REVIEWS THE EVOLUTION AND GENETICS OF INNATE IMMUNITY Deborah A. Kimbrell* and Bruce Beutler‡ The immune system provides protection from a wide range of pathogens. One component of immunity, the phylogenetically ancient innate immune response, fights infections from the moment of first contact and is the fundamental defensive weapon of multicellular organisms. The Toll family of receptors has a crucial role in immune defence. Studies in fruitflies and in mammals reveal that the defensive strategies of invertebrates and vertebrates are highly conserved at the molecular level, which raises the exciting prospects of an increased understanding of innate immunity. CLONAL EXPANSION The proliferation of a lymphocyte clone bearing an antibody or T-cell receptor that is specific for a particular antigen. CLONAL ELIMINATION The removal, generally in the thymus, of a T cell bearing a receptor that recognizes molecules within the host. Such cells, if not eliminated, would otherwise cause autoimmune disease. GRANULOCYTES White blood cells, encompassing neutrophils, eosinophils and basophils, which are dedicated to the ingestion and destruction of microorganisms (bacteria, for example). *Department of Molecular and Cellular Biology, University of California, 1 Shields Avenue, Davis, California 95616-8535, USA. ‡Department of Immunology, The Scripps Research Institute, 10,550 N. Torrey Pines Road, La Jolla, California 92037, USA. Correspondence to D.A.K. e-mail: [email protected] 256 The need for defence against microbial invasion poses two fundamental problems for the host. First, there are many would-be pathogens. How does the host recognize and destroy all of them? Second, how does the host discriminate between the constituents of the external world and the constituents of ‘self ’? In vertebrates, defence against microbial invasion is subserved by two distinct cellular systems: the acquired (‘specific’ or ‘adaptive’) immune system, and the innate immune system. In different ways, each system has solved both fundamental problems. Acquired immunity is mediated by lymphocytes (white blood cells), which have evolved to express an enormous array of recombinant receptors — the immunoglobulins and T-cell receptors — that are capable of recognizing any pathogen that the host might ever encounter. Through CLONAL EXPANSION, cells bearing reactive receptors that are appropriate to the circumstance are called into service; through CLONAL ELIMINATION, selftolerance is enforced. The acquired immune response has arisen only recently; it was built atop the phylogenetically older innate immune system, by which it is controlled and assisted. In the absence of an innate immune system, the acquired immune response offers weak protection — a circumstance that is all too evident in those patients that have inadequate numbers of circulating GRANULOCYTES. Innate immunity developed before the separation of vertebrates and invertebrates, and most | APRIL 2001 | VOLUME 2 multicellular organisms exclusively depend on it. It is a system that acts effectively without previous exposure to a pathogen. Moreover, it confers broad protection against pathogens. Whereas the acquired immune response takes days or weeks to develop maximum efficacy, the innate immune response is essentially instantaneous. Although both immune systems were discovered at around the same time, insight into the mechanisms used by acquired immunity quickly outpaced a comparable understanding of innate immunity. Ehrlich’s ‘antitoxins’1 (antibodies) were, after all, abundant proteins that were known to circulate in the bloodstream, which made them accessible to measurement and chemical analysis from the time that they were first detected. The purification of antibodies, the determination of their primary and tertiary structure and, ultimately, the triumphant understanding of the rearrangements that occur to yield antibody diversity, had partly been achieved by the early 1980s. By contrast, the ‘eyes’ of Metchnikoff ’s phagocytes2 in the innate system have evaded detection for a much longer time. The elucidation and insight into innate immunity required very different methods and different perspectives, drawn from two separate domains of biology that involve insects and mammals. The last common ancestor of insects and mammals is thought to have lived more than half a billion years ago. During that time, the physiology of insects and mammals has diverged considerably: innate immune © 2001 Macmillan Magazines Ltd www.nature.com/reviews/genetics REVIEWS a b Microglial cell Circulating antimicrobial peptides Digestive tract Melanotic cluster Trachea Alveolar macrophage Fat body Lungs Kupffer cell Spleen Liver Stomach Reproductive system Clotted wound Lymph node Needle Haemocyte Microbe inactivated by antimicrobial peptides Phagocytosed microbe Natural killer cell Figure 1 | The immune response in Drosophila and in mammals. a | In Circulation Drosophila, the hallmark of the humoral immune response is the induction of antimicrobial peptides. A systemic infection induces the transcription of antimicrobial peptides, mainly in the fat body of the fruitfly (blue), which is analogous to the liver. These peptides are transported into the haemolymph Granulocytes (blood), where they accumulate to high concentrations and circulate 54 throughout the body . Some tissues respond directly to localized sites of infection23,27. For example, the trachea (orange) — the respiratory system — produces antimicrobial peptides in response to airway infections and the reproductive system (yellow) produces antimicrobial peptides23,27,53. The Monocyte cellular immune response is characterized by the presence of haemocytes (blood cells), which circulate or attach themselves to organs. A subset of haemocytes produces antimicrobial peptides in response to infection. Haemocytes mobilize throughout the body to phagocytose invading microbes and to produce melanotic clusters, which are composed of melanized haemocytes that surround other cells. Melanotic clusters are formed when: haemocytes encapsulate the egg of a parasitic wasp that has been injected into the HAEMOCOEL of a larva95; haemocytes form nodules around masses of bacteria; abnormal haemocytes or haematopoietic organs form melanotic tumours, which if not lethal persist in the adults78; haemocytes respond to and melanize around abnormal self tissue, which is generally not lethal and found in larvae and adults78–79,96. A systemic infection can be instigated in the laboratory by puncture with a septic needle (as indicated in the figure) or in nature by a septic wound. In both cases, the site of wounding clots with a melanincontaining seal. Infection can also be instigated in nature through internal organs, such as bacterial infection through the larval gut by Erwinia carotovora97. b | Macrophages are distributed throughout the mammalian body and, although macrophage cells are morphologically diverse, they fulfil similar functions. The liver and spleen on the one hand, and