Circulation Research. 2007;101:248-257
Published online before print June 14, 2007,
doi: 10.1161/CIRCRESAHA.106.147124
(Circulation Research. 2007;101:248.)
© 2007 American Heart Association, Inc.
CTLA-4 Ablation and Interleukin-12–Driven Differentiation Synergistically Augment Cardiac Pathogenicity of Cytotoxic T Lymphocytes
Victoria A. Love,
Nir Grabie,
Paurene Duramad,
George Stavrakis,
Arlene Sharpe,
Andrew Lichtman
From the Vascular Research Division (V.A.L, N.G., P.D., G.S., A.L.), Department of Pathology, Brigham and Womens Hospital and Harvard Medical School; and Department of Pathology (A.S.), Harvard Medical School, Boston, Mass.
Correspondence to Andrew H. Lichtman, MD, PhD, Department of Pathology, Brigham and Womens Hospital, 77 Ave Louis Pasteur, NRB 752N, Boston, MA 02115. E-mail alichtman{at}rics.bwh.harvard.edu
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Abstract
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CD8
+ cytotoxic T lymphocytes contribute to viral and autoimmune
myocarditis and cardiac allograft rejection. The role of cytotoxic
T-lymphocyte–associated antigen (CTLA)-4 as a negative
regulator of CD4
+ T cells is well defined, yet CTLA-4 regulation
of CD8
+ T cells is less clear. We studied CTLA-4 regulation
of cytotoxic T lymphocytes in a transgenic model of CD8
+ T-cell–mediated
myocarditis. We generated
CTLA-4–/– Rag 2–/– OT-1 mice, the CD8
+ T cells of which express an ovalbumin (OVA)
peptide-specific, class I major histocompatibility complex–restricted
T-cell receptor.
CTLA-4–/–Tc12 OT-1 effectors, differentiated
with interleukin-12 present, are hyperproliferative in vitro,
compared with
CTLA-4+/+Tc12 OT-1 controls. Transfer of low doses
of
CTLA-4–/–Tc12 OT-1 cells to cMy-mOVA mice, which
express OVA on cardiac myocytes, causes severe myocarditis,
with 99% mortality, compared with no mortality after transfer
of low doses of
CTLA-4+/+Tc12 OT-1 cells. High doses of
CTLA-4+/+Tc12
cells cause lethal myocarditis in cMy-mOVA mice, but high doses
of
CTLA-4+/+Tc0 CTL, generated without interleukin-12, are hypoproliferative
within the cardiac-draining lymph node and do not significantly
infiltrate the heart. In contrast,
CTLA-4–/–Tc0 cytotoxic T lymphocytes do proliferate in the cardiac-draining
lymph node and diffusely infiltrate the heart. Nonetheless,
high doses of
CTLA-4–/–Tc0 cells cause only limited
tissue damage, and the disease is not lethal. These data show
that CTLA-4 regulates myocarditic CD8
+ T cell responses and
that CTLA-4 deficiency partly overcomes a differentiation block
that exists when naïve CD8
+ T cells are stimulated without
interleukin-12. Therefore, targeting CTLA-4 solely or in conjunction
with interleukin-12 could influence effector CD8
+ T cell responses
in therapeutically beneficial ways.
Key Words: rodent cytotoxic T lymphocytes CTLA-4 myocarditis
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Introduction
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The regulation of CD8
+ T-cell activation and differentiation
by members of the B7 and CD28 regulatory molecules remain incompletely
understood. Cytotoxic T-lymphocyte antigen (CTLA)-4 is a CD28
family member that is expressed on the surface of lymphocytes
after T-cell receptor (TCR) stimulation.
1 CTLA-4 and CD28 share
specificity for the B7 molecules CD80 (B7-1) and CD86 (B7-2).
It is well documented that CD80 and CD86 binding to CTLA-4 on
CD4
+ T cells results in downregulation of cell-cycle progression
and interleukin (IL)-2 production.
2,3 In contrast, there are
conflicting studies regarding the effects of CTLA-4 ligation
on CD8
+ T-cell regulation.
4,5 Several reports indicated that
CTLA-4 blockade does not alter cytotoxic T lymphocyte (CTL)
responses to lymphocytic choriomeningitis virus, mouse mammary
tumor virus, or
Leishmania major infection in mice.
4,6,7 Yet
experiments with CTLA-4–deficient class I major histocompatibility
complex–restricted TCR transgenic mice indicate that CTLs
are hyperresponsive to antigen on restimulation, suggesting
a negative regulatory role in CTL activation.
