Gene Therapy (1998) 5, 828–834 1998 Stockton Press All rights reserved 0969-7128/98 $12.00 http://www.stockton-press.co.uk/gt Systemic long-term delivery of antibodies in immunocompetent animals using cellulose sulphate capsules containing antibody-producing cells ¨ ¨ M Pelegrin1, M Marin1, D Noel1, M Del Rio2, R Saller3, J Stange4, S Mitzner4, WH Gunzburg5 and M Piechaczyk1 ´ ´ ´ Institut de Genetique Moleculaire de Montpellier, UMR 5535/IFR 24, Montpellier; 2UMR 9921, UFR Sciences Pharmaceutiques et ¨ ¨ Biologiques, Montpellier, France; 3Bavarian Nordic, Munchen, Germany; 4Klinic fur Innere Medezin, Rostock, Germany; and 5 University of Veterinary Sciences, Vienna, Austria 1 Implantation of capsules containing antibody-producing cells into patients would potentially permit systemic longterm delivery of antibodies and might, thus, be useful in the development of surveillance treatments for cancers and severe viral diseases. We show that cellulose sulphate (CS) capsules containing hybridoma cells, when implanted subcutaneously or in the intraperitoneal cavity, can be used for delivering monoclonal antibodies into the bloodstream of immunocompetent mice for at least several months. In contrast to capsules implanted into the intraperitoneal cavity, which remain mobile and nonvascularized, capsules implanted under the skin form neo-organs which become vascularized within days. This may explain the higher blood concentration of the antibody we have observed in the latter case. Importantly, neither an isolating fibrosis nor an obvious inflammatory response was detected at the capsule implantation sites during observation periods as long as 10 months. Finally, no antiidiotypic immune response against the ectopically delivered antibody was shown to occur. This rules out any potent adjuvant effect of the cellulose sulphate matrix that might have stimulated a neutralizing humoral response. Taken together, our data indicate that encapsulation of antibody-producing cells into CS might be used in antibody-based gene/cell therapy approaches. Keywords: antibody delivery; anti-idiotypic response; capsules; hybridoma; cellulose sulphate matrix Introduction Provided that cytostatic or cytotoxic tumor-specific antibody genes are available, systemic delivery of antibodies by engineered cells grafted to patients may be highly valuable for long-term anti-cancer surveillance treatments to prevent relapse after a primary treatment such as surgery, chemo- or radiotherapy. Such an approach could also be used for treating severe viral diseases, such as AIDS, if virus-neutralizing antibodies or antibodies toxic for virus-producing cells are delivered. In addition, long-term systemic delivery of antibodies may also be useful for more fundamental purposes such as the development of new animal models of autoimmune diseases in which the humoral response contributes to the development of the illness (see Ref. 1). Yet another possible application could involve the development of a new cell ablation technique useful for studying in vivo various differentiation pathways and/or the biological importance of specific cell subsets. This could be achieved by the release into the blood stream of cytotoxic antibodies recognizing cell type-specific membrane markers; in this situ´ ´ ´ Correspondence: M Piechaczyk, Institut de Genetique Moleculaire de Montpellier, UMR 5535/IFR 24, 1919 route de Mende, 34293 Montpellier Cedex 05, France Received 21 October 1997; accepted 18 December 1997 ation, antibodies would kill target cells, for instance after a specific differentiation step, immediately following the appearance of cognate antigens at the cell surface. Using retroviral gene transfer, we have recently shown that several cell types (including skin fibroblasts, myogenic cells and hepatocytes), amenable to genetic modification and grafting to patients, can produce antibodies retaining the specificity and the affinity of the parental antibody.2 Furthermore, the grafting of engineered myogenic cells allows the systemic delivery of cloned antibodies in the mouse for at least several months. Although these observations lend support to the idea that engineering of patients’ cells may be useful for long-term antibody-based gene therapies,2 several issues potentially limit the application of such a technology in the clinic. First, such a therapeutic approach would be labour-intensive, time-consuming and costly given the present state of the technology. Second, stable genetic modification of patients’ cells currently utilizes ex vivo retroviral infection followed by autologous grafting in order to avoid rejection of non-MHC-matched cells by the immune system. This reduces the versatility of the approach since engineered cells from one individual cannot be used for another. Third, efficient gene transfer and long-term expression of transgenes in cells that can be used in gene