Name: Retrograde Parotid Gland Infusion through Stensens Duct in a Non-Human Primate for Vectored Gene Delivery (Video) | JoVE Journal
Uploaded: 2021-08-12T14:00:00.000+00:00
Duration: 3 min 50 s
Description: Learn retrograde parotid gland infusion for gene therapy and vaccination in non-human primates. This reproducible technique enables vectored gene delivery through Stensen's duct without requiring surgical expertise.

ai_agent_IP

ai_agent

maintenance

instantTrialDurationMinutes

isBiopharma

enableNewMyJoveSectionDesign

educationFeatures

seoMetaApi

ai_copilot_institution_blacklist

ai_chat_institution_blacklist

freeAccessWindow

ssoRoleCapture

scheduledMaintenanceBanner

joveLabsFeatures

disable_autoplay_for_bots

extended_trial_duration

5 minutes

The authors want to thank Mr. Cagney Gentry for his audiovisual support in filming the procedure. We also want to acknowledge the Hefner VA medical center for academic support in pursuit of this project.

All procedures were performed at Wake Forest School of Medicine Clarkson Campus for animal studies. The Institutional Animal Care and Use Committee (IACUC) was consulted for ethical considerations and details of the procedures was submitted for review. Wake Forest IACUC approved our study protocol and all procedures were done under IACUC approved protocol #A17-147.
1. Preparing the infusion device
<ol>
	<li>Cut size 10 Polyethylene Tube (PET10) into 25 cm lengths using a pair of scissors.</li>
	<li>Mark PET10 at 1 cm and 2 cm from one end using a black marker.</li>
	<li>Prefill 0.5 mL of Ad5-EGFP solution (109 viral particles/mL) into a 1 mL (tuberculin) syringe.</li>
	<li>Slide non-marked end of PET10 tube over 29-31 G needle attached to a syringe. It is generally easier to perform this task under magnification.</li>
	<li>Infuse the solution into the PET10 until tube is completely full (visible drop at free end).</li>
	<li>Use full standard PPE, including&#160;surgical scrubs, long sleeved gown, impermeable gloves, surgical mask, face shield, hair bonnet, and shoe covers.</li>
</ol>
2. Preparing the animal
NOTE: Cynomolgus macaques were used for the video demonstration. The anatomy of other non-human and human primates is very similar, and the protocol should be translatable to other species.
<ol>
	<li>Inject subcutaneously 0.05 mg/kg of atropine 15 min prior to the procedure to minimize salivary secretions and optimize distribution and retention of the infusate.</li>
	<li>Provide anesthesia using 5 mL syringes with intramuscular ketamine/midazolam (10-15 mg/kg of ketamine and 0.01-0.05 mg/kg of midazolam). Confirm proper anesthesia when the sedated animal becomes unconscious and is unable to react to stimuli.</li>
</ol>
3. Performing the procedure
<ol>
	<li>Use oral retractors to brace open mouth.
	<ol>
		<li>Place the rubber pad of one end of the retractor on the hard palate behind the upper teeth on the side of the mouth opposite to the gland that will be infused. Place the rubber pad of the other end on the lower canine on the same side as upper retractor. Gently allow the spring action of the retractor to expand and open the mouth.</li>
	</ol>
	</li>
	<li>Identify the parotid papilla, the opening of Stensen&#39;s Duct, on the posterior cheek, adjacent to the upper 2nd molar. This is best visualized using dental loops for magnification.</li>
	<li>Gently dilate the parotid papilla with the point of the conical dilator. It is best to place the point of the dilator into the center or opening of the papilla and then gently rotate it back and forth. The point should slowly enter the papilla and dilate it over approximately 20 - 30 s of gentle rotating.</li>
	<li>Insert the PET10 tubing into the dilated parotid papilla. This is best achieved by holding the marked end of the PET10 tube with tweezers approximately 0.5 cm from the distal end and gently inserting the tip of the tube into the dilated papilla.
	<ol>
		<li>Gently advance the tube, which is often facilitated by small rotating movements to help the tube slide, followed by readjustment of the tweezers 0.5 cm proximal to the previous grip. Repeat this until the 2 cm mark reaches the parotid papilla.</li>
	</ol>
	</li>
	<li>Apply cyanoacrylate on the cheek around the papilla and the inserted tube and wait for it to dry (no specific amount recorded, just enough to seal the entrance of Stensen&#39;s duct papilla). This typically takes less than a minute and helps seal the parotid papilla and reduce spillage of infusate back in the oral cavity.</li>
	<li>Slowly push the syringe content over 5 min at a rate of 100 &#181;L/min. This slow infusion rate minimizes risk of duct injury due to sudden increase in intra-ductal pressure.</li>
	<li>Leave PET10 in place for at least 5 min after infusion is complete. Keep the duct sealed and allow the infusate to remain in the parotid gland.</li>
	<li>Remove PET10 with gentle traction. The cyanoacrylate will pull free with the tube.</li>
	<li>Repeat steps 3.2 through 3.8 on the opposite side.</li>
	<li>Slowly release oral retractors after both parotids have been infused and both PET10 tubes removed. 
	NOTE: The whole procedure for both sides should take less than 30 min.</li>
</ol>
4. Post-procedural care
<ol>
	<li>After infusion is completed and Stensen&#39;s duct decannulated, observe animals until anesthesia effect wears off (usually between 20-30 min post-procedure).</li>
	<li>Offer the animal drinks and then food after they are fully awake and resume routine care.</li>
</ol>

