基于TRAIL的肿瘤治疗策略进展

肿瘤坏死因子相关凋亡诱导配体(TRAIL)能选择性诱导肿瘤细胞凋亡,且对机体正常组织细胞无毒副作用,被认为是一种非常有潜力的抗癌药物。我们简要介绍TRAIL及其配体诱导细胞凋亡的机制、肿瘤细胞对TRAIL的耐受机制及其克服策略。     

TRAIL诱导肿瘤细胞凋亡的分子机制及其在肿瘤生物治疗中的应用前景

肿瘤坏死因子相关的凋亡诱导配体(tumor necrosis factor related apoptosis-inducingligand,TRAIL)是肿瘤坏死因子超家族成员之一,由于它能特异性诱导肿瘤细胞的凋亡而对正常细胞无毒性,因此具有被开发成治疗肿瘤的蛋白质药物的可能性。目前已经有5个与TRAIL相关的受体被鉴定出,其中,TRAILR1和TRAILR2是与诱导细胞凋亡最直接相关的受体,也是最具有前景的药物设计靶点。本文基于TRAIL蛋白及其受体复合物的三维结构分析,阐述TRAIL诱导肿瘤细胞凋亡的机制以及影响凋亡的因素和途径,对以TRAIL为靶点的肿瘤治疗的研究现状作全面综述,为探索肿瘤生物治疗的新方法和途径提供帮助。     

肿瘤坏死因子相关凋亡诱导配体（TRAIL）及抗肿瘤作用

肿瘤坏死因子相关凋亡诱导配体（TRAIL）是肿瘤坏死因子（TNF）超家族成员之一,能选择性的诱导肿瘤细胞、转化细胞凋亡,而对正常组织无毒性,有望成为肿瘤治疗的新方法,备受人们的关注。本文从TRAIL的结构、受体、诱导肿瘤细胞凋亡机制及在肿瘤治疗中的应用等方面作了介绍,以期为TRAIL临床应用提供参考。     

Procaspase-8失调与肿瘤细胞对TRAIL的耐受

肿瘤坏死因子相关凋亡诱导配体(TRAIL)可激活胱天蛋白酶（caspase）家族蛋白系列级联反应,最终诱导细胞凋亡. TRAIL选择性地诱导肿瘤细胞凋亡而不损伤正常细胞,使其成为治疗癌症的潜在药物靶点. 目前已知,细胞型FADD样白介素-1-β转换酶抑制蛋白(c FLIP)和凋亡抑制蛋白(IAPs)是肿瘤细胞对TRAIL耐受的主要原因.胱天蛋白酶原-8（procaspase-8）是TRAIL凋亡信号途径中的凋亡起始蛋白. 然而近年发现,在某些肿瘤细胞中procaspase-8功能失调常会阻碍凋亡信号传导,使肿瘤细胞对TRAIL诱导的凋亡产生耐受. 本文就其机制进行概述.     

以TRAIL为靶点的肿瘤治疗研究进展

肿瘤坏死因子相关凋亡配体（tumor necrosis factor-related apoptosis-inducing ligand,TRAIL）是肿瘤坏死因子（tumor necrosis factor,TNF）超家族成员。TRAIL与其受体结合后启动凋亡信号转导,选择性地诱导肿瘤细胞凋亡,而对正常组织细胞没有明显的伤害,而且一些药物和细胞因子可协同TRAIL诱导肿瘤细胞凋亡。本文就TRAIL及其受体、TRAIL诱导凋亡的机制以及影响凋亡的因素和途径,以TRAIL为靶点的肿瘤治疗的研究现状作一综述。     

TRAIL联合多西紫杉醇对人鼻咽癌CNE2细胞的体外作用研究

目的:研究肿瘤坏死因子相关凋亡配体(TRAIL)联合化疗药物多西紫杉醇对鼻咽癌CNE2细胞凋亡诱导作用。方法:应用MTT法检测不同浓度多西紫杉醇的抗癌活性,计算其亚毒性剂量,流式细胞仪检测多西紫杉醇及TRAIL单独或者联合作用于鼻咽癌CNE2细胞后的细胞凋亡发生率,TUNEL法观察细胞凋亡发生情况。结果:鼻咽癌细胞对TRAIL的作用敏感,多西紫杉醇可以增强其凋亡诱导作用。结论:TRAIL与多西紫杉醇具有协同抗鼻咽癌作用,有望应用于鼻咽癌的临床治疗。     

