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Volume 66, Issue 2
15 January 2006

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Immunology| January 19 2006


DE NOVO INDUCTION OF A CANCER/TESTIS ANTIGEN BY 5-AZA-2′-DEOXYCYTIDINE AUGMENTS
ADOPTIVE IMMUNOTHERAPY IN A MURINE TUMOR MODEL

Z. Sheng Guo;
Z. Sheng Guo
1Thoracic Oncology Section and
4University of Pittsburgh Cancer Institute and Department of Surgery, School of
Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Julie A. Hong;
Julie A. Hong
1Thoracic Oncology Section and
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Kari R. Irvine;
Kari R. Irvine
2Tumor Immunology Section, Surgery Branch, National Cancer Institute, NIH,
Bethesda, Maryland;
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G. Aaron Chen;
G. Aaron Chen
1Thoracic Oncology Section and
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Paul J. Spiess;
Paul J. Spiess
2Tumor Immunology Section, Surgery Branch, National Cancer Institute, NIH,
Bethesda, Maryland;
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Yang Liu;
Yang Liu
3Department of Pathology and Comprehensive Cancer Center, Ohio State University
Medical Center, Columbus, Ohio; and
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Gang Zeng;
Gang Zeng
2Tumor Immunology Section, Surgery Branch, National Cancer Institute, NIH,
Bethesda, Maryland;
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John R. Wunderlich;
John R. Wunderlich
2Tumor Immunology Section, Surgery Branch, National Cancer Institute, NIH,
Bethesda, Maryland;
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Dao M. Nguyen;
Dao M. Nguyen
1Thoracic Oncology Section and
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Nicholas P. Restifo;
Nicholas P. Restifo
2Tumor Immunology Section, Surgery Branch, National Cancer Institute, NIH,
Bethesda, Maryland;
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David S. Schrump
David S. Schrump
1Thoracic Oncology Section and
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Author & Article Information
Requests for reprints: Z. Sheng Guo, University of Pittsburgh Cancer Institute,
UPCI Research Pavilion, 1.46, 5117 Centre Avenue, Pittsburgh, PA 15213. Phone:
412-623-7711; Fax: 412-623-7709; E-mail: guozs@upmc.edu.
Received: September 01 2005
Revision Received: October 20 2005
Accepted: October 20 2005
Online ISSN: 1538-7445
Print ISSN: 0008-5472
©2006 American Association for Cancer Research.
2006
Cancer Res (2006) 66 (2): 1105–1113.
https://doi.org/10.1158/0008-5472.CAN-05-3020
Article history
Received:
September 01 2005
Revision Received:
October 20 2005
Accepted:
October 20 2005

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   * Version of Record January 19 2006

Citation

Z. Sheng Guo, Julie A. Hong, Kari R. Irvine, G. Aaron Chen, Paul J. Spiess, Yang
Liu, Gang Zeng, John R. Wunderlich, Dao M. Nguyen, Nicholas P. Restifo, David S.
Schrump; De novo Induction of a Cancer/Testis Antigen by 5-Aza-2′-Deoxycytidine
Augments Adoptive Immunotherapy in a Murine Tumor Model. Cancer Res 15 January
2006; 66 (2): 1105–1113. https://doi.org/10.1158/0008-5472.CAN-05-3020

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ABSTRACT

Recent studies suggest that immunotherapy targeting specific tumor-associated
antigens (TAAs) may be beneficial in cancer patients. However, most of these
TAAs are tumor type specific and heterogeneous among patients, thus limiting
their applications. Here, we describe the de novo induction of a cancer/testis
antigen (CTA) for immunotherapy of tumors of various histologies. The murine CTA
P1A, normally expressed only in a few tumor lines, could be induced de novo in
all P1A-negative cancer lines of eight histologic origins in vitro and in
various murine xenografts by systemic administration of 5-aza-2′-deoxycytidine.
The induction of P1A expression correlated strongly with demethylation of the
CpG island in the promoter region of this gene. The induced antigen was
processed and presented properly for recognition by H-2Ld-restricted
P1A-specific CTLs. The combination of a demethylating agent and adoptive
transfer of P1A-specific CTL effectively treated lung metastases in syngeneic
mice challenged with P1A-negative 4T1 mammary carcinoma cells. These data show a
novel strategy of combined chemoimmunotherapy of cancer targeting a CTA induced
de novo in a broad range of tumor histologies, and support further evaluation of
chromatin-remodeling agents for human cancer therapy. (Cancer Res 2006; 66(2):
1105-13)




INTRODUCTION

Pioneering work a decade ago showed the existence of human tumor-associated
antigens (TAAs) using patient CTLs that recognized peptides derived from these
antigens (1–3). However, the scarcity of clinically significant tumor-specific
immune responses in cancer patients had cast doubt for many years that
antigen-specific immunotherapy would play an important role in treating human
cancer. Although earlier studies focused on melanoma, TAAs that react with T
cells have been characterized in several other types of cancer (1–3), suggesting
that most if not all tumors express antigens that allow recognition and attack
by antigen-specific CTLs. Consequently, clinical efforts proceeded to target
these TAAs in using vaccination and adoptive T-cell therapy in cancer patients
(4–9). Recently, adoptive T-cell therapy has achieved significant clinical
results, including cancer regression in patients with metastatic melanoma (10,
11).

Unfortunately, the expression of most known TAAs that are reactive with
autologous T cells is restricted to one or a few types of tumors and to a
fraction of patients with these malignancies and the expression can vary among
metastases obtained from the same patient. Immune selection of antigen loss
variants may be an additional obstacle for targeting most known tumor antigens
for cancer immunotherapy. In addition, immune tolerance is one of the major
obstacles in immunotherapy. This may be related to low levels of antigen
expression in solid tumors (12). Due to these factors, clinical studies have
progressed slowly because strategies have been tested one malignancy at a time
and, in some cases, patient by patient (13). To circumvent these obstacles,
investigators have attempted to find universal TAA that could trigger CTL
responses against a broad range of tumor types (14).

