The liver is the most frequent site of blood-borne metastases, being involved in about one third of all cancers, including the most frequent cancer types. 1 Despite extensive exploration for novel therapies, there is no effective treatment for liver metastases. A recent study suggests liver cancer may be susceptible to immunotherapy. Thus, there was a decreased frequency and risk of recurrence of disease for patients treated by infusion of activated autologous lymphocytes, and treated patients had a longer diseasespecific survival. 2 Vaccination with B7.1-transfected tumor cells induces specific anti-tumor immunity in models of relatively immunogenic tumors. 3-5 However, cell adhesion molecule (CAM)-mediated immunotherapy is problematical in that it is ineffective against large immune-resistant tumors and generates weak anti-tumor systemic immunity. 6 In searching for ways to more effectively harness and strengthen the anti-tumor activity of CAM-mediated immunotherapy, we reported that immunogene therapy employing the T-cell costimulator B7.1 could be vastly improved by combining it with anti-angiogenic agents such as angiostatin 7 and antisense hypoxia inducible factor (HIF)-1␣. 8 Combination therapy overcame tumor immune-resistance and caused the complete and rapid eradication of large tumor burdens, which were refractory to monotherapy with either angiostatin, antisense HIF-1␣ or B7.1. This finding is highly relevant for the treatment of liver cancer, as Kim et al. 9 demonstrated that the HBV X-protein increases the transcriptional activity of HIF-1 under both normoxic and hypoxic conditions, and stimulates angiogenesis. Microvessels were found to be more abundant in dysplastic regions of the liver than in nonneoplastic regions, indicating that liver cancer may be critically dependent on angiogenesis. 10 Adeno-associated-virus (AAV) is a nonpathogenic, helper-dependent member of the parvovirus family with several major advantages such as stable integration, low immunogenicity, longterm expression and the ability to infect both dividing and nondividing cells. We have established AAV as a system to rapidly induce persistent expression of anti-cancer agents. With this system, we have previously demonstrated that intraportal injection of AAV expression vector encoding angiostatin led to high-level, long-term (6 months) transgene expression localized to hepatocytes. AAV-generated angiostatin significantly suppressed the growth of both nodular EL-4 tumors, and EL-4 metastases that had disseminated to the liver. 11 However, angiostatin therapy, which indirectly targets tumors by inhibiting vascular endothelial cells, was unable to completely eradicate the liver tumors.In our study, we investigate whether follow-up AAV-mediated, anti-angiogenic therapy can augment B7.1 immunotherapy to generate anti-tumor immunity sufficient to combat intractable liver cancer.
Materials and methods
Plasmid constructionThe cytomegalovirus (CMV) enhancer/chicken -actin promoter, 12 a 1.4 kb complementary DNA (cDNA) encoding fullleng...