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Background: Multiple myeloma (MM) is a B-cell malignancy, where malignant plasma cells clonally expand in the bone marrow of older people, causing significant morbidity and mortality. Typical clinical symptoms include increased serum calcium levels, renal insufficiency, anemia, and bone lesions. With standard therapies, MM remains incurable; therefore, the development of new drugs or immune cell-based therapies is desirable. To advance the goal of finding a more effective treatment for MM, we aimed to develop a reliable preclinical MM mouse model applying sensitive and reproducible methods for monitoring of tumor growth and metastasis in response to therapy. Material and Methods: A mouse model was created by intravenously injecting bone marrow-homing mouse myeloma cells (MOPC-315.BM) that expressed luciferase into BALB/c wild type mice. The luciferase in the myeloma cells allowed in vivo tracking before and after melphalan treatment with bioluminescence imaging (BLI). Homing of MOPC-315.BM luciferase+ myeloma cells to specific tissues was examined by flow cytometry. Idiotype-specific myeloma protein serum levels were measured by ELISA. In vivo measurements were validated with histopathology. Results: Strong bone marrow tropism and subsequent dissemination of MOPC-315.BM luciferase+ cells in vivo closely mimicked the human disease. In vivo BLI and later histopathological analysis revealed that 12 days of melphalan treatment slowed tumor progression and reduced MM dissemination compared to untreated controls. MOPC-315.BM luciferase+ cells expressed CXCR4 and high levels of CD44 and a4b1 in vitro which could explain the strong bone marrow tropism. The results showed that MOPC-315.BM cells dynamically regulated homing receptor expression and depended on interactions with surrounding cells. Conclusions: This study described a novel MM mouse model that facilitated convenient, reliable, and sensitive tracking of myeloma cells with whole body BLI in living animals. This model is highly suitable for monitoring the effects of different treatment regimens.
Optical in vivo imaging methods have advanced the fields of stem cell transplantation, graft-versus–host disease and graft-versus-tumor responses. Two well known optical methods, based on the transmission of light through the test animal are bioluminescence imaging (BLI) and fluorescence imaging (FLI). Both methods allow whole body in vivo imaging of the same animal over an extended time span where the cell distribution and proliferation can be visualized. BLI has the advantages of producing almost no unspecific background signals and no necessity for external excitation light. Hence, BLI is a highly sensitive and reliable detection method. Yet, the BLI reporter luciferase is not applicable with common microscopy techniques, therefore abolishing this method for cellular resolution imaging. FLI in turn, presents the appealing possibility to use one fluorescent reporter for whole body imaging as well as cellular resolution applying microscopy techniques. The absorption of light occurs mainly due to melanin and hemoglobin in wavelengths up to 650 nm. Therefore, the wavelength range beyond 650 nm may allow sensitive optical imaging even in deep tissues. For this reason, significant efforts are undertaken to isolate or develop genetically enhanced fluorescent proteins (FP) in this spectral range. “Katushka” also called FP635 has an emission close to this favorable spectrum and is reported as one of the brightest far-red FPs. Our experiments also clearly showed the superiority of BLI for whole body imaging over FLI. Based on these results we applied the superior BLI technique for the establishment of a pre-clinical multiple myeloma (MM) mouse model. MM is a B-cell disease, where malignant plasma cells clonally expand in the bone marrow (BM) of older people, causing significant morbidity and mortality. Chromosomal abnormalities, considered a hallmark of MM, are present in nearly all patients and may accumulate or change during disease progression. The diagnosis of MM is based on clinical symptoms, including the CRAB criteria: increased serum calcium levels, renal insufficiency, anemia, and bone lesions (osteolytic lesions or osteoporosis with compression fractures). Other clinical symptoms include hyperviscosity, amyloidosis, and recurrent bacterial infections. Additionally, patients commonly exhibit more than 30% clonal BM plasma cells and the presence of monoclonal protein is detected in serum and/or urine. With current standard therapies, MM remains incurable and patients diagnosed with MM between 2001 and 2007 had a 5-year relative survival rate of only 41%. Therefore, the development of new drugs or immune cell-based therapies is desirable and necessary. To this end we developed the MOPC-315 cell line based syngeneic MM mouse model. MOPC-315 cells were labeled with luciferase for in vivo detection by BLI. We validated the non-invasively obtained BLI data with histopathology, measurement of idiotype IgA serum levels and flow cytometry. All methods affirmed the reliability of the in vivo BLI data for this model. We found that this orthotopic MM model reflects several key features of the human disease. MOPC-315 cells homed efficiently to the BM compartment including subsequent proliferation. Additionally, cells disseminated to distant skeletal parts, leading to the typical multifocal MM growth. Osteolytic lesions and bone remodeling was also detected. We found evidence that the cell line had retained plasticity seen by dynamic receptor expression regulation in different compartments such as the BM and the spleen.
