Abstract
purpose. To evaluate the transduction efficiency and localization of a reporter gene after intravitreous injection of adenovirus vector in laser photocoagulation (PC)- and photodynamic therapy (PDT)–treated eyes.
methods. Adult Lewis rats received fundus PC, fundus PDT, or no treatment. Intravitreous injection of an adenovirus vector containing the construct expressing β-galactosidase (AdlacZ.11D) was performed in each group. All eyes were then enucleated for histochemistry and processed for quantitative image analysis.
results. In eyes with no treatment, there was moderate to intense staining for lacZ in the anterior segment, but little in the retina. In eyes treated with PC and PDT, there was significantly more LacZ staining in the retina. The increased staining corresponded closely with the sites treated with PC and PDT. Gene transduction in PC-treated eyes was enhanced and extended to at least 135 days after virus delivery, but not extended in PDT-treated eyes. Gene transfer and expression were targeted and enhanced at the site of laser burns, at all doses tested (3 × 105 to 3 × 109 particles per eye).
conclusions. Compared with untreated eyes, eyes treated with PC and to a lesser extent PDT, manifest increased transduction efficiency, in areas of the retina that are targeted by laser treatment. This finding suggests a new and promising strategy for the treatment of retinochoroidal neovascularization. Adenovirus gene therapy in combination with PC or PDT would have the advantage of increased transduction efficiency; increased duration of transgene expression; targeted delivery; and, potentially, a lower effective dose of virus.
Currently adenovirus (AdV), adenoassociated virus, and lentivirus are actively being investigated as vector platforms for ocular gene therapy.
1 2 3 Several factors determine the relative advantages and disadvantages of each platform and include, but are not limited to, the vector tropism, the efficiency of transduction, the size of the transgene, needs related to latency and duration of expression, vector-related toxicity, and the integration necessary for the vector to express. Adenoassociated virus and lentivirus vectors have extended durations of transgene expression compared with AdV.
4 5 There are clinical settings (e.g., chronic disease) in which prolonged transgene expression may be desired. Currently, the risk of prolonged transgene expression is unknown for most proteins and must be evaluated for each protein. In the eye, even increased expression of wild-type rhodopsin or peripherin/
rds can result in degeneration of photoreceptors.
6 7
Replication-deficient AdV vectors are characterized by a large capacity, short latency, transduction in both dividing and nondividing cells, high expression levels, and relative ease of production, allowing concentration to high titers. Local delivery of AdV vector for relatively short-term ocular indications may therefore be desirable. AdV vectors induce a dose-dependent ocular immune response that may contribute to a shorter duration of expression, particularly at higher doses—the major disadvantage of AdV vectors. Enrollment is completed in a phase I clinical trial of AdV vector expressing human pigment epithelium-derived factor (PEDF)
8 for choroidal neovascularization (CNV) in patients with age-related macular degeneration (AMD), and current findings indicate that intravitreous injection of AdV vector expressing PEDF is well-tolerated at all doses tested (Campochiaro PA, et al.
IOVS 2004; 45:ARVO E-Abstract 2361). Therefore, local delivery of AdV vector in the eye remains a promising treatment approach.
It is known that, in normal eyes, intravitreous injection of AdV vector results in transduction of anterior segment tissues and sporadic transduction of retinal cells.
9 10 11 12 13 After intravitreous injection, transgene expression peaks within days and decreases to low levels by 1 month in preclinical mouse models.
13 This transient expression profile has been considered a disadvantage for the treatment of most chronic retinochoroidal disease. Our work and the work of others indicate that AdV transduction and expression profiles in pathologic retina differ from those observed in normal retina. Neovascular and nonneovascular proliferative retinopathy, surgical vitrectomy, and laser induction of CNV appear to increase transduction efficiency.
13 14 15 In this study, laser photocoagulation (PC) and, to a lesser extent, photodynamic therapy (PDT) increased viral transduction efficiency and expression in the area of laser treatment. We designed four experimental protocols to address the following questions: (1) At what time point, relative to PC and PDT, should we deliver AdV vector to maximize transduction efficiency and expression? (2) How do PC and PDT affect the duration of AdV vector expression? (3) What is the dose of AdV vector necessary to achieve enhanced focal expression? (4) By what mechanisms could enhanced transduction efficiency and gene expression occur in laser-treated retina?