therapy protocols are issues that have not yet been completely solved.3–6 Antibody production by encapsulated cells M Pelegrin et al In this context, implantation into patients of engineered cells encapsulated into immunoprotective devices7,8 may represent a more versatile and cost-effective approach. On the one hand, it should allow the same batch of nonMHC-matched cells (possibly selected in vitro for optimal antibody expression) to be used for several patients and, on the other, implantation of capsules is a simple surgical operation. In addition, such a technique would also offer the possibility of easy surgical removal of antibody-producing cells in case the treatment needed to be terminated. For optimal function, the capsule pores must meet two criteria. First, they must be large enough to permit both the exit of molecules of interest, such as antibodies, and the entry and diffusion of nutrients necessary for cell survival. Second, they must be small enough to prevent, on one hand, the encapsulated cells from leaving the capsules and, on the other hand, cells of the host immune system from entering the capsules. Several types of polymers, such as alginate,9 alginate–poly(l)lysine–alginate,8,10 various acrylic polymers11,12 and cellulose sulphate13 have already been used for encapsulating cells. The various matrices differ in their physical and mechanical properties. Cellulose sulphate (CS) capsules seem to offer several advantages over other capsule types. Particularly, their larger pore size allows the release of molecules as large as (or bigger than) antibodies.14 Moreover, they show excellent mechanical properties, conferring strength resistance important to withstand the mechanical stress of the implantation procedure as well as to ensure long-lifetime in vivo. Finally, the encapsulation technique is simple as compared with others,14 which is an important consideration for large-scale production. The aim of this study was to demonstrate the feasibility of the systemic delivery of antibodies in living animals by cells encapsulated in a CS matrix. Capsules containing a hybridoma cell line (Tg10) secreting a mouse monoclonal antibody (mAb) directed against human thyroglobulin, used as a model system, were implanted subcutaneously and intraperitoneally. Reasons for the choice of the Tg10 mAb included: (1) the availability of a sensitive ELISA for monitoring its concentration in blood samples;15,16 (2) the anti-idiotypic response which can be induced against it has previously been studied;17 and (3) the availability of the cDNAs encoding its heavy and light chains would allow further genetic modification of various cell types which can be used in gene/cell therapy protocols2 involving capsule implantation (see Discussion). Antibody production was detected for as long as 4 months after subcutaneous implantation of the encapsulated cells although this was accompanied by a steady decrease with time correlating with hybridoma cell death and not with capsule destruction, the latter remaining intact for at least 10 months in vivo. Importantly, no anti-idiotypic response against the Tg10 antibody was shown to occur. This rules out any potent adjuvant effect of cellulose sulphate that may have led to a humoral response against the Tg10 antibody. Taken together, our data suggest that this method is suitable for antibody-based gene therapy approaches directed against cancers and viral diseases. hybridoma cells or could affect antibody production. Encapsulated cells, placed in cell culture conditions, were counted at various time-points post-encapsulation after crushing of capsules. Cell viability was assessed using the trypan blue exclusion method. In parallel, Tg10 mAb production was assayed by ELISA. The main observations were as follows: (1) each capsule, the diameter of which varied from 0.5 to 2 mm with an average of 1 mm, contained a mean of 2 × 104 Tg10 cells at the moment of encapsulation; (2) the viability of encapsulated cells 4 days post-encapsulation was estimated to be at least 80%; (3) production of the Tg10 mAb was detectable over a period of 50 days (Figure 1); (4) an initial increase in antibody production lasting 10 days was observed and correlated with limited proliferation of Tg10 cells within capsules (which cannot exceed one or two rounds of division because of space limitations) (Figure 1); and (5) a marked drop in antibody production, which correlated with the onset of cell death, began between day 10 and day 20 (Figure 1). Taken together, our data indicate that the encapsulation process per se is not toxic for Tg10 cells. Rather, cell survival within the CS matrix seems favoured since Tg10 cells cultured in parallel under standard culture conditions but without passage died within 1–2 weeks. Results Figure 1 In vitro antibody production by CS-encapsulated Tg10 hybridoma cells. Twenty-five CS capsules