TY - THES A1 - Wiese, Teresa T1 - Pharmacological targeting of acid sphingomyelinase increases CD4\(^+\) Foxp3\(^+\) regulatory T cell subsets in patients with major depression T1 - Pharmakologische Hemmung der sauren Sphingomyelinase verstärkt CD4\(^+\) Foxp3\(^+\) regulatorische T-Zell-Subpopulationen bei Patienten mit Depression N2 - Lack of acid sphingomyelinase (ASM) activity, either through genetic deficiency or through pharmacological inhibition, is linked with increased activity and frequency of Foxp3+ regulatory T cells (Treg) among cluster of differentiation (CD) 4+ T cells in mice in vivo and in vitro1. Thus, pharmacological blockade of ASM activity, which catalyzes the cleavage of sphingomyelin to ceramide and phosphocholine, might be used as a new therapeutic mechanism to correct numeric and/ or functional Treg de-ficiencies in diseases like multiple sclerosis or major depression. In the present study, the effect of pharmacological inhibition of ASM in humans, in vitro and in vivo, was analyzed. In the in vitro experiments, peripheral blood mono-nuclear cells (PBMC) of healthy human blood donors were treated with two widely prescribed antidepressants with high (sertraline, Ser) or low (citalopram, Cit) capaci-ty to inhibit ASM activity. Similar to the findings in mice an increase in the frequency of Treg among human CD4+ T cells upon inhibition of ASM activity was observed. For the analysis in vivo, a prospective study of the composition of the CD4+ T cell com-partment of patients treated for major depression was done. The data show that pharmacological inhibition of ASM activity was superior to antidepressants with little or no ASM-inhibitory activity in increasing CD45RA- CD25high effector Treg (efTreg) frequencies among CD4+ T cells to normal levels. Independently of ASM inhibition, correlating the data with the clinical response, i.e. improvement of the Hamilton rat-ing scale for depression (HAMD) by at least 50 per cent (%) after four weeks of treatment, it was found that an increase in efTreg frequencies among CD4+ cells dur-ing the first week of treatment identified patients with a clinical response. Regarding the underlying mechanism, it could be found that the positive effect of ASM inhibition on Treg required CD28 co-stimulation suggesting that enhanced CD28 co-stimulation was the driver of the observed increase in the frequency of Treg among human CD4+ T cells. Inhibition of ASM activity was further associated with changes in the expression and shuttling of CTLA-4, a key inhibitory molecule ex-pressed by Treg, between cellular compartments but the suppressive activity of CTLA-4 through its transendocytosis activity was unaffected by the inhibition of ASM activity. In summary, the frequency of (effector) Treg among CD4+ T cells in mice and in hu-mans is increased after inhibition of ASM activity suggesting that ASM blockade might beneficially modulate autoimmune diseases and depression-promoting in-flammation. N2 - Ein Mangel an Aktivität der sauren Sphingomyelinase (ASM), entweder durch ge-netisches Defizit oder durch pharmakologische Hemmung, ist mit einer erhöhten Aktivität und Häufigkeit von Foxp3+ regulatorischen T-Zellen (Treg) innerhalb der CD4+ (cluster of differentation 4) T-Zellen in Mäusen in vivo und in vitro verbun-den1. Daher könnte die pharmakologische Blockade der ASM-Aktivität, die die Spaltung von Sphingomyelin in Ceramid und Phosphocholin katalysiert, als neuer therapeutischer Mechanismus zur Korrektur von numerischen und/oder funktionel-len Treg-Defiziten bei Erkrankungen wie Multipler Sklerose oder schwerer Depres-sion eingesetzt werden. In der vorliegenden Studie wurde die Wirkung der pharmakologischen Hemmung von ASM beim Menschen, in vitro und in vivo analysiert. In den In-vitro-Experimenten wurden die peripheren mononukleären Blutzellen (PBMC) gesunder menschlicher Blutspender mit zwei weithin verschriebenen Antidepressiva mit ho-her (Sertralin, Ser) oder niedriger (Citalopram, Cit) Fähigkeit zur Hemmung der ASM-Aktivität untersucht. Ähnlich wie bei Mäusen wurde bei Hemmung der ASM-Aktivität ein Anstieg der Häufigkeit von Treg innerhalb der menschlichen CD4+ T-Zellen festgestellt. Für die Analyse in vivo wurde eine prospektive Studie über die Zusammensetzung des CD4+ T-Zellkomplexes bei Patienten, die wegen einer De-pression