Prise en charge du cancer du sein,avancées et perspectives

Breast cancer treatment has developed rapidly for the last 15 years, promoted by a better understanding of tumour growth biology. Targeted therapies have been rapidly expending: immunotherapy, targeted chemotherapy, endocrine therapy efficacy enhanced by mTOR inhibitors. Changes of molecular profiling tumours during the illness need to perform regularly biopsies and to adapt drugs. This article will focus on a high-level overview of main advances across systemic treatment.     

晶体氨基酸替代鱼粉蛋白对半滑舌鳎稚鱼消化酶和代谢酶活力的影响

为研究人工微颗粒饲料中晶体氨基酸替代鱼粉蛋白对半滑舌鳎（Cynoglossus semilaevis Gnther）稚鱼消化酶和代谢酶活力的影响, 以晶体氨基酸混合物分别替代0%、25%、50%、75%和100%鱼粉蛋白（0%CAA、25%CAA、50%CAA、75%CAA和100%CAA）, 在25%替代水平设计棕榈酸甘油酯包被晶体氨基酸混合物组（C-25%CAA）, 配制实验微颗粒饲料。每种微颗粒饲料随机投喂三组实验鱼[初始体重（0.0940.02） g, 35日龄], 每组实验鱼放养150尾, 养殖周期28d。研究结果表明, 在不包膜条件下, 各处理组的胰蛋白酶活力随替代水平的升高显著下降（P0.05）, 且包膜处理组（C-25%CAA）与全鱼粉组无显著差异（P0.05）。肠段胰蛋白酶活力与胰段胰蛋白酶活力比值随氨基酸替代水平的升高显著下降（P0.05）, 鱼粉组显著高于75%和100%处理组（P0.05）, 但与25%处理组、包膜处理组（C-25%CAA）和50%处理组无显著差异（P0.05）。各处理组淀粉酶活力随替代水平的升高显著上升（P0.05）。亮氨酸氨肽酶（LA）和碱性磷酸酶（AP）活力（肠段与刷状缘）均随替代水平的升高显著下降（P0.05）, 包膜处理组（C-25%CAA）与全鱼粉组无显著差异（P0.05）。谷丙转氨酶（GPT/ALT）和谷草转氨酶（GOT/AST）活力随替代水平的升高显著上升（P0.05）, 50%、75%和100%处理组显著高于鱼粉组、25%处理组和包膜处理组（C-25%CAA）。研究结果显示, 饲料中晶体氨基酸显著影响了半滑舌鳎稚鱼的消化酶和代谢酶活力, 而且在25%的替代水平下, 与未包膜组相比, 包膜处理组能显著促进半滑舌鳎稚鱼消化系统的发育。     

血清肿瘤标志物检测对晚期非小细胞肺癌靶向治疗的预后分析

目的：探究检测血清肿瘤标志物对预测晚期非小细胞肺癌靶向治疗预后的影响。方法：选取2010年4月至2012年12我院收治的晚期非小细胞肺癌患者70例,均予以吉非替尼进行治疗,检测治疗前及治疗后2个月肿瘤标志物癌胚抗原CEA、角蛋白19的可溶性片段（CYFRA21—1）、癌抗原125（CA125）的表达水平,观察其表达水平与患者疗效之间的关系。结果：治疗后,患者完全缓解1例,部分缓解37例,疾病稳定19例,疾病进展13例,有效率为54．3％。治疗后,治疗有效的患者CEA、CA125明显比治疗前降低,结果具有统计学意义（P〈0．05）;而疾病稳定、疾病进展的患者治疗后CEA、CA125与治疗前比却无明显差异（P〉0．05）。治疗有效与疾病稳定的患者治疗后CYFRA21．1有明显降低,但与治疗前比却无明显差异（P〉0．05）;而疾病进展患者的CYFRA21—1却明显升高,与治疗前比有显著差异（P〈0．05）。而治疗前,治疗有效的患者血清中CEA、CA125比疾病稳定、疾病进展的患者明显较高,结果具有统计学意义（P〈0．05）;疾病稳定患者的CEA、CA125与疾病进展患者的相比,治疗有效的患者CYFRA21-1与疾病稳定、疾病进展的相比,结果均不具有统计学意义（P〉0．05）。结论：治疗前CEA、CA125浓度较高则治疗效果不错．治疗后效果较好则CEA、CA125浓度较低,效果不好则CYFRA21-1浓度较高。利用血清肿瘤标志物可显著反映肿瘤靶向药物治疗的预后情况,为临床判断其治疗效果提供依据。     

