京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22694号 / 医博第4638号 / 新制||医||1045(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 生田 宏一, 教授 竹内 理, 教授 濵﨑 洋子 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Breast cancer (BC) is one of the most common cancers among women worldwide that ~25% of new cancer cases diagnosed every year would be BC; moreover, ~15% of cancer deaths per year caused by BC makes it the leading cause of cancer death among women worldwide. To date, though the cause of a large proportion of BC are still unclear, recent studies have revealed that a supportive breast tissue microenvironment is critical for the development and progression of BC, especially the communication with immune cells within breast tissue. Therefore, breast inflammatory microenvironment is currently received a substantial attention in the prevention and treatment of BC. Research on breast cancer immunology suggests that inflammatory mediators, estrogen and several inflammation-related tumorigenic pathways are potentially contributors for inflammatory breast tumorigenesis. It is evidenced that elevated levels of inflammatory mediators, such as cytokines, chemokines, prostaglandins, and enhanced estrogen production while suffering from chronic inflammation is responsible for not only activating oncogenic pathways, for example NF-κB, STAT3 and Wnt signaling pathways, but also reducing the efficacy of cancer-specific immunity against tumor cells. Accordingly, targeting the chronic inflammatory status in breast tissue has become a promising strategy for breast cancer therapy. Recently, due to the annoying side effects accompanying by traditionally anticancer drugs, there is an increased interest in finding out natural sources to treat BC. Herein, we report that antroquinonol (AQ) and/or 4-acetylantroquinonol B (4-AAQB) isolated from Antrodia Camphorata were able to modulate the expression of several inflammatory mediators, IL-6 and IFN-γ in particular, and downregulate the aromatase expression and Wnt signaling responses induced by inflammatory status. Taken together, the present findings provide new insights into the role of AQ and 4-AAQB in inflammatory breast tumors and also suggest them as promising candidates for breast cancer immunotherapy.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23105号 / 医博第4732号 / 新制||医||1050(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 竹内 理, 教授 上野 英樹, 教授 椛島 健治 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

The first reports of bacteria as a cancer therapy date back to the pioneering work of Dr. William Coley–now widely regarded as the father of immunotherapy. As far back as 1891, Coley demonstrated that the intratumoral injection of live and later heat-killed isolates of Streptococcus pyogenes and Serratia marcescens could induce durable remission in patients with bone and soft tissue sarcoma. While this therapy was deemed to unsafe at the time, Coley’s findings have formed the basis for our modern understanding of immunology and cancer immunotherapy. Over the past two decades, the advent of synthetic biology is driving a new era of medicine through the genetic programming of living cells. This transformative approach enables the creation of engineered systems that sense and respond to diverse environments, permitting safe and effective targeted delivery of therapeutic payloads within disease sites. In this thesis, I seek to utilize principles from synthetic biology and immunology to engineer bacteria for immunotherapeutic delivery. I have developed multiple strains of non-pathogenic E. coli capable of colonizing solid tumors and delivering diverse immunotherapeutic payloads specifically within the tumor. This local delivery approach enables the utilization of therapeutic agents that may be otherwise systemically toxic. In one instance, we engineered an encoded nanobody antagonist of CD47 (CD47nb), an anti-phagocytic receptor commonly overexpressed in several human cancers. We show that delivery of CD47nb by tumor-colonizing bacteria increases activation of tumor-infiltrating T cells, stimulates rapid tumor regression, prevents metastasis, and leads to long-term survival in a syngeneic tumor model. Thus, engineered bacteria may be used for safe and local delivery of diverseimmunotherapeutic payloads leading to systemic antitumor immunity.

