CTLA4 gene polymorphism and autoimmunity

Balancing co-stimulation and inhibition with BTLA and HVEM

The interaction between B- and T-lymphocyte attenuator (BTLA), an inhibitory receptor whose extracellular domain belongs to the immunoglobulin superfamily, and herpesvirus-entry mediator (HVEM), a co-stimulatory tumour-necrosis factor receptor, is unique in that it is the only receptor-ligand interaction that directly bridges these two families of receptors. This interaction has raised many questions about how receptors from two different families could interact and what downstream signalling events might occur as a result of receptor ligation. As we discuss, recent studies show that engagement of HVEM with its endogenous ligand (LIGHT) from the tumour-necrosis factor family induces a powerful immune response, whereas HVEM interactions with BTLA negatively regulate T-cell responses.

Genetic variation in ICOS regulates mRNA levels of ICOS and splicing isoforms of CTLA4

Genetic and functional studies suggest that polymorphism in cytotoxic T lymphocyte-associated antigen-4 (CTLA4) and inducible costimulator (ICOS) genes, both reported to harbour autoimmune susceptibility loci, could regulate the immune activation through affecting their expression and splicing of CTLA4. To address this, we studied expression of CTLA4 and ICOS and the role of polymorphisms in the gene region by measuring the relative amounts of transcripts, including the soluble CTLA4 (sCTLA4) splicing isoform in healthy volunteers. We combined a physiologically relevant in vitro activation for human CD4(+) T lymphocytes and a quantitative RT-PCR. The susceptibility allele CT60G in CTLA4 gene was confirmed to be associated with a decreased amount of sCTLA4, but only in resting cells. During the T cell activation two genetic variants in ICOS gene, IVS1+173T/C and c.1624C/T, affected expression of CTLA4 isoforms and ICOS, respectively. We could not confirm that the level of sCTLA4 is down-regulated following T lymphocyte activation, instead the levels of CTLA4 splicing isoforms correlated to each others. Our results indicate that genetic variation in this gene region regulates the expression of both CTLA4 and ICOS and not only the splicing of sCTLA4 as suggested earlier.

Association of T-cell regulatory gene polymorphisms with susceptibility to gastric mucosa-associated lymphoid tissue lymphoma

PURPOSE

Helicobacter pylori infection and host susceptibility interact to develop gastric mucosa-associated lymphoid tissue (MALT) lymphoma, and activation of specific T cells might play a crucial role in this process. Recent investigations show that the CTLA4, CD28, and ICOS genes are located on chromosome 2q33 and their polymorphisms confer susceptibility to infectious and immune diseases through deregulation of T-cell stimulation. We aimed to determine the role of CTLA4, CD28, and ICOS polymorphisms in gastric MALT lymphoma.

PATIENTS AND METHODS

Genotyping for CTLA4 (49 A/G, -318 C/T, and CT60 A/G), CD28 (IVS3+ 17T/C), and ICOS (c.602 A/C and c.1624C/T) was performed for 62 patients with gastric MALT lymphoma and compared with 250 unrelated healthy controls.

RESULTS

H pylori infection was significantly higher in patients with gastric MALT lymphoma (90.3%) compared with controls (66.4%; P < .001). The CTLA4 -318 C/T genotype was associated with a lower risk of developing gastric MALT lymphoma (odds ratio [OR] = 0.3; P = .022), whereas CTLA4 49 G/G genotype was linked to a higher risk (OR = 4.1; P = .044). In patients with H pylori infection, CTLA4 49 G/G genotype was associated with an even higher risk (OR = 6.4; P = .047). Carriage of the tightly linked -318C -49G haplotype conferred a four-fold higher susceptibility to MALT lymphoma (OR = 4.2; P = .042). Complete remission after H pylori eradication was related to tumor stage but not to genotypes or haplotypes.

CONCLUSION

These results indicate a genetic link of CTLA4 gene polymorphisms to development of gastric MALT lymphoma and indirectly support the crucial role of host activated T cells in the MALT lymphomagenesis.

