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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Immun.</journal-id>
<journal-title>Frontiers in Immunology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Immun.</abbrev-journal-title>
<issn pub-type="epub">1664-3224</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fimmu.2012.00408</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Immunology</subject>
<subj-group>
<subject>Mini Review Article</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>NKG2D and DNAM-1 activating receptors and their ligands in NK-T cell interactions: role in the NK cell-mediated negative regulation of T cell responses</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>Zingoni</surname> <given-names>Alessandra</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="author-notes" rid="fn001"><sup>&#x0002A;</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Ardolino</surname> <given-names>Michele</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="author-notes" rid="fn002"><sup>&#x02020;</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Santoni</surname> <given-names>Angela</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Cerboni</surname> <given-names>Cristina</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
</contrib-group>
<aff id="aff1"><sup>1</sup><institution>Department of Molecular Medicine, Istituto Pasteur-Fondazione Cenci Bolognetti, &#x0201C;Sapienza&#x0201D; University of Rome</institution> <country>Rome, Italy</country></aff>
<aff id="aff2"><sup>2</sup><institution>Neuromed</institution> <country>Pozzilli, Italy</country>
</aff>
<author-notes>
<fn fn-type="edited-by"><p>Edited by: <italic>Eric Vivier, Centre d&#x02019;Immunologie de Marseille-Luminy, France</italic></p></fn>
<fn fn-type="edited-by"><p>Reviewed by: <italic>Georges Leclercq, Ghent University, Belgium; Jacques Zimmer, Centre de Recherche Public de la Sant&#x000E9;, Luxembourg</italic></p></fn>
<fn fn-type="corresp" id="fn001"><p>&#x0002A;Correspondence: <italic>Alessandra Zingoni, Department of Molecular Medicine, Istituto Pasteur-Fondazione Cenci Bolognetti, &#x0201C;Sapienza&#x0201D; University of Rome, Viale Regina Elena 291, 00161 Rome, Italy. e-mail: <email>alessandra.zingoni@uniroma1.it</email></italic></p></fn>
<fn fn-type="other" id="fn002"><p><sup>&#x02020;</sup>Present address: Michele Ardolino, Department of Molecular and Cell Biology, University of California at Berkeley, Berkeley, CA 94720-3200, USA.</p></fn>
<fn fn-type="other" id="fn003"><p>This article was submitted to Frontiers in NK Cell Biology, a specialty of Frontiers in Immunology.</p></fn>
</author-notes>
<pub-date pub-type="epub">
<day>09</day>
<month>01</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="collection">
<year>2012</year>
</pub-date>
<volume>3</volume>
<elocation-id>408</elocation-id>
<history>
<date date-type="received">
<day>30</day>
<month>10</month>
<year>2012</year>
</date>
<date date-type="accepted">
<day>17</day>
<month>12</month>
<year>2012</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x000A9; Zingoni, Ardolino, Santoni and Cerboni.</copyright-statement>
<copyright-year>2013</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/3.0/"><p> This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in other forums, provided the original authors and source are credited and subject to any copyright notices concerning any third-party graphics etc.</p></license>
</permissions>
<abstract>
<p>The negative regulation of adaptive immunity is relevant to maintain lymphocyte homeostasis. Several studies on natural killer (NK) cells have shown a previously unappreciated immunomodulatory role, as they can negatively regulate T cell-mediated immune responses by direct killing and by secretion of inhibitory cytokines. The molecular mechanisms of T cell suppression by NK cells, however, remained elusive. Only in the last few years has it become evident that, upon activation, human T cells express MICA&#x02013;B, ULBP1&#x02013;3, and PVR, ligands of the activating receptors NKG2D and DNAM-1, respectively. Their expression renders T cells targets of NK cell lysis, representing a new mechanism taking part to the negative regulation of T cell responses. Studies on the expression of NKG2D and DNAM-1 ligands on T cells have also contributed in understanding that the activation of ATM (ataxia-telangiectasia, mutated)/ATR (ATM/Rad3-related) kinases and the DNA damage response is a common pathway regulating the expression of activating ligands in different types of cells and under different conditions. The functional consequences of NKG2D and DNAM-1 ligand expression on activated T cells are discussed in the context of physiologic and pathologic processes such as infections, autoimmunity, and graft versus host disease.</p>
