Retrospektive Untersuchung des gemischten Chimerismus der Megakaryopoese im Rahmen der chronisch myeloischen Leukämie vor und nach allogener gegengeschlechtlicher Knochenmarktransplantation

Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Biochemical Sciences Candidate: Bc. Michaela Řehounková Supervisor: doc. PharmDr. Martin Beránek, Ph.D. Title of diploma thesis: Genetic markers for monitoring post-transplant chimerism The aims of the thesis: Data processing of patients, who underwent allogenic hematopoietic stem cell transplantation in a period from 2010 to 2014 in University Hospital Hradec Kralove and whose state of chimerism was monitored at the Section of Molecular Biology at the Institute of Clinical Biochemistry and Diagnostics. Consequently, analysis of the possible relationship between selected clinical parameters and used genetic markers for chimerism quantification was carried out after the processing of acquired data. Finally, the possible influence of treatment success and mortality by chosen clinical parameters was evaluated. Methods: Analysis of short tandem repeat loci, which uses genetic variability between donor and recipient of transplanted graft, was employed for quantification of post- transplant chimerism. DNA of donor and recipient was isolated by QIAmp DNA Blood Mini Kit (QIAGEN, Germany), amplified by AmpFlSTR Identifier Kit (Applied Biosystems, USA) and separated by capillary electrophoresis (analyzer ABI 3130-4, Applied...

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18896号 / 医博第4007号 / 新制||医||1009(附属図書館) / 31847 / 京都大学大学院医学研究科医学専攻 / (主査)教授 坂井 義治, 教授 伊達 洋至, 教授 前川 平 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM

Hematologic malignancies are among the most often diagnosed forms of cancers. Treatment regimens often utilise various combination of cytostatic drugs and total body irradiation and subsequent transplantation of hematopoietic stem cells. One of the most common combinations includes ionising radiation with the antineoplastic alkylating agent cyclophosphamide. In this study we used congenic Ly5.2 and L5.1 mouse strains that express different isoforms of CD45 antigen to evaluate the effects of various time interval between cyclophosphamide and irradiation treatments on the viability of hematopoietic stem cells and their viability. This was done by competitive repopulation assay. The results revealed that level of engraftment and subsequent reconstitution of hematopoiesis can significantly vary and depend on the time interval between cyclophosphamide and total body irradiation administrations. The results indicate that patients with hematologic malignancies could possibly benefit from the treatment especially if they received transplants after being irradiated five or seven days after cyclophosphamide because at that time point their own stem cells would be least competitive. Key words: bone marrow transplantation, cyclophosphamide, chimerism, hematopoietic stem cells, ionising radiation

