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The Journal of Immunology, 2001, 167: 3057-3063.
Copyright © 2001 by The American Association of Immunologists

Gene Microarrays Reveal Extensive Differential Gene Expression in Both CD4+ and CD8+ Type 1 and Type 2 T Cells1

Tatyana Chtanova2,*, Roslyn A. Kemp2,{dagger}, Andrew P. R. Sutherland*, Franca Ronchese{dagger} and Charles R. Mackay3,*

* Garvan Institute of Medical Research, Darlinghurst, Australia; and {dagger} Malaghan Institute of Medical Research, Wellington School of Medicine, Wellington, New Zealand


    Abstract
 Top
 Abstract
 Introduction
 Materials and Methods
 Results and Discussion
 References
 
An important subdivision of effector T cells can be made based on patterns of cytokine production and functional programs. Type 1 T cells produce IFN-{gamma} and protect against viral pathogens, whereas type 2 cells produce cytokines such as IL-4 and IL-5 and protect against large extracellular parasites. Both CD4+ and CD8+ T cells can be polarized into type 1 or type 2 cytokine-secreting cells, suggesting that both populations play a regulatory role in immune responses. In this study, we used high-density oligonucleotide arrays to produce a comprehensive picture of gene expression in murine CD4+ Th1 and Th2 cells, as well as CD8+ type 1 and type 2 T cells. Polarized type 1 and 2 cells transcribed mRNA for an unexpectedly large number of genes, most of which were expressed in a similar fashion between type 1 and type 2 cells. However, >100 differentially expressed genes were identified for both the CD4+ and CD8+ type 1 and 2 subsets, many of which have not been associated with T cell polarization. These genes included cytokines, transcription factors, molecules involved in cell migration, as well as genes with unknown function. The program for type 1 or type 2 polarization was similar for CD4+ and CD8+ cells, since gene expression patterns were roughly the same. The expression of select genes was confirmed using real-time PCR. The identification of genes associated with T cell polarization may give important insights into functional and phenotypic differences between effector T cell subsets and their role in normal responses and inflammatory disease.


    Introduction
 Top
 Abstract
 Introduction
 Materials and Methods
 Results and Discussion
 References
 
T cells use different functional programs to deal with diverse pathogens (1). CD4+ type 1 (Th1) cells produce IFN-{gamma}, which activates phagocytes and promotes protection against intracellular pathogens. Type 2 (Th2) cells produce IL-4, IL-5, IL-13, and IL-9 (2, 3), which together with IgE, eosinophils, and basophils promote clearance of large extracellular parasites. Th1 or Th2 responses are also important for inflammatory diseases. For instance, allergic diseases such as asthma are thought to arise through dysregulated type 2 responses, whereas many autoimmune diseases involve type 1 responses (4, 5, 6).

CD8+ T cells can also be polarized to effector subsets with distinct cytokine production profiles similar to those found in CD4+ T cells (7, 8). This polarization has been observed both in vitro and in vivo (9, 10, 11), and it is now likely that CD8+ T cells play an important regulatory role during immune responses. Both type 1 and type 2 CD8+ cells retain cytolytic activity (11), although relatively little is known about their regulatory roles in immune responses or pathological reactions.

Because of the importance of type 1 and type 2 T cells for immune responses, considerable effort has gone into defining the molecular differences between these two subsets. Transcription factors control type 1 and type 2 differentiation and include the type 2-associated factors GATA-3 (12), c-maf (13), and Stat6 (14, 15), as well as the type 1 factors T-bet (16), Stat4 (17), and IFN regulatory factor 1 (18, 19). What initiates transcription factor activity and type 1 or type 2 polarization is unclear, but may relate to the type and dose of Ag (20, 21, 22) or the nature of the APC (23, 24, 25). However, the ultimate determinant of T cell polarization is the cytokine milieu present at the time of T cell activation. IL-4 drives differentiation to type 2 cells, while IL-12 drives type 1 development (2, 3). The functional program of type 1 and 2 T lymphocytes requires these cells to home to different sites (26, 27, 28). Th1 cells preferentially express the chemokine receptors CCR5 and CXCR3, while Th2 cells preferentially express CCR3, CCR4, CCR8, and CRTh2 (reviewed in Ref. 1). Other cell surface molecules also distinguish type 1 and type 2 T cells, including ST2 (29), IL-18R (30), and P-selectin glycoprotein ligand 1 (28).

