Transplantation is the best therapeutic solution for patients with chronic renal failure. Due to the great advances in immunosuppressive therapy in the last decades, graft and patient survival have improved significantly. On the other hand, immunosuppressive therapy has serious side effects - too strong immunosuppression may lead to infection or malignancies, conversely insufficient immunosuppression may lead to graft rejection. Due to the grave consequences of acute rejection, the main goal of cooperation of clinicians and transplant immunologists is to stratify patients into groups with low, moderate and high risk of rejection based on the evaluation of various immunologic risk factors. There are reports in the literature that the numbers (frequencies) of interferon gamma (IFNγ) producing cells before transplantation may be helpful to identify patients with high risk of acute cellular rejection and to predict long-term survival of the graft. In this retrospective study we determined the pre-transplant frequencies of activated donor specific T lymphocytes producing IFNγ after short stimulation (24 hrs) by ELISpot (Enzyme-linked immunosorbent spot assay). The results were correlated with the incidence of acute cellular (ACR) and antibody-mediated (AMR) rejection and with other risk factors. In our...

INTRODUCTION: Allergic women have been reported to give birth to more children than non-allergic women, speculatively explained by the former's predisposition for Th2 polarization, possibly favoring pregnancy. AIM: The aim of this study was to test the hypothesis that allergy is associated with more Th2-deviated responses to paternal antigens throughout pregnancy. METHODS: Blood samples were collected on six occasions during pregnancy and two occasions postpartum (pp). Of the 86 women initially included, 54 women had a normal pregnancy and completed the sampling procedures. Eleven women fulfilled the strict criteria for allergy (allergic symptoms and circulating IgE antibodies to inhalant allergens) and 23 were strictly non-allergic (non-sensitized without symptoms). The numbers of blood mononuclear cells secreting IFN-gamma and IL-4, spontaneously and in response to paternal alloantigens, were compared between the groups. RESULTS: The numbers of spontaneously as well as paternal antigen-induced IFN-gamma- and IL-4-secreting cells were similar in allergic and non-allergic pregnant women on all occasions. A similar increase in the numbers of both IFN-gamma- and IL-4-secreting cells were found in allergic and non-allergic women during pregnancy, both regarding spontaneous and paternal antigen-induced secretion. CONCLUSIONS: This study does not support the hypothesis of a more pronounced Th2-deviation to paternal antigens in allergic pregnant women compared with non-allergic pregnant women, as measured by number of cytokine-secreting cells. The observed increase of both IFN-gamma- and IL-4-secreting cells during normal pregnancy may be interpreted as a Th2-situation, since the effects of IL-4 predominate over the effects of IFN-gamma.

Os adjuvantes são moléculas, compostos ou complexos macromoleculares que aumentam a potência e a longevidade da resposta imune específica aos antígenos. A sua adição na preparação vacinal aumenta, sustenta e dirige a imunogenicidade de antígenos, modulando de forma eficaz respostas imunes apropriadas, reduzindo a quantidade de antígeno ou número de imunizações necessárias e melhorando a eficácia de vacinas em recém-nascidos, idosos ou indivíduos imunocomprometidos. O objetivo desse estudo foi avaliar a imunogenicidade das preparações antigênicas baseadas em OMVs de Neisseria meningitidis B complexados com dois diferentes adjuvantes, o lípide catiônico brometo de dioctadecildimetilamônio (DODAB-BF) e hidróxido de alumínio (HA) utilizando a via intranasal e a via subcutânea em camundongos neonatos Swiss aplicando o sistema heterólogo prime-booster. Como métodos de estudo foram utilizadas as técnicas universais imunológicas como: Immunoblot, DOT-ELISA, ELISA e ELISpot visando à avaliação da resposta imunológica humoral e celular de camundongos machos e fêmeas. Na análise por Immunoblot avaliou-se a especificidade dos anticorpos com a cepa homóloga e com as bactérias íntegras de N. meningitidis da cepa B:4:P1.19,15. Por DOT-ELISA verificou-se a reatividade cruzada com DODAB-BF para diferentes sorogrupos (B, C, W e Y) e o mesmo não foi observado com HA. Por ELISA foram quantificados e comparados os títulos de anticorpos nos soros pool dos camundongos imunizados com DODAB-BF+OMVs e HA+OMVs para IgG, IgG1 e IgG2a as vias de imunização utilizadas exibiram títulos de IgG. E ambos adjuvantes promoveram a produção de IgG1 e IgG2a variando de acordo com a via de imunização utilizada. Por ELISpot foram analisadas as citocinas IFN-γ e IL-4 e os resultados demonstraram uma resposta direcionada para o perfil Th1 e Th2. / Adjuvants are molecules, compounds or macromolecular complexes that increase the power and longevity of the specific immune response to antigens.Their addition in the vaccine preparation increases, sustains and directs immunogenicity of antigens, effectively modulating appropriate immune responses, reducing the amount of antigen or number of immunizations required, and improving the efficacy of vaccines in infants, the elderly, or immunocompromised patients.The aim of this study was to evaluate the immunogenicity of antigenic from OMVs of N. meningitidis B complexed with two different adjuvants: DODAB-BF and aluminium hydroxide (HA) comparing the evaluation of subcutaneous and intranasal route of immunization for the first time using the prime-boost system in outbred neonatal mice. As universal methods of antibody detection were used: Immunoblot, DOT-ELISA, ELISA and ELISpot aiming for the humoral and cellular immune response and of male and female mice. By Immunoblot analysis the specificity of antibodies with the homologous strain N. meningitidis B:4:P1.19.15. By DOT-ELISA was verified the cross-reactivity with DODAB-BF to different sorogroups (B, C, W and Y) that was not observed with HA. By ELISA the antibodies titers were quantified and compared in the sera of mice immunized with DODAB-BF+OMVs and HA+OMVs for IgG, IgG1 and IgG2a. The immunization routes used exhibited IgG titers, and both adjuvants promoted the production of IgG1 and IgG2a varying according to the route of immunization used. By ELISpot was analyze IFN-γ- and IL-4 and the results showed the response directly to Th1 and Th2 profile.

