P-糖蛋白对结肠癌多药耐药的影响

结肠癌是常见的消化道恶性肿瘤。对术后患者以及无法采用手术治疗的患者,临床多采用化疗、放疗等综合性治疗方法。随着大量化疗药物在临床的广泛使用,结肠癌多药耐药性成为化疗失败的最主要原因。研究表明,P-糖蛋白(P-glycoprotein, P-gp)作为ATP结合盒(ABC)转运蛋白超家族成员之一,与多种肿瘤的多药耐药相关,其介导的多药耐药已经成为目前研究的热点。本文旨在通过对P-糖蛋白的结构、耐药机制以及逆转P-糖蛋白介导的结肠癌多药耐药新发现进行阐述,引导读者对P-糖蛋白在结肠癌多药耐药中的作用有更深入的了解。     

P-糖蛋白在乳腺癌多药耐药中的作用及其调控机制

P-糖蛋白（P-glycoprotein, P-gp）是ABC转运蛋白超家族的一员,能将其药物底物单向转运出细胞. P-gp的过表达被认为是乳腺癌多药耐药（multi-drug resistance, MDR）的主要原因之一. 在乳腺癌MDR的发生和发展中,P-gp受到多种信号通路和转录因子的调控,调控网路非常复杂. 揭示P-gp在乳腺癌中的调控机制,对于克服乳腺癌MDR极其重要. 本文综述了其在乳腺癌MDR中的作用及其调控机制的最新研究进展.     

P-糖蛋白线粒体转位与线粒体DNA缺失肿瘤细胞多药耐药产生的关系

线粒体DNA缺失细胞(ρ~0细胞)拮抗化疗药物诱导的凋亡,但其确切机制尚不明确。本研究探讨P-gp线粒体转位与人肝癌细胞(SK-Hepl)mtDNA缺失细胞(ρ~0SK-Hep1)多药耐药产生的关系。以SK-Hep1、ρ~0SK-Hep1和转线粒体细胞SK-Hep1Cyb为研究对象,CCK-8方法检测细胞对药物敏感性;AnnexinV/PI双染法及DAPI染色法检测细胞凋亡;Westernblot检测P-gp表达;激光共聚焦显微镜结合免疫荧光检测P-gP细胞内分布。结果显示,SK-Hep1、ρ~0SK-Hep1和SK-Hep1Cyb细胞对多柔比星(DOX)的IC_(50)分别为0.62±0.02μg/ml、4.93±0.17μg/ml和0.57±0.02μg/ml。SK-Hep1、ρ~0SK-Hep1和SK-Hep1Cyb细胞凋亡率分别为1 1.25%±1.36%、4.75%±0.98%和14.50%±1.57%,ρ~0SK-Hep1对细胞凋亡有明显抗性。Western blot检测发现ρ~0细胞内P-gP、Bax、Bcl-2表达增加,Bcl-2/Bax比值增加。免疫荧光共定位显示,ρ~0细胞线粒体内P-gP...     

P-糖蛋白的细胞内转运及表达调控

肿瘤多药耐药(multidrug resistance,MDR)的发生多与P-糖蛋白(P-glycoprotein,P-gp)过度表达相关。作为一种糖蛋白,P-糖蛋白在内质网中合成、折叠,然后转运到高尔基体进行加工、修饰,最终定位于细胞膜,且只有定位于细胞膜的P-糖蛋白才与肿瘤多药耐药的产生相关。P-糖蛋白的表达与多种信号通路如MAPK、Wnt/β-catenin、PKC、NF-κB有关。研究证实,还有多种miRNA与肿瘤多药耐药的发生相关。本文综述了P-糖蛋白的细胞内转运过程及P-糖蛋白表达相关信号通路的研究进展,为以P-糖蛋白为靶标的肿瘤多药耐药逆转剂提供新的研究策略。     

P-糖蛋白的表达及其结合肽的筛选

为获得P 糖蛋白胞外段 ,构建了高效表达载体pGEX Pgp ,转化大肠杆菌DH5α ,进行表达、鉴定及纯化 ,以获得的融合蛋白为靶蛋白 ,筛选噬菌体随机 12肽库 ,免疫细胞化学方法进行鉴定 .SDS PAGE分析 ,表达出约 30kD大小的蛋白 ;从噬菌体随机肽库中筛选获得了与P 糖蛋白特异性结合的噬菌体阳性克隆 ,测序获得了其特异性结合肽序列 :NDGLLFTWQPSP .免疫细胞化学结果显示 :筛选得到的噬菌体阳性克隆可与耐药细胞BIU 87 ADM结合 ,而与敏感细胞BIU 87不结合 .结果表明 ,筛选获得的结合肽可与耐药的肿瘤细胞结合 ,表现出一定的肿瘤特异性 .P 糖蛋白结合肽的筛选 ,为进行人膀胱癌多药耐药的靶向治疗等工作奠定了基础 .     