4,5,8 Furthermore,
blockade of CTLA-4 with neutralizing antibody augments CTL-mediated
responses against tumors in mice and humans and heightens cardiac
allograft rejection.
9–12
CD8+ CTLs contribute to the pathogenesis of several myocardial diseases, including Coxsackie B3–induced myocarditis,13 autoimmune myocarditis,14 and cardiac allograft rejection.11 We explored whether CTLA-4 influences CTL responses, using cMy-mOVA mice that express ovalbumin (OVA) exclusively in cardiac myocytes and develop a robust myocarditis after receiving adoptive transfer of OVA peptide-specific OT-1 CD8+ T cells.15,16
We reported previously that in vitro OT-1 effector CTLs generated in the presence of IL-12 (OT-1Tc12) cause lethal myocarditis in cMy-mOVA mice, if transferred in sufficient numbers. However, CTLs generated in the absence of added IL-12 (OT-1Tc0) are nonpathogenic in cMy-mOVA mice. We found that OT-1Tc0 cells fail to divide in vivo, do not egress from a cardiac-draining lymph node (CDLN), and have reduced cytotoxic activity.15
Because evidence supports a role for CTLA-4 in the negative regulation of CTLs against tissue-derived antigens, we hypothesized that abrogating CTLA-4 signals would enhance myocarditis and overcome the requirement for IL-12. To test this hypothesis, we compared the phenotypes of the CTLA-4–deficient and wild-type OT-1 cells and their responses in cMy-mOVA mice. Our results indicate that CTLA-4 significantly limits CTL proliferation and pathogenicity in the cMy-mOVA model, but CTLA-4 ablation does not overcome the limited pathogenicity of CTLs generated without IL-12.
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Materials and Methods
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Mice and Cell Lines
C57BL/6 and C57BL/6 Rag2 knockout mice were purchased from Charles
River Laboratories (Wilmington, MA) and Taconic (Hudson, NY),
respectively. The previously described OT-1 TCR transgenic mice
were kindly provided by W. R. Heath and F. Carbone (Walter and
Eliza Hall Institute of Medical Research, Melbourne, Australia).
17 Thy 1.1
+ OT-1 mice lacking both CTLA-4
18 and Rag2 were generated
by interbreeding relevant transgenic and knockout parental strains.
C57BL/6 cMy-mOVA were previously described.
15 Mice were bred
in a pathogen-free facility at the Harvard Medical School in
accordance with the Committee of Animal Research at the Harvard
Medical School and the NIH animal research guidelines (see the
online data supplement at http://circres. ahajournals.org).
Naïve OT-1 Isolation and In Vitro Generation of OT-1 Effector Cells
Isolation of naïve OT-1 cells from 8- to 16-week-old CTLA-4–/– and CTLA-4+/+ OT-1 mice and generation of effector cells was performed as described previously.15,16,19 Antigen-stimulated T cells generated in the presence of 60 U/mL recombinant mouse IL-2 (R&D Systems, Minneapolis, Minn) and 10 ng/mL recombinant mouse IL-12 (R&D Systems), are referred to as CTLA-4+/+Tc12 or CTLA-4–/–Tc12 OT-1 cells. In some cultures, no IL-12 was added, to generate CTLA-4+/+Tc0 or CTLA-4–/–Tc0 OT-1 cells.
In Vitro Assays of T-Cell Proliferation and Cytokine Secretion Assays
To measure proliferation in primary and restimulation cultures, [3H]-thymidine incorporation assays were performed in microwell plates and incorporated radioactivity was assayed by liquid scintillation. Supernatants (100 µL) from restimulation cultures were collected for cytokine analyses. Interferon (IFN)-
– or IL-2–specific ELISAs, and IFN-
– and tumor necrosis factor (TNF)-
–specific Cytokine Bead assays (BD Biosciences) were performed as described.15,20
Antibodies and Flow Cytometric Analyses
All fluorescein isothiocyanate–, phycoerythrin-, and CyChrome– conjugated antibodies were obtained from BD Pharmingen for fluorescence-activated cell sorting (FACS) analysis. Stained-cell preparations were analyzed using a FACScalibur instrument and CellQuest software (Becton Dickinson, San Jose, Calif) as described previously.15,16,19 For cytoplasmic staining of perforin and granzyme (GzB), effector OT-1 cells were incubated with Golgistop (Monensin) and Golgiplug (Brefeldin A) (BD Biosciences) for 6 hours. Surface staining using anti-CD8a (Ly-2) was performed before fixation with Cytofix (BD Biosciences), and intracellular staining was done in the presence Cytoperm (BD Bioscience). The following antibodies were used: anti–GzB–allophycocyanin (APC) (Caltag clone GB11) plus APC–mouse IgG1 (Caltag) or anti-perforin Ab (clone eBioOMAK-D; Ebiosciences) plus phycoerythrin–rat IgG2a,
.
