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The Journal of Immunology, 1999, 162: 5965-5972.
Copyright © 1999 by The American Association of Immunologists

Differential Induction of Adhesion Molecule and Chemokine Expression by LT{alpha}3 and LT{alpha}ß in Inflammation Elucidates Potential Mechanisms of Mesenteric and Peripheral Lymph Node Development1

Carolyn A. Cuff2, Rosalba Sacca3 and Nancy H. Ruddle4

Department of Epidemiology and Public Health and Section of Immunobiology, Yale University School of Medicine, New Haven, CT 06520


    Abstract
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Lymphotoxin (LT) is a member of the proinflammatory TNF family of cytokines that plays a critical role in the development of lymphoid tissue. It has previously been reported that the presence of the LT{alpha} transgene under the control of the rat insulin promoter results in inflammation at the sites of transgene expression. LT{alpha} transgene expression results in expression of the adhesion molecules VCAM, ICAM, peripheral node addressin (a marker of peripheral lymph nodes), and mucosal addressin cellular adhesion molecule (a marker of mucosal lymphoid tissue, including mesenteric lymph nodes). In this study to determine the mechanisms by which LT promotes inflammation and lymphoid tissue organization, we analyzed the regulation of expression of adhesion molecules and chemokines in LT transgenic mice. The results demonstrate that LT{alpha}3 induces expression of the adhesion molecules VCAM, ICAM, and mucosal addressin cellular adhesion molecule as well as the chemokines RANTES, IFN-inducible protein-10, and monocyte chemotactic protein-1, while LT{alpha}ß is required for the induction of peripheral node addressin that may contribute to the recruitment of L-selectinhigh CD44low naive T cells. These data provide candidate mediators of LT-induced inflammation as well as potential mechanisms by which LT{alpha} and LT{alpha}ß may differentially promote the development of mesenteric and peripheral lymph nodes.


    Introduction
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Inflammation has been shown to play a critical role in autoimmune diseases such as multiple sclerosis (MS)5 and insulin-dependent diabetes mellitus (IDDM), with the inflammatory process causing tissue damage to the CNS and pancreas, respectively. In the course of investigating the mechanisms of lymphotoxin (LT)-induced inflammation, we observed that chronic inflammation exhibits several features characteristic of organized lymphoid tissue (1). Similar observations in autoimmune-induced inflammation include the presence of aggregates that histologically resemble primary and secondary lymphoid follicles (2), compartmentalization of these aggregates into distinct B and T cell zones (3), and high endothelial venules (MS, IDDM) that express the adhesion molecules MAdCAM and PNAd (4, 5). These aggregates form tertiary lymphoid organs through a process we have termed lymphoid neo-organogenesis (3).

LT{alpha} (TNFß) is a member of the TNF family of cytokines that also includes TNF-{alpha} and LTß. LT is produced as both a secreted LT{alpha} homotrimer as well as an LT{alpha}ß heterotrimeric complex expressed on the surface of activated lymphocytes. LT{alpha}3 interacts with both TNFR1 and TNFR2, while the LT{alpha}1ß2 complex interacts with LTßR (reviewed in 6). In addition to its proinflammatory effects, LT plays a critical role in lymphoid organ development. Mice genetically deficient in LT{alpha} lack peripheral and mesenteric lymph nodes (LN) and Peyer’s patches (PP) and have a disrupted splenic architecture (7, 8). These effects are mediated in part by the LT{alpha}ß heterotrimeric complex, as mice genetically deficient in LTß also have a disrupted splenic architecture and lack PP and peripheral LN (9, 10). However, interestingly, these mice still have mesenteric LN, suggesting a possible role for LT{alpha}3 in promoting the development of these lymph nodes. Data obtained with various combinations of knockout mice and agonist Abs now suggest that LT{alpha}3 acting through TNFR1 and LT{alpha}ß can contribute to the development of the mesenteric LNs (11, 12).

We have developed a mouse model of chronic inflammation in which LT is expressed under the control of the rat insulin promoter (RIPLT) (13). These mice develop inflammation of the pancreas and kidney at the sites of transgene expression. In addition, these infiltrates exhibit the characteristics of lymphoid tissue noted above, including lymphoid aggregates, the presence of APC (macrophages, follicular dendritic cells, and interdigitating dendritic cells), and high endothelial venules that express the lymph node addressins MAdCAM and PNAd (3). Our data are consistent with the idea that this local infiltrate can respond to antigenic challenge as the B cells produce Abs and undergo class switching after immunization with exogenous Ag (3). The similarities between RIPLT-inflamed tissues and lymphoid tissue, whose development is also driven by LT, suggests that the mechanisms of lymphoid neo-organogenesis observed in chronic inflammation may be similar to those of lymphoid organogenesis during embryonic development.

In the present study we have employed the RIPLT mouse model to investigate the mechanisms by which chronic inflammation is initiated and becomes organized into lymphoid tissue. Toward that end, we have analyzed the regulation of adhesion molecule and chemokine expression in RIPLT mice. The data presented here demonstrate that LT{alpha}, in the absence of LTß, induces the expression of the adhesion molecules VCAM, ICAM, and the mucosal addressin, MAdCAM, while LT{alpha}ß may contribute to the recruitment of naive T cells at least in part through its ability to induce the peripheral node addressin, PNAd. Further, the LT{alpha} transgene induces the expression of several chemokines at the sites of transgene expression. This effect is dependent upon interaction with TNFR1, not LTßR. These data provide insight into the mechanisms by which LT mediates both pathogenic and developmental processes.