containing Tg10 hybridoma cells (mean of 2 × 104 cells per capsule) were cultured as described in Materials and methods. The culture medium was replaced every 24 h, and Tg10 mAb production was determined by ELISA on the days indicated. Production of Tg10 is expressed in ng of antibody produced per capsule per 24 h using the purified Tg10 mAb as a standard. In vitro antibody production by Tg10 cells encapsulated into cellulose sulphate Our first aim was to determine whether the encapsulation process and the CS matrix could be toxic for Tg10 In vivo delivery of Tg10 mAb after implantation into mice of Tg10 cell-containing CS capsules We addressed whether systemic delivery of the Tg10 mAb could be achieved after implantation of capsules into mice. Both subcutaneous (abdominal zone) and intraperitoneal implantations were tested to determine which localization would allow better delivery of antibodies into the bloodstream. Three C3H mice (mice 1, 2 and 3) were implanted intraperitoneally with six capsules 829 Antibody production by encapsulated cells M Pelegrin et al 830 and one mouse (mouse 6) with 20 capsules (Figure 2a). Similarly, three mice (mice 7, 8 and 9) were implanted subcutaneously with six capsules and three mice (mice 10, 11 and 12) with 20 capsules (Figure 2b). Tg10 antibody concentration in the bloodstream was subsequently monitored by ELISA. Data presented in Figure 2 can be summarized as follows: antibody production (1) is directly correlated with the number of capsules implanted, (2) reaches a peak between the second and third week post-implantation, (3) is reproducibly higher when capsules are implanted subcutaneously since it can reach a value as high as 12.5 g/ml as compared with 2.5 g/ml in the case of intraperitoneal implantation, and (4) can be detected for as long as 4 months although Tg10 antibody concentration in the blood progressively dropped down to only several tens of ng/ml. Finally, the decrease in the concentration of Tg10 antibody in the serum seemed to be linked to progressive death of encapsulated cells and not just to antibody degradation after a short period of production since, on the one hand, mouse IgG1 half-life in vivo is approximately 4 days (Ref. 18 and our unpublished data), which is a shorter time than that required for disappearance of 50% of Tg10 in implanted mice, and, on the other, viability of encapsulated cells in capsules removed from mice 2 months after subcutaneous implantation was estimated to be 20–30%, which is a value that correlates with the reduction in antibody concentration. Follow-up of the vascularization of capsules Capsules implanted intraperitoneally and subcutaneously behave differently with regard to their vascularization. Thus, 2 months after implantation, subcutaneously implanted capsules appear wrapped in a vascularized pouch made up of loose connective tissue (Figure 3). Importantly, formation of such neo-organs occurs regardless of whether capsules contain hybridoma cells or not. In contrast, when capsules are implanted intraperitoneally, they do not form clusters but remain mobile and no vascularization is observed. We next investigated the onset of vascularization and whether the treatment of capsules with angiogenic factors could accelerate and/or improve the vascularization of subcutaneously implanted capsules. Capsules treated with bFGF, a growth factor long known to have angiogenic activity19,20 and/or type I rat collagen, as described in Materials and methods, were implanted and followed with respect to their vascularization. No obvious difference was observed between the various experimental conditions tested. Blood vessels developing around capsules were easily visible as early as 3 days after implantation and complete vascularization was reached after 2 to 3 weeks, with a network of blood vessels being present both around and within the neorgan remaining stable for at least 10 months (data not shown). No detectable inflammatory response developed at the level of implanted Tg10 cell-containing CS capsules Mice were examined for the development of possible inflammatory responses triggered by implanted capsules. No macroscopically detectable immediate or delayed inflammatory response was observed in the vicinity of capsules after intraperitoneal or subcutaneous implantation. Also noteworthy was the lack of change in the vascularization of capsules even 10 months after subcutaneous implantation. Figure 2 In vivo antibody production by CS-encapsulated Tg10 hybridoma cells. C3H mice were implanted with Tg10 cell-containing CS capsules either intraperitoneally (a) or subcutaneously (b) as described in Materials and methods. Six mice were implanted with six capsules (mice 1, 2, 3, 7, 8 and 9) and four mice with 20 capsules (mice 6, 10, 11 and 12). Tg10 mAb concentration in serum was assayed by ELISA on the days indicated. Production of Tg10 mAb is