Increased ILT2 expression contributes to dysfunction of CD56^dimCD16⁺NK cells in chronic hepatitis B virus infection

Natural killer (NK) cells play a crucial role in the control of human viral infections but their activity is significantly impaired in patients infected with chronic hepatitis B (CHB). The mechanism that contributes to NK cell dysfunction in CHB needs further elucidation. In this study, we analyzed the expression and function of the novel inhibitory receptor immunoglobulin-like transcript-2 (ILT2) on NK cells from 131 CHB patients and 36 healthy controls. We observed that ILT2 expression on circulating CD56^dimCD16⁺NK cells was increased in immune-tolerant, immune-active and HBeAg-negative hepatitis patients compared with inactive carriers and controls. The frequency of ILT2⁺CD56^dimNK cells was positively correlated with serum viral load in immune-tolerant patients. The percentage of ILT2⁺CD56^dimNK cells decreased along with HBV load in CHB patients who received antiviral therapy. Functional analysis showed that ILT2⁺CD56^dimNK cells in CHB patients had significantly reduced degranulation and IFN-γ production. Upregulation of ILT2 was associated with high levels of apoptosis in CD56^dimCD16⁺NK cells from CHB patients. ILT2 blockade was shown to increase the cytotoxicity and IFN-γ production of CD56^dimNK cells in some CHB patients. Finally, ILT2 was found to be moderately upregulated by TGF-β1, which was increased in immune-tolerant, immune-active and HBeAg-negative hepatitis patients. Our results show that chronic HBV infection increases the levels of the inhibitory receptor ILT2 on CD56^dimNK cells and inhibits their functions, providing a new mechanism of NK-cell disability in CHB patients.