Immunotherapy of cancer has been shown to be promising in prolonging patient survival. However, complete elimination of cancer and life-long relapse-free survival remain to be major challenge for anti-cancer therapeutics. We have previously reported that ex vivo reprogramming of tumor-sensitized immune cells by bryostatin 1/ionomycin (B/I) and the gamma-chain (γ-c) cytokines IL-2, IL-7, and IL-15 resulted in the generation of memory T cells as well as CD25+ NKT cells and CD25+ NK cells. Adoptive cellular therapy (ACT) utilizing these reprogrammed immune cells protected FVBN202 mice from tumor challenge, and overcame the suppressive functions of myeloid-derived suppressor cells (MDSCs). We then demonstrated that the presence of CD25+ NKT cells was required for anti-tumor efficacy of T cells as well as their resistance to MDSCs. Similar results were obtained by reprogramming of peripheral blood mononuclear cells (PBMC) from patients with early stage breast cancer, demonstrating that an increased frequency of CD25+ NKT cells in reprogrammed immune cells was associated with modulation of MDSCs to CD11b-HLA-DR+ immune stimulatory cells. Here, we tested the efficacy of immunotherapy in a therapeutic setting against established primary breast cancer (Chapter One), experimental metastatic breast cancer (Chapter Three) as well as against minimal residual disease (MRD) in patients with multiple myeloma (Chapter Two). We evaluated the ability of reprogrammed immune cells, including CD25+ NKT cells, to convert MDSCs to myeloid immune stimulatory cells, in vivo; this resulted in the identification and characterization of a novel antigen presenting cell (APC). These novel immune stimulatory cells differed from conventional APCs, including dendritic cells (DCs) and macrophages. We have also demonstrated that enhancing immunogenicity of mammary tumors by treatment with Decitabine (Dec) along with overcoming MDSCs by utilizing reprogrammed T cells and NKT cells in ACT prolongs survival of animals, but fails to eliminate the tumor. However, targeting cancer during a setting of MDR, when tumor cells are dormant, results in objective responses as evidenced in our multiple myeloma studies. This suggests that targeting breast cancer with immunotherapy following conventional therapies, in a setting of residual disease when tumor cells are dormant, may be effective in eliminating such residual cells or maintaining dormancy and extending time-to-relapse for breast cancer patients.

No description available.

La radiothérapie interne vectorisée (RIV) permet une irradiation systémique la plus élective possible des lésions métastatiques de cancers. Nous rapportons une étude de phase I avec première injection à l’homme mise en place au Centre Léon Bérard pour le traitement de patients porteurs de métastases de synovialosarcomes. Sur un schéma théranostique, une étape d’imagerie et de dosimétrie était réalisée afin d’étudier la biodistribution du radiopharmaceutique diagnostique (RPD) compagnon du radiopharmaceutique thérapeutique (RPT). En cas de biodistribution favorable (fixation tumorale supérieure aux organes sains environnant) permettant d’envisager la RIV avec un effet tumoricide tout en limitant les effets secondaires de l’irradiation de tissus sains, les patients recevaient le RPT. Au total 20 patients ont été inclus. Dix d’entre eux étaient éligibles à la phase thérapeutique : 2 n’ont pas pu être traités du fait d’une progression de la maladie et 8 ont été traités, incluant 1 patiente ayant pu recevoir une 2ème injection de RPT du fait d’une stabilisation de la maladie. Les effets secondaires ont été principalement hématologiques. Les réponses au traitement ont été des stabilisations transitoires. Face à ces résultats modestes, nous avons réalisé une étude dosimétrique plus approfondie pour mieux les comprendre. Nous discuterons des voies possibles pour optimiser ce traitement en s’appuyant notamment sur les études de RIV ayant montré de réels bénéfices pour les patients / Vectorized Radionuclide Therapy allows a more elective systemic irradiation of metastatic cancer lesions. We are reporting a first in human phase I study set up at the Léon Bérard Cancer Centre for the treatment of patients with synovialosarcoma metastases. Following a theranostic scheme, an imaging and dosimetry step was performed to study the biodistribution of the diagnostic radiopharmaceutical (DRP) companion of the therapeutic radiopharmaceutical (TRP). In case of favorable biodistribution (tumor uptake greater that surrounding healthy organs tracer uptake) allowing IVR to be considered with a tumoricidal effect while limiting the side effects of irradiated healthy tissues, patients received the TRP. A total of 20 patients were included. Ten of them were eligible for the therapeutic phase: 2 could not be treated due to disease progression and 8 were treated, including 1 patient who received a 2nd injection after disease stabilization. The side effects were mainly hematological. Treatment responses were transient stabilizations. In response to these modest results, we conducted a more in-depth dosimetric study to better understand them. We will discuss possible ways to optimize this treatment, based in particular on RIV studies that have shown real benefits for patients

