Long-term survival of cardiac transplant recipients continues to be severely limited by the development of a pathological, chronic rejection process, termed allograft vasculopathy (AV). This remains to be the case despite dramatic improvements in the areas of surgical techniques, pre- and post-operative care, and immunosuppression. To model the clinical setting we used calcineurin inhibitor (CNI) immunosuppression, the cornerstone of post-transplant immunosuppression, in a murine aortic interposition transplant model for our analysis of AV development. This model mimics the presentation of AV in human cardiac transplants through the development of a progressively occlusive neointimal lesion. Our previous work in this model has demonstrated that CD8+, but not CD4+, T cells play a role in neointimal lesion formation. Further investigation also highlighted a specific requirement for either CD8+ T cell-derived IFN-γ or direct cytotoxicity in the development of lesion formation. In the current study we confirmed that CD8+ T cell-derived IFN-γ also leads to the loss of medial smooth muscle cells, an event which inversely correlates with lesion formation. The Fas/FasL direct cytotoxic pathway was also significantly involved in neointimal lesion formation and medial remodeling. This work clarified the pathways utilized by CD8+ T cells in their role as mediators of AV development. Recognizing the threat that CD8+ T cells pose to cardiac transplant recipients in the presence of CNI immunosuppression, and a growing concern with the presence of anti-donor memory T cells in transplant recipients, we next explored the development of memory CD8+ T cells in the presence of CNI immunosuppression. We first established that memory CD8+ T cells could not develop when CNI immunosuppression was initiated immediately post-challenge. Next, we hypothesized that the clinical practice of CNI delay post-transplant would permit the development of de novo memory CD8+ T cells. Immediate and early initiation was sufficient to prevent the development of de novo memory CD8+ T cells. However, later delay to within a clinically practiced timeframe did permit the development of de novo memory CD8+ T cells. Our analysis revealed that this population demonstrated equivalent functionality to de novo memory CD8+ T cells generated in the absence of CNI immunosuppression.

