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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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引用次数: 0
CDK12 inactivation across solid tumors: an actionable genetic subtype CDK12在实体肿瘤中的失活:一种可操作的遗传亚型
Pub Date : 2019-05-01 DOI: 10.18632/oncoscience.481
C. H. Marshall, E. Imada, Zhuojun Tang, L. Marchionni, E. Antonarakis
Inactivating CDK12 alterations have been reported in ovarian and prostate cancers and may have therapeutic implications; however, the prevalence of these mutations across other cancer types is unknown. We searched the cBioPortal and GENIE Project (public release v4.1) databases for cancer types with > 200 sequenced cases, that included patients with metastatic disease, and in which the occurrence of at least monoallelic CDK12 alterations was > 1%. The prevalence of at least monoallelic CDK12 mutations was highest in bladder cancer (3.7%); followed by prostate (3.4%), esophago-gastric (2.1%) and uterine cancers (2.1%). Biallelic CDK12 inactivation was highest in prostate cancer (1.8%), followed by ovarian (1.0%) and bladder cancers (0.5%). These results are the first (to our knowledge) to estimate the prevalence of monoallelic and biallelic CDK12 mutations across multiple cancer types encompassing over 15,000 cases.
据报道,在卵巢癌和前列腺癌中,CDK12的失活改变可能具有治疗意义;然而,这些突变在其他癌症类型中的流行程度尚不清楚。我们检索了cbiopportal和GENIE Project(公开发布版本v4.1)数据库,寻找有bbbb200例测序病例的癌症类型,包括转移性疾病患者,其中至少发生单等位基因CDK12改变的发生率为b>1%。至少单等位基因CDK12突变的患病率在膀胱癌中最高(3.7%);其次是前列腺癌(3.4%)、食管胃癌(2.1%)和子宫癌(2.1%)。双等位基因CDK12失活在前列腺癌中最高(1.8%),其次是卵巢癌(1.0%)和膀胱癌(0.5%)。这些结果是第一次(据我们所知)估计单等位基因和双等位基因CDK12突变在超过15,000例的多种癌症类型中的患病率。
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引用次数: 18
Suppression of vascular endothelial growth factor expression in breast cancer cells by microRNA-125b-mediated attenuation of serum amyloid A activating factor-1 level 通过microrna -125b介导的血清淀粉样蛋白A激活因子-1水平的衰减抑制乳腺癌细胞中血管内皮生长因子的表达
Pub Date : 2019-05-01 DOI: 10.18632/oncoscience.483
A. Ray, B. Ray
Increased level of an inflammation-responsive transcription factor called serum amyloid A-activating factor (SAF-1) has been linked to the pathogenesis in human breast cancer. SAF-1 is found to promote vascular endothelial growth factor (VEGF) expression in breast carcinoma cells and boost angiogenesis. In an effort to develop a cellular mechanism to control VEGF expression, we sought to limit SAF-1 activity in breast cancer cells. We report here several targets within the SAF-1 mRNA for binding of microRNA-125b (miR-125b) and we show that VEGF expression is reduced in breast cancer cells when SAF-1 level is reduced with the microRNA action. Within the 3' un-translated region (UTR) of SAF-1 transcript, we have identified four highly conserved miR-125b responsive elements. We show that these miR-125b binding sites mediate repression of SAF-1 by miR-125b. Ectopic expression of miR-125b in nonmetastatic and metastatic breast cancer cells repressed SAF-1-mediated activity on VEGF promoter function and inhibited cancer cell migration and invasion potentials in vitro. Together, these results suggest that termination of SAF-1 function by miR-125b could be developed as a potential anti-VEGF and anti-angiogenic agent, which has high clinical relevance.