To address some of these important issues, we have turned our attention to
cancer/testis antigens (CTA). The cancer/testis genes are regulated, at least in
part, by epigenetic mechanisms. DNA methylation has been identified as one of
the predominant epigenetic mechanisms to modulate gene expression in cancer,
aging, and normal development (15–17). Patterns of DNA methylation and chromatin
structure are profoundly altered in neoplasia, which include genome-wide losses
of and regional gains in DNA methylation. CTAs are expressed in a wide range of
human malignancies (3). Genes encoding CTAs are expressed in a stage-specific
manner in germ cells yet are strictly silenced in normal somatic cells (17).
During malignant transformation, cancer/testis genes are derepressed via complex
epigenetic mechanisms (18, 19). Numerous cancer/testis genes map to the
X-chromosome and encode proteins, such as MAGE-3 and NY-ESO-1, that are
recognized by CTL from cancer patients (3). Despite the fact that most human
malignancies simultaneously express multiple CTAs, immune response to those
antigens seems limited. In part, this is due to levels of expression that appear
below the threshold for immune recognition in vivo (20, 21). Conceivably,
innovative treatment regimens that enhance CTA expression in primary
malignancies may facilitate the development of efficacious immunotherapy
protocols with broad applicability in cancer patients (22). Our group has shown
previously that NY-ESO-1 and MAGE-3 can be induced in vitro in thoracic cancer
cell lines by 5-aza-2'-deoxycytidine (5-azadC) alone or in combination with the
histone deacetylase inhibitor depsipeptide (23–25). Others have also shown that
MAGE antigens and LAGE-1 can be induced by 5-azadC in certain cancer cell lines
in vitro (26, 27).

Recently, we utilized murine models to address many basic scientific questions
regarding the induction of CTAs and their suitability as targets for cancer
immunotherapy. The mouse CTA P1A, originally identified in mastocytoma P815
cells, is encoded by a single gene located in the X-chromosome (28, 29). A
single peptide named P1A 35-43 (NH2-Leu-Pro-Tyr-Leu-Gly-Trp-Leu-Val-Phe-COOH) is
presented to anti-P815 CTL clones by MHC H-2Ld molecules (29). P1A is a
nonmutated self-protein expressed in mastocytoma P815 and in several other
tumors. It was unclear why P1A is expressed at high levels in testes and a few
cancer lines. Previous studies suggested that P1A is silent in normal tissues,
except testis and placenta (28, 30), a generalized concept for CTAs. However,
recent meticulous studies have indicated that P1A is expressed at extremely low
levels in normal tissues, including hematopoietic cells (31) and medullary
thymic epithelial cells, along with a wide range of tissue-specific antigens
(32). These low expression levels, however, do not prevent safe induction of CTL
against P1A-expressing tumors (30). Immunization with P1A-expressing vaccinia
virus or tumor cells can induce CTL that provide protection against challenge of
P1A-expressing tumors (33) indicating that PIA can function as a tumor rejection
antigen (34).

Here, we describe a novel phenomenon of inducing the CTA P1A de novo in tumors
of multiple histologies, and show that the induced CTA can be effectively used
as a target for adoptive immunotherapy of cancer in a murine tumor model. The
results of these studies suggest that combined chemoimmunotherapy may represent
a novel strategy for human cancer treatment.


MATERIALS AND METHODS

Cell lines. Most tumor cell lines were obtained from American Type Culture
Collection (Manasass, VA), or were available in cell line repositories at the
National Cancer Institute (NCI). 4T1 mammary tumor cells (35) were obtained from
Dr. Fred Miller (Wayne State University, Detroit, MI). Tumor cells were
propagated in vitro as recommended by the respective providers.

Tumor cells treated with 5-azadC. 5-AzadC (Sigma Chemical Co., St. Louis, MO)
was dissolved as 1.0 mmol/L stock solution in HBSS and stored at −20°C. 5-AzadC
was added to tissue culture medium daily at a final concentration of 1.0 μmol/L
for 48 hours unless specified otherwise. Drug-treated cells were cultured for an
additional 24 hours in normal medium before harvesting for analysis of P1A
expression.

Reverse transcription-PCR reactions. Total RNA was prepared using an RNeasy mini
kit (Qiagen, Inc., Valencia, CA). Reverse transcription was done using a Reverse
Transcription System at the suggested conditions (Promega, Madison, WI). One
microgram of total RNA was used in each 20 μL reaction. PCR was done using the
following primers and thermal cycle conditions: 5′-CCCTTCATTGACCTCAACTACATGG-3′
[glyceraldehyde-3-phosphate dehydrogenase (GAPDH) forward],
5′-CCTGCTTCACCACCTTCTTGATGTC-3′ (GAPDH reverse),
5′-CGGAATTCTGTGCCATGTCTGATAACAAGAAA-3′ (P1A forward),
5′-CGTCTAGATTGCAACTGCATGCCTAAGGTGAG-3′ (P1A reverse), 94°C × 5 minutes (94°C × 1
minute, 58°C × 1 minute, and 72°C × 1 minute) × 30 cycles, and 72°C × 7 minutes.
PCR products were separated on 1% agarose gels and visualized by ethidium
bromide techniques.

Methylation-specific PCR. Methylation status of a CpG island in the 5′
regulatory region of the P1A gene was evaluated by methylation-specific PCR
techniques as described by Herman et al. (36) using CpGenome DNA modification
and CpG Wiz amplification kits (Serologicals Corp., Norcross, GA). CpG Ware™
software (Serologicals) was used to design the following PCR primers that would
specifically amplify methylated or unmethylated templates following bisulfite
modification of genomic DNA: 5′-TTAAGTGCGTTATTACGTTTGGTTTTTAC-3′ (methylated
forward), and 5′-ATAACCGATTATTTAATACAAAAATCGACG-3′ (methylated reverse),
5′-GATTAAGTGTGTTATTATGTTTGGTTTTTAT-3′ (unmethylated forward), and
5′-ACATAACCAATTATTTAATACAAAAATCAACA-3′ (unmethylated reverse). The
methylation-specific PCR thermal cycle conditions were 94°C for 45 seconds, 60°C
for 45 seconds, 72°C for 30 seconds, for a total of 40 cycles. The PCR products
were analyzed by gel electrophoresis with 2.0% agarose gel.

