17 However, these were not randomized controlled trials. The first significant randomized controlled

trial was the HEMO study – a US study that randomized more than 1800 patients in a 2 × 2 design to high or low flux as well as to selleck screening library normal or high doses of dialysis (as defined by Kt/V).18,19 Flux was defined by Kuf (with 20 mL/min per mmHg as the cut-off) and good separation of the Kuf values was achieved. However, for the group as a whole, there was no survival benefit for high-flux dialysis. Nevertheless, for those patients who had already received 3.7 years of dialysis (the median for the study) – high-flux dialysis appeared to offer a survival benefit. Many issues were raised with regards to this trial – including the inclusion of prevalent patients who had demonstrated

their survival ‘toughness’ and the fact that 60% of patients had been receiving high-flux dialysis before inclusion in the trial. The other major trial published recently was the Membrane Permeability Outcome (MPO) study conducted in Europe.20 This enrolled incident patients only with an intended minimum follow up of 3 years. Patients had to maintain a minimum Kt/V of 1.2 and were meant to have an enrolment albumin level below 40 gm/l. However, difficulty enrolling enough patients saw this latter aspect relaxed, although analyses for the less than 40 subgroup were performed. For the group of 647 included patients, there was no survival benefit for high-flux over Fulvestrant manufacturer Phospholipase D1 low-flux dialysis. However, for the ‘less than 40’ subgroup (the initially intended target group with albumin levels below 40 gm/l) there was a significant survival benefit, as there was for diabetics. Thus, current evidence is suggestive of a survival benefit for high-flux dialysis

given the large numbers of diabetic patients and those with serum albumin levels below 40 gm/l; yet the evidence is not definitive. The downside of high-flux membranes relate particularly to their cost. Initially, this was prohibitive but now, given the volume of sales, it has approached the cost of low-flux membranes. Nevertheless, some have argued that the benefit of these membranes is predominantly speculative and the cost cannot be justified. The other disadvantage is the potential for backfiltration of dialysate contaminants to the patient. Much of this relates to the putative shift of water contaminants from the dialysate into the patient’s blood both by convection and diffusion. As dialysate water and dialysate is commonly not pure, it contains small numbers of bacteria, especially gram negative bacteria that are able to survive in nutrient poor conditions, such as some pseudomonas species. These bacteria may produce endotoxins, which are the concerning elements. However, living organisms are certainly too large to cross an intact dialysis membrane and endotoxins have a MW of 150 000 plus.

It is striking that TREM-2-deficient BMDCs are better at inducing antigen-specific T-cell priming, whereas DAP12-deficient mice have been shown to have defects in Th1 cell priming during EAE 34. This suggests that the DCs that are key for inducing these Th1 cell responses in vivo likely express a this website distinct DAP12-associated receptor or receptors from TREM-2 that can promote the differentiation of T cells into Th1 cell effectors by DCs. Interestingly, we found that TREM-2 cell surface expression was greatly reduced in DAP12-deficient BMDCs compared with WT DCs, whereas we have previously shown that TREM-2 surface expression is

only slightly reduced in DAP12-deficient macrophages 15. This difference between DCs and macrophages is interesting and could possibly be due to differences in the availability of DAP10, a related signaling adapter, in macrophages and DCs. DAP10 has recently been shown to associate with TREM-2 in WT macrophages, and we postulate that the robust surface expression of TREM-2 in DAP12-deficient macrophages is due to the availability of DAP10 to pair with TREM-2 in these macrophages

35. It is possible that there is less available DAP10 to pair with TREM-2 and allow surface expression in BMDCs than in macrophages, either because of lower expression of DAP10 or a higher ratio of DAP10 to DAP12 pairing receptors in BMDCs Buparlisib concentration than macrophages. TREM-2 and DAP12 have been implicated positively in the development and function of several macrophage populations in mouse and human. Mutations in TREM-2 and DAP12 cause the rare recessive disease Nasu–Hakola syndrome (also called PLOSL), which is characterized by bone cysts and fractures, and progressive dementia and Gemcitabine order eventual CNS failure 36. These phenotypes of Nasu–Hakola patients suggest dysfunction of osteoclasts and microglia, the TREM-2 and DAP12 expressing resident macrophage-like cells in the bone and brain, respectively. DAP12-deficient mice have mild osteopetrosis and have defects in the development of osteoclasts from BM precursors in vitro 37. Similarly, human peripheral

