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Experimental Therapeutics |
Departments of Pathology [S. R., I. H., G. F., K. H., F. P., P. T., D. E., H. K.], Molecular Oncology [S. D. S., L. A. L.], Antibody Technology [C. T., J. H., B. D.], Toxicology [L. R., G. A. K.], and Immunology [P. S.], Genentech, Inc., South San Francisco, California 94080; ImmunoGen, Inc., Cambridge, Massachusetts 02139 [R. M. S., R. J. L.]; and Department of Pathology and Urology, University of Michigan, Ann Arbor, Michigan 48109 [M. A. R.]
| ABSTRACT |
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| INTRODUCTION |
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Antibody-based therapy using unconjugated, toxin-conjugated, or radiolabeled reagents against tumor-associated target antigens has proven beneficial for solid and hematolymphoid neoplasms (for a review, see Ref. 9 ). Recent clinical efforts have focused on the toxic natural compounds calicheamicin and maytansinoid DM1. Immunoconjugates with these two toxins have shown efficacy with limited toxicity in preclinical studies and are now in various stages of clinical development for hematological and solid tumors (10 , 11) .
The present study evaluates PSCA4 as a potential target for an antibody-based therapeutic approach against prostate cancer. We describe the expression pattern of PSCA in normal adult urogenital tissues and in primary and metastatic prostate cancer as well as the in vitro and in vivo characteristics of unconjugated and DM1-conjugated anti-PSCA antibodies. PSCA was originally identified as a glycosylated, glycosylphosphoinositol-linked cell surface antigen expressed in normal prostate, urinary bladder, kidney, and placenta. Expression has also been described in primary and metastatic prostate cancer as well as in neoplasms of the urinary bladder, esophagus, and pancreas by several groups using diverse methodologies (12, 13, 14) . Here we conclusively show that PSCA is strongly expressed in differentiated luminal cells of the prostate and urothelium. PSCA RNA is present in 48% of primary and 64% of metastatic prostatic adenocarcinomas. In addition, we generated anti-PSCA monoclonal antibodies that specifically reacted with cell surface PSCA and, upon conjugation with maytansinoid DM1, demonstrated in vitro cytotoxicity and marked in vivo efficacy with complete tumor eradication in a large proportion of treated animals. To our knowledge, this is the first study showing eradication of established xenograft tumors using PSCA as a target in a passive immunotherapy approach.
| MATERIALS AND METHODS |
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Scoring and Analysis of TMA PSCA Expression.
The intensity of PSCA expression evaluated microscopically was given a score of 04, with 4 being the highest expression observed. The percentage of epithelial cells positive for PSCA within a TMA element was estimated as <10%, 1050%, or >50%. Patients with expression of PSCA in <10% of epithelial cells were considered negative. The intensity score and percentage of positive cells in elements from the same patient were averaged. Pathological diagnoses and ISH results were tabulated using Microsoft Excel.
Immunohistochemistry.
Immunohistochemical staining for Ki-67 was performed with a rabbit polyclonal antibody (DAKO Corporation, Carpinteria, CA) on the two in-house-built prostate TMAs according standard procedures and the manufacturers guidelines. Represented on these two TMAs were 22 normal prostate tissues, 4 cases of BPH, 7 cases of PIN, and 90 primary and 27 metastatic prostatic adenocarcinomas. Antigen retrieval was performed at 99°C for 40 min in Target Retrieval Solution (DAKO). The primary antibody was used at a dilution of 1:100. Cases of prostate cancer were scored according to the percentage of nuclei positive for Ki-67 and separated into four categories:
10%, 1025%, 2550%, or >50% of the nuclei positive. The Ki-67 score was then compared with the PSCA intensity score, using Statview software (SAS, Inc). Staining for chromogranin A was performed on a paraffin TMA section with a rabbit polyclonal antibody (DAKO Corporation) at a 1:400 dilution without antigen retrieval.
Recombinant Plasmids and Cell Lines.
