肿瘤新生血管及分子靶向治疗新策略

肿瘤血管靶向治疗是基于肿瘤新生血管与正常血管的不同,药物专一识别并阻断肿瘤新生血管,使肿瘤细胞“饿死”,而不影响正常细胞。从1971年Folkman提出“饿死肿瘤”的假说到2004年第一个血管靶向药物上市,记载着30多年领域发展的传奇经历。当今,肿瘤血管已成为生物医学和临床研究的热点,新的发现层出不穷。该文重点介绍肿瘤血管新靶点、新机制、新药物与未来发展。     

具新生血管抑制及血管阻断双重作用的肿瘤血管靶向药物研究进展

以血管新生抑制剂和血管阻断剂为代表的肿瘤血管靶向药物作为一种新的抗肿瘤疗法,其研究与开发已取得显著进展,尤其是二者联用已在临床实践中获得更好疗效。因而,近年来具有新生血管抑制和血管阻断双重作用的肿瘤血管靶向药物研究备受关注。这种具双重作用的肿瘤血管靶向药物因同时保持了血管新生抑制剂和血管阻断剂的各自作用特点,在临床肿瘤治疗上更具优势,不仅能一药多靶,增强抗肿瘤疗效,同时还可降低用药剂量,减少毒副作用,提高用药耐受性,故临床应用前景广阔。综述新生血管抑制剂和血管阻断剂的作用机制及特点,介绍具代表性的兼有新生血管抑制和血管阻断双重作用的肿瘤血管靶向药物研究进展。     

肿瘤血管靶向药物的研究进展

肿瘤血管在实体瘤的发生发展中具有重要的作用,靶向肿瘤血管的新药研发已成为一个热点领域.抗肿瘤血管的治疗策略分为肿瘤新生血管生成抑制剂（tumor angiogenesis inhibitor,TAI）和肿瘤血管靶向药物（vascular targeting agents,VTAs）两方面的研究.肿瘤新生血管生成抑制剂旨在抑制肿瘤新生血管生成的过程,而肿瘤血管靶向药物则是通过快速而有选择性地破坏肿瘤血管功能,使肿瘤血供受阻,导致肿瘤坏死.VTA类药物分为两类：一是小分子抑制剂（small molecule agents）,利用肿瘤血管和正常组织血管存在的差别选择性地破坏肿瘤血管;另一种是生物制剂（biological agents）,借助能够特异结合肿瘤血管的配体将毒素、凝血诱导剂、凋亡诱导分子等运送到肿瘤血管,引起血管阻塞使肿瘤坏死.     

CXC趋化因子与肿瘤血管新生

趋化因子在免疫调节、血管新生以及介导肿瘤的器官特异性转移中发挥重要作用。其中CXC趋化因子超家族由于N-端谷氨酸-亮氨酸-精氨酸基序（Glu—Leu-Arg,ELR motif）的有无使其在血管新生过程中具有了促进或者抑制血管新生的不同作用：含有ELR（ELR^＋）的CXC趋化因子经血管内皮组织上CXCR2介导血管新生促进作用;而不含有ELR（ELR^-）的CXC趋化因子通过血管内皮组织上CXCR3介导血管新生抑制作用。     

肿瘤血管新生的数值模拟

利用Overture开发肿瘤血管新生模型的计算程序,使用有限差分法模拟肿瘤血管新生过程中,血管内皮细胞在细胞间基质中的增生和迁徙,阐明了血管内皮生长因子和血管新生因子的调节机制.针对三种调节因子的不同组合下的模型进行数值模拟,对比说明三种因子在肿瘤血管新生中的不同作用.模型计算结果与病理学现象实验一致.     

肿瘤干细胞与血管新生的研究进展

肿瘤生长及转移依赖于新生血管的形成,大量研究认为肿瘤干细胞与血管新生之间存在密切联系,肿瘤干细胞可能转分化为内皮细胞参与新生血管生成,并通过分泌促血管生长因子、基质衍生因子和低氧诱导因子参与对血管新生的调控。     

肿瘤血管新生抑制因子的研究进展

血管新生是肿瘤发生发展中一个重要的病理特征,抗血管新生已经成为肿瘤治疗研究的一大热点.目前抗血管新生的策略主要是应用血管新生刺激因子拮抗剂或血管新生抑制因子,以抑制肿瘤异常增加的血管新生.相比于血管新生刺激因子拮抗剂,内源性血管新生抑制因子展现出更好的治疗前景,但是其分子机制还有待进一步阐明.内源性血管新生抑制因子包括...     

