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Estrogen Receptor-Dependent Regulation of Dendritic Cell Development and Function

Identifieur interne : 002F27 ( Pmc/Corpus ); précédent : 002F26; suivant : 002F28

Estrogen Receptor-Dependent Regulation of Dendritic Cell Development and Function

Auteurs : Sophie Laffont ; Cyril Seillet ; Jean-Charles Guéry

Source :

RBID : PMC:5300975

Abstract

Autoimmunity, infectious diseases and cancer affect women and men differently. Because they tend to develop more vigorous adaptive immune responses than men, women are less susceptible to some infectious diseases but also at higher risk of autoimmunity. The regulation of immune responses by sex-dependent factors probably involves several non-redundant mechanisms. A privileged area of study, however, concerns the role of sex steroid hormones in the biology of innate immune cells, especially dendritic cells (DCs). In recent years, our understanding of the lineage origin of DC populations has expanded, and the lineage-committing transcription factors shaping peripheral DC subsets have been identified. Both progenitor cells and mature DC subsets express estrogen receptors (ERs), which are ligand-dependent transcription factors. This suggests that estrogens may contribute to the reported sex differences in immunity by regulating DC biology. Here, we review the recent literature and highlight evidence that estrogen-dependent activation of ERα regulates the development or the functional responses of particular DC subsets. The in vitro model of GM-CSF-induced DC differentiation shows that CD11c+ CD11bint Ly6cneg cells depend on ERα activation by estrogen for their development, and for the acquisition of competence to activate naive CD4+ T lymphocytes and mount a robust pro-inflammatory cytokine response to CD40 stimulation. In this model, estrogen signaling in conjunction with GM-CSF is necessary to promote early interferon regulatory factor (Irf)-4 expression in macrophage-DC progenitors and their subsequent differentiation into IRF-4hi CD11c+ CD11bint Ly6cneg cells, closely related to the cDC2 subset. The Flt3L-induced model of DC differentiation in turn shows that ERα signaling promotes the development of conventional DC (cDC) and plasmacytoid DC (pDC) with higher capability of pro-inflammatory cytokine production in response to TLR stimulation. Likewise, cell-intrinsic ER signaling positively regulates the TLR-driven production of type I interferons (IFNs) in mouse pDCs in vivo. This effect of estrogens likely contributes to the greater proficiency of women’s pDCs than men’s as regards the production of type I IFNs elicited by TLR7 ligands. In summary, evidence is emerging in support of the notion that estrogen signaling regulates important aspects of cDC and pDC development and/or effector functions, in both mice and humans.


Url:
DOI: 10.3389/fimmu.2017.00108
PubMed: 28239379
PubMed Central: 5300975

Links to Exploration step

PMC:5300975

Le document en format XML

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<p>Autoimmunity, infectious diseases and cancer affect women and men differently. Because they tend to develop more vigorous adaptive immune responses than men, women are less susceptible to some infectious diseases but also at higher risk of autoimmunity. The regulation of immune responses by sex-dependent factors probably involves several non-redundant mechanisms. A privileged area of study, however, concerns the role of sex steroid hormones in the biology of innate immune cells, especially dendritic cells (DCs). In recent years, our understanding of the lineage origin of DC populations has expanded, and the lineage-committing transcription factors shaping peripheral DC subsets have been identified. Both progenitor cells and mature DC subsets express estrogen receptors (ERs), which are ligand-dependent transcription factors. This suggests that estrogens may contribute to the reported sex differences in immunity by regulating DC biology. Here, we review the recent literature and highlight evidence that estrogen-dependent activation of ERα regulates the development or the functional responses of particular DC subsets. The
<italic>in vitro</italic>
model of GM-CSF-induced DC differentiation shows that CD11c
<sup>+</sup>
CD11b
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Ly6c
<sup>neg</sup>
cells depend on ERα activation by estrogen for their development, and for the acquisition of competence to activate naive CD4
<sup>+</sup>
T lymphocytes and mount a robust pro-inflammatory cytokine response to CD40 stimulation. In this model, estrogen signaling in conjunction with GM-CSF is necessary to promote early interferon regulatory factor (
<italic>Irf</italic>
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expression in macrophage-DC progenitors and their subsequent differentiation into IRF-4
<sup>hi</sup>
CD11c
<sup>+</sup>
CD11b
<sup>int</sup>
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<sup>neg</sup>
cells, closely related to the cDC2 subset. The Flt3L-induced model of DC differentiation in turn shows that ERα signaling promotes the development of conventional DC (cDC) and plasmacytoid DC (pDC) with higher capability of pro-inflammatory cytokine production in response to TLR stimulation. Likewise, cell-intrinsic ER signaling positively regulates the TLR-driven production of type I interferons (IFNs) in mouse pDCs
<italic>in vivo</italic>
. This effect of estrogens likely contributes to the greater proficiency of women’s pDCs than men’s as regards the production of type I IFNs elicited by TLR7 ligands. In summary, evidence is emerging in support of the notion that estrogen signaling regulates important aspects of cDC and pDC development and/or effector functions, in both mice and humans.</p>
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</TEI>
<pmc article-type="review-article">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Front Immunol</journal-id>
<journal-id journal-id-type="iso-abbrev">Front Immunol</journal-id>
<journal-id journal-id-type="publisher-id">Front. Immunol.</journal-id>
<journal-title-group>
<journal-title>Frontiers in Immunology</journal-title>
</journal-title-group>
<issn pub-type="epub">1664-3224</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">28239379</article-id>
<article-id pub-id-type="pmc">5300975</article-id>
<article-id pub-id-type="doi">10.3389/fimmu.2017.00108</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Immunology</subject>
<subj-group>
<subject>Review</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Estrogen Receptor-Dependent Regulation of Dendritic Cell Development and Function</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Laffont</surname>
<given-names>Sophie</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="corresp" rid="cor1">*</xref>
<uri xlink:type="simple" xlink:href="http://frontiersin.org/people/u/100171"></uri>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Seillet</surname>
<given-names>Cyril</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<uri xlink:type="simple" xlink:href="http://frontiersin.org/people/u/74480"></uri>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Guéry</surname>
<given-names>Jean-Charles</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="corresp" rid="cor1">*</xref>
<uri xlink:type="simple" xlink:href="http://frontiersin.org/people/u/163065"></uri>
</contrib>
</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>Centre de Physiopathologie de Toulouse Purpan (CPTP), Université de Toulouse, INSERM, CNRS, UPS</institution>
,
<addr-line>Toulouse</addr-line>
,
<country>France</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>Division of Molecular Immunology, The Walter and Eliza Hall Institute of Medical Research</institution>
,
<addr-line>Melbourne, VIC</addr-line>
,
<country>Australia</country>
</aff>
<aff id="aff3">
<sup>3</sup>
<institution>Department of Medical Biology, University of Melbourne</institution>
,
<addr-line>Melbourne, VIC</addr-line>
,
<country>Australia</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: Manfred B. Lutz, University of Würzburg, Germany</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: Meredith O’Keeffe, Monash University, Australia; Pieter J. M. Leenen, Erasmus University Rotterdam, Netherlands</p>
</fn>
<corresp content-type="corresp" id="cor1">*Correspondence: Sophie Laffont,
<email>sophie.laffont-pradines@inserm.fr</email>
; Jean-Charles Guéry,
<email>jean-charles.guery@inserm.fr</email>
</corresp>
<fn fn-type="other" id="fn002">
<p>Specialty section: This article was submitted to Antigen Presenting Cell Biology, a section of the journal Frontiers in Immunology</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>10</day>
<month>2</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="collection">
<year>2017</year>
</pub-date>
<volume>8</volume>
<elocation-id>108</elocation-id>
<history>
<date date-type="received">
<day>14</day>
<month>9</month>
<year>2016</year>
</date>
<date date-type="accepted">
<day>23</day>
<month>1</month>
<year>2017</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright © 2017 Laffont, Seillet and Guéry.</copyright-statement>
<copyright-year>2017</copyright-year>
<copyright-holder>Laffont, Seillet and Guéry</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</license-p>
</license>
</permissions>
<abstract>
<p>Autoimmunity, infectious diseases and cancer affect women and men differently. Because they tend to develop more vigorous adaptive immune responses than men, women are less susceptible to some infectious diseases but also at higher risk of autoimmunity. The regulation of immune responses by sex-dependent factors probably involves several non-redundant mechanisms. A privileged area of study, however, concerns the role of sex steroid hormones in the biology of innate immune cells, especially dendritic cells (DCs). In recent years, our understanding of the lineage origin of DC populations has expanded, and the lineage-committing transcription factors shaping peripheral DC subsets have been identified. Both progenitor cells and mature DC subsets express estrogen receptors (ERs), which are ligand-dependent transcription factors. This suggests that estrogens may contribute to the reported sex differences in immunity by regulating DC biology. Here, we review the recent literature and highlight evidence that estrogen-dependent activation of ERα regulates the development or the functional responses of particular DC subsets. The
