Progress in the development of nucleic acid therapeutics

Abnormal gene expression is a hallmark of many diseases. Gene-specific downregulation of aberrant genes could be useful therapeutically and potentially less toxic than conventional therapies due its specificity. Over the years, many strategies have been proposed for silencing gene expression in a gene-specific manner. Three major approaches are antisense oligonucleotides (AS-ONs), ribozymes/DNAzymes, and RNA interference (RNAi). In this brief review, we will discuss the successes and shortcomings of these three gene-silencing methods, and the approaches being taken to improve the effectiveness of antisense molecules. We will also provide an overview of some of the clinical applications of antisense therapy.     

Novel virally targeted therapies of EBV-associated tumors

EBV is associated to the development of several malignancies of lymphoid and epithelial origin, including Burkitt's Lymphoma, post-transplant lymphoproliferative disorders, Hodgkin's disease, AIDS-associated lymphomas, NK/T cell lymphoma and Nasopharyngeal carcinoma. EBV genes play an essential role in the development of the malignant phenotype and therefore molecules interfering with the function of these genes may represent an essential tool to treat EBV-associated malignancies. Several strategies to inhibit virus-induced tumorigenesis have been developed including antiviral and antitumor molecules, gene therapy approaches, interference with epigenetic regulatory mechanisms, adoptive and active immunotherapeutic protocols. While gene therapy and epigenetic approaches gave inconsistent results, immunological therapies using ex vivo expanded autologous and allogenic cells specific for EBV have obtained promising results. The major challenge is now to improve the current knowledge on virus replication strategies and on the characteristics of protective immune response that may result in more effective therapeutic protocols.     

Genetic approaches for biologic therapy of cancer

Recently, there has been an increase in the types of biological therapeutic approaches developed for the treatment of cancer. This rapid advance in the biological therapy of cancer is due in part to advances in the field of molecular and cell biology as well as in the development of gene transfer systems. In particular, a better understanding of the mechanism of antigen presentation and T lymphocyte activation has resulted in the development of new immunotherapeutic strategies targeting tumor-associated antigens (TAA). The discovery of dendritic cells (DC) as potent antigen presenting cells and the development of methods for their use in immunotherapeutic regimens has led to novel approaches for treating cancer. Furthermore, the identification of genes encoding TAA and their peptide products, which are recognized by T lymphocytes in the context of major histocompatibility complexes class I and class II molecules, has led to the development of DNA-based vaccines against defined tumor antigens. Cytokines have been shown to be important adjuvant tools for immunization protocols by directing a T helper response favorable for an adequate cytotoxic T lymphocyte-mediated immune response. Novel gene transfer technologies have made it possible to employ a wide range of gene delivery systems, either viral or nonviral based, in anticancer therapies. Current immunotherapeutic strategies, including the use of DC transduced with genes coding for tumor antigens and cytokines delivered by recombinant viral vectors, have shown promise in animal tumor models.     

Use of Transgenic Animals in Understanding Molecular Mechanisms of Toxicity*

Understanding molecular mechanisms of chemical toxicity and the potential risks of drugs to man is a pivotal part of the drug development process. With the dramatic increase in the number of new chemical entities arising from high throughput screening, there is an urgent need to develop systems for the rapid evaluation of potential drugs so that those agents which are most likely to be free of adverse effects can be identified at the earliest possible stage in drug development. The complex mechanisms of action of chemical toxins has made it extremely difficult to evaluate the precise toxic mechanism and also the relative role of specific genes in either potentiating or ameliorating the toxic effect. This problem can be addressed by the application of genetic strategies. Such strategies can exploit strain differences in susceptibility to specific toxic agents or, with the rapidly developing technologies, can exploit the use of transgenic animals where specific genes can be manipulated and subsequent effects on chemical toxicity evaluated. Transgenic animals can be exploited in a variety of ways to understand mechanisms of chemical toxicity. For example, a human gene encoding a drug metabolizing enzyme can be directly introduced and the effects on toxic response evaluated. Alternatively, specific genes can be deleted from the mouse genome and the consequences on toxicological response determined. Many toxic chemical agents modulate patterns of gene expression within target cells. This can be used to screen for responses to different types of toxic insult. In such experiments the promotor of a stress-regulated gene can be ligated to a suitable reporter gene, such as lacZ, or green fluorescent protein, and inserted into the genome of an appropriate test species. On administration of a chemical agent, cells which are sensitive to the toxic effects of that chemical will express the reporter, which can then be identified using an appropriate assay system. This latter strategy provides the potential for screening a large number of compounds rapidly for their potential toxic effects and also provides information on tissue and cellular specificity. Experiments using transgenic animals can be complex, and care must be taken to ensure that the results are not affected by background activities within the species being used. For example, the introduction of a specific human cytochrome P450 gene may have no effect on the metabolic disposition of a drug or toxin because of the background activity within the mouse. As the toxicity of a chemical agent is determined by a wide range of different factors including drug uptake, metabolism, detoxification and repair, differences between man and the species being used could potentially generate a toxic response in the animal model whereas no toxicity may be observed in man. In spite of these confounding factors, the application of transgenic animals to toxicological issues has enormous potential for speeding up the drug discovery process and will undoubtedly become part of this process in the future.     