Generation of CTL. Initially, H-2Ld-restricted CTL recognizing P1A or
β-galactosidase were generated by vaccinating BALB/c mice twice with 2 × 107
plaque-forming units/mouse of vv.ES-P1A or vv.lacZ, as described (33).
Splenocytes from immunized mice were isolated and pulsed with 1.0 μmol/L of
Ld-restricted synthetic peptides derived from P1A (P1A 35-43: LPYLGWLVF) or
β-galactosidase protein (β-galactosidase 876-884:TPHPARIGL). These cells were
cultured in vitro for 1 week before adding rhIL-2 (Chiron Corp., Emeryville, CA)
to the medium for T-cell expansion. The specificity of the CTLs was confirmed by
assaying their activities against appropriate targets. Later in the study for
immunotherapy in vivo, P1A-specific CTLs were generated from splenocytes
isolated from P1A35-43 T-cell receptor transgenic mice (31). These splenocytes
were pulsed with 1.0 μmol/L of the H-2Ld-restricted peptide (P1A 35-43). Three
days later, rhIL-2 was added to growth medium for T-cell expansion.

Cytotoxicity assays. The cytotoxicity of H-2Ld-restricted P1A and
β-galactosidase CTL was measured in an improved
3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay as described
by Ribeiro-Dias et al. (37). Briefly, target cells were cultured in normal
medium with or without 1.0 μmol/L 5-azadC for 48 hours and were rested for 24
hours. Normal splenocytes were used as controls. Target cells (1 × 104) in 50 μL
of culture medium were added to effector cells suspended in 50 μL culture medium
in 96-well flat-bottomed culture plates at effector-to-target cell ratios of
0.2:1, 1:1, 5:1, and 25:1. After 16 hours of incubation at 37°C, 20 μL of
3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium,
inner salt (Promega), was added to each well, and the absorbance at 492 nm was
measured 1 hour later. Percent lysis was calculated as follows: [1 −
{(absorbance of effector + target cells) − (absorbance of effector cells)} /
(absorbance of target cells)] × 100.

IFN-γ release assays. Target cells were prepared as described for cytotoxicity
assays. Five microliters of 104 target cells in 100 μL culture medium were added
to effector cells in 100 μL medium in 96-well flat-bottomed culture plates at an
effector-to-target cell ratio of 1:10. Following 16 hours incubation at 37°C,
culture supernatants were harvested and IFN-γ levels were determined using a
murine IFN-γ ELISA kit (Pierce, Rockford, IL).

S.c. tumor models. Female BALB/c and C57BL/6 (B6) mice (6 weeks of age) were
purchased from the NCI-Frederick facility (Frederick, MD). Lewis lung carcinoma
(LLC), B16, MC38, MCA102, or 4T1 tumor cells grown in log phase were washed
thrice in cold HBSS, and 1.0 × 105 cells in 100 μL HBSS were injected s.c. into
the flank of syngeneic mice (day 0). Commencing on day 10, 5-azadC (1.0 mg/kg
body weight or other specified concentrations in 100 μL HBSS) or HBSS alone was
injected i.p. twice daily for 5 consecutive days. Two days after completion of
drug treatments, mice were euthanized and tumors as well as a variety of normal
tissues were collected for analysis of P1A gene expression.

4T1 Mammary tumor lung metastasis model and treatment. On day 0, 2.0 × 105 4T1
mammary tumor cells in 200 μL HBSS were injected into tail veins of syngeneic
BALB/c mice. Commencing on day 7, mice were injected i.p. with 5-azadC (0.8
mg/kg body weight) or HBSS once daily for 6 consecutive days. Subsequently, the
mice were rested for 1 day. On day 13, 1 × 106 H-2Ld-restricted P1A-specific CTL
or β-galactosidase-specific CTL were injected i.v.; rhIL-2 (50 K CU/mouse) was
administered i.p. twice during the first 24 hours. On day 21, mice were
euthanized, and mediastinal organs harvested. Lungs were perfused with 15% India
ink solution, and metastases were enumerated. For doses of 5-azadC to be used in
mice, maximal tolerable doses vary among different strains of mice and need to
be determined empirically.

Statistics. All data from animal experiments were analyzed by using Student's t
test (SigmaPlot), where P < 0.05 indicated that the value of the test sample was
significantly different from that of the relevant controls.


RESULTS

P1A gene induction by 5-azadC is dose and time dependent. Initial screening by
reverse transcription-PCR (RT-PCR) indicated that P1A was expressed in only 5 of
21 tumor cell lines (Table 1). To examine if P1A could be induced de novo in
cultured cells, a P1A-negative tumor cell line LLC was treated with 5-azadC at
varying doses and exposure durations. As shown in Fig. 1, LLC cells grown under
normal conditions did not express P1A. Under 48-hour exposure conditions, 0.3
μmol/L 5-azadC was sufficient to induce P1A in LLC cells; higher levels of P1A
expression were observed with increasing doses of 5-azadC (Fig. 1A). A
significant percentage of cells exhibited growth arrest or apoptosis following
treatment with 3 or 10 μmol/L 5-azadC, a phenomenon observed previously (38). As
such, a dosage of 1.0 μmol/L 5-azadC was chosen for additional in vitro studies.

Table 1.

