Effect of neoadjuvant chemotherapy on low-density lipoprotein (LDL) receptor and LDL receptor-related protein 1 (LRP-1) receptor in locally advanced breast cancer

Low-density lipoprotein (LDL) receptors are overexpressed in most neoplastic cell lines and provide a mechanism for the internalization and concentration of drug-laden nanoemulsions that bind to these receptors. The aim of the present study was to determine whether the administration of standard chemotherapeutic schemes can alter the expression of LDL and LDL receptor-related protein 1 (LRP-1) receptors in breast carcinoma. Fragments of tumoral and normal breast tissue from 16 consecutive volunteer women with breast cancer in stage II or III were obtained from biopsies before the beginning of neoadjuvant chemotherapy and after chemotherapy, from fragments excised during mastectomy. Tissues were analyzed by immunohistochemistry for both receptors. Because complete response to treatment was achieved in 4 patients, only the tumors from 12 were analyzed. Before chemotherapy, there was overexpression of LDL receptor in the tumoral tissue compared to normal breast tissue in 8 of these patients. LRP-1 receptor overexpression was observed in tumors of 4 patients. After chemotherapy, expression of both receptors decreased in the tumors of 6 patients, increased in 4 and was unchanged in 2. Nonetheless, even when chemotherapy reduced receptors expression, the expression was still above normal. The fact that chemotherapy does not impair LDL receptors expression supports the use of drug carrier systems that target neoplastic cells by the LDL receptor endocytic pathway in patients on conventional chemotherapy.

Early Diagnosis of Myocardial Dysfunction in Patients With Hematological Malignancies Submitted to Chemotherapy. Preliminary Results.

Early Diagnosis of Miocardial Dysfunction in Patients with Hematological Malignancies Submitted to Chemotherapy. Preliminary Background: Considering the current diagnostic improvements and tl1erapeutic approaches, patients witl 1 cancer can now be healed or keep the disease under control, still, the chemotherapy may cause heart damage, evolving to Congestive Heart Failure. Recognition of those changes increases the chances of control the endpoints; hence, new parameters of cardiac and fluid mechanics analysis have been used to assess the myocardial function, pursuing an earlier diagnosis of the cardiac alterations. This study aimed to detect early cardiac dysfunction consequently to chemotherapy in patients with hematological malignancies (HM). Methods: Patients with leukemia and lymphoma, submitted to chemotherapy, without knowing heart diseases were studied. Healthy volunteers served as the control group. Conventional 2DE parameters of myocardial function were analyzed. The peak global longitudinal, circumferential and radial left ventricular (LV) strain were deternined by 2D and 3D speckle tracking (STE); peak area strain measured by 3D STE and LV torsionn, twisting rate, recoil / recoil rate assessed by 2D STE. The LV vortex formation time (VFT) during the rapid diastolic filling was estimated by the 2D mitral valve (MV) planimetry and Pulsed Doppler LV inflow by: VFT- 4(1-β) / π x α3 x LVEF Where 1- β is the E wave contribution to the LV stroke volume and α3 is a volumetric variable related to the MV area. The statistical level was settled on 5%. Results: See Table. Conclusion: Despite the differences between the two groups concerning the LVESV, LVEF and E´, those parameters still are in the normal range when considering the patients submitted to chemotherapy; thus, in the clinical setting, they are not so noticeable. The 3D GLS was smaller among the patients, oppositely to the 2D GLS, suggesting that the former variable is more accurate to assess tlhe LV systolic function. The VFT is a dimensionless measure of the optimal vortex development inside the LV chamber; reflecting the efficiency of the diastolic filling and, consequently, blood ejection. This index showed to be diminished in patients with HM submitted to chemotherapy, indicating an impairment of the in1pulse and thrust, hence appearing to be a very early marker of diastolic and systolic dysfunction in this group.

