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Garib FY, Rizopulu AP, Kuchmiy AA, Garib VF. Inactivation of Inflammasomes by Pathogens Regulates Inflammation. BIOCHEMISTRY (MOSCOW) 2017; 81:1326-1339. [PMID: 27914458 DOI: 10.1134/s0006297916110109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Inflammatory response is initiated and sustained by the action of quintessential pro-inflammatory cytokines of immune system namely IL-1β and IL-18. The maturation process of those cytokines is ensured by caspase-1 enzymatic activity, that is in turn is tightly controlled by multiprotein complexes called inflammasomes. Inflammasomes are activated in cells of innate immune system in response to recognition of conservative parts of microbes (pathogen-associated molecular patterns) or by sensing molecular signs of tissue damage (damage-associated molecular patterns). Inflammasome activation apart of cytokines secretion leads to pro-inflammatory cell death, so-called pyroptosis. That culminates in release of cytoplasmatic content of cells including cytokines and alarmins that boost immune response against pathogens, as well as pyroptosis destroys replicative niches of intracellular pathogens. During co-evolution with the host, bacterial and viral pathogens developed a range of molecular inhibitors targeting each step of inflammasome activation. In current review, we will discuss the latest knowledge of inflammasomes' signaling pathways and tricks that pathogens use to avoid immune recognition and clearance. Our better understanding of inflammasome inhibition by pathogens can lead to better therapeutic approaches for the treatment of infectious diseases.
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Affiliation(s)
- F Yu Garib
- Lomonosov Moscow State University, Biological Faculty, Moscow, 119991, Russia
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2
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Martelli S, Pender SLF, Larbi A. Compartmentalization of immunosenescence: a deeper look at the mucosa. Biogerontology 2015; 17:159-76. [PMID: 26689202 DOI: 10.1007/s10522-015-9628-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/09/2015] [Indexed: 12/30/2022]
Abstract
Developments in medical care and living conditions led to an astonishing increase in life-span perspective and subsequently a rise in the old population. This can be seen as a success for public health policies but it also challenges society to adapt, in order to cope with the potentially overwhelming cost for the healthcare system. A fast-growing number of older people lose their ability to live independently because of diseases and disabilities, frailty or cognitive impairment. Many require long-term care, including home-based nursing, communities and hospital-based care. Immunosenescence, an age-related deterioration in immune functions, is considered a major contributory factor for the higher prevalence and severity of infectious diseases and the poor efficacy of vaccination in the elderly. When compared with systemic immunosenescence, alterations in the mucosal immune system with age are less well understood. For this reason, this area deserves more extensive and intensive research and support. In this article, we provide an overview of age-associated changes occurring in systemic immunity and discuss the distinct features of mucosal immunosenescence.
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Affiliation(s)
- Serena Martelli
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Singapore Immunology Network (SIgN), Aging and Immunity Program, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - Sylvia L F Pender
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anis Larbi
- Singapore Immunology Network (SIgN), Aging and Immunity Program, Agency for Science Technology and Research (A*STAR), Singapore, Singapore.
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Hidaka M, Nakamura M, Ohmichi Y, Itoh J, Fukuzawa K, Masuko T, Yagi H. Involvement of intestinal intraepithelial lymphocytes in turnover of intestinal epithelial cells: Morphological and functional alterations due to daily administration of FK506. Cell Immunol 2012; 279:124-33. [DOI: 10.1016/j.cellimm.2012.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 08/29/2012] [Accepted: 10/02/2012] [Indexed: 12/21/2022]
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Abstract
PURPOSE OF REVIEW To provide an overview of the emerging role of cellular stress responses in inflammatory bowel disease (IBD). RECENT FINDINGS The unfolded protein response (UPR) is a primitive cellular pathway that is engaged when responding to endoplasmic reticulum stress and regulates autophagy. Highly secretory cells such as Paneth cells and goblet cells in the intestines are particularly susceptible to endoplasmic reticulum stress and are exceedingly dependent upon a properly functioning UPR to maintain cellular viability and homeostasis. Primary genetic abnormalities within the components of the UPR (e.g. XBP1, ARG2, ORMDL3), genes that encode proteins reliant upon a robust secretory pathway (e.g. MUC2, HLAB27) and environmental factors that create disturbances in the UPR (e.g. microbial products and inflammatory cytokines) are important factors in the primary development and/or perpetuation of intestinal inflammation. SUMMARY Endoplasmic reticulum stress is an important new pathway involved in the development of intestinal inflammation associated with IBD and likely other intestinal inflammatory disorders.
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News & Highlights. Mucosal Immunol 2010. [DOI: 10.1038/mi.2009.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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6
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Girardi M, Lewis JM, Filler RB, Hayday AC, Tigelaar RE. Environmentally responsive and reversible regulation of epidermal barrier function by gammadelta T cells. J Invest Dermatol 2006; 126:808-14. [PMID: 16439970 DOI: 10.1038/sj.jid.5700120] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The intraepithelial lymphocyte (IEL) network possibly composes the largest T-cell compartment in the body, but it is poorly understood. IELs show limited T-cell receptor (TCR) diversity and have been proposed to respond to generic stress signals rather than pathogen-specific antigens. Consistent with this, skin-resident TCRgammadelta+ cells, known as dendritic epidermal T cells (DETC), downregulate cutaneous inflammation, promote wound healing, and protect against cutaneous neoplasia. These pleiotropic effects collectively suggest that DETC (and IEL more generally) may contribute to epithelial maintenance and barrier function. The present studies test this hypothesis. Using skin surface impedance analysis to measure hydration status and transepidermal water loss, we show that the epidermal barrier is defective in gammadelta T-cell deficient mice. However, this does not represent a constitutive role of gammadelta cells, but rather one that is dependent on environmental challenge, consistent with the primary role for lymphocytes being the response of the host to its environment. Likewise, the importance of the physiologic DETC-associated TCR is demonstrated by showing that Vgamma5+ fetal thymocytes reconstitute the barrier function defect in TCRdelta-/- mice, while Vgamma5-/- mice also show environmentally responsive defects in cutaneous physiology.
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Affiliation(s)
- Michael Girardi
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut 06520-8059, USA.
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Hosseini S, Inserra P, Araghi-Niknam M, Watson RR. Colostrum and milk in the treatment of disease. ADVANCES IN NUTRITIONAL RESEARCH 2002; 10:201-12. [PMID: 11795041 DOI: 10.1007/978-1-4615-0661-4_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Hosseini
- Arizona Prevention Center, P.O. Box 245155, 1501 N. Campbell Ave, University of Arizona, Tucson, AZ 85724, USA
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8
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Morita CT, Li H, Lamphear JG, Rich RR, Fraser JD, Mariuzza RA, Lee HK. Superantigen recognition by gammadelta T cells: SEA recognition site for human Vgamma2 T cell receptors. Immunity 2001; 14:331-44. [PMID: 11290341 DOI: 10.1016/s1074-7613(01)00113-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Human gammadelta T cells expressing the Vgamma2Vdelta2 antigen receptors recognize nonpeptide prenyl pyrophosphate and alkylamine antigens. We find that they also recognize staphylococcal enterotoxin A superantigens in a manner distinct from the recognition of nonpeptide antigens. Using chimeric and mutant toxins, SEA amino acid residues 20-27 were shown to be required for gammadelta TCR recognition of SEA. Residues at 200-207 that are critical for specific alphabeta TCR recognition of SEA do not affect gammadelta TCR recognition. SEA residues 20-27 are located in an area contiguous with the binding site of V beta chains. This study defines a superantigen recognition site for a gammadelta T cell receptor and demonstrates the differences between Vgamma2Vdelta2+ T cell recognition of superantigens and nonpeptide antigens.
