肿瘤生长抑制因子—血管抑素和内皮抑素

血管生成是肿瘤生长转移过程中的一个关键环节,因此控制血管生成成为抑制肿瘤生长的重要途径之一。目前已发现了许多血管生成抑制因子,尤以血管抑素和内皮抑素最为引人瞩目。综述了两种肿瘤生长抑制因子的发现、分子结构、生物学活性等,尤其侧重于它们抗肿瘤作用的实验研究。血管抑素与内皮抑素的发现与研究为恶性肿瘤的治疗开辟了新的道路。     

抗肿瘤血管生成治疗的研究进展及应对策略

抗血管生成疗法作为癌症治疗的重要方法之一,能够显著抑制肿瘤的生长与转移。然而,在临床应用中仍无法避免抗血管生成药物耐药性的产生,且目前对其耐药机制的研究尚不完善,严重阻碍了临床治疗进程。因此,基于抗血管生成药物耐药机制的研究,寻找新的靶点,以及整合新的治疗方案,对于改善肿瘤的临床治疗效果意义重大。基于此,本文主要从血管生成在肿瘤发展中的作用机制、抗血管生成治疗药物的应用现状及其介导的耐药机制、未来的研究策略等方面综述了抗肿瘤血管生成治疗的最新研究进展。     

肿瘤血管生成抑制因子在实体瘤治疗中的应用

肿瘤的治疗是近年来广大科研及医务工作者共同关注的问题。本文通过对血管生成与肿瘤生长的关系、血管生成因子和血管生成抑制因子功能的阐述,说明了血管生成抑制因子在肿瘤发生过程中的可能作用,从而为实体瘤的抗血管生成疗法提供了理论依据。     

肿瘤血管生成调节因子的研究进展

血管生成促进因子和血管生成抑制因子的平衡控制着肿瘤新生血管的形成。当促进因子的作用强于抑制因子时,便会引起肿瘤血管的生长。因此,了解血管生成调节因子的特点及其作用机制是一项非常重要的研究任务,针对肿瘤血管的抗血管新生治疗有着重要的理论意义和临床实用价值。这为肿瘤的诊断、分期、治疗和预后提供了新的参数指标,为寻找有效的治疗靶点提供了有利的依据。该文就有关的重要血管生成调节因子作一综述。     

肿瘤血管生成及抗血管生成的分子影像学研究进展

血管生成是肿瘤发生、发展的重要生物学过程,因此针对其的抗肿瘤血管生成治疗成为肿瘤治疗的重要策略.随着分子影像学的出现,以及对血管生成机制研究的不断深入,活体监测肿瘤血管生成及评价靶向介入治疗的疗效成为可能.本文就血管生成与肿瘤血管生成、肿瘤抗血管生成治疗,以及介入导向的抗血管生成治疗在肿瘤分子影像学领域的研究进展做一综述.     

抗血管生成治疗联合免疫检查点抑制剂 在NSCLC中的研究进展

血管生成是非小细胞肺癌(NSCLC)生长、复发和转移的关键环节。抗血管生成治疗可以通过使肿瘤血管及微环境正常化,改善肿瘤血供和含氧量,增强放、化疗效果。也可以抑制肿瘤内毛细血管生长,使肿瘤细胞进入休眠状态,并诱导其凋亡。因此,靶向抗血管生成已成为NSCLC治疗研究的主要方向。贝伐珠单抗和雷莫芦单抗已被批准用于联合一线标准化疗治疗局部晚期或转移性NSCLC。然而,在这一治疗过程中,肿瘤会逐渐对抗血管生成药物产生耐药,这可能与肿瘤微环境(tumor microenvironment,TME)的改变有关。最近,免疫检查点抑制剂(immune checkpoint inhibitors,ICI)已经取得了相当大的成功,但是反应率仍然被认为不是最佳的。因此,为了提高疗效,各种组合疗法正在测试中。临床前数据表明促血管生成因子具有免疫抑制作用,为ICI和抗血管生成药物联合使用提供了合理的解释。并且有研究认为,抗血管生成治疗与肿瘤免疫治疗相联合可能是一种相互增益的治疗策略。     

