基于Wnt/β-catenin信号通路的结直肠癌研究进展

结直肠癌是临床常见的消化道恶性肿瘤之一,目前以手术为主的治疗手段术后复发率高,寻找既高效又安全的预防药物成为研究热点。在结直肠癌的发生、发展过程中,Wnt/β-catenin信号通路的异常激活发挥了重要作用,探索该通路的多种成分和研究它们之间的相互作用机制,有助于开发出针对该通路特定靶位的有效拮抗剂,为早期防治结直肠癌提出全新的思路。本文就Wnt/β-catenin信号通路及相关基因和结直肠癌的关系及以Wnt/β-catenin信号通路为靶点的抗结直肠癌药物做一综述。     

曲美替尼与GSK2126458联合用药逆转结直肠癌SW480细胞的耐药

近年来, 肿瘤靶向药物因其特异性强与对正常细胞损伤小等特点,已成为癌症治疗的热点药物。但由肿瘤异质性导致的靶向药物的耐受现象,成为癌症治疗需要解决的难题之一。为解决单一药物的耐受现象,可以通过药物组合来达到理想的治疗效果。本课题以结直肠癌为研究对象,评估8种结直肠癌细胞对30种靶向药物的敏感性,并筛选可逆转耐药的药物组合,探究药物组合的作用。通过MTT实验测定细胞存活率,计算IC50值进行敏感性分析,敏感标准为IC50值≤100 nmol/L。对敏感的单药进行组合筛选,选取细胞存活率最小的组合。采用流式细胞术和Western印迹检测联合用药对细胞凋亡及MAPK、PI3K通路相关蛋白质表达水平的影响。MTT结果显示,结直肠癌SW480细胞耐受30种肿瘤靶向药物,经联合用药筛选,SW480细胞对曲美替尼与GSK2126458组合最为敏感,与对照组和单药组相比,该组合可使SW480细胞凋亡明显增加。免疫印迹结果显示,ERK、Akt和mTOR磷酸化水平降低,Cleaved PARP表达增加。上述结果表明,8种结直肠癌细胞存在不同程度耐受靶向抑制剂的现象,曲美替尼与GSK2126458联合应用可逆转结直肠癌SW480细胞的耐药现象。     

曲美替尼与GSK2126458联合用药逆转结直肠癌SW480细胞的耐药

近年来, 肿瘤靶向药物因其特异性强与对正常细胞损伤小等特点,已成为癌症治疗的热点药物。但由肿瘤异质性导致的靶向药物的耐受现象,成为癌症治疗需要解决的难题之一。为解决单一药物的耐受现象,可以通过药物组合来达到理想的治疗效果。本课题以结直肠癌为研究对象,评估8种结直肠癌细胞对30种靶向药物的敏感性,并筛选可逆转耐药的药物组合,探究药物组合的作用。通过MTT实验测定细胞存活率,计算IC50值进行敏感性分析,敏感标准为IC50值≤100 nmol/L。对敏感的单药进行组合筛选,选取细胞存活率最小的组合。采用流式细胞术和Western印迹检测联合用药对细胞凋亡及MAPK、PI3K通路相关蛋白质表达水平的影响。MTT结果显示,结直肠癌SW480细胞耐受30种肿瘤靶向药物,经联合用药筛选,SW480细胞对曲美替尼与GSK2126458组合最为敏感,与对照组和单药组相比,该组合可使SW480细胞凋亡明显增加。免疫印迹结果显示,ERK、Akt和mTOR磷酸化水平降低,Cleaved PARP表达增加。上述结果表明,8种结直肠癌细胞存在不同程度耐受靶向抑制剂的现象,曲美替尼与GSK2126458联合应用可逆转结直肠癌SW480细胞的耐药现象。     

结直肠癌中Hedgehog信号通路的研究进展

结直肠癌(colorectal cancer, CRC)是全球最常见的恶性肿瘤之一,其病因复杂且死亡率较高。结直肠癌的发展和转移涉及多个因素和机制。Hedgehog(Hh)信号在胚胎发生和体细胞发育中起重要作用。研究证明,Hh通路的异常激活与几种类型的人类肿瘤有关。然而,Hh信号传导在结直肠癌中的作用仍然是有争议的。在此综述中,我们将介绍近些年关于Hh信号及其在结直肠癌中的相关研究,讨论靶向Hh信号通路在治疗,预后和预防结直肠癌方面的潜力。     