BACKGROUND: Immune cells promote periodontal bone loss through an unresolved inflammatory response to bacterial pathogens. The limited availability of ex vivo gingival immune cells severely impedes identification of cell types and cell-specific functions that drive human periodontitis and thus impedes the development of effective pharmacotherapeutics. Previous studies have largely relied on mRNA analysis and confocal microscopy to imprecisely estimate gingival immune cell function. The aim of the study was to develop a cell type-specific technique to quantitate function of resident gingival immune cells. METHODS: Diseased tissues from chronic periodontitis in non-diabetes or type 2 diabetes subjects or relatively healthy gingival tissues were removed during standard-of-care surgery for pocket reduction surgery or crown lengthening, respectively. Gingiva was dissociated with collagenase to generate single cell suspensions, then 9-color flow cytometry was used quantitate and/or isolate myeloid cells (CD11b+), B cells (CD20+), T cells (CD4+ or CD8+) and natural killer (NK) cells (CD56+). We stimulated the sorted cells with lineage-appropriate activators for 36 hrs and measured cytokine production by ELISPOT, an assay that identifies individual cytokine-producing cells by fixed “spots” on a solid support. RESULTS: A higher proportion of gingival CD4+ T helper cells and not CD8+cytoxic T cells from subjects with periodontal disease with or without type 2 diabetes produce pro-inflammatory cytokines compared to CD4+ T cells from crown lengthening subjects. CD4+ T cells were the dominant cell population in gingiva from all three groups, and all groups contained similar proportions of cytotoxic (CD8+) T cells, myeloid cells (CD11b+), B cells (CD20+) and natural killer cells (CD56+). CONCLUSION: The combination of flow cytometry, cell sorting and ELISPOT identified CD4+ T cells as dominant immune cells in human periodontal lesions, and identified T cell cytokines that may uniquely promote periodontitis in type 2 diabetes.

<p>Contact allergy is one of the most common skin diseases with great social and economical impact. The origin and nature of contact allergens (haptens) capable of inducing T-cell mediated allergic reactions are diverse, ranging from organic molecules to metal ions. Most of the current knowledge on T-cell responses to haptens in humans with contact allergy have been established by studies on the metal ion nickel (Ni), the most common cause of contact allergy, whereas reactivity to the large group of organic haptens has been less studied.</p><p>Haptens are not immunogenic by themselves but must bind carrier molecules prior to their presentation on MHC class I or II molecules and subsequent recognition by T cells. Due to differences in their chemical nature, haptens interact with host molecules by different mechanisms and differences in their solubility can influence their access to different antigen-presenting pathways.</p><p>The aim of the present study was to define immune responses elicited by haptens of different chemical nature including Ni (hydrophilic metal ion), methylisothiazolinones (hydrophilic organic molecule) and parthenolide (lipophilic organic molecule). The immune response displayed by subjects with allergy to these substances, and non-allergic control subjects, was assessed by measuring hapten-induced cytokine production in peripheral blood mononuclear cells (PBMC) with a focus on ELISpot analysis of T-cell type 1 (e.g. IFN-g and IL-2) and type 2 (e.g. IL-4, IL-5 and IL-13) cytokines. For Ni and parthenolide, the phenotype of the hapten-reactive T cells was determined. The allergic status of subjects was defined by clinical history and patch testing. The latter is the established diagnostic method for contact allergy, based on applying various haptens to the subjects’ back and grading the skin reaction after 2-3 days.</p><p>All three haptens elicited a concomitant T-cell type 1 and 2 response in subjects with contact allergy to the corresponding hapten, suggesting the induction of a functionally related cytokine profile, irrespective of the chemical character of the hapten. The cytokine response was related to the degree of the subjects’ patch test reactivity; PBMC from a vast majority of subjects with strong and moderate patch test reactivity displayed detectable cytokine responses to the corresponding haptens, whereas subjects with weak or no (controls) patch test reactivity did not. Despite the similar cytokine profile induced, the phenotype of the reactive T cells was found to differ between haptens with Ni eliciting CD4+ T cells and parthenolide eliciting CD8+ T cells. This difference may be explained by a better ability of a lipophilic hapten to gain access to the MHC class I-restricted antigen-presentation pathway. Moreover, the data suggest that analysis of cytokine responses to haptens may facilitate future development of <i>in vitro</i>-based diagnostics assay for contact allergy.</p><p>Finally, the relationship between the variation over time in patch test reactivity and systemic reactivity to Ni, in terms of cytokine responses to Ni <i>in vitro</i>, was investigated. The degree of patch test reactivity is known to vary over time, in particular in subjects with weak reactivity. Ni-allergic subjects were patch tested three times with three month intervals and PBMC obtained at the same time points were assessed for<i> in vitro</i> reactivity to Ni. The overall reactivity in the patch test and the <i>in vitro</i> test was well correlated confirming that both methods provide a good and comparable estimate of the systemic reactivity to Ni. However, fluctuations in the patch test reactivity over time were not well correlated with variations in the cytokine response elicited <i>in vitro</i> suggesting that other parameters besides changes in the systemic reactivity could significantly contribute to the variation in patch test reaction over time.</p>

