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【摘要】
Objective- The purpose of this study was to investigate the presence and functionality of P-selectin glycoprotein ligand-1 (PSGL-1) on activated endothelial cells (ECs).
Methods and Results- We show here that PSGL-1 is expressed at the mRNA and protein levels in umbilical vein and microvascular ECs. Furthermore, this endothelial PSGL-1 (ePSGL-1) is functional and mediates adhesion of monocytes or platelet-monocyte complexes (PMCs) to the activated endothelium in a flow model. ePSGL-1 expression was not affected by treating ECs with inflammatory stimuli (tumor necrosis factor, interleukin-1ß, thrombin, or histamine). However, the functional binding capacity of ePSGL-1 to monocytes or P-selectin/Fc chimera significantly increased by stimulation of the ECs with TNF. By means of a siRNA approach to specifically knock-down the genes involved in the glycosylation of PSGL-1 we could show that tumor necrosis factor -induced glycosylation of ePSGL-1 is critical for its binding capacity.
Conclusion- Our results show that ECs express functional PSGL-1 which mediates tethering and firm adhesion of monocytes and platelets to inflamed endothelium.
We describe here the presence of PSGL-1 on human endothelial cells, both in vitro and in vivo (arteriosclerotic coronary lesions). Only activated endothelial cells showed functional PSGL-1, suggesting a role for this molecule in the arrest of monocytes during inflammation.
【关键词】 Pselectin glycoprotein ligand monocyte adhesion plateletmonocyte complexes endothelium glycosylation
Introduction
PSGL-1 is one of the best characterized selectin ligands known to date. PSGL-1 is expressed as a homodimer of two 120-kDa subunits that binds all three selectins, with the highest affinity for P-selectin, 1 and is known to be constitutively expressed on the surface of platelets 2 and most types of leukocytes. 3 PSGL-1, besides playing a critical role in the inflammatory response by mediating leukocyte-leukocyte and leukocyte-endothelium interactions it also participates in the hemostatic process by mediating leukocyte-platelet interactions. 4 In vivo studies showed that leukocyte PSGL-1 mediates rolling of leukocytes over E-selectin and P-selectin on activated ECs 5 whereas PSGL-1 - L-selectin interactions mediate leukocyte secondary tethering at the activated endothelium. 6 See page 990
PSGL-1-dependent interactions appear to enable the presence of inflammatory cells at the hemostatic thrombus by binding to P-selectin on activated platelets localized at the injured vessel wall. 7 These platelet-leukocyte interactions, however, also occur when activated platelets are present in the circulation giving rise to circulating platelet-leukocyte complexes, mainly platelet-monocyte complexes (PMCs). PMCs are currently regarded not just as markers of vessel wall disease 8,9 but also as thromboatherogenic particles with high adhesive capacity to activated endothelium. 10,11
Only few studies have assessed the presence of PSGL-1 on the endothelium. Laszik et al 3 described the presence of PSGL-1 in the small venules and capillaries of benign hyperplasia samples, although no vascular-associated staining could be detected in normal tissues or tissues undergoing acute inflammation. Also Sperandio et al 6 failed to show PSGL-1 expression on resting or inflamed endothelium and platelets in mice. For many years the presence of PSGL-1 on ECs has not been considered to be important and therefore not further investigated. Recently, Ley et al 12 demonstrated the presence of PSGL-1 in venules of the mesenteric lymph node and small intestine of mice. We show in this report that PSGL-1 is expressed at the mRNA and protein levels in human vein and foreskin microvascular ECs (HUVECs and FMVECs, respectively). Importantly, we also show that endothelial PSGL-1 plays an important role in mediating the rolling and adhesion of monocytes, platelets, and PMCs over activated endothelium. Further, PSGL-1 expression was demonstrated on the endothelial lining of atherosclerotic coronary arteries, suggesting a role in the formation of the inflammatory infiltrate in this type of lesions. These findings reveal a new mechanism by which selectins and their ligands participate in the onset of inflammation and/or atherosclerosis.
Materials and Methods
Endothelial Cells
HUVECs were isolated from human umbilical cord veins as described. 13 Immortalized HUVECs, EC-RF24 14 cells, were kindly provided by Prof H. Pannekoek (Academic Medical Center, Amsterdam, The Netherlands). FMVECs 15,16 were kindly provided by Prof V.W.M. van Hinsbergh (VU Medical Center, Amsterdam, The Netherlands). Cells were cultured in RPMI 1640 containing 20% (v/v) human serum, 200 µg/mL penicillin, and streptomycin (Life Technologies) and grown to confluence in 5 to 7 days.
