Cancer

Coding Dimension ID: 
280
Coding Dimension path name: 
Cancer

Derivation and Characterization of Cancer Stem Cells from Human ES Cells

Funding Type: 
SEED Grant
Grant Number: 
RS1-00228
ICOC Funds Committed: 
$642 500
Disease Focus: 
Blood Cancer
Cancer
Stem Cell Use: 
Cancer Stem Cell
Embryonic Stem Cell
Cell Line Generation: 
Cancer Stem Cell
oldStatus: 
Closed
Public Abstract: 
Cancer is the leading cause of death for people younger than 85 (1). High cancer mortality rates underscore the need for more sensitive diagnostic techniques as well as therapies that selectively target cells responsible for cancer propagation (1) Compelling studies suggest that human cancer stem cells (CSC) arise from aberrantly self-renewing tissue specific stem or progenitor cells and are responsible for cancer propagation and therapeutic resistance (2-9). Although the majority of current cancer therapies eradicate rapidly dividing cells within the tumor, the rare CSC population may be quiescent and then reactivate resulting in disease progression and relapse (2-9). We recently demonstrated that CSC are involved in progression of chronic phase chronic myelogenous leukemia (CML), a disease that has been the subject of many landmark discoveries in cancer research(19-30), to a more aggressive and therapeutically recalcitrant myeloid blast crisis (BC) phase. These CSC share the same cell surface markers as granulocyte-macrophage progenitors (GMP) but have aberrantly gained the capacity to self-renew as a result of activation of the Wnt/-catenin stem cell self-renewal pathway (4). Because human embryonic stem cells (hESC) have robust self-renewal capacity and can provide a potentially limitless source of tissue specific stem and progenitor cells in vitro, they represent an ideal model system for generating and characterizing human CSC (10-18). Thus, hESC cell research harbors tremendous potential for developing life-saving therapy for patients with cancer by providing a platform to rapidly and rationally test new therapies that specifically target CSC (2-18). To provide a robust model system for screening novel anti-CSC therapies, we propose to generate and characterize CSC from hESC (10-18). We will investigate the role of genes that are essential for initiation of CML such as BCR-ABL and additional mutations such as b-catenin implicated in CSC propagation (19-30). The efficacy of specific Wnt/b-catenin antagonists at inhibiting BCR-ABL+ human ES cell self-renewal, survival and proliferation alone and in combination with potent BCR-ABL antagonists will be assessed in sensitive in vitro and in vivo assays with the ultimate aim of developing highly active anti-CSC therapy that may halt cancer progression and obviate therapeutic resistance (4,31).
Statement of Benefit to California: 
The research outlined in this proposal represents a unique opportunity for collaborations between investigators from disparate disciplines to use human embryonic stem cells to challenge an existing paradigm namely that leukemic blasts are responsible for progression of chronic myelogenous leukemia (CML) rather than leukemic stem cells (LSC). Current clinical diagnostic tests are not sufficiently sensitive to predict timing of progression for all patients with CML nor are they adequate for determining the type of therapeutic intervention required. Moreover, the primary therapy for CML, Abl kinase inhibition, was shown to be cardiotoxic when given long-term at high doses. Furthermore, amplification of BCR-ABL is not the sole event that occurs during CML progression to blast crisis. Identification and inhibition of molecular mutations responsible for the generation of LSC in CML blood and/or marrow may prevent progression to blast crisis (BC) and would represent an innovative, effective form of CML therapy. Modeling of LSC responsible for CML progression in human embryonic stem cells could have a significant impact on our understanding of the pathophysiology of CML, provide novel diagnostic and therapeutic modalities and improve the quality and possibly quantity of life of patients with CML. By using BCR-ABL transduced human embryonic stem cells, we will rigorously evaluate the LSC hypothesis and as a consequence, the additional molecular events required for progression to blast crisis CML. The ultimate aims of this grant are to develop more sensitive methods to predict leukemic progression and to identify novel molecular therapeutic targets through the development of LSC models using human embryonic stem cells. We aim to provide a robust, reproducible system for testing novel anti-LSC compounds alone and in combination in order to expedite the development of novel therapeutic agents for anti-LSC clinical trials at {REDACTED}. Not only may the translational research performed in the context of this grant speed the delivery of innovative anti-LSC therapies for Californians with leukemia, it will help to train California’s future R&D workforce in addition to developing leaders in translational medicine. This grant will provide the personnel working on the project with a clear view of the importance of their research to cancer therapy and a better perspective on future career opportunities in California.
