A hallmark of chronic human immunodeficiency virus (HIV) infection is the impairment of CD8 T cell survival and effector functions, which likely contributes to HIV pathogenesis. A number of factors could be attributed to this impairment, including the declining number of CD4 T cells, progressive destruction of secondary lymphoid tissues and an increasingly inhibitory environment. As highly active antiretroviral therapy shows limited efficacy in improving CD8 T cell functions, this thesis explores the therapeutic application of costimulatory molecules in directly stimulating non-functional HIV-specific CD8 T cells and ultimately their relevance to the control of chronic HIV infection. Costimulatory molecules are adjuvants for functional activation of T cells that act in concert with the antigen-specific signal. The Tumor Necrosis Factor (TNF) family member, 4-1BBL, emerges as the most effective costimulatory molecule in the antigen-specific expansion of human memory CD8 T cells as compared to the related TNF family members CD70 and LIGHT. As well, 4-1BBL improves the cytolytic function of T lymphocytes on a per cell basis. Furthermore, 4-1BBL is identified as a key component in the therapeutic rescue of CD8 T cell function and its effect is at least partially dependent on its signaling adaptor TNF receptor associated factor 1 (TRAF1), both in vitro and in vivo. This thesis also identifies the loss of TRAF1 as a new mechanism of immune dysregulation of HIV-specific CD8 T cells during the chronic phase of HIV infection and offers a means to correct it. The loss of TRAF1 has functional relevance in HIV suppression and HIV-specific CD8 T cell responses. Finally, a combination therapy involving agonistic anti-4-1BB antibody is shown to be successful in a proof of concept treatment of chronic lymphocytic chroriomeningitis virus (LCMV) infection in mice, resulting in sustained reduction in viral load. A new model of HIV-specific CD8 T cell dysfunction is constructed based on these findings.

GITR and CD30 are T cell costimulatory members of the TNFR superfamily known to regulate T cell responses. Elucidating the mechanisms whereby these receptors modulate T cell responses is crucial for maximizing their potential for immunotherapy. In this thesis, I examine the role of GITR and CD30 on CD8 T cell responses to influenza virus. I show that CD8 T cell intrinsic GITR is required for both maximal primary and secondary CD8 T cell expansion to influenza, while in contrast, CD30 is dispensable for anti-influenza CD8 T cell responses. GITR does not impact on CD8 T cell proliferation or homing, however, it mediates CD8 T cell survival signaling. GITR induces TRAF2/TRAF5 dependent, but TRAF1 independent, NF-κB activation, resulting in the upregulation of the pro-survival molecule Bcl-xL. Furthermore, I show that GITR on CD8 T cells can augment viral clearance and confer protection from death upon severe influenza infection of mice. Similarly, CD30 also elicits protection from death upon severe influenza infection, although the cells responsible for this effect remain to be elucidated. In this thesis, I also show that in unimmunized mice GITR expression is upregulated to higher than basal levels on a population of CD8 memory phenotype cells in the bone marrow. In contrast, CD8 memory phenotype T cells in the spleen and LN have GITR levels similar to that on naïve T cells. The upregulation of GITR in the bone marrow is IL-15 dependent and therefore, GITR serves as a marker for cells that have recently received an IL-15 signal. Furthermore, GITR is required for the persistence, but not for the homeostatic proliferation of CD8 memory phenotype T cells in the bone marrow. Therefore, GITR plays a key role for CD8 T cell intrinsic responses to influenza, as well as for the persistence of CD8 memory phenotype T cells.

A hallmark of chronic human immunodeficiency virus (HIV) infection is the impairment of CD8 T cell survival and effector functions, which likely contributes to HIV pathogenesis. A number of factors could be attributed to this impairment, including the declining number of CD4 T cells, progressive destruction of secondary lymphoid tissues and an increasingly inhibitory environment. As highly active antiretroviral therapy shows limited efficacy in improving CD8 T cell functions, this thesis explores the therapeutic application of costimulatory molecules in directly stimulating non-functional HIV-specific CD8 T cells and ultimately their relevance to the control of chronic HIV infection. Costimulatory molecules are adjuvants for functional activation of T cells that act in concert with the antigen-specific signal. The Tumor Necrosis Factor (TNF) family member, 4-1BBL, emerges as the most effective costimulatory molecule in the antigen-specific expansion of human memory CD8 T cells as compared to the related TNF family members CD70 and LIGHT. As well, 4-1BBL improves the cytolytic function of T lymphocytes on a per cell basis. Furthermore, 4-1BBL is identified as a key component in the therapeutic rescue of CD8 T cell function and its effect is at least partially dependent on its signaling adaptor TNF receptor associated factor 1 (TRAF1), both in vitro and in vivo. This thesis also identifies the loss of TRAF1 as a new mechanism of immune dysregulation of HIV-specific CD8 T cells during the chronic phase of HIV infection and offers a means to correct it. The loss of TRAF1 has functional relevance in HIV suppression and HIV-specific CD8 T cell responses. Finally, a combination therapy involving agonistic anti-4-1BB antibody is shown to be successful in a proof of concept treatment of chronic lymphocytic chroriomeningitis virus (LCMV) infection in mice, resulting in sustained reduction in viral load. A new model of HIV-specific CD8 T cell dysfunction is constructed based on these findings.

