Gene Ther Mol Biol Vol 9, 269-280,
2005
Oncolytic virotherapy of cancer with vesicular stomatitis
virus
Peyman Nakhaei1, Suzanne Paz1, Stephanie Oliere1,
Vanessa Tumilasci1, John C. Bell2 and John Hiscott1,*
1Molecular
Oncology Group, Lady Davis Institute - Jewish General Hospital and Depts. Of
Microbiology and Medicine, McGill University, Montreal Canada H3T 1E2.
2Ottawa
Regional Cancer Centre, University of Ottawa, Ottawa Canada.
__________________________________________________________________________________
*Correspondence: Dr. John Hiscott, Lady Davis
Institute for Medical Research, 3755 Cote Ste. Catherine, Montreal, Quebec,
Canada H3T 1E2; Telephone: (514) 340-8222 Ext. 5265; Fax: (514) 340-7576;
E-mail: john.hiscott@mcgill.ca
Key words: VSV, oncolysis, apoptosis,
virotherapy
Abbreviations: adult T-cell leukemia,
(ATL); CARD adaptor inducing IFN-b,
(CARDIF); chronic lymphocytic leukemia, (CLL); double-stranded, (ds); hepatitis
C virus, (HCV); human rhinovirus, (HRV); interferon regulatory factor, (IRF);
interferon-b
stimulator 1, (IPS-1); Interferon, (IFN); internal ribosome entry site, (IRES);
mitochondrial antiviral response, (MAVS); plasmacytoid dendritic cells, (pDCs);
retinoic acid inducible gene I, (RIG-I); single-stranded, (ss); virus induced
signaling adapter, (VISA)
This
research was supported by grants from the National Cancer Institute with funds
from the Terry Fox Foundation to JH and JB, the Canadian Institutes of Health
Research and CANVAC, the Canadian Network for Vaccines and Immunotherapeutics.
JH is a recipient of a CIHR Senior Investigator award.
Summary
Recent basic and pre-clinical studies have demonstrated that
several innocuous, non-disease causing, replication competent viruses can
selectively replicate in and kill a large panel of human tumor cells, clear
bone marrow of leukemic cells and effectively arrest metastatic spread of
tumors, while apparently sparing normal cells. These studies have revived
interest in the clinical applicability of these oncolytic (onco=cancer;
lytic=killing) viruses. Although it is as yet unknown why oncolytic viruses
preferentially target and kill tumor cells, it appears that during the evolution
of malignancies, genetic abnormalities accumulate that, while providing the
cancer cells with growth and survival advantages, compromise the normal
antiviral program of transformed cells. Defects in the Interferon (IFN)
antiviral signaling network within transformed cells have been implicated in
preferential oncolysis; according to this model, IFN-related defects allow VSV
and other oncolytic viruses to replicate to high titers, uninterrupted by the
host antiviral response, resulting in high virus production and virus induced
lysis. The goal of our research program is to understand the molecular basis of
virus-induced oncolysis and to identify important changes in the genetic
response to virus infection in tumor cells. Basic, pre-clinical and clinical studies
will attempt to harness what we believe is a potent new form of cancer therapy
with promise in many areas of cancer treatment.
An ideal
cancer therapeutic will selectively kill malignant cells while leaving normal
tissues intact. Unfortunately, the current standards of care for cancer -
chemotherapy and radiation therapy - fall well short of this goal. It is
imperative that emerging knowledge of the molecular biology of cancer be used
to generate novel therapeutics that are targeted specifically to cancer cells.