Progress Report: 
  • SEED Grant Research Summary
  • Compelling studies suggest that cancer stem cells (CSC) arise from primitive self-renewing progenitor cells. Although many cancer therapies target rapidly dividing cells, CSC may be quiescent i.e. asleep resulting in therapeutic resistance. Recently, we demonstrated that CSC drive progression of chronic phase (CP) chronic myeloid leukemia (CML), a subject of many landmark cancer research discoveries, to a therapeutically recalcitrant myeloid blast crisis (BC) phase. CML CSC share cell surface markers with granulocyte-macrophage progenitors (GMP) and have amplified expression of the CML fusion gene, BCR-ABL. In addition, they aberrantly gain self-renewal capacity, in part, as a result Wnt/β-catenin activation. Because human embryonic stem cells (hESC) have robust regenerative capacity and can provide a potentially limitless source of tissue specific progenitor cells in vitro, they represent an ideal model system for generating and characterizing human CSC. The main goals of this research were to generate CSC from hESC to provide an experimentally amenable platform to expedite the development of sensitive diagnostics that predict progression and combined modality anti-CSC therapy.
  • To this end, we tested whether BCR-ABL expression in hESC is sufficient to induce changes characteristic of CML stem cells. Unlike mouse ESC, introduction of a novel lentiviral BCR-ABL vector into hESC did not drive myeloid differentiation nor did it induce stromal independence in vitro underscoring key differences between mouse and human hESC and the importance of in vivo models. Notably, Hues16 cells had a higher propensity to differentiate into CD34+ cells than other hESC lines particularly in AGM co-cultures and thus, were used in subsequent in vivo experiments. Moreover, this SEED grant funded Yosuke Minami in Professor Jean Wang’s lab to create a unique CML blast crisis mouse model typified by GMP expansion and resistance to a BCR-ABL inhibitor, imatinib (Minami et al, PNAS 2008;105:17967-72). In addition, a bioluminescent humanized model of blast crisis CML was created based on transplantation of GMP from patient blood into immune deficient mice (RAG2-/-gc-/-). Cells were tagged with firefly luciferase that emits a bioluminescent signal so that leukemic transplantation efficiency could be tracked in vivo (IVIS). As few as 1,000 human blast crisis CML GMP could transplant leukemia in immune deficient mice thereby providing an important model for studying the molecular events that contribute to leukemic transformation (Abrahamsson et al, PNAS 2009;106:3925-9).
  • In the second aim, we hypothesized that BCR-ABL is sufficient for generating CML from self-renewing stem cells. In these studies, Hues16 cells differentiated into CD34+ cells were lentivirally transduced with BCR-ABL leading to sustained BCR-ABL engraftment in 50% of transplanted mice. Chronic phase CD34+ cells derived from CML blood were less efficient at sustaining CML engraftment (7%) suggesting that hESC derived CD34+ cells have higher self-renewal potential and are similar to advanced phase CML progenitors.
  • Thirdly, we hypothesized that BCR-ABL was necessary but not sufficient for progression to blast crisis. Introduction of lentiviral activated beta-catenin or shRNA to GSK3beta, together with BCR-ABL did not enhance BCR-ABL engraftment compared with BCR-ABL transduction of hESC alone. These studies suggested that hESC may already have sufficient self-renewal capacity to sustain the malignant CML clone and are molecularly comparable to advanced CML progenitors that behave like CSC. In addition, through extensive cDNA sequencing of human blast crisis CML progenitors, we found that 57% of samples harbored a misspliced form of GSK3beta that promoted tumor production and could serve as a novel prognostic marker in CML clinical trials (Abrahamsson et al, PNAS 2009;106:3925-9).
  • In the final aim, we hypothesized that CML CSC are not eliminated by BCR-ABL inhibitors alone and that combined modality therapy will be required. In collaborative research involving in vitro analysis of imatinib resistant CML progenitors and more recently in a humanized mouse model of blast crisis CML, we found that dasatinib, a potent BCR-ABL inhibitor, is necessary but not sufficient for CSC eradication. Discovery of a GSK3beta deregulation, a negative regulator of both beta-catenin and sonic hedgehog (Shh) pathways (Zhang et al, Nature 2009), led us to disover that Shh combined with BCR-ABL inhibition abrogated CSC driven tumor formation (manuscript in preparation) providing the impetus for an upcoming Pfizer sponsored Shh inhibitor clinical trial for refractory hematologic malignancies.

