奥拉帕尼对黑素瘤细胞的作用及机制研究

目的:探讨奥拉帕尼对黑素瘤细胞的作用及其机制。方法:应用不同浓度的奥拉帕尼处理黑素瘤细胞,利用CCK8检测肿瘤细胞活性。应用Western blot技术检测奥拉帕尼处理黑素瘤细胞后肿瘤细胞内凋亡及周期相关蛋白表达水平。结果:与对照组相比,5μM奥拉帕尼处理黑素瘤A2058细胞即可抑制肿瘤细胞活性(85.53±2.593)%。随着奥拉帕尼处理浓度倍增对黑素瘤细胞活性的抑制作用越强。在10μM、20μM、40μM、80μM奥拉帕尼处理浓度下,黑素瘤细胞活性分别是(68.88±1.484)%、(47.21±1.759)%、(33.04±1.261)%、(28.17±1.731)%。奥拉帕尼处理黑素瘤细胞后可促进肿瘤细胞内凋亡相关蛋白PARP1剪切体表达增加,并可抑制细胞周期相关蛋白cyclin D1的表达。结论:奥拉帕尼通过促进黑素瘤细胞凋亡及抑制肿瘤细胞周期蛋白表达的机制发挥抑制黑素瘤细胞活性的作用。     

RNA干扰抑制Beclin1基因对裸鼹鼠成纤维细胞增殖与凋亡的影响

目的应用RNA干扰技术抑制自噬调控基因Beclin 1的表达,检测Beclin 1表达对裸鼹鼠皮肤成纤维细胞增殖与凋亡的影响以及p53、BAX、Bcl2等基因表达的影响。方法分别检测裸鼹鼠成纤维细胞经饥饿、H_2O_2刺激等处理后Beclin 1的表达,然后采用设计的Beclin l基因的干扰RNA及阴性对照分别瞬时转染裸鼹鼠成纤维细胞。采用real-time PCR及Western blot法检测沉默效果后,采用CCK-1实验检测沉默后细胞增殖活性,流式细胞仪检测细胞凋亡情况,然后采用Western blot检测相关基因蛋白表达水平。结果饥饿与H_2O_2刺激均能导致Beclin 1表达水平的改变。采用gene expresso转染试剂对裸鼹鼠皮肤成纤维细胞转染效率可达到90%以上,real-time PCR及Western blot结果显示所设计的Beclin 1 siRNA可有效降低Beclin 1的表达。Beclin 1基因沉默后,裸鼹鼠皮肤成纤维细胞增殖抑制率均显著高于对照组,细胞早期凋亡与晚期凋亡率均显著升高,同时p53、BAX、Bcl2、LC3B、p-AKT、m TOR等表达量下降。结论 Beclin 1在裸鼹鼠成纤维细胞抵抗饥饿、H_2O_2刺激等过程中表达量显著变化,同时抑制Beclin 1的表达,可抑制裸鼹鼠细胞增殖,促进其凋亡,这提示Beclin 1基因对裸鼹鼠自噬、增殖、凋亡起到调控作用。     

毛蕊异黄酮抑制SIRT1促乳腺癌细胞MCF-7凋亡

目的:探讨毛蕊异黄酮促乳腺癌细胞MCF-7凋亡的机制。方法:MTT检测低、中、高(10μM,50μM,100μM)剂量的毛蕊异黄酮对细胞活力的影响;Tunel检测毛蕊异黄酮对细胞凋亡的影响;Western blot检测SIRT1,p53和cleaved caspase-3的蛋白表达;Real-time PCR检测caspase-3 mRNA的表达。结果:毛蕊异黄酮能够剂量依赖性地降低细胞活力,100μM剂量组的毛蕊异黄酮显著地促进肿瘤细胞凋亡并降低SIRT1,增加p53和cleaved caspase-3的蛋白表达。SIRT1抑制剂烟酰胺(Nicotinamide,NAM,300μM)组与毛蕊异黄酮处理组相比显著地抑制SIRT1的蛋白表达,p53和cleaved caspase-3蛋白表达水平进一步增加;SRT1720(SIRT1特异性激动剂)与毛蕊异黄酮共孵育组逆转SIRT1蛋白表达,降低p53和cleaved caspase-3的蛋白水平。结论:毛蕊异黄酮促进肿瘤细胞MCF-7的凋亡,部分可能是通过降低SIRT1的表达水平,从而增加p53和cleaved caspase-3的蛋白表达促进细胞凋亡。     

