They lie buried—their long, tentaclelike arms out stretched—in all the tissues of our bodies that interact with the environment. In the lining of our nose and lungs, lest we inhale the influenza virus in a crowded subway car. In our gastrointestinal tract, to alert our immune system if we swallow a dose of salmonella bacteria. And most important, in our skin, where they lie in wait as stealthy sentinels should microbes breach the leathery fortress of our epidermis.
They are dendritic cells, a class of white blood cells that encompasses some of the least understood but most fascinating actors in the immune system. Over the past decade, researchers have begun to unravel the mysteries of how dendritic cells educate the immune system about what belongs in the body and what is foreign and potentially dangerous. Intriguingly, they have found that dendritic cells initiate and control the overall immune response. For instance, the cells are crucial for establishing immunological “memory,” which is the basis of all vaccines. Indeed, physicians, including those at a number of biotechnology companies, are taking advantage of the role that dendritic cells play in immunization by “vaccinating” cancer patients with dendritic cells loaded with bits of their own tumors to activate their immune system against their cancer. Dendritic cells are also responsible for the phenomenon of immune tolerance, the process through which the immune system learns not to attack other components of the body.
But dendritic cells can have a dark side. The human immunodeficiency virus (HIV) hitches a ride inside dendritic cells to travel to lymph nodes, where it infects and wipes out helper T cells, causing AIDS. And those cells that become active at the wrong time might give rise to autoimmune disorders such as lupus. In these cases, shutting down the activity of dendritic cells could lead to new therapies.[break] Rare and Precious
DENDRITIC CELLS are relatively scarce: they constitute only 0.2 percent of white blood cells in the blood and are present in even smaller proportions in tissues such as the skin. In part because of their rarity, their true function eluded scientists for nearly a century after they were first identified in 1868 by German anatomist Paul Langerhans, who mistook them for nerve endings in the skin.
In 1973 Ralph M. Steinman of the Rockefeller University rediscovered the cells in mouse spleens and recognized that they are part of the immune system. The cells were unusually potent in stimulating immunity in experimental animals. He renamed the cells “dendritic” because of their spiky arms, or dendrites, although the subset of dendritic cells that occur in the epidermis layer of the skin are still commonly called Langerhans cells. This groundbreaking research laid the foundation for all of the progress that we are seeing in dendritic cell science today. In 2007 Steinman received the Albert Lasker Basic Medical Research Award for his pioneering work in rediscovering and characterizing dendritic cells.
For almost 20 years after the cells’ rediscovery, researchers had to go through a painstakingly slow process to isolate them from fresh tissue for study. But in 1992, when I was at the Schering-Plough Laboratory for Immunology Research in Dardilly, France, my co-workers and I devised methods for growing large amounts of human dendritic cells from bone marrow stem cells in culture dishes in the laboratory. At roughly the same time, Steinman—in collaboration with Kayo Inaba of Kyoto University in Japan and her colleagues—reported that he had invented a technique for culturing dendritic cells from mice.
In 1994 researchers led by Antonio Lanzavecchia, now at the Institute for Research in Biomedicine in Bellinzona, Switzerland, and Gerold Schuler, now at the University of Erlangen-Nuremberg in Germany, found a way to grow the cells from white blood cells called monocytes. Scientists now know that monocytes can be prompted to become either dendritic cells, which turn the immune system on and off, or macrophages, cells that crawl through the body scavenging dead cells and microbes.
The ability to culture dendritic cells offered scientists the opportunity to investigate them in depth for the first time. Some of the initial discoveries expanded the tenuous understanding of how dendritic cells function.
There are several subsets of dendritic cells, which arise from precursors that circulate in the blood and then take up residence in immature form in the skin, mucous membranes, and organs such as the lungs and spleen. Immature dendritic cells are endowed with a wealth of mechanisms for capturing invading microbes: they reel in invaders using suction cup–like receptors on their surfaces, they take microscopic sips of the fluid surrounding them, and they suck in viruses or bacteria by engulfing them in sacks known as vacuoles. Yong-Jun Liu, a former colleague of mine from Schering-Plough who is now at the University of Texas M. D. Anderson Cancer Center, has found that some immature dendritic cells can also zap viruses immediately by secreting a substance called interferon-alpha.
Once they devour foreign objects, the immature cells chop them into fragments (antigens) that can be recognized by the rest of the immune system [see box on next two pages]. The cells use pitchfork-shaped molecules termed the major histocompatibility complex (MHC) to display the antigens on their surfaces. The antigens fit between the tines of the MHC, which comes in two types, class I and class II. The two types vary in shape and in the ways they acquire their antigen cargo while residing inside cells.
