Lorsque l'hépatite chronique C a occasionné une cirrhose et que, du fait de ses complications, le pronostic vital est en jeu au terme de quelques mois, la transplantation hépatique (TH) représente l'unique traitement efficace,. Malheureusement, la récidive quasi-systématique de la cirrhose C, après la transplantation hépatique, est la principale barrière à la survie du greffon. De nombreux facteurs ont été associés à la sévérité des récidives, et une implication des lymphocytes T régulateurs CD4+CD25+ (Treg) et de certains immunosuppresseurs a été suggérée. Par ailleurs, le patient transplanté peut également être confronté au problème du rejet aigu d’allogreffe, qui est partiellement contrôlé par les Treg et par une thérapie immunosuppressive rigoureuse. Paradoxalement, plusieurs études ont suggéré que certains immunosuppresseurs sont moins efficaces que d’autres dans la prophylaxie du rejet d’allogreffe et peuvent même être associés à des épisodes de rejet plus fréquents. Il existait donc un besoin urgent d’évaluer le rôle joué par les immunosuppresseurs sur les Treg dans la récidive de la fibrose C et dans le rejet du greffon. Dans un premier temps, nous avons confirmé l’implication des Treg dans la progression de la récidive de l’hépatite C. En effet, les marqueurs associés à cette population sont surexprimés dans le foie et dans le sérum de patients, 1 an et 5 ans après la TH, et ce proportionnellement à la sévérité de la récidive. Dans un deuxième temps, nous avons évalué l’effet d’immunosuppresseurs utilisés après la TH (cyclosporine A (CsA), tacrolimus, rapamycine et mycophénolate mofétif) sur l’activité des Treg. Nous avons ainsi montré que seule la CsA a une action inhibitrice sur l’activité des Treg, et ce, uniquement aux doses thérapeutiques de 20 et 40 ng/mL (doses administrées au long terme, 5 ans après la TH). Cette inhibition de l’activité des Treg par la CsA ne modifie pas leur phénotype (expression protéique ou génique), mais conduit à la sécrétion d’IL-2 et d’IFN-γ par les Treg, cytokines de la voie Th1. Le mécanisme immunosuppresseur de la CsA étant d’inhiber la transcription de l’IL-2, via la voie calcineurine/N-FAT, nous avons tenté d’identifier si elle agissait sur les Treg par cette voie ou par une voie indépendante de la calcineurine. Deux observations ont renforcé l’hypothèse d’un mode d’action calcineurine/N-FAT - indépendant : (i) le fait que le tacrolimus, qui a le même mécanisme immunosuppresseur que la CsA, n’inhibe pas l’activité des Treg et (ii) le fait que NIM811, un analogue de la CsA n’agissant pas sur la voie de la calcineurine, inhibe l’activité des Treg aux mêmes doses que la CsA. Cette hypothèse a par ailleurs été directement confirmée par l’absence de modification du profil de déphosphorylation du facteur de transcription N-FAT, en présence de CsA. Enfin, bien que les corticoïdes soient connus pour préserver l’activité des Treg et induisent leur prolifération in vitro, ils sont incapables de reverser l’effet inhibiteur de la CsA sur les Treg. Nos résultats suggèrent donc qu’une dose thérapeutique de CsA inhiberait l’activité des Treg CD4+CD25+. Les cellules T régulatrices jouent un rôle important dans la tolérance du greffon et dans la sévérité des récidives après la TH, leur inhibition par la CsA pourrait alors favoriser le rejet du greffon et diminuer la sévérité des récidives. Ces résultats sont importants dans la mesure où la transplantation hépatique est à l’heure actuelle la seule alternative de survie au stade du carcinome hépatocellulaire, et qu’il n’existe aucun traitement efficace contre le rejet du greffon ou la récidive de l’hépatite C. Le traitement immunosuppresseur idéal n’existe pas, cependant il ne devrait pas augmenter l’activité suppressive des Treg, au risque de favoriser la récidive de l’hépatite C, ni inhiber cette activité, au risque de favoriser le rejet du greffon. / Liver transplantation (LT) remains the only effective therapeutic approach for cirrhosis related HCC patients. Inevitable hepatitis C virus (HCV) recurrence after liver transplantation is a major barrier to the survival of a transplanted liver. It may be promoted by immunosuppression and the emergence of CD4+CD25+ regulatory T cells (Treg). Transplanted patients are also been confronted to allograft rejection, which is partially controlled by Treg cells and the administration of an immunosuppressive therapy. However, some immunosuppressive drugs have been associated with more frequent graft rejection. In this context, it was important to assess the effect of immunosuppressive drugs on regulatory T cells, both in HCV recurrence and graft rejection. We have first confirmed the implication of Treg cells in hepatitis C recurrence progression. Indeed, regulatory T cells markers are over-expressed, 1 and 5 years after LT, both in the liver and in periphery and proportionally of the recurrence severity. In a second time, we have analysed the effect of immunosuppressive drugs used after LT (cyclosporine A (CsA), tacrolimus, rapamycine and mycophenolate mofetil) on regulatory T cell activity. We have shown that only low concentrations of CsA (20 and 40 ng/mL) inhibit regulatory T cell activity (these doses are used 5 years after LT). It seems that CsA does not affect regulatory T cell phenotype (protein and gene expression) but lead to a secretion of Th1 cytokines in Treg cells : IL-2 and IFN-γ. As CsA, is known to inhibit IL-2 transcription through the calcineurin/N-FAT pathway, we have tried to identify if CsA inhibits Treg cells via this pathway or via a calcineurin -independent pathway. Two observations have confirmed the hypothesis of a calcineurin -independent pathway : (i) tacrolimus, which have the same immunosuppressive mechanism as CsA, could not inhibit Treg activity, and (ii) NIM811, a calcineurin - independent CsA analog, inhibits regulatory T cell activity at the same concentrations than CsA. Moreover, this hypothesis has been directly confirmed by the absence of of modification of the N-FAT dephosphorylation profile. Lastly, corticoids, known to preserve Treg activity, could induce Treg cell proliferation in vitro. However, they could not reverse the inhibitory effect of CsA on Treg cells. Our results suggest that a therapeutical dose of CsA could inhibit CD4+CD25+ regulatory T cell activity. Treg cells play an important role in graft tolerance and hepatitis C recurrence after LT, so their inhibition by CsA could favour graft rejection and decrease recurrence severity. These results are important, as liver transplantation iscurrently the only survival alternative for HCC related patients. The ideal immunosuppressive therapy does not exist, but it would not increase Treg activity, which may promote hepatitis C recurrence, neither abrogate this activity due to the risk of graft rejection.

