二甲双胍在II型糖尿病合并肝癌中的研究进展

多年来二甲双胍以其安全性高、价格低及疗效好的优点而广泛应用于临床治疗糖尿病。糖尿病增加了肝癌的罹患率并影响其预后。近年来研究发现二甲双胍在治疗Ⅱ型糖尿病(T2MD)患者时亦降低了其罹患肝癌的风险,大量研究证明其具有抗癌及协同抗癌作用。现本文对二甲双胍在Ⅱ型糖尿病患者中对肝癌发生的影响进行探讨,对二甲双胍抑制肿瘤的分子生物学机制进行了介绍,列举了最新的实验研究数据,并对现有临床数据进行分析,对于二甲双胍未来的研究方向提出了预期,对于二甲双胍未来在Ⅱ型糖尿病患者中肝癌的预防作用进行了简要的总结及未来使用的展望,对于其在Ⅱ型糖尿病合并肝癌的患者中的治疗作用进行了前瞻性的探讨,为二甲双胍在其他癌症防治中的应用提出了可能性。     

二甲双胍联合阿霉素应用对人乳腺癌细胞增殖和凋亡的影响

目的：观察二甲双胍联合阿霉素应用对人乳腺癌细胞MDA-MB-231增殖和凋亡的影响。方法：MTT法分别检测二甲双胍、阿霉素和二甲双胍联合阿霉素对MDA-MB-231细胞生长的抑制作用;平板克隆实验检测二甲双胍联合阿霉素对MDA-MB-231细胞克隆形成能力的影响;流式细胞仪检测二甲双胍联合阿霉素对MDA-MB-231细胞凋亡的影响。结果：二甲双胍和阿霉素分别对MDA-MB-231细胞生长有抑制作用,二甲双胍联合阿霉素应用对MDA-MB-231细胞生长的抑制作用更加显著,并且随着药物浓度的增加而增加;二甲双胍联合阿霉素应用与单药相比能够明显降低MDA-MB-231细胞克隆形成率,并且促进细胞凋亡。结论：二甲双胍联合阿霉素应用与单药相比能够显著抑制人乳腺癌细胞MDA-MB-231细胞的增值,促进其凋亡,可见两药联用对肿瘤细胞的杀伤具有协同性。     

二甲双胍通过下调c-Myc增强他莫昔芬对乳腺癌的抗肿瘤作用

乳腺癌是一种常见的高度恶性肿瘤,在临床病人的治疗中,寻找有效的抑制肿瘤生长的治疗方法尤为重要。他莫昔芬目前被用于治疗雌激素受体阳性乳腺癌。二甲双胍是一种抗糖尿病药物,据报道可以降低人类癌症发病率,提高乳腺癌患者的生存率。该文主要研究二甲双胍联合他莫昔芬对乳腺癌细胞的协同作用及其机制。采用CCK-8法和平板克隆形成实验检测细胞活力和增殖;流式细胞术检测细胞凋亡; Transwell实验检测细胞迁移、侵袭能力;免疫印迹法检测MAPK信号通路和c-Myc蛋白。结果显示,他莫昔芬与二甲双胍联合用药对乳腺癌细胞增殖、克隆形成、迁移侵袭及凋亡的作用均优于单独用药,表明二甲双胍可以增强他莫昔芬对肿瘤生长的抑制作用,并能下调c-Myc蛋白的表达。该研究结果显示,二甲双胍能明显提高乳腺癌细胞的抗肿瘤作用,这些影响是通过下调c-Myc蛋白介导的。该发现可能对乳腺癌的治疗有潜在的临床应用价值。     

二甲双胍抗肿瘤效应的基础与临床研究进展

二甲双胍(Metformin)是一种胰岛素增敏剂,临床上主要用于2型糖尿病的治疗。越来越多的证据表明,二甲双胍能够发挥抗肿瘤效应,它通过活化磷酸腺苷蛋白激酶(AMPK),阻断哺乳动物雷帕霉素靶蛋白(m TOR)信号通路抑制肿瘤细胞的生长,并且参与细胞周期、凋亡、血管新生等多种生物学行为。不仅如此,二甲双胍的抗肿瘤临床研究也不断出现,包括大样本回顾性研究和前瞻性研究。这些研究数据不仅为二甲双胍抗肿瘤效应提供了有益的证据支持,也为二甲双胍及其介导的抗肿瘤分子信号途径的阐明奠定了理论依据。     

