Transmembrane TNF-TNFR2 signaling as a critical immunoregulatory node in pancreatic cancer

Pancreatic cancer is characterized by extreme therapeutic resistance. In pancreatic cancers harboring high-risk genomes, we describe that cancer cell-neutrophil signaling circuitry provokes neutrophil-derived transmembrane (tm)TNF-TNFR2 interactions that dictate inflammatory polarization in cancer-associated fibroblasts and T-cell dysfunction - two hallmarks of therapeutic resistance. Targeting tmTNF-TNFR2 signaling may sensitize pancreatic cancer to chemo±immunotherapy.

Abstract B77: TNFR2 blockade alone or in combination with PD-1 blockade shows therapeutic efficacy in murine cancer models

Tumor necrosis factor receptor 2 (TNFR2) is central to immune balance control in humans and mice. We created human-directed anti-TNFR2 antibodies as a therapeutic approach in cancer, with positive findings (Torrey H, et al. Sci Signal 2017). We have also identified a murine-directed surrogate antagonistic antibody to TNFR2. This antibody shares traits identified in our human-directed antibodies as critical to limiting regulatory T cell (Treg) expansion and activating T effector (Teff) cells. We now present data on this surrogate anti-TNFR2 antibody in two syngeneic mouse models of colon cancer. To study the therapeutic effects of solo and combined immunotherapy using the murine-directed anti-TNFR2 antibody, we used CT26 and MC38 colon tumor models to compare: (i) the murine-directed surrogate anti-TNFR2 antibody therapy, (ii) a commercially available anti-PD1 therapy, and (iii) anti-TNFR2/anti-PD1 combination immunotherapy. Mice were dosed bi-weekly (100ug/mouse antibody). Antigen-specific CD8 and Treg infiltrates were also studied. Mice were tested and monitored for tumor growth by either Champions Oncology (Hackensack, NJ) or a third-party pharmaceutical company in accordance with their respective animal welfare guidelines. In the CT26 model, anti-TNFR2 antagonism alone or cotreatment with anti-PD1 and anti-TNFR2 was highly efficacious (55-62% of mice cured). Anti-PD1 alone was less efficacious (25% cured). In the MC38 model, therapy with anti-TNFR2 alone showed some efficacy (20% cured), anti-PD1 alone had the least efficacy (10% cured), and anti-PD1 in combination with anti-TNFR2 yielded the best overall survival (70% cured). Sequential antibody dosing with anti-PD1 followed by anti-TNFR2 showed no synergy. In contrast, sequential treatment with anti-TNFR2 first followed by anti-PD1, or the combination of anti-TNFR2 plus anti-PD1, showed synergy and highest efficacy. Anti-TNFR2 therapy was distinct from anti-PD1 in showing pronounced Treg depletion and enhanced Teff infiltration in the tumor microenvironment, demonstrating in vivo specificity for disease-causing cells only in the tumor. Anti-TNFR2 immunotherapy provides benefits in two colon cancer models, both as a single agent and when administered in combination with anti-PD1. Anti-PD1 before anti-TNFR2 was associated with poor outcomes for survival, histology, and lack of long-term cure, suggesting that nonspecific unleashing of the immune system with anti-PD1 destroys the tumor microenvironment specificity of anti-TNFR2. These results highlight the value of anti-TNFR2 antagonism in vivo in mouse tumor models as solo therapy or as a combination therapy, administered first or concurrently with anti-PD1. This study of new immunotherapy combinations highlights the need to test both single-agent therapy and sequential combination therapy as new agents are brought forward to the clinic.

Citation Format: Russell LaMontagne, Katie Case, Lisa Tran, Hui Zheng, Michael Yang, Denise Faustman. TNFR2 blockade alone or in combination with PD-1 blockade shows therapeutic efficacy in murine cancer models [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2019 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Immunol Res 2020;8(3 Suppl):Abstract nr B77.

MON-179 Repeat BCG Vaccination Creates Lasting HbA1c Reductions in Adult Subjects with Longstanding Type 1 Diabetes by Correcting Immune-Metabolic Defects

The move to cleaner and more urban environments is speculated to be involved in not just how type 1 diabetes develops, but also in the increased incidence of many immune diseases. The bacillus Calmette-Guérin (BCG) vaccine, originally developed to prevent tuberculosis and recently shown to reduce blood sugar levels in humans with advanced type 1 diabetes, may safely mimic the microbial exposures modern societies have lost. We investigated how the BCG vaccine impacts the immune system and lowers blood sugars by analyzing data from 282 adult human research participants from in vivo clinical trial studies (n=52) and in vitro mechanistic studies (n=230). Of these subjects, 211 had type 1 diabetes and 71 were non-diabetic controls. Participants with type 1 diabetes were followed for 8 years (Phase I trial subjects) or up to 5 years (additional subjects) after receiving BCG vaccinations, and all had disease >10 years duration without complications at enrollment. Mechanistic studies of RNAseq, metabolomics and epigenetics were performed in parallel to the clinical trial to track the systemic and mechanistic effects of BCG vaccinations. Subjects with type 1 diabetes had cellular metabolism consistent with fewer microbial exposures, resulting in white blood cells that use minimal blood sugar compared to non-diabetic control subjects. BCG led to a systemic shift in glucose metabolism from oxidative phosphorylation to aerobic glycolysis, which corrected metabolism to normal within the lymphoid compartment. Exposing the patients to microbes through the BCG vaccine exerted major epigenetic effects on the immune system related to Treg tolerance and resulted in white blood cells using more blood sugar by increasing aerobic glycolysis. Starting after Year 03 follow up, only BCG vaccinated subjects had lowered HbA1c for >1 year (p=0.02) and BCG lowering of blood sugar was maintained for 5 continuous years (p=0.0002). BCG-treated subjects had no post-enrollment change in insulin pump use, none utilized a CGM device, and insulin usage was reduced. We conclude that microbial exposure through BCG vaccination appears to result in white blood cells using more serum sugar by increasing aerobic glycolysis, a process of high cellular glucose utilization. After an onset delay, repeat BCG vaccination was associated with stable, long-term lowering of HbA1c in type 1 diabetes for > 5 years without hypoglycemia. These findings support the hygiene hypothesis, which suggests that early life exposure to microbes is actually beneficial to the development of the immune system and is an important determinant of sensitivity to autoimmune diseases such as type 1 diabetes. The discovery that individuals with type 1 diabetes have too little lymphoid sugar utilization sets the stage for more clinical trials using the BCG vaccine, even in advanced type 1 diabetes, to stably and safely lower blood sugars.