</abstract>
<kwd-group>
<kwd>NKG2D ligands</kwd>
<kwd>DNAM-1 ligands</kwd>
<kwd>NK&#x02013;T cell cross-talk</kwd>
<kwd>DNA damage response</kwd>
<kwd>cell proliferation</kwd>
</kwd-group>
<counts>
<fig-count count="1"/>
<table-count count="1"/>
<equation-count count="0"/>
<ref-count count="89"/>
<page-count count="7"/>
<word-count count="0"/>
</counts>
</article-meta>
</front>
<body>
<sec>
<title/>
<p>Natural killer (NK) cells contribute to the suppression of T cell responses and to the maintenance of T lymphocyte homeostasis through the release of inhibitory cytokines, such as TGF-&#x003B2; and IL-10, which can inhibit dendritic cell (DC) maturation or T cell activation and functions, and/or through the direct elimination of antigen-presenting cells and activated T cells (<xref ref-type="bibr" rid="B2">Andoniu et al., 2008</xref>). The activating receptors expressed by NK cells and involved in the direct elimination of T cells remain still elusive although they have been recently focus of intense research. 2B4/CD244, LFA-1/D11a/CD18, NKp46/CD335, NKp30/CD337, KIR2DS1/CD158h, and in particular NKG2D/CD314 and DNAM-1/CD226 appear to play a prominent role.</p>
</sec>
<sec>
<title>EXPRESSION OF NKG2D AND DNAM-1 LIGANDS ON T CELLS</title>
<sec>
<title>NKG2D AND ITS LIGANDS</title>
<p>NKG2D is an activating receptor expressed on NK cells, CD8<sup>+</sup> T cells and &#x003B3;/&#x003B4; T cells that binds to several inducible self-proteins belonging to the MIC (MICA, MICB) and ULBP (ULBP1 to ULBP6) families in humans, and H60 (a&#x02013;c), Rae (&#x003B1;-&#x003B5;) and MULT1 in mice (<xref ref-type="bibr" rid="B12">Eagle and Trowsdale, 2007</xref>). NKG2D ligands (NKG2DLs) are mainly induced on the surface of transformed, infected or otherwise &#x0201C;stressed&#x0201D; cells, while the expression on healthy cells is low. However, increasing evidences show that NKG2DLs can be constitutively expressed or induced on normal hematopoietic cells including bone marrow cells (<xref ref-type="bibr" rid="B49">Nowbakht et al., 2005</xref>; <xref ref-type="bibr" rid="B56">Poggi et al., 2005</xref>; <xref ref-type="bibr" rid="B74">Spaggiari et al., 2006</xref>), mature DCs (<xref ref-type="bibr" rid="B25">Jinushi et al., 2003a</xref>,<xref ref-type="bibr" rid="B26">b</xref>; <xref ref-type="bibr" rid="B1">Andoniou et al., 2005</xref>; <xref ref-type="bibr" rid="B66">Schrama et al., 2006</xref>; <xref ref-type="bibr" rid="B20">Galazka et al., 2007</xref>; <xref ref-type="bibr" rid="B57">Qiao et al., 2008</xref>), monocytes and macrophages (<xref ref-type="bibr" rid="B23">Hamerman et al., 2004</xref>; <xref ref-type="bibr" rid="B49">Nowbakht et al., 2005</xref>; <xref ref-type="bibr" rid="B43">Nedvetzki et al., 2007</xref>; <xref ref-type="bibr" rid="B28">Kloss et al., 2008</xref>; <xref ref-type="bibr" rid="B67">Schulz et al., 2010</xref>), B cells (<xref ref-type="bibr" rid="B49">Nowbakht et al., 2005</xref>), and T cells. In general, NKG2DLs are not expressed by resting T lymphocytes, but their expression can be induced by different stimuli (<bold>Table <xref ref-type="table" rid="T1">1</xref></bold>). The first evidence of NKG2DL expression on T cells came from a study by <xref ref-type="bibr" rid="B41">Molinero et al. (2002)</xref> indicating that human T cells can express MICA in response to alloantigen and to CD3/CD28 cross-linking. Furthermore, also other NKG2DLs namely MICA, MICB, and ULBP1&#x02013;3, but not ULBP4, are detected on both CD4<sup>+</sup> and CD8<sup>+</sup> T lymphocytes following stimulation with alloantigens, SEB superantigen, a specific antigenic peptide or upon PMA/ionomycin treatment (<xref ref-type="bibr" rid="B7">Cerboni et al., 2007a</xref>,<xref ref-type="bibr" rid="B9">2009</xref>). As a consequence, activated T cells become susceptible to autologous NK cell lysis, with an NKG2D/NKG2DL-dependent mechanism (<xref ref-type="bibr" rid="B7">Cerboni et al., 2007a</xref>). <xref ref-type="bibr" rid="B44">Nielsen et al. (2012)</xref> further demonstrated that NKG2D, LFA-1, and NKp46 are involved in NK cell degranulation triggered by activated autologous CD4<sup>+</sup> T cells, with both subsets of human NK cells (CD56<sup>dim</sup> and CD56<sup>bright</sup>) equally cytotoxic. Expression of NKG2DLs was described also on regulatory T cells (Treg) in response to <italic>Mycobacterium tuberculosis</italic> and NK-cell mediated