Islet transplantation is a developing therapy for type 1 diabetic patients (T1D), which has been limited by problems associated with hypoxia, poor revascularisation and allograft rejection. Immunosuppressive agents used to prevent rejection are associated with severe side effects including islet toxicity, increased susceptibility to the development of cancer, infections and cardio-vascular problems. In order for islet transplantation to be used widely as a potentially curative treatment for T1D there is a need to develop novel therapies to treat allograft rejection without the use of immunosuppressive agents. In chapter 3, the immunomodulatory effects of IFN-γ on human monocyte-derived DC were investigated, using a standard 7-day in vitro DC propagation protocol. IFN-γ was shown to exert its immunomodulatory function on monocytes early during DC differentiation (IFNγ-DC[subscript]D0), resulting in an immature DC (iDC) phenotype with reduced expression of maturation markers CD83 and RelB. IFNγ-DC[subscript]D0 induced a state of T-cell hyporesponsiveness in a MLR, whilst IFN-γ treatment at day 5 (IFNγ-DC[subscript]D5) did not modulate DC function. The ability of IFN-γ to promote the generation of maturation arrested DC, could potentially serve as a cellular therapy for transplant rejection. However DC propagation using the standard 7-10 day protocol is not clinically applicable in the islet transplant setting. In chapter 4, a 'FAST-DC' protocol to promote the rapid generation of tolerogenic DC was investigated and used to generate IFNγ modulated DC in 48h. These IFNγ-DC featured an iDC phenotype similar to that seen in chapter 3. Maturation arrested IFNγ-DC caused significant T-cell hyporesponsiveness and promoted a higher frequency of CD4+CD25+ Foxp3[superscript]HI T-regulatory cells. IFNγ-DC primed T-cells were shown to be functionally suppressive in an antigen specific manner. It was also confirmed that IFN-γ reduced the phosphorylation of IL-4 activated STAT-6, which in turn affected the downstream gene expression of Interferon regulatory factor 4 (IRF4). IFNγ-DC were also investigated in vivo, where a humanised model of islet allo-transplantation model was developed. Diabetic NOD-SCID mice were transplanted with human islets and challenged with donor-derived DC and allogeneic PBMNC. After 21 days post transplantation, there was no significant change to euglycaemic state, between the tested groups. Genetic modification of the allograft is an alternative therapy to protecting the graft from the recipient‟s immune system. In chapter 5, human islets were genetically modified with programmed cell death ligand 2 (PD-L2), an inhibitory molecule known inhibit T-cell immune responses. Two recombinant adenovirus constructs carrying the PD-L2 gene were generated. One construct encoded a soluble isoform, while the other expressed a full transmembrane PD-L2 molecule. Adenoviral transduction did not affect the viability or insulin producing capacity of islets. Interestingly, soluble PD-L2 was more efficient at inducing signalling by 1000 fold, compared to the transmembrane isoform. In summary, this thesis demonstrated the timing of IFN-γ exposure is crucial in determining the function of DC and their maturational state, where IFN-γ exposure only during DC differentiation resulted in the inhibition of DC maturation. Secondly, the combination of IFN-γ and a FAST-DC protocol, enabled the generation of tolerogenic DC in 48h, making DC therapy more clinically applicable. Finally, the induced expression of soluble PD-L2 by human islets potently signals through human PD-1, which may provide the basis for the protection of islets from allo- and auto T-cell responses.Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 201
