Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an aggressive, rare malignancy. Exact incidence is unknown due to lack of diagnostic criteria. Typically, it involves skin and bone marrow and less likely, lymph nodes and visceral organs. We present a 76 year old male who started having a lesion on the left side of his back that was progressively enlarging. He initially started on antibiotic and topical medications for more than a month which did not help. Punch biopsy of the lesion was consistent with blastic plasmacytoid dendritic cell neoplasm, positive for CD2, CD5, CD7, CD43, weak CD58,Tdt, bcl-6. Patient denies fever, chills, night sweats, weight loss, change in appetite. Physical exam revealed a purplish lesion raised in the left upper back with multiple satellite-like purple lesions throughout the back. Laboratory showed white cell count 3.2 K/uL, hemoglobin 13 g/dL, platelet 135 K/uL. Bone marrow biopsy shows immature blastic neoplasm involving 15% of the bone marrow. Cytogenetics showed normal karyotype. Flow cytometry shows an immature lymphoid population with expression of CD4, CD56, and CD 123, negative for FLT3, IDH1, IDH2, NPM1 mutations. Positron emission tomography (PET) scan showed skin thickening with minimal FDG uptake in left posterior skin soft tissue of the chest near the shoulder with no other abnormal focal uptake and splenomegaly. BPDCN is a rare aggressive malignancy that is more common in older populations. The origin is from type 2 dendritic cells. Typical presentations are skin lesions, cytopenia, lymphadenopathy, and splenomegaly. Some of the cytological features of BPDCN include cloudy sky (blue cytoplasm with clearer areas), pseudopods, and microvacuoles. Confirmation of diagnosis is with immunophenotyping. Workup after diagnosis include complete blood count, liver and renal function, hepatitis panel, peripheral blood smear, bone marrow evaluation, systemic imaging, cerebrospinal fluid cytology. Treatment of BPDCN is challenging in this era. Most patients respond to chemotherapy, although they relapse. Tegraxofusp is suggested for remission induction therapy following allogeneic hematopoietic cell transplantation. Median overall survival is about one year. Only patients who underwent hematopoietic stem cell transplant had prolonged survival. Myelemia, old age and altered general state have worse prognosis.

Dendritic cells (DC) are a heterogeneous population of hematopoietic cells that play a versatile role in orchestrating immune responses against an array of invading pathogens, including influenza virus. These cells reside in lymphoid organs as well as in non-lymphoid tissues such as mucosal surfaces of respiratory and gastro-intestinal system. Recent investigations have suggested that in the steady state, dendritic cells are derived mainly from bone marrow precursor cells without a monocytic intermediate whereas during inflammation or infection, monocytes readily differentiate to generate monocyte derived dendritic cells (MoDC). The ability of virus infected monocytes to differentiate into MoDC was investigated and the results demonstrated that in vitro infection of monocytes with influenza virus impaired their development into MoDC. It was also observed that influenza infection of monocytes, pre-treated with GM-CSF and IL-4 for DC differentiation, was minimally-productive and non-cytopathic. In spite of successful viral genome transcription, viral protein synthesis was restricted at an early stage. However, despite of the limited replication, influenza virus infected monocytes failed to develop the distinctive DC- like morphology when cultured with GM-CSF and IL- 4 as compared to their mock infected counterparts. Infected cells, after 4 days in culture, expressed reduced amounts of CD11c, CD172a (myeloid marker), CD1w2 (CD1b) and CCR5. Influenza virus infected monocytes also retained substantial non-specific esterase activity, a characteristic for monocytes and macrophages. Antigen presentation capability of infected cells was also affected as indicated by decreased endocytosis. Production of IL-12, a pro-inflammatory cytokine and IL-10, a reciprocal inhibitory cytokine, was coordinately modified in influenza virus infected monocytes in order to arrest their differentiation into DCs. At least limited viral replication was necessary to impede the differentiation process completely. However, viral NS1 protein activity, as evidenced with a mutant influenza virus, was not essential for this inhibition. This identified a new strategy by influenza virus to interfere with DC differentiation and evade a virus specific immune response.

