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From the First Department of Internal Medicine,* Gifu University School of Medicine, Gifu, Japan; the Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California; the Center for Emerging Infectious Diseases, Gifu University, Gifu, Japan; the Department of Immunopathology, Gifu University Graduate School of Medicine, Gifu, Japan; the Department of Gastroenterology,¶ Kanazawa University Graduate School of Medicine, Kanazawa, Japan; the Department of Cellular Function,|| Division of Cellular and Molecular Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Abstract |
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CD40) causes a biphasic inflammatory liver disease in inbred mice. The late phase of disease was suppressed in B-cell-deficient mice and by the depletion of macrophages, but not T cells or natural killer cells. We also report that SCID mice were not susceptible to CD40-induced liver disease unless they were reconstituted with normal B cells and that B cells as well as macrophages played key roles in CD40-induced late phase of liver inflammation. Finally, liver disease and the recruitment of inflammatory cells into the liver were mediated by interferon-
and tumor necrosis factor-, but not by Fas. In conclusion, these results indicate that CD40 ligation can trigger a B-cell-mediated inflammatory response that can have pathogenic consequences for the liver.
CD40 is a 50-kd glycoprotein that is present on the surface of B cells, follicular dendritic cells, monocytes, and some endothelial, epithelial, and cancer cells.9-11
CD40 plays a crucial role in B-cell proliferation; immunoglobulin secretion and differentiation;11
T-cell activation;10
and monocyte, macrophage, and dendritic cell functions, including their survival and ability to secrete several inflammatory cytokines.9,12
Recent studies have shown that anti-CD40 (CD40) therapy may have a place in the treatment of infectious diseases and cancer. For example, CD40 induced marked isotype switching and protective antibody responses to a polysaccharide antigen,13
and indirectly activated natural killer (NK) cells resulting in significant anti-tumor and anti-metastatic effects.14
Furthermore, CD40 ligation has been shown to trigger an inflammatory response in the lungs secondary to activation of bone marrow-derived CD40-positive cells.15,16
Finally, CD40 ligation has been shown to induce the secretion of antiviral cytokines that inhibit hepatitis B virus replication in the liver of HBV transgenic mice.17
We recently showed that CD40 ligation induces a biphasic inflammatory disease in the mouse liver that peaks on day 1 and again on day 5,17
and that nuclear factor (NF)-
B signaling controls this liver inflammation.18
In the former study, we focused on the mechanisms responsible for the early (day 1) phase of the disease, and demonstrated that it was mainly triggered by activated APCs and mediated by interferon (IFN)- and tumor necrosis factor (TNF)-.17
In the current study, we focused on the mechanisms responsible for the late (day 5) phase of the disease, and discovered a hitherto unexpected role for activated B cells in the pathogenesis of liver injury, although once again the disease is mediated by IFN- and the cells it recruits. Our results indicate that the late phase of inflammatory liver disease induced by CD40 ligation is a macrophage- and B-cell-dependent process, and provide new insight into the pathogenic roles of B cells as effectors of the immune response.
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Materials and Methods |
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CB6F1/J and C57BL/6 mice were purchased from Japan SLC (Shizuoka, Japan). SCID and C.B.17 mice were obtained from Japan Clea (Shizuoka, Japan). µMT mice were obtained from Jackson Laboratory (Bar Harbor, ME). Fas KO mice19 were generously provided by Dr. S. Nagata (Osaka University, Osaka, Japan). All animals were housed in pathogen-free rooms under strict barrier conditions, and received humane care according to the guidelines of the Animal Care Committee of Gifu University School of Medicine.
Anti-CD40 and Anti-Cytokine Antibodies
The FGK45 hybridoma producing a rat IgG2a monoclonal antibody (mAb) against mouse CD40 (CD40) was kindly provided by Dr. A. Rolink (Basel Institute for Immunology, Basel, Switzerland). Mice were injected intravenously with either 100 µg of CD40 or 100 µg of purified rat IgG2a (BD Pharmingen, San Diego, CA) as a control. To neutralize IFN- and TNF-, mice were injected intraperitoneally (250 µg/mouse) on days 0 and +2 with 1) hamster mAb H22 specific for murine IFN-20
; 2) hamster mAb TN3 19.12 specific for murine TNF-21
(both generously provided by Dr. R. Schreiber, Washington University, St. Louis, MO); or 3) control hamster IgG (Jackson ImmunoResearch, West Grove, PA).