<italic>in vitro</italic>
model of GM-CSF-induced DC differentiation shows that CD11c
<sup>+</sup>
CD11b
<sup>int</sup>
Ly6c
<sup>neg</sup>
cells depend on ERα activation by estrogen for their development, and for the acquisition of competence to activate naive CD4
<sup>+</sup>
T lymphocytes and mount a robust pro-inflammatory cytokine response to CD40 stimulation. In this model, estrogen signaling in conjunction with GM-CSF is necessary to promote early interferon regulatory factor (
<italic>Irf</italic>
)
<italic>-4</italic>
expression in macrophage-DC progenitors and their subsequent differentiation into IRF-4
<sup>hi</sup>
CD11c
<sup>+</sup>
CD11b
<sup>int</sup>
Ly6c
<sup>neg</sup>
cells, closely related to the cDC2 subset. The Flt3L-induced model of DC differentiation in turn shows that ERα signaling promotes the development of conventional DC (cDC) and plasmacytoid DC (pDC) with higher capability of pro-inflammatory cytokine production in response to TLR stimulation. Likewise, cell-intrinsic ER signaling positively regulates the TLR-driven production of type I interferons (IFNs) in mouse pDCs
<italic>in vivo</italic>
. This effect of estrogens likely contributes to the greater proficiency of women’s pDCs than men’s as regards the production of type I IFNs elicited by TLR7 ligands. In summary, evidence is emerging in support of the notion that estrogen signaling regulates important aspects of cDC and pDC development and/or effector functions, in both mice and humans.</p>
</abstract>
<kwd-group>
<kwd>sex differences</kwd>
<kwd>dendritic cells</kwd>
<kwd>estrogens</kwd>
<kwd>estrogen receptors</kwd>
<kwd>toll-like receptors</kwd>
</kwd-group>
<funding-group>
<award-group>
<funding-source id="cn01">Fondation Arthritis
<named-content content-type="fundref-id">10.13039/100008319</named-content>
</funding-source>
</award-group>
<award-group>
<funding-source id="cn02">Fondation ARC pour la Recherche sur le Cancer
<named-content content-type="fundref-id">10.13039/501100004097</named-content>
</funding-source>
</award-group>
<award-group>
<funding-source id="cn03">Fondation pour la Recherche Médicale
<named-content content-type="fundref-id">10.13039/501100002915</named-content>
</funding-source>
<award-id rid="cn03">DEQ2000329169</award-id>
</award-group>
<award-group>
<funding-source id="cn04">Agence Nationale de Recherches sur le Sida et les Hepatites Virales
<named-content content-type="fundref-id">10.13039/501100003323</named-content>
</funding-source>
</award-group>
<award-group>
<funding-source id="cn05">Fondation pour l’Aide à la Recherche sur la Sclérose en Plaques
<named-content content-type="fundref-id">10.13039/100007379</named-content>
</funding-source>
</award-group>
</funding-group>
<counts>
<fig-count count="1"></fig-count>
<table-count count="1"></table-count>
<equation-count count="0"></equation-count>
<ref-count count="155"></ref-count>
<page-count count="14"></page-count>
<word-count count="13522"></word-count>
</counts>
</article-meta>
</front>
<body>
<sec sec-type="introduction" id="S1">
<title>Introduction</title>
<p>The pro-inflammatory role of estrogens, particularly through their actions on the innate immune system, has been proposed to contribute to the higher immune responses that develop in women (
<xref rid="B1" ref-type="bibr">1</xref>
,
<xref rid="B2" ref-type="bibr">2</xref>
). Estrogen mediates their effects through two receptors, estrogen receptors (ERs) ERα and ERβ, which are members of the nuclear receptor super family (
<xref rid="B3" ref-type="bibr">3</xref>
). ERα and ERβ function in the nucleus as transcription factors in a ligand-dependent manner. Many studies have shown that mature cells both from the innate and the adaptive immune system express ERs, particularly ERα in mouse (
<xref rid="B4" ref-type="bibr">4</xref>
<xref rid="B10" ref-type="bibr">10</xref>
) suggesting that estrogens could regulate their effector functions. Estrogens could also directly act, through their receptors, on progenitor cells to influence the development of myeloid and lymphoid cells (
<xref rid="B11" ref-type="bibr">11</xref>
<xref rid="B17" ref-type="bibr">17</xref>
).</p>
<p>Dendritic cells (DCs) are professional antigen-presenting cells that bridge innate and adaptive immunity. They are essential for the activation of naive T cells specific to self or non-self protein antigens and for their subsequent differentiation into effector T (Teff) cells through the secretion of specific cytokines (
<xref rid="B18" ref-type="bibr">18</xref>
). Ontogeny and global gene expression studies indicate that DCs form a separate lineage of mononuclear phagocytes or mononuclear-derived cells, notably on the basis of their continual replenishment from common DC precursors that are distinct from the precursors of monocytes and macrophages (
<xref rid="B19" ref-type="bibr">19</xref>
). DCs are subdivided into three main subtypes: conventional DCs (cDCs), monocyte-derived DCs and plasmacytoid DCs (pDCs) (
<xref rid="B19" ref-type="bibr">19</xref>
). While cDCs are specialized in antigen processing and presentation, thereby converting naive T cells into effector CD4
<sup>+</sup>
and CD8
<sup>+</sup>
Teff cells, blood monocytes can be rapidly mobilized from the circulation and differentiate into monocyte-derived cells (MCs) with distinct functions such as local reactivation of Teff cells, and superior inflammatory and chemokine production relative to cDCs (
<xref rid="B18" ref-type="bibr">18</xref>
). By contrast, pDCs produce massive amounts of type I interferons (IFNs) in response to viral infections (
<xref rid="B20" ref-type="bibr">20</xref>
).</p>
<p>This review surveys the state of the knowledge regarding estrogen-dependent regulation of DC biology and revisits previously published experiments in light of recent advances in the DC field (
<xref rid="B18" ref-type="bibr">18</xref>
,
<xref rid="B19" ref-type="bibr">19</xref>
,
<xref rid="B21" ref-type="bibr">21</xref>
). We will focus on key experimental studies supporting a direct regulatory role of sex hormone estrogens vis-à-vis cDCs and pDCs, which hinges on the ligand-dependent activation of their nuclear receptor, ERα (summarized in Table
<xref ref-type="table" rid="T1">1</xref>
).</p>
<table-wrap id="T1" position="float">
<label>Table 1</label>
<caption>
<p>
<bold>Effect of estrogen receptor (ER)α signaling on dendritic cells (DCs) and monocyte-derived cells in mouse models</bold>
.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top" align="left" rowspan="1" colspan="1">Cell population</th>
<th valign="top" align="left" rowspan="1" colspan="1">Models</th>
<th valign="top" align="left" rowspan="1" colspan="1">Effect of ERα signaling</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">GM-CSF-induced conventional DCs (cDCs)</td>
<td align="left" valign="top" rowspan="1" colspan="1">
<italic>In vitro</italic>
ERα-deficient mice</td>
<td align="left" valign="top" rowspan="1" colspan="1">
<list list-type="simple">
<list-item>
<label>(a)</label>
<p>Estrogen deficiency or ER-blockade with ICI
<sub>182,780</sub>
<italic>in vitro</italic>
inhibits the development of CD11c
<sup>+</sup>
CD11b
<sup>int</sup>
Ly6C
<sup></sup>
Csf-2-induced-DC (
<xref rid="B12" ref-type="bibr">12</xref>
,
<xref rid="B22" ref-type="bibr">22</xref>
,
<xref rid="B23" ref-type="bibr">23</xref>
); partial inhibition of DC development with first generation of ERα-mutant mice still expressing a truncated form of ERα lacking AF-1 domain (
<xref rid="B12" ref-type="bibr">12</xref>
)</p>
</list-item>
<list-item>
<label>(b)</label>
<p>First demonstration of the unique role of ERα, but not ERβ, in the development of Csf-2-induced-DC; promotion of the maturation and pro-inflammatory cytokine production in response to CD40 and TLR9 stimulation (
<xref rid="B16" ref-type="bibr">16</xref>
)</p>
</list-item>
<list-item>
<label>(c)</label>
<p>E2 acts on macrophage-DC progenitor (MDP) to promote the development and the effector functions of CD11c
<sup>+</sup>
MHCII
<sup>+</sup>
cells through the upregulation of interferon regulatory factor (IRF)-4 (
<xref rid="B15" ref-type="bibr">15</xref>
,
<xref rid="B17" ref-type="bibr">17</xref>
,
<xref rid="B24" ref-type="bibr">24</xref>
); ERα AF-1 is partially dispensable for Csf-2-induced GM-DC development (
<xref rid="B24" ref-type="bibr">24</xref>
)</p>
</list-item>
</list>
</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">FLT3L-induced cDCs</td>
<td align="left" valign="top" rowspan="1" colspan="1">
<italic>In vitro</italic>
ERα-deficient mice</td>
<td align="left" valign="top" rowspan="1" colspan="1">
<list list-type="simple">
<list-item>
<label>(a)</label>
<p>E2 inhibits the development of plasmacytoid DCs (pDCs) and cDCs in Flt3L-driven BM cultures, through direct action on MDP, functional impact of E2/ERα not evaluated in this study (
<xref rid="B15" ref-type="bibr">15</xref>
)</p>
</list-item>
<list-item>
<label>(b)</label>
<p>E2/ERα enhances the maturation and pro-inflammatory cytokine production (IL-6, IL-12) in response to dual signaling through CD40 and TLR4 or TLR9 stimulation; normal cDC development in the absence of ERα (
<xref rid="B24" ref-type="bibr">24</xref>
)</p>
</list-item>
</list>
</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">FLT3L-induced pDCs</td>
<td align="left" valign="top" rowspan="1" colspan="1">
<italic>In vitro</italic>
ERα-deficient mice</td>
<td align="left" valign="top" rowspan="1" colspan="1">E2/ERα signaling blunts the development of pDCs
<italic>in vitro</italic>
, but enhances the expression of maturation markers and their effector functions in response to TLR9
<italic>in vitro</italic>
; ERα-AF-1
<sup>−/−</sup>
pDCs
<italic>in vivo</italic>
exhibited reduced production of interferon (IFN)-α in response to TLR7 ligand (
<xref rid="B24" ref-type="bibr">24</xref>
)</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">pDCs (bone marrow)</td>
<td align="left" valign="top" rowspan="1" colspan="1">
<italic>In vivo</italic>
CD11c-Cre x Esr1
<sup>flox/flox</sup>
and Tie2-Cre × Esr1
<sup>flox/flox</sup>
deleter models</td>
<td align="left" valign="top" rowspan="1" colspan="1">
<list list-type="simple">
<list-item>
<label>(a)</label>
<p>Promotion of type I IFNs and pro-inflammatory cytokine production in response to TLR7 and TLR9 ligand (
<xref rid="B10" ref-type="bibr">10</xref>
,
<xref rid="B25" ref-type="bibr">25</xref>
)</p>
</list-item>
<list-item>
<label>(b)</label>
<p>Enhanced type I IFN production in female bone marrow pDCs stimulated through TLR7 associated with upregulation of