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MESH Headings
- Amino Acid Sequence
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/pharmacology
- Antigen Presentation
- Antigen-Presenting Cells/immunology
- Binding Sites
- Biological Evolution
- Cell Line
- Clone Cells/immunology
- Clone Cells/metabolism
- Enterotoxins/chemistry
- Enterotoxins/immunology
- HLA-D Antigens/immunology
- Humans
- Models, Molecular
- Molecular Sequence Data
- Polyisoprenyl Phosphates/chemistry
- Polyisoprenyl Phosphates/immunology
- Protein Conformation
- Receptors, Antigen, T-Cell, alpha-beta/chemistry
- Receptors, Antigen, T-Cell, alpha-beta/immunology
- Receptors, Antigen, T-Cell, gamma-delta/chemistry
- Receptors, Antigen, T-Cell, gamma-delta/immunology
- Substrate Specificity
- Superantigens/chemistry
- Superantigens/immunology
- T-Lymphocytes/chemistry
- T-Lymphocytes/immunology
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Affiliation(s)
- C T Morita
- Division of Rheumatology, Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, IA 52242, USA.
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Adjei AA, Shrestha AK, Castro M, Enriquez FJ. Adoptive transfer of immunity with intraepithelial lymphocytes in Cryptosporidium parvum-infected severe combined immunodeficient mice. Am J Med Sci 2000; 320:304-9. [PMID: 11093682 DOI: 10.1097/00000441-200011000-00002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intestinal infections with the protozoan parasite Cryptosporidium parvum are prevalent in both immunocompetent and immunocompromised hosts. Although C parvum is an important cause of outbreaks and opportunistic infections worldwide, little is known about protective mucosal immune responses. This is in part because animal models of infection are limited to those with genetic or induced immunodeficiencies. METHOD In this report, we isolated immune (primed) or nonimmune (unprimed) intraepithelial lymphocytes (IEL) from BALB/cJ mouse intestines, adoptively transferred them into C parvum-infected severe combined immunodeficient (SCID) mice, and evaluated infection and cell phenotype responses. RESULTS Control SCID mice that received no IEL shed large numbers of oocysts throughout the experimental period (day 18 to day 72). Transfer of primed IEL significantly reduced fecal oocyst shedding in recipient SCID mice compared with SCID mice that received unprimed IEL or no IEL. SCID mice transferred with unprimed IEL shed variable numbers of fecal oocysts that increased and decreased in bursts until day 57 after infection. SCID mice transferred with primed IEL exhibited significantly higher proportions of T-cell receptor (TCR) alphabeta+, CD8+, and CD8alphabeta+ EL compared with inoculated SCID mice that received unprimed or no IEL. CONCLUSION We conclude that primed IEL from immunocompetent mice may influence protective mucosal response against cryptosporidiosis when transferred into SCID mice. In addition, the increased percentage of TCR alphabeta+, CD8+, CD8alphabeta+ IEL in recipient SCID mice may reflect mucosal cell populations involved in these responses during chronic C parvum infection.
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Affiliation(s)
- A A Adjei
- Department of Veterinary Science and Microbiology, University of Arizona, Tucson 85721, USA.
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Baldwin CL, Sathiyaseelan T, Rocchi M, McKeever D. Rapid changes occur in the percentage of circulating bovine WC1(+)gamma delta Th1 cells. Res Vet Sci 2000; 69:175-80. [PMID: 11020371 DOI: 10.1053/rvsc.2000.0410] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
gamma delta T cells found in the peripheral blood of cattle include a major subpopulation distinguished by expression of WC1. These cells are distinct from the WC1(-)gamma delta T cell population based on T cell receptor gene usage. We documented that a group of 6-month-old calves allowed free-range grazing and access to their mothers had a significantly greater proportion of total gamma delta T cells in their blood, attributable to the WC1(+)gamma delta T cell subpopulation, compared to age and breed-matched calves held in conventional housing. When the animals with the greater proportion of gamma delta T cells were transferred to conventional housing there was a decrease in the WC1(+)population so that by 3 weeks after transfer there was no longer a significant difference between the two groups. To investigate the biological activities of WC1(+)gamma delta T cells, the cells were purified by flow cytometric sorting. In vitro, they responded to stimulation by irradiated monocytes in autologous mixed leukocyte reaction (AMLR) cultures but not to direct stimulation through the T cell receptor (T c R) by anti-delta monoclonal antibody. After stimulation in the AMLR, WC1(+)gamma delta T cells had a Th1 cytokine profile characterised by production of IFN -gamma and lack of IL -4. Thus we propose that higher levels of the WC1(+)gamma delta T cells may provide calves with a mechanism to produce Th1 cytokines and that the level of these cells may be modulated according to environment or stress since both groups of calves were apparently disease-free.
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Affiliation(s)
- C L Baldwin
- Department of Veterinary and Animal Sciences, Paige Laboratory, University of Massachsetts, Amherst, MA 01003, USA
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11
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Weidanz WP, Kemp JR, Batchelder JM, Cigel FK, Sandor M, Heyde HCVD. Plasticity of Immune Responses Suppressing Parasitemia During Acute Plasmodium chabaudi Malaria. THE JOURNAL OF IMMUNOLOGY 1999. [DOI: 10.4049/jimmunol.162.12.7383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Abstract
γδ T cells have a crucial role in cell-mediated immunity (CMI) against P. chabaudi malaria, but δ-chain knockout (KO) (δo/o) mice and mice depleted of γδ T cells with mAb cure this infection. To address the question of why mice deficient in γδ T cells resolve P. chabaudi infections, we immunized δo/o mice by infection with viable blood-stage parasites. Sera from infection-immunized mice were tested for their ability to protect JHo/o, δo/o double KO mice passively against P. chabaudi challenge infection. The onset of parasitemia was significantly delayed in mice receiving immune sera, compared with saline or uninfected serum controls. Immune sera were then fractionated into Ig-rich and Ig-depleted fractions by HPLC on a protein G column. Double KO mice were passively immunized with either fraction and challenged with P. chabaudi. The onset of parasitemia was significantly delayed in recipients of the Ig-rich fraction compared with recipients of the Ig-poor fraction of immune sera. We conclude that δo/o mice, which are unable to activate CMI against the parasite, suppress P. chabaudi infection by a redundant Ab-mediated process.
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Affiliation(s)
| | | | | | | | - Matyas Sandor
- †Pathology, University of Wisconsin Medical School, Madison, WI 53706; and
| | - Henri C. van der Heyde
- ‡Department of Microbiology and Immunology, Louisiana State University Medical Center, Shreveport, LA 71103
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King DP, Hyde DM, Jackson KA, Novosad DM, Ellis TN, Putney L, Stovall MY, Van Winkle LS, Beaman BL, Ferrick DA. Cutting Edge: Protective Response to Pulmonary Injury Requires γδ T Lymphocytes. THE JOURNAL OF IMMUNOLOGY 1999. [DOI: 10.4049/jimmunol.162.9.5033] [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
γδ intraepithelial lymphocytes are thought to coordinate responses to pathogens that penetrate the epithelial barrier. To directly test this, mice were inoculated with Nocardia asteroides. At doses that were nonlethal for control mice, γδ-deficient mice became severely ill and died within 14 days. Histologic examination of these lungs demonstrated the presence of severe tissue damage and unimpeded bacterial growth in the γδ-deficient mice compared with neutrophilic lesions and clearance of the organism in control mice. Interestingly, ozone exposure that targets a comparable lung region also resulted in diffuse epithelial necrosis associated with a similar lack of neutrophil recruitment in γδ-deficient mice. These data demonstrate that γδ intraepithelial lymphocytes can protect the host from pathogenic and nonpathogenic insults by targeting the inflammatory response to epithelial necrosis.
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Affiliation(s)
| | - Dallas M. Hyde
- †Anatomy, Physiology, and Cell Biology, School of Veterinary Medicine, University of California, Davis, CA 95616; and
| | | | - Denise M. Novosad
- ‡Department of Medical Microbiology, School of Medicine, University of California, Davis, CA 95616
| | - Terri N. Ellis
- ‡Department of Medical Microbiology, School of Medicine, University of California, Davis, CA 95616
| | - Lei Putney
- †Anatomy, Physiology, and Cell Biology, School of Veterinary Medicine, University of California, Davis, CA 95616; and
| | - Mary Y. Stovall
- †Anatomy, Physiology, and Cell Biology, School of Veterinary Medicine, University of California, Davis, CA 95616; and
| | - Laura S. Van Winkle
- †Anatomy, Physiology, and Cell Biology, School of Veterinary Medicine, University of California, Davis, CA 95616; and
| | - Blaine L. Beaman
- ‡Department of Medical Microbiology, School of Medicine, University of California, Davis, CA 95616
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Abstract
The increasing realization that the current vaccine for tuberculosis, bacille Calmette-Guérin (BCG), is of varying effectiveness, and is less protective in adults than in children, has prompted new research for a replacement. New research has resulted in innovative approaches, including the use of sub-unit vaccines, auxotropic vaccines, DNA vaccines, and recombinant vaccines, among others. This article reviews these approaches and test results in animal models, and discusses their potential for use in humans.
