<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0864-0289</journal-id>
<journal-title><![CDATA[Revista Cubana de Hematología, Inmunología y Hemoterapia]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Cubana Hematol Inmunol Hemoter]]></abbrev-journal-title>
<issn>0864-0289</issn>
<publisher>
<publisher-name><![CDATA[Centro Nacional de Información de Ciencias MédicasEditorial Ciencias Médicas]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0864-02892013000400006</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[La molécula CD28 y su función en la activación de células T]]></article-title>
<article-title xml:lang="en"><![CDATA[CD28 and its role in T cell activation]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Saavedra Hernández]]></surname>
<given-names><![CDATA[Danay]]></given-names>
</name>
<xref ref-type="aff" rid="A01"/>
</contrib>
</contrib-group>
<aff id="A01">
<institution><![CDATA[,Instituto de Ciencias Básicas y Preclínicas Victoria de Girón  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Cuba</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2013</year>
</pub-date>
<volume>29</volume>
<numero>4</numero>
<fpage>359</fpage>
<lpage>367</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_arttext&amp;pid=S0864-02892013000400006&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_abstract&amp;pid=S0864-02892013000400006&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_pdf&amp;pid=S0864-02892013000400006&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[La molécula CD28 es considerada uno de los receptores coestimuladores más importantes en las células T, necesaria para la completa activación celular. En los últimos años se ha acumulado suficiente evidencia sobre su participación en los mecanismos conocidos como señal 2 de activación celular o coestimuladora. De esta forma se convierte en un blanco atractivo para estrategias terapéuticas en enfermedades autoinmunes y trasplante de órganos. Esta revisión se concentra en los principales mecanismos por los cuales esta molécula participa en la completa activación de las células T.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[CD28 is a very important correceptor among T cells and provide positive signals that promote and sustain T-cell responses. In the last few years, CD 28 has become an interesting target in grafts and autoimmune diseases. This review will focus on the mechanisms whereby CD28 allowing a complete T cell activation.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[coestimulación]]></kwd>
<kwd lng="es"><![CDATA[CD28]]></kwd>
<kwd lng="es"><![CDATA[activación célula T]]></kwd>
<kwd lng="en"><![CDATA[costimulation]]></kwd>
<kwd lng="en"><![CDATA[CD28]]></kwd>
<kwd lng="en"><![CDATA[T cell signaling]]></kwd>
</kwd-group>
</article-meta>
</front><body><![CDATA[ <p align="right"><font face="Verdana" size="2"> <B>ART&Iacute;CULO DE REVISI&Oacute;N  </B></font></p>    <p>&nbsp; </p>    <P>     <P>     <P>     <P><font size="4"><b><font face="Verdana">La  mol&eacute;cula CD28 y su funci&oacute;n en la activaci&oacute;n de c&eacute;lulas  T </font></b></font>     <P>     <P>     <P>     <P> <B>     ]]></body>
<body><![CDATA[<P>     <P>&nbsp;     <P><font face="Verdana" size="3">CD28  and its role in T cell activation</font>     <P>&nbsp;     <P><font face="Verdana" size="2">Dra.  Danay Saavedra Hern&aacute;ndez</font> </B>     <P>     <P><font face="Verdana" size="2">Instituto  de Ciencias B&aacute;sicas y Precl&iacute;nicas &#171;Victoria de Gir&oacute;n&#187;.  Universidad de Ciencias M&eacute;dicas de La Habana, Cuba. </font>     <P>&nbsp;     <P>&nbsp;     <P>&nbsp;  <hr size="1" noshade>     ]]></body>
