Ching Y. Wang

Expression of prostate-specific membrane antigen in normal and malignant human tissues.

BackgroundProstate-specific membrane antigen (PSMA) is upregulated in androgen-dependent prostate carcinoma and it has been targeted for immunotherapy and diagnosis of this cancer. However, this protein is also expressed in other tissues. The objective of this study is to investigate its expression in normal and malignant human tissues.MethodsUsing monoclonal antibodies 24.4E6 (specific for residues 638–657) and 7E11.C5 (specific for the transmembrane domain of PSMA), immunohistochemical detection of PSMA was performed in surgical specimens.ResultsProstate-specific membrane antigen was detected in the epithelium of prostate, urinary bladder, proximal tubules of kidney, liver, esophagus, stomach, small intestine, colon, breast, fallopian tubes and testicular seminiferous tubules, hippocampal neurons and astrocytes, ependyma, cortex and medulla of the adrenal gland, and ovary stroma. It was also detected in neoplasms of the prostate, kidney, urinary bladder, stomach, small intestine, colon, lung, adrenal gland, and testis. It was not detected in normal seminal vesicles or the lung.ConclusionsThese findings demonstrate that PSMA is widely distributed in normal tissues, and, depending on the tumors, its expression is up- or down-regulated, or unchanged. The broad distribution of PSMA may make it suitable for the diagnosis and therapy of a wide variety of tumors.

Pathological Characteristics of Prostate Cancer in Elderly Men

PURPOSE Recent guidelines recommend that men older than 75 years should not be screened for prostate cancer. However, increased life expectancy and the development of less invasive treatments have led to an interest in characterizing prostate cancer in elderly men. We determined how prostate cancer pathological characteristics differ in men older vs younger than 70 years. MATERIALS AND METHODS We studied differences in prostate cancer pathological characteristics in autopsied glands from men 70 years old or older and compared findings to those in men younger than 70 years. All men died of causes unrelated to prostate cancer. Prostates were whole mounted at 4 mm intervals. Histological analysis was done to identify and characterize each cancer focus observed. Tumor volume was measured by computerized planimetry. Cancer was defined as clinically significant or insignificant based on established histological characteristics. RESULTS Of 211 prostates evaluated 74 were from men 70 years old or older. We identified cancer in 33 men (45%) in this age group vs in 26 of 137 (19%) younger than 70 years (p <0.001). Men older than 70 years had significantly larger cancer and more clinically significant cancer (64% vs 23%, p <0.005). Older men had more advanced stage cancer and greater Gleason scores (p <0.001). CONCLUSIONS In an autopsy study of men with no history of prostate cancer those older than 70 years were more likely to have larger and higher grade prostate cancer than younger men.

Immunotherapy for Lung Metastases of Murine Renal Cell Carcinoma: Synergy Between Radiation and Cytokine-producing Tumor Vaccines

We investigated the combination therapy of local radiation of lung metastasis and vaccination with autologous tumor cells that produced interleukin (IL)-2, interferon-gamma (IFN-gamma), and granulocyte-macrophage colony-stimulating factor (GM-CSF) using the mouse Renca pulmonary metastasis model. Wild-type Renca (W/Renca) were transfected with pEF-BOS vector incorporating cDNAs for IL-2, IFN-gamma, or GM-CSF to express these cytokines. W/Renca, IL-2-producing Renca (Renca/IL-2), and IFN-gamma-producing Renca (Renca/IFN-gamma) produced subcutaneous tumor at the injection site in eight of eight, one of eight, and two of eight mice, respectively. No tumors were found in the GM-CSF-producing Renca (Renca/GM-CSF) group (zero of eight). Renca/IFN-gamma produced subcutaneous (s.c.) tumors in all Balb/c nude mice, but Renca/IL-2 and Renca/GM-CSF did not. To test the elicitation of antitumor activity, Balb/c mice were injected intravenously with 1 x 10(5) W/Renca on day 0, vaccinated, s.c., with 1 x 10(6) cells each of 5,000 rad preirradiated Renca/IL-2, Renca/IFN-gamma, and Renca/GM-CSF or 3 x 10(6) cells of preirradiated W/Renca on days 1, 7, and 14, and radiated with 300 rad to both lungs on day 5. The animals were killed on day 21 and tumor nodules in the lungs were enumerated. Neither local irradiation alone nor the combination of lung radiation and multiple vaccination with irradiated W/Renca significantly reduced the number of lung tumors. In contrast, the combination of lung radiation and the multiple vaccinations with cytokine-producing Renca cells significantly reduced the number of lung tumors. This regimen was more effective than the multiple vaccinations with cytokine-producing Renca cells alone. These studies demonstrate the efficacy of vaccination with autologous tumor cells expressing these cytokines and sensitization of the tumor target with radiation.

