|  
             * This work has been supported by U .S. Public 
              Health Service Grants 5 ROI CA25250-06 and 1 ROI CA-44882-01 awarded 
              by the National Cancer Institute, The Swedish Cancer Society, The 
              Swedish Society for Medicine, the Bristol Myers Company, and the 
              Royal Swedish Academy of Sciences.  
              1 Dept. of Tumor Biology, Karolinska Institutet, Box 60400, S-10401 
              Stockholm, Sweden.  
             
              Introduction 
             Natural killer (NK) cells represent an important subset of lymphocytes. 
              These cells fulfil crucial cytotoxic as well as regulatory functions 
              of the immune system. Compromised NK cell activity has been found 
              to be associated with the development of several diseases, including 
              cancer, AIDS and virus infections. Intact NK cell activity appears 
              to play an important role in health. More recent data suggests that 
              NK cells may be involved in the pathogenisis of some human diseases 
              and serve as an early predictor for susceptibility to disease [1]. 
              In transplantation, NK cells participate in rejection of allogeneic 
              bone marrow cells [2]. The molecular basis for the ability of NK 
              cells to discriminate between normal and aberrant cells is not known 
              in detail [3-5]. The aim of the present overview is to discuss studies 
              of how target cell major histocompatibility complex (MHC) class 
              I expression affects NK-target interactions and ultimately target 
              susceptibility to NK cell mediated lysis. The rationale for current 
              studies is a hypothesis which has provided one test able model for 
              self- non-self discrimination by NK cells [4, 5]. This hypothesis 
              was originally based on (a) the patterns common to the various cytotoxic 
              reactions attributed to NK cells and (b) a comparative analysis 
              of the different strategies employed by vertebrates and invertebrates 
              in order to distinguish between self and non-self. This hypothesis, 
              presented as the "missing self" hypothesis [3], provided testable 
              predictions for the investigation of the influence of the MHC class 
              I gene products by NK cells. Briefly, it was suggested that NK cells 
              could kill certain target cells because the latter express reduced 
              levels of MHC class I molecules. This model underlies the work presented 
              below. However, before going into the missing self hypothesis, present 
              knowledge of NK cells and in particular their cytotoxic activity 
              is briefly recapitulated.  
             
