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Interleukin-7 receptor

The Interleukin-7 receptor (IL-7R) is a heterodimeric transmembrane protein complex expressed on the surface of various immune cells, including T cells, B cells, natural killer (NK) cells, and dendritic cells, that specifically binds the cytokine interleukin-7 (IL-7) to regulate lymphocyte development, proliferation, survival, and homeostasis.^[1]^[2] Composed of an alpha chain (IL-7Rα, also known as CD127) and the common gamma chain (γc, CD132), which is shared with receptors for several other cytokines such as IL-2 and IL-4, the receptor facilitates IL-7 signaling primarily through the Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway, activating JAK1 and JAK3 to phosphorylate STAT5, which in turn promotes anti-apoptotic proteins like Bcl-2 and Mcl-1 to enhance cell survival.^[3]^[2] IL-7R plays a non-redundant role in early lymphopoiesis, being essential for the progression of pro-B to pre-B cells in the bone marrow and for thymocyte development in T cells, as evidenced by severe combined immunodeficiency (SCID) phenotypes in IL-7R-deficient models where γδ T cells and certain B cell stages are absent.^[3] In mature lymphocytes, IL-7R maintains peripheral T cell pools by supporting homeostatic proliferation, particularly of naïve and memory CD8+ T cells, and contributes to NK cell maturation and function through enhanced cytotoxicity and interferon-γ production.^[2] Beyond adaptive immunity, it influences innate immune components, such as promoting dendritic cell generation and monocyte activation, underscoring its broad immunomodulatory effects.^[2] Dysregulation of IL-7R signaling is implicated in several diseases; for instance, loss-of-function mutations in the IL7R gene cause autosomal recessive SCID and Omenn syndrome by primarily impairing T cell development (resulting in T- B+ NK+ SCID), with B cells present but dysfunctional due to lack of T cell support, while gain-of-function variants, such as Thr244Ile, increase susceptibility to multiple sclerosis by altering T cell homeostasis and promoting autoimmunity.^[1] In oncology, IL7R mutations drive constitutive signaling in B- and T-cell acute lymphoblastic leukemia (ALL), highlighting its therapeutic potential, as IL-7-based immunotherapies have shown promise in enhancing T cell recovery in lymphopenic conditions like HIV infection and cancer. As of 2025, IL-7 agonists such as rhIL-7-hyFc are in advanced clinical trials to enhance T cell responses in cancer and infectious diseases.^[1]^[3]^[4]

Introduction

Definition and overview

The interleukin-7 receptor (IL-7R) is a heterodimeric type I cytokine receptor composed of two subunits: the interleukin-7 receptor alpha chain (IL-7Rα, also designated CD127) and the common gamma chain (γc, CD132).^[5]^[6] This receptor complex specifically binds interleukin-7 (IL-7), a non-redundant cytokine produced primarily by stromal cells in lymphoid tissues, which is indispensable for the development and function of adaptive immune cells.^[5]^[6] IL-7R is a member of the common gamma chain cytokine receptor family, also known as the IL-2 receptor family, where it shares the γc subunit with receptors for IL-2, IL-4, IL-9, IL-15, and IL-21.^[5]^[6] The IL-7Rα chain provides specificity for IL-7 binding, while the γc chain is constitutively expressed on most lymphoid cells and contributes to signal transduction upon ligand-induced heterodimerization.^[5]^[6] By facilitating IL-7 signaling, IL-7R exerts a profound influence on lymphocyte biology, supporting the survival, proliferation, and differentiation of T cells and B cells during early lymphopoiesis and peripheral homeostasis.^[5]^[6] This receptor's activity is particularly vital for T cell maturation in the thymus and the maintenance of naïve and memory T cell pools, thereby underpinning effective adaptive immune responses against pathogens.^[5]^[6]

Historical discovery

The discovery of interleukin-7 (IL-7) occurred in the mid-1980s, when researchers identified it as a novel growth factor supporting the proliferation of pre-B cells derived from murine bone marrow. This breakthrough was reported by Namen et al. in 1988, who cloned and characterized the murine IL-7 gene from a stromal cell line, demonstrating its specific stimulation of B-cell progenitors in vitro.^[7] Building on this, the IL-7 receptor alpha chain (IL-7Rα) was cloned in 1990 by Goodwin et al., who isolated cDNA sequences for both human and murine forms and expressed them in COS-7 cells to confirm ligand binding. The human IL7R gene was subsequently mapped to chromosome 5p13 through in situ hybridization and hybrid cell panel analysis.^[8]^[9] In the early 1990s, the receptor's complexity was further elucidated with the identification of the common gamma chain (γc) as a critical subunit forming the functional heterodimer with IL-7Rα. Noguchi et al. in 1993 demonstrated that IL-2Rγ (now known as γc) is an essential component of the high-affinity IL-7 receptor, enhancing ligand binding and internalization, and its mutations underlie X-linked severe combined immunodeficiency.^[10] A pivotal clinical link emerged in 1998, when Puel et al. identified mutations in the IL7R gene as the cause of a distinct form of severe combined immunodeficiency (SCID) characterized by T⁻B⁺NK⁺ phenotype,^[11] affecting approximately 10% of SCID cases^[12] and highlighting the receptor's indispensable role in T-cell development. The receptor's nomenclature was formalized through the Human Leukocyte Differentiation Antigens (HLDA) workshops, with the IL-7Rα chain designated as CD127 during the series of international conferences beginning in 1982, standardizing its identification in leukocyte immunophenotyping.^[13] Advancements continued into 2025, with structural studies enabling the computational design of IL-7 superkines, such as Neo-7, which features enhanced folding efficiency and binding affinity to IL-7R through targeted loop remodeling and mutations like I45T, promising improved immunotherapeutic applications.^[14]

