1. Introduction
Small interfering RNAs (siRNAs) silence the expression of the target genes by inducing RNA interference (RNAi) [
1]. The catalytic sequence-specific silencing activity of siRNA provides high efficiency and selectivity of their action, which allows them to be considered as a new class of drugs for the therapy of diseases that are not treatable by small molecules or monoclonal antibodies [
2]. Currently, the clinical use of siRNA is limited to liver diseases; however, methods for delivering RNA to other organs, including the brain and spinal cord [
3,
4], kidneys [
5,
6], spleen [
7], lungs [
3,
8] are currently under development. The employment of siRNA covalent conjugates with transport ligands is the most promising among siRNA delivery methods due to their low toxicity and high delivery efficiency [
9]. 4 from 5 siRNA based drugs already approved for clinical use are siRNA conjugates, and they demonstrate safe toxicity and immunogenicity profiles [
10,
11,
12,
13,
14]. The lungs are important target organs for siRNA therapy since they are involved in the development of life-threatening diseases. On the other hand, non-invasive local delivery to lungs could be used to reduce the incidence of systemic side effects and provide effective accumulation of the drug. The use of cholesterol-conjugated siRNA for this purpose seems particularly promising since it can retard in the organs after local delivery and excludes the use of delivery vehicles to avoid additional lung injury [
15,
16,
17]. Therefore, in this work, we used intranasal administration of cholesterol-containing siRNA conjugates to block target gene expression in the lungs.
Inflammatory diseases affect, according to various estimates, 5%-9% of the world population [
18,
19], and their incidence increases every year [
20]. Inflammation is associated with reduced life expectancy [
19], as well as an elevated risk of cancer [
21]. Existing drugs for the treatment of inflammation are characterized by side effects, including toxicity, immunogenicity, and an increased risk of developing infectious diseases [
22,
23]. In addition, not all patients respond to existing therapy, and drug resistance may develop over time [
22,
24].
Acute lung injury (ALI), or its more severe manifestation, acute respiratory distress syndrome (ARDS), is a clinical syndrome characterized by damage of the vascular endothelium and alveolar epithelium, which leads to interstitial and pulmonary edema and, ultimately, alveolar collapse [
25]. An important role in increasing the permeability of the alveolar–capillary barrier is played by neutrophils that migrate into the lung, secreting pro-inflammatory and pro-apoptotic mediators that damage neighboring cells [
26]. An estimated incidence of ALI/ARDS is 64.2 cases per 100,000 person-years, the mortality rate is 29-42% [
26,
27]. ALI treatment is not addressed adequately by available therapy and represents an unmet medical need.
We chose interleukin-6 (
Il6) as a target gene, which is one of the master regulators of inflammatory processes [
28], facilitating neutrophil recruitment to the lungs [
29]. A decrease in its level is associated with a weakening of ALI symptoms [
30]. Thus, in this work, we developed an anti-
Il6 siRNA, conjugated it with cholesterol, validated their silencing activity
in vitro, and examined its anti-inflammatory properties in the ALI mouse model.
2. Materials and Methods
Synthesis of siRNAs, their cholesterol-containing analogues, and duplex annealing
The anti-
Il6 siRNA sequences are listed in
Table 1, the control siRNA (siSCR) has no significant homology to any known mouse, rat, or human mRNA sequence. Oligoribonucleotides and their analogs were synthesized by the phosphoramidite method on an automatic ASM-800 synthesizer (Biosset, Novosibirsk, Russia). 2'-
O-TBDMS-protected, 2'-F-, 2'-
O-Me-ribophosphoramidites, and CPG polymeric carriers with an attached first nucleoside (Glen Research, Sterling, VA, USA) were used in the synthesis. Sulfurizing Reagent II (Glen Research, Sterling, VA, USA) was used to introduce phosphothioate linkages. For the synthesis of siRNA conjugates containing a cholesterol residue with a hexamethylene linker at the 5'-end, a solid-phase synthesis method was used based on the activation of the free 5'-hydroxyl group of a protected polymer-bound oligonucleotide with
N,N'-disuccimidyl carbonate (Acros Organics, Geel, Belgium), followed by the interaction with cholesteryl-6-aminohexylcarbamate by analogy with [
31]. After standard deprotaction the target products were isolated by preparative gel electrophoresis in 15% polyacrylamide gel (PAAG) under denaturing conditions, followed by elution of the products with a 0.3 M NaClO
4 solution. The isolated products were desalted on a Sep-Pac C18 cartridge (Waters, Milford, MA, USA) or Amicon Ultra 3K (Millipore, Burlington, MA, USA) and precipitated with a 2% NaClO
4 solution in acetone. To obtain duplexes, equimolar concentrations of the sense and antisense siRNA strands were incubated in 30 mM HEPES-KOH (pH 7.4), 100 mM potassium acetate, and 2 mM magnesium acetate at 90°C for 5 min. With a gradual decrease in temperature, the strands hybridized for 1 h, and the duplexes were stored at -20°C.
Cell Culture
The J774 macrophage cell line was obtained from the Russian Cell Culture Collection (Institute of Cytology, RAS, St. Petersburg, Russia). Cells were cultured in Dulbecco’s modified Eagle’s medium (DMEM) (Sigma-Aldrich Inc., St. Louis, MO, USA) supplemented with 10% heat-inactivated fetal bovine serum (BioloT, St. Petersburg, Russia) and an antibiotic-antimycotic solution (100 U/mL penicillin, 100 μg/mL streptomycin, 0.25 μg/mL amphotericin) and incubated at 37°C in a humidified 5% CO2-containing air atmosphere (hereafter standard conditions).
Mice
Female 6–8-week-old Balb/C mice (average weight 20–22 g) were obtained from the Vivarium of the Institute of Chemical Biology and Fundamental Medicine SB RAS (Novosibirsk, Russia). The mice were housed in plastic cages (3-6 animals per cage) under normal daylight conditions. Water and food were provided ad libitum. Experiments were carried out in accordance with the European Communities Council Directive 86/609/CEE. The experimental protocols were approved by the Committee on the Ethics of Animal Experiments of the Administration of the Siberian Branch of the Russian Academy of Sciences (Novosibirsk, Russia) (protocol No. 56 from August 10, 2019).
Transfection of siRNA
One day before the experiment, J774 cells in the exponential phase of growth were plated in 24-well plates at a density of 1.5×105 cells/well. After 24 h, the growth medium was replaced by fresh serum-free DMEM. The cells were transfected with siRNAs (1-100 nM) using Lipofectamine 2000 (Invitrogen, Waltham, MA, USA) according to the manufacturer’s protocol (2 μL of Lipofectamine 2000 per well). Two days after transfection, cells were replated to prevent overgrowth. Then, 4 days after transfection, LPS (final concentration: 1 nM) was added to the cells. 6 hours after the addition of LPS, total RNA was isolated from the cells using a kit for RNA isolation, Namagp100 (Biolabmix, Novosibirsk, Russia), and an Auto-Pure 96 automatic nucleic acid isolation and purification system (Allsheng, Hangzhou, China), according to the manufacturer’s protocol. RT-qPCR was performed using M-MuLV-RH revertase and BioMaster HS-qPCR (Biolabmix, Novosibirsk, Russia). The amount of Il6 mRNA was normalized to the amount of Hprt mRNA used as an internal standard. To assess the mRNA level of the genes, the following primers and probes were used:
Il6_F 5'-AAACCGCTATGAAGTTCCTCTC-3'
IL6_Probe: 5'-((5,6)-FAM)-TTGTCACCAGCATCAGTCCCAAGA-3'-BHQ1
IL6_R: 5'-GTGGTATCCTCTGTGAAGTCTC-3'
Hprt_F: 5'-CCCCAAAATGGTTAAGGTTGC-3'
Hprt_Probe: 5'- ((5,6)-ROX)-CTTGCTGGTGAAAAGGACCT-3'-BHQ2
Hprt_R: 5'-AACAAAGTCTGGCCTGTATCC-3'
Data processing was carried out using Bio-Rad CFX Manager 3.1 software (Bio-Rad Laboratories Inc., Hercules, CA, USA).
LPS-induced acute lung injury (ALI)
Mice (n = 3-5 in each group) were challenged with LPS (10 µg per mouse, 055:B5, Sigma-Aldrich, USA) via intranasal (i.n.) instillations under isoflurane anesthesia. Ch-siIL6PS were administered i.n. 4 days before ALI induction. The mice were euthanized 6 h after the induction of lung inflammation; the lungs were lavaged with 1 mL of ice-cold saline buffer.
