Würzburg, Univ., Diss., 2009. / Zsfassung in engl. Sprache.

To supplement and modify the diagnosis and clinical research of B-cell Chronic Lymphocytic Leukemia (B-CLL), a new method based on cell imaging and image processing was developed and applied to the B-CLL patient samples. The fluorophore-labelled leukemia cells were clearly visualized, reflecting the positive/negative expression of the corresponding surface markers and their distribution. Computer algorithms were devised and used to analyze a large number of images. The fluorescence intensity of the labelled antibodies on a given cell directly reflects the expression of the corresponding surface markers. The morphology and size of leukemia cells were not identical even in the same patient’s sample and the size variation does not correlate with the number of surface markers. The amount of each surface marker was approximately fixed for each patient, but there were some relationships, for instance, the number of CD19 and CD38 markers were correlated to each other. The heterogeneous expression of surface markers confirmed an assumption that surface markers have their preferred membrane positions. One of the most important results is that the cell imaging and our image processing method has provided an alternative and reliable way to diagnose B-CLL and new insights in the prognosis of subtype of B-CLL.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22882号 / 医博第4676号 / 新制||医||1047(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 髙折 晃史, 教授 濵﨑 洋子, 教授 羽賀 博典 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

CAR T-cellbehandling är en immunterapi som har visat lovande resultat vid behandling av cancer. Trots det riktade immunsvaret som kan uppnås, betonar komplexiteten i tillverkningsprocessen och behandlingsproceduren det utrymme somm finns för förbättringar. Omprogrammerade T-celler har illustrerat en hög persistens hos patienter, som utsätter dem för risken för systemisk toxicitet. In-vivo transienta CAR T-celler som använder självförstärkande mRNA leverade genom affinitetsproteinbelagda LNP, föreslås som ett standardiserat alternativ som möjligör dosering av terapin vid behov.  Med hjälp av fagdisplay utfördes ett urval av affibody molekyler mot de tre immunonkologiska målproteinerna CD5, CD8 och CD19, i fyra cykler. Monoklonal fag-ELISA och DNA-sekvensering identifierade sju förmodade kandidater mot CD5, en förmodad kandidat mot CD8 och tre mot CD19. SPR analys visade specifik binding från CD5 kandidaterna, medan binding till målprotein inte kunde påvisas för CD8- och CD19 kandidaterna. De identifierade CD5-bindarna kan konjugeras till LNP för T-cell inriktad leverans av själv-amplififerande mRNA, med genetisk kod för en valfri CAR. / Chimeric antigen receptor (CAR) T-cell therapy is an immunotherapy which has shown promising results in treating patients suffering from oncological malignancies. Despite the targeted immune response that can be achieved, elaborate manufacturing and procedure processes emphasise room for improvement. Engineered T-cells have illustrated a high persistence in patients, exposing them to the risk of systemic toxicity. In-vivo transient CAR T-cells using self-amplifying mRNA by delivery through affinity protein coated lipid nanoparticles (LNP) is proposed as a standardised and reversible alternative, allowing for dosing when needed. Using phage display technology, selection of affibody molecules toward the three immune oncology proteins CD5, CD8 and CD19 was performed in four cycles. Monoclonal phage enzyme-linked immunosorbent assay (ELISA) and DNA sequencing identified seven putative candidates toward CD5, one putative candidate was isolated toward CD8, and three toward CD19. Surface plasmon resonance analysis (SPR) showed specific target binding of the CD5 candidate binders, while target binding could not be demonstrated for the CD8 and CD19 candidates. The identified CD5 binders could be conjugated to LNP for T-cell targeted delivery of self-amplifying mRNA encoding any CAR of interest.

Tableau d'honneur de la Faculté des études supérieures et postdoctorales, 2006-2007 / La présence de lymphocytes T infiltrant (TILs) a été démontrée dans plusieurs types de cancer. Par contre, la fonctionnalité des TILs est affectée par de nombreux facteurs qui font du milieu tumoral un environnement inhibiteur pour ceux-ci. Notre hypothèse de travail était qu'il est possible de prendre avantage des TILs encore activés afin d'élaborer une stratégie anti-tumorale. Nous avons mis au point un système qui permet d'isoler spécifiquement les TILs activés. Pour ce faire, nous avons construit un vecteur contenant le gène codant pour la partie extracellulaire et transmembranaire du CD 19 (ACD19), que nous avons mis sous le contrôle du promoteur minimal de l'interleukine 2. Nous avons démontré que le ACD19 est exprimé de façon stable à la surface cellulaire, que le vecteur est inductible suite à l'activation des lymphocytes T et qu'il est possible d'isoler spécifiquement les cellules exprimant le ACD19. Finalement, nous avons caractérisé un modèle tumoral animal et déterminé les conditions nécessaires pour tester notre hypothèse in vivo.

No description available.

