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Welsh RA, Song N, Sadegh-Nasseri S. How Does B Cell Antigen Presentation Affect Memory CD4 T Cell Differentiation and Longevity? Front Immunol 2021; 12:677036. [PMID: 34177919 PMCID: PMC8224923 DOI: 10.3389/fimmu.2021.677036] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Dendritic cells are the antigen presenting cells that process antigens effectively and prime the immune system, a characteristic that have gained them the spotlights in recent years. B cell antigen presentation, although less prominent, deserves equal attention. B cells select antigen experienced CD4 T cells to become memory and initiate an orchestrated genetic program that maintains memory CD4 T cells for life of the individual. Over years of research, we have demonstrated that low levels of antigens captured by B cells during the resolution of an infection render antigen experienced CD4 T cells into a quiescent/resting state. Our studies suggest that in the absence of antigen, the resting state associated with low-energy utilization and proliferation can help memory CD4 T cells to survive nearly throughout the lifetime of mice. In this review we would discuss the primary findings from our lab as well as others that highlight our understanding of B cell antigen presentation and the contributions of the MHC Class II accessory molecules to this outcome. We propose that the quiescence induced by the low levels of antigen presentation might be a mechanism necessary to regulate long-term survival of CD4 memory T cells and to prevent cross-reactivity to autoantigens, hence autoimmunity.
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Affiliation(s)
- Robin A Welsh
- Graduate Program in Immunology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Nianbin Song
- Department of Biology, Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - Scheherazade Sadegh-Nasseri
- Graduate Program in Immunology, Johns Hopkins School of Medicine, Baltimore, MD, United States.,Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, United States
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Shen H, Whitmire JK, Fan X, Shedlock DJ, Kaech SM, Ahmed R. A specific role for B cells in the generation of CD8 T cell memory by recombinant Listeria monocytogenes. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2003; 170:1443-51. [PMID: 12538706 DOI: 10.4049/jimmunol.170.3.1443] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In this study, we investigated whether B cells play a role in the induction and maintenance of CD8 T cell memory after immunization with an intracellular bacterium, Listeria monocytogenes. Our results show that B cells play a minimal role in the initial activation and Ag-driven expansion of CD8 T lymphocytes. However, absence of B cells results in increased death of activated CD8 T cells during the contraction phase, leading to a lower level of Ag-specific CD8 T cell memory. Once memory is established, B cells are no longer required for the long-term maintenance and rapid recall response of memory CD8 T cells. Increased contraction of Ag-specific CD8 T cells in B cell-deficient mice is not due to impaired CD4 T cell responses since priming of epitope-specific CD4 T cell responses is normal in B cell-deficient mice following L. monocytogenes infection. Furthermore, no exaggerated contraction of Ag-specific CD8 T cells is evident in CD4 knockout mice. Thus, B cells play a specific role in modulating the contraction of CD8 T cell responses following immunization. Elucidation of factors that regulate the death phase may allow us to manipulate this process to increase the level of immunological memory and thus, vaccine efficacy.
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Affiliation(s)
- Hao Shen
- Department of Microbiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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Braley-Mullen H, Yu S. Early requirement for B cells for development of spontaneous autoimmune thyroiditis in NOD.H-2h4 mice. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2000; 165:7262-9. [PMID: 11120860 DOI: 10.4049/jimmunol.165.12.7262] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
B cells are known to play an important role in the pathogenesis of several autoimmune diseases. NOD.H-2h4 mice develop spontaneous autoimmune thyroiditis (SAT) and anti-mouse thyroglobulin (MTg) autoantibodies, the levels of which correlate closely with the severity of thyroid lesions. NOD.H-2h4 mice genetically deficient in B cells (NOD.Kmu(null)) or rendered B cell-deficient by treatment from birth with anti-IgM develop minimal SAT. B cells were required some time in the first 4-6 wk after birth, because NOD.Kmu(null) or NOD.H-2h4 mice did not develop SAT when they were reconstituted with B cells as adults. The requirement for B cells was apparently not solely to produce anti-MTg autoantibodies, because passive transfer of anti-MTg Ab did not enable B cell-deficient mice to develop SAT, and mice given B cells as adults produced autoantibodies but did not develop SAT. B cell-deficient mice developed SAT if their T cells developed from bone marrow precursors in the presence of B cells. Because B cells are required early in life and their function cannot be replaced by anti-MTg autoantibodies, B cells may be required for the activation or selection of autoreactive T cells. These autoreactive T cells are apparently unable to respond to Ag if B cells are absent in the first 4-6 wk after birth.
