Fighting cancer with nanobodies and computer simulations


Researchers in the Netherlands are hoping to move vaccine therapy from the lab to inside the body.

Stimulating or enhancing someone’s own immune system to fight cancer is not a new concept but scientists are taking it one step further by using nanoscience and computer simulations to improve existing treatments.

Immunotherapy drugs are specifically designed to help the immune system respond to cancerous cells, something that it doesn’t naturally do. That’s because cancer cells are essentially the body’s own cells gone rogue and the immune system is programmed not to target native cells.

 

Now, a new computer simulation that mimics the body’s response when exposed to certain immunotherapy drugs could speed up their development by eliminating any dud ideas at an earlier stage.

Scientists on the EU-funded MODICELL project have developed prototype software that can trial potential recipes for drugs by using a kind of graphic interface called reactive animation to demonstrate the body’s expected response.

With the information gained from the simulation, the scientists can decide whether to pursue developing a potential drug or to go back to the drawing board, without wasting valuable time and resources.

‘We wanted to develop a computerised approach that will allow us to simulate and to make predictions regarding immune responses that could be used to improve therapies against cancer or in-organ transplantations,’ said Dr Nuno Andrade of St. Anna Children’s Cancer Research Institute, Austria, who managed the project.

To improve the accuracy of the simulations, the researchers first of all conducted real-life experiments in the laboratory and collected extensive biological information from published literature.

Computer scientists worked in the lab together with biologists to better understand the behaviour of the immune system, and used the knowledge gained to develop the computer simulation.

‘There is no way that we can keep doing science without computerised approaches.’

Dr Nuno Andrade, St. Anna Children’s Cancer Research Institute, Austria

Dr Andrade says this type of collaboration is likely to continue. ‘Biology is such a complex science. There is no way that we can keep doing science without computerised approaches.’

Vaccines

One drug-based approach to immunotherapy that is currently used to treat cancer is vaccine therapy. Today this involves taking a blood sample from a patient and mixing it with molecules found on the tumour called antigens. A substance known as an adjuvant is then added to help the immune cells in the blood sample respond to these antigens, and these activated immune cells are injected back into the patient’s body.

However, because this takes place in a lab, the process is cumbersome and time-consuming. The EU-funded PRECIOUS project is developing a novel nano-sized vaccine containing nanoparticles packed with both antigens and an adjuvant, which can be injected into the patient to stimulate the immune response inside the body.

Professor Carl Figdor of Radboud University Medical Center, the Netherlands, who leads the project, said that this couldn’t happen without nanoparticles. ‘These particles are so small that you can inject them directly into the bloodstream without harming the patient. If you were to use bigger particles or bigger molecules then you would have all kinds of difficulties, perhaps small blood vessels would clog.’

Advantages include reduced wait times for the patient and a stable vaccine that is not so heavily affected by the individual health concerns of each patient.

‘Here we are going to have a product that is much more stable and of a constant quality, and is cheaper in the end because it can be used in a much wider way for a lot of patients,’ said Prof. Figdor.

Large scale

The idea is to find an efficient process for creating these nanoparticles en masse so that nanovaccines can be manufactured on a large scale. The PRECIOUS team will test their nanoparticles for safety in humans and if successful will move up to trials involving 500 people.

‘There is a lot of gain because you make one product that you can use for a lot of patients, rather than having to take blood from each patient, making an individual vaccine, which is labour intensive and expensive,’ said Prof. Figdor.

Nano-sized particles are also being used to improve a kind of cancer therapy called photodynamic therapy (PDT). PDT involves a photoactive drug, called a photosensitiser, which, when introduced into the body, acts like a ticking bomb – it is safe until it is activated by contact with a particular wavelength of light and then it reacts with oxygen to form a chemical that kills the cells.

It’s not fully understood how or why, but PDT is also thought to activate the immune system to attack the cancer.

Expel

However, the problem with the photosensitisers currently in use is that they stick to all the body’s cells, not only cancer cells. Healthy cells will expel the drug after two to four days, whereas cancer cells find the photosensitisers much more difficult to remove. Patients returning after two to four days are exposed to the type of light which activates the photoactive drug, killing the cancer cells.

Now, scientists on the KILLCANCER project, funded by the EU’s European Research Council, plan to reduce this waiting period to just a couple of hours by developing an approach where small nanobodies – fragments of antibodies – are bound chemically to the photosensitiser. These actively target cancerous cells, but not healthy cells.

‘We expect that we can more efficiently reach cancer cells compared to traditional antibodies,’ said Dr Sabrina Oliveira of Utrecht University, the Netherlands, who leads the work. The project is also investigating how PDT interacts with the immune system response.