lysis of Treg involves both NKG2D and NKp46 (<xref ref-type="bibr" rid="B63">Roy et al., 2008</xref>). Expression of NKG2DLs was also reported on activated murine T cells. H60 is up-regulated on T cells upon <italic>in vitro</italic> stimulation with ovalbumin and T cell blasts become susceptible to syngeneic NK cell killing (<xref ref-type="bibr" rid="B58">Rabinovich et al., 2003</xref>). Of note, an <italic>in vivo</italic> study showed that chronic antigenic stimulation of CD4<sup>+</sup> T lymphocytes determined up-regulation of H60 and MULT1 ligands (<xref ref-type="bibr" rid="B48">Noval Rivas et al., 2010</xref>). NKG2DL expression was observed on thymocytes of BALB/c mice and was modulated during thymocyte development, suggesting a possible but yet undefined function in this process (<xref ref-type="bibr" rid="B33">Li et al., 2005</xref>). In support of these findings, a role for NK cell-mediated cytotoxicity during thymocyte development was demonstrated (<xref ref-type="bibr" rid="B65">Schott et al., 2003</xref>).</p>
<table-wrap position="float" id="T1">
<label>Table 1</label>
<caption><p>Different stimuli implicated in the induction or up-regulation of NKG2D and DNAM-1 ligands on activated T cells.</p></caption>
<table cellspacing="4" cellpadding="4" frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top" align="left"></th>
<th valign="top" align="left"><bold>Stimulus</bold></th>
<th valign="top" align="left"><bold>NKG2DLs</bold></th>
<th valign="top" align="left"><bold>DNAM1Ls</bold></th>
<th valign="top" align="left"><bold>T cell type</bold></th>
<th valign="top" align="left"><bold>Reference</bold></th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">Human</td>
<td valign="top" align="left">anti-CD3 plus anti-CD28</td>
<td valign="top" align="left">MICA/B, <break/>ULBP1&#x02013;3</td>
<td valign="top" align="left">PVR </td>
<td valign="top" align="left">T cells</td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B41">Molinero et al. (2002)</xref>,<break/> <xref ref-type="bibr" rid="B44">Nielsen et al. (2012)</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left">Superantigen, alloantigen, <break/>PMA/ionomycine, antigenic <break/>peptide</td>
<td valign="top" align="left">MICA/B, <break/>ULBP1&#x02013;3</td>
<td valign="top" align="left"></td>
<td valign="top" align="left">CD4<sup>+</sup> and <break/>CD8<sup>+</sup> T cells</td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B7">Cerboni et al. (2007a)</xref>,<break/> <xref ref-type="bibr" rid="B9">Cerboni et al. (2009)</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left">Anti-CD3 plus IL-2</td>
<td valign="top" align="left">MICA</td>
<td valign="top" align="left"></td>
<td valign="top" align="left">CD8<sup>+</sup> T cells</td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B37">Maasho et al. (2005)</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left">Superantigen</td>
<td valign="top" align="left"></td>
<td valign="top" align="left">PVR, Nectin-2</td>
<td valign="top" align="left">T cells</td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B4">Ardolino et al. (2011)</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left">PHA</td>
<td valign="top" align="left"></td>
<td valign="top" align="left">PVR</td>
<td valign="top" align="left">CD4<sup>+</sup> T cells</td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B6">Cella et al. (2010)</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left">Histone deacetylase inhibitors</td>
<td valign="top" align="left">MICA/B</td>
<td valign="top" align="left"></td>
<td valign="top" align="left">Jurkat and activated<break/> T cells</td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B72">Skov et al. (2005)</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left">Propionic acid</td>
<td valign="top" align="left">MICA/B</td>
<td valign="top" align="left"></td>
<td valign="top" align="left">Jurkat and activated <break/>CD4<sup>+</sup> T cells</td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B3">Andresen et al. (2009)</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>M. tuberculosis</italic></td>
<td valign="top" align="left">ULBP-1</td>
<td valign="top" align="left"></td>
<td valign="top" align="left">Treg</td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B63">Roy et al. (2008)</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left">HIV</td>
<td valign="top" align="left">MICA, <break/>ULBP-1, 2,3</td>
<td valign="top" align="left"></td>