expressed in g/ml. Concentrations of Tg10 mAb in the blood of mice 10 and 12 at day 78 were 210 ng/ml and 320 ng/ml, respectively. Concentration of Tg10 mAb in mouse 11 at day 126 was 150 ng/ml. Anti-idiotypic humoral response against the Tg10 antibody released by encapsulated cells was not detectable The possibility that a humoral response against the Tg10 antibody had developed in mice implanted with encapsulated hybridoma cells was also investigated. A previously characterized rabbit serum containing anti-Tg10 antibodies17 was used as a positive control for these experiments. Additionally, a series of mice was immunized with the purified monoclonal antibody in the presence of Freund adjuvant, as described in Materials and methods. Of the 13 mice injected, six developed a clear anti-idiotypic response, indicating that mice are not intrinsically refractory to induction of such a response (Figure 4a). In contrast, no anti-idiotypic response was Antibody production by encapsulated cells M Pelegrin et al 831 Figure 3 Vascularization of capsules implanted subcutaneously (abdominal zone) at day 3, day 8, day 45 (× 20 magnitude) and day 60 (× 15 magnitude), respectively, after implantation. Vascularization progressing to the inner part of the neoorgan is reproducibly observed as early as 15 days after implantation. detected in any of the mice implanted with capsules regardless of the blood concentration of antibody and the site of implantation (Figure 4b). These data indicate that the CS matrix does not exert any obvious adjuvant effect that would have favoured the induction of a neutralizing humoral response against the Tg10 antibody. Discussion Using the Tg10 hybridoma cell line as a model system, we show that long-term systemic delivery of antibodies by cells encapsulated in a cellulose sulphate matrix is possible. Antibody production in the blood was detectable for as long as 4 months after implantation of cellcontaining capsules with, however, a peak of production between 2 and 3 weeks and a steady decrease thereafter. The initial increase in antibody delivery is most likely partially accounted for by cell growth within capsules, the extent of which is limited because of space constraints, and the subsequent decrease correlates with progressive cell death. It seems likely that Tg10 cell death is not a result of the encapsulation per se and/or of capsule implantation but rather reflects poor survival capability of the implanted cells. This poor capability can indeed be observed both in vitro under standard cell culture conditions where the presence of macrophages is necessary for reducing the fraction of cells undergoing apoptosis, and in vivo, where the Tg10 cells poorly develop ascites in immunodeficient mice. In contrast, the cellulose sulphate polymer significantly extended Tg10 cell survival. An interesting possibility for long-term delivery of antibody would thus be the encapsulation of long-lived antibodyproducing cells rather than repeated implantation of cellcontaining capsules. Primary myoblasts, hepatocytes or skin fibroblasts, which are all cell types capable of secretion of antibodies upon genetic modification,2 are candidates currently being tested for such a purpose. Indeed, mouse fibroblasts have been shown to survive for at least 1 year when implanted into mice in capsules made up of alginate–poly-l-lysine–alginate.8 Polymers other than CS have also been used for encapsulating hybridoma cells. Rat hybridoma cells secreting a mAb directed against murine IL-4 have been encapsulated in alginate and implanted intraperitoneally and subcutaneously into mice.9 Serum antibody concentrations were comparable with those reached in our experiments. However, the levels of antibody delivered in the blood stream declined after 14 days as a consequence of capsule deterioration. Moreover, in this system a 100% incidence of ascite development was observed 30 days after implantation as a result of cells released from the capsules into the intraperitoneal cavity. Cellulose sulphate capsules thus offer an obvious advantage with respect to mechanical resistance over alginate capsules since they are malleable and can resist relatively high pressure on them and despite careful analysis, we have found no evidence that they can rupture in vivo. With respect to the latter point, capsules were found intact as long as 10 months after implantation regardless of whether they were implanted subcutaneously or intraperitoneally and as long as 3 months after implantation into the thymus, the pancreas and the mammary gland (unpublished data). On the other hand, intraperitoneal implantation into mice of hybridoma cells encapsulated in an alginate–poly(l)lysine–alginate matrix has permitted delivery of anti-human IL6 antibodies at levels markedly higher21 than those we obtained for Tg10. One reason for this difference resides in the higher number