Novel therapies for renal cell carcinoma--an update

Effects of recombinant human canstatin protein in the treatment of pancreatic cancer

AIM: To examine the effect of canstatin, a newly discovered endogenous inhibitor of angiogenesis, in the treatment of pancreatic cancer in vivo.

METHODS: The canstatin cDNA fragment was synthesized and amplified from the total RNA extracted from human placenta tissues by RT-PCR. The resulting product was firstly cloned into pUCm-T vector, then into plasmid pET-22b (+) and transformed into E. coli BL21. Isopropyl-1-thio-b-Dgalactopyran-oside (IPTG) was used to induce the expression of canstatin protein and affinity chromatography was used to purify the protein. To determine the activity of purified recombinant human canstatin (rhCanstatin), orthotopic xenograft human pancreatic cancer models were established. Human pancreatic cancer cells (SW1990) were injected into the pancreas of BALB/c nude mice. Twenty-four nude mice with orthotopic xenograft tumor were randomly divided into 3 groups 10 d after the inoculation, and were treated with PBS 0.3 mL, or canstatin 5 mg/kg, or 10 mg/kg per day for 3 wk intraperitoneally. When the experiment was over, all tumors were resected and the effects of rhCanstatin on tumor growth, microvessel density (MVD) were analyzed.

RESULTS: After IPTG induction, SDS-PAGE showed a new monomeric 24 kDa protein band. This protein was purified through affinity chromatography and refolded through dialysis with a final concentration of 60 mg/L. In orthotopic pancreatic cancer models, the final tumor volume in groups treated with PBS, canstatin 5 mg/kg, 10 mg/kg were 355.21 ± 39.54 mm³, 112.73 ± 10.47 mm³, and 61.75 ± 6.99 mm³ respectively. The immunohistochemical examination showed that the MVD in tumors treated with canstatin was significantly less than that in other group.

CONCLUSION: These findings demonstrate that the rhCanstatin effectively retards the growth of pancreatic cancer in a dose-dependent manner through inhibiting angiogenesis and may be a promising therapeutic agent for pancreatic cancer treatment in the clinic.

Generation of RAGE-1 and MAGE-9 peptide-specific cytotoxic T-lymphocyte lines for transfer in patients with renal cell carcinoma

Renal cell carcinomas (RCCs) are supposed to be immunogenic, and several clinical trials of immunotherapy using tumor lysate-pulsed dendritic cells (DCs) have been performed. We report on the generation of RAGE-1 and MAGE-9 peptide-specific CTL lines. RAGE-1 and MAGE-9 are expressed in 56% and 38% of RCCs. Seven MAGE-9- and 13 RAGE-1-derived peptides were found to be immunogenic in the context of the HLA-A*0201 MHC. CTLs were generated by coculture with peptide-pulsed, activated B cells, which were easily generated in great quantities and displayed functional activity for a prolonged period of time. MAGE-9 and RAGE-1 peptide-specific CTL lines were strictly peptide-specific and displayed high cytotoxic activity not only against peptide-loaded T2 cells but also against HLA-A*0201-positive RCC lines, which naturally express MAGE-9, RAGE-1 or both. Thus, B cells are well suited as APCs for the generation of large numbers of tumor peptide-specific CTLs for adoptive transfer. MAGE-9 as well as RAGE-1 may well provide suitable targets for immunotherapy of RCC.

Renal cell carcinoma: Current status and future prospects

The incidence of renal cell carcinoma (RCC) is increasing. Despite improvements in the management of localized RCC, most patients are diagnosed with advanced RCC, which is often refractory and associated with a poor prognosis. Although surgery is the only curative treatment for localized RCC, improved diagnostic methods facilitating early detection and characterization of renal tumors have enabled more effective use of less invasive treatments. Adrenal-sparing radical total nephrectomy, and laparoscopic radical and total nephrectomy are increasingly being performed in preference to radical nephrectomy. However, standard treatments for advanced RCC are largely unsuccessful. Radiotherapy is often used to control symptoms associated with RCC in patients unsuitable for surgery. Immunotherapy with cytokines is the standard systemic treatment for advanced RCC, and is associated with prolonged survival in a subset of patients, but is generally poorly tolerated. An increased knowledge of the underlying pathophysiology of RCC has resulted in the identification of molecular pathways involved in tumor growth. Promising new agents designed to target these pathways are in development.

Emerging drugs for renal cell carcinoma

Renal cell carcinoma (RCC) still represents a therapeutic challenge when patients have advanced or metastatic disease. Treatment using IL-2 and IFN-alpha continues to be the standard of care in patients who are able to tolerate such regimens. Targeted therapy may become the first-line treatment for patients resistant or intolerant to cytokines as new emerging drugs continue to be investigated. Understanding the genetic abnormalities related to the development of RCC (e.g., VHL gene abnormalities) and identifying molecular targets (e.g., epidermal growth factor, vascular endothelial growth factor and carbonic anhydrase IX) are playing a major role in the emergence of these novel agents for the treatment of this malignancy. Overall, these drugs are better tolerated and more acceptable to use by patients than the traditional cytokine-based regimens. The use of oral drugs to treat various malignancies including RCC seems to be the new paradigm of the future. Further understanding of their mechanisms of action and confirmation of their benefits on the clinical outcome is needed.