              Natural Killer Cells  
            The ability to kill certain tumour cell lines in vitro, without 
              prior immunization or sensitization, was the first attribute of 
              NK cells to be identified (reviewed in [6]). While this reaction 
              was investigated in detail in the late 1970s several new insights 
              as to their morphology, cell surface marker expression, tissue expression 
              and action have become evident during the last 10 years (for reviews 
              see e.g. [7-9]). Morphologically, most NK cells are large granular 
              lymphocytes (LGL). They are characterized by their intracytoplasmatic 
              azurophilic granules and a high cytoplasm to nucleus ratio. In man, 
              LGL comprise 2%5% of peripheral blood lymphocytes. Early on, NK 
              cells were found in the spleen peritoneal exudate and blood whereas 
              they were scarcely found in lymph nodes, bone marrow, thoracic duct 
              and the thymus. Later, NK cells were also isolated from the liver 
              , tonsils, the epithelial lining of the upper respiratory tract 
              and the lung interstitium [79]. NK cells commonly express certain 
              cell surface markers, defined by monoclonal antibodies against CD 
              16 (the Fcgammalll receptor for IgG) and NKH-l in humans and NK-l.l/2.1 
              in mice [7-9]. Additional cell surface markers, some of which define 
              subsets of NK cells, have recently been described [10]. NK cells 
              are of bone marrow origin [6], but their exact lineage is uncertain. 
              They share certain cell surface markers with T cells and also share 
              some characteristics with monocytes. There is now a general belief 
              that mature NK cells are distinct from T lymphocytes [6-10]. The 
              T -cell antigen receptor is not involved in NK cell recognition 
              or cytotoxicity [7- 9] .NK cells do not express CD 3. There is no 
              rearrangement of alpha-, beta-, gamma-, or delta- T cell receptor 
              (TCR) genes and no synthesis of functional TCR messenger ribonucleic 
              acid (mRNA) (even though nonfunctional beta and gamma TCR transcripts 
              may be detected). However, CD3 positive (alpha-beta or gamma-delta) 
              T cells may express, particularly upon activation, MHC nonrestricted 
              cytolytic activity against target cells that are also sensitive 
              to NK cells. According to a new definition proposed at the 5th International 
              Natural Killer Cell Workshop (Hilton Head, S.C., 1988) these cells 
              should not be termed NK cells but rather T cells displaying "NK-like" 
              activity or "nonMHC-requiring" cytolysis [7, 8]. NK cells also respond 
              to various lymphokines and interferons by elevated cytotoxic activity. 
              They have been reported to produce different regulatory lymphokines 
              themselves, e.g. IL-l, IL-2, IL-4, IL-5, interferons and colony 
              stimulating factors. Through such mediators (and maybe yet other 
              unknown factors) NK cells are involved in regulation of haematopoesis 
              and lymphocyte functions [7-9]. Natural resistance to infectious 
              agents may be one of the more important functions for NK cells in 
              vivo [11,12]. Particularly during virus infections, high levels 
              of IFN (primarily alpha or beta), are induced in lymphoid organs. 
              Interferons activate NK cells to a higher level of cytotoxicity 
              and stimulate their blastogenesis and proliferation in vivo. Biron 
              et al. [12] recently described a patient with a complete and persistent 
              absence of NK cells but otherwise normal immune functions. This 
              patient first presented with an overwhelming varicella virus infection 
              requiring treatment with acyclovir and later a life-threatening 
              cytomegalovirus (CMV) infection. 
             
              Graft Rejection Mediated by NK Cells  
            Soon after the discovery of NK cells it became clear that these 
              cells could kill certain tumour cell lines in vitro in spite of 
              the fact that they expressed no or only low amounts of MHC class 
              I molecules [13, 14]. This was a significant difference from cytotoxic 
              T cells, which require the presence of MHC molecules to specifically 
              kill target cells [15]. Further, NK cells were shown to be the effectors 
              in rejection of small numbers of certain transplanted tumour cells 
              [6, 16], in the prevention of metastasis [17] and in bone marrow 
              graft rejection [2, 18]. However, NK cells seem to have no or only 
              little impact on established larger cancers. NK cells are not found 
              within tumours; there is no clonal expansion, but rather a systemic 
              suppression of NK activity [1]. A peculiar rejection mechanism, 
              now attributed to NK cells, is the F I-hybrid resistance [2, 19, 
              20]. This phenomenon has been instrumental in recognizing the in 
              vivo activity of NK cells and it is of particular importance for 
              the following discussion. Hybrid resistance was first reported in 
              1958 when Snell [21] observed that homozygous lymphomas grew better 
              in the strain of origin than in F 1 hybrids obtained by crossing 
              this strain with another strain. This F1 hybrid effect violated 
              a principle in tissue transplantation. According to the genetic 
              rules of histocompatibility, an F1 hybrid should accept grafts from 
              either of its parents. The most extensive genetic analysis of the 
              F 1 hybrid effect was carried out by Cudkowicz [in 20] who studied 
              rejection of normal bone marrow cells in F 1 hosts. They explained 
              the phenomenon on the basis of a positive recognition of hypothetical 
              recessive Hh genes expressed in the parental (and on the graft) 
              but suppressed in the F 1 animal [20]. Snell [22] later offered 
              an alternative interpretation in which F 1 hybrid resistance was 
              seen as a result of a combined match and mismatch rather than a 
              complete match between host effector cells and transplanted cells. 
              This theory originated before NK cells were known to be the effector 
              mechanism in hybrid resistance but nevertheless formed the basis 
              for the missing self hypothesis (developed below), providing an 
              alternative explanation to the Hh model. Critical experiments demonstrating 
              that NK cells were the effector mechanism in F1 hybrid resistance 
              were published in 1977 by Kiessling et al. [2]. Before that, Kiessling 
              et al. [23] and Petranyi et al. [24] had reported a correlation 
              between NK activity in vitro and tumour resistance in vivo among 
              F 1 hybrids. Klein et al. [25] extended these conclusions and mapped 
              F 1 hybrid resistance to the H-2 gene complex in several different 
              tumour combinations. Carlson et al. [26] observed a rapid elimination 
              of intravenously injected leukaemia cells whenever these were "mismatched", 
              i.e. H-2K or D products were not present in relation to the host. 
              This elimination occurred in nude mice but not in NK depleted mice. 
              Allogeneic lymphocyte cytotoxicity is a term used for the rapid 
              destruction of intravenously injected allogeneic lym phocytes by 
              unsensitized hosts. Allogeneic lymphocyte cytotoxicity has been 
              reported in several mammalian species and it has been studied most 
              extensively in rats [27]. It is mediated by NK cells and is in certain 
              aspects related to F1 hybrid resistance.  
             
