Engagement of both adhesion and activating receptors lead to recruitment and phosphorylation of Vav1, a guanine exchange factor [
53]. Vav1 ultimately regulates actin cytoskeleton rearrangement for polarization of granules and activation receptor clustering [
39]. Phosphorylation of Vav1 ultimately leads to phosphorylation of phospholipase C-γ (PLCγ) following LFA-1 and/or NKG2D engagement (). Phosphorylated PLCγ in turn hydrolyzes phosphatidylinositol 4, 5 bisphosphate (PIP
2) to inositol 1, 4, 5 trisphosphate (IP
3) and diacylglycerol (DAG) [
54,
55]. DAG recruits mammalian uncoordinated (Munc) 13-4, an essential component of the vesicle fusion complex crucial for regulated degranulation, to the plasma membrane [
56]. Vesicle fusion to the plasma membrane is further facilitated by Rab27a, a Rab GTPase. Rab27a is recruited to the cell surface after LFA-1 engagement allowing for the granules to dock with Munc 13-4 at the plasma membrane [
57]. IP
3 binds to inositol trisphosphate receptor on the endoplasmic reticulum membrane and opens a calcium channel resulting in the release of calcium into the cytoplasm [
58]. Calcium is necessary for the final fusion between the cytolytic granule and plasma membrane [
59].
The amount of Vav1 phosphorylation induced by integrins and activating receptor(s) is insufficient to lead to degranulation. However, there may be a sufficient amount of phosphorylated Vav1 to lead to granule polarization and immunological synapse formation. This is because Vav1 is negatively regulated by the ubiquitin ligase c-Cbl. c-Cbl is induced upon engagement of an activating receptor (e.g., NKG2D), to dampen NK cell cytotoxicity, which in turn, leads to Vav1’s ubiquitination and proteosomal degradation. The loss of Vav1 decreases the levels of phosphorylated PLCγ and prevents NK cell degranulation [
55]. To overcome the effects of c-Cbl’s inhibition of Vav1, NK cells require concomitant engagement of activating and co-activating receptors [
55].
Co-activation receptors include the CD2 family of activating receptors (e.g., 2B4, CRACC, NTB-A) (See for list of caNKR) [
60–
62]. The CD2 family of receptors associates with signaling lymphocyte activation molecule (SLAM)-associated protein (SAP) to induce cellular cytotoxicity [
63–
65]. When these receptors bind their respective ligands, tyrosine residues in the cytoplasmic tail become phosphorylated allowing for the recruitment of SAP. SAP binds to the tyrosine kinase, Fyn, through an arginine at position 78 in its SH2 domain [
66,
67]. Once bound to SAP, Fyn phosphorylates both the SLAM-family receptor as well as molecules such as PLCγ to induce the NK cell to degranulate [
68]. More importantly, degranulation of resting NK cells requires at least a specific pair of activating and/or co-activating receptors to be engaged. Such pairs include NKG2D and NKp46, NKp46 and DNAM-1, and 2B4 and DNAM-1. However, combinations such as NKG2D and DNAM-1 do not result in NK cell degranulation [
42].
| Table 2Natural Killer Cell co-Activation Receptors. |