The JI
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
 QUICK SEARCH:   [advanced]


     
 


This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Scheckelhoff, M.
Right arrow Articles by Deepe, G. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Scheckelhoff, M.
Right arrow Articles by Deepe, G. S., Jr.
Right arrowPubmed/NCBI databases
*Substance via MeSH
The Journal of Immunology, 2002, 169: 5818-5826.
Copyright © 2002 by The American Association of Immunologists

The Protective Immune Response to Heat Shock Protein 60 of Histoplasma capsulatum Is Mediated by a Subset of V{beta}8.1/8.2+ T Cells1

Mark Scheckelhoff*,{dagger} and George S. Deepe, Jr.2,{dagger}

* Department of Molecular Genetics, Biochemistry, and Microbiology, and {dagger} Veterans Affairs Hospital and Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH 45267


    Abstract
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Immunization with recombinant heat shock protein 60 (rHsp60) from Histoplasma capsulatum or a region of the protein designated fragment 3 (F3) confers protection from a subsequent challenge in mice. To determine the T cell repertoire involved in the response to Hsp60, T cell clones from C57BL/6 mice immunized with rHsp60 were generated and examined for V{beta} usage by flow cytometry and RT-PCR. V{beta}8.1/8.2+ T cells were preferentially expanded; other clones bore V{beta}4, -6, or -11. When V{beta}8.1/8.2+ cells were depleted in mice, V{beta}4+ T cell clones were almost exclusively isolated. Measurement of cytokine production demonstrated that nine of 16 V{beta}8.1/8.2+ clones were Th1, while only three of 13 non-V{beta}8.1/8.2+ clones were Th1. In mice immunized with rHsp60, depletion of V{beta}8.1/8.2+, but not V{beta}6+ plus V{beta}7+, T cells completely abolished the protective efficacy of Hsp60 to lethal and sublethal challenges. Examination of the TCR revealed that a subset of V{beta}8.1/2+ clones that produced IFN-{gamma} and were reactive to F3 shared a common CDR3 sequence, DGGQG. Transfer of these T cell clones into TCR {alpha}/{beta}-/- or IFN-{gamma}-/- mice significantly improved survival, while transfer of other V{beta}8.1/8.2+ clones that were F3 reactive but were Th2 or clones that were not reactive to F3 but were Th1 did not confer protection. These data indicate that a distinct subset of V{beta}8.1/8.2+ T cells is crucial for the generation of a protective response to rHsp60.


    Introduction
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Histoplasma capsulatum (Hc)3 is a dimorphic, pathogenic fungus that causes disease in various mammalian species, including humans. Infection occurs via inhalation of conidial spores that transform into pathogenic yeasts within the mammalian host. Hc yeasts are readily phagocytosed by resident macrophages, where they survive and replicate unless the immune system is activated. The effective immune response to Hc relies on adaptive immunity and the collaboration between infected macrophages with T cells (1, 2). This interaction results in an increase in the amounts of Th1 cytokines, including IL-12, IFN-{gamma}, and TNF-{alpha}, and the formation of granulomas that function to surround and contain the infection (3, 4, 5). In patients without underlying immune dysfunction, this response is usually successful at limiting the infection and preventing serious, disseminated disease. While the initial infection is contained, it does persist in the host in a dormant state within calcified granulomas and is capable of causing disease by reactivation if immunological dysfunction develops (2).

Protection against Hc infection can be achieved in mice by immunizing with Ag from a cell wall/cell membrane extract of cultured yeasts (6). Subsequent studies revealed that a particular Ag within the extract, heat shock protein 60 (Hsp60), is immunogenic and confers protection against infection (7, 8). Moreover, a region of Hsp60 between aa 172 and 443, termed fragment 3 (F3), is the protective domain of this protein (9). Studies have demonstrated Hsp60 to be a potent inducer of cellular immunity and an immunodominant Ag from Hc as well as other pathogenic organisms (10, 11, 12, 13). The protective response to Hsp60 and the resulting efficacy of vaccination are critically dependent on the presence of CD4+ T cells. It is believed that activated T cells produce IFN-{gamma} which activates macrophages enabling the cells to kill intracellular yeasts.

While extremely diverse overall, T cells are organized as clonal populations that contain identical Ag specificity as determined by limited sequences, including 3 complementarity determining regions (CDR), of which CDR3, in the {beta}-chain of the TCR, is believed to determine Ag-specificity (14, 15). Interaction with a defined epitope of an Ag by the TCR is required to activate the T cell to proliferate and generate cytokines, including IFN-{gamma}. Previous work with Hc has indicated that biases in TCR repertoires are generated during the immune response to Hc. In a primary infection of Hc at the onset of CMI, V{beta}4+ T cells are preferentially expanded in the lungs of mice (16). On the other hand, V{beta}4+ and 6+ cells are important in secondary infection (17). The expansion of V{beta}6+ T cells also occurs following immunization with the protective Ag F3, and they play an integral role in the protective response to this Ag (18).

In this study we analyzed T cells from recombinant Hsp60 (rHsp60)-immunized mice and demonstrated that T cells expressing V{beta}8.1/8.2 are dominant. Among all T cells, regardless of their V{beta} expression, there was wide variation in the ability to respond to F3, but Th1-producing clones were almost exclusively V{beta}8.1/8.2+. Depletion of V{beta}8.1/8.2+ T cells in mice abrogated the protective response to rHsp60 immunization in both lethal and sublethal models. In addition, transfer of a V{beta}8.1/8.2 + clone, which was reactive to F3 and produced IFN-{gamma}, to {alpha}/{beta} T cell-deficient mice, restored protection from infection with Hc. These data indicate that a clonal subset of T cells that express the V{beta}8.1/8.2 region of the TCR is sufficient to generate a protective response to rHsp60 of Hc.


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

Male C57BL/6 mice and athymic nude mice were purchased from the National Cancer Institute (Fredrick, MD). TCR {alpha}/{beta}-/- and IFN-{gamma}-/- mice were purchased from The Jackson Laboratory (Bar Harbor, ME). Athymic nude mice were used to produce ascites. Animals were housed under barrier conditions and were age- and sex-matched for all experiments. All animal experiments were performed in accordance with the Animal Welfare Act guidelines of the National Institutes of Health.