<td valign="top" align="left">Jurkat and activated <break/>CD4<sup>+</sup> T cells</td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B8">Cerboni et al. (2007b)</xref>,<break/> <xref ref-type="bibr" rid="B84">Ward et al. (2007)</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left">HIV</td>
<td valign="top" align="left"></td>
<td valign="top" align="left">PVR</td>
<td valign="top" align="left">Activated CD4<sup>+</sup> T cells</td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B40">Matusali et al. (2012)</xref>
</td>
</tr>
<tr>
<td valign="top" align="left">Mouse</td>
<td valign="top" align="left">mHA antigen</td>
<td valign="top" align="left">H60, MULT1</td>
<td valign="top" align="left"></td>
<td valign="top" align="left">CD4<sup>+</sup> T cells</td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B48">Noval Rivas et al. (2010)</xref>
</td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left">ConA, PMA/ionomycine, ovalbumin</td>
<td valign="top" align="left">H60</td>
<td valign="top" align="left"></td>
<td valign="top" align="left">T cells</td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B58">Rabinovich et al. (2003)</xref></td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec>
<title>DNAM-1 AND ITS LIGANDS</title>
<p>DNAM-1/CD226 is an activating receptor belonging to the Ig superfamily and is constitutively expressed by most NK cells, T cells, macrophages, and DCs. DNAM-1 interacts with LFA-1, required for its functional activity on both NK and cytotoxic T cells (<xref ref-type="bibr" rid="B70">Shibuya et al., 1996</xref>). Ligands for DNAM-1 (DNAM1Ls) include Nectin-2/CD112 and PVR/CD155 belonging to the Nectin/Nectin-like family of adhesion molecules (<xref ref-type="bibr" rid="B5">Bottino et al., 2003</xref>; <xref ref-type="bibr" rid="B78">Tahara-Hanaoka et al., 2004</xref>). The activating effects of DNAM-1 can be counteracted by TIGIT, a recently identified inhibitory receptor binding to PVR, and expressed by T and NK cells (<xref ref-type="bibr" rid="B76">Stanietsky et al., 2009</xref>). DNAM1Ls are broadly distributed on hematopoietic, epithelial, and endothelial cells as well as on several tumors (<xref ref-type="bibr" rid="B5">Bottino et al., 2003</xref>; <xref ref-type="bibr" rid="B54">Pende et al., 2006</xref>; <xref ref-type="bibr" rid="B79">Tahara-Hanaoka et al., 2006</xref>). We have shown that PVR and Nectin-2 are induced on T cells in response to SEB stimulation at both the mRNA and protein levels, but only PVR can reach the cell surface (<xref ref-type="bibr" rid="B4">Ardolino et al., 2011</xref>). PVR expression on CD4<sup>+</sup> T lymphocytes was also observed upon phytohemagglutinin (PHA) stimulation or co-engagement of CD3/CD28 molecules (<xref ref-type="bibr" rid="B6">Cella et al., 2010</xref>; <xref ref-type="bibr" rid="B44">Nielsen et al., 2012</xref>; <bold>Table <xref ref-type="table" rid="T1">1</xref></bold>). DNAM-1/PVR axis is involved in the NK cell-mediated lysis of allogeneic activated T cells (<xref ref-type="bibr" rid="B4">Ardolino et al., 2011</xref>), while in an autologous setting, NKG2D emerges as the dominant receptor (<xref ref-type="bibr" rid="B58">Rabinovich et al., 2003</xref>; <xref ref-type="bibr" rid="B7">Cerboni et al., 2007a</xref>; <xref ref-type="bibr" rid="B44">Nielsen et al., 2012</xref>).</p>
</sec>
<sec>
<title>ROLE OF THE DDR IN THE REGULATION OF NKG2D AND DNAM-1 LIGANDS ON ACTIVATED T LYMPHOCYTES</title>
<p>NKG2DL expression is tightly regulated at various levels. During malignant transformation, cells undergo genotoxic or other forms of cellular stress with <italic>de novo</italic> expression of NKG2DLs. <xref ref-type="bibr" rid="B21">Gasser et al. (2005)</xref> demonstrated that murine and human NKG2DLs are up-regulated in fibroblasts by genotoxic stress and stalled DNA replication, conditions known to activate the DNA damage response (DDR) initiated by ATM (ataxia-telangiectasia, mutated) or ATR (ATM/Rad3-related) kinases. Studies aimed at investigating the signaling pathways leading to NKG2DL expression on antigen-activated T cells highlighted a role for the DDR as well. Treatment with ATM/ATR inhibitors blocked MICA induction on T cells with a mechanism involving NF-&#x003BA;B (<xref ref-type="bibr" rid="B7">Cerboni et al., 2007a</xref>), which regulates MICA expression on activated T lymphocytes by binding a specific sequence in the long intron 1 of the <italic>MICA</italic> gene (<xref ref-type="bibr" rid="B42">Molinero et al., 2004</xref>). NKG2DLs were found also on HIV-infected CD4<sup>+</sup> T cells and their expression requires the activation of the DDR and stress pathways, via the HIV-1-encoded molecule Vpr (<xref ref-type="bibr" rid="B85">Ward et al., 2009</xref>; <xref ref-type="bibr" rid="B60">Richard et al., 2010</xref>; <xref ref-type="bibr" rid="B55">Pham et al., 2011</xref>), a potent activator of ATR and of a cell cycle arrest in G<sub>2</sub> (<xref ref-type="bibr" rid="B24">He et al., 1995</xref>; <xref ref-type="bibr" rid="B27">Jowett et al., 1995</xref>; <xref ref-type="bibr" rid="B59">Re et al., 1995</xref>; <xref ref-type="bibr" rid="B61">Roshal et al., 2003</xref>). Similarly, oxidative stress and DDR strongly contribute to induce PVR expression on activated T cells (<xref ref-type="bibr" rid="B4">Ardolino et al., 2011</xref>). Thus, activation of ATM/ATR kinases and DDR could be a common pathway regulating the expression of different activating ligands on T lymphocytes. Of note, we also found that genotoxic stress triggered ATM/ATR-dependent up-regulation of both DNAM1Ls and NKG2DLs on multiple myeloma cells (<xref ref-type="bibr" rid="B75">Soriani et al., 2009</xref>).</p>
<p>Increasing evidences show the involvement of DDR in many physiological processes, such as mitosis (<xref ref-type="bibr" rid="B53">Oricchio et al., 2006</xref>), insulin response (<xref ref-type="bibr" rid="B88">Yang and Kastan, 2000</xref>), V(D)J recombination (<xref ref-type="bibr" rid="B10">Chen et al., 2000</xref>) or after lipopolysaccharide stimulation in macrophages (<xref ref-type="bibr" rid="B13">Eissmann et al., 2010</xref>). In addition, up-regulation of ATM protein levels was observed in PBMCs (peripheral blood mononuclear cells) in response to mitogenic stimuli (<xref ref-type="bibr" rid="B19">Fukao et al., 1999</xref>). Increased phosphorylation of either ATM or one of its substrates, the histone H2AX, was described on T cells upon CD3 triggering, PHA or SEB stimulation (<xref ref-type="bibr" rid="B7">Cerboni et al., 2007a</xref>; <xref ref-type="bibr" rid="B80">Tanaka et al., 2007</xref>; <xref ref-type="bibr" rid="B4">Ardolino et al., 2011</xref>). Remarkably, PVR and NKG2DLs expression was mainly observed on T cells that had gone through at least one mitosis (<xref ref-type="bibr" rid="B7">Cerboni et al., 2007a</xref>, <xref ref-type="bibr" rid="B9">2009</xref>; <xref ref-type="bibr" rid="B4">Ardolino et al., 2011</xref>). This is only one of the numerous examples showing a correlation of either NKG2DL or PVR expression with cell proliferation. In murine bone marrow grafts, Rae-1 was detected on donor proliferating hematopoietic cells in the spleen of the transplant recipients rather than on the long-term hematopoietic stem cells (<xref ref-type="bibr" rid="B50">Ogasawara et al., 2005</xref>). The presence of MIC molecules on rheumatoid arthritis synoviocytes was strongly associated with the expression of the nuclear Ki-67 proliferation marker (<xref ref-type="bibr" rid="B22">Groh et al., 2003</xref>) and <italic>MIC</italic> gene promoter contains elements for cell proliferation-associated transcriptional activation (<xref ref-type="bibr" rid="B82">Venkataraman et al., 2007</xref>). A preferential expression of PVR on proliferating rat hepatocytes during liver regeneration and acute injury was previously described (<xref ref-type="bibr" rid="B14">Erickson et al., 2006</xref>). These authors also reported that PVR expression in epithelial cells was tightly regulated by changes in cell density. NK cells react more efficiently to concanavalin A-stimulated, proliferating MHC class I-deficient target cells than to non-activated cells <italic>in vitro</italic> and <italic>in vivo</italic> (<xref ref-type="bibr" rid="B11">Correa et al., 1994</xref>) and proliferating T cells become more susceptible to NK cell killing (<xref ref-type="bibr" rid="B4">Ardolino et al., 2011</xref>). In line with these results, Davis&#x02019;s group reported that human NK cells bound to cells in mitosis more effectively than the same cells in other phases of the cell cycle (<xref ref-type="bibr" rid="B46">Nolte-&#x02019;t Hoen et al., 2007</xref>). Thus, we envisage that the expression of PVR and NKG2DLs on proliferating T lymphocytes is a possible mechanism used by NK cells to restrict the expansion of activated/proliferating T cells (<bold>figure <xref ref-type="fig" rid="F1">1</xref></bold>).</p>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption><p><bold>NKG2D and DNAM-1 ligands are expressed on activated/proliferating T cells</bold>. Resting T cells do not express ligands of the activating receptors NKG2D and DNAM-1 and are resistant to NK cell-mediated killing. However, upon T cell activation triggered by different stimuli (listed in <bold>Table <xref ref-type="table" rid="T1">1</xref></bold>), as well as upon HIV-1 infection, MICA/B, ULBP1&#x02013;3, and PVR become detectable on the cell surface, preferentially on T lymphocytes that were undergone at least one cell division. The signaling pathways regulating the expression of NKG2D and DNAM-1 ligands involve the activation of ATM/ATR and of their substrates (e.g., phosphorylation of the histone H2AX). The final outcome is the direct elimination of activated/proliferating T lymphocytes by NK cells.</p></caption>