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Affiliation(s)
- I M Orme
- Department of Microbiology, Colorado State University, Fort Collins, USA
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García VE, Jullien D, Song M, Uyemura K, Shuai K, Morita CT, Modlin RL. IL-15 Enhances the Response of Human γδ T Cells to Nonpetide Microbial Antigens. THE JOURNAL OF IMMUNOLOGY 1998. [DOI: 10.4049/jimmunol.160.9.4322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Human γδ T cells have the ability to rapidly expand and produce IFN-γ in response to nonpeptide Ags of microbial pathogens, in particular a class of compounds known as the prenyl phosphates. We investigated the ability of IL-15, a T cell growth factor, to modulate prenyl phosphate-induced γδ T cell proliferation and cytokine production. IL-15 significantly enhanced the expansion of γδ T cells in the peripheral blood after stimulation in vitro with isopentenyl pyrophosphate. Moreover, using γδ T cell clones, we determined that IL-15-induced T cell proliferation was dependent on the IL-2Rβ chain but not the IL-2Rα chain. We therefore studied the IL-15Rα chain expression in human γδ T cells in the presence or absence of nonpeptide Ags. We found IL-15Rα mRNA expression in IL-15-stimulated and Ag-stimulated human γδ T cells but not in resting γδ T cells. Although IL-15 itself had little effect on the production of IFN-γ, IL-15 plus IL-12 acted synergistically to augment IFN-γ production by γδ T cells. Moreover, we showed that this increase in IFN-γ could be explained by the dual activation of STAT1 and STAT4 by IL-15 and IL-12, respectively. Taken together, these results suggest that IL-15 may contribute to activation of human γδ T cells in the immune response to microbial pathogens.
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Affiliation(s)
| | | | - Mark Song
- ‡Molecular Biology Institute and Departments of
| | | | - Ke Shuai
- ‡Molecular Biology Institute and Departments of
- §Medicine and
- ¶Biological Chemistry and
- ∥Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA 90095; and
| | - Craig T. Morita
- #Division of Rheumatology and Immunology, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115
| | - Robert L. Modlin
- *Division of Dermatology and
- †Department of Microbiology and Immunology, UCLA School of Medicine, Los Angeles, CA 90095
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Yamada K, Shimaoka M, Nagayama K, Hiroi T, Kiyono H, Honda T. Bacterial invasion induces interleukin-7 receptor expression in colonic epithelial cell line, T84. Eur J Immunol 1997; 27:3456-60. [PMID: 9464835 DOI: 10.1002/eji.1830271246] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The intestinal epithelial layer forms the interface between the external and the internal environments of a host. Since the interleukin-7 (IL-7) and IL-7 receptor (IL-7R) signaling pathway has been shown to play an important role in the mucosal immune system, we studied the expression of IL-7R in T84, a colonic epithelial cell line, after cells were infected with several types of enteropathogenic bacteria, including Salmonella typhimurium, enteropathogenic Escherichia coli and enteroinvasive Escherichia coli. Bacterial invasion induced IL-7R expression in T84 assessed by a semi-quantitative reverse transcription-polymerase chain reaction technique and flow cytometry. The inhibition of bacterial invasion by cytochalasin D, a specific inhibitor of actin polymerization, led to a reduction in the expression of IL-7R. These data indicate that bacterial invasion into intestinal epithelial cells is likely to be an essential process in the induction of IL-7R. The communication between the epithelium and mucosal lymphocytes which is mediated via IL-7 and IL-7R may be involved in the modulation of the mucosal inflammation which occurs in bacterial infection.
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Affiliation(s)
- K Yamada
- Department of Bacterial Infections, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
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17
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François A, Lesesve JF, Stamatoullas A, Comoz F, Lenormand B, Etienne I, Mendel I, Hémet J, Bastard C, Tilly H. Hepatosplenic gamma/delta T-cell lymphoma: a report of two cases in immunocompromised patients, associated with isochromosome 7q. Am J Surg Pathol 1997; 21:781-90. [PMID: 9236834 DOI: 10.1097/00000478-199707000-00006] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Two cases of peripheral T-cell lymphoma, characterized by hepatosplenic presentation and gamma/delta T-cell receptor phenotype on malignant cells, are reported. Little is known about the chromosomal changes in these peculiar lymphomas. We report the cytogenetic analysis of these two patients. Isochromosome 7q and trisomy 8 were observed. These abnormalities were reported previously in five cases of gamma/delta T-cell lymphoma. These two patients had lymphomatous infiltration of the spleen, liver, bone marrow, and (in one case) lymph nodes. These abnormalities occurred in immunocompromised patients (i.e., immunosuppressive therapy for kidney transplantation and chemotherapy for Hodgkin's disease), without Epstein-Barr virus infection stigmata in tumor cells.
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MESH Headings
- Adult
- Antigens, CD/analysis
- Bone Marrow/pathology
- Cell Nucleus/pathology
- Chromosome Aberrations
- Chromosome Disorders
- Chromosomes, Human, Pair 7
- Chromosomes, Human, Pair 8
- Clone Cells
- Cytogenetics
- Cytoplasm/pathology
- Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor/genetics
- Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor/immunology
- Humans
- Immune Tolerance
- Immunophenotyping
- In Situ Hybridization
- Karyotyping
- Liver Neoplasms/genetics
- Liver Neoplasms/immunology
- Liver Neoplasms/pathology
- Lymph Nodes/pathology
- Lymphoma, T-Cell/genetics
- Lymphoma, T-Cell/immunology
- Lymphoma, T-Cell/pathology
- Male
- Metaphase
- Mitosis
- Splenic Neoplasms/genetics
- Splenic Neoplasms/immunology
- Splenic Neoplasms/pathology
- Trisomy
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Affiliation(s)
- A François
- Department of Pathology, University Hospital, Rouen, France
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18
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Abstract
The lymphoid tissues associated with the intestine are exposed continuously to antigen and are the largest part of the immune system. Many lymphocytes are found in organised tissues such as the Peyer's patches and mesenteric lymph nodes, as well as scattered throughout the lamina propria and epithelium of the mucosa itself. These lymphocyte populations have several unusual characteristics and the intestinal immune system is functionally and anatomically distinct from other, peripheral compartments of the immune system. This review explores the anatomical and molecular basis of these differences, with particular emphasis on the factors which determine how the intestinal lymphoid tissues discriminate between harmful pathogens and antigens which are beneficial, such as food proteins or commensal bacteria. These latter antigens normally provoke immunological tolerance, and inappropriate responses to them are responsible for immunopathologies such as food hypersensitivity and inflammatory bowel disease. We describe how interactions between local immune cells, epithelial tissues and antigen-presenting cells may be critical for the induction of tolerance and the expression of active mucosal immunity. In addition, the possibility that the intestine may act as an extrathymic site for T-cell differentiation is discussed. Finally, we propose that, under physiological conditions, immune responses to food antigens and commensal bacteria are prevented by common regulatory mechanisms, in which transforming growth factor beta plays a critical role.
