Strategies for modifying the chimeric antigen receptor (CAR) to improve safety and reduce toxicity in CAR T cell therapy for cancer

Immune cell therapy with chimeric antigen receptor (CAR) T cells, which has shown promising efficacy in patients with some hematologic malignancies, has introduced several successfully approved CAR T cell therapy products. Nevertheless, despite significant advances, treatment with these products has major challenges regarding potential toxicity and sometimes fatal adverse effects for patients. These toxicities can result from cytokine release or on-target off-tumor toxicity that targets healthy host tissue following CAR T cell therapy. The present study focuses on the unexpected side effects of targeting normal host tissues with off-target toxicity. Also, recent safety strategies such as replacing or adding different components to CARs and redesigning CAR structures to eliminate the toxic impact of CAR T cells, including T cell antigen coupler (TAC), switch molecules, suicide genes, and humanized monoclonal antibodies in the design of CARs, are discussed in this review.

Extracellular vesicles derived from dental mesenchymal stem/stromal cells with gemcitabine as a cargo have an inhibitory effect on the growth of pancreatic carcinoma cell lines in vitro

Extracellular vesicles (EVs) are nowadays a target of interest in cancer therapy as a successful drug delivering tool. Based on their many beneficial biocompatible properties are designed to transport nucleic acids, proteins, various nanomaterials or chemotherapeutics. Extracellular vesicles derived from mesenchymal stem/stromal cells (MSCs) possess their tumor-homing abilities. This inspired us to engineer the MSC's EVs to be packed with chemotherapeutic agents and deliver it as a Trojan horse directly into tumor cells. In our study, human dental pulp MSCs (DP-MSCs) were cultivated with gemcitabine (GCB), which led to its absorption by the cells and subsequent secretion of the drug out into conditioned media in EVs. Concentrated conditioned media containing small EVs (potentially exosomes) significantly inhibited the cell growth of pancreatic carcinoma cell lines in vitro. DP-MSCs were simultaneously engineered to express a suicide gene fused yeast cytosinedeaminase:uracilphosphoribosyltransferase (yCD::UPRT). The product of the suicide gene converts non-toxic prodrug 5-fluorocytosine (5-FC) to highly cytotoxic chemotherapeutic drug 5-fluorouracil (5-FU) in the recipient cancer cells. Conversion of 5-FC to 5-FU had an additional effect on cancer cell's growth inhibition. Our results showed a therapeutic potential for DP-MSC-EVs to be designed for successful delivering of chemotherapeutic drugs, together with prodrug suicide gene therapy system.

Construction of Minicircle Suicide Genes Coding for Ribosome-Inactivating Proteins

Due to the lower risks of adverse effects, nonviral gene therapy is a suitable alternative to transfect cancer cells with a suicide gene to let them kill themselves by expressing toxic ribosome-inactivating proteins. Plasmids are stable and easy-to-produce vectors, but they have some disadvantages due to the bacterial backbone. Applying the minicircle technology, this problem can be solved with manageable effort in a well-equipped laboratory. With the described methodology, minicircle-DNA can be produced at low costs. The cell killing properties are monitored following transfection using the CytoSMART^® Omni system-a camera based live cell imaging device.

Suicide gene therapy in cancer and HIV-1 infection: An alternative to conventional treatments

Suicide Gene Therapy (SGT) aims to introduce a gene encoding either a toxin or an enzyme making the targeted cell more sensitive to chemotherapy. SGT represents an alternative approach to combat pathologies where conventional treatments fail such as pancreatic cancer or the high-grade glioblastoma which are still desperately lethal. We review the possibility to use SGT to treat these cancers which have shown promising results in vitro and in preclinical trials. However, SGT has so far failed in phase III clinical trials thus further improvements are awaited. We can now take advantages of the many advances made in SGT for treating cancer to combat other pathologies such as HIV-1 infection. In the review we also discuss the feasibility to add SGT to the therapeutic arsenal used to cure HIV-1-infected patients. Indeed, preliminary results suggest that both productive and latently infected cells are targeted by the SGT. In the last section, we address the limitations of this approach and how we might improve it.

Serotype-dependent recombinant adeno-associated vector (AAV) infection of Epstein-Barr virus-positive B-cells, towards recombinant AAV-based therapy of focal EBV + lymphoproliferative disorders

BACKGROUND

B-cell proliferative disorders, such as post-transplant lymphoproliferative disease (PTLD), are increased among persons afflicted by T-cell compromise. Most are Epstein-Barr virus (EBV) + and can first present with a focal lesion. Direct introduction of oncolytic viruses into localized tumors provides theoretical advantages over chemotherapy, immunotherapy and radiation therapy by reducing systemic toxicity. Despite extensive study as a vehicle for gene therapy, adeno-associated viruses (AAV) have rarely been applied to human cancer research due to technical and theoretical obstacles. Moreover, human B-cells have historically been described as resistant to AAV infection. Nonetheless, advances using different recombinant (r)AAV serotypes with unique tropisms to deliver cytotoxic therapy suggested a localized anti-tumor approach was feasible.

METHODS

As a prelude to the development of a therapeutic vehicle, the ability of fifteen distinct EGFP-bearing rAAV serotypes to transduce human B-cells, including primary, immortalized, and B-cell tumor lines ± EBV was assessed by confocal microscopy, flow cytometry and subsequently cell viability assay.

RESULTS

Rank order analysis revealed augmented transduction by rAAV6.2 and closely related virions. EBV infection of EBV-negative B-cell tumor lines and EBV immortalization of primary B-cells increased susceptibility to rAAV6.2 transduction. As a proof of concept, transduction by rAAV6.2 encoding herpes simplex virus type 1 (HSV1)-thymidine kinase (TK) eliminated TK-negative rhabdomyosarcoma cells and diminished viability of transduced B-cell lines upon incubation with ganciclovir.

CONCLUSIONS

rAAV serotypes differentially transduce human B-cell lines reversing the dogma that human B-cells are refractory to AAV infection. EBV + B-cells display increased susceptibility to rAAV6.2 infection, uncovering a new method for improved nucleic acid transfer into transfection-resistant B-cell lines. The introduction of a functional suicide gene into the rAAV6.2 genome identifies a candidate vector for the development of rAAV-based oncolytic therapy targeting focal EBV-bearing B-lymphoproliferative disorders.