IRX-2 increases the T cell-specific immune response to protein/peptide vaccines

Therapeutic cancer vaccines are attractive due to the prospect of specificity and their lack of toxicity; however, their clinical development has been hampered by several biologic and clinical challenges. One of the most important biologic challenges is the relative lack of effective cellular immune adjuvants. Effective physiologic immune responses are characterized by the local generation of a complex cytokine environment that activates and regulates multiple immune cell types. IRX-2 is a primary cell-derived biologic with physiological levels of multiple active cytokine components, produced under pharmaceutical standards. The hypothesis that IRX-2 amplifies the T cell response to defined antigens was assessed in mice by measuring the T cell-specific peptide response to a dominant mouse peptide (NFT) derived from human prostate-specific membrane antigen (PSMA). IRX-2 enhances the T cell response to NFT when antigens were delivered either via irradiated cells expressing human PSMA, NFT peptide in Incomplete Freunds adjuvant (IFA) or NFT peptide conjugated to KLH. The T cell-specific activity was measured in spleen or lymph nodes cells by IFN-γ ELISpot and/or IFN-γ secretion over 6 days or in vivo by peptide-specific delayed-type hypersensitivity reaction (DTH). Further more, a single administration of IRX-2 with the antigen was not active as compared to 4 or 9 additional administrations which were sufficient to enhance the T cell response to antigens. The influence of IRX-2 on the B cell response to ovalbumin when it was used as a carrier protein was measured by ELISA. IRX-2 was compared to a commercially available combination adjuvant (MPL+TDM in squalene/Tween 80) which based on the literature is a potent adjuvant in murine systems. In the T cell assay IRX-2 was superior to the commercially available combination adjuvant and while IRX-2 also increased antibody titer, it was not as potent as the combination adjuvant. Mice immunized with IRX-2 and antigen also exhibited delayed tumor progression following challenge with PSMA-expressing tumor cells. These studies demonstrate that IRX-2 is an immunomodulator with adjuvant activity which preferentially enhances the T cell-specific responses to tumor associated antigens. Based on these studies, IRX-2 is a candidate for evaluation as a T cell adjuvant in a variety of preclinical vaccine delivery systems as well as in human clinical trials with cancer vaccine candidates.

Association of Prostate Cancer and Manganese Superoxide Dismutase AA Genotype Influenced by Presence of Occult Cancer in Control Group

OBJECTIVES To investigate whether the inclusion of occult cancer in the control group can influence the association of prostate cancer and the polymorphism of manganese superoxide dismutase (MnSOD). METHODS Prostate specimens and sera were obtained from 194 deceased men who did not have a history of prostate cancer. Eighteen-core biopsy specimens and whole-mount sections were evaluated histologically. The MnSOD genotype of the specimens was determined by polymerase chain reaction restriction fragment length polymorphism analysis. RESULTS Tumors were present in 57 of the prostates, and biopsy detected 33 (including 1 false-positive finding). It detected 17 (1 false-positive finding) and missed 14 tumors in the subgroup of 135 specimens with a prostatic-specific antigen <4 ng/mL. The MnSOD AA genotype was associated with prostate cancer found in the step-sectioned specimens vs the control group in whom the absence of occult prostate cancer had been verified. However, no association was found if the control group consisted of subjects with negative biopsy results from the overall group or the subgroup with a prostatic-specific antigen level of <4 ng/mL. CONCLUSIONS The MnSOD AA genotype was associated with prostate cancer in our study; however, contamination of occult prostate cancer in the control group reduced the power of analysis and might yield seemingly negative results. Epidemiologic studies should strive to include control groups with a verified absence of occult cancer.

Induction of Antibodies against Prostate-Specific Membrane Antigen (PSMA) by Vaccination with a PSMA DNA Vector