紫草素逆转埃克替尼对肺癌EGFR-TKI 耐药及其机制的研究

目的:观察紫草素联合埃克替尼对肺腺癌耐药细胞H1975增殖的影响,探讨克服耐药可能的作用机制。方法:应用MTT法检测紫草素(1.25~20μmo/L)、埃克替尼(5~100μmol/L)及两药联合干预对H1975细胞生长的抑制作用;流式细胞术观察紫草素(1.25μmol/L)、埃克替尼(10μmol/L)及联合使用对H1975凋亡作用;Western blot检测不同干预对H1975细胞EGFR、p-EGFR、AKT、p-AKT、ERK、p-ERK和凋亡相关蛋白PARP表达水平的影响。结果:MTT检测结果显示,与单药组相比,联合用药组细胞H1975增殖能力明显减弱,差异有统计学意义(P0.05);流式细胞术结果显示,联合用药组细胞的凋亡率达到(52.45±3.04)%,较紫草素组细胞凋亡率(22±1.17)%和埃克替尼处理组细胞凋亡率(15.35±5.85)%明显提高,差异有统计学意义(P0.05)。Western blot结果显示,单药组下调了p-EGFR、p-Akt蛋白水平的表达,而联合用药组显著抑制了p-ERK、PARP蛋白水平的表达,差异有统计学意义(P0.05),EGFR、AKT、ERK蛋白表达无差异(P0.05)。结论:紫草素联合埃克替尼能明显抑制H1975细胞增殖,促进肿瘤细胞凋亡;抗肿瘤机制可能与调节EGFR信号通路相关蛋白表达有关。     

MITF在葡萄膜黑色素瘤细胞中的功能研究

该研究首先通过qRT-PCR和Western blot发现,MITF在人葡萄膜黑色素瘤细胞中的RNA水平及蛋白水平都显著高于葡萄膜黑色素细胞中的水平。通过RNA干扰技术下调葡萄膜黑色素瘤细胞中的MITF的表达,采用MTS实验、细胞平板克隆实验发现,MITF下调后葡萄膜黑色素瘤细胞的增殖能力被显著抑制。利用流式细胞术及Hoechst染色、Caspase 3/7活性检测发现其细胞周期受到阻滞,且凋亡水平增加。通过RTCA xCELLigence DP检测系统定量检测发现,si-MITF能抑制葡萄膜黑色素瘤细胞的迁移及侵袭能力。Western blot检测发现,MITF下调后葡萄膜黑色素瘤细胞中细胞周期相关蛋白p-Rb(retinoblastoma)、CDK2(cyclin-dependent kinase 2)、CDK6、细胞周期蛋白D2(Cyclin D2)以及CyclinE2的表达水平下调,与增殖及迁移侵袭密切相关的FAK(focal adhesion kinase)及ERK(extracellular signal-regulated protein kinases)蛋白的磷酸化水平降低。该研究表明,在葡萄膜黑色素瘤细胞中下调MITF的表达后,细胞内部分周期相关蛋白、细胞增殖及迁移侵袭相关蛋白的表达均有下调,导致细胞发生G_1期阻滞,使细胞的增殖、迁移及侵袭能力受到抑制,同时也促使细胞发生凋亡。     

阿帕替尼对人肝癌细胞增殖及凋亡的作用机制研究

目的:探讨阿帕替尼抑制肝癌细胞增殖促进凋亡的作用机制。方法:选取肝癌细胞系SNU739、HepG2,以CCK-8细胞增殖实验、平板克隆实验测定阿帕替尼对肝癌细胞增殖及克隆形成能力的影响;流式细胞术检测阿帕替尼对肝癌细胞凋亡的影响;蛋白免疫印迹法检测阿帕替尼影响肝癌细胞凋亡相关蛋白Bax、Bcl-2及Caspase3的表达情况。结果:与对照组相比,阿帕替尼可显著抑制肝癌细胞增殖(P0.05)。平板克隆实验提示与对照组相比,10μM和20μM阿帕替尼组肝癌细胞克隆数明显减少(P0.05)。流式细胞术结果提示10μM和20μM阿帕替尼处理组细胞凋亡率明显增加(P0.05)。蛋白免疫印迹法结果显示经阿帕替尼处理的肝癌细胞,促凋亡蛋白Bax及Caspase3的活性片段Cleaved-caspase3表达水平显著上调,抗凋亡蛋白Bcl-2显著下调(P0.01)。结论:阿帕替尼通过调节肝癌细胞凋亡相关蛋白从而抑制肝癌细胞增殖、促进其凋亡。     