Purging e alte dosi di chemioterapia con reinfusione di cellule staminali autologhe in linfomi non Hodgkin follicolari resistenti/refrattari

In the era of monoclonal antibodies the role of autologous stem cell transplantation (ASCT) in the management of follicular lymphoma (FL) is still debated. To evaluate the safety and efficacy of myeloablative therapy with rescue of purged or unpurged harvests in FL pts. At our institution form 1997 to 2007 28 pts with refractory/resistant FL were eligible for ASCT. Before high dose therapy they received 2-3 cycles of CHOP-like regimen (ACOD), followed by Cyclophosphamide 4g/mq to mobilize the stem cells (SC). After SC collection the pts underwent 3 cycles of subcutaneous Cladribine at a daily dose of 0,14-0,10 mg/Kg for Day 1-5 every 3-4 weeks. The conditioning regimen was based on Mitoxantrone 60mg/mq + Melphalan 180 mg/mq, followed by SC re-infusion 24-hours later and G-CSF starting 24 hours after re-infusion. In 19 pts the SC underwent purging: in 10 harvests the CD34+ were selected by immunomagnetic beads, while in the other 9 pts, only Rituximab was used as “purging in vivo” agent. The remaining 9 pts received unpurged SC. Before ASCT 11 pts were in complete response (CR), 9 in partial response (PR) and 2 in stable disease. Two pts were not eligible for ASCT because of progressive disease (PD). The remaining 25 pts were eligible for ASCT. The engraftment was at a median of 11 days for leucocytes and 14 days for platelets (>20.000/mmc), with a delay of one day in the pts, who received purged SC. Grade 3-4 mucositis was described in 8 pts. During aplasia a 48% infection rate was reported, without differences between pts with purged or unpurged SC. One patient in CR presented myelodysplastic syndrome at 18 months from ASCT. After ASCT 22 pts were in CR, 2 in PR and one patient were not valuable, because died before response assessment. Nine pts in CR showed PD at a median time of 14 months from ASCT. With a median follow up of 5 years (range 2 months -10 years), 22 pts are alive and 11 (44%) in CR. Ten pts died, 5 for progressive disease and 5 for treatment-related causes; in particular 7 of them received in-vitro purged SC. Conclusions: Our chemotherapy regimen, which included the purine analogue Cladribine in the induction phase, seems safe and feasible. The high rate of CR reported and the sustained freedom from progression up to now, makes such modality of treatment a valid option principally in relapsing FL patients. In our experience, the addition of a monoclonal antibody as part of treatment confirms its role “in vivo purging” without observing an increased incidence of infection.

Induction Motor Diagnosis in Variable Speed Drives

Several diagnostic techniques are presented for the detection of electrical fault in induction motor variable speed drives. These techinques are developed taking into account the impact of the control system on machine variables and non stationary operating conditions.

Evaluation of a viral vector system, based on a defective interfering RNA of tomato bushy stunt virus, for protein expression and the induction of gene silencing

A viral vector system was developed based on a DI-RNA, a sub-viral particle derived from TBSV-BS3-statice. This newly designed vector system was tested for its applicability in protein expression and induction of gene silencing. Two strategies were pursued. The first strategy was replication of the DI-RNA by a transgenically expressed TBSV replicase and the second was the replication by a so called helper virus. It could be demonstrated by northern blot analysis that the replicase, expressed by the transgenic N. benthamiana plant line TR4 or supplied by the helper virus, is able to replicate DI-RNA introduced into the plant cells. Various genes were inserted into different DI constructs in order to study the vector system with regard to protein expression. However, independent of how the replicase was provided no detectable amounts of protein were produced in the plants. Possible reasons for this failure are identified: the lack of systemic movement of the DI-RNA in the transgenic TR4 plants and the occurrence of deletions in the inserted genes in both systems. As a consequence the two strategies were considered unsuitable for protein expression. The DI-RNA vector system was able to induce silencing of transgenes as well as endogenous genes. Several different p19 deficient helper virus constructs were made to evaluate their silencing efficiency in combination with our DI-RNA constructs. However, it was found that our vector system can not compete with other existing VIGS (virus induced gene silencing) systems in this field. Finally, the influence of DI sequences on mRNA stability on transient GUS expression experiments in GUS silenced plants was evaluated. The GUS reporter gene system was found to be unsuitable for distinguishing between expression levels of wild type plants and GUS silenced transgenic plants. The results indicate a positive effect of the DI sequences on the level of protein expression and therefore further research into this area is recommended.