O melanoma é o mais agressivo tumor da pele, cuja resistência aos tratamentos quimioterápicos tem promovido a crescente utilização de imunoquimioterapia, como é o caso da utilização de agonistas dos receptores Toll-Like (TLRs). Nesse contexto, os compostos abreviados por P-MAPA e seu sintético estrutural MRB-CFI-1 com reconhecidas propriedades antitumorais e imunológicas, são fortes candidatos na terapia e prevenção desse tipo de câncer. Esse estudo visa determinar o potencial anticâncer do P-MAPA e de MRB-CFI-1 contra o melanoma murino em consequência ao padrão de resposta microambiental semelhante ao de morte imunogênica, em regimes de tratamento terapêutico ou vacinal, na vigência de quimioterapia com cisplatina e/ou em associação com antígenos de células tumorais totais. Após avaliação In vivo do crescimento de tumores B16F10 implantados em modelos murinos selvagem e nocaute para o gene Myd88, na vigência ou não do tratamento com cisplatina e/ou P-MAPA, nossos resultados mostraram que o P-MAPA apresentou atividade pró-tumoral e antagonizou a ação da cisplatina em inibir o crescimento dos tumores, de forma dependente de Myd88. Além disso, através de análises qualitativa e quantitativa pelo software ImageJ em fotomicrografias de secções tumorais coradas histologicamente, observamos que o P-MAPA promoveu mudanças microambientais nos tumores que podem impactar negativamente em seu desempenho. Como monoterapia em esquema de vacinação com lisado tumoral total em combinação com quimioterapia, o P-MAPA em dose baixa falhou em suprimir o crescimento de tumores B16F10, mas o seu sintético MRB-CFI-1 foi capaz de prevenir o crescimento desse tipo de melanoma num regime de vacinação profilática. Apesar do sucesso terapêutico desse imunomodulador em diversos modelos de câncer e de doenças infecciosas, o P-MAPA não foi eficaz em produz respostas microambientais contra o melanoma murino, dados esses que limitam a aplicabilidade clínica do composto. De outro modo, o composto fosfato inorgânico MRB-CFI-1 foi protetivo em retardar o aparecimento desse tipo de doença. Assim, o presente estudo foi importante por ampliar o entendimento funcional do P-MAPA numa abordagem imunoquimioterápica em modelos biológicos de tumores de melanoma, e representa uma importante mudança na utilização de constituintes individuais similares ao P-MAPA que sejam mais eficazes, de fácil obtenção, e de produção controlada e garantida / Melanoma is the most aggressive skin cancer, whose resistance to chemotherapeutic treatments has promoted the increasing use of immunochemotherapy, as is the case for the use of Toll-Like receptor agonists (TLRs). In this context, the compounds abbreviated by P-MAPA and its structural synthetic MRB-CFI-1 with recognized antitumor and immunological properties are strong candidates in the therapy and prevention of this type of cancer. This study aims to determine the anti-cancer potential of P-MAPA and MRB-CFI-1 against murine melanoma as a consequence of the microenvironmental response pattern similar to that of immunogenic death in therapeutic or vaccine treatment regimens when using chemotherapy with cisplatin alone or in combination with whole tumor cell antigens. After In vivo evaluation of the growth of B16F10 tumors implanted in wild-type and Myd88 gene knockout mice, under treatment or not with cisplatin and / or P-MAPA, our results showed that P-MAPA showed pro-tumor activity and antagonized the action of cisplatin in inhibiting the growth of tumors in a Myd88-dependent manner. In addition, using qualitative and quantitative analysis by ImageJ software in histological images of tumor sections, we observed that P-MAPA promoted microenvironmental changes in tumors that may negatively impact its performance. As monotherapy in vaccination schedule with total tumor lysate in combination with chemotherapy, low dose P-MAPA failed to suppress the growth of B16F10 tumors, but its synthetic MRB-CFI-1 was able to prevent the growth of this type of melanoma in prophylactic vaccination regimen. Despite the therapeutic success of this immunomodulator in various cancer models and infectious diseases, P-MAPA has not been effective in producing microenvironmental responses against murine melanoma, data that limit the clinical applicability of the compound. Otherwise, the inorganic phosphate compound MRB-CFI-1 was protective in delaying the onset of this type of disease. Thus, the present study was important because it broadened the functional understanding of P-MAPA in an immuno-chemotherapeutic approach in biological models of melanoma tumors and represents an important change in the use of individual constituents similar to P-MAPA that are more efficient, easily obtainable, and controlled and guaranteed production

