Posttransplant lymphoproliferative disorders (PTLDs) represent life-threatening complications of bone marrow and solid organ transplantation (SOTx). These are B-cell malignancies triggered by Epstein-Barr Virus (EBV) infection in chronically immunosuppressedRestoration of protective anti-Epstein-Barr Virus (anti-EBV) T-cell immunity by adoptive transfer of ex vivo expanded EBV-specific cytotoxic T lymphocytes (CTLs) has been shown to be a safe and effective approach to prevent or treat posttransplant lymphoproliferative disorders (PTLDs) in bone marrow transplant recipients (1-3). Standard published protocols emphasize the effectiveness of using autologous lymphoblastoid cell lines (LCLs) as stimulator cells in boosting memory immune responses to EBV in vitro (2,3). However this same approach has not proven effective in priming naïve anti-EBV T cells in vitro (4,5). As EBV − SOTx recipients are at high risk of developing PTLD, we have been interested in establishing protocols to generate EBV-specific CTLs from these individuals. Studies performed by other groups, and in our laboratory, have recently established the key role of using dendritic cells (DCs) as antigen-presenting cells in activating naïve T cells against EBV epitopes (6,7). In the current study we wanted to assess and compare the ability of DCs loaded with necrotic/apoptotic LCLs in cross-priming autologous naïve EBV-reactive T cells vs. boosting memory T cells, and to further characterize the quality of the resulting immune responses.The CTL lines were evaluated by flow cytometry analyses with MHC Class I/peptide tetramers and mAbs to detect memory/activation markers, ELISPOT analysis for IFN-c production, and in cytotoxicity tests. Results indicate that in our system, in vitro cross-priming promotes both activated poly-epitope viral-specific CD8+ CTLs and Th1-type CD4+ T-cell responses in EBV − donors. The polarized Type 1 pattern of cytokine expression induced by DCs fed with apoptotic/necrotic LCLs correlated with the ability of T cells to mediate cytotoxicity against autologous LCLs, which was further enhanced by addition of rhIL-12 in the first round of in vitro stimulation. These results support the prospective development of DC-based cellular immunotherapy for EBV − SOTx patients at high risk of developing PTLD or patients with refractory PTLD.
Materials and Methods
Human subjectsSeven immunocompetent adult volunteers were recruited in this study following informed consent under IRB-approved protocol. Peripheral blood mononuclear cells (PBMCs) were isolated from heparinized blood (8), while sera served as material for determination of EBV status.
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