一种被称为血清淀粉样蛋白a激活因子(SAF-1)的炎症反应转录因子水平的升高与人类乳腺癌的发病机制有关。研究发现,SAF-1可促进乳腺癌细胞中血管内皮生长因子(VEGF)的表达,促进血管生成。为了开发一种控制VEGF表达的细胞机制,我们试图限制SAF-1在乳腺癌细胞中的活性。我们在此报告了SAF-1 mRNA中与microRNA-125b (miR-125b)结合的几个靶点,并表明当SAF-1水平随着microRNA的作用而降低时,VEGF在乳腺癌细胞中的表达降低。在SAF-1转录本的3'未翻译区(UTR)中,我们鉴定了四个高度保守的miR-125b响应元件。我们发现这些miR-125b结合位点介导miR-125b对SAF-1的抑制。在非转移性和转移性乳腺癌细胞中异位表达miR-125b可抑制saf -1介导的VEGF启动子功能活性,并抑制癌细胞在体外的迁移和侵袭潜力。综上所述,这些结果表明miR-125b终止SAF-1功能可能被开发为一种潜在的抗vegf和抗血管生成药物,具有很高的临床相关性。
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引用次数: 4
BRG1 and BRM loss selectively impacts RB and P53, respectively: BRG1 and BRM have differential functions in vivo BRG1和BRM的缺失分别选择性影响RB和P53: BRG1和BRM在体内具有不同的功能
Pub Date : 2016-12-21 DOI: 10.18632/oncoscience.333
Stefanie B. Marquez-Vilendrer, S. Rai, Sarah J B Gramling, Li Lu, D. Reisman
The SWI/SNF complex is an important regulator of gene expression that functions by interacting with a diverse array of cellular proteins. The catalytic subunits of SWI/SNF, BRG1 and BRM, are frequently lost alone or concomitantly in a range of different cancer types. This loss abrogates SWI/SNF complex function as well as the functions of proteins that are required for SWI/SNF function, such as RB1 and TP53. Yet while both proteins are known to be dependent on SWI/SNF, we found that BRG1, but not BRM, is functionally linked to RB1, such that loss of BRG1 can directly or indirectly inactivate the RB1 pathway. This newly discovered dependence of RB1 on BRG1 is important because it explains why BRG1 loss can blunt the growth-inhibitory effect of tyrosine kinase inhibitors (TKIs). We also observed that selection for Trp53 mutations occurred in Brm-positive tumors but did not occur in Brm-negative tumors. Hence, these data indicate that, during cancer development, Trp53 is functionally dependent on Brm but not Brg1. Our findings show for the first time the key differences in Brm- and Brg1-specific SWI/SNF complexes and help explain why concomitant loss of Brg1 and Brm frequently occurs in cancer, as well as how their loss impacts cancer development.
SWI/SNF复合物是基因表达的重要调控因子,通过与多种细胞蛋白相互作用发挥作用。SWI/SNF的催化亚基BRG1和BRM在一系列不同的癌症类型中经常单独或同时丢失。这种缺失消除了SWI/SNF复合物的功能以及SWI/SNF功能所需的蛋白质的功能,如RB1和TP53。然而,虽然已知这两种蛋白都依赖于SWI/SNF,但我们发现BRG1(而不是BRM)在功能上与RB1相关,因此BRG1的缺失可以直接或间接地使RB1途径失活。这一新发现的RB1对BRG1的依赖性是重要的,因为它解释了为什么BRG1缺失会减弱酪氨酸激酶抑制剂(TKIs)的生长抑制作用。我们还观察到Trp53突变的选择发生在brm阳性肿瘤中,而不发生在brm阴性肿瘤中。因此,这些数据表明,在癌症发展过程中,Trp53在功能上依赖于Brm而不是Brg1。我们的研究结果首次揭示了Brm-和Brg1特异性SWI/SNF复合物的关键差异,并有助于解释为什么Brg1和Brm的同时缺失经常发生在癌症中,以及它们的缺失如何影响癌症的发展。
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引用次数: 9
Gene enhancer deregulation and epigenetic vulnerability 基因增强子解除管制与表观遗传脆弱性
Pub Date : 2016-12-21 DOI: 10.18632/oncoscience.334
Rui Lu, G. Wang
