Snook Adam E, Baybutt Trevor R, Hyslop Terry, Waldman Scott A
1 Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania.
2 Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University , Durham, North Carolina.
Hum Gene Ther Methods. 2016 Dec;27(6):238-250. doi: 10.1089/hgtb.2016.114.
There is an unmet need for improved therapeutics for colorectal cancer, the second leading cause of cancer mortality worldwide. Adjuvant chemotherapy only marginally improves survival in some patients and has no benefit in others, underscoring the clinical opportunity for novel immunotherapeutic approaches to improve survival in colorectal cancer. In that context, guanylate cyclase C (GUCY2C) is an established biomarker and therapeutic target for metastatic colorectal cancer with immunological characteristics that promote durable antitumor efficacy without autoimmunity. Preliminary studies established non-replicating human type 5 adenovirus (Ad5) expressing GUCY2C as safe and effective to induce GUCY2C-specific immune responses and antitumor immunity in mice. This study characterized the biodistribution, immunogenicity, and safety of a vector expressing GUCY2C fused with the human CD4 T helper cell epitope PADRE (Ad5-GUCY2C-PADRE) to advance this vaccine into clinical trials in colorectal cancer patients. Ad5-GUCY2C-PADRE levels were highest in the injection site and distributed in vivo primarily to draining lymph nodes, the liver, spleen and, unexpectedly, to the bone marrow. Immune responses following Ad5-GUCY2C-PADRE administration were characterized by PADRE-specific CD4 T-cell and GUCY2C-specific B-cell and CD8 T-cell responses, producing antitumor immunity targeting GUCY2C-expressing colorectal cancer metastases in the lungs, without acute or chronic autoimmune or other toxicities. Collectively, these data support Ad5-GUCY2C-PADRE as a safe and effective vaccination strategy in preclinical models and position Ad5-GUCY2C-PADRE for Phase I clinical testing in colorectal cancer patients.
全球癌症死亡的第二大主要原因是结直肠癌,目前对改善结直肠癌治疗方法仍存在未满足的需求。辅助化疗仅能在部分患者中略微提高生存率,对其他患者则无益处,这凸显了采用新型免疫治疗方法提高结直肠癌患者生存率的临床机遇。在此背景下,鸟苷酸环化酶C(GUCY2C)是转移性结直肠癌已确立的生物标志物和治疗靶点,其具有促进持久抗肿瘤疗效且无自身免疫性的免疫学特征。初步研究表明,表达GUCY2C的非复制型人5型腺病毒(Ad5)在小鼠中安全有效,可诱导GUCY2C特异性免疫反应和抗肿瘤免疫。本研究对表达与人类CD4 T辅助细胞表位PADRE融合的GUCY2C载体(Ad5-GUCY2C-PADRE)的生物分布、免疫原性和安全性进行了表征,以便将这种疫苗推进到结直肠癌患者的临床试验中。Ad5-GUCY2C-PADRE在注射部位的水平最高,在体内主要分布到引流淋巴结、肝脏、脾脏,出乎意料的是还分布到骨髓。给予Ad5-GUCY2C-PADRE后的免疫反应表现为PADRE特异性CD4 T细胞、GUCY2C特异性B细胞和CD8 T细胞反应,产生针对肺部表达GUCY2C的结直肠癌转移灶的抗肿瘤免疫,且无急性或慢性自身免疫或其他毒性。总体而言,这些数据支持Ad5-GUCY2C-PADRE在临床前模型中作为一种安全有效的疫苗接种策略,并为Ad5-GUCY2C-PADRE在结直肠癌患者中进行I期临床试验奠定了基础。