The comprehensive study of gene expression in cells has recently been made possible by the development of gene microarrays, including Affymetrix high-density oligonucleotide arrays. Teague et al. (31) analyzed changes in gene expression following naive T cell activation and found a surprisingly large number of genes expressed and regulated during T cell activation. A recent study that examined the differences in gene expression between human Th1 and Th2 cells identified genes involved in transcriptional regulation, apoptosis, and proteolysis, particularly for Th1 cells (32). In this study, we generated polarized populations of murine Th1 and Th2 cells as well as CD8+ T cells (Tc1)4 and Tc2 cells and analyzed gene expression using Affymetrix gene arrays. The pattern of gene expression in these polarized T cells provided detailed information not only on the differences between type 1 and type 2 cells, but also on the distinction between polarized CD4+ and CD8+ T cells.


    Materials and Methods
 Top
 Abstract
 Introduction
 Materials and Methods
 Results and Discussion
 References
 
Generation of Th1, Th2, Tc1, and Tc2 cultures

Single-cell suspensions from spleen and lymph nodes of C57BL/6J mice (The Jackson Laboratory, Bar Harbor, ME) were washed in IMDM (Life Technologies, Auckland, New Zealand) containing 2 mM glutamine, 1% penicillin-streptomycin, 5 x 10-5 M 2-ME (all from Sigma, St. Louis, MO) without FCS, resuspended at 2 x 106cells/ml, and incubated for 2 h at 37°C to deplete macrophages. Anti-CD4 (5 µg/ml, GK1.5) or anti-CD8 (5 µg/ml, 2.43) was added to the suspension (1 x 106 cells/ml in incomplete medium) and cells were incubated for 30 min at 4°C under gentle rotation. This was followed by an identical incubation with streptavidin-conjugated Dynabeads (Dynal Biotech, Oslo, Norway) added at five beads per cell. After magnetic enrichment, cells were 90–100% CD4+ or CD8+ by FACS staining.

Purified T cells (1 x 106/ml) were grown in 6-well plates (Falcon; BD Biosciences, Mountain View, CA) coated with Armenian (5 µg/ml) and Syrian (2 µg/ml) anti-hamster Abs (both from BD PharMingen, San Diego, CA) and recoated with anti-CD3 (2C11). 10 U/ml IL-2 (human recombinant IL-2L6), 10 ng/ml IL-6, and soluble anti-CD28 (1:50 final concentration of 37.51 hybridoma supernatant) were added to Tc1 cultures. For Th1, Th2, and Tc2 cell generation, conditions were identical to those for Tc1 generation; however, 10 ng/ml IL-12 (BD PharMingen) was added to Th1 cultures and IL-4 (produced in stationary cultures of a mouse IL-4-producing cell line) was added to Th2 and Tc2 cultures at 2000 U/ml. Cultures were maintained for 5 days, with replacement anti-CD28 and cytokines on days 2–4. On day 5, cells were removed from the plates and transferred to uncoated 6-well plates with 100 U/ml IL-2 for 48 h (IL-2 was replaced after 24 h). After which cells were restimulated with anti-CD3 without the cytokines for 24 h and harvested.

Real-time PCR to monitor gene expression

Total RNA was isolated from cells using the RNeasy Total RNA Isolation kit (Qiagen, Chatsworth, CA) as per the manufacturer’s instructions. RNA (2 µg per reaction) was reverse transcribed using avian myeloblastosis virus Reverse transcriptase (Promega, Madison, WI) at 42°C for 70 min in the presence of 250 µM dNTPs, avian myeloblastosis reverse transcription 5x reaction buffer (250 mM Tris-HCl, 250 mM KCl, 50 mM MgCl2, 50 mM DTT, and 2.5 mM spermidine; Promega) and 1 µM oligo-p(dT)15 primer (Roche Molecular Biochemicals, Sydney, Australia). Following cDNA synthesis, 2 µl of cDNA template was used for each PCR. Real-time PCR were conducted using a Light Cycler-FastStart DNA Master SYBR Green I kit (Roche Molecular Biochemicals) according to the manufacturer’s specifications using 3 mM MgCl2 and 1 µM primers. Primers used for the analysis of cytokine expression are as in the study by Overbergh et al. (33). Each gene was normalized to a housekeeping gene ({beta}-actin) before fold change was calculated (using crossing point values) to account for variations between different samples. Following identification of the differentially expressed genes, the expression of selected genes was analyzed by real-time PCR as described above using primers designed for the particular genes using MacVector software (version 6.5.3; Oxford Molecular Group).