<ol><li>Isenman, L., Liebow, C., Rothman, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+secretion+of+mammalian+digestive+enzymes+by+exocrine+glands%5BTitle%5D)+AND+%22The+American+Journal+of+Physiology%22%5BJournal%5D)">The secretion of mammalian digestive enzymes by exocrine glands.</a> The American Journal of Physiology. 276, 223-232 (1999).</li>
<li>Perez, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Salivary+epithelial+cells%3A+An+unassuming+target+site+for+gene+therapeutics%5BTitle%5D)+AND+%22The+International+Journal+of+Biochemistry+%26+Cell+Biology%22%5BJournal%5D)">Salivary epithelial cells: An unassuming target site for gene therapeutics.</a> The International Journal of Biochemistry & Cell Biology. 42, 773-777 (2010).</li>
<li>Kochel, T. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+dengue+virus+serotype-1+DNA+vaccine+induces+virus+neutralizing+antibodies+and+provides+protection+from+viral+challenge+in+Aotus+monkeys%5BTitle%5D)+AND+%22Vaccine%22%5BJournal%5D)">A dengue virus serotype-1 DNA vaccine induces virus neutralizing antibodies and provides protection from viral challenge in Aotus monkeys.</a> Vaccine. 18, 3166-3173 (2000).</li>
<li>Ponzio, T. A., Sanders, J. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+salivary+gland+as+a+target+for+enhancing+immunization+response%5BTitle%5D)+AND+%22Tropical+Diseases%2C+Travel+Medicine+and+Vaccines%22%5BJournal%5D)">The salivary gland as a target for enhancing immunization response.</a> Tropical Diseases, Travel Medicine and Vaccines. 3, 4(2017).</li>
<li>Baum, B. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Early+responses+to+adenoviral-mediated+transfer+of+the+aquaporin-1+cDNA+for+radiation-induced+salivary+hypofunction%5BTitle%5D)+AND+%22Proceedings+of+the+National+Academy+of+Sciences+of+the+United+States+of+America%22%5BJournal%5D)">Early responses to adenoviral-mediated transfer of the aquaporin-1 cDNA for radiation-induced salivary hypofunction.</a> Proceedings of the National Academy of Sciences of the United States of America. 109, 19403-19407 (2012).</li>
<li>Voutetakis, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Sorting+of+Transgenic+Secretory+Proteins+in+Rhesus+Macaque+Parotid+Glands+After+Adenovirus-Mediated+Gene+Transfer%5BTitle%5D)+AND+%22Human+Gene+Therapy%22%5BJournal%5D)">Sorting of Transgenic Secretory Proteins in Rhesus Macaque Parotid Glands After Adenovirus-Mediated Gene Transfer.</a> Human Gene Therapy. 19, 1401-1405 (2008).</li>
<li>Niedzinski, E. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Enhanced+systemic+transgene+expression+after+nonviral+salivary+gland+transfection+using+a+novel+endonuclease+inhibitor%2FDNA+formulation%5BTitle%5D)+AND+%22Gene+Therapy%22%5BJournal%5D)">Enhanced systemic transgene expression after nonviral salivary gland transfection using a novel endonuclease inhibitor/DNA formulation.</a> Gene Therapy. 10, 2133-2138 (2003).</li>
<li>Niedzinski, E. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Zinc+Enhancement+of+Nonviral+Salivary+Gland+Transfection%5BTitle%5D)+AND+%22Molecular+Therapy%22%5BJournal%5D)">Zinc Enhancement of Nonviral Salivary Gland Transfection.</a> Molecular Therapy. 7, 396-400 (2003).</li>
<li>Samuni, Y., Baum, B. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Gene+delivery+in+salivary+glands%3A+From+the+bench+to+the+clinic%5BTitle%5D)+AND+%22Biochimica+et+Biophysica+Acta+-+Molecular+Basis+of+Disease%22%5BJournal%5D)">Gene delivery in salivary glands: From the bench to the clinic.</a> Biochimica et Biophysica Acta - Molecular Basis of Disease. , (2011).</li>
<li>Voutetakis, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Adeno-Associated+Virus+Serotype+2-Mediated+Gene+Transfer+to+The+Parotid+Glands+of+Nonhuman+Primates%5BTitle%5D)+AND+%22Human+Gene+Therapy%22%5BJournal%5D)">Adeno-Associated Virus Serotype 2-Mediated Gene Transfer to The Parotid Glands of Nonhuman Primates.</a> Human Gene Therapy. 18, 142-150 (2007).</li>
</ol>

