CMV-, EBV- and ADV-Specific T Cell Immunity: Screening and Monitoring of Potential Third-Party Donors to Improve Post-Transplantation Outcome Cinja Sukdolak,

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CMV-, EBV- and ADV-Specific T Cell Immunity: Screening and Monitoring of Potential Third-Party Donors to Improve Post-Transplantation Outcome Cinja Sukdolak, Sabine Tischer, Daria Dieks, Constanca Figueiredo, Lilia Goudeva, Hans-Gert Heuft, Murielle Verboom, Stephan Immenschuh, Albert Heim, Sylvia Borchers, Eva Mischak-Weissinger, Rainer Blasczyk, Britta Maecker-Kolhoff, Britta Eiz-Vesper Biology of Blood and Marrow Transplantation Volume 19, Issue 10, Pages 1480-1492 (October 2013) DOI: 10.1016/j.bbmt.2013.07.015 Copyright © 2013 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 1 Detection of CMV-specific T Cells by IFN-γ ELISpot. Frequency of CMV-specific T cells detected by IFN-γ secretion after stimulation with CMVpp65 and IE-1 peptide pools. Peripheral blood mononuclear cells (PBMCs) from 204 donors were isolated, suspended at a density of 2.5 × 105 cells in 1 mL culture medium (negative control), stimulated with .6 nmoL of each peptide/mL peptide pool, and incubated over night. PBMCs stimulated with 10 μg/mL cytomegalovirus, Epstein-Barr, and flu virus control peptide pool (CEF pool) served as positive controls. Asterisks indicate statistically significant differences between levels of induced cytokine responses (∗P < .05, †P < .01, ‡P < .001). (A) All 204 donors were tested for anti-CMV IgG antibodies by ELISA. 143 were CMV-seropositive (CMV+) and 61 were CMV-seronegative (CMV–). CMV-seropositive donors were grouped according to the number of spots per well (spw) generated in response to each peptide pool as follows: high responders (HR) (≥50 spw), low responders (LR) (10 to 50 spw), and nonresponders (NR) (≤10 spw); high responders and low responders were summed to yield the overall responder group. After confirmatory serological testing by Western blot analysis, the number of CMV-seronegative donors increased to 80 (80C) and the number of actual nonresponders decreased to 0 (0C) for pp65 and to 26 (26C) for IE-1. (B) Differentiation between confirmed CMV-seropositive donors (CMV+, n = 124) in the overall group and responder groups; the results of independent experiments are expressed as mean number of spw ± SD. (C) The response of each donor to both peptide pools in comparison, ie, the numbers of pp65-high, low, and nonresponders among each of the IE-1 responder groups. The pp65 peptide pool induced more cytokine secretion in all but 1 donor, who showed a high response to IE-1 but only a low response to pp65. (D) Frequencies of pool-specific T cells identified by ELISpot among the 17 HLA-A*02:01+/CMV-seropositive donors who remained negative in the flow cytometric analysis using the mA02-pp65. Biology of Blood and Marrow Transplantation 2013 19, 1480-1492DOI: (10.1016/j.bbmt.2013.07.015) Copyright © 2013 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 2 Frequencies of antigen-specific T cells against different EBV-derived peptide pools. Detection of EBV-specific T cells in 204 donors by antigen-induced IFN-γ secretion in ELISpot after stimulation with 3 different peptide pools: EBNA-1, LMP2 A and BZLF1. (A) Donors were tested by Western blot for anti-EBV IgG antibodies (195 EBV-seropositive, EBV+; 9 EBV-seronegative, EBV−). Seropositive donors were divided into responder groups for each peptide pool according to the frequency of generated spots per well (spw) as follows: high responders (HR) (≥50 spw), low responders (LR) (10 to 50 spw), nonresponders (NR) (≤10 spw) and “responders” (total of HR and LR). (B) Distribution of positive (+) and negative (−) T cell responses against the 3 different EBV-specific peptide pools among EBV-seropositive donors (n = 195). (C) Differentiation between EBV-seropositive donors (EBV+, n = 195) in the overall and individual responder groups. Results of independent experiments are expressed as the mean number of spw ± SD. Asterisks indicate statistically significant differences between levels of induced cytokine responses (∗P < .05, †P < .01, ‡P < .001). Biology of Blood and Marrow Transplantation 2013 19, 1480-1492DOI: (10.1016/j.bbmt.2013.07.015) Copyright © 2013 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 3 Detection of ADV hexon pool-specific T cells by IFN-γ ELISpot. (A) Donors were screened for anti-ADV IgG antibodies by ELISA (196 ADV-seropositive, ADV+; 9 ADV-seronegative, ADV−). Seropositive donors were divided into responder groups according to the number of generated spots per well (spw) as follows: high responders (HR) (≥50 spw), low responders (LR): (<50 and >10 spw; n = 85), nonresponder (NR) ≤10 spw), and “responders” (total of HR and LR). (B) Classification of responder groups for the ADV5 hexon pool as determined for ADV-seropositive donors (ADV+, n = 196). Results of independent experiments are expressed as the mean number of spw ± SD. Asterisks indicate statistically significant differences between levels of induced cytokine responses (∗P < .05, †P < .01, ‡P < .001). Biology of Blood and Marrow Transplantation 2013 19, 1480-1492DOI: (10.1016/j.bbmt.2013.07.015) Copyright © 2013 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 4 Antiviral T cells detected by IFN-γ cytokine secretion assay and ELISpot. Representative ELISpot data and results of IFN-γ cytokine secretion assay for 2 representative donors. Fresh peripheral blood mononuclear cells were stimulated with ppCMVpp65, ppADV5hexon and ppEBVBZLF1, and secretion of IFN-γ was determined by ELISpot and cytokine secretion assay. Cells stimulated with 10 μg/mL cytomegalovirus, Epstein-Barr virus, and flu virus control peptide pool (CEF pool) served as positive controls, cells suspended in 1 mL culture medium as negative controls. Biology of Blood and Marrow Transplantation 2013 19, 1480-1492DOI: (10.1016/j.bbmt.2013.07.015) Copyright © 2013 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 5 High-responder ELISpot data for fresh and frozen peripheral blood mononuclear cells (PBMCs) at baseline, 4 weeks, and 3 months after donation. IFN-γ ELISpot data sets for 17 healthy donors were divided as follows into 3 responder groups per peptide pool according to the number of spots per well (spw) after stimulation of fresh PBMCs: high responders (HR) (≥50 spw), low responders (LR) (<50 and > 10 spw), and nonresponders (NR) (≤ 10 spw). The PBMCs were cryopreserved and retested after thawing the samples 4 weeks (4wk) and 3 months (3mo) after donation. The figure shows only data for donors categorized as high responders by ELISpot with fresh PBMCs (CMVpp65: n = 9; CMV IE-1: n = 8; ADV5 hexon: n = 9; EBV EBNA-1: n = 5; EBV LPM2 A: n = 3; EBV BZLF1: n = 10). Data are expressed as mean ± SD. There was no variation of the means determined with fresh and frozen PBMCs thawed 4 weeks and 3 months after donation in any of the peptide pools (*P > .05). Biology of Blood and Marrow Transplantation 2013 19, 1480-1492DOI: (10.1016/j.bbmt.2013.07.015) Copyright © 2013 American Society for Blood and Marrow Transplantation Terms and Conditions