RNA Interference
The plasmids pSUPER/ß4GalT-7, pSUPER/GST-1, pSUPER/GST-2, pSUPER/PSGL-1, and pSUPER/FX were generated and transfected into HUVECs as described in supplemental Methods (available online at http://atvb.ahajournals.org) to induce silencing of the genes ß4GALT-7, GST-1, GST-2, PSGL-1, and FX.
Isolation of Blood Cells
Whole blood, anticoagulated with 0.4% trisodium citrate (pH 7.4), was obtained from healthy volunteers from the Sanquin Blood Bank (Amsterdam, The Netherlands). Monocytes were isolated by negative selection from human peripheral blood by means of a MACS monocyte isolation kit according to the manufacturer?s instructions (Miltenyi Biotech GMBH). This procedure resulted in more than 90% pure monocyte suspensions (measured as CD14-positive cells by flowcytometry).
Reverse Transcriptase Polymerase Chain Reaction
Total RNA was prepared from freshly isolated monocytes and untreated or IL-1ß (4 hours) treated HUVECs or EC-RF24 cells with the Absolutely RNA kit (Stratagene). Total RNA (2 µg) was converted to cDNA using 0.5 µg of dT12-18 primer (Invitrogen), Superscript II (Invitrogen), and 20 U of RNAsin (Promega).
Western Blotting
Monocytes and HUVECs were lysed in 1.5% Triton X-100, 0.1% SDS, 0.1% NP-40, 100 mmol/L Tris-HCl pH 7.4, 150 mmol/L NaCl, and 1 mmol/L CaCl 2 buffer. Proteins from the cell lysates (1 x 10 6 monocytes and 2 x 10 6 HUVECs) were separated on 7% SDS-PAGE, transferred to a polyvinylidene fluoride (PVDF) membrane, and blotted with PL-1 antibody. The bound antibody was detected by using HRP-conjugated secondary antibody.
Flow Cytometry and Confocal Microscopy
PSGL-1 surface expression on ECs was investigated by flow cytometry (FACS; Vantage, Becton Dickinson) with cells from different passages, stimulated or not with TNF- (10 and 30 minutes, 2, 6, 12, and 24 hours), IL-1ß (6 hours), thrombin (5 and 10 minutes), or histamine (5 and 10 minutes). After stimulation, ECs were resuspended in washing buffer and incubated with a control antibody (fluorescein isothiocyanate -labeled goat anti-mouse IgG), or an antibody against PSGL-1, P-selectin, E-selectin, vascular cell adhesion molecule (VCAM)-1, or PECAM-1 for 45 minutes at 4°C.
Monocyte/Platelet Perfusion and Evaluation of Adhesion and Rolling Velocity
Monocytes (2 x 10 6 cells/mL) were perfused over ECs seeded on glass slides as previously described. 11 The perfusion chamber was mounted on a microscope stage (Axiovert 25, Zeiss), equipped with a B/W charge-coupled device (CCD) video camera (Sanyo). The flow rate through the chamber was precisely controlled and the monocytes were perfused at 0.8 dyn/cm 2. The cut-off value to distinguish between rolling and static adherent cells was set at 1 µm/s.
Tissue Specimens: Immunohistochemistry and Immunofluorescence
Portions of coronary arteries were obtained from autopsy specimens at the Academic Medical Centre (Amsterdam, The Netherlands) according to institutional guidelines. Coronary arteries undergoing atherosclerosis were snap-frozen and sectioned using conventional techniques.
Statistical Analysis
Data are represented as the mean±SEM of at least 3 independent experiments and were compared with a two-tailed Student t test or a one-way ANOVA with Bonferroni correction. Probability values <0.05 were considered to be significant.
For detailed Methods please see the supplemental materials, available online at http://atvb.ahajournals.org.