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

De récents résultats d’études cliniques ont démontré l’efficacité de l’immunothérapie chez des patients atteints de cancer. Ce type de thérapie consiste à traiter les cellules cancéreuses en stimulant les défenses immunitaires du patient. Le but de ce projet de thèse est de mettre au point un biomarqueur d’efficacité de cette thérapie, afin d’une part de mieux comprendre les mécanismes biologiques mis en jeu, et d’autre part d’avoir un indicateur précoce et non-invasif de réponse du patient à l’immunothérapie. Pour ce faire, deux techniques d’imagerie (IRM et TEP) ont été utilisées comme outils de suivi in vivo de la biodistribution de différentes populations de cellules immunitaires. La première étape de ce travail a été d’établir différents protocoles de marquage des cellules immunitaires. Pour l’approche TEP, les cellules immunitaires ont été marquées avec du Zirconium 89 ; quant à l’IRM, deux techniques de marquage ont été étudiées : la première utilise des nanoparticules de fer, l’autre des micelles chargées en Fluor 19. Après validation de leur non-toxicité, la sensibilité de chaque marquage a été évaluée in vitro dans un premier temps, puis in vivo dans un deuxième temps, permettant ainsi d’étudier la biodistribution des cellules immunitaires après différents types d’injections. Le marquage au Zirconium 89 a ensuite été testé sur différents modèles animaux d’immunothérapies (par exemple PD1/PDL1). Enfin, les marquages directs ne permettant pas un suivi optimal des cellules à long terme, une approche de marquage cellulaire utilisant des gènes rapporteurs a été envisagée. Il s’agissait de modifier le génome des cellules immunitaires afin qu’elles puissent exprimer une enzyme (par exemple la thymidine kinase virale HSV1-TK) ou un transporteur (tel que le transporteur d’iode NIS) permettant l’internalisation d’un traceur radioactif in vivo, et de pouvoir ainsi réaliser un marquage indirect des cellules. / Recent clinical trial results have demonstrated the efficacy of immunotherapy in cancer patients. This type of therapy involves treating cancer cells by stimulating the patient's immune defenses. The aim of this thesis project is to develop a biomarker of efficacy for this therapy, in order to better understand the biological mechanisms involved, and to have an early and non-invasive indicator of the patient’s response to immunotherapy. To do this, two imaging techniques (MRI and PET) were used as in vivo monitoring tools for the biodistribution of different populations of immune cells. The first step of this work was to establish different protocols for labeling immune cells. For the PET approach, the immune cells were labeled with Zirconium 89; and for MRI, two labeling techniques were studied: the first uses iron nanoparticles, and the other uses micelles loaded with Fluorine 19. After validation of their non-toxicity, the sensitivity of each labeling was evaluated in vitro, then in vivo in a second step, thus making it possible to study the biodistribution of the immune cells after different types of injections. The labeling with Zirconium 89 was then tested on different animal models of immunotherapies (PD1/PDL1 for example). Finally, since direct markings do not allow optimal cellular monitoring in the long term, a cell labeling approach using reporter genes has been considered. It involved modifying the genome of the immune cells so that they could express an enzyme (for example the viral thymidine kinase HSV1-TK) or a transporter (such as the NIS iodine transporter) allowing the internalization of a radioactive tracer in vivo, and thus be able to carry out indirect labeling of the cells.