Enzyme-Linked Immunosorbent Assay
Serum IFN- and TNF- concentrations were assayed using enzyme-linked immunosorbent assay kits (Genzyme Techne Co., Minneapolis, MN) according to the manufacturer’s protocols.
In Vivo Depletion of CD4+ and CD8+ T Cells, NK Cells, and Macrophages
To deplete CD4+ and CD8+ T cells, mice were injected intravenously with rat anti-mouse CD4 (YTS191.1) and rat anti-mouse CD8 (YTS169.4) mAb,22
both kindly provided by Dr. R. Zinkernagel (University of Zurich, Zurich, Switzerland). To deplete NK cells in the liver, mice were injected intravenously with rabbit anti-mouse asialo-GM1 antibody (50 µg/mouse) (Wako Pure Chemical, Osaka, Japan) on days –1 and +2 relative to the CD40 injection. Purified rabbit IgG (Sigma-Aldrich, St. Louis, MO) was used as a negative control. To deplete macrophages in the liver, mice were injected intravenously (100 µl/mouse) with liposome-encapsulated dichloromethylene diphosphonate (L-MDP)23
on days –1 and +2 relative to the CD40 injection, kindly provided by Dr. M. Naito (Niigata University School of Medicine, Niigata, Japan).
Tissue DNA and RNA Analyses
Frozen liver was mechanically pulverized under liquid nitrogen and total RNAs were isolated for RNase protection assays (RPA) as previously described.17 All reagents for RPA were purchased from BD Pharmingen. Specific signals were detected using a BAS-2500 imaging analyzer (Fuji Film, Nakanuma, Japan) and a FLA-3000 phosphoimager (Fuji Film). The mRNA expression levels were calculated as relative percentage values of the L32 housekeeping gene expression by using Image J soft ware.
Biochemical and Histological Analyses
The extent of hepatocellular injury was monitored biochemically by measuring the serum alanine aminotransferase (sALT) activity at multiple time points using a standard clinical automatic analyzer. For histological analysis, liver tissue was fixed in 10% zinc-buffered formalin, embedded in paraffin, sectioned (3 µm), and stained with hematoxylin and eosin (H&E).
Immunohistochemistry
For immunofluorescent microscopic analyses, liver sections were fixed with acetone at 4°C for 10 minutes, and preincubated with 10 µg/ml of rat anti-CD16/32 antibody (clone 2.4G2, BD Pharmingen) for 30 minutes. The sections were then incubated with rat anti-mouse B220-PE (clone RA3-6B2, BD Pharmingen) followed by rat anti-mouse IgM-FITC (clone R6-60.2, BD Pharmingen) for 1 hour each at room temperature. After each step of the staining, the sections were washed three times with phosphate-buffered saline (PBS) for 10 minutes each. Finally, the sections were observed using a DMRA fluorescence microscope and the QFISH software (Leica Microsystems Imaging Solutions, Cambridge, UK).
Liver tissues were treated with biotin conjugated with rat anti-mouse B220 mAb (BD Pharmingen) followed by streptavidin biotin-horseradish peroxidase complex (DAKO, Glostrup, Denmark). The reaction was visualized with 0.035% H2O2 and 0.03% 3,3'-diaminobenzidine (WAKO, Tokyo, Japan) in 50 mmol/L Tris-HCl (pH 7.6) for 2 to 3 minutes. After 4% formaldehyde fixation, specimens were counterstained with hematoxylin and observed.
IHLs
To isolate intrahepatic leukocytes (IHLs), single-cell suspensions were prepared from liver perfused with PBS via the inferior vena cava and were digested in 10 ml of RPMI 1640 (Life Technologies, Gaithersburg, MD) containing 0.02% (w/v) collagenase IV (Sigma-Aldrich) and 0.002% (w/v) DNase I (Sigma-Aldrich) for 40 minutes at 37°C. Cells were overlaid on 24% (w/v) metrizamide (Sigma-Aldrich) in PBS. After centrifugation for 20 minutes at 1500 x g, IHLs were isolated at the interface.
Fluorescence-Activated Cell Sorting (FACS) Analysis
To examine cytokine production in IHLs, isolated IHLs were cultured ex vivo for 4 hours in Brefeldin A (BD Pharmingen) and then stained with anti-CD3, anti-NK1.1, anti-CD11b, anti-CD11c, or anti-B220 (all from BD Pharmingen). After fixation, the cells were permeabilized for 30 minutes in 25 µl of PBS plus 0.5% saponin. Anti-mouse IFN-, TNF--PE, or allophycocyanin (APC) or isotype control mAb were added at a final dilution of 1/100, and the cells were incubated for 30 minutes at room temperature. The cells were washed and re-suspended in 1 ml of FACS buffer for analysis using a FACScalibur flow cytometer (BD Immunocytometry Systems, San Jose, CA).
