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Reddy R, Yan SC, Hasanpour Segherlou Z, Hosseini-Siyanaki MR, Poe J, Perez-Vega C, Chiocca EA, Lucke-Wold B. Oncolytic viral therapy: a review and promising future directions. J Neurosurg 2024; 140:319-327. [PMID: 37877961 DOI: 10.3171/2023.6.jns23243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/06/2023] [Indexed: 10/26/2023]
Abstract
Oncolytic viral therapy is quickly emerging as a promising subset of immunotherapy, which theoretically can target tumor cells while sparing surrounding healthy cells by harnessing the replication machinery of viruses with tropism for tumor cells, resulting in direct oncolysis, and by transforming immunologically "cold" tumor into areas that elicit the host's immune response. This review provides an overview of oncolytic viral therapy until the present day, starting with the original concept in 1912. The general mechanism of oncolytic viruses (OVs) depends on selectively integrating them into tumor cells based on genetic engineering of viral genomic material, inducing oncolysis and eliciting the host's innate immune response. Moreover, a major component of oncolytic viral therapy has been herpes simplex virus, with talimogene laherparepvec being the only FDA-approved oncolytic viral therapy for the treatment of melanomas. This review explores the characteristics, advantages, disadvantages, and therapeutic uses of several DNA and RNA viral families. A snapshot of the oncolytic viral treatments used in the most recent and advanced clinical trials is also provided. Lastly, the challenges of implementing oncolytic viral therapy are explored, both at a molecular and clinical level, with a highlight of promising future directions. In particular, the lack of an optimal delivery method based on tumor type for oncolytic viral therapy poses a significant obstacle, even in clinical studies. Intrathecal continuous delivery of OVs is a promising prospect, potentially by adapting the novel continuous irrigation and drainage IRRAflow catheter. Further exploration and testing of the IRRAflow catheter should be undertaken.
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Affiliation(s)
- Ramya Reddy
- 1Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Sandra C Yan
- 1Department of Neurosurgery, University of Florida, Gainesville, Florida
| | | | | | - Jordan Poe
- 1Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Carlos Perez-Vega
- 3Department of Neurosurgery, Mayo Clinic, Jackonsville, Florida; and
| | - E Antonio Chiocca
- 4Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brandon Lucke-Wold
- 1Department of Neurosurgery, University of Florida, Gainesville, Florida
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Poe J, Sriram S, Mehkri Y, Lucke-Wold B. Electrolyte Imbalance and Neurologic Injury. CNS Neurol Disord Drug Targets 2023; 22:CNSNDDT-EPUB-129526. [PMID: 36790006 PMCID: PMC10425572 DOI: 10.2174/1871527322666230215144649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/09/2022] [Accepted: 12/20/2022] [Indexed: 02/16/2023]
Abstract
Neurologic injury continues to be a debilitating worldwide disease with high morbidity and mortality. The systemic sequelae of a neural insult often lead to prolonged hospital stays and challenging nutritional demands that contribute to poorer prognoses. Clinical management of a given condition should prioritize preserving the homeostatic parameters disrupted by inflammatory response cascades following the primary insult. This focused review examines the reciprocal relationship between electrolyte disturbance and neurologic injury. A prolonged electrolyte imbalance can significantly impact morbidity and mortality in neurologic injuries. A detailed overview of the major electrolytes and their physiologic, iatrogenic, and therapeutic implications are included. The pathophysiology of how dysnatremias, dyskalemias, dyscalcemias, and dysmagnesemias occur and the symptoms they can induce are described. The manifestations in relation to traumatic brain injury, status epilepticus, and acute ischemic stroke are addressed. Each type of injury and the strength of its association with a disruption in either sodium, potassium, calcium, or magnesium is examined. The value of supplementation and replacement is highlighted with an emphasis on the importance of early recognition in this patient population. This review also looks at the current challenges associated with correcting imbalances in the setting of different injuries, including the relevant indications and precautions for some of the available therapeutic interventions. Based on the findings of this review, there may be a need for more distinct clinical guidelines on managing different electrolyte imbalances depending on the specified neurologic injury. Additional research and statistical data on individual associations between insult and imbalance are needed to support this potential future call for context-based protocols.