<body><![CDATA[<P><font face="Verdana" size="2"><B>RESUMEN</B> </font>      <P><font face="Verdana" size="2">La mol&eacute;cula<FONT COLOR="#ff0000"> </FONT>CD28  es considerada uno de los receptores coestimuladores m&aacute;s importantes en  las c&eacute;lulas T, necesaria para la completa activaci&oacute;n celular. En  los &uacute;ltimos a&ntilde;os se ha acumulado suficiente evidencia sobre su participaci&oacute;n  en los mecanismos conocidos como se&ntilde;al 2 de activaci&oacute;n celular o  coestimuladora. De esta forma se convierte en un blanco atractivo para estrategias  terap&eacute;uticas en enfermedades autoinmunes y trasplante de &oacute;rganos.  Esta revisi&oacute;n se concentra en los principales mecanismos por los cuales  esta mol&eacute;cula participa en la completa activaci&oacute;n de las c&eacute;lulas  T. </font>     <P>     <P><font face="Verdana" size="2"><B>Palabras clave:</B> coestimulaci&oacute;n,  CD28, activaci&oacute;n c&eacute;lula T. </font> <hr size="1" noshade>     <P>     <P><font face="Verdana" size="2"><B>ABSTRACT</B>  </font>     <P><font face="Verdana" size="2">CD28 is a very important correceptor  among T cells and provide positive signals that promote and sustain T-cell responses.  In the last few years, CD 28 has become an interesting target in grafts and autoimmune  diseases. This review will focus on the mechanisms whereby CD28 allowing a complete  T cell activation. </font>     <P><font face="Verdana" size="2"><B>Keywords:</B> costimulation,  CD28, T cell signaling. </font> <hr size="1" noshade>     <p>&nbsp;</p>    <p>&nbsp;</p>    ]]></body>
<body><![CDATA[<P>     <P><font face="Verdana" size="3"><B>INTRODUCCI&Oacute;N</B>  </font>     <P><font face="Verdana" size="2">La mol&eacute;cula<FONT COLOR="#ff0000">  </FONT>CD28 es uno de los receptores coestimuladores m&aacute;s importantes descritos  en c&eacute;lulas T, esencial para la completa activaci&oacute;n de estas c&eacute;lulas.  <SUP>1, 2</SUP> </font>     <P><font face="Verdana" size="2">En la actualidad se conoce  que unido a la se&ntilde;al emitida tras el reconocimiento del ant&iacute;geno  espec&iacute;fico (p&eacute;ptido presentado en el contexto del complejo principal  de histocompatibilidad (MHC)) por el complejo del receptor de linfocito T (se&ntilde;al  1), a las c&eacute;lulas T les resulta imprescindible se&ntilde;ales coestimuladoras  adicionales (se&ntilde;al 2) para lograr la completa activaci&oacute;n. Adem&aacute;s  necesitan el concurso de citocinas (se&ntilde;al 3) que consolidan el proceso  de activaci&oacute;n. <SUP>3</SUP> </font>     <P><font face="Verdana" size="2">El  t&eacute;rmino coestimulaci&oacute;n habitualmente describe la modificaci&oacute;n  del proceso de activaci&oacute;n de la c&eacute;lula T a partir de la interacci&oacute;n  de receptores expresados en las c&eacute;lulas T con sus     <BR> ligandos expresados  en las membranas de las c&eacute;lulas dendr&iacute;ticas (CD) u otras c&eacute;lulas  presentadoras de ant&iacute;genos (APC). <SUP>1, 3</SUP> </font>     <P><font face="Verdana" size="2">Aunque  la activaci&oacute;n de las c&eacute;lulas T puede ocurrir con una potente se&ntilde;al  de su receptor de linfocito T (TCR), la coligaci&oacute;n con CD28 es necesaria  en la mayor&iacute;a de las respuestas a un p&eacute;ptido antig&eacute;nico <SUP>4,  5</SUP> sin esta, generalmente se induce un estado de no respuesta, anergia o  muerte celular <SUP>6</SUP>. Consecuentemente las v&iacute;as de coestimulaci&oacute;n  son atractivos blancos terap&eacute;uticos en enfermedades que se asocian con  respuestas inmunes da&ntilde;inas o aberrantes como por ejemplo: enfermedades  