非小细胞肺癌EGFR-TKIs治疗及PET分子成像的研究进展

表皮生长因子受体(epithelial growth factor receptor,EGFR)信号转导通路在非小细胞肺癌(Non-Small Cell Lung Cancer,NSCLC)中发挥重要作用,尤其胞内酪氨酸激酶结构域的突变状态决定了目前NSCLC的靶向治疗。针对EGFR突变的分子靶向药物表皮生长因子受体酪氨酸激酶抑制剂(epithelial growth factor receptor tyrosine kinase inhibitors,EGFR-TKIs)已开发并应用于NSCLC的治疗。在治疗过程中,EGFR的突变状态随时间发生动态变化,因此精准掌握EGFR的突变状态是靶向治疗方案制定、优化的关键。PET分子成像可在细胞和分子水平,对在体生物活动的发生、发展过程进行实时成像,使实时、在体揭示EGFR的突变状态成为可能。因此,多种以TKIs为前体标记放射性核素作为靶向肿瘤突变EGFR胞内段分子成像探针的研究逐渐增多。本文就EGFR-TKIs在NSCLC治疗及相关PET分子成像方面的研究进展进行综述。     

EGFR家族受体的分子结构与药物作用机制

表皮生长因子受体(EGFR)及其同源蛋白HER2,HER3,HER4是调控细胞生长与分化的重要酪氨酸激酶受体.这些受体的突变或过表达将会引起激酶活性的失调,并导致包括肺癌与乳腺癌在内的各种癌症.因此,这些受体是治疗癌症的重要药物靶点.虽然目前对于EGFR激酶突变所引起的激酶活性失调及其致癌机制已有较深入的研究,但对于由EGFR或HER2过表达所引发的跨膜信号变化,相应的分子结构,以及由此导致的癌症发生与耐药性产生的分子机制则均不甚明了,在临床上也缺乏有效的靶向性药物或治疗窗口.本文将对EGFR家族受体的分子结构、跨膜信号传导机制,以及EGFR靶向药物的研究进行回顾和展望.     

基于PCR的KRAS基因突变检测研究进展

体细胞基因的突变是癌症预后和治疗疗效预测的一类生物标记物,服务于分子靶向治疗。在化疗无效的结直肠癌患者中,针对EGFR的靶向治疗药物近年来取得了较为重大的进展。但携带有KRAS第2号外显子密码子12和13突变的患者对EGFR靶向药物耐药,其可作为EGFR靶向治疗的预测因子。本文就KRAS突变检测的研究现状作一回顾。     

VEGF靶向分子探针的制备及对卵巢癌细胞SKOV3体外成像的初步研究

目的:制备分子探针VEGF-USPIO和研究其在体外对卵巢癌细胞的靶向成像作用。方法:采用化学偶联法将VEGF抗体与USPIO连接,构建成具有免疫活性的靶向分子探针VEGF-USPIO。用CCK-8法检测该探针对卵巢癌细胞株SKOV3细胞活性的影响;普鲁士蓝染色法检测细胞磁性标记情况,并对经过标记的细胞进行体外磁共振成像,观察其对磁共振信号强度的影响。结果:成功合成了分子靶向探针VEGF-USPIO;当探针浓度在60μg/mL及以下时对细胞活性无影响(P0.05);细胞普鲁士蓝染色结果显示标记了靶向探针VEGF-USPIO的细胞其胞膜及胞浆含铁颗粒沉积较多;细胞体外磁共振成像结果显示经靶向探针标记的细胞,T2WI信号强度较未标记探针的对照组细胞降低(P0.05)。结论:所合成的VEGF-USPIO通过磁共振信号强度的变化实现MRI成像。     

基于金属配合物的生物小分子发光探针研究进展

生物体内存在各种内源性活性物质,帮助生物进行信号传递与代谢调控。正常条件下,细胞环境不断变化,内源性小分子的时 空分布在生物体内保持动态平衡。但当它们的种类和浓度超过生理过程所需的限定范围时,就会影响细胞活性,进而导致疾病,甚至 是肿瘤和癌症的发生。因此,这些活性物质在体内活动的实时追踪及可视化对人们理解生命现象、研究疾病发生机制十分重要。与传 统有机染料相比,金属配合物发光(荧光/磷光)探针因光稳定性好、生理功能易调控等优势,已成为生物体系小分子活性物质示踪和 成像的研究热点。依照不同的作用靶点,对应用于生物体系的金属配合物探针的最新进展进行分类和总结,并展望金属配合物在生物 成像中的未来应用,以期可以为人们继续设计出新的具有良好示踪成像性能金属配合物探针提供参考,并从分子水平理解探针作用及 癌症治疗的机制。     

