The sodium iodide symporter (NIS) is responsible for thyroidal, salivary, gastric, intestinal and mammary iodide uptake. It was first cloned from the rat in 1996 and shortly thereafter from human and mouse tissue. In the intervening years, we have learned a great deal about the biology of NIS. Detailed knowledge of its genomic structure, transcriptional and post-transcriptional regulation and pharmacological modulation has underpinned the selection of NIS as an exciting approach for targeted gene delivery. A number of in vitro and in vivo studies have demonstrated the potential of using NIS gene therapy as a means of delivering highly conformal radiation doses selectively to tumours. This strategy is particularly attractive because it can be used with both diagnostic (99mTc, 125I, 124I) and therapeutic (131I, 186Re, 188Re, 211At) radioisotopes and it lends itself to incorporation with standard treatment modalities, such as radiotherapy or chemoradiotherapy. In this article, we review the biology of NIS and discuss its development for gene therapy.

Amongst the various methods that can be developed for noninvasive monitoring of gene expression in vivo, the use of positron emission tomography (PET) appears to be the most promising both for preclinical and clinical studies. Various genes have been described as potential PET reporters, but there is a need to develop new approaches that exploit transgenes with both therapeutic and imaging potential. The Na/I symporter (NIS) gene is expressed mainly in the thyroid and is responsible for iodide accumulation in this organ. The NIS gene has been used in gene therapy experimentation. Ectopic expression of this gene in various type of malignant cells has led to radiosensitization and in some cases tumor regression in xenograft models in nude mice, highlighting the therapeutic potential of this approach. In the present study, we demonstrate the potential of the human NIS gene (hNIS) as a reporter gene. Expression of hNIS, after plasmid transfection or adenoviral gene delivery, can be monitored in vitro on incubation with (125)I. Iodide uptake in the transduced cells can be directly correlated with the levels of gene expression in vitro. Ectopic expression of the NIS gene in vivo can be monitored in biodistribution studies on intravenous injection of (125)I. Adenovirus delivery induces gene expression essentially in the liver, adrenal glands, lungs, pancreas, and spleen. Expression of hNIS in tumor xenograft models can also be detected when the virus is injected intratumorally. Finally, hNIS expression was monitored by PET after intravenous injection of (124)I, demonstrating the potential of this approach for noninvasive imaging.

A key impediment to successful cancer therapy with adenoviral vectors is the inefficient transduction of malignant tissue in vivo. Compounding this problem is the lack of cancer-specific targets, coupled with a shortage of corresponding high-efficiency ligands, permitting selective retargeting. The epithelial cell-specific integrin ␣v␤6 represents an attractive target for directed therapy since it is generally not expressed on normal epithelium but is upregulated in numerous carcinomas, where it plays a role in tumor progression. We previously have characterized a high-affinity, ␣v␤6-selective peptide (A20FMDV2) derived from VP1 of footand-mouth disease virus. We generated recombinant adenovirus type 5 (Ad5) fiber knob, incorporating A20FMDV2 in the HI loop, for which we validated the selectivity of binding and functional inhibition of ␣v␤6. The corresponding ␣v␤6-retargeted virus Ad5-EGFP A20 exhibited up to 50-fold increases in coxsackievirusand-adenovirus-receptor-independent transduction and up to 480-fold-increased cytotoxicity on a panel of ␣v␤6-positive human carcinoma lines compared with Ad5-EGFP WT . Using an ␣v␤6-positive (DX3-␤6) xenograft model, we observed a ϳ2-fold enhancement in tumor uptake over Ad5-EGFP WT following systemic delivery. Furthermore, ϳ5-fold-fewer Ad5-EGFP A20 genomes were detected in the liver (P ‫؍‬ 0.0002), correlating with reduced serum transaminase levels and E1A expression. Warfarin pretreatment, to deplete coagulation factors, did not improve tumor uptake significantly with either virus but did significantly reduce liver sequestration and hepatic toxicity. The ability of Ad5-EGFP A20 to improve delivery to ␣v␤6, combined with its reduced hepatic tropism and toxicity, highlights its potential as a prototype virus for future clinical investigation.

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Transgene expression can be measured in living animals by positron emission tomography (PET) using reporter genes associated with radiolabeled substrates or ligands. We examined here whether PET images obtained with a new reporter gene system (sodium/iodide symporter (NIS) and [124I]iodide) could provide quantitative information on gene expression in mice. Mice received various doses of recombinant adenovirus in which the expression of the NIS cDNA was driven by the CMV promoter and subsequently [124I]iodide. Postmortem gamma counting of liver biopsies was correlated to the adenovirus dose and with NIS mRNA concentration. In addition, immunohistochemically NIS-positive cells increased with higher tissue activities. Finally, a linear relationship existed between the postmortem gamma counting in liver tissues and that calculated from images obtained through small animal PET scanning (r = 0.9581), although there was a bias at high and low specific values. This systematic study on 35 animals demonstrates that quantitative information on gene expression can be obtained from PET images using the NIS reporter system. This new methodology of quantitative imaging of gene expression presents the advantage of avoiding extensive radiochemistry, an important step for more disseminated use of this emerging technology. In addition, this work supports further development of the NIS system for noninvasive assessment of gene delivery in preclinical and clinical studies.

The ability of bacteria to mediate gene transfer has only recently been established and these observations have led to the utilization of various bacterial strains in gene therapy. The types of bacteria used include attenuated strains of Salmonella, Shigella, Listeria, and Yersinia, as well as non-pathogenic Escherichia coli. For some of these vectors, the mechanism of DNA transfer from the bacteria to the mammalian cell is not yet fully understood but their potential to deliver therapeutic molecules has been demonstrated in vitro and in vivo in experimental models. Therapeutic benefits have been observed in vaccination against infectious diseases, immunotherapy against cancer, and topical delivery of immunomodulatory cytokines in inflammatory bowel disease. In the case of attenuated Salmonella, used as a tumour-targeting vector, clinical trials in humans have demonstrated the proof of principle but they have also highlighted the need for the generation of strains with reduced toxicities and improved colonization properties. Altogether, the encouraging results obtained in the studies presented in this review justify further development of bacteria as a therapeutic vector against many types of pathology.

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Cell permeabilization using microbubbles (MB) and low-intensity ultrasound (US