Novel Approach to the Formulation of an Epstein-Barr Virus Antigen-Based Nasopharyngeal Carcinoma Vaccine

Epstein-Barr virus (EBV) is associated with several malignant diseases including nasopharyngeal carcinoma (NPC), a common neoplasm throughout southeast Asia. Radiotherapy and chemotherapy can achieve remission, but a reemergence of disease is not uncommon. Therefore, there is a need for specific therapies that target the tumor through the recognition of EBV antigens. In NPC, latent membrane protein 1 (LMP1) and LMP2 offer the best opportunity for specific targeting since they are typically expressed and T-cell determinants in each of these proteins have been defined. We have attempted to maximize the opportunity of incorporating every possible CD4 and CD8 determinant in a single formulation. We have achieved this by generating a scrambled protein incorporating random overlapping peptide sets from EBNA1, LMP1, and LMP2, which was then inserted into a replication-deficient strain of adenovirus (adenovirus scrambled antigen vaccine [Ad-SAVINE]). This report describes the construction of this Ad-SAVINE construct, its utility in generating LMP1 and LMP2 responses in healthy individuals as well as NPC patients, and its capacity to define new epitopes. This formulation could have a role in NPC immunotherapy for all ethnic groups since it has the potential to activate all possible CD4 and CD8 responses within EBNA1 and LMPs.Epstein-Barr virus (EBV) is a member of the herpesvirus family and is one of the most common human viruses. It occurs worldwide, and most people become infected with the virus sometime during their lives. EBV is associated with a range of neoplasms. These include various B- and T-cell non-Hodgkin''s lymphomas such as posttransplant lymphoproliferative disease (PTLD), Hodgkin''s lymphoma (HL), and several lymphoepithelioma-like carcinomas, of which nasopharyngeal carcinoma (NPC) is the archetype (1). The association of the virus with these malignancies and its oncogenic potential have been well established (19).Worldwide, NPC is characterized epidemiologically by foci of relatively high endemicity in certain geographic regions including southern China, Hong Kong, Taiwan, the Philippines, Singapore, Vietnam, Kenya, Tunisia, Sudan, and Uganda. The reason for the focal distribution of NPC is uncertain, although genetics and environmental factors have been suggested to be causes (14, 49).Currently, the mainstay for the treatment of NPC is radiation and chemotherapy. Indeed, this treatment is frequently successful when the extent of the tumor is small and confined. However, when disease is advanced at diagnosis and where metastatic spread has become apparent, more radical treatments may need to be adopted, including surgery. In either case, all these treatments are associated with severe short- and long-term side effects including secondary malignancies (16). Hence, there is a need for specific therapies that target the tumor itself rather than therapies that are associated with the destruction of normal tissue.Virus-associated malignancies offer a distinct advantage in this regard since therapy can be directed specifically toward viral proteins expressed in the tumor, thus avoiding collateral damage to normal tissue. This has been dramatically demonstrated in the case of PTLD, where the adoptive transfer of EBV-specific cytotoxic T lymphocytes (CTLs) activated in vitro by using autologous lymphoblastoid cell lines (LCLs) has resulted in a resolution of disease with a very low frequency of side effects (9, 18, 40). In this case, it is likely that the effector cells infused into these patients are directed