e c u l e (ss e eF i g 6 - 13 ) , E a c h o f t h e s e s t e p s m a y b e t a r g e t e df o r i n h i b i t i o n by a viral p r o d u c t S o m ee x a m p l e sa r e s h o w n i n t h e f i g u r eb e l o w a n d l i s t e dh e r e :
. H u m a nC M Vp r o d u c e tsw o p r o t e i n sU, S 2a n dU S 11 , w h i c h b i n dt o c l a s sI m o l e c u l e si n t h e e n d o p l a s m i c r e t i c u l u ma n d a c t i v e l yc a t r y ,o t " d i s l o c a t e , t"h e s e m o l e c u l e si n t o t h e c y t o s o l w , h e r e t h e y c a n n o tb e l o a d e dw i t h a n t i g e n i cp e p t i d e sa n d a r e d e g r a d e di n the proteasome. . Kaposisarcomaherpesvirus(KSHV)K3 and K5 prot e i n si n d u c er a p i di n t e r n a l i z a t ioofnc l a s sI M H C m o l e c u l e sf r o m t h e c e l ls u r f a c e . T w o p r o t e i n so f H I V V p u a n d N e f ,a l s oi n h i b i ct l a s s I e x p r e s s i oinn i n f e c t e dc e l l s ;N e f a p p e a r st o d o t h i s b y f o r c i n gi n t e r n a l i z a t i o n f c l a s sI m o l e c u l e sf r o m t h e s u r f a c eo f i n f e c t e dc e l l s ,a n d V p u d e s t a b i l i z e s n e w l ys y n t h e s i z ecdl a s sI m o l e c u l e s
T h e c o n s e q u e n coef b l o c k i n gc l a s sl - p e p t i d ea s s o c i a t i o n i n a l lt h e s ec a s e si s t h a t i n f e c t e dc e l l ss h o w r e d u c e d e x p r e s s i o no f s t a b l ec l a s s I m o l e c u l e so n t h e s u r f a c e a n d d o n o t d i s p l a yv i r a lp e p t i d e sf o r T c e l l r e c o g n i t i o n However, it is diffrcultto prove that the vtral genes e n c o d i n gp r o t e i n st h a t i n h i b i ta n t i g e np r e s e n t a t i oanr e a c t u a l l yv i r u l e r c eg e n e s ,r e q u i r e df o r t h e i n f e c t i v i t yo r p a t h o g e n i c io t yf t h e v i r u s e s A n e x c e l l e n te x a m p l e o f t h e c o n s t a n t s t r u g g l e b e t w e e nm i c r o b e sa n d t h e i r h o s t s i s t h e a d a p t a t i o o nf t h e m a m m a l i a ni m m u n e s y s t e m t o r e c o g n i z ec l a s s l d e f i c i e n tc e l l s T h u s , v i r u s e st r y t o e v a d e r e c o g n i t i o n b y C T L s b y i n h i b i t i n gc l a s sI M H C e x p r e s s i o nb, u t N K c e l l sh a v ee v o l v e dt o r e s p o n ds p e c i f i c a l tl o y the absence tLhrar E i rr I n o n i i rLl tou Y u nd a r Ingnu . o f c l a s s I M H C o n v i r u s - i n f e c t ecde l l s ( s e e C h a p t e r Psl,/ o T h e h u m a n c y t o m e g a l o v i r u(sC M V ) U 5 3 p r o t e i n 2 ) N o t s u r p r i s i n g l yt h, e r e i s e m e r g i n ge v i d e n c et h a t s e q u e s t e r sc l a s s I m o l e c u l e si n t h e e n d o p l a s m i c s o m e v i r u s e sm a y p r o d u c ep r o t e i n st h a t a c t a s l i g a n d s r e t r c u l u ma, n d m u r i n eC M V g p 4 0 ( 4 0 - k Dg l y c o p r o - f o r N K c e l l i n h i b i t o r yr e c e p t o r sa n d t h u s i n h i b i tN K c e l l t e i n ) r e t a i n s c l a s s I m o l e c u l e si n t h e c i s - G o l q i acilvalron compartment . T h e t r a n s c r i p t i oonf c l a s sI M H C g e n e si s i n h i b i t e d b y t h e E 1 A p r o t e i n o f p a t h o g e n i cs t r a i n s o f adenovirus . H e r p e ss i m p l e xv i r u s e s1 a n d2 p r o d u c ea p r o t e i n , c a l l e dI C P - 4 7t,h a t b i n d st o t h e p e p t i d e - b i n d i n s igt e o f t h e T A Pt r a n s p o r t earn d p r e v e n t st h e t r a n s p o r t e r f r o m c a p t u r i n gc y t o s o l i cp e p t i d e sa n d t r a n s p o r t i n g t h e m i n t ot h e e n d o p l a s m irce t r c u l u m f o r b i n d i n gt o c l a s sI m o l e c u l e s . T h e a d e n o v i r u sE 3 1 9 - k D p r o t e i n b i n d s t o a n d r e t a i n sc l a s sI m o l e c u l e si n t h e e n d o p l a s m irce t i c u l u m , p r e v e n t i n tgh e s e m o l e c u l e sf r o m e x i t i n gw i t h
Inhibition of Blockin MHCsynthesis proteasomal activity: and/orER retention: EBV,humanCMV adenovirus, humanCMV
uytosottc protein
proteasome
Class I MHC pathway
Blockin TAP transport: HSV
Removalof classI from ER: CMV
Interference with CTL recognition by "decoy"viralclassl-like molecules: murineCMV
The pathwayof class I MHC-associated antrgenpresentation is shown, with examplesof virusesthat blockdifferentsteps in this pathwayCMV cytomegalovirus; EBV,Epstein-Barr virus;ER,endoplasmic reticulum;HSV,herpessimplexvirus;TAP,transporter associatedwith antigenprocessing
C h a p t e1r5-
I M M U N I TTY0 M I C R O B E S! .,.,.',',,,if..s.".,,
also activate the alternative pathway of complement, although as we shall discuss later, parasites recovered from infected hosts appear to have developed resistance to complement-mediated lysis. Adaptive
lmmunity
exacerbation of lesions because of the macrophagesuppressiveactions of Ts2 cltokines, notably IL-4. Most inbred strains of mice are resistantto infection with I. major,bul"inbred BALB/c mice are highly susceptible and die if they are infected with large numbers of parasites.After infection, the resistant strainsproduce largeamounts of IFN-1in responseto leishmanial antigens, whereas the strains that are susceptible to fatal leishmaniasis produce more IL-4 in response to the parasite. IFN-1 activates macrophages and enhances intracellular killing of Leishmania,and high levelsof IL-4 inhibit the activation of macrophagesby IFN-y.Treatmentof resistant mice with anti-IFN-y antibody makesthem susceptible, and conversely,treatment of susceptible mice with anti-Il-4 antibody induces resistance.The same resultsare seenin knockout mice lacking IFN-y or IL4. Treatment of susceptiblemice with IL-12 at the time of infection also induces resistanceto the infection. IL-12 enhancesthe production of IFN-1 and the development of Trrl cells.This result is the basis for the suggesteduse of IL-12 as a vaccineadjuvant,not only for leishmaniasisbut also for other infections that are combated by cell-mediatedimmunity.
to Parasites
Different protozoa and helminths vary greatly in their structural and biochemical properties, life cycles, and pathogenic mechanisms. It is therefore not surprising that different parasites elicit distinct adaptive immune responses(Table 15-4). Some pathogenic protozoa have evolved to survive within host cells, so protective immunity against these organisms is mediated by mechanisms similar to those that eliminate intracellular bacteria and viruses. In contrast, metazoa such as helminths survive in extracellular tissues, and their elimination is often dependent on special types of antibody responses. The principal defense mechanism against protozoa that suruiue within macrophages is cell-mediated immunity, particularly macrophage actiuation by Tfl cell-deriued cytokines. Infection of mice with Leishmania major, a protozoan that survives within the endosomes of macrophages,is the best documented example of how dominance of Tsl or Ts2 responses determines diseaseresistanceor susceptibility(seeFig. l5-5). Resistance to the infection is associated with activation of Leishmania-specific THl CD4* T cells, which produce IFN-y and thereby activate macrophages to destroy intracellular parasites.Conversely,activation of Ts2 cells by the protozoa results in increasedparasite survival and
Multiple genes appear to control the balance of protective and harmful immune responses to intracellular parasites in inbred mice and presumably in humans as well. Attempts to identify these genes are ongoing in many laboratories. Protozoa that replicate inside various host cells and lyse these cells stimulate specific antibody and CTL
Parasites Table 15-4. lmmune Responsesto Disease-Causing
Diseases
Principalmechanisms of protectiveimmunity
Plasmodiumsoecies
Malaria
Antibodiesand CD8+CTLs
Leishmania donaUAni
Leishmaniasis (mucocutaneous, disseminated)
CD4+Tu1cellsactivate to kill macrophages parasites phagocytosed
Trypanosoma brucei
A ntibodies Africantrypanosomiasis
Entamoeba histolytica
Amebiasis
phagocytosis Antibodies,
Schistosomiasis
ADCC mediatedby eosinophils,macrophages
Filariasis
Cell-mediatedimmunity; role of antibodies?
Parasite Protozoa
Metazoa
'i cell-mediatedcytotoxicity; ro. n ADCC, uvv. l nAbbrev u v t 9 v t a a t v tiationsr cantibody-dependent lymphocytes. CTLs, cytotoxic cytotoxicT lympl iCfls, to themare listed. Selectedexamplesof parasitesand immuneresponses
367 -,
368
-
,
I M M U N I Tt Y ND E F E N S AE N DD T S E A S E
:,:"'.'v
responses,similar to cytopathic viruses. An example of such an organism is the malaria parasite. It was thought for manyyears that antibodies were the major protective mechanism against malaria, and early attempts at vaccinating against this infection focused on generating antibodies. It is now apparent that the CTL response is an important defense against the spread of this intracellular protozoan (Box l5-5). Defense against many helminthic infections is mediated by the actiuation of TpZ cells, which results in production of IgE antibodies and actiuation of eosinophils. IgE antibodies that bind to the surface of the helminths may activate mast cells, and IgG and IgA antibodies bring eosinophils to the helminths and activate the eosinophils to release granule contents. The combined actions of mast cells and eosinophils lead to expulsion and destruction of the parasites (see Chapter 14). Production of specific IgE antibody and eosinophilia are frequently observed in infections by helminths. These responsesare attributed to the propensity of helminths to stimulate differentiation of naive CD4* helper T cells to the T,r2 subset of effector cells, which secrete IL-4 and IL-5. IL-4 stimulates the production of IgE, and IL-5 stimulates the development and activation of eosinophils. Eosinophils may be more effective at killing helminths than other leukocl.tes are because the major basic protein of eosinophil granules may be more toxic for helminths than the proteolytic enzymes and reactive oxygen intermediates produced by neutrophils and macrophages. The expulsion of some intestinal nematodes mav be due to Il-4-deoendent m e c h a n i s m ss u c h a s i n i r e a s e d p e r i s t a l s i st h a i d o n o t require IgE. Adaptive immune responses to parasites can also contribute to tissue injury. Some parasites and their products induce granulomatous responses with concomitant fibrosis. Schistosomamansoni eggs deposited in the liver stimulate CD4. T cells, which in turn activate macrophages and induce DTH reactions. DTH reactions result in the formation of granulomas around the eggs; an unusual feature of these granulomas, especially in mice, is the association with Tu2 responses.(Recallthat granulomas are generally induced by Tsl responses against persistent antigens; see Chapter 13.) Such Tr2induced granulomas may result from the process of "alternative" macrophage activation induced by IL-4 and IL-13 (see Chapter 13). The granulomas serve to contain the schistosome eggs,but severefibrosis associated with this chronic cell-mediated immune response leads to disruption of venous blood flow in the liver, portal hypertension, and cirrhosis. In lymphatic filariasis, lodging of the parasites in lymphatic vesselsleads to chronic cell-mediated immune reactions and ultimately to fibrosis. Fibrosis results in lymphatic obstruction and severe lymphedema. Chronic and persistent parasitic infestations are often associated with the formation of complexes of parasite antigens and specific antibodies. The complexes can be deposited in blood vessels and kidney glomeruli and produce vasculitis and nephritis, respectively (seeChapter 20). Immune complex disease is a complication of schistosomiasisand malaria.
lmmune
Evasion by Parasites
Parasites euade protectiue immunity by reducing their immunogenicity and W inhibiting host immune responses, Different parasites have developed remarkably effective ways of resisting immunity (Table 15-5). @ Parasiteschange their surface antigens during their life cycle in vertebrate hosts. TWo forms of antigenic variation are well defined. The first is a stage-specific change in antigen expression, such that the mature tissue stages of parasites produce different antigens than the infective stages do. For example, the infective sporozoite stage of malaria parasites is antigenically distinct from the merozoites that reside in the host and are responsible for chronic infection. By the time the immune system has responded to infection by sporozoites, the parasite has differentiated, expressesnew antigens, and is no longer a target for immune elimination. The second and more remarkable example of antigenic variation in parasites is the continuous variation of major surface antigens seen in African trlpanosomes such as Trypanosomabrucei and Trypano so ma rh odesi ense. Continuous antigenic variation in trypanosomes is probably due to programmed variation in expression of the genes encoding the major surface antigen. Infected individuals showwaves of blood parasitemia, and eachwave consists of parasites expressing a surface antigen that is different from the previous wave (Fig. 15-7). Thus, by the time the host produces antibodies against the parasite, an antigenically different organism has grown out. More than a hundred such waves of parasitemia can occur in an infection. One consequence of antigenic variation in parasites is that it is difficult to effectively vaccinate individuals against these infections. @ Parasitesbecome resistant to immune effector mechanisms during their residence in vertebrate hosts. Perhaps the best examples are schistosome larvae, which travel to the lungs of infected animals and
T a b l e1 5 - 5 .M e c h a n i s m so f l m m u n e E v a s i o n by Parasites
Mechanism of immune lExamples evasron Antigenic variation
Trypanosomes, Plasmodium
Schistosomes Acquiredresistance to complement, CTLs Inhibition to of hostimmuneFilaria(secondary lymphatic obstruction), responses trypanosomes
Antigenshedding
Entamoeba
Abbreviation;CTL, cytotoxicT lymphocyte.
C h a p t e1r5- I M M U N I TTY0 M I C R 0 B E S
Malariais a diseasecausedby a protozoanparasite/P/asm o d i u m )t h a t i n f e c t sm o r e t h a n 1 0 0 m i l l i o np e o p l ea n d c a u s e s1 t o 2 m i l l i o nd e a t h sa n n u a l l yI n f e c t i o ni s i n i t i a t e d w h e n s p o r o z o i t easr ei n o c u l a t eidn t ot h e b l o o ds t r e a mb y the bite of an infectedmosquito(Anopheles)The sporoz o i t e sr a p i d l yd i s a p p e afrr o m t h e b l o o da n d i n v a d et h e parenchyma l l l so f t h e l i v e r I n t h e h e p a t o c y t e s ,p o r o ce z o i t e s d e v e l o p i n t o m e r o z o i t e sb y a m u l t i p l ei-sf s i o n processtermed schrzogony. One to 2 weeks after infect i o n , t h e i n f e c t e dh e p a t o c y t e bs u r s t a n d r e l e a s et h o u s a n d so f m e r o z o i t e st ,h e r e b yi n i t i a t i n gt h e e r y t h r o c y t i c stageof the life cycle The merozoitesinvadered blood c e l l sb y a p r o c e s st h a t i n v o l v e sm u l t i p l el i g a n d - r e c e p t o r interactions,such as bindingof the P/asmodiumfalciparumproleinEBA-175to glycophorin A on erythrocytes M e r o z o i t ed s e v e l o ps e q u e n t i a l li yn t o r i n gf o r m s ,t r o p h o z o i t e s ,a n d s c h i z o n t se, a c h o f w h i c h e x p r e s s e sb o t h s h a r e da n d u n i q u ea n t i g e n sT. h e e r y t h r o c y t iccy c l ec o n t i n u e sw h e n s c h i z o n t - i n f e c t reedd b l o o dc e l l sb u r s ta n d releasemerozoitesthat invadeotherervthrocvtesSexual s t a g eg a m e t o c y t eds e v e l o pi n s o m e c e l l sa n d a r e t a k e n u p b y m o s q u i t o ed s u r i n ga b l o o dm e a l ,a f t e rw h i c h t h e y f e r t i l i z ea n d d e v e l o pi n t o o o c y s t s l m m a t u r es p o r o z o i t e s d e v e l o pi n t h e m o s q u i t o e sw i t h i n 2 w e e k s a n d t r a v e l , h e r e t h e y m a t u r ea n d b e c o m e t o t h e s a l i v a r yg l a n d s w infective T h e c l i n i c afl e a t u r e so f m a l a r i ac a u s e db y t h e f o u r speciesof Plasmodtum that infect humansincludefever c ans p i k e sa, n e m i aa, n ds p l e n o m e g a lM y a n yp a t h o l o g im i f e s t a t i o nos f m a l a r i am a y b e d u e t o t h e a c t i v a t i o o nf T c e l l sa n d m a c r o p h a g easn d p r o d u c t i oonf T N F T . h ed e v e l o p m e n t o f c e r e b r am l a l a r i ai n a m u r i n e m o d e l i s p r e ventedby depletionof CD4*T lymphocytes or by injection o f n e u t r a l i z i nagn t i - T N F antibody T h e i m m u n er e s p o n s teo m a l a r i a i s c o m p l e xa n ds t a g e s p e c i f i ct;h a t i s , i m m u n i z a t i owni t h a n t i g e n sd e r i v e df r o m sporozortes,merozoites,or gametocytesprotectsonly a g a i n s t h e p a r t i c u l asrt a g e .O n t h e b a s i so f t h i s o b s e r v a t i o n ,i t i s p o s t u l a t e tdh a t a v a c c i n ec o n s i s t i n g of comb i n e di m m u n o g e n iecp i t o p e sf r o m e a c ho f t h e s es t a g e s s h o u l ds t i m u l a t em o r ee f f e c t i v ei m m u n i t yt h a na v a c c i n e t h a t i n c o r p o r a t easn t i g e n sf r o m o n l yo n e s t a g e T h e b e s t c h a r a c t e r i z emda l a r i va a c c i n e as r ed i r e c t e da g a i n sst p o r o zoites.Becauseof the stage-specific natureof sporozoite a n t i g e n ss,u c hv a c c i n e m s u s tp r o v i d es t e r i l i z i ni g mmunity to be effective Protectiveimmunitvmav be inducedin h u m a n sb y i n j e c t i o no f r a d i a t i o n - i n a c t i v astpeodr o z o i t e s This type of protectionis partlymediatedby antibodies t h a t i n h i b i st p o r o z o i tien v a s i o n o f l i v e rc e l l si n v l t r o .S u c h a n t i b o d i e rse c o g n i z e t h e c i r c u m s p o r o z o i(tC e S )p r o t e i n , w h i c hm e d i a t e tsh e b i n d i n go f p a r a s i t etso l i v e rc e l l s T h e C S p r o t e i nc o n t a i n sa c e n t r a rl e g i o no f a b o u t4 0 t a n d e m r e p e a t so f t h e s e q u e n c eA s n - A l a - A s n - P( rNoA N P )w, h i c h m a k e s u p t h e i m m u n o d o m i n a nBt c e l l e p i t o p eo f t h e p r o t e i n A n t r - ( N A N P )ann t i b o d i e sn e u t r a l i z es p o r o z o i t e l roi n f e c t i v i t yb, u t s u c h a n t i b o d i e sp r o v i d eo n l y p a r t i a p t e c t i o na g a i n s ti n f e c t i o nT. h e a n t i b o d yr e s p o n s et o C S
p r o t e i ni s d e p e n d e not n h e l p e rT c e l l s .M o s t C S - s p e c i f i c h c l n e r T c e l l s rI vcv vrv:, o o n, , iL zv p e n i t n n c q | ,v'vv,
nrrtqidc the
NANP
r e g i o na, n d s o m e o f t h e s eT c e l le p i t o p e sc o r r e s p o ntdo , h i c hs u g t h e m o s t v a r i a b l er e s i d u e so f t h e C S p r o t e i nw g e s t st h a t v a r i a t i o no f t h e a n t i g e n so f t h e s u r f a c ec o a t m a y h a v e a r i s e n i n r e s p o n s et o s e l e c t i v ep r e s s u r e s i m p o s e db y s p e c i f i cT c e l lr e s p o n s e s C D 8 *T c e l l sp l a ya n i m p o r t a nrto l ei n i m m u n i t yt o t h e h e p a t i cs t a g e so f i n f e c t i o nl f s p o r o z o i t e - i m m u n i zmei dc e o f a n t i - C Da 8n t i a r ed e p l e t e do f C D 8 *T c e l l sb y i n j e c t i o n b o d i e s ,t h e y a r e u n a b l et o r e s i s ta c h a l l e n g ei n f e c t i o n . T, ,h, vc n rotc.tive v , v L v v L , v v
effects nf CDR* T r:ells marr hc mediated
hepatocytes or indiby directkillingof sporozoite-infected rectlyby the secretionof IFN-yand activationof hepatoc y t e s t o p r o d u c en i t r i co x i d ea n d o t h e r a g e n t st h a t k i l l p a r a s i t e sl L - 1 2 i n d u c e sr e s i s t a n c et o s p o r o z o i t ec h a l l e n g e i n r o d e n t sa n d n o n h u m a np r i m a t e s ,p r e s u m a b l y b y s t i m u l a t i n gI F N - yp r o d u c t i o nC. o n v e r s e l yr ,e s i s t a n c e mice to a oI Plasmodiumbergheisporozoite-immunized b y t r e a t m e n tw i t h a n t i c h a l l e n g ei n f e c t i o ni s a b r o g a t e d I F N - ya n t i b o d i e s T h e s e x u a lb l o o d s t a g e o f m a l a r i ai s a n i m p o r t a n t t , h e m a j o rg o a l o f t h i s t a r g e tf o r v a c c i n ed e v e l o p m e n T f o r m o f i m m u n i z a t i oins t o g e n e r a t ea n t i b o d i e tsh a t k i l l infectederythrocytesor blockmerozoiteinvasionof new s ount strong r e d c e l l s A l t h o u g hi n f e c t e di n d i v i d u a l m i m m u n er e s p o n s e a s g a i n s tb l o o ds t a g ea n t i g e n sd u r i n g , o s t o f t h e s e r e s p o n s e sd o n a t u r am l a l a r i ai n f e c t i o n sm not appearto affect parasitesurvivalor to result in the , me s e l e c t i o no f n e w a n t i g e n i vc a r i a n t sN e v e r t h e l e s s o merozoiteproteinsmay be good vaccinecandidatesOf p a r t i c u l ai n r t e r e s its t h e m a j o rm e r o z o i t e s u r f a c ea n t i g e n M S P - 1 ,w h i c h c o n t a i n sa h i g h l y c o n s e r v e dc a r b o x y t NAn i t h r e c o m b i n a nD t e r m i n a lr e g i o n l m m u n i z a t i o w peptides has been shown to derived carboxy-terminal c o n f e rs i g n i f i c a npt r o t e c t i o na g a i n s tm a l a r i ai n r o d e n t s a n d h a s s h o w n p r o m i s i n gr e s u l t si n p r i m a t et r i a l sw i t h a a r a s i t set r a i n sT h er e s i s t a n cien d u c e db y h u m a nm a l a r i p MSP-1vaccinationappearsto involveantibody-dependent mechanrsms T r a n s m i s s i o n - b l o c kvi a n cgc i n e sa r e b e i n g d e v e l o p e d to act on stagesof the parasitelife cyclethat are found i n m o s q u i t o e sS u c hv a c c i n e sp r o v i d en o p r o t e c t i o nf o r i n d i v i d u ablu t a c t t o r e d u c et h e n u m b e ro f an immunized p a r a s i t e sa v a i l a b l ef o r d e v e l o p m e n ti n t h e m o s q u i t o v e c t o r O n e s u c h v a c c i n ei s a n a n t i g e n ,P f s 2 5 ,t h a t i s l o c a t e do n t h e s u r f a c eo f z y g o t e sa n d o o k i n e t e sa n d i s i n v o l v e di n p a r a s i t ei n v a s i o no f m o s q u i t og u t e p i t h e l i u m e n t i g e nt,h e d g a i n stth i sp a r a s i t a I n i n d i v i d u ailm s m u n i z ea a n t i b o d i e st h a t d e v e l o pa r e i n g e s t e db y t h e m o s q u i t o d u r i n ga b l o o dm e a la n d b l o c kt h e a b i l i t yo f t h e p a r a s i t e t o i n f e c ta n d m a t u r ei n t h e m o s q u i t o T h e s e p a r a s i t e s t a g e sa r ef o u n do n l y i n t h e m o s q u i t ov e c t o ra n da r e n o t e x p o s e dt o h o s t i m m u n e r e s p o n s e sT h e r e f o r e ,t h e i n t h e m o s q u i t od o n o t u n d e r g ot h e a n t i g e n se x p r e s s e d h l g hr a t e so f v a r i a t i otnh a ta r et y p i c aol f i m m u n o d o m i n a n t p a r a s i t ea n t i g e n si n t h e v e r t e b r a t e host
This box was writtenwith the assistance of Drs Alan Sherand LouisMiller,NatlonalInstltutesof Health,Bethesda,Maryland
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VSection
IMMUNITY lN DEFENSE ANDDISEASE
FIGURE 15-7 Antigenic variation in trypanosomes. In a mouseinfectedexperimentally with a single clone of T. rhodesiense,the blood parasite countsshow cyclicwaves Eachwave is due to a new antigenicvariantof the parasite(labeled variants A, B, and C) that expressesa new variablesurface (VSG,the immunodominant glycoprotein antigenof the parasite), and each declineis a resultof a specific antibodyresponseto that variant (Courtesy of Dr John Mansfield,Universitvof Wisconsin, Madison)
during this migration develop a tegument that is resistant to damage by complement and by CTLs.The biochemical basis of this change is not known. o Protozoan parasitesmay conceal themselvesfrom the immune system either byliving inside host cells or by developing cysts that are resistant to immune effectors. Some helminthic parasites reside in intestinal lumens and are sheltered from cell-mediated immune effector mechanisms. Parasites may also shed their antigenic coats, either spontaneously or after binding specific antibodies. Shedding of antigens renders the parasites resistant to subsequent antibody-mediated attack. o Parasitesinhibit host immune responsesby multiple mechanisms. T cell anergy to parasite antigens has been observed in severeschistosomiasisinvolving the liver and spleen and in filarial infections. The mechanisms of immunologic unresponsiveness in these infections are not well understood. In lymphatic filariasis, infection of l}'rnph nodes with subsequent architectural disruption may contribute to deficient immunity. Some parasites, such as Leishmania, stimulate the development of CD25* regulatory T cells, which suppress the immune response enough to allow persistence of the parasites. More nonspecific and generalized immunosuppression is observed in malaria and African trypanosomiasis. This immune deficiency has been attributed to the production of immunosuppressive cytokines by activated macrophages and T cells and defects in T cell activation. The worldwide implications of parasitic infestations for health and economic development are well appreciated. Attempts to develop effective vaccines against these infections have been actively pursued for many years. Although the progress has been slower than one would have hoped, elucidation of the fundamental mechanisms of immune responses to and immune evasion by parasites holds promise for the future.
FoB Drvruopnarur SrnRrrurs Vnccrur The birth of immunology as a sciencedates from Edward Jenner'ssuccessfulvaccination against smallpox in 1796. The importance of prophylactic immunization against infectious diseases is best illustrated by the fact that worldwide programs of vaccination have led to the complete or nearly complete eradication of many of these diseases in developed countries (see Chapter l, Table 1-1). The successof actiue immunization in eradicating infectious dkease is d,ependent on numerous factors: O Vaccines are effective if the infectious agent does not establish latency, if it does not undergo much or any antigenic variation, and if it does not interfere with the host immune response. It is difficult to effectively vaccinate against microbes such as HI\{ which establishes latent infection, is highly variable, and disables key components of the immune system. O Vaccines are most effective against infections that are limited to human hosts, and do not have animal reservoirs. Vaccines induce protection against infections by stimulating the development of antibodies, long-lived effector cells, and memory cells. Most vaccines in routine use today work by inducing humoral immunity, and attempts to stimulate cell-mediated immune responsesby vaccination are ongoing. In the following section, we summarize the approaches to vaccination that have been tried (Table 15-6) and their major value and limitations.
Attenuated
and Inactivated
Bacterial
and Viral Vaccines Vaccines composed of intact nonpathogenic microbes are made by treating the microbe in such a way that it can no longer cause disease (i.e.,its virulence is attenu-
T:',T:i::::__ 15- TMMUNTTY chapter ,_::
Table 15-6. VaccineApproaches
Typeof vaccine
I Examples
Liveattenuated or killedbacteria Liveattenuated viruses (antigen) Subunit vacctnes vaccines Conjugate
BCG, cholera
Polio,rabies Tetanus toxoid,diphtheria toxoid Haemophilusinfluenzae, oneumococcus
vaccines Synthetic
(recombinant Hepatitis proteins)
Viralvectors
Clinicaltrials of HIV antigensin canarypox vector
DNAvaccines
Clinicaltrialsongoingfor severalinfections
Abbreviations; BCG,bacillus Calmette-Gu6rin, HlV,humanimmunodeficiency virus.
Vaccinescomposed of bacterial polysaccharide antigens are used against Pneumococcus and H. influenzae. Because polysaccharides are T-independent antigens, they tend to elicit low-affinity antibody responses,and may be poorly immunogenic in infants (who do not mount strong T cell-independent antibody responses). High-affinity antibody responses may be generated against polysaccharide antigens even in infants by coupling the polysaccharides to proteins to form conjugate vaccines. Such vaccines work like hapten-carrier conjugates and are an excellent practical application of the principle of T-B cell cooperation (see Chapter l0). The currently used H. influezae, pneumococcal, and meningococcal vaccines are conjugate vaccines. Purified protein vaccines stimulate helper T cells and antibody responses,but they do not generate potent CTLs. The reason for poor CTL development is that exogenous proteins (and peptides) are inefficient at entering the classI MHC pathwayof antigenpresentation and cannot readily displace peptides from surface class I molecules. As a result, protein vaccines are not recognized efficiently by class I-restricted CD8* T cells.
Synthetic Antigen Vaccines ated) or by killing the microbe while retaining its immunogenicity. The great advantage of attenuated microbial vaccines is that they elicit all the innate and adaptive immune responses (both humoral and cellmediated) that the pathogenic microbe would, and they are therefore the ideal way of inducing protective immunity. Live, attenuated bacteria were first shown by Louis Pasteur to confer specific immunity. The attenuated or killed bacterial vaccines in use today generally induce Iimited protection and are effective for only short periods. Live, attenuated viral vaccines are usually more effective; polio, measles,and yellow fever are three good examples. The most frequently used approach for producing such attenuated viruses is repeated passage in cell culture. More recently, temperature-sensitive and deletion mutants have been generated with the same goal in mind. Viral vaccines often induce long-lasting specific immunity, so immunization of children is sufficient for lifelong protection. Some attenuated viral vaccines (e.9., polio) may cause disease in immunecompromised hosts, and for this reason inactivated poliovirus vaccines are now more commonly used. Purified
Antigen
{Subunit}
ccines
Subunit vaccines are composed of antigens purified from microbes or inactivated toxins and are usually administered with an adjuvant. One effective use of purified antigens as vaccines is for the prevention of diseasescaused by bacterial toxins. Toxins can be rendered harmless without loss of immunogenicity, and such "toxoids" induce strong antibody responses.Diphtheria and tetanus are two infections whose life-threatening consequences have been largely controlled because of immunization of children with toxoid preparations.
A goal of vaccine research has been to identify the most immunogenic microbial antigens or epitopes, to synthesize these in the laboratory, and to use the synthetic antigens as vaccines.It is possible to deduce the protein sequences of microbial antigens from nucleotide sequence data and to prepare large quantities of proteins by recombinant DNA technology.Vaccinesmade of recombinant DNA-derived antigens are now in use for hepatitis virus, herpes simplex virus, and foot-andmouth disease virus (a major pathogen for livestock), and are being tested for human papilloma virus and rotavirus.
Live Viral
ctors
Another approach for vaccine development is to introduce genes encoding microbial antigens into a noncytopathic virus and to infect individuals with this virus. Thus, the virus serves as a source of the antigen in an inoculated individual. The great advantage of viral vectors is that they, like other live viruses, induce the full complement of immune responses, including strong CTL responses.This technique has been used most commonly with vaccinia virus vectors. Inoculation of such recombinant viruses into many species of animals induces both humoral and cell-mediated immunity against the antigen produced by the foreign gene (and, of course, against vaccinia virus antigens as well). A potential problem with viral vectors is that the viruses may infect various host cells, and even though they are not pathogenic, they may produce antigens that stimuIate CTL responsesthat kill the infected host cells.These and other safety concerns have limited widespread use ofviral vectors for vaccine deliverY.
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I M M U N I Tl N Y DEFENS AE N DD I S E A S E
d
DNA Vaccines An interesting method of vaccination was developed on the basis of an unexpected observation. Inoculation of a plasmid containing complementary DNA (cDNA) encoding a protein antigen leads to strong and longIived humoral and cell-mediated immune responsesto the antigen. It is likely that APCs, such as dendritic cells, are transfected by the plasmid and the cDNA is transcribed and translated into immunogenic protein that elicits specific responses. The unique feature of DNA vaccines is that they provide the only approach, other than live viruses, for eliciting strong CTL responses because the DNA-encoded proteins are synthesized.in the cltosol of transfected cells. Furthermore, bacterial plasmids are rich in unmethylated CpG nucleotides and are recognized by a TLR (TLR9) on macrophages and other cells, thereby eliciting an innate immune response that enhances adaptive immunity (see Chapter 2). Therefore, plasmid DNA vaccines are effective even when they are administered without adjuvants.The ease of manipulating cDNAs to express many diverse antigens, the ability to store DNA without refrigeration for use in the fleld, and the ability to co-expressother proteins that may enhance immune responses (such as cl.tokines and costimulators) make this technique promising. However, DNA vaccines have not been as effective as hoped in clinical trials, and the factors that determine the efficacy of these vaccines, especially in humans, are still not fullv defined. Adjuvants
and lmmunomodulators
The initiation of T cell-dependent immune responses against protein antigens requires that the antigens be administered with adjuvants. Most adjuvants elicit innate immune responses,with increased expression of costimulators and production of cytokines such as IL-12 that stimulate T cell growth and differentiation. Heatkilled bacteria are powerful adjuvants that are commonly used in experimental animals. However, the severe local inflammation that such adjuvants trigger precludes their use in humans. Much effort is currently being devoted to development of safe and effective adjuvants for use in humans. Severalare in clinical practice, including aluminum hydroxide gel (which appears to promote B cell responses)and lipid formulations that are ingested by phagocytes.An alternative to adjuvants is to administer natural substancesthat stimulate T cell responses together with antigens. For instance, lL-12 incorporated in vaccines promotes strong cell-mediated immunity and is being tested in early clinical trials. As mentioned, plasmid DNA has intrinsic adjuvant-like activities, and it is possible to incorporate costimulators (e.g., 87 molecules) or cltokines into plasmid DNA vaccines. Passive lmmunization Protective immunity can also be conferred by passive immunization, for instance, by transfer of specific anti-
bodies. In the clinical situation, passiveimmunization is most commonly used for rapid treatment of potentially fatal diseasescaused by toxins, such as tetanus, and for protection from rabies and hepatitis. Antibodies against snake venom can be lifesaving treatments of poisonous snakebites.Passiveimmunity is short-lived because the host does not respond to the immunization and protection lasts only as long as the injected antibody persists. Moreover, passive immunization does not induce memory, so an immunized individual is not protected against subsequent exposure to the toxin or microbe.
SUMMARY @ The interaction of the immune system with infectious organisms is a dlmamic interplay of host mechanisms aimed at eliminating infections and microbial strategies designed to permit survival in the face of powerful defense mechanisms. Different types of infectious agents stimulate distinct types of immune responses and have evolved unique mechanisms for evading immunity. In some infections, the immune responseis the cause of tissue injury and disease. @ Innate immunity against extracellular bacteria is mediated by phagocytes and the complement system (the alternative and lectin pathways). @ The principal adaptive immune response against extracellular bacteria consists of specific antibodies that opsonize the bacteria for phagocltosis and activate the complement system. Toxins produced by such bacteria are also neutralized by specific antibodies. Some bacterial toxins are powerful inducers of cytokine production, and cytokines account for much of the systemic disease associated with severe, disseminated infections with these microbes. I
Innate immunity against intracellular bacteria is mediated mainly by macrophages. However, intracellular bacteria are capable of surviving and replicating within host cells, including phagocytes, because they have developed mechanisms for resisting degradation within phagocytes.
A Adaptive immunity against intracellular bacteria is principally cell mediated and consists of activation of macrophages by CD4*T cells (asin DTH) aswell as killing of infected cells by CD8* CTLs.The characteristic pathologic responseto infection byintracellular bacteria is granulomatous inflammation. @ Protective responses to fungi consist of innate immuniry mediated by neutrophils and macrophages, and adaptive cell-mediated and humoral immunity. Fungi are usually readily eliminated
15Chaoter
by phagocytes and a competent immune system, because of which disseminated fungal infections are seen mostly in immunodeficient persons. 6 Innate immunity against viruses is mediated by type I IFNs and NK cells. Neutralizing antibodies protect against virus entry into cells early in the course of infection and later if the viruses are released from killed infected cells. The major defense mechanism against established infection is CTl-mediated killing of infected cells. CTLs may contribute to tissue injury even when the infectious virus is not harmful by itself. Viruses evade immune responses by antigenic variation, inhibition of antigen presentation, and production of immunosuppressive molecules. o Parasites such as protozoa and helminths give rise to chronic and persistent infections because innate immunity against them is weak and parasites have evolved multiple mechanisms for evading and resisting specific immunity. The structural and antigenic diversity of pathogenic parasites is reflected in the heterogeneity of the adaptive immune responsesthat they elicit. Protozoa that live within host cells are destroyed by cell-mediated immunity, whereas helminths are eliminated by IgE antibody and eosinophilmediated killing as well as by other leukocytes. Parasites evade the immune system by varying their antigens during residencein vertebrate hosts, by acquiring resistance to immune effector mechanisms, and by masking and shedding their surface antigens.
Selected
Readings
Antoniou AN, and SJPowis.Pathogenevasionstrategiesfor the major histocompatibilitycomplexclassI assemblypathway. Immunology 124:l-L2, 2008. BakerMD, and KRAcharya.Superantigens:structure-function InternationalJournalof MedicalMicrobiology relationships. 293:529-537,2004. Burton DR. Antibodies,virusesand vaccines.NatureReviews Immunology2:7O6-713,2002. Casanova J-L,and L Abel.The human model:a geneticdissection of immunity to infection in natural conditions. Nature ReviewsImmunology4:55-66,2004. Doherty PC, and IP Christensen.Accessingcomplexity:the Annual Review dlmamicsof virus-specificT cell responses. of ImmunologylB:561-592, 2000. DonnellyJJ,B Wahren,and MA Liu. DNA vaccines:progress 2005. and challenges. Journalof Immunology175:633-639,
IMMUNITY T0 MICROBES
Finlay BB, and G McFadden. Anti-immunology: evasion of the host immune system by bacterial and viral pathogens. Cell 124:767-782,2006. Fllnn IL, and I Chan. Immune evasion by Mycobacterium tuberculosis: living with the enemy. Current Opinion in Immunology I5:450-455, 2003. Good ME H Xu, M Wykes, and CR Engwerda. Development and regulation of cell-mediated immune responsesto the blood stages of malaria: implications for vaccine research. Annual Review of Immunology 23:69-99, 2005. Guidotti LG, and FV Chisari. Noncl'tolytic control of viral infections by the innate and adaptive immune response. Annual Review of Immunology 19:65-91,2001. Kaufmann SHE. Tuberculosis: back on the immunologists' agenda. Immunity 24:35r-357, 2006. Kaufmann SHE, and AJ McMichael. Annulling a dangerous liaison: vaccination strategiesagainstAIDS and tuberculosis. Nature Medicine l1:533-44, 2005. Kawai T, and S Akira. Innate immune recognition of viral infection. Nature Immunology 7:I3l-I37, 2006. Klenerman B and A Hill. T cells and viral persistence: lessons from diverse infections. Nature Immunology 6:873-879' 2005. Langhorne j, FM Ndungu, A-M Sponaas,and K Marsh. Immunity to malaria: more questions than answers. Nature Immunology 9:725-7 32, 20O8. Lybarger L, X Wang, MR Harris, HW Virgin, and TH Hansen' Virus subversion of the MHC class I peptide-loading complex. Immunity 1B:121-130, 2003. McCulloch R. Antigenic variation in African trypanosomes: monitoring progress. Trends in Parasitology 20:ll7-l2l' 2004. Munford RS. Severesepsis and septic shock: the role of gramnegative bacteria. Annual Review of Pathology: Mechanisms of Disease l:467 -495, 2006. North RL and Y-J Iung' Immunity to tuberculosis. Annual Review of Immunology 22:599-623, 2004. PearceEL and AS MacDonald. The immunobiology of schistosomiasis. Nature Reviews Immunology 2:499-511, 2002. PerryAK, G Chen, D Zheng, H Tang, and G Cheng. The host type I interferon response to viral and bacterial infections. Cell Research 15:407-422, 2005. Romani L. Immunity to fungal infections. Nature Reviews Immunology 4:l-23, 2004. Sacks D, and N Noben-Trauth. The immunology of susceptibility and resistance to Leishmania maior in mice. Nature Reviews Immunology 2:845-858, 2002. Seet BT, IB Iohnston, CR Brunetti, IW Barrett, H Everett, C Cameron, I Slpula, SH Nazarian, A Lucas, and G McFadden. Poxviruses and immune evasion' Annual Review of Immunology 2l'.377-423, 2003. Van Lier RAW UM ten Berge,and LE Gamadia. Human CDB*T cell differentiation in response to viruses. Nature Reviews Immunology 3:931-939,2003. Wong B and EG Pamer. CDB T-cell responses to infectious pathogens.Annual Review of Immunology 2I'.29-70,2003. Zinkernagel RM. On natural and artificial vaccinations. Annual Review of Immunology 2l:515-546, 2003.
lmmune Responses to Allografts,377 Recognition of Alloantigens, 377 Activationof Al loreactive Lymphocytes,381 Effector Mechanisms of Allograft Rejection,382 Hyperacute Rejection, 383 AcuteRejection, 384 GraftVasculopathy and Chronic Rejection,387 Prevention and Treatment of Allograft Rejection,387 lmmunosuppression to Preventor to Treat AllograftRejection, 387 Methodsto Reducethe lmmunogenicity of Allografts,389 Methodsto InduceDonor-Specific Tolerance, 391 Xenogeneic Transplantation, 391 Bfood Transfusion, S92 Bone Marrow Transplantation, 393 Disease,394 Graft-Versus-Host lmmunodeficiency afterBoneMarrow Transplantation, 394 Summary,395 Transplantationis the processoftaking cells,tissues,or organs,calleda graft, from one individual and placing them into a (usuall9 differentindividual.The individual who providesthe graft is calledthe donor, and the individual who receivesthe graft is calledeither the recipient or the host. If the graft is placed into its normal
the procedure is called heterotopic man$pJantatio Transfusion refers to the transfer of cirCrrlatirrgblat cells or plasrna from one individual to anctfigr; In'clfud.' cal practice, transplantation is used to overeornea functional or anatomic deficit in the recipient.Thie approach to treatment of human diseaseshas increased steadily during the past 40 years, and transplantation ofkidneys, hearts, lungs, livers, pancreata, and bone marrow is widely used today. More than 30,000kidney' 5964, lungr liver, and pancreas transplantations are currently performed in the United States each year. In addition, transplantation of many other organs or cells is now being attempted. A maj or factor limiting the successof transplantation is the immune response of the recipient to the donor tissue. This problem was first appreciated when attempts to replace damaged skin on burn patients with skin from unrelated donors proved to be uniformly unsuccessful.During a matter of I to 2 weeks, the transplanted skin would undergo necrosis and fall off' The failure of the grafts led Peter Medawar and many other investigators to study skin transplantation in animal models. These experiments established that the failure of skin grafting was caused by an inflammatory reaction called rejection. Severallines of experimental evidence indicated that rejection is caused by an adaptive immune response(Fig. 16-l). A skin graft transplanted between geneticallyunrelated individuals,for example,from a strain A mouse to a strain B mouse,is rejectedby a naive recipient in 7 to 10 days.This processis called first-set rejection and is due to a primary immune responseto the graft. A subsequentskin graft transplantedfrom the same donor to the original recipient is rejected more rapidly,in only 2 or 3 days.This acceleratedresponse, called second-setrejection, is due to a secondary immune response.Thus, grafts that are genetically disparate from the recipients induce immunologic memory, one of the cardinal features of adaptive lmmune resDonses.
375
S e c t i oVn-
I M M U N I Tl N Y D E F E NA SN E DD I S E A S E
Donor
Donor
Skin
(StrainB injected (StrainB sensitized Recipient with Recipient lymphocytes fromstrainA animal by previousgraftfromstrain that has rejecteda strainB graft) A donor) m
H
w Graftrejection 3
Yes Second-setrejection
Second-setrejection
Graftrejection Dav10 First-setreiection FIGURE 16-1 First'and second-setallograftreiection.Resultsof the experimentsshown indicatethat graft rejectiondisplaysthe features of adaptivelmmuneresponses,namely,memoryand mediationby lymphocytesAn inbredstrainB mousewill relecta graftfrom an inbredstrainA mouse with first-setkinetics(leftpanel) An inbredstrainB mouse sensitizedby a previousgraft from an inbredstrainA mouse will reject a secondgraft from an inbredstrainA mouse with second-setkinetics(middtepanel),demonstratingmemory An inbred strainB mouseinjectedwith lymphocytesfrom anotherstrainB mousethat has rejecteda graft from a strainA mousewill rejecta graft from a strainA mousewith second-setkinetics(rightpanel),demonstrating the roleof lymphocytesin mediatingrejectionand memory An inbredstrainB mousesensitized by a previousgraftfrom a strainA mousewill rejecta graftfrom a third unrelatedstrainwith first-setkinetics,thus demonstrating (notshown) Syngeneicgraftsare neverrejected(not shown) anotherfeatureof adaptiveimmunity,specifrcity
Second-setrejection ensuesif the first and second skin grafts are derived from the same donor or from genetically identical donors, for example, strain A mice. However, if the second graft is derived from an individual unrelated to the donor of the flrst graft, for example,strain C, no second-setrejectionoccurs;the new graft elicits only a first-set rejection. Thus, the phenomenon of second-setrejection shows specificiry another cardinal feature of adaptive immune responses. The ability to mount second-set rejection against a graft from strain A mice can be adoptively transferred
to a naive strain B recipient by li..rnphocytestaken from a strain B animal previously exposed to a graft from strain A mice. This experiment demonstrated that second-set rejection is mediated by sensitized ly.rnphocytes and provided the definitive evidence that rejection is the result of an adaptive immune response. Transplant immunologists have developed a special vocabulary to describe the kinds of cells and tissues encountered in the transplant setting. A graft transplanted from one individual to the same individual is called an autologous graft (shortened to autograft). A
; IMMUN0L0GY 16- TRANSPLANTATI0.N Chapter & 377 graft transplanted between two genetically identical or slmgeneic individuals is called a syngeneic graft. A graft transplanted between two genetically different individuals of the same speciesis called an allogeneic graft (or allograft). A graft transplanted between individuals of different species is called a xenogeneic graft (or xenograft). The molecules that are recognized as foreign on allografts are called alloantigens, and those on xenografts are called xenoantigens. The lymphocltes and antibodies that react with alloantigens or xenoantigens are described as being alloreactive or xenoreactive, respectively. The immunology of transplantation is important for tvvo reasons. First, the immunologic rejection response is still one of the major barriers to transplantation today. Second, although an encounter with alloantigens is unlikely in the normal life of an organism, the immune response to allogeneic molecules is strong and has therefore been a useful model for studying the mechanisms of lymphoclte activation. Most of this chapter focuses on allogeneic transplantation because it is far more commonly practiced and better understood than xenogeneic transplantation, which is discussedbriefly at the end of the chapter. We consider both the basic immunology and some aspectsof the clinical practice of
Donor(StrainA)
Donor(StrainB)
transplantation.We concludethe chapterwith a discussion of bone marrow transplantation, which raises specialissuesnot usuallyencounteredwith solid organ transplants.
ro AtLocRAFrs luuururRrsporusrs Alloantigens elicit both cell-mediated and humoral immune responses. In this section of the chapter, we discuss the molecular and cellular mechanisms of allorecognition, with an emphasis on the nature of graft antigens that stimulate allogeneic responses and the features of the responding ll,rnphocytes.
Recognition
of Alloantigens
Recognition of transplnnted, cells as self or foreign is determined by polymorphic genes that are inherited from both parents and are expressed codominantly. This conclusion is based on the results of experimental transplantation between inbred strains of mice. The basic rules of transplantation immunology are derived from such animal experiments (Fig. 16-2).
Donor(StrainB)
Donor(StrainAxB)
w Recipient (StrainA,
Recipient (StrainA,
MHCA)
No Fully allogeneic graft is
Graftfrom inbred parentalstrain is not reiectedby F1hybrid
Graftfrom F1hybrid is rejectedby inbred parentalstrain
the two differentmousecolorsrepresentinbredstrainswith different FIGURE 16-2 The geneticsof graft rejection.In the illustration, expressedin the skinof an A x B offspring,andthereforethese MHC haplotypes. InheritedMHC allelesfrom both parentsare codominantly mice are representedby both colors.Syngeneicgraftsare not rejected(A).Allograftsare alwaysrejected(B).Graftsfrom a parentof an A x B matingwill not be rejectedby the offspring(C),but graftsfrom the offspringwill be rejectedby eitherparent(D) Thesephenomena for graft relection;graftsare rejectedonly if they expressan MHC type (repare due to the fact that MHC gene productsare-responsible resentedby a color)that is not expressedby the recipientmouse
37a :.r}1r!@,;r.
Section V- IMMUNITY lN DEFENSE ANDDTSEASE
I
6
Cells or organs transplantgd between individuals of the sameinbred strain of a speciesare never rejected. Cells or organs transplanted between individuals of different inbred strains of a speciesare almost always rejected. The offspring of a mating between two different inbred strains will typically not reject grafts from either parent. In other words, an (A x B)F, animal will not reject grafts from an A or B strain animal. (This rule is violated by bone marrow transplantation, which we will discuss later in the chapter.) A graft derived from the offspring of a mating between two different inbred strains will almost always be rejected by either parent. In other words, a graft from an (A x B)F, animal will be rejected by either an A or a B strain animal. Such experimental results suggested that polymorphic, codominantly expressed molecules in the grafts were responsible for eliciting rejection. Polymorphism refers to the fact that these graft antigens differed among individuals of a species or between different inbred strains of animals, for example, between strain A and strain B mice. Codominant expression means that an (A x B)F, animal expressesboth A strain and B strain alleles. (A x B)Fr animals see both A and B tissues as seli and A or B animals see (A x B)F, tissues as partly foreign. This is why an (A x B)F, animal does not reject either A or B strain grafts and why both A and B strain recipients reject an (A x B)F1graft. Major histocompatibility complex (MHC) molecules are responsible for almost all strong (rapid) rejection reactions. George Snell and colleagues used congenic strains of inbred mice to identify the MHC complex as the locus of polymorphic genes that encode the molecular targets ofallograft rejection (seeChapter 5, Fig. 5-2).
@
Because MHC molecules, the targets of allograft rejection, are widely expressed, many different kinds of tissues evoke responses from alloreactive T cells. As discussed in Chapters 5 and 6, MHC molecules play a critical role in normal immune responsesto foreign antigens, namely, the presentation of peptides derived from protein antigens in a form that can be recognized by T cells. The role of MHC molecules as alloantigens is incidental, as discussed later. Allogeneic MHC molecules are presented for recognition by the T cells of a graft recipient in two fundamentally different ways (Fig. 16-3). The first way, called direct presentation, involves recognition of an intact MHC molecule displayed by donor antigen-presenting cells (APCs) in the graft and is a consequence of the similarity in structure of an intact foreign (allogeneic) MHC molecule and self MHC molecules. Therefore, direct presentation is unique to foreign MHC molecules. The second way, called indirect presentation, involves processing of donor MHC molecules by recipient APCs and presentation of peptides derived from the allogeneic MHC molecules in associationwith self MHC molecules. In this case, the foreign MHC molecule is handled as though it were any foreign protein antigen, and the mechanisms of indirect antigen presentation are the same as the mechanisms of presentation of a microbial protein antigen. Alloantigens other than MHC molecules in a graft can also be presented to host T cells by the indirect pathway. We discuss the molecular basis of direct and indirect presentation separately.
Direct Recognition
of Alloantigens
Direct recognition of foreign MHC molecules is a crossreaction of a normal T cell receptor (TCR), which was selected to recognize a self MHC molecule plus foreign
oir""t alloantigenrecognition
Allogeneic antigenpresenting cellin graft
Alloreactive T cell
cell recognizes unprocessed allogeneic MHCmolecule on APC
Indirectalloantigenrecognition Alloreactive T cell
Peptidederived from allogeneic MHC molecule
Presentation of processedpeptide of allogeneic MHCmoleculebound to self MHCmolecule
FIGURE 16-3 Directandindirect alloantigenrecognition.A Direct alloantigen recognition occurswhen T cells bind directlyto an intact a l l o g e n e i cM H C m o l e c u l e o n a graft (donor)antigen-presenting cell (APC)B. Indirectalloantigen recognitionoccurswhen allogeneic MHC moleculesfrom graftcellsaretaken up and processed by recipient APCs, and peptide fragments of t h e a l l o g e n e iM c H C m o l e c u r ecso n taining polymorphic amino acid residuesare bound and presented by recipient(self)MHC molecules
peptid.e, with an allogenefu MHC molecule plus peptide. On face value, it seems puzzlingthat T cells that are normally selected to be self MHC restricted are capable of recognizing foreign MHC molecules.The explanation for this apparent paradox is related to the fact that the repertoire of TCR specificities is already biased to recognize any MHC molecule, even before selection. In other words, the TCR genes have evolved to encode a protein structure that has intrinsic affinity for MHC molecules. DuringT cell development in the thymus, positive selection results in survival of T cells with weak self-MHC reactivity, but does not eliminate T cells with strong reactivity to allogenic MHC molecules. Negative selection in the thymus efficiently eliminates T cells with high affinity for self MHC, but again does not necessarily eliminate T cells that bind strongly to allogeneic MHC molecules, unless they also happen to bind strongly to self MHC. The result is a mature repertoire that has an intrinsic affinity for self MHC molecules, which includes many T cells that bind allogeneic MHC molecules with high affinity. Many of these mature T cells will strongly bind both self MHC-foreign peptide complexes and allogeneic MHC molecules. By chance, some may be uselessT cells that bind allogenic MHC molecules but do not bind strongly to self-MHC-foreign peptide complexes. An allogeneic MHC molecule with a bound. peptide can mimic the determinant formed by a self MHC molecule plus a particular foreign pepti.de (Fig. 16-4) . MHC molecules that are expressedon cell surfaces normally contain bound peptides. The peptides bound to allogeneic MHC molecules may play several roles in the recognition of these molecules. Peptides may simply be required for stable cell surface expression of the allogeneic MHC molecules. However, some alloreactive T cell clones have been shown to recognize allogeneic MHC molecules with some, but not other, bound peptides. This observation suggests that the peptide contributes to the determinant recognized by the alloreactive T cell, exactly like the role of peptides in the normal recognition of antigen by self MHC-restricted T cells. Many of the peptides associated with allogeneic MHC molecules that are involved in direct presentation are derived from proteins that are identical in the donor and recipient. In other words, they are self peptides. The mechanisms of tolerance induction, described in Chapter 11,work only to eliminate or to inactivate T cells that respond to complexes of self peptides plus self MHC molecules.Therefore,T cells specific for self peptide plus
@ trtormal
Self MHCmoleculepresentsforeignpeptide to T cell selectedto recognizeself MHCweakly,but may recognizeself MHC-foreignpeptidecomplexeswell
@nltorecognition
Self peptide
T cell recognizes The self MHC-restricted the allogeneicMHCmoleculewhose structureresemblesa self MHC-foreign peptidecomPlex
@lltorecognition
Self peptide FIGURE 16-4 Molecular basis of direct recognitionol allogeneicMHGmolecules.Directrecognition MHC molof allogeneic in which a T cell ecules may be thought of as a cross-reaction peptidecomplex(A)also specificfor a self MHC molecule-foreign recognizesan allogeneicMHC molecule(8, C) Nonpolymorphic " may not contributeto donor peptides,labeled "self peptide, (B),or they may (C) allorecognition
T cell recognizesa The self MHC-restricted structurefor ed by both the allogeneic MHCmolec e and the bound Peptide
tt:
t_..'::::'"
v - TMMUNTTY rNDEFENSE ANDDTSEASE
allogeneic MHC are not removed from the repertoire and are available to respond to allografts. As many as 2Voof an indiuid.ual's T celk are capable of directly recognizing and responding to a singLe foreign MHC molecule, and this highfrequency ofT cells reactiue with allogeneic MHC molecules is one reason that allografts elicit strong immune responses in uiuo. The fact that each allogeneic MHC molecule is directly recognized by so many different TCRs,each selected for different foreign peptides, may be due to severalfactors. € The highly polymorphic nature of the MHC implies that an allogeneic MHC molecule will differ from self MHC molecules at multiple amino acid residues. Because many of the polymorphic residues are concentrated in the regions that bind to the TCR, each different residue may contribute to a distinct determinant recognized by a different clone of self MHC-restricted T cells. Thus, each allogeneic MHC molecule can be recognized by multiple T cell clones. In this case,the cross-reactiveT cell allorecognition is entirely attributable to differences in amino acid sequences between self MHC and allogeneic MHC molecules, and bound peptide serves only to ensure stable expression of the allogeneic MHC molecule. @ Many different peptides may combine with one allogeneic MHC gene product to produce determinants that are recognized by different cross-reactiveT cells. The surface of each allogeneic cell has 105or more copies of each allogeneic MHC molecule, and each MHC molecule can form a complex with a different peptide. Thus, any cell in an allograft may express many distinct peptide-MHC complexes composed of different peptides bound to one or a few alleles of the foreign MHC molecules. Becauseonly a few hundred peptide-MHC complexes are needed to activate a particular T cell clone, many different clones may be activated by the same allogeneic cell. o All of the MHC molecules on an allogeneic ApC are foreign to a recipient and can therefore be recognized by T cells. In contrast, on self APCs, most of the self MHC molecules are displaying self peptides, and any foreign peptide probably occupies l% or less of the total MHC molecules expressed. As a result, the density of allogeneic determinants on allogeneic APCs is much higher than the density of foreign peptide-self MHC complexes on selfAPCs.The abundance of recognizable allogeneic MHC molecules may allow activation of T cells with low affinities for the determinant, thereby increasing the numbers of T cells that can respond. @ Many of the alloreactive T cells that respond to the first exposure to an allogeneic MHC molecule are memory T cells that were generated during previous exposure to other foreign (e.9., microbial) antigens. Thus, in contrast to the initial naive T cell responseto microbial antigens, the initial response to alloantigens is mediated in part by already expanded clones of memory T cells.
Becauseof the high frequency of alloreactive T cells, primary responsesto alloantigens are the only primary responsesthat can readily be detected in uitro. lndirect Presentation
of Alloantigens
Allogeneic MHC molecules may be processed and, presented by recipient APCs that enter grafrs, and the processed,MHC molecules are recognized. by T celk like conuentional foreign protein antigens (see Fig. 16-3). Because allogeneic MHC molecules differ structurally from those of the host, they can be processed and presented in the same way that any foreign protein antigen is, generating foreign peptides associatedwith self MHC molecules on the surface of host APCs. Indirect presentation may result in allorecognition by CD4* T cells because alloantigen is acquired by host APCs primarily through the endosomal vesicular pathway (i.e.,as a consequence ofphagocltosis) and is therefore presented by classII MHC molecules. Some antigens of phagocytosed graft cells appear to enter the class I MHC pathway of antigen presentation and are indirectly recognized by CD8. T cells. This phenomenon is an example of crosspresentation or cross-priming (see Chapter 9, Fig. 9-3), in which professional APCs, usually dendritic cells, present antigens of another cell, from the graft, to activate, or "prime," CD8. T lymphocytes. Because MHC molecules are the most polymorphic proteins in the genome, each allogeneic MHC molecule may give rise to multiple foreign peptides, each recognizedby different T cells. One of the first indications that T cell responsesto allogeneic MHC molecules can occur by indirect presentationwas the demonstrationof cross-priming of alloreactive CDB+cytotoxic T lymphocltes (CTLs) by selfAPCsthat had been exposedto allogeneiccells. Evidence that indirect presentation of allogeneic MHC molecules occurs in graft rejection was obtained from studies with knockout mice lacking class II MHC expression.For example, skin grafts from donor mice lacking class II MHC are able to induce recipient CD4* (i.e.,classIl-restricted) T cell responsesto the donor alloantigens,including peptides derivedfrom donor classI MHC molecules.This result implies that the donor classI MHC molecules are processedand presentedby classII moleculeson the recipient's APCs and stimulate the recipient's helper T cells. More recently, evidence has been obtained from human transplant recipients that indirect antigen presentationmay contribute to late rejection of allografts. For example, CD4* T cells from heart and liver allograft recipients can be activated in uitro by peptides derivedfrom donor MHC and presentedby host APCs. There may be polyrnorphic antigens other than MHC molecules that differ between the donor and the recipient. These antigens induce weak or slower (more gradual) rejection reactions than do MHC molecules
IMMUN0L0GY 16- TRANSPLANTATI0N Chaoter
and are called minor histocompatibility antigens. Most minor histocompatibility antigens are proteins that are processed and presented to host T cells in association with self MHC molecules on host APCs (i.e.,by the indirect pathway).
Activation
of Alloreactive
Lymphocytes
The actiuation of alloreactiue T cells in uiuo requires presentation of alloantigens by donor-d.eriued APCs in the grafr (direct presentation of alloantigens) or by host APCs that pick up and present grafr alloantigens (indirect presentation). Most organs contain resident APCs such as dendritic cells. Transplantation of these organs into an allogeneic recipient provides APCs that express donor MHC molecules as well as costimulators. Presumably, these donor APCs migrate to regional lymph nodes and are recognized by the recipient's T cells that circulate through the peripheral lymphoid organs (the direct pathway). Dendritic cells from the recipient may also migrate into the graft, or graft alloantigens may traffic into lymph nodes, where they are captured and presented by recipient APCs (the indirect pathway). Alloreactive T cells in the recipient may be activated by both pathways, and these T cells migrate into the grafts and cause graft rejection. Alloreactive CD4* helper T cells differentiate into cytokine-producing effector cells that damage grafts by reactions that resemble delayed-type hlpersensitivity (DTH). Alloreactive CD8* T cells activated by the direct pathway differentiate into CTLs that kill nucleated cells in the graft, which express the allogeneic class I MHC molecules. The CD8* CTLs that are generated by the indirect pathway are self MHC restricted, and they cannot directly kill the foreign cells in the graft. Therefore,when alloreactiveT cells are stimulated by the indirect pathway, the principal mechanism of rejection is probably DTH mediated by CD4* effector T cells that infiltrate the graft and recognize donor alloantigens being displayed by host APCs that have also entered the graft. The relative importance of the direct and indirect pathways in graft rejection is still unclear. It has been suggested that CD8* CTLs induced by direct recognition of alloantigens are most important for acute rejection of allografts, whereas CD4* effector T cells stimulated by the indirect pathway play a greater role in chronic rejection. The importance of MHC molecules in the rejection of tissue allografts has been established by studies with inbred animals showing that rapid rejection usually requires class I or class II MHC differences between the graft donor and the recipient. In clinical transplantation, minimizing MHC differences between the donor and the recipient improves graft survival, as we shall discuss later. The response of alloreactive T cells to foreign MHC molecules has also been analyzed in an in uitro reaction called the mixed lymphocyte reaction (MLR). The MLR is a model of direct T cell recognition of allogeneic MHC molecules and is used as a predictive test of T cell-mediated graft rejection. Studies of the MLR were among the first to establish the role of classI and classII MHC mol-
ecules in activating distinct populations of T cells (CD8. and CD4*, respectively). The MLR is induced by culturing mononuclearleukoc1'tes(which include T cells, B cells,natural killer [NK] cells, mononuclear phagocytes,and dendritic cells) from one individual with mononuclear leukocytes derived from another individual. Clinically, these cells are typicallyisolatedfrom peripheralblood; in mouse or rat experiments, mononuclear leukocytes are usually purified from the spleen or lymph nodes. If the two indMduals have differences in the alleles of the MHC genes,a large proportion of the mononuclear cells will proliferate during a period of 4 to 7 days. This proliferative response is called the allogeneic MLR (Fig. 16-5). In this experiment,the cells from each donor react and proliferate against the other, thus resulting in a two-way MLR. To simplify the analysis,one of the two leukoclte populationscan be rendered incapable of proliferation before culture, either by 1-irradiation or by treatment with the antimitotic drug mitomycin C' In this one-way MLR' the treated cells serve exclusively as stimulators, and the untreated cells, still capable of proliferation, serve as the responders. Among the T cells that have responded in an MLR, any one cell is specificfor only one allogeneicMHC molecule, and the entire population of activated T lyrnphocltes contains cells that recognize all the MHC differencesbetween stimulators and responders.CD8*CTLsare generatedonly if the classI MHC allelesof the stimulatorsand respondersaredifferent. Similarly, CD4* effector T cells are generated only if the class II molecules are different. Stimulator cells lacking MHC molecules cannot activate respondercellsin an MLR. Transfectionof MHC genesinto the stimulators makes these cells capable of inducing an MLR. CDB* CTLs generated in an MLR will kill cells from other donors only if these cells share some class I alleleswith the original stimulators. Similarly, CD4t T cellsgeneratedin an MLR recognizeAPCsfrom other donors only if theseAPCsshareclassII alleleswith the stimulators. Such experiments demonstrate that alloreactive T cells are specific for allogeneic MHC molecules, and activation of alloreactiveT cells in the MLR occurs mainly by the direct pathway. In addition to recognition of alloantigen, costimulation of T cells by 87 molecules on APCs is important for activating alloreactive T cells. Rejection of allografts, and stimulation of alloreactive T cells in an MLR, can be inhibited by agentsthat bind to and block 87 molecules.Most studiesindicate that 87 antagonists are more effective at blocking acute rejection of allografts and activation of alloreactive T cellsby the direct pathway.In contrast,chronic rejection and activation of alloreactive T cells by the indirect pathway are often insensitive to such agents,for unknor.trytreasons.
3a2
I
Section V-
IMMUNITY tN DEFENSE ANDDTSEASE
Mitotically i n a c t i v a tie- . . . . .
Mixblood mononuclear cells fromtwodonors in tissueculture
*r
i. I
I
& -. :e'
rl b. t'
DonorX
DonorY
Si
Responder T cell recognition of allogeneic MHC molecules
DonorX CD4+ T lymphocyte (Responder cell)
Clonalexpansion andfunctional differentiation of responder T cells
Effector functions of T cells
DonorY classI MHC+ targetcell
AJlograftssurvive for longer periods when they are transplantedinto knockout mice lacking 87-1 (CDg0) and B7-2 (CDB6) compared with transplants into normal recipients.Both acute rejection and graft vasculopathy are reduced in this model. In contrast to T cell alloreactivitv, much less is knor,rm about the mechanisms that lead io the production of alloantibodies against foreign MHC mblecules. The helper T cell-dependent production of antibodies
DonorY classll MHC+ stimulator cell
F The mixed lymp n (MLR).In a oneway prrmary MLR, stimulator cells (from donory) activateand causethe expansion of two types of responderT cells (from donor X) CD4. T cells from donor X react to donor Y class ll molecules, and CDB*T lymphocytes from donor X react to donor Y c l a s sI M H C m o l e c u l e sT h eC D 4 . T cellsdifferentiate into cytokinesecretinghelperT cells,and the CDB* T cells differentiateinto CTLs APC, antigen-presenting cell
Many of the issues that arise in discussions of alloreactivity and graft rejection are also relevant to maternalfetal interactions. The fetus expresses paternal MHC molecules and is therefore semiallogeneicto the mother. Nevertheless,the fetus is not rejected by the maternal immune system. Many possible mechanisms have been proposed to account for this lack of rejection, and it is not yet clear which of these mechanisms is the most significant (Box 16-l).
Errrcton MrcnnusMs oF AtrocnRrr Rr.lrcnon cells and B cells process and present the allogeneic MHC protein to host T cells, and helper T cells "indirectly', recognize foreign MHC molecules presented by host APCs.This sequence of events is, of course, the same as in any B cell response to foreign protein antigens (see Chapter 10).
Thus far, we have described the molecular basis of alloantigen recognition and the cells involved in the recognition of and responsesto allografts.We now turn to a consideration of the effector mechanisms used by the immune system to reject allografts. In different experimental models in animals and in clinical transplantation, alloreactive CD4* or CDB*T cells or alloanti-
IMMUN0L0GY 16- TRANSPLANTATI0N Chaoter
The mammalian f e t u s ,e x c e p ti n i n s t a n c e si n w h i c h t h e m o t h e ra n d f a t h e ra r e s y n g e n e i cw, i l l e x p r e s sp a t e r n a l l y i n h e r i t e da n t i g e n st h a t a r e a l l o g e n e i ct o t h e m o t h e r l n e s s e n c e t, h e f e t u s i s a n a t u r a l l yo c c u r r i n ga l l o g r a f t . Nevertheless, fetuses are not normallyrejectedby the m o t h e r l.t i s c l e a rt h a tt h e m o t h e ri s e x p o s e dt o f e t a la n t i g e n sd u r i n gp r e g n a n csyi n c em a t e r n aal n t i b o d i easg a i n s t p a t e r n aM l H C m o l e c u l eas r ee a s i l yd e t e c t a b l eP r o t e c t i o n o f t h e f e t u sf r o m t h e m a t e r n ailm m u n es y s t e mp r o b a b l y i n v o l v e s e v e r am l e c h a n i s misn c l u d i n sg p e c i am l olecular a n d b a r r i e rf e a t u r e so f t h e p l a c e n t aa n d l o c a li m m u n o suooressron Severalexperimentalobservationsindicatethat the anatomiclocationof the fetus is a criticalfactor in the a b s e n c eo f r e j e c t i o nF o re x a m p l ep, r e g n a nat n i m a l sa r e able to recognizeand rejectallograftssyngeneicto the fetus placedat extrauterinesites without compromising fetal blastocysts that lack fetalsurvivalWhollyallogeneic m a t e r n agl e n e sc a ns u c c e s s f u l d l ye v e l o pi n a p r e g n a not r p s e u d o p r e g n am n to t h e r T h u s ,n e i t h e rs p e c i f i cm a t e r n a l Jorsurvivalof the fetus nor paternalgenesare necessary H y p e r i m m u n i z a t i oonf t h e m o t h e r w i t h c e l l s b e a r i n g p a t e r n aal n t i g e n sd o e s n o t c o m p r o m i s ep l a c e n t aal n d fetal growth. The failureto rejectthe fetus hasfocusedattentionon the regionof physicalcontactbetween the mother and fetus The fetal tissues of the placentathat most intimatelycontactthe mother are composedof eithervast ,h i c h i s e x p o s e dt o m a t e r n abl l o o df o r c u l a rt r o p h o b l a sw p u r p o s e so f m e d i a t i n g n u t r i e net x c h a n g eo,r i m p l a n t a t i o n site trophoblast,which diffusely infiltratesthe uterine to l i n i n g( d e c i d u af o) r p u r p o s e so f a n c h o r i ntgh e p l a c e n t a the mother. O n e s i m o l ee x o l a n a t i ofno r f e t a l s u r v i v ails t h a t t r o l H C m o l e c u l e sS o p h o b l a sct e l l sf a i lt o e x p r e s sp a t e r n aM {ar, class ll moleculeshave not been detectedon trop h o b l a s tI n m i c e ,c e l l so f i m p l a n t a t i otnr o p h o b l a s b t ,u t not of vasculartrophoblast,do expresspaternalclass I M H C m o l e c u l e sI.n h u m a n s t, h e s i t u a t i o nm a y b e m o r e c o m p l e xi n t h a t t r o p h o b l a scte l l se x p r e s so n l ya n o n p o l y . hismolecule m o r p h i cc l a s sl B m o l e c u l ec a l l e dH L A - G T may be involved in protectingtrophoblastcells from subsetof maternalNK cell-mediatedlvsis A specialized N K c e l l sc a l l e du t e r i n eN K c e l l sa r et h e m a j o rt y p eo f l y m phocytepresentat implantation sites,and IFN-yproduct i o n b y t h e s ec e l l si s e s s e n t i af lo r d e c i d u adl e v e l o p m e n t T h e w a v u t e r i n eN K c e l l sa r e s t i m u l a t e d a n d t h e i rr o l ei n are not known. maternalresponsesto fetal alloantigens Evenif trophoblastcellsdo expressclassicalMHC mole-
bodies are capable of mediating allograft rejection. These different immune effectors cause graft rejection by different mechanisms. For historical reasons, graft rejection is classified on the basis of histopathologic features or the time course of rejection after transplantation rather than on the basis of immune effector mechanisms. Based on the experience of renal transplantation, the histopathologic
r o l e c u l e sa n d f a i l t o c u l e s ,t h e y m a y l a c kc o s t i m u l a t om A P C s . actas for lack of rejectionis that the A secondexplanation uterinedeciduamay be an immunologically privileged site. These anatomicsites are tissues where immune r e s p o n s eg s e n e r a l l fya i lt o o c c u ra n d i n c l u d eb r a i n ,e y e , andtestis Severalfactorsmay contributeto immuneprivi l e g e .F o r e x a m p l et,h e b r a i nv a s c u l a t u rlei m i t sl y m p h o c y t ea c c e s st o t h e b r a i nt i s s u e ,a n dt h e a n t e r i ocr h a m b e r o f t h e e y e m a y c o n t a i nh i g hc o n c e n t r a t i o nosf i m m u n o suppressivecytokinessuch as TGF-B In supportof the i d e at h a t t h e d e c i d u ai s a n i m m u n e - p r i v i l e gseidt e i s t h e o b s e r v a t i otnh a t m o u s ed e c i d u ai s h i g h l ys u s c e p t i b lteo and cannotsupport infectionbv ListeriamonocYtogenes c r i v i l e g ei s a D T H r e s p o n s eT. h e b a s i so f i m m u n o l o g i p c l e a r l vn o t a s i m p l ea n a t o m i cb a r r i e rb e c a u s em a t e r n a l bloodis in extensivecontactwith trophoblast'Rather,the l h i b i t i o nC. u l b a r r i e irs l i k e l yt o b e c r e a t e db y f u n c t i o n ai n t a c r o p h a gaen dT c e l l t u r e dd e c i d u acl e l l sd i r e c t l yi n h i b i m f unctions, perhaps by producing inhibitorycytokines, . o m e o f t h e s e i n h i b i t o r yd e c i d u acl e l l s suchas TGF-8S T cells,althoughthe evidence mav be residentregulatory f o r t h i s p r o p o s ails l i m i t e d .S o m e e x p e r i m e n t hs a v el e d to the suggestionthat Ts2 cytokinesare producedat the for localsupinterfaceand are responsible maternal-fetal pressionof Ts1 responsesto fetal antigens However, t h i s i d e ai s n o t s u p p o r t e db y t h e d a t at h a t l L - 4a n d l L - 1 0 knockoutmice have normal pregnanciesThere is also evidencethat the fetus containsabundantregulatoryT c e l l s ,b u t t h e i rs i g n i f i c a n ci es u n c l e a r . Thereis evidencethat immuneresponsesto the fetus of tryptophan may be regulatedby localconcentrations a n d i t s m e t a b o l i t e si n t h e d e c i d u a . T h e e n z y m e (lDO)catabolizes tryptophan, indolamine2,3-dioxygenase ad nuces a n d t h e I D O - i n h i b i t i ndgr u g 1 - m e t h y l - t r y p t o p hi n abortionsin mice in a T cell-dependentmanner'These led to the hypothesisthat T cell responses observations to the fetus are normallyblockedbecausedecidualtryptophanlevelsare kept low or the levelsof toxic metabol i t e sa r e h i g h and deciduamay also be relativelyresistTrophoblast damage because they ant to complement-mediated expresshigh levelsof a C3 and C4 inhibitorcalledCrry' embryos die before birth and show eviCrry-deficient dence of complementactivationon trophoblastcells T h u s , t h i s i n h i b i t o rm a y b l o c k m a t e r n a la l l o a n t i b o d y mediated damage through the classicalpathway of c o m p l e m e nat c t i v a t i o n .
patterns are called hlryeracute, acute, and chronic (Fig. 16-6).
Hyperacute
Reiection
Hyperacute rejection is characterized by thrombotic occlusion of the grafr uasculature that begins within
383
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i
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Section V-
tMMUNtTy tN DEFENSE ANDDTSEASE
FIGURE 16-6 Histopathology of differentformsof graft reiection.A. Hyperacuterejectionof a kidneyallograftwith endothelial damage, plateletand thrombinthrombi,and earlyneutrophilinfiltration in a glomerulus.B. Acute relectionof a kidneywith inflammatorv cellsin the connectivetissuearoundthe tubulesand betweenepithelialcellsof the tubules C Acute rejectionof a kidneyallograftwith destructive inflammatory reactrondestroyingthe endothelial layerof an artery.D. Chronicrejectionin a kidneyallograftwith grafiarteriosclerosis. The vascularlumenis replacedby an accumulation of smoothmusclecellsand connectivetissuein the veisel intima.(Courtesvof Dr. Helmut Rennke,Departmentof Pathology, Brighamand Women'sHospitaland HarvardMedicalSchool,Boston)
minutes to hours afier host blood uessek are &nastomosed to grafr uessek and is mediated by preexisting antibodies in the host circulation that bind to donor endothelial antigens (Fig. 16-7). Binding of antibody ro endothelium activates complement, and antibody and complement induce a number of changes in the graft endothelium that promote intravascular thrombosis. Complement activation leads to endothelial cell injury and exposure of subendothelial basement membrane proteins that activate platelets. The endothelial cells are stimulated to secrete high molecular weight forms of von Willebrand factor that mediate platelet adhesion and aggregation. Both endothelial cells and platelets I'ndergo membrane vesiculation, leading to shedding of lipid particles that promote coagulation. Endothelial cells lose the cell surface heparan sulfate proteoglycans that normally interact with antithrombin III to inhibit coagulation. These processescontribute to thrombosis and vascular occlusion (seeFig. 16-6A), and the grafted organ suffers irreversible ischemic damage. In the early days of transplantation, hlperacute rejection was often mediated by preexisting IgM alloantibodies, which are present at high titer before transplantation. Such "natural antibodies" are believed to arise in response to carbohydrate antigens expressed by bacteria that normally colonize the intestine. The best knor,tmexamples of such alloantibodies are those directed against the ABO blood group antigens expressed on red blood cells (Box 16-2). ABO antigens are also expressedon vascular endothelial cells. Today, hyperacute rejection by anti-ABO antibodies is extremely rare because all donor and recipient pairs are selected so that they have the same ABO type. However, as we shall discusslater in this chapter, hyperacute rejection caused by natural antibodies is the major barrier to renotransplantation and limits the use of animal organs for human transplantation. Currently, hlperacute rejection of allografts, when it occurs, is usually mediated by IgG antibodies directed
against protein alloantigens, such as foreign MHC molecules, or against less well defined alloantigens expressedon vascular endothelial cells. Such antibodies generally arise as a result of previous exposure to alloantigens through blood transfusion, previous transplantation, or multiple pregnancies. If the titer of these alloreactive antibodies is loW hyperacute rejection may develop slowly, over several days. In this case, it is sometimes referred to as accelerated allograft rejection because the onset is still earlier than that typical for acute rejection. As we will discuss later in this chapter, patients in need of allografts are routinely screened before grafting for the presence of antibodies that bind to cells of a potential organ donor to avoid hyperacute rejection. Acute
Rejection
Acute rejection is a process of uascular and parenchymal injury mediated by T celk and antibodies that usually begins after the first week of transplantation. Effector T cells and antibodies that mediate acute rejection develop over a few days or weeks in response to the graft, accounting for the time of onset of acute rejection. T lymphocytes play a central role in acute rejection by responding to alloantigens, including MHC molecules, present on vascular endothelial and parenchymal cells (seeFig. 16-78). The activated T cells cause direct killing of graft cells or produce cytokines that recruit and activate inflammatory cells, which injure the graft. In vascularized grafts such as kidney grafts, endothelial cells are the earliest targets of acute rejection. Microvascular endothelialitis is a frequent early finding in acute rejection episodes. Endothelialitis or intimal arteritis in medium sized arteries also occurs at an early stage of acute rejection and is indicative of severe rejection, which, if left untreated, will likely result in acute graft failure.
@ rro"r"cute rejection Endothelial cell
Blood vessel
Complement activation, endothelial damage, inflammation and thrombosis Alloantigen ( e . 9 . ,b l o o d groupantigen)
Acuterejection Parenchymal cell damage, interstitial inflammation Alloreactive antibody
Endothelialitis Endothelial cell
Chronicreiection
Macrophage
ChronlcDTH reactionin vesselwall, intimalsmooth musclecell proliferation, vesselocclusion
$Cytokines 'Alloantigenspecific CD4+T cell lmmune mechanismsof graft reiection. A In hyperacuterejection,preformedantibodiesreactivewith vascularendotheFIGURf, 1 thrombosisand necrosisof the vesselwall B. In acuterejection,CD8*T lympholium activatecomplementand triggerrapidintrav'ascular formed antibodies cellsmediatedamageto thesecelltypes Alloreactive cellsand parenchymal on endothelial cytesreactivewith alloantigens injuryto the vesselwall leadsto aiter engraftmentmay alsocontributeto vascularinjury.C In chronicrejectionwith graftarteriosclerosis, in the This lesionmay be causedby a chronicDTH reactionto alloantigens intimalsmooth musclecell proliferation and luminalocclusion, vesselwall
386
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IMMUNIW lNDEFENS AE N DD T S E A S E
,,..,..,,,.,,1,. . ....
T h e f i r s t a l l o a n t i g esny s t e mt o b e d e f i n e di n m a m m a l s r a r e ;p e o p l ew h o a r e h o m o z y g o u fso r s u c h a m u t a t i o n w a s a f a m i l yo f r e d b l o o d c e l l s u r f a c ea n t i g e n sc a l l e d c a n n o t n r o d r n e H A o r R a n t i n e n s T h e q e i n d i v i d U a l s A B O ,w h i c ha r et h e t a r g e t so f b l o o dt r a n s f u s i orne a c t i o n s m a k ea n t i b o d i easg a i n s H t , A , a n d B a n t i g e n sa n dc a n n o t ( s e et e x t ) T h e a n t i g e n si n t h i s s y s t e ma r e c e l l s u r f a c e receivetype O, A, B, or AB blood g l y c o s p h l n g o l r p rA d sl l n o r m a l i n d i v i d u a l s y n t h e s i z ea T h e s a m e g l y c o s p h i n g o l i ptihda t c a r r i e st h e A B O c o m m o n c o r e g l y c a n ,c a l l e d t h e O a n t i g e n ,t h a t i s d e t e r m i n a n t sc a n b e m o d i f i e db y o t h e r g l y c o s y l t r a n s a t t a c h e dt o a s p h i n g o l i p i dM o s t i n d i v i d u a lpso s s e s sa f e r a s e st o g e n e r a t em i n o rb l o o dg r o u pa n t i g e n st h a t m a y f u c o s y l t r a n s f e r atshea t a d d s a f u c o s em o i e t yt o a n o n e l i c i tm i l d e rt r a n s f u s i orne a c t i o ntsh a nt h e A B O a n t i g e n s t e r m r n asl u g a rr e s r d u eo f t h e O a n t i g e na, n d t h e f u c o s y - F o r e x a m p l e a , d d i t i o no f f u c o s em o i e t i e sa t o t h e r n o n l a t e dg l y c a ni s c a l l e dt h e H a n t i g e nA s i n g l eg e n eo n c h r o terminalpositionscan be catalyzedby differentfucosylm o s o m e9 e n c o d e sa g l y c o s y l t r a n s f e r aesnez y m ew , hich t r a n s f e r a s easn d r e s u l t si n e p i t o p e so f t h e L e w i s a n t i f u r t h e rm o d i f i e st h e H a n t i g e nT h e r ea r et h r e ea l l e l i cv a r i - g e n s y s t e m L e w i s a n t i g e n sh a v e r e c e n t l yr e c e i v e d a n t so f t h i s g e n e T h e O a l l e l eg e n ep r o d u c ti s d e v o i do f m u c h a t t e n t i o n f r o m i m m u n o l o g i s t sb e c a u s e t h e s e e n z y m a t i ca c t i v i t yT h e A a l l e l e - e n c o d eedn z y m et r a n s - c a r b o h y d r a tger o u p ss e r v ea s l i g a n d sf o r E - s e l e c t iann d f e r s a t e r m i n a tl V - a c e t y l g a l a c t o s a m mioniee t y a , ndthe B P-selectin. a l l e l eg e n ep r o d u c t r a n s f e r a e oiety s t e r m i n agl a l a c t o s m T h e R h e s u s( R h )a n t i g e n sn, a m e da f t e r t h e m o n k e y l n d i v i d u a lws h o a r e h o m o z y g o ufso r t h e O a l l e l ec a n n o t s p e c i e si n w h i c ht h e yw e r eo r i g i n a l liyd e n t i f i e di s, a n o t h e r a t t a c ht e r m i n asl u g a r st o t h e H a n t i g e na n d e x p r e s so n l y c l i n i c a l l yi m p o r t a n tg r o u p o f b l o o d g r o u p a n t i g e n s .R h t h e H a n t i g e n I n c o n t r a s t i,n d i v i d u a lw s h o p o s s e s sa n a n t i g e n sa r e n o n g l y c o s y l a t ehdy, d r o p h o b icce l l s u r f a c e A allele (AA homozygotes,AO heterozygotes,or AB p r o t e i n sf o u n d i n t h e r e d b l o o dc e l l m e m b r a n e sa n d a r e h e t e r o z y g o t e sf o) r m t h e A a n t i g e nb y a d d i n gt e r m i n a l s t r u c t u r a l lrye l a t e dt o o t h e rr e d c e l l m e m b r a n eg l y c o p r o l V - a c e t y l g a l a c t o s a mt ion es o m e o f t h e i r H a n t i g e n s t e i n sw i t h t r a n s p o r t ef u r n c t i o n sR h p r o t e i n sa r ee n c o d e d S i m i l a r l yi n, d i v i d u a w l sh o e x p r e s sa B a l l e l e( B B h o m o z y - b y t w o t i g h t l yl i n k e da n d h i g h l yh o m o l o g o u gs e n e s ,b u t gotes,BO heterozygotes, or AB heterozygotes) form the o n l yo n e o f t h e m ,c a l l e dR h D ,i s c o m m o n l yc o n s i d e r eidn B a n t i g e nb y a d d i n g t e r m i n a lg a l a c t o s et o s o m e o f c l i n i c abl l o o dt y p i n g T h i s i s b e c a u s eu p t o 1 5 % o f t h e t h e i r H a n t i g e n sA B h e t e r o z y g o t ef so r m b o t h A a n d B p o p u l a t i o nh a v e a d e l e t i o no r o t h e r a l t e r a t i o n o s f the a n t i g e n sf r o m s o m e o f t h e i rH a n t i g e n sT h e t e r m i n o l o g y R h D a l l e l e T h e s e p e o p l e ,c a l l e dR h n e g a t i v ea, r e n o t h a s b e e n s i m p l i f i e ds o t h a t O O i n d i v i d u a lasr e s a i d t o t o l e r a n t o t h e R h D a n t i g e na n d w i l l m a k ea n t i b o d i etso b e b l o o dt y p e O ; A A a n dA O i n d i v i d u aal sr e b l o o dt v p eA ; t h e a n t i g e ni f t h e ya r ee x p o s e dt o R h - p o s i t i vbel o o dc e l l s B B a n d B O i n d i v i d u a lasr e b l o o dt v p e B ; a n d A B i n d i v i d - T h e m a j o r c l i n i c a sl i g n i f i c a n coef a n t i - R ha n t i b o d i e si s u a l sa r e b l o o dt y p e A B M u t a t i o n si n t h e g e n ee n c o d i n g r e l a t e dt o p r o b l e m sw i t h p r e g n a n c ya,s d i s c u s s e di n t h e t h e f u c o s y l t r a n s f e r atshea t p r o d u c e st h e H a n t i g e na r e TCXl
Both CD4'T cells and CD8* T cellsmay contribute to acute rejection. Several lines of evidence suggest that recognition and killing of graft cells by alloreactive CD8* CTLs is an important mechanism of acute rejection. The cellular infiltrates present in grafts undergoing acute cellular rejection (Fig. 16-68) are markedly enrichedfor CDB*CTLsspecificfor graft alloantigens. The presenceof CTLsin renal graft biopsy specimens, as indicated by sensitivereverse-transcriptase polymerase chain reaction assays for RNAs encoding CTl-specific genes (e.g.,perforin and granzyme B), is a specific and sensitiveindicator of clinical acute rejection. Alloreactive CDB* CTLs can be used to adootivelv transf'eracute cellular graft rejection. The destruction of allogeneiccells in a graft is highly specific,a hallmark of CTL killing. The best evidence for this specificity has come from mouse skin graft experiments using chimeric grafts that contain two distinct cell populations, one syngeneicto the host and one allogeneicto the host.\Aihentheseskin grafts are transplanted, the allogeneic cells are killed without injury to the "bystander"syngeneiccells.
CD4* T cells may be important in mediating acute graft rejection by secreting cytokines and inducing DTH-like reactions in grafts, and some evidence indicates that CD4* T cells are sufficient to mediate acute rejection. Acute rejection of allograftsdoes occur in knockout mice lacking CDB*T cellsor perforin, suggestingthat other effectormechanismsalso contribute. Adoptive transfer of alloreactiveCD4* T cells into a mouse can causerejection of an allograft. Antibodies can also mediate acute rejection if a graft recipient mounts a humoral immune response to vessel wall antigens and the antibodies that are produced bind to the vessel wall and activate complement. The histoIogic pattern of this form of acute rejection is one of transmural necrosis of graft vessel walls with acute inflammation (see Fig. 16-6C), which is different from the thrombotic occlusion without vessel wall necrosis seen in hyperacute rejection. Immunohistochemical identification of the C4d complement fragment in capillaries of renal allografts is used clinically as an indicator of activation of the classical complement pathway and humoral rejection.
IMMUN0L0GY1 16- TRANSPLANTATI0N Chapter
387
,...i*.-.,,,,.
Graft Vasculopathy Chronic Rejection
and
Vascularized grafrs that suruiue for more than 6 months slowly deuelop arterial occlusion as a result of the proliferation of intimal smooth muscle cells, and euentually fail due to ischemic damage. The arterial changes are called graft vasculopathy or accelerated graft arteriosclerosis (see Fig. 16-6D). Graft vasculopathy is frequently seen in failed cardiac and renal allografts and can develop in any vascularized organ transplant within 6 months to a year after transplantation. The pathogenesis of the lesions likely involves a combination of processes,including a response of the vessel to injury caused by perioperative ischemia and acute rejection episodes,in combination with a chronic DTH-like reaction of host lymphocytes to donor alloantigens in the graft vessel.The smooth muscle cell accumulation in the graft arterial intima appears to be stimulated by growth factors and chemokines secreted by endothelial cells, smooth muscle cells, and macrophages in response to interferon-y (IFN-f) and tumor necrosis factor (TNF) produced by alloreactive T cells (seeFig. l6-7C). Knockout mice lacking different components of the adaptive immune system have been used as graft recipients and show varying resistanceto graft arteriosclerosis. For instance, accelerated graft arteriosclerosis does not develop in IFN-y-deflcient recipients,consistentwith the hypothesisthat DTH is involved in lesion formation. Other studies with knockout mice indicate that CD4*T cells and B l)..rnphocltes are more important for the developmentof graft arteriosclerosisthan are CDB*T cells. As the arterial lesions of graft arteriosclerosis progress,blood flow to the graft parenchyma is compromised, and the parenchyma is slowly replaced by nonfunctioning fibrous tissue. In addition, fibrosis in older grafts may also reflect the final outcome of parenchymal injury caused by episodes of acute rejection. Several growth factors and cytokines have been implicated in graft fibrosis, including fibroblast growth factor, transforming growth factor-B (TGF-B),and interleukin-13 (ILl3). Often, the process of graft fibrosis is called chronic rejection. As therapy for controlling acute rejection has improved, graft vasculopathy and chronic rejection have emerged as the major cause of allograft loss. Chronic rejection of different transplanted organs is associatedwith distinct pathologic changes.Lung transplants undergoing chronic rejection show thickened small airways (bronchiolitis obliterans), and liver transplants show fibrotic and nonfunctional bile ducts (the vanishing bile duct syndrome).
AND PnrvrrunoN TnrRrmerur or Rrrrcnonr Alr-ocRnrr If the recipient of an allograft has a fully functional immune system, transplantation almost invariably results in some form of rejection. The strategiesused in
clinical practice and in experimental models to avoid or delay rejection are general immunosuppression and minimizing the strength of the specific allogeneic reaction. An important goal in transplantation is to induce donor-specific tolerance, which would allow grafts to survive without nonspecific immunosuppression. to Prevent lmmunosuppression Treat Allograft Rejection
or to
Immunosuppression is the major approach for the prevention and management of transplant rejection. Severalmethods of immunosuppression are commonly used (Table 16-l). Immunosuppressiue drugs that inhibit or kill T lymphocytes are the principal treqtment regimen for grafr rejection. The most important immunosuppressive agents in current clinical use are the calcineurin cyclosporine and FK-506 including inhibitors, (tacrolimus). The major action of these drugs is to inhibit T cell transcription of certain genes,most notably those encoding cytokines such as IL-2. Cyclosporine is a cyclic peptide made by a species of fungus, which binds with high affinity to a ubiquitous cellular protein called cyclophilin. As discussed in Chapter 9, the complex of
T a b l e1 6 - 1 .M e t h o d so f l m m u n o s u p p r e s s i o n i n C l i n i c aU l se
Drug
I Mechanismof action
Cyclosporine BlockT cellcytokineproduction of the activation by inhibiting and FK-506 factor NFATtranscription Azathioprine
of Blocksproliferation lymphocyteprecursors
MycophenolateBlockslymphocyteproliferation guaninenucleotide by inhibiting mofetil synthesisin lymphocytes Rapamycin
proliferation Blockslymphocyte lL-2signaling by inhibiting
CorticosteroidsReduceinflammationby inhibiting macrophagecytokinesecretion
Anti-CD3 monoclonal antibody
T cellsby bindingto CD3 Depletes phagocytosis or andpromoting lysis complement-mediated (usedto treatacuterejection)
by T cellproliferation Inhibits Anti-lL-2 bindinganddepletes receptor(CD25)blockinglL-2 activatedT cellsthatexpressCD25 antibody
CTLA-4-lg
T cellactivation by blocking Inhibits bindingto 87 costimulator T cellCD28;in clinicaltrials
Anti-CD40 ligand
Inhibitsmacrophageand endothelialactivationby blocking T cell CD40 ligandbindingto CD40; in clinicaltrials
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cyclosporine and cyclophilin binds to and inhibits the enzl,rnatic activity of the calcium/calmodulin-activated protein phosphatase calcineurin. Because calcineurin is required to activate the transcription factor NFAT (nuclear factor of activated T cells), cyclosporine blocks NFAT activation and the transcription of IL-2 and other cltokine genes.The net result is that cyclosporine blocks the IL-2-dependent growth and differentiation ofT cells. FK-506 is a macrolide lactone made by a bacterium that functions like cyclosporine. FK-506 and its binding protein (called FKBP) share with the cyclosporinecyclophilin complex the ability to bind calcineurin and inhibit its activity. The introduction of cyclosporine into clinical practice ushered in the modern era of transplantation. Before the use of cyclosporine, the majority of transplanted hearts and livers were rejected. Now the majority of these allografts survive for more than 5 years (Fig. 16-8). Nevertheless,cyclosporine is not a panacea for transplantation. Drug levels needed for optimal immunosuppression cause kidney damage, and some rejection episodes are refractory to cyclosporine treatment. FK-506 has been used most frequently in liver transplant recipients and in cases of kidney allograft rejection that are not adequately controlled by cyclosporine. Another class of immunosuppressive agents that are used frequently to control allograft rejection are the inhibitors of the cellular enzyme called mammalian target of rapamycin (mTOR).The first drug discoveredin this class is rapamycin, whose principal effect is to inhibit T cell proliferation. Like FK-506, rapamycin also
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FIGURE 1F8 Influenceof cyclosporineon graft survival.Fiveyearsurvivalratesfor patientsreceivingcardiacallograftsincreased significantly beginningwhen cyclosporine was introducedin 1983. (Data from TransplantPatient DataSource,United Network for OrganSharing,Richmond,Va RetnevedFebruary'16, 2000,from http:ll2jl 239 150 l3ltpdl )
binds to FKBB but the rapamycin-FKBP complex does not inhibit calcineurin. Instead, this complex binds to mTOR, which is a serine/threonine protein kinase required for translation of proteins that promote cell proliferation. Interaction of the rapamycin-FKBP complex with mTOR inhibits the function of mTOR and thus blocks cellular proliferation. Combinations of cyclosporine (which blocks IL-2 syrthesis) and rapamycin (which blocks Il-2-driven proliferation) are potent inhibitors of T cell responses. In addition to rapamycin, other mTOR inhibitors have been developed for immunosuppression of allograft recipients and for cancer therapy. Metobolic toxins that kill proliferatingT cells are ako used to treat grafi rejection. These agents inhibit the maturation of lymphocytes from immature precursors and also kill proliferating mature T cells that have been stimulated by alloantigens. The first such drug to be developed for the prevention and treatment of rejection was azathioprine. This drug is still used, but it is toxic to precursors of leukocytes in the bone marrow and enterocytes in the gut. The newest and most widely used drug in this class is mycophenolate mofetil (MMF). MMF is metabolized to mycophenolic acid, which blocks a ll.rnphoclte-specific isoform of inosine monophosphate dehydroxygenase,an enzyme required for de novo slmthesis of guanine nucleotides. Because MMF selectively inhibits the l1'rnphocyte-specific isoform of this enzyme, it has relatively few toxic effects on other cells.MMF is now routinely used, often in combination with cyclosporine, to prevent acute allograft rejection. Antibodies that react with T cell surface structures and deplete or inhibit T celk are used to treet acute rejection episodes. The most widely used antibody is a mouse monoclonal antibody called OKT3 that is specific for human CD3. It may seem surprising that one would use a potential polyclonal activator such as anti-CD3 antibody to reduce T cell reactivity. In vivo, however, OKT3 either acts as a lytic antibody by activating the complement system to eliminate T cells or opsonizes T cells for phagocl,tosis. T cells that escape elimination probably do so by endocltosing ("modulating") CD3 off their surface, but such cells may be rendered nonfunctional. Another antibody now in clinical use is specific for CD25, the cr-subunit of the IL-2 receptor. This reagent, which is administered at the time of transplantation, may prevent T cell activation by blocking IL-2 binding to activated T cells, and it may deplete CD25expressing activated T cells by mechanisms similar to those described for OKT3. The major limitation on the use of mouse monoclonal antibodies is that humans given these agents produce anti-mouse immunoglobuIin (Ig) antibodies that eliminate the injected mouse Ig. For this reason, human-mouse chimeric ("humanized") antibodies to CD3 and CD25 that may be less immunogenic have been developed. Drugs that block T cell costimulatory pathways are now used to preuent acute allngrafr rejection. The rationale for the use of these types of drugs is to prevent the delivery of second signals required for activation of
IMMUN0L0GY 16- TRANSPLANTATI0N Chaoter
T cells (see Chapter 9). A soluble form of CTIA-4 fused to an IgG Fc domain (called CTiA-4-Ig) prevents 87 molecules on APCs from interacting with T cell CD28, and is approved for use in allograft recipients. Clinical studies have shonryrthat CTt"{-4-Ig can be as effective as cyclosporine in preventing acute rejection. Studies with experimental animals show that graft rejection is reduced or delayed by CTI"{-4-Ig, and aswell asby an antibody that binds to T cell CD40 ligand and prevents its interactions with CD40 on APCs (seeChapters7 and 9). In some experimental protocols, simultaneous blockade of both 87 and CD40 appearsto be more effectivethan either alone in promoting graft survival.Antibody to CD40 ligand alsodelaysthe rejectionofkidney and pancreaticislet allograftsin primates.It is likely that thesetreatments inhibit the activationof alloreactiveT cellsand do not induce long-lived tolerancein these cells. Acute antibody-mediated rejection can be treated with drugs that inhibit antibody production. Several new immunosuppressive agents, including rapamycin and brequinar, inhibit antibody synthesis and are therefore potentially useful in preventing acute vascular rejection. Anti-inflammq.tory a.gents are also routinely used for the preuention and treatment of graft rejection. The most potent anti-inflammatory agents available are corticosteroids. The proposed mechanism of action of these natural hormones and their synthetic analogues is to block the synthesis and secretion of cytokines, including TNF and IL-1, and other inflammatory mediators by macrophages. Lack of TNF and IL-l synthesis reduces graft endothelial cell activation and recruitment of leukocltes (see Chapters 2 and 13). Corticosteroids may also block the generation of prostaglandins, reactive oxygen species, and nitric oxide. Very high doses of corticosteroids may inhibit T cell secretion of cytokines or even kill T cells, but it is unlikely that the levels of corticosteroids achieved in vivo act in this way. Newer anti-inflammatory agents are in clinical trials, including soluble cytokine receptors, anti-cltokine antibodies, and antibodies that block leukocyte-endothelial adhesion (e.g., anti-intercellular adhesion molecule-1 [anti-
rcAM-11). A new therapeutic agent, called FTY720, works by binding to and blocking sphingosine l-phosphate receptors on lymphocytes. This phospholipid is involved in the egressof Iymphocytes from lymphoid organs (see Chapter 3), and blocking its action leads to the sequestration of lymphocytes in lymph nodes. This inhibits immune responses to transplants. This drug is now in clinical trials for preventing graft rejection and treating some autoimmune diseases. Current immunosuppressiue protocok hque d,ramatically improued graft suruiuaL Before the use of cyclosporine, the 1-year survival rate ofunrelated cadaveric kidney grafts was between 50% and 60%, with a 90% rate for grafts from living related donors (which are
better matched with the recipients). Since cyclosporine and MMF have been introduced, the survival rate of unrelated cadaveric kidney grafts has approached about 90Voat I year. The use of rapamycin promises to improve early survival of grafts even more. Heart transplantation, for which human leukocyte antigen (HI"{) matching (discussed later) is not practical, has significantly improved with the use of cyclosporine and now has a similar 90% l-year survival rate. Experience with other organs is more limited, but survival rates for liver and lung transplants have also benefited from modern immunosuppressive therapy. Acute rejection, when it occurs, is managedbyrapidly intensirying immunosuppressive therapy. In modern transplantation, chronic rejection has become a more common cause of allograft failure, especially in cardiac transplantation. Chronic rejection is more insidious than acute rejection, and it is much less reversible by immunosuppression. Sustained immunosuppression required' for prolonged grafr suruiual leads to increased' susceptibility to uiral infections and uirus-associnted tumors. The major thrust of transplant-related immunosuppression is to reduce the generation and function of helper T cells and CTLs,which mediate acute cellular rejection. It is therefore not surprising that defense against viruses, the physiologic function of CTLs, is also undermined in immunosuppressed transplant recipients. Reactivation of latent cytomegalovirus, a herpesvirus, is particularly common in immunosuppressed patients. For this reason,transplant recipients are now given prophylactic antiviral therapy for cytomegalovirus infections. TWo malignant tumors commonly seen in allograft patients are B cell lymphomas and squamous cell carcinoma of the skin. The B cell lymphomas are thought to be sequelae of unchecked infection by Epstein-Barr virus, another herpesvirus (see Chapter 17, Box I7-2). The squamous cell carcinomas of the skin are associated with human papillomavirus.
Methods to Reduce the lmmunogenicaty of Allografts In human transplnntation, the maior strategy to reduce grafr immunogenicity has been to minimize alloantigenic dffirences between the donor and recipient - To avoid hyper-acute rejection, the ABO blood group antigens of the graft donor are selected to be identical to those of the recipient. Patients in need of allografts are also tested for the presence of preformed antibodies against donor cells. This type of testing is called crossmatching. It is done by mixing recipient serum with leukocytes from potential donors and adding complement to promote classical pathway-mediated Iysis of donor cells. If preformed antibodies, usually against donor MHC molecules, are present in the recipient's serum, the donor cells are lysed (called a positive crossmatch), and such lysis indicates that the donor is not suitable for that recipient. For kidney transplantation from living related donors, attempts are made to
39O
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minimize both class I and class II MHC allelic differences between the donor and recipient. All potential kidney donors and recipients are "tissue typed" to determine the identity of the HIA molecules that are expressed(Box l6-3).