              Strategies for Self- Non-self Discrimination: the Missing Self 
              Hypothesis   
            Multicellular organisms need defence systems against destruction 
              of their tissues by foreign invaders as well as against altered 
              endogenous cells. A prerequisite for such a defence reaction is 
              recognition of the potential threat. An organism should be able 
              to discriminate between "self", i.e. everything constituting an 
              integral part of a given individual, and the rest. This recognition 
              could, in theory, be positive or negative [28]. In positive recognition, 
              the organism actively recognizes "non-self" and reacts against it. 
              In negative recognition, there is an active recognition of self 
              and the reaction is triggered only as a consequence of the failure 
              to recognize self. It is well known that higher vertebrates have 
              evolved defence systems based on positive recognition. This is mediated 
              by T and B cells which have clonally distributed receptors generated 
              partly by a random process. The receptor repertoire is then somatically 
              selected for the ability to positively identify "foreignness" either 
              directly (B cells) or in the context of molecules of the MHC (T 
              cells). The missing self hypothesis is based on the second, negative 
              type of recognition. It was suggested that NK cells kill certain 
              targets because they fail to express adequate levels of self MHC 
              class I gene products [3- 5] (Table 1 ). This hypothesis originated 
              from the observations that NK cells mediate rejection of allogeneic 
              lymphoma and bone marrow grafts (H 2a/a rejects H-2b/b) and also, 
              in contrast to cytotoxic T lymphocyte (CTL), F1hybrid anti-parental 
              resistance.  
             
              Table I. Triggering signals for T cells and NK cells  
               
             
             
             
               
              In the allogeneic as well as in the F 1 hybrid antiparental situation, 
              the graft "fails" to express at least one H-2 class I allele of 
              the host. This failure to express a complete set of self MHC class 
              I molecule by the target was postulated to be sufficient to cause 
              elimination by NK cells [4, 5]. Transposed to an autologous situation, 
              the hypothesis predicted that absence or reduced expression of self 
              MHC class I products (whether caused by mutation, transformation, 
              arrest in differentiation or virus infection) could be sufficient 
              to make a cell recognized and rejected by NK cells [4, 5]. Conversely, 
              an induction of self MHC class I molecules on such a target cell 
              should be sufficient to prevent rejection mediated by NK cells. 
              These predictions have been tested in vivo and the results will 
              briefly be discussed below.  
             