T-Cell Cytotoxic Activity Assays
Four-hour [51Cr] sodium chromate release and live/dead assays (Molecular Probes Inc, Eugene, Ore) were performed as described previously.15,19
OT-1 Adoptive Transfer and Myocarditis Studies in cMy-mOVA Mice
OT-1 cells removed from primary stimulation cultures on day 5 were injected intraperitoneally into cMy-mOVA mice as described previously.5,16,19 Doses ranged from 0.5x105 to 5x106 OT-1 effector cells. Hematoxylin and eosin staining and immunohistochemistry of heart sections and serum troponin (Tn)I analyses were performed on samples taken from mice euthanized 5 days after adoptive transfer.15
In Vivo Cell Proliferation Analysis, Carboxyfluorescein Ester Dilution, and 5-Bromodeoxyuridine Labeling
Thy 1.1+ OT-1 effector cells were labeled with carboxyfluorescein ester (CFSE) as described.15,20 Subsequently, 5x106 cells were transferred by intraperitoneal injection to Thy 1.2+ cMy-mOVA mice. The CDLNs were harvested from recipients 2 days after transfer.15 Cells were stained with phycoerythrin anti–Thy 1.1 antibody and Thy 1.1/CFSE double-positive cells were quantified by FACS. For 5-bromodeoxyuridine (BrdUrd) experiments, 1x106 day 5 OT-1 cells were adoptively transferred to cMy-mOVA mice, and 24 hours later, mice were injected with 1.5 mg of BrdUrd solubilized in PBS. Sixteen hours after the labeling, mice were euthanized, cryostat sections of heart were prepared, and BrdUrd-positive cells were identified by immunohistochemistry, using the In-Situ detection Kit (BD-Pharmingen).
Real-Time PCR
Total RNA isolation, conditions for quantitative real-time PCR, and primers sequences have been described elsewhere.15,20
Statistical Analysis
Data are presented as mean±SD of multiple samples. Analyses were performed using the Mann–Whitney test for data that was not normally distributed, as determined by the Kruskal–Wallis test, and Students t test for normally distributed data. A value of P<0.05 was considered to be significant.
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Results
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CTLA-4 Deficiency Enhances the Proliferative Response of Differentiated Effector but Not Naïve CD8+ T Cells In Vitro
Mice deficient in CTLA-4 die of a lymphoproliferative disorder.
21,22 TCR transgenic mice develop the same disorder, albeit with delayed
kinetics.
23 Therefore, we generated OT-1 mice that also lack
Rag2. For simplicity, we will refer to the Rag2
–/– OT-1 cells as either
CTLA-4–/– or
CTLA-4+/+. Analysis
of cell surface markers indicated that naïve and in vitro
stimulated CTLs from both
CTLA-4–/– and
CTLA-4+/+ mice were phenotypically similar (see the online data supplement).
CTLA-4–/–Tc12 and CTLA-4+/+Tc12 cells proliferated identically during primary stimulation, as measured by [3H]-thymidine incorporation (Figure 1A). However, on restimulation, CTLA-4–/–Tc12 cells incorporated significantly more [3H]-thymidine compared with CTLA-4+/+Tc12 cells, 300 000 versus 91 000 counts per minute, respectively (Figure 1B). We measured IL-2 from antigen-restimulated OT-1 cells and found a trend toward higher IL-2 production in CTLA-4–/–Tc12 cultures compared with CTLA-4+/+Tc12 cultures (Figure 1C).

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Figure 1. CTLA-4–/–Tc12 cells, but not CTLA-4–/– naïve CD8+ T cells, are hyperproliferative. A, Naïve CTLA-4–/– and CTLA-4+/+ OT-1 cells (5x104 cells per well) were stimulated with splenic APCs, IL-12, and the indicated concentrations of SIINFEKL peptide, cultured for 72 hours, and pulsed with [3H]-thymidine for the last 16 hours. Incorporated radioactivity was measured. The data represent the means±SD of 2 experiments. There was no significant difference in proliferation between the 2 groups at any of the antigen concentrations. P>0.05. When IL-12 was not added, there still was no difference in the proliferative responses of CTLA-4–/– vs CTLA-4+/+ naïve T cells (data not shown). B, CTLA-4–/–Tc12 and CTLA-4+/+Tc12 cells were restimulated with SIINFEKL and APCs. Data represent the means±SD of 2 experiments. #P<0.001, *P<0.008. C, Supernatants from cultures described in B were sampled at 36 hours, and IL-2 was measured by ELISA. The data represent the means±SD of 2 experiments. P=0.18.
