Text in Afrikaans / Gesinne met aangenome kinders bevind hulself in 'n eiesoortige gesinsituasie. Die situasie stel verskeie eise aan die ouers asook aan die kinders in die gesin. Bo en behalwe die universele gesinsuitdagings, moet bulle ook die uitdagings uniek aan die aannemingsituasie bemeester. Gesinne met aangenome kinders bevind hulself soms in moeilike situasies en benodig dan ondersteuning. Daarom is daar in hierdie studie besluit om ondersoek in te stel na die effek van gesinsterapie in gesinne met aangenome kinders. Die doel was om vas te stel in watter mate gesinne met aangenome kinders gehelp kan word om probleme te oorkom met gesinsterapie as terapeutiese intervensie. Die navorsing is gedoen aan die hand van 'n kwalitatiewe ontwerp waar data hoofsaaklik ingesamel is deur vraelyste, observasie en onderhoudvoering. Daar is tot die gevolgtrekking gekom dat gesinsterapie effektief gebruik kan word om hulp te verleen aan die gesin met aangenome kinders. Daar word as 'n span aan die probleme gewerk aangesien gesamentlike doelwitstelling-plaasvind en dit dien ook as 'n belangrike saambindende faktor van die gesinslede. AI die gesinslede se probleme kon gelyktydig aangespreek word in plaas van op 'n individuele basis. / Families with adopted children find themselves in a situation with unique demands made on them as a family as well as on an individual level as a parent or a child. They have to master the universal family challenges as well as the challenges of the family with adopted children. These families often find themselves in complex situations, which are difficult to handle and thus need the necessary support. The reason for this study was therefore to investigate the effect of family therapy in families with adopted children. The aim was to find out how effective a family with adopted children could be helped to solve the problems experienced with family therapy as therapeutic intervention. A qualitative analysis was conducted and data was gathered primarily through questionnaires, observation and interviewing. The results of the research led to the conclusion that family therapy was indeed an effective therapeutic intervention as far as families with adopted children were concerned. It provided the family to work together as a team and created unity. All the family members' problems could also be addressed at once instead of individually. / Psychology of Education / M. Ed. (Voorligting)

Les cellules Natural Killer (NK) sont jouent un rôle essentiel dans la surveillance des hémopathies malignes. Cependant, les cellules tumorales développent des mécanismes immunosuppresseurs pour échapper à l'immunité cellulaire NK. Ainsi, le maintien ou l'amélioration des performances des cellules NK sont considérés comme des défis majeurs. Les objectifs de cette partie étaient d'évaluer l'impact de la perfusion de cellules NK activées sur la récupération et la biologie des cellules NK circulantes après l'allo-SCT. Des doses croissantes de cellules NK activées par IL-2 ex-vivo ont été perfusées chez des patients atteints de tumeurs malignes hématologiques 3 mois après allo-SCT. Nos résultats ont montré une fréquence plus élevée des cellules NK dans la périphérie des patients traités. Bien que le phénotype immature soit remarquable peu après le traitement, les cellules NK circulantes, présentaient un état d'activation avec un profil de maturation amélioré après 6 mois de traitement. Nous avons également constaté que l'expression des récepteurs NK activateurs (NKG2D, NKp30 et NKp46) augmentait sur les cellules NK circulantes des patients. De plus, ces cellules ont montré une augmentation significative de la capacité de dégranulation ainsi que de la sécrétion de cytokines (IFN-Ƴ et TNF-α) tout au long de l'étude. Ces différences ont notamment été observées chez les patients ayant reçu des doses plus importantes de cellules NK activées. En conclusion, nous supposons que la perfusion de fortes doses de cellules NK activées ex-vivo pourrait être associée à l'amélioration du phénotype et des fonctions des cellules NK au cours de la reconstitution immunitaire après allo-SCT. / Natural killer (NK) cells are effector lymphocytes of the innate immune system that have the ability to kill transformed cells. They play a critical role in hematological malignancies surveillance, however, tumor cells develop immunosuppressive mechanisms to escape NK cell-mediated killing. So, maintaining or improving NK cell performance is considered a major challenge. Our goals are to evaluate the impact of activated NK cells infusion on the recovery and biology of circulating NK cells post allo-SCT.Three different doses (dose 1: 106 NK cell/Kg, n=3; dose 2: 5x106 NK cell/Kg, n=7; dose 3: >5x106 NK cell/Kg, n=6) of ex-vivo IL-2 activated NK cells were infused into patients with hematological malignancies after all-SCT. Our results showed higher frequency of NK cells in the periphery of patients treated with larger doses of activated NK cells. Although the notable immature phenotype shortly after treatment, the circulating NK cells in patients receiving larger doses of activated NK cells displayed more activation status with improved maturation profile after 6 months of treatment. We also found that the expression of activating NK receptors (NKG2D, NKp30, and NKp46) augmented on circulating CD56dim NK cells of patients receiving larger doses of activated NK cells. Moreover, these cells showed a significant increase in degranulation capacity as well as cytokine secretion (IFN-Ƴ and TNF-α) throughout study period. In conclusion, we hypothesize that infusion of high-dose of ex-vivo activated NK cells could be associated with improvements of NK cell phenotype and function during immune reconstitution after allo-SCT.