Abstract A50: Direct oncogene cancer killing and selective tumor Treg killing through the TNFR2 receptor via dominant antibody antagonists

A major barrier to cancer immunotherapy is lack of selective inhibitors of the regulatory T cells (Tregs) of the cancer microenvironment and methods to directly kill tumors through novel surface oncogenes. Tumor necrosis factor receptor 2 (TNFR2) is a target protein with restricted expression on the most potent Tregs of the tumor infiltrate and on human tumors as a newly discovered human oncogene. We characterized the effect of TNFR2 antibody antagonists via TNFR2 in human samples from ovarian ascites compared to healthy controls. TNFR2 antagonists potently inhibited Treg proliferation with exponential potency and selectivity for the tumor microenvironment Tregs. Furthermore, common ovarian cancer cell lines such as OVCAR3 expressed the TNFR2 oncogene and were rapidly and completely killed by TNFR2 antagonistic antibodies. Dominant TNFR2 antagonists demonstrate tumor-specific Treg depletion. Blocking TNFR2 signaling with antagonist antibodies also creates a novel tool to possibly eliminate tumors expressing the TNFR2 oncogene and to more potently suppress Tregs of the tumor environment.

Citation Format: Heather Torrey, John Butterworth, Toshi Mera, Yoshiaki Okubo, Limei Wang, Danielle Baum, Sarah Warden, Sara Plager, Daniel Huang, Eva Vanamee, Rosemary Foster, Denise Faustman. Direct oncogene cancer killing and selective tumor Treg killing through the TNFR2 receptor via dominant antibody antagonists. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2016 Oct 20-23; Boston, MA. Philadelphia (PA): AACR; Cancer Immunol Res 2017;5(3 Suppl):Abstract nr A50.

TNF receptor 2 pathway: drug target for autoimmune diseases

Although drug development has advanced for autoimmune diseases, many current therapies are hampered by adverse effects and the frequent destruction or inactivation of healthy cells in addition to pathological cells. Targeted autoimmune therapies capable of eradicating the rare autoreactive immune cells that are responsible for the attack on the body's own cells are yet to be identified. This Review presents a new emerging approach aimed at selectively destroying autoreactive immune cells by specific activation of tumour necrosis factor receptor 2 (TNFR2), which is found on autoreactive and normal T lymphocytes, with the potential of avoiding or reducing the toxicity observed with existing therapies.

Characterization of mouse spleen cells by subtractive proteomics

Major analytical challenges encountered by shotgun proteome analysis include both the diversity and dynamic range of protein expression. Often new instrumentation can provide breakthroughs in areas where other analytical improvements have not been successful. In the current study, we utilized new instrumentation (LTQ FT) to characterize complex protein samples by shotgun proteomics. Proteomic analyses were performed on murine spleen tissue separated by magnetic beads into distinct CD45- and CD45+ cell populations. Using shotgun protein analysis we identified approximately 2,000 proteins per cell group by over 12,000 peptides with mass deviations of less than 4.5 ppm. Datasets obtained by LTQ FT analysis provided a significant increase in the number of proteins identified and greater confidence in those identifications and improved reproducibility in replicate analyses. Because CD45- and not CD45+ cells are able to regenerate functional pancreatic islet cells in a mouse model of type I diabetes, protein expression was further compared by a subtractive proteomic approach in search of an exclusive protein expression profile in CD45- cells. Characterization of the proteins exclusively identified in CD45- cells was performed using gene ontology terms via the Javascript GoMiner. The CD45- cell subset readily revealed proteins involved in development, suggesting the persistence of a fetal stem cell in an adult animal.