Structure

Receptor subunits

The interleukin-7 receptor (IL-7R) is composed of two subunits: the IL-7 receptor alpha chain (IL-7Rα, also known as CD127) and the common gamma chain (γc, also known as CD132 or IL-2Rγ).^[15] IL-7Rα is a type I transmembrane glycoprotein encoded by the IL7R gene located on chromosome 5p13, spanning approximately 23 kb with 8 exons.^[16]^[17]^[18] The full-length human IL-7Rα protein consists of 459 amino acids, including an extracellular domain with two fibronectin type III-like domains, a transmembrane domain of about 25 amino acids, and an intracellular signaling domain of approximately 195 amino acids.^[19]^[20] The extracellular region features a conserved WSXWS motif essential for proper protein folding and receptor maturation, while the cytoplasmic tail contains a Box 1 motif involved in Janus kinase (JAK) association.^[19] Due to N-linked glycosylation, the mature IL-7Rα migrates at approximately 60-70 kDa on SDS-PAGE, higher than its calculated mass of ~52 kDa.^[21]^[22] The γc subunit is a 369-amino-acid type I transmembrane protein encoded by the X-linked IL2RG gene at Xq13.1, which spans about 4.2 kb across 8 exons.^[23]^[24] Its structure includes an extracellular cytokine-binding domain with a WSXWS motif, a short transmembrane segment, and a cytoplasmic tail featuring Box 1 and Box 2 motifs that facilitate JAK3 binding and signal transduction.^[25]^[26] Glycosylation contributes to an apparent molecular weight of ~50-70 kDa for γc, compared to its unglycosylated mass of ~42 kDa.^[27]^[28] This subunit is shared among receptors for IL-2, IL-4, IL-9, IL-15, and IL-21, underscoring its role in multiple cytokine signaling pathways.^[15] The functional IL-7R assembles as a 1:1 heterodimer of IL-7Rα and γc on the cell surface, enabling ligand-specific signaling while leveraging the common γc for shared downstream activation.^[29]

Tertiary structure

The tertiary structure of the interleukin-7 (IL-7) receptor complex has been elucidated primarily through X-ray crystallography of its components, revealing key conformational features essential for ligand binding and assembly. The extracellular domain of the IL-7/IL-7Rα binary complex was resolved at 2.8 Å resolution in 2009, demonstrating a 1:1 stoichiometry where IL-7, a four-helix bundle cytokine, engages the IL-7Rα receptor chain via its helices A, C, and D. This high-affinity site 1 interface buries approximately 1,300 Å² of surface area, dominated by hydrophobic interactions and hydrogen bonds between IL-7's helix A-C loop and the cytokine-binding module of IL-7Rα.^[30] The unliganded IL-7Rα ectodomain structure, determined at 2.15 Å resolution in 2012, captures a homodimeric arrangement in the crystal lattice with asymmetric interfaces, suggesting a pre-liganded conformation poised for activation. In this model, the membrane-proximal fibronectin type III domain (D2) of one IL-7Rα chain rotates approximately 90° relative to its partner, facilitating IL-7 accommodation and subsequent recruitment of the common γ-chain (γc). The N-terminal immunoglobulin-like domain of IL-7Rα contributes to structural stability by shielding the core and modulating flexibility at the D1-D2 junction, distinct from other γc family receptors lacking this feature.^[31] Although no atomic-resolution structure of the full ternary IL-7/IL-7Rα/γc complex exists, homology modeling based on related γc cytokines (e.g., IL-2 and IL-21) indicates a functional 1:1:1 stoichiometry, where IL-7's low-affinity site 2 engages γc through helix F and the A-B loop, inducing further rotation and dimerization of the intracellular domains for signaling initiation. Crystal lattice contacts in the binary structure hint at potential 2:2 higher-order assemblies, but biophysical data support the 1:1:1 model as physiologically relevant, with the asymmetric dimer interfaces promoting efficient ternary formation upon ligand binding.^[31]^[30]

