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The Journal of Immunology, 1998, 161: 1183-1193.
Copyright © 1998 by The American Association of Immunologists

TNF Receptor-Associated Factor-3 Signaling Mediates Activation of p38 and Jun N-Terminal Kinase, Cytokine Secretion, and Ig Production Following Ligation of CD40 on Human B Cells1

Amrie C. Grammer*, Jennifer L. Swantek{dagger}, Richard D. McFarland{ddagger}, Yasushi Miura*, Thomas Geppert* and Peter E. Lipsky2,*

* Harold C. Simmons Arthritis Research Center and Departments of Internal Medicine, {dagger} Pharmacology, and {ddagger} Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75235


    Abstract
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
CD40 engagement induces a variety of functional outcomes following association with adaptor molecules of the TNF receptor-associated factor (TRAF) family. Whereas TRAF2, -5, and -6 initiate NF-{kappa}B activation, the outcomes of TRAF3-initiated signaling are less characterized. To delineate CD40-induced TRAF3-dependent events, Ramos B cells stably transfected with a dominant negative TRAF3 were stimulated with membranes expressing recombinant CD154/CD40 ligand. In the absence of TRAF3 signaling, activation of p38 and control of Ig production were abrogated, whereas Jun N-terminal kinase activation and secretion of IL-10, lymphotoxin-{alpha}, and TNF-{alpha} were partially blocked. By contrast, induction of apoptosis, activation of NF-{kappa}B, generation of granulocyte-macrophage CSF, and up-regulation of CD54, MHC class II, and CD95 were unaffected by the TRAF3 dominant negative. Together, these results indicate that TRAF3 initiates independent signaling pathways via p38 and JNK that are associated with specific functional outcomes.


    Introduction
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Engagement of CD40 on B cells induces functional outcomes that are essential for generation and maintenance of the humoral immune response, such as up-regulation of surface proteins, aggregation, proliferation, heavy chain class switching, and secretion of cytokines and Ig (1). Recent evidence has demonstrated that functional outcomes of CD40 engagement depend on the activation and differentiation state of the B cell as well as the degree of CD40 ligation. For example, engagement of CD40 rescues GC B cells from spontaneous apoptosis and lymphoma B cells from apoptosis induced by surface Ig cross-linking (2, 3). By contrast, ligation of CD40 on certain B cell lines induces apoptosis and decreases proliferation and Ig production (4, 5, 6, 7, 8, 9, 10, 11). Bidirectional signaling via CD40 is not unique to B cell lines, as similar effects have been observed for resting peripheral B cells (5). Whereas low occupancy of surface CD40 on resting peripheral B cells induces proliferation and Ig secretion, high occupancy results in apoptosis and reduced Ig secretion. Importantly, although the details of the signaling pathways have not been delineated, control of cellular growth and that of Ig production have been demonstrated to be regulated independently (4, 5, 12).

Early biochemical events following CD40 engagement include activation of src family tyrosine kinases as well as PLC-{gamma}2, JAK3-STAT3, PI3K, and STAT6 (13, 14, 15, 16). Since the cytoplasmic domain of CD40 lacks intrinsic enzymatic activity, it has been hypothesized that these early biochemical signals as well as the subsequent activation of kinases such as MKK13 (17), ERK (18, 19), JNK (19, 20, 21), and p38 (22, 23), and the nuclear translocation of transcription factors AP-1, NF-AT (24), and NF-{kappa}B (24, 25) induced by CD40 engagement may be mediated by adaptor molecules. In this regard, a family of TNF receptor-associated factor (TRAF) molecules that is induced to associate with members of the TNF receptor superfamily, including CD40 (26), upon engagement has been characterized. Whereas the C-terminal portions of TRAF2, -3, and -5 associate with overlapping sites contained in residues 226 to 249 (27, 28, 29, 30, 31) of the cytoplasmic tail of CD40, the C-terminal portion of TRAF6 associates with the more membrane-proximal residues 210 to 225 of CD40 (32, 33).

The signaling portion of TRAF2, -3, -5, and -6 has been found to be contained in the N-terminal ring and zinc fingers. Whereas TRAF2 (27), TRAF5 (28), and TRAF6 (32, 33) have been shown to mediate activation of NF-{kappa}B following engagement of CD40, the downstream transducers involved in TRAF3 signaling are unknown (29, 30, 31). These considerations prompted an examination of the functional consequences of TRAF3-mediated signaling following engagement of CD40 on human B cells.


    Materials and Methods
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Cell lines

The Ramos Burkitt lymphoma R-F6 and R-D4 cell lines were stably transfected with the control vector pEBVHis/lacZ or a DN mutant of TRAF3, pEBVHis/C26, respectively (29) (gifts from Dr. Seth Lederman, Columbia University, New York, NY). The TRAF3 DN (C26) contains C-terminal TRAF-C and TRAF-N domains, but lacks the N-terminal leucine zippers as well as the ring and zinc fingers. R-F6 and R-D4 cell lines were maintained in hygromycin (Calbiochem, La Jolla, CA)/DMEM (Life Technologies, Grand Island, NY) selection medium supplemented with penicillin G (200 U/ml), gentamicin (10 µg/ml), L-glutamine (0.3 mg/ml), and 10% FCS (Life Technologies).

Culture conditions

Ramos cells were cultured in U-bottom 96-well microtiter plates (1 x 105/well; Costar, Cambridge, MA). Where indicated, Ramos cells were stimulated with 400 µM sorbitol (Sigma, St. Louis, MO). In some cases, the cells were activated with 10 µg/ml mouse IgG1 anti-human CD40 mAb (G28.5, American Type Culture Collection, Manassas, VA; or 626.1, gift from Dr. Shu Man Fu, University of Virginia, Charlottesville, VA) or an isotype-matched control mAb (MOPC; American Type Culture Collection) in the presence or the absence of cross-linking with immobilized goat anti-mouse Ig (GaMIg). GaMIg (4 ng/well) was immobilized on plates by incubation in Tris buffer for 2 h at 37°C before washing extensively with PBS. Alternatively, Ramos cells were incubated with membranes from Sf9 cells infected with wt AcMNPV or recombinant baculovirus encoding mCD154/CD40L prepared as previously described (5) in the presence or the absence of 5 to 10 µg/ml of either MR1, a hamster anti-mouse CD154 mAb (gift from Dr. Randolph Noelle, Dartmouth Medical School, Lebanon, NH), or 2C11, a control hamster anti-murine CD3 mAb (American Type Culture Collection) that has no reactivity with human lymphocytes, to demonstrate specificity.

