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The Journal of Immunology, 1998, 160: 5654-5660.
Copyright © 1998 by The American Association of Immunologists

Soluble IL-15 Receptor {alpha}-Chain Administration Prevents Murine Collagen-Induced Arthritis: A Role for IL-15 in Development of Antigen-Induced Immunopathology1

Holger Ruchatz2, Bernard P. Leung2, Xiao-qing Wei, Iain B. McInnes and Foo Y. Liew3

* Department of Immunology and Centre for Rheumatic Diseases, University of Glasgow, United Kingdom


    Abstract
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
IL-15 has recently been detected in the synovium of patients with rheumatoid arthritis. IL-15-activated T cells induce significant TNF-{alpha} synthesis by macrophages via a cell contact-dependent mechanism, suggesting a key regulatory role for IL-15. Here, we report that the administration of a soluble fragment of IL-15R{alpha} into DBA/1 mice, profoundly suppressed the development of collagen-induced arthritis. This was accompanied in vitro by marked reductions in Ag-specific proliferation and IFN-{gamma} synthesis by spleen cells from treated mice compared with control mice and in vivo by a significant reduction in serum anti-collagen Ab levels. These data directly demonstrate a pivotal role for IL-15 in the development of inflammatory arthritis and also suggest that antagonists to IL-15 may have therapeutic potential in rheumatic diseases.


    Introduction
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Rheumatoid arthritis (RA)4 is characterized by chronic inflammatory infiltration of the synovial membrane, which is associated with the destruction of cartilage and underlying bone. Considerable evidence supports a crucial role for proinflammatory cytokines in disease pathogenesis, particularly TNF-{alpha} (1). We recently demonstrated that the novel cytokine, IL-15, is present in the RA synovium, in which it may recruit and activate synovial T cells in the relative absence of IL-2 (2, 3). Following IL-15-mediated activation, synovial T cells both secrete TNF-{alpha} directly and induce TNF-{alpha} synthesis by macrophages through cognate interactions (4, 5), indicating an important role for IL-15 in the inflammatory cascade within the synovium. Furthermore, IL-15 expression has recently been detected in several diseases, including inflammatory bowel disease, sarcoidosis, and chronic active hepatitis (6, 7, 8), suggesting that such proinflammatory pathways may be of general importance.

IL-15 is derived from several cell types, including macrophages and fibroblasts (9, 10). It uses the IL-2Rß and common {gamma}-chain subunits in combination with a unique {alpha}-chain, IL-15R{alpha} (11), through which it induces T cell chemotaxis and activation together with B cell maturation and isotype switching (12, 13). It enhances NK cell cytotoxicity and cytokine production, activates neutrophils, and modifies monokine secretion (14, 15, 16). Thus IL-15 potentially mediates diverse effects at multiple stages of the immune response. Thus far, however, the functional effects of the IL-15 blockade in vivo in inflammatory models have not been explored.

Therefore, we have generated a soluble fragment of the murine IL (mIL)-15R {alpha}-chain to investigate the effect of IL-15 neutralization on the development of inflammation in vivo. IL-15R{alpha} administration inhibited the onset of collagen-induced arthritis (CIA) in susceptible DBA/1 mice. Parallel ex vivo studies demonstrated the suppression of Ag-specific T cell proliferation and cytokine production as well as Ig synthesis. Together, these observations provide the first data implicating IL-15 in the evolution of specific immune responses and the concomitant development of immunopathology.


    Materials and Methods
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Cloning, expression, purification, and biologic activity of soluble fragment of IL-15R{alpha} (sIL-15R{alpha})