TRAIL联合多西紫杉醇诱导喉鳞癌Hep-2 细胞凋亡的实验研究

目的：观察肿瘤坏死因子相关凋亡诱导配体( TRAIL) 联合多西紫杉醇应用于人喉鳞癌Hep-2 细胞生长的抑制增殖和诱导 凋亡作用。方法：实验分四组,1 组对照组,2 组为应用TRAIL组,3 组单独应用多西紫杉醇,4 组联合应用TRAIL及多西紫杉醇。 分别应用MTT、流式细胞仪检测细胞凋亡率,倒置显微镜观察细胞的形态学改变。结果：TRAIL 与多西紫杉醇联合作用于Hep-2 细胞,能显著增强对Hep-2 细胞的杀伤、抑制增殖及诱导凋亡作用,其联合应用的凋亡抑制率明显高于单独应用TRAIL组和多西 紫杉醇组( P<0.05)。结论：TRAIL与多西紫杉醇联用能显著提高对喉鳞癌Hep-2 细胞的生长抑制和诱导凋亡作用。     

TRAIL联合多西紫杉醇诱导喉鳞癌Hep-2细胞凋亡的实验研究

目的：观察肿瘤坏死因子相关凋亡诱导配体（TRAIL）联合多西紫杉醇应用于人喉鳞癌Hep-2细胞生长的抑制增殖和诱导凋亡作用。方法：实验分四组,1组对照组,2组为应用TRAIL组,3组单独应用多西紫杉醇,4组联合应用TRAIL及多西紫杉醇。分别应用MTT、流式细胞仪检测细胞凋亡率,倒置显微镜观察细胞的形态学改变。结果：TRAIL与多西紫杉醇联合作用于Hep-2细胞,能显著增强对Hep-2细胞的杀伤、抑制增殖及诱导凋亡作用,其联合应用的凋亡抑制率明显高于单独应用TRAIL组和多西紫杉醇组（P〈0．05）。结论：TRAIL与多西紫杉醇联用能显著提高对喉鳞癌Hep-2细胞的生长抑制和诱导凋亡作用。     

Ap5A延迟TRAIL诱导Novikoff细胞的凋亡

通过荧光分子标记和CONFOCAL技术检测方法,建立了TRAIL（TNF-related apoptosis inducing ligand, 一种类肿瘤坏死因子）诱导Novikoff细胞凋亡的模型,并探讨了TRAIL诱导凋亡的机制和Ap5A（P¹, P⁵-Di（adenosine-5′）pentaphosphate）在其中的作用.结果显示：TRAIL可诱导Novikoff细胞凋亡,且具有剂量和时间依赖性,同时胞内钙离子浓度显著上调.Ap5A能延迟TRAIL诱导的Novikoff细胞凋亡,同时下调胞内钙离子浓度.TRAIL和Ap5A分别上调和下调胞内钙离子浓度的作用可能是其诱发和延迟Novikoff细胞凋亡的一个机制.     

乙型肝炎病毒X蛋白调节TRAIL诱导的肝细胞凋亡

观察乙型肝炎病毒X蛋白(HBx)对肿瘤坏死因子相关的凋亡诱导配体(TNF-related apoptosis-inducing ligand, TRAIL)诱导肝细胞凋亡的影响并初步探讨其分子机制. 构建包含HBx基因的真核表达载体pcDNA-HBx, 转染BEL7402肝癌细胞, 建立可稳定表达HBx的肝癌细胞系BEL7402-HBx, 同时设立空载体pcDNA3转染对照组细胞BEL7402-cDNA3. 台盼蓝染色计数, Caspase3活性检测和TUNEL法检测TRAIL诱导BEL7402, BEL7402-cDNA3, BEL7402-HBx细胞凋亡的情况, 并通过流式细胞术分析3组细胞表面TRAIL受体的表达水平. 此外, 利用硫代反义寡核苷酸封闭HBV全基因转染肝癌细胞系HepG2.2.15中HBx蛋白的表达, 观察阻断前后对TRAIL诱导凋亡敏感性的改变, 进一步反向验证HBx对TRAIL诱导凋亡的调节作用. 台盼蓝染色计数提示TRAIL 对BEL7402, BEL7402-cDNA3, BEL7402-HBx均有剂量依赖性的细胞毒作用, 但在相同浓度TRAIL作用下, BEL7402-HBx细胞较BEL7402, BEL7402-cDNA3细胞有更高的敏感性. Caspase3活性检测结果分析发现, TRAIL作用后BEL7402-HBx细胞在较短时间内有更高的Caspase3活化水平. TUNEL结果显示, 10 mg/LTRAIL作用下, BEL7402-HBx细胞凋亡率可达(41.4±7.2)%, 显著高于对照组细胞. 反义封闭HepG2.2.15细胞中HBx基因的表达可部分阻断TRAIL诱导的凋亡. 两组实验结果均显示HBx的表达变化并不影响细胞表面TRAIL受体的表达模式. HBx蛋白参与调节TRAIL诱导的细胞凋亡, 可能在HBV相关疾病的发生中起一定作用, 这一作用与TRAIL受体表达水平无关. 从两个不同的侧面证实了HBx对TRAIL诱导细胞凋亡的调节作用, 为进一步论证凋亡失衡在HBV感染相关肝炎及肝癌发生中的作用提供了新的论据.     

