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Figure S2 from Safety and Efficacy of Intraventricular Immunovirotherapy with Oncolytic HSV-1 for CNS Cancers

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posted on 2023-04-01, 00:02 authored by Kyung-Don Kang, Joshua D. Bernstock, Stacie K. Totsch, Sam E. Gary, Abbey Rocco, Li Nan, Rong Li, Tina Etminan, Xiaosi Han, Elizabeth A. Beierle, Tanja Eisemann, Robert J. Wechsler-Reya, Sejong Bae, Richard Whitley, G. Yancey Gillespie, James M. Markert, Gregory K. Friedman

Toxicity from IVT oHSV in the left lateral ventricle and third and fourth ventricles at different time points.

Funding

U.S. Department of Defense (DOD)

U.S. Food and Drug Administration (FDA)

National Institutes of Health (NIH)

Rally Foundation (Rally)

CureSearch for Children's Cancer (CureSearch)

V Foundation for Cancer Research (VFCR)

Hyundai Hope On Wheels (Hope On Wheels)

Andrew McDonough B+ Foundation (AMBF)

Pediatric Cancer Research Foundation (PCRF)

Kaul Pediatric Research Institute (KPRI)

History

ARTICLE ABSTRACT

Oncolytic virotherapy with herpes simplex virus-1 (HSV) has shown promise for the treatment of pediatric and adult brain tumors; however, completed and ongoing clinical trials have utilized intratumoral/peritumoral oncolytic HSV (oHSV) inoculation due to intraventricular/intrathecal toxicity concerns. Intratumoral delivery requires an invasive neurosurgical procedure, limits repeat injections, and precludes direct targeting of metastatic and leptomeningeal disease. To address these limitations, we determined causes of toxicity from intraventricular oHSV and established methods for mitigating toxicity to treat disseminated brain tumors in mice. HSV-sensitive CBA/J mice received intraventricular vehicle, inactivated oHSV, or treatment doses (1×107 plaque-forming units) of oHSV, and toxicity was assessed by weight loss and IHC. Protective strategies to reduce oHSV toxicity, including intraventricular low-dose oHSV or interferon inducer polyinosinic-polycytidylic acid (poly I:C) prior to oHSV treatment dose, were evaluated and then utilized to assess intraventricular oHSV treatment of multiple models of disseminated CNS disease. A standard treatment dose of intraventricular oHSV damaged ependymal cells via virus replication and induction of CD8+ T cells, whereas vehicle or inactivated virus resulted in no toxicity. Subsequent doses of intraventricular oHSV caused little additional toxicity. Interferon induction with phosphorylation of eukaryotic initiation factor-2α (eIF2α) via intraventricular pretreatment with low-dose oHSV or poly I:C mitigated ependyma toxicity. This approach enabled the safe delivery of multiple treatment doses of clinically relevant oHSV G207 and prolonged survival in disseminated brain tumor models. Toxicity from intraventricular oHSV can be mitigated, resulting in therapeutic benefit. These data support the clinical translation of intraventricular G207.

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