O objetivo central desta dissertação de mestrado foi analisar se, pela sua resposta ao interferon-g (IFNg), as células não leucocitárias contribuem ao controle dos protozoários Trypanosoma cruzi, Plasmodium chabaudi AS e Plasmodium berghei ANKA. O IFNg é uma citocina que promove a ativação de diversos tipos de leucócitos, a sua ação sobre as células mononucleares fagóciticas merece um destaque especial. Apesar de conhecermos os pormenores do papel desta citocina na ativação dos leucócitos, desconhecemos se o IFNg exerce ação ativadora sobre as células estruturais (não leucocitárias), ou seja, sobre as células não profissionais da resposta imune. A nossa hipótese de trabalho é que, no caso dos parasitas intracelulares, o IFNg poderia reforçar a ação sinalizadora e efetora das células estruturais infectadas. Por outro lado, em ambas as situações de parasitas intracelulares e extracelulares, o IFNg, ao agir sobre diversas células estruturais, poderia induzir a produção de mediadores inflamatórios (citocinas, quimiocinas, etc) que contribuiriam direta ou indiretamente à remoção/controle do parasita. A nossa abordagem tem sido o estudo da infecção por estes protozoários em quimeras de medula óssea B6/IFNgRKO, nas quais as células não leucocitárias são deficientes em receptores para IFNg e as células leucocitárias são normais. A análise por imunofluorescência de cortes histológicos mostrou uma alta expressão de IFNgR pelas células estruturais do coração dos animais B6 e quimeras controle B6/B6, mas nenhuma expressão deste receptor nos cortes histológicos correspondentes de animais IFNgRKO e quimeras experimentais B6/IFNgRKO, apesar de grande parte dos leucócitos dos animais deste último grupo ter se tornado IFNgR+. Após infecção pelo T. cruzi, o coração e músculo esquelético dos animais quiméricos B6/IFNgRKO mostraram maior carga parasitária e menor intensidade dos infiltrados 8 inflamatórios do que aqueles dos animais quiméricos B6/B6, resultados que sugerem o envolvimento das células estruturais no controle do parasita e promoção do recrutamento leucocitário. Na infecção pelo Plasmodium chabaudi AS a análise comparativa dos grupos IFNgRKO e quimera B6/IFNgRKO mostrou que no início da infecção as curvas de parasitemia destes grupos são idênticas sugerindo que nesta fase da infecção a presença do IFNgR nos leucócitos em pouco contribui na evolução da parasitemia. Por outro lado, a análise comparativa dos grupos quimera B6/IFNgRKO e quimera B6/B6 mostrou níveis mais elevados de parasitemia e maior índice de mortalidade nos animais B6/IFNgRKO, sugerindo que as células estruturais participam no controle do parasita através da sua resposta ao IFNg. Entretanto, em uma experiência preliminar de infecção pelo Plasmodium berghei ANKA não observamos grandes diferenças entre os animais dos grupos B6/IFNgRKO e B6/B6, não somente no que se refere à curva de parasitemias, como também na indução de morte precoce decorrente de malária cerebral. / The main purpose of our work was to analyze if by their response to Interferon-g (IFN-g), the non-leucocyte cells are able to control Trypanosoma cruzi, Plasmodium chabaudi AS and Plasmodium berghei ANKA protozoans. IFNg was described as a cytokine that promote activation on different types of leucocytes, its action on mononuclear phagocytic cells is important. Despite the fact that this cytokine activate leucocytes, it is unknown whether IFNg activates the structural cells (non-leucocytes), that is, the non-professional cells of the immune response. Our hypotheses suggest that in the case of intracellular parasites, IFNg could help the infected structural cells by increasing their signaling and effect actions. In addition, during the response against intracellular and extracellular parasites, IFNg could induce the production of inflammatory mediators by these cells guaranteeing direct or indirectly the parasite clearance. In the present study, we analyzed the infection of diferente protozoans on bone marrow B6/IFNgRKO chimeras, in which the non-leukocyte cells are deficient in IFNg receptor and the leukocyte cells are normal. Immunofluorescence analyses of histological sections revealed a high expression of IFNgR on the structural cells from the heart of B6 and control chimeras B6/B6 animals, but non-expression of this receptor on histological sections from IFNgRKO and experimental chimeras B6/IFNgRKO, despite the fact that a great part of leucocytes from the last group of animals express the receptor. After T. cruzi infection, the cardiac and skeletal muscle from B6/IFNgRKO chimera animals showed a huge amount of parasite and less infiltration inflammatory than B6/B6 animals, suggesting that the structural cells are involved in the parasite control and leukocyte recruitment. During Plasmodium chabaudi AS infection, comparative analyses from IFNgRKO and 10 B6/IFNgRKO groups showed that parasitemia curves at the early phase are similar, suggesting that during this phase IFNgR expression on leukocytes are not important. On the other hand, parasitemia and mortality levels on B6/IFNgRKO and B6/B6 groups were higher than those on B6/IFNgRKO animals, determining that structural cells participate during the course of infection through their response to IFNg. However, when B6/IFNgRKO and B6/B6 animals were infected with Plasmodium berghei ANKA no significantly difference was observed between these groups related to the course of parasitemia and cerebral malaria.

