Scientific background: In recent years, the development of new targeted therapies and gene therapies has redefined the ways of cancer treatment. However, classical approaches such as chemotherapy and radiotherapy remain a gold standard. Therefore, preclinical studies are focusing on therapies that combine classical approaches with novel strategies, which include gene therapies to increase overall antitumor efficacy. Gene electrotransfer (GET) as a gene therapy method uses electric pulses to achieve enhanced local delivery of plasmid DNA into cells of various tissues. The use of GET also enables the delivery of plasmid DNA encoding the chemokines CCL5 and CCL17 into tumors, where they are expressed by transfected cells and act as proinflammatory chemokines to elicit an immune response. Although gene therapy utilizing GET of cytokines has been described in the literature, GET of chemokines CCL5 and CCL17 has never been studied in tumors. Several studies describe the important role of proinflammatory chemokines CCL5 or CCL17 in recruiting and directing cytotoxic T cells (CD8+) and other immune cells into the tumor microenvironment [1]. However, increased infiltration of immune cells into tumors does not necessarily lead to immune activation and antitumor activity [2]. Therefore, gene therapy with chemokines can be effective only in combination with a therapy capable of eliciting an immune response. One of these therapies is radiotherapy [3,4]. The aim of this doctoral dissertation was to investigate the antitumor effect of GET of plasmid DNA encoding the chemokines CCL5 or CCL17 on tumor cells and tumor carcinoma models in laboratory mice. We determined the direct effect of plasmids encoding chemokines CCL5 or CCL17 on tumor cells, their effect on the expression of several cytokines in tumor cells and tumors after therapy, and the immunological effect in vitro and in vivo. With the above studies, we aimed to expand the existing knowledge on the mechanisms of action of the chemokines CCL5 and CCL17 after GET and to investigate the efficacy of this therapy as a complementary immunotherapy in combination with tumor irradiation.
Methods: In the first section of the doctoral dissertation, we determined the effect of in vitro lipofection of cells with plasmid DNA encoding chemokines CCL5 or CCL17 on the viability and gene expression of selected cytokines in murine colon cancer cell lines CT26 and MC38, and murine breast cancer cell lines 4T1 and E0771. Viability was determined on attached cells 24 hours after seeding, by adding a mixture of plasmid DNA encoding CCL5 or CCL17 and lipofectamine, which enables transfection (or lipofection) of cells. After 48 hours, the effect of transfection was assessed using the PrestoBlue〢 viability assay. In parallel, RNA of treated cells was isolated 48 hours after lipofection and the expression levels of cytokines Ccl5, Ccl17, Cxcl9, Cxcl10, Il-1b, Il-6, Il-12α, Il-18, Ifn-γ, Ifn-β and Tnf-α were determined by quantitative real-time PCR (qRT-PCR). Because we subsequently combined chemokine therapy with irradiation, we also characterized the survival of selected cell lines CT26 and 4T1 after lipofection with plasmid DNA encoding chemokine CCL5 or CCL17 and different doses of irradiation using the clonogenic assay, which is a standard test for determining radiosensitivity. Using the linear-quadratic model, we determined the α/β ratio and then calculated the inhibitory doses IC10, IC50, IC90. In the next part of the study, we determined the chemotactic properties of chemokines CCL5 and CCL17. In vitro, we used chemotaxis assays, Boyden chamber and a four-well insert assay (Culture-Inserts 4 Well), and observed migration of mouse macrophages RAW264.7 and mouse killer T cells CTLL-2 against a chemokine gradient, which is established by tumor cells 48 hours after lipofection with plasmid DNA encoding chemokine CCL5 or CCL17. In both chemotaxis assays, immune cells were first labeled with the fluorescent dye CellTrace〢 CFSE and their migration was determined by single or multiple acquisition of images with Cytation 1 multimodal imaging reader. In vivo, we evaluated immune cell extravasation after GET of plasmid DNA encoding CCL5 or CCL17 to CT26 colon and 4T1 breast tumors grown in dorsal window chamber model. Twenty-four hours after surgical implantation of the dorsal window chamber, tumors were induced