- Journal List
- Front Immunol
- v.4; 2013
- PMC3870411
Front Immunol. 2013; 4: 478.
Published online 2013 December 23. doi: 10.3389/fimmu.2013.00478
PMCID: PMC3870411
TNF Receptor 2 and Disease: Autoimmunity and Regenerative Medicine
Denise L. Faustman1,* and Miriam Davis2
Abstract
The
regulatory cytokine tumor necrosis factor (TNF) exerts its effects
through two receptors: TNFR1 and TNFR2. Defects in TNFR2 signaling are
evident in a variety of autoimmune diseases. One new treatment strategy
for autoimmune disease is selective destruction of autoreactive T cells
by administration of TNF, TNF inducers, or TNFR2 agonism. A related
strategy is to rely on TNFR2 agonism to induce T-regulatory cells (Tregs)
that suppress cytotoxic T cells. Targeting TNFR2 as a treatment
strategy is likely superior to TNFR1 because of its more limited
cellular distribution on T cells, subsets of neurons, and a few other
cell types, whereas TNFR1 is expressed throughout the body. This review
focuses on TNFR2 expression, structure, and signaling; TNFR2 signaling
in autoimmune disease; treatment strategies targeting TNFR2 in
autoimmunity; and the potential for TNFR2 to facilitate end organ
regeneration.
Keywords: TNF, TNF receptor 2, autoimmune disease, type 1 diabetes, regeneration
Introduction
Tumor
necrosis factor (TNF) is a pleiotropic cytokine involved in regulating
diverse bodily functions including cell growth modulation, inflammation,
tumorigenesis, viral replication, septic shock, and autoimmunity (1).
These functions hinge upon TNF’s binding to two distinct membrane
receptors on target cells: TNFR1 (also known as p55 and TNFRSF1A) and
TNFR2 (also known as p75 and TNFRSF1B). TNFR1 is ubiquitously expressed
on the lymphoid system and nearly all cells of the body, which likely
accounts for TNF’s wide-ranging functions. TNFR2 is expressed in a more
limited manner on certain populations of lymphocytes, including
T-regulatory cells (Tregs) (2, 3), endothelial cells, microglia, neuron subtypes (4, 5), oligodendrocytes (6, 7), cardiac myocytes (8), thymocytes (9, 10), islets of Langerhans (personal communication, Faustman Lab), and human mesenchymal stem cells (11).
Its more restricted cellular expression makes TNFR2 more attractive
than TNFR1 as a molecular target for drug development. Activation of
TNFR1 alone by exogenous TNF is systemically toxic (12, 13).
As
a general rule, TNF depends on TNFR1 for apoptosis and TNFR2 for any
function related to cell survival, although there is some degree of
overlapping function depending upon the activation state of the cell and
a variety of other factors (14). Likewise, TNFR1 and TNFR2 have distinct intracellular signaling pathways, although there is some overlap and crosstalk (15).
TNF binding to TNFR1 triggers apoptosis through two pathways, by
activation of the adaptor proteins TNFR1-associated death domain (TRADD)
and Fas-associated death domain (FADD). In contrast, TNFR2 signaling
relies on TRAF2 and activation and nuclear entry of the pro-survival
transcription factor nuclear factor-kB (NFkB) (16–18). TNFR2 expression on Tregs is induced upon T-cell receptor activation (19).
While
the etiologies of autoimmune disorders vary, there is some degree of
overlap in their genetic, post-translational, and environmental origins.
One overlapping feature is that various defects in TNF signaling
pathways, acting through the TNF receptors and NFkB in autoreactive T
cells, occur in both human and mouse models of various autoimmune
disorders, including Crohn’s disease, Sjogren’s syndrome, multiple
sclerosis, ankylosing spondylitis, and type I diabetes (20–39).
The defects range from defects in the proteasome in both the non-obese
diabetic (NOD) mouse model and humans with Sjogren’s syndrome, to
specific polymorphisms in the TNFR1 or TNFR2 receptors themselves, to
punitive interruptions in genes that control the ubiquitination of the
NFkB pathway.
TNFR Expression, Structure, and Signaling
As
noted above, TNFR1 and TNFR2 possess different patterns of expression.
