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REVIEW doi: 10.1111/j.1365-3083.2006.01818.

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Antibody-Mediated Regulation of the Immune


Response
F. Hjelm, F. Carlsson, A. Getahun & B. Heyman

Abstract
Department of Genetics and Pathology, Antibodies administered in vivo together with the antigen they are specific for
Uppsala University, Uppsala, Sweden can regulate the immune response to that antigen. This phenomenon is called
antibody-mediated feedback regulation and has been known for over 100 years.
Both passively administered and actively produced antibodies exert immuno-
Received 10 May 2006; Accepted in revised
form 13 June 2006 regulatory functions. Feedback regulation can be either positive or negative,
resulting in >1000-fold enhancement or >99% suppression of the specific
Correspondence to: Dr B. Heyman, Department antibody response. Usually, the response to the entire antigen is up- or down-
of Genetics and Pathology, Rudbeck regulated, regardless of which epitope the regulating antibody recognizes. IgG
Laboratory, Uppsala University, SE-751 85
of all isotypes can suppress responses to large particulate antigens like erythro-
Uppsala, Sweden. E-mail: birgitta.heyman@
genpat.uu.se cytes, a phenomenon used clinically in Rhesus prophylaxis. IgG suppression
works in mice lacking the known Fc-c receptors (FccR) and a likely mechan-
ism of action is epitope masking. IgG1, IgG2a and IgG2b administered
together with soluble protein antigens will enhance antibody and CD4+ T-cell
responses via activating FccR, probably via increased antigen presentation by
dendritic cells. IgG3 as well as IgM also enhance antibody responses but their
effects are dependent on their ability to activate complement. A possible
mechanism is increased B-cell activation caused by immune complexes
co-crosslinking the B-cell receptor with the complement-receptor 2/CD19
receptor complex, known to lower the threshold for B-cell activation. IgE-anti-
bodies enhance antibody and CD4+ T-cell responses to small soluble proteins.
This effect is entirely dependent on the low-affinity receptor for IgE, CD23,
the mechanism probably being increased antigen presentation by CD23+ B
cells.

can enhance antibody responses albeit by different mecha-


Introduction
nisms. In other situations, antibodies can exert negative
It is remarkably difficult to generate an antibody response effects on antibody responses. An interesting finding is
to small soluble protein antigens without using adju- the dual effects of IgG1, IgG2a and IgG2b administered
vants, a fact referred to by Charlie Janeway as ‘the immu- with soluble protein antigens. Their enhancing effects
nologist’s dirty little secret’. Therefore, a significant part seem to be mediated via activating Fc-c receptors (FccR)
of our knowledge about antibody responses stems from but the enhancement is simultaneously negatively regula-
studies of mice immunized with antigens in adjuvants. ted via the inhibitory FccRIIB. Another example is the
In contrast, antibody feedback regulation is studied in ability of IgG to inhibit responses to erythrocytes which
systems where antibodies and antigens are administered takes place in the absence of the known FccR, notewor-
in physiological salt solutions either as pre-formed com- thy also in the absence of FccRIIB. This effect is prob-
plexes or within hours of each other. In this situation, ably caused by antibodies masking the antigen and
antibodies can function as natural adjuvants, and potent preventing its recognition by B cells.
primary and secondary antibody responses as well as Antibody-mediated feedback regulation has been
T-cell responses are generated (reviewed in [1, 2]). Anti- known for over a century [3] and has been extensively
bodies produced early in humoral responses, IgM and reviewed elsewhere [1, 2]. The purpose of the present
IgG3, as well as later on, IgG1, IgG2a, IgG2b and IgE, review is to give a comprehensive summary of the four

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Journal compilation  2006 Blackwell Publishing Ltd. Scandinavian Journal of Immunology 64, 177–184 177
178 Antibody-Mediated Regulation of the Immune Response F. Hjelm et al.
..................................................................................................................................................................

major feedback pathways operating when antibodies and


external antigens form immune complexes in vivo.

