Sjuksköterskan bör ha kunskap om begreppet livskvalitet för att kunna bemöta patienter som genomgått en levertransplantation, då den upplevda livskvalitén är betydelsefull för patienterna. Syftet var att beskriva livskvalitet hos patienter som genomgått en levertransplantation. Studien är genomförd som en litteraturstudie där 12 vetenskapliga artiklar har granskats. Resultatet visar att den upplevda livskvalitén hos levertransplanterade patienter är relativt god men det finns delar av livskvalitén som påverkas negativt efter levertransplantationen. Livskvalitén påverkas av fysiska, psykiska och sociala aspekter. De delar som påverkade livskvalitén positivt var familjen, att kunna återvända till det yrkesverksamma livet och att få en chans till ett nytt liv. Negativa aspekter som framkom i resultatet var bland annat förlorad autonomi, fysisk inaktivitet och en känsla av utanförskap i samhället. Vidare omvårdnadsforskning inom området livskvalitet relaterat till levertransplantation bör utföras. Sjuksköterskor behöver utbildning i ämnet för att i omvårdnadsarbetet kunna främja och bevara patienters livskvalitet. / The nurse should have knowledge of the concept of quality of life to respond to patients who underwent a liver transplant, when the perceived quality of life is important for patients. The aim was to describe the quality of life in patients undergoing a liver transplant. The study was conducted as a literature review of 12 scientific papers that have been reviewed. The results show that the perceived quality of life in liver transplant patients is relatively good but there are elements of quality of life adversely affected by post-liver transplant. Quality of life is affected by physical, psychological and social aspects. The elements affecting the quality of life positively were the family, ability to return to the working life and to get a chance to start a new life. Negative aspects that emerged from the results included the loss of autonomy, physical inactivity and a sense of alienation in society. In addition, nursing research in the field of quality of life related to liver transplantation should be performed. Nurses need education on the topic of the nursing work to promote and preserve patients' quality of life.

München, Techn. Univ., Diss., 2004.

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

After priming in Peyer's patches (PPs) and mesenteric lymph nodes (mLN) T- cells infiltrate the intestine through lymphatic draining and homing through the bloodstream. However, we found that in mouse models of acute graft-versus-host disease (GvHD), a subset of alloreactive T-cells directly migrates from PPs to the adjacent intestinal lamina propria (LP), bypassing the normal lymphatic drainage and vascular trafficking routes. Notably, this direct migration occurred in irradiated and unirradiated GvHD models, indicating that irradiation is not a prerequisite for this observed behavior. Next, we established a method termed serial intravascular staining (SIVS) in mouse models to systematically investigate the trafficking and migration of donor T- cells in the early stages of acute GvHD initiation. We found that the direct migration of T-cells from PPs to LP resulted in faster recruitment of cells after allogeneic hematopoietic cell transplantation (allo-HCT). These directly migrating T-cells were found to be in an activated and proliferative state, exhibiting a TH1/TH17-like phenotype and producing cytokines such as IFN-γ and TNF-α. Furthermore, we observed that the directly migrating alloreactive T-cells expressed specific integrins (α4+, αE+) and chemokine receptors (CxCR3+, CCR5+, and CCR9+). Surprisingly, blocking these integrins and chemokine-coupled receptors did not hinder the direct migration of T- cells from PPs to LP, suggesting the involvement of alternative mechanisms. Previous experiments ruled out the involvement of S1PR1 and