              Immunological Defence Against H-2 Class I Deficient Cells in Vivo 
             In order to test the missing self hypothesis we chose to work 
              with the wellcharacterized C57Bl/6 derived RBL-5 and EL-4 murine 
              lymphoma cell lines (H2b haplotype). These lymphomas express high 
              levels of H-2 and are highly malignant in the syngeneic host. Our 
              experimental approach was to test the prediction that selection 
              for loss of H-2 class I expression should be accompanied by an increased 
              sensitivity to natural resistance in vivo and in vitro [4, 5]. As 
              a starting point, H-2 deficient variant lines were selected from 
              the RBL-5 and EL-4 lymphomas [5, 29]. Titrated doses of wild type 
              and variant cells were inoculated either subcutaneously [5, 29], 
              intravenously or intraperitoneally [30] in small groups of mice, 
              age matched and usually littermates, in several independent experiments 
              and tumorigeneicity was scored. This strategy minimized the risk 
              that random fluctuations in the quality of the respective cell suspensions 
              would be responsible for differences in the ability to form tumours. 
              In line with the prediction of the hypothesis, the H-2 class I deficient 
              RBL-5 and EL-4 variants were rejected in syngeneic C57BL/6 mice 
              after a small tumour inoculum (1000 to 100.000 cells), whereas mutagenized 
              but non-selected, H-2 positive, wild type lines were highly tumorigenic 
              in the corresponding doses [5, 29]. The H-2 deficient cells required 
              a 1000 to 10.000-fold higher dose than the H-2 positive cells to 
              induce more than 50% tumour take irrespective if the cells were 
              inoculated subcutaneously, intravenously or intraperitoneally [5,29, 
              30]. The rejection of the H-2 deficient lines showed several characteristics 
              of an NK mediated response, including thymus independence and no 
              requirement for preimmunization [5, 29]. The resistance was weakened 
              (but not totally abrogated) by 400 rad irradiation [29], and it 
              was sufficient to remove asialo-GM1 or NK1.1 positive cells (NK 
              cells) from the animal to abrogate the rejection ([29], unpublished 
              results). Experiments comparing the distribution and survival of 
              isotope prelabeled variant and wild type cells indicated that a 
              rapid elimination of the former took place within 24 h after intravenous 
              injection. These differences in rapid elimination of tumour cells 
              were abolished in NK depleted mice [29]. The above mentioned pattern 
              was observed in all organs studied with one exception the brain 
              (discussed in detail in [30-32]). One possible explanation for the 
              differential rejection patterns of the H-2 positive and H-2 deficient 
              lymphoma cell lines in the syngeneic B 6 mice was a difference in 
              an afferent arm of a NK dependent host response [33]. In this scenario 
              the H-2 deficient cells would recruit NK effector cells which would 
              kill H-2 positive and deficient cells equally well without discriminating 
              between them. However, the differential rejection pattern remained 
              when H-2 positive and deficient cells were inoculated into the same 
              animals, whether in different flanks [29] or mixed in the same inoculum 
              [33]. H-2 deficient cells were selectively eliminated even when 
              they were present in a 10-fold excess compared to H-2 positive cells 
              in the same inoculum [33]. These results suggested that the NK dependent 
              response against H-2 deficient cells was selective in an efferent 
              (effector) arm of the response [33]. In recent experiments we have 
              demonstrated that it is possible to restore the tumorigenicity of 
              ß2-microglobulin ß2m) negative EL-4 cell lines by transfection of 
              ß2m (R. Glas et al., to be published). This indicates that ß2m may 
              act as a tumour growth promoting gene when the host defence is dominated 
              by NK cells . The "missing self' hypothesis predicted that it should 
              be possible to obtain NK mediated rejection of a H-2 positive target 
              provided that the host carried one ( or several) extra MH C class 
              I allele( s) in relation to the target. F 1 hybrid resistance and 
              allogeneic lymphocyte rejection were postulated to be examples of 
              this [4,5]. To directly test this concept, still within the RBL-5 
              model, we used the transgenic strain D 8 generated by Bieberich 
              et al. [34]. The D8 strain was produced by introducing an 8.0-kb 
              genomic fragment containing the H-2Dd gene and 2.5 Kb 5' and 2.0 
              Kb 3' flanking sequences into B6 zygotes. The transgene product 
              was expressed in different tissues in the same way as the endogenous 
              H-2b haplotype products, without alterations in the expression of 
              the latter. Tumour growth was followed after subcutaneous inoculation 
              of graded doses of RBL-5 lymphoma cells in D 8 and B 6 control mice 
              [35]. The D8 strain was more resistant to subcutaneous challenge 
              of "previously syngeneic" RBL-5 lymphoma cells than B6 controls. 
              The direct role of the H-2Dd gene in this resistance was investigated 
              by the use of (D 8 XB 6)F 1 crosses and (D8XB6)XB6 backcrosses. 
              The latter showed cosegregation with regard to the Dd expression 
              and lymphoma resistance, both of which were inherited in a pattern 
              consistent with control by a single dominant gene [35]. The resistance 
              to RBL-5 (or other B6 derived lymphomas) in the D 8 strain could 
              be abrogated by pretreating mice with anti-asialo GM1 antiserum 
              or anti-NK1.1 mAb, indicating that NK cells were necessary for the 
              rejection [35] Subsequent studies have shown that the elimination 
              of RBL-5 in D8 is a rapid event taking place within 24 h (P. Höglund 
              et al., J Exp Med, in press). In thus entirely resembles the elimination 
              of RBL-5 H-2 deficient variant cells in B6 mice. A similar pattern 
              was seen when the D 8 strain was grafted with B 6 bone marrow. The 
              D8 recipients had acquired an ability to reject bone marrow from 
              C57BL/6 donors but not from D8 donors and this rejection was dependent 
              on the presence of NK cells in the host [18]. Recessive Hh antigens 
              have been mapped to the D region of the H-2 complex, although rejection 
              did not require expression of the dominant D locus product of the 
              graft (reviewed in [20]). Our data do not address the role of putative 
              Hh antigens at the tumour/graft level. However, no transcripts have 
              been detected from the flanking sequences of the Dd gene carried 
              by the construct (a. Jay, unpublished observations). It is therefore 
              concluded that the Dd gene itself is responsible for the resistance 
              at the level of the host. These results are consistent with the 
              predictions of the missing self hypothesis [3- 5]. In conclusion, 
              the results are in line with an NK cell mediated rejection of small 
              tumour or bone marrow grafts providing that the graft lacks (or 
              expresses greatly reduced levels) of at least one MHC class I allele 
              of the host.  
             