Preparation of cRNA and GeneChip hybridization

cDNA was specifically transcribed from the poly(A) mRNA using a poly(T) nucleotide primer containing a T7 RNA polymerase promoter (GeneWorks, Adelaide, Australia). Biotinylated antisense target cRNA was subsequently synthesized by in vitro transcription using the Enzo BioArray High-Yield RNA Transcript Labeling kit. The biotin-labeled target cRNA was then fragmented and used to prepare a hybridization mixture, which included probe array controls and blocking agents. This mixture was initially hybridized to test arrays to evaluate the quality of the cRNA and then to Mu11K (11,000 murine genes and expressed sequence tag (EST) clusters) arrays for expression analysis. Washing and staining of the hybridized probe array were performed by an automated fluidics station according to the manufacturer’s protocols. The stained array was then scanned and the resultant image captured as a data image file.

Data analysis

From data image files, gene transcript levels were determined using algorithms in the GeneChip Analysis Suit software (Affymetrix). The expression levels of all genes on the array set were compared between type 1 and type 2 cells, with differences of 2-fold or larger likely to reflect significant changes in gene expression. Genes that showed a change of 2-fold or greater in at least two separate experiments were considered as differentially expressed. Each probe was assigned a call of present (expressed) or absent (not expressed) using Affymetrix decision matrix. GenBank, BLAST, and Celera databases were regularly monitored for the presence of full-length genes corresponding to EST probes. A small percentage of probes on Mu11K array set was found by Affymetrix to be made using mouse sequences that were input into the databases with ambiguous directionality assignments. The results presented in this paper are only minimally affected by these ambiguities.


    Results and Discussion
 Top
 Abstract
 Introduction
 Materials and Methods
 Results and Discussion
 References
 
High-density oligonucleotide arrays were used to analyze gene expression following polarization of murine T cells. Both CD4+ and CD8+ type 1 and type 2 T cells were generated and before GeneChip analysis cytokine gene expression was assessed by real-time PCR (Fig. 1Go). We performed polarization using procedures which in our laboratory have been shown to generate highly distinctive cytokine-secreting subsets. Thus, the Th2 cells that we generated showed a much higher expression of RNA transcripts for IL-4, IL-5, and IL-10, whereas Th1 cells expressed higher levels of transcripts for IL-2 and IFN-{gamma} as expected (2, 3). Other genes such as IL-13 showed expression patterns consistent with published reports, indicating that our polarization protocol was yielding well-differentiated Th1 and Th2 cells. The cytokine expression profiles in CD8+ cells followed a similar pattern; IFN-{gamma} was expressed at a higher level in Tc1 cells, while expression of IL-4, IL-5, IL-10, and IL-13 was much higher in Tc2 cells similar to previous reports (8, 11). Expression of type 2 cytokines was particularly strong, for both CD4+ and CD8+ cells, and our experimental protocol may favor high type 2 cytokine expression compared with type 1 cytokine expression. For CD8+ cells, IFN-{gamma} has been reported to be expressed abundantly in type 1 cells, but also to some extent in type 2 cells (10, 34). In addition to the RNA studies, we also showed, using cytokine ELISAs, that our polarized cells had differentiated to type 1 and type 2 cytokine-producing phenotypes (data not shown). For instance, Tc2 cells produced >35-fold more IL-4 and IL-5 protein than Tc1 cells.



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FIGURE 1. Real-time PCR analysis of gene expression in Th1, Th2, Tc1, and Tc2 cells after polarization. The changes in mRNA levels of several cytokines important in differentiation of type 1 and 2 T cell subsets were assessed using real-time PCR. Total RNA was extracted from polarized cells and transcribed to cDNA. Cytokine-specific primers were used to amplify the cDNA template and the increase in product was monitored for each amplification cycle. The fold-change values obtained after normalizing each sample to a housekeeping gene ({beta}-actin) represent the change in mRNA level of a particular gene when comparing Th2 to Th1 (A) and Tc2 to Tc1 (B) cells. Positive values indicate that the transcript is present at a higher level in type 2 cells, while negative values indicate that the transcript is more abundant in type 1 cells.