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Affiliation(s)
- A M Mowat
- Department of Immunology, University of Glasgow, Western Infirmary, Scotland
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Bürk MR, Carena I, Donda A, Mariani F, Mori L, De Libero G. Functional inactivation in the whole population of human V gamma 9/V delta 2 T lymphocytes induced by a nonpeptidic antagonist. J Exp Med 1997; 185:91-7. [PMID: 8996245 PMCID: PMC2196105 DOI: 10.1084/jem.185.1.91] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Nonpeptidic compounds stimulate human T cells bearing the TCR-gamma delta in the absence of major histocompatibility complex restriction. We report that one of these ligands, 2,3-diphosphoglyceric acid (DPG), which induces expansion of V gamma 9/V delta T cells ex vivo, antagonizes the same cell population after repetitive activation. Stimulation with DPG results in partial early protein tyrosine phosphorylation and a prolonged, but reversible, state of unresponsiveness to agonist ligands in V gamma 9/V delta 2, but not in other T cells. These findings show that TCR antagonism is a general phenomenon of T cells. However, in contrast to the clonal specificity of altered peptides antagonizing alpha beta T cells, all the tested V gamma 9/V delta 2 polyclonal cell lines and clones become unresponsive, a fact that may be relevant for the regulation of their response in vivo.
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Affiliation(s)
- M R Bürk
- Department of Research, University Hospital, Basel, Switzerland
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20
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Affiliation(s)
- G De Libero
- Dept of Research, University Hospital, Basel, Switzerland
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21
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Kowalczyk D, Skorupski W, Kwias Z, Nowak J. Activated gamma/delta T lymphocytes infiltrating renal cell carcinoma. Immunol Lett 1996; 53:15-8. [PMID: 8946212 DOI: 10.1016/0165-2478(96)02605-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Gamma/delta (gamma delta) T lymphocytes have been postulated to play a role in a surveillance mechanism that eliminates transformed or otherwise damaged cells. In this study, we examined by flow cytometry the frequency and phenotype of gamma delta T cells in the tumour infiltrating lymphocytes (TIL) and peripheral blood (PBL) from renal cell carcinoma patients. The TCR gamma delta + cells comprised an average of 3.8% of the CD3+ TIL and 5.2% of circulating T cells. Analysis of surface immunophenotype revealed that activation markers of T lymphocytes: CD25 and HLA DR were highly expressed on the tumour infiltrating gamma delta + T lymphocytes (median 27.6% for CD25 and 52.0% for HLA DR). More importantly, percentage of activated gamma delta T cells was found to be much higher than compared to all activated CD3+ cells. Furthermore, an unusually high proportion of gamma delta positive TILs express CD4 or CD8 molecules (17.2 and 36.8%, respectively), indicating that they might recognise antigen presented within MHC II or I context. These results suggest that gamma delta T lymphocytes may play a certain role in immune response against tumour cells.
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MESH Headings
- CD3 Complex/immunology
- CD4 Antigens/immunology
- CD8 Antigens/immunology
- Carcinoma, Renal Cell/immunology
- Carcinoma, Renal Cell/pathology
- Flow Cytometry/methods
- HLA-DR Antigens/immunology
- Humans
- Lymphocytes, Tumor-Infiltrating/immunology
- Receptors, Antigen, T-Cell, gamma-delta/classification
- Receptors, Antigen, T-Cell, gamma-delta/immunology
- Receptors, Interleukin-2/immunology
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Affiliation(s)
- D Kowalczyk
- Institute of Human Genetics, Polish Academy of Sciences, Poznań, Poland
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22
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Ferrick DA, Braun RK, Lepper HD, Schrenzel MD. Gamma delta T cells in bacterial infections. RESEARCH IN IMMUNOLOGY 1996; 147:532-41. [PMID: 9127885 DOI: 10.1016/s0923-2494(97)85219-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- D A Ferrick
- Department of Pathology, School of Veterinary Medicine, University of California at Davis 95616, USA
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23
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Tabata A, Kaneda K, Watanabe H, Abo T, Yano I. Kinetics of organ-associated natural killer cells and intermediate CD3 cells during pulmonary and hepatic granulomatous inflammation induced by mycobacterial cord factor. Microbiol Immunol 1996; 40:651-8. [PMID: 8908610 DOI: 10.1111/j.1348-0421.1996.tb01123.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We investigated here the kinetics of natural killer (NK) cells and extrathymic T cells, which include intermediate CD3 cells and gamma delta T cells, in the cord factor-induced granulomatous inflammation of the lungs and liver. In Balb/c mice, pulmonary inflammation elevated the proportion of NK cells and that of extrathymic T cells to mononuclear cells in the lungs. C3H/He mice exhibited shorter-term inflammation of the lungs than Balb/c mice and accordingly showed a smaller increase in the proportions of pulmonary NK cells and intermediate CD3 cells. In the liver of Balb/c mice, hepatic NK cells increased as well with the granulomatous changes, while intermediate CD3 cells exhibited a transient decrease before they increased. The present study has demonstrated that granulomatous inflammation is accompanied by the increase of lung-associated NK cells and extrathymic T cells and that there exists a difference between these two mouse strains in the induction of these lymphocyte subsets by cord factor.
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Affiliation(s)
- A Tabata
- Department of Bacteriology, Osaka City University Medical School, Japan
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24
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Abstract
The association of a pronounced gammadelta T-cell response with Plasmodium infections is intriguing. The ability of parasite material to activate gammadelta T cells in vitro, and the localization of these cells in vivo in the red pulp of the spleen, suggests that these cells could play a role in the killing of bloodstage malaria parasites. However, the magnitude, the response and the predominance of inflammatory cytokines secreted by these cells may also indicate a role in the pathology of malaria infections. In this article, Jean Langhorne reveiws the current status of gammadelta T cells in malaria in the context of what is known about the function and specificity of gammadelta T cells in general.
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Affiliation(s)
- J Langhorne
- Infection and Immunity Section in the Department of Biology, Imperial College of Science, Technology and Medicine, Prince Consort Rd London, UK.
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25
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Gan YH, Pauza CD, Malkovsky M. Gamma delta T cells in rhesus monkeys and their response to simian immunodeficiency virus (SIV) infection. Clin Exp Immunol 1995; 102:251-5. [PMID: 7586674 PMCID: PMC1553420 DOI: 10.1111/j.1365-2249.1995.tb03773.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Recent reports of the increase in peripheral blood gamma delta T cells in HIV+ patients prompted us to examine the gamma delta T cell system in rhesus monkeys (Macaca mulatta) and the responses of these cells to SIV infection. Our results reveal differences in the gamma delta T cell subset composition and their expression of CD8 in the peripheral blood of monkeys and humans. The outgrowth of simian gamma delta T cells in response to Daudi cells is similar to that in humans, but the exposure to IL-2 stimulates preferentially the simian V delta 1 subset rather than the V gamma 9/V delta 2 subset as found in humans. Upon SIV infection of the monkeys, we observed a transient increase of the percentage of total gamma delta T cell and the V gamma 9 subset. gamma delta T cells from infected animals also express more activation markers such as CD69, CD44 and the memory marker CD45RO. However, they respond to a lesser degree to Daudi or IL-2 stimulation in the outgrowth experiments compared with uninfected animals, although the subset composition of total gamma delta T cells is similar in infected and uninfected animals. The results clearly indicate that gamma delta T cells in rhesus monkeys are influenced by SIV infection. The detailed analysis of the gamma delta T cell response to SIV infection can serve as a model for understanding human gamma delta T cell responses to HIV infections.
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Affiliation(s)
- Y H Gan
- Department of Medical Microbiology and Immunology, University of Wisconsin Medical School, Madison 53706, USA
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26
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Miura S, Tsuzuki Y, Fukumura D, Serizawa H, Suematsu M, Kurose I, Imaeda H, Kimura H, Nagata H, Tsuchiya M. Intravital demonstration of sequential migration process of lymphocyte subpopulations in rat Peyer's patches. Gastroenterology 1995; 109:1113-23. [PMID: 7557076 DOI: 10.1016/0016-5085(95)90569-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND & AIMS Although recirculation of lymphocytes through Peyer's patches is important for specific immune defense, the intraorgan migration of lymphocyte subpopulations has not been clearly understood. The aim of this study was to compare the spatial distributions of labeled lymphocytes among various subpopulations in rat Peyer's patches. METHODS Lymphocytes collected from intestinal lymph were separated into CD4+, CD8+, and T and B cells, labeled with a fluorochrome carboxyfluorescein diacetate succinimidyl ester, and injected into the jugular vein. Peyer's patches of recipient rats were observed by intravital fluorescence microscopy. RESULTS No significant difference was found in the percentage of lymphocytes in transit or in the rolling velocity among different subpopulations. Lymphocytes sticking to the venules increased in number at 10-20 minutes, with preferential adherence of CD4+ cells to venules of 25-50 microns and preferential adherence of B cells to the venules of a wider size range. After 30 minutes, extravasated lymphocytes moved into the interstitium. B cells migrated from venules more quickly than CD4+ cells. CD8+ cells showed an intermediate pattern between CD4+ and B cells in sticking and migratory behaviors. Subsequently, CD4+ and CD8 cells preferentially appeared in parafollicular microlymphatics. CONCLUSIONS Significant differences were observed among lymphocyte subpopulations in terms of spatial distribution of lymphocytes sticking to venules, migration into the interstitium, and their lymphatic transport.
