乳腺癌相关的细胞内信号通路

乳腺癌是女性中常见的恶性肿瘤之一.乳腺癌的发生、发展、转移及耐药性的产生与细胞内的信号通路密切相关,其中雌激素受体(estrogen receptor,ER)信号通路、胰岛素样生长因子受体（insulin-like growth factor receptor,IGFR)信号通路和表皮生长因子受体（epidermal growth factor receptor,EGFR）信号通路尤为重要．深入了解ER、IGFR和EGFR三条信号通路的作用机制及它们之间的交叉对话对于寻找新的更有效的肿瘤治疗靶点至关重要．本文综述了近年来有关ER、IGFR和EGFR三条信号通路研究进展及这三条通路与乳腺癌关系．     

雌激素受体信号通路在乳腺癌发生和治疗中的作用

雌激素受体信号通路在调控乳腺细胞增殖和凋亡等生理机能中发挥重要功能,该通路出现调控异常时可导致乳腺癌发生。雌激素受体在乳腺癌发生中的作用机制包括核受体介导的基因组信号通路和膜受体介导的非基因组信号通路以及二者的相互作用。基于雌激素受体信号通路及其关键信号分子的靶向治疗是开展乳腺癌治疗的重要策略与有效途径。对雌激素受体结构以及雌激素受体信号通路在乳腺癌发生和治疗中的作用作一综述。     

雌激素受体β在乳腺癌生长中的作用研究进展

雌激素受体 β(ERβ) 是雌激素受体的另一亚型。众多体内外实验证明,ERβ 与乳腺癌的生长有密切联系。ERβ 低表达会促进乳腺 癌增殖,介导转移,还能抑制乳腺癌细胞的凋亡。临床数据证明,ERβ 在乳腺癌患者的癌旁组织中表达高于癌组织,且与乳腺癌患者的 总生存率相关。ERβ 与雌激素受体 α(ERα)、表皮生长因子受体(EGFR)、孕激素受体(PR)均有密切联系:ERα 和 ERβ mRNA 平 均表达水平比值(ERβ/ERα)升高,对抗癌药物有拮抗作用,反之则有协同作用;ERβ 的表达量受 PR 调节,并能通过 EGFR 及下游信 号通路,抑制上皮-间充质转化。临床乳腺癌样本表明,ERβ 低表达可能与启动子甲基化有关。因此,采用药物调节 ERβ 的表达以及敏感性, 是具有很大临床价值的潜在治疗手段。综述 ERβ 以及 ERβ 与相关受体之间的联系在乳腺癌生长中的作用。     

雌激素受体阳性乳腺癌内分泌治疗耐药机制及靶向治疗策略

乳腺癌是中国女性最常见的恶性肿瘤之一。内分泌治疗是雌激素受体(estrogen receptor, ER)阳性乳腺癌有效的治疗手段之一,也是最常用的方法,主要包括选择性雌激素受体调节剂(selective estrogen receptor modulators, SERMs)、芳香化酶抑制剂(aromatase inhibitors, AIs)、选择性雌激素受体下调剂(selective estrogen receptor down regulators, SERDs)。尽管内分泌治疗增加了患者生存率,但耐药问题也极大地影响了乳腺癌患者的预后。越来越多的耐药机制被报道,如ESR1突变、受体酪氨酸激酶改变、细胞信号通路、表观遗传调控、代谢重编程、肿瘤干细胞、肿瘤微环境改变等。该文对近几年报道的乳腺癌内分泌治疗耐药机制及靶向治疗策略进行详细的综述。     

新型雌激素受体ER-α36与乳腺癌

雌激素受体(estrogen receptor,ER)是诊断和治疗乳腺癌的分子标志和靶点.雌激素受体包括ER-α和ER-β,其中ER-α有ER-α66、ER-α46和ER-α36三种亚型.ER-α36作为新型雌激素受体,参与膜起始的雌激素信号或非基因组雌激素信号转导,在肿瘤细胞的增殖、分化、侵袭和转移等过程中发挥作用.胃癌、子宫内膜腺癌、前列腺癌、尤其是乳腺癌的发生发展与ER-α36密切相关.本文介绍了ER-α36的结构域特点,ER-α36介导的信号通路及ER-α36在乳腺癌治疗中的作用研究进展.     