Renal Perfusion in Scleroderma Patients Assessed by Microbubble-Based Contrast-Enhanced Ultrasound
(2012)
Abstract: Objectives: Renal damage is common in scleroderma. It can occur acutely or chronically. Renal reserve might already be impaired before it can be detected by laboratory findings. Microbubble-based contrast-enhanced ultrasound has been demonstrated to improve blood perfusion imaging in organs. Therefore, we conducted a study to assess renal perfusion in scleroderma patients utilizing this novel technique. Materials and Methodology: Microbubble-based contrast agent was infused and destroyed by using high mechanical index by Siemens Sequoia (curved array, 4.5 MHz). Replenishment was recorded for 8 seconds. Regions of interests (ROI) were analyzed in renal parenchyma, interlobular artery and renal pyramid with quantitative contrast software (CUSQ 1.4, Siemens Acuson, Mountain View, California). Time to maximal Enhancement (TmE), maximal enhancement (mE) and maximal enhancement relative to maximal enhancement of the interlobular artery (mE%A) were calculated for different ROIs. Results: There was a linear correlation between the time to maximal enhancement in the parenchyma and the glomerular filtration rate. However, the other parameters did not reveal significant differences between scleroderma patients and healthy controls. Conclusion: Renal perfusion of scleroderma patients including the glomerular filtration rate can be assessed using microbubble-based contrast media.
SMAC Mimetic BV6 Induces Cell Death in Monocytes and Maturation of Monocyte-Derived Dendritic Cells
(2011)
Background: Compounds mimicking the inhibitory effect of SMAC / DIABLO on X-linked inhibitor of apoptosis (XIAP) have been developed with the aim to achieve sensitization for apoptosis of tumor cells resistant due to deregulated XIAP expression. It turned out that SMAC mimetics also have complex effects on the NFkB system and TNF signaling. In view of the overwhelming importance of the NFkB transcription factors in the immune system, we analyzed here the effects of the SMAC mimetic BV6 on immune cells. Principal Findings: BV6 induced apoptotic and necrotic cell death in monocytes while T-cells, dendritic cells and macrophages were largely protected against BV6-induced cell death. In immature dendritic cells BV6 treatment resulted in moderate activation of the classical NFkB pathway, but it also diminished the stronger NFkB-inducing effect of TNF and CD40L. Despite its inhibitory effect on TNF- and CD40L signaling, BV6 was able to trigger maturation of immature DCs as indicated by upregulation of CD83, CD86 and IL12. Significance: The demonstrated effects of SMAC mimetics on immune cells may complicate the development of tumor therapeutic concepts based on these compounds but also arise the possibility to exploit them for the development of immune stimulatory therapies.