 
Following confirmation of type 1 and type 2 polarization, gene expression in four subsets (Th1, Th2, Tc1, and Tc2) was analyzed using the Affymetrix Mu11K array set. For an overall picture of gene expression in the different T cell subsets, log average difference values (which are reflective of the level of expression of the gene) were plotted for each T cell subset for biologically relevant comparisons (Fig. 2Go). Of 11,000 full-length genes and ESTs analyzed, we found that ~60% of all probes for both CD4+ and CD8+ T cells were expressed (according to a call made for each probe using an Affymetrix decision matrix) in either type 1 or type 2 cells (Fig. 2Go, insets). A previous study also showed a high degree of gene expression in naive and activated T cells (31). The majority of genes expressed by T cells did not show biased expression under type 1- or type 2-polarizing conditions, suggesting that most gene products perform housekeeping processes or functions common to both type 1 and type 2 T cells. Nevertheless, we found a number of genes expressed preferentially in either type 1 or type 2 T cells.



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FIGURE 2. Comparison of gene expression between type 1 and type 2 T cells. cRNA probes were prepared from polarized cells, hybridized to a Mu11K array set (containing 11,000 full-length genes and ESTs), stained, and scanned as described in Materials and Methods. The levels of expression of transcripts were calculated using algorithms in the GeneChip analysis software and expressed as average differences. The diagonal lines indicate meaningful fold change ranges, the outer most lines representing 3-fold change and the inner two lines representing 2-fold change. Each gene transcript was defined as present or absent based on the level of expression according to an Affymetrix software algorithm. The insets show all of the probes that were defined as present in at least one T cell subset. The results are representative of two separate experiments.

 
Genes that were differentially expressed (a difference of 2-fold or greater is likely to reflect a real change in gene expression) in at least two separate experiments are listed in Fig. 3Go. These genes could be classified into a number of functional categories. A large number of cytokines and growth factors were preferentially expressed by either type 1 or type 2 cells (Fig. 3Goi). We had a high degree of confidence in our array results, since expected patterns of cytokine gene expression were observed. For instance, IL-4, IL-5, IL-10, IL-6, IL-3, IL-13, GM-CSF, IL-2, lymphotoxin {alpha}, and IFN-{gamma} were expressed as expected. We also noted that type 2 cells expressed higher levels of stromal cell-derived factor 3, as well as the epidermal growth factor-like growth factor amphiregulin. Both of these factors have not been previously associated with T cell functions. Furthermore, according to our microarray results, Tc2 cells for the most part resembled Th2 cells in their cytokine profile (see below). IL receptors were also differentially expressed on type 1 and type 2 cells. For instance, IL-1R-related protein 1, which has recently been shown to be a component of the IL-18R (35, 36, 37), was preferentially expressed in both Th1 and Tc1 cells. Preferential expression of this molecule by Th1 cells was first shown by Xu et al. (30). We have noted that another member of the IL-1R-like family, IL-1R type II was expressed at a higher level in Tc2 cells.



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FIGURE 3. Differential gene expression patterns in murine Th1, Th2, Tc1, and Tc2 cells. Gene expression profiles of murine Th1, Th2 (A), Tc1, and Tc2 (B) were generated using an Affymetrix Mu11K set and analyzed using GeneChip software. Genes were considered as differentially expressed if a change of at least 2-fold or greater was observed in at least two separate experiments. The x-axis represents fold-change Th2 relative to Th1 (A) and Tc2 relative to Tc1 (B). Positive fold-change values indicate that the transcript is present at a higher level in type 2 cells, while negative values indicate that the transcript is more abundant in type 1 cells. An asterisk next to the gene name signifies that the gene is differentially expressed in a similar fashion in both CD4+ and CD8+ T cells. The level of expression of a gene (arbitrary fluorescence units) is indicated by color: high level of expression (>5000) is red for type 1 genes and navy blue for type 2; medium level (1500–5000) is orange for type 1 and blue for type 2; low level (<1500) is yellow for type 1 and light blue for type 2 genes. As a comparison, the level of expression of {beta}-actin is ~25,450 for CD4+ T cells and 44,000 for CD8+ T cells (arbitrary fluorescence units). GenBank accession numbers are indicated next to the gene name. Differentially expressed genes were grouped into several broad categories based on known functions of genes: i, Cytokines, cytokine receptors and growth factors; ii, transcriptional regulation; iii, adhesion, migration, and cell surface molecules; iv, apoptosis, proteolysis, cell cycle, and nuclear proteins; v, transport proteins; vi, proteins involved in signaling; vii, other enzymes; viii, miscellaneous.

