Canceris one of the world’s most dreadful diseases and the battle against cancer
continues till date. Suicide gene therapy for cancer is one of the best
approaches for annihilation of cancer. In brief, suicide gene codes for an
enzyme which converts a nontoxic prodrug into toxic metabolites and
subsequently mediates death of host cells itself on account of which it is
named “suicide” gene therapy. These suicide gene when constitutively
expressed by the cells not only mediates death of host cells but also inflicts
strong bystander effects on neighboring cells by predisposing them to toxic
downstream metabolites. Due to such advantages, they manifest minimal systemic
toxicity and are also effective against many drug resistance cancer cells. Among
all existing suicide genes, Cytosine Deaminase (CD) and Herpes Simplex
Virus-thymidine kinase (HSVtk) have shown promising results initially and has
been investigated extensively since long. The HSVtk enzyme initially
phosphorylates the prodrug Ganciclovir (GCV) to its monophosphate form, which
is subsequently phosphorylated again by endogenous cellular kinase to generate
nucleotide analogs (di- and triphosphate forms of GVC). Triphosphate form of
GCV is then readily incorporated into DNA during the course of DNA synthesis
and acts as a chain terminator to prevent further DNA synthesis, which
ultimately induces cell death.
The
therapeutic efficacy of HSVtk suicide gene therapy is often limited by
cell-to-cell contact which is a prerequisite for transport of downstream
metabolic byproducts of ganciclovir to neighboring cells so as to attain
bystander-killing effect. As an outcome of such drawbacks, HSVtk suicide gene
does not seem to be effective against different cell types. In contrary to
this, Cytosine Deaminase (CD) efficiently converts prodrug 5-Fluorocytosine (5-
FC) into therapeutically active anticancer agent 5-Fluorouracil (5- FU), which
subsequently permeates across the cell membrane to mediate bystander killing
effects on adjacent neighboring cells. Thus, 5-FC/CD system attains suicide
gene therapy much more efficiently as compared to other counterparts. Although
5-FC/CD system attains better therapeutic outcomes, it is ineffective against
5-FC resistant cancer cells and thus its anticancer potential could not be
generalized for all cancer types. In order to overcome such drawback, Gopinath
et al. have designed Cytosine Deaminase-Uracil Phosphoribosyltransferase
(CD-UPRT) bifunctional suicide gene construct in which Uracil
Phosphoribosyltransferase (UPRT) acts upon product of CD i.e. 5-FU and converts
it further into other toxic metabolites.
The
therapeutic effect of suicide genes can be enhanced by combinatorial
approaches. In combination therapy, two or more drugs with similar or different
mode of action are employed to realize synergistic anticancer therapeutic
potentials. Such synergistic anticancer potential of combination of radiation
therapy and 5-FC/ CD plus UPRT gene therapy was demonstrated by Kambara et al.
against malignant gliomas. Apart from this, the combination therapy also
provides scope for exploiting radio sensitizing properties of 5-FU and by
stander effects during the course of treatment. Many research groups
have reported the use of suicide gene in combination with chemotherapy and
radiation to enhance the therapeutic effect and to overcome the drug
resistance. Gopinath et al. were the first to report the applications of silver
nanoparticles for synergizing the therapeutic effect of suicide gene. They
have also reported the synergistic therapeutic effect of suicide gene with
anticancer drug curcumin. One of the major challenging tasks in suicide gene
therapy is lack of suitable vectors for targeted delivery of suicide gene to
cancer cells. The application of such DNAbased therapeutics is largely limited
due to poor cellular uptake, degradation by serum nucleases and rapid renal
clearance following systemic administration. In addition to these, organ
specific targeted DNA therapy has been a major challenge to overcome off-target
gene therapy. In order to circumvent these limitations, numerous organ specific
targeted nanocarriers have been developed recently for systemic administration.
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