No description available.

Human umbilical cord blood (HUCB) cells consist of a heterogeneous population of cells, rich in hematopoietic stem and progenitor cells. These cells have been used in the treatment of various nonmalignant and malignant hematopoietic diseases. With in the last few years HUCB cells have been used in pre-clinical animal models of brain and spinal cord injuries, in which functional recovery has been shown. The properties of cord blood cells that could be important in cell transplantation (repair or replacement) of CNS injury or disease are currently being evaluated. The major focus of this study was to determine whether HUCB cells would migrate to ischemic tissue extracts. In addition, factors that may be inducing the cells to migrate were examined by identifying the cytokines or chemokines present in the ischemic tissue extracts. The secondary focus was to establish whether cultured HCUB cells are releasing cytokines and chemokines (in vitro) in response to their environment. The results of these studies showed that HUCB cells migrate to ischemic tissue in a time dependent manner. In which there is a 48 to 72 hour window of opportunity for the delivery of HUCB cells to the ischemic brain. In addition, the cord blood cells were shown to release cytokines that may be aiding in the behavioral recovery seen in the transplantation studies. The results from this study are promising in that the current 3-hour therapeutic window for the treatment of stroke victims, using approved anticoagulant treatment, may be extended with the use of cord blood cell therapy with the peak at 48 hours.

