Interleukin 17A (IL-17 or IL-17A) is a pro-inflammatory cytokine. This cytokine is produced by a group of T helper cell known as T helper 17 cell in response to their stimulation with IL-23. Originally, Th17 was identified in 1993 by Rouvier et al. who isolated IL17 transcript from a rodent T-cell hybridoma. The protein encoded by IL17A is a founding member of IL-17 family (see below). IL17 protein exhibits a high homology with a viral IL-17-like protein encoded in the genome of T-lymphotropic rhadinovirus Herpesvirus saimiri. In rodents, IL-17 is often referred to as CTLA8.
|Alt. symbols||IL17, CTLA8|
|Locus||Chr. 6 p12|
|Locus||Chr. 5 q32-34|
|Alt. symbols||, CX2|
|Locus||Chr. 16 q24|
|Locus||Chr. 13 q11|
|Locus||Chr. 14 q11.2|
|Locus||Chr. 6 p12|
The biologically active IL-17 interacts with type I cell surface receptor IL-17R. In turn, there are at least three variants of IL-17R referred to as IL17RA, IL17RB, and IL17RC. After binding to the receptor, IL-17 activates several signalling cascades that, in turn, lead to the induction of chemokines. Acting as chemoattractants, these chemokines recruit the immune cells, such as monocytes and neutrophils to the site of inflammation. Typically, the signaling events mentioned above follow an invasion of the body by pathogens. Promoting the inflammation, IL-17 acts in concert with tumor necrosis factor and interleukin-1. Moreover, an activation of IL-17 signalling is often observed in the pathogenesis of various autoimmune disorders, such as psoriasis.
The IL-17 family comprises IL17A, IL-17B, IL-17C, IL-17D, IL-17E and IL-17F. IL-17E is also known as IL-25. All members of the IL-17 family have a similar protein structure. Their protein sequences contain four highly conserved cysteine residues. These conserved cysteine residues are critical to the right 3-dimensional shape of the entire protein molecule. To the reference, the members of IL-17 family do not exhibit a significant sequence homology with other cytokines. Among IL-17 family members, the IL-17F isoforms 1 and 2 (ML-1) have the highest sequence homology with IL-17A (55 and 40%, respectively). They follow by IL-17B, which has 29% similarity to IL-17A, IL-17D (25%), IL-17C (23%), and IL-17E (17%). In mammals, the sequences of these cytokines are highly conserved. For instance, the sequence homology between the corresponding human and mouse proteins is usually between 62–88%.
Numerous immune regulatory functions have been reported for the IL-17 family of cytokines, presumably due to their induction of many immune signaling molecules. The most notable role of IL-17 is its involvement in inducing and mediating proinflammatory responses. IL-17 is commonly associated with allergic responses. IL-17 induces the production of many other cytokines (such as IL-6, G-CSF, GM-CSF, IL-1β, TGF-β, TNF-α), chemokines (including IL-8, GRO-α, and MCP-1), and prostaglandins (e.g., PGE2) from many cell types (fibroblasts, endothelial cells, epithelial cells, keratinocytes, and macrophages). IL-17 acts with IL-22 (produced by T helper 17 cells) to induce expression of antimicrobial peptide by keratinocytes.
The release of cytokines causes many functions, such as airway remodeling, a characteristic of IL-17 responses. The increased expression of chemokines attracts other cells including neutrophils but not eosinophils. IL-17 function is also essential to a subset of CD4+ T-Cells called T helper 17 (Th17) cells. As a result of these roles, the IL-17 family has been linked to many immune/autoimmune related diseases including rheumatoid arthritis, asthma, lupus, allograft rejection, anti-tumour immunity and recently psoriasis and multiple sclerosis.
The gene for human IL-17 is 1874 base pairs long and was cloned from CD4+ T cells. Each member of the IL-17 family has a distinct pattern of cellular expression. The expression of IL-17A and IL-17F appear to be restricted to a small group of activated T cells, and upregulated during inflammation. IL-17B is expressed in several peripheral tissues and immune tissues. IL-17C is also highly upregulated in inflammatory conditions, although in resting conditions is low in abundance. IL-17D is highly expressed in the nervous system and in skeletal muscle and IL-17E is found at low levels in various peripheral tissues.