<italic>Irf5</italic>
, but not
<italic>Irf7</italic>
expression (
<xref rid="B25" ref-type="bibr">25</xref>
)</p>
</list-item>
</list>
</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Monocyte/macrophages</td>
<td align="left" valign="top" rowspan="1" colspan="1">
<italic>Ex vivo</italic>
ERα-deficient mice peritoneal macrophages (PM); testicular macrophages; bone marrow-derived macrophages; wound macrophages</td>
<td align="left" valign="top" rowspan="1" colspan="1">Pro-inflammatory effects:
<list list-type="simple">
<list-item>
<label>(a)</label>
<p>E2 supplementation in Ovx mice increases the LPS-mediated production of pro-inflammatory cytokines [IL-1β, IL-6, intracellular nitric oxide synthase (iNOS)] by PM through inhibition of phosphoinositide 3-kinase activity; no effect on TLR4 expression (
<xref rid="B7" ref-type="bibr">7</xref>
)</p>
</list-item>
<list-item>
<label>(b)</label>
<p>ERα in testicular macrophages promotes CD69, TAM receptor expression, tumor necrosis factor (TNF)-α production macrophage activation, and engulfment of Leidig cells (
<xref rid="B26" ref-type="bibr">26</xref>
)</p>
<p>Anti-inflammatory effects, tissue repair:</p>
</list-item>
</list>
<list list-type="simple">
<list-item>
<label>(c)</label>
<p>ERα-deficient PM exposed
<italic>ex vivo</italic>
to LPS or
<italic>Mycobacterium avium</italic>
exhibited enhanced production of TNF-α (
<xref rid="B27" ref-type="bibr">27</xref>
)</p>
</list-item>
<list-item>
<label>(d)</label>
<p>ERα promotes alternative macrophage activation and tissue repair in cutaneous wounds healing (
<xref rid="B28" ref-type="bibr">28</xref>
)</p>
</list-item>
</list>
</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Monocyte/macrophages</td>
<td align="left" valign="top" rowspan="1" colspan="1">LysM-Cre × Esr1
<sup>flox/flox</sup>
deleter model PM; bone marrow-derived macrophages</td>
<td align="left" valign="top" rowspan="1" colspan="1">
<list list-type="simple">
<list-item>
<label>(a)</label>
<p>Related to Ref. (
<xref rid="B7" ref-type="bibr">7</xref>
), first demonstration that cell-intrinsic ERα-signaling
<italic>in vivo</italic>
in PM positively regulates the TLR4-dependent production of pro-inflammatory cytokines (IL-1β, IL-6, and iNOS) (
<xref rid="B8" ref-type="bibr">8</xref>
)</p>
</list-item>
<list-item>
<label>(b)</label>
<p>ERα is necessary for full phagocytic capacity of PM; ERα directly regulates transglutaminase 2 expression; ERα is critical for the maintenance of macrophage metabolism (
<xref rid="B29" ref-type="bibr">29</xref>
)</p>
</list-item>
</list>
</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="S2">
<title>ER Expression in Hematopoietic Cells</title>
<p>Estrogen receptors are ligand-inducible transcription factors whose activity is regulated by endogenous estrogens naturally produced over the estrus cycle or during pregnancy. The main endogenous estrogens are estrone (E1), 17β-estradiol (E2), estriol (E3) and estetrol (E4), with E2 as the predominant and most biologically active of the four. In humans, E3 and E4 are selectively produced during pregnancy, by the placenta or by the fetal liver, respectively. ER activities can be modulated also by exogenous ligands, such as synthetic, non-steroidal, non-hormonal agonist, and antagonist ligands known as selective ER modulators (SERMs) (
<xref rid="B30" ref-type="bibr">30</xref>
). SERMs such as tamoxifen and raloxifen are in current clinical use for the treatment of breast cancer and osteoporosis, respectively. It is, therefore, important to understand how such molecules, through ER signaling, may interfere with the development and/or function of immune cells. Despite a growing body of evidence that ER-dependent mechanisms influence both the development and the function of innate immune cells, few studies have sought to determine the relative expression of ER isotypes in different steady-state populations of immune cells. Estrogens exert their effects through two known nuclear receptor family members: ERα, which is encoded by
<italic>ESR1</italic>
on human chromosome 6, and ERβ, which is encoded by the
<italic>ESR2</italic>
locus on chromosome 14 (
<xref rid="B30" ref-type="bibr">30</xref>
).</p>
<p>Estrogen receptors are widely expressed in most tissues of both women and men (
<xref rid="B31" ref-type="bibr">31</xref>
). They have also been identified in many different immune cell types including hematopoietic precursors (
<xref rid="B32" ref-type="bibr">32</xref>
). Both ER are expressed in CD34
<sup>+</sup>
human hematopoietic progenitor cells (HPCs) found in the bone marrow, but not in HPCs from cord blood (
<xref rid="B33" ref-type="bibr">33</xref>
<xref rid="B36" ref-type="bibr">36</xref>
). These findings indicate that hormone-receptor expression is highly regulated in hematopoietic precursors during development. The absence of ER expression in HPCs from cord-blood may protect the fetus from high hormone levels that suppress maternal lymphopoiesis (
<xref rid="B33" ref-type="bibr">33</xref>
) while promoting hematopoietic stem cell (HSC) self-renewal and myelopoiesis (
<xref rid="B35" ref-type="bibr">35</xref>
). Indeed, E2 signaling through ERα was recently reported to promote the cycling of HSCs and multipotent progenitors, thereby supporting the increased demand for erythropoiesis during pregnancy (
<xref rid="B35" ref-type="bibr">35</xref>
).</p>
<p>In mature human cells, monocyte-derived DCs express
<italic>ESR1</italic>
transcripts and low levels of
<italic>ESR2</italic>
mRNA (
<xref rid="B37" ref-type="bibr">37</xref>
,
<xref rid="B38" ref-type="bibr">38</xref>
).
<italic>ESR1</italic>
expression was comparable between CD4
<sup>+</sup>
, CD8
<sup>+</sup>
T cells, and natural killer cells, which also expressed
<italic>ESR2</italic>
although at lower levels. B lymphocytes expressed the highest levels of
<italic>ESR1</italic>
mRNA relative to other leukocytes. Of note, B cells and pDCs displayed the highest levels of
<italic>ESR2</italic>
mRNA in comparison with any other cell type examined (
<xref rid="B38" ref-type="bibr">38</xref>
). As previously reported (
<xref rid="B39" ref-type="bibr">39</xref>
), expression levels of both ER isotypes were low in blood monocytes, despite evidence in mouse that E2 promoted the TLR4-mediated production of pro-inflammatory cytokines by peritoneal monocyte and macrophage cells, through cell-intrinsic ERα-signaling
<italic>in vivo</italic>
(
<xref rid="B7" ref-type="bibr">7</xref>
,
<xref rid="B8" ref-type="bibr">8</xref>
) (Table
<xref ref-type="table" rid="T1">1</xref>
).</p>
<p>In mice,
<italic>Esr1</italic>
, but not
<italic>Esr2</italic>
, is expressed in bone marrow progenitor cells, including the common lymphoid progenitor (CLP) and myeloid progenitor (MP) compartments (
<xref rid="B15" ref-type="bibr">15</xref>
). Most of the mature immune cells likewise express
<italic>Esr1</italic>
, with so far little evidence for
<italic>Esr2</italic>
-dependent regulation. A notable exception is microglia, the brain-resident macrophages, where TLR-mediated response can be differentially regulated through ERα- or ERβ-dependent mechanisms (
<xref rid="B40" ref-type="bibr">40</xref>
,
<xref rid="B41" ref-type="bibr">41</xref>
). Murine splenic cDCs and pDCs, as well as bone marrow-derived DCs (BMDCs), also express
<italic>Esr1</italic>
, but only negligible levels of
<italic>Esr2</italic>
(
<xref rid="B32" ref-type="bibr">32</xref>
). However, ER expression can be modulated by the tissue microenvironment or by the activation status of the cells, as DCs infiltrating the brain during experimental autoimmune encephalomyelitis (EAE) express ERβ, unlike splenic DCs (
<xref rid="B42" ref-type="bibr">42</xref>
). Moreover, evidence exists that regulatory cytokines, such as IL-27, can induce a dramatic increase in
<italic>Esr1</italic>
gene expression in cDCs, although the functional consequences of this upregulation are presently unknown (
<xref rid="B43" ref-type="bibr">43</xref>
). ERα appears thus to be the most prominent ER in the human and murine dendritic cell lineages, even though human pDCs express both
<italic>ESR1</italic>
and
<italic>ESR2</italic>
transcripts (
<xref rid="B38" ref-type="bibr">38</xref>
).</p>
</sec>
<sec id="S3">
<title>Mechanisms of ER Signaling</title>
<p>The ERα and ERβ paralogs are conserved across vertebrate lineages (
<xref rid="B44" ref-type="bibr">44</xref>
). The proteins share five functional and structural domains: two transcriptional activation function domains, AF-1 (A/B domain) and AF-2 (F domain); a DNA-binding domain (DBD; C domain); a hinge domain (D); and a ligand-binding domain (LBD; E/F domain) (
<xref rid="B45" ref-type="bibr">45</xref>
<xref rid="B47" ref-type="bibr">47</xref>
).</p>
<p>Following interaction with its estrogen ligand, an ER can regulate cellular function through either of two different mechanisms: the nuclear genomic mechanism, implying direct or indirect binding of the receptor to transcription control regions of targeted genes, and the non-genomic mechanism, initiated by receptors at the cell membrane, which signal through kinase pathways (
<xref rid="B47" ref-type="bibr">47</xref>
).</p>
<p>Occupation of the ligand cavity of the LBD results in conformational changes in the receptor allowing interaction with coactivators, if the ligand is an agonist, or preventing such interactions, if the ligand is an antagonist (
<xref rid="B48" ref-type="bibr">48</xref>
). Transcriptional responses to estrogens were initially recognized to depend on specific interaction of homo/heterodimeric ERs with estrogen-response elements (EREs, GGTCANNNTGACC) found in the promoters of target genes. In addition to this “
<italic>classical</italic>
” pathway, a “
<italic>tethered</italic>
” signaling pathway has been described in which ligand-activated ERs can interact with other transcription factor complexes and bind to non-ERE sequences. ERs can thus regulate a number of key transcriptional pathways including those of NF-κB, AP-1, Sp-1, and C/EBPβ (
<xref rid="B30" ref-type="bibr">30</xref>
). Of note, the AP-1 and Sp-1 transcription factor family members are ubiquitously expressed and are known to regulate the expression of several genes important for immune cell development and function (
<xref rid="B49" ref-type="bibr">49</xref>
,
<xref rid="B50" ref-type="bibr">50</xref>
).</p>
