Effects of febrile temperature on adenoviral infection and replication: Implications for viral therapy of cancer

We previously conducted a phase I/II study using arterial infusions of ONYX-015 (dl1520), a replication-selective adenoviral vector, with E1b deleted, for patients with metastatic colorectal cancer. No dose-limiting toxicities occurred, but >90% of the patients experienced fever. The effects of temperature on the replication of dl1520 in normal and transformed cells had not been studied. Therefore, replication and cell viability assays were performed with a panel of nontransformed and transformed cell lines cultured at 37 and 39.5degreesC and treated with adenovirus type 5 (Ad5) or dl1520. Ad5-mediated cytolytic effects were inhibited and production of infectious particles decreased by >1,000-fold in the nontransformed cells at 39.5degreesC. Seven of nine of the tumor cell lines retained significant cell-killing effects when treated with Ad5 at 39.5degreesC. When dl1520 was used, no cytolytic effects were observed at 39.5degreesC in the nontransformed cell lines; however, cytolytic effects occurred in six of nine tumor cell lines at 39.5'C. Notably, a subset of the tumor cell lines demonstrated increased dl1520-mediated cytolytic effect and replication at 39.5degreesC. Suppression of Ad5 and dl1520 replication at 39.5degreesC was not related to p53 status or HSP70 expression. Also, at 39.5degreesC, E1a expression was inhibited in nontransformed cells but was still abundant in the transformed cells, indicating that a novel early block in viral replication occurred in the nontransformed cells. Fever may therefore augment the therapeutic index of oncolytic viruses by inhibiting replication in normal cells while permitting or enhancing viral replication in some tumor cells.