Expression and regulation

Cellular expression

The interleukin-7 receptor (IL-7R) is predominantly expressed on hematopoietic cells within the immune system, where it plays a key role in lymphoid development and maintenance. High levels of IL-7R are observed on naive and memory CD4⁺ and CD8⁺ T cells, double-negative (DN) thymocytes—particularly the DN2 stage—pro-B cells, and natural killer (NK) cells, including the CD56ᵇʳⁱᵍʰᵗ subset.^[32]^[2] Expression is notably lower on mature B cells, which often lack detectable surface IL-7R, as well as on dendritic cells, monocytes, and certain myeloid lineages such as neutrophils and eosinophils, where it supports limited homeostatic functions.^[2]^[32] To a lesser extent, IL-7R has been reported on some non-immune cells, including epithelial tumor cell lines derived from lung, colon, and breast tissues, though functional expression in normal non-hematopoietic cells remains limited.^[33] In terms of tissue distribution, IL-7R is primarily found in the thymus, bone marrow, and secondary lymphoid organs such as the spleen and lymph nodes, reflecting its central role in lymphoid priming and recirculation.^[32]^[2] Expression is minimal in non-lymphoid tissues, with sparse detection outside immune compartments. Quantitative assessments via flow cytometry indicate surface densities of approximately 30,000 to 50,000 IL-7R molecules per cell on various T cell subsets, varying by maturation state and activation.^[34] During development, IL-7R expression peaks in early stages of T- and B-cell ontogeny, such as on DN thymocytes and pro-B cells, to drive proliferation and survival, before declining on mature effector T cells as they differentiate and respond to antigens.^[32] This pattern ensures robust support for naive and memory lymphocyte pools while adapting to effector responses.^[2]

Regulation of expression

The expression of the IL7R gene is controlled at the transcriptional level through promoter elements responsive to key transcription factors. Foxp1 represses IL7R transcription by binding to the Il7r promoter and antagonizing the activating effects of Foxo1, thereby maintaining T cell quiescence and limiting IL-7 responsiveness. STAT5, activated downstream of IL-7 signaling, supports the transcriptional maintenance of IL7R expression in developing and mature lymphocytes, ensuring sustained receptor availability for homeostatic signals. Similarly, basal NF-κB activity in naïve T cells binds to the IL7R promoter to sustain surface IL-7Rα expression and IL-7 responsiveness in quiescent states. In contrast, TCR signaling during T cell activation induces Blimp-1, which represses IL7R transcription in effector T cells, promoting a shift toward IL7R^low phenotypes associated with terminal differentiation. Post-translational mechanisms further fine-tune IL-7R surface levels. Upon IL-7 ligand binding, the receptor undergoes rapid clathrin-mediated endocytosis, leading to internalization, JAK3-dependent signaling, and lysosomal degradation, which attenuates prolonged activation. The soluble isoform of IL-7Rα (sIL-7Rα) is predominantly generated via alternative mRNA splicing that skips exon 6, yielding a secreted form lacking the transmembrane domain; this acts as a decoy receptor that binds IL-7 and limits its bioavailability to membrane-bound receptors. Although proteolytic shedding contributes modestly to sIL-7Rα production in activated T cells, it is not the primary mechanism. Environmental factors dynamically influence IL-7R expression as part of homeostatic and inflammatory responses. IL-7 availability inversely regulates surface IL-7R expression through negative feedback, where elevated IL-7 levels suppress IL7Rα transcription to conserve cytokine for naïve or lymphopenic cells. During inflammation, IFN-γ upregulates IL-7R expression on T cells and myeloid cells, enhancing IL-7 responsiveness and amplifying Th1-mediated immune activation. Genetic variants in the IL7R gene modulate expression and splicing efficiency. The single nucleotide polymorphism rs6897932 (located in exon 6) promotes alternative splicing toward the soluble isoform, increasing sIL-7Rα production and reducing membrane-bound IL-7R levels, which confers susceptibility to autoimmune diseases like multiple sclerosis through epistatic interactions with other loci. Circulating sIL-7Rα levels in healthy individuals typically range from 10 to 100 ng/mL in serum, with variations reflecting immune status; these levels modulate IL-7 bioavailability by sequestering the ligand and preventing excessive signaling.

