Oncolytic adenovirus based on serotype 3

Oncolytic adenoviruses have been safe in clinical trials but the efficacy has been mostly limited. All published trials have been performed with serotype 5 based viruses. The expression level of the Ad5 receptor CAR may be variable in advanced tumors. In contrast, the Ad3 receptor remains unclear, but is known to be abundantly expressed in most tumors. Therefore, we hypothesized that a fully serotype 3 oncolytic adenovirus might be useful for treating cancer. Patients exposed to adenoviruses develop high titers of serotype-specific neutralizing antibodies, which might compromise re-administration. Thus, having different serotype oncolytic viruses available might facilitate repeated dosing in humans. Ad3-hTERT-E1A is a fully serotype 3 oncolytic adenovirus controlled by the promoter of the catalytic domain of human telomerase. It was effective in vitro on cell lines representing seven major cancer types, although low toxicity was seen in non-malignant cells. In vivo, the virus had anti-tumor efficacy in three different animal models. Although in vitro oncolysis mediated by Ad3-hTERT-E1A and wild-type Ad3 occurred more slowly than with Ad5 or Ad5/3 (Ad3 fiber knob in Ad5) based viruses, in vivo the virus was at least as potent as controls. Anti-tumor efficacy was retained in presence of neutralizing anti-Ad5 antibodies whereas Ad5 based controls were blocked. In summary, we report generation of a non-Ad5 based oncolytic adenovirus, which might be useful for testing in cancer patients, especially in the context of high anti-Ad5 neutralizing antibodies.

Prolonged systemic circulation of chimeric oncolytic adenovirus Ad5/3-Cox2L-D24 in patients with metastatic and refractory solid tumors

Eighteen patients with refractory and progressive solid tumors were treated with a single round of triple modified oncolytic adenovirus (Ad5/3-Cox2L-D24). Ad5/3-Cox2L-D24 is the first non-Coxsackie-adenovirus receptor-binding oncolytic adenovirus used in humans. Grades 1-2 flu-like symptoms, fever, and fatigue were seen in most patients, whereas transaminitis or thrombocytopenia were seen in some. Non-hematological grades 3-5 side effects were seen in one patient with grade 3 ileus. Treatment resulted in high neutralizing antibody titers within 3 weeks. Virus appeared in serum 2-4 days after treatment in 83% of patients and persisted for up to 5 weeks. One out of five radiologically evaluable patients had partial response (PR), one had minor response (MR), and three had progressive disease (PD). Two patients scored as PD had a decrease in tumor density. Tumor reductions not measurable with Response Evaluation Criteria In Solid Tumors (RECIST) were seen in a further four patients. PR, MR, stable disease, and PD were seen in 12, 23.5, 35, and 29.5% of tumor markers analyzed, respectively (N=17). Ad5/3-Cox2L-D24 appears safe for treatment of cancer in humans and extended virus circulation results from a single treatment. Objective evidence of anti-tumor activity was seen in 11/18 (61%) of patients. Clinical trials are needed to extend these findings.

The risk of rupture of the uterus: an analysis of 1086 births after previous caesarean section

In the work presented here, obstetric management after a previous caesarean section was studied in a large patient group at the University Department of Gynecology and Obstetrics in Cologne from 1979 to 1995. Particular attention was given to the feared complication of uterine rupture. From a total of 15 166 deliveries, 1086 of the births had been preceded by one or more caesarean sections. These 1086 births formed the basis for the present study. Vaginal delivery was attempted in 44.5% of patients and was successful in 86% of those cases. Where there had been only one previous caesarean section, the percentage shifted in favor of vaginal delivery. All patients with more than two previous caesarean sections were delivered by elective caesarean section. The feared complication of rupture of the uterus occurred in four cases, for which case reports are presented. In view of such cases, signs of imminent uterus rupture often constitute an indication for elective (11.5%) or emergency resectioning (31.9%). No relationship was found between fetal outcome and mode of delivery. This retrospective study confirms the general recommendation and safety of vaginal delivery after a previous caesarean section as long as risks are minimised by a readiness to proceed with a repeat caesarean when signs of imminent rupture of the uterus arise.

[Risk of uterine rupture after cesarean section--analysis of 1,086 births]

OBJECTIVE

In the presented paper, obstetrical management after previous caesarian section was studied in a large patient collective at the University Department of Gynaecology and Obstetrics in Cologne from 1979 to 1995. Particular attention was given to the feared complication of rupture of the uterus.

PATIENTS

From a total of 15,166 deliveries, 1,086 of the births had been preceded by one or more caesarian section. These 1,086 births formed the patient collective for the present study.

RESULTS

Vaginal delivery was attempted in 44.5% of patients and was successful in 86% of those cases. If there had been a previous caesarian section, the percentage shifted in favour of vaginal delivery. All patients with more than two previous caesarian sections were delivered by a primary caesarian section. The feared complication of rupture of the uterus occurred in four cases, for which case reports are presented. In view of such cases, signs of imminent uterus rupture often constitute an indication for primary (11.5%) or secondary resectioning (31.9%). No relationship was found between fetal outcome and mode of delivery.

CONCLUSION

This retrospective study confirms the general recommendation of vaginal delivery following previous caesarian section as long as risks are minimized by a readiness to proceed with resectioning when signs of imminent rupture of the uterus arise.