Cancer gene therapy with the aid of herpes simplex virus type 1 thymidine kinase gene (HSV-TK) and anti-herpes drug ganciclovir (GCV) has been widely used and its efficacy has been demonstrated in a variety of different malignant cells and animal tumor models. It is also commonly accepted, however, that this gene therapy regimen needs to be enhanced for a true clinical success. We studied whether polyamine biosynthesis inhibition by 2-difluoromethylornithine (DFMO), a clinically tested and well-tolerated chemotherapeutic drug, can increase the cytotoxicity of HSV-TK/GCV in 9L rat glioma cells. Our initial experiments showed that polyamine depletion actually protected the cells from cytotoxicity if GCV treatment was started too early after removal of DFMO. Analyses of cell growth, intracellular polyamine pools and cell cycle phase distribution suggested that later initiation of GCV treatment would be more beneficial due to increased proportion of cells in the middle of the cell cycle S phase. When the cells were exposed to GCV 3 or 4 days after removal of DFMO from growth medium, the cytotoxicity was increased up to 2.5-fold. We also verified whether cell cycle blockage per se could yield similar effect as DFMO. Our results from serum deprivation experiments showed that, despite of apparent cell growth and cell cycle phase distribution effects, serum starvation was weaker enhancer of HSV-TK/GCV cytotoxicity than DFMO. Finally, the general utility of HSV-TK/GCV + DFMO combination was tested in another tumor cell type, human prostate carcinoma cell line DU-145. DFMO sensitized these cells to HSV-TK/GCV cytotoxicity, but the effect was less prominent than in 9L cells. In conclusion, we have demonstrated that a correctly timed induction of DFMO-mediated polyamine biosynthesis inhibition can enhance the efficiency of HSV-TK/GCV gene therapy in vitro. The observed synergistic effect is potentially useful in clinical trials because, as opposed to use of other cell cycle-altering drugs, DFMO has already been tested in the treatment of human tumors and used as chemo preventive regimen with excellent tolerability.
Copyright 2003 Wiley-Liss, Inc.