TNFR1 and TNFR2 regulate the extrinsic apoptotic pathway in myeloma cells by multiple mechanisms
(2011)
The huge majority of myeloma cell lines express TNFR2 while a substantial subset of them failed to show TNFR1 expression. Stimulation of TNFR1 in the TNFR1-expressing subset of MM cell lines had no or only a very mild effect on cellular viability. Surprisingly, however, TNF stimulation enhanced cell death induction by CD95L and attenuated the apoptotic effect of TRAIL. The contrasting regulation of TRAIL- and CD95L-induced cell death by TNF could be traced back to the concomitant NFjBmediated upregulation of CD95 and the antiapoptotic FLIP protein. It appeared that CD95 induction, due to its strength, overcompensated a rather moderate upregulation of FLIP so that the net effect of TNF-induced NFjB activation in the context of CD95 signaling is pro-apoptotic. TRAIL-induced cell death, however, was antagonized in response to TNF because in this context only the induction of FLIP is relevant. Stimulation of TNFR2 in myeloma cells leads to TRAF2 depletion. In line with this, we observed cell death induction in TNFR1-TNFR2-costimulated JJN3 cells. Our studies revealed that the TNF-TNF receptor system adjusts the responsiveness of the extrinsic apoptotic pathway in myeloma cells by multiple mechanisms that generate a highly context-dependent net effect on myeloma cell survival.
No abstract avDendritic cells (DC) are the most important antigen presenting cells and play a pivotal role in host immunity to infectious agents by acting as a bridge between the innate and adaptive immune systems. Monocyte-derived immature DCs (iDC) were infected with viable resting conidia of Aspergillus fumigatus (Af293) for 12 hours at an MOI of 5; cells were sampled every three hours. RNA was extracted from both organisms at each time point and hybridised to microarrays. iDC cell death increased at 6 h in the presence of A. fumigatus which coincided with fungal germ tube emergence; .80% of conidia were associated with iDC. Over the time course A. fumigatus differentially regulated 210 genes, FunCat analysis indicated significant up-regulation of genes involved in fermentation, drug transport, pathogenesis and response to oxidative stress. Genes related to cytotoxicity were differentially regulated but the gliotoxin biosynthesis genes were down regulated over the time course, while Aspf1 was up-regulated at 9 h and 12 h. There was an up-regulation of genes in the subtelomeric regions of the genome as the interaction progressed. The genes up-regulated by iDC in the presence of A. fumigatus indicated that they were producing a pro-inflammatory response which was consistent with previous transcriptome studies of iDC interacting with A. fumigatus germ tubes. This study shows that A. fumigatus adapts to phagocytosis by iDCs by utilising genes that allow it to survive the interaction rather than just up-regulation of specific virulence genes.
Allogeneic hematopoietic stem cell transplantation (HSCT) is often the only effective treatment for patients with hematological malignancies, but its curative potential is often limited by the development of acute or chronic graft-versus-host disease (GvHD). Although extensive immunosuppressive therapy is highly efficient in the prevention or treatment of GvHD, it greatly increases the risk for life-threatening opportunistic fungal or viral infections and the recurrence of malignant disease. The possibility to selectively deplete alloreactive T cells from donor grafts prior or after transplantation would greatly diminish the need for immunosuppressive therapy in the transplant recipient and thereby greatly improve its clinical outcome. The molecular chaperone heat shock protein of 90 kDa (Hsp90) has been previously shown to stabilize many signal transduction proteins involved in T lymphocyte activation and proliferation and is furthermore able to exert anti-apoptotic effects in different cell types. The aim of this study was therefore to investigate the possibility to selectively target activated, proliferating T cells in lymphocyte populations by inhibition of Hsp90, without compromising viability and function of non-reactive T cell populations including pathogen-specific T lymphocytes. It could be shown in this work, that activated T cells are indeed more prone to apoptotic cell death in the presence of Hsp90 inhibitors than resting cells and that treatment of mixed lymphocyte cultures with such inhibitors eliminates the proliferation of alloreactive cells. In contrast, T cells remaining in a resting state during inhibitor treatment remain viable and also display functional