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tel-00827710, version 1 - 29 May 2013 5) Different T cell activation depending on the timing of activation? Our immunoscope data (Figures 29 and 30), as well as the work from Van Heijst (van Heijst et al., 2009), suggest that the route of immunization will not impact T cell recruitment and or T cell activation because the recruitment occurs rapidly regarless the site of immunization. However other studies have investigated the timing of T cell recruitment to lymphoid organs upon immunization and demonstrated that this timing plays a role in the differential activation of these cells after immunization. Specifically, they compared naïve T cells that are already present in the draining lymphoid organ at the time of immunization to the “latecomer” T cells that are recruited later to the lymphoid tissue after immunization. Catron and colleagues studied CD4 + T cell responses after i.d. immunization of antigen and isolated the lymphoid resident T cells from the ‘latecomers” using treatment with an anti-CD62L antibody to prevent latecomer T cell entry into lymph node (Catron et al., 2006). They showed that the latecomer cells divided less due to a lower density of peptide-MHC-II complexes on DC surfaces and competition with T cells that already divided and, thus, became central-memory cells. D’Souza et al. did similar studies for CD8 + T cells after viral infection. They compared activation and differentiation of low numbers of specific T cells that were transferred at the time of, or several days after infection. They observed that the timing of recruitment had a substantial impact on the differentiation program of T cells (D'Souza and Hedrick, 2006). These studies can be directly compared to the work reported here. Upon i.d. immunization, antigen cross-presentation remains localized mainly in the skin-draining lymph node. Some naïve T cells are resident in this lymphoid organ at the time of injection. Other, recirculating naïve T cells will be attracted via inflammatory signals and will enter this lymph node over the course of a prolonged period of time, thereby resulting in the non-synchronous activation of antigen-specific T cells. It is possible that T cells that arrive later may receive less stimulatory signals and are incompetition with specific T cells that have already divided. This differential activation based on timing of recruitment and inter-cellular competition for stimulatory signals may explain the extensive diversity of functional T cells generated after i.d. immunization. In contrast, i.v. immunization induces a systemic dissemination of antigen and allows for a more simultaneous activation of antigen-specific T cells, resulting in a relatively functionally homogenous T cell population. C. Clinical applications Our studies strongly highlight the importance of considering the route of immunization and persistence of antigen presentation in the design of clinical trials and vaccine strategies. 152

tel-00827710, version 1 - 29 May 2013 Moreover, the data clearly suggest that intradermal injection is the optimal strategy for achieving robust CD8 + T cell cross-priming. Although initially the model of Ovalbumin- expressing splenocytes appears to be very distant from physiologically relevant conditions, this form of cell-associated antigen is being used in clinics. Russo and Fontana have conducted pre-clinical and clinical studies utilizing peripheral blood lymphocytes genetically modified to express tumor antigens as a strategy for inducing tumor immunity in cancer patients (Russo et al., 2007; Fontana et al., 2009). In their treatment protocols, patients received five bi-weekly, i.v. infusions of escalating doses of 5x10 8 total lymphocytes on average (range: 2-7x10 8 ). Their clinical trial was not initially designed with the goal of assessing efficacy; nonetheless, it was possible to observe clinical responses in 3/10 patients, which correlated to the priming of Mage-3 specific CD8 + T cells. These preliminary studies highlight the feasibility of utilizing cell-associated antigen as a means of immunizing patients. Additionally, the use of T cells as antigen vehicles for vaccination has recently been described (Bear et al., 2011). These cells were able to migrate by themselves to lymphoid organs after immunization where the activation of antigen-specific T cells by DCs will occur. This mechanism provides an advantage, as compared to the injection of antigen-loaded DCs, which may remain at the site of injection and limit vaccination efficiency. Since one crucial limitation of existing cell-based vaccines is the access to lymphoid organs, it may appear that the i.v. route may be optimal since antigen would be disseminated systemically. In fact, this route has been chosen by Fontana and colleagues for their clinical trial (Fontana et al., 2009). However, our data suggest that they may obtain more efficient anti-tumor responses by immunizing patients via the i.d. route. Furthermore, in a practical sense, local immunizations are more straightforward and easier to perform on patients, as compared to i.v. inoculation. While T cells may appear to have some advantages when acting as antigen vehicles, as compared to DCs, there remains the limitation that, in vivo, T cells do not express high levels of costimulatory molecules and inflammatory cytokines. This means that DCs would still have to be activated in parallel with the vaccination. It may be possible to accomplish this by genetically modifying T cells to express molecules that are able to induce DC maturation, in addition to carrying the antigen. TLR ligands, such as flagellin, which can be easily artificially expressed in T cells might be a good candidate to use for this approach, as well as CD40 ligand. Page 153 of 256