the lymph nodes on the other, are particularly important stations for the interception of pathogens that circulate in the blood or lymph, respectively. Macrophages engulf and destroy microbes upon first encounter, and also secrete cytokines that orchestrate both the innate and adaptive immune responses. The dendritic cell, a specialized relative of the macrophage, presents antigens to lymphoid cells to stimulate adaptive immunity. Neutrophils patrol the blood to detect pathogens, but rapidly attach to the walls of small blood vessels and leave the circulation by extravasation when the body is threatened by an extravascular infection. Many cells can produce antimicrobial peptides, which guard epithelial surfaces against invasion and also help to ensure the sterility of the plasma. In addition to the indicated epithelial surfaces, antimicrobial peptides also protect additional sites such as the skin and the reproductive tracts. CYTOKINES A wide array of proteins, functionally similar to classical endocrine hormones, that mediate signalling between cells. Cytokines have a vital role in communication between different cells of the immune system. Although usually secreted, they might occasionally be anchored to cell surfaces. They often act at close range, but also circulate and exert their effects at a distance. defence based on antimicrobial peptides predominates in insects, whereas CYTOKINE-mediated inflammation seems to hold sway in mammals. Was there reason to suspect that they would have much in common? In fact, innate defence is so fundamental that vertebrates, invertebrates and plants have many similarities. Genetic studies in Drosophila and mice were central to the appreciation of such similarities. In this review, we examine common themes in the defensive strategies used by Drosophila and mammals, and focus in particular on Toll-receptor signalling. NATURE REVIEWS | GENETICS How is an invader recognized? Invasive microbes of all types must be recognized, regardless of the route by which they enter the host. Where does such recognition take place, and what is the crucial interface between the pathogen and the immune system of the host? A multilaminar array of defences is the rule in multicellular organisms and, in most, the first tier of defence is a physical barrier (for example, the skin in mammals and the exoskeleton in insects). Once this layer of defence has been breached, various specialized cells and tissues are responsible for the containment of © 2001 Macmillan Magazines Ltd VOLUME 2 | APRIL 2001 | 2 5 7 REVIEWS HAEMOCOEL The haemocoel is the blood space of arthropods and molluscs. It is a very large, blood-filled cavity, which occupies most or all of the body. HUMORAL IMMUNITY B-cell-mediated immunity in mammals that fights bacteria and viruses in body fluids with antibodies that circulate in blood plasma and lymph, fluids formerly called humours. In insects, humoral immunity refers to the immune response that produces antimicrobial peptides, particularly at high concentrations in the haemolymph (blood). MACROPHAGES Phagocytic cells that respond to non-self material (for example, bacteria, protozoa or tumour cells) to release substances that stimulate other cells of the immune system. They are also involved in antigen presentation and are derived from monocytes, which circulate in the blood. GRAM-NEGATIVE Bacteria that fail to take up Gram stains during histological preparation for identification: typically bacteria present in the bowel rather than the throat and respiratory tissues. Examples of infections caused by this class of bacteria include the plague, tularemia, cholera and typhoid fever. REL ONCOGENE The Rel oncogene was originally found in an avian reticuloendotheliosis virus; it is the prototype of a family of transcription factors that includes NF-κB, c-rel, Relish, Dif and Dorsal. GRAM-POSITIVE Bacteria that take up Gram stains during histological preparation for identification: typically bacteria present in the throat and respiratory tissues. Infections caused by this class of bacteria include anthrax and listeriosis. 258 infection, and constitute the next tier of defence (FIG. 1). In Drosophila, for instance, haemocytes (blood cells) are the bulwark of the cellular response, and the fat body (analogous to the liver) is the main site of the HUMORAL IMMUNE RESPONSE, which produces abundant antimicrobial proteins. In mammals, MACROPHAGES and other phagocytic cells patrol the blood and interstitial tissues, and are found at their highest density in specialized lymphoreticular organs (the lymph nodes and spleen). Recognition of infection by this second tier of defence lies at the centre of innate immunity. Here, as in most biological systems, recognition implies the existence of specific receptors. Microorganisms have various features that distinguish them from multicellular organisms — features that have been exploited by the innate defence system to recognize and combat pathogens. These features are known as ‘microbial patterns’ and their detectors are defined as ‘pattern-recognition receptors’3. Examples of microbial patterns include β-1,3-glucan of fungi, peptidoglycan and lipopolysaccharide (LPS) of bacteria, and phosphoglycan of parasites. Many pattern-recognition receptors have been identified in vertebrates and in invertebrates. For example, the β2 integrin CR3 (also known as ITGB2 in humans) is a broad-range pattern-recognition receptor4. Scavenger receptors, known in mammals as a family of proteins with diverse ligands, have many counterparts in Drosophila5,6. In insects other than Drosophila, the peptidoglycan-recognition protein (PGRP) has been identified in Trichoplusia ni 7, and the GRAM-NEGATIVEbinding protein (GNBP) has been isolated from both the silkmoth Bombyx mori 8 and the mosquito Anopheles gambiae 9. In Drosophila, a family of PGRP genes and one GNBP gene have been identified10,11. Lectins (the mannose-binding protein, for example), which have carbohydrate-recognition domains, are also common in vertebrates and are increasingly being found in invertebrates12. The Drosophila genome project has revealed many other genes of these types13, but none has been shown to directly mediate an immune response. The best candidates include the PGRP family and GNBP, as some of the PGRP proteins bind peptidoglycan10 and GNBP confers a response in Drosophila cells in tissue culture11. Pattern-recognition receptors are not necessarily cell associated. The mammalian LPS-binding protein (LBP) is one example. This circulating protein, produced by the liver, delivers LPS to the surface of macrophages, permitting the quick detection of a Gram-negative infection. But it does not directly alert cells. Mannosebinding protein, and soluble versions of CD14 (a lipidanchored membrane protein), are other examples of ‘peripheral’ sensors that detect host invasion. Drosophila Toll protein The most striking paralogous system for innate-immunity sensing is the array of Toll family receptors, of which Drosophila