The authors have nothing to disclose.

Here we describe a protocol of retrograde infusion into the parotid gland through Stensen&#39;s Duct. The methodology described offers guidance that can potentially be used by researchers exploring the utility of salivary tissue as a site for gene therapy and other applications.
There are multiple critical steps to ensure the success of the procedure. First and foremost, all the procedural steps should be completed gently. Forceful bracing of the mouth could result in mandibular subluxation. F...

While salivary glands are well known for their exocrine production of saliva, researchers have long recognized their ability to secrete proteins directly into the bloodstream1, making them a potential target for gene therapy for systemic administration, such as replacement hormones or antibody production. In fact, salivary glands offer several advantages over other tissue targets, such as the inherent ability to produce proteins for secretion (a property muscles lack), heavy encapsulation that can limit vector diffusion, and well-differentiated tissue providing stability for non-integrating vectors. Furthermore, in the event of a serious adverse event, salivary glands are not critical for life and can be surgically removed. While not immediately intuitive, parotid glands are also easily accessible from the mouth through their main excretory duct, Stensen&#39;s Duct2.
Given the advantages of salivary tissue for gene therapy, there is increasing interest in exploring this tissue target. Numerous studies have already been performed in rodent, canine, and non-human primate models and at least one human clinical trial is underway3,4,5. To further explore and develop the utility of this tissue target for gene therapy purposes, more non-human primate studies will need to be performed. This paper describes a method for accessing the parotid glands through Stensen&#39;s Duct to deliver a vectored gene for transduction in the non-human primate model. To visibly demonstrate the delivery of the infusate and the anatomy of the duct as it enters the gland, fluoroscopy using radiocontrast was performed. To demonstrate successful transduction of a vector, an Adenovirus serotype 5 (Ad5) vectored egfp gene was used. Ad5 is a well-described vector capable of transducing salivary tissue. Although it is too immunogenic for ultimate clinical use, an Ad5 vector was chosen for this demonstration study to assure efficient transduction. Evaluating Enhanced Green Fluorescent Protein (EGFP) production is a well-described method to demonstrate successful transcription and translation of a vectored gene following transduction and was done here.