Targeting the extrinsic apoptosis signaling pathway for cancer therapy

The extrinsic apoptosis pathway is triggered by the binding of death ligands of the tumor necrosis factor (TNF) family to their appropriate death receptors (DRs) on the cell surface. One TNF family member, TNF-related apoptosis-inducing ligand (TRAIL or Apo2L), seems to preferentially cause apoptosis of transformed cells and can be systemically administered in the absence of severe toxicity. Therefore, there has been enthusiasm for the use of TRAIL or agonist antibodies to the TRAIL DR4 and DR5 in cancer therapy. Nonetheless, many cancer cells are very resistant to TRAIL apoptosis in vitro. Therefore, there is much interest in identifying compounds that can be combined with TRAIL to amplify its apoptotic effects. In this review, I will provide a brief overview of apoptosis signaling by TRAIL and discuss apoptosis-sensitizing agents, focusing mainly on the proteasome inhibitor bortezomib (VELCADE) and some novel sensitizers that we have recently identified. Alternative ways to administer TRAIL or DR agonist antibodies as therapeutic agents will also be described. Finally, I will discuss some of the gaps in our understanding of TRAIL apoptosis signaling and suggest some research directions that may provide additional information for optimizing the targeting of the extrinsic apoptosis pathway for future cancer therapy.     

TRAIL promotes membrane blebbing, detachment and migration of cells displaying a dysfunctional intrinsic pathway of apoptosis

Recently, tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL/Apo2L) has been shown to be a potential candidate for cancer therapy. TRAIL induces apoptosis in various cancer cells but not in normal tissues. Here we show that HCT116 and SW480 cells with a deficient mitochondrial apoptotic pathway were resistant to TRAIL-induced apoptosis, whereas HCT116 and SW480 cells with a functional mitochondrial apoptotic pathway underwent apoptosis upon exposure to TRAIL. Surprisingly, TRAIL induced phenotypic changes in cells with a dysfunctional mitochondrial apoptotic pathway, including membrane blebbing and a transient loss of adhesion properties to the substratum. Accordingly, TRAIL stimulated the ability of these cells to migrate. This behavior was the consequence of a transient TRAIL-induced ROCK1 cleavage. In addition, we report that Bax-deficient HCT116 cells exposed to TRAIL for a prolonged period lost their sensitivity to TRAIL as a result of downregulation of TRAIL receptor expression, and became resistant to combination of TRAIL and other drugs such as MG-132 and bortezomib. These findings may have important consequences for TRAIL anti-cancer therapy.     

Stiffness changes of tumor HEp2 cells correlates with the inhibition and release of TRAIL-induced apoptosis pathways

Tumor necrosis factor (TNF)-related apoptosis inducing ligand (TRAIL) is a promising apoptotic agent that can selectively act on tumor cells. However, some cancer cells are resistant to TRAIL mediated apoptosis. In specific type of cells, sensitization by chemotherapeutic drugs may overcome the resistance to TRAIL induced apoptosis. In this work, atomic force microscopy (AFM) nanoindentation spectroscopy combined with fluorescence methods were used to investigate the biomechanical aspects of the resistance and unblocking of apoptosis in larynx carcinoma HEp2 cells treated with TRAIL. It is shown that there is a direct correlation between the increase in mechanical cell stiffness and the inhibition of apoptosis induced by TRAIL in HEp2 cells. Conversely, unblocking of apoptosis by sensitization of HEp2 cells with a chemotherapeutic drug Actinomycin D is related to the depolymerization of F-actin and to the decrease in the cell stiffness. Both effects, that is, changes in the mechanical stiffness of the cell and the inhibition of apoptotic pathway, are closely related to the Bcl-2 activity. Most probably, the depolymerization of F-actin results from downregulation of Rho protein, which in turn is accompanied by a lower activity of Bcl-2 and in consequence releases the intrinsic apoptotic channel. The presented results reveal a promising application of nanoindentation spectroscopy with an AFM tip as a novel tool for monitoring the processes of apoptosis inhibition.     