Signaling mechanism

Ligand binding and activation

The binding of interleukin-7 (IL-7) to its receptor occurs through a stepwise mechanism, initiating with interaction between IL-7 and the IL-7Rα subunit, which exhibits low-to-moderate affinity with a dissociation constant (Kd) of approximately 60 nM.^[35] This initial binding is followed by recruitment of the common γc subunit, forming a high-affinity ternary complex with a Kd of about 50 pM, which is essential for stable receptor assembly and signal initiation.^[36] The process is characterized by rapid kinetics, with an association rate constant (k_on) for IL-7 binding to glycosylated IL-7Rα reaching around 1.5 × 10^6 M^{-1} s^{-1}, primarily driven by enhanced on-rates facilitated by receptor glycosylation.^[35] Equilibrium binding studies, such as those employing Scatchard analysis, have demonstrated curvilinear plots for IL-7 binding to cells expressing the receptor, reflecting the coexistence of high- and low-affinity sites corresponding to the binary (IL-7/IL-7Rα) and ternary (IL-7/IL-7Rα/γc) complexes, respectively.^[36] This analysis qualitatively illustrates the cooperative nature of subunit assembly, where the γc subunit stabilizes the complex without direct initial binding to IL-7 alone, thereby shifting the equilibrium toward the high-affinity state.^[36] Glycosylation on IL-7Rα further enhances affinity by up to 300-fold compared to unglycosylated forms, primarily through accelerated association rather than altered off-rates.^[35] Ligand-induced activation proceeds via dimerization of the receptor subunits, where IL-7 binding triggers a conformational reorganization, including a approximately 90° rotation in the IL-7Rα homodimer, that repositions the cytoplasmic domains from over 100 Å apart in the inactive state to less than 30 Å in the active complex.^[31] This spatial approximation enables the associated Janus kinase (JAK) molecules to interact and initiate downstream signaling.^[31] Key residues on IL-7, including Arg133, His136, Glu137, Lys139, and Thr140 in helix D, contribute to the interface with γc, burying significant surface area and forming hydrogen bonds critical for complex stability.^[35] Additionally, a conformational shift in the membrane-proximal stalk region of IL-7Rα, influenced by O-glycosylation at Ser133 and adjustments in loop L5, optimizes the geometry for γc recruitment and overall ternary assembly.^[31] Post-binding, the activated receptor complex undergoes rapid clathrin-mediated endocytosis, with surface IL-7Rα levels decreasing by about 20% within 5 minutes and 30% within 15 minutes of IL-7 stimulation, corresponding to an internalization half-life of roughly 10 minutes.^[37] This process is integral to regulating receptor availability and preventing prolonged signaling, while the overall receptor half-life shortens from 24 hours in unstimulated cells to approximately 3 hours following ligand engagement.^[37]

Intracellular signaling pathways

Upon binding of interleukin-7 (IL-7) to its receptor, the intracellular domain of the IL-7 receptor α chain (IL-7Rα) associates with Janus kinase 1 (JAK1) via a membrane-proximal Box 1 motif, while the common γ chain (γc) recruits JAK3 through its Box 1 region.^[38] This dimerization induces trans-phosphorylation and activation of JAK1 and JAK3, which in turn phosphorylate tyrosine residues on the cytoplasmic tails of IL-7Rα and γc, creating docking sites for downstream effectors.^[39] The primary pathway activated is JAK-STAT, where signal transducer and activator of transcription 5 (STAT5) isoforms a and b bind to these phosphotyrosines via their SH2 domains and become phosphorylated at tyrosine 694 (Tyr694), enabling STAT5 dimerization, nuclear translocation, and transcription of genes such as Bcl2 (promoting survival) and Ccnd2 (encoding cyclin D2 for proliferation).^[40]^[41] A parallel pathway involves recruitment of insulin receptor substrate (IRS)-1 and IRS-2 to phosphotyrosines on IL-7Rα, activating phosphatidylinositol 3-kinase (PI3K).^[40] PI3K generates phosphatidylinositol (3,4,5)-trisphosphate (PIP3), which recruits and activates Akt (protein kinase B) at the plasma membrane; activated Akt then phosphorylates and inactivates Forkhead box O1 (Foxo1), suppressing pro-apoptotic genes while promoting metabolic reprogramming for cell survival and growth via the mTOR complex.^[40] This pathway enhances glucose uptake and anabolic processes essential for lymphocyte expansion.^[40] The mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinase (ERK) pathway is initiated through adapter proteins like Shc, which bind to phosphotyrosines on IL-7Rα, recruiting growth factor receptor-bound protein 2 (Grb2) and son of sevenless (SOS) to activate Ras.^[40] This leads to sequential phosphorylation of Raf, MEK, and ERK1/2, culminating in ERK nuclear translocation and induction of proliferation-associated genes.^[40] Negative regulation prevents excessive signaling: suppressors of cytokine signaling (SOCS) proteins, particularly SOCS1 and SOCS3, are transcriptionally induced by STAT5 and inhibit JAK activity either by direct binding to the kinase inhibitory region or by targeting the receptor complex for ubiquitination and degradation.^[40] Additionally, protein tyrosine phosphatase non-receptor type 6 (PTPN6, also known as SHP-1) dephosphorylates STAT5 at Tyr694, attenuating the JAK-STAT cascade.^[41] IL-7R signaling integrates with T cell receptor (TCR) pathways to amplify T cell responses; for instance, IL-7 priming enhances TCR-induced ERK activation and IL-2 production by modulating cytoskeletal dynamics and adapter recruitment, while TCR stimulation can reciprocally downregulate IL-7R surface expression to balance homeostasis.^[42]