mainly toward the dominant EBV nuclear antigen 3A (EBNA3A), EBNA3B, and EBNA3C. The concept of immunological intervention as a treatment option for NPC is greatly enhanced by a range of previously reported studies that indicated the presence of transport-associated proteins (TAP1 and TAP2) and major histocompatibility complex class I and class II in NPC (23, 37, 42, 48), all of which are required for efficient CTL recognition. In NPC, EBNA1, latent membrane protein 1 (LMP1), and LMP2 offer the best opportunity for specific targeting since these are the only EBV proteins expressed in this malignancy. This is particularly so in the case of immunotherapy since defined CD4⁺ and CD8⁺ T-cell determinants in each of these proteins have been defined (12, 15, 20, 31). However, the CTL response in the case of the LMPs is relatively weak (particularly LMP1), and the glycine-alanine repeat sequence within EBNA1 may affect immunological processing (29), although this may not be the absolute barrier that was first hypothesized (46). Recent studies have provided some encouragement that immunotherapeutic intervention may be a realistic treatment option for NPC (4, 5, 7, 8, 10, 30, 43, 45). For example, Straathof et al. (43) and Comoli et al. (10) adoptively transferred effector cells expanded in vitro by using LCLs to activate CTLs in patients with advanced NPC, resulting in some cases in the resolution of disease, although in other cases, efficacy was limited and transient (3). Those studies, however, have provided a promising hint that the immunotherapeutic control of NPC might be feasible.Indeed, recent studies have shown that multiple human leukocyte antigen (HLA) A2-restricted LMP1 CTL epitopes, when used as a polyepitope vaccine in a poxvirus vector, efficiently induced a strong CTL response, and this response could reverse the outgrowth of LMP1-expressing tumors in HLA-A2/Kb mice (13). The poxvirus-based LMP1-polyepitope vaccine tested in these studies contained only HLA A2-restricted epitopes, and targeting just one HLA allele will not be suitable for all ethnic groups. If a CTL-based therapy for NPC is to be universally applicable, the target epitopes must bind to a range of HLA alleles preferably present at a high frequency in patient populations and include determinants irrespective of whether they have previously been defined.It is likely that the essential difference between the very successful treatment of patients with PTLD and the partial success in the case of NPC is that in the former case, immunodominant targets are available, while in the latter case, only relatively weak responses are seen even for healthy individuals. The present communication has arisen in an attempt to maximize the possibility of activating a response toward the three proteins present in NPC rather than skewing the effector population toward the immunodominant EBNA3A, -B, and -C proteins. We have achieved this by generating a “scrambled-antigen vaccine” (referred to as SAVINE) incorporating random overlapping peptide sets from EBNA1, LMP1, and LMP2. This SAVINE has been incorporated into a replication-deficient adenovirus (Ad5/F35) as a 6.9-kb insert (Ad-SAVINE). An important feature of the Ad-SAVINE strategy is that it provides a platform for the activation of all possible immunological determinants (including helper cells and CTLs) within EBNA1, LMP1, and LMP2 and should be applicable to all populations for which NPC is endemic. This report describes the construction of this Ad-SAVINE construct and its utility in generating LMP1 and LMP2 responses from peripheral blood mononuclear cells (PBMCs) from healthy individuals and NPC patients.     

