Identification of a CD40L gene mutation and genetic counselling in a family with immunodeficiency with hyperimmunoglobulinemia M

A 13-year-old boy with immunodeficiency with hyper-IgM was analyzed for mutations in the CD40L gene. An insertional mutation of an extra T in a run of four T's was found in the second exon of the gene, leading to a premature translation stop. Genetic counselling of the family was performed, based on mutation detection by PCR/oligohybridization.     

CD40/CD40L expression in leukocytes from chronic granulomatous disease patients

Chronic granulomatous disease (CGD) is an inherited disorder caused by defects in the NADPH oxidase complex, which generates superoxide, the precursor of hydrogen peroxide (H(2)O(2)) and other reactive oxygen derivatives with microbicidal activity. Because CGD patients are at risk of chronic inflammatory manifestations, including inflammatory bowel disease and autoimmune diseases, and it is not clear whether these pathologies are exclusively secondary to altered superoxide production, or whether distinct immunologic defects are involved, we explored cell proliferation, lymphocyte cell counts, immunoglobulin levels, presence of autoimmune antibodies and expression of costimulatory molecules in leukocytes from CGD patients. We found that CGD patients have a diminished phytohemagglutinin-induced proliferation of blood mononuclear cells. Following stimulation with PMA plus ionomycin, a reduced percentage of CD40L expression in T lymphocytes and a diminished expression of CD40 molecules in neutrophils were observed on leukocytes from these patients. Our results suggest an altered interplay between elements of innate and adaptive immunity in CGD patients, which may be reflected in an increased susceptibility to opportunistic infections.     

CD40L: a multi-functional ligand

B cells can be stimulated to proliferate and differentiate in response to cell-contact dependent signals provided by activated, but not resting, T cells. In the human system, antibodies specific for the surface antigen CD40 induce similar B cell responses. The cloning of a ligand for CD40, and the generation of reagents which can block the interaction of this ligand with its receptor, have demonstrated that the major component of the contact-dependent signal leading to B cell activation is CD40 ligand. Studies of individuals lacking functional CD40 ligand have indicated that signaling through CD40 is essential for immunoglobulin (Ig) heavy chain switching and the production of all isotypes other than IgM. In addition to its activities on B cells, CD40 ligand is stimulatory for cells of monocyte and T lineages suggesting a pleiotropic role for CD40 ligand in vivo.     

The role of CD40 and CD154/CD40L in dendritic cells

In this review, we focus on the function of CD40–CD40L (CD154) interactions in the regulation of dendritic cell (DC)–T cell and DC–B cell crosstalk. In addition, we examine differences and similarities between the CD40 signaling pathway in DCs and other innate immune cell receptors, and how these pathways integrate DC functions. As research into DC vaccines and immunotherapies progresses, further understanding of CD40 and DC function will advance the applicability of DCs in immunotherapy for human diseases.     

Critical function of the CD40 pathway in parvovirus B19 infection revealed by a hypomorphic CD40 ligand mutation

Parvovirus B19-induced chronic anemia has been associated with failure to mount an effective neutralizing antibody response. We describe an adolescent male with a 13-year history of parvovirus B19-induced anemia as the primary manifestation of X-linked hyper IgM immunodeficiency (XHIM). This patient, whose serum IgG concentration was at the low end of the normal range and who mounted IgG antibody responses to T cell-dependent antigens, suffered from a nonsense mutation (R11 --> X) in the CD40 ligand (CD40L) gene. This resulted in low-level expression of a mutant CD40L predicted to lack the cytoplasmic domain. Intravenous immunoglobulin therapy alone or in combination with interferon gamma, given in the context of impaired Th1 cytokine production, suppressed but did not eradicate the infection. These results highlight the critical function of the CD40/CD40L pathway in parvovirus B19 infection and suggest that subtle defects in this pathway may underlie cases of chronic parvovirus B19 infection atypical of XHIM.     