    Materials and Methods
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Animals

Mice transgenic for the rat insulin promoter driving the murine lymphotoxin-{alpha} gene (RIPLT) have previously been described (13). These mice were bred to mice deficient in RAG2 (RAG2-/-; provided by Dr. David Schatz) (14), TNFR1 (TNFR1-/-; provided by Dr. Werner Lesslauer) (15), or LTß (LTß-/-) (9). All animals were housed under specific pathogen-free conditions at Yale University (New Haven, CT). At least three mice of each genotype were analyzed between 5 and 12 wk of age.

RNase protection analysis

Total RNA was isolated from the kidneys of 5-wk-old mice using Tri-Reagent (Molecular Research Center, Cincinnati, OH) according to the manufacturer’s recommendations. Chemokine mRNA levels were determined using the Riboquant Multiprobe RNase Protection Assay System (PharMingen, San Diego, CA). 32P-labeled riboprobes were synthesized from the plasmid template set using T7 polymerase, after which the DNA template was digested with DNase. Ten micrograms of total kidney RNA was hybridized with the riboprobes in a 10-µl volume overnight at 56°C. The following day, ssRNA species were removed by digestion with RNase A at 37°C for 45 min. Following phenol/chloroform extraction, the protected RNA species were ethanol precipitated, resuspended in loading buffer, and electrophoresed on a 5% polyacrylamide gel. Protected chemokine probes were visualized by autoradiography of the dried gel, and the level of mRNA expression was quantified by densitometric analysis using ImageQuant software (Molecular Dynamics, Sunnyvale, CA).

Protein analysis

Chemokine protein expression in the kidney was assessed by ELISA. Lysates of whole kidney were prepared by homogenization in lysis buffer containing 1 mM PMSF (Sigma, St. Louis, MO), 100 µg/ml soybean trypsin inhibitor (Sigma), 100 µg/ml aprotinin (Sigma), 100 µg/ml leupeptin (Boehringer Mannheim, Indianapolis, IN), 1% Nonidet P-40 (Sigma), and 0.1% deoxycholate (Sigma) in calcium- and magnesium-free PBS. RANTES protein was measured using sandwich ELISA purchased from R&D Systems (Minneapolis, MN), and monocyte chemoattractant protein-1 (MCP-1) was measured with matched Ab pairs purchased from PharMingen according to the manufacturer’s recommendations. Data were normalized to the amount of total protein in the kidney lysate as determined by bicinchoninic acid protein assay (Pierce, Rockford, IL). Reagents were not available to measure IP-10 protein levels.

Immunohistochemistry

Pancreas and kidney were dissected and immediately snap-frozen in OCT compound (Miles, Elkhart, IN). Sections of 5 µm were cut and stored at -20°C. Sections were air-dried for 10 min at room temperature, fixed in 100% acetone, and blocked with 3% BSA in 0.1 M phosphate buffer. Primary Abs were diluted in 1% BSA in 0.1 M phosphate buffer and incubated for 1–2 h at room temperature. Biotinylated species-specific secondary Abs (Vector, Burlingame, CA) diluted 1/250 were then incubated for 30 min at room temperature, followed by alkaline phosphatase-conjugated AB (Vector) for 30 min according to the manufacturer’s recommendations. Biotinylated primary Abs were reacted directly with AB complex. Enzymatic reactivity was visualized using Vector Red with 100 mM levamisole added to inhibit endogenous alkaline phosphatase activity. In all experiments a species-specific irrelevant Ab was used as a control for nonspecific reactivity. Tissues were counterstained with 3% methyl green. Dr. Eugene Butcher provided Abs to PNAd (MECA 79) and MAdCAM (MECA 367) as cell culture supernatants that were used at a dilution of 1/5. Rabbit anti-factor VIII-specific Ab was purchased from Dako (Carpinteria, CA) and was used at a dilution of 1/200. Biotinylated hamster anti-MCP-1 was purchased from PharMingen and was used at a concentration of 50 µg/ml. The macrophage marker BM8 was purchased from Accurate (Westbury, NY) and was used at a concentration of 5 µg/ml.

Statistics

Data were analyzed by Student’s t test, and p < 0.05 was considered significant.


    Results
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
LTß regulates the recruitment of naive T cells through PNAd expression

