Peter J. Wettstein

Biologic properties and enucleation of red blood cells from human embryonic stem cells

Human erythropoiesis is a complex multistep process that involves the differentiation of early erythroid progenitors to mature erythrocytes. Here we show that it is feasible to differentiate and mature human embryonic stem cells (hESCs) into functional oxygen-carrying erythrocytes on a large scale (10(10)-10(11) cells/6-well plate hESCs). We also show for the first time that the oxygen equilibrium curves of the hESC-derived cells are comparable with normal red blood cells and respond to changes in pH and 2,3-diphosphoglyerate. Although these cells mainly expressed fetal and embryonic globins, they also possessed the capacity to express the adult beta-globin chain on further maturation in vitro. Polymerase chain reaction and globin chain specific immunofluorescent analysis showed that the cells increased expression of beta-globin (from 0% to > 16%) after in vitro culture. Importantly, the cells underwent multiple maturation events, including a progressive decrease in size, increase in glycophorin A expression, and chromatin and nuclear condensation. This process resulted in extrusion of the pycnotic nuclei in up to more than 60% of the cells generating red blood cells with a diameter of approximately 6 to 8 mum. The results show that it is feasible to differentiate and mature hESCs into functional oxygen-carrying erythrocytes on a large scale.

Does HLA-Dependent Chimerism Underlie the Pathogenesis of Juvenile Dermatomyositis?

Juvenile dermatomyositis (JDM) is a multisystem autoimmune disease that at times resembles chronic graft-vs-host disease. This led us to suggest that nonself cells may play a role in the disease process. In this study we examined the relationship between HLA genotype and the presence of maternally derived chimeric cells in JDM patients and healthy controls, and assessed immunologic activity in the chimeric cells. We identified chimeric cells more often in children with JDM (60 of 72) than in their unaffected siblings (11 of 48) or in healthy controls (5 of 29). The presence of chimerism in the JDM patients, their healthy siblings, and unaffected control children was associated with a HLA-DQA1*0501 allele in the mother (p = 0.011). Further, we show that maternally transferred chimeric T cells are responsive to the host’s (JDM childs’) lymphocytes (33.75 ± 8.4 IFN-γ-producing cells from JDM cells vs 5.0 ± 1.25 from maternal cells), and that this is a memory response. These combined data indicate that chimeric cells play a direct role in the JDM disease process and that the mother’s HLA genotype facilitates the transfer and/or persistence of maternal cells in the fetal circulation.

Inhibition of adenine nucleotide translocator pore function and protection against apoptosis in vivo by an HIV protease inhibitor

Inhibitors of HIV protease have been shown to have antiapoptotic effects in vitro, yet whether these effects are seen in vivo remains controversial. In this study, we have evaluated the impact of the HIV protease inhibitor (PI) nelfinavir, boosted with ritonavir, in models of nonviral disease associated with excessive apoptosis. In mice with Fas-induced fatal hepatitis, Staphylococcal enterotoxin B-induced shock, and middle cerebral artery occlusion-induced stroke, we demonstrate that PIs significantly reduce apoptosis and improve histology, function, and/or behavioral recovery in each of these models. Further, we demonstrate that both in vitro and in vivo, PIs block apoptosis through the preservation of mitochondrial integrity and that in vitro PIs act to prevent pore function of the adenine nucleotide translocator (ANT) subunit of the mitochondrial permeability transition pore complex.

Concentration and separation of hypoglycemic drugs using solid-phase extraction-capillary electrophoresis

Solid-phase extraction-capillary electrophoresis (SPE-CE) is a technique whereby very dilute analytes may be selectively extracted from a sample matrix and concentrated on-line for analysis. This study describes the first phase in the development of a method exploiting this technique for the direct analysis of hypoglycemic drugs in urine. Effective separation and detection of six sulfonylurea drug standards at concentrations below the detection limit of conventional capillary electrophoretic techniques is shown to be attainable. Since surfactant interfered with the on-line concentration process, non-MEKC (micellar electrokinetic chromatography) separation conditions were defined. Using 250 mM borate/5 mM phosphate at pH 8.4, all drugs in a mixture at 285 ng/ml were effectively extracted, concentrated from an injected volume of 2.5 microliters, non-selectively desorbed with an organic-based elution buffer and electrophoretically resolved. Sample loading was found to be linear in the 0.12-1.9 microliters range and drugs in a volume of up to 190 microliters could be concentrated and detected with a sensitivity of approximately 5 ng/ml. Not only was resolution of the desorbed material uncompromised by the presence of the SPE-tip, but separation of glipizide and glyburide was observed despite the fact that these drugs were unresolved under the same separation conditions by standard capillary zone electrophoresis (CZE). From these results, it is clear that SPE-CE not only increases the sensitivity for detection but that selectivity may be altered due to chromatographic processes occurring on the solid-phase resin.

