IntroductionCD8 ϩ T cells are important for immune defense against cancers. 1 Costimulation is a critical process not only for initiating activation of naive T cells but also for differentiating primed cells into effector T cells. T-cell activation and differentiation are tightly regulated by suppressive cytokines such as TGF-1 and regulatory T cells. 2,3 T cell immune responses may reflect a balance between costimulating and suppressing immune reactions. To achieve CD8 ϩ T cell-mediated immune responses, costimulatory effects have to be dominant over immune suppression in response to antigens.NKG2D, a C-type lectin-like molecule for CD8 ϩ T cells, is a potent costimulatory molecules for promoting immunosurveillance of tumor and infected cells. 4,5 In humans, NKG2D is present on most natural killer (NK) cells, CD8 ϩ T cells, and ␥␦T cells. 4,6 Human NKG2D interacts with MHC class I chain-related proteins A and B (MICA and MICB). MIC molecules are not detected on most healthy tissues, but are induced by stress such as heat shock, viral infection, or malignant transformation. 7,8 Atypically high MICA expression on healthy tissues is linked to immunopathology of diabetes, rheumatoid arthritis, and celiac disease, suggesting involvement of NKG2D in autoimmune pathogenesis. [9][10][11][12] Similarly, NKG2D ligands (NKG2DL) expressed on tumor cells increase antitumor reactions of tumor-infiltrating cytotoxic T lymphocytes (CTLs) in vivo. 8,[13][14][15] This indicates that NKG2D and its ligand are involved in promoting various immune responses. Paradoxically, persistent expression of MICA results in impaired NK and CD8 ϩ T-cell immune responses. [16][17][18] This negative effect of MICA is mainly due to pronounced down-modulation of NKG2D. 17,19 Consistent with this, tumor-infiltrating and systemic NK cells and CD8 ϩ T-cells in cancer patients with MICA ϩ or MICB ϩ tumors are often functionally compromised. 20 In addition, MIC proteins released in the serum as a soluble form (sMIC) from some types of tumors impair NKG2D function by down-regulating NKG2D surface expression on NK and CD8 ϩ T cells. 17,[19][20][21] Transforming growth factor-1 (TGF-1) is a central molecule responsible for tumor immune escape by down-modulating NKG2D in CD8 ϩ T and NK cells. 22 Consistent with this, systemic NKG2D down-modulation is pronounced in subjects with malignancies associated with expression of TGF-1. 17,20,23 We previously demonstrated that 4-1BB, a specific costimulatory receptor primarily for previously primed CD8 ϩ T cells, is a unique costimulatory molecule that reverses TGF-1-mediated inhibition of CD8 ϩ T-cell responses. 24 4-1BB, a member of the tumor necrosis factor receptor family that includes CD40, CD27, CD30, and OX-40, is involved in enhancement of CD8 ϩ T cell-mediated responses to tumor, allografts and virus. 25 A major role of 4-1BB is to promote long-term survival and to facilitate development of effector and memory CD8 ϩ T cells. 26 The ligand for 4-1BB is expressed on activated dendritic cells (DCs), B cell...