Dendritic cells are very efficient at capturing and presenting antigens: they can pick up antigens that occur in only minute concentrations. As they process antigens for presentation, they travel to the spleen through the blood or to lymph nodes through a clear fluid known as lymph. Once at their destinations, the cells complete their maturation and present their antigen-laden MHC molecules to naive helper T cells, those that have never encountered antigens before. Dendritic cells are the only cells that can educate naive helper T cells to recognize an antigen as foreign or dangerous. This unique ability appears to derive from co-stimulatory molecules on their surfaces that can bind to corresponding receptors on the T cells.
Once educated, the helper T cells go on to prompt so-called B cells to produce antibodies that bind to and inactivate the antigen. The dendritic cells and helper cells also activate killer T cells, which can destroy cells infected by microbes. Some of the cells that have been educated by dendritic cells become “memory” cells that remain in the body for years—perhaps decades—to combat the invader in case it ever returns.
Whether the body responds with antibodies or killer cells seems to be determined in part by which subset of dendritic cell conveys the message and which of two types of immune-stimulating substances, called cytokines, the dendritic cells prompt the helper T cells to make. In the case of parasites or some bacterial invaders, type 2 cytokines are best because they arm the immune system with antibodies; type 1 cytokines are better at mustering killer cells to attack cells infected by other kinds of bacteria or by viruses.
If a dendritic cell prompts the wrong type of cytokine, the body can mount the wrong offense. Generating the appropriate kind of immune response can be a matter of life or death: when exposed to the bacterium that causes leprosy, people who mount a type 1 response develop a mild, tuberculoid form of the disease, whereas those who have a type 2 response can end up with the potentially fatal lepromatous form.[break] Cancer Killers
ACTIVATING NAIVE helper T cells is the basis of vaccines for everything from pneumonia to tetanus to influenza. Scientists are now turning the new knowledge of the role that dendritic cells play in immunity against microbes and their toxins into a strategy to fight cancer.
Cancer cells are abnormal and as such are thought to generate molecules that healthy cells do not. If researchers could devise drugs or vaccines that exclusively targeted those aberrant molecules, they could combat cancer more effectively while leaving normal cells and tissues alone—thereby eliminating some of the pernicious side effects of chemotherapy and radiation, such as hair loss, nausea and weakening of the immune system caused by destruction of the bone marrow.
Antigens that occur only on cancerous cells have been hard to find, but researchers have succeeded in isolating several of them, most notably from the skin cancer melanoma. In the early 1990s Thierry Boon of the Ludwig Cancer Institute in Brussels, Steven A. Rosenberg of the National Cancer Institute and their colleagues independently identified melanoma-specific antigens that are currently being targeted in a variety of clinical trials involving humans.
Such trials generally employ vaccines made of dendritic cell precursors that have been isolated from cancer patients and grown in the laboratory together with tumor antigens. During this process, the dendritic cells pick up the antigens, chop them up and present them on their surfaces. When injected back into the patients, the antigen-loaded dendritic cells are expected to ramp up patients’ immune response against their own tumors.
Various researchers—including our own group as well as scientists at several biotechnology companies—are testing this approach against cancers as diverse as melanoma, B cell lymphoma, and tumors of the prostate and colon. There have been glimmers of success. In September 2001, for instance, my co-workers and I, in collaboration with Steinman’s group, reported that 16 of 18 patients with advanced melanoma to whom we gave injections of dendritic cells loaded with melanoma antigens showed signs in laboratory tests of an enhanced immune response to their cancer. What is more, tumor growth was slowed in the nine patients who mounted responses against more than two of the antigens.
Scientists are now working to refine the approach and test it on larger numbers of patients. So far cancer vaccines based on dendritic cells have been tested only in patients with advanced cancer. Although researchers believe that patients with earlier-stage cancers may respond better to the therapy—their immune systems have not yet tried and failed to eradicate their tumor—several potential problems must first be considered.
Some researchers fear that such vaccines might induce patients’ immune systems to attack healthy tissue by mistake. For instance, vitiligo—white patches on the skin caused by the destruction of normal pigment-producing melanocytes—has been observed in melanoma patients who have received the earliest antimelanoma vaccines. (No major adverse events have been reported, however, in more than 1,000 vaccinated patients.) Conversely, the tumors might mutate to “escape” the immune onslaught engendered by a dendritic cell vaccine. Tumor cells could accomplish this evasion by no longer making the antigens the vaccine was designed to stimulate the immune system against. This problem is not unique to dendritic cells, though: the same phenomenon can occur with traditional cancer therapies.
