Previous Article | Next Article 
Journal of Virology, September 2007, p. 9568-9571, Vol. 81, No. 17
0022-538X/07/$08.00+0 doi:10.1128/JVI.00663-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.
Targeting of Adenovirus Serotype 5 (Ad5) and 5/47 Pseudotyped Vectors In Vivo: Fundamental Involvement of Coagulation Factors and Redundancy of CAR Binding by Ad5
Simon N. Waddington,1
Alan L. Parker,2
Menzo Havenga,3
Stuart A. Nicklin,2
Suzanne M. K. Buckley,1
John H. McVey,4 and
Andrew H. Baker2*
Department of Haematology, Haemophilia Centre and Haemostasis Unit, Royal Free and University College Medical School, London NW3 2PF, United Kingdom,1
British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, United Kingdom,2
Crucell, P.O. Box 2048, 2301 CA Leiden, The Netherlands,3
Haemostasis and Thrombosis, MRC Clinical Sciences Centre, Imperial College London, Du Cane Road, London W12 0NN, United Kingdom4
Received 28 March 2007/
Accepted 29 May 2007

ABSTRACT
Vitamin K-dependent coagulation factors can promote adenoviral
cell transduction in vitro. In vivo, warfarin pretreatment ablates
liver targeting of an adenovirus serotype 5 (Ad5) vector deleted
of CAR binding capability. Here, we assess in vivo transduction
and biodistribution of Ad5 vectors with nonmodified fibers (Ad5)
and a serotype 47 fiber-pseudotyped Ad5 (Ad5/47; subgroup D)
virus following intravascular injection. Warfarin reduced liver
transduction by both viruses. However, no impact on early liver
virus accumulation was observed, suggesting no effect on Kupffer
cell interactions. Hence, coagulation factors play a pivotal
role in selectively mediating liver hepatocyte transduction
of Ad5 and Ad5/47 vectors.

TEXT
Adenovirus (Ad) vectors are commonly used biological tools for
in vitro and in vivo gene delivery. The route of Ad delivery
principally defines both the infectivity profile and the subsequent
toxicity of the virus. The delivery of Ad via the intravascular
route is broadly appealing both for liver-directed gene therapy
(
7,
13) and for targeting of nonhepatic tissues via alternate
receptors (
5,
19). In the paradigm of intravascular gene delivery,
there is a complex yet poorly characterized pattern of virus-host
interactions, including those with blood cells and plasma proteins.
A fuller understanding of these interactions is necessary for
the development of safe and efficient targeting to individual
organs. Prior studies have demonstrated Ad interactions with
red blood cells (
2,
12) and white blood cells (
9), as well as
plasma proteins such as coagulation zymogens and complement
pathway components (
15,
18,
23). Recent evidence has shown a
substantial role for coagulation zymogens in the delivery of
Ad to the liver following intravascular injection (
15,
18).
This contrasts sharply with the accepted mechanism of Ad serotype
5 (Ad5) vector transduction in vitro with tethering to the cell
surface through the fiber knob domain, which binds CAR (
1,
21),
and internalization through the penton base, which engages
v integrins (
22). Potential redundancy of CAR in Ad5-mediated
transduction of the liver is supported by studies showing little
or no difference in liver sequestration for CAR binding and
non-CAR binding Ad (reviewed in reference
11). Anatomically,
the distribution of CAR expression is restricted to tight junctions
(
3); hence, the considerable levels of hepatocyte transduction
observed with systemically administered Ad vectors would be
difficult to reconcile with such restricted expression of CAR.