autoinmunes, respuestas a al&eacute;rgenos o trasplante de &oacute;rganos. <SUP>7,  8</SUP>. Este trabajo persigue el objetivo de realizar una revisi&oacute;n sobre  la mol&eacute;cula CD28 y su participaci&oacute;n en la activaci&oacute;n de los  linfocitos T. </font>     <P>     <P><font face="Verdana" size="2"><B>La mol&eacute;cula  CD28 </B> </font>     <P><font face="Verdana" size="2">Esta mol&eacute;cula<FONT COLOR="#ff0000">  </FONT>es una prote&iacute;na de 44 kDa, miembro de la superfamilia de las inmunoglobulinas  (Ig). Se expresa en la superficie de las c&eacute;lulas T como un homod&iacute;mero  estabilizado por un puente disulfuro. Sus genes est&aacute;n localizados en el  cromosoma 2q33. <SUP>9</SUP> </font>     ]]></body>
<body><![CDATA[<P><font face="Verdana" size="2">Estructuralmente  forma un homod&iacute;mero que se une a sus ligandos: CD80 (B7-1) y CD86 (B7-2),  con una constante de disociaci&oacute;n de aproximadamente 12 nM <SUP>10</SUP>.  (<a href="#fig1">Figura 1</a>) </font>     <P><a name="fig1"></a>     <P align="center"><img src="/img/revistas/hih/v29n4/f0106413.jpg" width="545" height="364">      <P><font face="Verdana" size="2">Como mol&eacute;cula coestimuladora, sus principales  funciones son: </font> <ul>     <li><font face="Verdana" size="2">Activaci&oacute;n  de los linfocitos T v&iacute;rgenes </font></li>    <li><font face="Verdana" size="2">Promueve  producci&oacute;n de IL-2 </font></li>    <li><font face="Verdana" size="2"> Supervivencia  de las c&eacute;lulas T y favorece su entrada en el ciclo celular <SUP>11, 12</SUP>  </font></li>    </ul>    <P>     <P><font face="Verdana" size="2"><B>Familia de B7:CD28</B>  </font>     ]]></body>
<body><![CDATA[<P>     <P><font face="Verdana" size="2">La familia B7:CD28 es el principal  grupo de receptores/mol&eacute;culas coestimuladoras involucradas en procesos  de coestimulaci&oacute;n y coinhibici&oacute;n en los linfocitos T. <SUP>13</SUP>  </font>     <P><font face="Verdana" size="2">Comprende los siguientes pares de receptores:  ligandos: </font> <ul>     <li><font face="Verdana" size="2">CD28: CD80/CD86. La mol&eacute;cula  CD28 es esencial para iniciar las respuestas de los linfocitos T CD4+. <SUP>13</SUP>  </font></li>    <li><font face="Verdana" size="2">CTLA-4 (Ant&iacute;geno 4 de c&eacute;lulas  T citol&iacute;ticas):CD80/CD86. La mol&eacute;cula CTLA-4 es un receptor inhibidor,  que se expresa desde el momento en que ocurre la activaci&oacute;n del linfocito.  <SUP>13</SUP> </font></li>    <li><font face="Verdana" size="2">ICOS (Coestimulador  indecible):ICOS-L (ligando de coestimulador indecible). La mol&eacute;cula ICOS  es muy importante para la activaci&oacute;n de linfocitos efectores. <SUP>13</SUP>  </font></li>    <li><font face="Verdana" size="2">PD-1 (Muerte programada 1): PDL1/PDL2  (ligandos 1 y 2 de muerte programada 1). La mol&eacute;cula PD-1 es un receptor  inhibidor, participa en la finalizaci&oacute;n de las respuestas inmunitarias.  <SUP>13</SUP> </font></li>    </ul>    <P><font face="Verdana" size="2">La v&iacute;a  de se&ntilde;alizaci&oacute;n CD28/CTLA-4:CD80/CD86 es la mejor caracterizada.  CD80 y CD86 comparten una especificidad dual para el receptor estimulador CD28  y para el inhibidor CTLA-4. <SUP>14</SUP> </font>     <P><font face="Verdana" size="2">La  familia CD28 de receptores se expresa por completo en los linfocitos T, el receptor  PD-1 tambi&eacute;n se expresa en los linfocitos B y en las c&eacute;lulas mieloc&iacute;ticas.  <SUP>13</SUP> </font>     ]]></body>