IgG-mediated suppression of antibody responses


The most frequently studied antibody feedback pathway
is IgG-mediated suppression of responses to erythrocytes
[4, 5], although IgG can also suppress responses to pro-
teins administered in adjuvants [6]. All murine IgG sub-
classes can suppress anti-erythrocyte responses [7, 8] but
the efficiency of suppression correlates with affinity of the
IgG antibodies [7, 9]. Both primary and secondary anti-
body responses are suppressed whereas T-cell priming Figure 1 Suggested mechanism for IgG-mediated suppression of anti-
body responses. Specific IgG (or IgE and IgM) antibodies bind to eryth-
appears to occur normally [10]. Remarkably, IgG admin- rocytes and prevent specific B cells from binding to the antigen. Lack of
istered several days after erythrocytes can suppress an B-cell receptor (BCR) stimulation leads to absence of an antibody
ongoing antibody response [11, 12] implying that the response, perceived as ‘suppression’. T helper-cell induction is not inhib-
antigen needs to be recognized by cells of the immune ited by IgG, neither in mice nor in vitro, although the antibody
system not only during the initiation of an antibody responses are suppressed.
response but also during the following days.
Three different mechanisms for how IgG exerts its suppression may be IgG-mediated prevention of an anti-
suppressive capacity have been proposed: body response.
(1) IgG may by masking of antigenic epitopes prevent The ability of IgG antibodies to suppress responses to
specific B cells from recognizing and binding to the anti- erythrocytes has been used clinically since the 1960s
gen. [20]. Rhesus-negative women, carrying Rhesus-positive
(2) IgG/erythrocyte complexes may be captured by fetuses, can be sensitized against fetal erythrocytes
FccR+ phagocytes and eliminated more rapidly than acquired via transplacental haemorrhage. This sometimes
erythrocytes alone. This would remove antigen from areas causes haemolytic disease of the newborn as maternal IgG
where it can be recognized by the immune system. antibodies specific for fetal Rhesus-positive erythrocytes
(3) IgG/erythrocyte complexes may co-crosslink the can pass the placenta and destroy fetal erythrocytes. To
B-cell receptor (BCR) with the inhibitory FccRIIB, also prevent this, IgG anti-Rhesus D (RhD) is routinely
expressed on the B-cell surface. This would lead to negat- administered to Rhesus-negative women after delivery of
ive regulation of the B cell, mediated by immunoreceptor a Rhesus-positive baby. The passively administered IgG
tyrosine-based inhibitory motifs in FccRIIB acting on antibodies prevent an active immune response against
immunoreceptor tyrosine-based activation motifs (ITAM) RhD and this treatment has dramatically decreased the
in the BCR [13]. Such co-crosslinking inhibits B-cell incidence of haemolytic disease of the newborn [21]. It
activation in vitro [14, 15]. seems reasonable to assume that IgG-mediated suppres-
The first mechanism, epitope masking, would function sion of responses to sheep erythrocytes (SRBC) in mice
without the IgG(Fc)-portion whereas the two latter reflects the IgG-mediated suppression of responses to
mechanisms would require intact IgG(Fc)-portions. Stud- RhD-positive erythrocytes in Rh-negative women. How-
ies testing whether F(ab¢)2 fragments were suppressive or ever, a few discrepancies are worth noting (discussed in
not have given conflicting results (for discussion, see [10, [22]). In the human system, doses of IgG anti-RhD
16]). In an alternative approach, FccR-deficient mice were which are too low to mask all D epitopes still result in
used to assay for FccR dependence and it was shown that efficient inhibition of the anti-RhD response [23]. More-
IgG suppresses equally well in wild-type mice as in mice over, IgG specific for another blood group antigen, Kell,
lacking all known FccR, including FccRIIB [10, 12]. was in one study shown to suppress the anti-D response
These observations together with previous findings that to D+K+ erythrocytes in D)K) humans [24]. One poss-
complement activation is not required for the suppressive ible explanation for the discrepancies between IgG-medi-
ability of IgG [17], suggest that an Fc-independent ated suppression in the murine and human systems could
mechanism is operative. Although direct evidence is diffi- be that the considerably lower responses to allogeneic
cult to obtain, epitope masking by IgG seems to be a erythrocytes in humans is easier to suppress than the vig-
likely explanation (Fig. 1). This is in agreement with the orous responses to sheep erythrocytes in mice. Therefore,
fact that not only IgG, but also IgM [4, 7, 18] and IgE also an incomplete epitope masking may be sufficient to
[10, 19] can in certain situations suppress anti-erythro- lower the immunogenicity of the RhD-positive erythro-
cyte responses. Should epitope masking be the mechan- cytes. Alternatively, antibodies may target an erythrocyte
ism, a more appropriate term for IgG-mediated for destruction via mechanisms that are not dependent on