topographical features of macrophages, leading us to hypothesize that mediators of cytoskeleton reorganization, such as Coro1a, Dock2, or Cdc42, may play a role in this unique migration process. Additionally, we observed that directly migrating T-cells created a local inflammatory microenvironment, which attracts circulating T-cells. Histological analysis confirmed that alloreactive PPs-derived T-cells and bloodborne T-cells colocalized. We employed two experimental approaches, including either photoconversion of T-cells in PPs or direct transfer of activated T-cells into the vasculature, to demonstrate this colocalization. We hypothesize that cytokines released by migrating T-cells, such as IFN-γ and TNF-α, may play a role in recruiting T-cells from the vasculature, as inhibiting chemokine-coupled receptors did not impair recruitment. / Nach der Priming-Phase in den Peyer-Plaques (PPs) und mesenterialen Lymphknoten (mLN) migrieren T-Zellen über die lymphatische Drainage und den Blutkreislauf die Darmschleimhaut. Allerdings haben wir festgestellt, dass in Mausmodellen der akuten Graft-versus-Host Erkrankung (GvHD) eine Untergruppe alloreaktiver T-Zellen direkt von den Peyer-Plaques in das benachbarte intestinale Lamina propria (LP) migriert, ohne lymphatische Drainage- oder vaskuläre Transportwege zu nutzen. Bemerkenswert ist, dass diese direkte Migration sowohl in bestrahlten als auch in nicht bestrahlten GvHD-Modellen auftrat, was darauf hindeutet, dass Gewebeschaden durch ionisierende Strahlung keine Voraussetzung für dieses beobachtete T-Zell-Migrationsverhalten ist. Anschließend haben wir die Methode der "serielle intravaskulären Zellmarkierung" (SIVS) für Mausmodelle etabliert, um systematisch das Migrationsverhalten von alloreaktiven Spender-T-Zellen in den frühen Stadien der akuten GvHD-Initiierung zu untersuchen. Wir beobachteten, dass die direkte Migration von T-Zellen von PPs zu LP zu einer schnelleren Rekrutierung von Zellen nach allogener hämatopoetischer Zelltransplantation (allo-HCT) führte. Diese direkt migrierenden T-Zellen befanden sich in einem aktivierten und proliferativen Zustand, wiesen einen TH1-/TH17- ähnlichen Phänotyp auf und produzierten Zytokine wie IFN- γ und TNF-α. Darüber hinaus beobachteten wir, dass die direkt migrierenden alloreaktiven T-Zellen spezifische Integrine (α4+, αE+) und Chemokinrezeptoren (CxCR3+, CCR5+ und CCR9+) exprimierten. Überraschenderweise verhinderte die Blockierung dieser Integrine und Chemokinrezeptoren nicht die direkte Migration von T-Zellen aus PPs in LP, was auf die Beteiligung alternativer T- Zellmigrationsmechanismen schließen lässt. Vorangegangene Experimente schlossen die Beteiligung von S1PR1 und topografischer Merkmale gewebeständiger Makrophagen aus, was uns zu der Hypothese führte, dass Mediatoren der Zytoskelett- Reorganisation wie Coro1a, Dock2 oder Cdc42 eine Rolle in diesem einzigartigen Migrationsprozess spielen könnten. Zusätzlich beobachteten wir, dass direkt migrierende T-Zellen in der Darmschleimhaut ein lokales entzündliches Mikromilieu schaffen, welches zirkulierende T-Zellen anzieht. Die histologische Analyse bestätigte die Kolokalisation von direkt aus PP stammenden T-Zellen und T Zellen, welche über die Blutbahn in die Darmmukosa einwanderten. Um die direkte T-Zellmigration eindeutig zu bestätigen, wählten wir zwei experimentelle Ansätze: Die Photokonversion von T-Zellen in PPs während der Priming-Phase sowie den direkten Transfer aktivierter T-Zellen in das Gefäßsystem, um eine T-Zellkolokalisierung nachzuweisen. Aufbauend auf den Ergebnissen vermuten wir, dass Zytokine, die von migrierenden T-Zellen freigesetzt werden, wie zum Beispiel IFN-γ und TNF-α, möglicherweise eine Rolle bei der Rekrutierung von T-Zellen aus dem Gefäßsystem spielen, da die Hemmung von G- Protein-gekoppelter Rezeptoren (und somit aller Chemokinrezeptoren) die T-Zell- Rekrutierung nicht beeinträchtigte.

