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Blood, 1 January 2001, Vol. 97, No. 1, pp. 14-32

REVIEW ARTICLE

Interleukin 15: biology and relevance to human disease

Todd A. Fehniger and Michael A. Caligiuri

From the Departments of Internal Medicine and Molecular Virology, Immunology, and Medical Genetics, Divisions of Hematology/Oncology and Human Cancer Genetics, and the Comprehensive Cancer Center, The Ohio State University, Columbus, OH.


    Introduction
Top
Introduction
Molecular and cellular biology...
IL-15 and immune cells
Function of IL-15 on...
Relevance of IL-15 to...
Conclusions
References

Since the cloning of interleukin (IL)-15 six years ago, there have been numerous studies examining the molecular and cellular biology of this cytokine. IL-15 and IL-2 have similar biologic properties in vitro, consistent with their shared receptor (R) signaling components (IL-2/15Rbeta gamma c). However, specificity for IL-15 versus IL-2 is provided by unique private alpha -chain receptors that complete the IL-15Ralpha beta gamma and IL-2Ralpha beta gamma heterotrimeric high-affinity receptor complexes and thereby allow differential responsiveness depending on the ligand and high-affinity receptor expressed. Intriguingly, both IL-15 and IL-15Ralpha transcripts have a much broader tissue distribution than IL-2/IL-2Ralpha . Further, multiple complex posttranscriptional regulatory mechanisms tightly control IL-15 expression. Thus, based upon complex regulation, as well as differential patterns of IL-15 and IL-15Ralpha expression, it is likely that the critical in vivo functions of this receptor/ligand pair differ from those of IL-2 and IL-2Ralpha . Studies to date examining the biology of IL-15 have identified several key nonredundant roles, such as IL-15's importance during natural killer (NK) cell, NK-T cell, and intestinal intraepithelial lymphocyte development and function. A role for IL-15 during autoimmune processes such as rheumatoid arthritis and malignancies such as adult T-cell leukemia suggest that dysregulation of IL-15 may result in deleterious effects for the host. This review attempts to present concisely our current understanding of the cellular and molecular biology of IL-15, IL-15's role in human disease, and its potential clinical utility as a therapeutic agent or target.


    Molecular and cellular biology of interleukin 15 (IL-15)
Top
Introduction
Molecular and cellular biology...
IL-15 and immune cells
Function of IL-15 on...
Relevance of IL-15 to...
Conclusions
References

The discovery of IL-15 and its relation to IL-2

IL-15 was identified by 2 independent groups based upon its ability to stimulate proliferation of the IL-2-dependent CTLL-2 T-cell line in the presence of neutralizing anti-IL-2 antibodies. The activity within cell culture supernatants of the simian kidney epithelial cell line CV-1/EBNA was purified, molecularly cloned, and designated IL-15.1 The activity identified in supernatants of the human T-cell leukemia virus-1 (HTLV-1) cell line, HuT-102, was purified and called IL-T.2,3

Scientists at the Immunex Corporation (Seattle, WA) isolated the 14- to 15-kd protein responsible for the CTLL proliferation within CV-1/EBNA supernatants using anion-exchange and high-pressure liquid chromatography and sequenced the NH2-terminal residues. Degenerate oligonucleotide primers were generated from this partial protein sequence and were used to obtain the full-length simian IL-15 cDNA from a CV-1/EBNA cDNA library. With simian IL-15 cDNA as a probe, the full-length human IL-15 cDNA was cloned from the IMTLH bone marrow stromal cell line.1 The IL-T protein identified by researchers at the National Institutes of Health within HuT-102 supernatants was later cloned and shown to be a chimera composed of the HTLV-1 long terminal repeat (LTR) and human IL-15. The HTLV-1 LTR was fused in frame immediately upstream of IL-15, thereby deleting a portion of its 5' untranslated region (UTR).2-4

Because IL-15 was initially identified through its ability to mimic IL-2-induced T-cell proliferation, the biochemical and functional relation between these cytokines was quickly examined. Comparisons of the primary protein and cDNA sequences of human or simian IL-15 yielded little primary homology to IL-2; however, computer modeling of IL-15's secondary structure suggested that IL-15 belonged to the 4 alpha -helix bundle cytokine family,1 including human growth hormone, IL-2, IL-3, IL-6, IL-7, granulocyte colony-stimulating factor (G-CSF), and granulocyte-macrophage colony-stimulating factor (GM-CSF).5,6 Functional studies using antibodies that blocked the various IL-2R subunits determined that IL-15 used the IL-2Rbeta subunit and the common gamma chain (gamma c), but not the IL-2Ralpha . Because signaling via IL-2 and IL-15 appears to occur exclusively via the same beta gamma chains, IL-15 mediates functions similar to IL-2 in vitro.1,3,7 However, in vivo it is the distribution of the distinct IL-15Ralpha and IL-2Ralpha chains that directs when and where each ligand will bind and activate via this beta gamma signaling pathway. Through the development of mice with targeted disruption of the IL-158 and IL-15Ralpha 9 genes, it is now apparent that IL-15 and IL-2 mediate very different in vivo functions. The similarities and differences between IL-15 and IL-2 are highlighted where appropriate below.

