title: Efficacy of antiangiogenic targeted toxins against glioblastoma multiforme.
abstract: OBJECTIVE
  Because the prognosis for patients with glioblastoma multiforme (GBM) remains poor, investigators have focused on developing new and more effective treatment modalities. Targeted toxins represent a new class of compounds composed of a potent protein toxin and a carrier ligand that will recognize cell surface antigens located on target tissue. A recombinant fusion protein was created that contains the translocation and catalytic portions of diphtheria toxin that are responsible for cell entry and killing, respectively, fused to the noninternalizing aminoterminal fragment portion of human plasminogen activator. This diptheria toxin-uPA fusion protein (DTAT) has the advantage over other fusion proteins of targeting malignant glioma cells and the endothelial cells of the neovasculature that express the urokinase-type plasminogen activator receptor (uPAR). Another protein, DTAT13, was synthesized to target uPAR on the neovasculature and the uPAR and interleukin-13 receptor-expressing GBM cells. The authors describe the in vitro and in vivo efficacy of DTAT and DTAT13 against GBM.
  
  
  METHODS
  The in vitro cytotoxicity of DTAT and DTAT13 was measured using cell proliferation assays. In vivo studies were performed in which DTAT, DTAT13, or a control protein was injected directly into GBM flank tumors in athymic nude mice. Tumor volume was assessed over time and analyzed using the Student t-test. The systemic organ effects of DTAT and DTAT13 were examined functionally and histologically in tumor-free C57BL/6 mice. In vitro, DTAT and DTAT13 were found to be highly potent and selective against U118MG, U87MG, and U373MG GBM cell lines and human umbilical vein endothelial cells. In vivo, DTAT and DTAT13 both caused a statistically significant (p < 0.05) regression of U87MG GBM flank tumors when administered every other day at 10 mg/day for five doses. No tumor regression was seen in control animals. Both DTAT and DTAT13 had little effect on histological findings in the liver, kidney, spleen, and lungs. Serum analysis did not demonstrate an effect on blood urea nitrogen levels, but liver alanine aminotransferase levels rose to statistically significant (p = 0.046) but not life-threatening levels. Also, DTAT13 was less toxic than DTAT in studies of mortality rates.
  
  
  CONCLUSIONS
  Both DTAT and DTAT13 might have potential for clinical application against GBM because of their ability to target both the tumor cells and neovasculature simultaneously with an absence of serious systemic side effects. The discovery that DTAT13 was less toxic than DTAT indicated that the bispecific fusion protein might target a broader subset of antigenetically diverse patients with tumors while reducing the systemic exposure to toxin that would be necessary if two agents were administered separately.
authors.affiliation: Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA. hallx003@umn.edu
authors.forename: Walter A
authors.initials: WA
authors.lastname: Hall
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Vallera
mesh_terms: D020533:Angiogenesis Inhibitors / Q000138:chemical synthesis / Q000494:pharmacology / Q000627:therapeutic use*; D000818:Animals; D000970:Antineoplastic Agents / Q000138:chemical synthesis / Q000494:pharmacology / Q000627:therapeutic use*; D001427:Bacterial Toxins / Q000494:pharmacology / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000098:blood supply / Q000188:drug therapy* / Q000503:physiopathology; D045744:Cell Line, Tumor; D049109:Cell Proliferation / Q000187:drug effects; D003603:Cytotoxins / Q000138:chemical synthesis / Q000494:pharmacology / Q000627:therapeutic use*; D004195:Disease Models, Animal; D005260:Female; D005909:Glioblastoma / Q000098:blood supply / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D053661:Interleukin-13 Receptor alpha1 Subunit; D008099:Liver / Q000187:drug effects / Q000201:enzymology; D051379:Mice; D008810:Mice, Inbred C57BL; D008819:Mice, Nude; D008970:Molecular Weight; D009389:Neovascularization, Pathologic / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control; D015514:Oncogene Proteins, Fusion / Q000138:chemical synthesis / Q000494:pharmacology / Q000627:therapeutic use*; D011956:Receptors, Cell Surface / Q000187:drug effects / Q000378:metabolism; D018123:Receptors, Interleukin / Q000187:drug effects / Q000378:metabolism; D053660:Receptors, Interleukin-13; D055293:Receptors, Urokinase Plasminogen Activator; D011993:Recombinant Fusion Proteins / Q000138:chemical synthesis / Q000494:pharmacology* / Q000627:therapeutic use*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000737:chemistry
chemical_list: D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; D001427:Bacterial Toxins; D003603:Cytotoxins; C512526:DTAT13 protein; C508181:IL13RA1 protein, human; C508183:Il13ra1 protein, mouse; D053661:Interleukin-13 Receptor alpha1 Subunit; D015514:Oncogene Proteins, Fusion; C524898:PLAUR protein, human; C524899:Plaur protein, mouse; D011956:Receptors, Cell Surface; D018123:Receptors, Interleukin; D053660:Receptors, Interleukin-13; D055293:Receptors, Urokinase Plasminogen Activator; D011993:Recombinant Fusion Proteins; C471586:diphtheria toxin-urokinase fusion protein, human; D014568:Urokinase-Type Plasminogen Activator