of cells that were implanted in Okada and coworkers’ experiments.21 Our data also support the notion that the number of implanted cells is the primary limiting factor for systemic antibody delivery (at least under the experimental conditions used) since Tg10 mAb serum concentrations roughly correlated with the number of capsules used in the various experiments. Additionally, antibody production by hybridoma cells was intrinsically better in Antibody production by encapsulated cells M Pelegrin et al 832 Figure 4 Anti-idiotypic response against the Tg10 mAb in immunized mice and in mice implanted with encapsulated Tg10 cells. (a) Antiidiotypic response against the Tg10 mAb in mice immunized with purified antibody. Experiments were conducted as described in Materials and methods. Six of 13 mice immunized developed a marked anti-idiotypic response (mice 1Im, 2Im, 3Im, 4Im, 5Im and 6Im). Two mice injected with PBS were used as negative controls (mice 7Non-Im and 8Non-Im). ELISA were performed using 1/250 dilutions of sera and values are expressed in absorbance units. (b) Anti-idiotypic response against Tg10 mAb in mice implanted with Tg10 cell-containing CS capsules. Experiments were conducted as described in Materials and methods. No antiidiotypic response was detected either in the case of capsules implanted intraperitoneally (mice 1, 2, 3 and 6) or subcutaneously (mice 7, 8, 9, 10, 11 and 12). ELISA were performed using 1/250 dilutions of sera and values are expressed in absorbance units. the case of Okada et al’s experiments.21 It must also be taken into account that alginate–poly(l)lysine–alginate capsules induce an inflammatory response22,23 and thus it cannot be excluded that local release of cytokines by activated macrophages could have stimulated antibody production from the encapsulated cells. Interestingly, no such inflammation is observed in the case of CS capsules. Subcutaneous and intraperitoneal implantations of CS cell-containing capsules revealed differences with respect to at least two points. First, the amount of antibody released in the bloodstream was markedly higher in the former situation. A likely explanation for this difference resides in the fact that capsules are rapidly vascularized when implanted subcutaneously and are not vascularized at all when implanted intraperitoneally. In our view, the beneficial effect of vascularization might be two-fold: first, facilitating antibody uptake by blood; and second, ensuring a better supply of nutrients favoring cell survival since viability of cells within intraperitoneally implanted capsules was reproducibly observed to be lower. In addition to extensive vacularization, which showed no significant alteration over the 10 months of follow-up, the clustering of cells within a connective pouch after subcutaneous implantation would allow removal of capsules through an easy one-step surgical ablation of the whole neo-organ should this prove necessary. Finally, it is important to underline that we have never observed any isolating fibrosis developing around implanted CS capsules even 10 months after implantation. This observation contrasts with that reported in the case of alginate–poly(l)lysine–alginate microcapsules around which a host reaction with fibrosis developed (within 4 weeks), probably as a result of macrophage activation by the encapsulating polymer.22 Anti-idiotypic responses are often observed in patients repeatedly treated with high doses of purified monoclonal antibodies and can sometimes, but not always, neutralize the effects of the treatment.24 Moreover, the mode of administration of antibodies has also been shown to be a crucial parameter with regard to the induction of anti-idiotypic responses. For example, subcutaneous and intradermal injections have been reported to be much more immunogenic than intravenous injection.25 Although the occurrence of an anti-idiotypic response was unlikely in the case of the experiments conducted by Savelkoul et al9 using alginate capsules, possible antiidiotypic responses occurring in mice implanted with alginate–poly(l)lysine–alginate, hybridoma cell-containing capsules has unfortunately not been studied. It is worth considering, however, that macrophages activated in the vicinity of capsules could provide a milieu favoring the initiation of an anti-idiotypic response directed against the antibody released by capsules. It is thus important to underline that no detectable anti-idiotypic response against the Tg10 mAb developed in mice implanted with CS-encapsulated Tg10 cells. Since mice are able to mount an anti-idiotypic response when properly immunized with the Tg10 mAb (ie in the presence of Freund’s adjuvant), these data rule out any potent adjuvant effect of the CS polymer that would favor the initiation of an anti-antibody humoral response and strengthen the idea that this polymer may be useful for the