Structure of the genomic locus encoding IL-15

The IL-15 gene spans 34 kb or more, mapping to human chromosome 4q31 and the central region of mouse chromosome 8.10,11 The genomic structure of human IL-15 contains 9 exons (7 coding exons), with a similar intron/exon structure and estimated size between the murine and human IL-15 genes.10,11 More recently, an alternative exon has been described in human12-14 and murine15,16 IL-15, consisting of an additional sequence between exons 4 and 5 that encodes an alternative leader peptide. The structure of the human IL-15 genomic locus is diagramed in Figure 1 and includes the recently described alternative exon (4A).11,12,14 The IL-2 gene is located on human chromosome 4q26-28 and consists of 4 exons and 3 introns.17,18 Of note, the overall intron/exon structure of the portion of the IL-15 gene encoding the mature IL-15 protein (4 exons and 3 introns) is similar to that of the IL-2 gene and other 4 alpha -helix bundle cytokines.5 However, consistent with other family members, there is little primary homology between IL-2 and IL-15 at the nucleotide or protein level (Figure 2).1 Thus, although it is doubtful that the IL-2 and IL-15 genes have a direct, recent ancestral relationship, the gene structure of all members of the 4 alpha -helix bundle cytokine family appears similar.5


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Figure 1. Human IL-15 gene, mRNA, and protein structure. The human IL-15 locus consists of 9 exons and 8 introns and is located on chromosome 4q31.10,11 Two IL-15 mRNA isoforms have been described, the classical LSP and alternative SSP, with both encoding an identical IL-15 mature protein of 114 AAs (see text for details). Translational start sites (right-arrow) and stop codons () are indicated; in2 indicates intron 2.



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Figure 2. Comparison of IL-15 and IL-2 homology at the DNA, primary protein, and tertiary protein levels. The model of IL-2's tertiary folding structure was generated from known crystal structures from protein data bank data file 3INK.284 The theoretical model of IL-15's tertiary structure was generated using IL-2's 3-dimensional structure as a template and the SwissProt software program, and yielded results similar to those described.23

IL-15 mRNA isoforms, signal sequences, and intracellular trafficking

The originally identified human IL-15 cDNA contains a 5' UTR of at least 316 base pairs (bp), a 486-bp open reading frame, and a 3' UTR of at least 400 bp, encoding a precursor IL-15 with an unusually long 48-amino acid (AA) leader peptide and a 114-AA mature protein.1 Identification of human, simian, and murine IL-15 indicated that IL-15 was conserved between species (97% identity comparing human and simian; 73% identity comparing human with murine).1 An alternative human IL-15 cDNA was identified containing an additional exon.12,13 This variant IL-15 human cDNA contains 119 nucleotides (nt) within intron 4 but lacks exons 1 and 2 of the original cDNA, resulting in a smaller spliced mRNA product (Figure 1).14 However, this exonic sequence encoded 3 premature stop codons and a novel downstream ATG translation start site, resulting ultimately in an IL-15 precursor protein with a 21-AA short signal peptide (SSP), compared with the original 48-AA long signal peptide (LSP). A similar alternative transcript has been described in the mouse.15,16 In human and mouse, both IL-15 isoforms encode an identical mature IL-15 protein, containing differences only within the signal sequence. Regulation of the IL-15 mRNA species expressed may occur through alternative splicing and/or an additional uncharacterized IL-15 promoter driving the expression of the SSP-IL-15.14

The 2 IL-15 mRNA isoforms have significant differences in the N-terminal portions of their leader peptides (Figure 1). Leader peptides determine the intracellular localization and potential secretion of the associated mature protein. Both LSP-IL-15 and SSP-IL-15 appear to have low secretion potential compared with well-secreted cytokines such as IL-2, as replacement of either endogenous IL-15 signal peptide (SP) by CD3313 or IgVkappa 19 signal peptides resulted in efficient secretion of bioactive IL-15 protein. Both LSP-IL-15 and SSP-IL-15 isoforms had 2 to 3 log-fold less secretion than IL-2 SP,14 and analysis with IL-15-green fluorescent protein (GFP) fusion proteins demonstrated that LSP-IL-15 was targeted to the secretory pathway (endoplasmic reticulum [ER]/Golgi apparatus), whereas SSP-IL-15 appeared to be restricted to the cytoplasm and nucleus.14,20,21 This differential trafficking is discussed later in the context of the regulation of IL-15 gene expression. SSP-IL-15 mRNA is expressed in the heart, thymus, appendix, and testis, whereas LSP-IL-15 is in skeletal muscle, placenta, heart, lung, liver, thymus, and kidney; the biologic significance of these observations will require further investigation.12,14 Recently, Nishimura et al22 generated transgenic mice that express both isoforms of IL-15 under the control of a major histocompatibility complex (MHC) class I promoter, documenting differential in vivo roles for LSP- and SSP-IL-15 (see below).