Much progress has been made in the understanding of the regulation of IL-17. At first, Aggarwal et al. showed that production of IL-17 was dependent on IL-23. Later, a Korean group discovered that STAT3 and NF-κB signalling pathways are required for this IL-23-mediated IL-17 production. Consistent with this finding, Chen et al. showed that another molecule, SOCS3, plays an important role in IL-17 production. In the absence of SOCS3, IL-23-induced STAT3 phosphorylation is enhanced, and phosphorylated STAT3 binds to the promotor regions of both IL-17A and IL-17F increasing their gene activity. In contrast, some scientists believe IL-17 induction is independent of IL-23. Several groups have identified ways to induce IL-17 production both in vitro and in vivo by distinct cytokines, called TGF-β and IL-6, without the need for IL-23. Although IL-23 is not required for IL-17 expression in this situation, IL-23 may play a role in promoting survival and/or proliferation of the IL-17 producing T-cells. Recently, Ivanov et al. found that the thymus specific nuclear receptor, ROR-γ, directs differentiation of IL-17-producing T cells.
IL-17(A) is a 155-amino acid protein that is a disulfide-linked, homodimeric, secreted glycoprotein with a molecular mass of 35 kDa. Each subunit of the homodimer is approximately 15-20 KDa. The structure of IL-17 consists of a signal peptide of 23 amino acids (aa) followed by a 123-aa chain region characteristic of the IL-17 family. An N-linked glycosylation site on the protein was first identified after purification of the protein revealed two bands, one at 15 KDa and another at 20 KDa. Comparison of different members of the IL-17 family revealed four conserved cysteines that form two disulfide bonds. IL-17 is unique in that it bears no resemblance to other known interleukins. Furthermore, IL-17 bears no resemblance to any other known proteins or structural domains.
The crystal structure of IL-17F, which is 50% homologous to IL-17A, revealed that IL-17F is structurally similar to the cysteine knot family of proteins that includes the neurotrophins. The cysteine knot fold is characterized by two sets of paired β-strands stabilized by three disulfide interactions. However, in contrast to the other cysteine knot proteins, IL-17F lacks the third disulfide bond. Instead, a serine replaces the cysteine at this position. This unique feature is conserved in the other IL-17 family members. IL-17F also dimerizes in a fashion similar to nerve growth factor (NGF) and other neurotrophins.
Role in psoriasisEdit
Recent work suggests the IL-23/IL-17 pathway plays a major role in the autoimmune disorder psoriasis. In this condition, immune cells react to inflammatory molecules released within the skin around the joints and scalp. This response causes the epidermal cells to recycle more rapidly than usual, which leads to the formation of red, scaly lesions and chronic skin inflammation. Analysis of biopsies taken from lesions of psoriasis patients show an enrichment of cytotoxic T cells and neutrophils containing IL-17. This indicates an excessive infiltration of pro-inflammatory immune cells and IL-17 cytokines are associated with the development of psoriasis.
Studies conducted in mice demonstrate that removing either IL-23 or IL-17 decreases the progression of psoriasis. Mice injected with monoclonal antibodies targeting IL-17 blocked, or neutralized, down stream signaling of this cytokine and decreased epidermal hyperplasia. Similarly, genetically modifying mice to not express IL-23 or IL-17 receptors significantly reduced psoriatic lesion development upon stimulation with the lesion-causing tumor promoter 12-O-tetradecanoylphorbol-13-acetate.
IL-17 promotes psoriasis by contributing to the inflammatory response that damages and overturns the keratinocyte cells of the epidermal layer. Inflammation begins with keratinocyte cells entering the final stages of their cell cycle, which activates immature dendritic cells (DC). Cytokines released from DCs stimulate dying keratinocytes to secrete TNF-alpha, IL-1 and IL-6 leading to the chemotaxis of T cells, natural killer cells and monocytes to the epidermis. These cells release IL-23 which induce Th17 cells to produce IL-17.