血脑屏障上P-糖蛋白与耐药性癫痫关系的研究进展

耐药性癫痫是癫痫治疗的瓶颈。P-糖蛋白通过跨膜外排泵作用阻止抗癫痫药物由血脑屏障入脑发挥期望效应是耐药性癫痫产生的重要原因。本文介绍了耐药性癫痫与血脑屏障上P-糖蛋白的相互关系,对目前提出的调节P-糖蛋白功能,改善耐药性癫痫预后应注意的问题进行说明。安全地调节P-糖蛋白功能到适度可能为耐药性癫痫的治疗带来希望。     

shRNA抑制c-fos表达对P-gp介导的乳腺癌多药耐药的影响

多药耐药(multidrug resistance,MDR)是导致化疗失败的重要原因,多药耐药基因(multidrug resistance gene,mdr1)产物P-糖蛋白(P-glycoprotein,P-gp)过表达是最主要的耐药机制。原癌基因c-fos在肿瘤MDR中的作用渐受重视。主要选用人乳腺癌敏感株MCF-7和阿霉素(adriamycin,ADR)筛选的、mdr1/P-gp高表达的耐药株MCF-7/ADR,探讨c-fos在P-gp介导的乳腺癌MDR中的作用。相对于MCF-7,c-fos在MCF-7/ADR高表达。采用shRNA法下调c-fos表达后,MCF-7/ADR对ADR的敏感性大大增强,且mdr1/P-gp表达减少、P-gp外排功能降低。c-fos表达下调可逆转对P-gp介导的乳腺癌MDR的实验结果,为c-fos成为逆转肿瘤耐药诊断和治疗的新靶标,对实现耐药乳腺癌的分子靶向治疗提供了理论基础。     

多药耐药基因1 C3435T 多态性与癫痫耐药的关联性研究

目的:探讨我国癫痫患者P-糖蛋白基因多态性(C3435T)与抗癫痫药物反应性的关联性.方法:采用PCR-RFLP(聚合酶链反应-限制性片段长度多态性分析)的方法对156例癫痫患者外周血进行分型.其中,耐药组癫痫患者85例,有效组癫痫患者71例.结果:耐药组癫痫患者CC基因型21例,占24.70%;有效组癫痫患者CC基因型19例,占26.76%.两组比较无显著差异性.结论:本研究未发现P-gpC3435T基因型与癫痫耐药的关联性.     

多药耐药基因1C3435T多态性与癫痫耐药的关联性研究

目的：探讨我国癫痫患者P-糖蛋白基因多态性（C3435T）与抗癫痫药物反应性的关联性。方法：采用PCR--RFLP（聚合酶链反应--限制性片段长度多态性分析）的方法对156例癫痫患者外周血进行分型。其中,耐药组癫痫患者85例,有效组癫痫患者71例。结果：耐药组癫痫患者CC基因型21例,占24.70%;有效组癫痫患者CC基因型19例,占26.76%。两组比较无显著差异性。结论：本研究未发现P-gp C3435T基因型与癫痫耐药的关联性。     

冬凌草活性部位逆转SGC7901/ADR细胞多药耐药性的体外研究

以SGC7901和SGC7901/ADR为细胞模型,检测了冬凌草活性部位与化疗药物联用后,对SGC7901/ADR耐药性的逆转效应;冬凌草活性部位处理细胞后,检测耐药细胞内阿霉素的蓄积变化、耐药细胞P-糖蛋白(P-gp)的表达水平以及mdr1基因的表达变化。结果显示,冬凌草氯仿部位和乙酸乙酯部位可以有效提高化疗药物阿霉素在SGC7901/ADR细胞内的蓄积,降低P-gp的表达,降低mdr1基因的转录。冬凌草逆转胃癌耐药细胞SGC7901/ADR多药耐药性的活性部位是冬凌草氯仿部位和乙酸乙酯部位,其逆转作用与抑制P-gp的表达相关。     