Hc culture

Hc strain G217B yeast cells were cultured and quantified as described previously (19). Following anesthesia with isoflurane, mice were infected intranasally (i.n.) with Hc. Infectious doses were 2 x 106 (sublethal) or 2 x 107 (lethal) yeasts in ~35 µl of HBSS.

Recombinant Hsp60 and F3 production

Recombinant Hsp60 and F3 from Hc were generated as described previously (9). Briefly, genes expressing each protein were cloned in to the NdeI and BamHI sites of pET19b. Expression of recombinant protein was achieved by transforming Escherichia coli cells with the plasmid and growing the bacteria in Luria-Bertoni broth until an OD600 of 0.4–0.5 was reached. Isopropylthiogalactose was added to cultures at a final concentration of 1 mM and cells were grown for 3 h. Cells were harvested by centrifugation, and the resultant pellet was resuspended in a buffer containing 5 mM imidazole, 500 mM NaCl, and 20 mM Tris-Cl, pH 7.9. Samples were lysed by freeze-thaw cycles, followed by sonication. Soluble and insoluble fractions were separated by centrifugation at 20,000 x g.

The insoluble pellet was suspended and denatured in a buffer containing 6 M urea, 500 mM NaCl, 5 mM imidizole, and 20 mM Tris-Cl, pH 7.9. Denatured material was recovered in the supernatants following centrifugation at 20,000 x g and was subsequently filtered to remove particulate material. The protein was purified by metal-chelate chromatography using a Ni2+-Sepharose affinity column (His-Bind; Novagen, Madison, WI). The resulting protein was eluted with the same buffer used to suspend the insoluble pellet, but with 1 M imidizole. The eluate was dialyzed against buffer containing decreasing amounts of urea, the recombinant protein was concentrated by ultrafiltration, and the protein concentration was measured. Each protein contained <10 pg of LPS/µg of protein.

Splenocyte preparation

Splenocytes were obtained by teasing apart spleens between the frosted ends of two glass slides. Cells were washed three times with HBSS and resuspended in RPMI (BioWhittaker, Walkersville, MD) supplemented with 10% FBS, 1% L-glutamine, 1% sodium pyruvate, 1% nonessential amino acids, 5 x 10-5 M 2-ME, and 10 µg/ml gentamicin if used for the establishment or expansion of T cell lines and clones, but with only 10% FBS, gentamicin and L-glutamine if used in proliferation assays.

T cell line and clone production

Mice were immunized with 100 µg of rHsp60 s.c. and again 2 wk later. Spleen cells were harvested 2 wk after the final immunization and were stimulated with rHsp60 at 5 µg/ml for 2 wk in supplemented RPMI. Following the initial stimulation, fresh medium and Ag were added at 2-wk intervals with fresh irradiated spleen cells that served as APC. Individual T cell clones were obtained following several passages of the parent line by limiting dilution and were propagated as described above with the addition of 5% supernatant derived from rat splenocytes stimulated with Con A (Sigma-Aldrich, St. Louis, MO) for 48 h (20).

Proliferation assay

To each well of a microtiter plate, 2 x 104 resting T cell clones in 0.1 ml and 5 x 105 irradiated splenocytes in 0.1 ml as APC were added; 50 µl of either medium or Ag (F3 or rHsp60) was added to each well (final concentration of Ag in each well, 5 µg/ml). The cells were incubated for 72 h. Cells were pulsed 18 h before being harvested with the addition of 1 µCi [3H]thymidine (sp. act., 6.7 Ci/mmol; New England Nuclear, Boston, MA). Cells were harvested onto glass-fiber filter paper, and incorporation of radioactivity was measured by a liquid scintillation counter. Activity is presented as stimulation index: the cpm of cells stimulated with Ag divided by the cpm of cells in medium alone. Reactivity to F3 was defined as a stimulation index of a >=2.5-fold increase in proliferation of cells compared with cells that were not stimulated with Ag.

V{beta} analysis and TCR sequencing

Expression of the V{beta}-chain on the surface of T cell clones was assessed by flow cytometry. Aliquots of each T cell clone containing ~105 cells were incubated with anti-CD16 mAb (Fc block; BD PharMingen, San Diego, CA) and one of the biotinylated Abs against each of the V{beta} families for 15 min at 4°C. After washing three times, the cells were incubated with streptavidin-PE for 15 min at 4°C and washed three times. Cells were then fixed with 1% paraformaldehyde. Fluorescence was measured using the FACSCalibur flow cytometer. V{beta} expression was determined by examining the number of cells within the PE channel divided by the total number of cells counted.

Once the V{beta} family was identified, RNA was isolated from the T cell clones using RNAzol (Biotecx, Houston, TX) lysis and chloroform extraction according to the manufacturer’s protocol. cDNA was synthesized by annealing RNA with 10 ng of an antisense primer specific to the C{beta} region of the TCR and incubating with avian reverse transcriptase (Invitrogen, La Jolla, CA). The nucleotide sequence of each TCR cDNA was obtained using a sense primer specific to the expressed V{beta} family and an antisense primer specific to the constant region of the {beta}-chain as previously described (8). PCR products were purified and subcloned into pCR2.1-TOPO (Invitrogen). Several colonies were selected and used to isolate DNA. Multiple DNA samples from each T cell clone were submitted for sequence analysis by automated sequencing at University of Cincinnati DNA core facility.

Preparation of mAb

Production of mAb was achieved by injection of hybridoma cells into athymic nude mice. The hybridoma cell line KJ16 (Rat IgG1 anti-V{beta}8.1/8.2) was provided by Dr. P. Marrack (National Jewish Hospital, Denver, CO), RR4-7 (Rat IgG2b anti-V{beta}6) was a gift from Dr. O. Kanagawa (Washington University, St. Louis, MO), and TR3-10 (rat IgG2b anti-V{beta}7) was provided by Dr. I. Weissman (Stanford University, Stanford, CA). mAb was purified using a protein G-Sepharose column (Amersham Pharmacia Biotech, Piscataway, NJ).

