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p53 Aerosol Formulation with Low Toxicity and High Efficiency for Early Lung Cancer Treatment

Authors' Affiliations: ¹ Department of Medicine, Albert Einstein College of Medicine, Bronx, New York and ² Department of Anatomic Pathology, Stony Brook University Hospital, State University of New York, Stony Brook, New York

Requests for reprints: Yiyu Zou, Department of Medicine/Cancer Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Chanin 602B, Bronx, NY 10461. Phone: 718-430-4146; Fax: 718-430-8663; E-mail: yiyuzou{at}yahoo.com.

Purpose: To develop an optimal nonviral aerosol formulation for locoregional treatment of early lung cancer.

Experimental Design: The formulation was made of polylysine/protamine combination (AND) as the carrier and p53 gene (p53sm) as therapeutic agent. To estimate the aerosol deposition, the aerodynamic size of the AND-p53sm was measured with extrusion-precipitation method. To accurately determine the dose, the aerosol efficiency in mice was measured with a fluorescent dye. The transfection efficiency and DNA protection function of the aerosolized formulation in cultured cells and mouse lungs were detected with reporter gene assays and/or reverse transcription-PCR. The preclinical safety and efficacy of AND-p53sm were studied in healthy mice and mice bearing orthotopic human non–small-cell lung cancer (NSCLC) xenograft.

Results: After aerosolization, AND is 3- to 17-fold more effective than commonly used PEI or cationic lipid formulations in transfecting the NSCLC cells (relative light units, 1,494 versus 534 and 86; P < 0.003). Aerodynamic size of AND-p53sm ranged 0.2 to 3 µm is the optimal aerosol droplets for deposition in the entire human respiratory tract. Significant gene expression was detected in the lungs of mice given aerosolized AND-p53sm and AND-luciferase. Aerosolized AND-p53sm significantly prolonged the life of mice bearing orthotopic human NSCLC xenografts, and it was more effective than an optimal i.v. cisplatin chemotherapy (increased life span, 93% versus 25%; P = 0.014). Inhalation of AND produced low and reversible pulmonary toxicity and no systemic toxicity.

Conclusions: This optimal formulation is suitable for delivering biological materials to human lung with aerosol administration. This therapeutic strategy is an option for patients with early lung cancer and bronchoalveolar carcinoma.