Contact allergy is one of the most common skin diseases with great social and economical impact. The origin and nature of contact allergens (haptens) capable of inducing T-cell mediated allergic reactions are diverse, ranging from organic molecules to metal ions. Most of the current knowledge on T-cell responses to haptens in humans with contact allergy have been established by studies on the metal ion nickel (Ni), the most common cause of contact allergy, whereas reactivity to the large group of organic haptens has been less studied. Haptens are not immunogenic by themselves but must bind carrier molecules prior to their presentation on MHC class I or II molecules and subsequent recognition by T cells. Due to differences in their chemical nature, haptens interact with host molecules by different mechanisms and differences in their solubility can influence their access to different antigen-presenting pathways. The aim of the present study was to define immune responses elicited by haptens of different chemical nature including Ni (hydrophilic metal ion), methylisothiazolinones (hydrophilic organic molecule) and parthenolide (lipophilic organic molecule). The immune response displayed by subjects with allergy to these substances, and non-allergic control subjects, was assessed by measuring hapten-induced cytokine production in peripheral blood mononuclear cells (PBMC) with a focus on ELISpot analysis of T-cell type 1 (e.g. IFN-g and IL-2) and type 2 (e.g. IL-4, IL-5 and IL-13) cytokines. For Ni and parthenolide, the phenotype of the hapten-reactive T cells was determined. The allergic status of subjects was defined by clinical history and patch testing. The latter is the established diagnostic method for contact allergy, based on applying various haptens to the subjects’ back and grading the skin reaction after 2-3 days. All three haptens elicited a concomitant T-cell type 1 and 2 response in subjects with contact allergy to the corresponding hapten, suggesting the induction of a functionally related cytokine profile, irrespective of the chemical character of the hapten. The cytokine response was related to the degree of the subjects’ patch test reactivity; PBMC from a vast majority of subjects with strong and moderate patch test reactivity displayed detectable cytokine responses to the corresponding haptens, whereas subjects with weak or no (controls) patch test reactivity did not. Despite the similar cytokine profile induced, the phenotype of the reactive T cells was found to differ between haptens with Ni eliciting CD4+ T cells and parthenolide eliciting CD8+ T cells. This difference may be explained by a better ability of a lipophilic hapten to gain access to the MHC class I-restricted antigen-presentation pathway. Moreover, the data suggest that analysis of cytokine responses to haptens may facilitate future development of in vitro-based diagnostics assay for contact allergy. Finally, the relationship between the variation over time in patch test reactivity and systemic reactivity to Ni, in terms of cytokine responses to Ni in vitro, was investigated. The degree of patch test reactivity is known to vary over time, in particular in subjects with weak reactivity. Ni-allergic subjects were patch tested three times with three month intervals and PBMC obtained at the same time points were assessed for in vitro reactivity to Ni. The overall reactivity in the patch test and the in vitro test was well correlated confirming that both methods provide a good and comparable estimate of the systemic reactivity to Ni. However, fluctuations in the patch test reactivity over time were not well correlated with variations in the cytokine response elicited in vitro suggesting that other parameters besides changes in the systemic reactivity could significantly contribute to the variation in patch test reaction over time.

During pregnancy, the woman carries a fetus partly foreign to her immune system, because of the expression of paternal antigens. Despite this, the fetus is normally tolerated and not rejected, as is often the case with organs in allogeneic transplantations. Systemic changes in maternal blood occur during pregnancy but, perhaps of greater importance, are changes in tissues locally in the uterus. The pregnant uterine endometrium, the decidua, is infiltrated by large numbers of leukocytes, mainly natural killer (NK) cells but also macrophages and T lymphocytes. Further, various cytokines are known to be secreted at the fetomaternal interface. However, the functions of these cells and the cytokine networks are not fully understood. The aim of this thesis was to investigate the local immune balance in normal human pregnancy decidua, both in the early phase of pregnancy and at parturition. First trimester decidual mononuclear cells, NK cells and macrophages were all shown to secrete IFN-γ, IL-4 and IL-10, as detected by ELISPOT. The secretion was not mirrored in blood from the same subjects. A significantly larger number of decidual macrophages secreted IL-10 than did their blood counterparts, indicating potential regulatory functions of this cell type. Further examination of early pregnancy decidual macrophages by microarray revealed 120 genes being differentially regulated at the transcriptional level in decidual compared to blood monocytes/macrophages. Several genes were associated with alternative activation/M2 polarization of macrophages, including CCL-18, CD209, IGF-1, MRC-1 and FN-1. Genes connected to immune regulation and tissue remodelling were common, in line with the potential functions for this cell type in utero. In addition, some molecules not previously connected to decidual macrophages, such as TREM-2, A2M and PGDS, were found to be upregulated, gaining new insights into the regulatory functions of decidual macrophages. Term decidual mononuclear cells spontaneously secrete IFN-γ, TNF, IL-4, IL-10, and TGF-β. No differences were seen between tissues obtained before and after the onset of labour, indicating that decidual mononuclear cells are not the main cell population responsible for plausible cytokine regulation in the process of labour induction. Placental and fetal membranes as well as cells in the maternal systemic circulation may instead contribute to a possible shift in immune balance prior to pregnancy termination. In conclusion, decidual leukocytes, including NK cells and macrophages, are potential producers of both Th1-like/pro-inflammatory and Th2-like/anti-inflammatory cytokines in early pregnancy as well as at parturition. Decidual macrophages are of a specialized phenotype with effector functions contributing to a proper invasion of the placenta and to immunological protection of the semi-allogeneic fetus. This thesis adds new knowledge on local immune balance during normal human pregnancy, however, the clinical significance of the presented data needs to be clarified.

