Optimization and regeneration kinetics of lymphatic-specific photodynamic therapy in the mouse dermis

Lymphatic vessels transport fluid, antigens, and immune cells to the lymph nodes to orchestrate adaptive immunity and maintain peripheral tolerance. Lymphangiogenesis has been associated with inflammation, cancer metastasis, autoimmunity, tolerance and transplant rejection, and thus, targeted lymphatic ablation is a potential therapeutic strategy for treating or preventing such events. Here we define conditions that lead to specific and local closure of the lymphatic vasculature using photodynamic therapy (PDT). Lymphatic-specific PDT was performed by irradiation of the photosensitizer verteporfin that effectively accumulates within collecting lymphatic vessels after local intradermal injection. We found that anti-lymphatic PDT induced necrosis of endothelial cells and pericytes, which preceded the functional occlusion of lymphatic collectors. This was specific to lymphatic vessels at low verteporfin dose, while higher doses also affected local blood vessels. In contrast, light dose (fluence) did not affect blood vessel perfusion, but did affect regeneration time of occluded lymphatic vessels. Lymphatic vessels eventually regenerated by recanalization of blocked collectors, with a characteristic hyperplasia of peri-lymphatic smooth muscle cells. The restoration of lymphatic function occurred with minimal remodeling of non-lymphatic tissue. Thus, anti-lymphatic PDT allows control of lymphatic ablation and regeneration by alteration of light fluence and photosensitizer dose.

New immunomodulatory roles of lymphatic endothelium and implications for immunotherapy

Efthymia Vokali

The lymphatic system serves a critical role in fluid homeostasis, lipid metabolism and immune surveillance. The growing appreciation of its implication in various diseases challenges the conventional view of lymphatics as a passive transport system. Traditionally, the lymphatic endothelium has been perceived as a structural scaffold with certain immunological functions but no active involvement in immunomodulation. In the lymph nodes (LNs), the main sites of immune regulation in the periphery, lymphatic endothelial cells (LECs) come to close contact with immune cells, suggesting potential interactions. Indeed, LECs have been recently shown to suppress dendritic cell maturation and present peripheral tissue and tumor antigen for CD8+ T cell deletion. While LECs have only begun to be acknowledged as active regulators of immunity, their function and relative contribution in shaping immune responses is as yet poorly understood. This thesis aimed to elucidate the direct role of LECs in the induction of CD8+ T cell immunity and tolerance. First, we demonstrated that murine LECs can actively scavenge and cross-present exogenous antigen to cognate CD8+ T cells under non-inflamed conditions. By utilizing an in vitro coculture system and the model antigen ovalbumin, we investigated the antigen-specific interactions between LECs and CD8+ T cells. LEC-educated CD8+ T cells proliferated, exhibiting an activated phenotype, however, they displayed early-generation apoptosis and failed to produce effector cytokines. Our findings establish LECs as antigen-presenting cells and suggest that they may assist in the maintenance of peripheral tolerance during homeostasis. The particular differentiation state of LEC-educated CD8+ T cells prompted us to investigate whether they are terminally tolerized or they could escape the dysfunctional state. We demonstrated that LEC-educated CD8+ T cells adopted a distinct phenotype with central memory-like characteristics and shared multiple functional properties with memory cells. Upon antigen re-encounter, LEC-educated CD8+ T cells mounted proliferative responses and generated cytotoxic effector cells. More importantly, they participated in anti-infectious immunity while preserving a secondary-memory persistent population. Our findings reveal a unique differentiation state of antigen-experienced CD8+ T cells, generated under steady-state conditions, which remain inactive but can be functionally reactivated upon antigenic inflammatory challenge. This previously unanticipated feature of LECs triggered questions for their antigen-presenting function in an inflammatory setting. We asked whether the previously observed extensive proliferation of LECs in the LN during inflammation might directly influence the induction of immunity. We employed an anti-VEGFR3 blocking antibody to inhibit LEC proliferation and thus, reduce the number of LECs following vaccine immunization. Alternatively, we generated the Prox1-Cre-DTR mouse model, allowing for specific ablation of LECs following administration of diphtheria toxin in vivo. Our findings advance our perception of the relative contribution of LECs in the establishment of adaptive immunity. This thesis elucidates the multifaceted immunological role of LECs and strongly suggests the importance of harnessing their immunomodulatory function to enhance current vaccines and immunotherapeutic strategies. Looking forward, our work will contribute to future advances in the clinic.

EPFL2016

New roles of the lymphatic endothelium in modulating adaptive immunity: implications for immune tolerance and cancer immunotherapy

