乳腺癌患者化疗后乙肝病毒再激活及拉米夫定预防性应用的临床研究

目的:探讨化疗引起的乳腺癌患者肝功能损害与乙肝病毒(HBV)感染的相关性及抗病毒治疗在预防化疗引起的HBV再激活中的作用。方法:2006年3月-2010年10月在武汉市第三医院接受化疗的病理确诊为乳腺癌患者(包括术后辅助化疗)为研究对象,比较HBs Ag阴性138例和HBs Ag阳性50例患者化疗后肝功能损害的发生情况,并分析在HBs Ag阳性患者中,预防性使用(21例)与未预防性使用(27例)抗病毒药物拉米夫定后乙肝病毒再激活率的差异。结果:化疗后出现肝功能损害的乳腺癌患者中,HBs Ag阳性患者(31.25%)与HBs Ag阴性患者(16.67%)所占比例的差异有统计学意义(P<0.001)。化疗前预防性使用拉米夫定(4.62%)与未预防性使用(25.93%)拉米夫定,患者出现HBV再激活率的差异亦有统计学意义(P<0.01)。结论:乳腺癌患者化疗后,HBs Ag阳性患者较HBs Ag阴性患者更易出现肝功能损害,预防性使用核苷类似物抗病毒药物拉米夫定,可明显降低乳腺癌合并乙肝患者化疗后HBV再激活肝炎的发生。     

Involvement of the insulin-like growth factor binding proteins in the cancer cell response to DNA damage

The complex mechanisms that cells have evolved to meet the challenge of constant exposure to DNA-damaging stimuli, also serve to protect cancer cells from the cytotoxic effects of chemo- and radiotherapy. IGFBPs appear to be involved, directly or indirectly, in some of these protective mechanisms. Activation of p53 is an early response to genotoxic stress, and all six human IGFBP genes have predicted p53 response elements in their promoter and/or intronic regions, at least some of which are functional. IGFBP3 has been extensively characterized as a p53-inducible gene, but in some cases it is suppressed by mutant p53 forms. DNA double-strand breaks (DSBs), induced by radiotherapy and some chemotherapies, potentially lead to apoptotic cell death, senescence, or repair and recovery. DSB damage can be repaired by homologous recombination or non-homologous end-joining (NHEJ), depending on the cell cycle stage, availability of key repair proteins, and other factors. The epidermal growth factor receptor (EGFR) has been implicated in the NHEJ pathway, and EGFR inhibition may inhibit repair, promoting apoptosis and thus improving sensitivity to chemotherapy or radiotherapy. Both IGFBP-3 and IGFBP-6 interact with components of the NHEJ pathway, and IGFBP-3 can facilitate this process through direct interaction with both EGFR and the catalytic subunit of DNA-PK. Cell fate after DNA damage may in part be regulated by the balance between the sphingolipids ceramide and sphingosine-1-phosphate, and IGFBPs can influence the production of both lipids. A better understanding of the involvement of IGFBPs in the DNA damage response in cancer cells may lead to improved methods of sensitizing cancers to DNA-damaging therapies.     

A Microenvironment Based Model of Antimitotic Therapy of Gompertzian Tumor Growth

A model of tumor growth, based on two-compartment cell population dynamics, and an overall Gompertzian growth has been previously developed. The main feature of the model is an inter-compartmental transfer function that describes the net exchange between proliferating (P) and quiescent (Q) cells and yields Gompertzian growth for tumor cell population N = P + Q. Model parameters provide for cell reproduction and cell death. This model is further developed here and modified to simulate antimitotic therapy. Therapy decreases the reproduction-rate constant and increases the death-rate constant of proliferating cells with no direct effect on quiescent cells. The model results in a system of two ODE equations (in N and P/N) that has an analytical solution. Net tumor growth depends on support from the microenvironment. Indirectly, this is manifested in the transfer function, which depends on the proliferation ratio, P/N. Antimitotic therapy will change P/N, and the tumor responds by slowing the transfer rate from P to Q. While the cellular effects of therapy are modeled as dependent only on antimitotic activity of the drug, the tumor response also depends on the tumor age and any previous therapies—after therapy, it is not the same tumor. The strength of therapy is simulated by the parameter λ, which is the ratio of therapy induced net proliferation rate constant versus the original. A pharmacodynamic factor inversely proportional to tumor size is implemented. Various chemotherapy regimens are simulated and the outcomes of therapy administered at different time points in the life history of the tumor are explored. Our analysis shows: (1) for a constant total dose administered, a decreasing dose schedule is marginally superior to an increasing or constant scheme, with more pronounced benefit for faster growing tumors, (2) the minimum dose to stop tumor growth is age dependent, and (3) a dose-dense schedule is favored. Faster growing tumors respond better to dose density.     