Immunotherapy for cancer is a young research field progressing at high speed. The first chimera of an antibody and a signaling chain was designed by Zelig Eshhar and was later further developed to enhance existing T cell therapy by combining a single-chain fragment of an antibody with the CD3 zeta chain of the TCR complex. T cells expressing these chimeric antigen receptors (CARs) could recognize and specifically kill tumor cells. However the T cells, lacked in persistence and tumor rejection did not occur. Thus, the CAR constructs have been improved by providing the T cell with costimulatory signals promoting activation. The focus of this thesis has been to evaluate second and third generation αCD19-CAR T cells for the treatment of B cell leukemia and lymphoma. B cell tumors commonly upregulate anti-apoptotic proteins such as Bcl-2, which generates therapy resistance. In the first paper a second generation (2G) αCD19-CD28-CAR T cell was combined with the Bcl-2 family inhibitor ABT-737. ABT-737 sensitized tumor cells to CAR T cell therapy and may be an interesting clinical combination treatment. In paper II, the phenotype and function of a third generation (3G) αCD19-CD28-4-1BB-CAR T cell were evaluated. B cell-stimulated CAR T cells showed increased proliferation and an antigen-driven accumulation of CAR+ T cells. 3G CAR T cells had equal cytotoxic capacity, similar lineage, memory and exhaustion profile phenotype compared to 2G CARs. However, 3G CAR T cells proliferated better and had increased activation of intracellular signaling pathways compared to 2G CAR T cells. In paper III, αCD19-CD28-4-1BB-CAR T cells were used to stimulate immature dendritic cells leading to an upregulation of maturation markers on co-cultured dendritic cells. Hence, CAR T cells may not only directly kill the tumor cells, but may induce bystander immunity that indirectly aids tumor control. This thesis also include supplementary information about the development and implementation of protocols for GMP production of CAR T cell batches for a phase I/IIa clinical trial currently ongoing for patients with refractory B cell leukemia and lymphoma. So far, two patients have safely been treated on the lowest dose.

Submitted by Michel Batista (mbatista@fiocruz.br) on 2014-11-28T11:47:15Z No. of bitstreams: 1 Tese Guilherme Ferreira Silveira.pdf: 9523097 bytes, checksum: 1944bdd5853c5e3e3e1fe8bda7c59f5b (MD5) / Approved for entry into archive by Michel Batista (mbatista@fiocruz.br) on 2014-11-28T11:50:19Z (GMT) No. of bitstreams: 1 Tese Guilherme Ferreira Silveira.pdf: 9523097 bytes, checksum: 1944bdd5853c5e3e3e1fe8bda7c59f5b (MD5) / Made available in DSpace on 2014-11-28T11:50:19Z (GMT). No. of bitstreams: 1 Tese Guilherme Ferreira Silveira.pdf: 9523097 bytes, checksum: 1944bdd5853c5e3e3e1fe8bda7c59f5b (MD5) / Fundação Oswaldo Cruz. Instituto Carlos Chagas, Fiocruz-PR. Curitiba, PR, Brasil. / A dengue representa na atualidade a mais prevalente arbovirose, caracterizando-se como um grave problema de saúde pública, tanto no Brasil como em todo o mundo. No entanto, o paciente que desenvolve a febre da dengue e/ou dengue com complicações recebe apenas tratamento de suporte, uma vez que não existem medicamentos ou vacinas específicas contra o vírus. Adicionalmente, pouco se sabe sobre os mecanismos imunopatológicos que desencadeiam os sintomas graves. Um dos aspectos que parece ser chave na patogenia é a resposta funcional dos linfócitos ao vírus da dengue (DV). Embora, a susceptibilidade destas células à infecção pelo DV ainda não fora bem caracterizada. Deste modo, os alvos principais deste trabalho foram à determinação da susceptibilidade e a caracterização da resposta funcional de linfócitos humanos de doadores saudáveis, analisadas na infecção por cepas dos quatro sorotipos do DV. Foi demonstrado que três diferentes populações de linfócitos (LT CD4+, LT CD8+ e LB CD19+) são susceptíveis ao DV, especialmente o LT CD8+, sendo o heparam sulfato um receptor de entrada para a infecção destas células pelo DV. Esta infecção foi produtiva, com replicação ativa e liberação de partículas virais viáveis no sobrenadante das culturas, além da produção da proteína não-estrutural 1 (NS1). Contudo, foram observados apenas níveis discretos de ativação celular e produção de citocinas. Adicionalmente, não foram observadas respostas funcionais como: apoptose de linfócitos, degranulação de LT CD8+, infecção diferencial de LT CD8+ “naïve” ou LT CD8+ de memória, resposta de polarização Th1/Th17 de LT CD4+ ou produção de IgM anti-DENV por LB CD19+. Ademais, a infecção dos linfócitos não foi capaz de reduzir a proliferação celular observada em ensaios de Ensaio Misto de Leucócitos e Ensaio de “Prime” de Linfócitos, sendo observada uma discreta elevação na proliferação quando as células foram infectadas com o DV4 360. Do mesmo modo, as infecções de culturas de células mononucleares do sangue periférico (PBMC) pelas cepas DV3 98 e DV4 360 foram capazes de induzir uma polarização de perfil Th2. Portanto, estes achados demonstram que, apesar das infecções produtivas, os linfócitos são pouco responsivos aos DV, sendo que importantes funções destas células não foram reguladas pela infecção. Desta forma, é possível sugerir que os linfócitos seriam uma fonte importante para a manutenção da viremia observada nos casos de dengue. / Dengue fever is the most prevalent arboviral disease, characterized as a serious public health problem, both in Brazil and worldwide. The patient who develops dengue fever, which could culminate in severe complications, receives only live-support therapy, since there are no specific drugs or vaccines against the virus. Furthermore, little is known about the immunopathogenic mechanisms that trigger the severe symptoms in dengue. One aspect that seems to be key in the pathogenesis is the functional response of lymphocytes to the dengue (DV) infection. The susceptibility of these cells to DV infection is not well characterized. Therefore, the main targets of this study were the determination of ex vivo susceptibility by DV infection and the characterization of functional response of human lymphocytes. Cells from healthy donors were analyzed against four DV serotypes. It has been shown that three populations of lymphocytes (LT CD4+, LT CD8+ and LB CD19+) are susceptible to DV, especially LT CD8+, infection by DV which occurs through the participation of heparan sulfate as the receptor. Infection was productive, with active replication and release of viable viral particles and NS1 protein in the culture supernatants. Only discrete levels of cellular activation and cytokine production were observed. In addition, lymphocyte apoptosis, LT CD8+ degranulation, differential infection of naïve or memory LT CD8+, LT CD4+ polarization (Th1/Th17) or production of IgM anti-DENV by LB CD19+ were not modulated. Furthermore, the infection of the lymphocytes was not able to reduce cell proliferation induced in Mixed Leukocyte Reaction and Lymphocytes Prime Assay, showing a slight increase in proliferation when the cells were infected with DV4 360. PBMC infection with DV3 98 and DV4 360 strains was able to induce a Th2 polarized response. These findings suggest that, despite the productive infection, lymphocytes are poor responders to DV, and important functions of these cells were not modulated by DV infection. However, it is possible that lymphocytes would be an important source for maintenance of viremia observed in dengue fever.