Bayesian analysis of case control polygenic etiology studies with missing data

Many genetic studies are based on analysing multiple DNA regions of cases and controls. Usually each is tested separately for association with disease. However, some diseases may require interacting polymorphisms at several regions, and most disease susceptibility is polygenic. In this paper, we develop new methods for determining combinations of polymorphisms that affect the risk of disease. For example, two different genes might produce normal proteins, but these proteins improperly function when they occur together. We consider a Bayesian approach to analyse studies where DNA data from cases and controls have been analysed for polymorphisms at multiple regions and a polygenic etiology is suspected. The method of Gibbs sampling is used to incorporate data from individuals who have not had every region analysed at the DNA sequence or amino acid level. The Gibbs sampling algorithm alternatively generates a sample from the posterior distribution of the sequence of combinations of polymorphisms in cases and controls and then uses this sample to impute the data that are missing. After convergence the algorithm is used to generate a sample from the posterior distribution for the probability of each combination in order to identify groups of polymorphisms that best discriminate cases from controls. We apply the methods to a genetic study of type I diabetes. The protein encoded by the TAP2 gene is important in T cell function, and thus may affect the development of autoimmune diseases such as insulin dependent diabetes mellitus (IDDM). We determine pairs of polymorphisms of genetic fragments in the coding regions of linked HLA genes that may impact the risk of IDDM.

A role for NF-kappaB and the proteasome in autoimmunity

Type 1 diabetes (also known as insulin-dependent diabetes mellitus or juvenile-onset diabetes) is usually caused by T cell-mediated autoimmunity, with a prediabetic state characterized by the production of autoantibodies specific for proteins expressed by pancreatic beta cells. The non-obese diabetic (NOD) mouse is a spontaneous model of type 1 diabetes with a strong genetic component that maps to the major histocompatibility complex (MHC) region of the genome. A specific proteasome defect has been identified in NOD mouse lymphocytes that results from down-regulation of expression of the proteasome subunit LMP2, which is encoded by a gene in the MHC genomic region. This defect both prevents the proteolytic processing required for the production and activation of the transcription factor nuclear factor kappaB (NF-kappaB), which plays important roles in immune and inflammatory responses, as well as increases the susceptibility of the affected cells to apoptosis induced by tumor necrosis factor alpha (TNF-alpha). The proteasome dysfunction is both tissue and developmental stage specific and likely contributes to disease pathogenesis and tissue targeting.

The role of the proteasome in autoimmunity

Type 1 diabetes is believed to be caused by T cell-mediated autoimmunity, with a prediabetic state characterized by the production of autoantibodies specific for proteins expressed by pancreatic beta cells. The non-obese diabetic (NOD) mouse is a spontaneous model of Type 1 diabetes with a strong genetic component that maps to the major histocompatibility complex (MHC) region of the genome. A specific proteasome defect has now been identified in NOD mouse lymphocytes that results from down-regulation of expression of the proteasome subunit LMP2, which is encoded by a gene in the MHC genomic region. This defect both prevents the proteolytic processing required for the production and activation of the transcription factor nuclear factor-kappaB (NF-kappaB), which plays an important role in immune and inflammatory responses, in addition to increasing the susceptibility of the affected cells to apoptosis induced by tumor necrosis factor-alpha (TNF-alpha). The proteasome dysfunction is both tissue- and developmental stage-specific and likely contributes to disease pathogenesis and tissue targeting.

Identification of premature ovarian failure patients with underlying autoimmunity

Although known causes of premature ovarian failure (POF) include X chromosome deletions, radiation and chemotherapy, and genetic defects of the gonadotropin hormones or receptors, at least one third to one half of cases remain idiopathic. A significant proportion of patients with apparently idiopathic POF have some evidence for an autoimmune etiology. However, the only gold standard for detecting autoimmune causes of immune ovarian destruction has been invasive ovarian biopsy. Serum antibodies to ovarian and other self-tissue have been described in up to one third of women with POF, but the tests are not well standardized, not well correlated with ovarian histology, and highly variable. Recently, specific defects of expression of cell surface markers on peripheral blood lymphocytes have been shown to identify, in population-based studies, individuals destined to develop autoimmune pancreatic destruction and type I diabetes mellitus, even before any other evidence of autoimmunity. We, therefore, sought to test the ability of cell surface marker expression in women with POF to identify autoimmune defects. Seventeen women with POF, 11 of whom had positive antibody titers to ovary, thyroid, or antinuclear antibody, were studied on at least two occasions and compared in blinded fashion with normal controls and patients with autoimmune type I diabetes mellitus. The most useful marker for identifying autoimmunity was the surface density of conformationally correct HLA class I molecules on macrophages, a structure essential for T cell education. Using this marker, 7 of the 9 patients with autoantibodies and 3 of the 8 patients without autoantibodies were identified as having evidence of a defect in self-antigen presentation similar to that of type I diabetics (chi-square, p = 0.03). Subsequent testing identified antismooth muscle antibodies in 1 of the women with a defect of HLA class I molecules but no previously identified autoimmunity. In addition, there were increased numbers of CD8 T cells in both autoimmune POF and insulin-dependent diabetes mellitus (IDDM) patients. Exclusive to POF patients was a statistically significant increase in CD8 density on T cells. This was most prominent in POF patients with an underlying autoimmune etiology. These data further support a role for autoimmunity in POF patients and suggest that the further development of cell surface markers in combination with other diagnostic tests could result in diagnosis before the development of complete ovarian failure. The possibility for disease-specific therapy to prevent further autoimmune ovarian damage in selected POF patients is also envisioned.