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Affiliation(s)
- Jordan Poe
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Sai Sriram
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Yusuf Mehkri
- Department of Neurosurgery, University of Florida, Gainesville, USA
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Klaas E, Mohamed S, Poe J, Reddy R, Dagra A, Lucke-Wold B. Innovative Approaches for Breast Cancer Metastasis to the Brain. Arch Med Case Rep Case Study 2022; 6:147. [PMID: 36468085 PMCID: PMC9717593 DOI: 10.31579/2692-9392/147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Breast cancer metastasis is a continued concern for patients with recent development in our understanding of disease progression. In this paper, we highlight the pathophysiology behind breast cancer metastasis. Blood brain barrier disruption plays a critical component in progression. We then investigate the current treatment strategies and recommended guidelines. This focuses on radiation and medical management. Finally, we address the role of surgical intervention. The data is organized into tables and figures to highlight key components. Finally, we address emerging treatments and pre-clinical data. The paper will serve as a user-friendly guide for clinicians and researchers to help formulate a strategy to manage breast cancer metastasis patients sufficiently.
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Affiliation(s)
| | | | - Jordan Poe
- College of Medicine, University of Florida
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Hunanyan AS, Kantor B, Puranam RS, Elliott C, McCall A, Dhindsa J, Pagadala P, Wallace K, Poe J, Gunduz T, Asokan A, Koeberl DD, ElMallah MK, Mikati MA. Adeno-Associated Virus-Mediated Gene Therapy in the Mashlool, Atp1a3Mashl/+, Mouse Model of Alternating Hemiplegia of Childhood. Hum Gene Ther 2021; 32:405-419. [PMID: 33577387 DOI: 10.1089/hum.2020.191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Alternating Hemiplegia of Childhood (AHC) is a devastating autosomal dominant disorder caused by ATP1A3 mutations, resulting in severe hemiplegia and dystonia spells, ataxia, debilitating disabilities, and premature death. Here, we determine the effects of delivering an extra copy of the normal gene in a mouse model carrying the most common mutation causing AHC in humans, the D801N mutation. We used an adeno-associated virus serotype 9 (AAV9) vector expressing the human ATP1A3 gene under the control of a human Synapsin promoter. We first demonstrated that intracerebroventricular (ICV) injection of this vector in wild-type mice on postnatal day 10 (P10) results in increases in ouabain-sensitive ATPase activity and in expression of reporter genes in targeted brain regions. We then tested this vector in mutant mice. Simultaneous intracisterna magna and bilateral ICV injections of this vector at P10 resulted, at P40, in reduction of inducible hemiplegia spells, improvement in balance beam test performance, and prolonged survival of treated mutant mice up to P70. Our study demonstrates, as a proof of concept, that gene therapy can induce favorable effects in a disease caused by a mutation of the gene of a protein that is, at the same time, an ATPase enzyme, a pump, and a signal transduction factor.
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Affiliation(s)
- Arsen S Hunanyan
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Boris Kantor
- Viral Vector Core, Department of Neurobiology, Duke University, Durham, North Carolina, USA
| | - Ram S Puranam
- Department of Neurobiology, Duke University, Durham, North Carolina, USA
| | - Courtney Elliott
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Angela McCall
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Justin Dhindsa
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Promila Pagadala
- Department of Clinical and Translational Science Institute, Duke University, Durham, North Carolina, USA
| | - Keri Wallace
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Jordan Poe
- Viral Vector Core, Department of Neurobiology, Duke University, Durham, North Carolina, USA
| | - Talha Gunduz
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Aravind Asokan
- Department of Surgery, Duke University, Durham, North Carolina, USA.,Molecular Genetics and Microbiology, Duke University, Durham, North Carolina, USA
| | - Dwight D Koeberl
- Division of Medical Genetics, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Mai K ElMallah
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Mohamad A Mikati
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, USA.,Department of Neurobiology, Duke University, Durham, North Carolina, USA
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