Up on the tightrope: natural killer cell activation and inhibition

Role of KIRs and KIR ligands in hematopoietic transplantation

This review focuses on recent research demonstrating the role alloreactive natural killer (NK) cells play in adoptive immunotherapy of leukemia in allogeneic hematopoietic transplantation. For patients with hematologic malignancies and an indication to allogeneic hematopoietic transplantation who do not have a matched sibling donor, unrelated donor, or cord blood transplants are almost always available (as long as the patient's ethnicity is represented in the donor registries). However, up to one half of patients relapse and do not make it to transplant during the time required for the donor search, completion of donor HLA typing, bone marrow harvest, and shipment. Donor-versus-recipient NK cell alloreactivity is effected by a functional repertoire of NK cells which express inhibitory Killer-Cell Immunoglobulin-like Receptor(s) (KIR) for self class I ligand(s), sense missing expression of donor KIR ligand(s) in the recipient and mediate alloreactions. It improves outcomes of HLA haplotype-mismatched ('haploidentical') transplants by controlling acute myeloid leukemia relapse without causing graft-versus-host disease. It is hoped the dramatic improvements afforded by the discovery of the role of NK cell alloreactivity will extend the use of haploidentical transplants, as the donors are, unlike the unrelated, immediately available family members.

Natural killer cells: diversity in search of a niche

Over the years, the enigmatic lifestyle of natural killer (NK) cells has fascinated immunologists. Elucidating the principles governing NK cell biology is a constant source of surprise, as these lymphocytes often break the rules of lymphocyte 'behavior' established by their T and B cell counterparts. In this Focus issue, experts address how NK cells have secured a fundamental place in the immune system, how they 'see' their targets and how they participate in and influence immune responses. We now need to understand how environmental 'niches' condition the generation and function of distinct NK cell subsets in vivo. Ultimately, we can hope that unraveling the mysteries of how these atypical lymphocytes function will have an impact on human disease therapies.