We recently documented a definitive role for plasma coagulation zymogens with the Gla-EGF-EGF-SP domain structure (factor VII [FVII], FIX, FX, and protein C) in enhancing hepatocyte transduction in vitro of both Ad5 and non-CAR binding Ad5 (15) and for Ad5 capsids pseudotyped with fibers from subgroup D Ad (14). Using a model system involving in vivo warfarin pretreatment of mice to reduce circulating levels of functional Gla domain-containing zymogens, we showed that warfarin blocked the ability of a non-CAR binding Ad5 (AdKO1) to target the liver (15). Liver targeting was reconstituted by injection of physiological concentrations of FX 30 min prior to virus injection, thereby confirming a particularly important role for FX. Because many studies have suggested that CAR is redundant in Ad-mediated liver targeting, we sought to assess the effect of coagulation zymogen depletion on liver targeting mediated by Ad vectors with a nonmodified capsid (Ad5). We injected Ad5 vectors into MF-1 mice in the presence or absence of warfarin pretreatment (Fig. 1) and first assessed transgene expression levels and then virion levels in organs postinjection. In an assessment of transduction at 48 h postinfection, a substantial reduction of liver targeting by warfarin was observed (Fig. 2). Hence, taken with data on CAR binding-deleted Ad vectors (15), this supports a redundancy of the CAR pathway in hepatocyte transduction in vivo, previously a controversial issue (4; reviewed in reference 11). Liver transduction was fully restored by FX injection (Fig. 2). FX injection resulted in physiological levels of circulating FX, confirmed by enzyme-linked immunosorbent assay (ELISA) (not shown). Hence, warfarin-sensitive coagulation factors are fundamentally important in Ad5 liver transduction. Although, as expected, Ad5 levels of transduction in the spleen were far lower than in the liver, transduction was again substantially reduced by the presence of warfarin and rescued by FX infusion (Fig. 2). This suggests that binding of Ad5 to coagulation factors also dictates Ad5 targeting to permissive cells in the spleen. Levels in the lung were lower than in the liver and spleen but were not significantly altered by warfarin or FX infusion (Fig. 2).
We next sought to define early virion accumulation in liver
and spleen postinjection to ascertain whether warfarin could
block virion sequestration in addition to cell transduction.
Early Ad accumulation in liver and spleen is strongly associated
with substantial targeting and clearance of Ad through Kupffer
cells, an effect that is acute (
8,
10,
20). We therefore assessed
Ad virion levels at 1 h and 48 h postinfusion in the warfarin
pretreatment and FX rescue model using quantitative Taqman PCR.
Ad virion levels at 1 h postinjection were not significantly
different with warfarin treatment or FX reconstitution from
those in control mice (Fig.
3). This contrasted sharply with
the levels quantified at 48 h postinjection, which, for the
liver, paralleled transduction profiles (Fig.
3). This observation
suggests that coagulation zymogens do not affect the substantial
Kupffer cell uptake and supports the concept that coagulation
zymogens play a pivotal role selectively in transduction of
cells, both in the liver and in the spleen.
To confirm that the in vivo effects of warfarin are not limited
to Ad5, we assessed the effect on liver targeting of a fiber-pseudotyped
virus containing fibers from subgroup D (Ad5/47). Previously,
we showed in vitro that FX at physiological concentrations promotes
cell attachment and transduction of HepG2 hepatocytes mediated
by a number of fiber-pseudotyped vectors with fibers from subgroup
D (
14). We therefore injected luciferase-expressing A5/47 into
mice at 2
x 10
10 virus particles (VP) per mouse and assessed
transgene expression by bioluminescence at 48 h (Fig.
4). As
shown, and in similarity to injection of the control Ad5 vector
expressing luciferase (
6), the liver infectivity of Ad5/47 was
substantially reduced by warfarin pretreatment (Fig.
4). Hence,
the effect of coagulation factors in vivo is relevant to Ad
vectors with fibers derived from subgroup D as well as from
subgroup C (Ad5).
Combined with our previous studies (
14,
15), we now show that
both CAR binding and non-CAR binding Ad vectors predominantly
utilize coagulation factors for liver and spleen transduction
in vivo, since warfarin substantially reduces transduction of
both viruses, an effect fully restored by FX infusion at physiological
levels. For Ad5, this suggests that CAR binding plays no role
in liver targeting when delivered via the bloodstream. This
explains why many studies have shown no effect of CAR binding
mutants on in vivo Ad liver transduction. For vector retargeting
strategies, however, it remains unknown whether blocking of
Ad-coagulation factor binding will allow efficient retargeting
of virus, since early virus accumulation in the liver is not
affected, at least for Ad5 (Fig.