Nesta tese, foi apresentado um estudo sistemático para o desenvolvimento de uma nova formulação do veneno de abelha (BV) encapsulado em microesferas (MS) de PLGA para VIT. Estudou-se a estabilidade das proteínas do BV durante o processo de microencapsulação. Houve uma correlação entre as diferentes soluções salinas e as alterações na solubilidade e nas conformações estruturais do BV. Foram preparadas formulações BV-MS-PLGA estáveis com atividade biológica preservada. As MS tiveram eficiência de encapsulação entre 49-75% e perfis trifásicos de liberação do BV. Houve mudanças estruturais no BV liberado, mas seu reconhecimento imunológico foi mantido. Ensaios ex vivo e in vivo mostraram que as formulações evitaram as reações inflamatórias causadas pelo contato direto do BV com o organismo, aumentando a fagocitose das partículas com BV, o entregando diretamente ao meio intracelular. As formulações BV-MS-PLGAs estimularam a produção de anticorpos anti-BV equivalentes à VIT tradicional com a redução do número de injeções necessárias para se produzir o mesmo efeito imunológico. Portanto, as MS-PLGA contendo BV são seguras e eficazmente superiores à VIT tradicional. / In this thesis, it was presented a systematic study to develop a new formulation of bee venom (BV) encapsulated within PLGA-MS for VIT. It was studied the stability of BV proteins during the microencapsulation process. There was a correlation between the different salt solutions and changes in the solubility and structural conformations of BV. It was prepared stable BV-PLGA-MS formulations with preserved biological activity. The MS showed encapsulation efficiencies between 49-75%, and a triphasic release profiles of BV. Although structural changes were observed in the released BV, its immunological recognition was maintained. Ex vivo and in vivo assays showed that formulations avoided the inflammatory reactions caused by direct contact of BV and organism leading to increases in phagocytosis rate of particles containing BV, providing its delivery directly to the intracellular environment. These formulations could stimulate the production of anti-BV antibodies comparable to traditional VIT with reduced number of injections needed to produce the same immunological effect. Therefore, PLGA-MS containing BV are safe and effectively superior to the VIT traditional.

Em 1993, a Organização Mundial da Saúde declarou a tuberculose (TB) como uma emergência global devido à sua relevância epidemiológica e a necessidade de seu controle. Atualmente, a TB ainda é considerada um problema de saúde pública e requer o desenvolvimento de vacinas e terapias que sejam mais eficazes na sua prevenção e tratamento. Nesse sentido, o Laboratório de Vacinas Gênicas da Faculdade de Medicina de Ribeirão Preto estuda há mais de dez anos a eficácia da vacina gênica DNAhsp65 na profilaxia e terapia da TB. Com o intuito de complementar o conhecimento existente sobre os mecanismos imunes desencadeados pela vacina DNAhsp65, assim como sua associação às drogas convencionais utilizadas no tratamento da TB, objetivou-se neste trabalho a caracterização de células natural killer (NK), T natural killer (NKT), e T ?? na imunoterapia da tuberculose experimental com a vacina DNAhsp65, no tratamento com as drogas rifampicina (RIF) e isoniazida (INH), e na associação DNAhsp65-drogas. Inicialmente, camundongos BALB/c foram infectados com Mycobacterium tuberculosis (Mtb) cepa H37Rv no dia 0 e nos dias 1, 7, 15, 30 e 70 após a infecção, foi promovida a eutanásia dos animais infectados ou não (controle) para análise das células T não convencionais no pulmão por citometria de fluxo. No dia 30 após a infecção, os animais infectados receberam os diferentes tratamentos: vacina DNAhsp65, vetor pVAX1, drogas RIF e INH, ou as drogas em associação à vacina. Dez dias após o fim dos tratamentos, foi promovida a eutanásia dos animais para análise das populações celulares no pulmão e linfonodo por citometria de fluxo, imunohistoquímica e PCR em tempo real. Os animais somente infectados com Mtb apresentaram aumento significativo no número das células NK (CD3-CD49b+), NKT (CD3+CD49b+) e T ?? (CD3+??