The APOBEC3 Gene Family as Guardians of Genome Stability in Human Embryonic Stem Cells

Funding Type: 
SEED Grant
Grant Number: 
RS1-00210
ICOC Funds Committed: 
$777 467
Disease Focus: 
Cancer
Stem Cell Use: 
Embryonic Stem Cell
oldStatus: 
Closed
Public Abstract: 
The successful use of human embryonic stem cells (hESCs) as novel regenerative therapies for a spectrum of currently incurable diseases critically depends upon the safety of such cell transfers. hESCs contain roughly 3 million “jumping genes” or mobile genetic retroelements that comprise up to 45% of their genetic material. While many of these retroelements have been permanently silenced during evolution by crippling mutations, many remain active and capable of moving to new chromosomal locations potentially producing disease-causing mutations or cancer. More mature differentiated cells control retroelement movement (retrotransposition) by methylating the DNA comprising these elements. Strikingly, such DNA methylation is largely absent in hESCs because these cells must be able to develop into a wide spectrum of different tissues and organs. Thus, in order to protect the integrity of their genomes, hESCs must deploy an additional defense to limit retroelement retrotransposition. Recent studies of HIV and other exogenous retroviruses have identified the APOBEC3 family of genes (A3A-A3H) as powerful anti-retroviral factors. These APOBEC3s interrupt the conversion of viral RNA into DNA (reverse transcription), a key step also used by retroelements for their successful retrotransposition. We hypothesize that one or more of the APOBECs function as guardians of genome integrity in hESCs. We propose to compare and contrast which APOBEC3s are expressed in one federally approved and nine nonapproved hESC lines and to assess the natural level of retroelement RNA expression occurring in each of these lines. Next we will test whether the knockdown of expression of these APOBEC3s in the hESCS lines by RNA interference leads to a higher frequency of retrolement retrotransposition. Finally, if higher levels of retrotransposition are detected, we will examine whether these cells display an impaired ability to differentiate into specific tissue types corresponding to the three germ cell layers (ectoderm, mesoderm, and endoderm) and whether increased retrotransposition is associated with a higher frequency of malignant transformation within the hESC cultures. These studies promise to provide important new insights into how genomic stability in is maintained in hESCs and could lead to the identification of specific GMP culture conditions that minimize the chances of such unwanted retrotransposition events in cells destined for infusion into patients. These studies are directly responsive to the CIRM request for application. If funded, these studies would allow the entry of my laboratory with extensive APOBEC experience, into the exciting field of stem cell biology.
Statement of Benefit to California: 
Harnessing the exciting potential of embryonic stem cells as therapies for a wide range of diseases like diabetes, Alzheimer’s disease, myocardial infarction among others first requires ensuring that the infusion of these cells into patients can be performed safely. Of note, human embryonic stem cells contain up to 3 million “jumping genes” or mobile genetic retroelements that can potentially move from location to another in the genome. Great harm could occur if the movement of these retroelements in human embryonic stem cells results in the mutation of key genes or the inactivation of tumor suppressor genes, the latter could facilitate the development of cancer in recipients of these cells. The safety of stem cell therapy thus depends on the rigorous maintenance of genomic integrity and stability within the embryonic stem cell during its manipulation. Strikingly, the major cellular defense against the movement of the retroelements to new genetic locations, DNA methylation, is greatly reduced in human embryonic stem cells. A general state of hypomethylation is likely required to permit these pluripotent cells to differentiate into multiple cell types. With DNA methylation no longer able to constrain the activity of these retroelements, we believe a second natural defense springs into action to protect these stem cells. We proposeto identify and characterize this defensive network. These studies could lead to new approaches for maintaining or even enhancing this defense when embryotic stem cells are manipulated in culture, thereby helping to ensure the safety of embryonic stem cells destined for therapeutic transfer. Thus, the results of these studies will have both scientific and practical value. As such, we believe these studies will benefit the citizens of California certainly at a societal level and potentially at a personal level.
Progress Report: 
  • Human embryonic stem cells contain roughly 3 million “jumping genes” or mobile genetic retroelements that comprise up to 45% of human genome. While many of these retroelements have been silenced during evolution by crippling mutations, many remain active and capable of jumping to new chromosomal locations potentially producing disease-causing mutations or cancer. In tissues, mobility of these elements is suppressed by DNA methylation, which inactivates expression of the retroelement RNAs. In sharp contrast, embryonic stem cells exhibit very dynamic changes in DNA methylation, where the methylation patterns are gained and lost at high rates. During periods of low DNA methylation, retroelement RNA expression likely increases. Accordingly, hESCs must deploy other defensive strategies in order to maintain genomic integrity. Recent studies have identified the APOBEC3 family of genes (A3A-A3H) as powerful antiviral factors. These A3s interrupt the conversion of viral RNA into DNA (reverse transcription), a key step also employed by retroelements for their successful retrotransposition. We hypothesized that one or more of the APOBECs function as guardians of genome integrity in hESCs. In the last two years we have found that six out of the seven human A3 genes located in a tandem array on chromosome 22 are expressed in hESCs. A3A, which in prior studies was suggested to exert the greatest anti-retroelement effects, surprisingly is not expressed in hESCs. Further, we find that the A3 proteins decrease when pluripotent cells differentiate into somatic cells suggesting an important function of these A3 proteins in pluripotent hESCs. We established a LINE1 retrotransposition assay in hESCs that allows us to visualize genetic jumping of this class of “marked” retroelements via flow cytometry. Using this assay we have found that LINE1 elements effectively jump in hESCs. To test our central hypothesis, namely that A3 proteins guard the genome in hESCs, we have established experimental conditions for RNAi knock-down of all expressed A3 genes. By combining the knock-down and the retrotransposition assay we demonstrated that the knock-down of one member of the A3 protein family leads to a 3.5-fold increase in LINE1 retrotranspositon. This finding highlights a protective role for the A3 family of cytidine deaminases that helps safeguard the genome integrity of hESCs.

Genetic Enhancement of the Immune Response to Melanoma via hESC-derived T cells

Funding Type: 
SEED Grant
Grant Number: 
RS1-00203
ICOC Funds Committed: 
$642 501
Disease Focus: 
Melanoma
Cancer
Stem Cell Use: 
Embryonic Stem Cell
oldStatus: 
Closed
Public Abstract: 
The overall goal of the proposed studies is to utilize human gene therapy approach using human embryonic stem cells to direct our body’s defenses to specifically attack melanoma tumor cells. Current technologies try to accomplish this by genetically manipulating certain circulating T lymphocytes, such that they will target tumor cells. T lymphocytes are the major cell type of our body’s immune system. However it is likely that this type of approach will not result in the presence of stable, lifelong genetically modified T cells. In contrast, a potentially more long-lasting approach would be to genetically modify human embryonic stem cells with the same therapeutic gene. Stem cells have the ability to form any type of blood cell, including T cells. Importantly, stem cells can persist for the life of the individual, and thus have the potential to produce genetically modified T cells for many years. In addition, these new tumor specific cells should expand in the body in response to the presence of the tumor, thus a large supply of tumor-fighting cells should be available as long as needed. This project proposes to develop novel means to introduce the anti-cancer gene into human embryonic stem cells. These stem cells will then be differentiated to generate tumor specific T cells utilizing animal model systems. We will then use several laboratory and mouse models to determine if the T cells derived from these genetically modified stem cells have anti-tumor activity. If successful, we will have provided proof-of principle that long-lived stem cells have the potential be utilized as a means of producing anti-cancer T cells. In the long run, these results could provide important information for design of future clinical trials designed to produce life-long improved anti-cancer immune responses.
Statement of Benefit to California: 
We propose to use human embryonic stem cells to develop a novel, yet potentially very effective method to treat invasive melanoma. Melanoma is a serious type of skin cancer which, if not removed early, spreads internally and is usually fatal. Overall melanoma is the 6th most common cancer in males and 7th in females and the incidence of this form of cancer is currently increasing at an epidemic rate. Although melanomas may occur in areas of skin that are not normally exposed to sunlight, sun exposure is believed to be a factor in about 70% of new cases. California’s mild winters and high number of sunny days provide opportunities for a number of occupational and recreational outdoor activities, and people in California are exposed to more than average levels of solar radiation. Consequently, there is a higher risk of developing this disease. As a matter of fact, California is one of the five US states with the highest predicted incidence of new cases of melanoma. According to the California Cancer Registry, each year 4,700 new cases of invasive melanoma and over 800 deaths related to this disease are reported in California, with the incidence rate increasing by 15% over the last decade. While the white population is at the greatest risk of developing this disease, it was recently reported that the rates of invasive melanoma have risen substantially in Hispanic people living in California as well. If our proposal is successful, our work could pave the way to the development of a new and effective form of melanoma therapy, one which would clearly benefit all the people of California affected by this disease.
Progress Report: 
  • In this grant we proposed to genetically engineer human embryonic stem cells (hESC) and hematopoietic stem cells (HSC) and to use them to produce T cells with enhanced ability to kill melanoma cells. Our proposal consists of several steps. In the first year of the grant, we completed the first step and introduced the genes for a melanoma specific T cell receptor (TCR) into hESC and HSC. In this, second year of funding we were able to generate genetically modified T cells from hESC and HSC and to characterize the HSC-derived cells in more details. We found that HSC-derived T cells carrying the new TCR are indistinguishable from normal T cells, based on the cell surface expression of other T cell specific proteins. Also, we found that they can kill human melanoma cells in a Petri dish. We are currently evaluating their ability to destroy tumors in experimental animals transplanted with human melanoma cells. This is a more relevant approach as it mimics the potential treatment of melanoma patients. We are also trying to obtain larger numbers of the genetically modified hESC-derived T cells and analyze them in the same types of assays. Our data are encouraging and suggestive of possible clinical application of these cells in future.