Die Mehrzahl der im Thymus generierten CD4+CD25high regulatorischen T-Zellen (Treg) besitzt hohe Affinität gegenüber körpereigenen Antigenen. Es ist bekannt, dass T-Zell Rezeptoren (TCR) auf Treg Zellen in der Peripherie zusätzlich auch fremde Antigene verschiedener Pathogene wie Parasiten, Bakterien und Viren erkennen. Wenig ist bekannt über das klonale T-Zell Rezeptor Repertoire dieser Treg Populationen und ihre Beziehung zu CD4+CD25low effektor T-Zellen (Teff) im Menschen. In dieser Studie analysieren wir humane TCR auf expandierten Treg and Teff Zellen mit definierter Antigen Spezifität für Haupthistokompatibilitätskomplex (MHC) Klasse II restringierte „fremde“ Epitope des Cytomegalovirus (CMV). Bemerkenswerterweise fanden wir, dass der gleiche TCR Vb-CDR3 Klon in beiden funktionell unterschiedlichen Subpopulationen in vitro dominant expandiert ist. Im Unterschied zu ihren klonal-identischen Teff Gegenspielern, exprimieren die suppressiven Treg Zellen kaum CD127 und IL-2, aber hohe Mengen an IFNg und IL-10. Zusammen mit der signifikant erhöhten FOXP3 Expression, trotz unvollständiger foxp3-DNA Demethylierung, lassen sich die CMV-spezifischen CD4+CD25high Treg Zellen einem induzierten Treg (iTreg) Phänotyp zuordnen mit Ähnlichkeit zum beschriebenen Tr-1 Phänotyp. Darüber hinaus konnten wir die klonale TCR Identität auch in frisch isolierten CD4+CD25low und CD4+CD25high Subpopulationen bestätigen, was die Entstehung von CMV-spezifischen Treg Zellen bereits in vivo nahe legt. Periphere CD25high Treg Zellen supprimieren die anti-virale Immunantwort in Patienten mit häufigen CMV-Reaktivierungen, was auf ihre Bildung als Reaktion chronischer Antigenexposition interpretiert werden kann. Unsere Ergebnisse beweisen erstmals direkt, dass aus dem gleichen humanen T-Zell Klon Teff und Treg Zellen mit identischer Spezifität entstehen können und lassen vermuten, dass die Treg Induktion in der Peripherie durch häufige Antigenexposition vorangetrieben wird. / The majority of thymically arised regulatory CD4+CD25high T cells (Treg) show high affinity to self-antigens. It has been proposed that T-cell receptors (TCR) on Treg cells in the periphery also recognize foreign-antigens from pathogens, such as bacteria and viruses. Studies in mice have shown that peripheral Treg cells can be generated not only from naïve T cells but also from effector T cells (Teff). However, in humans the clonal TCR-repertoire of these Treg populations and their relation to effector CD4+CD25low Teff is not sufficiently known up to date. Here, we analyzed human TCRs derived from expanded Treg and Teff cells with defined specificity to MHC class-II restricted “foreign” epitopes of Cytomegalovirus (CMV). Remarkably, we found that both functionally distinct subsets share the same dominant TCR-CDR3 clones in vitro. In contrast to their Teff counterparts, the Treg cells express low CD127 and IL-2, but high IL-10 upon antigen stimulation. Therefore, together with increased FOXP3 expression, but incomplete foxp3 DNA-demethylation, human CMV-antigen specific Treg cells exhibit an induced phenotype (iTreg) in vitro with similarity to recently described Tr-1 phenotype. Moreover, the clonal identity was confirmed in freshly isolated CD4+CD25low and CD4+CD25high subsets, suggesting their generation occurred already in vivo. Peripheral CD25high Treg cells suppress the anti-viral immune response in patients with frequent CMV-reactivations, implying their development as reaction on chronic antigen-exposure. Our results demonstrate directly for the first time, that the same human T-cell clone can possess the phenotype of Teff and Treg cells with specificity to identical foreign epitopes and suggest that Treg-induction in the periphery is supported by frequent antigen-exposure.