The common −318C/T polymorphism in the promoter region of CTLA4 gene is associated with reduced risk of ophthalmopathy in Chinese Graves' patients

Studies in the past have clearly established that CTLA4 is a susceptible gene for Graves' disease (GD). However, association studies between CTLA4 and the risk of developing Graves' ophthalmopathy (GO) in GD patients have shown conflicting results. In this study, associations of five CTLA4 single nucleotide polymorphisms (-1722A/G, -1661A/G, -318C/T, +49G/A, CT60) with GD risk and GO susceptibility in GD patients were investigated in a Chinese population. Our results showed that either +49A/G or CT60 polymorphism was associated with GD susceptibility in the Chinese population. Significant differences in the distribution of the genotypes or alleles evaluated between GD patients with and without clinically evident GO were only found for -318C/T polymorphism (P = 0.03). Multiple logistic regressions revealed that the -318T allele was negatively associated with GO under both additive and dominant genetic models (adjusted OR = 0.56, 95%CI 0.35-0.89, P = 0.014; adjusted OR = 0.51, 95%CI 0.30-0.84, P = 0.009, respectively). Stratification analysis according to gender demonstrated different scenarios concerning the role of the -318T allele in GO risk: a significant protective role for GO was only confirmed in male but not in female GD patients. Haplotype analyses showed that only the haplotypes containing the -318T allele played a protective role in GO. In conclusion, results from this study suggested that the -318T allele might play a protective role in GO susceptibility for GD patients at least in the Chinese population. However, extended analyses with larger sample size should be carried out in patients from different ethnic origins to further verify this association.

Immunogenomics: molecular hide and seek

Similar to other classical science disciplines, immunology has been embracing novel technologies and approaches giving rise to specialised sub-disciplines such as immunogenetics and, more recently, immunogenomics, which, in many ways, is the genome-wide application of immunogenetic approaches. Here, recent progress in the understanding of the immune sub-genome will be reviewed, and the ways in which immunogenomic datasets consisting of genetic and epigenetic variation, linkage disequilibrium and recombination can be harnessed for disease association and evolutionary studies will be discussed. The discussion will focus on data available for the major histocompatibility complex and the leukocyte receptor complex, the two most polymorphic regions of the human immune sub-genome.

CTLA4 polymorphisms and ophthalmopathy in Graves' disease patients: association study and meta-analysis

Studies in the past have clearly established that cytotoxic T-lymphocyte antigen-4 (CTLA4) is a susceptible gene for Graves' disease (GD). However, association studies between the CTLA4 exon-1 +49A/G polymorphism and the risk of developing Graves' ophthalmopathy (GO) in GD patients have revealed conflicting results. In this study, associations of two CTLA4 polymorphisms (+49A/G and CT60) with GD risk and GO susceptibility in GD patients were investigated in a Chinese population. In addition, a meta-analysis was performed to better assess the purported association between the +49A/G polymorphism and GO susceptibility in GD patients. Our results demonstrated that both the +49A/G and CT60 polymorphisms were associated with GD susceptibility in the Chinese population. No significant association with GO susceptibility in GD patients was confirmed regardless of which polymorphism was tested individually. Similarly, the meta-analysis results provided minimal evidence about the role of the +49A/G polymorphism and GO risk in GD patients. Interestingly, haplotypic analysis demonstrated different scenarios concerning the role of CTLA4 in GO susceptibility in the Chinese GD patients. We found that the +49A-CT60G haplotype was marginally statistically associated with the increased risk of GO in GD patients (OR = 1.63, 95%CI 1.00-2.64, p = 0.05). In conclusion, our results suggested that CTLA4 might be involved in the susceptibility to GD in the Chinese population. Although neither +49A/G nor CT60 polymorphism was associated with the risk of GO in GD patients, the haplotypic analysis provided some evidence about its role in GO susceptibility in the Chinese GD patients. We suggest that more association studies recruiting haplotypic analysis should be performed to investigate the role of CTLA4 gene in GO susceptibility in patients from different nations.

Emerging possibilities in the development and function of regulatory T cells

CD25+CD4+ Regulatory T cells (Treg) represent a unique population of lymphocytes capable of powerfully suppressing immune responses. A large body of experimental data have now confirmed the essential role played by these cells in a host of clinically relevant areas such as self-tolerance, transplantation, allergy and tumor/microbial immunity. Despite this mass of knowledge, significant gaps in our understanding of fundamental Treg biology remain, particularly regarding their development and mechanisms of suppression. In this review we attempt to highlight the current controversies and directions in which this exciting field is moving.

