Prostaglandin E2 promotes survival of naive UCB T cells via the Wnt/β-catenin pathway and alters immune reconstitution after UCBT

The outcome of umbilical cord blood transplantation (UCBT) is compromised by low hematopoietic stem cell (HSC) doses leading to prolonged time to engraftment, delayed immunological reconstitution and late memory T-cell skewing. Exposure of UCB to dimethyl-prostaglandin E2 (dmPGE2) increases HSC in vivo. We determined that exposure of UCB T lymphocytes to dmPGE2 modified Wnt signaling resulting in T cell factor (TCF)-mediated transcription. Wnt signaling upregulated interleukin (IL)-7R and IL-2Rβ, resulting in enhanced survival mediated by the homeostatic cytokines IL-7 and IL-15. dmPGE2 also induced components of the Wnt pathway and Wnt receptors, thereby priming UCB T cells to receive signals via Wnt ligands in vivo. We observed that the Wnt transcription factor TCF7 and its target EOMES were elevated in the T cells of patients who received PGE2-treated UCBs. Consistent with the role of Wnt/β-catenin signaling to induce and maintain naive, memory precursors and long-lived central memory CD8(+) cells, these patients also had increased fractions of CD8(+)CD45RO(-)CD62L(+) plus CD8(+)CD45RO(+)CD62L(+) subsets encompassing these T-cell populations. These effects of the PGE2/Wnt/β-catenin axis may have significant implications for harnessing immunity in the context of UCBT, where impaired immune reconstitution is associated with late memory T-cell skewing.

Tn and sialyl-Tn antigens, aberrant O-glycomics as human disease markers

In many different human disorders, the cellular glycome is altered. An interesting but poorly understood alteration occurs in the mucin-type O-glycome, in which there is aberrant expression of the truncated O-glycans Tn (GalNAcα1-Ser/Thr) and its sialylated version sialyl-Tn (STn) (Neu5Acα2,6GalNAcα1-Ser/Thr). Both Tn and STn are tumor-associated carbohydrate antigens and tumor biomarkers, since they are not expressed normally and appear early in tumorigenesis. Moreover, their expression is strongly associated with poor prognosis and tumor metastasis. The Tn and STn antigens are also expressed in other human diseases and disorders, such as Tn syndrome and IgA nephropathy. The major pathological mechanism for expression of the Tn and STn antigens is compromised T-synthase activity, resulting from alteration of the X-linked gene that encodes for Cosmc, a molecular chaperone specifically required for the correct folding of T-synthase to form active enzyme. This review will summarize our current understanding of the Tn and STn antigens in terms of their biochemistry and role in pathology.

Measurement of oral chronic GVHD: results from the Chronic GVHD Consortium

Oral chronic GVHD (cGVHD) is a serious complication of alloSCT. Scales and instruments to measure oral cGVHD activity and severity have not been prospectively validated. The objective of this study was to describe the characteristics of oral cGVHD and determine the measures most sensitive to change. Patients enrolled in the cGVHD Consortium with oral involvement were included. Clinicians scored oral changes according to the National Institutes of Health (NIH) criteria, and patients completed symptom and quality-of-life measures at each visit. Both rated change on an eight-point scale. Of the 458 participants, 72% (n=331) had objective oral involvement at enrollment. Lichenoid change was the most common feature (n=293; 89%). At visits where oral change could be assessed, 50% of clinicians and 56% of patients reported improvement, with worsening reported in 4-5% for both the groups (weighted kappa=0.41). Multivariable regression modeling suggested that the measurement changes most predictive of perceived change by clinicians and patients were erythema and lichenoid, NIH severity and symptom scores. Oral cGVHD is common and associated with a range of signs and symptoms. Measurement of erythema and lichenoid changes and symptoms may adequately capture the activity of oral cGVHD in clinical trials but require prospective validation.

DC-SIGN targeting carbohydrate moieties identified on 67 kDa mfa-1 fimbriae of mucosal pathogen Porphyromonas gingivalis (42.7)

We recently reported that the oral mucosal pathogen Porphyromonas gingivalis targets the C- type lectin receptor DC-SIGN for invasion and persistence within human monocyte-derived dendritic cells (DCs). The DCs respond by inducing an immunosuppressive and Th2-biased CD4+ T cell response (Zeituni et al 2009); moreover, DC invasion and immunosuppression are dependent upon expression of the 67 kDa mfa-1 fimbriae by P. gingivalis . We have now purified mfa-1 by ion exchange chromatography and sequenced it by tandem mass spectrometry (MS/MS), confirming its identify and revealing two putative N-glycosylation motifs as well as numerous O-glycosylation motifs. We further show mfa-1 is glycosylated by ProQ staining. Further monosaccharide analysis by gas chromatography-mass spectrometry (GC-MS) confirmed that mfa-1 contains fucose (1.35 nmol/mg) mannose (2.68 nmol/mg), N-acetylglucosamine (2.27 nmol/mg) and N-acetylgalactosamine (0.652 nmol/mg). Analysis by transmission electron microscopy reveals mfa-1 form oligomeric strains approximately 200 nm in length, which could be involved in targeting/ cross-linking DC-SIGN. These findings shed further light on mechanisms of invasion and immunosuppression by this unique mucosal pathogen.

