CDK 抑制剂在抗肿瘤领域的研发进展

细胞周期蛋白依赖性激酶（cyclin dependent kinase，CDK）为细胞周期调节的关键激酶，参与细胞增殖、转录、存活等生理过程。 CDK 在多种肿瘤中异常活化，是抗肿瘤药物研发的重要靶点之一。目前已有 1 个 CDK 抑制剂（palbociclib, CDK4/CDK6 抑制剂）被美国 食品药品监督管理局批准于 2015 年上市，数十个 CDK 抑制剂处于针对实体瘤和血液系统肿瘤的临床或临床前研究阶段。综述目前抗肿瘤 领域 CDK 抑制剂的研发现状、遇到的问题和可能的解决方案，并讨论其临床应用的可能。     

CDK16在人类癌症中的作用与机制

细胞周期蛋白依赖性激酶16(cyclin-dependent kinase 16,CDK16)是细胞周期蛋白依赖性激酶(cyclin-dependent kinase,CDK)家族中重要的成员之一,参与了一系列生物学过程,包括调控细胞的周期进程、肿瘤转移、凋亡、代谢和自噬等。CDK16在肿瘤的发生发展中起到重要的调控作用,包括肝癌、乳腺癌、肺癌、肠癌等。因此,CDK16在肿瘤早期诊断、预后、靶向治疗等方面具有巨大的临床应用潜力。本文就CDK16在人类癌症中的作用及机制进行综述,并对靶向CDK16在临床的应用展开讨论。     

周期蛋白和周期蛋白依赖性激酶及相关激酶抑制剂在细胞周期进程中的调控机制研究进展

在细胞发育过程中,细胞周期起着至关重要的作用。细胞周期进程主要受细胞周期蛋白依赖性激酶(cyclin dependent kinase, CDK)、周期蛋白和内源性CDK抑制剂(cyclin-dependent kinase inhibitors,CKI)调控。其中,CDK是主要的细胞周期调节因子,可与周期蛋白结合形成周期蛋白-CDK复合物,从而使数百种底物磷酸化,调控分裂间期和有丝分裂进程。各类细胞周期蛋白的活性异常,可引起不受控制的癌细胞增殖,导致癌症的发生与发展。因此,了解CDK的活性变化情况、周期蛋白-CDK的组装以及CKI的作用,将有助于了解细胞周期进程中潜在的调控过程,为癌症与疾病的治疗和CKI治疗药物的研发提供基础。本文关注了CDK激活和灭活的关键事件,并总结了周期蛋白-CDK在特定时期及位置的调控过程,以及相关CKI治疗药物在癌症及疾病中的研究进展,最后简单阐述了细胞周期进程研究面临的问题和存在的挑战,以期为后续细胞周期进程的深入研究提供参考和思路。     

抗乳腺癌新药 palbociclib

Palbociclib 是 2015 年 2 月 3 日获美国食品药品监督管理局加速批准的乳腺癌新药,联合来曲唑作为以内分泌治疗为基础的初 始方案,用于治疗绝经期女性雌激素受体阳性（ER+）、人表皮生长因子受体 2 阴性（HER2-）的绝经期女性晚期乳腺癌。Palbociclib 是首个口服、靶向性 CDK4/6 抑制剂,阻止细胞周期从生长期（G1 期）到 DNA 复制期（S1 期）的转变,从而抑制肿瘤增殖,其上市为 晚期乳腺癌患者提供了新的治疗选择。介绍 palbociclib 的化学合成、临床前药理学研究、临床研究及专利保护情况等 , 为抗乳腺癌新药 研发提供参考。     

CDK2在肿瘤中的非细胞周期功能

细胞周期依赖性激酶(Cyclin-dependent kinases,CDKs)是真核生物细胞周期有序驱动的核心调控子,CDK2作为CDK家族成员,调控细胞周期G1-S期和S-G2期的转变。近年来研究表明,CDK2在哺乳动物细胞周期调控中的作用不是必需的,但与肿瘤发生发展密切相关。CDK2参与调节多种致癌信号通路,其含量或活性失调常常导致肿瘤细胞失控性增殖,影响肿瘤细胞分化、衰老、凋亡、染色体不稳定等多种生物学功能。该文综述了CDK2在肿瘤中的非细胞周期功能。     

