Manish R. Patel, DO, Blake A

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Manish R. Patel, DO, Blake A

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Measles Vaccine Strains for Virotherapy of Non–Small-Cell Lung Carcinoma Manish R. Patel, DO, Blake A. Jacobson, PhD, Holly Belgum, BS, Ahmad Raza, MD, Ahad Sadiq, MD, Jeremy Drees, BS, Hengbing Wang, MD, Joseph Jay-Dixon, BS, Ryan Etchison, BS, Mark J. Federspiel, PhD, Stephen J. Russell, MD, PhD, Robert A. Kratzke, MD Journal of Thoracic Oncology Volume 9, Issue 8, Pages 1101-1110 (August 2014) DOI: 10.1097/JTO.0000000000000214 Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 A,B. CD46 expression on non–small-cell lung cancer cells. A, Plot of fluorescence intensity (relative to isotype) of cells stained with PE-labeled anti-CD46 and assessed by flow cytometry. (B) Representative histograms. LLC, murine Lewis lung carcinoma cell line as a negative control. (C) Plot of fluorescence intensity (relative to isotype) of cells stained with PE-labeled anti-Nectin-4 and assessed by flow cytometry. (D) Representative histograms. (E) Light (LM-top) and fluorescence (FM-bottom) microscopy of H2009 cells infected with measles virus (MV)-green fluorescent protein (GFP) after treatment with blocking antibodies against CD46 and nectin-4 or the combination. (F) Quantification of fluorescence after blocking CD46 and nectin-4. Isotype IgG and H2009 cells untreated with MV-GFP were used as positive and negative controls, respectively. Journal of Thoracic Oncology 2014 9, 1101-1110DOI: (10.1097/JTO.0000000000000214) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 A-C, Measles virus (MV) infects and lyses non–small-cell lung cancer (NSCLC) cells in vitro. A, Cell viability assay of cells treated with MV-green fluorescent protein (GFP) after 72 hours of treatment. Immortalized bronchial epithelial cells (human bronchial epithelial cells and Beas2B) are used as a nonmalignant control. MOI, multiplicity of infection. Data are expressed as a percentage of untreated cells. (B) Fluorescence microscopy of cells 72 hours after treatment with MV-GFP at multiplicity of infection of 1.0 demonstrating fluorescent syncitia. Corresponding light microscopy photographs are shown. (C) Human CEA measurement from supernatants of MV-infected NSCLC cells. Supernatants were collected 48 hours after infection of cells and measured by enzyme-linked immunosorbent assay assay. CEA, carcinoembryonic antigen. Error bars indicate standard deviation of the mean. Journal of Thoracic Oncology 2014 9, 1101-1110DOI: (10.1097/JTO.0000000000000214) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 A, B. Measles virus (MV) infection of non–small-cell lung cancer (NSCLC) induces apoptosis. A, Immunoblot of poly-ADP ribose polymerase (PARP) and PARP cleavage products after 48 hours of treatment with MV-green fluorescent protein (GFP) at an multiplicity of infection (MOI) = 1.0. Presence of the 89 kDa fragement is indicative of apoptosis induction. (B) Caspase 3/7 cleavage assay done on NSCLC cells 48 hours after treatment with MV-GFP at an MOI = 1.0. Data are normalized to untreated NSCLC cells. Error bars indicate standard deviation of the mean. Journal of Thoracic Oncology 2014 9, 1101-1110DOI: (10.1097/JTO.0000000000000214) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 A-C, Measles virus (MV) oncolysis in non–small-cell lung cancer xenografts. A, H2009 tumors treated for 3 weeks, twice weekly with MV-carcinoembryonic antigen intratumoral injections. Tumor volumes were estimated by caliper measurements in two dimensions. Four weeks after initial treatment, all mice were killed and tumors excised and weighed. N = 10 per group. (B) A549 tumors were treated as above. (C) Carcinoembryonic antigen enzyme-linked immunosorbent assay performed on blood samples collected weekly after treatment of mice bearing A549 xenografts. Error bars depict the standard error of the mean. p value less than 0.05 was taken as significant. Journal of Thoracic Oncology 2014 9, 1101-1110DOI: (10.1097/JTO.0000000000000214) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 5 A–D, Effects of measles virus (MV) infection on protein translation signaling pathways. A, H2009, A549, and H838 cell lysates were assayed by immunoblot before and 48 hours after infection with MV-green fluorescent protein (GFP) for key proteins involved in cap-dependent and independent translation initiation. (B) Beas2B expressing empty vector (Beas2B-V) and Beas2B expressing eIF4E (Beas2B-E) were infected with MV-carcinoembryonic antigen (CEA) at indicated MOI and assayed for cell viability 72 hours after infection. 5′ cap-affinity assay of untreated Beas2B-V and Beas2B-E are shown. Relative increases in eIF4G binding in the cap-affinity assay correspond to enhanced eIF4F cap-complex formation. (C) H2009 and H522 non–small-cell lung cancer (NSCLC) cells were treated with MV-CEA (MOI = 0.01), rapamycin (Rap), or the combination and assayed for cell viability 72 hours after infection. Supernatants were collected from cells and assayed for CEA production as a measure of viral replication. Error bars indicate standard deviation of the mean. * indicates statistical significance. (D) H2009 and H522 cells were treated with MV-CEA (multiplicity of infection [MOI] = 0.01), 4EGI-1 (15 μM), or the combination and cell viability assayed 72 hours after infection. (E) NSCLC cell lines were treated with MV-GFP at MOI of 0.25 either alone or in combination with rapamycin. Representative fluorescence micrographs are shown. Journal of Thoracic Oncology 2014 9, 1101-1110DOI: (10.1097/JTO.0000000000000214) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 6 Measles virus (MV) combined with gemcitabine results in enhanced cytotoxicity. H522 and H2009 cells were treated with MV (multiplicity of infection = 0.1), gemcitabine (25 nM), or the combination. Cells were assayed 72 hours after MV infection for viability by trypan blue exclusion. Error bars indicate standard deviation of the mean. Journal of Thoracic Oncology 2014 9, 1101-1110DOI: (10.1097/JTO.0000000000000214) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions