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Innate immunity

Article  in  The Journal of allergy and clinical immunology · November 2009

DOI: 10.1016/j.jaci.2009.07.016 · Source: PubMed

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J Allergy Clin Immunol. Author manuscript; available in PMC 2011 February 1.
Published in final edited form as:
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J Allergy Clin Immunol. 2010 February ; 125(2 Suppl 2): S24–S32. doi:10.1016/j.jaci.2009.07.016.

Chapter 2: Innate Immunity

Stuart E. Turvey, MB BS, DPhil1 and David H. Broide, MB ChB2

1Department of Paediatrics, BC Children’s Hospital and Child & Family Research Institute,

University of British Columbia, Vancouver, BC, Canada.

2Department of Medicine, University of California San Diego, La Jolla, CA, USA.

Abstract
Recent years have witnessed an explosion of interest in the innate immune system. Questions about
how the innate immune system senses infection and empowers a protective immune response are
being answered at the molecular level. These basic science discoveries are being translated into a
more complete understanding of the central role innate immunity plays in the pathogenesis of many
human infectious and inflammatory diseases. It is particularly exciting that we are already seeing a
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return on these scientific investments with the emergence of novel therapies to harness the power of
the innate immune system. In this review we explore the defining characteristics of the innate immune
system, and through more detailed examples, we highlight recent breakthroughs that have advanced
our understanding of the role of innate immunity in human health and disease.

Keywords
host defense; innate immunity; Toll-like receptors; NOD-like receptors

THE “NEW” SCIENCE OF INNATE IMMUNITY

The integrated human immune response has traditionally been divided into two branches:
innate and adaptive (or acquired) immunity. While appreciation of innate immunity dates back
to at least the 1908 Nobel Prize winning efforts of Ilya Mechnikov; until the last decade, study
of innate immunity has been eclipsed by dramatic discoveries in the field of adaptive immunity.
However, the recent molecular definition of how the innate immune system senses infection
to empower protective immune responses has precipitated a renaissance in the field of innate
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immunity. Innate immunity has shed its older, disparaging title of ‘non-specific immunity’ and
now stands as a proud partner with the adaptive immune system in protecting human hosts
from infectious insults. For any who doubt the impressive protective capacity of the innate
immune system, it is instructive to consider that only vertebrates boast the added benefits of
an adaptive immune system, leaving most organisms on our planet to survive on innate
immunity alone!

© 2009 American Academy of Allergy, Asthma and Immunology. Published by Mosby, Inc. All rights reserved.
Corresponding Author: Stuart Turvey MB BS DPhil FRCPC, Assistant Professor, Division of Infectious and Immunological Diseases,
BC Children's Hospital and Child & Family Research Institute, University of British Columbia, 950 West 28 Avenue, Vancouver BC
V5Z 4H4, Ph: 604 875 2345 x5094, Fax: 604 875 2226, sturvey@cw.bc.ca.
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 Turvey and Broide Page 2

While innate immunity is critical for host defense against infectious challenges, the innate
immune system is emerging as a critical regulator of human inflammatory disease. Indeed,
innate immune responses have been implicated in the development of asthma and atopy, as
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well as a variety of autoimmune disorders including Type 1 diabetes, inflammatory bowel

disease and systemic lupus erythematosus.

In this review we examine the basic structure of the innate immune system and how innate
immunity interfaces with adaptive immune responses. We explore the role of innate immunity
in human health and disease and we outline how novel therapies may harness the beneficial
capacity of the innate immune system. Rather than attempting to comprehensively review this
enormously broad topic, our focus is on highlighting common defining mechanisms of innate
immunity and illustrating the clinical relevance of innate immunity to human health. We have
deliberately avoided a detailed exploration of the complement system as a separate Primer
chapter is devoted to this important aspect of innate immunity (Chapter 23: Complement
Disorders and Hereditary Angioedema. Michael Frank).

ORGANIZATION OF THE HUMAN IMMUNE SYSTEM: THREE LEVELS OF

HOST DEFENSE
The human microbial defense system can be simplistically viewed as consisting of three levels:
(i) anatomical and physiological barriers; (ii) innate immunity; and (iii) adaptive immunity
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(Figure 1 and Table 1). Failure in any of these systems will greatly increase susceptibility to
infection.

Anatomical and physiological barriers provide the crucial first line of defense against
pathogens. These barriers include intact skin, vigorous mucociliary clearance mechanisms, low
stomach pH and bacteriolytic lysozyme in tears, saliva and other secretions. The extreme
susceptibility to infections observed in individuals with severe cutaneous burns or primary
ciliary dyskinesia demonstrates that intact innate and adaptive immune systems are not able to
compensate for failure of essential anatomical and physiological barriers.

Innate immunity augments the protection offered by anatomical and physiological barriers.1
The innate immune system relies upon a limited repertoire of receptors to detect invading
pathogens, but compensates for this limited number of invariant receptors by targeting
conserved microbial components that are shared by large groups of pathogens. Speed is a
defining characteristic of the innate immune system—within minutes of pathogen exposure
the innate immune system starts generating a protective inflammatory response. Moreover,
innate immunity plays a central role in activating the subsequent adaptive immune response.
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T- and B-lymphocytes are the main self-defense weapons of the adaptive immune system, so-
named because this system is shaped by antigen exposure. In contrast to the limited number
of pathogen receptors utilized by the innate immune system, the adaptive immune system
boasts an extremely diverse, randomly-generated repertoire of receptors. The benefit of this
receptor diversity is that the adaptive immune system can recognize virtually any antigen, but
there is a price for this diversity. First is the risk of autoimmune disease. Receptors specific
for self proteins (such as insulin and myelin) are created by the random process of gene
rearrangement that generates receptors expressed by T cells and B cells. Consequently,
elaborate tolerance mechanisms have evolved to eliminate or regulate self-reactive cells.
Second is the time delay required to generate a protective adaptive immune response following
the first exposure to a pathogen. Adaptive immunity relies upon a clonal system with each T
cell and B cell expressing its own unique receptor and following the initial encounter with a
pathogen, it takes up to five days for clonal expansion of these rare antigen-specific T and B
cells to occur before the adaptive immune response is sufficiently robust to clear the pathogen.

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ELEMENTS OF THE INNATE IMMUNE SYSTEM

In contrast to the adaptive immune system which depends upon T and B lymphocytes, innate
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immune protection is a task performed by cells of both hematopoietic and non-hematopoietic

origin (Figure 1 and Table 1). Hematopoietic cells involved in innate immune responses include
macrophages, dendritic cells, mast cell, neutrophils, eosinophils, natural killer (NK) cells and
natural killer T cells. In addition to hematopoietic cells, innate immune responsiveness is a
property of the skin and the epithelial cells lining the respiratory, gastrointestinal and
genitourinary tracts.