紫草素促进肺癌A549细胞凋亡

目的:探讨紫草素对A549人肺癌细胞凋亡的影响和可能的作用机制。方法:采用不同浓度的紫草素对体外培养的A549人肺癌细胞进行干预,CCK-8法和流式细胞术分别检测紫草素对A549细胞增殖和凋亡的影响,Western blot观察凋亡相关蛋白(Bcl-2和Bax)表达水平的变化,激光共聚焦显微镜检测紫草素处理12 h并用JC-1染色的A549细胞线粒体膜电位改变。结果:CCK-8分析显示,0.5μM、1μM、2μM、4μM和6μM实验组A549细胞相对存活率分别为(83.71±1.02)%、(57.47±2.78)%、(27.39±1.96)%、(16.96±1.47)%和(14.72±1.93)%,与对照组相比实验组A549细胞相对存活率明显降低;流式细胞术结果表明,1μM、2μM、4μM实验组A549细胞的凋亡率分别为(13.80±1.76)%、(40.90±3.48)%和(78.80±2.52)%,与对照组相比紫草素呈剂量依赖型促进A549细胞凋亡;Western blot结果证实,紫草素能降低A549细胞中Bcl-2蛋白的表达量,而升高Bax蛋白的水平;激光共聚焦显微镜扫描结果显示紫草素能降低A549细胞的线粒体膜电位,呈剂量依赖型。结论:紫草素能显著促进A549细胞凋亡,其机制可能与下调抗凋亡蛋白Bcl-2的表达和上调促凋亡蛋白Bax的表达有关。     

BI-847325诱导甲状腺癌细胞BCPAP凋亡并促进钠/碘转运体的表达

[目的]研究新型MEK抑制剂BI-847325对BRAFV600E突变型甲状腺癌细胞BCPAP增殖的抑制作用以及对凋亡相关蛋白、摄碘蛋白钠/碘转运体(sodium/iodide symporter,NIS)的表达调控。[方法]不同浓度的BI-847325处理BCPAP细胞,CCK-8法测定存活率并计算半抑制浓度IC50;流式细胞术测定细胞凋亡;Western Blot测定MEK 1/2、ERK1/2的活化水平及其下游抗凋亡蛋白BCL-2、促凋亡蛋白BIM、BAX,以及NIS的表达。[结果]BI-847325浓度依赖性抑制BCPAP细胞的增殖,48 h IC50为0.46μmol/L。BI-847325浓度为0.4μmol/L时,BCPAP细胞凋亡率为(26.41±2.23)%,差异极显著(p0.01);BI-847325可以抑制MEK 1/2、ERK1/2的活化,下调BCL-2、上调BIM和BAX的表达,并上调NIS的表达。[结论]BI-847325通过MEK信号通路诱导甲状腺癌细胞BCPAP细胞凋亡,并上调NIS的表达,有促进131I摄取的潜力。     

PRDX2在乙醇致雄性小鼠生殖损害中的机制研究

目的:探讨过氧化氧化还原蛋白2(PRDX2)在乙醇所致的雄性小鼠生殖损害中的作用机制。方法:以雄性昆明小鼠为研究对象,分为对照组及模型组,分别以蒸馏水和乙醇灌胃处理12周,采集血清用于激素水平测定;收集精子,一部分用于精液分析,另一部分用于Q-PCR检测PRDX2、BCL-2、BAX、Caspase3的m RNA表达,Western blot检测PRDX2、BCL-2、BAX、Caspase3和Cleaved-Caspase3的蛋白表达,免疫荧光法鉴定PRDX2的表达;统计分析研究结果。结果:与对照组比较,模型组小鼠的精子活率降低,雌激素水平升高而雄激素水平降低(P0.05);模型组小鼠的PRDX2、BCL-2蛋白及m RNA水平较对照组均降低(P0.05),免疫荧光显示PRDX2可在精子中表达,且模型组小鼠精子的荧光强度明显减低;在BAX及Caspase3 m RNA的表达上,模型组高于对照组(P0.05),模型组小鼠的BAX及Cleaved-Caspase3的蛋白表达亦高于对照组(P0.05);Pearson相关系数分析显示PRDX2与BCl-2呈正相关、与BAX、Caspase3呈负相关,差异均有统计学意义(P0.05)。结论:乙醇造成精子PRDX2表达降低,间接诱导精子发生凋亡,影响精子的生成和发育,损害雄性小鼠的生殖功能。     

