Yosef S. Haviv

Adenoviral Gene Therapy for Renal Cancer Requires Retargeting to Alternative Cellular Receptors

Metastatic renal cell carcinoma (RCC) is one of the most treatment-resistant malignancies in humans. Therefore, the identification of new agents with better antitumor activity merits a high priority in the treatment of advanced RCC. In this regard, gene therapy with adenoviral (Ad) vectors is a promising new modality for cancer. However, a primary limiting factor for the use of Ad vectors for cancer gene therapy is their critical dependence on cellular expression of the primary Ad receptor, the coxsackie and adenovirus receptor (CAR), known to be down-regulated in many cancer types. Following the identification of CAR deficiency in RCC lines, we have found abundant membrane expression of alpha(v)beta 3 and alpha(v)beta 5 integrins and of the putative receptor to Ad serotype 3 (Ad3). As an alternative gene therapy approach for RCC that would circumvent CAR deficiency, we employed retargeting of replication-incompetent Ad vectors and replication-competent Ad viruses to alpha(v)beta 3 and alpha(v)beta 5 integrins and to the putative Ad3 receptor. These strategies to genetically alter Ad tropism were based on either the insertion of a cysteine-aspartate-cysteine-arginine-glycine-aspartate-cysteine-phenylalanine-cysteine (RGD) motif into the HI loop of the Ad fiber knob domain or on generation of a chimeric Ad fiber composed of adenovirus serotype 5 shaft/Ad3 knob. Both strategies proved highly efficient to circumvent CAR deficiency and enhance gene delivery into RCC cells. Furthermore, in the context of replication-competent Ad, tropism alteration resulted in distinct capacity of the retargeted viruses to infect, replicate, and lyse RCC models in vitro and in vivo. The retargeting strategies were particularly beneficial in the context of replication-competent Ad. These findings underscore the importance of CAR-independent cellular entry mechanisms in RCC and are highly consequential for the development of viral antitumor agents for RCC and other CAR-negative tumors.

Human Immunodeficiency Virus Type 1-Mediated Syncytium Formation Is Compatible with Adenovirus Replication and Facilitates Efficient Dispersion of Viral Gene Products and De Novo-Synthesized Virus Particles

Conditionally replicative adenovirus (CRAd) vectors are designed for specific oncolytic replication in tumor tissues with concomitant sparing of normal cells. As such, CRAds offer an unprecedented level of anticancer potential for malignancies that have been refractory to previous cancer gene therapy interventions. CRAd efficacy may, however, be compromised by inefficient dispersion of the replicating vector within the tumor tissue. To address this issue, we evaluated the utility of a fusogenic membrane glycoprotein (FMG), which induces the fusion of neighboring cellular membranes to form multinucleated syncytia. We hypothesized that the FMG-mediated syncytia would facilitate dispersion of the adenovirus (Ad) gene products and viral progeny. To test this, human immunodeficiency virus type 1 (HIV-1) envelope glycoproteins, which induce syncytia in the presence of CD4+ target cells, were expressed by an Ad (Ad5HIVenv) in permissive (CD4-positive) and nonpermissive (CD4-negative) cell lines. After validating this Ad-FMG model, the efficiency of Ad replication in the presence or absence of syncytia was evaluated. The results demonstrated that syncytium formation was compatible with Ad replication and dramatically increased the dispersion of virus gene products within the cytoplasm of the syncytia as well as viral particles in the nuclei of the syncytial mass. Moreover, progeny virions were released more efficiently from syncytia compared with nonsyncytial cells. These data demonstrate the utility of FMGs as a dispersion agent and suggest that FMGs can improve the efficacy of CRAd gene therapy.

Gene transfer to cervical cancer with fiber-modified adenoviruses

Successful adenoviral (Ad) vector–mediated strategies for cancer gene therapy mandate gene‐delivery systems that are capable of achieving efficient gene delivery in vivo. In many cancer types, in vivo gene‐transfer efficiency remains limited due to the low or highly variable expression of the primary Ad receptor, the coxsackie Ad receptor (CAR). In this study, we evaluated the expression of CAR on cervical cancer cells as well as CAR‐independent targeting strategies to integrins (Ad5.RGD), heparan sulfate proteoglycans (Ad5.pK7) or both (Ad5.RGD.pK7). We used a panel of established cervical cancer cell lines and primary cervical cancer cells isolated from patients to quantify the expression of CAR mRNA and to evaluate the gene‐transfer efficiency of fiber‐modified Ads. Of the fiber‐modified vectors, Ad5.pK7 and Ad5.RGD.pK7 displayed significantly enhanced gene‐transfer efficiency in vitro. Gene‐delivery efficiency in vivo was evaluated using an s.c. cervical cancer mouse model. Ad5.RGD.pK7 significantly improves tumor targeting in vivo, resulting in a significantly improved tumor/liver ratio in mice. Our results suggest that the double‐modified Ad5.RGD.pk7 vector enhances gene transfer to clinically relevant cervical cancer substrates, while the infectivity of nontarget cells in the mouse is not increased and comparable to Ad5. The fiber‐modified virus described here can help achieve higher clinical efficacy of cervical cancer gene therapy.

