Antiviral and Immunoregulatory Roles of Natural Killer Cells in Chronic Hepatitis B Virus Infection
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Title page Antiviral and immunoregulatory roles of Natural Killer cells in chronic hepatitis B virus infection A THESIS PRESENTED TO UNIVERSITY COLLEGE LONDON FOR THE DEGREE OF DOCTOR OF PHILOSOPHY BY DIMITRA PEPPA APRIL 2013 DEPARTMENT OF IMMUNOLOGY AND MOLECULAR PATHOLOGY, DIVISION OF INFECTION AND IMMUNITY, UNIVERSITY COLLEGE LONDON UNITED KINGDOM 1 Declaration 'I, Dimitra Peppa, confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated in the thesis.' 2 Abstract Persistent infection with hepatitis B virus (HBV) is a global health burden accounting for more than a 1 million deaths worldwide. Much work has focused on the failure of the adaptive immune response in persistent HBV infection. In contrast innate responses remain poorly characterised. Accumulating evidence indicates the involvement of natural killer (NK) cells in the control of viral infections and shaping of adaptive immunity. Here we investigated the antiviral and immunoregulatory potential of NK cells in chronic Hepatitis B virus infection (CHB). We found that the combination of immunosuppressive cytokines seen in CHB suppresses the non-cytolytic antiviral function of NK cells, whilst maintaining TRAIL mediated killing, which has been associated with hepatocyte apoptosis. Our findings also implicate NK cells in the down-regulation of antiviral T cells, which are profoundly diminished and prone to apoptosis in CHB. Our data show that in vitro depletion of NK cells results in recovery of HBV-specific CD8+ T cells, an effect that was not observed for control virus responses. When NK cells were depleted or not in contact with T cells, the degree of caspase activation in HBV-specific T cells was decreased, supporting a direct and contact dependent NK cell effect on virus-specific CD8+ T cell survival involving induction of apoptosis. NK cells, the predominant population of TRAIL expressing cells in the HBV infected liver, were found in intimate contact with T cells within the liver sinusoidal spaces. The observed upregulation of the death receptor, TRAIL-R2 on CD8+ T cells, imposed by the intrahepatic milieu in HBV infection may sensitise them to apoptosis. Our findings illustrate an important and novel mechanism of immune dysregulation contributing to viral persistence in humans. The potential to selectively deviate NK cells from pathogenic roles, whilst augmenting antiviral functions could improve HBV control and enhance the design of future therapeutic strategies. 3 Acknowledgements I am indebted to Ian Weller for his mentorship and for steering me in the direction of Mala Maini. Mala has been an excellent PhD supervisor. I am truly thankful for the confidence she has shown in me, for always being available for informal chats, for her many words of encouragement and for helping me to maintain a clear focus. Her drive and enthusiasm continues to inspire me. I would also like to thank my co-supervisor, John Trowsdale, for his valuable advice and help over the last four years. None of this work would have been possible without the support from all the members, past and present, of the Maini group. Thank you all for creating such a great working environment, your technical advice, day-to-day help, unlimited supply of caffeine, bottles of wine and importantly your friendship. I would also like to extend my gratitude to our collaborators, clinic staff and patients. In particular, Upkar Gill at the Royal London Hospital for his tireless ability to recruit patients for our study, Chiwen Chang at Cambridge for his help, and Gary Reynolds at Birmingham for his expertise in immunohistochemistry. A big thank you goes to Raymond Welsh and Stephen Waggoner for kindly agreeing to host my short visit at UMass, for providing me with a better insight of murine modeIs and for their thought provoking discussions. I am also grateful to the MRC for funding me during the duration of my PhD. Finally I would like to thank my friends and family for always being there for me. My parents for teaching me to persevere in life, my sister Sofia and George for their unconditional love and support even from a distance and my little nephew, Nikolas, who always manages to put a smile on my face even when experiments are not working. Last but not least, thank you Nick for putting up with me, for counterbalancing Mediterranean emotions so effectively and for never failing to inject optimism and a sense of perspective into our lives. I couldn’t have managed through all the ups and downs without you. 4 List of common abbreviations ADCC Antibody-dependent cellular cytotoxicity ALT Alanine aminotransferase APC Antigen presenting cell Bid Bcl2- interacting domain death agonist Bim Bcl2-interacting mediator Breg Regulatory B cell cccDNA Covalently closed circular DNA CCR7 Chemokine (C-C motif) receptor 7 CD Cluster of differentiation CD3z CD3zeta C-FLIP Cellular FLICE inhibitory protein CFSE Carboxyfluorescein diacetate succinimidyl ester CHB Chronic hepatitis B virus infection CMV Cytomegalovirus CpG Cytosine and guanine separated by phosphate CTL Cytotoxic T lymphocyte CTLA-4 Cytotoxic T-lymphocyte antigen 4 CXCR6 CXC-chemokine receptor 6 DAP-10 DNAX activating protein of 10kD DC Dendritic cell DD Death Domain DED Death effector domain DISC Death inducing signalling complex DNA Deoxyribonucleic acid EAE Experimental autoimmune encephalomyelitis E4BP4 E4 Promoter Binding Protein 4 EBV Epstein-Barr virus ELISA Enzyme-Linked ImmunoSorbent Assay EMCV Encephalomyocarditis virus ER Endoplasmic reticulum FACS Fluorescence activated cell sorter FBS Fetal bovine serum FADD Fas associated protein with death domain FLT3 Fms-like Tyrosine Kinase-3 GATA-3 GATA binding protein 3 GM-CSF Granulocyte-macrophage colony-stimulating factor HA Haemagglutinin HBcAg Hepatitis B virus core antigen HBeAg Hepatitis B virus precore-core antigen HBsAg Hepatitis B virus surface/envelope antigen HBV Hepatitis B virus HCC Hepatocellular carcinoma 5 HCV Hepatitis C virus HDV Hepatitis delta virus HIV Human immunodeficiency virus HLA Human leucocyte antigen HSC Hepatic stellate cell HPC Haematopoietic cell HTLV-1 Human T-cell Lymphotropic Virus ID-2 Inhibitor of DNA binding 2 iDC Immature dendritic cell IFN-α Interferon alpha IFN-γ Interferon gamma IFN-λ Interferon-lamda Ig Immunoglobulin ILC Innate lymphoid cell IL-10 Interleukin-10 IL-12 Interleukin-12 IL-15 Interleukin-15 IL-17 Interleukin-17 IL-18 Interleukin-18 IL-2 Interleukin-2 IL-22 Interleukin-22 IL-29 Interleukin-29 IL-6 Interleukin-6 IL-7 Interleukin-7 IL-8 Interleukin-8 INF-A Influenza A iNK Immature Natural Killer ITAM Immunoreceptor tyrosine–based activation motif ITIM Immunoreceptor tyrosine-based inhibitory motif JAK Janus kinase KC Kupffer cell KIR Killer immunoglobulin receptor KLRG-1 Killer cell lectin-like receptor subfamily G, member 1 LCMV Lymphocytic Choriomeningitis Virus LPS Lipopolysaccharide LSEC Liver sinusoidal epithelial cell LTA Lipoteichoic acid LTi Lymphoid tissue inducer MAPK Mitogen activated protein kinase MCMV Mouse cytomegalovirus MDSC Myeloid-derived dendritic cell MFI Mean fluorescence intensity MHC Major histocompatability complex MHV Murine hepatitis virus 6 MIP Macrophage inflammatory protein MTP Microsomal triglyceride transfer protein NCAM Neural cell adhesion molecule NCR Natural cytotoxicity receptor NEMO NF-kappa-B essential modulator NK Natural killer NKG2A Natural-killer group 2, member A NKG2C Natural-killer group 2, member C NKG2D Natural-killer group 2, member D NKp30 Natural killer cell p30-related protein NKp44 Natural killer cell p44-related protein NKp46 Natural killer cell p46-related protein NKP Natural killer precursor NK-R Natural killer receptor NKT Natural killer T NPC Non-parenchymal cells OPG Osteoprotegerin ORF Open reading frame PAMP Pathogen-associated molecular pattern PBMC Peripheral blood mononuclear cells PBS Phosphate buffered saline pDC Plasmacytoid dendritic cell PCR Polymerase chain reaction PD-1 Programmed death-1 Peg-IFN-α Pegylated-Interferon-α PI3K Phosphoinositide 3-kinase PLC-γ Phospholipase C gamma PMA Phorbol 12-Myristate 13-Acetate PMN Polymorphonuclear PRR Pattern recognition receptor RIP1 Receptor Interacting protein 1 RNA Ribonucleic acid RORγt Retinoic acid receptor related orphan receptor gamma SHP-1 Src homology 2 domain-containing phosphatase-1 SIV Simian immunodeficiency virus SLT Secondary lymphoid tissue SNP Single nucleotide polymorphism STAT-1 Signal transducer and activator of transcription 1 Tcm Central memory CD8+ T cells TCR T cell receptor Tem Effector memory CD8+ T cells Temra Revertant CD8+ T cells TGF-β Transforming growth factor beta Tim-3 T cell immunoglobulin mucin-3 7 TLR Toll-like receptor TNF-α Tumour necrosis factor alpha TNFR1 Tumour necrosis factor receptor 1 TRADD TNF-receptor associated death domain TRAF-2 TNF-receptor associated protein TRAIL TNF-related apoptosis inducing ligand TRAIL-R TNF-related apoptosis inducing ligand receptor Treg Natural regulatory T cell uPa/SCID Urokinase-type plasminogen activator-severe combined immunodeficiency VV Vaccinia virus WHV Woodchuck hepatitis virus ZAP-70 Zeta-chain-associated protein kinase 70 8 Table of Contents Title page ............................................................................................................... 1 Declaration 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