Total RNA was extracted from J774 cells that had been stimulated for 18 h with murine rIFN-{gamma} (100 U/ml, a kind gift of Dr. G. Adolf, Bender Wien, Austria) using the TRIzol Reagent (Life Technologies, Paisley, U.K.). The RNA was then transcribed into cDNA using SuperScript II reverse transcriptase (Life Technologies) according to a standard protocol. sIL-15R{alpha} was cloned using nested PCR, and two restriction sites (BamHI and SalI) were introduced during the second amplification. The following primer sets were designed from the published cDNA sequence of mIL-15R{alpha} (7): Set I, 5'TTG CTG CTG CTG CTG TTG CTA CTG TTG CTC CC-3'; 5'-GCA CCA ACC AAG AGG ACC GAT GTA GAG ATG GC-3'. Set II, 5'-GGT GGG ATC CGG CAC CAC GTG TCC ACC TCC CG-3'; 5'-AGA TGT CGA CTT TCG TCA TTT AAC TGT GG3' (sequences in italics are the BamHI and SalI site, respectively). The PCR product was confirmed by sequencing, cloned into the pQE-30 expression vector (Qiagen, Dorking, U.K.), and then expressed in the Escherichia coli M15 strain (Qiagen). Following induction with isopropyl-ß-D-thiogalactoside (Life Technologies), sIL-15R{alpha} was extracted from the bacteria under denaturing conditions and purified as 6x histidine-tagged fusion protein using a nickel agarose purification system (Qiagen) according to the manufacturer’s recommendations. The purity was analyzed by SDS-PAGE following Coomassie blue staining. The final product consisted of 193 amino acid residues, 173 of which contained the "Sushi" domain (a protein-binding motif also referred to as a "short consensus repeat" or GP-I motif, 17 , linker, and Pro/Thr-rich region of the native IL-15R{alpha}. The final product was ~26 kDa in SDS-PAGE. For Western blot analysis, affinity-purified material was electrophoresed in 15% SDS-PAGE and transferred onto Trans-Blot medium (Bio-Rad, Hempstead, U.K.) at 250 mA overnight. Simian rIL-15 (a gift of Immunex, Seattle, WA) was added after blocking with 1% BSA, and binding was detected with mouse anti-human L-15 mAb (MAB 647, R&D Systems, Oxon, U.K.) and developed by enhanced chemiluminescence (Amersham International, Little Chalfont, U.K.). The biologic activity of the sIL-15R{alpha} was determined by ELISA and by inhibition of IL-15-induced T cell proliferation. For the ELISA, 96-well plates (Immulon 4, Dynatech Laboratories, Chantilly, VA) were coated with 1 µg/ml of sIL-15R{alpha} in 0.1 M NaH2CO3 overnight at 4°C. After blocking with 10% FCS (Life Technologies), graded concentrations of simian rIL-15 or 500 pg/ml mIL-2 (Genzyme, Cambridge, MA) were added. After washing with PBS/Tween-20, biotin-conjugated anti-mIL-2 or anti-simian IL-15 (200 ng/ml) was added, respectively, followed by avidin peroxidase, conjugated (1/1000 dilution, Sigma, Poole, U.K.), and developed with 100 µl/well of tetramethylbenzidine substrate (Kirkegaard and Perry, Gaithersburg, MD). To block IL-15 bioactivity, CTLL (American Type Culture Collection (ATCC), Rockville, MD) and D10.G4.1 (ATCC) cell lines were cultured in 96-well plates (Nunc, Roskilde, Denmark) with 0.1 ng/ml (CTLL) or 1 ng/ml (D10) of rIL-15, which were concentrations that had been previously titrated for optimal proliferation. sIL-15R{alpha} (200 ng/ml) was added to triplicate cultures which were then incubated at 37°C in 5% C02 for up to 72 h. [3H]thymidine uptake over the final 6 h of culture was measured in a beta-plate counter (Wallac Oy, Turku, Finland).

Induction and treatment of CIA in mice

Male DBA/1 mice (6–8-wk-old, Harlan Olac, Bicester, U.K.) received 200 µg of bovine type II collagen (Sigma) in Freund’s complete adjuvant (Difco, Detroit, MI) by intradermal injection (day 0). Collagen (200 µg in PBS) was given again on day 21 by i.p. injection. Daily injections of sIL-15R{alpha} (10 or 40 µg/mouse/day) or human serum albumin (HSA) (40 µg) were administered i.p. for 2 wk starting on day 22. Mice were monitored daily for signs of arthritis, for which severity scores were derived as follows: 0 = normal, 1 = erythema, 2 = erythema plus swelling, 3 = extension/loss function, and total score = sum of four limbs. Paw thickness was measured with a dial-caliper (Kroeplin, Munich, Germany). For histologic assessment, the hind limbs from five sIL-15R{alpha} recipients and five control mice were fixed in 10% neutral-buffered formalin, and 5-µm sections were stained with hematoxylin and eosin (Sigma). The quantification of arthritis was performed by two treatment-blinded observers as previously described (18).