An excellent example of this approach has been the design or selection of
replication selective oncolytic viruses that exploit genetic defects commonly
found in tumor cells (Bell et al, 2002; Hawkins et al, 2002; Kruyt and Curiel,
2002). These same viruses are unable to replicate efficiently in normal tissues
and thus have a superior therapeutic index. Malignant cells, by virtue of the
constellation of genes they do or do not express, can be unique niches for the
growth of Oncolytic Viruses. As an example, we have evidence that the genetic
abnormalities contributing to the malignant phenotype also compromise the
innate antiviral programs of these same cells. Malignant cells with defects in:
IFN induction (IRF-3 and IRF-7), activation of IFN-inducible genes such as PKR,
and deficiencies in IFN-mediated signaling pathways mediated by STAT1 and IFNAR
are susceptible to virus oncolytic activity (Balachandran et al, 2000; Lu et
al, 2000; Matin et al, 2001; Jackson et al, 2003; Caras et al, 2004; Murad et
al, 2005). Our goals are to understand virus-host cell interactions in a
comprehensive manner, exploit this knowledge to selectively target tumor cells,
and develop oncolytic viruses as therapeutics.
II.
Canadian oncolytic virus consortium
With the support of the National Cancer Institute of Canada, a program
to accelerate the development of candidate oncolytic virus therapeutics has
been initiated. Candidate viruses at all stages of development are being
studied; it is the goal of this consortium to combine scientific and clinical
expertise to foster the continuous generation of new information, therapeutics
and clinical approaches. The members of the Consortium are: OTTAWA REGIONAL
CANCER CENTRE - Drs. John Bell, Earl Brown and Harry Atkins MCGILL UNIVERSITY -
Drs. Nahum Sonenberg and John Hiscott TOM BAKER CANCER CENTRE, UNIVERSITY OF
CALGARY - Drs. Peter Forsyth and Don Morris ROBARTS RESEARCH INSTITUTE,
UNIVERSITY OF WESTERN ONTARIO: Dr. Grant McFadden.
Several
replicating virus platforms are being developed concurrently. Some candidates
(eg. Myxoma and Human Rhinovirus) are at early developmental stages, others are
poised to launch into clinical trials (eg VSV) while a third group has already
passed into phase 1 studies (NDV and Reovirus). In the following we present a
brief overview of the biology of each of the virus platforms.
VSV is an
enveloped virus with a single stranded RNA genome that encodes only five
proteins. The G or glycoprotein is found on the surface of the virion and
mediates cell surface attachment through a ubiquitous cellular receptor that
minimally contains sialic acid. The Nucleocapsid protein (N), the
phosphoprotein (P) and polymerase or L protein function in unison to bring
about the production of viral mRNAs and subsequently constitute the viral
genome replication complex (Wagner, 1996). The Matrix or M protein is a
sophisticated multi-functional protein that was initially thought to serve only
a structural role in virus assembly but is now known to act as a critical
player in the oncolytic activity of VSV (von Kobbe et al, 2000; Petersen et al,
2001; Terstegen et al, 2001 Yuan et al, 2001; Ahmed et al, 2003; Stojdl et al,
2003; Faria et al, 2005) (Figure 1). VSV has many virtues that make it an
excellent therapeutic candidate: (1) VSV rapidly and effectively kills a wide
range of tumor cells; (2) From a commercial point of view, VSV is easy to
produce, is physically stable and can be purified in high concentrations; (3)
VSV is not a human pathogen and most humans have never been infected nor have
pre-existing neutralizing antibodies that could limit clinical application; (4)
the virus is amenable to genetic manipulation because of a relatively efficient
recombinant system, a feature that can be exploited in the generation of novel
recombinant VSV vectors (Figure 1).

Figure 1. Desirable properties of oncolytic virotherapies
and VSV subgenomic mRNA. VSV mRNAÕs encode for five
distinct proteins: nucleocapsid (N), phosphoprotein (P), Matrix (M),
Glycoprotein (G), and large (L) polymerase.
NDV is a
single stranded negative sense RNA virus encoding six gene products similar in
some ways to VSV described above (de Leeuw and Peeters, 1999). As a member of the
paramyxovirus family, it seems likely that NDV derives its oncolytic
specificity from tumor specific defects in the IFN pathway. NDV has a long
history as an oncolytic virus and perhaps has been administered to more humans
in one form or another as a cancer therapeutic than any other virus product.
