Background To investigate vascular-related pathophysiological characteristics of two human lung cancers with modifiable vascularisation using MRI and CT. Methods Tumour xenografts with modifiable vascularisation were established in 71 rats (approval by the Animal Care Committee was obtained) by subcutaneous transplantation of two human non-small-cell lung cancer (NSCLC) cells (A549, H1299) either alone or co-transplanted with vascular growth promoters. The vascularity of the tumours was assessed noninvasively by MRI diffusion-weighted-imaging (DWI), T2-weighted, and time-of-flight (TOF) sequences) as well as contrast-enhanced CT (CE-CT), using clinical scanners. As a reference standard, histological examinations (CD-31, fluorescent beads) were done after explantation. Results Microvessel density (MVD) was higher in co-transplanted tumours (171 ± 19 number/mm2) than in non-co-transplanted tumours (111 ± 11 number/mm2; p = 0.002). Co-transplanted tumours showed higher growth rates and larger tumour vessels at TOF-MRI as well as larger necrotic areas at CE-CT. In co-transplanted tumours, DWI revealed higher cellularity (lower minimal ADCdiff 166 ± 15 versus 346 ± 27 mm2/s × 10−6; p < 0.001), highly necrotic areas (higher maximal ADCdiff 1695 ± 65 versus 1320 ± 59 mm2/s × 10−6; p < 0.001), and better-perfused tumour stroma (higher ADCperf 723 ± 36 versus 636 ± 51 mm2/s × 10−6; p = 0.005). Significant correlations were found using qualitative and quantitative parameters: maximal ADCperf and MVD (r = 0.326); maximal ADCdiff and relative necrotic volume on CE-CT (r = 0.551); minimal ADCdiff and MVD (r = −0.395). Conclusions Pathophysiological differences related to vascular supply in two human lung cancer cell lines with modifiable vascularity are quantifiable with clinical imaging techniques. Imaging parameters of vascularisation correlated with the results of histology. DWI was able to characterise both the extent of necrosis and the level of perfusion.

Background To investigate vascular-related pathophysiological characteristics of two human lung cancers with modifiable vascularisation using MRI and CT. Methods Tumour xenografts with modifiable vascularisation were established in 71 rats (approval by the Animal Care Committee was obtained) by subcutaneous transplantation of two human non-small-cell lung cancer (NSCLC) cells (A549, H1299) either alone or co-transplanted with vascular growth promoters. The vascularity of the tumours was assessed noninvasively by MRI diffusion-weighted-imaging (DWI), T2-weighted, and time-of-flight (TOF) sequences) as well as contrast-enhanced CT (CE-CT), using clinical scanners. As a reference standard, histological examinations (CD-31, fluorescent beads) were done after explantation. Results Microvessel density (MVD) was higher in co-transplanted tumours (171 ± 19 number/mm2) than in non-co-transplanted tumours (111 ± 11 number/mm2; p = 0.002). Co-transplanted tumours showed higher growth rates and larger tumour vessels at TOF-MRI as well as larger necrotic areas at CE-CT. In co-transplanted tumours, DWI revealed higher cellularity (lower minimal ADCdiff 166 ± 15 versus 346 ± 27 mm2/s × 10−6; p < 0.001), highly necrotic areas (higher maximal ADCdiff 1695 ± 65 versus 1320 ± 59 mm2/s × 10−6; p < 0.001), and better-perfused tumour stroma (higher ADCperf 723 ± 36 versus 636 ± 51 mm2/s × 10−6; p = 0.005). Significant correlations were found using qualitative and quantitative parameters: maximal ADCperf and MVD (r = 0.326); maximal ADCdiff and relative necrotic volume on CE-CT (r = 0.551); minimal ADCdiff and MVD (r = −0.395). Conclusions Pathophysiological differences related to vascular supply in two human lung cancer cell lines with modifiable vascularity are quantifiable with clinical imaging techniques. Imaging parameters of vascularisation correlated with the results of histology. DWI was able to characterise both the extent of necrosis and the level of perfusion.

Cancer cells use the interaction between immune-checkpoint receptor programmed cell death protein 1 (PD-1) on activated T cells and programmed cell death ligand 1 (PD-L1) on tumor cells and various cell types of the tumor microenvironment to evade immune surveillance. Blocking the interaction between PD-1 and PD-L1 with checkpoint inhibitors can improve T-cell reactions and mediate efficient antitumor activity in a variety of solid tumors including melanoma. However, clinical data from patients with myeloid diseases that are treated with these agents are limited to clinical trials in advanced disease. Pembrolizumab (PEM) is a humanized monoclonal antibody of the immunoglobulin G4/κ isotype designed to block PD-1/PD-L1 interactions and is approved for various solid tumors including advanced melanoma.

