Gene therapy for pituitary tumors: from preclinical models to clinical implementation

Detailed visualization of the functional regions of the rat pituitary gland by high-resolution T2-weighted MRI

This high-resolution MRI study focuses on the visualization of the detailed morphology of the rat's pituitary gland by means of post-mortem as well as in vivo MRI at 9.4 T. Determination of the local T1- and T2-relaxation decay times allows to explain the regional image intensities which reflects the degree of tissue organization at the molecular level. Detailed characterization of the molecular level of the pituitary gland, as provided by the relaxation decay times, can offer a rigid platform with respect to functional or pathological explorations. It is demonstrated that T1-weighted imaging, as is routinely used in the clinic, can differentiate between the posterior and anterior lobe but not between the posterior and intermediate lobe. T2-weighted images, however, clearly show the three distinct lobes of the rat pituitary gland without the use of contrast agents, i.e. the posterior, the intermediate and the anterior lobe. Histological analysis of the rat's pituitary gland confirms the morphological structures seen on the MR images. Although the intermediate lobe is less defined in humans and can neither be differentiated by T1-weighted MRI, its clinical visualization might be possible in T2-weighted images.

Development of a suspension serum-free helper-dependent adenovirus production system and assessment of co-infection conditions

Helper-dependent adenovirus (HDAd), deleted in all viral protein-coding sequences has been designed to reduce immune response and favor long-term expression of therapeutic genes in clinical programs. Its production requires co-infection of E1-complementing cells with helper adenovirus (HAd). Significant progresses have been made in the molecular design of HDAd, but large scale production remains a challenge. In this work, a scalable system for HDAd production is designed and evaluated focusing on the co-infection step. A human embryo kidney 293 (293) derived cell line, the 293SF/FLPe was generated to produce efficiently HDAd while restricting the packaging of HAd. This cell line was adapted to grow in suspension and in serum-free medium. Multiplicity of infection (MOI) of HDAd ranging from 0.1 to 50 was evaluated in presence of HAd at a MOI of 5. Optimal MOIs for HDAd amplification were found in the range of 5-10. HAd contamination was only 1%. These results were validated in a 3 L bioreactor under controlled operating conditions where a higher HDAd yield of 2.6 x 10(9) viral particles (VP)/mL or 3.5 x 10(8) infectious units (IU)/mL of HDAd was obtained.

Advances in the treatment of prolactinomas

Prolactinomas account for approximately 40% of all pituitary adenomas and are an important cause of hypogonadism and infertility. The ultimate goal of therapy for prolactinomas is restoration or achievement of eugonadism through the normalization of hyperprolactinemia and control of tumor mass. Medical therapy with dopamine agonists is highly effective in the majority of cases and represents the mainstay of therapy. Recent data indicating successful withdrawal of these agents in a subset of patients challenge the previously held concept that medical therapy is a lifelong requirement. Complicated situations, such as those encountered in resistance to dopamine agonists, pregnancy, and giant or malignant prolactinomas, may require multimodal therapy involving surgery, radiotherapy, or both. Progress in elucidating the mechanisms underlying the pathogenesis of prolactinomas may enable future development of novel molecular therapies for treatment-resistant cases. This review provides a critical analysis of the efficacy and safety of the various modes of therapy available for the treatment of patients with prolactinomas with an emphasis on challenging situations, a discussion of the data regarding withdrawal of medical therapy, and a foreshadowing of novel approaches to therapy that may become available in the future.

Studies on in vivo gene transfer in pituitary tumors using herpes-derived and adenoviral vectors

Suicide gene therapy has met limited success for the treatment of rat pituitary tumors. In order to determine the cause of primary pituitary tumor resistance to suicide gene therapy, we studied the transgene expression of an adenoviral (Ad.RSV.beta gal.nls) and a herpes simplex virus-derived (tsK/beta-gal) vector, both harboring the beta-galactosidase reporter gene in rat prolactinomas. Rats carrying experimental prolactinomas received bilateral 1 microl intrapituitary injections of either saline (saline group), 5 x 10(5) plaque-forming units (pfu) tsK/beta-gal (HSV Group) or 5 x 10(5) pfu Ad.RSV.beta gal.nls (RAd Group). Two or seven days later the tumors were examined. Macroscopic inspection of glands injected with either vector showed that the tissue expressing beta-gal was concentrated at the ventral area around the site reached by the tip of the needle. Almost no transgene expression was observed in other sites. Cellularity and lactotrophic cell density was not affected by saline or virus injection. In the injected areas, apoptotic levels were (x +/-S.E.M.): 9.3+/-0.5, 22.1+/-1.1 and 31.7+/-1.4%, for the saline, RAd and HSV groups, respectively. Serum prolactin and growth hormone levels were not affected by virus injection. We conclude that the low diffusibility of viral suspensions in the pituitary tissue may constitute a significant obstacle for achieving full remission of in situ pituitary tumors in rats.