乳腺癌细胞表皮生长因子受体、HER-2对雌激素受体的调控及三苯氧胺耐药机制

雌激素受体(ER)在乳腺癌的发生和发展中起重要作用,抗雌激素治疗的内分泌治疗为重要的治疗方案,但易产生三苯氧胺(TAM)的耐药性而使治疗失效,原因之一可能是由于表皮生长因子受体(EGFR)和HER-2高表达引起ER磷酸化所致。本文概述了其中的分子机制和可能涉及的传导通路等。     

小分子酪氨酸激酶抑制剂耐药机制

表皮生长因子受体（epidermal growth factor receptor,EGFR）通路异常在肿瘤发生、发展过程中起到非常重要的作用,特异性抑制该通路的小分子受体酪氨酸激酶抑制剂在肿瘤治疗上取得了显著的效果,但是该药在临床上已经出现耐药现象,现将有关EGFR基因突变、EGFR旁路信号通路的激活、下游信号分子的结构性活化3个方面对EGFR抑制剂耐药机制的研究进展进行综述。     

秦皮素通过抑制EGFR及其下游AKT信号通路抑制MCF-7细胞增殖及迁移

表皮生长因子受体(EGFR)是细胞内多种信号调节通路的交汇点,其介导的信号通路与乳腺癌的发生、发展、转移和侵袭等密切相关,已成为乳腺癌治疗的新靶点之一。但目前关于秦皮素的抗乳腺癌作用与EGFR通路的关系,国内外尚未见相关报道。本研究结果表明,秦皮素能够通过抑制EGFR及其下游的AKT信号通路来发挥其抗乳腺癌作用。秦皮素在体外可促进T、B 淋巴细胞增殖及巨噬细胞吞噬能力,提示秦皮素可能促进小鼠免疫功能。Western印迹结果表明,秦皮素能显著抑制EGFR蛋白及其下游的AKT蛋白磷酸化水平。划痕实验结果表明,秦皮素能抑制MCF-7细胞的迁移。此外,秦皮素还能促进小鼠巨噬细胞的吞噬能力和代谢活力,促进T、B淋巴细胞的增殖,提高NK细胞的杀伤活力。本研究结果提示,秦皮素的抗乳腺癌作用是通过抑制EGFR信号通路,抑制MCF-7细胞迁移和促进小鼠的免疫功能等多种途径来实现的。     

雌激素信号通路概述

过去几十年,人们一直认为雌激素信号通路是雌激素与细胞核中的雌激素受体(ER)结合,作用于雌激素受体反应元件调节基因表达,从而改变细胞功能。雌激素不但与核ER结合,也能与膜ER结合激活PI3K信号通路。G蛋白偶联受体(GPR30)也能与雌激素结合,激活PI3K信号通路。雌激素通过结合不同雌激素受体改变细胞生理功能。我们对雌激素信号通路做简要综述。     

生长因子及其受体在淋巴瘤中异常表达的研究进展

生长因子是一类与受体结合后可以促进细胞增殖和调节细胞多项功能的多肽分子。生长因子及其受体信号通路包括Ras/MAPK、PI3K/AKT和STAT等不仅调控正常细胞的生物学行为,对恶性肿瘤细胞增殖、分化、转化和迁移也具有重要意义。研究发现多种生长因子如VEGF、PDGF和IGF及其受体在多种实体肿瘤如肺癌、乳腺癌、结肠癌中发现有异常表达,在淋巴瘤如DLBCL、PTCL、ML和NL中也存在异常的共同表达,提示在淋巴瘤中可能构成生长因子及其受体的自分泌/旁分泌环路。生长因子及其受体的表达对淋巴瘤患者的预后有一定指导意义,临床研究发现表达生长因子或其受体阳性患者比表达阴性患者有较差的临床预后。这可能与生长因子及其受体对淋巴瘤细胞的增殖、转移和耐药调控有关。目前生长因子及其受体已成为潜在的药物靶点,多种生长因子及其受体抑制剂在开发和临床试验中。本文就近年来生长因子及其受体在淋巴瘤中异常表达研究进展作简要综述。     

