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(American Journal of Pathology. 2003;162:1629-1638.)
© 2003 American Society for Investigative Pathology

Preferential Expansion of V{gamma}9-J{gamma}P/V{delta}2-J{delta}3 {gamma}{delta} T Cells in Nasal T-Cell Lymphoma and Chronic Active Epstein-Barr Virus Infection

Michiko K. Oyoshi*, Hiroshi Nagata*{dagger}, Nobuhiro Kimura{ddagger}, Yu Zhang*, Ayako Demachi*, Toshiro Hara§, Hirokazu Kanegane, Yoshinobu Matsuo||, Tomohiro Yamaguchi*, Tomohiro Morio**, Atsuyoshi Hirano{dagger}{dagger}, Norio Shimizu* and Kohtaro Yamamoto*

From the Department of Virology,* Division of Medical Science, Medical Research Institute, and the Department of General Medicine,** School of Medicine, Tokyo Medical and Dental University, Tokyo; the Department of Otorhinolaryngology,{dagger} Sannoh Hospital, Chiba; the First Department of Internal Medicine,{ddagger} School of Medicine, Fukuoka University, Fukuoka; the Department of Pediatrics,§ Graduate School of Medical Sciences, Kyushu University, Fukuoka; the Department of Pediatrics, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Toyama; the Fujisaki Cell Center,|| Hayashibara Biochemical Laboratories, Okayama; and the Department of Gastroenterology and Hepatology,{dagger}{dagger} School of Medicine, Yamaguchi University, Yamaguchi, Japan


   Abstract
Top
 Abstract
Materials and Methods
 Results
 Discussion
 References
 
We recently established an Epstein-Barr virus (EBV)-positive {gamma}{delta} T-cell line from a nasal T/natural killer (NK)-cell lymphoma (Nagata H, Konno A, Kimura N, Zhang Y, Kimura M, Demachi A, Sekine T, Yamamoto K, Shimizu N: Characterization of novel natural killer (NK)-cell and {gamma}{delta} T-cell lines established from primary lesions of nasal T/NK-cell lymphomas associated with the Epstein-Barr virus. Blood 2001, 97:708–713). Subsequently, we established two novel EBV-positive {gamma}{delta} T-cell lines from the peripheral blood of patients with chronic active EBV infection. Analysis of the terminal repeat of EBV showed that the three cell lines consisted of monoclonal populations, and flow cytometry showed that they had a common phenotype of {gamma}{delta} T cells: CD3+ CD4- CD8- CD16- CD19- CD56+ CD57- HLA-DR+ T-cell receptor (TCR) {alpha}ß- TCR {gamma}{delta}+. Analysis for the expression of TCR by flow cytometry showed that all three cell lines were V{gamma}9+/V{delta}2+, but negative for V{gamma}I, V{delta}1, or V{delta}3 TCR. Southern blot analysis for TCR genes showed that the three cell lines had a common rearrangement of V{gamma}9-J{gamma}P and J{delta}3 genes. Polymerase chain reaction and sequence analysis of the junction between V{delta} and J{delta} genes revealed that the J{delta}3 genes were rearranged with the V{delta}2 genes. In contrast, none of the EBV-negative {gamma}{delta} T-cell lines, Molt-14, Peer, or Loucy, which were analyzed for controls, had V{gamma}9 or V{delta}2 TCR, or a rearrangement of J{delta}3 genes. These results indicated that V{gamma}9-J{gamma}P/V{delta}2-J{delta}3+ {gamma}{delta} T cells were preferentially affected by EBV and expanded in patients with nasal {gamma}{delta} T-cell lymphoma and chronic active EBV infection. J{delta}3+ {gamma}{delta} T cells are known to be a very minor population in {gamma}{delta} T cells of peripheral blood, whereas V{gamma}9-J{gamma}P/V{delta}2-J{delta}1+ cells are the major population. The close association of EBV with this particular {gamma}{delta} T-cell population may provide a key to the etiology of EBV-positive lymphoproliferative diseases.

{gamma}{delta} T cells comprise only a small proportion (1 to 5%) of the lymphocytes in the peripheral blood and organs, but are far more widespread within epithelial-rich tissues such as the skin, gut, and reproductive tract, where they comprise up to 50% of T cells.1 Postthymic peripheral T-cell lymphomas of the {gamma}{delta} T-cell subset are rare, and most present as hepatosplenic {gamma}{delta} T-cell lymphomas.2,3 Otherwise, they arise in the skin, nose, larynx, lung, or gastrointestinal tract.4 They are believed to include some different disease entities based on their clinical and morphological features. Hepatosplenic {gamma}{delta} T-cell lymphomas show a specific sinusoidal localization of malignant cells in the spleen, liver, and bone marrow. Other nonhepatosplenic {gamma}{delta} T-cell lymphomas appear to be regarded as activated cytotoxic lymphomas arising in the mucosae and skin. Among these, nasal {gamma}{delta} T-cell lymphomas in particular show a strong association with Epstein-Barr virus (EBV), and together with natural killer (NK)-cell lymphomas, constitute the distinct disease category nasal T/NK-cell lymphoma.4-7