Human cytomegalovirus (HCMV) is a β-herpesvirus that establishes a life-long presence in the infected host. The adaptive immune response is indispensable in controlling HCMV infection. Consequently, healthy individuals show no or mild symptoms following primary infection. In contrast, immunocompromised individuals who develop primary infection or recrudescence of HCMV can experience severe morbidity, and sometimes mortality. HCMV-specific T cell populations undergo changes in the architecture of their T cell receptor (TCR) repertoire following each episode of viral reactivation. A diverse TCR repertoire is thought to be required to provide the most efficient protection against virus infection. Perturbation to this repertoire, as can occur in immunocompromised individuals following transplantation, can lead to an increase risk of developing virus-associated clinical disease. Therefore, the study of factors influencing TCR selection is critically important in both healthy and immunocompromised individuals. To further understand the factors governing TCR selection in a persistent virus infection, the current thesis examined this process in different settings. CD8+ T cell responses to persistent viral infections are characterised by the accumulation of T cells exhibiting an oligoclonal T cell repertoire, with a parallel reduction in the naïve T cell pool. However, the precise mechanism for this phenomenon remains elusive. Here, we showed that HCMV-specific CD8+ T cells recognising distinct epitopes from the pp65 protein and restricted through an identical HLA class I allele (HLA B*3508) exhibited either a highly conserved public T cell repertoire, or a private, diverse T cell response, which was uniquely altered in each donor following in vitro antigen exposure. Selection of a public TCR was co-incident with an atypical peptide-MHC (pMHC) structure, whereby the epitope adopted a helical conformation that bulged from the peptide-binding groove, whilst a diverse TCR profile was observed in response to the epitope that formed a flatter, more ‘featureless’ landscape. Clonotypes with biased TCR usage demonstrated more efficient recognition of virus-infected cells, a greater CD8 dependency, and were more terminally differentiated in their phenotype when compared to the T cells expressing diverse TCR. These findings provide new insights into our understanding of how the biology of antigen presentation, in addition to the structural features of the pMHC, might shape the T cell phenotype and its corresponding repertoire architecture. Next, the role of HCMV in shaping the global and antigen-specific TCR repertoire in healthy donors was examined. First, exposure to HCMV led to an inflation of terminally differentiated CD57-expressing T cells. This effect was not seen in HCMV seronegative individuals who showed evidence of exposure to another persistent herpesvirus, Epstein-Barr virus (EBV). More importantly, these terminally differentiated CD8+ T cells in HCMV-exposed individuals displayed a highly skewed architecture of their peripheral blood T cell repertoire, with large monoclonal/oligoclonal expansions. However, ex vivo analyses of HCMV-specific T cells revealed a heterogeneous pattern of CD57 expression that showed no correlation to the antigenic source of its cognate epitope. Based on these observations, we proposed that exposure to HCMV drives the differentiation of not only the global T cell population, but select HCMV-specific T cell populations as well, and that expression of CD57 by these cells was co-incident with an oligoclonal T cell repertoire. Finally, the TCR repertoire was examined in a cohort of solid organ transplant (SOT) recipients, where primary infection or recrudescence of latent virus infection can be manifested either as asymptomatic or symptomatic disease. We examined 18 SOT recipients, and observed that symptomatic HCMV or EBV infection or recrudescence following solid organ transplantation was co-incident with a dramatic skewing of the TCR repertoire, with expansions of monoclonal/oligoclonal clonotypes. As the clinical symptoms resolved, the peripheral blood repertoire reverted to a more diverse distribution. In contrast, SOT recipients with asymptomatic or no HCMV/EBV infection or recrudescence showed minimal or no skewing of the TCR repertoire, and maintained TCR repertoire diversity. Interestingly, this disparate repertoire showed no correlation with levels of viral load in the peripheral blood. More importantly, we showed that large monoclonal/oligoclonal repertoire expansions was linked to the loss of antigen-specific T cell function observed in SOT patients undergoing symptomatic viral infection or recrudescence, while SOT recipients who maintained peripheral blood TCR repertoire diversity and functional antigen-specific T cell responses could resist clinical symptomatic disease in spite of high levels of viral load. Therefore, the work presented in this thesis provides additional evidence on the factors governing TCR selection in HCMV-exposed healthy individuals, as well as the consequences that perturbation to the TCR repertoire has on the functionality of the T cell compartment in immunocompromised individuals.

