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β-Galactosylceramidase in cancer: more than a psychosine scavenger 癌症中的β-半乳糖神经酰胺酶:不仅仅是一种精神病清除剂
Pub Date : 2022-03-23 DOI: 10.18632/oncoscience.551
M. Belleri, M. Presta
Sphingolipids, a class of compounds composed by a sphingoid base backbone, represent major components of biological membranes, and play a pivotal role in a variety of subcellular signaling processes. Abnormal sphingolipid metabolism sets the basis for the pathogenesis of variety of genetic diseases known collectively as sphingolipidosis, or sphingolipodystrophy. Among them, globoid cell leukodystrophy (also named Krabbe disease; OMIM #245200), is an autosomal recessive sphingolipidosis characterized by degeneration of oligodendroglia and progressive demyelination due to the genetic deficiency of β-galactosylceramidase (GALC; EC 3.2.1.46) [1], a lysosomal acid hydrolase that catalyzes the removal of β-galactose from β-galactosylceramide (GalCer) and other terminal β-galactose-containing sphingolipids. Based on a long-held and recently confirmed “psychosine hypothesis” [2], Krabbe disease may manifest as a consequence of the accumulation of the neurotoxic GALC substrate β-galactosylsphingosine (psychosine) in the central and peripheral nervous system [3]. Thus, most of the studies concerning the biological role of GALC have been performed on Krabbe patients and Galc-deficient twitcher mice (an authentic animal model of the disease [4]), leading to the envision that the major biological function of GALC may consist in its psychosine “scavenging” activity. However, experimental evidence indicates that GALC may act not only as a psychosine scavenger, but its modulation also exerting a series of psychosineindependent effects [5, 6]. For instance, GALC deficiency affects neovascularization in in vitro and in vivo in the presence of negligible, if any changes in psychosine levels [7, 8]. In addition, knock-down of the human GALC ortholog galcb in zebrafish embryos affects cell survival and neuronal differentiation in the absence of any significant accumulation of this metabolite [9]. In this frame, a recent study has shown that Galc knockdown in murine melanoma B16 cells causes a significant increase of the levels of the oncosuppressive sphingolipid ceramide mirrored by a decrease of sphingomyelins, phosphatidylethanolamines and cholesteryl esters, paralleled by an increased concentration of diacylglycerols [10]. These alterations of the lipidomic profile resulted in the inhibition of the tumorigenic activity of murine melanoma B16 cells. Increased levels of ceramide were observed also in GALC-silenced human melanoma A2058 cells and tumor xenografts, with a consequent decrease of their tumorigenic potential [10]. In keeping with these observations, a progressive increase of GALC expression occurs during tumor progression in human pathological skin specimens ranging from common nevi to stage IV melanoma. Again, the levels of GALC expression were inversely related to the levels of ceramide immunoreactivity in the same tumor samples [5, 10]. Together, these findings indicate that GALC might act as an oncogenic enzyme during melanoma progression by decreasin