JBC:研究鉴别出糖尿病药物二甲双胍的新型作用靶点

正近日,一项刊登于国际杂志Journal of Biological Chemistry上的研究报告中,来自日本名古屋大学的研究人员利用线虫作为模式动物进行研究,鉴别出了2型糖尿病药物二甲双胍的新型靶点,研究者发现,在果蝇机体中离子交换蛋白NHX-5和其相关的蛋白质或许是潜在的二甲双胍的靶点,这就表明二甲双胍能够控制细胞内吞作用的周期。2型糖尿病是一种常见的糖尿病类型,患者主要特点表现为胰岛素耐受性及高血糖,很多患者都服用二甲双胍药物来进行治疗,二甲双胍能     

非酒精性脂肪肝合并2型糖尿病的降糖药物选择

非酒精性脂肪性肝病(non-alcoholic fatty liver disease, NAFLD)是常见的慢性肝病病因,在一般人群中的患病率约为20%～30%,但在2型糖尿病(type 2 diabetes mellitus, T2DM)患者中则达到55%。降糖药物可能在延缓疾病进展中起关键作用。二甲双胍在T2DM的治疗中是最常用的药物,对肝纤维化未见明显改善,但可用于NAFLD危险因素的治疗,如体重、转氨酶、胆固醇、糖化血红蛋白水平,且降低患者罹患肝癌的风险。噻唑烷二酮类药物在肝脏气球样变、小叶炎症和纤维化方面均有改善。胰高血糖素样肽-1受体激动剂中最常用的药物是利拉鲁肽,能显著降低转氨酶水平、改善肝细胞气球样变和脂肪变性。关于二肽基肽酶-4和钠-葡萄糖共转运蛋白-2抑制剂作用的资料较少。胰岛素的使用与实体肿瘤,尤其是肝细胞癌的发生可能相关。所有的降糖药物都可以安全地应用于代偿期肝硬化患者,而胰岛素则是肝硬化失代偿期的首选药物。本文就降糖药物治疗NAFLD的有效性和安全性进行综述。     

二甲双胍抑制H1299细胞迁移及其机制研究

该文主要研究二甲双胍(metformin, Met)对肺腺癌H1299细胞增殖、迁移和凋亡的影响,并探讨其可能作用机制。利用显微镜观察二甲双胍处理后细胞形态,划痕实验检测二甲双胍对细胞迁移的影响; Annexin V/PI标记,流式检测二甲双胍对细胞凋亡的影响; 5-乙炔基-2’脱氧尿嘧啶(Edu)法检测二甲双胍对细胞增殖的影响。结果表明,二甲双胍能改变H1299细胞形态且能显著抑制细胞迁移;二甲双胍不能诱导H1299细胞凋亡;二甲双胍能抑制H1299细胞增殖。进一步研究发现,二甲双胍能下调p-ERK和p-MEK蛋白水平,同时增加E-Cadherin和减少FAK、vimentin蛋白表达,说明二甲双胍主要通过抑制ERK信号通路抑制H1299细胞增殖和迁移,并通过上调E-Cadherin、下调FAK、vimentin使H1299细胞迁移受到明显抑制,为二甲双胍应用于肺腺癌的预防及治疗提供了指导依据。     

二甲双胍联合卡铂对三阴性乳腺癌细胞增殖的影响

目的:探讨二甲双胍联合卡铂对三阴性乳腺癌细胞MDA-MB-231增殖的影响。方法:体外培养三阴性乳腺癌细胞MDA-MB-231,分别给予不同浓度(0、2.5、5、10 mmol/L)二甲双胍和20μmol/L卡铂处理后,采用MTT实验、平板克隆实验检测二甲双胍联合卡铂对MDA-MB-231细胞增殖的影响。结果:MTT实验结果显示:二甲双胍抑制MDA-MB-231细胞的增殖,5、10mM组细胞OD490值均显著低于对照组(P0.05),且10 mM组细胞OD490值明显低于其他各组(P0.05);与单药相比,二甲双胍和卡铂联用组细胞生长抑制率显著升高,差异具有统计学意义(P0.05)。平板克隆实验结果显示:与单药相比,二甲双胍和卡铂联用组细胞的克隆形成抑制率率显著升高,差异具有统计学意义(P0.05)。结论:二甲双胍联合卡铂能够有效的抑制三阴性乳腺癌细胞MDA-MB-231的增殖。     

