Introduction: The major cause of local recurrence after initial surgery for hepatic malignancy is residual carcinoma macroscopically or microscopically at the surgical site. Although many surgical devices and skills have developed, the recurrence rate of hepatic malignancy is still high. At present, for those patients with recurrent disease, adjuvant therapies such as chemotherapy, radiation therapy and immunotherapy are combined. However, in such cases, severe side-effects make the patient's QOL (quality of life) considerably worse. Therefore, a novel approach for residual carcinoma at the time of surgery is urgently needed. In this study we proposed the use of a novel gene therapy for residual carcinoma of the liver. Purpose: The fibrin glue system (FGS) consists of liquid forms of fibrinogen and thrombin and is used widely in surgical operation as it has a sealing effect and promotes tissue adhesion at the surgically resected site. In this study, we proposed the efficacy and safety of loco-regional gene transfer using adenoviral vector mixed with FGS to prevent local recurrence of liver carcinoma. We demonstrated that the adenoviral vector containing the E.coli LacZ gene (AxCALacZ) was delivered to the liver of rats by FGS. Materials and Methods: Experiment 1 in vitro Rat colon carcinoma cell line, RCN-9 was incubated on a membrane containing multiple 0.02μm-sized holes. Various concentrations of the adenoviral vector mixed with FGS (AxCALacZ/FGS) were applied on the RCN-9 and incubated for 48 hours. The optimum efficiency of transduction was evaluated by X-Gal staining and NIH imaging. Experiment 2 in vitro To examine the survival period of adenoviral vector in FGS, AxCALacZ/FGS put on the monolayer cultured RCN9 after being left for various periods. Transgene expression was evaluated by β-gal assay. The β-gal activity was measured photometrically using the Promega β-gal enzyme assay kit according to the manufacture's instructions (Promega, Madison, USA). Experiment 3 in vivo 8-week-old male F344 rats underwent a partial hepatectomy. AxCALacZ/FGS was applied on the cut surface of the dissected liver and the rats were kept for 48 hours under normal conditions. AxLacZ/PBS was treated as the control study. The transducted and non-transducted parts of the liver were extirpated, stained with X-gal liquid and β-gal was measured to compare the efficacy of transduction in each organ. Results: Experiment 1 significantly more transgene expression was shown by the X-gal staining and NIH imaging than 1MOI. Experiment 2 LacZ expression revealed infected RCN9 when AxCALacZ/FGS was left for a period of less than 96 hours. Experiment 3 AxCALacZ/FGS transgene expression was shown at the treated and non-treated part of the liver more than AxCALacZ/PBS expression. Discussion and conclusion: It was demonstrated that adenoviral vector survives and being stable for enough time to transduct in FGS. AxCALacZ/FGS can transduct the target gene. Furthermore, the transduction efficiency was comparable to those of existing methods. In the future, FGS will be studied with an adenoviral vector containing the gene which enhances antitumor immunity for preventing recurrence loco-regionally site as well as its original tissue adhesive purpose.
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