以VEGF及VEGFR2为靶位的抗肿瘤血管生成主动免疫治疗的研究进展

肿瘤细胞通过刺激新生血管生成来满足对营养及供氧的不断增长的需求,因此,肿瘤组织生长对于新生血管形成的依赖性使得抗血肿瘤管生成已经成为肿瘤学基础研究与临床治疗领域中最吸引人的策略之一.在众多的促血管生成因子中,血管内皮生长因子(VEGF)及其受体VEGFR2(鼠和人中也分别称为Flk-1和KDR)对于与肿瘤生长、转移及复发相关的血管生成是至关重要的.此外,通过打破肿瘤组织自身介导的免疫耐受与逃避,主动免疫治疗已成为一种崭新的抗肿瘤治疗方法.通过将这两种策略联合应用,抗血管生成主动免疫治疗使得更加有效地抑制肿瘤血管生成成为可能.这种免疫治疗与抗血管生成的联合应用有望成为一种有良好前景的研究方案.本文总结了通过打破VEGF/VEGFR2信号通路实现的抗肿瘤血管生成主动免疫治疗方面最新研究进展.本文讨论了旨在抑制血管生成的三种不同形式的抗肿瘤疫苗-细胞疫苗、蛋白质/多肽疫苗及基因/DNA疫苗,以及这一领域未来的研究方向.     

血管生成抑制素作用机理的研究进展

血管生成抑制素(angiostatin)是纤溶酶原(plasminogen)在体内的天然水解产物,能够有效抑制血管内皮细胞的增殖、迁移和管状结构的形成而参与对血管生成过程(angiogenesis)的调节。血管生成是指从已经存在的血管生长出新的分枝血管的过程。该过程在成体组织并不活跃,然而在某些病理条件下如伤口愈合、炎症、肿瘤的生长和恶性转移时却常常伴随活跃的血管生成过程。血管生成抑制素对血管生成的抑制作用,提示其作为一种特异性的针对血管内皮细胞的药物治疗与血管生成有关的一些疾病,如肿瘤的可能性。本文主要介绍近年来关于Angiostatin作用机理的研究进展以及其作为治疗药物的应用前景。     

抑制血管生成治疗肿瘤的策略和展望

新生血管生成是绝大多数肿瘤得以生长和转移的必要前提。所以 ,通过抑制肿瘤血管生成来抑制肿瘤是非常有前途的一种方法 ,有望发展成为一种新型的癌症疗法。主要可以分为两大类 :一是通过抑制促血管生成信号或扩大抑制血管生成因子的作用来干扰肿瘤新生血管的形成过程 ,这领域的广泛研究已经发现了一系列促血管生成因子及其抑制剂和血管生成抑制因子 ;二是利用肿瘤血管与正常血管的差别来携带杀伤性药物直接特异性破坏已形成的肿瘤血管 ;另外 ,内皮细胞及其前体细胞制成疫苗也可起到直接杀伤作用。到目前为止 ,虽然很多抑制肿瘤血管的药物已经被用于临床试验 ,但结果往往不尽如人意 ,从长远来看 ,需要更有效的治疗方法。包括抗血管基因治疗策略 ,靶向药物导入系统的研究 ,以及抗血管生成药物和免疫疗法、化疗和放射治疗的联合应用都在探讨中。随着肿瘤模型评估系统的发展 ,抗血管治疗肿瘤的方法在不久的将来一定会广泛进入临床应用。     

胎盘生长因子与肿瘤的研究进展

血管内皮生长因子(vascular endothelial growth factor,VEGF)家族及其受体已被公认在促进血管生成中起关键作用,大量研究证实其与肿瘤生长及血管生成具有相关性.胎盘生长因子(placental growth factor,PlGF)为VEGF家族的一个成员,与其受体VEGFR-1可以通过特异性结合而产生生物学活性.P1GF在正常组织中几乎不表达,但在病理条件下,其在一些细胞中表达增加.在肿瘤生长和血管生成的基础研究中,P1GF的作用备受争议.PlGF在人类多种肿瘤组织中表达,并且在部分肿瘤中其表达水平与预后不良相关.抗P1GF治疗可抑制血管生成及肿瘤细胞生长.同抗VEGF治疗相比,抗P1GF治疗副作用较小,而且不损害健康血管.现就P1GF及其与肿瘤相关研究予以综述.     

Vasoactive drugs and tumor blood flow

Different observations on the reactivity of tumor vessels to vasoactive drugs have suggested a decreased, a similar or an increased reactivity to vasoactive stimuli in the vascular bed of tumors as compared to normal tissues. No adrenergic innervation of newly developed tumor vessels has been found, while preexisting normal vessels incorporated during tumor growth may retain some innervation. In transplantable rat tumors, contractile cells, including smooth muscle cells, have been seen in tumor vessels. From recent experimental studies, it was concluded that the tumor's vascular bed is probably in a state of maximal dilatation and therefore sensitive to vasoconstriction, but less sensitive to pharmacological dilatation. These observations may correspond to regional tumor hypoxia and progressive development of tumor necrosis during tumor growth. The results of experimental tumor studies might question the reliability of diagnostic and therapeutic procedures in clinical oncology, which are based on differences in the reactivity to vasoactive drugs between normal and malignant tissues.     