Kras突变与肿瘤发生及治疗

RAS蛋白是一类与GTP/GDP结合并具有GTP水解酶活性的小G蛋白。作为分子开关,RAS通过结合GTP而激活下游MAPK及PI3K-AKT等信号通路,从而调控细胞生长、增殖、分化和凋亡等生命过程,其突变与癌症发生发展密切相关。KRAS是RAS家族中最常见的突变类型。Kras突变将导致其丧失GTP水解酶活性,从而持续激活下游信号通路,促使细胞增殖失控而癌变;同时,Kras突变是肿瘤细胞的维持生长增殖所必需条件,也是肿瘤获得性耐药的关键原因之一。然而迄今为止,临床上尚无有效治疗Kras突变肿瘤的药物,探索针对Kras突变肿瘤的有效治疗策略与方法也成为近年来的研究热点。该文从KRAS的功能、信号通路、突变与肿瘤的关系及目前Kras突变肿瘤的不同治疗策略和研究现状进行简要综述。     

维罗非尼联合爱必妥对结直肠癌细胞株的作用研究

探讨BRAF抑制剂维罗非尼联合EGFR单克隆抗体西妥昔单抗对BRAF突变型和野生型结直肠癌细胞株的作用。应用MTT法检测,将不同浓度西妥昔单抗、维罗非尼单药以及两药联合分别作用于BRAF突变型结直肠癌细胞株RKO、HT-29和BRAF野生型结直肠癌细胞株DIFI、CACO-2后,观察各细胞株增殖变化;通过集落形成实验,经过长时间培养细胞验证不同处理因素对细胞增殖的抑制作用;Western blot实验检测EGFR下游通路靶蛋白的活性在两药联合后是否出现明显下调。结果显示,单药治疗,西妥昔单抗能一定程度抑制BRAF野生型结直肠癌细胞株增殖,抑制率达26%~40%,而BRAF突变组两种细胞株对西妥昔单抗均耐药。维罗非尼对不同基因状态细胞的增殖均有一定的抑制作用,IC50均小于7μmol/mL,其中BRAF突变细胞更为敏感。对比单药西妥昔单抗,联合维罗非尼后更加明显地抑制了细胞增殖,4种细胞存活率均明显降低(P0.05)。长时间集落形成实验证实两药联合形成集落的面积和数量均明显减少。Western Blot实验显示对比单药,两药联合明显下调了p-EGFR、BRAF、p-ERK的表达。结果显示,BRAF抑制剂维罗非尼无论在BRAF突变型还是野生型结直肠癌细胞株中,均能增强西妥昔单抗作用的敏感性。     

Hippo-YAP信号通路在结直肠癌发生发展中的作用

结直肠癌是消化系统常见的恶性肿瘤,发生发展机制复杂。Hippo-YAP信号通路作为肿瘤抑制的一个重要信号通路,具有调节器官大小和维持细胞增殖与凋亡的动态平衡等功能。研究发现Hippo-YAP信号通路可以通过影响细胞的增殖、凋亡等从而参与结直肠癌的发生发展。本文就Hippo-YAP信号通路在结直肠癌中的作用及其机制进行综述。     

p38丝裂原活化蛋白激酶抑制剂研究进展

p38丝裂原活化蛋白激酶（MAPK）通路是细胞内应激反应信号通路,与炎症反应密切相关。炎症反应失控是很多疾病产生的重要原因之一,传统抗炎药物的严重副作用使得寻找强效、安全的抗炎药物极为迫切。通过抑制剂调节信号通路的炎症药物研发成为目前发展的趋势,而p38MAPK的中心地位使其成为首选靶点。p38MAPK抑制剂和p38MAPK的研究进展相辅相成,发展迅速。已报道的100多种不同化学结构的p38MAPK特异性抑制剂中已有20多种进入临床试验阶段,但至今尚没有一种化合物被批准应用于临床治疗。我们讨论了p38MAPK抑制剂的研究现状和研究策略。     