Two recent trials held in Canada (Ottawa and Hamilton) are particularly
important. In these studies, both safety and efficacy were attained using high
doses of virus administered slowly. NDV is also amenable to genetic
manipulation.
Reovirus is
a double-stranded RNA (dsRNA, non-enveloped) virus with a segmented genome
composed of ten individual linear dsRNA molecules (Rux and Burnett, 2004). As
the genome is segmented, it is possible to exchange genome segments and
therefore biological properties between reovirus strains. Co-infection of cells
with two parental strains of reovirus yields progeny viruses, termed
reassortants, that possess novel combinations of the ten genome segments and
novel biological properties (Nibert et al, 1996). Mammalian reoviruses have
broad host ranges, replicating in a variety of human and animal cell lines but
are not associated with any human disease.
Myxoma
virus, is a poxvirus (double stranded DNA, enveloped) that induces lethal
myxomatosis in rabbits and was utilized in the early 1950s to control rabbit
populations in Australia (Cameron et al, 1999). As part of the Australian
regulatory process to certify this eradication program, the virus was tested
for pathogenicity in a wide range of vertebrates, including the three lead
investigators themselves, to prove that the virus was completely rabbit
specific (Kerr and Best, 1998). The virulence of this virus in the rabbit model
has been extensively studied and a wide variety of virus-encoded
immunomodulatory genes have been discovered. It was recently shown that myxoma
virus, although unable to replicate in normal human cells, grows to high titer
in a number of tumor cell lines, particularly those harboring defects in the
STAT signaling pathway (Barrett et al, 2001; Masters et al, 2001).
HRVs are
non-enveloped, positive sense, single stranded RNA viruses. Recent data has
demonstrated that exchange of the poliovirus internal ribosome entry site
(IRES) with its counterpart from HRV type 2 resulted in attenuation of
virulence and slow virus propagation in cells of neuronal origin (Campbell et
al, 2005). In contrast, malignant glioma cells maintained either in tissue
culture or as xenografts in athymic mice remained highly susceptible to the
infection with the recombinant virus (Gromeier et al, 2000). These studies are
consistent with tumor-specific function of the HRV IRES and applicability of
HRV for cancer therapy. An exciting prospect is that human rhinovirus (HRV, or
common cold viruses) may be a novel candidate virus in treating neoplasia. An
important consideration in favoring the use of HRV is that this virus is
extraordinarily harmless and causes either no symptoms or very mild upper
respiratory tract-restricted infections.
VSV is an
arthropod borne virus that primarily infects cattle, swine and horses, although
infection of humans and other species can also occur (Mead et al, 2000).
Because VSV produces an acute disease in cattle characterized by ulceration of
the oral cavity and feet, the pathology mimics the early symptoms of foot and
mouth disease virus (Flanagan et al, 2001). Naturally occurring human
infections with VSV on the other hand are extremely rare, except in cases where
individuals are exposed to infected livestock or in researchers exposed within
the laboratory environment. Most VSV infections are asymptomatic in humans or
cause mild flu-like symptoms.
VSV contains
a single-strand RNA genome of negative polarity (11kb) that is completed
protected by viral nucleoprotein (Wagner, 1996). VSV synthesizes five
subgenomic mRNAs that encode the five distinct proteins (Figure 1): the nucleoprotein in conjunction with the
phosphoprotein, the large polymerase protein and specific host proteins is
responsible for both viral transcription and replication; the viral
glycoprotein is necessary for budding, viral binding to target cells; and the
multi-function matrix protein which consists of 229 aminoacids has an important
role in virus assembly, budding, cellular apoptosis and disruption of the host
cell innate immunity programs (Barr et al, 2002). The VSV glycoprotein serves
to bind to the surface of the host cell and to fuse viral and cellular membranes
enabling the release of the viral genome and replicase into the cytoplasm. The
glycoprotein binds to phosphatidylserine, a universal
component of the cell surface membranes, thus enabling VSV to infect virtually
all animal cells (Barr et al, 2002). This extensive tissue tropism therefore
enables VSV to be used as anti-cancer agent in all types of tumors, although
normal tissues can also be infected.
