心血管疾病在他汀类药物多效性中的获益

心血管疾病是危害人类健康的严重疾病,是造成死亡的重要原因。随着社会的发展,人们生活水平的提高,人口的老龄化,心血管疾病已经成为仅次于肿瘤的第二大杀手。他汀类药物在心血管疾病特别是冠状动脉粥样硬化性心脏病的防治中意义重大,其对血脂的的确切调节作用已经被大家所认可,并被公认为是此类药物临床获益的首要机制。然而,随着他汀类药物的广泛应用与基础、临床研究的不断深入,越来越多的证据表明除了对血脂的调节作用,他汀类药物还有抗炎症反应、抗氧化应激、减轻血管内皮损伤、改善心肌重塑、抑制血栓形成和抗血小板聚集、保护肾功能等其他作用,这些独立于降脂作用的其他作用统称为他汀类药物的多效性。他汀类药物多效性的发现进一步增加了其在心血管疾病防治中的临床应用价值。本文就几种常见心血管疾病在他汀类药物多效性中的获益做一简单介绍。     

匹伐他汀临床应用的最新进展

匹伐他汀(pitavastatin)是新一代人工合成的降血脂类药物。该药是新一代HMG-COA还原酶抑制剂,用于治疗原发型高脂血症和混合型血脂障碍,能够显著降低LDL、TC、TG、及升高HDL-C。药物动力学性质优良,具有肝细胞选择性,并且毒性低,安全性好,具有抗动脉粥样硬化、促进血管生成和抗炎作用。本文就匹伐他汀的临床研究进展进行综述。     

基于腺相关病毒的多手段联合肿瘤治疗策略

腺相关病毒(adeno-associated virus,AAV)本身具有抗肿瘤活性,以其为基础构建的重组腺相关病毒(rAAV)作为肿瘤基因治疗载体已应用于临床试验研究。与其他的药物一样,单一的AAV基因药物,可能无法对肿瘤这一多基因、多步骤的复杂疾病发挥有效的治疗作用。国内外实验研究发现,多种化疗药物和放疗手段,不但可以提高rAAV载体的基因表达效率,也能促进AAV病毒本身的复制;反过来,AAV可以提高肿瘤细胞对放化疗的敏感性。联合AAV与其他的肿瘤治疗策略将有助于优化肿瘤治疗效果。     

肿瘤治疗电场研究进展

随着交流电场在医学领域的研究和应用逐步深入,研究人员发现低强度(1-2 V/cm)、中频(100-200 kHz)交流电场对肿瘤具有良好的治疗作用,此类电场也因此被称为肿瘤治疗电场(Tumor Treating Fields,TTFields)。研究表明TTFields对体外培养的肿瘤细胞具有干扰有丝分裂,诱导肿瘤细胞凋亡,抑制肿瘤的生长的作用;同时TTFields相关临床研究显示出TTFields对多种肿瘤的增殖和转移都发挥了抑制作用。而将TTFields与化疗药物联合应用作为二线方案治疗肿瘤,也被证明十分可行。更重要的是,无论是单独应用还是联合使用,TTFields产生的副作用与传统放疗、化疗手段相比甚小,患者生存质量也极大提高。本文就肿瘤治疗电场的相关机制以及临床前、临床研究进展做一综述。     

多肽类药物的研究进展

多肽在包括细胞增殖分化、免疫防御、肿瘤病变等在内的生命活动过程中起着至关重要的作用。自 1953 年首个人工合成的具有生 物活性的多肽问世至今,全球上市的多肽药物有 80 多个,有大量多肽药物进入临床研究。多肽类药物具有独特的优势：活性显著、特异性 强、毒性较弱,在体内不易产生蓄积,与其他药物的相互作用比较少。综述了目前国内外多肽药物的发展情况,希望对从事多肽类药物研 发的同行有所帮助。     