Au cours des dernières années, l’immunothérapie a révolutionné le paysage en oncologie. L’anti-CTLA-4 a montré son efficacité sur la survie globale des patients atteints de mélanome métastatique. Cependant, ce traitement présente des limites à son utilisation telles que l'efficacité clinique obtenu chez seulement 20% des patients et la survenue fréquente de colites pouvant être sévères. La recherche de biomarqueurs prédictifs de réponse clinique et/ou de développement de toxicité devient maintenant un enjeu majeur pour sélectionner les patients pouvant avoir un bénéfice à l’utilisation de ces traitements. En partant de l’observation que les colites induites par l’anti-CTLA-4 présentent des similitudes avec les maladies inflammatoires chroniques de l'intestin, nous avons émis l’hypothèse de l’existence d’un microbiote intestinal associé à une dysrégulation du système immunitaire pouvant prédire la réponse clinique et/ou la survenue d’une colite induite par l’anti-CTLA-4. Nous avons montré dans une cohorte de patients atteints de mélanome métastatique et traités par ipilimumab, qu'un microbiote intestinal enrichi en Faecalibacterium et autres Firmicutes est associé à une meilleure survie globale et sans progression ainsi qu'un risque accru de développer une colite. Les patients avec une flore enrichie en Firmicutes présentent également après traitement par ipilimumab, une activation lymphocytaire plus efficace. Par la suite, nous nous sommes intéressés aux métabolites issus du microbiote fécal et leur implication dans la réponse à l'anti-CTLA-4. Le butyrate est le principal métabolite produit par les Firmicutes. Nous avons observé chez la souris, une inhibition de l'efficacité anti-tumorale de l'anti-CTLA-4 lorsqu'elles étaient supplémentées en butyrate. In vivo, nous avons montré que le butyrate inhibe la surexpression sur les cellules dendritiques, des molécules CD80 et CD86 (molécules B7) induite par l'anti-CTLA-4. Cette immaturité des cellules dendritiques entraine un défaut d'activation des lymphocytes T spécifiques d'antigènes dépendant de l'axe CD28/B7 réduisant ainsi l'efficacité anti-tumorale. Chez l'Homme, nous avons valider cette hypothèse en montrant qu'une concentration sérique élevée en butyrate est associée à une diminution de la survie globale et sans progression comparativement aux patients avec un faible niveau de butyrate sérique.Ces travaux mettent en évidence le lien entre la composition du microbiote et les réponses immunologiques au blocage du CTLA-4. Ils apportent une explication sur un lien indirect via le butyrate entre la composition du microbiote intestinal et la réponse anti-tumorale aux immunothérapies. / In the last years, immunotherapy has revolutionized the landscape in oncology. The efficacy of anti-CTLA-4 has been demonstrated by improving overall survival of patients with metastatic melanoma. However, this treatment has limitations to its use such as the clinical efficacy obtained in only 20% of patients and the high incidence of severe colitis. Predictive biomarkers of clinical response and / or toxicity development are mandatory for a better selection of patients who will benefit from this treatment. Based on the observation that anti-CTLA-4-induced colitis has similarities with inflammatory bowel disease, we hypothesized that the gut microbiota associated with dysregulation of the immune system may predict the clinical response and / or occurrence of anti-CTLA-4-induced colitis.In a cohort of patients with metastatic melanoma treated with ipilimumab, we have shown that a gut microbiota enriched with Faecalibacterium and other Firmicutes is associated with a better of overall and progression-free survival as well as an increased risk of developing colitis. Firmicutes-driven microbiota is also associated with an improvement in lymphocyte T activation after ipilimumab treatment. Subsequently, we were interested in microbial metabolites and their involvement in the clinical response to anti-CTLA-4. Butyrate is the main metabolite produced by the Firmicutes. In mice, we observed an inhibition of anti-tumor effect of anti-CTLA-4 in butyrate-supplemented mice. In vivo, we have shown that butyrate inhibits the overexpression on dendritic cells, of CD80 and CD86 molecules (B7molecules) induced by anti-CTLA-4. This immaturity of the dendritic cells leads to a poor signaling of CD28 / B7 axis and activation of antigen-specific T-cells, thereby reducing anti-tumor efficacy. In humans, we validated this hypothesis by showing that a high serum concentration of butyrate is associated with decreased overall and progression-free survival compared to patients with low serum butyrate levels.This studie highlights the link between the composition of gut microbiota and the immunological responses to CTLA-4 blockade. They provide an explanation of an indirect link via butyrate, between the composition of the gut microbiota and the anti-tumor response to immunotherapies.

Millions of people worldwide die of cancer every year. In the last decade, im- munotherapy offered new treatment options achieving long-lasting remissions in a number of patients. Several new immunotherapy-based drugs have been ap- proved by Food and Drug Administration. However, majority of patients either do not respond or soon relapse. Combination of therapies as well as exploring new immune checkpoints seems promising. This thesis focuses on the new immunotherapeutic target CD73. CD73 is membrane ectonucleotidase, widely expressed on the regulatory leukocytes and on cancer cells. The enzymatically active CD73 contributes to the tumour mi- croenvironment by production of immunosuppressive adenosine. This novel im- mune checkpoint is being intensively studied. This thesis aims on development of new approaches for targeting and inhibition of CD73. Soluble recombinant CD73 (rhCD73) was prepared in mammalian expression system and transfectants stably expressing membrane-bound CD73 were prepared as well. Inhibitors necessary for both of my goals have been designed based on published inhibitor of CD73. Development and evaluation of novel antibody mimetic for CD73 characteri- sation was done. The so-called iBody, HPMA polymer conjugate decorated with CD73 inhibitor for targeting, fluorophore for...