To generate a successful novel therapy, a deep understanding of oncogenesis in combination with mechanistic understanding of anti-cancer compounds are needed. The work described in this thesis aims... Show moreTo generate a successful novel therapy, a deep understanding of oncogenesis in combination with mechanistic understanding of anti-cancer compounds are needed. The work described in this thesis aims to contribute to the knowledge on SUMO regulated oncogenesis, understanding the consequences of abolishment of SUMO signaling and exploiting the potential of SUMO E1 inhibitors. To this end, we describe SUMO as a potential biomarker for cancer aggressiveness and increase our understanding on SUMO’s role in cell cycle progression. We exploited the potential of SUMO E1 inhibition by combining with hypomethylating compound 5-Aza-2’ deoxycytidine, leading to increased cytostatic efficacy. Furthermore, we repurposed the SUMO E1 inhibitor TAK981 and hypomethylating drug 5-Aza-2’ deoxycytidine to improve engineered TCR (eTCR) T cell therapy and broaden our understanding of its immunomodulatory potential. Show less
The aim of this thesis was to investigate if a text-mining tool is suitable for collecting real-world data from electronic health records to evaluate cancer treatments in clinical practice. By... Show moreThe aim of this thesis was to investigate if a text-mining tool is suitable for collecting real-world data from electronic health records to evaluate cancer treatments in clinical practice. By investigating a range of use cases including treatments of patients with renal cell carcinoma, hepatocellular carcinoma, melanoma, breast cancer, and COVID-19, it showed that the text-mining tool is a suitable method of data needed for the evaluation of treatment patterns, effectiveness, safety, prognostic factors, and guideline adherence. The discussion showed that enhancing the data quality and actively using real-world data for treatment evaluation regarding treatment policies are some of the next steps. Show less
Monique Krystyna van der Kooij shows that a combination of treatments enhancing the immune system can conquer metastasized melanoma in heavily pre-treated patients. Immunotherapy is not a new... Show moreMonique Krystyna van der Kooij shows that a combination of treatments enhancing the immune system can conquer metastasized melanoma in heavily pre-treated patients. Immunotherapy is not a new concept. However, in Leiden a milder, and therefore better tolerated preconditioning regimen is used before the immune cells are administered. This milder preconditioning, in combination with the patient’s own immune cells and an immune checkpoint inhibitor is unique. This thesis shows that this combination is safe and preliminary data also show that some patients have (lasting) clinical responses. A second important finding described in this thesis is that treatment with immune checkpoint inhibitors can safely be prescribed to patients with common autoimmune diseases. Approximately 1 in 10 metastatic melanoma patients suffer from such an autoimmune disease. Until now clinicians were hesitant to prescribe these immune checkpoint inhibitors out of fear of unleashing the autoimmune disease. Showing that this is not the case made it possible for this large group of patients to gain access to this often-successful treatment. However, immune checkpoint inhibitor monotherapy is not indicated for all patients with metastatic melanoma. Patients with uveal melanoma do not benefit from this type of treatment, and do suffer from the adverse events. Show less
T cell exhaustion is a state of T cell hypofunction arising during persistent viral infections and cancer. Recent advances in the field of immunology uncover the roles of cytokines in regulating T... Show moreT cell exhaustion is a state of T cell hypofunction arising during persistent viral infections and cancer. Recent advances in the field of immunology uncover the roles of cytokines in regulating T cell responses. Using LCMV Clone-13 as a model of persistent viral infection, this thesis investigates the roles of IL-27 and IFN-I in regulating T cells during infection. In addition, the thesis explores the potential of JAK inhibitor in rescuing T cell exhaustion during persistent viral infection and cancer. Show less
Most lymphomas and leukemias are neo¬plasms of B cells. Due to the many different B cell development stages from which these neoplasms arise, the resulting diseases are quite heterogeneous, which... Show moreMost lymphomas and leukemias are neo¬plasms of B cells. Due to the many different B cell development stages from which these neoplasms arise, the resulting diseases are quite heterogeneous, which amongst other things is manifested in different tumor growth location, proliferation potential and surface antigen repertoire. Neverthe¬less, some population characteristics are found in almost all B cell malignancies as the cell-of-origin is identical. One of these is the cell surface antigen CD20. Originally used as a marker to distinguishing B cells from other lymphocytes, it quickly became a target for immunotherapy. Immuno-therapy is a treatment that makes use of immune system components to fight cancer, in this case by the injection of a monoclonal antibody specifically targeting one protein: CD20. The addition of CD20-targeting an¬tibodies to an anti-tumor treatment allows your immune system to recognize CD20-ex¬pressing B cells (diseased and healthy), and dispose of them. Overall, after several decades of research and therapeutic experience with antibodies targeting CD20, new functional discoveries as well as therapeutic advances are still being made, and CD20 therefore remains a highly attractive and fruitful target for the therapy of B cell malignancies as well as certain B-cell mediated autoimmune diseases. Show less