TAP-Independent Presentation of CTL Epitopes by Trojan Antigens

The majority of CTL epitopes are derived from intracellular proteins that are degraded in the cytoplasm by proteasomes into peptides that are transported into the endoplasmic reticulum by the TAP complex. These peptides can be further processed into the optimal size (8–10 residues) for binding with nascent MHC class I molecules, generating complexes that are exported to the cell surface. Proteins or peptides containing CTL epitopes can be introduced into the cytoplasm of APCs by linking them to membrane-translocating Trojan carriers allowing their incorporation into the MHC class I Ag-processing pathway. The present findings suggest that these “Trojan” Ags can be transported into the endoplasmic reticulum in a TAP-independent way where they are processed and trimmed into CTL epitopes. Furthermore, processing of Trojan Ags can also occur in the trans-Golgi compartment, with the participation of the endopeptidase furin and possibly with the additional participation of a carboxypeptidase. We believe that these findings will be of value for the design of CTL-inducing vaccines for the treatment or prevention of infectious and malignant diseases.

Immunodominance in the immune response to “multiple” histocompatibility antigens

Cytotoxic effector T cells putatively specific for multiple non-H-2 histocompatibility (H) antigens were generated by immunizing and boosting C57BL/6 and B6.C-H-2dmice with BALB.B and BALB/c stimulator cells, respectively. The generated effectors were tested for cell-mediated lympholysis on a panel of targets whose BALB/c-derived non-H-2 H antigens were donated by CXB recombinant inbred mice. The spectrum of reactivity of cytotoxic effector T cells with CXB targets demonstrated that the effectors did not recognize multiple H antigens but rather preferentially recognized a single immunodominant non-H-2 H antigen. The identity of the immunodominant H antigen was determined by the H-2 genotype of the stimulator cells when (B6 × B6.C-H-2d)F1 cytotoxic effectors were tested. These observations indicate that despite the fact that responders were challenged with more than 40 individual non-H-2 H antigens, they preferentially responded to a single immunodominant antigen.

Idiotype-pulsed antigen presenting cells following autologous transplantation for multiple myeloma may be associated with prolonged survival

Vaccines are attractive as consolidation therapy after autologous stem cell transplantation (ASCT) for multiple myeloma (MM). We report the results of a phase II trial of the immunotherapeutic, APC8020 (Mylovenge™), given after ASCT for MM. We compared the results with that of other patients with MM who underwent ASCT at Mayo Clinic during the same time period. Twenty‐seven patients were enrolled on the trial between July, 1998 and June, 2001, and the outcomes were compared to that of 124 consecutive patients transplanted during the same period, but not enrolled on the trial. The median (range) follow‐up for patients still alive from the vaccine trial is 6.5 (2.9–8 years), and 7.1 (6–8 years) in the control group. The median age was 57.4 range (36.1–71.3) in the DB group and 56.4 (range, 30–69) in the trial group. Known prognostic factors including PCLI, B2M, and CRP were comparable between the groups. The median overall survival for the trial patients was 5.3 years (95% CI: 4.0 years—N/A) compared to 3.4 years (95% CI: 2.7–4.6 years) for the DB group (P = 0.02). The median time to progression and progression‐free survival for the trial group was similar to the DB group. Although not a controlled trial, the vaccines given after ASCT appear to be associated with improved overall survival compared to historical controls. This approach warrants further investigation to confirm this and define the role of vaccine therapy in myeloma. Am. J. Hematol. 2009.