The relationship between EBV and peripheral T/NK-cell neoplasms has been studied intensely since 1988, when Kikuta and associates8 detected EBV in T lymphocytes in a boy with chronic active EBV infection (CAEBV), and Jones and colleagues9 identified EBV in T-cell lymphomas arising in patients with CAEBV. As a result, it is now recognized that nasal T/NK-cell lymphoma has the strongest association with EBV among various kinds of peripheral T/NK-cell lymphomas.2,3,10 However, studies on this disease have been limited because of the rarity of the disease and the tendency of the tumor to cause necrosis. To investigate this disease, we recently established two EBV-positive NK- and {gamma}{delta} T-cell lines, SNK-6 and SNT-8, from independent patients with nasal T/NK-cell lymphomas, showing that there are at least two phenotypes in this tumor, NK and {gamma}{delta} T cells.7

Another important lymphoproliferative disease inevitably associated with EBV is CAEBV. In most CAEBV cases, the T and NK cells become positive for EBV,8,9,11-25 and such EBV-positive T or NK cells showed monoclonal or oligoclonal expansion in many cases.11,12,17,19,20,24,25 In addition, in some severe CAEBV cases, the establishment of cell lines of T- and NK-cell lineage has been reported,16,21 suggesting that the clonal expansion of T/NK cells in CAEBV is in part because of an acquired great proliferative capacity brought by EBV. In an effort to understand the role of EBV in lymphoproliferative diseases of T/NK-cell lineage, we have been trying to establish cell lines from patients with CAEBV. Fortunately, we have to date successfully established six EBV-positive cell lines from the peripheral blood of patients with CAEBV. These include two NK–cell lines, two {alpha}ß T-cell lines, and two {gamma}{delta} T-cell lines.

In the present study, to clarify the role of EBV in the lymphoproliferative diseases of {gamma}{delta} T cells, we determined to analyze and compare the three EBV-positive {gamma}{delta} T-cell lines established. One was the previously reported SNT-8, and the other two were newly established lines from patients with CAEBV, SNT-13 and SNT-15. We aimed to analyze the phenotypes of the cell surface markers, the expression of T-cell receptors (TCRs) and the rearrangement of TCR genes in the cell lines. In addition, EBV-negative {gamma}{delta} T-cell lines, Molt-14, Peer, and Loucy were used for controls. We determined that V{gamma}9-J{gamma}P/V{delta}2-J{delta}3 TCR was commonly expressed in the three EBV-positive cell lines, but was not observed in the EBV-negative cell lines. The present study suggests that EBV probably affects {gamma}{delta} T cells expressing specific TCR to develop lymphoproliferative diseases.


   Materials and Methods
Top
 Abstract
 Materials and Methods
Results
 Discussion
 References
 
Patients and Cell Lines

Three cell lines, designated as SNT-8, SNT-13, and SNT-15, established from patients with nasal T-cell lymphoma or CAEBV were used in this study. The clinical features of the patients are summarized in Table 1 . SNT-8 is a {gamma}{delta} T-cell line established from the primary lesion of a nasal T-cell lymphoma. Some of the characteristics of the cell line, as well as the case history, have been reported previously.7 The other two cell lines were newly established from the peripheral blood of two unrelated patients with CAEBV. Both patients suffered from chronic mononucleosis-like symptoms, but showed no immunological abnormality or infection other than EBV infection; patient 2 had repeated fever and aphthae, and patient 3 had hepatosplenomegaly. They showed elevated titers for IgG to the Epstein-Barr viral capsid antigen (VCA-IgG) and diffuse and restricted components of early antigens (EA-DR IgG). They were thus diagnosed as having CAEBV in accordance with the criteria described by Straus.26 They had increased {gamma}{delta} T-cell numbers among peripheral blood lymphocytes, and their peripheral blood was strongly positive for the EBV genome by polymerase chain reaction (PCR).


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  		Table 1. Clinical Profile of Patients

 
For controls, three EBV-negative {gamma}{delta} T-cell lines, Molt-14, Peer, and Loucy, were analyzed in parallel. Molt-14 and Peer were obtained from Fujisaki Cell Center (Hayashibara Biochemical Laboratories, Inc., Okayama, Japan), and Loucy was kindly provided by Dr. Hannah Ben-Bassat (Hadassah University Hospital, Jerusalem, Israel). The origin of these EBV-negative cell lines has been described elsewhere.27-29

Establishment of EBV-Positive {gamma}{delta} T-Cell Lines

The method used for establishing SNT-8 was described in our previous report.7 Essentially the same method was used for the establishment of the SNT-13 and SNT-15 cell lines. Briefly, peripheral blood mononuclear cells were isolated from 10 ml of peripheral blood of the patients with CAEBV by the Ficoll-Hypaque method, and suspended in a 10-ml RPMI 1640 medium supplemented with 10% heat-inactivated human serum and 700 U/ml of interleukin (IL)-2. Then, CD4+ and CD8+ lymphocytes were removed using anti-CD4 and anti-CD8 monoclonal antibody-conjugated magnetic beads (Dynal, Oslo, Norway). The remaining CD4- CD8- cell fraction was seeded in a 96-well plate at 1 x 104 cells/well and cultured in a humidified atmosphere at 37°C with 5% CO2. Two days later, rapid cell growth was observed in all wells of the plate. After 1 week of culture, the growing cells were collected together. These cultured cells have been maintained in the presence of IL-2 for more than 40 months and 34 months, respectively, and were designated SNT-13 and SNT-15.