Abstract not available

Doctor of Philosophy (PhD) / The BCNU + O6benzylguanine (O6BG) driven selective enrichment strategy was first established for enhanced transplantation of hematopoietic stem cells. This study describes a novel application of this BCNU + O6BG driven selective enrichment strategy in skeletal muscle stem cell transplantation. Furthermore, this study addresses the three main limitations observed in previously reported skeletal muscle stem cell transplantation strategies. Limitation of ineffective donor cells which lack the ability for successful engraftment was overcome by using a heterogeneous population of donor cells which are present during a normal skeletal muscle regeneration response. The limitation of donor cell death upon transplantation as a result of competition from the endogenous stem cells of the host muscles was overcome by elimination of host muscle stem cells with BCNU + O6BG treatment. Efficiency of elimination of host muscle stem cells was further demonstrated by the complete inhibition of a regeneration response up to 3 months in injured, BCNU + O6BG treated muscles. The limitation of localised engraftment as a result of intramuscular injection of donor cells was also addressed. The transplanted donor cells demonstrated the ability to migrate via systemic circulation. This characteristic of the donor cells would allow the transplantation of cells via intraarterial or intravenous delivery which would overcome the limitation of localised engraftment. Finally, application of the BCNU + O6BG driven selective enrichment strategy in skeletal muscle stem cell transplantation demonstrated enhanced engraftment. This is the first reported attempt of enhanced stem cell transplantation in a solid tissue achieved upon application of the BCNU + O6BG driven selective enrichment strategy. This study provides the basis for application of the BCNU + O6BG driven selective enrichment strategy in other tissues where stem cell transplantation is considered.

Fetal pig islet-like cell clusters (ICCs) were transplanted into the thymus or omentum of STZ-induced diabetic pigs immunosuppressed with cyclosporine (CsA) and deoxyspergualin (DSG), as a potential treatment for type 1 diabetes. C-peptide levels in response to glucagon and arginine significantly increased over time using 1 litter of ICCs with highest levels obtained at 100 days post-transplantation. Increasing the number of ICCs to 2 litters was not advantageous. Histology of the graft showed all 4 pancreatic endocrine cells. Normoglycaemia was achieved for transient periods without insulin administration in 4 out of 12 pigs. These results suggest sub-optimal insulin production, possibly due to the adverse effects of CsA on the grafted β cells. The effect of CsA on adult porcine β cells was investigated and adverse effects were shown. Renal toxicity and adverse changes to the haematological parameters did not occur despite high CsA levels although minimal toxicity to the liver was observed. The results indicate that the use of CsA monotherapy in the maintenance phase to prevent rejection of allografted pancreatic β cells may become a subsequent problem over time. As an alternative to chronic immunossuppression, anti-CD3 monoclonal antibody was administered for 10 days in pigs. Using anti-CD3 alone, only 1 out 4 pigs showed cells positive for insulin. The addition of a 5-day CsA course administered the day before transplantation did not promote allograft survival. The use of DSG for 10 days with anti-CD3 promoted graft survival with the histology showing the 4 endocrine cells 3 weeks post-transplantation. An attempt was made to replace any form of immunossuppression by encapsulating fetal pig ICCs in barium alginate, which were able to remain viable when transplanted in NOD/SCID mice. Fibrosis was detected in BALB/c mice transplanted with encapsulated fetal ICCs suggesting that fetal pig ICCs shed antigens that elicit an immune response. Results from this study show that although fetal pig ICCs may be a viable source of insulin-producing cells, the use of CsA to prevent rejection has adverse effects on graft function. Encapsulation as well as transient immunosuppression is worthy of further investigation to prevent rejection of fetal pig ICCs.

