Alternatively activated macrophages (AAM) accumulate in tissues during
IntroductionThe effector phase of Th2-biased immunity, which develops in response to allergens or infection with parasitic nematodes, is mainly regulated by the transcription factor Stat6 that mediates signaling through the receptors for interleukin 4 (IL-4) and IL-13. Stat6 is recruited to phosphorylated tyrosine motifs in the cytoplasmic tail of the IL-4R␣ chain, gets phosphorylated by Jak kinases, and finally translocates as a homodimer to the nucleus where it regulates expression of numerous target genes. 1 IL-4R␣ can also trigger Stat6-independent signaling pathways leading to activation of the mitogen-activated protein kinase (MAPK) or phosphoinositide-3 kinase (PI3K) pathways that can enhance cell growth and survival. 2 Th2 cells require Stat6 to maintain their differentiation state, although initial commitment is 4 Stat6 regulates class switch recombination to IgE in B cells and expression of chemokines like Ccl11, Ccl17, Ccl22, and Ccl24, which mediate recruitment of eosinophils and other effector cells to target tissues. 1 Stat6 further induces goblet cell hyperplasia, collagen production by fibroblasts, activates smooth muscle cells, and is required for expulsion of gastrointestinal helminths.However, Stat6 is also associated with immunosuppression and poor immunosurveillance. Studies with tumor models have shown that Stat6-deficient mice develop enhanced tumor immunity compared with wild-type mice. 5,6 Furthermore, it has been shown that infection of BALB/c mice with Leishmania major results in progressive inflammation mainly due to IL-4R␣/Stat6-mediated signals. 7 IL-4 or IL-13 inhibit the differentiation of classically activated macrophages (CAM), which are required for parasite clearance, and rather induce the Stat6-mediated differentiation of alternatively activated macrophages (AAM). These cells are generally associated with chronic Th2-biased inflammatory conditions or tissue injury and produce characteristic markers like resistin-like molecule ␣ (Relm-␣/Fizz1), the chitinase-like protein Ym1, and arginase 1 (Arg1). 8 One mechanism by which AAM can inhibit T-cell proliferation is metabolic starvation. T cells require arginine for proliferation, and AAM deplete arginine by expression of Arg1. 9,10 Indeed, Arg1 from AAM has been shown to protect Schistosoma mansoni-infected mice from IL-4/IL-13-mediated lethal inflammation. 10,11 Relm-␣/Fizz1 is another secreted factor that has been reported to suppress activation of Th2 cells. 12,13 In addition, suppression could also be mediated by direct cell contacts between AAM and T cells, as it has been described for AAM isolated from the peritoneum of Brugia malayi-infected mice. 14 Potential inhibitory ligands on AAM include E-cadherin, which binds to killer cell lectin-like receptor G1 (KLRG-1) 15 and members of the B7-family like CD80 and CD86 which bind cytotoxic T-lymphocyte antigen 4 (CTLA-4) or programmed death ligand 1 (PD-L1) and PD-L2, which bind the receptor PD-1. 16 The pot...