By Janice Chithelen
Do you spend a good amount of time choosing the next new mobile or laptop? What built-in features do you look for? Now imagine the same level of customization for cancer treatment. What if individuals undergoing broad-spectrum chemotherapy – a common method of cancer treatment that is often harsh and produces side effects, could instead avail a more tailored, bacterial-based vaccine designed specifically for their tumors?
From Traditional Vaccines to Personalized Cancer Immunotherapy
Traditional bacterial-based vaccines for infectious diseases work by expressing antigens – specific biomolecules such as proteins, lipids and others that are recognized by the immune system. This recognition triggers elimination of the pathogen and results in a robust immune response and long-term memory. Typically, these vaccines use pathogenic bacteria or viruses that express antigenic proteins foreign to the host. Factors such as biosafety profile, host tolerance, and efficacy determine whether the vaccine would contain whole live bacteria, attenuated (weakened) bacteria or just antigenic subunits – i.e specific protein fragments. Normally a host immune response is triggered when patrolling immune cells, such as macrophages, engulf antigens or bacteria and process them into smaller fragments. These fragments are then displayed on the cell surface to be recognized by T cells (a type of immune system cells), which initiate an immune response – such as killing target cells, recruiting other immune cells, and activating antibody response.
Unlike foreign infections, cancer presents a unique challenge since cancer cells are transformed non-foreign cells. In order to specifically recognize cancer cells from normal host cells, researchers use neoantigens – i.e. modified or altered proteins uniquely produced by tumour cells due to their abnormal state. In their recent study, Columbia postdocs Mathieu Rouanne, Edward Ballister, Jaeseung Hahn and their colleagues developed a novel cancer vaccine by expressing tumour specific neoantigens. They used the probiotic Escherichia coli Nissle 1917 (EcN) strain as the antigen expression system. The EcN strain was chosen for its biosafety profile as a non-pathogenic bacteria known to have a beneficial action on the gut.
Engineering a Probiotic Vaccine Platform
The researchers undertook a specific approach to further optimize the bacteria for the production and delivery of multiple neoantigen-containing short protein sequences. In order to clearly distinguish the tumor cells from normal host cells, multiple tumor specific neoantigens were identified from databases and included in the therapeutic vaccine so that the collectively expressed neoantigens would initiate a specific and durable immune response similar to a multivalent vaccine. The authors included additional features to fine tune their system :
1) Deletion of specific bacterial proteases (proteins that degrade other proteins) which significantly increased the neoantigen accumulation. A higher neoantigen accumulation also led to better antigen presentation on the surface of the patrolling immune cells which triggered a better T cell-mediated killing of the cancerous cells.
2) Absence of proteases led to increased susceptibility to clearance of the bacteria by human blood factors like phagocytosis (ingestion by patrolling immune cells essential to clear the pathogen and also present them to other immune cells) – indicating a good biosafety profile.
3) Removal of suppressive plasmids (naturally occurring non-genomic DNA molecules that negatively influence the stability of the engineered therapeutic DNA). This additionally boosted the neoantigen production by another 10-fold.
4) Optimizing the neoantigen producing DNA with regulatory regions that additionally increased the neoantigenes’ levels.
5) Coexpression in their system of the protein LLO (listeriolysin perforin), a protein from intracellular pathogen Listeria, in order to release the antigen inside the immune cell which further triggers a more potent T cell-mediated immune response.

Figure a: Scheme of the bacterial vaccine platform and its engineered components – deletion of bacterial proteases OmpT and Lon for neoantigen accumulation, removal of suppressive (cryptic) plasmids and LLO coexpression thereby leading to defensive host responses like primary phagocytosis, and T cell immune response. Figure b: Representative images (tumor intensity in blue) of lung metastases in mice and treatment with the bacterial vaccine for 22 days. M1 – M5 are the different mice treated with either saline (PBS – upper row), negative control (empty) bacterial vaccine (middle row), or bacterial vaccine expressing respective tumour neoantigen (lower row). Image adapted from the original publication and from www.vecteezy.com/eezy.
The vaccine was tested in mouse models of colorectal and aggressive melanoma cancer using various delivery methods. The live vaccine was not only found to be well tolerated by mice and specific against tumor cells, but it also shrank tumours, prevented metastases, and enhanced mice survival. It was also observed that intravenous vaccine delivery which is one of the less invasive forms (as compared to surgical tumour removal) led to optimal anti-tumor effects. The vaccine effectively activated both helper and killer T cells, which is crucial for killing the tumour cell. This also demonstrated signs of long-term protection, suggesting an overall broad and lasting defense against tumor growth. The authors also showed that the tumour specific neoantigen expressing DNA sequence could be exchanged with sequences expressing neoantigens of another cancer type and the modification worked when applied to respective specific cancer mice models. This meant that the bacterial vaccine could be re-programmed based on the tumour type.
Such a model of using a live bacterial vaccine to treat solid tumours presents a major leap in cancer treatment by turning a probiotic bacteria EcN into a programmable cancer vaccine. This paper reflects a comprehensive demonstration that engineered bacteria could be customized to safely and effectively direct the immune system against solid tumors. It combines precision, safety, and adaptability paving the way for personalized cancer vaccines, but further testing in human trials is still required. What still remains to be accomplished would be to test the system further in human trials and further improving the vaccine platform and adapting it for patients with weakened immune systems, especially those undergoing chemotherapy. Though more research is needed before human trials, the approach described by Columbia postdocs Mathieu Rouanne, Edward Ballister, Jaeseung Hahn and their colleagues could one day lead to safer, smarter, and more personalized cancer treatments.
Reviewed by : Margarita T Angelova, Saheli Chowdhury, Maithê R. M. de Barros