To augment these cellular defenses, innate immunity also has a humoral component that
includes well characterized components such as complement proteins, LPS binding protein
(LBP), C-reactive protein and other pentraxins, collectins, and anti-microbial peptides
including defensins. Circulating innate immune proteins are involved in both in sensing
microbes and effector mechanisms to facilitate clearance of the infection. For example,
mannose-binding lectin (MBL), a member of the collectin family of receptors, binds mannose-
containing carbohydrates on microbes triggering activation of the complement cascade which
enhances clearance of the pathogen.

HOST DEFENSE IS ACHIEVED THROUGH INTEGRATION OF INNATE AND

ADAPTIVE IMMUNITY
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Innate immunity, an evolutionarily ancient component of host defense, is present in all

multicellular organisms while adaptive immunity evolved much later and is only found in
jawed fish and all ‘higher' vertebrates.2 During evolution, adaptive immunity developed in the
context of a functioning innate immune system. Consequently, the classic demarcation between
innate and adaptive immunity is overly simplistic as many adaptive immune responses build
on the foundation of innate immunity. For example, the capacity of neutrophils to kill bacteria
is enhanced when the bacteria are opsonized by antibodies produced through the coordinated
efforts of T and B cells. In a similar fashion, the C3d fragment that is generated in the course
of complement activation acts as a molecular adjuvant to profoundly influence the subsequent
adaptive immune response. Specifically, Cd3 fragments act to bridge innate and adaptive
immunity as covalent binding of single or multiple copies of C3d to a foreign antigen generally
enhances B cell effector and memory function.3 Another illustrative example of the
interdependence of innate and adaptive immunity is the critical role played by antigen-
presenting cells of the innate immune system (e.g. dendritic cells) to empower full activation
of the T and B cells of the adaptive immune system. Further blurring of the distinction between
innate and adaptive immunity is highlighted by the fact that cells of the adaptive immune
system, including regulatory T lymphocytes, express Toll-like receptors (TLRs) and other
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innate immune receptors.4 The inter-relatedness of innate and adaptive immunity is most
eloquently articulated by Beutler in his observation that “…the roots of adaptive immunity are
buried deep in the soil of the innate immune system”.5

INNATE IMMUNE RECOGNITION STRATEGIES

The innate immune system serves as the initial immune defense against foreign and dangerous
material. In the most simplistic view, the innate immune system is hardwired with germline-
encoded receptors for immediate responsiveness. In contrast to adaptive immunity, innate
immune responses do not require genetic recombination events or a developmental phase to
mediate function.

The strategy used for immune recognition is the main feature distinguishing innate and adaptive
immunity. In contrast to the massive, randomly-generated repertoire of antigen receptors

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expressed by T and B lymphocytes, the innate immune system relies upon a limited number
of genetically predetermined germline-encoded receptors that recognize either highly
conserved structures expressed by large groups of microbes or common biological
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consequences of infection. Pathogens can rapidly evolve and, in principle, could avoid
detection by the innate immune system by simply altering the targeted microbial molecules.
However, the innate immune system has evolved to recognize either microbial components
that are essential for the viability and virulence of microbes and are thus less prone to
modifications, or common biological consequences of infection.

At least three broad strategies are used by the innate immune system to recognize invading
microorganisms (Table 2). In the first, innate immunity relies upon a limited repertoire of
germline-encoded receptors to recognize ‘microbial non-self’ – conserved molecular structures
that are expressed by a large variety of microbes. Charles Janeway coined the terms ‘pattern
recognition receptors’ (PRRs) to collectively describe these receptors and ‘pathogen-
associated molecular patterns’ (PAMPs) to denote the microbial structures recognized by the
PRRs.6 However, this terminology has been criticized as being vague5; therefore in this review
we will focus on naming specific receptors and their microbial ligands. A second approach
used by the innate immune system is to detect immunological ‘danger’ in the form of ‘damage-
associated molecular patterns’ (DAMPs). DAMPs represents common metabolic
consequences of infection and inflammation.7 DAMPs are molecules that are upregulated and
released during the cell lysis and tissue damage that occurs in the context of both infectious
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and sterile inflammation. Well characterized DAMPs include high mobility group box 1 protein
(HMGB-1) and other endogenous alarmins, heat-shock proteins (HSPs) and uric acid. In the
third innate immune recognition strategy, innate immune receptors detect “missing self” –
molecules expressed by normal, healthy cells but not expressed by infected cells or microbes.
Recognition of these signals indicates that ‘all-is-well’ and an inhibitory signal is delivered to
prevent activation of the immune response against host tissues. This inhibitory system is well
illustrated by NK cells. Inhibitory receptors specific for self-MHC class I molecules play a
central role in missing-self recognition by NK cells, ensuring NK cells preferentially attack
infected cells that downregulate their MHC class I proteins.8

ROLE OF THE INNATE IMMUNE SYSTEM IN HEALTH AND DISEASE

We will now turn our attention to specific components of the innate immune system. We
deliberately selected two illustrative examples – TLRs and NLRs – where our mechanistic
understanding has increased considerably in the past 5 years and where the clinical relevance
of these systems is beginning to emerge.

1. TOLL-LIKE RECEPTORS (TLRS)

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Overview of TLR Structure and Function—The recent explosion of interest in innate

immunity was catalyzed in the mid-1990s when the Drosophila protein Toll was shown to be
critical for defending fruit flies against fungal infections.9 This observation opened the way
for the subsequent description of similar proteins, called Toll-like receptors (TLRs), in
mammalian cells. The human TLR family consists of 10 receptors that are critically important
for innate immunity.10, 11 TLRs allow for recognition and response to diverse microbial
epitopes on pathogens enabling the innate immune system to discriminate among groups of
pathogens and to induce an appropriate cascade of effector adaptive responses.