             
             Table 2. Influence of experimental protocol 
              on NK versus T cell mediated rejection  
              of RBL-5 H-2 positive and H-2 deficient sublines in B6 mice a  
               
             
             
             
               
              MHC Expression and Tumorigenicity -a Re-evaluation 
             The results obtained with the H-2 deficient lymphoma grafts in 
              vivo predicted that if the critical immunological hosttumour interaction 
              is dominated by NK cells rather than T cells in a given system, 
              up-regulation of MHC class I expression would make tumour cells 
              more malignant because they would survive interactions with NK effectors. 
              This has been observed in studies with different sublines of the 
              mouse B 16 melanoma, pioneered by Taniguchi et al. [37]. H-2 positive 
              melanoma cells gave rise to a high number of metastatic lung colonies, 
              whereas the H-2 low or deficient melanoma cells gave no or only 
              few colonies after intravenous inoculation [37]. Subsequent studies 
              showed that the nonmetastatic H-2 deficient sub lines acquired metastatic 
              capacity if they were pretreated with inteferon (IFN), known to 
              enhance H-2 class I expression, or if the mice were pretreated with 
              anti-asialo OM 1 serum, known to deplete NK cells [38]. In contrast 
              to the result reviewed above, there are several reports in which 
              decreased expression of MHC class I molecules are associated with 
              enhanced tumour growth (reviewed in [39,40]). The apparently conflicting 
              results may depend on the antigenicity of the tumour and/or the 
              experimental protocol used [3, 41]. This can be illustrated with 
              the RBL5 lymphoma, for which opposite results with regard to tumorigenicity 
              were obtained when H-2 positive and deficient variants of this tumour 
              were compared in two different experimental situations (Table 2): 
              1) A small subcutaneous inoculum in untreated mice led to growth 
              of H-2 positive cells and NK dependent elimination of H-2 deficient 
              cells, and 2) A large subcutaneous inoculum in preimmunized mice 
              resulted in T cell dependent elimination of H-2 positive cells and 
              growth of H-2 deficient cells which overrode the limited non adaptive 
              NK response. Had the tumours only been tested under the latter conditions, 
              we would erroneously have concluded that loss of class I molecules 
              is only associated with enhanced tumorigenicity of the tumour . 
              Thus, there is no obligatory association between reduced H-2 class 
              I expression and increased malignancy. The effect of MHC class I 
              expression on rejection or escape from immunological rejection will 
              depend on the dominant host-tumour interaction. Such interactions 
              may vary in different phases of tumour progression and under different 
              experimental conditions [3, 41]. Tests for the effect of MHC modulation 
              on tumour growth or immunotherapy therefore require careful experimental 
              design to cover the action of different effector mechanisms in vivo. 
              Since T cell responses, once elicited, would playa dominant role 
              in the final outcome of tumour growth, the effect of H-2 changes 
              on the NK defence could rather easily be missed in studies with 
              relatively large tumour grafts and immunogenic tumours. This possibility 
              can be controlled in any system, by using small grafts or short-term 
              assays where rapid rejection of grafted cells is monitored, either 
              in conventional transplantation assays or in tests of the survival 
              of radiolabelled cells [29]. Additional controls can be obtained 
              by the use of mice with either genetically inherited immunodeficiencies 
              ( e.g. nude mice or SCID mice) or mice where different subsets of 
              the host immune defence experimentally has been depleted ( e.g. 
              irradiated, thymectomized, anti-NK1.1 treated, anti-asialo GMl treated, 
              antiL3T4 treated or anti-Ly2 treated mice). 
             