新型小分子酪氨酸激酶抑制剂NXGH/NXGF对不同肺癌细胞的敏感性研究

目的:研究新型小分子酪氨酸激酶抑制剂NXGH和NXGF对不同EGFR表达水平及突变状态肺癌细胞的敏感性,为构建EGFR分子分型成像探针提供参考依据。方法:构建基于NXG结构的新型小分子酪氨酸激酶抑制剂NXGH和NXGF,选择4种不同EGFR表达水平及突变状态肺癌细胞:PC9(EGFR 19外显子缺失突变)、H1975(EGFR L858R突变合并T790M二次突变)、H358(EGFR野生型表达)及H520(EGFR阴性表达),应用MTT方法分析梯度浓度NXGH及NXGF 48 h时间点对4种肺癌细胞的抑制作用,分别计算IC_(50)及细胞存活率,比较NXGH及NXGF对不同肺癌细胞的敏感性。结果:NXGH作用下,PC9、H358、H520、H1975肺癌细胞IC_(50)分别是0.675μmo L·L~(-1)、12.097μmo L·L~(-1)、11.368μmo L·L~(-1)和0.981μmo L·L~(-1),NXGH浓度为1.25、2.5和5μmo L·L~(-1)时,PC9和H1975细胞的IC_(50)低于H358和H520(P0.05)。NXGF作用下,PC9、H358、H520、H1975肿瘤细胞IC_(50)分别是0.685μmo L·L~(-1)、4.265μmo L·L~(-1)、3.097μmo L·L~(-1)和0.331μmo L·L~(-1),NXGF浓度为1.25、2.5μmo L·L~(-1)时,PC9和H1975的IC_(50)低于H358和H520(P0.05)。结论:本实验室设计构建的新型小分子酪氨酸激酶抑制剂NXGH和NXGF对不同EGFR表达水平和突变状态的肺癌细胞均有较高亲和性,且低浓度时对EGFR突变型更敏感。     

~(18)F标记表皮生长因子受体酪氨酸激酶抑制剂4-苯氨基-喹唑啉类方法进展

分子成像可在活体状态下直观判断分子靶向药物靶位点存在状态,分子靶向药物与靶位点结合率及精确监测分子靶向药物的治疗疗效,为临床治疗方案的选择和调整提供依据。EGFR是多种恶性肿瘤的关键靶点。研究表明放射性核素标记的表皮生长因子酪氨酸激酶抑制剂是很有潜力的成像探针,其中尤以4-苯氨基-喹唑啉类研究最为广泛。本文简要介绍4-苯氨基-喹唑啉不同衍生物的结构及性质。阐述了18F标记4-苯氨基-喹唑啉类的主要方法:先用18F标记苯氨基,然后将18F标记化合物与喹唑啉或衍生物进行连接,和18F标记喹唑啉或其衍生物,然后与苯胺或其衍生物进行连接。并且进一步比较不同示踪剂在体外、动物和人体内生物分布、肿瘤摄取和代谢的异同。特别是对18F标记示踪剂与11C标记示踪剂在动物和人体分布进行比较。尤其是[18F]ML04肝脏摄取低,肿瘤-本底高,多数学者认为[18F]ML04是最有潜力成为18F标记表皮生长因子受体酪氨酸激酶抑制剂4-苯氨基-喹唑啉类示踪剂。     