Bioluminescent imaging of hepatocellular carcinoma in live mice

A non-invasive orthotopic hepatocellular carcinoma (HCC) model was created with human HCC cells (HepG-Luc) constitutively expressing luciferase (Luc) in nude mice. Development of tumor growth and response to anti-tumor therapy combined with 5-fluorouracil and cisplatin was monitored by whole-body bioluminescent imaging (BLI). Luciferase activity in the tumor, determined by BLI, correlated with the tumor volume and weight. The anti-tumor therapy proved effective by BLI monitoring. In conclusion, BLI by luciferase provides a non-invasive method of monitoring tumor activities that can prove useful for therapeutic intervention studies.     

Probability of resistance evolution for exponentially growing virus in the host

Chemotherapy for tumor and pathogenic virus often faces an emergence of resistant mutants, which may lead to medication failure. Here we study the risk of resistance to evolve in a virus population which grows exponentially. We assume that infected cells experience a "proliferation event" of virus at a random time and that the number of newly infected cells from an infected cell follows a Poisson distribution. Virus starts from a single infected cell and the virus infection is detected when the number of infected cells reaches a detection size. Initially virus is sensitive to a drug but later acquires resistance by mutations. We ask the probability that one or more cells infected with drug-resistant virus exist at the time of detection. We derive a formula for the probability of resistance and confirm its accuracy by direct computer simulations. The probability of resistance increases with detection size and mutation rate but decreases with the population growth rate of sensitive virus. The risk of resistance is smaller when more cells are newly infected by viral particles from a single infected cell if the viral growth rate is the same.     

Chemotherapy and zoledronate sensitize solid tumour cells to Vγ9Vδ2 T cell cytotoxicity

Combinations of cellular immune-based therapies with chemotherapy and other antitumour agents may be of significant clinical benefit in the treatment of many forms of cancer. Gamma delta (γδ) T cells are of particular interest for use in such combined therapies due to their potent antitumour cytotoxicity and relative ease of generation in vitro. Here, we demonstrate high levels of cytotoxicity against solid tumour-derived cell lines with combination treatment utilizing Vγ9Vδ2 T cells, chemotherapeutic agents and the bisphosphonate, zoledronate. Pre-treatment with low concentrations of chemotherapeutic agents or zoledronate sensitized tumour cells to rapid killing by Vγ9Vδ2 T cells with levels of cytotoxicity approaching 90%. In addition, zoledronate enhanced the chemotherapy-induced sensitization of tumour cells to Vγ9Vδ2 T cell cytotoxicity resulting in almost 100% lysis of tumour targets in some cases. Vγ9Vδ2 T cell cytotoxicity was mediated by perforin following TCR-dependent and isoprenoid-mediated recognition of tumour cells. Production of IFN-γ by Vγ9Vδ2 T cells was also induced after exposure to sensitized targets. We conclude that administration of Vγ9Vδ2 T cells at suitable intervals after chemotherapy and zoledronate may substantially increase antitumour activities in a range of malignancies. Financial support and conflicts of interest: This study was supported by grants from Medinet (Japan), and Suncorp Metway and Gallipoli Research Foundation (Australia). No financial or commercial interests arise from this study. Informed consent: This study was approved by Human Research Ethics Committees of the University of Queensland and Greenslopes Private Hospital and informed consent was obtained from all subjects.     

艾迪注射液对急性白血病患者化疗减毒增效作用及肠道菌群影响的研究

艾迪注射液可扶植肠道正常菌群生长,减轻化疗药副作用,提高白血病患者化疗疗效。方法将选择病例随机分为艾迪注射液治疗组(试验组)及常规化疗组(对照组)。观察其化疗前后肠道常驻菌(肠杆菌、肠球菌、双歧杆菌、乳酸杆菌)指标,骨髓象检查及化疗后毒副作用观察。结果各项指标同单纯化疗组相比,差异均有显著性(P<0.05或P<0.01)。结论艾迪注射液具有扶植肠道正常菌群生长的作用,与化疗合用,减轻了化疗药的毒副作用,保证了化疗的顺利进行,提高了急性白血病患者的化疗疗效。     