IL-17 interaction with IL-17RA receptors, abundant on the keratinocyte cell surface, incite epidermal cells to increase expression of IL-6, antimicrobial peptides, IL-8 and CCL20. Increased concentration of IL-6 alters the epidermal environment by decreasing the ability of T regulatory cells to control the behavior of Th17 cells. Reduced regulation allows uninhibited proliferation of Th17 cells and production of IL-17 in psoriatic lesions, augmenting IL-17 signaling. Antimicrobial peptides and IL-8 attract neutrophils to the site of injury where these cells remove damaged and inflamed keratinocyte cells. New immature DCs are also recruited by CCL20 via chemotaxis where their activation restarts and amplifies the cycle of inflammation. IL-17 and additional cytokines released from the influx of neutrophils, T and dendritic cells mediate effects on localized leukocytes and keratinocytes that supports the progression of psoriasis by inciting chronic inflammation.
Role in asthmaEdit
The IL-17F gene was discovered in 2001, and is located on chromosome 6p12. Notably, among this family, IL-17F has been well characterized both in vitro and in vivo, and has been shown to have a pro-inflammatory role in asthma. IL-17F is clearly expressed in the airway of asthmatics and its expression level is correlated with disease severity. Moreover, a coding region variant (H161R) of the IL-17F gene is inversely associated with asthma and encodes an antagonist for the wild-type IL-17F. IL-17F is able to induce several cytokines, chemokines and adhesion molecules in bronchial epithelial cells, vein endothelial cells, fibroblasts and eosinophils. IL-17F utilizes IL-17RA and IL-17RC as its receptors, and activates the MAP kinase related pathway. IL-17F is derived from several cell types such as Th17 cells, mast cells and basophils, and shows a wide tissue expression pattern including lung. Overexpression of IL-17F gene in the airway of mice is associated with airway neutrophilia, the induction of many cytokines, an increase in airway hyperreactivity, and mucus hypersecretion. Hence, IL-17F may have a crucial role in allergic airway inflammation, and have important therapeutic implications in asthma.
Because of its involvement in immune regulatory functions, IL-17 inhibitors are being investigated as possible treatments for autoimmune diseases such as rheumatoid arthritis, psoriasis and inflammatory bowel disease. In January 2015, the FDA approved the use of secukinumab (trade name Cosentyx), an IL-17 inhibiting monoclonal antibody, for the treatment of moderate to severe plaque psoriasis. In addition, Cosentyx has been approved in Japan for use in treating psoriatic arthritis. The anti-IL-23 antibody ustekinumab can also be used to effectively treat psoriasis by reducing IL-17.
Based on emerging evidence from animal models, IL-17 has been suggested as a target for anti-inflammatory therapies to improve recovery post-stroke and to reduce the formation of skin cancer. IL-17 has also been implicated in multiple sclerosis.
The IL-17 receptor family consists of five, broadly distributed receptors (IL-17RA, B, C, D and E) that present with individual ligand specificities. Within this family of receptors, IL-17RA is the best-described. IL-17RA binds both IL-17A and IL-17F and is expressed in multiple tissues: vascular endothelial cells, peripheral T cells, B cell lineages, fibroblast, lung, myelomonocytic cells, and marrow stromal cells. Signal transduction for both IL-17A and IL-17F requires the presence of a heterodimeric complex consisting of both IL-17RA and IL-17RC and the absence of either receptor results in ineffective signal transduction. This pattern is reciprocated for other members of the IL-17 family such as IL-17E, which requires an IL-17RA-IL-17RB complex (also known as IL-17Rh1, IL-17BR or IL-25R) for effective function.
Another member of this receptor family, IL-17RB, binds both IL-17B and IL-17E. Furthermore, it is expressed in the kidney, pancreas, liver, brain, and intestine. IL-17RC is expressed by the prostate, cartilage, kidney, liver, heart, and muscle, and its gene may undergo alternate splicing to produce a soluble receptor in addition to its cell membrane-bound form. In similar manner, the gene for IL-17RD may undergo alternative splicing to yield a soluble receptor. This feature may allow these receptors to inhibit the stimulatory effects of their yet-undefined ligands. The least-described of these receptors, IL-17RE, is known to be expressed in the pancreas, brain, and prostate.
Signal transduction by these receptors is as diverse as their distribution. These receptors do not exhibit a significant similarity in extracellular or intracellular amino acid sequence when compared to other cytokine receptors. Transcription factors such as TRAF6, JNK, Erk1/2, p38, AP-1 and NF-κB have been implicated in IL-17 mediated signaling in a stimulation-dependent, tissue-specific manner. Other signaling mechanisms have also been proposed, but more work is needed to fully elucidate the true signaling pathways used by these diverse receptors.