TLRs exist as dimeric proteins (either heterodimers or homodimers). The ectodomains of TLRs
are composed of leucine-rich repeat motifs while the cytosolic component, called a Toll/
interleukin-1 receptor (TIR) domain, is involved in signaling. Individual TLRs recognize a
distinct, but limited, repertoire of conserved microbial products; for example, well
characterized receptor-ligand pairs include TLR4 and lipopolysaccharide (LPS), TLR5 and

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flagellin, TLRs1/2/6 and lipoproteins. Collectively, the complete TLR family allows the host
to detect infection by most (if not all) types of microbial pathogens. For example, Gram positive
organisms, such as Streptococcus pneumoniae, are initially recognized by TLR1, 2, 4, 6 and
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9, which in turn interact with a range of downstream signaling molecules to activate an

inflammatory cascade. TLR signaling pathways have been the focus of considerable attention
(reviewed in 11, 12 and depicted in Figure 2). The emerging model has ligation of microbial
products by TLRs culminating in the activation of nuclear factor kappa-B (NF-κB), activator
protein-1 (AP-1), interferon-regulatory factor (IRF)-3 and other transcription factors, driving
the production of proinflammatory cytokines, maturation of dendritic cells and other
immunological responses.

Human Disease Resulting from TLR Defects—Naturally-occurring genetic mutations

in humans, causing extreme immunodeficiency phenotypes, present powerful opportunities to
determine the relationship between specific immunological defects and human disease
processes in vivo. Recent description of human primary immunodeficiencies associated with
abnormal TLR signaling demonstrate that this pathway is critical for human defense against
infection. Empowered by technological advances in genotyping and bioinformatics, we are
now beginning to appreciate how common genetic variation and polymorphisms in genes
controlling the innate immune response alters infectious susceptibility in a subtle but specific
fashion. Importantly, human primary immunodeficiencies associated with abnormal TLR
signaling provide unique insights into the immunological pathways vital for host defense and
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identify candidate genes that may cause subtle immunodeficiencies in the broader population
of apparently healthy people13.

a) Monogenic primary immunodeficiencies: Interleukin-1 receptor associated kinase 4

(IRAK4) deficiency (OMIM #607676)14 and myeloid differentiation primary response gene
88 (MyD88) deficiency (OMIM #612260)15 are novel primary immunodeficiencies
specifically affecting TLR function. MyD88 and IRAK4 are binding partners involved in
downstream signaling from most TLRs (Figure 2); hence, the clinical and laboratory
phenotypes of IRAK4- and MyD88-deficiencies are identical. The narrow spectrum of
infections experienced by affected individuals is striking in light of their profound impairment
of TLR function and pathogen sensing. IRAK4- and MyD88-deficient patients predominantly
suffer from recurrent infections caused by pyogenic Gram-positive bacteria, with
Streptococcus pneumoniae causing invasive infection in all reported cases while
Staphylococcus aureus and Pseudomonas aeruginosa caused infections in about half the
patients. The surprising clinical observation that IRAK4-deficient patients are resistant to viral
infections was recently explained at a molecular level as IRAK4-deficient patients are able to
control viral infections by TLR3- and TLR4-dependent production of IFNs.16
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Arguably one of the most powerful messages to arise from the recognition of IRAK4- and
MyD88-deficiency is the value of studying humans to understand human immune function!
While MyD88-deficient patients are susceptible to Streptococcus pneumoniae and a limited
number of pyogenic bacteria, they are able to resist infection by most common bacteria, viruses,
fungi, and parasites. In contrast, MyD88-deficiency renders mice profoundly susceptible to
most pathogens tested.

b) Contribution of TLR polymorphisms to human disease: At the population level

susceptibility to common diseases, such as infections, seldom follows the simple pattern of
Mendelian inheritance seen in IRAK4- and MyD88-deficiency.17 Most infections follow a
complex mode of inheritance, with disease arising from an intricate interplay between
environmental and genetic factors. The complexity of common infectious diseases has made
them, until very recently, largely impervious to genetic analysis. However, advances in high

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throughput genotyping techniques and bioinformatics is now allowing us to understand how

common genetic variants alter human susceptibility to infection.
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Although humans are identical at most of the 3 billion base pairs in their genome, inter-
individual variation is present in approximately 3 million nucleotides (i.e. 0.1% of the genome).
18 A common type of human genetic variation is the single nucleotide polymorphism (SNP),
where two alternative bases occur at appreciable frequency (>1%) in the population. There is
convincing evidence that common TLR SNPs regulate cellular signaling events, cytokine
production and susceptibility to infection based on the specific pathogens recognized by the
TLR. Arguably the best evidence implicates amino acid changing (i.e. non-synonymous) SNPs
in TLRs 1, 2 and 5, as well as variants in the adaptor molecule TIR domain-containing adaptor
protein (TIRAP, also know as MAL). This genetic variation in the population results in some
individuals having a ‘subtle’ but specific immunodeficiency. For example, a common TLR5
polymorphism in the ligand-binding domain of TLR5 (392STOP) abolishes flagellin signaling
and is associated with increased susceptibility to Legionnaire’s disease caused by the
flagellated bacterium, Legionella pneumophila.19 In a similar fashion, polymorphisms in the
adaptor molecule MAL/TIRAP which mediates signaling through TLR1, 2, 4, and 6, have been
associated with susceptibility to tuberculosis, malaria and pneumococcal disease.20

Given the role of TLRs in sensing the extracellular environment and shaping inflammatory
response, the TLR pathway has been hypothesized to influence the development of atopy and
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asthma. The best studied example is CD14. CD14 is encoded on chromosome 5q31.1 in a
region linked to atopy and asthma, and CD14 partners with TLR4 to recognize LPS. Therefore,
a SNP in this gene (CD14/–159 C to T) which appeared to alter the functional production of
CD14, made an excellent candidate to influence susceptibility to asthma and atopy. Initial
investigations showed remarkable variation with some studies indicating the T-allele as a risk
factor, others the C-allele, and others finding no association.21 However, when the level of
LPS (or endotoxin) exposure was considered a biologically plausible gene-by-environment
interaction was revealed with data suggesting that the C-allele is a risk factor for allergic
phenotypes at low levels of exposure, whereas the T-allele is a risk factor at high levels of
exposure.22 Through this informative example it is clear that complex interactions between
genes and environment determine asthma-related outcomes. Consequently, if we fail to
integrate genetic and environmental factors in our study of asthma and allergy, we will only
generate an impoverished appreciation of the etiology of atopic disease.

While a rapidly growing number of genetic association studies suggest that TLR
polymorphisms may be associated with susceptibility to different infectious and
immunologically-mediated diseases, very few of these studies have been replicated in a
convincing fashion. For example, the initial association reported between MAL/TIRAP and
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susceptibility to tuberculosis was not replicated in another large study.23 As this field advances
and expands to include genome-wide association studies, it is essential to appreciate that the
best studies will include large sample sizes, statistical adjustments for multiple comparison,
replication of findings with independent cohorts, multiple study designs (including case-
control and family-based studies), adjustment of the analysis for population admixture,
consideration of environmental variables and detailed molecular and cellular analyses to
determine whether a polymorphism alters function.