GITR and CD30 are T cell costimulatory members of the TNFR superfamily known to regulate T cell responses. Elucidating the mechanisms whereby these receptors modulate T cell responses is crucial for maximizing their potential for immunotherapy. In this thesis, I examine the role of GITR and CD30 on CD8 T cell responses to influenza virus. I show that CD8 T cell intrinsic GITR is required for both maximal primary and secondary CD8 T cell expansion to influenza, while in contrast, CD30 is dispensable for anti-influenza CD8 T cell responses. GITR does not impact on CD8 T cell proliferation or homing, however, it mediates CD8 T cell survival signaling. GITR induces TRAF2/TRAF5 dependent, but TRAF1 independent, NF-κB activation, resulting in the upregulation of the pro-survival molecule Bcl-xL. Furthermore, I show that GITR on CD8 T cells can augment viral clearance and confer protection from death upon severe influenza infection of mice. Similarly, CD30 also elicits protection from death upon severe influenza infection, although the cells responsible for this effect remain to be elucidated. In this thesis, I also show that in unimmunized mice GITR expression is upregulated to higher than basal levels on a population of CD8 memory phenotype cells in the bone marrow. In contrast, CD8 memory phenotype T cells in the spleen and LN have GITR levels similar to that on naïve T cells. The upregulation of GITR in the bone marrow is IL-15 dependent and therefore, GITR serves as a marker for cells that have recently received an IL-15 signal. Furthermore, GITR is required for the persistence, but not for the homeostatic proliferation of CD8 memory phenotype T cells in the bone marrow. Therefore, GITR plays a key role for CD8 T cell intrinsic responses to influenza, as well as for the persistence of CD8 memory phenotype T cells.

The infrequency of known T cell targets in high grade serous ovarian carcinoma (HSGC) is a substantial barrier to the development of targeted immunotherapies. Due to their infrequency, antigen discovery is a crucial component of immunotherapeutic design. In our cohort of HGSC cases, the cancer testis (CT) antigen lactate dehydrogenase C (LDHC) is expressed in 76% of tumours (22/29). As LDHC presents with tumour specificity in women, I hypothesize that LDHC is an immunogenic target in HGSC patients, and that LDHC-specific T cells can be activated and expanded for therapeutic purposes. As such, I sought to examine whether endogenous LDHC-specific T cells were present in the ascites of HGSC patients. A standard Rapid Expansion Protocol was used to expand CD8 T cell cultures from patient ascites. These cultures were screened for reactivity to a peptide library encompassing all possible epitopes of the LDHC protein by interferon-γ ELISpot. With this approach, T cell clones from one of five patients were identified that were reactive to minimal peptides contained within LDHC. In this patient, the antigenic LDHC peptide differentiated from LDHA by a single amino acid at its C-terminus (YTSWAIGLSVM versus YTSWAIGLSVA). In recognition assays, tumour cell lines expressing endogenous LDHC, autologous ascites, or autologous B cells transfected with LDHC were unable to elicit T cell responses. Although this study suggests that LDHC is not immunogenic, continued screening of LDHC and other CT proteins will likely provide additional immunotherapeutic targets. / Graduate

