Abstract
Intraocular inflammation has been recognized as a major factor leading to blindness. Because tumor necrosis factor-α (TNF-α) enhances intraocular cytotoxic events, systemic anti-TNF therapies have been introduced in the treatment of severe intraocular inflammation, but frequent re-injections are needed and are associated with severe side effects. We have devised a local intraocular nonviral gene therapy to deliver effective and sustained anti-TNF therapy in inflamed eyes. In this study, we show that transfection of the ciliary muscle by plasmids encoding for three different variants of the p55 TNF-α soluble receptor, using electrotransfer, resulted in sustained intraocular secretion of the encoded proteins, without any detection in the serum. In the eye, even the shorter monomeric variant resulted in efficient neutralization of TNF-α in a rat experimental model of endotoxin-induced uveitis, as long as 3 months after transfection. A subsequent downregulation of interleukin (IL)-6 and iNOS and upregulation of IL-10 expression was observed together with a decreased rolling of inflammatory cells in anterior segment vessels and reduced infiltration within the ocular tissues. Our results indicate that using a nonviral gene therapy strategy, the local self-production of monomeric TNF-α soluble receptors induces a local immunomodulation enabling the control of intraocular inflammation.
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References
Dick AD, Forrester JV, Liversidge J, Cope AP . The role of tumour necrosis factor (TNF-alpha) in experimental autoimmune uveoretinitis (EAU). Prog Retin Eye Res 2004; 23: 617–637.
Koizumi K, Poulaki V, Doehmen S, Welsandt G, Radetzky S, Lappas A et al. Contribution of TNF-alpha to leukocyte adhesion, vascular leakage, and apoptotic cell death in endotoxin-induced uveitis in vivo. Invest Ophthalmol Vis Sci 2003; 44: 2184–2191.
Santos Lacomba M, Marcos Martín C, Gallardo Galera JM, Gómez Vidal MA, Collantes Estévez E, Ramírez Chamond R et al. Aqueous humor and serum tumor necrosis factor-alpha in clinical uveitis. Ophthalmic Res 2001; 33: 251–255.
Ahn JK, Yu HG, Chung H, Park YG . Intraocular cytokine environment in active Behçet uveitis. Am J Ophthalmol 2006; 142: 429–434.
El-Shabrawi Y, Wegscheider BJ, Weger M, Renner W, Posch U, Ulrich S et al. Polymorphisms within the tumor necrosis factor-alpha promoter region in patients with HLA-B27-associated uveitis: association with susceptibility and clinical manifestations. Ophthalmology 2006; 113: 695–700.
Kuo NW, Lympany PA, Menezo V, Lagan AL, John S, Yeo TK et al. TNF-857T, a genetic risk marker for acute anterior uveitis. Invest Ophthalmol Vis Sci 2005; 46: 1565–1571.
Hale S, Lightman S . Anti-TNF therapies in the management of acute and chronic uveitis. Cytokine 2006; 33: 231–237.
Lindstedt EW, Baarsma GS, Kuijpers RW, van Hagen PM . Anti-TNF-alpha therapy for sight threatening uveitis. Br J Ophthalmol 2005; 89: 533–536.
Biester S, Deuter C, Michels H, Haefner R, Kuemmerle-Deschner J, Doycheva D et al. Adalimumab in the therapy of uveitis in childhood. Br J Ophthalmol 2007; 91: 319–324.
Galor A, Perez VL, Hammel JP, Lowder CY . Differential effectiveness of etanercept and infliximab in the treatment of ocular inflammation. Ophthalmology 2006; 113: 2317–2323.
Dick AD, McMenamin PG, Körner H, Scallon BJ, Ghrayeb J, Forrester JV et al. Inhibition of tumor necrosis factor activity minimizes target organ damage in experimental autoimmune uveoretinitis despite quantitatively normal activated T cell traffic to the retina. Eur J Immunol 1996; 26: 1018–1025.
Dick AD, Duncan L, Hale G, Waldmann H, Isaacs J . Neutralizing TNF-alpha activity modulates T-cell phenotype and function in experimental autoimmune uveoretinitis. J Autoimmun 1998; 11: 255–264.
Murphy CC, Greiner K, Plskova J, Duncan L, Frost A, Isaacs JD et al. Neutralizing tumor necrosis factor activity leads to remission in patients with refractory noninfectious posterior uveitis. Arch Ophthalmol 2004; 122: 845–851.
Greiner K, Murphy CC, Willermain F, Duncan L, Plskova J, Hale G et al. Anti-TNFalpha therapy modulates the phenotype of peripheral blood CD4+ T cells in patients with posterior segment intraocular inflammation. Invest Ophthalmol Vis Sci 2004; 45: 170–176.
Ohno S, Nakamura S, Hori S, Shimakawa M, Kawashima H, Mochizuki M et al. Efficacy, safety, and pharmacokinetics of multiple administration of infliximab in Behçet's disease with refractory uveoretinitis. J Rheumatol 2004; 31: 1362–1368.
Calabrese L . The yin and yang of tumor necrosis factor inhibitors. Cleve Clin J Med 2006; 73: 251–256.
Kempen JH, Gangaputra S, Daniel E, Levy-Clarke GA, Nussenblatt RB, Rosenbaum JT et al. Long-term risk of malignancy among patients treated with immunosuppressive agents for ocular inflammation: a critical assessment of the evidence. Am J Ophthalmol 2008; 146: 828–836.
Bongartz T, Sutton AJ, Sweeting MJ, Buchan I, Matteson EL, Montori V . Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA 2006; 295: 2275–2285.