Flow Cytometric Analysis

The cell lines were analyzed by two-color immunofluorescence with a flow cytometer (EPICS XL; Beckman Coulter, Hialeah, FL) for the expression of surface markers. The following antibodies conjugated with fluorescein isothiocyanate or phycoerythrin (Becton Dickinson, San Jose, CA) were used: anti-CD3, -CD4, -CD8, -CD16, -CD19, -CD21, -CD56, -CD57, -HLA-DR, -TCR {alpha}/ß, and -TCR {gamma}/{delta}.

Flow cytometry was also performed to analyze variable regions of {gamma}{delta} TCR expressed on the cells. Antibodies used were anti-V{gamma}I and anti-V{delta}1 monoclonal antibodies (Beckman Coulter), which required secondary antibodies to be detected: F(ab')2 goat anti-mouse IgG conjugated with fluorescein isothiocyanate was used. Other antibodies used were fluorescein isothiocyanate-labeled anti-V{gamma}9, anti-V{delta}2, and anti-V{delta}3 monoclonal antibodies (Beckman Coulter).

Assessment of the Number of EBV Terminal Repeats

To determine the clonality of the EBV-positive cell lines, the number of EBV terminal repeats (EBV-TR) was assessed by Southern blot analysis. DNA extracted from the cell lines was digested with BamHI, separated on a 0.7% agarose gel, and transferred to a nylon membrane. A 1.9-kb XhoI subfragment of BamHI-Dhet derived from EBV termini was used as a probe for EBV-TR DNA.30 Hybridization was visualized using a Fluorescein Gene Images System (Amersham, Buckinghamshire, UK) according to the manufacturer’s instructions. Raji and B95-8 cells were used as controls for monoclonal cell expansion with a single EBV-TR and polyclonal cell proliferation with EBV replication, respectively.

Southern Blot Analysis for TCR and Immunoglobulin Genes

The cell lines were analyzed for rearrangements of the TCR ß-, {gamma}-, and {delta}-chain and the immunoglobulin heavy-chain genes by Southern blotting. Three µg of DNA extracted from each of the cell lines was digested with a restriction endonuclease BamHI, EcoRI, HindIII, or KpnI (Takara, Kyoto, Japan), electrophoresed through a 0.7% agarose gel, and transferred onto a nylon membrane. Human placental DNA was used as a germline control. The membrane was exposed to a fluorescein-labeled Cß1, J{gamma}1, J{delta}1, or J{delta}3 probe for the TCR genes, or a JH probe for the immunoglobulin heavy-chain gene.31-35 The J{gamma}1 probe, a 700-bp HindIII-EcoRI fragment, includes the J{gamma}1 segment and cross-hybridizes with J{gamma}2 but not with the additional J{gamma} segments. The J{delta}1 probe consists of a 1-kb PstI-EcoRI segment. The J{delta}3 probe was a 1.5-kb XbaI genomic fragment of the J{delta}3 region. The organization of the human TCR{gamma} and TCR{delta} loci is shown in Figure 1 . Hybridization was visualized by the same methods used for the Southern blot analysis of the EBV-TR.



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  		Figure 1. Schematic organization of the human TCR{delta} and TCR{gamma} loci. The TCR{delta} locus is located entirely within the TCR{alpha} locus between the TCRV{alpha} and the TCRJ{alpha} gene segments. TCRV{gamma} genes are divided into four subfamilies (I to IV) based on sequence similarity. Each V{gamma} gene is assigned to its subgroup as indicated. The solid boxes are gene segments used in SNT cell lines.

 
PCR Analysis for Combinations of V{delta} and J{delta} Genes

To define V{delta}-J{delta} gene rearrangements in the cell lines, PCR analysis of the V{delta}1, V{delta}2, or V{delta}3 gene and the J{delta}1 or J{delta}3 gene was performed. The sequences of primers used are listed in Table 2 .


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  		Table 2. Primers for PCR Analysis of TCR Rearrangement

 
Fifty ng of DNA extracted from each cell line was amplified with a pair of each combination of L-V{delta}1, L-V{delta}2, or L-V{delta}3 and 3'-J{delta}1 or J{delta}3 primers. The PCR was performed with reagents composed of 500 nmol/L of primers, 200 µmol/L of dNTPs, 20 mmol/L of Tris-HCl, 1.2 mmol/L of MgCl2, and 2.5 U of TaqDNA polymerase (Takara) in a 100-µl reaction solution. The program was 94°C for 1 minute, 55°C for 1 minute, and 72°C for 1 minute for 40 cycles. The products were analyzed by electrophoresis on a 2% agarose gel after staining with ethidium bromide.