Educational Studies / M.Ed.

Text in Afrikaans / Gesinne met aangenome kinders bevind hulself in 'n eiesoortige gesinsituasie. Die situasie stel verskeie eise aan die ouers asook aan die kinders in die gesin. Bo en behalwe die universele gesinsuitdagings, moet bulle ook die uitdagings uniek aan die aannemingsituasie bemeester. Gesinne met aangenome kinders bevind hulself soms in moeilike situasies en benodig dan ondersteuning. Daarom is daar in hierdie studie besluit om ondersoek in te stel na die effek van gesinsterapie in gesinne met aangenome kinders. Die doel was om vas te stel in watter mate gesinne met aangenome kinders gehelp kan word om probleme te oorkom met gesinsterapie as terapeutiese intervensie. Die navorsing is gedoen aan die hand van 'n kwalitatiewe ontwerp waar data hoofsaaklik ingesamel is deur vraelyste, observasie en onderhoudvoering. Daar is tot die gevolgtrekking gekom dat gesinsterapie effektief gebruik kan word om hulp te verleen aan die gesin met aangenome kinders. Daar word as 'n span aan die probleme gewerk aangesien gesamentlike doelwitstelling-plaasvind en dit dien ook as 'n belangrike saambindende faktor van die gesinslede. AI die gesinslede se probleme kon gelyktydig aangespreek word in plaas van op 'n individuele basis. / Families with adopted children find themselves in a situation with unique demands made on them as a family as well as on an individual level as a parent or a child. They have to master the universal family challenges as well as the challenges of the family with adopted children. These families often find themselves in complex situations, which are difficult to handle and thus need the necessary support. The reason for this study was therefore to investigate the effect of family therapy in families with adopted children. The aim was to find out how effective a family with adopted children could be helped to solve the problems experienced with family therapy as therapeutic intervention. A qualitative analysis was conducted and data was gathered primarily through questionnaires, observation and interviewing. The results of the research led to the conclusion that family therapy was indeed an effective therapeutic intervention as far as families with adopted children were concerned. It provided the family to work together as a team and created unity. All the family members' problems could also be addressed at once instead of individually. / Psychology of Education / M. Ed. (Voorligting)

L’immunothérapie représente une avancée majeure dans la prise en charge des patients atteints de cancer. L’utilisation thérapeutique récente des anticorps anti-"checkpoints", qui renforcent la réponse immunitaire cellulaire naturelle anti-tumorale, a relancé l’intérêt d’approches d’immunothérapie cellulaire spécifique dans les cancers. Malgré tout, l’identification d'antigènes capables de stimuler efficacement des lymphocytes T (LT) anti-tumoraux représente un obstacle majeur au développement de telles approches. Pour identifier de tels antigènes, des cellules présentatrices d’antigène (CPA) artificielles (CPAA), capables d’exprimer, après transduction gamma-rétrovirale, des peptides directement codés ou des antigènes entiers, dégradés par ces cellules, comme le feraient des CPA humaines, en peptides présentés au sein de la molécule du CMH de classe I la plus fréquente chez l'homme, HLA-A2.1, ont été développées au laboratoire. Ces CPAA sont capables de stimuler efficacement des LT cytotoxiques (LTC) spécifiques contre des antigènes tumoraux. Deux grandes approches d’identification des antigènes tumoraux d’intérêt thérapeutique, ont été utilisées. La première est une approche directe d’identification des peptides basée sur l’élution des peptides HLA-A2.1-restreints présentés par nos CPAA et leur analyse par spectrométrie de masse. La seconde est une approche d’immunologie inverse basée sur des prédictions in silico d’épitopes HLA-A2.1-restreints reposant sur des données biochimiques des poches du CMH. Dans les deux approches, des tests fonctionnels d’activation de LTC spécifiques ont été effectués avec nos CPAA. Dans la première étude, nous avons utilisé la spectrométrie de masse en tandem couplée à la chromatographie en phase liquide, qui a été jusqu'à présent la technologie