The degree of CD40 engagement on Ramos B cells by a given amount of mCD154-expressing membranes was determined by a competitive binding assay using a mCD154-CD8 construct (5) (gift from Peter Lane, Basel Institute for Immunology, Basel, Switzerland). Specifically, 100 x 103 B cells were incubated with increasing volumes of membranes from either wt or mCD40L-Sf9 cells for 2 h at 37°C. Cells were washed to remove unbound membranes before incubation with a nonsaturating amount of mCD40L-CD8{alpha} (5 µl of a 1/10 dilution) for 30 min at 4°C. After washing to remove unbound construct, cells were incubated with a 1/20 dilution of anti-CD8-FITC (YTS 169.4; American Type Culture Collection) for 30 min at 4°C. Before analysis with the use of the FACScan system, cells were washed and resuspended in PBS with 2% normal human serum. Live cells were gated using propidium iodide staining (Sigma).

Inhibitors

SB203580 (10 µM; Calbiochem) was used to inhibit activation of the {alpha} and ß isoforms of p38 expressed in lymphocytes (34, 35, 36, 37, 38). Cyclosporine (100 ng/ml; Sandoz, East Hanover, NJ), N-acetyl cysteine (100 mM; Sigma Chemical Co.), and zVAD-fluoro methyl ketone (20 µM; Enzyme Systems Products, Livermore, CA) were added to cultures to inhibit activation of NF-AT, NF-{kappa}B, and caspase, respectively.

Analysis of TRAF3 protein

Control (R-F6) or TRAF3 DN (R-D4)-expressing Ramos cells were washed once with PBS and lysed for 10 min in cold buffer (20 mM HEPES (pH 8), 1 mM EDTA, 1 mM DTT, 10 mg/ml leupeptin, 10 mg/ml limabean extract, and 16 µg/ml each of PMSF, L-p-tosylamino-2-phenylethyl chloromethyl ketone, and TN-{alpha}-p-tosyl-L-lysine chloromethyl ketone) before homogenization using a 27.5-gauge needle. Lysates were centrifuged at 3000 x g for 2 min to remove nuclei before concentration using Microcon 10 columns (Amicon, Beverly, MA) following the manufacturer’s instructions. The protein concentration was determined using the DC protein assay (Bio-Rad, Hercules, CA) before analysis by SDS-PAGE and transfer to polyvinylidene difluoride membranes (Millipore, Bedford, MA). Blots were blocked for 1 h at room temperature in Tris-buffered saline, pH 7.6, with 0.5% Tween-20, 5% nonfat dried milk, and 5% BSA before incubation for 2 h with 1 µg/ml of affinity-purified biotinylated polyclonal rabbit anti-human TRAF3 (26) (gift from Dr. Randolph Noelle) directed against the C-terminus or a 1/250 dilution of a rabbit polyclonal anti-TRAF3 (gift from Dr. Marilyn Kehry, Boehringer Ingelheim, Ridgefield, CT) directed against the C-terminus. Following extensive washing in Tris-buffered saline with 0.2% Tween-20 and 0.2% BSA, blots were incubated for 2 h at room temperature with either a 1/2000 dilution of strepavidin-horseradish peroxidase (Vector, Burlingame, CA) or a 1/3000 dilution of goat anti-rabbit horseradish peroxidase (Bio-Rad). After extensive washing as described above, blots were developed using ECL reagents (Amersham, Arlington Heights, IL) and analyzed by autoradiography. The densities of the resulting bands were digitized, quantitated, and expressed as a fold increase over background.

Analysis of p38 and JNK

Following stimulation, cytoplasmic lysates were analyzed for p38 and JNK by Western analysis using a mixture of anti-p38 polyclonal rabbit antisera (P287, gift from Dr. Melanie Cobb, University of Texas Southwestern Medical Center, Dallas, TX; C-20, Santa Cruz Biotechnology, Santa Cruz, CA) or anti-JNK polyclonal rabbit antisera (0977, gift from Dr. Cobb; C-17, Santa Cruz Biotechnology) and for specific kinase activity using GST-ATF2{Delta}1–254 and GST-c-jun1–221 (gifts from Dr. Cobb) as respective substrates.

Specifically, cells were centrifuged, washed once with PBS, and lysed in cold buffer (50 mM HEPES (pH 7.5), 150 mM NaCl, 0.2 mM MgCl2, 1 mM EGTA, 10% glycerol, 1% Triton X-100, 100 mM NaF, 0.2 mM sodium orthovanadate, and 1% PMSF). Lysates were centrifuged for 10 min at 14,000 rpm at 4°C, supernatants were transferred to fresh Eppendorf tubes, and protein content was quantitated using the Bio-Rad protein assay. Following immunoprecipitation for 2 h at 4°C with appropriate Ab and protein A-Sepharose (Pharmacia, Piscataway, NJ), immunoprecipitates were centrifuged for 5 min at 6000 rpm and washed twice with lysis buffer and once with 50 mM Tris (pH 7.4), 1 mM DTT, and 10 mM MgCl2. Kinase reactions were conducted for 40 min at 30°C in this same buffer with the addition of 50 µM ATP, 10 µCi [{gamma}-32P]ATP/sample, and 0.3 mg/ml of the appropriate substrate. Reactions were terminated by centrifugation, addition of sample buffer, and boiling for 5 min. Proteins were resolved on a 10% SDS-polyacrylamide gel and visualized by Coomassie blue staining. Following destaining in MeOH/H2O/acetic acid, the gel was dried and analyzed by autoradiography. Kinase activity was quantitated by liquid scintillation spectroscopy of appropriate bands.

Analysis of B cell function

After activation for 4 h at 37°C and permeabilization with Triton X-100 (Sigma), cells were stained with propidium iodide to detect DNA strand breaks and were analyzed for percent apoptosis by flow cytometry using the FACScan with CellQuest Software (Becton Dickinson, San Jose, CA). Alternatively, apoptosis was detected by [3H]TdR release. Cells were labeled for 12 h at 37°C with 1 µCi of [3H]TdR (6.7 Ci/mM; ICN Biomedicals, Irvine, CA) in the presence of 50 µg of fluorouridine deoxyribose (Sigma) and then were washed, counted, and incubated at 37°C under various conditions. [3H]TdR release was determined by liquid scintillation spectroscopy.