熊果酸在肿瘤治疗中的研究进展

熊果酸(ursolic acid)是广泛存在于自然界植物中的一种五环三萜类化合物,具有广泛的生物学活性,主要经肝脏代谢。传统临床治疗中熊果酸多用于抗炎、抗病毒、调节免疫功能以及保肝治疗等。近年来的研究表明,在体外和体内实验中,熊果酸能够对不同肿瘤细胞产生杀伤作用,抑制恶性肿瘤组织的生长,具有广谱的抗肿瘤活性。此外,熊果酸联合放化疗能够提高肿瘤细胞对治疗的敏感性,产生辅助增强放化疗疗效的作用,并且在放疗中可保护受照射机体的正常组织,促进免疫机能的恢复。熊果酸的抗肿瘤作用机制与下调促肿瘤生长、侵袭和转移相关基因的水平,增强凋亡基因的表达有关,并且能够通过调节多种细胞信号转导通路,杀灭肿瘤细胞,延缓肿瘤组织生长。同时,熊果酸可影响肿瘤细胞周期的分布,导致细胞的G1/S期阻滞,从而抑制肿瘤细胞的有丝分裂,诱导细胞凋亡。因此,熊果酸是一种极具潜力的天然抗肿瘤药物。本文对熊果酸在肿瘤治疗中的研究结果进行整合,阐述了熊果酸的抗肿瘤分子机制及其疗效,为熊果酸今后在临床中的进一步应用提供指导思路。     

肿瘤治疗中的多细胞耐受性与三维细胞培养

肿瘤治疗中的多细胞耐受性是由于体内肿瘤具有三维结构而产生的对药物、射线等作用的耐受性。近年来人们利用体外三维细胞培养技术研究多细胞耐受性,发现其机制主要为三维结构相关的耐受性和接触性耐受性,并发现一些逆转或减弱多细胞耐受性的方法,显示了其作为临床肿瘤单独治疗或联合治疗的应用前景。     

异源物代谢核受体PXR与肿瘤多药耐药相关性的研究进展

肿瘤的多药耐药性是临床化疗中迫切需要解决的问题.孕烷X受体(pregnane X receptor,PXR)为配体活化的转录因子,其下游靶基因均为主司异源性药物/毒物生物转化功能的I相、II相代谢酶及III相转运蛋白,可对药物代谢动力学过程产生重要的影响,故有可能成为逆转肿瘤多药耐药的新的药物作用靶点.本文总结了PXR在肿瘤多药耐药中的作用及机制、新型PXR配体类药物研发等方面的研究进展.     

川芎嗪抗组织粘连研究进展

对近年来川芎嗪抗组织粘连的作用,为临床研究和研发新药提供参考。结果发现,川芎嗪可通过抑制胶原增生过度、与粘连相关的因子过度表达、降低血浆中白细胞和纤维蛋白的浓度等多靶点、多环节发挥抗粘连作用。但是研究多集中在体外实验及动物实验,亟需进一步从临床研究上证实其抗粘连作用,未来基础研究应集中在川芎嗪生物材料的研发。     

死亡受体信号通路耐受机制及肿瘤治疗CSCD

死亡受体介导的凋亡通路是治疗肿瘤的理想方案。凋亡通路中具有复杂的调控机制,控制细胞的生死存亡。其中有多类抗凋亡因子,致使肿瘤细胞对凋亡信号耐受,使得凋亡在肿瘤治疗领域的应用受限。临床前体外细胞及裸鼠研究发现,单独靶向这些死亡受体或抗凋亡因子的药物或与传统化疗联合可以有效引起肿瘤细胞凋亡,但临床II期实验没有明显治疗效果。本综述总结分析多种抗凋亡因子产生的耐受机制以及靶向药物的研究现状,提出同时靶向死亡受体、c-FLIP及IAP是治疗肿瘤的理想方案。     

Flavonoids and steroid hormone-dependent cancers

Steroid-hormone dependent cancers, including those of the breast, prostate and colon, are leading causes of morbidity and mortality in western countries. In rural Asian areas, these diseases are relatively uncommon. Dietary factors, including low consumption of fruit, vegetables and soy in the west have been shown in various epidemiologic studies as reasons for these differences. This review discusses flavonoids, one component of these plant foods that is being investigated for their role in chemoprevention. Epidemiological, in vitro, animal and human studies shall be explored to look at mechanisms involved, including steroid hormone activity, effects on cell growth, antioxidant activities, inhibition of chemical carcinogenesis and influences on modulators of cancer risk. Although the in vitro and animal models point to several pathways by which flavonoids may reduce incidence of these cancers, the clinical data are still relatively lacking. More research is needed to determine how best to use foods containing these compounds to reduce steroid hormone-dependent cancer risk.     