Cancer is one of the most pervasive health problems in the world today. Despite major advances in its treatment in recent decades, conventional therapies have seen limited success. Aggressive, drug-resistant cancer cells can reemerge after treatment, resulting in relapse. Immunotherapy, a strategy that utilizes a patient's own immune system to specifically destroy cancer cells, is a potential solution to this problem. Immunotherapy, however, is limited by multiple mechanisms of cancer-induced immunosuppression. One of the most important of these mechanisms is the induction of Treg, which are capable of suppressing multiple arms of the anti-cancer immune response. In the current study, we evaluated strategies to hinder the deleterious function of Treg on cancer immunotherapy. First, we determined that imatinib mesylate could inhibit Treg function in vivo and in vitro and increase the efficacy of dendritic cell-based immunization against an imatinib-resistant lymphoma. Then, searching for further methods to inhibit Treg, we found that Th-1 cells were capable of inhibiting Treg function and synergizing with a tumor lysate vaccine to treat leukemia. This process was dependent on IFN-γ secretion by the Th-1 cells. While investigating the influence of Th-1 on Treg and the resulting immunomodulatory effects of these cells in vivo, we discovered that they were capable of promoting the non-conventional direct tumor killing function of DC. We determined that Th-1 induce the cytotoxic function of bone marrow-derived DC generated with GM-CSF and IL-4 by a mechanism dependent on IFN-γ. Finally, because our results indicate that the antigen presenting function of KDC may depend upon their cytotoxic ability, and since DC generated with IL-15 have been reported to be more efficient APC than those generated with IL-4, we evaluated their ability to also function as direct tumor cell killers. We found that while IL-15 DC can indeed kill tumor cells, only LPS and not IFN-γ was capable of inducing this capability. These findings contribute to both arms of anti-cancer immunity by impairing immunosuppression with imatinib and Th-1, and promoting anti-tumor immunity with KDC. This double-pronged approach may contribute to further strategic advances in the field of cancer immunotherapy.

Dendritic cells are equipped with a range of different pattern-recognition receptors (PRR) aimed at recognizing foreign pathogens. Recent evidence has suggested that PRR signalling regulates the expression of microRNAs (miRNAs), important post-transcriptional regulators of gene expression, which have been shown to fine-tune innate immune responses. This thesis describes the discovery of miR-650, a novel PRR-responsive miRNA that is down regulated in monocyte-derived dendritic cells (DCs) on PRR stimulation. Chapter 4 describes the characterisation of miR-650 expression in DCs matured by exposure to a variety of different pathogen-derived ligands, or during Influenza A virus infection. When correlating the level of miR-650 to the induction of DC activation markers on the cell surface, an inverse correlation was observed, suggesting a relationship between miR-650 down regulation and the effective dose of the ligand. Work presented in this thesis further explores the potential function of miR-650 by using a multi-pronged approach encompassing computational biology, genome-wide expression profiling and individual reporter assays, to gain insight into the gene networks regulated by miR-650. While Chapter 5 focuses on the identification and confirmation of individual miR-650:target interactions, Chapter 6 investigates both direct as well as secondary effects exerted by miR-650 on a global level. The work in these two chapters identifies a number of novel miR-650 targets and suggests a dual role for miR-650 in the innate immune response. Firstly, it is shown that miR-650 directly regulates a group of interferon-stimulated genes with known antiviral activity. Supporting its role in antiviral host defence, miR-650 is also shown to directly target components of the autophagic machinery, and even more importantly, down regulation of miR-650 induces autophagosome formation. Secondly, identified targets also include negative regulators of innate signalling suggesting that, in addition to its antiviral function, PRR-mediated down regulation of miR-650 expression may also provide a negative feedback loop controlling inflammatory responses. Notably, miR-650 displays reciprocal target regulation with miR-155, a well-studied miRNA with established functions in the innate immune system, thus suggesting cooperativity between the two miRNAs. The original aim of this thesis was to examine the effect of HIV-1 infection on the global miRNAome of DCs using a genome-wide profiling method. However, as outlined in Chapter 3, the data generated suggest that HIV-1 infection has little or no impact on miRNA expression. Further work is needed to establish if this represents deliberate immune evasion by HIV-1, or just indicates the limits of the methodology employed.