Espressione dell'Enzima ad Azione Immunoregolatoria Indoleamina 2,3-Diossigenasi nella Leucemia Mieloide Acuta dell'Adulto: correlazioni Clinico-Biologiche

L’enzima IDO interviene nella via di degradazione del triptofano, essenziale per la vita cellulare; l’iperespressione di IDO favorisce la creazione di un microambiente immunotollerante. Nelle LAM IDO è funzionalmente attivo nelle cellule blastiche e determina l’acquisizione di un fenotipo regolatorio da parte delle cellule T alloreattive; l’espressione della proteina aumenta in modo consensuale con l’evoluzione clinica della patologia. Scopo della Tesi è indagare l’esistenza di una correlazione tra l’iperespressione di IDO da parte delle cellule leucemiche, le caratteristiche di rischio alla diagnosi e l’outcome dei pazienti. Sono stati esaminati 45 pazienti adulti affetti da LAM afferiti all’Istituto di Ematologia di Bologna. I pazienti sono stati stratificati a seconda di: età di insorgenza della leucemia, secondarietà a Mielodisplasia o radio chemioterapia, iperleucocitosi, citogenetica, biologia molecolare (sono state valutate le alterazioni a carico dei geni FLT3 ed NPM). I pazienti sono stati analizzati per l’espressione del gene IDO mediante RT-PCR, seguita da Western Blot, allo scopo di stabilire la presenza di una proteina attiva; successivamente si è proceduto a verificare l’esistenza di una correlazione tra l’espressione di IDO e le caratteristiche di rischio alla diagnosi per identificare una relazione tra l’espressione del gene ed un subset di pazienti a prognosi favorevole o sfavorevole. Dei 45 pazienti adulti affetti da LAM il 28,9% è risultato negativo per l’espressione di IDO, mentre il rimanente 71,1% è risultato positivo ed è stato suddiviso in tre ulteriori categorie, in base ai livelli di espressione. I dati non sembrano al momento suggerire l’esistenza di una correlazione tra l’espressione di IDO e le caratteristiche di rischio alla diagnosi. Nel gruppo di pazienti ad elevata espressione di IDO si riscontra un rate di resistenza alla chemioterapia di induzione più elevato, con una quota di pazienti resistenti pari al 71,4%, contro il 23,1% nel gruppo di pazienti IDO-negativi.

Modulation der Strahlen- und Chemosensitivität menschlicher Tumorzellen durch Interferon