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Journal compilation  2006 Blackwell Publishing Ltd. Scandinavian Journal of Immunology 64, 177–184
F. Hjelm et al. Antibody-Mediated Regulation of the Immune Response 179
..................................................................................................................................................................

FccR or complement. There is to date no evidence to genic TCR. Specific T cells expanded rapidly and peaked
support that Rh prophylaxis requires FccRIIB in vivo, 3 days after immunization [38] (Fig. 2). The enhanced
although this, based on in vitro studies, is sometimes T-cell response was followed by an enhanced OVA-speci-
assumed to be the mechanism. Although IgG-mediated fic antibody response and both T- and B-cell responses
suppression of antibody responses to sheep erythrocytes were dependent on activating FccR [38]. This observation
in vitro is dependent on FccRIIB, suppression in vivo is compatible with the idea that complexes of IgG and
works equally well in the absence of this receptor [12]. antigen are captured by FccR+ APC and that they
Therefore, one has to be careful when interpreting the in enhance immune responses in vivo via increased antigen
vivo relevance of findings made in vitro. presentation to specific T helper cells (Fig. 3). The biolo-
Although IgG antibodies are used with great success gical role of IgG-mediated enhancement is most likely to
to suppress anti-RhD responses in humans and easily help in the induction of an efficient memory response, as
suppress >99% of a vigorous anti-SRBC response in antigen-specific IgG would often be present in the circu-
mice, the biological role of this feedback pathway is lation when the immune system encounters a booster
probably not to completely suppress antibody responses. dose of an immunogen.
More likely, the masking of certain epitopes by high FccRIIB is the only inhibitory FccR and is expressed
affinity IgG antibodies emerging relatively early in an on most cells of the immune system except NK and T
immune response may give the immune system the cells. It exerts its negative regulation on ITAM-bearing
opportunity of responding also to other epitopes and receptors such as the BCR, FccRI, FccRIII, FccRIV and
thereby ensure a broader range of antibody specificities. FceRI [39]. This gives FccRIIB a central role in immu-
noregulation and it has been shown to negatively regulate
a number of immune responses such as B-cell activation,
IgG1-, IgG2a- and IgG2b-mediated enhancement
BCR-mediated antigen presentation, antigen presentation
of antibody responses
by DC, maturation of DC and release of mediators
Although IgG1, IgG2a and IgG2b suppress responses to
particulate antigens, they are able to enhance responses
when administered together with soluble protein antigens
such as ovalbumin (OVA), bovine serum albumin and
keyhole limpet haemocyanine (KLH). This dual effect is
indeed dependent on the type of antigen and not on dif-
ferences in the IgG antibodies used: one and the same
monoclonal trinitrophenyl (TNP)-specific IgG suppressed
SRBC-specific responses when administered with SRBC-
TNP but enhanced KLH-specific responses when admin-
istered with KLH-TNP [25, 26]. These IgG isotypes
enhance primary as well as memory responses [27–29]
and immunization with IgG1 anti-nitrophenyl (NP)/NP-
KLH complexes increases somatic mutations in NP-speci-
fic germinal centre B cells [30].
IgG1-, IgG2a- and IgG2b-mediated enhancement is
dependent on the presence of activating FccR and these
must be expressed on bone marrow-derived cells [29, 31].
In vitro and ex vivo, antigens complexed to IgG are cap-
tured by FccR-expressing antigen-presenting cells (APCs)
and presented more efficiently to CD4+ T cells than anti-
gen alone [32–36]. To test whether such a mechanism
also explains IgG-mediated enhancement of antibody
Figure 2 Visualization of proliferating ovalbumin (OVA)-specific CD4+
responses, we have used a system where expansion of
T cells after immunization with antigen/antibody complexes. Mice were
antigen-specific CD4+ T cells can be studied directly adoptively transferred with CD4+ T cells from DO11.10 mice, expres-
in vivo [37]. CD4+ T cells from DO11.10 mice, trans- sing a transgenic T-cell receptor (TCR) specific for an OVA-peptide on
genic for a T-cell receptor (TCR) recognizing an OVA- MHC-II Ad. The day after transfer, mice were immunized i.v. with
peptide together with MHC-II Ad, were transferred to 20 lg OVA-trinitrophenyl (TNP) alone or together with 50 lg mono-
clonal IgG3 anti-TNP, IgG2a anti-TNP or IgE anti-TNP. Seventy-two
syngeneic wild-type BALB/c mice. After immunization
hours after immunization spleens were removed, sectioned and analysed
with IgG2a anti-TNP/OVA-TNP intravenously without by confocal microscopy. OVA-specific T cells (red) are stained with a
adjuvants, the expansion of OVA-specific T cells was fol- monoclonal antibody specific for the transgenic OVA-specific TCR and
lowed using a monoclonal antibody specific for the trans- B cells (blue) are stained with anti-B220.