In vitro depletion of T cells

Mice were injected i.p. with 100 µg of mAb on days 7 and 3 before and on the day of immunization. Animals were subsequently injected once a week until the end of each experiment. Depletion of >95% of the T cell population was confirmed by flow cytometry.

Analysis of cytokine production

Cytokine production was measured using commercially available ELISA kits for IFN-{gamma}, IL-4, GM-CSF, TNF-{alpha} (Endogen, Cambridge, MA), IL-13 (R&D Systems, Minneapolis, MN), and IL-10 (BD PharMingen). Cytokine measurements are presented as the amount of cytokine produced following stimulation, with correction for the levels of production from unstimulated cells. For purposes of definition, clones designated Th1 had a ratio of IFN/IL-4 production that was >1, and clones defined as Th2 had a ratio <1.

Quantitative organ culture

Mice were sacrificed and examined for fungal burden in lungs and spleens. Organs were harvested and homogenized in 5 ml HBSS. Organ homogenates were plated on blood-heart infusion agar plates at multiple 10-fold dilutions and incubated at 30°C until colony growth could be measured. Colony counts are given as mean log10 CFU per organ ± SE.

Adoptive transfer

T cell clones selected based on cytokine production and F3 reactivity were expanded to generate sufficient cells to inject 2 x 106 T cell clones i.v. into each TCR {alpha}/{beta}-/- mouse. Mice were infected with 5 x 105 Hc yeasts i.n. 8 h later and observed for survival.

Statistical analysis

To analyze differences in fungal burden, a one-way ANOVA was performed. Under normalized conditions, the Tukey test was used to allow multiple comparisons among the different groups. Differences in survival were assessed by a log-rank test. Fisher’s exact test was used to compare the proportions of T cell clones.


    Results
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
V{beta} expression of Hsp60 T cell clones

To determine the TCR repertoire following rHsp60 immunization, T cells were harvested separately from two groups of mice, each immunized twice with 100 µg of rHsp60. T cells were propagated at 2-wk intervals, and individual T cell clones were isolated by limiting dilution. Analysis of V{beta} expression of each T cell clone was determined by flow cytometry. Of the 29 clones isolated, the expression of V{beta}8.1/8.2 was present in 56% of the T cell clones. Smaller proportions of the isolated T cell clones isolated expressed V{beta}4, -6, -10, or -11 (Fig. 1Go).



View larger version (15K):
[in this window]
[in a new window]
 
FIGURE 1. V{beta} usage among T cell clones isolated following rHsp60 immunization. T cell clones were analyzed for V{beta} expression using biotinylated isotype matched or mAb to V{beta}8.1/8.2, followed by incubation with PE-labeled streptavidin. Bars represent the proportion of clones expressing a given V{beta}.

 
The T cell clones were analyzed by RT-PCR to determine TCR sequence, including J{beta} expression, and the sequence of the Ag recognition domain, CDR3 (Table IGo). Several different J{beta} families were represented, with no clear dominant family or correlation between V{beta} and J{beta} expression. Several CDR3 domains were also identified. In each case, clones sharing common CDR3 sequences shared the same V{beta} and J{beta} expression. The J{beta} sequence among clones of the same J{beta} family did manifest slight differences at the nucleotide level. Expression of a particular V{beta} or J{beta} region was not indicative of CDR3 sequence. The most conserved CDR3 sequences among V{beta}8.1/8.2+ T cell clones were DGGQG (3 of 16) or GVGTP (5 of 16), while analysis of other V{beta} families revealed no shared CDR3 sequences.


View this table:
[in this window]
[in a new window]
 
Table I. TCR sequence of T cell clones isolated following rHsp 60 immunization

 
In vitro characterization of T cell activity

To examine cytokine production by T cell clones, supernatants from clones were incubated with or without 5 µg/ml rHsp60, harvested after 48 h, and analyzed by ELISA (Fig. 2Go). Among the 16 clones expressing V{beta}8.1/8.2, nine were considered Th1, and seven were Th2. All of these clones produced measurable amounts of IFN-{gamma}, and all but three produced IL-4. Among non-V{beta}8.1/8.2+ clones, three of 13 produced no IFN-{gamma}, while three others produced no IL-4. Unlike V{beta}8.1/8.2+ clones, only three of 13 non-8.1/8.2 clones were Th1, while the remaining 11 were categorized as Th2.



View larger version (35K):
[in this window]
[in a new window]
 
FIGURE 2. Cytokine production by clones derived from rHsp60-immunized mice. Clones were stimulated with 5 µg/ml of rHsp60, and supernatants were harvested at 48 h. Supernatants were analyzed for cytokine production by ELISA and are presented as the mean picograms per milliliter ± SEM of stimulated-unstimulated cells. V{beta}8.1/8.2+ clones are indicated by unshaded bars. Data represent results from four or more samples.

 
Production of GM-CSF was tightly linked to IFN-{gamma}. In general, IFN-{gamma}-producing clones also secreted GM-CSF. Similarly, production of IL-10 and IL-13 by T cell clones directly correlated with IL-4 production. All clones produced detectable levels of IL-13, and only one did not produce GM-CSF, while IL-10 was not produced by three of the T cell clones. None of the T cell clones stimulated with rHsp60 released more TNF-{alpha} than unstimulated cells.

In addition to cytokine analysis, each T cell clone was examined for F3 reactivity (Table IGo). T cell clones were stimulated with F3 or rHsp60 to determine whether a correlation existed between TCR sequence and reactivity. Among the 16 V{beta}8.1/8.2+ clones, nine were reactive to F3. Only two of 7 V{beta}4+ clones reacted to F3, while one of two clones expressing V{beta}6 or -10 demonstrated reactivity, and neither of the clones expressing V{beta}11 responded. Using Fisher’s exact test, there was not a significant difference (p > 0.05) in F3 reactivity among T cell clones expressing different V{beta} families. Reactivity to F3 correlated with clones expressing the CDR3 regions GVGTP and DGGQG.