Structure of the mature IL-15 protein

The 14- to 15-kd, 114-AA mature IL-15 protein is encoded by exons 5 to 8 of the IL-15 gene (Figure 1).1,10,11 IL-15 contains 2 disulfide bonds at positions C42-C88 and C35-C85 (single-letter amino acid codes), the former being homologous to the C-C within IL-2. There are 2 N-linked glycosylation sites at the C-terminus of the IL-15 protein, at N79 and N112. The mature IL-15 protein has been predicted to have strong helical moments at AAs 1 to 15, 18 to 57, 65 to 78, and 97 to 114, supporting a theoretical model of a 4 alpha -helix bundle structure (Figure 2).1,23

The IL-15 receptor (R) complex and its relation to the IL-2R complex

Three different IL-2R complexes exist: The isolated IL-2Ralpha binds IL-2 with low affinity (Ka approximately 108 M-1) without transducing a signal; the heterodimeric IL-2Rbeta gamma binds IL-2 with intermediate affinity (Ka approximately 109 M-1) and transduces intracellular signals; and the heterotrimeric IL-2Ralpha beta gamma binds IL-2 with high affinity (Ka approximately 1011 M-1) and also signals.18,24,25 The IL-2Rgamma , also referred to as gamma c, is shared by receptors for IL-2, IL-4, IL-7, IL-9, and IL-15.26,27 Early experiments using specific blocking monoclonal antibodies (MoAbs) documented the participation of the IL-2Rbeta and gamma c, but not the IL-2Ralpha , in IL-15 binding and function, suggesting the presence of an additional subunit for high-affinity IL-15 binding to the IL-15R complex.3,7,28,29 The murine and human IL-15Ralpha subunits were subsequently cloned and characterized and shown to be highly homologous to their IL-2Ralpha counterparts.29,30 The full-length human IL-15Ralpha is a type-1 transmembrane protein with a signal peptide of 32 AAs, an extracellular domain of 173 AAs, a transmembrane domain of 21 AAs, a 37-AA cytoplasmic tail, and multiple N- or O-linked glycosylation sites.30,31 Comparison of the IL-2Ralpha and the IL-15Ralpha revealed the presence of a conserved protein binding motif (sushi domain or GP-1 motif) and similar intron/exon structure, placing IL-2Ralpha and IL-15Ralpha as the founding members of a new receptor family.29 Through transfection experiments, it was established that the full-length IL-15Ralpha alone was sufficient for high-affinity (Ka greater than or equal to 1011 M-1) binding of IL-15, but, similar to IL-2Ralpha , it played no role in signal transduction. This high affinity of the isolated IL-15Ralpha for IL-15 is in stark contrast to the IL-2Ralpha , which has low affinity for IL-2 (Ka approximately 108 M-1) in the absence of the IL-2Rbeta gamma . Thus, the IL-15Ralpha binds IL-15 with high affinity, but transduces signals only in the presence of the IL-2/15Rbeta and gamma c (Figure 2). IL-15, like IL-2, may also bind and signal through the heterodimeric IL-2/15Rbeta gamma c with intermediate affinity (Ka approximately 109 M-1) in the absence of IL-15Ralpha .28

Eight splicing variants of the hIL-15Ralpha have been identified, including all combinations of exon-2 deletion, exon-3 deletion, and alternative use of exon 7 or 7'.10,31 Isoforms that lacked exon 2 (Delta 2) were unable to bind IL-15, raising the possibility that Delta 2IL-15Ralpha may associate with IL-2/15Rbeta gamma c, removing them from participation in high-affinity IL-15R complexes. Although all isoforms of IL-15Ralpha were detected within the plasma membrane, ER, and Golgi apparatus, only IL-15Ralpha forms containing exon 2 localized to the nuclear membrane.31 The localization of both IL-15Ralpha and SSP-IL-15 to the nuclear membrane/nucleus calls for additional studies to better characterize their biologic significance.

The originally identified full-length IL-15Ralpha transcript (approximately 1.7 kb) was detected in numerous tissues and cell lines, demonstrating a much wider distribution than the IL-2Ralpha .30 Expression of all 8 IL-15Ralpha isoforms was observed in multiple tissues (eg, brain, intestine, liver, peripheral blood mononuclear cells [PBMCs]) and cell lines; however, the relative expression of each isoform varied.31 Because of the high affinity of IL-15Ralpha for IL-15, it has been hypothesized that the IL-15Ralpha may act as a molecular sink for excess IL-15 or may associate with other receptor components yet to be identified.30,32 A distinct high-affinity binding receptor (60 to 65 kd, IL-15RX) has been identified on mast cells that does not include the identified IL-2/15Rbeta , gamma c, or IL-15Ralpha and that transduces different intracellular signals than IL-15Ralpha beta gamma .33 Further studies are required to understand the functional importance of IL-15's binding to IL-15RX in mast cell biology because no mast cell developmental defects were found in IL-15-/- mice.8

How does IL-15 relate to other cytokines that use the gamma c receptor?

Several cytokines share the gamma c receptor, including IL-2, IL-4, IL-7, IL-9, and IL-15, all of which use additional subunit(s) for specificity or signaling.34,35 In vivo experiments engineering mice with targeted disruption of these cytokines or their specific receptor subunits elegantly demonstrated that although gamma c is shared, it mediates different biologic functions when paired with individual cytokines. Comprehensive comparative reviews of gamma c-binding cytokines have been provided elsewhere.36-38