以EGFR为靶点的肿瘤分子靶向药物研究进展

随着分子生物学研究的进展,分子靶向治疗已成为除手术、放疗、化疗之外的第4种治疗方法,越来越多的用于临床治疗恶性肿瘤。分子靶向药物进入体内能够特异地选择致癌位点,杀伤肿瘤细胞,而不会波及周围正常的组织细胞,因此分子靶向治疗又被称为"生物导弹"。与传统化疗药物相比,分子靶向药物具有特异性强、疗效明显、副作用少等优点。按照分子靶向药物的性质主要归为两大类:一类是单克隆抗体,如西妥昔单抗等;另一类是单靶点或多靶点的小分子抑制剂,如吉非替尼等。表皮生长因子受体(EGFR)对肿瘤的生长、发展以及肿瘤干细胞的维持都有着非常重要的作用,并且在多种实体瘤中存在过表达或异常表达,因此在肿瘤治疗中,EGFR成为一个非常重要的用药靶点。现主要对目前国内已上市的针对EGFR的分子靶向药物最新的临床研究进展作一简要综述。     

^18F标记表皮生长因子受体酪氨酸激酶抑制剂4-苯氨基-喹唑啉类方法进展

分子成像可在活体状态下直观判断分子靶向药物靶位点存在状态,分子靶向药物与靶位点结合率及精确监测分子靶向药物的治疗疗效,为临床治疗方案的选择和调整提供依据。EGFR是多种恶性肿瘤的关键靶点。研究表明放射性核素标记的表皮生长因子酪氨酸激酶抑制剂是很有潜力的成像探针,其中尤以4-苯氨基．喹唑啉类研究最为广泛。本文简要介绍4-苯氨基-喹唑啉不同衍生物的结构及性质。阐述了^18F标记4-苯氨基．喹唑啉类的主要方法：先用^18F标记苯氨基,然后将^18F标记化合物与喹唑啉或衍生物进行连接,和^18F标记喹唑啉或其衍生物,然后与苯胺或其衍生物进行连接。并且进一步比较不同示踪剂在体外、动物和人体内生物分布、肿瘤摄取和代谢的异同。特别是对^18F标记示踪剂与11c标记示踪剂在动物和人体分布进行比较。尤其是[^18F]ML04肝脏摄取低,肿瘤．本底高,多数学者认为[^18F]ML04是最有潜力成为^18F标记表皮生长因子受体酪氨酸激酶抑制剂4-苯氨基-喹唑啉类示踪剂。     

超顺磁氧化铁纳米探针用于磁共振分子成像的研究进展

分子影像学是近年来分子生物学和影像学相结合而形成的新型交叉学科,磁共振分子成像技术是分子影像学的重要手段之一,为临床医学诊断提供重要依据。但是由于不同组织之间的弛豫时间相互重叠等问题,导致较小的病变难以显示,磁共振造影剂能提高对软组织的分辨率,其中超顺磁性氧化铁纳米探针作为近年来发展起来的一种新型磁共振分子造影剂。由于具有敏感性、安全性、大的比表面积、高稳定性、靶向性等优点,近年来已成为国内外研究的热点之一。本文就超顺磁性氧化铁纳米探针的增强原理、制备工艺及靶向作用做一综述,以期为该技术的应用与研究提供借鉴和启示。     

Licochalcone A inhibits EGFR signalling and translationally suppresses survivin expression in human cancer cells

Dysfunction of epidermal growth factor receptor (EGFR) signalling plays a critical role in the oncogenesis of non–small-cell lung cancer (NSCLC). Here, we reported the natural product, licochalcone A, exhibited a profound anti-tumour efficacy through directly targeting EGFR signalling. Licochalcone A inhibited in vitro cell growth, colony formation and in vivo tumour growth of either wild-type (WT) or activating mutation EGFR-expressed NSCLC cells. Licochalcone A bound with L858R single-site mutation, exon 19 deletion, L858R/T790M mutation and WT EGFR ex vivo, and impaired EGFR kinase activity both in vitro and in NSCLC cells. The in silico docking study further indicated that licochalcone A interacted with both WT and mutant EGFRs. Moreover, licochalcone A induced apoptosis and decreased survivin protein robustly in NSCLC cells. Mechanistically, we found that treatment with licochalcone A translationally suppressed survivin through inhibiting EGFR downstream kinases ERK1/2 and Akt. Depletion of the translation initiation complex by eIF4E knockdown effectively inhibited survivin expression. In contrast, knockdown of 4E-BP1 showed the opposite effect and dramatically enhanced survivin protein level. Overall, our data indicate that targeting survivin might be an alternative strategy to sensitize EGFR-targeted therapy.     

