Pathology · Immunopathology (Hypersensitivity, Autoimmunity, Immunodeficiency, Amyloidosis)

CTLA-4 (CD152) and PD-1 (CD279) are two distinct immune checkpoint molecules targeted by current cancer immunotherapy. Their molecular mechanisms of T-cell inhibition differ in that:

  • A CTLA-4 activates the PI3K-AKT pathway in effector T cells to promote anergy; PD-1 activates cAMP to promote regulatory T-cell function
  • B CTLA-4 is exclusively expressed on CD8+ cytotoxic T cells; PD-1 is exclusively on Treg cells
  • C CTLA-4 competes with CD28 for B7 (CD80/CD86) on APCs during priming in lymph nodes, reducing co-stimulatory signal; PD-1 binds PD-L1/PD-L2 in peripheral tissues to recruit SHP-2 phosphatase, dampening TCR-CD3 signaling during effector phase
  • D Both CTLA-4 and PD-1 activate identical SHP-1/SHP-2 phosphatase cascades at the immunological synapse with no spatial or temporal distinction
Correct answer: C. CTLA-4 competes with CD28 for B7 (CD80/CD86) on APCs during priming in lymph nodes, reducing co-stimulatory signal; PD-1 binds PD-L1/PD-L2 in peripheral tissues to recruit SHP-2 phosphatase, dampening TCR-CD3 signaling during effector phase

Explanation

CTLA-4 acts primarily at the T-cell priming stage in secondary lymphoid organs: it outcompetes CD28 for B7 ligands on antigen-presenting cells due to higher affinity, reducing the co-stimulatory signal required for naïve T-cell activation. PD-1, in contrast, is upregulated on effector and memory T cells in peripheral tissues and tumors; PD-L1/PD-L2 engagement recruits SHP-1 and SHP-2 phosphatases to the TCR signaling complex, directly attenuating antigen-specific effector T-cell function. This mechanistic and anatomical separation is why anti-CTLA-4 (ipilimumab) and anti-PD-1/PD-L1 antibodies have complementary effects and why combination checkpoint blockade shows synergistic antitumor activity.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

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