Spleen cell culture

Spleen cells were cultured at 2 x 106 cells/ml for up to 96 h in RPMI 1640 (Life Technologies) supplemented with 2 mM L-glutamine, 100 international units/ml penicillin, 100 µg/ml streptomycin, 25 mM HEPES buffer, and 10% FCS (all from Life Technologies) at 37°C in 5% CO2. Cells were stimulated either with graded concentrations of type II collagen or with Con A (1 µg/ml, Sigma). Proliferation assays were performed in triplicate in U-bottom 96-well plates (Nunc) as previously described. Supernatants from parallel triplicate cultures were stored at -70°C until estimation of cytokine content by ELISA.

Cytokine assays

Murine TNF-{alpha}, IFN-{gamma}, IL-4, IL-6, and IL-10 were assayed by ELISA using paired Abs (PharMingen, San Diego, CA) according to the manufacturer’s instructions. Lower limits of detection were as follows: IL-4, IL-6, and TNF-{alpha} were all at 10 pg/ml; IL-10 was at 80 pg/ml; and IFN-{gamma} was at 150 pg/ml.

Anti-collagen Ab ELISA

Serum anti-collagen II Ab titers in pooled sera (n = 5) that were obtained at the end of sIL-15R{alpha} treatment were measured by ELISA. Briefly, 96-well plates (Immulon 4, Dynatech Laboratories) were coated with 4 µg/ml bovine type II collagen in 0.1 M NaH2CO3 overnight at 4°C, blocked, and serial dilutions of sera were added. Bound, total IgG was detected with horseradish peroxidase-conjugated goat anti-mouse IgG (Genzyme) or biotin-conjugated anti-mouse IgG1 or IgG2a (PharMingen), respectively, and developed as described above. Plates were read at 630 nm.

Statistical analysis

Statistical analysis was performed using Minitab software for Macintosh. The analyses were performed using the log-rank test, {chi}2 test, Mann-Whitney U test, or Student’s t test as indicated.


    Results
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Generation of sIL-15R{alpha}

To obtain a specific IL-15 antagonist for in vivo application, a sequence corresponding to the extracellular domain of mIL-15R{alpha} (Fig. 1GoA) was cloned by nested PCR from the mRNA that were prepared from an IFN-{gamma}-activated murine macrophage cell line (J774). The cDNA was inserted into an expression vector (pQE-30) and expressed in E. coli (M15). The soluble protein was extracted and purified to homogeneity as a 6x histidine-tagged fusion protein using a nickel-tagged agarose purification system (Fig. 1GoC). Western blot analysis against anti-IL-15 Ab following binding with simian rIL-15 showed a single band at a molecular mass of 26 kDa (Fig. 1GoD). The purified protein bound rIL-15 and neutralized its biologic activity in a dose-dependent manner (Fig. 1Go, E and F) but did not cross-react with IL-2 in parallel assays (data not shown).



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FIGURE 1. Cloning, expression, and characterization of sIL-15R{alpha}. A schematic representation of sIL-15R{alpha} (A) and native, full-length IL-15R{alpha} (B) is shown. The purified sIL-15R{alpha} was analyzed on SDS-PAGE that had been stained for total protein with Coomassie blue (C) or by Western blotting (D). The Western blot was probed with simian rIL-15 and developed with anti-IL-15 mAb. The purified sIL-15R{alpha} was also assayed for its ability to bind rIL-15 using ELISA (E). The plate coated with sIL-15R{alpha} bound rIL-15 in a dose-dependent manner but did not bind rIL-2 (data not shown). sIL-15R{alpha} also inhibited the ability of rIL-15 to stimulate T cells (CTLL and D10) (F). The inhibition was reversible by the addition of excess rIL-15 (data not shown).

 
sIL-15R{alpha} administration prevents development of CIA

We subsequently examined whether the administration of sIL-15R{alpha} could modify CIA in susceptible DBA/1 mice, the immunopathogenesis of which closely resembles RA (19, 20). Mice injected intradermally with type II collagen in Freund’s complete adjuvant developed severe arthritis when challenged i.p. 21 days later with collagen. The incidence and severity of disease development were markedly suppressed in mice that received daily i.p. injections of 10 or 40 µg of sIL-15R{alpha} beginning on the day after collagen challenge (day 22; Fig. 2Go) in comparison with controls which received HSA. Histologic examination of the hind limb joints from HSA-treated mice revealed massive mononuclear and polymorphonuclear infiltration of the synovial membrane with synovial hyperplasia and adjacent bone erosion. sIL-15R{alpha} markedly suppressed each of these parameters (Fig. 3Go).