Epidemiology and biology of insulin-like growth factor binding protein-3 (IGFBP-3) as an anti-cancer molecule.

The Insulin-like Growth Factor (IGF) signaling system plays a central role in cellular growth, differentiation and proliferation. IGFBP-3 is the most abundant IGF binding protein in human serum and has been shown to be a growth inhibitory, apoptosis-inducing molecule, capable of acting via IGF-dependent and IGF-independent mechanisms. Over the last decade, several clinical studies have proposed that individuals with IGFBP-3 levels in the upper range of normal may have a decreased risk for certain common cancers. This includes evidence of a protective effect against breast cancer, prostate cancer, colorectal cancer, and lung cancer. In addition, a series of in vitro studies and animal experiments point towards an important role for IGFBP-3 in the regulation of cell growth and apoptosis. In this brief review, we discuss the biological role of IGFBP-3 and summarize the epidemiological and experimental evidence suggesting a role for IGFBP-3 as an anti-cancer molecule.     

Tea polyphenols, their biological effects and potential molecular targets

Tea is the most popular beverage in the world, second only to water. Tea contains an infusion of the leaves from the Camellia sinensis plant rich in polyphenolic compounds known as catechins, the most abundant of which is (-)-EGCG. Although tea has been consumed for centuries, it has only recently been studied extensively as a health-promoting beverage that may act to prevent a number of chronic diseases and cancers. The results of several investigations indicate that green tea consumption may be of modest benefit in reducing the plasma concentration of cholesterol and preventing atherosclerosis. Additionally, the cancer-preventive effects of green tea are widely supported by results from epidemiological, cell culture, animal and clinical studies. In vitro cell culture studies show that tea polyphenols potently induce apoptotic cell death and cell cycle arrest in tumor cells but not in their normal cell counterparts. Green tea polyphenols were shown to affect several biological pathways, including growth factor-mediated pathway, the mitogen-activated protein (MAP) kinase-dependent pathway, and ubiquitin/proteasome degradation pathways. Various animal studies have revealed that treatment with green tea inhibits tumor incidence and multiplicity in different organ sites such as skin, lung, liver, stomach, mammary gland and colon. Recently, phase I and II clinical trials have been conducted to explore the anticancer effects of green tea in humans. A major challenge of cancer prevention is to integrate new molecular findings into clinical practice. Therefore, identification of more molecular targets and biomarkers for tea polyphenols is essential for improving the design of green tea trials and will greatly assist in a better understanding of the mechanisms underlying its anti-cancer activity.     

Growth hormone-releasing hormone antagonists inhibit growth of human ovarian cancer

Epithelial ovarian carcinoma is the leading cause of cancer-related deaths among women with gynecologic malignancies. Antagonists of the growth hormone-releasing hormone (GHRH) have been shown to inhibit growth of various cancers through endocrine, autocrine, and paracrine mechanisms. In this study, we have investigated the effects of GHRH antagonists (GHRHa) in ES-2 human clear cell ovarian cancer and in UCI-107 human serous ovarian cancer in vitro and in vivo. We evaluated the expression of mRNA for GHRH receptor, the binding to GHRH receptors, in specimens of ES-2 ovarian cancer. We evaluated also the in vitro effects of GHRHa on ES-2 cells and the in vivo effect of 2 different GHRHa on ES-2 and UCI-107 tumors. Nude mice bearing xenografts on ES-2 and UCI-107 ovarian cancer were treated with JMR-132 and MZ-J-7-118, respectively. Tumor growth was compared to control. ES-2 cells expressed mRNA for the functional splice variant SV1 of the GHRH receptor. JMR-132 inhibited cell proliferation in vitro by 42% and 18% at 10 and 1 μM concentration, respectively. Specific high affinity receptors for GHRH were detected in ES-2 cancer samples. In vivo daily subcutaneous injections of GHRHa significantly reduced tumor growth compared to a control group in both animal models. Our results indicate that GHRHa such as JMR-132 and MZ-J-7-118 can inhibit the growth of human ovarian cancer. The efficacy of GHRHa in ovarian cancer should be assessed in clinical trials.     