Reverse Transcriptase (RT)-PCR and Direct Sequencing for Junction of V{delta}-J{delta} Genes

Total RNA was extracted from each of the cell lines using TRIzol reagent (Life Technologies, Inc., Gaithersburg, MD), and 0.5 µg was reverse-transcribed into cDNA using a Thermoscript RT-PCR System (Life Technologies, Inc.). An oligo(dT)20 primer was used for the generation of cDNAs. After incubation at 60°C for 60 minutes, the samples were heated for 5 minutes at 85°C to terminate the reactions. PCR amplification of TCR {delta}-chain cDNA was accomplished by use of a C{delta} anti-sense primer in combination with a V{delta}2 sense primer. A human ß-actin primer pair was obtained from Takara. The PCR cycling conditions were 94°C for 1 minute, 60°C for 1 minute, and 72°C for 1 minute for 40 cycles. Amplified products were identified by 2% agarose gel electrophoresis followed by staining with ethidium bromide. Amplification products were purified using the QIAquick PCR purification kit (Qiagen, Hilden, Germany), and direct sequencing was performed using a BigDye Terminator Reaction kit version 2.0 and an ABI PRISM 377 genetic analyzer (Applied Biosystems, Foster City, CA), according to the manufacturer’s protocols.


   Results
Top
 Abstract
 Materials and Methods
 Results
Discussion
 References
 
Phenotypes and Clonality of the Cell Lines

Flow cytometry showed that the SNT-8, SNT-13, and SNT-15 cells had an identical phenotype: CD3+ CD4- CD8- CD16- CD19- CD21- CD56+ CD57- HLA-DR+ TCR {alpha}/ß- TCR {gamma}/{delta}+ (Table 3) . Although they were positive for the NK-cell marker CD56, the expression of CD3 and {gamma}{delta} TCR indicated that they were derived from {gamma}{delta} T cells and distinct from NK-cell lines. We previously reported phenotypes of two NK-cell lines SNK-1 and SNK-6 as CD3- CD4- CD8- CD19- CD25+ CD56+ CD57- TCR {alpha}/ß- TCR {gamma}/{delta}-.7,25


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  		Table 3. Immunophenotype of SNT Cells

 
Because the established EBV-positive cell lines proved to be of the {gamma}{delta} T-cell subset, we analyzed the expression of variable regions of {gamma}{delta} TCR by flow cytometry. We found the three EBV-positive cell lines to be positive for the anti-V{gamma}9 and anti-V{delta}2 antibodies and negative for the anti-V{gamma}I, anti-V{delta}1, and anti-V{delta}3 antibodies (Table 4) . By contrast, the EBV-negative cell lines Molt-14, Peer, and Loucy were negative for the anti-V{delta}2 antibodies, and the former two were negative for the anti-V{gamma}9 antibody as well; the last cell line weakly reacted with the anti-V{gamma}9 antibody (Table 4) .


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  		Table 4. Expression of TCR-V{gamma} and -V{delta} Proteins by {gamma}{delta} T-Cell Lines

 
Regarding the clonality of the EBV-positive cell lines, the Southern blot analysis for the number of EBV-TR showed a single band in each of the SNT-8, SNT-13, and SNT-15 cells (Figure 2) . The results indicated that these cell lines consisted of respective monoclonal cell populations and were V{gamma}9/V{delta}2+ {gamma}{delta} T cells. In addition, we previously reported that the clonality of SNT-8 was identical to that of the original tumor.7 As to SNT-13, we could confirm that the clonality was the same as that detected in the peripheral blood mononuclear cells of the patient (data not shown).



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  		Figure 2. Clonality of cells assessed using EBV terminal repeats. Southern blot analysis of the number of EBV-TRs as evidence for monoclonal expansion of EBV-positive cells in SNT cell lines. Lane 1, SNT-8; lane 2, SNT-13, and lane 3, SNT-15 cells. B95-8 cells (B) and Raji cells (R) were used as controls for cells with productive EBV expansion and monoclonal EBV replication, respectively.