Evolution of resistance to anti-cancer therapy during general dosing schedules

Anti-cancer drugs targeted to specific oncogenic pathways have shown promising therapeutic results in the past few years; however, drug resistance remains an important obstacle for these therapies. Resistance to these drugs can emerge due to a variety of reasons including genetic or epigenetic changes which alter the binding site of the drug target, cellular metabolism or export mechanisms. Obtaining a better understanding of the evolution of resistant populations during therapy may enable the design of more effective therapeutic regimens which prevent or delay progression of disease due to resistance. In this paper, we use stochastic mathematical models to study the evolutionary dynamics of resistance under time-varying dosing schedules and pharmacokinetic effects. The populations of sensitive and resistant cells are modeled as multi-type non-homogeneous birth-death processes in which the drug concentration affects the birth and death rates of both the sensitive and resistant cell populations in continuous time. This flexible model allows us to consider the effects of generalized treatment strategies as well as detailed pharmacokinetic phenomena such as drug elimination and accumulation over multiple doses. We develop estimates for the probability of developing resistance and moments of the size of the resistant cell population. With these estimates, we optimize treatment schedules over a subspace of tolerated schedules to minimize the risk of disease progression due to resistance as well as locate ideal schedules for controlling the population size of resistant clones in situations where resistance is inevitable. Our methodology can be used to describe dynamics of resistance arising due to a single (epi)genetic alteration in any tumor type.     

Bioavailability of phenolic acids

Two large classes of phenolic acids were comprised in this review: benzoic acid derivatives and cinnamic acid derivatives. They have been found to be very extended in fruits and vegetables at different concentrations. For example, hydroxycinnamic acids concentration was higher than that found for hydroxybenzoic acids. Concerning their consumption, hydroxycinnamic acids provide larger contributions to the total polyphenol intake than benzoic acid derivatives or flavonoids. This phenolic acid intake is led by the coffee intake since it has very rich concentrations in hydroxycinnamic acids. Moreover, several experimental and epidemiological studies report the protection of phenolic acids against various degenerative diseases. However, despite all these interesting attributions and even if phenolic acids are the main polyphenols consumed, their bioavailability has not received as attention as that flavonoids. This concept is an essential step to understand the health-promoting properties of phenolic acids and to serve as tool to design in vivo and in vitro experiments to know their biological properties. Therefore, a compilation of bioavailability data of phenolic acids have been presented here paying attention to the two types of phenolic acid bioavailability, direct and indirect derived from the direct phenolic acid and flavonoid consumption, respectively. Then, a new relevant concept which may be named as total bioavailability of phenolic acids includes the direct absorption and metabolism of phenolic acids from food consumption and phenolic acids bioavailability as a result of the cleavage on the main skeleton ring of flavonoids by the gut microflora.     

