Breast cancer is known as the most common malignancy among female adults of various races and ages, and it is the second cause of cancer mortality (
1). According to numerous studies and observations, it has been stated that conventional therapies for breast cancer such as surgery, radiation, and chemotherapy have not decreased mortality rates (
2). Among subtypes of breast cancer, it is revealed that HER2-positive patients demonstrate worse prognosis and shorter survival. Therefore, HER2, an overexpressed surface receptor on breast cancer cells, is selected for targeted therapy, and over the years, the survival of HER2-positive patients has increased (
17). The first humanized monoclonal anti-HER2 antibody is trastuzumab (Herceptin). According to inquiries, it is declared that only 20% of patients with the overexpression of HER2 respond to trastuzumab. Although this drug improves HER2-positive patients’ condition and reduces metastasis, resistance to trastuzumab has been documented (
18). Nowadays, immunotoxin therapy has attracted great consideration for its specificity and effectiveness on cancer cells. Immunotoxins obtain their toxicity from a protein toxin and their specificity from an antibody (
3).
Nowadays, bioinformatics is changing biology and medicine (
19). In the current study, we employed in silico procedures to design a special bio-conjugate (immunotoxin), including HER2-specific scFv derived from trastuzumab and a functional segment of
Campylobacter jejuni cytolethal distending toxin (Cj-CdtB) for healing patients with breast cancer with increased HER2 receptors. Our immunotoxin design was similar to Sokolova et al.’s study in 2017. They utilize scFv fragment of the HER2-specific monoclonal antibody “trastuzumab” and PE40, which is a part of
Pseudomonas exotoxin A (PE) for constructing a toxic module. This chimeric protein was an efficient immunotoxin against HER2 positive breast cancer cells
in vitro and
in vivo. Their results confirmed the powerful anticancer potential of scFv-PE40 (
20).
At first, we created a scFv, using V
L and V
H of trastuzumab and attached these small segments of the antibody through a short peptide linker. In fact, the reason for scFv usage was its superior properties, including lower molecular weight, lower antigenicity, higher binding, and greater specificity compared to antibodies (
13). In fact, V
L and V
H were bound together by the GGGGSGGGGSGGGGS linker and constituted scFv. The length and amino acid composition of the peptide linker is important in maintaining the scFv structure and stability. Typically, due to its flexibility, the linker peptide is about 3.5 nm (35°A) in length and contains hydrophobic amino acids such as glycine and serine residues (
21). In order to create an efficient anticancer immunotoxin, the scFv was conjugated to Cj-CdtB, which is a subunit of the bacterial toxin obtained from
Campylobacter jejuni (
22). In order to create a linkage between scFv and Cj-CdtB, hydrophobic GGSGG amino acid was selected as the optimal flexible linker. Zhang et al. constructed two immunotoxins based on trastuzumab scFv and a cytotoxic drug DM1 called T-SA1-HAS-DM1 and T-SA2-HAS-DM1. T-SA1-HAS-DM1 showed potential anti-tumor activity and was distributed in xenograft models. Our immunotoxin design was similar to T-SA1-HSA. T-SA1-HAS consisted of V
L and V
H of trastuzumab, which was bound together by the GGGGSGGGGSGGGGS linker. Furthermore, the linker between scFv and HSA was GGSGG (
23). Recently, Goleij et al. designed an immunotoxin that contained a scFv, whose V
L and V
H were bound together by the GGGGSGGGGSGGGGS linker. Their results showed that this scFv was stable and could bind to HER2 effectively (
24). In accordance with this study, our scFv was also stable and docking of our immunotoxin and HER2 showed intense binding.