The
matrix-protein of VSV functions in diversified roles to control VSV replication
and pathogenesis; matrix protein partially regulates transcription of VSV genes
by the virally encoded polymerase and in late infection, catalyzes the
generation of inactive RNP cores preparing them for packaging into virions
(Carroll and Wagner, 1979; Clinton et al, 1979). In addition to its role in
budding, matrix has a crucial role in the early phases of viral infection by
helping VSV to avoid the cellular antiviral programs. The interruption of
cellular transcription programs and the blockade of mRNA export from the nucleus
are both targeted by matrix. The inhibition of cellular transcription by matrix
protein has been demonstrated in several ways: matrix-protein expression causes
an inhibition of transcription of host genes whether transcribed by RNA
polymerase I, II or III (Ahmed and Lyles, 1998; Ahmed et al, 2003). Matrix
protein of VSV blocks nucleocytoplasmic transport which involves an interaction
between matrix protein and the cellular Nup98, one of the nucleoporins present
at the nucleopore. Interestingly, Nup 98 is an interferon responsive gene and
pre-treatment of cells with interferon increases (Petersen et al, 2000, 2001;
von Kobbe et al, 2000). Nup 98 expression and reduces the ability of VSV matrix
protein to inhibit nucleocytoplasmic transport (Enninga et al, 2002). Mutations
in matrix protein that abolish the ability of the protein to block host cell
transcription and restore nucleocytoplasmic transport suggest that these two
activities of the matrix-protein are not mutually exclusive. Infection of
susceptible cells with VSV leads to cell rounding in ultimately to cell death
by apoptosis. The induction of apoptosis by matrix protein probably results
from the blockage of host cell gene expression since mutations in matrix that
abrogate this blockade also reduce its cytotoxicity (Kopecky et al, 2001;
Kopecky and Lyles, 2003).
The majority
of tumor-derived cells are either non responsive to interferon treatment or
develop resistance with time (Figure 2).
The natural preference of the virus for transformed cells can be seen both in vitro and in vivo where VSV will preferentially target and replicate in
tumors implanted in rodents (Stojdl et al, 2003). The ability to VSV to infect
malignant cells because of the impairment of the interferon response has also
been demonstrated for primary cells from patients (Figure 3). In a recent study, we investigated the ability of VSV
to lyse primary CD4+ T lymphocytes from patients with adult T cell leukemia
(ATL) and compared the ability of VSV to infect and lyse normal CD4+ T cells
(Cesaire et al,

Figure 2. Induction of interferon by VSV protects normal
cells from viral infection, whereas transformed cells are eliminated. VSV
infection in normal cells generates type interferons that establish an
anti-viral state protecting neighboring cells from VSV infection. Transformed
cells are non-responsive to interferon due to defects in the interferon pathway
and remain susceptible to infection and killing by VSV.

Figure 3. VSV oncolytic activity in different malignant
tissue. VSV has the ability to infect and
kill malignant cells from different tissue due to various defects in the
interferon response in primary cells.
2005). Ex vivo primary ATL cells were permissive for VSV and underwent
rapid oncolysis in time-dependent manner. Importantly, VSV infection showed
neither viral replication nor oncolysis in HTLV-1 infected, non-leukemic cells
from patients with HTLV-1-associated myelopathy/tropical spastic paraparesis
(HAM/TSP), in naive CD4+ T lymphocytes from normal individuals or in ex vivo cell samples from patients with
chronic lymphocytic leukemia (CLL). Interestingly, activation of primary CD4+ T
lymphocytes with anti-CD3/CD28 monoclonal antibody, and specifically with
anti-CD3, was sufficient to induce limited viral replication and oncolysis.