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Affiliation(s)
- H Braley-Mullen
- Departments of Internal Medicine and Medical Microbiology and Immunology, University of Missouri, Columbia, MO 65212, USA.
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Linton PJ, Harbertson J, Bradley LM. A critical role for B cells in the development of memory CD4 cells. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2000; 165:5558-65. [PMID: 11067910 DOI: 10.4049/jimmunol.165.10.5558] [Citation(s) in RCA: 179] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Activated B cells express high levels of class II MHC and costimulatory molecules and are nearly as effective as dendritic cells in their APC ability. Yet, their importance as APC in vivo is controversial and their role, if any, in the development of CD4 memory is unknown. We compared responses of CD4 cells from normal and B cell-deficient mice to keyhole limpet hemocyanin over 6 mo and observed diminished IL-2 production by cells primed in the absence of B cells. This was due to lower frequencies of Ag-responsive cells and not to decreased levels of IL-2 secretion per cell. The absence of B cells did not affect the survival of memory CD4 cells since frequencies remained stable. Despite normal dendritic cell function, multiple immunizations of B cell-deficient mice did not restore frequencies of memory cells. However, the transfer of B cells restored memory cell development. Ag presentation was not essential since B cells activated in vitro with irrelevant Ag also restored frequencies of memory cells. The results provide unequivocal evidence that B cells play a critical role in regulating clonal expansion of CD4 cells and, as such, are requisite for the optimal priming of memory in the CD4 population.
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Affiliation(s)
- P J Linton
- Sidney Kimmel Cancer Center, San Diego, CA 92121, USA
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Yu XZ, Bidwell S, Martin PJ, Anasetti C. Visualization, Fate, and Pathogenicity of Antigen-Specific CD8+ T Cells in the Graft-Versus-Host Reaction. THE JOURNAL OF IMMUNOLOGY 1999. [DOI: 10.4049/jimmunol.163.9.4780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
To follow the fate of alloreactive T cell effectors in graft-vs-host disease, Ld-specific CD8+ T cells from C57BL/6 2C TCR-transgenic donors were transplanted into sublethally irradiated (750 cGy) Ld+ or Ld− recipients. In Ld− C57BL/6 or (BALB/c-dm2 × C57BL/6)F1 recipients, naive 2C T cells engrafted and survived long term, but did not acquire effector function. In Ld+ (BALB/c × C57BL/6)F1 recipients, 2C T cells engrafted, expanded, became cytolytic, destroyed host B cells and double-positive thymocytes, and later disappeared. Despite marked damage to lymphoid and hemopoietic cells by 2C T cells, no significant pathology was detected in other organs, and recipients survived. Ld+ (BALB/c × C57BL/6)F1 recipients died when LPS/endotoxin was administered on day 7 after cell transfer, while Ld− (BALB/c-dm2 × C57BL/6)F1 recipients survived. Our findings show that under certain conditions, a CD8+ T cell population recognizing an extremely limited repertoire of Ags can initiate graft-vs-host disease.
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Affiliation(s)
- Xue-Zhong Yu
- *Division of Clinical Research, Fred Hutchinson Cancer Research Center, and
| | - Sasha Bidwell
- *Division of Clinical Research, Fred Hutchinson Cancer Research Center, and
| | - Paul J. Martin
- *Division of Clinical Research, Fred Hutchinson Cancer Research Center, and
- †Department of Medicine, Division of Oncology, University of Washington, Seattle, WA 98105
| | - Claudio Anasetti
- *Division of Clinical Research, Fred Hutchinson Cancer Research Center, and
- †Department of Medicine, Division of Oncology, University of Washington, Seattle, WA 98105
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Matsuzaki G, Vordermeier HM, Hashimoto A, Nomoto K, Ivanyi J. The role of B cells in the establishment of T cell response in mice infected with an intracellular bacteria, Listeria monocytogenes. Cell Immunol 1999; 194:178-85. [PMID: 10383820 DOI: 10.1006/cimm.1999.1503] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To clarify the role of B cells in the establishment of T cell response against intracellular bacteria, B-cell-deficient (muMT-/-) mice were infected with an intracellular bacteria, Listeria monocytogenes, and T cell response against the bacteria was analyzed. On day 6 of primary Listeria infection, spleen T cells of the muMT-/- mice showed significantly lower levels of proliferative response and IFN-gamma production than those of normal infected mice after in vitro stimulation with listerial antigen. Even in the secondary Listeria infection after immunization with viable bacteria, spleen T cells of the muMT-/- mice proliferated and produced IFN-gamma against listerial antigen at significantly lower levels than those of normal immunized mice. These results demonstrate participation of B cells in priming of Listeria-specific T cells in vivo. However, B cells failed to present Listeria antigen to Listeria-specific T cells in vitro unless Listeria antigen was solubilized. Furthermore, transfer of immune serum from Listeria-infected normal mice failed to enhance the Listeria-specific T cell response of muMT-/- mice. The results indicate that B cells support the T cell response against intracellular bacteria through a mechanism other than their Ig production or antigen presentation function.