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FIGURE 2. srIL-15R{alpha} inhibited the development of CIA. Collagen-primed DBA/1 mice were randomly divided into groups of 10, challenged on day 21, and given 14 daily i.p. injections of 40 µg of sIL-15R{alpha} ({circ}) or 40 µg of HSA (•) starting on day 22. Mice were monitored daily for disease progression, which was quantified as mean clinical score (A), mean number of arthritic paws (B), or mean paw thickness (C). Values are mean ± SEM. At the end of treatment (day 36), 20% of mice developed mild CIA in the sIL-15R{alpha}-treated group compared with 90% which developed severe CIA in the HSA control group (p < 0.05). Additional groups of mice that received 10 µg/day of sIL-15R{alpha} had scores that were similar to those seen for mice treated with 40 µg/day of sIL-15R{alpha}; for clarity, only data for the 40-µg group are shown. The experiment was repeated with similar results. The total number of sIL-15R{alpha}-treated mice was 29, while the total number of HSA control mice was 19.

 


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FIGURE 3. sIL-15R{alpha} significantly reduced articular inflammation and destruction. Immediately following 14 days of sIL-15R{alpha} administration, hind limbs (five mice/group) were removed, formalin-fixed, and decalcified, and hematoxylin and eosin sections were prepared (day 36). A, Histologic appearances in the knee, carpus, and interphalangeal joints in parallel sections (HSA, n = 17; sIL-15R{alpha}, n = 13) were scored independently (0–3) by two treatment-blinded histologists (data are mean ± SD). Extensive erosion (p < 0.002), inflammatory infiltration (p < 0.001), and synovial hyperplasia (p < 0.001) were observed in HSA-treated animals (B) (x40 magnification), but were usually absent in sIL-15R{alpha} recipients (C) (x40 magnification).

 
Immunologic consequences of sIL-15R{alpha} administration

To further explore the effect of sIL-15R{alpha} on immunologic responses, the spleen cells from mice that had been treated with 40 µg of sIL-15R{alpha} or control HSA were harvested after 2 wk of treatment (day 36) and cultured with type II collagen in vitro. Cells from arthritic mice that received control protein proliferated vigorously in response to collagen in a dose-dependent manner. This proliferative response was significantly reduced in cultures of cells from mice treated with sIL-15R{alpha} (Fig. 4GoA, p < 0.001). Cells from the sIL-15R{alpha}-treated mice produced less IFN-{gamma} (Fig. 4GoB) than cells from control HSA-treated mice, which indicates a suppression of Th1 responses. Moreover, IL-4 was undetectable, and IL-10 was only found at low levels (100–120 pg/ml) that were indistinguishable between the groups (data not shown), suggesting that the mechanism of disease suppression by sIL-15R{alpha} was not by the preferential enhancement of Th2 cells. IL-6 production was significantly suppressed in sIL-15R{alpha}-treated animals compared with HSA controls (Fig. 4GoC). TNF-{alpha} synthesis was not detected, which was consistent with previous observations that the collagen-stimulated expression of TNF-{alpha} in vitro occurs primarily during the early acute phase of CIA (21). However, the T cell mitogen, Con A, stimulated equally high levels of both proliferation and IFN-{gamma}, IL-4, IL-10, and IL-6 production by spleen cells from both groups of mice (data not shown), indicating that suppression of the immune response was Ag-specific. Commensurate with the above observations, sera from sIL-15R{alpha}-treated mice contained significantly less IFN-{gamma} than those from control mice (982.8 ± 155.4 vs 1960.8 ± 51.9 pg/ml, p < 0.02). Humoral responses were clearly modified, since serum anti-collagen Ab concentrations were significantly reduced in sIL-15R{alpha} recipients (Fig. 5Go), particularly for the IgG2a isotype and consistent with the preferential suppression of the Th1-type immune response that predominates in CIA.