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CTLA-4 Deficiency Does Not Alter Cytotoxic or IFN-
Secretory Functions of CD8+ T Cell In Vitro
Granule exocytosis- and contact-dependent killing of target cells is the major mechanism by which CTLs protect against infections and tumors and cause tissue damage in autoimmune disease and allograft rejection.24 We examined cytotoxic function of CTLA-4–/–Tc12 and CTLA-4+/+Tc12 OT-1 cells against SIINFEKL-pulsed EL4 target cells in vitro and found no significant difference between the 2 cell populations (Figure 2A and 2B).

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Figure 2. Effector phenotypes of CTLA-4–/–Tc12 and CTLA-4+/+Tc12 cells are not different by in vitro assay. CTLA-4–/–Tc12 and CTLA-4+/+Tc12 OT-1 cells were generated from naïve T cells by 5-day culture with SIINFEKL, APCs, IL-12, and IL-2. A, Effector cells were tested for cytotoxicity against SIINFEKL-loaded target cells using 51Cr-release assay. A representative experiment of 6 using this assay is shown, each experiment using T cells derived from different mice. In all repeated studies, there was no statistically significant difference between CTLA-4–/–Tc12 and CTLA-4+/+Tc12 cytotoxicity at any of the effector-to-target cell ratios (P>0.05). B, The mean cytotoxicity data from 8 different experiments, at an effector-to-target ratio of 10:1, by using either 51Cr-release assays (n=6) or flow cytometric live/dead assays (n=2) are shown. There was no significant difference between the groups, using this pooled data (P=0.149). The differences between the 2 groups remained insignificant if only the 51Cr-release or the live/dead experiments were included. C and D, CTLA-4–/–Tc12 and CTLA-4+/+Tc12 cells (5x104) were restimulated with SIINFEKL (1 µg/mL) and APCs for 36 hours and supernatant TNF- , and IFN- were measured by Cytokine Bead assay (BD Biosciences). The data represent the means±SD of 3 experiments. The differences between groups was not significant. P=0.26 for TNF- ; P=0.89 for IFN- .
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Activated CTLs also secrete inflammatory cytokines which help to promote clearance of intracellular pathogens.25 We measured IFN-
secretion by restimulated OT-1 cells and found moderately higher concentrations of this cytokine in culture supernatants of CTLA-4–/–Tc12 cells compared with CTLA-4+/+Tc12 cells; 1150 pg/mL and 975 pg/mL, respectively (Figure 2C). Additionally, TNF-
levels were similar, measuring 1420 and 1573 pg/mL for CTLA-4–/–Tc12 and CTLA-4+/+Tc12 cells, respectively (Figure 2D).
CTLA-4 Deficiency Markedly Enhances Cardiopathogenicity of CTL
To determine whether CTLA-4 influences CTL responses in vivo, we used the cMy-mOVA model of myocarditis.15 After adoptive transfer of 1x106 OT-1Tc12 effectors, cMy-mOVA animals do not survive longer than 6 days. We titrated the number of transferred cells and determined that 5x104 cells is a nonlethal dose (data not shown). Subsequently, we transferred 5x104 CTLA-4–/–Tc12 and CTLA-4+/+Tc12 effector cells into cMy-mOVA mice. Recipients did not survive longer than 10 days following low-dose adoptive transfer of CTLA-4–/–Tc12 cells. In contrast, mice receiving CTLA-4+/+Tc12 cells were healthy longer than 30 days (Figure 3A). To determine whether enhanced lethality of CTLA-4–deficient CTLs correlated with myocardial damage, we measured cardiac TnI levels in serum collected 5 days after adoptive transfers. TnI levels were almost 8 times higher in recipients of CTLA-4–/–Tc12 cells compared with recipients of CTLA-4+/+Tc12 cells (Figure 3B).

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Figure 3. CTLA-4 deficiency in CTLs results in markedly enhanced cardiac pathogenicity. A, Survival of cMy-mOVA mice was followed after adoptive of 5x104 Thy 1.1+ CTLA-4–/–Tc12 or CTLA-4+/+Tc12 cells. Data represent combined data from 3 experiments performed the same way, with a total of 23 mice per group. B, TnI levels were measured in samples collected from cMy-mOVA mice injected with the same T-cell preparations used for the survival study in A but were euthanized 5 days posttransfer. The data represent means±SD, 8 mice per group. C, Tissue sections were prepared from hearts of cMy-mOVA mice 5 days following adoptive transfer. Formalin-fixed, paraffin-embedded sections were stained with hematoxylin and eosin (H&E), and frozen sections were analyzed by immunohistochemistry to detect Thy 1.1+ OT-1 cells. Representative sections are shown. D, Histopathology scoring for myocarditis was performed on the hematoxylin and eosin sections. Data represent mean SD scores from 1 of 3 experiments, which included 4 to 6 animals per group.