P1A gene expression as detected by RT-PCR assays

Tumor type . Cancer cells . Relative P1A expression

--------------------------------------------------------------------------------

.  .  .  . −5azadC . +5azadC . Mastocytoma P815 +++ +++ Colon
carcinoma CA07/A − +++  CA51 +/− +++  CT26 − +++  MC38 − +++ Lung
carcinoma LC12 − +++  LLC1 − +++  LM2 − +++  M109 − +++ Lymphoma A20 +/− +++  CH-1 − +++  EL4 + +++  TIMI.4 + +++  YAC-1 − +++ Sarcoma MCA
102 − +++  MCA 205 − +++  WEHI 164 − +++ Mammary
tumor 4T1 − +++  C127I − +++ Hepatoma Hepa
1-6 + +++ Melanoma B16 − +++ Neuroblastoma Neuro-2a − +++ 

Tumor type . Cancer cells . Relative P1A expression

--------------------------------------------------------------------------------

.  .  .  . −5azadC . +5azadC . Mastocytoma P815 +++ +++ Colon
carcinoma CA07/A − +++  CA51 +/− +++  CT26 − +++  MC38 − +++ Lung
carcinoma LC12 − +++  LLC1 − +++  LM2 − +++  M109 − +++ Lymphoma A20 +/− +++  CH-1 − +++  EL4 + +++  TIMI.4 + +++  YAC-1 − +++ Sarcoma MCA
102 − +++  MCA 205 − +++  WEHI 164 − +++ Mammary
tumor 4T1 − +++  C127I − +++ Hepatoma Hepa
1-6 + +++ Melanoma B16 − +++ Neuroblastoma Neuro-2a − +++ 

NOTE: The relative expression of P1A mRNA was determined by a semiquantitative
RT-PCR assay using total RNA extracted from cells. +++, levels of mRNA detected
easily by 30 cycles of PCR after reverse transcription; +, a faint band of PCR
product by 30 cycles of PCR; +/−, extremely low levels of expression, barely
detectable by 35 cycles of PCR. −, no DNA product detected by 35 cycles of PCR.

View Large
Figure 1.
View largeDownload slide

Dose- and time-dependent induction of P1A by 5-azadC in LLC tumor cells, as
determined by RT-PCR assays. A, 5-azadC dose response. LLC cells were treated
for 48 hours with 5-azadC at concentrations of 0, 0.01, 0.03, 0.1, 0.3, 1.0, 3,
and 10 μmol/L. B, blank; P, positive control. B, duration of 5-azadC treatment
with a fixed concentration of 5-azadC at 1.0 μmol/L. LLC cells were incubated
with 5-azadC for 0, 6, 12, 24, 48, 96, and 144 hours. The treated cells were
harvested and total RNA was purified and used as templates for RT-PCR to
determine the expression of the antigen P1A and control gene GAPDH. N, negative
control for P1A; M, DNA molecular weight markers.

Figure 1.
View largeDownload slide

Dose- and time-dependent induction of P1A by 5-azadC in LLC tumor cells, as
determined by RT-PCR assays. A, 5-azadC dose response. LLC cells were treated
for 48 hours with 5-azadC at concentrations of 0, 0.01, 0.03, 0.1, 0.3, 1.0, 3,
and 10 μmol/L. B, blank; P, positive control. B, duration of 5-azadC treatment
with a fixed concentration of 5-azadC at 1.0 μmol/L. LLC cells were incubated
with 5-azadC for 0, 6, 12, 24, 48, 96, and 144 hours. The treated cells were
harvested and total RNA was purified and used as templates for RT-PCR to
determine the expression of the antigen P1A and control gene GAPDH. N, negative
control for P1A; M, DNA molecular weight markers.

Close modal

The relationship between duration of drug exposure and P1A gene expression was
also investigated. At a dose of 1.0 μmol/L, 6-hour 5-azadC exposure was
sufficient to induce P1A expression; longer exposure times increased the
expression of this CTA until 48 hours when the level of gene induction seemed to
plateau (Fig. 1B). These results showed that 5-azadC induced P1A expression de
novo in a dose- and time-dependent manner in LLC cells.

The persistence of induced P1A antigen expression was also examined in
5-azadC-treated cells. LLC cells were mock-treated or treated with 5-azadC at
1.0 μmol/L for 48 hours. Then, drug was removed and cells were washed with 1×
PBS and fed with fresh growth medium and split when necessary. Aliquots of cells
were taken at different time points and stored until analysis. As shown in Fig.
2, P1A was peaked within 2 to 6 days and remained at significant levels for 1
month. Its expression gradually reduced to background level in 2 months. These
results showed that the induced P1A expression was quite stable for several
weeks, which might be a sufficient time window for immunotherapy targeting this
CTA.

Figure 2.
View largeDownload slide

Duration of induced P1A expression by 5-azadC in LLC cells. The cells were
treated with 5-azadC at 1.0 μmol/L at day 0 for 2 days. After 2 days, the drug
was removed and cells were split when necessary. Aliquots of cells were
collected and stored at −80°C. Total RNA was extracted and RT-PCR was done as
described.

Figure 2.
View largeDownload slide

Duration of induced P1A expression by 5-azadC in LLC cells. The cells were
treated with 5-azadC at 1.0 μmol/L at day 0 for 2 days. After 2 days, the drug
was removed and cells were split when necessary. Aliquots of cells were
collected and stored at −80°C. Total RNA was extracted and RT-PCR was done as
described.

Close modal

De novo induction of P1A in vitro is universal. We were interested in knowing
whether de novo P1A induction as seen in LLC cells was universal among various
types of tumors. Therefore, 21 murine tumor cell lines representing cancer of
eight different histologies were selected for study. These tumor cells were
untreated or treated with 5-azadC at 1.0 μmol/L for 48 hours. The results
obtained with RT-PCR are summarized in Table 1. Under normal growth conditions,
no P1A expression was detected by RT-PCR, except five tumor lines—EL4, TIMI.4,
Hepa1-6, A20, and CA51, which naturally expressed P1A at very low levels. It is
interesting to note that three of the five P1A weakly positive cell lines are
lymphomas, and only 2 of 16 tumor lines derived from other solid tumors
expressed P1A. Treatment with 5-azadC induced P1A expression to significant
levels in all P1A-negative tumor lines and further enhanced P1A expression in
those P1A weakly positive tumor cell lines. These results were consistent with
induction of CTAs in cultured human cancer cells (23–27).