T cell repertoire following V{beta}8.1/8.2 depletion

To characterize the T cell repertoire in the absence of V{beta}8.1/8.2+ T cells, rHsp60-immunized mice were administered with a V{beta}8.1/8.2-specific mAb, KJ16. T cells were isolated from spleens 2 wk after the last immunization and cultured with rHsp60. Twenty-three clones were isolated, of which 75% (15 of 20) expressed V{beta}4, and only 25% (5 of 23) expressed either V{beta}6 or -7 (Table IIGo). Several of the V{beta}4+ clones shared CDR3 homology, with six of the 15 clones expressing QEGTQ, three expressing DGQLG, and four expressing DRQGA. F3 reactivity was observed among only clones that expressed the QEGTQ sequence in the CDR3 region, but not other conserved CDR3 sequences.


View this table:
[in this window]
[in a new window]
 
Table II. T cell clones isolated from V{beta}8.1/8.2-depleted mice

 
In addition to changes in CDR3 sequence and F3 reactivity, cytokine production by T cell clones isolated in the absence of V{beta}8.1/8.2+ cells was also altered. The number of clones that produced IL-10, IL-4, or IL-13 was greatly reduced (Fig. 3Go). Of the 23 clones, 14 produced no IL-4, 19 clones produced no IL-10, and 16 of the 23 generated no detectable IL-13. To ensure that altered levels of cytokine production were not due to problems of sensitivity using the ELISA, clones 20 (Th1), 12 (Th2), and 7 (Th2), which were isolated from V{beta}8.1/8.2-intact mice, were run in parallel to clones isolated from depleted mice to directly compare levels of production. The results demonstrated that clones from V{beta}8.1/8.2-intact mice had cytokine production equivalent to that observed in earlier experiments, but the amount of Th2 cytokines generated from depleted mice was consistently lower. IFN-{gamma} production was detected in 11 of 23 clones, of which all were classified as Th1. GM-CSF was produced by 10 of 23 clones, of which eight were classified as Th1. Unlike the Th2 cytokines, the amount of GM-CSF or IFN-{gamma} produced among these clones was similar to the amount generated by rHsp60 clones from V{beta}8.1/8.2-sufficient mice.



View larger version (32K):
[in this window]
[in a new window]
 
FIGURE 3. Cytokine production by clones derived from V{beta}8.1/8.2-depleted mice. Clones isolated from depleted mice were stimulated with 5 µg/ml of rHsp60, and supernatants were harvested 48 h later. Supernatants were analyzed for cytokine production by ELISA and are presented as the mean picograms per milliliter ± SEM of stimulated-unstimulated cells. Clones H7, H12, and H20 were derived from 8.1/8.2-intact mice and were run in parallel as an internal control. Data represent results from four or more samples.

 
Role of V{beta}8.1/8.2 cells in Hc infection

To determine whether V{beta}8.1/8.2+ cells were required for the generation of the protective immune response to rHsp60, immunized mice were injected with mAb to V{beta}8.1/8.2+ cells and V{beta}6+ and V{beta}7+ cells or were given rat IgG. Two weeks after the second immunization, mice were challenged with a lethal inoculum of Hc (2 x 107) i.n. and observed for survival. All mice that had not been immunized with rHsp60 succumbed to infection by 11 days postinfection (dpi; Fig. 4GoA). Similarly, immunized mice depleted of V{beta}8.1/8.2+ T cells did not survive beyond 12 dpi. Conversely, all mice immunized with rHsp60 and injected with rat IgG or mAb to V{beta}6 and 7+ T cells survived. At 40 dpi, lungs and spleens were harvested from the surviving animals and examined for fungal burden. In both groups the number of CFU was below the level of detection (102).



View larger version (38K):
[in this window]
[in a new window]
 
FIGURE 4. Effect of V{beta}8.1/8.2 depletion on rHsp60-immunized mice. Mice (n = 6) were immunized; treated with rat IgG, mAb to V{beta}8.1/8.2, or mAb to V{beta}6 and -7; and infected i.n. with 2 x 107 Hc yeast cells (A), and survival was monitored for 40 days. B, Immunized and depleted mice were infected with 2 x 106 Hc yeasts in parallel with unimmunized controls. Lungs and spleens were harvested at 7 and 14 dpi and assayed for Hc CFU. The data represent the mean ± SEM. *, p < 0.05 compared with rHsp60-immunized mice given either rat IgG or mAb to V{beta}6 and -7.

 
To determine whether elimination of V{beta}8.1/8.2+ T cells was associated with increased fungal burden, rHsp60-immunized mice were administered rat IgG depleted of V{beta}8.1/8.2+ or V{beta}6 and V{beta}7+ T cells. Two weeks following the second immunization with rHsp60, mice were infected with 2 x 106 Hc yeasts i.n. and sacrificed at 7 and 14 dpi. Fungal burden in lungs and spleens of mice depleted of V{beta}8.1/8.2+ T cells was not significantly different (p > 0.05) from that in unimmunized controls on days 7 and 14 (Fig. 4GoB). The lungs and spleens of mice immunized with rHsp60 and given rat IgG or mAb to V{beta}6 and V{beta}7 contained significantly fewer CFU (p < 0.05) than unimmunized controls or those given mAb to V{beta}8.1/8.2. No difference in fungal recovery was detected between rHsp60-immunized mice and immunized mice that lacked V{beta}6 and V{beta}7 (p > 0.05) on both days 7 and 14.

Depletion of the entire V{beta}8.1/8.2+ repertoire could have a profound effect on the ability to mount an effective immune response. To ensure that the increase in fungal burden and loss of survival was attributable to the specific response to Hsp60 and not a general defect in the immune system, unimmunized mice were depleted of V{beta}8.1/8.2+ cells. These mice in parallel with nondepleted controls were infected with a sublethal inoculum, and the fungal burden was determined at 7 dpi. No significant (p > 0.05) difference was observed between depleted and intact animals in either lungs or spleens. The mean log10 CFU (±SEM) in lungs (6.1 ± 0.21) and spleens (4.7 ± 0.10) from V{beta}8.1/8.2-depleted mice did not differ (p > 0.05) from that in lungs (6.0 ± 0.12) and spleens (4.6 ± 0.15) of infected controls.