The RIPLT transgene induces an infiltrate in both the pancreas and kidney, which are the sites of transgene expression. This infiltrate consists of memory and naive T cells (16), B cells, macrophages, and dendritic cells (3). We have previously determined that the LT{alpha}ß complex contributes to the recruitment of CD44low, L-selectinhigh naive cells as fewer of these cells were detected in the kidneys of RIPLT.LTß-/- than in those of RIPLT wild-type (wt) mice (16). Since alterations in the expression of adhesion molecules on the inflamed vasculature contribute to the recruitment of naive and memory cells (17), we analyzed the regulation of MAdCAM, PNAd, ICAM, and VCAM in RIPLT.wt and RIPLT.LTß-/- animals. We have previously demonstrated that the adhesion molecules ICAM and VCAM are up-regulated in the blood vessels near the islets of RIPLT.wt animals (3) as are the vascular addressins MAdCAM and PNAd (Fig. 1Go, A and C). ICAM, VCAM, and MAdCAM expression were also induced by the RIPLT transgene in RAG2-/- mice in the absence of a lymphocytic infiltrate (3) as well as in vitro by recombinant murine and human LT{alpha} (18, 19). Here we evaluated whether adhesion molecule expression in vivo was regulated by LT{alpha}3 or the LT{alpha}ß complex. Comparable levels of MAdCAM were expressed within the vessels of the inflamed pancreas in RIPLT.wt and RIPLT.LTß-/- mice (Fig. 1Go, A and B). However, in RIPLT.LTß-/- mice, no expression of PNAd was apparent (Fig. 1GoD) despite the detection of vessels in a serial section with an Ab to factor VIII that reacts with endothelial cells (Fig. 1GoF). Furthermore, although PNAd expression was detected in RIPLT.wt kidneys in the vessels near the infiltrate (Fig. 1GoG), no PNAd expression was detected in the kidneys of RIPLT.LTß-/- mice (Fig. 1H). ICAM and VCAM were expressed at a similar level in RIPLT.LTß-/- inflamed tissues compared with their expression in RIPLT.wt tissues (data not shown). These data together suggest that LT{alpha}3, not LT{alpha}ß, is required for MAdCAM-1, VCAM-1, and ICAM-1 expression in RIPLT-inflamed tissues. In contrast, LT{alpha}ß is required for PNAd expression. LT{alpha} may induce adhesion molecules through multiple receptors. One candidate is TNFR1. RIPLT.TNFR1-/- mice lack the infiltrate observed in RIPLT.wt mice (16), and the expression of VCAM-1, ICAM-1, and MAdCAM-1 was markedly reduced in these mice (data not shown), suggesting a role for TNFR1 in the induction of adhesion molecule expression by LT{alpha}3.



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FIGURE 1. LTß is required for PNAd, but not MAdCAM, expression. Immunohistochemistry of inflamed tissues of RIPLT.wt (A, C, and E) and RIPLT.LTß-/- (B, D, and F) mice. MAdCAM is expressed in the vessels of inflamed pancreas in both RIPLT.wt (A) and RIPLT.LTß-/- (B) mice. PNAd is expressed in inflamed vessels of RIPLT.wt (C), but not RIPLT.LTß-/- (D), mice. Serial section of the pancreas of an RIPLT.LTß-/- mouse demonstrates the location of factor VIII-positive vessels (F). Incubation of pancreas with isotype-matched irrelevant Ab demonstrates the level of nonspecific reactivity (E). PNAd was expressed in the vessels around the infiltrate of RIPLT.wt kidneys (G), but was undetectable in the kidneys of RIPLT.LTß-/- mice (H). Magnification of all panels, x125.

 
RANTES, IP-10, and MCP-1 are candidate mediators of LT-induced iflammation

The recruitment of leukocytes is also regulated through the expression of individual chemokines (20). To determine which chemokines may participate in the recruitment of infiltrating cells to RIPLT-inflamed tissues, we performed multiprobe RNase protection analysis with a set of chemokine probes that detects lymphotactin (Ltn), RANTES, eotaxin, MIP-1{alpha}, MIP-1ß, MIP-2, IP-10, MCP-1, and TCA-3 on RNA purified from the RIPLT kidney. These analyses indicated that the levels of RANTES, IP-10, and MCP-1 mRNA were all elevated in the inflamed kidney compared with those in nontransgenic littermates (Fig. 2Go). Densitometric analyses in which the levels of chemokines were normalized to the housekeeping gene GAPDH indicated that RANTES mRNA levels were elevated 6.5-fold above those in wt controls, while IP-10 and MCP-1 mRNA levels were increased 18- and 30-fold, respectively (Fig. 3GoA). There was no consistent increase in the other chemokines analyzed, including MIP-1{alpha}, MIP-1ß, and Ltn, although these were also variably elevated in some experiments. To determine which chemokines were induced directly by LT and which were secondary to inflammation, we analyzed the chemokine profile in RIPLT mice on a RAG2-/- background. We have previously shown that these mice, which lack mature B and T cells, have a much reduced infiltrate in the pancreas and kidney. Densitometric analysis of the autoradiogram shown in Fig. 2Go as well as data from other experiments indicated that IP-10 and MCP-1 mRNA expression was elevated 3-fold above the level detected in nontransgenic littermates. RANTES mRNA, however, was not induced, indicating that at least some of its expression was secondary to inflammation (Figs. 2Go and 3GoB). The infiltrate also influenced IP-10 and MCP-1 production, as these mRNAs were further increased following infiltration by T and B lymphocytes.



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FIGURE 2. The presence of the LT{alpha} transgene results in the expression of chemokines RANTES, IP-10, and MCP-1. RNA from kidneys of RIPLT.wt or RIPLT.RAG2-/- mice and nontransgenic littermates was purified, and chemokine mRNA expression was analyzed by multiprobe RNase protection assay. Note that the size of protected riboprobes is smaller than that of the unprotected riboprobe.

 


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FIGURE 3. RIPLT transgene induces the expression of IP-10 and MCP-1, while RANTES expression is secondary to lymphocytic infiltration. Densitometric analysis of mRNA expression of RANTES, IP-10, and MCP-1 in the kidneys of RIPLT.wt (A) and RIPLT.RAG2-/- (B) mice. Data are expressed as fold induction above levels detected in nontransgenic littermates (n = 3 experiments).