Immunotherapy based on chimeric antigen receptor (CAR)-expressing T lymphocytes has proven to be highly successful in the treatment of acute lymphoblastic leukemia (ALL), leading to development of CAR-based immunotherapies for other hematologic malignancies. Currently, efforts are underway to refine T cell modifications to make patient treatment more effective. Each time, this modification then needs to be empirically validated in in vitro experiments. We decided to study the effect of the cytokine IL-21 on the antitumor function of CD19-specific CAR T cells using in vitro assays. A construct that co-expressed IL-21 under the control of the inducible NFAT promoter together with CARs against CD19 was introduced into T cells. In a series of experiments, the properties of these cells were compared after coculture with tumor B cell lines and CLL cells obtained from patients. The results showed that CAR T cells that express IL-21 proliferate and activate better, even after repeated stimulation with leukemia cells. In addition to CARs specific against the CD19 molecule, we also investigated CARs specific against the CLL1 molecule, which has been described in the literature as one of the promising targets for the treatment of AML. We prepared CAR T cells against CLL1 producing IL-21. For this purpose, we...

Adoptive immunotherapy using chimeric antigen receptor (CAR)-T cells has achieved successful remissions in refractory B-cell leukemia and B-cell lymphomas. In order to estimate both success and severe side effects of CAR-T cell therapies, longitudinal monitoring of the patient’s immune system including CAR-T cells is desirable to accompany clinical staging. To conduct research on the fate and immunological impact of infused CAR-T cells, we established standardized 13-colour/15-parameter flow cytometry assays that are suitable to characterize immune cell subpopulations in the peripheral blood during CAR-T cell treatment. The respective staining technology is based on pre-formulated dry antibody panels in a uniform format. Additionally, further antibodies of choice can be added to address specific clinical or research questions. We designed panels for the anti-CD19 CAR-T therapy and, as a proof of concept, we assessed a healthy individual and three B-cell lymphoma patients treated with anti-CD19 CAR-T cells. We analyzed the presence of anti-CD19 CAR-T cells as well as residual CD19+ B cells, the activation status of the T-cell compartment, the expression of co-stimulatory signaling molecules and cytotoxic agents such as perforin and granzyme B. In summary, this work introduces standardized and modular flow cytometry assays for CAR-T cell clinical research, which could also be adapted in the future as quality controls during the CART cell manufacturing process.