Title page, table of contents and summary only. The complete thesis in print form is available from the University of Adelaide Library. / Herpes simplex virus type I (HSV-I) produces acute muco-cutaneous infections, followed by spread to sensory nerve ganglia, and establishment of latency. In the peripheral nervous system, primary sensory neurons, which are found in dorsal root ganglia of the of the spinal nerves, are the target for HSV and they may undergo either productive or latent intection. Productive infection of sensory neurons generates the potential for lethal spread of virus through the nervous system but in immunocom petent hosts, viral replication is terminated by limely development of an adaptive immune response. The infection of dorsal root ganglia that follows cutaneous inoculation of the flanks of mice with HSV provides a well-characterized model of peripheral nervous system infection. The mechanisms responsible for clearance of HSV are complex. At mucosal and cutaneous sites, local innate immune mechanisms act to interrupt the initial spread of virus to the nervous system, while adaptive immunity is important in limiting replication in the ganglia and extension of the virus to adjacent dennatomes. Thus actions of both the innate and the adaptive immune systems are vital in defence against replicating HSV-1, while it is thought that latent infection in the ganglia is contained by the surveillance of the adaptive immune system. Natural killer T (NKT) cells are a conserved subpopulation of lymphocytes that recognize glycolipid antigens presented by the invariant MHC class I-like molecule CD1d. Upon activation through their semi-invariant T cell receptor, these cells rapidly release large amounts of immuno-modulating Th1 and Th2 cytokines. NKT cells have, therefore, been implicated in immune responses controlling various diseases, including infection, cancer, and autoimmunity, as well as having an involvement in allo-graft survival. Consideration of the important contributions of innate and adaptive immunity to clearance of HSV prompted this investigation of the role of CD1d and of CD1d-restricted NKT cells in the pathogenesis of HSV infection. The first part of this thesis (Chapter 3 and 4) describes investigations into the role of NKT cells in immunity to HSV-1, using a zosteriform model of infection and two gene knockout strains of C57BL/6 mice. CD1d GKO and Ja18 GKO mice, which are deficient in NKT cells, are compromised in controlling HSV-1 as evidenced by mortality, virus loads in skin and dorsal root ganglia, presence and size of skin lesions, persistence of HSV antigen, neuronal damage and extent of latency. Comparisons between wild type (NKT cell replete), Ja18 GKO (deficient in invariant Va14⁺ NKT cells) and CD1d GKO (deficient in all CD1d-dependant NKT cells) mice allowed assessment of CD1d-dependant NKT cell subsets in defence against the virus at various stages of infection. It was concluded that both subsets play important roles in controlling the virus and in preventing lethal neuro-invasive disease, that both are vital adjuncts to the adaptive immune response and that without them, low doses of neuropathogenic HSV-1 can establish quickly and cause fatal infections. The NKT-cell population appears to be quite dynamic in its response to a range of pathogens and other disease processes. The study described in Chapter 5 presents evidence suggesting that the response of NKT cells during HSV infection is no less dynamic. In the axillary lymph nodes, observations on numbers of cells expressing NK1.1 antigen and the invariant TCR suggest that NKT cells are activated in the regional lymph nodes draining the infection site. Observations on lymphocytes prepared from liver and spleen also suggested activation of NKT cells, indicating that NKT cells at these sites are also activated during the course of acute HSV infection. The role of NKT cells in the control of HSV infection was further examined by adoptive transfer studies, to investigate whether the defect in handling of HSV-1 by Ja18 GKO mice could be complemented by the adoptive transfer of lymphocytes from wt mice (Chapter 6). Finally, the relevance of activated NKT cells in the anti-HSV response was examined by observing the effects of a-GalactosylCeramide therapy on the severity of HSV-1 infection (Chapter 6). Activation of NKT cells by this compound delayed the onset of HSV disease, decreased prevalence and severity of zosteriform lesions and reduced viral titres in skin and ganglia. The beneficial effects of a-GalactosylCeramide on the outcome and severity of HSV infection in the skin were dose-dependent. Collectively, the studies described in this thesis provide insights into how NKT cells, normally a rare population of cells, has the ability to regulate the protective immune response to HSV-1. As more understanding is gained about how NKT cells become activated during HSV-1 infection, and how they mediate their antiviral effects, other ways may be developed to modulate and activate this interesting subset to the benefit of infected individuals. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1277283 / Thesis (Ph.D.) -- University of Adelaide, School of Molecular and Biomedical Science, 2007