Proliferation was analyzed by [3H]thymidine incorporation as previously described (39). Secreted Ig was analyzed by ELISA as previously described (39), and cytoplasmic IgM content was analyzed by intracellular staining. To analyze cytoplasmic IgM, cells were preactivated with CD154 for 1 h at 37°C, after which 500 ng/ml brefeldin A (Sigma) was added, and the cells were incubated for 5 h. Cells were harvested, washed with PBS, fixed with 4% paraformaldehyde, and washed again with 0.1% BSA/PBS before being resuspended in 10% DMSO/1% BSA/PBS and frozen for 12 h at -80°C. After incubation at 37°C for 5 min, cells were washed with PBS and incubated for 10 min in the dark with in the presence or the absence of permeabilization reagents (Becton Dickinson). Cells (2.6 x 105) were washed with 0.1% BSA/0.1% NaN3/PBS, blocked for 10 min with 10% mouse and rat sera in 0.1% BSA/0.1% NaN3/PBS at room temperature, and incubated with rabbit anti-human IgM-FITC (Dako, Carpinteria, CA). As a control, cells were incubated with rabbit anti-human IgA-FITC (Dako) that has no reactivity with IgM+ Ramos B cells (data not shown). Cells were washed and resuspended in 1% paraformaldehyde before analysis using the FACScan (Becton Dickinson).

Secretion of GM-CSF, LT-{alpha}/TNF-ß, TGF-ß, IL-1, IL-4 (R&D Systems, Minneapolis, MN), IL-6, IL-10, IL-12, IL-13, IFN-{gamma}, and TNF-{alpha}, (Biosource International, Camarillo, CA) was analyzed by ELISA according to the manufacturer’s instructions and normalized to the number of cells present at supernatant harvesting.

EMSA analysis of NF-{kappa}B activation

Nuclear extracts were incubated with a 32P-labeled double-stranded DNA probe containing the sequence of the I{epsilon} NF-{kappa}B binding site (5'-AGC TTC AGA GTG GGG TTC CCG AGA GG-3' and 5'-TC GAC CTC TCG GGA ACC CCA CTC TGA-3') in the presence or the absence of a 10-fold excess of unlabeled competitor probe and analyzed for NF-{kappa}B binding activity following electrophoresis on a 4% native polyacrylamide gel and autoradiography. The densities of the resulting bands were digitized, quantitated, and expressed as the fold increase over background.

Flow cytometric analysis

Cells were stained for surface Ags with mAb as previously described (39). Anti-human IgM-FITC, IgG-FITC, IgA-FITC, and a control FITC are mouse IgG1 F(ab')2 (Caltag Laboratories, South San Francisco, CA). Anti-human CD19-FITC, CD20-FITC (Becton Dickinson, San Jose, CA), CD30-FITC, CD10-FITC, CD38-FITC, and a control FITC (Caltag) are mouse IgG1. Anti-CD21 (THB.5; American Type Culture Collection), CD23 (MHM; Dako), CD39 (AC2; Biodesign, Kennebunk, ME), CD44 (A3D8; American Type Culture Collection), CD70 (Dako), CD95 (DX2; PharMingen, San Diego, CA), and HLA-DR/MHC class II (L243; American Type Culture Collection) are mouse IgG1. Anti-CD11a/LFA1{alpha} (TS1/18.1; American Type Culture Collection), CD18/LFA-1ß (TS1/22.1.1; American Type Culture Collection), and CD54/ICAM-1 (R6.5; gift from Dr. Robert Rothlein, Boehringer Ingelheim) are mouse IgG2a. Anti-CD77 (Biodesign) is rat IgM. The isotype-matched control mAb were MOPC (IgG1; American Type Culture Collection), P1.17 (IgG2a; American Type Culture Collection), and rat IgM (Biodesign). Where required, the secondary stain was GaMIg [F(ab')2]-FITC (Calbiochem).

Expression of LMP1 in control (R-F6) and TRAF3 DN (R-D4)-expressing Ramos cells was determined by intracellular staining. Cells (2 x 105) were washed with 1% BSA/0.1% NaN3/PBS at room temperature, blocked with 2% normal human serum for 15 min, and incubated for 10 min in the dark with FACS permeabilization solution (Becton Dickinson) before additional washing and blocking. Cells were stained with either 2 µg of mouse IgG1 anti-human LMP1 mAb (Dako) or the isotype-matched control MOPC, washed, and blocked before development with goat anti-mouse IgG1-FITC (The Binding Site, Birmingham, U.K.). Cells were washed and resuspended in 1% paraformaldehyde before analysis using the FACScan (Becton Dickinson).


    Results
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
R-F6 and R-D4 cells express comparable levels of CD40 but do not express the EBV-encoded LMP1 that has been previously demonstrated to mimic CD40 signaling by self-associating via its transmembrane domain and binding the same TRAFs (40, 41) (Fig. 1Go). Furthermore, R-F6 and R-D4 express equivalent levels of CD19, CD20, IgM, and HLA-DR and have comparable surface phenotypes typical of Burkitt lymphoma cell lines (42), in that they are positive for CD10, CD38, CD54, CD70, CD77, and CD95 (Fig. 1Go) and are negative for IgG, IgA, CD11a, CD18, CD21, CD23, CD30, CD39, and CD44 (data not shown). In addition, R-F6 and R-D4 constitutively secrete similar amounts of Ig, GM-CSF, TNF-{alpha}, and IL-6, but do not secrete IL-1, IL-4, IL-10, IL-12, IL-13, IFN-{gamma}, LT-{alpha}, or TGF-ß1 (data not shown). Finally, Western analysis of TRAF3 protein demonstrated equivalent expression of the 66-kDa wt protein in R-F6 and R-D4 cell lines. Of importance, the 30-kDa TRAF3 DN protein was expressed in R-D4 cells at a level approximately ninefold less than the wt protein, but was not found in R-F6 cells (Fig. 2Go).