Adoptive transfer of V{beta}8.1/8.2+ T cells

To determine whether individual subsets of V{beta}8.1/8.2+ T cells were capable of conferring a protective response, individual clones were injected into TCR {alpha}/{beta}-/- mice that were infected with 5 x 105 Hc. T cell clones were selected based on F3 reactivity and cytokine production. In control mice that were not injected with T cells, all mice succumbed to infection by day 32 (Fig. 5GoA). Mice that were injected with clone 17 that produced IFN-{gamma} but was not reactive to F3 did not survive beyond 30 days (p > 0.05 compared with controls). Transfer of clone S cells that were reactive to F3 but produced IL-4 caused an acceleration of infection, and no mouse survived beyond 22 days (p < 0.05 compared with controls). Mice that were injected with clone D, which was reactive to F3 and produced IFN-{gamma}, prolonged survival (p < 0.05) beyond that of control animals, with mean survival reaching 46 days.



View larger version (17K):
[in this window]
[in a new window]
 
FIGURE 5. Adoptive transfer of T cell clones into TCR {alpha}{beta}-/- (A) and IFN-{gamma}-/- (B) mice. T cell clones S (Th2, F3+), D (Th1, F3+), or 17 (Th1, F3-) were injected i.v. into TCR {alpha}/{beta}-/- (n = 6) or IFN-{gamma}-/- mice (n = 5). Following transfer of cells, mice were infected i.n. with 5 x 105 Hc yeast cells and monitored for survival.

 
In an alternative model, V{beta}8.1/8.2+ T cell clones were injected into IFN-{gamma}-/- mice to determine whether protection could be restored in animals highly sensitive to Hc infection (5). Clones S, 17, and D were transferred. All mice receiving no T cells succumbed to infection with 5 x 105 Hc by day 11 (Fig. 5GoB). IFN-{gamma}-/- mice that received clone S or clone 17 were similar to mice that received no cells. Transfer of clone D dramatically enhanced survival (p < 0.05). All animals survived beyond 35 dpi, and only 40% succumbed by 40 dpi, at which time the study was terminated. The lungs and spleens of the surviving mice were analyzed for the presence of Hc, and in two of the three mice they contained <102 CFU. The remaining animal had ~106 CFU in lungs and spleen.


    Discussion
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Both primary and secondary immune responses to Hc are dependent on T cell activation and production of cytokines that activate phagocytes to express antifungal activity. The ability of a T cell to respond to an Ag relies on the recognition of specific epitopes presented by APC, and this interaction causes activation and expansion of Ag-specific T cell clonotypes. Native or rHsp60 is a protective Ag that elicits a T cell response and is associated with increased production of IFN-{gamma}, IL-10, and IL-12 (7, 8, 21). In the results presented here, rHsp60 from Hc caused the expansion of murine T cells that predominantly express the V{beta}8.1/8.2 region of the TCR. Elimination of V{beta}8.1/8.2+ cells abolished the protective efficacy following immunization with rHsp60 and led to increased fungal burden in the lungs and spleens of mice. More important, subsets of V{beta}8.1/2+ T cells that were F3 reactive and produced IFN-{gamma}, specifically those expressing the DGGQG CDR3 region, were able to confer a protective response to T cell- or IFN-{gamma}-deficient mice. Thus, defined populations of T cells are involved in the generation of the protective response to rHsp60.

The importance of clonal T cell expansion in response to a pathogen (22, 23, 24, 25, 26) or as a cause of an autoimmune condition (27, 28) has been documented in several experimental models. V{beta}8.1/8.2+ and V{beta}10+ T cells are expanded during primary and memory response to lymphocytic choriomeningitis virus (29). A specific T cell repertoire also has been identified following infection with Leishmania major and has been correlated to a bias in Th2 production in susceptible mice (30, 31). However, the functional properties of the expanded repertoire in a protective immune response have not been rigorously addressed. We have reported that V{beta}4+ T cells are preferentially expanded in the lungs of mice during a primary infection with Hc and that depletion of these cells causes an increase in fungal burden during primary infection (16). In secondary infection, V{beta}4+ and V{beta}6+ cells are important in protection (17). In addition to infection models with Hc, immunization with the protective fragment F3 drives the expansion of a specific V{beta} repertoire. Following immunization with F3, only V{beta}6+ and V{beta}14+ T cells are isolated from infected mice. Depletion of V{beta}6+ cells causes a complete abrogation in the protective response of F3 immunization, indicating that these cells are functionally required for the protective response to F3 (18).

Immunization with rHsp60 produced a very different profile in the TCR repertoire compared with immunization with F3 in the same strain of mouse. The response to rHsp60 was dominated by V{beta}8.1/2+ T cells, whereas V{beta}6+ cells were the preponderant TCR found following F3 immunization. The contributions of these two dominant V{beta} families to the protective responses induced by each of their specific Ag were similar. In both, elimination of the V{beta} population led to the abolition of protection. The absence of V{beta}6+ cells was associated with an inability to isolate reactive T cell clones, indicating that this family was necessary for clonal expansion. A similar finding was observed in DBA/2 mice immunized with peptide 110–121 from sperm whale myoglobin. Elimination of the dominant V{beta}8.2+ family blunts Ag responsiveness in vitro (32). Conversely, depletion of V{beta}8.1/8.2+ cells from mice immunized with rHsp60 did not prevent the emergence of multiple Ag-reactive clones. Of the clones isolated from V{beta}8.1/8.2+-deficient mice, V{beta}4+ cells emerged with the highest frequency. These clones, however, showed a more limited diversity in terms of CDR3 sequences and V{beta} expression. Despite the ability to generate rHsp60-reactive clones from V{beta}8.1/8.2+-depleted mice, no other V{beta} family was able to compensate for the loss of these cells in vivo.

Despite the multiple differences among T cell clones isolated, there were common CDR3 sequences found between F3- and rHsp60-isolated clones. After F3 immunization, 83% of the CDR3 sequences contained a GG region, and among F3-reactive clones isolated following immunization with rHsp60, 28% had a GG sequence in the CDR3 region. However, while the F3 clones were V{beta}6+, Hsp60 clones that contained a GG region of the CDR3 expressed V{beta}8.1/8.2 or -10. The difference in proportion of GG-containing clones could be an example of differences in the abundance of epitopes presented following immunization with the intact protein.