Transplants of olfactory ensheathing cells (OECs) from olfactory bulbs have recently been shown to support regrowth and reinnervation of damaged spinal cord, which has led to improved functional recovery. Using complete transection in adult rat, the studies presented in this thesis examine the role of peripherally derived olfactory tissue in promoting axonal regeneration and functional recovery. Chapter One and Two provide the background to the area of spinal cord regeneration and the methods used in this thesis. Chapter Three shows that transplants of OECs from rat olfactory lamina propria (OLP) are able to support axon regrowth in the lesioned spinal cord. The BBB score was significantly higher in experimental rats (5.4???0.84) compared with control animals (1.9???0.33) (P&lt0.001). These dissociated OECs from OLP can promote axonal regrowth through the lesion. Histological assessment showed that: 1) axons labelled with Fluororuby grew into the injury site in OECs-transplanted rats, with occasional fibres extending into the rostral cord; 2) brainstem neurons in the raphe nucleus were retrogradely labeled with Fluororuby; and 3) serotonergic axons were detectable distal to the lesion in OECs-transplanted rats. No fibres grew into the injured region and no retrograde labeling or serotonergic fibres were seen in control animals. The role of regenerated serotonergic fibres in OECs-transplanted rats is discussed. Chapter Four demonstrates that solid pieces of OLP dissected from the nose can re-establish the continuity of the transected cord and supply the OECs that can migrate to the cord stumps to support the axon regeneration. Experimental rats which received OLP from olfactory mucosa showed significantly greater locomotive recovery (BBB scores: OLP, 5.0???1.9; control, 1.5???0.5, p&lt0.0001). In animals with OLP transplants, histological analysis indicated that nerve fibres, expressing neurofilament and serotonin were present at the transection site. Locomotive recovery of the hindlimbs occurred, similar to that seen after OECs transplantation. Retrograde labeling of medullary raphe neurons and gigantocellular reticular nucleus occurred following Fluororuby injection in the cord distal to the lesion, further supporting the supraspinal origin of the 5-HT innervation in the present studies. These results indicate that OLP is effective in promoting partial spinal cord repair. Chapter Five examines functional recovery of spinal reflex circuitry, ie., H-reflex excitability using paired stimuli, in OLP-transplanted rats compared with normal and respiratory lamina propria (RLP) transplanted animals. H-reflex amplitude of the conditioned response was significantly reduced in OLP transplanted rats compared to RLP transplanted animals (p&lt 0.05). Therefore, hindlimb reflex excitability can be modulated by OLP transplants after transection of the spinal cord in adult rats. Chapter Six examines whether functional recovery can occur if transplantation of OLP tissue is delayed by 1 month after the spinal cord transection. The BBB score was significantly higher in experimental rats (4.3???0.8 for OLP) compared with control animals (1.0???0.3, P&lt 0.001), but recovery was less than after acute transplantation. Asx before, histological assessment of OLP animals showed: a) serotonergic axons were present in the cord below the transection site; b) brainstem raphe nuclei was retrogradely labeled; c) bisbenzimide pre-labeled cells from OLP transplants migrated in host spinal cord. These changes were not seen in control animals. These results indicate that OLP has the ability to promote axonal regeneration in chronically injured cord of adult rats. Chapter Seven compares the results from these three types of intervention. In conclusion, these studies show that peripherally derived OECs or solid pieces of OLP can promote partial spinal cord repair in acute or chronic transection injuries. Such tissue might provide a potential source for autologous grafting in human paraplegia.