S e v e r acl l i n i c al la b o r a t o rt ye s t sa r er o u t i n e lpy e r f o r m e tdo r e d u c et h e r i s kf o r i m m u n o l o g irce j e c t i o ni n t r a n s p l a n t a t i o n T h e s ei n c l u d eA B O b l o o dt y p i n g t; h e d e t e r m i n a t i o n o f H L A a l l e l e se x p r e s s e do n d o n o ra n d r e c i p i e nct e l l s , c a l l e dt i s s u et y p i n g ;t h e d e t e c t i o no f p r e f o r m e da n t i b o d i e si n t h e r e c i p i e nt th a t r e c o g n i z H e L Aa n do t h e ra n t i g e n s r e p r e s e n t a t i voef t h e d o n o rp o p u l a t i o na;n dt h e d e t e c t i o n o f p r e f o r m e da n t i b o d i eisn t h e r e c i p i e ntth a t b i n dt o a n t i g e n s o f a n i d e n t i f i e dd o n o r ' sl e u k o c y t e sc, a l l e dc r o s s m a t c h i n gN o t a l l o f t h e s et e s t s a r e d o n e i n a l l t v p e so f t r an s p l an t a t t o n
In kidney transplantation, the larger the number of MHC alleles that are matched betweenthe donor and recipient, the better the grafr suruiual, especiallyin the first year after transplantation (Fig.16-9). MHC matching had a more profound influence on graft survival
P C Rm e t h o d sw i t h u s eo f p r i m e r st h a t b i n dt o c o n s e r v e d s e q u e n c e sw i t h i nt h e 5 ' a n d 3 ' e n d so f e x o n se n c o d i n g t h e p o l y m o r p h irce g i o n so f c l a s sI a n d c l a s sl l M H C m o l e c u l e sT . h e a m p l i f i e ds e g m e n to f D N A c a n t h e n r e a d i l y b e s e q u e n c e dT h u s ,t h e a c t u anl u c l e o t i dsee q u e n c ea,n d t h e r e f o r et h e p r e d i c t e da m i n o a c i d s e q u e n c e c, a n b e d i r e c t l yd e t e r m i n e df o r t h e a l l e l e so f a n y c e l l ,p r o v i d i n g p r e c i s em o l e c u l a tri s s u et y p i n g B a s e do n t h e s e D N A s e q u e n c i negf f o r t s t, h e n o m e n c l a t u roef H L Aa l l e l e sh a s c h a n g e dt o r e f l e c t h e i d e n t i f i c a t i oonf m a n y a l l e l e sn o t d i s t i n g u i s h ebdy p r e v i o u s e r o l o g i m c e t h o d s E a c ha l l e l e d e f i n e db y s e q u e n c eh a sa t l e a s ta f o u r - d i g n i t u m b e rb, u t A B O B L O O DT Y P I N G .T h i st e s t i s u n i f o r m l yu s e d i n a t l s o m e a l l e l e sr e q u i r e6 o r 8 d i g i t sf o r p r e c i s ed e f i n i t i o n . transplantation becauseno type of graft will surviveif T h ef i r s tt w o d i g i t su s u a l l yc o r r e s p o ntdo t h e s e r o l o g i c a l l y t h e r ea r e A B O i n c o m p a t i b i l i t i b ee s t w e e nt h e o o n o ra n d d e f i n e da l l o t y p eT. h e t h i r da n d f o u r t hd i g i t si n d i c a t et h e r e c i p i e n tN . a t u r a l g M a n t i b o d i e s p e c i f i cf o r a l l o g e n e i c s u b t y p e sA . l l e l e sw i t h d i f f e r e n c e isn t h e f i r s t f o u r d i g i t s A B O b l o o d g r o u p a n t i g e n s( s e e B o x 1 6 - 2 ) w i l l c a u s e e n c o d ep r o t e i n sw i t h d i f f e r e nat m i n oa c i d s F o re x a m p l e , h y p e r a c u tree l e c t i o nB l o o dt y p i n gi s p e r f o r m e d bymixing H L A - D R 8 1 " 1 3 0i s1a s e q u e n c e - d e f i nael lde l et h a ti s o n e a p a t i e n t ' sr e d b l o o d c e l l sw i t h s t a n d a r d i z esde r a c o n o f m a n y a l l e l e sp r e v i o u s l yc a l l e dH L A - D R B 1b a s e do n t a i n i n ga n t i - Ao r a n t i - Ba n t i b o d i e sl f.t h e p a t i e net x p r e s s e s s e r o l o g i tce c h n i q u e s e i t h e rb l o o dg r o u pa n t i g e n t, h e s e r u m s p e c i f i cf o r t h a t a n t i g e nw i l l a g g l u t i n a tteh e r e d c e l l s SCREENINGFOR THE PRESENCEOF PREFORMED A N T I B O D I E SP. a t i e n t sw a i t i n gf o r o r g a nt r a n s p l a n tasr e TISSUE TYPING: HLA MATCH|NG. For living retated screenedfor the presenceof preformedantibodiesreack i d n e yt r a n s p l a n t a t i oant ,t e m p t sa r e m a d et o r e d u c et h e t i v e w i t h a l l o g e n e i cH L A m o l e c u l e sT h e s ea n t i b o d i e s , n u m b e ro f d i f f e r e n c eisn H L Aa l l e l e se x p r e s s e o dn d o n o r w h i c h m a y b e p r o d u c e da s a r e s u l to f p r e v i o u sp r e g n a n a n d r e c i p i e nct e l l s ,w h i c h w i l l h a v ea m o d e s te f f e c t i n c i e s ,t r a n s f u s i o n o s ,r t r a n s p l a n t a t i ocna,n i d e n t i f yr i s kf o r r e d u c i n gt h e c h a n c eo f r e j e c t i o nI n b o n e m a r r o wt r a n s - h y p e r a c u toer a c u t ev a s c u l arre j e c t i o nS. m a l la m o u n t so f p l a n t a t i o nH, L A m a t c h i n gi s e s s e n t i atlo r e d u c et h e r j s k t h e p a t i e n t ' ss e r u m a r e m i x e d ,i n s e p a r a t ew e l l s , w i t h f o r G V H D R o u t i n eH L A t y p i n gf o c u s e so n l y o n H L A - A , c e l l sf r o m a p a n e lo f 4 0 t o 6 0 d i f f e r e ndt o n o r sr e p r e s e n H L A - B a, n d H L A - D Rb e c a u s et h e s ea r e t h e o n l yl o c it h a t . i n d i n go f t h e t a t i v e o f t h e o r g a n d o n o r p o p u l a t i o nB a p p e atro p r e d i ctth e l i k e l i h o oodf r e j e c t i o o nr G V H D U n t i l patient'a s n t i b o d i etso c e l l so f e a c hd o n o ro f t h e p a n e li s recently,most HLA haplotypedeterminations were perdetermined b y c o m p l e m e n t - m e d i a tley d s i s ,a s d e s c r i b e d f o r m e d b y s e r o l o g i ct e s t i n g T h i s p r o c e d u r er e l i e so n before, or by flow cytometrywith use of fluorescents t a n d a r d i z ecdo l l e c t i o nosf s e r af r o m m u l t i p l ed o n o r sp r e l a b e l e ds e c o n d a r ay n t i b o d i etso h u m a nl g G T h e r e s u l t s v i o u s l ys e n s i t i z e d t o d i f f e r e n tH L A m o l e c u l e sb y p r e g - a r e r e p o r t e da s p e r c e n rt e a c t i v e a n t i b o d y( P R A )w, h i c h i s n a n c yo r t r a n s f u s i o n sE a c ho f t h e s es e r ai s m i x e dw i t h t h e p e r c e n t a g eo f t h e d o n o r c e l l p o o l w i t h w h i c h t h e a p e r s o n ' sl y m p h o c y t e si n s e p a r a t ew e l l s o f a t i s s u e p a t i e n t ' s e r u mr e a c t sT . h e P R Ai s d e t e r m i n e d on mutlc u l t u r ep l a t e A s o u r c eo f c o m p l e m e n its a d d e dt o t h e p l e o c c a s i o nw t a i t sf o r a n o r g a na l l o g r a f t s h i l ea p a t i e n w w e l l s ,a s i s a f l u o r e s c e ndt y e t h a t w i l l e n t e r o n l y d e a d T h i s i s b e c a u s et h e P R A c a n v a r y ,s i n c ee a c h p a n e li s c e l l s A f t e r a n i n c u b a t i o tni m e , t h e w e l l s a r e e x a m i n e d c h o s e na t r a n d o ma, n dt h e p a t i e n t ' s e r u ma n t i b o d tyi t e r s u n d e ra f l u o r e s c e n c e m i c r o s c o p ef o r t h e p r e s e n c eo f m a y c h a n g eo v e rt i m e d e a d c e l l s B l y m p h o c y t e sa r e u s e d a s t a r g e t c e l l s b e c a u s et h e y n o r m a l l ye x p r e s sb o t h c l a s sI a n d c l a s sl l CROSSMATCHING. lf a potentialdonoris identified,the M H C m o l e c u l e sO n t h e b a s i so f w h i c h a n t i s e r ac a u s e c r o s s m a t c h i ntge s t w i l l d e t e r m i n ew h e t h e rt h e p a t i e n t l y s i s ,t h e H L A h a p l o t y p eo f t h e i n d i v i d u acla n b e d e t e r - h a sa n t i b o d i etsh a t r e a c ts p e c i f i c a lw l yi t h t h e d o n o rc e r r s . m i n e d S i n c et h e t y p i n gs e r am a y n o t b e a b s o l u t e lsyp e T h e t e s t i s p e r f o r m e di n a w a y s i m i l a rt o t h e a n t i b o d y c i f i c f o r a s i n g l ea l l e l i cp r o d u c t s, e r o l o g i ct y p i n gc a n n o t s c r e e n i n g a s s a y sb, u t i n t h i s c a s e ,t h e r e c i p i e n t 'sse r u m a l w a y sr e s o l v ee x a c t l yw h i c h a l l e l e sa r e p r e s e n t is tested for reactivityagainstonly the particulardonor's T h e p o l y m e r a s ec h a i n r e a c t i o n( P C R )h a s r e c e n t l y cells (typicallylymphocytes)Cytotoxicand flow cytob e e n u s e df o r m o r e d e t a i l e dt y p i n go f t h e N / H C ,r e p l a c - metricassayscan be used. i n g s e r o l o g i cm e t h o d s .M H C g e n e sc a n b e a m p l i f i e db y
IMMUN0L0GY 16- TRANSPLANTATI0N Chaoter
nisms that are involved in tolerance to self antigens (see Chapter 11), namely peripheral anergy, deletion, o(E active suppression of alloreactive T cells. Tolerance or >L is desirable in transplantation because it is alloantigen specific and will therefore avoid the major 6o problem associated with nonspeciflc immunosuppreshE sion, namely, increased susceptibility to infection and to E6 virus-induced tumors. In addition, achieving graft tolerance may reduce chronic rejection, which has to date L been unaffected by the commonly used immunosup23456 pressive agents that prevent and reverse acute rejection Number of mismatched HLA alleles episodes. FIGUREt6-9 lnfluence of MHCmatching on graftsurvival. Severalexperimental approaches and clinical obserMatchingof MHC allelesbetweenthe donorand recipientsignifihave suggested that it should be possible to vations cantlyimprovesrenalallograftsurvivalThe datashownarefor living achieve tolerance to allografts. donorgrafts HLA matchinghasevenmore of an impacton survival
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of renalallograftsfrom cadaverdonors,and some MHC allelesare more importantthan others in determiningoutcome (Datafrom OrganProcurement andTransplantation Network/Scientific Registry annualreport,2003)
before modern immunosuppressive drugs were routinely used. Clinical experience has shornmthat of all the class I and class II loci, matching only HLA-A, HIA-B, and HI"\-DR is important for predicting outcome. (Hl,AC is not as polymorphic as HI,A-A or H[-{-8, and HI-A.DR and HI"C.-DQ are in strong linkage disequilibrium, so matching at the DR locus often also matches at the DQ locus. DP tlping is not in common use, and its importance is unknorm.) Because two codominantly expressed alleles are inherited for each of these MHC genes,it is possible to have zero to six MHC antigen mismatches between the donor and recipient. Zero-antigen mismatches predict the best survival of living related donor grafts, and one-antigen-matched grafts do slightly worse. The survival of grafts with two to six MHC mismatches all are significantlyworse than zero- or oneantigen mismatches. MHC matching has an even greater impact on nonliving (unrelated) donor renal allografts. HtA matching in renal transplantation is possible because donor kidneys can be stored in organ banks before transplantation until a well-matched recipient can be identified, and becausepatients needing a kidney allograft can be maintained on dialysis until a wellmatched organ is available. In the caseof heart and liver transplantation, organ preservation is more difficult, and potential recipients are often in critical condition. For these reasons, HIA tlping is not considered in pairing of potential donors and recipients, and the choice of donor and recipient is based only on ABO blood group matching and anatomic compatibility.
Methods to Induce Donor-Specific Tolerance Allografr rejection may be prevented by making the host tolerant to the alloantigens of the graft. Tolerance in this setting means that the host does not injure the graft despite the absence or withdrawal of immunosuppressive and anti-inflammatory agents. It is presumed that tolerance to an allograft will involve the same mecha-
In experiments with skin grafts in mice, Medawar and colleaguesshowedthat if neonatalmice of one strain (the recipient) are given spleencellsof another strain (the donor), the recipients will subsequentlyaccept grafts from the donor. Such tolerance is alloantigen specific because the recipients will reject grafts from mouse strains that express MHC alleles that differ from the donor's (seeChapter 11,Fig. 11-2). Renal transplant patients who have received blood transfusions containing allogeneic leukocl'tes have a lower incidence of acute rejection episodesthan do those who have not been transfused.The postulated explanation for this effect is that the introduction of allogeneicleukocl'tesby transfusion produces tolerance to alloantigens.Indeed, pretreatment of potential recipientswith blood transfusionsis now used as prophylactictherapy to reduce rejection. Animals given bone marrow transplants who subsequently contain both donor and recipient cellsin the circulation (called mixed chimerism) are tolerant to organ allograftsderived from the same donor as the bone marrow graft. Human allogeneicbone marrow transplantation to establish mixed chimerism has been tried in a small number of patients before solid organ transplantation, but this approach may be Iimited by the problem of graft-versus-hostdisease (GVHD),which is discussedlater in this chapter.More benign methods to establish mixed chimerism in humans are under investigation. Strategiesare also being developed for inducing regulatory T ll.rnphocytes specific for graft alloantigens. Although the best approaches for inducing tolerance need to be established in clinical trials, it is hoped that tolerance induction will become a standard part of transplantation therapy in the near future.
TRANSPTANTATION XrruOCrrurIC The use of solid organ transplantation as a clinical therapy is greatly limited by the lack of availability of donor organs. For this reason, the possibility of transplantation of organs from other mammals, such as pigs, into human recipients has kindled great interest.
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Section V - IMMUNITY lN DEFENSE ANDDTSEASE
A major immunologic barrier to xenogeneic transplantation k the presence of natural antibodies that cause hyperacute rejection. More than 95% of primates have natural IgM antibodies that are reactive with the carbohydrate determinants expressed by the cells of members of speciesthat are evolutionarily distant, such as the pig. The vast majority of human anti-pig natural antibodies are directed at one particular carbohydrate determinant formed by the action of a pig cr-galactosyltransferase enz).rne. This enzyme places an a-linked galactose moiety on the same substrate that in human and other primate cells is fucosylated to form the blood group H antigen (see Box 16-2). Species combinations that give rise to natural antibodies against each other are said to be discordant. Natural antibodies are rarely produced against carbohydrate determinants of closely related, concordant species,such as humans and chimpanzees. Thus, chimpanzees or other higher primates technically can and have been used as organ donors for humans. However, ethical and logistic concerns have limited such procedures. For reasons of anatomic compatibility, pigs are the preferred xenogeneic species for organ donation to humans. Natural antibodies against xenografts induce hyperacute rejection by the same mechanisms as those seen in hyperacute allograft rejection. These mechanisms include the generation of endothelial cell procoagulants and platelet-aggregating substances, coupled with the loss of endothelial anticoagulant mechanisms. However, the consequences of activating human complement on pig cells are typically more severe than the consequences of activation of complement by natural antibodies on human allogeneic cells, possibly because some of the complement regulatory proteins made bypig cells, such as decay acceleratingfactor, are not able to interact with human complement proteins and thus cannot limit the extent of complementinduced injury (see Chapter 14). A strategy under exploration for reducing hyperacute rejection in xenotransplantation is to breed transgenic pigs expressing human proteins that inhibit complement activation or fail to express enzyrnes that synthesize pig antigens. Such pigs could, for example, overexpress human H group fucosyltransferaseand overexpresshuman complement regulatory proteins such as decay accelerating factor. Even when hyperacute rejection is prevented, xenografts are often damaged by a form of acute vascular rejection that occurs within 2 to 3 days of transplantation. This form of rejection has been called delayed xenograft rejection, acceleratedacute rejection, or acute vascular rejection and is characterized by intravascular thrombosis and fibrinoid necrosis of vessel walls. The mechanisms of delayed xenograft rejection are incompletely understood, but it is likely to be caused by natural antibodies to various endothelial antigens and byT cell activation and cytokine-mediated endothelial damage. Xenografis cqn ako be rejected by T cell-mediated immune responsesto xenoantigens. The mechanisms of cell-mediated rejection of xenografts are believed to be
similar to those that we have described for allograft rejection, and T cell responsesto xenoantigens can be as strong as or even stronger than responses to alloantigens. Human T cell recognition of pig MHC molecules may involve both direct and indirect pathways. Furthermore, several intercellular molecular interactions required for T cell responses,such as CD4lclass II MHC, CD8/classI MHC, CDzlLFA-3, CD28l87, CD40L/CD40, and VIA-4 /vascular cell adhesion molecule- I (VCAM - I ), are functional even when one member of these pairs is from a pig and the other from a human. Cell-mediated responses to xenografts may be too strong to be adequately controlled by the immunosuppressive protocols used for allograft rejection, and research is therefore focused on inducing specific tolerance to xenografts.The methods of tolerance induction that are being considered include those we have discussed for allografts, such as mixed hematopoietic chimerism, costimulation blockade, and administration of peptides from xenogeneic MHC molecules to induce specific tolerance.
BloooTRnrusrusrorrr Blood transfusion is a form of transplantation in which whole blood or blood cells from one or more individuals are transferred intravenously into the circulation of a host. Blood transfusions are performed to replace blood lost by hemorrhage or to correct defects caused by inadequate production of blood cells, which may occur in a variety of diseases.The major barrier to successfulblood transfusions is the immune responseto cell surface molecules that differ between individuals. The most important alloantigen system in blood transfusion is the ABO system (seeBox 16-2).ABO antigens are expressedon all cells,including red blood cells.Individuals lacking a particular blood group antigen may produce natural IgM antibodies against that antigen, probably as a result of responses to cross-reactive antigens expressed on bacteria that colonize the gut. If such individuals are given blood cells expressingthe missing antigen, the preexisting antibodies bind to the transfused cells, activate complement, and lyse the transfused cells. Lysis of the foreign red blood cells results in transfusion reactions, which can be life threatening. Transfusion acrossanABO barrier may trigger an immediate hemolytic reaction, resulting in both intravascular lysis of red blood cells, probably mediated by the complement system, and extensive phagocytosis of antibody- and complementcoated erythrocytes by macrophages of the liver and spleen. Hemoglobin is liberated from the lysed red cells in quantities that may be toxic for kidney cells, producing acute renal tubular cell necrosis and kidney failure. High fevers, shock, and disseminated intravascular coagulation may also develop, suggestive of massive cytokine release(e.g.,of TNF or IL-1; seeChapter 15, Box 15-l). The disseminated intravascular coagulation consumes clotting factors faster than they can be synthesized, and the patient may paradoxically die of bleeding
IMMUN0LOGY 16- TRANSPLANTATI0N Chaoter
in the presence of widespread clotting. More delayed hemolytic reactions may result from incompatibilities of minor blood group antigens.These result in progressive loss of the transfused red cells, leading to anemia, and jaundice, a consequence of overloading the liver with hemo globin-derived pigments. The choice of blood donors for a particular recipient is based on our understanding of blood group antigens. Virtually all individuals express the H antigen, and therefore they are tolerant to this antigen and do not produce anti-H antibodies. Individuals who expressA or B antigens are tolerant to these molecules and do not produce anti-A or anti-B antibodies, respectively. However, OO and AO individuals (see Box 16-2) produce anti-B IgM antibodies, and OO and BO individuals produce anti-A IgM antibodies. If a patient receivesa transfusion of red blood cells from a donor who expressesthe antigen not expressedon self red blood cells, a transfusion reaction may result (described above). It follows that AB individuals can tolerate transfusions from all potential donors and are therefore called universal recipients; similarly, OO individuals can tolerate transfusions only from OO donors but can provide blood to all recipients and are therefore called universal donors. In general, differences in minor blood groups lead to red cell lysis only after repeated transfusions trigger a secondary antibody response. ABO antigens are expressedon many other cell tJ,pes in addition to blood cells,including endothelial cells.For this reason, ABO typing is critical to avoid hlperacute rejection ofsolid organ allografts, as discussedearlier in the chapter. The Rhesus (Rh) antigen is another important red blood cell antigen that may be responsible for transfusion reactions (see Box 16-2). Although there are no natural antibodies to Rh antigens, individuals who do not express the RhD antigen (approximately 15% of the population) can be sensitized to this antigen and produce anti-Rh antibodies if they receive blood transfusions from an RhD-expressing donor. Transfusion reactions can arise after a second transfusion of Rhpositive blood. In addition, Rh-negative mothers carrying an Rh-positive fetus can be sensitized by fetal red blood cells that enter the maternal circulation, usually during childbirth. Subsequent pregnancies in which the fetus is Rh positive are at risk becausethe maternal antiRh antibodies can cross the placenta and mediate the destruction of the fetal red blood cells. This causes erythroblastosis fetalis (hemolytic disease of the newborn) and can be lethal for the fetus. This disease can be prevented by administration of anti-RhD (RhDimmune) antibodies to the mother within 72 hours of birth of the first Rh-positive baby. The treatment prevents the baby's Rh-positive red blood cells that entered the mother's circulation from inducing the production of anti-Rh antibodies in the mother. The exact mechanisms of action of the antibodies are not clear, but may include phagocytic clearance or complement-mediated lysis of the baby's red cells, or Fc receptor-dependent feedback inhibition of the mother's RhD-specific B cells (see Chapter 10).
Bonr MnnnowTRRtusptRNTATtoN Bone marrow transplantation is the transplantation of pluripotent hematopoietic stem cells, most commonly in an inoculum of bone marrow cells collected by aspiration. Hematopoietic stem cells can also be purifled from the blood of donors. after treatment with colonystimulating factors, which mobilize stem cells from the bone marrow. After transplantation, stem cells repopulate the recipient's bone marrow and differentiate into all the hematopoietic lineages.We consider bone marrow transplantation separately in this chapter because several unique features of this t!?e of grafting are not encountered with solid organ transplantation. Bone marrow transplantation may be used clinically to remedy acquired defects in the hematopoietic system or in the immune system because blood cells and lymphocytes develop from a common stem cell. It has also been proposed as a means of correcting inherited deficiencies or abnormalities of enzymes or other proteins (e.g., abnormal hemoglobin) by providing a self-renewing source of normal stem cells. Some stem cells in the bone marrow may also have the potential to differentiate into various nonhematopoietic tissue cell qpes, which is an area of active investigation for the possible treatment of diseasesof many organ systems.In addition, allogeneic bone marrow transplantation may be used as part of the treatment of bone marrow malignant disease (i.e., leukemias) and disseminated solid tumors. In this case, the chemotherapeutic agents needed to destroy cancer cells also destroy normal marrow elements, and bone marrow transplantation is used to "rescue" the patient from the side effects of chemotherapy. In addition, in some forms of leukemia, the grafted cells can be effective in destroying residual leukemia cells by a process analogous to the graft-versus-host responses discussed later. For other malignant tumors, when the marrow is not involved by tumor or when it can be purged of tumor cells, the patient's own bone marrow may be harvested and reinfused after chemotherapy. This procedure, called autologous bone marrow transplantation, does not elicit the immune responses associated with allogeneic bone marrow transplantation and will not be discussed further. Before bone marrow is transplanted, recipients must often be "prepared" with radiation and chemotherapyto deplete their orm marrow cells and vacate these sites to allow the transplanted stem cells to "home" to the marrow and establish themselves in the appropriate environment. Allogeneic stem cells are readily rejected by even a minimally immunocompetent host, and therefore the donor and recipient must be carefully matched at all polymorphic MHC loci. In addition, it is often necessary to greatly suppress the recipient's immune system to permit successful bone marrow transplantation. Such suppression is accomplished by radiation and chemotherapy. The mechanisms of rejection of bone marrow cells are not completely knor,rrn,but in addition to adaptive immune mechanisms, hematopoietic stem cells may also be rejected by NK cells.The role of NK cells
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in bone marrow rejection has been studied in experimental animals. Irradiated F, hybrid mice reject bone marrow donated by either inbred parent. This phenomenon, called hybrid resistance,is in distinction to the classical laws of solid tissue transplantation (see Fig. 16-2). Hybrid resistanceis seen in T cell-deficient mice, and depletion of recipient NK cells with anti-NK cell antibodies prevents the rejection of parental bone marrow. Hybrid resistanceis probably due to host NK cells reacting against bone marrow precursorsthat lack classI MHC moleculesexpressed by the host. Even after successful engraftment, two additional problems are frequently associated with bone marrow transplantation, namely, G\|FID and immunodeficiency. Graft-Versus-Host
Disease
GVHD is caused by the reaction of grafied mature T cells in the marrow inoculum with alloantigens of the host. It occurs when the host is immunocompromised and therefore unable to reject the allogeneic cells in the graft. In most cases, the reaction is directed against minor histocompatibility antigens of the host because bone marrow transplantation is not performed when the donor and recipient have differencesin MHC molecules. G\TID may also develop when solid organs that contain significant numbers of T cells are transplanted, such as the small bowel, lung, or liver. GVHD is the principal limitation to the success of bone marrow transplantation. As in solid organ transplantation, G\TID may be classified on rhe basis of histologic patterns into acute and chronic forms. Acute GVHD is characterizedby epithelial cell death in the skin, Iiver (mainlythe biliaryepithelium), and gastrointestinal tract (Fig. l6-I0). It is manifested clinically
t
,
I
d
-t,
FIGURE 16-1O Histopathology of acute GVHDin the skin. A sparselymphocyticinfiltratecan be seen at the dermal-epidermal layeris indicatedbVspacesat lunction,and damageto the epithelial junction(vacuolization), the dermal-eprdermal cells with abnormal keratinstaining(dyskeratosis), apoptotickeratinocytes, and disorganizationof maturatron of keratinocytes from the basallayerto the surface (Counesyof Dr Scott Grantor,Departmentof Pathology, BrighamandWomen'sHospital andHarvard MedicalSchool,Boston)
by rash, jaundice, diarrhea, and gastrointestinal hemorrhage. \Mhen the epithelial cell death is extensive, the skin or lining of the gut may slough off. In this circumstance, acute G\aHD may be fatal. Chronic GVIID is characterized by fibrosis and atrophy of one or more of the same organs,without evidence of acute cell death. Chronic GVHD may also involve the lungs and produce obliteration of small airways.lVhen it is severe,chronic GVHD leads to complete dysfunction of the affected organ. In animal models, acute GVHD is initiated by mature T cells present in the bone marrow inoculum, and elimination of mature donor T cells from the graft can prevent the development of GVHD. Efforts to eliminate T cells from the marrow inoculum have reduced the incidence of GVHD but also reduce the efficiency of engraftment, probably because mature T cells produce colony-stimulating factors that aid in stem cell repopulation. A current approach is to combine removal of T cells with supplemental granulocyte-macrophage colony-stimulating factor treatment to promote engraftment. Elimination of T cells from the donor marrow also decreasesthe graft-versus-leukemia effect that is often critical in treating leukemias by bone marrow transplantation. Although GVHD is initiated by grafted T cells recognizing host alloantigens, the effector cells that cause epithelial cell injury are less well defined. On histologic examination, NK cells are often attached to the dying epithelial cells, suggesting that NK cells are important effector cells of acute GVHD. CD8* CTLs and cytokines also appear to be involved in tissue injury in acute GVFID. The relationship of chronic GVHD to acute GVHD is not known and raises issues similar to those of relating chronic allograft rejection to acute allograft rejection. For example, chronic GVHD may represent the fibrosis of wound healing secondary to loss of epithelial cells. However, chronic GVHD can arise without evidence of prior acute GVHD. An alternative explanation is that chronic GVHD representsa responseto ischemia caused by vascular injury. Both acute and chronic GVHD are commonly treated with intense immunosuppression. It is not clear that either condition responds very well. A possible explanation for this therapeutic failure is that conventional immunosuppression is targeted against T lyrnphocytes, especially CTLs, but is less effective in controlling NK cell-mediated responses.Agents that suppress cytokine production, such as the drug thalidomide, or that antagonize cytokine action have been used for treating GVHD in clinical trials. Much effort has focused on prevention of GWID, and HIA typing is important in this regard. Cyclosporine and the metabolic toxin methotrexate are also used for prophylaxis against GVHD. lmmunodeficiency after Bone Marrow Transplantation Bone marrow transplantation is often accompanied by clinical immunodeficiency. Several factors may con-
tribute to defective immune responses in recipients. Bone marrow transplant recipients may be unable to regeneratea complete new lymphocyte repertoire. Radiation and chemotherapy used to prepare recipients for transplantation are likely to deplete the patient's memory cells and long-lived plasma cells, and it can take a long time to regeneratethese populations. The consequence of immunodeficiency is that bone marrow transplant recipients are susceptible to viral infections, especially cltomegalovirus infection, and to many bacterial infections. They are also susceptible to Epstein-Barr virus-provoked B cell lymphomas. The immunodeficiencies of bone marrow transplant recipients can be more severe than those of conventionally immunosuppressed patients. Therefore, bone marrow transplant recipients commonly receive prophylactic antibiotics and anticytomegalovirus therapy and are often actively immunized against capsular bicteria such as Pneumococcusprior to transplantation.
Chronic rejection is characterizedby fibrosis and vascular abnormalities (accelerated arteriosclerosis), which may represent a chronic DTH reaction in the walls of arteries.
o Rejection may be prevented or treated by immunosuppression of the host and by minimizing the immunogenicity of the graft (by limiting MHC allelic differences). Most immunosuppression is directed at T cell responsesand entails the use of cytotoxic drugs, specific immunosuppressive agents, or anti-T cell antibodies. The most widely used immunosuppressive agent is cyclosporine, which blocks T cell cytokine slmthesis. Immunosuppression is often combined with anti-inflammatory drugs such as corticosteroids that inhibit cytokine synthesis by macrophages. @
Patients receiving solid organ transplants may become immunodeficient because of their therapy and are susceptible to viral infections and virusrelated malignant tumors.
@
Xenogeneic transplantation of solid organs is limited by the presence of natural antibodies to carbohydrate antigens on the cells of discordant speciesthat cause hlperacute rejection, antibodymediated acute vascular rejection, and a strong T cell-mediated immune response to xenogeneic MHC molecules.
@
Bone marrow transplants are susceptible to rejection, and recipients require intense preparatory immunosuppression. In addition, T l1'rnphocltes in the bone marrow graft may respond to alloantigens of the host and cause GVHD. Acute GVHD is characterized by epithelial cell death in the skin, intestinal tract, and liver; it may be fatal. Chronic GVHD is characterizedby fibrosis and atrophy of one or more of these same target organs as well as the lungs and may also be fatal. Bone marrow transplant recipients also often develop severe immunodeficiency, rendering them susceptible to infections.
SUMMARY @ Transplantation of tissues from one individual to a genetically nonidentical recipient leads to a specific immune response called rejection that can destroy the graft. The major molecular targets in transplant rejection are allogeneic classI and class II MHC molecules. @ Many different, normally present T cell clones specific for different foreign peptides plus self MHC molecules may cross-reactwith an individual allogeneic MHC molecule. This high frequency of T cells capable of directly recognizing allogeneic MHC molecules explains why the response to alloantigens is much stronger than the response to conventional foreign antigens. 6 Allogeneic MHC molecules may be presented on donor APCs to recipient T cells (the direct pathway), or the alloantigens may be picked up by host APCs that enter the graft or reside in draining lymphoid organs and be processed and presented to T cells as peptides associated with self MHC molecules (the indirect pathway). I
Graft rejection is mediated by T cells, including CTLs that kill graft cells and helper T cells that cause DTH reactions, and by antibodies.
g Several effector mechanisms cause rejection of solid organ grafts, and each mechanism may lead to a histologically characteristic reaction. Preexisting antibodies cause hyperacute rejection characterized by thrombosis of graft vessels.Alloreactive T cells and antibodies produced in response to the graft cause blood vessel wall damage and parenchymal cell death, called acute rejection.
Selected Readings Akl A, S Luo, and KJ Wood. Induction of transplantation tolerance-the potential of regulatory T cells. Transplantation Immunology 14:225-230, 2005. BrinkmanV IG Cyster,and T Hla. FTY720:sphingosine 1-phosphate receptor-l in the control of lymphocyte egress and endothelial barrier function. American Journal of Transplantation 4: l0l9-1025, 2004. Cascalho M, and JL Platt. Xenotransplantation and other means of organ replacement. Nature Reviews Immunology 1:154-160,2001. Chidgey AII D Lalton, A Trounson, and RL Boyd. Tolerance strategiesfor stem-cell-basedtherapies.Nature 453:330-377, 2008.
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Clarkson MR, and MH Sayegh. T-cell costimulatory pathways in allograft rejection and tolerance. Transplantation B0:555-563,2005. Cobbold SP Regulatory T cells and transplantation tolerance. Iournal of Nephrology 2l:485-496, 2008. Colvin RB, and RN Smith. Antibody-mediated organ-allograft rejection. Nature Review Immunolo gy 5:807-817, 2005. Cornell LD, RN Smith, and RB Colvin. Kidney transplantation: mechanisms of rejection and acceptance.Annual Review of Pathology3: I 89-220,2008. Erlebacher A. \A/hy isn't the fetus rejected?Current Opinion in Immunology l3:590-593,2001. Felix NL and PM Allen. Speciflcity of T-cell alloreactivity. Nature Reviews Immunology 7 :9 42-953, 20O7. Gibbons C, and M Sykes.Manipulating the immune system for anti-tumor responses and transplant tolerance via mixed hematopoietic chimerism. Immunological Reviews 223:334-360,2008. Halloran PF.Immunosuppressive drugs for kidney transplantation. New England fournal of Medicine 351.2715-2729,2004. Heeger PS. T-cell allorecognition and transplant rejection: a summary and update. American Journal of Transplantation 3:525-533,2003. fiang, S, O Herrera, and RI Lechler. New spectrum of allorecognition pathways: implications for graft rejection and transplantation tolerance. Current Opinions in Immunology 16:550-557,2004.
LaRosa DB AH Rahman, and LA Turka. The innate immune system in allograft rejection and tolerance. Journal of Immunology 17B;7503-7 509, 2007. Lechler RI, M Sykes, AW Thomson, and l.A Turka. Organ transplantation-how much of the promise has been realized? Nature Medicine l 1:605-613,2005. Newell KA, CP Larsen, and AD Kirk. Transplant tolerance: converging on a moving target. Transplantation 81:l-6, 2006. Pascual M, T Theruvath, T Kawai, N Tolkoff-Rubin, and AB Cosimi. Strategies to improve long-term outcomes after renal transplantation. New England Iournal of Medicine 346:580-590,2002. Ricordi C, and TB Strom. Clinical islet transplantation: advances and immunological challenges. Nature Reviews Immunology 4:259-268,2O04. Trowsdale L and AG Betz. Mother's little helpers: mechanisms of maternal-fetal tolerance. Nature Immunology 7 :24I-246, 2006. Wood KJ, and S Sakaguchi. RegulatoryT cells in transplantation tolerance. Nature Reviews Immunology 3:199-210,2003. Yamada A, AD Salama, and MH Sayegh.The role of novel costimulatory pathways in autoimmunity and transplantation. Journal of the American Society of Nephrology 13:559-575, 2002. Yang YG, M Sykes. Xenotransplantation: current status and a perspective on the future. Nature Reviews Immunology 7:519-531,2007.
General Features of Tumor lmmunity, 397
tumor immunologY.The concePt lance,which wasproposedbYMac
Tumor Antigens,399 Productsof MutatedGenes,399 AbnormallyExpressed CellularProteins,402 Antigensof OncogenicViruses,403 OncofetalAntigens,405 AlteredGlycolipidand Glycoprotein Antigens,406 Tissue-Specific DifferentiationAntigens,406
1950s,states that a physiologic funct system is to recognize and destroy c cells before they grow into tumors after thev are formed. The existence lance has been demonstratedby the increasedincidence of some types of tumors in immunocompromised experinrcntal animals and humans. Although the overall importance of immune surveillancehas been contro-
fmmune Responses to Tumors,40,6 to Tumors,406 InnatelmmuneResponses AdaptivelmmuneResponses to Tumors,407 Evasion of lmmune Responses by Tumors, 4O8 lmmunotherapy for Tumors, 41O Stimulationof ActiveHost lmmuneResponses to Tumors.410 Passivelmmunotherapy for Tumorswith T C e l l sa n d A n t i b o d i e s4.1 4 The Role of the lmmune System in Promoting Tumor Growth, 416 Summary,416
Cancer is a major health problem worldwide and one of the most important causesof morbidity and mortality in children and adults. Cancersarise from the uncontrolled proliferation and spread of clones of transformed cells. The growth of malignant tumors is determined in large part by the proliferative capacity of the tumor cells and by the ability of these cells to invade host tissues and metastasizeto distant sites.The possibility that cancers can be eradicated by specific immune responses has been the impetus for a large body of work in the field of
u".iiul, it is now clearthat the immune systemdoesreact againstmany tumors, and exploiting theffereaetiffls to specificallydestroytumors remainsan impofia4t goal of tumor immunologists.In addition, one of the factors in the growth of malignant tumors is the ability of these cancersto evadeor overcomethe mechanismsof host defense.In this chapter,we describethe types of antigens that are expressedby malignant tumors, how the immune systemrecognizesand respondsto theseantigens,and the application of immunologic approachesto the treatmentof cancer.
lunnururv 0FTUMoR FeRrunrs GrrurRRl Several characteristics of tumor antigens and immune responsesto tumors are fundamental to understanding tumor immunity and developing strategies for cancer immunotherapy. @ Tumors express antigens that are recognized as foreign by the immune system of the tumor-bearing host. Clinical observations and animal experiments have established that although tumor cells are derived from host cells, the tumors elicit immune responses. Histopathologic studies show that many tumors are surrounded by mononuclear cell infiltrates composed of T lymphocytes, natural killer (NK) cells' and macrophages,and activated l1'rnphocltes and macrophagesare present in lyrnph nodes draining the sites of tumor growth. The presenceof lymphoc1'ticinfiltratesin sometypesof melanomaand breast canceris predictive of a better prognosis.
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The first experimental demonstration that tumors can induce protectiveimmune responsescame from studies of transplanted tumors performed in the 1950s(Fig. l7-l). A sarcomamay be induced in an inbred mouse by painting its skin with the chemical carcinogenmethylcholanthrene(MCA). If the MCAinduced tumor is excisedand transplantedinto other syngeneicmice, the tumor grows. In contrast, if the tumor is transplantedback into the original host, the mouse rejectsthe tumor. The same mouse that had becomeimmune to its tumor is incapableof rejecting MCA-inducedtumors producedin other mice. Furthermore,T cellsfrom the tumor-bearing animal can transferprotectiveimmunity to the tumor to another tumor-free animal. Thus, immune responses to tumors exhibit the defining characteristicsof adaptive immunity, namely, specificity and memory, and are mediated by lymphocltes. The immunogenicity of tumors implies that tumor cells express antigens that are recognized as foreign by the adaptive immune system. As predicted from the transplantation experiments, defense against tumors is mediated mainly by T lymphocyes.
@ Immune responses ftequently fail to preuent the growth of tumors. There may be several reasons that anti-tumor immunity is unable to eradicate transformed cells. First, tumor cells are derived from host cells and therefore resemble normal cells in many respects.In other words, most tumors expressonly a few antigens that may be recognized as nonself, and as a result, most tumors tend to be weaklv immunogenic. Tumors that elicit strong immune responses include those induced by oncogenic viruses, in which the viral proteins are foreign antigens, and tumors induced in animals by potent carcinogens, which often causemutations in normal cellular genes.Many spontaneous tumors induce weak or even undetectable immunity, and studies of such tumors led to considerable skepticism about the concept of immune surveillance. In fact, the importance of immune surveillance and tumor immunity is likely to vary with the type of tumor. Second, the rapid growth and spread of tumors may overwhelm the capacity of the immune system to eradicate tumor cells, and control of a tumor requires that all the malignant cells be eliminated. Third, many tumors have specialized mechanisms for evading host
lsolateCD8+T cells
,,.;,tl' tlij"
Transplant tumor intooriginal tumor-bearinq mouse
No tumor growth
Transplant tumorcells into svnqeneicmouse cells
Adoptively transfer T cellsintorecioient of tumortransplant
Tumor
FIGURE 17-1 Experimentaldemonstrationof tumor immunity.Mice that have been surgicallycured of a chemicalcarcinogen(MCA)inducedtumor rejectsubsequenttransplants of the same tumor,whereasthe transplanted turnorgrows in normalsyngeneic-miceThe tumor ls alsorelectedin normalmice that are g ven adoptivetransferof T lymphocytes from the originaltumor-bearing animal
T0 TUMORS Chaoter17- IMMUNITY
immune responses.We will return to these mechanisms later in the chapter. @ The immune system can be actiuated by external stimuli to effectiuely kill tumor celk and eradicate tumors. As we shall see at the end of the chapter, this realization has spurred new directions in tumor immunotherapy in which augmentation of the host anti-tumor response is the goal of treatment.
TuuoR Auncrrus A variety of tumor antigens that may be recognized by T and B lyrnphocytes have been identified in human and animal cancers. In the experimental situation, as in MCA-induced mouse sarcomas, it is often possible to demonstrate that these antigens elicit adaptive immune responses and are the targets of such responses.Tirmor antigens have also been identified in humans, but the methods used in this case are generally not suitable for proving that these antigens can elicit protective immunity to tumors. Nevertheless,it is important to identify tumor antigens in humans because they may be used as components of tumor vaccines, and antibodies and effector T cells generated against these antigens may be used for immunotherapy. The earliest classification of tumor antigens was based on their patterns of expression.Antigens that are expressed on tumor cells but not on normal cells are called tumor-specific antigens; some of these antigens are unique to individual tumors, whereas others are shared among tumors of the same type. Tumor antigens that are also expressedon normal cells are called tumorassociated antigens; in most cases, these antigens are normal cellular constituents whose expression is aberrant or dysregulated in tumors. The modern classification of tumor antigens relies on the molecular structure and source of the antigens, which is how we will discuss tumor antigens. The existence of tumor antigens was first established by transplantation experiments in animals, as described earlier. The initial attempts to purify and characterize these antigens were based on producing monoclonal antibodies specific for tumor cells and defining the antigens that these antibodies recognized. The antibodies were made by immunizing mice with tumors from other species, and most of the anti-tumor antibodies recognized antigens that are shared by different tumors arising from the same tlpes of cells and that are also found on some normal cells and benign tumor cells. A more recently developed approach for identification of tumor antigens specifically recognized by antibodies in the serum of cancer patients is called serologic analysis of recombinant complementary DNA expression (SEREX). In this method, expression libraries of complementary DNA (cDNA) derived from a patient's tumor RNA are screened using the cancer patient's serum immunoglobulins. In this way, gene sequencesare obtained, and predicted protein products are identified.
Anti-tumor antibodies do not recognize the major histocompatibility complex (MHC)-associated peptides that are the antigens seen byT cells.Tumor antigens that are recognized byT cells are likely to be the major inducers of tumor immunity and the most promising candidates for tumor vaccines. An important breakthrough in tumor immunology was the development of techniques for identifying antigens that are recognized by tumorspecific T lymphocltes (Box 17-l). Much of our knowledge of these antigens is limited to antigens recognized by CD8* cltotoxic T lymphocytes (CTLs), and only recently have attempts been made to identiff antigens that are recognized by CD4* helper cells.Tumor antigens that are recognized by CD8- T cells are peptides derived from proteins processedin the cytosol and displayed on the tumor cell surface bound to class I MHC molecules (seeChapter 5). In the following section, we describe the main classes of tumor antigens (Fig. l7-2 and Table 17-l) and use selected examples of human and animal tumors to illustrate the importance of these antigens in tumor immunity and their potential as therapeutic targets. Products
of Mutated
Genes
Some tumor antigens are produced by oncogenic muta.nts of normal cellular genes. Many tumors express genes whose products are required for malignant transformation or for maintenance of the malignant phenotype. Often, these genes are produced by point mutations, deletions, chromosomal translocations, or viral gene insertions affecting cellular proto-oncogenes or tumor suppressor genes. The products of these altered proto-oncogenes and tumor suppressor genes are synthesizedinthe cltoplasm of the tumor cells, and like any cltosolic protein, they may enter the class I antigen-processing pathway. In addition, these proteins may enter the class II antigen-processing pathway in antigen-presenting cells (APCs)that have phagocltosed dead tumor cells. Because these altered genes are not present in normal cells, peptides derived from them do not induce self-tolerance and may stimulate T cell responses in the host. Some patients with cancer have circulating CD4* and CD8*T cells that can respond to the products of mutated oncogenes such as Ras and Bcr-Abl proteins and mutated tumor supressor genes such as p53. Furthermore, in animals, immunization with mutated Ras or p53 proteins induces CTLs and rejection responses against tumors expressing these mutants. However, these proteins do not appear to be major targets of tumor-specific CTLs in most patients with a variety of tumors. Tumor antigens may be prod'uced by rand'omly mutated genes whose products are not related to the transformed, phenotype. Tumor antigens that were defined by the transplantation of carcinogen-induced tumors in animals, called tumor-specific transplantation antigens (TSTAs),are mutants of various host cellular proteins. Studies with chemically induced rodent sarcomas,such as those illustrated in Figure 17-I, established that different rodent tumors, all induced by the
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I M I V I U N IlT NYD E F E N S AE N DD I S E A S E
T u m o ra n t i g e n sr e c o g n i z e bd y T c e l l sh a v eb e e n i d e n t i f i e d b y t w o m a i n a p p r o a c h e st r:a n s p l a n t a t i oonf t u m o r s i n r o d e n t sa n d t h e i d e n t i f i c a t i oonf p e p t i d e sr e c o g n i z e d b y t u m o r - s p e c i f iCc T L s o r i d e n t i f i c a t i oonf t h e o c n c q e n c o d i n gt h e s ep e p t i d e s
t h e e x i s t e n c eo f t u m o r a n t i g e n sr e c o g n i z e b dy T c e l l s I n i t i asl t u d i e so f t h i st y p e u s e dc h e m i c a l liyn d u c e dr o d e n t s a r c o m a s( s e eF i g 1 7 - 1 a n dt h e t e x t ) ,a n d t h e y d e m o n strated the existenceof tumor-specifictransplantation a n t i g e n s( T S T A st)h a t e l i c i t e dh i g h l y s p e c i f i ci m m u n e responsesAnother,more recentapproachto characteri z ea n t i g e n st h a ts t i m u l a t et u m o rr e j e c t i o n b y C T L sr e l i e s o n t h e l n y i t r om u t a g e n e s iosf a n e s t a b l i s h etdu m o r i g e n i c
TUMOR TRANSPLANTATION. Studiesof transplanted t u m o r si n r o d e n t sw e r e t h e f i r s te x n e r i m e n ttso i n d i c a t e
iAl --
Generation of tumor-specific CTLclones tPatient's mononuclear cells
lsolate and clone activated
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Coculture mononuclear cells and melanomacells
9o, ,r* Tumor cells
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ldentificationof tumor antigensrecognizedby tumor-specificCTLs
CoculturewithCTL clone
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ransfectint classI MHC+ targetcellline
lsolatetransfected I D N Aa n ds e q u e n c e ,
Geneencodingtumor antigenrecognizedby melanoma-specific CT ClonedCTLlinesspecificfor humantumolsare usedto identifyspecifictumorantigens.A CD8.T cellsisolatedf rom blood,lvmph nodes,or turnorsof patientswith melanomaare propagated in cultureby stimulatingthem with melanomacell Iinesderivedfrom t h e p a t r e n t 'tsu m o r S i n g l eT c e i l sf r o m t h e s ec u l t u r e a s r ee x p a n d e d i n t oc l o n aC l T Ll i n e s B D N Af r o m m e l a n o m g a e n el i b r a r i eiss transfectedinto classI MHC-expressing targetcells Genesthat sensrtizethe targetcellsfor lysisby the melanoma-specific CTL clonesare analyzedto identifythe melanomaproteinantigensrecognized by the patient'sCTLs
Continuedon followingpage
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m o u s ec e l l l i n ea n d i s o l a t i o n o f n o n t u m o r i g e nvi ca r i a n t s t h a t a r e r e j e c t e do n t r a n s p l a n t a t i oi nnt o s y n g e n e i m c ice I n t h i s s y s t e m t, h e t u m o r i g e n rcce l ll i n ed o e sn o t e x p r e s s TSTAsandthereforegrows uncheckedwhen it is injected i n t o a h o s t a n i m a l ,b u t t h e m u t a g e n i z ecde l l l i n e d o e s expressmutantproteinantigensthat induceits rejection. The role of CTLs in the rejectionprocessin this model has been establishedby adoptivetransferexperiments and by the propagation of CTL clonesthat recognizethe t u m o r ,a s d i s c u s s e db e l o w .T h e a c t u a lg e n e se n c o d i n g the rejectionantigensin a few of these tumor variants havebeen cloned,by methodsdescribedbelow.
tumor-specificCTL lines These tumor antigens have been identifiedby two methods First,a directbiochemi c a la p p r o a c hi s u s e d i n w h i c h p e p t i d e sb o u n dt o t u m o r s r e e l u t e db y a c i dt r e a t m e n t c e l lc l a s sI M H C m o l e c u l e a and f ractionatedby reverse-phasehigh-performance (HPLC)The fractionsare tested liquidchromatography for their ability to sensitizeMHC-matchednontumor CTL clone This targetcellsfor lysisby a tumor-specific strategyrelieson havinga targetcell that expressesthe c l a s sI M H C m o l e c u l e fso r w h i c h t h e C T L c l o n ei s s p e cific but does not normallyexpressthe tumor antigen, a n d o n t h e a b i l i t yt o l o a dt h e s e c e l l s u r f a c eM H C m o l e peptides. c u l e s w i t h t h e e x o g e n o u sH P L C - p u r i f i e d GENERATION OF TUMOR-SPECIFIC Peptidefractionsthat do sensitizethe target cells are GTLCLONES.The e s t a b l i s h m e notf c l o n e dC T L l i n e st h a t r e c o g n i z teu m o r then analyzedby mass spectroscopyto determinetheir antigenshas been a key advancein the identification . n c e t h e p e p t i d es e q u e n c ei s a m i n o a c i d s e q u e n c e sO of t u m o r a n t i g e n sb e c a u s es u c h c l o n e sp r o v i d es e n s i t i v e known, it may be possibleto compareit with databases p r o b e sf o r i d e n t i f y i ntgu m o ra n t i g e n st h a t a r e l i k e l yt o b e of proteinsequencesto see whetherit matcheswith any previously characterizedprotein and to determine importanttargetsof host anti-tumorimmune responses T h i s a p p r o a c hi s p a r t i c u l a r vl ya l u a b l e f o r h u m a nt u m o r s , whether any point mutationsare presentin the normal w h o s ei m m u n o g e n i c ict ya n n o e t a s i l yb e s t u d i e db y t r a n s - s e q u e n c e s . p l a n t a t i o inn a n i m a l sM a n yc l o n e dC T L l i n e ss p e c i f i cf o r T h e s e c o n dm e t h o do f i d e n t i f y i n tgu m o r a n t i g e n si s l y e l a n o m a sh, a v eb e e n g e n h u m a nt u m o r s ,p a r t i c u l a r m m o l e c u l acr l o n i n go f t h e g e n e se n c o d i n gt h e s ea n t i g e n s ( s e e F i g u r e )T. h i s m e t h o d r e l i e so n p r e p a r i n ga c D N A e r a t e df r o mt h e T c e l l so f p a t i e n t sM e l a n o m a sw, h i c ha r e m a l i g n a nt u t m o r so f m e l a n o c y t e as r, eo f t e nr e a d i l a y c c e s - l i b r a r yf r o m a t u m o r c e l l l i n et h a t c o n t a i n sg e n e se n c o d s i b l e ,s u r g i c a l lrye s e c t a b lteu m o r st h a t m a y b e g r o w n i n i n ga l lt h e t u m o rp r o t e r n sT.h el i b r a r yi s p r e p a r e idn m o l e c t i s s u ec u l t u r e C T L s s p e c i f i cf o r t h e s e t u m o r s m a y b e ular constructsthat will allow constitutiveexpressionof p r o p a g a t eadn d s u b s e q u e n t lcyl o n e db y c u l t u r i n gT c e l l s t h e g e n e sw h e n t h e y a r e i n t r o d u c e idn t oc e l ll i n e s .P o o l s f r o m a m e l a n o m ap a t i e n tw i t h c e l l s d e r i v e df r o m t h e of DNA from such a libraryare transfectedinto a cell line a c l a s sI M H C a l l e l ea l s o e x p r e s s e db y t h e o a t i e n t ' sm e l a n o m aT. h e T c e l l s c a n b e i s o l a t e df r o m expressing p e r i p h e r abll o o d ,l y m p hn o d e sd r a i n i n tgh e t u m o r ,o r c e l l s tumor,and the transfectedcellsare testedfor sensitivity r T Lc l o n e .T h e D N A p o o l st h a t that have actuallyinfiltratedthe tumor in vivo. Because t o l y s i sb y a n a n t i - t u m oC t h e T c e l l sa n d t h e t u m o r a r e f r o m t h e s a m e i n d i v i d u a l , s e n s i t i z et h e t a r g e t c e l l l i n e c o n t a i nt h e g e n e t h a t t h e M H C r e s t r i c t i o no f t h e T c e l l s m a t c h e st h e M H C e n c o d e st h e p r o t e i na n t i g e nr e c o g n i z ebdy t h e C T Lc l o n e . allelesexpressedbVthe tumor In thesecocultures,CTLs M u l t i p l er o u n d so f t r a n s f e c t i o nuss i n gs m a l l ear n ds m a l l e r p e p t i d ea n t i g e n sd i s p l a y e db y t h e t u m o r of the DNA pool can leadto isolationof the that recognize subfractions c e l l sa r e s t i m u l a t e dt o g r o w , a n d s i n g l e - c ecl ll o n e sa r e s i n g l er e l e v a ngt e n e T h e s e q u e n c eo f t h e g e n ec a nt h e n p r o p a g a t e di n l L - 2 b y l i m i t i n gd i l u t i o nt e c h n i q u e s( s e e b e d e t e r m i n e d a, n d c o m p a r i s o n sc a n b e m a d e w i t h to difFigure). known genes Syntheticpeptidescorresponding ferent regionsof the encodedproteincan be tested for IDENTIFICATIONOF TUMOR ANTIGENS RECOG. t h e i ra b i l i t yt o s e n s i t i ztea r g e tc e l l si n m u c ht h e s a m ew a y NIZEDBY T CELLS.ldentification of the peptideantigens a s i n t h e p e p t i d ee l u t i o na p p r o a c hB o t ht h e b i o c h e m i c a l to that induceCTL responsesin patientswith tumors and and geneticapproacheshave been used successfully i d e n t i f i c a t i oonf t h e g e n e s e n c o d i n gt h e p r o t e i n sf r o m i d e n t i f yh u m a n m e l a n o m aa n t i g e n st h a t s t i m u l a t eC T L w h i c h t h e p e p t i d e sa r e d e r i v e dh a v e r e l i e do n c l o n e d r e s o o n s e isn t h e p a t i e n t sw i t h m e l a n o m a .
same carcinogen, expressed different transplantation antigens. For example, an MCA-induced sarcoma will induce protective immunity against itself but not against another MCA-induced sarcoma, even if both tumors are derived from the same normal cell type and in the same mouse. We now know that the tumor antigens identified by such experiments are peptides derived from mutated self proteins and presented in the form of peptide-class I MHC complexes capable of stimulating CTLs. These antigens are extremely diverse because the carcinogens that induce the tumors may randomly mutagenize virtually any host gene, and the class I MHC antigenpresenting pathway can display peptides from any
mutated cltosolic protein in each tumor. Mutated cellular proteins are found more frequently in chemical carcinogen- or radiation-induced animal tumors than in spontaneous human cancers, probably because chemical carcinogens and radiation mutagenize many cellular genes. Nevertheless, TSTAs of experimental animal tumors are relevant to the study of human cancers in two ways. First, the flnding of TSTAs was the first result to prove that adaptive immune responses may be able to control tumors. Second, the general principle that mutated host proteins can function as tumor antigens, which also came from studies of animalTSTAs, has been demonstrated in human cancers as well.
no:
rNDEFENSE ANDDTSEASE t**,_::::'" v - TMMUNTTY
Examples Normalhost celldisplaying multiple MHCassociated selfantigens
response
Productof oncogeneor mutatedtumor suppressor gene
Variousmutantproteins in carcinogen or radiation inducedanimaltumors; variousmutatedproteins in melanomas Oncogeneproducts:mutated Ras,BcrlAblfusionproteins gene Tumorsuppressor products: mutatedp53 protein
or aberrantly expressed self protein
tyrosinase, Overexpressed: 9p100,MARTin melanomas. Aberrantly expressed: Cancer/testis antigens (MAGE,BAGE)
Mutatedself protein
Tumorcells expressing different typesof tumorantigensOverexpressed cD8+ CTL
Virus
Humanpapilloma virus E6, E7 proteinsin cervical carcinoma; EBNAproteins in EBV-induced lymphomas
antigenspecific CD8+CTL FIGUREt Z-Z Typesof tumorantigens recognized byT cells.Tumorantigens thatarerecognized by tumor-specif ic CDB.T cellsmaybe mutated formsof normalselfproteins, products of oncogenes, overexpressed or aberrantly expressed selfproteins, or products of oncog e n r vc r r u s e s
Abnormally
Expressed Cellular Proteins
Tumor antigens may be normal cellular proteins that are abnormally expressed in tumor cells and elicit immune responses.Many such antigens have been identified in human tumors, such as melanomas, by the molecular cloning of antigens that are recognized by T cells from tumor-bearing patients (see Box 17-1). One of the surprises that emerged from these studies was that some tumor antigens are normal proteins that are produced at low levels in normal cells and overexpressed in tumor cells (see Table 17-1). One such antigen is tyrosinase,an enzyme involved in melanin biosynthesis that is expressed only in normal melanocytes and melanomas. Both class I MHC-restricted CD8. CTL clones and class II MHC-restricted CD4* T cell clones from melanoma patients recognize peptides derived from tyrosinase. On face value, it is surprising that these patients are able to respond to a normal self antigen. The Iikely explanation is that tyrosinase is normally produced in such small amounts and in so few cells that it is not recognized by the immune system and fails to induce tolerance. The finding of tyrosinase-specific T
cell responses in patients raises the possibility that tyrosinase vaccines may stimulate such responses to melanomas; clinical trials with these vaccines are ongoing. Cancerltestk antigens are proteins expressed in gametes and trophoblasts, and.in many types of c&ncers, but not in normal somatic tissues.The first cancer/testis antigens were identified by cloning genes from human melanomas that encoded cellular protein antigens recognized by melanoma-specific CTL clones derived from the melanoma-bearing patients. These were called MAGE proteins, and theywere subsequentlyfound to be expressed in other tumors in addition to melanomas, including carcinomas of the bladder, breast, skin, lung, and prostate, and some sarcomas, as well as in normal testes. Subsequent to identification of the MAGE genes, several other unrelated gene families have been identified that encode melanoma antigens recognized by CTL clones derived from melanoma patients. Like the MAGE proteins, these other melanoma antigens are silent in most normal tissues, except the testes or trophoblasts in the placenta, but they are expressed in a variety of malignant tumors. There are now over 44 different
17Chapter
IMMUNITY T0 TUMORS
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.-,,,,,..-.."-,*"3*-.".....,. .
Table 17-1.Tumor Antigens
Typeof antigen
I Examplesof humantumor antigens
Products of oncogenes, Oncogenes: p210productof Bcr/Abl (-10%of humancarcinomas), Rasmutations (breastandothercarcinomas) (CML),overexpressed Her-2lneu tumorsuppressor genes rearrangements genes:mutatedp53(present Tumorsupressor in -50% of humantumors)
Mutants of cellular genesnot involvedin tumorigenesis Products of genes thataresilentin mostnormaltissues Products of genes overexpressed P.roducts of oncogenic
p91Amutation in variousmutatedproteins in mutagenized murinemastocytoma; melanomas recognized by CTLs andmanycarcinomas; Cancer/testis in melanomas antigens expressed normally expressed mainlyin thetestisandplacenta (normally in melanocytes) Tyrosinase, expressed 9p100,MARTin melanomas
VITUSES
(cervical Papillomavirus carcinomas) E6 andE7 proteins nasopharyngeal carcinoma) EBNA-1proteinof EBV(EBV-associated lymphomas,
Oncofetal antigens
SV40T antigen(SV40-induced rodenttumors) in liverand Carcinoembryonic antigen(CEA)on manytumors,alsoexpressed othertissuesduringinflammation (AFP) Alpha-fetoprotein
GMz,GDzon melanomas Glycolipids and glycoproteins ic antigen Differentiation antigens Prostate-specif normallypresentin Markersof lymphocytes: on B cells CD10,CD20,lg idiotypes tissueof origin Abbreviations; CML, chronic nuclearantigen;EBV,
EBNA,Epstein-Barr T lymphocyte; CTL,cytotoxic Jenousleukemia; by T cells. virus;lg, immunoglobulin; antigenrecognized MART,melanoma
cancer/testis antigen families identified. About half are encoded by genes on the X-chromosome, while the rest are encoded by genes distributed throughout the genome. Although some cancer/testis antigens have been shown to regulate transcription or translation of other genes,the functions of most cancer/testis antigens are unknown. In general, they are not required for the malignant phenotype of the cells, and their sequences are identical to the corresponding genes in normal cells; that is, they are not mutated. SeveralX-linked cancer/ testis antigens are currently being used in tumor vaccine trials.
Antigens
of Oncogenic
Viruses
The products of oncogenic uiruses function as tumor antigens and elicit specific T cell responses that may serue to eradicate the tumors. DNA viruses are implicated in the development of a variety of tumors in humans and experimental animals. Examples in humans include the Epstein-Barr virus (EBV), which is associatedwith B cell lymphomas and nasopharyngeal carcinoma (Box l7-2), and human papillomavirus
(HPV), which is associated with cervical carcinoma. Papovaviruses, including polyomavirus and simian virus 40 (SV40),and adenovirusesinduce malignant tumors in neonatal or immunodeficient adult rodents. In most of these DNA virus-induced tumors, virus-encoded protein antigens are found in the nucleus, c),toplasm, or plasma membrane of the tumor cells. These endogenously synthesizedproteins can be processed,and complexes of processed viral peptides with class I MHC molecules may be expressedon the tumor cell surface. Because the viral peptides are foreign antigens, DNA virus-induced tumors are among the most immunogenic tumors knoltm. The ability of adaptive immunity to prevent the growth of DNA virus-induced tumors has been estabIished by many observations. EBV-associated l1'rnphomas and HPV-associated skin and cervical cancers arise more frequently in immunosuppressed individuals, such as allograft recipientsreceivingimmunosuppressivetherapy and patients with acquired immunodeficiency s1'ndrome (AIDS),than in normal individuals.
V- IMMUNITY INDEFENSE ANDDISEASE i::-:-":."':ON
E B V i s a d o u b l e - s t r a n d eDdN A v i r u so f t h e h e r p e s v i r u s f a m i l yT h ev i r u si s t r a n s m i t t e b d y s a l i v ai,n f e c t sn a s o p h a r y n g e ael p i t h e l i acle l l sa n d B l y m p h o c y t e sa,n d i s u b i q u i t o u s i n h u m a no o p u l a t i o nwso r l d w i d el t i n f e c t sh u m a nB c e l l sb y b i n d i n gs p e c i f i c a ltl o y c o m p l e m e nrte c e p t otry p e 2 lCR2,or CD2'1 enoo), followed bv receptor-mediateo cytosisand fusionof the viralenvelopewith the endosom a l m e m b r a n e T w o t v o e s o f c e l l u l a ri n f e c t i o n sc a n o c c u r I n a l y t i ci n f e c t i o nv,i r a lD N A ,R N A ,a n d p r o t e i na r e s y n t h e s i z e df o, l l o w e db y a s s e m b l yo f v i r a lp a r t i c l e sa n d lysis of the infectedcell. Alternatively, a latent nonlytic i n f e c t i o nc a n o c c u ri n w h i c h t h e v i r a lD N A i s m a i n t a i n e d a s a n e p i s o m ei n i n f e c t e dc e l l s V a r i o u sv i r a l l ye n c o d e d a n t i g e n sa r e d e t e c t a b l ei n i n f e c t e dc e l l s .A t l e a s t s i x E p s t e i n - B a rnru c l e a ra n t i g e n s( E B N A s )a r e e x p r e s s e d early in lytic infectionsand may also be expressedby some latentlyinfectedcells Two other proteins,called l a t e n tm e m b r a n ep r o t e i n s( L M P s )a, r e e x p r e s s e d on the surfaceof latentlyinfectedcells Viralantigensare typicallyexpressedin infectednaiveand recentlyactivatedB c e l l s b u t n o t i n m e m o r y B c e l l s .O t h e r v i r a l s t r u c t u r a l p r o t e i na n t i g e n si,n c l u d i n gv i r a lc a p s i da n t i g e n s( V C A s ) , a r ee x p r e s s e d w i t h i n i n f e c t e dc e l l sa n d o n r e l e a s e d viral p a r t i c l ed s u r i n gl y t i ci n f e c t i o n s . EBV has profoundeffects on B lymphocytegrowth i n v i t r o T h e v i r u s i s a T c e l l - i n d e p e n d e npto l y c l o n a l n B Vi m m o r t a l i z ehsu m a n a c t i v a t oor f B c e l lp r o l i f e r a t i o E B c e l l s s o t h a t t h e y p r o l i f e r a t ei n c u l t u r ei n d e f i n i t e l y T h e r e s u l t i n gl o n g - t e r mB l y m p h o b l a s t o ci de l l l i n e sa r e l a t e n t l yi n f e c t e dw i t h t h e v i r u s , e x p r e s s E B N A s a n d L M P s ,a n d h a v ea m a l i g n a npt h e n o t y p a esdemonstrated b v t r a n s p l a n t a t i o inn t o i m m u n o d ei cf i e n t m i c e F i v e EBNAs and LMP-1 have been shown to be criticalfor transformingB lymphocytesinto immortalcells The cytop l a s m i ct a i lo f L M P - 1b i n d st h e p h y s i o l o g isci g n a l i nm g ole c u l e sc a l l e dT R A F s ,w h i c h n o r m a l l yt r a n s d u c es i g n a l s r e s u l t i n gf r o m e n g a g e m e not f T N F r e c e p t o r sa n d t h e i m p o r t a nB t c e l la c t i v a t i o n m o l e c u l eC D 4 0 ( s e eC h a p t e r 12, Box 12-1], By this mechanism,EBV appearsto have co-opteda normal B cell activationpathway to promoteproliferation of the cellsthat the virusinfectsand l i v e si n . T h e s p e c t r u mo f c l i n i c asl e q u e l a et o E B Vi n f e c t i o ni s w i d e M o s t p e o p l ea r e i n f e c t e dd u r i n gc h i l d h o o dt h ; e yd o n o t e x p e r i e n c ea n y s y m p t o m s ,a n d v i r a l r e p l i c a t i o n is a p p a r e n t l yc o n t r o l l e db y h u m o r a la n d T c e l l - m e d i a t e d i m m u n e r e s p o n s e s .I n p r e v i o u s l yu n i n f e c t e dy o u n g s o n o n u c l e o sti ys p i c a l l yd e v e l o p sa f t e r a d u l t s ,i n f e c t i o u m E B V i n f e c t i o n .T h i s d i s e a s ei s c h a r a c t e r i z ebdv s o r e throat, fever, and generalizedlymphadenopathy. Large m o r p h o l o g i c aal ltyy p i c al ly m p h o c y t easr ea b u n d a nitn t h e peripheralbloodof patientswith infectiousmononucleos i s M o s t o f t h e s ec e l l sa r e C T L s :i n f a c t .i n a c u t ei n f e c t i o n s ,u p l o 1 0 % o f a l lt h e C D 8 *T c e l l si n t h e b l o o dm a y b e E B Vs p e c i f i ca, n d s m a l ln u m b e r so f t h e s eC T L sm a y p e r s i s tf o r l i f e . P r e v i o u s l iyn f e c t e d ,h e a l t h yi n d i v i d u a l s h a r b o rt h e v i r u s f o r t h e r e s t o f t h e i r l i v e s i n l a t e n t l y i n f e c t e dB c e l l sa n d o f t e n i n n a s o p h a r y n g eeapl i t h e l i u m .
An estimatedone of every millionB cellsin a previously infectedindividualis latentlyinfected lmportantly,EBV infectionis one of the etiologicfactorsfor the developnasopharynm e n t o f c e r t a i nm a l i g n a nttu m o r s ,i n c l u d i n g g e a l c a r c i n o m a i n C h i n e s e p o p u l a t i o n s ,B u r k i t t ' s l y m p h o m ai n e q u a t o r i aAl f r i c a ,a n d B c e l l l y m p h o m a si n r m m u n o s u p p r e s speadt r e n t s . T h e e v i d e n c ei s c o m p e l l i n gt h a t T c e l l - m e d i a t e d i m m u n i t yi s r e q u i r e d f o r c o n t r ool f E B Vi n f e c t i o nas n d ,i n p a r t i c u l afro, r k i l l i n go f E B V - i n f e c t eBdc e l l s .F i r s t ,i n d i v i d u a l s w i t h d e f i c i e n c i eisn T c e l l - m e d i a t e idm m u n i t ya r e s u s c e p t i b l et o u n c o n t r o l l e dw, i d e l y d i s s e m i n a t e da,n d l e t h aal c u t eE B Vi n f e c t i o n sS. e c o n dE , B V - i n f e c t eBdc e l l s isolatedfrom patientswith infectiousmononucleosis can in vitro indefinitely, but only if the patient's be propagated T cells are removed or inactivatedby drugs such as cyclosporineIn fact, immortalization of normalperipheral blood B cellsby in vitro infectionwith EBV is successful only if the donor'sT cells are removedor inactivated. T h i r d ,C T L ss p e c i f i cf o r E B V - e n c o d eadn t i g e n si,n c l u d i n g E B N A sa n d L M P ,a r e p r e s e n ti n p a t i e n t ss u f f e r i n gf r o m acute infectiousmononucleosis and recoveredoatients. Cloned CTL lines have been establishedin vitro that specificallylyse EBV-infectedB cells, and these CTLs most often recognizepeptidefragmentsof EBNAor LMP p r o t e i n si n a s s o c i a t i owni t h c l a s sI M H C m o l e c u l e sE. B V s p e c i f i cT c e l l sa r e r e q u i r e di n v i v ot o l i m i tt h e n u m b e ro f i n f e c t e dB c e l l s ,b u t l a t e n t l yi n f e c t e dB c e l l sc a nb e f o u n d in up to 90% of peopleworldwide.A loss of normalT cell-mediatedimmunityallowsthese infectedB cellsto progresstoward malignanttransformationInfusionof EBV-specific CTLs restoresthe normalbalanceand provides protectionagainstthe growth of malignantB cell tumors. T h e e p i d e m i o l o gayn d m o l e c u l agr e n e t i c so f B u r k i t t ' s lymphomaand other EBV-associated lymphomashave been the subjectof intenseinvestigation, and they offer f a s c i n a t i n gi n s i g h ti n t o v a r i o u sa s p e c t so f v i r a l o n c o g e n e s i sa n d t u m o r i m m u n i t y .B u r k i t t ' sl y m p h o m ai s a h i s t o l o g i tcy p e o f m a l i g n a nB t c e l l t u m o r c o m p o s e do f m o n o t o n o u s m a l l m a l i g n a nB t c e l l s .T h e A f r i c a nf o r m o f t h e d i s e a s ei s e n d e m i ci n r e g i o n sw h e r e b o t h E B V a n d m a l a r i ai n f e c t i o na r e c o m m o n .I n t h e s e r e g i o n st,h e t u m o r o c c u r sf r e q u e n t l yi n y o u n gc h i l d r e no, f t e n b e g i n n i n g i n t h e j a w . V i r t u a l l y1 0 0 % o f p a t i e n t sw i t h A f r i c a n Burkitt'slymphomahaveevidenceof previousEBVinfect i o n ,a n d t h e i rt u m o r su s u a l l yc a r r yt h e E B Vg e n o m ea n d e x p r e s sE B V - e n c o d eadn t i g e n sM . a l a r i ai n l f e c t i o n isn t h i s population a r e k n o w n t o c a u s eT c e l l i m m u n o d e f i c i e n c i e s ,a n d t h i s a s s o c i a t i om n a y b e t h e l i n k b e t w e e nE B V i n f e c t i o na n d t h e d e v e l o p m e not f l y m p h o m a S . poradic Burkitt'slymphomaoccursless frequentlyin other parts o f t h e w o r l d ,a n d a l t h o u g ht h e s eB c e l lt u m o r sa r e h i s t o l o g i c a l l ys i m i l a rt o t h e e n d e m i cf o r m , o n l y a b o u t 2 0 % c a r r y t h e E B V g e n o m e . B o t h e n d e m i ca n d s p o r a d i c Burkitt'slymphomacells have reciprocalchromosomal t r a n s l o c a t i o ni nsv o l v i n g l g g e n el o c ia n dt h e c e l l u l aM r YC q e n eo n c h r o m o s o m e 8. Continued on following page
C h a p t el 7r
IMIVUNITY 0TUM0RS
B c e l l l y m p h o m a so c c u r a t a h i g h f r e q u e n c yi n T c e l l - i m m u n o d e f i c i e ni nt d i v i d u a l si,n c l u d i n gi n d i v i d u a l s w i t h c o n g e n i t ai m l m u n o d e f i c i e n c i ep sa,t i e n t sw i t h A I D S , a n d k i d n e yo r h e a r ta l l o g r a frte c i p i e n trse c e i v i n igm m u n o suppressivedrugs Only some of these tumors can be called Burkitt's lymphomason the basis of histology R e g a r d l e sosf t h e i rh i s t o l o g iacp p e a r a n c e m,a n yo f t h e s e tumors are latentlyinfectedwith EBV like Burkitt'slymp h o m a .A s m a l l e rs u b s e ta l s o c o n t a i n sM Y C t r a n s l o c a t i o n st o l g l o c i . These observationscan be synthesizedinto a hypothesis about the pathogenesis of EBV-associated B cell t u m o r s .A f r i c a nc h i l d r e nw i t h m a l a r i aa, l l o g r a frte c i p i e n t s , c o n g e n i t a lilm y m u n o d e f i c i ecnht i l d r e na, n dA I D Sp a t i e n t s a l lh a v ea b n o r m a l i t i ei nsT c e l lf u n c t i o nB. e c a u s e of a defipolyclonal ciency of EBV-specific T cells, EBV-induced proliferation of B cellsis uncontrolledThisexuberantproliferationof B cellsincreasesthe chancesof errorsmade d u r i n gD N A r e p l i c a t i o ni n, c l u d i n tgr a n s l o c a t i o nosf o n c o g e n e s .T h e l g l o c ia r e a c c e s s i b lsei t e sf o r t r a n s l o c a t i o n s
of the comparedwith other loci in B cells.Translocation deregMYC geneto the lg locusleadsto transcriptional ulationand abnormalexpressionof MYC, and this alteration appears to be causally related to malignant transformationand outgrowth of a neoplasticclone of tumors in immunosuppressed cells. Many EBV-positive and the propatientsdo not have MYC translocations, teinsencodedby the integratedEBVgenomemay be sufficient to cause lymphomas.This proposed scheme B predicts that early in their course, EBV-associated cell tumors may be polyclonalbecausethey arisefrom a p o l y c l o n a l lsyt i m u l a t e dp o p u l a t i o no f n o r m a lB c e l l s . Later,one or a few clonesmay obtainselectivegrowth perhapsbecauseof deregulation of MYC or advantages, o t h e r c e l l u l a or r v i r a lg e n e s .A s a r e s u l t ,t h e p o l y c l o n a l proliferationevolves into a monoclonalor oligoclonal tumor. In fact, such has been shown to be the case by b l o ta n a l y s ios f l g g e n er e a r r a n g e m e ni tnss o m e Southern EBV-positiveB cell tumors from immunosuppressed oatients.
Adenovirusinfection inducestumors much more frequently in neonatal or T cell-deficient mice than in normal adult mice.
I (HTLV-l), the etiologic agent for adult T cell leukemia/lymphoma (ATL), a malignant tumor of CD4* T cells. Although immune responses speciflc for HTLVl-encoded antigens have been demonstrated in individuals infected with the virus, it is not clear whether they play any role in protective immunity against the development of tumors. Furthermore, patients withATL are often profoundly immunosuppressed, probably because the virus infects CD4* T cells and induces functional abnormalities in these cells.
Tumor transplantation experiments of the kind illustrated in Figure 17-1 have shornmthat animals may be specifically immunized against DNA virus-induced tumors and will reject transplants of these tumors. Unlike MCA-induced tumor antigens, which are the products of randomly mutated cellular genes,virus-encodedtumor antigensare not unique for each tumor but are sharedby all tumors induced by the same type of virus. Immunization of experimental animals with SV40 virus and adenovirusproduces protective immunity againstthe development of tumors induced by each virus, and immunity is mediated by class I MHCrestrictedCTLsspecificfor the antigensof that virus. Immunization of women with human papillomavirus (HPV)coat proteinspreventsthe developmentof precancerouslesionsin the uterine cervix. Thus, a competent immune system may play a role in surveillance againstvirus-induced tumors because of its ability to recognize and kill virus-infected cells. In fact, the concept of immune surveillance against tumors is better established for DNA virus-induced tumors than for any other type of tumor. RNA tumor viruses (retroviruses) are important causes of tumors in animals. Retroviral oncogene products theoretically have the same potential antigenic properties as mutated cellular oncogenes,and humoral and cell-mediated immune responsesto retroviral gene products on tumor cells can be observed experimentally. The only well-defined human retrovirus that is known to cause tumors is human T cell lymphotropic virus
Oncofetal
Antigens
Oncofetal antigens are proteins that are expressed,at high leuels in cancer celk and in normal deueloping fetal but not adult tksues.It is believed that the genes encoding these proteins are silenced during development and are derepressed with malignant transformation. Oncofetal antigens are identified with antibodies raised in other species, and their main importance is that they provide markers that aid in tumor diagnosis. As techniques for detecting these antigens have improved, it has become clear that their expression in adults is not Iimited to tumors. The proteins are increased in tissues and in the circulation in various inflammatory conditions and are found in small quantities even in normal tissues.There is no evidence that oncofetal antigens are important inducers or targets of anti-tumor immunity. The two most thoroughly characteized oncofetal antigens are carcinoembryonic antigen (CEA) and crfetoprotein (AFP). CEA (CD66) is a highly glycosylated integral membrane protein that is a member of the immunoglobulin (lg) superfamily. It is an intercellular adhesion molecule that functions to promote the binding of tumor cells to one another. High CEA expression is normally restricted to cells in the gut, pancreas, and liver during the first two
4O5
406 Vi Section . ,,,.,.,,,*,-*."s""-,",,.,....,
IMMUNITY lN DEFENSE ANDDTSEASE
trimesters of gestation, and low expression is seen in normal adult colonic mucosa and the lactating breast. CEA expression is increased in many carcinomas of the colon, pancreas, stomach, and breast, and serum levels are increased in these patients. The level of serum CEA is used to monitor the persistence or recurrence of the tumors after treatment. The usefulness of CEA as a diagnostic marker for cancer is limited by the fact that serum CEA can also be elevated in the setting of non-neoplastic diseases,such as chronic inflammatory conditions of the bowel or liver. AFP is a circulating glycoprotein normally slmthesized and secreted in fetal life bv the volk sac and liver. Fetal serum concentrations ian be as high as 2 to 3mg/ml, but in adult life, the protein is replaced by albumin, and only low levels are present in serum. Serum levels of AFP can be significantly elevated in patients with hepatocellular carcinoma, germ cell tumors, and, occasionally, gastric and pancreatic cancers.An elevated serum AFP level is a useful indicator of advanced liver or germ cell tumors or of recurrence of these tumors after treatment. Furthermore, the detection of AFP in tissue sections by immunohistochemical techniques can help in the pathologic identification of tumor cells. The diagnostic value of AFP as a tumor marker is limited by the fact that elevated serum levels are also found in non-neoplastic diseases,such as cirrhosis of the liver. Altered Glycolipid and Glycoprotein Antigens Most human and experimental tumors express higher than normal leuek or abnormalforms of surface glycoproteins and glycolipi.ds, which may be diagnostic markers and targets for therapy. These altered molecules include gangliosides, blood group antigens, and mucins. Some aspects of the malignant phenotype of tumors, including tissue invasion and metastatic behavior, may reflect altered cell surface properties that result from abnormal glycolipid and glycoprotein slnthesis. Many antibodies have been raised in animals that recognize the carbohydrate groups or peptide cores ofthese molecules. Although most of the epitopes recognized by these antibodies are not specifically expressed on tumors, they are present at higher levels on cancer cells than on normal cells. This class of tumor-associated antigen is a target for cancer therapy with specific antibodies. Among the glycolipids expressed at high levels in melanomas are the gangliosides GM2, GD2, and GD3. Clinical trials of anti-GM2 and anti-GD, antibodies and immunization with vaccines containing GM, are under way in patients with melanoma. Mucins are high molecular weight glycoproteins containing numerous Olinked carbohydrate side chains on a core pollpeptide. Tumors often have dysregulated expression of the enz)rynesthat synthesizethese carbohydrate side chains, which leads to the appearance of tumor-specific epitopes on the carbohydrate side chains or on the abnormally exposed pollpeptide core. Several mucins have
been the focus of diagnostic and therapeutic studies, including CA-125 and CA-19-9, expressed on ovarian carcinomas, and MUC-1, expressed on breast carcinomas. Unlike many mucins, MUC-1 is an integral membrane protein that is normally expressed only on the apical surface of breast ductal epithelium, a site that is relatively sequestered from the immune system. In ductal carcinomas of the breast, however, the molecule is expressed in an unpolarized fashion and contains new tumor-specific carbohydrate and peptide epitopes detectable by mouse monoclonal antibodies. The peptide epitopes induce both antibody and T cell responses in cancer patients and are therefore being considered as candidates for tumor vaccines. Tissue-Specific
Differentiataon
Antigens
Tumors express molecules that are normally present on the cells of origin. These antigens are called differentiation antigens because they are speciflc for particular lineagesor differentiation stagesof various cell rypes.Their importance is as potential targets for immunotherapy and for identifying the tissue of origin of tumors. For example, several melanoma antigens that are targets of CTLs in patients are melanocyte differentiation antigens, such as tyrosinase,mentioned earlier. Lymphomas may be diagnosed as B cell-derived tumors by the detection of surface markers characteristic of this lineage, such as CDl0 (previously called common acute lymphoblastic leukemia antigen, or CALLA) and CD20. Antibodies against these molecules are also used for tumor immunotherapy. The idiotypic determinants of the surface Ig of a clonal B cell population are markers for that B cell clone because all other B cells expressdifferent idiotypes. Therefore, the Ig idiotype is a highly specific tumor antigen for B cell l1'rnphomas and leukemias.These differentiation antigens are normal self molecules, and therefore they do not usually induce strong immune responsesin tumor-bearing hosts.
lurururue Rrsporusrs ro TUMoRS The effector mechanisms of both innate and adaptive immunity have been shor,rmto kill tumor cells in vitro. The challenge for tumor immunologists is to determine which of these mechanisms may contribute to protective immune responses against tumors in vivo, and to enhance these effector mechanisms in ways that are tumor specific. In this section, we review the evidence for tumor killing by various immune effector mechanisms and discuss which are the most likely to be relevant to human tumors. Innate lmmune
Responses to Tumors
Much of the early research on functions of effector cells of the innate immune system, including NK cells and macrophages, focused on the ability of these cells to kill cultured tumor cells.
17Chaoter
NK Cells NK celk kill many types of tumor cells, especially celts that haue reduced class I MHC expression but do acpress Iigands for NK cell actiuating receptors.In vitro, NK cells can kill virally infected cells and certain tumor cell lines, especially hematopoietic tumors. NK cells also respond to the absence of class I MHC molecules because the recognition of classI MHC molecules delivers inhibitory signals to NK cells (seeChapter 2,Fig.2-10). As we shall see later, some tumors lose expression of class I MHC molecules, perhaps as a result of selection against class I MHC-expressing cells by CTLs.This loss of classI MHC molecules makes the tumors particularly good targets for NK cells. Some tumors also expressMICA, MICB, and ULB, which are ligands for the NKG2D activating receptor on NK cells. In addition, NK cells can be targeted to IgG antibody-coated cells by Fc receptors (FcyRIII or CDl6). The tumoricidal capacity of NK cells is increased by cltokines, including interferons and interleukins (IL-2 and IL-12), and the anti-tumor effecrs of these cytokines are partly attributable to stimulation of NK cell activity. Il-2-activated NK cells, called lymphokineactivated killer (LAK) cells, are derived by culturing peripheral blood cells or tumor-infiltrating lymphocytes (TILs) from tumor patients with high doses of IL-2. The use of t-{K cells in adoptive immunotherapy for tumors is discussed later. The role of NK cells in tumor immunity in vivo is unclear. It has been suggestedthat T cell-deficient mice do not have a high incidence of spontaneous tumors because they have normal numbers of NK cells that serve an immune surveillance function. A few patients have been described with deficiencies of NK cells and an increased incidence of EBV-associatedlymphomas. Macrophages The role of macrophages in anti-tumor immunity is largely inferred from the demonstration that, in vitro, activated macrophages can kill many tumor cells more efficiently than they can kill normal cells. How macrophages are activated by tumors is not knornrn. Possible mechanisms include direct recognition of some surface antigens of tumor cells and activation of macrophages by interferon-y (IFN-y) produced by tumor-specific T cells. Macrophages can kill tumor cells by severalmechanisms, probably the same as the mechanisms of macrophage killing of infectious organisms. These mechanisms include the release of lysosomal enzymes, reactive oxygen species,and nitric oxide. Activated macrophages also produce the cytokine tumor necrosis factor (TNF), which was first characterized, as its name implies, as an agent that can kill tumors mainly by inducing thrombosis in tumor blood vessels. Adaptive
lmmune
Responses to Tumors
Both T cell-mediated and humoral immune responses occur spontaneously to tumors, and some evidence suggeststhat the T cell responsesplay a protective role. Par-
IMMUNITY T0 TUMORS
ticular efforts are now being made to enhance these T cell responsesin immunotherapeutic protocols. T Lymphocytes The principal mechanism of tumor immunity is killing of tumor cells by CD& CTLs. The ability of CTLs to provide effective anti-tumor immunity in vivo is most clearly seen in animal experiments using carcinogeninduced and DNA virus-induced tumors. As discussed previously, CTLs mayperform a surveillance function by recognizing and killing potentially malignant cells that express peptides derived from mutant cellular proteins or oncogenic viral proteins and presented in association with class I MHC molecules. The role of immune surveillance in preventing common, non-virally induced tumors remains controversial because the frequency of such tumors in T cell-deficient animals or people is not clearly greater than the frequency in immunocompetent individuals. However, tumor-specific CTLs can be isolated from animals and humans with established tumors, such as melanomas. Furthermore, mononuclear cells derived from the inflammatory infiltrate in human solid tumors, called TILs, also include CTLs with the capacity to kill the tumor from which they were derived. CD$! T cell responsesspecific for tumor antigens may require cross-presentation of the tumor antigens by professional APCs,such as dendritic celJs.Most tumor cells are not derived from APCs and therefore do not express the costimulators needed to initiate T cell responses or the class II MHC molecules needed to stimulate helper T cells that promote the differentiation of CDB* T cells. A likely possibility is that tumor cells or their antigens are ingested by host APCs, particularly dendritic cells; the tumor antigens are then processed inside the APCs, and peptides derived from these antigens are displayed bound to classI MHC molecules for recognition by CD8* T cells.TheAPCs expresscostimulators that mayprovide the signals needed for differentiation of CDS*T cells into anti-tumor CTLs, and the APCs express class II MHC molecules that may present internalized tumor antigens and activate CD4'helper T cells as well (Fig. 17-3). This process of cross-presentation, or cross-priming, has been described in earlier chapters (see Chapter 9, Fig. 9-3). Once effector CTLs are generated, they are able to recognize and kill the tumor cells without a requirement for costimulation. A practical application of the concept of cross-priming is to grow dendritic cells from a patient with cancel incubate the APCs with the cells or antigens from that patient's tumor, and use these antigen-pulsed APCs as vaccines to stimulate anti-tumor T cell responses. The importance of CD4* helper T cells in tumor immunity is less clear. CD4* cells may play a role in antitumor immune responses by providing cytokines for effective CTL development (seeChapter 13).In addition, helper T cells specific for tumor antigens may secrete c)'tokines, such as TNF and IFN-y, that can increase tumor cell class I MHC expression and sensitivity to lysis by CTLs. IFN-T may also activate macrophages to kill
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i
S e c t i oVn-
I M M U N I Tl N Y DEFENS AE N DD I S E A S E
r, .
Effectorphase of anti-tumor GTLresponse
Inductionof anti-tumor T cell response (cross-priming) Tumor antigen
Tumorcells and antigens ingestedby hostAPCs.
Phagocytosed t u m o rc e l l
Tumor-specif ic CD8+CTL recognrzes tumorcell
Differentiation
Costimulator of tumor-
specific T cells
t-Jo'
cell
cD4+ helper T lymphocyte (crossFIGURE 17-3 Inductionof T cell responsesto tumors. CDB. T cell responsesto tumors may be inducedby cross-priming presentation), in which the tumor cellsor tumor antigensare taken up, processed,and presentedto T cells by professional antigen-presentingcells(APCs)In some cases,B7 costimulators erpressedby the APCsprovidethe secondsignalsfor differentlation of CD8*T cells The APCsmay also stimulateCD4*helperT cells,which providethe secondsignalsfor CTL developmentDifferentiated CTLskill tumor cellswithout a requirement for costimulation or T cell heip (Therolesof cross-presentation and CD4*helperT cellsin CTL responsesare d i s c u s s e idn C h a p t e9r )
tumor cells.The importance of IFN-yin tumor immunity is demonstrated by the finding of increased incidence of tumors in knockout mice lacking this cytokine, the IFNy receptor, or components of the IFN-y receptor signaling cascade. Antibodies Tumor-bearing hosts may produce antibodies against various tumor antigens. For example, patients with EBVassociated lymphomas have serum antibodies against EBV-encoded antigens expressed on the surface of the lymphoma cells. Antibodies may kill tumor cells by activating complement or by antibody-dependent cellmediated cytotoxiciry in which Fc receptor-bearing macrophages or NK cells mediate the killing. However, the ability of antibodies to eliminate tumor cells has been demonstrated largely in vitro, and there is little evidence for effective humoral immunity against tumors. Antibodies specific for oncogenic viruses, such as HPV can prevent infection by these viruses and thereby prevent virally induced tumors.
Tumor antigen T cell
specificfor tumor antigen
MHC molecule
Failureto producetumor antigen Antigen-loss
Lackof T cell recognitionof tumor Mutationsin MHCgenesor genesneeded for antigenprocessing ClassI MHC-deficient t u m o rc e l l
EvRsrolrt oFIMMUNE RESpoNSES BYTUMORS Many malignant tumors possess mechanisms that enable them to evade or resist host immune responses (Fig. 17-4). A major focus of tumor immunology is to understand the ways in which tumor cells evade immune destruction, with the hope that interventions can be designed to increase the immunogenicity of tumors and the responses of the host. The process of evasion may involve many different mechanisms. Experimental evidence in mouse models indicates that immune responsesto tumor cells impart selective pressures that result in the survival and outgrowth of variant tumor cells with reduced immunogenicity, a process that has been called "tumor editing."
T cell recognition of tumorantigen leadingto T cell activation
Lackof T cell recognitionof tumor
Productionof immunosuppressive proteins
Inhibitionof T cell activation
" -o-'r
PPressive $ililnosu
tumor antigensand are activatedTumorcellsmay evadeimmune responsesby losingexpressionof antigensor MHC moleculesor by producingimmunosuppressive cytokines
T0 TUMORS 17- IMMUNITY Chaoter
lVhen tumors are induced by carcinogen-treatment in either immunodeficient or immunocompetent mice, and the tumors are then transplantedinto new immunocompetent mice, the tumors that were derivedfrom the immunodeficient mice are more frequently rejected by the recipient animal's immune system than are the tumors derived from the immunocompetent mice. This result indicates that tumors developingin the settingof a normal immune systembecome lessimmunogenic over time. Tumor editing is thought to underlie the emergence of tumors that "escape" immunosurveillance. Tirmor editing and escape may be a result of several mechanisms. @ Tfumor antigens may induce specific immunological tolerance. Tolerance may occur because tumor antigens are self antigens encountered by the developing immune system or because the tumor cells present their antigens in a tolerogenic form to mature lymphocytes. Several experimental studies have shown that tolerance to tumor antigens promotes the outgrowth of tumors expressingthese antigens. ' , Neonatal mice may acquire the mouse mammary tumor virus from their mothers during nursing. The mice become tolerant to the virus and carry it for life. \Mhenthese mice become adults, mammary cancers induced by the virus often develop, and the tumors do not elicit immune responses.However,the tumors are potentially immunogenic because they are rejectedwhen they are transplanted into s1'ngeneic, virus-free (uninfected)adult mice. Transgenic mice expressing the SV40 T antigen throughout their lives developtumors when they are infected with the SV40virus, and the high incidence of thesetumors correlateswith toleranceto the SV40 T antigen. In contrast, other SV40T antigen transgenic mice in which expressionof the transgeneis delayed until later in life are not tolerant to the T antigen and have a low incidence of tumors. In some experimental models, tumor cells transplanted into adult mice induce anergyin T cells specific for antigens expressed in these tumors. Immunity against the tumors may be stimulated by blocking CT[-A,-4, the inhibitory T cell receptorfor 87 molecules.This result suggeststhat the tumor antigens may be presentedto host T cells by APCs that induce T cell tolerance,in part as a resultof 87 : CTt A4 interactions (seeChapter 11).
o Regulatory T cells m&y suppress T cell responses to tumors. Evidence from mouse model systems and cancer patients indicates that the numbers of regulatory T cells are increased in tumor-bearing individuals, and these cells can be found in the cellular infiltrates in certain tumors. Depletion of regulatory T cells in tumor-bearing mice enhances antitumor immunity and reduces tumor growth.
o Tumors lose expression of antigens that elicit immune responses. Such "antigen loss variants" are
common in rapidly growing tumors and can readily be induced in tumor cell lines by culture with tumorspecific antibodies or CTLs. Given the high mitotic rateof tumor cellsand their geneticinstabilirymutations or deletionsin genesencodingtumor antigens are common. If these antigensare not requiredfor growth of the tumors or maintenance of the transtumor cells formed phenotype,the antigen-negative of host. Analysis in the growth advantage a have tumors that areseriallytransplantedfrom one animal to another has sholrm that the loss of antigens recognized by tumor-specific CTLs correlateswith increased growth and metastatic potential. Apart from tumor-speciflcantigens,classI MHC expression on tumor cells so that they may be dor,rm-regulated cannot be recognized by CTLs. Various tumors show decreasedsynthesisof classI MHC molecules, pr-microglobulin,or components of the antigenprocessing machinery including the transporter associatedwith antigen processingand some subunits of the proteasome.Thesemechanismsare presumably adaptationsof the tumors that arise in responseto the selectionpressuresof host immunity, and they may allow tumor cells to evade T cellmediated immune responses.However, when the Ievelof MHC expressionon a broad rangeof experimentalor human tumor cellsis comparedwith the in vivo growth of thesecells,thereis no clearcorrelation. Tumorsmay fail to induce CTLsbecausemost turnor celk do not expresscostimulators or class II MHC molecules.Costimulatorsare required for initiating T cell responses,and classII moleculesare neededfor the activation of helper T cells,which are required,in for the differentiationof CTLs. some circumstances, Therefore,the induction of tumor-specificT cell responsesoften requirescross-primingby dendritic cells,which expresscostimulatorsand classII molecules.If such APCsdo not adequatelytake up and present tumor antigens and activate helper T cells, CTLs specificfor the tumor cells may not develop. Tumor cells transfected with genes encoding the costimulators87-1 (CD80)andBT-2(CD86)are able Preto elicit strongcell-mediatedimmune responses. dictably,CTLsinduced by B7-transfectedtumors are effective against the parent (B7-negative)tumor as well becausethe effector phase of CTl-mediated killing doesnot requirecostimulation(seeFig. 17-3). As we shall see later, these experimental results are being extended to the clinical situation as immunotherapy for tumors.
o Theproductsof tumor celk may suppressanti-tumor immune responses.An example of an immunosuppressivetumor product is transforming growth factor-p,which is secretedin largequantitiesby many tumors and inhibits the proliferation and effector functions of lymphocytes and macrophages (see Chapter12).Sometumors expressFasligand (FasL), which recognizesthe death receptorFas on leukocytes that attempt to attack the tumor; engagement of Fasby FasLmay result in apoptotic death of the leukocytes.The importance of this mechanism of
41(J
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I M M U N I Tl N Y DEFENS AE N DD T S E A S E
tumor escape is not established because FasL has been detected on only a few spontaneous tumors, and when it is expressedin tumors by gene transfection, it is not always protective. @ The cell surface antigens of tumors may be hidden from the immune system by glycocallx molecules, such as sialic acid-containing mucopolysaccharides. This process is called antigen masking and may be a consequenceof the fact that tumor cells often express more of these glycocallx molecules than normal cells do.
the most tumor-specific treatment that can be devised. Advances in our understanding of the immune system and in defining antigens on tumor cells have encouraged many new strategies.Immunotherapy for tumors aims to augment the weak host immune response to the tumors (active immunity) or to administer tumorspecific antibodies or T cells, a form of passive immunity. In this section, we describe some of the modes of tumor immunotherapy that have been tried in the past or are currently being investigated. Stimulation of Active Responses to Tumors
InamuruorHERApy FoR TUMoRS The potential for treating cancer patients by immunologic approaches has held great promise for oncologists and immunologists for many years.The main reason for interest in an immunologic approach is that current therapies for cancer rely on drugs that kill dividing cells or block cell division, and these treatments have severe effects on normal proliferating cells. As a result, the treatment of cancers causes significant morbidity and mortality. Immune responsesto tumors may be specific for tumor antigens and will not injure most normal cells. Therefore, immunotherapy has the potential of being
Host lmmune
The earliest attempts to boost anti-tumor immunity relied on nonspecific immune stimulation. More recently, vaccines composed of killed tumor cells or tumor antigens have been administered to patients, and strategies for enhancing immune responses against the tumor are being developed. Vaccination with Tumor Cells and Tumor Antigens Immunization of tumor-bearing indiuiduals with killed tumor cells or tumor antigens may result in enhanced immune responses against the tumor (Table l7-2 and
Table 17-2. Tumor Vaccines
Typeof vaccine
Vaccinepreparation Animalmodels
Killedtumor vaccine
Killedtumorcells+ adjuvants Tumorcelllysates+ adjuvants
Melanoma, coloncancer, Melanoma,colon cancer others
s"rcohi
Melanoma
Melanoma antigens Heatshockproteins
Melanoma Various
Melanoma trrtetanoma, renaiiancer, sarcoma
Melanoma,B cell lymphoma,sarcoma
Melanoma, non-Hodgkin's prostate lymphoma, cancer, others Various carcinomas
Purified tumor antigens
Professional cellspulsedwith APC- Dendritic basedvaccines tumorantigens
Dendritic cellstransfected Melanoma,coloncancer withgenesencoding tumorantigens Tumorcellstransfected Renalcancer,sarcoma, Cytokineand withcytokine or 87 genes B cellleukemia, costimulatorrungcancer enhanced vaccines
DNAvaccines Viralvectors
Clinicaltr ials
Melanoma, sarcoma, others
APCstransfected with genesandpulsed cytokine withtumorantigens
Melanoma, renalcancer, others
lmmunization withplasmidsMelanoma encoding tumorantigens Adenovirus, vaccinia virus Melanoma, sarcoma encoding tumorantigen+ cvtokines
Melanoma
Abbreviations;APC,antigen-presenting cell.
Melanoma
T0 TUM0RS Chaoter17- IMMUNITY
Vaccinatewith tumor-antigen pulsed dendriticcell ?e
cD8+ T cell
Dendritic cells pulsedwith tumorantigens
Activationof tumor-specific T cells
Plasmid expressing cDNAencoding tumorantioen ^VrrI Vaccinate with DNAor
FIGURE 17-5 Tumorvaccines. The tvoes of tumor vaccinesthat have shown efficacy in anrmal modelsare illustratedMany vaccine approachesare undergoing clinicaltesting
Fig. l7-5). The identification of peptides recognized by tumor-specific CTLs and the cloning of genes that encode tumor-specific antigens recognized by CTLs have provided many candidates for tumor vaccines. One of the earliest vaccine approaches, immunization with purified tumor antigens plus adjuvants, is still being tried. More recently, attempts to immunize patients with cancer have been made with dendritic cells purified from the patients and either incubated with tumor antigens or transfected with genes encoding these antigens and by injection of plasmids containing cDNAs encoding tumor antigens (DNA vaccines). The cell-based and DNA vaccines may be the best ways to induce CTL responsesbecausethe encoded antigens are sgrthesized in the cltoplasm and enter the class I MHC pathway of antigen presentation. For antigens that are unique to individual tumors, such as antigens produced by random point mutations in cellular genes, these vaccination methods are impractical because they would require identification of the antigens from every tumor. On the other hand, tumor antigens shared by many tumors, such as the MAGE, tyrosinase, and gp100 antigens on melanomas and mutated Ras and p53 proteins in various tumors, are potentially useful immunogens for all patients with certain types of cancer. In fact, clinical trials of such cancer vaccines are under way for a variety of tumors. A limitation of treating established tumors with vaccines is that these vaccines need to be therapeutic and not simply preventive, and it is often difflcult to induce a strong enough immune response that will eradicate all the cells of growing tumors.
Activationof tumor-specific T cells
The development of virally induced tumors can be blocked by preventivevaccinationwith viral antigensor attenuatedlive viruses.This approachis successfulin reducingthe incidenceof felineleukemiavirus-induced hematologic malignant tumors in cats and in preventlymphoma called Marek's ing the herpesvirus-induced diseasein chickens.In humans,the ongoingvaccination program against hepatitis B virus may reduce the incidence of hepatocellularcarcinoma,a liver cancer associatedwith hepatitis B virus infection. As mentioned earlier, newly developedHPV vaccinespromise to reducethe incidenceof HPV-inducedtumors,including uterinecervicalcarcinoma. Augmentation of Host ImmunitY to Tumors with Costimulators and Cytokines Cell-mediated immunity to tumors may be enhanced' by expressingcostimulators and. cytokines in tumor celk and by treating tumor-bearing ind'iui.dualswith cytokinesthat stimulate the proliferation and,d.ffirentiation of T lymphocytesand NK celk. As discussed earlier in this chapter, tumor cells may induce weak becausethey lack costimulatorsand immune responses usuallydo not expressclassII MHC molecules,so they do not activatehelper T cells.TWopotential approaches for boosting host responsesto tumors are to artificially providecostimulationfor tumor-specificT cellsand to provide cytokines that can enhance the activation of tumor-speciflcT cells, particularly COB- CTLs (Fig. 17-6).Many cytokinesalso have the potential to induce
472
V - IMMUN|TY tNDEFENSE ANDDTSEASE $ Section
Vaccinatewith tumor cell expressing costimulators or lL-2
87
cDg+ T cell
B7-expressing tumor cellstimulates tumor-specific T cell
3transfected with genefor lymphocyte
87) 3?il2,,",o'(e.s.,
'9.-8--.v
tfz GM-CSForomotes recruitment and maturation of dendritic cells
IL-2enhancesproliferation and differentiation of tumor-specific T cells
Activationof tumor-specific T cells
Dendritic cell ingests,processes, andpresents tumor antigens to tumorspecific T cells
cD8+ T cell
Activationof tumor-specific T cells
RE 1 7-6 Enhancementof tumor cell immunogenicityby transfectionof costimulatorand cytokine genes.Tumorcells that do not atelystimulateT cellson transplantation intoan animalwill not be rejectedandwill thereforegrow intotumors Vaccination with tumor cellstransfectedwith genesencodingcostimulators or lL-2(A)can leadto enhancedactivation of i cells,and tumorstransfectedwith GMCSF {B)activateprofessional APCs,notablydendriticcells Thesetransfectedtumor cell vaccinesstimulatetumor-specific T cells,leading to T cell-mediated rejectionof the tumor (evenuntransfected tumor cells)
nonspecific inflammatory responses, which by themselves may have anti-tumor activity. The efficacy of enhancing T cell costimulation for anti-tumor immunotherapy has been demonstrated by animal experiments in which tumor cells were transfected with genes that encode 87 costimulatory molecules and used to vaccinate animals. These B7-expressing tumor cells induce protective immunity against unmodified tumor cells injected at a distant site. The successeswith experimental tumor models have led to therapeutic trials in which a sample of a patient's tumor is propagated in vitro, transfected with costimulator genes, irradiated, and reintroduced into the patient. Such approaches may succeed even if the immunogenic antigens expressed on tumors are not knor,r,n. It is possible to use cltokines to enhance adaptive and innate immune responses against tumors. Tumor cells may be transfected with cytokine genes to localize the cltokine effects to where they are needed (Table 17-3). For instance, when rodent tumors transfected with lL-z, lL-4, IFN-1, or granulocyte-macrophage colonystimulating factor (GM-CSF) genes are injected into animals, the tumors are rejected or begin to grow and then regress.In some cases,intense inflammatory infiltrates accumulate around the cytokine-secreting
tumors, and the nature of the infiltrate varies with the cytokine. Different cytokines may stimulate anti-tumor immunity by different mechanisms (see Fig. 17-6). Importantly, in several of these studies, the injection of cytokine-secreting tumors induced specific, T cell-mediated immunity to subsequent challenges by unmodified tumor cells. Thus, the local production of cytokines may augment T cell responsesto tumor antigens, and cytokine-expressing tumors may act as effective tumor vaccines. Several clinical trials with cytokine gene-transfected tumors are under way in patients with advanced cancer. Cltokines may also be administered systemically for the treatment of various human tumors (Table l7-4). The largest clinical experience is with IL-2 administered in high doses alone or in combination with adoptive cellular immunotherapy (discussedlater). IL-2 presumably works by stimulating the proliferation and anti-tumor activity of NK cells and CTLs. The limitation of this treatment is that it can be highly toxic and induces fever, pulmonary edema, and vascular shock. These side effects occur because IL-2 stimulates the production of other cytokines by T cells, such as TNF and IFN-y, and these cytokines act on vascular endothelium and other cell types. IL-2 has been effective in inducing measurable tumor regressionresponsesin about 10% of patients
T0TUM0RS, 17- IMMUNITY Chapter
413
,,,",,,.....,i*-"",.", TumorCells Table17-3.lmmunotherapy with CytokineGene-Transfected
Cytokine
Tumorreiection Inflammatory lmmunityagainst in animals parentaltumor infiltrate
Clinicaltr ials
(animalmodels) Yes;mediatedby lnterleukin-2
Lymphocytes, neutroohils
ln somecasesof renal cancer,melanoma
Yes Interleukin-4
Eosinophils, macrophages
immunitYMelanoma, No long-lasting renalcancer in humantrials
Interferon-yVariable
Macrophages, Sometimes othercells
T cells
No
TNF
Variable
Neutrophils and lymphocytes
GM-CSF
Yes
T cell Macrophages, Yes(long-lived immunity) othercells
lnterleukin-3Sometimes
Renal cancer, melanoma
Renalcancer
Macrophages, Sometimes othercells
factor;TNF,tumornecrosisfactor' colony-stimulating Abbreviations: GM-CSF,granulocyte-macrophage
with advanced melanoma and renal cell carcinoma and is currently an approved therapy for these cancers.IFNo may be effective against tumors because it increases the c],totoxic activity of NK cells and increases class I MHC expression on various cell tlpes (see Chapter 12). Clinical trials of this cytokine indicate that it can induce the regressionof renal carcinomas, melanomas, Kaposi's sarcoma, various lymphomas, and hairy cell leukemia (a B cell lineage tumor). IFN-cx is currently used in combination with chemotherapy for the treatment of melanoma. Other cltokines, such as TNF and IFN-1, are effective anti-tumor agents in animal models, but their use in patients is limited by serious toxic side effects.The potential of IL-12 to enhance anti-tumor T cell- and NK cell-mediated immune responses has aroused great interest, and early trials in patients with advanced
cancer are now under way. Hematopoietic growth factors, including GM-CSE G-CSE and IL-11, are used in cancer treatment protocols to shorten periods of neutropenia and thrombocytopenia after chemotherapy or autologous bone marrow transplantation' Blocking Inhibitory
Pathways
to Promote
Tumor lmmunity Another immunotherapy strategy is based on the idea that T cells exploit various normal pathways of immune regulation or tolerance to evade the host immune response.One series of studies in mice and humans has targeted the inhibitory receptor for 87, called CTLA-4' which functions normally to shut off responses (see Chapter 11). If tumor-bearing mice are vaccinated with
Table17-4. SystemicCytokineTherapyfor Tumors
Cytokine
TumorreiectionClinicaltrials in animals
Interleukin-2Yes
lnterferon-oc No TNF
Only with local administration
Variable lnterleukin-12
GM-CSF
No
Toxicity
renalcancer, Vascularleak, Melanoma, shock,pulmonary coloncancer;limited success(
Antibody deposition
:.,T.
.:-
:::,--7 reactiveoxygen specres
matrix extracellular
tissueinjury lmmunecomplex-mediated
Complement-and Fc receptormediatedrecruitment and activationof inflammatorvcells mm.::=.Jm:::rft,-
Blood VCSSEI
granule Neutrophil reactive enzymes, oxygenspecles
rmmunecomplexes to tissueantigens(A),or they may be depositedas diseases,Antibodiesmay bindspecifically FIGuRE 18-1 Typesof antibody-mediated leadingto tissue that are formed ln the circulation(B) In both cases,the depositedantibodiesinduceinflammation, immunecomplexe-s t nt u r v
:,
422 :
:
Section V-
IMMUNITY tN DEFENSE ANDDISEASE
-:;.:i*,eM*!e;,:,.,,
Diseases Caused by Antibodies Fixed Cell and fissue Antigens
Against
Antibodies against cellular or matrix antigens cause diseases that specifically affect the cells or tissues where these antigens are present, and these diseases are often not systemic. In most cases,such antibodies are autoantibodies, but they may occasionally be produced against a foreign antigen that is immunologically crossreactive with a component of self tissues. Antibodies against tissue antigens cause disease by three main mechanisms (Fig. l8-2). First, antibodies may directly opsonize cells, or they may activate the complement system, resulting in the production of complement proteins that opsonize cells. These cells are phagocltosed and destroyed by phagoc),testhat expressreceptors for the Fc portions of antibodies and receptors for complement proteins. This is the principal mechanism of cell
destruction in autoimmune hemolytic anemia and autoimmune thrombocltopenic purpura. The same mechanism is responsible for hemolysis in transfusion reactions. Second, antibodies deposited in tissues recruit neutrophils and macrophages,which bind to the antibodies or attached complement proteins by Fc and complement receptors. These leukocytes are activated and their products induce acute inflammation and tissue injury. This is the mechanism of injury in antibody-mediated glomerulonephritis and many other diseases.Third, antibodies that bind to normal cellular receptors or other proteins may interfere with the functions of these receptors or proteins and cause disease without inflammation or tissue damage. Antibodymediated functional abnormalities are the cause of Graves' disease (hyperthpoidism) and myasthenia gravis. Examples of hypersensitivity diseases in humans that are caused by autoantibodies against self antigens
@ Op"onirationand phagocytosis
Phagocyte Ops6nized
Fc receptor
Phagocytosis
@Complement-and Fc receptor-mediated inflammation
Inflammationand tissue injury Abnormalphysiologicresponseswithoutcell/tissueinjury FIGURE 1&2 Eflector mechanisms of antibody-mediated disease.A AntiNerveending bodiesopsonizecells and may activate Acetylcholine complement, generatingcomplement Antibodyto ACh receptor: ACh receptor
;: ,/ Thyroidhormones *iL
Antibodystimulates receptorwithout ligand
Antibody inhibits bind g of ligand to recepto
products that also opsonize cells, leading to phagocytosisof the cells throughphagocyteFc receptorsor c3 receptors B Antibodiesrecruit leukocytes by bindingto Fc receptorsor by actrvatrngcomplement and thereby releasingby-productsthat are chemotacticfor leukocytesC Antibodiesspecific f or cell surface receptors f or hormones or neurotransmittersmay stimulatethe activityof the receptors evenin the absenceof the hormone//eft panel)or may inhibitbindingof the neurotransmitterto its receptor(rightpanel) TSH,thyroid-stimulating hormone
Chapter 18-
ANDAUTOIMMUNITYi HYPERSENSITIVITY RESPONSES: BYIMMUNE DISEASES CAUSED 6
Antibodies Table18-2.Examples by Cell-or Tissue-Specific of Diseases Caused of Mechanisms disease
Glinicopathologic manifestations
Erythrocyte membrane Autoimmune (Rhbloodgroup hemolytic anemia proteins
Hemolysis,anemia
I antigen) antigens,
and Opsonization phagocytosis of erythrocytes
Plateletmembrane Autoimmune proteins thrombocytopenic (gpllb:llla integrin) purpura
and Oosonization phagocytosis of olatelets
Bleeding
Disease
Pemphigus vulgaris
Targetantigen
in intercellular Antibody-mediated Proteins junctions of epidermal cells activationof proteases, (epidermal disruotionof cadherin)
Skinvesicles(bullae)
adhesions intercellular
proteins,Neutrophildegranulation Vasculitis granule Vasculitis caused Neutrophil presumably from and inflammation released by ANCA neutrophils activated
Goodpasture's syndrome
proteinin Noncollagenous basementmembranesof kidneyglomeruliand lung alveoli
and ComplementFc receptormediatedinflammation
lung Nephritis, hemorrhage
Acuterheumatic fever
Streotococcalcell wall antigen;antibodycrossreactswith myocardial antigen
Inflammation, macropnage activation
arthritis Myocarditis,
gravis Acetylcholinereceptor Myasthenia
Muscleweakness, Antibodvinhibits paralysis binding, acetylcl'ioline recePtors down-modulates
Graves'disease TSHreceptor (hyperthyroidism)
Antibody-mediated stimulation of TSHreceptors
Hyperthyroidism
Insulin-resistant Insulinreceptor diabetes Pernicious anemia Intrinsicfactorof gastric
Antibodyinhibits b i n d i n go f i n s u l i n
Hyperglycemia, ketoacidosis
oarietalcells
erythropoiesis, of intrinsic Abnormal Neutralization anemta factor,decreased of vitamin812 absorption
hormone. antibodies;TSH,thyroid-stimulating ANCA,antineutrophil cytoplasmic Abbreviations:
are listed in Table 18-2. Tissue deposits of antibodies may be detected by morphologic examination in some of these diseases,and the deposition of antibody is often associatedwith local complement activation, inflammation, and tissue injury @ig. 1B-3). lmrnune
Gomplex-fiflediated
Diseases
Immune complexes that cause disease may be composed of antibodies bound to either self antigens or foreign antigens. The pathologic features of diseases caused by immune complexes reflect the site of immune complex deposition and are not determined by the cellular source of the antigen. Therefore, immune complex-mediated diseases tend to be systemic, with little or no specificity for a particular tissue or organ. The occurrence of diseases caused by immune complexes was suspected as early as 1911 by an astute physician named Clemens von Pirquet. At that time,
diphtheria infections were being treated with serum from horses immunized with the diphtheria toxin, which is an example of passive immunization against the toxin by the transfer of serum containing antitoxin antibodies. von Pirquet noted that joint inflammation (arthritis), rash, and fever developed in patients injected with the antitoxin-containing horse ierum. Two clinical features of this reaction suggested that it was not due to the infection or a toxic component of the serum itself. First, these sgnptoms appeared even after the injection of horse serum not containing the antitoxin, so the lesions could not be attributed to the anti-diphtheria antibody. Second, the symptoms appeared at least a week after the first injection of horse ierum and more rapidly with each repeated injection. von Pirquet concluded that this diseasewas due to a host response to some component of the serum. He suggested that the host made antibodies to horse serum proteins, these antibodies formed complexes with the
423
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I M M U N | Tt Y ND E F E NA SN E DD T S E A S E
,,,,.".,,,l;i,,.,,,,.