Results
Expression of PSGL-1 in Endothelial Cells
Because PSGL-1 is involved in leukocyte-endothelium interactions and there is controversy concerning the presence of PSGL-1 on inflamed endothelium, we investigated whether PSGL-1 is indeed expressed on ECs. Immunofluorescence analysis (flow cytometry and microscopy) showed that PSGL-1 is expressed on the surface of ECs ( Figures 1A, 1B, and 2 C). In contrast to E-selectin and VCAM-1, there was no increase in surface levels of PSGL-1 after EC activation using TNF- (6 hours, Figures 1A, 1B, and 2 C) or IL-1ß (data not shown), at different incubation times (10 or 30 minutes, 2, 6, 12, or 24 hours; data not shown). PSGL-1 expression levels on FMVECs were similar to those obtained on HUVECs (data not shown). PSGL-1 was not upregulated by recruitment from intracellular stores as shown by stimulation with thrombin or histamine for 5 or 10 minutes ( Figure 1 C), in contrast to P-selectin (used as positive control).
Figure 1. Expression pattern of PSGL-1 on EC. A, Flow cytometry histograms comparing the expression pattern of different adhesion molecules (E-selectin, VCAM-1, and PSGL-1) between untreated and TNF- -treated HUVECs. The values on the upper right corner of each histogram represent the specific mean fluorescence intensity for each marker on the two different conditions (mean±SD, n=4). B, Flow cytometry dot-plots showing dual-labeling of cells with a PE-labeled antibody against PECAM-1 (standard EC marker) or E-selectin (control of EC activation) versus FITC-labeled antibody against PSGL-1. The percentage of cells positive for each of the markers or double positive are indicated at the right upper corner of each quadrant. Data shown in A and B are representative of 3 experiments. C, HUVECs were left untreated or were stimulated with thrombin (1 U/mL) or histamine (1 U/mL) for 5 or 10 minutes. Cells were then incubated with a control mouse IgG1 (empty bars), PL-1 (blocking anti PSGL-1 antibody, filled bars), PL-2 (non-blocking anti PSGL-1 antibody, hatched bars), or with WASP12.2 (blocking anti P-selectin antibody, gray bars) and analyzed by flowcytometry. Data represent the mean±SD (n=4).
Figure 2. PSGL-1 mRNA and protein are present in endothelial cells. A, Presence of PSGL-1 mRNA in HUVECs and monocytes. For RT-PCR, total RNA was prepared from untreated HUVECs, 6 hour IL-1ß-treated HUVECs, and human monocytes. A fragment of the expected length was obtained in the different cells (arrow, 240 bp). The marker and the product of the reaction without reverse transcriptase (-RT) are indicated. B, PSGL-1 expression on HUVECs was determined by Western blot. Lysates from monocyte, purified from whole blood, or from stimulated HUVECs were analyzed and showed a protein of the expected molecular weight (arrow, 120 kDa). C, HUVECs were treated or not with TNF for 6 or 18 hours and PSGL-1 expression was detected by confocal microscopy. PSGL-1 was detected with PL-1 antibody (blocking antibody directed against PSGL-1) followed by an Alexa-488-labeled goat anti-mouse Ig antibody. In a similar way, specific antibodies were used to detect VCAM-1, E-selectin, and PECAM-1 on HUVECs. Cells were counterstained for F-actin with Texas Red-phalloidin (shown in red). PSGL-1, VCAM-1, E-selectin, and PECAM-1 are displayed in green. In the control the cells were incubated only with the secondary antibody (Alexa-488-labeled goat anti-mouse Ig antibody). Data are shown as the representative of 3 experiments (bar=20 µm).
PSGL-1 transcripts were shown by RT-PCR in untreated and TNF- or IL-1ß-treated primary HUVECs ( Figure 2 A), EC-RF24 cells (data not shown), and monocytes (positive control). No detectable differences between stimulated and unstimulated cells were observed. As a positive control for TNF or IL-1ß stimulation we analyzed intercellular adhesion molecule-1 (ICAM-1) mRNA which showed a dramatic increase in expression in response to these cytokines (data not shown). Quantitative real-time PCR did not show significant differences in the expression levels of PSGL-1 transcripts in both HUVECs and FMVECs (shown in supplemental Figure I). The expression of PSGL-1 was also confirmed by Western blot analysis ( Figure 2 B). Although the level of PSGL-1 protein in ECs was much lower than in monocytes, a protein of similar apparent molecular weight was observed in both cell types ( 120 kDa).