<p>In cancer cells, it has been shown that estrogen-bound ERα can regulate gene expression through its direct or indirect recruitment to target gene promoters, or through its binding to distant regulatory elements or enhancers. ERα molecules can associate with other cofactors such as GATA-3, P2A-g, and FOXA1 to the establishment of chromatin loops, bringing distal ERα-bound elements to the vicinity of the transcription start site in target genes (
<xref rid="B51" ref-type="bibr">51</xref>
,
<xref rid="B52" ref-type="bibr">52</xref>
). Once bound, ERα associates with coactivator proteins displaying chromatin-modification properties potentiating the recruitment of RNA polymerase II and chromatin remodeling enzymes, such as histone modifying enzymes (HATs, HDACs, and HMTs) (
<xref rid="B53" ref-type="bibr">53</xref>
,
<xref rid="B54" ref-type="bibr">54</xref>
). It is unknown, however, whether such mechanisms occur in non-reproductive tissues, such as immune cells, in which ER expression is 100-fold lower than in breast cancer cells. Moreover, limited information exists regarding the expression of ER at the protein level in immune cell subsets, as control experiments using appropriate knockout cells are often missing in many experimental settings. However, ER protein levels do not necessarily correlate with mRNA expression, as shown for ER
<sup>-</sup>
cancer cells, owing to the coupling of ER cytoplasmic signaling cascades and target gene transcription with rapid ER proteolysis effected by the ubiquitin-proteasome system (
<xref rid="B55" ref-type="bibr">55</xref>
).</p>
<p>Full ligand-dependent ERα activation entails interactions between the AF domains, but the AF-1 and AF-2 transactivation domains can independently activate transcription in a promoter- and cell type-specific manner (
<xref rid="B46" ref-type="bibr">46</xref>
,
<xref rid="B56" ref-type="bibr">56</xref>
,
<xref rid="B57" ref-type="bibr">57</xref>
). The relative contribution of AF-1 and AF-2 in ERα activity may depend upon the differentiation stage of the cells (
<xref rid="B58" ref-type="bibr">58</xref>
) or the tissue examined (
<xref rid="B59" ref-type="bibr">59</xref>
). Mice lacking either AF-1 (ERαAF-1
<sup>0</sup>
) or AF-2 (ERαAF-2
<sup>0</sup>
) have been recently generated (
<xref rid="B60" ref-type="bibr">60</xref>
<xref rid="B62" ref-type="bibr">62</xref>
). Using these animal models, it has been shown that ERαAF-1 was required neither for the E2-dependent vasculoprotective effects (
<xref rid="B60" ref-type="bibr">60</xref>
) nor for osteoporosis prevention (
<xref rid="B62" ref-type="bibr">62</xref>
). AF1 was, however, necessary for breast cancer cell proliferation (
<xref rid="B63" ref-type="bibr">63</xref>
) and uterine growth (
<xref rid="B60" ref-type="bibr">60</xref>
). Unlike AF-1, AF-2 was required for all E2-mediated actions with the exception of the acceleration of endothelial healing (
<xref rid="B61" ref-type="bibr">61</xref>
,
<xref rid="B62" ref-type="bibr">62</xref>
).</p>
<p>Apart from the “genomic/nuclear” actions that classically rely on AF-1 and/or AF-2 activation, E2 modulates also the activation of several kinases [MAPK, phosphoinositide 3-kinase (PI3K) or PKC], phosphatases, and adenylyl cyclase as well as changes in intracellular calcium (
<xref rid="B30" ref-type="bibr">30</xref>
). These membrane-initiated steroid signaling (MISS) actions are mediated by a pool of intracellular receptors localized to caveolae or rafts at the plasma membrane (
<xref rid="B64" ref-type="bibr">64</xref>
). The palmitoylation of human ERα cysteine 447 appears to be crucial for the targeting of ERα to the plasma membrane through physical interaction with caveolin-1 (
<xref rid="B65" ref-type="bibr">65</xref>
,
<xref rid="B66" ref-type="bibr">66</xref>
). Recently, a mouse model where ERα Cys
<sub>451</sub>
, the putative palmitoylation site, was mutated into alanine has provided the first evidence for a tissue-specific physiological role of MISS effects of ERα
<italic>in vivo</italic>
(
<xref rid="B67" ref-type="bibr">67</xref>
).</p>
<p>These new tools should boost our understanding of the ER-dependent signaling mechanisms by which estrogens regulate the development and function of DC subpopulations
<italic>in vivo</italic>
.
<italic>In vitro</italic>
studies using mice mutant for AF-1 and AF-2 domains have already led to advances in this field (
<xref rid="B24" ref-type="bibr">24</xref>
), but we still lack a detailed understanding of the respective contributions of the genomic and MISS effects of ERα signaling to DC biology in physiological settings
<italic>in vivo</italic>
.</p>
</sec>
<sec id="S4">
<title>DC Development and Lineages</title>
<p>Murine DCs are generally categorized into three main groups: cDCs, pDCs and monocyte-derived inflammatory DCs (moDCs). These different populations arise from the common MPs (CMPs) found in the bone marrow (
<xref rid="B21" ref-type="bibr">21</xref>
), which become progressively restricted into macrophage-DC progenitors (MDPs) (
<xref rid="B68" ref-type="bibr">68</xref>
). Although the MDP has been identified as the first progenitor committed to the DC and monocyte lineage, the clonal potential of MDPs to give rise to both monocytes and DCs is still debated (
<xref rid="B69" ref-type="bibr">69</xref>
). Subsequently, a common DC progenitor (CDP), expressing high levels of Flt3 has been identified, which gives rise to both the cDC and pDC lineages (
<xref rid="B70" ref-type="bibr">70</xref>
).</p>
<sec id="S4-1">
<title>Conventional DCs</title>
<p>Conventional DCs are subdivided into two main lineages, cDC1 and cDC2 (
<xref rid="B19" ref-type="bibr">19</xref>
). Conventional cDC1s express the chemokine receptor XCR1 (
<xref rid="B71" ref-type="bibr">71</xref>
,
<xref rid="B72" ref-type="bibr">72</xref>
) and express either CD8α or CD103 (also known as αE integrin), but do not express CD11b. The cDC1 subset is highly efficient at cross-presenting exogenous antigens on MHC class I molecules (
<xref rid="B73" ref-type="bibr">73</xref>
<xref rid="B75" ref-type="bibr">75</xref>
) and cDC1s further depend on a common set of transcription factors (Irf-8, Id2, Nfil3, and Batf3) for their development. DCs from the cDC2 subset found in the spleen express CD4 and CD172α and cross-present antigens poorly. They are, however, highly competent at presenting MHC class II-restricted antigens to CD4
<sup>+</sup>
T cells. In peripheral tissues, the homologous subset, CD11b
<sup>+</sup>
DCs (either CD103
<sup>+</sup>
or CD103
<sup></sup>
), do not express CD4 but functionally resemble their splenic counterparts (
<xref rid="B76" ref-type="bibr">76</xref>
,
<xref rid="B77" ref-type="bibr">77</xref>
). CDC2s mainly depend on Irf-4 (
<xref rid="B78" ref-type="bibr">78</xref>
) and Relb (
<xref rid="B79" ref-type="bibr">79</xref>
) for their development.</p>
</sec>
<sec id="S4-2">
<title>Plasmacytoid DCs</title>
<p>Plasmacytoid DCs are a distinct lineage separated from the cDCs by their transcriptional dependency (particularly on E2-2), their capacity to secrete abundant type 1 IFN, their morphology, and their poor antigen presentation capacity (
<xref rid="B80" ref-type="bibr">80</xref>
<xref rid="B82" ref-type="bibr">82</xref>
). They are characterized by their expression of marker molecules B220, Ly49Q, Siglec-H, and Bst2 (CD317, bone marrow stromal cell antigen 2, also known as PDCA-1) (
<xref rid="B83" ref-type="bibr">83</xref>
) in mouse, and BDCA-2 (CD303) and BDCA-4 (CD304) in humans (
<xref rid="B84" ref-type="bibr">84</xref>
).</p>
</sec>
<sec id="S4-3">
<title>Monocyte-derived DCs</title>
<p>Monocyte-derived cells were initially considered an important reservoir for DC development based on the observation that murine and human monocytes can differentiate
<italic>in vitro</italic>
into “DC-like” cells in the presence of granulocyte-macrophage colony-stimulating factor (GM-CSF, Csf-2) (
<xref rid="B85" ref-type="bibr">85</xref>
,
<xref rid="B86" ref-type="bibr">86</xref>
). The
<italic>in vivo</italic>
equivalent of GM-CSF-derived cells has been difficult to identify, and it is now clear that they represent a distinct type of highly plastic cells able to acquire multiple functions in response to environmental cues (
<xref rid="B87" ref-type="bibr">87</xref>
). MCs were initially described as a subset of DCs emerging during inflammation induced by
<italic>Listeria monocytogenes</italic>
infection and characterized as cells producing large amounts of tumor necrosis factor α (TNF-α) and intracellular nitric oxide synthase (iNOS); as such, they were called Tip-DC (TNF-α and iNOS-producing DCs) (
<xref rid="B88" ref-type="bibr">88</xref>
). MCs were subsequently identified in the response to infection by other pathogens (
<xref rid="B87" ref-type="bibr">87</xref>
,
<xref rid="B89" ref-type="bibr">89</xref>
) and were shown to differentiate from CCR2
<sup>+</sup>
Ly6C
<sup>hi</sup>
monocytes recruited to the site of inflammation where they can present antigens to both CD4
<sup>+</sup>
and CD8
<sup>+</sup>
T cells (
<xref rid="B89" ref-type="bibr">89</xref>
). MCs were shown to be crucial for the induction of Th1 and Th17 immunity in response to pathogens and following immunization in Freund’s complete adjuvant (
<xref rid="B90" ref-type="bibr">90</xref>
,
<xref rid="B91" ref-type="bibr">91</xref>
). In addition, human MCs have been identified in the joints of rheumatoid arthritis patients and in tumor ascites and preferentially primed Th17 responses (
<xref rid="B92" ref-type="bibr">92</xref>
). Another subset of MCs has been reported to accumulate in inflammatory lymph nodes in response to LPS and to express CD14 and the c-type lectin DC-SIGN (CD209a) (
<xref rid="B93" ref-type="bibr">93</xref>
). However, these cells were subsequently found to express the DC-specific transcription factor Zbtb46 (
<xref rid="B94" ref-type="bibr">94</xref>
). Unlike Tip-DCs, LPS-induced MCs were lost in Zbtb46-DTR deleter mice treated with diphtheria toxin and failed to accumulate in Flt3L
<sup>−/−</sup>
mice, suggesting that these inflammatory DCs were more closely related to the cDC lineage (
<xref rid="B94" ref-type="bibr">94</xref>
).</p>
</sec>
</sec>
<sec id="S5">
<title>Critical Role of E2/ERα-Signaling in the Generation of CSF-2-Induced CDCs</title>
<p>Most of the evidence regarding the capacity of estrogens to regulate DC development and function has been obtained using
<italic>in vitro</italic>
models of DC development, particularly the culture of bone marrow cells in the presence of GM-CSF (Csf-2), a cytokine involved in the development and homeostasis of the myeloid lineage (
<xref rid="B95" ref-type="bibr">95</xref>