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Histological samples were evaluated following adoptive transfer. Inflammatory cell infiltration was much more extensive within the hearts of the mice receiving CTLA-4–/–Tc12 cells compared with CTLA-4+/+Tc12 cells (Figure 3C, top panels, and 3D); the mean scores were 3.11±0.23 versus 1.5±0.36, respectively. Because histological scoring does not distinguish between endogenous and transferred leukocyte infiltration, we performed immunohistochemistry to identify transferred Thy 1.1+ OT-1 cells in the hearts of the Thy 1.2+ recipient mice. Significantly more CTLA-4–/–Tc12 than CTLA-4+/+Tc12 cells were found in hearts (Figure 3B, bottom).
CTLA-4–/–Tc12 OT-1 Cells Are Hyperproliferative In Vivo
Because CTLA-4–/–Tc12 cells proliferate more vigorously than CTLA-4+/+Tc12 cells in vitro, we hypothesized that the enhanced pathogenicity of the CTLA-4–/–Tc12 cells in vivo was related to hyperproliferation. We therefore evaluated whether there were differences in the proliferative capacities of CTLA-4–/–Tc12 and CTLA-4+/+Tc12 cells after adoptive transfer by comparing CFSE dye dilution of Thy 1.1+ OT-1 cells. We previously described a peribronchial CDLN that drains the heart and is a site of OT-1 proliferation in cMy-mOVA mice.15,26 Adoptively transferred IL-12–stimulated OT-1 cells are found within the CDLN for approximately 72 hours posttransfer and thereafter are found within the hearts. In the present study, we found that the fraction of CFSE-labeled CTLA-4–/–Tc12 cells in the CDLN that had divided after 72 hours was 9.2-fold greater than the fraction of labeled CTLA-4+/+Tc12 cells that had divided (Figure 4A and 4B). To further characterize proliferative differences between CTLA-4–/–Tc12 and CTLA-4+/+Tc12 cells, we used a BrdUrd-labeling technique.27 Sixteen hours after T-cell transfer, we found 8 times more BrdUrd-positive cells in hearts of cMy-mOVA mice that received CTLA-4–/–Tc12 cells, compared with recipients of CTLA-4+/+Tc12 cells (Figure 4C and 4D). The stained cells have the morphology of lymphocytes, and our prior experience with this model indicates that the inflammatory infiltrate is largely composed of transferred OT-1 cells and endogenous neutrophils. Nonetheless, it possible that some of the BrdUrd staining reflects endogenous inflammatory cell proliferation.

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Figure 4. CTLA-4–/–Tc12 OT-1 cells proliferate more in cMy-mOVA mice than CTLA-4+/+Tc12 OT-1 cells. A, Thy1.1+ CTLA-4–/–Tc12 or Thy1.1+ CTLA-4+/+Tc12 cells were labeled with CFSE, and 5x106 labeled cells were injected into Thy 1.2+ cMy-mOVA mice. After 40 hours, the CDLNs were harvested and single-cell suspensions were analyzed by FACS. The histograms show CFSE fluorescence in Thy1.1+-gated cells from 1 of 3 mice per group. The horizontal bars represent the range of CFSE signal intensity in the input populations (CFSEhi). B, The percentage of cells from the CDLN that retained input CFSE signal (% CSFEhi) is shown. The data represent the mean±SD percentages from 1 of 2 experiments with similar results; n=3 per group in each experiment. A total of 100 000 events were collected from each lymph node suspension; the mean number of Thy 1.1+ cells was 275 for the CTLA-4+/+ cells and 2699 for CTLA-4–/– cells. C, BrdUrd labeling of proliferating cells was performed by injecting 1.5 mg of BrdUrd into cMy-mOVA mice 24 hours after transfer of 1x106 CTLA-4–/–Tc12 or CTLA-4+/+Tc12 effector cells (n=3 mice per group). The mice were euthanized 16 hours later, and heart sections were prepared and stained for BrdUrd by immunohistochemistry. Representative sections from each group are shown. Arrows in the CTLA-4+/+ sample show inflammatory infiltrates indicated by counterstain, which are not BrdUrd positive. D, BrdUrd-positive cells were counted in 12 high-power fields in 3 sections per heart, 3 hearts per experimental group. Data represent the mean±SD numbers of BrdUrd-positive cells per high-power field (n=3 mice per group).