 
Chemokine protein analysis

To determine whether the elevations in chemokine mRNA levels resulted in increases in protein production, we measured RANTES and MCP-1 protein expression from whole kidney lysates of RIPLT and nontransgenic mice. As shown in Fig. 4Go, nontransgenic mice express very low levels of RANTES protein (60 pg/ml). The RIPLT transgene induced the RANTES protein level to 3.6 ng/ml (p < .001). Similarly, kidneys of nontransgenic animals expressed a baseline level of MCP-1 (5.4 ng/ml), and this was elevated in the kidney lysates of RIPLT animals to 20.6 ng/ml (p < 0.02).



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FIGURE 4. RIPLT transgene induces RANTES and MCP-1 protein expression. Kidney lysates from wt and RIPLT were analyzed for RANTES (A) and MCP-1 (B) by ELISA. RIPLT transgenic mice expressed elevated levels of both chemokines relative to those detected in nontransgenic control mice (n = 3; *, p < 0.001; **, p < 0.02).

 
The islets are the source of MCP-1 in RIPLT-induced inflammation

Chemokines can be produced by both inflammatory cells as well as nonhemopoietic resident cells. To investigate which cells were the source of chemokines in RIPLT-induced inflammation, we performed immunohistochemistry for the chemokine MCP-1 in the pancreas of LT transgenic and nontransgenic littermates. Frozen sections of the pancreas were unreactive with a biotinylated isotype control Ab (Fig. 5GoA), and no MCP-1 reactivity was detected in the pancreas of nontransgenic mice (Fig. 5GoB). However, the RIPLT.wt pancreas stained intensely for MCP-1 (Fig. 5GoC). This MCP reactivity was restricted to the islets; the lymphocytic infiltrate that surrounds the islets was not reactive for MCP-1. To further discriminate between MCP-1 production by inflammatory cells vs resident cells, we analyzed the expression of this chemokine in RIPLT.RAG2-/- mice. As shown in Fig. 5Go, MCP-1 expression in these animals was similarly restricted to the islets of Langerhans (Fig. 5GoD).



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FIGURE 5. Islet production of MCP-1 correlates with recruitment of macrophages. Immunohistochemistry of pancreas from RIPLT.wt (A, C, E, andG), RIPLT.RAG2-/- (D andF), or RAG2-/- (B andH) mice reacted with isotype-matched irrelevant Abs (A and G), anti-MCP-1 (B–D), or the macrophage marker BM8 (E, F, and H). Immunoreactivity was visualized with Vector Red substrate, and the tissue was counterstained with methyl green. No immunoreactivity was detected in the pancreas of a RIPLT.wt mouse reacted with irrelevant Ab (A) or that of a nontransgenic RAG2-/- littermate incubated with anti MCP-1 Ab (B). Pancreata of RIPLT.wt (C) and RIPLT.RAG2-/- (D) mice demonstrate intense reactivity for MCP-1 within the islets of Langerhans. BM8+ macrophages encircle and infiltrate the islets of RIPLT.wt mice (E) and RIPLT.RAG2-/- mice (F). Isotype-matched irrelevant Ab reacted with the pancreas of an RIPLT.wt mouse (G). BM8+ macrophages are distributed randomly in nontransgenic pancreas (H). Magnification of all panels, x62.5.

 
Since MCP-1 has been reported to be chemotactic for monocytes in vitro (21, 22) and in vivo (23, 24), we analyzed the spatial relationship between the macrophage infiltrate and the chemokine-producing islet cells. Immunohistochemistry with the macrophage marker BM8 indicated that the macrophages in the pancreata of RIPLT.wt and RIPLT.RAG2-/- mice were localized around the islet, with several BM8+ cells infiltrating the islet (Fig. 5Go, E and F), suggesting a directed migration of macrophages to the islets. This is in contrast to the situation observed in nontransgenic animals in which macrophages were distributed randomly throughout the pancreas (Fig. 5GoH).

Chemokine expression is dependent upon TNFR1, but not LTß receptor

We have previously demonstrated that TNFR1 is essential for the induction of RIPLT-induced inflammation, whereas TNFR2 plays no obvious role in RIPLT-induced inflammation (16). To determine whether the mechanism of TNFR1-mediated inflammation included up-regulation of the chemokines, we analyzed the chemokine expression pattern in RIPLT.TNFR1-/- mice. While the baseline expression of RANTES, IP-10, and MCP-1 mRNAs in TNFR1-/- mice was comparable to that in wild-type animals, none of these chemokines was up-regulated in RIPLT.TNFR1-/- transgenic littermates (Fig. 6Go), indicating an essential role for that receptor in the induction of these chemokines.



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FIGURE 6. TNFR1 is essential for the induction of RANTES, IP-10, and MCP-1 by the RIPLT transgene. RNase protection analysis of RNA from kidneys of RIPLT.wt, RIPLT.TNFR1-/-, and nontransgenic littermates. Yeast transfer RNA serves as a control for nonspecific hybridization to riboprobes.