However, at a similar level of T cell activation, VSV replication was increased
4-fold in ATL cells, compared to activated CD4+ T lymphocytes, emphasizing the
concept that VSV targets genetic defects unique to tumor cells to facilitate
its replication. These findings have provided the first essential information
for the development of a VSV-based treatment for ATL (Cesaire et al, 2005).
Although treatments for hematological malignancies have improved considerably
over the past decade, the growing therapeutic arsenal has not benefited adult
T-cell leukemia (ATL) patients who are completely refractory to conventional
chemotherapeutic regimens. The possibility of a novel virotherapy approach to
hematological malignancies such as ATL illustrates the potential for this
technology, particularly under circumstances where delivery and cost
effectiveness may be practical issues.
Stojdl et al have identified what may be
considered Òsecond generationÓ oncolytic variants of VSV – naturally
occurring, interferon inducing VSV mutants originally identified by reduced
plaque size on cells able to produce and respond interferon. Mutations to the
matrix protein render these viruses interferon-inducing and prevent the matrix
protein from blocking nucleocytoplasmic transport and inhibiting host cell
transcription. Wild-type and mutant strains of VSV are both able to induce the
expression of the gene encoding interferon, but the mutant viruses fail to
block the export and translation of the interferon mRNA (Ahmed et al, 2003;
Stojdl et al, 2003). The induction of interferon and other antiviral genes by
these viruses generates what is been termed a Ôcytokine cloudÕ that protects
the host not only from the mutant virus but also from any wild-type virus
present in the innoculum. The strategy produces an effective oncolytic virus
that is less toxic than a recombinant virus engineered to express interferon.
Many
advantages to VSV argue that this virus may be a superior oncolytic virus: VSV
grows to high titer in bioreactors and is very well characterized at the
molecular level in the mammalian cell cultures. VSV is a relatively innocuous
virus that even in its most virulent state causes a very mild disease in cattle
and humans. It is unlikely that most humans have come into contact with VSV and
therefore do not have pre-existing immunity. The virus replicates quickly in vivo and maybe be able to mediate a
significant or complete tumor response before the patient develops an acquired
immunity to the virus. Cytoplasmic replication and genetic stability also
preclude problems associated with integrating viral vectors (Figure 1).
Direct and
indirect lytic effects of some viruses have been exploited recently in a novel
virus-based approach to biological therapy of cancer, involving oncolytic
viruses (Chiocca, 2002). The enveloped, negative strand RNA virus –
vesicular stomatitis virus (VSV) - has been added to a growing list of viruses
with nonpathogenic, oncolytic properties that include: Reo, Paramyxo and
Rhinoviruses (Chiocca, 2002). VSV infection selectively killed a large panel of
human tumor cell lines (Figure 3)
including 80% of the NCI 60 tumor cell bank,
cleared bone marrow of leukemic AML cells (Stojdl et al, 2000) and effectively
arrested metastatic spread of CT26 lung metastases in immunocompetent animals (Figures 4 and 5) (Stojdl et al, 2003).
Although VSV fails to replicate efficiently in primary cells that contain a
functional interferon system (Stojdl et al, 2000), this virus replicates to
high titers in the majority of immortalized and transformed cell lines. The
current hypothesis is that aspects of IFN signaling and the action of
downstream effectors are compromised in such malignant cells, thus affording a
cellular environment that facilitates viral replication - uninterrupted by the
host antiviral response - resulting in virus induced lysis.
The Type 1
IFNs - a family of antiviral cytokines composed of IFNb and several IFNa species - induce a cascade
of events through the activation of signaling mediated by the Jak STAT pathway,
resulting in the production of hundreds of proteins that function to limit
viral replication and signal adaptive immune responses (Malmgaard, 2004). IRF-3
and IRF-7 are critical mediators of IFN gene activation, with complementary
roles in the induction of the host antiviral state following virus infection
(Au et al, 1998; Lin et al, 1998, 1999a; Marie et al, 1998; Sato et al, 1998,
2000; Wathelet et al, 1998; Weaver et al, 1998; Yoneyama et al, 1998; Mamane et
al, 1999). IRF-7 activation is one (of many) steps that may be defective in VSV
infected cells, although IFN inducibility can be restored using the attenuated
variant of VSV. Other studies demonstrate that translation control downstream
of PKR activation, frequently dysregulated in transformed cells, can cooperate
with the attenuated IFN antiviral activity to facilitate VSV oncolysis.
