Detection of CD8+ T cell Responses in Individuals with Long-term Type 1 Diabetes and Generation of Human CD8+ T Cell Lines Specific to Islet-associated Autoantigens

Type 1 diabetes (T1D) is an autoimmune disease characterized by the activation of lymphocytes against insulin-producing β-cells in the pancreas. In humans, CD8+ T cells are predominantly found in sites of insulitis and are considered to be one of the main drivers of β-cell destruction, thus indicating the need to analyze the frequency and function of these autoreactive CD8+ T cells. Peripheral blood mononuclear cells (PBMC) from individuals with long-term T1D were stained ex vivo for T cell surface markers and HLA-A2 pentamers containing known islet-associated epitopes to determine if there are autoreactive CD8+ T cells circulating in the periphery. All T1D donors tested had at least one detectable autoreactive CD8 T cell population and the frequencies of these autoantigen-specific T cells were comparable to previously published data from T1D individuals. We then developed a method of establishing CD8 T cell lines by co-culturing negatively isolated CD8 T cells and peptide-pulsed monocyte-derived dendritic cells from the PBMC of one T1D donor (A*02:01, A*33:01, B*14:02, B*40:01, DRB1*01:02, DRB1*04:04). We expanded a CD8 T cell line specific to the preproinsulin peptide PPI15-24. This cell line produced IFN-γ and expressed CD107a in the presence of PPI15-24-pulsed target cells, but not to an unrelated peptide or media alone. Using a similar approach, we were able to generate CD8 T cell lines from the same T1D donor that were cytotoxic to target cells pulsed with the autoantigens glutamic acid decarboxylase peptide (GAD65114-123) and islet-specific glucose-6-phosphatase catalytic subunit-related protein peptide (IGRP265-273). These autoreactive T cell lines can be utilized in in vivo assays using humanized mouse models to further understand the mechanism of β-cell destruction and disease progression. Studying the functionalities of these autoreactive T cells will also provide insights into identifying immune correlates to better assess both novel and existing immunotherapeutic strategies for T1D

Cystic fibrosis-related diabetes is caused by islet loss and inflammation

Cystic fibrosis-related (CF-related) diabetes (CFRD) is an increasingly common and devastating comorbidity of CF, affecting approximately 35% of adults with CF. However, the underlying causes of CFRD are unclear. Here, we examined cystic fibrosis transmembrane conductance regulator (CFTR) islet expression and whether the CFTR participates in islet endocrine cell function using murine models of beta cell CFTR deletion and normal and CF human pancreas and islets. Specific deletion of CFTR from murine beta cells did not affect beta cell function. In human islets, CFTR mRNA was minimally expressed, and CFTR protein and electrical activity were not detected. Isolated CF/CFRD islets demonstrated appropriate insulin and glucagon secretion, with few changes in key islet-regulatory transcripts. Furthermore, approximately 65% of beta cell area was lost in CF donors, compounded by pancreatic remodeling and immune infiltration of the islet. These results indicate that CFRD is caused by beta cell loss and intraislet inflammation in the setting of a complex pleiotropic disease and not by intrinsic islet dysfunction from CFTR mutation

Umbilical Cord Tissue-Derived Mesenchymal Stem Cells Inhibit T Cell Response to Peptide

Mesenchymal stem cells (MSC) have been shown to possess immunomodulatory properties that highlight their potential as a cellular therapy for autoimmune disease. We propose to examine the in vitro potential of stem cells derived from umbilical cord tissue to suppress the effector functions of human auto-reactive T cells. While the mechanism(s) of suppression of T cell function are not fully understood, it has been hypothesized that MSC-derived immunosuppressive soluble factors and cell-to-cell contact are important. We developed an in vitro culture assay to assess the effects of umbilical cord derived MSC (TC-MSC) on T cell function. Various doses of low-passage TC-MSCs were adhered to collagen-coated 96 well plates or in the lower chamber wells of transwell plates. HLA-matched EBV transformed B cells were pulsed +/- with appropriate autoantigenic peptide and cultured with adherent MSC or in the upper transwell chambers with the appropriate T cell clone. After 48 hours, cells were stained for CD4 and stained intracellularly for IFN-γ and analyzed by flow cytometry. We observed decreased T cell effector function with MSC co-culture and this was partially restored by separation of MSC and T cell+B cell+peptide in the transwell. We examined if prostaglandin E2 derived from the MSC also contributed to decreased T cell effector function. The inclusion of a COX-2 inhibitor in the culture system led to partially restored T cell effector function. We conclude that TC-MSC-derived soluble factor(s) and TC-MSC:T cell contact both contribute to the TC-MSC’s immunosuppressive effects. Primary TC-MSC isolates (with no prior cell culture) will also be tested in this system to determine if they possess similar immunosuppressive effects as adherent, cultured TC-MSC. These studies will pinpoint the functional mechanisms of the TC-MSC immunomodulatory properties on T cell effector function and may suggest avenues of enhancing MSC function in the treatment of autoimmune disease