 
Recently, LT{alpha}ß has been reported to induce RANTES expression in melanoma cells (25). To analyze whether LT{alpha}ß contributes to the induction of RANTES and/or other chemokines in the RIPLT model, the chemokine expression profile was analyzed in RIPLT.LTß-/- mice. The mRNA expression profile of these chemokines in RIPLT.LTß-/- mice was comparable to that in RIPLT.wt mice (Fig. 7Go), with a similar up-regulation of RANTES, IP-10, and MCP-1. Densitometric analysis of shorter exposures of the gel shown in Fig. 7Go demonstrated equivalent levels of RANTES, IP-10, and MCP-1 mRNA expression in RIPLT.LTß-/- kidneys compared with that in RIPLT.LTß+/- littermates and with that in RIPLT.wt kidneys. In addition, immunohistochemical analysis of RIPLT.LTß-/- pancreas indicated that MCP-1 protein was expressed within the islets of Langerhans in the same pattern as that detected in RIPLT.wt mice (data not shown). These data suggest that LTß is not needed for the induction of RANTES, IP-10, and MCP-1 in RIPLT mice.



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FIGURE 7. LTß is not necessary for the induction of RANTES, IP-10, or MCP-1 by the RIPLT transgene. RNase protection analysis of RNA from kidneys of RIPLT.LTß-/- mice and nontransgenic littermates. Yeast transfer RNA serves as a control for nonspecific hybridization to riboprobes.

 

    Discussion
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
In this study evaluating the mechanisms of LT-induced inflammation, we demonstrate that LT{alpha}3 and LT{alpha}ß differentially regulate adhesion molecule expression. LT{alpha}3 induces the up-regulation of the adhesion molecules VCAM-1, ICAM-1, and MAdCAM, while the LT{alpha}ß complex is required for the induction of the adhesion molecule PNAd that may contribute to the recruitment of L-selectinhigh naive T cells to the infiltrate. We further demonstrate that LT{alpha}3, not LT{alpha}ß, induces expression of the chemokines RANTES, IP-10, and MCP-1. These data elucidate the mechanisms of LT-induced inflammation and also potential pathways of LT-induced lymphoid organogenesis. They suggest that LT{alpha}3 may promote the development of all LN in part through the induction of MAdCAM-1, while LT{alpha}ß may promote the development of peripheral lymph nodes by inducing a distinct set of inflammatory mediators that includes PNAd.

Adhesion molecule induction is a necessary event in the recruitment of inflammatory cells to sites of inflammation. In fact, the nature of the inflammatory response is regulated in part by the expression of adhesion molecules (17). These studies demonstrate that both LT{alpha}3 and LT{alpha}ß regulate adhesion molecule expression in endothelial cells. We have previously demonstrated that RIPLT mice crossed onto a RAG2-/- background lacking mature lymphocytes still express VCAM, ICAM, and MAdCAM in the absence of a lymphocytic infiltrate, suggesting that the LT{alpha} transgene itself induces the expression of these molecules. The data presented here, which demonstrate persistent expression in the absence of LTß, support a role for LT{alpha}3 in the induction of these inflammatory mediators and are consistent with in vitro data in which recombinant murine LT{alpha}3 induces the expression of VCAM, ICAM, and MAdCAM in a murine endothelial cell line (18). VCAM and ICAM have been shown to mediate the adhesion of macrophages and T cells to endothelial cells both in vitro and in vivo at sites of inflammation (reviewed in 26), while MAdCAM has been shown to mediate the trafficking of both naive and memory T cells to mesenteric LN and PP (27). The expression of MAdCAM within the RIPLT-inflamed tissues may contribute to the recruitment of the naive mucosal lymphoid cells to tissues of both RIPLT.wt and RIPLT.LTß-/- mice. Interestingly, the LT{alpha}ß complex is necessary for the expression of the L-selectin ligand PNAd within RIPLT-inflamed tissues. This adhesion molecule is a marker for peripheral LN and has been demonstrated to mediate the recruitment of L-selectin+ naive T cells. In fact, expression of this adhesion molecule correlates with the recruitment of L-selectinhigh naive T cells into the inflamed kidney (16). The absence of PNAd expression in the inflamed vasculature of RIPLT.RAG2-/- mice (3) further suggests that production of LT{alpha}ß by the infiltrating lymphocytes may induce the expression of this vascular addressin.

The similarities between RIPLT-induced inflammation and LT-induced lymphoid organ development suggest that these two processes may have overlapping mechanisms. We have shown that LT{alpha}3 is a potent inducer of MAdCAM expression in vivo (this study) and in vitro (18). It has previously been demonstrated that MAdCAM is expressed on high endothelial venules in the developing mesenteric LN and peripheral LN of perinatal animals (28), while PNAd is induced following population of the LN by a CD4+CD3-LT{alpha}ß+ cell (29). In addition, treatment of LT{alpha}-/- mice with an agonist Ab to LTßR induces the formation of pLN with a transient induction of PNAd (12), further supporting the idea that LT{alpha}ß is an important inducer of PNAd in vivo. We propose that induction of MAdCAM by LT{alpha}3 may be an early event in the development of all lymph nodes, and while PNAd expression is not essential for LN development (30), the LT{alpha}ß/LTßR interaction may induce additional mediators that are critical for LN development.

The present study also demonstrates that a select group of chemokines is up-regulated in response to the LT transgene. IP-10 and MCP-1 are regulated directly by LT{alpha} or a downstream cytokine, as they are induced in RIPLT.RAG2-/- mice that lack a mature T and B cell infiltrate. These particular chemokines may play a role in the initiation of LT-induced inflammation, since both have been shown to recruit T cells in vitro (31, 32). In addition, MCP-1 is a potent chemotactic agent for monocytes and macrophages (21, 22, 23, 24).

