Vascular disrupting agent DMXAA enhances the antitumor effects generated by therapeutic HPV DNA vaccines
© Peng et al; licensee BioMed Central Ltd. 2011
Received: 24 November 2010
Accepted: 8 March 2011
Published: 8 March 2011
Antigen-specific immunotherapy using DNA vaccines has emerged as an attractive approach for the control of tumors. Another novel cancer therapy involves the employment of the vascular disrupting agent, 5,6-dimethylxanthenone-4-acetic acid (DMXAA). In the current study, we aimed to test the combination of DMXAA treatment with human papillomavirus type 16 (HPV-16) E7 DNA vaccination to enhance the antitumor effects and E7-specific CD8+ T cell immune responses in treated mice. We determined that treatment with DMXAA generates significant therapeutic effects against TC-1 tumors but does not enhance the antigen-specific immune responses in tumor bearing mice. We then found that combination of DMXAA treatment with E7 DNA vaccination generates potent antitumor effects and E7-specific CD8+ T cell immune responses in the splenocytes of tumor bearing mice. Furthermore, the DMXAA-mediated enhancement or suppression of E7-specific CD8+ T cell immune responses generated by CRT/E7 DNA vaccination was found to be dependent on the time of administration of DMXAA and was also applicable to other antigen-specific vaccines. In addition, we determined that inducible nitric oxide synthase (iNOS) plays a role in the immune suppression caused by DMXAA administration before DNA vaccination. Our study has significant implications for future clinical translation.
Advanced stage cancers are difficult to control using conventional therapies such as chemotherapy, surgery and radiation. Therefore, new innovative therapies are urgently required in order to combat the high mortality and morbidity associated with cancers. Antigen-specific immunotherapy has emerged as an attractive approach for the treatment of cancers since it has the ability to specifically eradicate systemic tumors and control metastases without damaging normal cells. DNA vaccination has become a potentially promising approach for antigen-specific immunotherapy due to its safety, stability and ease of preparation (for review, see [1, 2]). We have previously developed several innovative strategies to enhance DNA vaccine potency by directly targeting the DNA into the dendritic cells (DCs) in vivo via gene gun as well as by modifying the properties of antigen-expressing DCs (for review see [3, 4]).
One of the strategies to enhance DNA vaccine potency uses intracellular targeting strategies to enhance MHC class I/II antigen presentation and processing in DCs. Previously, we have studied the linkage of calreticulin (CRT), a Ca2+-binding protein located in the endoplasmic reticulum (ER) (for review, see ) to several antigens, including human papillomavirus type-16 (HPV-16) E7 [6, 7], E6 , and nucleocapsid protein of severe acute respiratory syndrome (SARS) coronavirus . Intradermal administration of CRT linked to any of these target antigens led to a significant increase in the antigen-specific CD8+ T cell immune responses and impressive antitumor effects. Thus, CRT has been shown to be highly potent in enhancing the antigen-specific immune responses and antitumor effects generated by DNA vaccination in several preclinical models.
Another novel cancer therapy involves the employment of the vascular disrupting agent, 5,6-dimethylxanthenone-4-acetic acid (DMXAA). Vascular disrupting agents are a new class of potential anticancer drugs that selectively destroy the established tumor vasculature and shutdown blood supply to solid tumors, causing extensive tumor cell necrosis (For reviews see [10, 11]). DMXAA is a synthetic flavonoid that induces the production of local cytokines including TNFα. DMXAA has been shown to induce antitumor effects in animal models, especially in combination with established anticancer agents. It has demonstrated a good safety profile and has been shown to be promising in phase I clinical trials .
In the current study, we aimed to test the combination of DMXAA treatment with E7 DNA vaccination to enhance the antitumor effects and E7-specific CD8+ T cell immune responses in treated mice. We also aimed at exploring the appropriate regimen and the mechanism of action of this drug. The clinical implications of the current study are discussed.
Materials and methods
C57BL/6 mice (5- to 8-week-old) were purchased from the National Cancer Institute (Frederick, MD). 5-8 week-old inducible nitric oxide synthase deficient (iNOS-/-) and wild-type control C57BL/6 mice were purchased from Jackson Laboratories (Bar Harbor, ME). 5-8 week old TNFα-/- and wild-type control C57BL/6 mice were purchased from Taconic (Hudson, NY). All animals were maintained under specific-pathogen free conditions, and all procedures were performed according to approved protocols and in accordance with recommendations for the proper use and care of laboratory animals.