Iron Oxide Nanoparticles Promote Cx43-Overexpression of Mesenchymal Stem Cells for Efficient Suicide Gene Therapy during Glioma Treatment

Background: Mesenchymal stem cells (MSCs) have been applied as a promising vehicle for tumour-targeted delivery of suicide genes in the herpes simplex virus thymidine kinase (HSV-tk)/ganciclovir (GCV) suicide gene therapy against malignant gliomas. The efficiency of this strategy is largely dependent on the bystander effect, which relies on high suicide gene expression levels and efficient transportation of activated GCV towards glioma cells. However, up to now, the methods to enhance the bystander effect of this strategy in an efficient and safe way are still lacking and new approaches to improve this therapeutic strategy are required.

Methods: In this study, MSCs were gene transfected using magnetosome-like ferrimagnetic iron oxide nanochains (MFIONs) to highly express HSV-tk. Both the suicide and bystander effects of HSV-tk expressed MSCs (MSCs-tk) were quantitatively evaluated. Connexin 43 (Cx43) expression by MSCs and glioma cells was measured under different treatments. Intercellular communication between MSCs and C6 glioma cells was examined using a dye transfer assay. Glioma tropism and the bio-distribution of MSCs-tk were observed. Anti-tumour activity was investigated in the orthotopic glioma of rats after intravenous administration of MSCs-tk followed by intraperitoneal injection of GCV.

Results: Gene transfection using MFIONs achieved sufficient expression of HSV-tk and triggered Cx43 overexpression in MSCs. These Cx43 overexpressing MSCs promoted gap junction intercellular communication (GJIC) between MSCs and glioma cells, resulting in significantly inhibited growth of glioma through an improved bystander effect. Outstanding tumour targeting and significantly prolonged survival with decreased tumour size were observed after the treatment using MFION-transfected MSCs in glioma model rats.

Conclusion: Our results show that iron oxide nanoparticles have the potential to improve the suicide gene expression levels of transfected MSCs, while promoting the GJIC formation between MSCs and tumour cells, which enhances the sensitivity of glioma cells to HSV-tk/GCV suicide gene therapy.

Brain HIV-1 latently-infected reservoirs targeted by the suicide gene strategy

Reducing the pool of HIV-1 reservoirs in patients is a must to achieve functional cure. The most prominent HIV-1 cell reservoirs are resting CD4 + T cells and brain derived microglial cells. Infected microglial cells are believed to be the source of peripheral tissues reseedings and the emergence of drug resistance. Clearing infected cells from the brain is therefore crucial. However, many characteristics of microglial cells and the central nervous system make extremely difficult their eradication from brain reservoirs. Current methods, such as the "shock and kill", the "block and lock" and gene editing strategies cannot override these difficulties. Therefore, new strategies have to be designed when considering the elimination of brain reservoirs. We set up an original gene suicide strategy using latently infected microglial cells as model cells. In this paper we provide proof of concept of this strategy.

Direct Reprogramming of Human Fibroblasts into Induced Neural Progenitor Cells Using Suicide Gene Embodied Episomal Vectors for Rapid Selection of Exogenous DNA-Free Cells

Direct neural reprogramming involves a rapid conversion of somatic cells into neural cells without passing through the intermediate pluripotent stage. This phenomenon can be mediated in the starting somatic cells by the introduction of lineage-specific master transcription factors or by pluripotency factors routinely used in iPS cell generation. In the latter process known as Pluripotency factor-mediated Direct Reprogramming (PDR), the pluripotency factors are used to elicit epigenetic changes producing a permissive state in the starting cells which are then driven to the neural lineages by simple manipulations of the culture conditions. When genes are exogenously introduced to achieve such conversion, their persistent expression after completion of the reprogramming can affect the properties of the resulting cells. Here, we describe a robust method for direct neural reprogramming using the episomal vectors that incorporate a suicide gene scFCY1 (encoding cytosine deaminase) that allows rapid and efficient generation of a homogenous population of transgene-free human-induced neural progenitor cells (hiNPCs). The resulting NESTIN⁺/PAX6⁺/CDH2⁺ hiNPCs can be expanded and cryopreserved and can be further differentiated into neurons and glia.

Synergistic inhibitory effect of resveratrol and TK/GCV therapy on melanoma cells

PURPOSE

To investigate the synergistic effect of resveratrol on the bystander effect of TK/GCV suicide gene system in melanoma cells.

METHODS

The effect of resveratrol on the growth of B16 cells and the synergistic effect of resveratrol with or without GCV were detected by MTT assay and high content screening assay. The effect of resveratrol on GJIC function was detected by flow cytometry combined with fluorescence tracer and fluorescence microscope, and the expression of gap junction protein was detected by western blotting. Synergistic killing effect of resveratrol plus TK/GCV was tested in vivo using transplanted melanoma model.

RESULTS

In vitro, resveratrol can enhanced GJ function and upregulated Cx32 and Cx43 protein expression in B16 cells. Resveratrol synergized with GCV to kill mixed B16 melanoma cells (20% TK⁺ cells and 80% TK^- cells) and to improve apoptosis rate of TK^- cells (the bystander effect of TK system), and the synergistic action was reversed by the GJ inhibitor AGA. In vivo, when B16 cells were mixed with 30% TK⁺ B16 cells, significantly reduced tumor weight and volume were observed after combinational treatment with resveratrol plus GCV as compared with GCV or resveratrol treatment alone.

CONCLUSIONS

Resveratrol could synergistically enhance the killing effect of TK/GCV suicide gene system in melanoma B16 cells and transplanted melanoma. It might be a promising adjuvant of TK/GCV therapy.

Next generation chimeric antigen receptor T cells: safety strategies to overcome toxicity

Chimeric antigen receptor T (CAR-T) cell therapy is an emerging and effective cancer immunotherapy. Especially in hematological malignancies, CAR-T cells have achieved exciting results. Two Anti-CD19 CAR-T therapies have been approved for the treatment of CD19-positive leukemia or lymphoma. However, the application of CAR-T cells is obviously hampered by the adverse effects, such as cytokines release syndrome and on-target off-tumor toxicity. In some clinical trials, patients quitted the treatment of CAR-T cells due to life-threatening toxicity. Seeking to alleviate these toxicities or prevent the occurrence, researchers have developed a number of safety strategies of CAR-T cells, including suicide genes, synthetic Notch receptor, on-switch CAR, combinatorial target-antigen recognition, bispecific T cell engager and inhibitory CAR. This review summarized the preclinical studies and clinical trials of the safety strategies of CAR-T cells and their respective strengths and weaknesses.

Conditional ablation of reactive astrocytes to dissect their roles in spinal cord injury and repair

Astrocytes become reactive in response to spinal cord injury (SCI) and ultimately form a histologically apparent glial scar at the lesion site. It is controversial whether astrocytic scar is detrimental or beneficial to the axonal regeneration and SCI repair. Therefore, much effort has focused on understanding the functions of reactive astrocytes. Here, we used a lentivirus-mediated herpes simplex thymidine kinase/ganciclovir (HSVtk/GCV) system to selectively kill scar-forming reactive proliferating astrocytes. The suicide gene expression was regulated by human glial fibrillary acidic protein (hGFAP) promoter, which is active primarily in astrocytes. Conditional ablation of reactive astrocytes in a mouse SCI model with crush injury impeded glial scar formation and resulted in widespread infiltration of inflammatory cells, increased neuronal loss, and severe tissue degeneration, which ultimately led to the failure of spontaneous functional recovery. These results suggest that reactive proliferating astrocytes play key roles in the healing process after SCI, shedding light on the potential benefit for the repair after central nervous system (CNS) injury.

Human Genomic Safe Harbors and the Suicide Gene-Based Safeguard System for iPSC-Based Cell Therapy

The use of human induced pluripotent stem cells (hiPSCs) and recent advances in cell engineering have opened new prospects for cell‐based therapy. However, there are concerns that must be addressed prior to their broad clinical applications and a major concern is tumorigenicity. Suicide gene approaches could eliminate wayward tumor‐initiating cells even after cell transplantation, but their efficacy remains controversial. Another concern is the safety of genome editing. Our knowledge of human genomic safe harbors (GSHs) is still insufficient, making it difficult to predict the influence of gene integration on nearby genes. Here, we showed the topological architecture of human GSH candidates, AAVS1, CCR5, human ROSA26, and an extragenic GSH locus on chromosome 1 (Chr1‐eGSH). Chr1‐eGSH permitted robust transgene expression, but a 2 Mb‐distant gene within the same topologically associated domain showed aberrant expression. Although knockin iPSCs carrying the suicide gene, herpes simplex virus thymidine kinase (HSV‐TK), were sufficiently sensitive to ganciclovir in vitro, the resulting teratomas showed varying degrees of resistance to the drug in vivo. Our findings suggest that the Chr1‐eGSH is not suitable for therapeutic gene integration and highlight that topological analysis could facilitate exploration of human GSHs for regenerative medicine applications. Our data indicate that the HSV‐TK/ganciclovir suicide gene approach alone may be not an adequate safeguard against the risk of teratoma, and suggest that the combination of several distinct approaches could reduce the risks associated with cell therapy. stem cells translational medicine2019;8:627&638

Noninvasive Monitoring of Suicide Gene Therapy by Using Multimodal Molecular Imaging

Cells expressing suicide genes can be used as therapeutic vehicles for difficult-to-treat tumors, for example, if stem cells are used that are able to track infiltrating tumor cells. An alternative application of suicide gene expression is their use as a safety switch in regenerative medicine where the presence of a few pluripotent stem cells could potentially cause unwanted side effects like the formation of teratoma. One potential bottleneck of these applications is that information on the initiation of cell suicide is needed early on, for example, when therapeutic cells have reached infiltrating tumor cells or when teratomas are formed. Therefore, in vivo imaging methods are needed that provide information on target location, (stem) cell location, (stem) cell viability, pathology, and suicide gene expression. This requires multimodal imaging approaches that can provide this information longitudinally and in a noninvasive way. Here, we describe examples of how therapeutic cells can be modified so that they express a suicide gene and genes that can be used for in vivo visualization.

Mesenchymal Stem Cell Exosome-Mediated Prodrug Gene Therapy for Cancer

Exosomes derived from human mesenchymal stem cells (MSCs) engineered to express the suicide gene yeast cytosine deaminase::uracil phosphoribosyl transferase (yCD::UPRT) represent a new therapeutic approach for tumor-targeted innovative therapy. The yCD::UPRT-MSC-exosomes carry mRNA of the suicide gene in their cargo. Upon internalization by tumor cells, the exosomes inhibit the growth of broad types of cancer cells in vitro, in the presence of a prodrug. Here we describe the method leading to the production and testing of these therapeutic exosomes. The described steps include the preparation of replication-deficient retrovirus possessing the yCD::UPRT suicide gene, and the preparation and selection of MSCs transduced with yCD::UPRT suicide gene. We present procedures to obtain exosomes possessing the ability to induce the death of tumor cells. In addition, we highlight methods for the evaluation of the suicide gene activity of yCD::UPRT-MSC-exosomes.