Essential role of human leukocyte antigen-encoded proteasome subunits in NF-kappaB activation and prevention of tumor necrosis factor-alpha-induced apoptosis

The multisubunit proteasome complex is the principal mediator of nonlysosomal protein degradation. The proteasome subunit varies minimally between cells with the exception of LMP2, LMP7, and LMP10 subunits in rodent and human cells. LMP2 and LMP7 subunits are encoded by the human lymphocyte antigen region, and they optimize proteolytic mediated antigen presentation. The proteasome is also important for the function of transcription factor nuclear factor-kappaB (NF-kappaB). It is required for NF-kappaB subunits p50 and p52 generation and catalyzes degradation of phosphorylated IkappaBalpha. These proteasome-mediated reactions have now been shown to be defective in T2 cells, a human lymphocyte cell line that lacks both LMP2 and LMP7. Although T2 cells contain normal expression of p100 and p105, the abundance of p50 and p52 was greatly reduced. Tumor necrosis factor-alpha (TNF-alpha) induced normal phosphorylation of IkappaBalpha but failed to induce degradation of phosphorylated IkappaBalpha. Both DNA binding assays and luciferase assays revealed that TNF-alpha-induced NF-kappaB activation is defective in T2 cells. Unlike parental cells, T2 cells were susceptible to TNF-alpha-induced apoptosis. These data indicate human leukocyte antigen-linked proteasome subunits are essential for NF-kappaB activation and protection of cells from TNF-alpha-induced apoptosis.

Defective function of the proteasome in autoimmunity: involvement of impaired NF-kappaB activation

Type 1 diabetes (also known as insulin-dependent diabetes mellitus or juvenile-onset diabetes) is usually caused by T cell-mediated autoimmunity, with a prediabetic state characterized by the production of autoantibodies specific for proteins expressed by pancreatic beta cells. The nonobese patient with diabetes (NOD) mouse is a spontaneous model of type 1 diabetes with a strong genetic component that maps to the major histocompatibility complex (MHC) region of the genome. A specific proteasome defect has been identified in NOD mouse in select lymphocytic and monocytic lineages that results from down-regulation of expression of the proteasome subunit LMP2, which is encoded by a gene in the MHC genomic region. This defect prevents the proteolytic processing required for the production and activation of the transcription factor nuclear factor-kappaB (NF-kappaB), which plays important roles in immune and inflammatory responses, as well as increases the susceptibility of the affected cells to apoptosis induced by tumor necrosis factor-alpha (TNF-alpha). The novel role of the proteasome in dysfunction in autoimmunity is presented and documented to be both tissue and developmental stage specific. We propose a role of the proteasome as a step in disease pathogenesis and tissue targeting.

NOD mice are defective in proteasome production and activation of NF-kappaB

The nonobese diabetic (NOD) mouse is an animal model of human type I diabetes with a strong genetic component that maps to the major histocompatibility complex (MHC) of the genome. We have identified in NOD lymphocytes a specific proteasome defect that results from the lack of the LMP2 subunit. The pronounced proteasome defect results in defective production and activation of the transcription factor NF-kappaB, which plays an important role in immune and inflammatory responses as well as in preventing apoptosis induced by tumor necrosis factor alpha. The defect in proteasome function in NOD mouse splenocytes was evident from impaired NF-kappaB subunit p50 and p52 generation by proteolytic processing and impaired degradation of the NF-kappaB-inhibitory protein IkappaBalpha. An obligatory role of MHC-linked proteasome subunits in transcription factor processing and activation has been established in a spontaneous-disease model and mutant cells similarly lacking the MHC-encoded subunit. These data suggest that NOD proteasome dysfunction is due to a tissue- and developmental-stage-specific defect in expression of the MHC-linked Lmp2 gene, resulting in altered transcription factor NF-kappaB activity, and that this defect contributes to pathogenesis in NOD mice. These observations are consistent with the diverse symptomatology of type I diabetes and demonstrate clear sex-, tissue-, and age-specific differences in the expression of this error which parallel the initiation and disease course of insulin-dependent (type I) diabetes mellitus.

Novel Splicing of the Human MHC-Encoded Peptide Transporter Confers Unique Properties

Presentation of intracellularly derived antigenic peptides to T cells requires their assembly together with MHC class I molecules in the endoplasmic reticulum (ER). Such peptides are delivered to the ER by an MHC-encoded transporter composed of TAP1 and TAP2 protein delivery. Here, the first alternative splicing of Tap2 is described. The human splice variant, termed Tap2iso, lacks exon 11 and original 3′ untranslated region and contains a newly identified exon 12 and 3′ untranslated region. The full-length Tap2iso cDNA (2496 bp) predicts a protein of 653 amino acids. Tap2iso mRNA was normally coexpressed with Tap2 mRNA in all human lymphocyte cell lines examined. Function of TAP2iso was evaluated at multilevel in TAP1/2iso and TAP1/2 cotransfected T2 cells, a mutant cell line deplete of endogenous Tap gene products. The TAP1-TAP2iso transporter facilitated the maturation of MHC class I molecules in the ER and restored surface expression of class I. Importantly, TAP1-TAP2iso transporters expressed in T2 cells exhibited distinct and opposing influences on peptide selectivities, at times exceeding 30-fold differences in competition experiments and attributable to diversity in the 3′-COOH tail. The common coexpression of an alternative splice product of the Tap2 gene may contribute to broaden immune diversity, a mechanism previously described to occur predominantly at the level of the TCR and MHC class I gene products.

