不同LET辐射对健康人血淋巴细胞和肿瘤细胞的损伤效应

目的: 探讨不同LET辐射对健康人外周血淋巴细胞的遗传损伤效应；了解重离子辐射诱导人血淋巴细胞染色体畸变的特点；研究用G2期染色体畸变预测肿瘤细胞辐射敏感性的可行性。材料与方法：采用兰州近代物理研究所重离子研究装置产生的12C离子和兰州大学第一附属医院放疗科提供的X射线照射健康人外周血，用常规染色体分析技术和姊妹染色体差别染色法研究不同LET辐射对健康人血淋巴细胞中期染色体的损伤效应、高LET辐射的剂量率效应、时程效应和染色体畸变的特点；用Calyculin A诱导间期染色体凝集技术研究12C 离子对淋巴细胞G2期染色体的损伤效应。用60Coγ射线照射人卵巢癌细胞和肝癌细胞，以细胞克隆存活率和G2期染色体畸变为生物学终点，探讨用G2期染色体畸变预测肿瘤细胞辐射敏感性的可行性。 结果与结论 1. 不同LET辐射诱导‘双+环’畸变与剂量之间存在良好的线性平方关系， 12C 离子诱导的畸变在细胞间的分布不符合泊松分布； 12C离子的相对生物学效应随着LET的增大而增大；12C离子诱导染色体畸变在1－5 Gy/min的范围内不存在剂量率效应；在0－4 Gy的剂量范围内不存在时程效应，说明培养48小时后中期‘双+环’畸变能很好的反应12C离子对淋巴细胞的损伤效应。本研究可以帮助人们了解重离子的相对生物学效应，为病人健康组织的保护以及放射医师的防护提供重要的理论数据。 2. LET为34.6 keV/μm的12C离子诱导淋巴细胞G2-期染色体数目畸变与剂量之间存在良好的线性关系(r=0.99)；最长G2-PCC与最短G2-PCC的长度之比与剂量之间存在良好的线性平方关系(r2=0.96)。表明有希望用G2-期染色体畸变评估重离子的相对生物学效应和估计重离子的辐射剂量，也为合理评估空间混合辐射场中重离子辐射所占比例提供了两个潜在的指标。 3. LET为34.6 keV/μm12C 离子诱导的畸变，除大部分染色体型畸变外，还出现少量的染色单体畸变，这一现象在理论上突破了传统的认识，对重离子辐射损伤机理的认识有重要意义。这可能是由于重离子特殊的离子径迹结构诱导染色单体畸变。重离子相对生物学效应是相对于常规射线而言的，而常规射线辐照G0期淋巴细胞只产生染色体型畸变，因此这一现象的存在对重离子相对生物学效应的确定提出了新的问题。 4. γ射线诱导肿瘤细胞G2期染色体初始断裂畸变和修复24小时后残余断裂畸变都与辐射剂量有良好的相关性；肿瘤细胞克隆存活率与G2染色单体初始断裂(r=0.96)和修复24小时后残余断裂(r=0.91)都有一定的相关性，比较而言，G2染色单体初始断裂畸变能更好的反映肿瘤细胞的辐射敏感性，预示G2染色单体初始断裂畸变有希望成为肿瘤细胞辐射敏感性的预测指标。 5. 2 Gyγ射线诱导的G2-染色单体断裂畸变，有近65% 的断裂在辐射后24小时内得以修复；对G2等点染色单体断裂畸变，在辐射后24小时内只有20%左右得以修复；两类畸变的修复主要发生在辐射后2小时内。 6. 在用G2-assay法测定染色体畸变的实验中，给予较高剂量时，很难获得足够的中期细胞以供观察。用G2-assay和G2-PCC技术获得的数据都与细胞克隆存活率有一定的相关性，比较而言，后者的相关性要好一些。表明G2-PCC技术可以作为细胞存活实验和用常规染色体畸变分析放射敏感性的替代方法

Capillary electrophoretic study on UDP-sugars in cells

Glucose is an important regulator of cell growth and metabolism. Uridine diphosphate sugars (UDP-sugars), as the intermediate products of metabolism, play pivotal roles as precursors in the synthesis of complex carbohydrates and glycolipids as well as lectose. It is very important to study their metabolism in cells in clinical biochemistry. A capillary electrophoretic method has been developed for the analysis of UDP-sugars and nucleotides, By using an uncoated capillary (70cm x 50 mu m) and 20 mmol/L borax buffer (pH 9), 4 important UDP-sugars can be analyzed in 15 min at 22 kV with satisfactory precision and sensitivity. The developed method has been applied to analyze UDP-sugars concentrations in lymphocytes, fibroblasts and mesangial cells, and the results show it not only is much better than HPLC method, but also can be used to measure the energy charge of cells.