One major goal of cancer research is to identify tumor-specific mechanisms that sustain cell proliferation or survival and to develop the corresponding therapies that target selectively against tumor. Recent sequencing of primary tumor samples supports that aberration of chromatin modification and epigenetic states plays a central role in oncogenesis. For example, mutation of DNA methyltransferase 3A (DNMT3A, Figure 1) occurs in approximately 20-30% of acute myeloid leukemia (AML) and 5-15% of other hematological malignancies and disorders, making DNMT3A one of the most frequently mutated genes in blood cancer [1]; genes encoding chromatin-remodeling protein complexes are found recurrently mutated or deleted in various tumors. Thus, DNMT3A and ATP-dependent chromatin remodelers appear to function as tumor suppressors, most likely, in a context-dependent manner. However, it remains elusive how alteration of chromatin-modifying machineries contributes to tumorigenesis, and mechanism-based therapeutic approaches are to be developed. Chromatin modifications ensure distinctive cellular identities. Past studies have shed light on several principles in chromatin modifications. One important property is reversibility. Epigenomic states are reset in response to developmental or environmental cues such as differentiation. Epigenetic changes are mediated by antagonizing enzymes that ‘write’ or ‘erase’ specific chromatin modification, exemplified by DNA methyltransferase or demethylase, and histone acetyltransferase (HAT) or deacetylase (HDAC). Second, epigenetic states can be relatively stable over cell divisions. Such ‘inheritance’ is partly owing to self-recruitment of modifying enzymes to promote self-propagation. Furthermore, different chromatin modifications that fall into the same gene-active or gene-repressive category often cooperate forming a selfreinforcement network. For example, methylated DNA is ‘read’ by MeCP2, which recruits HDACs to deacetylate histones (Figure 1). Due to the epigenetic crosstalk via antagonizing and reinforcing networks, one would Editorial
癌症研究的一个主要目标是确定维持细胞增殖或存活的肿瘤特异性机制,并开发选择性靶向肿瘤的相应治疗方法。最近对原发肿瘤样本的测序支持染色质修饰和表观遗传状态的畸变在肿瘤发生中起核心作用。例如,DNA甲基转移酶3A (DNMT3A,图1)突变发生在大约20-30%的急性髓性白血病(AML)和5-15%的其他血液恶性肿瘤和疾病中,使DNMT3A成为血癌中最常见的突变基因之一;编码染色质重塑蛋白复合物的基因在各种肿瘤中经常发生突变或缺失。因此,DNMT3A和atp依赖的染色质重塑物似乎作为肿瘤抑制因子发挥作用,很可能以一种环境依赖的方式发挥作用。然而,染色质修饰机制的改变如何促进肿瘤的发生仍是一个谜,基于机制的治疗方法有待开发。染色质修饰确保独特的细胞身份。过去的研究已经阐明了染色质修饰的几个原理。一个重要的性质是可逆性。表观基因组状态会根据发育或环境因素(如分化)进行重置。表观遗传变化是由“写”或“擦除”特定染色质修饰的拮抗酶介导的,例如DNA甲基转移酶或去甲基化酶,组蛋白乙酰转移酶(HAT)或去乙酰化酶(HDAC)。其次,表观遗传状态在细胞分裂过程中相对稳定。这种“遗传”部分是由于修饰酶的自我招募来促进自我繁殖。此外,属于同一基因活性或基因抑制类别的不同染色质修饰经常合作形成一个自我强化网络。例如,甲基化的DNA被MeCP2“读取”,它招募hdac使组蛋白去乙酰化(图1)。由于通过拮抗和强化网络的表观遗传串扰,有人会编辑
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引用次数: 0
Adaptive survival mechanism to glucose restrictions 葡萄糖限制的适应性生存机制
Pub Date : 2016-12-16 DOI: 10.18632/oncoscience.332
N. Djouder
Glucose is partly metabolized through the glucose sensing hexosamine biosynthetic pathway (HBP) leading to the formation of an end product called acetylated amino sugar nucleotide uridine 5'-diphospho-N-acetylglucosamine (UDP-GlcNAc). UDP-GlcNAC serves as a donor substrate during O-GlcNAcylation (O-linked β-N-acetylglucosamine or O-GlcNAc) [1]. Serine or threonine residues of nuclear and cytoplasmic proteins are directly O-GlcNAcylated, competing with phosphorylation. O-GlcNAcylation is catalyzed by one unique enzyme called O-linked N-acetylglucosamine (O-GlcNAc) transferase (OGT). O-GlcNAcylation is cleaved and removed by another one enzyme called N-acetyl-β-D-glucosaminidase (OGA) [1]. The existence of single and unique enzymes (OGT and OGA) acting on various different substrates suggest that enzyme activity can be modulated by binding partners in response to glucose levels [1]. O-GlcNAcylation levels are very dynamic and cycles rapidly, fluctuating in response to glucose concentrations influencing cell signaling pathways [1]. O-GlcNAcylation is thus relevant to various chronic human diseases such as diabetes, cardiovascular and neurodegenerative disorders and cancer. For example, OGT promotes aneuploidy, regulates cell-cycling via HCF-1 cleavage, and participates in regulatory links between metabolic changes and carcinogenesis [2]. Changes in OGA or OGT activity and hence, in O-GlcNAcylation levels may occur in human breast cancer and hepatocellular carcinoma (HCC) tissues [1]. The oncoprotein c-MYC is also O-GlcNAcylated. c-MYC protein is very unstable; its levels and activity are regulated by ubiquitination and proteasomal degradation, initiated by its phosphorylation at Thr-58 by GSK3β. Thr-58 is an OGT target which regulates c-MYC stability. O-GlcNAcylation at Thr-58 stabilizes c-MYC, promoting tumorigenesis [1]. Unconventional prefoldin RPB5 interactor (URI) binds and modulates OGT activity in response to glucose concentrations. In presence of glucose, URI, OGT and protein phosphatase 1 gamma (PP1γ) form a heterotrimeric complex. Glucose deprivation induces anaplerotic reactions, increasing ATP/cAMP levels, thereby activating PKA which in turn, phosphorylates URI at Ser-371. Phosphorylated URI frees PP1γ from the heterotrimeric complex and, URI becomes a potent inhibitor of OGT [1]. PKA reportedly forms a mitochondrial complex with PP1 catalytic units and the pro-apoptotic Bcl-2-associated death promoter (BAD) that influences glucose homeostasis [3]. Thus, URI/OGT/PP1γ complex may integrate glucose metabolism, possibly through a mitochondrial supra-molecular complex including PKA and BAD [3,4]. Abnormal glucose metabolism and BAD requirement in glucose deprivation-induced death is reported in Bad knockout and non-phosphorylatable BAD(3SA) knockin mice [3,5]. BAD is thus an apoptotic sentinel that monitors glucose signaling. Notably, OGT overexpression in a transgenic mouse model yields a type 2 diabetes (T2D) phenotype with insulin resist
葡萄糖通过葡萄糖感应己糖胺生物合成途径(HBP)部分代谢,导致最终产物乙酰化氨基糖核苷酸尿苷5'-二磷酸- n -乙酰氨基葡萄糖(UDP-GlcNAc)的形成。在o - glcn酰化(O-linked β- n -乙酰氨基葡萄糖或O-GlcNAc)过程中,UDP-GlcNAC作为供体底物[1]。核蛋白和细胞质蛋白的丝氨酸或苏氨酸残基直接被o - glcn酰化,与磷酸化相互竞争。O-GlcNAc酰化是由一种称为o -连接n -乙酰氨基葡萄糖(O-GlcNAc)转移酶(OGT)的独特酶催化的。o - glcn酰化被另一种称为n -乙酰-β- d -氨基葡萄糖酶(OGA)的酶切割和去除[1]。单一和独特的酶(OGT和OGA)作用于各种不同的底物,表明酶的活性可以通过结合伙伴来调节,以响应葡萄糖水平[1]。o - glcnac酰化水平是非常动态和快速循环的,随着葡萄糖浓度影响细胞信号通路而波动[1]。因此,o - glcn酰化与各种慢性人类疾病,如糖尿病、心血管和神经退行性疾病以及癌症有关。例如,OGT促进非整倍体,通过HCF-1切割调节细胞周期,并参与代谢变化与癌变之间的调节联系[2]。人类乳腺癌和肝细胞癌(HCC)组织中可能发生OGA或OGT活性以及o - glcn酰化水平的变化[1]。癌蛋白c-MYC也被o - glcn酰化。c-MYC蛋白非常不稳定;其水平和活性受泛素化和蛋白酶体降解调控,泛素化和蛋白酶体降解由GSK3β在Thr-58位点磷酸化引发。Thr-58是调节c-MYC稳定性的OGT靶点。Thr-58位点的o - glcn酰化稳定c-MYC,促进肿瘤发生[1]。非常规折叠蛋白RPB5相互作用因子(URI)结合并调节葡萄糖浓度对OGT活性的响应。在葡萄糖存在下,URI、OGT和蛋白磷酸酶1γ (PP1γ)形成异三聚体复合物。葡萄糖剥夺诱导回缩反应,增加ATP/cAMP水平,从而激活PKA,进而使URI Ser-371位点磷酸化。磷酸化的URI将PP1γ从异三聚体复合物中释放出来,URI成为一种有效的OGT抑制剂[1]。据报道,PKA与PP1催化单元和影响葡萄糖稳态的促凋亡bcl -2相关死亡启动子(BAD)形成线粒体复合物[3]。因此,URI/OGT/PP1γ复合物可能通过包括PKA和BAD在内的线粒体超分子复合物整合葡萄糖代谢[3,4]。据报道,在BAD敲除和非磷酸化BAD(3SA)敲除小鼠中,葡萄糖剥夺引起的死亡中存在异常的糖代谢和BAD需求[3,5]。因此BAD是一个凋亡哨兵,监视葡萄糖信号。值得注意的是,在转基因小鼠模型中,OGT过表达会产生伴有胰岛素抵抗和高瘦素血症的2型糖尿病(T2D)表型[6]。此外,……