V{beta}4+ T cell clones were consistently isolated from mice immunized with rHsp60 in the presence or the absence of V{beta}8.1/8.2+ cells. V{beta}4+ cells are preferentially expanded in the lungs of mice during primary infection, suggesting that this family of T cells recognizes an important Ag (8). Despite the importance of V{beta}8.1/8.2+ cells following rHsp60 immunization, these cells were not significantly expanded during primary infection. While V{beta}4+ clones were frequently isolated in these experiments, the results suggest that these cells, like V{beta}6+ cells, cannot compensate for the loss of V{beta}8.1/8.2+ cells and are not required for the protective response to rHsp60. Additional experiments have suggested that the V{beta}4+ populations obtained from spleens in these experiments differ from those expanded in the lung during primary infection, and that the lung-derived cells recognize an Ag other than Hsp60, which may also be crucial in generation of the primary immune response. This result is in agreement with additional data that most V{beta}4+ T cells isolated from lungs of infected mice show little or no reactivity to Hsp60 (M. Scheckelhoff, unpublished observation). Studies are currently underway to determine the Ag specificity and CDR3 sequences of lung-derived V{beta}4+ T cells.

The protective response to rHsp60 requires the production of type 1 cytokines, especially IFN-{gamma} (5, 21). Only T cells expressing V{beta}8.1/8.2+ demonstrated higher proportions of IFN-{gamma} production among the clones. Only three of the 13 non-V{beta}8.1/8.2+ T cell clones generated were classified as Th1. In addition, while other V{beta} families demonstrated IFN-{gamma} production, these collective T cell populations were not able to compensate for the loss of V{beta}8.1/8.2+ cells. This finding does not exclude the possibility that individual Th1 clones that do not express V{beta}8.1/8.2 may be protective. Among V{beta}8.1/8.2+ clones, the production of IFN-{gamma} alone was not indicative of protection. Transfer of T cell clones demonstrated that Th1+ that were also reactive to F3 prolonged survival, while Th1+ clones that did not respond to F3 did not extend survival beyond that of infected control animals. These data suggest that following interaction with Ag, Th1+ V{beta}8.1/8.2+ cells are activated and probably function to activate phagocytes to stimulate antifungal activity, but only those that produce Th1 cytokines and are reactive to F3 are involved in the protective response to rHsp60. F3 reactivity, however, is not alone indicative of protective immunity, as transfer of an F3-reactive 8.1/8.2+ clone that produced IL-4 and IL-10 into TCR {alpha}/{beta}-/- mice caused the animals to succumb to infection at a faster rate than control mice that received no transferred cells. These results support the finding that excess production of IL-4 and/or IL-10 can be deleterious to control of Hc infection (4, 21). However, transfer of these clones does not accelerate the loss of survival in IFN-{gamma}-/- mice. This finding is most likely the result of the Th2-biased environment already present in animals lacking IFN-{gamma}. Hence, specific clonotypes of V{beta}8.1/8.2+ T cells are capable of generating a protective response in a highly organized manner that is controlled through cytokine production among these and other Hsp60-reactive clones.

Among V{beta}8.1/8.2+ clones, 15 of 16 demonstrated dual production of IL-10 and IFN-{gamma}. Recent work has demonstrated that T cells that produce both these cytokines may play an important regulatory role in the generation of a protective immune response. Following infection with L. major or Mycobacterium tuberculosis, IL-10 has been suggested to play a role in controlling the Th1 response to prevent immunopathology in host tissues, but may also prevent sterilization of the tissue and allow dormancy and persistence (33, 34). Evidence that these cells were pivotal in the immune response was demonstrated by the lack of clones that produce both IL-10 and IFN-{gamma} isolated when V{beta}8.1/8.2+ cells were depleted before immunization. All but five of the clones derived from depleted mice produced IFN-{gamma}, and 13 of 22 were classified as Th1, suggesting that compensation for Th1 production may be possible. However, only two of the 22 clones isolated from depleted animals produced both IL-10 and IFN-{gamma}. This assertion is supported by the finding that neutralization of IL-10 interferes with the efficacy of rHsp60 immunization (21).

The results generated here demonstrate that vaccination with the protective protein Hsp60 in C57BL/6 mice can be directly correlated to the presence or the absence of V{beta}8.1/8.2+ T cells expressing a specific CDR3 region (in this case, DGGQG). This finding has important implications for vaccine development for Hsp60 as well as other protein Ags that require T cell activity. While V{beta} usage may vary depending on genetic differences among populations, the CDR3 region that determines epitope specificity will be shared among these cells, and therefore serve as an indicator for a protective response. In this example, the V{beta} family identified is useful in terms of identification and categorization, but the efficacy remains dependent on the CDR3. Correlation of a vaccine and a specific, protective repertoire found within the population can be used as an indicator for an effective vaccine and reduce the requirement for extensive efficacy trials. Conversely, proteins that activate TCR repertoires that are found only in restricted populations will probably have limited success. In addition, the experiments presented here indicate that an epitope-specific subset of T cells can successfully direct the protective response to a single immunogenic Ag, suggesting that under favorable circumstances, the development of complex multivariant vaccines may not be necessary.

In summary, a repertoire of T cells expressing V{beta}8.1/8.2 are generated following rHsp60 immunization and are required for the efficacy of rHsp60-induced protection. Among these cells, a defined subset that produces IFN-{gamma} and is F3 reactive has been shown to prolong survival in mice and is likely to provide the functional attributes required for protective immunity.


    Footnotes
 
1 This work was supported by Grants AI34361 and AI42747 from the National Institutes of Health and by a Merit Review from the Department of Veterans Affairs. Back

2 Address correspondence and reprint requests to Dr. George S. Deepe, Jr., Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH 45267. E-mail address: george.deepe{at}uc.edu Back

3 Abbreviations used in this paper: Hc, Histoplasma capsulatum; CDR3, complementarity-determining region; dpi, days postinfection; F3, fragment 3; i.n., intranasal; rHsp60, recombinant heat shock protein 60. Back

Received for publication May 31, 2002. Accepted for publication September 12, 2002.