Die Nierentransplantation ermöglicht Patienten die Wiederherstellung der Nierenfunktion. Aufgrund der begrenzten Verfügbarkeit an Organen nimmt dabei die Zahl der Transplantationen von einem lebenden Spender stetig zu. Zudem ermöglichen die präzisen und genauen Vorbereitungen und Abläufe bei Lebendnierenspenden eine bessere 5-Jahres-Überlebensrate als bei Kadaverspenden. Die genetische Verschiedenheit zwischen Spender und Empfänger bedingt jedoch eine lebenslange immunsuppressive Therapie, um Abstoßungsreaktionen und damit das Scheitern einer Organtransplantation zu verhindern. An den Universitätskliniken Leipzig und Halle/Saale besteht diese Therapie aus einer Dreifachkombination von Tacrolimus, Mycophenolat-Mofetil und Prednisolon, wobei mögliche Nebenwirkungen wie opportunistische Infektionen, kardiovaskuläre und metabolische Erkrankungen sowie Tumore in Kauf genommen werden. Zudem besteht für den immunsupprimmierten Organismus die ständige Gefahr einer Abstoßungsreaktion. Diese Aspekte führen bei den Empfängern zu einer massiven Einschränkung der Gesundheit und Lebensqualität. Inwieweit die ausgeprägte Immunsuppression notwendig ist, bleibt unklar und muss individuell festgelegt werden. Bisher existiert kein geeignetes Verfahren für ein Immunmonitoring, weshalb in vielen Fällen eine umfangreiche und überdosierte Immunsuppression in Kauf genommen wird. Im Rahmen dieser Arbeit wurde ein geeignetes Testverfahren, der Elispot-Assay, für die Expression der beiden proinflammatorischen Zytokine IFN-γ und IL-17 erstellt. Dafür wurden die PBMC der Spender und Empfänger aus Vollblut separiert, um sie anschließend sowohl separat als auch in einer Lymphozytenmischreaktion zu untersuchen. Die Darstellung von IL-17 konnte nur aufgrund einer zusätzlichen Stimulation mit OKT3 gelingen, während der IFN-γ-Elispot sowohl im Leerwert als auch unter Stimulation mit IL-2 zu ausreichenden Spotanzahlen führte. Die Spotanzahlen der Spender-PBMC wurden mit Hilfe von γ-Strahlung signifikant reduziert (IFN-γ: p=0,047 | IFN-γ + IL-2: p=0,007 | IL-17: p = 0,001), um in den Lymphozytenmischreaktionen die alleinige Zytokinausschüttung der Empfänger-PBMC messen zu können. Die Spender- PBMC fungierten dabei nur als Antigene. Insgesamt konnten zwischen 2009 und 2012 zwölf von siebzehn Patientenpaaren in die Studie eingeschlossen werden. Die Spotanzahlen der Paare wurden dabei sowohl im IFN-γ- als auch im IL-17-Elispot-Assay zu vier unterschiedlichen Zeitpunkten gemessen (vor Transplantation | 21±3 d postoperativ | 28±3 d postoperativ | 75±15 d postoperativ). In den meisten Fällen zeigte sich vor Transplantation eine erhöhte Spotanzahl im Vergleich zu den drei postoperativen Werten. Zudem stiegen die Spotanzahlen sowohl für IFN-γ als auch für IL-17 nach niedrigen Messergebnissen kurz nach der Transplantation im postoperativen Verlauf wieder an und erreichten in einigen Fällen die Spotanzahl der präoperativen Ausgangswerte. Ein signifikanter Unterschied konnte aufgrund der geringen Fallzahl nicht erreicht werden. Die kurzfristige Reduktion der Spotanzahlen postoperativ ist dabei aller Wahrscheinlichkeit nach auf die hohen Dosen an immunsuppressiven Medikamenten zurückzuführen. Insgesamt zeigten die Verläufe der IFN-γ- und der IL-17- Elispot-Assays ähnliche Verläufe. Daraus lässt sich schlussfolgern, dass der IL-17-Elispot- Assay in Bezug auf mögliche Abstoßungsreaktionen eine ähnliche Aussagekraft besitzen könnte wie der bereits vielfach untersuchte IFN-γ-Elispot-Assay. Weiterhin wurden die Messergebnisse mit der Serumkreatininmolarität verglichen. Diese zeigte präoperativ höhere Molaritäten als postoperativ, wobei die postoperativen Molaritäten im Verlauf, im Gegensatz zu den Elispot-Messungen, abnahmen, was das Einsetzen der Nierenfunktion widerspiegelt. Unter den zwölf Patientenpaaren gab es keine einzige nachgewiesene akute Abstoßungsreaktion, der Verlauf der Serumkreatininmolaritäten war bei allen zwölf Empfängern vergleichbar. Demzufolge konnten die Werte der Elispot-Assays nicht herangezogen werden, um an ihnen eine Abstoßungsreaktion der transplantierten Nieren erkennen zu können. Das präoperative Abschätzen einer möglichen Abstoßungsreaktion anhand der Elispot-Assays konnte aufgrund fehlender Abstoßungsreaktionen ebenfalls nicht untersucht werden. Zusätzlich wurde bei den Patienten eine HLA-Typisierung vorgenommen, wobei der Bereich von optimalen bis maximal ungünstigen Konstellationen reichten (HLA-Mismatch: 0-0-0 bis 2-2-2). Auch hier konnten die Ergebnisse nicht mit möglichen Abstoßungsreaktionen verglichen werden. In der vorliegenden Arbeit wurden zahlreiche Varianten untersucht, die das Abschätzen einer Immunreaktion nach Nierentransplantation (Immunmonitoring) ermöglichen könnten. Aufgrund fehlender Abstoßungsreaktionen bei den Empfängern konnte das Testverfahren nicht an den klinischen Verläufen validiert werden. Mit dem in dieser Arbeit entwickelten Messverfahren kann jedoch eine neue und größer angelegte Studie erfolgen, die in Zukunft ein Immunmonitoring bei Patienten nach Nierentransplantation ermöglicht. / Introduction Since the first kidney transplantation in the 1950ies, kidney transplantation is still being challenged by graft dysfunction and complete graft failure. Permanent immunsuppressive treatment is mandatory to avoid an unfavourable outcome. The treatment with Prednisolone, Tacrolimus and Mycophenolat-Mofetil may cause toxic side effects resulting in Diabetes mellitus, hypertension, infections and cancer. In the present study we tried to demonstrate that the amount of spots in the Enzyme linked immunospot assay (Elispot-Assay) of IFN-γ and IL-17 correlates with the probability of graft dysfuction and complete graft failure. We also compared the results to clinical parameters. Methods Between the years 2009 and 2012, twelve pairs of related living kidney transplantations were included in this study. From each pair blood samples were taken at four time points (before transplantation, and at 21±3, 28±3 and 75±15 days after kidney transplantation, respectively). After establishing the technique of IFN-γ- and IL-17-Elispot-Assays, we separated the periphale blood mononuclear cells (PBMC) and performed follow up examinations at the four time points mentioned above. The PBMC of each donor and each recipient were examined separatly, and in addition together in a lymphocyte mixed reaction. We stimulated the PBMC of the IFN-γ-Elispot with Interleukin-2 (IL-2) and the PBMC of the IL-17-Elispot with OKT3 to get significant characteristics. PBMC of the donors were irradiated with 30 Gy before mixing them with the PBMC of the recipients. We also took the HLA-matches and serum creatinine molarity to compare important clinical parameters with the results of the Elispot-Assays. Results Sufficient spots were measured