Development of Highly Active Anti-Leukemia Stem Cell Therapy (HALT)

Funding Type: 
Disease Team Research I
Grant Number: 
DR1-01430
ICOC Funds Committed: 
$19 999 826
Disease Focus: 
Blood Cancer
Cancer
Collaborative Funder: 
Canada
Stem Cell Use: 
Cancer Stem Cell
oldStatus: 
Active
Public Abstract: 
Leukemias are cancers of the blood forming cells that afflict both children and adults. Many drugs have been developed to treat leukemias and related diseases. These drugs are often effective when first given, but in many cases of adult leukemia, the disease returns in a form that is not curable, causing disability and eventual death. During the last few years, scientists have discovered that some leukemia cells possess stem cell properties that make them more potent in promoting leukemia growth and resistance to common types of treatment. These are called leukemia stem cells (LSC). More than in other cancers, scientists also understand the exact molecular changes in the blood forming cells that cause leukemias, but it has been very difficult to translate the scientific results into new and effective treatments. The main difficulty has been the failure of existing drugs to eliminate the small numbers of LSC that persist in patients, despite therapy, and that continue to grow, spread, invade and kill normal cells. In fact, the models used for drug development in the pharmaceutical industry have not been designed to detect drugs or drug combinations capable of destroying the LSC. Drugs against LSC may already exist, or could be simple to make, but there has not been an easy way to identify these drugs. Recently, physicians and scientists at universities and research institutes have developed tools to isolate and to analyze LSC donated by patients. By studying the LSC, the physicians and scientists have identified the molecules that these cells need to survive. The experimental results strongly suggest that it will eventually be possible to destroy LSC with drugs or drug combinations, with minimal damage to most normal cells. Now we need to translate the new knowledge into practical treatments. The CIRM Leukemia Team is composed of highly experienced scientists and physicians who first discovered LSC for many types of leukemia and who have developed the LSC systems to test drugs. The investigators in the Team have identified drug candidates from the vigorous California pharmaceutical industry, who have already performed expensive pharmacology and toxicology studies, but who lack the cells and model systems to assess a drug’s ability to eliminate leukemia stem cells. This Team includes experts in drug development, who have previously been successful in quickly bringing a new leukemia drug to clinical trials. The supported interactive group of physicians and scientists in California and the Collaborative Funding Partner country has the resources to introduce into the clinic, within four years, new drugs for leukemias that may also represent more effective therapies for other cancers for the benefit of our citizens.
Statement of Benefit to California: 
Thousands of adults and children in California are afflicted with leukemia and related diseases. Although tremendous gains have been made in the treatment of childhood leukemia, 50% of adults diagnosed with leukemia will die of their disease. Current therapies can cost tens of thousands of dollars per year per patient, and do not cure the disease. For the health of the citizens of California, both physical and financial, we need to find a cure for these devastating illnesses. What has held up progress toward a cure? Compelling evidence indicates that the leukemias are not curable because available drugs do not destroy small numbers of multi-drug resistant leukemia stem cells. A team approach is necessary to find a cure for leukemia, which leverages the expertise in academia and industry. Pharmaceutical and biotech companies have developed drugs that inhibit pathways known to be involved in leukemia stem cell survival and growth, but are using them for unrelated indications. In addition, they do not have the expertise to determine whether the inhibitors will kill leukemia stem cells. The Leukemia Team possesses stem cell expertise and has developed state of the art systems to determine whether drugs will eradicate leukemia stem cells. They have also have access to technologies that may allow them to identify patients who will respond to the treatment. The development plan established by the Leukemia Disease Team will also serve as a model for the clinical development of drugs against solid tumor stem cells, which are not as well understood. In summary, the benefits to the citizens of California from the CIRM disease specific grant in leukemia are: (1) direct benefit to the thousands of leukemia patients (2) financial savings due to definitive treatments that eliminate the need for costly maintenance therapies
Progress Report: 
  • Development of Highly Active Leukemia Therapy (HALT)
  • Leukemias are cancers of the blood forming cells that affect both children and adults. Although major advances have been made in the treatment of leukemias, many patients still succumb to the disease. In these patients, the leukemias may progress despite therapy because they harbor primitive malignant stem-like cells that are resistant to most drugs. This CIRM disease specific grant aims to develop a combination of highly active anti-leukemic therapy (HALT) that can destroy the drug-resistant cancer stem-like cells, without severely harming normal cells.
  • During the current year of support, substantial progress has been made in achieving this goal. The CIRM investigators have shown that two different drugs that inhibit different proteins in leukemia stem cells can sensitize them to chemotherapeutic agents, and block their ability to self-renew. The CIRM investigators have also demonstrated that two different antibodies against molecules on the surface of the leukemia cells can inhibit their survival in both test tube experiments and in mouse models.
  • Extensive experiments are underway to confirm these promising results. The results will enable the planning and implementation of potentially transforming clinical trials in leukemia patients, during the period of CIRM grant support.
  • During the past 12 months, our disease team has made further progress in
  • the development of stem cell targeted treatment for chronic lymphocytic
  • leukemias and other leukemias. Stem cells express some molecules on the
  • surface that are different from the corresponding molecules on adult
  • cells. The ROR1 molecule is highly expressed by malignant cells from
  • patients with chronic lymphocytic leukemia, as well as by progenitor cells
  • from other forms of leukemia and lymphoma. It is not expressed by normal
  • adult cells. With the support of the CIRM Disease Team grant, the
  • cooperating investigators have prepared monoclonal antibodies against the
  • ROR1 molecule, that are potent and specific. In animal models, the
  • antibodies can retard leukemia growth and spread. Unlike other anti-cancer
  • drugs, the new antibodies are not toxic for normal bone marrow cells.
  • Thus, they can potentiate the action of other agents used for the
  • treatment of leukemia.
  • The disease team is now focused on the pre-clinical development, safety
  • testing, and scale-up manufacturing of our new, promising agents, in
  • preparation for their introduction into the clinic.
  • During the past 12 months, our disease team has made further progress in
  • the development of stem cell targeted treatment for chronic lymphocytic
  • leukemias and other leukemias. Stem cells express some molecules on the
  • surface that are different from the corresponding molecules on adult
  • cells. The ROR1 molecule is highly expressed by malignant cells from
  • patients with chronic lymphocytic leukemia, as well as by progenitor cells
  • from other forms of leukemia and lymphoma. It is not expressed by normal
  • adult cells. With the support of the CIRM Disease Team grant, the
  • cooperating investigators have prepared a humanized monoclonal antibody against the
  • ROR1 molecule, that is potent and specific. In animal models, the
  • antibodies can retard leukemia growth and spread. Unlike other anti-cancer
  • drugs, the new antibodies are not toxic for normal bone marrow cells.
  • Thus, they can potentiate the action of other agents used for the
  • treatment of leukemia.
  • The disease team is now focused on the pre-clinical development, safety
  • testing, and scale-up manufacturing of our new, promising agents, in
  • preparation for their introduction into the clinic.
  • During the past 12 months, our disease team has made further progress in
  • the development of stem cell targeted treatment for chronic lymphocytic
  • leukemias and other leukemias. Stem cells express some molecules on the
  • surface that are different from the corresponding molecules on adult
  • cells. The ROR1 molecule is highly expressed by malignant cells from
  • patients with chronic lymphocytic leukemia, as well as by progenitor cells
  • from other forms of leukemia and lymphoma. It is not expressed by normal
  • adult cells. With the support of the CIRM Disease Team grant, the
  • cooperating investigators have prepared a humanized monoclonal antibody against the
  • ROR1 molecule, that is potent and specific. In animal models, the
  • antibodies can retard leukemia growth and spread.
  • The disease team has now finalized the pre-clinical development, safety
  • testing, and scale-up manufacturing of our new, promising agent, in
  • preparation for their introduction into the clinic.

Stem Cell-Mediated Oncocidal Gene Therapy of Glioblastoma (GBM)

Funding Type: 
Disease Team Research I
Grant Number: 
DR1-01426
ICOC Funds Committed: 
$19 162 435
Disease Focus: 
Brain Cancer
Cancer
Stem Cell Use: 
Adult Stem Cell
Cell Line Generation: 
Adult Stem Cell
oldStatus: 
Closed
Public Abstract: 
Brain tumors (BTs) are incurable, whether they start in the brain or spread there from other sites. Despite advances in surgical, radiation, pharmacologic, and gene therapies, survival with a BT remains dismal. Current therapies are limited by their inability to reach widely disseminated tumor cells that become dispersed within normal brain structures. Interestingly, the therapeutic property that is needed to overcome this major obstacle to effective treatment of BTs matches well with one of the better accepted attributes of neural stem cells (NSCs): an attraction for sites of pathology in the adult brain, including primary & metastatic cancer. If armed with a proper tumor-killing gene, NSCs (whether administered into the brain or into the bloodstream), that are drawn to cancers, will dramatically reduce tumor burden, and will track after even single migrating tumor cells. The NSCs perform this action without themselves becoming tumorigenic or augmenting the pre-existing tumor, and this can be assured by having NSCs express a suicide gene that can be activated and cause NSCs to die. The tumor homing phenomenon of NSCs was first revealed by researchers on this proposed team and, in fact, the central concepts presented here have since been extended to many other kinds of disease. In this proposal, we will use a number of authentic mouse models of primary BTs to pre-clinically test therapeutic NSCs. Human NSCs (hNSCs) will be derived from 3 distinct sources, with each having been proffered as therapeutic, but never having been compared head-to-head in treating tumors. Each of these hNSCs will be modified using two therapeutic genes: TRAIL, which is a protein that specifically kills tumor cells, but does not harm normal cells and tissues, and cytosine deaminase which converts a non-toxic chemical into a toxic chemotherapeutic. We expect our research to identify the best hNSC + therapeutic gene combination to advance for clinical trial in patients with BTs, following our obtaining regulatory approval for using hNSC therapy at the end of this project. Because immunocompatibility of the hNSCs with recipient patients is not a concern in BT therapy, a limited number of hNSC lines can be used for treating all prospective patients. Furthermore, BT treatment does not require long-term NSC survival and can be combined with commonly used BT therapies. Finally, NSCs can be imaged in patients and therefore monitored after administration. Developing this approach for treatment of BT patients offers an ideal setting and opportunity for achieving dramatic results from stem cell therapy, and the results of this project will likely be applicable to the treatment of other cancers.