blood monocytes lacking DAP12 or TREM-2 from patients with Nasu–Hakola disease have a reduced ability to differentiate into mature, functional osteoclasts 38, 39. In osteoclasts and DCs, it has been shown that the cell surface receptor Plexin-A1 associates with TREM-2. Interestingly, treatment of BMDCs with Semaphorin 6D (Sema6D), a ligand of Plexin-A1, induces IL-12 p40 production, and optimal IL-12 p40 secretion after Sema6D treatment requires TREM-2 and DAP12 expression 40. These data suggest that Sema6D/Plexin-A1 positively regulate osteoclast and DC function in the absence of TLR ligation. Also in support of a positive role for TREM-2 in DC function, Bouchon et al. showed that monoclonal antibody cross-linking of TREM-2 on human monocyte-derived DCs results in partial maturation of the DCs 41.

2E,F). In INIBD, ubiquitin-positive nuclear inclusions were found in both neurons

and glial cells. FIG4 immunoreactivity was present in nuclear inclusions in neurons (Fig. 2G), but not in glial cells. In aged normal controls and patients with neurodegenerative diseases, Marinesco bodies were observed in the nuclei of substantia nigra pigmented neurons, and were strongly positive for FIG4 (Fig. 2H). In addition, Hirano bodies in the hippocampus were FIG4 positive (Fig. 2I). There was no apparent difference in the staining intensity of neuronal cytoplasms with and without inclusions between patients with neurodegenerative diseases and normal controls. Double immunofluorescence MEK inhibitor analysis Alpelisib manufacturer revealed co-localization of FIG4 and phosphorylated tau in Pick bodies (Fig. 3A–C) and neuropil threads (Fig. 3D–F) in Pick’s disease, the latter corresponding to small Pick bodies in the neurites.[27, 28] The average proportion of FIG4-positive Pick bodies relative to the total number of inclusions was

88.7%. In both brainstem-type and cortical Lewy bodies, FIG4 immunoreactivity was concentrated in the central portion and α-synuclein immunoreactivity was more intense in the peripheral portion (Fig. 3G–L). The average proportion of FIG4-positive brainstem-type and cortical Lewy bodies relative to the total number of inclusions was 88.9% and 45.3%, respectively. Co-localization of FIG4 with polyglutamine or ubiquitin was demonstrated in NNIs Cediranib (AZD2171) in DRPLA (Fig. 3M–O), SCA3 (Fig. 3P–R) and INIBD (Fig. 3S–U). The FIG4 positivity rate of NNIs in DRPLA, SCA3 and INIBD was 19.5%, 19.7% and 28.6%, respectively. Almost all Marinesco bodies (99.8%) were positive for FIG4. In rodents, FIG4 is abundantly expressed in neurons and myelin-forming cells in the central and peripheral nervous systems during neural development, and is markedly diminished in neurons of the adult CNS.[4] In the present study, we demonstrated that FIG4 immunoreactivity was present

in neuronal cytoplasm in the brain, spinal cord and peripheral ganglia of adult humans. Schwann cells in the peripheral nervous system were also strongly immunolabeled with anti-FIG4, whereas oligodendrocytes and astrocytes in the CNS were weakly positive. These findings suggest that FIG4 is widely expressed in neurons and glial cells throughout the adult human nervous system. In the present study, no FIG4 immunoreactivity was found in a variety of neuronal and glial inclusions in sporadic TDP-43 proteinopathy (ALS and FTLD-TDP type B). Although TDP-43-positive neuronal and glial cytoplasmic inclusions have been found in a previous case of SCA2,[13] no FIG4-immunoreactive inclusions were noted in that case. Our data indicate that FIG4 is not incorporated into TDP-43 inclusions. We further demonstrated that the majority of Pick bodies were immunopositive for FIG4.

Its adherence decreased over 10-fold and the defect was completely recovered by complementation with a wt allele Idasanutlin cell line in trans (Fig. 2b). We assessed the effects of crp mutation on two V. vulnificus exotoxins, hemolysin and protease. V. vulnificus CRP regulates the transcriptional activity of hemolysin gene (Fig. 3a); hemolysin production was not detected at all in the crp mutant (Fig. 3b). V. vulnificus CRP decreased the transcriptional activity of protease gene (Fig. 3c) and significantly delayed and decreased protease production (Fig. 3D). In trans

complementation by the wild-type crp gene restored the decreased production of hemolysin and protease to the isogenic wild-type level. To address whether CRP plays an important role in the in vivo virulence of V. vulnificus, the LD50s of the V. vulnificus strains were determined. Intragastric infection of suckling mice has been used to reproduce the natural infection route of primary V. vulnificus septicemia [5]. The LD50s of the crp mutant in intraperitoneal and intragastric challenge were increased by 127- and 395-fold in comparison with that of wt strain, respectively (Table 1). In iron-overloaded mice, the LD50 of the crp mutant to intraperitoneal Bortezomib solubility dmso challenge increased 3200-fold in comparison with that of wt strain