<body><![CDATA[<P><font face="Verdana" size="2">Estos receptores son prote&iacute;nas  transmembranarias y todos incluyen un &uacute;nico dominio similar a la regi&oacute;n  variable de las Ig y una cola citoplasm&aacute;tica con tirosinas. <SUP>13</SUP>  </font>     <P><font face="Verdana" size="2">CD28, CTLA-4 e ICOS aparecen como homod&iacute;meros  unidos por puentes disulfuro; PD-1 se expresa como mon&oacute;mero. <SUP>13</SUP>  </font>     <P>     <P><font face="Verdana" size="2"><B>V&iacute;as de Se&ntilde;alizaci&oacute;n  de CD28</B> </font>     <P><font face="Verdana" size="2">El dominio citoplasm&aacute;tico  de CD28, carece de actividad catal&iacute;tica propia, por lo que el correceptor  se&ntilde;aliza a trav&eacute;s de la uni&oacute;n de prote&iacute;nas se&ntilde;alizadoras  intracitoplasm&aacute;ticas. <SUP>15, 16</SUP> </font>     <P><font face="Verdana" size="2">La  activaci&oacute;n de su v&iacute;a de se&ntilde;alizaci&oacute;n, se asocia con  la uni&oacute;n de varias prote&iacute;nas se&ntilde;alizadoras a su motivo intracitoplasm&aacute;tico,  formado por los residuos: Tirocina, Metionina, Asparagina, Metionina (TyrMetAsnMet  o YMNM). En ocasiones la primera Metionina se sustituye por Valina (Tyr-Val-Asn-Met  o YVNM). <SUP>12</SUP> </font>     <P><font face="Verdana" size="2">La se&ntilde;alizaci&oacute;n  se relaciona con la composici&oacute;n de su peque&ntilde;o dominio intracitoplasm&aacute;tico  de 44 amino&aacute;cidos y su interacci&oacute;n con prote&iacute;nas intracelulares.  El motivo amino terminal (YMNM), una vez fosforilado en su residuo de tirosina,  se une a la subunidad p85 de PI3K (fosfatidilInositol 3 cinasa). <SUP>17, 18,  19, 20</SUP> Corriente abajo del motivo YMNM, la mol&eacute;cula CD28     <BR> cuenta  con dos regiones ricas en prolina, (PRRP N terminal) que se unen a Itk (cinasa  inducible por IL-2). <SUP>21-22</SUP> </font>     <P><font face="Verdana" size="2">La  literatura consultada refiere la existencia de numerosas v&iacute;as de se&ntilde;alizaci&oacute;n  a partir de CD28, con la participaci&oacute;n de diversas mol&eacute;culas tambi&eacute;n  involucradas en la transducci&oacute;n de se&ntilde;ales de otros receptores como  CD3, CD40, entre otros. <SUP>12, 23-25</SUP>. Se detallan a continuaci&oacute;n  las tres v&iacute;as mejor estudiadas y descritas. </font>     <P>     ]]></body>
<body><![CDATA[<P><font face="Verdana" size="2"><I>V&iacute;a  de la fostatidilinositol 3 cinasa (PI3K)</I> </font>     <P><font face="Verdana" size="2">La  uni&oacute;n de PI3K al motivo fosforilado de CD28 desencadena la producci&oacute;n  de PIP2 (fosfatidilInositol bifosfato) y PIP3 (fosfatidilInositol trifosfato)  que se unen a los dominios con homolog&iacute;a pleckstrima en prote&iacute;nas  como PDK-1 (prote&iacute;na cinasa dependiente de fosfoinositol 1), la cual activa  la prote&iacute;na cinasa B (PKB/AKT). Ambas, PDK-1 y PKB, pueden fosforilar otras  prote&iacute;nas y regular m&uacute;ltiples v&iacute;as ligadas a s&iacute;ntesis  de prote&iacute;nas, metabolismo celular, y supervivencia. <SUP>23, 24</SUP> En  este sentido, CD28PI3K y PKB proveen se&ntilde;ales para aumento del metabolismo  celular. <SUP>25</SUP> </font>     <P><font face="Verdana" size="2">Est&aacute; claro  que la uni&oacute;n de CD28-YMNM fosforilado con PI3K genera se&ntilde;ales pro  supervivencia que previenen la apoptosis de la c&eacute;lula T. <SUP>26, 27, 28,  29</SUP> </font>     <P>     <P><font face="Verdana" size="2"><I>V&iacute;a de las Rac-MAP  cinasas/Ras-Map-cinasas</I> </font>     <P><font face="Verdana" size="2">El motivo  YMNM puede igualmente acomodar la uni&oacute;n de la prote&iacute;na adaptadora  Grb2 (prote&iacute;na 2 unidora del receptor de factor de crecimiento). La imposibilidad  de uni&oacute;n de Grb2, por existir