+) logo na primeira semana após a infecção, e esta diferença em relação aos animais controle permaneceu em até 70 dias após a infecção. Entre as células NK presentes no pulmão, observou-se predominância da subpopulação CD11bhighCD27low em todos os animais. Nos animais infectados, verificou-se aumento significativo das subpopulações de NK: CD11bhighCD27high e CD11blowCD27high, nos dias 7 e 15 e somente no dia 15 após a infecção, respectivamente. Entre a população de células T ?? presentes no pulmão, houve predomínio do fenótipo CD27- em animais controles e infectados nos diferentes tempos experimentais. Quanto aos animais infectados com Mtb e tratados com DNAhsp65, verificou-se aumento significativo de células T ?? produtoras de IFN-? e IL-17 no pulmão, e apesar de não ter sido observada diferença na freqüência de células NK e NKT neste grupo, as células NK apresentavam maior expressão da molécula FasL relacionada à morte celular induzida por apoptose. Nos grupos drogas e DNAhsp65-drogas observou-se aumento da freqüência de células T ?? no pulmão, assim como aumento de células NK produtoras de IL-10 e que expressavam o marcador de ativação CD69. Os resultados deste trabalho mostram mais uma vez a eficácia da vacina DNAhsp65 e da associação DNAhsp65- drogas no tratamento de animais infectados com Mtb e sugerem que células T não convencionais como as células NK, NKT e T ?? podem participar na modulação da resposta immune na TB. Estes achados devem ser levados em consideração no desenho de novas estratégias terapêuticas e também profiláticas para a TB. / In 1993, the World Health Organization declared tuberculosis (TB) as a global emergence due to its epidemical relevance and the need to improve its control. Nowadays, TB still remains a public health problem and requires the development of more effective vaccines and therapies. In this sense, the Laboratory of Genetic Vaccines from the School of Medicine of Ribeirão Preto studies, for more than ten years, the efficiency of the genetic vaccine DNAhsp65 in TB prophylaxis and therapy. In order to complement the knowledge about the immune mechanisms triggered by DNAhsp65 vaccine and by its association with conventional drugs used in TB, our aim in this work was to characterize natural killer (NK), natural killer T (NKT) and gamma-delta (??) T cells in the immunotherapy of experimental tuberculosis with the DNAhsp65 vaccine, in the treatment with rifampicin and isoniazid drugs and in the association DNAhsp65-drugs. Initially, BALB/c mice were infected with Mtb strain H37Rv on day 0, and on days 1, 7, 15, 30 and 70 after infection, infected animals or not (control) were euthanized for lung cell analysis by flow cytometry. On day 30 after infection, infected animals received the following treatment: DNAhsp65 vaccine, pVAX1 vector, rifampicin and isoniazid drugs, or drugs in association with DNAhsp65. Ten days after the end of treatment, animals were euthanized for lung and lymph node cell analysis by flow cytometry, immunohistochemistry and real time PCR. Infected animals showed a significant increase of NK (CD3-CD49b+), NKT (CD3+CD49b+) and ?? (CD3+??+) T cells in the first week of infection and this difference compared to control animals remained until 70 days after infection. Within the lung NK cell population, we observed a predominance of CD11bhighCD27low phenotype in all animals. In infected animals, we verified a significant increase of the following NK cell subpopulations: CD11bhighCD27high and CD11blowCD27high on days 7 and 15, and only on day 15 after infection, respectively. Within the lung ?? T cell population, there was a predominance of CD27- ?? T cell in control and infected animals in the different experimental times. In infected animals and subsequently vaccinated with DNAhsp65, we verified a significant increase in ?? T cells producing IFN-? and IL-17 in the lungs. Although we have not seen any differences in NK and NKT cells in this group, NK cells showed higher expression of FasL molecule related to induced cell death by apoptosis. In DNAhsp65-drugs and drugs groups, we observed an increase in lung ?? T cells frequency, as well as increase in NK cells producing IL-10 and expressing CD69, an activation marker. Our results confirm the effectiveness of DNAhsp65 vaccine and its association with drugs in Mtb infected animals and suggest a modulation in the immune response through unconventional T cells such as NK, NKT and ?? T cells. These findings should be taken into consideration in the design of new therapeutic and prophylactic strategies for TB.