虎眼万年青多糖对小鼠免疫功能的调节作用

依据虎眼万年青组分中多糖对小鼠巨噬细胞吞噬功能的影响,筛选并优化出60%醇浓度中性多糖活性组分S3,进而研究其对体液免疫、细胞免疫及细胞因子变化的影响,并从细胞和分子水平探讨其作用的机理.方法:采用溶血素测定方法,测定S3对小鼠脾细胞溶血素抗体的诱导作用;采用3H-TdR渗入法,测定S3对ConA诱导小鼠脾淋巴细胞的增殖作用;采用3H-TdR后标记法,测定S3对NK细胞细胞毒活性的影响;以ELISA法测定S3对小鼠脾细胞IL-2产生的影响;利用流式细胞术,检测S3对T淋巴细胞亚群CD3、CD4、CD8、CD4/CD8阳性细胞百分率的影响;采用RT-PCR方法检测IL-2 mBNA的表达水平.结果:S3高、中剂量组能明显增强小鼠脾细胞溶血素抗体的形成(P<0.05);各剂量组均能明显增强ConA诱导的淋巴细胞增殖能力(P<0.001);各剂量组均能增强NK细胞的细胞毒活性并促进IL-2的产生(P<0.001,P<0.01);高、中剂量组CD8阳性细胞百分率明显降低(P<0.001),各剂量组均能显著地提高CD4/CD8阳性细胞百分率(P<0.001);高剂量组可明显促进脾细胞中细胞因子IL-2的mRNA表达,使表达量增加(P<0.05).结论:S3具有较强的增强机体多种免疫功能的作用,可利用开发为一种免疫增强药物.

Identification and analysis of a Sciaenops ocellatus ISG15 homologue that is involved in host immune defense against bacterial infection

ISG15 is an interferon-stimulated gene that encodes a ubiquitin-like protein. ISG15 homologues have been identified in a number of fish species, some of which are known to be regulated at expression level by virus infection and lipopolysacchande (LPS) treatment However, the relationship between ISG15 and live bacterial infection has not been investigated in piscine models. In this study, an ISG15 homologue, SoISG15, was identified from red drum Scraeriops ocellaws and analyzed at expression and functional levels The open reading frame ofSolSG15 is 477 base pairs (bp) and mtronless, with a 5'-untranslated region (UTR) of 91 bp and a 3'-UTR of 415 bp The deduced amino acid sequence of S0ISG15 shares 60-67% overall identities with the ISG15 of several fish species. S0ISG15 possesses two conserved ubiquinn-like domains and the canonical ubiquitin conjugation motif, LRGG, at the C-terminus. Expressional analysis showed that constitutive expression of SolSG15 was highest in blood and lowest in kidney Experimental challenges with LPS and bacterial pathogens induced significant S0ISG15 expression in the kidney but not in the liver Similar differential induction was also observed at cellular level with primary hepatocytes and head kidney (HK) lymphocytes. Poly(' C), however, effected drastic induction of S0ISG15 expression in kidney and liver at both tissue and cellular levels. Immunoblot analysis showed that S0ISG15 was secreted by cultured HK lymphocytes into the extracellular milieu. Recombinant S0ISG15 expressed in and purified from Eschenclua colt was able to enhance the respiratory burst activity, acid phosphatase activity, and bactericidal activity of HK macrophages. Taken together, the results of this study indicated that SoISG 15 possesses apparent immunological property and is likely to be involved in host immune defense against bacterial infection. (C)2010 Elsevier Ltd All rights reserved.