2. NUCLEOTIDE OLIGOMERIZATION DOMAIN (NOD)-LIKE RECEPTORS (NLRS)

Overview of NLR Structure and Function—While TLRs are outward looking innate
immune receptors detecting microbial signatures either in the extracellular milieu or engulfed
in the lumen of endocytic vesicles, nucleotide oligomerization domain (NOD)-like receptors
(or NLRs) are a recently appreciated family of receptors that survey the intracellular
environment.24, 25 In common with other innate immune receptor systems, the NLRs have

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ancient origins being structurally reminiscent of plant R-proteins that mediate plant cell defense
against pathogenic bacteria. NLRs sense microbial products and metabolic stress driving
inflammation through the formation of an inflammasome—a large cytoplasmic complex that
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activates inflammatory caspases and the production of the cytokines IL-1β and IL-18.26

The human NLR family consists of at least 23 members and can be structurally divided into
four subfamily designations N-terminal effector domains.27 The first NLRs reported to have
a direct function as intracellular pathogen detectors were NOD1 and NOD2.25 Both NOD
proteins detect distinct substructures generated during the synthesis, degradation and
remodeling of bacterial peptidoglycan, ensuring the recognition of peptidoglycan from both
Gram-positive and Gram-negative bacteria. IPAF (for ICE protease-activating factor) is
another member of the NLR family known to detect bacterial pathogens.28 IPAF partners with
TLR5 to detect infection by flagellated bacteria—TLR5 senses extracellular flagellin while
IPAF focuses on intracellular flagellin. In addition to sensing microbial products, NLRs can
sense metabolic stress related to infection and sterile inflammation. This sensing capacity is
best demonstrated by NLRP3 (NLR family, pyrin domain-containing 3).29 When triggered
NLRP3 (also called NALP3 or cryopyrin) activates the caspase-1 'inflammasome' leading to
interleukin 1β (IL-1β) and IL-18 processing (Figure 2). The NLRP3 inflammasome appears to
be activated by common metabolic ‘danger signals’ such as potassium efflux which occurs
during inflammation due to disruption of the plasma membrane or increased extracellular ATP
released by injured cells. Other clinically relevant NLRP3 activators include uric acid, asbestos,
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silica and alum.

Role of NLRs in human health and disease—Although our molecular appreciation of

NLRs is very recent, this class of innate immune receptors plays a central role in several human
inflammatory diseases and mediates the adjuvant effect of a common vaccine component,
alum.

a) NLR defects associated with inflammatory diseases: The convergence of clinically

defined autoinflammatory disease with the biology of innate immunity and NLRs came with
the discovery that three well-established autoinflammatory diseases are all caused by
activating, gain-of-function mutations in NLRP3.30 These diseases, collectively known as the
cryopyrinopathies, are: (i) familial cold autoinflammatory syndrome (OMIM #120100), which
presents with cold-induced fevers, urticaria-like rash, and constitutional symptoms; (ii)
Muckle-Wells syndrome (OMIM #191900), which is characterized by fevers, hives,
sensorineural hearing loss, and arthritis unrelated to cold exposure; and (iii) neonatal-onset
multisystem inflammatory disease (NOMID) [or chronic infantile neurologic cutaneous
articular (CINCA) syndrome] (OMIM #607115), which is a devastating neonatal disease
presenting with fever, urticaria and chronic aseptic meningitis. In these disorders NLRP3
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mutations affect IL-1β production, and IL-1β is upregulated in these diseases.31 Appreciation
of the role of the IL-1β axis in these diseases associated with NLRP3 mutations has allowed
the rational use of targeted anti-inflammatory therapy.32 Strikingly, even the most clinically
severe cryopyrinopathy, NOMID/CINCA, appears to respond well to the IL-1 receptor
antagonist, anakinra.33

More insight into the clinical relevance of NLRs arose when it was recognized that 30–50%
of patients with Crohn's disease in the Western hemisphere carry NOD2 mutations on at least
one allele.34, 35 The most common mutations are located in or near the leucine-rich repeat
(LRR) domain of NOD2 and patients homozygous for the 3020insC mutation, resulting in
partial truncation of the LRR, demonstrate a much more severe disease phenotype. It seems
paradoxical that while Crohn's disease results in overt inflammation that probably is triggered
by normal bacterial flora, the NOD2 mutations associated with Crohn’s disease result in a
protein product less capable of responding to the bacterial ligand, muramyl dipeptide (MDP)

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which is a component of peptidoglycan. A unifying paradigm addressing this paradox is that

NOD2 appears to provide homeostatic signals to maintain the gut environment in a state that
is tolerant of its flora and cells with NOD2 mutations are deficient in their production of IL-10,
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an immunomodulatory and tolerogenic cytokine.36 Other evidence suggests that NOD2

variants are associated with Crohn's disease because they lead to a decrease in the negative
regulation of TLR responses occurring in the normal gut, and thus a pathologic increase in
responses to the normal flora.37 Nevertheless, the genetic polymorphisms that show a well-
established association with Crohn's disease (including NOD2) account for only approximately
20% of the genetic variance observed in Crohn's disease, suggesting that significant additional
genetic contributions have yet to be discovered.

b) NLR contribution to vaccine responsiveness: Increased understanding of NLRs has

allowed us to shed light on the mechanism of action of vaccine adjuvants.6 Aluminum-
containing adjuvants (alum) have historically served as immunopotentiators in vaccines and
continue to be the most widely used clinical adjuvants. Despite the fact that most people reading
this review have received vaccines containing alum, it is only very recently that we have begun
to fully appreciate the molecular mechanism of alum adjuvancy. Studies published in 2008
demonstrated that the NLRP3 (NALP3) inflammasome is involved in mediating the adjuvant
effects of alum.38–40 This adjuvancy may occur directly via the triggering of the NALP3
inflammasome by alum crystals, or indirectly through release of the endogenous danger signal,
uric acid, which subsequently activates NLRP3.
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THERAPEUTIC MODULATION OF INNATE IMMUNITY

With increased appreciation of the contribution of innate immunity to human health and
disease, attention quickly shifted to the possibility of therapeutic modulation of innate
immunity. This is an area of active investigation, so rather than attempting to survey the field
broadly, we will focus our review on recent attempts to harness the TLR system to modulate
infectious and allergic diseases.