/R
Anti-basement membrane antibody-mediated glomerulonephritis
lmmunecomplex mediated glomerulonephritis
Light microscopy
lmmunofluorescence
Electronmicroscopy
onephritis.A Glomerulonephritis rnducedby an antibodyagainstthe mtcrograph shows glomerularinflammation and severedamage,and t e m b r a n eB. . G l o m e r u l o n e p h riint idsu c e db y t h e d e p ; t h e b a s e m e nm o p h r l i icn f l a m m a t i oann, dt h e i m m u n o f l u o r e s c e nacnede l e c t r o nm i c r o _ r a l o n gt h e b a s e m e nm t e m b r a n e(.l m m u n o f l u o r e s c e nmciec r o g r a p h s tf California San Francisco, and the electronmicrograph is courtesyof ; Hospital,Boston.)
injected proteins, and the disease was due to the antibodies or immune complexes. We now know that his conclusions were entirely accurate. He called this diseaseserum disease;it is now more commonly known as serum sickness and is the prototype for systemic immune complex-mediated disorders. Much of our current knowledgeof immune complex diseasesis basedon analysesof experimentalmodels of serum sickness.Immunization of an animal such
as a rabbit with a large dose of a foreign protein antigen leads to the formation of antibodies against the antigen (Fig. 1B-a). These antibodies complex with circulating antigen and initially lead to enhancedphagocl'tosisand clearanceof the antigen by macrophagesin the liver and spleen.As more and more antigen-antibodycomplexesare formed, some of them are deposited in vascular beds. In these tissues,the antibodiesin the complexesmay activate complement, with a concomitant fall in serum com-
C h a o t e1r8-
NIDTAYU T O I M M U N I T Y HS Y:P E H S E N S I TAI V EESP0NSE DISEASE CS A U S EBDYI M M U N R
Antigen-antibody complexes are produced during normal immune responses, but they cause disease only when they are produced in excessive amounts, are not efficiently cleared, and become deposited in tissues.The amount of immune complex deposition in tissues is determined by the nature of the complexes and the characteristics of the blood vessels.Small comantibody plexes are often not phagocytosed and tend to be deposited in vesselsmore than large complexes, which are usually cleared by phagocltes. Complexes containing cationic antigens bind avidly to negatively charged components of the basement membranes of blood vessels and kidney glomeruli. Such complexes typically produce severeand long-lasting tissue injury. Capillaries in the renal glomeruli and synovia are vessels in which plasma is ultrafiltered (to form urine and synovial fluid, respectivelg by passing through the capillary 1 4 1 6 1 8 20 wall at high hydrostatic pressure, and these locations are among the most common sites of immune complex deposition. Immune complexes may also bind to Fc Antigen receptors of mast cells and leukocWesand activate these cells to secrete cytokines and vasoactive mediators. These mediators may enhance immune complex depointoa rabbitleadsto theproduction of specific antibody andtheforsition by increasing vascular permeability and blood mationof immunecomplexes Thesecomplexes aredeposited in flow. (leading multipletissues,activate complement to a fall in serum The deposition of immune complexes in vesselwalls levels), complement andcauselnflammatory lesions, whichresolve asthecomplexes andtheremaining antigen areremoved(Adapted leads to complement- and Fc receptor-mediated from Cochrane CG lmmunecomplex-mediated tissueinjury /n inflammation and injury to the vessels and adjacent CohenS, PA Ward,and RT McCluskey of [eds] Mechanisms tissues. Deposits of antibody and complement may be lmmunopathology Werbel& Peck,New York,1979,pp 29-48 detected in the vessels, and if the antigen is knor,tm, it 1979,Wiley-Liss, Copyright Inc) is possible to identiff antigen molecules in the deposits as well (see Fig. 18-3). Many systemic immunologic diseases in humans are caused by the deposition of plement levels. Complement activation leads to immune complexes in blood vessels(Table 18-3).A prorecruitment and activation of inflammatory cells, totype of such diseasesis systemic lupus erythematosus predominantly neutrophils, at the sites of immune (SLE), an autoimmune disease in which numerous complex deposition,and the neutrophils causetissue autoantibodies are produced. Its clinical manifestations injury. Neutrophils also bind to the immune cominclude glomerulonephritis and arthritis, which are plexesby their Fcy receptors.Becausethe complexes attributed to the deposition of immune complexes comare deposited mainly in small arteries, renal posed of self DNA or nucleoprotein antigens and specific glomeruli, and the synoviaof joints, the clinical and antibodies (Box l8-1). pathologic manifestations are vasculitis, nephritis, and arthritis. The clinical slmptoms are usually short lived, and the lesions heal unless the antigen BYT LYMPHOCYTES CNUSTO DIsrRsrS is injected again.This type of diseaseis an example of acute serum sickness. A more indolent and T lymphocytes injure tissues either by triggering DTH prolonged disease,called chronic serum sickness,is reactions or by directly killing target cells (Fig. 1B-5). produced by multiple injections of antigen, which DTH reactions are elicited by CD4* T cells of the THI Iead to the formation of smaller complexesthat are subset and CD8* cells, both of which secrete cltokines deposited most often in the kidneys, arteries, and that activate macrophages (interferon-y [IFN-y]) and lungs. induce inflammation (such as tumor necrosis factor r A localized form of experimental immune ITNFI). The inflammatory reaction associated with T cell-mediated diseases is typically chronic inflamcomplex-mediated vasculitis is called the Arthus mation. Because inflammation plays a central role reaction. It is induced by injecting an antigen subcuin many T cell-mediated diseases, these are often taneouslyinto a previouslyimmunized animal or an inflammatory referred to as "immune-mediated animal that has been given intravenous antibody diseases." In some T cell-mediated disorders, CD8* specificfor the antigen.Circulatingantibodiesrapidly (CTLs) kill target cells cltotoxic T lymphocltes bind to the injected antigen and form immune comcomplex histocompatibility I major plexesthat are depositedin the walls of small arteries bearing class cause tissue (MHC)-associated The T cells that antigens. the injection gives a at site. This deposition rise to injury may be autoreactive, or they may be specific for local cutaneousvasculitiswith tissuenecrosis.
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Section V-
IMMUNITY lN DEFENSE ANDDISEASE
Table 18-3. Examplesof Human lmmune Complex-MediatedDiseases
Disease
lAntigeninvolved lClinicopathologic manifestations
Systemic lupus DNA,nucleoproteins,Nephritis,afthritis, vasculitis erythematosus others B virus Vasculitis Polyarteritis nodosa Hepatitis surfaceantigen
Poststreptococcal Streotococcalcell walI Nephritis antigen(s);may be glomerulonephritis "planted"in glomerular basementmembrane
Serumsickness
Variousproteins
foreign protein antigens that are present in or bound to cells or tissues. T lymphocye-mediated tissue injury may also accompany strong protective immune responses against persistent microbes, especially intracellular microbes that resist eradication by phagocytes and antibodies. A role for T cells in causing a particular immunologic diseaseis suspectedlargely based on the demonstration of T cells in lesions and the isolation of T cells specific for self or microbial antigens from the tissues or blood of patients. Animal models have also been very useful for elucidating the pathogenesis of these disorders.
@
Afthritis, vasculitis, neohritis
Diseases Caused hy Delayed-Type Hypersensitivity In DTH reactions,tissueinjury resultsfrom the products of activatedmacrophages, such as lysosomalenz],rynes, reactiveoxygen intermediates,nitric oxide, and proinflammatory cytokines (see Chapter l3). Vascular endothelialcells in the lesionsmay expressenhanced levels of cy'tokine-regulated surface proteins such as adhesion molecules and class II MHC molecules. ChronicDTH reactionsoften producefibrosisasa result of the secretionof cytokinesand growth factorsby the macrophages.
o"t"y"o-type hypersensitivity
lnflammation APCor tissue antigen
cD8+ T cell
MMM
ffi3
Tissueinjury
@60
Normaltissue T cell-mediatedcytolysis cD8+ CTLs
C e l l k i l l i n ga n d tissue injury
FIGURE t8-5 Mechanismsof T cell-mediateddiseases.A ln delayed-type hypersensitivity reactions, CD4t T cells (and sometimesCD8* cells) respond to tissue antigensby secreting cytokinesthat stimulateinflammationand activatephagocytes, leading to tissue injury APC, antigen-presenting cell B ln some diseases, CDB* CTLs directlykill tissuecells
DAI T UYT o I M M U N I T | Y 427 c h a p t et 8r- D | S E A SCEASU S E BD yT M M U N R E S P o N SHEYSP: E R S E N S IATNI V .....','.,..'..; .
C L I N I C A LF E A T U R E SS. L E i s a c h r o n i c ,r e m i t t i n ga n d r e l a p s i n gm, u l t i s y s t e m a u t o i m m u n ed i s e a s et h a t a f f e c t s p r e d o m i n a n t lwy o m e n , w i t h a n i n c i d e n c eo f 1 i n 7 0 0 a m o n g w o m e n b e t w e e nt h e a g e s o f 2 0 a n d 6 0 y e a r s ( a b o u t1 i n 2 5 0 a m o n g b l a c kw o m e n )a n d a f e m a l e - t o m a l e r a t i oo f 1 0 : ' 1. T h e o r i n c i o acl l i n i c am l anifesralons are rashesa , r t h r i t i sa, n d g l o m e r u l o n e p h r i tbi su,t h e m o l y t i c a n e m i a ,t h r o m b o c y t o p e n iaan, d C N S i n v o l v e m e n t a r e a l s o c o m m o n M a n y d i f f e r e n ta u t o a n t i b o d i easr e f o u n d i n p a t i e n t sw r t h S L E .T h e m o s t f r e q u e n ta r e a n t i n u c l e a rp, a r t i c u l a r al yn t i - D N Aa, n t i b o d i e so;t h e r si n c l u d e a n t i b o d i e sa g a i n s t r i b o n u c l e o p r o t e i nhsi,s t o n e s ,a n d n u c l e o l a ra n t i g e n s l m m u n e c o m p l e x e sf o r m e d f r o m t h e s e a u t o a n t i b o d i easn d t h e i r s p e c iifc a n t i g e n sa r e r e s p o n s i b lfeo r g l o m e r u l o n e p h r i tai sr t, h r i t i sa, n d v a s c u l i tis involvingsmall arteries throughout the body H e m o l y t i ca n e m i a a n d t h r o m b o c y t o p e n iaar e d u e t o autoantibodies againsterythrocytes and platelets,respect i v e l y T h e p r i n c i p adl i a g n o s t itce s t f o r t h e d i s e a s ei s t h e p r e s e n c eo f a n t i n u c l e aar n t i b o d i e sa; n t i b o d i e sa g a i n s t double-strande nd a t i v eD N A a r e s p e c i f i cf o r S L E P A T H O G E N E S I ST.h e p a t h o g e n i ca n t i b o d i e si n t h e d i s e a s ea r e h i g h - a f f i n i t yh,e l p e rT c e l l - d e p e n d e natn t i b o d i e ss p e c i f i cf o r n u c l e a cr o m p o n e n t sl .t i s n o t k n o w n w h e t h e rt h e p r i m a r yp a t h o g e n idce f e c ti s f a i l u r eo f c e n t r a l o r p e r i p h e r at ol l e r a n c ien B l y m p h o c y t e si n, h e l p e T r cells, o r i n b o t h .l t i s t h o u g h t h a t t h e a n t i g e n st h a t e l i c i ta u t o a n t i b o d yp r o d u c t l o na r e r e l e a s e df r o m a p o p t o t i cc e l l s , w h i c h i s o n e r e a s o nt h a t e x p o s u r et o u l t r a v i o l elti g h t ( w h i c h p r o m o t e s a p o p t o s i s )e x a c e r b a t e sd i s e a s e A currenm t o d e lf o r t h e p a t h o g e n e soi sf t h e d i s e a s ei s t h a t a p o p t o t i c e l l sa r e n o t c l e a r e de f f i c i e n t l yr e in per, sulting s i s t e n c eo f n u c l e aar n t i g e n sT o g e t h ewr i t h f a i l u r eo f s e l f t o l e r a n c et,h i s r e s u l t si n t h e p r o d u c t i o no f a n t i b o d i e s a g a i n s tn u c l e a rp r o t e i n sa n d t h e f o r m a t i o no f i m m u n e c o m n l e x e s G e n e t i c f a c t o r s a l s o c o n t r i b u t et o t h e d i s e a s eT h e r e l a t i v er i s kf o r i n d i v i d u aw l si t h H L A - D R 2 or H L A - D R 3i s 2 t o 3 , a n d i f b o t h h a p l o t y p eas r e p r e s e n t , t h e r e l a t i v er i s k i s a b o u t 5 D e f i c i e n c i e os f c l a s s i c a l p a t h w a yc o m p l e m e npt r o t e i n se, s p e c i a l lCy | q , C 2 ,o r C 4 , a r e s e e n i n a b o u t ' 10 % o f p a t i e n t sw i t h S L E .T h e c o m p l e m e n td e f i c i e n c i em s a y r e s u l ti n d e f e c t i v ec l e a r a n coef i m m u n e c o m p l e x e sa n d a p o p t o t i cc e l l s . S t u d i e sw i t h m i c e a l s os u g g e s ta r o l eo f c o m p l e m e npt r o t e i n si n d i s p l a y i n gs e l f a n t i g e n sa n d m a i n t a i n i n g B cell tolerance. I n t e r e s t i n g l yt,h e p e r i p h e r a lb l o o d l y m p h o c y t e so f p a t i e n t ss h o w e v i d e n c eo f e x c e s s i v ep r o d u c t i o na n d r e s p o n s et o t y p e I l F N s W h a t t h i s c y t o k i n eh a s t o d o w i t h t h e d e v e l o p m e not f t h e d i s e a s er e m a i n su n k n o w n B e c e n t s t u d i e s s u g g e s tt h a t e n g a g e m e n o t f Toll-like r e c e p t e r sb y R N Aa n d D N A m a y p l a ya r o l ei n a c t i v a t i n g B c e l l st o p r o d u c ea n t i b o d i easg a i n stth e s en u c l e i ca c i d s a n d n u c l e o p r o t e i nAs d u p l i c a t i oinn T L R Tm a y b e a s u s c e p t i b i l i t yg e n e f o r l u p u s i n t h e B X S B m o u s e s t r a i n , d e s c r i b e db e l o w A N I M A L M O D E L S . S e v e r a li n b r e d m o u s e s t r a i n si n w h i c h l u p u s - l i k ea u t o i m m u n ed i s e a s e ss p o n t a n e o u s l y v a l u a b l e x p e r i m e n t sa yl s t e m sf o r d e v e l o ph a v ep r o v i d e d a n a l y z i n tgh e p a t h o g e n e s iosf t h i s d i s o r d e rT h e f i r s t t o
b e d e s c r i b e da n d t h e o n e s m o s t l i k e S L E a r e t h e N Z B s t r a i na n d ( N Z Bx N Z W ) F I K i d n e yl e s i o n sa n d h e m o l y t i c a n e m i ad e v e l o pi n f e m a l em i c e ,a n d a n t i - D N Aa u t o a n t i b o d i e sa r e p r o d u c e ds p o n t a n e o u s lTyh. e B c e l l so f ( N Z B x N Z W ) F rm i c e a r e h y p e r r e s p o n s i tvoe f o r e i g na n t i g e n s a s w e l l a s t o p o l y c l o n aal c t i v a t o r sa n d c y t o k i n e sa, n d a u t o a n t i b o d yp r o d u c t i o ni s d e p e n d e n to n p a t h o g e n i c h e l p e rT c e l l s r e a c t i v ew i t h n u c l e o s o m apl e p t i d e sT. h e a c t i v a t i o no f B c e l l s m a y a l s o i n v o l v ee n g a g e m e not f Toll-likereceptors (TLR-9)by nuclear DNA, perhaps complexedwith antibody Extensivebreedingstudies have shown that MHC genes from the NZW parent f r o m b o t h p a r e n t asl t r a i n s a n d n o n - M H Cg e n e si n h e r i t e d c o n t r i b u t et o d e v e l o p m e n ot f t h e d i s e a s e .A t t e m p t s yenes a r e b e i n g m a d e t o d e fi n e t h e s u s c e p t i b i l i t g i n t h e s em i c e . M i c e w i t h m u t a t i o n si n e i t h e rt h e F a s o r F a s l i g a n d g e n e s d e v e l o p a n a u t o i m m u n ed i s e a s e w i t h s o m e resemblanceto SLE.The lpr and gld genes are mutant a l l e l e so f t h e F a sa n d F a sl i g a n dg e n e s ,r e s p e c t i v e layn, d t h e m o u s es t r a i n st h a t a r eh o m o z y g o ufso r t h e s em u t a n t of Fasor nona l l e l e sh a v e g r e a t l yr e d u c e de x p r e s s i o n functionalFas ligand Both /pr and gld mrce produce m u l t i p l ea u t o a n t i b o d i eess, p e c i a l l ay n t i - D N Aa n t i b o d i e s , a n d d e v e l o pi m m u n ec o m p l e xn e p h r i t i sS. e v e r el y m p h a d e n o p a t hayl s od e v e l o p isn t h e s ei n b r e ds t r a i n sb e c a u s e of funco f t h e a c c u m u l a t i oonf a n u n u s u a lp o p u l a t i o n t i o n a l l yi n e r t C D 3 * C D 4 - C D 8T- c e l l s B e c a u s eo f t h e d e f e c ti n F a so r F a sl i g a n di n t h e s em i c e ,a n e r g i cB c e l l s , nd selfc a n n o tb e e l i m i n a t e db y F a s - m e d i a t ekdi l l i n g a r e a c t i v eh e l p e rT c e l l s m a y s u r v i v ef o r a b n o r m a l l lyo n g times, as well The diseaseoI lpr and gld mice is also i n f l u e n c ebdy b a c k g r o u ngde n e si n t h a t i t i s m o r es e v e r e i n a n i n b r e ds t r a i nc a l l e dM R L t h a n i n a n y o t h e r .A p h e n o t y p i c a l lsyi m i l a rh u m a nd i s e a s ec a l l e dt h e a u t o i m m u n e syndromeis causedby mutationsin lymphoproliferative t h e g e n e e n c o d i n gF a s t h a t a b o l i s ht h e a b i l i t yo f t h i s . o evidence d e a t hr e c e p t o tro d e l i v e ra p o p t o t i cs i g n a l sN f o r F a s o r F a s l i g a n da b n o r m a l i t i ehsa s b e e n d e m o n l LE. s t r a t e di n t y p i c a S A t h i r d i n b r e ds t r a i n i n w h i c h a l u p u s - l i k ed i s e a s e d e v e l o p si s a r e c o m b i n a nstt r a i nc a l l e dB X S B ;d i s e a s e s u s c e p t i b i l iitnyt h i ss t r a i ni s l i n k e dt o t h e Y c h r o m o s o m e , . h e s em i c e p r o d u c ea n t j a n d o n l y m a l e sa r e a f f e c t e d T a n t i b o d i easg a i n snt u c l e aar n t i g e n sa, n d s e v e r en e p h r i t i s a n d v a s c u l i t ids e v e l o p A n o t h e rm u t a n tm o u s es t r a i n c, a l l e dt h e v i a b l em o t h e a t e n m o u s e ( b e c a u s eo f s k i n l e s i o n s )a, l s o p r o d u c e s s .h e m o t h - e a t e nm o u s e h i g h l e v e l so f a u t o a n t i b o d i eT e H P - ,1 c a r r i e sa m u t a t i o no f t h e t y r o s i n ep h o s p h a t a sS which associateswith several receptors that serve n e g a t i v er e g u l a t o r yf u n c t i o n si n c e l l s o f t h e i m m u n e s y s t e m T h e s i g n atl r a n s d u c t i oanb n o r m a l i t i ecsa u s e db y e u t a t i o na n d t h e m e c h a n i s mo f a u t o t h e p h o s p h a t a sm a n t i b o d yp r o d u c t i o ni n m o t h - e a t e nm i c e a r e n o t w e l l y c r e c e p t o rF, c y R l l b , d e f i n e d .K n o c k o uot f t h e i n h i b i t o r F a l s oc a u s e sa l u p u s - l i kdei s e a s ei n m i c e . T r a n s g e n im c o u s em o d e l so f l u p u sh a v eb e e nc r e a t e d in B i n w h i c h a n a n t i b o d ya g a i n sst e l f D N A i s e x p r e s s e d c e l l sa s a t r a n s g e n eT h e s em o d e l sa r e u s e f u lf o r s t u d y B cells inq the controlof self-reactive
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IMMUNITY lN DEFENSE ANDDISEASE
Many organ-specific autoimmune diseases are causedby DTH reactions induced by autoreactiveT cells (Table l8-4). In type I diabetes mellitus (TtD) (Box lB-2), infiltrates of lymphocltes and macrophages are found around the islets of Langerhans in the pancreas, with destruction of insulin-producing B cells in the islets and a resultant deficiencv in insulin oroduction. In animal models of TlD, the diseasecan be transferred to young, prediseased animals by injecting T cells from older diseased animals. Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) in which CD4. T cells of the Tnl and/or TslT subset react against self myelin antigens (Box 1B-3).The DTH reaction results in the activation of macrophages around nerves in the brain and spinal cord, destruction of the myelin, abnormalities in nerve conduction, and neurologic deficits. An animal model of MS is experimental autoimmune encephalomyelitis (EAE),induced by immunization with protein antigens of CNS myelin in adjuvant. Such immunization leads to an autoimmune T cell response against myelin. EAE can be transferred to naive animals with myelin antigen-specific CD4* T cells, and the diseasecan be prevented bytreating immunized animals with antibodies speciflc for class II MHC or for CD4 molecules, indicating that CD4* class II MHCrestricted T cells play an obligatory role in this disorder. Rheumatoid arthritis (Box 18-4) is a systemic disease affecting the small joints and many other tissues.A role for T cell-mediated inflammation is suspected in this disease because of its similarity to animal models in
which arthritis is known to be caused by T cells specific for joint collagen. Antibodies may also contribute to joint inflammation in this disease.Antagonists against the inflammatory cytokine TNF have a beneficial effect in rheumatoid arthritis. Cell-mediated immune responses to microbes and other foreign antigens may also lead to tissue injury at the sites of infection or antigen exposure. Intracellular bacteria such as Mycobacterium tuberculosls induce strong T cell and macrophage responses that result in granulomatous inflammation and fibrosis; the inflammation and fibrosis may cause extensive tissue destruction and functional impairment, in this casein the lungs. Tuberculosis is a good example of an infectious disease in which tissue injury is mainly due to the host immune response (seeChapter 15).A variety of skin diseasesthat result from topical exposure to chemicals and environmental antigens, called contact sensitivity, are due to DTH reactions, presumably against neoantigens formed by the binding of the chemicals to self proteins. Inflammatory bowel disease (IBD) consists of a group of disorders, including Crohn diseaseand ulcerative colitis, in which an immunologic etiology has been suspected for many years. Crohn disease is an inflammatory diseasecaused by T cells that presumably react against intestinal microbes as well as self antigens. About 25Toof patients with this disease have mutations in NOD2, an intracellular sensor of microbial products (see Chapter 2). The pathogenetic link between NOD2 mutations and the diseaseis still not understood. Recent
T a b l e1 8 - 4 .E x a m p l e so f T C e l l - M e d i a t e d l m m u n o l o g i c aD l iseases
Disease
Specificityof Humandisease pathogenicT cells
Type| (insulin- lsletcell antigens ( i n s u l i ng, l u t a m i ca c i d dependent) diabetes mellitus decarboxylase,others) Unknown antigenin Rheumatoid jointsynovium afthritis
Animalmodels
Yes;specificity of NODmouse.BB rat. T cellsnotestablished transgenic mouse models Yes;specificity of T cells Collagen-induced and roleof antibody arthritis,others notestablished
Multiple sclerosis,Myelinbasicprotein, Yes;T cells recognize EAEinducedby immunization withCNS myelinantigens experimental proteolipidprotein myelinantigens;TCR autoimmune transgenic models encephalomyelitis Yes Inflammatory Unknown Colitisinducedby depletion of regulatory boweldisease T cells,knockout of lL-10 (Crohn's, ulcerative colitis) Peripheral svndromeInducedby immunization neuritisP2 proteinof peripheralGuillain-Barre nervemyelrn
Autoimmune myocarditis
proteins Myocardial
withperipheral nerve myelinantigens
Inducedby immunization Yes(post-viral myocarditis); specificity withmyosinor infection virus of T cellsnotestablishedby Coxsackie
Abbreviations: CNS,centralnervoussystem;NODnonobese diabetic; TCR,T cellreceptor
NIDTAYU T O I M M U N I TiY E E S P O N SH EY SP : E R S E N S I TAI V C h A D I1E8T- D I S E A S E CS A U S EBDYI M M U N B
T 1D , p r e v i o u s lcya l l e di n s u l i n - d e p e n d edni at b e t e sm e l l i t u s ( I D D M ) i,s a m u l t i s y s t e m m e t a b o l id c i s e a s er e s u l t i n g f r o m i m o a i r e di n s u l i no r o d u c t i o nT.h e d i s e a s ei s c h a r a c t e r i z e db y h y p e r g l y c e mai an d k e t o a c i d o s iC s hronic omp l i c a t i o n os f T 1D i n c l u d ep r o g r e s s i vaet h e r o s c l e r o soi sf a r t e r i e sw, h i c hc a nl e a dt o i s c h e m i cn e c r o s i o s f l i m o sa n o i n t e r n ao l r g a n s ,a n d m i c r o v a s c u l aorb s t r u c t i o nc a u s i n g d a m a g et o t h e r e t i n a ,r e n a l g l o m e r u l i a, n d p e r i p h e r a l n e r v e sT h e r e l a t i o n s h oi pf a b n o r m agl l u c o s em e t a b o l i s m andvascularlesionsis not known Type1 diabetesaffects aboul 0.2o/oof the U S population,with a peak age at '1 , n dt h e i n c i d e n c e o n s e to f i t o 1 2 y e a r s a is increasing T h e s ep a t i e n t sh a v ea d e f i c i e n coy f i n s u l i nr e s u l t i n fgr o m d e s t r u c t i oonf t h e i n s u l i n - p r o d u c ipncge l l so f t h e i s l e t so f L a n g e r h a n isn t h e p a n c r e a sa, n d c o n t i n u o u sh o r m o n e r e p l a c e m e nt ht e r a p yi s n e e d e d . Severalmechanismsmay contributeto P cell destrucg T Hr e a c t i o n m s e d i a t e db y C D 4 .T p 1c e l l s t i o n ,i n c l u d i n D r e a c t i v ew i t h i s l e t a n t i g e n s ( i n c l u d i n gi n s u l i n ) ,C T L mediatedlysisof isletcells,localproductionof cytokines ( T N Fa n d l L - 1 )t h a t d a m a g ei s l e tc e l l s ,a n d a u t o a n t i b o d i e sa g a i n s its l e tc e l l s I n t h e r a r ec a s e si n w h i c ht h e p a n c r e a t i cl e s i o n sh a v e b e e n e x a m i n e da t t h e e a r l va c t i v e s t a o e so f t h e d i s e a s et h e i s l e t ss h o w c e l l u l a n r ecrosis a n d l y m p h o c y t iicn f i l t r a t i o n T h i sl e s i o ni s c a l l e di n s u l i t i s T h e i n f i l t r a t ecso n s i s ot f b o t hC D 4 *a n d C D 8 .T c e l l s S u r v i v i n gi s l e tc e l l so f t e n e x p r e s sc l a s sl l M H C m o l e c u l e s , probablyan effect of localproductionof IFN-yby the T c e l l s A u t o a n t i b o d i easg a i n s ti s l e t c e l l s a n d i n s u l i na r e a l s od e t e c t e di n t h e b l o o do f t h e s e p a t i e n t sT h e s ea n t i b o d i e sm a y p a r t i c i p a tien c a u s i n gt h e d i s e a s eo r m a y b e a r e s u l to f T c e l l - m e d i a t eidn j u r ya n d r e l e a s eo f n o r m a l l y s e q u e s t e r eadn t i g e n sl n s u s c e p t i b l ceh i l d r e nw h o h a v e the not developeddiabetes(suchas relativesof patients), p r e s e n c eo f a n t i b o d i eas g a i n s its l e tc e l l si s p r e d i c t i v o ef t h e d e v e l o p m e notf T ' 1D . T h i ss u g g e s t st h a tt h e a n t i - i s l e t c e l la n t i b o d i ecso n t r i b u t e t o i n l u r yt o t h e i s l e t s . M u l t i p l eg e n e sa r e i n v o l v e di n T 1D . A g r e a t d e a l o f attentionhas been devotedto the role of HLA genes. Ninetv oercentto 95% of whites with T1D have HLADR3,or DR4,or both,in contrastto about40o/ooI normal subjects,and40o/oto 50% of patientsare DR3/DR4heterozygotes,in contrastto 5% of normalsubjects.Intere s t i n g l ys, u s c e p t i b i l i t oy T 1D i s a c t u a l l ya s s o c i a t ew dith a l l e l e so f D 0 2 a n d D 0 8 t h a t a r eo f t e n i n l i n k a g ed i s e q u i l i b r i u mw i t h D R 3a n d D R 4 .S e q u e n c i nogf D O m o l e c u l e s associatedwith diabeteshas led to the hvoothesisthat developmentof T1D is influencedby the structureof the D O p e p t i d e - b i n d i ncgl e f t , w i t h o n e p a r t i c u l a r e s i d u e (residu5 e 7 )p l a y i n ga s i g n i f i c a nr o t l e .D e s p i t et h e h i g hr e l s i t h p a r t i c u l acr l a s s l l a t i v e r i s k f o r T 1D i n i n d i v i d u a lw a l l e l e sm , o s t p e r s o n sw h o i n h e r i tt h e s e a l l e l e sd o n o t d e v e l o pt h e d i s e a s e . N o n - H L Ag e n e s a l s o c o n t r i b u t et o t h e d i s e a s eT h e f i r s t o f t h e s e t o b e i d e n t i f i e di s i n s u l i n ,w i t h t a n d e m repeats in the promoter region being associatedwith o f t h i sa s s o c i a t i o n d i s e a s es u s c e p t i b i l i tTvh e m e c h a n i s m ls unknown;it may be relatedto the levelof expression o f i n s u l i ni n t h e t h y m u s ,w h i c h d e t e r m i n e sw h e t h e ro r n o t i n s u l i n - s p e c i fTi c c e l l s w i l l b e d e l e t e d( n e g a t i v e l y s e l e c t e dd) u r i n gm a t u r a t i o nS.e v e r apl o l y m o r p h i s mhsa v e
gne i n t h e N O D m o u s em o d e l ,i n c l u d i n o b e e ni d e n t i f i e d b e l i e v e dt o b e i n t h e l L - 2 g e n e T h e f u n c t i o n acl o n s e q u e n c e so f t h i s p o l y m o r p h i s m are not known.Some s t u d i e sh a v e s u g g e s t e dt h a t v i r a l i n f e c t i o n s( e 9 . , w i t h coxsackievirus84) may precede the onset of T1D, p e r h a p sb y i n i t i a t i ncge l li n j u r yi,n d u c i n gi n f l a m m a t i oann d t h e e x p r e s s i oonf c o s t i m u l a t o rasn, dt r i g g e r i nagn a u t o i m m u n e r e s p o n s eH . o w e v e r ,e p i d e m i o l o g idca t a s u g g e s t that repeatedinfectionsprotectagainstT1D, and this is s i m i l a tro t h e N O D m o d e l I n f a c t ,i t h a s b e e np o s t u l a t e d that one reasonfor the increasedincidenceof T1D in developedcountriesis the controlof infectiousdiseases. ANIMAL MODELSOF SPONTANEOUST1D. The NOD mouse strain developsa spontaneousT cell-mediated i n s u l i t i sw, h i c hi s f o l l o w e db y o v e r td r a b e t e sD. i s e a s ec a n to youngNOD micewith T cellsfrom older, be transferred e a r l i e rt ,h e l i n k a g eo f t h i s a f f e c t e da n i m a l sA. s m e n t i o n e d d i s e a s ew i t h t h e M H C i s r e m a r k a b lsyi m i l a rt o t h e H L A l i n k a g eo f T 1D i n h u m a n s .l n N O D m i c e , d i s e a s ei s c cells that may recognize i n d u c e db y d i a b e t o g e n i T v a r i o u si s l e t a n t i g e n si,n c l u d i n gi n s u l i na n d a n i s l e t c e l l e n z y m ec a l l e dg l u t a m i ca c i dd e c a r b o x y l a slen.d u c t i o no f T c e l lt o l e r a n cteo t h e s ea n t i g e n sr e t a r d st h e o n s e to f d i a b e t e si n N O D m i c e T h e u n d e r l y i nagb n o r m a l i t i ei ns N O D m i c e t h a t l e a dt o a u t o i m m u n i tiyn c l u d ed e f e c t i v en e g a T cells in the thymus and tive selectionof self-reactive r e d u c e dn u m b e r so f r e g u l a t o r yT c e l l s i n p e r i p h e r a l t i s s u e sA . n o t h e ra n i m a lm o d e lo f t h e d i s e a s ei s t h e B B d ith r a t , i n w h i c h i n s u l i t i sa n d d i a b e t e sa r e a s s o c i a t e w lymphopenia MOUSE MODELS OF T1D' SeveraldifTRANSGENTC ferenttransgenicmodelshavebeen createdby expressi n g t r a n s g e n e si n p a n c r e a t iics l e t B c e l l sb y i n t r o d u c i n g t h e s e g e n e si n t o m i c e u n d e rt h e c o n t r o lo f i n s u l i np r o m o t e r s A l l o g e n e i c l a s sI a n d c l a s sl l M H C m o l e c u l e s can be expressedin isletcellsto test the hypothesisthat t h i sw i l l c r e a t ea n e n d o g e n o u"sa l l o g r a f tt"h a t s h o u l db e a t t a c k e db y t h e i m m u n e s y s t e m . I n s u l i t i sd o e s n o t T c e l l ss p e c iifc f o r t h e a l l o d e v e l o pi n t h e s em i c eb e c a u s e g e n e i cM H C m o l e c u l e b s e c o m et o l e r a n ti,n p a r tb e c a u s e t h e i n s u l i np r o m o t e ri s l e a k ya n d t h e a l l o a n t i g e nasr e e x p r e s s e idn t h e t h y m u s .E x p r e s s i oonf t h e c o s t i m u l a t o r B 7 - 1i n i s l e tc e l l si n c r e a s essu s c e p t i b i l ittoy i n s u l i t i (ss e e c HCmolecules t e x t ) l n s o m e m o d e l s i,f b o t ha l l o g e n e iM a n d l L - 2 a r e e x p r e s s e di n i s l e t s ,i n s u l i t i sd o e s d e v e l o p , probablybecause local lL-2 productionbreaks T cell a n e r g ya n d i n i t i a t e sa n a l l o g e n e i cr e a c t i o na g a i n s t h e islets Other model protein antigens have also been e x p r e s s e di n i s l e tB c e l l s ,a n d t h e r e a c t i o no f T c e l l st o t h e s ea n t i g e n sh a s b e e ns t u d i e da s a m o d e lf o r T 1D . A differenttransgenicmodel involvesexpressingin T cells a T cell receptor(TCR)specificfor an islet B cell a n t i g e nA s t h e s em i c ea g e ,t h e yd e v e l o pi n s u l i t ias n dd i a betes A variationof this approachis to expressa model p r o t e i na n t i g e ni n t h e i s l e t s a n d i n t r o d u c ei n t o t h e s e a n t i g e n - e x p r e s s im n gi c e T c e l l s f r o m T C R t r a n s g e n i c mice expressingreceptors specific for that antigen T h e s em o d e l sa r e v a l u a b l ef o r s t u d y i n gT c e l l t o l e r a n c e a n d r e s p o n s etso t i s s u ea n t i g e n s .
429
43O Section V - IMMUNITY lN DEFENSE ANDDTSEASE I .,,.-.".**t**...-
M S i s t h e m o s t c o m m o nn e u r o l o g id c i s e a s eo f y o u n g The sequenceof events in the developmentof EAE, adultsO . n p a t h o l o g iecx a m i n a t i o nt h, e r ei s i n f l a m m a t i o n a n db y a n a l o g yM S , i s t h o u g h t o b e t h e f o l l o w i n gP. o t e n i n t h e C N S w h i t e m a t t e rw i t h s e c o n d a r d y e m y e l i n a t i o n . tiallyautoreactive T cellsspecificfor myelinproteinsare T h ed i s e a s ei s c h a r a c t e r i z ec d l i n i c a l lbyy w e a k n e s sp, a r a l - p r e s e n ti n t h e c r r c u l a t i oonf n o r m a li n d i v i d u a l sl m . muy s i s ,a n do c u l a rs y m p t o m sw i t h e x a c e r b a t i o nasn dr e m i s - n i z a t i o n w i t h a m y e l i na n t i g e nt o g e t h e rw i t h a n a d j u v a n t s i o n s ;C N Si m a g i n gs u g g e s t st h a t i n p a t i e n t sw i t h a c t i v e leadsto T cell activationagainstepitopesof autologous d i s e a s e ,t h e r e i s f r e q u e n tn e w l e s i o nf o r m a t i o n T . c t i v a t e dT c e l l s t r a f f i c i n t o t h e C N S . he m v e l i np r o t e i n s A d i s e a s ei s m o d e l e db y E A Ei n m i c e ,r a t s ,g u i n e ap i g s ,a n d m o r er e a d i l yt h a nd o n a i v ec e l l s .l n t h e C N S ,t h e a c t i v a t e d n o n h u m a np r i m a t e sa, n d t h i s i s o n e o f t h e b e s t c h a r a c - T c e l l se n c o u n t e m r y e l i np r o t e i n sa n d r e l e a s ec y t o k i n e s terizedexperimentalmodelsof an organ-specific autorm- that recruitand activatemacrophages and other T cells, m u n ed i s e a s em e d i a t e dm a i n l yb y T l y m p h o c y t e sE.A Ei s leadingto myelindestructionThe diseaseis propagated i n d u c e db y i m m u n i z i n ga n i m a l sw i t h a n t i g e n sn o r m a l l y by the process known as epitope spreading.Within p r e s e n ti n C N S m y e l i n ,s u c h a s m y e l i n b a s i c p r o t e i n weeks afterthe onsetof EAE,there is tissuebreardown (MBP)p , r o t e o l i p ipdr o t e i n( P L P )a, n d m y e l i no l i g o d e n d r o - with release of new protein epitopes; local antigen( M O G ) ,w i t h a n a d j u v a n tc o n t a i n i n g p r e s e n t i n g cyte glycoprotein c e l l si n t h e C N S i t s e l fe x p r e s sh i g hl e v e l so f h e a t - k i l l em d ycobacterium w,h i c h i s n e c e s s a rfyo r e l i c i t - c l a s s l l M H C a n d c o s t i m u l a t o rm y o l e c u l e sT. h u s , t h e ing a strongT cell response About 1 to 2 weeks after i m m u n o l o g i c a lal yc t i v a t e db r a i nt i s s u ei n d u c e st h e a c t i i m m u n i z a t i o na, n i m a l sd e v e l o p a n e n c e p h a l o m y e l i t i s , vation of autoreactiveT cells recognizingmany myelin characterized by perivascular infiltratescomposedof lymp r o t e i n so t h e rt h a nt h e a n t i g e nt h a tt r i g g e r e tdh e d i s e a s e . phocytesand rlacrophagesin the CNSwhite matter,folT h e c l i n i c arle l e v a n c o ef the phenomenon is thatby the lowed by dernyelinationThe severity of the lesions t i m e p a t i e n t sp r e s e n t o t h e c l i n i c t, h e r ei s u n l i k e l yt o b e d e p e n d so n t h e a n i m a ls p e c i e s a , n t i g e n ,a n d a d j u v a n t a s i n g l ea n t i g e nd r i v i n gt h e d i s e a s e . T h e n e u r o l o g i cl e s i o n sc a n b e m i l d a n d s e l f - l i m i t e o dr EAE has been used to analyzethe fine specificityof c h r o n i ca n d r e l a p s i n g . m y e l i n - r e a c t i veen c e p h a l i t o g e nTi c c e l l s a n d t o h e l p I n m i c e ,E A Ei s c a u s e db y a c t i v a t e dC, D 4 *T c e l l ss p e d e f i n ei m m u n o d o m i n a nr et g i o n so f m y e l i np r o t e i n st h a t c i f i cf o r M B P ,P L Po, r M O G .T h i sh a sb e e ne s t a b l i s h ebdy m a y b e r e l e v a ntto M S i n h u m a n s M . u t a t i o n aaln a l y s i os f m a n y l i n e so f e x p e r i m e n t aelv i d e n c e M . i c e i m m u n i z e d v a r i o u sM B P a n d P L P p e p t i d e sh a s s h o w n t h a t s o m e w i t h M B P o r P L Pc o n t a i nC D 4 .T c e l l st h a t s e c r e t el L - 2 a m i n oa c i dr e s i d u e sa r e c r i t i c aflo r b i n d i n gt o M H C m o l and IFN-yand proliferatein responseto that antigenln e c u l e s a n d o t h e r s f o r r e c o g n i t i o nb y T c e l l s .A l t e r e d vitro fhe diseasecan be transferredto naiveanimalsby peptide ligands may be produced by introducing C D 4 . T c e l l s f r o m M B P - o r P L P - i m m u n i z esdy n g e n e i c conservative substitutions in the TCRcontactresiduesof a n i m a l so r w i t h M B P -o r P l P - s p e c i f iccl o n e dC D 4 *T c e l l M B P o r P L P A d m i n i s t r a t i oonf s u c h m u t a n t p e p t i d e s l i n e s A l t h o u g hi t h a sb e e na c c e p t e df o r m a n yy e a r st h a t b l o c k st h e i n d u c t i o n o f E A E .l t i s t h o u g h t h a tt h e a l t e r e d t h e p a t h o g e n iTc c e l l sa r e T s 1 c e l l s ,r e c e n ts t u d i e sh a v e p e p t i d el i g a n d si n d u c ea n e r g yi n T c e l l ss p e c i f i cf o r n a t i v e i n d i c a t e tdh a t l L - 1 7 - p r o d u c i nTgs ' 7 1 c e l l sa l s oc o n t r i b u t e M B P o r P L Po r s t i m u l a t et h e d e v e l o p m e notf a n t i - i n f l a m t o t h e d e v l e o p m e not f E A E i n m i c e . I n h u m a n s T , cells m a t o r yT s 2 c e l l ss p e c i f i cf o r t h e s em y e l i na n t i g e n sT. h i s specificfor myelin proteins can be isolatedfrom the approachhas recentlybeen tried in patientswith MS p e r i p h e r abl l o o d o f n o r m a l s u b j e c t sa s w e l l a s f r o m T C R c o n t a c tr e s i d u e si d e n t i f i e di n a n i m m u n o d o m i n a n t patientswith MS; however,as predictedby the EAE MBP peptidewere modifiedto producean APL, and the m o d e l ,t h e m y e l i n - r e a c t i T v ec e l l sd e r i v e df r o m p a t i e n t s APL was injectedinto patients At high antlgendoses,a with MS are rn an activatedstate comparedwith those subsetof patientsexperienceda flare-upof the disease from normalsubjects,which appearto be naive. associatedwith very highfrequenciesof MBP-reactive T D i s e a s e - c a u s iTn gc e l l si n E A Ee x p r e s sh i g hl e v e l so f cellsthat were cross-reactive with the nativeself antigen. the B, integrinvery lateantigen-4(VLA-4)The infiltration These unfortunateresultsprovidestrong evidencethat o f T c e l l s i n t o t h e C N S i s t h o u g h tt o d e p e n do n t h e flare-upsof MS are relatedto T cell responsesto myelin b i n d i n go f V L A - 4 t o i t s l i g a n d ,v a s c u l a rc e l l a d h e s i o n p r o t e r n s . m o l e c u l e - 1( V C A M -)1, o n m i c r o v a s c u l aern d o t h e l i u m . Both EAE and MS have strong geneticcomponents Studiesin EAEhavedemonstratedthat monoclonar anrr- a n d o c c u ro n l y i n g e n e t i c a l lsyu s c e p t i b l he o s t s .l d e n t i c a l bodies blockingthe VLA-4-VCAMinteractionblock the twins havea 25o/oto 407oconcordance ratefor developo n s e to f E A E S i m i l a r l yb,l o c k i n gV L A - 4c a n s i g n i f i c a n t l y ment of MS, whereasnonidentical twins haved 1o/oconpreventthe onset of new lesionsin MS patients c o r d a n c er a t e I n b o t h m i c e a n d h u m a n s ,c e r t a i nM H C However,in rare patients,blockingT cell traffic into the h a p l o t y p ehs a v eb e e nl i n k e dt o t h e d i s e a s e . b r a i nh a s a l l o w e ds e c o n d a r vy i r a li n f e c t i o n st o o c c u r I n t h e C N S ,w i t h s e r i o u sc o n s e q u e n c e s
Chapter 18-
': ANDAUT0IMMUNITY HYPERSENSITIVITY RESP0NSES: DISEASES BYIMMUNE CAUSED
R h e u m a t o iadr t h r i t i si s a n i n f l a m m a t o rdyi s e a s ei n v o l v i n g s m a l lj o i n t so f t h e e x t r e m i t i e sp,a r t i c u l a rol yf t h e f i n g e r s , a s w e l l a s l a r g e rj o i n t s i n c l u d i n gs h o u l d e r s e , lbows, k n e e s ,a n d a n k l e s ,R h e u m a t o iadr t h r i t i si s c h a r a c t e r i z e d b y i n f l a m m a t i oonf t h e s y n o v i u ma s s o c i a t ewdi t h d e s t r u c t i o n o f t h e j o i n t c a r t i l a g ea n d b o n e ,w i t h a m o r p h o l o g i c p i c t u r es u g g e s t i voef a l o c a li m m u n er e s p o n s eB o t hc e l l m e d i a t e da n d h u m o r a li m m u n e r e s p o n s e sm a y c o n tribute to development of synovitis CD4* T cells, plasmacells,and macrophages, activatedB lymphocytes, a s w e l l a s o t h e r i n f l a m m a t o r cy e l l s ,a r e f o u n d i n t h e i n f l a m e ds y n o v i u m ,a n d i n s e v e r ec a s e s ,w e l l - f o r m e d l y m p h o i df o l l i c l e sw i t h g e r m i n acl e n t e r sm a y b e p r e s e n t N u m e r o u sc y t o k i n e si ,n c l u d i n g l L - 1, l L - 8 ,T N F ,a n d I F N - y , h a v eb e e nd e t e c t e di n t h e s y n o v i a(lj o i n tf)l u i d .C y t o k i n e s , especiallyTNF,are believedto activateresidentsynovial c n z y m e s ,s u c h a s c o l l a g e c e l l st o p r o d u c ep r o t e o l y t i e n a s e t, h a t m e d i a t ed e s t r u c t i oonf t h e c a r t i l a g el i,g a m e n t s , a n dt e n d o n so f t h e j o i n t s .M a n yo f t h e c y t o k i n e tsh o u g h t jointdestruction t o p l a ya r o l e i n i n i t i a t i n g are probably p r o d u c e da s a r e s u l to f l o c a T l c e l la n d m a c r o p h a gaec t i vation.AntagonistsagainstTNF have proved to be of b e n e f i ti n p a t i e n t sa, n d s o l u b l eT N F r e c e p t o a r s well as anti-TNFantibodyare now approvedfor treatmentof the d i s e a s eT h e b o n e d e s t r u c t i o n in rheumatoid a r t h r i t i si s due to increasedosteoclastactivityin the joints,and this m a y b e r e l a t e dt o t h e p r o d u c t i o no f t h e T N F f a m i l y cytokineRANK (receptoractivatorof nuclearfactor rB) l i g a n db y a c t i v a t e d T c e l l s R A N Kl i g a n db i n d st o R A N K , a m e m b e ro f t h e T N F r e c e p t o fra m i l yt h a t i s e x p r e s s e d o n o s t e o c l a sptr e c u r s o r sa ,n di n d u c e st h e i rd i f f e r e n t i a t i o n a n d a c t i v a t i o nT.h e s p e c i f i c i toyf t h e T c e l l st h a t m a y b e i n v o l v e di n t h e p a t h o g e n e soi sf a r t h r i t i a s n dt h e n a t u r eo f t h e i n i t i a t i n ag n t i g e na r e n o t k n o w n .S i g n i f i c a nntu m b e r s of T cells expressingthe T6 antigenreceptorhave also beendetectedin the svnovialfluid of some oatientswith rheumatoidarthritis.However,the pathogenicrole of t h i s s u b s e to f T c e l l s ,l i k e t h e i r p h y s i o l o g ifcu n c t i o n ,i s ooscure. S v s t e m i c o m o l i c a t i o nosf r h e u m a t o iadr t h r i t i isn c l u d e v a s c u l i t i sp, r e s u m a b l yc a u s e db y i m m u n e c o m p l e x e s , a n d l u n gi n j u r yT. h e n a t u r eo f t h e a n t i g e no r t h e a n t i b o d -
studies suggestthat a mutation in the gene encoding the IL-23 receptor is strongly associated with IBD. IL-23 is the cytokine that enhances Ts17 responses, and TglT cells maybe involved in the inflammatorylesions of IBD. It is not knor.tmif the IL-23R mutation influences this reaction. Severalmouse models of IBD suggestthat deficiency of regulatory T cells may be involved in the excessive reactions to enteric bacteria. Although T cell-induced chronic inflammation is believed to be the common pathogenetic basis for all these diseases, recent therapeutic trials suggest that there may be subtle differences in the pathogenesis of these diseases.For instance, TNF antagonists are beneficial in patients with rheumatoid arthritis and Crohn's disease but not multiple sclerosis.Also, as mentioned
ies in these comolexesis not known Patientswith the d r t h r i t i sf r e q u e n t l yh a v ec i r c u a d u l tf o r m o f r h e u m a t o i a with l a t i n ga n t i b o d i e sw,h i c hm a y b e l g M o r l g G ,r e a c t i v e the Fc (and rarelyFab)portionsof their own lgG molesre called rheumatoid c u l e s . T h e s e a u t o a n t i b o d i ea factorsa , n d t h e i r p r e s e n c ei s u s e d a s a d i a g n o s t itce s t for rheumatoidarthritis Rheumatoidfactorsmay particip a t ei n t h e f o r m a t i o no f i n j u r i o uism m u n ec o m p l e x e sb, u t t h e i r p a t h o g e n i cr o l e i s n o t e s t a b l i s h e dA l t h o u g ha c t i vated B cells and plasmacells are often presentin the synoviaof affectedjoints, the specificitiesof the antib o d i e sp r o d u c e db y t h e s e c e l l so r t h e i r r o l e si n c a u s i n g j o i n tl e s i o n sa r e n o t k n o w n .S u s c e p t i b i l ittoy r h e u m a t o i d arthritisis linkedto the HLA-DR4haplotypeand less so t o D R 1 a n d D R W 1 D ,I n a l l t h e s ea l l e l e st,h e a m i n oa c i d s e q u e n c e sf r o m p o s i t i o n s6 5 t o 7 5 o f t h e B c h a i na r e n e a r l yi d e n t i c aTl .h e s er e s i d u e sa r e l o c a t e di n o r c l o s et o t h e p e p t i d e - b i n d i ncgl e f t s o f t h e H L A m o l e c u l e ss, u g g e s t i n gt h a tt h e y i n f l u e n c e a n t i g e np r e s e n t a t i oonr T c e l l recognrllon. There are severalexperimentalmodels of arthritis. s r t h r i t i sa n d h a v e M R L / l p rm i c e d e v e l o ps p o n t a n e o u a h i g h s e r u m l e v e l so f r h e u m a t o i df a c t o r s .T h e i m m u n e m e c h a n i s m so f j o i n t d i s e a s ei n M R L / l p rm i c e a r e n o t k n o w n T c e l l - m e d i a t eadr t h r i t i sc a n b e l n d u c e di n s u s nith c e p t i b l es t r a i n so f m i c e a n d r a t s b y i m m u n i z a t i ow t y p e l l c o l l a g e n( t h e t y p e f o u n d i n c a r t i l a g e )a,n d t h e to unimmunized d i s e a s ec a n b e a d o p t i v e l yt r a n s f e r r e d a n i m a l sw i t h c o l l a g e n - s p e c iTf i cc e l l s .H o w e v e r ,i n t h e g v i d e n c ef o r c o l h u m a nd i s e a s et,h e r e i s n o c o n v i n c i n e arthriautoimmunityAn antibody-mediated lagen-specific a r t h r i t i si s t i s t h a t m i m i c ss o m e a s p e c t so f r h e u m a t o i d s e e ni n a T C Rt r a n s g e n isct r a i no f m i c ec a l l e dK i Bx N . I n t h i s m o d e l ,a u t o a n t i b o d i et hsa t r e c o g n i z teh e u b i q u i t o u s isomerase cytoplasmic enzyme glucose-6-phosphate m e d i a t ei n f l a m m a t i o snp e c i f i c a l loyn a r t i c u l a sr u r f a c e s . E x p e r i m e n t aalr t h r i t i sc a n a l s o b e p r o d u c e db y i m m u n i z a t i o nw i t h v a r i o u sb a c t e r i aal n t i g e n si,n c l u d i n gm y c o bacterialand streptococcalcell wall proteins.However, s u c hd i s e a s e sb e a rl i t t l er e s e m b l a n cteo h u m a nr h e u m a toidarthritis.
earlierin the chapter,T cellsmay play an indirectrole in B by activatingself-reactive diseases antibody-mediated O2L-66950639 lymphocytes.RoshanKetab Diseases Caused hy Cytotoxic T Lymphocytes CTLresponsesto uiral infection can leq'dto tissueiniury by killing infected.cells,euen if the uirus itself has no cytopathiceffects.The principal physiologicfunction of CTLs is to eliminate intracellularmicrobes,primarily viruses,by killing infected cells.Somevirusesdirectly injure infected cells and are said to be cytopathic, whereasothers are not. BecauseCTLs cannot distinguish a priori between c)'topathicand noncytopathic
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viruses, they kill virally infected cells regardless of whether the infection itself is harmful to the host. Examples of viral infections in which the lesions are due to the host CTL response and not the virus itself include llmphocytic choriomeningitis in mice and certain forms of viral hepatitis in humans (seeChapter 15). Few examples of autoimmune diseases mediated only by CTLs have been documented. Myocarditis with infiltration of the heart by CD8. T cells develops in mice, and sometimes in humans, infected with coxsackievirus B. The infected animals contain virus-speciflc, class I MHC-restricted CTLs as well as CTLs that kill uninfected myocardial cells. It is postulated that the heart lesions are initiated by the virus infection and virus-specific CTLs, and myocardial injury leads to the exposure or alteration of self antigens and the subsequent development of autoreactive CTLs. CTLs may also contribute to tissue injury in disorders that are caused primarily by CD4. T cells, such as type I diabetes.
PRIHocrruEsts oFAurorrumurury The possibility that an individual's immune system may react against autologous antigens and cause tissue injury was appreciated by immunologists from the time that the specificity of the immune system for foreign antigens was recognized. In the early 1900s,Paul Ehrlich coined the rather melodramatic phrase "horror autotoxicus" for harmful ("toxic") immune reactions against self.\A/henMacfarlane Burnet proposed the clonal selection hypothesis about 50 years later, he added the corollary that clones of autoreactive lymphocytes were deleted during development to prevent autoimmune reactions.We now know that the key events in the development of autoimmunity are the recognition of self antigens by autoreactive lymphocltes, the activation of these cells to proliferate and differentiate into effector cells, and the tissue injury caused by the effector cells and their products. How self-tolerance fails and selfreactive lymphocytes are activated are the fundamental issues in autoimmunity and likely to be the basis for understanding the pathogenesis of these diseases. Autoimmunity is an important cause of disease in humans and is estimated to affect 2% to 5Toof the U.S. population. The term autoimmunl4r is often erroneously used for any diseasein which immune reactions accompany tissue injury, even though it may be difflcult or impossible to establish a role for immune responses to self antigens in causing these disorders. Our understanding of autoimmunity has improved greatly during the past two decades, mainly because of the development of a variety of animal models of these diseases and the identification of genes that may predispose to autoimmunity. Nevertheless, the etiology of most human autoimmune diseases remains obscure, and understanding these disorders is a major challenge in immunology. Several important general concepts have emerged from analyses of autoimmunity.
@ Autoimmunity resultsfrom afailure or breakdown of the mechanisms normally responsible for maintaining self-tolerance in B cells,T celk, or both. The potential for autoimmunity exists in all individuals because during their development, lymphocytes may express receptors specific for self antigens, and many self antigens are readily accessibleto the immune system. As discussed in Chapter 11, tolerance to self antigens is normally maintained by selection processes that prevent the maturation of some self antigen-specific lyrnphocltes and by mechanisms that inactivate or delete self-reactivelymphocytes that do mature. Loss of self-tolerance may result from abnormal selection or regulation of self-reactive llrnphocytes and by abnormalities in the way that self antigens are presented to the immune system. Much recent attention has focused on the role of T cells in autoimmunity, for two main reasons. First, helper T cells are the key regulators of all immune responses to proteins. Second, several autoimmune diseasesare genetically linked to the MHC (the HIA complex in humans), and the function of MHC molecules is to present peptide antigens to T cells.Therefore, it is believed that failure of T cell tolerance is an important mechanism of autoimmune diseases. Failure of self-tolerance in T lymphocytes may result in autoimmune diseases in which the lesions are caused by cell-mediated immune reactions. Helper T cell abnormalities may also lead to autoantibody production because helper T cells are necessary for the production of high-affinity antibodies against protein antigens. @ The majorfactors that contribute to the deuelopment of autoimmunity are genetic susceptibility and enuironmental triggers, such as infections. Susceptibility genes and infections both contribute to the breakdor,r,rrof self-tolerance, and infections in tissues promote the influx of autoreactive lymphocytes and activation of these cells, resulting in tissue injury (Fig. 18-6). Infections and tissue injury may also alter the way in which self antigens are displayed to the immune system, leading to failure of self-tolerance. The roles of these factors in the development of autoimmunity are discussed later. @ Autoimmune diseases may be either systemic or organ specific. For instance, the formation of circuIating immune complexes composed of self antigens and specific antibodies typically produces systemic diseases,such as SLE. In contrast, autoantibody or T cell responses against self antigens with restricted tissue distribution lead to organ-specific diseases, such as myasthenia gravis,TlD, and MS. @ Various effictor mechanisms are responsible for tissue injury in dffirent autoimmune diseases.These mechanisms include immune complexes, circulating autoantibodies, and autoreactive T lymphocltes and are discussed earlier in the chapter. o Autoimmune reactions initiated against one self antigen that injure tissues may result in the release
Chapter 18-
ANDAUT0IMMUNITYi RESP0NSES: HYPERSENSITIVITY DISEASES BYIMMUNE CAUSED
Geneticsusceptibility
inflammation lnfection.
Tissue t^
Failure of self-tolerance
Tissueinjury: disease autoimmune autoimmunedisease, FIGURE 18-6 Postulatedmechanismsof autoimmunity. T cell-mediated In this proposedmodelof an organ-specific Environmental trigvariousgenetlcloci may confersusceptibility of self-tolerance the maintenance to autoimmunity, in part by rnfluencing gers,such as infectionsand other inflammatory stimuli,promotethe rnfluxof lymphocytesinto tissuesand the activationof self-reactive T c e l l s ,r e s u l t i n iqn t i s s u ei n i u r v
and alterations of other tissue antigens, activation of Iymphocltes specific for these other antigens, and exacerbation of the disease. This phenomenon is called epitope spreading, and it may explain why once an autoimmune diseasehas developed, it tends to be chronic and often progressive. In the following section, we describe the general principles of the pathogenesisof autoimmune diseases,with an emphasis on susceptibility genes, infections, and other factors that contribute to the develooment of autoimmunity. Genetic Susceptibility
to Autoimmunity
From the earliest studies of autoimmune diseases in patients and experimental animals, it has been appreciated that these diseases have a strong genetic component. For instance, TID (see Box 18-2) shows a concordance of 35Toto 50% in monozygotic twins and 5To to 6To in dizygotic twins. Much more has been learned about the genes involved in autoimmune diseasesby linkage analysesin families, breeding studies in animal models, and genome scanning methods exploiting the large amount of information that has been developed about human and mouse genome sequences. Most autoimmune diseases are polygenic, and affected indiuiduals inherit multiple genetic polymor-
phisms that contribute to diseqse susceptibility, Some of these polymorphisms are associated with several autoimmune diseases, suggesting that the causative genesinfluence general mechanisms of immune regulation and self-tolerance. Other loci are associated with particular diseases, suggesting that they affect endorgan damage (Fig. f 8-7). It is believed that the products of many of these polymorphic genesinfluence the development of self-tolerance, and affected individuals eipress products of the genes that are defective in the maintenance of tolerance. However, most of the susceptibility loci identified to date span large chromosomal segmentsthat have been shornrnto be diseaseassociated by family and linkage studies. These loci may contain tens or hundreds of genes, and the actual diseaseassociated genes or their causal associations with the disease are often not knovr'n.Furthermore, the mechanistic links between suspected genes and failure of selftolerance are not defined. An illustrative example is TlD (see Box l8-2). In both the human disease and the mouse model, the nonobese diabetic (NOD) strain, more than 20 susceptibility loci have been identified; several of these are also susceptibility loci for other autoimmune diseases.The first disease-associatedgene to be identified in TlD, and the only one that is common to both humans and mice, is a class II MHC gene, consistent with the fact that the disease is caused by class Il-restricted CD4' T l).rynphocytes.
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8
12 14 16 18
10
20x
It
rlll
I'
I PDCDl
sLEI rol
AlrDI r1D
FIGURE 18-7 Susceptibilityloci for autoimmunediseases.Thechromosomal lociassociated with someautoimmunediseasesareshown. The locationof candidategenesof immunologic interestare indicatedas ovalson the left of the chromosomesTheseovalsare colorcoded to indicatethe diseasesto whrchthe genesare linked.SLE,systemiclupuserythematosus; AITD,autoimmunethyroiddisease;RA,rheumatoid arthritis;T1D, type 1 diabetes(Modified from YamadaR and K Ymamoto.Recentfindingson genesassociated with inflammatory diseases MutationResearch573:136-1 51, Copyright2005with permissionfrom Elsevier)
Among the genes that are associated with autoimrnunity, the strongest associntions ere with MHC genes, especially classII MHC genes. HIA tlping of large groups of patients with various autoimmune diseases has shown that some HtA alleles occur at higher frequency in these patients than in the general population. From such studies, one can calculate the relative risk for development of a disease in individuals who inherit various HLA alleles (Table I8-5). The strongest such association is between ankylosing spondylitis, an inflammatory presumably autoimmune, disease of vertebral joints, and the class I HLA allele B27. Individuals who areHLA-P.27 positive have a 90- to 100-fold greater chance for developing ankylosing spondylitis than do individuals lacking B27. Neither the mechanism of this diseasenor the basis of its association with HIA-P.?7 is known. The association of classII HLA-DR and HIA-DQ alleleswith autoimmune diseases has received great attention, mainly because class II MHC molecules are involved in the selection and activation of CD4* T cells, and CD4* T cells regulate both humoral and cell-mediated immune responsesto protein antigens. Several features of the association of HIA alleles with autoimmune diseases are noteworthy. First, an HIAdiseaseassociation maybe identified by serologic ryping of one HLA locus, but the actual association may be with other alleles that are linked to the typed allele and inher-
ited together.For instance,individuals with a particular HI"{-DR allele (hypothetically,DRI) may show a higher probability of inheriting a particular HIA-DQ allele (hlpothetically DQ2) than the probability of inheriting these alleles separatelyand randomly (i.e., at equilibrium) in the population. Suchinheritanceis an example of linkagedisequilibrium.A diseasemay be found to be DRI associatedby HLA tFping,but the causalassociation may actuallybe with the co-inheritedDQ2. This realization has emphasized the concept of "extended HLA haplotypes,"which refers to sets of linked genes, both classicalHIA and adjacentnon-HlA genes,that tend to be inheritedtogetherasa singleunit. Second,in many autoimmune diseases,the disease-associated HLA moleculesdiffer from H[,A moleculesthat are not diseaseassociatedin their peptide-bindingclefts.This flnding is not surprisingbecausepolymorphicresidues of MHC moleculesarelocatedwithin and adjacentto the clefts,and the structure of the clefts is the key determinant of both functions of MHC molecules, namely, antigen presentationand recognition by T cells (see Chapters5 and 6). Theseresults support the general concept that MHC molecules influence the development of autoimmunity by controlling T cell selection and activation. Third, disease-associatedHI"C, sequencesare found in healthy individuals.In fact, if all individualsbearinga particulardisease-associated HLA
Chapter l8 -
ANDAUTOIMMUNITY HYPERSENSITIVITY DISEASES RESPONSES: CAUSED BYIMMUNE tl
allele are monitored prospectively, most will never acquire the disease.Therefore, expressionofa particular HLA gene is not by itself the cause of any autoimmune disease,but it may be one of several factors that contribute to autoimmunity. The mechanisms underlying the association of particular HLA alleles with various autoimmune diseases are still not clear.The disease-associatedMHC molecule may present a particular self peptide and activate pathogenic T cells, or it may influence negative selection of developing T cells. Studies with knockout mice and patients haue identified seueral non-MHC genes that influence the maintenance of tolerance to self antigens. Many of these genes were mentioned in Chapter 11, when we discussed the molecular pathways of self-tolerance. The known mutations that predisposeto autoimmunity have provided valuable information about the importance of various mechanisms of self-tolerance (Table 18-6). Knockout of the gene encoding CT[-A-4, the inhibitory T cell receptor for 87 molecules,resultsin fatal autoimmunity with T cell infiltrates and tissue destruction involving the heart, pancreas,and other organs. Blocking CTt-{-4 with specific antibodies also greatly exacerbatesthe severityof autoimmune tissue injury in mouse models of encephalomyelitis and diabetes.BecauseCTt"{-4 may function normally to induce and maintain T cell anergyto self antigens, eliminating this function leads to autoimmunity. A poly.rnorphismof CTLA4has been sholtn to be associated with autoimmune thy'roid diseaseand TlD. This polymorphism affects production of a splice variant of the protein that is believedto inhibit T cell activation.
Table 18-5. Examplesof HLA-L|nked l m m u n o l o g i c aD l iseases
Disease
IHLAallelelRelativerisk*
Rheumatoid afthritisDR4 Insulin-dependent DR3 diabetesmellitus DR4
4
5 5-6 DR3/DR4 25 heterozygote DR2 4
Multiple sclerosis Systemiclupus DR2iDR3 erythematosus Pemphigus DR4 vulgaris Ankylosing spondylitis
827
14
90-100
.Relativerisk is definedas the probability of development of a diseasein individuals with a oarticularHLA alleleversus individualslackingthat HLA allele The numbersgivenare approximations.
Mutations in the autoimmune regulator (NRE) gene in humans and mice result in the autoimmune polyendocrine slmdrome (APS),characterizedby destruction of severalendocrine organs.NRE is required for expressionor presentationof tissue-specificproteins in thymic epithelialcells,and hencefor deletion (negativeselection)ofT cellsthat recognizetheseselfproteins (seeChapterI l). Mutations in the gene encoding the transcription factor FoxP3cause deficienciesof regulatoryT cells and systemic autoimmunity. The human disease associated with these mutations is called IPEX (immune dysregulation, polyendocrinopathy, enteropathy,X-linked), and the mouse strain that develops systemic autoimmunity because of mutations in FoxP3 is called the scurfr mouse. FoxP3is required for the developmentof regulatoryT cells. :' Mice lacking interleukin-2 (IL-2) or the cxor B chain of the IL-2 receptor develop splenomegaly,lymphadenopathy, autoimmune hemolytic anemia, antiDNA autoantibodies, and IBD. These mice are deficientin CD4*CD25*regulatoryT cells,which need IL-2 for their survival and function. r Geneticdeficienciesof severalcomplement proteins, including CIq,C2, and C4 (seeChapter 14,Boxl4-2), are associatedwith lupus-like autoimmune diseases. The postulatedmechanism of this associationis that complement activation promotes the clearance of circulating immune complexes and apoptotic cell bodies, and in the absenceof complement proteins, these complexes accumulate in the blood and are deposited in tissues and the antigens of dead cells persist. , As mentioned above, mutations in the intracellular microbial sensor NOD2 are associatedwith Crohn's disease,and mice in which the NOD2 gene is knocked out develop IBD. It is not clear if these mutations reduce host defense against microbes and allow infectionsto become chronic and elicit inflammatory reactions,or if the mutations lead to excessivehost reactionsto intestinal microbes. , Severalautoimmune diseases(RA,TlD, autoimmune thyroid disease)are associatedwith particular variants of the protein tynosine phosphatase PTPN22, especiallyin white populations. BecauseRA is the most prevalent autoimmune disease, PTPN22 is the most common autoimmunity-associatedgene. One explanation for this association is that the variants have reduced function, disease-associated and decreasedphosphatase activity allows uncontrolled lyrnphocyte stimulation by self antigens. However, some of the variants are thought to be gain of function, and could promote autoimmunity by altering selectionof self-reactivelyrnphocytesduring maturation. , Mice carrying homozygous mutations of the fas or fas ligand gene provided the first clear evidence that failure of apoptotic cell death results in autoimmunity (seeBox lB-1). These mice die by the age of 6
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Table18-6. Examplesof Gene Mutationsthat Resultin Autoimmunity
Gene
Phenotypeof mutant Mechanismof or knockoutmouse failureof tolerance
AI R E
Destruction of endocrine organsby antibodies, lymphocytes
Failureof centraltolerance Autoimmune polyendocrine (APS) syndrome
c4
SLE
Defectiveclearanceof SLE immune complexes; failureof B celltolerance? Failureof anergyin CTLA-4polymorphisms CD4+T cells withseveral associated autoimmune diseases
CTLA-4 Lymphoproliferation;
T cellinfiftrates in multiple organs,especially heart; lethalby 3-4weeks
Fas/FasLAnti-DNAandother
Humandisease?
Defectivedeletionof anergic Autoimmune
self-reactive B cells;reduced autoantibodies; immune deletionof matureCD4+ complexnephritis; arthritis; lymphoprolif eration T c e l l s lymphocytic Deficiencyof regulatory FoxP3 Multi-organ infiltrates, wasting T cells Inflammatory bowel Defectivedevelopment, tL-2; anti-erythrocyte survivalor functionof lL-2Ro/p disease; andanti-DNA autoantibodies regulatoryT cells
lymphoproliferative (ALPS) syndrome IPEX None known
SH P - 1 Multioleautoantibodies
Failureof negative regulationNoneknown of B cells
PTPN22 lncreasedlymphocyte
Reducedinhibitionby tyrosinephosphatase?
proliferation, antibody production
PTPN22polymorphisms areassociated withseveral autoimmune diseases
Abbreviationsr gene;lL-2,interleukin-2; AIRE,autoimmune regulator IPEX,immunedysregulation, polyendocrinopathy, enteropathy, X-linked phosphatase-1. syndrome; SHP-1,SH2-containing
months of a systemicautoimmune diseasewith multiple autoantibodies and nephritis. The lpr/lpr (for "lymphoproliferation") mouse strain produces low levelsofFas protein, and the gld/gld (for "generalized Iymphoproliferative disease") strain produces Fas Iigand with a point mutation that interfereswith its signaling function. A principal cause of autoimmunity is believedto be accumulation of autoreactiveB cells,becausetheseB cellsarenormally eliminatedby Fas-dependentdeath resultingfrom interactionswith T cells,and this pathway of B cell deletion is defective in lpr and gld mice. In addition, defectsin Fasor Fas ligand may result in an inability to delete mature CD4t T cells by activation-inducedcell death. Children with a phenotypicallysimilar diseasehave been identified and shornrnto carry mutations in the gene encoding Fas or in genes encoding proteins in the Fas-mediateddeath pathway that result in a failure of activation-inducedcell death.Thesediseasesare the only ones knor,r,'n in which genetic abnormalities in one apoptosis-inducingligand-receptorpair lead to phenotypicallycomplex autoimmune diseases. Role of Infections
in Autoimmunity
Viral and bacterial infections may contribute to the deuelopment and exacerbation of autoimmunity. ln patients, the onset of autoimmune diseases is often
associatedwith or preceded by infections, and in several animal models, autoimmune tissue injury is reduced when the animals are free of infections. (One notable and unexplained exception is the NOD mouse, in which infections tend to ameliorate insulitis and diabetes.) In most of these cases,the infectious microorganism is not present in lesions and is not even detectable in the individual when autoimmunity develops. Therefore, the lesions of autoimmunity are not due to the infectious agent itself but result from host immune responsesthat may be triggered or dysregulated by the microbe. Infections may promote the development of autoimmunity by two principal mechanisms (Fig. 18-8). @ Infections of particular tissues may induce local innate immune responsesthat recruit leukocytes into the tissues and result in the activation of tissue APCs. These APCs express costimulators and secrete T cell-activating cytokines, resulting in the breakdor.vn of T cell tolerance. Thus, the infection results in the activation of T cells that are not specific for the infectious pathogen; this type of response is called bystander activation. The importance of aberrant expression of costimulators has been demonstrated by several types of experiments. ExperimentalT cell-mediatedautoimmune diseases, such as encephalomyelitis(see Box lB-3) and thyroiditis, developonly if the self antigens (myelin pro-
ANDAUTOIMMUNITY HYPERSENSITIVITY RESP0NSES: Chapter18- DISEASES BYIMMUNE CAUSED
Self
Self-tolerance
antigen
@Microbe
APCexpresses costimulatory Selfreactive molecules iI cell
FtcuRE 18-g Role ol infections in the developmentof autoimmunity. A Normally,encounteTof a mature T cell with a self antigen self-reactive oresentedbv a costimulator-deficient restingtissue antigen-presenting cell (APC)resultsin peripheral toleranceby anergy (Other possiblemechanisms of self-toleranceare not shown) B Microbesmay activatethe APCs to express costrmulators, and when theseAPCspresentself antigens,the T cellsareactivatedrather self-reactive thanrenderedtolerantC Somemicrobialantigensmay cross-react with self antigens(molecularmimicry).Therefore, immune responsesinitiatedby the microbesmay activateT cellsspecificfor self antigens
o-
87 CD28 of Presentation antigenbyAPC
Self-.tissue
Autoimmunity
-!il- rli^'^Lo ---
x3'-": v
Activation of T cells Self
antigen
teins and th1'roglobulin, respectively) are administered with strong adjuvants. Such adjuvants may function like infectious agents to activate tissue dendritic cells and macrophages,leading to the expression of the costimulators 87-1 and B7-2, the breakdornmof T cell anergy, and the development of effector T cells reactive with the self antigen. More formal demonstration of autoimmune tissue injury resulting from the abnormal expressionof costimulators and breakdor,rmof T cell anergy has come from transgenicmouse models of type I diabetes(see Box l8-2). Variousgenescan be expressedselectively in pancreatic islet B cells as transgenesunder the control of insulin promoters.If a foreign antigensuch as a viral protein is expressedas a transgenein islet B cells,this antigen effectivelybecomes"self" and does not elicit an autoimmune reaction (seeChapter 11, Fig. 11-5).However,coexpressionof the viral antigen and 87-1 breaks peripheral tolerance in viral antigen-specific T cells, triggers a response to the antigen in the islets, and results in insulitis and diabetes. In this model, transgene-encodedexpression of the costimulator is equivalent to converting resting tissue APCs to activated APCs, much like what happens in infections. @ Infectious microbes may contain antigens that crossreact with self antigens, so immune responsesto the microbes may result in reactions against self antigens. This phenomenon is called molecular mimicry because the antigens of the microbe cross-reactwith, or mimic, self antigens.
that recognizes microbialpeptide
tissue
Autoimmunity
r ir One example of an immunologic cross-reaction between microbial and self antigens is rheumatic fever, which develops after streptococcal infections and is caused by antistreptococcalantibodies that cross-reactwith myocardialproteins.Theseantibodies are depositedin the heart and causemyocarditis. Molecular sequencinghas revealednumerous short stretchesof homologiesbetweenmyocardialproteins and streptococcalprotein. o Microbes may engage Toll-like receptors ITLRs) on dendritic cells, Ieading to the production of lymphocyte-activating cytokines, or on autoreactive B cells, leading to autoantibody production. A role of TLR signaling in autoimmunity has been demonstrated in mouse models of SLE,but its significance in human autoimmune diseases is unclear. The significance of limited homologies between microbial and self antigens remains to be established, and it has been difficult to prove that a microbial protein can actually cause a disease that resembles a spontaneous autoimmune disease.On the basis of transgenic mouse models, it has been suggested that molecular mimicry is involved in triggering autoimmunity when the frequency of autoreactive lymphocytes is low; in this situation, the microbial mimic of the self antigen serves to expand the number of self-reactive lymphocytes above some pathogenic threshold. lVhen the frequency of self-reactive lymphocytes is high, the role of microbes may be to induce tissue inflammation, to recruit selfreactive lymphocltes into the tissue, and to provide
4:t8
i
Section V- IMMUNITY tNDEFENSE ANDDTSEASE
,...-*""J**-*. second signals for the activation of these bystander ll.rnphocltes. Some infections may protect against the deuelopment of autoimmunity. Epidemiologic studies suggest that reducing infections increasesthe incidence of TID and MS, and experimental studies show that the disease of NOD mice (the mouse model of tvne I diabetes) is greatly retarded if the mice are infecied. It seems paradoxical that infections can be triggers of autoimmunity and also inhibit autoimmune diseases.How thev mav reduce the incidence of autoimmune diseaies ii unkno'ntm. Other Factors
in Autoimmunity
The development of autoimmunity is related to several factors in addition to susceptibility genes and infections. Anatomic alterations in tksues, caused by inflammation (possibly secondary to infections), ischemic injury, or tr&uma, may lead to the exposure of self antigens that are normally concealedfrom the immune system. Such sequestered antigens may not have induced selftolerance. Therefore, if previously hidden self antigens are released,they can interact with immunocompetent lymphocytes and induce specific immune responses. Examples of anatomically sequesteredantigens include intraocular proteins and sperm. Posttraumatic uveitis and orchitis are thought to be due to autoimmune responses to self antigens that are released from their normal locations by trauma. Hormonal influences play a role in some autoimmune diseases. Many autoimmune diseases have a higher incidence in females than in males. For instance, SLE affects women about 10 times more frequently than men. The SLE-like disease of (NZB x NZW)F, mice develops only in females and is retarded by androgen treatment. \Mhether this predominance results from the influence of sex hormones or other gender-related factors is not knor,rm. Autoimmune diseasesare among the most challenging scientific and clinical problems in immunology. The current knowledge of pathogenetic mechanisms remains incomplete, so theories and hypotheses continue to outnumber facts. The application of new technical advances and the rapidly improving understanding of self-tolerance will, it is hoped, lead to clearer and more definitive answers to the enigmas of autoimmunity.
THrnRprunc AppRoAcHES FoR Iwtwtutrto tocIc DISEASES Strategiesfor treatment of immune-mediated diseases are similar to the approaches used to prevent graft rejection, another form of injurious immune response (see Chapter l6). The mainstay of therapy for hlpersensitivity diseasesis anti-inflammatory drugs, particularly corticosteroids. Such drugs are targeted at reducing tissue injury, speciflcally,the effector phases of the pathologic immune responses.Biologic agents that inhibit immune
responses and inflammation have become important treatment options for many immune-mediated inflammatory diseases. Many of these newer therapies are based on our improving understanding of immune response, and are remarkable examples of rational drug design.A soluble form of theTNF receptor and anti-TNF antibodies that bind to and neutralize TNF are of great benefit in many patients with rheumatoid arthritis and Crohn's disease.Antagonists of other proinflammatory cltokines, such as IL-1, and agents that block leukocyte emigration into tissues,such as antibodies against integrins, are also being tested for their anti-inflammatory effects.Agents that block 87 costimulators are approved for treatment of rheumatoid arthritis and psoriasis. These antagonists are now in clinical trials for SLE,psoriasis, and other diseases.Depletion of B cells with antiCD20 antibody is being tested in rheumatoid arthritis and other diseases.In severecases,immunosuppressive drugs such as cyclosporine are used to blockT cell activation, or anti-proliferative drugs such as methotrexate are used to reduce the generation and expansion of lymphocytes. Plasmapheresis has been used during exacerbations of antibody-mediated diseasesto reduce circulating levels of antibodies or immune complexes. Large doses ofintravenous IgG have beneficial effects in some hypersensitivity diseases.It is not clear how this agent suppressesimmune inflammation; one possibility is that the IgG binds to inhibitory Fc receptors on B lymphocytes and shuts off antibody production, similar to the phenomenon of antibody feedback (seeChapter 10, Fig. 10-19). There are ongoing attempts at more specific treatment, such as inducing tolerance in disease-producing lymphocyte clones, or inducing regulatoryT cells specific for self antigens.
SUMMARY Q Disorders caused by abnormal immune responses are called hypersensitivity diseases. Pathologic immune responses may be autoimmune responsesdirected against selfantigens or uncontrolled and excessiveresponses to foreign antigens. @ Hypersensitivity diseasesmay result from antibodies that bind to cells or tissues,circulating immune complexes that are deposited in tissues, or T lymphocltes reactive with antigens in tissues. I
The effector mechanisms of antibody-mediated tissue injury are complement activation and Fc receptor-mediated inflammation. Some antibodies cause disease by interfering with normal cellular functions without producing tissue injury. The effector mechanisms of T cell-mediated tissue injury are DTH reactions and cell lysis by CTLs.
o Autoimmunity results from a failure of selftolerance.Autoimmune reactions may be triggered
I
439 HYPERSENSITIVITY ANDAUTOIMMUNITY Chapter 18- DISEASES BYIMMUNE RESP0NSES: CAUSED i * . } . . : . ' r ,
by environmental stimuli, such as infections, in geneticallysusceptibleindividuals. O Most autoimmune diseasesare polygenic, and numerous susceptibility genes contribute to diseasedevelopment.The greatestcontributionis from MHC genes;other genes are believed to influence the selection of self-reactivelymphocltes and the developmentof self-tolerance. 6 Infections may predisposeto autoimmunity by severalmechanisms,including enhancedexpressionof costimulatorsin tissuesand cross-reactions betweenmicrobial antigensand self antigens. o The current treatment of autoimmune diseasesis targeted at reducing immune activation and the injurious consequences of the autoimmunereaction. A future goal of therapy is to inhibit the responsesof lymphocytesspecificfor self antigens and to inducetolerancein thesecells.
Selected Readings Bach J-F, Infections and autoimmune diseases. Iournal of Autoimmunity 25 suppl l:7 4-BO,2005. Crow MK, and KA Kirou. Interferon-alpha in systemic lupus erythematosus. Current Opinion in Rheumatology t6: 54I-547,2004. Davidson A, and B Diamond. Autoimmune diseases. New England Iournal of Medicine 345:340-350,2001. Deng L, and RA Maritzza. Recognition of self-peptide-MHC complexes by autoimmune T-cell receptors. Trends in Biochemical Sciences32:500-508,2007. Eckmann L, and M Karin. NOD2 and Crohn's disease:loss or gain of function? Immunity 22:661-667,2005. Fernando MM, et al. Defining the role of the MHC in autoimmunity: a review and pooled analysis. PLoS Genetics 4:e1000024, 2008. Fourneau IM, IM Bach, PM van Endert, and IF Bach. The elusive case for a role of mimicry in autoimmune diseases. Molecular Immunology 40:1095-1102,2004. Frohman EM, MK Racke,and CS Raine. Multiple sclerosis-the plague and its pathogenesis.New EnglandJournal of Medicine 354:942-955,2006. Goodnow CC, I Sprent, BF de St Groth, and CGVinuesa. Cellular and genetic mechanisms of self tolerance and autoimmunity. Nature 435:590-597,2005.
* a i @ * ; ' * ' i ,
Gregersen PK. Gaining insight into PTPN22 and autoimmunity. Nature Genetics 37:1300-1302,2005. Hill NL C King, and M Flodstrom-Tullberg. Recent acquisitions on the genetic basis of autoimmune disease.Frontiers in Bioscience l3:4838-4851, 2008. Kuchroo \K, AC Anderson, H Waldner, E Bettelli, and LB Nicholson. T cell response in experimental autoimmune encephalomyelitis (EAE): role of self and cross-reactive antigens in shaping, tuning, and regulating the autopathogenic T cell repertoire. Annual Review of Immunology 20:10I-123, 2002. Marrack B I Kappler, and BL Kotzin. Autoimmune disease: why and where it occurs. Nature Medicine 7:899-905, 2001. Marshak-Rothstein A. Toll-like receptors in systemic autoimmune disease.Nature ReviewsImmunology 6:823-835,2006. Melanitou E, P Fain, and GS Eisenbarth. Genetics of type lA (immune mediated) diabetes. Journal of Autoimmunity 2l:93-98, 2003. Nicholson MJ, M Hahn, and KWWucherpfennig. Unusual features of self-peptide/MHC binding by autoimmune T cell repertoires. Immunity 23:351-360,2005. O'Shea IJ, A Ma, and P Lipsky. Cytokines and autoimmunity. Nature Reviews Immunology 2:37-45, 2002. Plotz PH. The autoantibody repertoire: searching for order. Nature Reviews Immunology 3:73-78, 2003. Riorx JD, and AK Abbas. Paths to understanding the genetic basis of autoimmune disease.Nature 435:584-589,2005. Rose NR, and C Bona. Defining criteria for autoimmune diseases (Witebsky's postulates revisited). Immunology Today 14:426-430, 1993. Shlomchik MJ. Sites and stages of autoreactive B cell activation and regulation. Immunity 2B:IB-28, 2008. Todd JA, and LS Wicker. Genetic protection from the inflammatory disease tlpe I diabetes in humans and animal models. Immunity 15:387-395,2001. Vanderlugt CL, and SD Miller. Epitope spreading in immunemediated diseases: implications for immunotherapy. Nature Reviews Immunology 2:85-95, 2002. von Herrath MG, RSFujinami, andJl\Mhitton. Microorganisms and autoimmunity: making the barren field fertile? Nature ReviewsMicrobiology l: 151-157,2003. Wakeland EW K Liu, RR Graham, and TW Behrens. Delineating the genetic basis of systemic lupus erythematosus. Immuniry 15:397-408,2001. Xavier RL and ID Rioux. Genome-wide association studies: a new window into immune-mediated diseases. Nature Reviews Immunology 8:631-643, 2008. Yamada R, and K Ymamoto. Recent flndings on genes associated with inflammatory diseases. Mutation Research 573:136-151,2005.
1.
General Features of lmmediate Hypersensitivity Reactions, 442 Production of lgE,443 The Natureof Allergens,443 Activationof T,Q Cells,443 Activationof B Cellsand Switchingto lgE,444 Binding of lgE to Mast Cells and Basophils,444 Role of Mast Cells, Basophils, and Eosinophils in lmmediate Hypersensitivity, 445 Properties 445 of Mast Cellsand Basophils, Activationof Mast Cells,447 MediatorsDerivedfrom Mast Cells,450 Properties 453 of Eosinophils, Reactions of lmmediate Hypersensitivity, 453 The lmmediateReaction, 453 The Late-Phase Reaction,454 Genetic Susceptibility to lmmediate Hypersensitivity, 455 Allergic Diseases in Humans: Pathogenesis and Therapy, 456 456 SystemicAnaphylaxis, BronchialAsthma.457
et
!
l m m e d i a t e H y p e r s e n s i t i v i t yR e a c t i o n si n t h e U pper Respiratory Tract, Gastrointestinal Tract, and Skin, 458 l m m u n o t h e r a p y o f A l l e r g i c D i s e a s e s ,4 5 9 The Protective Roles of lgE- and Mast Cell-Mediated lmmune Reactions, 459 Summary,46O A variety of human diseases are caused by immune responsesto environmental antigens that lead to CD4* T,,2 differentiation and production of immunoglobulin E (IgE) antibodies that are specific for the antigens and bind to Fc receptors on mast cells and basophils.!\rhen these cell-associated IgE antibodies are cross-linked by antigen, the cells are activated to rapidly release a variety of mediators. These mediators collectively cause increased vascular permeability, vasodilation, and bronchial and visceral smooth muscle contraction. This reaction is called immediate hlpersensitivity because it begins rapidly, within minutes of antigen challenge (immediate), and has major pathologic consequences (hypersensitivity). In clinical medicine, these reactions are commonly called allergy or atopy' and the associated diseasesare called allergic or immediate hypersensitivity diseases.These diseases also have a major inflammatory component, which is triggered by cytokines produced by CD4. Ts2 cells and mast cells, as well as by lipid mediators secreted by mast cells. Although atopy originally meant "unusual," we now realize that allergy is the most common disorder of immunity and affects 20% of all individuals in the United States.This chapter focuses on immune reactions mediated byTn2 cells and IgE and mast cells. We begin by summarizing some
441
Section V-
IMMUNITY lN DEFENSE ANDDTSEASE
important general features of immediate hypersensitivity and proceed to describe the production of IgE, the structure and functions of IgE-specific Fc receptors, and the cellular mediators of immediate hypersensitivity, including mast cells, basophils, and eosinophils. We then describe selected clinical slmdromes associated with immediate hypersensitivity and the principles of therapy for these diseases.We conclude with a discussion of the physiologic role of IgE-mediated immune reactions in host defense.
GrrurnRl FrRrunrs oFIMMEDIATE Hyprnsrrustnvtry RrRcnorus All immediate hypersensitivity reactions share common features, although they differ greatly in the types of antigens that elicit these reactions and their clinical and pathologic man ifestations. @ The hallmarks of allergic dkeases are the actiuation of To2 celk and the production of IgE antibod.y. \dhereas healthy individuals either do not respond or have harmless T cell and antibody responses to common environmental antigens, atopic individuals develop strong Tg2 responsesand produce IgE upon exposure to these potentially allergenic substances. o The typical sequence of euents in immediate hypersensitiuity consists of exposure to an antigen, actiuation of Tr2 celk and B cells specific for the antigen, prod,uction of IgE antibody, binding of the antibody to Fc receptors of mast celk, and triggering of the mast celk by re-exposure to the antigen, resulting in the release of medintors ftom the mast celk and the subsequent pathologic reaction (Fig. l9-l). Binding of IgE to mast cells is also called sensitization because IgE-coated mast cells are ready to be activated on antigen encounter (i.e., they are sensitive to the antigen). We describe each of these steps in the following sections. O There is a strong genetic predisposition for the deuelopment of immediate hypersensitiuity. Many susceptibility genes are associated with atopy. These genes are thought to influence different steps in the development and reactions of immediate hlpersensitivity. We will discuss some of the major knor,rmsusceptibility genes and their likely roles later in the chapter. @ The antigens that elicit immediate hypersensitiuity, ako called allergens, are usually common enuironmental proteins and chemicals. Many structurally distinct antigens can be allergenic. It is still not established if allergens share particular chemical features that are the basis for stimulation of Tg2 responsesin genetically susceptible individuals. @ The cytokines produced by Tp2 cells are responsibl.e for many of the features of immediate hypersensitiuify. Thus, immediate hlryersensitivity is the prototypic Ttt2-mediated disorder, in contrast to delayed-type hlpersensitivity, which is the classical Tsl-mediated immune reaction.
Firstexposure to allergen Activationof Tn2 cellsand stimulation of lgEclass switching in B cells
Ts2 cell
Production of lgE
Binding of lgE to FceRlon mastcells
Repeated exposure to allergen
Activationof mastcellr release of mediators
Vasoactive amines, lipidmediators EI 4
$b v
lmmediate Latephase hypersensitivity reaction(2-4 reaction(minutes hoursafter after repeat repeatexposure exposure to allergen) to allergen) introduction of an allergen, whichstimulates Tn2reactions andlgE production lgEsensitizes mastcellsby binding to FceRl, andsubsequent exposure to theallergen activates themastcellsto secrete the mediators thatareresponsible for the pathologic reactions of immediate hypersensitivity @ The clinical and pathologic manifestations of immediate hypersensitiuity consist of the uascular and smooth muscle reaction that deuelops rapidly afrer repeat exposure to the allergen (the immediate reaction) and a delayed late-phase reaction consisting mainly of inflammation. These reactions may be
C h a p t e1r9-
triggered by lgE-mediated mast cell activation, but different mediators are responsible for different components of the immediate and late-phase reactions. Since mast cells are present in all connective tissues and under all epithelia, these are the most common sites of immediate hlpersensitivity reactions. Some immediate hlpersensitivity reactions may be triggered by nonimmunologic stimuli, such as exercise and exposure to cold. Such stimuli presumably induce mast cell degranulation and the releaseof mediators without antigen exposure or IgE production. Such reactions are said to be nonatopic. @ Immediate hypersensitiuity reactions &re manifested. in dffirent ways, including skin and mucosal allergtes, food allergies, asthma, and systemic anaphylaxis, ln the most extreme systemic form, called anaphylaxis, mast cell-derived mediators can restrict airways to the point of asphlxiation and produce cardiovascular collapse leading to death. (The term anaphylaxis was coined to indicate that antibodies, especiallyIgE antibodies, could confer the opposite of protection [prophylaxis] on an unfortunate individual.) We will return to the pathogenesis of these reactions later in the chapter. With this introduction, we proceed to a description of the steps in the development and reactions of immediate hlpersensitivity.
PRooucnoN oFlcE IgE antibody k responsible for sensitizing mast cells and prouides recognition of antigen for immediate hypersensitiuity reactions. IgE is the antibody isotype that contains the e heary chain (seeChapter 4), and of all the Ig isotypes, IgE is the most efficient at binding to Fc receptors on mast cells and activating these cells.We will describe the experimental evidence demonstrating the essential role of IgE in immediate hypersensitivity later in the chapter. Atopic indiuiduals produce high lnuek of IgE in response to enuironmental allergens, whereas normal indivi.d.uals generally synthesize other Ig isotypes, such as IgM and IgG,and only small amounts of IgE. Regulation of IgE synthesis depends on the propensiry of an individual to mount a Ts2 responseto allergensbecause Ts2 cell-derived cytokines stimulate heavy chain isotype switching to the IgE class in B cells. This propensity toward Ts2 responses against particular antigens may be influenced by a variety of factors, including inherited genes, the nature of the antigens, and the history of antigen exposure.
HE Y P E R S E N S I T I V I T Y4 4 3 IMMEDIAT
antigens induce strong Ts2 responsesand allergic reactions whereas others do not. TWoimportant characteristics of allergens are that individuals are exposed to them repeatedly and, unlike microbes, they do not stimulate the innate immune responses that would promote macrophage activation and secretion of the Tslinducing cytokines interleukin-lz (IL-12) and IL-18. Chronic or repeated T cell activation in the absence of innate immunity may drive CD4* T cells toward the Ts2 pathway, as the T cells themselves make IL-4, the major Ts2-inducing cytokine (seeChapter 13). The property of being allergenic may also reside in the chemical nature of the antigen itself. Although no structural characteristics of proteins can definitively predict whether they will be allergenic, some features are typical of many common allergens. These features include low molecular weight, glycosylation, and high solubility in body fluids. Anaphylactic responses to foods typically involve highly glycosylated small proteins. These structural features probably protect the antigens from denaturation and degradation in the gastrointestinal tract and allow them to be absorbed intact. Curiously, many allergens, such as the cysteine protease of the house dust mite Dermatophagoides pteronyssinus and phospholipase & in bee venom, are enzymes, but the importance of the enzymatic activity in triSgering immediate hypersensitivity reactions is not knor,rm. Because immediate hypersensitivity reactions are dependent on T cells, T cell-independent antigens such as polysaccharides cannot elicit such reactions unless they become attached to proteins. Some drugs such as penicillin often do elicit strong IgE responses. These drugs react chemically with amino acid residues in self proteins to form hapten-carrier conjugates,which stimulate Ts2 responsesand IgE production. The natural history of antigen exposure is an important determinant of the amount of specific IgE antibodies produced. Repeated exposure to a particular antigen is necessary for development of an allergic reaction to that antigen because switching to the IgE isotype and sensitization of mast cells with IgE must happen before a hypersensitivity reaction to an antigen can occur. IndMduals with allergic rhinitis or asthma often benefit from a geographic change of residence with a change in indigenous plant pollens, although environmental antigens in the new residence may trigger an eventual return of the symptoms. The most dramatic examples of the importance of repeated exposure to antigen in allergic disease are seen in casesof bee stings. The proteins in the insect venoms are not usually of concern on the first encounter because an atopic individual has no preexisting specific IgE antibodies. Howeve! an IgE response may occur after a single encounter with antigen, and a second sting by an insect of the same species may induce fatal anaphylaxis!
The Nature of Allergens Antigens that elicit immedinte hypersensitiuity reactions (allergens) are proteins or chemicak bound to proteins to which the atopic indiuidual k chronically exposed..Typical allergens include proteins in pollen, house dust mites, animal dander, foods, and chemicals like the antibiotic penicillin. It is not knor,rryrwhy some
Activation
of TH2 Gells
IgE synthesk k dependent on the activatinn of CD4' helper T cells of the Tu2 subset and. their secretion of IL4 and IL-13.lt is likely that dendritic cells in epithelia through which allergens enter capture the antigens, transport them to draining ly-ph nodes, process them,
444
[
Section V-
IMMUNITY lN DEFENSE ANDDTSEASE
c
and present peptides to naive T cells.The T cells then differentiate into the Tn2 subset of effector cells. Differentiated Tg2 cells promote switching to IgE mainly through the secretion of IL-4 and IL-13. Ts2 cells are involved in other components of the immediate hypersensitivity reaction in addition to promoting switching to IgE. IL-5 secretedbyT;,2 cells activateseosinophils, a cell type that is abundant in many immediate hypersensitivity reactions. IL-13 stimulates epithelial cells (e.g., in the airways) to secrete increased amounts of mucus, and excessivemucus production is also a common feature of these reactions.Consistentwith a central role of Ts2 cells in immediate hlpersensitiviry atopic individuals contain larger numbers of allergen-specificIL-4-secretingT cells in their circulation than do non-atopic persons.In atopic patients, the allergen-specificT cells also produce more IL-4 per cell than in normal individuals. The role of Tn2 cells in allergic reactions is demonstrated by experiments in which mice are made to inhale a model protein antigen, such as chicken egg albumin, and are injected with T cellsspecificfor the antigen. The adoptive transfer of Ts2 cells induces airway hlperresponsiveness,resembling asthma. In the same model, blocking Tn2 responsesreducesthe severityof the allergicreaction. Knockout mice lacking the Ts1 transcription factor T-bet (seeChapter 13) show defectiveTnl responses and a compensatoryincreasein Ts2 responses.Such mice develop spontaneousairway allergicreactions. In addition to stimulating IgE production, Ts2 cells contribute to the inflammation of the late-phasereaction. Accumulations of T"2 cells are found at sites of immediate hypersensitivity reactions in the skin and bronchial mucosa. These T cells are recruited to sites of immediate hlpersensitivity, mainly in response to chemokines. Ts2 cells expressthe chemokine receptors CCR4 and CCR3, and the chemokines that bind to these receptors are produced by many cell types at sites of immediate hypersensitivity reactions, including epithelial cells. Activation Switching
of B Cells and to lgE
B cells specific for allergens are activated byTs2 cells, as in other T cell-dependent B cell responses (seeChapter 10). Under the influence of CD40 ligand and clrokines, mainly IL-4, produced by the TsZ cells, the B cells undergo heavy chain isotype switching and produce IgE. IgE circulates as a bivalent antibody and is normally present in plasma at a concentration of less than I pg/ml-. In pathologic conditions such as helminthic infections and severe atopy, this level can rise to more than 1000pg/ml. Allergen-specific IgE produced by B cells enters the circulation and binds to Fc receptors on tissue mast cells, so that these cells are sensitized and poised to react to a subsequent encounter with the allergen. Circulating basophils are also capable of binding IgE. We will first describe the Fc receptors used by these cell types to bind IgE and then the properties and reactions of the cells.
Brnorrrrc oFlcEro MAST Gnr-s ANDBASOPHITS Mast cells and basophils express a high-affinity Fc receptor specific for e heauy chains, called FceRI that binds IgE,IgE, like all other antibody molecules, is made exclusively by B cells, yet IgE functions as an antigen receptor on the surface of the cells of immediate hlpersensitivity. This function is accomplished by IgE binding to FceRIon these cells.The affinity of FceRIfor IgE is very high (dissociation constant U l of about I x 10-'0M); this binding is much stronger than that of any other Fc receptor for its ligand (see Chapter 14, Box l4-l). Therefore, the normal serum concentration of IgE, although low in comparison to other Ig isotypes (less than 5 x 10 10M),is sufficiently high to allow occupancy of FceRIreceptors.Tissue mast cells in all individuals are normally coated with IgE, which is bound to the FceRI. In atopic individuals, enough of this bound IgE is speciflc for one or a few antigens that exposure to that antigen or antigens is able to cross-link the Fc receptors and activate the cells (discussed later). In addition to mast cells and basophils, FceRI, usually lacking the p chain, has been detected on eosinophils, epidermal Langerhans cells, some dermal macrophages, and activated monocytes; its function on these cells is not known. Each FceRI molecule is composed of one a chain that mediates ligand binding and a p chain and two ychains that are responsible for signaling (Fig. 19-2). The amino-terminal extracellular portion of the cr chain includes two Ig-like domains that form the binding site for IgE. The B chain of FceRI contains a single immunoreceptor tyrosine-based activation motif (ITAM) in the cytoplasmic carboxyl terminus. The two identical y chain polypeptides are linked by a disulfide bond and are homologous to the ( chain of the T cell antigen receptor complex (seeChapter 6). The cytoplasmic portion of each y chain contains one ITAM. The y chain of FceRI serves as the signaling subunit for FcyRI, Fc1RIIIA, and FccrR and is called the FcR y chain (see Chapter 14, Box 14-l). Tyrosine phosphorylation of the ITAMs of the B and ychains initiates the signals from the receptor that are required for mast cell activation. We will return to the nature of these signals when we discuss mast cells later in the chapter. The importance of FceRIin lgE-mediatedimmediate hypersensitivityreactionshas been demonstratedin FceRI q chain knockout mice. \iVhen these mice are given intravenous injections of IgE specific for a known antigen followed by that antigen, anaphylaxis does not develop,whereasit does in wild-type mice treated in the same way. FceRI expression on the surface of mast cells and basophils is up-regulated by IgE, thereby providing a mechanism for the amplification of IgE-mediated reactions. The relationship between the levels of IgE and FceRIexpression is supported by several observations.
'145 HYPERSENSITIVITY 19- IMMEDIATE Chapter i
AnotherIgE receptorcalledFceRI;;;T**
Bound
CD23, is a protein related to C-type mammalian lectins, whose affinity for IgE is much lower than that of FceRI. The biologic roles of FceRII are not knor,rrn.
BRSopHtts, Rou or MnsrCELLS, IN IMMEDIATE ANDEOSINOPHITS
HYprRsrrusrnvtrY
A positive correlation between FceRIexpressionon human blood basophilsand circulatingIgE levelshas been observed.
Mast cells, basophik, and eosinophik are the effictor cells of immediate hypersensitiuity reactions and allergic disease. Although each of these cell types has unique characteristics, all three contain cytoplasmic granules whose contents are the major mediators of allergic reactions, and all three cell types produce lipid mediators and cytokines that induce inflammation. Tg2 cells also function as effector cells of immediate hlpersensitivity; their role has been discussed earlier. In this section of the chapter, we discuss the properties and functions of mast cells, basophils, and eosinophils (Table 19-1). Becausemast cells are the major cell type responsible for immediate hlpersensitivity reactions in tissues, much of our subsequent discussion focuses on mast cells.
Treatment of mast cells in vitro with IgE induces increasedexpressionof FceRI.
Properties
Mast cellsfrom knockout mice lacking IgE have very Iow levels of FceRI.
All mast cells are derived from progenitors in the bone marrow. Normallv mature mast cells are not found in
FIGURE19-2 Polypeptide chainstructureof thehigh-affinity lgE (FceRl). Fcreceptor lgEbindsto the lg-like domains of thecrchain TheBchainandthe"ycharns mediate Theboxes signal transduction. in the cytoplasmic regionof the p andy chainsarelTAMs,similar (seeFig 6-5) A model to thosefoundintheT cellreceptor complex structure of FceRlis shownin Chaoter 14.Box14-1
of Mast Cells and Basophils
T a b l e1 9 - 1 .P r o p e r t i e o s f M a s t C e l l s ,B a s o p h i l sa, n d E o s i n o p h i l s
Characteristic
Mastcells
tissue Majorsiteof maturation Connective Majorcellsin circulation N o
Basophils
Eosinophils
Bonemarrow
Bonemarrow
Yes (0.5%of blood leukocytes)
Yes (-2o/"of blood leukocytes)
Maturecellsrecruited into tissuesfromcirculation Maturecellsresidingin connective tissue Proliferative abilityof maturecells Lifespan
No
Yes
Yes
Yes
No
Yes
Yes
No
No
Weeksto months
Days
Daysto weeks
Majordevelopment factor (cytokine)
Stem cellfactor,lL-3
tL-3
tL-5
Expression of FceRl
High levels
High levels
Lowlevels(functionunclear)
Majorgranulecontents
chondroitinMajorbasicprotein, heparinandi Histamine, Histamine, cationicprotein, eosinophil or chondroitin sulfate, sulfate,protease peroxidases, hydrolases, proleases lysophospholipase
Abbreviations; FceRl,Fcereceptortype l; lL-3,interleukin-3.
u:_,
|
v - IMMUNITY lNDEFENSE ANDDlsEAsE ..,:.:rt'on
the circulation. Progenitors migrate to the peripheral tissues as immature cells and undergo differentiation ln sifiz. Mature mast cells are found throughout the body, predominantly near blood vessels and nerves and beneath epithelia. They are also present in lymphoid organs. Human mast cells vary in shape and have round nuclei, and the cytoplasm contains membrane-bound granules and lipid bodies (Fig. 19-3). The granules contain acidic proteoglycans that bind basic dyes. There are two major subsetsof mast celk that dffir in their anatomic locqtions, granule contents, and actiuities (Table l9-2). In rodents, one subset of mast cells is found in the mucosa of the gastrointestinal tract. These mucosal mast cells have abundant chondroitin sulfate and little histamine in their granules. The development
lgE-coated resting mastcell
of mucosal mast cells in vivo depends on the cytokine IL-3 produced by T cells. Mast cells may be cultured from rodent bone marrow in the presence of IL-3, and such cultured mast cells resemble mucosal mast cells on the basis of the high granule content of chondroitin sulfate and low histamine concentration. The human counterpart of mucosal mast cells is most often identified by the presence of trlptase and the absence of other neutral proteases in the granules. In humans, the mucosal type of mast cells predominate in intestinal mucosa and alveolar spaces in the lung, and their presence is also T cell dependent. A second subset of mast cells, also first identified in rodents, is found in the lung and in the serosa of body cavities, and these cells are called connective tissue mast cells.Their maior
Antigen-activated mastcell
FceRl
esl II H"t" T["/r p'dl lcyb-kh] meotalors I
vv il
il
Vascular/ Inflammation: late phase smooth reaction muscle response: immediate reaction
ot*5\-
FIGURE 19-3 Mast cell activation. Antigen bindingto lgE cross-links FceRlmoleculeson mast cells,which inducesthe releaseof mediatorsthat cause the hypersensitivity reaction(A, B) Other s t i m u l ii,n c l u d i ntgh e c o m p l e m e nf rt a g m e nC t 5 a ,c a n alsoactivatemast cells A lightphotomicrograph of a resting mast cell with abundantpurple-staining granulesis shown in C Thesegranules cytoplasmic arealsoseen in the electronmicrograph of a resting mast cell shown in E In contrast,the depleted granulesof an activatedmast cell are shown in the (D) and electronmicrograph light photomicrograph (F) (Courtesyof Dr DanielFriend,Departmentof P a t h o l o g yB, r i g h a ma n d W o m e n ' s H o s p i t a la n d HarvardMedicalSchool,Boston,Massachusetts )
19Chapter
HYPERSENSITIVITY 447 IMMEDIATE
Table 19-2. Mast Cell Subsets
Mucosalmastcells
T celldependence for development of phenotype in tissues Granulecontents
Majorneutralprotease: Low levels of Majorneutral proteases: tryptase,histamine;high levels tryptase of chondroitin chymase, carboxypeptidase,sulfate G cathepsin
granule proteoglycan is heparin, and they also produce large quantities of histamine. Unlike mucosal mast cells, connective tissue mast cells show little T cell dependence. In humans, the corresponding subset is identified by the presence of several neutral proteases in the granules, including trlptase, ch1'rnase,cathepsin G-like protease, and carboxypeptidase.Human connective tissue mast cells are found in the skin and intestinal submucosa. Although we do not know if these mast cell subsets serve distinct functions, their locations, granule contents, and relative T cell dependence suggest that each subset may be important in a different set of disease processes.It is likely that mucosal mast cells are involved in T cell- and IgE-dependent immediate hypersensitivity diseases involving the airways, such as bronchial asthma, and other mucosal tissues.Conversely,connective tissue mast cells mediate immediate hlpersensitivity reactions in the skin. The phenotype of a mast cell is not fixed and may vary in response to cltokines and growth factors. For example, bone marrow-derived mucosal mast cells can be changed to a connective tissue mast cell phenotype by coculture with fibroblasts or incubation with c-Kit ligand (stem cell factor) (see Chapter 12). Repopulation experiments in mast cell-deficient mice further suggestthat the mucosal and connective tissue phenotlpes are not distinct lineages and that bidirectional changes occur in different microenvironments.