virus-specific responses after inhibitor removal. These data suggest, that Hsp90 could represent a novel target for selective depletion of alloreactive T cells and that application of Hsp90 inhibitors could be a potential approach to prevent or treat GvHD without impairing pathogen-specific T cell immunity. In the second part of this work, the immune responses to strictly defined antigens of the opportunistic pathogenic fungus Aspergillus fumigatus were characterized. Opportunistic fungal infections are highly prevalent in immunocompromized and immunosuppressed individuals, especially in HSCT recipients suffering from GvDH. Although antifungal treatment is permanently improved, invasive fungal infections are still often fatal. In healthy individuals clinical disease is rare, because innate and adaptive immunity act in conjunction to protect the host. Therefore one possible strategy to prevent and treat life-threatening fungal infections in immunocompromized patients is to improve host resistance by augmenting the antifungal functions of the immune system, for example by vaccination or adoptive transfer of antigen-specific T cells. Based on previous findings, the objective of this dissertation was to identify and characterize distinct immunogenic A. fumigatus antigens that could be used for clinical application like vaccination or ex vivo generation of antigen-specific T cells and to characterize the interaction of this antigen-specific lymphocytes with cells of the innate immune system. First, memory T cell responses to different recombinant A. fumigatus proteins in healthy individuals were evaluated. The majority of tested donors displayed stable CD4+ TH1 responses to the Crf1 protein, whereas responses to the other antigens tested could only be detected in a limited number of donors, qualifying Crf1 as potential candidate antigen for clinical use. It was also possible to identify an immunodominant MHC class II DRB1*04-restricted epitope of Crf1 and to generate T cell clones specific for this epitope. This Crf1-specific T cell clones could be specifically activated by dendritic cells fed with synthetic peptide, recombinant protein or germinating A. fumigatus conidia or outgrown hyphae. Interestingly, these A. fumigatus-specific T cell clones also responded to stimulation with Candida albicans, which likewise causes opportunistic infections in immunocompromized patients and encodes for a glucosyltransferase similar to A. fumigatus Crf1. It was also possible to show that supernatant harvested from activated Crf1-specific T cell cultures was able to significantly increase fungal killing by monocytes. These data indicate that the specified FHT epitope of the A. fumigatus protein Crf1 could be potentially used as antigen for vaccination protocols or for the generation of Aspergillus-specific effector T cells for adoptive transfer.
Diverse roles of B cells in the pathophysiology of rheumatoid arthritis are now well established. B cells contribute to autoimmunity by producing autoantibodies, processing autoantigen and the production of different cytokines which are involved in the inflammatory cascade. Therefore approaches to target B lymphocytes directly or indirectly are developed for clinical practice to treat autoimmune diseases including rheumatoid arthritis. Transient B cell depletion by rituximab (anti-CD20 antibody) has gained prime importance in recent years. Meanwhile anti-CD20 mediated transient B cell depletion therapy is now used with clinical efficiency in the treatment of patients with rheumatoid arthritis. Rituximab induces noteworthy changes in the homeostasis of peripheral B cell subpopulations during the repletion phase with emerging immature B cells in peripheral blood followed by normalization of the naïve B cell pool and a longterm delay in memory B cell subsets in patients with rheumatoid arthritis. Particularly IgD+CD27+ memory B cells repopulate very slowly during B cell regeneration. In a prospective clinical study, our laboratory has shown that the overall number of memory B cells correlates well to the duration of clinical response to rituximab. Little is known about the particular molecular changes in the memory B cell repertoire after rituximab therapy. To better understand peripheral memory B cell subsets, we explored in detail the somatic mutational frequency and pattern of Ig-VH3 gene rearrangements by using a single B cell sorting technique followed by nested PCR before and up to 6 years after rituximab therapy in 18 RA patients. We compared rituximab inflicted dynamics of mutational acquisition to memory B cell repopulation in 4 healthy donors and 6 non RA patients