In the RIPLT model, MCP-1 is produced in the islets of Langerhans, and its expression correlates with the accumulation of macrophages that both encircle and infiltrate the islet. Of particular note is the ability of the islets themselves to produce chemokines in response to LT{alpha}. Inflammation of the pancreas can occur following microbial infection or as part of the autoimmune process in IDDM. In the latter case, the pancreas is infiltrated by macrophages and lymphocytes that inappropriately recognize the islet cells as foreign and destroy them. However, the mechanisms by which the cells are initially recruited to the islets are unknown. Our results demonstrate that the islets themselves can produce the chemokine MCP-1, which may then contribute to the recruitment of inflammatory cells. Immunohistochemical analysis does not definitively demonstrate the source of chemokine production, as these molecules are matrix binding proteins and adhere to both matrix and to surrounding cells that express the appropriate chemokine receptors. The nature of the MCP-1-producing cells is not known. It could be produced by the {alpha}-cells, the ß-cells, underlying stroma, and/or the infiltrating macrophages. It appears that the islets themselves, rather than the infiltrating cells, are producing MCP-1. While macrophages reside within RIPLT-inflamed islets, they and the macrophages with the same morphologic and histochemical phenotype (BM8+) surrounding the islet are not immunoreactive for MCP-1. We consider it unlikely that the chemokines would be selectively produced by the infiltrating macrophages.

These studies support our previous observations that the LT{alpha}3/TNFR1 interaction is crucial for the inflammatory process observed in RIPLT mice (16). The induction of IP-10 and MCP-1 by LT{alpha}3 in this in vivo model is also supported by the recent demonstration of induction of these same chemokines by LT treatment in a murine endothelial cell line (18). Although recombinant LT{alpha}ß was shown to induce RANTES and IL-8 expression through the LTßR in a human melanoma cell line (25), and LT{alpha}ß may contribute to chemokine production in vivo as well, we did not find that LT{alpha}ß was necessary for the induction of RANTES, IP-10, or MCP-1 in RIPLT-induced inflammation. It is possible that additional chemokines not analyzed in this study are induced by LT{alpha} and/or LT{alpha}ß and may also contribute to the inflammation observed. However, to definitively elucidate the precise role of the chemokines in LT-induced inflammation, further studies, including the use of blocking Abs or the generation of RIPLT mice deficient in the various chemokine genes, will need to be performed.

LT-induced expression of chemokines may also play a role in lymphoid organogenesis. One chemokine receptor, BLR1, is involved in compartmentalization of B cells within lymphoid tissue and the development of lymph nodes (33), possibly through interaction with a recently identified ligand (34, 35). Several other chemokines have also recently been shown to be preferentially expressed within lymphoid tissue (BLC, SLC, ELC, and DC-CK1) and may play a role in regulating the migration of cells within the lymphoid compartment. It has recently been shown that LT{alpha}, LTß, and TNF-{alpha} contribute to the expression of BLC, and that LT{alpha} and LTß contribute to the expression of SLC and ELC within the spleen (36). With this in mind, it will be interesting to determine whether LT can induce these lymphoid-associated chemokines in inflammation and/or whether LT-induced IP-10 or MCP-1 plays a role in lymphoid organ development.

In summary, these data demonstrate that LT induces the expression of a select set of chemokines and adhesion molecules at the site of transgene expression. While LTß is not required for expression of these chemokines, it is required for induction of the peripheral node addressin PNAd in RIPLT-inflamed tissues. These results suggest that LT contributes to inflammatory processes in the adult mouse and lymphoid organogenesis during development through regulation of adhesion molecule and chemokine expression.


    Acknowledgments
 
We thank Dr. Eugene Butcher for the generous gift of MECA 79 and MECA 367 Abs. We also thank Cheryl Bergman for assistance in manuscript preparation and technical expertise.


    Footnotes
 
1 This work was supported by National Cancer Institute Grant R01CA16885 and National Institutes of Health Grant RO1AI34405 (to N.H.R.), the National Institutes of Health Office of Research on Women’s Health/Scientists Re-Entry Program Fellowship (to R.S.), and National Institutes of Health Grant 5T32AI07019–20 (to C.C.). Back

2 Current address: The Wistar Institute, 3601 Spruce St., Philadelphia, PA 19104. Back

3 Current address: Department of Genetic Technologies, Central Research Division, Pfizer, Inc., Groton, CT 06340. Back

4 Address correspondence and reprint requests to Dr. Nancy H. Ruddle, Department of Epidemiology and Public Health, Yale University School of Medicine, 60 College St., P.O. Box 208034, New Haven, CT 06520-8034. E-mail address: Back

5 Abbreviations used in this paper: MS, multiple sclerosis; IDDM, insulin-dependent diabetes mellitus; LT, lymphotoxin; MAdCAM, mucosal addressin cellular adhesion molecule; PNAd, peripheral node addressin; LN, lymph node; PP, Peyer’s patch; RIP, rat insulin promoter; RAG, recombination-activating gene; MCP, monocyte chemotactic protein; IP-10, IFN-inducible protein-10; wt, wild type; Ltn, lymphotactin; MIP, macrophage inflammatory protein. Back

Received for publication December 11, 1998. Accepted for publication March 3, 1999.