The next goal for the research is to progress from mouse studies to larger animals like cats and dogs. In the near future, Dr Oliveira will start working with veterinary centres to offer PDT as a therapy for cats with oral cancer, and can then use the resulting data to produce a body of evidence supporting nanobody-targeted PDT.

The issue

Improving immunotherapy treatments isn’t just about developing better drugs, it’s also about manufacturing those treatments on a large scale so they can be used in the wider population.

To support this, the EU has allocated more than €1.5 billion to research into industrial leadership in the areas of nanotechnologies, advanced materials, biotechnology and advanced manufacturing and processing between 2018 and 2020.

The work includes addressing the regulatory framework and developing an environment that enables high-quality healthcare for Europeans. Nanomedicines that are developed in the EU for use in tumour-targeted treatment strategies are produced at an industrial level that respects the highest possible quality standards.

In 2013, the European Technology Platform on Nanomedicine (ETPN) set up Nano World Cancer Day, which this year takes place on 2 February and is supported by the EU-funded ENATRANS project. There will be simultaneous events in 10 countries to demonstrate the disruptive nanomedicine-based innovations that are being developed to beat cancer.

Efficacy and safety of photodynamic therapy for recurrent, high grade nonmuscle invasive bladder cancer refractory or intolerant to bacille Calmette-Guérin immunotherapy.


Abstract

Purpose

We evaluated the effectiveness of photodynamic therapy using Radachlorin in patients with high grade, nonmuscle invasive bladder cancer refractory or intolerant to bacillus Calmette-Guérin therapy who refused radical cystectomy.

Materials and methods

Between July 2009 and December 2011 photodynamic therapy was performed in 22 men and 12 women. Radachlorin (0.5 to 0.6 mg/kg) was injected intravenously 2 to 3 hours before photodynamic therapy. After complete transurethral resection, a diffuser using a 22 Fr cystoscope was placed in the bladder for irradiation with a 662 nm laser. Output beam power was adjusted to 1.8 W and the light dose was 15 J/cm(2). Photodynamic therapy was performed for 16 to 30 minutes. Recurrence after photodynamic therapy was followed by regular cystoscopy at 1, 2 and 3 months, and at 3-month intervals thereafter for up to 2.8 years. Efficacy was assessed by cystoscopy, cytology and histology, and defined as the number of patients who were tumor free after initial photodynamic therapy.

Results

Mean±SD patient age was 62.94±8.71 years. Average followup was 26.74±6.34 months (median 28.12). As the primary efficacy outcome, the recurrence-free rate was 90.9% at 12 months, 64.4% at 24 months and 60.1% at 30 months. As the secondary efficacy outcome, there was no statistical difference in mass size, carcinoma in situ, number of previous bacillus Calmette-Guérin administrations, number of transurethral bladder resections or tumor multiplicity on Kaplan-Meier analysis (each p>0.05). No evidence of severe adverse effects was detected after photodynamic therapy.

Conclusions

Photodynamic therapy with Radachlorin is a safe, effective treatment for nonmuscle invasive bladder cancer refractory or intolerant to bacillus Calmette-Guérin therapy in select patients.

Photodynamic therapy versus topical imiquimod versus topical fluorouracil for treatment of superficial basal-cell carcinoma: a single blind, non-inferiority, randomised controlled trial.


Background

Superficial basal-cell carcinoma is most commonly treated with topical non-surgical treatments, such as photodynamic therapy or topical creams. Photodynamic therapy is considered the preferable treatment, although this has not been previously tested in a randomised control trial. We assessed the effectiveness of photodynamic therapy compared with imiquimod or fluorouracil in patients with superficial basal-cell carcinoma.

Methods

In this single blind, non-inferiority, randomised controlled multicentre trial, we enrolled patients with a histologically proven superficial basal-cell carcinoma at seven hospitals in the Netherlands. Patients were randomly assigned to receive treatment with methylaminolevulinate photodynamic therapy (MAL-PDT; two sessions with an interval of 1 week), imiquimod cream (once daily, five times a week for 6 weeks), or fluorouracil cream (twice daily for 4 weeks). Follow-up was at 3 and 12 months post-treatment. Data were collected by one observer who was blinded to the assigned treatment. The primary outcome was the proportion of patients free of tumour at both 3 and 12 month follow up. A pre-specified non-inferiority margin of 10% was used and modified intention-to-treat analyses were done. This trial is registered as an International Standard Randomised controlled trial (ISRCTN 79701845).

