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Feng G, Bajpai G, Ma P, Koenig A, Bredemeyer A, Lokshina I, Lai L, Förster I, Leuschner F, Kreisel D, Lavine KJ. CCL17 Aggravates Myocardial Injury by Suppressing Recruitment of Regulatory T Cells. Circulation 2022; 145:765-782. [PMID: 35113652 PMCID: PMC8957788 DOI: 10.1161/circulationaha.121.055888] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent studies have established that CCR2 (C-C chemokine receptor type 2) marks proinflammatory subsets of monocytes, macrophages, and dendritic cells that contribute to adverse left ventricle (LV) remodeling and heart failure progression. Elucidation of the effector mechanisms that mediate adverse effects of CCR2+ monocytes, macrophages, and dendritic cells will yield important insights into therapeutic strategies to suppress myocardial inflammation. METHODS We used mouse models of reperfused myocardial infarction, angiotensin II and phenylephrine infusion, and diphtheria toxin cardiomyocyte ablation to investigate CCL17 (C-C chemokine ligand 17). We used Ccl17 knockout mice, flow cytometry, RNA sequencing, biochemical assays, cell trafficking studies, and in vivo cell depletion to identify the cell types that generate CCL17, define signaling pathways that controlled its expression, delineate the functional importance of CCL17 in adverse LV remodeling and heart failure progression, and determine the mechanistic basis by which CCL17 exerts its effects. RESULTS We demonstrated that CCL17 is expressed in CCR2+ macrophages and cluster of differentiation 11b+ conventional dendritic cells after myocardial infarction, angiotensin II and phenylephrine infusion, and diphtheria toxin cardiomyocyte ablation. We clarified the transcriptional signature of CCL17+ macrophages and dendritic cells and identified granulocyte-macrophage colony-stimulating factor (GM-CSF) signaling as a key regulator of CCL17 expression through cooperative activation of STAT5 (signal transducer and activator of transcription 5) and canonical NF-κB (nuclear factor κ-light-chain-enhancer of activated B cells) signaling. Ccl17 deletion resulted in reduced LV remodeling, decreased myocardial fibrosis and cardiomyocyte hypertrophy, and improved LV systolic function after myocardial infarction and angiotensin II and phenylephrine infusion. We observed increased abundance of regulatory T cells (Tregs) in the myocardium of injured Ccl17 knockout mice. CCL17 inhibited Treg recruitment through biased activation of CCR4. CCL17 activated Gq signaling and CCL22 (C-C chemokine ligand 22) activated both Gq and ARRB (β-arrestin) signaling downstream of CCR4. CCL17 competitively inhibited CCL22 stimulated ARRB signaling and Treg migration. We provide evidence that Tregs mediated the protective effects of Ccl17 deletion on myocardial inflammation and adverse LV remodeling. CONCLUSIONS These findings identify CCL17 as a proinflammatory mediator of CCR2+ macrophages and dendritic cells and suggest that inhibition of CCL17 may serve as an effective strategy to promote Treg recruitment and suppress myocardial inflammation.
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Affiliation(s)
- Guoshuai Feng
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA (G.F., G.B., P.M., A.K., A.B., I.L., L.L., K.L.)
| | - Geetika Bajpai
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA (G.F., G.B., P.M., A.K., A.B., I.L., L.L., K.L.)
| | - Pan Ma
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA (G.F., G.B., P.M., A.K., A.B., I.L., L.L., K.L.)
| | - Andrew Koenig
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA (G.F., G.B., P.M., A.K., A.B., I.L., L.L., K.L.)
| | - Andrea Bredemeyer
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA (G.F., G.B., P.M., A.K., A.B., I.L., L.L., K.L.)
| | - Inessa Lokshina
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA (G.F., G.B., P.M., A.K., A.B., I.L., L.L., K.L.)
| | - Lulu Lai
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA (G.F., G.B., P.M., A.K., A.B., I.L., L.L., K.L.)
| | | | - Florian Leuschner
- LIMES Institute, University of Bonn, Department of Internal Medicine III, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany (F.L.)
| | - Daniel Kreisel
- Department of Surgery, Washington University, Saint Louis, Missouri, USA (D.K.)
- Department of Pathology and Immunology, Washington University, Saint Louis, Missouri, USA (D.K., K.L.)
| | - Kory J. Lavine
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA (G.F., G.B., P.M., A.K., A.B., I.L., L.L., K.L.)