靶向肿瘤新生血管纳米粒的构建和质量控制

目的：制备F56多肽修饰的长春新碱纳米粒（F56-VCR-NP）,并建立其质量控制方法。方法：乳化－溶剂挥发法优化制备F56．VCR-NP：HPLC法测定其载药量、包封率,透射电镜下观察其形态,激光粒度分析仪测定其粒径和Zeta电位,CBQCA试剂盒测定纳米粒表面多肽密度,XPS进行表面元素分析。结果：优化制备的F56－VCR-NP粒径约为153nm,Zeta电位为－20．8mv,包封率为21．4％,载药量为1．9％,多肽连接效率为26．3％。结论：以聚乙二醇－聚乳酸（PEG-PLA）为原料,长春新碱为模型药物,成功制备出纳米粒子,并建立起有效的质量控制方法,对该实验样品进行了表征。结果表明此类纳米粒子尺寸均匀,表面多价连接F56多肽,载药量和包封率稳定可控,工艺成熟。     

组织因子与肿瘤靶向治疗

组织因子(tissue factor,TF)是一种分子量为47kD的跨膜糖蛋白,作为凝血因子Ⅶ的受体启动外源性凝血过程。近年来,人们发现组织因子在肿瘤血管生成和肿瘤细胞转移过程中也发挥重要作用,并且在针对组织因子的肿瘤靶向的治疗方面取得了一些重要进展。     

Vasohibin蛋白质家族与肿瘤血管新生

血管新生存在于包括肿瘤在内的多种生理和病理过程中,且受到局部环境中血管生成促进因子和抑制因子的共同调节,这一过程对肿瘤增殖、侵袭、转移能力尤为重要。体内存在着许多内源性血管生成调节因子。最近,vasohibin家族作为一个新的血管新生调节因子进入人们的视线,备受关注。本文就vasohibin家族在肿瘤血管新生过程中的重要角色及其在抗血管生成治疗中的应用做一综述。     

端粒酶与癌症靶向治疗

端粒酶是癌组织中特异表达的关键酶,与肿瘤细胞无限增殖关系密切。端粒酶在癌细胞表面表达特异性抗原,是癌细胞的标记之一。靶向治疗作为癌症新兴的治疗方法,具有特异性强、副作用小等传统方法所不具有的优点。针对端粒酶这一特异靶点的靶向治疗可以利用免疫学基本原理,通过抗原的特异性识别有效杀伤癌细胞。已有许多端粒酶肽段应用于实验室及临床研究,具有广阔的应用前景;但应用免疫疗法也有其缺陷,端粒酶抗原免疫耐受的问题也是亟待解决的问题之一,在临床上的广泛应用还有一段路要走。     

Biomarker-guided sequential targeted therapies to overcome therapy resistance in rapidly evolving highly aggressive mammary tumors

Combinatorial targeted therapies are more effective in treating cancer by blocking by-pass mechanisms or inducing synthetic lethality. However, their clinical application is hampered by resistance and toxicity. To meet this important challenge, we developed and tested a novel concept of biomarker-guided sequential applications of various targeted therapies using ErbB2-overexpressing/PTEN-low, highly aggressive breast cancer as our model. Strikingly, sustained activation of ErbB2 and downstream pathways drives trastuzumab resistance in both PTEN-low/trastuzumab-resistant breast cancers from patients and mammary tumors with intratumoral heterogeneity from genetically-engineered mice. Although lapatinib initially inhibited trastuzumab-resistant mouse tumors, tumors by-passed the inhibition by activating the PI3K/mTOR signaling network as shown by the quantitative protein arrays. Interestingly, activation of the mTOR pathway was also observed in neoadjuvant lapatinib-treated patients manifesting lapatinib resistance. Trastuzumab + lapatinib resistance was effectively overcome by sequential application of a PI3K/mTOR dual kinase inhibitor (BEZ235) with no significant toxicity. However, our p-RTK array analysis demonstrated that BEZ235 treatment led to increased ErbB2 expression and phosphorylation in genetically-engineered mouse tumors and in 3-D, but not 2-D, culture, leading to BEZ235 resistance. Mechanistically, we identified ErbB2 protein stabilization and activation as a novel mechanism of BEZ235 resistance, which was reversed by subsequent treatment with lapatinib + BEZ235 combination. Remarkably, this sequential application of targeted therapies guided by biomarker changes in the tumors rapidly evolving resistance doubled the life-span of mice bearing exceedingly aggressive tumors. This fundamentally novel approach of using targeted therapies in a sequential order can effectively target and reprogram the signaling networks in cancers evolving resistance during treatment.     

HER-2/neu基因高表达及靶向治疗

HER-2/neu癌基因在许多肿瘤,如乳腺癌、卵巢癌、非小细胞肺癌等肿瘤中高表达,在肿瘤的发生与发展中起重要作用,与肿瘤的转化、转移、复发、预后差、患者生存期缩短有关。HER-2/neu在乳腺癌过度表达率约为20%～30%,编码蛋白P185HER2属生长因子受体家族,抗P185HER2单克隆抗体(Herceptin)作为靶向药物已临床应用治疗HER2/neu高表达乳腺癌。     

骨桥蛋白与肿瘤治疗

骨桥蛋白(osteopontin,OPN)是一种分泌型磷酸化糖蛋白,由多种组织细胞合成与分泌,参与调节细胞的黏附、增殖、趋化、转移、浸润和凋亡过程。OPN在多种肿瘤中高表达,与肿瘤的发生和发展密切相关,组织和血液中的OPN表达量也是肿瘤诊断和预后的指标。近年来,越来越多的研究通过抑制OPN、OPN的受体以及OPN的下游信号通路的方法抑制了肿瘤的发展。本文将从多方面阐述OPN与肿瘤的关系以及与肿瘤治疗的研究进展。     