三氧化二砷对K562/A02 细胞的凋亡及细胞周期的影响

目的:研究三氧化二砷对多药耐药急性白血病细胞株K562/A02凋亡与细胞周期的影响及可能机制。方法:取阿霉素(Adr)的耐药白血病细胞株分为未加药的对照组及加入不同浓度的三氧化二砷(其终浓度为4.0μmol/L、5.0μmol/L)组,流式细胞仪检测细胞凋亡及细胞周期分布,Western blot方法检测不同浓度三氧化二砷对K562/A02细胞核NF-κBp65蛋白水平。结果:与对照组比较,三氧化二砷可显著增加Adr对K562/A02细胞凋亡率,阻滞细胞于G0/G1期,降低K562/A02细胞胞核中NF-kB p65的表达(P均<0.05)。结论:三氧化二砷可能是通过抑制NF-kB的胞内活化转位,从而促进K562/A02细胞凋亡及抑制细胞增殖。     

X连锁凋亡抑制蛋白反义寡核苷酸逆转K562细胞及难治性癫痫大鼠对卡马西平和苯妥英钠耐药性

凋亡在癫痫发生机制中起重要作用,但其在难治性癫痫耐药机制中的作用尚不清楚．为研究X连锁凋亡抑制蛋白(X-linked inhibitor of apoptosis protein, XIAP)反义寡核苷酸对K562/Dox(阿霉素诱导)耐药细胞及难治性癫痫大鼠耐药性的影响,首先建立耐药的K562/Dox细胞株,比较XIAP在耐药细胞株和正常K562细胞株的表达情况,观察转染XIAP反义寡核苷酸后,线粒体膜电位变化以及对卡马西平和苯妥英钠耐药性的影响．另外,建立慢性杏仁核点燃癫痫模型,筛选出耐药组和药物敏感组,通过侧脑室注射XIAP反义寡核苷酸,对照组注射生理盐水．观察其对各组大鼠后放电阈值(after discharge threshold,ADT)、后放电时程(after discharge duration,ADD)等电生理指标的影响．结果发现,XIAP在K562/Dox耐药细胞上的表达明显高于正常K562细胞,XIAP反义寡核苷酸转染K562/Dox耐药细胞后,XIAP的表达明显下降．导致了K562/Dox细胞线粒体跨膜电位的下降,而且对苯妥英钠和卡马西平的耐药性明显下降,IC₅₀分别由(1 978.2 ± 90.3) mg/L和(1 875.6 ± 83.2) mg/L,降低到(1 123.5 ± 54.2) mg/L和(1 084.5 ± 60.6) mg/L,逆转倍数分别为1.76和1.73．同时动物实验发现,耐药组大鼠在给予XIAP反义寡核苷酸后,ADT明显高于对照组(P < 0.05), ADD时程也明显缩短．上述结果证明,XIAP在耐药的K562/Dox细胞株存在高表达,下调XIAP在K562/Dox细胞株表达可以改善K562/Dox对卡马西平和苯妥英钠的耐药性．而且下调XIAP表达可以协助AEDs改善耐药大鼠的电生理活动,提示XIAP参与了难治性癫痫的耐药．     

耐药结核病及其防治

目前结核病呈现出高发病、高感染、高耐药、高死亡的特点。耐药结核病则是结核病防治工作的重点和难点。为有效控制其发展,本文分析了其产生和流行的医源性和社会性原因,并从7个方面阐述了耐药结核病的防治措施。即广泛普及结核病防治的知识;加强对流动人口的管理和监测;提高对耐药结核病的诊治水平;开展中西医结合和其他辅助治疗;预防社区和医院感染;完善结核病的耐药监测;积极开展抗结核新药、新手段和新方法的研究。     