Physiological functions

Role in lymphocyte development

The interleukin-7 receptor (IL-7R) is essential for T-cell development in the thymus, where it supports the survival of double-negative (DN2 and DN3) thymocytes through signaling that promotes anti-apoptotic pathways and cell cycle progression.^[43] During β-selection, IL-7R coordinates with pre-TCR signaling to drive proliferation and differentiation of these progenitors, enabling successful TCRβ rearrangement.^[44] This process is non-redundant, as evidenced by IL-7Rα knockout mice, which exhibit severe arrest of T-cell development at early DN stages due to impaired expansion and increased apoptosis. In humans, IL7RA mutations causing severe combined immunodeficiency (SCID) similarly block T lymphopoiesis at immature stages, confirming the receptor's indispensable role.^[45] In B-cell development, IL-7R facilitates the transition from pro-B to pre-B cells in the bone marrow by providing survival and proliferative signals that sustain progenitor viability during heavy-chain rearrangement.^[46] IL-7R signaling cooperates with IL-7 to enhance V(D)J recombination at immunoglobulin loci, promoting diverse antibody gene usage and progression through developmental checkpoints.^[47] As with T cells, IL-7R deficiency in mice leads to early arrest at the pro-B stage, underscoring its non-redundant function in B lymphopoiesis. IL-7R also contributes to natural killer (NK) cell maturation by promoting the survival and differentiation of early NK progenitors in the bone marrow and secondary lymphoid tissues such as lymph nodes.^[48] These progenitors, marked by IL-7Rα expression, rely on the receptor for initial expansion before transitioning to IL-15-dependent stages. IL-7R also supports the development of other innate lymphoid cells (ILCs), such as ILC2 and ILC3, which express IL-7Rα and depend on IL-7 for differentiation and maintenance in mucosal and lymphoid tissues.^[49] In vitro studies demonstrate that IL-7 is sufficient to sustain progenitor development and proliferation across these lineages, highlighting the receptor's quantitative role in ontogeny. IL-7R primarily signals through STAT5 to mediate these survival effects during lymphocyte ontogeny.^[50]

Role in immune homeostasis

The interleukin-7 receptor (IL-7R) plays a pivotal role in maintaining T-cell homeostasis by promoting the survival of naive and memory CD8+ T cells through upregulation of anti-apoptotic proteins such as Bcl-2.^[50] This signaling prevents apoptosis in these populations under steady-state conditions, ensuring a stable peripheral T-cell pool essential for immune surveillance.^[51] Additionally, IL-7R controls homeostatic proliferation of naive T cells in lymphopenic environments, where reduced lymphocyte numbers trigger IL-7-dependent expansion to restore compartment size without antigen stimulation.^[52] In B-cell maintenance, IL-7R supports the survival of peripheral memory B cells and long-lived plasma cells indirectly by inducing BAFF expression on T cells, which in turn provides survival signals to these mature B-cell subsets.^[53] This mechanism contributes to the persistence of humoral immunity in the periphery, allowing sustained antibody production from long-lived plasma cells.^[50] IL-7R signaling integrates into adaptive immune responses by enhancing effector T-cell expansion during acute infections, where it synergizes with T-cell receptor stimulation to amplify clonal proliferation.^[54] In chronic infection settings, IL-7R activation limits T-cell exhaustion by boosting effector functions, reducing regulatory T-cell suppression, and promoting viral control while minimizing tissue pathology.^[55] A key regulatory feature of IL-7R-mediated homeostasis involves feedback loops in lymphoid tissues, where IL-7 consumption by responding lymphocytes signals stromal cells to adjust production, thereby maintaining cytokine availability and preventing overexpansion.^[56] This consumption-driven regulation ensures balanced stromal IL-7 output in secondary lymphoid organs. Animal models demonstrate the critical nature of IL-7R in memory T-cell persistence; blockade of IL-7R significantly reduces the long-term maintenance of antigen-specific memory CD8+ T cells, blunting their expansion and survival in chronic response scenarios.^[57]