Novel splicing of the human MHC-encoded peptide transporter confers unique properties

Presentation of intracellularly derived antigenic peptides to T cells requires their assembly together with MHC class I molecules in the endoplasmic reticulum (ER). Such peptides are delivered to the ER by an MHC-encoded transporter composed of TAP1 and TAP2 protein delivery. Here, the first alternative splicing of Tap2 is described. The human splice variant, termed Tap2iso, lacks exon 11 and original 3' untranslated region and contains a newly identified exon 12 and 3' untranslated region. The full-length Tap2iso cDNA (2496 bp) predicts a protein of 653 amino acids. Tap2iso mRNA was normally coexpressed with Tap2 mRNA in all human lymphocyte cell lines examined. Function of TAP2iso was evaluated at multilevel in TAP1/2iso and TAP1/2 cotransfected T2 cells, a mutant cell line deplete of endogenous Tap gene products. The TAP1-TAP2iso transporter facilitated the maturation of MHC class I molecules in the ER and restored surface expression of class I. Importantly, TAP1-TAP2iso transporters expressed in T2 cells exhibited distinct and opposing influences on peptide selectivities, at times exceeding 30-fold differences in competition experiments and attributable to diversity in the 3'-COOH tail. The common coexpression of an alternative splice product of the Tap2 gene may contribute to broaden immune diversity, a mechanism previously described to occur predominantly at the level of the TCR and MHC class I gene products.

Antigen processing and autoimmunity. Evaluation of mRNA abundance and function of HLA-linked genes

Quantitative defects in the density of conformationally correct human lymphocyte antigen (HLA) class I complexes on the surface of lymphocytes are apparent in patients with diverse HLA-linked autoimmune diseases, including Type I diabetes and Sjögren's syndrome. First, HLA class I expression was investigated in individuals with two rare and genetically divergent polyglandular autoimmune diseases. Polyglandular failure patients whose disease showed HLA linkage, but not those whose disease was not HLA linked, exhibited decreased HLA class I expression on the surface of their lymphocytes as well as a reduced abundance of transcripts of the HLA-linked genes Tap1 and Tap2, both of which encode proteins that contribute to HLA class I processing. Second, lymphocytes from patients with insulin-dependent diabetes mellitus (IDDM), Sjögren's syndrome, Graves' disease, and Hashimoto's disease showed varying degrees of decreased abundance of mRNAs that encode Tap1, Tap2, Lmp2, or Lmp7 (the latter two proteins also contribute to HLA class I processing). Third, in twins discordant for IDDM, reduced transcript abundance was preferential to diabetic subjects. Fourth, functional assays of isolated diabetic proteasomes, the peptide cutting complex containing LMP2 and LMP7 proteins, revealed altered peptidase activity. These data suggest that defective transcription of HLA class I-processing genes could contribute to the quantitative defect in cell-surface expression in autoimmune lymphocytes of HLA-controlled disease.

Evaluation of TAP1 polymorphisms with insulin dependent diabetes mellitus in Finnish diabetic patients. The Childhood Diabetes in Finland (DiMe) Study Group

Insulin dependent diabetes mellitus (IDDM) is an autoimmune disease with a strong association between disease and the HLA class II region. Because abnormal antigen processing, in part characterized by altered class I processing, has been identified in patients with IDDM, the TAP (transporter associated with antigen processing) genes located in the HLA class II region make attractive candidate genes for IDDM. Five coding region variants of TAP1 were typed in a cohort of well characterized Finnish patients with diabetes (n = 119) and compared to racially marched control subjects (n = 92). We found that although no single TAP1 polymorphism was associated with IDDM, a genotypic combination of Ile/Val at codon 333 with Asp/Asp at codon 637 was found more frequently in subjects with IDDM (9.4%) compared to controls (1.2%; p = 0.025). This could not be accounted for by an association with any particular haplotype defined by class I or class II serology.

Human TAP1 polymorphisms detected by denaturing gradient gel electrophoresis

Presentation of endogenous peptides by major histocompatibility complex class I (MHC) molecules is controlled, in part, by the Tap1 and Tap2 genes in the MHC class II region that encode a heterodimeric peptide transporter. Polymorphisms of human Tap1 in normal individuals have now been investigated systematically by denaturing gradient gel electrophoresis (DGGE) analysis of fragments of genomic DNA generated by the polymerase chain reaction. Polymorphisms identified by distinctive DGGE band patterns were confirmed by DNA sequencing. In addition to four previously described polymorphisms in the open reading frame, DGGE detected three new polymorphisms: a G-->T substitution in the promoter region, a 10-bp insert in intron 9, and a G-->T substitution 80-bp downstream of the translation termination codon.

New monoclonal antibody diagnostic reagents for type I diabetes: differential lymphocyte surface antigen expression related to disease

New cellular-based reagents are needed to diagnose type I diabetes as well as to monitor the outcomes of clinical trials at early time points. Four new monoclonal antibodies (mAbs) have been shown to demonstrate reduced binding to lymphocytes from identical twins with long-term type I diabetes relative to that observed with lymphocytes from their twin partners without diabetes or from control subjects. Biochemical analysis revealed mAb 3G12EG recognized an unidentified 45-kDa protein, whereas mAb 2E8F1 and 5B6E11 did not appear to precipitate specific proteins as detected by SDS-PAGE. Electrophoresis under reducing and nonreducing conditions and peptide mapping revealed that mAb 8F410 recognizes a novel dimeric form of HLA class I molecule. Predictions from crystallography studies suggested previously this class I dimer as the optimal activation of a single CD8 T-cell. In B-cells from both normal and diabetic individuals, the class I dimer was minimally associated with beta2-microglobulin rapidly formed in the endoplasmic reticulum. These new reagents appear to be able to identify new lymphocyte surface phenotypes associated with diabetes expression in both fresh blood samples and Epstein-Barr virus-established cell lines.

