Some aspects of complementarity in the immune system. A bird's eye view

Interesting possibilities to improve the safety and efficacy of ipilimumab (Yervoy)

As predicted, an anti-CTLA-4 mAb (ipilimumab) on binding to T lymphocytes breaks down immune-tolerance. Thereby, it was hoped, tumor-specific-T cells would be freed for a sustained attack on cancer cells. Data on ipilimumab treatment in 1498 patients with advanced melanoma (in 14 phase I-III trials) has shown immune-related adverse events (irAEs) in 64.2% of the patients consistent with tolerance breakdown. However, there is no evidence that the antitumor effects via a CTLA-4 blockade are attributable to T cells specifically targeting tumor cells. In fact, several trials indicate a possible correlation between grade 3 and 4 irAEs with clinical efficacy of ipilimumab; tumor regression may be associated with autoimmunity development. Therefore, we suggest a new treatment paradigm. The non-tumor specific pan-lymphocytic activation should be exploited by a 'pretargeting' approach proven successful in radioimmunodetection and radioimmunotherapy. First, an anti-tumor mAb conjugated with streptavidin (StAv) should be administered to be followed by the delivery of biotin-labeled anti-CTLA-4 mAb. This schedule has the virtue of endowing T cells with the ability to travel to tumor sites without prematurely succumbing to apoptosis, while streptavidin's ultra-high affinity for biotin (K(D), 10⁻¹⁵ M) ensures capturing all T cells binding biotin labeled anti-CTLA-4. Using the law of mass action, we calculated that following administration of ipilimumab at >1 mg/L concentration (∼5 mg per patient ∼70 kgbw), the immense forces of the immune system liberated by the anti-CTLA-4 antibody blockade would then be focused with laser sharp accuracy on tumor cells without collateral damage to normal host cells.

SUFFICIENT TO RECOGNIZE SELF TO ATTACK NON-SELF: BLUEPRINT FOR A ONE-SIGNAL T CELL MODEL

Current consensus postulates that the class I-antigen processing system is evolved to present microbial antigens to specific T cells. Since such cells are rare and short-lived, they require three to five days to attain fighting strength. During this critical period he innate immune system holds back the briskly multiplying pathogens. Nevertheless, a T cell response is measurable in the lymph nodes draining the infection site within 12 to 18 h. In order to explain this paradox here we suggest a new T cell model. This is based on the observation that T cells require continuous contact of the T cell receptor (TCR) with selecting self-peptide–major histocompatibility complex (MHC) molecules in the periphery for their survival. We postulate that a dynamic steady state, a so-called coupled system is formed through low affinity complementary TCR–MHC interactions between T cells and host cells. Under such condition it is sufficient to recognize what is self in order to attack what is not self. A coupled system is regulated via soluble forms of peptide–MHC and TCR molecules by the law of mass action. In a coupled system one signal is sufficient for T cell activation. The new model implies that a significant fraction of the naive polyclonal T cells are recruited into the first line of defense from the very outset of an infection, so the number of activated T cells is increased by several orders of magnitude compared to conventional models. The one-signal model also predicts that therapeutic administration of soluble agonist or antagonist T cell receptor ligands may be able to fine tune the homeostatic physiological regulatory mechanism and thus improve the treatment of some chronic diseases such as metastatic cancer, HIV/AIDS, and transplantation.

T Cells Survey the Stability of the Self: A Testable Hypothesis on the Homeostatic Role of TCR-MHC Interactions

In the lifetime of an individual, every single gene will have undergone mutation on about 10(10) separate occasions. Nevertheless, cancer occurs mainly with advancing age. Here, we hypothesize that the evolutionary pressure driving the creation of the T cell receptor (TCR) repertoire was primarily the homeostatic surveillance of the genome. The subtly variable T cells may in fact constitute an evolutionary link between the invariable innate and hypervariable B cell systems. The new model is based on the homeostatic role of T cells, suggesting that molecular complementarity between the positively selected TCR and the self peptide-presenting major histocompatibility complex molecules establishes and regulates homeostasis, strictly limiting variations of its components. Notwithstanding, the 'homeostatic role of T cells' model offers a more realistic explanation as to how a naïve clonal immune system can cope with the much faster replicating pathogens, despite a limited repertoire that is capable of facing only a small fraction of the vast antigenic universe at a time.