Immunosurgery via IVT-mRNA for the implementation of personalized/precision anticancer-immunotherapy, and tailored circumvention of immunoresistance in non-inflamed or cold-tumors. Prof Dr Med John Giannios, MD/MBBS, GP, Hon Prof in...
moreImmunosurgery via IVT-mRNA for the implementation of personalized/precision anticancer-immunotherapy, and tailored circumvention of immunoresistance in non-inflamed or cold-tumors.
Prof Dr Med John Giannios, MD/MBBS, GP, Hon Prof in Medicine, BSc (Biol & Chem), PostCert (Transl Med with Distinction) Med School, Univ of Edinburgh, PostDipl (Transl Med with Distinction) Med School, Univ of Edinburgh, MSc (Transl Med) Med School, Univ of Edinburgh, Post Dipl (Genomic Medicine & Healthcare), Univ of South Wales, Cardiff, Professional Doctorate in Translational CANCER MEDICINE, University of Middlesex, London, UK, Postgraduate Specialty in Family Medicine, Hon President of the Academy of Thermal Medicine, GR, EU, President of the Hel and Int Society of Genomic & Molecular Medicine and Res., GR, EU, ACADEMIC DIRECTOR OF THE POSTGRADUATE PROGRAMME IN GENOMIC (PRECISION) MEDICINE AND HEALTHCARE, UNIVERSITY OF SOUTH WALES, and RECOGNIZED TUTOR IN THE POSTGRADUATE PROGRAMME OF MEDICAL ONCOLOGY OF UNIVERSITY OF BUCKINGHAM, UK.
Immunosurgery utilizing IVT-mRNA for Cancer-Immunotherapy is an innovative therapeutic idea that is merging immune-focused techniques, such as IMMUNOSURGERY with in vitro-transcribed IVT-mRNA for accurately targeting, and eliminating cancer-cells while preserving cells of healthy-tissue.
Immunosurgery consists of a phrase which had been used in developmental-biology for the use of antibodies, and complement for eliminating the outer-layer of an embryo. However, in oncology, it is being referred as the directed destruction of cancer-cells via modified immune-responses consisting of cellular-therapies for immunity, such as CAR-T or TCR-T, antibody-mediated elimination, and targeted-activation of the immune-system which may function as a personalized/precision surgical-instrument.
Very importantly, the in-vitro transcribed-mRNA is an artificially generated-RNA which may be delivered into cells for encoding cancer- markers or molecules which may stimulate the immune-system including cytokines or costimulatory-ligands, and reconfiguring specialized immune-cells, such as T-cells or dendritic-cells.
Its benefits consist of temporary-expression which is secure for DNA, complete inability involving genomic-incorporation, adjustability or expandability, and mainly utility in mRNA-vaccines, such as the BioNTech-Pfizer’s COVID19-vaccine.
The merging of IVT-mRNA with immunosurgery is characterized by clinical actionabilities including cancer-vaccines based on mRNA that involves the administration of tumor specific-antigens via mRNA to dendritic-cells or injected directly to cancer-patients for stimulating cytotoxic T-lymphocytes or CTLs that may lead to the eradication of cancer cells. Analytically, there are tumor-specific (TSA) or tumor associated-antigens (TAAs) which are recognized as neoantigens that refer to proteins resulting from mutations specific to an individual's tumor. Furthermore, synthetic-mRNA may be generated encoding these antigens, and mRNA is containing features that enhance stability, and translation, such as 5’ cap, UTRs or poly(A) tail. The delivery-techniques may include dendritic-cells or DCs which are isolated from the cancer-patient, and they are introduced to mRNA which encodes tumor antigens.
Then these primed-DCs are reinfused into the cancer-patient, and the mRNA may be delivered with lipid-nanoparticles (LNPs) or alternative-carriers via intramuscular or intradermal injection. The antigen-presenting cells may exhibit tumor antigens via MHC class I and II leading to the activation of the immune-system via stimulation of the CD8+ T cells or CTLs, and CD4+ helper T-cells. The In-Situ Immunosurgical-Procedure involves the direct injection of IVT-mRNA into tumors for producing inflammatory-cytokines including IL-12 or IFN-γ, costimulatory-factors, such as CD80 and 86, and antibodies or bispecific T-cell activators (BiTEs). This may generate a pro-inflammatory, and immune-favorable microenvironment resulting in localized-immunosurgery. Furthermore,
IVT-mRNA may also modify immune-cells via temporary-expression of chimeric antigen-receptors (CARs), TCRs specific to tumors, and checkpoint-inhibitors. Subsequently, these immune cells which have been modified with mRNA may be introduced into the cancer-patient for establishing a precise immune-assault. The subsequent destruction of tumor-cells is achieved by the mRNA regulated immune-pathways which may include program immune-cells, such as T cells or NK-cells. The anticancer-effect of mRNA which is functioning as a precise-tool for immunosurgery may be activated only after the presence of tumor-specific signals.