(Table 1). The crp mutation in V. vulnificus impeded growth in vivo (Fig. 1) and decreased its motility and adhesion to host cells (Fig. 2). Contrary to our expectations, numerous repeated cell culture experiments showed that host cells infected with the V. vulnificus crp mutant developed reproducible morphological changes. As shown in Figure 4a, the crp mutant strain caused significant cell rounding and actin aggregation in HeLa cells, similar to the V. vulnificus wt strain. In contrast, the rtxA1 mutant did not cause cytoskeletal

rearrangement in HeLa cells. Vibrio vulnificus RtxA1 toxin is a major cytotoxin, causing host cell rounding and contact-dependent PRKD3 cytotoxicity [7, 9]. Because V. vulnificus crp mutant causes host cell rounding (Fig. 4a), we used western blot analysis to study the effect of the crp mutation on RtxA1 expression. The V. vulnificus crp mutant significantly increased RtxA1 expression, this was restored by in trans complementation with a plasmid-encoded wt allele, crp− (pLAFR3::crp) (Fig. 4b). This study shows that CRP plays a central role in the expression of various virulence genes of the pathogenic bacterium V. vulnificus. The crp mutation in V. vulnificus impedes growth in vivo and in vitro and decreases capsule production (Fig. 1). V. vulnificus CRP is required for pathogen motility and adhesion to host cells (Fig. 2). The decreased motility of the crp mutant may be attributable to both the growth decrease and the possible down-regulation of motility/chemotaxis genes. V. vulnificus CRP regulates the production of hemolysin and protease at the transcriptional level (Fig. 3). These results imply that the V.

The structures of CD1d-β-linked self-antigen–iNKT TCR complexes show how the headgroup is flattened so that the complex resembles that formed with αGalCer.[55] The energetic penalty incurred in this squashing explains the lower affinity of the iNKT TCR for endogenous ligands. The bulky headgroup of iGb3, rather than hindering binding, contributes TCR contacts from its flattened position to compensate.[69] The iNKT TCR affinity for an antigen in

complex with CD1d is not always sufficient to predict PD-1 antibody the nature of the cytokine response (Th1 or Th2 biased) it elicits. Evidence now suggests that the strength of interaction between antigen and CD1d, the longevity of this complex on the cell surface, and antigen-presenting cell (APC) type determines the cytokine

polarization seen in an iNKT-cell response (Fig. 1). Invariant NKT antigens with Th2 cytokine-biasing effects are characterized by shortened unsaturated tails, increased overall polarity and reduced hydrophobicity. Shortening of either acyl or sphingosine chains can polarize responses towards Th2.[70] For example, OCH, an αGalCer analogue with a shortened sphingosine chain, elicits a Th2 response,[8, 71, 72] as does an acyl https://www.selleckchem.com/products/VX-809.html truncated and di-unsaturated αGalCer (C20 : 2).[73] Intracellular staining for cytokines produced by iNKT cells after a short (2 hr) exposure to agonists reported as Th1 or Th2 polarizing fails to reveal a Th1 or Th2 bias.[73] Cytokine measurements from culture supernatants include IFN-γ from trans-activated NK cells as well

as from iNKT cells. For a Th1 bias to be measured, the activation of iNKT cells must be sustained enough to activate NK cells, requiring a strong interaction between CD1d and antigen. CD1d ligands characterized as Th1-biasing include Plakoside A analogues (structurally similar to αGalCer, and also derived from sea sponge) and analogues of αGalCer with a carbon-based glycosidic linkage (α-C-GalCer and other C-glycosides). Plakoside A analogues bind deeply inside the groove of CD1d. Similarly, C-glycoside binds CD1d very tightly, facilitating a sustained (though weak) see more interaction with the iNKT TCR and a Th1-biased response.[74] α-C-GalCer also elicits sustained iNKT TCR interaction and a Th1 response.[66] Inclusion of aromatic rings on the acyl chain of αGalCer creates a Th1 bias by enhancing the stability of a TCR–antigen–CD1d complex.[75, 76] Sub-cellular location of antigen loading into CD1d controls persistence of antigen–CD1d complexes, influencing the Th1 versus Th2 bias of a response. Presentation of iNKT antigens was tracked using antibody specific for the complex formed between αGalCer and CD1d.[77] The Th2-biasing ligands show an ability to directly load on to CD1d at the cell surface. When CD1d trafficking through the endosome was ablated by removal of its cytoplasmic tail, Th1-biasing αGalCer analogues lost much of their activity.