Pathways of IL-15 signal transduction

Because IL-2 and IL-15 share common signaling components (IL-2/15Rbeta gamma c), most evidence to date suggests that the interaction of IL-15 with its receptor complex in various cell types leads to a series of signaling events that are similar, if not identical, to those elicited by IL-2.39 These include activation of the Janus kinase (Jak)/signal transducer and activator of transcription (STAT) pathway.40 IL-2/15Rbeta is associated with Jak1 and the gamma c is associated with Jak3, resulting in STAT3 and STAT5 phosphorylation, respectively, after ligation with IL-15 (Figure 2).41,42 Additional signaling pathways through the IL-2/15R complexes include the src-related tyrosine kinases, induction of Bcl-2, and stimulation of the Ras/Raf/MAPK pathway that ultimately results in fos/jun activation.43 In neutrophils, IL-15 has been shown to activate NF-kappa B but not AP-1, whereas IL-15 stimulation of bulk human peripheral blood lymphocytes activated both transcription factors.44 However, reports of IL-15- but not IL-2-induced signals in an IL-15Ralpha +IL-2/15Rbeta colonic epithelial cell line leave open the possibility of alternative IL-15Ralpha signaling mechanisms.45 The alternative receptor system in mast cells (IL-15RX) has been shown to induce phosphorylation of Jak2 and STAT5,33,46 as well as Tyk2 and STAT6.47

Physiologic expression of IL-15

IL-15 mRNA is produced by multiple tissues (placenta, skeletal muscle, kidney, lung, heart, monocytes/macrophages)1 and numerous cell types through various stimulatory conditions.48-60 The first cell types to be implicated as a functionally relevant source of IL-15 in the context of the immune response were members of the monocyte/macrophage lineage.48,49 Other antigen-presenting cells (APCs), such as blood-derived dendritic cells, have been shown to produce IL-15 mRNA and protein, suggesting a role in the attraction and stimulation of T cells.50,51 IL-15 is also produced by bone marrow (BM) stromal cell lines,1 primary human BM stromal cells,52 thymic epithelium,53 and fetal intestinal epithelium,54 consistent with IL-15's role during hematopoiesis. Epithelial and fibroblast cells from various tissues have been documented to produce IL-15 mRNA and/or protein, including kidney epithelial cell lines,1 epidermal skin cells and keratinocytes,55 fetal skin,56 retinal pigment epithelium,57 and intestinal epithelial cells.58 Other cells producing IL-15 with a less obvious function, and requiring further investigation, include kidney proximal tubule cells59 as well as astrocytes and microglia.60 Although not detected initially,1 T cells were later shown by more sensitive techniques to express IL-15 mRNA.61 Considering the extensive posttranscriptional control of IL-15 now evident (see below), it will be important to document IL-15 protein production, either intracellularly, at the cell surface, or secreted extracellularly, to better understand the true role of IL-15 during normal homeostasis and immune defense.

Regulation of IL-15 gene expression

IL-15 transcription, translation, and secretion have proved to be regulated through multiple complex mechanisms. This topic has been recently reviewed in depth elsewhere,46,62 and only the major points of interest are summarized here. Although transcriptional control of IL-15 is important,63,64 the principle level of IL-15 regulation appears to be posttranscriptional.

Control of transcription. Both human and murine 5' regulatory regions upstream of exon 1 have been cloned, sequenced, and analyzed for consensus transcription factor binding motifs.61,65 These studies revealed some common consensus binding sites within the mouse and human promoter regions, including alpha -INF-2, NF-IL-6, gamma -IRE, myb, GCF, and NF-kappa B. The NF-kappa B site located at -75 to -65 relative to the transcription start site of the human IL-15 promoter was shown to be important for HTLV-1 Tax protein-induced IL-15 mRNA up-regulation61 and for lipopolysaccharide (LPS)-induced IL-15 gene expression in murine macrophages.65 The region -201 and -141 in the human IL-15 promoter was reported to contain an unidentified site responsible for negative regulation of IL-15 expression, as 5' deletion of this region resulted in a dramatic increase in IL-15 promoter activity.61

An essential interferon regulatory factor (IRF)-E consensus-binding site was identified at -348 to -336 relative to the cap site of the murine IL-15 promoter, following the observation that IRF-1-/- mice simultaneously lack inducible IL-15 expression and natural killer (NK) cells.63,64 It remains unclear what upstream signals are responsible for IRF-induced IL-15 expression during the normal physiologic process of NK cell development in the BM (discussed below).

Primary regulation of IL-15: translation, intracellular trafficking, and secretion. Three primary checkpoints have been identified that regulate IL-15 mRNA translation into the IL-15 precursor protein: multiple start codons (AUGs) in the 5' UTR, the unusual LSP and SSP, and a negative regulator near the C-terminus of the precursor proteins. The LSP-IL-15 5' UTR is relatively long (more than 316 nt in humans) and contains multiple (12 in humans) AUGs upstream of the actual translation start site that have been shown to dramatically reduce translational efficiency.1,4,66 Bamford et al4 demonstrated that removal of 8 of 10 upstream AUGs in the 5' UTR of the human LSP-IL-15 by fusion with the HTLV-1R region resulted in enhanced IL-15 protein production in the HuT-102 cell line (approximately 5- to 10-fold). However, when the upstream AUGs were circumvented, IL-15 translation and secretion still appeared lower than those of other cytokines, such as IL-2.