). It was initially suggested that the CD11c
<sup>+</sup>
MHCII
<sup>+</sup>
cells that develop under these conditions were equivalent to the inflammatory DCs arising from monocytes during inflammation
<italic>in vivo</italic>
(
<xref rid="B96" ref-type="bibr">96</xref>
), as mice lacking Csf-2 or its receptor do not carry any major defects in the development of lymph node and spleen cDCs (
<xref rid="B21" ref-type="bibr">21</xref>
). Csf-2 deficiency has, however, been associated with a reduction in the numbers of CD103
<sup>+</sup>
cDCs and CD11b
<sup>+</sup>
cDCs in the intestine, dermis, and lung (
<xref rid="B97" ref-type="bibr">97</xref>
). Thus,
<italic>in vivo</italic>
Csf-2 appears dispensable for lymphoid DC homeostasis, but necessary for the development and maintenance of some tissue-resident DCs, suggesting that Csf-2 is a critical regulator of cDC survival in non-lymphoid tissues (
<xref rid="B97" ref-type="bibr">97</xref>
). Although some studies have suggested that inflammatory or mo-DCs can
<italic>in vivo</italic>
develop from progenitor cells constitutively lacking Csf-2 receptor (
<xref rid="B91" ref-type="bibr">91</xref>
,
<xref rid="B97" ref-type="bibr">97</xref>
), evidence also exists for a Csf-2-dependent regulation of mo-DC accumulation in tissues during injury and response to pathogens (
<xref rid="B98" ref-type="bibr">98</xref>
). For instance, Csf-2 neutralization has been recently reported to inhibit the development of a cycling mo-DC population (
<xref rid="B99" ref-type="bibr">99</xref>
). On the other hand, CD4
<sup>+</sup>
T cell-derived Csf-2 production can drive the generation of mo-DC during inflammatory diseases (
<xref rid="B100" ref-type="bibr">100</xref>
,
<xref rid="B101" ref-type="bibr">101</xref>
) and is essential for the pathogenicity of Th17 cells in CNS autoimmunity (
<xref rid="B102" ref-type="bibr">102</xref>
,
<xref rid="B103" ref-type="bibr">103</xref>
). After subcutaneous immunization with antigen in complete Freund’s adjuvant, Csf-2 has been reported to promote the differentiation of Th1 or Th17 effector cells, by acting on CD103
<sup>+</sup>
dermal DCs (
<xref rid="B104" ref-type="bibr">104</xref>
) or mo-DCs (
<xref rid="B91" ref-type="bibr">91</xref>
), respectively. Indeed, Csf-2 is critical for IL-6 and IL-23 production by DCs and for Th17 induction in autoimmune myocarditis (
<xref rid="B105" ref-type="bibr">105</xref>
) and EAE (
<xref rid="B91" ref-type="bibr">91</xref>
). Thus, besides its potential role in promoting the expansion of mo-DCs during inflammation (
<xref rid="B99" ref-type="bibr">99</xref>
<xref rid="B101" ref-type="bibr">101</xref>
), Csf-2 appears also critical in assigning the Th17-inducing potential of mo-DCs
<italic>in vivo</italic>
(
<xref rid="B91" ref-type="bibr">91</xref>
,
<xref rid="B105" ref-type="bibr">105</xref>
).</p>
<p>Application of this
<italic>in vitro</italic>
model of Csf-2-induced differentiation to either bulk bone marrow cells or highly purified progenitors, such as MDPs, has shown the presence of E2 in the culture medium to be critical in promoting the development of CD11c
<sup>+</sup>
MHCII
<sup>+</sup>
cells (
<xref rid="B106" ref-type="bibr">106</xref>
) (Table
<xref ref-type="table" rid="T1">1</xref>
). This was initially demonstrated by using either steroid-free culture medium supplemented with estrogens, pure ER antagonists, or SERMs shown to block ER signaling by estrogens originating from fetal calf serum (FCS) supplementation (
<xref rid="B12" ref-type="bibr">12</xref>
,
<xref rid="B15" ref-type="bibr">15</xref>
,
<xref rid="B16" ref-type="bibr">16</xref>
,
<xref rid="B22" ref-type="bibr">22</xref>
,
<xref rid="B107" ref-type="bibr">107</xref>
). These studies concluded that estrogens in standard FCS-supplemented medium, probably in the 10
<sup>−10</sup>
–10
<sup>−9</sup>
M range, are sufficient to promote the development of CD11c
<sup>+</sup>
DC-like cells. Such estrogen doses are compatible with physiological concentrations in female mice during diestrus and estrus (
<xref rid="B108" ref-type="bibr">108</xref>
). It was then formally established that estrogen-mediated activation of ERα, but not ERβ, was necessary to promote BMDC development in the presence of Csf-2 (
<xref rid="B16" ref-type="bibr">16</xref>
). This was not related to a progenitor deficiency in ERα-deficient mice, as the frequency of MDPs and CDPs in the bone marrow was not affected (
<xref rid="B24" ref-type="bibr">24</xref>
).</p>
<p>Time-course experiments using the pure ER-antagonist ICI
<sub>182,780</sub>
showed that the essential effect of E2 in promoting Csf-2-mediated DC development occurred within the first 48 h of culture (
<xref rid="B17" ref-type="bibr">17</xref>
). This suggested that E2-dependent activation of ERα could regulate the activation state or expression level of transcription factors implicated in DC lineage commitment in the early stages of the differentiation of bone marrow precursors. Indeed, it was subsequently reported that E2 acts directly on highly purified MPs, including MDPs, to regulate GM-CSF-induced differentiation of CD11c
<sup>+</sup>
DC-like cells through the upregulation of the transcription factor Irf-4 (
<xref rid="B15" ref-type="bibr">15</xref>
,
<xref rid="B17" ref-type="bibr">17</xref>
,
<xref rid="B24" ref-type="bibr">24</xref>
) (Figure
<xref ref-type="fig" rid="F1">1</xref>
).</p>
<fig id="F1" position="float">
<label>Figure 1</label>
<caption>
<p>
<bold>Growth factors and transcription factors regulating conventional dendritic cell (cDC) and plasmacytoid DC (pDC) development</bold>
. A simplified view of the current transcriptional network in DC development is depicted. The plausible developmental stages where E2/ERα-signaling is likely to regulate DC development and/or functions are shown. The common DC progenitors (CDPs) that originate from the common progenitor for monocytes and DCs [macrophage-DC progenitor (MDP)] produce exclusively the cDC and pDC subsets, but have lost the capacity to generate monocytes. Previous works demonstrated that E2 may act directly in MDP to promote interferon regulatory factor (Irf)-4 expression and GM-DC development. Whether E2 may also signal through ERα at later stage in CDP to promote cDC2 development still remains to be established. In the pDC lineage, E2 is likely to signal through ERα to promote optimal TLR-dependent production of type I interferons (IFNs) through the upregulation of signaling intermediate such as Irf-5, and also possibly through additional unknown mechanisms. Solid arrows indicate connections that have been proven, while dotted arrows indicate direct or indirect relationships.</p>
</caption>
<graphic xlink:href="fimmu-08-00108-g001"></graphic>
</fig>
<p>Even though Csf-2 has been widely used to promote the differentiation of mouse and human hematopoietic progenitors and monocytes into cells resembling mouse splenic DCs (
<xref rid="B85" ref-type="bibr">85</xref>
,
<xref rid="B109" ref-type="bibr">109</xref>
), it was appreciated from the beginning that this culture system harbors heterogeneous cell populations. These include monocyte/macrophage-like cells (
<xref rid="B85" ref-type="bibr">85</xref>
,
<xref rid="B109" ref-type="bibr">109</xref>
) and CD11c
<sup>hi</sup>
CD86
<sup>hi</sup>
MHCII
<sup>hi</sup>
DCs, which arise spontaneously in the absence of exogenous danger signals (
<xref rid="B110" ref-type="bibr">110</xref>
). A clarification has been provided recently regarding the origin and phenotypic characterization of the cells generated in such
<italic>in vitro</italic>
model system (
<xref rid="B111" ref-type="bibr">111</xref>
).</p>
<p>Based on their hematopoietic origin and the expression of phenotypic markers, it was reported that the CD11c
<sup>+</sup>
MHCII
<sup>+</sup>
cells arising in these cultures were comprised of: (i) cMoP-derived macrophages (GM-Macs) defined as CD11b
<sup>hi</sup>
MHCII
<sup>int</sup>
CD115
<sup>+</sup>
, and (ii) CDP-derived classical DCs (GM-DCs) expressing high levels of MHCII, PDL-2, and Irf-4 and defined as CD115
<sup></sup>
CD135
<sup>+</sup>
cells. The latter subset was enriched in BMDC cultures generated with GM-CSF and IL-4, and its development was dependent on Irf-4 expression in CD11c
<sup>+</sup>
cells (
<xref rid="B112" ref-type="bibr">112</xref>
). Thus, GM-DCs may be more closely related to the CD8α
<sup></sup>
cDC2 subset, consistent with their expression of CD11b and SIRP-α (
<xref rid="B111" ref-type="bibr">111</xref>
).</p>
<p>These results have important implications for the interpretation of earlier studies on the origin (GM-Macs or GM-DCs) of the estrogen-dependent CD11c
<sup>+</sup>
MHCII
<sup>+</sup>
cells that preferentially develop in Csf-2-stimulated bone marrow cultures. In previous investigations by different laboratories, the relative expression of CD11b and Ly6C among CD11c
<sup>+</sup>
cells was used to better define the CD11c
<sup>+</sup>
cell subsets in this model (
<xref rid="B16" ref-type="bibr">16</xref>
,
<xref rid="B22" ref-type="bibr">22</xref>
), as Ly6C expression appears to represent a reliable marker of inflammatory macrophages, both
<italic>in vitro</italic>
and
<italic>in vivo</italic>
(
<xref rid="B21" ref-type="bibr">21</xref>
). From initial studies, it was clear that the CD11b
<sup>hi</sup>
Ly6C
<sup>+</sup>
population was mostly unchanged by the absence of E2/ERα-signaling. E2, however, preferentially promoted the differentiation of CD11c
<sup>+</sup>
CD11b
<sup>int</sup>
cells lacking Ly6C expression, likely including the GM-DC population (
<xref rid="B16" ref-type="bibr">16</xref>
,
<xref rid="B22" ref-type="bibr">22</xref>
). We corroborated this effect in competition experiments using wild-type and ERα-deficient bone marrow cells, which provided direct evidence for a cell-autonomous function of ERα-signaling in promoting the development of CD11c
<sup>+</sup>
CD11b
<sup>int</sup>
Ly6C
<sup></sup>
cells. By contrast, the CD11b
<sup>hi</sup>
Ly6C
<sup>+</sup>
population was reciprocally enriched in estrogen-deprived cultures or in the absence of ERα function in the bone marrow precursors. This cell population may correspond to the “GM-Macs-like” monocyte/macrophage population described by Helft et al. (
<xref rid="B111" ref-type="bibr">111</xref>
). Indeed, we observed a twofold to threefold increase in the occurrence of macrophage-like cells in ERα
<sup>−/−</sup>
BMDC cultures (
<xref rid="B16" ref-type="bibr">16</xref>
). This observation correlated with an increased frequency of cells expressing high levels of TLR4-MD2 active complexes and CD11b among ERα
