TY - THES A1 - Nguyen, Hoang Duong T1 - Vaccinia virus mediated expression of human erythropoietin in colonized human tumor xenografts results in faster tumor regression and increased red blood cell biogenesis in mice T1 - Expression von humanem Erythropietin in Vaccinia Virus-kolonisierten Tumorxenograftmodellen fördert die Tumorregression und die Biogenese roter Blutzellen N2 - Cancer-related anemia is prevalent in cancer patients. Anemia negatively affects normal mental and physical function capacity with common symptoms s like fatigue, headache, or depression. Human erythropoietin (hEPO), a glycoprotein hormone regulating red blood cell formation, is approved for the treatment of cancer-related anemia. It has shown benefits in correcting anemia, and subsequently improving health-related quality of life and/or enhancing radio-, and chemotherapy. Several recent clinical trials have suggested that recombinant hEPO (rhEPO) may promote tumor growth that raises the questions concerning the safety of using rhEPO for cancer treatment. However in others, such effects were not indicated. As of today, the direct functional effect of rhEPO in tumor models remains controversial and needs to be further analyzed. Based on the GLV-1h68 backbone, the hEPO-expressing recombinant VACV strains (EPO-VACVs) GLV-1h210, GLV-1h211, GLV-1h212 and GLV-1h213 were generated by replacing the lacZ expression cassette at the J2R locus with hEPO under the control of different vaccinia promoters p7.5, pSE, pSEL, pSL, respectively. Also, GLV-1h209 was generated, which is similar to GLV-1h210 but expresses a mutated non-functinal EPO (R103A). The EPO-VACV strains were characterized for their oncolytic efficacy in lung (A549) cancer cells in culture and tumor xenografts. Concomitantly, the effects of locally expressed hEPO in tumors on virus replication, host immune infiltration, tumor vascularization and tumor growth were also evaluated. As expected, EPO-VACVs enhanced red blood cell (RBC) formation in xenograft model. The number of RBCs and hemoglobin (Hb) levels were significantly increased in EPO-VACVs-treated mice compared to GLV-1h68-treated or untreated control mice. However, the mean size of RBC or Hb content per RBC remained normal. Furthermore, over-expression of hEPO did not significantly affect numbers of lymphocytes, monocytes, leucocytes or platelets in the peripheral blood stream. The expression of hEPO in colonized tumors of mice treated with EPO-VACVs was demonstrated by immunohistological staining. Interestingly, there were 9 - 10 hEPO isoforms detected either in tumors, cells, or supernatant, while 3-4 basic isoforms were missing in blood serum, where only six hEPO isoforms were found. Tumor-bearing mice after treatment with EPO-VACVs showed enhanced tumor regression compared to GLV-1h68. The virus titers in tumors in EPO-VACVs-treated mice were 3-4 fold higher compared to GLV-1h68-treated mice. Nevertheless, no significant difference in virus titers among EPO-VACVs was found. The blood vessels in tumors were significantly enlarged while the blood vessel density remained unchanged compared to the GLV-1h68 treated mice, indicating that hEPO did not affect endothelial cell proliferation in this model. Meanwhile, rhEPO (Epoetin alfa) alone or in combination with GLV-1h68 did not show any signs of enhanced tumor growth when compared to untreated controls and GLV-1h68 groups, while doses used were clinical relevant (500 U/kg). These findings suggested that hEPO did not promote angiogenesis or tumor growth in the A549 tumor xenograft model. Human EPO has been reported to function as an immune modulator. In this study, however, we did not find any involvement of hEPO in immune cytokine and chemokine expression or innate immune cell infiltration (leucocytes, B cells, macrophages and dendritic cells) into infected tumors. The degree of immune infiltration and cytokine expression was directly correlated to the number of virus particles. Increased virus replication, led to more recruited immune cells and secreted cytokines/chemokines. It