<table><tbody><tr><td>500 &amp;micro;L U100 syringes with 30-gauge needles</td><td>Becton Dickinson</td><td>328466</td><td>fixed needle for less waste</td></tr><tr><td>Adhesive (e.g., Ethicon Dermabond)</td><td>Various</td><td></td><td>Cyanoacrylate adhesive to seal and keep the tubing in the duct during infusion.</td></tr><tr><td>Atropine injectable solution</td><td>Patterson Veterinary</td><td>07 869-6061</td><td>Atropine inj. 0.54 mg/mL</td></tr><tr><td>BD Ultra-Fine Insulin Syringes 30G</td><td>Walmart</td><td>N/A</td><td>Avilable in 0.5 mL and 1.0 mL sizes.</td></tr><tr><td>Cyanoacrylate (medical glue)</td><td>Ethicon</td><td>DNX12</td><td>Dermabond topical skin adhesive</td></tr><tr><td>Dental loops with light</td><td>Amazon (DDP)</td><td>B012M3IV80</td><td>Used to enhance visualization of Stensen&#039;s duct papilla</td></tr><tr><td>Infant Lacrimal Dilator</td><td>Surgipro</td><td>SPOI-137</td><td></td></tr><tr><td>Ketamine injectable solution</td><td>Patterson Veterinary</td><td>07-803-6637</td><td>Ketaset inj. 100 mg/mL</td></tr><tr><td>Lacrimal Dilator</td><td>Surgipro</td><td>SPOI-132</td><td>Used to dialate the Stensen&#039;s duct.</td></tr><tr><td>Midazolam injectable solution</td><td>Patterson Veterinary</td><td>07 890-6698</td><td>Midazolam inj. 5mg/mL</td></tr><tr><td>Pair of scissors</td><td>Amazon (DDP)</td><td>N/A</td><td>Used to cut PET10 tube</td></tr><tr><td>Polyethylene Tubing (PE-10)</td><td>Scientific Comodities, Inc</td><td>BB31695-PE/1</td><td>Tubing connecting the 30G syringe and inserted into the duct.</td></tr><tr><td>Q-tips</td><td>Walmart</td><td>N/A</td><td>Used to spread cyanoacrylate on the cheek</td></tr><tr><td>Size 10 Polyethylene Tube (PET 10)</td><td>Scientific Commodities</td><td>BB31695-PE/1</td><td>low density polyethylene tubing</td></tr><tr><td>Small Animal Mouth Opener</td><td>Amazon (DDP)</td><td>B01F3LVJXC</td><td>Used to keep the animal&#039;s mouth open.</td></tr><tr><td>Tweezers</td><td>Amazon (DDP)</td><td>N/A</td><td>Used to insert PET10 tube into Stenson&#039;s duct</td></tr><tr><td>Zinc Chloride</td><td>Sigma-Aldrich</td><td>7646-86-7</td><td>Included in plasmid DNA infusates</td></tr></tbody></table>

retrograde parotid gland infusion through stensen's duct in a non-human primate for vectored gene delivery

Retrograde Parotid Gland Infusion through Stensen's Duct in a Non-Human Primate for Vectored Gene Delivery

Salivary glands are an attractive tissue target for gene therapy with promising results already leading to human trials. They are inherently capable of secreting proteins into the bloodstream and are easily accessible, making them potentially superior tissue sites for replacement hormone production or vaccination by gene transfer. Suggested methods for gene delivery include transcutaneous injection and retrograde infusion through salivary ducts. We demonstrate how to perform Retrograde Salivary Gland Infusion (RSGI) in non-human primates. We describe the important anatomic landmarks including identification of the parotid papilla, an atraumatic method of cannulating and sealing Stensen&#39;s Duct utilizing basic dental tools, polyethylene tubing, and cyanoacrylate, and the appropriate rate of infusion. While this is the least traumatic method of delivery, the method is still limited by the volume able to be delivered (&#60;0.5 mL) and the potential for trauma to the duct and gland. We demonstrate using fluoroscopy that an infusate can be fully delivered into the gland, and further demonstrate by immunohistochemistry the transduction of a typical vector and expression of the delivered gene.

Successful procedure, transduction and transcription 
Figure 1 shows the parotid papilla adjacent to the 2nd molar on the posterior superior cheek. The image also shows the correct placement of the mouth brace, one rubber end on the hard palate and the other rubber end on the ipsilateral canine. Figure 2 shows an image taken after successful cannulation of the parotid papilla at the 2 cm mark on the PET10. Figu...

Salivary glands have been proposed as a tissue target site for gene therapy, especially in the area of vaccination by gene transfer. We demonstrate gene delivery in a non-human primate model utilizing retrograde parotid infusion.

Salivary glands are an attractive tissue target for gene therapy with promising results already leading to human trials. They are inherently capable of ...

retrograde-parotid-gland-infusion-through-stensen-s-duct-non-human

Research

JoVE Journal

Immunology and Infection

A protocol for the cannulation of the mouse submandibular salivary gland via the Wharton's duct is described. For this experiment, the trypan blue solution is used as a dyer to demonstrate how this technique effectively delivers infusions into the targeted gland, and to suggest the reliability of this new approach as a potential clinical drug/cell therapy for the regeneration of salivary glands.