3). Hence, Kupffer cell-depleting
or avoidance strategies may also be required. Observations from
this and previous studies, however, do provide evidence to suggest
that blockade of coagulation factor-mediated liver transduction
by Ad may be a useful approach for achieving transductional
targeting. In the presence of a high-affinity retargeting strategy
using bispecific antibodies to retarget Ad to the angiotensin
converting enzyme, detectable transduction was achieved in target
lung endothelium; however, the majority of Ad still transduced
the liver (
17). Transcriptional control was required to completely
eliminate liver transgene expression (
16). Clearly, in this
paradigm, assessing the effect of warfarin depletion of coagulation
factors on angiotensin converting enzyme-targeted Ad biodistribution
is warranted. Our experiments with Ad5/47 also highlight the
breadth of the effect that coagulation zymogens have on the
biology of different human Ad serotypes upon contact with the
bloodstream. In sum, our study defines the importance of vitamin
K-dependent coagulation zymogens on Ad5- and Ad5/47-mediated
liver transduction. It is likely that such mechanisms are relevant
in defining the in vivo infectivity of many human Ad vectors
being developed for gene-based therapeutics.

ACKNOWLEDGMENTS
This work was supported by the European Commission and the Biotechnology
and Biophysical Research Council. Hemostasis and Thrombosis
are supported by the Medical Research Council. S.N.W. is a Philip
Gray Memorial Fellow, Katharine Dormandy Trust.

FOOTNOTES
* Corresponding author. Mailing address: Division of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, United Kingdom. Phone: 44 141 330 1977. Fax: 44 141 330 6997. E-mail:
ab11f{at}clinmed.gla.ac.uk 
Published ahead of print on 6 June 2007. 

REFERENCES
1 - Bergelson, J. M., J. A. Cunningham, G. Droguett, E. A. Kurt-Jones, A. Krithivas, J. S. Hong, M. S. Horwitz, R. L. Crowell, and R. W. Finberg. 1997. Isolation of a common receptor for coxsackie B viruses and adenoviruses 2 and 5. Science 275:1320-1323.[Abstract/Free Full Text]
2 - Cichon, G., S. Boeckh-Herwig, D. Kuemin, C. Hoffmann, H. H. Schmidt, E. Wehnes, W. Haensch, U. Schneider, U. Eckhardt, R. Burger, and P. Pring-Akerblom. 2003. Titer determination of Ad5 in blood: a cautionary note. Gene Ther. 10:1012-1017.[CrossRef][Medline]
3 - Cohen, C. J., J. T. C. Shieh, R. J. Pickles, T. Okegawa, J.-T. Hsieh, and J. M. Bergelson. 2001. The coxsackievirus and adenovirus receptor is a transmembrane component of the tight junction. Proc. Natl. Acad. Sci. USA 98:15191-15196.[Abstract/Free Full Text]
4 - Einfeld, D. A., R. Schroeder, P. W. Roelvink, A. Lizonova, C. R. King, I. Kovesdi, and T. J. Wickham. 2001. Reducing the native tropism of adenovirus vectors requires removal of both CAR and integrin interactions. J. Virol. 75:11284-11291.[Abstract/Free Full Text]
5 - Gaggar, A., D. M. Shayakhmetov, and A. Lieber. 2003. CD46 is a cellular receptor for group B adenoviruses. Nat. Med. 9:1408-1412.[CrossRef][Medline]
6 - Havenga, M. J. E., A. A. C. Lemckert, O. J. A. E. Ophorst, M. V. Meijer, W. T. V. Germeraad, J. Grimbergen, M. A. V. D. Doel, R. Vogels, J. V. Duetekom, A. A. M. Janson, J. D. D. Bruijn, F. Uytdehaag, P. H. A. Quax, T. Logtenberg, M. Mehtali, and A. Bout. 2002. Exploiting the natural diversity in adenovirus tropism for therapy and prevention of disease. J. Virol. 76:4612-4620.[Abstract/Free Full Text]
7 - Huard, J., H. Lochmuller, G. Ascadi, A. Jani, B. Massie, and G. Karpati. 1995. The route of administration is a major determinant of the transduction efficiency of rat tissues by adenoviral recombinants. Gene Ther. 107:107-115.