Strategies for circumventing transplant rejection: modification of cells, tissues and organs

New technologies may permit the therapeutic use of transplanted cells or whole organs to be extended to the treatment of a wider range of diseases and a greater number of individuals. At present, the replacement of failing organs or the treatment of disease by transplantation is restricted by the need for co-administration of toxic immunosuppressive drugs to prevent rejection, and the limited availability of donor organs. Recent advances, however, suggest that genetically engineered or immunologically modified donor organs or cells can eliminate the need for host immunosuppression and can allow organ and cell survival across species. Transplantation could thus become a widespread therapeutic approach in the next century.

Abnormal class I assembly and peptide presentation in the nonobese diabetic mouse

Presentation of self-antigens by major histocompatibility complex (MHC) class I molecules requires the function of the MHC class II-linked genes Tap-1 and Tap-2. Evidence suggests that interruption of self-peptide presentation results in reduced cell surface expression of MHC class I molecules and the interruption correlates with progression to diabetic autoimmunity in nonobese diabetic (NOD) mice and humans. NOD mice possess a rare Tap-1 allele (Tap-1b); this is associated with reduced Tap-1 mRNA abundance in lymphocytes from diabetes-prone females and decreased conformationally correct class I molecules on the cell surface. In this study, we demonstrate that, similar to lymphoma cell lines with mutations in Tap-1 or Tap-2, the reduced expression of class I molecules on the surface of lymphocytes from diabetes-prone female NOD mice was normalized by incubation at low temperatures or by exposure to class I allele-specific peptides. As would be expected for cells that express surface class I molecules not associated with peptide, female NOD lymphocytes were resistant to lysis by class I-restricted, peptide-specific cytotoxic T lymphocytes. Furthermore, the rate of class I exit from the endoplasmic reticulum of lymphocytes from female NOD mice was delayed as demonstrated by delayed glycosylation. Male NOD mice, which are not prone to diabetes, lacked these functional defects in class I assembly and had near-normal levels of Tap-1 mRNA and exhibited normal density of class I epitopes that were peptide filled. These results are consistent with the possibility that the rare Tap-1b allele is associated with a quantitative defect in Tap-1 expression that influences disease course.

Use of donor beta 2-microglobulin-deficient transgenic mouse liver cells for isografts, allografts, and xenografts

Donor graft major histocompatibility complex class I antigens are targets for both allogeneic and xenogeneic rejection. Mice homozygous for beta 2-microglobulin gene disruption express reduced amounts of surface MHC class I antigens. Liver cells from such mutant mice were transplanted into isogeneic, allogeneic, and xenogeneic recipients to evaluate the potential of these animals as transplant donors. The survival of allografts of transgenic 129 mouse liver cells in 15 immunocompetent and histoincompatible mouse recipients (BALB/c, D1.C) was only slightly improved 30 days after transplantation relative to normal 129 mouse allografts. These results could be attributable: (1) to host natural killer cell-mediated lysis of donor MHC class I antigen-deficient cells; (2) to donor liver cell MHC class I determinants that are reduced but not eliminated serving as rejection targets; (3) to the plentiful host supply of serum beta 2-microglobulin reconstituting the graft and restoring donor MHC class I. Culture studies confirmed the ability of exogenous human and bovine beta 2-microglobulin to restore rapidly MHC class I antigen expression on transgenic cells. Because cell surface exchange of beta 2-microglobulin is less efficient between species with divergent beta 2-microglobulin sequences, the survival of transgenic 129 mouse liver cells in guinea pig (60% beta 2-microglobulin identity) and Xenopus (34% beta 2-microglobulin identity) hosts was investigated. Significant prolongation of MHC class I antigen-deficient liver cell xenografts was apparently only in Xenopus hosts. Furthermore, transplants of transgenic 129 mouse liver cells into isogeneic normal 129 mouse recipients showed evidence of rejection in seven of nine recipients, suggesting that transgenic donor cells also may be susceptible to lysis by host natural killer cells.

Expression of major histocompatibility complex antigens in cultures of clonally derived human myoblasts

We examined class I and class II HLA antigen expression by flow cytometry in clonal cultures derived from normal human skeletal muscle biopsies. Both HLA class I and class II antigens were constitutively expressed in all clones studied. By altering the constituents of the culture medium, we could modulate the expression of HLA class II but not HLA class I antigens. We noted heterogeneity in the expression of HLA class II antigens among different clones; an increased expression was associated with an increased propensity of myoblasts to fuse. These findings indicate that normal aneurally cultured myoblasts may express both HLA class I and class II antigens, that this expression may be modulated by in vitro agents, and that the presence of these antigens may relate to the process of in vitro myoblast fusion.

