Cancer immunotherapy has gained attention in recent years for its successes in potentiating immune responses that can elicit tumor control. In particular, adoptive cell therapy (ACT), which involves the autologous/allogeneic transplant of ex vivo-cultivated tumor-specific T lymphocytes, can mediate potent tumor recognition and killing; however, durable clinical responses are often difficult to obtain in solid tumors. Solid tumors and their unique microenvironments have the capacity to evade and suppress antitumor immune responses and represent significant hurdles for effective ACT. Recently, we have discovered that chemical inhibition of histone deacetylases via MS-275 (Entinostat) during ACT can subvert tumor resistance to foster potent, broad-spectrum antitumor immunity. Overall, the work described supports the efficacy of ACT in the treatment of immunosuppressive, solid tumors; however, consistency in durable clinical outcomes can only be achieved through the concurrent therapeutic targeting of tumor resistance mechanisms. This thesis uses pre-clinical models to describe how tumor resistance to ACT can manifest, and demonstrates that concurrent MS-275 delivery drives extensive immunomodulation to promote sustained tumor clearance. This includes: 1) The polarization of tumor-infiltrating myeloid cells into cytotoxic effectors with the ability to reject immune escape variants 2) The inflammatory remodeling of the tumor microenvironment to potentiate epitope spreading against secondary tumor antigens 3) The transcriptional reprogramming of adoptively transferred T cells to overcome tumor-burden-dependent exhaustion We expect that the results will help facilitate the development of next-generation ACT platforms that will feature strategies for multi-mechanistic perturbation of tumor resistance. / Thesis / Doctor of Philosophy (PhD) / The host immune system has the ability to recognize and destroy tumor cells. Therapeutic platforms that leverage antitumor immune cells, specifically T cells, have shown potency in the elimination of cancer. In the clinic, cancer immunotherapies have demonstrated early success against hematological malignancies; however, are unreliable in the treatment of solid tumors. Solid tumors utilize intrinsic and adapted mechanisms of resistance to mitigate the effectiveness of cancer immunotherapy. This thesis pursues research questions aimed at understanding how tumors resist immunotherapy, what mechanisms are utilized, and how to overcome these obstacles. We anticipate that these results will contribute to the development and incorporation of strategies to subvert tumor resistance and potentiate T cells against solid tumors.

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Les interactions neuro-immunitaires entre les systèmes sensoriels et immunitaires ont été abondamment étudiées; cependant, leur rôle dans la régulation des cancers est encore mal connu. Les interactions croisées entre les cytokines, les facteurs de croissance et les neuropeptides peuvent promouvoir la progression des tumeurs. Les neuropeptides libérés par les nocicepteurs peuvent affecter la polarisation, la chimiotaxie et l'activité du système immunitaire acquis. Étant donné que les neurones sensoriels libèrent localement des neuropeptides qui modulent l'activité des lymphocytes, nous faisons l'hypothèse que les nocicepteurs sécrètent des neuropeptides qui induisent l'épuisement des cellules T CD8 et la croissance tumorale. L’épuisement des lymphocytes T CD8 est un phénomène observé dans le cadre d’infections chroniques et de cancers. Elle est définie comme une perte de la fonction effectrice des lymphocytes T CD8 (diminution de la production d'IFN-γ, de TNF-α et d'IL-2) ainsi qu'une expression élevée de récepteurs inhibiteurs tels que PD-1 (protéine 1 de mort cellulaire programmée), LAG-3 (gène 3 d'activation des lymphocytes) et TIM-3 (protéine 3 d'immunoglobuline des lymphocytes T et de contenant du domaine mucine). Nous avons utilisé le modèle murin de mélanome pour tester cette hypothèse et avons observé que les cellules malignes de cancer de la peau B16F10 interagissent avec les nocicepteurs pour promouvoir la croissance des neurites, la sensibilité aux ligands activateurs et la libération de neuropeptides. En conséquence, le peptide lié au gène de la calcitonine (CGRP), qui est libéré par les nocicepteurs, augmente directement l'épuisement des cellules T CD8 et réduit leur capacité à éliminer les cellules du mélanome. L'ablation génétique des neurones sensoriels, leur inhibition pharmacologique ou le blocage du récepteur au CGRP (RAMP1) suffisent à limiter l'épuisement des lymphocytes infiltrés dans la tumeur et la croissance tumorale. De plus, l'injection de CGRP recombinant dans des souris dépourvues de neurones sensoriels réduit l'épuisement des cellules T CD8. Les cellules T CD8 RAMP1-/- montrent aussi moins d'épuisement que leurs homologues sauvages lorsqu'elles sont co-transplantées dans des souris immunodéficientes