Tagaya et al14 showed that replacement of endogenous IL-15 signal peptides with the human IL-2 signal peptide resulted in dramatically elevated IL-15 levels detectable in supernatants from COS-7 transfectants. LSP-IL-15 was shown to have a lower translational efficiency than SSP-IL-15 or IL-2SP-IL-15. With the use of IL-15-GFP fusion constructs, it was evident that SSP-IL-15 was restricted to the cytoplasm and nucleus, whereas LSP-IL-15 was detected within the ER/Golgi apparatus. Thus, it appears that SSP-IL-15 is translated efficiently but not secreted, whereas LSP-IL-15 is translated less efficiently but has complex trafficking through the ER/Golgi pathway and is secreted from the cell at low levels.14,21 Similarly, Gaggero et al20 showed that LSP-IL-15 and exogenous IL-15 were detectable in Chinese hamster ovary (CHO) cell endosomes, indicating that rapid uptake by IL-15R-bearing cells may have a regulatory effect on the action of IL-15. The CTLL bioactivity of the LSP-IL-15-GFP construct was significantly higher than that of the LSP-IL-15 without a 3' tag, suggesting that a signal in the carboxyl portion of the mature IL-15 protein results in inefficient secretion, possibly through a retention signal.20

Through the systematic elimination of these 3 checkpoints, that is, removing upstream AUGs, replacing the endogenous human IL-15 leader with that of IL-2, and fusing the C-terminus of the IL-15 mature protein with the FLAG epitope tag, the synthesis of bioactive IL-15 increased 250-fold.67 Such complex and tight control of the IL-15 gene product is unusual for most cytokines characterized thus far and may indicate that IL-15, if overproduced, is somehow dangerous to the host. Transgenic mice that overexpress IL-15 as a result of elimination of posttranscriptional checkpoints recently provided in vivo evidence supporting this hypothesis.68 These mice developed a fatal lymphocytic leukemia following early expansions in NK and CD8+ T cells (see below).

Recently, Musso et al69 detected bioactive IL-15 protein constitutively expressed on the surface of human monocyte/macrophage cell lines and primary human monocytes. Cell surface expression was increased upon stimulation with interferon (IFN)-gamma , suggesting a mechanism by which IL-15 could exert a biologic effect while being undetectable in culture supernatants. It is unclear whether this membrane expression of IL-15 depends upon signal peptide expression. Another recent report demonstrated constitutive IL-15 protein expression in human PBMCs by Western analysis and flow cytometry, which was up-regulated by Cryptococcus neoformans, LPS, or IFN-gamma .70 Further study should reveal the exact cell types, tissue distribution, and functional significance of constitutive cell surface expression of IL-15. IL-15's function in promoting the survival of IL-15-responsive cell types, such as NK cells71 and memory T cells,72 may be one hypothesis explaining the reason for low constitutive protein expression. Then, in response to an infectious insult, cytoplasmic protein may be translocated to the cell surface to further stimulate IL-15R-bearing cells, in combination with additionally induced monokines such as IL-12.

In other physiologic settings such as NK cell development (discussed below), it will be interesting to examine BM stromal cells for constitutive cell-surface expression of IL-15 and to test whether any signals induce the movement of cytoplasmic IL-15 protein to the cell surface. In both of these settings, it seems likely that activation of monocytes/macrophages (and other cells such as dendritic cells and epithelium) or appropriate stimulation of BM stromal cells could result in more efficient IL-15 synthesis, translocation, and secretion through removal of the multiple posttranscriptional control points.


    IL-15 and immune cells
Top
Introduction
Molecular and cellular biology...
IL-15 and immune cells
Function of IL-15 on...
Relevance of IL-15 to...
Conclusions
References

An essential role for IL-15 in NK cell development

Two critical features of the mammalian innate immune system are its ability to rapidly limit the spread of infectious pathogens and its ability to prepare the antigen-specific or adaptive immune system to effectively clear the pathogens.73 NK cells74,75 are large granular lymphocytes (LGLs) that demonstrate cytotoxicity against tumor and virally infected cells, produce immunoregulatory cytokines and chemokines, and are an important component of the innate immune defense against viruses, fungi, bacteria, and protozoa.76-80 NK cells also express a number of cell surface receptors that recognize MHC class I ligands and regulate NK cell activation and lysis of target cells,81,82 and are likely to be important for the control of some cancers.83

It has long been appreciated that NK cells require the BM microenvironment for complete maturation, based upon studies examining mice with BM ablation by strontium 89 or beta -estradiol.84-86 However, the precise factors and events responsible for orchestrating NK cell development within the BM remained elusive for decades. Long-term BM cultures that included stromal cells but lacked exogenous cytokines were able to differentiate low numbers of the NK cell lineage.87 Moreover, through the addition of recombinant (r) IL-2, NK cells were produced in cultures that lacked stromal cells,88 and when added to cultures containing stroma, rIL-2 produced NK cells with high efficiency.89-91 In addition, provision of rIL-2 to mice92,93 and humans94-98 in vivo results in an expansion of NK cells. However, the physiologic relevance of these IL-2 effects was a mystery during NK cell development because IL-2 is produced primarily by antigen-activated T cells located in the periphery,18 and mice deficient in IL-2 contain functional NK cells.99,100 In addition, mice101 and humans102 that lack the gamma c subunit of the IL-2R lack NK cells, as do mice103 and humans104 that lack the IL-2/15Rbeta . Collectively, these data suggested that a factor other than IL-2 was produced in the BM and used signaling components of the IL-2R to induce NK cell development. Numerous studies from many laboratories have now shown convincingly that this factor critical for NK cell development is IL-15, acting through the IL-15Ralpha beta gamma . Two broad lines of evidence support this assertion: (1) experiments using in vitro models of human and murine NK cell differentiation and (2) genetically targeted mice with disruption of IL-2, IL-15, IL-2/15 receptors, their signaling components, or transcription factors that regulate gene expression critical to NK cell development (Table 1).