Morphology of basophils and FIGURE r eosinophils. Photomicrographsof a Wrightperipheralblood basophil(A) and Giemsa-stained eosinophil(B)are presentedNote the characteristic red stainingof the cytoplasmicgranulesin the cytoplasmicgranules eoslnophiland blue-staining of the basophil(Courtesvof Dr JonathanHecht, Departmentof Pathology,Brighamand Women's Hospital,Boston,Massachusetts )
Basophils are blood granulocyteswith structural and functional sintilarities to mast celk Like other granulocytes, basophils are derived from bone marrow progenitors (a lineage different from that of mast cells), mature in the bone marrow and circulate in the blood (Fig. 19-4). Basophils constitute less than 1% of blood leukocytes.Although they are normally not present in tissues, basophils may be recruited to some inflammatory sites. Basophils contain granules that bind basic dyes, and they are capable of synthesizing many of the same mediators as mast cells (see Table 19-3). Like mast cells, basophils expressFceRI,bind IgE, and can be triggered by antigen binding to the IgE. Therefore, basophils that are recruited into tissue sites where antigen is present may contribute to immediate hlpersensitivity reactions' Activation
of Mast Gells
Mast celk are actiuated by cross-linking of FceRI molecul.es,which occurs by binding of multivalent antigens to the IgE molecules that are attached to the Fc receptors (see Fig. 19-3). In an individual allergic to a particular antigen, a large proportion of the IgE bound to mast cells is specific for that antigen. Exposure to the antigen will cross-link sufficient IgE molecules to trigger mast cell activation. In contrast, in nonatopic individuals, the mast cell-associated IgE is specific for many different antigens, all of which may have induced low levels of IgE production. Therefore, no single antigen will cross-link
444
S e c t i oVn- I I V I M U Nl INTDYE F E NASNEDD T S E A S E
enough of the IgE molecules to cause mast cell activation. Experimentally, antigen binding can be mimicked by polywalent anti-IgE or by anti-FceRl antibodies. In fact, anti-IgE antibodies can cross-link IgE molecules regardlessof antigen specificity and lead to comparable triggering of mast cells from both atopic and nonatopic individuals. Actiuation of mast celk results in three types of biologic response: secretion of the preformed contents of their granules by a regulated process of exocytosis,synthesis and secretion of lipid mediators, and synthesis and secretion of cytokines. These responses result from the
cross-linking of FceRI,which initiates a signaling cascade in mast cells involving protein tyrosine kinases (Fig. 19-5). The signaling cascade is similar to the proximal signaling events initiated by antigen binding to lymphocltes (seeChapters 9 and l0). The Lyn tyrosine kinase is constitutively associatedwith the cytoplasmic tail of the FceRI B chain. On cross-linking of FceRI molecules by antigen, L1n tyrosine kinase phosphorylates the ITAMs in the cytoplasmic domains of FceRIB and ychains. The Syk ty'rosine kinase is then recruited to the ITAMs of the y chain, becomes activated, and phosphorylates and activates other proteins in the signaling cascade,including
FceRl
DAG
Mastcell plasma memorane
PLCy
Arachidonicacid
Ras/MAPkinases
rl li
ri
Fcpt Frc4l
Myosinlightchain phosphorylation, granulemovemenl
gene Cytokine expressron
SNAREcomolex formation, membrane fusion Cytokine RNA O
Ccytot LTDa..) LTEa
Lipid mediators
''i i' A ^ - ( () )- T N F
plasma memorane Histamine I
Granulecontents
FIGURE 19-s Biochemicaleventsof mast cell activation.Cross-linking of bound lgE by antigenis thoughtto activateproteintyrosine ;s such as myosinlightchainproteinand therebyleadsto the degra_ dationand releaseof preformedmediatorsCalciumand MAP krnasescombineto actrvatethe enzymecytosolicphospholipase Az (cpLAz), which initiatesthe synthesisof lipidmedrators
HYPERSENSITIVITY 19- IMMEDIATE Chapter $ ++e $
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several adapter molecules and enzlmes that participate in the formation of multicomponent signaling complexes, as described in T cells. Linker for activation ofT cells (t"{I) is one of the essential adapter proteins involved in mast cell activation, and one of the enz)rynes recruited to tAI is the l isoform of a phosphatidylinositol-speciflc phospholipase C (PLCT).Once bound to lAI, PLCy is phosphorylated and then catalyzes phosphatidylinositol bisphosphate breakdovrrnto yield inositol triphosphate (IP3) and diacylglycerol (DAG) (see Chapter 9). IP. causes elevation of cltoplasmic calcium Ievels and DAG activates protein kinase C (PKC).Another adapter protein essential for mast cell degranulation is Grb-2-associatedbinder-like protein 2 (Gab2).Phosphorylation of Gab2 by the tyrosine kinase Fyrr leads to binding and activation of phosphoinositide 3 (PI-3) kinase, which also leads to activation of PKC. Phosphorylation of the myosin light chains by activated protein kinase C leads to disassembly of the actin-myosin complexes beneath the plasma membrane, thereby allowing granules to come in contact with the plasma membrane. Fusion of the mast cell granule membrane with the plasma membrane is mediated by members of the SNARE protein family, which are involved in many other membrane fusion events. Different SNARE proteins present on the granule and plasma membranes interact to form a multimeric complex that catalyzes fusion. The formation of SNARE complexes is regulated by several accessorymolecules, including Rab3 guanosine triphosphatases,and Rab-associatedkinases and phosphatases. In resting mast cells, these regulatory molecules inhibit mast cell granule membrane fusion with the plasma membrane. Upon FceRI cross-linking, the resulting increased cytoplasmic calcium concentrations and the activation of PKC block the regulatory functions of the accessory molecules. In addition, calcium-sensor proteins, called s)'naptotagmins, respond to the elevated calcium concentrations by promoting SNARE complex formation and membrane fusion. Synthesis of lipid mediators is controlled by activation of the cytosolic enzyme phospholipase A" (PtA') (see Fig. f 9-5). This enzyrne is activated by two signals: elevated cytoplasmic calcium and phosphorylation catalyzed by a mitogen-activated protein (MAP) kinase such as extracellular receptor-activated kinase (ERK). ERK is activated as a consequence of a kinase cascade initiated through the receptor ITAMs, probably using the same intermediates as in T cells (see Chapter 9). Once activated, PlAr hydrolyzes membrane phospholipids to release substrates that are converted by enzl'rne cascades into the ultimate mediators. The major substrate is arachidonic acid, which is converted by cyclooxygenase or lipoxygenaseinto different mediators (discussed later). C1'tokine production by activated mast cells is a consequence of newly induced c),tokine gene transcription. The biochemical events that regulate cltokine gene transcription in mast cells appear to be similar to the events that occur in T cells. Recruitment and activation of various adapter molecules and kinases in response to FceRI cross-linking lead to nuclear translocation of
nuclear factor of activated T cells (NFAI) and nuclear factor rB (NF-rB), as well as activation of activation protein-l (AP-l) by protein kinases such as c-Iun Nterminal kinase. These transcription factors stimulate transcription of several c1'tokines(IL-4, IL-5, IL-6, IL-13, and tumor necrosis factor [TNF], among others) but, in contrast to T cells, not IL-2. Mast cell activation through the FceRIpathway is regulated byvarious inhibitory receptors,which contain an immunoreceptor tyrosine-based inhibition motif (ITIM) within their cytoplasmic tails (see Chapter 2, Box24). One such inhibitory receptor is FcyRIIb,which coaggregates with FceRI during mast cell activation, and the ITIM is phosphorylated by Lyn. This leads to recruitment of the phosphatase called SH2 domain-containing inositol S-phosphatase (SHIP) and inhibition of FceRI signaling. Experiments in mice indicate that FcyRIIb can regulate mast cell degranulation in vivo. Several other inhibitory receptors are also expressedon mast cells,but their relative importance in vivo is not yet knor,rrn. Mast cells can be directly activated by a variety of bioIogic substances independent of allergen-mediated cross-linking of FceRI,including polybasic compounds, peptides, chemokines, and complement-derived anaphylatoxins. These additional modes of mast cell activation may be important in non-immune-mediated immediate hypersensitivity reactions, or they may amplify lgE-mediated reactions. Certain types of mast cells or basophils may respond to mononuclear phagoclte-derived chemokines, such as macrophage inflammatory protein-lcr (MIP-lcx), produced as part of innate immunity, and to T cell-derived chemokines, produced as part of adaptive cell-mediated immunity. The complement-derived anaphylatoxins, especiallyC5a,bind to specific receptors on mast cells and stimulate degranulation. These chemokines and complement fragments are likely to be produced at sites of inflammation' Therefore, mast cell activation and release of mediators may amplify even IgE-independent reactions. Polybasiccompounds, such as compound 48140 andmastoparan, are used as pharmacologic triggers for mast cells. These agents contain a cationic region adjacent to a hydrophobic moiety, and they work by activating G proteins. Many neuropeptides, including substance B somatostatin, and vasoactive intestinal peptide, induce mast cell histamine release and may mediate neuroendocrine-linked mast cell activation. The nervous system is knor,rrnto modulate immediate hypersensitivity reactions, and neuropeptides may be involved in this effect. The flare produced at the edge of the wheal in elicited immediate hlpersensitivity reactions is in part mediated by the nervous system, as shor.tmby the observation that it is markedly diminished in skin sites lacking innervation. Cold temperatures and intense exercise may also trigger mast cell degranulation, but the mechanisms involved are not knovvn. Mast cells also expressactivating Fc receptors for IgG heavy chains, and these cells can be activated by crosslinking bound IgG. This IgG-mediated reaction is the likely explanation for the finding that € chain knockout mice remain susceptible to antigen-induced mast cell-
45O .
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Section V-
IMMUN|TY tN DEFENSE ANDDTSEASE
.$s.&w&!&F$rj
mediated anaphylaxis. However, IgE is by far the major antibody isotype involved in most immediate hypersensitivity reactions. Mast cell activation is not an all-or-nothing phenomenon, and different types or levels of stimuli may elicit partial responses, with production of some mediators but not others. Such variations in activation and mediator release may account for variable clinical presentations. Mediators
Derived
from
Mast Cells
The effector functions of mast celk are mediated by soluble molecuLes released ftom the cells on actiuation (Fig. 19-6 and Table Ig-3). These mediators may be divided into preformed mediators, which include biogenic amines and granule macromolecules, and newly slmthesized mediators, which include lipid-derived mediators and cltokines.
Biogenic Amines Many of the biologic effects of mast cell actiuation are mediated by biogenic amines that are stored in and released from cytoplasmic granules. Biogenic amines, sometimes called vasoactive amines, are low molecular weight compounds that contain an amine group. In human mast cells, the major mediator of this class is histamine, but in some rodents, serotonin may be of equal or greater import. Histamine acts by binding to target cell receptors, and different cell types express distinct classes of histamine receptors (e.9., Hr, Hr, H.) that can be distinguished by their sensitivity to pharmacologic inhibitors. The actions of histamine are short lived because histamine is rapidly removed from the extracellular milieu by amine-specific transport systems.On binding to cellular receptors, histamine initiates intracellular events, such as phosphatidylinositol breakdovrm to IP, and DAG,
T a b l e1 9 - 3 .M e d i a t o r sP r o d u c e db y M a s t C e l l s ,B a s o p h i l sa, n d E o s i n o p h i l s
Celltype
Mediatorcategory Mediator
Function/pathologiceffects
Mastcellsandbasophils Storedpreformedin granules cytoplasmic
Histamine
permeability; Increases vascular stimulates smoothmusclecellcontraction Enzymes:neutralproteases Degrademicrobial structures; (tryptaseand/orchymase), tissuedamageiremodeling acidhydrolases, cathepsinG, carboxypeptidase
Major lipid mediators Prostaglandin D2 producedon activation
Leukotrienes Ca,Da,Ea Platelet-activatin g factor Cytokinesproducedon tL-3 activation T N F ,M I P - 1 o tL-4,tL-13 tL-5
Vasodilation, bronchoconstriction, neutrophil ctremotaxis Prolonged bronchoconstriction, mucus
peryeg{tjlv g99f91lo! ygscytar | il9l9gs99 Chemotaxis andactivation of leukocvtes, bronchoconstriction, increased vascular permeability Mastcell proliferation Inflammation/latephase reaction
Ig-Eetg9-q"-tj gl:_l! 99-s9e9Etl9l
production Eosinophil andactivation
Eosinophils Storedperformedin granules cytoplasmic
Majorbasicprotein,
e9!1!9P,!! cetl9I9_PI9!9i! peroxidase, Eosinophil lysosomalhydrolases, lysophospholipase
Major lipidmediators Leukotrienes Ca,Da,Ea producedon activation
Cytokinesproducedon IL-3,IL-s,GM.CSF activation
I L - 8 ,I L - 1 0 ,R A N T E S , MIP-1cr,eotaxin
Prolonged bronchoconstriction ; mucus secretion, increased permeability vascular production Eosinophil andactivation Chemotaxis of leukocytes
Abbreviations; granuloc_yte-monocyte GM-CSF, colony-stimulating factor;lL-3,interleukin-3, Mlp-1o,monocyte inflammatory protein-1cr; RANTES, regulated by activation, normalTcellexpressed andsecreted;TNF, tum6r necrosis factor.
19 Chapter
ll\,llvlEDlATE HYPEBSENSITIVITY 451
Vascularleak
Biogenic amines (e .9 .,h i stamines)
Bronchoconstriction
r
Lipidmediators (e.9.,PAF,PGDz,LTC+)
Intestinal hypermotility mastcell (orbasophil)
Cytokines ( e . 9 .T , NF) Lipidmediators (e.9.,PAF,PGD2,LTC+)
Inflammation
Enzymes (e.9.,tryptase)
granuleproteins Cationic (e.9.,majorbasicprotein, -**.F protein) eosinophil cationic
Killingof parasitesand host cells
Mast cellsand basophilmediatorsincludebiogenrcamines ogic effectsof mediatorsof immediatehypersensitivity. on cell activation. which are largelynewly synthesized pieformedin granulesas well as cytokineaand llpidmediators, all componentsof the and intestinalhypermotility, and lipidmediatorsinducevascularleakage,bronchoconstriction, reaction,Enzymesprobably which is part of the late-phase immediateresponse.Cytokinesand lipidmedlatorscontributeto inflammation, releasepreformedcationicproteinsas well as enzymesthat are toxic to parasitesand contributeto tissuedamage Activatedeosinophils granuleenzymesprobablycontributeto tissuedamagein chronicallergicdiseases host cells Some eosinophil
and these products cause different changes in different cell types. Binding of histamine to endothelium causes cell contraction, leading to increased interendothelial spaces, increased vascular permeability, and leakage of plasma into the tissues. Histamine also stimulates endothelial cells to synthesize vascular smooth muscle cell relaxants, such as prostacyclin (PGIJ and nitric oxide, which cause vasodilation. These actions of histamine produce the wheal and flare response of immediate hlpersensitivity (described later). Hr histamine receptor antagonists (commonly called antihistamines) can inhibit the wheal and flare
response to intradermal allergen or anti-IgE antibody. Histamine also causes constriction of intestinal and bronchial smooth muscle. Thus, histamine may contribute to the increased peristalsis and bronchospasm associated with ingested and inhaled allergens, respectively. However, in some allergic disorders, and especially in asthma, antihistamines are not effective at blocking the reaction. Moreover, bronchoconstriction in asthma is more prolonged than are the effects of histamine, suggesting that other mast cell-derived mediators are important in some forms of immediate hypersensitivitY.
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v - IMMUNTTY lN DEFENSE ANDDrsEAsE ,.:::,r'
Granule Enzymes and Proteoglycans Neutral serine proteases, including tryptqse and, chymase, are the most abundant protein constituents of mast cell secretory granules and contribute to tissue damage in immediate hypersensitiuity reactions. Trlptase is present in all human mast cells and is not known to be present in any other cell type. Consequently, the presence of tryptase in human biologic fluids is interpreted as a marker of mast cell activation. Chymase is found in some human mast cells, and its presence or absence is one criterion for characterizing human mast cell subsets,as discussed earlier. The functions of these enzymes in vivo are not known; however, several activities demonstrated in vitro suggest important biologic effects. For example, tr)?tase cleaves fibrinogen and activates collagenase, thereby causing tissue damage, whereas chymase can convert angiotensin I to angiotensin II, degrade epidermal basement membrane, and stimulate mucus secretion. Other enzymes found within mast cell granules include carboxypeptidase A and cathepsin G. Basophil granules also contain several enzymes, some of which are the same as those in mast cell granules, such as neutral proteases,and others are found in eosinophil granules,such as major basic protein and lysophospholipase. Proteoglycans, including heparin and chondroitin sulfate, are also major constituents of both mast cell and basophil granules. These molecules are composed of a polypeptide core and multiple unbranched glycosaminoglycan side chains that impart a strong net negative charge to the molecules. Within the granules, proteoglycans serve as storage matrices for positively charged biogenic amines, proteases, and other mediators and prevent their accessibilityto the rest of the cell. The mediators are released from the proteoglycans at different rates after granule exocl'tosis,biogenic amines dissociating much more rapidly than tryptase or chymase. In this way, the proteoglycans may control the kinetics of immediate hypersensitivity reactions.
The major arachidonic acid-derived mediators produced by the lipoxygenase pathway are the leukotrienes, especially LIC. and its degradation products LID. and LIE'. LIC, is made by mucosal mast cells and basophils, but not by connective tissue mast cells. Mast cell-derived leukotrienes bind to specific receptors on smooth muscle cells, different from the receptors for PGDr, and cause prolonged bronchoconstriction. \l/hen injected into the skin, these leukotrienes produce a characteristic long-lived wheal and flare reaction. Collectively, LTC4, LTD4, and LIE, constitute what was once called slow-reacting substance of anaphylaxis (SRS-A) and are thought to be major mediators of asthmatic bronchoconstriction. Pharmacologic inhibitors of 5lipoxygenasealso block anaphylactic reactions in experimental systems. A third type of lipid mediator produced by mast cells is called platelet-activating factor (PAF) for its original bioassay as an inducer of rabbit platelet aggregation. In mast cells and basophils, PAFis symthesizedby acylation of lysoglyceryl ether phosphorylcholine, a derivative of PlAr-mediated hydrolysis of membrane phospholipids. PAF has direct bronchoconstricting actions. It also causes retraction of endothelial cells and can relax vascular smooth muscle. However, PAF is hydrophobic and is rapidly destroyed by a plasma enzyme called PAF hydrolase, which limits its biologic actions. Pharmacologic inhibitors of PAF receptors ameliorate some aspectsof immediate hlpersensitivity in the rabbit lung. Recent genetic evidence has pointed to PAF as a mediator of asthma. Asthma develops in early childhood in individuals with a genetic deficiency of PAF hydrolase. PAF may also be important in late-phase reactions, in which it can activate inflammatory leukocytes. In this situation, the major source of PAF may be basophils or vascular endothelial cells (stimulated by histamine or leukotrienes) rather than mast cells.
Cytokines
Lipid Mediators Mast cell actiuation results in the rapid de novo synthesis and release of lipid-deriued mediators that haue a uariety of efficts on blood uessels,bronchial smooth muscle, and leukocyfes. The most important of these mediators are metabolites of arachidonic acid generated by the actions of cyclooxygenaseand lipoxygenase. The major arachidonic acid-derived mediator produced by the cyclooxygenasepathway in mast cells is prostaglandin Dz (PGDz).ReleasedPGD2binds to receptors on smooth muscle cells and acts as a vasodilator and a bronchoconstrictor. PGD, also promotes neutrophil chemotaxis and accumulation at inflammatory sites. PGD, synthesis can be prevented by inhibitors of cyclooxygenase,such as aspirin and other nonsteroidal anti-inflammatory agents. These drugs may paradoxically exacerbate asthmatic bronchoconstriction, because they shunt arachidonic acid toward production of leukotrienes, discussed next.
Mast cells (and basophik) produce many dffirent cytokines that contribute to allergic inflammation (the Iate-phase reaction). These cytokines include TNB IL-1, IL-4, lL-s, IL-6, IL-13, MIP-1u, MIP-18, and various colony-stimulating factors such as IL-3 and granulocytemonoclte colony-stimulating factor (GM-CSF).As mentioned before, mast cell activation induces transcription and synthesis of these cyokines, but preformed TNF may also be stored in granules and rapidly released on FceRI cross-linking. Ts2 cells that are recruited into the sites of allergic reactions also produce some of these cytokines. The cytokines that are released on IgEmediated mast cell or basophil activation or on T'2 cell activation are mainly responsible for the late-phase reaction. TNF activates endothelial expression of adhesion molecules and, together with chemokines, accounts for neutrophil and monoc],te infiltrates (see Chapter 2). In addition to allergic inflammation, mast cell cytokines also apparently contribute to the innate immune responsesto infections. For example, as we will discuss later, mouse models indicate that mast cells are
C h a p t e1r9-
required for effective defense against some bacterial infections, and this effector function is mediated largely by TNE Properties of Eosinophils Eosinophils are bone marrow-deriued granulocytes that qre abundant in the inflammatory infiltrates of latephase reactions and contribute to many of the pathologic processesin allergic diseases.Eosinophils develop in the bone marrow and after maturation they circulate in the blood. GM-CSE IL-3, and IL-5 promote eosinophil maturation from myeloid precursors. Eosinophils are normally present in peripheral tissues, especially in mucosal linings of the respiratory, gastrointestinal, and genitourinary tracts, and their numbers can increase by recruitment in the setting of inflammation. The granules of eosinophils contain basic proteins that bind acidic dyes such as eosin (seeFig. l9-5). Cytokines produced W TrZ cells promote the actiuation of eosinophils and their recruitment to late-phase reaction inflammatory sites.IL-5 is a potent eosinophilactivating cytokine. It enhancesthe ability of eosinophils to releasegranule contents. IL-5 also increases maturation of eosinophils from bone marrow precursors, and in the absenceof this cytokine (e.9.,in IL-5 knockout mice), there is a deficiency of eosinophil numbers and functions. Eosinophils are recruited into late-phase reaction sites as well as sites of helminthic infection, and their recruitment is mediated by a combination of adhesion molecule interactions and chemokines. Eosinophils bind to endothelial cells expressing E-selectin and the ligand for theVtA-4 integrin. IL-4 produced byTs2 cells may enhance expression of adhesion molecules for eosinophils. Eosinophil recruitment and infiltration into tissues also depend on the chemokine eotaxin (CCLIl), which is produced by epithelial cells at sites of allergic reactions and binds to the chemokine receptor CCR3 expressedconstitutively by eosinophils. In addition, the complement product CSa and the lipid mediators PAF and LTBr, which are produced by mast cells, also function as chemoattractants for eosinophils. Eosinophils releasegranule proteins that are toxic to parasitic organisms and. may injure normal tissue. Little is knor,r,n about the mechanisms involved in eosinophil degranulation and mediator production. Although eosinophils express Fc receptors for IgG, IgA, and IgE, they do not appear to be as sensitive to activation by antigen-mediated cross-linking of these receptors as are mast cells and basophils. The granule contents of eosinophils include lysosomal hydrolases found in other granulocytes as well as eosinophilspecific proteins that are particularly toxic to helminthic organisms, including major basic protein and eosinophil cationic protein. These two cationic pollpeptides have no knor,rm enz].rynaticactivities, but they are toxic to helminths, bacteria, and normal tissue. In addition, eosinophilic granules contain eosinophil peroxidase,which is distinct from the myeloperoxidase found in neutrophils and catalyzes the production of hlpochlorous or hlpobromous acid. These products are also toxic to helminths, protozoa, and host cells.
IMMEDIAH TE Y P E R S E N S I T I V I T Y4 5 3
Activated eosinophils, like mast cells and basophils, produce and release lipid mediators, including PAf; prostaglandins, and leukotrienes (LIC+ and its derivatives LTD, and LIE.). The importance of eosinophilderived lipid mediators in immediate hlpersensitivity is not completely knor,r'n, but it is likely that they contribute to the pathologic processesof allergic diseases. Eosinophils also produce a variety of cytokines that may promote inflammatory responses,but the biologic significance of eosinophil cltokine production is not knor,rryt.
OFIMMEDIATE RrnCrIOruS
HvprRsrrusmvlrY The IgE- and mast cell-mediated reactions of immediate hypersensitivity consist of the immediate reaction, in which vascular and smooth muscle responsesto mediators are dominant, and the late-phase reaction, characterized by leukocyte recruitment and inflammation (Fig. 19-7). The lmmediate
Reaction
The early uascular changes that occur during immediate hypersensitiuity reactions are d.emonstrated by the wheal andflare reaction to the intradermal iniection of an allergen (Fig. I 9-B). \.Alhenan individual who has previously encountered an allergen and produced IgE antibody is challenged by intradermal injection of the same antigen, the injection site becomes red from locally dilated blood vesselsengorged with red blood cells.The site then rapidly swells as a result of leakage of plasma from the venules. This soft swelling is called a wheal and can involve an area of skin as large as several centimeters in diameter. Subsequently, blood vessels at the margins of the wheal dilate and become engorged with red blood cells and produce a characteristic red rim called a flare. The full wheal and flare reaction can appear within 5 to 10 minutes after administration of antigen and usually subsides in less than an hour. By electron microscopy, the venules in the area of the wheal show slight separation of the endothelial cells, which accounts for the escape of macromolecules and fluid, but not cells, from the vascular lumen. The whealandflare reaction is d'ependent on IgE and mast celk. Histologic examination shows that mast cells in the area of the wheal and flare have released preformed mediators; that is, their c1'toplasmic granules have been discharged. A causal association of IgE and mast cells with immediate hlpersensitivity was deduced from three kinds of experiments. :; Immediate hlryersensitivity reactions against an allergen can be elicited in unresponsiveindividuals if the local skin site is first injected with IgE from an allergic individual. Thus, IgE is responsible for specific recognition of antigen and can be used to adoptively transfer immediate hypersensitivity. Such adoptive transfer experiments were first performed with serum from immunized individuals, and the serum factor
trction V - IMMUNITY lN DEFENSE ANDDTSEASE
OUl*,,' ..
Latereaction
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$
FIGURE 19-7 The immediateand late-phasereactions.A Kinetics: The immediatevascular andsmoothmusclereactionto allergendevelops within minutesafter challenge(allergenexposurein a previouslysensitizedindlvidual), and the late-phase reactiondeveops 2 ro 24 hourslater B, C Morphology: The immediatereaction(B)is characterized by vasodilation, congestion, and edema,and the late-phase react i o n ( C )l s c h a r a c t e r i z e bd y a n n f l a m m a t o ri yn f i l t r a trei c hi n e o s i n o p h i lns e , u t r o p h i las n , dT c e l l s ( C o u r t e soyf D r D a n i eFl r i e n dD , epartment of Pathology, Brighamand Women'sHospital,Boston,Massachusetts )
responsible for the reaction was originally called reagin. For this reason,IgE moleculesare still sometimes called reaginic antibodies. The antigen-initiated skin reactionthat follows adoptivetransferof IgE is called passivecutaneousanaphylaxis. Immediate hypersensitivity reactions can be mimicked by injecting anti-IgE antibody instead of antigen. Anti-IgE antibodies act as an analogue of antigen and directly activate mast cells that have bound IgE on their surface.This use of anti-lgE to activate mast cells is similar to the use of anti-IgM antibodiesas analoguesof antigen to activateB cells (seeAppendix III), except that in the case of mast cells,secretedIgE, made by B cells,is bound to highafflnity Fc receptors on the cell surface rather than being synthesizedas membrane IgE. Anti-IgE antibodies activatemast cellsevenin normal (nonatopic) individuals because,as mentioned earlier,mast cells are normally coatedwith IgE that can be cross-linked by the anti-lgE. In contrast, an antigen will activate mast cells only in individuals who are allergicto that antigen becauseonly these individuals will produce enough specificIgE to be cross-linkedby the antigen. Immediate hlpersensitivity reactions can be mimicked by the injection of other agents that directly activate mast cells, such as the complement fragments C5a,C4a,and C3a,calledanaphylatoxins,or by local trauma, which also causes degranulation of mast cells.Conversely,these reactionscan be inhibited by agentsthat prevent mast cell activation. The wheal and flare reaction results from sensitization of dermal mast cells by IgE bound to FceRI,crosslinking of the IgE by the antigen, and activation of mast cells with releaseof mediators, notably histamine. Histamine binds to histamine receptors on venular endothelial cells; the endothelial cells synthesize and release PGIr, nitric oxide, and PAF; and these mediators cause
vasodilation and vascular leak, as described earlier in the chapter. Skin mast cells appear to produce only small amounts of long-acting mediators such as leukotrienes, and the wheal and flare responsetypically subsides after about 15 to 20 minutes. Allergists often test patients for allergiesto different antigens by examining the ability of these antigens applied in skin patches to elicit wheal and flare reactions.
The l-ate-Phase
Reaction
The immediate wheal ond flare reaction is followed 2 to 4 hours later by a late-phase reaction consisting of the accumulation of inflammatory leukocytes, including neutrophils, eosinophils, basophik, and To2 cells (see Fig. I9-7). The inflammation is maximal by about 24 hours and then gradually subsides. The capacity to mount a late-phase reaction can be adoptively transferred with IgE, and the reaction can be mimicked by anti-IgE antibodies or mast cell-activating agents, like the immediate wheal and flare reaction. Mast cells produce cytokines, including TNE that can up-regulate endothelial expressionof leukocyte adhesion molecules, such as E-selectin and intercellular adhesion moleculeI (ICAM-l), and chemokines that recruit blood leukocltes. Thus, mast cell activation promotes the recruitment of leukocytes into tissues. The types of leukocytes that are tlpical of late-phase reactions are eosinophils and Ts2 cells; in addition, neutrophils are often present in these reactions. Eosinophils and Tn2 cells express receptors for many of the same chemokines, such as eotaxin, and this is why both cell types are recruited to sites of production of these chemokines. The late-phase reaction differs from delayed-type hlpersensitivity reactions, in which macrophages and Tnl cells are dominant. The late-phase reaction may occur without a detectable preceding immediate hypersensitiuity reac-
HYPERSENSITIVITY 19- IMMEDIATE Chapter E 455 . ."***,,,,'*--&**.,.
lntradermal injection of
activation,and the cytokinesthat sustainthe late-phase reactionmay be producedmainly by T cells.
To SuscrpiletlfiY Gerumc Irvr u rotRrrHYptRsrusffilvlrY
The propensity to prod.uceIgE is influencedby the inheritance of seueral genes. Abnormally high levels of IgE slmthesis and associated atopy often run in families. Family studies have shown clear autosomal transmission of atopy, although the full inheritance pattern is multigenic. Within the same family, the target organ of atopic disease is variable. Thus, hay fever, asthma, and eczema can be present to various degrees in different members of the same kindred. All these individuals' however, will show higher than average plasma IgE levels. Wheal Genome-wide linkage analysesfor atopy/asthma susceptibility loci have identified several chromosomal regions of importance in allergic disease (Table 19-4)' Each of these loci may contain severalgenes of potential importance to disease.Some of the genes in these loci may regulate Tg2 responses and IgE production. Other genes may have tissue-specific influences, such as airway remodeling in the asthmatic lung. One of these susceptibility loci for atopy is on chromosome 5q, near the site of the gene cluster encoding the cytokines IL-3, IL-4, IL-5, IL-9, and IL-13 and the IL-4 receptor. This region is of great interest because of the connection between severalof the geneslocated here and the mechanisms of IgE regulation and mast cell and eosinophil growth and differentiation. Furthermore, the homologous chromosomal region in mice has been linked to a propensity for CD4* T cells in some inbred strains of mice to differentiate into Tg2 cells in response to model protein antigens. Among the genes in this cluster, polymorphisms in the IL-13 gene appear to have the strongest associations with asthma. The tendency to produce IgE antibodies against some but not all antigens, such as ragweed pollen, may be linked to particular class II major histocompatibility complex (MHC) alleles. This linkage may be an example of an "immune response gene" (1r gene) effect in which atopic individuals inherit class II MHC alleles that can bind and display dominant epitopes of certain allergens (see Chapter 4). Several other chromosomal regions have FIGURE 19-8 The wheal and flare reaction in the skin. A In been shorrrmto be associated with high serum IgE levels, releaseof mastcellmediators,local responseto antigen-stimulated atopy, and asthma. In addition to these linkage studies, bloodvesselsfirst dilateand then becomeleakVto fluidand macro(a produces wheal) individual asthma-associated genes have been identiredness local which and swelling molecules, dilationof vesselson the edgeof the swellingproduces Subsequent fied by positional cloning. These include ADAM33, of a typical of a red rim (the flare) B Photograph the appearance DPP|I, and PHFll (see Table 19-4). Although there are wheal and flare reactionin the skin in responseto injectionof an signiflcant associations of polymorphisms of allergen(Courtesyof Dr JamesD Faix,Departmentof Pathology, highly genes with asthma, the way in which the prodthese StanfordUniversitySchoolof Medicine,PaloAlto, California ) ucts of the genes contribute to disease are not yet understood. Some genes whose products regulate the innate tion. Bronchial asthma is a disease in which there may immune response to infections have been associated be repeated bouts of inflammation with accumulations allergy and asthma. These include CD14' a compowith vascular of eosinophils and TnZ cells without the nent of the lipopolysaccharide receptor, and Tim-1, a changes that are characteristic of the immediate protein thought to influence helperT cell differentiation. response.In such disorders, there may be little mast cell
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Table 19-4. Examplesof ChromosomalLocationsand GenesAssociatedwith Atopy and Asthma
ChromosomalI Candidategenes Putativerole of gene products location in disease 5q
gene Cytokine cluster(lL-4,lL-5, r L - 1 3C ) , D 1 4B , 2adrenergic receptor
l L - 4a n d l L - 1 3p r o m o t el g E s w i t c h i n gl,L - 5 promoteseosinophilgrowthand activation; CD14 is a componentof the LPS receptor which,via interactionwith TLR4, may influencethe balancebetweenTpl vs. T62 responsesto antigens;B2-adrenergic receptorregulatesbronchialsmooth musclecontraction
6p
Classll MHC
Someallelesmayregulate T cell responses to allergens
11q
Mediatesmast cell activation
12q
FceRlB chain Stemcellfactor, intederon-1, STAT6
16
lL-4 receptorcrchain
Subunitof bothlL-4and lL-13receotors
2op
ADAM33
Metallooroteinase involved in ainruay remodeling
2q
DPPlO
Peptidasethat may regulatechemokineand cytokineactivity
13q
PHFl1
Transcriptional regulator involved in B cell clonalexpansion and lg expression
Stemcellfactorregulatesmastcellgrowth and differentiation; interferon-T opposes actionsof lL-4;STATO mediates lL-4 signaltransduction
Abbreviations: FceRl,Fcereceptor typel; lL-4,interleukin-4.
Strong innate responses to infections generally favor development of Ts1 responses, and inhibit T12 responses (see Chapter l3). Therefore, polymorphisms or mutations in genes that result in diminished innate responses to common infectious organisms may increase the risk for development of atopy.
Au-rRclc DtsrnsrstNHUMANS: PnrHocrruESIs ANDTHrnRpy Mast cell degranulation is q central component of all allergic diseases,and the clinical and pathologic manifestations of the diseasesdepend on the tksues in which the mast cell mediators haue effects as well as the chronicity of the resulting inflammatory process.Atopic individuals may have one or more manifestations of atopic disease. The most common forms of atopic disease are allergic rhinitis (hay fever), bronchial asthma, atopic dermatitis (eczema), and food allergies. The clinical and pathologic features of allergic reactions vary with the anatomic site of the reaction, for several reasons. The point of contact with the allergen determines the organs or tissues that are involved. For example, inhaled antigens cause rhinitis or asthma, ingested antigens often cause vomiting and diarrhea, and injected antigens cause systemic effects on the cir-
culation. The concentrations of mast cells in various target organs influence the severity of responses. Mast cells are particularly abundant in the skin and the mucosa of the respiratory and gastrointestinal tracts, and these tissues frequently suffer the most injury in immediate hlpersensitivity reactions.The local mast cell phenotype may influence the characteristics of the immediate hlpersensitivity reaction. For example, connective tissue mast cells with abundant histamine are responsible for wheal and flare reactions in the skin. In the following section, we discuss the major features of allergic diseasesmanifested in different tissues.
Systemic
Anaphylaxis
Anaphylaxis is a systemic immediate hypersensitiuity reaction characterized by edema in many tissues and a fall in blood pressure, secondary to uasodilatioz. These effects usually result from the systemic presence of antigen introduced by injection, an insect sting, or absorption across an epithelial surface such as the skin or gut mucosa. The allergen activates mast cells in many tissues, resulting in the release of mediators that gain access to vascular beds throughout the body. The decreasein vascular tone and leakage of plasma caused by the releasedmediators can lead to a fall in blood pressure or shock, called anaphylactic shock, which is often
457 HYPERSENSITIVITY 19- IMMEDIATE Chapter ;
fatal. The cardiovascular effects are accompanied by constriction of the upper and lower airways, Iaryngeal edema, hypermotility of the gut, outpouring of mucus in the gut and respiratory tract, and urticarial lesions (hives) in the skin. It is not knolr.'n which mast cell mediators are the most important in anaphylactic shock. The mainstay of treatment is systemic epinephrine, which can be lifesaving by reversing the bronchoconstrictive and vasodilatory effects of the various mast cell mediators. Epinephrine also improves cardiac output, further aiding survival from threatened circulatory collapse. Antihistamines may also be beneficial in anaphylaxis, suggestinga role for histamine in this reaction. In some animal models, PAF receptor antagonists offer partial protection. Bronchial Asthma Asthma is an inJlammatory disease caused by repeated immediote hypersensitiuity and late-phase reactions in the lung leading to the clinicopathologic triad of intermittent and reuersible airway obstruction, chronic bronchial inflammation with eosinophik, and bronchial smooth muscle cell hypertrophy and hyperreactiuity to bronchoconstrictors (Fig. 19-9). Patients suffer paroxysms of bronchial constriction and increased production of thick mucus, which leads to bronchial obstruction and exacerbatesrespiratory difficulties. Asthma frequently coexists with bronchitis or emphysema, and the combination of diseasescan cause severe damage to lung tissue. Affected individuals may suffer considerable morbidity, and asthma can be fatal. Asthma affects about 10 million people in the United States, and the frequency of this disease has increased significantly in recent years. The prevalence rate is similar to that in other industrialized countries, but it may be lower in less developed areas of the world. One possible explanation for the increased prevalence of asthma and other atopic diseasesin industrialized coun-
tries is that the fiequency of irrf"Aion, i.t tt'"r" ;;:* is generally lower. As we discussed earlier, the innate immune responses associated with most infections promote Tg1 responses and suppress Trr2 responses required for development of atopy.A variety of epidemiologic data are consistent with the idea that reducing infections leads to increased prevalence of allergic disease.This idea has been given the catchy name the hygiene hypothesis. About 70% of cases of asthma are due to IgEmediated immediate hlpersensitivity. In the remaining 30% of patients, asthma may not be associated with atopy and may be triggered by nonimmune stimuli such as drugs, cold, and exercise.Even among nonatopic asthmatics, the pathophysiologic process of airway constriction is similar, which suggests that alternative mechanisms of mast cell degranulation (e.g.,by locally produced neurotransmitters) may underlie the disease. The pathophysiologic sequence in atopic asthma is probably initiated by mast cell activation in response to allergen binding to IgE as well as by T"2 cells reacting to allergens (Fig. 19-10). The cltokines produced by the mast cells and T cells lead to the recruitment of eosinophils, basophils, and more Ts2 cells. The chronic inflammation in this disease may continue without mast cell activation. Smooth muscle cell hlpertrophy and hyperreactivity are thought to result from leukocltederived mediators and cytokines. Mast cells, basophils, and eosinophils all produce mediators that constrict airway smooth muscle. The most important of the bronchoconstricting mediators are LTC., its breakdorryn products LID, and LIE', and PAE In clinical experiments, antagonists of LICa synthesis or leukotriene receptor antagonists prevent allergen-induced airway constriction. Increased mucus secretion results from the action of cltokines, mainly IL-13, on bronchial epithelial cells. Current therapy for asthma has two major targets: prevention and reversal of inflammation and relaxation
Excessive mucussecretion inflammatory Submucosal infiltratewith lymphocytes andeosinophils basement Thickened membrane Smoothmusclecell hypedrophy
featuresol bronchialasthma,Aropicbronchialasthmaresultsfrom repeatedimmediatehypersensitivity FIGURE 19-9 Histopathologic of a normalbronchusls shown ln A; a bronchusfrom a patientwith reactionsin the lungswith chroniclate-phase reactionsA cross-section eosinophils), cells(including inflammatory manysubmucosal asthmais shown in B The diseasedbronchushasexcessivemucusproduction, (Courtesyof Dr James D Faix,Departmentof Pathology, StanfordUniversitySchoolof Medicine,Palo and smooth musclehypertrophy, Alto, California )
458 V $ Section . ,,,,*,***"***-.,..
IMMUN|TY tNDEFENSE ANDDTSEASE
of airway smooth muscle. In recent years, the balance of therapy has shifted toward anti-inflimmatory agents as the primary mode of treatment. Severalclassesof drugs are in current use to treat asthma. Corticosteroids block the production of inflammatory cytokines. Sodium cromolgr appears to antagonize IgE-induced release of mediators. Both agents can be used prophylactically as inhalants. Corticosteroids may also be given systemically, especially once an attack is under way, to reduce inflammation. Leukotriene inhibitors block the binding of bronchoconstricting leukotrienes to airway smooth muscle cells. Humanized monoclonal anti-lgE antibody is a recently approved therapy that effectively reduces serum IgE levels in patients. Becausehistamine has little role in airway constriction, antihistamines (Hr receptor antagonists) are not useful in the treatment of asthma. Indeed, because many antihistamines are also anticholinergics, these drugs may worsen airway obstruction by causing thickening of mucus secretions. Bronchial smooth muscle cell relaxation has principally been achieved by elevating intracellular cyclic adenosine monophosphate (cAMP) levels in smooth muscle cells, which inhibits contraction. The major drugs used are activators of adenylate cyclase, such as epinephrine and related B2-adrenergic agents. Theophylline is a commonly used anti-asthma drug, which inhibits phosphodiesteraseenzymes that degrade cAMP
However, theophylline may also have anti-inflammatory effects unrelated to its effects on smooth muscle cell relaxation, which contribute to its effectiveness. lmmediate Hypersensitivity Reactions in the Upper Respiratory Tract, Gastrointestanal Tract, and Skin Allergic rhinitis, also called hay fever, is perhaps the most common allergic disease and is a consequence of immediate hypersensitivity reactions to common allergens such as plant pollen or house dust mites localized to the upper respiratory tract by inhalation. The pathoIogic and clinical manifestations include mucosal edema, leukocyte infiltration with abundant eosinophils, mucus secretion, coughing, sneezing,and difficulty breathing. Allergic conjunctivitis with itchy eyes is commonly associated with the rhinitis. Focal protrusions of the nasal mucosa, called nasal pollps, filled with edema fluid and eosinophils may develop in patients who suffer frequent repetitive bouts of allergic rhinitis. Antihistamines are the most common drugs used to treat allergic rhinitis. Food allergies are immediate hypersensitivity reactions to ingested foods that lead to the release of mediators from intestinal mucosal and submucosal mast cells. Clinical manifestations include enhanced peristal-
Antigen-activated mastcellor basophil
l-Bbj--.'i."-;1
ITNF,lL- 4,ll- s, I I othercytokines I FIGURE t9-ro Mediators and treatment of asthma, Mast cell-derivedleukotrienes and PAF are thoughtto be the majormediatorsof acutebronchoconstriction Therapyis targetedboth at reducing mast cell activation with inhibitorssuch as cromolynand at countering mediator actions on bronchialsmooth muscleby bronchodilatorssuch as epinephrine and theophyllineThesedrugsalso inhibit mast cell activation lvlast cell-derivedcytokinesare thought to be the majormediatorsof sustainedairwayinflammation, which is an exampleof a late-phase reaction, and corticosteroid theraovis used to inhibitcytokinesynthesis Cytokines arealsoproducedby Tp2 cells(not shown)
19Chaoter
sis, increased fluid secretion from intestinal lining cells, and associatedvomiting and diarrhea. Urticaria is often associatedwith allergic reactions to food, and systemic anaphylaxis may occasionally ensue. Allergic reactions to many different tlpes of food have been described,but some of the most common are peanuts and shellfish. Individuals may be so sensitive to these allergens that severe systemic reactions can occur in response to minute contaminants of the allergen introduced accidentally during food preparation. Allergic reactions in the skin are manifested as urticaria and eczema. Urticaria, which is essentially an acute wheal and flare reaction induced by mast cell mediators, occurs in response to direct contact with the allergen or after an allergen enters the circulation through the intestinal tract or by injection. Becausethe reaction that ensues is mediated largely by histamine, antihistamines (H1 receptor antagonists) can block this response almost completely. The urticaria may persist for several hours, probably because antigen persists in the plasma. Chronic eczema is a common skin disorder that may be caused by a late-phase reaction to an allergen in the skin. In the cutaneous late-phase reaction, TNE IL-4, and other cltokines, probably derived from Ts2 cells and mast cells, act on the venular endothelial cells to promote inflammation. As may be expected for a cltokine-mediated response, the late-phase inflammatory reaction is not inhibited by antihistamines. It can be blocked by treatment with corticosteroids, which inhibit cytokine synthesis.
lmmunotherapy
for Allergic
Diseases
In addition to therapy aimed at the consequences of immediate hlpersensitivity, clinical immunologists often try to limit the onset of allergic reactions by treatments aimed at reducing the quantity of IgE present in the individual. Several empirical protocols have been developed to diminish specific IgE synthesis. In one approach, called desensitization, small quantities of antigen are repeatedly administered subcutaneously. As a result of this treatment, specific IgE levels decreaseand IgG titers often rise, perhaps further inhibiting IgE production by neutralizing the antigen and by antibody feedback (seeChapter 10). It is also possible that desensitization may work by inducing specific T cell tolerance or by changing the predominant phenotype of antigenspecific T cells fromTs2 to Tsl; however,there is no clear evidence to support any of these hypotheses.The beneficial effects of desensitization may occur in a matter of hours, much earlier than changes in IgE levels.Although the precise mechanism is unknor,rm,this approach has been successful in preventing acute anaphylactic responses to protein antigens (e.g., insect venom) or vital drugs (e.g., penicillin). It is more variable in its effectivenessfor chronic atopic conditions such as hay fever and asthma. Other approaches being used to reduce IgE levels include systemic administration of humanized monoclonal anti-IgE antibodies mentioned earlier.
HYPERSENSITIVITY IMMEDIATE
MAsr Rolrs0FlcE-AND THrPnorrcruE Rrncrlons lrunaurur Cru-MroIATED Although most of our understanding of mast cell- and basophil-mediated responses comes from analysis of hypersensitivity diseases, it is logical to assume that these responseshave evolved because they provide protective functions. In fact, some evidence shows that IgEand mast cell-mediated responses are important for defense against certain types ofinfection. A major protectiue function of lgE'initi"ated immune reactions is the eradication of parasites. Eosinophilmediated killing of helminths is an effective defense against these organisms. The activities of IL-4, IL-5, and IL-13 in IgE production and eosinophil activation contribute to a coordinated defense against helminths. It has also been speculated that lgE-dependent mast cell activation in the gastrointestinal tract promotes the expulsion of parasitesby increasing peristalsis and by an outpouring of mucus. Studies in mice have highlighted the beneficial roles of IgE and mast cells. rrr Mice treated with anti-Il-4 antibody and IL-4 knockout mice do not make IgE and appearto be more susceptible than normal animals to some helminthic infections. IL-S knockout mice, which are unable to activateeosinophils,also show increasedsusceptibility to some helminths. r r Geneticallymast cell-deficient mice show increased susceptibility to infection by tick laryae, and immunity can be provided to these mice by adoptive transfer of specific IgE and mast cells (but not by either component alone). The larvae are eradicatedby the late-phasereaction. Mast celk play an important protective role as part of the innate immune response to bacterial infections. Studies in mice have indicated that mast cells can be activated by IgE-independent mechanisms in the course of an acute bacterial infection and that the mediators they release are critical for clearing the infection. 1.1Mast cell-deficient mice are less capable of clearing, and are more likely to die of, acute bacterial infection of the peritoneum than are normal mice. The protective role of mast cells in this setting is mediated by TNF and depends on TNF-stimulated influx of neutrophils to the peritoneum, specifically, the latephasereaction.The mechanismsby which mast cells are activated during innate immune responses to bacterial infection are not known but may involve complement activation by the alternative pathway' Ieading to the release of C5a, which directly triggers mast cell degranulation.It is also possible that the classicalpathway of complement could be activated by natural antibodiesthat are produced by B-1 B cells and that recognizecommon microbial pathogens. Mast cell-derived proteaseshave been shor,rmto destroy some snake and insect venoms in mice. This is an
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I M M U N I Tl N Y D E F E NA SN E DD T S E A S E
unusual form of "innate immunity" against a potentially lethal encounter with non-microbial organisms.
SUMMARY I
Immediate hypersensitivity is an immune reaction that is triggered by antigen binding to IgE preattached to mast cells and that leads to inflammatory mediator release.
e The steps in the development of immediate hlpersensitivity are exposure to an antigen (allergen) that stimulates Ts2 responsesand IgE production, binding of the IgE to Fce receptors on mast cells, cross-linking of the IgE and the Fce receptors by the allergen, activation of mast cells, and releaseof mediators. e Individuals susceptible ro immediate hlpersensitivity reactions are called atopic and often have more IgE in the blood and more IgE-specific Fc receptors per mast cell than do nonatopic individuals. IgE synthesis is induced by exposure to antigen andTs2 cytokines, particularly IL-4. o Mast cells are derived from the bone marrow and mature in the tissues. They express high-affinity receptors for IgE (FceRI)and contain cytoplasmic granules in which are stored various inflammatory mediators. Subsets of mast cells, including mucosal and connective tissue mast cells, mav produce different mediators. Basophils are a typ; of circulating granulocyte that expresses highaffinity Fce receptors and contains granules with contents similar to mast cells. o Eosinophils are a special class of granulocyte; they are recruited into inflammatory reactions by chemokines and IL-4 and are activated by IL-5. Eosinophils are effector cells that are involved in killing parasites. In allergic reactions, eosinophils contribute to tissue injury. e On binding of antigen to IgE on the surface of mast cells or basophils, the high-affinity Fcr receptors become cross-linked and activate intracellular second messengers that lead to granule release and new synthesis of mediators. Activated mast cells and basophils produce three important classesof mediators: biogenic amines, such as histamine; lipid mediators, such as prostaglandins, leukotrienes, and PAF;and cytokines, such as TNB IL-4, IL-13, and IL-5. 0 Biogenic amines and lipid mediators cause the rapid vascular and smooth muscle reactions of immediate hypersensitivity, such as vascular
leakage, vasodilation, and bronchoconstriction. Cytokines mediate the late-phase reaction. O Various organs show distinct forms of immediate hlpersensitivity involving different mediators and target cell rypes. Any allergen may lead to a systemic reaction called anaphylactic shock. Asthma is a manifestation of immediate hypersensitivity and late-phase reactions in the lung. Allergic rhinitis (hay fever) is the most common allergic disease of the upper respiratory tract. Food allergens can cause diarrhea and vomiting. In the skin, immediate hypersensitivity is manifested as wheal and flare and late-phase reactions and may lead to chronic eczema. o Drug therapy is aimed at inhibiting mast cell mediator production and at blocking or counteracting the effects of released mediators on target organs. The goal of immunotherapy is to prevent or to reduce Ts2 cell responsesto specific allergens and the production of IgE. o Immediate hypersensitivity reactions provide protection against helminthic infections by promoting IgE- and eosinophil-mediatedADCC and gut peristalsis.Furthermore, mast cells may play an important role in innate immune responsesto bacterial infections.
Selected Readings Blank U, and J Rivera.The ins and outs of IgE-dependent mastcell exocytosis. Trends in Immunology 25:266-273,2004. Bufford JD, and lE Gern. The hygiene hypothesis revisited. Immunology and Allergy Clinics of North America 25:247-262. v-vi, 2005. Cohn L, IA Elias, and GL Chupp. Asthma: mechanisms of disease persistence and progression. Annual Review of Immunology 22:789-815, 2004. Galli SJ, M Grimbaldeston, and M Tsai. Immunomodulatory mast cells: negative, as well as positive, regulators of immunity. Nature Reviews Immunology 8:478-486, 2008. Galli Sl, M Tsai, and AM Piliponsky. The development of allergic inflammation. Nature 454:445-454, 2008. Geha RS, HH Jabara, and SR Brodeur. The regulation of immunoglobulin E class-switch recombination. Nature ReviewsImmunology 3:721-732, 2003. Gilfillan AM, and C Tkaczyk. Integrated signalling pathways for mast-cell activation. Nature Reviews Immunology 6:2lB230,2006. Gould Hl, and BJ Sutton. IgE in allergy and asthma today. Nature Reviews Immunology 8:205-217, 2008. Herrick CA, and K Bottomly. To respond or not to respond: T cells in allergic asthma. Nature Reviews Immunology 3:405-412,2003. Kalesnikoff L and SJ GaIIi. New developments in mast cell biolo gy. Nature Immunolo gy 9 :l2l 5-1223, 2O08. Kay AB. Allergy and allergic diseases. New England Iournal of Medicine 344:30-37,r09-l 13, 2001.
19Chapter
LambrecthBN, and H Hammad.Takingour breath away:dendritic cells in the pathogenesisof asthma. Nature Reviews Immunology 3:99,1-1003, 2003. Maddox L, and DA Schwartz.The pathophysiologyof asthma. Annual Reviewof Medicine 53:477498,2002. MedoffBD,SYThomas,andAD Luster.T cell trafnckingin allergic asthma:the ins and outs.Annual Reviewof Immunology 26:205-232,2008. NadlerMJ, SAMatthews,H Turner,and J-PKinet. Signaltransduction by the high affinity immunoglobulin E receptor FceRI:coupling form to function. Advancesin Immunology 76:325-355, 2000. Piccinni MB E Maggi,and SRomagnani.Environmentalfactors favoring the allergen-specificTh2 responsein allergic sub-
jects. Annals of the New York Academy of Sciences 917:844-852,2000. RiveraJ, NA Fierro,A Olivera,and R Suzuki.New insights on mast cell activation via the high affinity receptor for IgE' Advancesin Immunology 98:85-120,2008. RothenbergME, and SPHogan.The Eosinophil.Annual Review of Immunology 24:147-174, 2006. Sullivan BM and RM Locksley.Basophils:A nonredundant contributor to host immunity. Immunity 30:12-20,2009. Vercelli D. Discovering susceptibility genes for asthma and allergy.Nature ReviewsImmunology 8:169-182,2008. Wills-Karp M, and SL Ewart. Time to draw breath: asthmasusceptibilitygenesare identified. Nature ReviewsGenetics 5t376-387,2O04.
GENI UIRE
General Features of lmmunodeficiency Diseases,463 Gongenital (Primary) lmmunodefi ciencies, 464 Defectsin Innatelmmunity,465 SevereCombinedlmmunodeficiencies, 467 AntibodyDeficiencies: Defectsin B Cell Development and Activation,470 Defectsin T LymphocyteActivationand Function.472 MultisystemDisorderswith lmmunodeficiency: Ataxia Telangiectasia, 474 Therapeutic Approaches for Congenital lmmunodeficiencies, 475 Acquired (Secondary) lmmunodeficiencies, 475 Human lmmunodeficiency Virus and the Acquired lmmunodeficiency Syndrome,476 Molecularand BiologicFeaturesof HIV 476 Pathogenesis of HIV Infectionand AIDS,481 484 ClinicalFeaturesof HIV Disease, lmmuneResponses to HIV 485 Treatmentand Prevention of AIDSand VaccineDevelopment, 486 Summary,487
in one or more components of the irftfnufle system can lead to serious and often fatal disorders, whlch are collectively called immunodeficiency diseases. These diseases are broadly classified into twn groupsr The congenital or primary immunodeficiencles are genetic defectsthat result in an increased susceptibili{y to infection that is frequently manifested early in infancy and childhood but is sometimes clinically detected later in life. It is estimated that in the United State$, approximately 1 in 500 individuals is born with a defectin some component of the immune system, although only a small proportion are affected severelyenough for development of life-threatening complications. Acquired or secondary immunodeficiencies develop as a consequence of malnutrition, disseminated cancer,treatment with immunosuppressive drugs, or infection of cells of the immune system, most notably with the human immunodeficiency virus (HlV), the etiologic agent of acquired immunodeficiency syndrome (AIDS). This chapter describes the major types of congenital and acquired immunodeficiencies, with an emphasis on their pathogenesis and the components of the immune system that are involved in each.
or FrRrunrs GerurRnl DtsrRsrs IwrvruruoorHctENcY Before beginning our discussion of individual diseases, it is important to summarize some general features of immunodeficiencies. @ The principal consequence of immunodeficiency is an increased susceptibility to infection. The nature of
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Table20-1. Featuresof lmmunodeficiencies AffectingT or B Lymphocytes
Feature
B cell deficiency
T cell deficiency
Diagnosis Serumlg levels Reduced DTHreactionsto N o r m a l commonantigens Absentor reducedfollicles Morphology of lymphoid tissues andgerminalcenters Susceptibility to infection
Normalor reduced Reduced
Usuallynormalfollicles, maybe reducedparafollicular cortical (B cellzones) regions(T cellzones) (otitis, pneumonia, Pyogenic bacteria Manyviruses, atypical meningitis, osteomyelitis), enteric mvcobacteria andother bacteria andviruses,someparasitesinfracellular bacteria, fungi
Abbreviations:DTH, delayed-typehypersensitivity.
the infection in a particular patient depends largely on the component of the immune system that is defective (Table 20-l). Deficient humoral immunity usually results in increased susceptibility to infection by pyogenic bacteria, whereas defects in cellmediated immunity lead to infection by viruses and other intracellular microbes. Combined deficiencies in both humoral and cell-mediated immunity make patients susceptible to infection by all classes of microorganisms. @ Patients with immunodeficiencies are ako susceptible to certain types of cancer. Many of these cancers appear to be caused by oncogenic viruses, such as the Epstein-Barr virus (EBV). An increased incidence of cancer is most often seen in T cell immunodeficiencies because,as discussed in Chapter 17, T cells play an important role in surveillance against oncogenic viruses and the tumors they cause. @ Immunodeficiency may result from defects in lymphocyte maturation or actiuation or from defects in the effector mechanisms of innate and adaptiue immunity. Immunodefi ciency diseasesare clinically and pathologically heterogeneous, in part because different diseasesinvolve different components of the rmmune system. O Paradoxically,certain immunodeficiencies are associated with an increased incidence of autoimmunity. The mechanism underlying this association is not known; it may reflect a deficiency of regulatory T lymphocyes that normally serve to maintain self-tolerance. In this chapter, we first describe congenital immunodeficiencies, including defects in the humoral and cellmediated arms of the adaptive immune system and defectsin components of the innate immune system.We conclude with a discussion of acquired immunodeficiencies, with an emphasis on AIDS.
(Pnlunny)IMMUN0DEFtctENctES CorucrrurrRr The first inherited immunodeficiency to be described, in 1952, was a disease called X-linked agammaglobulinemia that affects boys and is now knornrnto be caused by a defect in B lymphocyte development (seebelow). Since then, a large number of other congenital immunodeficiencies have been described, and the genetic bases of many of these disorders are now knor,tm.This understanding has led to an increased hope for gene replacement as therapy for these diseases. In dffirent immunodeficiencies, the primary abnormality may be in components of the innate immune system, at dffirent stages of lymphocyte maturation, or in the responses of mature lymphocytes to antigenic stimulation Inherited abnormalities affecting innate immunity generally affect the complement pathway or phagocytes.Abnormalities in lymphocyte development may be caused by mutations in genesencoding a variety of molecules, including enzymes and transcription factors. These inherited defects, and the corresponding targeted disruptions in mice, have been useful in elucidating the mechanisms of lymphocyte development (see Chapter 8). Abnormalities in B ll.rnphoclte development and function result in deficient antibody production and increased susceptibility to infection by extracellular microbes, particularly encapsulated bacteria. B cell immunodeficiencies are diagnosed by reduced levels of serum immunoglobulin (Ig), defective antibody responses to vaccination, and, in some cases, reduced numbers of B cells in the circulation or lymphoid tissues or absent plasma cells in tissues (seeTable 20-l). Abnormalities in T lymphocyte maturation and function lead to deficient cell-mediated immunity and an increased incidence of infection with intracellular microbes. Deficiencies of helper T cells may also result in reduced antibodyproduction. PrimaryT cell immunodeficiencies are diagnosed by reduced numbers of peripheral blood T
IM DM U N 0 D E F I C I E N C I E S465 C h a p t e2r0- C 0 N G E N I TAANLDA C O U I R E
cells, low proliferative responses of blood lymphocytes to polyclonal T cell activators such as phytohemagglutinin, and deficient cutaneous delayed-type hypersensitivity (DTH) reactions to ubiquitous microbial antigens, such as Candida antigens. In the following sections, we describe immunodeficiencies caused by inherited mutations in genes encoding components of the innate immune system, or of genes required for lymphocyte development and activation. We conclude with a brief discussion oftherapeutic strategiesfor these diseases. Defects in Innate lmmunity Innate immunity constitutes the first line of defense against infectious organisms. TWo important mediators of innate immunity are phagocytes and complement, both of which also participate in the effector phases of adaptive immunity. Therefore, congenital disorders of phagocytes and the complement system result in recurrent infections. Complement deficiencies were described in Chapter 14 (see Box l4-2). They typically present with recurrent bacterial infections, particularly by Neisseriaespecies, and often also contribute to susceptibility to autoimmune disorders, particularly systemic lupus erl.thematosus. Deficiencies have been described in the classical and alternative complement pathways, as well as in the lectin pathway. Mannosebinding lectin (MBL) is absent in a high frequency of individuals (up to 5% in some studies), and while some MBl-deficient patients present with recurrent infections, mosl are asvmptomatic.
In this section of the chapter, we discuss some examples of congenital phagocyte disorders (Table 20-2). Defective Microbicidal Activities of Phagocytes: Chronic Granulomatous
Disease
Chronic granulomatous disease (CGD) is a rare disease, estimated to affect about I in I million individuals in the United States. About two thirds of cases show an Xlinked recessivepattern of inheritance, and the remainder are autosomal recessive. CGD is caused by mutations in components of the phagoclte oxidase (phox) enzyme complex. The most common X-linked form of the diseaseis caused by a mutation in the gene encoding the 91-kD o subunit of cltochrome bsse,?rr integral membrane protein also knornrnas phox-91. This mutation results in defective production of superoxide anion, a reactive oxygen speciesthat constitutes a major microbicidal mechanism of phagocltes (seeChapter 2). Mutations in other components of the phox complex contribute to autosomal-recessive variants of CGD. Defective production of reactive oxygen species results in a failure to kill phagocltosed microbes. The diseaseis characterized by recurrent infections with catalaseproducing intracellular bacterial and fungi, usually from early childhood. (Many of the organisms that are particularly troublesome in CGD patients produce catalase, which destroy the microbicidal hydrogen peroxide that may be produced by the microbes themselves or by host cells.) Because the infections are not controlled by phagocytes, they stimulate chronic cell-mediated
Table2O-2.CongenitalDisordersof Innatelmmunity
Disease
Functionaldeficiencies
Mechanismof defect
Chronic granulomatous disease
Defectiveproduction of reactiveoxygenspecies by phagocytes; and recurrent intracellular bacterial fungalinfections
Mutation in genesof phagocyte phox-91 oxidasecomplex; (cytochrome b5564subunit) form is mutatedin X-linked
Leukocyte adhesion deficiency type1
Defectiveleukocyteadhesionand migrationlinkedto decreased or absentexpression of B2integrins; recurrent bacterial andfunoalinfections
the in geneencoding Mutations p chain(CD18)of B2integrins
Leukocyte adhesion deficiency type2
linkedto Defective leukocyte andmigration adhesion ligands decreased or absentexpression of leukocyte for endothelial E- andP-selectins causingfailureof leukocyte bacterial migration intotissues;recurrent andfungalinfections
in geneencoding a Mutations transpofter GDPJucose of the forthesynthesis required of sialylLewisxcomponent ligands E- and P-selectin
Ch6diak-Higashi syndrome
functionin Defective vesiclefusionandlysosomal neutrophils, dendritic cells,natural macrophages, killercells,cytotoxic T cells,andmanyothercelltypes; recurrentinfections by pyogenicbacteria
Mutationin LYSTleading to defectin secretorygranule exocytosis and lysosomal function
Toll-likereceptor signaling defects
Recurrentinfectionsbecauseof defectsin TLR and CD40 signaling
Mutations in NEMO,kBs,,and NF-rB IRAK4comoromise of activationdownstream Toll-like receptors
traffickingregulatorprotein; Abbreviations; lRAK4,lL-1 receptorassociated kinase4; LYST,lysosomal NEMO,NF-rBessential modulator.
466
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VSection
IMMUNITY lN DEFENSE ANDDISEASE
immune responses resulting in T cell-mediated macrophage activation and the formation of granulomas composed of activated macrophages. Presumably, these activated macrophages try to limit or eliminate the microbes despite defective production of reactive oxygen species.This histologic appearance is the basis for the name of the disorder. The disease is often fatal, even with aggressive antibiotic therapy. The cytokine interferon-T (IFN-y) enhances transcription of the phox-91 gene and also stimulates other components of the phagoclte oxidase enzyme complex. Therefore, IFN-y stimulates the production of superoxide by normal neutrophils, as well as CGD neutrophils, especially in cases in which the phox-91 gene is intact but its transcription is reduced. Once neutrophil superoxide production is restored to about l}Vo of normal Ievels, resistanceto infection is greatly improved. IFN-y therapy is now commonly used for the treatment of X-linked CGD.
Leukocyte Adhesion
Deficiencies
Leukocyte adhesion deficiency type I (l-A,D-l) is a rare autosomal-recessivedisorder characterizedby recurrent bacterial and fungal infections and impaired wound healing. In these patients, most adhesion-dependent functions of leukocytes are abnormal. These functions include adherence to endothelium, neutrophil aggregation and chemotaxis, phagocytosis, and cytotoxicity mediated by neutrophils, natural killer (NK) cells, and T lymphocyes. The molecular basis of the defect is absent or deficient expression of the B, integrins (heterodimers of CDIS and the CDll family of glycoproteins) due to various mutations in the CDIS gene. The B, integrins include leukoclte function-associated antigen- I (LFA-1 or CDllaCDlS), Mac-l (CDllbcDf8), and p150,95 (CDf lcCDlS). These proteins participate in the adhesion of leukocytes to other cells, notably endothelial cells, and the binding of T lymphocltes to APCs (see Chapter 2,Box2-3). LAD-? is another rare disorder that is clinically similar to tAD-l but is not due to integrin defects. In contrast, IAD-2 results from an absence of sialyl Lewis X, the tetrasaccharidecarbohydrate ligand on neutrophils that is required for binding to E-selectin and P-selectin on cytokine-activated endothelium (see Chapter 2, Box 2-2). This defect is caused by a mutation in a fucose transporter gene. The failure to transport fucose into the Golgi complex results in failure to slmthesize sialyl Lewis X. The result is defective binding of neutrophils to endothelium and defective recruitment of the leukocltes to sites of infection.
Defects in NK Cells and Other Leukocytes: The Ch6diak-Higashi Syndrome The Chddiak-Higashi syndrome is a rare autosomalrecessivedisorder characterized by recurrent infections by pyogenic bacteria, partial oculocutaneous albinism, and infiltration of various organs by non-neoplastic l]..rn-
phocytes.The neutrophils, monocytes, and lymphocytes of these patients contain giant lysosomes. This disease is caused by mutations in the gene encoding the lysosomal-trafficking regulator protein LYST,resulting in defective phagosome-lysosome fusion in neutrophils and macrophages (causing reduced resistance to infection), defective melanosome formation in melanocytes (causing albinism), and lysosomal abnormalities in cells of the nervous system (causing nerve defects) and platelets (leading to bleeding disorders). The giant lysosomes found in neutrophils form during the maturation of these cells from myeloid precursors. Some of these neutrophil precursors die prematurely, resulting in moderate leukopenia. Surviving neutrophils may contain reduced levels of the lysosomal enzymes that normally function in microbial killing. These cells are also defective in chemotaxis and phagocltosis, further contributing to their deficient microbicidal activity. NK cell function in these patients is impaired, probably because of an abnormality in the cytoplasmic granules that store proteins mediating cltotoxicity. The defect in cytotoxic T lyrnphocyte (CTL) function seen in some patients is relatively mild, but other patients have a more pronounced CTL defect. A mutant mouse strain called the beige mouse is an animal model for the Ch6diak-Higashi syndrome. This strain is characterized by deficient NK cell function and giant lysosomes in leukocytes. The beige mutation has been mapped to the mouse IYSI locus. Other mutations that affect both CTL and NK cell function will be considered below when we discuss defects in T lymphocyte activation and function. A mutation in CD16/FcyRIII, the Fc receptor on NK cells that is required for antibody-dependent cellular cytotoxicity (seeChapter 14),has been described in a subject with recurrent viral infections.
lnherited Defects in Toll-like Receptor Pathways and Nuclear Factor rB Signaling A naturally occurring mutation in Toll-like receptor 4 (TLR4) has been described in lps mice. In humans, more global inherited defects in TLR signaling have been described. Some immune deficiencies are caused by defects in signaling pathways downstream of TLRs. Mutations in the inhibitor of rB kinase ^J(IKI(1), also knovm as nuclear factor rB essential modulator (NEMO), a component of the kB kinase complex, contribute to the X-linked recessive condition known as anhidro tic ectoder mal dysplasia with immuno defi ciency (EDA-ID).IKKy/NEMO is required for NF-rB activarion, and point mutations that partially impair NEMO function contribute to a disorder in which differentiation of ectoderm-derived structures is abnormal and immune function is impaired in a number of ways. Responsesto TLR signals as well as CD40 signals are compromised. These patients suffer from infections with encapsulated pyogenic bacteria, as well as with intracellular bacterial pathogens including mycobacteria, viruses, and fungi
IMMUNODEFICIENCIES ANDAC0UIRED Chaoter 20- C0NGENITAL
such as Pneumocystis jiroueci (previously known as Pneumocystis cariniD. An autosomal-recessiveform of EDA-ID has been described in which a hypermorphic point mutation in kBo prevents the phosphorylation, ubiquitinlation, and degradation of kBo, thus leading to impaired NF-rB activation. Another immunodeficiency state in which recurrent bacterial infections are observed is linked to mutations in the IRAK-4 gene. Interleukin-1 receptor-associated kinase 4 (IRAK-4)is a critical kinase dor.trnstreamof TLRs and the interleukin-l (IL-l) receptor (see Chapter 2). Defective TLR and IL-l receptor signaling presumably contributes to the relatively mild immunodeflciencv in these patients.
Pro-T
RAG|, RAG2 Pre-TCR pre-BCR ARTEMIS cnecKPolnlcheckpoint BTK, ?u5,lga lqt chain, BLNK
Severe Gombined lmmunodeficiencies In this section, we focus on congenital immunodeficiencies in humans that are known to result from impaired progression at various checkpoints during T lymphoclte development with or without defects in B cell maturation (Fig. 20-1). Disorders that affect both humoral and cell-mediated immunity are called severe combined immunodeficiencies (SCIDs) (Table 20-3). These diseasesare characterized by deficiencies ofboth B and T cells, or onlyT cells; in the latter cases,the defect in humoral immunity is due to the absence of T cell help. Children with SCID usually have infections during the first year of life and succumb to these infections unless they are treated. The process of T (and B) lymphocyte maturation from hematopoietic stem cells to functionally competent mature lyrnphocytes involves proliferation of early lymphoclte progenitors, rearrangement of the locus encoding one chain of the antigen receptor followed by selection of cells that have made in-frame productive rearrangements at a preantigen receptor checkpoint, expression ofboth chains of the antigen receptor, and selection of cells with useful speciflcities (see Chapter B). Defects in many of these steps have been described in different forms of SCID. Immunodeficiencies Linked to Defective Cytokine Receptor Signaling: X-Linked SCID Caused by Mutations in the Cytokine Receptor Common y Chain Approximately 50% of SCID casesare X-linked and due to mutations in the gene encoding the common T (yc) chain shared by the receptors for the interleukins IL-2, lL-4,1L-7,IL-9, and IL-15 (seeChapter 12).Thesemutations are recessive,so heterozygous females are usually phenotlpically normal carriers, whereas males who inherit the abnormal X chromosome manifest the disease.Because developing cells in females randomly inactivate one of the two X chromosomes, the normal allele encoding a functional y6 protein will not be expressed in half the l1'rnphocyte precursors in a female carrier. These cells will fail to mature, and consequently, all the mature llrnphocytes in a female carrier will have inactivated the same X chromosome (carrying the mutant allele). In contrast, half of all nonlyrnphoid cells
Cyclingpre-T ts H
W DPT cells
T cells
T cells
MZB
B-18
FIGUFE 2O-1 lmmunodeficiencycaused by delects in B and T caused by genetic cell maturation.Primaryimmunodeficiencies defects in lymphocytematurationare shown These defects (in italics)may affectT cell maturationalone,B cell maturationalone, or both The survivalof all lymphocyteprogenitorpopulations requiresthe purinesalvagepathwayenzymes,ADA,and PNP lL-7R andJAK3)is requiredfor humanpro-Tcellgensignaling(y6,lL-7Rcr,, machinery(RAG-1 eration The V(D)Jrecombination , RAG-2,and pre-Band pre-Tcells,as is sigis requiredfor generating ARTEIVIS) for pre-Tcells nalingthroughthe pre-TCR(CD45,CD3)specifically and the pre-BCR(lgp chain,1.5,lgo, and BLNK)for pre-Bcells.DP, stem FoB, follicularB cells; HSC, hematopoietic double-positive; c e l l ;M Z B ,m a r g i n azlo n eB c e l l s .
will have inactivated other. A comparison
and half the one X chromosome, of X chromosome inactivation in
lyrnphoid cells versus nonlyrnphoid cells may be used to identify carriers of the mutant allele. The nonrandom use of X chromosomes in mature lymphocytes is also characteristic of female carriers of other X-linked mutations of genes that affect lyrnphocyte development, as discussed later. X-linked SCID is characterized by impaired maturation of T cells and NK cells and greatly reduced numbers of mature T cells and NK cells, but the number of B cells is usually normal or increased. The humoral immunodeficiency in this disease is due to a lack of T cell help
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I M M U N I Tl N Y D E F E NA SN E DD I S E A S E
Table20-3. SevereCombinedlmmunodeficiencies
Disease
Functionaldeficiencies
Mechanismof defect
A. Defectsin cytokinesignaling Markeddecrease in T cells;normalor X-linked SCID increased B cells;reducedserumlg
Markeddecrease in T cells;normalor Autosomal increased B cells;reducedserumlg recessiveforms B. Defectsin nucleotide salvagepathways
ADA deficiency
receptor commony chainmutations; Cytokine T celldevelooment in theabsence defective of lL-7derivedsionals Mutationsin ll-2Rcrchain.lL-7Rochain. JAK3
Progressive decrease in T, B, andNKcells; reducedserumlg
ADAdeficiency leadingto accumulation of toxicmetabolites in lymphocytes
Progressive in T, B, andNK cells; decrease reducedserumlg
PNP deficiencyleadingto accumulationof toxic metabolitesin lymphocytes
C. Defectsin V(D)Jrecombination Decreased T and B cells;reducedserumlg; RAG1or RAG2 absenceor deficiency of T andB cells deficiency* T andB cells;reducedserumlg; ARTEMISdefects* Decreased absenceor deficiency of T andB cells
D. Defective thymusdevelopment T cells;normalor reducedB cells; Defectivepre-TCR Decreased reducedserumlg checkpoint Decreased T cells;normalB cells;normalor DiGeorge reducedserumlg syndrome
CleavagedefectduringV(D)J recombination; mutationsin RAG1 or RAG2
Failureto resolvehairpins duringV(D)J recombination; mutations in ARTEMIS
Mutations in CD45,CD36,CD3e,Orail (CRACchannelcomponent) 22q11 deletion; T box-1(TBX1) transcription factormutations
E. Otherdefects Heticular dysgenesis
Decreased T, B, andmyeloidcells
Mutation notidentified
Abbreviations; ADA, adenosinedeaminase;CRAC, calciumreleaseactivatedchannel; PNP, purinenucleosidephosphorylase.
.Hypomorphic mutations in RAGgenesandin ARTEMIS cancontribute to Omennsyndrome. l
for antibody production. This disease is a result of the inability of the lymphopoietic cltokine IL-7, whose receptor uses the y6 chain for signaling, to stimulate the growth of immature thymocytes. In addition, the receptor for IL-15, which is a potent stimulus for the proliferation of NK cells, also usesthe y6signaling chain, and the failure of IL-15 function accounts for the deficiencv of NK cells.
Box l2-2). Knockout mice lacking the y6 chain, IL-7, the cytokine-binding cr chain of the IL-7 receptor, or JAK3 develop a disease similar to human X-linked SCID, although B cell maturation is decreasedmore in mutant mice than in human SCID patients.
Autosomal-Recessive Mutations in Cytokine Signaling that Lead to Impaired T Cell Development
About 507oof patients with SCID show an autosomalrecessivepattern of inheritance, and many of these cases are due to deficiency of an enzyrne called adenosine deaminase (ADA). ADA functions in the salvage pathway of purine synthesis and catalyzesthe irreversible deamination of adenosine and 2'-deoxyadenosine to inosine and 2'-deoxyinosine, respectively. Deficiency of the enzyme leads to the accumulation of deoxyadenosine and its precursors S-adenosylhomocysteine and de-
Some patients with a diseaseidentical to X-linked SCID show an autosomal-recessive inheritance. These patients have mutations in the IL-7 receptor cxchain or the JAK3 kinase, which associateswith the y6 chain and is required for signaling by this protein (see Chapter 12,
Severe Combined lmmunodeficiency Linked to Defects in Purine Salvage Pathways
DMUN0DEFICIENCIES C h a o t e2r0- C 0 N G E N I TAANLDA C 0 U I R EI M
oxyadenosine triphosphate (dAIP). These by-products have many toxic effects, including inhibition of DNA synthesis. Although ADA is present in most cells, developing lymphocltes are less efficient than most other cell ty?es at degrading dAIP into 2'-deoxyadenosine, and therefore lymphocyte maturation is particularly sensitive to ADA deficiency. ADA deficiency leads to reduced numbers of B and T cells; lynphocyte cell numbers are usually normal at birth but fall off precipitously during the flrst year of life. A few patients may have a nearly normal number of T cells, but these cells do not proliferate in response to antigenic stimulation. A rarer autosomal-recessiveform of SCID is due to the deficiency of another enzyrne, called purine nucleoside phosphorylase (PNP), that is also involved in purine catabolism. PNP catalyzes the conversion of inosine to hypoxanthine and guanosine to guanine, and deficiency of PNP leads to the accumulation of deoryguanosine and deoxyguanosine triphosphate, with toxitlffects on immature lymphocltes, mainly T cells. Severe Combined Immunodeficiency to Defects in V(D)J Becombination
Linked
Mutations in the RAGI or MG2 genes [whose protein products mediate the cleavagestep duringV(D)J recombinationl or the ARTEMIS gene, which encodes an endonuclease that resolves coding-end hairpins during V(D)J recombination, account for a large number of the autosomal-recessive forms of SCID. The normal functions of these genes are discussed in Chapter 8. In children with these mutations, B and T lgnphocytes are absent and immunity is severely compromised. Hypomorphic mutations in the RAG genes, in ARTEMIS, and in IL-7Rcrcan contribute to a disorder characterized by restricted generation of T and B cells, immunodeficiency and immune dysregulation. This disorder is knor.tm as Omenn's syndrome. It is possible that this immune dyscrasia, in which immunodeficiency coexists with exaggerated immune activation and autoimmunity, may reflect the relative absence of regulatoryT cells. An instructive experimental model is the SCID mouse, in which B and T cells are absent because of an early block in maturation from bone marrow precursors. The defect in SCID mice is a mutation in the catalytic subunit of a DNA-dependent protein kinase, which is required for double-stranded break repair during V(D)J recombination (seeChapter B).This defect results in the failure of B and T cell development. Defective Pre-TCR Checkpoint
Signaling
Although most autosomal-recessiveforms of SCID are linked to mutations in,4DA, RAGI, RAG2, andARTEMIS, rare forms of this slndrome have been linked to mutations in the genes encoding CD45 and the CD3 6 or e chains. Another rare form of SCID is caused by mutation in a gene encoding Orail, a component of CRAC channels (see Chapter 9). Activation of antigen receptors as well as pre-antigen receptors leads to the activation of the y isoform of phospholipase C (PLCy)and the inositol
triphosphate (IPJ-dependent release of calcium ions from the endoplasmic reticulum and mitochondria (see Chapter 9). The released calcium is replenished by store-operated CRAC channels that facilitate an influx of extracellular calcium, and this process is crucial for lymphocyte activation, and it is defective in cells with mutant Orail. Defective Thymic Development: DiGeorge's Syndrome This selectiveT cell deficiency is due to a congenital malformation that results in defective development of the thymus and the parathyroid glands as well as other structures that develop from the third and fourth pharyngeal pouches during fetal life. The congenital defect is manifested by hypoplasia or agenesis of the thymus leading to deficient T cell maturation, absent parathyroid glands causing abnormal calcium homeostasis and muscle twitching (tetany), abnormal development of the great vessels, and facial deformities. Different patients may show varying degrees of these abnormalities. The diseaseis caused by a deletion in chromosome 22q11.2. Mutations in a gene encoding a transcription factor called T box-l (TBXI), which lies within the deleted region, also result in a similar defect in thymic development. It is likely that the immunodeficiency associated with DiGeorge's syndrome can be explained, at least in part, by the deletion of the TBXL gene. In this slmdrome, peripheral blood T lyrnphocytes are absent or greatly reduced in number, and the cells do not respond to polyclonal T cell activators or in mixed leukocyte reactions. Antibody levels are usually normal but may be reduced in severely affected patients. As in other severe T cell deficiencies, patients are susceptible to mycobacterial, viral, and fungal infections. The immunodeficiency associated with DiGeorge's syndrome can be corrected by fetal thymic transplantation or by bone marrow transplantation. Such treatment is usually not necessary, however, because T cell function tends to improve with age and is often normal by 5 years. Improvement with age probably occurs because of the presence of some thymic tissue or because some as yet undefined extrathymic sites assume the function of T cell maturation. It is also possible that as these patients grow older, thymus tissue develops at ectopic sites (i.e.,other than the normal location). An animal model of T cell immunodeficiency resulting from abnormal development of the thgnus is the nude (athymic) mouse. These mice have an inherited defect of certain types of epithelial cells in the skin, leading to hairlessness, and in the lining of the third and fourth phanTngeal pouches, causing thymic hypoplasia. The disorder is due to a mutation in the FoxNl gene encoding a Forkhead family transcription factor that is required for the normal development of certain ectoderm-derived cell types. Affected mice have rudimentary thymuses in which T cell maturation cannot occur normally. As a result, few or no mature T cells are present in peripheral lymphoid tissues, and cellmediated immune reactions cannot occur.
o:.:o
v - tMMUNtTy tNDEFENSE ANDDrsEAsE
t ,_::"'"
Reticular Dysgenesis and SCID A particularly severe form of SCID is seen in a disease called reticular dysgenesis. This disorder is characterized by the absence of T and B lymphocytes and most myeloid cells, including granulocytes,and is presumably due to a defect in the hematopoietic stem cell. This disease is rare, and neither its molecular basis nor its mode of inheritance is known. Antibody Deficiencies: Defects in B Cell Development and Activation \Mhile defects in T cell development or in both T and B cell development contribute to the SCID phenotype, more circumscribed defects in B cell development or function result in disorders in which the primary abnormality is in antibody synthesis (Table 20-4 and
Fig. 20-2). However, in one subset of hyper-IgM syndromes discussed below, antibody deficiencies are also accompanied by defects in macrophage and antigenpresenting cell (APC) activation, which in turn result in attenuated cell-mediated immunitv.
An X-linked Pre-B Cell Receptor Signaling Defect: X-Linked Agammaglohulinemia X-linked agammaglobulinemia, also called Bruton's agammaglobulinemia, is characterized by the absence of gamma globulin in the blood, as the name implies. It is one of the most common congenital immunodeficiencies and the prototlpe of a failure of B cell maturation. The defect in X-linked agammaglobulinemia is a failure of B cells to mature beyond the pre-B cell stage in the bone marrow (seeFig. 20-1). This failure is causedby
Table20-4. Antibody Deficiencies
Disease
Functionaldeficiencies
Mechanismof defect
A.Agammaglobulinemias X-linked
Autosomal recessive forms
Decrease in all serumlg isotypes; reducedB cellnumbers Pre-Breceptor checkpoint defect;Btkmutation Decrease in all serumlg isotypes; reducedB cellnumbers Pre-Breceptorcheckpoint defect;mutations in lgMheavy chain(p),surrogate lightchains (1,5), lga, BLNK
B. Hypogammaglobulinemias/isotype defects Decreased lgA;maybe associated withincreased susceptibility to bacterial infections andprotozoa suchas Giardialamblia Increased susceptibility Selective to bacterial infections lgG2 deficiency CommonVariable Hypogammaglobulinemia; normalor decreased lmmunodeficiencvB c e l l n u m b e r s
(cvrD)
Hypogammaglobulinemia, ICFsyndrome occasionalmild T cell defects C. Hyper-lgM syndromes
Autosomal recessivewithcellmediated immune defects Autosomal
Mutations in TACIin some patients Smallsubsethave deletionin lgH y2 locus
Mutations in ICOSandTACIin someoatients Mutations in DNMT3B
Defectsin T helpercell-mediated B cell,macrophage and dendritic cellactivation, defectsin somaticmutation, classswitching, andgerminal centerformation; defective cell-mediated immunitv
Mutation in CD40L
Defectsin T helpercell-mediatedB cell, macrophageand dendriticcell activation;defectsin somaticmutation, class switching,and germinalcenterformation;defective cell-mediatedimmunity
Mutations in CD40,NEMO
Defectsin somaticmutationand isotypeswitching i..tl,t,:::l'
recessivewithl..,:r;,: antibodydefectonlV
Mutations inAlD,UNG
AlD,Activation-induc_ed cytidine deaminase; DNMT3B, DNAmethyltransferase 3B; fppryvlatlons: ICOS,inducible costimulator; NEMO,NFrB essential modulator; TACI,transmembrane activator ano calciummodulator andcyclophilin ligandinteractor; UNG,uracilN-glycosylase.
IMMUNODEFICIENCIES ANDAC0UIRED 20- C0NGENITAL Chaoter
Activated "licensed" Naive cD8+ APC T cell
Resting
Defectsin TCR plexsignaling Naive T cell
SAP(XLP Perforin(HLH RAB27A(HLH (HLH UNC13-4
Activated T cells
CD40ligand,CD40, NEMOmutations (hyper-lgM syndrome) Helper T-cell
B cell
rcos(cvrD) Antibodyproducing B cell
cD8+ T cell
syndrome) AlD,UNG(hyper-lgM TACI(CVlD,SelectivelgA deficiency) may be causedby genetic FIGURE 20-2 lmmunodeficiency causedby defectsin B and T cell activation.Primaryimmunodeficiencies activationof B cellsand antigen defectsin moleculesrequiredfor T or B lymphocyteantigenreceptorsignaling, for helperT cell-mediated (CVID)has a presentingcells (APCs),or for the activationof cytotoxicT lymphocytesand NK cells Commonvariableimmunodeficiency activatorand calciummodulatorand numberof causes,includingmutationsin ICOS(induciblecostimulator) and TACI (transmembrane ligandinteractor). cyclophilin TACImutationsare alsoa frequentcauseof selectivelgA deficiencyPatientswith hyper-lgMsyndromewho B cell harbormutationsin the CD40signalingpathway(CD4OligandICD4OL], CD40,or NEMO)havedefectsin both T helpercell-mediated activationand the activationof APCsand cell-mediated immunity.The most frequentlymutatedgene causingthe hyper-lgMsyndromeis the CD40Lgene,which is X-linkedMutationsin the enzymesAID and in UNG causehyper-lgMsyndromesthat onlyaffect B cells lvlutations in a signalingmolecule(SAP),in perforin,and in genes encodingproteinsinvolvedin granuleexocytosis,such as Rab27A,and the (HLH) Rab2lA bindingproteinMUNC13-4,are all causesof hemophagocytic lymphohistiocytosis
mutations or deletionsin the geneencodingan enzyme called Bruton tyrosine kinase (Btk). Btk is involved in transducingsignalsfrom the pre-B cell receptor (preBCR)that are required for the suryival and differentiation of pre-B cells (seeChapter8). In femalecarriersof this disease,only B cellsthat haveinactivatedthe X chromosome carrying the mutant allele mature. Unlike the casewith X-linkedSCID,describedearlier,this nonrandom X chromosomeinactivationis not seenin T cells. Patients with X-linked agammaglobulinemia usually havelow or undetectableserumIg, reducedor absentB cellsin peripheralblood and lymphoid tissues,no germinal centersin lgnph nodes,and no plasmacells in tissues.The maturation,numbers, and functions of T cells are generallynormal. Some studies have revealed reducednumbersof activatedT cellsin patients,which may be a consequenceof reducedantigenpresentation causedby the lack of B cells.Autoimmune disorders developin almost 20%of patients,for unknor,rmreasons. The infectiouscomplicationsof X-linked agammaglobulinemiaaregreatlyreducedby periodic(e.g.,weeklyor monthlp injectionsof pooledgammaglobulinpreparations. Suchpreparationscontain preformedantibodies against common pathogensand provide effectivepassiveimmunity.
Autosomal-Recessive Pre-B Cell Receptor Checkpoint Defects Autosomal-recessiveforms of agammaglobulinemia have been described,most of which can be linked to defects in pre-BCR signaling. Mutant Senes that have been identified in this context include the p (IgM heavychain) gene,the /.5 surrogatelight chain gene,the Iga gene,which encodesa signaling component of the pre-BCRand BCR,and the BIIy'K gene,which encodes an important adapter dolrmstreamof the pre-BCRand BCR. Knockout mice lacking Btk, as well as naturally Btkmutant Xld mice, show a lessseveredefectin B cell maturation than humans do because a Btk-like tylosine kinasecalledTecis activein mouse pre-B cells that lack Btk. The main abnormalities in Xid mice are defective antibody responsesto some polysaccharideantigens and a deficiencyin mature follicular and B-l B cells. Selective Immunoglobulin lsotype Deficiencies Many immunodeficienciesthat selectivelyinvolve one or a few Ig isotypeshave been described.The most
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IMMUNITY lN DEFENSE ANDDISEASE
common is selective IgA deficiency, which affects about I in 700 caucasian individuals and is thus the most common primary immunodeficiency knor,r,n.IgA deficiency usually occurs sporadically, but many familial caseswith either autosomal-dominant or recessivepatterns of inheritance are also known. The clinical features are variable. Many patients are entirely normal; others have occasional respiratoryinfections and diarrhea; and rarely, patients have severe,recurrent infections leading to permanent intestinal and airway damage, with associated autoimmune disorders. IgA deficiency is characterized by low serum IgA, usually less than 50pg/ml (normal, 2 to 4mglmL), with normal or elevated levels of IgM and IgG. The defect in these patients is a block in the differentiation of B cells to IgA antibody-secreting plasma cells. The a heavy chain genes and the expression of membrane-associated IgA are normal. No gross abnormalities in the numbers, phenotypes, or functional responses of T cells have been noted in these patients. In a small proportion of patients with selective IgA deficiency, mutations have been described in TACI (transmembrane activator and calcium modulator and cyclophilin ligand interactor), one of the three types of receptors for the cytokines BAFF (B cell activating factor) and APRIL (a proliferation-inducing ligand). MCI mutations are also an important cause of common variable immunodeficiency (CVID), discussed below IgA deficiency may represent a forme fruste of CYID. Selective IgG subclass deficiencies have been described in which total serum IgG levels are normal but concentrations of one or more subclasses are below normal. Deficiencyof IgG3 is the most common subclass deficiency in adults, and IgG2 deficiency associatedwith IgA deficiency is the most common in children. Some individuals with these deficiencies have recurrent bacterial infections, but many do not have any clinical problems. SelectiveIgG subclass deficiencies are usually due to abnormal B cell differentiation and rarely to homozygous deletions of various constant region (Cr) genes. Defects in B Cell Differentiation: Com mon Vari able I m m u n odeficiency Common variable immunodeflciency is a group of heterogeneousdisorders defined by reduced levels ofserum Ig, impaired antibody responsesto infection or vaccines, and increased incidence of infections. The diagnosis is usually one of exclusion when other primary immunodeficiency diseasesare ruled out. The presentation and pathogenesis are, as the name implies, highly variable. Although Ig deficiency and associated pyogenic infections are major components of these disorders, autoimmune diseases,including pernicious anemia, hemolytic anemia, and rheumatoid arthritis, may be just as significant. A high incidence of malignant tumors is also associated with common variable immunodeficiency. These disorders may be diagnosed early in childhood or late in life. Both sporadic and familial cases occur, the latter with both autosomal-dominant and -recessive inheritance patterns. Mature B lymphocl'tes are present in these patients, but plasma cells are absent in lymphoid
tissues, which suggestsa block in B cell differentiation to antibody-producing cells.The defective antibody production has been attributed to multiple abnormalities, including intrinsic B cell defects, deficient T cell help, and excessive"suppressor cell" activity. A small proportion of patients with CMD have a shared deletion in the /COS (inducible T cell costimulator) gene. A more common cause of this syndrome is the existence of mutations in TACI, described above in the context of selective IgA defi ciency. Hypogammaglobulinemia is also a feature of a distinct syndrome of immunodeficiency,centromeric instability, and facial anomalies (ICF) linked to mutations in the Dl/A methyltransferase 38 gene, which is a major participant in the de novo methylation of DNA. How DNA hypomethylation contributes to immunodeficiency is not understood. Defects in T Cell-Dependent B Cell Activation: Hyper-lgM Syndromes The X-linked hyper-IgM syndrome is a rare disorder associated with defective switching of B cells to the IgG and IgA isotypes;these antibodies are therefore reduced, and a compensatory increasein IgM in the blood occurs. The defect is caused by mutations in the gene encoding the T cell effector molecule CD40 ligand. The mutant forms of CD40 ligand produced in these patients do not bind to or transduce signals through CD40 and therefore do not stimulate B cells to undergo heavy chain isotype switching, which requires T cell help (see Chapter 10). Patients suffer from infections similar to those seen in other hypogammaglobulinemias. Patients with X-linked hyper-IgM s1'ndromealso show defects in cell-mediated immunity (seeChapter 13),with a striking susceptibility to infection by the intracellular fungal microbe Pneumocystisj iroueci. This defective cell-mediated immunity occurs because CD40 ligand is also involved in T cell-dependent activation of macrophages and dendritic cells (see Chapter 13). Knockout mice lacking CD40 or CD40ligand have a phenotype similar to that of the human disease. Rare cases of hyper-IgM symdrome show an autosomal-recessive inheritance pattern. In these patients, the genetic defects may be in CD40 or in the enzyme activation-induced deaminase (AID) that is involved in heaqr chain isotype switching and somatic mutation (see Chapter 10). One form of the hlper-IgM syndrome is caused by autosomal-recessivemutations in uracil N glycosylase(UNG; see Chapter 10), an enzyme that removes U residues from Ig genes during class switching and somatic mutation. An inherited disorder, EDA-ID, in which hypomorphic NEMO mutations contribute to a hlper-IgM state as well as defects in ectodermal structures, is described above in the section on TLR signaling defects. Defects in T Lymphocyte and Function
Activation
Congenital abnormalities in the activation of T lymphocltes are being increasingly recognized as our under-
C h a o t e2r0
AA NLDA C 0 U I R EI M D M U N 0 D E F I C I E N C I E S4 7 3 CONGENIT
Table 20-5. Defectsin T Cell Activation
Disease
Mechanismof defect
Functionaldeficiencies
A. Defectsin MHCexpression factorsregulating in transcription DefectiveMHC class ll expressionand deficiency Defects including in CD4+T cells;defectivecell-mediatedimmunity, MHCclassll geneexpression, RFXS,and RFXAP CllTA,RFXANK, and T-deoendenthumoralimmuneresponses Decreased MHCclassI levels;reduced MHCclassI CD8+T cells deficiency B. Defective T cellsignaling
in TAPl,TAP2, Mutations andtapasin
Defectsin cell-mediatedimmunityand T-dependenthumoralimmunity
in CD3genes,CD45 Mutations
Defective T cellactivation, leukocytemobility
actin-cytoskeletal TCR dependent are defectivebecause rearrangements in WASP of mutations
lymphohistiocytoses C. Familialhemophagocytic
rX-tinrcd.t...
UncontrolledEBV inducedB cell proliferation, uncontrolledmacrophageand CTL activation, defectiveNK cell and CTL function
in SAP Mutations
Uncontrolled macrophage and CTLactivation, defective NK cellandCTLfunction
in perforin Mutations
Uncontrolledmacrophageand CTL activation, defectiveNK cell and CTL function
Defectivecytotoxicgranuleexocytosis; MUNCl3-4(andin in RAB27A, mutations syndrome LYSTin Ch6diak-Higashi - seeTable20-2)
protein;. Abbreviations; LYST,lysosomaltrafficking regulatorprotein;SAP,SLAM-associated protein. syndrome TAP,transporter associated withantigenproCessing; WASP,Wiskott-Aldrich
standing of the molecular basis of lymphocyte activation improves (Table 20-5). Included in this broad category are some disorders of CTL and NK cell granule composition or exocytosis.
cells in the periphery. Affected individuals are deficient in DTH responses and in antibody responses to T cell-dependent protein antigens. The disease appears within the first year of life and is usually fatal unless it is treated by bone marrow transplantation.
Defective Class Il MHC Expression.' The Bare Lymphocyte Syndrome
Defective
Class II major histocompatibility complex (MHC) deficiency, also called bare lymphocyte syndrome, is a rare heterogeneousgroup of autosomal-recessivediseasesin which patients expresslittle or no HIA-DB HLA-DQ, or HtA-DR on B lymphocytes, macrophages,and dendritic cells and fail to express class II MHC molecules in response to IFN-y. They expressnormal or only slightly reduced levels of class I MHC molecules and Brmicroglobulin. Most cases of the bare lymphoclte syndrome are due to mutations in genes encoding proteins that regulate class II MHC transcription. For example, mutations in the constitutively expressedtranscription factor RFX5 or the IFN-y-inducible transcriptional activator CIITA lead to reduced classII MHC expressionand a failure of APCs to activate CD4. T lymphocltes. Failure of antigen presentation may result in defective positive selection of T cells in the thymus with a reduction in the number of mature CD4'T cells or defective activation of
Autosomal-recessiveclass I MHC deficiencies have also been described and are characterizedby decreasedCD8* T cell numbers and function. In some cases,the failure to express class I MHC molecules is due to mutations in the gene encoding the TAP-I or TAP-2 subunit of the TAP (transporter associated with antigen processing) complex, which normally transports peptides from the cystol into the endoplasmic reticulum, where they are required for classI MHC assembly (seeChapter 6). These TAP-deficient patients express few cell surface class I MHC molecules, a phenotype similar to TAP gefie knockout mice. Such patients suffer mainly from respiratory tract bacterial infections and not viral infections, which is surprising considering that a principal function of CD8. T cells is defense against viruses. A similar deficiency of class I MHC expression has been observed in patients with mutations in the gene encoding the tapasin protein (seeChapter 6).
Class I MHC ExPression
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Defects in TCR Signal Transduction
The X-linked
Many examples of rare immunodeficiency diseases caused by defects in the expression of molecules required for T cell activation and function have been identified. Modern biochemical and molecular analyses of affected individuals have revealed mutations in the genes encoding various T cell proteins. Examples include impaired TCR complex expression or function caused by mutations in the CD3 e or T genes, defective TCR-mediated signaling caused by mutations in the ZAP-70 gene, reduced synthesis ofcytokines such as IL2 and IFN-1 (in some cases caused by defects in transcription factors), and lack of expression of IL-2 receptors. These defects are often found in only a few isolated cases or in a few families, and the clinical features and severityvarywidely. Patientswith these abnormalities may have deficiencies predominantly in T cell function or have mixed T cell and B cell immunodeficiencies despite normal or even elevated numbers of blood lymphocytes. Some of these defects are associated with abnormal ratios of CD4* and CDB* T cell subsets,which may reflect impaired development of one subset in the thymus or impaired expansion of one subset in the peripheral immune system. For example, patients with ZAP-70 deficiency have reduced CDS* T cells but not CD4- T cells;the reason for the selectiveloss is not clear.
X-linked lymphoproliferative disease is a disorder characterized by an inability to eliminate Epstein-Barr virus (EBV), eventually leading to fulminant infectious mononucleosis and the development of B cell tumors and associatedhlpogammaglobulinemia. In about 80% of cases, the disease is due to mutations in the gene encoding an adapter molecule called SAP (SLAM-associated protein) that binds to a family of cell surface molecules involved in the activation of NK cells and T and B lymphocltes, including the prototypic signaling l1.rnphoclte activation molecule (SL{M). SAP links the membrane-associated proteins SIAM and 2B4 (see Chapter 8) to the Src-family kinase FynT. Defects in SAP contribute to attenuated NK and T cell activation and result in increased susceptibility to viral infections. In about 20Voof cases,the genetic defect residesnot in SAP but in the gene encoding XIAP (X-linked inhibitor of apoptosis). The resulting enhanced apoptosis of T cells and NK-T cells leads to a marked depletion of these cell types in the patients. This immunodeficiency is most commonly manifested by severe EBV infections, which probably arise opportunistically because of the ubiquitous nature of EBV
Wiskott-Aldrich
Syndrom e
Variable degreesof T and B cell immunodeficiency occur in certain congenital diseaseswith a wide spectrum of abnormalities involving multiple organ systems. One such disorder is Wiskott-Aldrich syndrome, an X-linked disease characterized by eczema, thrombocltopenia (reduced blood platelets), and susceptibility to bacterial infection. Some of the abnormalities in this disorder can be traced to defective T cell activation, though intrinsic loss of B cell function also contributes to the pathogenesis. In the initial stages of the disease, Iymphocyte numbers are normal, and the principal defect is an inability to produce antibodies in response to T cell-independent polysaccharide antigens, because of which these patients are especially susceptible to infections with encapsulated pyogenic bacteria. The lymphocytes (and platelets) are smaller than normal. With increasing age, the patients show reduced numbers of lymphocytes and more severe immunodeficiency. The defective gene responsible for Wiskott-Aldrich syndrome encodes a cltoplasmic protein called WASp (Wiskott-Aldrich syndrome protein), expressed exclusively in bone marrow-derived cells, which interacts with several proteins, including adapter molecules do'vrmstreamof the antigen receptor, such as Grb-2 (see Chapter 9), the Arp2l3 complex involved in actin polymerization, and small G proteins of the Rho family that regulate actin cltoskeletal rearrangement. Defective activation and synapse formation in lymphocytes, and defective mobility of all leukoc)'tes,may account for the immunodeficiency observed in this syndrome.
Lymphoproliferative
Syndrome
Defective CTL and NK Cell Activation: the Familial Hemophagocytic Ly m p h o h i sti ocytosis Sy n dro m es The hemophagocytic lymphohistiocytosis (HLH) slndromes are a group of life-threatening immunodeficiency disorders characterized by uncontrolled CTL and macrophage activation in which NK cell and CTL granule secretion is defective. A late but striking feature of these disorders is the ingestion of red blood cells by activated macrophages (hemophagocytosis).Mutations in the perforin gene, as well as mutations in genes encoding the cellular machinery involved in granule exocltosis, can contribute to the phenotypes observed in this slmdrome. Specifically, mutations in MB27A, a small guanosine triphosphatase involved in vesicular fusion, and in MUNCL3-4, which encodes an adapter that participates in granule exocytosis,compromise the fusion of lytic granules with the plasma membrane and thus contribute to various subtypes of HLH. Similarly, mutations in the gene for one component of the AP-3 cltosolic adapter protein complex can also disrupt intracellular transport and contribute to a form of HLH. It is believed that T cells and macrophages respond strongly to microbes to compensate for the CTL and NK cell defects, and these responses are manifested by hemophagocytosis and lymphadenopathy in the context of immunodefi ciencv. Multisystem Disorders with lmmunodeficiency: Ataxia Telangiectasia Immunodeficiency is often one of a constellation of symptoms in a number of inherited disorders. Examples of such syndromes discussed above include Ch6diak-
lMMUNoDEFlclEtrl:: ANDAcoulRED 20- coNGENITAL Chapter " :*":1t Higashi syndrome, Wiskott-Aldrich sy,ndrome, and DiGeorge's syndrome. Ataxia telangiectasia is an autosomal-recessivedisorder characterizedby abnormal gait (ataxia),vascular malformations (telangiectases),neurologic deficits, increased incidence of tumors, and immunodeflciency. The immunologic defects are of variable severity and may affect both B and T cells.The most common humoral immune defects are IgA and IgG2 deficiency. The T cell defects, which are usually less pronounced, are associated with thymic hypoplasia. Patients experience upper and lower respiratory tract bacterial infections, multiple autoimmune phenomena, and increasingly frequent cancers with advancing age. The gene responsible for this disorder is located on chromosome l1 and encodes a protein called AIM (ataxia telangiectasia mutated) that is related structurally to phosphatidylinositol-3 (PI-3) kinase, but is a protein kinase. The ATM protein can activate cell cycle checkpoints and apoptosis in response to double-stranded DNA breaks and has also been shown to contribute to the stability of DNA double-strand break complexes during V(D)J recombination. Because of these abnormalities in DNA repair, the generation of antigen receptors may also be abnormal.
Therapeutic Approaches lmmunodeficiencies
for Congenital
The current treatment of immunodeflciencies has two aims: to minimize and control infections and to replace the defective or absent components of the immune system by adoptive transfer or transplantation. Passive immunization with pooled gamma globulin is enormously valuable for agammaglobulinemic patients and has been lifesaving for many boys with X-linked agammaglobulinemia. Bone marrow transplantation is currently the treatment of choice for many immunodeficiency diseasesand has been successful in the treatment of SCID with ADA deficiency, Wiskott-Aldrich syndrome, bare lymphocyte syndrome, and lAD. It is most successful with careful T cell depletion from the marrow and HLA matching to prevent graft-versushost disease (see Chapter 16). Enzyme replacement therapy for ADA and PNP deficiencies has been attempted, with red blood cell transfusions used as a source of the enzymes. This approach has produced temporary clinical improvement in severalpatients with autosomal SCID. Injection of bovine ADA conjugated to polyethylene glycol to prolong its serum half-life has proved successful in some cases, but the benefits are usually short lived. In theory, the therapy of choice for congenital disorders of lymphocytes is to replace the defective gene in self-renewing stem cells. Gene replacement remains a distant goal for most human immunodeficiencies at present, despite considerable effort. The main obstacles to this tlpe of gene therapy are difficulties in purifying self-renewing stem cells, which are the ideal target for introduction of the replacement gene, and the lack of a method for introducing genes into cells to achieve
stable, long-lived, and high-level expression. A smail number of patients with X-linked SCID have been successfully treated by transplantation of autologous bone marrow cells engineered to express a normal 15 chain gene. However, a few treated patients have developed Ieukemia, apparently because the introduced y6 gene inserted adiacent to an oncogene and activated this gene. As a result, the future of gene therapy for this diseaseis uncertain. For unknown reasons,gene therapy has not been as successfulin treating patients with autosomal SCID caused byADA mutations.
(SrcoruonnY) AcourRro IwrwruruonrFtctENctEs Deflciencies of the immune system often develop because of abnormalities that are not genetic but acquired during life (Table 20-6). The most prominent of these abnormalities is HIV infection, and this is described in the next section. Acquired immunodeficiency diseasesare caused by two main types of pathogenic mechanisms. First, immunosuppression may occur as a biologic complication of another disease process. Second, so-called iatrogenic immunodeflciencies may develop as complications of therapy for other diseases. Diseases in which immunod.eficiency is a common complicating element include malnutrition, neoplasms, and infections. Protein-calorie malnutrition is extremely common in developing countries and is associatedwith impaired cellular and humoral immunity to microorganisms.Much of the morbidityand mortalitythat afflict
Table20-6. Acquired lmmunodeficiencies
Cause Hum an immunodeficiency virusinfection Protein-calorie malnutrition
lMechanism Depletionof CD4+ helperT cells Metabolic derangementsinhibit lymphocytematuration and function
bone Decreased and lrradiation lymphocyte marrow chemotherapy precursors treatments for cancer Cancermetastases Reducedsite of involvingleukocytedevelopment andleukemia bonemarrow lmmunosuppressionReducedlymphocyte activation for transplants, diseases autoimmune
Removalof spleen
Decreased phagocytosis of microbes
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malnourished people is due to infections. The basis for the immunodeficiency is not well defined, but it is reasonable to assume that the global metabolic disturbances in these individuals, caused by deficient intake of protein, fat, vitamins, and minerals, will adversely affect maturation and function of the cells of the lmmune system. Patients with advanced widespread cancer are often susceptible to infection because of impaired cellmediated and humoral immune responsesto a variety of organisms. Bone marrow tumors, including cancers metastatic to marrow and leukemias that arise in the marrow may interfere with the growth and development of norma-l ll,rnphocytes and other leukocytes. In addition, tumors may produce substancesthat interfere with lymphocyte development or function. An example of malignancy-associatedimmunodefi ciency is the impairment in T cell function commonly observed in patients with a type of lymphoma called Hodgkin's disease. This defect was first characterized as an inability to mount a DTH reaction on intradermal injection of various common antigens to which the patients were previously exposed, such as Candida or tetanus toxoid. Other in uitro measures of T cell function, such as proliferative responsesto polyclonal activators, are also impaired in patients with Hodgkin's disease. Such a generalized deficiency in DTH responsesis called anergy. The cause of these T cell abnormalities is unknown. Various types of infections lead to immunosuppression. Viruses other than HIV are kno'*m to impair immune responses;examples include the measles virus and human T cell lymphotropic virus I (HTLV-l). Both viruses can infect l1'rnphocltes,which may be a basis for their immunosuppressive effects. Like HIV HTLV-I is a retrovirus with tropism for CD4* T cells; however, instead of killing helper T cells, it transforms them and produces an aggressiveT cell malignancy called adult T cell leukemia/lymphoma (ATL). Patients with ATL typically have severe immunosuppression with multiple opportunistic infections. Chronic infections with Mycobacterium tuberculosis and various fungi frequently result in anergy to many antigens. Chronic parasitic infections may also lead to immunosuppression. For example, African children with chronic malarial infections have depressedT cell function, which may be important in the pathogenesis of EBV-associatedmalignant tumors (seeChapter 17,Boxl7-2). Iatrogenic immunosuppression is most ofien due to drug therapies that either kill or functionally inactiuate lymphocytes. Some drugs are given intentionally to immunosuppress patients, either for the treatment of inflammatory diseasesor to prevent rejection of tissue allografts.The most commonly used anti-inflammatory and immunosuppressive drugs are corticosteroids and cyclosporine, respectively. Various chemotherapeutic drugs are administered to patients with cancer, and these drugs are usually cytotoxic to both mature and developing lymphocytes as well as to granulocyte and monoclte precursors. Thus, cancer chemotherapy is almost always accompanied by a period of immunosuppression and risk for infection. Iatrogenic immuno-
suppression and tumors involving the bone marrow are the most common causes of immunodeficiency in developed countries. One other form of acquired immunosuppression results from the absence of a spleen caused by surgical removal of the organ after trauma and as treatment of certain hematologic diseasesor by infarction in sickle cell disease.Patients without spleens are more susceptible to infection by some organisms, particularly encapsulated bacteria such as Streptococcuspneumoniae. This enhanced susceptibility is partly due to defective phagocytic clearance of opsonized blood-borne microbes, an important physiologic function of the spleen, and partly because of defective antibody responsesresulting from the absence of marginal zone B cells.