Rag1-/- portant une tumeur. En résumé, réduire la libération de CGRP en bloquant localement les nocicepteurs associés à la tumeur limite les effets immunomodulateurs de CGRP sur les cellules T cytotoxiques CD8 et représente une stratégie d'intérêt pour protéger l'immunité antitumorale. / Neuroimmune crosstalk between the nervous and the immune systems has been widely studied; however, their modulating roles are largely unknown in cancer. Bilateral interactions of cytokines, growth factors and neuropeptides may support tumor progression. Nociceptor-released neuropeptides can affect polarization, chemotaxis and adaptive immune system activity. Since sensory neurons locally release neuropeptides that modulate the activities of lymphocytes, we hypothesized that nociceptors might secrete neuropeptides leading to CD8+ T-cell exhaustion and tumor growth. CD8 T cell exhaustion is a phenomenon observed in the context of chronic infections and cancer. It is defined as loss of effector function of CD8 T cells (decreasing the production of IFN-γ, TNF-α, and IL-2) as well as high expression of inhibitory receptors such as PD-1 (programmed cell death protein 1), LAG-3 (lymphocyte-activation gene 3), and TIM-3 (T-cell immunoglobulin and mucin domain-containing protein 3). We used the mouse model of melanoma cancer to test this hypothesis and found that malignant B16F10 skin cancer cells interacted with nociceptors to expand neurite outgrowth, responsiveness to noxious ligands, and neuropeptide release. Consecutively, neuropeptide calcitonin gene-related peptide (CGRP), which is released by nociceptors, directly increased the exhaustion of cytotoxic CD8+ T cells and reduced their ability to eliminate melanoma cells. Genetic ablation of sensory neurons, local pharmacological silencing, and antagonism of the CGRP receptor (RAMP1) were all able to limit the exhaustion of tumor-infiltrating lymphocytes (TIL) and tumor growth. Moreover, treatment with recombinant CGRP in sensory neuron- depleted mice reduced the exhaustion of CD8+ T cells. Compared with wild-type cells, RAMP1-/- CD8+ T cells were rescued to go under exhaustion when co-transplanted into tumor-bearing Rag1-/- deficient mice. In summary, reducing CGRP release by local silencing of tumor-associated nociceptors, limits the immunomodulatory effects of CGRP on cytotoxic CD8+ T cells and represents an ideal strategy to protect anti-tumor immunity.

Allogeneic Hematopoietic stem cell transplants (HSCT) are used for the treatment of bone marrow aplasias. Allogeneic HSCT is performed by treating the patient with chemotherapy drugs and irradiation and then transplanting hematopoietic stem cells from a healthy donor to restore the immune system and hematopoietic cells. Allogeneic HSCTs has the added benefit of the graft vs leukemia effect (GvL), whereby donor allogeneic T cells are able to mount immune responses against any residual cancer cells. However, alloreactivity towards the mismatched minor and major histocompatibility antigens the patient's healthy tissues leads to graft vs host disease (GvHD). This process is also mediated by Macrophages, Dendritic cells, B cells. Furthermore, a decrease in the number of NK, B, and T regulatory cells exacerbates GvHD. This leads to a state of systemic inflammation, tissue damage and multiorgan fibrosis. Current therapies designed to suppress the immune system have been shown to be efficacious in preventing GvHD but patients become susceptible to infection or experience cancer relapse through the elimination of the GvL response as well. In this thesis, we explore two strategies for targeting T cell activation in two mouse models of GvHD. In the first model, we examined the contribution of donor-derived complement C5 on the induction GvHD. We observed that recipient mice were only protected from GvHD when donor cells were deficient for complement protein C5. Our second strategy involves selective targeting of alloreactive T cells using peptide immunotherapy. For this approach, we first developed a humanized mouse model of GvHD whereby cells from donor mice expressing human class II HLA were reconstituted into recipient mice expressing human class I HLA. We then tested peptide immunotherapy using peptides derived from the human class I HLA. Our initial results were inconclusive and require further optimization. / Thesis / Doctor of Philosophy (PhD) / Graft vs Host Disease is an unwanted side effect of mismatched bone marrow transplant. Donor T cells recognize and attack mismatched tissues of the recipient and this leads to systemic inflammation and tissue scarring. Current treatments primarily target T-cell activation by suppressing the immune system, however, this leaves the patients susceptible to recurrent infections. In this thesis we describe the creation of two mouse models of Graft vs Host Disease and then examine two ways of specifically targeting donor T cell activation that is designed not to affect normal immune responses.