    References
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 

  1. Deepe, G. S., Jr. 1994. The immune response to Histoplasma capsulatum: unearthing its secrets. J. Lab. Clin. Med. 123:201.[Medline]
  2. Deepe, G. S., Jr, W. E. Bullock. 1992. Histoplasmosis: a granulomatous inflammatory response. J. I. Gallin, Jr, and I. M. Goldstein, Jr, and R. Snyderman, Jr, eds. Inflammation: Basic Principles and Clinical Correlates 2nd Ed.943. Raven Press, New York.
  3. Allendoerfer, R., G. S. Deepe, Jr. 1998. Blockade of endogenous TNF-{alpha} exacerbates primary and secondary pulmonary histoplasmosis by differential mechanisms. J. Immunol. 160:6072.[Abstract/Free Full Text]
  4. Allendoerfer, R., G. P. Biovin, G. S. Deepe, Jr. 1997. Modulation of immune responses in murine pulmonary histoplasmosis. J. Infect. Dis. 175:905.[Medline]
  5. Allendoerfer, R., G. S. Deepe, Jr. 1997. Intrapulmonary response to Histoplasma capsulatum in {gamma} interferon knockout mice. Infect. Immun. 65:2564.[Abstract]
  6. Gomez, A. M., J. C. Rhodes, G. S. Deepe, Jr. 1991. Antigenicity and immunogenicity of an extract from the cell wall and cell membrane of Histoplasma capsulatum yeast cells. Infect. Immun. 59:330.[Abstract/Free Full Text]
  7. Gomez, F. J., A. M. Gomez, G. S. Deepe, Jr. 1991. Protective efficacy of a 62-kilodalton antigen, HIS-62, from the cell wall and cell membrane of Histoplasma capsulatum yeast cells. Infect. Immun. 59:4459.[Abstract/Free Full Text]
  8. Gomez, F. J., R. Allendoerfer, G. S. Deepe, Jr. 1995. Vaccination with recombinant heat shock protein 60 from Histoplasma capsulatum protects mice against pulmonary histoplasmosis. Infect. Immun. 63:2587.[Abstract]
  9. Deepe, G. S., Jr, R. Gibbons, G. D. Brunner, F. J. Gomez. 1996. A protective domain of heat-shock protein 60 from Histoplasma capsulatum. J. Infect. Dis. 174:828.[Medline]
  10. Blander, S. J., M. A. Horwitz. 1993. Major cytoplasmic membrane protein of Legionella pneumophila, a genus common antigen and member of the hsp 60 family of heat shock proteins, induces protective immunity in a guinea pig model of Legionnaires’ disease. J. Clin. Invest. 91:717.
  11. Kaufmann, S. H.. 1990. Heat shock proteins and the immune response. Immunol. Today 11:129.[Medline]
  12. Morrison, R. P., R. J. Belland, K. Lyng, H. D. Caldwell. 1989. Chlamydial disease pathogenesis: the 57-kD chlamydial hypersensitivity antigen is a stress response protein. J. Exp. Med. 170:1271.[Abstract/Free Full Text]
  13. Young, D., R. Lathigra, R. Hendrix, D. Sweetser, R. A. Young. 1988. Stress proteins are immune targets in leprosy and tuberculosis. Proc. Natl. Acad. Sci. USA 85:4267.[Abstract/Free Full Text]
  14. Delves, P. J., I. M. Roitt. 2000. The immune system: first of two parts. N. Engl. J. Med. 343:37.[Free Full Text]
  15. Davis, M. M.. 1990. T cell receptor gene diversity and selection. Annu. Rev. Biochem. 59:475.[Medline]
  16. Gomez, F. J., J. A. Cain, R. Gibbons, R. Allendoerfer, G. S. Deepe, Jr. 1998. V{beta} 4+ T cells promote clearance of infection in murine pulmonary histoplasmosis. J. Clin. Invest. 102:984.[Medline]
  17. Gomez, F. J., E. O. Woodward, R. Pilcher-Roberts, R. S. Gibbons, G. S. Deepe, Jr. 2001. V{beta}6+ and V{beta}4+ T cells exert cooperative activity in clearance of secondary infection with Histoplasma capsulatum. J. Immunol. 166:2855.[Abstract/Free Full Text]
  18. Deepe, G. S., Jr, R. Gibbons. 2001. V{beta}6+ T cells are obligatory for vaccine-induced immunity to Histoplasma capsulatum. J. Immunol. 167:2219.[Abstract/Free Full Text]
  19. Allendorfer, R., G. D. Brunner, G. S. Deepe, Jr. 1999. Complex requirements for nascent and memory immunity in pulmonary histoplasmosis. J. Immunol. 162:7389.[Abstract/Free Full Text]
  20. Deepe, G. S., Jr, J. G. Smith, G. Sonnenfeld, D. Denman, W. E. Bullock. 1986. Development and characterization of Histoplasma capsulatum-reactive murine T-cell lines and clones. Infect. Immun. 54:714.[Abstract/Free Full Text]
  21. Deepe, G. S., Jr, R. S. Gibbons. 2002. Cellular and molecular regulation of vaccination with heat shock protein 60 from Histoplasma capsulatum. Infect. Immun. 70:3759.[Abstract/Free Full Text]
  22. Busch, D. H., I. Pilip, E. G. Pamer. 1998. Evolution of a complex T cell receptor repertoire during primary and recall bacterial infection. J. Exp. Med. 188:61.[Abstract/Free Full Text]
  23. Prevost-Blondel, A., R. Lengagne, F. Letourneur, C. Pannetier, E. Gomard, J. G. Guillet. 1997. In vivo longitudinal analysis of a dominant TCR repertoire selected in human response to influenza virus. Virology 233:93.[Medline]
  24. Wang, X., J. Ohmen, K. Uyemura, T. Rea, M. Kronenberg, R. Modlin. 1993. Selection of T lymphocytes bearing limited T-cell receptor {beta} chains in the response to a human pathogen. Proc. Natl. Acad. Sci. USA 90:188.[Abstract/Free Full Text]
  25. Uyemura, K., J. D. Ohmen, C. L. Grisso, P. A. Sieling, R. Wyzykowski, D. M. Reisinger, T. H. Rea, R. L. Modlin. 1992. Limited T-cell receptor {beta}-chain diversity of a T-helper cell type 1-like response to Mycobacterium leprae. Infect. Immun. 60:4542.[Abstract/Free Full Text]
  26. Soudeyns, H., P. Champagne, C. L. Holloway, G. U. Silvestri, N. Ringuette, J. Samson, N. Lapointe, R. P. Sekaly. 2000. Transient T cell receptor {beta}-chain variable region-specific expansions of CD4+ and CD8+ T cells during the early phase of pediatric human immunodeficiency virus infection: characterization of expanded cell populations by T cell receptor phenotyping. J. Infect. Dis. 181:107.[Medline]
  27. Babbe, H., A. Roers, A. Waisman, H. Lassmann, N. Goebels, R. Hohlfeld, M. Friese, R. Schroder, M. Deckert, S. Schmidt, et al 2000. Clonal expansions of CD8+ T cells dominate the T cell infiltrate in active multiple sclerosis lesions as shown by micromanipulation and single cell polymerase chain reaction. J. Exp. Med. 192:393.[Abstract/Free Full Text]
  28. Tsuchida, M. Y., H. Hirahara, H. Hanawa, K. Tomiyama, T. Abo. 1993. Preferential distribution of V{beta}8.2-positive T cells in the central nervous system of rats with myelin basic protein-induced autoimmune encephalomyelitis. Eur. J. Immunol. 23:2399.[Medline]
  29. Sourdive, D. J., K. Murali-Krishna, J. D. Altman, A. J. Zajac, J. K. Whitmire, C. Pannetier, P. Kourilsky, B. Evavold, A. Sette, R. Ahmed. 1998. Conserved T cell receptor repertoire in primary and memory CD8 T cell responses to an acute viral infection. J. Exp. Med. 188:71.[Abstract/Free Full Text]
  30. Reiner, S. L., D. J. Fowell, N. H. Moskowitz, K. Swier, D. R. Brown, C. R. Brown, C. W. Turck, P. A. Scott, N. Killeen, R. M. Locksley. 1998. Control of Leishmania major by a monoclonal {alpha}{beta} T cell repertoire. J. Immunol. 160:884.[Abstract/Free Full Text]
  31. Louis, J. A., F. Conceicao-Silva, H. Himmelrich, F. Tacchini-Cottier, P. Launois. 1998. Anti-leishmania effector functions of CD4+ Th1 cells and early events instructing Th2 cell development and susceptibility to Leishmania major in BALB/c mice. Adv. Exp. Med. Biol. 452:53.[Medline]
  32. Gaur, A., C. G. Fathman, L. Steinman, S. Brocke. 1993. SEB induced anergy: modulation of immune response to T cell determinants of myoglobin and myelin basic protein. J. Immunol. 150:3062.[Abstract]
  33. Trinchieri, G.. 2001. Regulatory role of T cells producing both interferon gamma and interleukin 10 in persistent infection. J. Exp. Med. 194:F53.
  34. Belkaid, Y., K. F. Hoffmann, S. Mendez, S. Kamhawi, M. C. Udey, T. A. Wynn, D. L. Sacks. 2001. The role of interleukin (IL)-10 in the persistence of Leishmania major in the skin after healing and the therapeutic potential of anti-IL-10 receptor antibody for sterile cure. J. Exp. Med. 194:1497.[Abstract/Free Full Text]