Lambert Charles François Potin

Lymphatic vessels have traditionally been considered as passive conduits for interstitial fluid drainage and for immune cell trafficking to lymph nodes. In the last two decades, many studies have challenged this classical dogma: lymphatic endothelial cells (LECs) were shown to actively interact with immune cells by secreting chemokines and cytokines, and presenting antigens to T cells. These newly described functions pinpoint a multi-faceted role of LECs in orchestrating the immune response through both passive and active mechanisms. Yet, precise mechanisms leading to antigen-specific fine-tuning of the T cell response remain unexplored. Moreover, although lymphatics have been shown to play important roles in cancer, the contributions of LECs in regulating antitumor immunity have been largely overlooked by the biomedical community. This doctoral thesis aimed at filling these gaps. First, in order to investigate the mechanisms and implications of LEC antigen presentation to CD4+ T cells, we engineered a mouse model where LECs lacked the ability to present antigens to CD4+ T cells. In these mice, antigen-specific responses to vaccination were increased when compared to wild-type controls. Moreover, we demonstrated that LECs were poor inducers of CD4+ T cell activation in vitro, and that they could dampen CD4+ T cell activation by dendritic cells. Taken together, these findings suggest that LECs participate to the peripheral immune tolerance of CD4+ T cells. Second, we investigated the immunological consequences of the development of lymphatic vessels, called lymphangiogenesis, in mouse melanoma. Upon induction of tumor lymphangiogenesis, we observed striking tumor enrichment with immune cells, which resulted in a higher sensitivity of those tumors to immunotherapy. We subsequently demonstrated that inducing lymphangiogenesis in a mouse model of cold tumors, which lack immune infiltrates and do not respond to immunotherapies, could restore their responsiveness to immunotherapy treatments. Third, to predict which cancer types were the most likely to replicate the findings we obtained in mouse melanoma, we mined The Cancer Genome Atlas database for gene expression. We identified a set of cancers, such as colon adenocarcinoma and cholangiocarcinoma, where high expression of the lymphangiogenic growth factor was associated with a strong T cell signature. This doctoral thesis unveiled new immunomodulatory functions of LECs by which antigen-specific immune tolerance is induced. Additionally, it opened new avenues to target lymphatics therapeutically in cancer to potentiate immunotherapies. We believe this work contributes to demonstrating the immunological importance of LECs, and hope that lymphatics will be considered as an important immunomodulatory player of the tumor microenvironment when developing novel immunotherapies.

EPFL2018

Biophysical Regulation of Lymphatic Vessel Function

Dimana Miteva

Lymphatic capillaries collect interstitial fluid and dendritic cells from the periphery and deliver them to the lymph nodes for immune surveillance and tolerance maintenance. Upon injury and inflammation, lymphatic drainage can increase rapidly, and thus the lymphatic capillaries experience a broad range of fluid stresses and need to respond rapidly to such changes. Our understanding of their functional biology, adaptive ability and response to pathological changes in the biophysical environment is still very limited. This thesis focuses on how the lymphatic capillary endothelium senses and responds to changes of its biophysical environment with respect to its function, including fluid and cell transport, in the context of physiological and pathophysiological conditions. Using in vitro and in vivo models, we demonstrate that lymphatic endothelium is exquisitely sensitive to transmural flow, modulating both fluid and cell transport functions even in the absence of inflammatory cytokines. Flow increased lymphatic permeability and dendritic cell (DC) transmigration, which were coincident with changes in gene and protein expression of factor known to be involved in these, including chemoattractant chemokines, adhesion molecules and junctional proteins. These data provide the first evidence that lymphatic endothelium can regulate its transport functions in response to flow cues. They also show for the first time that transmural flow can, in the absence of inflammatory cues like TNF-a, drive expression of DC adhesion molecules like ICAM-1 and chemokines like CCL21 by lymphatic endothelium. Based on these findings we suggest that lymphatic flow is an important mediator of lymphatic function, particularly with respect to DC recruitment and trafficking to the lymph node. Furthermore, the response of the lymphatic endothelium to flow may be specific to the type of low, as lymphatic endothelial cells (LECs) might react differently to luminal shear flow, at physiological and pathophysiological levels, compared to transmural flow. To address this we used laminar shear stress chambers to expose only the apical surface of the lymphatic endothelial cells (LECs) to shear stress and demonstrated that lymphatic endothelium is indeed sensitive to luminal flow, fine-tuning its expression of adhesion molecules to modulate DC adhesion according to the shear stress. Specifically, at extremely low shear, adhesion was enhanced, unlike at higher shear, adhesion was downregulated. This is consistent with the notion that DC adhesion to LECs is only needed for entry but not transport in conducting vessels, since only the absorbing capillaries have low shear stresses. The interactions between DCs and LECs were strongly mediated by CCL21 and its receptor CCR7. These findings suggest that luminal shear stress acts as an active mechanosignal in LECs to potentially facilitate the traffic of immune cells inside of the lymphatic vessel to reach the lymph node and trigger an immune response. Additionally, we demonstrated that lymphatic vessels respond differentially to immunogenic and tolerogenic inflammatory stimulus. We used in vitro models to evaluate lymphatic uptake and lymphatic participation in dendritic cell transmigration in the presence of various inflammatory stimuli. We found that lymphatic endothelium exposed to TNF-a or complement activation were more conductive to dendritic cell transmigration, while LPS and TGF-β had opposite effect, affecting DCs to decrease DC transmigration. We further presented some insights in similarities in tumor and dendritic cells intravasation into inflamed lymphatic capillaries. These findings imply that lymphatic activation and participation in immune cells transport is not a universal phenomenon, but is strongly dependent on the nature of the inflammation. In conclusion, this work highlights the critical role of biophysical environment in lymphatic endothelial function, and how exquisitely sensitive the lymphatic capillaries are to their extracellular environment and how they use multiple cues to sense inflammation and danger, modulating their transport functions accordingly to regulate the delivery of antigens and immune cells to the lymph nodes.

EPFL2010