                              
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Table 1. Summary of major phenotypes affecting immune cell compartments exhibited by mice with targeted disruption of IL-15, IL-15R components, IL-15R downstream signals, and transcription factors affecting IL-15 expression

IL-15 differentiates human NK cells in vitro. First, for IL-15 to be the major physiologic growth factor responsible for NK cell ontogeny, it must be expressed at the anatomic site of NK cell differentiation, the BM. In support of this, the human IL-15 cDNA was first cloned from the IMTLH BM stromal cell line.1 Mrozek et al52 directly demonstrated that primary human BM stromal cells produced IL-15 at the transcript and protein levels, while lacking any expression of IL-2. Further, a 3-week culture of CD34+ hematopoietic progenitor cells (HPCs) supplemented with rIL-15 induced the differentiation of functional CD56+ NK cells in the absence of stroma or other cytokines. The CD56+ NK cells generated in these cultures lysed MHC class I tumor targets, produced cytokine and chemokines upon stimulation, and expressed cytoplasmic CD3-zeta chain protein similar to mature peripheral blood NK cells.52

Two additional BM stromal cell factors, ligands for the class III receptor tyrosine kinases (RTKs) c-kit (c-kit ligand, KL) and flt3 (flt3 ligand, FL), have been shown to potentiate the expansion of other hematopoietic cell lineages, usually in combination with a lineage-specific growth factor.105 KL or FL alone induces no NK cell differentiation, but when combined with IL-15, each of these factors potentiated IL-15-induced expansion of NK cells from CD34+ HPCs.52,106 Subsequent studies demonstrated that culture of CD34+ HPCs in FL or KL increased the NK cell precursor frequency, as determined by limiting dilution analysis. What was the mechanism whereby the RTK ligands FL and KL increased NK cell precursor frequency? Culture of CD34+ BM HPCs in FL or KL alone induced a population of CD34brightIL-2/15Rbeta + cells after 10 days, and cell sorting experiments showed that these CD34brightIL-2/15Rbeta + cells have a 65- to 200-fold higher NK cell precursor frequency compared with freshly isolated CD34+ HPCs. FL and KL also increased expression of IL-15Ralpha mRNA within CD34+ HPCs measured by reverse transcriptase polymerase chain reaction (RT-PCR). Thus, human NK cell development can be divided into an early phase in which an NK progenitor cell responds to early-acting stromal cell growth factors (eg, FL or KL) and develops into an NK cell precursor intermediate with the basic phenotype CD34brightIL-2/15Rbeta +CD56-. This NK precursor is then responsive to IL-15 for maturation into a functional CD56+ NK cell (Figure 3).106


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Figure 3. Schematic diagram of human NK cell development. NK cell progenitors that respond to early-acting RTK ligands (FL and KL) differentiate into IL-15-responsive NK cell precursors by up-regulating the IL-15R complex on their surface. The NK precursors then respond to IL-15 to differentiate into mature NK cells. Characterization of the resultant CD56bright NK cells produced strongly suggests that other (eg, stromal) signals are likely required for complete NK cell differentiation. FL-/- mice are deficient in NK cells, suggesting that this RTK ligand serves a critical, nonredundant function in NK cell development or expansion in mice in vivo, most likely at the level of the NK cell progenitor.285 In addition, RAG2/gamma c-/- mice (lacking T, B, and NK cells) reconstituted with c-kit-/- progenitors have defects in NK cell expansion and survival, suggesting that KL serves a critical role in these functions in vivo.286 Further, IL-15Ralpha -/- and IL-15-/- mice lack NK cells, suggesting that IL-15 is critical for the differentiation of mature NK cells from NK cell precursors (Table 1).

It is important to note that the NK cells resulting from adult CD34+ HPCs in stroma-free cultures with IL-15 are CD56+, lyse tumor target cells, and produce immunoregulatory cytokines and chemokines upon stimulation. However, these NK cells have high-density expression of CD56, closely resembling the minor CD56bright NK cell population in peripheral blood, as they have little surface expression of CD16, with most cells expressing C-type lectin CD94/NKG2 NK receptors (NKR) and only small (1% to 8%) percentages of cells expressing killer-cell immunoglobulin-like receptor (KIR).106 This suggests that other soluble or cell-contact signals, perhaps from BM stroma, are required for normal KIR acquisition and other CD56dim NK characteristics, or alternatively the CD56dim NK cell may have a different precursor. To address these issues, further experiments are needed comparing IL-15-based culture systems using various starting HPC populations, with and without autologous BM stroma (or other MHC class I interaction systems).