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Affiliation(s)
- S Miura
- Department of Medicine, School of Medicine, Keio University, Tokyo, Japan
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27
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Openshaw PJ. Immunity and immunopathology to respiratory syncytial virus. The mouse model. Am J Respir Crit Care Med 1995; 152:S59-62. [PMID: 7551415 DOI: 10.1164/ajrccm/152.4_pt_2.s59] [Citation(s) in RCA: 109] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Infection with respiratory syncytial virus (RSV) is a major unsolved challenge for vaccine development. RSV is worldwide in distribution and infects almost all children during the first 2 yr of life. The mouse model of RSV lung disease has been very successful in reproducing many aspects of the human disease. In particular, the role of antiviral T cells in both eliminating virus and causing enhanced disease has been shown dramatically. This immunopathologic paradox is now more clearly understood than for any other common human infection, largely due to insights gained from the mouse model. This review focuses on the unique ability of different RSV proteins to prime for specific functional subsets in the mouse, and the association between sensitization to the major surface glycoprotein G, the induction of T helper 2 cells, and the subsequent appearance of lung eosinophilia during RSV infection.
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Affiliation(s)
- P J Openshaw
- St. Mary's Hospital Medical School, Imperial College of Science, Technology and Medicine, London, United Kingdom
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28
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Affiliation(s)
- P G Holt
- Division of Cell Biology, Institute for Child Health Research, West Perth, Western Australia
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29
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Schuhmachers G, Ariizumi K, Mathew PA, Bennett M, Kumar V, Takashima A. Activation of murine epidermal gamma delta T cells through surface 2B4. Eur J Immunol 1995; 25:1117-20. [PMID: 7737283 DOI: 10.1002/eji.1830250440] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Dendritic epidermal T cells (DETC) are gamma delta T cells that normally reside in murine skin. They express on their surface the 2B4 molecule, a 66-kDa glycoprotein of the immunoglobulin gene superfamily thought to be associated with anti-tumor cytotoxicity by natural killer and lymphokine-activated killer cells. Here, we show that ligation of surface 2B4 transduces cell activation signals in DETC. Treatment with anti-2B4 monoclonal antibodies triggers the secretion of interferon-gamma and interleukin-2 by DETC lines, induces proliferation of resting DETC lines, amplifies anti-CD3-dependent proliferation of DETC freshly isolated from mouse skin; and up-regulates egr-1 and c-fos mRNA expression. These results indicate a unique pathway for DETC activation.
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Affiliation(s)
- G Schuhmachers
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas 75235, USA
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30
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Tanaka Y, Sano S, Nieves E, De Libero G, Rosa D, Modlin RL, Brenner MB, Bloom BR, Morita CT. Nonpeptide ligands for human gamma delta T cells. Proc Natl Acad Sci U S A 1994; 91:8175-9. [PMID: 8058775 PMCID: PMC44568 DOI: 10.1073/pnas.91.17.8175] [Citation(s) in RCA: 292] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
gamma delta T cells respond to a variety of microbial pathogens and transformed cells. Their limited receptor repertoire and activation by mycobacterial antigens resistant to proteases suggest that they may recognize nonpeptide antigens. We have tested a variety of nonpeptide molecules for stimulation of human gamma delta T cells. Synthetic alkyl phosphates, particularly monoethyl phosphate (MEP), selectively activated gamma delta T cells and stimulated their proliferation in vitro. All gamma delta T cells stimulated by MEP expressed V gamma 2/V delta 2 receptors. The purified natural ligand of mycobacteria is chemically similar to, though distinct from, MEP and contains a phosphate residue that is critical for biological activity. Recognition and expansion of a specific T-cell receptor-bearing population to non-peptide ligands is unprecedented among T cells. We suggest that MEP mimics small natural ligands capable of expanding one subset of gamma delta T cells and that this recognition of nonpeptide antigens may play an important role in human immunity to pathogens.
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MESH Headings
- Antibodies/pharmacology
- Antigens, Bacterial/pharmacology
- Arthritis, Rheumatoid/immunology
- Clone Cells
- Cytotoxicity, Immunologic
- Flow Cytometry
- Humans
- Ligands
- Lymphocyte Activation
- Mycobacterium tuberculosis/immunology
- Organophosphates/metabolism
- Organophosphates/pharmacology
- Receptors, Antigen, T-Cell, gamma-delta/drug effects
- Receptors, Antigen, T-Cell, gamma-delta/immunology
- Receptors, Antigen, T-Cell, gamma-delta/physiology
- Synovial Fluid/immunology
- T-Lymphocytes/drug effects
- T-Lymphocytes/immunology
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Affiliation(s)
- Y Tanaka
- Howard Hughes Medical Institute, Albert Einstein College of Medicine, Bronx, NY 10461
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31
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Mochizuki M, Suzuki N, Takeno M, Nagafuchi H, Harada T, Kaneoka H, Yamashita N, Hirayama K, Nakajima T, Mizushima Y. Fine antigen specificity of human gamma delta T cell lines (V gamma 9+) established by repetitive stimulation with a serotype (KTH-1) of a gram-positive bacterium, Streptococcus sanguis. Eur J Immunol 1994; 24:1536-43. [PMID: 7517873 DOI: 10.1002/eji.1830240712] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We have established human gamma delta T cell lines specific for Streptococcus sanguis (S. sanguis) KTH-1 present in normal oral cavity flora. The CD4-CD8-CD3+V gamma 9+V delta 1-CD45RO+ CD25+ T cell lines showed a proliferative response to the streptococcal antigen (Ag) in the presence of autologous antigen-presenting cells without apparent evidence of HLA restriction. The proliferative response of the gamma delta T cell lines was completely blocked by anti-TcR gamma delta monoclonal antibody (mAb) and anti-HLA class I mAb (W6/32), whereas anti-HLA classical class Ia mAb (B-H9; anti-HLA-A,B,C), anti-HLA class II mAb (anti-DR, anti-DQ, and anti-DP) and anti-CD4 mAb did not have any inhibitory effects. Surprisingly, the gamma delta T cell lines showed the proliferative response against the original bacterial Ag KTH-1 exclusively, and exhibited no cross-reactivity with nominal Ag such as purified protein derivative of tuberculin, tetanus toxoid and Mycobacterium tuberculosis, or the same species but different strain of S. sanguis, American Type Culture Collection (ATCC) standard strain (10556), or even with the same strain but different serotype of S. sanguis, KTH-3. Moreover, cytokine production of the gamma delta T cell lines was similar to the Th1 pattern [interferon-gamma, tumor necrosis factor (TNF)-alpha and TNF-beta]. They also produced interleukin-8 that functions as one of chemoattractants for polymorphonuclear cells. Using direct sequencing technique of the polymerase chain reaction products, we found that junctional diversity of the T cell receptor (TcR) used by the parental KTH-1 specific gamma delta T cell line and its subclones is rather limited. It is suggested that gamma delta T cells with canonical TcR could preferentially respond to KTH-1 Ag. Thus, in addition to a broad or cross-reactivity of gamma delta T cells against phylogenetically conserved stress/heat-shock protein, which is well characterized by others, some peripheral blood gamma delta T cells could recognize and kill exogenous agents with fine antigenic specificity to protect the body against them.