Clinical significance

Genetic mutations and immunodeficiencies

Mutations in the IL7R gene, which encodes the alpha chain (IL-7Rα or CD127) of the interleukin-7 receptor, cause autosomal recessive severe combined immunodeficiency (SCID) of the T^-B⁺NK⁺ phenotype. Hypomorphic mutations in IL7R can also lead to Omenn syndrome, characterized by generalized erythroderma, hepatosplenomegaly, and elevated IgE levels due to partial T-cell development.^[1] This form accounts for approximately 10% of all SCID cases. Common mutations include nonsense, frameshift, and splice-site variants that abolish IL-7Rα expression or function, thereby blocking IL-7 signaling essential for T-cell development and resulting in profound T-cell lymphopenia while sparing B and natural killer (NK) cell numbers.^[58]^[59]^[60] In contrast, mutations in the IL2RG gene, encoding the common gamma chain (γc) shared by the IL-7 receptor and receptors for several other cytokines (IL-2, IL-4, IL-9, IL-15, and IL-21), lead to X-linked SCID (X-SCID) with a T^-B⁺NK^- phenotype. These mutations, inherited in an X-linked recessive manner and primarily affecting males, represent about 50% of SCID cases and disrupt multiple cytokine pathways, including IL-7 signaling, causing absent or severely reduced T and NK cells alongside nonfunctional B cells.^[61]^[60] Clinically, both IL7R- and IL2RG-related SCIDs present in infancy with recurrent severe infections (bacterial, viral, fungal, and opportunistic such as Pneumocystis jirovecii pneumonia), failure to thrive, chronic diarrhea, and oral thrush; radiographic findings often include an absent thymic shadow. Diagnosis involves newborn screening detecting low T-cell receptor excision circles (TRECs), flow cytometry revealing absent T cells and, for IL7R defects, low CD127 expression on remaining lymphocytes, followed by targeted genetic sequencing of IL7R or IL2RG to confirm biallelic or hemizygous pathogenic variants.^[59]^[61]^[60] Hematopoietic stem cell transplantation (HSCT) is the standard curative treatment for both forms, achieving greater than 90% long-term survival when performed early before overwhelming infections; patients with IL7R-specific defects typically exhibit improved post-transplant B-cell function compared to those with IL2RG mutations due to preserved intrinsic B- and NK-cell development. Overall SCID prevalence is approximately 1 in 50,000 to 58,000 live births.^[60]^[61]^[62]

Associations with autoimmune diseases

Single nucleotide polymorphisms (SNPs) in the IL7R gene, particularly rs6897932, have been implicated in susceptibility to several autoimmune diseases. The rs6897932 T allele is associated with an increased risk of multiple sclerosis (MS), with meta-analyses reporting an odds ratio (OR) of approximately 1.18 (95% CI 1.11–1.26).^[63] This SNP has also shown associations with rheumatoid arthritis (RA) and type 1 diabetes (T1D), where it influences disease risk through genetic variation in IL-7 signaling.^[64] Similarly, rs6897932 is linked to higher susceptibility to sarcoidosis and inflammatory bowel disease (IBD), including ulcerative colitis, in genome-wide association studies (GWAS).^[65] The primary mechanism underlying these associations involves altered splicing of IL7R mRNA caused by rs6897932, which reduces production of soluble IL-7Rα (sIL-7Rα) and increases membrane-bound IL-7Rα expression. This shift enhances IL-7 signaling, promoting T-cell survival via anti-apoptotic pathways (e.g., BCL-2 and MCL-1 upregulation) and expansion of autoreactive T-cell clones, particularly Th1 and Th17 subsets that drive inflammation.^[65] In contrast, sIL-7Rα typically modulates IL-7 bioavailability by sequestering the ligand, and its dysregulation contributes to excessive immune activation in autoimmunity.^[66] In MS, IL-7R-expressing T cells are prominent among those infiltrating the central nervous system (CNS), contributing to demyelination and neuroinflammation.^[67] Experimental models of MS, such as experimental autoimmune encephalomyelitis (EAE), demonstrate that IL-7R blockade reduces disease severity by limiting Th17 responses and CNS infiltration.^[68] Meta-analyses of GWAS data from European cohorts up to 2023 confirm these IL7R hits, with consistent replication across large-scale studies involving thousands of cases.^[64] Serum sIL-7Rα levels serve as a potential biomarker in autoimmune diseases, notably correlating with disease activity in primary Sjögren's syndrome (pSS), where elevated concentrations (median 610 pMol/mL vs. 294 pMol/mL in controls) align with higher ESSDAI scores.^[69]