Morphological and ultrastructural characterization of the coelomocytes in Apostichopus japonicus

The coelomocytes suspended in the coelomic fluid and occurring in the coelomic epithelial layer of the sea cucumber Apostichopus japonicus (Selenka) (Holothuroidea: Aspidochirota: Stichopodidae) function as mediators of the immune system, trephocytic cells and nutrient transport cells. Types of coelomocytes are characterized based on their morphological and ultrastructural features. Flow cytometry plus light and electron microscopic analyses were conducted in order to characterize the coelomocytes of A. japonicus. Six types of coelomocytes were identified: lymphocytes, morula cells, amoebocytes, crystal cells, fusiform cells and vibratile cells. Within these major categories, several distinctive cell types occurred that might represent developmental stages. The mean +/- SD coelomocyte concentration in the individuals (body length: 10 to 15 cm; weight: 100 to 150 g) was (3.79 +/- 0.65) X 10(6) cells ml(-1). The coelomic fluid contained mainly hyalinocytes (76.69%) and granulocytes (23.31 %).

Effect of ethanol extract of alga Laurencia supplementation on DNA oxidation and alkylation damage in mice

Laurencia terpenoid extract (LET) had been extracted from the red alga Laurencia tristicha. The study is to investigate the effects of LET supplementation on DNA oxidation and alkylation damages in mice. Forty healthy kunming mice weighing between 18g and 25g were randomly assigned into 4 groups, each consisting of ten animals. The mice were orally intubated respectively for 60 days with the designed concentrations of LET (25, 50, 100 mg/kg b.w.) for three exposed groups and salad oil (0.2 ml) for the blank group. Food and water were free for the animals. Mice in the blank and exposed groups were sacrificed after the last treatment and the blood of each animal was quickly taken for further experiments. The spontaneous and oxidized DNA damages of peripheral lymphocytes induced by H2O2 were analysed by SCGE. O-6-Methy-guanine (O-6-MeG) was measured by high performance capillary zone electrophoresis. There was no significantly difference in DNA spontaneous damage on peripheral lymphocytes of all the mice. The oxidative DNA damage in the 50 mg/Kg body weight supplement group are 286AU with the oxidation of 10 mu mol/L H2O2, significantly lower than the blank group 332AU (p<0.05). The contents of O-6-MeG in plasma in the 50mg/kg b.w. and 100mg/kg b.w. supplement group were 1.50 mu mol/L andl.88 mu mol/L, significantly lower than that of the blank group, which was 2.89 mu mol/L(p<0.05). The results from the present study indicated that the LET were rich in terpenoids and safety to be taken orally and it could improve antioxidative and decrease DNA damage effectively.

心理干预对围手术期乳腺癌患者情绪、自评健康及免疫功能的影响研究

Objective：Developing a generalized psychological intervention program, and explore its influence on the emotion, subjective health, and immunity function of the perioperation patients with breast cancer. Method：Sixty patients with breast cancer were randomly divided into intervention and control groups. The clinical psychological intervention was performed on patients in the intervention group for 20 days, in addition to the routine therapy and care. Levels of emotion (SAS & SDS), subjective health (SF-36), and immunity function (t lymphocyte subsets) of the patients were tested. Results: 1.There was no significant difference between the age, income, educational level, and type of prefession of the two groups. There was no significant difference between SAS, SDS, SF-36 and lymphocyte subsets（CD3+, CD4+, CD8+, CD4+/CD8+, NK） of the two groups. 2. Scores of SAS and SDS decreased significantly after intervention in experimental group, while the score of SF-36, the average value of CD4+, CD4+/CD8+, and NK increased significantly. For the control group, the score of depression decreased significantly after intervention, while the score of PF, GH, VT, SF, RE, and MH increased significantly. 3. In comparison of the intervention and control group, the intervention effect of SAS, SDS, SF-36 scores (except SF), CD3+, CD4+, CD4+/CD8+, and NK differed significantly, with the priority of experimental group. 4. SDS, SAS, and CD3+, CD4+, NK correlated in negative respectively, while SDS, SAS, and CD8+ correlated in positive. PF, RP, GH, SF, and MH of subjective health correlated in positive with every index of immunity function in positive, except negative correlation with CD4+/CD8+. BP, RE correlated with CD3+,CD4+,CD8+, and NK in positive. VT correlated in positive with CD3+, CD8+, and NK, in negative with CD4+/CD8+. Conclusions: 1. Anxiety, depression, and subjective health, correlated with immunity function in perioperation patients with breast cancer. 2. Psychological intervention can improve the emotional status, subjective health, and immune function of patients with breast cancer to the optimum in perioperative period.