1. ACTIVATION OF TLRS AND MODULATION OF ALLERGIC IMMUNE RESPONSE

The interaction of two fields of research in the 1990s--epidemiologic investigations of the
“hygiene hypothesis” in allergy and asthma, and basic research in the field of TLRs--provided
the impetus to investigate whether activating TLRs might represent a novel therapeutic option
for the treatment and prevention of allergy and asthma.41 TLR based therapies in allergy target
in particular the dendritic cell interaction with T cells, which is a critical component in shaping
the Th2 immune response associated with allergic inflammation. As TLRs are highly expressed
on dendritic cells but not on T cells, the goal of TLR based therapies in allergy and asthma is
to activate dendritic cells to produce a cytokine milieu (IL-12, IFNs, etc) that favors inhibition
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of Th2 immune response. Thus, TLR based therapies target the innate immune response to
consequently inhibit the adaptive Th2 immune response and do not directly target T cells.

Studies have examined whether activation of TLRs can modulate allergic immune responses
in pre-clinical animal models of allergy and asthma as well as in more limited studies in human
subjects. The majority of studies have evaluated TLR9 agonists, but additional studies have
also examined TLR4 agonists and a TLR7/8 agonist. Studies of the TLR9 agonist CpG DNA
have demonstrated that it inhibits eosinophilic airway inflammation, Th2 cytokine responses,
mucus expression, airway remodeling, and airway responsiveness in a mouse model.41, 42
Administration of an inhaled TLR9 agonist for approximately 8 months to monkeys allergic
to dust mite demonstrated that they had reduced eosinophilic airway inflammation, mucus,
airway remodeling, and reduced airway responsiveness.43 The only published studies in
human asthmatics were performed in mild asymptomatic asthmatics treated with an inhaled
TLR9 agonist prior to allergen challenge.44 Although treatment with the inhaled TLR9 agonist

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increased expression of IFN-inducible genes, there was no inhibition of the early or late phase
decrease in forced expiratory volume in one second (FEV1), nor a reduction in sputum
eosinophils. These studies suggest that either TLR9 based therapies will not be effective in
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human subjects with asthma, or that different doses, routes of administration (i.e. systemic vs
local), or different study populations (symptomatic asthmatics as opposed to allergen
challenged asymptomatic asthmatics) need to be evaluated.

In addition to TLR9 agonists, studies predominantly in mouse models have also evaluated the
ability of TLR4 and TLR7/8 based therapies to modulate allergic responses. In mouse models
of asthma TLR4 ligands either inhibit or potentiate allergic responses depending upon the
timing of administration of the TLR4 ligand and associated allergen sensitization or challenge.
In human studies in ragweed allergic rhinitis subjects, administration of a topical intranasal
TLR4 ligand was safe but did not inhibit allergic responses in asymptomatic subjects
challenged intranasally with ragweed allergen.45 Studies have also investigated whether
administration of a TLR7/8 agonist imiquimod would inhibit asthma responses in pre-clinical
models. Imiquimod is an FDA-approved therapy which is used as a topical treatment for genital
warts, actinic keratoses, and superficial basal cell cancer. In pre-clinical mouse models the
TLR7/8 agonist inhibits asthma responses. At present no human studies in allergy or asthma
have been reported with the TLR 7/8 agonist.

2. TLR-BASED VACCINE ADJUVANTS IN ALLERGIC DISEASE

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Studies have also examined whether administering a TLR9 agonist conjugated to an allergen
would enhance the immunogenicity of the allergen when used as a TLR9 conjugated allergen
vaccine in allergic rhinitis or asthma. Studies in mouse models have demonstrated that a
conjugate of a TLR9 agonist and an allergen had a 100-fold enhanced uptake by antigen
presenting cells compared to TLR9 ligand alone.41, 46 The ability of a TLR9 ligand to induce
a Th1 immune response is also approximately 100 fold greater than that induced by equivalent
amounts of a non-conjugated mixture of the TLR9 ligand and allergen. In mouse models, the
TLR9 allergen conjugate significantly reduces rhinitis and asthma responses.41

Thus, based on this enhanced immunogenicity of the TLR9 allergen conjugate, studies have
examined whether a TLR9 ragweed allergen conjugate would reduce allergic responses in
human subjects with allergic rhinitis. Studies in humans have demonstrated mixed results in
terms of the effectiveness of the TLR9 ragweed allergen vaccine. Studies in ragweed allergic
rhinitis subjects in Canada demonstrated that administration of the TLR9 ragweed allergen
vaccine reduced nasal mucosal biopsy eosinophil counts and Th2 cytokines, but did not reduce
nasal symptom scores during the ragweed season.47 A second study in Baltimore demonstrated
that administration of the same TLR9 ragweed allergen vaccine significantly reduced rhinitis
symptom scores in subjects with ragweed induced allergic rhinitis during the ragweed season.
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48 Subjects treated with the TLR9 ragweed allergy vaccine also used fewer doses of allergy
rescue medications during the ragweed season compared to placebo treated subjects.
Interestingly, although the study subjects immunized with the TLR9 ragweed vaccine only
received six injections of the vaccine prior to the first ragweed season, the beneficial reduction
in symptoms persisted through the second ragweed season without administration of additional
vaccine.

At present there are limited numbers of published human studies with either administration of
TLRs alone or with TLRs conjugated to allergens. Further studies are thus needed to determine
whether the interesting observations regarding TLRs in pre-clinical models will, or will not,
translate into safe and effective therapeutic advances in allergy and asthma. Potential safety
concerns of TLR based therapies in allergy and asthma include the induction of autoimmune
disease. However, induction of autoimmune disease has not been observed in the limited
number of clinical trials with TLR-9 based therapies.

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3. TLR-BASED VACCINE ADJUVANTS IN INFECTIOUS DISEASE

Vaccination has proved extremely effective in preventing infectious diseases, but knowledge
of the immunological mechanisms that allow vaccines to be so successful is rather limited. In
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contrast to live vaccines, subunit vaccines which consist of specific components of pathogens
have little inherent immunogenicity and need to be supplemented with adjuvants to promote
a protective immune response. However, there is a paucity of licensed adjuvants for clinical
use and, thus, there is a critical need to develop safe and effective adjuvants. The renaissance
in innate immune biology is facilitating the rational design of novel vaccine adjuvants.49
Characterization of the NLR system has shed light on the mechanism of action of alum
adjuvancy, while our understanding of TLR function is accelerating the discovery of safe and
effective vaccine adjuvants.

An illustrative example is development of the novel adjuvant, monophosphoryl lipid A (MPL).