 
A number of differentially expressed genes between type 1 and type 2 subsets are involved in transcriptional regulation (Fig. 3Goii), some of which (GATA3, c-maf, and Stat4) have been well characterized (12, 13, 17, 38, 39). In addition, several transcription factors that have not been associated with T cell polarization were also identified, including c-fos and mouse HLF 1{alpha}-like factor for type 2 cells and early B cell factor for type 1 T cells. It is conceivable that these various transcription factors might control individual cytokine gene expression. For instance, c-maf controls IL-4 production (13, 39), whereas T-bet has been shown to be linked with IFN-{gamma} production (16).

Two members of the TNF receptor-associated factor (TRAF) family were found to be differentially expressed in type 1 and type 2 cells. TRAF4 was expressed at a higher level in type 1 cells while TRAF5 was preferentially expressed in type 2 cells (Fig. 3Govi). Members of this family serve as adapter proteins that mediate cytokine signaling, in particular they seem to play a role in signal transduction from TNF receptor and Toll/IL-1R families, resulting in activation of transcription factors NF-{kappa}B and AP-1 (40).

A consistent finding by various groups, including our own, is the differential expression of cell migration-related molecules on type 1 and type 2 cells (26, 27). As shown in Fig. 3GoAiii, Th2 cells expressed higher levels of transcripts for CCR1, {beta}7 integrin, and CXCR4, while Th1 cells expressed higher levels of {alpha}4 integrin. The expression of CCR1 on polarized T cells has been the subject of some debate because it was previously considered to be Th1 specific but recently there has been emerging evidence to suggest otherwise (27). Higher levels of CCR1 transcript were expressed by both CD4+ and CD8+ type 2 T cells. A recent study showed that CCR1-deficient mice have significantly lower levels of the Th2 cytokines IL-4 and IL-13 in an allergic airway model (41). Th2 cells also produced chemokines such as I-309 (the ligand of a Th2-associated receptor CCR8 (42, 43). Our GeneChip experiments failed to confirm preferential expression of several other chemokine receptors. In particular, type 2 chemokine receptor CCR3 was not differentially expressed in most of the experiments, nevertheless, we noted preferential expression of CCR4 by type 2 cells in one of the experiments. Type 1 chemokine receptor CCR5 was not differentially expressed in CD8+ cells but was slightly (2-fold) overexpressed by Th2 cells. This deviation from the expected chemokine receptor profile could be due to the fact that the expression of some chemokine receptors varies depending on cytokine stimulation and other factors (44). The receptors CXCR3 and CRTh2 were not included in the array set.

Interestingly, our GeneChip experiments identified differential expression of several granzymes. For instance, Th1 cells expressed higher levels of granzyme C compared with Th2 cells (Fig. 3GoAiv), while Tc2 cells expressed elevated levels of granzymes D, E, and F (Fig. 3GoBiv). Granzymes are a family of serine proteases which are found in cytotoxic lymphocyte granules. Although granzymes A and B have been shown to be involved in cytolysis, the biological functions of granzymes C–F are yet to be identified (45). Several studies have compared cytolytic abilities of Tc1 and Tc2 cells but the results have been inconclusive (46, 47). Tc1 cells may be more efficient at clearing some viral infections than Tc2 cells, although this could relate to different migration properties of the two subsets (48, 49).

Expression of select genes identified as differentially expressed by microarray analysis was confirmed by real-time PCR (Fig. 4Go). Although there were differences in the fold-change values detected by the two methods, real-time PCR results correlated well with the differential gene expression data produced using Affymetrix GeneChips. This gave us confidence that the gene expression data derived from the gene arrays was reliable. In addition to the differentially expressed full-length genes, we also identified a number of differentially expressed ESTs (Table IGo). For some of the ESTs, full-length genes have now been identified. Among the differentially expressed ESTs for which the full-length genes are already known, we noted preferential expression by Th2 and Tc2 cells of cytochrome P450 side chain cleavage enzyme 11a1 and aldoketoreductase {alpha}, while both Th1 and Tc1 cells expressed higher levels of transcripts homologous to Jun dimerization protein gene. The significance of these genes in T cell polarization and function needs to be addressed in additional studies.