Female Lewis rats were obtained at 4 to 8 weeks of age. Animals were anesthetized by intramuscular injections of 80 mg/kg ketamine hydrochloride. Pupils were dilated with 0.5% tropicamide and 0.5% phenylephrine hydrochloride. All animals were treated while under deep general anesthesia in accordance with the ARVO Statement for the Use of Animals in Ophthalmic and Vision Research.
At predetermined time points before and after PC or PDT treatment, according to treatment protocol, rats received intravitreous injection of AdlacZ.11D. All injections were performed with a syringe (Hamilton, Reno, NV) fitted with a 33-gauge beveled needle. The rats were anesthetized; the pupils were dilated; and, under an operating microscope, the needle was passed through the sclera at the equator, into the vitreous cavity; and the vector was injected. The needle tip was directly observed to be in the center of the vitreous cavity throughout the procedure.
Thermal diode laser PC (532-nm wavelength, 200-μm spot size, 0.5-second duration, 300 mW) was delivered using the slitlamp delivery system (SL130; Carl Zeiss Meditec, Inc., Oberkochen, Germany) and a hand-held cover slip as a contact lens. Fifty PC burns were delivered to each eye, confined to the left half of the posterior fundus.
PDT was performed with the novel hydrophilic photosensitizer; mono-
l-aspartyl chlorin e6 (NPe6, LS11; Light Science, Seattle, WA).
19 20 21 A solution of 10 mg/kg body weight LS11 was administered through the tail vein. Irradiation with a diode laser (664-nm wavelength, 100-μm spot size, 10-second duration, 4.5 mW) was started within 5 minutes after intravenous injection. Five PDT laser spots were placed in the left half of the posterior fundus in each eye equally, using a 664-nm diode laser delivery system (prototype for NPe6; Panasonic, Osaka, Japan).
19
Protocol 1.
To determine the time point, relative to PC and PDT, when the AdV vector should be delivered, to maximize transduction efficiency and expression, we administered intravitreous injections to the rats of AdlacZ.11D at a concentration of 3 × 109 particles per eye on days 1, 3, 7, and 28 after laser treatment. Five days after viral delivery, all eyes were enucleated and examined histochemically for LacZ staining.
Protocol 2.
To evaluate how PC and PDT affects the duration of AdV vector expression in the retina, we injected rats intravitreously with AdlacZ.11D, 3 × 109 particles per eye, 3 days after laser treatment. The eyes were enucleated and examined histochemically on days 5, 14, 28, 90, 135, and 180 after viral delivery.
Protocol 3.
To investigate the dose–response of transgene expression in laser treated retina, we injected rats intravitreously with AdlacZ.11D at a concentration of 3 × 105, 3 × 106, 3 × 107, 3 × 108, or 3 × 109 particles per eye, 3 days after laser photocoagulation. Eyes were enucleated and examined histochemically 5 days after viral delivery.
Protocol 4.
Histochemical analysis consisted of fixing eyes in 2.5% glutaraldehyde in phosphate-buffered saline (PBS) for 60 minutes and rinsing five times for 10 minutes in PBS. The anterior segments were removed, and the remaining posterior segments were incubated overnight in 1 mg/mL 5-bromo-4-chloro-3-indolyl galactopyranoside (X-gal; Sigma-Aldrich, St. Louis, MO) in a solution containing 5 mM K3Fe(CN)6, 5 mM K4Fe(CN)6-3H2O, and 1 mM MgCl2 in PBS. Eyes were postfixed for 15 minutes and then rinsed with PBS.
For quantitative analysis of X-gal staining in the posterior segment of eyes, a dissecting microscope and its camera system (MZ 8 and MPS 30; Leica, Wetzlar, Germany) were used. Images were captured, digitized, and analyzed by image-analysis software (Win ROOF; Mitani Corp., Fukui, Japan) to delineate X-gal-stained areas. Area ratios (X-gal-stained area to total retinal area) were calculated for each eye. Statistical analysis comparing the area ratio between the treated left hemisphere and the untreated right hemisphere was performed using the Wilcoxon signed-rank test. P < 0.05 was prospectively assigned as the level at which a finding would be considered statistically significant.
Enhanced Focal Gene Transfer in Rat Retina at Various Time Points after PC and PDT
The Time Course of LacZ Expression in Laser-Treated Rat Retina after Intravitreous Injection