im Krankenhaus behandelt wurden, durchgeführt. Die Daten zeigen, dass die pharmakologische Hemmung der ASM-Aktivität Antidepressiva mit ge-ringer oder keiner ASM-hemmenden Aktivität überlegen war, was die Vermehrung der CD45RA- CD25hoch-Effektor-Treg (efTreg)-Frequenzen innerhalb der CD4+ T-Zellen betraf. Unabhängig von der Untersuchung zur ASM-Aktivität beobachteten wir, dass die klinische Reaktion (d.h. der Verbesserung der Hamilton-Bewertungsskala für Depressionen (HAMD) um mindestens 50 Prozent (%) nach vierwöchiger Behandlung) mit einem frühen Anstieg der efTreg-Frequenzen unter CD4+-Zellen während der ersten Behandlungswoche positiv korrelierte. Hinsichtlich des zugrunde liegenden Mechanismus konnte festgestellt werden, dass die positive Wirkung der ASM-Hemmung auf Treg eine CD28-Kostimulation erforderte, was darauf hindeutet, dass eine verstärkte CD28-Kostimulation die Ur-sache für den beobachteten Anstieg der Frequenz von Treg innerhalb menschli-cher CD4+ T-Zellen war. Die Hemmung der ASM-Aktivität war darüber hinaus mit Veränderungen in der Expression und im zellulären Umsatz von CTLA-4, einem von Treg exprimierten inhibitorischen Schlüsselmolekül, verbunden. Die suppressi-ve Aktivität von CTLA-4 durch seine Transendozytose-Aktivität wurde jedoch durch die Hemmung der ASM-Aktivität nicht beeinflusst. Zusammenfassend lässt sich sagen, dass die Häufigkeit von (Effektor-)Treg unter-halb der CD4+ T-Zellen in Mäusen und beim Menschen nach Hemmung der ASM-Aktivität erhöht ist, was darauf hindeutet, dass eine ASM-Blockade Autoimmuner-krankungen und depressionsfördernde Entzündungen vorteilhaft modulieren könn-te. KW - Treg KW - CD28 KW - ASM KW - CTLA-4 KW - Major depression KW - Ceramid Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-233471 ER - TY - JOUR A1 - Koch, Elias A. T. A1 - Petzold, Anne A1 - Wessely, Anja A1 - Dippel, Edgar A1 - Gesierich, Anja A1 - Gutzmer, Ralf A1 - Hassel, Jessica C. A1 - Haferkamp, Sebastian A1 - Kähler, Katharina C. A1 - Knorr, Harald A1 - Kreuzberg, Nicole A1 - Leiter, Ulrike A1 - Loquai, Carmen A1 - Meier, Friedegund A1 - Meissner, Markus A1 - Mohr, Peter A1 - Pföhler, Claudia A1 - Rahimi, Farnaz A1 - Schadendorf, Dirk A1 - Schell, Beatrice A1 - Schlaak, Max A1 - Terheyden, Patrick A1 - Thoms, Kai-Martin A1 - Schuler-Thurner, Beatrice A1 - Ugurel, Selma A1 - Ulrich, Jens A1 - Utikal, Jochen A1 - Weichenthal, Michael A1 - Ziller, Fabian A1 - Berking, Carola A1 - Heppt, Markus V. T1 - Immune checkpoint blockade for metastatic uveal melanoma: re-induction following resistance or toxicity JF - Cancers N2 - Re-induction with immune checkpoint blockade (ICB) needs to be considered in many patients with uveal melanoma (UM) due to limited systemic treatment options. Here, we provide hitherto the first analysis of ICB re-induction in UM. A total of 177 patients with metastatic UM treated with ICB were included from German skin cancer centers and the German national skin cancer registry (ADOReg). To investigate the impact of ICB re-induction, two cohorts were compared: patients who received at least one ICB re-induction (cohort A, n = 52) versus those who received only one treatment line of ICB (cohort B, n = 125). In cohort A, a transient benefit of overall survival (OS) was observed at 6 and 12 months after the treatment start of ICB. There was no significant difference in OS between both groups (p = 0.1) with a median OS of 16.2 months (cohort A, 95% CI: 11.1–23.8) versus 9.4 months (cohort B, 95% CI: 6.1–14.9). Patients receiving re-induction of ICB (cohort A) had similar response rates compared to those receiving ICB once. Re-induction of ICB may yield a clinical benefit for a small subgroup of patients even after resistance or development of toxicities. KW - uveal melanoma KW - immune checkpoint blockade KW - PD-1 KW - CTLA-4 KW - re-induction KW - treatment resistance KW - toxicity Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-254814 SN - 2072-6694 VL - 14 IS - 3 ER - TY - JOUR A1 - Koch, Elias A. T. A1 - Petzold, Anne A1 - Wessely, Anja A1 - Dippel, Edgar A1 - Gesierich, Anja A1 - Gutzmer, Ralf A1 - Hassel, Jessica C. A1 - Haferkamp, Sebastian A1 - Hohberger, Bettina A1 - Kähler, Katharina C. A1 - Knorr, Harald A1 - Kreuzberg, Nicole A1 - Leiter, Ulrike A1 - Loquai, Carmen A1 - Meier, Friedegund A1 - Meissner, Markus A1 - Mohr, Peter A1 - Pföhler, Claudia A1 - Rahimi, Farnaz A1 - Schadendorf, Dirk A1 - Schell, Beatrice A1 - Schlaak, Max A1 - Terheyden, Patrick A1 - Thoms, Kai-Martin A1 - Schuler-Thurner, Beatrice A1 - Ugurel, Selma A1 - Ulrich, Jens A1 - Utikal, Jochen A1 - Weichenthal, Michael A1 - Ziller, Fabian A1 - Berking, Carola A1 - Heppt, Markus T1 - Immune checkpoint blockade for metastatic uveal melanoma: patterns of response and survival according to the presence of hepatic and extrahepatic metastasis JF - Cancers N2 - Background: Since there is no standardized and effective treatment for advanced uveal melanoma (UM), the prognosis is dismal once metastases develop. Due to the availability of immune checkpoint blockade (ICB) in the real-world setting, the prognosis of metastatic UM has improved. However, it is unclear how the presence of hepatic and extrahepatic metastasis impacts the response and survival after ICB. Methods: A total of 178 patients with metastatic UM treated with ICB were included in this analysis. Patients were recruited from German skin cancer centers and the German national skin cancer registry (ADOReg). To investigate the impact of hepatic metastasis, two cohorts were compared: patients with liver metastasis only (cohort A, n = 55) versus those with both liver and extra-hepatic metastasis (cohort B, n = 123). Data were analyzed in both cohorts for response to treatment, progression-free survival (PFS), and overall survival (OS). The survival and progression probabilities were calculated with the Kaplan–Meier method. Log-rank tests, χ\(^2\) tests, and t-tests were performed to detect significant differences between both cohorts. Results: The median OS of the overall population was 16 months (95% CI 13.4–23.7) and the median PFS, 2.8 months (95% CI 2.5–3.0). The median OS was longer in cohort B than in cohort A (18.2 vs. 6.1 months; p = 0.071). The best objective response rate to dual ICB was 13.8% and to anti-PD-1 monotherapy 8.9% in the entire population. Patients with liver metastases only had a lower response to dual ICB, yet without significance (cohort A 8.7% vs. cohort B 16.7%; p = 0.45). Adverse events (AE) occurred in 41.6%. Severe AE were observed in 26.3% and evenly distributed between both cohorts. Conclusion: The survival of this large cohort of patients with advanced UM was more favorable than reported in previous benchmark studies. Patients with both hepatic and extrahepatic metastasis showed more favorable survival and higher response to dual ICB than those with hepatic metastasis only. KW - uveal melanoma KW - immune checkpoint blockade KW - PD-1 KW - CTLA-4 KW - liver metastasis KW - treatment resistance Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-242603 SN - 2072-6694 VL - 13 IS - 13 ER - TY - THES A1 - Lin, Chia-Huey T1 - Functional characterization of rat CTLA-4 and CD25+CD4+ regulatory T cells T1 - Funktionelle Chracterisierung der Ratte CTLA-4 und CD25+CD4+ regulatorischen T Zellen N2 - Summary: In the present work, two important negative regulators of T cell responses in rats were examined. At the molecular level, rat CTLA-4, a receptor important for deactivating T cell responses, was examined for the expression pattern and in vitro functions. For this purpose, anti-rat CTLA-4 mAbs were generated. Consistent with the studies in mice and humans, rat CTLA-4 was detectable only in CD25+CD4+ regulatory T cells in unstimulated rats, and was upregulated in all activated T cells. Cross-linking rat CTLA-4 led to the deactivation of anti-TCR- and anti-CD28 stimulated (costimulation) T cell responses such as reduction in activation marker expression, proliferation, and cytokine IL-2 production. Although T cells stimulated with the superagonistic anti-CD28 antibody alone without TCR engagement also increased their CTLA-4 expression, a delayed kinetics of CTLA-4 upregulation was found in cells stimulated in this way. The physiological relevance of this finding needs further investigation. At the cellular level, rat CD25+CD4+ regulatory T cells were examined here in detail. Using rat anti-CTLA-4 mAbs, the phenotype of CD25+CD4+ regulatory T cells was investigated. Identical to the mouse and human Treg phenotype, rat CD25+CD4+ T cells constitutively expressed CTLA-4, were predominantly CD45RC low, and expressed high level of CD62L (L-selectin). CD25+CD4+ cells proliferated poorly and were unable to produce IL-2 upon engagement of the TCR and CD28. Furthermore, rat CD25+CD4+ cells produced high amounts of anti-inflammatory cytokine IL-10 upon stimulation. Importantly, freshly isolated CD25+CD4+ T cells from naïve rats exhibited suppressor activities in the in vitro suppressor assays. In vitro, CD25+CD4+ regulatory T cells proliferated vigorously upon superagonistic anti-CD28 stimulation and became very potent suppressor cells. In vivo, a single injection of CD28 superagonist into rats induced transient accumulation and activation of CD25+CD4+ regulatory T cells. These findings suggest firstly that efficient expansion of CD25+CD4+ cells without losing their suppressive effects (even enhance their suppressive activities) can be achieved with the superagonistic anti- CD28 antibody in vitro. Secondly, the induction of disproportional expansion of CD25+CD4+ cells by a single injection of superagonistic anti-CD28 antibody in vivo implies that superagonistic anti-CD28 antibody may be a promising candidate in treating autoimmune diseases by causing a transient increase of activated CD25+CD4+ T cells and thus tipping ongoing autoimmune responses toward selftolerance. N2 - Zusammenfassung: In der vorliegenden Arbeit wurden zwei wichtige negative Regulatoren von T Zellantworten in der Ratte untersucht. Auf molekularer Ebene wurde Ratten-CTLA-4, ein für die Deaktivierung von T-Zellimmunantworten wichtiger Rezeptor, hinsichtlich seines Expressionsmusters und seiner in vitro Funktionen untersucht. Zu diesem Zweck wurden spezifische monoklonale Antikörper gegen Ratten-CTLA-4 erzeugt. In Übereinstimmung mit anderen Untersuchungen in Mensch und Maus war CTLA-4 konstitutiv nur in CD25+CD4+ regulatorischen T-Zellen exprimiert, nach Stimulierung war es in allen aktivierten T-Zellen nachweisbar. Kreuzvernetzung von CTLA-4 führte zur Inhibition von mit anti-TCR- und anti-CD28-Antikörpern stimulierten (Kostimulation) TZellantworten, insbesondere zur Verminderung der Expression von Aktivierungsmarkern, der Proliferation und der Produktion von IL-2. Obwohl T-Zellen mit superagonistischem Anti-CD28-Antikörper ohne T-Zellrezeptor stimulation ihre CTLA-4-Expression ebenfalls steigerten, wurde eine verzögerte Kinetik für die Hochregulation von CTLA-4 in diesen Zellen festgestellt. Die physiologische Bedeutung dieses Befundes bedarf noch weiterer Untersuchungen. Auf zellulärer Ebene wurden CD25+CD4+ regulatorische T-Zellen detailliert analysiert. Der Phänotyp CD25+CD4+ regulatorischen T-Zellen wurde charakterisiert. Wie in Mensch und Maus exprimierten die regulatorischen T-Zellen der Ratte konstitutiv CTLA-4, in größerem Umfang CD62L (L-Selectin), aber nur wenig CD45RC. CD25+CD4+ Zellen proliferierten nach Stimulation von CD28 und T-Zellrezeptor nur schwach und produzierten kein IL-2, im Gegensatz dazu aber große Mengen an IL-10. Hervorzuheben ist, dass für frisch isolierte CD25+CD4+ T-Zellen aus naiven Ratten Suppressoraktivität durch in vitro-Suppressionsassays nachgewiesen werden konnte. In vitro proliferierten CD25+CD4+ regulatorische T-Zellen nach superagonistischer anti-CD28-Stimulation äußerst stark und wurden zu potenten Suppressorzellen. Eine einzelne Injektion von superagonistischem Anti-CD28-Antikörper resultierte in einer transienten Akkumulation von CD25+CD4+ regulatorischen T-Zellen in vivo und induzierte deren Aktivierung. Diese Ergebnisse weisen zum einen darauf hin, dass eine effiziente Expansion von CD25+CD4+ Zellen ohne Verlust ihrer supprimierenden Effekte durch superagonistischen Anti-CD28-Antikörper in vitro erzielt werden kann. Zum anderen läßt die Induktion einer disproportionalen Expansion von CD25+CD4+ Zellen durch eine einzige Injektion des CD28-Superagonisten den Schluss zu, dass dieser Antikörper ein vielversprechender Kandidat zur Behandlung von Autoimmunkrankheiten sein könnte, der über eine transiente Zunahme von aktivierten CD25+CD4+ T-Zellen eine bestehende Autoimmunantwort hin zur Selbsttoleranz lenkt. KW - Ratte KW - T-Lymphozyt KW - Desaktivierung KW - CTLA-4 KW - Regulatorische T Zellen KW - CD28 superagonist KW - Ratte KW - Toleranz KW - CTLA-4 KW - CD25+CD4+ regulatory T cells KW - CD28 superagonist KW - rat KW - peripheral tolerance Y1 - 2004 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-8521 ER -