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Affiliation(s)
- M Mochizuki
- Division of Allergy and Rheumatic Diseases, St. Marianna University School of Medicine, Kanagawa, Japan
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32
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Langhorne J, Morris-Jones S, Casabo LG, Goodier M. The response of gamma delta T cells in malaria infections: a hypothesis. RESEARCH IN IMMUNOLOGY 1994; 145:429-36. [PMID: 7899708 DOI: 10.1016/s0923-2494(94)80173-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- J Langhorne
- Max-Planck Institut für Immunobiologie, Freiburg, Germany
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33
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Abstract
Recent evidence demonstrates the important role played by gamma delta T cells in resistance to infections. Despite this, in most cases the antigens recognized by the responding gamma delta T cells are unknown. Antigen recognition by some gamma delta T-cell populations may not require the participation of either MHC class I or class II molecules. In other cases, evidence exists for the participation of MHC-encoded molecules, particularly non-classical class I molecules.
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Affiliation(s)
- M Kronenberg
- University of California at Los Angeles School of Medicine
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34
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Ohno H, Ono S, Hirayama N, Shimada S, Saito T. Preferential usage of the Fc receptor gamma chain in the T cell antigen receptor complex by gamma/delta T cells localized in epithelia. J Exp Med 1994; 179:365-9. [PMID: 8270881 PMCID: PMC2191308 DOI: 10.1084/jem.179.1.365] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
zeta and eta chains of the T cell antigen receptor (TCR) complex and the gamma chain of Fc receptors (FcR gamma) constitute a family of proteins important for the expression of, and signal transduction through, these receptors in hematopoietic cells. In zeta-deficient mice, TCR expression was reduced in most T cells. By contrast, CD8 alpha alpha + TCR-gamma/delta + intestinal intraepithelial lymphocytes in these mice expressed a normal level of TCR. Biochemical analysis of the TCR complex in these cells from zeta-deficient as well as normal mice revealed the predominant usage of FcR gamma. Furthermore, gamma/delta + T cells in epithelia of the skin and female reproductive organs from zeta-deficient mice also showed relatively high TCR expression, indicating the usage of FcR gamma. These observations demonstrate the preferential usage of FcR gamma by gamma/delta + T cells localized in epithelia of normal mice.
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Affiliation(s)
- H Ohno
- Division of Molecular Genetics, Chiba University School of Medicine, Japan
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35
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Gradoni L, Gramiccia M. Leishmania infantum Tropism: Strain genotype or host immune status? ACTA ACUST UNITED AC 1994; 10:264-7. [PMID: 15275441 DOI: 10.1016/0169-4758(94)90142-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In apparently immunocompetent patients, Leishmania infantum provokes a spectrum of disease, ranging from simple skin lesion to severe visceral leishmaniasis, that is determined mainly by the protozoan genotype. In HIV-positive individuals, leishmanial infection results almost exclusively in visceral disease. In this review, Luigi Grodoni and Marina Gromiccia discuss the role o f the intrinsic virulence of L. infantum strains and the immune condition of the host, and focus on recently described mechanisms of immunological control of leishmanial infection.
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Affiliation(s)
- L Gradoni
- Laboratorio di Parossitologia, Istituto Superiore di Sanitá Viale Regina Elena 299, 00161 Rome, Italy
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36
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Richmond I, Pritchard GE, Ashcroft T, Corris PA, Walters EH. Distribution of gamma delta T-cells in the bronchial tree of smokers and non-smokers. J Clin Pathol 1993; 46:926-30. [PMID: 8227410 PMCID: PMC501620 DOI: 10.1136/jcp.46.10.926] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIMS To assess the distribution of gamma delta T-cells in the human bronchial tree; and to compare quantitatively the differences between gamma delta T-cell numbers in different parts of the airway wall in smokers and non-smokers. METHODS Full thickness bronchial wall sections were taken from 10 whole lung specimens from both smokers and non-smokers. Serial cryostat sections stained with the monoclonal antibodies CD3 and TCR delta-1 were examined with the aid of interactive image analysis to assess gamma delta T-cell numbers both in absolute terms and as a proportion of total T lymphocyte numbers. RESULTS In all cases gamma delta T-cells were demonstrable throughout the airway wall. Although in absolute terms they tend to occur predominantly in the bronchial epithelium, this seems to reflect higher numbers of T lymphocytes in the epithelium in general compared with the submucosa. No genuine epitheliotropism is evident. Comparison by smoking status shows a significant increase in gamma delta T-cell numbers in the bronchial glands of smokers compared with non-smokers. CONCLUSIONS gamma delta T-cells form an integral though variable component of the immunocompetent cell population of the human airway in both smokers and non-smokers. Although epitheliotropism does not exist in the bronchial tree, gamma delta T-cells seem to form a significant part of the bronchial gland inflammation associated with smoking.
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Affiliation(s)
- I Richmond
- Department of Histopathology, Freeman Hospital, Newcastle upon Tyne
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37
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Kitayama J, Atomi Y, Nagawa H, Kuroda A, Mutoh T, Minami M, Juji T. Functional analysis of TCR gamma delta+ T cells in tumour-infiltrating lymphocytes (TIL) of human pancreatic cancer. Clin Exp Immunol 1993; 93:442-7. [PMID: 8370173 PMCID: PMC1554920 DOI: 10.1111/j.1365-2249.1993.tb08198.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
In six patients with advanced pancreatic carcinoma, TIL and tumour-draining lymphocytes (TDL) were isolated from primary pancreatic tumour and regional lymph nodes. In comparison with TDL and peripheral blood lymphocytes (PBL), TIL contained a comparatively higher percentage of TCR gamma delta+ cells, although they were still a small fraction. By 2 weeks culture with rIL-2 and immobilized OKT-3 antibody, the TCR gamma delta+ cells in TIL were preferentially expanded at the early culture periods, although it was temporary. In four cases, the TCR gamma delta+ and CD8+ TCR alpha beta+ TIL were separated by negative sorting using flowcytometry. All the TCR gamma delta+ TIL were CD4-, CD8- (double negative), and one of the TIL lines was mostly composed of delta TCS1+ cells, while the others were delta TCS1-. In comparison with CD8+ TCR alpha beta+ TIL, all the TCR gamma delta+ TIL exhibited much stronger lytic activity against freshly isolated autologous pancreatic cancer cells. However, all the gamma delta+ TIL also exhibited a strong non-MHC-restricted cytotoxicity, and there was no correlation between the lytic pattern and the percentage of delta TCS1+ cells. These data suggest that the TCR gamma delta+ T cells can proliferate vigorously in a certain condition, and if successfully expanded in vitro they might be helpful material for effective adoptive immunotherapy.
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Affiliation(s)
- J Kitayama
- First Department of Surgery, Tokyo University, Japan
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38
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Sturgess R, Kontakou M, Nelufer J, Hung T, Ciclitira PJ. Gamma/delta T-cell receptor expression in the jejunal epithelium of patients with dermatitis herpetiformis and coeliac disease. Clin Exp Dermatol 1993; 18:318-21. [PMID: 8403465 DOI: 10.1111/j.1365-2230.1993.tb02206.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The density of jejunal intra-epithelial T cells expressing the gamma/delta form of the T-cell receptor is known to be increased in coeliac disease, the significance of which remains a mystery. The expression of the gamma/delta T-cell receptor in the jejunum of patients with dermatitis herpetiformis, coeliac disease, treated and untreated, and controls were studied. Expression of the gamma/delta T-cell receptor was significantly increased in patients with dermatitis hepetiformis (P < 0.0005) and in both untreated (P < 0.0005) and treated coeliac patients (P < 0.05) compared with controls. There were significant correlations between the indices of enteropathy, enterocyte height (P < 0.005) and villous height/crypt depth ratio (P < 0.0001), and expression of the gamma/delta T-cell receptor in the jejunum of all the patients. This argues against the hypothesis that gamma/delta T-cells have a fundamental role in the aetiology of gluten-sensitive enteropathy. It suggests that gamma/delta T cells may be involved in the effector arm of the mucosal immune response to cereal peptides in susceptible individuals.