Optimale Konservierungsmethoden sind erforderlich, um die bedarfsgerechte Verfügbarkeit kardiovaskulärer Transplantate für den Ersatz geschädigter Gewebe (Herzklappen oder Gefäße) zu garantieren. Die konventionelle Kryokonservierung (engl.: Conventional Frozen Cryopreservation, CFC) ist derzeit der Standard zur Konservierung kardiovaskulärer Allografts. Jedoch limitieren Immunreaktionen deren Langzeitfunktionalität. Die Alternative der eisfreien Kryokonservierung (engl.: Ice-free Cryopreservation, IFC) wurde kürzlich entwickelt. In der Arbeit wurde die Reaktion des humanen Immunsystems auf allogene kardiovaskuläre Gewebe nach Anwendung unterschiedlicher Konservierungsmethoden umfänglich charakterisiert. Zusätzlich wurde Glutaraldehyd (GA)-fixiertes Gewebe untersucht, um die Ergebnisse in den Gesamtkontext der Gewebekonservierung einzuordnen. Die Analyse des konservierten humanen Aortengewebes, welches als Modellmaterial diente, ergab, dass die Gewebestruktur nach IFC erhalten blieb, jedoch die metabolische Aktivität sowie Apoptose und Nekrose des Gewebes durch IFC reduziert wurde. Dies spiegelte sich auch in der verminderten Freisetzung von Zytokinen aus IFC-Gewebe wider. Funktionelle In-vitro-Tests zeigten deutlich, dass Immunzellen verstärkt in Richtung der löslichen Faktoren aus CFC- und GA-fixiertem Gewebe, jedoch nicht aus IFC-Gewebe migrieren. In Kokulturen der Makrophagen auf dem Aortengewebe konnte ausschließlich bei Makrophagen, welche auf GA-fixiertem Gewebe kultiviert wurden, eine Polarisation zum M1-Phänotyp festgestellt werden. Weiterhin zeigte sich, dass lediglich Faktoren des CFC-Gewebes in der Lage waren, die Aktivierung und Proliferation von T-Zellen zu verstärken. Insgesamt belegen diese Daten detailliert, dass IFC die Eigenschaften des Gewebes selektiv moduliert und dadurch eine verringerte Aktivierung des Immunsystems stattfindet. Die Ergebnisse verdeutlichen, dass IFC eine aussichtsreiche Strategie zur verbesserten Konservierung darstellt. / Optimal preservation methods are needed, to ensure constant availability of biological matrices for the replacement of damaged cardiovascular structures (heart valves or vessels). Conventional frozen cryopreservation (CFC) is currently the gold standard for cardiovascular allograft preservation. However, inflammation and structural deterioration limit transplant durability. The recently developed method of Ice-free cryopreservation (IFC) might be a superior method. The aim of this study was to characterize the reaction of the human immune system to allogeneic cardiovascular tissues after different cryopreservation methods. Regarding some aspects, the cryopreservation was compared to glutaraldehyde (GA) fixation, which is another common tissue preservation method. Human aortic tissue served as a proof-of-principle material for heart valves and vascular allografts. First, the histological and metabolic features of the differently preserved aortic tissues were analyzed. Tissues preserved by IFC exhibited typical architecture but significantly lower metabolic activity and the absence of necrotic or apoptotic cells. The reduced release of cytokines from IFC-tissue reflected these latter observations. In functional in-vitro-assays it was shown that migration of immune cells was significantly enhanced by soluble factors from CFC and GA-fixed tissue, but not by factors from IFC-tissue. In co-cultures of macrophages on aortic tissue, none of the preserved tissue induced activation. Exclusively GA-fixed tissue triggered the polarization of macrophages towards a M1-phenotype. Moreover, cues from only CFC-tissue but not IFC-tissue amplified T cell activation and proliferation. In conclusion, IFC selectively modulates the characteristics of tissues resulting in an attenuated activation of the human immune system. Therefore, IFC treatment is a promising strategy for improved tissue preservation and storage of cardiovascular allografts for clinical use.