Exossomos (Exo) originados de células dendríticas (DCs) carregam moléculas associadas à apresentação antigênica. Neste trabalho procurou-se estabelecer se Exo de DCs seriam capazes de conferir imunogenicidade às células tumorais. Os Exo isolados de culturas de DCs expressavam as moléculas HLA-ABC, HLA-DR, CD86, CD11c, CD81, CD54 e CD18. Estes foram então adicionados às células da linhagem humana de adenocarcinoma mamário, SK-BR-3, as quais passaram a expressar as moléculas HLA-DR, CD86 e CD11c. As células tumorais modificadas pelos Exo induziram a produção de IL-6 e IL-10, detectados no sobrenadante das co-culturas destas com linfócitos T. Estas células tumorais também induziram aumento do número de linfócitos produtores de IFN-<font face=\"Symbol\">g, pré-sensibilizados contra antígenos tumorais, e aumento da expressão de SOCS3 nestes. Em conclusão, nossos resultados mostram que, Exo de DCs alteram o fenótipo de células tumorais, modificando sua interação com linfócitos T, sem induzir nas mesmas capacidade de ativar respostas proliferativas ou citotóxicas de linfócitos T in vitro. / Exosomes (Exo) originated from dendritic cells (DCs) contain molecules involved in antigen presentation. The present work sought to determine if Exo from DCs would be able to transfer immunogenicity to tumor cells. Exo isolated from DCs cultures carried HLA-ABC, HLA-DR, CD86, CD11c, CD81, CD54 and CD18. These Exo were added to cultures of the human breast adenocarcinoma cell line, SK-BR-3, which gained expression of HLA-DR, CD86 and CD11c. Tumor cells modified by Exo induced IL-6 and IL-10 production, detected in the supernatant of their co-cultures with T lymphocytes. These tumor cells also induced an increase in the frequency of IFN-<font face=\"Symbol\">g-producing T lymphocytes, pre-sensitized against tumor antigens, and an increased expression of SOCS3. In conclusion, our results show that, Exo from DCs affect the phenotype of tumor cells, modifying their interaction with T lymphocytes, without inducing the ability to activate cytotoxic or T cell proliferative responses in vitro.

Les anticorps monoclonaux (AcM) ont été utilisés pour traiter des cancers dès le début des années 1980, en particulier lors du travail pionnier de l’équipe de Ronald Levy dans le traitement des lymphomes. Ces traitements ont pendant longtemps été considérés comme une sérothérapie passive à effet immédiat et à court terme. Cependant, au cours de ces dernières années, le concept d’un effet « vaccinal » des anticorps à usage thérapeutique en oncologie a peu à peu vu le jour du fait de réponses cliniques à long terme observées chez certains patients et de différentes études précliniques. En 2010, notre équipe a démontré que des souris immunocompétentes injectées avec les cellules tumorales EL4-huCD20 et traitées avec un AcM anti-huCD20 générait une réponse immunitaire anti-tumorale à long-terme par le biais de mécanismes dépendants de la région constante de l’anticorps et de lymphocytes T CD4+. Mon travail de thèse a donc porté sur l’analyse des mécanismes cellulaires et moléculaires par lesquels le traitement par un AcM anti-CD20 génère une immunité cellulaire adaptative anti-tumorale. J’ai ainsi pu montrer que le traitement des souris avec l’AcM anti-CD20 conduit à une expansion de lymphocytes Th1 producteurs d’IFN-γ, à l’apparition de lymphocytes T CD4+ effecteurs mémoires spécifiques des cellules tumorales CD20+, et au blocage de l’expansion de lymphocytes Tregs induite par les cellules tumorales. Le rôle central dans la protection anti-tumorale et la genèse d’une réponse adaptative anti-tumorale joué par l’axe IL-12/IFN-γ et leurs principales sources cellulaires, cellules dendritiques (DCs) et cellules NK, a été démontré par des expériences de neutralisation de ces cytokines, qui provoque une importante diminution du nombre de Th1 spléniques, de déplétion des cellules NK, ainsi que par des analyses phénotypiques qui ont permis d’identifier des DCs activées par le traitement - comme le montre l’expression accrue des molécules de classe II du CMH et de co-stimulation CD80 et CD86 - comme une importante source cellulaire de l’IL-12. Enfin, nous avons pu montrer qu’un variant de l’IL-2, liant préférentiellement le récepteur de l’IL-2By