Whole document restricted, see Access Instructions file below for details of how to access the print copy. / Huntington’s disease [HD] is a debilitating adult onset inherited neurodegenerative disorder with primary degeneration in the striatum and widespread secondary degeneration throughout the brain. There are currently no clinical treatments to prevent onset, delay progression or replace lost neurons. Striatal cell transplantation strategies under clinical evaluation appear viable and effective for the treatment of HD. However, the future of regenerative medicine lies in developing renewable, expandable multipotent neural cell sources for transplantation. This Thesis has investigated a range of novel developments for enhancing the therapeutic potential of neural progenitor cell transplantation in a quinolinic acid [QA] lesion rat model of HD using two cell sources, adult neural progenitor cells and human embryonic stem cell [hESC] derived neural progenitor cells. Chapter Three identified a novel method for in vitro lithium priming of adult neural progenitor cells which enhances their neurogenic potential at the expense of glial formation. Chapter Four demonstrated that lithium priming of adult neural progenitor cells altered their phenotypic fate in vivo after transplantation, enhancing regional specific differentiation and efferent projection formation. The therapeutic potential of this strategy was demonstrated by accelerated acquisition of motor function benefits in the QA model. Chapter Five then demonstrated the ability for post transplantation environmental enrichment to modify therapeutic functional outcomes in the QA lesion model, and through lithium priming and enrichment demonstrated that adult neural progenitors are amenable to combinatorial interventions which can alter their phenotypic fate and enhance anatomical integration. Chapter Six investigated the in vivo effects of in vitro noggin priming of hESC derived neural progenitor cells and identified enhanced safety and neuronal differentiation in the QA lesioned striatum after noggin priming. Furthermore Chapter Seven provided evidence for functional reconstruction and therapeutic functional benefits from transplantation of noggin primed hESC derived neural progenitor cells and also highlighted the need for systematic evaluations of hESC derived transplants to optimise their safety in vivo. These results are beneficial in demonstrating the realistic therapeutic potential held by these two cell sources. They demonstrate how transient interventions can enhance therapeutic outcomes of neural progenitor cell transplantation for HD and have developed the understanding of neural progenitor cell transplantation as a therapeutic tool, bringing transplantation from different cell sources closer to eventual translation for HD sufferers.

Xenotransplantation is the final frontier of using vascularised organs or cellular grafts to treat end-organ disease and offers a potential solution to the worldwide shortage of human tissue available for transplantation. The main immunological barrier to xenografting from pig-to-primate is the antigen, Galactose-α1,3-Galactose (Gal) which is found in all species except humans and other higher primates. Even with the major advancement of deleting Gal from the potential pig donor species with the aid of cloning technology, complete elimination may be elusive as alternative genes yet to be fully characterised, may still produce Gal at low levels. Thus, the human immune response against Gal may continue to be a barrier to successful xenotransplantation. The aim of this project was to develop small animal models of the important components of xenograft rejection that largely relate to the anti-Gal immune response. These include models of hyperacute, acute vascular and chronic xenograft-like rejection that in turn, provide new insights in the immune mechanisms of the rejection processes. The role of antibody and both innate and cognate cellular immunity are explored. Both vascularised heart grafts and non-vascularised skin graft models are examined as rejection of solid organs may differ from cellular transplantation. The project also provides a platform for future studies in testing genetic and pharmacotherapeutic strategies to overcome the rejection processes uncovered.

Cellular immune responses to Hepatitis C (HCV) epitopes are crucial for successful host response to HCV infection. We investigated a platform to assess specific and global immune responses in HCV infection. We identified 57 HCV peptides from literature (24 of CD4+, 33 of CD8+ specificity) and tested them in two peptide pools to assess specific response in non-transplanted and post-liver transplant (LT) patients. Robust interferon-gamma (IFN) response to CD4+ peptide and mitogen stimulation was seen in sustained virological clearance. IFN response to the CD4+ peptide pool could differentiate between SVR and NR with 82% accuracy. In patients with recurrent HCV post-LT, HCV-specific responses were attenuated, but global immune responses were preserved. Significantly lower specific (CD4+) and global immune responses (mitogen response) were observed in patients with advanced allograft disease (fibrosis score>2). Quantiferon-HCV may identify patients likely to respond to anti-HCV treatment, as well as post-LT patients with aggressive HCV recurrence. / Experimental Surgery