TNFR1 is found on nearly all bodily cells, whereas TNFR2 is largely
found on certain immune cells (CD4+ and CD9+ lymphocytes), certain CNS
cells, and endothelial cells, among others. Neither receptor is located
on erythrocytes. Typically, cells that express TNFR2 also express TNFR1,
with the ratio of expression varying according to cell type and
functional role. Because TNFR1 typically signals cell death, while TNFR2
typically signals cell survival, the ratio of their co-expression will
shift the balance between cellular survival and apoptosis.
TNFR1
and TNFR2 have extracellular, transmembrane, and cytoplasmic
components. The extracellular component of both receptors is rich in
cysteine, which is characteristic of the TNF superfamily. TNFR1 contains
434 amino acids. Its intracellular region of 221 amino acids contains a
death domain that binds TRADD or FADD. In T cells, activation of TRADD
or FADD activates the caspases, resulting in apoptosis (Figure (Figure1).1). A second apoptotic pathway relies on TRADD’s activation of RIP (receptor interacting protein) (Figure (Figure1A).1A).
In contrast to TNFR1, TNFR2 does not have a cytoplasmic death domain.
The receptor consists of 439 amino acids. Its extracellular domain is
formed by the first 235 amino acids, its transmembrane domain is formed
by 30 amino acids, while its cytoplasmic domain is formed by 174 amino
acids. TNFR2’s cytoplasmic domain has a TRAF2 binding site. TRAF2, in
turn, binds TRAF1, TRAF3, cIAP1, and cIAP2 (17, 18). These signaling proteins activate several other signaling proteins, yielding cell survival (Figure (Figure1A).1A).
Cell survival is ensured when the transcription factor NFkB is
liberated from its inhibitor protein IkBα in the cytoplasm and
translocates to the nucleus where it activates pro-survival target genes
(40).
Both TNFR1 and TNFR2 can bind monomeric TNF or trimeric soluble TNF
although soluble TNF induces no or weak signaling for TNFR2. This may be
related to altered association or dissociation kinetics or more optimal
kinetics with pre-formed transmembrane TNF (41). TNFR2 also preferentially binds transmembrane TNF (42).
Transmembrane TNF is a trimer on the cell surface and transmits signals
to the cell where it is contained, i.e., reverse signaling. It is
thought that TNFR2 preferentially binds transmembrane bound TNF (43).
Solution of the crystal structure of the TNF-TNFR2 complexes
demonstrated that these interactions also result in the formation of
aggregates on the cell surface and this likely promotes signaling (44).
TNF Signals throughTNFR1 andTNFR2
receptors (A) but abnormalities in this signaling pathway in
autoimmunity (B) can favor a pathway of selective apoptosis due to a
variety of protein signaling defects.
Transgenic mice have been produced to try to understand better the function of TNFR2 (45). TNFR2−/− mice homozygous for TNFR2−/−
are viable and fertile. They also show normal T-cell development and
activity and are resistant to TNF-induced death. The T-cell
proliferation responses are diminished and they also show abnormal
central nervous system regeneration (JAX Mice Database – 00260).
TNF in Development and Autoimmunity
Tumor
necrosis factor, and its signaling through the two receptors, plays
several crucial roles during normal development. It shapes the efficacy
of the immune system and protects against infectious disease, cancer,
and autoimmune disease (46).
Upon release, TNF proceeds throughout the lifecycle to exert regulatory
roles over immune cells by triggering transcription of genes
responsible for inflammation, proliferation, differentiation, and
apoptosis. To counter a pathological infection, TNF facilitates
proliferation of immune cell clones. To continue to fight against the
infection, TNF stimulates differentiation and recruitment of naïve
immune cells. Subsequently, TNF orchestrates destruction of superfluous
immune cell clones to reduce inflammation and tissue damage once the
infection is resolved.
In the process
of developing autoimmunity, abnormal progenitors to T cells and other
immune cell types proliferate and begin to mature in the thymus. T-cell
education occurs through two parallel pathways for CD4 and CD8 T cells
through either HLA class II or HLA class I cell surface structures. For
almost all autoimmune disease there is strong genetic linkage to the HLA
class II region. This genetic region is rich in immune response genes
and contains not only the class II genes themselves but also the HLA
class I assembly genes such as the tap transporters (Tap1/Tap2) and
proteasome genes (that control self peptide presentation) such as LMP2
(PSMB9), LMP7 (PSMB8), and LMP10 (PSMB10) (47).
During T-cell education, the vast majority of immature immune cells die
by apoptosis, which serves to remove defective progenitors. The process
is not foolproof, however. Failures in T-cell education in humans
perhaps driven by defective antigen presentation allow autoreactive but
still immature T cells defined as CD45RA+ (2H4) and lesser numbers of
CD45RO+ (4B4) to enter the circulation (36, 48, 49).
In humans and autoimmune animal models diverse mutations and
polymorphisms drive altered proteasome function with varying phenotypes
of autoimmunity (50–55).
Once in the circulation, the cells differentiate into mature
autoreactive T cells when they encounter specific self-antigens (56).
The failure of T-cell education of autoreactive CD8 T cells, due to HLA
class I interruption, yields self-reactive T cells directed at specific
self-antigens. This failure underlies various immune diseases,
including type I diabetes, Crohn’s disease, multiple sclerosis, and
Sjogren’s syndrome (50).
TNFR2 Signaling and Benefits to Health
TNFR2
signaling pathways appear to offer protective roles in several
disorders, including autoimmune disease, heart disease, demyelinating
and neurodegenerative disorders, and infectious disease. According to in vitro and in vivo studies, TNF or TNFR2 agonism is associated with pancreatic regeneration (57–59), cardioprotection (60, 61), remyelination (5, 6), survival of some neuron subtypes (5, 62, 63), and stem cell proliferation (11, 64–66).
Knockout of the tnfr2 gene in a mouse model produces a higher rate of heart failure and reduced survival after myocardial infarction (60).
TNFR1 signaling is deleterious and TNFR2 signaling is protective in
regeneration and repair processes following infarcted myocardium in
female mice (61).
An
agonist for TNFR2 selectively destroys autoreactive T cells but not
healthy T cells in blood samples from type I diabetes patients, as well
as multiple sclerosis, Graves, Sjogren’s autoreactive T cells (57).
Animal models of type I diabetes exhibit massive regeneration of the
pancreas after elimination of autoreactive T cells with low-dose TNF (58, 59). TNFR2 is crucial for TNF-induced regeneration of oligodendrocyte precursors that make up myelin (6),
a finding that may be important in the treatment of multiple sclerosis
and other demyelinating disorders, regardless of whether they have an
autoimmune etiology. In viral encephalitis-infected knockout mice, the
TNFR2 pathway is relied upon to repair the brain’s hippocampus, and
TNFR1 is relied upon to repair the brain’s striatum (63).
Oligodendrocyte regeneration appears to occur as a result of TNFR2
activation on astrocytes, which promotes oligodendrocyte proliferation
through the induction of chemokine CXCL12 in an animal model of
demyelination (67).
Lastly, TNFR1 promotes neurodegeneration while TNFR2 promotes
neuroprotection in an animal model of retinal ischemia in knockout mice (68).
TNF Receptor and Autoimmune Disease
A
variety of defects in TNFR2 and downstream NFKB signaling are found in
various autoimmune diseases. The defects include polymorphisms in the
TNFR2 gene, upregulated expression of TNFR2, and TNFR2 receptor
shedding. A recently published study implicates a new decoy splice
variant of the TNFR1 receptor in multiple sclerosis. This causes a
relative deficiency in TNF with inadequate TNFR2 signaling for
autoreactive T-cell selection and induction of beneficial Tregs (39). Polymorphisms in TNFR2 have been identified in some patients with familial rheumatoid arthritis (69–71), Crohn’s disease (72), ankylosing spondylitis (38), ulcerative colitis (73), and immune-related conditions such as graft versus host disease associated with scleroderma risk (74).
Common to several autoimmune diseases, with the notable exception of
type I diabetes, is a polymorphism in which the amino acid methionine is
substituted for arginine at position 196 in exon 6 of chromosome 1p36 (16).
This polymorphism may alter the binding kinetics between TNF and TNFR2,
the result of which may reduce signaling through NFkB.
Upregulated expression of TNFR2 is also found in several immune diseases (16, 75).
Higher systemic levels of soluble TNFR1 (sTNFR1) and soluble TNFR2
(sTNFR2) are produced by administration of TNF to patients, likely by
shedding of receptors into the extracellular space (76, 77).
The greater the TNF stimulation, the greater is the increase in sTNFR1
and sTNFR2. Higher levels of sTNFR2 but not sTNFR1 are found in serum
and bodily fluids of patients with familial rheumatoid arthritis (78)
and systemic lupus erythematosus, both of which are marked by
polymorphisms in TNFR2. TNFR2, but not TNFR1, is upregulated in the
lamina propria of mice with Crohn’s disease, and it causes in vivo experimental colitis (79).