Statement of Benefit to California: 
Brain tumors (BTs) are incurable, whether they start in the brain or spread there from other sites. Despite advances in surgical, radiation, drug, & gene therapies, survival with a BT is extremely short, because current therapies are limited by their inability to reach tumor cells that spread widely to normal brain structures. Interestingly, the therapeutic property that is needed to overcome this major treatment obstacle matches well with one of the better accepted attributes of neural stem cells (NSCs): an attraction for sites of disease in the adult brain, including primary & metastatic cancer. If engineered to be armed with a tumor-killing gene, NSCs (whether administered into the brain or into the bloodstream), that are attracted to cancers, could dramatically reduce patient tumor burden, and track after even single migrating tumor cells, in a manner that has never been achieved. The NSCs would perform this action without themselves causing tumors or increasing growth of the patient’s tumor, and this would be assured by engineering the NSCs to self-destruct. The tumor homing phenomenon of NSCs was first revealed by researchers on this proposed team and, in fact, the central concepts presented here have since been extended to many other kinds of disease. In this proposal, we will use a number of authentic mouse models of primary BTs to test therapeutic NSCs before testing them in humans. Human NSCs (hNSCs) will be derived from 3 distinct sources, with each having been proposed as therapeutic, but never having been compared head-to-head in treating cancer. Each of these stem cells will be modified using two different therapeutic genes: TRAIL, a protein that specifically kills tumor cells, but does not harm normal cells and tissues, and cytosine deaminase, which converts a non-toxic chemical into a chemotherapy drug that kills the tumor. We expect our research to identify the best hNSC + therapeutic gene combination to advance for evaluation in clinical trials in patients with intracranial BTs, after we have performed all necessary animal safety testing and submitted a complete plan for review by the US FDA and NIH. Members of this proposed team have experience in bringing cancer therapies to clinical trial, hold the IP surrounding the use of stem cells against cancer, have begun discussions with the FDA and NIH, and have enlisted a GMP facility. Because immune system compatibility between donor and recipient of the hNSCs with the recipient is not a concern in BT therapy, a small number of donors could be used to produce genetically modified hNSCs to treat all prospective patients. Developing this approach for treatment of BTs offers an ideal setting and opportunity for achieving dramatic results from stem cell therapy, and accomplishing substantial improvements in quantity and quality of life for BT patients would no doubt increase California's worldwide visibility in offering the best possible medical care for cancer patients.
Progress Report: 
  • During the first year of this project we have made substantial progress toward achieving the ultimate goal of developing a stem cell (SC) therapy for treating patients with recurrent glioblastoma (GBM). At the outset, we began investigating three SC candidates as the cellular vehicle to carry a therapeutic payload and disperse within the tumor of GBM patients: mesenchymal stem cells (MSCs); fetal neural stem cells (fNSCs); and adult neural stem cells (aNSCs). In addition, we were considering two therapeutic genes as the payload, cytosine deaminase (CD) and tumor necrosis factor related apoptosis-inducing ligand (TRAIL), and two routes of therapeutic SC administration for treating brain tumor patients, intravascular and direct intratumoral. Thus, at the start of the project, there were twelve possibilities (3 stem cell vehicles x 2 therapeutic genes x 2 routes of administration) to investigate and compare prior to determining the best combination to develop for a GBM clinical trial. From this starting point we have been able to rapidly eliminate the aNSCs from consideration due to their slow rate of proliferation that would limit their expansion to sufficient number for use in a clinical product for patients. Next we determined that SC access to intracranial tumor through intravascular injection was negligible, and that it is highly unlikely that SC administration by this route would result in a sufficient number of SCs reaching intracranial tumor for achieving therapeutic benefit in treating patients with recurrent GBM. Thus, our work to date has resulted in the narrowing options for SC + therapeutic gene + route of delivery to four: two cellular vehicle candidates (fNSCs and MSCs) and two therapeutic gene payloads (CD and TRAIL). During the first year of this project, each of the four combinations has been tested and have demonstrated anti-tumor activity. During early year 2 research we will determine the most effective combination based on preclinical testing results using multiple human GBM models. The decision regarding most effective therapeutic gene + stem cell vehicle will be achieved within six months, and from that point, in going forward, project emphasis will focus on the development of a specific product candidate, including manufacturing process and assay development, GLP/GMP product manufacturing, further preclinical animal studies to demonstrate efficacy and safety, and development of a clinical protocol. In association with the research accomplished to date we have developed and applied several approaches that will prove useful for SC research and clinical application in general. Foremost among these is the use of micron-sized particles of iron oxide (MPIOs) for labeling SCs prior