Proinsulin-Reactive CD4 T Cells in the Islets of Type 1 Diabetes Organ Donors

Proinsulin is an abundant protein that is selectively expressed by pancreatic beta cells and has been a focus for development of antigen-specific immunotherapies for type 1 diabetes (T1D). In this study, we sought to comprehensively evaluate reactivity to preproinsulin by CD4 T cells originally isolated from pancreatic islets of organ donors having T1D. We analyzed 187 T cell receptor (TCR) clonotypes expressed by CD4 T cells obtained from six T1D donors and determined their response to 99 truncated preproinsulin peptide pools, in the presence of autologous B cells. We identified 14 TCR clonotypes from four out of the six donors that responded to preproinsulin peptides. Epitopes were found across all of proinsulin (insulin B-chain, C-peptide, and A-chain) including four hot spot regions containing peptides commonly targeted by TCR clonotypes derived from multiple T1D donors. Of importance, these hot spots overlap with peptide regions to which CD4 T cell responses have previously been detected in the peripheral blood of T1D patients. The 14 TCR clonotypes recognized proinsulin peptides presented by various HLA class II molecules, but there was a trend for dominant restriction with HLA-DQ, especially T1D risk alleles DQ8, DQ2, and DQ8-trans. The characteristics of the tri-molecular complex including proinsulin peptide, HLA-DQ molecule, and TCR derived from CD4 T cells in islets, provides an essential basis for developing antigen-specific biomarkers as well as immunotherapies

IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT) : cluster randomised controlled trial study protocol

Background: Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidencebased clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim: This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design: This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters), which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the control arm will receive access to the guideline using the existing dissemination strategy. Practitioners in the intervention arm will be invited to participate in facilitated face-to-face workshops that have been underpinned by behavioural theory. Investigators (not involved in the delivery of the intervention), patients, outcome assessors and the study statistician will be blinded to group allocation. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN012606000098538 (date registered 14/03/2006).The trial is funded by the NHMRC by way of a Primary Health Care Project Grant (334060). JF has 50% of her time funded by the Chief Scientist Office3/2006). of the Scottish Government Health Directorate and 50% by the University of Aberdeen. PK is supported by a NHMRC Health Professional Fellowship (384366) and RB by a NHMRC Practitioner Fellowship (334010). JG holds a Canada Research Chair in Health Knowledge Transfer and Uptake. All other authors are funded by their own institutions

Broad Repertoire of T Cell Autoreactivity Directly from Islets of Donors with Type 1 Diabetes (T1D)

Type 1 diabetes (T1D) is an autoimmune disease characterized by the infiltration of lymphocytes into the insulin-producing β-cells in the pancreas. We have isolated live T cells sorted or grown directly from the isolated, handpicked islets of human donors with T1D. We received ~500 islet equivalent EQ of variable purity (10-90%) from 12 donors with T1D (disease duration 0.42-20 years) and from seven control donors and two donors with type 2 diabetes (T2D). A total of 321 T cell lines and clones were derived from the islets of donors with T1D (3 lines from the 9 control donors). These are 131 CD4+ lines and clones, 47 CD8+ lines and 143 lines that contain both CD4+ and CD8+ T cells. From 50 lines and clones examined to date, we have determined the autoreactivity of 19 and have seen a broad repertoire of T cell autoreactivity in the islets, including characterized targets and post-translationally modified targets. Autoreactivity of CD4+ T cell lines was to three different peptides from glutamic acid decarboxylase 65 (GAD; GAD115-127, GAD274-286, GAD555-567), proinsulin76-90, and to chromogranin A or proinsulin expressed by DR4+DQ8+ B cells transduced with lentivirus containing constructs with the open reading frames corresponding to whole autoantigens. Reactivity to modified peptides included the glucose-regulated protein 78 and islet amyloid polypeptide with arginine to citrulline modifications (GRP78292-305(Arg-Cit297) and IAPP65-84(Arg-Cit 73, 81)), deaminations (IA-2545-562(Gln-Glu 548, 551, 556), and to several insulin hybrid peptides. These autoreactive CD4+ T cell lines and clones secreted only pro-inflammatory cytokines (IFN-γ, TNFα) upon peptide stimulation. For CD8+ T cells from islets, from one donor with T1D, we saw binding of a pool of HLA-A2 pentamers loaded with insulin B10-18, IA-2797-805 and insulin specific glucose-6-phosphatase catalytic subunit related protein, IGRP265-273. These results have implications for the development of successful prevention and reversal therapeutic strategies in T1D

Palladin Mutation Causes Familial Pancreatic Cancer and Suggests a New Cancer Mechanism

