Caractérisation de DKK1 comme antigène tumoral et manipulation des lymphocytes T CD8 : utilisation de la voie de Wnt en immunothérapie du cancer

Cell-mediated cancer immunotherapy is based on the priming of the patient’s CD8+ T lymphocytes (CD8+ T cells) to mediate an immune response directed against the tumour. This anti-tumour response is antigen-specific and directed against tumour associated antigens (TAA), which are defined as proteins expressed principally by cancer cells and absent from non-malignant tissues. By utilizing a bio-informatic approach, we identified the gene DKK1, a Wnt pathway inhibitor, as a potential TAA. This was an important novel finding as the identification of a new TAA is one of the key elements to enhance cell-mediated cancer immunotherapy. Furthermore, patient treatment options may also be improved through the amplification of the force and duration of the anti-tumour immune response mediated by TAA specific T cells. This thesis is divided in two parts: 1- The characterization of DKK1 expression and immunogenicity in common cancers as validation of TAA candidate. 2- The reprogrammation of CD8+ T cells from patient with common cancers to restore a less-differentiated phenotype in an attempt to improve their anti-tumour response.  We first characterized DKK1 expression in breast cancer and other common cancers. In order to prove its specificity to malignant tissues, the DKK1 expression profile was initially established by RT-PCR and ELISA assay using cancer cell lines and in RNA panels from normal tissues. DKK1 expression was also described using clinical samples from breast, lung and kidney cancers. We found that 30% of breast cancer clinical samples were positive for DKK1 expression. Interestingly, half of the triple negative breast cancer tumours (negative for the expression of progesterone and estrogen receptors and Her-2/neu) were DKK1 (+). Moreover, 50% of the lung cancer and 30% of the kidney cancer clinical samples were also DKK1 (+). These results have been corroborated by other groups who recently reported similar observations in lung cancer with a correlation with poor prognosis.  After confirming that the DKK1 gene expression profile in common cancer qualifies DKK1 as a relevant TAA, we then explored its immunogenicity. To do so, we performed in vitro stimulations of peripheral blood mononuclear cells (PBMC) from lung and breast cancer patients with DKK1-derived synthetic peptides, which were selected for their capacity to be presented by the major histocompatibility complex (MHC) HLA-A*0201. With this method, we identified and isolated CD8+ T cell clones with a specificity unique for one DKK1 peptide. Cytokine secretion profile of anti-DKK1 T cells was established by cytokine mutiplex assay and flow cytometry. This study revealed that DKK1-specitfic CD8+ T cells had an effector profile with polyfunctionality proprieties, thereby reinforcing DKK1 as a TAA candidate. Altogether, the results obtained in this first part of this thesis suggest the possible use of DKK1 in common cancer immunotherapy as it is principally expressed by malignant tissues and can generate the activation of effector CD8+ T cells.  In the second part of this thesis, I will describe in vitro manipulations of patients’ CD8+ T cells in the goal of augmenting their longevity and the strength of the anti-tumour response. Previous research revealed that a less-differentiated phenotype correlated with an augmented capacity of persistence and the intensity of the T cell response. For this project, we generated less-differentiated CD8+ T cells by activating the Wnt pathway with a pharmalogical inhibitor of GSK-3. These less-differentiated T cells shared a phenotype of both naive and memory T cells. As for their immune functions, viral antigen specific CD8+ T cells cultured with the inhibtitor showed an elevation in interferon (IFN)-γ production and cytotoxic activity. This represent the first report of such observations in humans CD8+ T cells and suggest a new stategy to prolonge the persistence of T cells in a cancer immunotherapy setting.  In conclusion, this work has strongly contributed to the validation of DKK1 as a TAA for common cancers, as it is expressed in malignant tissues and relatively absent in form normal tissues. It demonstrated the immunogenicity of DKK1 with the identification of a DKK1 peptide recognized by CD8+ T cells. Moreover, these DKK1-specific CD8+ T cells appear to be polyfunctional with an effector profil, which is favorable to mount a potent anti-tumour response. These findings could serve in novel strategies to be exploited in cell-mediated immunotherapy against common cancers. Furthermore, the phenotypic and functional study of the Wnt pathway activation resulting in a less-differentiated CD8+ T cells, generated observations that had never been reported in humans. These findings are relevant for cancer immunotherapy because they could help generate less-differentiated cells with augmented persistance and anti-tumorale capacities. Altogether, the results presented in this doctoral thesis provide significant evidence that DKK1 may serve as a TAA in cell-mediated immunotherapy for patients affected by common cancers and that reprogramming of CD8+ T cells through activation of the Wnt pathway could generate more effective mediator for this type of treatment.

Keyphrases: Cd8 t lymphocyte, Cancer Immunotherapy, Tumour associated antigens, Human, Breast cancer, Lung cancer, Wnt pathway