Hunanru InttrvruruoorFrcrENcy VtnusANDTHE AcourRro IurvruruoorFrcrENcy SyrrroRomr AIDS is the diseasecaused by infection with HIV and is characlerized by profound immunosuppression with associated opportunistic infections and malignant tumors, wasting, and central nervous system (CNS) degeneration. HIV infects a variety of cells of the immune system, including CD4* helper T cells, macrophages, and dendritic cells. HIV evolved as a human pathogen very recently relative to most other knor,rm human pathogens, and the HIV epidemic was first identified only in the 1980s.However, the degree of morbidity and mortality caused by HIV and the global impact of HIV infection on health care resources and economics are already enormous and continue to grow. HIVhas infected 50 to 60 million people and has caused the death of over 22 million adults and children. More than 42 million people are living with HIV infection and AIDS, of which approximatelyT0Toare inAfrica and20Vo in Asia, and almost 3 million die of the disease every year. It is estimated that there are approximately 14,000 new infections every day, and by the year 2010, 50 to 75 million infected people will be added to the already staggering pool of casesworldwide. The diseaseis especially devastating because about half of the approximately 5 million new cases every year occur in young adults (15-24 years old). As a result, AIDS has left approximately 14 million orphans, and this number may climb to 25 million by 2010. Currently, there is no effective vaccine or cure for AIDS, although new anti-retroviral therapies have been developed. In this section of the chapter, we describe the molecular and biologic properties of Hry the pathogenesis of HlV-induced immunodeficiency, and the clinical and epidemiologic features of HIV-related diseases. Molecular
and Biologic
Features of HIV
HIV is a member of the lentivirus family of animal retroviruses. Lentiviruses, including visna virus of sheep and the bovine, feline, and simian immunodeficiencyviruses (SIVs),are capable of long-term latent infection of cells and short-term cytopathic effects, and they all produce
20Chapter
slowly progressive, fatal diseases that include wasting slmdromes and CNS degeneration. TWo closely related types of HI! designated HIV-I and HIV-2, have been identified. HIV-I is by far the most common cause of AIDS, but H|y'-2, which differs in genomic structure and antigenicity, causes a similar clinical slmdrome.
HIV Structure and Genes An infectious HIV particle consists of two identical strands of RNA packaged within a core of viral proteins and surrounded by a phospholipid bilayer envelope derived from the host cell membrane but including virallyencoded membrane proteins (Fig.20-3). The RNA genome of HIV is approximately 9.2 kb long and has the basic arrangement of nucleic acid sequencescharacteristic of all known retroviruses (Fig. 20-4). Long terminal repeats (LIRs) at each end of the genome regulate viral gene expression,viral integration into the host genome, and viral replication. The gag sequences encode core structural proteins. The ezzusequencesencode the envelope glycoproteins gpl20 and gp41, which are required for infection of cells. Tl:'e pol sequencesencode reverse transcriptase, integrase, and viral protease enzymes required for viral replication. In addition to these typical retrovirus genes,HIV- I also includes six other regulatory genes, namely, the tat, reu, uif, nef, upr and upu genes, whose products regulate viral reproduction in various ways. The functions of these genes are summarized in Figure 20-4.
+ll IMMUN0DEFICIENCIES ANDACoUIRED C0NGENITAL |
Viral Life Cycle HIV infection of cells begins when the envelope glycoprotein (Env) of a viral particle binds to both CD4 and a coreceptor that is a member of the chemokine receptor family (Fig. 20-5). The viral particles that initiate infection are usually in the blood, semen, or other body fluids of one individual and are introduced into another individual by sexual contact, needle stick, or transplacental passage.Env is a complex composed of a transmembrane gp41 subunit and an external, noncovalently associated gpl20 subunit. These subunits are produced by proteolytic cleavage of a gp160 precursor. The Env complex is expressed as a trimeric structure of three gpl2}lgp4l pairs. This complex mediates a multistep process of fusion of the virion envelope with the membrane of the target cell (Fig. 20-6). The first step of this process is the binding of gp120 subunits to CD4 molecules, which induces a conformational change that promotes secondary gp120 binding to a chemokine coreceptor. Coreceptor binding induces a conformational change in gp41 that exposesa hydrophobic region, called the fusion peptide, that inserts into the cell membrane and enables the viral membrane to fuse with the target cell membrane. After the virus completes its life cycle in the infected cell (described later), free viral particles are releasedfrom one infected cell and bind to an uninfected cell, thus propagating the infection. In addition, gpl20 and gp41,which are expressedon the plasma membrane of infected cells before virus is released, can mediate cell-cell fusion with an uninfected cell that
Lipidbilayer p17 matrix RNA
gp120 Reverse transcriptase Protease Integrase
p24capsid
FIGURE 2O-3 Structureof HIV-I.An HIV-1virion is shownnextto a T cellsurface HIV-1consistsof two identicalstrandsof RNA (the viral genome) and associatedenzymes,includingreversetranscriptase,integrase,and protease,packagedin a corecomposedof p24 capsidprotein cone-shaped with a surroundinp g 1 7 p r o t e i nm a t r i x ,a l l s u r d e m b r a n ee n v e l o p e r o u n d e db y a p h o s p h o l i p im derivedfrom the host cell Virallyencodedmembrane proteins(9p41 and 9p120) are bound to the envelope CD4 and chemokinereceptorson the host cell surfacefunctionas HIV-1receptors (@2000TereseWinslow)
T lymphocyte suface
478 *:M;i.
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Section V-
IMMUNITY lN DEFENSE ANDDISEASE
4
!
Transcription of viralgenome;integration of viralDNAintohostcellgenome; bindingsitefor hosttranscription factors Nucleocapsid coreandmatrixproteins
I
protease, Reverse transcriptase, integrase, and ribonuclease
I
(9p120andgp41) anv Yiralcoatproteins Overcomes inhibitory effectof hostcellenzyme(APOBEC3G), promotesviralreplication vpr Increases promotesHIV infectionof macrophages viralreplication;
#
!
Required for elongation of viraltranscripts traty Promotesnuclearexportof incompletely splicedviralRNAs
I
Down-regulates hostcellCD4expression; enhances releaseof virusfromcells
I
Down-regulates hostcellCD4andclassI MHCexpression; enhances releaseof infectious virus
LTR,longterminalrepeat;pol,polymerase; env,envelope;vif,viral fQbrgvlatigns; infectivity factor;vpr,viralproteinR; tat,transcriptional activator;rev,regulatorof viral geneexpression; vpu,viralproteinu; nef,negativeeffector FIGURE 2O-4 HIV-I genome.The genesalongthe lineargenomeare indicatedas differentlycoloredblocks Some genes use some of the samesequencesas othergenes,as shownby overlapping blocks,but are readdifferentlyby hostcellRNApolymeraseSimilarly shaded blocksseparatedby linesindicategeneswhose codingsequencesare separatedin the genomeand requireRNAsplicingto producefunctionalmRNA (Adaptedfrom GreeneW AIDSand the immunesystem Copyright1993by ScientificAmerican,Inc All rightsreserveol
expressesCD4 and coreceptors, and HIV genomes can then be passed between the fused cells directly. The identification of CD4 and chemokine receptors as HIV receptors came from several different experimental approaches and clinical observations. CD4 was first suspectedas a viral receptorbecauseof the selective destruction of CD4* T cells in HIVinfected individuals and the subsequentdemonstration that HIV infects only CD4* cells in vitro. Receptor-binding studiesusing purifi ed recombinant molecules have established that gp120 specifically binds to CD4, and mutational and x-ray crystallographic studies have identified the regions of both molecules that interact physically. The requirement for a coreceptorin addition to CD4 in HIV infection was first suspectedbecauseexpression of recombinanthuman CD4 in many nonhuman cell lines did not render the cells susceptibleto HIV infection but subsequent fusion with human cells did. The formal demonstration that a chemokine receptorcan act as a cofactorfor HIV entry into a cell was accomplishedby screeninghuman complementary DNA (cDNA) libraries for the ability to make a human CD4-expressingmouse cell line infectableby a T cell line-tropic HIV strain. A cDNA isolated by this strategy encoded the CXCR4 chemokine receptor, which binds the chemokinesSDF-ls and SDF-1p.
,lr Concurrent with these studies,investigatorsdiscovered that soluble factors released by CDB* T cells could suppress HIV infection of macrophages by some isolates of HIV These factors were identified as the chemokines MNTES (regulated by activation, normal T cell expressed and secreted), MIP-1c (macrophageinflammatory protein- lcr), and MIP- 1B, all of which bind to the CCR5receptor and competitively inhibit virus binding. (The modern nomenclature of these chemokinesis in Chapter 12.) The most important chemokine receptors that act as coreceptors for HIV are CXCR4 and CCRS. More than seven different chemokine receptors have been shor,vnto serve as coreceptors for HIV entry into cells, and several other proteins belonging to the sevenmembrane-spanning G protein-coupled receptor family, such as the leukotriene 84 receptor, can also mediate HIV infection of cells. Different isolates of HIV have distinct tropisms for different cell populations that are related to the specificity of gp120 variants for different chemokine receptors. All HIV strains can infect and replicate in freshly isolated human CD4* T cells that are activated in vitro. In contrast, some strains will infect primary cultures of human macrophages but not continuous T cell lines (macrophage-tropic, or M-tropic, virus), whereas other strains will infect T cell lines but not macrophages (T-tropic virus). Some virus strains
D I V I U N O D E F I C I E N C I E4S7 9 C h a p t e2r0- C 0 N G E N I TAANLDA C 0 U I R EI M
H I Vv i r i o n
V i r i o nb i n d i n g to CD4 and chemokine receptor
Plasma
Fusionof HIV membranewith cell membrane;entry of viralgenome into cytoplasm
memorane
receptor
HIV RNA----1K/ genome
Reverse transcriptasemediated synthesis of proviralDNA
gp120/9p41 '|cellsurface; buddingof maturevirion Cytokineactivation of cell;transcription of HIV genome; transportof spliced and unsplicedRNAs to cytoplasm
Integration of provirusinto cellgenome
/\r HIV DNA
provlrus Nucleus
HIVcore structure
of HIV Synthesis proteins; assembly of virioncorestructure
A 4l ;l ^d HIV RNA F.5=.
&
t,u proteins
FIGURE 2O*5 HIV life cycle.The sequential stepsin the life cycleof HIVare shown,irom initialinfectionof a host cellto viralreplication and releaseof a new virion For the sakeof clarity,the productionand releaseof only one new virlonare shown An infectedcell actually producesmanyvirions,eachcapableof lnfectingcells,therebyamplifyingthe infectiouscycle
also infect both T cell lines and macrophages (dualtropic virus). Macrophage-tropic virus isolates expressa gpl20 that binds to CCRs, which is expressed on macrophages (and some memory T cells), whereas T cell-tropic viruses bind to CXCR4,which is expressedon T cell lines. HIV variants are described as X4 for CXCR4 binding, R5 for CCRS binding, or R5X4 for the ability to bind to both chemokine receptors. In many HIVinfected individuals, there is a change from the production of virus that uses CCR5 and is predominantly macrophage tropic early in the disease to virus that binds to CXCR4 and is T cell line tropic late in the disease.The T-tropic strains tend to be more virulent, presumably becausethey infect and deplete T cells more than do M-tropic strains. The importance of CCR5 in HIV infection in vivo is supported by the finding that individuals who do not expressthis receptor because of genetic mutations are resistant to HIV infection.
Once an HIV uirion enters a cell, the enzJlmeswithin the nucleoprotein complex become actiue and begin the uiral reproductiue cycle (see Fig. 20-5). The nucleoprotein core of the virus becomes disrupted, the RNA genome of HIV is transcribed into a double-stranded DNA form by viral reverse transcriptase, and the viral DNA enters the nucleus. The viral integrase also enters the nucleus and catalyzes the integration of viral DNA into the host cell genome. The integrated HIV DNA is called the provirus. The provirus may remain transcriptionally inactive for months or years, with little or no production of new viral proteins or virions, and in this way HIV infection of an individual cell can be latent. Transcription of the genes of the integrated DNA prouirus is regulated. by the LTR upstream of the uiral structural genes, and cytokines or other physiologic stimuli to T cells and macrophages enhance uiral gene transcription. The LIRs contain polyadenylation signal
48O
i
Section V-
IMMUNITY lN DEFENSE ANDDTSEASE
CD4 Chemokine
Host cell memDrane
recepror HIV memDrane gp41
gp120 CD4 T cell memorane CCR5/
"*-#F, Gp41 fusion
peptide
CXCR4
H I V9 p 1 2 0b i n d s Conformational change Conformational change to T cellCD4 in 9p120promotes in gp41exposesfusion binding to chemokine peptide,whichinserts receptor intoT cellmembrane
Fusionof viraland cellmembranes
FIGURE 20-6 Mechanismof HIV entry into a cell. In the model depicted,sequentialconformational changesin gp120 and gp41 are inducedby bindingto CD4 Thesechangespromotebindingof the virusto the coreceptor(a chemokinereceptor)and fusionof the HIV-1 and host cell membranesThe fusion peptideof activatedgp41 containshydrophobic aminoacid residuesthat mediateinsertioninto the h o s tc e l lp l a s m am e m b r a n e
sequences, the TATA box promoter sequence, and binding sites for two host cell transcription factors, NFrB and SPI . Initiation of HIV gene transcription in T cells is linked to activation of the T cells by antigen or cytokines. For example, polyclonal activators of T cells, such as ph1'tohemagglutinin, and cytokines such as IL2, tumor necrosis factor (TNF), and lymphotoxin stimulate HIV gene expression in infected T cells, and IL-l, IL-3, IL-6, TNII lymphotoxin, IFN-y, and granulocltemacrophage colony-stimulating factor (GM-CSF)stimulate HIV gene expressionand viral replication in infected monocytes and macrophages. TCR and cltokine stimulation of HIV gene transcription probably involves the activation of NF-rB and its binding to sequencesin the LTR. This phenomenon is significant to the pathogenesis of AIDS because the normal response of a latently infected T cell to a microbe may be the way in which latency is ended and virus production begins. The multiple infections that AIDS patients acquire thus stimulate HIV production and infection of additional cells. The Tat protein is required for HIV gene expression and acts by enhancing the production of complete viral messenger RNA (mRNA) transcripts. Even in the presence of optimal signals to initiate transcription, few if any HIV mRNA molecules are actually synthesized because transcription of HIV genes by mammalian RNA polymerase is inefficient and the polymerase complex usually stops before the mRNA is completed. Tat protein binds to the nascent mRNA and increases the "processivity" of RNA polymerase by several hundred-fold, which allows transcription to be completed to produce a functional viral nRNA.
Synthesk of mature, infectious uiral particles begins ajter full-Iength viral RNA transcripts are produced, and the uiral genes are expressed as proteins. The mRNAs encoding the various HIV proteins are derived from a single full-genome-length transcript by differential splicing events.HIV gene expressionmay be divided into an early stage, during which regulatory genes are expressed, and a late stage, during which structural genes are expressed and full-length viral genomes are packaged. The ReV Tat, and Nefproteins are early gene products encoded by fully spliced mRNAs that are exported from the nucleus and translated into proteins in the cytoplasm soon after infection ofa cell. Late genes include enu, gag, and pol, which encode the structural components of the virus and are translated from singly spliced or unspliced RNA. The Rev protein initiates the switch from early to late gene expression by promoting the export of these incompletely spliced late gene RNAs out ofthe nucleus. T}:'epol gene product is a precursor protein that is sequentially cleaved to form reverse transcriptase, protease, ribonuclease, and integrase enzymes. As mentioned before, reverse transcriptase and integraseproteins are required for producing a DNA copy of the viral RNA genome and integrating it as a provirus into the host genome. The gag gene encodes a 55-kD protein that is proteol)'rically cleaved into p24, pl7, and pl5 polypeptides by the action of the viral protease encoded by the pol gene.These polypeptides are the core proteins that are required for assembly of infectious viral particles. The primary product of tlireenu gene is a 160-kD glycoprotein (gpl60) that is cleaved by cellular proteases within the endoplasmic reticulum into
C h a o t e2r0-
the gp120 and gp4l proteins required for HIV binding to cells, as discussed earlier. Current antiviral drug therapy for HIV disease includes inhibitors of the enzymes reversetranscriptase, protease, and integrase. After transcription of various viral genes, viral proteins are synthesized in the cytoplasm. Assembly of infectious viral particles then begins by packaging fulllength RNA transcripts of the proviral genome within a nucleoprotein complex that includes the gag core proteins and the pol-encoded enzymes required for the next cycle of integration. This nucleoprotein complex is then enclosed within a membrane envelooe and released from the cell by a process of budding ?rom the plasma membrane. The rate of virus production can reach sufficiently high levels to cause cell death, as discussed later. Naiue T cells are resistant to HIV infection because these celk contain an actiue form of an enzyme that introduces mutations in the HIV genonle. This enzyme has been given the rather cumbersome name APOBEC3G (apolipoprotein B mRNA-editing enzyme catalytic polypeptide-like editing complex 3). It is a member of a family of cytidine deaminases that inhibit retroviral replication. APOBEC3G introduces cl.tosine to uracil mutations in the viral DNA that is produced by reverse transcription, and these mutations inhibit further DNA replication by mechanisms that are not fully defined. Activation of T cells converts cellular APOBEC3G into an inactive, high molecular mass complex. HIV has evolved to counteract this cellular defense mechanism-the viral protein Vif binds to APOBEC3G and promotes its degradation by cellular proteases. Pathogenesis
of HIV Infection
and AIDS
HIV disease begins with acute infection, which is only partly controlled by the adaptiue immune response,and aduances to chronic progressiue infection ofperipheral lymphoid, tissues (Fig. 20-7). Virus typically enters through mucosal epithelia. The subsequent events in the infection can be divided into several phases. Acute (early) infection is characterizedby infection of memory CD4* T cells (which ercpressCCRS)in mucosal lymphoid tissues, ond death of many infected cells. Becausethe mucosal tissues are the largest reservoir of T cells in the body, and the major site of residence of memory T cells, this local loss is reflected in considerable depletion of lymphocltes. In fact, within 2 weeks of infection, the majority of CD4* T cells may be destroyed.
D M U N 0 D E F I C I E N C I E S4 8 1 C 0 N G E N I TAANLDA C 0 U I R EI M
of lnfection mucosaltissues
Deathof mucosalmemory CD4+T cells
lnfection in established tissues, lymphoid e.9.,lymphnode Spreadof infection throughout the body lm m une response HIV-specific Anti-HlV antibodies CTLs
Partialcontrol of viralreplication
of chronic Establishment virusconcentrated infection; Clinicallatency tissues; in lymphoid virusproduction low-level
Studiesof simian immunodeficiency virus infection in macaques have shor.rmthat within 4 days of infec-
Increased viral replication FIGURE 2O-7 Proglessionof HIV infection.The progression of HIVinfectioncorrelates with spreadof the virusfrom the initialsite of rnfectionto lymphoidtissuesthroughoutthe body The immune responseof the host temporarily controlsacuteinfectionbut does not preventthe establishment of chronicinfectionof cells in lympholdtissues Cytokinestimullinducedby other microbesserveto enhanceHIV productionand progression to AIDS
AIDS
Destructionof lymphoid tissue;depletionof CD4+T cells
482
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Section V-
IMMUNITY lN DEFENSE ANDDISEASE
microbes, and few or no clinical manifestations of the HIV infection are present. Therefore, this phase of HIV diseaseis called the clinical latency period. Although the majority of peripheral blood T cells do not harbor the virus, destruction of CD4* T cells within lymphoid tissues steadily progressesduring the latent period, and the number of circulating blood CD4t T cells steadily declines (Fig.20-8). More than 90% of the body's approximately 1012T cells are normally found in peripheral and mucosal lymphoid tissues, and it is estimated that HIV destroys up to I to 2 x 10eCD4t T cells every day. Early in the course of the disease,the body may continue to make new CD4* T cells, and therefore CD4* T cells can be replaced almost as quickly as they are destroyed. At this stage,up to 10% of CD4t T cells in llrrnphoid organs may be infected, but the number of circulating CD4* T cells that are infected at any one time may be less than 0.17oof the total CD4. T cells in an individual. Eventually, during a period of years, the continuous cycle of virus infection, T cell death, and new infection leads to a steady decline in the number of CD4* T cells in the ll.rnphoid tissues and the circulation.
tion, about 60% of mucosal memory CD4*T cells are infected, and B0%of these cells die in the first week. The transition from the acute phase to a chronic phase of infection is characterized by dksemination of the uirus, uiremin, and the deuelopment of host immune responses.Dendritic cells in epithelia at sites of virus entry capture the virus and then migrate into the lymph nodes. Dendritic cells expressa protein with a mannosebinding lectin domain that may be particularly important in binding the HIV envelope and transporting the virus. Once in lymphoid tissues,dendritic cells may pass HIV on to CD4* T cells through direct cell-cell contact. Within days after the first exposure to HIV viral replication can be detected in the ll.rnph nodes. This replication leads to viremia, during which large numbers of HIV particles are present in the patient's blood, accompanied by an acute HIV slmdrome that includes a variety of nonspecific signs and slrnptoms typical of many viral diseases(described below). The viremia allows the virus to disseminate throughout the body and to infect helper T cells, macrophages, and dendritic cells in peripheral lymphoid tissues. As the HIV infection spreads, the adaptive immune system mounts both humoral and cell-mediated immune responses directed at viral antigens, which we will describe later. These immune responses partially control the infection and viral production, and such control is reflected by a drop in viremia to low but detectable levels by approximately l2 weeks after the primary exposure. In the next, chronic phase of the disease,Iymph nodes and the spleen are sites of continuous HIV replication and cell destruction (see Fig. 20-7). During this period of the disease,the immune system remains competent at handling most infections with opportunistic
Mechanisms of Immunodeficiency Caused by HIV HIV infection ultimately results in impaired function of both the adaptive and innate immune systems. The most prominent defects are in cell-mediated immunity, and they can be attributed to several mechanismi, including direct cytopathic effects of the virus and indirect effects. An important cause of the loss of CD4'T cells in HIVinfected people is the direct cytopathir effect of infection of these celk by HIV Death of CD4* T cells is associated
-AcuteHIVsyndrome -Widedissemination of virus -Seedingof lymphoidorgans
a
Anti-envelope
E 10sI
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F I G U R E 2 O - 8 C l i n i c a cl o u r s e o fH l V d i s e a s e . AP l a s m a v i r e m i a , b l o o d C D 4 t T c e o lul n t s , a n d c l i n i csat a l g e s o fd i s e a s eA b o u t l 2 w e e k s afterinfection,blood-borne virus(plasmaviremia)is reducedto very low levels(detectable polymerase onlyby sensitiveTeverse-transcriptase chainreactlonassays)and staysthis way for manyyears Nonetheless, CD4*T cellcountssteadilydeclineduringthis clinicallatencyperiod becauseof activeviralreplication and T cell infectionin lymphnodes When CD4.T cellcountsdrop belowa criticallevel(about200/mm3), the riskfor infectionand other clinicalcomponentsof AIDS is high (FromPantaleoG, C Graziosi, and AS Fancim The immunopathogenesis of humanimmunodefrciency virus infection New EnglandJournalof Medicine328:327-335,1993 CopyrightO 1993 Massachuserrs MedicalSocietyAll rightsreserved) B lmmuneresponseto HIV infectionA CTL responseto HIV is detectableby 2 to 3 weeks afterthe initialinfectionand peaksby 9 to 12 weeks Markedexpansionof virus-specific CDB*T cellsoccursduringthis time, and up to 1O%of a patient'sCTLsmay be HIV specificat 'l2 weeks.The humoralimmuneresponseto HIV peaksat about'12 weeks
I
IMMUNoDEFICIENCIES ANDACoUIRED 20- c0NGENTTAL chapter & oes
with production of virus in infected cells and is a major cause of the decline in the numbers of these cells, especially in the early (acute) phase of the infection. Several direct toxic effects of HIV on infected CD4* cells have been described: @ The process of virus production, with expression of gp41 in the plasma membrane and budding of viral particles, may lead to increased plasma membrane permeability and the influx of lethal amounts of calcium, which induces apoptosis, or osmotic lysis of the cell caused by the inflrx of water. @ Viral production can interfere with cellular protein synthesis and thereby lead to cell death. @ The plasma membranes of HlV-infected T cells fuse with uninfected CD4* T cells by virtue of 9p120-CD4 interactions, and multinucleated giant cells or syncytia are formed. The process of HlV-induced syncytia formation can be lethal to HlV-infected T cells as well as to uninfected CD4* T cells that fuse to the infected cells. However, this phenomenon has largely been observed in vitro, and slncytia are rarely seen in the tissues of patients with AIDS. Mechanisms in addition to direct lysk of infected CD4t T cells by uirus haue been proposed for the depletion and loss of function of these cells in HIVinfected indiuiduals. One mechanism that has been suggestedis related to chronic activation of uninfected cells by the infections that are common in patients infected with HIV and also by cytokines produced in response to these infections. Chronic activation of the T cells may predispose the cells to apoptosis; the molecular pathway involved in this type of apoptosis is not yet defined (see Chapter 11, Box 11-2). Apoptotic death of activated lymphocytes may account for the observation that the loss of T cells greatly exceeds the numbers of HlV-infected cells. HlV-specific CTLs are present in many patients with AIDS, and these cells can kill infected CD4* T cells. In addition, antibodies against HIV envelope proteins may bind to HlV-infected CD4. T cells and target the cells for antibody-dependent cellmediated cytotoxicity (ADCC). Binding of gp120 to newly synthesized intracellular CD4 may interfere with normal protein processing in the endoplasmic reticulum and block cell surface expression of CD4, making the cells incapable of responding to antigenic stimulation. Other proposed mechanisms include defective maturation of CD4* T cells in the thymus. The relative importance of these indirect mechanisms in CD4* T cell depletion in HlV-infected patients is uncertain and controversial. Functional defects in the immune system of HIVinfected ind,iuiduals exacerbate the immune deficiency caused by d,epletion of CD4' T cells. These functional defects include a decreasein T cell responsesto antigens and weak humoral immune responseseven though total serum Ig levels may be elevated. The defects may be a result of the direct effects of HIV infection on CD4* T cells, including the effects of soluble gp120 released
from infected cells binding to uninfected cells. For example, CD4 that has bound gp120 may not be available to interact with class II MHC molecules on APCs, and thus T cell responsesto antigens would be inhibited. Alternatively, gpl20 binding to CD4 may deliver signals that down-regulate helper T cell function. HlV-infected T cells are unable to form tight synapses with APCs, and this may also interfere with T cell activation. Some studies have demonstrated that the proportion of IL-2and IFN-1-secreting (THl) T cells decreases in HIVinfected patients and the proportion of IL-4- and IL- l0secreting (Tr2-like) T cells increases. This altered balance of Tsl and Ts2 responsesmay partially explain the susceptibility of HlV-infected individuals to infection by intracellular microbes because IFN-1 activates and Tg2 cltokines may inhibit macrophage-mediated killing of such microbes. Patients with HlVinfection may have increased numbers of CD4* CD25* regulatory T cells, but it is not yet clear if this is a consistent finding or if these cells actually contribute to defective immunity. The Tat protein may play some role in the pathogenesis of immunodeficiency caused by HIV Within T cells, Tat can interact with a variety of regulatory proteins, such as the p300 coactivator of transcription, and these interactions can interfere with normal T cell functions such as cltokine synthesis. Remarkably, Tat not only enters the nucleus of infected T cells but can also escape across the plasma membrane and enter neighboring cells, thus interfering with activation of uninfected T cells in a paracrine fashion. Macrophages, d.endritic cells, and follicular dendritic cells ako play important roles in HIV infection and the p r ogressio n of immuno deficiency. @ Macrophages express much lower levels of CD4 than helper T lyrnphocytes do, but they do express CCR5 coreceptors and are susceptible to HIV infection. However, macrophages are relatively resistant to the cytopathic effects of HIV Macrophages may also be infected by agpI20lgp4l-independent route, such as phagocytosis of other infected cells or Fc receptor-mediated endocytosis of antibody-coated HIV virions. Because macrophages can be infected but are not generally killed by the virus, they may become a reservoir for the virus. In fact, the quantity of macrophage-associated HIV exceeds T cellassociated virus in most tissues from patients with AIDS, including the brain and lung. HlV-infected macrophages may be impaired in antigen presentation functions and cytokine secretion. o Dendritic cells can also be infected by HIV Like macrophages, dendritic cells are not directly injured by HIV infection. Howeve! these cells form intimate contact with naive T cells during the course of antigen presentation. It is proposed that dendritic cells infect naive T cells during these encounters and may thus be an important pathway for T cell injury. g Follicular dendritic cells (FDCs) in the germinal centers of lymph nodes and the spleen trap large
484 : l,re.,uxr*i*"e.*
.
S e c t i oVn-
I M M U N I Tl N Y DEFENS AE N DD I S E A S E
..
amounts of HIV on their surfaces,in part by Fc receptor-mediated binding of antibody-coated virus. Although FDCs are not efficiently infected, they contribute to the pathogenesis of HlV-associated immunodeficiency in at least two ways. First, the FDC surface is a reservoir for HIV that can infect macrophages and CD4* T cells in the lymph nodes. Second, the normal functions of FDCs in immune responses are impaired, and they may eventually be destroyed by the virus. Although the mechanisms of HlV-induced death of FDCs are not understood, the net result of loss of the FDC network in the lymph nodes and spleen is a profound dissolution of the architecture of the peripheral lymphoid system. HIV Beservoirs and Viral Turnover The uirus detected in patients'blood is produced mostly by short-liued infected CD4* T cells and in smaller amounts by other infected celk. Three phases of decay of plasma viremia have been observed in patients treated with anti-retroviral drugs, or predicted by mathematical modeling, and these decay curves have been used to surmise the distribution of HIV in different cellular reservoirs. Over 90% of plasma virus is believed to be produced by short-lived cells (half-lives of -l day), which are most likely activated CD4* T cells that are major reservoirs and sources of the virus in infected patients. About 5To of plasma virus is produced by macrophages,which have a slower turnover (half-life of about 2 weeks). It is hypothesized that a small fraction of the virus, perhaps as little as l%, is present in latently infected memory T cells. Becauseof the long life span of memory cells, it could take decades for this reservoir of virus to be eliminated even if all new rounds of infection were blocked. Clinical
Features of HIV Disease
A vast amount of information has accumulated about the epidemiology and clinical course of HIV infection. As anti-retroviral drug therapy is improving, many of the clinical manifestations are changing. In the following section we describe the "classical"features of HIV infection, and refer to the changing pictures when relevant. Transmission of HIV and Epidemiology
of AIDS
HIV is transmitted from one individual to another bV three major routes: O Sexual contact is the most frequent mode of transmission, either between heterosexual couples (the most frequent mode of transmission in Africa and Asia) or between homosexual male partners. In subSaharanAfrica, where the infection rate is the highest in the world (estimated to be about 10,000new cases every day), more than half the infected individuals are women. o Mother-to-child transmission of HIV accounts for the majority of pediatric casesof AIDS. This tlpe of trans-
mission occurs most frequently in utero or during childbirth, although transmission through breast milk is also possible. @ Inoculation of a recipient with infected blood or blood products is also a frequent mode of HIV transmission. Needles shared by intravenous drug abusers account for most cases of this form of transmission. With the advent of routine laboratory screening, transfusion of blood or blood products in a clinical setting accounts for a small portion of HIV infections. Major groups at risk for the development of AIDS in the United Statesinclude homosexual or bisexual males, intravenous drug abusers, heterosexual partners of members of other risk groups, and babies born of infected mothers. Health care workers have a small increased risk for infection. Clinical Course of HIV lnfection The course of HIV diseasecan be followed by measuring the amount of virus in the patient's plasma and by the blood CD4* T cell count (seeFig. 20-B). The acute phase of the illness, also called the acute HIV slmdrome, is the period of viremia characterized by nonspecific symptoms of infection. It develops in 50%
Table2O-7.ClinicalFeaturesof HIV Infection
Phaseof diseaseI Clinicalfeature sorethroat AcuteHIVdisease Fever,headaches. generalized withpharyngitis, lymphadenopathy, rashes
latency Clinical period
DecliningbloodCD4+T cell amounl
AIDS
Opportunisticinfections: Protozoa(Toxoplasma Cryptosporidium) Bacteria(Mycobacte ruim avium, Nocardia,Salmonella) Fungi(Candida,Cryptococcus neoformans,Coccidioides immitis,Histoplasma capsulatum, Pneumocystis) Viruses(cytomegalovirus, herpessimplex, varicella-zoster) Tumors: (including Lymphomas EBVassociated B celllymphomas) Kaoosi's sarcoma Cervical carcinoma Encephalopathy Wastingsyndrome
Abbreviations; AIDS, aquiredimmunedeficiencv syndrome;EBV, Epstein-Barr virus.
C h a p t e2r0-
to 70Toof infected adults typically 3 to 6 weeks after infection. There is a spike of plasma virus and a modest reduction in CD4* T cell counts, but the number of blood CD4* T cells often returns to normal. In many patients, however, the infection is occult and there are no symptoms. The chronic phase of clinical latency may last for many years. During this time, the virus is contained within lymphoid tissues, and the loss of CD4. T cells is corrected by replenishment from progenitors. Patients are aslrnptomatic or suffer from minor infections. Within 2 to 6 months after infection, the concentration of plasma virus stabilizesat a particular set-point, which differs among patients. The level of the viral set-point and the number of blood CD4* T cells are clinically useful predictors of the progression of disease.As the diseaseprogresses,patients become susceptible to other infections, and immune responses to these infections may stimulate HIV production and accelerate the destruction of lymphoid tissues. As discussed earlier, HIV gene transcription can be enhanced by stimuli that activate T cells, such as antigens and a variety of cltokines. Cytokines, such as TNB that are produced by the innate immune system in response to microbial infections are particularly effective in boosting HIV production. Thus, as the immune system attempts to eradicate other microbes, it brings about its or.tmdestruction by HIV HIV diseaseprogressesto the final and almost invariably lethal phase, called AIDS, when the blood CD4* T cell count drops below 200 cellsimm3. HIV viremia may climb dramatically as viral replication in other reser-voirs accelerates unchecked. Patients with AIDS suffer from combinations of opportunistic infections, neoplasms, cachexia (HIV wasting syndrome), kidney failure (HIV nephropathy), and CNS degeneration (AIDS encephalopathy) (seeTable 20-7). BecauseCD4* helper T cells are essentialfor both cell-mediated and humoral immune responsesto various microbes, the loss of these lymphocltes is the main reason that patients with AIDS become susceptible to many different types of infections. Furthermore, many of the tumors that arise in patients with AIDS have a viral etiology, and their prevalence in the setting of AIDS reflects an inability of the HlV-infected patient to mount an effective immune response against oncogenic viruses. Most of the opportunistic infections and neoplasms associated with HIV infection occur after the blood CD4t T cell count drops below 200 cells/mm3. Cachexia is often seen in patients with chronic inflammatory diseasesand may result from effects of inflammatory cytokines (such as TNF) on appetite and metabolism. The CNS diseaseinAIDS may be due to neuronal damage by the virus or by shed viral proteins such as gp120 and Tat as well as to the effects of cltokines elaborated by infected microglial cells. Many of these devastating consequences of HIV infection, including opportunistic infections and tumors, have been significantly reduced by highly active antiretroviral therapy. Although this summary of the clinical course is true for the most severecases,the rate of progression of the
I MDM U N O D E F I C I E N C; I E S4 8 5 C 0 N G E N I TAANLDA C O U I R E
variable, andr"-" t".;;;;;trishighly disease term nonprogressors. The immunologic correlates of variable progression remain unknown. Also, recent antiretroviral therapy has changed the course, and greatly reduced the incidence, of severe opportunistic infections (such as Pneumocysfzs) and tumors (such as Kaposi's sarcoma). lmmune
Responses to HIV
HlV-specific humoral and cell-med.iated immune responses d,euelnp follnwing infection but generally prouide limited. protection. The early response to HIV infection is, in fact, similar in manyways to the immune response to other viruses and serves effectively to clear most of the virus present in the blood and in circulating T cells. Nonetheless, it is clear that these immune responses fail to eradicate all virus, and the infection eventually overwhelms the immune system in most individuals. Despite the poor effectiveness of immune responses to the virus, it is important to characterize them for three reasons. First, the immune responses may be detrimental to the host, for example, by stimulating the uptake of opsonized virus into uninfected cells by Fc receptor-mediated endocytosis or by eradication of CD4* T cells expressing viral antigens by CD8* CTLs. Second, antibodies against HIV are diagnostic markers of HIV infection that are widely used for screening purposes.Third, the design of effective vaccines for immunization against HIV requires knowledge of the types of immune responses that are most likely to be protective (the "correlatesof protection'). Many innate immune responses against HIV have been described. These include anti-microbial peptides (defensins), NK cells, dendritic cells (particularly plasmacytoid dendritic cells producing type I IFNs), and the complement system.The role of these responsesin combating the infection are not established. The initial adaptiue immune response to HIV infection is characterized. by expansion of CD&* T celk specific for HIV peptid.es. As many as l0% or more of circulating CD8. T cells may be specific for HIV during the early stages of infection. These CTLs control infection in the acute phase (see Fig. 20-8), but ultimately prove ineffective because of the emergence of viral escape mutants (variants with mutated antigens). Although CD4* T cells also respond to the virus, the importance of this response is unclear. Antibod.y responses to a uariety of HIV antigens are detectable within 6 to 9 weeks afier infection. The most immunogenic HIV molecules that elicit antibody responsesappear to be the envelope glycoproteins, and high titers of anti-gpl20 and anti-gp4l antibodies are present in most HlV-infected individuals. Other antiHIV antibodies found frequently in patients' sera include antibodies to p24, reverse transcriptas e, and gag and pol products (seeFig. 20-8). The effect ofthese antibodies on the clinical course of HIV infection is uncertain. The early antibodies are not neutralizing, and are generally poor inhibitors of viral infectivity or cytopathic effects.Neutralizing antibodies against gp120 develop 2
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IMMUNITY lN DEFENSE ANDDISEASE
to 3 months after primary infection, but even these antibodies cannot cope with a virus that is able to rapidly change the most immunodominant epitopes of its envelope glycoproteins. Mechanisms
of lmmune
Evasion by HIV
The failure of cell-mediated and humoral immune responsesto eradicate HIV infection is probably due to several factors. Importantly, because of the depletion and functional inhibition of the CD4* T cells, the immune responses may be too compromised to eliminate the virus. In addition, several features of HIV may help the virus to evade host immunity. @ HIV hos an extremely high mutation rate because of error-prone reuerse transcription, and in thk way it may euade detection by antibodies or T cells generated in response to uiral proteins. It has been estimated that in an infected person, every possible point mutation in the viral genome occurs every day. A region of the gp120 molecule, called the V3 loop, is one of the most antigenically variable components of the virus; it varies in HIV isolates taken from the same individual at different times. Furthermore, the regions of the V3 loop that are critical for viral entry and therefore are less frequently mutated are not readily exposed to the humoral immune system. It is possible that the host immune response may work as a selective pressure that promotes survival of the most genetically variable viruses. @ HlV-infected cells may euade CTLs through downregulation of class I MHC molecule expression. The HIV Nef protein inhibits expression of class I MHC molecules, mainly by promoting internalization of these molecules. @ HIV infection may inhibit cell-mediated immunity. We have mentioned previously that in infected individuals, Ts2 cells specific for HIV and other microbes may expand relative to THI cells. Because TH2 cytokines inhibit cell-mediated immunity, the net result of this imbalance is a form of dysregulation (called immune deviation) that increases host susceptibility to infection by intracellular microbes, including HIV itself. Along the same vein, increased numbers of regulatory T cells may inhibit host defenses. Treatment and Prevention Vaccine Development
of AIDS and
Active research efforts have been aimed at developing reagents that interfere with the viral life cycle. Treatment of HIV infection and AIDS now includes the administration of three classesof antiviral drugs, used in combination, that target viral molecules for which no human homologues exist. The first type of drug to be widely used consists of nucleoside analogues that inhibit reverse-transcriptase activity. These drugs include deoxythl'rnidine nucleoside analogues such as 3'-
azido -3' - deoxythymidine (AZT), deoxycltidine nucleo side analogues, and deoxyadenosine analogues.\dhen these drugs are used alone, they are often effective in signiflcantly reducing plasma HIV RNA levels for several months to years.They usually do not halt progression of HlV-induced disease,largely because of the evolution of virus with mutated forms of reverse transcriptase that are resistant to the drugs. More recently, viral protease inhibitors have been developed that block the processing of precursor proteins into mature viral capsid and core proteins. \A/hen these protease inhibitors are used alone, mutant viruses resistant to their effects rapidly emerge. However, protease inhibitors are now being used in combination with two different reversetranscriptase inhibitors. This new triple-drug therapy, commonly referred to as FIAAR'T (highly active antiretroviral therapy), has proved to be remarkably effective in reducing plasma viral RNA to undetectable levels in most treated patients for up to 3 years. An integrase inhibitor is also now used as part of anti-viral therapy. Although anti-retroviral therapy has reduced viral titers to below detection for up to 10 years in some patients, it is unlikely that such treatment can eliminate the virus from all reservoirs (especiallylong-lived infected cells), and resistance to the drugs may ultimately develop. Other formidable problems associated with these new drug therapies, which will impair their effective use in many parts of the world, include high expense,complicated administration schedules,and serious side effects. The individual infections experienced by patients with AIDS are treated with the appropriate prophylaxis, antibiotics, and support measures. More aggressive antibiotic therapy is often required than for similar infections in less compromised hosts. Efforts at preventing HIV infection are extremely important and potentially effective in controlling the HIV epidemic. In the United States,the routine screening of blood products for evidence of donor HIV infection has already reduced the risk of this mode of transmission to negligible levels. Various public health measures to increase condom use and to reduce the use of contaminated needles by intravenous drug users are now widespread. Perhaps the most effective efforts at prevention are campaigns to increase public awareness of HIV The deuelopment of an effectiue uaccine against HIV is a priority for biomed.ical research institutions worldwi.d,e.Thetask has been complicated by the ability of the virus to mutate and vary many of its immunogenic antigens. It is likely that an effective vaccine will have to stimulate both humoral and cell-mediated responses to viral antigens that are critical for the viral life cycle. To achieve this goal, several approaches are being tried for HIV vaccine development. Much of the preliminary work has involved SIV infection of macaques, and effective vaccines against SIV have already been developed. This successis encouraging because SIV is molecularly closely related to HIV and causes a disease similar to AIDS in macaques.Various live virus vaccines have been tested in the hope that they will induce strong CTL responses.Such vaccines include nonvirulent recombi-
IMMUN0DEFICIENCIES t, 487 ANDAC0UIRED 20- C0NGENITAL Chapter
. nant hybrid viruses composed of part SIV and part HIV sequencesor viruses that have been attenuated by deletions in one or more parts of the viral genome, such as the nef gene. One concern with live virus vaccines is their potential to cause disease if they are not completely attenuated and possibly after recombination in vivo with wild-type HIV to produce a pathogenic variant. Another approach that avoids this safety concern but retains efficacy in inducing CTl-mediated immunity is the use of live recombinant non-HIV viral vectors carrying HIV genes. Preliminary trials in human volunteers have already shor,rmthat canarypox vaccines expressing several HIV-1 genes can induce strong CTL responsesto the HIV antigens. Many DNA vaccines have also been studied; these vaccines are composed of combinations of structural and regulatory genes of SIV or HIV packaged in mammalian DNA expressionvectors. Combinations of vaccines, such as initial immunization with a DNA vaccine followed by boosting with a canarypox vector expressing HIV genes, have yielded some of the most promising results to date. Recombinant protein or peptide subunit vaccines that elicit antibodies are of limited value by themselves because the antibodies often do not neutralize clinical isolates of HIV It is possible that such vaccines may be useful given with live virus vaccines.
SUMMARY @ Immunodeficiency diseasesare causedby congenital or acquired defects in lymphocltes, phagoc1tes, and other mediators of adaptive and innate immunity. These diseasesare associated with an increased susceptibility to infection, the nature and severity of which depend largely on which component of the immune system is abnormal and the extent of the abnormality. @ Disorders of innate immunity include defects in microbial killing by phagocytes (e.9., CGD or Ch6diak-Higashi syndrome), in leukocyte migration and adhesion (e.9.,LAD), and in TLR signaling. Complement deficiencies were described in Chapter 14. @ Severe combined immunodeficiencies include defects in lymphocyte development that affect both T and B cells, and are caused by defective cltokine signaling, abnormal purine metabolism, defectiveV(D)I recombination, and mutations that affect T cell maturation. @ Antibody immunodeficiencies include diseases causedby defective B cell maturation or activation, and defects in T cell-B cell collaboration (X-linked hlper-IgM s1'ndrome). @ T cell immunodeficiencies include diseases in which the expression of MHC molecules is defec-
...,,,",-*6-*-.".,, ,.
tive, T cell signaling disorders, and rare diseases involving CTL and NK cell functions. @
Treatment of congenital immunodeficiencies involves transfusions of antibodies, bone marrow or stem cell transplantation, or enzyrne replacement. Gene therapy may offer improved treatments in the future.
@
Acquired immunodeficiencies are caused by infections, malnutrition, disseminated cancel and immunosuppressive therapy for transplant rejection or autoimmune diseases.
g AIDS is a severe immunodeficiency
caused by infection with HIV This RNA virus infects CD4* T lymphocytes, macrophages, and dendritic cells, and causes massive dysfunction of the immune system. Most of the immunodeficiency in AIDS can be ascribed to the depletion of CD4* T cells.
@ HIV enters cells by binding to both the CD4 molecule and a coreceptor of the chemokine receptor family. Once inside the cell, the viral genome is reverse-transcribed into DNA and incorporated into the cellular genome. Viral gene transcription and viral reproduction are stimulated by signals that normally activate the host cell. Production of virus is accompanied by cell death. @ The acute phase of infection is characterized by death of memory CD4* T cells in mucosal tissues and dissemination of the virus to lymph nodes. In the subsequent latent phase, there is low level virus replication in ll.rnphoid tissues and slow progressive loss of T cells. Persistent activation of T cells promotes their death, leading to rapid loss and immune deficiency in the chronic phase of the infection. @ CD4* T cell depletion in HlV-infected individuals is due to direct cytopathic effects of the virus, toxic effects of viral products such as shed gp120, and indirect effects such as activation-induced cell death or CTL killing of infected CD4' cells. @ Several reservoirs of HIV exist in infected individuals, including short-lived activated CD4* T cells, longer-lived macrophages, and very long lived, latently infected memory T cells. o HlV-induced depletion of CD4* T cells results in increased susceptibility to infection by a number of opportunistic microorganisms. In addition, HlV-infected patients have an increased incidence of tumors, particularly Kaposi's sarcoma and EBVassociatedB cell lymphomas, and encephalopathy frequently develops, the mechanism of which is not fully understood.
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,..!,,4r:61,@']:i
g HIV has a high mutation rate, which allows the virus to evade host immune responses and becomeresistantto drug therapies.Geneticvariability also posesa problem for the designof an effectivevaccineagainstHM HIV infection can be treated by a combination of inhibitors of viral enzyrnes.
Selected Readings Barouch DH. Challenges in the development of an HIV-I vaccine. Nature 455:613-619,2008. Blackburn MR, and RE Kellems. Adenosine deanimase deficiency: metabolic basis of immune deficiency and pulmonary inflammation. Advances in Immunology 86:l-4, 2005. Bonilla FA, and RS Geha. Update on primary immunodeflciency diseases.fournal of Allergy and Clinical Immunology r l7(Suppl):435-44r, 2006. Brenchley JM, DA Price, and DC Douek. HIV disease:fallout from a mucosal catastrophe?Nature Immunology 7:235-239, 2006. Buckley RH. Molecular defects in human severe combined immunodeficiency and approaches to immune reconstitution. Annual Review of Immunology 22:625-685,2004. Bustamante L S Boisson-Dupuis, E Jouanguy,C picard, A puel, LAbel, and IL Casanova.Novel primarv immunodeficiencies revealed by the investigation bf paeiiatric infectious diseases.Current Opinion in Immunology 20:39-48, 2008. Casanova]L, and L Abel. Inborn errors of immunity to infection: the rule rather than the exception. Iournal of Experimental Medicine 202:197-20I, 2005. Castigli E, and RS Geha. Molecular basis of common variable immunodeficiency. Iournal of Allergy and Clinical Immunology Il7:740-746,2006. Chen X, and PE lensen. MHC class II antigen presentation and immunological abnormalities due to deflciency of MHC class II and its associatedgenes.Experimental and Molecular Pathology 85:40-44, 2O08. Chiu Y-L, and WC Greene. Multifaceted antiviral actions of APOBEC3 c1'tidine deaminase. Trends in Immunology 27:291-297,2006. Cunningham-Rundles C, and PP Ponda. Molecular defects in T- and B-cell primary immunodeflciency diseases.Nature ReviewsImmunology 5:BB0-892,2005. Derdeyn CA, and G Silvestri.Viral and host factors in the pathogenesis of HIV infection. Current Opinion in Immunology l7:366-373,2005. Fauci AS, D Mavilio, and S Kottilil. NK cells in HIV infection: paradigm for protection or targets for ambush. Nature ReviewsImmunology 5:835-843,2005. FischerA. Human primary immunodeficiency diseases.Immunity 28:835-846,2008. Greene WC, and BM Pererlin. Charting HIV's remarkable voyage through the cell: basic science as a passport to future therapy. Nature Medicine 8:673-680, 2002.
Groneberg DA, D Quarcoo, N Frossard, and A Fischer. Gene therapy for severe combined immunodeficiency. Annual Review of Medicine 56:585-602,2005. Grossman Z, M Meier-Schellersheim,AE Sousa,RM Victorino, and \ME Paul. CD4* T-cell depletion in HIV infection: are we closer to understanding the cause? Nature Medicine 8:319-323,2002. Haase AL Perils at mucosal front lines for HIV and SIV and their hosts. Nature Reviews Immunology 5:783-792, 2005. Hladik B and MJ McElrath. Setting the stage: host invasion by HIV Nature Reviews Immunology 8:447457,2008. Ianka GE. Hemophagocytic lymphohistiocltosis. Hematology 10 Suppl I:104-107,2005. Iohnston MI, and AS Fauci. An HIV vaccine-evolving concepts. New England lournal of Medicine 356:2073-208I,2007. Lavin ME Ataxia-telangiectasia: from a rare disorder to a paradigm for cell signalling and cancer. Nature Reviews Molecular and Cell Biology 9:759-769,2008. Letvin NL. Progress and obstacles in the development of an AIDS vaccine. Nature ReviewsImmunology 6:930-939,2006. Letvin NL, and BD Walker. Immunopathogenesis and immunotherapy in AIDS virus infections. Nature Medicine 9:861-866,2003. Lusso P HIV and the chemokine system: l0 years later. EMBO Journal 25:447-456, 2006. McCune IM. The dynamics of CD4n T-cell depletion in HIV disease.Nature 4lO:974-979, 2001. McMichael AI. HIV vaccines. Annual Review of Immunology 24:227-255,2006. McMichael AL and SL Rowland-Iones. Cellular immune responsesto HIV Nature 410:980-987,2001. Morra M, D Howie, M Simarro, et al. X-linked l1'rnphoproliferative disease: a progressive immunodeficiency. Annual Review of Immunology 19:657-G82, 2001. Nixon DE EM Aandahl, and J Michaelsson. CD4+CD25+ regulatory T cells in HIV infection. Microbes and Infection 7:1063-I065,2005. Ochs HD, and AJ Thrasher. The Wiskott-Aldrich Sgrdrome. Journal of Allergy and Clinical Immuology 117:725-238, 2006. Peterlin MB, and D Trono. Hide, shield, and strike back: how HlV-infected cells avoid immune eradication. Nature ReviewsImmunology 3:97-IO7, 2003. Puel A, K Yang, CL Ku, et al. Heritable defects of the human TLR signaling pathways. Journal of Endotoxin Research IL:220-224,2005. Reith W and B Mach. The bare lymphocyte syndrome and the regulation of MHC expression. Annual Review of Immunology 19:331-373,2001. Simon V and DD Ho. HIV- I dynamics in vivo: implications for therapy. Nature ReviewsMicrobiology l:181-190, 2003. Stebbing J, B Gazzard, and DC Douek. \dhere does HIV Iive? New England Journal of Medicine 350:1872-lBB0, 2004. StevensonM. HIV-f pathogenesis.Nature Medicine 9:853-860, 2003. Villa A, V Marrella, F Rucci, and LD Notarangelo. Genetically determined lymphopenia and autoimmune manifestations. Current Opinion in Immunology 20:318-324, 2008.
SA opT cell receptor(sFTCR). The most common form of TCR,expressed on both CD4*and CD8*Tcells.The cB TCR recognizespeptide antigen bound to an MHC molecule.Both crand B chainscontain highlyvariable (V) regions that together form the antigen-binding site as well as constant (C) regions.TCR V and C regions are structurally homologous to the V and C regionsof Ig molecules. ABOblood group antigens. Glycosphingolipidantigens presenton many cell types,includingred blood cells. These antigens differ between different individuals, dependingon inherited allelesencodingthe enzymes required for synthesisof the antigens.The ABO antigensact as alloantigensresponsiblefor blood transfusion reactionsand hlperacute rejection of allografts. Accessorymolecule. A llrnphocyte cell surface molecule distinct from the antigen receptor complex that mediates adhesiveor signaling functions important for activation or migration of the lymphocyte. Acquired immunodeficiency. A deficiency in the immune system that is acquired after birth, usually becauseof infection (e.g.,AIDS), and that is not relatedto a geneticdefect. Acquired immunodeficiency syndrome (AIDS). A disease caused by human immunodeficiency virus (HIV) infection that is characterized by depletion of CD4*T cells leadingto a profound defectin cellmediated immunity. Clinically,AIDS includes opportunistic infections, malignant tumors, wasting, and encephalopathy. Activation protein-l (AP-l). A family of DNA-binding transcription factors composed of dimers of two proteins that bind to one another through a shared structural motif called a leucine zipper. The bestAP-I factoris composedof the proteins characterized Fos and Iun. AP-l is involved in transcriptional regulation of many different genes important in the immune system,such as cltokine genes. Activeimmunity. The form of adaptiveimmunity that is induced by exposureto a foreign antigen and activation of lyrnphocytes and in which the immunized individual plays an active role in responding to the antigen.This type contrastswith passiveimmunity, in which an individual receivesantibodies or lymphocytes from another individual who was previously activelyimmunized.
Acute-phase reactants. Proteins, mostly synthesized in the liver, whose plasma concentrations increase shortly after infection as part of the systemic inflammatory responseslmdrome.Examplesinclude C-reactive protein, fibrinogen, and serum amyloid A protein. Hepatic synthesis of these molecules is up-regulated by inflammatory cytokines, especially IL-6 and TNF.The acute-phasereactants play various roles in the innate immune response to microbes. Acute-phaseresponse.The increasein plasmaconcentrations of severalproteins, called acute-phasereactants, that occurs as part of the early innate immune responseto infections. Acute rejection. A form of graft rejection involving vascular and parenchymal injury mediated by T cells, macrophages,and antibodiesthat usuallybeginsafter the flrst week of transplantation. Differentiation of effector T cells and production of antibodies that mediateacuterejectionoccurin responseto the graft, thus the delay in onset. Adapter protein. Proteins involved in intracellular signal transduction pathways by serving as bridge moleculesor scaffoldsfor the recruitment of other signaling molecules.During lymphocyte antigen receptor or cytokine receptor signaling,adapter molecules may be phosphorylatedon tyrosineresiduesto enable them to bind other proteins containing Srchomology 2 (SH2)domains.Adaptermoleculesinvolved in T cell activation include I"{I, SLP-76,and Grb-2. Adaptiveimmunity. The form of immunity that is mediated by lymphocytes and stimulated by exposureto infectious agents. In contrast to innate immunity, adaptiveimmunity is characterizedby exquisitespecificity for distinct macromoleculesand memory,which is the ability to respond more vigorously to repeated exposureto the samemicrobe. Adaptive immunity is also called specificimmunity. Addressin. Moleculesexpressedon endothelial cells in different anatomic sitesthat bind to counterreceptors on lymphocytes called homing receptors and that direct organ-specific lymphocyte homing. Mucosal addressincell adhesionmolecule-l (MadCAM-1)is an exampleof an addressinexpressedin Peyer'spatches in the intestinal wall that binds to the integrin aaBron gut-homingT cells.
::3"::1oixr-GL0SSARY Adhesion molecule. A cell surface molecule whose function is to promote adhesive interactions with other cells or the extracellular matrix. Leukocytes expressvarious tlpes of adhesion molecules, such as selectins,integrins, and members of the Ig superfamily, and these molecules play crucial roles in cell migration and cellular activation in innate and adaptive immune responses. Adjuvant. A substance, distinct from antigen, that enhances T cell activation by promoting the accumulation and activation of antigen presenting cells (APCs) at a site of antigen exposure. Adjuvants enhance APC expression of T cell-activating costimulators and c1'tokinesand may also prolong the expression of peptide-MHC complexes on the surface of APCs. Adoptive transfer. The process of transferring lymphocytes from one, usually immunized, individual into another individual. Adoptive transfer is used in research to define the role of a particular cell population (e.g., CD4. T cells) in an immune response. Clinically, adoptive transfer of tumor-reactive T lymphoq,'tes is used in experimental cancer therapy. Affinity. The strength of the binding between a single binding site of a molecule (e.g., an antibody) and a ligand (e.g., an antigen). The affinity of a molecule X for a ligand Y is represented by the dissociation constant (IQ), which is the concentration of Y that is required to occupy the combining sites of half the X molecules present in a solution. A smaller IQ indicates a stronger or higher-affinity interaction, and a lower concentration of ligand is needed to occupy the sites. Affinitymaturation. The processthat leads to increased affinity of antibodies for a particular protein antigen as a humoral responseprogresses.Affinity maturation takes place in germinal centers of ll.rnphoid tissues, and is the result of somatic mutation of Ig genes, followed by selectivesurvival of the B cells producing the highest affinity antibodies. Allele. One of different forms of a gene present at a particular chromosomal locus. An individual who is heterozygous at a locus has two different alleles, each on a different member of a pair of chromosomes, one inherited from the mothei and one from the father. lf a particular gene in a population has many different alleles, the gene or locus is said to be polymorphic. The MHC locus is extremely polymorphic. Allelic exclusion. The exclusive expression of only one of two inherited alleles encoding Ig heavy and light chains and TCR B chains. Allelic exclusion occurs when the protein product of one productively recombined antigen receptor locus on one chromosome blocks rearrangement of the corresponding locus on the other chromosome. This property ensures that all the antigen receptors expressedby one clone of lymphocltes will have the identical antigen specificities. Because the TCR cxchain locus does not show allelic exclusion, some T cells do expresstwo different Wpes ofTCR. Allergen. An antigen that elicits an immediate hlpersensitivity (allergic) reaction. Allergens are proteins or
chemicals bound to proteins that induce IgE antibody responsesin atopic individuals. Allergy. A form of atopy or immediate hypersensitivity disease, often referring to the tlpe of antigen that elicits the disease, such as food ailergy, bee sting allergy, and penicillin allergy. All these conditions are related to antigen-induced mast cell or basophil activation. Alloantibody. An antibody specific for an alloantigen (i.e., an antigen present in some individuals of a speciesbut not in others). Alloantigen. A cell or tissue antigen that is present in some members of a speciesand not in others and that is recognized as foreign on an allograft. Alloantigens are usually products of polymorphic genes. Alloantiserum. The alloantibody-containing serum of an individual who has previously been exposed to one or more alloantigens. Allogeneic graft. An organ or tissue graft from a donor who is of the same speciesbut genetically nonidentical to the recipient (also called an allograft). Alloreactive. Reactive to alloantigens; describes T cells or antibodies from one individual that will recognize antigens on cells or tissues of another genetically nonidentical individual. Allotype. The property of a group of antibody molecules defined by their sharing a particular antigenic determinant found on the antibodies of some individuals but not others. Such determinants are called allotopes. Antibodies that share a particular allotope belong to the same allotype. Allotype is also often used synonyrnously with allotope. Altered peptide ligands (APLs). Peptides with altered TCR contact residues that elicit responses different from the responsesto native peptide ligands. Altered peptide ligands may be important in the regulation of T cell activation in physiologic, pathologic, or therapeutic situations. Alternative pathway of complement activation. An antibody-independent pathway of activation of the complement system that occurs when the C3b protein binds to microbial cell surfaces. The alternative pathwayis a component of the innate immune system and mediates inflammatory responsesto infection as well as direct lysis of microbes. Anaphylactic shock. Cardiovascular collapse occurring in the setting of a systemic immediate hlpersensitivity reaction. Anaphylatoxins. The C5a, C4a, and C3a complement fragments that are generated during complement activation. The anaphylatoxins bind specific cell surface receptors and promote acute inflammation by stimulating neutrophil chemotaxis and activating mast cells. At high concentrations, anaphylatoxins activate enough mast cells to mimic anaphylaxis. Anaphylaxis. An extreme systemic form of immediate hlpersensitivity in which mast cell or basophil mediators cause bronchial constriction, massive tissue edema, and cardiovascular collapse. Anchor residues. The amino acid residues of a peptide whose side chains fit into pockets in the peptide-
binding cleft of an MHC molecule. The side chains bind to complementary amino acids in the MHC molecule and therefore serve to anchor the peptide in the cleft of the MHC molecule. Anergy. A state of unresponsivenessto antigenic stimulation. Clinically, anergy describes the lack of T cell-dependent cutaneous delayed-type hypersensitivity reactions to common antigens. Lymphoclte anergy (also called clonal anergy) is the failure of clones of T or B cells to react to antigen and may be a mechanism of maintaining immunologic tolerance to self. Angiogenesis. New blood vesselformation regulated by a variety of protein factors elaborated by cells of the innate and adaptive immune systems and often accompanying chronic infl ammation. Antagonist peptide. Variant peptide ligands of a TCR in which one or two TCR contact residues have been changed and in which negative signals are delivered to speciflc T cells that inhibit responses to native peptides. Antibody. A tlpe of glycoprotein molecule, also called immunoglobulin (Ig), produced by B lymphocytes that binds antigens, often with a high degree of speciflcity and affinity. The basic structural unit of an antibody is composed of two identical healy chains and two identical light chains. N-terminal variable regions of the heavy and light chains form the antigen-binding sites, whereas the C-terminal constant regions of the heavy chains functionally interact with other molecules in the immune system. Every individual has millions of different antibodies, each with a unique antigen-binding site. Secreted antibodies perform various effector functions, including neutralizing antigens, activating complement, and promoting leukocyte-dependent destruction of microbes. Antibody-dependent cell-mediated cytotoxicity (ADCC). A process by which NK cells are targeted to IgG-coated cells, resulting in lysis of the antibodycoated cells.A specific receptor for the constant region of IgG, called FcyRIII (CD16), is expressedon the NK cell membrane and mediates binding to the IgG. Antibody feedback. The down-regulation of antibody production by secreted IgG antibodies that occurs when antigen-antibody complexes simultaneously engageB cell membrane Ig and Fcyreceptors (FcyRII). Under these conditions, the cytoplasmic tails of the Fc1 receptors transduce inhibitory signals inside the B cell. Antibody repertoire. The collection of different antibody specificities expressedin an individual. Antibody-secreting cell. A B lymphocyte that has undergone differentiation and produces the secretory form of Ig. Antibody-secreting cells are produced in response to antigen and reside in the spleen and Iymph nodes as well as in the bone marrow. Antigen. A molecule that binds to an antibody or a TCR. Antigens that bind to antibodies include all classesof molecules. TCRs bind only peptide fragments of proteins complexed with MHC molecules; both the
peptide ligand and the native protein from which it is derived are called T cell antigens. Antigen presentation. The display of peptides bound by MHC molecules on the surface of anAPC that permits specific recognition by TCRs and activation of T cells. Antigen-presenting cell (APC). A cell that displays peptide fragments of protein antigens, in association with MHC molecules, on its surface and activates antigen-speciflc T cells. In addition to displaying peptide-MHC complexes, APCs must also express costimulatory molecules to activate T lymphocytes optimally. Antigen processing. The intracellular conversion of protein antigens derived from the extracellular space or the cytosol into peptides and loading of these peptides onto MHC molecules for display to T Iymphocytes. Antiserum. Serum from an individual previously immunized against an antigen that contains antibody specific for that antigen. Apoptosis. A process of cell death characterizedby DNA cleavage, nuclear condensation and fragmentation, and plasma membrane blebbing that leads to phagocytosis of the cell without inducing an inflammatory response. This type of cell death is important in lymphocyte development, regulation of lymphocyte responsesto foreign antigens, and maintenance of tolerance to self antigens. Arthus reaction. A localized form of experimental immune complex-mediated vasculitis induced by injection of an antigen subcutaneously into a previously immunized animal or into an animal that has been given intravenous antibody specific for the antigen. Circulating antibodies bind to the injected antigen and form immune complexes that are deposited in the walls of small arteries at the injection site and give rise to a local cutaneous vasculitis with necrosls. Atopy. The propensity of an individual to produce IgE antibodies in responseto various environmental antigens and to develop strong immediate hypersensitivity (allergic) responses. People who have allergies to environmental antigens, such as pollen or house dust, are said to be atopic. Autoantibody. An antibody produced in an individual that is specific for a self antigen. Autoantibodies can cause damage to cells and tissues and are produced in excessin systemic autoimmune diseases,such as systemic lupus erythematosus. Autocrine factor. A molecule that acts on the same cell that produces the factor. For example, IL-2 is an autocrine T cell growth factor that stimulates mitotic activity of the T cell that produces it. Autoimmune disease. A disease caused by a breakdown of self-tolerance such that the adaptive immune system responds to self antigens and mediates cell and tissue damage. Autoimmune diseases can be organ specific (e.B.,thyroiditis or diabetes) or systemic (e.g.,systemic lupus erythematosus). Autoimmune regulator (AIRE). A gene or its encoded protein, which functions to stimulate expression of
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peripheral tissue protein antigens in thymic epithelial cells. Mutations in the,41/?Egenein humans and mice lead to tissue specific autoimmune disease,consistent with a role for AIRE in central T cell tolerance. Autoimmunity. The state of adaptive immune system responsiveness to self antigens that occurs when mechanisms of self-tolerance fail. Autologous graft. A tissue or organ graft in which the donor and recipient are the same individual. Autologous bone marrow and skin grafts are commonly performed in clinical medicine. Avidity. The overall strength of interaction between two molecules, such as an antibody and antigen. Avidity depends on both the affinity and the valency of interactions. Therefore, the avidity of a pentameric IgM antibody, with l0 antigen-binding sites, for a multivalent antigen may be much greater than the avidity of a dimeric IgG molecule for the same antigen. Avidity can be used to describe the strength of cell-cell interactions, which are mediated by many binding interactions between cell surface molecules. B-f B llnnphocytes. A subset of B lymphocytes, which develop earlier during ontogeny than do conventional B cells, and express a limited repertoire of V genes with little junctional diversity, and secrete IgM antibodies that bind T-independent antigens. Many B-l cells expressthe CD5 (Ly-1) molecule. B cell tyrosine kinase (Btk). A tyrosine kinase of the Src family that plays an essentialrole in B cell maturation. Mutations in the gene encoding Btk cause X-linked agammaglobulinemia, a disease characterized by failure of B cells to mature beyond the pre-B cell stage. B lymphocyte. The only cell type capable of producing antibody molecules and therefore the central cellular component of humoral immune responses. B lymphocytes, or B cells, develop in the bone marrow, and mature B cells are found mainly in l1'rnphoid follicles in secondary lymphoid tissues, in bone marrow, and in low numbers in the circulation. BCR (B cell receptor) complex. A multiprotein complex expressedon the surface of B l}'rnphocytes that recognizes antigen and transduces activating signals into the cell. The BCR includes membrane Ig, which is responsible for binding antigen, and Igo and IgB proteins, which initiate signaling events. Bare lymphocyte syndrome. An immunodeficiency diseasecharacterized by a lack of class II MHC molecule expression that leads to defects in antigen presentation and cell-mediated immunity. The disease is caused by mutations in genes encoding factors that regulate class II MHC gene transcription. Basophil. A Vpe of bone marrow-derived, circulating granulocye with structural and functional similarities to mast cells that has granules containing many of the same inflammatory mediators as mast cells and expressesa high-affinity Fc receptor for IgE. Basophils that are recruited into tissue sites where antigen is present may contribute to immediate hlpersensitivity reactions. p2-Microglobulin. The light chain of a class I MHC molecule. Br-Microglobulin is an extracellular protein
encoded by a nonpolyrnorphic gene outside the MHC, is structurally homologous to an Ig domain, and is invariant among all class I molecules. Biogenic amines. Low molecular weight, nonlipid compounds, such as histamine, that share the structural feature of an amine group, are stored in and released from the cltoplasmic granules of mast cells, and mediate many of the biologic effects of immediate hypersensitivity (allergic) reactions. (Biogenic amines are sometimes called vasoactive amines.) Biologic response modifiers. Molecules, such as cytokines, used clinically as modulators of inflammation, immunity, and hematopoiesis. Bone marrow. The central cavity of bone that is the site of generation of all circulating blood cells in adults, including immature lymphocytes, and the site of B cell maturation. Bone marrow transplantation. The transplantation of bone marrow, including stem cells that give rise to all mature blood cells and lymphoc)'tes; it is performed clinically to treat hematopoietic or lynnphopoietic disorders and malignant diseases and is also used in various immunologic experiments in animals. Bronchial asthma. An inflammatory disease usually caused by repeated immediate hypersensitivity reactions in the lung that leads to intermittent and reversible airway obstruction, chronic bronchial inflammation with eosinophils, and bronchial smooth muscle cell hlpertrophy and hyperreactivity. Burkitt's lymphoma. A malignant B cell tumor that is deflned by histologic features but almost always carries a reciprocal chromosomal translocation involving Ig gene loci and the cellular myc gene on chromosome B. Many casesof Burkitt's lymphoma are associatedwith Epstein-Barr virus infection. C (constant region) gene segments. The DNA sequencesin the Ig and TCR gene loci that encode the nonvariable portions of Ig heavy and light chains and TCR a, B, y, and 6 chains. C1. A serum complement system protein composed of several polypeptide chains that initiates the classical pathway of complement activation by attaching to the Fc portions of IgG or IgM antibody that has bound antigen. Cl inhibitor (Cf INH). A plasma protein inhibitor of the classical pathway of complement activation. CI INH is a serine protease inhibitor (serpin) that mimics the normal substrates of the Clr and Cls components of C1. A genetic deficiency in Cl INH causesthe disease hereditary angioneurotic edema. C3. The central and most abundant complement system protein; it is involved in both the classicaland alternative pathway cascades. C3 is proteolytically cleaved during complement activation to generate a C3b fragment, which covalently attaches to cell or microbial surfaces, and a C3a fragment, which has various proinfl ammatory activities. C3 convertase. A multiprotein enzyme complex generated by the early steps of either the classical or alternative pathway of complement activation. C3
convertase cleaves C3, which gives rise to two proteolytic products called C3a and C3b. C5 convertase. A multiprotein enzyme complex generated by C3b binding to C3 convertase. C5 convertase cleavesC5 and initiates the late steps of complement activation leading to formation of the membrane attack complex and lysis of cells. Calcineurin. A cytoplasmic serineithreonine phosphatase that dephosphorylates and thereby activates the transcription factor NFAT. Calcineurin is activated by calcium signals generated through TCR signaling in response to antigen recognition, and the immunosuppressive drugs cyclosporine and FK-506 work by blocking calcineurin activity. Carcinoembryonic antigen (CEA, CD66). A highly glycosylated membrane protein; increased expression of CEA in many carcinomas of the colon, pancreas, stomach, and breast results in a rise in serum levels. The level of serum CEA is used to monitor the persistence or recurrence of metastatic carcinoma after treatment. Because CEA expression is normally high in many tissues during fetal life but is suppressed in adults except in tumor cells, it is called an oncofetal tumor antigen. Caspases. Intracellular proteaseswith cysteinesin their active sites that cleave substrates at the C-terminal sides of aspartic acid residues and are components of enz],'rnatic cascades that cause apoptotic death of cells. Lymphoclte caspases may be activated by two pathways; one is associated with mitochondrial permeability changes in growth factor-deprived cells, and the other is associated with signals from death receptors in the plasma membrane. Cathelicidins. Pollpeptides produced by neutrophils and various barrier epithelia that serve various functions in innate immunity including direct toxicity to microorganisms, activation of leukocytes, and neutralization of lipopolysaccharide. Cathepsins. Thiol and aspartyl proteases with broad substrate specificities. The most abundant proteases of endosomes in APCs, cathepsins play an important role in generating peptide fragments from exogenous protein antigens that bind to class II MHC molecules. CD molecules. Cell surface molecules expressed on various cell types in the immune system that are designated by the "cluster of differentiation" or CD number. See Appendix II for a list of CD molecules. Cell-mediated immunity (Cnng. The form of adaptive immunity that is mediated by T lymphoc)'tes and serves as the defense mechanism against microbes that survive within phagocytes or infect nonphagocytic cells. CMI responses include CD4. T cell-mediated activation of macrophages that have phagocltosed microbes and CDB* CTL killing of infected cells. Central tolerance. A form of self-tolerance induced in generative (central) ly'rnphoid organs as a consequence of immature self-reactive lyrnphocltes recognizing self antigens and subsequently leading to their death or inactivation. Central tolerance prevents the
emergence of lymphocytes with high-affinity receptors for the ubiquitous self antigens that are likely to be present in the bone marrow or thyrnus. autosomalrare syndrome. A Chddiak-Higashi by a caused disease immunodeficiency recessive defect in the cytoplasmic granules of various cell types that affects the lysosomes of neutrophils and macrophages as well as the granules of CTLs and NK cells. Patients show reduced resistance to infection with pyogenic bacteria. Chemokine receptors. Cell surface receptors for chemokines that transduce signals stimulating the migration of leukocltes. These receptors are members of the seven-transmembrane cr-helical, G proteinlinked family of receptors. Chemokines. A large family of structurally homologous, low molecular weight cytokines that stimulate leukocyte movement and regulate the migration of leukocytes from the blood to tissues. Chemotaxis. Movement of a cell directed by a chemical concentration gradient. The movement of lymphocltes, polymorphonuclear leukocytes, monocytes, and other leukocltes into various tissues is often directed by gradients of low molecular weight cytokines called chemokines. Chromosomal translocation. A chromosomal abnormality in which a segment of one chromosome is transferred to another. Many malignant diseases of are associated with chromosomal llrnphocltes translocations involving an Ig or TCR locus and a chromosomal segment containing a cellular oncogene. Chronic granulomatous disease. A rare inherited immunodeficiency disease caused by a defect in the gene encoding a component ofthe phagocyte oxidase enzyme that is needed for microbial killing by polymorphonuclear leukocytes and macrophages. The disease is characterized by recurrent intracellular bacterial and fungal infections, often accompanied by chronic cell-mediated immune responsesand the formation of granulomas. Chronic rejection. A form of allograft rejection characterized by fibrosis with loss of normal organ structures occurring during a prolonged period. In many cases, the major pathologic event in chronic rejection is graft arterial occlusion, which is caused by proliferation of intimal smooth muscle cells and is called graft arteriosclerosis. c-Kit ligand (stem cell factor). A protein required for hematopoiesis, early steps in T cell development in the thyrnus, and mast cell development. c-Kit ligand is produced in membrane-bound and soluble forms by stromal cells in the bone marrow and thlmus and binds to the c-Kit tytosine kinase membrane receptor on pluripotent stem cells. Class I major histocompatibility complex (MHC) molecule. One of two forms of poll'rnorphic, heterodimeric membrane proteins that bind and display peptide fragments of protein antigens on the surface of APCsfor recognition byT lyrnphocytes' ClassI MHC molecules usually display peptides derived from the cytoplasm of the cell.
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Class Il-associated invariant chain peptide (CLIP). A peptide remnant of the invariant chain that sits in the class II MHC peptide-binding cleft and is removed by action of the HIA-DM molecule before the cleft becomes accessibleto peptides produced from extracellular protein antigens. Class II major histocompatibility complex (MHC) molecule. One of two major classesof polymorphic, heterodimeric membrane proteins that bind and display peptide fragments of protein antigens on the surface of APCs for recognition by T lymphocytes. Class II MHC molecules usually display peptides derived from extracellular proteins that are internalized into phagocltic or endocytic vesicles. Class II vesicle (CIry). A membrane-bound organelle identified in murine B cells that is important in the class II MHC pathway of antigen presentation. The CIIV is similar to the MHC class II compartment (MIIC) identified in other cells and contains all the components required for the formation of complexes of peptide antigens and class II MHC molecules, including the enzymes that degrade protein antigens, class II molecules, invariant chain, and HIA-DM. Classical pathway of complement activation. The pathway of activation of the complement system that is initiated by binding of antigen-antibody complexes to the Cl molecule and induces a proteolytic cascade involving multiple other complement proteins. The classical pathway is an effector arm of the humoral immune system that generates inflammatory mediators, opsonins for phagocl.tosis of antigens, and lytic complexes that destroy cells. Clonal anergy. A state ofantigen unresponsivenessofa clone of T lymphocltes experimentally induced by recognition of antigen in the absence of additional signals (costimulatory signals) required for functional activation. Clonal anergy is considered a model for one mechanism of tolerance to self antigens and may be applicable to B lyrnphocytes as well. Clonal deletion. A mechanism of lymphocyte tolerance in which an immature T cell in the thvmus or an immature B cell in the bone marrow undergoes apoptotic death as a consequence of recognizing an abundant antigen in the generative organ. Clonal expansion. The increase in number of lymphocytes specific for an antigen that results from antigen stimulation and proliferation of naive T cells. Clonal expansion occurs in l1'rnphoid tissues and is required to generate enough antigen-specific effector lymphocytes from rare naive precursors to eradicate infections. Clonal ignorance. A form of ll.rnphocyte unresponsiveness in which self antigens are ignored by the immune system even though lymphocytes specific for those antigens remain viable and functional. Clonal selection hlpothesis. A fundamental tenet of the immune system (no longer a hypothesis) stating that every individual possessesnumerous clonally derived lymphocytes, each clone having arisen from a single precursor and being capable of recognizing and
responding to a distinct antigenic determinant. \dhen an antigen enters, it selectsa speciflc preexisting clone and activates it. c-myc, A cellular proto-oncogene that encodes a nuclear factor involved in cell cycle regulation. Translocations of the c-myc gene into Ig gene loci are associatedwith B cell malignant neoplasms. Collectins. A family of proteins, including mannosebinding lectin, that are characterized by a collagenlike domain and a lectin (i.e., carbohydrate-binding) domain. Collectins play a role in the innate immune system by acting as microbial pattern recognition receptors, and they may activate the complement system by binding to Clq. Colony-stimulating factors (CSFs). Cltokines that promote the expansion and differentiation of bone marrow progenitor cells. CSFs are essential for the maturation of red blood cells, granulocytes, monocltes, and lymphocltes. Examples of CSFs are granulocyte-monocyte colony-stimulating factor (GM-CSF),c-Kit ligand, IL-3, and IL-7. Combinatorial diversity. Combinatorial diversity describes the many different combinations of variable, diversiry and joining segments that are possible as a result of somatic recombination of DNA in the Ig and TCR loci during B cell or T cell development. Combinatorial diversity is one mechanism for the generation of large numbers of different antigen receptor genes from a limited number of DNA gene segments. Complement. A system of serum and cell surface proteins that interact with one another and with other molecules of the immune system to generate important effectors of innate and adaptive immune responses.The classical and alternative pathways of the complement system are activated by antigenantibody complexes or microbial surfaces, respectively, and consist of a cascadeof proteolytic enzymes that generate inflammatory mediators and opsonins. Both pathways lead to the formation of a common terminal cell lytic complex that is inserted in cell membranes. Complement receptor type I (CRf). A high-affinity receptor for the C3b and C4b fragments of complement. Phagocltes use CRI to mediate internalization of C3b- or C4b-coated particles. CRI on erlthrocltes servesin the clearanceof immune complexes from the circulation. CRI is also a regulator of complement activation. Complement receptor type 2 (CRz). A receptor expressedon B cells and follicular dendritic cells that binds proteolytic fragments of the C3 complement protein, including C3d, C3dg, and iC3b. CR2 functions to stimulate humoral immune responsesby enhancing B cell activation by antigen and by promoting the trapping of antigen-antibody complexes in germinal centers. CR2 is also the receptor for EpsteinBarr virus. Complementarity-determining region (CDR). Short segments of Ig and TCR proteins that contain most of the sequence differences among different antibodies
or TCRs and that make contact with antigen. Three CDRs are present in the variable domain of each antigen receptor polypeptide chain and six CDRs in an intact Ig or TCR molecule. These hypervariable segments assume loop structures that together form a surface that is complementary to the threedimensional structure of the bound antigen. Congenic mouse strains. Inbred mouse strains that are identical to one another at every genetic locus except the one for which they are selected to differ; such strains are created by repetitive back-crossbreeding and selection for a particular trait. Congenic strains that differ from one another only at a particular MHC allele have been useful in defining the function of MHC molecules. Constant (C) region. The portion of Ig or TCR pollpeptide chains that does not vary in sequence among different clones and is not involved in antigen binding. Contact sensitivity. The propensity for a T cell-mediated, delayed-t1pe hlpersensitivity reaction to develop in the skin on contact with a particular chemical agent. Chemicals that elicit contact hypersensitivity bind to and modify self proteins or molecules on the surfaces of APCs, which are then recognized by CD4* or CDB*T cells. Coreceptor. A lymphocyte surface receptor that binds to an antigen complex at the same time that membrane Ig or TCR binds the antigen and delivers signals required for optimal lymphocyte activation. CD4 and CDB are T cell coreceptors that bind nonpolymorphic parts of an MHC molecule concurrently with the TCR binding to polymorphic residues and the bound peptide. CR2 is a coreceptor on B cells that binds to complement-opsonized antigens at the same time that membrane Ig binds another part of the antigen. Costimulator. A molecule on the surface of or secreted by an APC that provides a stimulus (or second signal) required for the activation of naive T cells, in addition to antigen. The best defined costimulators are the 87 molecules on professionalAPCs that bind to the CD2B molecule on T cells. cytidine-guanine CpG nucleotides. Unmethylated sequences found in microbial DNA that stimulate innate immune responses. CpG nucleotides are recognized by TLR-9, have adjuvant properties in the mammalian immune system, and may be important to the efficacy of DNA vaccines. C-reactive protein (CRP). A member of the pentraxin family of plasma proteins involved in innate immune responses to bacterial infections. CRP is an acutephase reactant, and it binds to the capsule of pneumococcal bacteria. CRP also binds to Clq and may thereby activate complement or act as an opsonin by interacting with phagocyte Clq receptors. Crossmatching. A screening test performed to minimize the chance of graft rejection in which a patient in need ofan allograft is tested for the presenceofpreformed antibodies against donor cell surface antigens (usually MHC antigens). The test involves mixing the recipient serum with leukocltes from potential
donors, adding complement, and observing whether cell lysis occurs. Cross-priming. A mechanism by which a professional APC activates (or primes) a naive CD8* CTL specific for the antigens of a third cell (e.g., a virus-infected or tumor cell). Cross-priming occurs, for example, when an infected (often apoptotic) cell is ingested by a professional APC and the microbial antigens are processed and presented in association with class I MHC molecules, just like any other phagocytosed antigen. The professional APC also provides costimulation for the T cells. Also called cross-presentation. Cutaneous immune system. The components of the innate and adaptive immune system found in the skin that function together in a specialized way to detect and respond to environmental antigens. Components of the cutaneous immune system include keratinocytes, Langerhans cells, intraepithelial lymphoc1tes, and dermal lymPhocYtes. Cyclosporine. An immunosuppressive drug used to prevent allograft rejection that functions by blocking T cell cytokine gene transcription. Cyclosporine (also called cyclosporin A) binds to a cytosolic protein called cyclophilin, and cyclosporine-cyclophilin complexes bind to and inhibit calcineurin, thereby inhibiting activation and nuclear translocation of the transcription factor NFAL Cytokines. Proteins produced by many different cell types that mediate inflammatory and immune reactions. Cytokines are principal mediators of communication between cells of the immune system. Cytopathic effect of viruses. Harmful effects of viruses on host cells that are caused by any of a variety of biochemical or molecular mechanisms and are independent of the host immune response to the virus. Some viruses have little cytopathic effect but still cause diseasebecausethe immune system recognizes
recognize microbial peptides displayed by class I MHC molecules. CTL killing of infected cells involves the release of cltoplasmic granules whose contents include membrane pore-forming proteins and enzymes that initiate apoptosis of the infected cell. Defensins. Cysteine-rich peptides present in the skin and in neutrophil granules that act as broad-spectrum antibiotics to kill a wide variety of bacteria and fungi. The synthesis of defensins is increased in response to inflammatory cltokines such as IL-1 and TNF. (DTH). An immune Delayed-type hypersensitivity reaction in which T cell-dependent macrophage activation and inflammation cause tissue injury' A DTH reaction to the subcutaneous injection of antigen is often used as an assay for cell-mediated immunity (e.g., the purified protein derivative skin test for immunity to Mycobacterium tuberculosis). DTH is a frequent accompaniment of protective cell-mediated immunity against microbes.
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Delayed xenograft rejection. A frequent form of rejection of xenografts that occurs within 2 to 3 days of transplantation and is characterized bv intravascular thrombosis and fibrinoid necrosis oi vessel walls. Delayed xenograft rejection is likely to be caused by antibody- and cytokine-mediated endothelial activation and damage. Dendritic cells. Bone marrow-derived immune accessory cells found in epithelial and lymphoid tissues that are morphologically characterized by thin membranous projections. Dendritic cells function as APCs for naive T lymphocytes and are important for initiation of adaptive immune responses to protein antigen. Desensitization. A method of treating immediate hypersensitivity d/sease (allergies) that involves repetitive administration of low doses of an antigen to which individuals are allergic. This process often prevents severe allergic reactions on subsequent environmental exposureto the antigen, but the mechanisms are not well understood. Determinant. The specific portion of a macromolecular antigen to which an antibody binds. In the case of a protein antigen recognized by a T cell, the determinant is the peptide portion that binds to an MHC molecule for recognition by the TCR. Synonymous with epitope. Determinant selection model. A model to explain MHC-linked immune responses that was proposed before the demonstration of peptide-MHC molecule binding. The model states that the products of MHC genes in each individual select which determinants of protein antigens will be immunogenic in that individual. Diacylglycerol (DAG). A membrane-bound signaling molecule generated by phospholipase C (plCyl)mediated hydrolysis of the plasma membrane phospholipid phosphatidylinositol 4,5-bisphosphate (plpz) during antigen activation of lymphocytes. The main function of DAG is to activate an enz\Tne called protein kinase C that participatesin the generationof active transcription factors. DiGeorge's syndrome. A selective T cell deficiency caused by a congenital malformation that results in defective development of the thymus, parathyroid glands, and other structures that arise from the third and fourth pharyngeal pouches. Direct antigen presentation (or direct allorecognition). Presentation of cell surface allogeneic MHC molecules by graft cells to a graft recipient's T cells that leads to T cell activation, with no requirement for processing. Direct recognition of foreign MHC molecules is a cross-reaction in which a normal TCR that recognizes a self MHC molecule plus foreign peptide cross-reacts with an allogeneic MHC molecule plus peptide. Direct presentation is partly responsible for strong T cell responsesto allografts. Diversity. The existence of a large number of lymphocytes with different antigenic specificities in any individual (i.e., the lymphocl'te repertoire is large and diverse). Diversity is a fundamental property of the
adaptive immune system and is the result of variability in the structures of the antigen-binding sites of lymphocyte receptors for antigens (antibodies and TCRs). Diversity (D) segments. Short coding sequences between the variable (V) and constant (C) gene segments in the Ig heavy chain and TCR B and yloci that together with J segments are somatically recombined with V segments during lymphoclte development. The resulting recombined VDI DNA codes for the carboxy-terminal ends of the antigen receptor V regions, including the third hypervariable (CDR) regions. Random use of D segments contributes to the diversity of the antigen receptor repertoire. DNA vaccine. A vaccine composed of a bacterial plasmid containing a complementary DNA encoding a protein antigen. DNA vaccines presumably work because professional APCs are transfected in uiuo by the plasmid and express immunogenic peptides that elicit specific responses. Furthermore, the plasmid DNA contains CpG nucleotides that act as potent adjuvants. DNA vaccines may elicit strong CTL responses. Double-negative thymocyte. A subset of developing T cells (thymocltes) in the thymus that express neither CD4 nor CD8. Most double-negative thymocytes are at an early developmental stage and do not express antigen receptors. They will later express both CD4 and CD8 during the intermediate double-positive stage before further maturation to single-positive T cells expressingonly CD4 or CD8. Double-positive thymocyte. A subset of developing T cells (thymocltes) in the thymus at an intermediate developmental stage that expressboth CD4 and CD8. Double-positive th)rmocytes also express TCRs and are subject to selection processes, the survivors of which mature to single-positiveT cells expressingonly CD4 or CD8. Ectoparasites. Parasites that live on the surface of an animal, such as ticks and mites. Both the innate and adaptive immune systems may play a role in protection against ectoparasites, often by destroying the larval stagesof these organisms. Effector cells. The cells that perform effector functions during an immune response, such as secreting cytokines (e.g.,helper T cells), killing microbes (e.g., macrophages), killing microbe-infected host cells (e.g., CTLs), or secreting antibodies (e.g., differentiated B cells). Effector phase. The phase of an immune response,after the recognition and activation phases, in which a foreign antigen is actually destroyed or inactivated. For example, in a humoral immune response, the effector phase may be characterized by antibodydependent complement activation and phagocytosis of antibody- and complement-opsonized bacteria. Endosome. An intracellular membrane-bound vesicle into which extracellular proteins are internalized during antigen processing.Endosomes have an acidic pH and contain proteolytic enzyrnes that degrade proteins into peptides that bind to class II MHC mole-
| - GL0SSARY Appendix
cules.A subset of classII MHC-rich endosomes,called MIIC, play a special role in antigen processing and presentation by the class II pathway. Endotoxin. A component of the cell wall of gramnegative bacteria, also called lipopolysaccharide (LPS),that is released from dying bacteria and stimulates many innate immune responses, including the secretion of cytokines, induction of microbicidal activities of macrophages,and expressionof leukocyte adhesion molecules on endothelium. Endotoxin contains both lipid components and carbohydrate (polysaccharide)moieties. Enhancer. A regulatory nucleotide sequence in a gene that is located either upstream or downstream of the promoter, binds transcription factors, and increases the activity of the promoter. In cells of the immune system, enhancers are responsible for integrating cell surface signals that lead to induced transcription of genes encoding many of the effector proteins of an immune response, such as cJ,tokines. Envelope glycoprotein (Env). A membrane glycoprotein encoded by a retrovirus that is expressedon the plasma membrane of infected cells and on the host cell-derived membrane coat of viral particles. Env proteins are often required forviral infectivity. The Env proteins of HIV include gp4l and gpl20, which bind to CD4 and chemokine receptors, respectively, on human T cells and mediate fusion of the viral and T cell membranes. Enz5rme-linked immunosorbent assay (ELISA). A method of quantifying an antigen immobilized on a solid surface by use of a specific antibody with a covalently coupled enzFne. The amount of antibody that binds the antigen is proportional to the amount of antigen present and is determined by spectrophotometrically measuring the conversion of a clear substrate to a colored product by the coupled enzyme. Eosinophil. A bone marrow-derived granulocyte that is abundant in the inflammatory infiltrates of immediate hypersensitivity late-phase reactions and that contributes to many of the pathologic processesin allergic diseases.Eosinophils are important in defense against extracellular parasites, including helminths. Epitope. The specific portion of a macromolecular antigen to which an antibody binds. In the case of a protein antigen recognized by a T cell, an epitope is the peptide portion that binds to an MHC molecule for recognition by the TCR. Slrronymous with determinant. Epstein-Barr virus (EBV). A double-stranded DNA virus of the herpesvirus family that is the etiologic agent of infectious mononucleosis and is associatedwith some B cell malignant tumors and nasopharyngeal carcinoma. EBV infects B lymphocytes and some epithelial cells by specifically binding to CR2 (CD21). Experimental autoimmune encephalomyelitis.An animal model of autoimmune demyelinating disease of the central nervous system (e.g.,multiple sclerosis) that is induced in rodents by immunization with components of the myelin sheath (e.g., myelin basic
protein) of nerves, mixed with an adjuvant. The diseaseis mediated in large part by cltokine-secreting CD4* T cells specific for the myelin sheath proteins. Extravasation. Escape of the fluid and cellular components of blood from a blood vessel into tissues. Fab (fragment, antigen-binding). A proteolytic fragment of an IgG antibody molecule that includes one complete light chain paired with one heary chain fragment containing the variable domain and only the first constant domain. Fab fragment retains the ability to monovalently bind an antigen but cannot interact with IgG Fc receptors on cells or with complement. Therefore, Fab preparations are used in research and therapeutic applications when antigen binding is desired without activation of effector functions. (The Fab' fragment retains the hinge region of the heavy chain.) F(ab')z fragment. A proteolltic fragment of an IgG molecule that includes two complete light chains but only the variable domain, first constant domain, and hinge region of the two heavy chains. F(ab')z fragments retain the entire bivalent antigen-binding region of an intact IgG molecule but cannot bind complement or IgG Fc receptors. They are used in research and therapeutic applications when antigen binding is desired without antibody effector functions. Fas (CD95). A member of the TNF receptor family that is expressedon the surface of T cells and many other cell types and initiates a signaling cascade leading to apoptotic death of the cell. The death pathway is initiated when Fas binds to Fas ligand expressed on activated T cells. Fas-mediated killing of T cells, called activation-induced cell death, is important for the maintenance of self-tolerance. Mutations in the Fas gene cause systemic autoimmune disease. Fas ligand (CDgsligand). Amembrane protein that is a member of the TNF family of proteins expressed on activated T cells. Fas ligand binds to Fas, thereby stimulating a signaling pathway leading to apoptotic cell death of the Fas-expressingcell. Mutations in the Fas ligand gene cause systemic autoimmune disease in mice. Fc (fragment, crystalline). A proteolytic fragment of IgG that contains only the disulfide-linked carboxyterminal regions of the two heavy chains. Fc is also used to describe the corresponding region ofan intact Ig molecule that mediates effector functions by binding to cell surface receptors or the Clq complement protein. (Fc fragments are so named because they tend to crystallize out of solution.) Fc receptor. A cell surface receptor specific for the carboxy-terminal constant region of an Ig molecule. Fc receptors are typically multichain protein complexes that include signaling components and Igbinding components. Several types of Fc receptors exist, including those speciflc for different IgG isotypes, IgE, and IgA. Fc receptors mediate many of the cell-dependent effector functions of antibodies, including phagocytosis of antibody-bound antigens, antigen-induced activation of mast cells, and targeting and activation of NK cells.
Appendix I - GL0SSARY
FceRI. A high-affinity receptor for the carboxy-terminal constant region of IgE molecules that is expressedon mast cells and basophils. FceRI molecules on mast cells are usually occupied by IgE, and antigen-induced cross-linking of these IgE-FceRI complexes activates the mast cell and initiates immediate hypersensitivity reactions. Fcyreceptor (F"ynl. A specific cell surface receptor for the carboxy-terminal constant region of IgG molecules. There are several different types of Fc1 receptors, including a high-affinity FcyRI that mediates phagocytosis by macrophages and neutrophils, a lowaffinity Fc1RIIB that transduces inhibitory signals in B cells, and a low-affinity FcyRIII.Athat mediates targeting and activation of NK cells. First-set rejection. Allograft rejection in an individual who has not previously received a graft or otherwise been exposed to tissue alloantigens from the same donor. First-set rejection usually takes about 7 to 10 days. FK-506. An immunosuppressive drug used to prevent allograft rejection that functions by blocking T cell cytokine gene transcription, similar to cyclosporine. FK-506 binds to a cytosolic protein called FK506-binding protein, and the resulting complex binds to calcineurin, thereby inhibiting activation and nuclear translocation of the transcription factor NFAT. Flow cytometry. A method of analysis of the phenotype of cell populations requiring a specialized instrument (flow cltometer) that can detect fluorescence on individual cells in a suspension and thereby determine the number of cells expressing the molecule to which a fluorescent probe binds. Suspensionsofcells are incubated with fluorescently labeled antibodies or other probes, and the amount of probe bound by each cell in the population is measured by passing the cells one at a time through a fluorimeter with a laser-generated incident beam. Fluorescence-activated cell sorter (FACS). An adaptation of the flow cltometer that is used for the purification of cells from a mixed population according to which and howmuch fluorescent probe the cells bind. Cells are first stained with fluorescently labeled probe, such as an antibody specific for a surface antigen of a cell population. The cells are then passedone at a time through a fluorimeter with a laser-generatedincident beam and are differentially deflected by electromagnetic fields whose strength and direction are varied according to the measured intensity of the fluorescence signal. Follicle. See Lymphoid follicle. Follicular dendritic cells. Cells found in lymphoid follicles that expresscomplement receptors, Fc receptors, and CD40 ligand and have long cytoplasmic processes that form a meshwork integral to the architecture of a lymphoid follicle. Follicular dendritic cells display antigens on their surface for B cell recognition and are involved in the activation and selection of B cells expressing high-affinity membrane Ig during the process of affinity maturation.
N-Formylmethionine. An amino acid that initiates all bacterial proteins and no mammalian proteins (except those synthesized within mitochondria) and serves as a signal to the innate immune system of infection. Specific receptors for l/-formylmethioninecontaining peptides are expressedon neutrophils and mediate activation of the neutrophils. FoxP3. A forkhead family transcription factor expressed by, and required for the development of, CD4* regulatory T cells. Mutations in FoxP3 in mice and humans result in an absence of CD25. regulatory T cells and multisystem autoimmune disease. yDT cell receptor (76TCR). A form of TCR that is distinct from the more common aB TCR and is expressedon a subset of T cells found mostly in epithelial barrier tissues. Although structurally similar to the cB TCR, the forms of antigen recognized by y6 TCRs are poorly understood; they do not recognize peptide complexes bound to polyrnorphic MHC molecules. G protein-coupled receptor family. A diverse family of receptors for hormones, lipid inflammatory mediators, and chemokines that use associated trimeric G proteins for intracellular signaling. G proteins. Proteins that bind guanyl nucleotides and act as exchange molecules by catalyzing the replacement of bound guanosine diphosphate (GDP) by guanosine triphosphate (GTP).G proteins with bound GTP can activate a variety of cellular enzyrnes in different signaling cascades.Trimeric GTP-binding proteins are associated with the cytoplasmic portions of many cell surface receptors,such as chemokine receptors. Other small soluble G proteins, such as Ras and Rac, are recruited into signaling pathways by adapter proteins. GATA3. A transcription factor that promotes the differentiation of Tg2 cells from naive T cells. Generative lymphoid organ. An organ in which lymphocytes develop from immature precursors. The bone marrow and thl.rnus are the major generative lymphoid organs in which B cells and T cells develop, respectively. Germinal center. A lightly staining region within a lymphoid follicle in spleen, lymph node, or mucosal lymphoid tissue that forms during T cell-dependent humoral immune responses and is the site of B cell affinity maturation. Germline organization. The inherited arrangement of variable, diversity, joining, and constant region gene segments of the antigen receptor loci in nonlymphoid cells or in immature ll.rnphocytes. In developing B or T lymphocytes, the germline organization is modified by somatic recombination to form functional Ig or TCR genes. Glomerulonephritis. Inflammation of the renal glomeruli, often initiated by immunopathologic mechanisms such as deposition of circulating antigenantibody complexes in the glomerular basement membrane or binding of antibodies to antigens expressed in the glomerulus. The antibodies can activate complement and phagocytes, and the resulting inflammatory response can lead to renal failure.
Graft. A tissue or organ that is removed from one site and placed in another site, usually in a different individual. Graft arteriosclerosis. Occlusion of graft arteries caused by proliferation of intimal smooth muscle cells. This process is evident within 6 months to a year after transplantation and is responsible for chronic rejection of vascularized organ grafts. The mechanism is likely to be a result of a chronic immune response to vessel wall alloantigens. Graft arteriosclerosis is also called accelerated arteriosclerosis. Graftrejection. Aspecific immune responseto an organ or tissue graft that leads to inflammation, damage, and possibly graft failure. Graft-versus-host disease. A diseaseoccurring in bone marrow transplant recipients that is caused by the reaction of mature T cells in the marrow graft with alloantigens on host cells. The disease most often affects the skin, Iiver, and intestines. Granulocyte colony-stimulating factor (G-CSF). A cytokine made by activated T cells, macrophages, and endothelial cells at sites of infection that acts on bone marrow to increase the production of and mobilize neutrophils to replace those consumed in inflammatory reactions. Granulocyte-monocyte colony-stimulating factor (GMCSF). A cltokine made by activated T cells, macrophages, endothelial cells, and stromal fibrobIasts that acts on bone marrow to increase the production of neutrophils and monocytes. GM-CSF is also a macrophage-activating factor and promotes the differentiation of Langerhans cells into mature dendritic cells. Granuloma. A nodule of inflammatory tissue composed of clusters of activated macrophages and T lymphocytes, often with associatednecrosis and fibrosis. Granulomatous inflammation is a form of chronic delayed-type hlryersensitivity, often in response to persistent microbes, such as Mycobacterium tubercu/osis and some fungi, or in response to particulate antigens that are not readily phagocytosed. Granzyme. A serine protease enzyme found in the granules of CTLs and NK cells that is released by exocltosis, enters target cells, and proteolytically cleavesand activates caspases,which in turn cleave several substrates and induce target cell apoptosis. H-2 molecule. An MHC molecule in the mouse. The mouse MHC was originally called the H-2 locus. Haplotype. The set of MHC alleles inherited from one parent and therefore on one chromosome. Hapten. A small chemical that can bind to an antibody but must be attached to a macromolecule (carrier) to stimulate an adaptive immune response specific for that chemical. For example, immunization with dinitrophenol (DNP) alone will not stimulate an anti-DNP antibody response, but immunization with a protein with covalently bonded DNP hapten will. Heavy chain class (isotype) switching. The process by which a B lymphocyte changes the class, or isotype, of the antibodies that it produces, from IgM to IgG, IgE, or IgA, without changing the antigen specificity of the
antibody. Heavy chain class switching is regulated by helper T cell cytokines and CD40 ligand and involves recombination of B cell VDI segments with downstream healy chain gene segments. Helminth. A parasitic worm. Helminthic infections often elicit Ts2-regulated immune responses characterized by eosinophil-rich inflammatory infiltrates and IgE production. Helper T cells. The functional subset of T lymphocytes whose main effector functions are to activate macrophages in cell-mediated immune responses and to promote B cell antibody production in humoral immune responses. These effector functions are mediated by secreted cytokines and by T cell CD40 ligand binding to macrophage or B cell CD40. Most helper T cells expressthe CD4 molecule. Hematopoiesis. The development of mature blood cells, including erythrocytes, leukocytes, and platelets, from pluripotent stem cells in the bone marrow and fetal liver. Hematopoiesis is regulated by several different cytokine growth factors produced by bone marrow stromal cells, T cells, and other cell types. Hematopoietic stem cell. An undifferentiated bone marrow cell that divides continuously and gives rise to additional stem cells and cells of multiple different lineages.A hematopoietic stem cell in the bone marrow will give rise to cells of the lymphoid, myeloid, and erythrocytic lineage. High endothelial venules (HEVs). Specialized venules that are the sites of lymphoclte extravasation from the blood into the stroma of a peripheral lymph node or mucosal lymphoid tissue. HEVs are lined by plump endothelial cells that protrude into the vessel lumen and express unique adhesion molecules involved in binding naive T cells. Highly active antiretroviral therapy (HAART). Combination chemotherapy for HIV infection consisting of reverse transcriptase inhibitors and a viral protease inhibitor. FIAART can reduce plasma virus titers to below detectable levels for more than I year and slow the progression of HIV disease. Hinge region. A region of Ig heaqr chains between the flrst two constant domains that can assume multiple conformations, thereby imparting flexibility in the orientation of the two antigen-binding sites. Becauseof the hinge region, an antibody molecule can simultaneously bind two epitopes that are anywhere within a range of distances from one another. Histamine. A biogenic amine stored in the granules of mast cells that is one of the important mediators of immediate hlpersensitivity. Histamine binds to specific receptors in various tissues and causes increased vascular permeability and contraction of bronchial and intestinal smooth muscle. HLA. See Human leukocyte antigens. HIA,-DM. A peptide exchange molecule that plays a critical role in the class II MHC pathway of antigen presentation. HI"q.-DM is found in the specialized MIIC endosomal compartment and facilitates removal of the invariant chain-derived CLIP peptide and the binding of other peptides to class II MHC mole-
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I
nppenoixl-GL0SSARY
cules. HI-A-DM is encoded by a gene in the MHC and is structurally similar to class II MHC molecules, but it is not polymorphic. Homeostasis. In the adaptive immune system, the maintenance of a constant number and diverse repertoire of lymphocytes, despite the emergence of new lymphocytes and tremendous expansion of individual clones that may occur during responses to immunogenic antigens. Homeostasis is achieved by several regulated pathways of ll.rnphoclte death and inactivation. Homing receptor. Adhesion molecules expressed on the surface of lymphocltes that are responsible for the different pathways of lymphocye recirculation and tissue homing. Homing receptors bind to ligands (addressins)expressedon endothelial cells in particular vascular beds. Human immunodeficiency virus (HIV). The etiologic agent of AIDS. HIV is a retrovirus that infects a variety of cell types, including CD4-expressinghelper T cells, macrophages, and dendritic cells, and causeschronic progressive destruction of the immune system. Human leukocyte antigens (HLAs). MHC molecules expressedon the surface of human cells.Human MHC molecules were first identified as alloantigens on the surface of white blood cells (leukocytes) that bound serum antibodies from individuals previously exposed to other individuals' cells (e.g.,mothers or transfusion recipients). Humanized antibody. A monoclonal antibody encoded by a recombinant hybrid gene and composed of the antigen-binding sites from a murine monoclonal antibody and the constant region of a human antibody. Humanized antibodies are less likely than mouse monoclonal antibodies to induce an antiantibody response in humans; they are used clinically in the treatment of tumors and transplant rejection. Humoral immunity. The type of adaptive immune response mediated by antibodies produced by B lyrnphocytes. Humoral immunity is the principal defense mechanism against extracellular microbes and their toxins. Hybridoma. A cell line derived by cell fusion, or somatic cell hybridization, between a normal lymphocye and an immortalized lymphocyte tumor line. B cell hybridomas created by fusion of normal B cells of defined antigen specificity with a myeloma cell line are used to produce monoclonal antibodies. T cell hybridomas created by fusion of a normal T cell of defined specificity with a T cell tumor line are commonly used in research. Hlperacute rejection. A form of allograft or xenograft rejection that begins within minutes to hours after transplantation and that is characterized by thrombotic occlusion of the graft vessels.Hyperacute rejection is mediated by preexisting antibodies in the host circulation that bind to donor endothelial antigens, such as blood group antigens or MHC molecules, and activate the complement system. Hlpersensitivity diseases. Disorders caused by immune responses. Hypersensitivity diseases include
autoimmune diseases, in which immune responses are directed against self antigens, and diseases that result from uncontrolled or excessive responses against foreign antigens, such as microbes and allergens.The tissue damage that occurs in hlpersensitivity diseasesis due to the same effector mechanisms used by the immune system to protect against microbes. Hypervariable loop (hlpervariable region). Short segments of about 10 amino acid residueswithin the variable regions of antibody or TCR proteins that form loop structures that contact antigen. Three hlpervariable loops, also called CDRs, are present in each antibody heary chain and light chain and in each TCR chain. Most of the variability between different antibodies or TCRs is located within these loops. Idiotype. The property of a group of antibodies or TCRs defined by their sharing a particular idiotope; that is, antibodies that share a particular idiotope belong to the same idiotype. Idiotypeis also used to describe the collection of idiotopes expressed by an Ig molecule, and it is often used synonymously with idiotope. Idiotypic network. A network of complementary interactions involving idiotypes and anti-idiotypic antibodies (or T cells) that, according to the network hypothesis, reach a steady state at which the immune system is at homeostasis. Theoretically, when one or a few clones of lymphocytes respond to a foreign antigen, their idiotypes are expanded and antiidiotype responsesare triggered that function to shut off the antigen-specific response. Iga and lgp. Proteins that are required for surface expressionand signaling functions of membrane Ig on B cells. Iga and IgB pairs are disulfide linked to one another, noncovalently associated with the cytoplasmic tail of membrane Ig, and form the BCR complex. The cytoplasmic domains of Igcr and IgB contain ITAMs that are involved in early signaling events during antigen-induced B cell activation. IL-l receptor antagonist (IL-lra). A natural inhibitor of IL-l produced by mononuclear phagocytes that is structurally homologous to IL- I and binds to the same receptors but is biologically inactive. Attempts to use IL-l inhibitors to reduce inflammation in diseases such as rheumatoid arthritis are ongoing. Immature B lymphocyte. A membrane IgM+, IgD- B cell, recently derived from marrow precursors, that does not proliferate or differentiate in response to antigens but rather may undergo apoptotic death or become functionally unresponsive. This property is important for the negative selection of B cells that are speciflc for self antigens present in the bone marrow Immediate hlpersensitivity. The tlpe of immune reaction responsible for allergic diseasesand dependent on IgE plus antigen-mediated stimulation of tissue mast cells and basophils. The mast cells and basophils release mediators that cause increased vascular permeability, vasodilation, bronchial and visceral smooth muscle contraction, and local inflammation. lmmune complex. A multimolecular complex of antibody molecules with bound antigen. Because each
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antibody molecule has a minimum of two antigenbinding sites and many antigens are mutivalent, immune complexes can vary greatly in size. Immune complexes activate effector mechanisms of humoral immunity, such as the classical complement pathway and Fc receptor-mediated phagocyte activation. Deposition of circulating immune complexes in blood vesselwalls or renal glomeruli can lead to inflammation and disease. Immune complex disease. An inflammatory disease caused by the deposition of antigen-antibody complexes in blood vesselwalls resulting in local complement activation and phagocyte recruitment. Immune complexes may form because of overproduction of antibodies to microbial antigens or as a result of autoantibody production in the setting of an autoimmune disease such as systemic lupus erythematosus. Immune complex deposition in the specialized capillary basement membranes of renal glomeruli can cause glomerulonephritis and impair renal function. Systemic deposition of immune complexes in arterial walls can cause thrombosis and ischemic damage to various organs. Immune deviation. The conversion of a T cell response associated with one set of cytokines, such as Tnl cytokines that stimulate cell-mediated immunity, to a response associatedwith other cytokines, such as Ts2 cytokines that stimulate the production of selected antibody isotypes. Immune inflammation. Inflammation that is a result of an adaptive immune responseto antigen. The cellular infiltrate at the inflammatory site may include cells of the innate immune system such as neutrophils and macrophages, which are recruited as a result of the actions of T cell cltokines. Immune response. A collective and coordinated response to the introduction of foreign substances in an individual mediated by the cells and molecules of the immune system. Immune response (Ir) genes. Originally defined as genes in inbred strains of rodents that were inherited in a dominant mendelian manner and that controlled the ability of the animals to make antibodies against simple synthetic polypeptides. We now know that Ir genes are polymorphic MHC genes that encode peptide-binding molecules required for the activation of T ll.rnphocytes and are therefore also required for helperT cell-dependent B cell (antibody) responsesto protein antigens. Immune surveillance. The concept that a physiologic function of the immune system is to recognize and destroy clones of transformed cells before they grow into tumors and to kill tumors after they are formed. The term immune surueillanceis sometimes used in a general sense to describe the function of T lymphocytes to detect and destroy any cell, not necessarily a tumor cell, that is expressingforeign (e.g.,microbial) antigens. Immune system. The molecules, cells, tissues, and organs that collectively function to provide immunity, or protection, against foreign organisms.