Platelet Adhesion to Endothelial PSGL-1
To determine the functionality of endothelial PSGL-1, platelets were perfused over ECs and adhesion was quantified. Washed and labeled platelets were incubated with a control (W6/32) or a blocking P-selectin antibody (WASP 12.2) and perfused at high shear over untreated or TNF- -treated (6 hours) ECs. Platelet adhesion was strongly increased after activation of ECs ( Figure 3 A). This effect was strongly inhibited when PSGL-1 on activated ECs or P-selectin on platelets was blocked with PL-1 or WASP12.2 antibodies, respectively.
Figure 3. PSGL-1 mediates platelet adhesion to TNF- -activated HUVECs. A, Platelets in suspension were labeled with calcein, washed, and perfused over untreated or 6 hour TNF- -activated HUVECs for 5 minutes at 6 dyn/cm 2. Video images of at least 60 different fields were taken per experiment. For every image the number of platelets adhered was manually determined. Where indicated, platelets were treated before perfusion with an antibody to P-selectin (WASP12.2). Similary, ECs were treated or not with a blocking antibody to PSGL-1 before perfusion. Data represent the mean±SD (n=4, * P <0.05). Untreated or TNF- (6 hours)-stimulated cells were incubated with a P-selectin/Fc chimera for 20 minutes at 37°C. Where indicated, the cells were incubated with a blocking antibody to PSGL-1 (PL-1). Protein binding to the ECs was detected with a Alexa-488-labeled goat anti-mouse Ig antibody by flowcytometry (B, control , unstimulated ECs , and stimulated ECs ) or by immunofluorescence confocal microscopy (C). Data are shown as the representative of 3 experiments. (bar: 20 µm).
Although similar amounts of PSGL-1 are present on the surface of unstimulated and stimulated ECs, only stimulated cells are able to support platelet adhesion. The P-Selectin/Fc chimera was used to test whether there is an increase in PSGL-1 affinity for its receptor on stimulation. Analysis by flow cytometry ( Figure 3 B) and immunofluorescence microscopy ( Figure 3 C) indeed showed that the P-selectin/Fc protein bound significantly more to stimulated than to unstimulated ECs. The binding of the P-selectin/Fc chimera to PSGL-1 was inhibited by a blocking antibody to PSGL-1, which underscored the specificity of the interaction between the P-selectin/Fc chimera and PSGL-1. These results indicate that, despite PSGL-1 being constitutively expressed on ECs, the affinity for its receptor is increased by cytokine stimulation of ECs.
PSGL-1 Expression in Atherosclerotic Coronary Arteries
Sections of coronary arteries undergoing acute inflammation such as atherosclerosis were examined for the expression of PSGL-1 ( Figure 4 ). Expression of PECAM-1 was used as a marker for endothelial cells and a strong and regular staining was observed. Although not as regular, the sections also exhibited luminal staining with the anti-PSGL-1 antibody indicating clear PSGL-1 expression on the vascular endothelium of these arteries. In contrast, staining of the endothelium with an irrelevant mouse IgG1 MAb was not detected ( Figure 4 A). Simultaneous detection of PSGL-1 and PECAM-1, as an endothelial marker, show that these two molecules colocalize on the surface of activated endothelium ( Figure 4 B). Detection of an IgG-control antibody was at background levels.
Figure 4. Analysis of PSGL-1 antigen expression in the vascular endothelium of atherosclerotic coronary arteries. A, Snap-frozen sections of coronary arteries undergoing atherosclerosis were incubated with an irrelevant IgG 1 antibody or antibodies against PSGL-1 or PECAM-1. Bound antibody was detected using avidin biotin peroxidase methodology (see Methods section). Arrows indicate strong PSGL-1 expression. B, Sections were also analyzed by immunofluorescence by incubation with fluorescently labeled antibodies against PSGL-1 (green), PECAM-1 (red), or both (merge). DAPI was used for nuclear staining (blue). Data shown are representative of 3 experiments.