mutaciones en el residuo de asparagina (N),  impide la fosforilaci&oacute;n del factor de intercambio Vav1 (factor de intercambio  de nucle&oacute;tidos de guanina) y con este de la activaci&oacute;n de JNK (serina/treonina  cinasa c-Jun cinasa). <SUP>30</SUP> CD28 y Grb2 cooperan con Vav1 en la activaci&oacute;n  de los factores de transcripci&oacute;n NFAT (Factor nuclear) y AP-1(Prote&iacute;na  activadora 1). <SUP>31</SUP> </font>     <P><font face="Verdana" size="2">Vav1 tiene  un dominio (Dbl, dominio de homolog&iacute;a) con actividad capaz de intercambiar  GDP/GTP, para la activaci&oacute;n de la prote&iacute;na Rac1, la cual desencadena  una cascada de activaci&oacute;n de enzimas que culmina con la activaci&oacute;n  de la MAP cinasa JNK, <SUP>32</SUP> que propicia la s&iacute;ntesis y activaci&oacute;n  de factores de transcripci&oacute;n como AP-1. </font>     <P><font face="Verdana" size="2">Vav1  se une igualmente a PKC&egrave; (prote&iacute;na cinasa C &egrave;), permitiendo  igualmente la activaci&oacute;n del factor de transcripci&oacute;n nuclear &ecirc;B  (NF-&ecirc;B). <SUP>32</SUP> </font>     <P>     <P><font face="Verdana" size="2"><I>V&iacute;a  del factor Nuclear &Ecirc;appa B (NF-&ecirc;B)</I> </font>     ]]></body>
<body><![CDATA[<P><font face="Verdana" size="2">Han  sido descritas otras v&iacute;as mediante las cuales CD28 puede activar el factor  de transcripci&oacute;n NF-&ecirc;B. En este caso, su activaci&oacute;n est&aacute;  regulada por una serina/treonina cinasa, I&ecirc;B cinasa (IKKs), la cual promueve  la fosforilaci&oacute;n de I&ecirc;B y su degradaci&oacute;n por ubiquitinaci&oacute;n,  permitiendo al factor NF-&ecirc;B entrar al n&uacute;cleo. <SUP>33, 34, 35</SUP>  </font>     <P><font face="Verdana" size="2">La PKC&egrave; se transloca al sitio  de uni&oacute;n de CD28 con su ligando, fosforila a la prote&iacute;na Carma1  (caspasa con dominio de reclutamiento de membrana asociado a guanilato cinasa  1), la cual forma un complejo junto a Bcl10 y MALT1 (gen de translocaci&oacute;n  de linfoma de tejido linfoide asociado a mucosas 1). <SUP>36, 37</SUP> </font>      <P><font face="Verdana" size="2">Este complejo recluta otra serina-cinasa, IKK,  que al fosforilar a I&ecirc;B (que se comporta como un inhibidor de NF-&ecirc;B),  es marcada para su degradaci&oacute;n en el proteasoma. <SUP>38, 39</SUP> </font>      <P><font face="Verdana" size="2">Al cesar la inhibici&oacute;n, NF-&ecirc;B puede  traslocarse al n&uacute;cleo donde interviene en la transcripci&oacute;n de genes,  por ejemplo de interleuquina 2 (IL-2). <SUP>38, 39</SUP> </font>     <P>     <P><font face="Verdana" size="2"><I>Principales  resultados de estas v&iacute;as de se&ntilde;alizaci&oacute;n </I> </font> <ul>      <li><font face="Verdana" size="2">Incremento de la expresi&oacute;n de prote&iacute;nas  antiapopt&oacute;ticas que promueven la supervivencia de la c&eacute;lula </font></li>    <li><font face="Verdana" size="2">Aumento  de la actividad metab&oacute;lica de la c&eacute;lula T </font></li>    <li><font face="Verdana" size="2">Incremento  de la capacidad proliferativa de las c&eacute;lulas T </font></li>    <li><font face="Verdana" size="2">Producci&oacute;n  de citocinas como IL-2 </font></li>    ]]></body>