permettant l'identification rapide de centaines de ligands du CMH dans différentes approches expérimentales. En partant de CPAA codant les peptides immunogènes connus M1m, M1 ou FSP02, des LTC spécifiques de ces peptides ont été obtenus, et nous avons réussi à les caractériser par spectrométrie de masse. En partant de CPAA codant les protéines entières desquelles ces peptides sont dérivés, des LTC spécifiques des peptides ont également été obtenus mais nous n’avons pas réussi à les caractériser par spectrométrie de masse. Des peptides très immunogènes, capables de stimuler de fortes réponses immunitaires cellulaires anti-tumorales, peuvent donc échapper à une détection par spectrométrie de masse, rendant ainsi discutable l'utilisation de cette technique pour sélectionner des peptides d’intérêt clinique. Dans la deuxième étude, nous sommes partis de peptides prédits. Nous avons pu monter des réponses immunitaires spécifiques contre les néoépitopes FSP25 et FSP26 prédits in silico, dérivés de la protéine mutée CASP5 (-1) retrouvée chez 60% de patients atteints de cancer colorectal (CCR) à instabilité microsatellitaire (IMS). La CASP5 est impliquée dans l’apoptose et nous avons montré que les patients atteints d’un CCR à IMS présentant cette mutation avaient un moins bon pronostic. Nous avons également montré que chez des patients HLA-A2+ atteints d’un CCR à IMS présentant la mutation, des LTC pouvaient être obtenus contre les épitopes FSP25 et FSP26, capables de lyser spécifiquement la lignée cellulaire HLA-A2.1+ HCT116 dérivée d’un CCR à IMS présentant également la mutation, faisant de la protéine mutée CASP5 (-1) une cible thérapeutique de choix chez ces patients. Dans ces deux études, nos CPAA constituaient un outil de choix pour le développement d’approches d’immunothérapie spécifique personnalisée, soit cellulaire adoptive, pour déterminer quels antigènes devraient être ciblés ou pour directement activer et amplifier in vitro des LT injectés in vivo, soit vaccinale, pour déterminer les antigènes les plus immunogènes à inclure dans un vaccin efficace. / Immunotherapy represents a major advance in cancer patient management. Recent use of anti-checkpoint antibodies, that reinforce the natural cellular anti-tumor immune response, has revived interest for specific cellular immunotherapy approaches in cancers. Nevertheless, the difficulty of identifying highly immunogenic tumor antigens capable of specifically stimulating efficient anti-tumor T lymphocytes (TLs) is a considerable barrier to the development of such approaches. In order to identify such antigens, artificial antigen presenting cells (AAPCs) expressing the most common HLA class I molecule, HLA-A2.1, were developed in the laboratory. After gammaretroviral transduction, these AAPCs also express a directly-encoded peptide of interest or a full-length antigen, degraded by these cells into peptides as human antigen presenting cells (APCs) do. These AAPCs are capable of efficiently stimulating specific cytotoxic T lymphocytes (CTLs) against tumor antigens. Two major approaches for the identification of tumor antigens of therapeutic interest have been used. The first one is a direct approach of identification of HLA-A2.1-restricted peptides based on the elution of HLA-A2.1-peptide complexes expressed by our AAPCs and their analysis by mass spectrometry. The second one is a reverse immunology approach based on in silico predictions of HLA-A2.1-restricted epitopes using available MHC pocket biochemical data. In both approaches, functional tests were performed in vitro with our AAPCs to test the immunogenicity of the studied peptides. In the first study, we used tandem mass spectrometry coupled with liquid chromatography, which has been until today the technology of choice for the rapid identification of hundreds of MHC ligands in different experimental approaches. Starting from AAPCs encoding known immunogenic M1m, M1 and FSP02 peptides, specific CTLs could be obtained against these peptides, and we were able to characterize them by mass spectrometry. Starting from AAPCs encoding full length antigens from which these peptides are derived, peptide-specific CTLs were also obtained, but we were unable to characterize them by mass spectrometry. Therefore, highly