Generation of Suicide Gene-Modified Chimeric Antigen Receptor-Redirected T-Cells for Cancer Immunotherapy

Chimeric antigen receptor (CAR)-redirected T-cells are a powerful tool for the treatment of several type of cancers; however, they can cause several adverse effects including cytokine release syndrome, off-target effects resulting in potentially fatal organ damage or even death. Particularly, for CAR T-cells redirected toward acute myeloid leukemia (AML) antigens myelosuppression can be a challenge. The previously validated inducible Caspase9 (iC9) suicide gene system is one of the approaches to control the infused cells in vivo through its activation with a nontherapeutic chemical inducer of dimerizer (CID). We performed a preclinical validation using a model of CD33⁺ AML, and generated iC9 CAR T-cells co-expressing a CAR targeting the AML-associated antigen CD33 and a selectable marker (ΔCD19). ΔCD19 selected (sel.) iC9-CAR.CD33 T-cells were effective in controlling leukemia growth in vitro, and could be partially eliminated (76%) using a chemical inducer of dimerization that activates iC9. Moreover, to completely eliminate residual cells, a second targeted agent was added. Future plans with these methods are to investigate the utility of iC9-CAR.CD33 T-cells as part of the conditioning therapy for an allogeneic hematopoietic stem cell transplant. Additional strategies that we are currently validating include (1) the modulation of the suicide gene activation, using different concentrations of the inducing agent(s), to be able to eliminate CAR T-cells modified by a regulatable gene, ideally aiming at preserving a proportion of the infused cells (and their antitumor activity) for mild to moderate toxicities, or (2) the co-expression of an inhibitory CAR aiming at sparing normal cells co-expressing an antigen not shared with the tumor.

Selective Ablation of Tumorigenic Cells Following Human Induced Pluripotent Stem Cell-Derived Neural Stem/Progenitor Cell Transplantation in Spinal Cord Injury

Tumorigenesis is an important problem that needs to be addressed in the field of human stem/progenitor cell transplantation for the treatment of subacute spinal cord injury (SCI). When certain “tumorigenic” cell lines are transplanted into the spinal cord of SCI mice model, there is initial improvement of motor function, followed by abrupt deterioration secondary to the effect of tumor growth. A significant proportion of the transplanted cells remains undifferentiated after transplantation and is thought to increase the risk of tumorigenesis. In this study, using lentiviral vectors, we introduced the herpes simplex virus type 1 thymidine kinase (HSVtk) gene into a human induced pluripotent stem cell‐derived neural stem/progenitor cell (hiPSC‐NS/PC) line that is known to undergo tumorigenic transformation. Such approach enables selective ablation of the immature proliferating cells and thereby prevents subsequent tumor formation. In vitro, the HSVtk system successfully ablated the immature proliferative neural cells while preserving mature postmitotic neuronal cells. Similar results were observed in vivo following transplantation into the injured spinal cords of immune‐deficient (nonobese diabetic–severe combined immune‐deficient) mice. Ablation of the proliferating cells exerted a protective effect on the motor function which was regained after transplantation, simultaneously defending the spinal cord from the harmful tumor growth. These results suggest a potentially promising role of suicide genes in opposing tumorigenesis during stem cell therapy. This system allows both preventing and treating tumorigenesis following hiPSC‐NS/PC transplantation without sacrificing the improved motor function. stem cells translational medicine2019;8:260&270

Cell-mediated enzyme prodrug cancer therapies

Cell-directed gene therapy is a promising new frontier for the field of targeted cancer therapies. Here we discuss the current pre-clinical and clinical use of cell-mediated enzyme prodrug therapy (EPT) directed against solid tumors and avenues for further development. We also discuss some of the challenges encountered upon translating these therapies to clinical trials. Upon sufficient development, cell-mediated enzyme prodrug therapy has the potential to maximize the distribution of therapeutic enzymes within the tumor environment, localizing conversion of prodrug to active drug at the tumor sites thereby decreasing off-target toxicities. New combinatorial possibilities are also promising. For example, when combined with viral gene-delivery vehicles, this may result in new hybrid vehicles that attain heretofore unmatched levels of therapeutic gene expression within the tumor.

Rapid eradication of colon carcinoma by Clostridium perfringens Enterotoxin suicidal gene therapy

Background

Bacterial toxins have evolved to an effective therapeutic option for cancer therapy. The Clostridium perfringens enterotoxin (CPE) is a pore-forming toxin with selective cytotoxicity. The transmembrane tight junction proteins claudin-3 and -4 are known high affinity CPE receptors. Their expression is highly upregulated in human cancers, including breast, ovarian and colon carcinoma. CPE binding to claudins triggers membrane pore complex formation, which leads to rapid cell death. Previous studies demonstrated the anti-tumoral effect of treatment with recombinant CPE-protein. Our approach aimed at evaluation of a selective and targeted cancer gene therapy of claudin-3- and/or claudin-4- expressing colon carcinoma in vitro and in vivo by using translation optimized CPE expressing vector.

Methods

In this study the recombinant CPE and a translation optimized CPE expressing vector (optCPE) was used for targeted gene therapy of claudin-3 and/or -4 overexpressing colon cancer cell lines. All experiments were performed in the human SW480, SW620, HCT116, CaCo-2 and HT-29 colon cancer and the isogenic Sk-Mel5 and Sk-Mel5 Cldn-3-YFP melanoma cell lines. Claudin expression analysis was done at protein and mRNA level, which was confirmed by immunohistochemistry. The CPE induced cytotoxicity was analyzed by the MTT cytotoxicity assay. In addition patient derived colon carcinoma xenografts (PDX) were characterized and used for the intratumoral in vivo gene transfer of the optCPE expressing vector in PDX bearing nude mice.

Results

Claudin-3 and -4 overexpressing colon carcinoma lines showed high sensitivity towards both recCPE application and optCPE gene transfer. The positive correlation between CPE cytotoxicity and level of claudin expression was demonstrated. Transfection of optCPE led to targeted, rapid cytotoxic effects such as membrane disruption and necrosis in claudin overexpressing cells. The intratumoral optCPE in vivo gene transfer led to tumor growth inhibition in colon carcinoma PDX bearing mice in association with massive necrosis due to the intratumoral optCPE expression.

Conclusions

This novel approach demonstrates that optCPE gene transfer represents a promising and efficient therapeutic option for a targeted suicide gene therapy of claudin-3 and/or claudin-4 overexpressing colon carcinomas, leading to rapid and effective tumor cell killing in vitro and in vivo.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-017-3123-x) contains supplementary material, which is available to authorized users.

A non-viral suicide gene delivery system traversing the blood brain barrier for non-invasive glioma targeting treatment

Herpes simplex virus type I thymidine kinase gene (HSV-TK) in viral vector is a promising strategy against glioblastoma multiforme (GBM). However, the biosafety risk restricts its application in clinic. In this work, poly (l-lysine)-grafted polyethylenimine (PEI-PLL), which combines the high transfection efficiency of polyethylenimine and the good biodegradability of poly (l-lysine), was adopted as the non-viral vector backbone. Angiopep-2, a blood brain barrier (BBB) crossing and glioma targeting bifunctional peptide was conjugated on PEI-PLL via polyethyleneglycol (PEG) and designated as PPA. The optimal transfection ratio of PPA/DNA complexes nanoparticles (PPA NPs) was firstly characterized. Next, the glioma targeting of the PPA NPs was confirmed through cellular uptake and transfection analysis. The in vivo imaging studies demonstrated that the PPA NPs could not only penetrate BBB but also accumulate in striatum and cortex via systemic administration. Moreover, the PPA/HSV-TK NPs showed remarkably anti-glioma effect and survival benefit in an invasive orthotopic human GBM mouse model through inhibiting proliferation and inducing apoptosis (p<0.05 vs control). This study firstly illustrated that the cationic polymer PPA could be exploited as an efficient gene vector to cross the BBB, and innovatively provided a potential non-viral nanomedicine for noninvasive suicide gene therapy in the glioma treatment.

Synergistic Effect of Expressed miR-128 and Puma Protein on Targeted Induction of Tumor Cell Apoptosis

BACKGROUND

Puma is a highly robust pro-apoptotic protein. The protein becomes activated by p53 ensuing beyond-repair DNA damage. Downregulation of SIRT 1, by miR-128, elevates activated p53 that foment Puma indirectly.

OBJECTIVES

In the present study, we used two-expression Adeno-Associated Virus (AAV) system for co-expression of miR-128 and Puma in order to evaluate apoptotic response; both in the tumor and normal cells, respectively.

MATERIALS AND METHODS

Three recombinant AAVs constructs were generated. The First rAAV bearing Puma under the control of hTERT (p-AAV), the second construct designed such that to carry miR-128 downstream of CMV (mi-AAV), and the last construct comprises of the both CMV-miR-128 and hTERT- Puma. Real-Time PCR and western blotting were used to evaluate expression levels of the transduced genes.

RESULTS

MTT assay and DAPI staining shown suicidal effect of each recombinant AAV vectors. p-AAV cytotoxicity was recorded for 62% of the tumor cells, while for normal cells it was only 20% cytotoxic. The second construct, mi-AAV, was not as potent and selective as p-AAV. This construct was shown to be 27% and 16% cytotoxic for BT-474 and HEK-293 cells, respectively. Co-expression of Puma and miR-128 (p-mi-AAV) was accomplished with a selective cytotoxicity toward BT-474. This construct was 85% toxic for tumor cells, although it was only 25% toxic for the normal cell line (HEK-293).

CONCLUSIONS

In this study, we have shown that not only Puma is able to instigate apoptotic response but also its co-expression along with miR-128 could significantly enhance apoptosis in a synergistic manner.

Preventing Pluripotent Cell Teratoma in Regenerative Medicine Applied to Hematology Disorders

Iatrogenic tumorigenesis is a major limitation for the use of human induced pluripotent stem cells (hiPSCs) in hematology. The teratoma risk comes from the persistence of hiPSCs in differentiated cell populations. Our goal was to evaluate the best system to purge residual hiPSCs before graft without compromising hematopoietic repopulation capability. Teratoma risk after systemic injection of hiPSCs expressing the reporter gene luciferase was assessed for the first time. Teratoma formation in immune‐deficient mice was tracked by in vivo bioimaging. We observed that systemic injection of hiPSCs produced multisite teratoma as soon as 5 weeks after injection. To eliminate hiPSCs before grafting, we tested the embryonic‐specific expression of suicide genes under the control of the pmiR‐302/367 promoter. This promoter was highly active in hiPSCs but not in differentiated cells. The gene/prodrug inducible Caspase‐9 (iCaspase‐9)/AP20187 was more efficient and rapid than thymidine kinase/ganciclovir, fully specific, and without bystander effect. We observed that iCaspase‐9‐expressing hiPSCs died in a dose‐dependent manner with AP20187, without reaching full eradication in vitro. Unexpectedly, nonspecific toxicity of AP20187 on iCaspase‐9‐negative hiPSCs and on CD34⁺ cells was evidenced in vitro. This toxic effect strongly impaired CD34⁺‐derived human hematopoiesis in adoptive transfers. Survivin inhibition is an alternative to the suicide gene approach because hiPSCs fully rely on survivin for survival. Survivin inhibitor YM155 was more efficient than AP20187/iCaspase‐9 for killing hiPSCs, without toxicity on CD34⁺ cells, in vitro and in adoptive transfers. hiPSC purge by survivin inhibitor fully eradicated teratoma formation in immune‐deficient mice. This will be useful to improve the safety management for hiPSC‐based medicine. Stem Cells Translational Medicine2017;6:382–393

Tumor-specific expression of shVEGF and suicide gene as a novel strategy for esophageal cancer therapy

AIM: To develop a potent and safe gene therapy for esophageal cancer.

METHODS: An expression vector carrying fusion suicide gene (yCDglyTK) and shRNA against vascular endothelial growth factor (VEGF) was constructed and delivered into EC9706 esophageal cancer cells by calcium phosphate nanoparticles (CPNP). To achieve tumor selectivity, expression of the fusion suicide gene was driven by a tumor-specific human telomerase reverse transcriptase (hTERT) promoter. The biologic properties and therapeutic efficiency of the vector, in the presence of prodrug 5-fluorocytosine (5-FC), were evaluated in vitro and in vivo.

RESULTS: Both in vitro and in vivo testing showed that the expression vector was efficiently introduced by CPNP into tumor cells, leading to cellular expression of yCDglyTK and decreased VEGF level. With exposure to 5-FC, it exhibited strong anti-tumor effects against esophageal cancer. Combination of VEGF shRNA with the fusion suicide gene demonstrated strong anti-tumor activity.

CONCLUSION: The shVEGF-hTERT-yCDglyTK/5-FC system provided a novel approach for esophageal cancer-targeted gene therapy.

Regulated apoptosis of genetically modified hematopoietic stem and progenitor cells via an inducible caspase-9 suicide gene in rhesus macaques

The high risk of insertional oncogenesis reported in clinical trials using integrating retroviral vectors to genetically modify hematopoietic stem and progenitor cells (HSPCs) requires the development of safety strategies to minimize risks associated with novel cell and gene therapies. The ability to ablate genetically modified cells in vivo is desirable, should an abnormal clone emerge. Inclusion of "suicide genes" in vectors to facilitate targeted ablation of vector-containing abnormal clones in vivo is one potential safety approach. We tested whether the inclusion of the "inducible Caspase-9" (iCasp9) suicide gene in a gamma-retroviral vector facilitated efficient elimination of vector-containing HSPCs and their hematopoietic progeny in vivo long-term, in an autologous non-human primate transplantation model. Following stable engraftment of iCasp9 expressing hematopoietic cells in rhesus macaques, administration of AP1903, a chemical inducer of dimerization able to activate iCasp9, specifically eliminated vector-containing cells in all hematopoietic lineages long-term, suggesting activity at the HSPC level. Between 75% and 94% of vector-containing cells were eliminated by well-tolerated AP1903 dosing, but lack of complete ablation was linked to lower iCasp9 expression in residual cells. Further investigation of resistance mechanisms demonstrated upregulation of Bcl-2 in hematopoietic cell lines transduced with the vector and resistant to AP1903 ablation. These results demonstrate both the potential and the limitations of safety approaches using iCasp9 to HSPC-targeted gene therapy settings, in a model with great relevance to clinical development.

Enhancement of expression of survivin promoter-driven CD/TK double suicide genes by the nuclear matrix attachment region in transgenic gastric cancer cells

This work aimed to study a novel transgenic expression system of the CD/TK double suicide genes enhanced by the nuclear matrix attachment region (MAR) for gene therapy. The recombinant vector pMS-CD/TK containing the MAR-survivin promoter-CD/TK cassette was developed and transfected into human gastric cancer SGC-7901 cells. Expression of the CD/TK genes was detected by quantitative real-time PCR (qPCR) and Western blot. Cell viability and apoptosis were measured using the methyl thiazolyl tetrazolium (MTT) assay and flow cytometry. When the MAR fragment was inserted into the upstream of the survivin promoter, the qPCR result showed that the expression of the CD/TK genes significantly increased 7.7-fold in the transgenic SGC-7901 cells with plasmid pMS-CD/TK compared with that without MAR. MTT and flow cytometry analyses indicated that treatment with the prodrugs (5-FC+GCV) significantly decreased the cellular survival rate and enhanced the cellular apoptosis in the SGC-7901 cells. The expression of the CD/TK double suicide genes driven by the survivin promoter can be enhanced by the MAR fragment in human gastric cancer cells.

Combined gene therapy system pcDNA 3.1(-)-shVEGF/yCDglyTK inhibits proliferation of gastric cancer cells

AIM: To observe the effect of combined gene therapy system pcDNA 3.1(-)-shVEGF/yCDglyTK, which is mediated by calcium phosphate nanoparticles, on the proliferation of human gastric cancer cells.

METHODS: Expression plasmid vectors pcDNA3.1(-) NULL, pGenesil-1-hVEGF4-shRNA, pcDNA3.1(-)-CV-yCDglyTK, or pcDNA3.1(-)-shVEGF/yCDglyTK were transfected into human gastric cancer cell line SGC7901. The mRNA and protein expression of yCDglyTK and VEGF was detected by RT-PCR and Western blot, respectively. The proliferation of transfected cells was analyzed by MTT assay. Apoptosis of SGC7901 cells was analyzed by flow cytometry.

RESULTS: After transfection with plasmid pcDNA3.1(-)-shVEGF/yCDglyTK, yCDglyTK mRNA and protein was detectable, and expression of VEGF was decreased by 30.3%. Compared to cells transfected with plasmid pcDNA3.1(-)-CV-yCDglyTK, cells treated with the combined gene therapy system showed more significant proliferation inhibition (P < 0.05) and apoptosis (apoptosis rate: 67.9% ± 4.78%).

CONCLUSION: The combined gene therapy system pcDNA3.1(-)-shVEGF/yCDglyTK has stronger killing effect on gastric cancer cells than RNA interference or suicide gene alone.

Characterization of human T lymphocytes engineered to express interleukin-15 and herpes simplex virus-thymidine kinase

INTRODUCTION

Preclinical studies have demonstrated that tumor-reactive T cells expressing the interleukin (IL)-15 transgene had enhanced activity. Gene therapy strategies using IL-15 should include a safety mechanism in anticipation of possible adverse effects because IL-15 overexpression has been implicated in autoimmune disorders and may be involved in the pathogenesis of some leukemias. We developed a retroviral vector carrying both IL-15 and the herpes simplex virus-thymidine kinase (HSV-TK) suicide gene and characterized its application in the transduction of human T lymphocytes.

METHODS

A retroviral vector carrying IL-15 and HSV-TK genes was optimized for the transduction of human T lymphocytes. IL-15 production was measured by enzyme-linked immunosorbent assay. Thymidine incorporation and cell viability assays were used to assess the efficacy of the HSV-TK suicide gene. Genetically modified tumor-infiltrating lymphocytes (TILs) were assayed for survival after withdrawal from exogenous IL-2. The activity and specificity of retrovirally transduced TILs were assessed using tumor coculture assays.

RESULTS

Human T cells transduced with the IL-15 HSV-TK vector exhibited thymidine uptake in the absence of exogenous cytokine support and survived in culture for up to 80 d without IL-2. IL-15 HSV-TK-transduced T cells were efficiently killed by ganciclovir at concentrations as low as 0.1 μM. TILs transduced with the IL-15 HSV-TK vector retained specific recognition of HLA-A2+, MART1+ melanomas, even after withdrawal of IL-2.

CONCLUSIONS

Human T lymphocytes genetically modified with the IL-15 HSV-TK retroviral vector retained the ability to recognize tumor antigen while gaining the ability to secrete IL-15 and prolong their own survival. IL-15 HSV-TK-transduced T cells expressed HSV-TK and could be efficiently eliminated by ganciclovir.

Mechanism of bystander effect in therapy of stomach cancer with the KDR-CDglyTK suicide gene system

AIM: To study the relation between intercellular gap connection and bystander effect in therapy of stomach cancer with the KDR-CDglyTK suicide system.

METHODS: SCG7901 and HeLa cells were infected with adenovirus-based KDR-CDglyTK system (AdKDR-CDglyTK), and the expression of CDglyTK fusion gene in infected cells was confirmed by RT-PCR. Gap junction intercellular communication was determined by fluorescence recovery after photobleaching (FRAC) in SCG7901 and HeLa cells in the presence or absence of versulin. Infected and non-infected cells were mixed with a proportion of 5% and 95% or 10% and 90%, cultured in the presence or absence of versulin, and then used to detect cell survival by MTT assay.

RESULTS: The expression of GFP was observed in both infected SCG7901 cells and HeLa cells. Fluorescence intensity was gradually recovered at different time points after bleaching in SCG7901 cells cultured with versulin. Compared to SCG7901 cells cultured without versulin, the fluorescence recovery of bleached cells cultured with versulin was more obvious at the same time points. In contrast, fluorescence intensity showed no significant changes in HeLa cells cultured with versulin. The mean fluorescence recovery rate had a significant difference between SCG7901 and HeLa cells cultured with versulin. When infected and non-infected cells were mixed at different proportions, cell survival showed a significant difference between groups of SCG7901 cells (F = 144.42, 407.83; both P = 0.000), but had no significance difference between groups of HeLa cells (F = 0.386, 0.895; P = 0.765, 0.472).

CONCLUSION: There is a relation between intercellular communication and gap connection in SCG7901 cells but not in HeLa cells. Versulin can enhance the bystander effect in therapy with the suicide gene system in vitro. The mechanism of bystander effect in therapy with the suicide gene system may involve gap connection.

Anticancer effect of cation lipofectin-mediated CD/5-FC suicide gene system on liver, biliary duct and pancreas carcinoma cells in vitro

AIM: To investigate the anticancer effect of the CD/5-FC suicide gene system on carcinoma cells of liver (Bel7402), bililary duct (QBC) and pancreas (Bxpc3), and to explore the possible anticancer mechanism.

METHODS: The growth curve and multiplication time of Bel-7402 QBC and Bxpc-3 were monitored by MTT; the transfection efficiency of the three kinds of carcinoma cells were detected by FACS after instant transfection. The anticancer efficiency of cation lipofectin-mediated CD/5-FC suicide gene system were monitored by MTT in vitro. Then, we analyzed the relation among multiplication time, transfection efficiency and anticancer effect; the apoptosis of CD/5-FC on the three cell lines were analyzed by FAM, and the apoptosis cells were stained by Hochest33342.

RESULTS: The multiplication time of Bel-7402, QBC and Bxpc-3 was 34.48, 64.94 and 26.29 h respectively, and difference between QBC and BEL-7402, BXPC-3 was significant (P < 0.05); the transfection efficiency of the three cell line were 26.99%, 2.25% and 30.36%, and the difference between QBC, and BEL-7402 and BXPC-3 was significant (P < 0.05); the anticancer efficiency was 83.24%, 16.97% and 92.32%, respectively. The apoptosis rates of the three kinds of carcinoma cells induced by CD/5-FC suicide gene system were 27.8%, 5.49% and 36.5%, respectively.

CONCLUSION: Carcinoma cells with shorter growth cycle and less multiplication time have higher instant transfection efficiency, and are more responsive to CD/5-FC suicide gene therapy. This suicide gene therapy may be a promising method for later malignant tumor in clinic.

Tumor inhibition and bystander effect of CD/5-FC suicide gene system in normal mice

AIM: To investigate the anticancer and distant bystander effect of CD/5-FC suicide gene system combined with g-IFN in normal mice.

METHODS: H22 cells instantly transfected with cytosine deaminase (CD) gene plasmid (lipo-CD) or empty plasmid, mediated by cation liposome, were subcutaneously inoculated into the left or right axilla of Kunming mice, respectively. Then the mice were injected with 5-FC and g-interferon (γ-IFN) once per day, and the anticancer effect and distant bystander effects were compared when g-IFN was used or not.

RESULTS: 5-FC obviously inhibited the growth of tumors transfected with lipo-CD, and the inhibitory efficiency was 79.39%. When in combination with g-IFN, the inhibitory efficiency (93.47%) was strengthened significantly (t = 3.49, P = 0.0036). There was a notable bystander effect in CD/5-FC suicide gene system in vivo, and the suppressive rate was 54.42% for the distant tumor cells without transfection. When in combination with γ-IFN, the inhibition rate (88.43%) was strengthened greatly (t = 2.86, P = 0.0212).

CONCLUSION: CD/5-FC suicide system combined with g-IFN has more significant anticancer effects and may be used as a promising method in the treatment of liver cancer.

Targeted killing effect of lentivirus-mediated CD/TK suicide genes on colorectal carcinoma cells

AIM: To investigate the killing effect of lentivirus-mediated double suicide genes under the regulation of kinase domain-containing receptor (KDR) promoter targeted on colorectal carcinoma cells.

METHODS: 293FT packaging cells were transfected by the constructed plasmids pLenti6/V5-D-KDR-CDglyTK and pLenti6/V5-D-GFP. After blasticidin selection and cell cloning, the infectious viruses were generated. Then SW620 (with KDR expression) and LS174T cells (without KDR expression) were transfected with the obtained viruses by lipofectamin 2000. The transfection efficacy was evaluated by the fluorecence microscopy. The expression of CDglyTK was detected by reverse transcription-polymerase chain reaction (RT-PCR). After treatment with 5-FC and GCV, the killing effects and bystander effect of CD/TK suicide genes on the two kinds of cell lines were assessed.