GLOSSARY
Immunity. Protection against disease, usually infectious disease,mediated by a collection of molecules, cells, and tissues collectively called the immune system. In a broader sense, immunity refers to the ability to respond to foreign substances, including microbes or molecules. Immunoblot. An analytical technique in which antibodies are used to detect the presence of an antigen bound to (i.e.,blotted on) a solid matrix such as filter paper (also knovrmas aWestern blot). epitope. A linear amino acid Immunodominant sequence of a multideterminant protein antigen for which most of the responding T cells in any individual are specific. Immunodominant epitopes correspond to the peptides proteolytically generated within APCs that bind most avidly to MHC molecules and are most likely to stimulate T cells. Immunofluorescence. A technique in which a molecule is detected by use of an antibody labeled with a fluorescent probe. For example, in immunofluorescence microscopy, cells that express a particular surface antigen can be stained with a fluorescein-conjugated antibody specific for the antigen and then visualized with a fluorescent microscope. Immunogen. An antigen that induces an immune response. Not all antigens are immunogens. For example, small molecularweight compounds may not stimulate an immune response unless they are linked to macromolecules. Immunoglobulin (Ig). Synonymous with antibody (see Antibody). Immunoglobulin domain. A three-dimensional globular structural motif found in many proteins in the immune system, including Igs, TCRs,and MHC molecules. Ig domains are about 110 amino acid residues in length, include an internal disulfide bond, and contain two layers of B-pleated sheets, each layer composed of three to five strands of antiparallel polypeptide chain. Ig domains are classified as V-like or C-like on the basis of closest homology to either the IgV or C domains. heavy chain. One of two types of Immunoglobulin polypeptide chains in an antibody molecule. The basic structural unit of an antibody includes two identical, disulfide-linked heavy chains and two identical light chains. Each heavy chain is composed of a variable (V) Ig domain and three or four constant (C) Ig domains. The different antibody isotypes, including IgM, IgD, IgG, IgA, and IgE, are distinguished by structural differences in their heavy chain constant regions. The heavy chain constant regions also mediate effector functions, such as complement activation or engagement of phagocltes. light chain. One of two types of Immunoglobulin polypeptide chains in an antibody molecule. The basic structural unit of an antibody includes two identical light chains, each disulfide linked to one of two identical heavy chains. Each light chain is composed of one variable (V) Ig domain and one constant (C) Ig domain. There are two light chain isotypes, called r and 1", both functionally identical. About 60Vo of
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GL0SSARY
human antibodies have r light chains and 4OTohave l, light chains. Immunoglobulin superfamily. A large family of proteins that contain a globular structural motif called an Ig domain, or Ig fold, originally described in antibodies. Many proteins of importance in the immune system, including antibodies, TCRs, MHC molecules, CD4, and CDB, are members of this superfamily. Immunohistochemistry. A technique to detect the presence of an antigen in histologic tissue sections by use of an enz)ryne-coupledantibody that is specific for the antigen. The enzyme converts a colorlesssubstrate to a colored insoluble substance that precipitates at the site where the antibody and thus the antigen are localized. The position of the colored precipitate, and therefore the antigen, in the tissue section is observed by conventional light microscopy. Immunohistochemistry is a routine technique in diagnostic pathology and various fields of research. Immunological tolerance. SeeTolerance. Immunologically privileged site. A site in the body that is inaccessibleto or constitutively suppressesimmune responses.The anterior chamber of the eye, the testes, and the brain are examples of immunologically privileged sites. Immunoperoxidase technique. A common immunohistochemical technique in which a horseradish peroxidase-coupled antibody is used to identifu the presence of an antigen in a tissue section. The peroxidase enzyme converts a colorless substrate to an insoluble brorrrm product that is observable by light mlcroscopy. Immunoprecipitation. A technique for the isolation of a molecule from a solution by binding it to an antibody and then rendering the antigen-antibody complex insoluble, either by precipitation with a second anti-antibody or by coupling the first antibody to an insoluble particle or bead. Immunoreceptor tyrosine-based activation motif flTAM). A conserved motif composed of two copies of the sequence tyrosine-X-X-leucine (where X is an unspecified amino acid) found in the cytoplasmic tails of various membrane proteins in the immune system that are involved in signal transduction. ITAMs are present in the ( and CD3 proteins of the TCR complex, in Igu and IgB proteins in the BCR complex, and in several Ig Fc receptors. \dhen these receptors bind their ligands, the tyrosine residues of the ITAMs become phosphorylated and form docking sites for other molecules involved in propagating cellactivating signal transduction pathways. Immunoreceptor tyrosine-based inhibition motif (ITIM). A six-amino acid (isoleucine-X-tyrosine-X-Xleucine) motif found in the cltoplasmic tails of various inhibitory receptors in the immune system, including FcyRIIBon B cells and killer cell lg-like receptors (KIR) on NK cells.\Mhen these receptors bind their ligands, the ITIMs become phosphorylated on their tyrosine residue and form a docking site for protein tyrosine phosphatases,which in turn function to inhibit other signal transduction pathways.
Immunosuppression. Inhibition of one or more components of the adaptive or innate immune system as a result of an underlying disease or intentionally induced by drugs for the purpose of preventing or treating graft rejection or autoimmune disease. A commonly used immunosuppressive drug is cyclosporine, which blocks T cell cltokine production. Immunotherapy. The treatment of a disease with therapeutic agents that promote or inhibit immune responses. Cancer immunotherapy, for example, involves promoting active immune responses to tumor antigens or administering anti-tumor antibodies or T cells to establish passive immunity. Immunotoxins. Reagentsthat may be used in the treatment of cancer and consist of covalent conjugates of a potent cellular toxin, such as ricin or diphtheria toxin, with antibodies specific for antigens expressed on the surface of tumor cells. It is hoped that such reagents can specifically target and kill tumor cells without damaging normal cells, but safe and effective immunotoxins have yet to be developed. Inbred mouse strain. A strain of mice created by repetitive mating of siblings that is characterized by homozygosity at every genetic locus. Every mouse of an inbred strain is genetically identical (syngeneic)to every other mouse of the same strain. Indirect antigen presentation (or indirect allorecognition). In transplantation immunology, a pathway of presentation of donor (allogeneic) MHC molecules by recipient APCs that involves the same mechanisms used to present microbial proteins. The allogeneic MHC proteins are processedby recipient professional APCs, and peptides derived from the allogeneic MHC molecules are presented, in association with recipient (self) MHC molecules, to host T cells. In contrast to indirect antigen presentation, direct antigen presentation involves recipient T cell recognition of unprocessed allogeneic MHC molecules on the surface of graft cells. Inflammation. A complex reaction of vascularized tissue to infection, toxin exposure,or cell injury which involves extravascular accumulation of plasma proteins and leukocytes. Acute inflammation is a common result of innate immune responses,and local adaptive immune responsescan also promote inflammation. Although inflammation serves a protective function in controlling infections and promoting tissue repair, it can also cause tissue damage and disease. Inflammatory bowel disease (IBD). A group of disorders, including ulcerative colitis and Crohn's disease, characterized by chronic inflammation in the gastrointestinal tract. The etiology of IBD is not knor,rm, but some evidence indicates that immune mechanisms may be involved. IBD develops in gene knockout mice lacking IL-2,lL-I}, or the TCR cxchain. Innate immunity. Protection against infection that relies on mechanisms that exist before infection, are capable of a rapid response to microbes, and react in essentially the same way to repeated infections. The innate immune system includes epithelial barriers,
phagocytic cells (neutrophils, macrophages),NK cells, the complement system, and cytokines, largely made by mononuclear phagocytes, that regulate and coordinate many of the activities of the cells of innate immunity. Inositol 1,4,5-triphosphate (IP3). A cytoplasmic signaling molecule generated by phospholipase C (PLCyl)mediated hydrolysis of the plasma membrane phospholipid PIP, during antigen activation of lymphocytes. The main function of IP3 is to stimulate the release of intracellular stores of calcium from membrane-bound compartments such as the endoplasmic reticulum. Insulin-dependent diabetes mellitus. A diseasecharacterized by a lack of insulin that leads to various metabolic and vascular abnormalities. The insulin deficiency results from autoimmune destruction of the insulin-producing B cells of the islets of Langerhans in the pancreas, usually during childhood. CD4. and CD8t T cells, antibodies, and cltokines have been implicated in the islet cell damage. Also called tlpe I diabetes mellitus. Integrins. Heterodimeric cell surface proteins whose major functions are to mediate the adhesion of leukocytes to other leukocytes, endothelial cells, and extracellular matrix proteins. Integrins are important for T cell interactions with APCs and for migration of leukocltes from blood into tissues. The ligand-binding affinity of the integrins can be regulated by various stimuli, and the cytoplasmic domains of integrins bind to the cytoskeleton. There are two main subfamilies of integrins; the members of each family express a conserved B chain (Fr, or CD29, and B2,or CDIB) associated with different cr chains. VIA-4 (verv late activation protein-4) is a B1 integrin expressed on T cells, and LFA-f (leukoclte function-associated antigen-l) is a B2 integrin expressed on T cells and phagocytes. Interferon-y GFN-!. A cytokine produced byT lymphocytes and NK cells whose principal function is to activate macrophages in both innate immune responses and adaptive cell-mediated immune responses.(IFNy is also called immune or tlpe II interferon.) Interleukin (IL). Another name for a cltokine originally used to describe a cytokine made by leukocltes that acts on leukocltes. The term is now generally used with a numerical suffix to designate a structurally defined cytokine regardless ofits source or target. Interleukin-l ([-1). A cytokine produced mainly by activated mononuclear phagocltes whose principal function is to mediate host inflammatory responsesin innate immunity. The two forms of IL-l (a and F) bind to the same receptors and have identical biologic effects, including induction of endothelial cell adhesion molecules, stimulation of chemokine production by endothelial cells and macrophages, stimulation of the synthesis of acute-phase reactants by the liver, and fever. Interleukin-z (lL-z). A cytokine produced by antigenactivated T cells that acts in an autocrine manner to
stimulate T cell proliferation and also potentiates the apoptotic cell death of antigen-activated T cells.Thus, IL-2 is required for both the induction and selfregulation of T cell-mediated immune responses. IL-2 also stimulates the proliferation and effector functions of NK cells and B cells. Interleukin-3 (IL-3). A cytokine produced by CD4- T cells that promotes the expansion of immature marrow progenitors of all knourn mature blood cell types. IL-3 is also knor,rrn as multilineage colonystimulating factor. Interleukin- 4 (lL-4). A cytokine produced mainly by the Tg2 subset of CD4* helper T cells whose functions include induction of differentiation of Ts2 cells from naive CD4* precursors, stimulation of IgE production by B cells, and suppression of IFN-y-dependent macrophage functions. Interleukin-s (IL-s). A cltokine produced by CD4'Ts2 cells and activated mast cells that stimulates the growth and differentiation of eosinophils and activates mature eosinophils. Interleukin-G (IL-6). A cytokine produced by many cell types, including activated mononuclear phagocytes, endothelial cells, and fibroblasts, that functions in both innate and adaptive immunity. IL-6 stimulates the synthesis of acute-phase proteins by hepatocltes as well as the growth of antibody-producing B lymphocltes. (IL-7). A cytokine secreted by bone Interleukin-7 marrow stromal cells that stimulates survival and expansion of immature, but lineage-committed, precursors of B and T lymphocltes. Interleukin-f0 ([-10). A cytokine produced by activated macrophages and some helper T cells whose major function is to inhibit activated macrophages and therefore to maintain homeostatic control of innate and cell-mediated immune reactions. (IL-f2). A cltokine produced by Interleukin-I2 mononuclear phagocytes and dendritic cells that serves as a mediator of the innate immune response to intracellular microbes and is a key inducer of cellmediated immune responsesto these microbes. IL-12 activates NK cells, promotes IFN-y production by NK cells and T cells, enhances the cltolytic activity of NK cells and CTLs, and promotes the development of Tsl cells. ([-15). A cltokine produced by Interleukin-15 mononuclear phagocytes and other cells in response to viral infections whose principal function is to stimulate the proliferation of NK cells. It is structurally similar to lL-z. Interleukin-17 (lL-17). A family of structurally related pro-inflammatory cytokines, some of which cause tissue damage in autoimmune disease, and others which protect against bacterial infections. lL-I7producing CD4* effector T cells are a distinct lineage from Tsl or Tn2 cells, called Ts17. (IL-f8). A cytokine produced by Interleukin-18 macrophages in response to LPS and other microbial products that functions together with IL-12 as an inducer of cell-mediated immunity. IL-18 synergizes
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Appendixl-GL0SSARY
with IL-12 in stimulating the production of IFN-y by NK cells and T cells. IL-18 is structurally homologous to but functionally different from IL-1. Intracellular bacterium. A bacterium that survives or replicates within cells, usually in endosomes. The principal defense against intracellular bacteria, such as Mycobacterium tuberculosis, is cell-mediated immunity. Intraepidermal lymphocytes. T lymphocytes found within the epidermal layer of the skin. In the mouse, most of the intraepidermal T cells expressthe y6 form of TCR (seeIntraepithelial T lymphocytes). Intraepithelial T lymphocytes. T lymphocytes present in the epidermis of the skin and in mucosal epithelia that typically express a limited diversity of antigen receptors. Some of these lymphocltes may recognize microbial products, such as glycolipids, associated with nonpolymorphic class I MHC-like molecules. Intraepithelial T lymphocytes may be considered effector cells of innate immunity and function in host defense by secreting cl.tokines and activating phagocltes and by killing infected cells. Invariant chain (I,). A nonpolymorphic protein that binds to newly syethesized class II MHC molecules in the endoplasmic reticulum. The invariant chain prevents loading of the class II MHC peptide-binding cleft with peptides present in the endoplasmic reticuIum, and such peptides are left to associatewith class I molecules.The invariant chain also promotes folding and assembly of class II molecules and directs newly formed class II molecules to the specialized endosomal MIIC compartment, where peptide loading takes place. Isotype. One of five types of antibodies, determined by which of five different forms of hea'"y chain are present. Antibody isotypes include IgM, IgD, IgG, IgA, and IgE, and each isotype performs a different set of effector functions. Additional structural variations characterize distinct subtypes of IgG and IgA. J chain. A small polypeptide that is disulfide bonded to the tail pieces of multimeric IgM and IgA antibodies. IAK/STAI signaling pathway. A signaling pathway initiated by cytokine binding to type I and type II cltokine receptors. This pathway sequentially involves activation of receptor-associatedJanuskinase (IAK) tyrosine kinases, JAK-mediated ty'rosine phosphorylation of the cytoplasmic tails of cytokine receptors, docking of signal transducers and activators of transcription (STAIs) to the phosphorylated receptor chains, IAKmediated tyrosine phosphorylation of the associated STATs,dimerization and nuclear translocation of the STAIS, and STAI binding to regulatory regions of target genes causing transcriptional activation of those genes. Ianus kinases (JAK kinases). A family of tyrosine kinases that associate with the cltoplasmic tails of several different cltokine receptors, including the receptors for lL-2, IL-4, IFN-X IL-12, and others. In response to cytokine binding and receptor dimerization, IAKs phosphorylate the cytokine receptors to permit the binding of STAIs, and then the fAKs phos-
phorylate and thereby activate the STAIs. Different IAK kinases associatewith different cltokine receptors. foining (f) segments. Short coding sequences,between the variable (V) and constant (C) gene segments in all the Ig and TCR loci, that together with D segments are somatically recombined withV segments during lymphocyte development. The resulting recombined VDJ DNA codes for the carboxy-terminal ends of the antigen receptor V regions, including the third hlpervariable (CDR) regions. Random use of different J segments contributes to the diversity of the antigen receptor repertoire. Iunctional diversity. The diversity in antibody and TCR repertoires that is attributed to the random addition or removal of nucleotide sequences at junctions betweenV D, and I gene segments. Kaposi's sarcoma. A malignant tumor of vascular cells that frequently arises in patients with AIDS. Kaposi's sarcoma is associated with infection by the Kaposi's sarcoma-associated herpesvirus (human herpesvirus 8). Killer lg-like receptors (KIRs). Ig superfamily receptors expressedby NK cells that recognize different alleles of HLA-A, HIA-B, and HLA-C molecules. Some KIRs have signaling components with ITIMs in their cytoplasmic tails, and these deliver inhibitory signals to inactivate the NK cells. Some members of the KIR familyhave short cytoplasmic tails without ITIMs, but associate with other ITAM-containing polypeptides and function as activating receptors. Knockout mouse. A mouse with a targeted disruption of one or more genes that is created by homologous recombination techniques. Knockout mice lacking functional genes encoding cltokines, cell surface receptors, signaling molecules, and transcription factors have provided extensive information about the roles of these molecules in the immune system. Langerhans cells. Immature dendritic cells found as a continuous meshwork in the epidermal layer of the skin whose major function is to trap and transport protein antigens to draining lymph nodes. During their migration to the lymph nodes, Langerhans cells mature into ll.rnph node dendritic cells, which can efficiently present antigen to naive T cells. Large granular lymphocyte. Another name for an NK cell based on the morphologic appearance of this cell type in the blood. Late-phase reaction. A component of the immediate hlpersensitivity reaction that ensues2 to 4 hours after mast cell and basophil degranulation and that is characterized by an inflammatory infiltrate of eosinophils, basophils, neutrophils, and lymphocytes. Repeated bouts of this late-phase inflammatory reaction can causetissue damage. Lck. An Src family nonreceptor tyrosine kinase that noncovalently associates with the cltoplasmic tails of CD4 and CD8 molecules in T cells and is involved in the early signaling events of antigen-induced T cell activation. Lck mediates Wrosine phosphorylation of the cytoplasmic tails of CD3 and ( proteins of the TCR complex.
Appendixl-GLOSSARY 5O5
Lectin pathway of complement activation. A pathway of complement activation triggered, in the absence of antibody, by the binding of microbial polysaccharides to circulating lectins such as MBL. MBL is structurally similar to Clq and activates the Clr-Cls enzyme complex (like Clq) or activates another serine esterase,called mannose-binding protein-associated serine esterase. The remaining steps of the lectin pathway, beginning with cleavage of C4, are the same as the classical pathway. Leishmanin An obligate intracellular protozoan parasite that infects macrophages and can cause a chronic inflammatory disease involving many tissues. Leishmania infection in mice has served as a model system for study of the effector functions of several cltokines and the helper T cell subsets that produce them. Tgl responsesto Leishmania major and associatedIFN-y production control infection, whereas Ts2 responses with IL-4 production lead to disseminated lethal disease. Lethal hit. A term used to describe the events that result in irreversible damage to a target cell when a CTL binds to it. The lethal hit includes CTL granule exocytosis, perforin poll'rnerization in the target cell membrane, and entry of calcium ions and apoptosisinducing enzyrnes (granzymes) into the target cell cyoplasm. Leukemia. A malignant disease of bone marrow precursors of blood cells in which large numbers of Ieukemic cells usually occupy the bone marrow and often circulate in the blood stream. Lymphocytic leukemias are derived from B or T cell precursors, myelogenous leukemias are derived from granulocyte or monoclte precursors, and erythroid leukemias are derived from red blood cell precursors. Leukocyte adhesion deficiency (I-AD). One of a rare group of immunodeflciency diseaseswith infectious complications that is caused by defective expression of the leukocyte adhesion molecules required for tissue recruitment of phagocl'tes and lymphocytes. I"q.D-l is due to mutations in the gene encoding the CD18 protein, which is part of p, integrins. LAD-2 is caused by mutations in a gene that encodes a fucose transporter involved in the synthesis of leukocyte ligands for endothelial selectins. Leukotrienes. A class of arachidonic acid-derived lipid inflammatory mediators produced by the lipoxygenase pathway in many cell types. Mast cells make abundant leukotriene C4 (LIC4) and its degradation products LID' and LIE^, which bind to specific receptors on smooth muscle cells and cause prolonged bronchoconstriction. Leukotrienes contribute to the pathologic processes of bronchial asthma. Collectively, LICa, LID+, and LIE4 constitute what was once called slow-reacting substance of anaphylaxis. Lipopolysaccharide. SFronl,rnous with endotoxin. Live viral vaccine. A vaccine composed of a live but nonpathogenic (attenuated) form of a virus. Attenuated viruses carry mutations that interfere with the viral life cycle or pathogenesis.Becauselive virus vaccines actually infect the recipient cells, they can effec-
tively stimulate immune responses, such as the CTL response,that are optimal for protecting against wildtype viral infection. A commonly used live virus vaccine is the Sabin poliovirus vaccine, and there is much interest in development of an attenuated live virus vaccine to protect against HIV infection. LMP-2 and LMP-7. Two catalytic subunits of the proteasome, the organelle that degrades cltosolic proteins into peptides in the class I MHC pathway of antigen presentation. LMP-2 and LMP-7 are encoded by genes in the MHC, are up-regulated by IFN-y, and are particularly important for generating class I MHCbinding peptides. Lymph node. Small nodular, encapsulated aggregates of lymphoclte-rich tissue situated along lymphatic channels throughout the body where adaptive immune responses to lymph-borne antigens are initiated. Lymphatic system. A system of vessels throughout the body that collects tissue fluid called lymph, originally derived from the blood, and returns it, through the thoracic duct, to the circulation. Lymph nodes are interspersed along these vessels and trap and retain antigens present in the lymPh. of Lymphocyte homing. The directed migration subsets of circulating lymphocytes into particular tissue sites. Lymphocyte homing is regulated by the selective expression of adhesion molecules, called homing receptors, on the lymphocytes and the tissuespecific expression of endothelial ligands for these homing receptors, called addressins,in different vascular beds. For example, some T lymphocltes preferentially home to intestinal lymphoid tissue (e.g., Peyer'spatches), and this directed migration is regulated by binding of the VLA-4 integrin on the T cells to the MadCAM addressin on Peyer'spatch endothelium. Lymphocyte maturation. The process by which pluripotent bone marrow precursor cells develop into mature, antigen receptor-expressing naive B orT lyrnphocltes that populate peripheral lymphoid tissues. This process takes place in the specialized environments of the bone marrow (for B cells) and the thymus (for T cells). Lymphocyte migration. The movement of l1'rnphocltes from the blood stream into peripheral tissues. Lymphocyte recirculation. The continuous movement of lymphocytes through the blood stream and lymphatics, between the lymph nodes or spleen, and, if activated, to peripheral inflammatory sites. Lymphocyte repertoire. The complete collection of antigen receptors and therefore antigen specificities expressed by the B and T lymphocltes of an individual. Lymphoid follicle. A B cell-rich region of a lymph node or the spleen that is the site of antigen-induced B cell proliferation and differentiation. In T cell-dependent B cell responsesto protein antigens, a germinal center forms within the follicles. Lymphokine. An old name for a cytokine (soluble protein mediator of immune responses)produced by l1'rnphocytes.
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Appendixl-GL0SSARY
Lymphokine-activated killer (LAK) cells. NK cells with enhanced cytolytic activity for tumor cells as a result of exposure to high doses of IL-2. LAK cells generated in uitro have been adoptively transferred back into patients with cancer to treat their tumors. Lymphoma. A malignant tumor of B or T lyrnphocltes usually arising in and spreading between lyrnphoid tissues but that may spread to other tissues. Lymphomas often express phenotypic characteristics of the normal lymphocytes from which they were derived. Lymphotoxin (LT, TNF-p). A cytokine produced by T cells that is homologous to and binds to the same receptors as TNE Like TNB LI has proinflammatory effects, including endothelial and neutrophil activation. LI is also critical for the normal development of lymphoid organs. Lysosome. A membrane-bound, acidic organelle abundant in phagocltic cells that contains proteolytic enzyrnes that degrade proteins derived both from the extracellular environment and from within the cell. Lysosomes are involved in the class II MHC pathway of antigen processing. M cells. Specialized epithelial cells overlying Peyer's patches in the gut that play a role in delivering antigens to Peyer'spatches. Macrophage. A tissue-based phagocytic cell derived from blood monocytes that plays important roles in innate and adaptive immune responses.Macrophages are activated by microbial products such as endotoxin and by T cell cytokines such as IFN-1. Activated macrophages phagocytose and kill microorganisms, secrete proinflammatory cytokines, and present antigens to helper T cells. Macrophages may assume different morphologic forms in different tissues, including the microglia of the central nervous system, Kupffer cells in the liver, alveolar macrophages in the lung, and osteoclastsin bone. Major histocompatibility complex (MHC). A large genetic locus (on human chromosome 6 and mouse chromosome 17) that includes the highly poll'rnorphic genes encoding the peptide-binding molecules recognized by T lgnphocytes. The MHC locus also includes genes encoding cytokines, molecules involved in antigen processing, and complement proteins. Major histocompatibility complex (MHC) molecule. A heterodimeric membrane protein encoded in the MHC locus that serves as a peptide display molecule for recognition byT lymphocytes. TWostructurally distinct types of MHC molecules exist. ClassI MHC molecules are present on most nucleated cells, bind peptides derived from cytosolic proteins, and are recognized by CD8. T cells. Class II MHC molecules are restricted largely to professional APCs, bind peptides derived from endocytosed proteins, and are recognized by CD4. T cells. Mannose receptor. A carbohydrate-binding receptor (lectin) expressed by macrophages that binds mannose and fucose residues on microbial cell walls and mediates phagocltosis of the organisms.
Mannose-binding lectin (MBL). A plasma protein that binds to mannose residues on bacterial cell walls and acts as an opsonin by promoting phagocltosis of the bacterium by macrophages. Macrophages express a surface receptor for Clq that can also bind MBL and mediate uptake of the opsonized organisms. Marginal zone. A peripheral region of splenic lymphoid follicles containing macrophages that are particularly efficient at trapping polysaccharide antigens. Such antigens may persist for prolonged periods on the surfaces of marginal zone macrophages, where they are recognized by specific B cells, or they may be transported into follicles. Marginal zone B lymphocytes. A subset of B lyrnphoc1tes, found exclusively in the marginal zone of the spleen, which respond rapidly to blood borne microbial antigens by producing IgM antibodies with limited diversity. Mast cell. The major effector cell of immediate hypersensitivity (allergic) reactions. Mast cells are derived from the marrow reside in most tissues adjacent to blood vessels,express a high-afflnity Fc receptor for IgE, and contain numerous mediator-filled granules. Antigen-induced cross-linking of IgE bound to the mast cell Fc receptors causes release of their granule contents as well as new synthesis and secretion of other mediators, leading to an immediate hypersensitivity reaction. Mature B cell. IgM- and IgD-expressing, functionally competent naive B cells that represent the final stage of B cell maturation in the bone marrow and that populate peripheral lymphoid organs. Membrane attack complex (MAC). A lytic complex of the terminal components of the complement cascade, including multiple copies of C9, that forms in the membranes of target cells. The MAC causes lethal ionic and osmotic changes in cells. Memory. The property of the adaptive immune system to respond more rapidly, with greater magnitude, and more effectively to a repeated exposure to an antigen, compared with the response to the first exposure. Memorylymphocytes. B orT lymphocytes that mediate rapid and enhanced (i.e.,memory or recall) responses to second and subsequent exposures to antigens. Memory B and T cells are produced by antigen stimulation of naive lymphocltes and survive in a functionally quiescent state for many years after the antigen is eliminated. MHC class II (MIIC) compartment. A subset of endosomes (membrane-bound vesicles involved in cell trafficking pathways) found in macrophages and human B cells that are important in the class II MHC pathway of antigen presentation. The MIIC contains all the components required for formation of peptide-class II MHC molecule complexes, including the enzymes that degrade protein antigens, class II molecules, invariant chain, and HIA-DM. MHC restriction. The characteristic of T lyrnphocytes that they recognize a foreign peptide antigen only when it is bound to a particular allelic form of an MHC molecule.
MHC-tetramer. A reagent used to identify and enumerate T cells that specifically recognize a particular MHC-peptide complex. The reagent consists of four recombinant, biotinylated MHC molecules (usually class I) bound to a fluorochrome-labeled avidin molecule and loaded with a peptide. T cells that bind the MHC-tetramer can be detected by flow cltometry. Mitogen-activated protein (MAP) kinase cascade. A signal transduction cascade initiated by the active form of the Ras protein and involving the sequential activation of three serine/threonine kinases, the last one being MAP kinase. MAP kinase in turn phosphorylates and activates other enzymes or transcription factors. The MAP kinase pathway is one of several signal pathways activated by antigen binding to the TCR. Mixed leukocyte reaction (MLR). lyn in uitro reaction of alloreactive T cells from one individual against MHC antigens on blood cells from another individual. The MLR involves proliferation of and cytokine secretion by both CD4* and CD8* T cells and is used as a screening test to assessthe compatibility of a potential graft recipient with a potential donor. Molecular mimicry. A postulated mechanism of autoimmunity triggered by infection with a microbe containing antigens that cross-react with self antigens.Immune responsesto the microbe result in reactions against self tissues. Monoclonal antibody. An antibody that is specific for one antigen and is produced by a B cell hybridoma (a cell line derived by the fusion of a single normal B cell and an immortal B cell tumor line). Monoclonal antibodies are widely used in research and clinical diagnosis and therapy. Monocyte. A tlpe of bone marrow-derived circulating blood cell that is the precursor of tissue macrophages. Monocytes are actively recruited into inflammatory sites, where they differentiate into macrophages. (M-CSF). A Monocyte colony-stimulating factor cytokine made by activated T cells, macrophages, endothelial cells, and stromal fibroblasts that stimulates the production of monocltes from bone marrow precursor cells. Monokine. An old name for a cltokine produced by mononuclear phagocltes. Mononuclear phagocytes. Cells with a common bone marrow lineage whose primary function is phagocytosis. These cells function as accessory cells in the recognition and activation phases of adaptive immune responsesand as effector cells in innate and adaptive immunity. Mononuclear phagoc)'tes circulate in the blood in an incompletely differentiated form called monocytes, and once they settle in tissues, they mature into macrophages. Mucosa-associated lymphoid tissue. Lymphocytes and accessorycells within the mucosa of the gastrointestinal and respiratory tracts that are sites of adaptive immune responses to environmental antigens. Mucosa-associated lymphoid tissues include intra-
epithelial lymphocytes,mainly T cells,and organized collectionsof lymphocytes,often rich in B cells,below mucosal epithelia, such as Peyer'spatchesin the gut or pha4mgealtonsils. Mucosalimmune system. A part of the immune system that respondsto and protectsagainstmicrobesthat enter the body through mucosal surfaces,such as the gastrointestinaland respiratory tracts. The mucosal immune systemis composedof mucosa-associated l1'rnphoid tissues,which are collections of lymphocytesand accessorycellsin the epitheliaand lamina propria of mucosalsurfaces. Multiple myeloma. A malignant tumor of antibodyproducingB cellsthat often secretesIgs or parts oflg molecules.The monoclonalantibodiesproducedby multiple myelomaswere critical for early biochemical analysesof antibody structure. Mycobacterium. A genus of aerobic bacteria, many speciesof which can survive within phagocytesand cause disease.The principal host defense against mycobacteriasuch as Mycobacteriumtuberculoslsis cell-mediatedimmunity. N nucleotides.The name given to nucleotidesrandomly addedto the junctionsbetween! D, and I gene segmentsin Ig or TCRgenesduring lymphocytedevelopment.The additionof up to 20 of thesenucleotides, which is mediated by the enzymeterminal deoxyricontributesto the diversity bonucleotidyltransferase, of the antibodyand TCRrepertoires. Naivelymphocyte. A mature B or T lyrnphocytethat has not previously encountered antigen, nor is it the progenyof an antigen-stimulatedmature lymphocyte. \Mhen naive lymphocytes are stimulated by antigen, they differentiate into effector lymphocytes,such as B cellsor helperT cellsand CTLs. antibody-secreting Naivelymphoc)'teshave surfacemarkersand recirculation patterns that are distinct from those of previously activatedlymphocytes.("Naive"alsorefersto an unimmunized individual.) Natural antibodies. IgM antibodies, largely produced by B-1 cells,specificfor bacteriathat are common in the environment and gastrointestinaltract. Normal individuals contain natural antibodies without any evidenceof infection, and these antibodiesserveas a preformed defensemechanismagainstmicrobesthat succeedin penetratingepithelial barriers.Some of these antibodiescross-reactwith ABO blood group antigensand areresponsiblefor transfusionreactions. Natural killer (NIO cells. A subset of bone marrow-derived lymphocl'tes, distinct from B or T cells,that function in innate immune responsesto kill microbe-infectedcellsby direct lltic mechanismsand by secretingIFN-Y.NK cells do not expressclonally distributedantigenreceptorslike Ig receptorsor TCRs, and their activation is regulatedby a combination of cell surfacestimulatory and inhibitory receptors,the latter recognizingselfMHC molecules. Natural killer T cells (NKT cells). A numerically small subsetof lymphocytesthat expresssurfacemolecules characteristic of both NK cells and T cells. They expresscrBT cell antigen receptors with very little
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A.o.o e n d i x l - G L O S S A R Y
diversity, and perform various effector functions typical of helper T cells. NKT cells are considered as part of both adaptive and innate immune systems. Some NKT cells recognize lipid antigens presented by CDI molecules. Negative selection. The process by which developing lymphocytes that express self-reactive antigen receptors are eliminated, thereby contributing to the maintenance of self-tolerance. Negative selection of developing T lymphocl.tes (thymocytes) is best understood and involves high-avidity binding of a thymocyte to self MHC molecules with bound peptides on thyrnic APCs Ieading to apoptotic death of the thymoclte. Neonatal Fc receptor (FcRn). An IgG-specific Fc receptor that mediates the transport of maternal IgG across the placenta and the neonatal intestinal epithelium. FcRn resemblesa classI MHC molecule. An adult form of this receptor functions to protect plasma IgG antibodies from catabolism. Neonatal immunity. Passive humoral immunity to infections in mammals in the first months of life, before full development of the immune system. Neonatal immunity is mediated by maternally produced antibodies transported across the placenta into the fetal circulation before birth or derived from ingested milk and transported across the gut epithelium. Neutrophil (also polymorphonuclear leukocyte, PMN). A phagocl'tic cell characterized by a segmented lobular nucleus and cytoplasmic granules filled with degradative enzymes. PMNs are the most abundant type of circulating white blood cells and are the major cell type mediating acute inflammatory responsesto bacterial infections. Nitric oxide. A biologic effector molecule with a broad range of activities that in macrophages functions as a potent microbicidal agent to kill ingested organisms. Nitric oxide synthase. A member of a family of enzl'rnes that synthesize the vasoactive and microbicidal compound nitric oxide from l-arginine. Macrophages express an inducible form of this enzyme on activation by various microbial or cytokine stimuli. Nuclear factor KB (NF-KB). A family of transcription factors composed of homodimers or heterodimers of proteins homologous to the c-Rel protein. NF-rB proteins are important in the transcription of many genes in both innate and adaptive immune responses. Nuclear factor of activated T cells (NFAT). A transcription factor required for the expression of lL-Z, lL-4, TNE and other cytokine genes. The four different NFATsare each encoded by separate genes; NFAIp and NFATc are found in T cells. Cytoplasmic NFAI is activated by calcium/ calmodulin- dependent, calcineurinmediated dephosphorylation that permits NFAT to translocate into the nucleus and bind to consensus binding sequencesin the regulatory regions of IL-2, IL4, and other cytokine genes, usually in association with other transcription factors such as AP-1. Nude mouse. A strain of mice that lacks development of the thymus, and therefore T lyrnphocytes, as well as
hair follicles. Nude mice have been used experimentally to define the role of T lymphocytes in immunity and disease. Oncofetal antigen. Proteins that are expressed at high levels on some t)?es of cancer cells and in normal developing (fetal) but not adult tissues. Antibodies specific for these proteins are often used in histopathologic identiflcation of tumors or to monitor the progression of tumor growth in patients. CEA (CD66) and o-fetoprotein are two oncofetal antigens commonly expressedby certain carcinomas. Opsonin. A macromolecule that becomes attached to the surface of a microbe and can be recognized by surface receptors of neutrophils and macrophages and that increasesthe efficiency ofphagocytosis ofthe microbe. Opsonins include IgG antibodies, which are recognized by the Fcy receptor on phagocltes, and fragments of complement proteins, which are recognized by CRI (CD35) and by the leukocyte integrin Mac-1. Opsonization. The process of attaching opsonins, such as IgG or complement fragments, to microbial surfaces to target the microbes for phagocytosis. Oral tolerance. The suppression of systemic humoral and cell-mediated immune responses to an antigen after the oral administration of that antigen as a result of anergy of antigen-specific T cells or the production of immunosuppressive cytokines such as transforming growth factor-B. Oral tolerance is a possible mechanism for preventing immune responses to food antigens and to bacteria that normally reside as commensals in the intestinal lumen. P nucleotides. Short inverted repeat nucleotide sequences in the VDJ junctions of rearranged Ig and TCR genes that are generated by RAG-I- and RAG-2mediated asymmetric cleavageof hairpin DNA intermediates during somatic recombination events. P nucleotides contribute to the junctional diversity of antigen receptors. Paracrine factor. A molecule that acts on cells in proximity to the cell that produces the factor. Most cytokines act in a paracrine fashion. Partial agonist. A variant peptide ligand of a TCR that induces only a subset of the functional responses by the T cell or responses entirely different from responses to the unaltered (native) peptide. For instance, a partial agonist may stimulate production of only some of the many cytokines that are induced by the native peptide or quantitatively smaller responses. Partial agonist peptides are usually slmthetic peptides in which one or two TCR contact residues have been changed; they are also called APLs. Passive immunity. The form of immunity to an antigen that is established in one individual by transfer of antibodies or lymphocltes from another individual who is immune to that antigen. The recipient of such a transfer can become immune to the antigen without ever having been exposed to or having responded to the antigen. An example of passiveimmunity is the transfer of human sera containing antibodies specific for
| - GL0SSARY Appendix
certain microbial toxins or snake venom to a previously unimmunized individual. Pathogenicity. The ability of a microorganism to cause disease. Multiple mechanisms may contribute to pathogenicity, including production of toxins, stimulation of host inflammatory responses,and perturbation of host cell metabolism. Pattern recognition receptors. Receptors of the innate immune system that recognize frequently encountered structures called molecular patterns produced by microorganisms and that facilitate innate immune responses against the microorganisms. Examples of pattern recognition receptors include CD14 receptors on macrophages, which bind bacterial endotoxin leading to macrophage activation, and the mannose receptor on phagocltes, which binds microbial glycoproteins or glycolipids. Pentraxins. A family of plasma proteins that contain five identical globular subunits; includes the acutephase reactant C-reactive protein. Peptide-binding cleft. The portion of an MHC molecule that binds peptides for display to T cells. The cleft is composed of paired cr-helicesresting on a floor made up of an eight-stranded B-pleated sheet. The polymorphic residues,which are the amino acids that vary among different MHC alleles, are located in and around this cleft. Perforin. A protein that is homologous to the Cg complement protein and is present as a monomer in the granules of CTLs and NK cells. \,Vhen perforin is released from the granules of activated CTLs or NK cells, it forms a complex with granzymes and proteoglycans that binds to the target cell plasma membrane and promotes entry of the granzymes into the target cell. This channel can cause osmotic lysis of the target cell and serve as a channel for the influx of enzyrnes derived from the CTL granules. Periarteriolar lymphoid sheath (PALS). A cuff of ll.rnphocytes surrounding small arterioles in the spleen, adjacent to lymphoid follicles. A PALScontains mainly T lymphocytes, about two thirds of which are CD4* and one third CD8.. In humoral immune responsesto protein antigens, B lymphocltes are activated at the interface between the PALS and follicles and then migrate into the follicles to form germinal centers. Peripheral lymphoid organs and tissues. Organized collections of lyrnphocytes and accessory cells, including the spleen, ly-ph nodes, and mucosaassociated lymphoid tissues, in which adaptive immune responsesare initiated. Peripheral tolerance. Physiologic unresponsiveness to self antigens that are present in peripheral tissues and not usually in the generativelymphoid organs.Peripheral tolerance is induced by the recognition of antigens without adequate levels of the costimulators required for lymphoclte activation or by persistent and repeated stimulation by these self antigens. Peyer's patches. Organized lymphoid tissue in the lamina propria of the small intestine in which immune responsesto ingested antigens may be initiated. Peyer'spatches are composed mostly of B cells,
with smaller numbers of T cells and accessorycells, all arranged in follicles similar to those found in lymph nodes, often with germinal centers. Phagocytosis. The process by which certain cells of the innate immune system, including macrophages and neutrophils, engulf large particles (>0.5pm in diameter) such as intact microbes. The cell surrounds the particle with extensions of its plasma membrane by an energy- and cytoskeleton-dependent process; this process results in the formation of an intracellular vesicle called a phagosome, which contains the ingested particle. Phagosome. A membrane-bound intracellular vesicle that contains microbes or particulate material from the extracellular environment. Phagosomes are formed duringthe processof phagocytosis,and fusion with other vesicular structures such as lysosomes leads to enzymatic degradation of the ingested material. Phosphatase (protein phosphatase). An enzyrne that removes phosphate groups from the side chains of certain amino acid residues of proteins. Protein phosphatasesin lymphocytes, such as CD45 or calcineurin, regulate the activity of various signal transduction molecules and transcription factors. Some protein phosphatases may be specific for phosphotyrosine residues and others for phosphoserine and phosphothreonine residues. Phospholipase C1 (PLCy). An enzyme that catalyzes hydrolysis of the plasma membrane phospholipid PIP, to generate two signaling molecules, IPgand DAG. PLCI becomes activated in lymphocytes by antigen binding to the antigen receptor. (P[IA). A carbohydrate-binding Phytohemagglutinin protein, or lectin, produced by plants that cross-links human T cell surface molecules, including the T cell receptol thereby inducing polyclonal activation and agglutination of T cells. PFIA is frequently used in experimental immunology to studyT cell activation. In clinical medicine, PHA is used to assess whether a patient's T cells are functional or to induce T cell mitosis for the purpose of generating karyotypic data. Plasma cell. A terminally differentiated antibodysecreting B lymphocyte with a characteristic histologic appearance, including an oval shape, eccentric nucleus, and perinuclear halo. factor (PAF). A lipid mediator Platelet-activating derived from membrane phospholipids in several cell types, including mast cells and endothelial cells. PAF can cause bronchoconstriction and vascular dilatation and leak and may be an important mediator in asthma. Polyclonal activators. Agents that are capable of activating many clones of ll,rnphocytes, regardless of their antigen specificities. Examples of polyclonal activators include anti-IgM antibodies for B cells and antiCD3 antibodies, bacterial superantigens, and PHA for T cells. Poly-Ig receptor. An Fc receptor expressedby mucosal epithelial cells that mediates the transport of IgA and
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Anoendixl-GLOSSARY
IgM through the epithelial cells into the intestinal lumen. Polymerase chain reaction (PCR). A rapid method of copying and amplifying specific DNA sequences up to about I kb in length that is widely used as a preparative and analytical technique in all branches of molecular biology. The method relies on the use of short oligonucleotide primers complementary to the sequencesat the ends of the DNA to be amplified and involves repetitive cycles of melting, annealing, and synthesis of DNA. Polymorphism. The existence of two or more alternative forms, or variants, of a gene that are present at stable frequencies in a population. Each common variant of a polymorphic gene is called an allele, and one individual may carry two different alleles of a gene, each inherited from a different parent. The MHC genes are the most polymorphic genes in the mammalian genome. Polyvalency. The presence of multiple identical copies of an epitope on a single antigen molecule, cell surface, or particle. Polyvalent antigens, such as bacterial capsular polysaccharides, are often capable of activating B lymphocytes independent of helper T cells. Positive selection. The process by which developing T cells in the thymus (thymocytes) whose TCRs bind to self MHC molecules are rescued from programmed cell death, whereas thymocytes whose receptors do not recognize self MHC molecules die by default. Positive selection ensures that mature T cells are self MHC restricted and that CD8* T cells are specific for complexes of peptides with class I MHC molecules and CD4. T cells for complexes of peptides with class II MHC molecules. Pre-B cell. A developing B cell present only in hematopoietic tissues that is at a maturational stage characterized by expression of cltoplasmic Ig p heavy chains and surrogate light chains but not Ig light chains. Pre-B cell receptors composed of p chains and surrogate light chains deliver signals that stimulate further maturation of the pre-B cell into an immature B cell. Pre-B cell receptor. A receptor expressed on maturing B lymphocytes at the pre-B cell stage that is composed of an Ig p heavy chain and an invariant surrogate light chain. The surrogate light chain is composed of two proteins, including the 1"5protein, which is homologous to the l" light chain C domain, and the V pre-B protein, which is homologous to aV domain. The preB cell receptor associateswith the Igo and IgB signal transduction proteins to form the pre-B cell receptor complex. Pre-B cell receptors are required for stimulating the proliferation and continued maturation of the developing B cell. It is not known whether the preB cell receptor binds a specific ligand. Pre-cytolytic T lymphocyte (pre-CTL). A mature, naive CD8* T lymphocyte that cannot perform effector functions but, on activation by antigen and costimulators, will differentiate into a CTL capable of lysing target cells and secreting cytokines.
Pre-T cell. A developing T lymphocyte in the thymus at a maturational stage characterized by expression of the TCR B chain, but not the s chain or CD4 or CD8. In pre-T cells, the TCR B chain is found on the cell surface as part ofthe pre-T cell receptor. Pre-T cell receptor. A receptor expressedon the surface of pre-T cells that is composed of the TCR p chain and an invariant pre-Tcr protein. This receptor associates with CD3 and ( molecules to form the pre-T cell receptor complex. The function of this complex is similar to that of the pre-B cell receptor in B cell development, namely, the delivery of signals that stimulate further proliferation, antigen receptor gene rearrangements, and other maturational events. It is not knor'rm whether the pre-T cell receptor binds a specific ligand. Pre-Tc. An invariant transmembrane protein with a single extracellular lg-like domain that associates with TCR p chain in pre-T cells to form the pre-T cell receptor. Primary immune response. An adaptive immune responsethat occurs after the first exposureofan individual to a foreign antigen. Primary responses are characterized by relatively slow kinetics and small magnitude compared with the responses after a second or subsequent exposure. Primary immunodeficiency. A genetic defect in which an inherited deficiency in some aspect of the innate or adaptive immune system leads to an increased susceptibility to infections. Primary immunodeficiency is frequently manifested early in infancy and childhood but is sometimes clinically detected later in life. Pro-B cell. A developing B cell in the bone marrow that is the earliest cell committed to the B lymphocyte lineage. Pro-B cells do not produce Ig, but they can be distinguished from other immature cells by the expression of B lineage-restricted surface molecules such as CDl9 and CDfO. Professional antigen-presenting cells (professional APCs). APCs for naive helper T lymphocytes, used to refer to dendritic cells, mononuclear phagocltes, and B lymphocytes, all of which are capable of expressing class II MHC molecules and costimulators. The most important professional APCs for initiating primary T cell responsesare dendritic cells. Programmed cell death. A pathway of cell death by apoptosis that occurs in lymphocltes deprived of necessary survival stimuli, such as growth factors or costimulators. Programmed cell death, also called death by neglect or passive cell death, is characterized by the release of mitochondrial cytochrome c into the cytoplasm, activation of caspase-9,and initiation of the apoptotic pathway. Promoter. A DNA sequence immediately 5'to the transcription start site of a gene where the proteins that initiate transcription bind. The term promoter is often used to mean the entire 5' regulatory region of a gene, including enhancers, which are additional sequences that bind transcription factors and interact with the basal transcription complex to increase the rate of transcriptional initiation. Other enhancers may be located at a significant distance
from the promoter, either 5' of the gene, in introns, or 3' of the gene. Prostaglandins. A classof lipid inflammatorymediators derived from arachidonic acid in many cell types through the cyclooxygenase pathway. Activated mast cells make prostaglandin D, (PGD2),which binds to receptors on smooth muscle cells and acts as a vasodilator and a bronchoconstrictor. PGD2also promotes neutrophil chemotaxis and accumulation at inflammatory sites. Pro-T cell. A developing T cell in the thymic cortex that is a recent arrival from the bone marrow and does not express TCRs, CD3, ( chains, or CD4 or CD8 molecules. Pro-T cells are also called double-negative thymocltes. Protease. An enzyme that cleaves peptide bonds and thereby breaks proteins do',nminto peptides. Different kinds of proteases have different specificities for bonds between particular amino acid residues. Proteases inside phagocytes are important for killing ingested microbes during innate immune responses, and proteasesreleasedfrom phagocytes at inflammatory sites can cause tissue damage. Proteasesin APCs are critical for generating peptide fragments of protein antigens that bind to MHC molecules during T cell-mediated immune responses. Proteasome. A large multiprotein enzyme complexwith a broad range of proteolytic activity that is found in the cytoplasm of most cells and generates from cltosolic proteins the peptides that bind to class I MHC molecules. Proteins are targeted for proteasomal degradation by covalent linkage of ubiquitin molecules. Protein kinase C (PKC). Any of several isoforms of an enzyme that mediates the phosphorylation of serine and threonine residues in many different protein substrates and thereby serves to propagate various signal transduction pathways leading to transcription factor activation. In T and B lymphocltes, PKC is activated by DAG, which is generated in response to antigen receptor ligation. Protein Wrosine kinases (PTKs). Enz),rynesthat mediate the phosphorylation of tyrosine residues in proteins and thereby promote phosphotyrosine-dependent protein-protein interactions. PTKs are involved in numerous signal transduction pathways in cells of the immune system. Protozoa. Single-celled eukaryotic organisms, many of which are human parasites and cause diseases.Examples of pathogenic protozoa include Entamoeba histolytica, which causes amebic dysentery; Plasmodium, which causes malaria; and Leishmania, which causes leishmaniasis. Protozoa stimulate both innate and adaptive immune responses.It has proved difficult to develop effective vaccines against many of these organisms. Provirus. A DNA copy of the genome of a retrovirus that is integrated into the host cell genome and from which viral genes are transcribed and the viral genome is reproduced. HIV proviruses can remain inactive for long periods and thereby represent a latent form of
HIV infection that is not accessible to immune defense. Purified antigen (subunit) vaccine. A vaccine composed of purified antigens or subunits of microbes. Examples of this type of vaccine include diphtheria and tetanus toxoids, pneumococcus and Haemophilus influenzae polysaccharide vaccines, and purified polypeptide vaccines against hepatitis B and influenza virus. Purified antigen vaccines may stimulate antibody and helper T cell responses,but they do not generate CTL responses. Pyogenic bacteria. Bacteria, such as the gram-positive staphylococci and streptococci, that induce inflammatory responses rich in polyrnorphonuclear leukoc1'tes (giving rise to pus). Antibody responses to these bacteria greatly enhance the efficacy of innate immune effector mechanisms to clear infections. Rac. A small guanine nucleotide-binding protein that is activated by the GDP-GTP exchange factorVav during the early events of T cell activation. GTP'Rac triggers a three-step protein kinase cascade that culminates in activation ofthe stress-activatedprotein (sAP) kinase, c-Jun N-terminal kinase (INK), and p38 kinase, which are similar to the MAP kinases. Radioimmunoassay. A highly sensitive and specific immunologic method of quanti$ring the concentration of an antigen in a solution that relies on a radioactively labeled antibody specific for the antigen. Usually, two antibodies specific for the antigen are used. The first antibody is unlabeled but attached to a solid support, where it binds and immobilizes the antigen whose concentration is being determined. The amount of the second, Iabeled antibody that binds to the immobilized antigen, as determined by radioactive decay detectors, is proportional to the concentration of antigen in the test solution. Ras. A member of a family of 21-kD guanine nucleotidebinding proteins with intrinsic GTPase activity that are involved in many different signal transduction pathways in diverse cell types. Mutated ras genes are associated with neoplastic transformation. In T cell activation, Ras is recruited to the plasma membrane by tyrosine-phosphorylated adapter proteins, where it is activated by GDP-GTP exchange factors. GTP'Ras then initiates the MAP kinase cascade, which leads to expression of the ps gene and assembly of the AP-l transcription factor. Reactive oxygen intermediates (ROIs). Highly reactive metabolites of oxygen, including superoxide anion, hydroxyl radical, and hydrogen peroxide, that are produced by activated phagocytes. ROIs are used by the phagocytes to form oxyhalides that damage ingested bacteria. ROIs may also be released from cells and promote inflammatory responses or cause tissue damage. Reagin. IgE antibody that mediates an immediate hlpersensitivity reaction. Receptor editing. A process by which some immature B cells that recognize self antigens in the bone marrow maybe induced to change their Ig specificities.Receptor editing involves reactivation of the RAG genes,
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additional light chain VJ recombinations, and new Ig light chain production, which allows the cell to expressa different Ig receptor that is not self-reactive. Recombination-activating gene I and 2 (RAGI and RAG2). The genes encoding RAG-I and RAG-2 proteins, which are the lymphocyte-specific components ofV(D)J recombinase and are expressedin developing B and T cells. RAG proteins bind to recombination recognition sequencesand are critical for DNA recombination events that form functional Ig and TCR genes. Therefore, RAG proteins are required for expression of antigen receptors and for the maturation of B and T lymphocytes. Recombination signal sequences. Specific DNA sequencesfound adjacent to the V D, and I segments in the antigen receptor loci and recognized by the RAG-l/MG-2 component of V(D)J recombinase.The recognition sequences consist of a highly conserved stretch of 7 nucleotides, called the heptamel located adjacent to the! D, or J coding sequence,followed by a spacerofexactly 12 or23 nonconservednucleotides and a highly conserved stretch ofg nucleotides, called the nonamer. Red pulp. An anatomic and functional compartment of the spleen composed of vascular sinusoids, scattered among which are large numbers of erythrocytes, macrophages, dendritic cells, sparse lymphocytes, and plasma cells. Red pulp macrophages clear the blood of microbes, other foreign particles, and damaged red blood cells. RegulatoryT cells. A population of T cells that regulates the activation of other T cells and is necessary to maintain peripheral tolerance to self antigens. Most regulatory T cells are CD4* and many constitutively expressCD25, the a chain of the IL-2 receptor, and the transcription factor FoxP3. Respiratory burst. The process by which reactive oxygen intermediates such as superoxide anion, hydroxyl radical, and hydrogen peroxide are produced in macrophages and poll.rnorphonuclear leukocytes. The respiratory burst is mediated by the enzyme phagocl,'te oxidase and is usually triggered by inflammatory mediators, such as LIB4, PAE and TNf; or by bacterial products, such as ly'-formylmethionyl peptides. Reverse transcriptase. An enzyme encoded by retroviruses, such as Hry that synthesizes a DNA copy of the viral genome from the RNA genomic template. Purified reversetranscriptase is used widely in molecular biology researchfor purposes of cloning complementary DNAs encoding a gene of interest from messenger RNA. Reversetranscriptase inhibitors are used as drugs to treat HIV- I infection. Reverse-transcriptase polymerase chain reaction (RTPCR). An adaptation of the polgnerase chain reaction (PCR) used to amplify a complementary DNA (cDNA) of a gene of interest. In this method, RNA is isolated from a cell expressing the gene, and cDNAs are synthesized by use of the reverse-transcriptase enzyme. The cDNA of interest is then amplified by conventional PCR techniques with gene-specific primers.
Rh blood group antigens. A complex system of protein alloantigens expressedon red blood cell membranes that are the cause of transfusion reactions and hemolytic diseaseof the newborn. The most clinically important Rh antigen is designated D. Rheumatoid arthritis. An autoimmune diseasecharacterized primarily by inflammatory damage to joints and sometimes inflammation of blood vessels,lungs, and other tissues. CD4* T cells, activated B lymphocytes, and plasma cells are found in the inflamed joint lining (synovium), and numerous proinflammatory cytokines, including IL-1 and TNB are present in the synovial (joint) fluid. RNaseprotection assay. A sensitivemethod of detecting and quantifying messenger RNA (mRNA) copies of particular genes based on hybridization of the nRNA to radiolabeled RNA probes and digestion of unhybridized RNA with the enz).ryneRNase. The doublestranded RNA duplexes created during the hybridization reaction resist degradation by RNase and are of a particular size determined by the length of the probe. They can be separated by gel electrophoresis and are detected and quantitated by radioautography. Scavenger receptors. A family of cell surface receptors expressed on macrophages, originally defined as receptors that mediate endoc],tosis of oxidized or acetylated low-density lipoprotein particles but that also bind and mediate the phagocltosis of a variety of microbes. SCID mouse. A mouse strain in which B and T cells are absent because of an early block in maturation from bone marrow precursors. SCID mice carry a mutation in a component of the enzl'rne DNA-dependent protein kinase, which is required for double-stranded DNA break repair. Deficiency of this enzyme results in abnormal joining of Ig and TCR gene segments during recombination and therefore failure to express antigen receptors. Secondary immune response. An adaptive immune response that occurs on second exposure to an antigen. A secondary response is characterized by more rapid kinetics and greater magnitude relative to the primary immune response, which occurs on first exposure. Second-set rejection. Allograft rejection in an individual who has previously been sensitized to the donor's tissue alloantigens by having received another graft or transfusion from that donor. In contrast to first-set rejection, which occurs in an individual who has not previously been sensitized to the donor alloantigens, second-set rejection is rapid and occurs in 2 to 3 days as a result of immunologic memory. Secretory component. The proteolytically cleaved portion of the extracellular domain of the poly-Ig receptor that remains bound to an IgA molecule in mucosal secretions. Selectin. Any one of three separate but closely related carbohydrate-binding proteins that mediate adhesion ofleukocytes to endothelial cells. Each ofthe selectin molecules is a single-chain transmembrane glycoprotein with a similar modular structure, including an
^'i"'l::_-::_T"::"1' L*:: extracellular calcium-dependent lectin domain. The selectins include L-selectin (CD62L), expressed on leukocytes; P-selectin (CD62P),expressedon platelets and activated endothelium; and E-selectin (CD62E), expressedon activated endothelium. Selective immunoglobulin deficiency. Immunodeficiencies characterized by a lack of only one or a few Ig classes or subclasses.Selective IgA deficiency is the most common selective Ig deficiency, followed by IgG3 and IgG2 deficiencies. Patients with these disorders may be at increased risk for bacterial infections, but many are normal. Self MHC restriction. The limitation (or restriction) of antigens that can be recognized by an individual's T cells to complexes of peptides bound to major histocompatibility complex (MHC) molecules that were present in the thymus during T cell maturation (i.e., self MHC molecules). The T cell repertoire is self MHC restricted as a result of the process of positive selection. Self-tolerance.Unresponsiveness of the adaptive immune system to self antigens, largely as a result of inactivation or death of self-reactive lymphocytes induced by exposure to those self antigens. Selftolerance is a cardinal feature of the normal immune system, and failure of self-tolerance leads to autoimmune diseases. Septic shock. An often lethal complication of severe gram-negative bacterial infection with spread to the blood stream (sepsis)that is characterized byvascular collapse, disseminated intravascular coagulation, and metabolic disturbances. This syndrome is due to the effects of bacterial LPS and cytokines, including TNB IL-12, and IL-1. Septic shock is also called endotoxin shock. Seroconversion. The production of detectable antibodies in the serum specific for a microorganism during the course of an infection or in response to immunization. Serology. The study of blood (serum) antibodies and their reactions with antigens. The term serology is often used to refer to the diagnosis of infectious diseasesby detection of microbe-specific antibodies in the serum. Serotype. An antigenically distinct subset of a speciesof an infectious organism that is distinguished from other subsetsby serologic (i.e.,serum antibody) tests. Humoral immune responses to one serotype of microbes (e.g.,influenza virus) may not be protective against another serotype. Serum. The cell-free fluid that remains when blood or plasma forms a clot. Blood antibodies are found in the serum fraction. Serum amyloid A (SAA). An acute-phase protein whose serum concentration rises significantly in the setting of infection and inflammation, mainly because of IL-l- and TNF-induced synthesis by the liver. SAA activates leukoclte chemotaxis, phagocytosis, and adhesion to endothelial cells. Serum sickness. A disease caused by the injection of Iarge doses of a protein antigen into the blood and characterized by the deposition of antigen-antibody
(immune) complexes in blood vesselwalls, especially in the kidneys and joints. Immune complex deposition leads to complement fixation and leukocyte recruitment and subsequently to glomerulonephritis and arthritis. Serum sicknesswas originally described as a disorder that occurred in patients receiving injections of serum containing antitoxin antibodies to prevent diphtheria. Severecombined immunodeficiency (SCID). Immunodeficiency diseases in which both B and T ll,rnphocltes do not develop or do not function properly, and therefore both humoral and cell-mediated immunity are impaired. Children with SCID usually have infections during the first year of life and succumb to these infections unless the immunodeficiency is treated. SCID has several different genetic causes. Shwartzman reaction. An experimental model of the pathologic effects of bacterial LPS and TNF in which two intravenous injections of LPS are administered to a rabbit 24 hours apart. After the second injection, the rabbit suffers disseminated intravascular coagulation and neutrophil and platelet plugging of small blood vessels. Signal transducer and activator oftranscription (STAT). A member of a family of proteins that function as signaling molecules and transcription factors in response to binding of cytokines to type I and type II cytokine receptors. STATs are present as inactive monomers in the cytoplasm of cells and are recruited to the cltoplasmic tails of cross-linked cytokine receptors, where they are tyrosine phosphorylated by IAKs. The phosphorylated STAI proteins dimerize and move to the nucleus, where they bind to speciflc sequences in the promoter regions of various genes and stimulate their transcription. Different STAIs are activated by different cytokines. Simian immunodeficiency virus. A lentivirus closely related to HIV-1 that causesdiseasesimilar to AIDS in monkeys. Single-positive thymocyte. A maturing T cell precursor in the thymus that expressesCD4 or CD8 molecules but not both. Single-positive thymocytes are found mainly in the medulla and have matured from the double-positive stage, during which th],rynocytes expressboth CD4 and CD8 molecules. Smallpox. A disease caused by variola virus. Smallpox was the first infectious disease shornrnto be preventable by vaccination and the first disease to be completely eradicated by a worldwide vaccination program. Somatic hSpermutation. High-frequency point mutations in Ig healy and light chains that occur in germinal center B cells. Mutations that result in increased affinity of antibodies for antigen impart a selective survival advantage to the B cells producing those antibodies and lead to affinity maturation of a humoral lmmune response. Somatic recombination. The process of DNA recombination by which the functional genes encoding the variable regions of antigen receptors are formed during lymphoclte development. A relatively limited set of inherited, or germline, DNA sequencesthat are
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l- GL0SSARY $ Appendix initially separated from one another are brought together by enzl'rnatic deletion of intervening sequencesand religation. This process occurs only in developing B or T lymphocytes. This process is sometimes referred to as somatic rearrangement. Southern blot. A technique used to determine the organization of genomic DNA around a particular gene. The DNA is cut into fragments by restriction endonucleases, different-sized fragments are electrophoretically separatedin a gel, and the DNA is then immobilized (blotted) onto a sheet of nitrocellulose or nylon. The position and therefore the size of a particular DNA fragment can then be detected by use of a radioactively labeled DNA probe with a homologous sequence. (See Appendix III for a detailed description.) Specificity. A cardinal feature of the adaptive immune system, namely, that immune responses are directed toward and able to distinguish between distinct antigens or small parts of macromolecular antigens. This fine specificity is attributed to lymphocy'te antigen receptors that may bind to one molecule but not to another with only minor structural differences from the first. Spleen. A secondary lymphoid organ in the left upper quadrant of the abdomen. The spleen is the major site of adaptive immune responses to blood-borne antigens.The red pulp of the spleen is composed of bloodfilled vascular sinusoids lined by active phagocytes that ingest opsonized antigens and damaged red blood cells.The white pulp of the spleen contains lymphocytes and l1'rnphoid follicles where B cells are activated. Src homology 2 (SH2) domain. A three-dimensional domain structure of about 100 amino acid residues present in many signaling proteins that permits specific noncovalent interactions with other proteins bv binding to phosphoryrosines.Each SH2 domain has i unique binding specificity that is determined by the amino acid residues adjacent to the phosphotyrosine on the target protein. Several proteins involved in early signaling events in T and B lymphocytes interact with one another through SH2 domains. Src homology 3 (SH3) domain. A three-dimensional domain structure of about 60 amino acid residues present in many signaling proteins that mediates protein-protein binding. SH3 domains bind to proline residues and function cooperatively with the SH2 domains of the same protein. For instance, Sos, the guanine nucleotide exchange factor for Ras,contains both SH2 and SH3 domains, and both are involved in Sos binding to the adapter protein Grb-2. Stem cell. An undifferentiated cell that divides continuously and gives rise to additional stem cells and to cells of multiple different lineages. For example, all blood cells arise from a common hematopoietic stem cell. Superantigens. Proteins that bind to and activate all the T cells in an individual that expressa particular set or family ofVgTCR genes.Superantigensare presented to T cells by binding to nonpolymorphic regions of class
II MHC molecules on APCs, and they interact with conserved regions of TCRVpdomains. SeveralstaphyIococcal enterotoxins are superantigens.Their importance lies in their ability to activate many T cells, which results in large amounts of cytokine production and a clinical slmdrome that is similar to septic shock. Suppressor T cell. T cells that block the activation and function of other effector T lymphocytes. Suppressor function may be attributed to a still poorly defined population of T cells currently called regulatoryT cells. Surrogate light chain. A complex of two nonvariable proteins that associatewith Ig p hear,y chains in preB cells to form the pre-B cell receptor. The two surrogate light chain proteins include V pre-B protein, which is homologous to a light chain V domain, and 1,5,which is covalently attached to the p heavy chain by a disulfide bond Switch recombination. The molecular mechanism underlying Ig isotype switching in which a rearranged VDf gene segment in an antibody-producing B cell recombines with a dovrmstream C gene and the intervening C gene is deleted. DNA recombination events in switch recombination are triggered by CD40 and cytokines and involve nucleotide sequences called switch regions located in the introns at the 5'end of each Cs locus. Syngeneic. Genetically identical. All animals of an inbred strain and monozygotic twins are syngeneic. Syngeneic graft. A graft from a donor who is genetically identical to the recipient. Syngeneic grafts are not rejected. Synthetic vaccine. Vaccines composed of recombinant DNA-derived antigens. Synthetic vaccines for hepatitis B virus and herpes simplex virus are now in use. Systemic inflammatory response slmdrome (SIRS). The systemic changes observed in patients who have disseminated bacterial infections. In its mild form, SIRSconsistsof neutrophilia, fever,and a rise in acutephase reactants in the plasma. These changes are stimulated by bacterial products such as LPS and are mediated by cltokines of the innate immune system. In severe cases, SIRS may include disseminated intravascular coagulation, adult respiratory distress slmdrome, and septic shock. Systemic lupus erythematosus (SLE). A chronic systemic autoimmune diseasethat affectspredominantly women and is characterized by rashes, arthritis, glomerulonephritis, hemolytic anemia, thrombocytopenia, and central nervous system involvement. Many different autoantibodies are found in patients with SLE, particularly anti-DNA antibodies. Many of the manifestations of SLE are due to the formation of immune complexes composed of autoantibodies and their specific antigens, with deposition of these complexes in small blood vessels in various tissues. The underlying mechanism for the breakdor.rm of selftolerance in SLE is not understood. T-bet. A T-box family transcription factor that promotes the differentiation of Tsl cells from naive T cells. T cell receptor (TCR). The clonally distributed anrigen receptor on CD4* and CDB*T lymphocytes that recog-
^*':T.: :::::::J:,: nizes complexes of foreign peptides bound to self MHC molecules on the surface of APCs. The most common form of TCR is composed of a heterodimer of two disulfide-linked transmembrane polypeptide chains, designated cr and B, each containing one Nterminal Ig-like variable (V) domain, one lg-like constant (C) domain, a hydrophobic transmembrane region, and a short cytoplasmic region. (Another less common type of TCR, composed of y and 6 chains, is found on a small subset of T cells and recognizes different forms of antigen.) T cell receptor complex. A multiprotein plasma membrane complex on T lymphocl'tes that is composed of the highly variable, antigen-binding TCR heterodimer and the invariant signaling proteins CD3 6, e, and y and the ( chain. T lymphocyte. The cell type that mediates cellmediated immune responsesin the adaptive immune system. T lymphocytes mature in the thymus, circulate in the blood, populate secondary lymphoid tissues,and are recruited to peripheral sites ofantigen exposure.They expressantigen receptors (TCRs) that recognize peptide fragments of foreign proteins bound to self MHC molecules. Functional subsetsof T lymphoc)'tes include CD4* helper T cells and CD8* CTLs. T-dependent antigen. An antigen that requires both B cells and helper T cells to stimulate an antibody response. T-dependent antigens are protein antigens that contain some epitopes recognized by T cells and other epitopes recognized by B cells. Helper T cells produce cytokines and cell surface molecules that stimulate B cell growth and differentiation into antibody-secreting cells. Humoral immune responsesto T-dependent antigens are characterized by isotype switching, affinity maturation, and memory. Tsl cells. A functional subset of CD4* helper T cells that secrete a particular set of cltokines, including IFN-1, and whose principal function is to stimulate phagoclte-mediated defense against infections, especially with intracellular microbes. TsZ cells. A functional subset of CD4' helper T cells that secretea particular set of cytokines, including IL-4 and IL-S, and whose principal functions are to stimulate IgE and eosinophil/mast cell-mediated immune reactions and to dor.nm-regulate Tsl responses. Ts 17 cells. A functional subset of CD4' helper T cells that secrete a particular set of inflammatory cytokines, including IL-17, which are protective against certain bacterial infections and also mediate pathogenic responsesin autoimmune diseases. Thymic epithelial cells. Epithelial cells abundant in the cortical and medullary stroma of the thymus that play a critical role in T cell development. Thymic epithelial cells secretefactors, such as IL-7, that are required for the early stagesof T cell development. In the process of positive selection, maturing T cells must recognize self peptides bound to MHC molecules on the surface of thymic epithelial cells to be rescued from programmed cell death.
Thymocyte. A precursor of a mature T lymphocyte present in the thymus. Thymus. A bilobed organ situated in the anterior mediastinum that is the site of maturation of T lymphocltes from bone marrow-derived precursors. Thymic tissue is divided into an outer cortex and an inner medulla and contains stromal thymic epithelial cells, macrophages, dendritic cells, and numerous T cell precursors (thymocytes) at various stages of maturation. T-independent antigen. Nonprotein antigens, such as polysaccharides and lipids, that can stimulate antibody responses without a requirement for antigenspecific helper T lymphocytes. T-independent antigens usually contain multiple identical epitopes that can cross-link membrane Ig on B cells and thereby activate the cells. Humoral immune responses to T-independent antigens show relatively little heavy chain isotype switching or affinity maturation, tvvo processesthat require signals from helper T cells. Tissue typing. The determination of the particular MHC alleles expressed by an individual for the purpose of matching allograft donors and recipients' Tissue tlping, also called HLA typing, is usually done by testing whether sera knovrm to be reactive with certain MHC gene products mediate complementdependent lysis of an individual's llmphocytes. PCR techniques are now also used to determine whether an individual carries a particular MHC allele. TNF receptor-associated factors (TRAFs). A family of adapter molecules that interact with the cytoplasmic domains of various receptors in the TNF receptor family, including TNF-RII, lymphotoxin (LI)-B receptor, and CD40. Each ofthese receptors contains a cytoplasmic motif that binds different TMFs, which in turn engageother signaling molecules leading to activation of the transcription factors AP-l and NF-rB. A transforming gene product of Epstein-Barr virus encodes a protein with a domain that binds TMFs, and therefore infection by the virus mimics TNF- or CD40-induced signals. Tolerance. Unresponsiveness of the adaptive immune system to antigens, as a result ofinactivation or death of antigen-specific lgnphocytes, induced by exposure to the antigens. Tolerance to self antigens is a normal feature of the adaptive immune system, but tolerance to foreign antigens may be induced under certain conditions of antigen exposure. Tolerogen. An antigen that induces immunologic tolerance, in contrast to an immunogen, which induces an immune response. Many antigens can be either tolerogens or immunogens, depending on how they are administered. Tolerogenic forms of antigens include large doses of the proteins administered without adjuvants, APLs, and orally administered antigens. Toll-like receptors. Cell surface molecules on phagocytes and other cell types that are involved in recognition of microbial structures, such as endotoxin, and the generation of signals that lead to the activation of innate immune responses. Toll-like receptors share
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A p p e n dl i-x G L O S S A R Y
structural homology and signal transduction pathways with the type I IL-l receptor. Toxic shock slmdrome. An acute illness characterized by shock, skin exfoliation, conjunctivitis, and diarrhea that is associated with tampon use and caused by a Staphylococcusaureus superantigen. Transforming growth factor-p (TGF-p). A cytokine produced by activated T cells, mononuclear phagocytes, and other cells whose principal actions are to inhibit the proliferation and differentiation of T cells, to inhibit the activation of macrophages, and to counteract the effects of proinflammatory cytokines. Transfusion. Transplantation of circulating blood cells, platelets, or plasma from one individual to another. Transfusions are performed to treat blood loss from hemorrhage or to treat a deficiency in one or more blood cell types resulting from inadequate production or excessdestruction. Transfusion reactions. An immunologic reaction against transfused blood products, usually mediated by preformed antibodies in the recipient that bind to donor blood cell antigens, such as ABO blood group antigens or histocompatibility antigens. Transfusion reactions can lead to intravascular lysis of red blood cells and, in severecases,kidney damage,fever, shock, and disseminated intravascular coagulation. Transgenic mouse. A mouse that expressesan exogenous gene that has been introduced into the genome by injection of a specific DNA sequence into the pronuclei of fertilized mouse eggs.Transgenesinsert randomly at chromosomal break points and are subsequently inherited as simple mendelian traits. By the design of transgenes with tissue-specific regulatory sequences,mice can be produced that express a particular gene only in certain tissues. Transgenic mice are used extensively in immunology research to study the functions of various cytokines, cell surface molecules, and intracellular signaiing molecules. Transplantation. The process of transferring cells, tissues, or organs (i.e., grafts) from one individual to another or from one site to another in the same individual. Transplantation is used to treat a variety ofdiseasesin which there is a functional disorder of a tissue or organ. The major barrier to successfultransplantation between individuals is immunologic reaction (rejection) to the transplanted graft. Transporter associated with antigen processing (TAp). An adenosine triphosphate (ATP)-dependent peptide transporter that mediates the active transport of peptides from the cytosol to the site of assembly of class I MHC molecules inside the endoplasmic reticulum. TAP is a heterodimeric molecule composed of TAP-l andTAP-2 polypeptides, both encoded by genesin the MHC. Becausepeptides are required for stable assembly of class I MHC molecules, TAP-deficient animals expressfew cell surface class I MHC molecules, which results in diminished development and activation of CD8* T cells. Tumor immunity. Protection against the development of tumors by the immune system. Although immune responses to naturally occurring tumors can fre-
quently be demonstrated, true immunity may occur only in the case of a subset of these tumors that express immunogenic antigens (e.g.,tumors that are caused by oncogenic viruses and therefore express viral antigens). Research efforts are under way to enhance weak immune responsesto other tumors by a variety of approaches. Tirmor-infiltrating lymphocytes (TILs). Lymphocltes isolated from the inflammatory infiltrates present in and around surgical resection samples of solid tumors that are enriched with tumor-specific CTLs and NK cells. In an experimental mode of cancer treatment, TILs are grown in uitro in the presence of high doses of IL-2 and are then adoptively transferred back into patients with the tumor. Tumor necrosis factor (TNF). A cytokine produced mainly by activated mononuclear phagocytes that functions to stimulate the recruitment of neutrophils and monocltes to sites of infection and to activate these cells to eradicate microbes. TNF stimulates vascular endothelial cells to expressnew adhesion molecules, induces macrophages and endothelial cells to secretechemokines, and promotes apoptosis of target cells. In severe infections, TNF is produced in large amounts and has systemic effects, including induction of fever, synthesis of acute-phase proteins by the liver, and cachexia. The production of large amounts of TNF can cause intravascular thrombosis and shock. (TNF-p, or lymphotoxin, is a closely related cltokine with biologic effects identical to those of TNF-cr but is produced by T cells.) Tumor necrosis factor (TNF) receptors. Cell surface receptors for TNF-c and TNF-B (LI), present on most cell types. There are two distinct TNF receptors, TNFRI and TNF-RII, but most biologic effects of TNF are mediated by TNF-RI. TNF receptors are members of a family of homologous receptors with cysteine-rich extracellular motifs that include Fas and CD40. Tumor-specific antigen. An antigen whose expression is restricted to a particular tumor and is not expressed by normal cells.Tumor-specific antigens may serve as target antigens for antitumor immune responses. Tumor-specific transplantation antigen (TSTA). An antigen expressedon experimental animal tumor cells that can be detected by induction of immunologic rejection of tumor transplants. TSTAswere originally defined on chemically induced rodent sarcomas and shown to stimulate CTl-mediated rejection of transplanted tumors. TWo-signal hlryothesis. A now proven hlpothesis that states that the activation of lymphocytes requires two distinct signals,the first being antigen and the second either microbial products or components of innate immune responsesto microbes. The requirement for antigen (so-called signal 1) ensures that the ensuing immune response is specific. The requirement for additional stimuli triggered by microbes or innate immune reactions (signal 2) ensures that immune responses are induced when they are needed, that is, against microbes and other noxious substances and not against harmless substances,including self anti-
ooo"o'|--.::-:,:,::-3"-:.:"1 i;
gens. Signal 2 is referred to as costimulation and is often mediated by membrane molecules on professional APCs, such as 87 proteins. Type I cytokine receptors. A family of cytokine receptors, also called hemopoietin receptors, that contain conserved structural motifs in their extracellular domains and bind cytokines that fold into four crhelical strands, including growth hormone, IL-z,1L-3, I L - 4 ,I L . 5 , I L - 6 , 1 L - 7 , I L - gI,L - 1 1 ,I L - 1 3 ,I L - I 5 , G M - C S E and G-CSE Some of these receptors consist of a ligand-binding chain and one or more signaltransducing chains, and all of these chains have the same structural motifs. Type I cltokine receptors are dimerized on binding their cytokine ligands, and they signal through IAK/STAI pathways. Type I interferons (IFN-o,IFN-p). A family of cytokines, including several structurally related IFN-cr proteins and a single IFN-B protein, all of which have potent antiviral actions. The major source of IFN-u is mononuclear phagocltes; IFN-0 is produced by many cells,including fibroblasts. Both IFN-cxand IFN-B bind to the same cell surface receptor and induce similar biologic responses.\pe I IFNs inhibit viral replication, increase the lytic potential of NK cells, increase expressionof classI MHC molecules on virus-infected cells, and stimulate the development of THI cells, especially in humans. Ubiquitination. Covalent linkage of several copies of a small pollpeptide called ubiquitin to a protein. Ubiquitination servesto target the protein for proteolltic degradation by proteasomes, a critical step in the class I MHC pathway of antigen processing and presentation. Urticaria. Localized transient swelling and redness of the skin caused by leakage of fluid and plasma proteins from small vessels into the dermis during an immediate hypersensitivity reaction. V gene segments. A DNA sequence that encodes the variable domain of an Ig heavy chain or light chain or a TCR a, F, T, or 6 chain. Each antigen receptor locus contains many different V gene segments, any one of which may recombine with downstream D or I segments during lymphoclte maturation to form functional antigen receptor genes. V(D)J recombinase. A collection of enzymes that together mediate the somatic recombination events that form functional antigen receptor genes in developing B and T lymphocytes. Some of the enz),rnes, such as RAG-1 and MG-2, are found only in developing lymphocytes, and others are ubiquitous DNA repair enzymes. Vaccine. A preparation of microbial antigen, often combined with adjuvants, that is administered to individuals to induce protective immunity against microbial infections. The antigen may be in the form of live but avirulent microorganisms, killed microorganisms, purified macromolecular components of a microorganism, or a plasmid that contains a complementary DNA encoding a microbial antigen. Variable region. The extracellular, N-terminal region of an Ig heavy or light chain or a TCR cr, p, y, or 6
chain that contains variable amino acid sequences that differ between every clone of lymphocytes and that are responsible for the specificity for antigen. The antigen-binding variable sequences are localized to extended loop structures or hlpervariable segments. Virus. A primitive obligate intracellular parasitic organism or infectious particle that consists of a simple nucleic acid genome packaged in a protein capsid, sometimes surrounded by a membrane envelope. Many pathogenic animal viruses cause a wide range of diseases. Humoral immune responses to viruses can be effective in blocking infection of cells, and NK cells and CTLs are necessary to kill cells already infected. Western blot. An immunologic technique to determine the presence of a protein in a biologic sample. The method involves separation of proteins in the sample by electrophoresis, transfer of the protein array from the electrophoresis gel to a support membrane by capillary action (blotting), and finally detection of the protein by binding of an enzgnatically or radioactively labeled antibody specific for that protein. Wheal and flare reaction. Local swelling and redness in the skin at a site of an immediate hlpersensitivity reaction. The wheal reflects increased vascular permeability and the flare results from increased local blood flow both changes resulting from mediators such as histamine released from activated dermal mast cells. White pulp. The part of the spleen that is composed predominantly of lyrnphocltes, arranged in periarteriolar lymphoid sheaths,and follicles and other leukocytes.The remainder of the spleen contains sinusoids lined with phagocytic cells and filled with blood, called the red pulp. Wiskott-Aldrich syndrome. An X-linked disease char(reduced acterized by eczema, thrombocltopenia blood platelets), and immunodeficiency manifested as susceptibility to bacterial infections. The defective gene encodes a cltosolic protein involved in signaling cascadesand regulation of the actin cytoskeleton. Xenoantigen. An antigen on a graft from another species. Xenogeneic graft (xenograft). An organ or tissue graft derived from a species different from the recipient. Transplantation of xenogeneic grafts (e.g.,from a pig) to humans is not yet practical becauseof special problems related to immunologic rejection. Xenoreactive. Describing a T cell or antibody that recognizes and responds to an antigen on a graft from another species (a xenoantigen). The T cell may recognize an intact xenogeneic MHC molecule or a peptide derived from a xenogeneic protein bound to a self MHC molecule. X-linked agammaglobulinemia. An immunodeflciency disease, also called Bruton's agammaglobulinemia, characterized by a block in early B cell maturation and absence of serum Ig. Patients suffer from pyogenic bacterial infections. The disease is caused by mutations or deletions in the gene encoding Btk, an
enzymeinvolved in signaltransduction in developing B cells. X-linked hyper-IgM syndrome. A rare immunodeficiency disease caused by mutations in the CD40 ligand geneand characterizedby failure of B cell heavy chain isotype switching and cell-mediatedimmunity. Patientssuffer from both pyogenicbacterial and protozoal infections. ( Chain. A transmembraneprotein expressedin T cells as part of the TCRcomplex that contains ITAMsin its
cytoplasmictail and binds the ZAP-70protein tyrosine kinaseduring T cell activation. Zeta-associated protein of 70kD QIO-70). An Src family cytoplasmicprotein tyrosinekinasethat is critical for early signalingstepsin antigen-inducedT cell activation.ZAP-70binds to phosphorylatedtyrosines in the cytoplasmic tails of the ( chain of the TCR complex and in turn phosphorylatesadapterproteins that recruit other components of the signaling cascade.RoshanKetabO2L-6695O639
c The table below includes selectedCD molecules that are referred to in the text. We have not included cl.tokine receptors and Toll-like receptors, many of which have been assigned CD numbers, because we refer to these molecules by the more descriptive names throughout
CD Common designation synonyms
the book. Many other molecules that have CD number designations are not described in the text, and therefore they are not included in this selected list. A complete and up-to-date listing of CD molecules may be found on the WVWVat http :/ /www.hlda8.org.
Molecularstructure, Maincellular expression family
Knownor proposedfunctions
CDla'
T6
49 kD; classI MHC family;p2 microglobulinassociated
Thymocytes,dendritic cells(including Langerhanscells)
Presentationof nonpeptide (lipidand glycolipid) antioensto some T cells
cDlb
T6
45 kD:classI MHC family;p2microglobulinassociated
Sameas CDla
Sameas CDla
CDlc
T6
43 kD; classI MHC family;p2 microglobulinassociated
Thymocytes,dendritic cells(including Langerhanscells), some B cells
Sameas CDla
Sameas CDla
cDld
49 kD;classI MHC family;p2microglobulin associated
CDle
28 kD; class I MHC family;p2 microglobulinassociated
cells Dendritic
Sameas CDla
cD2
T11;LFA-2; sheepredblood cellreceptor
50 kD;lg superfamily; family CD2|CD48|CD58
T cells,NK cells
Adhesionmolecule (bindsCD58);Tcell activation;CTL- and NK cell-mediated lysis
CD3y
T3;Leu-4
25-28 kD; associated with CD36and CD3ein TCR complex;lg supedamily;ITAMin cytoplasmictail
T cells
Cell surfaceexpressionof and signaltransductionby the T cell antigenreceptor
cD36
T3;Leu-4
with 20 kD;associated CD36andCD3ein TCRcomplex; lg superfamily; ITAMin 6) cytoplasmic tail(Chapter
T cells
ot Cellsurfaceexpression bY andsignaltransduction theT cellantigenreceptor
The complete listing of CD molecules, called Human Cell Differentiation Markers (HCDM), formerly called Human Leukocyte Differentiation Antigeris, is compiled by the Collaborative Research on Cellular Markers workshop. The HCDM website, http:// www.hlda8.org/, includes links io various gene and protein databases,which contain information about each molecule'
52O
I
Appendix ll -
PRINCIPAL FEATURES 0F SELECTED CDM0LECULES
CD Common designation synonyms
Molecularstructure, Main cellular family expression
Knownor proposedfunctions
CD3e
T3;Leu-4
20 kD; associatedwith CD36and CD3ein TCR complex;lg superfamily; ITAMin cytoplasmictail
T cells
Cell surfaceexpressionof and signaltransductionby the T cell antigenreceptor
cD4
T4;Leu-3;L3T4
55 kD; lg superfamily
Class ll MHC-restricted T cells,monocytesand macropnages
Signalingand adhesion coreceotorin class ll MHC-restrictedantigeninducedT cell activation (bindsto classll MHC molecules); receptorfor HIV
cD5
T1; Ly-1
67 kD; scavenger receptorfamily
T cells. B cell subset
Signalingmolecule; bindsCD72
CDBa
T8; Leu2; Lyt2
34 kD; expressedas Class I MHC-restricted homodimer or heterodimer T cells withCD8 B
Signalingand adhesion coreceptorin class I MHCrestrictedantigen-induced T cell activation(bindsto class I MHC molecules);thymocyte develooment
cDsp
T8;Leu2;Lyt2
34 kD; expressedas heterodimerwith CD8 cr; lg supedamily
Same as CDScr
cD10
Commonacute 100 kD; type ll membrane protein lymphoblastic leukemiaantigen (CALLA);neutral endopeptidase. metalloendopeptidase; enkephalinase
lmmatureand some mature Metallooroteinase: B cell B cells;lymphoidprogenitors,develooment granulocytes
CD11a
LFA-1crchain;cr1 integrinsubunit
180 kD; noncovalently linkedto CD18to form LFA-1integrin
Leukocytes
Cell:celladhesion;bindsto lcAM-1 (CD54),|CAM-2 (CD102),and ICAM-S(CD50)
cD11b
M a c - 1M ; o 1 ;C R 3 (iC3breceptor); oM integrinchain
165 kD; noncovalently linkedto CDlB to lorm Mac-1integrin
Granulocytes,monocytes/ macrophages, dendritic cells,NK cells
Phagocytosisof iC3b-coated particles; neutrophil and monocvteadhesionto (bindsCD54) endoth-elium and extracellularmatrixoroteins
CD11c
p150,95;CR4 o chain;ox integrin cnarn
145 kD: noncovalentlv linkedto CD18 to forrir p150,95integrin
Monocytes/macrophages, granulocytes,NK cells
Similarfunctionsto CD11b; majorCD11CD18 integrin on macropnages
cD14
Mo2; LPS receptor
53 kD; GPI-linked
Monocytes,macrophages, granulocytes
Bindscomolexof LPS and protein;requiredfor LPS-binding LPS-inducedmacrophage activation
CD16a
Fq'RlllA
50-70 kD; transmembrane NK cells,macrophages protein;lg superlamily
cD16b
Fc1RlllB
50-70 kD; GPI linked; lg superfamily
Neutrophils
Binds Fc regionof lgG; synergy with FcyRllin immunecomplexmediatedneutroohilactivation
cD18
B chain of LFA-1 family;B2integrin subunit
95 kD; noncovalently l i n k e dt o C D 1 1 aC , D11b, or CD11cto form B2 inteorins
Leukocytes
S e eC D 1 1 aC. D 1 1 bC. D 1 1 c
cD19
B4
95 kD; lg superfamily
MostB cells
B cell activation;forms a coreceptorcomplexwith CD21 and CDBl whichdeliverssionals that synergizewith signalsfiom B cell antigenreceptorcomplex
cD20
B1
35*37 kD; tetraspan (TM45F)tamily
Mostor all B cells
? Role in B cell activationor regulation; calciumion channel
MatureB cells,follicular dendriticcells
Receptorfor comolement JragmentC3d; forms a coreceptorcomplexwith CD19 and CD81whichdelivers activating signalsin B cells; Epstein-Barrvirus receptor
cD21
!!z;
csoreceotor;145 kD; regulatorsof complementactivation
Same as CDSo
Binds Fc regionof lgG; phagocytosisand antibodydependentcellularcytotoxicity
CDMoLECULES 0FSELECTED FEATURES ll - PRINCIPAL Appendix $ SZf
CD Common designation synonyms
Molecularstructure, Main cellular expression family
Knownor proposedfunctions Regulationof B cell activation; adhesionmolecule
cD22
BL-CAM;LybS
130-140kD; lg supedamily; B cells family;lTlM in sialadhesin cytoplasmictail
cD23
FceRllb;low-affinity lgE receptor
45 kD; c-typelectin
cD25
lL-2 receptors chain; 55 kD; regulatorsof TAC; p55 complementactivation family;noncovalently associateswith lL-2RB (CD122)and lL-2Ry (CD132)chainsto form high-afiinitylL-2 receptor
A c t i v a t e d T a n d B c e l l s ; BindslL-2;subunitof lL-2R T cells; regulatory macrophages activated
cD28
rp44
Homodimer ot 44kD chains;lg superfamily
T cells(mostCD4,some CDBcells)
cD29
p chain of VLA antigens;p1 integrin subunit;platelet GPlla
130 kD; noncovalently linkedwith CD49a-dchains to form VLA (pl ) integrins
T cells,B cells,monocytes, granulocytes
cD30
Ki-1
120kD;TNF-Rfamily
ActivatedTandBcells; NK cells,monocytes, cells in Reed-Sternberg Hodqkin'sdisease
cDsl
PECAM-1;platelet GPlla
130-140kD; lg superfamily Platelets;monocytes, granulocytes,B cells, endothelialcells
cD32
FcyRllA;FcyRllB; FcyRllC
lTlM 40 kD; lg superfamily; in cytoplasmic tail;A, B, and C lorms productsof differentbut homologous genes
cD34
gp105-120
'105-120 kD;sialomucin
cD35
CR1:C3b receotor
cD36
PlateletGPlllb;GPIV 85-90 kD
ActivatedB cells,monocyles, macropnages
T cell receotorfor costimulator moleculesCD80(87-1)and cD86 (87-2)
cell Role in activation-induced death of CD8+T cells;bindsto CD153(CD30L)on neutrophils, activatedT cells,and macropnages Adhesionmoleculeinvolvedin the leukocytetransmigration throughendolhelium
Macrophages,granulocytes Fc receptorfor aggregatedlgc; plaietetibinds C-reactiveprotein;role in a i;ti{ eoii#p"nits, phagocytosis, ADCC; acts as inhibitorvreceptorthat terminates activatiohsignalsinitiatedby the B cell antigenreceptor
Precursorsof hematopoietic Cell-celladhesion;binds cellsin high CD62L (L-selectin) cells,endothelial endothelialvenules BindsC3b and C4b; promotes 190-285kD (fourproducts phagocytosisof C3b- or of polymorphic alleles); C4b-coatedparticlesand regulators of complement immunecomplexes;regulates activationfamily complementactivation Scavengerreceptorfor oxidized and monocytes, Platelets, microvascularlow-densitylipoprotein;platelet macrophages, adhesion;phagocytosisof cells endothelial apoptoticcells
cD40
Homodimerot 44-48 kD chains:TNF-Rfamilv
B cells,macrophages, dendriticcells,endothelial cells
BindsCD154(CD40ligand);role B cell, in T cell-deoendent activation,and macroPhage, dendriticcell,and endothelial cell activation
cD43
Sialophorin; leukosialin
95-135 kD; sialomucin
Leukocytes(excepl circulatingB cells)
Adhesiveand anti-adhesive functions
CD44
P g p - 1H ; ermes
80 to >100kD, highly glycosylated;cartilage linkproteinfamily
Leukocytes,erythrocytes
involvedin Bindshvaluronan; leukocvieadhesionto endothelial cells and extracellularmatrix; leukocyteaggregation
cD45
Leukocvtecommon antigen'(LCA); f2O0: B22O
cells Hematopoietic Multioleisoforms. 180-220kD (see CD45R); proteintyrosinephosphatase receptorfamily;f ibronectin t y p el l l f a m i l y
CD45R
Formsof CD45with CD4SRO:180 kD restricted cellular CD45RA:220 kD C D 4 5 R B1: 9 0 , 2 0 5 , expressron and 22OkD isoforms
Tyrosinephosphatasewhich plays criticalrole in regulating T and B cell antigen signaling receptor-mediated
See CD45 CD45RO:memoryT cells, subsetof B cells, monocytes,macroPhages CD45RA:naiveT cells, B cells,monocytes CD4SRB:B cells,subsetof T cells
522
Appendix ll -
PRINCIPAL FEATURES 0F SELECTED CDM0LECULES
CD Common designation synonyms
Molecularstructure, Maincellular family expression
Knownor proposedfunctions
cD46
Membranecojactor protein(MCP)
52-58kD;regulators of Leukocytes,epithelialcells, complement activation family fibroblasts
Regulationof complement activation
CD49a
cr1integrinsubunit
210 kD: noncovalentlv linkedto CD29 to forrir VLA-1(81 integrin)
ActivatedT cells,monocvtes Leukocyteadhesionto extracellularmatrix; bindscollagens, laminin
cD49b
integrin cr,2 subunit; plateletGPla
165 kD; noncovalently linkedto CD29 to form VLA-2 (p1 integrin)
Platelets.activatedT cells. monocytes,some B cells
Leukocvteadhesionto extraceilularmatrix;binds collagen,laminin
CD49c
d3 integrinsubunit
Dimerof 130and 25 kD chains;noncovalently linkedto CD29 to form VLA-3(81 integrin)
T cells,some B cells, monocyres
Leukocyteadhesionto extracellularmatrix;binds f ibronectin, collagens, laminin
cD49d
oa integrinsubunil
150 kD; noncovalently linkedto CD29 to form VLA-4 (oapl) integrin
T cells,monocytes,B cells, NK cells,eosinophils, dendriticcells,thymocytes
Leukocyteadhesionto endotheliumand extracellular matrix;bindsto VCAM-1and MAdCAM-1; bindsfibronectin and collagens
CD49e
0s integrinsubunil
Heterodimer of 135and T cells;few B cellsand 25 kD chains;noncovalently monocytes,thymocytes linkedto CD29 to form VLA-S(81 integrin)
cD49f
u6 integrinsubunit
Heterodimerof 125 and Platelets,megakaryocytes, Adhesionto extracellularmatrix; 25 kD chains;noncovalently activatedT cells,monocytes bindsfibronectin linkedto CD29 to form VLA-6 (81 integrin)
cD54
lcAM-1
75-114 kD; lg superfamily Endothelial cells, T cells, B cells,monocytes, endothelial cells (cytokineinducible)
cD55
Decav-acceleratinq 55-70 kD: GPI linked: factoi (DAF) regulatorsof complement activationtamily
cD58
Leukocytefunction- 55-70 kD; GPI linkedor Broad associaledantiqen-3 integralmembraneprotein; (LFA-3) CD21CD481CD58 familv
Leukocyte adhesion;bindsCD2
cD59
Membraneinhibitor of reactivelysis (MrRL)
18-20 kD; GPI linked;Ly-6 superfamily
Broad
BindsC9; inhibitsformationof complementmembraneattack comolex
CD62E
E-selectin; ELAM-1
115kD; selectinfamily
Endothelial cells
Leukocyte-endothelial adhesion
CD62L
L-selectin;LAM-1; MEL-14
74-95 kD; selectinfamily
B cells,T cells,monocytes, granulocytes,some NK cells
Leukocyte-endothelial adhesion; homingof naiveT cells to peripherallymph nodes
CD62P
P-selectin; gmp140; PADGEM
140 kD; selectinfamilv
Platelets, endothelial cells (presentin granules, translocatedto cell surface upon activation)
Leukocyteadhesionto platelets; endothelium, b i n d sC D 1 6 2( P S G L - 1 )
cD64
Fcyfll
72 kD; lg superfamily; noncovalently associated with the common FcR v chain
Monocytes,macrophages, activatedneutroohils
High-afiinityFcryreceptor;role in phagocytosis, ADCC, macrophageactivation
CD66e
Carcinoembryonic 180-220 kD; lg superfamily; Colonicand otherepithelial (CEA) antigen carcinoembryonic antioen cells
? Adhesion;clinicalmarkerof carcinomaburden
cD74
Classll MHC invariant(y) chain; li
33, 35, and 41 kD isoforms
B cells,monocytes, macrophage,otherclass ll MHC-expressingcells
Bindsto and directsintracellular sortingof newlysynthesized classll MHC molecules
CD79a
l g o ,M B 1
32, 45 kD: formsdimerwith CD79B;lg superfamily; ITAMin cytoplasmictail
MatureB cells
Requiredfor cell surface expressionof and signal transduction bv the B cell antigenrecept-or complex
cD79b
lsp,829
37-39 kD; forms dimerwith CD790; lg superfamily; ITAMin cytoplasmictail
MatureB cells
Requiredfor cell surface expressionol and signal transductionby the B cell antigenreceptorcomplex
Broad
(CEA)family
Adhesionto extracellularmatrix; bindsfibronectin
Cell-celladhesion:lioandfor C D 1 1 a C D 1(8L F A - 1 i a n d CD11bCDl8 (Mac-1 ); receptor for rhinovirus Regulationof complement activation:bindsC3b. C4b
ll Aooendix
CD Gommon designation synonyms
CDM0LECULES FEATURES 0F SELECTED PRINCIPAL
Molecularstructure, Maincellular expression family
Knownor proposedfunctions
cD80
8 7 - 1 ;B B 1
60 kD; lg superfamily
Dendriticcells,activated B cells and macrophages
forT lymphocyte Costimulator ligandfor CD28and activation; cD152(CTLA-4)
cD81
Targetfor antiproliferative antigen-1(TAPA-1)
26 kD; tetraspan(TM4SF)
T cells,B cells,NK cells, dendriticcells,thymocytes, endothelium
B cell activation;forms a coreceptorcomplexwith CD19and CD21whichdelivers signalsthat synergizewith signalsfrom B cellantigen receptorcomplex
cD86
87-2
80 kD;lg superfamily
forT lymphocYte B cells,monocytes,dendritic Costimulator ligandfor CD28and activation; cells;some T cells cD152(CTLA-4)
43 kD; G protein--coupled, Granulocytes,monocytes, dendriticcells,mastcells 7-membrane-spanning receptorfamily
Receptorfor C5a complement fragment;role in complementinducedinflammation
cD88
C5a receptor
cD89
monocytes, Fco receptor(FccrR) 55-75 kD;lg superfamily; Granulocytes,
cD90
Thy-1
25-35 kD; GPI linked;lg superfamily
Thvmocvtes,periPheral T iells (mice);CD34* hematopoieticprogenitor cells,neurons
Markerfor T cells;? rolein T cell activation
cD94
Kp43;KIR
43 kD; C-typelectin;on NK cells,covalently assembleswith other C-typelectinmolecules (NKG2)
NK cells;subsetof CD8+ T cells
complexfunctions CD94/NKG2 receptor; as an NKcellinhibitory bindsHLA-EclassI MHCmolecules
cD95
Fas antigen,APO-1
Multiplecelltypes Homotrimerof 45 kD chains;TNF receptorfamily
cD102
tcAM-2
55-65 kD;lg superfamily Endothelialcells,
cD103
HML-1; cr6integrin subunit
Dimerof 150 and 25 kD subunits;noncovalently linkedto B7integrinsubunit to form ctgpTintegrin
cD106
100-110 kD;lg superfamilyEndothelialcells, Vascularcell macrophages,follicular adhesionmolecule-1 dendriticcells,marrow (VCAM-1); stromalcells tNoAM-110
cD1s0
Signalinglymphocyte 75-95 kD; lg supedamily activationmolecule (SLAM);lPo-3
Reoulationof B cell-T cell Thvmocvtes,activated lymphocytes,dendriticcells, intdractionsand proliferative signalsin B lymphocytes;binds cells endothelial itselfas a self ligand
cD152
33, 50 kD; lg superfamily Cytotoxic T lymphocyteassociatedprotein-4 (cTLA-4)
ActivatedT lymphocytes
signalingin T cells; Inhibitory b i n d sC D 8 0( 8 7 - 1 ) a n dC D 8 6 (B7-2)on antigen-presenting cells
cD153
CD30ligand(CD30L) 40 kD; TNF family
ActivatedT cells, resting B cells,granulocytes, macrophages,thymocytes
cell Rolein activation-induced deathof CD8+T cells;binds to CD30
cD154
ActivatedCD4* T cells Homotrimerol 32-39 kD CD40 ligand (CDaoL);TNFchains;TNF receptorfamily relatedactivation protein(TRAP);gp39
cD158
Killerlg receptor
50, 58 kD; lg superfamily; killerlg-likereceptor(KlR) familv:ITIMSin cytoflasmictail
NK cells,T cell subsets
of NK cells or activation lnhibition uoon interactionwith the appropriateclass I HLA molecules
CD159a
NKG2A
43 kD;C-typelectin;forms heterodimer withCD94
NKcells,T cellsubsets
lnhibitionor activationof NK cells uoon interactionwith the appropriateclass I HLA molecules
noncovalently associated withthecommonFcR y chain
(KrR)
BindslgA;mediates cellular T cellsubset, lgA-dependent macrophages, cytotoxicity B cellsubset
lymphocytes,monocytes, platelets lymphocytes, Intraepithelial other cell types
(LFA-1); Ligandfor CD11aCD18 cell-celladhesion Rolein T cell homingto and retentionin mucosa; bindsE-cadherin Adhesion;receptorfor CD49dCD29(VLA-4)integrin; role in lymphocytetrafficking, activati6n:role in hematoPoiesis
ActivatesB cells,macroPhages, cells;ligand and endothelial for CD40
524
|
Appendix ll -
PRINCtPAL FEATURES 0F SELECTED CDM0LECULES
CD Common designation synonyms
Molecularstructure, Maincellular family expression
CD159c
NKG2C
40 kD; C{ype lectin;forms heterodimerwith CD94
NK cells
Activationof NK cells uoon interactionwith the appropriateclass I HLA molecules
cD162
PSGL-1
Homodimerof 120 kD chains;sialomucin
T cells,monocytes, granulocytes, some B cells
Ligandfor selectins(CD62P. CD62L):adhesionof leukocytesto endothelium
cD247
Zeta chain:TCR (
17 kD; ITAMsin cytoplasmictail
T cells,NK cells
Signalingchainof TCR and NK cell-activatingreceptors
cD273
B7-DC,PD-L2
25 kD; lg superfamily; 87 costimulator familv
Dendriticcells,monocytes, macropnages
BindsPD-1;inhibition of T cell activation
cD274
B 7 - H 1P , D-L1
33 kD; lg superfamily; 87 costimulatorfamily
Leukocytes
BindsPD-1;inhibition of T cell activation
cD275
B7-H2,ICOSliqand. 60 kD; lg superlamily; 87-BP1 B7 costimulator familv
B cells,dendriticcells, monocytes
BindsICOS(CD278);T cell costimulation
CD276
87.H3
40-45 kD: lg superfamily; B7 costimulatorfamilv
Dendriticcells,monocytes, activatedT cells
T cell costimulation
cD278
I C O SA , ILIM
55-60 kD: lq suoerfamilv: CD28costiriulaiorfamilv
ActivatedT cells
BindsICOS-L(CD275);T cell costimulation
cD279
P D 1 ,S L E B 2
55 kD; lg superfamily; CD28 costimulatorfamilv
ActivatedT cells,activated B cells
BindsB7-H1(CD27\ and 87-DCrcD279:requlation of ' T cellaitivation
cD280
ENDO180,UPARAP 180 kD; C-typelectin
Macrophages,chondrocytes, Mannosereceptor;endocytic f ibroblasts, endothelial cells patternrecognitionof innate immunityreceptor
cD314
NKG2D.KLR
NK cells,activatedCD8+ T cells.NK1.1 T cells. some myeloidcells
'The
42 kD; C-typelectin
Knownor proposedfunctions
BindsMHC classI, MICA,MICB, Rael and ULBP4;NK cellano CTL activation
lowercaselettersaffixedto some CD numbersreferto complexCD moleculesthat are encodedby multipleqenesor that belonqro
proteins. related gfs.trqcturally Forinstance, cD1a,cD1b,cD1c,andcoio areiiructuiirVrerdt"o oii oiit'nbij"inid df;'-"" lal1ti9s p2 mrcrogtobuttn-associated protein. nonpolymorphic
' Abbreviations.ADCC_, antibody-depejde-nt cell-mediated cytotoxicity; Gp,glycoprotein; ICAM,intercellular adhesion molecule; interleu.kqr; niorit;iiiM, immunoreiepior tyrosinL-oaseo ITAM,immunoreceptoityrosinei6aseb?'ctiy'ation lgl jnn:ryq1.",.9u-lin;,1L, LFA, lvmohocvte function-associated antigen: LPS,.lipopolysaccharide; MHC,riralorhistocompaiiOitity i[b]1'9.1ll9titi IP:Iil,99alton; complex; NK,natural killer:GPl,glycbphosphatidylinositol; VCAM,vascrilar cetlidfiesion'molecule; VLA,veryldteantigen.
i
Laboratory Methods Using Antibodies, 525 of Antigenby lmmunoassays, Ouantitation 525 of Proteins,527 Purification and ldentification Labelingand Detectionof Antigensin Cells and llssues, 528 Purification of cells,531 Measurement of Antigen-Antibody Interactions, 531 Transgenic Mice and Targeted Gene Knockouts, 532 Methods for Studying T Lymphocyte Responses, 535 PolyclonalActivationof T cells,535 Antigen-lnducedActivationof PolyclonalT 535 CellPopulations, Activationof T Cell Antigen-lnduced Populations with a SingleAntigen Specificity,535 Methodsto Enumerateand StudyFunctional Reponsesof T Cells,536 Methods for Studying B Lymphocyte Responses, 537 B CellPopulations,53T Activationof Polyclonal Activationof B Cell Antigen-lnduced Populations with a SingleAntigenSpecificity,537 Assaysfor B Cell Antibody Production,537 Many laboratorytechniquesthat areroutine in research and clinical settingsarebasedon the use of antibodies. In addition,many of the techniquesof modern molecuIar biology have provided invaluableinformation about the immune system.We have mentioned these techniquesoften throughoutthe book.In this appendix,we
describe the principles underlying some of the most commonly used laboratory methods in immunology. In addition, we summarize how B and T lymphocyte responses are studied using laboratory techniques. Deiails of how to carry out various assaysmay be found in laboratory manuals.