Title page, table of contents and summary only. The complete thesis in print form is available from the University of Adelaide Library. / Herpes simplex virus type I (HSV-I) produces acute muco-cutaneous infections, followed by spread to sensory nerve ganglia, and establishment of latency. In the peripheral nervous system, primary sensory neurons, which are found in dorsal root ganglia of the of the spinal nerves, are the target for HSV and they may undergo either productive or latent intection. Productive infection of sensory neurons generates the potential for lethal spread of virus through the nervous system but in immunocom petent hosts, viral replication is terminated by limely development of an adaptive immune response. The infection of dorsal root ganglia that follows cutaneous inoculation of the flanks of mice with HSV provides a well-characterized model of peripheral nervous system infection. The mechanisms responsible for clearance of HSV are complex. At mucosal and cutaneous sites, local innate immune mechanisms act to interrupt the initial spread of virus to the nervous system, while adaptive immunity is important in limiting replication in the ganglia and extension of the virus to adjacent dennatomes. Thus actions of both the innate and the adaptive immune systems are vital in defence against replicating HSV-1, while it is thought that latent infection in the ganglia is contained by the surveillance of the adaptive immune system. Natural killer T (NKT) cells are a conserved subpopulation of lymphocytes that recognize glycolipid antigens presented by the invariant MHC class I-like molecule CD1d. Upon activation through their semi-invariant T cell receptor, these cells rapidly release large amounts of immuno-modulating Th1 and Th2 cytokines. NKT cells have, therefore, been implicated in immune responses controlling various diseases, including infection, cancer, and autoimmunity, as well as having an involvement in allo-graft survival. Consideration of the important contributions of innate and adaptive immunity to clearance of HSV prompted this investigation of the role of CD1d and of CD1d-restricted NKT cells in the pathogenesis of HSV infection. The first part of this thesis (Chapter 3 and 4) describes investigations into the role of NKT cells in immunity to HSV-1, using a zosteriform model of infection and two gene knockout strains of C57BL/6 mice. CD1d GKO and Ja18 GKO mice, which are deficient in NKT cells, are compromised in controlling HSV-1 as evidenced by mortality, virus loads in skin and dorsal root ganglia, presence and size of skin lesions, persistence of HSV antigen, neuronal damage and extent of latency. Comparisons between wild type (NKT cell replete), Ja18 GKO (deficient in invariant Va14⁺ NKT cells) and CD1d GKO (deficient in all CD1d-dependant NKT cells) mice allowed assessment of CD1d-dependant NKT cell subsets in defence against the virus at various stages of infection. It was concluded that both subsets play important roles in controlling the virus and in preventing lethal neuro-invasive disease, that both are vital adjuncts to the adaptive immune response and that without them, low doses of neuropathogenic HSV-1 can establish quickly and cause fatal infections. The NKT-cell population appears to be quite dynamic in its response to a range of pathogens and other disease processes. The study described in Chapter 5 presents evidence suggesting that the response of NKT cells during HSV infection is no less dynamic. In the axillary lymph nodes, observations on numbers of cells expressing NK1.1 antigen and the invariant TCR suggest that NKT cells are activated in the regional lymph nodes draining the infection site. Observations on lymphocytes prepared from liver and spleen also suggested activation of NKT cells, indicating that NKT cells at these sites are also activated during the course of acute HSV infection. The role of NKT cells in the control of HSV infection was further examined by adoptive transfer studies, to investigate whether the defect in handling of HSV-1 by Ja18 GKO mice could be complemented by the adoptive transfer of lymphocytes from wt mice (Chapter 6). Finally, the relevance of activated NKT cells in the anti-HSV response was examined by observing the effects of a-GalactosylCeramide therapy on the severity of HSV-1 infection (Chapter 6). Activation of NKT cells by this compound delayed the onset of HSV disease, decreased prevalence and severity of zosteriform lesions and reduced viral titres in skin and ganglia. The beneficial effects of a-GalactosylCeramide on the outcome and severity of HSV infection in the skin were dose-dependent. Collectively, the studies described in this thesis provide insights into how NKT cells, normally a rare population of cells, has the ability to regulate the protective immune response to HSV-1. As more understanding is gained about how NKT cells become activated during HSV-1 infection, and how they mediate their antiviral effects, other ways may be developed to modulate and activate this interesting subset to the benefit of infected individuals. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1277283 / Thesis (Ph.D.) -- University of Adelaide, School of Molecular and Biomedical Science, 2007

München, Techn. University, Diss., 2007.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Thesis (D.M.A.)--UCLA, 2004. / Includes bibliographical references (leaves 62-64).

Honors Project--Smith College, Northampton, Mass., 2009. / Includes bibliographical references (p. 76-78).

Thesis (Ph. D.)--University of Washington, 1998. / Vita. Includes bibliographical references (leaves [88]-114).

Thesis (PhD)--Montana State University--Bozeman, 2009. / Typescript. Chairperson, Graduate Committee: David Pascual. Includes bibliographical references (leaves 76-103).