Moklsiniame darbe tirtas chimerizmas vaikams po alogeninės kraujodaros kamieninių ląstelių transplantacijos. Tyrimas pradėtas Charité klinikose (Humboldto universitetas, Berlynas), kur chimerizmo tyrinėjimams pasirinkti recipientai, sergantys ūmia limfoblastine leukemija (ŪLL), Fanconi anemija (FA) ir adrenoleukodistrofija (ALD). Sergant šiomis ligomis nuoseklus chimerizmo stebėjimas ALP atliktas pirmą kartą. Darbas tęstas Vilniaus universitete, kuomet pirmą kartą buvo atlikti chimerizmo tyrinėjimai Lietuvoje transplantuotiems vaikams. Donoro ir recipiento ląstelėms atskirti naudoti polimorfiniai DNR žymenys, kurie tirti periferinio kraujo leukocituose (PKL) ir atskirose ląstelių populiacijose (ALP): CD3, CD19 ir CD34. Ląstelių frakcijoms atskirti naudotos imunomagnetinės dalelės. Atlikus chimerizmo analizę nutatyta, kad esant visiškam donoro chimerimui PKL, 74,4% ŪLL ir 66,7% ALD recipientų po mieloabliacinio kondicionavimo ląstelių populiacijose išlieka autologinė, aptinkama iki kelerių metų po transplantacijos. Po sumažinto intensyvumo kondicionavimo 45,5% FA recipientų autologinės kraujodaros pėdsakų nerandama nei PKL, nei ALP. FA ligoniams vystosi stabilus ilgalaikis mišrus chimerizmas, kuris susijęs su su ilgesniu išgyvenamumu po transplantacijos. Nustatėme, kad sergantiems FA galimybė išsivystyti mišriam chimerizmui yra 20 kartų didesnė perpylus kaulų čiulpus, nei periferinio kraujo kamienines ląsteles. / The doctoral thesis aimed to evaluate in a comparative way the benefit chimerism assessment in isolated cell populations (ICP) versus conventional monitoring in whole blood cells (WBC). The study was initiated in Pediatric Bone Marrow Transplant Service of Charité Children’s Hospital (Humboldt University, Berlin). Children suffered from: acute lymphoblastic leukemia (ALL), Fanconi anemia (FA) and adrenoleukodystrophy (ALD) were included into the study. Thereafter the doctoral thesis was accomplished at the Vilnius University where evaluation of the own experience of chimerism analysis in pediatric patients was performed. Chimerism was prospectively monitored in WBC and three cell subsets: CD3, CD19 and CD34. Cell populations were extracted from peripheral blood using immunomagnetic beads. Following polymorphisms of short tandem repeats between donor and recipient were compared. The analysis reveled that following myeloablative conditioning in patients with ALL and ALD analysis of ICP revealed persistent autologous hemopoiesis despite stable donor chimerism in WBC. In contrast after reduced intensity conditioning 45.5% of FA recipients had no evidence of autologous signals either in WBC, or in ICP. FA were found to develop stable long-lasting mixed chimerism associated with better overall survival. development of MC was related to the infusion of bone marrow but not to peripheral blood stem cells. Chimerism in ICP did no affected transplant outcome in any disease group.

The doctoral thesis aimed to evaluate in a comparative way the benefit chimerism assessment in isolated cell populations (ICP) versus conventional monitoring in whole blood cells (WBC). The study was initiated in Pediatric Bone Marrow Transplant Service of Charité Children’s Hospital (Humboldt University, Berlin). Children suffered from: acute lymphoblastic leukemia (ALL), Fanconi anemia (FA) and adrenoleukodystrophy (ALD) were included into the study. Thereafter the doctoral thesis was accomplished at the Vilnius University where evaluation of the own experience of chimerism analysis in pediatric patients was performed. Chimerism was prospectively monitored in WBC and three cell subsets: CD3, CD19 and CD34. Cell populations were extracted from peripheral blood using immunomagnetic beads. Following polymorphisms of short tandem repeats between donor and recipient were compared. The analysis reveled that following myeloablative conditioning in patients with ALL and ALD analysis of ICP revealed persistent autologous hemopoiesis despite stable donor chimerism in WBC. In contrast after reduced intensity conditioning 45.5% of FA recipients had no evidence of autologous signals either in WBC, or in ICP. FA were found to develop stable long-lasting mixed chimerism associated with better overall survival. development of MC was related to the infusion of bone marrow but not to peripheral blood stem cells. Chimerism in ICP did no affected transplant outcome in any disease group. / Moklsiniame darbe tirtas chimerizmas vaikams po alogeninės kraujodaros kamieninių ląstelių transplantacijos. Tyrimas pradėtas Charité klinikose (Humboldto universitetas, Berlynas), kur chimerizmo tyrinėjimams pasirinkti recipientai, sergantys ūmia limfoblastine leukemija (ŪLL), Fanconi anemija (FA) ir adrenoleukodistrofija (ALD). Sergant šiomis ligomis nuoseklus chimerizmo stebėjimas ALP atliktas pirmą kartą. Darbas tęstas Vilniaus universitete, kuomet pirmą kartą buvo atlikti chimerizmo tyrinėjimai Lietuvoje transplantuotiems vaikams. Donoro ir recipiento ląstelėms atskirti naudoti polimorfiniai DNR žymenys, kurie tirti periferinio kraujo leukocituose (PKL) ir atskirose ląstelių populiacijose (ALP): CD3, CD19 ir CD34. Ląstelių frakcijoms atskirti naudotos imunomagnetinės dalelės. Atlikus chimerizmo analizę nutatyta, kad esant visiškam donoro chimerimui PKL, 74,4% ŪLL ir 66,7% ALD recipientų po mieloabliacinio kondicionavimo ląstelių populiacijose išlieka autologinė, aptinkama iki kelerių metų po transplantacijos. Po sumažinto intensyvumo kondicionavimo 45,5% FA recipientų autologinės kraujodaros pėdsakų nerandama nei PKL, nei ALP. FA ligoniams vystosi stabilus ilgalaikis mišrus chimerizmas, kuris susijęs su su ilgesniu išgyvenamumu po transplantacijos. Nustatėme, kad sergantiems FA galimybė išsivystyti mišriam chimerizmui yra 20 kartų didesnė perpylus kaulų čiulpus, nei periferinio kraujo kamienines ląsteles.