Nupr1调控非小细胞肺癌细胞迁移、凋亡机制的研究

目的:探讨核蛋白1(Nupr1)调控非小细胞肺癌细胞迁移、凋亡机制的研究。方法:肿瘤抑制剂盐酸素(salinomycin)不同时间处理非小细胞肺癌细胞A549后采用Western Blot法检测非小细胞肺癌细胞A549中Cleaved Caspase-3、Nupr1的蛋白表达;Transwell小室检测Nupr1基因沉默后非小细胞肺癌细胞A549细胞体外迁移、侵袭能力的变化;Western Blot法检测Nupr1沉默后非小细胞肺癌细胞A549 MMP-2、TIMP-1的蛋白表达;流式细胞仪检测Nupr1沉默后非小细胞肺癌细胞A549的凋亡情况。结果:与未经肿瘤抑制剂salinomycin处理对照组相比较,salinomycin处理后的非小细胞肺癌细胞A549中Nupr1蛋白表达量下降,Cleaved Caspase-3蛋白表达量升高,并且随着作用时间呈依赖关系。Nupr1-siRNA转染组的迁移能力相比对照组未转染组下降(64.4±7.2)%,Nupr1-siRNA转染组的侵袭能力相比对照组下降(58.7±7.3)%。与未转染Nupr1-siRNA对照组相比较,转染后TIMP-1的表达明显上调,而MMP-2的表达则明显下调。流式细胞仪检测结果显示Nupr1沉默后非小细胞肺癌细胞A549出现大量凋亡。结论:Nupr1基因沉默后通过上调TIMP-1的表达,下调MMP-2的表达降低肺癌A549细胞的侵袭和迁移能力,进而促进非小细胞肺癌细胞凋亡。     

Milk fat globule-epidermal growth factor 8 is decreased in intestinal epithelium of ulcerative colitis patients and thereby causes increased apoptosis and impaired wound healing

Milk fat globule-epidermal growth factor 8 (MFG-E8) plays an important role in maintaining intestinal barrier homeostasis and accelerating intestinal restitution. However, studies of MFG-E8 expression in humans with ulcerative colitis are lacking. We examined MFG-E8 expression in colonic mucosal biopsies from ulcerative colitis patients and healthy controls (n = 26 each) by real-time quantitative polymerase chain reaction (PCR), Western blot analysis and immunohistochemistry. MFG-E8 mRNA and protein expression was lower in ulcerative colitis patients than in controls. MFG-E8 expression was inversely correlated with mucosal inflammatory activity and clinical disease activity in patients. MFG-E8 was present in human intestinal epithelial cells both in vivo and in vitro. Apoptosis induction was also detected in the intestinal epithelium of ulcerative colitis patients by terminal-deoxynucleoitidyl transferase mediated nick-end labeling assay. We used lentiviral vectors encoding human MFG-E8 targeting short hairpin RNA to obtain MFG-E8 knockdown intestinal epithelia cell clones. MFG-E8 knockdown could promote apoptosis in intestinal epithelial cell lines, accompanied by a decrease in level of the antiapoptotic protein B-cell lymphoma 2 (BCL-2) and induction of the proapoptotic protein BCL2-associated protein X (BAX). The addition of recombinant human MFG-E8 led to decreased BAX and cleaved caspase-3 levels and induction of BCL-2 level in intestinal epithelia cells. MFG-E8 knockdown also attenuated wound healing on scratch assay of intestinal epithelial cells. The mRNA level of intestinal trefoid factor 3, a pivotal factor in intestinal epithelial cell migration and restitution, was downregulated with MFG-E8 knockdown. In conclusion, we demonstrated that decreased colonic MFG-E8 expression in patients with ulcerative colitis may be associated with mucosal inflammatory activity and clinical disease activity through basal cell apoptosis and preventing tissue healing in the pathogenesis of ulcerative colitis.     