using the unstimulated and stimulated IFN-γ-Elispot and the stimulated IL-17-Elispot. Radiation was significant at all three tests (IFN-γ: p=0,047 | IFN-γ + IL-2: p=0,007 | IL-17: p = 0,001). All twelve recipients showed a high number of spots before transplantation in both types of Elispot-Assays and most of them an increasing number of spots after a minimal turning point three weeks after transplantation. Due to the small number of cases, no significant results could be obtained at follow up. Non recipient developed a graft rejection as proven by biopsy or graft failure. The molarity of serum creatinine was permanently reduced whereas it was high before transplantation. Because of the abscence of any rejection episodes, HLA matches could not be compared. Discussion Due to the absence of rejection episodes or graft failure, no prediction for rejection by the IFN-γ- and IL-17-Elispot was possible. The low number of cases of living related kidney transplantation demonstrated the challange of the investigation of living related kidney transplantation. Although we could prove a significant effect of the irradiation of PBMC, there was no significant result in the follow up investigations. A higher number of cases are needed in future investigations. The established method of the IFN-γ- and IL-17-Elispot can be used in a future study with an extended number of cases and a longer follow up of time.

Die Nierentransplantation ermöglicht Patienten die Wiederherstellung der Nierenfunktion. Aufgrund der begrenzten Verfügbarkeit an Organen nimmt dabei die Zahl der Transplantationen von einem lebenden Spender stetig zu. Zudem ermöglichen die präzisen und genauen Vorbereitungen und Abläufe bei Lebendnierenspenden eine bessere 5-Jahres-Überlebensrate als bei Kadaverspenden. Die genetische Verschiedenheit zwischen Spender und Empfänger bedingt jedoch eine lebenslange immunsuppressive Therapie, um Abstoßungsreaktionen und damit das Scheitern einer Organtransplantation zu verhindern. An den Universitätskliniken Leipzig und Halle/Saale besteht diese Therapie aus einer Dreifachkombination von Tacrolimus, Mycophenolat-Mofetil und Prednisolon, wobei mögliche Nebenwirkungen wie opportunistische Infektionen, kardiovaskuläre und metabolische Erkrankungen sowie Tumore in Kauf genommen werden. Zudem besteht für den immunsupprimmierten Organismus die ständige Gefahr einer Abstoßungsreaktion. Diese Aspekte führen bei den Empfängern zu einer massiven Einschränkung der Gesundheit und Lebensqualität. Inwieweit die ausgeprägte Immunsuppression notwendig ist, bleibt unklar und muss individuell festgelegt werden. Bisher existiert kein geeignetes Verfahren für ein Immunmonitoring, weshalb in vielen Fällen eine umfangreiche und überdosierte Immunsuppression in Kauf genommen wird. Im Rahmen dieser Arbeit wurde ein geeignetes Testverfahren, der Elispot-Assay, für die Expression der beiden proinflammatorischen Zytokine IFN-γ und IL-17 erstellt. Dafür wurden die PBMC der Spender und Empfänger aus Vollblut separiert, um sie anschließend sowohl separat als auch in einer Lymphozytenmischreaktion zu untersuchen. Die Darstellung von IL-17 konnte nur aufgrund einer zusätzlichen Stimulation mit OKT3 gelingen, während der IFN-γ-Elispot sowohl im Leerwert als auch unter Stimulation mit IL-2 zu ausreichenden Spotanzahlen führte. Die Spotanzahlen der Spender-PBMC wurden mit Hilfe von γ-Strahlung signifikant reduziert (IFN-γ: p=0,047 | IFN-γ + IL-2: p=0,007 | IL-17: p = 0,001), um in den Lymphozytenmischreaktionen die alleinige Zytokinausschüttung der Empfänger-PBMC messen zu können. Die Spender- PBMC fungierten dabei nur als Antigene. Insgesamt konnten zwischen 2009 und 2012 zwölf von siebzehn Patientenpaaren in die Studie eingeschlossen werden. Die Spotanzahlen der Paare wurden dabei sowohl im IFN-γ- als auch im IL-17-Elispot-Assay zu vier unterschiedlichen Zeitpunkten gemessen (vor Transplantation | 21±3 d postoperativ | 28±3 d postoperativ | 75±15 d postoperativ). In den meisten Fällen zeigte sich vor Transplantation eine erhöhte Spotanzahl im Vergleich zu den drei postoperativen Werten. Zudem stiegen die Spotanzahlen sowohl für IFN-γ als auch für IL-17 nach niedrigen Messergebnissen kurz nach der Transplantation im postoperativen Verlauf wieder an und erreichten in einigen Fällen die Spotanzahl der präoperativen Ausgangswerte. Ein signifikanter Unterschied konnte aufgrund der geringen Fallzahl nicht erreicht werden. Die kurzfristige Reduktion der Spotanzahlen postoperativ ist dabei aller Wahrscheinlichkeit nach auf die hohen Dosen an immunsuppressiven Medikamenten zurückzuführen. Insgesamt zeigten die Verläufe der IFN-γ- und der IL-17- Elispot-Assays ähnliche Verläufe. Daraus lässt sich schlussfolgern, dass der IL-17-Elispot- Assay in Bezug auf mögliche Abstoßungsreaktionen eine ähnliche Aussagekraft besitzen könnte wie der bereits vielfach untersuchte IFN-γ-Elispot-Assay. Weiterhin wurden die Messergebnisse mit der Serumkreatininmolarität verglichen. Diese zeigte präoperativ höhere Molaritäten als postoperativ, wobei die postoperativen Molaritäten im Verlauf, im Gegensatz zu den Elispot-Messungen, abnahmen, was das Einsetzen der Nierenfunktion widerspiegelt. Unter den zwölf Patientenpaaren gab es keine einzige nachgewiesene akute Abstoßungsreaktion, der Verlauf der Serumkreatininmolaritäten war bei allen zwölf Empfängern vergleichbar. Demzufolge konnten die Werte der Elispot-Assays nicht herangezogen werden, um an ihnen eine Abstoßungsreaktion der transplantierten Nieren erkennen zu können. Das präoperative Abschätzen einer möglichen Abstoßungsreaktion anhand der Elispot-Assays konnte aufgrund fehlender Abstoßungsreaktionen ebenfalls nicht untersucht werden. Zusätzlich wurde bei den Patienten eine HLA-Typisierung vorgenommen, wobei der Bereich von optimalen bis maximal ungünstigen Konstellationen reichten (HLA-Mismatch: 0-0-0 bis 2-2-2). Auch hier konnten die Ergebnisse nicht mit möglichen Abstoßungsreaktionen verglichen werden. In der vorliegenden Arbeit wurden zahlreiche Varianten untersucht, die das Abschätzen einer Immunreaktion nach Nierentransplantation (Immunmonitoring) ermöglichen könnten. Aufgrund fehlender Abstoßungsreaktionen bei den Empfängern konnte das Testverfahren nicht an den klinischen Verläufen validiert werden. Mit dem in dieser Arbeit entwickelten Messverfahren kann jedoch eine neue und größer angelegte Studie erfolgen, die in Zukunft ein Immunmonitoring bei Patienten nach Nierentransplantation ermöglicht.:I Inhaltsverzeichnis................................................................I II Bibliographische Beschreibung....................................................................IV III Abkürzungsverzeichnis...................................................................................V 1 Einleitung...........................................................................................................01 1.1 Die T-Zell-vermittelte Immunität..................................................................01 1.1.1 Die verschiedenen Klassen der T-Lymphozyten................................ 