二甲双胍抗肿瘤作用及其分子机制的研究进展

二甲双胍是全球范围内治疗2型糖尿病最常用的药物之一,具有使用方便、疗效好、价格低廉且毒副作用小等优点。近年来大量的流行病学研究及体内外实验研究发现二甲双胍能够用于多种肿瘤的治疗及预防,然而其分子机制尚不十分明确;主要包括调节体内胰岛素/IGF-1轴、激活AMPK信号通路、调控micro RNAs的表达、活化Caspase分子、阻断AGEs-RAGE系统等,这些机制为将来二甲双胍应用于肿瘤的预防及临床治疗提供了重要的理论依据。本文针对糖尿病治疗药物二甲双胍在抗肿瘤中的作用及其分子机制进行全面综述。     

二甲双胍联合放射线照射对鼻咽癌细胞CNE-1增殖的影响

目的:探讨二甲双胍联合放射线照射对鼻咽癌细胞CNE-1增殖的影响。方法:分别给予鼻咽癌细胞CNE-1二甲双胍(5m M)、2Gy放射线照射、二甲双胍(5 m M)联合2Gy放射线照射处理后,采用MTT实验、克隆形成实验检测和比较其细胞增殖抑制率和克隆形成抑制率。结果:MTT实验结果显示:与二甲双胍组或2Gy放射线照射组相比,二甲双胍联合放射线照射组细胞增殖抑制率显著升高,差异具有统计学意义(P0.05);克隆形成实验结果显示,与二甲双胍组或2Gy放射线照射组相比,二甲双胍联合放射线照射组细胞克隆形成抑制率显著升高,差异具有统计学意义(P0.05)。结论:二甲双胍联合放射线照射能够有效的抑制鼻咽癌细胞CNE-1的增殖。     

Anticancer effect of ursolic acid stearoyl glucoside in chemically induced hepatocellular carcinoma

Hepatocellular carcinoma is one of the leading causes of death in cancer and yet no drug has proven to be a successful candidate for its treatment in advanced stages. Ursolic acid stearoyl glucoside (UASG) is a newly discovered triterpene in Lantana camara and there lies a possibility that it possess anti-hepatocellular carcinoma property. In the present study, we induced hepatocellular carcinoma in Wistar rats by diethylnitrosamine (DENA) and treated it with ursolic acid stearoyl glucoside. The ability to treat hepatocellular carcinoma was measured by comparing biochemical serum markers such as serum alanine aminotransferase, serum aspartate aminotransferase, serum alkaline phosphatase, and the specific marker for hepatocellular carcinoma, alpha fetoprotein. The histological studies of the livers were also performed. The results have shown significant elevated levels of these parameters as compared to normal control and the drug receiving groups have shown significant reduction in these marker levels. Histopathological studies also indicated the reduced liver damage in drug-treated groups. It was noted that a significant and dose-dependent reversal of DENA-diminished activity of antioxidant enzymes like superoxide dismutase, catalase, glutathione peroxidase, glutathione transferase, and the reduced DENA-elevated level of lipid peroxidation (LPO) with a marked change. UASG significantly suppressed free radical formation by scavenging the hydroxyl radicals. It also modulates the levels of LPO and markedly increases the endogenous antioxidant enzymes level in DENA-induced hepatocellular carcinogenesis.     

Altered glycosaminoglycan composition in reactive and neoplastic human liver

We have investigated the glycosaminoglycan composition of normal human liver, focal nodular hyperplasia, hepatic adenoma, and hepatocellular carcinoma. Uronic acid increased about 4 fold in the benign and reactive lesions, and greater than 7 fold in the carcinoma. Whereas in focal nodular hyperplasia and adenoma dermatan sulfate was the predominant glycosaminoglycan, in hepatocellular carcinoma chondroitin sulfate was the predominant species; it increased 24 fold over normal liver and 3-5 fold over all the other tissues. HPLC analysis of chondroitinase ABC or AC digests showed a 58 fold increase in Delta-Di-OS disaccharides in hepatocellular carcinoma, indicating significant undersulfation of chondroitin sulfate. Surprisingly, the normal-appearing liver surrounding the carcinoma showed glycosaminoglycan changes similar to adenoma and nodular hyperplasia. These results thus indicate that specific glycosaminoglycan changes occur in hepatocellular carcinoma, and suggest for the first time that proteoglycan metabolism is also altered in the non-cirrhotic, hepatic parenchyma adjacent to liver carcinoma.     