8 - Lieber, A., C. Y. He, L. Meuse, D. Schowalter, I. Kirillova, B. Winther, and M. A. Kay. 1997. The role of Kupffer cell activation and viral gene expression in early liver toxicity after infusion of recombinant adenovirus vectors. J. Virol. 71:8798-8807.[Abstract]
9 - Lyons, M., D. Onion, N. K. Green, K. Aslan, R. Rajaratnam, M. Bazan-Peregrino, S. Phipps, S. Hale, V. Mautner, L. W. Seymour, and K. D. Fisher. 2006. Adenovirus type 5 interactions with human blood cells may compromise systemic delivery. Mol. Ther. 14:118-128.[CrossRef][Medline]
10 - Manickan, E., J. S. Smith, J. Tian, T. L. Eggerman, J. N. Lozier, J. Muller, and A. P. Byrnes. 2005. Rapid Kupffer cell death after intravenous injection of adenovirus vectors. Mol. Ther. 13:108-117.[CrossRef][Medline]
11 - Nicklin, S., E. Wu, G. Nemerow, and A. Baker. 2005. The influence of adenovirus fiber structure and function on vector development for gene therapy. Mol. Ther. 12:384-393.[CrossRef][Medline]
12 - Nicol, C., D. Graham, W. Miller, S. White, T. Smith, S. Nicklin, S. Stevenson, and A. Baker. 2004. Effect of adenovirus serotype 5 fiber and penton modifications on in vivo tropism in rats. Mol. Ther. 10:343-353.
13 - Oka, K., L. Pastore, I. Kim, A. Merched, S. Nomura, H. Lee, M. Merched-Sauvage, C. Arden-Riley, B. Lee, M. Finegold, A. Beaudet, and L. Chan. 2001. Long term stable correction of low-density lipoprotein receptor-deficient mice with a helper-dependent adenoviral vector expressing the very low-density lipoprotein receptor. Circulation 103:1274-1281.[Abstract/Free Full Text]
14 - Parker, A. L., J. H. McVey, J. H. Doctor, O. Lopez-Franco, S. N. Waddington, M. J. E. Havenga, S. A. Nicklin, and A. H. Baker. 2007. Influence of coagulation factor zymogens on the infectivity of adenoviruses pseudotyped with fibers from subgroup D. J. Virol. 81:3627-3631.[Abstract/Free Full Text]
15 - Parker, A. L., S. N. Waddington, C. G. Nicol, D. M. Shayakhmetov, S. M. Buckley, L. Denby, G. Kemball-Cook, S. Ni, A. Lieber, J. H. McVey, S. A. Nicklin, and A. H. Baker. 2006. Multiple vitamin K-dependent coagulation zymogens promote adenovirus-mediated gene delivery to hepatocytes Blood. 108:2554-2561.