Culture of bovine hepatocytes: a non-perfusion technique for cell isolation

In this work we have studied the isolation and culture of mature bovine hepatocytes on plastic dishes without exogenous matrix. The liver has been disaggregated in a collagenase solution instead of undergoing a perfusion step. After a few days in culture, the plates showed several clusters of different cell types. Although the average yield was 1.60±0.57×10⁸ viable liver cells per gram of tissue, these cultures were formed by non-parenchymal cells and only very few or none by parenchymal cells. In these cultures, actin structures used as a marker for Stellate (Ito) cells have been visualized by immunocytochemical techniques. In order to increase the proportion of parenchymal cells a centrifugation on Percoll, which separates cell sub-populations, has been introduced. Though the yield was lower than in the previous method, these pre-purified cultures were only composed of hepatocytes. It has been shown that these cells exhibited albumin synthesis, which is a specific hepatocytes function. In addition, these cultures were capable of producing metabolites of 7-ethoxycoumarin at a higher rate than non purified cell cultures. Therefore this simplified procedure for the isolation and culture of functional and viable hepatocytes may be applied for in vitro studies in bovine.     

TP53 and p16INK4A, but not H-KI-Ras, are involved in tumorigenesis and progression of pleomorphic adenomas

The putative role of TP53 and p16(INK4A) tumor suppressor genes and Ras oncogenes in the development and progression of salivary gland neoplasias was studied in 28 cases of pleomorphic adenomas (PA), 4 cases of cystic adenocarcinomas, and 1 case of carcinoma ex-PA. Genetic and epigenetic alterations in the above genes were analyzed by Polymerase Chain Reaction/Single Strand Conformational Polymorphism (PCR/SSCP) and sequencing and by Methylation Specific-PCR (MS-PCR). Mutations in TP53 were found in 14% (4/28) of PAs and in 60% (3/5) of carcinomas. Mutations in H-Ras and K-Ras were identified in 4% (1/28) and 7% (2/28) of PAs, respectively. Only 20% (1/5) of carcinomas screened displayed mutations in K-Ras. p16(INK4A) promoter hypermethylation was found in 14% (4/28) of PAs and 100% (5/5) carcinomas. All genetic and epigenetic alterations were detected exclusively in the epithelial and transitional tumor components, and were absent in the mesenchymal parts. Our analysis suggests that TP53 mutations and p16(INK4A) promoter methylation, but not alterations in the H-Ras and K-Ras genes, might be involved in the malignant progression of PA into carcinoma.     

Differential subcellular distribution of glucose transporters GLUT1-6 and GLUT9 in human cancer: ultrastructural localization of GLUT1 and GLUT5 in breast tumor tissues

It has been proposed that the enhanced metabolic activity of tumor cells is accompanied by an increased expression of facilitative hexose transporters (GLUTs). However, a previous immunohistochemical analysis of GLUT1 expression in 154 malignant human neoplasms failed to detect the GLUT1 isoform in 87 tumors. We used 146 normal human tissues and 215 tumor samples to reassess GLUT1 expression. A similar number of samples were used to compare the expression of GLUT2-6 and 9. The classical expression of GLUT1-5 in different normal human tissues was confirmed, however, we were unable to detect GLUT2 in human pancreatic islet cells. GLUT6 was principally detected in testis germinal cells and GLUT9 was localized in kidney, liver, heart, and adrenal. In tumor samples, GLUT1, 2, and 5 were the main transporters detected. GLUT1 was the most widely expressed transporter, however, 42% of the samples had very low-to-negative expression levels. GLUT2 was detected in 31% of the samples, being mainly expressed in breast, colon, and liver carcinoma. GLUT5 was detected in 27% of breast and colon adenocarcinoma, liver carcinoma, lymphomas, and testis seminoma samples. In situ RT-PCR and ultrastructural immunohistochemistry confirmed GLUT5 expression in breast cancer. GLUT6 and 9 are not clearly over-expressed in human cancer. The extensive expression of GLUT2 and 5 (glucose/fructose and fructose transporters, respectively) in malignant human tissues indicates that fructose may be a good energy substrate in tumor cells. Our functional data obtained in vitro in different tumor cells support this hypothesis. Additionally, these results suggest that fructose uptake could be used for positron emission tomography imaging and, may possibly represent a novel target for the development of therapeutic agents in different human cancers.     

Critical role of the C-terminal domains of factor H in regulating complement activation at cell surfaces

The plasma protein factor H primarily controls the activation of the alternative pathway of complement. The C-terminal of factor H is known to be involved in protection of host cells from complement attack. In the present study, we show that domains 19-20 alone are capable of discriminating between host-like and complement-activating cells. Furthermore, although factor H possesses three binding sites for C3b, binding to cell-bound C3b can be almost completely inhibited by the single site located in domains 19-20. All of the regulatory activities of factor H are expressed by the N-terminal four domains, but these activities toward cell-bound C3b are inhibited by isolated recombinant domains 19-20 (rH 19-20). Direct competition with the N-terminal site is unlikely to explain this because regulation of fluid phase C3b is unaffected by domains 19-20. Finally, we show that addition of isolated rH 19-20 to normal human serum leads to aggressive complement-mediated lysis of normally nonactivating sheep erythrocytes and moderate lysis of human erythrocytes, which possess membrane-bound regulators of complement. Taken together, the results highlight the importance of the cell surface protective functions exhibited by factor H compared with other complement regulatory proteins. The results may also explain why atypical hemolytic uremic syndrome patients with mutations affecting domains 19-20 can maintain complement homeostasis in plasma while their complement system attacks erythrocytes, platelets, endothelial cells, and kidney tissue.     