              NK Sensitivity of MHC Class I Deficient Cells In Vitro 
             A detailed review of the in vitro NK sensitivity of MHC class 
              I deficient cells has recently been published [3]. A brief summary 
              is given below. The MHC class I deficient RBL-5 and EL-4 murine 
              lymphoma cell lines, used in the in vivo studies described above, 
              showed enhanced NK sensitivity in vitro compared to their wild type 
              counterparts [3, 5, 33]. The association between high NK sensitivity 
              and reduced MHC class I expression in murine models is not confined 
              to lymphoma or melanoma variants derived by mutagenization and selection 
              in vitro. Fibrosarcoma clones with constitutively low H-2 expression 
              derived by cloning without selection were sensitive to NK mediated 
              lysis, while clones (from the same primary tumour) with high levels 
              of H-2 expression were resistant [42]. Increased NK sensitivity 
              of human MHC class I deficient variants was first reported by Harel-Bellan 
              et al. [43] and Storkus et al. [44]. They analysed T -LCL, B-LCL 
              and Band T cell hybrid cell lines. The latter group analysed three 
              different sets of cloned cell lines with corresponding variants 
              that differed in their relative HLA class I expression. While sensitivity 
              correlated with reduced class I expression it did not correlate 
              with class II expression or transferring receptor expression [44]. 
              In one of two more recent confirmatory studies on NK sensitivity 
              of HLA deficient variants [45, 46], IL-2 activated effectors gave 
              the same MHC class I related pattern as fresh NK cells while allospecific 
              CTL lines showed an opposite pattern [45]. The latter study also 
              showed that an intermediate HLA class I expressor (Haplotype loss) 
              variant was moderately NK sensitive (compare to the relatively resistant 
              wild type line ), whereas a weak HLA class I expressor (with an 
              additional down regulation of the remaining haplotype) was highly 
              sensitive [45]. Enhanced NK sensitivity of murine and human MHC 
              class I deficient variant lines does not correlate with a single 
              molecular defect (see [47]). Rather, it appears that increased NK 
              sensitivity can result from different defects in the MHC class I 
              biosynthesis with the common denominator that cell surface expression 
              of class I molecules was impaired. In order to directly study whether 
              MHC class I gene products can affect NK sensitivity it is essential 
              to study cell lines transfected with different genes with the purpose 
              to specifically restore the HLA/H-2 class I expression. The first 
              studies in this direction did not support a role for MHC class I 
              gene products. The murine line 1 carcinoma express little if any 
              H-2Dd in vitro [48]. Transfection of H-2DP into line 1 led to a 
              constitutive and dimethyl sulphoxide (DMSO) inducible expression 
              of H-2DP but this expression had no influence on NK sensitivity. 
              Transfection of H-2Kb into a hepatoma gave a less conclusive result 
              (reduced NK sensitivity in 4/9 experiments, no effect in 5/9 experiments) 
              [49]. The authors further concluded that there was no difference 
              in tumour formation between wild type and transfected cells, and 
              thus that H-2Kb did not affect either NK susceptibility or tumorigenicity. 
              The latter conclusion was based on an i.m. inoculation of 10 high7 
              cells [49], as opposed to low dose inocula used to study rejection 
              of H-2 deficient cells as reviewed in the present overview (Table 
              2). However, when Quillet et al. [ 50] transfected the humanß2m 
              gene into theß2m negative human Burkitt lymphoma cell line Daudi, 
              this led to the establishment of a line permanently expressing HLAA10, 
