University for All: Embedding and Mainstreaming Equality of Access, Participation and Success in Higher Education.

This paper describes University for All - a whole-institution initiative undertaken by University College Dublin to move student access, participation and success from the margins to the mainstream. This initiative extends access beyond entry, to include access to an inclusive learning environment, designed for the full range of human diversity, rather than a perceived notion of a typical or so-called 'traditional' student. The University for All approach requires that programmes, teaching, student supports, and campus facilities are designed inclusively, so that they can be accessed, understood and used to the greatest extent possible, by all students, regardless of background, personal circumstances, age, disability, or pace of study. This paper documents the implementation of this whole-institution initiative, offering insights into this change journey, and outlining the lessons learnt and challenges encountered.

Changes in hepatic immunoregulatory cytokines in patients with metastatic colorectal carcinoma: implications for hepatic anti-tumour immunity.

The hepatic immunological environment, dominated by NK and NKR(+) T cells, seems specialised to respond to malignant challenge. Ineffective immune responses to malignancy are likely determined by factors including alterations in the local cytokine profile. This study examines the cytokine milieu of normal and tumour-bearing liver, quantifying pro-/anti-inflammatory cytokines using modified ELISAs and real-time quantitative PCR. Cytokine protein was localised using immunohistochemistry. We demonstrate an active cytokine environment in normal liver, with high levels of inflammatory and regulatory cytokines. Inflammatory IFN-gamma was increased in tumour-bearing liver (p<0.0001). However, a much greater increase in anti-inflammatory IL-10, produced by non-parenchymal cells (p<0.0005), resulted in a reduced IFN-gamma:IL-10 ratio in tumour-bearing liver (p<0.02). In contrast, immunosuppressive TGF-beta and IL-13 were significantly downregulated (p<0.02). Furthermore, IL-2 was not increased and IL-15 was reduced (p<0.02). The IFN-gamma inducing cytokine, IL-18 was increased in tumour-bearing liver (p<0.02), while pro-inflammatory TNF-alpha was suppressed (p<0.05). These results suggest that, whilst there is a significant inflammatory immune response in tumour-bearing liver, evidenced by increased levels of IFN-gamma, disproportionate increase in IL-10 may be a key factor in facilitating tumour progression. Therapies aimed at antagonising IL-10-mediated immunosuppression may prove a useful strategy in the future treatment of metastatic disease.

Interleukin 12 (IL-12) is increased in tumour bearing human liver and expands CD8(+) and CD56(+) T cells in vitro but not in vivo.

Human liver is enriched with CD8(+)T- and CD3(+)CD56(+) natural T (NT)-lymphocytes, important anti-tumour effectors, similar to murine NKTs. IL-12 promotes anti-tumour functions of NKTs. We quantified IL-12 and CD56(+)/CD8(+)T lymphocytes in normal and tumour bearing liver. We also examined the effect of IL-12 on the expansion/activation of peripheral blood cells in vitro. IL-12 was detected in normal (n=13, median 2032 pg/100 mg protein) and increased in tumour bearing liver (n=9, 3678 pg, p< 0.01). Infiltrating monocytes appear to be the principal producers. Culture with IL-12 selectively expanded CD8(+)T and CD3(+)CD56(+)NT cells and polarised their cytokine responses to Th1-type. However, there was no in vivo expansion of these cells in tumour bearing liver. Changes observed in culture required addition of IL-2. We therefore quantified IL-2 in hepatic tissue. IL-2 was detected in normal liver (median 4700 pg/100 mg protein). Surprisingly, there was no increase in tumour-infiltrated liver (4910 pg). The presence of IL-12 may create an environment in healthy liver that promotes the accumulation of CD8(+)T and CD56(+)NT cells. Therefore, the development of metastases in the presence of high levels of IL-12 may be due to an insufficient IL-12 response. Alternatively, lack of IL-2 rather than a defect in IL-12, may be responsible for insufficient expansion/activation of tumour specific cytotoxic T lymphocytes.