P1A induction correlates with demethylation of the P1A promoter region. A series
of experiments were done to ascertain if 5-azadC mediated induction of P1A via
direct modulation of chromatin structure within the promoter region of P1A.
Using the generally accepted definition (39, 40) and the CpG Plot software
online,5

5

http://www.ebi.ac.uk/emboss/cpgplot/.

a region extending from nucleotides −798 to −551 that fulfilled current criteria
for CpG island was identified ∼300 bp proximal to the major initiation site of
transcription in the gene (41). Methylation-specific PCR assays were used to
examine the status of this CpG island in untreated as well as 5-azadC-treated
tumor cells. Results are depicted in Fig. 3. PCR products corresponding to
methylated template were detected in bisulfite-treated genomic DNA from normal
murine liver cells that do not express P1A. In contrast, unmethylated template
was detected in P815 cells that express high levels of P1A. From cells grown
under normal conditions, methylated as well as unmethylated templates were
observed in CA51 cells that normally exhibit very low level P1A expression. The
P1A CpG island seemed to be completely methylated in P1A-deficient MC38 and 4T1
cells. When the three cancer lines were treated with 5-azadC, a concurrent
switch from hypermethylation to hypomethylation of the CpG island with induction
of P1A was noted. Collectively, these results strongly suggest that
5-azadC-mediates P1A induction via direct chromatin remodeling mechanisms
targeted to the 5′ regulatory region of this cancer/testis gene.



Figure 3.
View largeDownload slide

Methylation status of the CpG island in the P1A gene promoter region as
determined by methylation-specific PCR. Two controls are genomic DNA from mouse
liver cells that express no P1A, and P815 tumor cells that express high level of
P1A. The three tested tumor cell lines are CA51, MC38, and 4T1. −, not treated
with 5-azadC; +, 5-azadC treatment of cells at 1.0 μmol/L for 48 hours. M,
methylated DNA; U, unmethylated DNA.

Figure 3.
View largeDownload slide

Methylation status of the CpG island in the P1A gene promoter region as
determined by methylation-specific PCR. Two controls are genomic DNA from mouse
liver cells that express no P1A, and P815 tumor cells that express high level of
P1A. The three tested tumor cell lines are CA51, MC38, and 4T1. −, not treated
with 5-azadC; +, 5-azadC treatment of cells at 1.0 μmol/L for 48 hours. M,
methylated DNA; U, unmethylated DNA.

Close modal

5-AzadC–treated cancer cells were recognized specifically by H-2Ld-restricted
P1A-specific CTL. Expression of P1A, as well as the integrity of antigen
processing and presentation pathways in 5-azadC-treated tumor cells, were
assessed in two functional assays using P1A epitope-specific CTL. First, CTL
recognition of tumor cells was assessed by cytokine release assays. When
cultured with H-2Ld-negative tumor cells, P1A-specific CTL released very little
IFN-γ regardless of whether target cells were treated with 5-azadC (Fig. 4A). In
contrast, when cultured with untreated H-2Ld-positive P815 cells expressing high
levels of P1A, H-2Ld-restricted P1A-specific CTL released a significant amount
of IFN-γ (Fig. 4B). Much less IFN-γ release was observed when these CTL were
cultured with CA51 or A20 cells (Fig. 4B). Furthermore, very little IFN-γ was
detected when M109, CT26, or 4T1 cells were used as targets. Increased levels of
IFN-γ release (2,000 to 16,000 pg/mL) were detected following culture of
P1A-specific CTL with 5-azadC-treated 4T1, CA51, A20, or P815 cells (Fig. 4B).
In contrast, minimal (<20 pg/mL) IFN-γ release was detected when these
5-azadC-treated targets were incubated with H-2Ld-restricted
β-galactosidase-specific CTL (data not shown). These results were consistent
with P1A expression data derived from RT-PCR experiments (Table 1).
Interestingly, very little IFN-γ release was observed when P1A-specific CTLs
were cultured with 5-azadC-treated M109 or CT26 cells, despite induction of P1A
in these targets (Table 1). Whereas the mechanisms responsible for this
phenomenon were not fully investigated, these results may have been attributable
to deficiencies regarding antigen processing/presentation that are known to
occur frequently in cancer cells (42).

Figure 4.
View largeDownload slide

IFN-γ release assays with H-2Ld-restriced P1A-specific CTL incubated with either
5-azadC-treated or untreated tumor cells. A, H-2Ld-negative tumor lines. B,
tumor lines derived from H-2Ld-positive mice, which may include H-2Ld antigen
down-regulated or negative tumor cell lines. The experiments were done in
duplicates and repeated thrice. Similar results were obtained.

Figure 4.
View largeDownload slide

IFN-γ release assays with H-2Ld-restriced P1A-specific CTL incubated with either
5-azadC-treated or untreated tumor cells. A, H-2Ld-negative tumor lines. B,
tumor lines derived from H-2Ld-positive mice, which may include H-2Ld antigen
down-regulated or negative tumor cell lines. The experiments were done in
duplicates and repeated thrice. Similar results were obtained.

Close modal

Cytotoxicity assays were next done to further examine recognition of
5-azadC-treated tumor cells by the P1A-specific CTL (Fig. 5). Two H-2Ld+ cancer
lines (A20 and 4T1) were selected for this analysis with MC38 (H-2Ld−) and P815
(H-2Ld+) serving as negative and positive controls, respectively, for MHC class
I expression. CTL-mediated cytotoxicity was observed only at high
effector-to-target cell ratio when untreated A20 cells, which naturally express
low levels of P1A (Table 1), were used as targets. However, when A20 cells were
treated with 5-azadC, high-level cytotoxicity was observed even at a low
effector-to-target cell ratio (Fig. 5A). No cytotoxicity was noted when
untreated P1A-negative 4T1 cells were used as targets. In contrast, when 4T1
cells were treated with 5-azadC, an enhancement of CTL-mediated cytotoxicity was
observed at the highest effector-to-target cell ratio. Little if any specific
activity was observed against MC38 cells (H-2Ld−), irrespective of drug
treatment. High levels of CTL-mediated cytotoxicity was observed against P815
cells (H-2Ld+ and P1A+); this cytotoxicity was further augmented by pretreatment
of these target cells with 5-azadC (Fig. 5D). Collectively, these data showed
that 5-azadC-induced P1A was properly processed and presented in most
H-2Ld-positive cancer cells enabling their recognition by Ld-restricted CTL
specific for this CTA.