<graphic xlink:href="fimmu-03-00408-g001.tif"/>
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<sec>
<title><italic>IN VIVO</italic> RELEVANCE FOR NK&#x02013;T CELL INTERACTION</title>
<sec>
<title>VIRAL INFECTIONS</title>
<p>A plethora of studies analyzed the role of NKG2D/NKG2DL axis by looking at infected cells, which very often express one or more ligands. These studies have demonstrated that NKG2D plays an important role in anti-viral immunity, via a direct NK cell-mediated lysis of infected cells. This evidence is also underscored by the countermeasures taken by viruses to avoid NKG2D-mediated triggering (<xref ref-type="bibr" rid="B30">Lanier, 2008</xref>; <xref ref-type="bibr" rid="B62">Rossini et al., 2012</xref>). However, NK cell contribution to anti-viral immunity can be seen also from another point of view: NK cells might restrain anti-viral T cell responses, thus promoting the return to T cell homeostasis.</p>
<p><italic>In vivo</italic> depletion studies established that NK cells act to negatively regulate CD4<sup>+</sup> and CD8<sup>+</sup> T cell-dependent IFN-&#x003B3; production and proliferation during murine cytomegalovirus infection, and they can mediate a similar effect on CD4<sup>+</sup> T cell responses during lymphocytic choriomeningitis virus (LCMV) infection in &#x003B2;2-microglobulin deficient mice (<xref ref-type="bibr" rid="B77">Su et al., 2001</xref>). Accordingly, a more recent study showed that perforin-deficient mice chronically infected with LCMV contain greater numbers of activated anti-viral T cells compared to control animals. The accumulation of activated CD8<sup>+</sup> T cells resulted in mortality within 2&#x02013;4 weeks, an event which is rarely seen following an i.p. injection with LCMV of normal mice (<xref ref-type="bibr" rid="B38">Matloubian et al., 1999</xref>). It was described also a three-way of NK&#x02013;T cell interaction, where NK cells directly eliminate activated CD4<sup>+</sup> T cells (via a perforin-dependent pathway), thereby affecting CD8<sup>+</sup> T cell function with beneficial or detrimental effects depending on the viral dose. However, no role for NKG2D/NKG2DLs could be observed (<xref ref-type="bibr" rid="B83">Waggoner et al., 2011</xref>). In another study, NK cell depletion promoted LCMV-induced CD8<sup>+</sup> T cell immunity with the involvement of both perforin and NKG2D (<xref ref-type="bibr" rid="B29">Lang et al., 2012</xref>). Altogether, these studies show that NK cells can be crucial in controlling viral infections not only by a direct elimination of infected cells, but also by altering the number and functions of virus-specific T cells. However, the role of NKG2D and other activating receptors awaits a better elucidation.</p>
<p>Considering HIV-1, a virus replicating (among other cell types) in CD4<sup>+</sup> T lymphocytes, we face a situation where NK cell targeting of activated T cells via NKG2D means, at the same time, eliminating the infected cell. In fact, expression of several NKG2DLs was observed on HIV-1 infected CD4<sup>+</sup> T cells, with increased susceptibility to NK lysis (<xref ref-type="bibr" rid="B8">Cerboni et al., 2007b</xref>; <xref ref-type="bibr" rid="B84">Ward et al., 2007</xref>; <xref ref-type="bibr" rid="B16">Fogli et al., 2008</xref>; <xref ref-type="bibr" rid="B60">Richard et al., 2010</xref>). However, HIV-1 has also evolved its own countermeasures as it can also down-regulate NKG2DLs via Nef and Vif proteins (<xref ref-type="bibr" rid="B8">Cerboni et al., 2007b</xref>; <xref ref-type="bibr" rid="B47">Norman et al., 2011</xref>). Thus, regulation of NKG2DL expression by Vpr, Nef and possibly other viral proteins might have different impacts on NK cell recognition of infected CD4<sup>+</sup> T cells.</p>
<p>The role of DNAM-1 and its ligands in the context of NK&#x02013;T cell interactions during viral infections has been less investigated. Recently, PVR was detected on HIV-1 infected CD4<sup>+</sup> T cells, and when the NKG2D pathway was inhibited, additional blocking of DNAM-1 strongly impaired the capacity of NK cells to kill HIV-1-infected cells, indicating the involvement of both receptors (<xref ref-type="bibr" rid="B40">Matusali et al., 2012</xref>). However, expression of PVR on CD4<sup>+</sup> T cells might also be responsible for the down-regulation of DNAM-1 on CD8<sup>+</sup> T cells observed in chronic HIV-1 infection (<xref ref-type="bibr" rid="B6">Cella et al., 2010</xref>).</p>
