GENE THERAPY FOR ENHANCING AND/OR INDUCING ANGIOGENESIS

Abstract: The invention relates to gene therapy for enhancing and/or inducing angiogenesis, wherein use is made of a nucleic acid sequence encoding Nitric Oxide Synthase (NOS). In particular, the nucleic acid sequence is administered in a systemic treatment, preferably comprising isolated tissue perfusion.

Description: Title : Gene therapy for enhancing and/or inducing angiogenesis FIELD OF THE INVENTION The present invention relates to the field of gene therapy, more in particular to gene therapy vehicles and methods of delivery to stimulate the formation of new blood vessels (angiogenesis) in patients with endothelial dysfunction. For these purposes the invention discloses the delivery of therapeutic genes through the blood circulation. BACKGROUND OF THE INVENTION Artherosclerosis is the accumulation of fatty deposits (plaque) inside blood vessels, leading to the blocking of the blood flow. Arteries throughout the body may be affected. The fibrous plaque forms occlusive lesions, because of its size and protusion into the arterial lumen. The fibrous cap covering the plague may rupture, leading to thrombus formation, resulting in further occlusion of the artery. When the lesion is located in the coronary artery, rupture will lead to a myocardial infarct . When the blood flow in brain vessels is blocked by lesions, this results in a stroke. In the limbs, the process of arterial narrowing will lead to ischemia, blocking of the vessel and finally to limb necrosis. The early phases of atherosclerosis are characterised by endothelial dysfunction. Many therapies have been investigated to assess the possibility to reverse the endothelial dysfunction, and to stimulate the formation of new blood vessels (angiogenesis) . It has recently been established that Nitric Oxide (NO) plays an important role in this process. Vascular endothelial dysfunction is characterised by the reduced release of NO in the arterial wall, which may cause a decrease in the blood flow in the arteries. Either process can lead to critical ischemia in the tissue drained by the affected vessel. Patients suffering from the consequences endothelial dysfunction could benefit from therapies to increase new collateral blood vessel formation. It is known that angiogenesis is mediated by a multitude of cytokines (like TNF-α and E-selectin) and angiogenic factors including bFGF (basic Fibroblast Growth Factor) , VEGF (Vascular Endothelial Growth Factor) , and TGF- β. Both bFGF and VEGF are key regulators of angiogenesis in adult tissues. They selectively stimulate proliferation of endothelial cells, starting with the binding of these growth factors to receptors present on the endothelial cell surface. Nitric oxide (NO) has been shown to play a role in this process. NO, originally identified as endothelium-derived relaxing factor, is an important endothelial vasoactive factor. While both NO and angiogenic factors like bFGF and VEGF play a key role in the endothelial functions, their precise mode of action is not known. On the one hand, levels of angiogenic factors like bFGF and VEGF are increased in patients suffering from endothelial dysfunction. On the other hand, the release of nitric oxide in dysfunctional vascular endothelium is often reduced. This reduced release may cause constriction of the coronary arteries and thus contribute to heart disease. It is postulated that patients suffering from endothelial dysfunction could benefit from therapies to increase new collateral blood vessel formation and/or therapies to increase vasodilation. Many experimental gene therapies concentrate on the stimulation of angiogenesis, in patients suffering from endothelial dysfunction, through the addition of VGEF or bFGF. Though these experimental therapies may have some effect, the level of therapy induced angiogenesis is low, leading to a slow, if at all, recovery or enhancement of blood flow. It has been demonstrated that NO is involved in VEGF- mediated proliferation of endothelial cells. Exposure of endothelial cells to VEGF was shown to lead to the activation of constitutive NO synthase (ceNOS, also called eNOS or NOSIII) and the release of biologically active NO. The proliferation of cells by VEGF can be inhibited by specific NOS-inhibitors like L-NAME, indicating that NO is an essential mediator in the VEGF- induced cell proliferation and angiogenesis . Likewise, the presence of bFGF can increase ceNOS protein levels and enzyme activity during healing of rat gastric ulcers. Here also, the healing was inhibited specifically by the NOS-inhibitor L-NAME. In transgenic mouse models, disruption of the endogenous ceNOS gene impaired angiogenesis (Murohara et al . ) . This could not be compensated by the administration of VEGF, showing the essential role for NO in growth factor mediated angiogenesis. The art teaches that a decreased NO synthesis in endothelial cells may limit new blood vessel formation in patients with endothelial dysfunction. It has been suggested that oral L-arginine supplementation in the diet may be a therapeutic