Additional human culture systems have also supported a central role for IL-15 in human NK cell development from various starting progenitor populations, including cord blood CD34+,107,108 adult BM CD34+,108 fetal liver CD34+CD38±,109 and thymocyte T/NK progenitors.110 Beginning with CD56-CD16+ cord blood cells, Gaddy and Broxmeyer111 have demonstrated that IL-15 induced the maturation of these cells into highly lytic, phenotypically mature NK cells. Collectively, these in vitro human culture systems demonstrate a central role for IL-15 in the later stages of NK cell development from various adult and fetal progenitors. Further studies are needed to clarify how IL-15 acts in concert with signals from early-acting growth factors and stromal cells to facilitate physiologic human NK cell development and normal NK cell repertoire acquisition. The basic understanding of how human NK cells develop can also be directly translated to optimizing the ex vivo112 and in vivo expansion of this lymphocyte subset for therapeutic intervention.

IL-15 differentiates murine NK cells. In vitro murine culture systems have also demonstrated a critical role for IL-15 during NK cell ontogeny. Leclercq et al showed that bipotential T/NK progenitors113 isolated from the thymus selectively differentiated into NK cells in the presence of IL-15.53 Addition of high concentrations of IL-15 to progenitors in fetal thymic organ cultures (FTOCs) blocked TCRalpha beta T-cell development and shifted differentiation toward the NK cell lineage.53 A series of studies by Kumar and colleagues examined the role of IL-15 during murine NK cell ontogeny from adult BM progenitors.114 First, Puzanov et al115 demonstrated that IL-15 corrected the lytic defect of immature NK1.1+ cells within mice rendered osteopetrotic by beta -estradiol treatment. This suggested that IL-15 may replace the BM microenvironment deficits resulting in such immature NK cells.115 Williams et al116 established a murine stroma-free culture system in which an NK progenitor population (c-kit+Sca2+Lin-IL-2/15Rbeta -) cultured in IL-6/IL-7/KL/FL differentiated into an NK cell precursor population (NK1.1-IL-2/15Rbeta +), which in turn responded to IL-15 for differentiation into mature, lytic NK1.1+ NK cells.

Overall, there are strong parallels between human106 and murine116,117 models of NK cell differentiation because both involve NK progenitors that respond to early-acting cytokines (eg, FL and KL) and NK precursors that express the IL-2/15Rbeta and respond to IL-15 for mature NK cell development. In both systems, there is abnormal NK receptor repertoire development in the presence of IL-15 alone, suggesting that other signals, as discussed earlier, are required for proper NKR acquisition.

Mice with targeted genetic alterations demonstrate that IL-15 is a critical NK cell differentiation factor in vivo. As introduced earlier, the phenotypes of mice with targeted disruption of IL-2, IL-2Ralpha , and gamma c first suggested that cytokines other than IL-2, acting through IL-2R components, may be important for NK cell development. After the identification and cloning of IL-15, the aforementioned in vitro studies provided the first evidence that IL-15 could indeed serve as the central physiologic NK cell hematopoietic factor. Consequently, additional gene-targeting experiments in mice have confirmed this postulate at the level of the whole animal (Table 1). Mice with targeted disruption of the IL-2/15Rbeta , shared only by IL-2 and IL-15, have a dramatic reduction in peripheral NK1.1+CD3- cells and an absence of NK cytotoxicity in vitro.103 In addition, Fujii et al118 recently demonstrated that the IL-2/15Rbeta H-region, which activates STAT5/STAT3, selectively affects the development of NK and gamma delta T cells through reconstitution of IL-2/15Rbeta -/- mice with IL-2/15Rbeta transgenes containing specific mutations in the cytoplasmic domain. Mice that have genetic disruption of the gamma c have multiple lymphoid defects, including a dramatic decrease in NK cells.101,119 Consistent with these models, mice that have disrupted signaling components that operate downstream of IL-15R, such as Jak3-/-, STAT5a/b-/-, or STAT5b-/-, also have NK cell defects.120-123

Mice with disruption of the IRF-1 gene fail to induce IL-15 in the BM and have NK cell deficiency.63,64 Progenitor cells from IRF-1-/- mice develop into functional NK cells upon culture in IL-15 or transfer into lethally irradiated wild-type mice, suggesting that IRF-1 is required for the expression of IL-15 in the BM microenvironment. Indeed, IRF-1-binding sites have been identified in the 5' regulatory region of the IL-15 gene, supporting this hypothesis.63 At present, it is unclear what provides the endogenous signal to activate IRF-1 within BM stromal cells, which in turn induces the IL-15 expression important for NK cell development.

Mice with targeted disruption of the Ets-1 transcription factor were shown to have a selective deficit of NK cells.124 Ets-1-/- mice do not appear to have defects in IL-15Ralpha beta gamma , IL-15, or IL-2 expression, leaving the precise mechanism responsible for this NK cell deficiency unknown. Because Ets-1 is expressed in mature NK cells, it is possible that upstream IL-15-derived signals may induce Ets-1 that may then orchestrate the expression of an NK cell genetic program. Further investigation into the genetic changes at the molecular level during NK cell differentiation will help to clarify the gene programs activated during NK cell ontogeny and the transcription factors involved in this process.