No description available.

O objetivo central desta dissertação de mestrado foi analisar se, pela sua resposta ao interferon-g (IFNg), as células não leucocitárias contribuem ao controle dos protozoários Trypanosoma cruzi, Plasmodium chabaudi AS e Plasmodium berghei ANKA. O IFNg é uma citocina que promove a ativação de diversos tipos de leucócitos, a sua ação sobre as células mononucleares fagóciticas merece um destaque especial. Apesar de conhecermos os pormenores do papel desta citocina na ativação dos leucócitos, desconhecemos se o IFNg exerce ação ativadora sobre as células estruturais (não leucocitárias), ou seja, sobre as células não profissionais da resposta imune. A nossa hipótese de trabalho é que, no caso dos parasitas intracelulares, o IFNg poderia reforçar a ação sinalizadora e efetora das células estruturais infectadas. Por outro lado, em ambas as situações de parasitas intracelulares e extracelulares, o IFNg, ao agir sobre diversas células estruturais, poderia induzir a produção de mediadores inflamatórios (citocinas, quimiocinas, etc) que contribuiriam direta ou indiretamente à remoção/controle do parasita. A nossa abordagem tem sido o estudo da infecção por estes protozoários em quimeras de medula óssea B6/IFNgRKO, nas quais as células não leucocitárias são deficientes em receptores para IFNg e as células leucocitárias são normais. A análise por imunofluorescência de cortes histológicos mostrou uma alta expressão de IFNgR pelas células estruturais do coração dos animais B6 e quimeras controle B6/B6, mas nenhuma expressão deste receptor nos cortes histológicos correspondentes de animais IFNgRKO e quimeras experimentais B6/IFNgRKO, apesar de grande parte dos leucócitos dos animais deste último grupo ter se tornado IFNgR+. Após infecção pelo T. cruzi, o coração e músculo esquelético dos animais quiméricos B6/IFNgRKO mostraram maior carga parasitária e menor intensidade dos infiltrados 8 inflamatórios do que aqueles dos animais quiméricos B6/B6, resultados que sugerem o envolvimento das células estruturais no controle do parasita e promoção do recrutamento leucocitário. Na infecção pelo Plasmodium chabaudi AS a análise comparativa dos grupos IFNgRKO e quimera B6/IFNgRKO mostrou que no início da infecção as curvas de parasitemia destes grupos são idênticas sugerindo que nesta fase da infecção a presença do IFNgR nos leucócitos em pouco contribui na evolução da parasitemia. Por outro lado, a análise comparativa dos grupos quimera B6/IFNgRKO e quimera B6/B6 mostrou níveis mais elevados de parasitemia e maior índice de mortalidade nos animais B6/IFNgRKO, sugerindo que as células estruturais participam no controle do parasita através da sua resposta ao IFNg. Entretanto, em uma experiência preliminar de infecção pelo Plasmodium berghei ANKA não observamos grandes diferenças entre os animais dos grupos B6/IFNgRKO e B6/B6, não somente no que se refere à curva de parasitemias, como também na indução de morte precoce decorrente de malária cerebral. / The main purpose of our work was to analyze if by their response to Interferon-g (IFN-g), the non-leucocyte cells are able to control Trypanosoma cruzi, Plasmodium chabaudi AS and Plasmodium berghei ANKA protozoans. IFNg was described as a cytokine that promote activation on different types of leucocytes, its action on mononuclear phagocytic cells is important. Despite the fact that this cytokine activate leucocytes, it is unknown whether IFNg activates the structural cells (non-leucocytes), that is, the non-professional cells of the immune response. Our hypotheses suggest that in the case of intracellular parasites, IFNg could help the infected structural cells by increasing their signaling and effect actions. In addition, during the response against intracellular and extracellular parasites, IFNg could induce the production of inflammatory mediators by these cells guaranteeing direct or indirectly the parasite clearance. In the present study, we analyzed the infection of diferente protozoans on bone marrow B6/IFNgRKO chimeras, in which the non-leukocyte cells are deficient in IFNg receptor and the leukocyte cells are normal. Immunofluorescence analyses of histological sections revealed a high expression of IFNgR on the structural cells from the heart of B6 and control chimeras B6/B6 animals, but non-expression of this receptor on histological sections from IFNgRKO and experimental chimeras B6/IFNgRKO, despite the fact that a great part of leucocytes from the last group of animals express the receptor. After T. cruzi infection, the cardiac and skeletal muscle from B6/IFNgRKO chimera animals showed a huge amount of parasite and less infiltration inflammatory than B6/B6 animals, suggesting that the structural cells are involved in the parasite control and leukocyte recruitment. During Plasmodium chabaudi AS infection, comparative analyses from IFNgRKO and 10 B6/IFNgRKO groups showed that parasitemia curves at the early phase are similar, suggesting that during this phase IFNgR expression on leukocytes are not important. On the other hand, parasitemia and mortality levels on B6/IFNgRKO and B6/B6 groups were higher than those on B6/IFNgRKO animals, determining that structural cells participate during the course of infection through their response to IFNg. However, when B6/IFNgRKO and B6/B6 animals were infected with Plasmodium berghei ANKA no significantly difference was observed between these groups related to the course of parasitemia and cerebral malaria.