- Department of Pathology and Immunology, Washington University, Saint Louis, Missouri, USA (D.K., K.L.)
- Department of Developmental Biology, Washington University, Saint Louis, Missouri, USA (K.L.)
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Deng S, Sherchan P, Jin P, Huang L, Travis Z, Zhang JH, Gong Y, Tang J. Recombinant CCL17 Enhances Hematoma Resolution and Activation of CCR4/ERK/Nrf2/CD163 Signaling Pathway After Intracerebral Hemorrhage in Mice. Neurotherapeutics 2020; 17:1940-1953. [PMID: 32783091 PMCID: PMC7851239 DOI: 10.1007/s13311-020-00908-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hematoma is a crucial factor leading to poor prognosis after intracerebral hemorrhage (ICH). Promoting microglial phagocytosis to enhance hematoma resolution may be an important therapeutic target for recovery after ICH. C-C chemokine receptor 4 (CCR4) is important for regulating immune balance in the central nervous system. However, whether CCR4 activation can attenuate hematoma after ICH remains unknown. We aimed to evaluate whether CCL17 (a specific ligand of CCR4) treatment can promote hematoma resolution through CCR4/ERK/Nrf2/CD163 pathway after ICH. A total of 261 adult male CD1 mice were used. Mice were subjected to intrastriatal injection of autologous blood to induce ICH and randomly assigned to receive recombinant CCL17 (rCCL17) or vehicle which was administered intranasally at 1 h after ICH. To elucidate the underlying mechanism, C021, a selective inhibitor of CCR4 and ML385 and a selective inhibitor of Nrf2 were administered 1 h prior to ICH induction. Clustered regularly interspaced short palindromic repeats (CRISPR) knockout for CD163 was administered by intracerebroventricular injection at 48 h before ICH. Brain edema, short- and long-term neurobehavior evaluation, hematoma volume, hemoglobin content, western blot, and immunofluorescence staining were performed. Endogenous CCL17, CCR4, and CD163 expression increased and peaked at 72 h after ICH. CCR4 was expressed by microglia. CCR4 activation with rCCL17 significantly improved neurobehavioral scores and reduced hematoma volume and brain edema compared with vehicle. Moreover, rCCL17 treatment significantly promoted phosphorylation of ERK1/2, increased the expression Nrf2, and upregulated CD163 expression after ICH. The protective effects of rCCL17 were abolished by administration of C021, ML385, and CD163 CRISPR knockout. This study demonstrated that CCR4 activation with rCCL17 promoted hematoma resolution by increasing CD163 expression and CCR4/ERK/Nrf2 pathway activation after ICH, thereby reducing brain edema and improving neurological function. Overall, our study suggests that CCR4 activation may be a potential therapeutic strategy to attenuate hematoma in early brain injury after ICH.
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Affiliation(s)
- Shuixiang Deng
- Department of Critical Care Medicine, HuaShan Hospital, Fudan University, 12 Middle WuLuMuQi, Shanghai, 200040, China
- Department of Physiology and Pharmacology, Center for Neuroscience Research, Loma Linda University School of Medicine, Loma Linda, California, 92350, USA
| | - Prativa Sherchan
- Department of Physiology and Pharmacology, Center for Neuroscience Research, Loma Linda University School of Medicine, Loma Linda, California, 92350, USA
| | - Peng Jin
- Department of Critical Care Medicine, HuaShan Hospital, Fudan University, 12 Middle WuLuMuQi, Shanghai, 200040, China
- Department of Physiology and Pharmacology, Center for Neuroscience Research, Loma Linda University School of Medicine, Loma Linda, California, 92350, USA
| | - Lei Huang
- Department of Neurosurgery, Loma Linda University School of Medicine, Loma Linda, California, 92350, USA
| | - Zachary Travis
- Department of Physiology and Pharmacology, Center for Neuroscience Research, Loma Linda University School of Medicine, Loma Linda, California, 92350, USA
| | - John H Zhang
- Department of Physiology and Pharmacology, Center for Neuroscience Research, Loma Linda University School of Medicine, Loma Linda, California, 92350, USA
- Department of Neurosurgery, Loma Linda University School of Medicine, Loma Linda, California, 92350, USA
- Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California, 92350, USA
| | - Ye Gong
- Department of Critical Care Medicine, HuaShan Hospital, Fudan University, 12 Middle WuLuMuQi, Shanghai, 200040, China.
| | - Jiping Tang
- Department of Physiology and Pharmacology, Center for Neuroscience Research, Loma Linda University School of Medicine, Loma Linda, California, 92350, USA.