Findings

601 patients were randomised: 202 to receive MAL-PDT, 198 to receive imiquimod, and 201 to receive fluorouracil. A year after treatment, 52 of 196 patients treated with MAL-PDT, 31 of 189 treated with imiquimod, and 39 of 198 treated with fluorouracil had tumour residue or recurrence. The proportion of patients tumour-free at both 3 and 12 month follow-up was 72·8% (95% CI 66·8—79·4) for MAL-PDT, 83·4% (78·2—88·9) for imiquimod cream, and 80·1% (74·7—85·9) for fluorouracil cream. The difference between imiquimod and MAL-PDT was 10·6% (95% CI 1·5—19·5; p=0·021) and 7·3% (—1·9 to 16·5; p=0·120) between fluorouracil and MAL-PDT, and between fluorouracil and imiquimod was −3·3% (—11·6 to 5·0; p=0·435. For patients treated with MAL-PDT, moderate to severe pain and burning sensation were reported most often during the actual MAL-PDT session. For other local adverse reactions, local skin redness was most often reported as moderate or severe in all treatment groups. Patients treated with creams more often reported moderate to severe local swelling, erosion, crust formation, and itching of the skin than patients treated with MAL-PDT. In the MAL-PDT group no serious adverse events were reported. One patient treated with imiquimod and two patients treated with fluorouracil developed a local wound infection and needed additional treatment in the outpatient setting.

Interpretation

Topical fluorouracil was non-inferior and imiquimod was superior to MAL-PDT for treatment of superficial basal-cell carcinoma. On the basis of these findings, imiquimod can be considered the preferred treatment, but all aspects affecting treatment choice should be weighted to select the best treatment for patients.

Source: Lancet.

 

 

Enhancement of photodynamic therapy by 2,5-dimethyl celecoxib, a non-cyclooxygenase-2 inhibitor analog of celecoxib


Photodynamic therapy (PDT) effectiveness can be improved by employing combined modality approaches involving pharmaceuticals targeting the tumor microenvironment and/or tumor cell death pathways. In one approach, combining PDT with celecoxib improves long-term tumoricidal activity without increasing normal tissue photosensitization. However, side effects arising from the use of coxib based cyclooxygenase-2 (COX-2) inhibitors, including cardiovascular injury, decreases the clinical applications of this class of compounds. A growing number of studies demonstrate that the tumoricidal actions of coxibs such as celecoxib involve non-COX-2 mediated mechanisms. The celecoxib analog, 2,5-dimethyl celecoxib (DMC), lacks COX-2 inhibitory activity but exhibits cytotoxic properties comparable to the COX-2 inhibitor celecoxib. We compared the effectiveness of DMC and celecoxib in modulating PDT response at both the in vitro and in vivo level using a C3H/BA murine mammary carcinoma model. Both DMC and celecoxib blocked PDT induced expression of the pro-survival protein survivin, enhanced the endoplasmic reticulum stress (ERS) response of PDT, and increased both apoptosis and cytotoxicity in BA cells exposed to combination protocols. DMC enhanced the in vivo tumoricidal responsiveness of PDT without altering PGE2 levels. Our data demonstrates that DMC improved PDT by increasing apoptosis and tumoricidal activity without modulating COX-2 catalytic activity. Our results also suggest that celecoxib mediated enhancement of PDT may involve both COX-2 dependent and independent mechanisms.

Enhancement of photodynamic therapy by 2,5-dimethyl celecoxib, a non-cyclooxygenase-2 inhibitor analog of celecoxib


Photodynamic therapy (PDT) effectiveness can be improved by employing combined modality approaches involving pharmaceuticals targeting the tumor microenvironment and/or tumor cell death pathways. In one approach, combining PDT with celecoxib improves long-term tumoricidal activity without increasing normal tissue photosensitization. However, side effects arising from the use of coxib based cyclooxygenase-2 (COX-2) inhibitors, including cardiovascular injury, decreases the clinical applications of this class of compounds. A growing number of studies demonstrate that the tumoricidal actions of coxibs such as celecoxib involve non-COX-2 mediated mechanisms. The celecoxib analog, 2,5-dimethyl celecoxib (DMC), lacks COX-2 inhibitory activity but exhibits cytotoxic properties comparable to the COX-2 inhibitor celecoxib. We compared the effectiveness of DMC and celecoxib in modulating PDT response at both the in vitro and in vivo level using a C3H/BA murine mammary carcinoma model. Both DMC and celecoxib blocked PDT induced expression of the pro-survival protein survivin, enhanced the endoplasmic reticulum stress (ERS) response of PDT, and increased both apoptosis and cytotoxicity in BA cells exposed to combination protocols. DMC enhanced the in vivo tumoricidal responsiveness of PDT without altering PGE2 levels. Our data demonstrates that DMC improved PDT by increasing apoptosis and tumoricidal activity without modulating COX-2 catalytic activity. Our results also suggest that celecoxib mediated enhancement of PDT may involve both COX-2 dependent and independent mechanisms.

source: cancer letter