This article has been cited by other articles:


Home page
Infect. Immun.Home page
M. Wuthrich, H. I. Filutowicz, H. L. Allen, G. S. Deepe, and B. S. Klein
V{beta}1+ J{beta}1.1+/V{alpha}2+ J{alpha}49+ CD4+ T Cells Mediate Resistance against Infection with Blastomyces dermatitidis
Infect. Immun., January 1, 2007; 75(1): 193 - 200.
[Abstract] [Full Text] [PDF]


Home page
J. Immunol.Home page
E. Heninger, L. H. Hogan, J. Karman, S. Macvilay, B. Hill, J. P. Woods, and M. Sandor
Characterization of the Histoplasma capsulatum-Induced Granuloma.
J. Immunol., September 1, 2006; 177(5): 3303 - 3313.
[Abstract] [Full Text] [PDF]


Home page
Infect. Immun.Home page
D. M. Lindell, M. N. Ballinger, R. A. McDonald, G. B. Toews, and G. B. Huffnagle
Diversity of the T-Cell Response to Pulmonary Cryptococcus neoformans Infection.
Infect. Immun., August 1, 2006; 74(8): 4538 - 4548.
[Abstract] [Full Text] [PDF]


Home page
Infect. Immun.Home page
M. Scheckelhoff and G. S. Deepe Jr.
A Deficiency in Gamma Interferon or Interleukin-10 Modulates T-Cell-Dependent Responses to Heat Shock Protein 60 from Histoplasma capsulatum
Infect. Immun., April 1, 2005; 73(4): 2129 - 2134.
[Abstract] [Full Text] [PDF]


Home page
Infect. Immun.Home page
M. G. Hartley, M. Green, G. Choules, D. Rogers, D. G. C. Rees, S. Newstead, A. Sjostedt, and R. W. Titball
Protection Afforded by Heat Shock Protein 60 from Francisella tularensis Is Due to Copurified Lipopolysaccharide
Infect. Immun., July 1, 2004; 72(7): 4109 - 4113.
[Abstract] [Full Text] [PDF]


Home page
Eukaryot CellHome page
B. R. Steen, S. Zuyderduyn, D. L. Toffaletti, M. Marra, S. J. M. Jones, J. R. Perfect, and J. Kronstad
Cryptococcus neoformans Gene Expression during Experimental Cryptococcal Meningitis
Eukaryot. Cell, December 1, 2003; 2(6): 1336 - 1349.
[Abstract] [Full Text] [PDF]


This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Scheckelhoff, M.
Right arrow Articles by Deepe, G. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Scheckelhoff, M.
Right arrow Articles by Deepe, G. S., Jr.
Right arrowPubmed/NCBI databases
*Substance via MeSH


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS