The present study sought to avoid LCL stimulation and to develop
an alternative means of probing EBV-specific CTL memory that was
efficient and that allowed even rare components of the memory pool to
be accessed without laborious cell cloning. Experiments in the
influenza virus system had first shown that individual epitope
specificities could be reactivated in vitro by stimulation with
epitope peptides and expanded thereafter as bulk effector populations in IL-2 (20, 30). However, those studies, which used PBMCs as a source both of peptide-loaded stimulator and of responder cells, were limited to immunodominant epitopes. In the EBV system also, such a protocol can reactivate CTL memory to immunodominant latent cycle epitopes (13, 23), but in
our experience it has been much more difficult to access low-frequency subdominant components of CTL memory as bulk effector populations in
this way (23a). It is only as rare clones in limiting
dilution assays that such subdominant components become detectable
after conventional peptide stimulation (50) and, even then,
recent evidence suggests that the limiting dilution approach may not be
accessing all memory cells with the relevant peptide specificity (14).
We therefore set out to determine whether the efficiency of EBV
epitope peptide stimulation could be improved by using DC preparations as the source of stimulator cells. This was prompted by
the mounting evidence on the potency of DCs as APCs both in vivo and in
vitro (reviewed reference 5). Thus CD8+
CTL responses can be elicited in a variety of mouse model systems by
DCs expressing the antigen endogenously from viral or plasmid vectors
(12, 17, 44, 47, 48, 54), or preexposed to exogenous antigen
in such a way as to encourage its entry into the MHC class I pathway
(1, 3, 11, 35, 46, 57), or preloaded with epitope
peptides (16, 27, 31). Studies to date in human systems are
more limited and most in vitro work has focused on DC presentation of
melanoma-associated target antigens or of epitope peptides, usually
HLA-A2.01 restricted, derived from such antigens (4, 34, 52, 53,
55). Here a number of groups have shown that an initial stimulus
with peptide-loaded DCs followed by several repeat stimulations,
usually involving adherent monocytes as presenting cells, can generate
bulk T-cell populations which contain epitope-specific reactivity
and which frequently also recognize melanoma cell lines endogenously
expressing the relevant antigen.
Our study used a DC-based in vitro stimulation protocol which is
essentially similar in design to those used in the melanoma studies. We
first sought to validate this protocol by testing the capacity of DCs
to reactivate CTL responses against immunodominant EBV latent cycle
epitopes. Using virus-immune donors known to possess the relevant
reactivities, we found that peptide-loaded DCs are quantitatively at
least as efficient at reactivating these immunodominant responses as is
LCL stimulation itself (Fig. 1). Furthermore the peptide-DC protocol
allows reactivities that are codominant in CTL memory to be accessed
individually; such selective access can only be achieved by LCL
stimulation in rare cases: for instance, where LCLs are available
carrying an EBV isolate with a natural mutation in one or more of the
immunodominant epitope sequences (2, 18). These initial
experiments also showed that DCs were more efficient than PBMCs as
stimulators of peptide-induced responses. As illustrated in Fig. 2 with
three epitope peptides relevant to donor CMc, only the two most
abundant components of latent-antigen-specific memory (to the QAK and
IVT epitopes) could be accessed as bulk effectors by PBMC
stimulators; by comparison, DC stimulation not only produced more
potent effector populations specific for these epitopes but also
generated a significant response from memory CTLs to a third
epitope, AVF. Throughout these initial experiments, it is important
to note that the effectors induced by peptide-loaded DCs were capable
of recognizing naturally processed antigen as well as epitope
peptide. Thus, these CTLs killed LCL targets, expressing the relevant
EBV latent cycle target antigen, as efficiently as did LCL-stimulated
effectors and displayed incremental lysis when the level of that target
antigen was selectively increased by expression from a recombinant
vaccinia vector (Fig. 1 and 2).