Antigen-specific CD8 T cells provide an important protective role in response to infection by viruses, intracellular bacteria, and parasites. Pathogen-specific CD8 T cells render this protection by undergoing robust expansion in numbers while gaining the ability to produce cytokines and cytolytic machinery. Following expansion and effector differentiation, pathogen-specific CD8 T cells will contract in number while further differentiating into a highly functional population of memory CD8 T cells. These antigen-experienced cells persist in secondary lymphoid organs and the periphery in order to rapidly respond to repeated infection. Creating optimal CD8 T cell responses to infection can be critical for raising sufficient armament to provide protection against invading intracellular pathogens. Although CD8 T cells have protective value, many vaccine strategies tend to focus on creating productive B cell antibody responses to promote immunological protection. Even though antibody responses can be highly protective, coupling optimal CD8 T cell responses with B cell responses could provide higher orders of protection than either one on their own. Therefore, a deeper understanding of the pathways that ultimately guide the magnitude of CD8 T cell responses is required to achieve this potential therapeutic benefit. My studies evaluate the role of receptor signaling events in guiding the expansion of activated CD8 T cells during primary and secondary responses. Specifically, the first portion of my studies dissect the mechanism by which direct IL-12 and Type I IFN stimulation can substantially bolster primary CD8 T cell responses in vivo. Within this context, I demonstrate that direct IL-12 and Type I IFN signaling increases CD8 T cell accumulation during primary expansion by prolonging division without altering survival. IL-12/Type I IFN signaling promoted prolonged division of activated CD8 T cells by maintaining high-affinity IL-2 receptor subunit (CD25) expression and IL-2 signaling. The other portion of my work was dedicated to understanding the expression and role of the inhibitory FcgR (FcgRIIB) during primary and secondary CD8 T cell responses. FcgRIIB expression could be detected as early as the peak of the CD8 T cell response and marked activated CD8 T cells that were highly sensitive to antigen stimulation. Although FcgRIIB did not appear to play a substantial role in regulating the magnitude of primary CD8 T cell responses, it played an important role in inhibiting the expansion and cytotoxicity of memory CD8 T cells during homologous challenge. Collectively, these data highlight potential avenues that could be exploited by future therapies that aim to achieve appropriately sized CD8 T cell responses.

De récents progrès dans la compréhension de la régulation de l'interaction moléculaire entre les lymphocytes T CD8 (LT CD8) et les cellules tumorales ont donné lieu à de nouvelles immunothérapies contre le cancer. En effet, les anticorps monoclonaux anti-CTLA-4 et anti-PD-1 (mAb), ciblant des récepteurs inhibiteurs à la surface des LT CD8, ont démontré des bénéfices de survie dans de nombreux cancers. Malheureusement, seule une partie des patients répond à ces traitements. Il est donc crucial de caractériser l'influence d'autres facteurs moléculaires régulant la migration et les activités fonctionnelles des LT CD8 afin d'améliorer les traitements actuels du cancer. Un candidat potentiel impliqué dans cette immunosuppression est le récepteur Neuropiline-1 (Nrp-1), qui a été initialement identifié dans le système nerveux. Nous avons identifié une large population de LT CD8 infiltrant le mélanome murin (lignée tumorale B16 greffée à des souris C57BL/6), qui exprime des niveaux élevés de Nrp-1. La présence de cette population augmente pendant la croissance tumorale, mais reste indétectable dans les organes lymphoïdes (rate et ganglion lymphatique drainant la tumeur). De plus, les LT CD8 infiltrant la tumeur exprimant Nrp-1 montre des caractéristiques d’épuisement. En parallèle, l’inhibition de la Nrp-1 avec un anticorps neutralisant augmente la capacité des LT CD8 à migrer, et à tuer les cellules tumorales autologues ex vivo. D’autre part, l’inhibition de la Nrp-1 in vivo agit en synergie avec la neutralisation du récepteur PD-1 pour le contrôle de la croissance tumorale et l’amélioration des fonctions effectrices des LT CD8. Nos résultats montrent donc comment le microenvironnement tumoral induit l'expression de la Nrp-1 sur les LT CD8 et comment ce récepteur neuronal peut participer à la régulation des fonctions effectrices des LT CD8 antitumoraux, avec de potentielles implications comme biomarqueur/cible pour une immunothérapie. / Recent advances in understanding the regulation of molecular interaction between CD8 T cell and tumor cells gave rise to novel cancer immunotherapies. Indeed, monoclonal antibodies against CTLA-4 and PD-1 (mAb), targeting inhibitory receptors on the surface of CD8 T cells, have demonstrated survival benefits in many cancers. Unfortunately, only a fraction of patients responds to these treatments. Therefore, it is crucial to characterize the influence of additional molecular factors regulating the migration and the functional activities of CD8 T cells, in order to improve current cancer treatments. A potential candidate involved in this immunosuppression function is the Neuropilin-1 (Nrp-1), which was originally identified in the nervous system. We identified a large subset of CD8 T cells infiltrating B16 melanoma (mouse model), which expresses high levels of Nrp-1. The frequency of Nrp-1+ CD8 T cells increased during tumor growth, but was undetectable in lymphoid organs (spleen and tumor-draining lymph node). Moreover, Nrp-1+ CD8 tumor-infiltrating lymphocytes (TIL) displayed features of T cell exhaustion. Importantly, blocking of Nrp-1 with a neutralizing mAb, increases the capacity of CD8 T cells to migrate and to kill autologous tumor cells. In addition, the blockade of Nrp-1 in vivo acts synergistically with the neutralization of the inhibitory receptor PD-1 to control tumor growth and restore TIL function. Our findings show how the tumor microenvironment induces Nrp-1 expression on CD8 T cells and how this neuronal receptor may participate in regulating antitumor CD8 T cell response, with potential implications as a biomarker/target for immunotherapeutic intervention.

