title: Phase I clinical trial of systemically administered TUSC2(FUS1)-nanoparticles mediating functional gene transfer in humans.
abstract: BACKGROUND
  Tumor suppressor gene TUSC2/FUS1 (TUSC2) is frequently inactivated early in lung cancer development. TUSC2 mediates apoptosis in cancer cells but not normal cells by upregulation of the intrinsic apoptotic pathway. No drug strategies currently exist targeting loss-of-function genetic abnormalities. We report the first in-human systemic gene therapy clinical trial of tumor suppressor gene TUSC2.
  
  
  METHODS
  Patients with recurrent and/or metastatic lung cancer previously treated with platinum-based chemotherapy were treated with escalating doses of intravenous N-[1-(2,3-dioleoyloxy)propyl]-N,N,N-trimethylammonium chloride (DOTAP):cholesterol nanoparticles encapsulating a TUSC2 expression plasmid (DOTAP:chol-TUSC2) every 3 weeks.
  
  
  RESULTS
  Thirty-one patients were treated at 6 dose levels (range 0.01 to 0.09 milligrams per kilogram). The MTD was determined to be 0.06 mg/kg. Five patients achieved stable disease (2.6-10.8 months, including 2 minor responses). One patient had a metabolic response on positron emission tomography (PET) imaging. RT-PCR analysis detected TUSC2 plasmid expression in 7 of 8 post-treatment tumor specimens but not in pretreatment specimens and peripheral blood lymphocyte controls. Proximity ligation assay, performed on paired biopsies from 3 patients, demonstrated low background TUSC2 protein staining in pretreatment tissues compared with intense (10-25 fold increase) TUSC2 protein staining in post-treatment tissues. RT-PCR gene expression profiling analysis of apoptotic pathway genes in two patients with high post-treatment levels of TUSC2 mRNA and protein showed significant post-treatment changes in the intrinsic apoptotic pathway. Twenty-nine genes of the 82 tested in the apoptosis array were identified by Igenuity Pathway Analysis to be significantly altered post-treatment in both patients (Pearson correlation coefficient 0.519; p<0.01).
  
  
  CONCLUSIONS
  DOTAP:chol-TUSC2 can be safely administered intravenously in lung cancer patients and results in uptake of the gene by human primary and metastatic tumors, transgene and gene product expression, specific alterations in TUSC2-regulated pathways, and anti-tumor effects (to our knowledge for the first time for systemic DOTAP:cholesterol nanoparticle gene therapy).
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00059605.
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America. clu@mdanderson.org
authors.forename: Charles
authors.initials: C
authors.lastname: Lu
authors.forename: David J
authors.initials: DJ
authors.lastname: Stewart
authors.forename: J Jack
authors.initials: JJ
authors.lastname: Lee
authors.forename: Lin
authors.initials: L
authors.lastname: Ji
authors.forename: Rajagopal
authors.initials: R
authors.lastname: Ramesh
authors.forename: Gitanjali
authors.initials: G
authors.lastname: Jayachandran
authors.forename: Maria I
authors.initials: MI
authors.lastname: Nunez
authors.forename: Ignacio I
authors.initials: II
authors.lastname: Wistuba
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Erasmus
authors.forename: Marshall E
authors.initials: ME
authors.lastname: Hicks
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Grimm
authors.forename: James M
authors.initials: JM
authors.lastname: Reuben
authors.forename: Veerabhadran
authors.initials: V
authors.lastname: Baladandayuthapani
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Templeton
authors.forename: John D
authors.initials: JD
authors.lastname: McMannis
authors.forename: Jack A
authors.initials: JA
authors.lastname: Roth
mesh_terms: D017209:Apoptosis / Q000187:drug effects / Q000235:genetics; D004305:Dose-Response Relationship, Drug; D005229:Fatty Acids, Monounsaturated / Q000008:administration & dosage; D020869:Gene Expression Profiling; D018014:Gene Transfer Techniques; D015316:Genetic Therapy / Q000379:methods*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000235:genetics*; D020714:Maximum Tolerated Dose; D053758:Nanoparticles / Q000008:administration & dosage / Q000627:therapeutic use*; D010957:Plasmids / Q000008:administration & dosage; D049268:Positron-Emission Tomography; D000644:Quaternary Ammonium Compounds / Q000008:administration & dosage; D020133:Reverse Transcriptase Polymerase Chain Reaction; D025521:Tumor Suppressor Proteins / Q000008:administration & dosage / Q000378:metabolism / Q000627:therapeutic use*
chemical_list: D005229:Fatty Acids, Monounsaturated; D000644:Quaternary Ammonium Compounds; C499993:TUSC2 protein, human; D025521:Tumor Suppressor Proteins; C070046:1,2-dioleoyloxy-3-(trimethylammonium)propane