Decreasing the concentration of TNFR2, via receptor shedding or other
means, is a possible compensatory mechanism to lower inflammation. The
extracellular component of TNFR2 is proteolytically cleaved to produce
sTNFR2. This component binds to TNF in the extracellular space, yielding
lower concentrations of TNF available for binding to functional T cells
(80, 81).
The development of the first anti-TNF medications, including soluble
TNFR2 fusion proteins like Enbrel, were therapeutic for some patients
with rheumatoid arthritis but consistently worsened or induced new
autoimmune diseases like type 1 diabetes, lupus, or multiple sclerosis.
The human data are consistent with past mouse data where overexpression
of TNFR2 triggered multi-organ inflammation especially in the presence
of TNF.
To achieve cell survival, the
final steps in the TNFR2 pathway rely on NFkB mobilization and
translocation to the nucleus. This can only occur with an intact
proteasome, which is responsible for cleaving the bond between NFkB and
its inhibitor protein IKBA. A defect that inhibits proteasomal-driven
cleavage of NFkB is seen in the type I diabetes-prone and Sjogren’s
syndrome-prone NOD mouse (33). A protein subunit of the proteasome, LMP2, is lowered in all patients with Sjogren’s syndrome (36, 52, 82). The LMP2 subunit of the proteasome is necessary for intracellular activation of NFkB in highly activated T cells (33).
TNF as Treatment for Autoimmune Disease
Given
the commonality of TNFR signaling abnormalities in autoimmune diseases,
the administration of TNF has emerged as a common treatment strategy.
Low-dose TNF exposure, acting through its receptors, selectively
destroys autoreactive, but not healthy, CD8+ T cells in blood samples
from patients with type I diabetes (57). Low-dose TNF also kills autoreactive T cells in an animal model of Sjogren’s syndrome (83). A similar result with TNF exposure is achieved in blood samples from patients with scleroderma (84).
A sustained effect need not require continuous dosing, unlike treatment
with anti-cytokines or immunosuppressive drugs: TNF can be effective
when administered intermittently (33).
However, the administration of TNF is not feasible in humans because it
is systemically toxic when given to cancer patients who already have
high TNF levels due to an intrinsic defense system (12, 13, 85).
The toxicity of TNF likely stems from the ubiquitous cellular
expression of TNFR1. Because TNFR2 is more restricted in its cellular
expression, TNFR2 agonism may offer a safer therapeutic approach than
administration of TNF. The possibility of intermittent exposure would
also enhance the safety profile. As noted earlier, upregulated
expression of TNFR2 in the target tissue is observed in several
autoimmune disorders on the target; this target tissue expression may be
responsible for the growth-promoting and regenerative properties of TNF
agonism. In a baboon study, TNFR2 agonism was generally safe but
exhibited adverse effects in the form of thymocyte proliferation, a
febrile reaction, and a small, transient inflammation caused by
mononuclear cell infiltration (86).
Not all TNFR2 antibodies are the same, however, as some can bind to the
receptor without eliciting an immune response. It may well be the case
that tissue-specific or cell-specific therapies afford a better safety
profile. Many factors have profound effects on the nature of TNFR
signaling with antibody agonists. Their safety and efficacy are affected
by changes in the ligand, receptor, adapter proteins, or other members
of the signaling pathway. Findings may also vary depending on culture
conditions, origin of cells, and activation state.
The
rationale for TNFR2 agonism as therapy for autoimmune disease was first
shown in type I diabetes. TNFR2 agonism or induction of TNF is an
effective means of selectively killing autoreactive CD8+ T cells in
animal models, in human cells in vitro (33, 58, 83, 87, 88) and in blood samples taken from patients with type I diabetes (57).
In the latter study, there was a dose-response relationship between
TNFR2 agonism and CD8+ T-cell toxicity. The CD8+ T cells were
autoreactive to insulin, a major autoantigen in type I diabetes.
How
is TNF effective at killing autoreactive T cells? A variety of TNFR2
signaling defects prevent liberation of NFkB from IkB, precluding
transcription of pro-survival genes. This in turn biases autoreactive T
cells to shift to the TRADD/FADD cell death signaling pathway which
leads to apoptosis (Figure (Figure1B).1B). In other words, NFkB dysregulation makes autoreactive T cells selectively vulnerable to TNF-induced apoptosis (20).