Mechanisms of autoimmunity in type I diabetes

The work presented in this review suggests that in human and murine type I diabetes, defective MHC class I expression on APC is linked to autoimmunity. The defect in self-antigen presentation is present on prediabetic and diabetic APC, and this presumably delivers abnormal or lack of signals to T cells to allow self tolerance. Since most autoimmune diseases have strong genetic linkage to MHC class II region, our recent results additionally demonstrating low MHC class I expression on lymphoid cells in a diversity of autoimmune diseases (hypothyroidism, rheumatoid arthritis, lupus, etc.) suggest that this pathway of abnormal class I presentation of self epitopes may be important for tolerance to many tissue-specific antigens (40). Certainly, the unanswered genetic questions will address the role of the specific genes controlling self-antigen presentation through MHC class I followed by T-cell education to self.

Linkage of faulty major histocompatibility complex class I to autoimmune diabetes

Pancreatic islet cells are the targets of an autoimmune response in type I diabetes. In the nonobese diabetic (NOD) mouse model of autoimmune diabetes, expression of major histocompatibility complex (MHC) class I proteins was inversely correlated with diabetes; in this mouse a mutation in the MHC class II-linked gene for the putative MHC class I peptide transporter was also present. Mice deficient in MHC class I expression because they do not produce beta 2-microglobulin also developed late onset autoimmune diabetes. In cells from humans with type I diabetes expression of MHC class I was decreased; subsets of prediabetics categorized as most likely to become hyperglycemic also had low MHC class I. T cell responses to self antigens are faulty in diabetics. In sets of genetically identical twins that are discordant for diabetes, the defect appeared to reside with the antigen presenting cell. Thus, a lack of surface MHC class I protein is associated with autoimmune diabetes; the concomitant defect in antigen presentation may impair the development of self tolerance, which could result in autoimmune disease.

Prevention of xenograft rejection by masking donor HLA class I antigens

Destruction of target cells by cytotoxic T lymphocytes requires the presence of HLA (human lymphocyte antigen) class I antigens on the target cells for adhesion as well as for triggering of the antigen-specific T cell receptor. Rejection of xenogeneic human pancreatic islets and liver was circumvented by masking, before transplantation, donor antigens with F(ab')2 antibody fragments to HLA class I or tissue-specific epitopes. This strategy eliminated the need for recipient immunosuppression and allowed islet xenograft survival beyond 200 days, as demonstrated functionally by C peptide secretion as well as by histology. These in vivo observations are consistent with the importance of donor HLA class I in eliciting graft rejection and have potential applicability to the successful transplantation of other HLA class I-bearing donor tissues.

T-lymphocyte changes linked to autoantibodies. Association of insulin autoantibodies with CD4+CD45R+ lymphocyte subpopulation in prediabetic subjects

The onset of insulin-dependent (type I) diabetes is predictable before hyperglycemia by the presence of islet cell autoantibodies (ICAs) and competitive insulin autoantibodies (CIAAs). CIAA+ICA+ first-degree relatives of individuals with type I diabetes have increased numbers of CD4 cells bearing the CD45R antigen and reciprocal depressions of the CD4 cells bearing the CD29 determinant. In addition, depressed CD4/CD8 ratios are present. In this study, we investigated the correlation between autoantibody levels and T-lymphocyte changes in the prediabetic state. The data demonstrate a clear linear relationship between rising CIAA levels, a marker of disease rate, and rising elevations in the CD4+CD45R+/CD4+CD29+ ratio in 37 CIAA+ICA+ and CIAA+ICA- relatives (r = 0.93). In marked contrast, the degree of CD4/CD8 depression found in individuals with prediabetes or long-term diabetes failed to correlate with either CIAA (r = 0.32) or ICA (r = 0.29) levels. The investigation of T-lymphocyte changes in siblings of individuals with type I diabetes with different stable autoantibody patterns (CIAAs and/or ICAs), and thus varying risks for diabetes, revealed differences in the prediabetic groups. Fifteen CIAA+ICA- relatives with high CIAA levels (greater than 80 nU/ml) had high CD4+CD45R+/CD4+CD29+ ratios (P = 0.03) and depressed CD4/CD8 ratios (P = 0.008). In contrast, CIAA+ICA- relatives with low CIAA levels (39-80 nU/ml), and thus low risk of diabetes, had no alteration in their CD4/CD8 ratio (P = 0.75) or CD4+CD45R+/CD4+CD29+ ratio (P = 0.33). Nineteen CIAA-ICA+ siblings with a predicted intermediate risk for diabetes showed heterogeneity in the presence of T-lymphocyte abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of T lymphocyte subsets in all stages of diabetes

Direct immunofluorescence analysis of circulating blood lymphocytes from patients with all stages of Type I diabetes revealed marked phenotypic abnormalities among all major T-lymphocyte subpopulations. The alterations were most pronounced in the prediabetics and comprised a stimulation of the T4+2H4+ and T8+2H4+ suppressor inducer subpopulations and corresponding depression of the T4+4B4+ helper inducers.