Mcm2, Geminin, and KI67 define proliferative state and are prognostic markers in renal cell carcinoma

PURPOSE

The origin licensing factors minichromosome maintenance 2 (Mcm2) and Geminin have recently been identified as critical regulators of growth and differentiation. Here we have investigated the regulation of these licensing factors together with Ki67 to further elucidate the cell cycle kinetics of renal cell carcinoma (RCC). Furthermore, we have examined the role of Ki67, Mcm2, and Geminin in disease-free survival after nephrectomy in patients with localized RCC.

EXPERIMENTAL DESIGN

Tissue sections from 176 radical nephrectomy specimens were immunohistochemically stained with Mcm2, Geminin, and Ki67 antibodies. Labeling indices (LI) for these markers were compared with clinicopathologic parameters (median follow-up 44 months).

RESULTS

In RCC, Mcm2 is expressed at much higher levels than Ki-67 and Geminin, respectively [medians 41.6%, 7.3%, and 3.5% (P < 0.001)] and was most closely linked to tumor grade (P < 0.001). For each marker, Kaplan-Meier survival curves provided strong evidence that increased expression is associated with reduced disease-free survival time (P < 0.001). Additionally, an Mcm2-Ki67 LI identified a unique licensed but nonproliferating population of tumor cells that increased significantly with tumor grade (P = 0.004) and was also of prognostic value (P = 0.01). On multivariate analysis, grade, vascular invasion, capsular invasion, Ki67 LI >12%, and age were found to be independent prognostic markers.

CONCLUSIONS

Although Ki67 is identified as an independent prognostic marker, semiquantitative assessment is difficult due to the very low proliferative fraction identified by this marker. In contrast, Mcm2 identifies an increased growth fraction that is closely linked to grade, provides prognostic information, and is amenable to semiquantitative analysis in routine pathologic assessment.

Fusion expression and purification of human endostatin gene and its activity analysis

AIM: To procure human endostatin fusion protein with biological activity.

METHODS: The total RNA was extracted from fetal liver and amplified to acquire human endostatin gene by reverse transcription polymerase chain reaction (RT-PCR). Then the obtained gene was cloned into expression vector pTRX and transformed into E.coli BL21 (DE3). Endostatin was expressed in the E.coli by IPTG inducement, and then purified. MTT assay was used to detect the inhibitory activity of endostatin on human umbilical vein endothelial cells (ECV304).

RESULTS: One band with a length of 573 bp was showed after electrophoresis of RT-PCR product. After the obtained gene was transformed into E.coli DH5a, the positive clone was identified by KpnI and NotI digestion and its sequence was identified by sequencing. The pTRX-endo expression vector was successfully constructed and expressed in E.coli BL21 (DE3). SDS-PAGE analysis showed that the expressed endostatin was the right one. It had good biological activity after purification. The growth of ECV304 cells was markedly inhibited by endostatin in a dose-dependent manner, and ED50 was 550 μg/L.

CONCLUSION: Human endostatin gene is successfully expressed in the prokaryotic expressing vector pTRX, and human endostatin protein can inhibit the proliferation of ECV 304 cells.

Molecular cloning of human canstatin gene

AIM: To clone human canstatin gene and to detect and analyze its coding sequence.

METHODS: The total RNA was extracted from human placenta. The canstatin gene fragment was synthesized and amplified from the total RNA by RT-PCR. pUCm-T vector was cloned into the RT-PCR product to obtain recombinant pUCm-T/ canstatin. The pUCm-T/canstatin was then transformed into E.coli DH 5a, and sequence of the gene was detected.

RESULTS: The extracted total RNA was separated into three clear bands indicating 28 S, 18 S, and 5 S after electrop-horesis. The values of A₂₆₀ and A₂₈₀ were 0.879 and 0.410 respectively (A₂₆₀:A₂₈₀ = 2.095). The concentration of total RNA was 1.8 g/L. The PCR product was the same as target gene canstatin. BamH I and Hind III digestion proved the final product positive. The sequence of the cloned gene (684 bp) completely matched with that of canstatin gene in Genbank.

CONCLUSION: Human canstatin gene is successfully cloned, which establishes the foundation for further study of its anti-tumor activity.