Primary and acquired resistance to anti-EGFR targeted drugs in cancer therapy

In recent years, the epidermal growth factor receptor (EGFR) has been recognized as a central player and regulator of cancer cell proliferation, apoptosis and angiogenesis and, therefore, as a potentially relevant therapeutic target. Several strategies for EGFR targeting have been developed, the most succesful being represented by monoclonal antibodies, that directly interfere with ligand-receptor binding and small molecule tyrosine kinase inhibitors, that interfere with activation/phosphorylation of EGFR. These agents have been authorized in advanced chemorefractory cancers, including colorectal cancer, non-small-cell lung cancer and head and neck cancer. However, evidence of resistance to these drugs has been described and extensive studies have been performed to investigate whether resistance to EGFR-targeted therapy is primary or secondary. Cellular levels of EGFR do not always correlate with response to the EGFR inhibitors. Indeed, in spite of the over expression and efficient inhibition of EGFR, resistance to EGFR inhibitors may occur. Moreover, given the genetic instability of cancer cells, genetic modifications could enable them to acquire a resistant phenotype to anti-EGFR therapies. Taken together, these findings support the importance of understanding the molecular mechanisms affecting cancer cell sensitivity or resistance to such inhibitors. This review will focus on the most relevant mechanisms contributing to the acquisition of sensitivity/resistance to EGFR inhibitors.     

The RAS paradox of the EGFR-targeted therapy in colorectal cancer

During the carcinogenesis of colorectal cancer in about half of the cases K-RAS, while much less frequently B-RAF mutation occur in early adenomas. While K-RAS mutant tumors are more likely present in male patients, B-RAF mutant tumors develop more frequently in females and are independent of the microsatellite status. Colorectal cancers are characterized by EGFR expression; the gene is not mutated, rarely amplified and increased copy number is due to chromosomal polysomy. This phenotype/genotype of colorectal cancer lent support to the introduction of anti-EGFR antibody therapies. For a while positive EGFR expression status of the tumor was the basis of patient selection for these targeted therapies in colorectal cancer. Monotherapies with the two available anti-EGFR antibodies of chemoresistant colorectal cancers resulted in appr. 10% objective response rate, which was independent of the level of EGFR expression. In case of panitumumab it was discovered that the efficacy of this targeted therapy depends on the K-RAS mutant status of the tumors. Furthermore, preliminary data suggest that cetuximab combined with chemotherapy is effective also exclusively in K-RAS wild-type tumors. Based on these data it is safe to say that K-RAS mutant status of colorectal cancer is a negative predictor for EGFR-targeted therapies of colorectal cancer. Accordingly, it is necessary to determine the K-RAS status of colorectal cancer before making therapeutic decisions.     

ANXA2 could act as a moderator of EGFR-directed therapy resistance in triple negative breast cancer

Triple negative breast cancer (TNBC) patients cannot benefit from EGFR-targeted therapy even though the EGFR is highly expressed, because patients exhibit resistance to these drugs. Unfortunately, the molecular mechanisms remain relatively unknown. ANXA2, highly expressed in invasive breast cancer cells, is closely related with poor prognosis, and acts as a molecular switch to EGFR activation. In this study, MDA-MB-231 cells and MCF7 cells were used. Our results showed that ANXA2 expression is inversely correlated with cell sensitivity to gefitinib. Knockdown of ANXA2 expression in MDA-MB-231 cells increased the gefitinib induced cell death. When ANXA2 was overexpressed in MCF7 cells, the gefitinib induced cell death was decreased. Furthermore, we demonstrated that phosphorylation of ANXA2 at Tyr23 is negatively correlated with the sensitivity of TNBC to gefitinib. Altogether, our results suggest a new role of ANXA2 in regulating sensitivity of TNBC MDA-MB-231 cells to the EGFR inhibitor gefitinib.     