鞘脂是一类由鞘碱骨架组成的化合物,是生物膜的主要成分,在多种亚细胞信号传导过程中起着关键作用。鞘脂代谢异常是多种遗传性疾病(统称为鞘脂病或鞘脂营养不良)发病机制的基础。其中,球状细胞白质营养不良(又称克拉伯病);OMIM #245200),是一种常染色体隐性鞘脂质病,其特征是少突胶质细胞变性和进行性脱髓鞘,是由于β-半乳糖神经酰胺酶(GALC;EC 3.2.1.46)[1],一种溶酶体酸水解酶,催化从β-半乳糖神经酰胺(GalCer)和其他末端含有β-半乳糖的鞘脂中去除β-半乳糖。基于一个长期存在且最近得到证实的“精神碱假说”[2],克拉伯病可能表现为神经毒性GALC底物β-半乳糖半胱氨酸(精神碱)在中枢和周围神经系统积累的结果[3]。因此,大多数关于GALC生物学作用的研究都是在Krabbe患者和GALC缺乏症抽搐小鼠(一种真正的疾病动物模型[4])身上进行的,导致人们设想GALC的主要生物学功能可能在于其精神“清除”活性。然而,实验证据表明GALC可能不仅仅是一种精神障碍清除剂,它的调节也发挥了一系列精神障碍无关的作用[5,6]。例如,GALC缺乏会影响体内和体外的新生血管形成,如果精神素水平有任何变化,则可以忽略不计[7,8]。此外,斑马鱼胚胎中与人类GALC同源的galcb的敲除会影响细胞存活和神经元分化,而这种代谢物没有任何显著的积累[9]。在这一框架下,最近的一项研究表明,在小鼠黑色素瘤B16细胞中,Galc敲低可导致抑制肿瘤的鞘脂神经酰胺水平显著增加,反映为鞘磷脂、磷脂酰乙醇胺和胆固醇酯的减少,并伴有二酰基甘油浓度的增加[10]。脂质组学谱的这些改变导致小鼠黑色素瘤B16细胞的致瘤活性受到抑制。在galc沉默的人黑色素瘤A2058细胞和肿瘤异种移植物中也观察到神经酰胺水平升高,从而降低其致瘤潜力[10]。与这些观察结果一致,从普通痣到IV期黑色素瘤,在人类病理皮肤标本的肿瘤进展过程中,GALC表达的逐渐增加。同样,在相同的肿瘤样本中,GALC表达水平与神经酰胺免疫反应性水平呈负相关[5,10]。总之,这些发现表明,GALC可能通过降低抑癌神经酰胺的水平,在黑色素瘤进展过程中作为一种致癌酶。这些数据也提出了在黑色素瘤中GALC活性和神经酰胺水平之间观察到的反比关系的机制问题。在这一框架下,我们观察到小鼠和人类黑色素瘤细胞中GALC的下调导致鞘磷脂磷酸二酯酶3 (Smpd3)的非冗余上调[10]。该基因编码中性鞘磷脂酶2,这是一种肿瘤抑制酶,可催化鞘磷脂水解形成磷脂胆碱和神经酰胺([11]及参考文献编辑)
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引用次数: 2
Systemic lipid peroxidation profile from patients with breast cancer changes according to the lymph nodal metastasis status 乳腺癌患者全身脂质过氧化谱随淋巴结转移状态的变化而变化
Pub Date : 2022-02-24 DOI: 10.18632/oncoscience.550
Stefania Tagliari de Oliveira, Monica Pavaneli Bessani, T. B. Scandolara, Janaína Carla da Silva, Aedra Carla Bufalo Kawassaki, Pâmella Aparecida Ferreira Fagotti, Vitor Teixeira Maito, Janoário Athanázio de Souza, D. Rech, C. Panis
Metastasis is the leading cause of cancer death. Considering that lymph nodes are the major pathway for cancer spreading and that the metastatic process is under oxidative stress effects, this study aims to evaluate the differential lipid peroxidation profile in the blood of breast cancer patients regarding their lymph nodal status (LN). A total of 105 women diagnosed with breast cancer were included before chemotherapy started. LN was determined by assessing the histopathological analysis of patients’ biopsies, and groups were categorized according to the presence (LN+, n = 48) or absence (LN−, n = 57) of metastases. Lipid peroxidation profiles (LPO) were determined in blood by high-sensitivity chemiluminescence. After patients’ categorization in groups according to their clinicopathological features, LN− patients aged over 50 years presented significantly lower LPO when compared to those under 50 years. Further, LN− patients carrying HER2 positive tumors presented augmented LPO when compared to patients bearing luminal B or triple-negative tumors. LN+ group also had reduced LPO when presented intratumoral clots. The significant contribution of this study was to show that LPO correlates with specific clinical features of patients with breast cancer according to their LN status and that such profile is significantly affected by the presence of metastases.