to their injection into animal subjects, and then monitoring the movement of labeled SCs using magnetic resonance imaging (MRI). This is a powerful technique with implications for understanding the distribution and persistence of SCs in patients receiving SC therapies. For our project, this method is informing us about the distribution of labeled SCs within and around brain tumors, as well as with regard to how long the SCs remain in animal subjects. In addition to the MRI detection of iron particle labeled SCs, we have developed and refined a technique for determining the amount of human SC DNA in animal subject tissues, which has a sensitivity of detecting one human cell among more than a million host cells. Similar to the MRI detection of labeled SCs, the DNA detection method provides us a very sensitive approach for monitoring SC biodistribution and persistence in animal subjects, and it is broadly applicable to all SC research in which rodent models are used for pre-clinical investigation of SCs for treating disease. We are also developing novel approaches for the use of optical imaging to visualize stem cells labeled with fluorescent reporters, and for monitoring the anti-tumor activity of therapeutic stem cells administered to animal subjects. These novel approaches are contributing to the repertoire of techniques available to expedite the identification and application of therapeutic SCs in clinical settings. This project is a collaboration among outstanding scientists and clinicians at five of California’s leading medical research institutions: the Sanford-Burnham and Salk Institutes in La Jolla, and the San Francisco, Los Angeles, and San Diego campuses of the University of California (including Ludwig Institute at UCSD). By leveraging complementary expertise of these investigators, we have made rapid progress in the preclinical animal studies, design of the clinical trial protocol, and the product development studies that will lead to preparation of a gene-modified SC product for the clinical trial. These activities will culminate in an IND application to FDA that will allow us to test the safety and efficacy of our SC product in patients with this devastating illness.
  • This project was initiated in April of 2010, and was for comparing
  • • three types of stem cells
  • • two distinct therapeutic gene modifications of stem cells, and
  • • intravascular administration vs. direct tumor injection of stem cells
  • in order to identify the most efficacious stem cell + therapeutic gene + route of administration for treating patients with recurrent glioblastoma (GBM), a brain tumor that has a dismal prognosis, and that badly needs innovative approaches for improving treatment outcomes.
  • Major conclusions from this project, as concerns the objectives indicated above, are:
  • 1. Stem cells administered by the vascular route do not reach brain tumors established in rodent subjects, to an extent which demonstrable therapeutic stem cell anti-tumor activity should be anticipated. In most instances, intravascular administration results in no detectable stem cells in intracranial tumor in rodent models. Therefore, therapeutic stem cells need to be administered direct into brain tumors in order to achieve a sufficient number and concentration of stem cells for observing anti-tumor effect.
  • 2. Neural stem cells and mesenchymal stem cells delivered directly into intracranial tumor display similar extents of dispersion in tumor, indicating these stem cell types should perform comparably as concerns their ability to disseminate within, and deliver therapy to tumor.
  • 3. However, unmodified (non-immortalized) neural stem cells, derived from single adult or fetal sources, have insufficient proliferative capacity for production as therapeutic stem cells to be used in clinical trials that enroll multiple patients. Because of the ready availability of mesenchymal stem cells (MSCs), from many donors, combined with the proliferative capacity of MSCs, MSCs were determined as the preferred candidate for developing therapeutic stem cells to treat patients with recurrent GBM.
  • 4. Studies conducted with therapeutic stem cell + tumor cell mixtures indicated superior anti-tumor activity of cytosine deaminase modified stem cells + 5-fluorocytosine (FC), relative to secretable TRAIL modified stem cells, when anti-tumor activity is examined in liquid media (cell culture). The two types of therapeutic stem cells showed comparable anti-tumor activities when administered directly into brain tumor in animal (rodent) subjects.
  • 5. In relation to other types of therapies (e.g., chemotherapeutics, antibodies, liposomal drugs) being tested by members of this disease team, manufactured therapeutic stem cells displayed low (modest) anti-tumor activity in animal subjects with brain tumor.
  • Technical advances, discovery, and products developed in association this project, and that can be shared/transferred in support of other CIRM funded research, include:
  • • Development of approaches for delivering stem cells through distinct routes of administration in rodent subjects.
  • • Development of a method, based on the use of polymerase chain reaction, for detecting human cells in rodent tissues, with a sensitivity of detection of one human cell per 100,000 mouse cells.
  • • Development of a cell labeling approach that enables tracking of stem cell migration in rodent subjects.
  • • Development of a histochemical method for detection of labeled human cells in rodent tissues.
  • • Development and characterization of multiple, tumorigenic human glioblastoma xenograft models for use in therapeutic testing.

Pages

Subscribe to RSS - Cancer

© 2013 California Institute for Regenerative Medicine