Pankreaskarzinome und maligne Melanome weisen eine hohe Resistenz gegenüber Zytostatika und Bestrahlung in der Therapie auf. Die Behandlung eines metastasierenden Pankreaskarzinoms besteht aus einer Kombination aus 5-FU, CDDP und IR. Für die Behandlung des malignen Melanoms ist das methylierende Agenz DTIC das Mittel erster Wahl. Das ebenfalls methylierende Agenz TMZ, welches jedoch in Deutschland noch nicht für die Behandlung von malignen Melanomen zugelassen ist, erlangt immer größere Bedeutung. Die Ansprechrate der Tumore kann durch Kombination mit IFNs erhöht werden. In der vorliegenden Arbeit wurde an Pankreaskarzinom- bzw. Melanomzelllinien untersucht, ob IFNs einen radio- bzw. chemosensibilisierender Effekt ausüben und, wenn ja, welcher Mechanismus hierfür verantwortlich ist. Es wurden zehn Pankreaskarzinom-Zelllinien (Panc-1, Su8686, Capan-1, Capan-2, Bxpc-3, PA-TU 8988T, Aspc-1, HS 766T, Mia-PaCa-2 und PA-TU 8902) untersucht. Diese zeigten eine hohe Variabilität in ihrer intrinsischen Radiosensitivität sowie in ihrer Sensitivität gegenüber IFN-alpha und IFN-beta. IFN-beta erwies sich als toxischer im Vergleich zu IFN-alpha. Die radiosensibilisierende Wirkung der IFNs an Pankreaskarzinom-Zelllinien war moderat, wobei IFN-beta im Vergleich zu IFN-alpha effektiver war. Der radiosensibilisierende Effekt ging mit einer deutlichen Erhöhung der alpha-Komponente, der Überlebenskurven einher und kam durch eine IFN-beta vermittelte Verstärkung der IR-induzierten Apoptoserate zustande. Dies wurde sowohl durch SubG1 als auch durch Annexin V / PI Messungen gezeigt. Einen Einfluss von IFN-beta auf den Zellzyklus und die DSB-Reparatur konnte durch funktionelle Untersuchungen sowie durch PCR bzw. Western-Blot-Analysen als Grund für den sensibilisierdenen Effekt ausgeschlossen werden. Ein sensibilisierender Effekt von IFN-beta auf die durch TMZ-induzierte Zytotoxizität war für die Pankreaskarzinom-Zelllinien weder in MGMT-profizientem noch –depletiertem Zustand zu beobachten. Zur Untersuchung der sensibilisierenden Eigenschaften von IFNs gegenüber TMZ in malignen Melanomzelllinien wurden p53-Wildtyp (D05 und A375) und mutierte Zelllinien (D14 und RPMI 7951) untersucht. Gegenüber alleiniger TMZ-Behandlung reagierten die untersuchten p53-Wildtyp Melanomzelllinien nicht sensitiver auf eine Behandlung mit TMZ als p53-mutierte Zelllinien. Der Nachweis des Spaltprodukts der Caspase-9 lieferte einen Hinweis darauf, dass in den Melanomzelllinien unabhängig vom p53-Status nach alleiniger TMZ-Behandlung der mitochondriale Apoptoseweg aktiviert wird. Durch eine Vorbehandlung der Zellen mit IFN-alpha oder IFN-beta konnte die TMZ-induzierte Apoptoserate in malignen Melanomzellen deutlich gesteigert werden. In p53-Wildtyp Melanomzellen war der chemosensibilisierende Effekt der IFNs besonders ausgeprägt. IFN-beta erwies sich hierbei als effektiver, weshalb es für die folgenden Versuche verwendet wurde. Durch stabile Transfektion der Zelllinie D05 mit MGMT konnte das durch TMZ-induzierte Addukt O6MeG als für den sensibilisieredenen Effekt ausschlaggebende DNA-Schädigung charakterisiert werden. Western-Blot-Analysen und gamma-H2AX-Immunfluoreszenz Untersuchungen konnten einen Einfluss von IFN-beta auf die Prozessierung der Läsion O6MeG sowie einen Einfluss von IFN-beta auf die Induktion und Reparatur von TMZ verursachten DSBs ausschließen. Durch Experimente mit einem Fas-aktivierenden Antikörper und durch eine stabile Transfektion der Zelllinien D05 und A375 mit DN-FADD konnte gezeigt werden, dass p53-Wildtyp Melanomzellen nicht oder nur eingeschränkt in der Lage sind, nach TMZ-Behandlung über den Fas-Rezeptor Signalweg Apoptose zu induzieren. Ausschlaggebend hierfür ist die geringe Pro-Caspase-8 Expression dieser Zelllinien. Eine IFN-beta Vorbehandlung bewirkte eine Reaktivierung des Fas-Rezeptor Signalweges, was mit einer verstärkten Expression der Pro-Caspase-8 einherging. Durch Experimente mit Caspase-8 siRNA konnte diese IFN-beta induzierte Verstärkung der Pro-Caspase-8 Expression als entscheidender Faktor für den sensibilisierenden Effekt ausgemacht werden. Zum ersten Mal konnte damit in dieser Arbeit gezeigt werden, dass p53-Wildtyp Melanomzellen durch eine IFN-beta vermittelte Hochregulation der Pro-Caspase-8 ihre Fähigkeit wiedererlangen, nach TMZ-Behandlung über den Fas-Rezeptor Signalweg Apoptose auszulösen. Diese Arbeiten weisen einen Weg, auf welchem die hohe Resistenz von malignen Melanomzellen, welche zu 80 % das nicht mutierte p53 Gen beherbergen, über eine IFN-beta induzierte Reaktivierung der Fas-Rezeptor vermittelten Apoptosekaskade überwunden werden kann.