ANTIEOOITS USING METHODS LRSoRRTONY The exquisite specificity of antibodies for particular antigens makes antibodies valuable reagents for detecting, purifying, and quantitating antigens' Because antibodies can be produced against virtually any t)?e of macromolecule and small chemical, antibody-based techniques may be used to study virtually any ty?e of molecule in solution or in cells.The method for producing monoclonal antibodies (seeChapter 4, Box 4-1) has greatly increased our ability to generate antibodies of itmost any desired specificity. Historically, many of the uses of antibody depended on the ability of antibody and specific antigen to form large immune complexes, eithei in solution or in gels, that could be detected by various optical methods. These methods were of great importance in early studies but have now been replaced almost entirely by simpler methods based on immobilized antibodies or antigens. of Antigen 0uantitation by lmmunoassay$ Immunologic methods of quantifying antigen concentration provide exquisite sensitivity and specificity and have become standard techniques for both researchand clinical applications. All modern immunochemical methods of quantitation are based on having a pure antigen or antibody whose quantity can be measured by an indicator molecule. \Mhen the indicator molecule is labeled with a radioisotope, as first introduced by Rosalyn Yalow and colleagues, it may be quantified by instruments that detect radioactive decay events; the assay is called a radioimmunoassay (RIA). \Mhen the 525
526
A p p e n d li lxl -
LABORATO TR EY CHNT0U CE0S M M O N LUYS E D INtMMUNOLOGY
m
Bind firstantibodvto well ol microtiterolate
varyingamount Q ofAdd antigen((!)
/a Removeunboundantioen
\Y"/
by washing
g Add labeledsecondantibodv specificfor nonoverlapping epitopesof antigen
Removeunboundlabeled secondantibodyby washing; measureamountof second antibodybound A
I
Determineamountof bound secondantibodvas a function of the concentration of antioen added (construction of a standardcurve)
c) _o (d
c a
m Concentration of antioen-+
indicator molecule is covalently coupled to an enzyme, it may be quantified by determining with a spectrophotometer the rate at which the enzyme converts a clear substrate to a colored product; the assay is called an enzyme-linked immunosorbent assay (ELISA). Several variations of RIA and ELISA exist, but the most commonly used version is the sandwich assay(Fig.A-1). The sandwich assay uses two different antibodies reactive with different epitopes on the antigen whose concentration needs to be determined. A flred quantity of one antibody is attached to a series of replicate solid supports, such as plastic microtiter wells. Testsolutions containing antigen at an unknown concentration or a series of standard solutions with known concentrations of antigen are added to the wells and allowed to bind. Unbound antigen is removed by washing, and the second antibody, which is enzyme linked or radiolabeled, is allowed to bind. The antigen serves as a bridge, so the more antigen in the test or standard solu-
assay.A fixed amountof one immobilized antibodyis usedto capturean antigenThe bindingof a second,labeledantlbodythat recognizesa nonoverlapping determinant o n t h e a n t i g e nw i l i i n c r e a s ae s t h e c o n c e n t r a t i o no f a n t i g e ni n c r e a s easn d t h u s a l l o w quantification f the antigen
tions, the more enzyme-linked or radiolabeled second antibody will bind. The results from the standard solutions are used to construct a binding curve for second antibody as a function of antigen concentration, from which the quantities of antigen in the test solutions may be inferred. \44ren this test is performed with two monoclonal antibodies, it is essential that these antibodies seenonoverlapping determinants on the antigen; otherwise, the second antibody cannot bind. In an important clinical variant of immunobinding assays,samples from patients may be tested for the presence of antibodies that are specific for a microbial antigen (e.g., antibodies reactive with proteins from human immunodeficiency virus [HIV] or hepatitis B virus) as indicators of infection. In this case,a saturating quantity of antigen is added to replicate wells containing plate-bound antibody, or the antigen is attached directly to the plate, and serial dilutions of the patient,s serum are then allowed to bind. The amount of the
A o o e n d li lxl -
patient's antibody bound to the immobilized antigen is determined by use of an enzyme-linked or radiolabeled second antihuman immunoglobulin (Ig) antibody.
lNIMMUN0L0GY L A B 0 R A T OTREYC H N I 0 UCE0SM M 0 N LUYS E D
is a widely used technique to determine the presence and size of a protein in a biologic sample. Im m u noprecipitati on and Affi nity Chromatography
Purification of Proteins
and ldentification
Antibodies can be used to purify proteins from solutions and to identify and characterize proteins. TWo commonly used methods to puriry proteins are immunoprecipitation and affinity chromatography.Western blotting
Immunoprecipitation is a technique in which an antibody specific for one protein antigen in a mixture of proteins is used to isolate the specific antigen from the mixture (Fig. A-2A). In most modern procedures, the antibody is attached to a solid-phase particle (e.9., an agarosebead) either by direct chemical coupling or indi-
@ lmmunoprecipitation
*"--*'=_,--..-i":-
r.L:::
Addexcess
Collect immobilized antibodyby centrifugation
bead-immobili
antibodyspecific for antigen of interest( )
--*-.---.J_\-
Washwith freshsolution to remove unbound antigens
: e '< Mixtureof antigenof interest (O) withotherantigens
@ lttinity chromatography Anti-Xantibody Addsolutionwith mixtureof boundto insoluble beads antigens
$1 $t' Purified X antigen or af FIGURE A-2 lsolationof an antigenby immunoprecipitation m i x t u r eo f a n t l g e n si n s e r u mo r o t h e rs o l u t i o n bs y a d d i n ga n t i b o d i ers antigensare then washedaway,and the desiredantigenis recovered can b ity of antibody-antigen blndingis lowered lmmunoprecipitation a m e a n so f i d e n t i f i c a t i o nf a n a n tg e n A n t g e n sp u r i f i e db y i m m u n c is basedon th B Affinitychromatography amidegel electrophoresis e a t r i xo r b e a d s u , s u a l l yi n a c o l u m nT h e m e t h o f i x e dt o a n i n s o l u b l m c i l i cf o r a n ' m m o b i l i z eadn t i q e n
Denature antibody to elute antigen
527
524
;
A p p e n d li lxl - L A B O R A T 0TREYC H N T O C U0 EM S M O N LUYS E D tNtMMUN0L0Gy
rectly.Indirect coupling may be achieved by means of an attached anti-antibody, such as rabbit antimouse Ig antibody, or by means of some other protein with specific affinity for the Fc portion of Ig molecules, such as protein A or protein G from bacteria. After the antibodycoated beads are incubated with the solution of antigen, unbound molecules are separated from the bead-antibody-antigen complex by washing. Specific antigen is then released (eluted) from the antibody by changing the pH or by other solvent conditions that reduce the affinity of binding. The purified antigen can then be analyzed by conventional chemical techniques. Alternatively, a small amount of radiolabeled protein can be purified and the characteristics of the macromolecule inferred from the behavior of the radioactive label in analytical separation techniques, such as sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE)or isoelectric focusing. Affinity chromatography, Iike immunoprecipitation, uses antibodies attached to an insoluble support to remove and thereby purifu antigens from a solution (Fig. A-2B). Antibodies specific for the desired antigen are attached to a solid support, such as agarose beads packed into a column, either by direct coupling or indirectly, as described for immunoprecipitation. A complex mixture of antigens is passed through the beads to allow the antigen that is recognized by the antibody to bind. Unbound molecules are washed away, and the bound antigen is eluted by changing the pH or by exposure to a chemical that breaks the antigen-antibody bonds. The same method may be used to purify antibodies from culture supernatants or natural fluids, such as serum, by first attaching the antigen to beads and passing the supernatants or serum through. Western Blotting Western blotting (Fig.A-3) is used to determine the relative quantity and the molecular weight of a protein within a mixture of proteins or other molecules. The mixture is first subjected to analytical separation, typically by SDS-PAGE,so that the final positions of different proteins in the gel are a function of their molecular size. The array of separated proteins is then transferred from the separating polyacrylamide gel to a support membrane by capillary action (blotring) or by electrophoresis such that the membrane acquires a replica of the array of separated macromolecules present in the gel. SDS is displaced from the protein during the transfer process, and native antigenic determinants are often regained as the protein refolds. The position of the protein antigen on the membrane can then be detected by binding of labeled antibody specific for that protein, thus providing information about antigen size and quantity. If radiolabeled antibody probes are used, the proteins on the blot are visualized by autoradiographic exposure of film. More recently, antibodv probes are labeled with enzymes that generate chemituminescent signals and leave images on photographic film. The sensitivity and specificity of this technique can be increased by starting with immunoprecipitated proteins instead of
crude protein mixtures. This sequential technique is especially useful for detecting protein-protein interactions. For example, the physical association of two different proteins in the membrane of a ll.rnphoc),.te can be established by immunoprecipitating a membrane extract by use of an antibody specific for one of the proteins and probing aWestern blot of the immunoprecipitate by use of a labeled antibody specific for the second protein that may have been co-immunoprecipitated along with the first protein. A variation of the Western blot technique is routinely used to detect the presence of anti-HIV antibodies in patients' sera. In this case, a defined mixture of HIV proteins is separated by SDSPAGEand blotted onto a membrane, and the membrane is incubated with dilutions of the test serum. The blot is then probed with a second labeled antihuman Ig to detect the presence of HIV-specific antibodies that were in the serum and bound to the HIV proteins. The technique of transferring proteins from a gel to a membrane is called Western blotting as a biochemist's joke. Southern is the last name of the scientist who first blotted DNA from a separating gel to a membrane, a technique since called Southern blotting. By analogy, Northern blotting was applied to the technique of transferring RNA from a gel to a membrane, andWestern blotting was applied to protein transfer.
Labeling and Detection Gells and Tissues
of Antigens
in
Antibodies specific for antigens expressedon or in particular cell rypes are commonly used to identifu these cells in tissues or cell suspensions and to separate these cells from mixed populations. In these methods, the antibody can be radiolabeled, enzyme linked, o! most commonly, fluorescently labeled, and a detection system is used that can identify the bound antibody. Antibodies attached to magnetic beads can be used to physically isolate cells expressingspecific antigens.
FIow Cytometry Cell Sorting
and Fluorescence-Activated
The tissue lineage, maturation stage,or activation status of a cell can often be determined by analyzing the cell surface or intracellular expression of different molecules.This technique is commonly done by staining the cellwith fluorescentlylabeled probes that are speciflc for those molecules and measuring the quantity of fluorescence emitted by the cell (Fig.A-4). The flow cytometer is a specialized instrument that can detect fluorescence on individual cells in a suspension and thereby determine the number of cells expressing the molecule to which a fluorescent probe binds. Suspensionsof cells are incubated with fluorescently labeled probes, and the amount of probe bound by each cell in the population is measured by passing the cells one at a time through a fluorimeter with a laser-generated incident beam. The relative amounts of a particular molecule on different cell populations can be compared by staining each pop-
l N I M M U N 0 L 0 G Yq SED LY A p p e n d li lxl - L A B 0 R A T 0TREYC H N I O UCEOSM M O NU
Mixtureof
T :e I
rtectropnoretic
q.S migration
&s0^ n
Denatureoroteins in the oresenceof SDS and applyto gel
Powersupply
lw
|7
)
Cathode(-)
Filterpaper/ cathodebuffer Membrane Gelwith separated proteins Filterpaper/ anodebuffer
to membrane transferof proteins @ etectropnoretic X-rayfilm
blot Antibody-labeled
Membrane
FIGURE A-3 Chalacterizationol antigens by Western blotting. Proteinantigens, separatedby sodium dodecyl gel elecsulfate (SDS)-polyacrylamide trophoresisand transferredto a memor brane.can be labeledwith radioactive (notshown)enzyme-coupled antibodles, Analysisof an antigenby Westernblotting providesinformationsimilarto that folobtainedfrom immunoprecipitatron lowed by polyacrylamidegel elecwork only trophoresisSome antibodies ln one or the othertechnique
Autoradiography
v\ proteinsin mem f4) - t-aoet antibod radioiodinated for antigenof specific
ulation with the same probe and determining the amount of fluorescence emitted. In preparation for flow cytometric analysis, cell suspensions are stained with the fluorescent probes of choice. Most often, these probes are fluorochrome-labeled antibodies specific for a cell surface molecule. Alternatively, cytoplasmic molecules can be stained by temporarily permeabilizing cells
sing (t)
Use labeledmembrane to exposex-rayfilm (autoradiogram)
and permitting the labeled antibodies to enter through the plasma membrane. In addition to antibodies, various fluorescent indicators of cytoplasmic ion concentrations and reduction-oxidation potential can be detected by flow cytometry. Cell cycle studies can be performed by flow cltometric analysis of cells stained with fluorescent DNA-binding probes such as propidium
529
A p p e n d li lxl - L A B 0 R A T 0TREYC H N T 0 U CE0S M M O N LUYS E D tNtMMUNOL0GY
ttO '_.
Nozzle
Mixedpopulation of cellslabeledwith f luorescent antibodies 1( )and2(>C)
Laser
ichroicfilter
Forward scattter detector
!:
Sidescatter detector
Dichroicfilter Fluorescence Photomultiplier tube-Fluor 1 detector
Parallelplates to deflect flowingcells
Analyzer controlscharge on platesto varydeflection
Dichroic filter Fluorescence Photomultiplier tube-Fluor 2 detector
lr9
I It I
,l^,I
Computer display FIG rincipleof-flowcytometryand fluorescence-activated cell sorting.The incidentlaserbeamis of a designated wavelength, and emergesfrom the sampleis analyzed for forwardand sidescatteias well as fluorescentlightof two or more wavelengths that he fluorochromelabelsattachedto the antibodies. The separation depictedhere is based'ontwo antrgenrc markersltwocolorsort ng) Moderninstruments can routinelyanalyze andseparatecellpopulations on the basisof threeor moTediffeientcoloredprobes
USEDlN IMMUN0L0GY C0MM0NLY TECHNI0UES lll - LAB0RAT0RY Aopendix
iodide. Apoptotic cells can be identified using fluorescent probes, such as AnnexinV that bind to abnormally exposed phospholipids on the surface of the dying cells. Modern flow c1'tometers can routinely detect three or more different-colored fluorescent signals, each attached to a different antibody or other probe. This technique permits simultaneous analysis of the expression of many different combinations of molecules by a cell. In addition to detecting fluorescent signals, flow cytometers also measure the forward and side lightscattering properties of cells, which reflect cell size and internal complexity, respectively. This information is often used to distinguish different cell types. For example, compared with lyrnphocytes, neutrophils cause greater side scatter because of their cltoplasmic granules, and monocytes cause greater forward scatter because of their size. Purification
of Cells
A fluorescent-activated cell sorter (FACS)is an adaptation of the flow cyotmeter that allows one to separate cell populations according to which and how much fluorescent probe they bind. This technique is accomplished by differentially deflecting the cells with electromagnetic fields whose strength and direction are varied according to the measured intensity of the fluorescent signal (Fig. A-4). The cells may be labeled with fluorescently tagged antibodies exvivo, or, in the case of experimental animal studies,labeling may be accomplished in vivo by expression of transgenes that encode fluorescent proteins, such as green fluorescent protein (GFP). (Transgenic technology is described later in this appendix.) Another commonly used technique to purify cells with a particular phenoqpe relies on antibodies that are attached to magnetic beads. These "immunomagnetic reagents" will bind to certain cells, depending on the specificity of the antibody used, and the bound cells can then be pulled out of suspension using a strong magnet. lmmunofluorescence and Immunohistochemistry Antibodies can be used to identifr the anatomic distribution of an antigen within a tissue or within compartments of a cell. To do so, the tissue or cell is incubated with an antibody that is labeled with a fluorochrome or enzyme, and the position of the label, determined with a suitable microscope, is used to infer the position of the antigen. In the earliest version of this method, called immunofluorescence, the antibody was labeled with a fluorescent dye and allowed to bind to a monolayer of cells or to a frozen section of a tissue.The stained cells or tissues were examined with a fluorescence microscope to locate the antibody. Although sensitive, the fluorescencemicroscope is not an ideal tool for identifying the detailed structures of the cell or tissue because of a low signal-to-noise ratio. This problem has been overcome by new technologies including confocal microscopy, which uses optical sectioning technology to filter out unfocused fluorescent light,
and two-photon microscopy, which prevents outof-focus light from forming. Alternatively, antibodies may be coupledto enzymesthat convertcolorlesssubstratesto coloredinsolublesubstancesthat precipitate at the position of the enzyme. A conventional light microscopemay then be usedto localizethe antibody in a stainedcell or tissue.The most commonvariantof this method uses the enzymehorseradishperoxidase,and the method is commonly referredto asthe immunoperoxidasetechnique.Another commonlyused enzymeis alkaline phosphatase.Different antibodiescoupled to different enzymes may be used in conjunction to
a technique called immunoelectron microscopy. Different-sizedgold particleshavebeenusedfor simultaneous localization of different antigens at the ultrastructural level. In all immunomicroscopicmethods,signalsmay be enhancedby use of sandwichtechniques'For example, insteadof attachinghorseradishperoxidaseto a specific mouse antibody directed againstthe antigen of interest, it can be attachedto a secondanti-antibody(e.g.,rabbit antimouse Ig antibody) that is used to bind to the first, unlabeled antibody.\{hen the label is attacheddirectly to the specific,primary antibody,the method is referred to asdirect;when the labelis attachedto a secondaryor eventertiary antibody,the method is indirect.In some cases,moleculesother than antibody can be used in indirect methods.For example,staphylococcalprotein A, which binds to IgG, or avidin, which binds to primary antibodieslabeledwith biotin, can be coupledto fluorochromesor enzymes. Measurement of Antigen-AntibodY lnteractions In many situations,it is important to know the affinity of an antibody for an antigen.For example,the usefulness of a monoclonalantibodyas an experimentalor thera-
celluloseand immersed in a solution containing the antigen. (Semipermeablein this context means that small molecules, such as antigen, can pass freely through the membraneporesbut that macromolecules, such as antibody, cannot.) If no antibody is present within the membrane-boundcompartment,the antigen in the bathing solution entersuntil the concentrationof antigen within the membrane-bound compartment becomesexactlythe sameas that outside.Anotherway to view the system is that at dynamic equilibrium' antigen entersand leavesthe membrane-boundcompartment at exactlythe samerate. However,when antibody is presentinsidethe membrane,the net amountof
532
Appendix lll - LAB0RATORY TECHNT0UES C0Mtvl0NLy USEDtN tMMUN0L0Gy
Dialysis membrane
Free antibody
Antigen molecules
Antibody with bound antigen
Antigen alone
Antigen+ antibody
Analysisof antigen-antibody bindingby equilib(B),theamount n thepresence of antibody of antlgen lysismembrane is increased compared with the (A) As described absence of antibody in the text,thisdifference, c a u s ebdya n t i b o dbyi n d r nogf a n t i g e n , nb e u s e dt o m e a s u rt eh e ca affinityof theantibody for theantigenThisexperimenr canbe perf o r m e do n l yw h e nt h ea n t i g eins a s m a lm l o l e c u l(ee . g .a, n a p r e n l c a p a b loef f r e e l yc r o s s i nt g h ed i a l y s m isembrane.
antigen inside the membrane at equilibrium increases by the quantity that is bound to anribody. This phenomenon occurs because only unbound antigen can diffuse across the membrane, and at equilibrium, it is the unbound concentration of antigen that must be identical inside and outside the membrane. The extent of the increase in antigen inside the membrane depends on the antigen concentration, on the antibody concentration, and on the dissociation constant (I(J of the binding interaction. By measuring the antigen and antibody concentrations, by spectroscopy or by other means, K6 can be calculated. _ An alternative way to determine K4 is by measuring the rates of antigen-antibody complex formation and dissociation. These rates depend, in part, on the concentrations of antibody and antigen and on the affinity of the interaction. All parameters except the concentrations can be summarized as rate constants, and both the on-rate constant (KJ and the off-rate constant (K"x) can be calculated experimentally by determining the concentrations and the actual rates ofassociation or dissociation, respectively.The ratio of K"6/Ie" allows one to cancel out all the parameters not related to affinity and is exactly equal to the dissociation constant IG. Thus, one can measure IQ at equilibrium by equilibrium dialysis or calculate IQ from rate constants measured under nonequilibrium conditions.
TRRruscTruIc MIcEANDTARGETED
Gerur Kruocxours
TWo important methods for studying the functional effects of specific gene products in vivo are the creation of transgenic mice that overexpressa particular gene in a defined tissue and the creation of gene knockout mice, in which a targeted disruption is used to ablate the func-
tion of a particular gene. Both techniques have been widely used to analyze many biologic phenomena, including the maturation, activation, and tolerance of lymphoc).tes. To create transgenic mice, foreign DNA sequences, called transgenes, are introduced into the pronuclei of fertilized mouse eggs, and the eggs are implanted into the oviducts of pseudopregnant females.Usually,if a few hundred copies of a gene are injected into pronuclei, abouL25Toof the mice that are born are transgenic. One to 50 copies of the transgene insert in tandem into a random site of breakage in a chromosome and are subsequently inherited as a simple mendelian trait. Because integration usually occurs before DNA replication, most (about 75To)of the transgenic pups carry the transgene in all their cells,including germ cells.In most cases,integration of the foreign DNA does not disrupt endogenous gene function. Also, each founder mouse carrying the transgene is a heterozygote, from which homozygous lines can be bred. The great value of transgenic technology is that it can be used to expressgenes in particular tissues by attaching coding sequences of the gene to regulatory sequences that normally drive the expression of genes selectively in that tissue. For instance, lymphoid promoters and enhancers can be used to overexpressgenes, such as rearranged antigen receptor genes, in lymphoc1tes, and the insulin promoter can be used to express genes in the B cells of pancreatic islets. Examples of the utility of these methods for studying the immune system are mentioned in many chapters of this book. Transgenes can also be expressedunder the control of promoter elements that respond to drugs or hormones, such as tetracycline or estrogens. In these cases,transcription of the transgene can be controlled at will by administration of the inducing agent. A powerful method for developing animal models of single-gene disorders, and the most definitive way of establishing the obligatory function of a gene in vivo, is the creation of knockout mice by targeted mutation or disruption of the gene. This technique relies on the phenomenon of homologous recombination. If an exogenous gene is inserted into a cell, for instance, by electroporation, it can integrate randomly into the cell's genome. However, if the gene contains sequences that are homologous to an endogenous gene, it will preferentially recombine with and replace endogenous sequences. To select for cells that have undergone homologous recombination, a drug-based selection strategyis used. The fragment of homologous DNA to be inserted into a cell is placed in a vector tlpically containing a neomycin resistance gene and a viral thymidine kinase (tk) gene (Fig.A-6A). This targeting vector is constructed in such a way that the neomycin resistance gene is always inserted into the chromosomal DNA, but the fk gene is lost whenever homologous recombination (as opposed to random insertion) occurs. The vector is introduced into cells, and the cells are grown in neomycin and ganciclovir, a drug that is metabolized by thymidine kinase to generate a lethal product. Cells in which the gene is integrated randomly will be resistant
lllAppendix
USEDlN IMMUN0L0GY C0MM0NLY TECHNI0UES LAB0RAT0RY
heterozygous disruption or mutation, that is, some of the tissues witl be derived from the ES cells and others from the remainder of the normal blastocyst. The germ cells are also usually chimeric, but because these cells are haploid, only some will contain the chromosome copy with the disrupted (mutated) gene. If chimeric mice are mated with normal (wild-type) animals and either sperm or eggs containing the chromosome with the mutation fuse with the wild-type partner, all cells in the offspring derived from such a zygote will be heterozygous for the mutation (so-called germline transmission). Such heterozygousmice can be mated to yield animals that will be homozygous for the mutation with a frequency that is predictable by simple mendelian segregation. Such knockout mice are deflcient in expression
to neomycin but will be killed by ganciclovir, whereas cells in which homologous recombination has occurred will be resistant to both drugs because the rk gene will not be incorporated. This positive-negative selection ensures that the inserted gene in surviving cells has undergone homologous recombination with endogenous sequences.The presenceof the inserted DNA in the middle of an endogenous gene usually disrupts the coding sequencesand ablates expression or function of that gene. In addition, targeting vectors can be designed such that homologous recombination will lead to the deletion of one or more exons of the endogenous gene. To generate a mouse carrying a targeted gene disruption or mutation, a targeting vector is used to first disrupt the gene in a murine embryonic stem (ES) cell line. ES cells are pluripotent cells derived from mouse embryos that can be propagated and induced to differentiate in culture or that can be incorporated into a mouse blastocyst,which maybe implanted in a pseudopregnant mother and carried to term. Importantly, the progeny of the ES cells develop normally into mature tissues that will express the exogenous genes that have been transfected into the ES cells. Thus, the targeting vector designed to disrupt a particular gene is inserted into ES cells, and colonies in which homologous recombination has occurred (on one chromosome) ate selectedwith drugs, as described before (Fig.A-68). The presence of the desired recombination is verified by analysis of DNA with techniques such as Southern blot hybridization or PCR.The selected ES cells are injected into blastocysts,which are implanted into pseudopregnant females. Mice that develop will be chimeric for a
site in the genome rather than in a random site as in conventional transgenic mice. This strategy is used when it is desirable to have the expression ofthe transgene reg-
recombination. Although the conventional gene-targeting strategy has proved to be of great usefulness in immunology iesearch, the approach has some potentially significant
vector Targeting i I I
Nonhomologous recombination
GeneX in EScell Fr-jaroet*-rg"t"dg"";-lH linsertion I W
Mutationin geneX; ES cell resistantto neomycin to ganciclovir and insensitive
Fandoml I I insertion
in ES cell oene Unrelated -
H v@
No mutationin geneX; ES cell resistantto neomYcin and sensitiveto ganciclovir
(ES)cell is accomplished by hom-ologous FIGSRE A-6 Generationof gene knockout.A The disruptionof gene X in an embryonicstem to two exonsof gene X with'a targeti;gvectorthat containssequenceshomologous oiES cellsis transfected recombinationA population or disruptsone of the exonsof gene X on homologousrecombination flankinga neomycinresistance(neo)gene The neo gene replaCes occurs' recombination The thimidine kinase/tkl gene in the"vectorwill be iiserted into the genomeonly if random,nonhomologous
534
i
Appendix lll - LAB0RAT0RY rEcHNtOuES COMMoNLy usEDtNtMMUN0L0GY
Transfecttargeting construct intoEScells frommousewith ES cellswith dominant coatcolor targetedgene Neomycin treatment (positive selection)
Ganciclovir treatment (negative selection)
inseftion
&
ES cells withno gene insertion ES cellswith randomgene inseftion
&
@o
$ InjectES cellswith targetedmutation intomouseblastocyst
@) \v_vl
$
Chooseoffsprino with chimericcbatdolor partlyderivedfrom ES cellsandbreed to achievegermline transmission
drawbacks. First, the mutation of one gene during development may be compensated for by altered expression of other gene products, and therefore the function of the targeted gene may be obscured. Second, in a conventional gene knockout mouse, the importance of a gene in only one tissue or at only one time during development cannot be easily assessed.Third, a functional selection marker gene, such as the neomycin resistance gene, is permanently introduced into the animal genome, and this alteration may have unpredictable results on the phenotype of the animal. An important refinement of gene knockout technology that can overcome many of these drawbacks takes advantage of the bacteriophage-derived CreI loxP recombination system. The Cre enz).rneis a DNA recombinase that recognizes
FIGURE ACont'd B The ES cells that were transfectedby the targetingvector are selectedby neomycrnand ganciclovir so that onlythosecellswith targeted insertron (homologous recombination) survive.Thesecellsarethen injectedinto a blastocvst, which is then implantedinto the uterusof a pseudopregnantmouse. A chimericmouse will developin whichsome of the tissuesarederivedf rom the EScell carryingthe targeted mutation in gene X These chimericmice are identifiedby a mixed-colorcoat, includingthe colorof the mousestrainfrom whichthe EScellswere derivedandthe colorof the mousestrairr from whichthe blastocyst was derived lf the mutation is presentin germcells,it can be propagated by further breedinq.
a 34-bp sequence motif called loxp and the enz\nne mediates the deletion of gene segments flanked by'two /oxPsites in the same orientation. To generatemice with loxP-tagged genes, targeting vectors are constructed with one IoxP site flanking the neomycin resistance gene at one end and a second loxP site flanking the sequences homologous to the target at the other end. These vectors are transfected into ES cells, and mice carrying the loxpflanked but still functional target gene are generated as described for conventional knockout mice. A second strain of mice carrying a cre transgene is then bred with the strain carrying ttre loxP-flanked target gene. In the offspring, expression of Cre recombinase will mediate deletion of the target gene. Both the normal gene sequences and the neomycin resistance gene will be
lN IMMUNOLOGY USED COMM0NLY TECHNI0UES Appendix lll - LAB0RATORY
deleted. Importantly, expressionof the cre gene, and thereforedeletionofthe targetedgene,can be restricted to certain tissuesor specifiedtimes by the use of cre transgene constructs with different promoters. For example,selectivedeletion of a gene only in helper T cells can be accomplishedby using a cre transgenic mouse in which creis driven by a CD4 promoter. Alternatively,a steroid-induciblepromoter can be used so that Creexpressionand subsequentgenedeletionoccur only after mice are given a dose of dexamethasone. Many other variations on this technologyhave been devisedto createconditional mutants. CrelloxP technologycan alsobe usedto createknock-in mice.In this case,loxPsitesareplacedin the targetingvectortoflank the neomycin resistancegene and the homologous sequences,but they do not flank the replacement (knock-in) gene sequences. Therefore, after cremediateddeletion,the exogenousgeneremainsin the genomeat the targetedsite.
T Lyrvrpnocvrr MrrnoosFoR SruDyrNG Rrsporusrs Our current knowledge of the cellular events in T cell activationis basedon a variety of experimentaltechniques in which different populations of T cells are activated by defined stimuli and functional responsesare measured.In vitro experimentshave provided a great dealof informationon the changesthat occurin a T cell when it is stimulated by antigen. More recently,several techniqueshavebeendevelopedto studyT cell proliferation,cltokine expression,and anatomicredistribution in responseto antigenactivationin vivo.The new experhavebeenparticularlyusefulfor the imentalapproaches study of naive T cell activation and the localization of antigen-specificmemory T cells after an immune responsehaswaned. Polyclonal Activation of T Cells Polyclonal actiuators of T cells bind to many or all TCR complexesregardlessof specificity and activate the T cells in ways similar to peptide-MHc complexeson APCs.Polyclonalactivatorsare mostly used in vitro to activateT cellsisolatedfrom human blood or the lymphoid tissuesof experimentalanimals.Polyclonalactivators can alsobe used to activateT cellswith unknourn antigen specificities,and they can evoke a detectable responsefrom mixed populationsof naiveT cells,even though the frequency of cells specific for any one antigenwould be too low to elicit a detectableresponse. Thepollnnericplant proteinscalledlectins,suchasconcanavalin-A (Con-A) and phytohemagglutinin (PHA), are one commonlyusedgroup of polyclonalT cell activator.Lectinsbind specificallyto certainsugarresidues on T cell surfaceglycoproteins,including the TCR and CD3 proteins,and therebystimulatethe T cells.Antibodiesspecificfor invariantframeworkepitopeson TCR or CD3proteinsalsofunction aspolyclonalactivatorsof
T cells. Often, these antibodies need to be immobilized on solid surfaces or beads or cross-linked with second-
polyclonal stimulus, bind to and activate all T cells that expressparticular types ofTCR p chain (seeChapter 15, gox tS-Z). T cells of any antigen speciflcity can also be stimulated with pharmacologic reagents, such as the combination of the phorbol ester PMA and the calcium ionophore ionomycin, that mimic signals generated by the TCR complex. Antigen-lnduced Cell Populations
Activation
of Polyclonal
T
Polyclonal populations of normal T cells that are enriched for T cells specific for a particular antigen can be derived from the blood and peripheral lymphoid organs of indMduals after immunization with the serves to expand the antigen. The immunization number of antigen-specific T cells, which can then be restimulated in vitro by adding antigen and MHCmatched APCs to the T cells.This approach can be used to study antigen-induced activation of a mixed population of previously activated ("primed") T cells expressing many different TCRs, but the method does not permit analysis of responsesof naive T cells. of T Cell Activation Antigen-lnduced Populations with a Single Antigen Specificity Monoclonal populations of T cells, which express identical TCRs,have been useful for functional, biochemical, and molecular analyses.The limitation of these monoclonal populations is that they are maintained as longterm tissue culture lines and therefore may have phenot)?ically diverged from normal T cells in vivo. One type of monoclonal T cell population that is frequently used in experimental immunologyis an antigen-specific T cell clone. Such clones are derived by isolating T cells from immunized individuals, as described for polyclonal T cells, followed by repetitive in vitro stimulation with the immunizing antigen plus MHC-matched APCs and cloning of single antigen-responsive cells in semisolid media or in liquid media by limiting dilution. Antigenspecific responsescan easily be measured in these populations because all the cells in a cloned cell line have the same receptors and have been selected for growth in response to a knornm antigen-MHC complex. Both helper and CTL clones have been established from mice and humans. Other monoclonal T cell populations used in the study of T cell activation include antigen-specific T cell hybridomas, which are produced like B cell hybridomas (see Box 3-1, Chapter 3), and tumor lines dirived from T cells have been established in vitro after removal of malignant T cells from animals or humans
536
1
A p p e n d li lxl -
LABORATO YHNTOU TR EC S M 0 N LUYS E D CE 0M tNtMMUNOL0GY
with T cell leukemias or lymphomas. Although some tumor-derived lines expressfunctional TCR complexes, their antigen specificities are not known, and the cells are usually stimulated with polyclonal activators for experimental purposes. The Iurkat line, derived from a human T cell leukemia cell, is an example of a tumor Iine that is widely used as a model to study T cell signal transduction. TCR transgenic mice are a source of homogeneous, phenotypically normal T cells with identical antigen specificities that are widely used for in vitro and in vivo experimental analyses.If the rearranged cr and B chain genes of a single TCR of knorrynspecificity are expressed as a transgene in mice, a majority of the mature T cells in the mice will expressthat TCR. If the TCR transgene is crossed onto a RAG-1- or MG-2-deficient background, no endogenous TCR gene expression occurs and 100% of the T cells will express only the transgenic TCR. TCR transgenic T cells can be activated in vitro or in vivo with a single peptide antigen, and they can be identified by antibodies specific for the transgenic TCR. One of the unique advantages of TCR transgenic mice is that they permit the isolation of sufficient numbers of naive T cells of defined specificity to allow one to study functional responses to the first exposure to antigen. This advantage has allowed investigators to study the in vitro conditions under which antigen activation of naive T cells leads to differentiation into functional subsets such as Tsl and Tg2 cells (see Chapter l2). Naive T cells from TCR transgenic mice can also be injected into normal syngeneic recipient mice, where they home to lymphoid tissues. The recipient mouse is then exposed to the antigen for which the transgenic TCR is specific. By use of antibodies that label the TCR transgenic T cells, it is possible to follow their expansion and differentiation in uiuo and to isolate them for analyzing recall (secondary) responsesto antigen ex vivo.
Methods to Enumerate and Study Functional Responses of T Cells Proliferation essays for T lyrnphocytes, Iike that of other cells, are conducted in uitro by determining the amount of 3H-labeled thymidine incorporated into the replicating DNA of cultured cells.Th]..rnidineincorporation provides a quantitative measure of the rate of DNA syrrthesis,which is usually directly proportional to the rate of cell division. Cellular proliferation in vivo can be measured by injecting the thymidine analogue bromodeoxyrrridine (BrdU) into animals and staining cells with anti-BrdU antibody to identify and enumerate nuclei that have incorporated BrdU into their DNA during DNA replication. Fluorescent dyes can be used to study proliferation of
of this tlpe is S,6-carboxyfluoresceindiacetate succinimidyl ester (CFSE),which can be detected in cells by standard flow cytometric techniques. Every time a T cell divides, its dye content is halved, and therefore it is possible to determine whether the adoptively transferred T cells present in ll.rnphoid tissues of the recipient mouse have divided in vivo and to estimate the number of doublings each T cell has gone through. Peptide-MHC tetramers are used to enumerate T cells with a single antigen specificity isolated from blood or lymphoid tissues of experimental animals or humans. These tetramers contain four of the peptide-MHC complexes that the T cell would normally recognize on the surface of APCs. The tetramer is made by producing a class I MHC molecule to which is attached a small molecule called biotin by use of recombinant DNA technology. Biotin binds with high affinity to a protein called avidin, and each avidin molecule binds four biotin molecules. Thus, avidin forms a substrate for assembling four biotin-conjugated MHC proteins. The MHC molecules can be loaded with a peptide of interest and thus stabilized, and the avidin molecule is labeled with a fluorochrome, such as FITC. This tetramer binds to T cells speciflc for the peptide-MHC complex with high enough avidity to label the T cells even in suspension. This method is the only feasible approach for identifuing antigen-specific T cells in humans. For instance, it is possible to identify and enumerate circulating HLAA2-restricted T cells specific for an HIV peptide by staining blood cells with a tetramer of H[A-A2 molecules Ioaded with the peptide. The same technique is being used to enumerate and isolate T cells specific for self antigens in normal individuals and in patients with autoimmune diseases. Peptide-MHC tetramers that bind to a particular transgenic TCR can also be used to quantiff the transgenic T cells in different tissues after adoptive transfer and antigen stimulation. The technique is nowwidely used with classI MHC molecules; in class I molecules, only one polypeptide is polymorphic, and stable molecules can be produced in vitro. This is more difficult for classII molecules, becauseboth chains are polymorphic and required for proper assembly,but class Il-peptide tetramers are also being produced. Cytokine secretion assays can be used to quantify cltokine-secreting effector T cells within lymphoid tissues. The most commonly used methods are cytoplasmic staining of cy'tokines and single-cell enzyrnelinked immunosorbent assays(ELISPOT).In these tlpes of studies, antigen-induced activation and differentiation of T cells take place in vivo, and then T cells are isolated and tested for cytokine expression in vitro. Cytoplasmic staining of cltokines requires permeabilizing the cells so that fluorochrome-labeled antibodies specific for a particular cytokine can gain entry into the cell, and the stained cells are analyzed by flow c)'tometry. Cytokine expression by T cells ipecifit for a particular antigen can be determined by additionally staining T cells with peptide-MHC tetramers or, in the caseof TCRtransgenic T cells, antibodies specific for the transgenic TCR. By use of a combination of CFSEand anticytokine
lll Appendix
antibodies, it is possible to examine the relationship between cell division and cltokine expression. In the ELISPOT assay,T cells freshly isolated from blood or lymphoid tissues are cultured in plastic wells coated with antibody specific for a particular cytokine. As cytokines are secreted from individual T cells, they bind to the antibodies in discrete spots corresponding to the location of individual T cells.The spots are visualized by adding secondary enzyme-linked anti-immunoglobulin, as in a standard ELISA (see Appendix III), and the number of spots is counted to determine the number of cytokine-secreting T cells.
B LvtrrtpHocvrr MrrHoos FoR SruDyrNc Rrporusrs Activation
of Polyclonal
B Gell Populations
It is technically difficult to study the effects of antigens on normal B cells because, as the clonal selection hypothesis predicted, very few lymphocytes in an individual are specific for any one antigen. An approach to circumventing this problem is to use anti-Ig antibodies as analoguesof antigens,with the assumption that antiIgwill bind to constant (C) regions of membrane Ig molecules on all B cells and will have the same biologic effects as an antigen that binds to the hypervariable regions of membrane Ig molecules on only the antigenspecific B cells. To the extent that precise comparisons are feasible, this assumption appears generally correct, indicating that anti-Ig antibody is a valid model for antigens.Thus, anti-Ig antibody is frequently used as a polyclonal activator of B lymphocltes, similar to the use of anti- CD3 antibodies as polyclonal activators of T lymphocltes discussed earlier.
USEDlN IMMUN0L0GY C0MM0NLY TECHNI0UES LAB0RAT0RY
Assays to Measure B Cell Proliferation Antibody Production
and
Much of our knowledge of B cell activation is based on in vitro experiments, in which different stimuli are used to activate B cells and their proliferation and differentiation can be measured accurately.The same assaysmay be done with B cells recoveredfrom mice exposedto different antigens or with homogeneous B cells expressing transgene-encoded antigen receptors. B cell proliferation is measured using 3H-labeled thymidine incorporation in vitro and BrdU labeling in vivo, a described for T cell proliferation, above. Antibody production is measured in two different ways: with assays for cumulative Ig secretion, which measure the amount of Ig that accumulates in the supernatant of cultured lymphocytes or in the serum of an immunized individuat andwith single-cell assays,which determine the number of cells in an immune population that secrete Ig of a particular specificity or isotype. The most accurate, quantitative, and widely used techniques for measuring the total amount of Ig in a culture supernatant or serum sample is ELISA. By use of antigens bound to solid supports, it is possible to use ELISA to quantify the amount of antibody in a sample specific for a particular antigen. In addition, the availability of antiIg antibodies that detect Igs of different heavy or light c-hain classes allows measurement of the quantities of
bound to cells, and this is reflected in the degree of cell
of B Gell Activation Antigen-lnduced Populations with a Single AntigenSpecificity To examine the effects of antigen binding to B cells, investigators have attempted to isolate antigen-specific B cells from complex populations of normal lymphocltes or to produce cloned B cell lines with deflned antigenic specificities. These efforts have met with little success.However, transgenic mice have been developed in which virtually all B cells express a transgenic Ig of knor.vn specificity, so that most of the B cells in these mice respond to the same antigen. A somewhat more sophisticated approach has been to generate antigen receptor knockin mice, in which rearranged Ig H and L chain genes have been homologously recombined into their endogenous loci. Such knockin animals have proved particularly useful in the examination of receptor editing.
antibodies that have been secreted and are bound to the
immune response.
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Note: Pagenumbers fbllowed by f indicate flgures;those followedby t indicate tables;and those followed by b indicate boxed material A ABO antigens,384,386b,489 in blood transfusion,392,393 ABO blood typing, 389,390b Acceleratedacute rejection allograft,384 xenograft,392 Acceleratedgraft arteriosclerosis, 384f, 387 Accessory molecules,ofT cells,I38, I38f, 1 4 5 1 4 8 ,1 4 5 f 1 4 7 f , 4 8 9 Acquired immunity. SeeAdaptive immunity. Acquiredimmunodeficiency,475-476, 475r AIDS as (SeeAcquired immunodeficiency syndrome (ArDS)) defined,463,4Bg Acquired immunodeficiency syndrome (ArDS),476-487 clinical featuresof, 484-485,4B4t defined,489 epidemiologyof, 476,484 immune evasionby, 365,366b immune responsesto, 481f,482f, 485-486 molecular and biologic featuresof, 476-481,477f-480f pathogenesisof, 481-484,481f,4B2f Pneumocystisjiroueci pneumonia with, 362 progression of, 481-482, 481f, 482f transmissionof, 484 treatment and preventionof, 486-487 Acquired immunodeficiency syndrome (AIDS)encephalopathy,485 Activation-inducedcell death, 253 Activation-induceddeaminase(AID),227, 230-231, 233, 233f mutationsin,47Lf,472 Activationprotein-I (AP-1),26,489 i n i r n m e d i a th e y p e r s e n s i t i v i 4r y4,9 in macrophageactivation,312 in'I cell activation,208f,209 Active immuniry, 7, 9f, 489 Acute lymphoblasticleukemia (ALL), chromosomaltranslocationsin, 166b, l67b Acute myelogenousleukemia, chromosomaltranslocationsin, 167b Acute myeloid leukemia,chromosomal translocationsin, l67b Acute-phasereactants,43, 356b,4Bg Acute-phaseresponse,489 Acute pre-T cell leukemia,chromosomal translocationsin, I67b Acute rejection,384-386,384f,385f,4Bg
Acute vascularrejection,392 ADA (adenosinedeaminase)deficiency, 468-469,46Br ADAM33, in immediate hypersensitivity, 456r Adapter proteins,in'f cell activation,203f, 205,489 Adaptiveimmune response(s) cardinalfeaturesof, 9-11, 10f, 10t to HIV infection, 485 overview of, 4Bf phasesof, 13-I6, 14f,15f stimulation by innate immunity of, 19, 44 45,45f to tumors,407-408,40Bf types of, 6-9, 8f, 9f Adaptiveimmune system,4-6, 5f, 5t, bone marrowin, 57 58,57f c e l l so f , I I 1 3 .l 2 i , 4 8 - 5 t i antigen-presenting,56 cutaneous,62-63,63f cytokine(s) of, 2701,289-298, 2901 APRILas,297 BAFFas,297 interferon-yas, 290r,294-296,295f interleukin-2 as,289-292,290t, 291f, 292f interleukin-4 as, 290t, 292-293, 293f interleukin-Sas,2901,293 interleukin-13as,2901,293-294 interleukin-16as,297 interleukin-17as,290t,296-297 interleukin-21as,297 interleukin-25as,297 lymphotoxin as,290t,296 migration inhibition factor as,297 transforminggrowth factor-Bas,2901, 296 evolution of, 6b-7b Iymph nodes and lymphatic systemin, 58-61,59f-6If lymphocyesin,49-56 activationof, 52, 53f d e v e l o p m e notf , 5 l - 5 2 .5 2 f effector, 47-48, 54r, 55, 55f by history of antigen exposure,52-56, 53f, 54t, 55f homing of, 64, 69-70 memory,47 48,54I, 55-56 naive,47,52-55,54t recirculationof, 64-68,65f-67f subsetsof, 49-50,50t, 5lb lymphoid tissuesof, 56-63 mucosal,63-64,64f specificityof, 20t spleenin, 6l-62,62f thymus in, 58, 5Bf
Adaptive immunity to bacteria extracellular,354,355f intracellular,358-362,35Sf defined,489 to fungi, 353t,362 to parasites,367-368,3S7t,369b to viruses,363-364,363f ADCC (antibody-dependent cellmediated cyrotoxicitg, 398-329, 399f, 491 in HiV inf'ection,483 Addressins,65, 66, 489 Adenosine deaminase (ADA) defi cieney' 468-469,46Bt Adenoviruses immune evasionby, 366b 405 and malignancy, Adhesionmolecules,138'490 tumor necrosisfactor and,274 Adjuvants, 45, 117, 490 in autoimmunity, 436-437, 437f in T cell activation,195 in vaccines,372 Adoptive cellular immunotherapy, for tumors, 414,4I4f Adoptive transfer, B, 9f, 453, 490 Adult respiratory distresssyndrome (ARDS),3s6b Adult T cell leukemia/lymphoma (ATL), 405,476 Affinity, of antibody, 91, 490 Affi nity chromato graPhY,527f , 528 Affinity maturation in antigenrecognition,93, 94f defined,93, 490 in humoral immune response,216*217, 21,6t somatic mutations and, 232-234,234f, 235f AFP (o-fetoProtein),406 Agammaglobulinemia,X-linked (Bruton's),17l, 202b,464,470-47l, 470t,517-51.8 AID (activation-induced deaminase),227, 230-23r, 233,233f mutationsin,471f,472 AIDS.SeeAcquired immunodeficiency syndrome (AIDS) AIRE (autoimmune regulator) gene, in autoimmune PolYendocrine slmdrome, 248, 435, 436t, 491-492 AIRE (autoimmune regulator)protein, 184-185,246,497-492 Akt, 200 Albumins, B0
539
ALL (acute ly.rnphoblasticleukemia), chromosomaltranslocationsin. 166b. lb/D
Allele,98, 490 Allelic exclusion,177,247b,490 Allergens,442, 442f, 443, 456, 490 Allergic conjunctivitis, 458 Allergicdiseases hallmarks of, 442 in humans, 456-459,457f,458f immunotherapy for, 458 Allergic reactions, clinical and pathologic manifestations of, 442-443 Allergic rhinitis, 443, 458 Allergy(ies) defined, 44I,490 food, 443,458-459 Alloantibodies,l0l. 490 againstforeign MHC molecules,382 Alloantigens,l0l, 377,386b,490 recognitionol 377-381,377f-379f direct, 378-380,378f,379f, 496 indirect, 378f,380-381,502 Alloantisera, l0l,490 Allogeneicfetus,immune responsesto, 382,383b Allogeneic graft. SeeAllograft (s). Allogeneic strains, 98 Allogeneictransplantation,377-39I donor-recipientcompatibility in, 389-391,390b.39lf immunology of,377-382 activationof alloreactiveT cellsin, 380,381-382.382f recognitionof alloantigensin, 377-38t, 377f-379f screeningfor preformed antibodiesin, 389,390b Allograft(s) defined,377.490 methods to induce donor-specific toleranceor suppressionof, 3gI methods to reduce immunogenicity of, 389-391,390b.39lf Allograft rejection accelerated,384 activationof alloreactiveT cellsin, 380, 38l-382,382f acute,384-386,3841 38514Bg chronic, 3841 3851387,493 effectormechanismsol 382-387,3B4i 385f experimental evidence of , 375-376, 376f first-set,375,376f geneticsof , 377 -37B, 377f hyperacute,383-384,3841385i 500 prevention and treatment oi 387-39I immunosuppressionin, 382-389, 387t,38Bf methods to induce donor-snecific toleranceor suppressionin, 391 methods to reduce allograft immunogenicityin, 389-391, 390b,39lf second-set,376.376f Allograft tolerance,391 Alloreactive, defined, 377, 490 Alloreactiveantibodies,3B5f Alloreactive T cells, activation ol 380, 381-382,382f,3B3b Allorecognition, 377-381, 377f-379f direct, 378-380,378f,379f, 496 indirect, 3781 380-381,502
Allotooes,BBb Allotypes, 88b, 490 s chain, in MHC molecules type I, 102-103,l03f type II, 104,104f c,-fetoprotein(AFP),406 oB T cell(s) developmentof, lB0-185, lSff-fffif origin of, 154,f55f aB T cell receptor, 28, 138-142,489 generation of diversity in, l6Bt in MHC-associatedpeptide antigen recognition,140-142,l4lf structureol 139-140,1401 l4lt Altered peptide ligands (APLs),490 Alternative pathway, of complement activation,330-33f, 33lf-333f defined,490 overviewof, 330-331,33lf-3331 332t, 490 proteins ol 332t Alveolar macrophages,29 Aminopterin, and hybridomas,77b AMLL, r67b Anaphylactic shock, 456-457, 490 Anaphylatoxins, 342, 454, 49O Anaphylaxis deflned, 490 slow-reacting substance of, 452 systemic, 456-457 ANCA (antineutrophil cytoplasmic antibodies), vasculitis caused by, 423t Anchor residues,106,107f,490-491 Anemia autoimmune hemoly.tic,422, 423t pernicious,4231 Anergy B cell, 258 defined,491 in Hodgkin's disease,476 T celI, 249-252, 250f-252f Angiogenesis chemokinesin, 281 defined,491 tumor, 416 Angioneurotic edema, hereditary 340 Anhidrotic ectodermal dysplasia with immunodeficiency(EDA-ID), 460-467 Ankylosing spondylitis, 434, 43st Antagonistpeptide,491 Anti-antibodies,86. 88b Anti-basement membrane antibodvmediatedglomerulonephritis, +Z+f Antibody(ies),7, B, Bf in adaptiveimmune response,13 affinity of, 9l alloreactive,3B5f defined,75. 491 disease-producing, 354-355 diseasescaused by, 420,420t, 421423 effectormechanismsof, 422,422f examples of, 422423, 423t pathologic features of , 423, 424f typesof, 42I,421f effectorfunctions of, 86, B7t,94-95, 32t-329,322f evolution oi 7b flexibility of, 86, B6f humanized,79b,88b,415,500 in humoral immunity, 16 laboratorymethods using,525-532 lifespan of, 16
Antibody(ies) (Continued) membrane-bound,75, 87-88,Bgf molecular structure of , 77-89 constantregionsin, 81, B1185-88, 86f, B7r,BBb,89f generalfeaturesol 80-84,B0l 8lf, 84f studyol 77-80,77b variableregionsin, 81, Bll 84-85,B5l B6f monoclonal, 77, 77b-79b, 507 anti-CD3,387t.3BB tumor-specific,415-4f6, 4l5f in mucosalimmunity, 346,347f natural, I /5 o e n n e o l./ 5 . 5 u / in innate immunity, 28-29 Tl antigensand, 238 in transplantation, 384, 392 natural distribution ol 76 in neonatal immunity, 346-347 neutralization of microbes and microbial toxins by, 323-324,324f, 325t opsonizationand phagocytosis mediated by, 324-329,325f, 326b-328b,329f preformed, in transplantation, 389, 390b reaginic,454 secreted,75, 76, B7-BB,Bgf specificity of, 93 structure-function relationships in, 92-9s,94f in tumor immunitv. 408 Antibody deficiencie's,464, 464t,47 0472, 470t,47tf Arrtibody-dependent cell-mediated cltotoxicity (ADCC),328-329,329f, 491 in HIV infection, 483 Antibody diversity, 93 Antibody feedback, 238-239,239f, 261, 491 Antibody fold, B3b Antibody-mediated effector functions, 76, 94-95 Antibody-mediated glomerulonephritis, 422,424f Antibody-mediated hypersensitivity, 420, 420t,421423 effector mechanisms of, 422, 422f examples of , 422423, 423t pathologic features of, 423, 424f t1lpesol 421,42If Antibody-mediated opsonization, 36 Antibody production, 76-77 assaysto measure, 537 Antibody repertoire,93, 491 Antibody responses to extracellular bacteria, 354, 355f to HIV infection, 485-486 primary 217-218,217f regulation by Fc receptors of, 238-239, 239f secondary2I7 -218, 2I7f , 236-237 T cell-depend ent, 222-237 affinity maturation in, 232-234, 234f, 235f antigen presentation in, 224, 226f B cell migration toward T cell zone in, 224 CD40ligand in, 226-228,227f
INDEX
Artibody responses(Continued) differentiation into plasma cells in, 234-236,236f generationof memory B cellsand secondary humoral immune responsesin,236-237 germinal center reaction in, 228, 229f hapten-carriereffectin, 224-226,226f heavy chain isotype (class)switching in, 228-232,230i 230t, 2321,233f helper T cell activation and migration toward follicle in, 224, 225f overviewof , 223-224.223f propertiesof,237t T cell-independent, 237-239,237t, 239f to viruses,363-364 Antibody-secreting cells, 276, 234-236, 236f Anti-CD3 antibodies,in tumor immunotherapy,414 Anti-CD3 monoclonal antibodv 387t,388 Anti-CD10 antibody,415t Anti-CD20 antibody,4I5t for hlpersensitivitydiseases,438 Anti-CD2Santibody,387t,388 Anti-CD30,415 Anti-CD4Oligand, 387t,389 Anti-GD3antibodies,in melanoma,406 Antigen(s) blood group, 384,386b captureand display ol 13-14 defined,6, 8, 51,75,89,491 elimination of, l4f, 15-16,75-76 fate of lymphocytes after encounter with,244f featuresol 89-91,9lf labeling and detectionof, 528-530,53lf in lymphatic system, 58-59 oncofetal,405-406 polyvalent, 238 quantificationof, 525-527,526f T-dependent,216,237t,515 T-independent,216,237-238, 237t, 515 tissue-specifi c differentiation,406 tolerogenic,243 Antigen-antibody complexes.SeeImmune complex(es). Antigen-antibody interactions, measurementof, 530-532,532f Antigen binding, 761,85, B6f,89-92, 9l f-93f and effector functions of antibodies, 94 epitopesand, 90 structuraland chemicalbasisol 91-92, 921 93f Antigen-bindingsites,B0f,81, 9f Antigen capture, 120-121, 120f, lzlf Antigen competition, for T cells,105, 105f Antigen entry routes of,120, l20f Antigen exposure,ll.rnphocltes distinguished by history of, 52-56, 53f. 54t, 55f Antigenic determinants,90-gl, 9lf immunodominant, 133-134,134f Antigenic variation by parasites,368,370f by viruses,364-365 Antigen-inducedB cell activation, 218-222,537 B cell antigen receptor complex in, 218-220, 2t8f, 2t9f
Antigen-inducedB cell activation (Continued) CR2/CDl complement receptorin, 220-22r,221f functional responsesof B cellsin, 22r-222,222f Antigen-inducedT cell activation, l9l-192,l93f polyclonal,535 with singleantigen-specificiry535-536 Antigen lossvariants,409 Antigen masking,410 Antigen presentation defined,491 to differentiated effector T l1'rnphocy'tes,122 inhibition by viruses of, 365 to naive T lymphocytes,ll7-122 physiologic significance of MHCassociated,132-134,132f-f34f Antigen-presentingcells (APCs),56, L16-122 in alloantigenrecognition,380,381 antigen uptake into vesicular compartments of, 123-124 in autoimmuniry 436, 437,437f B cellsas,117f,1l8t d e f i n e d , 5 61, 1 3 , 4 9 1 dendritic cells as, lI7-122, I I7l I l8t, l r9l 12rf discoveryol l16-117 donor, 38l macrophagesas, tl7f, llSt overviewof,12,74, l4f on, peptide-MHC complexexpression tzg-129 professional, 117,510 and T cell activation,11U722,ll6f and T cell antigen recognition,l14 T cell surveillanceof,732, l32f in tumor immunity, 408f tlpes of, 56 functionsof, 117,rl7f, Il8f Antigen processing, 1,16,122-131,723f, 124r of cytosolicantigens,123,123f,124t, 125f, 129-131,129f, l3rf, r32f defined,491 of endocytosed antigens, 123-129,I23f, t24t, t25f-t2&f time neededfor, l27f viral inhibition of, 365,366b Antigen receptor(s) antigenrecognitionand signaling functions ol 13Bf clonally distributed,49 evolution of, 6b-7b ofy6T cells,144 of NK-T cells,144-145 propertiesof, 1411 Antigen receptorgenes diversity of, l62f rearrangementol 158,160-165, 162f-165f in llnnphocy'te maturation, 154, l54f , 155 Antigen recognition,12f, 14-15,14i l5l 218-222 of alloantigens, 377-381, 377f-379f direct, 378-380,378f,379f indirect, 3781380-38f antigenbinding and, 9l-92, 92f byB cells,215,2I6f by CD4*T cells,115-l 16
Antigen recognition (Continued) by CDB-T cells,ll5-116, 316 features of, 92-93, 94f and immunologic tolerance, 244-245 b y T c e l l s l, 4 - I 5 , l l 4 - 1 1 6 ,1 1 4 t I, l 5 f , 116f Antigen-specificT cell clone,535 Antigen-specificT cells,methods to enumerate and study functional responsesol 536-537 Antigen uptake, 123-L24,1231125f,l33f Anti-GMz antibodies,in melanoma,406 Anti-Her-2/Neu antibody,4 15t Antihistamines,451 for anaphylaxis,457 Anti-idiotlpic antibodies,in tumor immunotherapy,416 Anti-Ig antibodies,86, BBb Anti-IgE antibodies,454 for asthma,458 Anti-IL-2 receptor antibody, 3871,3BB Anti-inflammatory drugs for asthma,458 for hlpersensitivity diseases,438 Anti-Ly'tl antibodies,5 lb Anti-L1't2antibodies,5lb Antineutrophil c1'toplasmicantibodies (ANCA),vasculitis caused by, 423t Anti-retroviraltherapy,486 Anti-RhD antibodies,393 Antiserum, 76, 491 Anti-Thvl antibodies,5lb Anti-TN-F antibodies, for hlpersensitivity diseases,438 Antitoxin(s),8, 75 Anti-toxin antibodies, 323-324,324f, 325t Anti-tumor antibodies,399 therapy with, 415-416,4I5t Anti-tumor immunity, 40Bf suppressionof, 409-410 AP-I. SeeActivation protein-1 (AP-l). factor-l), APAF-I (apoptosis-activating 256b APCs.SeeAntigen-presenting cells (APCs). ApeI endonuclease,231,233f APLs (alteredpeptide ligands),490 APOBEC3G,480 Apoptosis,l4f of B cells,258 caspasesin, 256b in contraction of immune resPonse, 26r,262f death receptor (extrinsic) pathway of, 255b-257b defined,255b,491 deletion of T cells by, 253-254, 254f in HIV infection, 482 in llnnphocyte s, 255b-257b mitochondrial (intrinsic) pathway ol 255b,256b morphology ol 255b role in immune system of,257b X-linked inhibitor oi 474 Apoptosis-activatingfactor-1 (APAF-1), 2560
Apoptosome,256b Apoptotic bodies,255b APRIL,297 in antibody production, 238 in B cell activation,218 APS (autoimmune polyendocrine syndrome), 248, 435, 436t ARDS (adult respiratorY distress syndrome),356b
541
542
INDEX
Artemis, 165 defectsin, 468t,469 Arteriosclerosis,graft, 499 accelerated,384f,387 Arthritis, rheumatoid, 428, 428t, 431b, 435t,512 Arthus reaction, 425, 491 Aspergillus fu m igat us, 353t Asthma, bronchial, 457-458, 45Bf antigen exposurein, 443 defined,492 geneticsusceptibilityto, 455,4561 histopathologicfeaturesof, 457f Ataxia telangiectasia,474-475 Ataxia telangiectasiamutated (ATM), 475 Ath1'rnicmouse, 469 ATL (adultT cell leukemia/lyrnphoma), 405,476 Atopic asthma,457 Atopy defined,441,491 geneticsusceptibilityto, 455,456t Attenuatedmicrobial vaccines,370-32l Autoantibody(ies) defined,491 diseasescausedby, 42O,420t, 421-423 effectormechanismsof, 422,422f examplesof , 422-423,4231 pathologic features of, 423, 424f R?es ol 421,421f Autocrine factors,491 cy'tokinesas, 269 Autograft, 376 Autoimmune diseases,11 defined,419.491 effectormechanismsin, 432 systemic us.organ-specific, 432 Autoimmune encephalomyelitis, experimental, 428, 430b, 497 Autoimmune hemolytic anemia, 422, 423t Autoimmune myocarditis,428t, 432 Autoimmune polyendocrinesyndrome (APS),248,435,436t Autoimmune regulator (AIRE) gene,in autoimmunepolyendocrine syndrome, 248, 435, 436t, 491-492 Autoimmune regulator(AIRE)protein, I 84-l 85, 246, 491-492 Auloimmunethrombocltopenicpurpura, 422,423r Autoimmunity anatomic alterationsand, 438 defined, 419.492 genetic susceptibility Io, 432, 433-436, 433f,434f,435t,436r hormonal influencesin, 438 immunodeficiencyand, 464 pathogenesisof , 432-438, 433f role of infection in, 432,4331436-438, 437f Autologous bone marrow transplantation, 393 Autologous graft, 376, 492 Autophagosomes,125 Autophagy,125 Avidin, 536 Avidiry of antibody-antigen interactions, 9t-92.92f. 492 Azathioprine,3871,388 Azurophilic granules,in neutrophils,29 B B-1 B cells,28-29,154,155f,I73, 174f, 175,238.492
B-2 B cells,173,174f 284, t4B 87 -t, t47, 194-198,l96b-197b in tumor immunity, 409 B7-2, 147, 194-198,r96b-197b in tumor immunity, 409 B7 molecules, in alloantigen recognition, 381-382 Ba, 330 BacillusCalmette-Gu6rin(BCG),36lb in tumor immunotherapy,414 Bacteria extracellular,352-355 adaptiveimmunity to, 354,355f examplesoi 3521-353t immune evasionby, 355,35Bt injurious effects of immune responsesto, 354-355,356b, 357b innate immunify to, 354 intracellular,355-362,35Bf-3601361b, 504 adaptiveimmunity to, 358-362,35Bf examples of, 353t immune evasionby, 358t,362 innate immunity to, 358,35Bf BAFF (B cell activating factor), 55, 174, 286 in antibody production, 238 in B cell activation,218 Bak, 256b Bare l1'rnphocytesyndrome, 170,473, 473t,492 Barrier immunity, Ts2 cells in, 314 Basophils defined,492 in immediate hypersensitivity binding of IgE to, 444445, 445f mediatorsderivedfrom, 4501,451f, 452-453 morphology of,447f properties of, 445t,447 number of, 49t Bax, 256b Bb, 330 B cell(s),7, Bl Il, l2l 49, 50t activation ol f4f, 16 antigenpresentationby, 56, I 17, I l7f, ttgt, I22 antigen receptors of, 49 antigen recognition by, 15 B-t, 28-29, 154,155f,173,t74f, 175, 238,492 B-2, r73, 174f. defined,492 differentiation of, 216, 216f, 234-236, 236f defects in, 472 effector, 54t Fc receptorson, 326b follicular, 154,l55i 174, 174f,2lB generationof diversityin, 167-169, 168f,l68t homing ol 69-70 immature, l7lf, 173,l74l 500 in l1'rnphnodes,59-60,60f, 61, 61f marginal zone,61, 174, 174f, 175, 238, 506 mature, 171f,174, 175,506 memory10,54t,55 generationof,236-237 naive, 14, l4f,54t pre-,89,90f, 170,I71f,174f,src pro-, 169,17lf, 174f,5lO
B cell(s) (Continued) recirculating, 174, 218 in spleen,6f, 62f, 69 subsetsof development of , 173-174, 174f preferentialresponsesof, 218 B cell activatingfactor (BAFF),55,174, 297 in antibody production, 238 in B cell activation,218 B cell activation,215-216,216f antigen-induc ed, 218-222 B cell antigenreceptorcomplex in, 2IB-220.2r8f.2r9f CR2/CD1complement receptorin, 220-22t,22tf functional responsesof B cells in, 22r-222,222f prcferential,224 defectsin, 464,464t,470-472,47Ot,47lf in immediate hypersensitMty, 444 polyclonal,537 regulation by Fc receptors of, 238-239, 239f B cell coreceptorcomplex,220-221, 22tf B cell deficiencies,464, 464t,470-472, 470t,47tf B cell development,5I, 52b, 169-175 defectsin, 464,464t,470472, 470t, 47tf Epstein-Barrvirus and, 404b immunoglobulin expressionduring, 89, 90f stagesof, 169-175,l70f-I74f transcriptional regulation of, 169, 170f B cell lineage,commitment to, 154-155, 1541r55f B cell linker protein (BLNK), 220 B cell ll.rrnphoma diffu se large, chromosomal translocationsin, 166b,l67b Epstein-Barrvirus and, 405b in transplantpatients,389,395 B cell maturation antigen (BCMA),235, 297 in B cell activation,218 B cell proliferation,216,2l6f assaysto measure,537 B cell receptor (BCR),pre-, 156,f56f, t70-173,r73f.510 B cell receptor (BCR)complex defined, 492 functional responsesto antigenmediated cross-linkingof, 22t-222, 222f signal transduction by, 2lB-220, 218f, 2tsf B cell repertoire,selectionol 154,l54i r55-1s7,156f,r57f, 175 B cell responses,methods for studying, 537 B cell selection,in germinal centers, 232-234. 234f. 235f B cell tolerance, 258-260, 259f, 260f, 26lr B cell tumors, chromosomal translocationsin, 165,f66b-167b BCG (bacillusCalmette-cu6rin),361b in tumor immunotherapy, 414 BCL2, t67b Bcl-2 family,in apoptosis,254,256b BCL6, r67b
Bcl-IO,2O7 Bcl family, in apoptosis, 254,256b Bcl-x and apoptosis,254 in T cell activation,197 Bcl-XL,256b BCMA (B cell maturation antigen),235, 297 in B cell activation,2IB BCR (B cell receptor),pre-, 156,156f, 1 7 0 - 1 7 31. 7 3 f . 5 1 0 BCRIC-ABLfusion gene, l67b BCR (B cell receptor)complex deflned,492 functional responsesto antigenmediated cross-linkingof , 221-222, 222f signal transduction by, 2IB-22O, 218f, 2t9f Bee stings, allergic reaction to, 444 Beigemouse strain,466 Benacerraf,Barui,99 Br-integrins,466 B2-microglobulin,in MHC molecules,102, r03, r03f,292 B-chain,in \pe II MHC molecules,104, l04f BH3-only proteins,256b Bid,,2s7b Bim, 185,253-2s4,256b,257b Binding protein (BiP),B9 Biogenicamines defined,492 in immediate hlpersensitivity, 451-452, 45lf Biologicresponsemodifiers,267,292 Biotin, 536 BLIMP-I,234 BLNK (B cell linker protein), 220 BLNK gene, 471 Blood group antigens,384,386b,3Bg Blood transfusion,375,392-393 Blood types,386b Blood typing, 389,390b B l1'rnphocltes. SeeB cell(s). B lyrnphocyte stimulator (BLyS),174, 2IB Bone marrow anatomy and functions of, 57-58, 57f deflned, 492 Bone marrow transplantation,393-395, 394f,4r5,475,492 Bordet,Jules,329 Branchial clefts, 58 Bromodeoxluridine (BrdU),536 Bronchial asthma, 457-458, 457f, 45Bf antigen exposurein, 443 defined,492 geneticsusceptibilityto, 455,456t histopathologic features of , 457f Bruton's agammaglobulinemia, 17l, 202b, 464.470-47t, 4701,517-518 Bruton tlrosine kinase (Btk), 171,202b, 220,47t,492 btk gene, l7L Btk homology domain, 202b Burkitt's lynphoma chromosomaltranslocationsin, 166b defined,492 Epstein-Barrvirus and, 404b Burnet, Macfarlane,14,397,432 BXSBmouse strain,427b Bvstander activation, 436, 438
C ct, 3351,492 binding to Fc portions of IgM and IgG ol 336f in classicalpathway,42,331,331i 334f, 336f regulationol 340,340f structure of, 334f ct inhibitor (cl INH), 3391,340, 340f,492 Clq, 335t in classicalpathway, 331-333 Fc region and, 94 pentraxinsand,43,44 structure ol 334f Clq binding protein (ClqBP),345 Clq receptor,mannose-bindingIectin and,44 Clr, 3351 in classicalpathway, 331-333 Cls, 335t in classicalpathway, 331-333 structure of, 334f c2, 335t in classicalpathway, 333, 334f C2a, in classicalpathway, 333, 334f C2b, in classicalpathway, 333, 334f C2 deficiency,344b c3, 43, 43f, 330,492 in alternative pathway, 330, 33li 332i 332t in classicalpathway, 334, 334f internal thioesterbonds ol 330,333f receptorsfor, 336-339,338t C3a,43, 43f, 330 in alternative pathway, 330, 33If, 332f in classicalpathway, 334, 334f in inflammation, 342 C3a receptor,343 c3b, 43, 43f, 330 in alternativepathway,330,331,33fl 332f in classicalpathway,334,334f factor I-mediated cleavageol 341,34lf inactivated,33b, 338,341 in phagocytosis,341-342 receptorfor, 336-338,33Bt C3bBbcomplex,330 C3 convertase,330, 492-493 alternativepathway,330,331,33fl 332f classicalpathway, 333, 334, 334f inhibition of, 340-341,340f c3d, 338 in B cell activation,220-221,221f, 343-344 C3 deficiency, 344b C3dg,338 C3 nephritic factor (C3NeF),344b C3 tickover, 330 c4, 335t in autoimmunity, 435, 436t in classicalpathway, 333, 334f C4a in classicalpathway, 333, 334f in inflammation, 342 c4b in classicalpathway, 333, 334f in phagocytosis,341 receptorfor, 336-338,338t C4b2b complex, in classicalpathway, 333 C4-bindingprotein (C4BP),339t,340 C4 deficiency, 344b c5, 4s, 43i 330 in late steps of complement activation' 335.336f.337t
CSa(Continued) in inflammation, 342 in late steps of complement activation, 335,336f C5a receptor, 342-343 c5b, 43, 43f, 330 in late steps of complement activation, 335,336f C5b,6,7complex,335 C5 convertase,330,493 alternative pathway, 33f, 33ff, 332f classicalpathway, 334, 334f inhibition ol 340-341 in late steps of complement activation, 335,336f c6, 43, 335,3361337t c7 , 4s, 335,3361337t cB, 43, 335,336f,337t c9, 43, 335-336,336f,337t 406 c"4,-19-9, cA-r25,406,4l5t Cachexia in AIDS,485 tumor necrosis factor and,277 CAD (caspase-activatedDNase),256b Calcineurin, 207, 493 Calcineurin inhibitors, 387-388, 3B7t Calcium-calcineurin pathway, in T cell activation, 199,2001 208-209, 209f Calcium releaseactivated calcium (CRAC) channels,206,469 CAll,A (common acute ll.rnphoblastic leukemia antigen), 406 Calnexin,89,126,131 Calreticulin, 131 Cancer.SeeTumor(s). immunodeficienry and, 464,475t, 476 Cancer/testis antigens, 402403 Cand i.d.aalb ican s, 353t Candida infections, 362 5,6-Carboxyfluoresceindiacetate succinimidyl ester (CFSE),536 Carcinoembryonic antigen (CEA), 405-406,415t,493 CARD (caspaseactivation and recruitment domain) -containing proteifis,26,220 cARMAl,207,220 Carrier protein, 90 Caspase(s) in apoptosis,256b in cell-mediated cy'totoxicity,318-319 defined,493 Caspase-1,278 Caspase-activatedDNase (CAD), 256b Caspaseactivation and recruitment domain (CARD)-containing proteins, 26,220 Cathelicidins, 28, 28f, 493 Cathepsin(s) in antigen processing,125 defined, 493 Cathepsin G, in phagolysosomes,36 cbl-b in T cell signalattenuation,212-213, 2r2f in T cell tolerance, 249 cclll, 453 cclrg, 60, 61, 66-68,69 ccl2r, 60, 6I, 66-68,69 ccR, 279,2B0t CCR4,69 CCRS,in HIV infection, 478, 479,48Of ccR7, 60,61,62,68,69, 121
544
INDEX
CCRg,69 ccRl0, 69 CD (clusterof differentiation),50, 5lb CD molecules,I1, 493, 519-524 CDl lipid antigen presentationby, t16, 134-135 and NK-T cell T cell receptors, t44-145 cD2, t47-t49 CD3, I38f cD4, l38f binding siteson MHC moleculesfor, r02 functions of, 145-146 in HIV infection, 477-478,479f,480f, 483 in MHC-restrictedT cell activation, 145-146,146f as phenotypic marker,50 in signaltransduction,146 specificityof, 146 structureof, 145,146f on thymoc).tes,180,1BOf CD4activationof, 190,191-192 in allograftrejection,386 antigen presentationto, 97, 145f antigen recognitionby, 115-116 a l l o - , 3 8 03, 8 1 , 3 8 2 f in B cell activation,216 in CDB-activation,192-194,l93f in cell-mediatedimmunity, l5 clonal expansionof, 192 in diabetesmellitus,429b differentiationof, Ig2 effector,55,304-315 in HIV infection, 478,481-483,48ll 482f,484485,486 i n h u m o r a li m m u n i r y l,6 ln lmmune response to extracellularbacteria,354,355f to fungi, 362 to intracellularbacteria,3s9-360, 359f in lynph nodes,60 in multiple sclerosis,428,430b in rheumatoid arthritis, 43lb TH], 305 activation of macrophagesby, 3ll-312,31rf in delayed-type hypersensitivity reactions,312-314,3l31 3f 4f developmentol 305-307,308f effectorfunctions ol 309-314,309f in HIV infection, 483 immune responsesmediatedby, 303, 304f,309-314,309f in immune responseto parasites, .1b /
interferon-1and, 295 migration to sites of antigen by, 3 10-311, 3 lOf propertiesof, 305,307f toll-like receprors and, 4445 TH2,305 developmentof, 305,307-309,30Bf effectorfunctions of, 314-315,315f in HIV infection, 483 homing of, 315 in immediate hypersensitivity,442, 442f,443-444 immune responsesmediatedby, 304, 3r4-31s,315f
CD4.,TH2(Continued) in immune responseto parasites,368 interferon-yand, 295 interleukin-4and, 293 propertiesof, 305,307f T H 1 7 , 3 15 1 ,5 tolerance rn,246-254 in tumor immunity, 4O7,40Bf cD5, 175 CDB,138f binding siteson MHC moleculesfor, t02 functions ol 145-146 in MHC-restrictedT cell activation, 145-146, t46f as phenotlpic marker, 50 in signaltransduction,146 speciflcityof, 146 structureol 145,l46f on thlrnocy.tes,IB0, l80f CD8activationof, 190,192-194,193f,194f, 316-317,3r7f in allograftrejection,386 antigenpresentationto, 97, 122,1451 antigen recognitionby, 115-f 16,316 allo-,380,38I, 3B2f in cell-mediatedimmunity, l5-16, 304, 304f clonal expansionol 194,194f cross-presentation of antigen Io, I92, 193f cltotoxicity mediatedby, 3t6-319, 3l6f in diabetesmellitus, 429b differentiation of, 1931 194 effector,55, 315-319 in HIV infection, 478,485 ln lmmune response to fungi, 362 to intracellularbacteria,359-360, 359f to malaria,369b to viruses,364 killing of targercellsby, 317-3l9.3l8f in lymph nodes,60 tolerance in,254-257 in tumor immunity, 407, 4OBf CD8 coreceptor,316 cDl0, 406 cDl lb, 338,3381 CD11c,338,33Bt CDI4 in immediate hypersensitivity,455 lipopolysaccharideand, 24 cDr6, 39b,4r, 326b,327b cDlB, 33b,338,33Br C D I 9 ,3 3 8 in B cell activation,220-22I,221f cD20, 406 cD2l, 338,338t in B cell activation,220-221,221f cD22,238 cD23,326b,327b,445 cD25, s5 in T cell tolerance, 252-253 cD28, r47 in costimulation, 146-147, 147f , 209 inhibitory receptorsof, 747, 209-21O, 2t0f in T cell activation,194-198,l96b-I97b cD29, 33b CD3l, in leukocl'terecruitment,35 cD32,238,326b-327b
cD34, 57,66 cD35, 336-338,338t cD36, 26 CD4O in B cell activation,226-227,227f in isotypeswitching,228,230-23I mutations in,471f, 472 in T cell activation,195,198,198f,312 CD40ligand (CD40L),r48,278 in B cell activation,22U228,227f mutationsin,47|f,472 in T cell activation,195,198,198f,312 cD44, t4B in memoryT cell migration, 311 CD45 on memory cells,55-56 inT cell activation,202,202b cD46, 339r,340 CD4B,147 CD49a-l 33b cD54, 33b CD'B, 147 cD59, 339r,340,341,342f CD62E,in leukocyterecruitment,31, 32b CD62L,in leukocyte recruitment, 31, 32b CD62Bin leukocyterecruitment,31, 32b cD64, 326b cD66, 405-406,493 CD6B,26 CDBO,147,194-198,l96b-197b in tumor immunity, 409 CDBl, 338 in B cell activation,220-221,221f CDBs,39b cDB6, 147,194-198,196b-r97b in tumor immunity, 409 cD89,326b,327b cD94, 39b CD94/NKG2,4I CD95.SeeFas. CD95ligand. SeeFasligand (FasL). CDIII-c,33b cD152, r47, 198 in T cell signalattenuation,209-210, 2LOf cD154, l4B in B cell activation,226-228,227f cDNA (complementary DNA) and monoclonal antibodies,79b in subtractive hybridization, l39b C domains,83b CDRs.SeeComplementarity-determining region(s)(CDRs). CEA (carcinoembryonic antigen), 405-406,415t,493 Cell(s),purification ol 530 Cell death,programmed (physiologic), 510.Seealso Apoptosis. Cell-mediated c)'totoxici$ antibodydependent, 328-329, 329f, 4gl in HIV infection, 483 Cell-mediatedimmunity (CMI) defined,493 effectormechanismsof, 303-320 to fungi, 362 to HII 486 induction and effectorphasesol 304, 306f to intracellularbacteria,359 overviewof, 7, I, Bl l4l 15-16 to parasites,367 types of, 303-304,304f-306f Cell surfaceproteins,on lymphocyes, 50, 51b,54t
Cellularimmunity. SeeCell-mediated immunity (CMI). Cellularinhibitors of apoptosis(cIAPs), 276b Cellularproteins,abnormally expressed, as tumor antigens, 402403 Cellular theory, of immuniry 9 Centralarteries,of spleen,6l Centraltolerance,lB4-185,245-246,245f in B lymphocytes,258,259f,260f defined,493 in T lynphocltes, 246-248,24Bf CFSE(5,6-carboxlfluorescein diacetate succinimidyl ester),536 CGD (chronic granulomatousdisease),37, 465-466,4651,493 Chaperones,89, 126,1261131 Ch6diak-Higashisy'ndrome,465t,466,493 Chemokine(s), 2741,279-281 biologic actions of , 27O,279-281 c,279,280t cc,279,280t cxc.279.280t defined,493 in leukocyterecruitment,31-35 in l1'mPhnodes,60 and l1'rnphocyterecirculation, 65 oroduction of. 279 receptors for, 279, 28Ot,493 in HIV infection,478 structureof, 279 in T cell homing, 68 in Tsl migration, 310 tumor necrosisfactor and,274 types of, 279,280t Chemokine inhibitory protein of staphylococci(CHIPS),346 Chemotaxis,493 Chemotherapy,immunodeficiency due to, 475t,476 Chimeric mice, 533,534f Chondroitin sulfate,452 Chromosomaltranslocations deflned,493 in lyrnphocy'tetumors, 165, 166b-f 67b Chronic granulomatousdisease(CGD), 37, 465-466,465t,493 Chronic myelogenousleukemia, chromosomaltranslocationsin, 166b, 167b Chronic rejection,38413851387,493 Chymase,452 clAPs(cellularinhibitors of apoptosis), 276b CIITA (classII transcriptionactivator),110 CIIV (classII vesicle),126,494 Circumsporozoite(CS)protein, 369b c-JunN-terminal kinase (lNK), 206 c-Kit ligand, 298-299,298f,2991,493 cLA-1,69 Classicalpathway, of complement activation,331-335,33fl 3341336f defined,494 overview oi 42, a3f, 330 oroteins of, 335t ClassII-associated invariant chain peptide(CLIP),126-128,127f,494 ClassII transcription activator (CIITA), 110 ClassII vesicle(CIIV), 126,494 Cleavage,in V(D)l recombination,164, l64f Clonal anergy,494 Clonal deletion,157,184,246,494
Clonal expansion of CD4. T cells, 192 of CD8. T cells,194,194f defined, 494 overviewof, 10-ll, 101,14f, 15 Clonal ignorance,494 Clonal selectionhypothesis,L4, 15f, 494 Clostr idi um tetani, 353t cLP 155,r5sl 169 Clusterof differentiation(CD).SeeCD (clusterof differentiation). CMI. SeeCell-mediatedimmunity (CMI). CMV (cltomegalovirus),365,366b in transplantpatients,389,395 C-IUNC,494 in Burkitt's lymphoma, l66b Coagulation, disseminated intravascular, 356b due to transfusionreaction,392-393 Coding end processing,in V(D)l recombination,164,l64f Codominant expression,378 of MHC genes,101 Colitis, ulcerative, 428-431,42Bt Collectins defined,494 in innate immune system,2lt, 44 Colony-stimulatingfactor(s)(CSFs),57, 298,494 multilineage,299-300,299t Combinatorial diversity, 167, 494 Common acute lymphoblasticleukemia antigen (CALI-A.),406 Common l chain defects,467 Common variableimmunodeficiencY (CVID),470t,471f,472 Complement activation central event in, 330 features of, 329-330 late stepsof,335-336,3361337f,337t pathways of, 42-43, 43f, 330-336, 33lf alternative,330-331,33lf-333f defined,490 overviewol 330-331,331f-3331 332t,490 proteins of, 3321 classical,331-335,33lf, 334f,336f defined,494 overview of, 42, 43f, 330 proteins of, 3351 lectin, 43, 43l 330,33If, 335,505 regulationof, 339-341,3391,340f-342f in serum sickness,424-425,425f Complementarity-determiningregion(s) (CDRs),85, 851 139,140,4s4-495 Complementarity-determiningregion I ( c D R l ) , 8 5 ,B s i r 4 r Complementarity-determining region 2 (cDR2),85,B5f,l4l Complementarity-determining region 3 (cDR3),85,85f, r39, 141 iunctional diversityat, 169 and ( proteins, 142-144,142f,l43f Complementary DNA (cDNA) and monoclonal antibodies,79b in subtractive hybridization, l39b Complementbinding site,BOf Complement deficiencies, 344b-345b, 465 in systemic lupus er5,'thematosus, 427b Complement proteins, receptors for, 336-339,33Br
Complementreceptor(s),deficienciesin, 344b-345b Complementreceptorof the immunoglobulin family (CRIg), 339 Complement receptortype I (CRl), 336-338,338t,340,494 Complementreceptortlpe 2 (CR2),338, 338t,494 in B cell activation,220-221,221t Complement receptortype 3 (CR3),338, 33Bt Complementreceptortype 4 (CR4),338, 3381 Complement regulatory proteins, 339-341, 339t, 340f-342f deficienciesin, 344b mimics of, 345-346 Complement system, 329-346 in allograft rejection, 384 in B cell activation, 220-221,221f cy'tolysismediated by, 343 defined, 494 in disease,344b-345b evasionby microbesol 345-346 Fc region and, 94 functions of, 341-345,343f in immune response to extracellular bacteria, 354, 355f innate.42-43,43f early, 13 in inflammatory responses,342-343 in opsonizationand PhagocYtosis, 34r-342 pathologic effects of normal, 345b Concanavalin-A(Con-A),535 Confocal microscopy, 530 Conformationaldeterminants,90-91, 91f Congenicstrains,98, 100b,495 Congenital immunodefi ciency(ies), 464-475 due to antibody deficiencies,464, 470472, 470t, 471f due to defects in innate immunity, 464, 465467,465t due to defects in T lymPhocl'te activation and function, 464465, 464t.47Lf, 47247 4, 473t defined, +63 multisystem disorders with, 47447 5 severecombined, 467-47 0, 467f , 468t therapeuticapproachesto, 475 Conjugatevaccines,237,371 Conjunctivitis, allergic, 458 Constant (C) regions ofantibody, BI, 8ll 85-88,B6f,87t, BBb, 89f defined, 492,495 of Ig and TCR genes,159,159f,f60, l6lf ofT cell receptor,139-140,140f Contact sensitiviry 193, 428, 495 l0f, Contraction,of immune responses, l0t, 11,r4l 261 Coreceptors defined,495 in HIV infection, 478 in T cells, 145-146,f45f, f46f Corticosteroids for asthma, 458 for hypersensitivity diseases,438 for immunosuppression,387t,389 Corynebacteriumdiphtheriae, 353t
546
INDEX
Costimulator(s) in antigen presentation,lI6 in autoimmunity, 436-437, 437f defined,495 on dendritic cells,56 inducible, 747, 196b,197b,l98 mutationsin,47Lf,472 in T cell activation,l93l I94-198, f95f, l96b-197b,198f,209 in T cell surveillance,132 in tumor immunity, 407, 408f, 409, 4tr-4t2,412f Costimulatoryreceptors,on T cells,145, t45f, r46-t48,147f CpG sequences,20,24b, 25, 372, 495 CR.SeeComplement receptor(CR). CRAC(calciumreleaseactivatedcalcium) channels,206,469 C-reactiveprotein (CRP) as acute-phasereactant,356b defined,495 in innate immune system,43 C regions.SeeConstant(C) regions. CreI IoxP recombination system, 52, 534-535 CRIg (complementreceptorof the immunoglobulin family), 339 Crohn's disease,428431, 428t, 435 Cross-matching,389-391,390b,39ll 495 Cross-presentation, 122,192,193f,364, 495 in T cell responseto tumors, 402,40Bf Cross-priming,122,192,193f,364,495 in T cell responseto tumors, 407, 40Bf Cross-reaction,93 CRPSeeC-reactiveprorein (CRp). Crypticidins,2B Cryptococcusneoformans,362 CSF(s)(colony-stimulatingfactors),57, 298,494 multilineage,299-300,2991 c-SMAC,202 CS (circumsporozoite)protein, 369b CTl"\-4. SeeCltotoxic T lymphocyte-associatedantigen4
(cTr-A-4).
CTLs.SeeCytoroxic T lymphocyte(s) (CTLs). C-tlpe lectins,in innate immune system, 2tt,26,32b Cutaneousimmune system,62-63,63f, 495 CMD (common variable immunodeficiency),470t,47If, 422 cxclr3, 61,69,70 in B cell activation,218 CXCR,279, 2BOt CXCR4,69 in HIV infection, 478,479,48Of CXCRs,60, 6I, 69 in B cell activation,2lB CXCRl3,60 Cyclooxygenase, 356b Cyclophilin,209 Cyclosporine,387-388,387t,3BBf,389, 495 Cytochromec, in apoptosis,256b Cytokine(s),267-301 of adaptiveimmuniry 270t,289-298, 290t APRILas,297 BAFFas,297 interferon-^yas, 290t, 294-296, 295f
C)'tokine(s),of adaptive immunity (Continued) interleukin-z as, 289-292,290t, 291f, 292f interleukin-4 as, 290t, 292-293, 293f interleukin-s as,290t,293 interleukin-13as,2901,293-294 interleukin-16as,297 interleukin-I7 as,290t,296-297 interleukin-21as,297 interleukin-25as,297 l1'mphotoxin as, 290t, 296 migration inhibition factor as, 297 transforming growth factor-p as, 2901, 296 antagonismol 269f in antibody responses,227-228, 227f autocrineactions of, 269 cellular responsesto, 270 regulation of,269-270 and classI MHC expression,1091 110 defined,267,268,495 functional categoriesof, 270-27l, 270t functions of selected,268f general properties of , 268-273, 26Bf, 269f hematopoietic,298-300,298f, zggt erlthropoietin as, 300 granulocy{eCSFas,299t,300 granulocy'te-monocy'te CSFas,2991, 300 interleukin-3as,299-300,299t interleukin-7as,299,299t interleukin-gas,300 interleukin-ll as,300 monoclte CSFas,299t,300 overuew oL 5 /-58. z / stem cell factor (c-Kit ligand) as, 298-299,298f.299t in immediate hypersensitivity, 442, 449, 450t,451f,452-453 in inflammation, 2BB-289,289f of innate immunity, 270t, 273-289, 274t, 289f chemokinesas,270, 274t, 279-281, 2801 early, 13 to extracellularbacteria,354.356b functions of selected,26Bf interleukin- 1 as,274t. 278-279 interleukin-6 as,274t, 287-ZBB interleukin-t0 as,274t. 287 interleukin- 12 as,274t, 281-285,2B2f interleukin- 15 as,274t. 288 interleukin- lB as,274L 288 interleukin-23 as,274t. 2BB interleukin-27 as,274t, 2BB to intracellularbacteria,360-362,360f and Jak-STAIsignal transduction pathway,27l, 27lt, 283b-285b overviewof,44,270 tumor necrosisfactor as,273-278. 273f,274t, 275b-276b,277f tlpe I interferons(interferon-oand interferon-B) as,27 41,285-287, 286f and integrins,35 in isotlpe switching, 227, 228-230, 230t and naive lymphocytes, 55 and natural killer cells,41-42 paracrineactions of, 269 pleotropism of , 268, 269f redundancy of, 268, 269f in rheumatoid arthritis,43lb
C)'tokine(s) (Continued) slrrergy of,269,269f synthesis of, 268 in tumor immunotherapy,411-413, 4t2f,4t3t ffieI,27l Cytokinereceptors classification of, 271-272, 272f generalpropertiesof, 269-27O,27l-27 3 regulationof expressionof, 269 signal transduction mechanisms of, 27I-273,27tt structureof , 27l-27 2. 272f type1,271,272f,517 t]/peII,271,272f Cytokine receptor signaling, defects in, 467-468,46Bt Cytokinesecretion,268 assaysof, 536-537 Cltokine storm, 354 Cytolysis,complement-mediated,343, 343f Cytolytic T lymphoc).tes.SeeCytotoxic T lymphocyte(st(CTLs). Cltomegalovirus(CMV), 365,366b in transplantpatients,389,395 Cytopathic viruses, immune responseto, 364,495 Cltosolic antigens presentationof, I32, l33f processingof, 123,123f,124t,725f, 1 2 9 - 1 3 r 1, 2 9 f ,l 3 l f proteolytic degradationof, 129-130, t29f sourcesol 129 transport to endoplasmicreticulum of, r 2 9 f , 1 3 0 - 1 3 rt,3 l f C)-totoxicT lymphocl'te(s) (CTLs).Seealso CDB*T cells. activationof, 316-317,3l7f defective,474 in allograft rejection, 386 antigen markersof, 5lb antigenpresentationto, 97 antigen recognitionby, 316 in cell-mediatedimmunity, 15-16,304, 304f cl,totoxicity mediated by, 3 I 6-3 19, 3l6f defined,495 diseasescausedby, 426t,43t-432 ln lmmune response adaptive,13 to viruses,363-364,365,366b killing of target cellsby, 317-319, 3l8f MHC restrictionol ll4-I15, 1t5f pre-,510 tissue injury due to, 364 in tumor immunity, 407,408f cytotoxic T lymphoclte-associated antigen 4 lCTl-\-4), 747 in autoimmunity,435,4361 in contractionof immune response,261 in T cell activation,f96b-l97b, l9B in T cell signalattenuation,209-210, 2t0f in T cell tolerance,250 in tumor immunotherapy, 413-414 Cltotoxic T lymphocy'te-associated antigen 4 immunoglobulin (CTI,A4Ig), 387t,3Bg Cytotoxic T lymphocye (CTL) clones, tumor-specific,400b,401b
D DAF (decay-accelerating factor),3391, 340-341 DAG (diacylglycerol) defined,496 inT cell activation,206,2O7 DAP10,4lb DAP12,4rb Dausset,Iean, 100 DCs.SeeDendritic cells (DCs). Death domains,257b TNF receptorsignalingby, 27lt, 276b Death receptorpathway,of apoptosis, 254,255b-257b Decay-accelerating factor (DAF),3391, 340-341 Dectin l, 26 Defensins, 28, 2Bf, 495 Delayed-type hlpersensitivity (DTH) diseases,426-431,428r, 429b-431b Delayed-\pe hypersensitivity (DTH) reactions,3 12-314,3 l3f defined,304,495 morphology of, 314f in schistosomiasis, 368 in tuberculosis,361b Delayed xenograft rejection, 392, 496 Deletion, 162,l63f in T cell tolerance,246,248f,253-254, 254f Dendritic cells (DCs) in adaptiveimmune system,12, 14 in antigen capture, 120-12I, l2lf antigenpresentationby, 56, ll7 -122, n7l ll8t, rrgf, 12lf in B cell activation,218 defined,496 epithelial, llgb, 120-121, l2lf follicular,56,60, 498 in affinity maturation, 233-234 in B cell activation,2IB,22B in HIV infection, 483-484 in HIV infection, 4BIl 482, 483-484 in innate immune system,30 interstitial/dermal,I l9b Langerhanscell type, 117-120,119b, t2tf lyrnph and, 59 lymphoid, 1l9b maturation of, 1l9b-120b, f20, L2l morphologyof, l17, ll8f myeloid,117,1lgb plasmacytoid,30, I19b subsetsol 117,l19b-120b in T cell activation,19I-192, l93f inT cell tolerance,25I-252 Dendritic cell vaccines,410t,4Il Desensitization,458,496 Determinant(s),9, 496 antigenic,90-9I, 9tf immunodominant, 133-134,134f Determinant selectionmodel, 496 Diabetesmellitus insulin- resistanl, 423t type I (insulin-dependent),428,428t, 429b,433,4351,437,503 Diacylglycerol (DAG) defined,496 inT cell activation,206,207 DIC (disseminatedintravascular coagulation),356b due to transfusion reaction, 392-393
Differentiation, 14f of CD4*T cells,192 of CDB.T cells,I94 Differentiation antigens,tissue-specific, 406 DiGeorge'ssyndrome,58, 176,4681,469, 496 Diohtheria toxin, in tumor immunotherapy,415 Diphtheria toxoid, 371 Diphtheriavaccine,325t Direct allorecognition,378-380,378t, 379f,496 Direct presentation, of alloantigens, 378-380,378f,3791496 Disseminated intravascular coagulation (Drc),3s6b due to transfusionreaction,392-393 Dissociationconstant (Iq), 532 Diversity antibody, 93 combinatorial,167 defined,496 of immune response,10, l0t, ll iunctional, 167-169,1681504 Diversity (D) segments,of Ig and TCR genes,159,I59f, 160,1611496 DNA-dependentprotein kinase (DNAPIQ, 165 DNA double-strandbreak repair (DSBR), 164,l64f DNA double-strandbreak repair (DSBR) enz]'rnes,161,165 DNA vaccines,372, 4lOI,4l l, 496 for HIV 487 DNA viruses immune responseto, 364 and malignancy,403-405 DO, l2B Doherty,Peter,l14 Donor, 375 Donor-recipientcompatibility,389-39l, 390b,39lf Donor-specifictolerance,391 Double-negative thymoc),te, 177, IBOf, 496 Double-positivethymoc)'te,I 761 178-180.lB0f, 181,496 DPPI 0, in immediate hlpersensitiviry 4561 DSBR(DNA double-strandbreak repair), 164,l64f DSBR(DNA double-strandbreak repair) enz].rnes,l6l, 165 D (diversity)segments,of Ig and TCR genes,159,159f,160,161f,496 DTH. SeeDelayed-type hypersensitivity (DTH) disease, Dyskeratosis,in graft-uersus-host 394f E EAE (experimental autoimmune encephalomyelitis),428, 430b,497 Early innate immune resPonse,13 EzA transcriptionfactor, 169,170f EBFtranscriptionfactor, 169,170f EBNAs(Eps6in-Barrnuclear antigens), 404b EBV SeeEpstein-Barrvirus (EBV). 496 Ectoparasites, Eczema,455,459 EDA-ID (anhidroticectodermaldysplasia with immunodefi ciencY), 466467
Edema, hereditary angioneurotic, 340 Effector B cells, 54t Effector CD4* cells, 55, 304-315 Effector CD8* cells, 55, 315-319 Effectorcells,l2-13, 15,55, 496 Effector functions, l2f of antibodies, 86, 87t, 9,1-95 of B lyrnphocytes, 54t of T lymphocYes, 54t Effector lymphocytes, 47-48, 55, 55f Effector memory cells, 56, 319 Effector phase,496 Effector T cells, 481 53f activation of, 190, l90f antigen presentation to, 122 characteristicsof, 54t migration ol 671 68-69,310-311,3l0f EGFR(epidermal growth factor receptor), antibodies that block 416 Ehrlich, Paul, B, 9, 432 El-A.M-f (endothelial leukocyte adhesion molecule-l),32b Elastase,in phagolysosomes,36 Electrophoresis,B0 Elicitation phase,313,3l3f E3 ligases,in T cell siSnal attenuation, 2ro-213,2rlb-2r2b ELISA (enzvme-linked immunosorbent assay),497, 526, 526f,537 ELISPOT(enz1'rne-linkedimmunosorbent spot),536-537 E]k, 205 Encephalomyelitis, exPerimental autoimmune, 428, 43Ob,497 Encephalopathy,AIDS,aB5 Endocytosed antigens presentationol 132,l33f processing of, 123-129, 123f, 124r, r25f-r28f Endogenousp1'rogens,356b Endoplasmic reticulum (ER),transport of peptidesfrom cytosolto, l3G-131, 13lf Endosomal pathway, 123-129, 123f, I24t, t25f-l29f Endosomal vesicles antigenprocessingin, 124-125,126f, t27f antigen uptake into, 123-124 classII MHC-rich, 126,I2Bf Endosomes,124,49H97 biosynthesis and transport of class II MHC moleculesrc, 125-126,127f, r28f Endothelial cells, in allograft rejection, 384 Endothelialitis, in allograft rejection, 384 Endothelial leukocyte adhesion moleculeI Gl-AM-r),32b Endotoxin(s),354,497 physiologicand pathologicresponses ro, 356b Endotoxin shock defined,513 due to humoral immune resPonse,354, 356b tumor necrosisfactor in,277-278' 2771 Enhancer,497 Entamoeba histolytica, 367t Enterotoxins, 357b Envelope glycoprotein (Env), 477, 497 enu gene,of HIV a78f,480,485 Environmental antigens, reactions against, 420
548
INDEX
Enzyme-linkedimmunosorbent assay (ELISA),497, s26, s26f, 537 Enzyme-linkedimmunosorbent spot (ELISPOT),s36_537 Eosinophil(s) in cell-mediatedimmunity, 15,323 defined,497 in immediate hypersensitivity mediatorsderivedfrom, 450t,453 morphology of,447f propertiesol 4451,453 in immune responseto parasites,368 interleukin-5and, 293 number of, 49t Eosinophilcationic protein, 453 Eotaxin,453 Epidermalgrowth faoor receptor(EGFR), antibodiesthat block, 416 Epinephrine,for anaphylaxis,457 Epithelialbarriers,in innate immune system,27-29,2Bf Epithelioidcells,29,313 Epitope(s), 9, 90-9I, 91f,497 immunodominant,133-134,134f,501 Epitopespreading,430b,433 Epo (erythropoietin),300 Epstein-Barrnuclear antigens(EBNAs), 404b Epstein-Barrvirus (EBV),3531,497 antibodiesto, 408 clinical sequelaeof, 404b CR2and, 338 immunodeficiencyand, 404b-405b and interleukin-I0, 287,365 and lymphoma, 227 and malignancy,403,404b-405b pathogenesisol 404b in transplantpatients,389,395 in X-linked lymphoproliferative syndrome,474 Equilibrium dialysis,530-532,532f ER (endoplasmicreticulum),transpoft of peptidesfrom cy.tosolto, 130-131, 1 31 f ERK (extracellularreceptor-activated kinase),205,449 Erythroblastosisfetalis,393 Erl,thropoietin(Epo),3OO Escherichiacoli,352t E-selectin,in leukoclte recruitment,31, 32b Exogenouspyrogens,356b Exotoxins,354 Experimentalautoimmune encephalomyelitis(EAE),428,430b, 497 Extracellularreceptor-activatedkinase (ERK),205,449 Extravasation,497 E
Fab fragment,84, B4f,861 323,497 F(ab),fragmenl, 323, 497 Fab region,BOf FACS(fluorescence-activated cell sorter), 498,530,531f FactorB, 330,332r FacrorD, 330,33213321 deficiencyin, 344b FactorH, 3391,340 deficiencyin, 344b recruitment by pathogensof, 345 FactorI, 339t,341,34lf deficiencyin, 344b
Familial hemophagocytic lyrnphohistiocfoses, 473t, 474 Fas,497 in apoptosis, 254, 256b-257b in autoimmunity,435-436,436t Fas-associated death domain (FADD), 257b,276b Fasligand (FasL),148,278,497 in apoptosis,254,256b in autoimmunity,435-436,436t in cell-mediatedcytotoxicity,318 in tumor immuniry 409-410 Fca receptor(FcsR),326b,327b FcereceptorI (FceRI),326b,327b, 498 in immediate hypersensitivity, 444-445, 445f,448,456t FcereceptorII (FceRII),326b,327b Fc fragment, 84, 84f, 497 Fcyreceptor(s)(FcyR),325-328, 326b-327b,498 Fc^yreceptor I (FcyRI),36, 325-328, 325f, 326b Fc1receptor II (FcyRII),326b-327b Fcy receptor IIA (FcyRIIA),326b-327b FcyreceptorIIB (FcyRIIB),326b,327b, 328,328b in antibody feedback, 238-239, 239f in immediate hypersensitivity,449 FcyreceptorIII (Fc1RIII),326b,327b,445 Fc^y receptorIIIA (FcTRIIIA),41,326b, 327b FcyreceptorIIIB (Fc1IRIIIB), 326b,327b Fc receptor(s)(FcRs),36, 80f,94,497 in complement activation,323 neonatal,347 phagoclte (leukoclte), 324-328, 326b-328b regulation of humoral immune responsesby, 238-239, 239f Fc regions,36, B0l 94 FDCs.SeeFolliculardendritic cells (FDCsl Fetus,immune responsesto, 382,383b fever in systemicinflammatory response syndrome,356b tumor necrosisfactor and,27Z Fibrinogen,as acute-phasereactant,356b Fibroblasticreticular cell(s)(FRCs),59, 60f Fibroblasticreticular cell (FRC)conduits, 59,60f Fibrosis in delayed-type hlpersensitivity reaction,3l3 interleukin-13in,294 Ficolins,335 in innate immune system,2lt, 44 Filaria,367t,370 Filariasis,lymphatic, 370 First-setrejection,375, 376f, 498 FITC,536 FK-506,387,387t,388,498 FK-506-bindingprotein (FKBP),209,3BB Flow cytometry,498,528-530,53lf Fluorescence-activated cell sorter (FACS), 498,530,53lf Fluorescentdyes,to studyT cell proliferation,536 FollicularB cells, 154, 155f,174,1Z4f,2lB Folliculardendritic cells (FDCs),56, 60, 498 in affinity maturation, 233-234 in B cell activation.218.228 in HIV infection, 483-484
Follicularlymphoma, chromosomal translocationsin, 166b,l67b Food allergies, 443, 458-459 Foreignprotein antigens,tolerance induced by, 250f,260 l/-Formylmethionine,20, 26, 498 Fos,205 in B cell activation,220 FOXA/Igene,469 FoxP3,498 in autoimmunity,435,4361 FOW3 gene,252-253 FPR,26 FPRLI,26 FRC(s)(fibroblasticreticular cells),59, 60f FRC (fibroblastic reticular cell) conduits. 59, 60f FTY720,68, 389 Fucosyltransferase, 386 Fungi, immunity to, 353t,362 Fyn, in T cell activation, 199 G Gab2(Grb-2-associated binder-like protein 2), 449 gaggene,ofHIV 47Bl 480,481,485 Gametocyes,369b yDT cell(s),49, 50t, 63 developmentof, 185 origin of, I54, l55f in tuberculosis,361b y6 T cell receptor,28, t44,4gB generarionof diversityin, l6Bt y chain defects,467 Gamma globulins,B0 Gangliosides, in melanoma,406 GAS(IFN-y-activatedsites),285 Gastrointestinalsystem,lymphoid tissue in, 122 GATA-3,169,l70i 498 in Tn2 differentiation,307,308,30Bf gC (glycoproteinC-1),346 G-CSF(granuloclte colony-stimulating factor),299t,300,499 GD, ganglioside,406 GD. ganglioside,406,4151 Geneconversion,108 Generativelgnphoid organ, 4Bf,52f, 56, 498 Genereplacement,4TS Genetargeting,532-535,533f-534f Gene therapy, 475 Geneticallycontrolled immune responsiveness, 134 Geneticpolymorphism,98 Geneticsusceptibility to autoimmune diseases,432, 433436, 433f,434f,4351,436r to immediate hypersensitivity, 442, 455-456,4561 Germinal center(s) B cell selection in, 232-234,234f, 23Sf defined,498 oflymph node, 59-60,60f Germinal center reaction,228, 229f Germlineorganization defined,498 of Ig and TCR genes,t58l 159-160, 159f,l6lf Germlinetransmission,533 GITR (glucocorticoid-inducedTNFrelated) ligand,278 gld mouse strain, 427b Globulins,B0
INDEX
Glomeruloneohritis antibody-med iated' 422, 424f defined,498 poststreptococcal, 354-355,426t Glucocorticoid-induced TNF-related (GITR)ligand,278 GIyCAM-1,66 Glycocalyxmolecules, in tumor immuniry 410 Glycolipid antigens, altered, 406 Glycolipid-enrichedmicrodomains,203 Glycoproteinantigens,altered,406 G l y c o p r o t e iCn - I { g C ) 3, 4 6 GM, ganglioside,406 GM-CSF(granulocy'te-macrophage colony-stimulatingfactor),2991,300 in tumor immunotherapy,412,4l2f , 4l3t GM-CSF(granulocy'te-macrophage colony-stimulating factor) receptor family,272f Goodpasture'ssyndrome, 4231,424f gp4l, in HlV, 477,477f,479f,480f,481 gpl20, in HIV, 477, 477f, 479f,480f, 481 GP160,346 G protein(s),26, 498 G protein-coupled receptors,272,272f, 498 271t G protein signaling,by cy.tokines, Graft(s) allogeneic(allo-) defined,377,490 methods to induce donor-specific toleranceor suppressionof, 391 methods to reduce immunogenicity of, 389-391,390b,39lf autologous(auto-),376, 492 defined,375,499 skin, 375 syngeneic,377, 377f xenogeneic(xeno-),377 Graft arteriosclerosis,499 accelerated.384f.387 Graft flbrosis, 387 Graft immunogenicity, methods to reduce,389-391,390b,39lf Graft reiection,98, 991 100b,499 accelerated,384,392 activationof alloreactiveT cellsin, 380, 38l-382,3B2f acute,384-386,384f,385f,489 chronic, 384f,385f,387,493 effectormechanismsof, 382-387,384f, 385f experimentalevidenceol 375-376, 376f first-set.375.376f geneticsof, 377-378, 377f hyperacute,383-384,3B4l 3B5l 500 preventionand treatment ol 387-391, 3871,3BBf,390b,39lf immunosuppressionin, 387-389, 387t,3BBf methods to induce donor-specific in, toleranceor suppression 391 methods to reduce allograft immunogenicity in, 389-391, 390b,39lf second-set,376,376f Graft vasculopathy,387 disease(G\rHD),394, Graft-uersas-host 3941 499 effect,4I4-415 Graft-uerszs-leukemia
Granuleenzymes,in immediate hypersensitivity, 451f, a52 Granulefusion defects,473t Granulocyte colony-stimulating factor (GcsF), 299t,300,499 colonyGranulocyte-macrophage stimulating factor (GM-CSF),2991, 300 in tumor immunotherapy,412,4l2f , 4l3r Granulocyte-macrophagecolonystimulating factor (GM-CSF)receptor family,272f Granuloma(s) defined,499 in delayed-type hlpersensitivity, 3r3-314,3l4f in responseto intracellularbacteria, 360 368 in schistosomiasis, in tuberculosis,361b Granulomatousdisease,chronic, 37, 465-466,465t,493 Granulomatous inflammation in delayed-type hypersensitiviry 313-314,314f in fungal infections, 362 in responseto intracellularbacteria, 360 in tuberculosis,36lb Granulysin,319 Granzymes,42, 257b,318,318f,499 Graves'disease,422, 423I Grb-2.205,206f binder-likeprotein 2 Grb-2-associated (Gab2),449 3521 Croup A streptococci, Guanosinetriphosphate(GTP)-binding (G) protein(s).SeeG Protein(s). Gut-associatedlgnphoid tissue,naive T cell migration into, 68 Gut-homingT cells,69 disease),394, GVHD (graft-uersus-host 394f,499 H FIAART(highly active anti-retroviral therapy),486,499 Haemophilus influenzae v accine,325t, aal
Hairpin opening, inV(D)J recombination, 164,l64f HAMA (human anti-mouse antibody) response,88b H antigen,386b,393 Haplotype,499 Hapten(s),90, 114,224,499 Hapten-carrier effect,224-226, 226f Hassall'scorouscles,5B FIATmedium, and hybridomas, 77b Hay fever, 458 HCDM (Human Cell Differentiation Markers), 519-524 Heaqr chain(s),antibody,BOf,Bl-83, 811 B4f,50r isotypesof, 85-86,87t recombinationand expressionof, 172f synthesis of, 88-89 and tissue distribution of antibody, 95 Heary chain isotlpe (class)switching, 228-232,230f CD40in, 228,230-23r c1'tokinesin, 227, 228-230, 230t defined.16.499
Heavy chain isotlpe (class)switching (Continued) during humoral immune responses, 94f, 95, 216-217, 2l7f in immediate hypersensitivity,444 interferon-yin, 295 interleukin-4 in, 292-293 interleukin-13in, 294 molecular mechanismsof , 231-232, 232f HEL (hen egglysozyme),133,134 toleranceto,258,260f Helminths,365-370 adaptive immunity to, 367-368,367t, 369b Tn2 in, 304,307-309,314-315,3l5f antibody mediated clearance of, 329 defined,+99 IgE-mediatedimmune reactionto, 459 immune evasion by, 368-370, 3681,370f innate immunity to, 365-367 HelperT lymphocltes, Bl 11, l2f, 49, 501. Seealso CD4. T cells;Tsl cells;TH2 cells. in antibody responses,222-237 activation and migration toward follicle in, 224,225f affinity maturation in, 232-234, 234f, 235f antigen presentation in, 224, 226f B cell migration toward T cell zone in, 224 CD40 ligand in, 226-228,227f differentiation into plasma cells in, 234-236,236f generation of memory B cells and secondary humoral immune responsesin,236-237 germinal center reaction in,228, 229f hapten-carrier effect in, 224-226, 226f heavy chain isotlpe (class)switching in, 228-232, 230f, 230t, 232f, 233f overview of , 223-224, 223f propertiesof,237r antigen markers of, 5lb antigen presentation to, 97 in autoimmunity, 432 in B cell activation,216 in CD8. activation,192-f94, l93f defined,499 Hematopoiesis,57-58, 57f , 499 Hematopoieticcltokines, 298-300,2981 299t erythropoietin as, 300 granuloqte CSFas, 299t, 300 granulocyte-monoclte CSFas, 299t, 300 interleukin-3as,299-300,299t interleukin-7as,299,2991 interleukin-9as,300 interleukin-11as,300 monoclte CSFas,2991,300 overview of, 57-58,271 stem cell factor (c-Kit ligand) as, 298-299.298f.299t Hematopoieticmicrochimerism,245 Hematopoieticstem cell(s)(HSCs),57, 154,155f,499 Hematopoieticstem cell (HSC) transplantation,393-395,394f HemocJ,tes,30
549
55O
INDEX
Hemoglobinuria, parorysmal nocturnal, 340-341 Hemolytic anemia, autoimmune, 422, 423t Hemophagocytic lymphohistiocytosis ( H L H ) ,4 7 1 f ,4 7 3 r , 4 7 4 Hemopoietin receptors,27l, 272f Hen egg lysozyme(HEL), f33, f34 tolerance to, 258, 260f Heparin, 452 Hepatitis, vtal,42O Hepatitis A vaccine, 325t Hepatitis B vaccine, 325t,411 HepatitisB virus,353t, 364 Hepatocytes,tumor necrosis factor and, 277 Heptamer,161-f62, l63f Hereditary angioneurotic edema, 340 Herpes simplex viruses, 353t, 366b Heterophilic interactions, in Ig superfamily, S3b Heterotopic transplantation, 375 HGPR (hypoxanthine-guanine phosphoribosyltransferase),and hybridomas, TTb H, histamine receptor antagonists,451 High endothelial venules (HEVs),59, 60, 601 6st 66, 661 499 Highly active anti-retroviral therapy ([IAAR'I), 486, 499 Hinge region, of antibody molecules, 86, 861 91, 499 Histamine defined, 499 in immediate hypersensitivity, 451452 Histocompatibiliry-2 (H-2) locus, 98 Histocompatibility genes,98 Hktoplasma capsulatum, 353t, 362 HM SeeHuman immunodeficiency virus (HTV). HLA (human leukocyte antigen), 99f, f00, 101,500 HT^A.-4,107 HI-A,-B,107 H[-A,-C,107 HLA-D, IOI HLA.-DM,107,499-500 class Il-associated invariant chain peptide and, 126-128, I27 f HI-A.-DMA,TO7 Hl-d-DMB, 107 HI-A.-DO,128 HrA-DQ, t0r Htn-DR, l0l HI-A-E,4I HLA-G,108,383b HIA genes in autoimmuniry 434-435, 434f,435t in diabetes mellitus, 429b in rheumatoid arthritis, 43lb HI-A,-H,108 HLA haplotypes, extended, 434 HLA matching,390-391,390b,39rf HLH (hemophagocytic lymphohistiocytosis), 471f, 473t, 474 H-2 (histocompatibiliry-2) locus, 98 H-2M, class ll-associated invariant chain peptide and, 126-128, t27f H-2 molecule, 499 Hodgkin'sdisease,476 Homeostasis,fot, ff, l4l 500 in immune system, 260-262,262f Homeostatic proliferation, 54
Homing,64,505 of B lymphocytes, 69-70 of T lymphocytes, 65-68 Homing receptors, 65, 500 Homologous recombination, 532-533, 5331 s34f Homophilic interactions, in Ig superfamily, 83b HPV (human papillomavirus) antibodies to, 408 and malignancy, 403, 405 vaccinefor,4ll HSC(s) (hematopoietic stem cells), 57, 154,r55f, 499 HSC (hematopoietic stem cell) transplantation, 393-395, 394f HTLV-I (human T cell lymphotropic virus r), 405 immunodeficiency due to, 476 Human anti-mouse antibody GIAMA) response,88b Human Cell Differentiation Markers (HCDM),519-524 Human immunodeficiency virus (HIV), 353t,47H87,500 acute phase of, 481482, 484485, 4B4t chronic phase of, 482,484t,485 clinical features of , 484485, 4B4t clinical latency period of, 481f, 482, 482f,485 dual-tropic,479 epidemiology of , 476, 484 immune evasion by, 365, 366b immune responsesto, 481f,482f, 485-486 life cycle of, 477481, 479f, 4BOf macrophage (M-)tropic, 478, 479 molecular and biologic features of, 47H8t,477f480f pathogenesisoi 481-484, 49lf, 482f progression of, 481482, 481f,4B2f provirus of, 479 R5X4variant ol 479 reservoirsand turnover of, 484 structure and genes of, 477, 477f, 478f T cell-tropic, 478,479 transmission of, 484 treatment and prevention of, 486-487 Western blot technique for,52B X4 variant of, 479 Human immunodeficiency virus (HIV) nephropathy,4B5 Human immunodeflciency virus (HIV) wasting syndrome, 485 Humanized antibodies, 79b, 8Bb,415, 500 Human leukocyte antigen. SeeHLA (human leukocyte antigen). Human papillomavirus (HPV) antibodies to, 408 and malignancy, 403, 405 vaccine for, 411 Human T cell lymphotropic virus I (HTLV-r),405 immunodeficienry due to, 476 Humoral immune responses changesin antibody structure during, 94f to extracellular bacteria, 354, 355f general features of, 215-218,216f, 2t7f primary 217-218,2l7f regulation by Fc receptors of, 238-239, 239f secondary 217-218, 217f , 23G237 T cell-depend ent, 222-237
Humoral immune responses(Continued) affinity maturation in, 232-234, 234f, 235f antigen presentation in, 224, 226f B cell migration toward T cell zone in, 224 CD40ligand in, 226-228,227f differentiation into plasma cells in, 234-236,236f generation of memory B cells and secondary humoral immune responsesin,236-237 germinal center reaction in,228, 229f hapten-carriereffectin, 224-226, 226f heary chain isotype (class)switching in, 228-232, 230f, 230t, 232f, 233f helper T cell activation and migration toward follicle in, 224, 225f overview of , 223-224. 223f propertiesof,237t T cell-indepen denI, 237-239, 237t, 239f to viruses, 363 Humoral immunity, 6-7, 8, 8l l4l 16 defined, 500 effector mechanisms ol 321-348 historical background of, 8-9 overview of , 32I-323, 322f, 323t vaccine-induced,325t Hybridization, subtractive, 139b Hybridomas,77, 77V79b,234i 500 Hygiene hypothesis, of asthma, 457 Hyperacute rejection, 383-384, 3B4i 385f, 500 Hyper-IgM sy'ndrome,X-linked, 3 12, 518 Hyper-IgM syndromes,47Ot,47lf, 472 Hypermutation, somatic, 232-234, 234f, 235f,513 Hypersensitivity antibody-mediated (type Il), 420,420t, 42t423 effector mechanisms of, 422, 422f examples of, 422423, 423t pathologic features of , 423, 424f t1lpesol 421,42If delayed-type,3 r2-3 14, 3 l3f defined,304.495 diseasescaused by, 42543I,426f, 428t,429b43rb morphology of, 3l4f in schistosomiasis,368 in tuberculosis, 36lb immediate (type I) (SeeImmediate hypersensitivity) immune complex-mediated (type III), 420,420t, 421f, 423425 Arthus reaction due to, 425 polyarteritis nodosa due to, 426t poststreptococcalglomerulonephritis due to, 426t serum sicknessdue to, 424425,425f, 426t systemic lupus erythematosus due to, 42tf, 425,426t, 427b T cell-mediated (type fD, 420421, 420t,425432 due to cytotoxic T l}'rnphocytes,426f, 431432 delayed-type, 425431, 426f, 428t, 429b-43Ib
I ND E X
Hlpersensitivity diseases,4 I 9-439 antibody-mediated, 420,420t, 42r-423 effectormechanismsof , 422,422f examples of , 422-423, 423t pathologic features of , 423, 424f types of, 421,421f autoimmune, 432-438, 433f, 434f, 4351, 436t,437f causesand types of, 419421,420t classification of , 420-421, 420t defined,419,500 delayed-type, 425-431, 426f, 428t, 429b-43rb due to immediate hypersensitivity,420, 4201,441-461. immune complex-mediarcd, 420,420t, 42tf A r t h u sr e a c t i o na s , 4 2 5 polyarteritis nodosa as, 426t poststreptococcalglomerulonephritis as,426t serum sickness as, 424-425,425f, 426t systemic lupus erythematosus as, 42rf, 425.426t. 427b T cell-mediated,,420-421,420t, 425-432 due to cJ,totoxicT lyrnphocytes,426f, 43t-432 delayed-type, 425-431, 426f, 428t, 429b-43rb therapeuticapproachesfor, 438 Hyperthyroidism, 422, 423t Hypervariable segments,84-85, 851 139, 500 Hypogammaglobulinemias, 4701 Hypoxanthine-guanine (HGPR), phosphoribosyltransferase and hybridomas,77b I molecules,l00b Ia (I region-associated) IAPs(inhibitors of apoptosis),256b IBD (inflammatorybowel disease), 428-43t, 428t,435,502 iC3b (inactivated C3b) fragment, 33b IC,q,D(inhibitor of caspase-activated DNasel.256b ICAM-I (intracellularadhesionmolecule1),33b,35 ICAM-2 (intracellularadhesionmolecule2). 33b ICAM-3 (intracellularadhesionmolecule3). 33b ICF syndrome,4701,472 ICOS(inducible costimulator),147,196b, 197b,198 mutations|n,471f,472 IDDM (insulin-dependentdiabetes mellitus), 428,428t, 429b, 433, 4351, s03 Idiotooes,88b Idiotype(s),BBb,262,500 Idiotype network, 500 I exon,231 IFNs. SeeInterferon(s)(IFNs). Ig(s).SeeImmunoglobulin(s)(Igs). Ig-like transcript(s)(ILTs),39b Ig-like transcript-2(ILI-2), 39b Ir (invariantchain), 125-128,127f,504 IrB(s),24 IrB kinase (IKK-,24, 220 IKKY (inhibitor of rB kinase 1), 466 IL(s).SeeInterleukin(s)(ILs).