undergoing high dose chemotherapy followed by autologous or allogeneic stem cell transplantation (SCT). Firstly we analyzed the peripheral composition of memory B cell subsets. The phenotypic analysis of peripheral pre-switch (IgD+CD27+) and post-switch (IgD-CD27+) memory B cells did not reveal any quantitative differences in RA patients prior to B cell depletion therapy compared to healthy donors. However extending those studies in directly analysing the B cell immunoglobulin receptor from individual B cells of RA patients and healthy controls brought interesting results. Pre-switched and post-switched memory B cells showed a highly significant difference in the amount of mutations/sequence. The population of IgD+CD27+ memory B cells is comprised of non-mutated, low and highly mutated (median= 9 mutations/ sequence) rearranged Ig receptors whereas the IgD-CD27+ memory B cell compartment shows quite uniformly highly mutated (median 18 mutations/ sequence) sequences indicating a significant difference between these two groups (mutational frequencies 3.83±0.19% vs. 7.1±0.53%; P=0.0001). Profound changes were noted in the re-emerging pre-switch memory B cells (IgD+/ CD27+) after transient B cell depletion with rituximab. These cells showed over a time period of 6 years after treatment with rituximab significantly delayed acquisition of mutations in Ig receptors on the single B cell level. One year after a single course of rituximab 84% of single repopulating IgD+/CD27+ B cells were unmutated and no highly mutated Ig-VH gene rearrangements were found(P=0.0001). Over time increasing numbers of mutations could be detected i-e 7.8% during 2nd year of regeneration (P=0.0001), 14% after 4 years (n=2). Nevertheless even 6 years after rituximab, VH mutations in IgD+ memory B cells were still reduced with 27% highly mutated sequences compared to 52% pre therapy(P=0.0001). Post-therapy analysis of CDR3 length of regenerated IgD+ memory B cells revealed increased CDR3 length which also correlates well with elevated number of non-mutated VH gene rearrangements observed during repletion phase. In comparison patients undergoing high dose chemotherapy followed by allogeneic stem cell transplantation repopulated IgD+ memory cells earlier with higher numbers of mutations in IgD+ memory B cells. One year after transplantation Ig receptors showed already 22% highly mutated and 42 % unmutated VH rearrangements. These findings indicated that anti-CD20 mediated B cell depletion seems not only to delay the production of pre-switch memory B cells but also significantly affects the acquisition of mutations in the IgD+ memory B cell pool. In contrary to the mutational pattern of IgD+ memory B cells after rituximab class switched memory B cells repopulate in the periphery with quantitatively normal mutations in their Ig receptors. Although the numeric replenishment of these recirculating class-switched memory B cells was also reduced after rituximab, we found no delay in quantitative acquisition of mutations also an increased proportion of IgA expressing B cells in this memory B cell subset was detected. Our data showed that post-therapy mutational targeting in RGYW/WRCY motifs were significantly increased as compared with that of pre-treatment (27% before rituximab vs. 43% after therapy, P=0.0003) indicating that affinity maturation may operate differently in class-switched memory B cells before and after B cell depletion. These results indicate a normal development process with an unimpaired mechanism of mutational acquisition in class-switched memory B cells. These data argue for different requirements to undergo somatic hypermutations in IgD+ memory B cells in comparison to class switched memory B cells. To conclude, our work has demonstrated for the first time a delayed acquisition of somatic hypermutations at single Ig receptor VH gene rearrangements of IgD+ memory B cells in comparison to class-switched memory B cells. These results demonstrate that IgD+ memory B cells are particularly susceptible to anti-CD20 treatment in patients with rheumatoid arthritis. In addition antigenic pressure and/or selection are substantially reduced by rituximab therapy which is basically not seen in the class-switched memory compartment. These data are in line with the hypothesis that IgD+ memory B cells have distinct requirements for activating their mutational machinery compared to class-switched memory B cells which recover normal mutations during regeneration phase. The results have implications in understanding the pathophysiology of memory B cell in rheumatoid arthritis and may be helpful in designing new targeted therapies.