转移是癌症死亡的主要原因。考虑到淋巴结是癌症扩散的主要途径,并且转移过程受到氧化应激的影响,本研究旨在评估乳腺癌患者血液中脂质过氧化谱的差异与淋巴结状态(LN)的关系。在化疗开始前,共有105名被诊断患有乳腺癌的女性被纳入研究。LN通过评估患者活检的组织病理学分析来确定,并根据转移存在(LN+, n = 48)或不存在(LN−,n = 57)进行分组。采用高灵敏度化学发光法测定血脂质过氧化谱(LPO)。根据患者的临床病理特征进行分组后,50岁以上LN患者的LPO明显低于50岁以下LN患者。此外,携带HER2阳性肿瘤的LN−患者与携带luminal B或三阴性肿瘤的患者相比,LPO增加。LN+组在出现肿瘤内血块时LPO也降低。本研究的重要贡献在于,根据LN状态,LPO与乳腺癌患者的特定临床特征相关,并且这种特征显著受转移灶的影响。
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引用次数: 1
Tissue-agnostic cancer drugs in the fight against molecular subsets of metastases of unknown origin 组织不可知的癌症药物在对抗分子亚群的转移不明来源
Pub Date : 2019-09-01 DOI: 10.18632/oncoscience.492
L. Roncati, B. Palmieri
Metastasis of unknown origin (MUO) means that a cancer is detected when it is already in metastasis, but without any evidence of the primary tumor, even after a full clinico-radiological workup, histological examination, immunohistochemical investigations and tissue-of-origin testing. [1] The occult tumor cannot be identified because it has regressed, due to immune system, or because it is too small for imaging; however, it has been proposed that the undetectable size and the apparent dormant status do not preclude the spreading of cancer stem cells from the original tissue, giving rise to bulky mass at distant sites. [2] About 90% of MUOs are adenocarcinomas, the remaining squamous cell carcinomas, neuroendocrine tumors, composite malignancies and poorly differentiated or anaplastic neoplasms. [3] MUO occurs in about 3 to 5% of all oncological patients and it is burdened by a poor prognosis in 80-85% of the cases, due to its wide dissemination; the survival rates range from 6 to 16 months. These rates are lower in those patients with visceral involvement, ranging from 6 to 9 months. [3] Surely, to know the primary tumor is important because it dictates the best treatment plan and the expected outcome. However, thanks to next generation sequencing (NGS), it is nowadays possible to bypass this dogma and to search for driver mutations in hundreds of cancer-related genes with high sensibility and specificity in a 10-days turnaround time, by exploiting formalin-fixed paraffinembedded metastatic bioptic samples or circulating tumor DNA in the patient’s blood. [4] In addition to reveal the clinically actionable mutations for a personalized therapy, this modern technology provides information about the mutational burden and microsatellite instability (MSI). [4, 5] This last datum is particularly relevant because, on May 2017, the U.S. Food and Drug Administration (FDA) has approved the immunotherapy with pembrolizumab for all unresectable or metastatic, MSI-high (MSI-H) or mismatch repair deficient (dMMR), solid malignancies and, thus, pembrolizumab has become the first tissueagnostic cancer drug. [6] Similarly, on