immunogenic peptides, capable of stimulating strong anti-tumor cellular immune responses, may not be detected by mass spectrometry, rendering questionable the use of this technique for selecting clinically relevant peptides. In the second study, we started from predicted peptides. We were able to mount specific immune responses against FSP25 and FSP26 in silico predicted neoepitopes, derived from the CASP5 (-1) mutated protein found in 60% of microsatellite instability (MSI) colorectal cancer (CCR) patients. CASP5 is involved in programmed cell death and we have shown that MSI CRC patients whose tumors harbored this CASP5 (-1) mutation had less good prognosis. We have also shown that in HLA-A2+ MSI CASP5 (-1)-mutated CRC patients, specific CTLs could be obtained against FSP25 and FSP26 epitopes, capable of specifically lysing HLA-A2+ MSI CRC cell line HCT116 also harboring this mutation. Therefore, the mutated caspase-5 protein might be a therapeutic target of major interest for personalized specific immunotherapy strategies in the context of MSI CASP5 (-1)-mutated CRCs. In both studies, our AAPCs were a tool of choice for the development of personalized specific immunotherapy strategies, either for cellular adoptive approaches, to determine which antigens should be targeted or to directly activate and amplify in vitro antigen of interest-specific TLs which would be transferred in vivo, or for vaccine approaches, to identify the most immunogenic antigens which should be included in an efficacious vaccine

Il progetto di ricerca mira ad indagare, nell’orizzonte della pedagogia della famiglia, l’accompagnamento da offrire ai coniugi che si accostano all’adozione. Lo studio muove dall’assunzione di un paradigma sistemico e dialogale, nel quale la famiglia è intesa come realtà in divenire, che concorre alla crescita reciproca e vicendevole dei suoi membri (Pati, 2014). L’analisi della letteratura scientifica e del contesto adottivo rivelano zone d’ombra nella ricerca interdisciplinare, in particolare rispetto al periodo pre-adottivo, ed una esiguità di contributi provenienti dall’area pedagogica. Il presente lavoro si prefigge, pertanto, di raggiungere una comprensione più profonda dell’oggetto di ricerca, al fine di promuovere interventi di sostegno e accompagnamento educativo alla genitorialità adottiva. In una costante circolarità fra teoria e prassi, si è scelto di coinvolgere alcuni genitori adottivi in interviste semi-strutturate. Ciò, nella convinzione che far parlare l’esperienza e riflettere su di essa può favorire una definizione epistemologica e contenutistica del discorso pedagogico sull’adozione (Pati, 2004). L’indagine si propone di chiarire come si struttura e consolida la scelta adottiva dentro il progetto di vita familiare, di rintracciare le peculiarità educative sottese alla genitorialità e filiazione adottiva e di individuare percorsi di accompagnamento educativo per la famiglia adottiva. / The research project aims to inquire, in the context of family pedagogy, the help offered to couples who are approaching adoption. The study starts from the assumption of a systemic and dialogical paradigm, in which the family is understood to be in progress and contributes to the mutual growth of its members (Pati, 2014). The analysis of scientific literature and of the context about adoption reveal many unexplored areas in the interdisciplinary research, specifically regarding the pre-adoption interventions, as well as some contributions coming from the educational area. This work tries to reach a deeper understanding of the research subject, to gain involvement of educational accompaniment and support to adoptive parenting. In a constant exchange between theory and practice, it has been proposed to involve some adoptive parents in semi-structured interviews. It is believed that talking and reflecting on the experience, should encourage an epistemological and of content definition of the educational subject on adoption (Pati, 2004). The expected results are to clarify how the adoptive choice is structured and consolidated within the family life project; to outline educational peculiarities of adoptive parenting and sonship; and to suggest way of educational accompaniment to the adoptive family.