B cells play diverse roles in the immunopathogensis of autoimmune diseases several approaches targeting B cell directly or indirectly are in clinical practice in the treatment of autoimmunity. In this regard, temporal B cell depletion by rituximab (anti CD20 antibody) is being appreciated and gaining more importance in recent years. To date, little is known about the regeneration profile of B cells following B cell depletion. We wanted to investigate the early replenishing B cells and examine the dynamic changes in the repertoire. we studied the immunoglobulin receptor (IgR) modulation of Ig-VH4 genes as representative of the heavy chain family. Five patients were included in the study and therapy induced alterations were assessed. Three time points namely before therapy, early regeneration phase (ERP- the early time point during regeneration where just above 1% B cells were found in the peripheral lymphocyte pool) and later regeneration phase (LRP- which commenced 2-3 months following ERP) were chosen. In three patients (A-C), Ig-VH4 genes were amplified from total genomic DNA during the above-mentioned all time points and in another two patients (D and E), Ig genes during ERP were studied by single cell amplification technique. Firstly, B cell regeneration followed the characteristic regeneration pattern as reported by several groups, with a predominant circulation of CD38hi expressing plasma cells and immature B cells in the ERP. During LRP, the proportion of these cells reduced relatively and the levels of naïve B cells rose gradually. On a molecular level, Ig-VH4 variable gene usage prior and post B cell depletion was determined and it was noticed that a diverse set of Ig-VH4 genes were employed in the repertoire before and after therapy. Mini gene segments such as VH4-34 and VH-4-39, which were reported to be connected with autoimmunity, were over expressed in the B cell repertoire before therapy. Profound changes were noticed in the early reemerging repertoire with a relatively increased population of intensely mutated B cells. These B cells acquired >=9 mutations in the Ig genes. Immunophenotyping with specific surface markers revealed that these highly mutated B cells evolve from the isotype-switched memory compartment especially the plasma cells. To support the hypothesis that the highly mutated B cells observed during ERP were plasma cells we carried out single cell amplification of individual plasma cells in another two patients during ERP and compared the mutational load, which remained similar. Actually plasma cells do not express CD20 on their surface and are not eliminated by rituximab therapy. However they were not observed in the peripheral blood following B cell depletion. The earliest time point when plasma cells are found again in peripheral circulation is the early recovery period (ERP). Therefore, it was intriguing to ascertain if the plasma cells were also modulated by rituximab therapy although they were not directly targeted by the therapy. We investigated if there is a therapy mediated mutational modulation of the plasma cells though these are not directly targeted by the therapy. We examined the confinement of mutations to the pre-defined RGYW/WRCY hotspot motifs (R=purine, Y=pyrimidine, W=A/T) in the plasma cells, which provides information on the involvement of T cells in B cell somatic hypermutation (SHM). Plasma cells before rituximab manifested the characteristics of active disease, which was revealed by restricted mutational targeting to the RGYW/WRCY motifs. The reemerging plasma cells during ERP had an increased targeting of the RGYW/WRCY motifs which indicated for a more pronounced T cell mediated B cell mutations which is the scenario observed in the healthy subjects. To further support the hypothesis of rituximab-mediated plasma cell modulation, we delineated the replacement to silent mutations ratio (R/S) in the hypervariable regions (CDRs) of the plasma cell Ig sequences. Within our study, the mean R/S ratio in the plasma cell CDRs of the patient group was relatively low (1.87) before rituximab treatment and interestingly this ratio increased significantly in the recirculating plasma cells to values of 2.67 and 3.60 in ERP and LRP status respectively. The increase in R/S ratios in reemerging plasma cells can be interpreted as a shaping of the Ig-repertoire by positive antigen selection as seen in healthy individuals. To conclude, our study demonstrates temporal B cell depletion by rituximab therapy seems to modulate also the plasma cell compartment, which is not directly targeted by the therapy. Modulation of plasma cells in RA could be also used as a potential biomarker in studying the effective response in RA treatment. This needs to be further explored to gain deeper insights into the underlying processes, which may be influenced by future therapies.