霉酚酸酯对血管内皮细胞与淋巴细胞粘附及其表达CD40L的影响

目的：观察霉酚酸酯（MMF）对细胞因子刺激下人脐静脉内皮细胞（mWEC）CD40L的影响。方法：正常分娩人脐带经胶原酶消化后，分离出内皮细胞，培养至3～5代，用于细胞粘附和CIMOL表达试验。以TNF-α和／或霉酚酸（船A）处理HUVEC 20小时后，用虎红法研究对淋巴细胞与内皮细胞粘附作用。以TNF-α、rIFN-γ、LPS分别和MPA同时作用HUVEC 24小时。加不同浓度的MPA与LPS诱导HUVEC 24小时，用Cell-ELISA检测CIMOL的表达。结果：（1）MMF能抑制静息及TNF-α激活的内皮细胞与淋巴细胞间的粘附作用。（2）三种细胞因子均可明显诱导内皮细胞表达CD40L分子。（3）MMF不能抑制静息状态下内皮细胞CD40L的表达，但抑制TNF-α、rIFN-γ和LPS诱导CIMOL的表达作用，且MMF抑制LPS诱导的内皮细胞CD40L表达呈剂量依赖效应。结论：MMF通过抑制内皮细胞表达CIMOL而影响淋巴细胞与内皮细胞的相互作用，这可能是MMF抗排斥反应机制之一。     

CD40 agonist antibody mediated improvement of chronic Cryptosporidium infection in patients with X-linked hyper IgM syndrome

X-linked hyper-IgM syndrome (XHM) is a combined immune deficiency disorder caused by mutations in CD40 ligand. We tested CP-870,893, a human CD40 agonist monoclonal antibody, in the treatment of two XHM patients with biliary Cryptosporidiosis. CP-870,893 activated B cells and APCs in vitro, restoring class switch recombination in XHM B cells and inducing cytokine secretion by monocytes. CP-870,893 infusions were well tolerated and showed significant activity in vivo, decreasing leukocyte concentration in peripheral blood. Although specific antibody responses were lacking, frequent dosing in one subject primed T cells to secrete IFN-g and suppressed oocyst shedding in the stool. Nevertheless, relapse occurred after discontinuation of therapy. The CD40 receptor was rapidly internalized following binding with CP-870,893, potentially explaining the limited capacity of CP-870,893 to mediate immune reconstitution. This study demonstrates that CP-870,893 suppressed oocysts shedding in XHM patients with biliary cryptosporidiosis. The continued study of CD40 agonists in XHM is warranted.     

CD40/CD40L交联在CD4+T细胞诱导肿瘤细胞凋亡中的机制研究

目的探讨CD40/CD40L交联在CIK细胞中CD4 T细胞(CD4 CIK)诱导肿瘤细胞凋亡中的作用机制.方法体外扩增CIK细胞并纯化CD4 T细胞亚群,AnnexinV染色法观察CD4 CIK诱导肿瘤细胞凋亡的作用;半定量PCR、流式细胞法及ELISA法比较CD4 CIK激活前后CD40L的表达变化;将转染质粒pIRES2-EGFP-sCD40L的CHO细胞(CHO-sCD40L)与乳腺癌细胞T47D共孵育,监测24小时后其表面分子Fas的表达变化及对Fas介导凋亡的敏感性.结果CD4 CIK细胞可诱导肿瘤细胞凋亡,凋亡率随孵育时间和效靶比的升高而增加,且肿瘤细胞表面分子Fas水平升高,可从1.98%±0.23%升高到31.62%±7.07%;CD4 CIK细胞被激活后,CD40L表达水平均较激活前明显增加;成功转染的CHO-sCD40L细胞与T47D共培养后,T47D表面分子Fas可被诱导升高,加入CH-11 24小时后可观察到明显T47D细胞的凋亡.结论CD4 CIK可能通过CD40/CD40L交联提升肿瘤细胞表面功能性Fas表达来诱导其凋亡.     