Role in cancer

The interleukin-7 receptor (IL-7R), composed of the IL-7Rα (CD127) and common γ-chain subunits, plays a significant pro-tumorigenic role in various malignancies through its overexpression and dysregulated signaling. In T-cell acute lymphoblastic leukemia (T-ALL), IL-7R expression occurs in approximately 70% of cases, often driven by gain-of-function mutations in about 30% of patients, which support leukemic cell survival and expansion.^[70] Similarly, in B-cell acute lymphoblastic leukemia (B-ALL), clonal IL7R mutations are present in a subset of cases, initiating pre-leukemic states and promoting disease progression via autocrine signaling loops where stromal cells produce IL-7 to stimulate tumor cells.^[71] In chronic lymphocytic leukemia (CLL), IL-7 signaling deregulation contributes to B-cell accumulation, with IL-7 stimulation enhancing leukemic cell viability.^[72] IL-7R signaling drives oncogenesis primarily through activation of the JAK/STAT5 pathway, which upregulates anti-apoptotic proteins like Bcl-2 to enhance tumor cell survival and promotes proliferation via Cyclin D induction.^[73] In hematological cancers such as T-ALL, this leads to chemotherapy resistance and leukemia-initiating cell activity, where IL-7R-positive cells exhibit stem-like properties essential for disease maintenance.^[74] In solid tumors, including breast cancer, IL-7R overexpression correlates with increased metastasis; IL-7 binding activates PI3K/AKT and Ras/ERK pathways, fostering invasion and migration through matrix metalloproteinase upregulation.^[75] For instance, in prostate and lung cancers, IL-7/IL-7R engagement similarly boosts tumorigenic potential via NF-κB-mediated inflammation.^[76] Tumors exploit IL-7R signaling for immune evasion, notably through production of soluble IL-7Rα (sIL-7Rα), which sequesters IL-7 in the microenvironment and limits its availability to anti-tumor T cells, thereby impairing cytotoxic responses.^[77] Conversely, high IL-7R expression on tumor-infiltrating lymphocytes (TILs) enhances CD8+ T-cell persistence and function, predicting improved prognosis in lung adenocarcinoma where it correlates with better overall survival.^[73] Supporting evidence from preclinical models underscores IL-7R's oncogenic necessity; in mouse xenografts of T-ALL, IL-7R blockade reduces leukemic burden, while activating mutations suffice to induce B-ALL, implying that IL-7R deficiency would diminish lymphoma incidence by curtailing lymphoid transformation.^[78] Recent studies, including 2024 analyses, link IL7R alterations to adverse outcomes in related leukemias like AML, with parallels in CLL where pathway hyperactivity portends poorer progression-free survival.^[79] Prognostically, CD127+ tumor cells in T-ALL confer chemoresistance, as these subsets persist post-treatment and drive relapse in steroid- and chemotherapy-refractory models.^[80]

Therapeutic applications

IL-7 agonists

Recombinant human interleukin-7 (rhIL-7), marketed as CYT107, is a glycosylated variant engineered to mimic native IL-7 and enhance receptor signaling for therapeutic immune boosting. Investigated in clinical trials since the early 2000s, including phase I/II studies initiated around 2009, CYT107 has demonstrated efficacy in expanding T cell populations in lymphopenic conditions such as HIV infection and sepsis. Administered subcutaneously at doses of 10-20 μg/kg weekly for up to three cycles, it selectively promotes proliferation of CD4+ and CD8+ T cells, achieving 3- to 4-fold increases in absolute lymphocyte counts without significant off-target effects on other immune subsets.^[81]^[82]^[83] Advanced IL-7 agonists include superkines and long-acting fusions designed to augment binding affinity and duration of action, thereby reducing required doses and improving clinical utility. The computationally designed superkine Neo-7, developed in 2025, features mutations that enhance folding stability and receptor binding compared to wild-type IL-7, enabling more potent T cell stimulation in preclinical models. Similarly, rhIL-7-hyFc, a fusion of rhIL-7 with a hybrid IgG4/IgD Fc domain, exhibits prolonged pharmacokinetics and has been applied to bolster chimeric antigen receptor (CAR)-T cell therapies by increasing engineered T cell expansion, persistence, and anti-tumor cytotoxicity in solid tumor models. These variants can achieve up to several-fold higher affinity for the IL-7 receptor α chain, supporting lower dosing regimens while maintaining specificity.^[14]^[84]^[85]^[4] In cancer immunotherapy, IL-7 agonists enhance adoptive cell therapies by amplifying tumor-reactive T cell responses. Phase II trials, such as one combining CYT107 with atezolizumab in locally advanced or metastatic urothelial carcinoma, reported improved T cell infiltration and response rates comparable to checkpoint inhibition alone, with evidence of boosted tumor-infiltrating lymphocytes (TILs). Preclinical data and early-phase studies in melanoma suggest similar benefits, where IL-7 supplementation during TIL expansion increases naive and memory T cell yields, potentially improving durable anti-tumor immunity. Following hematopoietic stem cell transplantation (HSCT), rhIL-7 accelerates naive T cell reconstitution, with clinical and experimental data showing 2- to 3-fold elevations in recent thymic emigrants and overall peripheral T cell numbers, aiding immune recovery without promoting graft-versus-host disease.^[86]^[87]^[88]^[89] Safety data from trials involving over 650 patients indicate that IL-7 agonists induce predictable, self-limiting effects including transient lymphocytosis peaking 7-14 days post-dose and mild cytokine release, typically resolving without intervention. No cases of autoimmunity or severe adverse events linked to excessive immune activation have been reported through 2025, supporting their tolerability in lymphopenic and oncology settings. Administration is primarily subcutaneous for optimal bioavailability, with CYT107 exhibiting a plasma half-life of 9-35 hours due to glycosylation-mediated stabilization; Fc-fused variants like rhIL-7-hyFc extend this to approximately 20-140 hours, facilitating less frequent dosing.^[90]^[91]^[86]^[14]