The following human cell lines were used: PC3 (prostate cancer; gift from E. Sauseville, National Cancer Institute, Bethesda, MD), HCT116 (colon cancer; ATCC, Manassas, VA), SW780 (bladder cancer; ATCC), and MCF7.Her2 (breast cancer; gift from G. P. Lewis, Genentech). All cell lines were grown in 50% Hams F-12, 50% DMEM supplemented with 10% FBS and penicillin-streptomycin (1000 units/ml; Life Technologies, Inc.) referred to hereafter as complete medium. The PSCA coding sequence (amino acids 16123) was subcloned into the plasmid pRK.tkneo (19)
, which was engineered to contain the herpes simplex virus glycoprotein D signal and epitope tag (20)
. Stable transfectants of CHO, PC3, and HCT116 cell lines expressing human gD.PSCA were generated by Fugene transfection (Roche Molecular Biochemicals, Indianapolis, IN) of pRK.gD.h.PSCA, followed by selection in 400 µg/ml G418. Individual clones were selected and analyzed for PSCA expression. The number of PSCA molecules expressed by the individual cloned cell lines was determined by Scatchard analysis (data not shown) and was as follows: 5,000,000 in PC3.gD.PSCA; 2,500,000 in MCF7.Her2.gD.PSCA; 1,600,000 in HCT116.gD.PSCA clone 6; and 400,000 in HCT116.gD.PSCA clone 8.
Monoclonal Anti-PSCA Antibodies.
BALB/c mice (Charles River Laboratories, Wilmington, DE) were immunized with an Escherichia coli-derived poly(His)-tagged PSCA polypeptide lacking the NH2- and COOH-terminal hydrophobic sequences and diluted in Ribi adjuvant (Ribi Immunochem Research, Inc., Hamilton, MO). B cells from the five mice demonstrating high anti-PSCA antibody titers were fused with mouse myeloma cells (X63.Ag8.653; ATCC) as described previously (21
, 22)
. After 1014 days, the supernatants were harvested and screened for antibody production by direct ELISA and by flow cytometry on CHO.gD.h.PSCA cells. For large-scale production of purified antibody, hybridoma clones were injected i.p. into pristane-primed mice (23)
. The ascites fluids were pooled and purified by protein A affinity chromatography (Pharmacia Fast Protein Liquid Chromatography; Pharmacia, Uppsala, Sweden) as described previously (22)
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Flow Cytometry.
Cells were incubated with primary anti-PSCA monoclonal antibody at a concentration of 20 µg/ml for 1 h on ice and then washed with cold PBS-1% FBS. Specifically bound antibody on the cell surface was detected with a FITC-conjugated goat antimouse IgG. The fluorescence intensity was measured on a Coulter Elite flow cytometer (Coulter Elite-EST; Beckman Coulter, Fullerton, CA).
Preparation of Anti-PSCA-DM1 Immunoconjugate.
The conjugation of the anti-PSCA antibody 8D11 and the control antiragweed antibody 10D9 with the maytansinoid toxin DM1 was performed according to the procedure described previously for the antibody C242 (11)
. 8D11-DM1 contains an average of 3.8 DM1 molecules/antibody molecule. Indicating that the conjugation did not affect the affinity of 8D11, the binding of the conjugated antibody to His-tagged PSCA protein in an ELISA assay was identical to that of the unconjugated antibody (data not shown).
Immunogold Labeling and EM.
Transfected cell lines expressing gD-PSCA were grown in 6-well plates and incubated at 4°C with 10 µg/ml anti-gD or anti-PSCA antibody for 1 h. After incubation with primary antibodies, the cells were treated with 10-nm gold adducts of goat antimouse IgG for 1 h. The cells were then switched to 37°C for 1.25 h before fixation in Karnovskys fixative and processed for EM. For autoradiography, transfected cells were incubated with iodinated anti-PSCA antibodies at 37°C, fixed, washed, and prepared for EM autoradiography as described elsewhere (24)
. Thin sections were observed in a Philips CM12 equipped with a digitizing GATAN camera.
Antibody Internalization Assay.
MCF7.Her2 cells stably transfected with gD.PSCA were grown in 6-well dishes and then incubated at 37°C with 20 nM 125I-labeled anti-PSCA and anti-HER2 monoclonal antibodies for 5 h in DMEM supplemented with 10% FBS. To determine the cellular distribution of radiolabeled antibody, the cells were first washed extensively with DMEM and then incubated for 5 min in 2 M urea-50 mM glycine (pH 2.4)-150 mM NaCl. The released radioactivity was considered to represent cell surface-associated antibody. Cells were then solubilized in 8 M urea-150 mM NaCl, and the radioactivity within the lysate was considered to represent internalized antibody. Assays were performed in duplicate wells. The number of antibody molecules bound and internalized per cell was determined on the basis of the specific activity of the iodinated antibody.