In addition, tailoring a dendritic cell vaccine to fight a particular patient’s tumors might not be economically feasible. But many scientists are working to circumvent the costly and time-consuming steps of isolating cells from patients and manipulating them in the laboratory for reinjection.
One approach involves prompting dendritic cell precursors already present in a person’s body to divide and start orchestrating an immune response against their tumors. While at Immunex in Seattle, David H. Lynch, now at Bainbridge Biopharma Consulting in Bainbridge Island, Wash., and his co-workers discovered a cytokine that causes mice to make more dendritic cells, which eventually induce the animals to reject grafted tumors. Other scientists, including Drew M. Pardoll of Johns Hopkins University, have observed that tumor cells that have been genetically engineered to secrete large amounts of cytokines that activate dendritic cells have the most potential as cancer vaccines.
Another approach, pioneered by Steinman and his Rockefeller colleague Michel C. Nussenzweig, is to selectively target antigens by coupling them to monoclonal antibodies that bind to receptors on the surface of dendritic cells. These receptors need to allow internalization of the antigens and their processing for presentation on both MHC class I and class II antigens. Several such molecules are now under intense scrutiny. Studies in mice have shown that targeting the antigens in the absence of dendritic cell activation results in tolerance induction. In contrast, delivering the antigen together with dendritic cell activators induces immunity, which can be protective.[break] Shutting Immunity Down
IN THE MEANTIME, other scientists are looking at ways to turn off the activity of dendritic cells in instances where they exacerbate disease instead of fighting it. Usually, in a phenomenon known as central tolerance, an organ in the chest called the thymus gets rid of young T cells that happen to recognize the body’s own components as foreign before they have a chance to circulate. Some inevitably slip through, however, so the body has a backup mechanism for restraining their activity.
But this mechanism, termed peripheral tolerance, appears to be broken in patients with autoimmune disorders such as rheumatoid arthritis, type 1 diabetes and systemic lupus erythematosus. In 2001 my colleagues and I reported that dendritic cells from the blood of people with lupus are unnaturally active. Cells from these patients release high amounts of interferon-alpha, an immune-stimulating protein that causes precursors to grow into mature dendritic cells while still in the bloodstream. The mature cells then ingest DNA, which is present in unusual amounts in the blood of people with lupus, and that in turn causes the individual’s immune system to generate antibodies against his or her own DNA. These antibodies result in the life-threatening complications of lupus when they lodge in the kidneys or the walls of blood vessels.
Accordingly, we propose that blocking interferon-alpha might lead to a therapy for lupus by preventing dendritic cell activation. A similar strategy might prevent organ transplant recipients from rejecting their new tissues.
A new treatment for AIDS might also rest on a better understanding of dendritic cells. In 2000 Carl G. Figdor and Yvette van Kooyk, then at the University Medical Center St. Radboud in Nijmegen, the Netherlands, identified a subset of dendritic cells that makes DC-SIGN, a molecule that can bind to the outer coat of HIV. These cells pick up HIV as they regularly prowl the mucous membranes and deep tissues. When they travel to the lymph nodes, they unwittingly deliver the virus to a large concentration of T cells. Drugs that block the interaction between DC-SIGN and HIV might slow the progression of AIDS.
Other infectious diseases—including malaria, measles and cytomegalovirus—also manipulate dendritic cells for their own ends. Red blood cells that have been infected by malaria parasites, for instance, bind to dendritic cells and prevent them from maturing and alerting the immune system to the presence of the invaders. Several groups of researchers are now devising approaches to prevent such microbes from hijacking dendritic cells; some are even seeking to use supercharged dendritic cells to fight the infections.
As we learn more about the molecules that control dendritic cells, we will find ways to harness their therapeutic potential. The increasing number of scientists and pharmaceutical corporations working on dendritic cells portends that we will soon be able to maximize the biological power of these cells to treat and prevent the diseases that plague humankind.[break] THE AUTHOR
JACQUES BANCHEREAU has directed the Baylor Institute for Immunology Research in Dallas since 1996. The institute aims to manipulate the human immune system to treat cancer as well as infectious and autoimmune diseases. Before 1996 Banchereau led the Schering-Plough Laboratory for Immunology Research in Dardilly, France. He obtained his Ph.D. in biochemistry from the University of Paris and holds many patents on immunological techniques.