VanderVeen Nathan, Paran Christopher, Appelhans Ashley, Krasinkiewicz Johnny, Lemons Rosemary, Appelman Henry, Doherty Robert, Palmer Donna, Ng Philip, Lowenstein Pedro R, Castro Maria G
Department of Neurosurgery, The University of Michigan School of Medicine, Ann Arbor, Michigan, USA ; Department of Cell and Developmental Biology, The University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
Department of Pathology, The University of Michigan School of Medicine, University Hospital, Ann Arbor, Michigan, USA.
Mol Ther Methods Clin Dev. 2014 Feb 5;1:10-. doi: 10.1038/mtm.2013.10.
We developed a combined conditional cytotoxic, , herpes simplex type 1-thymidine kinase (TK), plus immune-stimulatory, , fms-like tyrosine kinase ligand-3-mediated gene therapy for glioblastoma multiforme (GBM). Therapeutic transgenes were encoded within high-capacity adenoviral vectors (HC-Ad); TK was expressed constitutively, while Flt3L was under the control of the TetOn regulatable promoter. We previously assessed efficacy and safety in intracranial GBM rodent models. But, since this approach involves expression of a cytokine within the brain, we chose the nonhuman primate, , (marmoset) as it has been established that its immune response shares similarities with man. We characterized the safety, cell-type specific expression, and doxycycline (DOX)-inducibility of HC-Ad-TetOn-Flt3L delivered within the striatum. We used allometrically scaled DOX doses delivered orally, twice daily for one month, mimicking the route and duration of DOX administration planned for the GBM trial. Flt3L was effectively expressed within astrocytes, microglia, oligodendrocytes, and neurons. No evidence of brain or systemic toxicities due to the treatment was encountered. Our data indicate that DOX doses equivalent to those used in humans to treat infections can be safely used "off-label" to turn "on" therapeutic gene expression from HC-Ad-TetOn-Flt3L; providing evidence for the safety of this approach in the clinic.
我们开发了一种联合条件性细胞毒性疗法,即单纯疱疹病毒1型胸苷激酶(TK),以及免疫刺激疗法,即FMS样酪氨酸激酶配体-3介导的多形性胶质母细胞瘤(GBM)基因疗法。治疗性转基因编码在高容量腺病毒载体(HC-Ad)中;TK持续表达,而Flt3L受TetOn可调节启动子的控制。我们之前在颅内GBM啮齿动物模型中评估了疗效和安全性。但是,由于这种方法涉及在脑内表达一种细胞因子,我们选择了非人灵长类动物狨猴,因为已经确定其免疫反应与人相似。我们对纹状体内递送的HC-Ad-TetOn-Flt3L的安全性、细胞类型特异性表达和强力霉素(DOX)诱导性进行了表征。我们采用按体表面积缩放的DOX剂量,每天口服两次,持续一个月,模拟GBM试验计划的DOX给药途径和持续时间。Flt3L在星形胶质细胞、小胶质细胞、少突胶质细胞和神经元中有效表达。未发现治疗导致的脑或全身毒性证据。我们的数据表明,与用于治疗感染的人类剂量相当的DOX剂量可以“超适应症”安全使用,以开启HC-Ad-TetOn-Flt3L的治疗性基因表达;为该方法在临床上的安全性提供了证据。