The 20 µL of collected bronchoalveolar lavage (BAL) fluids were processed for cell counting. 20 µl BAL fluids were incubated for 7 min after the addition of a 400 µL solution with 150 mM NH4Cl, 10 mM NaHCO3, and 0.1 mM EDTA (рН 7.5). Then the solution was centrifuged for 5 min at 500 g at room temperature, supernatant was removed, and cells were counted in 30 µl of saline solution. To determine the differential leukocyte counts, 50 µL of bronchoalveolar cell suspension were placed onto slides, stained with azur-eosin by Romanovsky-Giemsa method, and examined microscopically. The results were expressed as the number of total leukocytes (×105 cells/ml) and the percentages of subpopulations of granulocytes, lymphocytes, and monocytes (%).
The rest of the BAL fluids were centrifuged (1600 rpm, 10 min, 4 °C), the supernatant was removed, RNA isolation and RT-qPCR were carried out as described above.
Histology
For the histological study, lung specimens were fixed in 10% neutral-buffered formalin (BioVitrum, Moscow, Russia), dehydrated in ascending ethanols and xylols, and embedded in HISTOMIX paraffin (BioVitrum, Russia). Paraffin sections (up to 5 µm) were sliced on a Microm HM 355 S microtome (Thermo Fisher Scientific, Waltham, MA, USA) and stained with hematoxylin and eosin. All the images were examined and scanned using an Axiostar Plus microscope equipped with an Axiocam MRc5 digital camera (Zeiss, Oberkochen, Germany) at magnification of × 200.
The intensity of inflammatory infiltration in the lung tissue was assessed by a semi-quantitative method, where 0 is no inflammatory infiltration, 1 is low intensity of inflammatory infiltration, 2 is moderate intensity of inflammatory infiltration, and 3 is high intensity of inflammatory infiltration. Morphometric analysis of lung sections included evaluation of the volume densities (Vv, %) of alveolar septa outside the foci of inflammatory infiltration, reflecting interstitial edema, and was performed using a counting grid consisting of 100 testing points in a testing area equal to 3.2 × 106 μm2. The quantification was performed at a magnification of ×200 in 5 test fields for each lung sample; the number of samples studied was from two to four for each experimental group; thus, 10-20 random fields were analyzed in each experimental group.
Statistical analysis
The variables were expressed as the mean ± standard deviation (SD) or standard error of the mean (SEM). The data were analyzed with the Student’s t-test. The data obtained in vivo were statistically processed using a two-way ANOVA followed by Bonferroni’s post hoc test. The differences between the values are considered statistically significant at p < 0.05. The statistical package STATISTICA, version 10.0, used for analysis.
4. Discussion
Acute inflammation is a protective response to infection or tissue damage, but chronic inflammation, on the contrary, can lead to tissue damage and the development of pathological conditions such as fibrosis, autoimmune processes, malignant transformation, and metastasis [
25,
26]. Corticosteroids are widely used to treat chronic inflammatory diseases, but their effectiveness as an anti-inflammatory drug is limited by steroid drug resistance, which occurs or develops in a significant proportion of patients [
36]. Long-term use of corticosteroids, which are required to treat chronic inflammation, can lead to serious side effects, causing immunosuppression, hypertension, diabetes, and adrenal dysfunction manifested by excess cortisol production [
37]. The use of specific antibodies to combat inflammation has shown promising results, but the technology is not yet free from unwanted side effects [
38]. So, for example, antidrug antibodies were detected in 53% of patients taking adalimumab (a fully humanized IgG1 anti-
TNFa monoclonal antibody [
22]), and high levels of antidrug antibodies were shown to lead to a reduced clinical response [
39]. siRNA-based drugs are much less toxic compared to small molecule drugs, and they mostly do not cause an immune response to siRNA as antibodies do [
11,
12,
13,
14]. Antidrug antibodies were detected only in 0.9%, 6.0%, 1.7%, and 2.5% of patients receiving siRNA-based drugs givosiran, lumasiran, inclisiran, and vutrisiran, respectively, and they did not have a significant effect on PK, PD, efficacy, or safety [
40,
41,
42]. Therefore, the development of drugs based on siRNA conjugates for the treatment of inflammatory diseases that are refractory to standard therapy is promising.