Peptides, antibodies and regents
The H-2Kb restricted HPV-16 E6 peptide, YDFAFRDL (E6 aa50-57), and the H-2Db restricted HPV-16 E7 peptide, RAHYNIVTF (E7 aa49-57) were synthesized by Macromolecular Resources (Denver, CO) at a purity of ≥70%. FITC-conjugated rat anti-mouse CD4, CD8, IFN-γ and PE-conjugated anti-mouse CD8 antibodies were purchased from BD Pharmingen (BD Pharmingen, San Diego, CA). 5,6-dimethylxanthenone-4-acetic acid (DMXAA) was purchased from Sigma (St. Louis, MO). DMXAA was dissolved in 5% sodium bicarbonate, and injected intraperitoneally (i.p.) at a dose of 20 mg/kg of body weight.
HPV-16 E6 and E7-expressing TC-1 tumor cells were generated as previously described  and was grown in RPMI 1640 medium containing 10% fetal bovine serum, 2 mM glutamine, 1 mM sodium pyruvate, 100 IU/ml penicillin, 100 μg/ml streptomycin, 100 μM non-essential amino acids and 0.4 mg/ml of G418.
The generation of HPV-16 E7-expressing plasmid (pcDNA3-CRT/E7), E6-expressing plasmid (pcDNA3-CRT/E6) , PADRE-expressing plasmid (pcDNA3-IiPADRE) , and vaccinia virus encoding HPV-16 E7 (SigE7LAMP1) , has been described previously.
Mouse tumor challenge model
C57BL/6 mice (five per group) were injected with 1 × 105 TC-1 tumor cells subcutaneously at the flank site in 100 μL PBS. Tumors were measured twice a week. Tumor volume was estimated using the formula 3.14 × [largest diameter × (perpendicular diameter)2]/6.
Preparation of DNA-coated gold particles and gene gun particle-mediated DNA vaccination was performed using a helium-driven gene gun (BioRad Laboratories Inc., Hercules, CA) according to a protocol described previously. Gold particles coated with pcDNA3 encoding HPV-16 E6 or HPV-16 E7 or PADRE were delivered to the shaved abdominal region of mice using a helium-driven gene gun with a discharge pressure of 400 psi. Mice were immunized with 2 μg of the various DNA vaccines and received boosts with the same regimen as indicated in the figure legends. For vaccinia encoding SigE7LAMP1 vaccination, 1 × 107 pfu viruses were injected intraperitoneally in 100 μl volume. Splenocytes were harvested 1 week after the last vaccination.
Intracellular cytokine staining and flow cytometry analysis
Before intracellular cytokine staining, pooled splenocytes from each vaccination group were incubated for 20 hours with 1 μg/ml of the HPV-16 E6 aa50-57 peptide, or HPV-16 E7aa49-57 peptide, or PADRE peptide at the presence of GolgiPlug (BD Pharmingen, San Diego, CA). The stimulated splenocytes were then washed once with FACScan buffer and stained with PE-conjugated monoclonal rat antimouse CD8a (clone 53.6.7). Cells were subjected to intracellular cytokine staining using the Cytofix/Cytoperm kit according to the manufacturer's instruction (BD Pharmingen, San Diego, CA). Intracellular IFN-γ was stained with FITC-conjugated rat antimouse IFN-γ. Flow cytometry analysis was performed using FACSCalibur with CELLQuest software (BD biosciences, Mountain View, CA).
Detection of T cell apoptosis
C57BL/6 mice were treated with DMXAA at 20 mg/kg via i.p. injection. 48 hours later, splenocytes were harvested and apoptosis of T cells were analyzed by staining splenocytes with annexin V staining kit from BD Pharmingen according to the protocol provided by the manufacturer.
Bio-Plex cytokine assay
5~8 week-old C57BL/6 mice were vaccinated with 2 μg of pcDNA3-CRT/E7 DNA via gene gun delivery. 3 days after the vaccination, the mice were treated with either 20 mg/kg of DMXAA or buffer via i.p. injection. Mouse serum was collected 5 hours later and stored at -80°C until assay. Mouse cytokines were analyzed using Bio-Plex Pro Mouse Cytokine 23-plex Assay from Bio-Rad according to manufacturer's protocol. Each sample was assayed in duplicate.
Data expressed as means ± standard deviations (SD) are representative of at least two different experiments. Comparisons between individual data points were made by 2-tailed Student's t test. A p value of less than 0.05 was considered significant.