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FIGURE 1. Phenotypes of control or TRAF3DN-expressing Ramos cells are comparable. Expression of CD19, CD20, CD40, surface IgM, HLA-DR, LMP1, CD10, CD38, CD54, CD70, CD77, and CD95 was determined by FACS analysis of control (R-F6) or TRAF3 DN (R-D4)-expressing Ramos cells. The results of one of two experiments with similar findings are shown.

 


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FIGURE 2. DN TRAF3 protein is expressed in R-D4 cells. Fifty micrograms of protein contained in lysates from control (R-F6) or TRAF3 DN (R-D4)-expressing Ramos cells was analyzed by SDS-PAGE and transferred to a polyvinylidene difluoride membrane. The blocked blot was incubated with biotinylated anti-TRAF3 Ab and extensively washed before incubation with strepavidin-horseradish peroxidase. Bands were developed with ECL reagents and analyzed by autoradiography. Comparison of digitized bands revealed that TRAF3 DN protein (30 kDa) was expressed at a level ninefold less than wt TRAF3 (66 kDa). Similar results were obtained with a second rabbit anti-TRAF3 antiserum provided by Dr. Marilyn Kehry (data not shown).

 
To examine CD40-induced TRAF3 signaling pathways, stable Ramos transfectants expressing a control vector (R-F6) or a DN mutant of TRAF3 (R-D4) were stimulated with Sf9 membranes expressing recombinant mCD154 and analyzed for activation of p38 and JNK. It is important to emphasize that engagement of CD40 was accomplished with an authentic recombinant ligand and that assessment of biochemical events was conducted using an amount of mCD154 previously shown to induce a variety of functional outcomes (5). Following CD40 ligation, both p38 and JNK activities were increased maximally at 30 min in the control Ramos cells. By contrast, activation of the former was completely blocked, and stimulation of the latter was markedly diminished in Ramos cells expressing a DN mutant of TRAF3 (Fig. 3A). Of note, p38 activation was not increased in Ramos cells expressing the TRAF3DN at any level of CD40 engagement from 1 to 100%. Furthermore, the time course of CD40-induced p38 or JNK activation was not altered in Ramos B cells by the TRAF3 DN (data not shown). Western blotting indicated that protein levels of p38 and JNK were similar in control Ramos cells and those expressing the TRAF3 DN mutant (Fig. 3GoB). In addition, the DN mutant of TRAF3 selectively inhibited CD40-mediated p38 and JNK activation as the pharmacologic agent, sorbitol, stimulated p38 and JNK activity in both the control Ramos cells as well as those expressing the DN version of TRAF3 (Fig. 3GoC).



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FIGURE 3. TRAF3 specifically mediates p38 and JNK activation following engagement of CD40 on B cells. Control (R-F6) or TRAF3 DN (R-D4)-expressing Ramos cells (10 x 106) were incubated for 30 min with mCD154-Sf9 membranes engaging approximately 60% surface CD40 (A–C) or 400 µM sorbitol (B) before analysis of p38 and JNK kinase activities (A andB) using their respective substrates, GST-ATF2{Delta}1–254 and GST-c-jun1–221, or of protein levels (C) by immunoblotting. Results from A are expressed as the mean of three experiments ± SEM, one of which is shown in B. Differences between p38 and JNK activation in the control cells and the TRAF3 DN-expressing cells are significant (p = 0.0001 and 0.04, respectively, by one-tailed Student’s t test, assuming unequal variance). B, CD40 ligation on control and TRAF3 DN-expressing cells increased p38 by 2.4- and 0.8-fold, respectively, and JNK by 3.9- and 1.9-fold, respectively. Sorbitol stimulation of control and TRAF3 DN-expressing cells increased p38 activity by 4.7- and 3.7-fold, respectively, and JNK activity by 5.8- and 13.0-fold, respectively.

 
Similar experiments were performed to investigate the role of TRAF3 in signaling pathways regulating functional outcomes of CD40 engagement. Ligation of CD40 on Ramos B cells with mCD154-expressing Sf9 membranes induced apoptosis, as assessed by propidium iodide staining (Fig. 4) and [3H]thymidine release that was associated with a decrease in proliferation (Fig. 5). The specificity for CD40 engagement by mCD154-expressing Sf9 membranes was documented, since all effects were blocked by an anti-mCD154 mAb (Fig. 5Go; data not shown).



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FIGURE 5. Inhibition of proliferation mediated by CD40 ligation is TRAF3 independent. Control or TRAF3 DN-expressing Ramos cells (1 x 105) were cultured with A) equal amounts of wt-Sf9 or mCD154-Sf9 membranes engaging approximately 60% surface CD40 in the presence of 10 µg/ml of an anti-mCD154 mAb (MR1) or a control mAb (2C11) that has no reactivity with human lymphocytes and analyzed for [3H]thymidine incorporation at day 1, or B) 10 µg/ml of an anti-hCD40 mAb or an isotype-matched control mAb in the presence or the absence of cross-linking with GaMIg and analyzed for [3H]thymidine release on day 1. Data are expressed as the mean ± SEM. These findings are representative of one of five experiments with similar results. The average percent decrease in [3H]thymidine incorporation or increase in [3H]thymidine release for five experiments was not significantly different for R-F6 and R-D4 cells (67 ± 17 and 69 ± 11%, respectively; p = 0.44, by one-tailed Student’s t test, assuming unequal variance).

 
Further examination of potential signaling pathways involved in CD40-mediated apoptosis and inhibition of proliferation revealed that these responses could be blocked with a caspase inhibitor (zVAD-fluoro methyl ketone), but were unaffected by blocking nuclear translocation of NF-ATc with cyclosporine or increased activation of p38 with SB203580. Additionally, these responses were increased with the anti-oxidant N-acetyl cysteine, which has been shown to inhibit nuclear translocation of NF-{kappa}B (data not shown). Importantly, CD40-induced apoptosis and inhibition of proliferation did not involve a TRAF3-dependent signaling pathway, as they were unaffected by the TRAF3 DN mutant (Figs. 4Go and 5Go). The increase in apoptosis as well as the inhibition of DNA synthesis following CD40 engagement were similar for both TRAF3 DN and control cells, even though the basal level of proliferation differed.