Previously, we demonstrated the possibility of reducing the severity of acute injury in the lungs after intranasal instillation of anti-
Timp1 siRNA complexed with cationic liposomes [
35]. We showed that the reduction of inflammation was accompanied by a reduced number of neutrophils in the BAL fluid. We also showed that silencing of
Timp1 expression by siRNA led to a significant decrease in
Il6 mRNA level, which can prevent leukocyte chemotaxis into lung tissue. IL6 is a multifunctional cytokine that plays an important role in a wide range of biological processes in various cell types, including tumor cells. There are evidences in the literature that deregulated IL6 expression is associated with tumor progression through inhibition of cancer cell apoptosis, stimulation of angiogenesis, and drug resistance [
43]. In chronic inflammation, IL6 plays a detrimental role by promoting the accumulation of mononuclear cells at the site of injury through persistent MCP-1 secretion, angioproliferation, and inhibition of T cell apoptosis. Circulating levels of IL6 are elevated in a number of inflammatory diseases, including rheumatoid arthritis, systemic lupus erythematosus, and Crohn's disease [
7,
44]. Blocking IL6 signaling is a potential strategy for treating cancers characterized by pathological overproduction of IL6.
In this study, we directly silenced
Il6 and found that this approach was effective in reducing the severity of ALI. We showed that cholesterol-conjugated anti-
Il6 siRNA, selected based on the results of preliminary
in vitro screening, has a dose-dependent therapeutic effect in LPS-induced ALI, reducing the number of cells in BAL fluid and the level of
Il6 mRNA in them, as well as reducing the severity of inflammatory and edema changes in the lungs. The treatment of mice by anti-
Il6 siRNA not only significantly changed the proportion of neutrophils in BAL but also reduced the absolute number of leukocytes compared with LPS-challenged mice, which was not achieved by the anti-
Timp1 siRNA treatment. The relative change in inflammatory processes evaluated by histological scoring also showed positive trends: 2.5 and 3.2 folds for anti-
Timp1 and anti-
Il6 siRNAs, respectively [
35]. However, these differences in therapy efficacy may also be due to the chosen targets as well as to different delivery methods and target cells. In a previous study [
35], anti-
Timp1 delivery to the target lung cells was performed using cationic lipids. In this study, we delivered anti-
Il6 siRNA by covalent attachment to cholesterol in order to deliver it to alveolar macrophages. It should be noted that we also tried delivering anti-
Il6 siRNA with cationic lipids; however, our preliminary data showed that delivery with a cholesterol conjugate was 44% more effective in reducing the level of
Il6 mRNA in BAL fluid cells than siRNA /liposome complex [data not presented].
Cytokines, including IL6, are quite difficult targets for regulation by siRNAs because their expression increases rapidly and produces significant amount of mRNA, the translation products of which are secreted from the cell and have an effect on surrounding tissues or even the entire organism. In this work, we applied Ch-siIL6.1PS to prevent ALI in mice in pre-treatment mode; however, it is basically impossible to predict the rapid development of ALI except in cases of epidemic or pathogen exposure. Therefore, the question of whether the developed siRNA can be used in therapeutic regimens during the development of the disease remains open. This may be hampered by the relatively slow development of silencing effect by cholesterol conjugates of siRNA compared to siRNA/liposome complexes because the conjugates are entrapped in the endosomes [
45,
46]. On the other hand, the ability to avoid the use of lipid delivery systems, which themselves can have an immunostimulating effect and cause side effects, may increase the safety of the preparation.
Two main factors limit the length of time during which a single administration of siRNA can prevent the development of ALI: the nuclease resistance of siRNA and the lifetime of target cells in the lungs. Since siRNA is fully protected by 2’F or 2’OMe modifications, as well as PS at the ends of the duplex, it can be expected that its nuclease resistance will allow it to cause silencing within several months, as has been documented for a drug with similar modifications in the liver [
32,
47]. However, the second factor more strongly limits the duration of action of Ch-siIL6.1PS in the lungs after local application. The primary target of siRNA is resident alveolar macrophages, which, in response to LPS, attract macrophages and monocytes from the bloodstream into the lung tissue. Alveolar macrophages reside in the lungs for 1-7 weeks [
48], therefore, we should not expect the effect of one instillation of Ch-siIL6.1PS to last more than a month. This purely theoretical assessment requires a more detailed experimental evaluation.
Thus, the designed cholesterol-conjugated anti-
Il6 siRNA showed its high potential for preventing the development of ALI. The findings indicate that IL6 inhibition is a productive strategy to combat inflammatory diseases. It can be assumed that such a strategy could be applied to the treatment of inflammation-associated diseases beyond the lungs including inflammatory bowel disease [
49], hepatic cirrhosis [
50], sepsis [
51], rheumatoid arthritis [
52], psoriasis [
53] and others. Moreover, further structural and chemical engineering of the anti-
Il6 siRNA and fine tuning of the delivery systems may expand the scope of its application.