by subcutaneous injection of a cell suspension containing 3x105 CT26-GFP cells (CT26 cells stably expressing green fluorescent protein (GFP)) or 4T1-GFP (4T1 cells stably expressing GFP). Therapy was performed when the diameter of the tumors reached 4 mm. After intratumoral injection of 5 µL of plasmid DNA (2 µg/µL) encoding CCL5 or CCL17, electrical pulses tipically used in electrochemotherapy [5] (ECT pulses - 8 pulses, 1300 V/cm, 100 µs, 1 Hz) were delivered using plate electrodes with a distance of 4 mm between the electrodes. After 48 hours, the mice were intravenously injected with splenocytes isolated from the spleen of healthy donor mice. Splenocytes were pre-labeled with the fluorescent dye CellTracker〢 CM-DiI Dye prior to injection. Then, 24 and 48 hours after the injection of fluorescently labeled splenocytes, 3D images of the tumors were acquired using a Zeiss LSM800 confocal microscope. The antitumor effect of GET of plasmid DNA encoding chemokine CCL5 or CCL17 was determined on tumor models CT26 and 4T1 by measuring the delay in growth of subcutaneous tumors after therapy. Tumors were induced by subcutaneous injection of 100 µL of a cell suspension containing 3x105 CT26 or 4T1 cells. When the tumor volume reached 50 mm3, we started the therapy. Five minutes after intratumoral injection of 25 µL of plasmid DNA (with a concentration of 1 or 2 µg/µL) encoding CCL5 or CCL17, ECT electric pulses were delivered delivered using plate electrodes with a distance of 6 mm between the electrodes. Tumor growth delay was deteremined by measuring the three rectangular diameters of the tumors with a caliper tool. Measured diameters were used to calculate the volume of the tumors according to the formula for ellipsoid (a × b × c × π/6; where a, b and c are perpendicular tumor diameters). The response to the therapy was additionally assessed by determining the infiltration of immune cells into the tumor by immunofluorescence labeling and determining the expression of selected cytokines by qRT-PCR. In this case, tumors were collected on day three and day seven after therapy. Half of each tumor was used to determine the expression of Ccl5, Ccl17, Cxcl9, Cxcl10, Il-6, Il-12α and Ifn-γ by the qRT-PCR, while the other half was used to prepare a series of frozen tumor sections, which were immunofluorescently labeled with primary and secondary antibodies against surface markers of helper T cells (CD4+), cytotoxic T cells (CD8+), macrophages (F4/80+), and endothelial cells (CD31+). We then used a Zeiss LSM800 confocal microscope to capture images of the tumor edges and tumor center and determined the number of immune cells and the surface area of the vessels. Combined therapy of GET plasmid DNA encoding chemokine CCL5 or CCL17 and radiotherapy on CT26 and 4T1 tumor models was performed in the same manner as the chemokine monotherapy described above, except that the tumors were additionally irradiated after GET. We used two irradiation regimens - irradiation with a single dose of 10 Gy and irradiation with a fractionated dose of 3x 5 Gy. After both irradiation regimens, tumors received a biologically equivalent dose of 䁈22 Gy. To increase anti-tumor efficacy, we also tested the combination of a double GET of plasmid DNA encoding chemokine CCL5 or CCL17 and irradiation, with the second GET performed 24 h after the last irradiation. For all combination therapies, the response to the therapy was assessed by determining the tumor growth delay, the immune cell infiltration into the tumor by immunofluorescence labeling, and the expression of selected cytokines by qRT-PCR. In the case of combined therapy, tumors were removed on day 3 after the last irradiation to allow comparison between groups. Animal experiments were performed in accordance with the instructions and approval of the Ministry of Agriculture, Forestry and Food of the Republic of Slovenia (permission no. U34401-1/2015/17 and U34401-3/2022/11). The GraphPad program was used for statistical analysis. All data were tested for normal distribution. Means and standard errors were determined for groups with normally distributed data, and statistically significant differences between groups were determined using the One-Way ANOVA or the t-test. Data that were not normally distributed were analyzed with nonparametric tests (Wilcoxon test, Mann-Whitney test, and Kruskal-Wallis ANOVA).