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FIGURE 4. CD40-induced apoptosis of B cells is TRAF3 independent. Control or TRAF3 DN-expressing Ramos cells (1 x 105) were cultured for 4 h with medium alone, 400 µM sorbitol, or equal amounts of wt-Sf9 or mCD154-Sf9 membranes engaging approximately 60% surface CD40. The percentage of apoptotic cells, indicated by the terms in each box, was assessed by FACS analysis after permeabilization and propidium iodide staining of DNA. The bracketed region in each plot indicates hypodiploid (apoptotic cells) followed to the right by diploid cells (G0, G1) and hyperdiploid cells (S, G2, M). Differences in the percentage of apoptotic cells over baseline following stimulation with sorbitol or mCD154-Sf9 membranes are significant (p < 0.001, Kolmogorov-Smirnov two-sample test). The results of one of two experiments with similar findings are shown.

 
By contrast, ligation of CD40 on Ramos cells with mCD154 expressing Sf9 membranes decreased Ig secretion (Fig. 6A) as well as the percentage of cells synthesizing cytoplasmic Ig by a mechanism that required activation of p38, as demonstrated by its prevention by SB203580 (Fig. 6GoC). Of note, engagement of CD40 with anti-CD40 mAb also decreased Ig secretion (Fig. 6GoB). In contrast to the effect on apoptosis and proliferation, the decrease in Ig secretion induced by engaging CD40 with mCD40L-expressing Sf9 membranes was dependent upon TRAF3-mediated p38 activation, as it was abrogated by either the DN TRAF3 construct or pharmacologic inhibitors of p38 (Fig. 6Go, A and C). Inhibition of Ig production caused by an anti-CD40 mAb was also blunted by the DN TRAF3 (Fig. 6GoB). The dichotomy between the finding that CD40-induced TRAF3-mediated signals regulated Ig secretion, but not cellular growth, is supported by previous findings that B cell growth and Ig production were independently regulated (4, 5, 12).



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FIGURE 6. CD40-mediated control of Ig secretion is abrogated by inhibiting TRAF3-mediated p38 activation. Control or TRAF3 DN-expressing Ramos cells were cultured with equal amounts of wt-Sf9 or mCD154-Sf9 membranes engaging approximately 60% surface CD40 in the presence or the absence of an inhibitor of p38 activation (SB203580; C) or 10 µg/ml of an anti-human CD40 mAb or an isotype-matched control mAb (B) and analyzed for cytoplasmic IgM after a 6-h incubation (C) or for IgM production by ELISA after a 5-day incubation (A and B). ELISA data are expressed as the mean ± SEM. Inhibition of Ig production in control cells by either mCD154-Sf9 membranes or anti-CD40 mAb is significant (p < 0.0001 and p = 0.007, respectively, by one-tailed Student’s t test, assuming unequal variance), whereas differences for cells expressing the TRAF3 DN are not statistically significant (p = 0.1 and p = 0.25, respectively). The results of one of four experiments with similar findings are shown. The average percent inhibition from control following CD40 ligation for four experiments was statistically different for R-F6 and R-D4 cells (81 ± 12 and 20 ± 5%, respectively; p = 0.004, by one-tailed Student’s t test, assuming unequal variance).

 
Engagement of CD40 on Ramos cells by mCD40L-expressing Sf9 membranes specifically induced the secretion of IL-10, TNF-{alpha}, LT-{alpha}, and GM-CSF. Induction of cytokine production specifically related to CD40 engagement, as it was blocked with an anti-mCD154 mAb (Fig. 7). CD40-induced secretion of IL-10, TNF-{alpha}, LT-{alpha}/TNF-ß, but not GM-CSF, involved TRAF3, as the DN construct significantly inhibited production of the former cytokines, but not that of the latter. Inhibition of cytokine secretion related to the TRAF3 DN could not be ascribed to potential differences in the number of cells, as the production of all cytokines was normalized to the actual cell number at the end of the culture.

Finally, TRAF3 was not involved in CD40-mediated induction of nuclear translocation of NF-{kappa}B (Fig. 8A), as previously shown (27, 28, 33), in that it was not blocked by expression of the DN TRAF3 construct (Fig. 2Go). Moreover, TRAF3 appeared to play no role in CD40-induced up-regulation of a variety of physiologically relevant surface molecules that have been previously shown to be regulated by NF-{kappa}B (43, 44) including CD54, MHC class II, and CD95 (Fig. 8GoB).



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FIGURE 8. Induction of NF-{kappa}B-dependent CD54/ICAM-1, CD95/Fas, and MHC class II expression following CD40 engagement on Ramos B cells is TRAF3 independent. A, NF-{kappa}B binding activity was analyzed by EMSA of nuclear protein isolated from control or TRAF3 DN-expressing Ramos cells that had been cultured for 3 h with equal amounts of wt Sf9 or mCD154–Sf9 membranes engaging approximately 40% of the surface CD40. EMSA was conducted in the presence or the absence of a 10-fold molar excess of cold competitor. The densities of bands representing the 50-kDa (white) and 65-kDa (striped) components of NF-{kappa}B were digitized and expressed as the fold increase over background. Results are representative of one of two experiments with similar findings. B, Expression of CD54/ICAM-1, CD95/Fas, and MHC class II was determined by FACS analysis of control or TRAF3 DN-expressing Ramos B cells (1 x 105) that had been incubated overnight with equal amounts of wt Sf9 or mCD154-Sf9 membranes that engage approximately 60% of the surface CD40 in the presence of 10 µg/ml anti-mCD154 (MR1) or with a control mAb (2C11). Results are expressed as {Delta}MFI (MFIstain - MFIcontrol).

 

    Discussion
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
The current data establish that TRAF3 mediates independent signaling pathways initiated by CD40 engagement that result in p38 and JNK activation and are associated with specific functional outcomes. Moreover, they extend previous reports of anti-CD40-induced p38 (22, 23) and JNK (19, 20, 21) activation by demonstrating that engagement of CD40 with authentic ligand induces TRAF3-mediated stimulation of the kinase activities of these mitogen-activated protein kinases and also secretion of Ig, IL-10, TNF-{alpha}, and LT-{alpha}. These findings provide new insight into the signaling pathway used by CD40 following ligation-induced recruitment of TRAF3 to its cytoplasmic tail (26).

The current results demonstrate that CD40 ligation on Ramos B cells induced TRAF3-mediated signaling uniquely linked to p38 activation and, in combination with other signaling pathways, coupled with JNK activation. Although these results are quite clear, and the cells are well characterized, it must be emphasized that the data were derived from a single cell line. Additional studies will be needed to determine whether other B cell lines or B cells at other stages of differentiation exhibit similar specific CD40 ligation response coupling.