The role of gelatinases in colorectal cancer progression and metastasis

Various proteases are involved in cancer progression and metastasis. In particular, gelatinases, matrix metalloproteinase-2 (MMP-2) and MMP-9, have been implicated to play a role in colon cancer progression and metastasis in animal models and patients. In the present review, the clinical relevance and the prognostic value of messenger ribonucleic acid (mRNA) and protein expression and proenzyme activation of MMP-2 and MMP-9 are evaluated in relation to colorectal cancer. Expression of tissue inhibitors of MMPs (TIMPs) in relation with MMP expression in cancer tissues and the relevance of detection of plasma or serum levels of MMP-2 and/or MMP-9 and TIMPs for prognosis are also discussed. Furthermore, involvement of MMP-2 and MMP-9 in experimental models of colorectal cancer is reviewed. In vitro studies have suggested that gelatinase is expressed in cancer cells but animal models indicated that gelatinase expression in non-cancer cells in tumors contributes to cancer progression. In fact, interactions between cancer cells and host tissues have been shown to modulate gelatinase expression in host cells. Inhibition of gelatinases by synthetic MMP inhibitors has been considered to be an attractive approach to block cancer progression. However, despite promising results in animal models, clinical trials with MMP inhibitors have been disappointing so far. To obtain more insight in the (patho)physiological functions of gelatinases, regulation of MMP-2 and MMP-9 expression is discussed. Mitogen activated protein kinase (MAPK) signalling has been shown to be involved in regulation of gelatinase expression in both cancer cells and non-cancer cells. Expression can be triggered by a variety of stimuli including growth factors, cytokines and extracellular matrix (ECM) components. On the other hand, MMP-2 and MMP-9 activity regulates bioavailability and activity of growth factors and cytokines, affects the immune response and is involved in angiogenesis. Because of the multifunctionality of gelatinases, it is unpredictable at what stage of cancer development and in which processes gelatinase activity is involved. Therefore, it is concluded that the use of MMP inhibitors to treat cancer should be considered carefully.     

Effects of propofol on the development of cancer in humans

Cancer is one of most the significant threats to human health worldwide, and the primary method of treating solid tumours is surgery. Propofol, one of the most widely used intravenous anaesthetics in surgery, was found to be involved in many cancer‐related pathophysiology processes, mainly including anti‐tumour and minor cancer‐promoting effects in various types of cancer. An increasing number of studies have identified that propofol plays a role in cancer by regulating the expression of multiple signalling pathways, downstream molecules, microRNAs and long non‐coding RNAs. Emerging evidence has indicated that propofol can enhance the anti‐tumour effect of chemotherapeutic drugs or some small molecular compounds. Additionally, in vivo animal models have shown that propofol inhibits tumour growth and metastasis. Furthermore, most clinical trials indicate that propofol is associated with better survival outcomes in cancer patients after surgery. Propofol use is encouraged in cancers that appear to have a better prognosis after its use during surgery. We hope that future large and prospective multicenter studies will provide more precise answers to guide the choice of anaesthetics during cancer surgery.     

Pre-clinical and clinical aspects of peptide-based vaccine against human solid tumors

Peptides deriving from tumor-associated antigens and recognized by patient T cells have been firstly defined in the early 90's, and then used as vaccine in animal models and in cancer patients. Early trials showed a variable, often even high frequency of patients developing peptide-specific T-cell mediated immune response usually accompanied by a lower frequency of clinical response. Modified, long peptides could be synthesized with a higher in vitro binding to the corresponding HLA allele that only seldom translated into a clear improvement in the tumor response. However, we show here that more recent studies of multipeptide-based vaccines resulted in a higher and more robust T cell response causing also a more effective clinical response particularly in melanoma and prostate cancer patients. In this article, we also used some of the recent patents describing different inventions related to pre-clinical and clinical aspects of peptide based vaccines against human solid tumors.     