Regulation of differential pro- and anti-apoptotic signaling by glucocorticoids

More than a quarter of a century ago, the phenomenon of glucocorticoid-induced apoptosis in the majority of hematological cells was first recognized. More recently, glucocorticoid-induced antiapoptotic signaling associated with apoptosis resistance has been identified in cells of epithelial origin, most of malignant solid tumors and some other tissues. Despite these huge amount of data demonstrating differential pro- and anti-apoptotic effects of glucocortioids, the underlying mechanisms of cell type specific glucocorticoid signaling are just beginning to be described. This review summarizes our present understanding of cell type-specific pro- and anti-apoptotic signaling induced by glucocorticoids. In the first section we give a summary and update of known glucocorticoid-induced pathways mediating apoptosis in hematological cells. We shortly introduce mechanisms of glucocorticoid resistance of hematological cells. We highlight and discuss the emerging molecular evidence of a general induction of survival signaling in epithelial cells and carcinoma cells by glucocorticoids. We provide a model for glucocorticoid-induced resistance in cells growing in a tissue formation. Thus, attachment to the extracellular matrix and cell-cell contacts typical for e.g. epithelial and tumor cells may be crucially involved in switching the balance of several interacting pathways to survival upon treatment with glucocorticoids.     

新疆维、汉P-gp、MRP1、GST-π与宫颈癌新辅助化疗疗效的相关性研究

目的：探讨新疆维吾尔族及汉族宫颈癌新辅助化疗前后P-gp、MRPI和GST-∏的表达及其与化疗疗效的关系。方法：运用S-P法检测分别检测维吾尔族妇女宫颈鳞癌组织22例和非宫颈鳞癌组织20例,汉族妇女宫颈鳞癌组织30例和非宫颈鳞癌组织30例,新辅助化疗前后P-gP、MRPI和GST-π的表达水平。结果：①新疆维吾尔族正常宫颈、初治宫颈癌组织中P-gp的阳性表达率分别为10%、72.7%;MRP1的阳性表达率分别为20%、40.9%;GST-π的阳性表达率分别为45%、90.9%。P-gp、和MRP1在各组间比较差异均有统计学意义（P〈0.05）,GST-π差异无统计学意义（P〉0.05）。②新疆汉族正常宫颈、初治宫颈癌组织中P-gp的阳性表达率分别为10%、56.7%;GST-π的阳性表达率分别为20%、60%,MRP1的阳性表达率分别为40%、86.7%。P-gp、GST-π和MRP1在各组间比较差异均有统计学意义（P〈0.05）。③在新疆维吾尔族妇女宫颈鳞癌组织中：NACT后宫颈癌组织中GST-π阳性表达显著上升（P〈0.05）,有统计学意义。NACT后宫颈癌组织中P-pg、MRP1阳性表达差异无统计学意义（P〉0.05）。④在新疆汉族妇女宫颈鳞癌组织中：NACT后宫颈癌组织中P-pg、GST-π阳性表达显著上升（P〈0.05）;有统计学意义。NACT后宫颈癌组织中MRP1阳性表达上升但差异无统计学意义（P〉0.05）。⑤新疆维吾尔族妇女化疗前宫颈鳞癌组织中MRP1及GST-π表达阴性和阳性患者NACT有效率无显著性差异（p〉0.05）,P-gp表达阴性患者NACT有效率显著高于P-gp表达阳性患者NACT有效率（p〈0.05）;⑥汉族化疗前宫颈鳞癌组织中P-gp、GST-π表达阴性患者NACT有效率显著高于P-gp、GST-π表达阳性患者NACT有效率（p〈0.05）;化疗前宫颈鳞癌MRP1表达阴性和阳性患者NACT有效率无显著性差异（p〉0.05）。结论：P-pg和GST-π可作为预测汉族宫颈鳞癌化疗敏感性指标。P-pg可作为预测维吾尔族宫颈鳞癌化疗敏感性指标。     

老年晚期非小细胞肺癌患者对放化疗的耐受性研究现况

近年多组大规模的随机对照研究已经证实：放化疗对于老年晚期NSCLC患者好于最佳支持治疗（BSC）,放化疗组的有效率、中住生存期、一年生存率显著高于BSC组,但老年人伴随着年龄的增长器官功能衰退、药代酶活性下降等生理因素,常合并其他疾病等原因,其药效学和药动学也随之发生变化,老年NSCLC放化疗的潜在毒性危险可能增加,治疗耐受性较差,综合治疗可能带来较多的并发症,甚至高的治疗相关死亡率。中医学认为化疗副反应主要表现为气血亏损、脾胃失调及肝肾虚损等症候群,放疗副反应的症候群以热象较重,属热毒之邪耗气伤阴,进而灼津烁血以致气血、肌肤、脏腑受损的火郁、燥结、热毒症候较多。中医药在减轻放化疗的毒副作用、提高老年患者对放化疗的耐受性等方面有明显优势。