Downregulation of CXXC Finger Protein 4 Leads to a Tamoxifen-resistant Phenotype in Breast Cancer Cells Through Activation of the Wnt/β-catenin Pathway

Tamoxifen is a successful endocrine therapy drug for estrogen receptor–positive (ER+) breast cancer. However, resistance to tamoxifen compromises the efficacy of endocrine treatment. In the present study, we identified potential tamoxifen resistance–related gene markers and investigated their mechanistic details. First, we established two ER + breast cancer cell lines resistant to tamoxifen, named MCF-7/TMR and BT474/TMR. Gene expression profiling showed that CXXC finger protein 4 (CXXC4) expression is lower in MCF-7/TMR cells than in MCF-7 cells. Furthermore, CXXC4 mRNA and protein expression are lower in the resistant cell lines than in the corresponding parental cell lines. We also investigated the correlation between CXXC4 and endocrine resistance in ER + breast cancer cells. CXXC4 knockdown accelerates cell proliferation in vitro and in vivo and renders breast cancer cells insensitive to tamoxifen, whereas CXXC4 overexpression inhibits cancer cell growth and increases tamoxifen sensitivity of resistant cells. In addition, we demonstrated that CXXC4 inhibits Wnt/β-catenin signaling in cancer cells by modulating the phosphorylation of GSK-3β, influencing the integrity of the β-catenin degradation complex. Silencing the CXXC4 gene upregulates expression of cyclinD1 and c-myc (the downstream targets of Wnt signaling) and promotes cell cycle progression. Conversely, ectopic expression of CXXC4 downregulates the expression of these proteins and arrests the cell cycle in the G0/G1 phase. Finally, the small-molecule inhibitor XAV939 suppresses Wnt signaling and sensitizes resistant cells to tamoxifen. These results indicate that components of Wnt pathway that are early in response to tamoxifen could be involved as an intrinsic factor of the transition to endocrine resistance, and inhibition of Wnt signaling may be an effective therapeutic strategy to overcome tamoxifen resistance.     

Modeling the estrogen receptor to growth factor receptor signaling switch in human breast cancer cells

Breast cancer cells develop resistance to endocrine therapies by shifting between estrogen receptor (ER)-regulated and growth factor receptor (GFR)-regulated survival signaling pathways. To study this switch, we propose a mathematical model of crosstalk between these pathways. The model explains why MCF7 sub-clones transfected with HER2 or EGFR show three GFR-distribution patterns, and why the bimodal distribution pattern can be reversibly modulated by estrogen. The model illustrates how transient overexpression of ER activates GFR signaling and promotes estrogen-independent growth. Understanding this survival-signaling switch can help in the design of future therapies to overcome resistance in breast cancer.     

Summary of aromatase inhibitor trials: the past and future

Antagonizing estrogen by inhibition of aromatase has become a mainstay of adjuvant endocrine therapy in women with hormone receptor positive (ER+) breast cancer. Recent trials have shown an incremental gain for the AIs over tamoxifen when given as an up-front alternative to tamoxifen, but additionally added benefit is achieved by giving them in sequence with tamoxifen after either an early switch (2–3 years) or as a late switch (5 years). The true clinical implications of accelerated bone resorption from AIs is becoming better understood and its management defined. AI minimally effect quality of life. The chronic relapsing nature of ER+ breast cancer implies long term therapy will be of benefit in selected patients. Outstanding issues under investigation include optimal duration of endocrine therapy, optimal sequence, optimal agents and whether combining anti-estrogens will yield advantage. The role of AIs is also under investigation in premenopausal women in combination with ovarian function suppression. Identifying prognostic and predictive factors of endocrine therapy is important as is the identification and overcoming of resistance mechanisms. Both tumor and host signatures are being pursued to this end. Optimizing, expanding and extending endocrine therapy is likely to add further to patient outcome.