50 The TLR4 ligand LPS is a potent adjuvant, but its toxicity prevents use in humans. However,
MPL comes from the cell wall LPS of Gram-negative Salmonella minnesota R595 and is
detoxified by mild hydrolytic treatment and purification. MPL lacks the toxicity of LPS but
retains the beneficial adjuvant properties. MPL combined with aluminum salt (referred to as
the AS04 adjuvant system) shows efficacy in a vaccine against human papilloma virus51, and
as a hepatitis B vaccine for patients with advanced renal disease.52 Interestingly, this adjuvant
combination likely benefits from the immune enhancing capacity of both the TLR pathway
(triggered by MPL) and the NALP3 inflammasome (triggered by alum crystals). Further
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advances in this area are almost certain as many other TLR ligands are being developed as
potential vaccine adjuvants.

CONCLUSIONS
In the last decade we have witnessed exhilarating advances in our understanding of the
molecular mechanisms used by the innate immune system to sense infection and trigger a
protective immune response. For clinicians and scientists alike, the challenge is to now translate
this basic mechanistic understanding into a more complete appreciation of the role of innate
immunity in health and disease.

ABBREVIATIONS
CINCA Chronic infantile neurological, cutaneous, and articular syndrome
DAMP Damage-associated molecular pattern
HMGB-1 High mobility group box 1
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HSP Heat-shock protein

IPAF ICE protease-activating factor
IRAK4 Interleukin-1 receptor associated kinase 4
KIR Killer-cell immunoglobulin-like receptors
LBP LPS binding protein
LPS Lipopolysaccharide
LRR Leucine-rich repeat
MAL MyD88 adapter-like
MBL Mannose-binding lectin
MDP Muramyl dipeptide

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MPL Monophosphoryl lipid A

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MyD88 Myeloid differentiation primary response gene 88

NLR nucleotide oligomerization domain (NOD)-like receptors
NOMID Neonatal-onset multisystem inflammatory disease
PAMP Pathogen-associated molecular pattern
PRR Pattern recognition receptor
RAGE Receptor of advance glycation end product
SNP Single nucleotide polymorphism
TIR Toll/interleukin-1 receptor-like domain
TIRAP Toll-interleukin 1 receptor (TIR) domain-containing adaptor protein
TLR Toll-like receptor

Acknowledgments
We wish to acknowledge members of the UBC Center for Understanding and Preventing Infections in Children for
constructive input and Rachel Victor for creating our high quality figures. SET is supported by a Chaim Roifman
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Scholar Award from the Canadian Immunodeficiency Society and a Career Development Award from the Canadian
Child Health Clinician Scientist Program (CCHCSP)-a CIHR Strategic Training Program, and operating grants from
the Canadian Cystic Fibrosis Foundation and the CIHR Team in Mutagenesis and Infectious Diseases.

REFERENCES
1. Janeway CA Jr, Medzhitov R. Innate immune recognition. Annu Rev Immunol 2002;20:197–216.
[PubMed: 11861602]
2. Pancer Z, Cooper MD. The evolution of adaptive immunity. Annu Rev Immunol 2006;24:497–518.
[PubMed: 16551257]
3. Dempsey PW, Allison ME, Akkaraju S, Goodnow CC, Fearon DT. C3d of complement as a molecular
adjuvant: bridging innate and acquired immunity. Science 1996;271:348–350. [PubMed: 8553069]
4. Kabelitz D. Expression and function of Toll-like receptors in T lymphocytes. Curr Opin Immunol
2007;19:39–45. [PubMed: 17129718]
5. Beutler B. Innate immunity: an overview. Mol Immunol 2004;40:845–859. [PubMed: 14698223]
6. Janeway CA Jr. Approaching the asymptote? Evolution and revolution in immunology. Cold Spring
Harb Symp Quant Biol 1989;54(Pt 1):1–13. [PubMed: 2700931]
7. Bianchi ME. DAMPs, PAMPs and alarmins: all we need to know about danger. J Leukoc Biol
NIH-PA Author Manuscript

2007;81:1–5. [PubMed: 17032697]

8. Joncker NT, Raulet DH. Regulation of NK cell responsiveness to achieve self-tolerance and maximal
responses to diseased target cells. Immunol Rev 2008;224:85–97. [PubMed: 18759922]
9. Lemaitre B, Nicolas E, Michaut L, Reichhart JM, Hoffmann JA. The dorsoventral regulatory gene
cassette spatzle/Toll/cactus controls the potent antifungal response in Drosophila adults. Cell
1996;86:973–983. [PubMed: 8808632]
10. Takeda K, Kaisho T, Akira S. Toll-like receptors. Annu Rev Immunol 2003;21:335–376. [PubMed:
12524386]
11. Akira S, Takeda K. Toll-like receptor signalling. Nat Rev Immunol 2004;4:499–511. [PubMed:
15229469]
12. Ho J, Li Y, Hirschfeld AF, Mansouri D, Turvey SE. Advances in Innate Immunity: The Role of Toll-
Like Receptor Signaling in Human Disease. Journal of Respiratory Disease, Thoracic Surgery,
Intensive Care, and Tuberculosis 2004;3:7–14.

J Allergy Clin Immunol. Author manuscript; available in PMC 2011 February 1.

 Turvey and Broide Page 12

13. Turvey SE, Hawn TR. Towards subtlety: understanding the role of Toll-like receptor signaling in
susceptibility to human infections. Clin Immunol 2006;120:1–9. [PubMed: 16563867]
14. Picard C, Puel A, Bonnet M, Ku CL, Bustamante J, Yang K, et al. Pyogenic bacterial infections in
NIH-PA Author Manuscript

humans with IRAK-4 deficiency. Science 2003;299:2076–2079. [PubMed: 12637671]

15. von Bernuth H, Picard C, Jin Z, Pankla R, Xiao H, Ku CL, et al. Pyogenic bacterial infections in
humans with MyD88 deficiency. Science 2008;321:691–696. [PubMed: 18669862]
16. Yang K, Puel A, Zhang S, Eidenschenk C, Ku CL, Casrouge A, et al. Human TLR-7-, -8-, and -9-
Mediated Induction of IFN-alpha/beta and -lambda Is IRAK-4 Dependent and Redundant for
Protective Immunity to Viruses. Immunity 2005;23:465–478. [PubMed: 16286015]
17. Notarangelo L, Casanova JL, Fischer A, Puck J, Rosen F, Seger R, et al. Primary immunodeficiency
diseases: an update. J Allergy Clin Immunol 2004;114:677–687. [PubMed: 15356576]
18. Goldstein DB, Cavalleri GL. Genomics: understanding human diversity. Nature 2005;437:1241–
1242. [PubMed: 16251937]
19. Hawn TR, Verbon A, Lettinga KD, Zhao LP, Li SS, Laws RJ, et al. A common dominant TLR5 stop
codon polymorphism abolishes flagellin signaling and is associated with susceptibility to
legionnaires' disease. J Exp Med 2003;198:1563–1572. [PubMed: 14623910]
20. Khor CC, Chapman SJ, Vannberg FO, Dunne A, Murphy C, Ling EY, et al. A Mal functional variant
is associated with protection against invasive pneumococcal disease, bacteremia, malaria and
tuberculosis. Nat Genet 2007;39:523–528. [PubMed: 17322885]
21. Martinez FD. CD14, endotoxin, and asthma risk: actions and interactions. Proc Am Thorac Soc
2007;4:221–225. [PubMed: 17607003]
NIH-PA Author Manuscript