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Affiliation(s)
- R Sturgess
- Rayne Institute, St Thomas's Hospital, London, UK
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39
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Morshed SA, Fukuma H, Kimura Y, Watanabe S, Nishioka M. Interferon-gamma, interleukin (IL)-2 and IL-2 receptor expressions in hepatitis C virus-infected liver. GASTROENTEROLOGIA JAPONICA 1993; 28 Suppl 5:59-66. [PMID: 8395442 DOI: 10.1007/bf02989208] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Cytokine response to viral infection can be of critical importance in the host defense against virus. Interferon (IFN)-gamma and interleukin (IL)-2 have wide ranges of activities in host defense mechanisms. Therefore, these cytokine genes in the liver were investigated in a series of patients with hepatitis C virus (HCV) infection using a reverse transcribed-polymerase chain reaction (RT-PCR). Total RNA was purified from liver biopsies, reverse transcribed to cDNA, amplified by specific primers, and the products were detected by agarose gel and slot blot hybridization. All samples from acute hepatitis (AH; n = 4) and chronic hepatitis patients (CH; n = 19) were positive for IFN-gamma at varying degrees. AH patients showed strong signals compared to CH patients, liver cirrhosis (LC; n = 12; 72% positive) patients, and hepatocellular carcinoma (HCC; n = 21; 19% positive) patients. IL-2 gene was undetectable in all patients tested. IL-2 receptor (IL-2R) was detectable in AH, CH and LC patients but not in HCC patients. We conclude that IFN-gamma has important roles in the cytokine network that indeed present in the liver of HCV patients while the presence of IL-2R gene may indicate that the signaling pathway for IL-2 is intact.
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Affiliation(s)
- S A Morshed
- Third Department of Internal Medicine, Kagawa Medical School, Japan
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40
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McMenamin C, Chilna B, Holt PG. Phenotypic and functional analysis of mucosal T cells isolated from tissue explants of rat upper respiratory tract. J Immunol Methods 1993; 160:219-26. [PMID: 8459109 DOI: 10.1016/0022-1759(93)90181-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
It has been hypothesised that T cells play a central role in the pathogenesis of asthma which is characterised by chronic inflammation of the airways. In order to further study the T cells identified in situ in the airways we have developed, in the rat, a novel method for the extraction of T cells directly from the airway mucosa. The T cells actively migrate from explant tissue under the influence of exogenous IL-2 yielding sufficient cells for phenotypic and functional analysis. The T cells obtained represent a random selection of cells present at the start of culture as determined by dot blot analysis of the T cell receptor. The majority of cells were CD8+ and did not express the alpha/beta T cell receptor. In addition, the cloning efficiency of the explant T cells was extremely low (1:28) compared to that of splenic T cells (1:2) in agreement with our earlier studies on peripheral lung T cells which also demonstrated a reduced proliferative capacity. This data suggests a generalised 'immunosuppressive' milieu throughout the respiratory tract.
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MESH Headings
- Animals
- Gene Expression
- Immunoenzyme Techniques
- Immunophenotyping
- Mucous Membrane/cytology
- Mucous Membrane/immunology
- Rats
- Rats, Inbred BN
- Rats, Inbred Strains
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Antigen, T-Cell, alpha-beta/immunology
- Receptors, Antigen, T-Cell, gamma-delta/genetics
- Receptors, Antigen, T-Cell, gamma-delta/immunology
- T-Lymphocytes/immunology
- Trachea/cytology
- Trachea/immunology
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Affiliation(s)
- C McMenamin
- Division of Cell Biology, Western Australian Institute for Child Health
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41
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Pamer EG, Bevan MJ, Lindahl KF. Do nonclassical, class Ib MHC molecules present bacterial antigens to T cells? Trends Microbiol 1993; 1:35-8. [PMID: 8143114 DOI: 10.1016/0966-842x(93)90023-k] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Immune responses to bacterial antigens that appear unrestricted by the MHC may involve oligomorphic MHC class Ib molecules. One example is H-2M3, which binds N-formylated peptides and presents a Listeria peptide to cytotoxic T cells from infected mice. Lack of polymorphism makes these molecules a promising target for peptide vaccines.
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Affiliation(s)
- E G Pamer
- Infectious Disease Section, Yale University School of Medicine, New Haven, CT 06510-8056
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42
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Pépin LF, Roger T, Morisset J, Seman M. Preferential V delta 1 expression among TcR gamma/delta-bearing T cells in human oral epithelium. Scand J Immunol 1993; 37:289-94. [PMID: 8382839 DOI: 10.1111/j.1365-3083.1993.tb02556.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The oral cavity is a septic area colonized by various bacterial species, and the oral mucosa is frequently submitted to microtraumas. Several mechanisms are implicated in the defence of the oral tissue, but little is known concerning the eventual presence and role of gamma/delta T cells at this site. Samples of healthy keratinized oral mucosa were examined with immunochemical techniques using anti-CD3, CD4, CD8, CD22, TcR delta 1, V delta 1 and V delta 2 monoclonal antibodies. Whatever the site examined, gamma/delta T cells represent at most 2% of the T-cell population, a value similar to that found in other tissues. In the connective tissue, under the basement membrane, V delta 2+ gamma/delta T cells are predominant whereas the epithelium mostly contains V delta 1+ gamma/delta T cells. The significance of this preferential V delta 1 intraepithelial presence is discussed.
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Affiliation(s)
- L F Pépin
- Laboratoire d'Immunodifférentiation, Institut Jacques Monod, Paris, France
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43
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Kirk AD, Ibrahim S, Dawson DV, Sanfilippo F, Finn OJ. Characterization of T cells expressing the gamma/delta antigen receptor in human renal allografts. Hum Immunol 1993; 36:11-9. [PMID: 8458734 DOI: 10.1016/0198-8859(93)90003-j] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
To investigate the role of gamma/delta+ T cells in allograft rejection, we have studied the TCR phenotype and function of lymphocytes infiltrating rejecting, rejected, and nonrejecting human renal allografts. Two-color immunohistologic staining showed that 19% of rejecting biopsies and 40% of rejected nephrectomies had significant infiltration (> 10% of the total T-cell population) with gamma/delta+ T cells. No biopsies from nonrejecting kidneys showed > 10% gamma/delta+ T cells. Flow-cytometry analysis of T-cell populations expanded from rejecting and rejected allografts demonstrated that 33% of biopsy- and 40% of nephrectomy-derived populations had significant percentages (> 10%) of gamma/delta+ T cells. Six cell lines with increased numbers of gamma/delta+ T cells were tested for cytolytic activity against the NK target cell line K562 and compared with cytotoxic activity of exclusively alpha/beta T-cell populations. Lysis was noted by all gamma/delta+, but no gamma/delta-, populations. To confirm that the cytotoxicity of these gamma/delta+ T-cell populations was not MHC directed, one nephrectomy-derived population with 69% gamma/delta+ T cells by cytometry and > 50% by immunohistology was studied extensively. High levels of killing were seen against the NK targets K562 and Daudi as well as other malignant, benign, and third-party renal cell lines, but relevant alloantigen-expressing targets were not killed. Sterile cell sorting was used to isolate the gamma/delta+ T cells. The gamma/delta+ cells displayed enhanced killing of K562 while the gamma/delta- cells showed no cytolytic activity. Cytotoxicity mediated by gamma/delta+ T cells was also demonstrated against donor-derived, untransformed renal cells.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A D Kirk
- Department of Microbiology and Immunology, Duke University Medical Center, Durham, NC 27710
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44
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O'Farrelly C, Gallagher RB. Intestinal gluten sensitivity: snapshots of an unusual autoimmune-like disease. IMMUNOLOGY TODAY 1992; 13:474-6. [PMID: 1463578 DOI: 10.1016/0167-5699(92)90020-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Gluten-sensitive disease is activated in genetically susceptible individuals by the ingestion of wheat protein (gluten). Breakdown in normal tolerogenic processes to dietary gluten is likely to play a primary pathogenic role. The disease is characterized by several autoimmune-type features and provides a model for studying autoimmune processes. A recent meeting emphasized the need for a clearer picture of the molecular interactions between disease triggering agents, molecules of the immune system and other products of disease susceptibility genes.