Dendritic cells (DCs), a hematopoietic cell type belonging to the sub-group of cells called antigen presenting cells (APCs), inhabit a central role in innate and adaptive immunity. Although the DC family is very heterogeneous, all members share unique features. Most importantly, DCs can stimulate an immune response. This is due to the cells’ ability to capture and process antigens and to maturate in the presence of danger signals presented by pathogens. Maturation in turn results in the migration of DCs from the tissue they reside in to the draining lymph nodes, as well as in the subsequent presentation of the acquired antigens to T cells. In the skin, which is one of the most immunogeneic organs, DCs are present in sizable numbers in both the epidermis and the dermis. This study focused on two types of DCs: epidermal Langerhans cells (LCs) and dermal DCs (DDCs). While much is understood about LCs, far less is known about the role that DDCs play in skin immunity. Therefore one purpose of this study was to characterize DDCs and to compare their phenotype and functions to that of LCs. This study used two different methods to characterize human skin resident immune cells with regard to their number and distribution. First, a stable analytical immunohistochemistry-based method was developed and applied to a substantial number of healthy skin donors. This enabled a quantitative analysis of skin DC types and skin resident T cells at different anatomical locations in situ. A novel method to count dermal cell populations in situ was developed that resulted in the first published quantification of APCs, DDCs, as well as T cells in human dermis. Second, the traditional form of the emigration assay, which selectively enriches vital cells capable of ex vivo emigration from the skin, was upgraded toward a stable analytical method to separate epidermal LCs from DDCs. In this way, both skin DC types became accessible in sufficient numbers to allow for a comparison of phenotypes and functions in vitro. The resulting phenotypic observations clearly showed that both, LCs and DDCs are not fully mature after their emigration ex vivo and that both can be transformed into a phenotypically more mature state by treating them with inflammatory cytokines. What’s more, LCs are also functionally in an immature state after their emigration. They efficiently took up antigen, showed a low capacity to trans-migrate in response to chemokines, and demonstrated a low capacity to stimulate allogeneic T cells in a mixed leukocyte reaction (MLR). For the first time this study observed all these main APC functions not only for LCs but additionally for DDCs. As these observations were made in relation to LCs of the same donor, it could be concluded that DDCs are functionally more mature than LCs after emigration. DDCs showed a lower antigen uptake capacity than LCs but were superior in terms of their migratory and stimulatory capacity. However, treatment with cytokines could skew LC functions toward functional capacities observed for DDCs, i.e., it decreased LCs’ Ag uptake and increased their migratory and stimulatory capacity, whereas the cytokine treatment did not alter DDCs’ functional capacities. After improving immuno-histochemistry and the emigration assay using healthy skin samples, these newly developed techniques were implemented in clinical trials to observe the number, distribution and migratory capacity of skin DCs and T cells in patients undergoing allogeneic hematopoietic cell transplantation (aHSCT). Such a study is of importance because the turnover of DCs and T cells is closely associated with the occurrence of acute graft-versus-host disease (aGvHD), the major cause of morbidity and mortality after aHSCT. Due to the study design used, this study concisely demonstrate that at the onset of aGvHD, different DC types accumulate along with effector T cells in skin lesions of aGvHD but not in uninvolved skin of the same patient. These results suggest that in addition to donor T cells LCs and DDCs play a role during the early phase of cutaneous aGvHD directly within the site of inflammation. The view of many authors that DC depletion in the transplant recipient, especially in target organs, is a promising approach for aGvHD prophylaxis and therapy is further underscored by these results. One targeting strategy to inhibit GvHD by eliminating recipient DCs may be the use of DC specific monoclonal antibodies. Alemtuzumab (anti-CD52) is a monoclonal antibody and has proven effective in preventing aGvHD after aHSCT. It may, despite depleting donor T cells, also work by targeting recipient DCs. To determine whether the last mechanism of action is significant, a second clinical study investigated the effects of intravenous alemtuzumab on DCs by comparing the number of these cells in skin and blood of patients before and after a 4-week course of alemtuzumab treatment. The result was that although skin DCs weakly express the target antigen CD52 the number of these cells was not consistently reduced by alemtuzumab. In contrast, circulating blood DCs have a stronger CD52 expression and were significantly reduced by the treatment. In conclusion, this work provides new insights into the phenotypical and functional characteristics of human skin DCs, as well as into the fate of these cell types during aHSCT. The investigation of the APC system during aGvHD as carried out here will help to understand the process of aGvHD in more detail. All these efforts may hopefully support the development of new approaches for therapy and prevention of this major limitation of aHSCT and may help to improve this only curative therapy for several life-threatening diseases.