    References
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 

  1. Sacca, R., A. Kratz, A. Campos-Neto, M. S. Hanson, N. H. Ruddle. 1996. Lymphotoxin: from chronic inflammation to lymphoid organs. J. Inflamm. 47:81.
  2. Mooij, P., H. J. D. Wit, H. A. Drexhage. 1993. An excess of dietary iodine accelerates the development of a thyroid-associated lymphoid tissue in autoimmune prone BB rats. Clin. Immunol. Immunopathol. 69:189.[Medline]
  3. Kratz, A., A. Campos-Neto, M. S. Hanson, N. H. Ruddle. 1996. Chronic inflammation caused by lymphotoxin is lymphoid neogenesis. J. Exp. Med. 183:1461.[Abstract/Free Full Text]
  4. Cannella, B., A. H. Cross, C. S. Raine. 1990. Upregulation and co-expression of adhesion molecules correlate with relapsing autoimmune demyelination in the central nervous system. J. Exp. Med. 172:1521.[Abstract/Free Full Text]
  5. Faveeuw, C., M.-C. Gagnerault, F. Lepault. 1994. Expression of homing and adhesion molecules in infiltrated islets of Langerhans and salivary glands of nonobese diabetic mice. J. Immunol. 152:5969.[Abstract]
  6. Ware, C. F., T. L. VanArsdale, P. D. Crowe, J. L. Browning. 1995. The ligands and receptors of the lymphotoxin system. G. M. Griffiths, and J. Tschopp, eds. Pathways for Cytolysis 175. Springer-Verlag, Basel.
  7. De Togni, P., J. Goellner, N. H. Ruddle, P. R. Streeter, A. Fick, S. Mariathasan, S. C. Smith, R. Carlson, L. P. Shornick, J. Strauss-Schoenberger, et al 1994. Abnormal development of peripheral lymphoid organs in mice deficient in lymphotoxin. Science 264:703.[Abstract/Free Full Text]
  8. Banks, T. A., B. T. Rouse, M. K. Kerley, P. J. Blair, V. L. Godfrey, N. A. Kuklin, D. M. Bouley, J. Thomas, S. Kanangat, M. L. Mucenski. 1995. Lymphotoxin-{alpha}-deficient mice: effects on secondary lymphoid organ development and humoral immune responsiveness. J. Immunol. 144:1685.
  9. Koni, P. A., R. Sacca, P. Lawton, J. L. Browning, N. H. Ruddle, R. A. Flavell. 1997. Distinct roles in lymphoid organogenesis for lymphotoxins {alpha} and ß revealed in lymphotoxin ß-deficient mice. Immunity 6:491.[Medline]
  10. Alimzhanov, M. B., D. V. Kuprash, M. H. Kosco-Vilbois, A. Luz, R. L. Turetskaya, A. Tarakhovsky, J. Rajewsky, S. A. Nedospasov, K. Pfeffer. 1997. Abnormal development of secondary lymphoid tissues in lymphotoxin ß-deficient mice. Proc. Natl. Acad. Sci. USA 94:9302.[Abstract/Free Full Text]
  11. Koni, P., R. Flavell. 1998. A role for tumor necrosis factor receptor type 1 in gut-associated lymphoid tissue development: genetic evidence of synergism with lymhotoxin ß. J. Exp. Med. 187:1977.[Abstract/Free Full Text]
  12. Rennert, P., D. James, F. Mackay, J. Browning, P. Hochman. 1998. Lymph node genesis is induced by signaling through the lymphotoxin ß receptor. Immunity 9:71.[Medline]
  13. Picarella, D. E., A. Kratz, C.-b. Li, N. H. Ruddle, R. A. Flavell. 1992. Insulitis in transgenic mice expressing TNF-ß (lymphotoxin) in the pancreas. Proc. Natl. Acad. Sci. USA 89:10036.[Abstract/Free Full Text]
  14. Shinkai, Y., G. Rathbun, K.-P. Lam, E. Oltz, V. Stewart, M. Mendelsohn, J. Charron, M. Datta, F. Young, A. Stall, et al 1992. Rag-2-deficient mice lack mature lymphocytes owing to inability to initiate V(D)J rearrangement. Cell 68:855.[Medline]
  15. Rothe, J., W. Lesslauer, H. Lotscher, Y. Lang, P. Koebel, F. Kontgen, A. Althage, R. Zinkernagel, M. Steinmetz, H. Bluethmann. 1993. Mice lacking the tumour necrosis factor receptor 1 are resistant to TNF-mediated toxicity but highly susceptible to infection by Listeria monocytogenes. Nature 363:798.
  16. Sacca, R., C. A. Cuff, N. H. Ruddle. 1998. Differential activities of secreted LT{alpha}3 and membrane LT{alpha}1ß2 in lymphotoxin-induced inflammation: critical role of TNFR1 signalling. J. Immunol. 160:485.[Abstract/Free Full Text]
  17. Springer, T.. 1994. Traffic signals for lymphocyte recirculation and leukocyte emigration: the multistep paradigm. Cell 76:301.[Medline]
  18. Cuff, C. A., J. Schwartz, C. M. Bergman, K. Russell, J. Bender, N. H. Ruddle. 1998. Lymphotoxin {alpha}3 induces chemokines and adhesion molecules: insight into the role of LT{alpha} in inflammation and lymphoid organ development. J. Immunol. 161:485.