miR-1298表达对PC-12细胞糖氧剥夺/复氧损伤的影响及其机制研究

摘要 目的：通过体外细胞培养探讨miR-1298对缺血缺氧性神经损伤的调节作用。方法：首先通过细胞活性检测和乳酸脱氢酶（LDH）细胞毒性法确定大鼠PC-12细胞糖氧剥夺/复氧（OGD/R）的造模效果,同时采用实时荧光定量PCR（RT-qPCR）检测细胞miR-1298的表达差异。体外转染miR-1298mimic、mimic NC、miR-1298 inhibitor和inhibitor NC至大鼠PC-12细胞系,检测mimic、mimic NC、inhibitor、inhibitor NC的转染效率。经过OGD/R处理后将细胞分为Control组、OGD/R组、mimic组、mimicNC组、inhibitor组和inhibitorNC组。流式细胞术检测各组PC-12细胞凋亡的情况,免疫印迹试验（Western blot）检测各组PC-12细胞凋亡相关蛋白B淋巴细胞瘤-2基因（BCL-2）和Bcl-2相关的x基因（Bax）表达的情况。结果：PC12细胞经过OGD/R处理后,其细胞存活率与Control组比明显下降且LDH漏出率明显上升（均P<0.05）;模型细胞中miR-1298相对表达量明显低于Control组（P<0.05）。转染24小时后mimic组细胞中miR-1298的相对表达量明显高于mimicNC组（P<0.05）;mimic组细胞凋亡率低于mimicNC组,而inhibitor组细胞凋亡率高于inhibitor NC组（均P<0.05）;mimic组的BCL-2表达量较mimicNC组升高,而BAX表达量下降,inhibitor组与inhibitorNC组相比,BCL-2表达量下降,而BAX表达量上升,差异均有统计学意义（均P<0.05）。结论：miR-1298通过抑制细胞凋亡减轻PC-12细胞OGD/R的损伤。     

BCL-2-Related Protein Expression in Apoptosis: Oxidative Stress Versus Serum Deprivation in PC12 Cells

Abstract: Expression of the BCL-2 protein family members, BAX, BAK, BAD, BCL-xL, BCL-xS, and BCL-2, was measured (by western blotting using specific antibodies) in PC12 cells before and during apoptosis induced by either H₂O₂ treatment or by serum deprivation and during rescue from apoptosis by nerve growth factor (NGF). H₂O₂-induced apoptosis, as measured by DNA fragmentation, caused: (a) a dose-dependent increase in BAX, (b) a dose-independent increase in BAK, and (c) a dose-dependent inhibition of BAD expression. By comparison, apoptosis induced by serum deprivation resulted in a time-dependent decrease in both BAX and BAK, along with a dramatic and sudden decrease in BAD expression. However, when PC12 cells were incubated in an apoptosis-sparing medium (i.e., NGF-supplemented serum-free medium), both BAX and BAK were increased significantly, whereas BAD expression remained inhibited. BCL-xL expression was increased by H₂O₂ but unaffected by serum deprivation or long-term NGF treatment. Neither BCL-2 nor BCL-xS expression could be detected in PC12 cells under the experimental conditions tested. Our results show that the expression of BAX, BAK, BAD, and BCL-xL is altered in a stimulus-dependent manner but cannot be used to define whether a cell will undergo or survive apoptosis. The similarity between changes in expression of BCL-2-related proteins induced by H₂O₂ exposure and NGF rescue could reflect activation in part of a common antioxidant pathway.     

ATP citrate lyase inhibitor triggers endoplasmic reticulum stress to induce hepatocellular carcinoma cell apoptosis via p-eIF2α/ATF4/CHOP axis

