Immunotoxins are hybrid molecules composed of a cell-surface bin domain and a protein toxin moiety that together target sifc cell popaons for elimination. These Vascular leak syndrome (VLS) is the dose-limiting toxicity found in many clinical trials utilizing immunotoxins, including those prepared with blocked ricin, ricin A chain (in native and deglycosylated forms), and saporin (1-10). VLS is characterized in humans by hypoalbuminemia, weight gain, and edema, resulting from the extravasation offluids and proteins from the vascular system into the periphery. VLS restricts the use of immunotoxins in humans and in many cases necessitates either a significant reduction in dose or a complete cessation of therapy. While peripheral edema is clinically manageable, pulmonary edema can be life threatening. Recently, VLS was found to have contributed to the death of two B-cell lymphoma patients who were treated with anti-CD22-deglycosylated ricin A chain (9). Other toxic effects in patients treated with immunotoxins may be a result of VLS, including tachycardia, nausea, aphasias as a result ofcerebral edema, and myocardial damage (4).Other proteins also have been found to induce VLS in humans. Systemic administration of the cytokine interleukin 2 (IL-2) results in the development ofVLS when approaching doses that may provide antitumor efficacy in patients with metastatic cancer (11,12). VLS has also been observed in patients following treatment with granulocyte/macrophage colony-stimulating factor or the anti-GD3 antibody R24 (13,14).BR96 sFv-PE40 is a single-chain immunotoxin fusion protein that has been shown to cure established human tumor xenografts in both athymic rats and mice (15,16). In this study, a rat model for VLS was established following administration of BR96 sFv-PE40 at doses beyond those required for cures of tumor xenografts in rodent models. The identification of an animal model for VLS that closely approximates the human VLS response to immunotoxins provides an opportunity to evaluate specific drugs for their ability to block immunotoxin-induced VLS and to determine whether they affect the antitumor activity of BR96 sFv-PE40.
MATERIALS AND METHODSReagents. The single-chain immunotoxin fusion protein BR96 sFv-PE40 was expressed in Escherichia coli and purified as described (16). Diphenhydramine hydrochloride was purchased from Elkins-Sinn (Cherry Hill, NJ). Cyclosporine A (CsA) was purchased from Sandoz Pharmaceutical. 15-Deoxyspergualin (DSG) was purchased from Nippon Kayaku (Tokyo). Dexamethasone (Dex) was purchased from Anpro Pharmaceuticals (Arcadia, CA).Toxicity Studies. Six-to 8-week-old female Wistar Furth and Rowett, nu/nu (athymic) rats (Harlan-Sprague-Dawley) were i.v. injected with various amounts of BR96 sFv-PE40 (0.25-4 mg/kg). After 24 hr, they were euthanized by exposure to C02, and the tissues were analyzed using gross and microscopic techniques. Cardiac blood was collected from comatose animals and placed either in serum collection tubes for blood chemistry analysis or in EDT...