1. ¹Department of Internal Medicine II, Ludwig-Maximilians-University, Munich, Germany
2. ²Department of Nuclear Medicine, Technical University, Munich, Germany
3. ³Department of Internal Medicine II, Albert-Ludwigs-University Freiburg, Germany
4. ⁴Division of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN, USA

Correspondence: Dr C Spitzweg, Department of Internal Medicine II, Klinikum Grosshadern, Medizinische Klinik II, Ludwig-Maximilians-University, Munich, Marchioninistrasse 15, Muenchen, 81377, Germany. E-mail: Christine.Spitzweg@med.uni-muenchen.de

Received 26 November 2006; Revised 10 October 2007; Accepted 10 October 2007; Published online 8 November 2007.

Abstract

Due to limited treatment options the prognosis of patients with advanced hepatocellular cancer (HCC) has remained poor. To investigate an alternative therapeutic approach, we examined the feasibility of radioiodine therapy of HCC following human sodium iodide symporter (NIS) gene transfer using a mouse -fetoprotein (AFP) promoter construct to target NIS expression to HCC cells. For this purpose, the murine Hepa 1–6 and the human HepG2 hepatoma cell lines were stably transfected with NIS cDNA under the control of the tumor-specific AFP promoter. The stably transfected Hepa 1–6 cell line showed a 10-fold increase in iodide accumulation, while HepG2 cells accumulated ¹²⁵I approximately 60-fold. Tumor-specific NIS expression was confirmed on mRNA level by northern blot analysis, and on protein level by immunostaining, that revealed primarily membrane-associated NIS-specific immunoreactivity. In an in vitro clonogenic assay up to 78% of NIS-transfected Hepa 1–6 and 93% of HepG2 cells were killed by ¹³¹I exposure, while up to 96% of control cells survived. In vivo NIS-transfected HepG2 xenografts accumulated 15% of the total ¹²³I administered per gram tumor with a biological half-life of 8.38 h, resulting in a tumor absorbed dose of 171 mGy MBq^{-1 131}I. After administration of a therapeutic ¹³¹I dose (55.5 MBq) tumor growth of NIS expressing HepG2 xenografts was significantly inhibited. In conclusion, tumor-specific iodide accumulation was induced in HCC cells by AFP promoter-directed NIS expression in vitro and in vivo, which was sufficiently high to allow a therapeutic effect of ¹³¹I. This study demonstrates the potential of tumor-specific NIS gene therapy as an innovative treatment strategy for HCC.