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Affiliation(s)
- G Matsuzaki
- MRC Clinical Sciences Centre, Hammersmith Hospital, London, W12 0NN, United Kingdom.
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Garraud O, Diouf A, Nguer CM, Dieye A, Longacre S, Kaslow DC, Holder AA, Tall A, Molez JF, Perraut R, Mercereau-Puijalon O. Different Plasmodium falciparum recombinant MSP1(19) antigens differ in their capacities to stimulate in vitro peripheral blood T lymphocytes in individuals from various endemic areas. Scand J Immunol 1999; 49:431-40. [PMID: 10219771 DOI: 10.1046/j.1365-3083.1999.00511.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study reports on T-cell proliferative responses to the 19-kDa C-terminal domain of the Plasmodium falciparum merozoite surface protein (MSP1(19)). Three different recombinant proteins were used: an Escherichia coli product expressing the first EGF-like domain and Saccharomyces cerevisiae and baculovirus/insect-cell-produced proteins containing both EGF-like domains, the latter protein being produced with or without N-glycosylation. Cell donors were P. falciparum-immune adults with no recent history of clinical malaria and recruited from three Senegalese settings with different epidemiological parasite transmission. Each mononuclear-blood-cell preparation was stimulated with a range of concentrations of the three proteins. Most subjects' mononuclear cells were reactive to at least one protein, but significant differences in lymphoproliferation were seen between the settings and within individual cultures depending on the protein source and concentration. Importantly, lymphoproliferation indices correlated inversely with the intensity of P. falciparum malaria transmission. When purified T lymphocytes were cultured in the presence of MSP1(19) plus autologous monocytes, B lymphocytes or a proposed CD1+ dendritic-cell population as costimulatory cells, significant differences were observed depending on the individual's previous exposure to parasites. This study shows that the stimulation of lymphocyte proliferation in vitro with MSP1(19) depends on several factors, including epidemiological conditions and protein preparations.
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Affiliation(s)
- O Garraud
- Unité d'Immunologie, Institut Pasteur, Dakar, Sénégal
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McCole DF, Doherty ML, Baird AW, Davis WC, McGill K, Torgerson PR. Concanavalin A-stimulated proliferation of T cell subset-depleted lymphocyte populations isolated from Fasciola hepatica-infected cattle. Vet Immunol Immunopathol 1998; 66:289-300. [PMID: 9880105 DOI: 10.1016/s0165-2427(98)00207-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over 14 weeks, peripheral blood lymphocytes (PBL) were isolated from eight adult cattle which had been orally infected with Fasciola hepatica via trickle infection over a 10-day period. Two age, breed and sex-matched cattle served as controls. CD4+, CD8+ and gammadelta+ T cells were depleted from whole PBL populations by magnetic bead depletion. Lymphocyte proliferation assays demonstrated a transient, but marked elevation in responsiveness to Concanavalin A (Con A) between weeks 2 and 4 post-infection in PBL from infected animals. Proliferative responses to Con A were significantly greater in PBL from infected cattle than uninfected/control cattle over the initial period of the experiment. Con A-stimulated proliferation of PBL isolated from infected cattle followed a similar pattern to PBL responses to F. hepatica antigen. In both whole and subset-depleted lymphocyte populations from infected cattle, proliferative responses to Con A decreased from day 28 post-infection. Depletion of CD4+, CD8+ and gammadelta+ T cell subpopulations significantly augmented responses soon after infection. These findings suggest that the capacity of bovine PBL to proliferate in response to Con A stimulation, was in some way attenuated by F. hepatica infection and proliferative responses due to non-specific activation was suppressed by the coordinated activities of various lymphocyte subsets.