Tugal-Tutkun I, Mudun A, Urgancioglu M, Kamali S, Kasapoglu E, Inanc M et al. Efficacy of infliximab in the treatment of uveitis that is resistant to treatment with the combination of azathioprine, cyclosporine, and corticosteroids in Behçet's disease: an open-label trial. Arthritis Rheum 2005; 52: 2478–2484.
Bloquel C, Bejjani R, Bigey P, Bedioui F, Doat M, BenEzra D et al. Plasmid electrotransfer of eye ciliary muscle: principles and therapeutic efficacy using hTNF-alpha soluble receptor in uveitis. FASEB J 2006; 20: 389–391.
Diaz-Llopis M, García-Delpech S, Salom D, Udaondo P, Bosch-Morell F, Quijada A et al. High-dose infliximab prophylaxis in endotoxin-induced uveitis. J Ocul Pharmacol Ther 2007; 23: 343–350.
Bloquel C, Bessis N, Boissier MC, Scherman D, Bigey P . Gene therapy of collagen-induced arthritis by electrotransfer of human tumor necrosis factor-alpha soluble receptor I variants. Hum Gene Ther 2004; 15: 189–201.
Avunduk MC, Avunduk AM, Oztekin E, Baltaci AK, Ozyazgan Y, Mogolkoc R . Etanercept treatment in the endotoxin-induced uveitis of rats. Exp Eye Res 2004; 79: 357–365.
Theodossiadis PG, Markomichelakis NN, Sfikakis PP . Tumor necrosis factor antagonists: preliminary evidence for an emerging approach in the treatment of ocular inflammation. Retina 2007; 27: 399–413.
Robertson M, Liversidge J, Forrester JV, Dick AD . Neutralizing tumor necrosis factor-alpha activity suppresses activation of infiltrating macrophages in experimental autoimmune uveoretinitis. Invest Ophthalmol Vis Sci 2003; 44: 3034–3041.
Imrie FR, Dick AD . Biologics in the treatment of uveitis. Curr Opin Ophthalmol 2007; 18: 481–486.
Lim LL, Fraunfelder FW, Rosenbaum JT . Do tumor necrosis factor inhibitors cause uveitis? A registry-based study. Arthritis Rheum 2007; 56: 3248–3252.
Carmona L, Gómez-Reino JJ, Rodríguez-Valverde V, Montero D, Pascual-Gómez E, Mola EM et al. Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in patients treated with tumor necrosis factor antagonists. Arthritis Rheum 2005; 52: 1766–1772.
Lin J, Ziring D, Desai S, Kim S, Wong M, Korin Y et al. TNFalpha blockade in human diseases: an overview of efficacy and safety. Clin Immunol 2008; 126: 13–30.
Waetzig GH, Rosenstiel P, Arlt A, Till A, Bräutigam K, Schäfer H et al. Soluble tumor necrosis factor (TNF) receptor-1 induces apoptosis via reverse TNF signaling and autocrine transforming growth factor-beta1. FASEB J 2005; 19: 91–93.
Wong M, Ziring D, Korin Y, Desai S, Kim S, Lin J et al. TNFalpha blockade in human diseases: mechanisms and future directions. Clin Immunol 2008; 126: 121–136.
Avunduk MC, Avunduk AM, Oztekin E, Baltaci AK, Ozyazgan Y, Mogolkoc R . Etanercept treatment in the endotoxin-induced uveitis of rats. Exp Eye Res 2004; 79: 357–365.
Robertson M, Liversidge J, Forrester JV, Dick AD . Neutralizing tumor necrosis factor-alpha activity suppresses activation of infiltrating macrophages in experimental autoimmune uveoretinitis. Invest Ophthalmol Vis Sci 2003; 44: 3034–3041.
Kowalczuk L, Touchard E, Camelo S, Naud MC, Castaneda B, Brunel N et al. Local ocular immunomodulation results from electrotransfer of plasmid encoding soluble TNF receptors in the ciliary muscle. Invest Ophthalmol Vis 2009; 50: 1761–1768.
Bloquel C, Denys A, Boissier MC, Apparailly F, Bigey P, Scherman D et al. Intra-articular electrotransfer of plasmid encoding soluble TNF receptor variants in normal and arthritic mice. J Gene Med 2007; 9: 986–993.
Behar-Cohen FF, Parel JM, Pouliquen Y, Thillaye-Goldenberg B, Goureau O, Heydolph S et al. Iontophoresis of dexamethasone in the treatment of endotoxin-induced-uveitis in rats. Exp Eye Res 1997; 65: 533–545.
Labbé A, Liang H, Martin C, Brignole-Baudouin F, Warnet JM, Baudouin C . Comparative anatomy of laboratory animal corneas with a new-generation high-resolution in vivo confocal microscope. Curr Eye Res 2006; 31: 501–509.
Acknowledgements
We thank Dr Jean-Louis Bourges for his help to perform the acquisition of confocal microscopy videos. We also thank Christophe Klein for his precious technical skills regarding videos retouching and Dr Serge Camelo for helpful discussions and critical reading of the paper. This work was funded in part by the ANR EMERGENCE project ANR-05-EMPB-001-02 and the European project EVI-GENORET LSHG-CT-2005-512036.
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Touchard, E., Bloquel, C., Bigey, P. et al. Effects of ciliary muscle plasmid electrotransfer of TNF-α soluble receptor variants in experimental uveitis. Gene Ther 16, 862–873 (2009). https://doi.org/10.1038/gt.2009.43
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DOI: https://doi.org/10.1038/gt.2009.43
Keywords
- nonviral gene therapy
- eye
- inflammation
- p55 TNFR
- electroporation
- drug delivery
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