Acute graft versus host disease (aGVHD) affects more than 40% of patients undergoing haematopoietic stem cell transplantation. aGVHD occurs after transplantation of donor haematopoietic cells into hosts incapable of rejecting the donor cells, when donor T cells attack host tissue. Despite extensive efforts, aGVHD remains problematic to prevent and difficult to control. Current therapies to prevent aGVHD induce profound immunosuppression, leaving patients at increased risk of infection and leukaemic relapse. Dendritic cells (DC) are professional antigen presenting cells of haematopoietic origin and are the primary stimulators of the immune system, uniquely being able to activate naïve T cells. A growing body of evidence suggests that DC are responsible for the stimulation of the donor T cells which cause aGVHD. I have used a model of aGVHD which utilizes conditioned severe combined immunodeficient mice transplanted with human peripheral blood mononuclear cells (PBMC). In this model human CD4+ T cells appear to be responsible for an aGVHD-like syndrome which results in death 15-30 days post transplant. I have shown, using in vitro depletion of individual populations, that other subpopulations of human PBMC did not affect the survival of the mice. I have also demonstrated that human DC are required for the induction of aGVHD in the majority of mice. This novel finding validated the use of this model to test the primary hypothesis; that antibody mediated depletion of DC would prevent aGVHD. The murine IgM monoclonal antibody (Mab), CMRF-44 Mab, is specific for an unknown molecule expressed on the surface of activated human DC. Previous work had shown that when mixed lymphocyte reaction stimulator cells were depleted of CMRF-44+ cells, there was a significant reduction in the proliferation of responder cells. Here I tested the efficacy of CMRF-44 as a therapy for the prevention of aGVHD in the model. CMRF-44 Mab did not improve survival of mice treated with human PBMC, despite recent data showing that CMRF-44 expression on DC was predictive of aGVHD in patients. In vitro depletion of CMRF-44+ cells from human PBMC prior to transplantation also did not reduce incidence of aGVHD. An alternate target for the depletion of human DC was CD83 which is also expressed on the surface of activated human DC. I generated a rabbit polyclonal antibody using a human CD83 fusion protein, which was then affinity purified in a multi-step process which yielded only antibody specific for human CD83. Treatment with this antibody greatly improved survival of transplanted mice. Further experiments showed that anti-CD83 treatment did not abrogate human leucocytes including CD8+ memory T cells suggesting that a therapy using an anti-CD83 antibody has the potential to prevent aGVHD without the immunosuppression associated with current anti-aGVHD therapies. The work described here has validated the use of a human mouse chimeric model as an in vivo assay of human DC function and shown that targeting CD83 has the potential to reduce the incidence of clinical aGVHD whilst preserving donor memory T cells.

Thesis (Ph. D.)--Ohio State University, 2006. / Available online via OhioLINK's ETD Center; full text release delayed at author's request until 2009 Apr 26

There is an urgent need for novel preventive and therapeutic strategies for graft versus host disease (GvHD) occurring after allogeneic hematopoietic cell transplantation (allo-HCT). T-cell-based immunotherapies have been developed, however there are still some hurdles for the use of currently availably regulatory T-cells in clinical practice (naturally occurring FOXP3 + nTregs and inducible regulatory T cells), mainly owing to the lack of specific cell surface markers. The hypomethylating agent azacytidine (5-aza-dC) has been shown to generate immunoregulatory T-cells ex vivo. Interestingly, it has been shown that genes other than FOXP3 are responsible for the suppressor function of 5-aza-dC induced T-regs. HLA-G is a surface molecule with potent immunoregulatory functions which is normally expressed during pregnancy protecting the “semi-allogeneic” fetus from maternal immune attack and then is epigenetically repressed. The aim of this study was the induction of HLA-G expression in T-lymphocytes with the use of the demethylating agent 5-Aza-dC and investigation of their possible immunoregulatory properties. Our results showed that short in vitro treatment of peripheral blood T-cells with 5-aza-dC induces HLA-G expression and, more importantly, these induced HLA-G + T-cells could suppress lymphoproliferation when added as third party cells in mixed lymphocyte cultures. This suppression seems to be reduced after HLA-G neutralization and cell-to-cell contact independent. Furthermore, these induced HLA-G + T-cells show a reduced proliferation to allogeneic stimuli. Taken together, our results indicate the ex vivo production of HLA-Gpos T-lymphocytes with immunoregulatory properties. Our long term goal is the use of this population as adoptive cellular therapy for GvHD and other T-cell mediated diseases. / -

Graft Versus Host Disease (GVHD) is a major inflammatory complication of hematopoietic stem cell transplantation (HSCT). Such transplantations are lifesaving in treating certain conditions, such as acute myeloid leukemia, acute lymphocytic leukemia, myelodysplastic syndrome, aplastic anemia, and thalassemia. However, the subsequent presentation of GVHD can pose a lethal threat, placing the patient’s life at risk, once again. The inflammatory response of the graft’s adaptive immunity towards the host’s native cells in GVHD is said to trigger a cytokine storm. Despite its widespread use both colloquially and in the medical field, criteria for “cytokine storms” do not exist. For this reason, a meta-analysis is being conducted that examines various cytokine levels of several different disease conditions, including acute respiratory distress syndrome, chimeric antigen receptor T cells, Crohn’s disease, SARS CoV-2, rheumatoid arthritis, sepsis, and graft versus host disease. The purpose of this study is to analyze a subset of data within this larger meta-analysis, specifically interleukin-6 (IL-6) levels in GVHD. Herein, I discuss the role of IL-6 in the pathogenesis of GVHD, examine the levels of IL-6 in varying stages of GVHD, and propose future directions for using IL-6 inhibition as a treatment for GVHD.

No description available.

Hematopoietic stem cell transplantation (HSCT) is an important form of therapy for hematological genetic disorders and malignancies, particularly hematological cancers. However, common usage of this procedure is obstructed by graft-versus-host disease (GvHD), in which transplanted donor T cells wage an attack on recipient antigens, causing severe tissue damage and mortality. GvHD prognosis remains poor, and current treatment methods continue to be insufficient, especially for patients with more advanced and severe GvHD. T cells have been identified as the fundamental force behind GvHD, and their cellular metabolism is deemed vital to their fate and function, especially in pathogenic environments. A hallmark of T cell metabolism in GvHD microenvironments is aerobic glycolysis, which maximizes biomass accumulation and supports growth and proliferation. Lactate dehydrogenase A (LDHA) is an essential enzyme that sustains this pathway and may be a potential therapeutic target. Using murine and in-vitro GvHD models, this study investigates the ameliorative impacts of LDHA inhibition on the fate and function of T cells following HSCT. The results reveal that LDHA depletion leads to an immunosuppressive donor T cell characterization that minimizes recipient harm induced by GvHD. Future studies should focus on investigating LDHA inhibition in in-vivo models to introduce a paradigm shift in the development of clinically relevant therapeutics.

No description available.

Die akute Graft-versus-Host Erkrankung (GvHD), insbesondere die Darm GvHD, stellt weiterhin eine der Hauptursachen für Mortalität und Morbidität nach allogener SZT dar. Aktivierte, alloreaktive Spender T-Zellen infiltrieren dabei über die Blutbahn die intestinale Lamina Propria. Erst kürzlich konnten wir zeigen, dass neben der vaskulären Migration ein Teil der Spender T-Zellen auch direkt aus den PP in die angrenzende Lamina Propria migrieren. Um Faktoren, die diese direkte Migration fördern, zu untersuchen und die direkt migrierenden T-Zellen genauer zu charakterisieren, verwendeten wir ein MHC-inkompatibles Mausmodell zur Induktion einer akuten GvHD. Durch RNA Sequenzierung und Massenspektrometrie lasermikrodissezierter Darmschleimhautproben konnte eine starke Expression der Chemokine CXCL9, CXCL10, CXCL11, CCL3, CCL4 und CCL5 während der akuten intestinalen GvHD aufgezeigt werden. Neben CCL4 und XCL1 wiesen verschiedene Faktoren der T-Zellaktivierung, wie CD3ζ, LAT, Lck und ZAP70, sowie Faktoren der zytoskelettalen Reorganisation, wie Dock2, Coro1α und Parvin-γ, eine vermehrte Expression insbesondere nahe der PP auf. Die Expression der migrationsfördernden Faktoren Coro1α und Parvin-γ in Spender T-Zellen nahe der PP konnte anschließend mittels histologischen Immunfluoreszenzfärbungen bestätigt werden. Durchflusszytometrische Analysen konnten weiterhin eine vermehrte Expression von CCR5, CCR9 und Intgerin α4β7 auf den vornehmlich Tbet+ Spender T-Zellen nahe der PP nachweisen. Funktionelle in vitro Migrationsversuche zeigten abschließend, dass in vivo aktivierte Spender T-Zellen eine gerichtete Migration in Richtung auf CXCL11 und zu späterem Zeitpunkt auch auf CCL4 vollziehen können. Zusammenfassend zeigt diese Arbeit die Bedeutung zahlreicher Chemokine für das sequenzielle T-Zell-Homing während der akuten intestinalen GvHD. Neben der insbesondere durch Faktoren der zytosekeletalen Reorganisation vermittelten amoeboiden Migration kann auch eine mesenchymale Fortbewegung über Faktoren wie CCR5, CCR9 und Integrin α4β7 die direkte Migration der T-Zellen fördern. Den direkt migrierenden vornehmlich TH1 polarisierten Zellen folgen weitere, CD27 und Integrin αLβ2 exprimierende, zytotoxische T-Zellen aus der Blutbahn. Die direkt migrierenden Zellen könnten als Initiator und Potentiator der intestinalen T-Zell Infiltration wirken und müssen für zukünftige therapeutische Strategien nicht nur der Darm GvHD, sondern der intestinalen Inflammation im Allgemeinen mitberücksichtigt werden. / Acute graft-verus-host disease (GvHD), especially intestinal GvHD, remains one of the main causes of mortality and morbidity after allogeneic hematopoietic stem cell transplantation. In this process activated alloreactive donor T cells infiltrate the intestinal lamina propria via the bloodstream. Our group could recently show that besides the vascular migration route some donor T cells migrate directly from the Peyer’s patches into the adjacent lamina propria. To investigate factors that could promote such a direct migration, and to characterize these direct migrating T cells we applied a major mismatch mouse model to induce acute GvHD. Using RNA sequencing and mass spectrometry of lasermicrodissected lamina propria samples, we detected a strong upregulation of the chemokines CXCL9, CXCL10, CXCL11, CCL3, CCL4 and CCL5 during acute intestinal GvHD. Alongside CCL4 and XCL1, several factors of T cell activation, such as CD3ζ, LAT, Lck und ZAP70, as well as factors of cytoskeletal reorganization, such as Dock2, Coro1α und Parvin-γ, showed higher expression near the Peyer’s patches. Subsequently, we validated the expression of Coro1α and Parvin-γ on donor T cells near the Peyer’s patches with histological immunofluorescence stainings. Flow cytometry analysis further revealed high expression of CCR5, CCR9 and Intgerin α4β7 on the predominantly Tbet+ donor T cells near the Peyer’s patches. Conclusively, in vitro migration assays showed that in vivo activated donor T cells can directly migrate towards CXCL11 and subsequently also towards CCL4. The present study shows the relevance of several chemokines for the sequential T-cell homing during acute intestinal GvHD. Besides the amoeboid migration mode, which is particularly driven by cytoskeletal reorganization, a mesenchymal movement using factors, such as CCR5, CCR9 and Integrin α4β7, can promote the direct migration of donor T cells. The directly migrating cells, which are predominantly of a TH1 phenotype, are followed by cytotoxic T cells, expressing CD27 and Integrin αLβ2 (LFA-1), from the systemic circulation. Thus, these directly migrating cells may act like an initiator and potentiator for the intestinal T cell infiltration and must be considered for new therapeutic strategies not only of GvHD but of intestinal inflammation in general