</sec>
<sec>
<title>AUTOIMMUNITY</title>
<p>The mechanisms by which NK cells modulate adaptive immune responses in the course of autoimmune diseases have been addressed by a large number of <italic>in vivo</italic> and <italic>in vitro</italic> studies. However, depending on the model system, NK cells might either promote or inhibit the generation and proliferation of autoreactive T cells (<xref ref-type="bibr" rid="B18">French and Yokoyama, 2004</xref>; <xref ref-type="bibr" rid="B69">Shi and Van Kaer, 2006</xref>; <xref ref-type="bibr" rid="B15">Flodstr&#x000F6;m-Tullberg et al., 2009</xref>; <xref ref-type="bibr" rid="B36">L&#x000FC;nemann et al., 2009</xref>).</p>
<p>Thinking in terms of negative regulation of (autoreactive) T cell responses, NK cells might exert a direct effect on activated, autoantigen-specific T cells. In experimental autoimmune encephalomyelitis (EAE), <italic>in vivo</italic> depletion of NK cells exacerbated demyelination and the clinical features of EAE; in addition, <italic>in vitro</italic> studies have shown that direct NK&#x02013;T cell contact inhibited T cell proliferation and cytokine production triggered by myelin-derived peptides (<xref ref-type="bibr" rid="B89">Zhang et al., 1997</xref>; <xref ref-type="bibr" rid="B39">Matsumoto et al., 1998</xref>; <xref ref-type="bibr" rid="B73">Smeltz et al., 1999</xref>; <xref ref-type="bibr" rid="B86">Xu et al., 2005</xref>). NK cells might thus ameliorate the course of EAE by limiting the expansion of myelin-reactive T cells in the periphery and in the absence of their suppressive action, central nervous system inflammation became more marked. However, these studies are in conflict with another report showing that NK cell depletion resulted in less severe clinical scores (<xref ref-type="bibr" rid="B68">Shi et al., 2000</xref>). In an <italic>in vivo</italic> model of colitis, NK cell-depleted animals developed accelerated disease, and it was suggested that NK cells inhibited effector CD4<sup>+</sup> T cells in a perforin-dependent manner (<xref ref-type="bibr" rid="B17">Fort et al., 1998</xref>; <xref ref-type="bibr" rid="B87">Yamaji et al., 2012</xref>). Such a protective effect also occurred in <italic>Staphylococcus aureus</italic>- and collagen-induced arthritis (CIA; <xref ref-type="bibr" rid="B45">Nilsson et al., 1999</xref>; <xref ref-type="bibr" rid="B31">Leavenworth et al., 2011</xref>), as well as in NOD mice (<xref ref-type="bibr" rid="B32">Lee et al., 2004</xref>).</p>
<p>A number of studies have identified the cytolytic mechanism underlying NK cell-mediated killing of autoreactive T cells, and the NK cell-mediated immunoregulatory activity was shown to be perforin-dependent in animal models of colitis, EAE, and CIA (<xref ref-type="bibr" rid="B17">Fort et al., 1998</xref>; <xref ref-type="bibr" rid="B34">Lu et al., 2007</xref>; <xref ref-type="bibr" rid="B31">Leavenworth et al., 2011</xref>). Thus, the receptor/ligand interactions triggering a perforin-mediated cytotoxicity play a key role in controlling T cell responses, and NKG2D might be part of the picture, since it plays a major role in NK cell lysis of autologous activated T cells (<xref ref-type="bibr" rid="B58">Rabinovich et al., 2003</xref>; <xref ref-type="bibr" rid="B7">Cerboni et al., 2007a</xref>; <xref ref-type="bibr" rid="B44">Nielsen et al., 2012</xref>). Moreover, NK cells can lyse autologous DCs, that under certain circumstances &#x02013; including EAE &#x02013; express NKG2DLs (<xref ref-type="bibr" rid="B25">Jinushi et al., 2003a</xref>,<xref ref-type="bibr" rid="B26">b</xref>; <xref ref-type="bibr" rid="B1">Andoniou et al., 2005</xref>; <xref ref-type="bibr" rid="B66">Schrama et al., 2006</xref>; <xref ref-type="bibr" rid="B20">Galazka et al., 2007</xref>; <xref ref-type="bibr" rid="B57">Qiao et al., 2008</xref>). These data, together with NKG2DL expression also on activated macrophages and monocytes, bone marrow cells and microglia (<xref ref-type="bibr" rid="B35">L&#x000FC;nemann et al., 2008</xref>), indicate that this receptor/ligand pair might play a more general immunoregulatory role besides killing autoreactive T cells, e.g., by eliminating macrophages and other antigen-presenting cells or their precursors under inflammatory conditions, as a feedback mechanism to silence uncontrolled antigen-specific immune responses.</p>