Hedgehog通路分子SuFu在结直肠癌中的作用

Hedgehog(Hh)信号通路在胚胎的正常发育过程中发挥关键作用,近年研究表明Hh信号通路在多种肿瘤中异常激活。Hh信号通路中的调控分子SuFu(suppressor of fused)在结直肠癌组织中普遍表达,而通路中其他关键分子并不存在此现象。SuFu可不通过Pcth1和Smo直接作用于转录因子Gli。SuFu在胞质中与Gli结合,阻止Gli进入细胞核;也可在细胞核内辅助其他蛋白抑制Gli的活性,从而负反馈调控Hh信号通路。当SuFu基因发生突变时,其构象改变,对Gli的抑制作用减弱,而且使得Gli的表达增加,Hh通路异常激活,促进结直肠癌的发生发展。本文综述了Hh信号通路的作用机制以及SuFu分子与结直肠癌的关系,旨在为结直肠癌的靶向治疗积累一定的理论基础。     

Pharmacogenomics of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors

The EGFR is a validated anticancer target whose successful exploitation has added novel agents to our current treatment protocols. Subsets of patients have shown to benefit the most from these therapies, and though these differential responses have yet to be completely defined, they are mostly of genetic nature. Egfr amplifications have shown to increase sensitivity to both small molecule inhibitors and specific monoclonal antibodies targeting the EGFR. A somatic/germline egfr intron 1 CA repeat sequence polymorphism has shown to have an important role in the control of EGFR protein expression, and has been linked to an increased risk of familial breast cancer, a worse outcome in patients with colorectal cancer, and anti-EGFR treatment efficacy in preclinical models. Egfr activating mutations have been recently described in lung cancer linking a cluster of genotypes with sensitivity to EGFR tyrosine kinase pharmacological inhibition. Despite the initial excitement that this discovery elicited, follow-up reports have not unequivocally confirmed this finding, and these drugs have been solidly efficacious both in individual patients and in diseases generally lacking egfr mutations such as pancreas cancer. We are witnessing exciting developments in the field of the pharmacogenomics of cancer, and this has particularly evolved in the area pertaining EGFR tyrosine kinase inhibitors. This review will discuss the background and currently available preclinical and clinical data.     

Network quantification of EGFR signaling unveils potential for targeted combination therapy

The epidermal growth factor receptor (EGFR) signaling network is activated in most solid tumors, and small‐molecule drugs targeting this network are increasingly available. However, often only specific combinations of inhibitors are effective. Therefore, the prediction of potent combinatorial treatments is a major challenge in targeted cancer therapy. In this study, we demonstrate how a model‐based evaluation of signaling data can assist in finding the most suitable treatment combination. We generated a perturbation data set by monitoring the response of RAS/PI3K signaling to combined stimulations and inhibitions in a panel of colorectal cancer cell lines, which we analyzed using mathematical models. We detected that a negative feedback involving EGFR mediates strong cross talk from ERK to AKT. Consequently, when inhibiting MAPK, AKT activity is increased in an EGFR‐dependent manner. Using the model, we predict that in contrast to single inhibition, combined inactivation of MEK and EGFR could inactivate both endpoints of RAS, ERK and AKT. We further could demonstrate that this combination blocked cell growth in BRAF‐ as well as KRAS‐mutated tumor cells, which we confirmed using a xenograft model.     

Anti-PD-1 combined with targeted therapy: Theory and practice in gastric and colorectal cancer

Gastric cancer (GC) and colorectal cancer (CRC) are frequent and aggressive malignancies worldwide. Despite the emergence of various therapeutic regimens, the prognosis of gastric and colorectal cancer is relatively poor. Immunotherapy targeting PD-1 is one of the most prevalent approaches, but it has a low response rate in most patients, particularly those with microsatellite stability (MSS). Recently, some targeted drugs have been found to remarkably enhance the anti-tumor immunity of cancer models, mainly through increasing the level of CD8⁺ T cells, M1-type macrophages, expression of PD-L1, and decreasing the level of regulatory T cells and M2 macrophages. The above finding implies that the combination of anti-PD-1 and targeted therapies may be a potential treatment for gastric and colorectal cancer patients. Although many encouraging preclinical results have been shown, the clinical outcomes were not approving enough. To further enhance the therapeutic efficacy and improve the prognosis in GC and CRC patients, deeper and larger-scale studies should be done to determine the complicated interactions between the two therapies and the concrete use of combination regimens.     