The inhibition of aerobic glycolysis as a therapeutic approach to improve cancer chemotherapy

The aim of the research project discussed in this thesis was to study the inhibition of aerobic glycolysis, that is the metabolic pathway exploited by cancer cells for the ATP generation. This observation has led to the evaluation of glycolytic inhibitors as potential anticancer agents. Lactate dehydrogenase (LDH) is the only enzyme whose inhibition should allow a blocking of aerobic glycolysis of tumor cells without damaging the normal cells which, in conditions of normal functional activity and sufficient oxygen supply, do not need this enzyme. In preliminar experiments we demonstrated that oxamic acid and tartronic acid, two LDH competitive inhibitors, impaired aerobic glycolysis and replication of cells from human hepatocellular carcinoma. Therefore, we proposed that the depletion of ATP levels in neoplastic cells, could improved the chemotherapeutic index of associated anticancer drugs; in particular, it was studied the association of oxamic acid and multi-targeted kinase inhibitors. A synergistic effect in combination with sorafenib was observed, and we demonstrated that this was related to the capacity of sorafenib to hinder the oxidative phosphorylation, so that cells were more dependent to aerobic glycolysis. These results linked to LDH blockage encouraged us to search for LDH inhibitors more powerful than oxamic acid; thus, in collaboration with the Department of Pharmaceutical Sciences of Bologna University we identified a new molecule, galloflavin, able to inhibit both A and B isoforms of LDH enzyme. The effects of galloflavin were studied on different human cancer cell lines (hepatocellular carcinoma, breast cancer, Burkitt’s lymphoma). Although exhibiting different power on the tested cell lines, galloflavin was constantly found to inhibit lactate and ATP production and to induce cell death, mainly in the form of apoptosis. Finally, as LDH-A is able to bind single stranded DNA, thus stimulating cell transcription, galloflavin effects were also studied on this other LDH function.

Grid Connected Doubly Fed Induction Generator Based Wind Turbine under LVRT

This project concentrates on the Low Voltage Ride Through (LVRT) capability of Doubly Fed Induction Generator (DFIG) wind turbine. The main attention in the project is, therefore, drawn to the control of the DFIG wind turbine and of its power converter and to the ability to protect itself without disconnection during grid faults. It provides also an overview on the interaction between variable speed DFIG wind turbines and the power system subjected to disturbances, such as short circuit faults. The dynamic model of DFIG wind turbine includes models for both mechanical components as well as for all electrical components, controllers and for the protection device of DFIG necessary during grid faults. The viewpoint of this project is to carry out different simulations to provide insight and understanding of the grid fault impact on both DFIG wind turbines and on the power system itself. The dynamic behavior of DFIG wind turbines during grid faults is simulated and assessed by using a transmission power system generic model developed and delivered by Transmission System Operator in the power system simulation toolbox Digsilent, Matlab/Simulink and PLECS.

Automatic induction of lexical features

This thesis concerns artificially intelligent natural language processing systems that are capable of learning the properties of lexical items (properties like verbal valency or inflectional class membership) autonomously while they are fulfilling their tasks for which they have been deployed in the first place. Many of these tasks require a deep analysis of language input, which can be characterized as a mapping of utterances in a given input C to a set S of linguistically motivated structures with the help of linguistic information encoded in a grammar G and a lexicon L: G + L + C → S (1) The idea that underlies intelligent lexical acquisition systems is to modify this schematic formula in such a way that the system is able to exploit the information encoded in S to create a new, improved version of the lexicon: G + L + S → L' (2) Moreover, the thesis claims that a system can only be considered intelligent if it does not just make maximum usage of the learning opportunities in C, but if it is also able to revise falsely acquired lexical knowledge. So, one of the central elements in this work is the formulation of a couple of criteria for intelligent lexical acquisition systems subsumed under one paradigm: the Learn-Alpha design rule. The thesis describes the design and quality of a prototype for such a system, whose acquisition components have been developed from scratch and built on top of one of the state-of-the-art Head-driven Phrase Structure Grammar (HPSG) processing systems. The quality of this prototype is investigated in a series of experiments, in which the system is fed with extracts of a large English corpus. While the idea of using machine-readable language input to automatically acquire lexical knowledge is not new, we are not aware of a system that fulfills Learn-Alpha and is able to deal with large corpora. To instance four major challenges of constructing such a system, it should be mentioned that a) the high number of possible structural descriptions caused by highly underspeci ed lexical entries demands for a parser with a very effective ambiguity management system, b) the automatic construction of concise lexical entries out of a bulk of observed lexical facts requires a special technique of data alignment, c) the reliability of these entries depends on the system's decision on whether it has seen 'enough' input and d) general properties of language might render some lexical features indeterminable if the system tries to acquire them with a too high precision. The cornerstone of this dissertation is the motivation and development of a general theory of automatic lexical acquisition that is applicable to every language and independent of any particular theory of grammar or lexicon. This work is divided into five chapters. The introductory chapter first contrasts three different and mutually incompatible approaches to (artificial) lexical acquisition: cue-based queries, head-lexicalized probabilistic context free grammars and learning by unification. Then the postulation of the Learn-Alpha design rule is presented. The second chapter outlines the theory that underlies Learn-Alpha and exposes all the related notions and concepts required for a proper understanding of artificial lexical acquisition. Chapter 3 develops the prototyped acquisition method, called ANALYZE-LEARN-REDUCE, a framework which implements Learn-Alpha. The fourth chapter presents the design and results of a bootstrapping experiment conducted on this prototype: lexeme detection, learning of verbal valency, categorization into nominal count/mass classes, selection of prepositions and sentential complements, among others. The thesis concludes with a review of the conclusions and motivation for further improvements as well as proposals for future research on the automatic induction of lexical features.