strategy to improve angiogenesis in patients with endothelial dysfunction. Recent data in animal studies show that activation of the NO-pathway may actually lead to a regression of the pre-existing intimal lesions in atherosclerosis . SUMMARY OF THE INVENTION It is an object of the present invention to provide a gene therapy for local administration of NO in blood vessels and surrounding tissues. It is also an object of the invention to induce angiogenesis in patients with endothelial dysfunction and to provide gene therapy methods for the treatment of atherosclerosis. It has been found that vectors expressing at least a gene encoding Nitric Oxide Synthase (NOS) , either alone or in combination with genes encoding angiogenic factors, can be used to transfect cells in ischemic areas to enhance angiogenesis in limbs, and thus restore blood flow. The synthesis of NO is regulated by a family of isozymes. Three isoforms are known: nNOS, ceNOS and iNOS . Both nNOS and ceNOS are constitutively expressed and tightly regulated by calmodulin, whereas iNOS is induced by the action of cytokines . In the context of the present invention, the term Nitric Oxide Synthase (NOS) is intended to encompass all members of the mentioned isozyme family. In one aspect the invention provides a method for increasing NO and/or endothelial growth factors such as, but not limited to, VGEF and/or bFGF. In another aspect the invention provides a method for increasing vasodilation of blood vessels. In yet another aspect, the invention provides a method for increasing angiogenesis through locally delivering an expression vector, preferably an adenovirus vector, comprising at least a nucleic acid encoding NOS, to sites selected for being provided with the capacity to induce, or at least in part promote, angiogenesis. Preferably, the delivery transpires through isolated tissue perfusion. BRIEF DESCRIPTION OF THE DRAWINGS Figure 1: Schematic representation of the adapter plasmid pAd5/CLIP. Figure 2: Schematic representation of the adapter plasmid Pad5/L420-HSApac. Figure 3 : Schematic representation of the adapter plasmid pAdApt . Figure 4 : Schematic representation of the adapter plasmid PAdApt-ceNOS . Figure 5 : Relative bloodflow after isolated limb perfusion in rat hindlimb after occlusion of the artery and vena femoralis. Animals were treated with either isolated limb perfusion alone or isolated limb perfusion and delivery of 5xl0 9 Ad. CLIP. ceNOS infectious adenoviral particles. Blood flow was determined by Laser Doppler measurement of both footsoles. Using these measurements, the relative bloodflow was calculated by dividing the amount of bloodflow in the treated legs by the bloodflow of the untreated leg. Measurements were performed directly before and after the procedure and from thereon every 3-4 days until the relative bloodflow returned approximately to 1. Figure 6. Nucleotide sequence of cloned NOS cDNAs DETAILED DESCRIPTION OF THE INVENTION The present invention discloses the delivery of gene therapy vectors to a mammal carrying at least a NOS gene for use in enhancing vascularisation/blood flow in stenosed limbs after isolated limb perfusion (ILP) . Because in most applications of the invention said mammal is a human, it is in most applications of the invention preferred that said nucleic acid molecule is a functional derivative from or includes at least a functional fragment of a nucleic acid molecule isolated from a human. The terms "functional derivative" and "functional fragment" are used here to indicate that said nucleic acid molecule encodes a peptide molecule with the same biological activity in kind, but not necessarily in amount, as said NOS. Three different isoforms of NOS have been identified. Two constitutively expressed isoforms are known, nNOS or NOSI, present in brain (Nakane et al . , 1993) and ceNOS or NOSIII, present in endothelial cells, (Janssens et al . , 1992) . Both isofroms are dependent on calmodulin and Ca2+ for their activity. The third isoform (iNOS or NOSII, see Geller et al . , 1993) is Ca2+ independent, and its gene is induced by inflammation, microbial products and cytokines . Many cDNAs have been cloned and sequenced from different species and different tissues (see also figure 2) . The isoforms share 50- 60% sequence homology (For a recent review see Hobbs et al . , 1999) . In gene therapy a molecule carrying genetic information is introduced in some or all cells of a host, whereby the genetic information is added to the host in a functional format . For the purpose of gene therapy, nucleic acid delivery vehicles are commonly used to introduced foreign genetic information into target cells. Suitable nucleic acid delivery vehicles for the present invention are those nucleic acid delivery vehicles capable of delivering nucleic acid to cells in vivo . Non-limiting examples of such nucleic acid delivery vehicles are viral vectors, non-viral nucleic acid delivery vehicles and hybrids of viral and non-viral vehicles. Non-limiting examples of suitable viral vectors are adenovirus vectors, adeno-associated virus vectors and