 
Southern Blot Analysis for TCR and Immunoglobulin Genes

TCR {gamma}-Chain Genes

Southern blot hybridization of the KpnI digests of DNA with the J{gamma}1 probe detected rearrangements of TCR {gamma}-chain genes in the three EBV-positive cell lines (Figure 3A) . The EBV-positive cell lines showed three bands in the KpnI digests, whereas the germline control showed two bands of 16 kb and 9 kb. The sizes of bands detected in the cell lines were as follows; 16 kb, 12 kb, and 4.7 kb in SNT-8; 16 kb, 12 kb, and 1.8 kb in SNT-13; 16 kb, 12 kb, and 8.5 kb in SNT-15. Thus, the three cell lines commonly showed 12-kb bands, which are known to be generated by rearrangement of the V{gamma}9 gene to the J{gamma}P gene. Rearranged genes were deduced from the sizes of KpnI digests, because it was reported that the V{gamma}9-J{gamma}P rearrangement frequently observed in rearranging {gamma}-loci can be detected with the KpnI digest, but the BamHI-rearranged bands are virtually the same size as the germline bands and the EcoRI and HindIII bands are in a germline configuration in this rearrangement for their restriction sites.36,37 The results, thus, showed that the three cell lines had the V{gamma}9-J{gamma}P rearrangement in one allele. Additionally, the other bands were supposed to be generated by the following rearrangement of the {gamma}-chain genes in the other alleles: the 4.7-kb band in SNT-8 was generated by rearrangement of the V{gamma}I or V{gamma}III gene to the J{gamma}P2 gene, the 1.8-kb band in SNT-13 was made by rearrangement of the V{gamma}I or V{gamma}III gene to the J{gamma}2 gene, and the 8.5-kb band in SNT-15 was derived from rearrangement of the V{gamma}I or V{gamma}III gene to the J{gamma}P1 gene. Although the three cell lines showed the rearrangement of {gamma}-chain genes in both alleles, it was suggested that the V{gamma}9-J{gamma}P chain was the expressed allele because flow cytometry showed that the three cell lines expressed V{gamma}9-encoded receptors.



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  		Figure 3. Southern blot analysis for TCR genes. Shown are the hybridizations with the J{gamma}1 probe (A), the J{delta}1 probe (B), and the J{delta}3 probe (C). Southern blot analysis shows rearrangement of the J{gamma}1, J{delta}1, and J{delta}3 genes in all SNT cell lines. Human placental DNA was used as a germline configuration (c); 8, SNT-8; 13, SNT-13; 15, SNT-15 cells.

 
The EBV-negative cell lines Molt-14, Peer, and Loucy were analyzed in the same manner, but none showed the 12-kb band in KpnI digests, a hallmark of the V{gamma}9-J{gamma}P rearrangement. Molt-14 showed rearrangements in both alleles: V{gamma}I or V{gamma}III to J{gamma}P1, and V{gamma}I or V{gamma}III to J{gamma}2. Peer and Loucy had the same rearrangement, V{gamma}9 to J{gamma}2 in one allele and V{gamma}I or V{gamma}III to J{gamma}2 in the other (data not shown). The results of the Southern blot analyses are summarized in Table 6 .


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  		Table 6. Summary of Analysis for {gamma}{delta} TCR

 
TCR {delta}-Chain Genes

Using the J{delta}1 probe, we detected no band in SNT-8 and a rearranged band in each digest of DNA of SNT-13 and SNT-15 (Figure 3B) . The sizes of the bands were 9.4 kb in the BamHI digest, 2.8 kb in the EcoRI digest, and 4.8 kb in the HindIII digest in SNT-13, and 19.5 kb in the BamHI digest, 6.9 kb in the EcoRI digest, and 7.1 kb in the HindIII digest in SNT-15. The deduced rearrangement was an incomplete rearrangement of D{delta}2-J{delta}1 in SNT-13 and V{delta}2-D{delta}3 in SNT-15.38,39 Therefore, a complete J{delta}1 rearrangement to be expressed was not detected in the three cell lines.

Hybridization with the J{delta}3 probe revealed that the three cell lines showed rearranged bands of an identical size in each of the BamHI, EcoRI, and HindIII digests (Figure 3C) . The results suggest that the three cell lines have a common rearrangement of J{delta}3 genes. Because of the lack of a precise map for restriction enzymes in this region, the Southern blot analysis could not determine how J{delta}3 genes were rearranged with V{delta} genes.

SNT-8 showed only rearranged bands in the BamHI, EcoRI, and HindIII digests, and these results suggested that SNT-8 had the rearrangement of J{delta}3 genes in both alleles, or the rearrangement of a J{delta}3 gene in one allele with a deletion of J{delta} genes in the other. In addition, the SNT-8 cells were found to express {gamma}{delta}TCR by flow cytometry, indicating that deletion of the J{delta}1 gene was a consequence of the usage of the J{delta}3 gene at the same {delta} locus.

Both SNT-13 and SNT-15 showed the rearranged band and a germline band in each digest obtained with the J{delta}3 probe. These results suggested that SNT-13 and SNT-15 had a rearrangement of J{delta}3 genes, which was common to that in SNT-8, in one allele, and incomplete rearrangements in the other allele upstream of the J{delta}3 segment as described above.

The three EBV-negative cell lines Molt-14, Peer, and Loucy showed rearranged bands with the J{delta}1 probe, but not with the J{delta}3 probe (data not shown). The deduced rearrangement in these cell lines is summarized in Table 6 .