条件反射性免疫抑制及其脑机制的c-fos研究

To explore the neural mechanisms underlying conditioned immunomodulation, this study employed the classical taste aversion (CTA) behavioral paradigm to establish the conditioned humoral and cellular immunosuppression (CIS) in Wistar rats, by paring saccharin (CS) with intraperitoneal (i.p.) injection of an immunosuppressive drug cyclophophamide (UCS). C-fos immunohistochemistry method was used to observe the changes of the neuronal activities in the rat brain during the acquisition, expression and extinction of the conditioned immunosuppression (CIS). The followings are the main results: 1. Five days after one trial of CS-UCS paring, reexposure to CS alone significantly decreased the level of the anti-ovalbumin (OVA) IgG in the peripheral serum. Two trials of CS-UCS paring and three reexposures to CS not only resulted in further suppression of the primary immune response, but also reduced the numbers of peripheral lymphocytes and white blood cells. This finding indicates that CS can induce suppression of the immune function, and the magnitude of the effects is dependent on the intensity of training. 2. On day 5 following two trials of CS-UCS pairing, CS suppressed the spleen lymphocytes responsiveness to mitogens ConA, PHA and PWM, and decreased the numbers of peripheral lymphocytes and white blood cells. On day 15, only PHA induced lymphocyte proliferation was suppressed by CS. On day 30, presentation of CS did not have any effect on these immune parameters. These results suggest that the conditioned suppression of the cellular immune function can retain 5-15 days, and extinct after 30 days. 3. CTA was easily induced by one or two CS-UCS parings, and remained robust even after 30 days. These data demonstrate that CIS can be dissociated from CTA, and they may be mediated by different neural mechanisms. 4. Immunohistochemistry assays revealed a broad pattern of c-fos expression throughout the rat brain following the CS-UCS pairing and reexposure to CS, suggesting that many brain regions are involved in CIS. Some brain areas including the solitary tract nucleus (Sol), lateral parabrachial nucleus (LPB) and insular cortex (IC), showed high level c-fos expressions in response to both CS and UCS, suggesting that they may be involved in the transmission and integration of the CS and UCS signals in the brain. There were dense c-FOS positive neurons in the paraverntricular nucleus (PVN) and supraoptic nucleus (SO) of hypothalamus, subfornical organ (SFO) and area postrema (AP) etc. after two trials of CS-UCS paring and after the reexposure to CS 5 days later, but not in the first training and after the extinction of CIS (30 days later). The results reflect that these nuclei may have an important role in CIS expression, and may also response to the immunosuppression of UCS. The conditioned training and reexposure to CS 5 days later induced high level c-fos expression in the cingulate cortex (Cg), central amygdaloid nucleus (Ce), intermediate part of lateral septal nucleus (LSI) and ventrolateral parabrachial nucleus (VLPB) etc. But c-fos induction was not apparent when presenting CS 30 days later. These brain regions are mainly involved in CIS, and may be critical structures in the acquisition and expression of CIS. Some brain regions, including the frontal cortex (Fr), ventral orbital cortex (VO), IC, perirhinal cortex (PRh), LPB and the medial part of solitary nucleus (SolM), showed robust c-FOS expression following the conditioning training and reexposure to CS both on day 5 and day 30, suggesting that they are critically involved in CTA.

Psoríase

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências Farmacêuticas

The use of different blood sample preparations in the development of biomarkers for the environmental monitoring of domestic farm animals