Hypermethylation of the death-associated protein kinase promoter attenuates the sensitivity to TRAIL-induced apoptosis in human non-small cell lung cancer cells

Death-associated protein (DAP) kinase plays an important role in IFN-gamma, tumor necrosis factor (TNF)-alpha, or Fas-ligand induced apoptosis. TNF-related apoptosis-inducing ligand (TRAIL) is a member of the TNF ligand family and can induce caspase-dependent apoptosis in cancer cells while sparing most of the normal cells. However, some of the cancer cell lines are insensitive to TRAIL, and such resistance cannot be explained by the dysfunction of TRAIL receptors or their known downstream targets. We reported previously that DAP kinase promoter is frequently methylated in non-small cell lung cancer (NSCLC), and such methylation is associated with a poor clinical outcome. To determine whether DAP kinase promoter methylation contributes to TRAIL resistance in NSCLC cells, we measured DAP kinase promoter methylation and its gene expression status in 11 NSCLC cell lines and correlated the methylation/expression status with the sensitivity of cells to TRAIL. Of the 11 cell lines, 1 had a completely methylated DAP kinase promoter and no detectable DAP kinase expression, 4 exhibited partial promoter methylation and substantially decreased gene expression, and the other 6 cell lines showed no methylation in the promoter and normal DAP kinase expression. Therefore, the amount of DAP kinase expression amount was negatively correlated to its promoter methylation (r = -0.77; P = 0.003). Interestingly, the cell lines without the DAP kinase promoter methylation underwent substantial apoptosis even in the low doses of TRAIL, whereas those with DAP kinase promoter methylation were resistant to the treatment. The resistance to TRAIL was reciprocally correlated to DAP kinase expression in 10 of the 11 cell lines at 10 ng/mL concentration (r = 0.91; P = 0.001). We treated cells resistant to TRAIL with 5-aza-2'-deoxycytidine, a demethylating reagent, and found that these cells expressed DAP kinase and became sensitive to TRAIL. These results suggest that DAP kinase is involved in TRAIL-mediated cell apoptosis and that a demethylating agent may have a role in enhancing TRAIL-mediated apoptosis in some NSCLC cells by reactivation of DAP kinase.     

Sensitivity of Ewing's sarcoma to TRAIL-induced apoptosis.

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is able to kill transformed cells. We have studied the expression and functionality of the TRAIL apoptotic pathway in Ewing's sarcoma. We demonstrate that tumors from patients with Ewing's sarcoma express receptors TRAIL-R1 and -R2. Using a panel of nine Ewing's sarcoma cell lines TRAIL could induce apoptosis in seven cell lines. Preincubation with interferon-gamma rendered the two resistant cell lines sensitive. TRAIL was the most potent inducer of apoptosis when compared to Fas ligand or TNF. TRAIL-mediated apoptosis could be inhibited by various caspase-inhibitors. No difference in the surface expression of TRAIL-receptors was observed between sensitive and resistant cell lines. Also, all cell lines had similar levels of expression of Flice-like inhibitory protein (FLIP) on immunoblot. However, the two resistant cell lines had only very low level expression of caspase 8 on RNA and protein level. In summary, we show that Ewing's sarcoma expresses receptors for TRAIL, and that cells are exquisitely sensitive to TRAIL-mediated apoptosis. These results may warrant clinical trials with TRAIL in Ewing's sarcoma once the safety of TRAIL for humans has been established.     

Generation of new TRAIL mutants DR5-A and DR5-B with improved selectivity to death receptor 5

TRAIL (tumor necrosis factor (TNF) related apoptosis-inducing ligand) has been introduced as an extrinsic pathway inducer of apoptosis that does not have the toxicities of Fas and TNF. However, the therapeutic potential of TRAIL is limited because of many primary tumor cells are resistant to TRAIL. Despite intensive investigations, little is known in regards to the mechanisms underlying TRAIL selectivity and efficiency. A major reason likely lies in the complexity of the interaction of TRAIL with its five receptors, of which only two DR4 and DR5 are death receptors. Binding of TRAIL with decoy receptors DcR1 and DcR2 or soluble receptor osteoprotegerin (OPG) fail to induce apoptosis. Here we describe design and expression in Escherichia coli of DR5-selective TRAIL variants DR5-A and DR5-B. The measurements of dissociation constants of these mutants with all five receptors show that they practically do not interact with DR4 and DcR1 and have highly reduced affinity to DcR2 and OPG receptors. These mutants are more effective than wild type TRAIL in induction of apoptosis in different cancer cell lines. In combination with the drugs targeted to cytoskeleton (taxol, cytochalasin D) the mutants of TRAIL induced apoptosis in resistant Hela cells overexpressing Bcl-2. The novel highly selective and effective DR5-A and DR5-B TRAIL variants will be useful in studies on the role of different receptors in TRAIL-induced apoptosis in sensitive and resistant cell lines. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Inhibition of CaMKII-mediated c-FLIP expression sensitizes malignant melanoma cells to TRAIL-induced apoptosis