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13631号 / 論医博第2322号 / 新制||医||1074(附属図書館) / (主査)教授 伊藤 能永, 教授 森信 暁雄, 教授 上野 英樹 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Porcine circovirus associated disease (PCVAD) is an umbrella term for a multitude of diseases and syndromes that have a negative impact on the health and economics of pig production operations throughout the world. Porcine circovirus type 2 is the causative agent of PCVAD; however the presence of PCV2 alone is rarely enough to cause clinical disease. In order for the full development of PCVAD the presence of a co-infecting pathogen is required. The mechanisms by which co-infection leads to disease remain ongoing areas of research, but it is thought that host immune modulations by PCV2 or a co-infecting pathogen are critical in the pathogenesis of PCVAD. In the first study of this dissertation the ability of PCV2 to induce regulatory T-cells (Tregs) and alter cytokine production was evaluated in vivo. The addition of PCV2 to a multiple viral challenge resulted in a significant increase in Tregs. Levels of IL-10 and IFN-γ were also found to be altered when PCV2 was added to a multiple viral challenge. In further experiments, monocyte derived dendritic cells (MoDC) were infected with different combinations and strains of PCV2 and PRRSV in vitro and evaluated for expression levels of programmed death ligand-1 (PD-L1), IL-10, CD86, swine leukocyte antigen-1 (SLA-1), and swine leukocyte antigen-2 (SLA-2). Expression levels of PD-L1 were significantly increased in PCV2 and PRRSV co-infected MoDCs. SLA-1, SLA-2, and CD86 expression levels were significantly decreased in the MoDC treatment groups containing both PCV2 and virulent stains of PRRSV. MoDC IL-10 expression was significantly increased by PCV2 and virulent strains of PRRSV co-infection. Finally, we investigated the role of the PD-L1/programmed death ligand-1 (PD-1) axis in porcine lymphocyte anergy, apoptosis, and the induction of Tregs. Lymphocyte populations with normal PD-1 expression had significantly higher percentages of anergic and apoptotic lymphocytes, and CD4+CD25HighFoxP3+ Tregs when compared to a PD-1 deficient lymphocyte population. The findings from these studies indicate host immune modulation by PCV2 in vivo and the development of a regulatory phenotype of dendritic cell following PCV2/PRRSV co-infections in vitro that may contribute to a dysfunctional adaptive immune response and the overall pathogenesis of PCVAD. / Ph. D.