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引用次数: 2
Breast-conserving therapy versus mastectomy 保乳治疗与乳房切除术
Pub Date : 2016-12-09 DOI: 10.18632/oncoscience.331
M. V. van Maaren, P. Poortmans, S. Siesling
There is an ongoing debate regarding the use of randomised controlled trials (RCTs) versus observational studies when investigating treatment effects in clinical practice [1]. This holds especially true for the comparison of breast-conserving therapy (BCT) and mastectomy (MAST), which gained much attention since the publication of our observational study in Lancet Oncology [2]. RCTs are highly appreciated as they are close to generate perfectly unbiased treatment comparison estimates. Treatment groups in a RCT are expected to be exchangeable; even when switching the treatment between the compared groups, results will be similar and are solely the effect of the treatment under study. Clinical decisions are largely based on this type of evidence. But is this always the best evidence? Is it always feasible or ethical? In the current era of personalised medicine and 'big data', clinical interpretation of an abundance of data (clinical reasoning) is becoming more and more crucial. It integrates all available and relevant information that may contribute to the best clinical decision-making for individual patients. This generally starts with existing guidelines, completed by evidence extracted from observational studies and clinicians' experiences [3]. Importantly, the patient's preference plays an important role in (shared) decision-making. In general, it is difficult to translate the overall results of a RCT in the response of an individual patient to the investigated treatment. Even for patients with identical characteristics to those in the trial population, the overall treatment effect observed in RCTs would only apply if the probability of treatment benefit and detriment was equally distributed in every individual participant [3]. Often, evidence forming the basis of treatment guidelines are based on RCTs conducted a long time ago, while observational studies include a more recently diagnosed population. For BCT and MAST, the trials were all conducted in the eighties. Another important discrepancy between the RCT populations and the real-world population is the increasing share of elderly breast cancer patients in the latter. This is not only due to the ageing population, but also to early detection of breast cancer in the national screening program (which upper age limit is 75 years in the Netherlands), leading to a higher incidence in the elderly. Furthermore, diagnostic and surgical procedures as well as local and systemic therapies improved considerably. Moreover, increasing knowledge about the biological features of breast tumours led to the introduction of more advanced tumour-directed therapies. The combination of these improvements are very likely to …