retroviral vectors. Non-limiting examples of non-viral nucleic acid delivery vehicles are liposomes, polyphosphazenes etc. In hybrid systems elements from viruses such as nucleic acid and/or proteins or parts thereof are incorporated into non-viral nucleic acid delivery vehicles to render the latter more effective. Gene-transfer vectors derived from adenoviruses receive a lot of attention in the field of gene therapy. Adenoviruses are convenient viruses for construction of vectors for gene therapy, because of their high efficacy compared to other systems to deliver DNA in most mammalian cell types. Vectors derived from human adenoviruses, in which at least the El region has been deleted and replaced by a gene-of-interest , have been used extensively for gene therapy experiments in the pre-clinical and clinical phase. There are several ways to administer recombinant adenovirus vectors. The recombinant virus can be injected intramuscularly, or be administered through a subcutaneous or a intravenous injection. These methods of administration have a disadvantage that leakage of the vector from the site of injection into the blood system leading to a diffuse uptake in other organs, especially the liver. Systemic delivery of adenovirus vectors has been hampered by the fact that this results mainly in uptake of the vectors by the liver [see: Connely S et al . , "High level tissue specific expression of functional human factor VIII in mice", Human Gene Ther. 7(2) .183-195 (1996); Herz J, Gerard, RD "Adenovirus mediated transfer of low density lipoprotein receptor gene acutely accelerates cholesterol clearance in normal mice", Proc. Natl . Acad. Sci. USA 90:2812-2816 (1993)] . Other organs are not or only minimally transduced by the adenovirus vectors . The invention discloses the administration of a nucleic acid delivery vehicle without systemic delivery. Herein, an improved way of accessing ischemic areas in the limbs is provided, by delivering the vectors directly via the bloodstream. In accordance with the invention it is achieved that NO production in the endothelium is increased, thereby removing a cause for endothelial dysfunction. Preferably, said nucleic acid delivery vehicle comprises a virus-like particle. Preferably said virus-like particle is an adenovirus particle, an adeno-associated virus particle and/or a retrovirus particle. In one embodiment of the invention, adenoviral vectors are employed to deliver these genes. In a further embodiment of the present invention, adenoviral vectors are provided that lack the early genes El and E2A. The recombinant adenoviral vectors according to the invention may be derived from any wild-type adenovirus serotype that f CQ MH 4-1 00 β -H MH β 0 • - β o -i 0) 0 -rl rH TJ o J β P MH φ fO o tβ rrj xi 4 CQ β rH rH TJ o Φ 4-1 • rl (0 rH o φ Xl β . o rt s -H CD TJ Φ -H 4-> <0 rH β φ 4-> > •- υ XI ft XI -rl β o -l • rl r-i φ Φ φ U CQ CQ N ε Φ 0 CQ J -rl φ X! β 4-> tO ^ υ -H S 13 -. to ε Φ (0 β CQ i-H o -d O t> 4- ) -Q r-i tO φ M ^ CQ 0 X! 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Other examples of vectors and packaging systems useful in the invention include, but are not limited to, those given in patent applications WO 93/19191, WO 94/28152, WO 96/10642, and WO 97/04119. The invention provides means and methods for isolated tissue perfusion, preferably isolated limb perfusion (ILP) , in which the blood circulation of the limb is isolated from the circulation of the body. The circulation through the limb is maintained by a pump. We have perfused the limb with an El deleted recombinant adenovirus vector harbouring a human ceNOS gene. Thus in a preferred embodiment the invention provides a systemic treatment which includes isolated tissue perfusion. Tissue perfusion is intended to read on isolated tissues as well as organs and/or extremities or any combination thereof. Two approaches of isolated perfusion are provided, one in which cells in the isolated perfunded tissue are target cells for the delivery of nucleic acid and one in which the target cells for the delivery of nucleic acid are not in the isolated perfunded tissue. Organs or body parts which are liable to be damaged by the treatment or which are likely to influence the uptake of virus by the target cells or which need to be isolated for a different reason can be excluded from the system to which the adenoviral vector encoding NOS activity is provided. For instance, liver delivery is for some applications not preferred. For instance with the current thymidine kinase suicide approaches it is better to avoid any possibility of toxicity for liver cells, since there are indications in mice that this organ is more sensitive for the cell killing effects of the treatment than other tissues. In the other isolated perfusion route the vector is delivered to the isolated part only. In one embodiment delivery of nucleic acid through isolated tissue perfusion of the heart is provided. In another embodiment, delivery of nucleic acid through isolated tissue perfusion of the liver is provided. Said organs may be isolated for the normal circulation