B cells of these subjects have a retained autoimmune potential, lack of somatic hypermutation, profound loss of proliferative potential, accelerated apoptosis and loss of normal Toll-like receptor Regorafenib molecular weight signalling. Treatment with high-dose immunoglobulin and/or steroids can be helpful, while rituximab provides

benefits in the treatment of refractory cytopenias with apparently little risk, even with repeated use, due to ongoing immune globulin therapy. For many years the association between the presence of autoimmunity in subjects with primary immune deficiency has been examined as a puzzling and yet potentially revealing biological phenomenon. While these immune defects are usually understood as leading to infections, the truth is that most

of these inborn errors also lead to greater or lesser degrees of immune dysregulation. Autoimmunity is certainly one of the most important of these manifestations. The autoimmune complications in primary immune deficiency are common in defects of both the adaptive and innate immune system, demonstrating that all these immune components must be required for the appropriate development of tolerance VX-809 cell line in humans. It may not be surprising that so many unique pathways to exclude autoimmunity are the norm in humans; what is not clear is the role that each component plays. However, careful dissection of these molecular pathways has proved fruitful in immune deficiency, and has led to enhanced understanding of autoimmunity in general. OSBPL9 All immune defects have characteristic general clinical manifestations, based on the specific immune component that is defective. Similarly, primary immune deficiencies that lead to autoimmunity also have a characteristic autoimmune phenotype, often overlapping with each other, but only in few cases are these well understood. Some of the more common autoimmune manifestations of primary immune deficiency are

shown in Table 1. Turning first to the control of self-reactive T cells, the great majority of these cells are deleted in the thymus, leading to central tolerance. These events depend upon the assembly of an effective T cell receptor that can display self-antigens, as these cells are best targeted for elimination. How a vast number of self-antigens can actually be arrayed in the thymus is unclear, but the crucial role of the autoimmune regulator gene (AIRE) in their expression is illustrated by the autoimmune polyendocrinopathy–candidasis–ectodermal dystrophy (APECED) syndrome, an autosomal recessive disease due to mutations in AIRE. The clinical condition includes hypoparathyroidism, mucocutaneous candidiasis, adrenal insufficiency, gonad failure, malabsorption and other tissue damages due to autoimmune attack. Loss of the AIRE gene, a thymic transcription factor that up-regulates the expression of tissue-specific genes in thymic epithelial cells, results in loss of tissue tolerance [1].

WANG KU-CHUNG, KUO LI-CHUEH, CHEN JIN-BOR Division of Nephrology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung Introduction: The aim of study was to investigate the influences of clinical variables RO4929097 on the quality of life (QoL) in incident peritoneal dialysis (PD) patients. Methods: The study was a prospective, case-control, observational design. Fifty-three incident patients who received chronic PD in one PD unit were enrolled. The mean age was 48.3 ± 12.6 year-old, men to women 21:32. The observational period was two years. SF-36 health survey questionnaires

were used to measure the QoL. Comparable variables included epidemiology, social status, concomitant medical status and biochemical data. Results: The scores of SF-36 components before PD therapy were general health 58.48 ± 20.05, pain 38.64 ± 21.84, social functioning 64.62 ± 27.54, emotional well-being 48.48 ± 18.29, energy/fatigue 56.82 ± 21.59, role limitations due to emotional problems 68.69 ± 15.74, role limitations due to physical health 54.88 ± 15.19, physical functioning 65.09 ± 20.24. After six months PD therapy, unmarried subjects demonstrated higher scores in role limitations due to emotional problems (76.19 vs 47.75, p < 0.05), role

limitations due to physical health (66.07 vs 37.16, p < 0.05) than married subjects. At the end of twenty-four months PD therapy, subjects who exchanged PD fluid by PF-562271 themselves showed higher scores in social functioning and physical functioning compared to those