TCR ß-Chain and Immunoglobulin Genes

All of the EBV-positive and -negative cell lines showed rearrangements of the Cß genes, whereas none showed a rearrangement of the immunoglobulin heavy-chain genes (data not shown). It is known that rearrangements of the ß-chain gene are commonly found in peripheral {gamma}{delta} T-cell lymphomas.40,41

PCR for Combinations of V{delta} and J{delta} Genes

To elucidate the rearrangement of V{delta} and J{delta} genes, PCR analysis was performed for each combination of the V{delta}1, V{delta}2, or V{delta}3 gene and the J{delta}1 or J{delta}3 genes. It was found that, only PCR using the L-V{delta}2 and J{delta}3 primers amplified fragments with an expected size of ~500 bp in the three EBV-positive cell lines, indicating that the cell lines had the V{delta}2-J{delta}3 rearrangement, but not the V{delta}1-J{delta}1, V{delta}1-J{delta}3, V{delta}2-J{delta}1, V{delta}3-J{delta}1, and V{delta}3-J{delta}3 rearrangements (Figure 4) . In terms of the EBV-negative cell lines, the DNA of Molt-14 and Peer was amplified with the L-V{delta}1 and 3'-J{delta}1 primers. This result indicated that these two cell lines had the V{delta}1-J{delta}1 rearrangement (data not shown).



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  		Figure 4. PCR analysis for the junction of V{delta} and J{delta} genes. PCR analysis shows the presence of the V{delta}2-J{delta}3 TCR gene rearrangement in the three SNT cell lines. Only the combination of a L-V{delta}2 sense primer and a J{delta}3 anti-sense primer amplified ~500-bp PCR products identified as V{delta}2-J{delta}3. Lane 1, SNT-8; lane 2, SNT-13; lane 3, SNT-15 cells. No signal was detected in EBV-negative {gamma}{delta} T-cell lines; lane 4, Molt-14; lane 5, Peer; lane 6, Loucy.

 
Analysis of TCR {delta}-Chain Transcripts

RT-PCR and direct sequencing were performed to confirm the results of flow cytometry, Southern blotting and PCR analysis showing that the three cell lines had the V{delta}2-J{delta}3 rearrangement. RT-PCR with the V{delta}2 and C{delta} primers commonly amplified ~550-bp single bands in the three cell lines (data not shown), and ß-actin transcripts were amplified in all of the samples and served as a control for amplifiable mRNA. Direct sequencing of the amplified RT-PCR products clearly showed that the three cell lines had sequences for the V{delta}2-D{delta}3-J{delta}3 rearrangement (Table 5) . The results demonstrate that the V{delta}2-J{delta}3 rearrangement took place, and mRNA for V{delta}2-J{delta}3-C{delta} receptor was then transcribed in the SNT cell lines. In addition, the same RT-PCR and sequence analysis was performed on peripheral blood of the patient from which SNT-13 was derived at primary diagnosis. The patient’s blood had completely the same sequence as that of SNT-13 (data not shown).


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  		Table 5. Nucleotide Sequence of V{delta}2-J{delta}3 Transcripts Expressed by {gamma}{delta} T-Cell Lines

 
The results of the flow cytometric, Southern blot, PCR, RT-PCR, and direct sequencing analyses are summarized in Table 6 . The table shows that the results are consistent. Overall, they demonstrate that the three EBV-positive cell lines always express V{gamma}9-J{gamma}P/V{delta}2-J{delta}3 TCR, a phenomenon not observed in the EBV-negative {gamma}{delta} T-cell lines.


   Discussion
Top
 Abstract
 Materials and Methods
 Results
 Discussion
References
 
In this study, we reported characteristics of three EBV-positive cell lines of {gamma}{delta} T cells. One of these was the previously-reported {gamma}{delta} T-cell line SNT-8, which was established from the primary lesion of a nasal T/NK-cell lymphoma,7 whereas the other two, SNT-13 and SNT-15, were newly established lines from the peripheral blood of patients with CAEBV. In the previous study, SNT-8 was demonstrated to have developed from the lymphoma cells in the patient, because SNT-8 had the same immunophenotype and monoclonal EBV clones as the original lesion.7 In patient 2, SNT-13 had the same EBV clone and TCR {delta}-chain as the peripheral blood mononuclear cells, indicating that SNT-13 had developed from cells predominantly expanding in the patient and responsible for her disease. These data, thus, suggest that it is the cells proliferating in patients with nasal T/NK-cell lymphoma and CAEBV that exclusively grow in our culture system.

The three cell lines showed a phenotype typical of {gamma}{delta} T cells, and were associated with a consistent rearrangement of the TCR genes V{gamma}9-J{gamma}P/V{delta}2-J{delta}3. To the best of our knowledge, these are the only {gamma}{delta} T-cell lines that have been found to be positive for EBV. Moreover, this study presented the first evidence of the existence of cases of CAEBV of the {gamma}{delta} T-cell subset.