November 2018, the FDA has approved the use of larotrectinib for all adult and pediatric solid tumors characterized by neurotrophic tyrosine receptor kinase (NTRK) gene fusion. [7] The adjective ‘agnostic’ (‘without knowledge’ from Ancient Greek) indicates a new subset of anti-cancer drugs (e.g. Keytruda®, Vitrakvi®) targeted towards the tumor on the basis of specific mutations found inside it, without knowing its tissue/site of origin just as happens in MUO. Therefore, the tissue-agnostic cancer drugs represent current treatment options against NTRK fusion-positive or MSI-H/dMMR MUOs. Other pipelines under development include: entrectinib for the therapy of pediatric and adult patients with recurrent or refractory extracranial solid tumors harboring NTRK, c-Ros oncogene 1 (ROS1) or anaplastic lymphoma kinase (ALK) gene fusions; BLU667 and Lo
起源不明的转移(MUO)是指当癌症已经发生转移时,即使经过全面的临床放射检查、组织学检查、免疫组织化学检查和起源组织检查,也没有发现原发肿瘤的证据。[1]隐匿性肿瘤不能被发现,因为它已经消退,由于免疫系统的原因,或者因为它太小而无法成像;然而,有人提出,无法检测到的大小和明显的休眠状态并不能阻止癌症干细胞从原始组织中扩散,从而在远处产生大块的肿块。[2]约90%的muo为腺癌,其余为鳞状细胞癌、神经内分泌肿瘤、复合恶性肿瘤和低分化或间变性肿瘤。[3]在所有肿瘤患者中,约有3%至5%发生MUO,由于其广泛传播,80-85%的病例预后较差;存活率为6至16个月。在6至9个月的患者中,这些比例较低。[3]当然,了解原发肿瘤是很重要的,因为它决定了最佳的治疗方案和预期的结果。然而,由于下一代测序技术(NGS)的发展,现在有可能绕过这一规则,通过利用福尔马林固定石蜡包埋的转移性生物样本或患者血液中的循环肿瘤DNA,在10天的时间内,以高灵敏度和特异性搜索数百种癌症相关基因的驱动突变。[4]除了揭示临床可操作的突变以进行个性化治疗外,这项现代技术还提供了有关突变负担和微卫星不稳定性(MSI)的信息。[4,5] 2017年5月,美国食品和药物管理局(FDA)批准了pembrolizumab用于所有不可切除或转移性、msi高(MSI-H)或错配修复缺陷(dMMR)、实体恶性肿瘤的免疫治疗,因此,pembrolizumab已成为首个组织肿瘤药物。[6]同样,2018年11月,FDA批准larorectinib用于所有以神经营养性酪氨酸受体激酶(NTRK)基因融合为特征的成人和儿童实体肿瘤。[7]形容词“agnostic”(来自古希腊语的“不知道”)表示一种新的抗癌药物(如Keytruda®,Vitrakvi®),根据肿瘤内部发现的特定突变靶向肿瘤,而不知道其组织/起源部位,就像在MUO中一样。因此,组织不可知的癌症药物代表了目前针对NTRK融合阳性或MSI-H/dMMR muo的治疗选择。其他正在开发的产品线包括:用于治疗含有NTRK、c-Ros癌基因1 (ROS1)或间变性淋巴瘤激酶(ALK)基因融合的复发性或难治性颅外实体瘤的儿童和成人患者的enterrectinib;bl667和Loxo-292用于“转染期间重排”(RET)基因改变的实体肿瘤;和Loxo-195用于NTRK融合阳性实体癌。[8-11]关于抗人表皮生长因子受体3 (Her3)抗体治疗具有神经调节蛋白1 (NRG1)基因重排的实体恶性肿瘤的初步临床原理证明数据已经发表。[12]所有这些都证明了科学对组织不可知癌症药物的极大关注,以期为肿瘤患者提供更多更有效的治疗方法。
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引用次数: 1
Inside a mystery of oncoscience: The cancer-sniffing pets 癌症科学的奥秘:嗅癌宠物
Pub Date : 2019-09-01 DOI: 10.18632/oncoscience.490
L. Roncati
Worldwide, sick people are daily enjoying the benefits of pet-therapy [1-6]. Next to this scientific evidence, the media report cases of patients who claim to have been saved by their cancer-sniffing pets through an early diagnosis of malignancy. By virtue of this, the concept of ‘canine cancer detection’ has been advanced, on the basis of the presumed olfactory ability of pets, in particular dogs, to smell very low concentrations of aromatic and/or alkanes compounds generated and released by malignant tumors in the patient’s breath, urine or watery stool and into adsorbent materials [7-15]. It is well known that the brain of a domestic dog (Canis lupus familiaris from the Latin) is dominated by a wide olfactory cortex unlike the humans, where a visual cortex predominates. More in detail, dogs are equipped up to 56 times more smellsensitive receptors than the human beings, reaching the number of 280 million in selected breeds, spread over an olfactory surface about the size of a pendrive (9.76 cm2), if compared to 5 million over an area about the size of a postage stamp (3.08 cm2) for the humans [16, 17]. This is thought to render its sense of smell up to 56 times more sensitive than human’s. The domestic cat (Felis silvestris catus from the Latin) also possesses an acute sense of smell, due to its well-developed olfactory bulb and, in addition, to a large surface of olfactory mucosa (about 5.8 cm2), which is almost twice that of the human beings [16]. In oncological medicine, among the diagnostic hallmarks of malignancy there are: lymphovascular and perineural invasion; infiltrative neoplastic growth; immune evasion; a high cytoproliferative index; an elevated mitotic cell count; and tumor necrosis [18, 19]. More in detail, tumor necrosis (νέκρωσις – death from the Greek) is a form of hypoxic death related to the high metabolic demand of cancer cells. It does not follow the apoptotic cascade, but the uncontrolled release of cell death products evokes in the surrounding space an inflammatory response Research Perspective
在世界范围内,病人每天都在享受宠物治疗的好处[1-6]。除了这些科学证据,媒体还报道了一些病人的案例,他们声称自己的嗅癌宠物通过早期诊断挽救了他们的生命。因此,“犬类癌症检测”的概念已经被提出,基于宠物,特别是狗的嗅觉能力,可以闻到患者呼吸、尿液或水汪汪的粪便中恶性肿瘤产生和释放的极低浓度的芳香和/或烷烃化合物,并进入吸附剂中[7-15]。众所周知,家犬(Canis lupus familiaris,源自拉丁语)的大脑由一个宽阔的嗅觉皮层主导,而人类的大脑则由视觉皮层主导。更详细地说,狗的嗅觉敏感受体是人类的56倍,在特定品种中达到2.8亿个,分布在大约一个pendrive大小的嗅觉表面(9.76 cm2)上,而人类在大约一个邮票大小的区域(3.08 cm2)上只有500万个[16,17]。这被认为使它的嗅觉比人类灵敏56倍。家猫(源自拉丁语Felis silvestris catus)也具有敏锐的嗅觉,这是因为它的嗅球发育良好,此外,它的嗅粘膜表面积很大(约5.8平方厘米),几乎是人类的两倍。在肿瘤医学中,恶性肿瘤的诊断标志包括:淋巴血管和神经周围浸润;浸润性肿瘤生长;免疫逃避;高细胞增殖指数;有丝分裂细胞计数升高;和肿瘤坏死[18,19]。更详细地说,肿瘤坏死(希腊语为σις - death)是一种与癌细胞的高代谢需求有关的缺氧死亡形式。它不遵循凋亡级联,但细胞死亡产物的不受控制的释放引起周围空间的炎症反应
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引用次数: 0
Menin: Expanding and dichotomous roles in cancer Menin:在癌症中的扩展和二分作用
Pub Date : 2019-08-23 DOI: 10.18632/oncoscience.485
Bryson W. Katona, Rebecca A Glynn, Taylor Hojnacki, X. Hua
Menin, the protein product of the MEN1 gene, is a ubiquitously expressed protein that lacks homology with other protein families, yet is highly conserved among various species [1]. Menin primarily resides in the nucleus, where it serves as a scaffold for epigenetic regulators [1, 2]. While much is known about menin and its diverse roles in numerous cellular processes, there remains much to be discovered, especially with regard to its role in cancer.