Toll is the prototype. Toll is a singlepass transmembrane receptor with an ectodomain marked by leucine-rich repeat motifs. The Toll gene | APRIL 2001 | VOLUME 2 was originally identified for its essential role in development as the determinant of dorsoventral polarity in the fruitfly embryo (BOX 1). In addition, Toll was found to have a crucial role in immune defence. This second function of Toll was discovered by investigating the transcriptional regulation of antimicrobial genes that are induced by infection. Subsequently, nuclear factorκB (NF-κB) immune signalling, first identified in mammals, was suggested to occur in insects because NF-κB-binding motifs were identified in promoters of immunoresponsive genes in the silkmoth (Hyalophora cecropia) and in Drosophila14. Several additional common features further supported the possibility of a NFκB-related system in Drosophila. For example, Dorsal and Cactus, which are downstream members of the Toll dorsoventral cascade, are homologous to mammalian NF-κB and to its inhibitor IκB, respectively. Cactus and Dorsal also associate with one another in a manner similar to that of NF-κB and IκB, to produce a latent transcription factor. Subsequently, Toll and the entire dorsoventral regulatory gene cassette were tested directly for involvement in the Drosophila immune response and found to control the response to fungal infection15. Flies deficient in Toll were so severely immunocompromised that a fungal infection was lethal and correlated to the lack of proper induction of the antifungal protein gene Drosomycin. By contrast, Toll mutants showed normal rates of survival when exposed to bacterial infection, although they showed a reduced induction of antibacterial protein genes. Therefore, the regulation of the genes induced by infection seemed to be quite complex15. At least part of this complex regulation could be understood from the results of previous studies on the gene imd (immune deficiency)16. Flies that were mutant for imd had an immunocompromised response to bacteria, but had normal resistance to fungal infection16. So, at least two pathways of immune response were established: one mediated by Toll and the other by Imd. In addition to dorsal, two more genes with homology to the NF-κB/REL ONCOGENE were identified. These are Dif (Dorsal-related immunity factor) and Rel (Relish)17,18. In parallel to NF-κB/REL proteins in mammals, Dorsal, Dif and Rel seem to function as homodimers and heterodimers in the regulation of the immune response19. Altogether, the results indicate largely separate but partially interrelated pathways for signalling that involve Toll and Imd, respectively, converging upon REL-domain-containing proteins. More specifically, the Toll dorsoventral regulatory cassette and Dif mainly respond to fungal and GRAM-POSITIVE bacterial infections, whereas Imd and Rel mainly respond to Gram-negative bacterial infections15–19. This has been confirmed and extended by the findings that Dif mutants are sensitive to fungal infection20, and that homologues of the mammalian IκB kinase (IKK) complex regulate Rel in the antibacterial response21,22 (see figure in BOX 1). Additionally, the response of antimicrobial peptide-encoding genes is tissue-specific, and in particular imd, rather than Toll, regulates Drosomycin in the respiratory tract23. © 2001 Macmillan Magazines Ltd www.nature.com/reviews/genetics REVIEWS Box 1 | Toll and Toll-like receptor signal transduction a | Drosophila development and immunity. Toll was first identified in the landmark genetic screens of Christiane Nusslein-Volhard and Eric Weischaus for mutations that alter embryonic patterning in Drosophila51,52. The original signal Serine for dorsoventral polarity is maternally derived and is relayed by a signalNec protease transduction pathway into the embryo to produce a nuclear morphogen Imd gradient51,52 (the members of the classical signal-transduction pathway are or Spätzle indicated in red type in part a). Toll is the cell membrane component of the IKK system and, as such, is centrally positioned in the cascade of events that lead to Toll dorsoventral axis formation. Downstream from Toll are Pelle, a protein kinase, β γ receptor Cell and Tube, both of which have domains characteristic of cell-death signalling membrane proteins (indicated as ‘d’ for death domain). The last member of the pathway is Tube d d Pelle encoded by the dorsal gene. Upon Toll signalling, Dorsal (a Rel-homology Rel domain protein) dissociates from the Dorsal–Cactus complex. This leads to the degradation of Cactus and the translocation of Dorsal into the nucleus, where it X X induces the transcription of zygotic genes. Ultimately, the nuclear gradient of Dorsal across the embryo sets the dorsoventral pattern of embryonic structures. These, plus additional genes (black type), are also used in immunity to direct the Cactus Dorsal Dif Cactus expression of immune-response target genes. In fact, the signalling pathways involved in the immune response are much more complicated, as the Imd and Rel pathways have also been found to mediate the DNA Nucleus immune response. The canonical Toll dorsoventral regulatory cassette and that Immune response target genes mediated through the Rel-oncogene domain protein Dif mainly respond to fungal Developmental target genes and Gram-positive bacterial infections, whereas Imd and Rel (also a Rel-oncogene domain protein) mainly respond to Gram-negative bacterial infections15–19. b b | Signal transduction. The immune pathways of Drosophila (blue in part b) that Ligand/ Lipopeptides LPS were shown in panel a are compared with the pathways in mammals (green). The inducer: Peptidoglycan Gram-negative bacteria Fungi term ligand refers to the molecules that bind to the mammalian receptors, whereas Gram-positive bacteria inducer refers to the the molecules that activate Drosophila receptors because Spätzle (which binds to Toll-1) is the only confirmed ligand in Drosophila. It is commonly asserted that Toll-like receptors (TLRs) are dimeric proteins, although Receptors: TLR2 TLR4 it is uncertain whether they are all homodimers, or whether some heterodimers Toll1 ? exist. Enforced dimerization of TLR4 leads to transduction of a signal in vitro29, as do polyclonal antibodies against TLR485. Moreover, a multimeric structure of Signalling: MyD88 MyD88 TLR4 would account for the dominant-negative phenotype of a Tlr4 mutation in IRAK IRAK the C3H/HeJ strain of mice. It is also widely believed that MYD88 transduces the TRAF6 TRAF6 signal from all ten mammalian TLR family members, although this has not been NIK/IKK NIK/IKK Tube/Pelle Imd tested for all of the receptors, nor can it be until their specific ligands have been IKKB/IKKγ identified. In mammals, MYD88 is presumed to associate with the interleukin-1 receptor-associated kinase (IRAK), which is homologous to Drosophila Pelle. IRAK might be recruited to the MYD88–TLR complex through the action of Targets: IκB/NF-κB IκB/NF-κB another protein, known as