Not only SNT-8 cells but also SNT-13 and SNT-15 cells proliferated in vitro, and an analysis of the number of EBV-TR showed that every cell line consisted of monoclonal cells. The monoclonal expansion of the cells suggested that not only SNT-8 cells but also SNT-13 and SNT-15 cells were transformed to a certain degree and acquired a greater proliferative capacity compared with normal T cells. Many studies have documented monoclonal and oligoclonal proliferation of EBV-positive T cells and NK cells in patients with CAEBV.11,12,17,19,20,24,25 In addition, the development of malignant lymphomas of T/NK-cell lineage from patients with CAEBV has been reported.9,14,18,19,23,25,42 Furthermore, the establishment of cell lines of {alpha}ß T-cell16 and NK-cell lineage21 has been reported in some severe CAEBV cases, and the present study described the establishment of {gamma}{delta} T-cell lines. Therefore, the present study, together with those previous reports, suggests that most cases of CAEBV are considered as lymphoproliferative diseases of NK cells, {alpha}ß T cells, or {gamma}{delta} T cells, rather than as infectious diseases.

The most interesting finding in the present study was that the EBV-positive {gamma}{delta} T-cell lines SNT-8, SNT-13, and SNT-15 expressed exactly the same TCR, V{gamma}9-J{gamma}P/V{delta}2-J{delta}3. This was, on the other hand, not observed in the EBV-negative {gamma}{delta} T-cell lines, which were established from T-lymphoblastic leukemia patients and expressed V{delta}1 protein with the V{delta}1-J{delta}1 gene rearrangement. Consistent with our observation, Arnulf and colleagues4 have reported that five EBV-positive cases (three nasal, one laryngeal, and one intestinal lymphomas) in a series of nonhepatosplenic {gamma}{delta} T-cell lymphomas were invariably V{delta}2+, whereas five EBV-negative or -weakly positive cases expressed one of the V{delta}1 (one case in the lung), V{delta}2 (two cases in the skin), or V{delta}3 (two cases in the gastrointestinal tract) chain. Thus, it was suggested that EBV has a close affinity to V{delta}2+ cells in the lymphoproliferative diseases, especially to V{gamma}9-J{gamma}P/V{delta}2-J{delta}3+ cells.

It is of interest when and where EBV affected the V{gamma}9-J{gamma}P/V{delta}2-J{delta}3+ cells in our patients. It is known that the usage of TCRs in human {gamma}{delta} T cells has limited diversity, and the type of cells that constitute the majority of changes during fetal and postnatal life in individual organs.1 For example, in the postnatal thymus and other epithelial-rich tissues such as the intestine and spleen, V{delta}1-J{delta}1+ cells are the major population.1,43,44 It is thus reasonable that cases of {gamma}{delta} T-cell acute lymphoblastic leukemia, cells of which are supposed to be the malignant counterpart of thymocytes, expressed V{delta}1-J{delta}1 TCR.45 Likewise, most hepatosplenic {gamma}{delta} T-cell lymphomas were reported to express V{delta}1 proteins and/or rearranged V{delta}1 genes.40,41,46,47 In contrast, V{delta}2+ cells are known to be the major population in the peripheral blood during adulthood.1,43,44 In the peripheral blood, V{delta}1+ cells constitute the majority at birth, and V{delta}2+ cells increase from a mean of 20% in the cord blood to ~60 to 70% before the age of 10.44 In addition, V{gamma}9-J{gamma}P/V{delta}2+ cells, which are capable of recognizing mycobacterium and Daudi Burkitt’s lymphoma cells,48,49 are believed to be selected and expand in number in the periphery.1 With regard to the nose, the major population among the nasal intraepithelial {gamma}{delta} T cells was reported to express V{gamma}1/V{delta}1 genes.50 Thus, it is likely that EBV affected the V{gamma}9-J{gamma}P/V{delta}2-J{delta}3+ cells in the peripheral blood in our patients with nasal T-cell lymphoma and CAEBV. Nonetheless, although V{delta}2-J{delta}3+ cells constitute the major population in cord blood, V{delta}2-J{delta}1+ cells comprise the largest population, ~50 to 98% of {gamma}{delta} T cells, in the peripheral blood of healthy adults.1,43 Therefore, V{gamma}9-J{gamma}P/V{delta}2-J{delta}3+ cells are a minor population in the peripheral blood in adulthood in the context of J{delta}3 expression, although probably more common in infants and youth. Thus, it may be reasonable that EBV affected these specific {gamma}{delta} T cells in the peripheral blood of our two patients with CAEBV because they were young people. It is unknown, however, why EBV affected these specific {gamma}{delta} T cells in SNT-8 because the patient was 48-years-old. It may be that EBV has particular affinity to the J{delta}3 TCR. Otherwise, EBV might affect V{gamma}9-J{gamma}P/V{delta}2-J{delta}3+ cells when the patient is young, and the cells transform later to form the nasal T-cell lymphoma.