was proposed that tumor regression was at least partially mediated through activation of innate immune mechanisms. In conclusion, the novel EPO-VACVs were shown to significantly increase the number of RBCs, Hb levels, and virus replication in tumors as well as to enhance tumor regression in the A549 tumor xenograft model. Moreover, locally expressed hEPO did not promote tumor angiogenesis, tumor growth, and immune infiltration but was shown to causing enlarged tumoral microvessels which facilitated virus spreading. It is conceivable that in a possible clinical application, anemic cancer patients could benefit from the EPO-VACVs, where they could serve as “wellness pills” to decrease anemic symptoms, while simultaneously destroying tumors. N2 - Blutarmut stellt eine häufige Begleiterscheinung in Krebspatienten dar. Anämie beeinträchtigt die normale mentale und körperliche Funktionsfähigkeit. Menschliches Erythropoetin (hEPO), welches die Bildung roter Blutzellen reguliert, ist klinisch zur Behandlung von Krebs-induzierter Blutarmut zugelassen. Wenn es zur Behandlung von Anämie benutzt wird, verbessert es den Gesundheitszustand sowie Bestrahlungs- und Chemotherapie. Verschiedene klinische zeigten, dass rekombinantes hEPO (rhEPO) das Tumorwachstum anregen kann, was die Frage nach Sicherheit der Anwendung von rhEPO aufbringt. In anderen Studien hingegen, gab es keine Anzeichen für eine Tumorwachstum anregenden Wirkung oder für ein Eingreifen in krebsspezifische Signalwege. Verschiedene hEPO exprimierende rekombinante VACV Stämme (EPO-VACV) wurden hergestellt, GLV-1h210, GLV-1h211 und GLV-1h213, in welchen die lacZ Expressionskassette im J2R Lokus durch das hEPO Gen unter der Kontrolle von verschiedenen Promotoren, p7.5, pSE und pSL, ersetzt wurde. Ebenfalls wurde GLV-1h209 hergestellt, welches ähnlich zu GLV-1h210 ist, jedoch ein mutiertes und nicht-funktionelles EPO Protein (R103A) exprimiert. Alle EPO-VACV Stämme wurden bezüglich ihrer onkolytischen Funktion in Zellkulturexperimenten sowie in in vivo Tumormodellen charakterisiert. Die Expression von zwei Markergene war in Zellkultur sowie in Tumorxenograften für alle EPO-VACV vergleichbar mit der des parentalen GLV-1h68 Virus. Unterschiede in hEPO Transkription und Translation der EPO-VACV war deutlich abhängig von der Promotorstärke und stieg an von p7.5, über pSE und pSL zu pSEL 12 h nach Infektion von Zellen. Darüberhinaus hatte die Insertion von hEPO in das virale Genom keinen Einfluss auf Replikation oder Zytotoxizität aller EPO-VACV in A549 oder NCI-H1299 Zelllinien, obwohl zu frühen Zeitpunkten (24-48 hpi) die Replikation der EPO-VACV etwas höher war, als die des GLV-1h68 Virus. Die A549 Zellen war zugänglicher für virale Infektion durch alle untersuchten Viren als die NCI-H1299 Zellen. Von besonderem Interesse ist, dass hypoxische Bedingungen (2% O2) die Replikation und damit Expression des Markergens gusA, sowie Zytotoxizität für alle untersuchten VACV unabhängig von hEPO Expression verlangsamte. Alle EPO-VACV erhöhen die Bildung von roten Blutzellen (RBC) in Mausmodellen. Anzahl und RBCs sowie Hämoglobin (Hb) Level waren signifikant erhöht im Vergleich zu unbehandelten oder GLV-1h68 behandelten Mäusen. Die Durchschnittsgröße einer RBC sowie der Hämoglobinanteil hingegen waren unverändert. Darüberhinaus hatte die Expression von hEPO keinen signifikanten Einfluss auf Lymphozyten, Monozyten, Leukozyten oder Blutplättchen im peripheren Blut. Die Expression von hEPO in EPO-VACV kolonisierten Tumoren wurde durch immunohistologische Färbungen bestätigt. Interessanterweise konnten 9-10 EPO Isoformen in Tumoren, Zellen oder Zellüberständen gefunden werden, während im Blutserum 3-4 basische Isoformen fehlten und nur 6 Isoformen auftraten. Tumortragende Mäuse, die mit EPO-VACV behandelt wurden, wiesen im Vergleich zu GLV-1h68 behandelten Mäusen eine erhöhte Tumorregression auf. Ausserdem waren virale Titer in EPO-VACV behandleten Tumoren 3-4 fach höher also in denen, die mit GLV-1h68 behandelt wurden. Kein signifikanter Unterschied hingegen wurde zwischen viralen