Phase I clinical trial of systemically administered TUSC2(FUS1)-nanoparticles mediating functional gene transfer in humans

• Published in: PloS one 2012-04, Vol.7 (4), p.e34833
• Main Authors: Lu, Charles, Stewart, David J, Lee, J Jack, Ji, Lin, Ramesh, Rajagopal, Jayachandran, Gitanjali, Nunez, Maria I, Wistuba, Ignacio I, Erasmus, Jeremy J, Hicks, Marshall E, Grimm, Elizabeth A, Reuben, James M, Baladandayuthapani, Veerabhadran, Templeton, Nancy S, McMannis, John D, Roth, Jack A
• Format: Article
• Language: English
• Subjects: Abnormalities; Adenoviruses; Anticancer properties; Apoptosis; Apoptosis - drug effects; Apoptosis - genetics; Biopsy; Cancer; Cancer metastasis; Cancer therapies; Chemotherapy; Chlorides; Cholesterol; Clinical trials; Correlation coefficient; Correlation coefficients; Cytokinins; Deoxyribonucleic acid; DNA; Dosage; Dose-Response Relationship, Drug; Emission analysis; Enzymes; Fatty Acids, Monounsaturated - administration & dosage; Gene expression; Gene Expression Profiling; Gene therapy; Gene Transfer Techniques; Genes; Genetic abnormalities; Genetic Therapy - methods; Humans; Intravenous administration; Lipids; Lung cancer; Lung diseases; Lung Neoplasms - drug therapy; Lung Neoplasms - genetics; Maximum Tolerated Dose; Medical schools; Medicine; Messenger RNA; Metabolic response; Metastases; Mutation; Nanoparticles; Nanoparticles - administration & dosage; Nanoparticles - therapeutic use; Patients; Peripheral blood; Plasmids - administration & dosage; Platinum; Polymerase chain reaction; Positron emission; Positron emission tomography; Pretreatment; Protein folding; Quality control; Quaternary Ammonium Compounds - administration & dosage; Reverse Transcriptase Polymerase Chain Reaction; Staining; Tissues; Tomography; Trimethylammonium chloride; Tumor suppressor genes; Tumor Suppressor Proteins - administration & dosage; Tumor Suppressor Proteins - metabolism; Tumor Suppressor Proteins - therapeutic use; Tumors; Vectors (Biology)
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0034833

Tumor suppressor gene TUSC2/FUS1 (TUSC2) is frequently inactivated early in lung cancer development. TUSC2 mediates apoptosis in cancer cells but not normal cells by upregulation of the intrinsic apoptotic pathway. No drug strategies currently exist targeting loss-of-function genetic abnormalities. We report the first in-human systemic gene therapy clinical trial of tumor suppressor gene TUSC2. Patients with recurrent and/or metastatic lung cancer previously treated with platinum-based chemotherapy were treated with escalating doses of intravenous N-[1-(2,3-dioleoyloxy)propyl]-N,N,N-trimethylammonium chloride (DOTAP):cholesterol nanoparticles encapsulating a TUSC2 expression plasmid (DOTAP:chol-TUSC2) every 3 weeks. Thirty-one patients were treated at 6 dose levels (range 0.01 to 0.09 milligrams per kilogram). The MTD was determined to be 0.06 mg/kg. Five patients achieved stable disease (2.6-10.8 months, including 2 minor responses). One patient had a metabolic response on positron emission tomography (PET) imaging. RT-PCR analysis detected TUSC2 plasmid expression in 7 of 8 post-treatment tumor specimens but not in pretreatment specimens and peripheral blood lymphocyte controls. Proximity ligation assay, performed on paired biopsies from 3 patients, demonstrated low background TUSC2 protein staining in pretreatment tissues compared with intense (10-25 fold increase) TUSC2 protein staining in post-treatment tissues. RT-PCR gene expression profiling analysis of apoptotic pathway genes in two patients with high post-treatment levels of TUSC2 mRNA and protein showed significant post-treatment changes in the intrinsic apoptotic pathway. Twenty-nine genes of the 82 tested in the apoptosis array were identified by Igenuity Pathway Analysis to be significantly altered post-treatment in both patients (Pearson correlation coefficient 0.519; p