Another important consideration is whether low level expression of TRAF3 DN protein uniquely interfered with TRAF3 signaling. This is likely to be the case for a number of reasons. First, TRAF2, -3, -5, and -6 have closely approximated, but distinct, binding sites on the cytoplasmic tail of CD40, with the binding sites for TRAF2, -3, and -5 clustered together (27, 28, 29, 30, 31) and the binding site for TRAF6 more membrane proximal (32, 33). Secondly, CD40 engagement may initiate several TRAF-mediated signaling pathways simultaneously and, therefore, probably the recruitment of various TRAFs (33, 45, 46, 47, 48, 49). This is confirmed by the observation that CD40 recruited TRAF2 and -3 (26) even though they bind overlapping sites on its cytoplasmic tail (27, 28, 29, 30, 31, 32, 33). Additionally, a transgenic mouse expressing a DN TRAF2 maintained a degree of NF-{kappa}B activation (48), implying that signaling through TRAF5 and/or -6 was not inhibited and that cross-blocking of TRAFs did not occur. Moreover, low level expression of TRAF3 DN protein did not interfere with LMP1-mediated NF-{kappa}B activation (50) that depends in part upon signaling mediated by TRAF2, -5, or -6 (27, 28, 32, 33). Similarly, in the current study, CD40-mediated activation of NF-{kappa}B and stimulation of NF-{kappa}B-dependent functional events were not inhibited by the TRAF3 DN construct (Figs. 7Go and 8Go), indicating that the linkage of TRAF2, -5, and/or -6 to CD40 was not blocked by low level expression of TRAF3 DN protein. Of note, the low expression of TRAF3 DN protein may have contributed to its specificity. Whereas overexpression of DN or wt TRAF3 protein interfered with LMP1- or CD40-induced NF-{kappa}B activation (27, 28, 51, 52), a signaling event previously shown to be TRAF3 independent (27, 28, 53), low level expression of TRAF3 DN protein appeared to inhibit TRAF3-mediated pathways specifically ( Figs. 3–8GoGoGoGoGoGo) (50). These findings are surprising but may have to do with competing avidities of TRAFs for TNF receptor family members as well as for cytoplasmic proteins such as I-TRAF/TANK (54, 55) and other downstream effector molecules. Thus, it is possible that the avidity of the TRAF3 DN protein for CD40 may be increased over that of the wt protein in the absence of the N-terminal that interacts with downstream effector molecules. Together, these observations suggest that low level expression of TRAF3 DN protein inhibits TRAF3-mediated signaling pathways specifically.



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FIGURE 7. TRAF3 mediates secretion of IL-10, TNF-{alpha}, and LT-{alpha} induced by ligation of CD40 on B cells. Control or TRAF3 DN-expressing Ramos cells (1 x 105) were incubated with medium alone or an amount of mCD154-Sf9 membranes engaging approximately 60% surface CD40 in the presence or the absence of 10 µg/ml of an anti-mCD154 mAb (MR1) or a control mAb (2C11) for 72 h. Multiple wells of supernatants were pooled for each cytokine determination (GM-CSF, TNF-{alpha}, LT-{alpha}, and IL-10). Cells cultured in medium alone did not produce detectable levels of LT-{alpha} or IL-10. The results of one of two experiments with similar findings are shown.

 
The current results indicate that CD40-mediated p38 activation proceeds uniquely via TRAF3, whereas stimulation of JNK may involve TRAF3 and other adaptor molecules, such as TRAF2 (45, 46, 47, 48, 49). Trivial explanations for this difference did not appear likely, in that both kinases were present in similar amounts and could be activated comparably by sorbitol in control and DN TRAF3-expressing Ramos cells. Moreover, there was no significant difference in the magnitude of CD40-mediated activation of p38 and JNK in control Ramos cells (p = 0.12), indicating that the potency with which they were stimulated did not contribute to their differential dependence on TRAF3 (Fig. 3Go). In conjunction, these results demonstrate that there is a difference in the degree of TRAF3 involvement linking CD40 to these specific mitogen-activated protein kinases.

Regulation of p38 and JNK involves potentially overlapping as well as selective upstream signaling cascades. MKK4 has been found to activate both p38 and JNK in vitro (56), but only JNK in vivo (57). Moreover, in vitro studies demonstrate that MKK3 (58, 59) and MKK6 (60, 61, 62, 63, 64, 65) specifically activate p38, whereas MKK7/SKK4 specifically activates JNK (66, 67, 68). These findings are consistent with the current findings that TRAF3 is uniquely involved in p38 activation, but that JNK can be activated by both TRAF3-dependent and -independent mechanisms. In this regard, overexpression of TRAF2, -5, or -6 induces JNK activity (45, 46, 47, 48, 49), and for TRAF2 this involves the MAPK/ERK kinase kinase (MEKK-1)-MKK4 pathway (45). The involvement of TRAF2 in JNK activation is further emphasized by the observation that its stimulation following CD40 engagement on purified B cells from mice expressing a DN TRAF2 protein is impaired compared with that in controls (48). Besides a role for TRAF2, -5, and -6 in JNK activation, TRAF3 is also involved, as indicated by the current studies (Fig. 3Go) and by the finding that overexpression of TRAF3 was found to induce activation of JNK, albeit to a lesser degree than that of TRAF2, -5, or -6 (45, 49).

The current results suggest that CD40 engagement may initiate several TRAF-mediated signaling pathways simultaneously and are consistent with previous studies showing that immunoprecipitation of CD40 following receptor engagement revealed recruitment of both TRAF2 and -3 (26) even though they bind overlapping sites on the cytoplasmic tail of CD40 (27, 28, 29, 30, 31). Previous reports also support the conclusion that a single TRAF may initiate several distinct independent signaling pathways. For example, TRAF2 has been shown to induce both JNK and NF-{kappa}B activation. Since a DN JNK did not interfere with TRAF2-induced nuclear translocation of NF-{kappa}B, it is likely that independent signaling pathways were activated (45, 46, 47, 48, 49). Moreover, TRAF6 has been shown to induce both NF-{kappa}B and ERK activation (33). The current data suggest that, like TRAF2 and -6, TRAF3 may initiate distinct signaling pathways leading to JNK and p38 activation. Finally, the low level of TRAF3 DN protein stably expressed in the Ramos cells used in this study (Fig. 2Go) would not be anticipated to interfere with docking of TRAF2, -5, or -6 to CD40 and subsequent initiation of downstream signaling events. In this regard, TRAF3 DN did not interfere with CD40-induced NF-{kappa}B activation (Fig. 8Go), which depends in part on recruitment of these adaptor molecules to CD40 (26).