Infection with human gastrointestinal (GI) parasites, such as Trichuris trichiura, affects more than billion people worldwide, causing significant morbidity and health problems especially in poverty-stricken developing countries. Despite extensive research, the mechanisms of induction and regulation of effector immune responses against these parasites are incompletely understood, which hinders the development of anti-parasite therapies. Infection with GI parasite is usually chronic suggesting that parasites are capable of modulating immune responses of their host to prevent expulsion. However, mechanisms by which parasites control host immunity to allow infection are still ill-defined. The aim of this PhD study was to characterise the role of different immunoregulatory mechanisms in immunity to GI parasite infection, with a focus on dendritic cells (DCs), regulatory T cells (Tregs) and the regulatory cytokine transforming growth factor β (TGF-β).Here we showed for the first time that loss of TGF-β-activating integrin alphavβ8 specifically on DCs resulted in protection from chronic infection with Trichuris muris, a mouse model of T. trichiura infection in man. Accelerated expulsion was immune-mediated and although increased levels of protective Th2 cytokines were observed very early during infection, elevated levels of non-protective Th1 cytokines were also detected. Partial depletion of CD4+ or FcεRI+ cells had no effect on the observed phenotype. Since deletion of alphavβ8 on DCs results in decreased numbers of Tregs in the gut, we tested whether depletion of Tregs using a mouse model that allows conditional ablation of Foxp3+ Tregs (DEREG mice) would alter infection development. Although transient Treg depletion at the beginning of infection had no major effect on expulsion kinetics, we observed a tendency for enhanced Th2 responses in DEREG mice. Moreover, even though DC-mediated TGF-β activation via alphavβ8 integrin was essential for T. muris infection development, transient depletion of DCs had no effect on the induction of Th2 responses or parasite expulsion. These data indicate a novel role for the TGF-β-activating integrin alphavβ8 and DCs in regulating effector immune responses during T. muris infection and may contribute to the development of new anti-parasite therapies.

Type 2 (Th2) immune responses are required for immune defence against helminths, but can also have pathogenic effects in allergic conditions. This thesis examined two factors which may influence Th2 immunity at a cellular and molecular level: cross-talk between Natural Killer (NK) cells and dendritic cells (DCs) and the cell surface organisation of DCs. Cross-talk between NK cells and DCs is well-established to impact Th1 responses against tumours and infection; however the influence of this interaction during Th2 inflammation is unknown. To investigate this, human monocyte-derived DCs were stimulated in vitro with different pathogen-associated molecules; LPS or Poly(I:C) which polarise a Th1 response, or soluble egg antigen (SEA) from the helminth worm Schistosoma mansoni, a potent Th2-inducing antigen. These cells were then combined with autologous NK cells. Confocal microscopy showed polarisation of the NK cell microtubule organising centre (MTOC) and accumulation of LFA-1 at contacts between NK cells and immature or Th2-polarising DCs, but not Th1-polarising DCs, indicative of the assembly of an activating immune synapse. NK cells did not lyse DCs treated with LPS or Poly(I:C), but degranulated to and lysed both immature DCs and Th2 polarising DCs. Antibody blockade of NK cell activating receptors NKp30 and DNAM-1 prevented this lysis. Furthermore, depletion of NK cells in mice which were then transferred with Th2 polarising DCs led to an enhanced Th2 recall response. Thus, these data indicate a previously unrecognised role of NK cell cytotoxicity in restricting the pool of DCs involved in Th2 immune responses. Secondly, this thesis investigated the nanoscale organisation of MHC-II on the surface of Th1 and Th2 polarising DCs using ground state depletion super-resolution microscopy. MHC-II was relatively homogenously distributed across the membrane with no significant changes in clustering between immature, Th1 and Th2 polarising DCs. In contrast, imaging CD74, which can mediate internalisation of MHC-II, revealed increased expression and a more homogenous distribution of this receptor on the surface of Th2-polarising DCs compared to Th1-polarising DCs. These data suggest that changes in the clustering of CD74 could modulate MHC-II surface expression during Th2 responses. Overall, the results in this thesis indicate that both molecular and cellular level modulation of DC function contribute to the development of Th2 responses.

Numerous studies have demonstrated that tumour cells have the ability to alter immune function to create an immune suppressed environment. This allows tumour cells to escape immune surveillance and consequently the tumour can progress. Dendritic and T cells have critical roles in immune activation and tolerance and are thus major targets of tumour-mediated immune suppression. Understanding the mechanism(s) by which tumour cells modulate the immune system will facilitate the development of immune system-based therapies for cancer treatments. In this study we sought to determine the nature of, and cellular and molecular mechanisms underlying, changes in immune status during tumour progression using mouse models of prostate cancer. Detailed analysis of the immunological status in a mouse prostate dysplasia model (12T-7slow) revealed that immune suppression accompanied tumour progression. We found that T cells isolated from tumour-bearing hosts were hypo-responsive to antigen stimulation. Furthermore, we demonstrated that CD4+CD25+ regulatory T cells were responsible, at least in part, for this alteration. Anti-CD25 antibody treatment reduced, but did not prevent, tumour growth in either a transplanted prostate tumour model or a spontaneously developing prostate tumour model. In addition, an altered dendritic cell phenotype and an elevated frequency of CD4+CD25+ regulatory T cells were observed within the tumour mass. Similar alterations were observed in the prostate-specific Pten knockout mice which develop advanced prostate adenocarcinoma. Interestingly, evidence of immune activation, such as an increased frequency of activated T cells, was detected in the tumour microenvironment in both mouse prostate tumour models. To identify factors that may play critical roles in the altered immune cell phenotype observed in the tumour microenvironment, a global gene expression profiling analysis was carried out to evaluate the changes in immune-related gene expression patterns. This analysis provided additional evidence for the co-existence of immune suppression and immune activation. Moreover, subsequent analyses suggested that one differentially expressed transcript, interferon regulatory factor 7, and its target genes might be involved in modulating immune cells and/or tumour progression. Taken together, these studies have important implications for designing specific and effective anti-tumour immune therapy strategies that involve manipulation of tumour cells, dendritic cells and regulatory T cells.

Multiple sclerosis is a chronic autoimmune neurological disease characterized by inflammatory cell infiltration and demyelination in the central nervous system (CNS). It is considered to be mediated by Th1 and Th17 immune responses. Experimental autoimmune encephalomyelitis (EAE) is widely used as a mouse model to study MS as it has features and histopathology similar to that of MS. Tolerogenic dendritic cells (DC) are reported to efficiently prevent sensitization for EAE. In this research, we induced tolerogenic DC (DC10) by differentiating them with IL-10. Compared to immature DC, DC10 did not show increased expression of MHC II or the co-stimulatory molecules CD40, CD80 and CD86, and produced low levels of pro-inflammatory cytokines IL-1â, IL-6, and IL-12 but higher levels of IL-10. This is consistent with their possessing a tolerogenic phenotype. We found that three intraperitoneal (i.p.) injections of DC10 successfully inhibited the signs of established, ongoing EAE: DC10 significantly reduced the clinical scores, demyelination and cell infiltration in the spinal cord, as well as the production of IL-4, IL-6, IL-10, IL-17 and IFN-ã by spleen and lymph node (LN) lymphocytes. DC10 treatments did not significantly affect inflammatory cytokine mRNA levels in the CNS. We found that there was higher FoxP3 expression in the CNS in response to DC10 treatments relative to PBS-treated animals. We also found that DC10 treatments significantly enhanced IgG1, IgG2a and IgG2b production and total spleen and LN lymphocyte proliferation following challenge with myelin oligodendrocyte glycoprotein (MOG) antigen. As far as we know, this is the first report showing the successful therapeutic treatment with tolerogenic DC10 of established EAE in mice.