TRAIL can induce apoptosis in melanoma cells and thus may offer new hope for melanoma therapy. However, many melanoma cells are resistant to TRAIL. To examine molecular mechanisms in cell resistance, we analyzed TRAIL-induced DISC in TRAIL-sensitive melanoma cells and showed that apoptosis-initiating caspase-8 and caspase-10 were recruited to the DISC where they became activated through autocatalytical cleavage, leading to apoptosis through cleavage of downstream substrates such as caspase-3 and DFF45. In TRAIL-resistant melanoma cells, however, c-FLIP proteins were recruited to the DISC, resulting in the inhibition of caspase-8 and caspase-10 cleavage in the DISC. Both calmodulin-dependent protein kinase II (CaMKII) protein and enzymatic activity were upregulated in resistant cells and CaMKII inhibitor KN-93 downregulated expression of c-FLIP proteins, thus sensitizing resistant cells to TRAIL-induced apoptosis. Transfection of CaMKII cDNA in sensitive melanoma cells resulted in cell resistance to TRAIL, where transfection of CaMKII dominant-negative cDNA in resistant cells restored TRAIL sensitivity in cells. These results indicate that the CaMKII-mediated pathway for c-FLIP upregulation protects melanoma cells from TRAIL-induced apoptosis and targeting this pathway may provide novel therapeutic strategies in treatment of melanomas.     

Effect of UV irradiation on colorectal cancer cells with acquired TRAIL resistance

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is a member of the TNF superfamily. TRAIL shows strong cytotoxicity to many cancer cells but minimal cytotoxicity to most normal cells. Interestingly, our recent studies have demonstrated that pretreatment with TRAIL induces acquired resistance to TRAIL (Song et al. 2007 J Biol Chem 282: 319). Acquired TRAIL resistance develops within 1 day and gradually decays within 5 days after TRAIL treatment. In our current study, we examined whether human colorectal carcinoma CX-1 cells with acquired TRAIL resistance are resistant to UV irradiation as well. CX-1 cells were treated with 200 ng/ml TRAIL for 6 h and incubated various times (0.25-5 days) and then challenged to UV irradiation. Unexpectedly, we observed an increase in apoptosis in acquired TRAIL resistant cells after UVC as well as UVB exposure. This was due to an increase in caspase activation which was mediated through cytochrome c release. These results suggest that cells with acquired TRAIL resistance are sensitive to UV irradiation.     

Pro-survival function of Akt/protein kinase B in prostate cancer cells. Relationship with TRAIL resistance.

Tumor necrosis factor superfamily member TRAIL/Apo-2L has recently been shown to induce apoptosis in transformed and cancer cells. Some prostate cancer cells express constitutively active Akt/protein kinase B due to a complete loss of lipid phosphatase PTEN gene, a negative regulator of phosphatidylinositol 3-kinase pathway. Constitutively active Akt promotes cellular survival and resistance to chemotherapy and radiation. We have recently noticed that some human prostate cancer cells are resistant to TRAIL. We therefore examined the intracellular mechanisms of cellular resistance to TRAIL. The cell lines expressing the highest level of constitutively active Akt were more resistant to undergo apoptosis by TRAIL than those expressing the lowest level. Down-regulation of constitutively active Akt by phosphatidylinositol 3-kinase inhibitors, wortmannin and LY294002, reversed cellular resistance to TRAIL. Treatment of resistant cells with cycloheximide (a protein synthesis inhibitor) rendered cells sensitive to TRAIL. Transfecting dominant negative Akt decreased Akt activity and increased TRAIL-induced apoptosis in cells with high Akt activity. Conversely, transfecting constitutively active Akt into cells with low Akt activity increased Akt activity and attenuated TRAIL-induced apoptosis. Inhibition of TRAIL sensitivity occurs at the level of BID cleavage, as caspase-8 activity was not affected. Enforced expression of anti-apoptotic protein Bcl-2 or Bcl-X(L) inhibited TRAIL-induced mitochondrial dysfunction and apoptosis. We therefore identify Akt as a constitutively active kinase that promotes survival of prostate cancer cells and demonstrate that modulation of Akt activity, by pharmacological or genetic approaches, alters the cellular responsiveness to TRAIL. Thus, TRAIL in combination with agents that down-regulate Akt activity can be used to treat prostate cancer.