Jill M. Kramer

The IL-17 cytokine family.

IL-17A and its receptor are the founding members of a recently described cytokine family, with unique sequences and functions in the immune system and elsewhere. Consisting of six ligands (IL-17A-F) and five receptors (IL-17RA-IL-17RE) in mammals, these molecules have distinct primary amino acid structures with only minimal homology to other cytokine families. By far the best studied of these cytokines to date are IL-17A and its receptor, IL-17RA. IL-17A is produced primarily by T cells, and is the hallmark cytokine of a newly defined T helper cell subset that appears to be involved in generation of autoimmunity. Despite its production by the adaptive immune system, IL-17A exhibits proinflammatory activities similar to innate immune cytokines such as IL-1beta and TNF-alpha and appears to play important and nonredundant roles in regulating granulocytes in vivo. As a result, IL-17A also plays key roles in host defense. In contrast to the restricted expression of IL-17A, the IL-17RA receptor is ubiquitously expressed, and thus most cells are potential physiological targets of IL-17A. This chapter describes the major molecular properties, biological activities, and known signaling pathways of the IL-17 family, with an emphasis on IL-17A and IL-17RA.

Evidence for ligand-independent multimerization of the IL-17 receptor.

IL-17 and its receptor are founding members of a novel inflammatory cytokine family. To date, only one IL-17 receptor subunit has been identified, termed IL-17RA. All known cytokine receptors consist of a complex of multiple subunits. Although IL-17-family cytokines exist as homodimers, the configuration and stoichiometry of the IL-17R complex remain unknown. We used fluorescence resonance energy transfer (FRET) to determine whether IL-17RA subunits multimerize, and, if so, whether they are preassembled in the plasma membrane. HEK293 cells coexpressing IL-17RA fused to cyan or yellow fluorescent proteins (CFP or YFP) were used to evaluate FRET before and after IL-17A or IL-17F treatment. In the absence of ligand, IL-17RA molecules exhibited significant specific FRET efficiency, demonstrating that they exist in a multimeric, preformed receptor complex. Strikingly, treatment with IL-17A or IL-17F markedly reduced FRET efficiency, suggesting that IL-17RA subunits within the IL-17R complex undergo a conformational change upon ligand binding.

Cutting edge: identification of a pre-ligand assembly domain (PLAD) and ligand binding site in the IL-17 receptor.

IL-17 is the hallmark cytokine of the newly described “Th17” lymphocyte population. The composition, subunit dynamics, and ligand contacts of the IL-17 receptor are poorly defined. We previously demonstrated that the IL-17RA subunit oligomerizes in the membrane without a ligand. In this study, computational modeling identified two fibronectin-III-like (FN) domains in IL-17RA connected by a nonstructured linker, which we predicted to mediate homotypic interactions. In yeast two-hybrid, the membrane-proximal FN domain (FN2), but not the membrane-distal domain (FN1), formed homomeric interactions. The ability of FN2 to drive ligand-independent multimerization was verified by coimmunoprecipitation and fluorescence resonance energy transfer microscopy. Thus, FN2 constitutes a “pre-ligand assembly domain” (PLAD). Further studies indicated that the FN2 linker domain contains the IL-17 binding site, which was never mapped. However, the FN1 domain is also required for high affinity interactions with IL-17. Therefore, although the PLAD is located entirely within FN2, effective ligand binding also involves contributions from the linker and FN1.

CXCL13 is elevated in Sjögren's syndrome in mice and humans and is implicated in disease pathogenesis

SS is an autoimmune disease. pSS affects exocrine glands predominantly, whereas sSS occurs with other autoimmune connective tissue disorders. Currently, care for patients with SS is palliative, as no established therapeutics target the disease directly, and its pathogenetic mechanisms remain uncertain. B‐cell abnormalities have been identified in SS. CXCL13 directs B‐cell chemotaxis and is elevated in several autoimmune diseases. In this study, we tested the hypothesis that CXCL13 is elevated in SS in mice and humans and that neutralization of the chemokine ameliorates disease in a murine model. We assayed CXCL13 in mouse models and human subjects with SS to determine whether CXCL13 is elevated both locally and systemically during SS progression and whether CXCL13 may play a role in and be a biomarker for the disease. Cxcl13 expression in salivary tissue increases with disease progression, and its blockade resulted in a modest reduction in glandular inflammation in an SS model. We demonstrate that in humans CXCL13 is elevated in serum and saliva, and an elevated salivary CXCL13 level distinguishes patients with xerostomia. These data suggest a role for CXCL13 as a valuable biomarker in SS, as 74% of patients with SS displayed elevated CXCL13 in sera, saliva, or both. Thus, CXCL13 may be pathogenically involved in SS and may serve as a new marker and a potential therapeutic target.

Early events in Sjögren’s Syndrome pathogenesis: The importance of innate immunity in disease initiation

Sjögrens Syndrome (SS) is a debilitating autoimmune disease that primarily affects women. Patients with SS experience dry eyes and dry mouth in addition to systemic disease manifestations, including arthritis, peripheral neuropathy and pulmonary fibrosis. As in many autoimmune diseases, the inciting factors that precipitate SS are poorly understood. Patients with SS have periductal and perivascular lymphocytic infiltration of salivary and lacrimal tissue, and this is a hallmark of disease. While this infiltration is well characterized, the pathologic events that precede and cause this inflammatory cell recruitment are unknown. Although few studies have examined SS salivary tissue prior to disease onset, there is strong evidence for innate immune hyperactivity. Accordingly, processes such as apoptosis of glandular tissue, heightened inflammatory cytokine and chemokine production, and toll-like receptor (TLR) activation are described in early disease and are each linked to innate immune activation in murine models of disease and SS patients. This review will explore the relationship between innate immunity and SS pathogenesis prior to overt disease onset and discuss therapeutic strategies to mitigate disease progression in SS patients.