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Affiliation(s)
- C O'Farrelly
- Dept of Immunology, Trinity College, Dublin, Ireland
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45
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Hutter C, Poulter LW. The balance of macrophage subsets may be customised at mucosal surfaces. FEMS MICROBIOLOGY IMMUNOLOGY 1992; 5:309-15. [PMID: 1466903 DOI: 10.1111/j.1574-6968.1992.tb05915.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Monoclonal antibodies (mAbs) can discriminate phagocytes (mAb, RFD7+), antigen presenting cells (mAb, RFD1+) and suppressor macrophages (mAbs, RFD1+RFD7+). Here we compare proportions of these subsets in normal mucosa and investigate changes associated with inflammatory disease. Biopsies were obtained from normal and inflamed lung, gut and skin. Cryostat sections were then analysed using mAbs RFD1 and RFD7. At normal mucosal surfaces the RFD1+RFD7+ suppressor cells consistently formed a major population: lung, RFD1+ 11.4%, RFD7+ 43.3%, RFD1+RFD7+ 45.2% and in gut, RFD1+ 37%, RFD7+ 12%, RFD1+RFD7+ 51% while in the skin the three subsets were in relatively equal proportions (RFD1+ 30%, RFD7+ 37%, RFD1+RFD7+ 33%). In inflamed eczematous skin the percentage of RFD1+RFD7+ increased at the expense of RFD1+ and RFD7+ cells whereas in inflamed mucosa the RFD1+RFD7+ population was significantly reduced (asthmatic lung 29%, RFD1+RFD7+, colitis 31% RFD1+RFD7+). In the lung this reduction was concomitant with a rise in RFD1+ cells while in the gut the RFD7+ population increased. It is concluded that balance of macrophage subsets may be customised at mucosal surfaces to sustain suppression of T cell reactivity. Inflammation here is associated with a loss of this suppression.
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Affiliation(s)
- C Hutter
- Academic Department of Clinical Immunology, Royal Free Hospital School of Medicine, London, UK
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46
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Uyemura K, Ho CT, Ohmen JD, Rea TH, Modlin RL. Selective expansion of V delta 1 + T cells from leprosy skin lesions. J Invest Dermatol 1992; 99:848-52. [PMID: 1469299 DOI: 10.1111/1523-1747.ep12614809] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
T cells bearing gamma delta T-cell receptors (TCRs) are prominent residents of murine epidermis and appear to be important participants in the immune response to infection in human skin. The Mitsuda reaction in leprosy, induced by intradermal challenge with Mycobacterium leprae, provides an opportunity to study the cellular events that mediate a form of delayed-type hypersensitivity (DTH) in skin. T cells bearing gamma delta TCRs comprise a significant proportion of the T-cell population in these DTH reactions. Presently we have generated T-cell lines from Mitsuda reactions in vitro and compared their TCR repertoire to that found in situ. gamma delta T cells comprised 20-40% of lines derived from these skin lesions, but < 10% of lines derived from the peripheral blood of the same individuals. Flow-cytometric analysis of variable (V) chain usage in T-cell lines derived from skin lesions indicated that V delta 1 was predominant. Evaluation of the TCR repertoire using PCR indicated that V delta 1-J delta 1 and V gamma 2-J gamma P gene rearrangements were prevalent. In comparison, V delta 2-J delta 1 gene rearrangements predominated in situ. Furthermore, nucleotide sequence analysis of the V-J junction of one T-cell line revealed limited genetic diversity of the gamma delta TCR. These findings suggest that the V delta 1 subpopulation of gamma delta T cells in Mitsuda skin reactions selectively outgrows from leprosy skin lesions in vitro. Such V delta 1 + T-cell lines should be useful for determining the relevant antigens and restriction elements in this response to a pathogen in skin.
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Affiliation(s)
- K Uyemura
- Section of Dermatology, UCLA School of Medicine 90024-1750
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47
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Ishida A, Yoshikai Y, Murosaki S, Hidaka Y, Nomoto K. Administration of milk from cows immunized with intestinal bacteria protects mice from radiation-induced lethality. BIOTHERAPY (DORDRECHT, NETHERLANDS) 1992; 5:215-25. [PMID: 1419469 DOI: 10.1007/bf02171054] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Oral administration of "immune milk", that had been obtained from cows immunized with a variety of human gut bacteria containing E. coli, S. typhimurium, S. dysenteriae and 23 others, protected AKR/J mice from the lethal effect of radiation, when immune milk was orally given to mice at 150 g kg-1 day-1 for 7 days prior to gamma-irradiation of 8 Gy. Mean survival times were 24.8 days for the group given immune milk but only 16.8 days for the group given control milk from unimmunized cows. Enterobacteriaceae were detected in various organs such as liver, lung and kidney on day 13 after irradiation, whereas the numbers were significantly fewer in the study group as compared with the control group. And fewer number of intestinal Enterobacteriaceae were detected in the study group compared with the control group prior to irradiation. Immune milk also enhanced the mitogenic response to mesenteric lymph node cells, the redirected cytolytic activity of intestinal intraepithelial lymphocytes to P815 tumor cells with anti-CD3 mAb, and in vitro killing activities of the phagocytes in mesenteric lymph nodes to E. coli as compared with control milk. These results suggest that immune milk may reduce the number of bacteria translocating from the intestinal-tract and augment the activities of the gut-associated lymphoid tissues against the invasion of intestinal bacteria, causing protection against the lethal effect of radiation.
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Affiliation(s)
- A Ishida
- Department of Immunology, Kyushu University, Fukuoka, Japan
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48
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Ramshaw I, Ruby J, Ramsay A, Ada G, Karupiah G. Expression of cytokines by recombinant vaccinia viruses: a model for studying cytokines in virus infections in vivo. Immunol Rev 1992; 127:157-82. [PMID: 1354650 DOI: 10.1111/j.1600-065x.1992.tb01413.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- I Ramshaw
- Division of Cell Biology, John Curtin School of Medical Research, Canberra, Australia
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49
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Westermann J, Blaschke V, Zimmermann G, Hirschfeld U, Pabst R. Random entry of circulating lymphocyte subsets into peripheral lymph nodes and Peyer's patches: no evidence in vivo of a tissue-specific migration of B and T lymphocytes at the level of high endothelial venules. Eur J Immunol 1992; 22:2219-23. [PMID: 1516614 DOI: 10.1002/eji.1830220906] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Lymphocytes continuously migrate through the body and thus immune competent cells are constantly delivered to most tissues. They interact with high endothelial venules (HEV) via specific homing receptors and vascular addressins, and these molecules seem to be the reason for a preferential homing of B lymphocytes into Peyer's patches and of T lymphocytes into peripheral lymph nodes. When lymphocytes derived from lymph node cell suspensions were applied in the in vitro lymphocyte/endothelium binding assay, the well-known preference of mouse lymph node B lymphocytes for Peyer's patch HEV compared to peripheral lymph node HEV was confirmed in the rat (2.8 times). When in the same in vitro assay thoracic duct lymphocytes (TDL) were used this preference was far less obvious (1.4 times). However, by injecting rat TDL intravenously and by tracing them directly in HEV, B, T, CD4+ and CD8+ lymphocytes are seen to enter Peyer's patches and peripheral lymph nodes in vivo without preference. Thus, in contrast to lymphocytes from lymph node cell suspensions, no evidence was found of a tissue-specific migration of thoracic duct B, T, CD4+ and CD8+ lymphocytes at the HEV level. This finding demonstrates the importance of considering both experimental conditions and the cell source used when investigating lymphocyte traffic.
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Affiliation(s)
- J Westermann
- Center of Anatomy, Medical School of Hannover, FRG
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50
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Stirrat GM, Scott JR. Overview and future perspectives. BAILLIERE'S CLINICAL OBSTETRICS AND GYNAECOLOGY 1992; 6:657-67. [PMID: 1446425 DOI: 10.1016/s0950-3552(05)80016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- G M Stirrat
- Faculty of Medicine and Professor, University of Bristol, Department of Obstetrics and Gynaecology, St Michael's Hospital, Bristol, UK
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