Abstract Introduction and Objectives: Prostate-specific membrane antigen (PSMA) is a 750 amino acid surface protein expressed primarily in prostate epithelium, and is upregulated 10-fold in prostate cancer. It is therefore an attractive target for immunotherapy. However, most reported antibodies to PSMA apparently recognize epitopes in the residue 43–570 region of the extracellular domain, and upon binding are rapidly removed from the cell surface by internalization. This would potentially limit their ability to mediate Fc-dependent cytoxicity. In this study, we constructed a DNA expression vector, pV/TM–PSMc, in which this region was deleted from full-length PSMA cDNA. Mice were vaccinated with pV/TM–PSMc DNA to determine whether humoral responses directed against PSMA-positive human prostate cancer cells could be induced by this C-terminal region. Methods: Polymerase chain reaction (PCR)-based techniques were used to delete codons 50–570 from the coding region of human PSMA cDNA, thereby joining the C-terminal end (PSMc) to the N-terminal cytoplasmic/transmembrane domain (TM). This truncated product, TM–PSMc, was cloned into the vector pNGVL3 (pV). The resulting vector, pV/TM–PSMc, was confirmed by DNA sequencing, and by expression studies using reverse transcriptase (RT)–PCR for transcripts and immunohistochemical (IHC) staining with the PSMA monoclonal antibody (mAb) 7E11.C5. BALB/c mice were injected in the tibialis anterior muscle four times, at biweekly intervals, with 100μg vector DNA per injection. One week after the last injection, blood was drawn for serum preparation. The serum was assayed for antibodies against PSMA by IHC staining of LNCaP, a PSMA-positive human prostate cancer line. Expression in vaccinated muscle cells was determined by RT–PCR assay for TM–PSMc transcripts. Results: NIH3T3 cells transfected with pV/TM–PSMc stained positively by IHC reaction with mAb 7E11.C5. 48h after one intramuscular (i.m.) injection of mice with 100μg pV/TM–PSMc vector DNA, TM–PSMc transcripts were detectable in muscle RNA by RT–PCR analysis. Anti-serum from pV/TM–PSMc-DNA vaccinated mice, at a dilution of 1:20, intensely IHC-stained both live and fixed LNCaP cells. Conclusions: These results demonstrate that anti-PSMA humoral responses were induced by i.m. injection of mice with pV/TM–PSMc DNA. Antibodies in the anti-serum were directed against extracellular epitopes of native PSMA expressed by human prostate cancer cells. Vaccination with DNA expression vectors such as pV/TM–PSMc may provide an immunotherapeutic approach for the treatment of prostate cancer.

Clinical trials of immunotherapy for advanced prostate cancer

There is a lack of effective therapeutic regimens for advanced hormone-refractory prostate cancer (HRPC). Recent combination regimens of chemotherapy have improved management of HRPC. Neither systemic chemotherapy nor radiation regimens have significantly improved survival. Conventional systemic cytokine therapy has had limited efficacy in the treatment of advanced prostate cancer patients and its toxicity is severe. Combinations of multiple biological response modifiers for treatment of this disease also have limited efficacy. Results from phase II trials have shown that the combination of interferon-alpha and interleukin-2 therapy and the infusion of dendritic cells primed with peptides of prostate specific membrane antigen are promising. The former showed 31% response using the National Prostatic Cancer Project criteria, and the latter showed 27% of objective partial response with a reduction of >50% prostate specific antigen level. The toxicity of these two regimens was tolerated by patients. New approaches with tumor vaccines in conjunction with cytokine gene therapy have also been investigated. The clinical responses of these trials have been limited but promising. Immunotherapy may become an effective modality of prostate cancer treatment in the future.

Differential gene expression in human prostate cancer cells adapted to growth in bone in Beige mice

OBJECTIVE A metastasis model was used to identify genes potentially related to the growth of human prostate cancer in the bone. Injection of the human prostate cancer line PC3 into the femurs of Beige mice induced tumors that ruptured the femurs in 4 to 6 weeks. MATERIALS AND METHODS The subline PC3a was cultured in vitro from one of these PC3 bone tumors. PC3a cells were reinjected into femurs, and the subline PC3b was then cultured from a resulting PC3a tumor. Likewise, PC3c was derived from a PC3b bone tumor. The PC3 tumors were osteolytic, invasive and metastatic. RESULTS Analysis of gene expression in these PC3 sublines by differential-display RT-PCR identified two groups of transcripts whose steady state levels differed substantially from the original PC3 line. One group of transcripts increased with progressive adaptation to tumor formation in bone. The second group showed the reverse pattern. They progressively diminished in subsequent sublines, and were virtually absent in PC3b and PC3c. Two in this group were fibroblast growth factor receptor-2 and caveolin-1. They were strongly expressed in non-malignant prostate tissue. CONCLUSION These two downregulated genes, which have been reported to play a role in the development of androgen independence and malignant progression, may reflect molecular changes in growth regulation of PC3 cells during readaptation to an intra-osseal environment.

Inspiring urology trainees to enter academic careers.

The physician-scientist in academic medical centers has been called as ‘an endangered species’. Adverse socioeconomic pressures, lack of dedicated research time, and increasing difficulties in obtaining grant support, make it more and more difficult to attract talented individuals for this career path, and consequently to recruit and retain them in the urology departments. The challenges facing the young academic faculty, physician-scientists, and the research trainees represent a danger to the future of academic medicine. Only a concerted effort to balance the financial disincentives, providing a protected time, a nurturing environment, and the emphasis on outstanding mentors and role models, can secure the continued research and academic success of urology programs. The disproportionate representation of women and the minorities among academic faculty must be recognized and addressed.