B and T lymphocyte attenuator (BTLA) is a coinhibitory receptor that interacts with herpesvirus entry mediator (HVEM), and this interaction regulates pathogenesis in various immunologic diseases. In graftversus-host disease (GVHD),
IntroductionActivation of T lymphocytes is regulated by 2 distinct signals: one is a primary signal delivered by T-cell receptor interaction with antigenic peptide/major histocompatibility complex (MHC), and the other is a cosignal delivered by interactions between cosignal receptors on T cells and their ligands on antigen-presenting cells. 1,2 Cosignaling receptors transmit stimulatory or inhibitory signals according to characteristics of their intracellular signaling motifs, and a balance of cosignals defines the fate of T-cell responses (ie, optimal activation or deactivation/tolerance induction). 3,4 Approaches to regulate cosignaling functions have been applied as novel and promising immunotherapies in various disorders, including cancer, infectious diseases, autoimmunity, organ transplantation, and graft-versus-host disease (GVHD).B and T lymphocyte attenuator (BTLA) is a cosignaling molecule that structurally belongs to the immunoglobulin (Ig) superfamily, expressed on broad ranges of immune cells, including T cells, B cells, and dendritic cells (DCs). [5][6][7] Intracellular domain of BTLA has 2 immunoreceptor tyrosine-based inhibition motifs, to which SH2 domain-containing protein tyrosine phosphatase-1 and tyrosine phosphatase-2 are recruited. 5,8,9 This signaling characteristic is consistent with its immune inhibitory functions, as BTLA gene-deficient mice exhibit an enhanced susceptibility to autoimmune diseases and increased inflammatory responses. 5,10-14 BTLA coinhibitory signal is induced by interaction with its endogenous ligand herpesvirus entry mediator (HVEM), a member of tumor necrosis factor-receptor superfamily. 8,15 In addition to BTLA, HVEM has 3 other binding partners, LIGHT (lymphotoxin-like, inducible expression, competes with herpes simplex virus glycoprotein D for HVEM, a receptor expressed by T lymphocytes), CD160 and lymphotoxin-␣. 16 LIGHT-HVEM interaction transmits HVEM-positive cosignal into T cells via activation of nuclear factor-B (NF-B) signaling pathway. [16][17][18] HVEM interactions with BTLA and LIGHT are dependent on distinct extracellular regions of HVEM (ie, cysteine-rich domain-1 for BTLA while opposing cysteine-rich domain-2 and -3 sites for LIGHT binding), and it has been suggested that ternary LIGHT-HVEM-BTLA complex either augments or disrupts HVEM-BTLA interactions according to soluble or membrane form of LIGHT. 19 In contrast to negative cosignaling functions of BTLA, recent studies also suggested prosurvival effects of BTLA. For instance, in nonirradiated parent-into-F1 GVHD model, transfer of BTLAknockout (KO) donor T cells resulted in significantly diminished donor-antihost responses because of an impaired donor T-cell survival. 20 In addition, intestinal inflammation induced by a transfer of BTLA-KO T cells into Rag-KO mice was ...