Tollip86. The signal from IRAK is carried, perhaps in Dorsal/Dif/Cactus Rel conjunction with TRAF6, to TAK1, NIK and finally, IκB. Degradation of IκB permits the nuclear translocation of NF-κB (a homologue of the Drosophila Dorsal protein), and ultimately, the transcription of many genes that are NF-κB dependent. Among these are genes that encode cytokines, which mediate inflammation and signal the activation of adaptive immunity. The sequence of events as outlined is incomplete because it is clear that some activating events can occur in the absence of MYD88 (REF. 87) and of IRAK. Other, unknown, proteins might function as part of the activation complex for individual TLRs, or perhaps for all TLRs collectively. In fact, a human mutation (in an uncloned locus) seems to abrogate signalling pathways as diverse as those initiated by TLRs, such as the TLR4 and the IL-1 receptor88. (Dif, Dorsal-related immunity factor; IκB, nuclear factor (NF)-κB inhibitor; IKK, IκB kinase; Imd, immune deficiency; Nec, Necrotic (a Drosophila serine protease inhibitor); NIK, NF-κB-inducing kinase; Rel, Relish; TAK1, TGF-β-activated kinase 1; TRAF6, tumour-necrosisfactor-receptor-associated factor 6.) a Fungi Gram-positive bacteria Gram-negative bacteria Surprisingly, the ligand for Toll in the immune response is not a microbial product, and so Toll is not a pattern-recognition receptor24. Instead, Toll is activated by the same ligand in the antimicrobial response as in the determination of dorsoventral polarity24. This ligand is the proteolytically cleaved product of spätzle, which encodes a growth factor of the cysteine knot family. Interestingly, the processing of Spätzle by an extracellular serine protease is nega- NATURE REVIEWS | GENETICS tively regulated by a serine protease inhibitor of the serpin family, encoded by Spn43Ac at the nec locus (necrotic)24. In Spn43Ac-deficient mutants, the antifungal protein gene Drosomycin is constitutively active, unless the mutant is also deficient for spätzle or Toll. Toll signalling thus involves negative regulation by this inhibitor24, indicating that the microbial activation of Toll signalling might also proceed by the inactivation of Spn43Ac. © 2001 Macmillan Magazines Ltd VOLUME 2 | APRIL 2001 | 2 5 9 REVIEWS The Drosophila Toll receptor is one of a family of Toll homologues, which includes Toll (Toll-1), 18 wheeler (18w or Toll-2) and Toll receptors 3–9 (REFS 25, 26). The 18w gene functions in development and in the response to bacterial infection25. Out of Tolls 1–8, only Toll-1 and Toll-5 can induce antimicrobial protein genes in a cellculture assay26, and these receptors only induce an antifungal response. Furthermore, Toll-5 seems to signal through the Toll dorsoventral signalling pathway. In contrast to systemic fungal infection, which uses the Toll-1 pathway, local fungal infections do not depend on Toll-1 or Spätzle signalling27. In principle, Toll-5 might mediate the local response, but would not depend on Spätzle for this purpose. As such, Toll-5, unlike Toll-1, might be a pattern-recognition receptor. An alternative hypothesis might be that an antifungal response signals through a pathway that does not involve the Toll family. Out of the remaining Toll genes, Toll-6, Toll-7 and Toll-8 are present at high levels during embryogenesis and moulting, which indicates that these, like Toll and 18w, might have a role in development26. As Tolls 3–9 have only been identified recently, mutants are not yet available to test the respective functions of these receptors. Mammalian Toll-like receptors The first mammalian protein that was shown to have homology to Toll was the interleukin-1 receptor (IL1R)28. This receptor signals through the IL-1R-associated kinase (IRAK), a homologue of the Drosophila dorsoventral protein kinase Pelle (BOX 1). IRAK activates NF-κB translocation in the same way that Toll activates a REL family member (later shown to be Dif 20). In spite of this, and although IL-1R has an undoubted role in immunity, it does not act as a primary sensor of infection. Instead, IL-1 is produced by macrophages that have previously sensed infection. Moreover, in structural terms, IL-1R and its close homologues in the mammalian genome (IL-18R and ST2) differ from Toll in their ectodomains, which are derived from the immunoglobulin superfamily and do not contain leucine-rich repeat motifs. In the late 1990s, interest in the immune function of Toll in Drosophila inspired a directed search for other mammalian genes that are related to Toll. This search was facilitated by the advent of expressed sequence tag (EST) databases, which permitted homologous genes to be quickly identified and cloned. By the beginning of 1998, five Toll-like receptors (TLRs) had been cloned from mammalian cDNAs on the basis of the observed homology between ESTs and Drosophila Toll. However, the function of these TLRs was not clear. More than 500 million years of divergence between Drosophila and mammals has drastically altered the function of many proteins and eliminated many others from one or the other species. However, in the realm of innate immunity, it might rightly have been pointed out that some things had not changed. The antimicrobial peptides of Drosophila were, after all, present in mammals (porcine cecropin, for example) and, among its many functions, NF-κB was well known to be important in mammalian innate 260 | APRIL 2001 | VOLUME 2 immunity, especially insofar as it assisted in the transcription of many cytokine genes. Moreover, one representative of the leucine-rich Toll-like receptor family (hToll; later called TLR4) elicits NF-κB translocation29. This reaffirmed that the Toll-like receptors might participate in the inflammatory response, but again, gave no clue as to their precise function. Attempts to establish function by expressing Toll-like receptors at high levels in mammalian cells gave the wrong impression of their function. Indeed, it was claimed (incorrectly) that mammalian Toll-like receptor 2 (TLR2) could transduce the LPS signal30,31, a proposition that was ultimately rejected on the basis of knockout and positional cloning studies in mice (see below). Hence, the TLRs remained orphans and, ultimately, the primary sensors of innate immunity in mammals were identified using a purely genetic approach. This approach grew from a biological puzzle of long standing, related to the responses of whole animals to infection by Gram-negative bacteria, and more precisely, to the response to LPS. LPS was widely known as an activator of innate immunity par excellence, and had been structurally defined from several species of Gramnegative bacteria32. When administered to most mammalian species, LPS causes the prompt development of fever, disturbances in the clotting of blood (hypercoagulability in some parts of the vascular tree and haemorrhage elsewhere), hypotension and shock33. All these effects are mediated by the activation of macrophages34,35, which in turn release toxic cytokines, notably tumour