Cannulation of the Mouse Submandibular Salivary Gland via the Wharton's Duct

Source: Tadokoro, T., et al. Subpial Adeno-associated Virus 9 (AAV9) Vector Delivery in Adult Mice. J. Vis. Exp. (2017)This video demonstrates a subpial injection technique for gene delivery to the spinal cord in mice. The procedure involves exposing the dura mater, puncturing the pia mater, and injecting a recombinant adeno-associated virus (rAAV) carrying a fluorescent protein-expressing gene into the subpial space. Following injection and recovery, the virus facilitates gene expression in...

Subpial Gene Delivery in the Mouse Spinal Cord to Evaluate Gene Expression

Salivary gland hypofunction, a major adverse effect of head and neck radiotherapy diminishes a patient's quality of life. The demonstration of efficacy of new therapies in animal models is a prerequisite before clinical transition. This protocol describes retroductal administration and local irradiation of rat submandibular glands.

Retroductal Submandibular Gland Instillation and Localized Fractionated Irradiation in a Rat Model of Salivary Hypofunction

This method describes the placement of interposition vein grafts in rabbits, the transduction of the grafts, and the achievement of durable transgene expression. This allows the investigation of physiological and pathological roles of transgenes and their protein products in grafted veins, and testing of gene therapies for vein graft disease.

A Rabbit Model of Durable Transgene Expression in Jugular Vein to Common Carotid Artery Interposition Grafts

Local drug delivery to the submandibular glands is of interest in understanding salivary gland biology and for the development of novel therapeutics. We present an updated and detailed retroductal injection protocol, designed to improve delivery accuracy and experimental reproducibility. The application presented herein is the delivery of polymeric nanoparticles.

Retroductal Nanoparticle Injection to the Murine Submandibular Gland

Here, we demonstrate magnetic resonance (MR)-guided convection enhanced delivery (CED) of viral vectors into the cortex as an efficient and simplified approach for achieving optogenetic expression across large cortical areas in the macaque brain.

Convection Enhanced Delivery of Optogenetic Adeno-associated Viral Vector to the Cortex of Rhesus Macaque Under Guidance of Online MRI Images

As currently implemented, optogenetics in non-human primates requires injection of viral vectors into the brain. An optimal injection method should be reliable and, for many applications, capable of targeting individual sites of arbitrary depth that are readily and unambiguously identified in postmortem histology. An injection method with these properties is presented.

Injections of AAV Vectors for Optogenetics in Anesthetized and Awake Behaving Non-Human Primate Brain

A surgical procedure is described to perform injections into the lumbar cistern of the juvenile rat. This approach has been used for the intrathecal delivery of gene therapy vectors, but it is anticipated that this approach can be used for a variety of therapeutics, including cells and drugs.

Intrathecal Vector Delivery in Juvenile Rats via Lumbar Cistern Injection

This article provides a protocol and an accompanying video for the retrobulbar sinus injection of up to a total volume of 150 µL for postnatal, juvenile, and runted adult mice. This procedure is particularly well suited for the injection of small mice (15 g) when tail vein injection is not feasible.

Systemic Treatment for Postnatal, Juvenile, and Runted Adult Mice by Retrobulbar Sinus Injection

This report details the localized injection method of AAV vectors via the renal pelvis for effective and safe gene transfer into the mouse kidney.

Effective and Safe Gene Delivery to the Mouse Kidney via Slow Retrograde Renal Pelvis Injection of Adeno-Associated Virus Vectors

We present a protocol for direct vagus nerve injection in rats, enabling drug delivery directly into the nerve without post-injection complications. This method applies to preclinical neurological studies involving autonomic nervous system manipulation. It can be used for direct nerve injection for other nerves in rats and other species, with necessary modifications.

Direct Vagus Nerve Injection Protocol For Rats

Learn retrograde parotid gland infusion for gene therapy and vaccination in non-human primates. This reproducible technique enables vectored gene delivery through Stensen's duct without requiring surgical expertise.

Retrograde Parotid Gland Infusion through Stensen's Duct in a Non-Human Primate for Vectored Gene Delivery

Explore More Videos