The application of biological effect monitoring for the detection of environmental chemical exposure in domestic animals is still in its infancy. This study investigated blood sample preparations in vitro for their use in biological effect monitoring. When peripheral blood mononuclear cells (PBMCs), isolated following the collection of multiple blood samples from sheep in the field, were cryopreserved and subsequently cultured for 24 hours a reduction in cell viability (<80%) was attributed to delays in the processing following collection. Alternative blood sample preparations using rat and sheep blood demonstrated that 3 to 5 hour incubations can be undertaken without significant alterations in the viability of the lymphocytes; however, a substantial reduction in viability was observed after 24 hours in frozen blood. Detectable levels of early and late apoptosis as well as increased levels of ROS were detectable in frozen sheep blood samples. The addition of ascorbic acid partly reversed this effect and reduced the loss in cell viability. The response of the rat and sheep blood sample preparations to genotoxic compounds ex vivo showed that EMS caused comparable dose-dependent genotoxic effects in all sample preparations (fresh and frozen) as detected by the Comet assay. In contrast, the effects of CdCl2 were dependent on the duration of exposure as well as the sample preparation. The analysis of leukocyte subsets in frozen sheep blood showed no alterations in the percentages of T and B lymphocytes but led to a major decrease in the percentage of granulocytes compared to those in the fresh samples. The percentages of IFN-γ and IL-4 but not IL-6 positive cells were comparable between fresh and frozen sheep blood after 4 hour stimulation with phorbol 12-myrisate 13-acetate and ionomycin (PMA+I). These results show that frozen blood gives comparable responses to fresh blood samples in the toxicological and immune assays used.

Repeated concanavalin A challenge in mice induces an interleukin 10-producing phenotype and liver fibrosis.

Weekly injections of Concanavalin A (Con A) were performed in BALB/c mice to evaluate the pattern of cytokine production and liver injury. High serum levels of tumor necrosis factor alpha (TNF-alpha), interleukin 2 (IL-2), IL-4, and interferon gamma (IFN-gamma) were found in the serum after the first 2 injections of Con A but rapidly decreased from the third injection. Conversely, IL-10 serum levels after repeated Con A challenge increased by 7 times from week 1 to 20. In vivo depletion studies indicated that CD4(+) T cells are essential in IL-10 production. Hepatocyte necrosis was only observed after the first injections of Con A whereas centrilobular inflammatory infiltrates persisted up to 20 weeks. Perisinusoidal liver fibrosis was also increasingly detected in BALB/c mice, whereas no fibrous change was observed in nude mice after 6 weeks of Con A challenge. The number of stellate cells, detected by immunostaining, increased after 20 weeks of Con A injections. Liver cytokine messenger RNA (mRNA) expression after 20 weeks showed expression of transforming growth factor beta1 (TGF-beta1), IL-10, and IL-4 whereas IL-2 was no more expressed. The present study shows that mice repeatedly injected with Con A develop liver fibrosis. The cytokine-release pattern observed after 1 injection of Con A is rapidly shifted towards an immunomodulatory phenotype characterized by the systemic production of large amounts of IL-10.

Helicobacter pylori modulation of gastric and duodenal mucosal T cell cytokine secretions in children compared with adults.

BACKGROUND: In contrast to adults, ulcers are un-common in Helicobacter pylori-infected children. Since immunological determinants influence the outcome of H. pylori infection, we have investigated mucosal T cell responses in H. pylori-infected children and compared them with those of adults and negative controls. MATERIAL AND METHODS: Mucosal biopsies were obtained from 43 patients undergoing an upper GI endoscopy for dyspeptic symptoms. The concentrations of released cytokines and the density of CD3+, CD25+ and CD69+cells were evaluated by flow cytometry, and the numbers of cytokine-secreting cells were measured by ELISPOT. RESULTS: The numbers of isolated antral CD3+ lymphocytes were only significantly raised in infected adults compared with noninfected controls (p < 0.05), whereas the proportion of CD3+ cells expressing activation markers (CD25 or CD69) remained low. In the stomach, IFN-gamma concentrations increased in infected children and infected adults compared with controls (p < 0.05), but IFN-gamma concentrations were tenfold lower in children than in adults (p < 0.01). IL-2, IL-4, IL-10 and TNF-alpha concentrations were similar in infected and in uninfected children and adults. In contrast, in the duodenum, IFN-gamma, as well as IL-4 and IL-10 concentrations were only increased in infected children compared with controls (p < 0.05). The concentrations of these cytokines were similar in both groups of adults who, however, like children, displayed a higher number of duodenal IL-4-secreting cells compared to controls (p < 0.05). CONCLUSION: These results suggest that IFN-gamma secretion in the stomach of H. pylori-infected patients is lower in children than in adults. This could protect children from development of severe gastro-duodenal diseases such as ulcer disease. In addition, infected patients are characterised by a dysregulation of the mucosal cytokine secretion at distance from the infection site.

A variant of SCID with specific immune responses and predominance of gamma delta T cells.