Der adoptive Transfer von T-Zell-Rezeptor (TZR) modifizierten T-Zellen gegen krebsspezifische Antigene ist ein vielversprechender Ansatz in der Immuntherapie. Geeignete Zielmoleküle für diese Therapie sollten wichtig für das Überleben von Krebszellen sein und zudem in ausreichenden Mengen auf der Zelloberfläche exprimiert werden, um von T-Zellen erkannt zu werden. Die Identifizierung dieser Zielmoleküle ist jedoch eine Herausforderung und erfordert eine intensive Charakterisierung, um eine ausreichende Prozessierung und Präsentation auf den Tumorzellen zu validieren. Ziel dieser Arbeit war, HLA-A2-spezifische Neoepitope als Zielmoleküle für adoptive T-Zell-Therapie zu validieren. Dafür wurden erfolgreich Immunantworten in einem humanen transgenen Mausmodell nach Peptidimmunisierung induziert und TZRs mit hoher Affinität isoliert. Trotz einer hohen funktionellen Avidität von H3.3K27M-spezifischen T-Zellen wurde keine Erkennung von Tumorzellen erreicht. Zweitens wurden TZR-transduzierte T-Zellen gegen die häufige Melanommutation Rac1P29S isoliert, welche zytotoxisch gegen Melanomzelllinien waren. Letztlich wurde beobachtetet, dass TZRs mit hoher Affinität gegen gespleißte Kras und Rac2 Epitope, welche durch Proteasom-katalysiertes Peptidspleißen erzeugt wurden, keine Immunantwort gegen endogen exprimierte Mutationen hervorrufen konnten. Daraus lässt sich schließen, dass gespleißte Epitope wahrscheinlich seltener vorkommen als zuvor angenommen und daher möglicherweise irrelevant für die adoptive T-Zelltherapie sind. Diese Daten deuten darauf hin, dass die Auswahl von Zielmolekülen für die adoptive T-Zell-Therapie mit Hilfe reverser Immunologie auf der Grundlage von Bindungsalgorithmen und der Häufigkeit von Mutationen allein nicht ausreicht. Daher sind vor der Isolierung und Charakterisierung von TZRs zusätzliche Strategien wie z.B. die Analyse des MHC-Immunopeptidoms erforderlich, um die Auswahl geeigneter Zielmoleküle für die T-Zelltherapie zu verbessern. / Adoptive transfer of T cell receptor (TCR)-engineered T cells against tumour-specific neoantigens is a promising approach in cancer immunotherapy. Ideally, targeted antigens are crucial for cancer cell survival and are generated in sufficient amounts to be recognised by T cells. However, the identification of ideal targets remains challenging and requires intensive characterisation to validate sufficient antigen processing and presentation by the tumour cells. This thesis focused on the validation of HLA-A2 binding neoepitopes carrying the recurrent cancer mutations H3.3K27M, Rac1P29S, Rac2P29L or KrasG12V as targets for adoptive T cell therapy. After peptide immunisation, immune responses in a human transgenic mouse model were elicited and high-affinity TCRs successfully isolated. Although H3.3K27M-specific T cells showed high functional avidity, no recognition of cells endogenously expressing mutant H3.3 was achieved. Furthermore, a mechanism to target the common melanoma mutation Rac1P29S with a TCR raised against a heterologous mutation with higher peptide-MHC affinity was described. TCR-transduced T cells induced cytotoxicity against Rac1P29S expressing melanoma cell lines. Lastly, high-affinity TCRs specific for mutant Kras and Rac2 spliced epitopes generated by proteasome-catalysed peptide splicing were successfully isolated, however, TCR-transduced T cells did not induce an immune response against endogenously expressed mutant transgenes. The results indicate that spliced epitopes are probably less abundant than previously estimated and therefore may play a minor role in the generation of targets for adoptive T cell therapy. These data suggest that target selection using a reverse immunology approach based on binding algorithms and frequency of mutations alone is not sufficient. Thus, additional strategies to improve the selection of suitable targets such as the analysis of the MHC immunopeptidome are required prior to TCR isolation and characterisation.

The purpose of this study was to try to interpret interactions between social worker and adoptive parents during the adoption process from a power perspective. The study was inspired by a hermeneutic inductive approach because we were interested in the interpretation of the empirical material. The study was conducted using four qualitative interviews with a total of seven people, four adoptive parents and three social workers. The collected material is then analyzed using a content analysis. To interpret the contact between the adoptive parents and social workers, we have used a power perspective. Our study showed that the applicant, generally speaking, was positive to that an investigation was made based on “the child’s interest”, but experienced some of the questions as intrusive. They found that the assessment made was crucial for the decision, and that it easily can vary from case to case for the decision and that the assessment can certainly vary in different cases. The social workers did not feel that they had any noticeable power, because they do not make the final decision. Their assessment was partly based on laws and guidelines that set the context, for example, how old the applicants may be and the requirement that the applicants must be married. Assessments are also made on the social worker’s individual characteristics based on the applicant's personal qualities such as insight and ability to care for a child.