在临床实践中调查治疗效果时,关于使用随机对照试验(RCTs)还是观察性研究一直存在争议[1]。这尤其适用于保乳治疗(breast- conservation therapy, BCT)和乳房切除术(mastectomy, MAST)的比较,自我们的观察性研究在《柳叶刀肿瘤学》(Lancet Oncology)上发表以来,这一研究备受关注[2]。随机对照试验是高度赞赏的,因为它们接近于产生完全无偏的治疗比较估计。随机对照试验中的治疗组预期是可互换的;即使在比较组之间切换治疗,结果也将是相似的,并且仅仅是所研究治疗的效果。临床决定很大程度上是基于这类证据。但这总是最好的证据吗?它是否总是可行或合乎道德?在当前个性化医疗和“大数据”时代,对大量数据的临床解释(临床推理)变得越来越重要。它整合了所有可用的和相关的信息,可能有助于个体患者的最佳临床决策。这通常从现有的指南开始,通过从观察性研究和临床医生经验中提取的证据来完成[3]。重要的是,患者的偏好在(共同)决策中起着重要作用。一般来说,很难将随机对照试验的总体结果转化为单个患者对所研究治疗的反应。即使对于与试验人群具有相同特征的患者,rct中观察到的总体治疗效果也只有在每个个体参与者中治疗获益和损害的概率均匀分布的情况下才适用[3]。通常,形成治疗指南基础的证据是基于很久以前进行的随机对照试验,而观察性研究包括最近诊断的人群。对于BCT和MAST,试验都是在80年代进行的。RCT人群与现实世界人群之间的另一个重要差异是后者中老年乳腺癌患者的比例不断增加。这不仅是由于人口老龄化,也是由于国家筛查方案对乳腺癌的早期发现(荷兰的年龄上限为75岁),导致老年人发病率较高。此外,诊断和外科手术以及局部和全身治疗也有了很大的改善。此外,对乳腺肿瘤生物学特征的了解不断增加,导致了更先进的肿瘤定向治疗的引入。这些改进的结合很可能会……
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引用次数: 5
Targeting BIP to induce Endoplasmic Reticulum stress and cancer cell death 靶向BIP诱导内质网应激和癌细胞死亡
Pub Date : 2016-12-09 DOI: 10.18632/oncoscience.330
Michaël Cerezo, R. Benhida, S. Rocchi
Melanoma is the most aggressive form of skin cancer. Recently, significant progress has emerged with the development of new strategies in melanoma treatment. We currently have specific BRAF and MAP3K/MEK inhibitors. However, after a short period of remission, melanomas acquire drug resistance and recurrence of metastases is observed in almost all cases [1]. Second, immunotherapies targeted against CTLA4 and PD1, developed to reactivate the antitumor immune response of the patient, result in an objective and long-lasting response in only approximately 30% of patients [2]. Nevertheless, more than 50% of patients are currently in treatment failure. Therefore, identification of new potential targets is an urgent need to improved melanoma treatment. One promising strategy is the targeting of the Unfolded Protein Response pathway which appears as an emerging pathway to selectively target cancer cells. Indeed, neoplasic growth requires synthesis of lot of different proteins and Unfolded Protein Response is activated to deal with the high flux of proteins processed through the Endoplasmic Reticulum to maintained homeostasis [3]. Recently, we have identified a new molecules family, Thiazole Benzensulfonamides (TZB), whose HA15 (1a) molecule appears as the lead compound, that induce an elevated and maintained Endoplasmic Reticulum stress specifically in cancer cells without any adverse events in normal cells [4] (Figure 1). Briefly, HA15 induces death of all melanoma cells independently of their mutational status and melanoma cells freshly isolated from patients both sensitive or resistant to BRAF inhibitors. HA15 exhibited also a strong efficacy in xenograft mouse models performed with melanoma cells sensitive and resistant to BRAF inhibitors without any sign of toxicity. We next performed pan-genomic, proteomic and biochemical studies to decipher the signaling pathway, the mechanism of action and the target of the best candidate. We identified BIP, an endoplasmic reticulum protein, as the specific target of our compound. We demonstrated clearly