et faiblement le récepteur de l’IL-2aBy exprimé majoritairement par les Tregs, permettait l’obtention d’une protection anti-tumorale accrue d’animaux porteurs de tumeurs et traités par l’AcM anti-CD20. En conclusion, nous avons démontré qu’un contexte immunitaire pro-tumoral façonné par la présence d’une tumeur en développement peut être inversé par le traitement par un anticorps anti-tumoral, aboutissant à un contexte anti-tumoral. Qu’une telle réponse immunitaire adaptative cellulaire puisse être observée chez des patients atteints de lymphomes, traités par un anticorps anti-CD20, reste encore à être déterminé. / Monoclonal antibodies have been used to treat cancers since the early 1980s, in particular with the pioneer work of Ronald Levy for the treatment of lymphomas. Those treatments have been considered for a long time as a passive serotherapy with immediate and short term actions. Yet, recently, the idea of a vaccine effect of therapeutic antibodies in oncology have appeared, after preclinical studies and clinic observations suggesting a long term immune response in patients. In 2010, our team demonstrated that immunocompetent mice injected with EL4-huCD20 tumor cells and treated with anti-huCD20 monoclonal antibody generated a long term anti-tumor immune response linked with mechanisms dependent on constant part of antibodies and CD4+ T cells. My PhD work was based on the analysis of cellular and molecular mechanisms by which the treatment by an anti-CD20 mAb generates a cellar adaptive anti-tumor immunity. I could show that the treatment of mice with anti-CD20 antibody lead to the expansion of Th1 lymphocytes IFN-γ producers, to the apparition of effector memory CD4+ T cells specific for CD20 antigen, and to the blockade of the expansion of Treg cells induced by tumor cells. The key role of an adaptive anti-tumor immune response played by IL-12/IFN- γ and their main cellular sources, dendritic cells and NK cells, in the anti-tumor protection and genesis, has been demonstrated by experiments of cytokine neutralization, provoking an important decrease of splenic Th1 number, by NK depletion and by phenotypic analysis that allowed the identification of DCs activated by the treatment – as it is shown by the increased expression of MHC-II and CD80 and CD86 costimulation molecules, - as an important cellular source of IL-12. Finally, we could show that a variant of IL-2, binding preferentially IL-2By with a lower affinity for the IL-2aBy receptor mainly expressed by Tregs, could induce an increased anti-tumor protection of tumor-bearing animals treated with anti-CD20 mAb. In conclusion, we have demonstrated that a pro-tumor immune contexture affected by a growing tumor can be modified by an anti-tumor antibody leading to an anti-tumor contexture. That such cellular adaptive immune response could be observed in lymphoma patients treated with anti-CD20 still need to be determined.

Die Studie auf die diese Arbeit aufbaut untersuchte die Immunogenität einer Wilms-Tumorgenprodukt-1-(WT1)-Peptid-Vakzinierung bei Patienten mit einer WT1-exprimierenden akuten myeloischen Leukämie (AML) ohne weitere Behandlungsoption. Trotz dem initalen immunologischen, molekularen und vorläufigen Nachweis einer möglichen klinischen Effektivität bei AML-Patienten, konnte nur in wenigen Fällen eine längerfristige Wirksamkeit dokumentiert werden. Es ist bekannt, dass eine Krebs-Immuntherapie durch Immunevasions-Mechanismen des Tumors beeinträchtigt werden kann. Da Analysen zu Mutationen oder Verlust des WT1-Epitops oder Epitop-flankierender Sequenzen keine Auffälligkeiten zeigten, konnte eine reduzierte Präsentation oder Erkennung des Epitops ausgeschlossen werden. Aus diesem Grunde sollte diese Arbeit weitere mögliche Immunevasions-Mechanismen identifizieren. Als Grundlage wurden Tumor-assoziierte Effekte, immunmodulatorische Faktoren und funktionelle Einschränkungen der Immunzellen in den Mittelpunkt der Untersuchungen gestellt. Die ermittelten Daten zeigen, dass in unserem spezifischen Therapieansatz, der wiederholten Vakzinierung von AML-Patienten mit einem HLA-A201-restringierten WT1126–134 -Epitop in Kombination mit GM-CSF und KLH, eine eingeschränkte T-Zell-Funktionalität einen wesentlichen Grund für die beobachtete