22. Simpson A, John SL, Jury F, Niven R, Woodcock A, Ollier WE, et al. Endotoxin exposure, CD14,
and allergic disease: an interaction between genes and the environment. Am J Respir Crit Care Med
2006;174:386–392. [PubMed: 16614348]
23. Nejentsev S, Thye T, Szeszko JS, Stevens H, Balabanova Y, Chinbuah AM, et al. Analysis of
association of the TIRAP (MAL) S180L variant and tuberculosis in three populations. Nat Genet
2008;40:261–262. author reply 2–3. [PubMed: 18305471]
24. Chen G, Shaw MH, Kim Y-G, Nuñez G. NOD-Like Receptors: Role in Innate Immunity and
Inflammatory Disease. Annual Review of Pathology: Mechanisms of Disease 2009;4:365–398.
25. Benko S, Philpott DJ, Girardin SE. The microbial and danger signals that activate Nod-like receptors.
Cytokine 2008;43:368–373. [PubMed: 18715799]
26. Martinon F, Mayor A, Tschopp. The Inflammasomes: Guardians of the Body. Annual Review of
Immunology 2009;27:229–265.
27. Ting JPY, Lovering RC, Alnemri ES, Bertin J, Boss JM, Davis BK, et al. The NLR Gene Family: A
Standard Nomenclature. Immunity 2008;28:285–287. [PubMed: 18341998]
28. Miao EA, Andersen-Nissen E, Warren SE, Aderem A. TLR5 and Ipaf: dual sensors of bacterial
flagellin in the innate immune system. Semin Immunopathol 2007;29:275–288. [PubMed: 17690885]
29. Franchi L, Eigenbrod T, Munoz-Planillo R, Nunez G. The inflammasome: a caspase-1-activation
platform that regulates immune responses and disease pathogenesis. Nat Immunol 2009;10:241–247.
NIH-PA Author Manuscript

[PubMed: 19221555]
30. Masters SL, Simon A, Aksentijevich I, Kastner DL. Horror autoinflammaticus: the molecular
pathophysiology of autoinflammatory disease (*). Annu Rev Immunol 2009;27:621–668. [PubMed:
19302049]
31. Aksentijevich I, Nowak M, Mallah M, Chae JJ, Watford WT, Hofmann SR, et al. De novo CIAS1
mutations, cytokine activation, and evidence for genetic heterogeneity in patients with neonatal-onset
multisystem inflammatory disease (NOMID): a new member of the expanding family of pyrin-
associated autoinflammatory diseases. Arthritis Rheum 2002;46:3340–3348. [PubMed: 12483741]
32. Hoffman HM, Rosengren S, Boyle DL, Cho JY, Nayar J, Mueller JL, et al. Prevention of cold-
associated acute inflammation in familial cold autoinflammatory syndrome by interleukin-1 receptor
antagonist. Lancet 2004;364:1779–1785. [PubMed: 15541451]
33. Goldbach-Mansky R, Dailey NJ, Canna SW, Gelabert A, Jones J, Rubin BI, et al. Neonatal-onset
multisystem inflammatory disease responsive to interleukin-1beta inhibition. N Engl J Med
2006;355:581–592. [PubMed: 16899778]

J Allergy Clin Immunol. Author manuscript; available in PMC 2011 February 1.

 Turvey and Broide Page 13

34. Hugot JP, Chamaillard M, Zouali H, Lesage S, Cezard JP, Belaiche J, et al. Association of NOD2
leucine-rich repeat variants with susceptibility to Crohn's disease. Nature 2001;411:599–603.
[PubMed: 11385576]
NIH-PA Author Manuscript

35. Ogura Y, Bonen DK, Inohara N, Nicolae DL, Chen FF, Ramos R, et al. A frameshift mutation in
NOD2 associated with susceptibility to Crohn's disease. Nature 2001;411:603–606. [PubMed:
11385577]
36. Noguchi E, Homma Y, Kang X, Netea MG, Ma X. A Crohn's disease-associated NOD2 mutation
suppresses transcription of human IL10 by inhibiting activity of the nuclear ribonucleoprotein
hnRNP-A1. Nat Immunol 2009;10:471–479. [PubMed: 19349988]
37. Strober W, Kitani A, Fuss I, Asano N, Watanabe T. The molecular basis of NOD2 susceptibility
mutations in Crohn's disease. Mucosal Immunol 2008;1:S5–S9. [PubMed: 19079230]
38. Franchi L, Nunez G. The Nlrp3 inflammasome is critical for aluminium hydroxide-mediated IL-1beta
secretion but dispensable for adjuvant activity. Eur J Immunol 2008;38:2085–2089. [PubMed:
18624356]
39. Li H, Willingham SB, Ting JP, Re F. Cutting edge: inflammasome activation by alum and alum's
adjuvant effect are mediated by NLRP3. J Immunol 2008;181:17–21. [PubMed: 18566365]
40. Eisenbarth SC, Colegio OR, O'Connor W, Sutterwala FS, Flavell RA. Crucial role for the Nalp3
inflammasome in the immunostimulatory properties of aluminium adjuvants. Nature
2008;453:1122–1126. [PubMed: 18496530]
41. Horner AA, Redecke V, Raz E. Toll-like receptor ligands: hygiene, atopy and therapeutic
implications. Curr Opin Allergy Clin Immunol 2004;4:555–561. [PubMed: 15640699]
NIH-PA Author Manuscript