Elevated levels of eIF2Be are required for increased permissiveness of transformed
cells to VSV replication. Cells transfected with siRNA against eIF2B were
almost completely protected against VSV-induced cytolysis and produced
approximately 10-fold less virus than control cells (Balachandran et al, 2004)
.The oncolytic activity of VSV is effective against tumors exhibiting aberrant
p53, Ras, or Myc function (Balachandran et al, 2001).
Upon
recognition of specific molecular components of viruses or other pathogens, the
host cell activates multiple signaling cascades through Toll-like
receptor-dependent and -independent pathways, culminating in the

Figure 4. Eradication of CT26 lung metastases following
intravenous or intranasal VSV inoculation in mice. A. Lung
tumors were established by injecting 3 x 105 CT26 cells into the tail vein of
Balb/C mice. Four days after treatment with intranasal and intravenous
inoculation with AV1 and AV2, all mice were sacrificed and their lungs were
removed. Arrows indicate residual tumors (Stojdl et al, 2003). B. Lung tumors were established as
described above. On day 12, mice received 5 x 107 pfu of AV1 or AV2 by
intranasal instillation every other day for 2 weeks (6 doses total), ÒnÓ
denotes number of mice in treatment group (Stojdl et al, 2003).

Figure 5. VSV-GFP time course in CT26 lung metastasis model.
Mice bearing CT-26 lung tumors were infected with VSV-GFP,
and the lungs were removed and visualized at different time intervals by
fluorescent microscopy (Stojdl et al, 2003).
production of cytokines and
chemokines that disrupt virus replication and initiate innate and adaptive
immune responses (Malmgaard, 2004; Samuel, 2001; Sen, 2001). Rapid induction of
type I IFN expression is a central event in establishing the innate antiviral
response and requires pathogen-inducible, activation of transcription factors
that function in a synergistic fashion to induce gene expression (reviewed in
(Hiscott et al, 1999; Levy et al, 2002; Mamane et al, 1999; Servant et al,
2002a; Servant et al, 2002b; Taniguchi et al, 2001). Among the members of the
interferon regulatory factor (IRF) family, IRF-3 and IRF-7
play essential roles in the virus-induced
type I IFN gene activation following virus infection (Au et al, 1998; Lin et
al, 1998, 1999a, b; Marie et al, 1998; Sato et al, 1998, 2000; Yoneyama et al,
1998). IRF-3 is activated by C-terminal phosphorylation which promotes
dimerization, cytoplasmic to nuclear translocation, DNA binding, association
with CBP/p300 histone acetyltransferases and transactivation of downstream
early genes such as IFNb. IFNa1 and RANTES. In contrast, IRF-7 protein is
synthesized de novo upon IFN
stimulation and contributes to the expression of delayed-type genes including
other IFNa subtypes. As with IRF-3,
virus infection induces C-terminal phosphorylation and activation of IRF-7
(Marie et al, 1998; Sato et al, 1998). The IKK-related kinases – IKKe (Peters et
al, 2000) and TBK-1 (Pomerantz and Baltimore, 1999; Bonnard et al, 2000; Tojima
et al, 2000) – were shown to be essential signaling components required
for IRF-3 and IRF-7 phosphorylation (Fitzgerald et al, 2003b; Sharma et al,
2003; McWhirter et al, 2004) (Figure 6).