- Department of Physiology and Pharmacology, Loma Linda University, Risley Hall, Room 219, 11041 Campus Street, Loma Linda, California, 92354, USA.
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Berlato C, Khan MN, Schioppa T, Thompson R, Maniati E, Montfort A, Jangani M, Canosa M, Kulbe H, Hagemann UB, Duncan AR, Fletcher L, Wilkinson RW, Powles T, Quezada SA, Balkwill FR. A CCR4 antagonist reverses the tumor-promoting microenvironment of renal cancer. J Clin Invest 2017; 127:801-813. [PMID: 28134623 PMCID: PMC5330727 DOI: 10.1172/jci82976] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 12/01/2016] [Indexed: 12/19/2022] Open
Abstract
Elevated expression of the chemokine receptor CCR4 in tumors is associated with poor prognosis in several cancers. Here, we have determined that CCR4 was highly expressed in human renal cell carcinoma (RCC) biopsies and observed abnormal levels of CCR4 ligands in RCC patient plasma. An antagonistic anti-CCR4 antibody had antitumor activity in the RENCA mouse model of RCC. CCR4 inhibition did not reduce the proportion of infiltrating leukocytes in the tumor microenvironment but altered the phenotype of myeloid cells, increased NK cell and Th1 cytokine levels, and reduced immature myeloid cell infiltrate and blood chemokine levels. In spite of prominent changes in the myeloid compartment, the anti-CCR4 antibody did not affect RENCA tumors in T cell-deficient mice, and treatment with an anti-class II MHC antibody abrogated its antitumor activity. We concluded that the effects of the anti-CCR4 antibody required the adaptive immune system and CD4+ T cells. Moreover, CCL17-induced IFN-γ production was reduced when Th1-polarized normal CD4+ T cells were exposed to the CCR4 ligand, evidencing the involvement of CCR4 in Th1/Th2 regulation. The anti-CCR4 antibody, alone or in combination with other immune modulators, is a potential treatment approach to human solid cancers with high levels of CCR4-expressing tumor-infiltrating leukocytes and abnormal plasma CCR4 ligand levels.
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MESH Headings
- Animals
- Antibodies, Neoplasm/immunology
- Antibodies, Neoplasm/pharmacology
- Carcinoma, Renal Cell/drug therapy
- Carcinoma, Renal Cell/genetics
- Carcinoma, Renal Cell/immunology
- Chemokine CCL17/genetics
- Chemokine CCL17/immunology
- Chemokine CCL17/pharmacology
- Female
- Humans
- Interferon-gamma/genetics
- Interferon-gamma/immunology
- Kidney Neoplasms
- Killer Cells, Natural/immunology
- Male
- Mice
- Mice, Inbred BALB C
- Neoplasm Proteins/antagonists & inhibitors
- Neoplasm Proteins/genetics
- Neoplasm Proteins/immunology
- Neoplasms, Experimental/drug therapy
- Neoplasms, Experimental/genetics
- Neoplasms, Experimental/immunology
- Receptors, CCR4/antagonists & inhibitors
- Receptors, CCR4/genetics
- Receptors, CCR4/immunology
- Th1 Cells/immunology
- Tumor Microenvironment/drug effects
- Tumor Microenvironment/genetics
- Tumor Microenvironment/immunology
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Affiliation(s)
- Chiara Berlato
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Moddasar N. Khan
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Tiziana Schioppa
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Richard Thompson
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Eleni Maniati
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Anne Montfort
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Maryam Jangani
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Monica Canosa
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Hagen Kulbe
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
- Department of Gynecology, Charité Universitätsmedizin, Berlin, Germany
| | | | | | | | | | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Sergio A. Quezada
- Cancer Immunology Unit, Research Department of Haematology, UCL Cancer Institute, University College London, London, United Kingdom
| | - Frances R. Balkwill
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
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Honjo A, Ogawa H, Azuma M, Tezuka T, Sone S, Biragyn A, Nishioka Y. Targeted reduction of CCR4⁺ cells is sufficient to suppress allergic airway inflammation. Respir Investig 2013; 51:241-9. [PMID: 24238232 PMCID: PMC5846619 DOI: 10.1016/j.resinv.2013.