La nécrolyse épidermique toxique (NET) est une réaction cutanée médicamenteuse (CADR - Cutaneous Adverse Drug Reaction) rare et sévère qui se caractérise par une nécrose brutale de l’épiderme, entraînant un décollement cutané plus ou moins étendu. Il s’agit d’une urgence vitale avec jusqu’à 30% de décès à la phase aiguë. L’importance de la surface décollée définit deux entités cliniques : le syndrome de Stevens-Johnson quand le décollement est inférieur à 10% et le syndrome de Lyell quand il est supérieur à 30%. A distance, le risque de complications, notamment sous forme de synéchies des muqueuses, est particulièrement élevé et doit être prévenu systématiquement. Le mécanisme physiopathologique repose essentiellement sur une réaction d’hypersensibilité médicamenteuse retardée dans laquelle les lymphocytes cytotoxiques jouent un rôle majeur. Le terrain génétique intervient également avec des associations HLA-médicament maintenant bien décrites, notamment dans les populations asiatiques. La question du traitement reste encore très débattue : il repose essentiellement sur la corticothérapie systémique, la ciclosporine ou encore les immunoglobulines IV. Quelques études suggèrent également un intérêt des anti-TNF-alpha. Le but de ce travail est de comprendre les mécanismes à l’origine des CADRs les plus sévères, à travers la caractérisation de patients atteints de NET à la phase aiguë et en les comparant à une CADR bénigne comme l’EMP. Nous avons dans un premier temps déterminé quelles étaient les principales populations CD45+ présentes à la phase aiguë des NET et de patients ayant présenté un exanthème maculo-papuleux (EMP) bénin, à la fois dans la peau et dans le sang. Nous avons cherché à déterminer la présence de populations cellulaires spécifiques de ces pathologies, notamment au sein des lymphocytes T CD8+ qui étaient la population majoritaire dans ces deux CADRs. Nous avons notamment montré qu’il existait une expansion majeure de lymphocytes T CD8+ effecteurs mémoires et polycytotoxiques au cours de la NET comparativement à l’EMP. Puis, nous nous sommes intéressés à la clonalité de ces populations lymphocytaires T CD8+ au travers de l’analyse de leurs séquences V-béta puis au moyen d’un séquençage ADN haut débit : nous avons notamment montré que ces expansions lymphocytaires T CD8+ étaient clonotypiques dans la peau. Nous avons également étudié l’expansion de ces clones cutanés dans le sang des patients atteints de NET et avons montré que leur expansion sanguine était directement corrélé à la sévérité clinique. Enfin, nous avons pu démontré in vitro chez deux patients que ces clones étaient spécifiques du médicament inducteur. / Toxic epidermal necrolysis (TEN) is a rare and severe cutaneous adverse drug reaction (CADR). The histologic hallmark of this reaction is necrosis with detachment of the epidermis resulting in skin blistering. This is a vital emergency with up to 30% deaths at the acute phase. The percentage of blistering skin determines two clinical entities: Stevens-Johnson syndrome when detachment represents less than 10% and Lyell's syndrome when it is greater than 30%. The development of late complications, notably mucous synechiae, is frequent and must be systematically prevented. Pathophysiologic mechanism consists in a delayed drug hypersensitivity reaction in which cytotoxic T lymphocytes play a major role. Genetic background is also very important with HLA-drug associations which have been reported, notably in asian ppopulations. Treatment remains very debated : systemic steroids, ciclosporin or intravenous immunoglobulins are commonly used. Some studies also suggest that TNF-alpha inhibitors are of interest in treating this disease. The aim of this work is to understand the mechanisms underlying the most severe CADRs, through the characterization of TEN patients. We first determined the main CD45+ populations present in the acute phase of both TEN and patients who devloped a benign maculo-papular exanthema (MPE). We sought to determine the presence of cell populations specific to these pathologies, particularly within CD8+ T lymphocytes, which were the majority population in these two CADRs. In particular, we have shown that there is a major expansion of CD8+ T lymphocytes in memory and polycytotoxic effectors during TEN compared to MPE. Then, we focused on the clonality of these CD8+ T lymphocyte populations through the analysis of their V-beta sequences and then by means of high throughput DNA sequencing: in particular, we showed that these CD8+ T lymphocyte expansions were clonotypic in the skin. We also studied the expansion of these skin clones in the blood of TEN patients and showed that their blood expansion was directly correlated with clinical severity. Finally, we were able to demonstrate in vitro in two patients that these clones were specific to the suspected drug

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