and perfunded through methods known in the art and can be combined with the means and methods of the invention to improve delivery of the nucleic acid of interest. It is preferred to deliver the vector in the form of a virus-like particle. This means that the vector is packed in an virus shell, preferably an adenovirus shell, an adeno-associated virus shell or a retrovirus shell. The present invention furthermore provides a pharmaceutical composition that comprises the nucleic acid delivery vehicle defined supra in combination with a diluent that is not toxic to the recipient mammal at the dosage used and that retains sufficient stability of the infectivity of said nucleic acid delivery vehicle for a time long enough to allow uptake of said nucleic acid delivery vehicle into the muscle cells and/or endothelial cells after administration of said composition to the circulation of the recipient mammal. Preferably, said nucleic acid delivery vehicle comprises an adenovirus vector. A typical non-limiting example of a diluent according to this aspect of the invention is an isotonic saline solution that is sterile and that is buffered at a physiological pH. Preferably, said diluent furthermore contains serum-substituting ingredients. In the examples given infra to illustrate the present invention Haemaccel (Behring Pharma) is used as a suitable diluent. It is to be understood, however, that those skilled in the art will be able to apply other diluents without departing from the invention. For some applications of the invention it is furthermore preferred that said pharmaceutical composition is oxygenated prior to administration. Optionally, said nucleic acid delivery vehicle (the recombinant adenoviral vector and/or virus) is prepared in lyophilized form. In the latter case, said nucleic acid delivery vehicle is suspended in solution to obtain said pharmaceutical composition before administering said pharmaceutical composition to the circulation of the recipient mammal. Typically, a pharmaceutical composition comprising one dose of the virus-like particle defined supra, contains at least about 10 s , preferably about 10 8 infectious units (iu) of the virus-like particle of the invention, but in certain conditions it is preferred that it 9 10 contains at least about 10 , more preferred 10 , or even more preferred 10 iu. The amount of virus to be provided depends on many parameters. As disclosed herein only a very limited portion of the administered virus actually infects the target cells. This may be one reason to increase the amount of virus to be administered. Another important aspect is of course the amount of NOS activity expressed by a cell infected with one or more viruses. This of course depends on the cell, but also on the promoter that drives the expression and its interaction with cell components of the expression machinery, etc. In another aspect, the invention provides a method to deliver said nucleic acid molecule that encodes NOS to smooth muscle cells and/or endothelial cells in the body of a mammal, whereby the adenoviral vector or pharmaceutical composition defined supra is administered to a site in the circulation of said mammal . Said circulation is meant to include both the blood circulation and the lymphatic circulation. Thus, the administration is performed to any site in the body of the recipient mammal where the blood or lymph fluids of said mammal pass . To more accurately restore blood flow, administrations of said nucleic acid delivery vehicle are preferably performed in conducting-arteria (intra-arterial or intravenous) , where it is further preferred that said administration is into an artery located upstream of the ischemic area. Preferably, rather than expanding the capillary vessel network, novel conducting vessels are generated. Typically occlusion occur in the conducting vessels, therefore typically expanding the < Φ Φ φ 4J 00 4-1 - ε Φ TJ β φ o X! 0 -H o CJ Φ . rl xi Φ -rl O 4-1 <φ 4-> 4-1 Φ Cn β O TJ 4-1 (0 TJ 10 MH a Φ -. o r? s X! rl J r-i CQ o MH o H • -rl MH -H O CQ rl o tO β β . β -i CQ o CQ MH Φ rH Φ 0) rl . tO β ε CQ rH rH rl -H 4-> CJ rH r-i -H 1 Φ > rH XI β φ β CQ φ xi -rl tO φ TJ β 4-1 -rl Φ Φ r-i 4-1 -H fO . 4-1 - £ ( 0 ft 0 X! 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O s ε β 4-1 0 -rl β 0 φ CQ TJ 4-1 XI XI U •rl Φ ! > Φ β rl TJ rl -rl φ 4-1 φ -rl tO rt MH • H -H (0 CQ -H 4-1 β β «. β 4-1 Φ -rl X r-i TJ TJ β • H > o φ -rl O 10 4J β 4-1 O rl β 4-> Φ 4-1 MH MH Φ β 0 β β (0 β rH o υ φ φ 0 O rH -H ft 10 CQ 10 O cr -H Xl MH Φ J -H EH φ -rl -H O rl ft 0 fa -rl ( 0 J Φ CQ rl X! -rl £ Φ Cn 4-1 CQ rl rl 4J -H CQ CD SH ft SH CQ u ϋ CQ Φ Φ -rl ε CJ CQ τJ υ β SH CQ 4-1 4J TJ β ( 0 O φ » β O β Φ -rl O . • l Φ O CQ ft TJ 4-1 • β • H • rl Φ -rl SH 4-1 MH 4-1 β β xl ft TJ J ε Φ fd (0 & 0 & β > ft Q> -H J o β 0 r-i rl MH £ rH β Φ 4-1 Φ 0 Φ r- O O CJ ε rl -rl ε O Φ CQ ε TJ 4 β M r*ι 0 0 Φ fO 4J xl φ β X! U β CQ X! XI -rl φ 0 Xl CO ( 0 TJ 0 -H TJ O Φ -rl β β tO 1 • H rH β ε • H 4-1 SH J r-i EH β φ 4-1 tO CO 4- Φ . T2 Φ 1 4 J 4J -H CQ φ J 4-1 Φ u 4-1 ( 0 X) MH in CO r-i -rl -H I-5 0 ft r- SH J