              -All and B-17 class I molecules. This transfected line showed a 
              reduced sensitivity to both NK and lymphokine activated killer (LAK) 
              cell lysis as compared to the HLA class I negative wild type cell 
              line [50]. Transfection of the human HLA class I deficient lymphoblastoid 
              B cell line C 1 R with HLA-A3, HLA-B7 and HLA-Bw58 also led to a 
              reduction in NK sensitivity [51]. Although there was no significant 
              variation among the HLA-A3, -A 7 and -Bw58 alleles, HLA-A2 appeared 
              unable to protect from NK cell lysis [51]. Comparison of amino acid 
              sequence suggests a restricted number of residues which may be relevant 
              to the protective effect. The protection did not extend to H-2DP 
              or Kb transfected C 1 R cells, nor was it seen when IL-2 stimulated 
              NK effector cells were used [51]. Another B cell lymphoblastoid 
              cell line, 0.221, with a selective loss of HLA class I expression 
              was transfected with HLA-Al, HLA-A2, HLAB8, HLA-B5 or an HLA-C gene 
              [46]. Expression ofMHC class I genes reduced NK cell sensitivity, 
              with a general tendency for HLA-B genes to have the most prominent 
              effect. Transfection of human melanoma cells with c-myc is associated 
              with a specific down regulation of class I expression which is most 
              prominent for the B locus products [52]. This is associated with 
              an increased sensitivity to NK cell lysis [53]. Interestingly, this 
              increased NK sensitivity can be overcome by super-transfection of 
              HLA-B7 and B27 genes to the melanoma cells which restores the original 
              NK resistant phenotype (P. Schrier, personal communication). The 
              increased NK sensitivity of melanomas with a cmyc induced HLA- B 
              suppression as well as some of the above-mentioned transfection 
              studies suggested that selective down regulation of certain allelic 
              or locus specific products (and not necessarily all class I molecules) 
              might be sufficient to induce NK sensitivity. This is interesting 
              in relation to two papers describing the failure to induce a significant 
              NK resistance upon transfection with HLA-A2 [54, 55]. There are 
              now two murine analogues to the rescue of HLA in ß2m transfected 
              Daudi cells. Sturmhöfel and Hämmerling [56] selected an H-2 class 
              I deficient line (S 3) from the murine EL-4 cell line. This variant 
              was found to have a defect in ß2m expression and was highly sensitive 
              to NK cell lysis. Transfection of the S 3 line with the ß2m clone 
              restored cell surface H-2 expression and resulted in a considerable 
              decrease in NK sensitivity. Transfection of class II genes had no 
              effect. Blocking of class I molecules with Fab fragments against 
              class I molecules increased NK sensitivity of EL-4 to the level 
              of the S3 variant [56]. The second example is the transfection of 
              the ß2m deficient Y AC-l variant A.H-2- with ß2m. This restored 
              the Y AC-l phenotype with respect to inducible class I expression 
              and a concomitant protection from NK cell lysis after treatment 
              with IFN-gamma [57]. The Y AC-1lymphoma has also recently been transfected 
              with H2Kb under control of the human metallothionein IIA promoter. 
              These transfected H-2Kb positive sublines showed a reduced sensitivity 
              to murine NK cell lysis [58]. At this stage it can be concluded 
              that expression of certain MHC class I molecules can reduce NK sensitivity 
              in several targets. Different molecular models for how MHC class 
              I molecules can protect certain target cells as well as interpretations 
              of the systems where MHC class I genes do not have this effect on 
              NK sensitivity has recently been discussed (see [3]).  
             
