Abstract
purpose. To study the role of costimulatory signaling through the CD28-B7
interaction in experimental autoimmune anterior uveitis (EAAU).
methods. Naive Lewis rats were immunized with insoluble melanin-associated
antigen (MAA) derived from bovine iris and ciliary body. CTLA4-Fc, a
recombinant protein comprised of the extracellular domain of human
CTLA4 bound to mouse IgG2a Fc, was used to block the CD28-B7
interaction. A mutant version (CTLA4-Fc-mutant) was used as a control.
The effect of CTLA4-Fc on the in vivo induction of disease with MAA was
studied. Subsequently, the mechanism by which CTLA4-Fc blocked the
interaction of CD28 and B7 was investigated in vivo, using the adoptive
transfer of T cells derived from CTLA4-Fc–treated rats, and in vitro,
using the proliferative response and cytokine production of MAA-T cells
in the presence of CTLA4-Fc.
results. CTLA4-Fc markedly reduced the incidence and severity of EAAU in Lewis
rats after sensitization with MAA. The adoptive transfer of sensitized
T cells from CTLA4-Fc–treated donors did not induce EAAU in naive
recipients. CTLA4-Fc inhibited the expansion of antigen-specific MAA-T
cells and the production of TNF-α.
conclusions. The costimulatory signal delivered through CD28-B7 is required for the
induction and pathogenesis of EAAU. In the absence of this signal,
antigen-specific expansion of MAA reactive T cells as well as
production of TNF-α is inhibited. Abrogation of this costimulatory
signal may be an important therapeutic option for
EAAU.
Acute anterior uveitis (AAU), the most common form of
uveitis, is an intraocular inflammatory disease of the anterior uvea of
the eye. Although a single episode of the disease usually does not
result in permanent visual loss, the recurrent nature of AAU is
associated with significant clinical complications such as cystoid
macular edema, cataract formation, and glaucoma. The cause of AAU is
unknown. However, it is thought to be an autoimmune disease similar to
the experimental model of autoimmune anterior uveitis (EAAU).
Broekhuyse and colleagues, in 1991, first described an organ-specific
autoimmune disease in the Lewis rat induced by a single injection of
melanin-associated antigen (MAA).
1
Although they termed this disease EAAU, it subsequently became apparent
that the experimental model that most closely resembled AAU was induced
solely by a single injection of MAA derived from the bovine iris and
ciliary body without melanin-associated antigen from the choroidal and
retinal pigment epithelium.
2 3 Histopathologic examination
of eyes with EAAU reveal a severely inflamed iris and ciliary body
infiltrated by mostly mononuclear cells with minimal choroidal and no
retinal involvement. Immunohistochemical study of inflamed
eyes.
4 and the adoptive transfer of AAU by activated T
cells
3 suggest that EAAU is a T-cell–mediated autoimmune
disease. However, the precise mechanism by which autoimmunity to ocular
antigens develops remains to be determined.
Recently, the role of costimulatory signaling in the induction of
autoreactive T cells in autoimmune diseases has been intensively
studied. The activation and differentiation of T cells require both
antigen/MHC recognition and costimulatory signals.
5 The
signal delivered by the T-cell reactivity determines the antigen
specificity of the response. The second signal, termed costimulation,
is provided by accessory molecules on antigen-presenting cells (APCs)
and appears to be necessary for functional T-cell activation. There are
several receptor–ligand pairs that can provide costimulation. However,
the signal provided by the B7 family of cell surface molecules, with
its receptors on T cells, CD28, and CTLA-4, seems to be dominant for
T-cell activation.
6 7 8
At least two members of the B7 family of CD28 ligands have been
defined, B7-1 (CD80) and B7-2 (CD86).
9 10 11 12 These
molecules, although homologous, are each capable of providing
costimulation to T cells for proliferation and IL-2 production. A mouse
genetically deficient for B7-1 is essentially
immunocompetent.
9 Likewise, T cells from a mouse deficient
for CD28 cannot produce IL-2 after stimulation with anti-CD3
antibody.
13 A mouse deficient for CTLA-4 has a fetal
phenotype analogous a lymphoproliferative disorder.
14 Thus, the costimulatory signal derived through this receptor ligand is
important for the development of an effective immunoresponse.
CTLA4-Fc, a recombinant fusion protein consisting of the extracellular
domain of human CTLA4 fused to mouse IgG2a Fc, binds to both B7-1 and
B7-2 and can thereby block the interaction between B7 and CD28 or
CTLA-4.
15 Administration of CTLA4-Ig prevented rat cardiac
allograft rejection and pancreatic islet cell xenograft rejection in
mice.
16 17 In both instances, it appeared the mechanism of
suppression involved the induction of antigen-specific tolerance. The
costimulation provided by B7 also appears to be important for the
development of autoimmunity. CTLA4-Ig treatment, initiated the day
before immunization of mice with myelin basic protein (MBP) and
continued for 3 weeks, prevented development of the clinical and
histologic manifestations of experimental allergic encephalomyelitis
(EAE).
18 19 CTLA4-Ig treatment is also effective if
initiated 10 days postimmunization with MBP, when clinical disease is
event.
20 21 22 23 In the adoptive transfer model of EAE,
moreover, treatment of donor cells with CTLA4-Ig during ex vivo
exposure to MBP inhibited T-cell proliferation and IL-2 secretion in
response to MBP and prevented transfer of EAE to
recipients.
22 24 As is the case with EAE, treatment with
CTLA4-Ig prevented the development of disease in other animal models of
organ-specific autoimmunity—for example, collagen-induced arthritis in
the BB/Wor rat,
25 , autoimmune oophoritis induced by zona
pellucida glycoprotein ZP23 peptide,
26 and experimental
antiglomerular basement membrane autoimmune
glomerulonephritis.
27 28 A recent clinical study suggested
a potential therapeutic use for this novel immunomodulatory approach in
T-cell–mediated diseases.
29 T-cell costimulation in
patients with psoriasis vulgaris was blocked using CTLA4-Ig and was
observed to have a beneficial effect.
Using an animal model of AAU, we investigated the role of ongoing
T-cell costimulation in the development and pathogenesis of ocular
autoimmunity. In this article, we have shown that interference with the
B7 costimulatory signal through CD28 by CTLA4-Fc reduced both the
incidence and the severity of intraocular inflammation in EAAU.
Furthermore, CTLA4-Fc resulted in a profound decrease in the
proliferative response and TNF-α production by a rat MAA-specific
T-cell line. Our results suggest a critical role for
B7-mediated costimulation in the development of intraocular
inflammation and identifies a promising therapeutic approach for the
treatment of autoimmune uveitis.