Towards personalized immunotherapy : development of in vitro models for imaging natural killer cell behavior in the tumor microenvironment

Abstract: Tremendous advances in the tumor immunology field have transformed immunotherapy from a promising approach to a standard clinical practice. However, a subset of cancer patients is non-responsive to immunotherapy. More research is therefore needed to understand the mechanisms underlying tumor resistance to immunotherapeutic treatments. The aim of this doctoral work was to develop new tools to study the mechanisms of cancer immunosurveillance and to test immunotherapeutic treatments in vitro. In this thesis, I describe the methods developed, and I discuss the main biological findings obtained by using these methods. The thesis is organized as follows. A short historical background of immunotherapy is provided in Chapter 1. Chapter 2 describes the principles of NK cell-mediated cancer immunosurveillance, and provides an overview on rare cancers, mainly focusing on sarcoma. The research aims are listed in Chapter 3. In Chapter 4, I describe the cell culture methods and cell analysis techniques relevant for my doctoral work. In Chapter 5, I describe the methods we developed to culture tumor spheroids in vitro using ultrasonic standing waves in microwell chips, focusing on the theory, design, and applications. Chapter 6 and Chapter 7 focus on the biological findings obtained using our platform in combination with traditional immunological methods, followed by future implementations discussed in Chapter 8. The constituent papers are provided at the end of the thesis. In Paper I, we combined the use of the microwell chip, ultrasonic standing waves and a protein-repellent polymer coating to enable the production of spheroids from multiple cell types. In absence of cell adhesion to the chip, spheroids could be collected and further analyzed by off-the-chip techniques. In Paper II, we designed a novel multichambered microwell chip to perform multiplexed fluorescence screening of two- or three-dimensional cell cultures. The platform allows the direct assessment of drug or immune cell cytotoxic efficacy, making it a promising tool for individualized cytotoxicity tests for personalized medicine. In Paper III, we investigate the function of PVR receptors in NK cells interacting with renal carcinoma spheroids, and the impact of PVR in NK cell-based cellular immunotherapy. We demonstrated that variations in PVR expression are primarily recognized by the inhibitory receptor TIGIT, while DNAM-1 strongly contributes to NK cell activation mainly through PVR-independent mechanisms. We performed NK cell-based cytotoxicity assays against renal carcinoma spheroids in the microwell chip. Anti-TIGIT treatment was effective only for TIGIThigh NK cells both when used as monotherapy or in combination with other drugs, suggesting that only a fraction of patients might respond to anti-TIGIT therapy. In Paper IV, a similar approach was used with primary sarcomas. We cultured patient-derived sarcoma spheroids and tested NK cell-based immunotherapy in the microwell chip, either alone or in combination with antibody therapy, and we identified promising treatment combinations. In Paper V, we applied the use of expansion microscopy to visualize NK cells infiltrating renal carcinoma spheroids. In conclusion, our multi-disciplinary work shows the development of new imaging-based platform and its use to study the mechanisms of NK cell-mediated tumor surveillance and for personalized therapy.

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