<sup>−/−</sup>
CD11c
<sup>+</sup>
cells and estrogen-deprived wild-type BMDCs (
<xref rid="B16" ref-type="bibr">16</xref>
,
<xref rid="B22" ref-type="bibr">22</xref>
). Accordingly, these cells produced massive amounts of IL-6 and IL-12 upon stimulation with LPS, but not in response to TLR9 or CD40 ligands (
<xref rid="B16" ref-type="bibr">16</xref>
,
<xref rid="B24" ref-type="bibr">24</xref>
). In striking contrast, ERα-signaling promoted the development of CD11b
<sup>int</sup>
Ly6C
<sup></sup>
CD11c
<sup>+</sup>
cells capable of producing higher levels of pro-inflammatory cytokines (IL-16 and IL-12) upon TLR9 or CD40 activation than ERα
<sup>−/−</sup>
CD11c
<sup>+</sup>
cells (
<xref rid="B16" ref-type="bibr">16</xref>
). Moreover, ERα
<sup>−/−</sup>
DCs, enriched in GM-Macs, were markedly inferior at stimulating naive CD4
<sup>+</sup>
T cells, when compared to BMDCs from E2-stimulated cultures, when given preprocessed antigenic peptides or unprocessed protein antigen (
<xref rid="B16" ref-type="bibr">16</xref>
). Further studies are warranted to explain how E2 promotes the development of GM-DCs in preference to GM-Macs in this culture model. As suggested in Figure
<xref ref-type="fig" rid="F1">1</xref>
, E2 could promote GM-DC generation by selectively acting in CDPs and/or by regulating the earlier transition from MDPs to CDPs.</p>
<p>While canceling estrogen signaling in the GM-CSF culture model had no apparent effect on the development of monocyte/macrophage-like cells, this does not necessarily indicate that monocytes or monocyte-derived cells are insensitive to estrogen
<italic>in vivo</italic>
. In fact, by using the LysM-cre deleter model, we provided compelling evidence that ERα signaling in murine monocytes/macrophages was associated
<italic>in vivo</italic>
with an enhanced production of pro-inflammatory cytokines by peritoneal macrophages (
<xref rid="B8" ref-type="bibr">8</xref>
). This ERα-dependent effect of E2 on the LPS-driven inflammatory response of macrophages was mediated by inhibition of PI3K activity acting as a negative feedback mechanism of TLR4-induced activation (
<xref rid="B7" ref-type="bibr">7</xref>
,
<xref rid="B8" ref-type="bibr">8</xref>
). This observation is at odds with other studies indicating that
<italic>in vivo</italic>
, estrogens exert pro-inflammatory actions on murine macrophages and microglia (
<xref rid="B40" ref-type="bibr">40</xref>
,
<xref rid="B41" ref-type="bibr">41</xref>
), whereas ERβ ligands are anti-inflammatory (
<xref rid="B41" ref-type="bibr">41</xref>
). This conclusion, however, does not seem to hold for human monocytes/macrophages, in light of reports describing
<italic>in vitro</italic>
E2-mediated inhibition of LPS-driven production of pro-inflammatory cytokines such as IL-6 (
<xref rid="B113" ref-type="bibr">113</xref>
) through the blockade of NF-κB signaling (
<xref rid="B114" ref-type="bibr">114</xref>
). Whether this effect involves classical ERα is unclear. A recent study showed that the 36-kDa isoform of ERα, which excludes the AF-1 and AF-2 domains owing to alternative mRNA splicing, was strongly expressed in human monocytes and could contribute to the inhibition of NF-κB transcriptional activity through direct interaction in the nucleus (
<xref rid="B115" ref-type="bibr">115</xref>
). Besides macrophages, the effects of estrogen signaling on MCs such as monocyte-derived DCs or TipDCs deserve further investigation. Table
<xref ref-type="table" rid="T1">1</xref>
summarizes known ERα-mediated modulatory effects of estrogen on the biological responses and functions of DC subsets and monocytes-macrophages in different contexts.</p>
</sec>
<sec id="S6">
<title>Irf-4 is a Key Target of ERα Signaling in the Regulation of DC Biology</title>
<p>Interferon regulatory factor-4 is a key transcription factor that plays an essential role in the regulation of Th2 responses through its function in Th2 cells themselves (
<xref rid="B116" ref-type="bibr">116</xref>
,
<xref rid="B117" ref-type="bibr">117</xref>
) but also in Treg cells (
<xref rid="B118" ref-type="bibr">118</xref>
), M2 macrophages (
<xref rid="B119" ref-type="bibr">119</xref>
) and, as shown more recently, the cDC2 subset (
<xref rid="B110" ref-type="bibr">110</xref>
,
<xref rid="B120" ref-type="bibr">120</xref>
). Irf-4 was initially shown to regulate the development of CD11b
<sup>hi</sup>
CD8α
<sup></sup>
DCs in the spleen (
<xref rid="B121" ref-type="bibr">121</xref>
), though it was unclear whether Irf-4 was required early during development, or for continued survival or functional competence of Irf-4
<sup>+</sup>
DCs in tissues. Recently, DC-specific deletion of Irf-4 has been associated with the absence of CD11b
<sup>+</sup>
CD8α
<sup></sup>
DCs from barrier tissues such as lamina propria, the lung, and the respective draining lymph nodes (
<xref rid="B122" ref-type="bibr">122</xref>
,
<xref rid="B123" ref-type="bibr">123</xref>
). Mice carrying a DC-specific deficiency for
<italic>Irf-4</italic>
correctly develop dermal CD11b
<sup>+</sup>
CD301b
<sup>+</sup>
PDL2
<sup>+</sup>
DCs
<italic>in vivo</italic>
, but these cells fail to localize to the draining lymph nodes (
<xref rid="B110" ref-type="bibr">110</xref>
). This is consistent with the known dependency on
<italic>Irf-4</italic>
for DC migration from the skin to the draining lymph nodes (
<xref rid="B124" ref-type="bibr">124</xref>
).</p>
<p>Kovats and colleagues identified Irf-4 as a key transcription factor whose expression was strongly up-regulated by E2 in Csf-2/Stat-5-stimulated MDPs (
<xref rid="B17" ref-type="bibr">17</xref>
). Retrovirally delivered
<italic>Irf-4</italic>
expression in ERα
<sup>-/-</sup>
MDPs restored their potential to develop into CD11b
<sup>+</sup>
Ly6C
<sup>-</sup>
GM-DCs, indicating that high levels of Irf-4 can substitute for the requirement for E2/ERα-signaling during Csf-2-mediated DC differentiation (
<xref rid="B17" ref-type="bibr">17</xref>
). Data from our laboratory, however, point to further ERα-dependent pathways contributing to Csf-2-driven DC development (
<xref rid="B24" ref-type="bibr">24</xref>
). Using mice expressing AF-1- or AF-2 domain-defective ERα, we showed that both AF domains were required for early
<italic>Irf-4</italic>
expression in Csf-2-stimulated MDPs (
<xref rid="B24" ref-type="bibr">24</xref>
). Intriguingly, in spite of the absence of
<italic>Irf-4</italic>
upregulation in ERα-AF-1
<sup>0</sup>
MDPs, E2 was able to sustain GM-DC development and functional responses to near-equivalent levels relative to wild-type cells at later time points. This observation may explain previous results by others showing substantial E2 effects in GM-DC cultures derived from the first-generation strain of ERα-mutant mice (
<xref rid="B12" ref-type="bibr">12</xref>
), which expressed a truncated form of ERα lacking the AF-1 domain (
<xref rid="B125" ref-type="bibr">125</xref>
), similar to the ERαAF-1
<sup>0</sup>
mice used in our study (
<xref rid="B24" ref-type="bibr">24</xref>
). That AF-1 synergizes with AF-2 to enhance Csf-2-dependent expression of Irf-4 in early stage MDPs, but is dispensable at later stages of Irf-4-dependent DC development, suggests indirect mechanisms of Irf-4 regulation by E2-ERα signaling. AF-2 critically controls ERα interactions with most transcription cofactors, but AF-1-specific coactivators have also been described (
<xref rid="B126" ref-type="bibr">126</xref>
). ERα signaling may regulate Irf-4 through the rapid activation of coactivators or corepressors (
<xref rid="B127" ref-type="bibr">127</xref>
), and the induction of other transcription factors whose early expression may require synergistic interactions between both ERα AFs. In the absence of ERα AF1, a longer signaling period could be required for alternative pathways of activation or for the accumulation of rate-limiting factors above the threshold level required to transactivate
<italic>Irf-4</italic>
expression. This would fit in with the delayed upregulation of Irf-4 observed in ERαAF-1
<sup>0</sup>
MP cells as compared to ERα-deficient ones, although many other mechanisms could conceivably be at play (
<xref rid="B24" ref-type="bibr">24</xref>
).</p>
</sec>
<sec id="S7">
<title>Relevance of E2/ERα Signaling in CDCs
<italic>in vivo</italic>
</title>
<p>Little is known regarding the role of ERα-signaling in the homeostasis of cDC subsets in lymphoid and non-lymphoid tissues
<italic>in vivo</italic>
. Competition experiments in irradiated bone marrow chimeras suggested that newly differentiated splenic CD11c CD11b
<sup>+</sup>
cDCs arose from ERα-proficient bone marrow cells in a ~2:1 ratio to cells derived from the ERα
<sup>−/−</sup>
donor (
<xref rid="B17" ref-type="bibr">17</xref>
). This model likely represents a pro-inflammatory environment where both GM-CSF and Flt3L may be elevated, suggesting that ERα-signaling
<italic>in vivo</italic>
may promote the development of CD11b
<sup>+</sup>
cDC2 subsets. This conclusion, however, needs further confirmation as few phenotypic and functional markers were used in this study (
<xref rid="B17" ref-type="bibr">17</xref>
).</p>
<p>Experiments by Kovats and colleagues have shown unexpectedly that the skin-derived CD103
<sup>+</sup>
cDCs were enriched in the cutaneous lymph nodes of female mice as compared to males (
<xref rid="B124" ref-type="bibr">124</xref>
). Whether this sex bias was due to estrogens was not addressed specifically, but it was independent from Irf-4 expression, in agreement with the currently accepted notion that CD103
<sup>+</sup>
cDCs in the skin belong to the Batf-3-dependent cDC1 subset. By contrast, the Irf-4-dependent CD11b
<sup>+</sup>
cDC subsets showed no such sex bias (
<xref rid="B124" ref-type="bibr">124</xref>
). Thus, despite strong evidence that E2-ERα-signaling strongly regulates Irf-4-dependent cDC subsets in the
<italic>in vitro</italic>
Csf-2 differentiation model, it is still unclear how this relates to particular cDC subsets found in lymphoid or non-lymphoid tissues
<italic>in vivo</italic>
, at the steady state, or during inflammation.</p>
<p>Our search of the ImmGen database at
<uri xlink:type="simple" xlink:href="http://www.immgen.org">http://www.immgen.org</uri>
(
<xref rid="B128" ref-type="bibr">128</xref>
) showed that lung CD11b
<sup>+</sup>
CD103
<sup>neg</sup>
DCs display the highest levels of
<italic>Esr1</italic>
expression among DC subsets. As mentioned above, several studies have shown that a subset of CD11b
<sup>+</sup>