No description available.

L’allogreffe de cellules hématopoïétiques est une stratégie thérapeutique importante dans les hémopathies malignes. La maladie du greffon contre l’hôte (GvH) en est une complication majeure menaçant le pronostic vital. Elle est due à la reconnaissance des antigènes du receveur par les lymphocytes T du donneur et à l’activation de ceux-ci, à l’origine de dommages tissulaires. L’altération de la barrière intestinale joue un rôle critique dans la GvH. La famille des protéines de choc thermique (HSP)90 comporte cinq membres dont trois cytosoliques dénommés HSP90, et un localisé dans le réticulum endoplasmique (RE), Gp96, qui peut être sécrété en cas de stress. Nous montrons dans nos travaux de thèse que la 17AAG, un inhibiteur des HSP90, réduit la mortalité liée à la GvH dans un modèle murin. Cet effet est associé à une augmentation de la réponse au stress du RE dans les cellules épithéliales intestinales comme en atteste l’augmentation de l’épissage du facteur de transcription XBP-1, corrélée à une diminution du dommage tissulaire intestinal. Ces résultats permettent d’envisager une place pour la 17AAG ou d’autres inhibiteurs de HSP90 dans la prévention de la GvH chez l’homme. D’autre part, nous montrons que Gp96 est sécrétée dans le sérum de patients développant une GvH aiguë sévère avec atteinte intestinale. Nous suggérons de valider la pertinence de Gp96 comme biomarqueur de GvH intestinale dans une étude de plus grande ampleur. Enfin, nous trouvons que Gp96 s’associe avec le composant 3 du complément, une protéine impliquée dans l’immunité innée et adaptative, et inhibe certaines de ses fonctions. Les conséquences fonctionnelles de cette association sont discutées. / Allogeneic hematopoietic cell transplantation is a treatment for certain disorders including hematologic malignancies. Graft-versus-host-disease (GvHD) is a major, life-threatening complication. It is due to the recognition of recipient antigens by donor T cells, which activate and damage tissues. Intestinal barrier alteration plays a critical role in GvHD. Heat shock proteins (HSP)90 include five members, three cytosolic members named HSP90, and one member localized in endoplasmic reticulum (ER) called Gp96 and able to gain extracellular level in case of stress. We show in our thesis that 17AAG, a HSP90 inhibitor, reduces GvHD mortality in a mouse model. This effect is associated with an increase in ER stress pathway in intestinal epithelial cells as figured by transcription factor XBP-1 splicing, correlated to a decrease in intestinal tissue damage. These results suggest that 17AAG could be considered in GvHD prevention in human. Moreover, we show that Gp96 is secreted in serum of patients developing an acute GvHD with intestinal involvement. We propose to validate the relevance of Gp96 as an intestinal GvHD biomarker is a larger study. Finally, we find that Gp96 associate with complement component 3, a protein involved in innate and adaptive immunity, and inhibit some of its functions. Functional consequences of this association are discussed.