<body><![CDATA[<li><font face="Verdana" size="2">Diferenciaci&oacute;n  de las c&eacute;lulas T v&iacute;rgenes en c&eacute;lulas efectoras y de memoria.  </font></li>    </ul>    <P>     <P><font face="Verdana" size="2"><B>Coestimulaci&oacute;n  a trav&eacute;s de CD28 en respuestas inmunes secundarias: rompiendo paradigmas</B>  </font>     <P><font face="Verdana" size="2">Estudios recientes en ratones han demostrado  que es tambi&eacute;n &uacute;til recibir coestimulaci&oacute;n para desarrollar  una adecuada respuesta de linfocitos T de memoria. Investigadores de Filadelfia  han observado que cuando la v&iacute;a de coestimulaci&oacute;n a trav&eacute;s  de CD28 se bloquea, ocurre una significativa reducci&oacute;n en la re-expansi&oacute;n  de las c&eacute;lulas T CD8+ de memoria y en la magnitud de la respuesta que se  genera contra el virus de la influenza. Se describe una reducci&oacute;n (de tres  veces) en el n&uacute;mero absoluto de c&eacute;lulas T CD8+ virus espec&iacute;ficas,  en ratones tratados con anticuerpos anti CD28, en comparaci&oacute;n con los ratones  del grupo control. Unido a este hallazgo se observ&oacute; una significativa reducci&oacute;n  en la funci&oacute;n citol&iacute;tica de estas c&eacute;lulas. <SUP>40</SUP>  </font>     <P>     <P><font face="Verdana" size="2"><B>Las v&iacute;as de coestimulaci&oacute;n  como dianas terap&eacute;uticas</B> </font>     <P><font face="Verdana" size="2">Nuevos  agentes terap&eacute;uticos han sido desarrollados para la supresi&oacute;n de  respuestas inmunes da&ntilde;inas sobre la base del conocimiento de estas v&iacute;as  de coestimulaci&oacute;n antes mencionadas. <SUP>40</SUP> </font>     <P><font face="Verdana" size="2">CTLA-4-Ig,  medicamento biol&oacute;gico, consiste en el dominio extracelular de CTLA-4 y  la porci&oacute;n Fc (Fracci&oacute;n cristalizable) de la IgG humana. Esta prote&iacute;na  se une a B7-1 y B7-2 y bloquea la interacci&oacute;n de CD28 con sus ligandos.  Es conocido que la mol&eacute;cula CTLA-4 se une a sus ligandos con una afinidad  entre 20 y 50 veces mayor que la afinidad mostrada por CD28 al unirse a estas  mismas mol&eacute;culas (ambos receptores comparten los mismos ligandos), es este  el motivo por el cual no se ha usado la propia mol&eacute;cula CD28 para obtener  producto. La uni&oacute;n de CTLA-4 a la porci&oacute;n de IgG, aumenta el tiempo  de vida media de la prote&iacute;na. <SUP>33</SUP> </font>     <P><font face="Verdana" size="2">CTLA-4-Ig  ha sido empleada en pacientes con Artritis Reumatoide, se desarrollan ensayos  cl&iacute;nicos para evaluar su efectividad en el tratamiento del rechazo a trasplantes,  psoriasis y enfermedad de Crohn. <SUP>40</SUP> </font>     ]]></body>
<body><![CDATA[<P><font face="Verdana" size="2">En  recientes investigaciones se ha determinado que las mol&eacute;culas CD28 y CTLA-4  resultan atractivas dianas para el tratamiento contra algunos tipos de c&aacute;ncer,  entre ellos de mama y melanoma. <SUP>41, 42</SUP> </font>     <P>&nbsp;     <P>     <P><font face="Verdana" size="3"><B>REFERENCIAS  BIBLIOGR&Aacute;FICAS </B></font><font face="Verdana" size="2"> </font>     <!-- ref --><P><font face="Verdana" size="2">1.  Acuto O, Mise-Omata S, Mangino G, Michel F. Molecular modifiers of T cell antigen  receptor triggering threshold: the mechanism of CD28 costimulatory receptor. Immunol  Rev 2003;192:2131.     </font>     <!-- ref --><P><font face="Verdana" size="2">2. Rudd CE, Taylor  A, Schneider H. CD28 and CTLA-4 coreceptor expression and signal transduction.  Immunol Rev 2009; 229:1226.     </font>     <P><font face="Verdana" size="2">3. Leitnera  J, Grabmeier-Pfistershammerb K, Steinbergera. Receptors and ligands implicated  in human T cell costimulatory processes. Immunology Letters 2010; 128: 8997. </font>      <!-- ref --><P><font face="Verdana" size="2">4. Bluestone J. New perspectives of CD28-B7 mediated  T cell costimulation. Immunity 1995;2:5559.     </font>     <!-- ref --><P><font face="Verdana" size="2">5.  