Loss of desmoglein-2 promotes gallbladder carcinoma progression and resistance to EGFR-targeted therapy through Src kinase activation

Gallbladder carcinoma (GBC) exhibits poor prognosis due to local recurrence, metastasis, and resistance to targeted therapies. Using clinicopathological analyses of GBC patients along with molecular in vitro and tumor in vivo analysis of GBC cells, we showed that reduction of Dsg2 expression was highly associated with higher T stage, more perineural, and lymphatic invasion. Dsg2-depleted GBC cells exhibited significantly enhanced proliferation, migration, and invasiveness in vitro and tumor growth and metastasis in vivo through Src-mediated signaling activation. Interestingly, Dsg2 binding inhibited Src activation, whereas its loss activated cSrc-mediated EGFR plasma membrane clearance and cytoplasmic localization, which was associated with acquired EGFR-targeted therapy resistance and decreased overall survival. Inhibition of Src activity by dasatinib enhanced therapeutic response to anti-EGFR therapy. Dsg2 status can help stratify predicted patient response to anti-EGFR therapy and Src inhibition could be a promising strategy to improve the clinical efficacy of EGFR-targeted therapy.Subject terms: Tumour biomarkers, Tumour-suppressor proteins     

Therapeutic efficacy and safety of paclitaxel/lonidamine loaded EGFR-targeted nanoparticles for the treatment of multi-drug resistant cancer

The treatment of multi-drug resistant (MDR) cancer is a clinical challenge. Many MDR cells over-express epidermal growth factor receptor (EGFR). We exploit this expression through the development of EGFR-targeted, polymer blend nanocarriers for the treatment of MDR cancer using paclitaxel (a common chemotherapeutic agent) and lonidamine (an experimental drug; mitochondrial hexokinase 2 inhibitor). An orthotopic model of MDR human breast cancer was developed in nude mice and used to evaluate the safety and efficacy of nanoparticle treatment. The efficacy parameters included tumor volume measurements from day 0 through 28 days post-treatment, terminal tumor weight measurements, tumor density and morphology assessment through hematoxylin and eosin staining of excised tumors, and immunohistochemistry of tumor sections for MDR protein markers (P-glycoprotein, Hypoxia Inducible Factor, EGFR, Hexokinase 2, and Stem Cell Factor). Toxicity was assessed by tracking changes in animal body weight from day 0 through 28 days post-treatment, by measuring plasma levels of the liver enzymes ALT (Alanine Aminotransferase) and LDH (lactate dehydrogenase), and by white blood cell and platelet counts. In these studies, this nanocarrier system demonstrated superior efficacy relative to combination (paclitaxel/lonidamine) drug solution and single agent treatments in nanoparticle and solution form. The combination nanoparticles were the only treatment group that decreased tumor volume, sustaining this decrease until the 28 day time point. In addition, treatment with the EGFR-targeted lonidamine/paclitaxel nanoparticles decreased tumor density and altered the MDR phenotype of the tumor xenografts. These EGFR-targeted combination nanoparticles were considerably less toxic than solution treatments. Due to the flexible design and simple conjugation chemistry, this nanocarrier system could be used as a platform for the development of other MDR cancer therapies; the use of this system for EGFR-targeted, combination paclitaxel/lonidamine therapy is an advance in personalized medicine.     

Can EGFR be a therapeutic target in breast cancer?

Epidermal growth factor receptor (EGFR) is highly expressed in certain cancer types and is involved in regulating the biological characteristics of cancer progression, including proliferation, metastasis, and drug resistance. Various medicines targeting EGFR have been developed and approved for several cancer types, such as lung and colon cancer. To date, however, EGFR inhibitors have not achieved satisfactory clinical results in breast cancer, which continues to be the most serious malignant tumor type in females. Therefore, clarifying the underlying mechanisms related to the ineffectiveness of EGFR inhibitors in breast cancer and developing new EGFR-targeted strategies (e.g., combination therapy) remain critical challenges. Various studies have demonstrated aberrant expression and maintenance of EGFR levels in breast cancer. In this review, we summarize the regulatory mechanisms underlying EGFR protein expression in breast cancer cells, including EGFR mutations, amplification, endocytic dysfunction, recycling acceleration, and degradation disorders. We also discuss potential therapeutic strategies that act directly or indirectly on EGFR, including reducing EGFR protein expression, treating the target protein to mediate precise clearance, and inhibiting non-EGFR signaling pathways. This review should provide new therapeutic perspectives for breast cancer patients with high EGFR expression.