CD40 ligand deficiency: treatment strategies and novel therapeutic perspectives

Introduction: CD40 ligand (CD40L) deficiency or X-linked Hyper-IgM syndrome is a severe primary immunodeficiency caused by mutations in the CD40L gene. Despite currently available treatments, CD40L-deficient patients remain susceptible to life-threatening infections and have poor long term survival.

Areas covered: Here, we discuss clinical and immunological characteristics of CD40L deficiency as well as current therapeutic strategies used for patient management. This review highlights that beyond B cell defects, patients’ susceptibility to opportunistic pathogens might be due to impaired T cell and innate immune responses. In this context, we discuss how better knowledge of CD40L function and regulation may result in the development of new treatments.

Expert opinion: Despite the introduction of hematopoietic stem-cell transplantation, immunoglobulin replacement, granulocyte colony-stimulating factor (G-CSF) administration, and prophylactic antibiotic therapies, life-threatening infections still cause high morbidity and mortality among CD40L-deficient patients. The reasons for this inadequate response to current therapies remains poorly understood, but recent reports suggest the involvement of CD40L–CD40 interaction in early stages of the innate immune system ontogeny. The development of novel gene therapeutic approaches and the use of redirected immunotherapies represent alternative treatment methods that could offer reduced morbidity and mortality rates for patients with CD40L deficiency.     

小儿川崎病CD4+T细胞CD40L和E-选择素的表达

目的：通过检测川崎病患儿静脉输注丙球治疗前后外周血T细胞表面CD40L（CD154）表达,探讨川崎病冠状动脉损伤的发病机制.方法：采用流式细胞仪检测26例川崎病患儿静脉输注丙球治疗前后、16例其他发热性疾病患儿、15例正常儿童外周血T细胞表面的CD40L表达.采用酶联免疫吸附试验检测相应血清中可溶性CD40L（sCD40L） 及E-选择素.结果：川崎病患儿CD4^＋T细胞表面CD40L表达及血清中E-选择素显著高于其他发热性疾病对照组及正常儿童对照组（P＜0.01）,川崎病患儿静脉输注丙球治疗后明显下降（P＜0.01）.CD4^＋T细胞表面CD40L表达及E-选择素与川崎病冠状动脉损伤有关,而CD8^＋T细胞表面CD40L的表达及可溶性CD40L与冠状动脉损伤无明显相关性.川崎病患儿CD4^＋T细胞表面CD40L表达与E-选择素水平正相关（r=0.626,P＜0.05）.结论：CD40L异常表达及血清中E-选择素在川崎病发病机制中起重要作用.静脉输注丙球能下调CD40L表达及血清中E-选择素,且有利于治疗血管炎.     

CD40L/CD40轴的生物学功能及其与疾病的关系研究进展

CD40L／CD40为体内免疫反应系统中一对重要的共刺激分子,参与机体的体液和细胞免疫反应。CD40L主要表达在CD4^＋T细胞、CD8^＋T细胞和B细胞,CD40主要表达于B细胞、活化的单核／巨噬细胞、树突状细胞（DC）、上皮细胞等。CD40L／CD40轴对B细胞的活化、增殖、细胞因子的分泌及免疫球蛋白的类别转换起到了非常重要的作用。CD40L／CIMO相互作用也对细胞毒性T细胞前体的活化,维持调节性T细胞的动态平衡及诱导辅助性T细胞的分化等方面起重要作用。CIMOL／CIMO轴还参与多种免疫相关疾病的致病过程,如自身免疫性疾病、肝炎等,且在抗肿瘤免疫中起到重要作用。多种动物模型的建立为探究疾病病因、研究CIMOL／CIMO轴在疾病发生过程中的作用提供了重要的平台。     