necrosis factor (TNF). This factor is known to provoke the release of terminal constituents of the inflammatory cascade36, and is considered to be largely responsible for LPS-induced lethality. In mice, and by implication perhaps in all mammals, genetic evidence favoured the existence of a single pathway to transduce the LPS signal37,38. So, spontaneous mutations at the Lps locus in C3H/HeJ mice and in C57BL/10ScCr mice entirely abolish responses to LPS. Although such animals survive the administration of any dose of LPS, they are highly susceptible to infection by Gram-negative bacteria, succumbing over a period of days to the injection of small numbers of Salmonella typhimurium, which seem to grow without restriction in the liver and spleen39. It therefore seems that LPS sensing is of crucial importance for innate immune recognition of Gram-negative infection. The pathway through which LPS signals has been investigated extensively at a biochemical level. The LPS is conveyed to the surface of cells by the acutephase reactant LBP. There, it binds to the glycosylphosphoinositol-anchored membrane protein CD14. However, as CD14 lacks a transmembrane domain, how the LPS signal might be transduced across the membrane remained unclear. The genetic lesions of C3H/HeJ and C57BL/10ScCr mice seemed to offer a clue to the puzzle. The Lps mutations of these mice were identified by a strict positional cloning approach and were found to affect the Tlr4 gene40,41. In C3H/HeJ mice, a point mutation (P712H) modified the cytoplasmic domain of the © 2001 Macmillan Magazines Ltd www.nature.com/reviews/genetics REVIEWS Figure 2 | Evolution of the Toll interleukin-1-receptor domain. Two great divisions in the evolution of the Toll interleukin-1-receptor (TIR) domain are immediately evident in the phylogenetic tree, as Metazoa (brown) and Viridiplantae (green) show only weak TIR homology at the protein level. TIR domains are found in most plant and animal taxa. In early metazoans, at least three lines of TIR became established. These gave rise to most of the Drosophila Tolls (1–8; a relatively primitive offshoot), to the IL-1R/IL18R/ST2/MYD88/SIGIRR cluster, and to the mammalian TLR cluster, in which Drosophila Toll-9 is also represented. Estimates of divergence dates include the mammalian radiation (~120 Myr); the divergence of birds and mammals (~310 Myr); the divergence of insects and mammals (~600 Myr); and the divergence of plants and animals (~1,800 Myr). Most sequences for plant disease resistance proteins (green) came from Arabidopsis thaliana (AT). Also included are sequences (obtained from GenBank and SMART) from Linum usitatissimum (LU), Solanum tuberosum (ST) and Nicotiana tabacum (NT). The animal sequences (brown) used were derived from Mus musculus (MUS), Homo sapiens (HUM), Equus caballus (EQU), Gallus gallus (GAL), Drosophila melanogaster (DM), Rattus norvegicus (RAT), Drosophila pseudoobscura (DP) and Schistocerca americana (SA). The plot was made using the MAXIMUM PARSIMONY method, and the phylogram is linear with respect to the time of divergence. Calculations were performed using GCG software. AT-O81747.-3 AT-F16620.210 AT-T1308.20 AT-AC00418 AT-F23E13.40 AT-F24J7.90 AT-O23001 AT-T8F5.18 AT-AC002342 AT-F16G20.210 AT-RPP1 AT-Q9ZSN4 AT-Q9ZSN5 AT-RPP1 AT-T22B4.150 AT-AC005167 AT-Z97342 AT-O04264 AT-AL161545 AT-Z97342 AT-Z97342 AT-Z97342 AT-T24H24.18 AT-F24J7.60 AT-A71438 AT-F23E13.30 AT-F24J7.80 AT-AC002354 AT-T7N9.24 AT-T7N9.23 AT-T7N9.24 AT-004565-2 LU-L6TR LU-U73916 ST-NL25 ST-NL27 NT-U15605 AT-O49469 AT-F24J7.60 MUSTLR9 HUMTLR9 MUSTLR8 HUMTLR8 MUSTLR7 HUMTLR7 MUSTLR5 HUMTLR5 HUMTLR3 HUMTLR4 EQUTLR4 MUSTLR4 MUSTLR2 HUMTLR2 GALTLR2 MUSTLR6 HUMTLR6 HUMTLR1 HUMTLR10 DMTOLL9 RATFIT1M MUSST2 MUSIL1RAP HUMIL1RAP RATL1RAP MUSIL1RRP HUMIL1RRP RATIL1R MUSIL1R HUMIL1R RATL1RRP2 HUMIL1RRP2 GALIL1R MUSIL18RAP HUMIL18RAP HUMSIGIRR HUMMYD88 DMMYD88 DMTOLL7 DMTOLL2 DMTOLL6 DMTOLL4 SATOLL DMTOLL3 DPTOLL DMTOLL1 DMTOLL5 DMTOLL8 MAXIMUM PARSIMONY A mathematical method for determining the evolutionary relationship between proteins, wherein account is taken of the minimum number of mutations that are required to effect transition from one member of the family to another. Last common ancestor of: Plants/animals 2,000 Myr ago NATURE REVIEWS | GENETICS 1,500 Myr ago Insects/mammals 1,000 Myr ago Birds/mammals 500 Myr ago Mammalian TLR cluster IL-1/IL-18/ ST2/SIGIRR/ MYD88 cluster Drosophila Toll cluster Mice/human Present © 2001 Macmillan Magazines Ltd VOLUME 2 | APRIL 2001 | 2 6 1 REVIEWS Tlr4 protein, creating a dominant-negative effect42. In C57BL/10ScCr mice, the locus was deleted entirely43, leading to a recessive failure of the LPS response. Later, a knockout mutation of Tlr4 (REF. 44) proved to be an excellent phenocopy of the C57BL/10ScCr mouse in terms of LPS response, confirming that the gene is required for LPS signal transduction. In further genetic studies of LPS responses, it was demonstrated that the species origin of Tlr4 was entirely responsible for species-specific responses to certain LPS partial structures45,46. For example, although a tetra-acylated form of lipid A (the toxic centre of LPS) elicits a strong response from mouse or hamster macrophages, it behaves as a pure antagonist of LPS when applied to human cells. Correspondingly, mouse and hamster Tlr4 is capable of responding to tetra-acylated lipid A, whereas human TLR4 is not and, indeed, is blocked by tetra-acylated lipid A in its ability to respond to LPS. This observation effectively proves that Tlr4 has direct contact with LPS. During 1999 and 2000, knockout mutations of Tlr2 and Tlr9 revealed that the former acts as a specific transducer for bacterial lipopeptide and peptidoglycan signals47, whereas the latter acts to detect bacterial DNA48. The general impression of TLR function, therefore, is one in which each of the TLRs recognizes a discrete subset of those molecules that are widely shared by microbial pathogens. In this way, ten TLRs collectively provide protection against an immense number of microorganisms. Evolution of Toll-like receptors BILATERIA Members of the animal kingdom that possess bilateral symmetry — the property of having two similar sides, with definite upper and lower surfaces, and anterior and posterior ends. PROTHROMBIN (clotting factor II). One of the 13 chemical components of the blood that create the clotting mechanism. Prothrombin is a blood plasma protein and is synthesized in the liver. COMPLEMENT Group of blood proteins that circulate and reside in the tissues, the actions of which ‘complement’ the work of antibodies. They ‘burst’ bacteria by creating pores in the bacteria’s membrane. Complement proteins can also cover the surfaces of bacteria and act as flags for phagocytes. Proteolytic cleavage fragments of complement proteins act as local signals for inflammation. 