Melanoma is a malignancy that arises from melanocytes, the pigment-producing cells that can be predominantly found in the eye or the epidermal basal layer of the skin. Mainly due to increased UV... Show moreMelanoma is a malignancy that arises from melanocytes, the pigment-producing cells that can be predominantly found in the eye or the epidermal basal layer of the skin. Mainly due to increased UV exposure, the incidence of melanoma has doubled worldwide over the past three decades (200.000 new cases in 2008). Primary melanomas can be easily treated by surgical resection, leading to a good prognosis for stage I patients. However, metastasized melanoma is almost completely resistant to therapeutic modalities such as radio- and chemotherapy, resulting in a median overall survival of less than one year for this patient group. Despite considerable efforts, for over 20 years there was no melanoma treatment developed that could improve survival of stage IV patients. However, the treatment of unresectable metastasized melanoma has progressed markedly in recent years due to the development of both immunotherapies that stimulate anti-tumor immunity and targeted therapies that block oncogenic proteins. This thesis will focus on pre-clinical work concerning the optimization of melanoma treatment. In detail, it will address for both targeted therapies and immunotherapies factors that play a role in the identification of response-predictive biomarkers, the toxicity of treatments, and the potential efficacy of combination treatments. Show less
For the successful application of immunotherapy for leukemia significant numbers of viable T cells with the right antigen specificity have to be available within a limited period of time. TCR gene... Show moreFor the successful application of immunotherapy for leukemia significant numbers of viable T cells with the right antigen specificity have to be available within a limited period of time. TCR gene transfer is a promising strategy enabling the generation of large numbers of T cells with a selective antigen specificity, while reducing the time required for in vitro culture. Future clinical application of TCR engineered T cells may result in an off-the-shelf therapy with TCRs suitable for large numbers of patients. Acquisition of more insight into the possibilities and restrictions of TCR gene transfer and assessment of the efficacy of the therapeutic cells may provide a solid basis for clinical application in the near future. However, the application of immunotherapy for hematological malignancies is currently limited by the restricted number of hematopoiesis specific mHags that can be used as target antigens. Furthermore, an important issue for clinical implementation of TCR gene therapy is the prevention of the formation of mixed TCR dimers, which have recently been shown to induce autoreactivity. In addition, the future development of TCR gene therapy strategies will benefit from increased knowledge about both the T cells that serve as host cell for TCR gene transfer and other T cells present in the patient that may manipulate the immunotherapeutic responses of the TCR engineered T cells. Unfortunately, function analysis of T cell populations using biologically relevant antigens is hampered by the large number of different T cell specificities present and the difficulty to identify the specificity of T cells. The aim of this thesis was to characterize novel T cell populations that may serve as host cells for TCR gene transfer and to determine their possibilities and restrictions as TCR engineered immunotherapeutic effector cells for the treatment of hematological malignancies. Show less
Type 1 diabetes is a common, multifactorial disease in which T cell autoimmunity plays an important role. Important research advances in recent years have fuelled the expectation that a definitive... Show moreType 1 diabetes is a common, multifactorial disease in which T cell autoimmunity plays an important role. Important research advances in recent years have fuelled the expectation that a definitive cure for the disease can be achieved for a large number of patients. In the first part of this thesis, the considerable clinical and immunological potential for intervention in the diabetogenic autoimmune process is described of the T cell costimulatory molecule CTLA4 and the autologous heat shock protein peptide DiaPep277. The second part focuses on islet and pancreas transplantation as a cure for type 1 diabetes. Next to the influence of allograft rejection and the effects of immunosuppressive therapy, associations are described between the presence and recurrence of diabetes-specific autoimmunity and clinical outcome of transplantation. Furthermore, possible factors are identified that may be modulated for improvement of outcome, and predictive biomarkers are suggested that may guide future treatment. In conclusion, this thesis recognizes T cell autoimmunity as an important entity in type 1 diabetes therapy, distinct from other types of immune reactivity. Tailored therapy for individual patients guided by close immune monitoring is being developed but needs to be improved further to establish a definitive cure for type 1 diabetes. Show less
Adoptive transfer of T cell immunity has been proposed as an attractive form of cancer immunotherapy in cases where the endogenous T cell repertoire is immune tolerant. In this thesis murine models... Show moreAdoptive transfer of T cell immunity has been proposed as an attractive form of cancer immunotherapy in cases where the endogenous T cell repertoire is immune tolerant. In this thesis murine models are used to study two different approaches to generate T cell grafts with defined tumor specificities. First the feasibility of minor antigen specific T cell depletion to limit the development of Graft-versus-Host Disease after allogeneic stem cell transplantation in combination with donor lymphocyte infusions is addressed. In the second part T cell receptor gene transfer is used to generate tumor specific T cells. Show less