In dieser Arbeit wurden Methoden entwickelt und verglichen, um aus Corneoskleralringen langzeitorgankonservierter Hornhäute und intakten, kryokonservierten Amnionmembranen Limbusepithel-Amnion-Transplantate herzustellen. Als erfolgreichste Kultivierungsmethode stellte sich hierbei signifikant die Explantat-Technik mit nach unten gerichtetem Limbusepithel heraus. Hier konnte eine Auswachsrate von 42 % erzielt werden. Es wurde weiterhin gezeigt, dass das ausgewachsene, mehrschichtige Limbusepithel proliferationsfähige TACs (Transient Amplifying Cells) enthält. Weiterhin konnten mittels Regressionsanalyse signifikante Zusammenhänge zwischen Spenderalter, Post-mortem-Zeit, Organkultur-Dauer und der Auswachsrate beschrieben werden. Kurzgefasst wurde die Vermutung bestätigt, dass jede Verlängerung der unterschiedlichen Zeiten eine Verringerung der Auswachsrate zur Folge hat. Die hergestellten Limbusepithel-Amnion-Transplantate könnten für Patienten mit Limbusstammzellinsuffizienz unterschiedlicher Genese verwendet werden.

Dendritic cells (DCs), a hematopoietic cell type belonging to the sub-group of cells called antigen presenting cells (APCs), inhabit a central role in innate and adaptive immunity. Although the DC family is very heterogeneous, all members share unique features. Most importantly, DCs can stimulate an immune response. This is due to the cells’ ability to capture and process antigens and to maturate in the presence of danger signals presented by pathogens. Maturation in turn results in the migration of DCs from the tissue they reside in to the draining lymph nodes, as well as in the subsequent presentation of the acquired antigens to T cells. In the skin, which is one of the most immunogeneic organs, DCs are present in sizable numbers in both the epidermis and the dermis. This study focused on two types of DCs: epidermal Langerhans cells (LCs) and dermal DCs (DDCs). While much is understood about LCs, far less is known about the role that DDCs play in skin immunity. Therefore one purpose of this study was to characterize DDCs and to compare their phenotype and functions to that of LCs. This study used two different methods to characterize human skin resident immune cells with regard to their number and distribution. First, a stable analytical immunohistochemistry-based method was developed and applied to a substantial number of healthy skin donors. This enabled a quantitative analysis of skin DC types and skin resident T cells at different anatomical locations in situ. A novel method to count dermal cell populations in situ was developed that resulted in the first published quantification of APCs, DDCs, as well as T cells in human dermis. Second, the traditional form of the emigration assay, which selectively enriches vital cells capable of ex vivo emigration from the skin, was upgraded toward a stable analytical method to separate epidermal LCs from DDCs. In this way, both skin DC types became accessible in sufficient numbers to allow for a comparison of phenotypes and functions in vitro. The resulting phenotypic observations clearly showed that both, LCs and DDCs are not fully mature after their emigration ex vivo and that both can be transformed into a phenotypically more mature state by treating them with inflammatory cytokines. What’s more, LCs are also functionally in an immature state after their emigration. They efficiently took up antigen, showed a low capacity to trans-migrate in response to chemokines, and demonstrated a low capacity to stimulate allogeneic T cells in a mixed leukocyte reaction (MLR). For the first time this study observed all these main APC functions not only for LCs but additionally for DDCs. As these observations were made in relation to LCs of the same donor, it could be concluded that DDCs are functionally more mature than LCs after emigration. DDCs showed a lower antigen uptake capacity than LCs but were superior in terms of their migratory and stimulatory capacity. However, treatment with cytokines could skew