42. Broide D, Schwarze J, Tighe H, Gifford T, Nguyen MD, Malek S, et al. Immunostimulatory DNA
sequences inhibit IL-5, eosinophilic inflammation, and airway hyperresponsiveness in mice. J
Immunol 1998;161:7054–7062. [PubMed: 9862743]
43. Fanucchi MV, Schelegle ES, Baker GL, Evans MJ, McDonald RJ, Gershwin LJ, et al.
Immunostimulatory oligonucleotides attenuate airways remodeling in allergic monkeys. Am J Respir
Crit Care Med 2004;170:1153–1157. [PubMed: 15306532]
44. Gauvreau GM, Hessel EM, Boulet LP, Coffman RL, O'Byrne PM. Immunostimulatory sequences
regulate interferon-inducible genes but not allergic airway responses. Am J Respir Crit Care Med
2006;174:15–20. [PubMed: 16574937]
45. Casale TB, Kessler J, Romero FA. Safety of the intranasal toll-like receptor 4 agonist CRX-675 in
allergic rhinitis. Ann Allergy Asthma Immunol 2006;97:454–456. [PubMed: 17069098]
46. Shirota H, Sano K, Hirasawa N, Terui T, Ohuchi K, Hattori T, et al. Novel roles of CpG
oligodeoxynucleotides as a leader for the sampling and presentation of CpG-tagged antigen by
dendritic cells. J Immunol 2001;167:66–74. [PubMed: 11418633]
47. Tulic MK, Fiset PO, Christodoulopoulos P, Vaillancourt P, Desrosiers M, Lavigne F, et al. Amb a 1-
immunostimulatory oligodeoxynucleotide conjugate immunotherapy decreases the nasal
inflammatory response. J Allergy Clin Immunol 2004;113:235–241. [PubMed: 14767435]
48. Creticos PS, Schroeder JT, Hamilton RG, Balcer-Whaley SL, Khattignavong AP, Lindblad R, et al.
Immunotherapy with a ragweed-toll-like receptor 9 agonist vaccine for allergic rhinitis. N Engl J
NIH-PA Author Manuscript

Med 2006;355:1445–1455. [PubMed: 17021320]

49. Pulendran B, Ahmed R. Translating innate immunity into immunological memory: implications for
vaccine development. Cell 2006;124:849–863. [PubMed: 16497593]
50. Casella CR, Mitchell TC. Putting endotoxin to work for us: monophosphoryl lipid A as a safe and
effective vaccine adjuvant. Cell Mol Life Sci 2008;65:3231–3240. [PubMed: 18668203]
51. Schwarz TF. AS04-adjuvanted human papillomavirus-16/18 vaccination: recent advances in cervical
cancer prevention. Expert Rev Vaccines 2008;7:1465–1473. [PubMed: 19053203]
52. Kong NCT, Beran J, Kee SA, Miguel JL, Sanchez C, Bayas JM, et al. A new adjuvant improves the
immune response to hepatitis B vaccine in hemodialysis patients. Kidney Int 2007;73:856–862.
[PubMed: 18160963]

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Figure 1. Integrated Human Immune System

The human microbial defense system can be simplistically viewed as consisting of three levels:
(i) anatomical and physiological barriers; (ii) innate immunity; and (iii) adaptive immunity. In
common with many classification systems, some elements are difficult to categorize. For
example, NKT cells and DCs could be classified as being on the cusp of innate and adaptive
immunity rather than being firmly in one camp.
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Figure 2. Overview of TLR Signaling and the NLRP3 Inflammasome

TLR ligation initiates a signaling cascade that culminates in the translocation of the
transcription factors, NF-κB and others, to the nucleus generating an acute inflammatory
response. The NLRP3 (or NALP3) inflammasome is triggered by a wide variety of stimuli
culminating in the activation of caspase 1 which will then cleave pro-IL1β and pro-IL18 to
drive an inflammatory response. Human mutations and polymorphisms in many of the genes
encoding elements of these pathways appear to alter susceptibility to infectious and
inflammatory diseases.

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Table 1
Overview of Defining Features of Innate and Adaptive Immunity
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Comparing and contrasting some of the defining features of the innate and adaptive immune systems. Adapted
from [1].

Innate Immune System Adaptive Immune System

Cellular elements Hematopoietic cells: macrophages, Hematopoietic cells: T & B

dendritic cells, mast cells, neutrophils, lymphocytes.
eosinophils, natural killer cells & natural
killer T cells.
Non-hematopoietic cells: epithelial cells
(e.g. skin, airways, gastrointestinal tract).

Humoral elements Large arsenal of components: Complement Immunoglobulins secreted by B

proteins, LPS binding protein, C-reactive cells.
protein and other acute phase reactants,
anti-microbial peptides, mannose-binding
lectin.

Receptor characteristics Invariant, germline encoded. Generated by random somatic

gene-segment rearrangement.
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All cells of a class express identical All cells of a class express a single
receptors (i.e. non-clonal). type of receptor with unique
specificity (i.e. clonal).

Ligands recognized Conserved microbial components. Specific ‘details’ or epitopes of

macromolecules (e.g. proteins,
Common metabolic or biological peptides, carbohydrates).
consequences of infection (e.g. uric acid,
K+ efflux, MHC class I downregulaton).

Types of receptors Activating: TLR, NLR, complement. B cell receptor and T cell receptor.
Inhibitory: Killer cell immunoglobulin-like
receptors (KIR).

Response time Immediate Delayed by hours to days.

Immunological memory None. Responses are the same with each Responsiveness enhanced by
exposure. Non-anticipatory immunity repeated antigen exposure.
Anticipatory immunity.
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Risk of autoreactivity Low. Self-tolerant receptors selected High. Random gene

during evolution rearrangement generates
autoreactive receptors requiring
presence of multiple tolerance
mechanisms.

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Table 2
Common Innate Immune Recognition Strategies
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Innate Immune Receptor Families Specific examples

Recognition
Strategy

Receptor Ligand

1. Detecting Toll-like receptors TLR4 Lipopolysaccharide

‘microbial non-
self’ TLR5 Flagellin (extracellular)
(i.e. pathogen-
associated
molecular NOD-like receptors NOD2 Muramyl dipeptide
patterns
(PAMPs)) IPAF Flagellin (intracellular)

Collectin family MBP Microbial terminal

mannose residues

2. Detecting NOD-like receptors NLRP3 (or NALP3) Uric acid, K+ efflux,

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common ATP
metabolic
consequences
of cell infection
or injury RAGE (receptor of advance glycation end RAGE HMGB1, S100
(i.e. damage- product) family
associated
molecular
patterns
(DAMPs))

3. Detecting MHC-class-I-specific inhibitory receptors KIR Self MHC class I

‘missing self’ (inhibitory signal)
CD94-NKG2A Self MHC class I
heterodimers (inhibitory signal)
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