Untersuchungen der letzten Jahre deuten darauf hin, daß Virusinfektionen ein potentieller Modulator der menschlichen Allergieentstehung sind. Die folgende Studie untersucht, ob frühkindliche Infektionen mit CMV, EBV und VZV einen protektiven Effekt auf die Entstehung atopischer Erkrankungen im späteren Leben haben. Die Studie berücksichtigt sowohl die humorale, als auch die zelluläre Immunantwort auf Virusinfektion. Die humorale Immunantwort wurde serologisch im Verlauf bei 672 Kindern von Geburt bis zum 7. Lebensjahr untersucht (ELISA). Die Antikörper-Titer für CMV, EBV und VZV im Alter von 1 Jahr und 3 Jahren wurden mit den atopischen Manifestationen (atopische Dermatitis, Asthma bronchiale, Rhinokonjunktivitis, Gesamt-Serum-IgE und atopische Sensibilisierung) verglichen. Die TH1 Immunantwort (intrazelluläre IFN gamma Produktion) wurde bei 100 Kindern mit und ohne atopische Manifestationen im Alter von 1 Jahr bis 16 Jahren nach CMV Stimulation untersucht (Durchflußzytometrie). Signifikante Unterschiede in den Häufigkeiten atopischer Symptome zwischen Kindern mit positivem und negativem Antikörper-Titer gegen CMV, EBV und VZV konnten nicht gezeigt werden. Auf zellulärer Ebene zeigte sich, daß Kinder und Jugendliche ohne atopische Symptome auf Virus-Stimulation (CMV-Antigen bzw. Peptid) statistisch ebenso häufig mit einer IFN-gamma-Produktion (TH1-Immunantwort) reagieren wie Kinder und Jugendliche mit atopischen Krankheitszeichen. Die Ergebnisse der vorliegenden Studie können die Hypothese eines protektiven Effekts viraler Infektion, zumindest der Herpesgruppe, in den ersten Lebensjahren hinsichtlich einer späteren Allergieentstehung nicht bestätigen. Die Zusammenhänge der Entwicklung atopischer Erkrankungen sind bisher noch nicht vollständig geklärt. Es gilt weiterhin zu erforschen, in welchem Maße frühkindliche Infekte, neben Allergenexposition, Ernährung, Luftschadstoffen und familiärer Prädisposition die Allergogenese beeinflussen. / Studies of the last years indicated that virus infections are a potential modulator of the human allergogenesis. The following study analysed if infections with CMV, EBV and VZV in early childhood have a protective effect on the development of atopic disorders in later life. The study considered the humoral and cellular immuneresponse to virus infection. The humoral immuneresponse of 672 children were serologically followed up from birth to the age of seven years (ELISA). The antibody titres of CMV, EBV and VZV at the age of 1 year and 3 years were compared with the atopic manifestations (atopic dermatitis, asthma bronchiale, rhinoconjunctivitis, total serum IgE levels and atopic sensitiziation) at the age of seven years. The TH1 immuneresponse (intracellular IFN gamma production) of 100 atopic and nonatopic children at the age of 1 year to 16 years were analysed after CMV stimulation (flowcytometry). There was no significant difference in atopic manifestations between seven-year-old children with seropositivity and seronegativity (CMV, EBV, VZV) in early childhood. Nonatopic children showed the same T cell reactivity after CMV stimulation like atopic children. The study could not show a protective effect of herpesvirus infections in early childhood on the development of atopic disorders in later life. Further studies will help to understand the influence of virus infections on the human allergogenesis.

Immune thrombocytopenia (ITP) is the consequence of a complex, still incompletely understood immunological dysregulation. Proposed mechanisms include autoantibody-induced platelet destruction, impaired platelet production as well as abnormalities in T-cell immunity, such as T helper cells (Th1) polarization, a high proportion of Th17 cells, and a reduced number of regulatory T cells. Although the etiology of ITP is incompletely understood and considered multifactorial in most cases, genetic variants are thought to play a key role in susceptibility to ITP, especially in persistent or chronic ITP. Efforts are currently underway to uncover possible predisposing genetic factors for the development of ITP. Single-nucleotide polymorphisms and copy number variations have been identified in several immune-related genes, such as cytokine genes, Fcγ receptor genes or T-cell costimulation genes, and have been associated with patients’ susceptibility to ITP. However, because of the clinical heterogeneity and low incidence of ITP it remains challenging to perform genetic analyses with sufficiently large sample size within informative patient populations, highlighting the need for collection of well-annotated biomaterials in clinical trials or registry projects. Another significant challenge is to go beyond performing association studies alone and to establish genotype-phenotype associations, thus proving causality between a genetic alteration and ITP pathogenesis. This review summarizes our current knowledge on genetic alterations identified as potential predisposing factors for the development of ITP in adults, thereby addressing signaling pathways considered critical for ITP pathogenesis.