JNK and p38 have overlapping and disparate substrate specificities, in that they both phosphorylate ATF-2, but only JNK phosphorylates Jun. Whereas ATF-2 homodimers and ATF-2/Jun heterodimers bind CRE promoter sites, Jun homodimers and Fos/Jun heterodimers associate with AP-1 binding sites (69, 70). Importantly, CD40 engagement has been shown to induce ERK (18, 19, 33), JNK (19, 20, 21), and p38 (22, 23) signaling pathways, leading to induction of Fos transcription as well as phosphorylation of Jun and ATF-2. In conjunction with the current data, these results suggest that CD40-induced, TRAF3-mediated activation of JNK and p38 may play a role in transcriptional regulation of genes controlled by AP-1 and/or CREB binding sites.

The current data also demonstrate that CD40-induced TRAF3-mediated signaling is required for regulation of Ig secretion independent of the control of proliferation and apoptosis ( Figs. 4–6GoGoGo) (4, 5, 12). The data in the current study focused on inhibition of Ig production by direct engagement of CD40 with recombinant CD154. However, Ramos cells can be induced to secrete more Ig following stimulation with polyclonal activators such as formalinized Staphylococcus aureus Cowan I (data not shown) that have been shown previously to increase Ig production by inducing low level expression of CD154 by B cells, with subsequent homotypic CD40L-CD40 interactions enhancing Ig secretion (39, 71). The increase in Ig secretion is dependent upon expression of CD154 by Ramos cells, as it is blocked by a CD40-Ig construct or by mAb to CD154. Of importance, S. aureus Cowan I does not increase Ig production by Ramos cells expressing the TRAF3 DN, even though CD154 is up-regulated normally (data not shown). These findings imply that CD40-mediated up- and down-regulation of Ig production are both dependent on TRAF3-mediated signaling.

The physiologic importance of these findings is supported by the observation that T cell-dependent Ab responses known to require functional CD154-CD40 interactions (1) are absent in TRAF3-deficient mice (53). Moreover, immunohistology reveals that TRAF3 is highly expressed in Ig-secreting plasmablasts in the interfollicular regions of secondary lymphoid tissues as in well as fully differentiated Ig-secreting plasma cells in the bone marrow (72) supporting a potential role for this effector molecule in regulation of Ig secretion. Furthermore, mutation of a region of the cytoplasmic tail of CD40 known to bind TRAF3 eliminates CD40-induced Ig secretion (73). Of interest, mice deficient in MKK4, an upstream regulator of JNK and thus a potential mediator between TRAF3 and JNK activities (Fig. 3Go), form germinal centers and mount T cell-dependent Ab responses comparably to those of their wt counterparts (74). Together with the findings that either pharmacologic inhibitors of p38 activation (Fig. 6GoC) or a DN version of TRAF3 abrogate CD40-mediated p38 activation (Fig. 3Go) and control of Ig production (Fig. 6Go, A and B) by Ramos B cells, these observations suggest that control of Ig secretion following CD40 engagement is mediated by a TRAF3 signaling pathway that is dependent upon p38, but is independent of JNK.

In vitro proliferation of B cells following CD40 ligation is unaffected in mice deficient in either TRAF3 (53) or MKK4 (57), an upstream regulator of JNK activation, compared with that in controls. By contrast, CD40-induced proliferation, but not Ig secretion, is impaired in mice deficient in the p52/p100/NF-{kappa}B2 (75) and the trans-activating c-Rel (76) and RelB (77) components of NF-{kappa}B, suggesting that regulation of proliferation resulting from CD40 ligation is likely to involve TRAF3-independent activation of NF-{kappa}B. The current studies are consistent with this conclusion and expand upon it by showing that CD40-induced inhibition of proliferation and stimulation of apoptosis are independent of TRAF3 (Figs. 4Go and 5Go) and are increased by inhibiting NF-{kappa}B with antioxidants such as N-acetyl cysteine (data not shown). Together, these observations confirm our previous findings that CD40-mediated Ig secretion is regulated independently of proliferation (4, 5, 12) and provide an explanation for this dichotomy by demonstrating that a TRAF3 signaling pathway exclusively controls Ig secretion with no influence on control of apoptosis or cellular growth.

Recent studies have also suggested that TRAF2 may mediate caspase-dependent apoptosis following engagement of TNF receptor family members via association with TRADD-FADD complexes (78) and/or FLIP/Casper (79, 80). The current data demonstrate that CD40 ligation also induces apoptosis that can be blocked by the caspase inhibitor, zVAD-fluoro methyl ketone (data not shown), but is independent of TRAF3 (Figs. 4Go and 5Go). This finding is consistent with the demonstration that engagement or overexpression of a variety of TNF receptor family members, including CD120a/TNF receptor I, CD95, LT-ß receptor, and LMP1 can induce apoptosis and may do so by a variety of signaling pathways in different cells. Thus, apoptosis induced following engagement of LT-ß receptor (81) or overexpression of LMP1 (82) in nonlymphoid cells involves a TRAF3-mediated signaling pathway, whereas the current data show that CD40-induced apoptosis of Ramos B cells is TRAF3 independent (Fig. 4Go). That the same signaling pathways can mediate different functional outcomes in nonlymphoid vs lymphoid cells is suggested by the finding that the TRAF2-associating protein FLIP/Casper mediates apoptosis in nonlymphoid cells (79), whereas it blocks apoptosis in cells of lymphoid origin (80). Together with the current finding that TRAF3 plays no role in CD40-induced apoptosis of Ramos cells, these observations suggest that apoptosis induced by engaging TNF receptor family members in nonlymphoid cells may be mediated by TRAF3, but the programmed cell death program may be induced by the TRAF2-associating protein FLIP/Casper in lymphoid cells.