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CTLA-4 Deficiency Partially Overcomes the Block in Differentiation of Myocarditic CD8+ T Cells in the Absence of IL-12
CTLA-4+/+Tc0 cells, generated by in vitro stimulation in the absence of IL-12, are unable to proliferate nor egress from the CDLN in cMy-mOVA mice.15 Furthermore, CTLA-4+/+Tc12 cells generated in the presence of IL-12 cause myocarditis in cMy-mOVA mice if sufficient numbers of CTLs are transferred (eg,
0.5x106), but CTLA-4+/+Tc0 cells do not.15 Given these observations, and the hyperproliferative, pathogenic phenotype of CTLA-4–/–Tc12, we hypothesized that CTLA-4 deficiency may overcome the proliferative block and low pathogenicity seen in CTLA-4+/+Tc0 cells. In response to antigen stimulation in vitro, naïve CTLA-4–/– and CTLA-4+/+ OT-1 cells proliferated comparably to one another in the absence of IL-12 (data not shown), but after antigen restimulation, the CTLA-4–/–Tc0 effector cells showed a significant proliferative response, whereas CTLA-4+/+Tc0 did not (see Figure III in the online data supplement). We therefore compared the consequences of transferring CTLA-4–/–Tc0 and CTLA-4+/+Tc0 cells into cMy-mOVA mice. As predicted, heart sections from recipients of CTLA-4+/+Tc0 showed only a few small foci of inflammatory cells confined to the papillary muscles (Figure 5A, right). In contrast, heart sections from recipients receiving CTLA-4–/–Tc0 cells showed diffused inflammatory infiltration throughout the specimen (Figure 5A, left). Transfer of 1x106 CTLA-4+/+Tc12 cells also caused severe myocarditis (not shown). Myocarditis scores in sections from recipients injected with CTLA-4–/–Tc0, CTLA-4+/+Tc0, and CTLA-4+/+Tc12 cells were 3.33, 1.63, and 3.75, respectively (Figure 5B). Interestingly, high levels of TnI could be found within serum of recipients receiving adoptive transfer of CTLA-4–/–Tc0 cells, indicating severe myocardial damage. TnI levels in cMy-mOVA mice receiving, CTLA-4–/–Tc0, CTLA-4+/+Tc0, and CTLA-4+/+Tc12 were 89, 15, and 119 pg/mL, respectively (Figure 5C). Additionally, survival experiments to evaluate pathogenicity were performed by transferring 5x106 CTLA-4–/–Tc0 and CTLA-4+/+Tc0 cells to recipients. Although CTLA-4–/–Tc0 cells clearly migrated to the myocardium and induced inflammation, the disease was not fatal. Three separate survival experiments were conducted and all recipients were alive at 2 months (Figure 5D). These data indicate that CTLA-4 deficiency enhances the ability of Tc0 cells to infiltrate and cause tissue damage; however, CTLA-4–/–Tc0 cells are less pathogenic than CTLA-4–/–Tc12 cells. Induction of even a nonlethal form of disease requires 100 times more CTLA-4–/–Tc0 cells than CTLA-4–/–Tc12 cells.

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Figure 5. CTLA-4–deficient OT-1 cells differentiated without IL-12 cause myocarditis. A, CTLA-4–/–Tc0 and CTLA-4+/+Tc0 cells were adoptively transferred to cMy-mOVA mice (5x106 cells for both groups). Six days post–adoptive transfer, recipients were euthanized and heart sections were prepared for hematoxylin and eosin staining. Representative low- and high-power fields of 1 heart from each experimental group are shown (n=4 mice per group). B, Sections were scored for degree of myocarditis. The data represent the mean±SD scores (n=4 mice per group). C, TnI levels were determined in serum samples obtained at time of euthanasia. The data represent the means±SD (n=4 per group). D, Three groups of cMy-mOVA mice were adoptively transferred with 1x106 CTLA-4+/+Tc12 cells, 5x106 CTLA-4–/–Tc0, or 5x106 CTLA-4+/+Tc0 cells, respectively (n=12 recipient mice per group; data pooled from 3 identically performed experiments, each with 4 mice per group).