BTLA and HVEM Cross Talk Regulates Inhibition and Costimulation

Recently a new inhibitory immunoglobulin domain-containing lymphocyte receptor was identified on the basis of its T helper 1 (T(H)1)-selective expression in murine T cell lines, which was named B and T lymphocyte attenuator (BTLA). Several groups have confirmed the initial characterization of BTLA as an inhibitory receptor, which was initially inferred from the mild increases in several parameters of BTLA-deficient mice. The initial expectation that BTLA would interact with a B7 family ligand, such as the B7x protein, was surprisingly overturned with the functional cloning of the actual BTLA ligand as herpesvirus entry mediator (HVEM). This was unexpected largely due to the fact that this interaction represents the convergence of two very different, although each quite extensive, families of receptors and ligands. The interaction of BTLA, which belongs to the CD28 family of the immunoglobulin superfamily, and HVEM, a costimulatory tumor-necrosis factor (TNF) receptor (TNFR), is quite unique in that it is the only receptor-ligand interaction that directly bridges these two families of receptors. This interaction has raised many questions about how receptors from two different families could interact and which are the signaling events downstream of receptor ligation. As we discuss here and recently demonstrated, HVEM interaction with BTLA serves to negatively regulate T cell responses, in contrast to the strong activation observed when HVEM engages its endogenous ligand from the TNF family. Finally, as studies of BTLA are just now beginning to extend beyond the initial characterizations, it is becoming clear that there are many complex issues remaining to be resolved, particularly potential polymorphisms that may engender disease susceptibility in the human.

Association of the truncating splice site mutation in BTNL2 with multiple sclerosis is secondary to HLA-DRB1*15

The major histocompatibility complex human leukocyte antigen (HLA)-DRB1*15 (DR2) haplotype is strongly associated with risk of multiple sclerosis (MS). The primary susceptibility has been localized to only approximately 200 kb encompassing the HLA-DR and -DQ loci. Further dissection of disease association with this region is demanding because of the high levels of linkage disequilibrium (LD). Recently, evidence was obtained for the involvement of a gene, potentially encoding an immune co-receptor, in another DR2-associated inflammatory condition, sarcoidosis. The implicated gene, BTNL2, is adjacent to DR and is in strong LD with HLA-DRB1. This fact, combined with a sequence relationship between BTNL2 and myelin oligodendrocyte glycoprotein, an autoantigen associated with MS, makes the gene an attractive candidate. To determine whether BTNL2 contributes to MS, we genotyped 1136 well-characterized MS families from the UK and the USA, as well as an African-American case-control data set, making this among the largest genetic studies in MS. Family-based and case-control association studies were performed for the BTNL2 and HLA-DRB1 loci. In all family data sets, the protein-truncating allele of BTNL2, implicated in sarcoidosis, was significantly over-transmitted to cases (combined data sets: global P=2.4x10(-11)). Given that the protein-truncating allele of BTNL2 virtually always occurred with DRB1*15, an effect could only be tested in DRB1*15-negative individuals or pedigrees. However, despite adequate power to detect an independent association, no difference in transmission of BTNL2 alleles or genotypes was observed in DRB1*15-negative individuals with MS. Conditional logistic regression modeling also strongly supported the conclusion that BTNL2 does not confer additional disease risk. The association of BTNL2 with MS observed in the African-American data set was also secondary to the primary DRB1*15 association.

Co-stimulatory blockade as therapy for rheumatoid arthritis

There is substantial evidence that rheumatoid arthritis is an autoimmune disease in which T cells are aberrantly activated. Existing therapies, including anti-tumor necrosis factor therapies, are successful for many patients, but the goal of lasting remission still frequently proves elusive. One novel therapeutic strategy is the blockade of T-cell co-stimulation to modulate T-cell activation. The first co-stimulation blocker to reach clinical trials is abatacept (CTLA4Ig). Initial abatacept trials have shown promise and further phase III trials are underway.