T cells, unlike B cells and other immune cells, do not constitutively
express the active form of NFkB. Only this active form can translocate
to the nucleus in order to transcribe pro-survival genes.
Therapeutic Strategies for Autoimmune Disease
Small-molecule agonists
Medicinal
chemists have found it challenging to create receptor-specific agonists
for the TNF superfamily. Developing an antagonist is generally
accomplished more readily than developing an agonist. That said,
peptides, antibodies, and small molecules have been developed as TNFR2
agonists (89, 90). Of these types, antibody agonists have been more effective at engaging a specific signaling pathway (57).
In a labor-intensive process, TNFR2 agonists have been developed by
point mutations in the TNF protein by site-directed mutagenesis (90). Our laboratory has recently generated a TNFR2 agonist that activates TNF signaling pathways and suppresses CD8 T cells (91). The advantage of this agonist is that it also induced proliferation of Treg
cells that exert an immunosuppressive function. TNFR2 agonists, while
less toxic than TNFR1 agonists, still may have toxicities, especially to
cells within the CNS (16). For that reason it may be desirable to develop agonists that do not succeed at crossing the blood-brain barrier.
TNF inducers
The
foremost inducer of TNF is the mycobacterium bovis bacillus
Calmette–Guerin (BCG), which has been on the market for decades as a
vaccine for tuberculosis and as a treatment for bladder cancer. Its
chemical equivalent that does not meet FDA’s standards for purity is
complete Freund’s adjuvant (CFA). In an early double blinded
placebo-controlled Phase I clinical trial, BCG administration produced a
transient increase in TNF in the circulation (92).
BCG or CFA have been successfully used in animal models of type I
diabetes to either prevent onset of diabetes or kill autoreactive T
cells, leading to the restoration of pancreatic islet cell function and
normoglycemia (58, 59, 93–95).
Furthermore, in a proof-of-concept randomized, controlled clinical
trial, BCG killed the insulin-autoreactive T cells in the circulation of
patients with type I diabetes (92).
With the removal of insulin-autoreactive T cells, pancreatic islets
managed to regenerate to the extent that there was a transient rise in
C-peptide, a marker for insulin production. The transient rise in
C-peptide was striking, considering that patients in the trial averaged
15years
of disease. This clinical trial data repudiated the presumption that
loss of pancreatic function is irreversible. Although BCG and CFA
release TNF and therefore are not specific for TNFR2, they have low
toxicity and thereby may be safe for treating autoimmune disease by
virtue of inducing low levels of TNF.
NFkB pathway modulation
Nuclear
factor-kB is thwarted from entering the nucleus to transcribe
pro-survival genes in autoimmune diseases featuring defects in TNF
signaling (33, 34).
Instead of being cleaved, NFkB remains bound in the cytoplasm to its
inhibitory chaperone protein IkBa. A genetic defect in type I
diabetes-prone and Sjogren’s syndrome-prone NOD mouse blocks the
proteasome from cleaving NFKB from IkBa (34). Patients with Sjogren’s syndrome also exhibit this defect (52).
Consequently, inhibiting NFkB’s translocation to the nucleus offers
another therapeutic approach to autoimmune disease if it could be done
in the select cells that are disease causing.
TNFR1 antagonism
Tumor
necrosis factor binds to TNFR1 and TNR2. Another way to make TNF
selective for TNFR2 signaling, an effect that could promote tissue
regeneration and remove autoimmunity, is to create a TNFR1 antagonist.
This strategy would bias TNF to act solely through the TNFR2 receptor.
This strategy also appears promising for hepatitis or autoimmunity in
murine models (96).
A humanized TNFR1-specific antagonistic antibody for selective
inhibition of TNF action has been tested with promising results (96–98).
Expansion of T-regulatory cells via TNFR2
T-regulatory
cells are a type of immunosuppressive cell that displays diverse
clinical applications in transplantation, allergy, infectious disease,
GVHD, autoimmunity, and cancer (99). Tregs
co-express CD4+ and the interleukin-2 receptor alpha chain CD25 hi and
feature inducible levels of intracellular transcription factor forkhead
box P3 (FOXP3). Naturally occurring Tregs appear to express TNFR2 at a higher density than TNFR1 (3, 100, 101). There is evidence from animal models that TNF signaling through TNFR2 promotes Treg activity: TNFR2 activates and induces proliferation of Tregs (100) and TNFR2 expression indicates maximally suppressive Tregs (102).