The Remarkable Transport Mechanism of P-Glycoprotein: A Multidrug Transporter

Human P-glycoprotein (ABCB1) is a primary multidrug transporter located in plasma membranes, that utilizes the energy of ATP hydrolysis to pump toxic xenobiotics out of cells. P-glycoprotein employs a most unusual molecular mechanism to perform this drug transport function. Here we review our work to elucidate the molecular mechanism of drug transport by P-glycoprotein. High level heterologous expression of human P-glycoprotein, in the yeast Saccharomyces cerevisiae, has facilitated biophysical studies in purified proteoliposome preparations. Development of novel spin-labeled transport substrates has allowed for quantitative and rigorous measurements of drug transport in real time by EPR spectroscopy. We have developed a new drug transport model of P-glycoprotein from the results of mutagenic, quantitative thermodynamic and kinetic studies. This model satisfactorily accounts for most of the unusual kinetic, coupling, and physiological features of P-glycoprotein. Additionally, an atomic detail structural model of P-glycoprotein has been devised to place our results within a proper structural context.     

Acquired and Transmitted Multidrug Resistant Tuberculosis: The Role of Social Determinants

Although risk factors for multi-drug resistant tuberculosis are known, few studies have differentiated between acquired and transmitted resistance. It is important to identify factors associated with these different mechanisms to optimize control measures. We conducted a prospective cohort study of index TB patients and their household contacts in Lima, Peru to identify risk factors associated with acquired and transmitted resistance, respectively. Patients with higher socioeconomic status (SES) had a 3-fold increased risk of transmitted resistance compared to those with lower SES when acquired resistance served as the baseline. Quality of housing mediated most of the impact of SES.     

DC-CIK对K562/A多药耐药基因mdr1 表达的影响

目的：体外观察树突状细胞（dendritic cell,DC）联合细胞因子诱导的杀伤细胞（cytokine inducedkiller,CIK）对K562/A细胞株多药耐药基因mdr1 表达的影响。方法：采集健康人的外周血,分离出单个核细胞( peripheral blood mononuclear cell,PBMC ),在体外加入多种细胞因子经诱导生成DC及CIK 细胞,以流式细胞仪检测其表面标志,将DC 细胞内加入K562/A 细胞裂解物致敏后,再与CIK细胞混合培养48 小时。将致敏后的DC-CIK 细胞与K562/A及K562 分组培养后以荧光定量PCR 检测其mdr1 基因表达的情况,PBMC 作为对照组。结果：RT-PCR 中可见K562/A+DC-CIK 组中mdr1 mRNA 表达较K562/A明显降低,经荧光定量PCR 观察到K562/A 内mdr1 mRNA 表达为K562 的10.27 倍、K562/A/PBMC 略低于未处理的K562/A（P>0.05）,K562/A/DC-CIK 细胞中mdr1 mRNA含量较K562/A、K562/A/PBMC 少（P<0.05）。DC-CIK细胞与细胞株混合培养后,mdr1 基因表达较混合培养前明显降低。结论：实验数据显示DC-CIK 可使耐药细胞株内mdr1 基因表达下调。但K562 与DC-CIK 混合培养后该基因降低不明显,提示该基因在细胞中存在着基础表达,意义在于维持细胞内稳态。目前针对逆转白血病耐药的研究较少,需要多进行相关研究以拓宽细胞免疫治疗在逆转耐药领域的应用。DC-CIK 是具有发展潜力的抗肿瘤方法。本实验将为下一阶段研究逆转耐药的机制提供依据,DC-CIK 细胞免疫疗法有望成为逆转肿瘤耐药的新方法。     

Chronotherapeutic Dose Schedule of Phenytoin and Carbamazepine in Epileptic Patients