Photodynamic activity of a new sensitizer derived from porphyrin-C60 dyad and its biological consequences in a human carcinoma cell line

The photokilling activity of a porphyrin-C₆₀ (P-C₆₀) dyad was evaluated on a Hep-2 human larynx-carcinoma cell line. This study represents the first evaluation of a dyad, with high capacity to form a photoinduced charge-separated state, to act as agent to inactivate cells by photodynamic therapy (PDT). Cell treatment was carried out with 1 μM P-C₆₀ incorporated into liposomal vesicles. No dark cytotoxicity was observed using 1 μM P-C₆₀ concentration and during long incubation time (24 h). The uptake of sensitizer into Hep-2 was studied at different times of incubation. Under these conditions, a value of 1.5 nmol/10⁶ cells was found after 4 h of incubation showing practically no change even after 24 h. The cell survival after irradiation of the cells with visible light was dependent upon light exposure level. A high photocytotoxic effect was observed for P-C₆₀, which inactivated 80% of the cells after 54 J/cm² of irradiation. Moreover, the dyad kept a high photoactivity even under argon atmosphere. Thus, depending on the microenviroment where the sensitizer is localized, this compound could produce a biological photodamage through either a ¹O₂-mediated photoreaction process or a free radical mechanism under low oxygen concentration.

The mechanism of cell death was analyzed by Hoechst-33258, toluidine blue staining, TUNEL and DNA fragmentation. Cell cultures treated for 24 h with P-C₆₀ and irradiated with a dose of 54 J/cm² showed a great amount of apoptotic cells (58%). Moreover, changes in cell morphology were analyzed using fluorescence microscopy with Hoechst-33258 under low oxygen concentration. Under this anaerobic condition, necrotic cellular death predominated on apoptotic pathway. There were more apoptotic cells under air irradiation condition than under argon irradiation condition. To determine the apoptotic pathway, caspase-3 activation was studied by caspase-3 activity detection kits. The last results showed that P-C₆₀ induced apoptosis by caspase-3-dependent pathway. These results indicated that molecular dyad, which can form a photoinduced charge-separated state, is a promising model for phototherapeutic agents and they have potential application in cell inactivation by PDT.     

CpG islands are the second main factor shaping codon usage in human genes

A correspondence analysis of codon usage in human genes revealed, as expected, that the first axis is strongly correlated with the base composition at synonymous third codon positions. At one extreme of the second axis were localized genes with a high frequency of NCG and CGN codons. The great majority of these sequences were embedded in CpG islands, while the opposite is true for the genes placed at the other extreme. The two main conclusions of this paper are: (1) the influence of CpG islands on codon usage, and (2) since the second axis is orthogonal (and therefore independent) of the first, GC3-rich genes are not necessarily associated with CpG islands.     

Complicaciones de la otitis media con parálisis del sexto par craneal contralateral en pediatría

Otitis media is a frequent infection during childhood. Complications may be present in up to 4 of 100 children including serious neurological complications, particularly in developing countries.We report the case of a 9-year-old girl with no disease history who presented with otitis media, otorrhea, intracranial hypertension syndrome, and paralysis of the VI cranial nerve contralateral to the lesion. A computed tomography scan of the skull and a brain magnetic resonance imaging revealed chronic otomastoiditis, petrous apicitis, and thrombosis of the transverse and sigmoid sinus, the jugular bulb, and the right internal jugular vein. She received antibiotics and surgical treatment.This case shows the spectrum of intra and extracranial complications associated with acute otitis media in the antibiotic era. The physical examination allows early identification of intracranial hypertension with signs such as papilledema and sixth contralateral nerve palsy as an unusual finding.