<p>The role of NKG2D/NKG2DLs in autoimmunity has been addressed also from another point of view. In fact, endogenous cells and/or tissues can aberrantly express NKG2DLs (as shown in particular for MICA and MICB in humans and Rae-1 in mice), promoting activation of autoreactive infiltrating NKG2D<sup>+</sup> T cells, leading to tissue destruction. Examples of this condition can be found in human type I diabetes and in NOD mice, in patients with rheumatoid arthritis, Crohn&#x02019;s disease, celiac disease, and in a mouse model of autoimmune vitiligo. These aspects are however reviewed elsewhere (<xref ref-type="bibr" rid="B69">Shi and Van Kaer, 2006</xref>; <xref ref-type="bibr" rid="B81">Van Belle and von Herrath, 2009</xref>).</p>
<p>Regarding DNAM-1, despite the expression of PVR on activated T cells (<xref ref-type="bibr" rid="B6">Cella et al., 2010</xref>; <xref ref-type="bibr" rid="B4">Ardolino et al., 2011</xref>; <xref ref-type="bibr" rid="B44">Nielsen et al., 2012</xref>), its role was not evident in autologous NK&#x02013;T combinations (<xref ref-type="bibr" rid="B4">Ardolino et al., 2011</xref>; <xref ref-type="bibr" rid="B44">Nielsen et al., 2012</xref>), while it was relevant in allogeneic settings (<xref ref-type="bibr" rid="B4">Ardolino et al., 2011</xref>), suggesting that DNAM-1 might not be involved in autoimmune reactions.</p>
</sec>
<sec>
<title>GRAFT VERSUS HOST DISEASE</title>
<p>Allogeneic bone marrow transplantation (BMT) was estimated to be an effective treatment for hematologic malignancies and some solid tumors. However, the high incidence of graft versus host disease (GVHD) mediated by the activation and proliferation of alloreactive T cells leads to severe host tissue damage. Previous studies demonstrated that donor NK cells are able to suppress the development of GVHD through the killing of host antigen-presenting cells which are essential for donor T cell activation (<xref ref-type="bibr" rid="B64">Ruggeri et al., 2002</xref>). More recently, several <italic>in vivo</italic> studies in the mouse showed a direct effect of donor NK cells on GVHD-inducing T cells. Allogeneic T cells and NK cells trafficked similarly after BMT (<xref ref-type="bibr" rid="B51">Olson et al., 2009</xref>) and donor NK cells limited the expansion of syngeneic donor T cells through different mechanisms mediated by perforin and Fas-FasL interaction (<xref ref-type="bibr" rid="B52">Olson et al., 2010</xref>). Similarly, in a model of chronic GVHD, donor NK cells could restrain the expansion of antigen-specific CD4<sup>+</sup> T cells responsible for GVHD. Interestingly, T cells under chronic antigenic stimulation up-regulated NKG2DLs and the immunoregulatory activity of NK cells was inhibited by injection of antibodies directed to NKG2D (<xref ref-type="bibr" rid="B48">Noval Rivas et al., 2010</xref>). In humans, a fraction of KIR2DS1<sup>+</sup> NK cells can mediate strong alloreactivity against both mDCs and activated T lymphocytes and DNAM-1 and NKp30 were shown to be involved in this process, supporting an important role of NK cells in the prevention of GVHD (<xref ref-type="bibr" rid="B71">Sivori et al., 2011</xref>).</p>
</sec>
</sec>
<sec>
<title>CONCLUSION</title>
<p>In summary, a central role for NK cell killing in mediating immunoregulatory effects is emerging. Studies of different conditions (infections, autoimmunity, transplants) indicate that NK cytotoxicity of activated T cells, as well as of other cells of the immune system, is important in immune regulation. The involvement of NKG2D and DNAM-1 receptors may represent the &#x0201C;tip of the iceberg,&#x0201D; with significant effects on the negative regulation of adaptive T cell responses, resulting in increased viral burdens, viral persistence, and/or inflammation. The locations where these events take place, and which are the NK cell subsets involved are still rather obscure parts of the picture.</p>
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<sec>
<title>Conflict of Interest Statement</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
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<ack>
<p>The authors are supported by grants of the Italian Ministry of Health (Giovani Ricercatori n. 000307 to Alessandra Zingoni), the Italian Association for Cancer Research (AIRC), AIRC 5x1000, and the &#x0201C;Sapienza&#x0201D; University of Rome. Michele Ardolino is a recipient of a fellowship from Istituto Pasteur-Fondazione Cenci-Bolognetti.</p>
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