  19. Sikorski, E. E., R. Hallmann, E. L. Berg, E. C. Butcher. 1993. The Peyer’s patch high endothelial receptor for lymphocytes, the mucosal vascular addressin, is induced on a murine endothelial cell line by tumor necrosis factor-{alpha} and IL-1. J. Immunol. 151:5239.[Abstract]
  20. Rollins, B. J.. 1997. Chemokines. Blood 90:909.[Free Full Text]
  21. Yoshimura, T., E. A. Robinson, S. Tanaka, E. Appella, E. J. Leonard. 1989. Purification and amino acid analysis of two human monocyte chemoattractants produced by phytohemagglutinin-stimulated human blood mononuclear leukocytes. J. Immunol. 142:1956.[Abstract]
  22. Rollins, B., A. Walz, M. Baggiolini. 1991. Recombinant MCP-1/JE induces chemotaxis, calcium flux, and the respiratory burst in human monocytes. Blood 78:1112.[Abstract/Free Full Text]
  23. Grewal, I. S., B. J. Rutledge, J. A. Fiorillo, L. Gu, R. P. Gladue, R. A. Flavell, B. J. Rollins. 1997. Transgenic monocyte chemoattractant protein-1 (MCP-1) in pancreatic islets produces monocyte-rich insulitis without diabetes: abrogation by a second transgene expressing systemic MCP-1. J. Immunol. 159:401.[Abstract]
  24. Gunn, M., N. Nelken, X. Lian, L. Williams. 1997. Monocyte chemoattractant protein-1 is sufficient for the chemotaxis of monocytes and lymphocytes in trans- genic mice but requires an additional stimulus for inflammatory activation. J. Immunol. 158:376.[Abstract]
  25. Degli-Esposti, M. A., T. Davis-Smith, W. S. Din, P. J. Smolak, R. G. Goodwin, C. A. Smith. 1997. Activation of the lymphotoxin ß receptor by cross-linking induces chemokine production and growth arrest in A375 melanoma cells. J. Immunol. 158:1756.[Abstract]
  26. Carlos, T. A., J. M. Harlan. 1994. Leukocyte-endothelial adhesion molecules. Blood 84:2068.[Abstract/Free Full Text]
  27. Williams, N., E. C. Butcher. 1997. Homing of naive and memory T lymphocyte subsets to Peyer’s patches, lymph nodes, and spleen. J. Immunol. 159:1746.[Abstract]
  28. Mebius, R. E., P. R. Streeter, S. Michie, E. C. Butcher, I. L. Weissman. 1996. A developmental switch in lymphocyte homing receptor and endothelial vascular addressin expression regulates lymphocyte homing and permits CD4+ CD3- cells to colonize lymph nodes. Proc. Natl. Acad. Sci. USA 93:11019.[Abstract/Free Full Text]
  29. Mebius, R., P. Rennert, I. Weissman. 1997. Developing lymph nodes collect CD4+ CD3- LTß+ cells that can differentiate to APC, NK cells, and follicular cells, but not T or B cells. Immunity 7:493.[Medline]
  30. Thall, M., B. Petryniak, C. Rogers, P. Smith, R. Marks, R. Kelly, K. Gersten, G. Cheng, T. Saunders, S. Camper, et al 1996. The {alpha}(1, 3) fucosyltransferase Fuc-TVII controls leukocyte trafficking through an essential role in L-, E-, and P-selectin ligand biosynthesis. Cell 86:643.[Medline]
  31. Taub, D., D. Longo, W. Murphy. 1996. Human interferon-inducible protein-10 induces mononuclear cell infiltration in mice and promotes the migration of human T lymphocytes into the peripheral tissues and human peripheral blood lymphocytes-SCID mice. Blood 87:1423.[Abstract/Free Full Text]
  32. Carr, M. W., S. J. Roth, E. Lutler, S. S. Rose, T. A. Springer. 1994. Monocyte chemoattractant protein 1 acts as a T lymphocyte chemoattractant. Proc. Natl. Acad. Sci. USA 91:3652.[Abstract/Free Full Text]
  33. Forster, R., A. E. Mattis, E. Kremmer, E. Wolf, G. Brem, M. Lipp. 1996. A putative chemokine receptor, BLR1, directs B cell migration to defined lymphoid organs and specific anatomic compartments of the spleen. Cell 87:1037.[Medline]
  34. Legler, D., M. Loetscher, R. Roos, I. Clark-Lewis, M. Baggiolini, B. Moser. 1998. B cell-attracting chemokine1, a human CXC chemokine expressed in lymphoid tissues, selectively attracts B lymphocytes via BLR1/CXCR5. J. Exp. Med. 187:655.[Abstract/Free Full Text]
  35. Gunn, M. D., V. N. Ngo, K. M. Ansel, E. H. Ekland, J. G. Cyster, L. T. Williams. 1998. A B-cell-homing chemokine made in lymphoid follicles activates Burkitt’s lymphoma receptor-1. Nature 391:799.[Medline]
  36. Ngo, V. N., H. Korner, M. D. Gunn, K. N. Schmidt, D. S. Riminton, M. D. Cooper, J. L. Browning, J. D. Sedgwick, J. G. Cyster. 1999. Lymphotoxin {alpha}/ß and tumor necrosis factor are required for stromal cell expression of homing chemokines in B and T cell areas of the spleen. J. Exp. Med. 189:403.[Abstract/Free Full Text]



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