脱氢表雄酮对人脐静脉内皮细胞CD40/CD40L表达的影响

目的:探讨脱氢表雄酮(DHEA)对干扰素-γ(I NF-γ)刺激下的人脐静脉内皮细胞(HUVECs)CD40/CD40L表达的影响。方法:原代培养人脐静脉内皮细胞,给予I NF-γ刺激和不同浓度DHEA干预。采用流式细胞术检测CD40/CD40L在细胞表面的表达,通过反转录-聚合酶链反应(RT-PCR)检测CD40/CD40L mRNA的表达。结果:I NF-γ刺激HUVECs表达CD40/CD40L,DHEA下调I NF-γ诱导的HUVECs表面CD40/CD40L的表达,同时对I NF-γ刺激下的CD40/CD40L mRNA的表达有抑制作用,并且呈剂量依赖性。结论:DHEA能减轻I NF-γ刺激下的人脐静脉内皮细胞CD40/CD40L的表达。     

CD40-CD40L在强直性脊柱炎患者外周血淋巴细胞上的表达

目的探讨共刺激分子CD40CD40L在强直性脊柱炎(AS)患者的外周血淋巴细胞亚群上的异常表达与免疫功能紊乱的关系。方法用流式细胞仪采用直接免疫荧光法测定30例AS患者和20例健康对照人外周血淋巴细胞表面标志CD3、CD4、CD8、CD19的表达情况,CD40L在CD4 T和CD8 T细胞上的表达及CD40在CD19 B细胞上的表达。用速率散射比浊法测定血清中免疫球蛋白IgG,IgA和IgM的水平。结果①AS患者CD3 、CD3 CD4 、CD19 细胞较正常对照组显著增高(P<0.05),CD3 CD8 细胞较正常对照组显著降低(P<0.05);②AS患者CD4 T细胞和CD8 T细胞上的CD40L、CD19 B细胞上CD40的表达都较对照组显著增高(P<0.05);③AS患者血清中2种免疫球蛋白IgG、IgA的水平均较对照组显著增高(P<0.05)。结论CD40CD40L途径在AS免疫功能紊乱中起了重要作用。     

Mutation analysis in CD40 ligand deficiency leading to X-linked hypogammaglobulinemia with hyper IgM syndrome

Mutations in the gene encoding CD40 ligand have been shown to be the cause of X-linked hypogammaglobulinemia with hyper IgM (HIGM1). We have used the technique of single strand conformational polymorphism (SSCP) analysis to screen for mutations in this gene in affected boys from nineteen unrelated families. Sixteen novel mutations were identified in patients, comprising six patients with single base substitutions, two patients with single base insertions, six patients with deletions ranging from one to seven bases and two patients with large deletions at the 5′ end of the gene. These mutations were distributed throughout the gene. SSCP band shifts and/or alterations in restriction enzyme digestion sites could be used for unambiguous determination of carrier status in at-risk female relatives of most of the affected boys and, in some cases, prenatal diagnosis also can be offered. © 1996 Wiley-Liss, Inc.     

RSV毛细支气管炎患儿血液CD4~+CD25~+Foxp3~+Treg与CD40/CD40L关系的研究

探讨CD40/CD40L信号通路对不同病原体毛细支气管炎(以下简称:毛支炎)患儿血液CD4~+CD25~+Foxp3~+ Treg的增殖分化及其分泌抑制性细胞因子TGF-β1、IL-10的影响。取呼吸道合胞病毒(RSV)及非RSV感染毛支炎患儿血液并检测CD4~+CD25~+Foxp3~+Treg的百分率;并将血液中分离的单个核细胞(PBMC)接种于24孔板内,加入CD40L McAb进行阻断,作用72h后采用流式细胞仪检测培养板内CD4~+CD25~+Foxp3~+Treg的百分率,激光共聚焦检测CD4~+CD25~+Foxp3~+Treg细胞表面Foxp3的平均密度,酶联免疫吸附法检测培养上清中TGF-β1、IL-10的含量。RSV毛支炎患儿血液中CD4~+CD25~+Foxp3~+Treg百分率显著低于非RSV毛支炎患儿及正常对照组(P<0.05);RSV毛支炎患儿体外培养PBMC中CD4~+CD25~+Foxp3~+Treg百分率均显著低于非RSV毛支炎患儿、正常对照组和抗CD40L McAb组(P<0.05)。毛支炎患儿PBMC经过体外培养72h后,抗CD40L McAb组培养的细胞中CD4~+CD25~+Foxp3~+Treg表面Foxp3的平均密度显著高于RSV毛支炎患儿组(P<0.05)。PBMC培养上清中IL-10和TGF-β1的水平抗CD40L McAb组明显高于非RSV毛支炎组,非RSV毛支炎组明显高于RSV毛支炎组,差异有统计学意义(P<0.05)。RSV毛支炎患儿体内存在严重的CD4~+CD25~+Foxp3~+Treg数量不足;体外用抗CD40L McAb阻断CD40/CD40L通路可促进RSV毛支炎PBMC中CD4~+CD25~+Foxp3~+Treg的增殖。     