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FIGURE 4. Assessment of in vitro responses against collagen from mice treated with sIL-15R{alpha}. Spleen cells (pooled from five mice per group) were collected from sIL-15R{alpha}-treated or HSA-treated mice at the end of the 2-wk treatment phase (day 36) and cultured with graded concentrations of collagen for 96 h. T cell proliferation (A), which was determined by [3H]thymidine uptake, is expressed as mean stimulation index ± SEM of triplicate cultures (medium control ranged from 3500 to 5000 cpm). Supernatants from parallel cultures were collected after 72 h, and IFN-{gamma} (B) and IL-6 (C) concentrations were determined by ELISA and expressed as mean ± SEM. *p < 0.05.

 


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FIGURE 5. Attenuation of serum anti-collagen Ab response in sIL-15R{alpha}-treated mice. Anti-collagen Ab titers, total IgG (A), IgG1 (B), and IgG2a (C) were measured at the end of treatment (day 36) by ELISA. Data are from pooled serum (five mice per group) and are expressed as mean absorbance (OD 630 nm) from doubling dilutions ± SEM.

 
Discontinuation of sIL-15R{alpha} administration facilitates disease expression

To determine the duration of disease suppression, sIL-15R{alpha} administration was withdrawn after 14 days. CIA was detected clinically at 5 to 7 days after the cessation of treatment, and 90% of previous sIL-15R{alpha} recipients developed CIA that was indistinguishable from the control HSA-injected group after 10 days (data not shown). Thus, treated mice developed acute phase CIA soon after the discontinuation of sIL-15R{alpha} injection. This observation was reflected in immune responsiveness in vitro. At 2 wk after the cessation of treatment (day 50), spleen cells from sIL-15R{alpha} recipients produced higher concentrations of IFN-{gamma} and IL-6 to collagen (Fig. 6Go, A and B) compared either with parallel cultures from HSA-treated controls, which were in the chronic phase of CIA at that point, or with spleen cell responses obtained earlier from littermates at the end of sIL-15R{alpha} treatment (day 36; compare with Fig. 4Go, B and C). Thus, treatment with sIL-15R{alpha} clearly suppressed the development of acute CIA.



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FIGURE 6. Mice were treated as described in Figure 4Go. At 14 days after the cessation of treatment (day 50), spleen cells (pooled from three mice per group) from sIL-15R{alpha}-treated mice or HSA-treated mice were cultured with collagen as described previously, and IFN-{gamma} (A) and IL-6 (B) synthesis was determined by ELISA. T cell proliferation in both groups (day 50) was similar (data not shown). *p < 0.05.

 

    Discussion
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
IL-15 mediates pleiotropic effects on a variety of immune cells (22). However, unlike IL-2, with which it shares partial functional homology, IL-15 may be generated not only by cells within the immune system but also by cells belonging to other tissues, including keratinocytes and synoviocytes (2, 3, 23). By this means, host tissues may contribute significantly to the regulation of protective or autoimmune responses. The functional effects of IL-15 that have been demonstrated thus far include the activation of NK cells and neutrophils and the autocrine regulation of macrophages; an important role for IL-15 in early, innate defense has also been proposed (14, 15, 16). However, IL-15 additionally induces the activation of T cell blasts and will support the maturation and isotype switching of B lymphocytes. Thus, a role in the development of Ag-specific responses might be predicted, although formal demonstration of this role in vivo has been lacking until now.

IL-15 expression has been detected in several human diseases including RA, pulmonary sarcoidosis, inflammatory bowel disease, and chronic active hepatitis, providing circumstantial evidence for a role in chronic immunopathology (2, 3, 6, 7, 8). The mechanisms whereby IL-15 could modify such inflammatory tissue destruction have not been clearly defined. Our current observations indicate that IL-15 expression is required for the induction of erosive inflammatory arthritis following a challenge of collagen-primed DBA/1 mice. Moreover, both the altered serum Ig levels detected and the in vitro evidence for suppressed spleen cell proliferation and cytokine production indicate that the collagen-specific response has been significantly modified. Since IL-15 induces T cell chemotaxis in vivo and in vitro (2, 12) and induces proliferation, adhesion molecule expression, and cytokine production in vitro (4, 24), it is therefore possible that IL-15 mediates effects in inflammatory arthritis, at least in part, through its activities on Ag-specific T cells. Several recent data have provided suggestive evidence for Ag-driven T cell clonal expansion in patients with long-standing RA (25, 26). Further possible explanations for our observations include the alteration of Ag-presentation or subsequent T cell costimulation, since both peripheral blood- and skin-derived dendritic cells are known to express IL-15 (27), or the modification of adjuvant activity, since IL-15 up-regulation has been detected during mycobacterial infection (28).