Multiple sclerosis is a chronic autoimmune neurological disease characterized by inflammatory cell infiltration and demyelination in the central nervous system (CNS). It is considered to be mediated by Th1 and Th17 immune responses. Experimental autoimmune encephalomyelitis (EAE) is widely used as a mouse model to study MS as it has features and histopathology similar to that of MS. Tolerogenic dendritic cells (DC) are reported to efficiently prevent sensitization for EAE. In this research, we induced tolerogenic DC (DC10) by differentiating them with IL-10. Compared to immature DC, DC10 did not show increased expression of MHC II or the co-stimulatory molecules CD40, CD80 and CD86, and produced low levels of pro-inflammatory cytokines IL-1â, IL-6, and IL-12 but higher levels of IL-10. This is consistent with their possessing a tolerogenic phenotype. We found that three intraperitoneal (i.p.) injections of DC10 successfully inhibited the signs of established, ongoing EAE: DC10 significantly reduced the clinical scores, demyelination and cell infiltration in the spinal cord, as well as the production of IL-4, IL-6, IL-10, IL-17 and IFN-ã by spleen and lymph node (LN) lymphocytes. DC10 treatments did not significantly affect inflammatory cytokine mRNA levels in the CNS. We found that there was higher FoxP3 expression in the CNS in response to DC10 treatments relative to PBS-treated animals. We also found that DC10 treatments significantly enhanced IgG1, IgG2a and IgG2b production and total spleen and LN lymphocyte proliferation following challenge with myelin oligodendrocyte glycoprotein (MOG) antigen. As far as we know, this is the first report showing the successful therapeutic treatment with tolerogenic DC10 of established EAE in mice.

<p>The histologic subtypes of malignant glial neoplasms range from anaplastic astrocytoma to the most deadly World Health Organization (WHO) Grade IV glioblastoma (GBM), the most common primary brain tumor in adults. Over the past 40 years, only modest advancements in the treatment of GBM tumors have been reached. Current therapies are predominantly for palliative endpoints rather than curative, although some treatment modalities have been shown to extend survival in particular cases. Patients undergoing current standard of care therapy, including surgical resection, radiation therapy, and chemotherapy, have a median survival of 12-15 months, with less than 25% of patients surviving up to two years and fewer than 10% surviving up to five years. A variety of factors contribute to standard treatment failure, including highly invasive tumor grade at the time of diagnosis, the intrinsic resistance of glioma cells to radiation therapy, the frequent impracticality of maximal tumor resection of eloquent cortical structures, and the fragile intolerance of healthy brain for cytotoxic therapies. Treatment with immunotherapy is a potential answer to the aforementioned problems, as the immune system can be harnessed and educated to license rather potent antitumor responses in a highly specific and safe fashion. One of the most promising vehicles for immunotherapy is the use of dendritic cells, which are professional antigen-presenting cells that are highly effective in the processing of foreign antigens and the education of soon-to-be activated T cells against established tumors. The work outlined in this dissertation encompasses the potential of dendritic cell therapy, the current limitations of reaching full efficacy with this platform, and the recent efforts employed to overcome such barriers. This work spans the characterization and preclinical testing of utilizing protein antigens such as tetanus-diphtheria toxoid to pre-condition the injection site prior to dendritic cell vaccination against established tumors expressing tumor-specific antigens. </p><p>Chapter 1 comprises an overview of the current standard therapies for malignant brain tumors. Chapters 2 and 3 provide a review of immunotherapy for malignant gliomas in the setting of preclinical animal models and discuss issues relevant to the efficacy of dendritic cell vaccines for targeting of GBM. Chapters 4 provides the rationale, methodology, and results of research to improve the lymph node homing and immunogenicity of tumor antigen-specific dendritic cell vaccines in mouse models and in patients with newly diagnosed GBM. Chapter 5 delineates the interactions discovered through efforts in Chapter 4 that comprise protein antigen-specific CD4+ T cell responses to induced chemokines and how these interactions result in increased dendritic cell migration and antitumor responses. Lastly, Chapter 6 discusses the future utility of migration of DC vaccines as a surrogate for antitumor responses and clinical outcomes. </p><p>This dissertation comprises original research as well as figures and illustrations from previously published material used to exemplify distinct concepts in immunotherapy for cancer. These published examples were reproduced with permission in accordance with journal and publisher policies described in the Appendix. </p><p>In summary, this work 1) identifies inefficient lymph node homing of peripherally administered dendritic cells as one of the glaring barriers to effective dendritic cell immunotherapy, 2) provides answers to overcome this limitation with the use of readily available pre-conditioning recall antigens, 3) has opened up a new line of investigation for interaction between recall responses and host chemokines to activate immune responses against a separate antigen, and 4) provides future prospects of utilizing chemokines as adjuvants for additional immunotherapies targeting aggressive tumors. Together, these studies hold great promise to improve the responses in patients with GBM.</p> / Dissertation