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/04/2013] [Accepted: 04/30/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Bronchial asthma is characterized by allergic airway inflammation involving C-C chemokine receptor type 4 (CCR4)-positive Th2 cells. As such, we hypothesize that the disease can be alleviated by targeted-elimination of CCR4⁺ cells. Thymus and activation-regulated chemokine (TARC)-PE38, a TARC fused the exotoxin fragment PE38 from Pseudomonas aeruginosa, has been shown to efficiently kill CCR4⁺ cells by delivering the exotoxin fragment PE38 into CCR4⁺ cells. To test our hypothesis, we examined whether TARC-PE38 could suppress allergic airway inflammation in a mouse model of house dust mite (HDM)-induced allergic airway inflammation. METHODS We evaluated the effect of TARC-PE38 on the major characteristics of HDM-induced allergic airway inflammation. Airway hyperresponsiveness, lung histopathology, lung Th1/Th2 cell populations, and concentrations of Th1/Th2 cytokines in the lungs were assessed in HDM-sensitized and challenged mice in the presence and absence of TARC-PE38. RESULTS TARC-PE38 efficiently suppressed allergic airway inflammation by significantly reducing airway hyperresponsiveness, the overall area of inflammation, and goblet cell hyperplasia. In HDM-sensitized and challenged mice, TARC-PE38 specifically reduced the numbers of CCR4⁺ cells. This reduction was associated with a significant decrease in the production of Th2 cytokines in the airway,and a decrease in the number of leukocytes, including macrophages, eosinophils and lymphocytes, within the subepithelial area of the lungs and airway lumen. TARC-PE38 had noeffect on Th1 cells. CONCLUSION Our data suggest that the elimination of CCR4⁺ cells via TARC-PE38 treatment is sufficient to control allergic airway inflammation and airway hyperresponsiveness.
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Affiliation(s)
- Akifumi Honjo
- Department of Respiratory Medicine & Rheumatology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan.
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Li CM, Hou L, Zhang H, Zhang WY. [Expression and function of chemokine TARC/CCR4 at fetal-maternal interface in first trimester]. Zhonghua Fu Chan Ke Za Zhi 2013; 48:421-426. [PMID: 24103120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate the expression and function of thymus and activation regulated chemokine (TARC) and its special receptor CCR4 at placenta villous in the first trimester placenta villous. METHODS Placenta villous was collected from healthy women undergoing artificial abortion at 6 to 8 weeks of gestation. mRNA levels of TARC, CCR4 were analyzed using semi-quantitative reverse transcription (RT)-PCR methods. Immunohistochemistry assay was used to assess the protein localization and expression of TARC, CCR4. Additionally, extravillous cytotrophoblasts were isolated and cultured. Expression of TARC and CCR4 was measured by immunofluorescence assay. Invasion of cell line HTR8/SVneo was analyzed by transwell assay at concentration of 10, 25, 50 and 100 ng/ml of TARC matched with RPMI 1640 fetal bovine serum free culture medium as control group. In the mean time, blocking experiment was also added to detect TARC regulating cell invasion, which were classified into four groups: control, 100 ng/ml rhTARC, 20 µg/ml anti-TARC+100 ng/ml rhTARC, 100 ng/ml rhTARC+20 µg/ml IgG. The influence of 100 ng/ml TARC on expression level of integrin-α5 and integrin-β1 were measured by using western-blot assay. RESULTS (1) In vivo assay:expression of TARC and CCR4 mRNA were detectable in first trimester placenta villous, TARC protein was localized in cytotrophoblasts, syncytiotrophoblasts and cell column especially on the distal portion, while CCR4 protein was localized on invading interstitial cytotrophobalsts. (2) In vitro assay: a. TARC, CCR4 was also expressed in primary isolated extravillous cytotrophoblasts by immunofluorescence assay; b. Matrigel invasion assay demonstrated that TARC had specific dose dependent stimulatory effects on the cells invading through the matrigel precoated filter, the number of cells migration into the lower chamber were:142±31 at 10 ng/ml group, 161±46 at 25 ng/ml group, 201±30 at 50 ng/ml group, 312±48 at 100 ng/ml group, 117±33 at control group, the significant response observed from 25 ng/ml (P<0.05) and reached a peak effect at 100 ng/ml (P<0.01); c. Blocking experiment demonstrated that when trophoblast invasion was monitored in response to TARC neutralizing antibody (15 µg/ml) together with rhTARC 100 ng/ml. The stimulatory activity of rhTARC was completely overcome, with the cells invasion into the lower chambers were 100 ng/ml rhTARC, 20 µg/ml anti-TARC+100 ng/ml rhTARC, 100 ng/ml rhTARC+20 µg/ml IgG, control: 313±47, 113±41, 287±75 and 128±23, respectively; d. Western-blot assay demonstrated that if cells were treated with 100 ng/ml rhTARC, the expression of integrin-α5 were significantly increased (P<0.01), integrin-β1 level also increased when compared with control (P<0.05). CONCLUSION TARC was expressed specifically at human fetal-maternal interface. Trophoblast invasion and migration mainly was regulated by up-regulation integrin-α5 and integrin-β1, which plays an role in trophoblasts differentiation and placentation.
