• 5 Year Expression and Neutrophil Defect Repair after Gene Therapy in Alpha-1 Antitrypsin Deficiency

      Mueller, Christian; Gernoux, Gwladys; Gruntman, Alisha M.; Borel, Florie; Reeves, Emer P.; Calcedo, Roberto; Rouhani, Farshid N.; Yachnis, Anthony; Humphries, Margaret; Campbell-Thompson, Martha; et al. (2017-06-07)
      Alpha-1 antitrypsin deficiency is a monogenic disorder resulting in emphysema due principally to the unopposed effects of neutrophil elastase. We previously reported achieving plasma wild-type alpha-1 antitrypsin concentrations at 2.5%-3.8% of the purported therapeutic level at 1 year after a single intramuscular administration of recombinant adeno-associated virus serotype 1 alpha-1 antitrypsin vector in alpha-1 antitrypsin deficient patients. We analyzed blood and muscle for alpha-1 antitrypsin expression and immune cell response. We also assayed previously reported markers of neutrophil function known to be altered in alpha-1 antitrypsin deficient patients. Here, we report sustained expression at 2.0%-2.5% of the target level from years 1-5 in these same patients without any additional recombinant adeno-associated virus serotype-1 alpha-1 antitrypsin vector administration. In addition, we observed partial correction of disease-associated neutrophil defects, including neutrophil elastase inhibition, markers of degranulation, and membrane-bound anti-neutrophil antibodies. There was also evidence of an active T regulatory cell response (similar to the 1 year data) and an exhausted cytotoxic T cell response to adeno-associated virus serotype-1 capsid. These findings suggest that muscle-based alpha-1 antitrypsin gene replacement is tolerogenic and that stable levels of M-AAT may exert beneficial neutrophil effects at lower concentrations than previously anticipated.
    • Interplay between IL-10, IFN-gamma, IL-17A and PD-1 Expressing EBNA1-Specific CD4(+) and CD8(+) T Cell Responses in the Etiologic Pathway to Endemic Burkitt Lymphoma

      Forconi, Catherine; Mulama, David H.; Saikumar Lakshmi, Priya; Foley, Joslyn; Otieno, Juliana A.; Kurtis, Jonathan D.; Berg, Leslie J.; Ong'echa, John M.; Munz, Christian; Moormann, Ann M. (2021-10-27)
      Children diagnosed with endemic Burkitt lymphoma (eBL) are deficient in interferon-gamma (IFN-gamma) responses to Epstein-Barr Nuclear Antigen1 (EBNA1), the viral protein that defines the latency I pattern in this B cell tumor. However, the contributions of immune-regulatory cytokines and phenotypes of the EBNA1-specific T cells have not been characterized for eBL. Using a bespoke flow cytometry assay we measured intracellular IFN-gamma, IL-10, IL-17A expression and phenotyped CD4(+) and CD8(+) T cell effector memory subsets specific to EBNA1 for eBL patients compared to two groups of healthy children with divergent malaria exposures. In response to EBNA1 and a malaria antigen (PfSEA-1A), the three study groups exhibited strikingly different cytokine expression and T cell memory profiles. EBNA1-specific IFN-gamma-producing CD4(+) T cell response rates were lowest in eBL (40%) compared to children with high malaria (84%) and low malaria (66%) exposures (p < 0.0001 and p = 0.0004, respectively). However, eBL patients did not differ in CD8(+) T cell response rates or the magnitude of IFN-gamma expression. In contrast, eBL children were more likely to have EBNA1-specific CD4(+) T cells expressing IL-10, and less likely to have polyfunctional IFN-gamma(+)IL-10(+) CD4(+) T cells (p = 0.02). They were also more likely to have IFN-gamma(+)IL-17A(+), IFN-gamma(+) and IL-17A(+) CD8(+) T cell subsets compared to healthy children. Cytokine-producing T cell subsets were predominantly CD45RA(+)CCR7(+) TNAIVE-LIKE cells, yet PD-1, a marker of persistent activation/exhaustion, was more highly expressed by the central memory (TCM) and effector memory (TEM) T cell subsets. In summary, our study suggests that IL-10 mediated immune regulation and depletion of IFN-gamma(+) EBNA1-specific CD4(+) T cells are complementary mechanisms that contribute to impaired T cell cytotoxicity in eBL pathogenesis.