262 The protein motif shared by Toll and IL-1R, or TIR, is evident in plant proteins as well as in animal proteins49,50, so this motif might be traceable to the origins of eukaryotic life, that is, between one and two billion years ago. In plants, the TIR motifs fulfil well-established but mechanistically undefined defensive functions, protecting plants from infection by fungal, viral or bacterial pathogens. Plant proteins that bear TIR domains are cytoplasmic, and the TIR domain is generally located at the amino-terminal end of the polypeptide chain, rather than at the carboxy-terminal end, in contrast to the arrangement of TIR domains in animal proteins. Plant TIRs are often present in conjunction with a nucleotide-binding domain or, alternatively, with leucine-rich repeat motifs. In animals, the modern descendants of the TIR superfamily were established within the BILATERIA, which includes the last common ancestors of humans and flies. Most mammalian TIR domains are a part of membrane-anchored proteins (the transducer MYD88 (myeloid differentiation primary response gene 88) being the exception). The fact that a close relative of MYD88 (SIGIRR — single immunoglobulin (Ig) IL1R-related molecule) is a transmembrane protein (although one that has acquired Ig-type repeats) might be evidence that transducers have, even in recent times, been able to acquire constitutive membrane localization. MYD88 and SIGIRR share a proximal common ancestor with the IL-1R/IL-18R/ST2 family | APRIL 2001 | VOLUME 2 of TIR-bearing receptors. In Drosophila, two lines of leucine-rich Toll receptors are represented: Tolls 1–8 and Toll-9. The Toll-9 receptor resembles the mammalian TLRs more closely than do any of the other Drosophila Tolls. Among mammals, only a single type of TLR survives (FIG. 2). There is a fundamental difference in the use of Tolls (by insects) and TLRs (by mammals). On the basis of present evidence, it is known that some Tolls respond to an endogenous protein ligand that is generated by proteolytic cleavage, as stated above for Toll-1, and have no direct contact with microbial molecules, whereas mammalian TLRs are pattern-recognition receptors. A final discrepancy between the Tolls and the TLRs relates to the dual function ascribed to the former proteins. As described above, Toll and 18w have developmental as well as immune functions, and other Drosophila Toll genes might be similar in this respect. By contrast, no representative of the TIR family is believed to be essential for development in mammals. Although the archetypal function of TIRs seems to be a defensive one, in the sense that both plants and animals broadly apply the TIR for this function, Drosophila has adopted the TLR for developmental tasks as well. Further studies will discern whether mammalian TLRs also have developmental functions, and if this current discrepancy between insects and mammals is meaningful. An intriguing question is raised by this last observation. To permit the normal development of dorsoventral polarity, the Toll ligand Spätzle is cleaved from pro-Spätzle in the extracellular space by the active form of the protease Easter 51,52. Easter is activated by Snake, which in turn is activated by Gd (Gastrulation defective). Gd, which is activated by Pipe, Nudel and Windbeutel, has the strongest homology to mammalian PROTHROMBIN, and Snake and Easter resemble several proteins known to participate in the coagulation and COMPLEMENT cascades and, therefore, in the inflammatory response. Do development and inflammation then share a genuine functional ancestry? Insofar as proteins might be ‘captured’ to discharge tasks wholly different from those that they originally evolved to serve, no clear answer can be given. What is the response to infection? Insects have three general innate responses (FIG. 1): the synthesis of antimicrobial peptides; phagocytosis or encapsulation of invading organisms by haemocytes; and the initiation of proteolytic cascades, leading to clotting and melanization. In Drosophila, several signalling pathways other than those that involve the Toll family and imd genes have been implicated in the response to infection, for example the JNK (jun kinase) and JAK/STAT (janus kinase/signal transducers and activators of transcription) pathways (see below and TABLE 1). The main effectors of the insect humoral immune response are the antimicrobial proteins, the study of which led to the first area of insect immunity to be © 2001 Macmillan Magazines Ltd www.nature.com/reviews/genetics REVIEWS Box 2 | Apoptosis and the immune response Cell death represents a threat to an organism because of the potential release of harmful cellular components. There is mounting evidence of a similarity between the mechanisms for dealing with this type of internal threat and that of the external threat towards which innate immunity is directed. Because both immunity and apoptosis involve engulfment of cells by macrophages, the connection is logical but highlights the problem of self versus non-self recognition. The consideration of response to internal and external threats as part of the same overall process of defending the organism has been termed the ‘danger model’89. In Drosophila, the transduction of cell-death signals and the induction of an antimicrobial response has recently been connected by the dual function of the CASPASE Dredd (Death-related ced-3/Nedd2-like protein), which was first shown to be an effector of apoptosis90, and now has been identified as a participant in the immune response91,92. More specifically, Dredd is a regulator that is essential for resistance to Gram-negative bacterial infections92. Additionally, dredd, imd (immune deficiency) and Rel (Relish) might define a pathway that is required for resistance to Gram-negative bacteria92. In mammals, the caspase cascade is activated by interactions between plasma membrane receptors and cytoplasmic proteins such as FADD (Fas-associated death-domain protein) — sometimes itself activated through interaction with another death-domain protein, TRADD, which associates with the tumour necrosis factor (TNF)-receptor. FADD triggers the activation of the procaspase 8 (FLICE) directly or through Apaf1, which triggers activation of procaspase 9. Both a Drosophila homologue of FADD (REF. 93) and a Drosophila homologue of Apaf1, known as Dark (REF. 94), are reported to engage Dredd, thereby triggering apoptosis. Therefore, a system with similarity to the Fas/TNF/LT (lymphotoxin) signalling cascades is present in flies and can be tested further for connections between immunity and apoptosis. CASPASE Enzymes that are responsible for the breakdown of the cell during apoptosis by cleaving numerous cellular proteins. They are synthesized as inactive procaspases that are later activated by proteolytic cleavage into active caspases. PUPARIUM A case formed by the hardening of the last larval skin, in which the pupa is formed. identified molecularly. The path of discovery in insect immunity has generally been from effector to sensor. The first studies found and characterized antibacterial proteins; then followed the identification of their corresponding genes and studies