大鼠心脏移植排斥反应过程中外周血CD28、CD40通路相关分子的变化

目的探讨CD28、CD40共刺激通路与排斥反应的关系,同时也为排斥反应的诊断寻找一种新的检测指标。方法采用大鼠异位心脏移植模型,用免疫组化方法动态检测外周血单核细胞（PBMC）CD28、CTLA4、CD40及CD40L分子的表达。结果在0～4级排斥反应中,外周血细胞CD28分子阳性表达率在各组间的差异无统计学意义。外周血细胞表达CTLA4分子的阳性率随排斥反应增强而升高（P〈0.01）。CD40及CD40L在PBMC中的表达强度也随排斥反应的分级逐渐增强（P〈0.01）。结论外周血CTLA4、CD40及CD40L分子的表达与排斥反应有密切关系,动态检测这些分子有助于对排斥反应状态的评价。     

IL-12基因联合CD40L基因治疗小鼠黑色素瘤的实验研究

目的：观察腺病毒介导的小鼠白细胞介素12基因（AdmIL-12）和CD40配体基因（AdmCD40L）对小鼠黑色素瘤的抗肿瘤效果。方法：利用B16细胞皮下注射C57BL/6小鼠建立小鼠黑色素瘤模型，单独或联合应用分别携带小鼠IL-12基因和CD40L基因的重组腺病毒进行直接瘤内注射治疗，观察小鼠皮下肿瘤生长及成活情况。采用乳酸脱氢酶释放法检测荷瘤小鼠脾细胞CTL活性变化。结果：AdmIL-12和AdmCD40L在体内外均能有效表达；AdmIL-12能显著抑制荷瘤小鼠皮下肿瘤的生长并明显延长其生存时间，能显著增强荷瘤小鼠的脾细胞CTL杀伤活性。AdmCD40L的抗瘤效果不明显，但与Ad-mIL-12联合应用可明显提高抗肿瘤效果。结论：腺病毒介导的mIL-12基因对小鼠黑色素瘤有显著的治疗效果，且与CD40L基因联合应用能进一步提高抗肿瘤效果。     

Normal CD40-mediated activation of monocytes and dendritic cells from patients with hyper-IgM syndrome due to a CD40 pathway defect in B cells

Patients with X-linked hyper-IgM syndrome [CD40 ligand (CD40L) deficiency] are prone to infections by intracellular parasites. It has been suggested that this susceptibility is caused by defective macrophage activation through the CD40L-CD40 pathway. We studied the CD40-mediated activation of monocytes and dendritic cells from patients affected with a CD40L⁺ hyper-IgM syndrome characterized by a defect of B lymphocyte responses to CD40 agonists. We show that the CD40-induced production of IL-6, IL-8 and TNF-α by monocytes, and IL-12 by dendritic cells, and expression of the activation markers CD83, the co-stimulatory molecules CD86 and CD80, and HLA-DR antigens were all similar in patient and control cells. This observation is consistent with the clinical characteristics of the syndrome: a defect of immunoglobulin switch but no susceptibility to opportunistic infections, as observed in CD40L-deficient patients. These observations suggest that CD40-mediated activation pathways could be, at least in part, different in B and monocytic/dendritic cell lineages.