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Affiliation(s)
- Chun-ming Li
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
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Xu L, Xu W, Wen Z, Xiong S. In situ prior proliferation of CD4+ CCR6+ regulatory T cells facilitated by TGF-β secreting DCs is crucial for their enrichment and suppression in tumor immunity. PLoS One 2011; 6:e20282. [PMID: 21655250 PMCID: PMC3105045 DOI: 10.1371/journal.pone.0020282] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 04/26/2011] [Indexed: 11/21/2022] Open
Abstract
Background CD4+CD25+ regulatory T cells (Tregs), a heterogeneous population, were enrichment in tumor mass and played an important role in modulating anti-tumor immunity. Recently, we reported a Treg subset, CCR6+ Tregs but not CCR6−Tregs, were enriched in tumor mass and closely related to poor prognosis of breast cancer patients. However, the underlying mechanism remains elusive. Here, we carefully evaluate the enrichment of CCR6+Tregs in tumor mass during progression of breast cancer and explore its possible mechanism. Methodology/Principal Findings The frequency of CCR6+Tregs in tumor infiltrating lymphocytes (TILs ) was analyzed at early stage and at late stage of tumor in a murine breast cancer model by FACS respectively. The expansion of CCR6+Tregs and their CCR6− counterpart in tumor mass were determined by BrdU incorporation assay. The effect and its possible mechanism of tumor-resident antigen presenting cells (APCs) on the proliferation of CCR6+Tregs also were evaluated. The role of local expansion of CCR6+Tregs in their enrichment and suppression in vivo also was evaluated in adoptive cell transfer assay. We found that the prior enrichment of CCR6+Tregs but not CCR6−Tregs in tumor mass during progression of murine breast cancer, which was dependent on the dominant proliferation of CCR6+ Tregs in situ. Further study demonstrated that tumor-resident DCs triggered the proliferation of CCR6+Treg cells in TGF-β dependent manner. Adoptive transfer of CCR6+Tregs was found to potently inhibit the function of CD8+T cells in vivo, which was dependent on their proliferation and subsequently enrichment in tummor mass. Conclusions/Significance Our finding suggested that CCR6+ Tregs, a distinct subset of Tregs, exert its predominant suppressive role in tumor immunity through prior in situ expansion, which might ultimately provide helpful thoughts for the designing of Treg-based immunotherapy for tumor in the future.
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Affiliation(s)
- Lin Xu
- Institute for Immunobiology and Department of Immunology, Shanghai Medical College of Fudan University, Shanghai, China
- Department of Immunology, Zunyi Medical College, Zunyi, Guizhou Province, China
| | - Wei Xu
- Institutes of Biology and Medical Sciences, Soochow University, Suzhou, China
| | - Zhenke Wen
- Institute for Immunobiology and Department of Immunology, Shanghai Medical College of Fudan University, Shanghai, China
| | - Sidong Xiong
- Institutes of Biology and Medical Sciences, Soochow University, Suzhou, China
- Institute for Immunobiology and Department of Immunology, Shanghai Medical College of Fudan University, Shanghai, China
- * E-mail:
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