Linsley PS. Distinct roles for CD28 and cytotoxic T lymphocyte-associated molecule  4 receptor during T-cell activation. J Exp Med 1995;182:28992.     </font>     <!-- ref --><P><font face="Verdana" size="2">6.  Rudd CE. The reverse stop-signal model for CTLA4 function. Nat Rev Immunol 2008;8:15360.      </font>     <!-- ref --><P><font face="Verdana" size="2">7. Podojil JR, Miller SD. Molecular mechanisms  of T-cell receptor and costimulatory molecule ligation/blockade in autoimmune  disease therapy. Immunol Rev 2009;229:33755.     </font>     <!-- ref --><P><font face="Verdana" size="2">8.  Li XC, Rothstein DM, Sayegh MH. 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Growth  factor receptor-bound protein 2 SH2 /SH3 domain binding to CD28 and its role in  cosignaling. J Biol Chem 1998;273:296301.     </font>     <!-- ref --><P><font face="Verdana" size="2">31.  Schneider H, Rudd C. CD28 and Grb2, relative to Gads or Grap, preferentially co-operate  with Vav1 in the activation of NFAT D AP-1 transcription. Biochem Biophys Res  Commun 2008;369:61621.     </font>     <!-- ref --><P><font face="Verdana" size="2">32. Bustelo XR.  Regulatory and signaling properties of the Vav family. Mol Cell Biol 2000; 20:146177.      </font>     <!-- ref --><P><font face="Verdana" size="2">33. Abbas A.K, Lichtman AH, Pillai S.  Activation of T Lymphocytes. En: Abbas A.K, Lichtman AH, Pillai S. Celular and  Molecular Immunology. 7th edition. Washington, DC: Elsevier Saunders;2011.203-24.      </font>     <!-- ref --><P><font face="Verdana" size="2">34. Hara H, Wada T, Bakal C, Kozieradzki  I, Suzuki S, Suzuki N, et al. 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Eur J Immunol 2008;38: 144651.     </font>      <!-- ref --><P><font face="Verdana" size="2">38. Sathish JG, Johnson KG, LeRoy FG, Fuller  KJ, Hallett MB, Brennan P, et al. Requirement for CD28 costimulation is lower  in SHP-1-deficient T cells. Eur J Immunol 2001;31:364958.     </font>     <!-- ref --><P><font face="Verdana" size="2">39.  Taylor A, Akdis M, Joss A, Akko&ccedil; T, Wenig R, Colonna M, et al. IL-10 inhibits  CD28 and ICOS costimulations of T cells via src homology 2 domain-containing protein  tyrosine phosphatase 1. J Allergy ClinImmunol 2007;120:7683.     </font>     <!-- ref --><P><font face="Verdana" size="2">40.  Boesteanu A, Katsikis P. Memory T cells need CD28 costimulation to remember. SeminImmunol.  2009; 21(2): 6977.     </font>     <!-- ref --><P><font face="Verdana" size="2">41. Janakiram M, Abadi  YM, Sparano JA, Zang X. T cell coinhibition and immunotherapy in human breast  cancer. Discov Med. 2012;14(77):229-36.     </font>     <!-- ref --><P><font face="Verdana" size="2">42.  Garbe C, Peris K, Hauschild A, Saiag P, Middleton M, Spatz A, et al. Diagnosis  and treatment of melanoma. European consensus-based interdisciplinary guideline  - Update 2012. Eur J Cancer. 2012;48(15):2375-90.     </font>     <P>&nbsp;     <P>&nbsp;     <P>     ]]></body>
<body><![CDATA[<P>     <P>      <P><font face="Verdana" size="2">Recibido: 14 de octubre de 2012.     <br> </font><font face="Verdana" size="2">Aprobado:  26 de noviembre de 2012. </font>     <P>&nbsp;     <P>&nbsp;     <P>     <P>     <P><font face="Verdana" size="2"><B>Dra.  Danay Saavedra Hern&aacute;ndez.</B> Direcci&oacute;n particular: Calle K # 15037  e/ 7ma y D. Altahabana, Boyeros, La Habana.     <br> </font><font face="Verdana" size="2">Tel&eacute;fono:  6461147     ]]></body>
<body><![CDATA[<br> </font><font face="Verdana" size="2">E-mail: <U><FONT COLOR="#0000ff"><a href="mailto:danay.saavedra@infomed.sld.cu">danay.saavedra@infomed.sld.cu</a></FONT></U>  </font>       ]]></body><back>
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