B- and T-lymphocyte attenuator (BTLA) is a co-inhibitory receptor belonging to the immunoglobulin superfamily, expressed predominantly on B and T lymphocytes . BTLA has an immunoglobulin superfamily domain in its extracellular region and immunoreceptor tyrosine-based inhibitory motif (ITIM) sequences in its intracellular region . Its ligand, herpesvirus entry mediator (HVEM), binds as a monomeric agonist that signals through BTLA to inhibit T cell proliferation . BTLA influences the effectiveness of immunotherapies .
BTLA is expressed on various immune cells, including B cells, T cells, dendritic cells, splenic macrophages, and natural killer (NK) cells . While it is absent on naive T cells, BTLA upregulates on activated T cells and remains on polarized T helper type 1 (Th1) cells in both mice and humans .
BTLA plays a crucial role in modulating immune responses:
Immune Suppression: BTLA induces immunosuppression by inhibiting B and T cell activation and proliferation .
T Cell Regulation: BTLA engagement on follicular T helper (Tfh) cells reduces T cell receptor (TCR) signaling and CD40 ligand mobilization, diminishing help to B cells and inhibiting their proliferation . BTLA can also inhibit IL-21 production by Tfh cells, suppressing the development of germinal center B cells and subsequent IgG responses .
CD4+ T Cell Activation: BTLA negatively regulates B and T cell activation .
BTLA's role has been investigated in various disease models, revealing its potential as a therapeutic target.
Atherosclerosis: BTLA stimulation protects against atherosclerosis by regulating follicular B cells . BTLA stimulation in Ldlr−/− mice reduces initial lesion development and increases collagen content of established lesions, potentially by shifting the balance between atherogenic follicular B cells and atheroprotective B cells and directing CD4+ T cells towards regulatory T cells .
Lupus: Targeting BTLA regulates lupus disease development in NZB/W mice . Administration of the 6F7 anti-BTLA antibody in NZB/W mice delayed the onset of proteinuria, limited kidney damage, and increased survival rate compared to isotype-treated mice .
Cancer: BTLA expression is up-regulated on spontaneous NY-ESO-1–specific CD8+ T cells in patients' PBLs . BTLA+PD-1+Tim-3− cells exhibit partial T-cell dysfunction, producing more IFN-γ, TNF, and IL-2 than BTLA+PD-1+Tim-3+ cells but less IFN-γ than BTLA−PD-1+Tim-3− and BTLA−PD-1−Tim-3− NY-ESO-1–specific CD8+ T cells .
Restoring lipid metabolism can rescue defective BTLA functionality . BTLA recruitment to TCR clusters was significantly lower in SLE patients compared to healthy controls (61% ± 7% in SLE vs. 87% ± 4% in HCs, P < 0.01) .
BTLA promoter hypomethylation correlates with enhanced immune cell infiltration in melanoma . Tumors with promoter hypomethylation exhibit higher infiltration levels of various immune cells . Lower promoter methylation of BTLA predicts higher infiltration levels in melanoma .
BTLA is a potential therapeutic target for treating lupus . BTLA stimulation emerges as a promising therapeutic approach for atherosclerosis .