Nonalcoholic fatty liver disease and the metabolic syndrome

PURPOSE OF REVIEW: Clinical, epidemiological and biochemical data strongly support the concept that nonalcoholic fatty liver disease is the hepatic manifestation of the metabolic syndrome. Insulin resistance is the common factor connecting obesity, diabetes, hypertension and dyslipidemia with fatty liver and the progression of hepatic disease to steatohepatitis, fibrosis, cirrhosis and hepatocellular carcinoma. RECENT FINDINGS: The association of nonalcoholic fatty liver disease with the features of the metabolic syndrome has been confirmed in several epidemiological studies. The diagnostic and clinical significance of raised liver enzymes has been questioned; advanced hepatic disease may also be present in individuals with ultrasonographically detected steatosis and normal aminotransferase levels. The role of adipokines (leptin, adiponectin) and cytokines (tumor necrosis factor-alpha, interleukin-6, transforming growth factor-beta) in disease progression is probably pivotal, mediated by oxidative stress. The importance of iron accumulation in this process has not been confirmed. Treatments aimed at weight loss remain a primary option; among pharmacological interventions, insulin sensitizers (glitazones and metformin) have confirmed beneficial effects on both biochemical and histological data, but new treatments are on the horizon. SUMMARY: Nonalcoholic fatty liver disease prevalence in Western countries is high and there is a trend towards a further increase, with millions of people at risk of advanced liver disease. The epidemiological evidence, the lifestyle origin of the disease and the cost of pharmacotherapy make prevention a primary goal, and will contribute to making behavior therapy the background treatment. We need specific programs and carefully controlled, randomized studies to tackle simultaneously all the components of the metabolic syndrome.     

Integration of HBV-DNA into liver and hepatocellular carcinoma cells during persistent HBV infection

The hepatitis B virus carrier state (persistent HBV infection) is characterized by the presence of viral surface antigen (HBsAg) and virion particles (Dane particles) in the blood. From 1% to 10% of carriers develop chronic liver disease and/or hepatocellular carcinoma. Recent studies have demonstrated integrated HBV-DNA in hepatocellular carcinomas and in several human hepatoma cell lines. In hepatoma patients, integrated HBV-DNA has been found in all HBsAg carriers. Nontumorous liver also revealed integrated HBV-DNA with the same or a different hybridization pattern from that observed in the tumor. To explore when integration occurs, carriers of short-term (less than 2 years) or long-term (greater than 8-10 years) were evaluated. DNA extracts from percutaneous (needle) liver biopsies showed free viral DNA with no specific integration bands in short-term carriers. In long-term carriers, HBV-DNA was integrated into the host genome with either a diffuse or a unique hybridization pattern. HBV-DNA integration correlated with the duration of the carrier state and absence of virions in the serum but did not correlate with histologic evidence of chronic hepatitis. These studies suggest that integration of HBV-DNA occurs during persistent HBV infection irrespective of liver disease and precedes development of hepatocellular carcinoma.     

Interstitial Fluid Flow Increases Hepatocellular Carcinoma Cell Invasion through CXCR4/CXCL12 and MEK/ERK Signaling

Hepatocellular carcinoma (HCC) is the most common form of liver cancer (~80%), and it is one of the few cancer types with rising incidence in the United States. This highly invasive cancer is very difficult to detect until its later stages, resulting in limited treatment options and low survival rates. There is a dearth of knowledge regarding the mechanisms associated with the effects of biomechanical forces such as interstitial fluid flow (IFF) on hepatocellular carcinoma invasion. We hypothesized that interstitial fluid flow enhanced hepatocellular carcinoma cell invasion through chemokine-mediated autologous chemotaxis. Utilizing a 3D in vitro invasion assay, we demonstrated that interstitial fluid flow promoted invasion of hepatocellular carcinoma derived cell lines. Furthermore, we showed that autologous chemotaxis influences this interstitial fluid flow-induced invasion of hepatocellular carcinoma derived cell lines via the C-X-C chemokine receptor type 4 (CXCR4)/C-X-C motif chemokine 12 (CXCL12) signaling axis. We also demonstrated that mitogen-activated protein kinase (MEK)/extracellular signal-regulated kinase (ERK) signaling affects interstitial fluid flow-induced invasion; however, this pathway was separate from CXCR4/CXCL12 signaling. This study demonstrates, for the first time, the potential role of interstitial fluid flow in hepatocellular carcinoma invasion. Uncovering the mechanisms that control hepatocellular carcinoma invasion will aid in enhancing current liver cancer therapies and provide better treatment options for patients.     

Controversies in patient selection for liver transplantation.