Treatment with DMXAA generates significant therapeutic effects against TC-1 tumors but does not enhance the antigen-specific immune responses in tumor bearing mice
Combination of DMXAA treatment with E7 DNA vaccination generates potent antitumor effects and E7-specific CD8+ T cell immune responses in the splenocytes of tumor-bearing mice
The DMXAA-mediated enhancement of E7-specific CD8+ T cell immune responses generated by CRT/E7 DNA vaccination is dependent on the time of administration of DMXAA
Furthermore, tumor-bearing mice treated with DMXAA 3 days after the first vaccination (d+3) generated a significantly increased number of activated dendritic cells compared to the control. In addition, treatment with DMXAA also led to increased expression of co-stimulatory markers for DC activation compared to the control (see Additional File 1; Figure S1). The increased number and function of DCs contribute to the enhanced processing and presentation of E7 antigen to the generation of E7-specific CD8+ T cells in treated mice. Taken together, our data indicate that the timing of administration of DMXAA significantly influences the E7-specific CD8+ T cell immune responses in treated mice.
The DMXAA-mediated enhancement of antigen-specific T cell-mediated immune responses generated by vaccination is also applicable to other antigen-specific vaccines
In order to determine if additional doses of DMXAA following the first vaccination would further enhance the immune responses generated in vaccinated mice, C57BL/6 mice (5 per group) were vaccinated with pcDNA3-CRT/E7 DNA vaccine via gene gun delivery and treated with either one dose or two doses of DMXAA as indicated in Additional File 2; Figure S2A. One week after last vaccination, splenocytes from mice were harvested and characterized for E7-specific CD8+ T cells using intracellular IFN-γ staining followed by flow cytometry analysis. As shown in Additional File 2; Figure S2B and C, vaccinated mice treated with two doses of DMXAA after vaccination generated significantly better E7-specific CD8+ T cell immune responses compared to vaccinated mice treated with one dose of DMXAA. Thus, our data indicate that administration of two doses of DMXAA after the first CRT/E7 DNA vaccination generates significantly better E7-specific CD8+ T cell immune responses in vaccinated mice compared to administration of one dose of DMXAA.
Co-administration of DMXAA with CRT/E7 DNA vaccine generates long term E7-specific memory CD8+ T cell immune responses in vaccinated mice
Co-administration of DMXAA with DNA vaccine leads to elevated levels of inflammatory cytokines in the serum of treated mice
iNOS plays a role in the immune suppression caused by DMXAA administration at the time of the first DNA vaccination
In order to determine the mechanism by which DMXAA leads to suppressed antigen-specific CD8+ T cell immune responses when administered before or at the time of the first DNA vaccination, we characterized the apoptotic cell death of CD4+ and CD8+ T cells in the splenocytes derived from mice treated with DMXAA. C57BL/6 mice (5 per group) were treated with DMXAA at 20 mg/kg via i.p. injection. 48 hours later, splenocytes were harvested and apoptosis of CD4+ and CD8+ T cells were analyzed by annexin V staining. There was no significant difference in the levels of apoptotic cell death in the CD4+ or CD8+ T cells among splenocytes from mice treated with DMXAA compared to those from the control mice (see Additional File 3; Figure S3). Thus, our data suggest that the mechanism by which DMXAA leads to suppressed antigen-specific immune responses is not through T cell apoptosis.
In the current study, we determined that treatment with DMXAA generates significant therapeutic effects against TC-1 tumors but does not enhance the antigen-specific immune responses in tumor bearing mice. We further found that combination of DMXAA treatment with therapeutic HPV DNA vaccination generates potent antitumor effects and E7-specific CD8+ T cell immune responses in tumor bearing mice. Furthermore, the DMXAA-mediated enhancement or suppression of E7-specific CD8+ T cell immune responses generated by CRT/E7 DNA vaccination was found to be dependent on the time of administration of DMXAA and was also applicable to other antigen-specific vaccines. In addition, we determined that iNOS plays a role in the immune suppression caused by DMXAA administration before DNA vaccination. Our data are consistent with a recent observation using E7 peptide-based vaccines in an E7-expressing cervicovaginal tumor model .
In our study, we observed that treatment of tumor-bearing mice with DMXAA alone leads to therapeutic antitumor effects without generating antigen-specific immune responses (Figure 1). This may be due to the fact that as a vascular disrupting agent, DMXAA has been shown to exert antitumor effects by non antigen-specific mechanisms such as selectively destroying the established tumor vasculature and shutting down blood supply to solid tumors, causing extensive tumor cell necrosis [10, 11]. The release of tumor antigen caused by DMXAA treatment may not be sufficient to generate detectable antigen-specific immune responses. Thus, while DMXAA treatment alone in TC-1 tumor-bearing mice failed to lead to appreciable E7 antigen-specific immune responses, the vaccination with CRT/E7 vaccine can lead to increased number of E7-specific CD8+ T cell precursors in tumor-bearing mice, which may be further expanded by treatment with DMXAA, resulting in a significant enhancement of E7-specific CD8+ immune responses in treated mice (Figure 2).