- "IL-17s adopt a cystine knot fold: structure and activity of a novel cytokine, IL-17F, and implications for receptor binding". EMBO J. 20 (19): 5332–41. doi:10.1093/emboj/20.19.5332. PMC 125646. PMID 11574464. ; Hymowitz SG, Filvaroff EH, Yin JP, Lee J, Cai L, Risser P, Maruoka M, Mao W, Foster J, Kelley RF, Pan G, Gurney AL, de Vos AM, Starovasnik MA (October 2001).
- Rouvier E, Luciani MF, Mattéi MG, Denizot F, Golstein P (Jun 1993). "CTLA-8, cloned from an activated T cell, bearing AU-rich messenger RNA instability sequences, and homologous to a herpesvirus saimiri gene". Journal of Immunology. 150 (12): 5445–56. PMID 8390535.
- Starnes T, Broxmeyer HE, Robertson MJ, Hromas R (Jul 2002). "Cutting edge: IL-17D, a novel member of the IL-17 family, stimulates cytokine production and inhibits hemopoiesis". Journal of Immunology. 169 (2): 642–6. doi:10.4049/jimmunol.169.2.642. PMID 12097364.
- Chiricozzi A, Guttman-Yassky E, Suárez-Fariñas M, Nograles KE, Tian S, Cardinale I, Chimenti S, Krueger JG (Mar 2011). "Integrative responses to IL-17 and TNF-α in human keratinocytes account for key inflammatory pathogenic circuits in psoriasis". The Journal of Investigative Dermatology. 131 (3): 677–87. doi:10.1038/jid.2010.340. PMID 21085185.
- Miossec P, Korn T, Kuchroo VK (Aug 2009). "Interleukin-17 and type 17 helper T cells". The New England Journal of Medicine. 361 (9): 888–98. doi:10.1056/NEJMra0707449. PMID 19710487.
- Martin DA, Towne JE, Kricorian G, Klekotka P, Gudjonsson JE, Krueger JG, Russell CB (2013). "The emerging role of IL-17 in the pathogenesis of psoriasis: preclinical and clinical findings". The Journal of Investigative Dermatology. 133 (1): 17–26. doi:10.1038/jid.2012.194. PMC 3568997. PMID 22673731.
- Kolls JK, Lindén A (Oct 2004). "Interleukin-17 family members and inflammation". Immunity. 21 (4): 467–76. doi:10.1016/j.immuni.2004.08.018. PMID 15485625.
- Aggarwal S, Gurney AL (Jan 2002). "IL-17: prototype member of an emerging cytokine family". Journal of Leukocyte Biology. 71 (1): 1–8. PMID 11781375.
- Paul O, Bland EF, Massell BF (May 1990). "T. Duckett Jones and his association with Paul Dudley White". Clinical Cardiology. 13 (5): 367–9. doi:10.1002/clc.4960130511. PMID 2189615.
- Yao Z, Painter SL, Fanslow WC, Ulrich D, Macduff BM, Spriggs MK, Armitage RJ (Dec 1995). "Human IL-17: a novel cytokine derived from T cells". Journal of Immunology. 155 (12): 5483–6. PMID 7499828.
- Aggarwal S, Ghilardi N, Xie MH, de Sauvage FJ, Gurney AL (Jan 2003). "Interleukin-23 promotes a distinct CD4 T cell activation state characterized by the production of interleukin-17". The Journal of Biological Chemistry. 278 (3): 1910–4. doi:10.1074/jbc.M207577200. PMID 12417590.
- Cho ML, Kang JW, Moon YM, Nam HJ, Jhun JY, Heo SB, Jin HT, Min SY, Ju JH, Park KS, Cho YG, Yoon CH, Park SH, Sung YC, Kim HY (May 2006). "STAT3 and NF-kappaB signal pathway is required for IL-23-mediated IL-17 production in spontaneous arthritis animal model IL-1 receptor antagonist-deficient mice". Journal of Immunology. 176 (9): 5652–61. doi:10.4049/jimmunol.176.9.5652. PMID 16622035.
- Chen Z, Laurence A, Kanno Y, Pacher-Zavisin M, Zhu BM, Tato C, Yoshimura A, Hennighausen L, O'Shea JJ (May 2006). "Selective regulatory function of Socs3 in the formation of IL-17-secreting T cells". Proceedings of the National Academy of Sciences of the United States of America. 103 (21): 8137–42. doi:10.1073/pnas.0600666103. PMC 1459629. PMID 16698929.