Isolation of B Cells
B cells were purified by negative selection using a B-cell isolation kit (Miltenyi Biotec, Bergisch Gladbach, Germany) according to the manufacturer’s instructions. The purified cells were routinely >95% B220+.
Data Analysis
All values in the figures and text are expressed as the mean ± SD. The significance of differences among mean values was evaluated according to the Mann-Whitney U-test.
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Results |
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CD40 Causes a Biphasic Inflammatory Liver Disease
To determine whether CD40 causes liver injury in inbred mice, four groups of age- and sex-matched CB6F1 mice (three mice/group) received an intravenous injection of CD40 (100 µg/mouse) or rat IgG2a (rat IgG). As shown in Figure 1
, sALT activity was mildly elevated (160 ± 32 U/L) at day 1, returned to normal (44 ± 12 U/L) at day 3, and then rebounded (242 ± 36 U/L) at day 5 after the injection.
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To evaluate inflammatory cytokine and chemokine expressions in the liver after CD40 ligation, RPA analysis of total liver RNA revealed that CD40 injection induced CD3, CD4, and CD8 mRNA expression in the liver on day 1, and progressively increased on days 3 and 5 (Figure 2A)
. These changes were accompanied by clear biphasic increases in IFN- and TNF- levels in the serum (Figure 2B)
and hepatic interleukin (IL)-1, IL-12, CXCL10, CCL2, CCL4, and CCL5 expression (Figure 2A)
on days 1 and 5, reflecting the biphasic increase in sALT activity described above (Figure 1)
, although the hepatic IFN- mRNA levels were too low to have confidence in their kinetics. Further, we found that other inflammatory cytokines, Th2 type cytokines, IL-4, IL-5, and IL-6 mRNA expressions were increased faintly on day 5 although IL-10 mRNA expression was gradually elevated until day 5. We also found that the expression of F4/80 mRNA (a macrophage marker24
that is down-regulated on activation24-26
) was reduced on days 1 and 5 compared with the rat IgG control mice, suggesting that intrahepatic macrophages were also activated by CD40 at these time points.25,26
To determine which cell population produced IFN- and TNF- on day 5 after the CD40 injection, we stained intrahepatic macrophages (CD11b+), dendritic cells (CD11c+), NK cells (NK1.1+), T cells (CD3+), and B cells (B220+) with antibodies against IFN- and TNF-. As shown in Figure 2C
, macrophages and dendritic cells were found to produce TNF-, in contrast, IFN- was produced by NK cells and at lower levels by T and B cells. We also found that intrahepatic inflammatory cells, including macrophages, dendritic cells, and B cells were detected in the liver, indicating that CD40 ligation induced migration and proliferation of these cells (data not shown).
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To determine the role of T cells in the late (day 5) phase of CD40-induced liver injury, mice were treated with CD4 and CD8 mAb or control rat IgG before the CD40 injection. As shown in Figure 3A
-1, CD40 caused liver injury irrespective of the presence or absence of T cells, suggesting that intrahepatic CD4+ and CD8+ T cells did not contribute to the late-phase liver injury or affect the recruitment of NK cells, macrophages, dendritic cells, and B cells to the liver by CD40 (Figure 3
, A-2 and A-3). Consistent with the result of liver injury we found that depletion of T cells did not affect the cytokine and chemokine expression in the liver after injection (Figure 4A)
.
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CD40-induced late-phase liver injury requires NK cells, mice were treated with asialo-GM1 antibody at days –1 and +2 relative to the CD40 injection. We found that NK cell depletion also had little or no effect on total IHL recruitment (Figure 3
, B-2 and B-3) or the severity of the liver disease (Figure 3B
-1). Further, as shown in Figure 4B
, we found that NK cell depletion significantly reduced IFN-, TNF-, and CCL2 mRNA expression in the liver though CXCL10 and CCL5 mRNA expression revealed the similar levels. As we showed NK cells produced IFN- at this time point (Figure 2C)
, this result is consistent with the finding that NK cells can produce IFN-.
To evaluate the role of macrophages in this process, mice were treated with L-MDP, which induces apoptosis of macrophages in the liver in vivo.23
One day later, the mice were injected intravenously with CD40 or rat IgG. As shown in Figure 3C
-1, elevation of sALT activity was significantly reduced in the L-MDP-treated mice, indicating that macrophages are necessary for liver injury on day 5 after CD40 injection (*P < 0.05). However, note that the sALT elevation was not completely blocked despite near total macrophage depletion (Figure 3C
-1), suggesting that inflammatory cells other than macrophages may be involved in liver inflammation. Also note that a B-cell infiltrate was observed in the liver despite macrophage depletion, demonstrating that hepatic B-cell recruitment is primarily macrophage-independent.
Because the intrahepatic B-cell population increased massively after CD40 injection, we investigated the role of B cells in the pathogenesis of the liver disease. µMT mice, which lack mature B cells because of a germline deletion of the membrane exon of the immunoglobulin µ heavy chain,27
and C57BL/6 mice were treated with CD40 or rat IgG, and sALT activity and IHL infiltration were monitored 5 days later. As shown in Figure 3D
-1, µMT mice displayed less liver disease (sALT activity: 138 ± 18 U/L) than normal control mice (sALT activity: 212 ± 23 U/L) after CD40 injection, and this difference was statistically significant (*P < 0.05), suggesting that B cells contribute to the pathogenesis of CD40-induced late-phase liver disease. Interestingly, macrophage and dendritic cell recruitment were increased in µMT mice (Figure 3
, D-2 and D-3), perhaps accounting for the relatively modest reduction in the severity of liver disease in the B-cell knockout animals. In addition, importantly we found that IFN-, CXCL10, CCL2, and CCL5 mRNA expression reduced in the liver with µMT mice although TNF- expression revealed the same level irrespective of B cell absence or presence (Figure 4D)
. These results suggested that B cells contribute to induction of IFN- and chemokines at late phase after CD40 injection.
Histological Analysis
To determine the distributions of B cells in the liver after CD40 injection, we performed H&E staining and immunohistological staining. Histological analysis revealed that lymphocytes had infiltrated around the portal tract (Figure 5
, arrow) and liver parenchyma with wild-type mice. In contrast, CD40-treated µMT mice did not show infiltration of these cells around the portal tract (Figure 5
, right). Immunohistochemical analysis revealed that huge numbers of B220+/IgM+ B cells had infiltrated into the parenchyma and around the portal tract and central vein on day 5 after the injection in wild-type mice (Figure 5
, left).
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To confirm the involvement of B cells in this model, we adoptively transferred 1 x 107 purified B cells isolated from the spleens of C.B.17 mice (Figure 6A)
into SCID mice, and then injected CD40 or rat IgG 1 day later. As shown in Figure 6A
, sALT activity was significantly elevated in B-cell-reconstituted mice that received CD40 compared with the NaCl-treated and rat IgG control groups (*P < 0.05). Further, we also showed that total number of IHLs increased in B-cell-reconstituted mice as compared with NaCl-treated mice after CD40 injection (Figure 6B)
. To evaluate which cell population is affected by adoptively transferred B cells, we analyzed the phenotype of IHLs by FACS. As shown in Figure 6B
, we used anti-mouse CD49b/Pan-NK cells mAb (clone DX-5) instead of anti-mouse NK1.1 mAb (clone PK136) as a marker of NK cells in this experiment because the PK136 antibody does not stain NK cells in C.B.17 and SCID mice (data not shown).28
Interestingly, the number of CD3–/DX-5+ cells (NK cells) and macrophages increased in B-cell-reconstituted mice, demonstrating that CD40 activated B cells can induce the proliferation and recruitment of these inflammatory cells (Figure 6B)
. Consistent with the result of sALT activity, histological analysis revealed the presence of a necroinflammatory liver disease (Figure 6C
, arrows) consisting of B cells that infiltrated the liver parenchyma (Figure 6, D and E)
. These results strongly support the hypothesis that B cells play a key role in CD40-induced liver injury.
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CD40-Induced Liver Injury
First, to determine whether IFN- or TNF- contribute to CD40-induced late-phase liver injury, we injected CB6F1 mice with IFN- or TNF- mAb, or an irrelevant hamster IgG before CD40 administration. The IFN- mAb completely blocked the induction of liver injury (*P < 0.05) and greatly attenuated the intrahepatic inflammatory cell infiltrate (Figure 7, B and C)
and cytokine/chemokine expression (Figure 7A
and Supplemental Figure S1; for supplemental figure, see http://ajp.amjpathol.org) in the same animals, indicating that IFN- is primarily responsible for all these events.