D tO β tO β 10 CQ 10 β tϋ Xl 4-1 0 r-i -H CO • β Φ o ϋ φ MH rl ( 0 r-i rl β 4-> 0 r-i rH & XI fO CQ CQ 4-1 r-i rt -. MH X) J ft ( 0 CQ 5 0 TJ ε ε Φ ( 0 J Φ 0 J Φ ε MH β 4-1 (0 O 0 tO r-i tO β (0 TJ CQ TJ 10 rH rl • fO fO φ -H CQ CQ CJ -H o CO SH -H φ X! υ J U a β u TJ β Φ ε φ φ Cn ε CQ O 4-1 SH > r-i rH β rl -rl • H -H β 4-1 4-1 -rl rl 0 -H •rl fO 4J -i 4-) ft β Φ β ft MH 0 ( 0 0 - ft TJ β 4-1 O tO tO 4-1 -rl ( 0 4-1 tO β ( 0 CQ tO -H tn ε o TJ IH Φ 4J Φ rl -rl φ Φ -rl β β -rl rl TJ β ϋ D β CQ β β -rl CJ CO β fa 0 rH Φ CQ 00 TJ MH Φ 4J CD • rH ε O Φ 4-> 4-1 φ Cn Φ CD β Φ -rl • H r-i φ - εH • H β β J X) XI CO XI ( 0 0 Φ Φ > ( 0 β 4J r-i TJ -rl CJ (0 CQ rl β J MH β -rl u - r-i -H rl O ( 0 CQ 10 r-i -H rl -rl tO O -rl TJ tO CQ ε ε Φ 4-1 X X r-i β ( 0 4-1 Φ r> r- 0 r-i rl φ X! φ o 0 >ι φ rl SH * . 5 r-i r-i υ ft CQ β rl ( 0 rl β ε β β Φ 4-1 ε CQ β ε β rH O 4-1 J MH rl J -rl MH 10 SH 4-1 β φ rl ( 0 ε β Xi 4-1 Φ β 4-1 . © - l XI • rl CJ 4-1 T ε σ> O ( 0 ft fO rl 4-1 MH MH CQ CD 0 ft X! Φ Φ rl CQ φ β -rl rl tO rl ε φ Φ tO rl ft td ε 1 TJ rl ft 4-1 tO 10 Φ rl ( 0 β Φ X! rl -H X! 0 tO Φ Xl -rl TJ rl X! ( 0 φ xi β o in β fO id β rl φ xl rl CQ -rl Φ J 0 > 4-1 fO ϋ tO 4-1 CJ ft ft ϋ ( 0 ft CJ ft ft XI TJ ft XI oo rH φ ft tO (0 XI 4-1 ft -rl MH pharmaceutical composition only) before said pharmaceutical composition is administered. Optionally, the blood that is washed away is collected and readministered at the end of the procedure. The perfusion liquid can be oxygenated if needed. Essentially washing the blood from the closed circuit, allows at least in part removal of antibodies that may affect the transduction procedure. Such may be the cases when the blood contains or is suspected of containing, neutralizing antibodies against the nucleic acid delivery vehicle. Surgical techniques for perfusion of parts of the circulation according to the present invention are under development and are already available for various specific parts of the circulation, such as, e.g., the liver (Fraker, DL et al . , Circulatory shock, 44, p.45-50, 1994), the lung (Progrebniak HW et al . , Ann. Thorac . Surg.,57, p.1477-83, 1994), and the kidney (Veen van de AH et al . , Eur. J. Surg. Oncol. 20, p.404-405, 1994). A typical non-limiting example of a routine perfusion technique useful in the invention is isolated limb perfusion (ILP) , where a closed circuit is created between the femoral artery and the femoral vein. Alternatively, essentially the same perfusion techniques can be employed in the invention to exclude the delivery of said nucleic acid molecule to a part or parts of the circulation. In this aspect of the invention, the part or parts of the circulation to which said delivery is unwanted are perfused with a diluent according to the invention while said pharmaceutical composition is administered to the circulation systemically (hence, outside the perfusion circulation) . An important example of this embodiment of the invention is exclusion of the liver circulation from delivery of said nucleic acid molecule. The invention will now be elucidated by the following, non-restrictive examples. EXAMPLES Example 1 Plasmid-based system for rapid RCA-free generation of recombinant adenoviral vectors A. Construction of adenovirus clones pBr/Ad.Bam-rlTR (ECACC deposit P970821212 In order to facilitate blunt end cloning of the ITR sequences, wild-type human adenovirus type 5 (Ad5) DNA was treated with Klenow enzyme in the presence of excess dNTPs. After inactivation of the Klenow enzyme and purification by phenol/chloroform extraction followed by ethanol precipitation, the DNA was digested with BairiΑI . This DNA preparation was used without further purification in a ligation reaction with pBr322 derived vector DNA prepared as follows: pBr322 DNA was digested with EσoRV and BamHI , dephosphorylated by treatment with TSAP enzyme (Life Technologies) and purified on LNP agarose gel (SeaPlaque GTG) . After transformation into competent E. coli DH5α (Life Techn.) and analysis of ampicillin resistant colonies, one clone was selected that showed a digestion pattern as expected for an insert extending from the BamHI site in Ad5 to the right ITR. Sequence analysis of the cloning border at the right ITR revealed that the most 3 ' G residue of the ITR was missing, the remainder of the ITR was found to be correct. Said missing G residue is complemented by the other ITR during replication. pBr/Ad.Cla-Bam (ECACC deposit P97082117) wt Adeno type 5 DNA was digested with Clal and BamHI, and the 20.6 kb fragment was isolated from gel by electro- elution. pBr322 was digested with the same enzymes and purified from agarose gel by Geneclean. Both fragments were ligated and transformed into competent DH5α. The resulting clone pBr/Ad.Cla-Bam was analyzed by restriction enzyme digestion and shown to contain an insert with adenovirus sequences from bp 919 to 21566. pBr/Ad.Afll-Bam (ECACC deposit P97082114) Clone pBr/Ad.Cla-Bam was linearized with EcoRI (in pBr322) and partially digested with Aflll. After heat inactivation of Aflll for 20 minutes at 65°C, the fragment ends were filled in with