T cell subsets involved in lethal graft-versus-host disease directed to immunodominant minor histocompatibility antigens

T cell responses to multiple minor histocompatibility antigens are governed by the complex phenomenon of immunodominance, as demonstrated clearly in the generation of CTL in the C57BL/6By (B6) anti-BALB.B strain combination. Immunodominance has also been found in lethal graft-versus-host disease (GVHD) responses directed to BALB.B minor histocompatibility antigens, after transplantation of B6 T cells and T cell-depleted bone marrow to irradiated (825 cGy) recipients of either the BALB.B or CXB recombinant inbred strains. However, previous results indicated that the hierarchy of immunodominance in GVHD differed from that predicted from the in vitro CTL studies. Lethal GVHD was observed in BALB.B, CXBE, CXBI, and CXBJ recipients, but not in CXBG and CXBK recipients, the latter 2 strains expressing immunodominant antigens for CTL generation. A major hypothesis to account for these discordant observations is that GVHD reflected the activity of CD4+, but not CD8+, T cell subsets, in contrast to only the in vitro cytolytic potential of CD8+ T cells. Therefore, the current study was undertaken to assess the GVHD potential of both T cell subsets in the B6-->BALB.B, CXBE, CXBI, and CXBJ strain combinations and to analyze the early GVHD responses in the B6-->CXBG and CXBK strains. The results indicate that lethal GVHD responses in the B6-->BALB.B combination can be mediated by either CD4+ T cells or CD4-dependent CD8+ T cells; a similar observation was made with the B6-->CXBI strain combination. Lethal GVHD in the B6-->CXBE strain combination is mediated only by CD4-dependent CD8+ T cells, whereas GVHD in the B6-->CXBJ combination involves either CD4+ T cells alone or CD4-independent CD8+ T cells. In the B6-->CXBG and CXBK recipients, which do not develop lethal GVHD, the early phases of a GVHD response was detected with involvement of both CD4+ and CD8+ T cells. These results indicate that CD8+ T cells are active at some level in all of the strain combinations tested, that CD4+ T cells do not account for the GVHD immunodominant response in the CXBE recipients, and that the failure to obtain extensive clinical disease in the CXBG and CXBK strains is not due to a lack of a graft-versus-host response.

Aerosolized granulocyte macrophage colony-stimulating factor (GM-CSF) therapy in metastatic cancer

A recent phase I study of aerosolized granulocyte macrophage colony-stimulating factor (GM-CSF) in patients with malignant metastases to the lungs demonstrated excellent tolerance and possible efficacy. This therapy was offered to other patients who refused “standard” treatment or when no effective therapy was available. Forty-five patients were treated; 40 had pulmonary metastases. Aerosolized GM-CSF (250 &mgr;g/dose) was administered twice a day using a 1 week on, 1 week off schedule. The mean interval between diagnosis and therapy was 32 months. Twenty-four patients had disease stabilization or partial regression. The mean duration of benefit was 10 months. This benefit was noted in 8 of 13 with a sarcoma, 6 of 14 with melanoma, and 5 of 12 with renal cell carcinoma. Eighteen patients reported mostly self-limiting toxicities. The frequency of certain melanoma-specific T lymphocytes in 1 patient with stable disease was found to have increased 10-fold after therapy. Aerosolized GM-CSF appears to have limited but promising efficacy in treatment of pulmonary metastatic disease. In one patient, we have evidence of upregulation of melanoma-specific cytotoxic T-cells. Further study is warranted to understand the impact of this therapy on the natural history of metastatic cancer.

Immunodominance in the T-cell response to multiple non-H-2 histocompatibility antigens

Immunization of C57BL/6 mice with BALB.B spleen cells in vivo and subsequent boosting in mixed lymphocyte culture result in the generation of cytolytic T lymphocytes (CTLs) which are specific for a limited number of immunodominant antigens. Experiments are described which suggest the existence of a hierarchy of immunodominance in this donor: host combination. Two antigens, CTT-1.3 and CTT-2.3, are dominant in the C57BL/6 anti-BALB.B CTL response. The distribution of these antigens among CXB recombinant inbred (RI) strains suggests that they segregate as single gene traits. Elimination of the CTT-1.3 and CTT-2.3 antigens by complementation in the responder, or elimination from the priming and boosting stages by the selection.of CXB RI strain mice as responders or stimulators, reveals a second level of immunodominant antigens which include CTT-3.3 and CTT-4.3. CXB mice which express one of the CTT-1.3 or CTT-2.3 antigens will produce CTLs specific for the other antigen upon priming and boosting with BALB.B cells. Expression of both antigens in responders results in the generation of CTLs specific for the second level, dominant antigens. Immunodominance is not confined to the C57BL/6 anti-BALB.B system but can also be observed in the BALB.B anti-C57BL/6 and B10.D2 anti-DBA/2 systems. Finally, generation of CTLs following priming and boosting with dominant and dominated antigens presented on different cells confirmed that immunodominance can only be observed when the dominant and dominated antigens are presented on the same cells. These observations suggest that immunodominance is revealed at the level of antigen-presenting cells primarily involved in vivo priming.