 2006 The Authors


Journal compilation  2006 Blackwell Publishing Ltd. Scandinavian Journal of Immunology 64, 177–184
180 Antibody-Mediated Regulation of the Immune Response F. Hjelm et al.
..................................................................................................................................................................

[44]. With the availability of gene-targeted mice, it


became clear that deficiencies in classical [45, 46] but not
alternative [47] pathway components resulted in impaired
antibody responses, suggesting that antibodies were
involved. Mice where complement receptor 1 and 2
(CR1/CR2) was blocked by monoclonal antibodies or
deleted by gene targeting have a similar phenotype with
regard to antibody responses as animals lacking classical
pathway components [48–51]. CR1/CR2 are derived by
alternative splicing of the same gene. In mice, they are
expressed on B cells and follicular dendritic cells (FDC)
implying that one or both of these cells are the effector
cells.
IgM is an efficient complement activator and when
Figure 3 Suggested mechanism for IgG1-, IgG2a- and IgG2b-mediated IgM is passively administered together with large anti-
enhancement of antibody responses. IgG1, IgG2a and IgG2b complexed gens like erythrocytes [5, 52], malaria parasites [53]
to soluble protein antigens bind to activating Fc-c receptors (FccR)
and KLH [54] it enhances the antibody responses. IgM
expressed on antigen-presenting cells (presumably dendritic cells). Com-
plexed antigen is internalized more efficiently than non-complexed anti- upregulates both primary [5, 52–54] and memory
gens. Antigenic peptides are presented on MHC-II to specific CD4+ T responses [55] and increases affinity maturation [56].
cells which expand and interact with antigen-specific B cells, resulting The enhancing effect is only seen with suboptimal
in an enhanced antibody response. doses of antigen [5] and in order to enhance, IgM
must be administered within a few hours of the anti-
(reviewed in [40]). FccRIIB-deficient mice have increased gen. The ability of specific IgM to enhance antibody
susceptibility to many autoimmune diseases [41] and responses requires a functioning complement system.
have increased anaphylactic reactions [42]. IgM cannot enhance in mice lacking C3 owing to
The role of the receptor in regulation of in vivo anti- treatment with cobra venom factor [52] or in mice
body responses has been studied using FccRIIB-deficient lacking CR1/CR2 [57]. Mutated or monomeric IgM
mice. As IgG-mediated enhancement is severely impaired molecules which no longer activate complement also
in mice lacking activating FccR, but which have normal loose their enhancing effects [52, 54].
levels of FccRIIB [31], FccRIIB is not required for We recently found that IgG3 also can enhance anti-
induction of enhancement. However, this receptor has a body responses [58]. IgG3 enhances in mice lacking all
negative effect on responses to IgG-complexed soluble activating FccR [58] and in mice selectively lacking
antigens, demonstrated by an enhanced IgG-mediated FccRI [59], which is suggested to be the IgG3-binding
enhancement in FccRIIB-deficient mice [31, 38]. The FccR [60]. Unlike IgE [61] and IgG2a [38], IgG3 did
response in FccRIIB-deficient mice to IgG-complexed not induce proliferation of specific T cells in vivo [59]
antigen was sometimes more than 100-fold higher than (Fig. 2). Enhancement was severely impaired in mice
in wild-type mice [31, 38]. Notably, FccRIIB does not lacking CR1/CR2 and in animals depleted of C3 by
completely turn off antibody production but ‘permits’ treatment with cobra venom factor [58].
IgG to enhance antibody responses, as demonstrated by Thus, both IgG3 and IgM depend on the complement
the enhancement seen in wild-type mice. This illustrates system for their enhancing capacity.
the intricate balance between inhibitory and activating Both isotypes are relatively T independent and both
effects mediated by IgG and FccR. The outcome of regu- are produced early in an immune response. One single
latory effects of IgG antibodies is dependent on factors IgM molecule can activate complement [62], provided it
such as the expression level of activating and inhibitory can change conformation. IgG3 has the capacity to self-
FccR, which are often co-expressed on the same cell. It associate into multivalent complexes, giving it a high
also depends on the IgG subclass composition, as differ- functional affinity and probably also increasing the likeli-
ent subclasses have different ratios of activating-to-inhibi- hood of C1q binding [63, 64]. These factors may explain
tory receptor binding [43]. why IgM and IgG3 utilize the complement system in
feedback enhancement and, speculatively, also why IgM
can only enhance responses to large antigens (which are
IgM- and IgG3-mediated enhancement of
required to enable the huge IgM molecule to bind with
antibody responses
its five arms and change conformation). IgE and IgG1 are
It has been known since the 1970s that complement fac- unable to activate complement, whereas IgG2a and
tor C3 is important for the capacity of animals to mount IgG2b require the rather unlikely event that two IgG
normal antibody responses to suboptimal doses of antigen molecules bind close enough on the antigen to cooperate

