chronic infection ͉ lymphocytic choriomeningitis virus ͉ T cell exhaustion ͉ PD-1 ͉ T cell memory R ecent studies have revealed an important role for the negative regulatory molecule programmed death-1 (PD-1) in T cell exhaustion during chronic viral infections (1). PD-1, a member of the CD28:CTLA-4 family of costimulatory and coinhibitory receptors, contains both immunotyrosine inhibitory motif (ITIM) and immunotyrosine switch motif (ITSM) signaling motifs, recruits the phosphatase Shp-2, and can deliver inhibitory signals (1). PD-1 interacts with two ligands, PD-ligand 1 (PD-L1), expressed by a wide variety of cells, and PD-L2, expressed mainly by macrophages and DC (1). A role for PD-1 in regulating T cell responses to chronic viral infections was identified by using lymphocytic choriomeningitis virus (LCMV) infection of mice (2). PD-1 was highly overexpressed on exhausted CD8 T cells from chronically infected animals compared with functional memory CD8 T cells from mice that had resolved acute infection. In vivo blockade of the PD-1:PD-L pathway during chronic LCMV infection led to a dramatic increase in the number and functionality of virus-specific CD8 T cells and enhanced control of infection (2). Other animal models of viral infection also supported a major role for the PD-1 pathway in regulating antiviral T cell responses (3, 4). These observations were quickly extended to primates and humans. Simian immunodeficiency virus (SIV)-, HIV-, hepatitis C virus (HCV)-, and hepatitis B virus (HBV)-specific CD8 T cells express elevated levels of PD-1 compared with CD8 T cells specific for nonpersisting pathogens such as influenza virus or vaccinia virus (5-12). In vitro blockade of PD-1:PD-L interactions reverses exhaustion of HIV-, HBV-, and HCV-specific T cells, and the proliferative capacity of these virus-specific T cell populations is dramatically improved. In light of these recent findings, PD-1 has emerged as not only a major regulator of T cell exhaustion during chronic infection, but also as an important potential therapeutic target.At least two models have been proposed for the mechanism of reversal of exhaustion by PD-1:PD-L blockade (13). In one model, PD-1:PD-L blockade reprograms all exhausted T cells, converting them to functional antiviral effector T cells. In a second model, PD-1:PD-L blockade selectively expands and/or enhances function of a subset of exhausted CD8 T cells. In the present work, we have addressed this question directly. We have identified two subsets of exhausted CD8 T cells during chronic LCMV infection in mice that differ in expression of PD-1 and CD44. One subset that expressed intermediate levels of PD-1 and high levels of CD44 (PD-1 Int CD44 Hi ) could be reinvigorated by blocking PD-1:PD-L interactions. In contrast, the second subset was PD-1 Hi but CD44Int and responded poorly to PD-1 pathway blockade. Thus, our data suggest that the cellular mechanism of reinvigorated T cell responses during chronic viral infection is by selective expansion of one subset of exhausted CD8...