Rolling/Adhesion of Monocytes and PMCs to ECs via Endothelial PSGL-1
To investigate whether endothelial PSGL-1 is also functional in mediating monocyte and platelet-monocyte complex (PMC) interactions with the endothelium under flow, monocytes were perfused over HUVECs (untreated or TNF- -treated for 6 hours). Video recordings were analyzed for the number of adhered monocytes and for rolling velocity. Perfusions of monocytes or PMCs only resulted in rolling when the ECs had been treated with TNF. In the presence of PMCs, blocking PSGL-1 on ECs significantly inhibited monocyte adhesion by 30% ( P <0.05, Figure 5 A, black bars) and strongly increased monocyte rolling velocity ( Figure 5 B, black bars). Simultaneous inhibition of PSGL-1 on ECs and on monocytes caused a synergistic reduction of monocyte adhesion (data not shown). To test the role of endothelial PSGL-1 in the adhesion of monocytes in the absence of platelets, PMCs were removed from the cell suspension by immunodepletion. As previously reported, 11 low levels of PMCs resulted in reduced monocyte adhesion to the endothelium. By blocking PSGL-1 on ECs, monocyte adhesion was further decreased 30% ( Figure 5 A, empty bars), whereas rolling velocity was significantly increased ( Figure 5 B, empty bars). As was shown before, 11 blocking of P-selectin on the endothelium did not have any effect in cell adhesion.
Figure 5. PSGL-1 functionality on monocyte adhesion to TNF- -activated endothelium. PMC-rich (10 to 20% PMC, filled bars) and -poor (< 5% PMC, empty bars) monocyte suspensions were perfused over TNF- -activated (6 hours) HUVECs for 5 minutes at 0.8 dyn/cm 2. Video images were evaluated for the number of adherent monocytes (A) and cell rolling velocity (B). Before perfusion, HUVECs were incubated either with W6/32 control antibody, with PL-1 (blocking antibody to PSGL-1), or WASP12.2 antibody (blocking antibody to P-selectin). Data represent the mean±SD (n=3, * P <0.01).
To investigate whether endothelial PSGL-1 can interact with L-selectin on monocytes, an L-selectin-blocking antibody was used on a monocyte suspension containing <5% PMCs. To rule out a possible contribution of remaining platelets, the monocytes were, where indicated, incubated with an antibody to P-selectin to prevent PMC formation. When the cells were incubated with the DREG 56 antibody to L-selectin, adhesion to the endothelium was inhibited by 35% ( P <0.05, supplemental Figure IIIA). This effect was similar to that obtained by blocking PSGL-1 on ECs. Although not statistically significant, when both L-selectin on monocytes and PSGL-1 on ECs were blocked, monocyte adhesion was further inhibited. As a control we used a nonblocking antibody against PSGL-1 (PL-2) which did not affect monocyte adhesion to ECs (data not shown).
Previously it has been shown that the expression of L-selectin ligands in endothelial cells is modulated by sulfation, 17 and that TNF- upregulates the expression of two sulfotransferases implicated in the sulfation of L-selectin ligands. 18,19 To investigate whether the mechanism of increase in monocyte adhesion described here is dependent on the sulfation of PSGL-1 an RNA interference approach was designed. The genes targeted were GST-1 and -2, implicated in the sulfation of N- and O-linked glycans, ß4GalT-7, involved in the initiation of the glycosaminoglycan chains, and FX, which controls the synthesis of GDP-Fucose (supplemental Figure I). Additionally, a knock-down for PSGL-1 and a sequence without homology in the human genome were used as a positive and negative control, respectively. The silencing of PSGL-1 results in a decrease in monocyte adhesion (supplemental Figure IIIB) and an increase in rolling velocity (data not shown), which are comparable to the effect of blocking with PL-1. Furthermore, the silencing of GST-1 was able to mimic the effects of silencing PSGL-1, whereas any of the other treatments were ineffective (supplemental Figure IIIB). In agreement, the binding of P-selectin/Fc to activated endothelial cells was also decreased when cells were transfected with pSUPER/PSGL-1, pSUPER/GST-1, and, to a lesser extent, with pSUPER/GST2 (shown in supplemental Figure II).
Discussion
The molecular mechanisms by which leukocyte recruitment to inflamed tissues occurs have been extensively studied over the past years. The initial tethering and rolling of monocytes along the vessel wall is generally accepted to be mediated by selectins and their ligands that are expressed on ECs, platelets, and leukocytes. PSGL-1, one of the primary selectin ligands, is known to be expressed on leukocytes and platelets. In this study we show that functional PSGL-1 is expressed on ECs on treatment with proinflammatory cytokines.