DCs-expressing Irf-4, present in the skin and at the mucosal surfaces in the lung and gut, is crucial in driving CD4
<sup>+</sup>
T cell responses and effector T cell development (
<xref rid="B129" ref-type="bibr">129</xref>
). As ERα-signaling controls the level of Irf-4 in Csf-2-stimulated MDPs, and thereby promotes efficient development of the Irf4-dependent CD11b
<sup>+</sup>
cDC subset
<italic>in vitro</italic>
, further investigations are warranted on the impact of cell-intrinsic ERα signaling in cDCs
<italic>in vivo</italic>
in the context of immune responses against allergens or viruses. A sex bias has in fact been reported for respiratory pathologies such as allergic asthma and influenza virus infection, which are more severe in females than in males (
<xref rid="B130" ref-type="bibr">130</xref>
,
<xref rid="B131" ref-type="bibr">131</xref>
). It was also reported recently that E2 treatment increased the frequency of Irf-4
<sup>+</sup>
DCs in the murine vaginal mucosa, associated with enhanced competence of vaginal DCs to prime Th17 cells
<italic>in vitro</italic>
. It is unresolved whether this effect of E2 hinged on ERα signaling in DCs (
<xref rid="B132" ref-type="bibr">132</xref>
).</p>
</sec>
<sec id="S8">
<title>E2-ERα-Signaling Regulates the Flt3L-Dependent DC Subsets, CDCs and PDCs:
<italic>In vitro</italic>
Evidence</title>
<p>As mentioned earlier, bone marrow progenitors cultured in the presence of cytokine Flt3L generate the two main conventional DC subsets (cDC1 and cDC2) as well as pDCs. E2 was initially reported to downregulate the development of these Flt3L-driven CD11c
<sup>+</sup>
DCs (FL-DCs) through ERα-signaling in MPs (
<xref rid="B15" ref-type="bibr">15</xref>
). Later studies used new strains of ERα mutant mice that allowed the relative contribution of each AF domain of ERα to be examined (
<xref rid="B24" ref-type="bibr">24</xref>
). It was thus shown that this effect of E2 depended on the AF-1 domain, but not on AF-2. Precise analysis of the DC subsets differentiated in the presence of Flt3L confirmed the previous observation that ERα signaling negatively regulates the absolute numbers of FL-DCs
<italic>in vitro</italic>
. This concerned mainly the development of pDCs, whereas cDC numbers were largely unchanged (
<xref rid="B24" ref-type="bibr">24</xref>
). Importantly, cDCs differentiated in the presence of E2 exhibited an enhanced expression of MHC class II and costimulatory molecules, and an increased capacity to produce IL-12 and IL-6 upon combined stimulation through TLR-4 and CD40. Although E2 likewise decreased the absolute numbers of pDCs, these cells exhibited a more mature phenotype and an enhanced capacity to produce the pro-inflammatory cytokine IL-12 in response to TLR9 stimulation. Similar to cDCs, these effects of E2 on pDC biology were missing in ERα-deficient mice as well as in mice defective for the AF-1 function of ERα (
<xref rid="B24" ref-type="bibr">24</xref>
). This requirement for AF-1 may point to a dominant role for the genomic actions of ERα signaling on target genes, but non-genomic mechanisms could also be at play. Studies in mice lacking the MISS function of ERα will help to resolve this issue.</p>
<p>Thus, in contrast to the Csf2-model of cDC2 development, which is strictly dependent of E2-ERα signaling, the development of Flt3L-driven cDCs and pDCs is not abolished in the absence of estrogens or
<italic>Esr1</italic>
expression. Instead, our data are consistent with a key role of estrogens in promoting the development of cDCs and pDCs endowed with a more mature functional phenotype, notably characterized by enhanced TLR-mediated responses.</p>
</sec>
<sec id="S9">
<title>Functional Impact of E2-ERα Signaling on TLR-Dependent Response of PDCs in Humans</title>
<p>An important issue regards the
<italic>in vivo</italic>
relevance of the effects of E2 observed
<italic>in vitro</italic>
on the development and effector functions of cDCs and pDCs, and its translation to human DCs. Addressing the hormonal regulation of immune cells in humans is challenging, and very few studies have as yet been reported. The most remarquable observation probably concerns the human pDC subsets, whose capacity to produce IFN-α in response to TLR ligands has been independently reported to be highly regulated by sex-dependent factors (
<xref rid="B10" ref-type="bibr">10</xref>
,
<xref rid="B25" ref-type="bibr">25</xref>
,
<xref rid="B38" ref-type="bibr">38</xref>
,
<xref rid="B133" ref-type="bibr">133</xref>
,
<xref rid="B134" ref-type="bibr">134</xref>
). Studying large cohorts of healthy donors, Berghöfer and colleagues demonstrated that pDCs in the peripheral blood of women produced more type I IFNs in response to TLR7 ligands than pDCs from men (
<xref rid="B133" ref-type="bibr">133</xref>
). Subsequent studies showed that this sex bias was in fact due to an increased frequency of pDCs capable to secreting IFN-α among PBMCs from women, rather than a sex bias in IFN-α production on a single cell-basis (
<xref rid="B10" ref-type="bibr">10</xref>
,
<xref rid="B134" ref-type="bibr">134</xref>
). Support for a key role of estrogens in regulating the TLR-mediated response of female pDCs came from observations that pDCs from postmenopausal women exhibited a reduced TLR7-mediated response by comparison with premenopausal women, which was partially reversed by hormone replacement therapy with E2 (
<xref rid="B10" ref-type="bibr">10</xref>
). Indeed, E2-supplementation of postmenopausal women was found to substantially enhance IFN-α production by blood pDCs not only in response to TLR7 stimulation but also to TLR9 ligands. Importantly, enhanced cytokine production by pDCs was elicited not only by synthetic ligands of TLR7 or TLR9 but also by natural ligands such as self nucleic acid-containing immune complexes present in the sera of systemic lupus erythematosus (SLE) patients (
<xref rid="B10" ref-type="bibr">10</xref>
).</p>
<p>Using an
<italic>in vitro</italic>
model of Flt3L/IL-7-driven human pDC differentiation from CD34
<sup>+</sup>
HPCs, we showed that blockade of ER signaling by the pure ER antagonist ICI
<sub>182,780</sub>
in developing human pDCs blunted the IFN-α response to TLR7 ligands (
<xref rid="B38" ref-type="bibr">38</xref>
). Unlike their mouse counterparts, however, human pDCs expressed both ER genes,
<italic>ESR1</italic>
and
<italic>ESR2</italic>
(
<xref rid="B38" ref-type="bibr">38</xref>
). It will, therefore, be of importance to investigate the respective contributions of ERα and ERβ to the TLR7-dependent response of human pDCs. The role of either receptor is complex and often mutually antagonistic when expressed in the same cells (
<xref rid="B135" ref-type="bibr">135</xref>
).</p>
</sec>
<sec id="S10">
<title>Mechanisms of ERα-Mediated Regulation of Type I IFNs in PDCs</title>
<p>Because they target virtually any cell type in the organism, understanding the mechanisms of immune cell regulation by estrogens is often not straightforward. New mouse models have been generated recently to induce conditional deletions of ER in order to discriminate between direct and indirect
<italic>in vivo</italic>
effects of estrogens on DC functions (
<xref rid="B8" ref-type="bibr">8</xref>
<xref rid="B10" ref-type="bibr">10</xref>
). Using such models, the impact of ER deficiency in specific immune cell types in the context of physiological hormone levels has been assessed (
<xref rid="B8" ref-type="bibr">8</xref>
,
<xref rid="B10" ref-type="bibr">10</xref>
,
<xref rid="B25" ref-type="bibr">25</xref>
). These studies pinpointing the cellular targets of estrogens are critical to understanding the molecular mechanisms of ER-regulated immune responses
<italic>in vivo</italic>
.</p>
<p>Using mice lacking ERα in CD11c-expressing cells specifically, it was established that ERα expression in pDCs was required for the estrogen-mediated increase of IFN-α (
<xref rid="B10" ref-type="bibr">10</xref>
,
<xref rid="B25" ref-type="bibr">25</xref>
). This
<italic>in vivo</italic>
cell-intrinsic modulation by estrogen of the TLR7- and TLR9-dependent responses in mouse pDCs (
<xref rid="B10" ref-type="bibr">10</xref>
,
<xref rid="B25" ref-type="bibr">25</xref>
) was corroborated by evidence from
<italic>in vitro</italic>
models of murine and human pDC development (
<xref rid="B24" ref-type="bibr">24</xref>
,
<xref rid="B38" ref-type="bibr">38</xref>
). Altogether, these studies provided new insights into the mechanism of sex bias in the TLR-driven IFN-α production of female pDCs and identified ERα as an attractive target for specific modulation of this pathway.</p>
<p>Interferon-α induction is regulated primarily at the transcriptional level by members of the interferon regulatory factor (Irf) family (
<xref rid="B136" ref-type="bibr">136</xref>
). Human pDCs constitutively express high levels of Irf-5 and Irf-7, and TLR9 engagement in pDCs leads to the activation and phosphorylation of both Irf-5 and Irf-7 (
<xref rid="B20" ref-type="bibr">20</xref>
). Irf-7 is widely recognized as the “master regulator” of type I IFN production (
<xref rid="B137" ref-type="bibr">137</xref>
), while Irf-5 has been shown to be a central mediator of TLR7 signaling in mice (
<xref rid="B138" ref-type="bibr">138</xref>
,
<xref rid="B139" ref-type="bibr">139</xref>
). In human pDCs, the production of IFN-α through TLR7 or TLR9 stimulation relies on PI3K activities and the phosphorylation of Akt, leading to nuclear translocation of Irf-7 (
<xref rid="B140" ref-type="bibr">140</xref>
). However, a recent study in human pDC leukemic cells challenged the notion of a key regulatory role of Irf-7 in type I IFN production by human pDCs. It was reported that Irf-5, rather than Irf-7, played a non-redundant role in IFN-β and IL-6 production following cell stimulation with TLR9 ligands (
<xref rid="B36" ref-type="bibr">36</xref>
). Thus, while Irf-7 is the master regulator of type I IFN production upon TLR7 or TLR9 stimulation in mouse pDCs, the respective contribution of Irf-7 and Irf-5 to IFN-α induction in human cells is yet to be clarified.</p>
<p>The role of Irf-5 in the differential IFN-α production between females and males was investigated recently (
<xref rid="B25" ref-type="bibr">25</xref>
). Basal levels of Irf-5 were significantly higher in the pDCs from women and positively correlated with the frequency of IFN-α-secreting pDCs upon TLR7 stimulation. Genetic ablation of the
<italic>Esr1</italic>