伊立替康联合卡铂辅助化疗对宫颈癌患者血清叶酸和CA125水平的影响

目的:探究伊立替康联合卡铂辅助化疗对宫颈癌患者血清叶酸、CA125及临床疗效的影响。方法:选择我院收治的宫颈癌患者41例,随机分成实验组和对照组。对照组19例予广泛全子宫切除及盆腔淋巴结清扫术;实验组22例在行全子宫切除及盆腔淋巴结清扫术前予卡铂和伊立替康治疗。对比两组的临床疗效以及治疗前后患者血清叶酸及CA125水平的变化。结果:实验组患者的有效率(81.8%)高于对照组(47.4%),其差异有统计学意义(P0.05);治疗后,两组患者的血清CA125水平均降低、叶酸水平均升高(P0.05),其差异有统计学意义;与对照组相比,实验组叶酸水平较高、血清CA125水平较低(P0.05),差异有统计学意义。结论:伊立替康联合卡铂辅助化疗对宫颈癌患者有较好的临床疗效,推测其机制可能与降低患者CA125水平及提高叶酸水平有关。     

重组腺相关病毒介导的RNAi靶向治疗作用研究

目的:采用前期成功构建的靶向沉寂CDK2基因的重组腺相关病毒r AAV-sh RNA-CDK2转染人肝癌Hep G2细胞,研究其对人肝癌细胞增殖的抑制作用。方法:取人肝癌Hep G2细胞于裸鼠前肢腋下接种,构建裸鼠皮下移植瘤模型,将成瘤裸鼠随机分为三组:肿瘤组、NC对照组、r AAV-sh RNA-CDK2给药组。各试验组均通过尾静脉注射给药,每隔五天用游标卡尺测量肿瘤的长径(a)、短径(b),计算肿瘤体积。根据每组裸鼠移植瘤体积的平均值,绘制移植瘤生长曲线。于给药24 h后处死,称取瘤重,计算抑瘤率,应用实时荧光定量PCR和Western blot方法检测各组肝癌组织中CDK2基因m RNA和蛋白的表达量,观察r AAV-sh RNA-CDK2对肝癌组织CDK2表达的影响;结果:r AAV-sh RNA-CDK2能够显著抑制肝癌Hep G2细胞的增殖,其抑瘤率为72.18%;并能够下调肝癌组织中CDK2基因m RNA与蛋白表达量;结论:r AAV-sh RNA-CDK2实现了体内靶向治疗肝癌的目的,并确定静脉定量给药方式。     

乳腺癌CXCR1的表达特征及其与新辅助化疗疗效的相关性

目的:研究趋化因子受体CXCR1在乳腺癌组织中的表达特征,并探讨新辅助化疗前后其表达变化与化疗疗效的关系。方法:选取20例正常乳腺组织,20例乳腺纤维腺瘤,104例乳腺癌标本,免疫组化染色后统计每例标本CXCR1的阳性表达积分,分析不同乳腺疾病CXCR1的表达差异。统计新辅助化疗前后乳腺癌标本CXCR1的阳性表达积分的变化,分析其与化疗病理反应的关系。结果:CXCR1在正常乳腺组织、乳腺纤维腺瘤中低表达,在乳腺癌组织上高表达;其表达与患者的年龄、原发肿瘤的大小无关(P0.05),与病理分期、癌细胞的分化程度、淋巴结转移个数、激素受体状态及Her2表达情况相关,P0.05,有统计学意义。新辅助化疗后,癌组织中CXCR1的表达下降,下降幅度越大,其化疗疗效越好。结论:CXCR1的检测对于乳腺疾病的良恶性判断有指导意义,可辅助判断乳腺癌的恶性程度、侵袭性以及预后,CXCR1表达的下降与化疗疗效相关,抑制其表达可能可以提高化疗疗效。     

促凋亡基因Bax在胰腺癌中的研究进展

胰腺癌的恶性程度高、转移早、浸润性强,这与胰腺癌的细胞凋亡异常有密切的关系。Bax是目前研究最深入的促凋亡基因之一。多数研究认为,Bax在胰腺癌中存在高表达,其表达率从53%到100%不等。有研究认为Bax的表达预示着胰腺癌的良性预后,也有研究发现胰腺癌中Bax的表达与胰腺癌的分级分化等有关。Bax在胰腺癌中的表达受p53、PERIOD1、P13K/AKT等的调控。Bax表达异常及其突变可能与胰腺癌的发生有关。研究发现Bax表达可增强胰腺癌对吉西他滨和5-FU等化疗药物以及放射治疗的敏感性,而Bax/Bcl-2的比值可能与胰腺癌放化疗敏感性更相关。提高Bax基因表达、上调Bax活性等针对Bax的靶向治疗已显示出促进胰腺癌细胞凋亡、增强药物抗癌效应的作用。同时,作为最重要的促凋亡蛋白之一,Bax成为评价各种抗胰腺癌药物的疗效、探讨其作用机制的重要指标之一。对胰腺癌中Bax的深入研究,有利于了解其与胰腺癌的预后和耐药性的关系,为胰腺癌的靶向治疗提供新的方向。     