In Vitro Cytotoxicity Assay.
Tumor cell lines stably transfected with gD.PSCA or with vector alone were plated in 96-well microtiter plates at the following densities in complete medium: 103 cells/well for HCT116.gD.PSCA, 2 x 103 cells/well for MCF7.Her2.gD.PSCA, 103 cells/well for PC3.gD.PSCA, and 1.5 x 104 cells/well for PC3.gD.PSCA. After the cells had been allowed to adhere for 16 h, they were exposed to various concentrations of immunoconjugate 8D11-DM1 (equivalent to 1200 to 0.06 ng/ml DM1). After incubation at 37°C for 7 days, the monolayers were washed twice with PBS and stained with crystal violet dye (0.5% in methanol). The stained cells were solubilized in 50 mM sodium citrate in 50% ethanol for 20 min with shaking. The absorbance at 450 nm (A450) of the solubilized cells was measured with a spectrophotometer, and the fraction of surviving cells determined by dividing the A450 of treated cells by the A450 of nontreated cells. To determine the cytotoxicity of the immunoconjugate on quiescent cells, the assay was performed in serum-free medium.
In Vivo Tumor Growth Assays.
Female NCR nude mice (68 weeks of age; Taconic, Inc., Germantown, NY) were inoculated s.c. with 5 x 106 PC3.gd.PSCA or 1.5 x 107 SW780 cells. Tumor volume was calculated based on two dimensions, measured using calipers, and was expressed in mm3 according to the formula: V = 0.5a x b2, where a and b are the long and the short diameters of the tumor, respectively. Antibody injections were started either 24 h before tumor inoculation or after tumors were established. In the latter type of study, animals were randomized according to tumor volume (mean tumor volume between 100 and 200 mm3) before antibody injections. Unconjugated anti-PSCA and control (antiragweed) antibodies were injected i.p. twice a week at a dose of 10 mg/kg for 4 weeks (unless otherwise indicated). Maytansinoid (DM1)-conjugated antibodies were injected i.v. at a concentration of 75 µg/kg DM1 toxin for the PC3.gD.PSCA tumor model and 150 µg/kg for the SW780 tumor model. Conjugated antibodies were administered twice a week for a total of eight doses for most studies unless otherwise indicated. Tumors were measured twice a week throughout the experiment. Mice were euthanized before mean tumor volumes reached 2000 mm3 or when tumors showed signs of impending ulceration. All studies were conducted in accordance with the Guide for the Care and Use of Laboratory Animals, published by the NIH (NIH Publication 85-23, revised 1985)
| RESULTS |
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PSCA Expression in Abnormal Prostate.
Expression of PSCA RNA was seen in BPH, PIN, and invasive prostatic adenocarcinoma (Table 1)
. The phosphorimager scan and image of a representative TMA examined are shown in Fig. 2, A and B
, respectively. This TMA included 5 cases of normal urothelium, 4 cases of normal prostate, 4 cases of BPH, 7 cases of PIN, 35 cases of well- and poorly differentiated primary prostate cancer, and 27 cases of metastatic prostate cancer.
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7, and those with a Gleason grade
8. Separation into these two categories has previously been shown to correlate with clinical outcome (25)
. Cases with metastatic prostate cancer represented a third category. Although expression was variable and no overt correlation with Gleason grade or stage of the disease could be found, the percentage of metastatic prostate cancer cases positive for PSCA was higher (64%) compared with nonmalignant prostate disease and organ-confined prostate cancer (48%; see Table 1
Tumors positive for PSCA RNA were stratified according to signal intensity (1+, 2+, 3+, and 4+) and according to percentage of positive tumor cells (<50% versus
50%). Most tumors that scored positive for PSCA showed expression in the majority of malignant cells (>50%). We did not observe statistically significant differences in the pattern or intensity of PSCA expression between cases with lower and higher Gleason grade or between cases of organ-confined and metastatic disease (data not shown).
Generation and Characterization of Monoclonal Antibodies to PSCA.
After an initial screen by ELISA, we identified three monoclonal antibodies (6F8, 8D11, and 5F2) that reacted strongly with PSCA protein on the surface of live cells by flow cytometry using a CHO cell line transfected to express PSCA (data not shown). The affinities of 6F8, 8D11, and 5F2 for His-tagged PSCA were 2.8 x 10-9 M, 3.6 x 10-9 M, and 2.6 x 10-9 M, respectively, as calculated from association and dissociation rate constants measured using a BIAcore system. Cross-competition experiments demonstrated that these antibodies recognized the same or overlapping epitopes (data not shown).