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TNF- mAb treatment provided substantial but partial protection against late-phase liver injury (Figure 7B
, left), which corresponded with its ability to only partially block the recruitment of NK and T cells into the liver (Figure 7B)
and the induction of inflammatory cytokines and chemokines (Figure 7A)
. These results suggest that TNF- also contributes to the pathogenetic activity of B cells and macrophages in the late phase of liver injury induced by CD40.
Furthermore, to determine whether the Fas-Fas ligand pathway plays an important role in the liver injury, we injected CD40 into Fas KO and C57BL/6 mice and then sacrificed them on day 5 for analysis. As shown in Figure 7D
, we found that Fas KO mice displayed wild-type levels of serum ALT activity and inflammatory cell recruitment, indicating that the CD40-induced liver disease is independent of the Fas pathway.
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Discussion |
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and TNF-) and chemokines that recruit additional inflammatory cells that damage the liver. We have previously shown that CD40 causes a biphasic, IFN--, and TNF--dependent liver disease,17
the first wave of which requires intrahepatic macrophages and NK cells. In the current study, we examined the pathophysiology of the second wave of the liver injury induced by CD40 ligation. Having observed that the liver injury occurred in the absence of macrophages, T cells, and NK cells after CD40 ligation while a large number of B cells infiltrated the portal and central veins in the liver during the delayed phase of the liver disease, we hypothesized that B cells might contribute to the pathogenesis of this disease.
On testing this hypothesis, we found that the late phase of CD40-induced liver injury was suppressed in µMT mice and normal mice treated with L-MDP, but that depletion of T or NK cells had no effect. We confirmed the involvement of B cells in this model by showing that CD40 treatment could cause liver injury after adoptive transfer of B cells into SCID mice (Figure 6)
. Based on these results, we conclude that CD40-activated B cells and macrophages mediate the second wave of liver injury in this model. Although the potential of B cells to produce a variety of cytokines and chemokines is well demonstrated in vitro,3,29
the ability of B cells to perform effector functions at inflammatory sites in vivo is not well defined. In the current article, we demonstrate that activated B cells can contribute to liver inflammation. Nonetheless, several questions remain to be elucidated.
First, how do CD40-activated B cells cause liver injury? One possible clue is our observation that CD40 treatment causes liver injury and cell recruitment in Fas knockout mice as well as in wild-type mice (Figure 7)
. This result demonstrates that the liver disease is not Fas-Fas ligand-dependent, although CD40 ligation increases Fas expression in B cells.11
Furthermore, we showed that the liver disease is mediated by inflammatory cytokines, especially IFN- and TNF-. However, several points remain obscure. First, NK cell depletion by asialo-GM1 treatment did not mitigate the liver disease or inflammatory cell recruitment, yet NK cells are the main producers of IFN- (Figure 2C)
. This suggests that cells other than NK cells, possibly B, T, and dendritic cells, produce the pathogenetic IFN-. Actually, we detected IFN- mRNA in the liver after CD40 injection in NK cell-depleted mice (Figure 4)
and also showed IFN- mRNA expression was suppressed in the liver with µMT mice (Figure 4)
. In support of this hypothesis, it has been reported that CD40-activated B cells could produce IFN- and induce IFN- production on CD4 T cells.3,30
Because IFN- is well known as a potent activator of macrophages,31,32
and TNF- (produced by macrophages) is also known to cause liver injury,33
we hypothesize that CD40 induced B cell and secondary activated other inflammatory cell-derived IFN- may be the inducer in the cascade leading to liver inflammation, and that IFN- activates macrophages and other inflammatory cells that serve as effectors in this disease. This scenario is supported by the findings that IFN- blockade completely protects against CD40-induced liver injury and cell recruitment, whereas TNF- blockade confers only partial protection. Importantly, as shown in Figure 3
, we found that CD40 treatment induced the migration of macrophages, dendritic cells, and NK cells in µMT mice, indicating that these cells can be recruited into the liver without B cell help, and suggesting that they also contribute to the residual late phase in the B-cell knockout animals.