RESULTS: The transfection efficacy was not significantly different between SW620 and LS174T cells, and elevated with the increase of virus titer. RT-PCR demonstrated that CDglyTK was expressed only in SW620 cells infected by pLenti6/V5-D-KDR-CDglyTK but not in LS147T cells. For the transfected SW620 cells, the survival rate was 32.34% ± 2.42% or 30.56% ± 2.14% when GCV (100 mg/L) or 5-FC (2.0 g/L) was used alone, respectively, and it was 5.36% ± 1.55% when GCV and 5-FC were used in combination. For the transfected LS174T cells, the survival rate was 95.48% ± 1.70% when GCV and 5-FC were used in combination. SW620 cells had a higher sensitivity to the prodrugs than LS174T cells did (P < 0.001), and the effects of double suicide genes were markedly stranger than that of either single gene (P < 0.001). Considerable bystander effect was also observed. When the infected cells covered a percentage of 40%, the survival rate of SW620 cells was 11.42% ± 2.66%, while that of LS174T cells was 99.54% ± 2.61% after treatment with GCV and 5-FC. There was significant difference between the two kinds of cells (P < 0.001).

CONCLUSION: Lentivirus-mediated CD/TK suicide genes driven by KDR promoter have specific killing effect on colorectal carcinoma cells with KDR expression.

Effects of Danshen and Total Saponins of Panax Notoginsen on rat hepatocarcinoma cells and bystander effect of suicide gene

AIM: To explore the effects of Danshen and Total Saponins of Panax Notoginsen (PNS) on rat hepatoca-rcinoma cells and the bystander effect of herpes simpl-ex virus thymidine kinase gene/ganciclovir (HSV-tk/GCV).

METHODS: Rat hepatocarcinoma cell line CBRH7919 (tk-), CBRH7919 (tk+) and the 5-10% tk+ mixed cells were treated with diverse concentrations of Danshen injection, PNS, GCV separately, or Danshen injection plus GCV and PNS plus GCV (n = 3, 6). The survival rate of the cells in each group was examined by MTT method, and q-value analysis was used to estimate the synergistic effect of traditional Chinese medicine on the suicide gene system. The q-value was equal to the ratio of the actual effect of combined treatment to its theoretical effect. The effect was classified into three categories: antagonistic effect (q ≤0.85), additive effect (0.85 ≤ q <1.15), and synergistic effect (q ≥1.15).

RESULTS: After the treatment of 5, 10, 20, 40 mL/L Danshen injection for 72 h, the survival rate of CBRH 7919 (tk-) was 81.0±17.3%, 55.6±12.0%, 14.6±4.4%, and 11.5±0.9%, respectively. IC₅₀ was 11.4 mL/L. The survival rate of the hepatocarcinoma cells was 78.9±27.9% in the 5% tk+/GCV group, and 84.3±18.2% in the GCV group, and the survival rate in the former was 7.6% lower than that in the latter. The survival rate of the cells was 47.8±16.5% (q = 1.60) in the group of 5 mL/L Danshen injection combined with 5% tk+/GCV, and 72.8±4.5% in the group of 5 mL/L Danshen injection combined with GCV, and the survival rate in the former was 34.3% lower than that in the latter. The survival rate was 12.2±5.9% (q = 1.46) in the group of 10 mL/L Danshen injection combined with 5% tk+/GCV, and 36.5±2.7% in the group of 10 mL/L Danshen injection combined with GCV, and the survival rate in the former was 66.3% lower than that in the latter. The survival rate of CBRH7919 (tk-) was 104.1±3.7%, 107.6±3.1%, 69.7±8.5%, and 59.3±2.9%, respectively, after the treatment of 10, 50, 100, and 140 mg/L PNS for 72 h. IC₅₀ was 220 mg/L. The survival rate in the 10% tk+/GCV group was 17.2% (P <0.05) lower than that in the GCV group. In the group of 50 mg/L and 100 mg/L PNS combined with 10% tk+/GCV (q = 0.89, 0.87), the survival rates were 17.7% and 18.3% lower than those in the corr-esponding groups of PNS combined with GCV, respec-tively.

CONCLUSION: Danshen injection can inhibit the prolif-eration of hepatocarcinoma cells significantly, and can synergically enhance the killing and bystander effect of tk/GCV system. PNS can also inhibit the proliferation of hepatocarcinoma cells to some extent, but it has only additive effect on the tk/GCV system, while no synerg-etic effect.

Kinase domain insert containing receptor promotor controlled suicide gene system kills human umbilical vein endothelial cells

AIM: To evaluate the killing effect of double suicide gene mediated by adenovirus and regulated under kinase domain insert containing receptor (KDR) promoter on human umbilical vein endothelial cells.

METHODS: By PCR technology, human KDR promoter gene, Escherichia coli (E. coli) cytosine deaminase (CD) gene and the herpes simple virus-thymidine kinase (TK) gene were cloned. Plasmid pKDR-CDglyTK was constructed with them. Then, a recombinant adenoviral plasmid pAdKDR-CDglyTK was constructed in a “two-step transformation protocol”. The newly constructed plasmids were transfected to 293 packaging cells to grow adenoviruses, which were further propagated and purified. Human umbilical vein endothelial cells (HUVEC) were infected with a different multiplicity of infection (MOI) of resultant recombinant adenovirus, the infection rate was measured with the aid of (GFP) expression. Infected cells were cultured in culture media containing different concentrations of (GCV) and/or 5-(FC), and the killing effects were measured.

RESULTS: Recombinant adenoviruses AdKDR-CDglyTK were successfully constructed, and they infected HUVEC cells efficiently. Our data indicated that the infection rate was relevant to MOI of recombinant adenoviruses. HUVEC cells infected with AdKDR-CDglyTK were highly sensitive to the prodrugs, their survival rate correlated to both the concentration of the prodrugs and the MOI of recombinant adenoviruses. Our data also indicated that the two prodrugs used in combination were much more effective on killing transgeneic cells than GCV or 5-FC used alone.

CONCLUSION: Prodrug/KDR-CDglyTK system is effective on killing HUVEC cells, its killing effect correlates to the concentration of prodrugs and recombinant adenovirus’ MOI. Combined use of the two prodrugs confers better killing effects on transgeneic cells.