PSGL-1 expression was shown at the mRNA and protein level on primary microvascular and umbilical ECs and on an endothelial cell line. PSGL-1 is restricted to the surface of ECs and is not increased by stimulation with inflammatory cytokines such as TNF or IL-1ß, in contrast to other cytokine-induced adhesion molecules such as ICAM-1, VCAM-1, and E-selectin. In addition, activators such as thrombin or histamine, which induce elevated surface expression of P-selectin on ECs, 20 had no effect on the expression levels of endothelial PSGL-1. Thus, PSGL-1 is constitutively expressed in primary ECs and in immortalized endothelial cells, and is not stored in P-selectin-containing vesicles within ECs.
Endothelial PSGL-1, at higher shear stress, was able to interact with platelets and recruit them to the endothelium. This effect was inhibited by blocking P-selectin on platelets or PSGL-1 on ECs. The increase in affinity of endothelial PSGL-1 to P-selectin was further demonstrated by the strong binding of a P-selectin/Fc protein to stimulated HUVECs, which was abrogated by incubating the cells with a blocking antibody to PSGL-1.
Our flow system enabled us to show functionality of endothelial PSGL-1 as a ligand for selectins also on monocytes. When 10 to 20% PMCs were present in the monocyte suspension, we found a significant reduction (30%) in monocyte adhesive interactions with the endothelium, accompanied by an increase in cell rolling velocity when TNF- -stimulated ECs were preincubated with a PSGL-1-blocking antibody. Under low shear conditions, platelet interactions with the endothelium are mainly characterized by transient tethering and rolling, whereas firm adhesion rarely occurs. 11,21 However, it is important to discern whether PSGL-1 on ECs interacts mainly with L-selectin on monocytes or might also interact with P-selectin on platelets. To investigate this, we used a PMC-free monocyte suspension. Blocking of endothelial PSGL-1 or L-selectin on monocytes increased monocyte rolling velocity and inhibited monocyte adhesion to ECs by 30%, indicating that monocyte L-selectin is a primary receptor for endothelial PSGL-1. However, the contribution of molecular interactions, other than selectin-dependent, cannot be completely ruled out. P-selectin on platelets or platelet microparticles has been implicated in triggering monocyte arrest by deposition of chemokines, namely RANTES, on activated endothelium. 22,23 Such mechanism could contribute to a more pronounced recruitment with PMC-rich monocyte suspensions. However, because preincubation of monocytes or platelets with a P-selectin-specific blocking antibody was able to block rolling to at least 50%, it is possible to conclude that P-selectin-PSGL-1 interactions are involved in monocyte/platelet rolling over activated endothelial cells.
Interestingly, PSGL-1 was only functional after cytokine treatment of ECs. Although most lymphocytes express PSGL-1, only 10 to 20% of cells are able to bind P-selectin, 24 which shows that PSGL-1 expression does not necessarily imply functional relevance. The glycosylation of PSGL-1 is essential for functionality, 25 and dramatic changes in endothelial cell glycosylation have been reported on TNF treatment. 19 Here we show that silencing of the sulfotransferase GST-1, and partially GST-2, mimics the effect of silencing PSGL-1 or using the blocking antibodies PL-1 or DREG 56. Altogether, these data indicate that TNF -induced expression of functional PSGL-1 is dependent on the expression of GST-1, and partially GST-2, whereas fucosylation, or the expression of glycosaminoglycans do not contribute. These findings are in line with those of Li et al, 18 demonstrating the critical role of GST-1 and -2 in shear-resistant leukocyte rolling via L-selectin.
Additionally, we show the expression of PSGL-1 on the ECs of atherosclerotic lesions, suggesting a potential role in the recruitment of inflammatory cells to the lesion. Although expressed at low levels, PSGL-1 on activated ECs is able to functionally bind P- and L-selectin on platelets and monocytes, respectively, mediating monocyte initial tethering and platelet recruitment to the endothelium. Our results strongly suggest that PSGL-1 has a crucial role in monocyte/PMCs and platelet recruitment to the vascular endothelium and should be considered as an important participant in the onset of inflammation and/or atherosclerosis.
Acknowledgments
Sources of Funding
This work was supported by grants from the Dutch Heart Foundation (1999B059 and M93.007).
Disclosures
None.
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作者单位：Department of Experimental Immunohematology (P.d.C.M., J.v.G., J.-J.Z.), Sanquin Research; the Department of Molecular Cell Biology and Immunology (J.-J.G.-V., M.F.-B., P.L.H.), VU Medical Center; the Department of Medical Biochemistry (J.V.v.T., A.J.H.), Academical Medical Center; the Department of