16 - Reynolds, P. N., S. A. Nicklin, L. Kaliberova, B. G. Boatman, W. E. Grizzle, I. V. Balyasnikova, A. H. Baker, S. M. Danilov, and D. T. Curiel. 2001. Combined transductional and transcriptional targeting improves the specificty of transgene expression in vivo. Nat. Biotechnol. 19:838-842.[CrossRef][Medline]
17 - Reynolds, P. N., K. R. Zinn, V. D. Gavrilyuk, I. V. Balyasnikova, B. E. Rogers, D. J. Buchsbaum, M. H. Wang, D. J. Miletich, W. E. Grizzle, J. T. Douglas, S. M. Danilov, and D. T. Curiel. 2000. A targetable, injectable adenoviral vector for selective gene delivery to pulmonary endothelium in vivo. Mol. Ther. 2:562-578.[CrossRef][Medline]
18 - Shayakhmetov, D., A. Gaggar, S. Ni, Z.-Y. Li, and A. Lieber. 2005. Adenovirus binding to blood factors results in liver cell infection and hepatotoxicity. J. Virol. 79:7478-7491.[Abstract/Free Full Text]
19 - Shayakhmetov, D., Z. Li, S. Ni, and A. Lieber. 2002. Targeting of adenovirus vectors to tumor cells does not enable efficient transduction of breast cancer metastases. Cancer Res. 62:1063-1068.[Abstract/Free Full Text]
20 - Tao, N., G. P. Gao, M. Parr, J. Johnston, T. Baradet, J. M. Wilson, J. Barsoum, and S. E. Fawell. 2001. Sequestration of adenoviral vector by Kupffer cells leads to a nonlinear dose response of transduction in liver. Mol. Ther. 3:28-35.[CrossRef][Medline]
21 - Tomko, R. P., R. Xu, and L. Philipson. 1997. HCAR and MCAR: the human and mouse cellular receptors for subgroup C adenoviruses and group B coxsackieviruses. Proc. Natl. Acad. Sci. USA 94:3352-3356.[Abstract/Free Full Text]
22 - Wickham, T. J., P. Mathias, D. A. Cheresh, and G. R. Nemerow. 1993. Integrins
vß3 and
vß5 promote adenovirus internalization but not virus attachment. Cell 73:309-319.[CrossRef][Medline] 23 - Zinn, K. R., A. Szalai, A. Stargel, V. Krasnykh, and T. R. Chaudhuri. 2004. Bioluminescence imaging reveals a significant role for complement in liver transduction following intravenous delivery of adenovirus. Gene Ther. 11:1482-1486.[CrossRef][Medline]
Journal of Virology, September 2007, p. 9568-9571, Vol. 81, No. 17
0022-538X/07/$08.00+0 doi:10.1128/JVI.00663-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.
This article has been cited by other articles:
-
Alba, R., Bradshaw, A. C., Parker, A. L., Bhella, D., Waddington, S. N., Nicklin, S. A., van Rooijen, N., Custers, J., Goudsmit, J., Barouch, D. H., McVey, J. H., Baker, A. H.
(2009). Identification of coagulation factor (F)X binding sites on the adenovirus serotype 5 hexon: effect of mutagenesis on FX interactions and gene transfer. Blood
114: 965-971
[Abstract]
[Full Text]
-
Jonsson, M. I., Lenman, A. E., Frangsmyr, L., Nyberg, C., Abdullahi, M., Arnberg, N.
(2009). Coagulation Factors IX and X Enhance Binding and Infection of Adenovirus Types 5 and 31 in Human Epithelial Cells. J. Virol.
83: 3816-3825
[Abstract]
[Full Text]
-
Russell, W. C.
(2009). Adenoviruses: update on structure and function. J. Gen. Virol.
90: 1-20
[Abstract]
[Full Text]
-
Parker, A. L., Waddington, S. N., Buckley, S. M. K., Custers, J., Havenga, M. J. E., van Rooijen, N., Goudsmit, J., McVey, J. H., Nicklin, S. A., Baker, A. H.
(2009). Effect of Neutralizing Sera on Factor X-Mediated Adenovirus Serotype 5 Gene Transfer. J. Virol.
83: 479-483
[Abstract]
[Full Text]
-
Xu, Z., Tian, J., Smith, J. S., Byrnes, A. P.
(2008). Clearance of Adenovirus by Kupffer Cells Is Mediated by Scavenger Receptors, Natural Antibodies, and Complement. J. Virol.
82: 11705-11713
[Abstract]
[Full Text]
-
Peerlinck, I., Amini-Nik, S., Phillips, R. K., Iggo, R., Lemoine, N. R., Tejpar, S., Vassaux, G.
(2008). Therapeutic Potential of Replication-Selective Oncolytic Adenoviruses on Cells from Familial and Sporadic Desmoid Tumors. Clin. Cancer Res.
14: 6187-6192
[Abstract]
[Full Text]
-
Shashkova, E. V., Doronin, K., Senac, J. S., Barry, M. A.
(2008). Macrophage Depletion Combined with Anticoagulant Therapy Increases Therapeutic Window of Systemic Treatment with Oncolytic Adenovirus. Cancer Res.
68: 5896-5904
[Abstract]
[Full Text]