Generally, IVT mRNA as an artificially created messenger-RNA may be generated externally to the cell by utilizing T7, T3 or SP6 RNA-polymerase, and it is capable of encoding almost any protein including tumor-antigens, cytokines or costimulatory-molecules. After being delivered into cells via lipid-nanoparticles, dendritic-cell loading or electroporation, the IVT-mRNA may be translated into nearly any type of protein without integrating into the genome. There are companies which are trying to develop mRNA cancer-vaccines against solid-tumors, such as lung, melanoma, etc. Also, research is performed for modifying the tumor-microenvironment or TME so mRNA based IL-12 may be delivered directly into tumor-cells, and IVT mRNA CART-cells are tested against blood-cancers. Delivery-approaches include direct-injection of mRNA- LNPs for vaccines with tumor-antigens, ex-vivo loading of dendritic-cells or DCs with IVT-mRNA for therapeutic-vaccines, and synergistic-combination with checkpoint-inhibitors or adoptive cell-therapy. Their advantages compared to DNA or viral-vectors include absolutely no integration into the host-genome, transient-expression which is limiting systemic-toxicity, rapid and mainly scalable production, and encoding of multiple-payloads in the same formulation composed of cytokines, adjuvants and antigens.
A huge issue in anticancer treatment consists of immunoresistance which inactivates the pathways of immunotherapy, and it is caused by several mechanisms which are evading the immune-system including tumor-heterogeneity and immunogenic-loss of tumor-antigens because tumor-cells can downregulate the expression of MHC-molecules leading to the prevention of T-cell recognition, T-cell exclusion and/or dysfunction, immunosuppressive-microenvironment composed of IL-10, TGFβ, TAM, TAN, CAF, NO, ROS, VEGF, FasL, TRAIL, MDSC or Tregs, upregulated immune-checkpoints, such as PDL1, CTLA4-ligands leading to the exhaustion of T-cells, downregulated MHC-I or major histocompatibility-complex class-I gene that may evade the immune-system in cancer by blocking the presentation of tumor-antigens to CD8+ T-cells.
All these immunoresistance-pathways may be circumvented with the use of IVT-mRNA by antigen-delivery that may cause encoding of multiple-tumor associated-neoantigens for broadening immune-recognition by stimulating CD4+ T-cell, and CD8+ responses which may target multiple tumor-clones or circumvent antigen-loss mutations, genetic-engineering of proteins, such as dominant negative TGFβ-receptors, and T-cell ex-vivo via mRNA which may upregulate costimulatory-molecules and resist to exhaustion, in-situ reprogramming of the local-immunosuppressive tumor-microenvironment to an inflammatory-state for converting non-inflamed cold to hot immune-inflamed tumors including NSCLC, H&N Ca, CRC, endometrial-Ca, melanoma, bladder and kidney-Ca (RCC) by delivering via nanoparticles mRNA that encodes specific-chemokines, such as CXCL-9, CXCL-10, CCL-5, IFN-γ, IL-15 or IL-12 for attracting stromal-cells or effector T-cells into cold-tumors which do not elicit strong immune-responses due to poor immune-cell infiltration, and proteins or enzymes which are degrading immunosuppressive-molecules, such as IDO-inhibitors which may be combined with chemo/radio-Tx and immune-checkpoint inhibitors, immune-stimulation by encoding costimulatory-molecules including 4IBBL-ligand or CD137L which is encoded by the TNFSF9-gene or cytokines consisting of IFNα, GM-CSF or IL12 for boosting dendritic-cells (DCs) or activating T-cells, personalized neoantigen-vaccines mediated by tumor cell-sequencing for identifying patient-specific variants, and encoding as IVT-mRNA vaccines which may lead to the induction of polyclonal T-cell responses that may circumvent tumor-escape pathways, and checkpoint-modulation for encoding soluble-decoy receptors and/or short lived CRISPR based soluble-immune inhibitors of PD-1, PD-L1 or CTLA-4 in the tumor-microenvironment that may lead directly to transient expression of checkpoint-inhibitors into immune-cells. Furthermore, IVT-mRNA may lead to checkpoint-inhibition via the expression of CARs and/or modified-TCRs which may resist inhibitory-signaling.
Thus, IVT-mRNA approaches may implement personalized/precision immunotherapy, and circumvent immunoresistance-pathways in cancer via vaccinations, immunomodulation, cell-engineering and gene-editing. Future-challenges include the development of self amplifying mRNA or saRNAs for prolonging expression, combination of synergistic-treatments, ligands for tumor-targeting on lipid-nanosomes or LNS, prevention of hyperactivation of the innate immune-system by unaltered-mRNA which may require optimized-nucleosides including pseudo-uridine, etc.