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Affiliation(s)
- D F McCole
- Department of Pharmacology, University College Dublin, Ireland
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Williams GS, Oxenius A, Hengartner H, Benoist C, Mathis D. CD4+ T cell responses in mice lacking MHC class II molecules specifically on B cells. Eur J Immunol 1998; 28:3763-72. [PMID: 9842919 DOI: 10.1002/(sici)1521-4141(199811)28:11<3763::aid-immu3763>3.0.co;2-d] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The role of B lymphocytes in initiating and maintaining a CD4+ T cell response has been examined using a variety of strategies, but remains controversial because of weaknesses inherent to each of the approaches. Here, we address this issue by measuring CD4+ T cell priming both in mutant mice devoid of B cells and in chimeric animals lacking major histocompatibility complex class II molecules specifically on B cells. We find that peptide and some protein antigens do not require B cells expressing class II molecules, nor B cells themselves, to efficiently prime. This could be demonstrated by the usual lymph node proliferation assay, a rather indirect in vitro measure of priming, and by a direct ex vivo assay of population expansion and activation marker expression. Interestingly, one protein antigen, conalbumin, could not prime in the absence of B cells, but could in the presence of B cells devoid of class II molecules. This finding constrains the possible mechanisms whereby B lymphocytes contribute to the initiation of a CD4+ T cell response, arguing against the importance of surface immunoglobulin-mediated antigen presentation by B cells.
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Affiliation(s)
- G S Williams
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (CNRS/INSERM/ULP), Illkirch, C.U. de Strasbourg, France
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10
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Lee RS, Tartour E, van der Bruggen P, Vantomme V, Joyeux I, Goud B, Fridman WH, Johannes L. Major histocompatibility complex class I presentation of exogenous soluble tumor antigen fused to the B-fragment of Shiga toxin. Eur J Immunol 1998; 28:2726-37. [PMID: 9754560 DOI: 10.1002/(sici)1521-4141(199809)28:09<2726::aid-immu2726>3.0.co;2-w] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Targeting exogenous antigen into the MHC class I-restricted presentation pathway is a prerequisite for the induction of cytotoxic T lymphocytes (CTL) which have been shown to represent an important component of the protective and therapeutic immune response to viral infections and tumors. In this study, we produced recombinant proteins composed of the receptor-binding non-toxic B-fragment of bacterial Shiga toxin derived from Shigella dysenteriae associated with an epitope from a model tumor antigen, Mage 1. We show that Shiga B-Mage 1 fusion proteins carrying an active or inactive endoplasmic reticulum retrieval signal (the C-terminal peptides KDEL or KDELGL, respectively) could be presented by peripheral blood mononuclear cells in an MHC class I-restricted manner to Mage 1-specific CTL. After pulsing B lymphoblastoid cells or dendritic cells with Shiga B-Mage 1 fusion protein, activation of the MHC class I-restricted Mage 1-specific CTL was also demonstrated. In further analysis, we showed that treatment with brefeldin A or paraformaldehyde fixation of Epstein-Barr virus-transformed B cells prevented the presentation of the Mage 1 T cell epitope, which excluded extracellular processing of the antigen. Immunofluorescence analysis also revealed that the Shiga B-Mage 1 fusion protein was largely excluded from Lamp-2-positive lysosomal structures. Therefore, the ability of Shiga toxin B-fragment to target dendritic cells and B cells and to direct antigen into the exogenous class I-restricted pathway makes it an attractive non-living and non-toxic vaccine vector.