verminderte Therapieeffizienz darstellt. Immunresistenzmechanismen leukämischer Blasten spielen hierbei keine übergeordnete Rolle, individuelle Effekte können aber nicht ausgeschlossen werden. Ebenso scheint es, dass auch die Präsenz von immunregulatorischen Zellen wie Tregs oder MDSCs nicht durch die Vakzinierung manipuliert wird und dass diese keinen generellen Einfluss auf die Therapieeffizienz ausüben. / The foregoing study investigated the immunogenicity of Wilms’ tumor gene product 1 (WT1)-peptide vaccination in WT1-expressing acute myeloid leukemia (AML) patients without curative treatment option. Despite the first immunologic, molecular, and preliminary evidence of potential clinical efficacy in AML patients, only in a few cases long-lasting responses could be documented. It is known that enduring efficacy of cancer vaccines may be limited due to immune escape mechanisms. On this account, we chose to work on three front lines: Investigations of immune modulatory counter-attack-mechanisms of the tumor, functional deficiencies of the T cell compartment and the presence of immune regulatory cells. The generated data demonstrates that in our specific setting, in which AML patients received consecutive vaccinations with HLA-A201-restricted WT1126–134 epitope together with GM-CSF and KLH, impaired vaccine efficacy is mainly attributed to restricted T cell functionality. Immune resistance mechanism exerted by leukemic blasts do not generally influence clinical outcome in our setting, neither do inert immunoregulative mechanisms like Treg or MDSC, respectively.

Die allogene Stammzelltransplantation ist das Therapieverfahren der Wahl für eine Reihe von malignen und nicht-malignen Erkrankungen des hämatopoetischen Systems. Dies ist darin begründet, daß dieses Verfahren nicht nur die Applikation einer myeloablativen und somit maximalen zytostatischen Therapie erlaubt (oder daß sie verbunden ist dem kompletten Ersatz der Empfängerhämatopoese durch den Spender), sondern vor allem dadurch, daß sie mit einem immunologisch vermittelten Anti-Tumor-Effekt, der Graft-versus-Leukämie-Reaktion (GVL) verbunden ist. In der Klinik ist die Anwendung der allogenen Stammzelltransplantation durch die assoziierten schwerwiegenden Komplikationen, zur Zeit noch erheblich eingeschränkt. Ziel dieser Arbeit war es die Mechanismen dieser T-zellvermittelten anti-Leukämie-Reaktion näher zu untersuchen. Im Mausmodell nach nicht-myeloablativer Konditionierung und alloegenr Kncohenmarktransplantation konnte gezeigt werden, dass die GVL-Reaktion welche durch die Spenderlympozyten vermittelt wird Alloantigen-abhänig ist, da sie in gemischten Chimären wesentlich stärker ausgeprägt ist als in vollen Chimären und ohne dass es zur entwicklung einer GVHD kommt..Weiterhin konnte gezeigt werden, dass diese Alloantigen-abhängige GVL-Reaktion nur kurzlebig ist, keine andauernde Immunität hinterlässt und dieser Verlust an GVL-reaktivität assoziiert ist mit dem verschwinden dieser alloreaktiven T-Zellpopulation. / Allogeneic stem cell transplantation is the treatment of choice for a number of malignant and benign hematological diseases. This is due to the fact that this procedure not only allows the administration of a myeloablative and thus maximal cytoreductive therapy, but leads also to the substitution of the recipient hematopoiesis with the donor hematopoeisis. More important however, is the fact that this type of therapy is associated with a significant immunologically-mediated T-cell-dependent anti-tumor response the so called graft-versus - leukemia-reaction (GVL). However, the extensive use of allogeneic stem cell transplantation has been prevented by the considerable treatment-elated morbidity and mortality associated with allogeneic transplantation and the development of Graft-versus-Host-disease (GVHD). Using mouse models it could be observed that in mice following conditioning and allogeneic bone marrow transplantation donor lymphocyte-mediated GVL responses are primarily driven by direct immune recognition of host alloantigen. Furthermore, it could be shown that this GVL response is only transient and that the loss of this GVL effect occurs concomitantly with the contraction of the alloantigen-reactive T cell population.