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Stimulatory or superagonistic (SA) CD28-specific monoclonal antibodies (mAbs) are potent polyclonal activators of regulatory T cells and have proven highly effective as treatment in a wide range of rodent models for autoimmune and inflammatory diseases. In these models, a preferential activation of regulatory T cells was observed by in vivo administration of CD28SA. In stark contrast, human volunteers receiving TGN1412, a humanized CD28-specific mAb, experienced a life-threatening cytokine release syndrome during the first-in-man trial. Preclinical tests employing human peripheral blood mononuclear cells (PBMC) failed to announce the rapid cytokine release measured in the human volunteers in response to TGN1412. The aim of this thesis project was to find an explanation of why standard PBMC assays failed to predict the unexpected TGN1412-induced "cytokine storm" observed in human volunteers. CD28 superagonists can activate T cells without T cell receptor (TCR) ligation. They do depend, however, on “tonic” TCR signals received by MHC scanning, signals that they amplify. PBMC do not receive these signals in the circulation. Short-term in vitro preculture of human PBMC at a high cell density (HDC) resulted in massive cytokine release during subsequent TGN1412 stimulation. Restoration of reactivity was cell-contact dependent, associated with TCR polarization and tyrosine-phosphorylation, and blocked by HLA-specific mAb. In HDC, both CD4 T cells and monocytes functionally mature in a mutually dependent fashion. However, only CD4 memory T-cells proliferate upon TGN1412 stimulation, and were identified as the main source of pro-inflammatory cytokines. Importantly, responses to other T-cell activating agents were also enhanced if PBMC were first allowed to interact under tissue-like conditions. A new in vitro protocol is provided that returns circulating T-cells to a tissue-like status where they respond to TGN1412 stimulation, and it might represent a more reliable preclinical in vitro test for both activating and inhibitory immunomodulatory drugs. Finally, the surprising observation was made that the IgG1 “sibling” of TGN1412, which is of the poorly Fc receptor-binding IgG4 isotype, has a much lower stimulatory activity. We could exclude steric hindrance as an explanation and provide evidence for removal of TGN1112 from the T-cell surface by trans-endocytosis.
T cell activation is supposed to require two signals via engagement of the TCR and a costimulatory molecule. However, the signaling cascade of costimulatory molecules has remained elusive. Here, I provide evidence that CD44 supports proliferation as well as apoptosis mainly, if not exclusively, by enhancing signal transduction via the TCR/CD3 complex. Blockade of CD44 interferes with mounting of an immune response. This has been demonstrated by the significantly decreased IL-2 production of a T helper line, when stimulated in the presence of a competing CD44 receptor globulin. To evaluate the underlying mechanism, CD44 was cross-linked by an immobilized antibody (IM7). Cross-linking of CD44 induces proliferation of peripheral T cells and apoptosis of thymocytes and a T helper line in the presence of subthreshold levels of anti-CD3. CD44-induced proliferation was accompanied by an upregulation of the activation markers CD25 and CD69 and an increased cytokine production. TCR-mediated apoptosis was accompanied by an upregulation of CD95 ligand and CD95 receptor, which could be greatly enhanced by costimulation via CD44. On the level of signal transduction, coligation of CD44 with CD3 resulted in a strong and sustained increase of early tyrosine phosphorylation events and upregulated downstream signal transduction pathways, such as the ras/ERK and the JNK signaling cascades. These pleiotropic effects of CD44 are due to its involvement in the most proximal events in TCR signaling, as demonstrated by a strong increase in the phosphorylation of the TCR z-chain and ZAP-70. Notably, cross-linking of CD44 was binding-site dependent and was only effective when supporting colocalization of the TCR/CD3 complex and CD44. Cross-linking of CD44 via immobilized IM7 also induced profound changes in cell morphology, characterized by strong adhesion, spreading and development of surface extensions, which were dependent on a functional tubulin and actin cytoskeleton. These cytoskeletal rearrangements were mediated by rac1, a small GTPase of the rho subfamily, and src-family kinases, two of which, fyn and lck, were found to be associated with CD44. By cross-linkage of CD44 these kinases were redistributed into so called lipid rafts. It is supposed that for T cell activation a relocation of the TCR/CD3 complex into the same membrane microdomains is required. The data are interpreted in the sense that the costimulatory function of CD44 relies on its cooperativity with the TCR. Most likely by recruitment of phosphokinases CD44 significantly lowers the threshold for the initiation of signaling via the TCR. The requirement for immobilized anti-CD44, the necessity for neighbouring anti-CD3 and the dependence on the binding site of CD44 strongly suggest that the costimulatory mechanism involves cytoskeletal rearrangements, which facilitate recruitment and redirection of src-family protein kinases in glycolipid enriched membrane microdomains.