gene in the hematopoietic compartment or the DC lineage of female mice reduced Irf-5 mRNA expression in pDCs and IFN-α production upon stimulation with TLR7 ligand-containing vesicles. Of note, Irf-7 expression in bone marrow pDCs was not affected by ERα deficiency (
<xref rid="B25" ref-type="bibr">25</xref>
). These results suggest that estrogens regulate pDC type I IFN production through Irf-5, which may act by enhancing IFN-α production in synergy with Irf-7 (
<xref rid="B141" ref-type="bibr">141</xref>
). This would be particularly relevant to human pDCs, whose capacity to produce IFN-β upon TLR9 engagement has been shown to depend strongly on Irf-5, rather than on Irf-7 (
<xref rid="B36" ref-type="bibr">36</xref>
,
<xref rid="B141" ref-type="bibr">141</xref>
). However, a direct relationship between E2-ERα signaling and Irf-5 expression has yet to be established. In parallel, it has been reported that estrogen signaling in immune cells upregulated the expression of the endoplasmic reticulum transmembrane protein Unc93b1 (
<xref rid="B142" ref-type="bibr">142</xref>
). This chaperone molecule regulates the trafficking of TLR3, TLR7, and TLR9 from the endoplasmic reticulum to the endosomal compartments, and Unc93b1 knockdown abrogates cytokine production (
<xref rid="B143" ref-type="bibr">143</xref>
). However, estrogen-mediated regulation of Unc93b1 was not assessed in pDCs, and it was unclear whether this regulation involved cell-intrinsic ERα signaling (
<xref rid="B142" ref-type="bibr">142</xref>
). The contribution of Unc93b1 to the sex-bias in the TLR-mediated response of pDCs remains an unsettled question.</p>
<p>While a study has suggested a direct regulation of TLR expression through ERα signaling in human monocyte-derived macrophages (
<xref rid="B144" ref-type="bibr">144</xref>
), we and others have failed to detect sex-dependent modulation of
<italic>TLR7</italic>
or
<italic>TLR9</italic>
gene expression in pDCs, at least at the mRNA level in bulk cell populations (
<xref rid="B38" ref-type="bibr">38</xref>
,
<xref rid="B133" ref-type="bibr">133</xref>
). Confirmation of these results in various TLR7-expressing cells both in mice and human will be necessary, along with analyses of protein expression levels using highly specific antibodies.</p>
<p>Other than TLRs and proteins implicated in their intracellular trafficking, a recent study pointed to ERα-dependent regulation of the cell surface molecule PDC-triggering receptor expressed on myeloid cells (TREM) in pDCs from lupus-prone mice. PDC-TREM is a pDC-specific receptor, a member of the TREM family, which is induced by TLR signaling and mediates IFN-α production (
<xref rid="B145" ref-type="bibr">145</xref>
). ERα deficiency reduced the TLR9-dependent expression of PDC-TREM in pDCs from mice of NZM2410 (lupus-prone) or C57BL/6 genetic background (
<xref rid="B146" ref-type="bibr">146</xref>
). Although PDC-TREM expression is reportedly required for optimal production of type I IFNs by TLR9-stimulated pDCs (
<xref rid="B145" ref-type="bibr">145</xref>
), further studies are needed for any functional links to be established between ERα-dependent regulation of PDC-TREM and changes in the TLR-responsiveness of pDCs.</p>
<p>Despite recent inroads, the mechanistic details of the functional impact of E2-ERα signaling on the TLR-dependent responses of pDCs remain largely unexplored. Apart from the direct regulation of genes implicated in the TLR signaling pathway, ERα could control the expression of key pDC transcription factors, such as E2-2, Spi-B, Irf-8, Irf-7, and Ikaros. One would also expect major effects on the development of pDCs in the bone marrow. This raises exciting questions for investigators, because understanding the mechanisms that promote pDC development and regulate their peripheral function will be key to manipulating this cellular compartment through ER signaling to enforce homeostasis and fight chronic inflammation. The sexual dimorphism in type I IFN production by pDCs could indeed be implicated in the increased susceptibility of women to autoimmunity, and in the sex differences vis-à-vis the acquisition and clinical course of certain viral diseases (
<xref rid="B1" ref-type="bibr">1</xref>
).</p>
</sec>
<sec id="S11">
<title>Concluding Remarks</title>
<p>Evidence is emerging that estrogens, through their nuclear receptor ERα, regulate various facets of cDC and pDC develoment and TLR-dependent responses in humans and mice. However, the full demonstration of a direct involvement of this pathway in the sex-biased susceptibility to autoimmunity or infection remains a work in progress. Genetic and cell type-specific
<italic>Esr1</italic>
deletion strategies have come to the fore as critical tools, and further investigations regarding genes regulated by estrogens in DCs are eagerly awaited. Such unbiased approaches should shed light on the molecular mechanisms set in motion by cell-intrinsic E2-ERα signaling in DCs in the physiological context of the female environment. Another important issue concerns the optimal experimental models to study the role of sex hormones. Although standard estrogen supplementation is useful in addressing certain questions, it does not mirror the estrus cycle and, because of the pleiotropic actions of sexual hormones, may introduce confounding factors, especially in integrated models of autoimmune or infectious diseases. The physiological context of natural estrogen production during the estrus cycle should, therefore, be preferred over experimental models of E2-supplementation, as the only natural instance of sustained steroid hormone production is pregnancy.</p>
<p>The pDC subset appears to be subjected to estrogen-dependent regulation, notably in regard of its functional capacity to produce type I IFNs in response to TLR7 ligands (
<xref rid="B133" ref-type="bibr">133</xref>
,
<xref rid="B134" ref-type="bibr">134</xref>
). Evidence has arisen that E2-ERα signaling and X-linked genetic factors independently contribute to the strong sex bias in the TLR7-driven response of pDCs (
<xref rid="B10" ref-type="bibr">10</xref>
,
<xref rid="B38" ref-type="bibr">38</xref>
). Cell type-specific strategies of genetic ablation have recently demonstrated the pivotal role of pDCs in the development of autoantibodies and in the progression of lupus-like syndrome (
<xref rid="B147" ref-type="bibr">147</xref>
,
<xref rid="B148" ref-type="bibr">148</xref>
). Targeting the ER signaling pathway in pDCs could represent a valuable therapeutic approach to limit the pathogenic production of type I IFN, particularly during the initial stages of SLE. Indeed, early studies suggested beneficial effects of RE antagonists or SERMs in mouse models of lupus (
<xref rid="B149" ref-type="bibr">149</xref>
,
<xref rid="B150" ref-type="bibr">150</xref>
). Encouraging results were reported from a clinical double-blind trial of fulvestrant (ICI
<sub>182,780</sub>
) in women with SLE (
<xref rid="B151" ref-type="bibr">151</xref>
). In patients treated for 12 months, an improvement in clinical signs was observed, associated with a reduction of medication dosage (
<xref rid="B151" ref-type="bibr">151</xref>
). Together with our
<italic>in vitro</italic>
results showing ICI
<sub>182,780</sub>
to downregulate the TLR7-type I IFN pathway in developing human pDCs, these clinical outcomes strongly suggest that ER signaling could be amenable to pharmacological manipulation in pDCs. Along this line, we reported earlier that E2 supplementation in postmenopausal women enhances the TLR7- and TLR9-dependent production of type I IFNs (
<xref rid="B10" ref-type="bibr">10</xref>
).</p>
<p>In addition to the well-established sex bias in the incidence and severity of autoimmune diseases, sex differences in the response to viral vaccines have been also clearly documented in humans and in mice (
<xref rid="B130" ref-type="bibr">130</xref>
,
<xref rid="B152" ref-type="bibr">152</xref>
). Given the central role of DCs in the initiation of adaptive immunity, studying how sex-related factors could regulate the homeostasis and responses of tissue-resident DC subsets at steady state and in the context of vaccination using attenuated viruses or vaccine sub-units is of critical importance. For instance, prophylactic vaccination with HSV-2 glycoprotein D in adjuvant exhibited efficacy in women, but not in men (
<xref rid="B153" ref-type="bibr">153</xref>
). More recently, systems biology approaches have shown that expression of genes associated with TLR and IFN pathways immediately after vaccination with yellow fever virus 17D predicted subsequent adaptive immune responses (
<xref rid="B154" ref-type="bibr">154</xref>
,
<xref rid="B155" ref-type="bibr">155</xref>
). Interestingly, re-analysis of these data according to the sex of the subjects demonstrated that most of the TLR-associated genes that activate the IFN pathway were upregulated to a greater extent in women as compared to men during the first 10 days after vaccination (
<xref rid="B130" ref-type="bibr">130</xref>
). Although this may suggest that disease protection might be greater in women than in men, this also indicates that the enhanced innate immune response to YF17FD vaccine might also underlie the increased incidence of side-effects in women (
<xref rid="B130" ref-type="bibr">130</xref>
). These examples illustrate the importance of understanding how sex-linked factors could contribute to regulate innate immunity, and particularly DC biology. This may help to explain and predict the heterogeneous responses to vaccines in humans according to sex, not only in the context of infectious diseases but also in cancer immunotherapy.</p>
</sec>
<sec id="S12">
<title>Author Contributions</title>
<p>SL, CS, and J-CG participated in the conception and the writing of the review.</p>
</sec>
<sec id="S13">
<title>Conflict of Interest Statement</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
</body>
<back>
<ack>
<p>This work was supported by grants from Arthritis Fondation Courtin, Fondation ARC pour la Recherche sur le Cancer, Fondation pour la Recherche Médicale (DEQ2000329169), Conseil Régional Midi-Pyrénées, and the French National Agency for Research on AIDS and Viral Hepatitis (ANRS). SL has been supported by fellowships from Association pour la Recherche sur la Sclérose en Plaques (ARSEP). CS is supported by fellowship and grant from the National Health and Medical Research Council (NHMCR, APP1123000 and APP1098832). We wish to thank Dr. JE Méjia for critical readings of the manuscript.</p>
</ack>
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