Compounds from diverse natural origin against triple-negative breast cancer: A comprehensive review

Triple-negative breast cancer (TNBC) is caused due to the lack of estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor 2 (HER2) expression. Triple-negative breast cancer is the most aggressive heterogeneous disease that is capable of producing different clones and mutations. Tumorigenesis in TNBC is caused due to the mutation or overexpression of tumor suppressor genes. It is also associated with mutations in the BRCA gene which is linked to hereditary breast cancer. In addition, PARP proteins and checkpoint proteins also play a crucial function in causing TNBC. Many cell signaling pathways are dysregulated in TNBC. Even though chemotherapy and immunotherapy are good options for TNBC treatment, the response rates are still low in general. Many phytochemicals that are derived from natural compounds have shown very good inhibitions for TNBC. Natural compounds have the great advantage of being less toxic, having lesser side effects, and being easily available. The secondary metabolites such as alkaloids, terpenoids, steroids, and flavonoids in natural products make them promising inhibitors of TNBC. Their compositions also offer vital insights into inhibitory action, which could lead to new cancer-fighting strategies. This review can help in understanding how naturally occurring substances and medicinal herbs decrease specific tumors and pave the way for the development of novel and extremely efficient antitumor therapies.     

Discovery, development and effectiveness of coagulation-inhibiting drugs for stroke therapy

Introduction: Stroke is the third leading cause of death in the US and the leading cause of major disability. A large variety of drugs and new therapeutic strategies are the basis for modern stroke therapy. There is scientific evidence for the effectiveness of only a few coagulation-inhibiting drugs for stroke prevention and treatment, but a lot of clinical trials have been conducted or are ongoing in order to gain more scientific data on stroke management and therapy. Areas covered: This paper gives a general overview of modern coagulation-inhibiting drugs discovered and investigated for prevention or acute stroke therapy and offers prospects of future therapy options. Expert opinion: Without the development of more cost-effective future therapies and implementation of extended prevention programs, stroke will remain the leading cause of disability. There is still a strong need for the discovery of novel drug therapies that effectively avoid blood clotting and stroke without increasing the risk of hemorrhage.     

Developmental toxicity of low generation PAMAM dendrimers in zebrafish

Biological molecules and intracellular structures operate at the nanoscale; therefore, development of nanomedicines shows great promise for the treatment of disease by using targeted drug delivery and gene therapies. PAMAM dendrimers, which are highly branched polymers with low polydispersity and high functionality, provide an ideal architecture for construction of effective drug carriers, gene transfer devices and imaging of biological systems. For example, dendrimers bioconjugated with selective ligands such as Arg-Gly-Asp (RGD) would theoretically target cells that contain integrin receptors and show potential for use as drug delivery devices. While RGD-conjugated dendrimers are generally considered not to be cytotoxic, there currently exists little information on the risks that such materials pose to human health. In an effort to compliment and extend the knowledge gleaned from cell culture assays, we have used the zebrafish embryo as a rapid, medium throughput, cost-effective whole-animal model to provide a more comprehensive and predictive developmental toxicity screen for nanomaterials such as PAMAM dendrimers. Using the zebrafish embryo, we have assessed the developmental toxicity of low generation (G3.5 and G4) PAMAM dendrimers, as well as RGD-conjugated forms for comparison. Our results demonstrate that G4 dendrimers, which have amino functional groups, are toxic and attenuate growth and development of zebrafish embryos at sublethal concentrations; however, G3.5 dendrimers, with carboxylic acid terminal functional groups, are not toxic to zebrafish embryos. Furthermore, RGD-conjugated G4 dendrimers are less potent in causing embryo toxicity than G4 dendrimers. RGD-conjugated G3.5 dendrimers do not elicit toxicity at the highest concentrations tested and warrant further study for use as a drug delivery device.     