development of long-term antibody-based gene/cell therapy protocols. Finally, the possibility of a cellular immune response against encapsulated cells must also be taken into consideration. In the case of cell death, as we observed with Tg10 hybridoma cells, debris released from capsules could elicit an immune response. However, rather than a drawback, we feel that such a response might reveal an advantage with respect to safety. On the one hand, production of antibodies by living encapsulated cells should not be affected since T lymphocytes cannot enter capsules and, on the other, encapsulated cells that would incidentally be released from capsules would be killed immediately. Experiments are currently underway to exploit this possibility. Antibody production by encapsulated cells M Pelegrin et al Materials and methods Cells and cell culture conditions The Tg10 hybridoma cell line has been described previously.15 Cells were grown in RPMI 1640 (GIBCO/BRL, Cergy Pontoise, France) supplemented with 10% FCS in the presence of 100 IU/ml streptomycin, 100 IU/ml of penicillin and 2 mm l-glutamine. Tg10 cells encapsulated in the CS matrix were cultured under the same conditions as free cells. Antibody and F(ab)⬘2 fragments purification Tg10 mAb was purified for Tg10 cell culture supernatant by affinity chromatography as previously described.26 Rabbit anti-idiotypic antibody against the Tg10 mAb was produced as described in Del Rio et al.17 Tg10 F(ab)⬘2 fragment was prepared electrophoretically after cleavage of Tg10 mAb by pepsin and purity of preparations was controlled by SDS-PAGE analysis.17 Cell encapsulation Tg10 hybridoma cells were encapsulated as described elsewhere.13 Briefly, 107 cells were resuspended in a 3.8% sodium cellulose sulphate solution (kind gift from Dr Dautzenberg, prepared as described in Ref. 14) and containing 5% fetal calf serum. The cell suspension was afterwards dropped into an agitated 2.5% poly-dimethyldiallyl-ammonium solution (PDDMDAAC; KatpolChemie, Bitterfield, Germany). Capsules, which formed within 90 s were washed in DMEM. Capsules implantation Four- to six-week-old C3H mice (IFFA-CREDO) were anaesthetized using 0.01 ml per gramme of body weight of a solution containing 0.1% Xylazine (Rompun, Bayer, ` ˆ Germany) and 10 mg/ml Ketamine (Imalgene, Rhone ´ Merieux, Lyon, France). Capsules were washed in phosphate-buffered saline (0.15 m NaCl, 0.01 m Na phosphate pH 7) before implantation. Six or twenty CSM-Tg10 capsules were implanted into mice either intraperitoneally or subcutaneously (abdominal zone). In the latter case, they were implanted at one or three sites in clusters of six or seven capsules per site. Mice immunization For generating Tg10 anti-idiotypic antibodies, 6-week-old B6D2F1 females (IFFA CREDO) were injected intradermally at multiple sites using 20 g per mouse of purified Tg10 mAb emulsified in a 1:1 volume ratio of complete Freund’s adjuvant (Sigma). Two booster injections of 20 g of purified Tg10 mAb (10 g intraperitoneally and 10 g intramuscularly) in incomplete Freund’s adjuvant (Sigma) were given 3 and 4 weeks after the first immunization, respectively. Mice were bled before each immunization and 1 week after the last one. After clotting, blood samples were centrifuged at 2900 g for 15 min and serum aliquots were stored at −20°C until use. Each serum sample was assayed for the presence of antiidiotypic antibody against Tg10 as described below. Immunoassay of Tg10 antibodies: analysis of the antiidiotypic immune response Tg10 antibodies in cell culture supernatants and in mouse sera were assayed by ELISA using human thyroglobulin (hTg) (UCB-Bioproducts, Belgium) for the coating of microtiter plates (Maxisorb, Nunc, Strasbourg, France) as ¨ described in Piechaczyk et al15 and Noel et al16 and absorbance at 450 nm was measured using the automated MR5000 plate reader from Dynatech, France. Protein A sepharose-purified Tg10 mAb was used as a standard for concentration determination. Anti-idiotypic antibodies against the Tg10 mAb were assayed by ELISA using Tg10 F(ab)⬘2 for the coating of microtiter plates as described in Del Rio et al.17 A rabbit anti-idiotypic antiserum17 against the Tg10 mAb was included in our experiments as a positive control. Acknowledgements This work was supported by grants from the Centre National de la Recherche Scientifique, the Ligue Nationale contre le Cancer, the Association de Recherche contre le Cancer (ARC), the Agence Nationale de Recherche contre le Sida (ANRS) and the EC Biotech Programme BIO 950100. References 1 Rose NR, Bona C. Defining criteria for autoimmune diseases (Witebsky’s postulates revisited). Immunol Today 1993; 14: 426– 430. ¨ 2 Noel D et al. In vitro and in vivo secretion of cloned antibodies by genetically modified myogenic cells. Hum Gene Ther 1997; 8: 1219–1229. 3 Crystal RG. 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