It is thus an intriguing question how EBV affected the V{gamma}9-J{gamma}P/V{delta}2-J{delta}3+ cells in our patients. A possible explanation for the close affinity between EBV and this specific cell population is that there is a specific receptor for EBV other than CD21 on the V{gamma}9-J{gamma}P/V{delta}2-J{delta}3+ cells because the three EBV+ cell lines were negative for the CD21 antigen, a known receptor for EBV.51,52 One approach to assessing such a possibility is to study whether isolated V{gamma}9-J{gamma}P/V{delta}2-J{delta}3+ cells can be infected with EBV.

Alternatively, the relationship between EBV and V{gamma}9-J{gamma}P/V{delta}2-J{delta}3+ cells may be explained as follows: the population of these cells expanded in response to a certain antigen and infiltrated a tissue to then be infected with resident EBV. Indeed, V{gamma}9-J{gamma}P-C{gamma}1/V{delta}2+ cells were reported to have a great ability to respond to Daudi cells or mycobacterial antigens and comprise a large proportion of the {gamma}{delta} T cells in the peripheral blood.49 This also suggests that they are highly responsive to antigens structurally identical or related to Daudi or mycobacterial antigens. Alternatively, V{gamma}9-J{gamma}P/V{delta}2-J{delta}3+ cells might expand in number during EBV infection because {gamma}{delta} T cells were reported to increase in acute and convalescent phases of infectious mononucleosis.53,54 Therefore, it seems to be worth investigating how V{gamma}9-J{gamma}P/V{delta}2-J{delta}3+ cells react with Daudi antigens, mycobacterial antigens, or EBV.

Another possible mechanism for the expansion of the V{gamma}9-J{gamma}P/V{delta}2-J{delta}3+ cell population in our three patients is that EBV affected immature T-lymphocytes and drove them to differentiate into this population. Indeed, it has been reported that EBV infects immature T lymphocytes. Imai and co-workers16 established four EBV-positive T-cell lines from patients with CAEBV, and one of the four had an immature T-cell phenotype without TCR gene rearrangement. It has also been reported that immature thymocytes and an immature T-cell line HPB-ALL expressed CD21 and could be infected with EBV.55,56 Moreover, it has been shown that infections of EBV in HPB-ALL altered the expression of T-cell surface molecules involved in antigen recognition. It has thus been suggested that EBV infection of T cells at early stage of differentiation may lead to a failure in the development of the normal T-cell repertoire.56 Therefore, we believe that the effect of EBV infection of immature thymocytes on the development of the T-cell repertoire is an important issue to be addressed.

The present study raised another important question as to why the infection by EBV of an identical {gamma}{delta} T-cell subset resulted in different diseases, ie, nasal T/NK-cell lymphoma and CAEBV; the former is a malignant lymphoma and the latter a nonmalignant lymphoproliferative disease. We recently reported a patient with CAEBV of NK-cell lineage who subsequently developed nasal NK-cell lymphoma.25 There were three NK-cell clones in the patient, and it was suggested that one of the three was involved in the formation of the malignant lymphoma. We concluded that the type and/or degree of transformation of EBV-positive NK cells could be variable even in a single patient. Similar conditions showing variability in the transformation of EBV-positive cells have been reported in the posttransplantation lymphoproliferative disorders (PT-LPD) of B lymphocytes.57-61 These reports hypothesized that the development of PT-LPD is a multistep process, initiates as polyclonal expansions of EBV-carrying B cells on the basis of immunosuppression, and may progress to lymphomas. The present study together with these previous reports, suggests that transformation of cells with EBV only is not sufficient for the development of a malignant lymphoma, and that an additional abnormality such as genetic mutation is likely to be involved in the malignant transformation of EBV-affected cells.

In conclusion, this study demonstrated that the three EBV-positive {gamma}{delta} T-cell lines expressed a common TCR, the V{gamma}9-J{gamma}P/V{delta}2-J{delta}3 TCR, and shed light on the etiology of nasal T-cell lymphoma and CAEBV of the {gamma}{delta} T-cell subset. The establishment of the cell lines allowed us to focus on these diseases. Thus, we believe that the results warrant the use of these cell lines in future studies, and necessitate further efforts to develop more cell lines from lymphoproliferative diseases caused by EBV.


   Acknowledgements
 
We thank Dr. Junko H. Ohyashiki for valuable discussion and to Mrs. Aya Kasuya for technical assistance.


   Footnotes
 
Address reprint requests to Dr. Norio Shimizu, Department of Virology, Division of Medical Science, Medical Research Institute, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan. E-mail: nshivir{at}mri.tmd.ac.jp

This work was supported by Grants-in-Aid for Scientific Research from the Ministry of Education, Science, Sports, and Culture of Japan (no. 11670207 and no. 09253103), the Sasakawa Scientific Research Grant from the Japan Science Society, and Grants-in-Aid for Education and Research Promotion Program 1999 from the Tokyo Medical and Dental University.

Accepted for publication January 28, 2003.


   References
Top
 Abstract
 Materials and Methods
 Results
 Discussion
 References
 

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