Abnormal T-lymphocyte subsets in type I diabetes

Type I (insulin-dependent) diabetes mellitus is a slow autoimmune disease associated with the selective destruction of beta-cells in the islets of Langerhans. Recent studies in humans indicate that autoantibodies to insulin and islets of Langerhans appear years before overt diabetes and identify a normoglycemic prediabetic state. To determine whether type I diabetes mellitus represents a generalized immunologic disorder, we studied the phenotypic characteristics of peripheral blood lymphocytes from all stages, i.e., prediabetic, new-onset diabetic, and long-term diabetic patients, with the anti-2H4 monoclonal antibody CD45R, which defines a human suppressor-inducer subset, and the anti-4B4 monoclonal antibody CDw29, which defines a human helper-inducer subset of peripheral blood lymphocytes. All 22 prediabetic patients had elevated T4+2H4+ (suppressor-inducer) cells and reciprocal depressed T4+4B4+ (helper-inducer) cells compared with healthy age-matched control subjects. In addition, the T4/T8 ratio in prediabetic patients was decreased compared with the age-matched control subjects. The abnormal T4+2H4+ and T4+4B4+ subsets were resolved in 20 new-onset and 15 long-term diabetic patients. Family studies showed that the changes in the 2H4 and 4B4 antigens were not part of an inherited polymorphic determinant, because these markers were normal in unaffected siblings and parents. Ten prediabetic patients were restudied greater than 1 yr after the original analysis and showed the persistence of the observed changes. This abnormal increase in suppressor-inducer cells and decrease in helper-inducer cells among islet and insulin antibody-positive prediabetic patients may be of help in understanding diabetes pathogenesis and may also be an early noninvasive screening tool for the detection of the prediabetic state.

Lymphocyte transfusions prevent diabetes in the Bio-Breeding/Worcester rat

The Bio-Breeding/Worcester (BB/W) rat develops spontaneous autoimmune diabetes similar to human insulin-dependent diabetes mellitus. Transfusions of whole blood from the nondiabetic W-line of BB/W rats prevent the syndrome in diabetes-prone recipients. We report three experiments designed to determine which blood component is protective. In all experiments, diabetes-prone BB/W rats 23 to 35 d of age were given four or six weekly intravenous injections. In the first experiment, animals received either saline or transfusions of erythrocytes, white blood cells, or plasma from W-line donors. Diabetes occurred in 7/22 (32%) erythrocyte, 2/27 (7%) white cell, 14/24 (58%) plasma, and 15/27 (56%) saline recipients (P less than 0.001). At 120 d of age, peripheral blood was obtained from nondiabetic rats. Fluorescence-activated cell sorter analysis of OX 19 tagged leucocytes revealed 35% T lymphocytes in white cell recipients (n = 13), compared with 9% in saline recipients (n = 7; P less than 0.001). Responsiveness to concanavalin A was also increased in the white cell group, whereas the frequency of both insulitis and thyroiditis was decreased. In the second experiment, 1/19 (5%) rats transfused with W-line spleen cells developed diabetes, as contrasted with 12/18 (67%) recipients of diabetes-prone spleen cells and 19/31 (61%) noninjected controls (P less than 0.001). In the third experiment, diabetes-prone rats received either W-line blood treated with a cytotoxic anti-T lymphocyte antibody plus complement, untreated blood, or saline. Diabetes occurred in 8/20 (40%), 1/20 (5%), and 13/19 (68%) rats in each group, respectively (P less than 0.001). We conclude that transfusions of W-line T lymphocytes prevent diabetes in the BB/W rat.

Transplantation without immunosuppression

Exciting new findings have been reported in the past few years that indicate that islets can be transplanted successfully across major histocompatibility barriers without the continuous use of immunosuppressive agents by techniques designed to eliminate passenger leukocytes. In vitro culture of donor islets either at a low temperature (24 degrees C) with a single injection of antilymphocyte serum or culture of megaislets in the presence of 95% O2 before transplantation permitted the successful transplantation of islet allografts and xenografts (rat to mouse). Definitive evidence in support of the passenger leukocyte concept has been obtained recently. Mouse islet cells have been shown to express the class I antigens of the H-2 complex, but do not express Ia antigens. Treatment of fresh mouse islets with specific anti-Ia sera and complement completely prevented rejection of islets transplanted across a major histocompatibility barrier. These findings indicate that Ia-positive cells (possibly dendritic cells) are primarily responsible for the initiation of immune rejection of the transplants. This is of particular importance with respect to the eventual transplantation of islets into human diabetics since it may be feasible to utilize antisera to HLA-DR antigens for pretreatment of islets before transplantation. In addition, these new developments may also be applicable to the transplantation of other organs such as the parathyroid, heart, kidney, liver, and skin.

Prevention of allograft rejection by immunization with donor blood depleted of Ia-bearing cells

Strain-specific unresponsiveness was induced in adult mice by immunizing them with donor blood treated with antiserum to Ia (I region-associated antigens) prior to the transplantation of islets of Langerhans. This regimen alone produced greater than 100-day survival of islet allografts transplanted across a major histocompatibility barrier.

Demonstration of active tolerance in maintenance of established islet of Langerhans allografts

Streptozotocin-induced diabetes in mice can be reversed by transplantation of islets of Langerhans from histoincompatible mice if the islets are treated with anti-Ia-serum and complement before transplantation. Here we show that anti-Ia-treated islets most likely induce tolerance in the recipient animals. Daily injections of recipient-specific anti-I-J-serum (beginning 80 or more days after transplantation) and small numbers of donor splenocytes caused the prompt rejection of the islets in half of the animals; neither anti-I-J-serum nor donor splenocytes alone were effective. It is likely that rejection of established allografts after this treatment is the result of abolition of the activity of allograft-specific suppressor cells.