Nucleic-acid therapeutics: basic principles and recent applications

The sequencing of the human genome and the elucidation of many molecular pathways that are important in disease have provided unprecedented opportunities for the development of new therapeutics. The types of molecule in development are increasingly varied, and include antisense oligonucleotides and ribozymes. Antisense technology and catalytic nucleic-acid enzymes are important tools for blocking the expression of abnormal genes. One FDA-approved antisense drug is already in the clinic for the treatment of cytomegalovirus retinitis, and other nucleic-acid therapies are undergoing clinical trials. This article reviews different strategies for modulating gene expression, and discusses the successes and problems that are associated with this type of therapy.     

Gene therapy approaches to HIV infection

The HIV pandemic represents a new challenge to biomedical research. What began as a handful of recognized cases among homosexual men in the US has become a global pandemic of such proportions that it clearly ranks as one of the most destructive viral scourges in history. In the past few years new treatments and drugs have been developed and tested, but the development of a new generation of therapies remains a major priority, because of the lack of chemotherapeutic drugs or vaccines that show long-term efficacy in vivo. Recently, gene therapeutic strategies for the treatment of patients with HIV infection have received increased attention because they are able to offer the possibility of simultaneously targeting multiple sites in the HIV genome, thereby minimizing the production of resistant virus. Recombinant genes for gene therapy can be classified as expressing interfering proteins (intracellular antibodies, dominant negative proteins) or interfering RNAs (antisense RNAs, ribozymes, RNA decoys). The latter group offers the advantage of avoiding the stimulation of host immune response which might progressively decrease the efficacy of proteins. The stumbling block to achieving lasting antiviral effects is still represented by the lack of efficient gene transfer techniques capable of generating persistent transgene expression and a high number of transduced cells relative to untransduced cells. Novel delivery vectors, such as lentiviruses, might overcome some of these shortcomings. The use of recombinant genes to generate immunity is a very promising concept that is rapidly expanding. Since the immune system can significantly amplify the response to tiny amounts of antigen, DNA vaccines can indeed be delivered by exploiting traditional gene therapy approaches without the need of high transduction efficiency.     

A balanced approach to the detection, characterisation and mechanism of the toxicity of industrial chemicals

Several thousands of new chemical entities are synthesised each year in the laboratories of the world. Currently there are estimated to be some 100,000 substances used commercially of the 7 million chemicals recorded by chemical abstracts (Ca 1.5%). Public attention is mainly attracted to the potential life threatening and ill health effects of chemicals such as systemic poisoning, carcinogenicity, teratogenicity and mutagenicity, although there are relatively few proven human chemical carcinogens, teratogens or mutagens. Many substances have been examined in animal toxicity studies for their acute toxic effects, far fewer for chronic toxic effects. The public's perception is that chemicals are toxic. In our laboratory, minimal to no lethal toxic effects were recorded for more than 60% of substances examined at doses below 2000 mg/kg/bwt by either oral or dermal routes. A similar spectrum of chemicals did not elicit skin or ocular irritant or skin sensitisation response in 70-80% of studies. Perversely although toxicity studies reasonably predict the probable human response following exposure, they are a focus of a strong public lobby supported by many scientists to curtail studies in experimental animals. Consequently, much effort is devoted towards the development of "alternative" in vitro and ex-vivo procedures. Often these are empirically based without consideration of the underlying fundamental physiology, biochemistry or toxic mechanism of action. Consequently there can be an over-estimation or expectation of their ability to predict potential toxicity. Attention is seldom directed towards the design requirements of the validation studies needed to test, performance and reproducibility and the evaluation of the parameters of sensitivity and specificity.(ABSTRACT TRUNCATED AT 250 WORDS)     

Targeting microRNAs in cancer: rationale, strategies and challenges

MicroRNAs (miRNAs) are evolutionarily conserved small non-coding RNAs that regulate gene expression. Early studies have shown that miRNA expression is deregulated in cancer and experimental data indicate that cancer phenotypes can be modified by targeting miRNA expression. Based on these observations, miRNA-based anticancer therapies are being developed, either alone or in combination with current targeted therapies, with the goal to improve disease response and increase cure rates. The advantage of using miRNA approaches is based on its ability to concurrently target multiple effectors of pathways involved in cell differentiation, proliferation and survival. In this Review, we describe the role of miRNAs in tumorigenesis and critically discuss the rationale, the strategies and the challenges for the therapeutic targeting of miRNAs in cancer.     