Epidermal growth factor receptor: a promising therapeutic target for colorectal cancer

The epidermal growth factor receptor is a 170,000-kd transmembrane glycoprotein involved in signaling pathways affecting cellular growth, differentiation, and proliferation. An abnormal expression of the epidermal growth factor receptor (EGFR) has been described in many human tumors and implicated in the development and prognosis of malignancies, thus representing not only a possible prognostic marker, but primarily a rational molecular target for a new class of anticancer agents. The aim of this analysis is to review the available data about the biology of the EGFR and its use as a target for a new class of anticancer agents for colorectal cancer. Several clinical trials have been reported with the use of EGFR-targeted monoclonal antibodies and tyrosine kinase inhibitors, mainly in combination with chemotherapy for advanced colorectal cancer patients. Results available so far demonstrated a manageable and acceptable toxicity profile and a promising level of activity. Many critical issues are yet unresolved, such as the optimal chemotherapy regimen to combine with anti-EGFR treatment and the most adequate patient setting. Moreover, the biological selection of colorectal tumors more likely to benefit from this treatment approach is still to be defined.     

Metformin Treatment Does Not Inhibit Growth of Pancreatic Cancer Patient-Derived Xenografts

There is currently tremendous interest in developing anti-cancer therapeutics targeting cell signaling pathways important for both cancer cell metabolism and growth. Several epidemiological studies have shown that diabetic patients taking metformin have a decreased incidence of pancreatic cancer. This has prompted efforts to evaluate metformin, a drug with negligible toxicity, as a therapeutic modality in pancreatic cancer. Preclinical studies in cell line xenografts and one study in patient-derived xenograft (PDX) models were promising, while recently published clinical trials showed no benefit to adding metformin to combination therapy regimens for locally advanced and metastatic pancreatic cancer. PDX models in which patient tumors are directly engrafted into immunocompromised mice have been shown to be excellent preclinical models for biomarker discovery and therapeutic development. We evaluated the response of four PDX tumor lines to metformin treatment and found that all four of our PDX lines were resistant to metformin. We found that the mechanisms of resistance may occur through lack of sustained activation of adenosine monophosphate-activated protein kinase (AMPK) or downstream reactivation of the mammalian target of rapamycin (mTOR). Moreover, combined treatment with metformin and mTOR inhibitors failed to improve responses in cell lines, which further indicates that metformin alone or in combination with mTOR inhibitors will be ineffective in patients, and that resistance to metformin may occur through multiple pathways. Further studies are required to better understand these mechanisms of resistance and inform potential combination therapies with metformin and existing or novel therapeutics.     

Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR‐TKIs): Simple drugs with a complex mechanism of action?

A range of target-based agents for the treatment of solid tumors are in development. The epidermal growth factor receptor (EGFR) has been identified as a relevant target as it is involved in regulating several cellular functions important in the proliferation and survival of cancer cells, is commonly expressed at high levels in a range of tumors, and high expression is often related to poor prognosis. EGFR is a member of the ErbB family of receptors which also includes ErbB-2, ErbB-3, and ErbB-4. These receptors form dimers of the same type (homodimers) or with other family members (heterodimers), each combination resulting in different downstream effects. Some of the most advanced targeted agents in development are the EGFR tyrosine kinase inhibitors (EGFR-TKIs), of which ZD1839 ('Iressa') is an example. In Phase II monotherapy trials, oral ZD1839 was well tolerated and demonstrated clinically meaningful antitumor activity and symptom relief in pretreated patients with advanced NSCLC. Preclinical studies have suggested that the antitumor activity of ZD1839 does not depend on the level of EGFR expression. Furthermore, in addition to an effect on EGFR signaling, treatment with ZD1839 as well as with other quinazoline EGFR-TKIs, may also affect signaling of other ErbB family members. EGFR-TKIs have been shown in preclinical studies to increase the efficacy of cytotoxic drugs and Phase III trials of such combinations are ongoing. On the basis that different signal transduction pathways contribute to the control of tumor growth, future therapeutic approaches are likely to involve combination of different targeted agents.     

