Simone M. Cross

A case report: Immune responses and clinical course of the first human use of granulocyte/macrophage-colony-stimulating-factor-transduced autologous melanoma cells for immunotherapy

Abstract The first use of granulocyte/macrophage-colony-stimulating-factor-transduced, lethally irradiated, autologous melanoma cells as a therapeutic vaccine in a patient with rapidly progressive, widely disseminated malignant melanoma resulted in the generation of a novel antitumour immune response associated with partial, albeit temporary, clinical benefit. An initially negative reaction to non-transduced, autologous melanoma cells was converted to a delayed-type hypersensitivity (DTH) reaction of increasing magnitude following successive vaccinations. While intradermal vaccine sites showed prominent dendritic cell accrual, DTH sites revealed a striking influx of eosinophils in addition to activated/memory T lymphocytes and macrophages, recalling the histology of challenge tumour cell rejection in immune mice. Cytotoxic T lymphocytes (CTL) reactive with autologous melanoma cells were detectable at high frequency after vaccination, not only in limiting-dilution analysis, but also in bulk culture without added cytokines. Clonal analysis of CTL showed a conversion from a purely CD8+ response to a high proportion of CD4+ clones following vaccination. A prominent acute-phase response manifested by a five- to tenfold increase in C-reactive protein was observed, as was a systemic eosinophilia. Vaccination resulted in the regression of axillary lymphatic metastases, stabilisation of pulmonary metastases, and a dramatic, reversible increase in cerebral oedema associated with multiple central nervous system metastases; however, lesions in the adrenal glands, pancreas and spleen proved refractory. The antitumour effects and immune response were not detectable 2 months following the last vaccination. Irradiation of the extensive cerebral metastases resulted in rapid deterioration and death of the patient.

A functional link for major TCR expansions in healthy adults caused by persistent Epstein-Barr virus infection.

Dramatic clonal expansions of unknown functional significance have been documented in the T cell receptor (TCR) alpha beta peripheral blood repertoires of apparently healthy adults. In this study, we provide evidence that persistent infection with the ubiquitous Epstein-Barr virus (EBV) causes major distortions within the memory repertoire of healthy virus carriers. Using complementarity determining region 3 (CDR3) length analysis to measure repertoire diversity, dominant expansions that dramatically skewed the entire TCRBV6 blood repertoire towards oligoclonality were enriched in the CD8(+)CD45RO+CD45RA- subset of HLA B8(+) healthy virus carriers. Evidence of phenotypic heterogeneity between individuals was also observed for these expansions based on their variable coexpression of CD45RO and CD45RA. TCR junctional region sequencing revealed that these expansions were clonal and that they represented commonly selected HLA B8-restricted memory cytotoxic T cells that recognize the immunodominant latent EBV epitope, FLRGRAYGL. Furthermore, the functional identity of these virus-specific CD8(+) T cells was confirmed by their FLRGRAYGL-specific cytotoxicity. Therefore, the functional significance of dramatic clonal expansions in healthy adults can be linked in some cases to virus-specific CD8(+) T cells that play an essential role in immunosurveillance. This first identified link for expansions in the circulation of healthy adults strongly implies that restricted-memory TCR responses to environmental antigens play a pivotal role in expansion development, which should have an important impact on studies interpreting TCR expansion patterns in health and disease.

An Arthrogenic Alphavirus Induces Monocyte Chemoattractant Protein-1 and Interleukin-8

Cytokines and chemokines play important roles in both autoimmune and infectious arthritides. Here we describe the cytokines and chemokines induced by Ross River (RR) virus infection of synovial fibroblasts and macrophages in vitro. RR virus is the aetiological agent of epidemic polyarthritis (EPA), a principally acute and chronic rheumatic disease affecting up to 7,000 Australians annually. Infected fibroblasts increased expression of mRNA coding for monocyte chemoattractant protein-1 (MCP-1), interleukin-8 (IL-8), and granulocyte-macrophage colony-stimulating factor. MCP-1, IL-8, macrophage inflammatory protein-2, and to a lesser extent interferon γ-induced protein-10 mRNA were upregulated in infected macrophages. Expression of MCP-1 is consistent with the predominantly monocytic effusion found in EPA synovia.