Klenow enzyme. The DNA was then ligated to a blunt double stranded oligo linker containing a Pad site (5 ' -AATTGTCTTAATTAACCGCTTAA-3 ' ) . This linker was made by annealing the following two oligonucleotides : 5'- AATTGTCTTAATTAACCGC-3 ' and 5 ' -AATTGCGGTTAATTAAGAC-3 ' , followed by blunting with Klenow enzyme. After precipitation of the ligated DNA to change buffer, the ligations were digested with an excess Pad enzyme to remove concatameres of the oligo. The 22016 bp partial fragment containing Ad5 sequences from bp 3534 up to 21566 and the vector sequences, was isolated in LMP agarose (SeaPlaque GTG) , religated and transformed into competent DH5α. One clone that was found to contain the Pad site and that had retained the large adeno fragment was selected and sequenced at the 5 ' end to verify correct insertion of the Pad linker in the (lost) Aflll site. pBr/Ad.Bam-rITRpac#2 (ECACC deposit P97082120) and pBr/Ad.Bam-rITR#8 (ECACC deposit P97082121) To allow insertion of a Pad site near the ITR of Ad5 in clone pBr/Ad.Bam-rlTR about 190 nucleotides were removed between the Clal site in the pBr322 backbone and the start of the ITR sequences. This was done as follows: pBr/Ad.Bam-rlTR was digested with Clal and treated with nuclease Bal31 for varying lengths of time (2 1 , 5', 10' and 15') . The extent of nucleotide removal was followed by separate reactions on pBr322 DNA (also digested at the Clal site) , using identical buffers and conditions. Bal31 enzyme was inactivated by incubation at 75°C for 10 minutes, the DNA was precipitated and resuspended in a smaller volume TE buffer. To ensure blunt ends, DNAs were further treated with T4 DNA polymerase in the presence of excess dNTPs. After digestion of the (control) pBr322 DNA with Sail, satisfactory degradation (~150 bp) was observed in the samples treated for 10 minutes or 15 minutes. The 10 minutes or 15 minutes treated pBr/Ad.Bam-rlTR samples were then ligated to the above described blunted Pad linkers (see pBr/Ad.Aflll-Bam) . Ligations were purified by precipitation, digested with excess Pad and separated from the linkers on an LMP agarose gel. After religation, DNAs were transformed into competent DH5a and colonies analyzed. Ten clones were selected that showed a deletion of approximately the desired length and these were further analyzed by T-track sequencing (T7 sequencing kit, Pharmacia Biotech) . Two clones were found with the Pad linker inserted just downstream of the RITR. After digestion with Pad , clone #2 has 28 bp and clone #8 has 27 bp attached to the ITR. pWE/Ad.Aflll-rlTR (ECACC deposit P97082116) Cosmid vector pWE15 (Clontech) was used to clone larger Ad5 inserts. First, a linker containing a unique Pad site was inserted in the EcoRI sites of pWE15 creating pWE.pac. To this end, the double stranded Pad oligo as described for pBr/Ad.Aflll-BamHI was used but now with its EcoRI protruding ends. The following fragments were then isolated by electro-elution from agarose gel:pWE.pac digested with Pad , pBr/AfIll-Bam digested with Pad and BamHI and pBr/Ad.Bam-rITR#2 digested with BamHI and Pad . These fragments were listed together and packaged using λ phage packaging extracts (Stratagene) according to the manufacturer's protocol. After infection into host bacteria, colonies were grown on plates and analyzed for presence of the complete insert. pWE/Ad. flll-rITR contains all adenovirus type 5 sequences, from bp 3534 (Aflll site) up to and including the right ITR (missing the most 3 ' G residue) . B. Construction of new adapter plasmids Generation of adapter plasmid pAd/L420-HSApac The absence of sequence overlap between the recombinant adenovirus and El sequences in the packaging cell line is essential for safe, RCA-free generation and propagation of new recombinant viruses. The adapter plasmid pMLPI.TK (described in WO 97/00326) is an example of an adapter plasmid designed for use in combination with improved packaging cell lines like PER.C6 (described in WO 97/00326 and US 08/892,873) . This plasmid was used as the starting material to make new adapter plasmids in which nucleic acid molecules comprising specific promoter and gene sequences can be easily exchanged. First, a PCR fragment was generated from pZipΔMo+PyFlOl (N ~ ) template DNA (described in PCT/NL96/00195) with the following primers: LTR-1: 5 ' -CTG TAC GTA CCA GTG CAC TGG CCT AGG CAT GGA AAA ATA CAT AAC TG-3 ' and LTR-2 : 5 ' -GCG GAT CCT TCG AAC CAT GGT AAG CTT GGT ACC GCT AGC GTT AAC CGG GCG ACT CAG TCA ATC G-3 ' . Pwo DNA polymerase (Boehringer Mannheim) was used according to manufacturers protocol with the following temperature cycles: once 5' at 95°C; 3' at 55°C; and 1' at 72°C, and 30 cycles of 1' at 95°C, 1' at 60°C, 1' at 72°C, followed by once 10' at 72°C. The PCR product was then digested with BamHI and ligated into pMLPIO (Levrero et al . , 1991) vector digested with PvuII and BamHI, thereby generating vector pLTRlO. This vector contains adenoviral sequences from bp 1 up to bp 454 followed by a promoter consisting of a part of the Mo-MuLV LTR having its wild-type enhancer sequences replaced