Whereas CD40-induced, TRAF3-mediated signals were uncharacterized previous to this study, CD40-mediated nuclear translocation of NF-{kappa}B was shown to involve TRAF2, -5, or -6 (27, 28, 32, 33). The current data extend the previous finding that TRAF3 is not involved in CD40-mediated NF-{kappa}B activation (Fig. 8GoA) (27, 28, 33) by demonstrating that physiologic processes known to be regulated by NF-{kappa}B (Figs. 7Go and 8GoB) (43, 44), such as GM-CSF secretion, CD54, MHC class II, and CD95 expression, are not affected by interference with TRAF3 signaling. These results are in agreement with the finding that induction of genes regulated by NF-{kappa}B, such as CD80 and CD23, are induced normally in B cells purified from TRAF3-deficient mice compared with that in controls (53).

This report documents that CD40 engagement induces the production of a variety of cytokines from Ramos cells (Fig. 7Go). The potential physiologic relevance of CD40-induced cytokine secretion from Ramos cells is emphasized by the detection of IL-10, TNF-{alpha}, and LT-{alpha} in B cells isolated from secondary lymphoid tissues, a variety of malignancies (83), and sites of inflammation, such as rheumatoid synovium (84, 85). The current data extend earlier studies showing that CD40 engagement increased the secretion of some cytokines (1) by demonstrating that production of a large array of cytokines was stimulated and that CD40-induced secretion of IL-10, TNF-{alpha}, and LT-{alpha}, but not GM-CSF, was partially, but not completely, dependent upon functional TRAF3. This finding suggested that TRAF3 as well as other signaling molecules were likely to be involved in the regulation of cytokine production by Ramos cells.

Transcriptional regulation of IL-10 and LT-{alpha} has not been delineated, so the role of TRAF3-mediated p38 and/or JNK pathways is unclear. However, the presence of NF-{kappa}B sites in these promoters suggests that CD40-induced activation of these genes may be partially regulated by nuclear translocation of NF-{kappa}B, dependent on TRAF2, -5, or -6, along with TRAF3-mediated signaling pathways. Although deletion of the NF-{kappa}B sites in the human TNF-{alpha} promoter did not affect its induction in B cells, optimal transcription has been shown to be mediated by a high affinity NF-AT element and binding of ATF2/Jun to CRE (86, 87). In addition, blocking nuclear translocation of NF-ATc with cyclosporine inhibited CD40-mediated TNF-{alpha} secretion (88, 89). Of interest, analysis of the promoters for IL-10 (90, 91) and LT-{alpha} (92) also revealed potential regulation by CREB. Moreover, previous studies have demonstrated cooperativity between CRE and either AP-1 or NF-{kappa}B sites (43). These findings together with the current results suggest that induction of these transcription factors in B cells (24, 25) via a CD40-mediated, TRAF3-dependent signaling pathway may regulate the secretion of TNF-{alpha} as well as that of other cytokines. Alternatively, or perhaps in parallel, the membrane-proximal, proline-rich JAK3 binding BOX1 motif in the cytoplasmic tail of CD40 (residues 202–209) may contribute to CD40-induced production of LT-{alpha} and other cytokines independently of TRAF2 or TRAF3 (15) and may explain residual cytokine production when TRAF3-mediated signaling is blocked by the DN construct.

Posttranscriptional regulation of cytokines may also be controlled by TRAF3-mediated activation of JNK and/or p38. Of note, TNF-{alpha} (93) mRNA has been shown to be negatively regulated by the AU-rich motif found in the 3'-untranslated region of this gene (94). Both JNK-mediated (95) and p38-mediated (96) signaling events have been demonstrated to be involved in posttranscriptional regulation of TNF-{alpha}. Moreover, TNF-{alpha} production can be blocked at the posttranscriptional level by specific pharmacologic inhibitors of p38 (96, 97). In conjunction, these studies suggest that CD40-induced, TRAF3-mediated signaling involving p38 and/or JNK may be involved in transcriptional and posttranscriptional regulation of the production of cytokines such as TNF-{alpha}.

In summary, the current data link TRAF3-mediated activation of specific kinases with physiologically relevant outcomes. Engagement of CD40 on Ramos B cells regulates Ig, IL-10, TNF-{alpha}, and LT-{alpha} secretion by TRAF3-mediated signaling pathways. Since CD40-mediated p38 activation and control of Ig secretion are entirely dependent upon functional TRAF3, it is possible that this member of the mitogen-activated protein kinase family uniquely regulates CD40-dependent Ig production by Ramos B cells. By contrast, activation of JNK and secretion of IL-10, TNF-{alpha}, and LT-{alpha} following CD40 engagement are partially dependent upon functional TRAF3, implying that signaling via other TRAF family members may be involved.


    Acknowledgments
 
We thank Leah Adix, Jonathan Heaney, Ellis Lightfoot, Pong Satumtira, and Jeff Scholes for excellent technical assistance, as well as Drs. Melanie Cobb, Laurie Davis, Louis Picker, and Don Smith for experimental advice.


    Footnotes
 
1 This work was supported by National Institutes of Health Grant AI31229 (to P.E.L.), American Heart Association Grant 94012650 (to T.D.G.), in part by National Institutes of Health National Cancer Institute Training Grant CA09082 and National Institutes of Health Postdoctoral Training Grant AR07055 (to A.C.G.), and in part by National Research Scientist Aware Postdoctoral Fellowship GM18550 (to J.L.S.). Back

2 Address correspondence and reprint requests to Dr. Peter E. Lipsky, Harold C. Simmons Arthritis Research Center, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX 75235-8884. E-mail address: Back

3 Abbreviations used in this paper: MKK1, mitogen-activated protein kinase kinase; JNK, Jun N-terminal kinase; TRAF, TNF receptor-associated factor; AP-1, activating protein-1; DN, dominant negative; GaMIg, goat anti-mouse immunoglobulin; wt, wild type; CD40L, CD40 ligand; mCD154, murine CD154; GST, glutathione-S-transferase; GM-CSF, granulocyte-macrophage colony-stimulating factor; LT-{alpha}, lymphotoxin-{alpha}; EMSA, electrophoretic mobility-shift assay; LMP1, latent membrane protein-1; CRE, cyclic adenosine 3',5'-monophosphate response element; CREB, cyclic adenosine 3',5'-monophosphate response element binding protein; FLIP, FLICE-inhibitory protein. Back

Received for publication December 8, 1997. Accepted for publication April 1, 1998.


    References
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 

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