Mechanism for ribonucleotide reductase inactivation by the anticancer drug gemcitabine

Gemcitabine (2',2'-difluoro-2'-deoxycytidine, dFdC) is a very promising anticancer drug, already approved for clinical use in three therapeutic indications. It is metabolized intracellularly to 5'-diphosphate (dFdCDP), which is known to be a potent inhibitor of ribonucleotide reductase (RNR). Although several nucleotide analogs show in vitro capacity of RNR inactivation, none has shown the in vivo efficacy of dFdCDP. Accordingly, the experimental data suggests that its mechanism of inhibition is different from the other known RNR suicide inhibitors. Enzyme inhibition in the absence of reductive species leads to complete loss of the essential radical in subunit R2, and formation of a new nucleotide-based radical. Interestingly, however, the presence of the reductants does not prevent inhibition--the radical is not lost but the targeted subunit of RNR becomes R1, which is inactivated possibly by alkylation. We have conducted a theoretical study, which led us to the first proposal of a possible mechanism for RNR inhibition by dFdCDP in the absence of reductants. This mechanism turned out to be very similar to the natural substrate reduction pathway and only deviates from the natural course after the formation of the well-known disulphide bridge. This deviation is caused precisely by the F atom in the beta-face, only present in this inhibitor. The essential radical in R2 is lost, and so is the enzyme catalytic activity. The nucleotide-based radical that constitutes the end product of our mechanism has been suggested in the literature as a possible candidate for the one detected experimentally. In fact, all experimental data available has been reproduced by the theoretical calculations performed here.

Down-Regulation of HLA Class I Antigen Processing Molecules: An Immune Escape Mechanism of Renal Cell Carcinoma?

PURPOSE

Proper HLA class I antigen processing and presentation is a prerequisite for the recognition of tumor cells by cytotoxic T lymphocytes. To date there exist only limited information on the expression of components of the HLA class I associated antigen processing machinery (APM) in surgically removed benign renal cell adenoma, and primary and metastatic renal cell carcinoma (RCC).

MATERIALS AND METHODS

A total of 133 primary RCCs of different subtypes, 10 renal cell adenoma biopsies, 32 matched metastases of different localization and autologous normal kidney epithelium were immunohistochemically analyzed for the expression of HLA class I antigens, low molecular weight protein (LMP)2 and LMP7, the transporter associated with antigen processing subunit (TAP1) and beta 2-microglobulin (beta 2-m).

RESULTS

Normal kidney tissue showed strong cytoplasmic staining intensity for LMP2, LMP7 and TAP1, whereas beta 2-m and HLA class I heavy chains were detected on the cell surface. A low frequency of HLA class I HC and beta 2-m down-regulation was found in RCC. In contrast, primary RCC and metastases showed a high frequency of a total lack of heterogeneous TAP1, LMP2 and LMP7 expression, which was often coordinately regulated. APM component deficiencies were associated with RCC subtypes but not with tumor grading and staging.

CONCLUSIONS

HLA class I APM component abnormalities appear to represent an immune escape mechanism of RCC. This finding emphasizes the need to evaluate the integrity and expression of these molecules in patients with RCC, especially in those selected for treatment with T-cell based immunotherapy.

Beta-glucan enhanced killing of renal cell carcinoma micrometastases by monoclonal antibody G250 directed complement activation

Metastases from renal cell carcinomas (RCC) are resistant to radiation and chemotherapy but are relatively immunogenic. We have investigated the possibility to eliminate human RCC micrometastases using MAb G250. G250 penetrates human micrometastases completely in a spheroid model and induces complement deposition rapidly on the outmost cell layers. However, complement dependent cytotoxicity (CDC) was barely detected using either (51)chromium release assays or confocal microscopy, due to relatively low expression of the G250 antigen and the effect of membrane bound complement regulatory proteins. Addition of blocking anti-CD59 MAbs enhanced formation of C5b-9 and consequently complement mediated lysis (13%). Complement assisted cellular cytotoxicity (CACC) was not detectable, although the iC3b ligand and CR3 receptor were present on respectively target and effector cells. Addition of soluble beta-glucan induced the killing of MAb and iC3b opsonized spheroids by effector cells (6-21%). Despite a lower affinity for G250 antigen, a bispecific anti-G250*anti-CD55 MAb enhanced cell killing in spheroids comparable to the parental G250 MAb. Our results suggest that complement-activating G250 in combination with anti-mCRP MAbs is able to kill human RCC cells in micrometastasis in vitro. For CACC the presence of CR3-priming beta-glucan seems to be obligatory. In vivo, bi-MAb may be more effective as therapeutic agent due to its increased C5a generating properties.

Stem-cell therapy for renal diseases

Significant attention is currently directed to the biological and therapeutic capabilities of stem cells for developing novel treatments for acute and chronic kidney diseases. To date, viable sources of stem cells for renal therapies include adult bone marrow and embryonic tissues, including the metanephric mesenchyme and mesonephros. Native adult kidney stem cells have yet to be identified. Systemically introduced stem cells can engraft in sites of renal disease and injury to show donor phenotypes. Stem cells can differentiate into cells similar to glomeruli, mesangium, and tubules in the kidneys. The impact of stem-cell engraftment and differentiation on renal function presently is unknown. Identification of renal diseases treatable with stem-cell therapies is expected to evolve as stem-cell technologies advance. Methods of modifying stem cells to improve homing, differentiation, and integration into host tissues need further characterization. Ethical and legal controversies about embryonic research and cloning are shaping the regulation and funding of stem-cell research for kidney diseases. Scientific and clinical understanding of stem cells and their potential for renal treatments are in the early stage of development. This field offers great promise, and there are significant opportunities for future investigation in clinical, biological, and ethical aspects of stem-cell therapy for kidney diseases.