              General Conclusions and Future Prospects 
             In the present overview we have discussed an NK cell defence against 
              MHC class I deficient cells. The data in support of this concept 
              were obtained with murine MHC class I deficient variant cell lines 
              and their corresponding wild type cell lines in in vivo and in vitro 
              studies. Using MHC class I transgenic mice, we have demonstrated 
              that a deficiency of a single host MHC class I allelic product on 
              a tumour cell graft is sufficient to cause rejection. ß2m, one of 
              the three subunits of an MHC class I molecule [59,60], is the first 
              identified molecule that contributes to the IFN-gamma mediated protection 
              from NK cell lysis [57]. This was suggested, although formally not 
              proven, to be mediated through the increased cell surface expression 
              of class I molecules of the MHC. The general concept of a surveillance 
              system geared to detect "missing self' explains some conflicting 
              results regarding the relationship between MHC class I expression, 
              tumorigenicity and metastasis (see [3]). The concept can also explain 
              F l-hybrid resistance and rapid elimination of allogeneic lymphocytes 
              by NK cells. Rapid elimination of allogeneic lymphocytes, transferred 
              during for example pregnancy or sexual contacts where the transferred 
              cells may cause tissue damage by graft versus host or by transmitting 
              infectious agents such as HIV, may be an important defence action 
              by NK cells. From a more general immunological point of view the 
              present results have challenged the notion that discrimination between 
              self and non-self is the only strategy for immunological elimination 
              of aberrant cells in mammals [3-5]. In relation to clinical bone 
              marrow transplantation, the present defence system may be taken 
              into consideration in discussions of host versus graft reactions 
              [18]. The analysis of models where MHC class I molecules clearly 
              do affect NK sensitivity must now focus on detailed molecular events. 
              Experimental strategies for this analysis has recently been described 
              [3]. The mechanism by which an NK cell recognizes a target cell, 
              deficient in self MHC class I expression is unknown. A detailed 
              analysis as to which parts of the MHC class I molecule contribute 
              to the inhibit ion of NK cell lysis must be undertaken. Such an 
              analysis may lead to insights into the recognition event. Other 
              studies must focus on defining receptor-like structures on NK cells. 
              In an "effector inhibition" model [3] certain specific questions 
              could be asked. Does one of the NK receptors resemble a T cell receptor 
              due to a possible MHC class I binding ability? Is such a receptor 
              primed to recognize only presence of self MHC class I molecules, 
              and does it trigger the lytic machinery if appropriate class I molecules 
              are not recognized? It would also be of interest to know when during 
              ontogeny NK cells learn to discriminate between self and non-self. 
              Do NK cells themselves need to express self MHC class I in order 
              to recognize absence of self MHC class I? Are quantitative levels 
              of MHC class Ion the target monitored relative to the MHC class 
              I expression on the NK cell itself? The ultimate model for such 
              and related studies may be ß2m deficient mice as recently described 
              in the literature [61, 62]. 
             
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