exchanged PD fluid by assistants. Furthermore, subjects with antihypertensive demonstrated higher scores in emotional well-being than those without antihypertensive. Conclusion: PD therapy had sequential influences on the components of QoL in term of PD duration. At 6-month PD therapy, marriage status had a positive influence on QoL. In contrast, self-care and antihypertensive use had a greater contribution on QoL improvement at 24-month PD therapy. Therefore, patient-oriented PD care should be implanted into contemporary situation of PD patients. RYU HAN JAK1, HAN IN MEE1, LEE MI JUNG1, OH HYUNG JUNG1, PARK JUNG TAK1, MOON SUNG JIN3, KANG SHIN-WOOK1,2, YOO TAE-HYUN1,2 1Department of Internal Medicine, College of Medicine, Yonsei University, Seoul; 2Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, Korea; Atorvastatin 3College of Medicine, Kwandong University, Gyeonggi-do, Korea Introduction: Endothelial dysfunction is implicated in increased cardiovascular risk in non-dialyzed population. However, the prognostic impact of endothelial dysfunction on cardiovascular outcome has not been investigated in peritoneal dialysis (PD) patients. Methods: We prospectively determined endothelial function by brachial artery endothelium-dependent vasodilation (flow-mediated dilation; FMD) in 143 non-diabetic PD patients and 32 controls. Primary outcome was a composite of fatal or nonfatal cardiovascular events.

This calls into question the applicability to the human situation of studies performed on the lower genital tract in animal models. In addition, the observed failure of HCl to substitute for lactic acid suggests the specificity of lactic acid, and not just an acidic pH, for IL-23 induction. Thus, experimental protocols as well as commercial products that attempt to acidify the vagina with acids other than lactic acid do not mimic the natural environment and may be less than ideal. The implication that lactic acid may specifically aid Venetoclax mouse in immune defense

leads one to question currently held beliefs about vaginal health. Vaginal lactic acid production by both the underlying epithelium (Gross, 1961) and endogenous lactobacilli and other bacteria contribute

to the final lactic acid concentration. Individual differences in colonizing lactobacilli and other components of the vaginal flora, variations in the genetic background that influence glucose metabolism and unique Dabrafenib manufacturer environmental and dietary exposures would all be expected to result in variations in lactic acid production. We postulate that the extent of lactic acid production, and not bacterial hydrogen peroxide production, is a key component of the innate immune defense mechanisms at this site. A recent investigation using gene amplification technology has revealed that the major Lactobacillus sp. in asymptomatic North American women is Lactobacillus inners, a bacterium that does not produce hydrogen peroxide (Ravel et al., 2010). Another study has demonstrated that both cervicovaginal fluid and semen block any hydrogen peroxide-induced microbicidal activity (O’Hanlon et al., 2010). Further study of larger numbers of women is clearly warranted to confirm our findings as well as to help unravel the misconceptions that now exist about vaginal bacterial flora and innate defense mechanisms

at this anatomical site. It would also be of interest to determine whether other organic acids that are structurally related to lactic acid, and that may be present in the vagina, have similar immunological Abiraterone molecular weight effects. In this regard, it has been demonstrated that lactate, but not butyrate, acetate, dichloroacetate, citrate or malate, augments lipopolysaccharide-induced IL-2 production by murine splenic T cells (Roth & Droge, 1991). In females before puberty and after menopause, vaginal lactic acid levels are much reduced and vaginal pH is elevated. Whether this contributes to a possible increased susceptibility to gram-negative bacterial infections under these conditions is not known and is worthy of investigation. In general, mucosal infection favors the induction of the Th17 subset while intravenous infection is characterized by the induction of Th1 cells (Pepper et al., 2010). This suggests that antimicrobial immunity at mucosal surfaces is preferentially geared towards IL-23 and IL-17 induction and away from the production of Th1 lymphocyte-generated IFN-γ.

The reasons for these divergent results are still unknown but as we understand more about the immune system in adipose tissue one could speculate several explanations for these discrepancies. One possibility is that microbiome differences between laboratories and between wild-type and knockout mice contribute to the difference in weight gain, as the microbiome has been to shown to significantly impact metabolism Proteasomal inhibitors and the development of obesity,[65] as well as iNKT cell development.[66] We have exchanged cages between non-littermate wild-type and iNKT knockout mice to reduce the impact of the microbiome. However, the reference standard is to use wild-type and knockout littermates to eliminate

the impact of the microbiome, which were used in some,[63, 67] but not most, of the studies summarized above. Another plausible explanation is the age of mice