01 1.1.2 Interferon-gamma als proinflammatorisches Zytokin......................... 04 1.1.3 Interleukin-17............................................................................................. 04 1.2 Die Nierentransplantation........................................................................... 05 1.2.1 Einführung.................................................................................................. 05 1.2.2 Besonderheiten der Lebendnierenspenden........................................ 06 1.3 Therapeutika bei Lebendnierenspenden................................................. 07 1.3.1 Calcineurininhibitoren............................................................................... 07 1.3.2 Prednisolon.................................................................................................. 08 1.3.3 Mycophenolat-Mofetil................................................................................. 09 1.4 Komplikationen bei Transplantationen....................................................... 10 1.4.1 Opportunistische Infektionen..................................................................... 10 1.4.2 Kardiovaskuläre und metabolische Erkrankungen................................ 11 1.4.3 Maligne Tumore.............................................................................................11 1.5 Transplantatrejektion........................................................................................ 12 1.5.1 Akute Abstoßungsreaktion............................................................................12 1.5.2 Chronische Transplantatnephropathie......................................................13 1.6 Zielsetzung der Arbeit.......................................................................................15 I2 Materialien und Methoden................................................................................. 16 2.1 Studiendesign.................................................................................................... 16 2.2 Materialien.......................................................................................................... 17 2.3 Methoden............................................................................................................ 19 2.3.1 Blutentnahmen................................................................................................ 19 2.3.2 Lymphozytenseparation.................................................................................19 2.3.3 Bestimmung der Zellzahl............................................................................... 20 2.3.4 Kryokonservierung der Zellen...................................................................... 20 2.3.5 Auftauen von kryokonservierten Zellen...................................................... 20 2.3.6 Bestrahlung von Zellen...................................................................................21 2.3.7 Stimulanzien.................................................................................................... 21 2.3.8 Durchflusszytometrie...................................................................................... 22 2.3.9 Elispot-Assay.................................................................................................... 23 3 Ergebnisse............................................................................................................... 29 3.1 Charakteristika der Patienten............................................................................ 29 3.2 Medikamentöse Therapieschemata nach Nierentransplantationen.......... 32 3.3 Versuche zur Etablierung des Elispot-Verfahrens......................................... 33 3.3.1 Vorversuche zum Nachweis von IFN-γ........................................................ 34 3.3.2 Vorversuche zum Nachweis von IL-17........................................................ 36 3.3.3 Versuche mit FKS-freiem Medium.................................................................37 3.3.4 Vitalitätsmessung in der Durchflusszytometrie.......................................... 38 3.4 Vergleich von Buffy Coats mit Patientenproben im Elispot-Assay..............38 3.5 Elispot-Assays der Spender-Empfänger-Paare............................................ 39 3.5.1 Ergebnisse der Elispot-Assays zum Nachweis von IFN-γ........................40 3.5.2 Ergebnisse der Elispot-Assays zum Nachweis von IL-17....................... 45 II3.6 Elispot-Ergebnisse unter Berücksichtigung der HLA-Kompatibilität........49 4 Diskussion............................................................................................................... 50 4.1 Bewertung der Methoden.................................................................................. 51 4.1.1 Patientenauswahl und -akquirierung........................................................... 51 4.1.2 Durchflusszytometrie....................................................................................... 51 4.1.3 Elispot-Assay..................................................................................................... 52 4.2 Vitalitätsmessung................................................................................................. 53 4.3 Elispot-Ergebnisse............................................................................................... 53 4.3.1 Vergleich der unbestrahlten und bestrahlten Elispot-Assays................... 53 4.3.2 Elispot-Assays der Patienten.......................................................................... 54 4.3.2.1 IFN-γ-Elispot-Assay........................................................................................ 54 4.3.2.2 IL-17-Elispot-Assay.........................................................................................56 4.3.2.3 IFN-γ-Elispot-Assay und IL-17-Elispot-Assay im Vergleich.................... 57 4.4 HLA-Merkmale und Serumkreatininmolarität...................................................58 4.5 Schlussfolgerung und Ausblick...........................................................................59 5 Zusammenfassung...................................................................................................62 6 Abstract...................................................................................................................... 65 7 Literaturverzeichnis................................................................................................. 