Antigen-dependent induction of a CD40 signal in peripheral B cells

Monoclonal antibodies have emerged as one of the most promising therapeutics in oncology over the last decades. The generation of fully human tumorantigen-specific antibodies suitable for anti-tumor therapy is laborious and difficult to achieve. Autoreactive B cells expressing those antibodies are detectable in cancer patients and represent a suitable source for human antibodies. However, the isolation and cultivation of this cell type is challenging. A novel method was established to identify antigen-specific B cells. The method is based on the conversion of the antigen independent CD40 signal into an antigen-specific one. For that, the artificial fusion proteins ABCos1 and ABCos2 (Antigen-specific B cell co-stimulator) were generated, which consist of an extracellular association-domain derived from the constant region of the human immunoglobulin (Ig) G1, a transmembrane fragment and an intracellular signal transducer domain derived of the cytoplasmic domain of the human CD40 receptor. By the association with endogenous Ig molecules the heterodimeric complex allows the antigen-specific stimulation of both the BCR and CD40. In this work the ability of the ABCos constructs to associate with endogenous IgG molecules was shown. Moreover, crosslinking of ABCos stimulates the activation of NF-κB in HEK293-lucNifty and induces proliferation in B cells. The stimulation of ABCos in transfected B cells results in an activation pattern different from that induced by the conventional CD40 signal. ABCos activated B cells show a mainly IgG isotype specific activation of memory B cells and are characterized by high proliferation and the differentiation into plasma cells. To validate the approach a model system was conducted: B cells were transfected with IVT-RNA encoding for anti-Plac1 B cell receptor (antigen-specific BCR), ABCos or both. The stimulation with the BCR specific Plac1 peptide induces proliferation only in the cotransfected B cell population. Moreover, we tested the method in human IgG+ memory B cells from CMV infected blood donors, in which the stimulation of ABCos transfected B cells with a CMV peptide induces antigen-specific expansion. These findings show that challenging ABCos transfected B cells with a specific antigen results in the activation and expansion of antigen-specific B cells and not only allows the identification but also cultivation of these B cells. The described method will help to identify antigen-specific B cells and can be used to characterize (tumor) autoantigen-specific B cells and allows the generation of fully human antibodies that can be used as diagnostic tool as well as in cancer therapy.

Untersuchungen zum Einfluss von NBN, ATM und ATR auf die Alkylanzien-induzierte Toxizität