Figure 5.
View largeDownload slide

Specific lysis of tumor cells mediated by H-2Ld-restricted P1A-epitope-specific
CTL. Two MHC-matched tumor cell lines, A20 (H-2Ld+) and 4T1 (H-2Ld+), were
tested, whereas MHC-mismatched MC38 (H-2Ld−) served as negative control, and
MHC-matched, P1A-positive P815 cells (H-2Ld+) served as positive control. ▪,
5-azadC-treated target cells (5-azadC+); ○, untreated target cells (nm). The
experiments were done with CTL generated from splenocytes isolated from BALB/c
mice vaccinated with vv.ES-P1A. Points, mean of duplicates. Representative of at
least three independent experiments. E:T ratio, effector-to-target cell ratio.

Figure 5.
View largeDownload slide

Specific lysis of tumor cells mediated by H-2Ld-restricted P1A-epitope-specific
CTL. Two MHC-matched tumor cell lines, A20 (H-2Ld+) and 4T1 (H-2Ld+), were
tested, whereas MHC-mismatched MC38 (H-2Ld−) served as negative control, and
MHC-matched, P1A-positive P815 cells (H-2Ld+) served as positive control. ▪,
5-azadC-treated target cells (5-azadC+); ○, untreated target cells (nm). The
experiments were done with CTL generated from splenocytes isolated from BALB/c
mice vaccinated with vv.ES-P1A. Points, mean of duplicates. Representative of at
least three independent experiments. E:T ratio, effector-to-target cell ratio.

Close modal

De novo induction of P1A in tumor xenografts. Logically, we then asked if P1A
would be induced in P1A-negative tumor cells in vivo. Preliminary
dose-escalation experiments were conducted with C57BL/6 mice bearing syngeneic,
s.c. LCC xenografts to examine 5-azadC-mediated toxicity and P1A induction. Mice
were divided into four groups (five per group) and treated with 5-azadC at 0,
0.4, 2.0, or 10 mg/kg body weight administered i.p. twice daily for 5
consecutive days. Forty-eight hours after completion of 5-azadC treatment, mice
were euthanized and tumor xenografts as well as various normal tissues were
collected for further examination. Throughout the duration of the experiment,
mice were observed frequently for signs of systemic toxicity. All of the five
animals receiving the maximal 5-azadC dose exhibited significant toxicity with
three mice dying before completion of the experiment. However, only mild
toxicity was observed in animals receiving 5-azadC at a dose of 2.0 mg/kg. No
toxicity was observed at doses of 0 and 0.4 mg/kg. RT-PCR analysis revealed no
P1A expression in tumor xenografts from mice treated with HBSS, results that
were consistent with in vitro data (Table 1). P1A expression in tumor xenografts
from 5-azadC-treated animals increased in a dose-dependent manner, a phenomenon
we observed in vitro (data not shown). On the basis of toxicities and levels of
P1A induction, a dose of 5-azadC ranging from 0.5 to 1.5 mg/kg body weight was
selected for use in subsequent studies.

Additional experiments were done to examine if the 5-azadC treatment was
sufficient to mediate P1A induction in cancer cells of various histologies in
vivo. Five P1A-negative cancer lines, comprising melanoma (B16), lung carcinoma
(LLC), colon carcinoma (MC38), sarcoma (MCA102), and mammary adenocarcinoma
(4T1) were grown as s.c. xenografts in syngeneic BALB/c or C57BL/6 mice. Eleven
days after inoculation, mice with tumor xenografts ∼5 × 5 mm in size were
treated with 5-azadC at 1.5 mg/kg using the treatment regimen described above.
P1A expression in tumor and normal tissues was examined using RT-PCR techniques.
As shown in Fig. 6A, no P1A expression was detected in xenografts from mice
treated with HBSS or untreated controls. In contrast, P1A was expressed in all
of the xenografts from mice treated with 5-azadC.

Figure 6.
View largeDownload slide

Induction of P1A in five different tumors in syngeneic BALB/c or C57BL/6
tumor-bearing mice. The five tumors represent melanoma (B16), lung carcinoma
(LLC), colon carcinoma (MC38), sarcoma (MCA102), and mammary adenocarcinoma
(4T1). The s.c. tumor-bearing mice were untreated or treated with
2-deoxy-5′-azacytidine systematically as described in Materials and Methods. P1A
expression was detected by RT-PCR assays (30 cycles of PCR). A, tumors of B16,
LLC, MC38, and MCA102 from mice untreated (−) or treated (+) with 5-azadC. B,
4T1 tumor and normal tissues from tumor-bearing BALB/c mice untreated (−) or
treated (+) with 5-azadC. BM, bone marrow; H, heart; K, kidney; Li, liver; Lu,
lung; Sp, spleen; N, non-input RNA; P, positive control of P815 cells. We have
noticed that lower levels of GAPDH detected by RT-PCR in the tissues of lung and
spleens represented real situations in those tissues.

Figure 6.
View largeDownload slide

Induction of P1A in five different tumors in syngeneic BALB/c or C57BL/6
tumor-bearing mice. The five tumors represent melanoma (B16), lung carcinoma
(LLC), colon carcinoma (MC38), sarcoma (MCA102), and mammary adenocarcinoma
(4T1). The s.c. tumor-bearing mice were untreated or treated with
2-deoxy-5′-azacytidine systematically as described in Materials and Methods. P1A
expression was detected by RT-PCR assays (30 cycles of PCR). A, tumors of B16,
LLC, MC38, and MCA102 from mice untreated (−) or treated (+) with 5-azadC. B,
4T1 tumor and normal tissues from tumor-bearing BALB/c mice untreated (−) or
treated (+) with 5-azadC. BM, bone marrow; H, heart; K, kidney; Li, liver; Lu,
lung; Sp, spleen; N, non-input RNA; P, positive control of P815 cells. We have
noticed that lower levels of GAPDH detected by RT-PCR in the tissues of lung and
spleens represented real situations in those tissues.