that the interaction between our compound and BIP increases Endoplasmic Reticulum Stress and leads to melanoma cell death by concomitant induction of autophagy and apoptosis mechanisms. Overexpression of target BIP in various cancers is described, it is thus not surprising that this molecule was also found to be active against other liquid and solid tumors. Taken together, our data suggest HA15 has an important impact on inhibition of melanoma growth by targeting ER stress, and may therefore be developed for treatment of melanoma and other cancers. Based on these strong data, we developed a lead optimization program in which two series of HA15 derivatives were synthesized that provided clear structure activity relationships. We then selected compound 1b as a new optimized analogue of HA15 [5]. This compound was found to be ten-fold more active then the parent compound on various cancer cell lines including melanom
黑色素瘤是最具侵袭性的皮肤癌。最近,随着黑色素瘤治疗新策略的发展,取得了重大进展。我们目前有特异性的BRAF和MAP3K/MEK抑制剂。然而,在短暂的缓解期后,黑色素瘤获得耐药性,几乎所有病例都观察到转移瘤的复发[1]。其次,针对CTLA4和PD1的免疫疗法,旨在重新激活患者的抗肿瘤免疫反应,仅在约30%的患者中产生客观且持久的反应[2]。然而,超过50%的患者目前治疗失败。因此,发现新的潜在靶点是改善黑色素瘤治疗的迫切需要。一种有前景的策略是靶向未折叠蛋白反应途径,这是一种选择性靶向癌细胞的新兴途径。事实上,肿瘤生长需要合成许多不同的蛋白质,而未折叠的蛋白质反应被激活,以应对通过内质网加工的高通量蛋白质,以维持体内平衡[3]。最近,我们发现了一个新的分子家族,噻唑苯磺酰胺(TZB),其HA15 (1a)分子作为先导化合物,在癌细胞中特异性诱导内质网应激升高和维持,而在正常细胞中没有任何不良事件[4](图1)。简而言之,HA15诱导所有黑色素瘤细胞死亡,而不依赖于其突变状态,以及从对BRAF抑制剂敏感或耐药的患者中新分离的黑色素瘤细胞。HA15在黑色素瘤细胞对BRAF抑制剂敏感和耐药的异种移植小鼠模型中也表现出很强的疗效,没有任何毒性迹象。接下来,我们进行了泛基因组学、蛋白质组学和生化研究,以破译信号通路、作用机制和最佳候选物的靶标。我们确定了BIP,一种内质网蛋白,作为我们化合物的特定靶标。我们清楚地证明,我们的化合物和BIP之间的相互作用增加内质网应激,并通过同时诱导自噬和凋亡机制导致黑色素瘤细胞死亡。靶BIP在各种癌症中的过表达被描述,因此发现该分子对其他液体和实体肿瘤也有活性也就不足为奇了。综上所述,我们的数据表明,HA15通过靶向内质网应激对抑制黑色素瘤生长有重要影响,因此可能被开发用于治疗黑色素瘤和其他癌症。基于这些强有力的数据,我们开发了一个先导优化程序,其中合成了两个系列的HA15衍生物,提供了明确的结构活性关系。然后我们选择化合物1b作为HA15的新优化类似物[5]。这种化合物在包括黑色素瘤在内的各种癌细胞系上的活性是母体化合物的十倍。此外,这种优化后的铅还对一组对标准治疗有抗性的癌细胞表现出很强的活性,并证明在低微摩尔范围内具有活性。此外,1b在体内显著延缓肿瘤生长,小鼠对该化合物表现出较高的耐受性。我们还证实,该化合物通过直接靶向BiP蛋白和诱导细胞死亡(伴随诱导自噬和凋亡机制)保持与HA15相似的作用模式。此外,HA15和1b显著的体内疗效和无毒性使得这类分子作为化学生物学研究凋亡和自噬信号传导以及临床应用的工具特别有趣。有趣的是,我们观察到TZB在癌细胞中诱导强烈的内质网应激导致细胞死亡,而在正常细胞中仅诱导适度的内质网应激而不诱导细胞死亡。这种差异效应可能是由于癌细胞与正常细胞相比,内质网应激升高导致癌细胞对内质网稳态扰动更敏感。事实上,BiP水平与黑色素瘤患者的进展、肿瘤大小和预后不良呈正相关[6]。综上所述,这些研究强调了未折叠蛋白反应在黑色素瘤中的关键作用,并加强了这样一种观点,即像BiP这样的靶向蛋白伴侣可能是各种癌症的有用替代治疗方法,尤其是这种新型化合物。
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引用次数: 6
Eradication of CML stem cells 根除CML干细胞
Pub Date : 2016-11-23 DOI: 10.18632/oncoscience.327
B. Carter, M. Andreeff
Bcr-Abl tyrosine kinase inhibitors (TKIs) have become the standard of care for patients with chronic myeloid leukemia (CML). Indeed, patients experience high response rates and long-term survival with continuous TKI treatment. However, TKIs rarely cure CML due to their inability to target CML stem cells. Consequently, CML will soon become the most prevalent leukemia with 100,000 patients in the U.S. alone. Long-term treatment with TKIs is extremely expensive, associated with side effects, and development of resistance in some patients. Resistance can fuel the progression to blast crisis (BC), which is associated with almost complete chemo-resistance and extremely poor treatment outcome. During the last decade, significant