In vivo characterization of tumor and tumor vascular network using multi‐modal imaging approach

We present a multi‐modal optical diagnostic approach utilizing a combined use of Fluorescence Intravital Microscopy (FIM), Dynamic Light Scattering (DLS) and Spectrally Enhanced Microscopy (SEM) modalities for in vivo imaging of tumor vascular network and blood microcirculation. FIM is used for imaging of tumor surroundings and microenvironment, SEM provides information regarding blood vessels topography, whereas DLS is applied for functional imaging of vascular network and blood microcirculation. This complementary combination of the imaging approaches is extremely useful for functional in vivo imaging of blood vasculature and tumor microenvironment. The technique has also a great potential in vascular biology and can significantly expand the capabilities of tumor angiogenesis studies and notably contribute to the development of cancer treatment. (© 2011 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

Pigment epithelium-derived factor regulates the vasculature and mass of the prostate and pancreas

Angiogenesis sustains tumor growth and metastasis, and recent studies indicate that the vascular endothelium regulates tissue mass. In the prostate, androgens drive angiogenic inducers to stimulate growth, whereas androgen withdrawal leads to decreased vascular endothelial growth factor, vascular regression and epithelial cell apoptosis. Here, we identify the angiogenesis inhibitor pigment epithelium-derived factor (PEDF) as a key inhibitor of stromal vasculature and epithelial tissue growth in mouse prostate and pancreas. In PEDF-deficient mice, stromal vessels were increased and associated with epithelial cell hyperplasia. Androgens inhibited prostatic PEDF expression in cultured cells. In vivo, androgen ablation increased PEDF in normal rat prostates and in human cancer biopsies. Exogenous PEDF induced tumor epithelial apoptosis in vitro and limited in vivo tumor xenograft growth, triggering endothelial apoptosis. Thus, PEDF regulates normal pancreas and prostate mass. Its androgen sensitivity makes PEDF a likely contributor to the anticancer effects of androgen ablation.     

Epidermal Growth Factor Receptor Inhibition Modulates the Microenvironment by Vascular Normalization to Improve Chemotherapy and Radiotherapy Efficacy

Background

Epidermal growth factor receptor (EGFR) inhibitors have shown only modest clinical activity when used as single agents to treat cancers. They decrease tumor cell expression of hypoxia-inducible factor 1-α (HIF-1α) and vascular endothelial growth factor (VEGF). Hypothesizing that this might normalize tumor vasculature, we examined the effects of the EGFR inhibitor erlotinib on tumor vascular function, tumor microenvironment (TME) and chemotherapy and radiotherapy sensitivity.

Methodology/Principal Findings

Erlotinib treatment of human tumor cells in vitro and mice bearing xenografts in vivo led to decreased HIF-1α and VEGF expression. Treatment altered xenograft vessel morphology assessed by confocal microscopy (following tomato lectin injection) and decreased vessel permeability (measured by Evan''s blue extravasation), suggesting vascular normalization. Erlotinib increased tumor blood flow measured by Power Doppler ultrasound and decreased hypoxia measured by EF5 immunohistochemistry and tumor O₂ saturation measured by optical spectroscopy. Predicting that these changes would improve drug delivery and increase response to chemotherapy and radiation, we performed tumor regrowth studies in nude mice with xenografts treated with erlotinib and either radiotherapy or the chemotherapeutic agent cisplatin. Erlotinib therapy followed by cisplatin led to synergistic inhibition of tumor growth compared with either treatment by itself (p<0.001). Treatment with erlotinib before cisplatin led to greater tumor growth inhibition than did treatment with cisplatin before erlotinib (p = 0.006). Erlotinib followed by radiation inhibited tumor regrowth to a greater degree than did radiation alone, although the interaction between erlotinib and radiation was not synergistic.

Conclusions/Significance

EGFR inhibitors have shown clinical benefit when used in combination with conventional cytotoxic therapy. Our studies show that targeting tumor cells with EGFR inhibitors may modulate the TME via vascular normalization to increase response to chemotherapy and radiotherapy. These studies suggest ways to assess the response of tumors to EGFR inhibition using non-invasive imaging of the TME.     