CIAPIN1基因与肿瘤

细胞因子诱导的凋亡抑制因子1(cytokine induced apoptosis inhibitor1,CIAPIN1)是最新发现的一个细胞因子依赖性抗凋亡分子,并已经被证实是独立于Bcl家族、胱天蛋白酶(caspase)家族等之外的Ras信号转导通路中的另一个调节分子。CIAPIN1广泛分布于胎儿和成人的正常组织中,特别在分化型组织和活性代谢组织中具有很高的表达水平,但是在某些癌症发生时表达受到抑制。通过基因转染、RNA干扰等技术手段研究CIAPIN1与肿瘤发生、发展的关联,揭示了CIAPIN1表达水平的改变与肿瘤进展具有相关性,CIAPIN1有望成为一个新的肿瘤治疗靶分子。     

干细胞的异常分化与肿瘤发生

干细胞是一类具有自我更新和多向分化潜能的细胞群体。越来越多的研究表明,干细胞异常分化可导致肿瘤。并且在肿瘤组织中存在部分细胞,它们具有干细胞的多种特性,被称为肿瘤干细胞(cancer stem cell,CSC)。肿瘤干细胞理论的提出,为肿瘤的治疗与研究提供了新的方向。本文综述了正常干细胞异常分化、肿瘤干细胞的存在和特性、肿瘤干细胞靶向治疗的前景及所面临的问题等方面的研究进展。     

Large anti-HER2/neu liposomes for potential targeted intraperitoneal therapy of micrometastatic cancer

Effective targeting and killing of intraperitoneally disseminated micrometastases remains a challenge.

Objective/Methods:?In this work, we evaluated the potential of antibody-labeled PEGylated large liposomes as vehicles for direct intraperitoneal (i.p.) drug delivery with the aim to enhance the tumor-to-normal organ ratio and to improve the bioexposure of cancer cells to the delivered therapeutics while shifting the toxicities toward the spleen. These targeted liposomes are designed to combine: (1) specific targeting to and internalization by cancer cells mediated by liposome-conjugated tumor-specific antibodies, (2) slow clearance from the peritoneal cavity, and (3) shift of normal organ toxicities from the liver to the spleen due to their relatively large size.

Results:?Conjugation of anti-HER2/neu antibodies to the surface of large (approximately 600?nm in diameter) PEGylated liposomes results in fast, specific binding of targeted liposomes to cancer cells in vitro, followed by considerable cellular internalization. In vivo, after i.p. administration, these liposomes exhibit fast, specific binding to i.p. cancerous tumors. Large liposomes are slowly cleared from the peritoneal cavity, and they exhibit increased uptake by the spleen relative to the liver, while targeted large liposomes demonstrate specific tumor uptake at early times. Although tissue and tumor uptake are greater for cationic liposomes, the tumor-to-liver and spleen-to-liver ratios are similar for both membrane compositions, suggesting a primary role for the liposome’s size, compared to the liposome’s surface charge.

Conclusions:?The findings of this study suggest that large targeted liposomes administered i.p. could be a potent drug-delivery strategy for locoregional therapy of i.p. micrometastatic tumors.     

Autophagy orchestrates adaptive responses to targeted therapy in endometrial cancer

Targeted therapies in endometrial cancer (EC) using kinase inhibitors rarely result in complete tumor remission and are frequently challenged by the appearance of refractory cell clones, eventually resulting in disease relapse. Dissecting adaptive mechanisms is of vital importance to circumvent clinical drug resistance and improve the efficacy of targeted agents in EC. Sorafenib is an FDA-approved multitarget tyrosine and serine/threonine kinase inhibitor currently used to treat hepatocellular carcinoma, advanced renal carcinoma and radioactive iodine-resistant thyroid carcinoma. Unfortunately, sorafenib showed very modest effects in a multi-institutional phase II trial in advanced uterine carcinoma patients. Here, by leveraging RNA-sequencing data from the Cancer Cell Line Encyclopedia and cell survival studies from compound-based high-throughput screenings we have identified the lysosomal pathway as a potential compartment involved in the resistance to sorafenib. By performing additional functional biology studies we have demonstrated that this resistance could be related to macroautophagy/autophagy. Specifically, our results indicate that sorafenib triggers a mechanistic MAPK/JNK-dependent early protective autophagic response in EC cells, providing an adaptive response to therapeutic stress. By generating in vivo subcutaneous EC cell line tumors, lung metastatic assays and primary EC orthoxenografts experiments, we demonstrate that targeting autophagy enhances sorafenib cytotoxicity and suppresses tumor growth and pulmonary metastasis progression. In conclusion, sorafenib induces the activation of a protective autophagic response in EC cells. These results provide insights into the unopposed resistance of advanced EC to sorafenib and highlight a new strategy for therapeutic intervention in recurrent EC.