tel-00827710, version 1 - 29 May 2013<br />

5) Different T cell activation <strong>de</strong>pending on the timing of activation?<br />

Our immunoscope data (Figures 29 and 30), as well as the work from Van Heijst (van Heijst<br />

<strong>et</strong> al., 2009), suggest that the route of immunization will not impact T cell recruitment and or<br />

T cell activation because the recruitment occurs rapidly regarless the site of immunization.<br />

However other studies have investigated the timing of T cell recruitment to lymphoid organs<br />

upon immunization and <strong>de</strong>monstrated that this timing plays a role in the differential activation<br />

of these cells after immunization. Specifically, they compared naïve T cells that are already<br />

present in the draining lymphoid organ at the time of immunization to the “latecomer” T cells<br />

that are recruited later to the lymphoid tissue after immunization. Catron and colleagues<br />

studied CD4 + T cell responses after i.d. immunization of antigen and isolated the lymphoid<br />

resi<strong>de</strong>nt T cells from the ‘latecomers” using treatment with an anti-CD62L antibody to<br />

prevent latecomer T cell entry into lymph no<strong>de</strong> (Catron <strong>et</strong> al., 2006). They showed that the<br />

latecomer cells divi<strong>de</strong>d less due to a lower <strong>de</strong>nsity of pepti<strong>de</strong>-MHC-II complexes on DC<br />

surfaces and comp<strong>et</strong>ition with T cells that already divi<strong>de</strong>d and, thus, became central-memory<br />

cells. D’Souza <strong>et</strong> al. did similar studies for CD8 + T cells after viral infection. They compared<br />

activation and differentiation of low numbers of specific T cells that were transferred at the<br />

time of, or several days after infection. They observed that the timing of recruitment had a<br />

substantial impact on the differentiation program of T cells (D'Souza and Hedrick, 2006).<br />

These studies can be directly compared to the work reported here. Upon i.d. immunization,<br />

antigen cross-presentation remains localized mainly in the skin-draining lymph no<strong>de</strong>. Some<br />

naïve T cells are resi<strong>de</strong>nt in this lymphoid organ at the time of injection. Other, recirculating<br />

naïve T cells will be attracted via inflammatory signals and will enter this lymph no<strong>de</strong> over<br />

the course of a prolonged period of time, thereby resulting in the non-synchronous activation<br />

of antigen-specific T cells. It is possible that T cells that arrive later may receive less<br />

stimulatory signals and are incomp<strong>et</strong>ition with specific T cells that have already divi<strong>de</strong>d. This<br />

differential activation based on timing of recruitment and inter-cellular comp<strong>et</strong>ition for<br />

stimulatory signals may explain the extensive diversity of functional T cells generated after<br />

i.d. immunization. In contrast, i.v. immunization induces a systemic dissemination of antigen<br />

and allows for a more simultaneous activation of antigen-specific T cells, resulting in a<br />

relatively functionally homogenous T cell population.<br />

C. Clinical applications<br />

Our studies strongly highlight the importance of consi<strong>de</strong>ring the route of immunization and<br />

persistence of antigen presentation in the <strong>de</strong>sign of clinical trials and vaccine strategies.<br />

152

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