67 8 Tabellenverzeichnis.................................................................................................83 9 Abbildungsverzeichnis........................................................................................... 84 10 Erklärung über die eigenständige Verfassung der Arbeit............................. 85 11 Lebenslauf..............................................................................................................86 12 Danksagung.......................................................................................................... 87 / Introduction Since the first kidney transplantation in the 1950ies, kidney transplantation is still being challenged by graft dysfunction and complete graft failure. Permanent immunsuppressive treatment is mandatory to avoid an unfavourable outcome. The treatment with Prednisolone, Tacrolimus and Mycophenolat-Mofetil may cause toxic side effects resulting in Diabetes mellitus, hypertension, infections and cancer. In the present study we tried to demonstrate that the amount of spots in the Enzyme linked immunospot assay (Elispot-Assay) of IFN-γ and IL-17 correlates with the probability of graft dysfuction and complete graft failure. We also compared the results to clinical parameters. Methods Between the years 2009 and 2012, twelve pairs of related living kidney transplantations were included in this study. From each pair blood samples were taken at four time points (before transplantation, and at 21±3, 28±3 and 75±15 days after kidney transplantation, respectively). After establishing the technique of IFN-γ- and IL-17-Elispot-Assays, we separated the periphale blood mononuclear cells (PBMC) and performed follow up examinations at the four time points mentioned above. The PBMC of each donor and each recipient were examined separatly, and in addition together in a lymphocyte mixed reaction. We stimulated the PBMC of the IFN-γ-Elispot with Interleukin-2 (IL-2) and the PBMC of the IL-17-Elispot with OKT3 to get significant characteristics. PBMC of the donors were irradiated with 30 Gy before mixing them with the PBMC of the recipients. We also took the HLA-matches and serum creatinine molarity to compare important clinical parameters with the results of the Elispot-Assays. Results Sufficient spots were measured using the unstimulated and stimulated IFN-γ-Elispot and the stimulated IL-17-Elispot. Radiation was significant at all three tests (IFN-γ: p=0,047 | IFN-γ + IL-2: p=0,007 | IL-17: p = 0,001). All twelve recipients showed a high number of spots before transplantation in both types of Elispot-Assays and most of them an increasing number of spots after a minimal turning point three weeks after transplantation. Due to the small number of cases, no significant results could be obtained at follow up. Non recipient developed a graft rejection as proven by biopsy or graft failure. The molarity of serum creatinine was permanently reduced whereas it was high before transplantation. Because of the abscence of any rejection episodes, HLA matches could not be compared. Discussion Due to the absence of rejection episodes or graft failure, no prediction for rejection by the IFN-γ- and IL-17-Elispot was possible. The low number of cases of living related kidney transplantation demonstrated the challange of the investigation of living related kidney transplantation. Although we could prove a significant effect of the irradiation of PBMC, there was no significant result in the follow up investigations. A higher number of cases are needed in future investigations. The established method of the IFN-γ- and IL-17-Elispot can be used in a future study with an extended number of cases and a longer follow up of time.:I Inhaltsverzeichnis................................................................I II Bibliographische Beschreibung....................................................................IV III Abkürzungsverzeichnis...................................................................................V 1 Einleitung...........................................................................................................01 1.1 Die T-Zell-vermittelte Immunität..................................................................01 1.1.1 Die verschiedenen Klassen der T-Lymphozyten................................ 01 1.1.2 Interferon-gamma als proinflammatorisches Zytokin......................... 04 1.1.3 Interleukin-17............................................................................................. 04 1.2 Die Nierentransplantation........................................................................... 05 1.2.1 Einführung.................................................................................................. 05 1.2.2 Besonderheiten der Lebendnierenspenden........................................ 06 1.3 Therapeutika bei Lebendnierenspenden................................................. 07 1.3.1 Calcineurininhibitoren............................................................................... 07 1.3.2 Prednisolon.................................................................................................. 08 1.3.3 Mycophenolat-Mofetil................................................................................. 09 1.4 Komplikationen bei Transplantationen....................................................... 10 1.4.1 Opportunistische Infektionen..................................................................... 10 1.4.2 Kardiovaskuläre und metabolische Erkrankungen................................ 11 1.4.3 Maligne Tumore.............................................................................................11 1.5 Transplantatrejektion........................................................................................ 12 1.5.1 Akute Abstoßungsreaktion............................................................................12 1.5.2 Chronische Transplantatnephropathie......................................................13 1.6 Zielsetzung der Arbeit.......................................................................................15 I2 Materialien und Methoden................................................................................. 16 2.1 Studiendesign.................................................................................................... 16 2.2 Materialien.......................................................................................................... 17 2.3 Methoden............................................................................................................ 19 2.3.1 Blutentnahmen................................................................................................ 19 2.3.2 Lymphozytenseparation.................................................................................19 2.3.3 Bestimmung der Zellzahl............................................................................... 