The tumor microenvironment (TME) comprising immune cells and stromal components, such as fibroblasts and vessels, emerged as one of the most significant predictors of patient survival in a variety of solid tumors. With T cells representing the major cellular effector cells of the adaptive immune system and B cells orchestrating the humoral immune response, both cell types acquire crucial roles in the antitumor immune response. Thus, a high abundance of tumor-infiltrating CD8+ T cells and B cells has been generally associated with longer survival, while immunosuppressive subsets such as regulatory T cells (Treg) and M2-polarized macrophages are frequently linked to poor prognosis. Besides the frequency, also the spatial organization emerged as a clinically relevant parameter. Hence, the formation of T and B cells in tertiary lymphoid structures (TLS) was found to favor improved clinical outcome of patients. It was further reported that besides the prognostic value, the baseline immune architecture harbors the ability to predict the response to immunotherapies such as immune checkpoint inhibitor treatment and even chemotherapy. In turn, standard cytotoxic treatment regimens like radio- and chemotherapy, as well as novel immunotherapeutic or targeted approaches, exhibit distinct effects on various immune cells. Depending on the tumor entity, therapy, and immune cell subsets, differing modulation of infiltrating immune cells after therapy was observed. While previous studies mainly investigated an altered abundance of T and B cells, changes in functional orientation and composition of lymphocyte populations are gaining increasing relevance. In this thesis, the aim was to uncover the phenotype, frequency, composition, spatial distribution, clinical significance, and therapeutic modulation of the T cell compartment in soft tissue sarcoma (STS), and B cell populations in pancreatic ductal adenocarcinoma (PDAC). Due to the low incidence and heterogeneous nature of STS, detailed analyses of distinct CD8+ and CD4+ T cell subsets are lacking. To assess the effect of multimodal treatment, comprising radiotherapy and locoregional hyperthermia with or without chemotherapy, on the immune architecture, the patient cohort included matched pre- and post-therapy tissue samples. By assessing both the peritumoral and intratumoral region, additional information about the spatial distribution of STS-infiltrating T cells was gained. In PDAC, the T cell compartment and its therapeutic modulation has been explored in detail recently, but equivalent insight into the B cell landscape is missing. Going beyond the abundance of pan B cells, the aim was to identify proliferating B and T cells, germinal center (GC) B cells, plasmablasts, and plasma cells to investigate their modulation by neoadjuvant chemo(radio)therapy (NeoTx). Further insight into the spatial composition was gained by analyzing different regions (intratumoral and peritumoral) and tissue compartments (epithelial, stromal, TLS). To achieve this, three novel multiplex immunohistochemistry panels were established enabling simultaneous staining of six markers plus DAPI. For CD4+ T helper (Th) cells, the master transcription factors for Th1 (T-box expressed in T cells), Th2 (GATA-binding protein 3), Th17 (retinoic acid receptor-related orphan receptor T), and Treg (Forkhead box protein 3) were included in addition to CD3 and the proliferation marker Ki67. The CD8+ T cell panel comprised the phenotypic marker CD8, the immune checkpoint molecules programmed cell death protein 1 and lymphocyte-activation gene 3 as well as the activation-associated molecules granzyme B and 4-1BB, in addition to Ki67. It was thus found that post-treatment STS samples displayed moderately reduced frequencies of both CD8+ and CD3+ T cells in comparison to the pretreatment biopsy. The Th cell landscape was dominated by Th2 cells, whose density was significantly reduced upon multimodal therapy and a moderate redistribution favoring Th1 and Th17 cells was observed. While high frequencies of CD3+ and CD8+ T cells in the posttreatment tissues were associated with significantly longer disease-free survival, these populations held no prognostic value in the biopsy obtained prior to treatment, suggesting a reshaping of the TME upon therapy. Furthermore, the spatial distribution, reflected by the ratio of intra- to peritumoral CD8+ T cells, emerged as an independent prognostic factor for the risk of recurrence. In PDAC, B cell subsets were identified by staining for CD3, CD20, Ki67, the transcription factor B cell lymphoma 6, and the plasma cell markers CD38 and CD138. While CD3+ T cells were unaffected, significantly lower frequencies of proliferating B cells, GC B cells, plasmablasts, and plasma cells were observed in the NeoTx group compared to patients undergoing primary resection (PR). Furthermore, neoadjuvant-treated patients exhibited a significantly lower abundance of TLS, which was validated in an independent cohort. These results indicate that NeoTx differentially affects distinct immune cell subsets, and that B cellmediated antitumor immunity may be inhibited by chemo(radio)therapy. Spatial analysis further revealed that plasma cell accumulations frequently localized close to TLS, being accompanied by C-X-C motif chemokine ligand 12-expressing fibroblasts. Furthermore, patients with TLS exhibited significantly higher plasma cell frequencies, suggesting that TLS can foster the generation of plasma cells whose migration is then guided by fibroblastic tracks. Lastly, a prognostic value of pan T and B cells was observed only in the PR group, while these populations provided no clinical significance in neoadjuvant-treated patients. However, proliferating Ki67+CD20+ B cells emerged as an independent prognostic factor for a lower risk of death in the NeoTx group, suggesting a restorative post-treatment TME in these patients. Altogether, this thesis provided novel insights into the TME of STS and PDAC and its therapeutic alteration. Spatial analyses further enabled an improved understanding of the immune architecture and potential cell-cell interactions within the TME. In addition, strong associations with patient survival highlight the enormous significance of the TME and may guide future therapy development. Although the results do not encourage a concomitant application of cytotoxic therapy regimens and immunotherapy, patients may benefit from sequential combination treatments. An enhanced understanding of the immunomodulatory effects of NeoTx is pivotal for overcoming the immunosuppressive TME of STS and PDAC by refining existing treatment regimens and developing novel therapy approaches in order to improve the long-term outcome of patients.