Vascularized composite allotransplantation has developed as a specialty at the interface of reconstructive and transplant surgery, offering restoration of function and form in scenarios where options for autologous reconstruction are limited, and for which the burden of donor-site morbidity may be high. Over the past 15 years some 28 patients have received face, and 85 patients upper extremity transplants. Results have been encouraging, with good functional outcomes, and the majority of patients reporting return to independence, employment and improved quality of life. However, the immunological management of these patients remains a significant challenge. While conventional immunosuppressive regimens have proven effective in preventing graft loss to rejection, they have failed to protect patients from acute rejection episodes, which have been reported in 85% during the first year post-transplant. When considered alongside the burden of comorbidity associated with life-long immunosuppression, the impetus for development of novel approaches to the prevention of rejection is clear. Induction of hematopoietic mixed chimerism has successfully achieved transplant tolerance, defined as specific unresponsiveness to donor antigens permitting life-long acceptance of transplanted tissues without maintenance immunosuppression, in numerous animal models and recently, of renal allografts in clinical trials. The work presented in this thesis investigates mixed chimerism for induction of tolerance of vascularized composite allografts (VCAs) across class I and II major histocompatibility (MHC) barriers in the Massachusetts General Hospital miniature swine model; a large animal model with defined MHC immunogenetics, and skin closely analogous to that of humans. The data presented demonstrate development of a reproducible model of VCA tolerance and stable hematopoietic mixed chimerism in a preclinical model. Importantly, tolerance extended to all components of VCAs including the epidermis and dermis, a previously un-reproducible finding. In vitro analysis demonstrated no evidence for either IL-2 reversible anergy or cellular regulation as mechanisms of donor-specific unresponsiveness, suggesting that at a systemic level, tolerance in this model may be primarily mediated by clonal deletion. In contrast, characterization of the cutaneous immune system demonstrated rapid infiltration of VCAs with recipient T cells and Langerhans’ cells, which in chimeric recipients did not cause rejection but rather established stable chimerism in all tissue-resident populations including dermal T cells with the phenotype of Tregs (CD25+FoxP3+); findings which suggest tissue-specific, and regulatory, mechanisms may play important roles. These data support the hypothesis that mixed chimerism is sufficient for whole-skin tolerance of VCAs, but further work is required to demonstrate the necessity of stable, rather than transient, chimerism and to confirm the necessity of other systemic or tissue-specific factors for prevention of epidermal rejection.