that focused on the regulation of induction of antimicrobial genes; finally, came the studies on immune recognition. All these arenas of inquiry have now broadened and branched out into new areas. The Drosophila antimicrobial proteins are Cecropin, Diptericin, Defensin, Attacin, Drosocin, Drosomycin and Metchnikowin, with the latter two being the most strongly antifungal and the remaining mainly antibacterial. In addition, Andropin is a constitutively expressed male-specific antibacterial peptide, and Lysozyme is produced in abundance. Cecropin, Diptericin and Drosomycin are encoded by two or more genes in a cluster, whereas Defensin, Drosocin and Metchnikowin are encoded by single genes, Andropin is encoded by a single gene in the Cecropin cluster, Lysozyme is encoded in unlinked clusters and Attacin is encoded by a pair and a single copy on the same chromosome arm13,53,54. Genes that encode Drosophila antimicrobial protein effectors are typically induced in response to infection, which leads to an accumulation of the corresponding mRNA. So, too, are genes that encode proteins with separate functions in insect innate immunity. For example, Toll and other genes in the signalling cascades, and recognition-receptor genes such as galactin and some members of the Pgrp family, are also induced by infection10,15,25,55. NATURE REVIEWS | GENETICS As in Drosophila, mammalian antimicrobial peptides protect epithelial surfaces and fluid compartments and, in some instances, also reside within the intracellular compartment. The emplacement of such defensive proteins, many of which have structural similarity across broad taxa, bespeaks a conserved evolutionary strategy 23,27,54,56,57. In general, mammalian antimicrobial proteins are produced constitutively, whereas insect antimicrobial proteins are typically induced by infection. One of the exceptions in mammals is bovine lung defensin, which is not only induced by infection but also has a promoter with NF-κB and Il-1 binding sites similar to the canonical promoters of insect antimicrobial protein genes 58. Antimicrobial proteins cause stasis or lysis of the target organisms59. Importantly, antimicrobial proteins can have additional effects, in particular a role in feedback regulation of cytokine responses, which makes antimicrobial proteins even more important as therapeutic agents56,59. In vertebrates, the inflammatory response is the hallmark of an innate immune reaction. Inflammation is an extremely complex phenomenon, which in the classical description entails swelling due to the extravasation of fluid (hyperaemia), the recruitment and activation of leukocytes, and the destruction and remodelling of tissues. It is orchestrated by cytokines, which are produced by host cells (chiefly tissue macrophages) that encounter infectious organisms. There is a broad consensus that inflammation limits the spread of infectious organisms, although a precise understanding of how it achieves this end remains elusive. Therefore, agents that prevent inflammation (for example, glucocorticoid hormones), and even selective inhibitors of individual cytokines60,61 might lead to overwhelming infection. In Drosophila, haemocytes are the hallmark of the cellular immune response. Two general types of haemocyte mediate the cellular response in flies: crystal cells and plasmatocytes5,62,63. Crystal cells release their crystalline contents, for example to provide substrates for melanin, blood clotting or tanning of the PUPARIUM. The plasmatocyte lineage functions as phagocytic cells that are comparable to vertebrate macrophages and natural killer cells. In contrast to embryonic haemocytes, larval haemocytes originate from the haematopoietic organ (lymph glands), and it is thought that adult haemocytes are carried over through metamorphosis. During the immune response, haemocytes mobilize to phagocytose cells, to produce antimicrobial proteins and to form melanotic clusters (FIG. 1). The phenotype of melanotic clusters, or tumours, is shared by mutations in various genes involved in immune function. Well-studied examples of these are Tumorous lethal (Tum) and lethal(1)aberrant immune response8 (RpS6air8). Tum is an oncogenic mutation in the janus kinase gene hop (hopscotch) that results in a leukaemia phenotype (hopTum )64. Further, in hopTum mutants the complement-like TepI (thiolester-containing protein I) gene is constitutively activated65. RpS6air8 is a tumoursuppressor mutation in the Drosophila homologue of © 2001 Macmillan Magazines Ltd VOLUME 2 | APRIL 2001 | 2 6 3 REVIEWS the human ribosomal protein S6 (RpS6), which also causes haematopoietic system overgrowth66. In addition, mutations in genes that encode proteins that are known to support developmental processes and immunity, such as Toll (REF. 67), are also often found to cause the formation of small melanotic tumours. Analysis of specific melanotic tumour mutations and of the process of melanotic cluster formation, offers clues for understanding haemocyte function and immune recognition and response. Table 1 | Immune-related genes in Drosophila and mammals: homologies and analogies Haematopoietic determinants Transcription factors Receptors Scavenger receptors (SR) Gram-negative-binding proteins (GNBP) Peptidoglycan-recognition proteins (PGRP) Lectins Toll family Drosophila Mammals* References§ lozenge serpent gcm AML1 Gata family Gcm family 98 98 98 epithelial membrane protein SR-Cl GNBP family CD36 Domains of SRC1 have homology to various mammalian proteins; see also SR family Not identified PGRP family Pglyrp family galactin See text Lgals family See text dorsal, Dif, Rel cactus spätzle pelle snake and easter IKK and kenny NF-κB family 17–19,101 IκB family 102 Bdnf; homology is to cysteine 103 knot nerve growth factors Spi17 and others that encode serine 24 protease inhibitors of the serpin family F2/prothrombin and others that 104,105 encode clotting factors IRAK1 106 Prss7 and Klk/kallikrein family 105 IKK family 21,22 hopscotch Stat92E/marelle raf basket p38b JAK family STAT family Raf1 JNK family p38 Various in Drosophila, but only reported insect immune related is hemolin of silkmoth Antimicrobial protein gene families malvolio Transferrin Other matrix metalloproteinase members, for example, kuzbanian Thor lethal(1)aberrant immune response8 Reactive intermediates of oxygen and nitrogen Immunoglobulin superfamily, including some TlR-related genes 110 Antimicrobial protein gene families 54,56,57,59 croquemort dredd CD36 CASP family 6 90–92 Tep family Various from genome annotation C3 and A2M For example, genes that encode C1 and fibrinogen domains 65,72 13,84 99 5,100 11 10 55 See text Toll signalling components Spn43Ac of necrotic locus gastrulation defective Signalling pathways other than Toll Effectors Immunoglobulin motif Antimicrobial proteins Metal ion accessibility and metalloproteinase regulation Translation related Cytotoxic molecules 64 107 108 109 Nramp/Scf11 Transferrin Mmp7/matrilysin 111 112 113 4E-binding protein family ribosomal protein S6 114 66 Reactive intermediates of oxygen and nitrogen 115 Apoptosis and immunity Additional components *Mammalian gene list shows representative members, for example, a human homologue might be listed but there might also be mouse and rat homologues. See links for direct accessing of homologous gene and protein sequences, for example, Flybase and Jackson Lab. § References are starting points to obtain fuller information. See Flybase and Jackson lab links for additional references linked directly to gene and protein sequences. (A2M, α2 macroglobulin; AML1, acute myeloid leukaemia 1; Dif, Dorsal-related immunity factor; Gata, GATA-binding protein; gcm, glial cells missing; IKK, IκB kinase; IRAK1, interleukin-1-receptor-associated kinase; JAK, janus kinase; JNK, jun kinase; Prss7, protease serine 7; Rel, Relish; Scf11, solute carrier family 11; STAT, signal transducers and activators of transcription.) 