Additional cell lines that stably expressed human PSCA after transfection were generated for further in vitro and in vivo studies. Flow cytometry analysis demonstrated that the anti-PSCA antibody 8D11 specifically recognized PSCA expressed on the surface of four of these cell lines (Fig. 3)
. None of our antihuman PSCA monoclonal antibodies cross-reacted with murine PSCA (data not shown).
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50100 nm in diameter that resembled caveolae (Fig. 4, A and C)
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1 ng/ml DM1 (equivalent to 3.8 x 10-10 M antibody; Fig. 5C
75 ng/ml DM1 in both the PC3.gD.PSCA cells and the antigen-negative PC3.neo cells (data not shown).
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1.6 x 106 receptors/cell as determined by Scatchard analysis; data not shown) was
6 ng/ml DM1; in clone 8 (
400,000 receptors/cell), the IC50 was 42 ng/ml DM1. These data show that the cytotoxic effects of the immunoconjugate are observed in an antigen-specific pattern and that the degree of cytotoxicity is dependent on the number of PSCA molecules on the cell surface.
In Vivo Efficacy of Anti-PSCA Antibody against PSCA-positive Tumors.
The growth of PSCA-positive tumors was significantly delayed (P < 0.05) in animals treated with unconjugated anti-PSCA antibody before tumor cell inoculation compared with animals treated with control antibody (Fig. 6A)
. Tumors eventually grew, although at a much slower rate than the control treated tumors. In addition, we observed a statistically significant retardation of tumor growth in animals treated with unconjugated anti-PSCA antibodies after tumor establishment compared with animals treated with control antibody (P < 0.05). The growth rates of the tumors in the different experimental groups appeared similar after day 20 of the experiment (Fig. 6B)
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1525 days after initiation of treatment in several experiments. Fig. 7B
500,000 PSCA molecules/cell by Scatchard analysis; data not shown) and exhibits minimal sensitivity in the in vitro cytotoxicity assay (data not shown). Treatment of SW780 tumor-bearing animals with DM1-conjugated anti-PSCA antibody resulted in marked retardation of tumor growth, whereas animals treated with control antibody-DM1 showed progressive tumor growth (Fig. 7C)
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| DISCUSSION |
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As our data show, PSCA is not a gene that is uniformly expressed within the secretory epithelium of normal prostate or within the malignant cell population of a prostatic adenocarcinoma. It might be argued that expression analysis using the TMA technology might not be the appropriate tool to determine the incidence of expression of PSCA given its sometimes focal expression pattern. Although only a very small portion of the original tissue specimen is available for review, the TMA technology has been valuable for expression profiling of numerous indications (30) . Adequate assessment of gene expression can typically be accomplished by sampling three representative areas of a given specimen (30) . Essentially all of our cases had been sampled at least three times. Furthermore, we observed a very high concordance in a subset of cases, in which elements of normal or neoplastic tissues had been represented in multiple sets of three (data not shown).
A previous report described up-regulation of PSCA in prostate cancer metastatic to bone (28) . Although there was a trend toward overexpression in metastatic cases in our series, the differences between the individual groups were not statistically significant. Because decalcification techniques lead to the loss of RNA integrity, we were not able to examine PSCA expression by our ISH technique in any bone marrow metastases. The differences in metastatic sites may contribute to any discrepancies in PSCA expression between the two studies.
The expression profile of PSCA together with the in vivo efficacy data suggests that PSCA is a promising therapeutic target for PSCA-expressing tumors. The two most important aspects in the consideration of toxin-conjugated therapeutic antibodies are potential toxicity and antitumor efficacy. Issues of toxicity can be addressed in our model only to a limited extent because the anti-PSCA antibody does not recognize the murine orthologue. Toxin-conjugated antimurine PSCA antibodies or a human PSCA transgenic or knock-in mouse model would be appropriate tools to evaluate toxicity in a mouse model. The efficacy of the toxin-conjugated anti-PSCA antibodies observed in the in vivo model should be interpreted in the context of our in vitro cytotoxicity studies, which demonstrate the broad concentration range in which DM1-conjugated anti-PSCA antibody exhibits antigen-specific cytotoxicity. This observation is consistent with previous studies using the same toxin conjugated to an antibody of different specificity (11) against a different tumor target. Because the therapeutic index for free DM1 is too small for clinical use (31) , it is necessary for the intact immunoconjugate to be internalized into the target cell. Using ultrastructural autoradiography, we could show that cell surface bound anti-PSCA antibody is internalized. PSCA is anchored to the cell surface through a glycosylphosphoinositol linkage, and proteins with this particular linkage have been described as being internalized after engagement with ligand or antibody (32 , 33) .