LC functions toward functional capacities observed for DDCs, i.e., it decreased LCs’ Ag uptake and increased their migratory and stimulatory capacity, whereas the cytokine treatment did not alter DDCs’ functional capacities. After improving immuno-histochemistry and the emigration assay using healthy skin samples, these newly developed techniques were implemented in clinical trials to observe the number, distribution and migratory capacity of skin DCs and T cells in patients undergoing allogeneic hematopoietic cell transplantation (aHSCT). Such a study is of importance because the turnover of DCs and T cells is closely associated with the occurrence of acute graft-versus-host disease (aGvHD), the major cause of morbidity and mortality after aHSCT. Due to the study design used, this study concisely demonstrate that at the onset of aGvHD, different DC types accumulate along with effector T cells in skin lesions of aGvHD but not in uninvolved skin of the same patient. These results suggest that in addition to donor T cells LCs and DDCs play a role during the early phase of cutaneous aGvHD directly within the site of inflammation. The view of many authors that DC depletion in the transplant recipient, especially in target organs, is a promising approach for aGvHD prophylaxis and therapy is further underscored by these results. One targeting strategy to inhibit GvHD by eliminating recipient DCs may be the use of DC specific monoclonal antibodies. Alemtuzumab (anti-CD52) is a monoclonal antibody and has proven effective in preventing aGvHD after aHSCT. It may, despite depleting donor T cells, also work by targeting recipient DCs. To determine whether the last mechanism of action is significant, a second clinical study investigated the effects of intravenous alemtuzumab on DCs by comparing the number of these cells in skin and blood of patients before and after a 4-week course of alemtuzumab treatment. The result was that although skin DCs weakly express the target antigen CD52 the number of these cells was not consistently reduced by alemtuzumab. In contrast, circulating blood DCs have a stronger CD52 expression and were significantly reduced by the treatment. In conclusion, this work provides new insights into the phenotypical and functional characteristics of human skin DCs, as well as into the fate of these cell types during aHSCT. The investigation of the APC system during aGvHD as carried out here will help to understand the process of aGvHD in more detail. All these efforts may hopefully support the development of new approaches for therapy and prevention of this major limitation of aHSCT and may help to improve this only curative therapy for several life-threatening diseases.

Functional impairment of the bone marrow (BM) niche has been suggested as a major reason for prolonged cytopenia and secondary graft failure after allogeneic hematopoietic cell transplantation (alloHCT). Because mesenchymal stromal cells (MSCs) serve as multipotent progenitors for several niche components in the BM, they might play a key role in this process. We used collagenase digested trephine biopsies to directly quantify MSCs in 73 patients before (n = 18) and/or after alloHCT (n = 65). For the first time, we demonstrate that acute graft-versus-host disease (aGvHD, n = 39) is associated with a significant decrease in MSC numbers. MSC reduction can be observed even before the clinical onset of aGvHD (n = 10). Assessing MSCs instantly after biopsy collection revealed phenotypic and functional differences depending on the occurrence of aGvHD. These differences vanished during ex vivo expansion. The MSC endotypes observed revealed an enhanced population of donor-derived classical dendritic cells type 1 and alloreactive T cells as the causing agent for compartmental inflammation and MSC damage before clinical onset of aGvHD was ascertained. In conclusion, MSCs endotypes may constitute a predisposing conductor of alloreactivity after alloHCT preceding the clinical diagnosis of aGvHD.