For clinical translation, it is important to determine the optimal regimen for treatment with DMXAA. Our study showed that administration of DMXAA 3 days after the first CRT/E7 DNA vaccination generates the best antigen-specific CD8+ T cell immune responses in vaccinated mice (Figure 3). Our data also indicated that administration of two doses of DMXAA after the first CRT/E7 DNA vaccination generates E7-specific CD8+ T cell immune responses in vaccinated mice (see Additional File 1; Figure S1). Thus, it will be of importance to further explore the optimal treatment for administration of DMXAA in clinical trials.
Our study explored the mechanism of enhancement induced by DMXAA. We found that DMXAA administered after the first DNA vaccination influences the cytokine profile in the serum of mice with observed immune enhancement (Figure 7). Mice treated with DMXAAA after the first DNA vaccination showed upregulation of the cytokines IL-6, G-CSF, KC, MIP-1β and RANTES. IL-6 can be secreted by T cells and macrophages to stimulate immune response to trauma, leading to inflammation (for review see ). G-CSF is a cytokine produced by a number of different tissues to stimulate the bone marrow to produce granulocytes and stem cells. KC, MIP-1β and RANTES are chemokines that act as chemo-attractants to guide the migration of T cells. All these molecules are believed to play a role in the immune enhancement generated by DMXAA administration. In additon, our data suggest that treatment with DMXAA 3 days after the first DNA vaccination can lead to enhancement of antigen-specific CD4+ T cells (Figure 5). Thus, it is possible that the enhancement of E7-specific CD8+ T cell responses by DMXAA treatment may also be contributed by both cytokines as well as antigen-specific CD4+ T cells.
Our data also suggested that iNOS plays a role in the immune suppression caused by DMXAA administration at the time of the first DNA vaccination (Figure 8). Our study also showed that the immune suppression mediated by DMXAA is abolished in iNOS knockout mice. Because DCs are essential for priming of antigen-specific CD8+ T cell immune response, it is conceivable that treatment with DMXAA may lead to the negative impact on DC function, presumably mediated by iNOS. It will be of interest to further characterize the role of iNOS on immunosuppression mediated by DMXAA treatment.
In summary, we have demonstrated that the combination of DMXAA treatment with HPV-16 E7 DNA vaccination can enhance or suppress the antitumor effects and E7-specific CD8+ T cell immune responses in treated mice depending on the time of administration of DMXAA. These results may have potential implications for future clinical translation.
This work was supported by R21 AI085380, P20 CA118770, 1 RO1 CA114425 01, and SPORE programs (P50 CA098252 and P50 CA96784-06) of the National Cancer Institute.
- Donnelly JJ, Ulmer JB, Liu MA: DNA vaccines. Life sciences. 1997, 60: 163-172. 10.1016/S0024-3205(96)00502-4.View ArticlePubMedGoogle Scholar
- Gurunathan S, Klinman DM, Seder RA: DNA vaccines: immunology, application, and optimization. Annual review of immunology. 2000, 18: 927-974. 10.1146/annurev.immunol.18.1.927.View ArticlePubMedGoogle Scholar
- Hung CF, Wu TC: Improving DNA vaccine potency via modification of professional antigen presenting cells. Current opinion in molecular therapeutics. 2003, 5: 20-24.PubMedGoogle Scholar
- Tsen SW, Paik AH, Hung CF, Wu TC: Enhancing DNA vaccine potency by modifying the properties of antigen-presenting cells. Expert review of vaccines. 2007, 6: 227-239. 10.1586/147605184.108.40.206.PubMed CentralView ArticlePubMedGoogle Scholar
- Gelebart P, Opas M, Michalak M: Calreticulin, a Ca2+-binding chaperone of the endoplasmic reticulum. The international journal of biochemistry & cell biology. 2005, 37: 260-266.View ArticleGoogle Scholar