Among the eleven members of
the human TLR family, TLR3, TLR4, TLR7, TLR8, and TLR9 are involved in the
initial sensing of viral components. In mice, viral single- and double-stranded
(ds) RNA, fusion protein of respiratory syncytial virus, single-stranded (ss)
RNA, and genomic DNA from herpes and cytomegalovirus are recognized by TLR3,
TLR4, TLR7, and TLR9, respectively (Kurt-Jones et al, 2000; Alexopoulou et al, 2001;
Lund et al, 2003; Diebold et al, 2004; Heil et al, 2004; Krug et al, 2004).

Figure 6. Double strand RNA and virus mediated signals
leading to interferon gene activation. Engagement
of TLR3 by dsRNA leads to recruitment of the TRIF adapter molecule and the
activation of TBK1 and IKKe
kinases that phosphorylate IRF3 and IRF7 transcription factors. TRIF can also
signal to NF-kB
activation, through a TRAF6 or RIP1 dependent mechanism, via the IKKa/b
complex which phosphorylates the inhibitory subunit IkBa,
resulting in release of NF-kB
DNA binding subunits. Recruitment of dsRNA also causes tyrosine phosphorylation
of the cytoplasmic tail of TLRs at multiple residues and the recruitment of PI3
kinase (Hiscott, 2004; Sarkar et al, 2004). In the absence of PI3K activation,
IRF3 is incompletely phosphorylated and fails to stimulate IFN gene
transcription. It remains to be determined at which level PI3K-Akt functions.
Virus infection represents a distinct stress to the cell that may utilize TLR3
independent mechanisms. RIG-1 has been shown to stimulate NF-kB
and IRF dependent pathways and may be the sensor molecule that initially
recognizes incoming cytoplasmic viral ribonucleoprotein complexes. RIG-I
contains two N-terminal caspase recruitment domains (CARD) and a C-terminal RNA
helicase activity that interacts with viral RNA and is thought to ÔsenseÕ
intracellular virus particles. A CARD-containing adapter molecule
(MAVS/IPS/VISA/Cardif) appears to be the link between sensing of incoming
virus, the triggering of downstream kinases and the activation of IRF and NF-kB target genes. Furthermore,
MAVS is the physiological target for inhibition by the NS3/4A protease activity
of Hepatitis C virus; cleavage of MAVS blocks signaling to the innate immune
response and contributes to chronic HCV persistence.
While the adapter molecule MyD88 is
commonly used by all TLRs, other adapter proteins including MAL/TIRAP,
TRIF/TICAM1 and TRAM/TICAM2 are involved in MyD88 independent pathways (Oshiumi
et al, 2003; Yamamoto et al, 2003b). TLR3 and TLR4 engage the adapter
TRIF/TICAM-1, leading to TBK1 and IKKe activation, which in turn
activates IRF3 and IFNa/b transcription (Fitzgerald et
al, 2003a; Sato et al, 2003; Yamamoto et al, 2003a).
A separate
signaling pathway utilizes the retinoic acid inducible gene I (RIG-I) to
recognize a variety of RNA viruses and trigger the innate antiviral response,
independent of the TLR-dependent pathways (Figure
6). RIG-I contains a DExD/H box RNA helicase domain and two caspase
recruitment domains (CARD; full-length RIG-I can interact with dsRNA through
its DExD/H box within C terminus and augment IFN production in response to
viral infection in an ATPase-dependent manner, and the two copies of the CARD
at its N terminus transduce signals leading to the activation of IRF-3 and NF-kB. The constitutively active
form of RIG-I (CARD domain alone) is capable of activating IRF-3 and NF-kB and stimulating IFN-b production (Yoneyama et al,
2004). Recent studies demonstrated that the hepatitis C virus (HCV) gene
product NS3/4A protease complex efficiently blocks RIG-I signaling pathway and
contributes to the establishment of HCV persistence (Breiman et al, 2005; Foy
et al, 2005; Sumpter et al, 2005). The generation of RIG-I-deficient mice
revealed that RIG-I, but not the TLR system, plays an essential role in
antiviral responses in various cells, except plasmacytoid dendritic cells
(pDCs). Reciprocally, the TLR system, but not RIG-I, was indispensable to IFN
secretion in pDCs. (Kato et al, 2005).