Titern der verschiedenen EPO-VACV in Tumoren gefunden. Tumorale Blutgefäße waren im Vergleich zu GLV-1h68 behandelten Mäusen deutlich vergrößert, wohingegen die Dichte an Blutgefäßen unverändert war, was andeuted, dass keine Proliferation von Endothelzellen angeregt wurde. Rekombinant hergestelltes Epoetin alfa in klinisch relevanten Dosen allein oder in Kombination mit GLV-1h68 hatte keinen Einfluss auf Verbesserung der Tumorregression verglichen mit unbehandelten oder GLV-1h68 behandelten Mäusen. Diese Ergbnisse legen nahe, dass weder Angiogenese noch Tumorwachstum durch hEPO im A549 Tumormodell angeregt wurde. In dieser Studie hingegen wurde kein Einfluss von hEPO im Bezug auf Zytokin- oder Chemokinexpression sowie Immunzellinfiltration in Tumore nachgewiesen. Das Ausmass an Immunzellinfiltratrion und Zytokinexpression konnte direkt mit der Anzahl an viralen Partikeln korreliert werden. Es wurde angenommen, dass Tumorregression zumindest teiweise durch eine Aktivierung des angeborenen Immunsystems bedingt ist. Zusammenfassend kann gesagt werden, dass durch die neuartigen EPO-VACV die Bildung von RBC, die Level an Hb und die virale Replikation signifikant angeregt wurden sowie eine erhöhte Tumorregression im Xenograftmodell auftrat. Darüberhinaus leitete lokal exprimiertes hEPO keine Tumorangiogenese oder Tumorwachstum ein, aber führte zu einer Vergrößerung von Tumorblutgefäßen, was die virale Ausbreitung erleichtern könnte. Es ist vorstellbar, dass anämische Patienten von einer möglichen klinischen Anwendung der EPO-Viren profitieren würden. KW - Erythropoietin KW - Lungenkrebs KW - Anämie KW - onkolytische Virotherapie KW - erythropoietin KW - lung cancer KW - anemia KW - oncolytic therapy KW - Onkolyse Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-85383 ER - TY - JOUR A1 - Draganov, Dobrin D. A1 - Santidrian, Antonio F. A1 - Minev, Ivelina A1 - Duong, Nguyen A1 - Kilinc, Mehmet Okyay A1 - Petrov, Ivan A1 - Vyalkova, Anna A1 - Lander, Elliot A1 - Berman, Mark A1 - Minev, Boris A1 - Szalay, Aladar A. T1 - Delivery of oncolytic vaccinia virus by matched allogeneic stem cells overcomes critical innate and adaptive immune barriers JF - Journal of Translational Medicine N2 - Background Previous studies have identified IFNγ as an important early barrier to oncolytic viruses including vaccinia. The existing innate and adaptive immune barriers restricting oncolytic virotherapy, however, can be overcome using autologous or allogeneic mesenchymal stem cells as carrier cells with unique immunosuppressive properties. Methods To test the ability of mesenchymal stem cells to overcome innate and adaptive immune barriers and to successfully deliver oncolytic vaccinia virus to tumor cells, we performed flow cytometry and virus plaque assay analysis of ex vivo co-cultures of stem cells infected with vaccinia virus in the presence of peripheral blood mononuclear cells from healthy donors. Comparative analysis was performed to establish statistically significant correlations and to evaluate the effect of stem cells on the activity of key immune cell populations. Results Here, we demonstrate that adipose-derived stem cells (ADSCs) have the potential to eradicate resistant tumor cells through a combination of potent virus amplification and sensitization of the tumor cells to virus infection. Moreover, the ADSCs demonstrate ability to function as a virus-amplifying Trojan horse in the presence of both autologous and allogeneic human PBMCs, which can be linked to the intrinsic immunosuppressive properties of stem cells and their unique potential to overcome innate and adaptive immune barriers. The clinical application of ready-to-use ex vivo expanded allogeneic stem cell lines, however, appears significantly restricted by patient-specific allogeneic differences associated with the induction of potent anti-stem cell cytotoxic and IFNγ responses. These allogeneic responses originate from both innate (NK)- and adaptive (T)- immune cells and might compromise therapeutic efficacy through direct elimination of the stem cells or