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Journal compilation  2006 Blackwell Publishing Ltd. Scandinavian Journal of Immunology 64, 177–184
F. Hjelm et al. Antibody-Mediated Regulation of the Immune Response 181
..................................................................................................................................................................

in C1q-binding. Therefore, it seems logical that these IgE-mediated enhancement of antibody responses
isotypes use Fc-receptors for their feedback-enhancing
effects. In the 1990s, in vitro experiments showed that IgE-com-
It is not understood why complement has such a dra- plexed antigens, binding to the low-affinity receptor for
matic impact on antibody responses, but several, not IgE (CD23) on the surface of B cells, could be internal-
mutually exclusive, mechanisms are possible: ized and presented efficiently to T helper cells [77, 78].
(1) Antibody/antigen/complement complexes co-cross- These observations led to the hypothesis that a physiolo-
link the BCR and the CR2/CD19 complex, known to gical role of IgE may be to capture antigens and enhance
lower the threshold for B-cell activation [65] (Fig. 4). T helper-cell activation [79]. We tested this idea in an
(2) Antibody/antigen/complement complexes are cap- in vivo system where mice were immunized with mono-
tured by FDC in the spleen and lymph nodes, increasing clonal IgE anti-TNP together with various protein anti-
the effective concentration of antigen [54, 66–68]. gens coupled to TNP and found that IgE indeed
(3) Antibody/antigen/complement complexes are endo- upregulated carrier-specific antibody responses [80]. IgE
cytosed efficiently via CR1/CR2 on B cells and presented enhances responses to small soluble protein antigens but
to T helper cells which in turn help B cells to produce not to erythrocytes or large proteins such as KLH [80,
antibodies. In vitro, B cells can take up antigen via CR1/ 81]. All isotypes, including IgE, are upregulated and the
CR2 and present to T cells [69–72], but in vivo studies IgG response peaks as early as 6 days after priming [81,
in adoptive transfer/hapten-carrier systems do not support 82]. The enhancing effect of IgE is mediated by CD23,
a role for complement in T helper-cell activation [45, evidenced by lack of enhancement in mice where CD23
73]. is blocked by a monoclonal antibody [80, 81] or in
Regardless of which mechanism(s) that cause anti- CD23-deficient mice [61, 83, 84]. Lack of involvement of
body/complement-mediated enhancement, it remains to the high-affinity IgE-receptor (FceRI) was confirmed by
be explained how a primary antibody response can be the normal IgE-mediated enhancement in FcRc-chain-
dependent on classical (antibody induced) complement deficient mice, which do not express FceRI [31].
activation: in naive mice very low amounts of specific IgE-mediated enhancement works normally in IL-4-
IgM or IgG3 is available to form complexes with the deficient mice [85]. As IL-4 is required for expression of
antigen. One possibility is that capture of antigen by the CD23b isoform [86], this observation suggests that
natural IgM and IgG3 suffices to start complement acti- enhancement is mediated via the constitutively expressed