Folic acid conjugates with photosensitizers for cancer targeting in photodynamic therapy: Synthesis and photophysical properties

Recent researches in photodynamic therapy have focused on novel techniques to enhance tumour targeting of anticancer drugs and photosensitizers. Coupling a photosensitizer with folic acid could allow more effective targeting of folate receptors which are over-expressed on the surface of many tumour cells. In this study, different folic acid–OEG-conjugated photosensitizers were synthesized, characterized and their photophysical properties were evaluated. The introduction of an OEG does not significantly improve the hydrophilicity of the FA–porphyrin. All the FA-targeted photosensitizers present good to very good photophysical properties. The best one appears to be Ce6. Molar extinction coefficient, fluorescence and singlet oxygen quantum yields were determined and were compared to the corresponding photosensitizer alone.     

Coordination conjugates of therapeutic proteins with drug carriers: a new approach for versatile advanced drug delivery

We present here a general system for the coordination attachment of therapeutic proteins to a drug delivery system and its application in combined therapy. Proof of concept is demonstrated by the synthesis and testing of the targeted drug delivery system for cytostatics, which is based on a combination of the drug carrier Zn-porphyrin-cyclodextrin conjugates and their supramolecular coordination complexes with immunoglobulins. This system can be as readily used for a variety of therapeutic and targeting proteins including PAs, MAs, lectins, and HSA. Moreover, it allows combined photodynamic therapy, cell targeted chemotherapy and immunotherapy. When tested in a mouse model with human C32 carcinoma, the therapeutic superiority of the coordination assembly nanosystem was shown in comparison with the efficacy of building blocks used for the construction of the system.     

SELEX技术在胰腺癌分子诊断及靶向治疗中应用的研究进展

胰腺癌由于起病隐匿,早期诊断率较低,临床治疗效果差,是目前预后最差的恶性肿瘤之一。目前,临床上尚缺乏有效的非创伤早期筛查胰腺癌的手段,因而胰腺癌的早期诊断和治疗显得尤为重要。近年来,指数富集配基的系统进化(SELEX)技术以其在其他疾病中所表现的应用价值为疾病的诊治提供了一个新的途径。对于缺乏有效确诊手段,发病隐匿且病死率高的胰腺癌而言,SELEX技术基于胰腺癌发病的分子机制,可以筛选出特异结合于胰腺癌分子靶标的适配体,对筛选所得适配体进一步化学修饰,可以实现分子水平成像及靶向治疗,进而达到胰腺癌早期诊治的目的,具有重要的临床意义。本文就SELEX技术在胰腺癌分子诊断及靶向治疗中的应用研究进展进行了综述。     

EGFR在晚期肺腺癌患者中的表达及临床意义

目的探讨表皮生长因子受体(EGFR)在晚期肺腺癌患者中的表达及其意义。方法收集60例晚期肺腺癌患者的胸腔积液及活检肺癌组织,采用免疫组化检测EGFR的表达,并探讨其表达与临床病理特征的关系。结果 EGFR在胸腔积液及肺癌组织中的阳性表达率分别为75.0%(45/60)、63.3%(38/60),两者差异无统计学意义(P0.05)。结论 EGFR均高表达于肺腺癌胸腔积液及腺癌组织,且与年龄、性别、吸烟史、分化程度及肿瘤的大小无明显相关,可指导肺腺癌患者的靶向治疗。     