by the enhancer from a mutant polyoma virus (PyFlOl) . The promoter fragment was designated L420. Next, the coding region of the murine HSA gene was inserted. pLTRlO was digested with BstBI followed by Klenow resulting in a linker with a Sail site and EcoRI overhang. The linker was ligated to the partially digested pAd5/Clip vector and clones were selected that had- the linker inserted in the EcoRI site 23 bp upstream of the left adenovirus ITR in pAd5/Clip resulting in pAd5/Clipsal . The vector pAd5/L420-HSA was then modified to create a Sail or Pad site upstream of the left ITR. Hereto pAd5/L420-HSA was digested with EcoRI and ligated to a Pad linker (5'- AATTGTCTTAATTAACCGCTTAA-3 ' ) . The ligation mixture was digested with Pad and religated after isolation of the linear DNA from agarose gel to remove concatamerised linkers. This resulted in adapter plasmid pAd5/L420-HSApac (Figure 2) . Generation of adapter plasmids pAdMire and pAdApt To create an adapter plasmid that only contains a polylinker sequence and no promoter or polyA sequences, pAd5/L420-HSApac was digested with Avrll and Bglll. The vector fragment was ligated to a linker oligonucleotide digested with the same restriction enzymes. The linker was made by annealing oligos of the following sequence: PLL-1: 5'- GCC ATC CCT AGG AAG CTT GGT ACC GGT GAA TTC GCT AGC GTT AAC GGA TCC TCT AGA CGA GAT CTG G-3 ' and PLL-2: 5'- CCA GAT CTC GTC TAG AGG ATC CGT TAA CGC TAG CGA ATT CAC CGG TAC CAA GCT TCC TAG GGA TGG C-3 ' . The annealed linkers were digested with Avrll and Bglll and separated from small ends by column purification (Qiaquick nucleotide removal kit) according to manufacterers recommendations. The linker was then ligated to the Avrll/Bglll digested pAd5/L420-HSApac fragment. A clone, named pAdMire, was selected that had the linker incorporated and was sequenced to check the integrity of the insert . Adapter plasmid pAdMire enables easy insertion of complete expression cassettes. An adapter plasmid containing the human CMV promoter that mediates high expression levels in human cells was constructed as follows: pAd5/L420-HSApac was digested with r * ι S • <or o 9 o O J g CJ <-, ™ N 00 « O o o The ceNOS sequence was removed from pAd5/Clip-ceNOS by digestion with HindiII and Xbal and the 3.7 kb ceNOS fragment was isolated from gel using the GeneClean spinkit (BiolOl Inc.) according to the manufacterers instructions. Adapter plasmid pAdApt was also digested with Hindlll and Xbal and the linear fragment was isolated as described above. Both fragments were ligated resulting in pAdApt-ceNOS (Figure 4) . The recombinant adenoviruses IGAdApt and IGAdApt-ceNOS were generated using the above described adapter plasmids and the adenovirus cosmid clone pWE/Ad.Aflll-rlTR. C. Generation of recombinant adenoviruses El-deleted recombinant adenoviruses To generate El deleted recombinant adenoviruses with the new plasmid-based system, the following constructs were prepared: an adapter construct containing the expression cassette with the gene of interest linearized with a restriction enzyme that cuts at the 3' side of the overlapping adenoviral genome fragment, preferably not containing any pBr322 vector sequences; and a complementing adenoviral genome construct pWE/Ad.Aflll-rITR digested with Pad . These two DNA molecules are further purified by phenol/chloroforme and ETOH precipitation. Co-transfection of these plasmids into an adenovirus packaging cell line, preferably a cell line as PER.C6 or derivative thereof, generates recombinant replication deficient adenoviruses by a one-step homologous recombination between the adapter and the complementing construct. Recombinant adenovirus can be produced following introduction of said plasmids in said cell. It is to be understood that those skilled in the art may use other combinations of adapter and complementing plasmids without departing from the present invention. r* 00 © © o o J 5 H υ P. N 00 © o O inguinal ligament the femoral and vein were approached and cannulated with silastic tubing (0.30 mm ID, 0.64 mm OD; 0.64 mm, 1.19 OD, respectively, Degania Silicone, Degania Bet, Israel) . Collaterals were temporarily occluded by the application of a tourniquet around the groin, which was fixed to the inguinal ligament. An oxygenation reservoir and a roller pump (Masterflex) , were included in the vascularly isolated circuit, which was, initially, perfused with haemaccel (Behring Pharma, Amsterdam, The Netherlands) for 3 minutes at a flow speed of 2 ml/min to wash out the blood. After the first wash out step, recirculation was performed with recombinant adenoviruses (50 μl-1 ml) dissolved in 2.5- 3.5 ml Haemaccel at the same flow rate for a time period of 15 minutes. Followed by a second perfusion step of 5 minutes to wash out the non-bound virus with Haemaccel. During the perfusion and recirculation steps the rat hind leg was kept at a constant temperature of 37-39°, a warm water mattress was applied around the leg. After the second wash-out step, the vascularly isolated circuit was discontinued and, after cannule removal, the femoral vessels