A Phase I Trial With Transgenic Bacteria Expressing Interleukin-10 in Crohn’s Disease

• Published in: Clinical gastroenterology and hepatology Vol. 4; no. 6; pp. 754 - 759
• Main Authors: Braat, Henri, Rottiers, Pieter, Hommes, Daniel W., Huyghebaert, Nathalie, Remaut, Erik, Remon, Jean–Paul, van Deventer, Sander J.H., Neirynck, Sabine, Peppelenbosch, Maikel P., Steidler, Lothar
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2006
• Subjects: C-Reactive Protein - analysis; Crohn Disease - pathology; Crohn Disease - therapy; Genetic Therapy; Humans; Interleukin-10 - administration & dosage; Interleukin-10 - genetics; Lactococcus lactis - genetics; Lactococcus lactis - metabolism; Organisms, Genetically Modified; Tablets, Enteric-Coated; Thymidylate Synthase - genetics; Transgenes; Q-PCR; CFU; LL-Thy12; IL-10
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2006.03.028

Background & Aims: The use of living, genetically modified bacteria is an effective approach for topical delivery of immunomodulatory proteins. This strategy circumvents systemic side effects and allows long-term treatment of chronic diseases. However, treatment of patients with a living, genetically modified bacterium raises questions about the safety for human subjects per se and the biologic containment of the transgene. Methods: We treated Crohn’s disease patients with genetically modified Lactococcus lactis ( LL-Thy12) in which the thymidylate synthase gene was replaced with a synthetic sequence encoding mature human interleukin-10. Ten patients were included in a placebo-uncontrolled trial. Patients were assessed daily for the presence of potential adverse effects by direct questioning and assessment of disease activity. We evaluated the presence and kinetics of LL-Thy12 release in the stool of patients by conventional culturing and quantitative polymerase chain reaction of LL-Thy12 gene sequences. Results: Treatment with LL-Thy12 was safe because only minor adverse events were present, and a decrease in disease activity was observed. Moreover, fecally recovered LL-Thy12 bacteria were dependent on thymidine for growth and interleukin-10 production, indicating that the containment strategy was effective. Conclusions: Here we show that the use of genetically modified bacteria for mucosal delivery of proteins is a feasible strategy in human beings. This novel strategy avoids systemic side effects and is biologically contained; therefore it is suitable as maintenance treatment for chronic intestinal disease.