264 | APRIL 2001 | VOLUME 2 © 2001 Macmillan Magazines Ltd www.nature.com/reviews/genetics REVIEWS IATROGENIC Disease caused by the physician in the course of treating the patient. Interestingly, many of the receptors involved in immune recognition also mediate apoptosis — the mammalian cytokine receptors of the TNF superfamily, for example68. Immunity and apoptosis are increasingly found to have a variety of connections (BOX 2). Many additional homologies and parallels to vertebrate innate immunity can be observed in Drosophila (TABLE 1). Some similar features have previously been well studied in other invertebrates (see, for example, REFS 69–71). In terms of evolutionary conservation, the α2macroglobulin family of conserved protease inhibitors might represent a prototypical immune response, in that it is a protein that envelops its molecular prey72. As only a limited set of topics can be covered here, some other mechanisms are also listed in TABLE 1. Undoubtedly, many other features and responses have not yet been recognized. Perspectives Striking similarities across phyla in innate immunity extend from initiation of infection through to mechanisms of infection clearance. In some respects, the similarities should not be surprising, as the characteristics of the infecting organisms have common themes and the demand for survival of infection is inescapably shared. Conversely, many questions remain, such as the recognition and activation of different Toll receptors. Clearly the study of many different organisms contributes to a greater understanding of immunity. Furthermore, this understanding provides both indirect and direct means of approach to deal with infection and disease in humans. For example, antimicrobial proteins from vertebrate and invertebrate sources can be used pharmaceutically to treat infections. It is also believed that mutations that affect the human TLRs and/or the associated proteins that transduce microbial signals might predispose to infection73. Many human diseases result from a failure of innate immunity, whether primary, secondary or IATROGENIC. For example, in cystic fibrosis the primary defect of transmembrane conductance secondarily leads to a high salt concentration in the surface fluid of the lung airway. This inactivates antimicrobial defensin, which in turn permits colonization by microbial pathogens74. A continuing challenge in immunity is the intersection of mammals and insects, through parasites that have life cycles in both. At times, a single pathogen might dwell within evolutionarily divergent hosts, assuming different forms in each, as suits its developmental strategy. Such is the case in malaria, leishmaniasis and many other parasitic diseases that are transmitted to mammals by way of an insect vector. Studies in 1. 2. 3. 4. Ehrlich, P. The Croonian lecture: on immunity. Proc. R. Soc. Lond. B 66, 424–448 (1900). Metchnikoff, E. Immunity in the Infectious Diseases (Macmillan, New York, 1905). Janeway, C. J. Approaching the asymptote? Evolution and revolution in immunology. Cold Spring Harbor Symp. Quant. Biol. 54, 1–13 (1989). Ehlers, M. R. CR3: a general purpose adhesion- NATURE REVIEWS | GENETICS 5. 6. 7. insects, parasites and humans can all lead to disease control, as targets for disruption of disease occur at all steps in the transmission cycle75–77. The multifaceted power of genomics is being brought to bear on all aspects of innate immunity. With the genomes of several species (human, mouse, Drosophila, Plasmodium, Leishmania and others) either completed or nearing completion, common themes in innate immunity are cast in sharp relief. Many new options have already been looked at and further opportunities have increased markedly. In Drosophila, genetic screens have been used to analyse immunity78–82, and the need for more screens has increased now that the genome has been sequenced. In particular, new genetic approaches and techniques for mutational analysis83 are needed, for example, to uncover additional components that support immune processes and to critically dissect the functions of genes known or predicted to have immune functions, whether in Drosophila, humans or other organisms. Genomics has changed the study of all organisms, and analyses using, for example, microarrays, proteomics and genetic screens in mice and many other organisms will also be essential. It is expected that, as before, many features of immunity will operate without respect for phyletic barriers. Discovering not only the similarities but also the differences in immune functions among organisms might also yield intriguing clues. Genome projects so far have shown that about one-third of the predicted proteins of each organism cannot be grouped either with those of that organism or other organisms84. These sequences can be viewed as identifiers that make each organism unique, and it will be interesting to see which of these might occur in the category of innate defence. Links DATABASE LINKS CR3 | Pgrp | Gnbp | Toll | Dorsal | Cactus | Drosomycin | imd | Dif | Rel | IKK | spätzle | nec | 18 wheeler | Toll-6 | Toll-7 | IRAK | Pelle | IL-18R | ST2 | TLR4 | MYD88 | SIGIRR | Toll-9 | Easter | Snake | Gd | Pipe | Nudel | Windbeutel | Cecropin | Diptericin | Defensin | Attacin | Drosocin | Metchnikowin | Andropin | Lysozyme | RpS6air8 | hop | hopTum | TepI | RpS6 | TRAF6 | TAK1 | NIK | Dredd | FADD | TRADD | FLICE | Apaf1 | Dark FURTHER INFORMATION Toll signalling in Drosophila | Flybase | Jackson lab ENCYCLOPEDIA OF LIFE SCIENCES Immune system | Immune mechanisms against extracellular pathogens | Antimicrobial proteins and peptides | Metchnikoff, Elie (Ilya) | Ehrlich, Paul | Drosophila embryo: dorsal–ventral specification recognition receptor essential for innate immunity. Microb. 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Acknowledgements D.A.K.’s lab is supported by the National Institutes of Health. B.B. is an investigator of the Howard Hughes Medical Institute. © 2001 Macmillan Magazines Ltd VOLUME 2 | APRIL 2001 | 2 6 7
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