Immature B lymphocyte, l7lf, 173,174f, 500 Immediate hypersensitivity, 420,420t, 44t-461 basoohilsin binding ofIgE to, 444-445,445f mediatorsderivedfrom, 450t,45If, 452-453 morphologyof,447f properties of, 445t,447 B cells in, 444 biogenic amines in, 451452, 45lf clinical and pathologic manifestations of,442-443 cytokinesin,442,449, 4501,451f, 452-453 deflned.441.500 diseasescaused by, 45U459 allergicrhinitis as,443,458 bronchial asthmaas,443,455,456t, 457-458.457f. 458f eczemaas,455,459 food allergiesas,458-459 immunotherapy for, 459 systemic anaphylaxis as, 456-457 urticaria as,459 eosinophilsin mediatorsderivedfrom, 450t,453 morphology of,447f properties of , 445t, 453 generalfeaturesof , 442-443,442f geneticsusceptibilityto, 442, 455-456, 456t granule enzymes in, 45lf , 452 IgE in binding to mast cells and basophils of. 442. 444-445, 445f oroduction of , 442, 442f, 443-444 protectiveroles ol 459 Iipid mediatorsin, 449, 450t,451f,452, 453 mast cellsin activation of, 442, 442f, 446f, 447450, 448f binding of IgE to, 442, 442f, 444-445, 445f mediatorsderivedfrom, 450-453, 4501,45lf properties of , 445-447,445t protective roles of, 459-460 subsets of, 446-447,447t protective roles of, 459-460 proteoglycansin, 452 reactionsof, 453-455 immediate, 442f, 453-454, 454f, 455f late-phase, 442f, 454-455, 454f Tg2 cells in, 442,442f,443-444 Immediate reaction, of immediate hlpersensitiviry 442f, 453-454, 454f' 455f Immortalized cell lines, 77b-79b Immune complex(es),92, 931 500-50f solubilization of, 343 due to viruses,364 Immune complex-mediateddisease, 345b.420,420r,423-425,50r Arthus reactionas,425 glomerulonephritisas,424f poststreptococcal, 426t polyarteritis nodosa as, 4261 serum sickness as, 424-425,425f, 426I systemic lupus erythematosus as, 42li 425,426t,427b Immune deviation,486,501
Immune evasion,352 by bacteria extracellular,355, 35Bt intracellular, 358t, 362 by parasites,368-370,368t,370f by tumors,408-410,408f by viruses,364-365,3641,366b Hry 486 Immune inflammation, 310,501 Immune-mediated infl ammatory diseases,312, 420-421,420t, 425432, 426f Immune recognition, 20-26 pattern recognition molecules in, 2l-22.2lt pattern recognition receptors in, 20, zlt,22-26 cellular locationsof, 22, 22f toll-like, 22-26, 23b-24b, 25f specificity and,,2O-22,2Or,zIt Immune repertoire,153 Immune response(s) adaptive cardinalfeaturesoi 9-11, l0l IOt to HIV infection, 485 overview of, 4Bf phasesof, f3-16, f4f, l5f itimulation by innate immunitY of, 19, 44-45,45f to tumors, 407-4O8,40Bf types oi 6-9, Bi 9f cell-mediated(SeeCell-mediated immunity (CMI)) contractionof, 10i l0t, ll,26I defined,3, 501 diseasescauseby, 419-439 antibody-mediated, 420, 420t, 421-423,42If, 422f, 423t, 424f autoimmune, 432-438, 433f, 434f, 435t,436r,437f causesand types of, 419421,420t due to delayed-type hlpersensitiviry 42643 l. 428t. 429b-431b due to immediate hypersensitivity, 420,420t,441461 immune complex-mediated, 420, 420t, 42lf , 423-425, 425f, 426t, 427b T cell-mediated,,420-421,4201,422f. 425432, 428t, 429b-43rb therapeutic approachesfor, 438 diversityol 10, 10t to HIV infection, 48li 482f,485-4BG humoral (SeeHumoral immune response(s)) innate (SeeInnate immune response(s)) to microbes,overviewof, 13-16,I4l lsf primary 10,l0l 510 secondary f0, 101 512 us.self-tolerance, 244f specificityof, 9-10, 101 10t, rl termination of normal, 260-262, 262f to tumors, 406-408 adaptive, 407-408,408f evasionof, 408-410,408f innare,406-407 stimulation of, 410-414,410t, 4l If, 412f,4r3t Immune response(Ir) genes,99-f 00, 134' 455,501 Immune responsiveness,genetically controlled, 134 Immune surveillance, 397, 407, 501
551
552
INDEX
Immune system adaptive(SeeAdaptiveimmune system) cell-mediated(cellular)(SeeCellmediated immune system) cutaneous,62-63,63f, 495 defined,3, 50I evolution of, 6b-7b homeostasisin, 26O-262,262f innate (SeeInnate immune system) mucosal,63-64,641 346,347f,507 Immunity active,7, 9f, 489 adaptive(specific,acquired)(See Adaptive immunity) cell-mediated(cellular)(SeeCellmediatedimmune system) cellulartheory of, 9 defined,3, 501 humoral (SeeHumoral immunity) innate (natural,native) (SeeInnate lmmune system) neonatal,508 antibodiesin,346-347 passive,7-8, 9f, 508-509 speciflc,6 Immunization,passive,8,372, 475 Immunoassays,quantificationof antigen by, 525-527,526f Immunobinding assays,526-527 Immunoblot, 501 Immunodeficiency(ies),463-488 acquired (secondary),475-476,4Z5r AIDS as (SeeAcquired immunodeficiency syndrome (AIDS)) defined,463,489 anhidrotic ectodermaldysplasiawith, 466-467 and autoimmunity, 464 after bone marrow transplantation, 394-395 and cancer,464 common variable,4701,471f,472 congenital (primary), 464-47S, St} due to antibody deficiencies,464, 470-472,470t,47lf due to defectsin innate immunity, 464, 465-467, 465r due to defectsin T lymphoclte activation and function, 464-465, 464r,47tf , 472_474, 473t defined,463 multisystemdisorderswith, 474-475 severecombined, 467-470,467f, 468t, 5t3 therapeuticapproachesto, 475 and Epstein-Barr virus, 404b-405b general features of , 454t, 463-454 and infection, 463-464 multisystem disorders with, 47 4-47s severecombin ed, 467-47 0, 467f , 468t, 513 Immunodominant epitopes,133-134, l34i sol Immunoelectronmicroscopy,530 Immunofluorescence,501,530 Immunogens,90, 501 Immunoglobulin(s)(Igs),80, 501 during B cell maturation, 89, 90f effector functions of, 86, B7t, 94-95 propertiesol l4lt synthesis,assembly,and expressionof, BB-89,90f
Immunoglobulin c, (Igcr),89, 219,500 Immunoglobulin A (IgA) effectorfunctions of, 3231 in humoral immunity, 16 maternal,347 in mucosalimmune system,346,347f production of, 77 secreted,346,347f structureoi 85-86,B7t,BB Immunoglobulin A (IgA) deficiency, selective,470t, 47lf. 472 Immunoglobulin F 0g0), 89, 219,500 Immunoglobulin D (lgD) coexpressionofIgM and, 174,l74f effectorfunctions ol 323t membrane,215,218.21Bf structureol 86, 87t, BB Immunoglobulin (Ig) deflciency,selective, 4 7 0 t , 4 7 t f 4. 7 2 . 5 t 3 Immunoglobulin (Ig) domains,81-84,B1l 83b,501 Immunoglobulin E (IgE) in cell-mediatedimmuniry 15 effector functions of, 94, 322, 323t in immediate hypersensitivity binding to mast cells and basophils of, 442, 444-445, 445f production of, 442,442f, 443444 protectiveroles of, 459 in immune responseto parasites,368 structureof, 871.BB Ts2 cellsand, 314 Immunoglobulin (Ig) fold, 83b Immunoglobulin G (IgG) in antibody feedback,238 effector functions of, 94, 322, 323t in humoral immunitv, l6 intravenous, for hypersensitivity diseases,438 maternal,347 selectivesubclassdeficienciesol 470t structureol B0l 83, B4l 85-86,87t Immunoglobulin (lg) genes expressionof, 170,171f,l72t generationof diversityin, I67-169, l6Bf, l68t germline organizationol 1581159-160, l59f somatic mutations in, 232-234,234f, 235f transcriptionalregulationoi 165, l65f V(D)I recombinationof, I58, 160-165, r62f-165f Immunoglobulin (Ig) homology units, B3b Immunoglobulin M (IgM) coexpressionofIgD and, 174,174f effector functions of , 322, 323t i n h u m o r a li m m u n i t y ,l 6 membrane,215,2lB, U,9f, 236,236f secreted,236,236f structureof, BOf,87-88.B7t Immunoglobulin M (IgM) memory 238 Immunoglobulin (Ig) proteins,domains of, l59f Immunoglobulin (Ig) secretion, cumulative,537 Immunoglobulin (Ig) superfamily,81, 82b-83b,160.502 Immunohistochemistry,502,530 Immunologically privileged site, 502 uterine decidua as,383b Immunologicalmemory 10, l0f, 10t, 11, 14f,16,s06
Immunologicalsynapse,142,202-205,204f between cytotoxic T l1'rnphocytesand targetcell, 316,3t7f Immunologic diseases,419-439 antibody-mediated, 420,420t, 421-423 effectormechanismsof,422, 422f examples of , 422-423, 423t pathologic features of, 423, 424f tl,pes ol 421,4211 autoimmune, 432-438, 433f,434f, 435t, 436t,437f causesand types of, 479-421,42Ot classiflcation of, 420-421, 420t due to immediate hypersensitivity, 420, 420t,44t-461 immune complex-mediated,42O,420t, 423-425 Arthus reaction as, 425 glomerulonephritisas,424f poststreptococcal, 426I polyarteritis nodosa as, 4261 serum sickness as,424-425, 425f, 426t systemic lupus erythematosus as, 4 2 1 f ,4 2 5 . 4 2 6 t . 4 2 7 b T cell-mediated,420-42I, 420t, 425-432 due to cltotoxic T lFnphocytes,426f, 431-432 delayed-type, 425-431, 426f, 428t, 429b-43lb therapeuticapproachesfor, 438 Immunologic tolerance, 243-263 allograft,391 antigen recognition and, 244-245 in autoimmunity, 432, 433f, 437f B lymphocl.te, 258-260,259f, 260f, 26lt central in B lymphocytes,258,259f,260f defined,493 in T l1'rnPhocY't es, 246-248, 248f defined,243,5l5 donor-specific,391 general features and mechanisms of, 244-246,245f and homeostasis, 260-262, 262f induced by foreign protein antigens, 250f,260 oral, 260,508 peripheral, 245, 245f, 246, 509 in B lymphocytes,259-260,259f in T lymphocytes,248-2SB regulatoryT cells in, 252-253,253f therapeutic uses of, 244 T lymphocyte, 246-258, 261,t anergyinduced by recognitionof self antigen in, 249-252, 250f-252f apoptotic cell death in, 253-254, 254f, 255b-257b cDB-,254-257 central, 246-248, 248f factors that determine, 257-258. 258t peripheral, 248-258 suppression of self-reactive lyrnphocytes by regulatory T cells in,252-253.253f transgenicand knockout mouse models of,246.247b to tumor antigens,409 Immunology defined,3 historical background of, 3-4 Immunomagneticreagents,530 Immunomodulators,in vaccines,372 Immunoperoxidasetechnique,502,530
INDEX
Immunoprecipitation,502,527-528, 527f Immunoreceptortyrosine-based activation motifs (ITAMs) and activatingreceptors,40b in B cell receptorcomplex,2l9f,2I9 defined,502 in immediate hypersensitivity,444, 445f,448 in phagocytosis,325-328 in T cell receptorcomplex, 143,199 Immunoreceptortyrosine-based inhibition motifs (ITIMs),39b,40b, 238.449.502 Immunoreceptortyrosine-basedswitch motif (ITSM),148 Immunosuppression for allograftrejection,387-389,3871, 3BBf defined,502 for graft-uersus-hostdisease,394 immunodeficiencydue to, 475t, 476 Immunotherapy for allergicdiseases,458 defined,502 for tumors, 410-416 cytokinesin, 411-413,412f,4l3t passive,414-416,414f, 4I5t Immunotoxin, 415-416,502 InactivatedC3b (iC3b)fragment,33b Inbred mouse strain,502 Indirect allorecognition,3781 380-381, 502 Indirect presentation,of alloantigens, 378f,380-381,502 Inducible costimulator (ICOS),f47, 196b, 197b,l9B mutationsin,471f,472 Inducible nitric oxide slrrthase (iNOS),in phagocytosis,35f,37, 295 Inducible oromoters.247b Infection(s).SeealsoMicrobes. and autoimmunily, 432,4331436-438, 437f chemokinesrn,279-281 immunodeficiency and, 463-464 immunodeficiencydue to, 476 opportunistic, in AIDS, 484I, 485 tumor necrosisfactor in, 277 Infectiousmononucleosis,404b Inflammation, l3 in antibody-mediateddisease,422,422f chemokinesin,279-2Bl complement in, 342-343,343f cyokines in, 2BB-289,289f d.efrned,27,5O2 in delayed-type hypersensitivity,425 granulomatous in delayed-qpe hlpersensitivity, 3 1 3 - 3 1 43, 1 4 f in fungal infections,362 in responseto intracellularbacteria, 360 in tuberculosis,36lb due to humoral immune response,354 in immediate hypersensitivity, 454-455 i m m u n e . 3 I 0 ,5 0 1 interleukin-13in, 294 leukocyteaccumulationin, 35 lymphotoxin in, 296 macrophagesin, 312 migration of effector T lymphocytes to site of, 68-69 and T cell traffic, 65-66 and tumor development,416 tumor necrosisfactor rn,276,277f
Inflammatory bowel disease(IBD), 428-431,428r,435,502 Infl ammatory diseases,immunemediated, 312, 420-421, 4201, 425-432,426f Influenzavirus, 353t,363 DNase Inhibitor of caspase-activated (rcAD), 256b Inhibitor of rB kinasey (IKKI, 466 Inhibitors of apoptosis(IAPs),256b Inhibitory receptors,in T cells, 147 Injured cells,innate immune recognition of,22 iNK-T (invariantNK-T) cells,144 Innate immune response(s),l9-46 to bacteria extracellula! 354 intracellular,358,35Bf early, 13 to fungi, 362 to parasites,365-367 to tumors, 406-407 363f to viruses,363, Hry 485 Innate immune system collectinsin,2lt, 44 complement systemin, 42-43,43f component(s)oI, 27-44,27t cytokine(s) of, 270t, 273-289,274t, zggf chemokinesas,274r, 279-281,2B0r early, 13 functions of selected,268f interleukin-I as,274r, 27B-27I interleukin-6 as,274t, 287-288 interleukin-10as,274r, 287 interleukin- 12 as,274t, 281-285,2B2f interleukin- 15 as,274t, 288 interleukin- I B as,274t, 288 interleukin-23as,274I, 288 interleukin-27 as,274r, 288 and Jak-STAIsignal transduction pathway, 271, 27lt, 293b-285b overviewof, 44,270 tumor necrosisfactor as,273-278, 273f,274r,275b-276b,277f type I interferons (interferon-o and interferon- B) as,274t, 285-287, 286f defects in, 464, 465-467,465I defined,502-503 dendritic cellsin, 30 effectorcells of, 27-42,27r effector proteins of, 42-44, 43f epithelialbarriers in, 27-29, 28f evolution of, 6b-7b, l9 flcolins in,2lt,44 functions of, 19 immune recognition in, 20-26 infl ammatory responsesin, 29-42 killing of phagocyosedmicrobesin, 35f, 36-37 leukocytes in, recruitment to infection site of, 30-35,31f, 32b-34b macrophagesin, effector functions of, 37-38,37f natural killer cellsin, 38-42,3Bf, 39b-41b,42t neutrophils in,29,29f overview ol 4, 5f, 5t pattern recognition molecules of, 2r-22,42-44,43f pattern recognitionreceptorsin, 20, 21t,22-26 cellularlocationsof , 22, 22f toll-like, 22-26,23b-24b,25f
Innate immune system (Continued) pentraxinsin,2l, 4344 phagocytesin,29-42 mononuclear,29-30, 29f, 30f phagocytosisof microbesin, 35-36,35f specificity ot, 20-22, 20t, zlt in stimulatjonof adaptiveimmune responses,19, 4445, 45f iNOS (induciblenitric oxide synthase),in phagocytosis,35f, 37, 295 Inositol 1,4,5-triphosphate(IPJ, 206,503 "Inside-out signaling,"33b Insulin-dependentdiabetesmellitus 0DDM), 428,428t,429b,433,435t, 503 Insulin-resistantdiabetes,4231 Insulitis,429b Integrin(s) activation ol 33b classificationof, 33b, 34b defined,503 in leukocyterecruitment,3l-35, 33b-34b signaling by, 33b-34b structureof,33b, l38f Interferon(s)(IFNs) in early innate immune resPonse,13 tlJT,eI, 274t, 285-287, 2B6f, 517 in immune responseto viruses,363, 363f tlpe II (immune), 294 274t, 285-287,517 Interferon-cr(IFN-oc), biologic actions of, 285-287, 2BGf in innate immunity, 289 natural killer cells and, 4l oroduction of, 285 ieceptorsfor, 285 structure of, 285 in tumor immunotheraPY,413,4l3t Interferon-p 0FN-B),274r,285-287, 517 biologic actions of, 285-287, 2B6f in innate immunity, 289 natural killer cells and, 41 oroduction of, 285 recentorsfor, 285 struiture ol 285 Interferon-y 0FN-T), 250t, 294-296 in antigen presentation,130 biologic actions of , 285t, 294-296 in cell-mediated immunity, l5 for chronic granulomatous disease,466 and classI MHC expression,109,l09f defined,503 and FcyRl, 328 in immediate hlpersensitivity, 456t ln lmmune response to extracellularbacteria,354' 355f to intracellularbacteria,359,359f to parasites,367,369b in innate immunity, 2BB interleukin- 12 and, 282 in isotypeswitching,228,230t,231 in lipopolysaccharide-induced injury 356b in macrophageactivation,3lfl 312 natural killer cells and,41,42 production ol 294,305 receDtorsfor,294 struiture of, 294 in Tsl differentiation,307,308f,309f in tumor immuniry 407,408f in tumor immunotheraPY,4L3,413t sites (GAS), Interferon-y(IFN-T)-activated 285 Interferon regulatory factor (IRF),285
553
554
INDEX
Interferon regulatoryfactor-l (lRF-I), in macrophageactivation,312 Interferon regulatoryfactor-3 (IRF-3),24 Interferon regulatoryfactor-7(IRF-7),24 Interferon-stimulatedresponseelements (lSREs), 285 Interleukin(s)(lls), 267,503 Interleukin-I (IL-1), 2741,278-229, 503 biologic actionsof , 278-279 forms ol 278 in innate immunity, 288 in leukocyterecruitment,31, 35 and pentraxin synthesis,43 production of, 278 structureof, 278 in THI migration,310 tumor necrosisfactor and,274 Interleukin-1receptorantagonist(IL-lra), 279,500 Interleukin-t (IL-1) receptor-associated kinase(IRAK),24,211t, 278 Interleukin-l (lL-I) receptor-associated kinase-4(IRAK4),2iB. 467 Interleukin-1 (lL-1) receptorfamily,27l, 272f,278 Interleukin-2 (IL-2), 289-292,290t, 503 in autoimmunity,435,4361 biologic actions of, 292, 292f in cell-mediatedimmunity, I5 production of, 289 receptorfor, 290-297, 29tf structure of,290,291f in T cell activation,192 in T cell tolerance,252-253 in tumor immuniry 407,4I2-4I3, 412f, 413t,414.4t4f Interleukin-2receptoro/F (IL-2Rcr/B), in autoimmunity,435,436t Interleukin-3(lL-3), 299-300,2991,503 in tumor immunotherapy,4131 Interleukin-4 (lL-4),2901,292-293,503 biologic actions of , 292-293, 293f in immediate hypersensitivity, 444, 456t rn lmmune responseto parasites,367 in isotype switching, 228,230r.,231 productionof,292,305 receptorfor,292 structureof, 292 in Tn2 differentiation,307-309,30Bf in tumor immunotherapy,412,4l3t Interleukin-S(lL-5),2901,293,305, 503 in immediate hlpersensitiviry 444,453, 4561 in isotl,peswitching,2301 Interleukin-G (lL-6), 274t, 287-288, 503 and pentraxin synthesis,43 Interleukin-6 (IL-6) receptorfamily,272f Interleukin-7(IL-7), 299,2991,503 in lymphocyte development,155 and memory cells,55,319 and naive lymphocytes,55 Interleukin-9(IL-g),300 Interleukin- I 0 (IL-10), 274t, 287, 503 Interleukin-lI (IL-I 1),300 Interleukin-12 (IL-12),2Z4t, 28l-285, 503 biologic actionsof, 281-285,2B2f ln lmmune response to intracellularbacteria,359.359f to parasites,367,369b in innate immunity, 2BB interleukin-10 and, 287 in lipopolysaccharide-induced injury J5bD
and natural killer cells,41-42
Interleukin- 12 (IL-12) (Continued) production of, 281 structureof, 2BI in Tnl differentiation,307,3081309f in tumor immunity, 4O7,413I Interleukin-12receptor 0L-f 2R),28l Interleukin-13(IL-f 3), 290t,293-294 in immediate hlpersensitivity,444,455, 4561 Interleukin-15(IL-Il), 274t, 2BB,503 and memory T cells,319 and natural killer cells, 41-42 Interleukin- 16 (IL-16), 297 Interleukin- 17 (lL-17), 290t, 296-297, 503 in immune responseto extracellular bacteria,354 Interleukin- I 8 (IL-IB), 274t, 2BB,503-504 in Tr11differentiation, 307 Interleukin-19(IL-19),288 Interleukin-20 (lL-20), 288 Interleukin-2 I (lL-21),297 Interleukin-23 (IL-23), 274t, 288 in inflammatory bowel disease,431 Interleukin-24 (IL-24), 288 Interfeukin-25 (lL-25),297 Interleukin-26(lL-26),2BB Interleukin-27 (IL-27), 274t, 2BB Intestines,mucosalimmune systemin, 63, 64f Intimal arteritis,in allograftrejection,384 Intracellularadhesionmolecule-l (ICAM1),33b,s5 Intracellularadhesionmolecule-2(ICAM2 ) .3 3 b Intracellularadhesionmolecule-3(ICAM3), 33b Intraepidermal lymphocytes, 62-63, 63i 504 Intraepithelial lymphocytes, 144, 504 Intravenous IgG, for hypersensitivity diseases,438 Invariant chain (IJ, 125-128, 127f, 504 Invariant NK-T (iNK-T) cells, 144 Inversion,162.l63f Invertebrates,immune systemol 6b IP, (inositol 1,4,5-triphosphate), 206,503 IPEX,252-253,435, 436t lpr mouse strain, 427b, 436 IRAK (IL-1 receptor-associated kinase), 24,27tt,278 IRAK4(IL-1 receptor-associated kinase4), 278,467 I region-associated(Ia) molecules,l00b I region promoter,231 IRE SeeInterferon regulatoryfactor (IRF). IRF-3,26 IRF-7,26 Ir (immune response)genes,99-100,134, 455,501 Isotype(s),70, 504 hea'"ychain, 85-86,87t light chain, 86-87 Isotlpe defecrs,470t, 4zt-47 2 Isotype-specifi c effectorfunctions, 322-323,323t Isotype switching. SeeHeaqr chain isotlpe (class)switching. ISREs(interferon-stimulatedresponse elements),285 ITAMs.SeeImmunoreceptortyrosinebased activation motifs (ITAMs). ITIMs (immunoreceptortyrosine-based inhibition motifs), 39b,40b, 238,449, 502
Itk,202b,206 ITSM (immunoreceptortyrosine-based switch motif), l4B J Iak-STAI signal transduction pathway, cy'tokinesignaling by, 27l, 27lt, 2BI, 283b-285b Januskinases(Jaks),281,283b-285b Jenner,Edward,4, 370 Jerne,Niels, 14,262 JNK (c-Iun N-terminal kinase),206 Ioining (I) chain,88, 50+ Ioining (I) segments,504 of Ig and TCR genes,159,1591f60, 16lf IunB, in B cell activation,220 Junctionaldiversity,167-169,l68i 504 K K4Bpollubiquitination, 2 I lb K63 ubiquitination, 211b Kaposisarcomaherpesvirus (KSHV), immune evasion by, 366b Kaposi'ssarcoma,504 K/BxNmice,43lb IQ (dissociationconstant),532 Keratinocytes,62, 63f Killed bacterial vaccines, 371 Killed tumor vaccines,410-411,4l0t Killer immunoglobulin receptor (KIR) family,39b,41, 316,504 Kitasato,Shibasaburo,B Knock-in mouse models, 246,247b, 533, 537 Knockout mouse models, 246,247b, 504, 532-535,533f-534f K"o(off-rateconstant),532 Krihler,Georges,77, 77b Ko"(on-rateconstant),532 KSHV (Kaposisarcomaherpesvirus), immune evasion by, 366b Ku70,165 Ku80,165 Kupffer cells, 29 Laboratory technique(s), 525-537 for labeling and detection of antigens in cells and tissues,528-530, 531f for measurementof antigen-antibody interactions,530-532,532f for purification and identification of proteins, 527-528,527f, 52gf for purification of cells,530 for quantification of antigen by immunoassays,525-527, 526f for studying B lymphocyte responses, 537 for studying T llmphocy'te responses, 535-537 using antibodies, 525-532 using transgenic mice and targeted geneknockouts,532-535,5331 534f l.AD. SeeLeukocyte adhesion deficiency (LAD). l-A.K(ll.rnphokine-activatedkiller) cells, 506 in tumor immunity, 4O7,414, 4l4f Landsteiner,Karl, 8, 9, 93 Langerhanscells,62, 631 117-120,119b, 121f,504
Large granular lgnphocyes. SeeNatural killer (NK) cells. LAI (linker for activationof T cells),205, 206f,449 Latent membrane protein(s) (LMPs),404b Latent membrane protein I (LMPI),227 Latent membraneprotein 2 (LMP-2),f30, 505 Latent membrane protein 7 (LMP-7),130, 505 Late-phasereaction,of immediate hypersensitivity, 442f, 454-455, 454f, 504 LBP (LPS-bindingprotein), 356b Lck, in T cell activation,199,203f,504 LCMV (lymphocytic choriomeningitis v i r u s ) ,1 9 4 , 3 6 4 , 3 6 5 Lectin(s) mannose-bindrng,43, 44,335,506 mutation of geneencoding,344b as polyclonal activators, 535 Lectin pathway,of complement activation,43, 43f, 330,33li 335, 505 Legionella p neumop h ila, 353t Leishmania donouanL 367t Leishmania major 36Of, 362, 367 Leishmaniaspp,505 immune evasion by, 370 Lentiviruses,476-477 LepromatousIeprosy,360-362 Leprosy,360-362,360f Lethal hit, 505 Leukemia acute llrnphoblastic, 166b,l67b acute myelogenous,167b acute myeloid, 167b acute pre-T cell, 167b adultT cell, 405,476 in, chromosomaltranslocations 166b-167b chronic myelogenous,166b,l67b deflned,505 Leukocyte(s) Fc receptorson, 326b-328b number ol 49t polymorphonuclear(SeeNeutrophil(s)) recruitment ol 30-35,3ff, 32b-34b rollingof, 31,3lf transmigration through endothelium oi 35 Leukocye adhesion deflciency, type I (r-A,Dl), 33b,4651,466 Leukocyte adhesion deficiency (l,AD), 505 Leukoc]'te adhesion deficiency type 2 (t-{D-2), 46st, 466 Leukocyte Fc receptors, 324-328, 326b-328b Leukoc).tefu nction-associated antigen-I GFA-r),33b,316 Leukocy'tefunction-associated antigen-3 (LFA-3),r47 Leukocytelg-like receptors(LIR),39b,41 Leukotriene(s), 452, 504 in asthma,457 Leukotrieneinhibitors, for asthma,458 Lewis antigens, 386 "Licensing,"198,lg8f Light chain(s),antibody,B0f,Bl-83, Bll B4l 501-502 isotlpes of, 86-87 recombinationand expressionof, l72f surrogate,170,514
Light chain isotypeexclusion,173 Linear determinants,90, 9lf Linker for activationofT cells (l.{I)' 205' 206f,445 Lipid antigens,presentationby CDI moleculesol 116,134-135 Lipid mediators,in immediate hypersensitivity, 449, 450t, 45lf, 452, 453 Lipid rafts, 203, 219, 220 Lipopolysaccharide(LPS),354, 497, 505 physiologicand pathologicresponses to, 356b and toll-like receprcr4,24 Lipopolysaccharide(LPS)-bindingprotein (LBP),356b LIR (leukocl.teIg-like receptors),4l Lister ia mo nocytogenes, 353t cell-mediatedimmunity to, 304,3051 359-360 Listeriolysin,129 Live viral vectors,in vaccines,371,505 LL-37,28 LMP(s).SeeLatent membrane protein(s) (LMPs). Long terminal repeat (LfR), of HIV 479-480 lox? 534-535 LPS.SeeLipopolysaccharide(LPS). Lps mice, 466 L-selectin in leukocy'terecruitment, 31,32b in T cell homing, 68 L-selectinligand, on endothelialcells,66, 66f LL SeeLymphotoxin (Uf). LIR (long terminal repeat),of HIV 479480 Ly-1,175 Lyrnph, 58, 59 soluble antigens in, 121-722 Lymphatic filariasis, 370 Lymphatic system anatomy and functions of, 58-61, 59f-6lf defined,505 Lymphaticvessels,58, 59f L1'rnphnodes anatomy and functions ol 58-61, 59f-61f B cell migration into, 69-70 defined,505 naive T cell migration into, 66-68 Lymphoblast,55f Lymphocyte(s),6, 11 acuvanonor, 52,5Jr two-signal hypothesis for, 44-45, 45f in adaptive immune system, 49-56 antigen recognitionby, 14-15,f4f, Isf apoptosis in, 255b-257b B (SeeB lyrnphoc].te(s)) bare,110,473,473t,492 ol 11,l2f classes effector,47-48,48f,53f,54t, 55, 55f after encounterwith antigens,244f by history of antigen exposure,52-56, 531 s4t, 5sf homing of, 64, 69-70,505 intraepidermal,, 62-63, 631 504 intraepithelial, 144, 504 large,55f granular (SeeNatural killer (NK) cells)
L1'rnphocl'te(s) (Continued) memory 47-48,4Bf,53l 54t, 55-56, 506 morphology of, 55f in mucosalimmune system,63, 64f naive, 14-15, l4f, 47, 48f,52-55,531 54r,507 number of, 49t recirculation of, 64-68, 65f-671 505 resting,52 small, 52, 55f subsetsof, 49-50, 50t, 5lb generationol 15a,l54l 157-158, t57f surfaceproteins on, 50, 51b T (SeeTlymphocyte(s)) tumor-infi ltrating, 407 Lymphocyte development, 5L-52, 52f, 154-l5B antigen receptor gene rearrangement and expressionin, 154,154f, 155 checkoointsin, 156,156f commitment to B and T lineagesin, 154-155,154f,l55f deflned, 153,505 generalfeaturesol 154-158,l54f generationof lymphocye subsetsin, r54, I54f, 157-158,l57f selectionprocessesthat shapeB and T llnnphocyterepertoiresin, 154, 154f,155-157,1561157f transcriptionalregulationol 169, 170f Lymphoqte markers,50, sfb Lymphocyte maturation. SeeLymphoclte development. Lymphocyte migration B cell, toward T cell zone, 224 deflned,505 T cell effector,67f, 68-69,310-311,3IOf helper,224,225f m e m o r y6 9 , 3 l l naive,66, 67f into gut-associatedlYmPhoid tissue,68 to sitesof antigen,310-311,310f to sites of inflammation, 68-69 Lymphocyte recirculation, 64-68, 65f-671 505 L1'rnphocl'terepertoire, 10, 505 selectionprocessesthat shape,154, l54l 155-157,r56f, 157f Lymphocy'tetumors, chromosomal translocationsin, 165,l66b-167b L1'rnphocl'ticchoriomeningitis virus (LCMV),194,364,365 hemophagocltic, Lymphohistiocytosis, 47\f,473t,474 follicles, 505 Llrynphoid primary and secondary 59, 60f Lymphoid organs,13 peripheral (secondary),47, 48f,52f, 56-57,509 primary (generative),48f, 521 56, 498 Lymphoid tissue anatomy and functions ol 56-64 in gastrointestinal and respiratory systems,122 Lvmphokine(s),267, 505 f-ymptrokine-activatedkiller (LAK) cells, s06 in tumor immuniry 407,4I4, 414f
556
INDEX
Lymphoma B cell diffuselarge,chromosomal translocationsin, 166b,l67b Epstein-Barrvirus and, 405b in transplantpatients,389, 395 Burkitt's chromosomaltranslocationsin, l66b defined,492 Epstein-Barrvirus and, 404b chromosomaltranslocationsin, l66b-167b defined,506 follicular,chromosomaltranslocations in, 166b,167b mantle cell, chromosomal translocationsin, l66b T cell,166b adult,405,476 tissue-specifi c differentiationantigens in, 406 Lymphoproliferatives)ndrome,X-linked, 473r,474 Ll.rnphotoxin(I:t), 223,2901,296,506 and cytokineproduction, 60 in immune responseto extracellular bacteria,354 overexpression of, 6I Lysosomalvesicles, anrigenprocessingin, r24-r25, t26f,727f Lysosomes azurophilicgranulesas,29 defined,506 interferon-yand, 295 phagosomes and,,124 LYST,466 M MAC. SeeMembrane attack complex (MAC). Mac-1,338,338t Mackaness,George,9, 304,359 Macrophage(s) activationof, 37-38,37f alternative,3l4 classical,314 interferon-Tin, 294-295 T cell-mediated, 3I l-312, 3tff, 314 alveolar,29 antigenpresentationby, 56, 117,lf7f, 7t8t,722 defined,506 effectorfunctions ol 37-38,37f Fc receptorson, 326b in HIV infection,483 ln lmmune response early innate, l3 to fungi, 362 to intracellularbacteria,358,35Bl 360 in innate immune system,29-30,29f, 30f killing of phagocy'tosed microbesby, 351 36-37 maturation of, 30f morphology of, 29, 30f phagocl.tosisby, 35-36,35f recruitment of, 30-35,31f in tumor immuniry 407 types of, 29-30 Macrophageinfl ammatory protein-I cx (MIP-1o),449 in HIV infection,478
Macrophageinfl ammatory protein-I B (MIP-lp), in HIV infection,478 MadCAM-I.66.68 MAGEproteins,402 Major basic protein, 329, 453 Major histocompatibilitycomplex (MHC), 97-110,506 discoveryof, 9B-101 genomic organizationof, 107-109,108f human, 99f, 100-101 mouse,98-100,99i 100b,108 Major histocompatibilitycomplex (MHC)associatedantigen presentation, physiologic significance of, 132-134, r32f-r34f Major histocompatibilitycomplex (MHC) classII compartment (MIIC), 126, 128f,506 Major histocompatibilirycomplex (MHC) genes,98-100 in autoimmunity, 434-435, 434f, 435t classI, l0l, 108f classI-like, 108f classII, l0l, lOBf classIII, 108,1OBf propertiesof, 101 Major histocompatibilitycomplex (MHC) haplotype,I01 Major histocompatibilitycomplex (MHC) matching,390-391,390b,39lf Major histocompatibilitycomplex (MHC) molecules in allograftrejection,378-382,37Bf, 379f binding ofpeptides to, 104-107,1051 107f classL 97. 493 antigenprocessingfor presentation by, 723, 723f, 124t, 125f, 129-131, 1 2 9 f , 1 3 1 fl 3 , 2f deficiencyof, 366b,473,473t expressionof, 109 defective,473,473t and natural killer cells,38, 39b, 4f polymorphic residuesof, 103,t03f propertiesol 102-104,1021,l03f structureof, 102-104,1021,103f classIB, 108 classII, 97,494 antigenprocessingfor presentation by, 123-729, r23f, 124t, r25f-t28f biosynthesisand transport to endosomesof , 125-126,127f , l28f expressionol 109,l09f defective,473.473t with invariant chains, 126-128, t27 f polymorphic residuesof, f 03, 103f propertiesof, 102t,104,l04f structureol 102t,104,104f defined,506 expression ol 109-110,l09f defectsin, 473.473t interferon-yin, 295 polynnorphicresiduesof, f03, 103f structureoi 102-104,102t,103f,104f and T cell antigen recognition,1I4-I15, t l5f Major histocompatibilitycomplex (MHC) restriction,100,506 self,114-115,ll5f, 513 Major histocompatibilitycomplex (MHC)tetramer,507
Mal,24 Malaria,365,368, 369b,370,476 Malaria vaccine,369b Malnutrition, protein-calorie,475-476, 475t MALTI,2O7 Mammalian target of rapamycin (mTOR), 388 Mannose-bindinglectin (MBL), 43, 44, 335,506 mutation of gene encoding,344b Mannose-bindinglectin (MBL)associatedserineproteases(MASPs), .1.1f,
Mannose receptor,26, 506 Mantle cell lymphoma, chromosomal translocationsin, l66b MAP (mitogen-activated protein) kinase pathways, 507 in B cell activation,220 inT cell activation,199,2001205-206, 206f Marek'sdisease,4ll Marginal sinus,of spleen,61, 62f Marginal zone, of spleen,61, 62f, 506 Marginal zone B cells,61, 174,174f,175, 238,506 MASPs(MBL-associated serine proteases),335 Mast cell(s) connective tiss]ue,446-447447t defined,506 in immediate hypersensitivity activation of, 442, 442f, 446f, 447-450, 448f bindingof lgE to,442,442t.444-445. 445f mediatorsderivedfrom, 450-453, 450t,45lf properties of, 445447, 445t protective roles of, 459-460 subsetsof, 446-447,447t intraepithelial,29 mucosal,446,447,447t Mast cell degranulation,in allergic diseases,456 Mature B cell, l7lf, 174,I75,506 MBL (mannose-bindinglectin), 43, 44, 335,506 mutation of geneencoding,344b MBP (myelin basic protein),430b MCA (methylcholanthrene)-induced sarcoma,398,398f,401 McDevitt, Hugh, 99 M (membranous)cells,63, 64f, 506 MCP (membranecofactorprotein), 339t, 340 M-CSF (monocytecolony-stimulating factor),299t,300,507 MD2, lipopolysaccharide and.,24 Measlesvirus, immunodeficiencv due to, 476 Medawar,PereL244.37s Melanoma CTL clonesfor, 400b,401b,402 gangliosidesin, 406 tissue-specifi c differentiationantigens in, 406 Melanoma differentiation-associated gene 5 (MDAs),26,363 Membrane attack complex (MAC) defined,506 formation of, 335,336f inhibitionof. 341.342f
Membraneattack complex (MAC) (Continued) function of, 343 pathologiceffectsof, 345b structureol 336,337f Membranecofactorprotein (MCP),3391, 340 Membranous (M) cells, 63, 64f, 506 Memory,immunological, 10, 101 101,f l, l4l 16,506 Memory B cells,10,541,55 generation of,236-237 Memory cells, 10, 16,55*56 central,56, 69, 319 differentiationinto, 216,2l6f effector,56, 69, 319 Memory lyrnphocltes,47-48,4Bi 531 54t, 55-56,506 MemoryT cells,10,54t, 55-56,319 central,319 derivation of, 319 effector,319 migration ol 69, 311 Meningococcalvaccines,371 Meningococci,3531 Merozoites,369b Merozoitesurfaceprotein I (MSP-f),369b Metazoa,367t Metchnikofi Elie, 9 Methylcholanthrene (MCA)-induced sarcoma,398,3981401 MHC. SeeMajor histocompatibility complex (MHC). Microbes,351-373,352t-353t bacteriaas extracellular,352-355 adaptiveimmunity to, 354,355f examplesof, 352t-353t immune evasionby, 355,35Bt injurious effects of immune responsesto, 354-355,356b, 357b innate immunity to, 354 intracellular, 355-362, 35Bf-360f, 36rb adaptive immunity to, 358-362, 358f examplesol 353t immune evasionby, 358t,362 innate immunity to, 358,35Bf complement evasionby, 345-346 elimination of extracellular,l6 fungi as,353t,362 lmmune responseto general features of, 352 overviewof, l3-I6, 14f, 15f neutralizationby antibodiesol 323-324,324f,3251 parasitesas,365-370 adaptiveimmunity to, 367-368,3671, 369b immune evasionby, 368-370,368t, 370f innate immunity to, 365-367 phagocytosisol 35-36,35f reactions against, 419-420 vaccines for, 370-372, 37lI virusesas,362-365 adaptive immunity to, 363-364, 363f examplesof, 353t immune evasionby, 364-365,364t, 366b innate immunity to, 363,363f
Microbial toxins, neutralization by antibodies of , 323-324,324f, 325t Microglial cells,29 Migration inhibition factor (MIF), 297 MIIC (MHC classII compartment),126, 1281506 Milstein, Cesar,77, 77b Minor histocompatibilityantigens,3Bl Minor lymphocy'te-stimulating (Mls) loci, 357b MIP-ls (macrophageinflammatory protein-lcr), 449 in HIV infection, 478 MIP-1p (macrophageinflammatory protein-lp), in HIV infection, 478 Mitochondrial pathway, of apoptosis, 255b,256b Mitogen-activated protein (MAP) kinase pathways, 507 in B cell activation, 220 inT cell activation,f99,2001 205-206, 206f Mixed leukocytereaction (MLR), 101,507 Mixed l1'rnphoclte reaction (MLR)' 380, 381,3B2f Mls (minor lymphocyte-stimulating)loci, 357b MMF (mycophenolatemofetil), 387t,3BB, 389 MOG (myelin oligodendrocyte glycoprotein),430b Molecular mimicry, in autoimmunity, 437, 437f,507 Monoclonal antibody(ies),77, 77b-79b, 507 anti-CD3,387t,388 tumor-specific,4 l5-4 16,415f MonoclonalT cell populations,antigeninduced activationof, 535-536 Monocy'te(s) antigen presentation by, 56 defined,507 in innate immune system, 29 morphology ol 29, 30f number of, 49t recruitment of. 30-35.3lf Monoclte colony-stimulating factor (McsF), 299t,300,507 Monokines.267. 507 Mononuclear phagocl'tes antigen presentation by, 56 defined,507 in innate immune system,29-30,29f, 30f Mononucleosis,infectious,404b Mono-ubiquitination,2 12b Monovalency,92f Motheatenmouse strain, 239,427b Mouse mammary tumor virus, 409 M protein, 354 MRL/pr mice, 43lb MS (multiple sclerosis),428,428t, 430b, 435t MSP-l (merozoitesurfaceprotein l), 369b mTOR (mammalian target of rapamycin), 388 MUC-r,406 Mucins, in cancer,406 lymphoid tissue,507 Mucosa-associated Mucosalimmune system,63-64,64f, 346, 347f,507 Mucus production, interleukin-13in, 294 Multilineage colony-stimulating factor, 299-300,2991
Multinucleated giant cells, in HIV infection, 482 Multiple myeloma defined,507 monoclonal antibodiesin, 77, 77b-79b Multiple sclerosis(MS),428,428r,430b, 435t Multivalency, 90 MUNCL3-4.474 Mutated genesproducts, as tumor antigens,399-401 Myasthenia gr avis,422, 423t Mycobacteria,353t,361b Mycobacterium, 507 Mycobacteri um auium - intraceIIuIare, 36rb Mycobacteriu m bouis, 36lb Mycobacterium leprae,36O-362,360f, 36lb Mycobacterium tuberculosis,361b, 428, 476 Mycophenolatemofetil (MMF), 387t,388, 389 Mycoses,immunity to, 3531,362 MYC translocation, and Epstein-Barr virus, 405b MyDBB,24,27B Myelin basic protein (MBP),430b Myelin oligodendrocyte glycoprotein (MOG),430b Myeloma, multiple defined,507 monoclonal antibodiesin, 77, 77b-79b Myocarditis, autoimmune, 428t, 432 N NACHT-LRRs,26 Naive lymphocytes, 14-15, l4f, 47, 4Bf, 52-55,531 54t,507 NALPs,26 Nasopharyngealcarcinoma, Epstein-Barr virus and, 404b Native immunity. SeeInnate immunity. Natural antibodies, 175 defined.175.5O7 in innate immunity, 28-29 T1 antigensand, 238 in transplantation,384,392 Natural cytotoxicity receptors, 39b Natural immunity. SeeInnate immunity. Natural killer (NK) cells, ll, 12f, 49, 50t activating receptors ol 3B-4f, 38f, 39b-41b in cell-mediated c]'totoxiciry 42 antibody-dependent,328-329 c)'tokines and',4142 defect(s)in, 466 defective activation oi 474 defined,38, 507 effector functions of , 42, 42f Fc receptorson, 326b in immune response early innate, 13 to intracellularbacteria,358,358f 363f to viruses,363, inhibitory receptorsol 381 39b,40b, 4r in innate immune system, 3842,38f, 39b41b,42f interleukin-2 and,292 recognitionof infected and stressed cellsby, 3B-42,39b-41b in tumor immunity, 407 uterine,383b
558
INDEX
Natural killer T cells (NK-T) cells,49, 50t antigenreceptorsof, 144-745 deflned,507-508 developmentof, 185 invariant, 144 lipid antigen recognitionby, f16, 134-135 in tuberculosis,36lb Natural resistance-associated macrophageprotein I (NRAMPI), 36rb Negativeselection in centraltolerance,246, 248,24Bf defined,508 in lymphocyte maturation, 157,l57f in maturation of MHC-restrictedaB T c e l l s l, B 0 - l 8 l , 1 B 1 f in selectionof mature B cell repertoire, 175 ofthymocytes,184-l85 Neisseriagonorrhoeae,and complement deficiency, 344b Neisseriameningitidis, 353t and complement deficiency,344b NEMO (nuclearfactor rcBessential modulator),466 NEMO (nuclearfactor rB essential modulator) mutations, 47Lf,472 Neoantigenic determinants, 91,9lf NeonatalFc receptor (FcRn),347,508 Neonatalimmuniry 508 antibodiesin,346-347 Nephropathy,HIV 485 Network hypothesis,262 Neuritis,peripheral,428t Neutralizingantibodies,323-324,324f, 325t Neutrophil(s) defined,508 Fc receptorson, 326b ln lmmune response to fungi, 362 to intracelluiarbacteria,358,358f in innate immune system,29 killing of phagocltosed microbes by, 35f, 36-37 morphology of,29,29f number of, 49t phagocy.tosis by, 35-36,35f production of, 29 recruitment of, 30-35,3lf Neutrophilia,in systemicinflammatory responsesyndrome,356b NFn-LSeeNuclear factor of activated T cells (NFAT). NF-rB. SeeNuclearfactor rB (NF-rB). l/-formyl Met-Leu-Phereceptors,in innate immune system,2lt, 26 NHE (nonhomologousend joining), 155 Nitric oxide (NO) defined,508 in phagoc).tosis, 37 Nitric oxide synthase(NOS),507 inducible, 35f,37,295 Nitrogen intermediates,in phagocytosis, J/
NK cells. SeeNatural killer (NK) cells. NKG2A,39b NKG2D,38-41,4rb, 316-317 NKp30,39b NKpaa,39b NKp46,39b NK-T cells. SeeNatural killer T cells (NK-T) cells.
N nucleotides,168,f68f, 170,507 NO (nitric oxide) deflned,508 in phagocytosis,37 N O D 2 , 4 2 B4, 3 5 Nod-like receptors(NLRs),in innate immune system,21t, 26 Nonamer,162,l63f Nonhomologousend joining (NHE), f 55 Nonhomologousrecombination,533f Nonobesediabetic (NOD) mouse model, 429b,433,436 Nonpoll'rnorphic genes,98 Nonreactivity,to self, lOt, ll Nonresponderstrains,100 Northern blotting, 528 NOS (nitric oxide synthase),507 inducible, 35f, 37, 295 Notch proteins, 169,l70f NRAMPI (natural resistanceassociated macrophageprotein 1), 36Ib N region(s),139 N region diversification,168-169,16Bt Nuclear factor rB (NF-rB) in B cell activation,220 defined,508 in immediate hl,?ersensi t iviry,449 in macrophageactivation,312 inT cell activation,208f,209 and toll-like receptor, 24, 26 Nuclearfactor rB essentialmodulator (NEMO),466 Nuclearfactor rB essentialmodulator (NEMO)mutations,471f,472 Nuclearfactor rB (NF-rB) signaling, inherited defects in, 466-467 Nuclear factor of activated T cells (NFAT) cyclosporineand, 388 defined,508 in immediate hypersensitivity, 449 inT cell activation,208-209,208f Nucleatedcells,antigenpresentationby, 122 Nude mouse,469, 508 NZB mouse strain,427b
o O antigen,3B6b Off-rateconstant (K"rt, 532 oKT3, 388 Omenn'ssyndrome,469 Omi/HtrM,256b Oncofetalantigens,405-406,508 Oncogenes,398 Oncogenicviruses,antigensof, 403-405, 404b-405b One gene-onepolypeptidehypothesis, 158 On-rateconstant(K""),532 Opportunisticinfections,in AIDS,484t, 485 Opsonins defined,508 in phagocl.tosis,36,42 Opsonization,9, 508 antibody-mediated, 36, 324, 325f in antibody-mediateddisease,422,422f complement in, 341,343f Orai, 206 Orail mutation, 469 Oral antigens,immune responsesto, 63-64 Oral tolerance,260,508 Orthotopic transplantation,375
Osteoclasts, 30 Overexpression, in transgenicmice, 532 OX40ligand, 278 P pI50,95,338,33Bt PAF (platelet-activating factor),452,509 PAL(s)(periarteriolarlymphoid sheaths), 6r,62f,228,509 PAL (periarteriolar llnnphoid sheath) foci, 228 PAMPs(pathogen-associated molecular patterns),20, zIt, 25f, 28 Panethcells,28 Papovaviruses,and malignancy, 403 Paracortex,oflymph node, 59, 60f Paracrinefactors cytokines as, 269 defined,508 Parafollicular cortex, of lymph node, 59, 60f Parasites,365-370 adaptiveimmunity to, 367-368,367t, 369b immune evasionby, 368-370,368t,370f innate immunity to, 365-367 Paroxysmalnocturnal hemoglobinuria, 340-34r Partialagonist,508 Passiveimmunity, 7-8, 91 508-509 Passiveimmunization, B, 372,475 Passiveimmunotherapy, for tumors, 414-416,4I4f,4t5t Pasteur,Louis, 371 Pathogen-associated molecularpatterns (PAMPs),20,21t, 25f,28 Pathogenicity,509 Pattern recognition molec;.lJes, 2l-22, 2tt cell-associated , 2l-26. 2It soluble (circulating),2lI, 22, 42-44 Patternrecognitionreceptors,20, zlt, 22-26,509 cellularlocationsof . 22. 22f encodingin germline DNA of, 22 in phagocytosis,36 toll-like, 22-26,23b-24b,25f Pax-S,170f PCR(polymerasechain reaction),510 PD-1.SeeProgrammeddeath-l (PD-1). PDKI,200 Pemphigus r,rrlgaris,423t, 435t Penicillin alleryy,444 Pentraxins defined,509 in innate immune system,21,43-44 Peptide-bindingclefts,f06, I07l 509 Peptide-MHCcomplex, 104-107,105f, r07f binding of T cell receptor to, 140-142, t41f classI, 131 class II, 128-129 T cell recognitionof, 97, 9Bf Peptide-MHCinteractions,104-I07, 1051 107f Peptide-MHCtetramers,536 Percentreactiveantibody (PRA),390b Perforin,42, 257b,3f8, 3IBl 509 Perforindeficiencies,4731 Periarteriolarlymphoid sheath(s)(PALs), 61,62f,228,509 Periarteriolar lymphoid sheath (PAL)foci, 228
INDEX
Peripherallymphoid organs,47, 48f,52f, 56-57,509 Peripheralneuritis, 4281 Peripheralnode addressin(PNAd),66 Peripheral tolerance, 245, 245f, 246, 509 in B l1'rnPhocY'tes, 259-260, 259f in T lyrnphocyt es,2 48-258 Perniciousanemia,423t Perox]'nitrite radicals, in phagocytosis,37 Peyer'spatches,63,641 122,509 Pfs25,369b PGD, (prostaglandinDr), 452 PHA (phytohemagglutinin),509535 Phagedisplay, 79b Phagoclte(s) defective microbicidal activities of, 465-466 disordersof, 465-467,465t rn Immune resDonse adaptive,13,303-304 to extracellularbacteria,354 to intracellularbacteria,358,358f in innate immune system, 29-42 mononuclear,29-30,291 30f mononuclear antigen presentationby, 56 defined,507 in innate immune system,29-30,29f, 30f PhagocyteFc receptors, 324-328, 326b-328b Phagocyteoxidase (phox), 36-37, 328 in chronic granulomatousdisease,455, 465 Phagocyteoxidase91 (phox-9l), 465 Phagocytosedmicrobes, killing of, 35f, 36-37 Phagocytosis,7, 8f antibody-mediated, 324-329, 325f, 326b-328b,329f in antibody-mediateddisease,422, 422f complement in, 34l-342, 343f defined,509 in immune responseto parasites,365 of microbes,35-36,35f Phagolysosomes, 35f, 36 Phagosomes, 35f, 36, f24, 509 Pharlngeal tonsils, 122 PH (pleckstrin homology) domain, 202b PHFl I, in immediate hlpersensitivity, 456t Philadelphiachromosome,l67b Phosphatase, 509 Phosphatidylinositol-3(PI-3)kinase,200 Phosphatidylinositoltriphosphate(PIP3), 200 PhospholipaseC (PLC),in B cell activation, 220 PhospholipaseCy (PLCy),449, 509 PhospholipaseCyl (PLCyr),206,207f phox (phagocyte oxidase),36-37, 328 in chronic granulomatousdisease,455, 465 phox-91 (phagocl'teoxidase91),465 Physiologic cell death, 5lO. Seealso Apoptosis. Phy'tohemagglutinin (PHA), 509, 535 PI-3 (phosphatidylinositol-3)kinase,200 PIP3(phosphatidylinositoltriphosphate), 200 PKC (protein kinaseC), 511 PKC-B,in B cell activation,220 PKC (protein kinase C) pathway, in T cell activation, 199,2001 208-209, 209f
PKC-g,204f,207 PKR,in immune responseto viruses,363 Plasmacells in bone marrow 58 defined,509 differentiation into, 2 16, 234-236, 236f in humoral immunity, 16 long-lived,235,322 morphology ol 55, 55f short-lived. 234-235.322 Plasmacytoiddendritic cells,30 Plasmapheresis, for hlpersensitMty diseases,438 PIasmodium berghei, 369b PLas modium falc ip ar u m, 369b Plasmodiumspp, 367t,368,369b Platelet(s),in allograftrejection,384 Platelet-activating factor (PAF),452,509 PLC (phospholipaseC), in B cell activation,220 (phospholipaseC!, 449,509 PLC^y PLCyI (phospholipaseCTI), 206,207f Pleckstrinhomology (PH) domain, 202b PLP (proteolipidprotein), 430b Pluripotentstem cells,154,l55f leukocltes). PMNs (poly'rnorphonuclear SeeNeutrophils. PNAd (peripheral node addressin),66 Pneumococcalpneumonia vaccine,325t, 371 Pneumococci,352t Pneumocystisj irouecipneumonia, 362, 472 PNP (purine nucleosidephosphorylase) deflciency,468t,469 P nucleotides,139,168,1681508 pol gene,of HIV a78f,480,48I, 485 Polio vaccine,3251 Polio virus, 3531 Polyarteritisnodosa,426t Polyclonal activation of B cells,537 ofT cells,535 Polyclonalactivators,357b,509,535 PolyclonalB cell populations,antigeninduced activation of, 537 PolyclonalT cell populations,antigeninduced activation of, 535 Poly-Igreceptor, 346,347f,509-510 Pollmerasechain reaction (PCR),5f0 Polgnorphic genes,98 Hl-A.,t0l Poly'rnorphicresidues,of MHC molecules, 103.103f.108 Polymorphism,3TB, 510 Polymorphonuclearleukocytes(PMNs). SeeNeutrophils. Polysaccharidevaccines,238 Polyrrbiquitination,2 I lb Polyvalency,90,91-92,92f, 510 Polyvalentantigens,238 Porter, Rodney,83 Positive-negative selection,533 Positive selection defined,156,510 lack of. 180.lBlf in l1'rnphocytedevelopment,156-157, 157f in maturation of MHC-restrictedo0 T c e l l s . 1 8 0l .B l f peptidesin, lB3-184, l83f of thymocytes,lBl-184, lBzf glomerulonephritis, Poststreptococcal 354-355,426t
Poxviruses,365 PPD (purified protein derivative),361b PRA (percent reactive antibody), 390b Pre-Bcell(s),89,90f,170,r7rf, r74f,510 Pre-Bcell receptor,156,1561170-173, 173f,510 Pre-Bcell receptorcheckpointdefects, 471 T lymphocyte (pre-CTL), Pre-c1'tol1.tic 510 Pre-To',177,510 Pre-Tcell(s),176f,177,510 Pre-T cell leukemia, acute, chromosomal translocationsin, l67b Pre-Tcell receptor,137-138,156,f56l 173f.t77-178.5t0 Pre-TCRcheckpoint signaling, defective, 468t,469 Primary immune response,f 0, f 0l 510 Primary immunodeficiency(ies). See Congenita-limmunodefi ciency(ies). Primary lymphoid follicles, 59, 60f Pro-Bcell,169,fTfi 174f,510 Programmedcell death, 5I0. Seealso Apoptosis. Programmeddeath-1 (PD-1),196b,197b, 2L0 in contractionof immune response, 261 in T cell inhibition, 147 in T cell tolerance, 250-251 Proliferation assays,for T llmphocl'tes, 536-537 Promoter,510-511 Properdin,330-33l, 3321 deficiencyin, 344b 51I Prostaglandin(s), ProstaglandinD2 (PGD), 452 Pro-T cells, 776f,177,5ll Protease(s) in antigen processing,124,125 deflned,511 Proteaseinhibitors, for HIV infection, 486 Proteasome,129-130,I29f, 5f l Protective immunity, antibody-mediated, 32t-329,322f Protein(s), purification and identification of, 527-528,527f.,529f Protein antigens antibody responsesto, 222-237 affinity maturation in, 232-234, 234f, 235f antigen presentation in, 224, 226f B cell migration toward T cell zone in, 224 CD40ligand in, 226-228,227f differentiation into plasma cells in, 234-236,236f generationof memory B cellsand secondary humoral immune responsesin,236-237 germinal center reaction in,228, 229f hapten-carriereffectin, 224-226, 226f heary chain isotype (class)switching in, 228-232, 230f, 230t, 232f, 233f helper T cell activation and migration toward follicle in, 224, 225f overview of , 223-224, 223f propertiesof,237t immunogenicity ol 133-134,l34f
559
560
INDEX
Protein-caloriemalnutrition, 475-476, 4751 ProteinkinaseC (PKC),511 Protein kinase C (PKC)pathway, in T cell activation, 199,200f, 208-209, 209f Protein phosphatase,509 Protein tyrosinekinases(PTKs) activation of, 199-202,20lb-2o2b, 203f defined,5lI Protein tyrosinephosphatases(PTPs), 202b Proteoglycans, in immediate hypersensitivity,452 Proteolipidprotein (PLP),430b Proto-oncogenes,166b as tumor antigens,398 Protozoa,365-370 adaptiveimmunity to, 367-368,3671, 369b def,ned,5ll immune evasionby, 368-370,368t,370f innate immunity to, 365-367 Provirus,of HIV 479,5ll P-selectin,in leukocyterecruitment,31, 32b P-selectin glycoproteinligand-l (PSGL-I), 32b Pseudogenes, l0S p-SMAC,20s PTKs(protein ty'rosinekinases) activation of, 199-202,20lb-202b, 2O3f defined,5ll PTP(s)(protein tyrosinephosphatases), 202b PTPN22,in autoimmuniry,435,436t PTX3,in innate immune system,43-44 Purification of cells,530 of proteins, 527-528,527f,52gf Purifled antigenvaccines,371,511 Purified protein derivative(PPD),361b Purified protein vaccines,371 Purifiedtumor antigens,410t,4l I Purine nucleosidephosphorylase(PNP) deficiency,468t,469 Purine salvagepathways, defects in, 468-469,46Bt Purpura,autoimmune thrombocl.topenic, 422,423r Pyogenicbacreria,352,51. Pyrogens,356b R Rab3,449 RA827A,474 Rabiesvirus, 353t Rac,205,511 Radiation therapy, immunodeficiency due ro,475t Radioimmunoassay(RIA),5ll, 525-526, 526f RAG.SeeRecombination-activating gene (RAG). RANK (receptoractivatorof NF-KB),278, 43lb RANK (receptoractivatorof NF-rB) ligand, 278 RANTES,in HIV infection, 478 Rapamycin,387t,3BB,389 Ras,511 Ras-MAPkinasepathways in B cell activation,220 in T cell activation,199,200f,205-206, 206f
Reactiveorygen intermediates(ROIs), 295,5l I complement and,,342 Reactiveoxygen species (ROS) in chronic granulomatousdisease,465, 465t fungicidal,362 in macrophageactivation,3f lf,312, 361b in phagocytosis,36-37, 295, 328 Reagin,454,5ll Reaginicantibodies,454 Receptoractivatorof NF-rB (RANIC,278, 43lb Receptor activator of NF-rB (RANK) ligand'27B Receptor-associated kinases,in cytokine signaling,271t Receptorediting in B cells,173,175,258 defined,5ll-512 in immunologic tolerance,246 in negativeselection,157 Recipient,375 RecirculatingB cells, 174,218 Recombination homologous,532-533,533f,534f nonhomologous,533f somatic,5f3-514 v(D)J,r58, 160-r6s,162f-1651r77-r80, 179f defectsin, 468t,469 Recombinationactivatinggene t (RAGI), deficiency of, 468t, 469 Recombination-activating gene I (RAGI), 164-165,I75,512 Recombination activating gene 2 (RAG2), deficiencyoi 468t,469 Recombination-activating gene2 (RAG2), 164-165,175.5r2 Recombination activating gene (RAG) proteins,expressionof, 169-170,lTll r76f,177 Recombinationsignalsequences(RSSs), 1 6 1 - 1 6 21. 6 3 f . 5 1 2 Redpulp, 62,62f,5I2 RegulatoryTcells,11, 121 49, 50t defined,512 developmentof, 245f,246,248,24Bf generationof, 197 interleukin-2 and.,292 natural, l97 suppressionof self-reactive lymphocytes by, 252-253, 253f in tumor immunity, 409 Rejection, allograft accelerated,384 activation of alloreactiveT cells in, 380, 381-382,382f acute,384-386,3B4l 3851489 chronic, 38413851 387,493 effectormechanismsof, 382-387,3B l 3B5f experimental evidence of, 375-376, 376f first-set.375.376f geneticsof, 377-37B, 377f hyperacure,383-384,3B4l 385f,500 preventionand treatment of, 387-391, 3 8 7 t , 3 8 8 f3, 9 0 b . 3 9 l f immunosuppressionin, 387-389, 387t,388f methods to induce donor-soecific loleranceor suppression in, 391
Rejection,allograft,prevention and treatment of (Continued) methods to reduce allograft immunogenicity in, 389-39l, 390b,39tf second-set,376,376f Renaltransplantation graft rejection in, 384f HLA matching in, 390-391 induction of donor-specific tolerance in, 391 Repairtissue,macrophagesand, 312 Respiratory burst defined,512 in phagocltosis,36 Respiratory distresssyndrome, adult, 356b Respiratorysystem,lgnphoid tissuein, 122 Resoonderstrains.100 Resiing lymphocytes, 52 Reticular dysgenesis,468t,470 Retinoicacid-inducible gene-I (RIG-I),26 in immune responseto viruses,363 Retroviruses,405 Reversetranscriptase,477, 480,485,512 Reversetranscriptase inhibitors, 486, 5I2 Reverse-transcriptase polymerasechain reaction (RT-PCR), 5f2 Revprotein, in HIV geneexpression,480 RF-3,24 Rh (rhesus)antigens,386b,393,512 RhD-immune antibodies,393 Rheumaticfever.354.437 acute,4231 Rheumatoid arthritis, 428,428t, 431b, 435r,5t2 Rheumatoidfactors.BBb.43Ib Rhinitis, allergic, 443, 458 RIA (radioimmunoassay),5ll, 525-526, 526f Ricin, in tumor immunotherapy,415 RIG-I (retinoicacid-inducible gene-I),26 in immune responseto viruses,363 RNA helicases,in immune responseto viruses,363 RNaseprotection assay,512 RNA tumor viruses, 405 RNA viruses, immune responseto, 364 ROIs (reactiveoxygenintermediates),295, 5ll complement and,342 ROS.SeeReactive oxygenspecies(ROS). RSSs(recombinationsignalsequences), 161-162.l63f. sl2 RT-PCR(reverse-transcriptasepolymerase chain reaction),512 S S I P I ,6 8 SAA (serum amyloid A) protein as acute-phasereactant,356b defined,513 Sandwich assay,526, 526f SAP(SIAM-associatedprotein), mutations in.471f.474 SAP(serum amyloid P), in innate immune system,43 protein) kinase,206 SAP(stress-activated Sarcoma Kaposi's,504 MCA-induced,398,398f,401 Sca-1(stemcell antigen-1),57 Scavengerreceptors defined,512 in innate immune system,2lt, 26
Schistosomamansoni, 367t Schistosoma spp, 3671 Schistosomes, immune evasionby, 368-370 Schistosomiasis, 365,368 SCID mouse, 469.512 SCIDs.SeeSeverecombined immunodeficiency(ies)(SCIDs). SCIN (staphylococcalcomplement inhibitor), 345-346 (sodium dodecyl SDS-PAGE sulfate-polyacrylamide gel electrophoresis), 528,529f Secondaryimmune responses,).0,512 Secondarylymphoid follicles,59, 60f Second-setrejection,376,376f, 5152 Secretorycomponent, 346,512 Selectin(s) defined,512-513 in leukocyterecruitment,31, 3ll 32b Selectin-selectin ligand interactions,31 SelectiveIgA deficiency,47Ot,47If, 472 SelectiveIgG subclassdeficiencies,470t Selectiveimmunoglobulin defi ciency, 4 7 0 t ,4 7 t f , 4 7 2 , 5 1 3 Self,nonreactivity to, l0t, I t Self antigens anergy induced by recognition of, 249-252,250f-252f in autoimmunity, 432 in B cell tolerance,259 in T cell tolerance, 245, 246, 257-258, 25BI SelfMHC restriction,Il4-115, 1f5f, 5f3 Self-peptide-MHCcomplexes,128-129 Selfrecognilion,in innateimmune system,21 Self-tolerance,ll in autoimmunity, 432, 433f, 437f B lyrnphocyte, 258-260, 259f, 260f, 26It central, lB4-185,245-246,245f in B lgnphocytes, 258, 259f, 260f defined,493 in T lymphocytes, 246-248, 248f defined,243,5I3 general features and mechanisms of, 244-246,245f importance of, 243-244, 244f normal immune responseus.,244f peripheral,245,245f,246,509 in B lyrnphocytes,259-260,259f in T lymphocytes, 248-258 regulatory T cells in, 252-253, 253f T lymphocyte, 246-258, 26lI anergy induced by recognition of self antigen in, 249-252, 250f-252f apoptotic cell death in, 253-254, 254f, 255b-257b cDB.,254-257 central, 246-248, 248f factorsthat determine,257-258, 258t periphera-I,248-258 suppressionof self-reactive lgnphocytes by regulatory T cells in,252-253,253f to tumor antigens,409 9, 312-313,3l3f Sensitization, Sepsis,356b Seoticshock denneo,5rJ due to humoral immune response,354, 356b tumor necrosisfactor in, 277-278,277f, 354
Serglycin,3lB, 3l8f Seroconversion, 513 Serology,76, 513 Serotype,513 Serum,76,513 Serum amyloid A (SAA)protein as acute-phasereactant,356b defined,513 Serum amyloid P (SAP),in innate immune system, 43 Serum sickness,424-425,425f, 426t, 513 Seventransmembranecr-helical receptors,272,272f Severecombined immunodeficiency(ies) (SCIDs), 467-470,467f, 468t, 5r3 due to defective pre-TCR checkpoint signaling,468t,469 due to defective thymus development, 468t,469 due to defects in cytokine receptor signaling, 467-468,468t due to defects in purine salvage pathways, 468-469,46Bt due to defectsinV(D)l recombination, 468r,469 reticular dysgenesisand, 468t,470 X-linked,155,467-468 SHI (Srchomology l) domains,202b SH2 domain-containinginositol phosphatase(SHIP),202,202b,238, 449 SH2 (Srchomology 2) domains,20o,zoIb, 202b,514 SH3 (Srchomology 3) domains,201b, 202b,5r4 Shizonts,369b Shock anaphylactic, 456-457, 49O septic (endotoxin) defined,513 due to humoral immune response, 354,3536b tumor necrosisfactor in,277-278, 277f,354 sHP-r, 39b,202,202b in autoimmunity, 436t sHP-2,39b,202,202b Shwartzmanreaction,513 Sialicacids,in evasionof complement, 345 Sialomucins,66 Sialyl Lewis X, 466 Signaling lyrnphocyte activation molecule (stAM), r4B,474 Signal transducers and activators of transcription. SeeSTAI(s) (signal transducersand activatorsof transcription). sIGN-Rr,333,339,342 Simian immunodeficiencyvirus (SIV), 4BU4B7,5t3 Single-positivethymocyte,176f,180,f80f, 513 SIRS(systemicinfl ammatory response syndrome),356b,514 Skin grafting,375-376,391 Skin-homingT cells,69 SLAM (signaling lymphocye activation molecule),I4B,474 protein (SAP), SLAM-associated mutations in. 4711.474 SLE.SeeSystemiclupus er)'thematosus (sLE).
Slow-reacting substanceof anaphylaxis (SRS-A), 452 SMAC (supramolecular activation cluster), 142, 202-205, 204f Smac/Diablo,256b Smads,296 Smallpox,3-4, 513 Smallpoxvaccination,4, 370 SNAREproteins,449 Snell,George,98, 378 SOCS(suppressorsof cytokine signaling), 284b-285b Sodium cromol]'n, for asthma, 458 Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE),528, 529f Solubleantigens,l2L-122 Somatic h)?ermutation, 232-234, 234f, 235f,s13 Somaticmutations,93, 232 Somaticrecombination,513-514 Sos,205,206f,220 Southernblot, 514,528 SIP (sphingosinel-phosphate),68 SP-A(surfactantprotein-A),44 SP-D(surfactantprotein-D), 44 Specialization,l0t, ll Speciflc granules, in neutrophils, 29 Specific immunity. SeeAdaptive immunity. Specificity of antibodies,93 defined,514 in immune recognition,20-22,20t, 2lr of immune response,9-10, fOl 10t, 11 and immunologic tolerance,244-245 Sphingosinel-phosphate (SlP), 68 Spleen anatomy and functions of,6l-62,62f in antigen captrre,122 B cell migration to, 69 defined,514 naive T cell migration into, 68 Splenectomy,immunodeficiency due to, 475t,476 Splenic artery, 61,62 Spondylitis, ankylosing, 434, 435t Soorozoites,369b S protein, 341,342f Squamous cell carcinoma, in transplant patients,389 SRB1,26 Src family,20lb Srchomology I (SHI) domains,2O2b Src homology 2 (SH2)domains, 200,201b, 202b,5L4 Srchomology 3 (SH3)domains,201b, 202b,5r4 SRS-A(slow-reactingsubstance of anaphylaxis),452 Staphylococcalcomplement inhibitor (scIN), 345-346 Staphylococcalenterotoxins, 357b Staphylococcusaureus, 352t STAI(s) (signal transducers and activators of transcription),281,283b-285b, 5I3 sTATl, 307,308f in macrophage activation, 312 sTAr4, 307,30Bf STAT6 in immediate hypersensitivity,456t in Ts2 differentiation,307,308,308f
562
INDEX
Stemcell(s),57,514 pluripotent (hematopoietic),154,l55l 499 Stem cell antigen-1(Sca-l),57 Stem cell factor,298-299,298f,299t in immediate hlpersensitivity, 456t Stem cell transplantation,393-395,394f Streptococcuspyogenes,3521 Stress-activated protein (SAP)kinase,206 Stressedcells,innate immune recognition of,22 Strominger,Jack,102 Subcapsularsinus,oflymph node, 59, 60f Subtractivehybridization, l39b S u b u n i tv a c c i n e s3,7 1 ,5 l I Superantigens, 354,357b,514,535 Superoxide,in phagocyosis,36 Suppressorsof cytokine signaling(SOCS), 284b-285b SuppressorT cell, 514 Supramolecularactivationcluster (SMAC),r42, 202-205,204f Surfaceproteins,on lymphocytes,50, 5lb, 54r Surfactantprotein-A (SP-A),44 Surfactantprotein-D (SP-D),44 Surrogatelight chains, 170,514 Susceptibility loci, for auloimmune diseases,433-436,4341435t,436t SV40virus, and malignancy, 405, 409 Switch recombination, 231, 514 Switchregions,231,233f Syk,200,20Ib-202b, 2rg Synapsis,inV(D)l recombination,164, r64f Sgrcytia formation, in HIV infection, 482 Syngeneicgrafts,377, 377f , Sl4 Syrrgeneicstrains,98, 514 Syntheticantigenvaccines,371, 514 Systemicanaphylaxis, 456-457 Systemicinfl ammatory response slndrome (SIRS),356b,514 Systemiclupus erythematosus(SLE),42\f, 426t,427b animal models of,427b clinical featuresof, 427b defined,514 Hl-A allele in, 435t immune complexesin, 425 pathogenesisof,427b pathologic features of , 424f T TACI in B cell activation,218 in isotypeswitching,231 TACI (transmembrane activator and CAML interactor),297 MCI gene,mutations in, 228-230,47lf , 472 Tacrolimus,387,387t.388 T activation (Tac)antigen,291 Tail pieces,BB TAKI (transforming growth factor pactivatedkinase| ). 24 TALt, r67b Talin, 204f TAP (transporterassociatedwith antigen processing), 107,129f,130-131,l3ll 516 mutations in, 473 Tapasin,f29f, 131,13ff Thrget cells, killing by cltotoxic T l1'rnphocytes of, 317-319,3l8f
Targetedgene knockouts, 532-535, 533f-534f Targetingvector,532,533,5331534f Target of antiproliferative antibody-l (TAPA-1),338 in B cell activation,220-221,221f Tat protein, in HW infection, 480,483 T-bet,307,308i 514 TBKI,24 T box-l (TBXI), 469 T cell(s) accessorymoleculesol l38, f38f, 145-148,t45f-t47f in adaptiveimmuniry 7,8f, LI in allograft rejection, 384-386 oB developmentol 180-185,lSlf-l83f origin of, f54, 155f antigen competition for, 105,l05f antigen receptors of, 49, 137-145 antigenrecognitionby, f4-f5, ll4-116, n4t, llsf, 116f calcium- and PKC-mediatedsignaling pathways tn, 2O6-207,207f classesof, l21 49-50,501,5lb coreceptorsin, 145-146,145f,l46f costimulatoryreceptorsin, 145,I45l 14UI48, t47f cltotoxic (cytolltic), Bf, ll, l2l 49,50t, 315-319(Seealso CD8*T cells) activationof, 316-3f7, 317f defective,474 in adaptive immune response,13 in allograftrejection,386 antigenmarkersof, 5lb antigen presentationto, 97 antigen recognitionby, 316 in cell-mediatedimmunity, 15-16 defined,495 diseasescausedby, 426f,431-432 in immune responseto viruses, 363-364,365,366b killing of target cells by, 3 17-319, 3rBf MHC restrictionof, 114-115, I l5f pre-,510 tissueinjury due to, 364 in tumor immunity, 407, 40Bf defined,515 deletion of, 246, 248f, 253-254, 254f double-negative,177,f BOf double-positive,176f,178-180,180f, lBl effector, 4Bf. 53 activationol 190,l90f antigenpresentationto, 122 characteristicsoi 54t migration of, 67f, 68-69,310-311, 3l0f 16,49, 50t, 63 developmentof, 185 origin of, 154,l55f in tuberculosis,361b generationof diversityin, 167-169, 1681168r helper,8l ll, 12f,49,SOt(Seealso CD4* T cells;Tsl cells;Ts2 cells) in antibody responses,222-237 activation and migration toward follicle in. 224.225f affinity maturation in, 232-234, 234f,235f antigen presentation in, 224, 226f
T cell(s) (Continued) B cell migration toward T cell zone in,224 CD40Iigand in, 226-228,227f differentiation into plasma cells in, 234-236,236f generation of memory B cells and secondary humora.l immune responsesin,236-237 germinal center reaction in,22B, 229f hapten-carriereffectin, 224-226, 226f heary chain isoty?e (class) switching in, 228-232, 230f, 230t.232f,233f overview of, 223-224, 223f propertiesof,237t antigen markers of, Slb antigenpresentationto, 97 in autoimmunity, 432 in B cell activation,216 in CDB*activation,192-194,f93f defined,499 homing of, 65-68 immature, l76f in immune responseto intracellular bacteria,358-362,35Bf-360f inhibitory receptorsin, 147 inhibitory signaling in, 209-213, 210f, 2rLb-2r2b,2r2f in l1'rnPhnodes migration ol 66-68,67f sequestrationof, 59-60,60f, 61, 61f MAP kinase signaling pathways in, 205-206,206f mature, l76f memory 10,54t,55-56,319 naive, 14-15,I4f,54t antigenpresentationto, ll7-122, rtTf migration of, 66, 67f natural killer, 49, 50t antigen receptors of, 144-145 defined,507-508 developmentof, 185 invariant, 144 lipid antigen recognitionby, f16, 134-135 in tuberculosis,36lb polyclonal activation of, 535 pre-, 1761177,5r0 pro-, 176f,177, 5I1 proliferation assaysfor, 536-537 properties of antigens recognized by, 1 1 4 - 1 1 6l ,l 4 t , 1 1 5 f recirculation ol 65-68, 65f-67f regulatory f f, lzf, 49, 50t defined,512 development of , 245f, 246, 248, 248f generation of, 197 interleukin-2 and.,292 natural, l97 suppressionof self-reactive l5.rnphocytes by, 252-253, 253f in tumor immunity, 409 responseto antigen by, 132-f33, 133f single-positive,176f,180,l80f specificityfor cell-bound antigensoi 132-133 in spleen,61,62f suppressor,514 surveillance for foreign antigens by, r32, I32f
T cell(s) (Continued) transcription factor activation in, 207-209,208f in tumor immuniry 407-408,40Bf T cell activation,l4f, l5-16, IB9-213 adapterproteins in, 205 alloreactive,380,381-382,3B2l 3B3b antigen-induced, 191-192,I93f polyclonal,535 with single antigen-specificity, 535-536 antigen presentationin, 191-192, l93f antigen-presentingcellsin, I 16-117, 1l6l rrTf attenuationof, 2O9-213,210f, 21rb-2r2b.2r2f calcium- and PKC-mediatedsignaling pathways in, 206-207, 207f coreceptorsin, 145-146,146f costimulatorsin, 193f,194-198,1951 l96b-r97b, 19Bl 209 defects in, 464-465,464t, 47If , 472-474, 473t dendritic cellsin, l9l-192, l93f and gene expression,198,l99f immunological slrrapse in, 2O0-205, 204f intracellularsignalingduring, 199-200, 200f MAP kinase signaling pathways in, 205-206,206f overviewol 189-191,f90f, fglf by peptide-MHC complexes,128 signaltransductionby TCR complex in, l98-209.199f.200f transcriptionfactorsin, 207-209, 2O8f ty'rosinekinases in, 199-202, 20tb-202b,203f T cell anergy,249-252,250f-252f T cell deficiencies,464-465,464t,471f, 472-474,473t T cell-dependentantibody responses, 222-237 affinity maturation in, 232-234, 234f, 235f antigen presentationin, 224,226f B cell migration toward T cell zone in, 224 CD40ligand in, 226-228,227f differentiation into plasma cells in, 234-236,236f generationof memory B cells and secondaryhumoralimmune responsesin,236-237 germinal center reaction in, 228,229f hapten-carriereffectin, 224-226,226f heaqr chain isotlpe (class)switching in, 228-232,230f,230t,232f,233f helper T cell activation and migration toward follicle in, 224, 225f overview of , 223-224, 223f properties of,237t T cell development,51-52,52b,58, 175-lB5 stagesof, 1761 177-180,l78f-lBOf thymus in, 176-185,l78f transcriptionalregulationof, 169,l70f T cell gene expression,activationof transcription factors that regulate, 207-209,20Bf T cell growth factor, 289 T cell-independentantibody responses, 237-239,237t, 239f
T cell leukemia/lymphoma,adult, 405, 476 T cell lineage,commitment to, 154-155, r54l 15sf T cell lymphoma, chromosomal translocationsin, l66b T cell-mediated hypersensitivity, 420421, 420t,425-432 due to cltotoxic T lymphocl'tes,426f, 43t-432 delayed-type,425-43r, 426f, 428t, 429b43rb T cell migration effector,67f, 68-69,310-311,310f helper,224,225f memory,69,3ll naive,66, 67f into gut-associatedlymphoid tissue, 6B to sitesof antigen,3 10-3I l, 3 l0f to sites of inflammation, 68-69 T cell receptor(s)(TCRs),137-138,138f in alloantigen recognition, 378-379, 379f olB,28,138-142, 489 generationof diversityin, l6Bt in MHC-associatedpeptide antigen recognition, 140-142, l4Lf structureof, 139-140,1401 l4lt antigen-binding site of, 140-142,l4If antigen recognition and signaling functions ol 138f binding to peptide-MHC comPlexof, 140-142,l4lf oenneo,5r4-515 develoomentof self MHC-restricted, l8l-r84, lBrf-183f y6,28, I44, 498 generationof diversitYin, 16Bt identificationof, 138,139b intraepithelial, 2B molecularcloning of, 139b of NK-T cells, 144-145 pre-, 137-138,r56, r561 173f,177-178, 5r0 propertiesoi l41t recombination and expression of, 176f, 177-180, l79f structureol 139-140,140f T cell receptor (TCR)complex, 137,138f assembly and surface expressionof, 143,143f CDR3and ( proteins of,142-144,142f, 143f components of , ),4lt, 742f defined,515 signaltransductionby, f98-209, f99f, 200f defectsin, 47lf T cell receptor(TCR)genes,l39b generationof diversityin, 167-169, l6Bf, I68t germline organizationof, 159i 160, 161f V(D)I recombinationof, 158,160-165, 162f-r6si 177-780,r79f T cell receptor (TCR)proteins,domains ol 159f T cell receptor (TCR) signal transduction, defectsin, 473t.474 T cell receptor(TCR)transgenicmice, 536 T cell recognition,of peptide-MHC complex,97, 9Bf
T cell repertoire,selectionoi 154,f54f, 155-157,156f,157f,181-l85 T cell resnonses after antigen elimination, 190-191 attenuation ol 196b,209-213, 2I0f methods for studying, 535-537 phasesol 191f T cell signalattenuation,209-2L3,210f, 2trb-2r2b,212f T cell signaling,defective,473t,474 T cell tolerance, 246-258, 26lt anergy induced by recognition of self antigen in, 249-252, 250f-252f apoptotic cell death in, 253-254,254f, 255b-257b cDB-,254-257 central, 246-248, 248f factorsthat determine,257-258, 25Bt peripheral, 248-258 suppressionof self- reactive Iymphocytes by regulatorYT cells in.252-253,253f T cell tumors, chromosomal translocationsin, 165,f66b-167b TCRs.SeeTcell receptor(s)(TCRs). TID (t}/peI diabetesmellitus), 428,4281, 429b. 433, 435t,437 T (thlmus)-dependentantigens,216, 237t,515 Tec, 171,201b,202b Techomology (TH) domain, 202b TELr, 167b Terminal deoxynucleotidyl transferase (TdT), 165,r69, 170,lTlf Tetanus toxoid, 371 Tetanusvaccine, 325t Tetrahydrofolate,and hybridomas, 77b TGF-p (transforming growth factor B;, 2901.296,516 in isotype switching,230t,231 Tsl cells,305 activationof macrophagesby, 31l-312, 3Ilf defined,515 in delayed-type hpersensitivitY reactions,312-314,3f 31 314f developmentoi 305-307,30Bf effectorfunctions ol 309-314,309f in HIV infection, 483 immune responsesmediatedbY,303, 304f,309-314,309f in immune responseto parasites,367 interferon-yand, 295 migration to sites of antigen bY, 310-311,3lOf propertiesof, 305,307f toll-like receptors and, 4445 Ts2 cells,305 defined,515 developmentol 305,307-309,30Bf effectorfunctions ol 3f4-315, 315f in HIV infection, 483 homing of, 315 in immediate hypersensitiviry 442, 442f,443-444 immune responsesmediated bY,304, 3r4-315,3l5f in immune responseto parasites,368 interferon-yand, 295 interleukin-4 and, 293 propertiesol 305,307f T s l T c e l l s , 3 l 55 , 15 TH (Tec homology) domain, 202b Theophylline, for asthma, 458
564
INDEX
Thrombocytopenicpurpura, autoimmune, 422,423t Thrombosis in allograftrejection,383-384,3B4f tumor necrosisfactor and,,277 Thyrnic epithelialcells,58, 177,Sls Th).rynidinekinase (TK), and hybridomas, /lo
Th1'rnidylate,and hybridomas, 77b Thlrmocyte(s),58, t7 6-177 CD4 and CD8 expressionon, lB0, 1B0f defined,515 double-negative,1,77,l}}f, 496 double-positive,1761l7B-180, l80i r8l,496 negativeselectionol lB0-181,l8ll 184-185 positiveselectionol lB0, 181-184, lSlf-lB3f single-positive,176f,lB0, 180f,513 Thymus anatomy and functions ol 58, s8f congenitalabsenceof, 176 defectivedevelopmentof, 468t,469 defined,515 in T-cellmaturation, 176-185,178f Thymus (T)-dependentantigens,216, 237t,515 Th).'rnus(T)-independent(TI) antigens, 216,237-238,237t. 51s TILs (tumor-infiltrating llmphocytes), 407.4r4. 5t6 Tim-1, in immediate hypersensitivity,455 T (thymus)-independent(TI) antigens, 216,237-238,237t,5r5 TIR (toll-like/Il-1 receptor),27t, 27tt, 278 Tirap,24 TIR (toll-like/IL-l receptor)homology domain,22,23b-24b,26 Tissueinjury in antibody-mediated disease, 422,422f Tissuerepair,macrophagesin, 312 Tissue-specificantibodies,diseases causedby, 422-423,422f,423t, 424f Tissue-specifi c differentiationantigens, 406 Tissuetyping, 390,390b,515 TK (thymidine kinase),and hybridomas, 77b TLRs.SeeToll-likereceptor(s)(TLRs). T lymphocyte(s).SeeTcell1s.1. TNF.SeeTumornecrosisfactor (TNF). Tolerance.SeeImmunologic tolerance. Tolerogen(s),243,515 Tolerogeniciry factors that determine, 257-2s8,258t Toll-like/lL-I receptor (TIR),2Zt, 271t, 278 Toll-like/lL-1 receptor(TIR) homology domain,22,23b-24b,26 Toll-like receptor(s)(TLRs) in autoimmuniry 437 defined,515-516 dimerization of, 24, 25f, 26 dolvnstream effects of, 24 in immune responseto viruses,363 in innate immune system,22-26, 23b-24b,25f ligands for, 24, 25-26, 25f location ol 25 signalingby,23b,2a structure oi 23b and Tsl cells,44-45 types of, 22,23b,25f
Toll-likereceptor3 (TLR-3),24, 25-26 Toll-likereceptor4 (TLR-4),24 Toll-like receptor 7 (TLR-7),25-26 Toll-likereceptorI (TLR-B),25-26 Toll-like receptor 9 (TLR-9),24, 25-26 Toll-like receptor (TLR) pathways, inherited defects in, 465t,466467 Tonegawa,Susumu,158 Tonsils, pharyngeal, 122 Toxic shocksyndrome (TSS),357b,516 Toxins bacterial,354 neutralization by antibodies of, 323-324.324f.325t in tumor immunotherapy,415-416 Toxoids,371 TRADD,276b TMFs. SeeTumor necrosis factor receptor-associated factor(s) (TMFs). TRAM,24 Transcy'tosis,346-347, 347f Transforming growth factor 0 (fCf-B;, 290r,296,516 in isotype switching,23Ot,231 Transforming growth factor p-activated kinase I (TAKl), 24 Transfusion,375,392-393,516 Transfusion reactions, 392-393,422, 516 Transgenicmouse models,532 ofB cell tolerance.258.260f defined,516 of diabetesmellitus, 429b of self-tolerance and autoimmunift 246,247b T cell receotor.536 ofT cell tolerance,249,25Of,251f Translocations defined,493 in lymphocyte tumors, f 65, l66b-f 67b Transmembrane activator and CAML interactor (TACD,297 Transplantation,375-395 allogeneic, 377-391 donor-recipientcompatibility in, 389-391,390b.39rf immunology of,377-382 activation of alloreactiveT cells in, 380,38r-382.3B2f recognition of alloantigens in, 377-38r, 377f-379f rejectionof accelerated,384 activation of alloreactiveT cells in, 380,381-382,3B2f acute,384-386,38413B5i 489 chronic, 3B4l 385f,387,493 effector mechanisms of, 382-387, 3B4l 38sf geneticsof, 377-378,377f hlperacute, 383-384,3B4l 3851 500 immunosuppressionfor, 387-389, 387t,3BBf methods to induce donor-specific tolerance or suppression for, 391 methods to reduce allograft immunogenicity for, 389-39l, 390b,39lf prevention and treatment of, 387-391,3871,3BBf,390b, 391f
Transplantation, a-llogeneic(Continued) screening for preformed antibodies in, 389.390b blood transfusionas,375,392-393 bone marrow, 393-395, 394f, 415, 475, 492 defined,375,516 heterotoDic,375 historical background of, 375 orthotopic, 375 terminology for, 376-377 tumor, 400b-40lb. 405 xenogeneic,391-392 Transporter associatedwith antigen processing(TAP),107.129f,130-f 3 f , 1 3 1 f 5, 1 6 mutations in, 473 Trif,24 Trophozoites,369b Trypanosomab rucei, 367t, 368 Trypanosomarhodesiense,368, 370f Trypanosomes antigenicvariation in, 368,370f inhibition of host immune resDonses by, 370 Trypanosomiasis,365 Tryptase,452 TSS(toxic shock syrrdrome),357b,516 TSST,357b TSTAs(tumor-specific transplantation antigens),398-401,400b*401b,516 Tuberculinskin test,313 Tuberculoid leprosy, 360-362 Tuberculosis,361b,476 Tumor(s), 397-417 in AIDS,484t.485 immune responsesto, 406-408 adaptive, 407-408, 408f evasionof, 408-410.408f innate, 406-407 stimulation of, 410-414,410t, 41Il 412f,4t3t immunogenicity of, 397-399,39Bf immunotherapy for, 410-416 cltokinesin, 4ll-413, 4l2f,4I3t passive,414-416, 414f , 475t Tumor angiogenesis, 416 Tumor antigens,397,399-406 abnormally expressedcellular proteins as,402403 altered glycolipid and glycoprotein, 406 identificationof, 399,400b-401b oncofetal,405-406 of oncogenicviruses,403-405, 404b-405b products of mutated genesas,399-401 purified, 410t,411 tissue-specific differentiation, 406 tumor-associated,399 tumor-specific,399 tlpes of, 402f,403t Tumor-associatedantigens,399 Tumor editing, 408-410 Tumor growth, role of immune system in promoting, 416 Tumorigenesis,role of immune systemin promoting, 416 Tumor immunitv. 516 blocking inhibitory pathways to promote, 413-414 experimental demonstration ol 398, 398f genera-lfeatures of, 397-399, 39Bf
t
|NDEXfr 565 Tumor-infiltratinglymphocyes (TILs), 407,4t4, 5t6 Tumor necrosisfactor (TNF),273-278 biologic actions of, 273-278,277f defined,516 in immediate hlpersensitivity, 452-453 in immune responseto extracellular bacteria,354,355f in innate immunity, 2BB in leukocyterecruitment,31, 35 in lipopolysaccharide-induced injury 356b membrane,273 production of, 273 in rheumatoid arthritis,43lb in septic shock, 277-27 8, 277f , 354 structure of, 273 in T cell activation,I95 in Tpl migration, 310 in tumor immunotherapy,413,4i3t Tumor necrosisfactor-o (TNF-cr),273 Tumor necrosisfactor-p (TNF-B),273, 296,506 Tumor necrosisfactor receptor(s) (TNF-R),273,516 structureof,273,273f Rpes ol 273,273f Tumor necrosisfactor receptorassociatedfactor(s)(TMFs), 276b, 5r5 in B cell activation,226,227 in innate immunity, 273 TNF receptorsignalingby,27lt Tumor necrosisfactor (TNF) receptorassociatedfactor 6 (TRAF-6),24, 278 Tumor necrosisfactor receptor (TNF-R) family,272,272f signaling by, 275b-276b Tumor necrosisfactor (TNF) signaling, 27lr Tumor-speciflcantigens,399,516 Tumor-specificCTL clones,400b,401b Tumor-speciflc monoclonal antibodies, 4I5-416,4l5f Tumor-specific transplantationantigens (TSTAs),398-401,400b-401b,516 Tumor suppressorgenes,mutated, as tumor antigens,398 Tumor transplantation,400b-40lb, 405 Tumor vaccines,410-411,410t,4llf TWo-photonmicroscopy,530 Two-signal hypothesis, for l}'rnphocl.te activation, 44-45, 45f, 147, 516-517 Type I diabetesmellitus (TID),428,428t, 429b, 433,435t,437 in melanoma, 402,406 TJ,rosinase, Tyrosinekinase(s) activation ol 199-202,20lb-202b, 203f Bruton's,17l, 2O2b,220,47l, 492 U Ubiquitin, 130 in T cell signalattenuation,210-213, 2ttb-2r2b,2t2f Ubiquitination, 130,517 in protein degradation and signaling, 2ttb-2t2b Ubiquitin E3 ligases,in T cell signal attenuation, 210-213,2l lb-212b Ulcerativecolitis,428-431.42Bt
Uracil N-glycosylase(UNG), 231, 233f mutations in,471f,472 Urticaria. 459.517 Uterine decidua,as immunologically privilegedsite,3B3b Uterine NK cells,3B3b V V3 loop, in HIV 486 Vaccination effectivenessof. 4. 4t historicalbackground,4 Vaccine(s) adjuvants and immunomodulators in, 372 attenuated and inactivated bacterial ano \nral.3/tr-3/ r conjugate,237, 371 oenneo,5l / D N A ,3 7 2 , 4 1 0 1 , 4 l l4, 9 6 for HM 487 Hry 486-487 live viral vector, 371 malaria,369b polysaccharide,238 purified antigen (subunit),371,5l I smallpox,4, 370 strategiesfor developmentof, 370-372, 37lt syntheticantigen,371 tumor,410-41l, 410t,41lf Vaccine-inducedhumoral immunity, 325t Vaccinia virus complement inhibitory p r o t e i n - l( V C P - l ) , 3 4 6 Vacciniavirus vectors,371 Vacuolization, in graft- uersus-host disease,394f Valency,of antibody-antigen interactions, 9r-92,92f van Rood,Ian, 100 Variable(V) domains,83b ofT cell receptors,139,l40f Variable(V) regions,of antibody,81, Blf, 84-85,B5f,B6f,s17 Variable(V) segments,of Ig and TCR genes,159,159f,160,1611517 Vascularcell adhesionmolecule-l (VCAM-l), and integrins,35 Vascular endothelial cells, antigen presentation by, ll8t, 122 Vascular endothelial growth factor (\'EGF),antibodiesthat block, 416 Vascular occlusion, in allograft rejection, 383-384.384f,387 Vasculitis,causedbyANCA, 423t Vasoactiveamines, in immediate hypersensitivity, 451452 Vav 205 VCA(s) (viral capsid antigens), 404b VCAM- I (vascularcell adhesion molecule-l), and integrins,35 VCP-1(vacciniavirus complement inhibitory protein-l), 346 V(D)Jrecombinase,163f,517 V(D)Jrecombination,158,160-165, l62f-165f. t7 7 -r80. 179f defectsin. 468t.469 V (variable)domains,83b ofT cell receptors,139,l40f VEGF (vascularendothelial growth factor),antibodiesthat block, 416 Vertebrates,immune system of, 6b-7b
Very late antigen-4 (\'LC.-4),430b in memoryT cellmigration,311 Very late antigen-s (\'l/.-5), in memory T cell migration,3ll Very late antigen (M,A) molecules, 33b, 34b Vesicular antigens presentationof, f32, f33f processing of, 123-129,123f, 124t, r25f-r2Bf V genes,somatic mutations in,232-234, 234f,235f Vibrio cholerae,353t Viral capsid antigens (VCAs),404b Viral hepatitis, 420 Viral replication, type I interferons and, 286,286f Viral vectors,in vaccines,371,410t,
4rr Viruses,362-365 adaptive immunity to, 363-364, 363f defined,362.517 examples ol 3531 immune evasion by, 364-365, 3641, 366b innate immunity to, 363, 363f latencv of, 362 IVSIS OV JT'Z
VtA-+ (v-erylate antigen-4), 430b in memory T cell migration, 3l I VtA-5 (verylate antigen-s),in memory T cell migration,3ll VLA (very late antigen) molecules, 33b, 34b von Behring, Emil, 8 von Pirquet,Clemens,423 von Willebrand factor, in allograft rejection,384 V (variable)regions,ofantibody, 81, 8lf, B4-Bs,85i B6f,5r7 V (variable) segments,of Ig and TCR genes,159,159f,f60, 16fl 5f7
w WASP(Wiskott-Aldrich syndrome prctein),474 Weibel-Paladebodies,32b Western blot, 501, 517, 528, 529f \{4real and flare reaction, 452,453-454, 455f,517 wlhite blood cells, number of, 49t \Mhite pulp, 6l-62, 62f, 5L7 Wiley,Don, I02 Wiskott-Aldrich syndrome, 473t, 474, 5L7 Wiskott-Aldrich syndrome protein (WASP),474 Wound healing,chemokinesin, 281 Wright, Almroth, 9 Wucheria bancrofi i, 367t X Xenoantigens,377, 392, 517 Xenogeneic graf\, 377, 517 Xenogeneic transplantation, 391-392 Xenograft,377,517 Xenograft rejection, 392 Xenoreactive,defined, 377, 517 xid, t7t,47l X-linked agammaglobulinemia (XLA), 17r,202b, 464,470-471,470t, s17-518 X-linked hyper-IgM slmdrome, 312, 472, 518
566
INDEX
X-linked inhibitor of apoptosis(XIAP),474 X-linked ll.rnphoproliferative syndrome, 473r,474 X-linked severecombined immunodeficiencydisease,155 I
Yalow,Rosalyn,525
protein of 7OkD(Z-\P-70) Zeta-associated defined,518 mutations in, 474 in T cell activation,200,201b-202b, 203f,205,206 and tolerance,248 ( chains, 137, 142-144, 5lB
( proteins, 137 CDR3 and, 142-144,142f, 143f Zinkernagel,Roli 114 Zone of antibody excess,92, 93f Zone of antigen excess,92, 93f Zone of equivalence,92, 93f Zymogens,329