Close modal

The 4T1 tumor model was used to examine P1A expression in normal tissues
relative to tumor xenografts following 5-azadC exposure (Fig. 6B). As
anticipated, no P1A expression was detected in tumors from control mice.
However, P1A expression was readily detected in tumor tissues from
5-azadC-treated animals. The 5-azadC treatment regimen did not induce P1A
expression in a variety of normal tissues, including heart, kidney, liver, or
lung. However, low-level P1A expression was observed in bone marrow from
5-azadC-treated mice. Collectively, these results indicated that P1A could be
induced in murine tumor xenografts of diverse histologies using a tolerable
5-azadC treatment regimen. Under these treatment conditions, induction of P1A in
vivo was restricted primarily to cancer cells.

Systemic 5-azadC administration followed by infusion of H-2Ld-restricted P1A CTL
effectively treated naturally P1A-negative 4T1 tumors. Finally, experiments were
done to ascertain the effects of combining the 5-azadC treatment regimen with
i.v. infusion of P1A-specific CTL in mice bearing P1A-negative tumors. A
well-established lung metastasis model was used to examine this issue. 4T1
mammary carcinoma cells are poorly immunogenic and highly metastatic in
syngeneic BALB/c mice. These cells exhibit in vivo growth characteristics
resembling human metastatic breast carcinoma and are typically refractory to
chemotherapy or immunotherapy (35, 43). Lung metastases were established by
injecting 4T1 tumor cells i.v. into syngeneic hosts. Seven days later,
tumor-bearing mice commenced a 6-day treatment regimen of 5-azadC administered
at a dose approximating 0.8 mg/kg i.p. For these experiments, the 5-azadC dose
was reduced somewhat to minimize cumulative toxicity from the interleukin 2
(IL-2), which was administered in conjunction with H-2Ld-restricted P1A-specific
or β-galactosidase-specific CTL following the P1A antigen induction regimen. On
day 21, animals were euthanized and the size and number of lung metastases were
determined. Representative data pertaining to these experiments are presented in
Fig. 7. As shown in Fig. 7A, control mice developed numerous, large lung
metastases. 5-AzadC treatment significantly reduced the number and size of lung
metastases. Treatment with H-2Ld-restricted P1A CTL alone had little effect on
the number or size of these tumors. However, the combination of 5-azadC
treatment and adoptive transfer of P1A-specific CTL significantly reduced the
number and size of lung metastases. Data from a representative experiment are
summarized in Fig. 7B. In this experiment, the average number of lung metastases
in untreated control mice was 72, whereas the average number of metastases in
5-azadC-treated mice was 32. Transfer of P1A-specific CTL alone did not diminish
the number of lung metastases relative to those observed in untreated control
animals. Similarly, transfer of β-galactosidase-specific CTL did not further
reduce the number of pulmonary metastases following 5-azadC treatment. However,
systemic administration of 5-azadC followed by transfer of P1A-specific CTL
reduced the average number of lung metastases per animal to three.
Interestingly, three of five mice receiving 5-azadC- and P1A-specific CTL seemed
to be tumor-free after treatment. Collectively, these results suggest that
5-azadC mediated direct cytotoxic effects in 4T1 cancer cells in vivo, and that
induced P1A expression in the cancer cells was sufficient for recognition and
lysis by adoptively transferred P1A-specific CTL. The effects of 5-azadC and
adoptive transfer of P1A-specific CTL seemed synergistic in this pulmonary
metastasis model.

Figure 7.
View largeDownload slide

The 4T1 mammary tumor lung metastases in syngeneic BALB/c mice treated by
5-azadC and P1A-specific CTL. BALB/c mice with 7-day lung metastases of 4T1
mammary tumor were sequentially treated with 5-azadC and/or H-2Ld-restricted CTL
specific to P1A or β-galactosidase epitope. The CTLs against P1A antigen were
derived from P1A T-cell receptor transgenic mice. The mice were sacrificed on
day 21 and lungs were perfused with India ink solution to distinguish between
the tumor nodules from the lung tissue proper. Representative of at least three
experiments. A, lungs from treatment groups, along with heart organ as a marker.
The tumor nodules appeared as white nodules in the background of black lung
tissue. B, the numbers of lung metastases in treatment groups, five mice per
group, were quantified. Columns, mean; bars, SD. P values between the most
important groups are given.

Figure 7.
View largeDownload slide

The 4T1 mammary tumor lung metastases in syngeneic BALB/c mice treated by
5-azadC and P1A-specific CTL. BALB/c mice with 7-day lung metastases of 4T1
mammary tumor were sequentially treated with 5-azadC and/or H-2Ld-restricted CTL
specific to P1A or β-galactosidase epitope. The CTLs against P1A antigen were
derived from P1A T-cell receptor transgenic mice. The mice were sacrificed on
day 21 and lungs were perfused with India ink solution to distinguish between
the tumor nodules from the lung tissue proper. Representative of at least three
experiments. A, lungs from treatment groups, along with heart organ as a marker.
The tumor nodules appeared as white nodules in the background of black lung
tissue. B, the numbers of lung metastases in treatment groups, five mice per
group, were quantified. Columns, mean; bars, SD. P values between the most
important groups are given.

Close modal


DISCUSSION

We as well as others have previously shown that some human CTAs can be
up-regulated by 5-azadC treatment in certain cancer cells in vitro. These
antigens included MAGE in melanoma cells (26), LAGE-1 in lymphoblastoid cancer
cells (27), and NY-ESO-1 plus MAGE-3 in thoracic malignancies (22, 23–25). De
Smet et al. (44) showed that DNA methylation is the primary silencing mechanism
for a set of germ line– and tumor-specific genes with a CpG-rich promoter.