p-MAPK、CyclinD1和CDK4蛋白在大肠癌中的表达及相关性

目的 检测p-MAPK、CyclinD1和CDK4蛋白在大肠癌中的表达,并探讨其相关性.方法 选取78例大肠癌组织,距癌灶3 cm以外的癌旁组织,进行组织切片,HE染色进行病理分型,应用S-P免疫组化法对组织中的p-MAPK、Cyclin D1和CDK4进行检测.结果 病理分型后,78例大肠癌中p-MAPK、CyclinD1和CDK4蛋白的阳性表达率分别为67.9 %（53/78）、57.7 %（45/78）和39.7 %（31/78）;78例相应癌旁组织中阳性表达率分别为6.4 %（5/78）、10.3 %（8/78）和19.2 %（15/78）.三者阳性表达率和阳性强度均以大肠癌中为高（P＜0.01）;大肠癌中p-MAPK与CyclinD1表达呈明显正相关（P＜0.01）,而与CDK4蛋白表达无明显相关性（P＞0.05）,CyclinD1和CDK4表达呈正相关（P＜0.05）,RT-PCR检测结果与免疫组化相似,p-MAPK、CyclinD1和CDK4蛋白的阳性表达率分别为8.2 %（61/78）、67.9 %（53/78）和53.8 %（42/78）;相应癌旁组织中阳性表达率分别为3.8 %（3/78）、2.6 %（2/78）和6.4 %（5/78）.结论 MAPK活化可能是cylinD1激活的原因之一,并在大肠癌发生过程中可能起重要作用;而Cyclin D1 在细胞周期中可与CDK4 结合,从而促进细胞周期进程.     

人细胞周期蛋白D1/CDK4基因的真核表达及生物活性鉴定

通过生物工程获得人重组细胞周期蛋白 (cyclinD1 )及细胞周期蛋白激酶CDK4蛋白 ,作为抗癌药物筛选的分子靶点 .从人HL 6 0细胞中获得细胞周期蛋白D1 CDK4基因的cDNA ,先克隆至pGEMT Easy载体上 ,再经重组构建供体质粒pFastBac D1和pFastBac CDK4 .重组供体质粒转化感受态DH1 0Bac细胞 ,挑取确证为白色克隆的菌落振荡培养 ,分离制备高纯度杆粒DNA .以重组病毒适量感染昆虫细胞Tn 5B1 4 ,利用Bac to Bac杆状病毒表达系统在昆虫细胞Tn 5B1 4 (Hi5 )中表达相应的重组蛋白 .应用昆虫杆状病毒表达系统 (Bac to Bac)在昆虫细胞Tn 5B1 4中分别高效表达了人细胞周期蛋白D1和CDK4蛋白 .SDS PAGE分析表明 ,表达量占细胞可溶性蛋白质的 2 0 %左右 ,表达产物经Ni2 + NTA亲和层析纯化后纯度达 85 %以上 .研究表明 ,昆虫细胞表达的细胞周期蛋白D1和CDK4蛋白能促进Rb蛋白的磷酸化 ,具有生物活性 .成功构建了细胞周期蛋白D1及CDK4真核杆状病毒表达载体 ,并且在昆虫细胞中正确表达了具有生物活性的细胞周期蛋白D1及CDK4融合蛋白 .     

RB-E2F信号通路与乳腺癌及其治疗

视网膜母细胞瘤基因（retinoblastoma gene, RB1）突变或调节CDK-RB-E2F通路其他成分的突变存在于几乎所有人类恶性肿瘤中。因此,通过抑制细胞周期蛋白激酶（CDK）来实现对细胞周期的调控,在肿瘤治疗中越来越显示出其优势。目前,CDK4/6抑制剂帕博西尼（palbociclib）联合芳香酶抑制剂,治疗ER 阳性乳腺癌是很有效的临床应用。研究显示,CDK-RB-E2F信号通路,对控制乳腺细胞增殖发挥关键作用。近期的研究结果,揭示了该通路在肿瘤发展、血管生成及转移中的作用。并且,E2Fs是不依赖于其他临床参数的乳腺癌预后指标。本综述总结了乳腺癌中RB E2F通路的最新研究进展,并且讨论应用高通量基因组学研究,筛选获得乳腺癌中CDK4/6抑制剂重要的作用靶点,旨在发展更有效的联合治疗手段。     

HMGB1对小鼠系膜细胞细胞周期及细胞周期相关蛋白表达的影响

该实验以小鼠系膜细胞MMC为研究对象,以重组HMGB1为刺激物,通过检测细胞周期的变化及细胞PCNA、CyclinD1、CDK4和p16的表达水平,初步探讨HMGB1对系膜细胞的细胞周期及其相关调控因子的影响。选取小鼠系膜细胞MMC为研究对象,随机分为对照组及0.05mg/LHMGB1刺激组,经流式细胞术检测发现HMGB1能够上调小鼠系膜细胞中S期细胞所占比例;免疫细胞化学检测显示,PCNA蛋白在小鼠系膜细胞中的表达上调;通过RT-PCR技术及Western blot技术检测到小鼠系膜细胞中CyclinD1 mRNA和蛋白以及CDK4蛋白的高表达情况,而p16蛋白的表达呈时间依赖性降低。由此可见,HMGB1可能是通过上调CyclinD1/CDK4的表达,并下调p16的表达,促进细胞从G_0/G_1期进入S期,介导了小鼠系膜细胞的异常增殖,可能是HMGB1参与狼疮性肾炎发病的可能机制之一。     

肾癌免疫治疗的研究进展CSCD

肾癌起源于肾小管上皮,恶性程度很高,患者就诊时大多已经发生转移。虽然VEGF和m TOR为主的靶向治疗大大改善了肾癌的治疗现状,但患者最终会出现耐药。幸运的是肾癌具有潜在的免疫原性,PD-1/PD-L1抑制剂、个体化疫苗和CAR-T疗法等免疫疗法显示了巨大的临床效益。而且PD-1/PD-L1抑制剂与抑制血管生成或CDK4/6抑制剂等药物联合使用可以发挥出更强的治疗效果。在肾细胞癌中针对免疫治疗靶点和肿瘤生物学的进一步研究有望提供更有效的治疗手段,改善患者预后。然而这些新的免疫疗法发挥作用的同时,随之也会带来很多毒副作用。因此探索预测治疗反应的生物标志物十分重要,可以帮助确定哪些肾细胞癌患者适合这类治疗,提高治疗效应并使毒副作用降到最低。本文就肾癌中新的免疫治疗通过不同的分子机制抑制肾癌的发展和用于治疗的靶点而展开综述。     

Targeting the cell cycle in breast cancer: towards the next phase

Deregulation of the cell cycle is a hallmark of cancer that enables limitless cell division. To support this malignant phenotype, cells acquire molecular alterations that abrogate or bypass control mechanisms in signaling pathways and cellular checkpoints that normally function to prevent genomic instability and uncontrolled cell proliferation. Consequently, therapeutic targeting of the cell cycle has long been viewed as a promising anti-cancer strategy. Until recently, attempts to target the cell cycle for cancer therapy using selective inhibitors have proven unsuccessful due to intolerable toxicities and a lack of target specificity. However, improvements in our understanding of malignant cell-specific vulnerabilities has revealed a therapeutic window for preferential targeting of the cell cycle in cancer cells, and has led to the development of agents now in the clinic. In this review, we discuss the latest generation of cell cycle targeting anti-cancer agents for breast cancer, including approved CDK4/6 inhibitors, and investigational TTK and PLK4 inhibitors that are currently in clinical trials. In recognition of the emerging population of ER+ breast cancers with acquired resistance to CDK4/6 inhibitors we suggest new therapeutic avenues to treat these patients. We also offer our perspective on the direction of future research to address the problem of drug resistance, and discuss the mechanistic insights required for the successful implementation of these strategies.     

Selective CDK6 degradation mediated by cereblon,VHL, and novel IAP-recruiting PROTACs

Inhibitors of CDK4 and CDK6 have emerged as important FDA-approved treatment options for breast cancer patients. The properties and pharmacology of CDK4/6 inhibitor medicines have been extensively profiled, and investigations into the degradation of these targets via a PROTAC strategy have also been reported. PROTACs are a novel class of small-molecules that offer the potential for differentiated pharmacology compared to traditional inhibitors by redirecting the cellular ubiquitin–proteasome system to degrade target proteins of interest. We report here the preparation of palbociclib-based PROTACs that incorporate binders for three different E3 ligases, including a novel IAP-binder, which effectively degrade CDK4 and CDK6 in cells. In addition, we show that the palbociclib-based PROTACs in this study that recruit different E3 ligases all exhibit preferential CDK6 vs. CDK4 degradation selectivity despite employing a selection of linkers between the target binder and the E3 ligase binder.     

Nafamostat mesylate overcomes endocrine resistance of breast cancer through epigenetic regulation of CDK4 and CDK6 expression

Breast cancer is common worldwide, and the estrogen receptor-positive subtype accounts for approximately 70% of breast cancer in women. Tamoxifen and fulvestrant are drugs currently used for endocrinal therapy. Breast cancer exhibiting endocrine resistance can undergo metastasis and lead to the death of breast cancer patients. Drug repurposing is an active area of research in clinical medicine. We found that nafamostat mesylate, clinically used for patients with pancreatitis and disseminated intravascular coagulation, acts as an anti-cancer drug for endocrine-resistant estrogen receptor-positive breast cancer (ERPBC). Epigenetic repression of CDK4 and CDK6 by nafamostat mesylate induced apoptosis and suppressed the metastasis of ERPBC through the deacetylation of Histone 3 Lysine 27. A combination of nafamostat mesylate and CDK4/6 inhibitor synergistically overcame endocrine resistance in ERPBC. Nafamostat mesylate might be an essential adjuvant or alternative drug for the treatment of endocrine-resistant ERPBC due to the low cost-efficiency of the CDK4/6 inhibitor.     

Immunomodulatory effects of CDK4/6 inhibitors

The dysregulation of the cell cycle is one of the hallmarks of cancer. Cyclin-dependent kinase 4 (CDK4) and CDK6 play crucial roles in regulating cell cycle and other cellular functions. CDK4/6 inhibitors have achieved great success in treating breast cancers and are currently being tested extensively in other tumor types as well. Accumulating evidence suggests that CDK4/6 inhibitors exert antitumor effects through immunomodulation aside from cell cycle arrest. Here we outline the immunomodulatory activities of CDK4/6 inhibitors, discuss the immune mechanisms of drug resistance and explore avenues to harness their immunotherapeutic potential when combined with immune checkpoint inhibitors (ICIs) or chimeric antigen receptor (CAR) T-cell therapy to improve the clinical outcomes.     

CDK4/6 inhibition antagonizes the cytotoxic response to anthracycline therapy

Triple-negative breast cancer (TNBC) is an aggressive disease that lacks established markers to direct therapeutic intervention. Thus, these tumors are routinely treated with cytotoxic chemotherapies (e.g., anthracyclines), which can cause severe side effects that impact quality of life. Recent studies indicate that the retinoblastoma tumor suppressor (RB) pathway is an important determinant in TNBC disease progression and therapeutic outcome. Furthermore, new therapeutic agents have been developed that specifically target the RB pathway, potentially positioning RB as a novel molecular marker for directing treatment. The current study evaluates the efficacy of pharmacological CDK4/6 inhibition in combination with the widely used genotoxic agent doxorubicin in the treatment of TNBC. Results demonstrate that in RB-proficient TNBC models, pharmacological CDK4/6 inhibition yields a cooperative cytostatic effect with doxorubicin but ultimately protects RB-proficient cells from doxorubicin-mediated cytotoxicity. In contrast, CDK4/6 inhibition does not alter the therapeutic response of RB-deficient TNBC cells to doxorubicin-mediated cytotoxicity, indicating that the effects of doxorubicin are indeed dependent on RB-mediated cell cycle control. Finally, the ability of CDK4/6 inhibition to protect TNBC cells from doxorubicin-mediated cytotoxicity resulted in recurrent populations of cells specifically in RB-proficient cell models, indicating that CDK4/6 inhibition can preserve cell viability in the presence of genotoxic agents. Combined, these studies suggest that while targeting the RB pathway represents a novel means of treatment in aggressive diseases such as TNBC, there should be a certain degree of caution when considering combination regimens of CDK4/6 inhibitors with genotoxic compounds that rely heavily on cell proliferation for their cytotoxic effects.     

CDK4/6 inhibition antagonizes the cytotoxic response to anthracycline therapy

Triple-negative breast cancer (TNBC) is an aggressive disease that lacks established markers to direct therapeutic intervention. Thus, these tumors are routinely treated with cytotoxic chemotherapies (e.g., anthracyclines), which can cause severe side effects that impact quality of life. Recent studies indicate that the retinoblastoma tumor suppressor (RB) pathway is an important determinant in TNBC disease progression and therapeutic outcome. Furthermore, new therapeutic agents have been developed that specifically target the RB pathway, potentially positioning RB as a novel molecular marker for directing treatment. The current study evaluates the efficacy of pharmacological CDK4/6 inhibition in combination with the widely used genotoxic agent doxorubicin in the treatment of TNBC. Results demonstrate that in RB-proficient TNBC models, pharmacological CDK4/6 inhibition yields a cooperative cytostatic effect with doxorubicin but ultimately protects RB-proficient cells from doxorubicin-mediated cytotoxicity. In contrast, CDK4/6 inhibition does not alter the therapeutic response of RB-deficient TNBC cells to doxorubicin-mediated cytotoxicity, indicating that the effects of doxorubicin are indeed dependent on RB-mediated cell cycle control. Finally, the ability of CDK4/6 inhibition to protect TNBC cells from doxorubicin-mediated cytotoxicity resulted in recurrent populations of cells specifically in RB-proficient cell models, indicating that CDK4/6 inhibition can preserve cell viability in the presence of genotoxic agents. Combined, these studies suggest that while targeting the RB pathway represents a novel means of treatment in aggressive diseases such as TNBC, there should be a certain degree of caution when considering combination regimens of CDK4/6 inhibitors with genotoxic compounds that rely heavily on cell proliferation for their cytotoxic effects.     

Design and synthesis of 4-(2,3-dihydro-1H-benzo[d]pyrrolo[1,2-a]imidazol-7-yl)-N-(5-(piperazin-1-ylmethyl)pyridine-2-yl)pyrimidin-2-amine as a highly potent and selective cyclin-dependent kinases 4 and 6 inhibitors and the discovery of structure-activity relationships

Cyclin-dependent kinases 4/6 play an important role in regulation of cell cycle, and overexpress in a variety of cancers. Up to now, new CDK inhibitors still need to be developed due to its poor selectivity. Herein we report a novel series of 4-(2,3-dihydro-1H-benzo[d]pyrrolo[1,2-a]imidazole-7-yl)-N-(5-(piperazin-1-ylmethyl)pyridine-2-yl)pyrimidin-2-amine anologues as potent CDK 4/6 inhibitors based on LY2835219 (Abemaciclib). Compound 10d, which exhibits approximate potency on CDK4/6 (IC₅₀?=?7.4/0.9?nM), has both good pharmacokinetic characters and high selectivity on CDK1 compared with LY2835219. Overall, compound 10d could be a promising candidate and a good starting point as anticancer drugs.     

CDK4/6 inhibition suppresses tumour growth and enhances the effect of temozolomide in glioma cells

In adults, glioma is the most commonly occurring and invasive brain tumour. For malignant gliomas, the current advanced chemotherapy includes TMZ (temozolomide). However, a sizeable number of gliomas are unyielding to TMZ, hence, giving rise to an urgent need for more efficient treatment choices. Here, we report that cyclin‐dependent kinases 4 (CDK4) is expressed at significantly high levels in glioma cell lines and tissues. CDK4 overexpression enhances colony formation and proliferation of glioma cells and extends resistance to inhibition of TMZ‐mediated cell proliferation and induction of apoptosis. However, CDK4 knockdown impedes colony formation and cell proliferation, and enhances sensitivity of glioma cells to TMZ. The selective inhibition of CDK4/6 impedes glioma cell proliferation and induces apoptotic induction. The selective inhibitors of CDK4/6 may enhance glioma cell sensitivity to TMZ. We further showed the possible role of RB phosphorylation mediated by CDK4 for its oncogenic function in glioma. The growth of glioma xenografts was inhibited in vivo, through combination treatment, and corresponded to enhanced p‐RB levels, reduced staining of Ki‐67 and enhanced activation of caspase 3. Therefore, CDK4 inhibition may be a favourable strategy for glioma treatment and overcomes TMZ resistance.     

Design of a brain-penetrant CDK4/6 inhibitor for glioblastoma

CDK4 and CDK6 are kinases with similar sequences that regulate cell cycle progression and are validated targets in the treatment of cancer. Glioblastoma is characterized by a high frequency of CDKN2A/CCND2/CDK4/CDK6 pathway dysregulation, making dual inhibition of CDK4 and CDK6 an attractive therapeutic approach for this disease. Abemaciclib, ribociclib, and palbociclib are approved CDK4/6 inhibitors for the treatment of HR+/HER2? breast cancer, but these drugs are not expected to show strong activity in brain tumors due to poor blood brain barrier penetration. Herein, we report the identification of a brain-penetrant CDK4/6 inhibitor derived from a literature molecule with low molecular weight and topological polar surface area (MW = 285 and TPSA = 66 Ų), but lacking the CDK2/1 selectivity profile due to the absence of a basic amine. Removal of a hydrogen bond donor via cyclization of the pyrazole allowed for the introduction of basic and semi-basic amines, while maintaining in many cases efflux ratios reasonable for a CNS program. Ultimately, a basic spiroazetidine (cpK_a = 8.8) was identified that afforded acceptable selectivity over anti-target CDK1 while maintaining brain-penetration in vivo (mouse K_p,uu = 0.20–0.59). To probe the potency and selectivity, our lead compound was evaluated in a panel of glioblastoma cell lines. Potency comparable to abemaciclib was observed in Rb-wild type lines U87MG, DBTRG-05MG, A172, and T98G, while Rb-deficient cell lines SF539 and M059J exhibited a lack of sensitivity.