Menin是MEN1基因的蛋白产物,是一种普遍表达的蛋白,与其他蛋白家族缺乏同源性,但在各种物种中高度保守[1]。Menin主要存在于细胞核中,作为表观遗传调控因子的支架[1,2]。虽然人们对menin及其在许多细胞过程中的不同作用了解甚多,但仍有许多有待发现,特别是关于其在癌症中的作用。
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引用次数: 1
Cytochrome P450 monooxygenase/soluble epoxide hydrolase-mediated eicosanoid pathway in colorectal cancer and obesity-associated colorectal cancer 结直肠癌和肥胖相关结直肠癌中细胞色素P450单加氧酶/可溶性环氧化物水解酶介导的类二十烷途径
Pub Date : 2019-08-23 DOI: 10.18632/oncoscience.488
Jianan Zhang, Katherine Z. Sanidad, Guodong Zhang
Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related deaths in the United States. Furthermore, it is well established that obese individuals have high risks of developing CRC, and obesity-associated CRC represents an unmet medical problem in the United States. Using a metabolomics approach, our recent research supports that the cytochrome P450 (CYP) monooxygenase/soluble epoxide hydrolase (sEH)-mediated eicosanoid pathway could play critical roles in the pathogenesis of CRC and obesity-associated CRC. Here in this review, we discuss recent studies about the roles of the CYP/sEH eicosanoid pathway in the pathogenesis of these diseases.
结直肠癌(CRC)是美国第三大常见癌症,也是导致癌症相关死亡的第二大原因。此外,肥胖个体患结直肠癌的风险很高,这是公认的事实,肥胖相关的结直肠癌在美国是一个未解决的医疗问题。利用代谢组学方法,我们最近的研究支持细胞色素P450 (CYP)单加氧酶/可溶性环氧化物水解酶(sEH)介导的类二十烷途径可能在结直肠癌和肥胖相关结直肠癌的发病机制中发挥关键作用。本文就近年来CYP/sEH类二十烷通路在这些疾病发病机制中的作用进行综述。
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引用次数: 6
In situ analysis of Her2 DNA and RNA in retinoblastoma and adjacent retina 视网膜母细胞瘤及邻近视网膜中Her2 DNA和RNA的原位分析
Pub Date : 2019-07-01 DOI: 10.18632/oncoscience.489
G. Seigel, D. Shah, Pia Mendoza, E. Szalai, H. Grossniklaus, Yinghui Song, J. Shan
Retinoblastoma (RB) is an ocular tumor of early childhood. Current treatments attempt to preserve visual function, but may spare chemoresistant tumor cells. One potential therapeutic target for RB is HER2, (ERBB2), expressed in RB in truncated form. In this study, we tested the hypothesis that Her2 DNA and RNA are expressed in RB tumors and adjacent retina. We examined 24 human RB tumors as well as normal-appearing adjacent retinal tissues for Her2 DNA and RNA expression by in situ hybridization. We also examined 28 RB tumors for HER2 protein immunoreactivity. 21/22 RB tumors expressed Her2 DNA and 14/19 tumors expressed Her2 RNA. In 17 paired cases, there were three cases in which Her2 DNA was detected, but not RNA. We also saw Her2 RNA signal in six instances of “normal” adjacent retinal tissue. Heterogeneous HER2 protein expression in specific tumor regions also was confirmed by quantitative HER2 immunohistochemistry. In summary, Her2 DNA and RNA are expressed in many RB tumors, and in some adjacent ocular tissues, with hetereogenous protein expression throughout. These results may provide important insights regarding RB tumor progression, and drug targeting approaches designed to spare the eye, preserve vision and improve quality of life for RB patients.
视网膜母细胞瘤是一种发生于儿童早期的眼部肿瘤。目前的治疗方法试图保留视觉功能,但可能会避免化疗耐药的肿瘤细胞。RB的一个潜在治疗靶点是HER2 (ERBB2),它以截断形式在RB中表达。在本研究中,我们验证了Her2 DNA和RNA在RB肿瘤和邻近视网膜中表达的假设。我们用原位杂交法检测了24例人RB肿瘤和正常邻近视网膜组织的Her2 DNA和RNA表达。我们还检测了28例RB肿瘤的HER2蛋白免疫反应性。21/22的RB肿瘤表达Her2 DNA, 14/19的肿瘤表达Her2 RNA。在17对病例中,有3例检测到Her2 DNA,但未检测到RNA。我们还在6例“正常”相邻视网膜组织中发现了Her2 RNA信号。定量免疫组化证实了HER2蛋白在特定肿瘤区域的异质表达。综上所述,Her2 DNA和RNA在许多RB肿瘤中表达,在一些邻近的眼组织中表达,并且在整个组织中表达异质蛋白。这些结果可能为RB肿瘤进展提供重要的见解,并为RB患者提供旨在拯救眼睛、保护视力和改善生活质量的药物靶向方法。
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引用次数: 0
Senescence regulation by nuclear N-WASP: a role in cancer? 细胞核N-WASP对衰老的调控:在癌症中的作用?