EGF receptor inhibitors increase ErbB3 mRNA and protein levels in breast cancer cells

The potential benefits of drugs directly targeting the ErbB receptors for cancer therapy have led to an extensive development within this field. However, the clinical effects of ErbB receptor-targeting drugs in cancer treatment are limited due to a high frequency of resistance. It has been reported that, when inhibiting the epidermal growth factor receptor (EGFR) with the tyrosine kinase inhibitor gefitinib, increased activation of ErbB3 via MET, or by re-localization of ErbB3 mediates cell survival. Here we show further evidence that members of the ErbB receptor family facilitate resistance to EGFR inhibitor treatment in ErbB2 overexpressing breast cancer cells. We found that gefitinib treatment increased ErbB3 expression, both at protein and mRNA levels. ErbB3 expression was upregulated not only by gefitinib but also by a panel of different EGFR inhibitors, suggesting that inhibition of EGFR in general affects ErbB3 expression. In addition, we found that gefitinib treatment increased ErbB2 expression levels while EGFR inhibitors decreased the activity of ErbB2. Concentrations of gefitinib that decreased phospho-ErbB2 reversely increased ErbB3 levels. We further examined changes induced by gefitinib treatment on mRNA levels of the most common genes known to be involved in breast cancer. As expected, we found that gefitinib downregulated genes whose functions were linked to cellular proliferation, such as Ki-67, topoisomerase II alpha and cyclins, and surprisingly downregulated gene expression of FAS which is involved in apoptotic signaling. Together, our data strongly suggest that resistance to EGFR inhibitors may result from the compensation of other family members and that combinations of anti-cancer drugs are required to increase the sensitivity of these treatments.     

PLK1 inhibition-based combination therapies for cancer management

Polo-like kinase I (PLK1), a cell cycle regulating kinase, has been shown to have oncogenic function in several cancers. Although PLK1 inhibitors, such as BI2536, BI6727 (volasertib) and NMS-1286937 (onvansertib) are generally well-tolerated with a favorable pharmacokinetic profile, clinical successes are limited due to partial responses in cancer patients, especially those in advanced stages. Recently, combination therapies targeting multiple pathways are being tested for cancer management. In this review, we first discuss structure and function of PLK1, role of PLK1 in cancers, PLK1 specific inhibitors, and advantages of using combination therapy versus monotherapy followed by a critical account on PLK1-based combination therapies in cancer treatments, especially highlighting recent advancements and challenges. PLK1 inhibitors in combination with chemotherapy drugs and targeted small molecules have shown superior effects against cancer both in vitro and in vivo. PLK1-based combination therapies have shown increased apoptosis, disrupted cell cycle, and potential to overcome resistance in cancer cells/tissues over monotherapies. Further, with successes in preclinical experiments, researchers are validating such approaches in clinical trials. Although PLK1-based combination therapies have achieved initial success in clinical studies, there are examples where they have failed to improve patient survival. Therefore, further research is needed to identify and validate novel biologically informed co-targets for PLK1-based combinatorial therapies. Employing a network-based analysis, we identified potential PLK1 co-targets that could be examined further. In addition, understanding the mechanisms of synergism between PLK1 inhibitors and other agents may lead to a better approach on which agents to pair with PLK1 inhibition for optimum cancer treatment.     

Antiangiogenic cancer therapy: why do mouse and human patients respond in a different way to the same drug?

The tumor vasculature is an increasingly attractive target for development of anticancer drugs. The fundamental principle for antiangiogenic cancer therapy is based on the inhibitory effect of chemical compounds, proteins or nucleotides on tumor angiogenesis. Indeed, in almost all preclinical tumor models, antiangiogenic monotherapy with different agents shows potent effects on suppression of tumor growth. However, antiangiogenic monotherapy has barely produced any clinical benefits in cancer patients. Although in combination with chemotherapy some antiangiogenic drugs demonstrate survival improvement in patients with certain types of cancers, the overall benefits by addition of antiangiogenic drugs (ADs) to chemotherapy remain modest. The disparity of AD responses between preclinical models and clinical cancer patients has raised important issues, which include: 1) Are current animal tumor models appropriate for assessing the therapeutic efficacy of ADs for clinical development? 2) What are the key differences between mouse tumor models and human cancer patients? 3) Are anti-VEGF drugs off target in cancer patients? 4) What are alternative options for improvement of the clinical benefits of ADs? In this short review, I discuss these critical issues in relation to the clinical practice of ADs.