Design of vascular endothelium-specific drug-targeting strategies for the treatment of cancer

Tumor endothelial cells are actively involved in the neovascularization processes that accompany tumor growth. Their easy accessibility for systemically applied therapeutics makes them interesting targets for therapeutic intervention. Especially for drug targeting-based therapeutics that often consist of macromolecular moieties, the tumor endothelium is considered a much better target than the tumor cells located behind the vascular wall barrier. In this review, the general principles underlying the development and choices in the development of vascular drug-targeting strategies are discussed. An overview of target epitopes identified in the past two decades is followed by a summary of those strategies that directly or indirectly induced tumor blood flow blockade in vivo. The demonstrated therapeutic success in pre-clinical animal models in debulking large tumor masses and inhibiting tumor outgrowth warrant further development of these therapeutic approaches. Yet, more effort should be put in studies in which the efficacy of different effector activities aimed at the same target, of one effector activity aimed at different targets, and of multiple target strategies are be compared. Combining these data with proper inventories on the molecular basis of tumor endothelial heterogeneity in general will make possible the development of tumor vascular drug-targeting strategies towards clinical application.     

Research advances on aquaporins and vascular function regulation and related diseases

Aquaporins (AQPs), mainly distributed in epithelial and endothelial cells, are a family of channel-forming membrane proteins, originally confirmed to mediate the cellular water-transportation. AQPs are essential for maintaining homeostasis of the body water. Recently, studies have shown that AQPs may be involved in vascular function regulation and the development of related diseases, especially in cerebral ischemia, congestion heart failure, hypertension and tumor angiogenesis. Therefore, further studies are needed to elucidate mechanism accounting for the association between AQPs and vascular function related diseases, which may lead to novel approaches to the prevention and treatment of these diseases. In this review, we will discuss the expression and physiological roles of AQPs in vascular tissues and summarize recent progress in the relationship between AQPs and vascular function related diseases.     

扣针蛋白-5与疾病

扣针蛋白-5(fibulin-5,FBLN-5)是一个胞外基质糖蛋白,广泛分布于富含弹性蛋白的组织中,可通过与其它胞外蛋白相互作用而调节基质的结构.近期研究发现,该蛋白是一个内源性的血管生成抑制剂,在血管发育中发挥了重要的作用.同时,扣针蛋白-5与一些肿瘤的增殖、转移和侵袭等相关,其基因突变则会导致遗传性疾病的发生.本文就扣针蛋白-5与血管生成、血管发育、肿瘤及遗传性疾病的关系及当前的研究进展进行综述.     

A transgenic Tie2-GFP athymic mouse model; a tool for vascular biology in xenograft tumors

We report the generation of a transgenic Tie2-GFP athymic nude mouse, carrying green fluorescent blood vessels throughout the body. This transgenic mouse is a tool for studies in vascular biology, and is especially of interest for imaging of tumor angiogenesis and the study of anti-angiogenesis strategies in (human) xenografts. Intravital microscopy identified the presence of blood conducting structures that are not lined by endothelial cells. Dedifferentiation of aggressive tumor cells can lead to acquisition of endothelial characteristics. This process of tumor cell plasticity, also referred to as vasculogenic mimicry, has been suggested to contribute to the circulatory system in a tumor. In plastic EW7 Ewing sarcoma tumors in these Tie2-GFP mice, we observed blood flow in both regular blood vessels and non-fluorescent tumor cell-lined channels, visualizing in vivo hemodynamics in vasculogenic channels. These results demonstrate that the transgenic Tie2-GFP athymic mouse model is a valuable tool for vascular biology research.     

Simultaneous in vivo optical quantification of key metabolic and vascular endpoints reveals tumor metabolic diversity in murine breast tumor models

Therapeutically exploiting vascular and metabolic endpoints becomes critical to translational cancer studies because altered vascularity and deregulated metabolism are two important cancer hallmarks. The metabolic and vascular phenotypes of three sibling breast tumor lines with different metastatic potential are investigated in vivo with a newly developed quantitative spectroscopy system. All tumor lines have different metabolic and vascular characteristics compared to normal tissues, and there are strong positive correlations between metabolic (glucose uptake and mitochondrial membrane potential) and vascular (oxygen saturations and hemoglobin concentrations) parameters for metastatic (4T1) tumors but not for micrometastatic (4T07) and nonmetastatic (67NR) tumors. A longitudinal study shows that both vascular and metabolic endpoints of 4T1 tumors increased up to a specific tumor size threshold beyond which these parameters decreased. The synchronous changes between metabolic and vascular parameters, along with the strong positive correlations between these endpoints suggest that 4T1 tumors rely on strong oxidative phosphorylation in addition to glycolysis. This study illustrates the great potential of our optical technique to provide valuable dynamic information about the interplay between the metabolic and vascular status of tumors, with important implications for translational cancer investigations.