DM1 inhibits the polymerization of tubulin into filaments and thus interferes with the formation of the mitotic spindle in mitotically active cells and with axonal transport in neuronal cells. This mechanism of action of DM1 would indicate that epithelial tissues with a rapid cellular turnover are particularly prone to potential side effects. Although free DM1 toxin may account for the temporary growth inhibition of control tumors (see Fig. 7, A and B
) because of its effect on mitotically active cells, we did not observe any in vivo toxicity related to free DM1 in normal host tissues. Normal urothelium, which shows the highest levels of PSCA RNA in postmitotic, terminally differentiated cells (18)
, would be an obvious concern in this context. However, we attempted to mimic cellular quiescence in our in vitro cytotoxicity assay by performing the assay in serum-free medium. Under those circumstances, cytotoxicity by the immunoconjugate on PSCA-positive cells was greatly reduced.
Although the in vitro cytotoxicity data are quite informative, they may lead to underestimation of the in vivo efficacy of the immunoconjugate. For example, the immunoconjugate shows limited in vitro cytotoxicity on the bladder cancer cell line SW780, which expresses
500,000 PSCA molecules on the cell surface. Nevertheless, there was marked in vivo efficacy with the same cell line and the same immunoconjugate. The increased length of exposure in the in vivo studies may explain this discrepancy, although additional mechanisms cannot be ruled out.
The efficacy of unconjugated anti-PSCA antibodies has now been convincingly demonstrated in two separate studies using independently derived monoclonal antibodies (Ref. 34 and this study). If treatment is started before tumor inoculation, retardation of tumor growth, inhibition of metastatic spread, and prolonged survival are observed (34) . Similar, although less dramatic, effects have been observed in models using established tumors (34) . The use of an antibody-toxin immunoconjugate in our studies markedly increased the in vivo efficacy and caused complete eradication of established tumors in the majority of animals when challenged with a cell line expressing high levels of PSCA. We observed significant growth retardation in animals challenged with cells expressing at least 10-fold lower levels of PSCA. The inability to achieve tumor eradication in the latter model may be attributable to several possible reasons. We know from ISH experiments that the residual tumors in animals treated with the anti-PSCA immunoconjugate still express high levels of PSCA RNA (data not shown), excluding the possibility of emerging antigen-loss tumor variants. Length of treatment and antibody dose could be manipulated to achieve increased efficacy in the treatment of tumors with low-level expression of PSCA. There is no evidence from our in vitro experiments that tumor cells acquire resistance to DM1. Tumor dormancy after continued treatment with the immunoconjugate is another possibility, although we observed mitotic activity in the residual microscopic tumors. Generation of neutralizing antibodies against the therapeutic antibody or against the toxin conjugate is not a consideration in this nude mouse xenograft model.
In summary, our studies illustrate a promising approach for the treatment of PSCA-expressing tumors. Advanced hormone-refractory prostate cancer, for which no effective therapies are available at this point, would be an obvious indication. Other tumor types that have been reported to express PSCA (35 , 36) should be considered as well.
| ACKNOWLEDGMENTS |
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| FOOTNOTES |
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1 Sarajane Ross and Susan D. Spencer contributed equally to this work. ![]()
2 To whom requests for reprints should be addressed, at Genentech, Inc., Mail Stop 72B, 1 DNA Way, South San Francisco, CA 94080. Phone: (650) 225-8134; Fax: (650) 225-8989; E-mail: hkoeppen{at}gene.com ![]()
4 The abbreviations used are: PSCA, prostate stem cell antigen; TMA, tissue microarray; ISH, in situ hybridization; PIN, prostatic intraepithelial neoplasia; BPH, benign prostatic hyperplasia; ATCC, American Type Culture Collection; FBS, fetal bovine serum; CHO, Chinese hamster ovary; EM, electron microscopy. ![]()
5 S. Ross and H. Koeppen, personal observation. ![]()
Received 9/27/01. Accepted 3/ 1/02.
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