Results: First, basal expression of inflammatory cytokines was determined in murine colon cancer cell lines CT26 and MC38 and breast cancer cell lines 4T1 and E0771. We then determined the effect of lipofection with plasmid DNA encoding CCL5 or CCL17 and the control plasmid pDNA Ctrl on cell viability. Lipofection did not affect cell viability, and introduction of single plasmid DNA resulted in a statistically significant change in the expression of the introduced chemokines as well as some inflammatory cytokines. Because we subsequently combined chemokine therapy with radiation, we also determined a dose-response of cell survival after transfection with individual plasmid DNA. The data were analyzed using a linear quadratic model, and we found that the CT26 cell line was more sensitive to radiation compared to 4T1. In vitro chemotaxis assays were used to determine the extent of migration of mouse macrophages RAW264.7 and cytotoxic T cells CTLL-2 toward tumor cells CT26 and 4T1 after lipofection with individual plasmid DNA. Boyden chamber chemotaxis assay showed reduced migration of macrophages and killer T cells towards transfected tumor cells CT26 and 4T1 compared to control. However, the difference between treatment groups was negligible. A four-well insert (Culture-Inserts 4 Well) chemotaxis assay showed an increased macrophage migration toward CT26 tumor cells transfected with plasmid DNA enocoding CCL17 or CCL5. Increased migration of macrophages was also observed against 4T1 tumor cells transfected with plasmid DNA encoding CCL17, whereas migration against 4T1 cells transfected with control plasmid DNA or plasmid DNA encoding CCL5 was much lower and comparable between groups. The chemotactic properties of the chemokines CCL5 and CCL17 were also determined in vivo by examining the extravasation of splenocytes in the dorsal window chamber model. In this setting GET of both chemokines showed that CCL5 and CCL17 induce the infiltration of splenocytes in CT26 and 4T1 tumors. We further evaluated the anti-tumor activity of GET plasmid DNA encoding CCL5 or CCL17 on tumor models CT26 and 4T1 by determining the expression of inflammatory cytokines, analyzing infiltrated immune cells in the tumor, and determining the tumor growth delay after therapy. Although increased expression of administered chemokines and altered expression of some inflammatory cytokines were observed after therapy, none of the therapies resulted in a complete response. The number of infiltrated helper CD4+ T cells, cytotoxic CD8+ T cells and F4/80+ macrophages did not change significantly after therapy in any tumor model. Combined therapy of GET plasmid DNA encoding CCL5 or CCL17 and radiotherapy was evaluated in the same manner as monotherapy in the CT26 and 4T1 mouse tumor models. Changes in the expression were detected in CT26 tumors after all combined therapies, even in combined therapies with GET pDNA Ctrl. In 4T1 tumors, combined therapies resulted mainly in increased expression of Ccl5 gene, regardless of the plasmid DNA used. In the case of 2x GET with 25 µg of plasmid DNA as monotherapy or in combination with fractionated irradiation of 3x 5 Gy, the expression level of inflammatory cytokines in both tumor models does not change significantly, with the exception of increased expression of introduced chemokines. Immunofluorescence labeling of frozen tumor sections after combined therapies showed changes in CD4+ and CD8+ T cell populations. Namely, the number of CD8+ T cells in the tumor edge of both tumor models decreased already after single or fractionated irradiation alone. After combined therapies, the decrease in the number of CD8+ T cells compared with controls was in some cases also statistically significant. From the number of complete responses and the tumor growth delay of CT26 tumors, it can be seen that GET of plasmid DNA contributes to the antitumor effect of irradiation regardless of the plasmid DNA used. In contrast, in non-immunogenic 4T1 tumors, comparison of tumor growth delay between groups showed a statistically significant antitumor effect of irradiation in combination with GET of chemokines CCL5 or CCL17 compared with irradiation combined with GET of control plasmid DNA.
Conclusions: In this study, we demonstrated that increased expression of the chemokines CCL5 or CCL17 in transfected tumor cells affects the expression of other inflammatory cytokines. Moreover, both chemokines show chemotactic properties in both in vitro chemotaxis assays and in vivo dorsal window chamber model. Gene electrotransfer of plasmid DNA encoding chemokines CCL5 or CCL17 leads to complete responses only in combination with irradiation. In immunogenic CT26 tumors, GET of chemokines and irradiation leads to complete responses regardless of the plasmid DNA used. In non-immunogenic 4T1 tumors, GET of chemokines and irradiation leads to a significantly longer tumor growth dealy, suggesting a contribution of chemokines to the antitumor effect. Therefore, chemokines CCL5 and CCL17 represent a potential in cancer immunotherapy, however in the case of combined therapy further optimization of the therapeutic regimen is required, especially in relation to the immunological status of the tumor.
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