IL-7R antagonists

IL-7R antagonists are therapeutic agents, primarily monoclonal antibodies targeting the IL-7 receptor alpha chain (CD127), designed to block IL-7 signaling and thereby modulate T-cell responses. By inhibiting IL-7-dependent proliferation, survival, and homeostasis of T cells, these antagonists aim to suppress pathogenic immune activity in conditions such as autoimmune diseases, chronic inflammation, transplant rejection, and certain leukemias where IL-7R signaling promotes disease progression. Unlike partial agonists or incomplete blockers, full antagonists prevent both IL-7 binding and receptor heterodimerization, avoiding unintended activation of downstream pathways like PI3K or ERK.^[92] In preclinical models of chronic inflammation, a site-1 + site-2b anti-IL-7Rα monoclonal antibody demonstrated potent suppression of antigen-specific memory T-cell responses without inducing lymphopenia or broadly impairing T-cell homeostasis. Administered as a single dose in cynomolgus monkeys with antigen-induced skin inflammation, it neutralized IFN-γ-producing memory T cells, achieving long-term control of inflammation for up to one year by blocking JAK/STAT signaling while preserving naive T cells and regulatory T cells (Tregs). This selective targeting of memory T cells highlights potential for preventing relapses in immune-mediated inflammatory diseases (IMIDs).^[92] For cancer therapy, particularly acute lymphoblastic leukemia (ALL), IL-7R antagonists exploit IL-7R overexpression on leukemic blasts to inhibit survival signals and induce effector functions. The fully human anti-IL-7Rα antibody B12 blocks IL-7-dependent and mutant IL-7R signaling in T-ALL cells, promoting apoptosis, enhancing antibody-dependent cellular cytotoxicity (ADCC) via natural killer cells, and overcoming drug resistance to agents like dexamethasone. In patient-derived xenograft (PDX) models of T-ALL in immunodeficient mice, B12 reduced leukemic burden in blood and bone marrow, extending median survival from 16 to 21 days. Similarly, lusvertikimab (LUSV), a humanized IgG4 anti-CD127 antibody, exhibits efficacy in both B-cell precursor (BCP)-ALL and T-ALL PDX models by blocking signaling and inducing antibody-dependent cellular phagocytosis (ADCP), with over 50% minimal residual disease (MRD) negativity when combined with polychemotherapy in CD127-high relapsed/refractory ALL PDX models. These findings support IL-7R blockade as a strategy for high-risk ALL, potentially integrated with standard chemotherapy.^[93]^[78] Clinically, several anti-IL-7R antibodies have advanced to human trials, primarily for autoimmune indications. GSK2618960, an anti-IL-7Rα monoclonal antibody, was well-tolerated in a phase I trial in healthy volunteers at doses up to 2.0 mg/kg, achieving >95% receptor occupancy and maximal inhibition of IL-7-induced STAT5 phosphorylation for up to 22 days, with elevated circulating IL-7 levels but no significant changes in immune cell counts or cytokines. Development was halted due to strategic reasons, though it informed subsequent IL-7 pathway inhibitors for rheumatoid arthritis. RN168, a humanized anti-IL-7R antibody, selectively depleted memory T cells while sparing naive T cells and Tregs in a phase I trial in type 1 diabetes patients at 1–3 mg/kg doses, suggesting utility in autoreactive T-cell-driven autoimmunity. Lusvertikimab, safe in a phase I trial in healthy volunteers, demonstrated positive results in a phase II trial (CoTikiS) for moderate to severe ulcerative colitis, announced in November 2024, with clinical response rates of 30% versus 12% for placebo at week 10 (p=0.017), endoscopic improvement in 32% versus 12% (p=0.013), and a favorable safety profile with no new signals; it is also in phase II for Sjögren's syndrome, where it reduces pathogenic T-cell activity. In transplantation, anti-CD127 blockade combined with immunosuppression failed to extend graft survival in nonhuman primate kidney models, indicating limited efficacy due to species-specific differences in IL-7 dependence. Overall, these antagonists underscore a promising but targeted role in T-cell-centric pathologies, with ongoing trials refining their clinical niche.^[94]^[95]^[78]^[96]^[97]

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