<p>Dysregulated inflammation underlies the pathogenesis of a myriad of human diseases ranging from cancer to autoimmunity. As coordinators, executers and sentinels of host immunity, T cells represent a compelling target population for immune-modulation. In fact, the antigen-specificity, cytotoxicity and promise of long-lived of immune-protection make T cells ideal vehicles for cancer immunotherapy. Interventions for autoimmune disorders, on the other hand, aim to dampen T cell-mediated inflammation and promote their regulatory functions. Although significant strides have been made in targeting T cells for immune-modulation, current approaches remain less than ideal and leave room for improvement. In this dissertation, I seek to improve on current T cell-targeted immunotherapies, by identifying and preclinically characterizing their mechanisms of action and in vivo therapeutic efficacy.</p><p>CD8+ cytotoxic T cells have potent antitumor activity and therefore are leading candidates for use in cancer immunotherapy. The application of CD8+ T cells for clinical use has been limited by the susceptibility of ex vivo-expanded CD8+ T cells to become dysfunctional in response to immunosuppressive microenvironments. To enhance the efficacy of adoptive cell transfer therapy (ACT), we established a novel microRNA-targeting approach that augments CTL cytotoxicity and preserves immunocompetence. Specifically, we screened for miRNAs that modulate cytotoxicity and identified miR-23a as a strong functional repressor of the transcription factor Blimp-1, which promotes CTL cytotoxicity and effector cell differentiation. In a cohort of advanced lung cancer patients, miR-23a was upregulated in tumor-infiltrating CD8+ T cells, and its expression correlated with impaired antitumor potential of patient CD8+ T cells. We determined that tumor-derived TGF-&#946; directly suppresses CD8+ T cell immune function by elevating miR-23a and downregulating Blimp-1. Functional blockade of miR-23a in human CD8+ T cells enhanced granzyme B expression; and in mice with established tumors, immunotherapy with just a small number of tumor-specific CD8+ T cells in which miR-23a was inhibited robustly hindered tumor progression. Together, our findings provide a miRNA-based strategy that subverts the immunosuppression of CD8+ T cells that is often observed during adoptive cell transfer tumor immunotherapy and identify a TGF&#946;-mediated tumor immune-evasion pathway.</p><p>Having established that miR-23a-inhibition can enhance the quality and functional-resilience of anti-tumor CD8+ T cells, especially within the immune-suppressive tumor microenvironment, we went on to interrogate the translational applicability of this strategy in the context of chimeric antigen receptor (CAR)-modified CD8+ T cells. Although CAR T cells hold immense promise for ACT, CAR T cells are not completely curative due to their in vivo functional suppression by immune barriers &#8210; such as TGF&#946; &#8210; within the tumor microenvironment. Since TGF&#946; poses a substantial immune barrier in the tumor microenvironment, we sought to investigate whether inhibiting miR-23a in CAR T cells can confer immune-competence to afford enhanced tumor clearance. To this end, we retrovirally transduced wildtype and miR-23a-deficient CD8+ T cells with the EGFRvIII-CAR, which targets the PepvIII tumor-specific epitope expressed by glioblastomas (GBM). Our in vitro studies demonstrated that while wildtype EGFRvIII-CAR T cells were vulnerable to functional suppression by TGF&#946;, miR-23a abrogation rendered EGFRvIII-CAR T cells immune-resistant to TGF&#946;. Rigorous preclinical studies are currently underway to evaluate the efficacy of miR-23a-deficient EGFRvIII-CAR T cells for GBM immunotherapy. </p><p>Lastly, we explored novel immune-suppressive therapies by the biological characterization of pharmacological agents that could target T cells. Although immune-suppressive drugs are classical therapies for a wide range of autoimmune diseases, they are accompanied by severe adverse effects. This motivated our search for novel immune-suppressive agents that are efficacious and lack undesirable side effects. To this end, we explored the potential utility of subglutinol A, a natural product isolated from the endophytic fungus Fusarium subglutinans. We showed that subglutinol A exerts multimodal immune-suppressive effects on activated T cells in vitro: subglutinol A effectively blocked T cell proliferation and survival, while profoundly inhibiting pro-inflammatory IFN&#947; and IL-17 production by fully-differentiated effector Th1 and Th17 cells. Our data further revealed that subglutinol A might exert its anti-inflammatory effects by exacerbating mitochondrial damage in T cells, but not in innate immune cells or fibroblasts. Additionally, we demonstrated that subglutinol A significantly reduced lymphocytic infiltration into the footpad and ameliorated footpad swelling in the mouse model of Th1-driven delayed-type hypersensitivity. These results suggest the potential of subglutinol A as a novel therapeutic for inflammatory diseases.</p> / Dissertation