BACKGROUND: Pancreatic cancer is a deadly disease. Discovery of the mutated genes that cause the inherited form(s) of the disease may shed light on the mechanism(s) of oncogenesis. Previously we isolated a susceptibility locus for familial pancreatic cancer to chromosome location 4q32–34. In this study, our goal was to discover the identity of the familial pancreatic cancer gene on 4q32 and determine the function of that gene. METHODS AND FINDINGS: A customized microarray of the candidate chromosomal region affecting pancreatic cancer susceptibility revealed the greatest expression change in palladin (PALLD), a gene that encodes a component of the cytoskeleton that controls cell shape and motility. A mutation causing a proline (hydrophobic) to serine (hydrophilic) amino acid change (P239S) in a highly conserved region tracked with all affected family members and was absent in the non-affected members. The mutational change is not a known single nucleotide polymorphism. Palladin RNA, measured by quantitative RT-PCR, was overexpressed in the tissues from precancerous dysplasia and pancreatic adenocarcinoma in both familial and sporadic disease. Transfection of wild-type and P239S mutant palladin gene constructs into HeLa cells revealed a clear phenotypic effect: cells expressing P239S palladin exhibited cytoskeletal changes, abnormal actin bundle assembly, and an increased ability to migrate. CONCLUSIONS: These observations suggest that the presence of an abnormal palladin gene in familial pancreatic cancer and the overexpression of palladin protein in sporadic pancreatic cancer cause cytoskeletal changes in pancreatic cancer and may be responsible for or contribute to the tumor's strong invasive and migratory abilities

Southern Ocean Action Plan (2021-2030) in support of the United Nations Decade of Ocean Science for Sustainable Development

In 2017, the United Nations proclaimed a Decade of Ocean Science for Sustainable Development (hereafter referred to as the UN Ocean Decade) from 2021 until 2030 to support efforts to reverse the cycle of decline in ocean health. To achieve this ambitious goal, this initiative aims to gather ocean stakeholders worldwide behind a common framework that will ensure ocean science can fully support countries in creating improved conditions for sustainable development of the world’s oceans. The initiative strives to strengthen the international cooperation needed to develop the scientific research and innovative technologies that can connect ocean science with the needs of society at the global scale. Based on the recommendations in the Implementation Plan of the United Nations Decade of Ocean Science for Sustainable Development (Version 2.0, July 2021), the Southern Ocean community engaged in a stakeholder - oriented process to develop the Southern Ocean Action Plan. The Southern Ocean process engaged a broad community, which includes the scientific research community, the business and industry sector, and governance and management bodies. As part of this global effort, the Southern Ocean Task Force identified the needs of the Southern Ocean community to address the challenges related to the unique environmental characteristics and governance structure of the Southern Ocean. Through this community-driven process, we identified synergies within the Southern Ocean community and beyond in order to elaborate an Action Plan that provides a framework for Southern Ocean stakeholders to formulate and develop tangible actions and deliverables that support the UN Ocean Decade vision. Through the publication of this Action Plan, the Southern Ocean Task Force aims to mobilise the Southern Ocean community and inspire all stakeholders to seek engagement and leverage opportunities to deliver innovative solutions that maintain and foster the unique conditions of the Southern Ocean. This framework provides an initial roadmap to strengthen links between science, industry and policy, as well as to encourage internationally collaborative activities in order to address existing gaps in our knowledge and data coverage

In-Vivo Biodistribution and Safety of 99mTc-LLP2A-HYNIC in Canine Non-Hodgkin Lymphoma

Theranostic agents are critical for improving the diagnosis and treatment of non-Hodgkin Lymphoma (NHL). The peptidomimetic LLP2A is a novel peptide receptor radiotherapy candidate for treating NHL that expresses the activated α4β1 integrin. Tumor-bearing dogs are an excellent model of human NHL with similar clinical characteristics, behavior, and compressed clinical course. Canine in vivo imaging studies will provide valuable biodistribution and affinity information that reflects a diverse clinical population of lymphoma. This may also help to determine potential dose-limiting radiotoxicity to organs in human clinical trials. To validate this construct in a naturally occurring model of NHL, we performed in-vivo molecular targeted imaging and biodistribution in 3 normal dogs and 5 NHL bearing dogs. 99mTc-LLP2A-HYNIC-PEG and 99mTc-LLP2A-HYNIC were successfully synthesized and had very good labeling efficiency and radiochemical purity. 99mTc-LLP2A-HYNIC and 99mTc-LLP2A-HYNIC-PEG had biodistribution in keeping with their molecular size, with 99mTc-LLP2A-HYNIC-PEG remaining longer in the circulation, having higher tissue uptake, and having more activity in the liver compared to 99mTc-LLP2A-HYNIC. 99mTc-LLP2A-HYNIC was mainly eliminated through the kidneys with some residual activity. Radioactivity was reduced to near-background levels at 6 hours after injection. In NHL dogs, tumor showed moderately increased activity over background, with tumor activity in B-cell lymphoma dogs decreasing after chemotherapy. This compound is promising in the development of targeted drug-delivery radiopharmaceuticals and may contribute to translational work in people affected by non-Hodgkin lymphoma