Pub Date : 2019-07-01 DOI: 10.18632/oncoscience.487
Hui Li, C. Brakebusch
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引用次数: 4
Correction: Regression of primary cardiac angiosarcoma and metastatic nodules following propranolol as a single agent treatment 更正:普萘洛尔单药治疗后原发性心脏血管肉瘤和转移性结节消退
Pub Date : 2019-07-01 DOI: 10.18632/oncoscience.491
Dana C. Galvan, A. Ayyappan, B. Bryan
[This corrects the article DOI: 10.18632/oncoscience.472.].
[这更正了文章DOI: 10.18632/ onscience .472]。
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引用次数: 0
Pomalidomide-induced changes in the pancreatic tumor microenvironment and potential for therapy 波马度胺诱导的胰腺肿瘤微环境变化及其治疗潜力
Pub Date : 2019-07-01 DOI: 10.18632/oncoscience.486
P. Storz
In pancreatic cancer, standard chemotherapy alone or its combination of with checkpoint inhibitors is largely ineffective, because the tumor microenvironment generates a fibrotic barrier for immunotherapy and for drugs to reach tumor cells. Current most promising efforts are strategies that combine chemotherapy with compounds that alter the tumor microenvironment. Here we discuss treatment with pomalidomide as a method to target immunosuppressive alternatively-activated tumor-associated macrophages, resulting in a decrease in fibrosis and formation of an immune-responsive environment. The pancreatic tumor microenvironment (TME) is an immunosuppressive, fibrotic barrier. It blocks the delivery of drugs that target tumor cells, but also excludes immune cells and prevents immunotherapy [1]. Major cell types in the TME are different populations of activated fibroblasts, and immune cells, including tumor-associated macrophages (TAMs). Alternatively-activated (M2) macrophages represent approximately 85% of TAMs in the pancreatic tumor microenvironment [2]. In pancreatic ductal adenocarcinoma (PDA) these macrophages regulate two hallmarks of immune escape, the exclusion of cytotoxic T lymphocytes and fibrosis [3, 4]. Both, either targeting immunosuppressive alternativelyactivated TAMs, or their repolarization to inflammatory macrophages, which drive destruction of the tumor stroma and presence of cytotoxic T cells, could be efficient strategies for this cancer [3-5]. Indeed, preclinical data indicate that neutralization of IL-13, a factor that mediates M2 polarization of macrophages, decreases the presence of alternativelyactivated macrophages, as well as fibrosis at pancreatic lesions [4]. In recent work, Bastea et al. now show that pomalidomide, a thalidomide analog that has been developed and tested for hematologic cancers [6], not