Lodolce et al9 recently generated mice with targeted disruption of the IL-15Ralpha , providing direct evidence that the IL-15/IL-15Ralpha beta gamma system is critical for murine NK cell development. These mice contain multiple defects in innate immune effectors, including an absence of splenic NK cells and NK cytotoxic activity. Moreover, IL-15-/- mice also lack any phenotypic or functional NK cells in the spleen and liver, a defect that is reversible upon administration of exogenous IL-15 for 1 week.8 Exogenous IL-15 treatment of normal mice increases NK cell activity and both the percentage and absolute number of splenic NK cells.8,125,126 Transgenic mice that overexpress murine IL-15 have been generated and demonstrate a striking early expansion in NK cells.68 Thus, in vivo evidence demonstrates that IL-15 is requisite for murine NK cell development, and exogenous IL-15 supports the differentiation of human NK cells in BM culture systems. These basic observations provide invaluable insight into the critical, nonredundant role of IL-15 during NK cell development and suggest the potential utility of IL-15 therapy to expand NK cells in patients.

IL-15 activates NK cell proliferation, cytotoxicity, and cytokine production and regulates NK cell/macrophage interaction

NK cells constitutively express cytokine receptors and produce abundant cytokines and chemokines during the early, innate immune response to infection. Such NK cell-derived immunoregulatory factors may be vital in the orchestration of the innate immune response, as well as influence the developing adaptive response.73,78,127 NK cells constitutively express IL-2/15Rbeta gamma c, but the lack of abundant IL-2 during the early innate immune response prompted us to investigate the role of IL-15 as the more important physiologic ligand for NK cell proliferation, cytotoxicity, and cytokine production in this setting. The majority (approximately 90%) of human NK cells have low-density surface expression of CD56 (CD56dim), express high surface density of CD16 (Fcgamma RIII), and have a low proliferative capacity. CD56bright NK cells represent a minor subset (approximately 10%) of human NK cells that are low or negative for CD16 and are capable of high proliferation.75

NK cell proliferation and cytotoxicity. IL-15 induced the proliferation of CD56bright NK cells in a dose-dependent fashion to a similar extent as IL-2, yet required a nanomolar concentration to activate the IL-2/15Rbeta for proliferative activity.7 However, picomolar amounts of IL-15 were effective at maintaining NK cell survival in serum-free media.71 IL-15 was found to activate cytotoxicity and antibody-dependent cellular cytotoxicity (ADCC) by sorted CD56bright and CD56dim human NK cell subsets.7 Incubation of purified, resting CD56dim NK cells with IL-15 resulted in significant, dose-dependent increases in lymphokine-activated killing activity against the NK-resistant COLO 205 cell line and ADCC against the P815 murine mastocytoma cell line. IL-15 and IL-2 induce nearly identical levels of cytotoxicity, and both depend upon signals through the IL-2/15Rbeta , as enhanced NK activity was abrogated in the presence of an anti-IL-2/15Rbeta MoAb.7 Infection of human PBMCs with herpesviruses resulted in endogenous IL-15-dependent increases in NK cell cytotoxicity, suggesting that IL-15 participates in the normal innate host defense against viral infections.128,129

IL-15 costimulates NK cell cytokine and chemokine production and regulates interactions between macrophages and NK cells. IL-15 acts in concert with IL-12 to induce the macrophage-activating factors IFN-gamma and tumor necrosis factor (TNF)-alpha ,7,130,131 whereas IL-15 alone appears to be a potent stimulus for GM-CSF production7,132 by resting CD56+ human and murine133 NK cells. Interestingly, human CD56bright NK cells stimulated with IL-15 plus IL-12 produce approximately 10-fold greater amounts of IFN-gamma , TNF-alpha , and GM-CSF protein compared with an equal number of CD56dim NK cells132 (and our unpublished observations). Thus, the CD56bright NK cell may have a unique biologic role in the production of immunoregulatory cytokines within the innate immune system.

Macrophages activated with LPS, IFN-gamma , mycobacteria, Toxoplasma gondii, C neoformans, and Salmonella have been shown to express IL-15.1,48,49,134,135 In human cocultures of LPS-stimulated macrophages and NK cells, endogenous IL-15 produced by the activated macrophages, working in concert with IL-12, was shown to be critical for optimal IFN-gamma production by human NK cells.48 Similarly, in vitro culture of LPS-activated severe combined immunodeficiency (SCID) mouse splenocytes (NK cells and macrophages) produced abundant IFN-gamma protein, which was abrogated by blocking the IL-2/15Rbeta or neutralizing IL-15.133 In vivo, preadministration of either an antibody that blocks the IL-2/15Rbeta or a neutralizing anti-IL-15 antiserum to SCID mice resulted in a significant reduction in serum IFN-gamma measured in vivo 6 hours after an LPS challenge.133 Therefore, in both mice and humans, activated macrophages and NK cells interact through a paracrine feedback loop, with macrophages producing monokines (eg, IL-15 and IL-12) that bind to surface receptors constitutively present on NK cells, resulting in the production of macrophage-activating factors (eg, IFN-gamma ). NK cell-derived macrophage-activating factors in turn feed back upon the macrophages to further augment their activation (Figure 4). Thus, macrophage-derived IL-15 contributes with other monokines (especially IL-12) to the proinflammatory cascade leading to innate immune IFN-gamma production. Additionally, Ross and Caligiuri130 demonstrated that continuous stimulation of CD56+ NK cells with IL-15 + IL-12 in vitro results in NK cell apoptosis mediated through an autocrine TNF-alpha -dependent mechanism, initiated after 24 hours of monokine stimulation. This may represent one means whereby the innate immune system limits itself after prolonged activation.130


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