In der vorliegenden Arbeit wurde der Einfluss der DNA-Reparaturenzyme NBN, ATM und ATR, die wichtige Funktionen während der Reparatur von DNA-Doppelstrangbrüchen (DSBs) besitzen, auf die Alkylanzien-induzierte Toxizität untersucht. Dabei konnte gezeigt werden, dass verschiedene menschliche Zelllinien, welche eine Beeinträchtigung in einem dieser drei Gene aufweisen, eine erhöhte Sensitivität gegenüber N-Methyl-N'-Nitro-N-Nitrosoguanidin (MNNG) und dem Chemotherapeutikum Temozolomid (TMZ) zeigen. Da das DNA-Reparaturenzym MGMT die Zellen vor der Induktion des Zelltods schützt, kann geschlussfolgert werden, dass die Hypersensitivität der mutierten Zelllinien auf die O6-MeG-Läsion zurückzuführen ist. Es konnte gezeigt werden, dass Mutationen von NBN oder ATM nicht zu einer verminderten Kapazität der Basen-Exzisions-Reparatur (BER) führen. Somit ist die erhöhte Sensitivität der mutierten Zellen sehr wahrscheinlich auf eine verminderte Reparatur der DSBs zurückzuführen, welche durch die O6-MeG-Läsion induziert werden. Damit konnte NBN, ATM und ATR als neue Faktoren in der Abwehr gegen Alkylanzien-induzierte Toxizität identifiziert werden. Dies ist von großer klinischer Bedeutung, da einerseits die drei Proteine als therapeutisches Angriffsziel Bedeutung gewinnen und andererseits verschiedene Tumore, die in der Klinik mit alkylierenden Agenzien behandelt werden, Mutationen in diesen Genen tragen.rnrnWeiterhin wurde beobachtet, dass NBN- und ATM-defiziente Zellen nach Behandlung mit methylierenden Agenzien eine ungewöhnlich hohe Nekrose-Rate aufweisen. Es konnte gezeigt werden, dass diese unabhängig von einer PARP1-Aktivierung induziert wird. Dennoch wurde in den NBN- und ATM-mutierten Zelllinien im Gegensatz zum Wildtyp eine sehr starke Verminderung der ATP-Menge nach MNNG-Behandlung beobachtet. Diese wird durch das Fehlen einer effektiven Aktivierung der AMP-Kinase in diesen Zellen verursacht. Somit kann angenommen werden, dass die hohe Nekrose-Rate auf eine ATP-Depletion zurückzuführen ist, welche durch die nicht ausreichende AMP-Kinase-Aktivierung in diesen Zellen bedingt wird. Daher konnte NBN und ATM als Faktoren des zellulären Schutzes gerichtet gegen die Induktion der „programmierten Nekrose“ identifiziert werden. Dies ist ebenfalls von klinischer Bedeutung. Tragen Tumorzellen von Tumoren, welche mit methylierenden Agenzien behandelt werden, Mutationen in einem dieser Gene, so muss mit einer vermehrten Induktion von Nekrose und daher mit einer Stimulierung des Immunsystems während der Chemotherapie gerechnet werden. Dies wäre einerseits mit erhöhten Nebenwirkungen, die sich insbesondere durch Entzündungsreaktionen äußern, verbunden. Andererseits zeigen verschiedene Arbeiten, dass die Stimulation des Immunsystems durch sterbende Tumorzellen während der Chemotherapie die Tumorregression positiv beeinflussen kann.

In vitro characterisation and expansion of human regulatory T cells for their in vivo application in the induction of tolerance in haematopoietic stem cell and solid organ transplantation

Solid organ transplantation (SOT) is considered the treatment of choice for many end-stage organ diseases. Thus far, short term results are excellent, with patient survival rates greater than 90% one year post-surgery, but there are several problems with the long term acceptance and use of immunosuppressive drugs. Hematopoietic Stem Cells Transplantation (HSCT) concerns the infusion of haematopoietic stem cells to re-establish acquired and congenital disorders of the hematopoietic system. The main side effect is the Graft versus Host Disease (GvHD) where donor T cells can cause pathology involving the damage of host tissues. Patients undergoing acute or chronic GvHD receive immunosuppressive regimen that is responsible for several side effects. The use of immunosuppressive drugs in the setting of SOT and GvHD has markedly reduced the incidence of acute rejection and the tissue damage in GvHD however, the numerous adverse side effects observed boost the development of alternative strategies to improve the long-term outcome. To this effect, the use of CD4+CD25+FOXP3+ regulatory T cells (Treg) as a cellular therapy is an attractive approach for autoimmunity disease, GvHD and limiting immune responses to allograft after transplantation. Treg have a pivotal role in maintaining peripheral immunological tolerance, by preventing autoimmunity and chronic inflammation. Results of my thesis provide the characterization and cell processing of Tregs from healthy controls and patients in waiting list for liver transplantation, followed by the development of an efficient expansion-protocol and the investigation of the impact of the main immunosuppressive drugs on viability, proliferative capacity and function of expanded cells after expansion. The conclusion is that ex vivo expansion is necessary to infuse a high Treg dose and although many other factors in vivo can contribute to the success of Treg therapy, the infusion of Tregs during the administration of the highest dose of immunosuppressants should be carefully considered.