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FIGURE 4. Real-time PCR of select genes identified as differentially expressed by GeneChip analysis. The fold-change values of select genes were obtained using real-time PCR as described above. Positive fold-change values (shown next to {blacksquare} and {square}) indicate that the transcript is present at a higher level in type 2 cells, while negative values indicate that the transcript is more abundant in type 1 cells. Corresponding fold-change values for CD4+ (A) and CD8+ (B) T cells as determined by GeneChip ({blacksquare}) are shown next to fold-change values as determined by real-time PCR ({square}).

 

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Table I. ESTs differentially expressed in Th1/Th2 and Tc1/Tc2 cells1

 
We next asked whether the broad pattern of gene expression for type 1 and type 2 polarization was similar for both CD4+ and CD8+ T cells. Most of the genes differentially expressed by CD4+ and CD8+ T cells followed the same pattern of expression in both Th and T cytotoxic cells, with only a handful of genes showing the opposite pattern of expression in the two cell types (Fig. 5Go). This indicates a degree of similarity in the genetic program leading to T cell polarization. This was expected since similar factors induce polarization of both Th and T cytotoxic cells into type 1 and type 2 subsets, and roughly similar cytokine-producing phenotypes are created. Despite some similarity in gene expression, there were also some differences since many of the genes that were differentially expressed in CD8+ T cells were not in CD4+ T cells and vice versa (Fig. 3Go). These genes could be responsible for the distinct properties of the Th and T cytotoxic subsets. In addition, a small number of genes differentially expressed by both showed the opposite patterns of expression.



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FIGURE 5. Genes differentially expressed between type 1 and type 2 subsets in both CD4+ and CD8+ T cells. Fold changes for all of the genes that were differentially expressed between type 1 and type 2 subsets for both CD4+ and CD8+ T cells were plotted. A fold change of <0.5 indicates that the gene is expressed at a higher level in type 1 cells, while a fold change of >2 indicates higher expression in type 2 cells.

 
Rogge et al. (32) also reported differential expression between human Th1 and Th2 cells in a number of gene classes, particularly transcription factors, cell migration molecules, signal transduction molecules, and cytokines and receptors. In our study, we found noteworthy differences that may reflect either species differences or differences in experimental design or polarizing conditions. For instance, Rogge et al. (32) noted a large number of apoptosis-related genes expressed in Th1 cells, which correlated with an increased susceptibility of Th1 cells to activation-induced cell death. However, our cells were polarized for 5 days, rested in IL-2, and then restimulated with anti-CD3 in contrast to Rogge et al. (32) who used T cells at day 3 after activation. In the Rogge et al. study (32), Th1-overexpressed genes predominated, whereas our study identified more type 2-biased genes. This may relate to the highly polarized type 2 cells we were able to generate using our experimental protocol. Thus, we believe that our study is particularly relevant for the identification of type 2 genes. Although some of the differentially expressed genes we identified are well-established markers of T cell polarization, the role of others in T cell differentiation and function remains to be investigated. The identity of numerous type 1- and type 2-expressed genes should lead to studies confirming a functional role for protein products using either in vitro or in vivo models.


    Acknowledgments
 
We thank Fabienne Mackay, Graham Legros, and Bill Sewell for helpful suggestions.


    Footnotes
 
1 This research was supported by the Cooperative Research Center for Asthma, the Glazebrook Trust, the National Health and Medical Research Council, and the New Zealand Cancer Institute. Back

2 T.C. and R.A.K. contributed equally to this manuscript. Back

3 Address correspondence and reprint requests to Dr. Charles R. Mackay, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, NSW 2010, Australia. E-mail address: c.mackay{at}garvan.org.au Back

4 Abbreviations used in this paper: Tc, CD8+ T cells; TRAF, TNF receptor-associated factor, EST, expressed sequence tag. Back

Received for publication May 14, 2001. Accepted for publication July 16, 2001.


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 Introduction
 Materials and Methods
 Results and Discussion
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