20 2.3.4 Kryokonservierung der Zellen...................................................................... 20 2.3.5 Auftauen von kryokonservierten Zellen...................................................... 20 2.3.6 Bestrahlung von Zellen...................................................................................21 2.3.7 Stimulanzien.................................................................................................... 21 2.3.8 Durchflusszytometrie...................................................................................... 22 2.3.9 Elispot-Assay.................................................................................................... 23 3 Ergebnisse............................................................................................................... 29 3.1 Charakteristika der Patienten............................................................................ 29 3.2 Medikamentöse Therapieschemata nach Nierentransplantationen.......... 32 3.3 Versuche zur Etablierung des Elispot-Verfahrens......................................... 33 3.3.1 Vorversuche zum Nachweis von IFN-γ........................................................ 34 3.3.2 Vorversuche zum Nachweis von IL-17........................................................ 36 3.3.3 Versuche mit FKS-freiem Medium.................................................................37 3.3.4 Vitalitätsmessung in der Durchflusszytometrie.......................................... 38 3.4 Vergleich von Buffy Coats mit Patientenproben im Elispot-Assay..............38 3.5 Elispot-Assays der Spender-Empfänger-Paare............................................ 39 3.5.1 Ergebnisse der Elispot-Assays zum Nachweis von IFN-γ........................40 3.5.2 Ergebnisse der Elispot-Assays zum Nachweis von IL-17....................... 45 II3.6 Elispot-Ergebnisse unter Berücksichtigung der HLA-Kompatibilität........49 4 Diskussion............................................................................................................... 50 4.1 Bewertung der Methoden.................................................................................. 51 4.1.1 Patientenauswahl und -akquirierung........................................................... 51 4.1.2 Durchflusszytometrie....................................................................................... 51 4.1.3 Elispot-Assay..................................................................................................... 52 4.2 Vitalitätsmessung................................................................................................. 53 4.3 Elispot-Ergebnisse............................................................................................... 53 4.3.1 Vergleich der unbestrahlten und bestrahlten Elispot-Assays................... 53 4.3.2 Elispot-Assays der Patienten.......................................................................... 54 4.3.2.1 IFN-γ-Elispot-Assay........................................................................................ 54 4.3.2.2 IL-17-Elispot-Assay.........................................................................................56 4.3.2.3 IFN-γ-Elispot-Assay und IL-17-Elispot-Assay im Vergleich.................... 57 4.4 HLA-Merkmale und Serumkreatininmolarität...................................................58 4.5 Schlussfolgerung und Ausblick...........................................................................59 5 Zusammenfassung...................................................................................................62 6 Abstract...................................................................................................................... 65 7 Literaturverzeichnis................................................................................................. 67 8 Tabellenverzeichnis.................................................................................................83 9 Abbildungsverzeichnis........................................................................................... 84 10 Erklärung über die eigenständige Verfassung der Arbeit............................. 85 11 Lebenslauf..............................................................................................................86 12 Danksagung.......................................................................................................... 87

The swine whipworm, Trichuris suis, is a parasite present throughout the United States and is of concern to the swine industry worldwide because it is very pathogenic to growing pigs. The economic threat posed by T. suis and other intestinal parasite infections has created a strong interest in the development of parasite vaccines for the swine industry. Use of a vaccine either alone or with anthelmintics should reduce the economic losses. However, before effective parasite vaccines can be created, the swine gastrointestinal immune response to parasite antigens must be understood. In this study, an enzyme-linked immunospot (ELISPOT) assay was developed to measure total and antigen-specific IgG and IgA antibody secreting cells (ASC) from gut-associated lymphoid tissues (GALT) [mesenteric lymph node explants from jejunal region of small intestine (SI-MLN) and cecum in large intestine (C-MLN); and ileocecal Peyer's patches (IC-PP)] and lamina propria from the proximal colon removed from T. suis infected pigs. Tbe local antibody responses were compared to peripheral antibody responses found in the spleen and submandibular lymph nodes. The hypotheses to be tested was that parasite antigen-specific antibody secreting cells would be greatest in lymphoid tissue draining the site of infection compared to peripheral lymphoid tissues and that 19A ASC would predominate over IgG ASC in the lamina propria of T. suis infected pigs. The total IgG and IgA ASC frequencies for the spleen, SI-MLN, and ICPP did not significantly change (P> 0.05) over time. For C-MLN, there was a significant increase (p< 0.05) of total IgG ASC during a primary infection with T. suis. Antigen-specific IgG ASC were greatest at the GALT site closest to the infection, CMLN, whereas, antigen-specific IgA ASC predominated in the proximal colonic: lamina propria. Host protection to T. suis develops after anthelmintic: treatment of a primary exposure to parasite. The ELISPOT assay provided valuable information on the localization and compartmentalization of the swine gastrointestinal immune response to T. suis which resides in the cecum and proximal colon. In the future, this technique may be useful for monitoring gastrointestinal immune parameters of pigs exposed to a T. sllis vaccine. / Ph. D.