Because they can be induced in cultured human cancer cells but not normal cells
following exposure to chromatin remodeling agents under conditions achievable in
clinical settings (22, 24, 25), the CTAs represent potential targets that can be
exploited not only for immunotherapy of melanoma and renal cell carcinomas but
also for the treatment of more common epithelial malignancies that to date have
seemed refractory to immunologic interventions. In this regard, NY-ESO-1 is a
particularly attractive target for the immunotherapy of thoracic malignancies
(22). NY-ESO-1 is the most immunogenic CTA identified to date. Nearly 50% of
patients whose tumors express NY-ESO-1 exhibit serum antibodies to this CTA,
which fluctuate with extent of disease (3, 45, 46). Vaccines using either CD4 or
CD8 T-cell-restricted peptide epitopes, or full-length recombinant NY-ESO-1
protein, have enhanced anti-ESO-1 reactivity in cancer patients, some of whom
have exhibited disease regression following immunization (47, 48). Whereas
NY-ESO-1 is frequently expressed in pulmonary carcinomas (23, 49), immune
response to this CTA seems limited in lung cancer patients (21). Nevertheless,
our experience concerning induction of NY-ESO-1 in tumor tissues from lung
cancer patients, and detection of NY-ESO-1 antibodies in several of these
individuals following exposure to chromatin remodeling agents,6

6

D.S. Schrump, et al., submitted for publication.

attests to the potential utility of gene induction regimens for enhancing the
immunogenicity of lung cancer cells in vivo. However, presently, there are no
published data indicating that CTAs induced by chromatin remodeling agents in
vivo can serve as bona fide targets for adoptive immunotherapy of cancer.



P1A may serve as an excellent model to address many basic scientific questions
regarding the induction of CTAs and their potential use for immunotherapy. P1A
is a well-characterized CTA in mice. It is naturally expressed in some cancer
cell lines, mostly leukemia (ref. 50; this study). Immunization with
P1A-expressing vaccinia virus or tumor cells can induce CTL that provide
protection against challenge of P1A-expressing tumors (33) and can function as a
tumor rejection antigen (34). In addition, P1A epitope-specific T-cell receptor
transgenic mice have been generated (31), making the study of immunotherapy in
vivo using this model antigen very feasible. All these properties of P1A, our
extensive knowledge of the antigen, and availability of relevant biological
reagents made it an ideal model for our study.

Our current study showed that P1A could be induced de novo by 5-azadC treatment
in all P1A-negative cancer cell lines derived from eight different histologies.
In addition, P1A expression was further enhanced in the four cancer cell lines
in which this CTA was expressed naturally but weakly. In vivo, P1A was induced
de novo in all five types of tumor we tested after the tumor-bearing mice were
treated with systemic 5-azadC. The P1A induction strongly correlated with
demethylation of the CpG island in the P1A gene promoter region as assessed by
MSP technique. Indeed, the CpG island of the P1A gene promoter region is
hypermethylated in mouse liver and those tumor cell lines where the gene is
silenced but hypomethylated in P815 tumor cells where the gene is strongly
activated. The induction of the gene expression in those P1A-negative tumor
cells by 5-azadC displayed a concurrent switch from hypermethylation to
hypomethylation of the CpG island in the P1A gene promoter region.

This study has generated a number of new findings pertaining to P1A. First,
similar to human CTAs, P1A can be induced by a demethylating agent. Second, the
de novo induction of P1A is universal. All cancer cell lines exhibited
significant levels of P1A expression in vitro after treatment with 5-azadC. P1A
was induced de novo in all five different cancers representing melanoma, lung
carcinoma, colon carcinoma, sarcoma, and mammary carcinoma in two strains of
mice bearing those tumors when treated with systemic 5-azadC. Third, cancer
cells treated with 5-azadC maintained the integrity and functionality of the
antigen processing and presentation pathways. This is important for the
subsequent application of immunotherapy. Fourth, the induction of P1A was
achievable in tumor-bearing mice in vivo and was quite tumor specific. Fifth,
the induced CTA can be used as a target for adoptive T-cell transfer–based
immunotherapy. Finally, the direct tumoridal effect of 5-azadC and adoptive
transfer of P1A-specific CTL seemed synergistic in this pulmonary metastasis
model.

Results derived from our current study may have direct translation regarding the
development of TAA induction regimens for human cancer therapy. First, if a TAA
is constitutively expressed in tumor tissues, anergic/suppressive CD4+CD25+ T
cells may be generated in the periphery as a consequence of repeated antigenic
encounter, thus anergy or tolerance to the antigen (51) may also result in the
tumor variants generating “tumor escape” phenotype (52). De novo induction of
CTAs in solid tumors may represent a novel means to break antigen-specific
tolerance, which is a major impediment to immune-mediated cancer regression (4).
Second, intratumoral heterogeneity of CTA expression seems related to
methylation status; 5-azadC treatment can revert this phenomenon (53). 5-AzadC,
particularly when administered in conjunction with depsipetide, mediates robust
CTA induction as well as apoptosis in cancer cells (24, 25), which may enhance
antitumor immunity. Third, self-antigens expressed by solid tumors do not
efficiently stimulate naïve or activated T cells (54). However, increased
levels of CTAs induced by demethylating agents may be sufficient for
cross-presentation by bone marrow–derived stromal cells, and may overcome
immunologic “ignorance” to solid tumors. Fourth, 5-azadC can enhance the
expression of HLA class I antigens and restoration of antigen-specific CTL
response in cancer cells in which HLA class I antigens are down-regulated by
hypermethylation (55, 56). This property may extend immunotherapy to those
cancers that are otherwise untreatable by this approach. Finally, an immunogenic
TAA that can be induced in many types of tumors may enable treatment of cancer
patients with standardized, potentially well-defined, and efficacious
immunotherapy regimens (4–9, 13, 57). Collectively, these data support and
provide guidance for further evaluation of chromatin remodeling agents for
cancer immunotherapy.


ACKNOWLEDGMENTS

The costs of publication of this article were defrayed in part by the payment of
page charges. This article must therefore be hereby marked advertisement in
accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

We thank Dr. Steve A. Rosenberg for his insight and helpful suggestions during
the course of this study; Pawel Kalinski, Lisa Butterfield, and Mike Gorry for
critical reading of the manuscript; and Arnold Mixon for help in flow cytometry.




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