in each study. In young mice, there is a substantial population of iNKT cells and fewer regulatory T cells in adipose tissue, and at 8–16 weeks, iNKT cells accumulate further but decline in old age, whereas adipose regulatory T cells greatly accumulate in old mice.[51] Therefore, it is plausible that iNKT cells may be more influential in younger mice, whereas in older mice it is the regulatory T cells that dominate and the role of iNKT cells, or lack of them may be less dominant. It is also possible that for some reason both wild-type and iNKT-deficient animal buy Nutlin-3 colonies in different laboratories have a more Th1 or more Th2 bias among iNKT cells or other lymphocytes, or in some colonies, there is a compensatory buy PLX4032 mechanism when iNKT cells are absent from birth. Despite the divergent results using iNKT-deficient mice, other methods

to measure the effects of iNKT cells on obesity and metabolism are more consistent. First, over 14 independent studies have shown that iNKT cells (when measured accurately) are depleted in obesity, and all human studies have also found iNKT deficiency associated with obesity. Other immune cells that are shown to be protective in obesity,[52] such as regulatory T cells,[51] alternatively activated macrophages and eosinophils,[54] are depleted in obesity, whereas those that are shown to be pathogenic in obesity like CD8+ T cells[50] and classically activated macrophages[56] are increased in obese adipose tissue. Based on this comparison, which is not direct evidence and merely an association, iNKT cells appear to be part of the protective anti-inflammatory immune cell group that are lost in obesity as an inflammatory response takes over. More direct evidence comes from gain of function experiments, when iNKT cells are adoptively transferred into wild-type or iNKT-deficient obese mice or activated in wild-type obese mice. The majority of studies have shown that this has a positive impact on metabolic control and on protection against weight gain.

In vivo, its effects are varied and have been shown to play important roles in inflammatory conditions [31]. CD30 has been reported to function in regulating autoimmune diseases [32,33]. CD30

signalling protected against autoimmunity by preventing extensive expansion of autoreactive CD8+ effector T cells during secondary encounters with antigen in parenchymal tissues [32,33]. Also, elevated screening assay concentrations of the soluble form of CD153 were observed in the sera of RA patients together with increased levels of CD30 and CD153 in biopsies [34]. There is also evidence that expression of CD153 in RA synovia contributes to mast cell activation [34]. Savolainen et al. [35] and Okamoto et al. [36] have observed elevated concentrations of the soluble form of CD30 in RA patients, thus underlining the importance of this molecule in the development of RA. Okamoto et al. [36] have noted further that although CD4+ T cells from peripheral blood and synovial tissue expressed CD30 and produced interleukin (IL)-4 after in vitro stimulation,

they underwent CD30-mediated cell death. In an analogous study, Gerli et al. [37] found that, in addition to IL-4 and IFN-γ, CD30+ T cells produced large amounts of inflammatory IL-10, and they suggested that synovial CD30+ T cells may play a role in the control of RA-induced inflammatory responses. Soluble forms of CD30 were found to be elevated in the sera buy Protease Inhibitor Library and cerebrospinal fluids of multiple sclerosis (MS) patients, particularly during remission [38,39]. In addition, soluble forms of CD30 were elevated in patients with systemic lupus erythematosus and Sjögren’s syndrome [40,41]. In non-obese diabetic (NOD) mice, expression of

both CD30 and CD30L was elevated on peripheral lymph node CD4+ and CD8+ T cells [42]. As a result, treatment of NOD mice with neutralizing Amisulpride anti-CD30L monoclonal antibodies (mAb) prevented the development of diabetes [42]. Taken together, these observations underscore the importance of CD30/CD153 signalling in the development of autoimmune diseases (Table 1, Fig. 1b). CD40 is the most extensively studied member of the TNF superfamily. First identified on B cells [43], it is present on a variety of cells including DCs, follicular DCs, monocytes, macrophages, mast cells, fibroblasts, vascular smooth muscle cells and endothelial cells [44], and as a functional molecule on CD4+ T cells [45]. CD4–CD154 interactions generate one of the most effective APC-activating signals. Signalling via dendritic cell CD40 up-regulates expression of CD80 and CD86 and induces IL-12 secretion [46–48], and signalling via CD40 activates nuclear factor (NF)-κB [49,50] and rescues B cell receptor (BCR)-induced cell death [51]. Moreover, studies using CD40−/− mice have shown that the CD40–CD154 pathway is central to germinal centre formation and immunoglobulin (Ig) isotype-switching [52].