- Cheng WF, Hung CF, Chai CY, Hsu KF, He L, Ling M, Wu TC: Tumor-specific immunity and antiangiogenesis generated by a DNA vaccine encoding calreticulin linked to a tumor antigen. The Journal of clinical investigation. 2001, 108: 669-678.PubMed CentralView ArticlePubMedGoogle Scholar
- Kim JW, Hung CF, Juang J, He L, Kim TW, Armstrong DK, Pai SI, Chen PJ, Lin CT, Boyd DA, Wu TC: Comparison of HPV DNA vaccines employing intracellular targeting strategies. Gene Ther. 2004, 11: 1011-1018. 10.1038/sj.gt.3302252.View ArticlePubMedGoogle Scholar
- Peng S, Ji H, Trimble C, He L, Tsai YC, Yeatermeyer J, Boyd DA, Hung CF, Wu TC: Development of a DNA vaccine targeting human papillomavirus type 16 oncoprotein E6. J Virol. 2004, 78: 8468-8476. 10.1128/JVI.78.16.8468-8476.2004.PubMed CentralView ArticlePubMedGoogle Scholar
- Kim TW, Lee JH, Hung CF, Peng S, Roden R, Wang MC, Viscidi R, Tsai YC, He L, Chen PJ, Boyd DA, Wu TC: Generation and characterization of DNA vaccines targeting the nucleocapsid protein of severe acute respiratory syndrome coronavirus. J Virol. 2004, 78: 4638-4645. 10.1128/JVI.78.9.4638-4645.2004.PubMed CentralView ArticlePubMedGoogle Scholar
- Cai SX: Small molecule vascular disrupting agents: potential new drugs for cancer treatment. Recent Pat Anticancer Drug Discov. 2007, 2: 79-101. 10.2174/157489207779561462.View ArticlePubMedGoogle Scholar
- Baguley BC: Antivascular therapy of cancer: DMXAA. The lancet oncology. 2003, 4: 141-148. 10.1016/S1470-2045(03)01018-0.View ArticlePubMedGoogle Scholar
- McKeage MJ, Fong P, Jeffery M, Baguley BC, Kestell P, Ravic M, Jameson MB: 5,6-Dimethylxanthenone-4-acetic acid in the treatment of refractory tumors: a phase I safety study of a vascular disrupting agent. Clin Cancer Res. 2006, 12: 1776-1784. 10.1158/1078-0432.CCR-05-1939.View ArticlePubMedGoogle Scholar
- Lin KY, Guarnieri FG, Staveley-O'Carroll KF, Levitsky HI, August JT, Pardoll DM, Wu TC: Treatment of established tumors with a novel vaccine that enhances major histocompatibility class II presentation of tumor antigen. Cancer research. 1996, 56: 21-26.PubMedGoogle Scholar
- Hung CF, Tsai YC, He L, Wu TC: DNA Vaccines Encoding Ii-PADRE Generates Potent PADRE-specific CD4(+) T-Cell Immune Responses and Enhances Vaccine Potency. Mol Ther. 2007, 15: 1211-1219.PubMed CentralPubMedGoogle Scholar
- Wu TC, Guarnieri FG, Staveley-O'Carroll KF, Viscidi RP, Levitsky HI, Hedrick L, Cho KR, August JT, Pardoll DM: Engineering an intracellular pathway for major histocompatibility complex class II presentation of antigens. Proc Natl Acad Sci USA. 1995, 92: 11671-11675. 10.1073/pnas.92.25.11671.PubMed CentralView ArticlePubMedGoogle Scholar
- Moilanen E, Thomsen LL, Miles DW, Happerfield DW, Knowles RG, Moncada S: Persistent induction of nitric oxide synthase in tumours from mice treated with the anti-tumour agent 5,6-dimethylxanthenone-4-acetic acid. British journal of cancer. 1998, 77: 426-433. 10.1038/bjc.1998.68.PubMed CentralView ArticlePubMedGoogle Scholar
- Peggs KS, Quezada SA, Allison JP: Cancer immunotherapy: co-stimulatory agonists and co-inhibitory antagonists. Clinical and experimental immunology. 2009, 157: 9-19. 10.1111/j.1365-2249.2009.03912.x.PubMed CentralView ArticlePubMedGoogle Scholar
- Xu W, Liu LZ, Loizidou M, Ahmed M, Charles IG: The role of nitric oxide in cancer. Cell research. 2002, 12: 311-320. 10.1038/sj.cr.7290133.View ArticlePubMedGoogle Scholar
- van der Veen RC: Nitric oxide and T helper cell immunity. International immunopharmacology. 2001, 1: 1491-1500. 10.1016/S1567-5769(01)00093-5.View ArticlePubMedGoogle Scholar
- Zeng Q, Monie A, Peng S, Hung C-F, Wu T-C: Control of Cervicovaginal HPV-16 E7-Expressing Tumors by the Combination of Therapeutic HPV Vaccination and Vascular Disrupting Agents Human gene therapy (in press). 2010Google Scholar
- Bettini M, Vignali DA: Regulatory T cells and inhibitory cytokines in autoimmunity. Current opinion in immunology. 2009, 21: 612-618. 10.1016/j.coi.2009.09.011.PubMed CentralView ArticlePubMedGoogle Scholar
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