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CTLA-4–Deficient Tc0 Cells Proliferate Within the Cardiac Lymph Node
Because CTLA-4 deficiency enhanced the proliferative capacity of Tc12 effector cells, we predicted that the enhanced infiltrative and pathogenic effects of CTLA-4–/–Tc0 cells might also be attributable to deregulated proliferation. Therefore, we compared in vivo proliferation of CFSE-labeled Thy 1.1+ CTLA-4–/–Tc0 and CTLA-4+/+Tc0 cells after transfer to Thy 1.2+ cMy-mOVA mice. As shown in Figure 6A, 62% of CTLA-4+/+Tc0 cells remained CFSEhi, but only 2% of CTLA-4–/–Tc0 cells remained CFSEhi, indicating that CTLA-4 deficiency resulted in a 30-fold increase in the number of proliferating cells within the CDLN (Figure 6B).

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Figure 6. CTLA-4 deficiency overcomes the proliferative block of OT-1 cells differentiated without IL-12. A, Thy 1.1+ CTLA-4–/–Tc0 or Thy 1.1+ CTLA-4+/+Tc0 cells were labeled with CFSE and adoptively transferred into Thy 1.2+ cMy-mOVA mice; 5x106 cells per animal. After 40 hours, recipients were euthanized and single-cell suspensions of the CDLN were analyzed by FACS for the presence of Thy 1.1+ CFSEhi donor cells. A representative FACS plot of 1 animal from each group is shown. Horizontal bars represent the range of CFSE signal intensity in the input population (CFSEhi) (n=3 mice per group). A total of 100 000 events were collected from each lymph node suspension; the mean number of Thy 1.1+ cells was 278 for the CTLA-4+/+ cells and 655 for CTLA-4–/– cells. B, The data are the mean percentages of CFSEhi cells±SD from 2 independent experiments (n=3 mice per group for each experiment).
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The Absence of IL-12 During Differentiation Results in Persistent Block in Full Differentiation in Both CTLA-4–/– and CTLA-4+/+ OT-1 T Cells
Given the unexpected result that CTLA-4–/–Tc0 cells induce a less-severe myocarditis compared with CTLA-4+/+Tc12 cells, we reasoned that CTLA-4–deficient cells still require IL-12 for complete terminal differentiation. We therefore examined the ability of CTLA-4+/+ and CTLA-4–/– cells, each differentiated with and without IL-12, to kill SIINFEKL-pulsed target cells (Figure 7A). At the highest effector-to-target ratio, CTLA-4+/+Tc0 cells had less cytotoxic activity than CTLA-4+/+Tc12 cells, consistent with previous studies.15 As predicted, CTLA-4–/–Tc0 cells also had impaired cytotoxic activity compared with CTLA-4–/–Tc12 cells (Figure 7A). Therefore, the enhanced pathogenicity of CTLA-4–deficient OT-1 cells cannot be explained by enhanced cytotoxic activity, and development of a maximally cytotoxic phenotype requires IL-12, even in the absence of CTLA-4.

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Figure 7. Both wild-type and CTLA-4–deficient OT-1 effector cells differentiated without IL-12 have impaired cytotoxic phenotypes. A, Cytotoxic activity against SIINFEKL-pulsed EL-4 cells was compared between CTLs differentiated in the presence and absence of IL-12 using either flow cytometric live/dead (top) or 51Cr-release (bottom) assays. Data are from 1 of 2 experiments, both of which showed reduced cytotoxicity in CTLs differentiated in the absence of IL-12 for each type of assay are shown. B, Intracellular stains for GzB and perforin were performed with CTLA-4+/+ and CTLA-4–/– OT-1 cells stimulated in culture with and without IL-12. The numbers represent mean fluorescence intensities. The results are typical of 3 staining experiments performed. C, Quantitative RT-PCR analysis of granzyme B mRNA was performed on CTLA-4+/+Tc12 and CTLA-4+/+Tc0 as well as CTLA-4–/–Tc12 and CTLA-4–/–Tc0 cells. The data represent the means±SD of 2 experiments. cntrl indicates control.
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We also evaluated GzB and perforin protein expression, using cytoplasmic staining and flow cytometry (Figure 7B). The results indicate that GzB is upregulated by IL-12 treatment, in both CTLA-4–deficient and control OT-1 cells. Furthermore, CTLA-4–deficient CTLs expressed slightly less GzB and equivalent amounts of perforin compared with control CTL, further supporting the conclusion that CTLA-4 deficiency does not result in enhanced cytotoxic function. We also found GzB mRNA levels were 1.9-fold lower in CTLA-4–/–Tc0 compared with CTLA-4–/–Tc12 cells and we found a 2.6-fold reduction of GzB mRNA in CTLA-4+/+Tc0 cells compared with CTLA-4+/+Tc12 cells.
