This may be obvious to you folk but not for me as I've not studied the implications of CTLA4 blockade..this popped out at me when I was reviewing Peter's link..
Loss of CTLA-4 leads to massive lymphoproliferation and fatal multiorgan tissue destruction, revealing a critical negative regulatory role of CTLA-4
Elizabeth A. Tivola, Frank Borrielloa, A. Nicola Schweitzera, William P. Lyncha, Jeffrey A. Bluestoneb and Arlene H. Sharpea
a Immunology Research Division Department of Pathology Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
b Committee on Immunology The University of Chicago, Chicago, Illinois 60637, USA
Received 10 October 1995; Revised 20 October 1995. Available online 21 April 2004.
Abstract
The B7-CD28/CTLA-4 costimulatory pathway can provide a signal pivotal for T cell activation. Signaling through this pathway is complex due to the presence of two 137 family members, B7-1 and B7-2, and two counterreceptors, CD28 and CTLA-4. Studies with anti-CTLA-4 monoclonal antibodies have suggested both positive and negative roles for CTLA-4 in T cell activation. To elucidate the in vivo function of CTLA-4, we generated CTLA-4-deficient mice. These mice rapidly develop lymphoproliferative disease with multiorgan lymphocytic infiltration and tissue destruction, with particularly severe myocarditis and pancreatitis, and die by 3–4 weeks of age. The phenotype of the CTLA-4-deficient mouse strain is supported by studies that have suggested a negative role for CTLA-4 in T cell activation. The severe phenotype of mice lacking CTLA-4 implies a critical role for CTLA-4 in down-regulating T cell activation and maintaining immunologic hemeostasis. In the absence of CTLA-4, peripheral T cells are activated, can spontaneously proliferate, and may mediate lethal tissue injury.
This may sound bizarre to those not in the ICU field, but, I wish I were there taking care of them..
Elisabeth
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