T-regulatory
cells have been proposed to prevent or treat autoimmune disease, but
the rate-limiting problem has been obtaining sufficient quantities,
whether by generating them ex vivo or stimulating their production in vivo. In vivo
stimulation turns out to be too toxic with standard expansion agents
IL-2, anti-CD3, and anti-CD28. These expansion agents can be used to
generate large quantities of Tregs
ex vivo, but the problem is that they produce heterogeneous
progeny consisting of mixed CD4+ populations. Heterogeneous progeny
carry risk: they are capable of releasing pro-inflammatory cytokines and
consist of cell populations with antagonistic properties. Some new
approaches are being attempted, including expansion of Tregs
in vivo with TL1A-Ig, a naturally occurring TNF receptor superfamily agonist (103). Additionally, our laboratory has developed a method of ex vivo
expansion using a newly synthesized TNFR2 monoclonal antibody agonist
that produces homogeneous progeny expressing a uniform phenotype of 14
cell surface markers (91). The TNFR2-agonist expanded Tregs are capable of suppressing CD8+ T cells. In healthy humans, the TNF inducer BCG causes transient expansion of Tregs (91). In a clinical trial, BCG triggers Treg production in patients with type I diabetes (92), which appears to contribute to the suppression of disease and temporary restoration of islet cell function.
Use of TNFR2 for tissue regeneration
When
type 1 diabetes was first reversed in end-stage diabetic mice with
boosting of TNF, the research showed an unexpected outcome (59).
The pancreas of the treated diabetic mice had regenerated their islets
and the original islet transplants that were performed to restore blood
sugars were not needed (59).
The histologic shape of the reappearing insulin secreting islets was
also remarkable. The newly regenerated islets were larger in size than
unaffected, untreated NOD mouse cohorts, and contrasted greatly from
islets of NOD mice that had received immunosuppressive drug strategies,
such as anti-lymphocyte serum or anti-CD4 or anti-CD3 antibodies, to
avert diabetes (104, 105). Past autoimmune treatments of diabetic NOD mice worked almost only in pre-diabetic mice or early new-onset diabetic mice (106).
Also the rescued islets of NOD mice, commonly treated with anti-CD3
immunosuppressive antibodies, were small in size, and demonstrated no or
limited regeneration. The immunosuppressive drug was best administered
to pre-diabetic mice or to mice with recent onset hyperglycemia. In
total, this data strongly suggested that administration of TNF directly
or boosting TNF indirectly with BCG or the heat-killed equivalent, CFA,
had a dual mechanism of action – a direct killing of the autoreactive T
cells and also a TNF effect directly on the target organ to promote
healing and regeneration. Also the TNF effect on the target tissue
indicated that even late stage diabetes could be reversed in large part
due to the regenerative effect in contrast to a pure rescue effect,
survival of existing islets without expansion, of standard
immunosuppressive strategies.
The
effect of TNF on the pancreas was not the only tissue showing possible
regeneration with TNF stimulation. In the field of neuroregeneration,
the Ting laboratory showed TNF similarly promoted proliferation of
oligodendrocytes progenitors and remyelination (6).
Gradually the broader literature reported the regenerative effect of
TNF and TNFR2 agonism on heart regeneration, bone marrow stem cells, and
even neuron regeneration in the setting of Parkinson’s disease model in
mice (11, 60, 66, 107).
Conclusion
An
overlapping feature across autoimmune disorders is various defects in
TNF signaling through its two receptors. TNFR2 is a more attractive
molecular target than TNFR1 because of its limited cellular expression. A
variety of strategies utilizing TNFR2 agonism can be pursued for
treatment of autoimmune disease and also used for regenerative medicine
therapies. TNFR2 agonism has been associated with selective death of
autoreactive T cells in type 1 diabetes and with induction of Tregs.
It holds promise for treating other autoimmune disorders featuring
dysregulation of NFkB, which is a key component of the TNFR2 signaling
pathway.
Conflict of Interest Statement
The
authors declare that the research was conducted in the absence of any
commercial or financial relationships that could be construed as a
potential conflict of interest.
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