A dependence of poliovirus on an unorthodox translation initiation mode can be targeted selectively to drive viral protein synthesis and cytotoxicity in malignant cells. Transformed cells are naturally susceptible to poliovirus, due to widespread ectopic upregulation of the poliovirus receptor, Necl-5, in ectodermal/neuroectodermal cancers. Viral tumor cell killing and the host immunologic response it engenders produce potent, lasting antineoplastic effects in animal tumor models. Clinical application of this principle depends on unequivocal demonstration of safety in primate models for paralytic poliomyelitis. We conducted extensive dose-range-finding, toxicity, biodistribution, shedding, and neutralizing antibody studies of the prototype oncolytic poliovirus recombinant, PVS-RIPO, after intrathalamic inoculation in Macaca fascicularis. These studies suggest that intracerebral PVS-RIPO inoculation does not lead to viral propagation in the central nervous system (CNS), does not cause histopathological CNS lesions or neurological symptoms that can be attributed to the virus, is not associated with extraneural virus dissemination or replication and does not induce shedding of virus with stool. Intrathalamic PVS-RIPO inoculation induced neutralizing antibody responses against poliovirus serotype 1 in all animals studied.
Several years ago, we proposed consideration of recombinant, nonpathogenic poliovirus (PV) for the treatment of glioblastoma (GBM) (17). This proposal is based on widespread ectopic expression of the PV receptor, nectin-like molecule-5 (Necl-5), in such cancers (26). Necl-5, an onco-fetal cell adhesion molecule of the nectin family, is broadly associated with ectodermal/neuroectodermal cancers (reviewed in reference 42). Necl-5 expression is abundant in GBM cells, "stem cell-like" GBM cells, and tumorassociated vasculature (6) and is implicated in GBM cell dispersion and invasion (39,40). Due to Necl-5 expression, GBM cells are naturally susceptible to infection with and rapid destruction by PV (17). Direct cytocidal effects of PV elicit host immunogenic responses directed against tumors in vivo (43).Any clinical application of engineered PVs must include a rigorous demonstration of safety in established nonhuman primate models for paralytic poliomyelitis. Such safety studies are modeled after standard neurovirulence assays for the live-attenuated (Sabin) PV vaccines (41). The three Sabin vaccine serotypes (PV1-S, PV2-S, and PV3-S), some stemming from serial passage in diverse simian tissue culture systems, exhibit substantially reduced primate neurovirulence (36). While the genetic base for attenuation is different for each Sabin strain (29), they have key sequence variables in common.PV plus-strand RNA genomes are not equipped with a 7-methyl-guanidine cap (31) and thus are unable to recruit ribosomal subunits via the cap-binding eukaryotic initiation factor (eIF) 4E. Instead, PV RNAs rely on an internal ribosomal entry site (IRES) within their 5= untranslated region (UTR) to recruit 40S ribosoma...