ATP citrate lyase (ACLY), a key enzyme in the metabolic reprogramming of many cancers, is widely expressed in various mammalian tissues. This study aimed to evaluate the effects and mechanisms of ACLY and its inhibitor BMS-303141 on hepatocellular carcinoma (HCC). In this study, ACLY was highly expressed in HCC tissues, especially in HepG2 and Huh7 cells, but was down-regulated in Hep3B and HCC-LM3 cells. Besides, ACLY knockdown inhibited HepG2 proliferation and clone formation, while opposite result was noticed in HCC-LM3 cells with ACLY overexpression. Moreover, ACLY knockdown impeded the migration and invasion abilities of HepG2 cells. Similarly, BMS-303141 suppressed HepG2 and Huh-7 cell proliferation. The p-eIF2α, ATF4, CHOP p-IRE1α, sXBP1 and p-PERK were activated in HepG2 cells stimulated by BMS-303141. In cells where ER stress was induced, ATF4 was involved in BMS-303141-mediated cell death procession, and ATF4 knockdown reduced HCC cell apoptosis stimulated by BMS-303141. In a mouse xenograft model, combined treatment with BMS-303141 and sorafenib reduced HepG2 tumour volume and weight. In addition, ACLY expression was associated with HCC metastasis and tumour-node-metastases staging. Survival analysis and Cox proportional hazards regression model showed that overall survival was lower in HCC patients with high ACLY expression; AFP level, TNM staging, tumour size and ACLY expression level were independent risk factors affecting their overall survival. In conclusion, ACLY might represent a promising target in which BMS-303141 could induce ER stress and activate p-eIF2α/ATF4/CHOP axis to promote apoptosis of HCC cells, and synergized with sorafenib to enhance the efficacy of HCC treatment.     

Suppressing ROS-TFE3-dependent autophagy enhances ivermectin-induced apoptosis in human melanoma cells

Melanoma is an aggressive skin malignancy with a high mortality rate; however, successful treatment remains a clinical challenge. Ivermectin, a broad-spectrum antiparasitic drug, has recently been characterized as a potential anticancer agent due to its observed antitumor effects. However, the molecular mechanisms of ivermectin remain poorly understood. In the current study, we tested the involvement of autophagy in the ivermectin mechanism of action in human melanoma cells. We exposed SK-MEL-28 cells to different concentrations of ivermectin (2.5, 5, and 10 μM) for 24 hours. Here, ivermectin-induced apoptosis, as evidenced by the upregulation of cleaved poly (ADP-ribose) polymerase, BAX expression, and caspase-3 activity and downregulation of BCL-2 expression. In line with the apoptosis response, ivermectin triggered autophagy. Pharmacological or genetic inhibition of autophagy further sensitized SK-MEL-28 cells to ivermectin-induced apoptosis. Mechanistically, ivermectin-induced TFE3^(Ser321) dephosphorylation, activated TFE3 nuclear translocation and increased TFE3 reporter activity, which contributed to lysosomal biogenesis and the expression of autophagy-related genes, and subsequently, initiated autophagy in SK-MEL-28 cells. Moreover, N-acetyl-cysteine, an reactive oxygen species (ROS) scavenger, abrogated the effects of ivermectin on TFE3-dependent autophagy. Taken together, we demonstrated that ivermectin increases TFE3-dependent autophagy through ROS signaling pathways in human melanoma cells and that inhibiting autophagy enhances ivermectin-induced apoptosis in human melanoma cells.     

Enhanced levels of the apoptotic BAX/BCL-2 ratio in children with acute lymphoblastic leukemia and high-risk features

It has been suggested that leukemia is characterized by an impaired balance between the proliferation of blood cells and their capacity to undergo apoptosis. The aim of this study was to examine the expression of key molecules related to apoptosis (BCL-2, BAX, FAS, FAS-L) in children with acute lymphoblastic leukemia (ALL). Measurement of BCL-2 and BAX mRNA was performed by quantitative real-time PCR, and membrane expression of FAS and FAS-L was assessed by flow cytometry in bone marrow mononuclear cells, both at diagnosis and at remission following induction chemotherapy. At diagnosis, increased levels of the apoptotic BAX/BCL-2 ratio were observed in children older than 10 years and with higher white blood cell counts. A DNA index < 1.16 was associated with increased BAX/BCL-2, both at diagnosis and at remission, and the del(9p) chromosome abnormality with increased BAX/BCL-2 at remission. The expression of the apoptotic receptor FAS was significantly higher at remission compared to diagnosis, which might reflect enhanced sensitivity of the leukemic clone to apoptosis and response to treatment. Altogether, our results highlight the association of apoptosis-related genes with clinical and cytogenetic prognostic parameters in pediatric ALL. A better understanding of the mechanisms and regulation of apoptosis should enable the design of novel targeted therapies for these patients.