vation in primary antibody responses. Once activation of CD23a isoform. In mice, CD23a is expressed only on B
specific B cells has taken place, these will secrete anti- cells and FDC. Adoptive transfer experiments demonstra-
gen-specific IgM and IgG3, further enhancing the posit- ted that FDC are not involved, leaving the B cells as the
ive feedback loop. In line with this, mice lacking likely effector cells [84]. Therefore, should the IgE-
secretory IgM had impaired antibody responses [74–76] enhanced antibody response in vivo be caused by enhanced
which could be reconstituted by transfusion of IgM from presentation of antigenic peptides to T helper cells, in
naive mice [74]. analogy with in vitro findings [77, 78], it would imply
that B cells can activate naive T cells. This is usually
considered to be performed by DC [87], and to investi-
gate whether IgE/antigen complexes do indeed activate
specific T cells in vivo, we used the DO11.10 experimen-
tal system described above. IgE anti-TNP administered
together with OVA-TNP induced a marked proliferation
of OVA-specific CD4+ T cells peaking 3 days after
immunization [61] (Fig. 2). Enhancement of T-cell
responses required the presence of CD23 which had to be
expressed on B cells. However, once such cells were pre-
sent (in chimaeric mice), also CD23) B cells produced
enhanced levels of specific antibody after immunization
with IgE/antigen [61]. These observations are compatible
with the antigen presentation hypothesis suggesting that
Figure 4 Suggested mechanism for IgM- and IgG3-mediated enhance- the enhanced antibody levels are a result of increased
ment of antibody responses. IgM and IgG3 forming a complex with T-cell help to specific B cells (Fig. 5). IgE-mediated
specific antigen activates complement leading to attachment of comple- enhancement, as well as all other feedback regulatory
ment factors to the immune complexes. The IgM or IgG3/antigen/com- pathways, is specific for the antigen within the immune
plement complexes co-crosslink the B-cell receptor (BCR) to the CR2/
CD19 co-receptor complex and lowers the threshold for B-cell activa-
complex. This means that although all CD23+ B cells
tion, thereby leading to enhanced antibody responses. regardless of BCR specificity, take up and present

 2006 The Authors


Journal compilation  2006 Blackwell Publishing Ltd. Scandinavian Journal of Immunology 64, 177–184
182 Antibody-Mediated Regulation of the Immune Response F. Hjelm et al.
..................................................................................................................................................................

Foundation; Hans von Kantzow’s Foundation; Ankar-


strand’s Foundation; King Gustaf V:s 80 Years Founda-
tion; Lilly and Ragnar Åkerhams’s Foundation; The
Swedish Research Council; Ollie and Elof Ericsson’s
Foundation; The ‘Network for Inflammation research’
funded by the Swedish Foundation for Strategic Research;
The Swedish Society for Medical Research; and Uppsala
University.

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Journal compilation  2006 Blackwell Publishing Ltd. Scandinavian Journal of Immunology 64, 177–184

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