Furthermore, we found that liver injury was observed in µMT mice and reduced in L-MDP-treated mice, indicating that macrophages also contribute to liver inflammation in this model. Notably, we confirmed that CD40-induced liver injury was completely prevented by depletion of both B cells and macrophages in the liver (Supplemental Figure S2 at http://ajp.amjpathol.org). It is well known that macrophages can induce liver injury through cytokine production.34-36
Accordingly, the interaction of macrophages and B cells in this liver injury model is interesting. We found that co-culture of B cells and macrophages under CD40 treatment increased IFN- or TNF- production, respectively, as compared with single cells (data not shown). These findings suggested that B cells and macrophages could stimulate each other by cell-to-cell or cytokine under some conditions. However, we have shown here that B cells infiltrate the liver in macrophage-depleted animals after CD40 ligation. In contrast, macrophages were also recruited to the liver in µMT mice after stimulation (Figure 3)
. Consistent with the fact that CD40 ligation induces macrophage and B cell activation and proliferation independently11,37,38
we consider that these cells work to establish liver inflammation independently in this system.
Interestingly, despite showing that B cells play an important role in the late-phase liver injury, we demonstrated that B cells do not contribute to the early phase liver disease (Supplemental Figure S3 at http://ajp.amjpathol.org). Furthermore, we found that the increase of intrahepatic B cells was small on day 1 after CD40 injection, indicating that recruitment and proliferation in B cells was not enough to function as effector cells at this time. With regard to effector functions of B cells, we have to exclude the possibility that CD40 ligation induced antibody-dependent effector functions because CD40 ligation can induce autoreactive antibody.12,39,40
To evaluate this hypothesis, we examined the number of antibody-producing cells, plasma cell populations in IHLs and spleen after CD40 injection. As shown in Supplemental Figure S4 at http://ajp.amjpathol.org, we found antibody-secreting cells (B220+/CD138+) in IHLs and spleen peaked at day 3 after injection despite liver injury were not observed at this time, suggesting that antibody-dependent mechanisms are not responsible for liver injury in this model.
Recently antibody-independent contributions of B cells have been demonstrated in murine models of autoimmune disease. Chan and colleagues41 have shown that MLR/lpr mice that are deficient in their ability to secrete Ig develop interstitial nephritis, vasculitis, and mortality when compared with secretary sufficient MLR/lpr. Based on this precedent, we suggest that CD40-activated B cells behave as effector cells in an antibody-independent manner in the current model.
Finally, we have also an interest for the role of NKT cells in this liver inflammation because NKT cells are abundant in the liver and recovered to base line at the late phase after CD40 injection (data not shown). A current report shows NKT cells recognize an endogenous ligand presented by CD1d on B cells and regulate B-cell proliferation and effector functions.42
This result suggests that NKT cells also might activate B cells and accelerate liver injury in this model.
In summary, we have shown here that CD40-activated B cells and macrophages produce inflammatory cytokines and contribute to the pathogenesis of a necroinflammatory liver disease. The present data illustrate that activated B cells can both cause and amplify tissue injury, and provide new evidence that B cells can function in a pathogenic manner at sites of tissue inflammation.
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Acknowledgements |
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and TNF- antibodies, Dr. Shigekazu Nagata (Osaka University) for providing the Fas KO mice, and Dr. Kazuhiro Kakimi (Tokyo Medical University School of Medicine) for critical advice. |
Footnotes |
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Supplemental material for this article can be found on http://ajp.amjpathol.org.
Accepted for publication October 28, 2005.
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B signaling in anti-CD40-induced liver injury in mice. Hepatology 2004, 40:1180-1189[Medline]B-dependent resistance against tumor necrosis factor -mediated liver injury in mice. Hepatology 2001, 34:535-547[CrossRef][Medline]This article has been cited by other articles:
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  C. L. Ahonen, A. Wasiuk, S. Fuse, M. J. Turk, M. S. Ernstoff, A. A. Suriawinata, J. D. Gorham, R. M. Kedl, E. J. Usherwood, and R. J. Noelle Enhanced efficacy and reduced toxicity of multifactorial adjuvants compared with unitary adjuvants as cancer vaccines Blood, March 15, 2008; 111(6): 3116 - 3125. [Abstract] [Full Text] [PDF]
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 J. Yu, A. Y Hui, E. S H Chu, A. S L Cheng, M. Y Y Go, H. L Y Chan, W. K Leung, K. F Cheung, A. K K Ching, Y. L Chui, et al. Expression of a cyclo-oxygenase-2 transgene in murine liver causes hepatitis Gut, July 1, 2007; 56(7): 991 - 999. [Abstract] [Full Text] [PDF]
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 C. Bartholdy, S. O. Kauffmann, J. P. Christensen, and A. R. Thomsen Agonistic Anti-CD40 Antibody Profoundly Suppresses the Immune Response to Infection with Lymphocytic Choriomeningitis Virus J. Immunol., February 1, 2007; 178(3): 1662 - 1670. [Abstract] [Full Text] [PDF]
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