The efficiency of an immunotoxin is dependent on successful endocytosis, which is based on scFv and receptor interaction and internalization of the receptor-bound immunotoxin (
25). The immunotoxin-HER2 complex is internalized via receptor-mediated endocytosis. After internalization, the complex can be sorted in early endosomes or in multivesicular bodies. Finally, HER2 is recycled to the membrane and the immunotoxin can go to Golgi (
26). The cleavage of cytolethal distending toxin (CDT) is initiated by the furin protease of the Golgi system; then, it retrogrades to the endoplasmic reticulum (ER) and, ultimately, it is transported into the nucleus and leads to DNA damage (
27). In accordance with this pathway and based on the fact that furin is enriched in the Golgi complex and acts as a protease for protein cleavage, a furin protease recognition site (RGRR amino acid sequence) was inserted between the GGSGG linker and Cj-CdtB. It is predicted that when the scFv + Cj-CdtB chimeric protein enters the Golgi, furin recognizes this site and breaks the peptide linker, which results in the scFv and Cj-CdtB separation and the CdtB segment could reach the nucleus alone (
28). Weldon et al. designed immunotoxins based on Pseudomonas Exotoxin A that contained furin cleavage sites. Their study results showed the furin cleavage site is necessary for toxin activation in the Golgi apparatus and after scFv omission, the toxin can release to the cytoplasm (
29). In accordance with the mentioned study results, in our immunotoxin, when scFv cleaved by furin protease in Golgi, the toxin could be transferred to the ER and then to the nucleus.
In the current study, the GORV web server was employed for the prediction of both scFv and scFv + Cj-CdtB secondary structures. This server estimates the probable secondary structures of proteins by predicting the impact of amino acids on the situations and structure of the adjacent amino acids. The comparison between the secondary structures of scFv and fusion protein, when Cj-CdtB attaches to scFv via the short linkers, showed no changes in their secondary structures. Based on the analysis of physicochemical features, the instability index for the fusion protein was 38.15, demonstrating that the scFv + Cj-CdtB protein is stable and its supposed high aliphatic index is associated with protein stability across a wide range of temperatures (
30).
The I-TASSER web server was applied to create the 3D model of the scFv + Cj-CdtB recombinant protein based on the c-score. C-score is commonly within the range of -5 to +2, and more positivity signifies higher confidence of the model and vice versa (
31). Among the 5 proposed 3D models constructed using this server for the chimeric protein, the model with the highest c-score was selected for further analysis. After the model structure’s refinement, the evaluation of unrefined and refined models was performed, using RAMPAGE and PROCHECK. Ramachandran plot results showed favor of residues residence before and after the model refinement. As illustrated in RAMPAGE results, most residues are determined in the favor and most favor regions, and even the following refinement, the favorness increased, showing that the models improved in the bond angles and location of amino acids. These results were confirmed by PROCHECK as well (
Table 1).
The RNA Fold server was employed to predict mRNA secondary structures according to energy minimization. The data indicated that the free energy of the thermodynamic scFv + Cj-CdtB complex was -667.58 kcal/mol, indicating that the chimeric protein mRNA is stable. Since the chimeric construct contains a CdtB that is a part of a bacterial genotoxin, it may act as an allergen for the human body; therefore, the evaluation of its allergenicity potential is required. Allergenic elements elicit harsh responses from the immune system and may result in unfavorable allergenic effect morbidities (
32). AlgPred web server predicted that the fusion protein is not an allergen for the human body. Ligand-receptor docking was used to investigate whether trastuzumab-derived scFv could retain its binding capacity to HER2 receptor and convey Cj-CdtB to HER2-positive breast cancer cells. Molecular docking was performed, using the ZDOCK server. The ZDOCK server results showed that scFv + Cj-CdtB chimeric protein can bind to HER2 receptors with high affinity and specificity. The visualization outputs determined that the binding ability of scFv + Cj-CdtB to its receptor was adequate.
5.1. Conclusions
The results reflected that scFv + Cj-CdtB could be a stable and non-allergenic chimeric protein with a proper affinity for increased HER2 receptors on breast cancer cells. Thus, the scFv + Cj-CdtB construct could be considered a new immunotoxin candidate against HER2-positive breast cancer.