were ligated. Previous experiments have shown that the collateral circulation via the internal iliac artery to the leg is so extensive that ligation of the femoral vessels can be performed without detrimental effects. Revascularization studies (NB : pre-treatment with haemacell to remove IGG) Revascularisation was determined by measuring the blood flow in the legs by using a Laser Doppler apparatus. Rats were used as an animal model, since rats have shown to be suitable for adenoviral vector testing. Rats were anaesthetized by using hypnorm. The blood flow in both hind limbs (the treated right and non-treated left leg) was measured by using a Laser Doppler apparatus according to the standard manufacturers protocol. Directly after ILP treatment the blood flow in the hind legs was determined again by using the Laser Doppler apparatus . Until day 30 after treatment every 3 or 4 days the blood flow in the hind limbs was measured by using the Laser Doppler apparatus . The method of isolated limb perfusion is used to deliver the recombinant adenoviral vectors since it has been shown in previous experiments to be able to deliver adenoviruses to the vasculature of the leg (see also figure 5) . Furthermore ILP is a good model to study revascularisation since the artery and vein used for virus delivery are disconnected from the blood circulation causing severe ischemia in the manipulated limb. CITED LITERATURE 1. Nakane M, Schmidt HH, Pollock JS, Forstermann U, Murad F FEBS Lett 1993 Jan 25; 316 (2) : 175-80 Cloned human brain nitric oxide synthase is highly expressed in skeletal muscle. 2. Janssens SP, Shimouchi A, Quertermous T, Bloch DB, Bloch KD J Biol Chem 1992 Jul 25 ;267 (21) : 14519-22 Cloning and expression of a cDNA encoding human endothelium-derived relaxing factor/nitric oxide synthase . 3. Geller DA, Lowenstein CJ, Shapiro RA, Nussler AK, Di Silvio M, Wang SC, Nakayama DK, Simmons RL, Snyder SH, Billiar TR Proc Natl Acad Sci U S A 1993 Apr 15; 90 (8) : 3491-5 Molecular cloning and expression of inducible nitric oxide synthase from human hepatocytes . 4. Hobbs AJ, Higgs A, Moncada S Annu Rev Pharmacol Toxicol 1999;39:191-220 Inhibition of nitric oxide synthase as a potential therapeutic target. 5. Kay, R. , Takei, F. , and Humphries, R.K. (1990). Expression cloning of a cDNA encoding Ml/69. J. Immunol . 145, 1952-1959. 6. Levrero, M. , Barban, V., Manteca, S., Ballay, A., Balsamo, C, Avantaggiata, M.L., Natoli, G. , Skellekens, H. , Tiollais, P., and Perricaudet, M. (1991). Defective and non-defective adenovirus vectors for expression foreign genes in vitro and in vivo. Gene 101, 195-202.

Claims: CLAIMS 1. Use of a nucleic acid delivery vehicle comprising a nucleic acid encoding NOS activity for the manufacture of a pharmaceutical composition for essentially isolated tissue perfusion treatment to enhance and/or induce angiogenesis. 2. Use according to claim 1, wherein the systemic treatment includes isolated limb perfusion. 3. Use according to claim 1 or 2, wherein said nucleic acid delivery vehicle comprises a virus-like particle. 4. Use according to claim 3, wherein the virus-like particle is an adenovirus particle, an adeno-associated virus particle or a retrovirus particle. 5. Means for enhancing and/or inducing angiogenesis comprising a pharmaceutical composition comprising NOS activity. 6. Means according to claim 5, wherein the NOS activity is provided by a recombinant adenoviral vector encoding said activity. 7. Means according to claim 5 or 6, wherein the pharmaceutical composition is a perfusion fluid. 8. Means according to claim 7, wherein the perfusion fluid comprises a virus-like particle comprising a recombinant adenoviral vector. 9. Means according to claim 8, wherein the virus-like particle is present in an amount of from about 10 6 to about 5.10 9 iu. 10. A pharmaceutical composition for enhancing and/or inducing angiogenesis comprising NOS activity provided by a nucleic acid delivery vehicle comprising nucleic acid encoding such activity, wherein said pharmaceutical composition is a perfusion fluid. 11. A pharmaceutical composition according to claim 10, wherein the nucleic acid delivery vehicle comprises a viruslike particle. 12. A pharmaceutical composition according to claim 10 or 11, wherein the virus-like particle is present in an amount of from about 10 6 to about 5.10 9 iu. 13. A pharmaceutical composition according to claims 10- 12, wherein the virus-like particle is an adenovirus particle, an adeno-associated virus particle and/or a retroviral particle. 14. A kit of parts for treatment to enhance and/or induce angiogenesis comprising a pharmaceutical composition according to claims 10-13, means for isolating certain tissues, and means for perfunding said isolated tissues.

Inventors: VERLINDEN STEFAN FREDERIK FRAN, VOGELS RONALD, VERLINDEN, STEFAN, FREDERIK, FRANCISCUS, VOGELS, RONALD
Applicants: INTROGENE BV, VERLINDEN STEFAN FREDERIK FRAN, VOGELS RONALD, INTROGENE B.V., VERLINDEN, STEFAN, FREDERIK, FRANCISCUS, VOGELS, RONALD
Application year: 2000
Main classification: A61K38
IPC codes: A61K38, A61K48