Genistein increases epidermal growth factor receptor signaling and promotes tumor progression in advanced human prostate cancer

Genistein is an isoflavone found in soy, and its chemo-preventive and -therapeutic effects have been well established from in vitro studies. Recently, however, its therapeutic actions in vivo have been questioned due to contradictory reports from animal studies, which rely on rodent models or implantation of cell lines into animals. To clarify in vivo effects of genistein in advanced prostate cancer patients, we developed a patient-derived prostate cancer xenograft model, in which a clinical prostatectomy sample was grafted into immune deficient mice. Our results showed an increased lymph node (LN) and secondary organ metastases in genistein-treated mice compared to untreated controls. Interestingly, invasive malignant cells aggregated to form islands/micrometastasis only in the secondary organs of the genistein-treated groups, not in the untreated control group. To understand the underlying mechanism for metastatic progression, we examined cell proliferation and apoptosis on paraffin-sections. Immunohistological data show that tumors of genistein-treated groups have more proliferating and fewer apoptotic cancer cells than those of the untreated group. Our immunoblotting data suggest that increased proliferation and metastasis are linked to enhanced activities of tyrosine kinases, EGFR and its downstream Src, in genistein-treated groups. Despite the chemopreventive effects proposed by earlier in vitro studies, the cancer promoting effect of genistein observed here suggests the need for careful selection of patients and safer planning of clinical trials.     

应用遗传改造的沙门菌介导肿瘤治疗的研究进展

肿瘤是机体在各种致瘤因子作用下,局部组织细胞异常增生所形成的赘生物。肿瘤治疗一直是临床上的一个难题,而放疗、化疗和手术等常规的肿瘤治疗方法均具有明显的局限性。早期研究发现某些厌氧菌或兼性厌氧菌具有抗肿瘤效应,例如兼性厌氧菌鼠伤寒沙门氏菌可以通过某些机制选择性定殖于肿瘤并抑制肿瘤生长,其应用于肿瘤治疗具有许多潜在的优势。过去的一二十年里,已有不少研究者通过遗传操作减弱沙门菌毒力,提高其定殖肿瘤的靶向性,或以减毒沙门菌作为载体向肿瘤靶向递呈各种治疗分子,并在许多动物试验中观察到遗传改造沙门菌的良好抗肿瘤效应。随着沙门菌抗肿瘤研究的不断深入,应用遗传改造的沙门菌有希望成为一条更有效的肿瘤治疗途径。本文将从沙门菌的抗肿瘤机制、遗传改造的沙门菌介导肿瘤治疗的研究进展和目前研究存在的问题等方面进行综述。     

Review on the in vitro interaction of insulin glargine with the insulin/insulin-like growth factor system: potential implications for metabolic and mitogenic activities

Insulin analogues provide clinically important benefits for people with diabetes, including more predictable action profiles and lower risk of hypoglycemia compared with human insulin. However, it has been suggested that certain insulin analogues may lead to greater activation of insulin-like growth factor-1 (IGF-1) signaling, with risk for adverse mitogenic effects. This article aims to critically review studies on the mitogenic effects of the insulin analogue insulin glargine (glargine) and its metabolites. A review of in vitro studies suggests that glargine may stimulate mitogenic activity in some cell lines at supraphysiological concentrations (nanomolar/micromolar concentrations). Mitogenicity appeared to be related to the expression of the IGF-1 receptor, being present in cells expressing high levels of the receptor and absent in cells with limited or no IGF-1 receptor expression. In animal studies, glargine did not promote tumor growth, despite administration at supraphysiological concentrations (nanomolar/micromolar), which are unlikely to be observed in clinical practice because the doses needed to produce these concentrations are liable to lead to hypoglycemia. Furthermore, glargine in vivo is rapidly transformed into its metabolites, the metabolic and mitogenic characteristics of which have been shown to be broadly equal to those of human insulin. Thus, the suggestion of increased relative mitogenic potency of insulin glargine seen in some cell lines does not appear to carry over to the in vivo situation in animals and humans.