Blood dendritic cells in cardiovascular disease risk (44.13)

An estimated 80 million U.S. adults have one or more types of cardiovascular diseases (CVD) with the total cost to the U.S. for 2009 estimated to be $475.3 billion. Atherosclerosis (ATH) is the single most important contributor to CVD; however, only 50% of ATH patients have currently identified risk factors. Chronic periodontitis (CP), a common inflammatory disease, is linked to an increased CVD risk. Dendritic cells (DCs) which infiltrate arterial walls and destabilize atherosclerotic plaques, have been implicated in CVD. While the source of atherogenic DCs is presently unclear, we propose that dermal DCs from peripheral inflamed sites, such as CP tissues are a source. We therefore designed a clinical study to elicit, quantitate and isolate DCs in the peripheral blood of otherwise healthy CP patients. Ten patients with CP were consented according to IRB standards and enrolled in the study. Peripheral blood collected at baseline and 24 hrs after mechanical debridement (MD) was used to identify and sort blood DCs. After PBMC separation, DCs were labeled with DC-SIGN-APC and BDCA-1-PE and quantitated by FACS analysis. We found that after MD there was a 5-6% increase in the numbers of blood DCs in this patient population. This increase in the blood may represent mobilization of DCs from bone marrow stores, as well as from CP tissues. We are presently analyzing the DC transcriptome of sorted DCs to identify markers of atherogenesis.

Radiometal complexes: characterization and relevant in vitro studies

Radiometals are, and will continue to be, very important to diagnostic and therapeutic nuclear medicine applications as they predominantly possess the most suitable nuclear properties for these types of applications. This article attempts to give the reader an overview of key aspects that need to be considered in the design and synthesis of a radiopharmaceutical using the commonly known and employed radionuclides, such as technetium, rhenium, the lanthanides and copper. While it is important to understand each radiometal ion has its own specific coordination chemistry requirements, there are several issues that are critical to all radiometal ions for their incorporation into a radiopharmaceutical. 1) The route of production and the presence of long lived contaminating radionuclides and or of naturally occurring metal ions that will interfere with the efficient and optimum radiolabelling of their ligand of choice as well as the final specific activity of the product; 2) the significant differences between the chemistry at the macroscopic (mM and higher concentrations) and radiotracer levels (uM and lower concentrations for the high specific activity radionuclides); 3) the rate of complexation and of dissociation of the radiometal ion vs the competing reaction of radiometal hydrolysis; 4) natural biological pathway of the radio-metal ion and therefore the design of the appropriate and relevant in vitro tests to assess the stability of the radiometal complex. These are a selection of critical factors that need to be considered in the design of a successful radiopharmaceutical, whether it is used for imaging or therapy. However, one should consider tailoring their investigations to suit the radiometal under investigation, and to be mindful where the technology is to be applied (e.g. imaging organs or disease).

Preinfusion variables predict the predominant unit in the setting of reduced-intensity double cord blood transplantation

Double cord blood transplantation (DCBT) may overcome the slow hematopoietic recovery and engraftment failure associated with infusion of a single cord blood unit. In DCBT, only one unit typically contributes to long-term hematopoiesis, but little is known about factors affecting cord predominance. As results from a phase I trial suggested that order of infusion may affect cord predominance, we analyzed the effect of preinfusion variables on chimerism patterns of 38 patients enrolled in the initial study and a subsequent phase II trial. All patients were treated with a reduced-intensity conditioning (RIC) regimen of fludarabine, melphalan and thymoglobulin followed by DCBT. By day 100, 66% of patients had hematopoiesis derived from a single cord blood unit. Higher post-thaw total nucleated cell and CD34+ cell dose were associated with cord predominance and in 68% of patients (P=0.03); the predominant cord blood unit was infused first. Only the post-thaw CD34+ cell dose of the predominant unit predicted time to both neutrophil and platelet engraftment. Although based on a small number of patients, our results identify parameters that may affect cord predominance and engraftment in the setting of DCBT following RIC and suggest possible strategies for selecting infusion order for cord blood units.