Oncolytic viruses (OVs) are being developed as anti-cancer therapeutics that specifically replicate within and kill tumor cells while leaving healthy tissues intact. It has now become common understanding that oncolytic virotherapy (OVT), in most cases, does not rely solely on complete tumor lysis by efficient replication and spreading of the virus, but requires additional mechanisms of action for treatment success, including vascular and stromal targeting and, importantly, immune stimulation1,2,3,4. While many early OV studies used unmodified viruses, current research has profited from an improved biological understanding, virus biobanks that potentially contain novel OVs, and the possibilities offered by genetic engineering in order to create advanced OV platforms5,6,7.
Given the recent success of immunotherapy, immunomodulatory transgenes are of particular interest regarding the genetic engineering of OVs. Targeted expression of such gene products by OV-infected tumor cells reduces toxicity compared to systemic administration. Targeting is achieved either by using viruses with inherent oncoselectivity or by modifying viral tropism8. Local immunomodulation enhances the multi-faceted anti-tumor mechanisms of OVT. Furthermore, this strategy is instrumental in interrogating the interplay between viruses, tumor cells, and the host immune system. To this end, this protocol provides an applicable and adjustable workflow to design, clone, rescue, propagate, and validate oncolytic paramyxovirus (specifically measles virus) vectors encoding such transgenes.
Modulation of the immune response can be achieved by a wide variety of transgene products targeting different steps of the cancer-immunity cycle9, including enhancing tumor antigen recognition [e.g., tumor-associated antigens (TAAs) or inducers of major histocompatibility complex (MHC) class I molecules] over supporting dendritic cell maturation for efficient antigen presentation (cytokines); recruiting and activating desired immune cells such as cytotoxic and helper T cells [chemokines, bispecific T cell engagers (BTEs)]; targeting suppressive cells such as regulatory T cells, myeloid-derived suppressor cells, tumor-associated macrophages, and cancer-associated fibroblasts (antibodies, BTEs, cytokines); and preventing effector cell inhibition and exhaustion (checkpoint inhibitors). Thus, a plethora of biological agents is available. Evaluation of such virus-encoded immunomodulators regarding therapeutic efficacy and possible synergies as well as understanding of respective mechanisms is necessary to improve cancer therapy.
Negative sense single-stranded RNA viruses of the Paramyxoviridae family are characterized by several features conducive to their use as oncolytic vectors. These include a natural oncotropism, large genomic capacity for transgenes (more than 5 kb)10,11, efficient spreading including syncytia formation, and high immunogenicity12. Therefore, OV platforms based on canine distemper virus13, mumps virus14, Newcastle disease virus15, Sendai virus16,17, simian virus 518, and Tupaia paramyxovirus19 have been developed. Most prominently, live attenuated measles virus vaccine strains (MV) have progressed in preclinical and clinical development20,21. These virus strains have been used for decades for routine immunization with an excellent safety record22. Moreover, there is no risk for insertional mutagenesis due to the strictly cytosolic replication of paramyxoviruses. A versatile reverse genetics system based on anti-genomic cDNA which allows for insertion of transgenes into additional transcription units (ATUs) is available11,23,24. MV vectors encoding sodium-iodide symporter (MV-NIS) for imaging and radiotherapy or soluble carcinoembryonic antigen (MV-CEA) as a surrogate marker for viral gene expression are currently being evaluated in clinical trials (NCT02962167, NCT02068794, NCT02192775, NCT01846091, NCT02364713, NCT00450814, NCT02700230, NCT03456908, NCT00408590, and NCT00408590). Safe administration has been confirmed and cases of anti-tumor efficacy have been reported in previous studies25,26,27,28,29,30 (reviewed by Msaouel et al.31), paving the way for additional oncolytic measles viruses that have been developed and tested preclinically. MV encoding immunomodulatory molecules targeting diverse steps of the cancer-immunity cycle have been shown to delay tumor growth and/or prolong survival in mice, with evidence for immune-mediated efficacy and long-term protective immune memory in syngeneic mouse models. Vector-encoded transgenes include granulocyte-macrophage colony stimulating factor (GM-CSF)32,33, H. pylori neutrophil-activating protein34, immune checkpoint inhibitors35, interleukin-12 (IL-12)36, TAAs37, and BTEs38, which cross-link a tumor surface antigen with CD3 and thus induce anti-tumor activity by polyclonal T cells, irrespective of T cell receptor specificity and co-stimulation (Figure 1). The promising preclinical results obtained for these constructs demand further translational efforts.
Talimogene laherparepvec (T-VEC), a type I herpes simplex virus encoding GM-CSF, is the only oncolytic therapeutic approved by the United States Food and Drug Administration (FDA) and European Medicines Agency (EMA). The phase III study leading to approvals in late 2015 has not only shown efficacy at the site of intra-tumoral injection, but also abscopal effects (i.e., remissions of non-injected lesions) in advanced melanoma39. T-VEC has since entered additional trials for application in other tumor entities (e.g., non-melanoma skin cancer, NCT03458117; pancreatic cancer, NCT03086642) and for evaluation of combination therapies, especially with immune checkpoint inhibitors (NCT02978625, NCT03256344, NCT02509507, NCT02263508, NCT02965716, NCT02626000, NCT03069378, NCT01740297, and Ribas et al.40).
This demonstrates not only the potential of oncolytic immunotherapy but also the need for further research to identify superior combinations of OVT and immunomodulation. Rational design of additional vectors and their development for preclinical testing is key to this undertaking. This will also advance understanding of underlying mechanisms and has implications for the progression towards more personalized cancer treatment. To this end, this publication presents the methodology for the modification and development of paramyxoviruses for targeted cancer immunotherapy and, more specifically, of oncolytic measles viruses encoding T cell-engaging antibodies (Figure 2).