Glioblastoma (GBM), a tumour thought to arise from neuroglial stem or progenitor cells, is the most aggressive primary adult brain cancer. It has an average incidence of 3 cases per 100 000 people per year worldwide[
1], making it the most common type of malignant adult brain neoplasm. The current standard treatment procedure for GBM involves the maximum surgical resection of the tumour (where possible), followed by radiation therapy and concomitant chemotherapy with the oral alkylating agent temozolomide (TMZ). Nevertheless, due to its heterogeneity, invasiveness, and rapid growth, the prognosis for GBM patients is very poor, where mean overall survival is only approximately 15 months [
2].
Oncolytic viruses, which are viruses engineered to selectively infect and lyse tumour cells, constitute a promising alternative therapeutic agent for GBM (reviewed in [
3]). Their ability to self-amplify within tumour cells not only expands the therapy at the point of need (i.e within the tumour microenvironment, TME), but also induces immunogenic cell death (ICD) through the lytic nature of cell death. The power of oncolytic viruses can be further augmented by engineering potent therapeutic transgenes into the viral genome that can further enhance immune activation and immune cell mediated tumour cell killing. Collectively, these traits have the potential to instigate an anti-glioma immune response against both the primary tumour and metastatic growth within the brain.
Whilst the array of viruses available for oncolytic applications are wide, adenoviruses (Ad) have proven most popular as oncolytic viruses against several types of cancer, as gauged by the volume of clinical trials conducted in the area to date [
4]. They have a proven safety profile clinically, are relatively amenable to genetic manipulation, and are able to accommodate relatively large transgene inserts [
5]. However, to date, the promising results demonstrated in vitro and in murine models of cancer have largely failed to translate into significant efficacy in clinical trials. Whilst these trials demonstrated feasibility and safety, improvements to cancer patient outcome have generally been modest . Limited efficacy may be due in part to the over reliance of many clinical studies focusing on adenovirus 5 (Ad5).
There have been over 100 human adenoviral serotypes described to date with differing entry receptors as well prevalence rates within the human population [
8]. Ad5 has a particularly high prevalence in the human population, especially in Africa and Asia. Neutralising antibodies against Ad5, generated in response to a natural pathogenic infection, may hamper the efficacy of Ad5 based therapies when deployed clinically due to immune inactivation. Alternative serotypes including Ad10 have been explored to overcome the effects of anti-Ad5 neutralization [
11]. In addition, Ad5 engages coxsackie and adenovirus receptor (CAR) [
12] as a primary means of cell entry, a receptor that is expressed both on erythrocytes and the tight junctions of epithelial cells (reviewed in [
13]), yet is commonly downregulated by some types of cancer . Furthermore, interactions between the major Ad5 capsid protein, hexon, and blood clotting factors, particularly factor (F) X, result in rapid and efficient cellular uptake of Ad5 virions via widely expressed heparan sulphate proteoglycans (HSPGs) [
16,
17,
18]. This results in depletion of the therapeutic effects due to widespread off-target infection and sequestration with inefficient tumour cell infection by Ad5 [
19]. Consequently, studies investigating Ad5 based therapies for recurrent GBM, have so far only been able to demonstrate modest success. Whilst demonstrating safety and oncolysis by the intratumoural delivery of the virus, overall median patient survival was not improved from standard of care (13 months) as the tumour invariably returned [
20]. Local delivery is likely a necessity in GBM to overcome the physical obstacle of the blood brain barrier and to prevent local recurrence after surgical resection. We therefore investigated whether the development of Ad based therapeutics using alternative adenovirus entry receptors may represent a more potent virotherapy for GBM. We have focused on Ad5 vectors pseudotyped with fiber knob proteins derived from serotypes Ad26, Ad35 and Ad3 which utilise the cell entry receptors sialic acid (SA) [
21], or CD46 [
22] and Desmoglein 2 (DSG2) [
23] respectively. We demonstrate that GBM cell lines and tissue express all three adenoviral entry receptors tested, namely CAR, CD46 and DSG2. In addition, sialic acid is known to be expressed at high levels in the brain[
24]. We have also shown that GBM does not express αvβ6 integrin, which is upregulated in many other types of aggressive cancers (e.g., ovarian, lung, skin and cervical cancer [
25], and is a promising target for novel adenoviral oncolytic therapies [
16,
17,
18]. We also investigated the efficacy of various Ad5 pseudotypes to gauge which adenoviral serotype may be better suited for oncolytic therapy in GBM. Our experiments revealed that both GBM and GBM stem cells express recognized adenoviral receptors and can be transduced by Ad5 and Ad5 with pseudotyped fiber knob proteins binding CD46, sialic acid and DSG2. Since these entry receptors are not unique to transformed GBM cells, and are expressed on normal cells, we additionally investigated whether improving selectivity, through the incorporation of tumour specific promoters, could be employed to regulate the expression of potentially toxic or immunostimulatory transgenes to transformed GBM cells. Our findings indicate that a combination of alternative receptor usage, either through the use of pseudotyped or whole serotyped vectors, in combination with tumour specific promoters such as survivin, may offer a powerful and highly selective means to deliver cytotoxic or immunostimulatory payloads selectively to GBM cells.