Overall, our data show that CTLA-4–/–Tc0 cells are more differentiated than CTLA-4+/+Tc0 cells, as indicated by proliferative, migratory, and pathogenic phenotypes, but CTLA-4 deficiency does not compensate for the lack of signals provided by IL-12 in the differentiation of a cytotoxic phenotype.
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Discussion
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We investigated the role of CTLA-4 in the regulation of effector
CD8
+ T-cell responses by comparing the functional phenotypes
and cardiac pathogenicity of
CTLA-4+/+ and
CTLA-4–/– OT-1 cells activated the presence or absence of IL-12. Some
studies examining CTL antiviral responses in mice found no evidence
of enhanced CTL responses in
CTLA-4–/– mice or in
mice treated with anti–CTLA-4 blocking antibody,
4,6,7 whereas other studies showed a role for CTLA-4 in the regulation
of CTLs.
9,11 The conflicting reports may reflect multiple experimental
systems used to study the impact of CTLA-4 on CTL regulation.
One way to reconcile these differences is to consider that CTLA-4
regulates CTL responses against tissue antigens, as shown here,
but may not have a significant impact on CTL responses against
viral or other microbial antigens.
Our data show synergistic effects of CTLA-4 ablation and IL-12 in CTL differentiation and function. This is consistent with mouse studies of low-dose oral tolerance28 and in anergy induction using systemic CTLA-4 monoclonal and IL-12 injections.29 Our data show that CTLA-4 regulates cellular proliferation, whereas IL-12 promotes CTL effector differentiation. In our model, CTLA-4+/+Tc0 cells are functionally anergic, consistent with other studies showing that IL-12 is required for CTL effector differentiation.30–32 However, CTLA-4 deficiency can overcome the proliferation block and partially overcome the differentiation block because CTLA-4–/–Tc0 cells proliferate in the CDLN and enter the myocardium. Nonetheless, CTLA-4–/–Tc0 cells are not fully differentiated, as indicated by their impaired cytotoxic function in vitro, and their inability to cause lethal myocarditis, even when 100-fold more of these cells are transferred than a lethal dose of CTLA-4–/–Tc12 cells. Our findings are consistent with studies showing that regulation of CD8+ T-cell proliferation and development of cytotoxic function are not obligatorily linked, and that a lack of IL-12 signals differentially impairs cytotoxic function.33
Our data are consistent with reports that both CD4+ and CD8+ T-cell proliferative responses are kept in check by CTLA-4, albeit at different stages of activation. Importantly, this study correlates the hyperproliferative CTL response caused by CTLA-4 ablation with disease in an animal model. CTLA-4–/– CD4+ T cells display a profound increase in production of IL-2. We also observed increases in secreted IL-2 from CTLA-4–/–Tc12 cells (Figure 1C) and CTLA-4–/–Tc0 cells (see supplemental Figure III) relative to control populations.
We found reduced GzB in both CTLA-4+/+Tc0 and CTLA-4–/–Tc0 cells, compared with CTLA-4+/+Tc12 and CTLA-4–/–Tc12 cells, which is a likely reason for their impaired cytotoxic function. We did not see differences in perforin expression. Previous work suggests that CTL killing is perforin dependent, but not GzB dependent, because CTLs from GzA/GzB double-knockout mice induced [51Cr] release in target cells at levels similar to wild-type mice.34 Recent work delineates a novel connection between IL-12 and GzB regulation, which is concordant with our results.35 It is possible that IL-12 influences expression of additional granzymes and other genes necessary for cell-mediated lysis and apoptosis induction.
The use of exogenous cytokines such as IL-2 and IL-12 as adjuvants in conjunction with vaccine regiments to control melanoma and other tumors has shown promise clinically.36,37 In addition, neutralizing anti–CTLA-4 antibodies have been used in mice and clinical trials with some positive results.10,38 Our data indicate that enhancement of CTL effector function may be more profound when CTLA-4 signals are blocked in the presence of IL-12. This finding may prove significant in consideration of new combinatorial therapies designed to enhance antitumor-specific responses. Alternatively, the effects of ligation of CTLA-4 in the absence of IL-12 may be instructive for the design of protocols to limit autoimmunity and graft rejection.
 |
Acknowledgments
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We thank Dr Avi-Hai Hovav for critically reviewing the manuscript
and Hong Pang for excellent technical assistance.
Sources of Funding
This work was supported by the following National Institutes of Health grants: AI059610 (VL, AHL) HL072056 (AHL), AI046414 (AS).
Disclosures
None.
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Footnotes
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Original received December 20, 2006; revision received May 25,
2007; accepted May 31, 2007.
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