only induces a decrease in alternatively-activated macrophages, which then results in decreased fibrosis at PanIN lesions and tumors, it also reprograms these populations into tumor suppressive macrophages [7]. Effects of pomalidomide on M2 macrophages are due to downregulation of interferon regulatory factor 4 (IRF4), a transcription factor for M2 macrophage polarization. Through its effects on macrophage populations pomalidomide generates a pro-inflammatory environment by decreasing tissue levels of interleukin 1 receptor antagonist (IL-1ra) and increasing Interleukin 1α (IL-1α), with the net effect of activating interleukin 1 receptor (IL-1R) signaling [7]. It had been shown previously that pancreatic tumors deficient of IL-1α have an immunosuppressive environment due to exclusion of cytotoxic T cells [8]. As expected, due to re-establishing IL-1R signaling, pomalidomide induced presence of activated (IFNγ-positive) CD4+ and CD8+ T cell populations [7]. This is in line with studies showing that in the pancreas shifting M2 to M1 populations orchestrates effective T cell immunotherapy [9]. In addition to its effects on im
在胰腺癌中,标准化疗单独或联合检查点抑制剂在很大程度上是无效的,因为肿瘤微环境为免疫治疗和药物到达肿瘤细胞产生了纤维化屏障。目前最有希望的努力是将化疗与改变肿瘤微环境的化合物结合起来的策略。在这里,我们讨论了用泊马度胺治疗作为一种靶向免疫抑制替代激活的肿瘤相关巨噬细胞的方法,导致纤维化减少和免疫应答环境的形成。胰腺肿瘤微环境(TME)是一种免疫抑制的纤维化屏障。它阻断靶向肿瘤细胞的药物递送,但也排斥免疫细胞,阻碍免疫治疗[1]。TME中的主要细胞类型是不同群体的活化成纤维细胞和免疫细胞,包括肿瘤相关巨噬细胞(tam)。交替活化(M2)巨噬细胞约占胰腺肿瘤微环境中tam的85%[2]。在胰腺导管腺癌(PDA)中,这些巨噬细胞调节免疫逃逸的两个标志,细胞毒性T淋巴细胞的排除和纤维化[3,4]。无论是靶向免疫抑制的选择性激活的tam,还是它们再极化到炎性巨噬细胞,从而驱动肿瘤基质的破坏和细胞毒性T细胞的存在,都可能是治疗这种癌症的有效策略[3-5]。事实上,临床前数据表明,IL-13(一种介导巨噬细胞M2极化的因子)的中和可以减少交替活化的巨噬细胞的存在,并减少胰腺病变处的纤维化[4]。在最近的研究中,Bastea等人发现,泊马度胺是一种沙利度胺类似物,已被开发并测试用于血液病[6],它不仅能诱导选择性活化的巨噬细胞减少,从而导致PanIN病变和肿瘤纤维化减少,还能将这些细胞群重编程为肿瘤抑制型巨噬细胞[7]。波马度胺对M2巨噬细胞的影响是由于干扰素调节因子4 (IRF4)的下调,IRF4是M2巨噬细胞极化的转录因子。通过对巨噬细胞群体的影响,波马度胺通过降低组织中白细胞介素1受体拮抗剂(IL-1ra)的水平和增加白细胞介素1α (IL-1α)的水平来产生促炎环境,其净效应是激活白细胞介素1受体(IL-1R)信号传导[7]。先前有研究表明,缺乏IL-1α的胰腺肿瘤由于排除了细胞毒性T细胞而具有免疫抑制环境[8]。正如预期的那样,由于重建IL-1R信号,泊马度胺诱导了活化的(ifn γ-阳性)CD4+和CD8+ T细胞群的存在[7]。这与研究表明,在胰腺中,将M2转移到M1群体协调有效的T细胞免疫治疗是一致的[9]。除了对免疫细胞群的影响外,最近已证明泊马度胺与标准护理化疗联合使用可促进化疗致敏[10]。上述临床前数据,以及波马度胺和其他沙利度胺类似物已经获得fda批准的事实,使它们成为临床试验的理想候选者,重点是与标准护理药物或免疫疗法联合治疗。最近完成的一项I期临床研究表明,泊马度胺联合吉西他滨治疗未经治疗的晚期胰腺癌是可行且安全的[11]。人用泊马度胺的潜在副作用很小,只有2-4%的患者观察到治疗引起的不良事件,这些不良事件可以通过额外给药抗凝剂或阿司匹林很容易预防。当泊马度胺/吉西他滨治疗与其他临床方法联合靶向tam和免疫抑制单核细胞,并使胰腺肿瘤对T细胞免疫治疗(如抑制局灶黏附激酶、抗pd1治疗、CD40激动剂或靶向CCL2)敏感时,可能会更有效(综述于[1])。总之,Bastea等人[7]的数据表明,通过重塑肿瘤微环境并产生从免疫抑制环境向免疫应答环境的转变,泊马度胺有望用于胰腺癌治疗(图1)。
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Oncoscience
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