We describe here a patient with a clinical and molecular diagnosis of recombinase activating gene 1-deficient (RAG1-deficient) SCID, who produced specific antibodies despite minimal B cell numbers. Memory B cells were detected and antibodies were produced not only against some vaccines and infections, but also against autoantigens. The patient had severely reduced levels of oligoclonal T cells expressing the alphabeta TCR but surprisingly normal numbers of T cells expressing the gammadelta TCR. Analysis at a clonal level and TCR complementarity-determining region-3 spectratyping for gammadelta T cells revealed a diversified oligoclonal repertoire with predominance of cells expressing a gamma4-delta3 TCR. Several gammadelta T cell clones displayed reactivity against CMV-infected cells. These observations are compatible with 2 non-mutually exclusive explanations for the gammadelta T cell predominance: a developmental advantage and infection-triggered, antigen-driven peripheral expansion. The patient carried the homozygous hypomorphic R561H RAG1 mutation leading to reduced V(D)J recombination but lacked all clinical features characteristic of Omenn syndrome. This report describes a new phenotype of RAG deficiency and shows that the ability to form specific antibodies does not exclude the diagnosis of SCID.

Selective defect of anti-pneumococcal IgG in a patient with persistent polyclonal B cell lymphocytosis.

BACKGROUND: Persistent polyclonal B cell lymphocytosis (PPBL) is a rare condition characterized by increased IgM and large excess of B cells with an IgD(+) CD27(+) phenotype. In normal individuals, these cells play a central role in the defense against pneumococcal infection. So far, few studies have characterized humoral immune responses in PPBL patients. We therefore measured IgG directed against S. pneumoniae antigens in a 51 yr-old woman with PPBL before and after vaccination with a pneumococcal 23-valent polysaccharide vaccine. METHODS: Antibodies against pneumococcal antigens were measured first with an overall immunoassay using microplates coated with the 23-valent pneumococcal vaccine. A serotype-specific test was also performed according to the WHO consensus protocol. RESULTS: Despite a large number of IgD(+) CD27(+) cells, our patient had low baseline titers of IgG directed against pneumococcal antigens and did not significantly respond to a 23-valent polysaccharide vaccine against S. pneumoniae. On the contrary, she had good titers of IgG directed against tetanus toxoid. CONCLUSION: IgM(+) IgD(+) CD27(+) cells which accumulate in this patient with typical PPBL patient failed to perform IgG isotype switch after a polysaccharide vaccine. The potential mechanisms and relationships with the main features of PPBL are discussed. Further studies on a larger number of similar patients are needed.

Anti-CTLA-4 treatment induces IL-10-producing ICOS+ regulatory T cells displaying IDO-dependent anti-inflammatory properties in a mouse model of colitis.

BACKGROUND AND AIMS: Cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) has been shown to act as a negative regulator of T cell function and has been implicated in the regulation of T helper 1 (Th1)/Th2 development and the function of regulatory T cells. Tests were carried out to determine whether anti-CTLA-4 treatment would alter the polarisation of naive T cells in vivo. METHODS: Mice were treated with anti-CTLA-4 monoclonal antibody (mAb) (UC10-4F10) at the time of immunisation or colonic instillation of trinitrobenzene sulfonic acid (TNBS). The cytokines produced by lymph node cells after in vitro antigenic stimulation and the role of indoleamine 2,3 dioxygenase (IDO) and of interleukin-10 (IL-10) were tested, and the survival of mice was monitored. RESULTS: Injection of anti-CTLA-4 mAb in mice during priming induced the development of adaptive CD4(+) regulatory T cells which expressed high levels of ICOS (inducible co-stimulator), secreted IL-4 and IL-10. This treatment inhibited Th1 memory responses in vivo and repressed experimental intestinal inflammation. The anti-CTLA-4-induced amelioration of disease correlated with IDO expression and infiltration of ICOS(high) Foxp3(+) T cells in the intestine, suggesting that anti-CTLA-4 acted indirectly through the development of regulatory T cells producing IL-10 and inducing IDO. CONCLUSIONS: These observations emphasise the synergy between IL-10 and IDO as anti-inflammatory agents and highlight anti-CTLA-4 treatment as a potential novel immunotherapeutic approach for inducing adaptive regulatory T cells.