the induction of an anti-viral state, which can block the potential of the Trojan horse to amplify and deliver vaccinia virus to the tumor. Conclusions Overall, our findings and data indicate the feasibility to establish simple and informative assays that capture critically important patient-specific differences in the immune responses to the virus and stem cells, which allows for proper patient-stem cell matching and enables the effective use of off-the-shelf allogeneic cell-based delivery platforms, thus providing a more practical and commercially viable alternative to the autologous stem cell approach. KW - vaccinia KW - cancer KW - stem Cells KW - oncolysis KW - oncolytic virus KW - virotherapy KW - immunity KW - immunotherapy Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-226312 SN - 100 VL - 17 ER - TY - JOUR A1 - Minev, Boris R. A1 - Lander, Elliot A1 - Feller, John F. A1 - Berman, Mark A1 - Greenwood, Bernadette M. A1 - Minev, Ivelina A1 - Santidrian, Antonio F. A1 - Nguyen, Duong A1 - Draganov, Dobrin A1 - Killinc, Mehmet O. A1 - Vyalkova, Anna A1 - Kesari, Santosh A1 - McClay, Edward A1 - Carabulea, Gabriel A1 - Marincola, Francesco M. A1 - Butterfield, Lisa H. A1 - Szalay, Aladar A. T1 - First-in-human study of TK-positive oncolytic vaccinia virus delivered by adipose stromal vascular fraction cells JF - Journal of Translational Medicine N2 - Background ACAM2000, a thymidine kinase (TK)-positive strain of vaccinia virus, is the current smallpox vaccine in the US. Preclinical testing demonstrated potent oncolytic activity of ACAM2000 against several tumor types. This Phase I clinical trial of ACAM2000 delivered by autologous adipose stromal vascular fraction (SVF) cells was conducted to determine the safety and feasibility of such a treatment in patients with advanced solid tumors or acute myeloid leukemia (AML). Methods Twenty-four patients with solid tumors and two patients with AML participated in this open-label, non-randomized dose-escalation trial. All patients were treated with SVF derived from autologous fat and incubated for 15 min to 1 h with ACAM2000 before application. Six patients received systemic intravenous application only, one patient received intra-tumoral application only, 15 patients received combination intravenous with intra-tumoral deployment, 3 patients received intravenous and intra-peritoneal injection and 1 patient received intravenous, intra-tumoral and intra-peritoneal injections. Safety at each dose level of ACAM2000 (1.4 × 106 plaque-forming units (PFU) to 1.8 × 107 PFU) was evaluated. Blood samples for PK assessments, flow cytometry and cytokine analysis were collected at baseline and 1 min, 1 h, 1 day, 1 week, 1 month, 3 months and 6 months following treatment. Results No serious toxicities (> grade 2) were reported. Seven patients reported an adverse event (AE) in this study: self-limiting skin rashes, lasting 7 to 18 days—an expected adverse reaction to ACAM2000. No AEs leading to study discontinuation were reported. Viral DNA was detected in all patients’ blood samples immediately following treatment. Interestingly, in 8 patients viral DNA disappeared 1 day and re-appeared 1 week post treatment, suggesting active viral replication at tumor sites, and correlating with longer survival of these patients. No major increase in cytokine levels or correlation between cytokine levels and skin rashes was noted. We were able to assess some initial efficacy signals, especially when the ACAM2000/SVF treatment was combined with checkpoint inhibition. Conclusions Treatment with ACAM2000/SVF in patients with advanced solid tumors or AML is safe and well tolerated, and several patients had signals of an anticancer effect. These promising initial clinical results merit further investigation of therapeutic utility. Trial registration Retrospectively registered (ISRCTN#10201650) on October 22, 2018. KW - clinical trial KW - oncolytic vaccinia virus KW - stromal vascular fraction KW - immunotherapy of cancer Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-224105 VL - 17 ER -