A variety of specific conditions often stimulate controversy regarding candidacy for liver transplantation. We review the published experience with liver transplantation for alcoholic liver disease, fulminant and chronic hepatitis B, and hepatocellular carcinoma and transplantation in older subjects. Liver transplantation for alcoholic liver disease and in subjects older than 60 years is becoming less controversial because recent data demonstrate that these patients have excellent survival and good quality of life after transplantation. Only 10% to 15% of persons with alcoholism return to drinking after transplantation, and most do so only transiently. Liver transplantation for patients with hepatitis B virus infection or primary liver cancer is more problematic because recurrent disease is common in both conditions. After transplantation for chronic hepatitis B, 80% to 90% of patients have reinfection of the allograft and long-term survival is 45% to 50%. Patients receiving transplants for hepatocellular carcinoma have only 20% to 30% long-term survival, but these survivors are cured of malignancy. Data are presented to support continued liver transplantation for chronic hepatitis B and hepatocellular carcinoma; however, patients must be selected based on factors that predict a favorable outcome, and experimental therapies should be employed to explore ways to improve the existing survival rates.     

Hepatitis C virus core protein: Its coordinate roles with PA28γ in metabolic abnormality and carcinogenicity in the liver

Hepatitis C virus (HCV) is a major cause of chronic liver diseases, including steatosis, cirrhosis and hepatocellular carcinoma, and epidemiological studies indicate that HCV is also associated with insulin resistance and type 2 diabetes mellitus. The HCV core protein is not only a viral structural component but also a pathogenic factor, since its expression leads to the development of liver steatosis, insulin resistance and hepatocellular carcinoma in mice. The nuclear proteasome activator PA28γ/REGγ, which specifically binds to the core protein, is required for the virulence of the core protein. Elucidation of the mechanisms by which HCV core protein participates in the above conditions may provide clues toward the development of novel therapeutic measures for chronic hepatitis C.     

Loss of the orphan nuclear receptor SHP is more pronounced in fibrolamellar carcinoma than in typical hepatocellular carcinoma

Hepatocellular carcinoma (HCC) remains a major problem in oncology. The molecular mechanisms which underlie its pathogenesis are poorly understood. Recently the Small Heterodimer Partner (SHP), an orphan nuclear receptor, was suggested to be involved as a tumor suppressor in hepatocellular carcinoma development. To date, there are no such studies regarding fibrolamellar carcinoma, a less common variant of HCC, which usually affects young people and displays distinct morphological features. The aim of our project was to evaluate the SHP levels in typical and fibrolamellar hepatocellular carcinoma with respect to the levels of one of the cell cycle regulators, cyclin D1. We assessed the immunoreactivity levels of SHP and cyclin D1 in 48 typical hepatocellular carcinomas, 9 tumors representing the fibrolamellar variant, 29 non malignant liver tissues and 7 macroregenerative nodules. We detected significantly lower SHP immunoreactivity in hepatocellular carcinoma when compared to non malignant liver tissue. Moreover, we found that SHP immunoreactivity is reduced in fibrolamellar carcinoma when compared to typical hepatocellular carcinoma. We also found that SHP is more commonly lost in HCC which arises in the liver with steatosis. The comparison between the cyclin D1 and SHP expression revealed the negative correlation between these proteins in the high grade HCC. Our results indicate that the impact of loss of SHP protein may be even more pronounced in fibrolamellar carcinoma than in a typical form of HCC. Further investigation of mechanisms through which the loss of SHP function may influence HCC formation may provide important information in order to design more effective HCC therapy.     

microRNAs在肝病中的研究进展

非编码小分子RNA(miRNA)调节肝脏生物学功能,大量实验表明,小分子RNA(miRNA)对肝脏病理学中有作用。本文概述了miRNA在肝炎、肝硬化肝病领域的进展。microRNA-122是肝细胞中最丰富的微小RNA,在丙型肝炎病毒复制中起着非常明确的作用。实验数据显示,microRNA-122亦可作为一种可行性的靶向治疗。microRNA-122在其他肝脏疾病中亦有作用。大量研究证明,与肝炎有关的其他类型miRNA的重要调节潜力与酒精性肝炎、代谢综合征和自身免疫过程有关。此外,在动物模型和人类研究中,miRNA系列与肝脏纤维化进程有关联。miRNA在肝脏中的功能与细胞分布重要性以及miRNA潜在地作为细胞与器官联系纽带,循环miRNA作为肝损伤、肝癌疾病早期和进展的生物学标志,这些是值得我们讨论的。重要的是:miRNA在肝脏中的调节作用,代表着未来肝病治疗医疗技术中的一种新方法。