The CIA model provides an opportunity to study the relative contribution of immune pathways to the development of inflammatory arthritis. Using this approach, previous studies have demonstrated a role for Th1 cells and several proinflammatory cytokines, including TNF-{alpha} and IL-1ß (21, 29, 30, 31, 32). Such observations in rodents are clearly of relevance, since subsequent clinical trials with neutralizing Abs against TNF-{alpha} and soluble TNF-{alpha}Rs have demonstrated efficacy in human RA (33, 34, 35) and implied a pivotal role for TNF-{alpha} in RA pathogenesis. We recently provided evidence that IL-15 is capable of "bystander" activation of RA synovial T cells; after this activation, these cells may produce cytokines, including TNF-{alpha}, either directly or through cognate interaction with adjacent macrophages (4). Thus, IL-15 could act upstream from TNF-{alpha} in orchestrating the production of inflammatory cytokines in the chronically inflamed RA synovium. The data presented here provide direct evidence in vivo that IL-15 can also play a pivotal role in the development of inflammatory arthritis. Further studies are now required to investigate the apparent dysregulation of IL-15 expression in synovial tissues.

Besides its postulated function in innate immunity (14, 15), a critical role in the modulation of acquired immunity is suggested for IL-15. IL-15R{alpha} administration effectively suppressed collagen-specific responses that were measured in vivo by serum Ig and in vitro by spleen cell responses. This finding was unexpected, since our animals were IL-2 replete. IL-15 and IL-2 share occupancy of the IL-2/15R ß-chain and the common {gamma}-chain and transduce similar JAK1/3-STAT3/5-dependent pathways thereafter (36), leading to the suggestion that some functional redundancy might exist. However, the sIL-15R {alpha}-chain did not exhibit any binding to IL-2 in vitro nor did it inhibit IL-2-mediated CTLL proliferation, making it unlikely that cross-reactivity could explain our observations. Rather, it is likely that early IL-15 production during Ag-challenge is necessary for the normal development of specific immune responses. The availability of sIL-15R{alpha} will facilitate future studies to investigate the precise relationship and functional crossover, if any, between IL-2 and IL-15.

Thus, sIL-15R{alpha} profoundly suppressed the development of CIA and markedly inhibited the onset of the humoral and Th1 cell-mediated anti-collagen response. These results provide the in vivo data which show a role for IL-15 in inflammatory arthritis and suggest that antagonists to this cytokine could be of therapeutic benefit. Wider application to other chronic inflammatory conditions in which IL-15 expression has been localized should also be considered.


    Acknowledgments
 
We thank the Immunex Corporation for simian IL-15, Dr. G. Adolf for rIFN-{gamma}, Dr. G. Feng for advice on Western blotting, and Mr. P. Kerr for histologic preparations. We also thank Dr. D. Boumpas for helpful discussions.


    Footnotes
 
1 This work was support by the Wellcome Trust, the Nuffield Foundation, and the Medical Council. H.R. was supported by a scholarship from the Gottlieb Daimler und Karl Benz Stiftung. B.P.L. was supported by a scholarship from the University of Glasgow. Back

2 These authors contributed equally to this work. Back

3 Address correspondence and reprint requests to Dr. Y. Liew, Department of Immunology, University of Glasgow, Glasgow G11 6NT, U.K. E-mail address: Back

4 Abbreviations used in this paper: RA, rheumatoid arthritis; mIL, murine IL; CIA, collagen-induced arthritis; sIL-15R{alpha}, soluble fragment of IL-15R{alpha}; HSA, human serum albumin. Back

Received for publication October 31, 1997. Accepted for publication January 28, 1998.


    References
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 

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