insights into CML stem cell biology and mechanisms of TKI resistance were gained leading to the development of combinatorial strategies to target CML stem/progenitor cells and to overcome TKI resistance [1,2]. We and others have established Bcl-2 family proteins as key apoptosis regulators and specifically anti-apoptotic Bcl-2 proteins as crucial survival factors for myeloid leukemia cells and stem/progenitor cells. Inhibition of anti-apoptotic Bcl-2 proteins with dual Bcl-2/Bcl-xL or pan-Bcl-2 inhibitors was shown to target CML stem/progenitor cells and enhance the therapeutic efficacy of TKIs [3,4]. The tumor suppressor p53 regulates apoptosis primarily by transcriptional activation of pro-apoptotic Bcl-2 family proteins. Although frequently mutated in solid tumors, p53 mutations are rare in CML. We demonstrated that the activation of p53 via inhibition of its negative regulator, MDM2, in combination with TKIs synergistically targeted quiescent CD34 + BC CML cells [5], and Holyoake recently reported that dual targeting of p53 and c-MYC selectively eliminated CML stem cells [6]. To improve specificity and efficacy, and minimize toxicity, it is important to recognize which Bcl-2 proteins are indispensable for CML stem cell survival. Until recently, most Bcl-2 inhibitors were relatively non-specific and targeted several Bcl-2 proteins. Furthermore, our knowledge of the expression of Bcl-2 family members in hematopoietic and CML stem/progenitor cells is essentially limited to RNA, not protein levels, primarily because stem/progenitor cells account for only a very small portion of total bone marrow (BM) cells. CyTOF (" cytometry by time-of-flight ") combines mass spectrometry and flow cytometry and constitutes a novel single cell proteomics system that can determine the expression of currently over 40 (potentially 120) cell surface and intracellular proteins simultaneously without the spectral overlap, and therefore able to determine the expression of multiple proteins/phosphoproteins in a phenotypically well-defined cell population. Using CyTOF, and an inducible …
Bcr-Abl酪氨酸激酶抑制剂(TKIs)已成为慢性髓性白血病(CML)患者的标准治疗。事实上,患者在持续TKI治疗中获得了高有效率和长期生存率。然而,由于TKIs不能靶向CML干细胞,因此很少能治愈CML。因此,CML将很快成为最普遍的白血病,仅在美国就有10万名患者。长期使用tki治疗非常昂贵,并且伴有副作用,一些患者还会产生耐药性。耐药可加速发展为blast危象(BC),这与几乎完全的化疗耐药和极差的治疗结果有关。在过去的十年中,对CML干细胞生物学和TKI耐药机制的深入研究导致了针对CML干细胞/祖细胞的组合策略的发展,并克服了TKI耐药[1,2]。我们和其他人已经确定Bcl-2家族蛋白是关键的凋亡调节因子,特别是抗凋亡Bcl-2蛋白是髓系白血病细胞和干细胞/祖细胞的关键存活因子。双Bcl-2/Bcl-xL或泛Bcl-2抑制剂抑制抗凋亡Bcl-2蛋白可靶向CML干细胞/祖细胞并增强TKIs的治疗效果[3,4]。肿瘤抑制因子p53主要通过促凋亡Bcl-2家族蛋白的转录激活来调节细胞凋亡。尽管p53在实体瘤中经常发生突变,但在CML中很少发生突变。我们证明了p53通过抑制其负调节因子MDM2激活,与TKIs联合靶向静止CD34 + BC CML细胞[5],Holyoake最近报道了p53和c-MYC的双重靶向选择性地消除CML干细胞[6]。为了提高特异性和疗效,减少毒性,认识哪些Bcl-2蛋白对CML干细胞存活是必不可少的是很重要的。直到最近,大多数Bcl-2抑制剂都是非特异性的,并且针对几种Bcl-2蛋白。此外,我们对Bcl-2家族成员在造血和CML干细胞/祖细胞中的表达的了解基本上局限于RNA水平,而不是蛋白质水平,主要是因为干细胞/祖细胞只占骨髓细胞总数的很小一部分。CyTOF(“飞行时间细胞术”)结合了质谱法和流式细胞术,构成了一种新的单细胞蛋白质组学系统,可以同时测定目前超过40种(可能120种)细胞表面和细胞内蛋白质的表达,而不存在光谱重叠,因此能够测定表型明确的细胞群中多种蛋白质/磷酸化蛋白的表达。利用细胞of和诱导…
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引用次数: 2
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Oncoscience
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