Multiple phase I and II clinical trials proved DC-based immunotherapies to be safer and less toxic than conventional cancer therapies. However, to date, the response to DC-based cancer immunotherapies is frequently unsatisfying as exemplified by the complete failure of a phase III trial in melanoma patients [
23]. Accordingly, various parameters such as the DC maturation status, the route of administration and, most prominently, the mode of antigen-delivery require further improvement [
24]. Many studies to evaluate antigen-delivery strategies were performed in mice, several of them using Her2 as a model TAA. In preventive vaccination models, a delayed tumor onset was achieved with DCs loaded with a heteroclitic variant of an Her2 peptide [
25]. In addition, DCs loaded with virus-like particles of murine polyoma virus that contained a Her2 subdomain fusion protein protected against challenge with Her2-expressing cells [
26]. Finally, DCs that were transduced with a replication deficient adenovirus encoding the Her2 extracellular and transmembrane domains not only protected vaccinated mice against challenge with Her2-expressing TUBO cells but also eliminated even established tumors and metastases [
27]. While the latter approach was most promising, concerns regarding safety and pre-existing immunity remain about vaccines that apply human pathogenic viruses as delivery systems.
In the present study, we used cytopathogenic BVDV replicons to load vaccine DCs with the Her2 TAA. Thus, a strategy that we originally developed to induce an anti-viral immune response [
13] was translated to anti-tumor vaccination and shown to induce an antigen-specific T cell response and to mediate a preventive anti-tumor effect (–). While the use of syngeneic DC would be more suitable for therapeutic applications in humans, we used allogeneic DC in this study for the following reason: the use of replicon-transfected DC2.4 cells of the H-2
b MHC haplotype to vaccinate mice of the H-2
q haplotype, allowed us to obtain the most important result of this study, the demonstration that cross-priming of T cells is sufficient to mediate a significant preventive anti-tumor response. While cross-priming was already shown to be relevant for the induction of immune responses against viruses such as herpes simplex virus 1 [
28] and modified vaccinia virus Ankara [
12], cytopathic BVDV replicons turned out to be particularly suitable to induce efficient cross-priming due to the time-delayed cytopathic effect of the replicating RNA. That is, apoptosis of the transfected DCs occurs 24–48 h after transfection (), which leaves sufficient time for the migration of the vaccine DCs to the secondary lymphoid organs, the MHC-restricted presentation of antigen/antigenic peptides on the cell surface, and, perhaps, the expression of danger signals that may act as adjuvants, for example via the TLR pathway [
29,
30] (see also below).
Several additional facts support our conclusion that BVDV replicons are useful vaccination tools. In contrast to viral vectors and RNA replicons of Semliki Forest virus [
31], Kunjin virus [
32], Venezuelan equine encephalitis virus [
33] or Sindbis virus [
34] that were utilized in previous studies, the BVDV replicons derive from an animal virus that does not infect humans. Hence, many safety issues do not apply to BVDV, and pre-existing immunity does not exist. The use of replicons to load DCs combines the advantages of using antigen-encoding mRNA with that of using viral vectors. RNA replicons are not infectious, and gene expression does not involve integration into the host genome. Replication of the replicon RNA mimics viral infections, and mediates adjuvant effects. In particular, double-strand RNA (dsRNA) replication intermediates of (+)-strand RNA viruses were recently shown to activate the Toll-like receptor TLR-3 pathway [
35]. Moreover, infections with cytopathogenic viruses were found to stimulate TLR-2, -4 and -7 expression [
36]. TLR signaling induces the differentiation and maturation of DCs and enhances antigen presentation [
37]. Finally, the cytopathogenic form of BVDV is known to induce the expression of type I interferons (IFN-α/β) [
37], which have been described to enhance cross-priming [
38].
Preventive vaccination with the DC/BVDV replicon system resulted in the suppression of tumor growth in a subset of the mice complete protection against tumor development. In a depletion experiment (), we demonstrated indispensable roles of CD8 and CD4 T cells for this immune response. These data are consistent with previous Her2 vaccination studies that demonstrated the requirement of CD8 T cell activation for a significant anti-tumor effect [
39–
41]. The activation of CD8 T cells is crucial for cancer immunotherapy as endogenous tumor antigens are generally presented via MHC class I. Accordingly, tumor infiltrating CD8 T cells have been associated with a better prognosis [
42], and adoptive transfer of CD8 T cells is highly effective against solid tumors, e.g. in melanoma patients [
43].
CD4 T cells contribute to the antitumor effect as shown in the depletion experiments even though there was no antibody production. Since CD4 T cell depletion was performed four weeks after the first vaccination and one week after the booster vaccination it is possible that CD4 T cells facilitate the priming of CD8 cells [
44], or that they secrete immunostimulatory cytokines and activate innate immune cells. CD4 T cells may also exert direct effector functions and kill tumor cells expressing MHCII molecules [
45] and facilitate the recruitment of CD8 T cells to tissues that harbor the antigen-expressing cells [
46].
We attempted to further improve the priming of anti-tumor T cells by co-delivery of IL-12. IL-12 was already tested in several immunotherapy studies [
47], and its paracrine application was found to be safe and efficient. However, while we observed a trend towards better protection against tumor growth, this effect was not significant (–). While earlier reports showed a clear beneficial effect of IL-12 in vaccination approaches with TAA-encoding DCs [
39] the adjuvant effects of the cytopathic BVDV replicon may have rendered this unnecessary in our system.
Likewise, the humoral immune response was not required in our vaccination model (). While antibody-independent immune responses against tumors were previously observed [
40,
41,
48], several studies specifically emphasized the requirement of a humoral immune response to the Her2 TAA [
27]. An important role of anti-Her2 antibodies has clearly been shown by the therapeutic effect of Trastuzumab in patients with Her2-positive breast cancer [
49]. Considering these reports and our results, it appears most promising to combine different immunotherapy regimens such as the here-presented T cell stimulating replicon approach with the already established therapeutic Her2 antibody Trastuzumab to achieve synergistic effects.