The re-emergence of aerosol gene delivery: a viable approach to lung cancer therapy

The long-term survival of lung cancer patients treated with conventional therapies (surgery, radiation therapy and chemotherapy) remains poor and has changed little in decades. The need for novel approaches remains high and gene therapy holds promise in this area. A number of genes have been shown in vitro, in animal studies and most recently, in human clinical trials, to have antitumor actions. However, a number of problems still exist and success in human patients to date has been marginal. Among the numerous considerations are the efficiency of delivery of the gene to the tumor or, if an indirect effect is the aim, possibly nontumor tissues, the efficiency and persistence of expression of the therapeutic gene, the specificity of the gene action against the tumor, potential toxic or pathogenic consequences of either the genes or the delivery vectors used, convenience of the therapy and how likely the therapy will compliment or complicate other conventional anticancer therapies. After the cloning of the cystic fibrosis gene, there was great interest in the noninvasive delivery of genes directly to the pulmonary surfaces by aerosol. Clearly, this approach could have application to some pulmonary cancers as well and most early efforts focused mainly on the use of nonviral vectors, primarily cationic lipids. Unfortunately, nebulization shear forces and inefficient pulmonary uptake and expression of plasmid DNA-cationic lipid formulations have generally resulted in a lack of therapeutic effect, so much of this work has diminished in recent years. Polyethyleneimine (PEI)-based formulations have proven stable during nebulization and result in nearly 100% efficient transfection throughout the airways and lung parenchyma. Therapeutic responses have been obtained in several animal lung tumor models when PEI-based formulations of p53 and other antitumor genes were delivered by aerosol. In addition, this mode of delivery seems to be associated with low toxicity and results in little or none of the immunostimulatory response typically associated with the delivery of bacterially produced plasmid DNA containing unmethylated CpG motifs, which has presented a challenge to repeated gene therapy via other modes of delivery. Other potential applications of PEI aerosol gene delivery include the treatment of asthma, lung alveolitis and fibrosis and a variety of monogeneic diseases such as cystic fibrosis and alpha-1-antitrypsin deficiency. In addition, a wide range of conditions treatable via genetic immunization could benefit from this approach to gene delivery as well.     

TOGA analysis of gene expression to accelerate target development.

With the availability of new technologies for analysis of gene expression, drug targets may now be identified through more focused rational approaches. We have developed an extremely sensitive, reproducible, and accurate method called TOGA, enabling analysis of nearly all genes within an RNA sample. This technology can be used to identify genes regulated in a great variety of situations. For example, we have been able to find genes with expression restricted to specific brain regions, and in a recent example, we found a gene regulated in specific brain regions in response to clozapine treatment. These studies will quickly lead to identification of genes critical to specific biological and clinical processes, accelerating the development of new targets and therapies.     

Genes for asthma: much ado about nothing?

The identification of genes that make individuals susceptible to developing asthma is an area of increasing focus by both academic and industrial groups. The complexity of asthma genetics has made the identification of susceptibility genes difficult; however, genome-wide screens followed by positional cloning have started to identify such genes for both asthma and asthma-related traits. In addition, evidence from candidate gene studies indicates that gene-gene interactions also play an important role in conferring genetic risk for asthma development. Although progress in terms of identifying new therapeutic targets has not been dramatic, our understanding of the complexity of the genetic basis of asthma has greatly increased. There can be little doubt that, in the future, this knowledge will lead to fundamental insights into the molecular pathophysiology of asthma and the development of new therapies.     

Section Review Pulmonary-Allergy,Dermatological, Gastrointestinal & Arthritis: New antirejection drugs

Immunosuppressive therapies to abrogate host reactivity to allografts have been applied since the early days of clinical transplantation. However, new immunosuppressive agents and treatment protocols are constantly evolving. Advances in our understanding of basic immune mechanisms have stimulated novel strategies for controlling graft rejection. T-cells play a central role in the specific immune response of allograft rejection, and strategies to prevent T-cell activation or effector function are thus potentially useful for immunosuppression. During the last few years numerous new immunosuppressive compounds have entered early and late phases of development for transplant immunomodulation. This review aims to define the field of antirejection drugs as it currently exists and to examine what the future holds by considering new compounds which have appeared recently in the patent literature.     

Microparticles and nanoparticles as delivery systems for DNA vaccines

DNA vaccines, also referred to as genetic vaccines, are generating significant preclinical and clinical interest. It has been proven that the expression of an antigen or antigens from plasmid DNA (pDNA) may elicit both humoral and cellular immune responses. Therefore, DNA vaccines may have potential as new vaccines for important pathogens such as HIV, hepatitis C, tuberculosis, and malaria. However, the clinical results using "naked" pDNA have been disappointing in the breadth and depth of the immune response and the relatively high doses of pDNA needed to elicit a response. Clinical trials with the gene gun have been promising, but it is unclear whether this technology will be commercially viable. As a result, there exists a clear need for new vaccine delivery systems that can be administered at low doses to elicit strong humoral and cellular immune responses. One promising approach is the development of microparticles and nanoparticles as delivery systems for DNA vaccines. In this review, the application of microparticles and nanoparticles as DNA vaccine delivery systems will be critically reviewed with a primary focus on those systems that have generated in vivo immune responses.     

Development of new drugs in angiogenesis

Angiogenesis, the growth of new capillaries from pre-existing vessels, contributes to the development and progression of a variety of physio-pathological conditions. There is growing evidence that anti-angiogenic drugs will improve future therapies of diseases like cancer, rheumatoid arthritis and ocular neovascularisation. Conversely, therapeutic angiogenesis is an important homeostatic response contributing to limit the damage to ischemic tissues. Molecular processes involved in angiogenesis include stimulation of endothelial growth by cytokine production (i.e. vascular endothelial growth factor, VEGF; fibroblast growth factor-2, FGF-2), degradation of extracellular matrix proteins by matrix metalloproteinases (MMPs), and migration of endothelial cells mediated by integrins (cell membrane adhesion molecules). Drugs targeting pathologic angiogenesis have been designed to interfere with any of these steps and are currently undergoing evaluation in early clinical studies. Important therapeutic strategies are: suppression of activity and signaling pathways activated by the major angiogenic regulators like VEGF and FGF-2; inhibition of function of alphav-integrins and MMPs; exploitation of endogenous anti-angiogenic molecules like angiostatin and endostatin. The strategy to "silence" endothelium with antiangiogenic drugs to starve tumors, provides a novel approach for cancer treatment. The unique targets of these drugs (endothelium) make them distinct from traditional cytotoxic chemotherapeutic agents. Conversely, gene transfer of angiogenesis inducers is the new approach for therapeutic neovascularization, which is under investigation using a variety of growth factors and a wide array of potential delivery systems, including the application of the gene as naked DNA or by viral vector. The status of pro- and anti-angiogenic therapies is here presented and discussed.     

Targeted drugs in oncology: new names, new mechanisms, new paradigm.

The molecular mechanisms of action, clinical development, and efficacy and safety of targeted antineoplastic drugs are discussed. Recently introduced mechanism-based systemic therapies for cancer may be more specific, less toxic, and more effective and represent a paradigm shift in treatment. Currently, receptor tyrosine kinases (RTKs), nonreceptor kinases, the angiogenic molecules, the enzymes involved in extracellular matrix degradation, and the enzymes responsible for protein anchorage to the cytoplasmic membrane are among the targets against which specific interventions have been developed. Monoclonal antibodies against the extracellular portion of RTKs and small-molecule inhibitors of their tyrosine kinase activity are strategies in more advanced phases of clinical development. Over the next few years, one can expect to see the results of many studies of such new pharmacologic agents or combinations. It seems likely, at this point, that targeted drugs will be used in association with existing medical, surgical, and radiotherapeutic modalities and will play an important role in the ultimate goal of reducting the burden of cancer. Targeting of molecular abnormalities that are differentially expressed in tumors may represent a more specific and less toxic way of treating cancer.