Durch den Transfer der Gene des heterodimeren T-Zellrezeptors (TZR) mithilfe viraler Vektoren können T-Zellen programmiert werden, ein ausgewähltes Antigen spezifisch zu erkennen. In klinischen Studien wurden solche T-Zellen bereits mit Erfolg zur Immuntherapie von Krebs und viralen Infektionen eingesetzt. Genmodifizierte T-Zellen unterscheiden sich jedoch von normalen T-Zellen, weil sie neben den beiden zelleigenen auch die zwei übertragenen TZR-Gene exprimieren. Diese Situation erlaubt die Bildung vier verschiedener TZR-Heterodimere: der zelleigene TZR, der übertragene TZR und zwei gemischte TZR, bestehend aus je einer übertragenen und einer zelleigenen TZR-Kette. Gemischte TZR bergen das Risiko von Nebenwirkungen, weil sie durch Zufall gesundes Körpergewebe erkennen und so Autoimmunität auslösen könnten. In dieser Arbeit wurden deshalb virale Vektoren entwickelt, die gleichzeitig mit der Übertragung von neuen TZR-Genen den zelleigenen TZR durch RNA Interferenz (RNAi) unterdrücken. Mikro-RNA (miRNA), die in den Vektor MP71 eingefügt wurden, reduzierten den zelleigenen TZR in Maus-T-Zellen um mehr als 85%. Dies hatte zur Folge, dass beide Ketten des übertragenen P14-TZR in gleicher Menge auf der Zelloberfläche exprimiert wurden und die Bildung von gemischten TZR reduziert wurde. In einem Mausmodell der adoptiven T-Zelltherapie verhinderte die Unterdrückung des zelleigenen TZR die Entstehung von Autoimmunität, die andernfalls durch gemischte TZR verursacht wurde. Im Gegensatz dazu führte die Anwendung von gentechnisch optimierten P14-TZR-Genen weder zur angeglichenen Oberflächenexpression der P14-TZR Ketten noch zu weniger Autoimmunität im Mausmodell. Ein anderes Tierexperiment zeigte, dass die miRNA die Funktion der genmodifizierten T-Zellen nicht beeinträchtigte. Schließlich wurde ein viraler Vektor entwickelt und getestet, der die Expression des zelleigenen TZR in menschlichen T-Zellen effektiv unterdrückte und die Bildung von gemischten TZR reduzieren konnte. / T cells can be genetically modified using viral vectors. The transfer of genes encoding both chains of the heterodimeric T cell receptor (TCR) programs T cells to specifically react towards an antigen of choice. Such TCR gene-modified T cells were already successfully applied in clinical studies to treat cancer and viral infections. However, in contrast to nonmanipulated T cells these cells express the transferred TCR in addition to the endogenous TCR and this situation allows the assembly of four different TCR heterodimers: the endogenous TCR, the transferred TCR, and two mixed TCR dimers, composed of one endogenous and one transferred TCR chain. The formation of mixed TCR dimers represents a safety issue because they may by chance recognize self-antigens and thereby cause autoimmune side effects. To overcome this problem, an RNAi-TCR replacement vector was developed that simultaneously silences the endogenous TCR and expresses an RNAi-resistant therapeutic TCR. The expression of miRNA encoded by a retroviral MP71 vector in transduced mouse T cells reduced the surface levels of the endogenous TCR by more than 85%. The knockdown of the endogenous TCR in turn resulted in equal surface expression levels of both transferred P14 TCR chains and prevented the formation of mixed TCR dimers. Accordingly, the development of lethal mixed TCR dimer-dependent autoimmunity (TI-GVHD) in a mouse model of adoptive T cell therapy was dramatically reduced by the knockdown of the endogenous TCR. In contrast, the usage of genetically optimized TCR genes neither resulted in equal surface levels of both P14 TCR chains nor in reduced autoimmunity. A second mouse model demonstrated that the in vivo functionality of the transduced T cells was not negatively influenced by the expression of the miRNA. Finally, an RNAi-TCR replacement vector for human T cells was developed that effectively reduced the expression of the endogenous TCR and prevented the formation of mixed TCR dimers.