Molecular concepts in the pathogenesis of ameloblastoma: Implications for therapeutics

Ameloblastoma is a benign odontogenic neoplasm that may exhibit aggressive biological behavior as evidenced by its rapid growth and significance recurrence rates following initial surgical resection. Currently, the only therapy for ameloblastoma is surgical, and adjunctive treatment modalities are needed to mitigate tumor growth and to reduce the need for extensive and disfiguring surgeries. Many studies have identified markers expressed by ameloblastoma and these lend insight to our understanding of tumor progression. This review provides a summary of the specific molecular pathways implicated in tumor pathogenesis, including those involved in bone remodeling, apoptosis, cell signaling, and tumor suppression. Based on these data, we identify several prognostic or therapeutic markers that have been used successfully in the treatment of other neoplastic processes that may also have diagnostic and prognostic utility for ameloblastoma. Thus, it is important to determine which markers hold the greatest promise for clinical management of this benign neoplasm in order to improve treatment options, particularly in patients with aggressive forms of ameloblastoma.

Early BAFF receptor blockade mitigates murine Sjögren's syndrome: Concomitant targeting of CXCL13 and the BAFF receptor prevents salivary hypofunction.

Sjögrens syndrome (SS) is a debilitating autoimmune disease. Patients with SS may develop xerostomia. This process is progressive, and there are no therapeutics that target disease etiology. We hypothesized BAFF receptor (BAFFR) blockade would mitigate SS disease development, and neutralization of CXCL13 and BAFF signaling would be more efficacious than BAFFR blockade alone. We treated NOD/ShiLtJ SS mice with soluble BAFF receptor (BAFFR-Fc) or anti-CXCL13/BAFFR-Fc in combination, prior to the development of clinical disease. Our results show treatment with BAFFR-Fc reduced peripheral B cell numbers and decreased sialadenitis. In addition, this treatment reduced total serum immunoglobulin as well as IgG and IgM specific anti-nuclear autoantibodies. NOD/ShiLtJ mice treated with BAFFR-Fc and anti-CXCL13 antibody were protected from salivary deficits. Results from this study suggest blockade of CXCL13 and BAFFR together may be an effective therapeutic strategy in preventing salivary hypofunction and reducing autoantibody titers and sialadenitis in patients with SS.

The osteopontin transgenic mouse is a new model for Sjögren's syndrome.

Osteopontin (Opn) is a cytokine involved in both physiological and pathological processes, and is elevated in many autoimmune diseases. Sjögrens syndrome (SS) is an autoimmune disease with a strong female predilection characterized by lymphocytic infiltration of exocrine glands. We hypothesized that Opn contributes to SS pathogenesis. We examined an established SS model and found increased Opn locally and systemically. Next, we examined Opn transgenic (Opn Tg) mice for evidence of SS. Opn Tg animals exhibited lymphocytic infiltration of salivary and lacrimal glands, and Opn co-localized with the infiltrates. Moreover, saliva production was reduced, and SS autoantibodies were observed in the serum of these mice. Finally, female Opn Tg mice showed more severe disease compared to males. Taken together, these data support a role for Opn in SS pathogenesis. We identify a new model of spontaneous SS that recapitulates the human disease in terms of sex predilection, histopathology, salivary deficits, and autoantibodies.

Innate immunity in Sjögren's syndrome

Sjögrens syndrome (SS) is an autoimmune disease of exocrine tissue that primarily affects women. Although patients typically experience xerostomia and xerophthalmia, numerous systemic disease manifestations are seen. Innate immune hyperactivity is integral to many autoimmune diseases, including SS. Results from SS mouse models suggest that innate immune dysregulation drives disease and this is a seminal event in SS pathogenesis. Findings in SS patients corroborate those in mouse models, as innate immune cells and pathways are dysregulated both in exocrine tissue and in peripheral blood. We will review the role of the innate immune system in SS pathogenesis. We will discuss the etiology of SS with an emphasis on innate immune dysfunction. Moreover, we will review the innate cells that mediate inflammation in SS, the pathways implicated in disease, and the potential mechanisms governing their dysregulation. Finally, we will discuss emerging therapeutic approaches to target dysregulated innate immune signaling in SS.

Calcifying aponeurotic fibroma with bone islands exhibiting hematopoiesis: a case report and review of the literature

Aponeurotic fibroma (AF) was originally described by Keasbey in 1953 as juvenile aponeurotic fibroma, most commonly occurring in the distal extremities. Initially described in children and adolescents, AF is now recognized to occur over a wide age range and at various anatomic sites. A variant of this lesion, termed calcifying aponeurotic fibroma (CAF) has been described. CAF is a slow-growing, solitary, and painless nodule often adherent to tendon, fascia, or periosteum. We report a patient who presented with a firm lobulated mass, portions of which were fixed to the left ascending mandibular ramus. The lesion represented a CAF arising juxtacortical to the mandible, with the calcified component composed of mature bone exhibiting focal areas of hematopoiesis. Additional reports of CAF occurring in the head and neck region are reviewed.