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Patent Granted Activation of CD4+ T cells occurs through the simultaneous engagement of the T cell receptor and a costimulatory molecule (like CD28, or ICOS) on the T cell by the major histocompatibility complex (MHCII) peptide and costimulatory molecules on the APC. Both are required for production of an effective immune response; in the absence of costimulation, T-cell receptor signalling alone results in anergy.