Inhibition of CX3CR1 reduces cell motility and viability in pancreatic adenocarcinoma epithelial cells

Increased expression of the chemokine CX₃CL1 and its sole receptor, CX₃CR1 have been correlated with poor pancreatic cancer patient survival and time to recurrence, as well as with pancreatic perineural invasion. We have previously shown that metastasis of prostate and breast cancer is in part driven by CX₃CL1, and have developed small molecule inhibitors against the CX₃CR1 receptor that diminish metastatic burden. Here we ask if inhibition of this chemokine receptor affects the phenotype of PDAC tumor cells. Our findings demonstrate that motility, invasion, and contact-independent growth of PDAC cells all increase following CX₃CL1 exposure, and that antagonism of CX₃CR1 by the inhibitor JMS-17-2 reduces each of these phenotypes and correlates with a downregulation of AKT phosphorylation. These data suggest that PDAC tumor cell migration and growth, elements critical in metastatic progression, may susceptible to pharmacologic intervention.     

Folate intake and bowel cancer risk

Folate is a B vitamin required for one-carbon transfer reactions including methylation of cell macromolecules including DNA and synthesis of the purines adenosine and guanosine and the pyrimidine thymidine. Epidemiological evidence suggests that diets providing higher amounts of folates lower the risk of colo-rectal cancer (CRC) and these observations are supported by plausible biological mechanisms. Inadequate folate supply results in DNA damage through (a) the incorporation of uracil (in place of thymidine) into DNA and subsequent unsuccessful attempts at DNA repair and (b) aberrant patterns of DNA methylation. However, human intervention studies using relatively large doses (500–5,000 μg/day) of folic acid (a synthetic form of folate) have provided no evidence of benefit in terms of adenoma recurrence. Indeed, there is some evidence of potential harm in increased risk of prostate cancer. Possible reasons for the apparent divergence in findings from the observational and intervention studies include the use of (unphysiologically) large doses of folic acid in the intervention studies whereas smaller intakes of food folates appeared to offer “protection” against CRC in case–control and prospective cohort studies. With intakes of folic acid greater than 400 μg/day, unmetabolised folic acid appears in peripheral blood and there are suggestions that this folic acid may have adverse effects e.g. reduced cytotoxicity of Natural Killer cells. Until the benefit-risk relationship associated with mandatory fortification with folic acid has been clarified (and, in particular, the possible risk of inducing extra cases of bowel or other cancer), it would seem wise to delay further mandatory folic acid fortification.     

叶酸-壳聚糖Prdx6 shRNA纳米粒的构建及其对胃癌细胞增殖的影响

目的:探讨叶酸-壳聚糖Prdx6 shRNA纳米粒对胃癌细胞生长的影响。方法:制备靶向性叶酸-壳聚糖Prdx6 shRNA纳米粒,原子力显微镜观察其形态,激光粒度分析仪测定纳米粒的粒径;倒置荧光显微镜观察叶酸-壳聚糖Prdx6 shRNA纳米粒的转染效率;采用蛋白质印迹法检测胃癌细胞Prdx6蛋白的表达变化;CCK8细胞增殖实验检测胃癌细胞的存活率。结果:1制备成功叶酸-壳聚糖Prdx6 shRNA向纳米粒。2荧光显微镜下观察靶向性叶酸-壳聚糖Prdx6 shRNA纳米粒转染胃癌细胞的效率明显高于非靶向纳米粒;胃癌细胞转染靶向组纳米粒后Prdx6蛋白的表达显著低于非靶向组。3与对照组相比,叶酸-壳聚糖Prdx6 shRNA纳米粒能够明显抑制胃癌细胞的增殖(P0.01)。结论:1叶酸-壳聚糖Prdx6 shRNA纳米粒可高效转染胃癌细胞。2转染叶酸-壳聚糖Prdx6 shRNA纳米粒后胃癌细胞的生长明显受抑制。