- Veldhoen M, Hocking RJ, Atkins CJ, Locksley RM, Stockinger B (Feb 2006). "TGFbeta in the context of an inflammatory cytokine milieu supports de novo differentiation of IL-17-producing T cells". Immunity. 24 (2): 179–89. doi:10.1016/j.immuni.2006.01.001. PMID 16473830.
- Mangan PR, Harrington LE, O'Quinn DB, Helms WS, Bullard DC, Elson CO, Hatton RD, Wahl SM, Schoeb TR, Weaver CT (May 2006). "Transforming growth factor-beta induces development of the T(H)17 lineage". Nature. 441 (7090): 231–4. doi:10.1038/nature04754. PMID 16648837.
- Bettelli E, Carrier Y, Gao W, Korn T, Strom TB, Oukka M, Weiner HL, Kuchroo VK (May 2006). "Reciprocal developmental pathways for the generation of pathogenic effector TH17 and regulatory T cells". Nature. 441 (7090): 235–8. doi:10.1038/nature04753. PMID 16648838.
- Ivanov II, McKenzie BS, Zhou L, Tadokoro CE, Lepelley A, Lafaille JJ, Cua DJ, Littman DR (Sep 2006). "The orphan nuclear receptor RORgammat directs the differentiation program of proinflammatory IL-17+ T helper cells". Cell. 126 (6): 1121–1133. doi:10.1016/j.cell.2006.07.035. PMID 16990136.
- Lowes MA, Suárez-Fariñas M, Krueger JG (2014). "Immunology of psoriasis". Annual Review of Immunology. 32: 227–55. doi:10.1146/annurev-immunol-032713-120225. PMC 4229247. PMID 24655295.
- Hu Y, Shen F, Crellin NK, Ouyang W (2011). "The IL-17 pathway as a major therapeutic target in autoimmune diseases". Annals of the New York Academy of Sciences. 1217: 60–76. doi:10.1111/j.1749-6632.2010.05825.x. PMID 21155836.
- Baliwag J, Barnes DH, Johnston A (2015). "Cytokines in psoriasis". Cytokine. 73 (2): 342–50. doi:10.1016/j.cyto.2014.12.014. PMC 4437803. PMID 25585875.
- Mudigonda P, Mudigonda T, Feneran AN, Alamdari HS, Sandoval L, Feldman SR (2012). "Interleukin-23 and interleukin-17: importance in pathogenesis and therapy of psoriasis". Dermatology Online Journal. 18 (10): 1. PMID 23122008.
- Lin AM, Rubin CJ, Khandpur R, Wang JY, Riblett M, Yalavarthi S, Villanueva EC, Shah P, Kaplan MJ, Bruce AT (2011). "Mast cells and neutrophils release IL-17 through extracellular trap formation in psoriasis". Journal of Immunology. 187 (1): 490–500. doi:10.4049/jimmunol.1100123. PMC 3119764. PMID 21606249.
- Nakajima K, Kanda T, Takaishi M, Shiga T, Miyoshi K, Nakajima H, Kamijima R, Tarutani M, Benson JM, Elloso MM, Gutshall LL, Naso MF, Iwakura Y, DiGiovanni J, Sano S (2011). "Distinct roles of IL-25 and IL-17 in the development of psoriasis-like lesions in a mouse model". Journal of Immunology. 186 (7): 4481–9. doi:10.4049/jimmunol.1000148. PMID 21346238.
- Krueger JG, Fretzin S, Suárez-Fariñas M, Haslett PA, Phipps KM, Cameron GS, McColm J, Katcherian A, Cueto I, White T, Banerjee S, Hoffman RW (2012). "IL-17A is essential for cell activation and inflammatory gene circuits in subjects with psoriasis". The Journal of Allergy and Clinical Immunology. 130 (1): 145–54.e9. doi:10.1016/j.jaci.2012.04.024. PMC 3470466. PMID 22677045.
- Dombrowski (2012). "Cathelicidin LL-37: a defense molecule with a potential role in psoriasis pathogenesis". Experimental Dermatology. 21 (5): 327–330. doi:10.1111/j.1600-0625.2012.01459.x. PMID 22509827.