Such pilot experiments allowed us to optimize a stimulation protocol
with which to probe EBV-induced CTL memory for reactivities that would
not be efficiently accessed by LCL stimulation. A first important
question in this regard concerned memory to lytic cycle antigens, since
recent work on IM patients has revealed that primary EBV infection is
accompanied by unusually strong responses of this kind (14,
49); this implies that such reactivities may be present, albeit
undetected, in long-term virus carriers. Here we focused on two
epitope-HLA combinations (GLC/A2.01 and RAK/B8) known to be
immunodominant targets of the primary CTL response in IM patients of
the relevant HLA type (14, 49) and on two other combinations
(TLD/A2.01 and APE/B35.01) which appear to be subdominant targets in
that the relevant reactivities are only detectable in IM effector
populations after extensive screening of in vitro-derived clones
(1a). Stimulation with peptide-loaded DCs revealed, for each
of these four epitopes, the existence of a specific memory CTL
response in healthy virus carriers with the appropriate HLA type (Fig.
3 and 4). This work adds significantly to the original study of
Bogedain et al. (8) who used in vitro stimulation with
pooled peptides from the sequence of the immediate-early lytic cycle
protein BZLF1 and, without including DCs in the protocol, elicited a
memory response from a B8-positive donor which was subsequently mapped
to the RAK epitope. We have indeed confirmed that RAK- (and also
GLC-) specific memory responses can be reactivated by peptide
stimulation alone (1a), a fact we presume to reflect the
unusual strength of these particular responses (14). These two studies, and recent evidence from T cells cloned from the synovium
of EBV-carrying rheumatoid arthritis patients (45), make it
clear that lytic-antigen-specific responses are not confined to primary
infection but are maintained throughout life. This strongly suggests
that virus replicative lesions, whose persistence in the oropharynx is
a feature of the asymptomatic carrier state (37), remain
under direct T-cell control.
It is worth noting, however, that these conclusions are only valid if
the responses observed in vitro are being generated from
antigen-experienced rather than naive T cells in the repertoire. This
is a particularly important issue to resolve because there are reports
that peptide-loaded DCs can initiate primary responses in vitro not
just in murine systems but also occasionally, with human
immunodeficiency virus peptides, in humans (28, 32). Furthermore, in vitro CTL responses to melanoma-associated epitope peptides are frequently reported even from healthy donors (39, 56), and it is not known whether this reflects a primary response or some preexisting T-cell immunity to "self" peptides from
lineage-restricted cellular proteins. Our studies with EBV-seronegative
donors by using immunodominant latent-cycle (FLR/B8 and QAK/B8) and
lytic-cycle (GLC/A2.01 and RAK/B8) epitopes suggest that primary
responses are not detectable when using our particular DC stimulation
protocol (Fig. 1 and 4). Where primary human CTL responses to microbial peptides have been elicited in vitro, with or without DCs as stimulator cells, the protocols have involved either multiple restimulation of
purified CD8+ T-cell responders (32) or
extensive screening of the PBMC response by cloning (36). In
contrast, our protocol involves a limited number of stimulations of the
entire PBMC population and analysis of the reactive cells in bulk.
A second important application of the peptide-DC stimulation protocol
is in the selective reactivation of responses to subdominant latent
cycle proteins, in particular proteins which constitute potentially
useful targets for the immune therapy of virus-associated tumours
(38). Of the few EBV latent-cycle proteins constitutively expressed in EBV-positive malignancies, such as NPC, LMP2 is arguably the best candidate target antigen (24), and yet CTLs
reactive to this protein are almost always minor components of the
memory response induced by virus infection (22, 33). Here we
show that DCs loaded with LMP2 epitope peptides are capable of
eliciting epitope-specific CTL responses in vitro from donors for
whom the conventional LCL-induced response contains little if any of
the relevant LMP2 reactivity. We tested five different LMP2
epitope-HLA class I combinations in this way and for each we
obtained positive responses in most (but not all) of the individuals
tested with the relevant HLA type. It is encouraging to note that the
range of restriction elements presenting LMP2 epitopes includes
some alleles (HLA-A11.01, -A24.02, and -B40.01) which are common in the
Southeast Asian population, where NPC is seen in particularly high
frequency (24). This opens up the possibility of using epitope peptide-loaded DCs therapeutically as stimulators of memory T cells with the capacity to recognize and destroy tumor cells.
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