Engineering Regulatory Elements for Conditionally-Replicative Adenoviruses

Virus-mediated oncolysis is a rapidly growing field with the potential to dramatically alter the future of cancer therapy. Replication-selective viruses are superior to non-replicating vectors in several aspects, such as the amplification of the initial low-dose viral inoculum up to 10(3)-10(3)-fold, lateralization into neighboring cells, introduction of novel cell killing mechanisms, and a potential for a safe profile. However, due to their capacity to replicate, the importance of tumor selectivity is further underscored. Of the replication-selective viruses, adenoviruses (Ad) possess several attributes that appear essential for targeting and eliminating tumor cells. These include susceptibility to genomic modifications, convergence with cellular pathways implicated in carcinogenesis, and a high oncolytic capacity. A primary tumor targeting strategy of oncolytic Ad is based on re-engineering the viral genome viruses to construct conditionally replicative adenoviruses (CRAds). In this regard, modification of CRAd genome is traditionally designated as type I or type II. Type I CRAds are based on mutation or deletion of early Ad genes. Type II CRAds are based on the placement of essential early Ad genes under tissue/tumor-specific regulatory elements in a heterologous context. Thus, both strategies confer varying degrees of tumor-specific replication. Recent data, however, indicate that type III CRAds, embodying the paradigms of both type I and II, offer better replication selectivity for tumor cells while maintaining efficient oncolysis. These characteristics of CRAds yield therapeutic indices unprecedented heretofore in cancer therapy. However, other biological aspects of CRAds should also be addressed before these agents prove as first-line antitumor agents. When these issues are resolved, novel tumor cell killing potential of CRAds may truly be realized and dramatically alter future cancer therapy.

Gene delivery into malignant glioma by infectivity-enhanced adenovirus: in vivo versus in vitro models.

Adenoviral (Ad) vectors demonstrate several attributes of potential utility for glioma gene therapy. Although Ad infection is limited in vitro by low expression levels of the coxsackie-adenoviral receptor (CAR), in vivo studies have shown the efficacy of Ad vectors as gene delivery vectors. To evaluate the in vivo utility of CAR-independent, infectivity-enhanced Ad vectors, we employed genetically modified Ad vectors in several experimental models of human gliomas. We used three capsid-modified Ad vectors: (1) a chimeric Ad vector with a human Ad backbone and a fiber knob of a canine Ad, (2) an Ad vector with a polylysine motif incorporated into the fiber gene, and (3) a double-modified Ad vector incorporating both an RGD4C peptide and the polylysine motif. These three modified Ad vectors target, respectively, the putative membrane receptor(s) of the canine Ad vector, heparan sulfate proteoglycans (HSPGs), and both integrins and HSPGs. Our in vitro studies indicated that these retargeting strategies all enhanced CAR-independent infectivity in both established and primary low-passage glioma cells. Enhancement of in vitro gene delivery by the capsid-modified vectors correlated inversely with the levels of cellular CAR expression. However, in vivo in orthotopic human glioma xenografts, the unmodified Ad vector was not inferior relative to the capsid-modified Ad vector. Although genetic strategies to circumvent CAR deficiency in glioma cells could reproducibly expand the cellular entry mechanisms of Ad vectors in cultured and primary glioma cells, these approaches were insufficient to confer in vivo significant infectivity enhancement over unmodified Ad vectors. Other factors, probably the extracellular matrix, stromal cells, and the three-dimensional tumor architecture, clearly play important roles in vivo and interfere with Ad-based gene delivery into glioma tumors.

Gene Therapy for Renal Cancer

Recent advances in understanding the molecular events associated with renal cell carcinoma (RCC) are revolutionizing the therapeutic options offered for patients with advanced-stage RCC. These targeted approaches for RCC are based primarily on antiangiogenesis and/or specific kinase inhibitors targeting the vascular-endothelial growth factor and platelet-derived growth factor receptors, Raf and mammalian target of rapamycin inhibitor. In this context, characterization of the molecular events unique to RCC is also of critical significance for gene therapy endeavors. The attributes of gene therapy for RCC may include true targeting to cancer cells, transfer of immunomodulatory or antiangiogenic genes and novel nonapoptotic cancer cell killing mechanisms. Gene therapy may thus become a promising new adjuvant modality for RCC and expand the therapeutic armamentarium against RCC. Beyond the current stage of preclinical proof of principle and toxicological analysis in animal models, the utility of RCC gene therapy will depend on safety and efficacy trials in human subjects. These trials will determine whether targeted therapy for RCC employing genome-based strategies will broaden the current therapeutic spectrum for RCC comprising kinome-based, immunomodulatory and antiangiogenesis strategies.