Several results suggested that an unidentified adapter molecule may link
RIG-I with the downstream IKK-related kinase complexes. Four groups recently
identified a CARD domain containing adapter molecule - mitochondrial antiviral
response (MAVS), interferon-b stimulator 1 (IPS-1), virus induced signaling adapter
(VISA), CARD adaptor inducing IFN-b (CARDIF) - involved in RIG-I-dependent signaling to
the IKKa/b complex and to TBK1/IKKe (Kawai et al, 2005; Seth et al,
2005). MAVS locates in the mitochondria via a C-terminal mitochondrial transmembrane
domain and triggers antiviral responses via activation of NF-kB and IRF3. MAVS also appears
sufficient to recruit IKKe
activation and insertion into the mitochondrial membrane appears to be
sufficient to trigger mitochondria depolarization and apoptosis, as well as
activation of IRF3 and the antiviral cascade. In addition, it was found that
CARDIF is targeted and cleaved at its C-terminal end by NS3/4A, a serine
protease from HCV known to block IFN-b production (Meylan et al, 2005). Furthermore, overexpression
of IKKe resulted in strong inhibition of
both negative and positive replicative strands of the HCV replicon, suggesting
an important role for IKKe in the
RIG-I pathway downstream of CARDIF and in suppression of HCV replication
(Breiman et al, 2005). Thus, the molecular signaling mechanisms that are
essential for the development of the innate immune response are being
delineated rapidly. It is intriguing that a direct relationship between
VSV-induced apoptosis and the initiation of the IFN antiviral state has been
uncovered in a variety of differentiated cell types. The details of the RIGI
dependent and -independent signaling mechanisms thus appear central to the
direct and indirect oncolytic functions of VSV.
As of yet,
there have been no clinical trials initiated with VSV in cancer patients.
However, Phase I trials with NDV and Reovirus have been completed in patients
with advanced solid cancers that were unresponsive to standard therapy (Pecora
et al, 2002). Phase I Trials with PV701, a replication-competent strain of NDV
on seventy-nine patients with advanced cancer displayed promising results: 1) a
biopsy conducted on one patient demonstrated budding of virus particles from
cancerous cells through electron microscopy and infiltration of the tumor mass
with mononuclear inflammatory cells; 2) side effects were confined to flu-like
symptoms; 3) 14 patients displayed a halt in progression of cancer, and 7
patients had measurable tumor reductions (Pecora et al, 2002). The latter
results were obtained with sub-optimal doses of the PV701 strain, but
collectively these results warrant further investigation into the potential of
NDV as new cancer therapy.
In addition,
two clinical trials with Reovirus have been completed. In the Phase I trial,
results indicate that patients with advanced cancer had no toxicity to various
administered doses of Reovirus, highlighting the efficacy of this oncolytic
virus. Furthermore, 62% of patients demonstrated tumor regression ranging from
32-100% (Morris, 2002; Norman and Lee, 2005). This led to Phase II trials by
Oncolytic Biotech Inc. on Reovirus-treated human prostate cancer. Following
intraprostatic injection of Reovirus, tumor cell death was observed in the
prostate gland in 4 of 6 patients and there were no observable signs of
toxicity in the subjects (Norman and Lee, 2005). In all cases, multiple
inoculations of oncolytic virus were used; given that immunity to virus builds
rapidly over time, it is not clear whether subsequent virus inoculations are
effective, or whether the strategy may ultimately require sequential
administration of different viruses. These and many other issues warrant
further investigation.
VI. Conclusions
Many advantages to VSV argue that this virus may be a
superior oncolytic virus: 1) VSV can be grown to high titers in bioreactors and
is easily amenable to genetic manipulation by recombinant techniques; 2) VSV
causes very mild disease in cattle and humans; 3) because most humans have not
come into contact with VSV, pre-existing immunity that could hamper the
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John
Hiscott