Dominant Cytotoxic T Lymphocyte Response to the Immediate-Early Trans-Activator Protein, BZLF1, in Persistent Type A or B Epstein-Barr Virus Infection

Five healthy human leukocyte antigen-B8 (HLA-B8)-positive virus carriers were studied to investigate the CD8+ cytotoxic T lymphocyte (CTL) response to an HLA-B8-restricted peptide, RAKFKQLLQ, located in the Epstein-Barr virus (EBV) immediate-early trans-activator protein, BZLF1. Of the 5 virus carriers, 4 were infected with type A and 1 with type B EBV. Using limiting-dilution analysis of peripheral blood mononuclear cells, a high RAKFKQLLQ-specific CTL precursor frequency was demonstrated after specific peptide or autologous lymphoblastoid cell line stimulation in both type A and type B EBV carriers. The RAKFKQLLQ-specific CTL precursor frequencies in all 5 persons were at least as dominant as those observed with two other EBV-associated, HLA-B8-restricted latent epitopes, FLRGRAYGL and QAKWRLQTL. These findings show that healthy virus carriers maintain a high frequency of BZLF1-specific memory T cells, potentially to control virus spread from lytically infected cells.

A-type and B-type Epstein-Barr virus differ in their ability to spontaneously enter the lytic cycle

In this study replication of A-type and B-type Epstein-Barr virus (EBV) strains has been assessed. A-type and B-type type lymphoblastoid cell lines (LCLs) were established by infecting B lymphocytes, isolated from five EBV-seropositive donors, with different A-type and B-type virus isolates. The presence of viral capsid antigens (VCA) in these LCLs was determined by immunofluoresence assay and by immunoblotting. All of the B-type EBV strains were capable of spontaneously generating virus regardless of the origin of the donor cells. In contrast the A-type strains, other than strain IARC-BL36, did not readily produce VCA in any of the different donor lymphocytes used. This study demonstrates another biological difference between the two virus types: their ability to spontaneously enter the lytic cycle.

Optimization of LMP-specific CTL expansion for potential adoptive immunotherapy in NPC patients

Nasopharyngeal carcinoma (NPC) is Epstein–Barr virus (EBV) positive in all undifferentiated cases, expressing the latency II phenotype of latent membrane proteins (LMPs) 1 and 2, in addition to EBV nuclear antigen (EBNA) 1. Several studies have attempted to treat NPC with EBV‐specific cytotoxic T lymphocyte (CTL) with a partial response. To improve this therapy, there is a need to expand CTL targeted to the latency II antigens of EBV, rather than the immunodominant EBV nuclear antigens 3–6 peptides typically expanded by lymphoblastoid cells. In order to maximize the expansion of LMP‐specific CTL in vitro for use in adoptive immunotherapy of nasopharyngeal carcinoma patients, we used lymphoblastoid cell lines coated with synthetic peptides corresponding to CTL determinants from the LMP proteins. We investigated several issues pertaining to the expansion of an immunologically weak CTL response, including peptide and interleukin‐2 concentration, and screening assays for selecting the optimal peptide for use in expansion of LMP‐specific CTL. Although screening of ex vivo peripheral blood mononuclear cells did not prove to be useful in the selection of an LMP peptide for use in CTL cultures, the peptide and interleukin‐2 concentrations were critical for the maximum expansion of CTL. Therefore, it is imperative that stimulation protocols are optimized for the expansion of LMP‐specific CTL.

Cohort Profile: Nausea and vomiting during pregnancy genetics consortium (NVP Genetics Consortium)

Nausea and vomiting during pregnancy (NVP), commonly known as morning sickness, is very common and is typically self-limiting. However, more severe forms and the development of hyperemesis gravidarum (HG), defined as persistent and excessive vomiting, with dehydration, ketonuria and >5% bodyweight loss,1 may lead to health consequences for the mother and the offspring exposed in utero. Despite efforts towards understanding the causes of NVP and HG, they are not well established. The NVP Genetics Consortium is an open collaborative network of researchers integrating data on NVP of women who have been pregnant at least once, with the goal of investigating NVP, NVP severity and HG. Currently, the NVP Genetics Consortium brings together data from Australia, Finland, Spain, the UK and Denmark. The Consortium is actively recruiting new members...