The objective of this study was to compare the efficacy and safety of a chronotherapeutic dosing schedule of phenytoin and carbamazepine versus a conventional dosing schedule for the treatment of tonic‐clonic epileptic patients. Of 148 epileptic subjects found to have subtherapeutic trough drug levels (subtherapeutic group, STG), 103 subjects who completed the study were randomized to either STG I (n=51) for treatment by the conventional dosing schedule (tablet phenytoin 100–400 mg/day OD or BD, tablet carbamazepine 200–800 mg BD, or both, equally divided doses with no fixed time of drug intake), with a dose increment but no change in usual time of drug administration allowed; or to STG II (n=52), with no dose increment permitted but a shift in all or most (two‐thirds or three‐fourths) of the daily dose of one or both medications to 20:00 h. The 62 patients who experienced drug toxicity reactions (toxicity group, TG) and who had serum drug levels in the toxic range were assigned to TG I for dose reduction or TG II for dose reduction and drug administration at 20:00 h. Those 16 subjects in STG I and 47 subjects in STG II who initially evidenced subtherapeutic trough drug concentrations exhibited therapeutic drug levels by the end of four weeks of treatment (p<0.01). A significantly greater number of TG II, as compared to TG I, subjects who experienced toxic reactions showed improved drug tolerance. There were no poor responders and more good responders (control of epilepsy for one year) in STG II compared to STG I subjects. The findings of this study indicate that a chronotherapeutic dosing schedule of phenytoin and carbamazepine involving the administration of most or all the daily dose of medication(s) at 20:00 h can improve the response of diurnally active epileptic patients not responding to standard doses, achieve therapeutic drug levels, and reduce toxic manifestations in subjects having drug concentrations beyond the therapeutic range.     

DC-CIK对K562/A多药耐药基因mdr1表达的影响

目的：体外观察树突状细胞（dendritic cell,DC）联合细胞因子诱导的杀伤细胞（cytokine inducedkiller,CIK）对K562/A细胞株多药耐药基因mdr1表达的影响。方法：采集健康人的外周血,分离出单个核细胞（peripheral blood mononuclear cell,PBMC）,在体外加入多种细胞因子经诱导生成DC及CIK细胞,以流式细胞仪检测其表面标志,将DC细胞内加入K562/A细胞裂解物致敏后,再与CIK细胞混合培养48小时。将致敏后的DC-CIK细胞与K562/A及K562分组培养后以荧光定量PCR检测其mdr1基因表达的情况,PBMC作为对照组。结果：RT-PCR中可见K562/A＋DC-CIK组中mdr1 mRNA表达较K562/A明显降低,经荧光定量PCR观察到K562/A内mdr1 mRNA表达为K562的10.27倍、K562/A/PBMC略低于未处理的K562/A（P〉0.05）,K562/A/DC-CIK细胞中mdr1 mRNA含量较K562/A、K562/A/PBMC少（P〈0.05）。DC-CIK细胞与细胞株混合培养后,mdr1基因表达较混合培养前明显降低。结论：实验数据显示DC-CIK可使耐药细胞株内mdr1基因表达下调。但K562与DC-CIK混合培养后该基因降低不明显,提示该基因在细胞中存在着基础表达,意义在于维持细胞内稳态。目前针对逆转白血病耐药的研究较少,需要多进行相关研究以拓宽细胞免疫治疗在逆转耐药领域的应用。DC-CIK是具有发展潜力的抗肿瘤方法。本实验将为下一阶段研究逆转耐药的机制提供依据,DC-CIK细胞免疫疗法有望成为逆转肿瘤耐药的新方法。     

Role of P-Glycoprotein in the Blood-Brain Transport of Colchicine and Vinblastine

Abstract: Classically, drug penetration through the blood-brain barrier depends on the lipid solubility of the substance, except for some highly lipophilic drugs, like colchicine and vinblastine, both substrates of P-glycoprotein, a drug efflux pump present at the luminal surface of the brain capillary endothelial cells. Colchicine and vinblastine uptake into the brain was studied in the rat using the in situ brain perfusion technique and two inhibitors of P-glycoprotein, verapamil and SDZ PSC-833. When rats were pretreated with PSC-833 (10 mg/kg, intravenous bolus), colchicine and vinblastine uptake was enhanced 8.42- and 9.08-fold, respectively, in all the gray areas of the rat brain studied. The mean colchicine distribution volume was increased from 0.67 ± 0.41 to 5.64 ± 0.70 µl/g and vinblastine distribution volume from 2.74 ± 1.15 to 24.88 ± 4.03 µl/g. When rats were pretreated with verapamil (1 mg/kg, intravenous bolus), colchicine distribution volume was increased 3.70-fold. The increase in colchicine and vinblastine did not differ between the eight brain gray areas. PSC-833 and verapamil pretreatment had no influence on the distribution volume of either drug in the choroid plexus. Nevertheless, distribution volumes remained small, considering the highly lipophilic nature of the substances. We suggest that P-glycoprotein is either only partially inhibited (difficulty of fully saturating P-glycoprotein, especially under in vivo conditions) or not the only barrier to these two drugs.