Brain tumors, both primary and metastatic, require the development of innovative new therapeutic agents due to the increase in their frequency and the inability of current therapies to provide beneficial results. Different replication-competent and noncompetent viral therapies for tumors located within the central nervous system are currently being studied, including herpes simplex viruses, adenoviruses, poxviruses, retroviruses, and Newcastle disease virus [
7,
8,
26–
32]. Of these, both HSV-1 and adeno-viruses have mounting potentials as therapeutic agents. Replication-competent adenoviruses are currently being used for squamous cell carcinomas of the head and neck [
33] and are being explored as therapeutic agents for many other types of tumors [
34–
39]. Neuroattenuated HSV-1 has the ability to replicate in dividing cells within the CNS and is unable to replicate or cause disease in nondividing cells [
40,
41]. Neuroattenuated HSV-1 is also unable to cause encephalitis [
42] and is avirulent in SCID mice [
43]. Thus, neuroattenuated HSV-1 is a leading candidate for intracranial tumor therapy and is currently being used in clinical trials [
44,
45]. Previous studies have demonstrated the proof of the principal that neuroattenuated HSV-1 is able to prolong survival of intracranial tumor-bearing animals [
7,
8,
11,
15,
16,
46–
48]. The study described herein was undertaken to define more fully the role of specific immune components in viral therapy.
To determine the specific immune components involved in viral-mediated prolongation in survival, a new syngeneic tumor model was needed. The natural host for HSV-1 is humans; however, the majority of the tumor models studied are in rodents. HSV-1 does not naturally infect rats or mice and thus it is not surprising that some murine and rodent tumor cell lines are resistant to HSV-1 infection [
11]. This resistance to infection is at the level of coreceptor expression in murine B16 melanoma cells [
13]. Thus, we reported previously the development of two new murine melanoma cell lines, B78H1-A10 and B78H1-C10, that have been stably transfected with human HSV-1 coreceptors [
13]. These cells are syngeneic in C57/Bl6 mice and develop tumors normally with a mean survival of 3 weeks. HSV-1 1716 replicates to levels similar to those of wild-type parental strains in these cell lines [
13]. Viral therapy prolongs survival significantly and the tumors remain modestly immunogenic [
13].
To determine further the specific components of the immune response important to viral therapy, different immunodeficient and knockout strains of mice were implanted with tumors, followed by either mock or viral therapy. Similar to earlier reports [
13], in immunodeficient RAG2
−/− mice the viral therapy was unable to prolong survival over that of mock-treated animals. Interestingly, in CD4
−/− and CD8
−/− mice viral therapy was also unable to prolong survival. Also, viral therapy was unable to prolong survival in NK-deficient beige mice. Thus an organized, balanced immune response is necessary to mediate the prolongation in survival seen following viral therapy. Interestingly, the survival of the CD8
−/− was not confined to a narrow range as with other immunodeficient strains. CD8
−/− mice succumbed to the tumor burden over a range of approximately 15 days, while RAG2
−/−, CD4
−/−, and NK-deficient mice succumbed over a range of 5–10 days. However, the median survival for all groups was 20–21 days. This difference in survival of CD8
−/− mice may indicate that CD8
+ T cells are important during later stages of viral-mediated tumor destruction and that CD4 T
+ cells and NK cells are more important earlier. This correlates with previous immuno-histochemistry data demonstrating increases in CD4
+ T cells and NK cells early following viral therapy [
12].
We next determined the ability of viral therapy to induce either a tumor- or a viral-specific CTL or proliferative T cell response. Previous reports have demonstrated that neuroattenuated HSV-1 is able to induce a tumor-specific CTL response in a flank model of tumor therapy; however, the ability of neuroattenuated HSV-1 to induce a tumor-specific CTL or proliferative response after intracranial therapy has not been demonstrated. In this paper, we utilized the newly created, lowly immunogenic B78H1-A10 and B78H1-C10 tumors to demonstrate that viral therapy of intracranial tumors induces both a CTL and a proliferative T cell response toward tumor antigens. The CTL response induced following viral therapy is both tumor- and viral-specific; however, the proliferative response is toward tumor antigens and not viral antigens. Thus, although a tumor-specific proliferative T cell response is induced earlier in viral-mediated tumor destruction, only a viral-specific CTL response develops following viral therapy. Accordingly, following viral therapy the lysis of tumor cells recruits CD4
+ T cells to the tumor mass, where the cells are triggered to respond to tumor antigens and not viral antigens. This may in part be due to the ability of the virus to block immune recognition of infected cells, through modulation of both MHC classes I and II [
49–
51]. CD4
−/−, CD8
−/−, and NK
−/− mice are unable to mount an immune response to prolong survival after viral therapy. Taken together, these data point to a model in which CD4
+ T cells are recruited to the tumor mass following viral therapy, as are NK cells. CD4
+ T cells secrete cytokines to recruit and activate CD8
+ T cells. CD8
+ T cells, along with NK cells, lyse both infected and uninfected tumor cells, leading to tumor destruction and the development of a tumor-specific CTL response. The proliferation of T cells in response to tumor antigen alone combined with the specific CTL response may translate to better recognition of distant, untreated metastases, which may in turn lead to better destruction of the metastases.
As viral therapy of intracranial tumors depends on an active integrated immune response, viral therapies will depend on the immune status of the recipients. Results of phase I clinical trials of HSV-1 for malignant gliomas have been published, with viral therapy demonstrating potential therapeutic benefits in both trials [
44,
45]. No significant detrimental effects were observed from the viral therapy in either study. These studies have shown that neuroattenuated HSV-1 is a viable therapy for intracranial malignant gliomas and may be useful for other CNS neoplasms, both primary and metastatic. The demonstration of a significant immune component necessary for viral-mediated tumor destruction highlights the importance of determining the immune status of potential recipients of viral therapy and the importance of monitoring the immune status of patients entered into future clinical trials. The creation of new neuroattenuated HSV-1 therapeutic viruses designed to engage more fully the immune response in viral therapy may provide additional useful viral candidates for tumor therapy. New viruses that are able to activate more fully a complete and harmonized immune response may lead not only to better destruction of the local treated tumor, but also to immune-mediated destruction of distant metastases and to the destruction of migratory cells within the CNS.