- Kawaguchi M, Kokubu F, Fujita J, Huang SK, Hizawa N (Dec 2009). "Role of interleukin-17F in asthma". Inflammation & Allergy Drug Targets. 8 (5): 383–9. doi:10.2174/1871528110908050383. PMID 20025586.
- Carbonell F, Heimpel H, Kubanek B, Fliedner TM (Aug 1985). "Growth and cytogenetic characteristics of bone marrow colonies from patients with 5q-syndrome". Blood. 66 (2): 463–5. PMID 4016279.
- Cleve H, Kirk RL, Gajdusek DC, Guiart J (1967). "On the distribution of the Gc variant Gc Aborigine in Melanesian populations; determination of Gc-types in sera from Tongariki Island, New Hebrides". Acta Genetica et Statistica Medica. 17 (6): 511–7. doi:10.1159/000152104. PMID 4168861.
- Seppälä M, Rönnberg L, Karonen SL, Kauppila A (Aug 1987). "Micronized oral progesterone increases the circulating level of endometrial secretory PP14/beta-lactoglobulin homologue". Human Reproduction. 2 (6): 453–5. doi:10.1093/oxfordjournals.humrep.a136569. PMID 3312283.
- "FDA approves new psoriasis drug Cosentyx". U.S. Food and Drug Administration. 2015-01-21. Retrieved 2015-03-12.
- "First in the world regulatory approval of Novartis' Cosentyx(TM) in Japan for both psoriasis and psoriatic arthritis". Novartis AG. 2014-12-26. Retrieved 2015-03-12.
- Leonardi CL, Kimball AB, Papp KA, Yeilding N, Guzzo C, Wang Y, Li S, Dooley LT, Gordon KB (May 2008). "Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1)". Lancet. 371 (9625): 1665–74. doi:10.1016/S0140-6736(08)60725-4. PMID 18486739.
- Swardfager W, Winer DA, Herrmann N, Winer S, Lanctôt KL (Mar 2013). "Interleukin-17 in post-stroke neurodegeneration". Neuroscience and Biobehavioral Reviews. 37 (3): 436–47. doi:10.1016/j.neubiorev.2013.01.021. PMID 23370232.
- Ortiz ML, Kumar V, Martner A, Mony S, Donthireddy L, Condamine T, Seykora J, Knight SC, Malietzis G, Lee GH, Moorghen M, Lenox B, Luetteke N, Celis E, Gabrilovich D (Mar 2015). "Immature myeloid cells directly contribute to skin tumor development by recruiting IL-17-producing CD4+ T cells". The Journal of Experimental Medicine. 212 (3): 351–67. doi:10.1084/jem.20140835. PMC 4354367. PMID 25667306.
- Chang, Seon Hee; Chung, Yeonseok; Dong, Chen (10 December 2010). "Vitamin D Suppresses Th17 Cytokine Production by Inducing C/EBP Homologous Protein (CHOP) Expression". The Journal of Biological Chemistry. 285 (50): 38751–38755. doi:10.1074/jbc.C110.185777. ISSN 0021-9258. PMC 2998156. PMID 20974859.
- Kawaguchi M, Adachi M, Oda N, Kokubu F, Huang SK (Dec 2004). "IL-17 cytokine family". The Journal of Allergy and Clinical Immunology. 114 (6): 1265–73, quiz 1274. doi:10.1016/j.jaci.2004.10.019. PMID 15577820.
- Moseley TA, Haudenschild DR, Rose L, Reddi AH (Apr 2003). "Interleukin-17 family and IL-17 receptors". Cytokine & Growth Factor Reviews. 14 (2): 155–74. doi:10.1016/S1359-6101(03)00002-9. PMID 12651226.
- Pappu R, Ramirez-Carrozzi V, Sambandam A (Sep 2011). "The interleukin-17 cytokine family: critical players in host defence and inflammatory diseases". Immunology. 134 (1): 8–16. doi:10.1111/j.1365-2567.2011.03465.x. PMC 3173690. PMID 21726218.
- Ley K, Smith E, Stark MA (2006). "IL-17A-producing neutrophil-regulatory Tn lymphocytes". Immunologic Research. 34 (3): 229–42. doi:10.1385/IR:34:3:229. PMID 16891673.