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Affiliation(s)
- R S Lee
- Laboratoire d'Immunologie Clinique, INSERM U255, Institut Curie, Paris, France
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Sellebjerg F, Christiansen M, Garred P. MBP, anti-MBP and anti-PLP antibodies, and intrathecal complement activation in multiple sclerosis. Mult Scler 1998; 4:127-31. [PMID: 9762660 DOI: 10.1177/135245859800400307] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intrathecal immunoglobulin synthesis and activation of the complement cascade occurs in patients with multiple sclerosis (MS). The present study aimed at further studying the relation between intrathecal immunoglobulin synthesis and complement activation. We compared total intrathecal synthesis of IgA, IgG, and IgM, the number of cells secreting anti-myelin basic protein (MBP) and anti-proteolipid protein (PLP) antibodies of the IgG isotype and intrathecal activation of the complement cascade in patients with possible onset symptoms of MS (n = 18) or clinically definite MS (n = 30). Early activation of the complement cascade correlated with intrathecal synthesis of IgM. Intrathecal IgG, IgA and IgM synthesis also correlated weakly with the presence of cells secreting anti-MBP or anti-PLP autoantibodies. Full activation of the complement cascade did not correlate with any measures of intrathecal antibody synthesis. These findings suggest a complex relation between different immunoglobulin isotypes and complement activation which may have similarly complex roles in the pathogenesis of MS.
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Affiliation(s)
- F Sellebjerg
- MS Clinic Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
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Dedhia V, Goluszko E, Wu B, Deng C, Christadoss P. The effect of B cell deficiency on the immune response to acetylcholine receptor and the development of experimental autoimmune myasthenia gravis. CLINICAL IMMUNOLOGY AND IMMUNOPATHOLOGY 1998; 87:266-75. [PMID: 9646836 DOI: 10.1006/clin.1998.4535] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To study the involvement of B cells in the immune response to acetylcholine receptor (AChR), B-cell-deficient (mu mutant) and control wild-type C57BL/6 mice were immunized with AChR and assessed for clinical and immunopathological manifestations of experimental autoimmune myasthenia gravis (EAMG). The mu mutant mice failed to generate anti-AChR antibodies and were completely resistant to the induction of EAMG. However, mu mutant mice developed clinical EAMG when antibodies to the AChR main immunogenic region were passively transferred. Further, the in vivo expansion of lymph node cells after AChR immunization was greatly impaired in mu mutant mice. The mu mutant mice gave an effective in vitro T cell immune response to the immunodominant pathogenic AChR alpha chain peptide 146-162 (alpha 146-162) and to the whole AChR protein when tested on day 90 after immunization with AChR, whereas the response to both AChR and its alpha 146-162 peptide was reduced when tested on day 7 after immunization. The in vitro production of IFN-gamma and IL-2 by AChR-specific and alpha 146-162 peptide-specific lymphocytes was lower in mu mutant mice. The AChR immune mu mutant T cells proliferated and produced IFN-gamma when AChR or alpha 146-162 peptide was presented by wild-type irradiated AChR-primed antigen-presenting cells (APCs). This indicates that B cells are important in the processing and presentation of AChR dominant peptide in vitro during the initial immune response to AChR. However, APCs of non-B-cell lineage are sufficient to process AChR and prime the T cells to AChR dominant T cell epitope peptides.
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Affiliation(s)
- V Dedhia
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston 77555-1070, USA
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Sellebjerg F, Jensen J, Ryder LP. Costimulatory CD80 (B7-1) and CD86 (B7-2) on cerebrospinal fluid cells in multiple sclerosis. J Neuroimmunol 1998; 84:179-87. [PMID: 9628461 DOI: 10.1016/s0165-5728(97)00261-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The costimulatory CD80 and CD86 molecules were measured by flow cytometry on cerebrospinal fluid (CSF) and blood lymphocytes from patients with possible first attacks of multiple sclerosis (MS, n = 25), clinically definite MS (n = 16), and noninflammatory neurological disease control subjects (n = 30). In patients with demyelinating diseases more CSF B cells expressed CD80 than in control subjects whereas the expression of CD86 by T cells in CSF was low in patients with demyelinating disease and highly variable in the control subjects. In patients with possible first attacks of MS the expression pattern of CD80 and CD86 differed significantly between patients with or without intrathecal synthesis of IgG. Increased expression of the CD80 molecule on CSF B cells may be of importance in the pathogenesis of MS. In contrast, CSF T cell expression of CD86 may be associated with protection from MS.
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Affiliation(s)
- F Sellebjerg
- Department of Neurology, University of Copenhagen, Glostrup Hospital, Denmark
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14
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Expression of heat shock protein in host macrophages correlates with a protective potential against infection with Leishmania major in mice. Parasitol Int 1997. [DOI: 10.1016/s1383-5769(97)00035-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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