Die pädiatrische Akute Lymphatische Leukämie ist heutzutage gut behandelbar. Trotzdem ist die Prognose im Falle eines Rezidives weiterhin schlecht. Die häufigsten extramedullären Orte für Rezidive sind das zentrale Nervensystem und der Hoden. Um ein Rezidiv im Hoden zu verhindern, ist es nötig die zellulären und molekularen Vorgänge zu verstehen. Dafür wurde Patientenmaterial auf seine Expression bestimmter Oberflächenmoleküle analysiert. Verglichen wurden Proben von Patienten mit verschiedenen Rezidiv-Arten. Um die funktionellen Aspekte der Hodenphysiologie auf die Leukämiezellmigration und -lokalisation zu untersuchen wurde ein PDX-ALL Mausmodel mit Hodenbeteiligung etabliert. Um potenziell involvierte Chemokin-Chemokinrezeptor-Achsen zu identifizieren, wurden 55 Knochenmarksproben von Patienten untersucht. Die Expressionsmuster der Rezeptoren wurde mittels Durchflusszytometrie analysiert. Es wurde festgestellt, dass CXCR4 meistens sehr hoch exprimiert wird. Deshalb wurde anschließend der Einfluss der CXCR4-CXCL12 Achse in in vitro Versuchen mit Hilfe primären Hodenstromas untersucht. Um verschiedene Subpopulationen zu untersuchen, wurde die Isolation von Hodenmakrophagen, Sertoli Zellen und Peritubulären Zellen aus der Maus etabliert und ihr Einfluss auf ALL Zellen untersucht. Es wurde festgestellt, dass Hodenmakrophagen bei Tumorkontakt ihren Phänotyp zugunsten einer tumorfördernden Subpopulation verändern. Zu guter Letzt wurde ein adaptives PDX-ALL Mausmodel mit Hodenbeteiligung entwickelt. Dabei wurden die Hoden von vorpubertären Mäusen bevorzugt infiltriert. Die Bedeutung der CXCR4-CXCL12 Achse für die Hodeninfiltration wurde in einem in vivo Versuch validiert. Während Knochenmark und Milz nach einer anti-CXCR4 Gabe kleine ALL Populationen aufwiesen, war der Hoden komplett Tumor-frei. Das Model kann für Versuche genutzt werden, um weitere Signalwege zu identifizieren, welche in die Hoden gerichtete Migration und das Überleben der Zellen involviert sind. / Advancing therapy strategies led to event-free-survival increase of paediatric acute lymphoblastic leukaemia (ALL). Relapses that occur are often drug resistant and come with poor prognosis. Extramedullary sites for relapse are the central nervous system (CNS) and the testis. To prevent testicular relapse, factors responsible for the infiltration and survival need to be discovered. Primary patient material was analysed with regard to differential expression of surface molecules on leukemic cells from BM. To analyse functional aspects of testis physiology on leukemic cell migration and localisation an adoptive PDX-ALL mouse model with testicular involvement was established. To identify potential chemokine-chemokine receptor axes responsible for the leukaemia cell migration towards the testis, a characterization of 55 patient BM samples was performed. The expression pattern of chemokine receptors on BM derived leukaemia cells was compared by flow cytometry. CXCR4 was identified to be highly expressed on patients cells, regardless of the subclass of relapse. Relevance of the CXCR4-CXCL12 axis was studied in vitro. Primary testicular stroma cultures were available, which provided a useful tool to examine testis directed migration. Isolation of testicular macrophages, Sertoli cells and peritubular cells was established and their impact on ALL cell survival was analysed. The macrophages were found to alter their phenotype upon ALL cell contact towards a tumour favourable subtype. Most importantly, a murine adoptive patient-derived xenograft (PDX)-ALL cell transfer model with testicular involvement was established. Testes of pre-puberty mice were preferentially infiltrated. Blocking CXCR4 with an antibody validated relevance of the CXCR4-CXCL12 signalling axis. The testis showed no infiltration in anti-CXCR4 treated animals. The mouse model will be useful to identify and validate further signalling pathways, participating in testis directed migration and survival.