诱导细胞焦亡抑制恶性肿瘤的新策略研究进展

细胞焦亡是一种非典型的细胞程序性死亡方式，其主要表现为各种外界刺激后细胞膜产生孔隙，随后细胞膨胀、胞液外流、分泌炎性因子引起炎性反应，最终导致细胞崩解。焦亡起初发现于感染性疾病，但后来在神经系统、心血管系统中均有所发现，近期研究也发现了其在肿瘤中也存在，探究其对肿瘤的作用成为研究热点之一。目前已有研究提出抗肿瘤药物、中药单体等可以诱导肿瘤细胞焦亡，故本文从此入手，探究肿瘤细胞焦亡相关影响分子，并总结归纳其作用方向，提出阻止化疗耐药与调节代谢分子两条可能的抗肿瘤新策略。     

细胞焦亡的生物学机制及其在乳腺癌中的研究进展

细胞焦亡是一种新近发现的促炎程序性死亡方式，细胞焦亡是由半胱天冬氨酸蛋白酶-1（Caspase-1）介导，通过GSDM家族蛋白的剪切活化，令细胞膜上形成小孔，从而使胞膜快速裂解，导致细胞内炎性内容物释放引起炎性反应的过程。细胞焦亡的三种途径分别为Caspase-1作用的经典通路、Caspase-4、5、11作用的非经典通路以及Caspase-3或Hela细胞作用的特殊通路。细胞焦亡在乳腺癌的发生、侵袭和转移方面起着重要的作用，与乳腺癌的预防和治疗有着密切的联系。本文就细胞焦亡的生物学机制及其在乳腺癌中的研究进展作一综述，以期为临床医生治疗乳腺癌提供新的思路。     

细胞焦亡、炎性体与肿瘤的关系

细胞焦亡是一种新的细胞程序性死亡的方式,多项研究显示其与多种疾病相关。炎性体、半胱天冬酶（caspase）在细胞焦亡的过程中扮演重要的角色。外来刺激使细胞内模式识别受体寡聚化,与凋亡相关微粒蛋白及 caspase 前体装配成炎性复合体,从而激活 caspase 诱导肿瘤细胞焦亡发生。而作为焦亡的上游调控机制,炎性体在肿瘤的生长中起着“双刃剑”的作用。一方面炎性体可以诱导肿瘤细胞发生焦亡,抑制肿瘤细胞的增殖;另一方面,炎性体的累积效应,也可以形成适宜肿瘤细胞生长的微环境,起着促瘤生长的作用。     

细胞焦亡的分子调控机制及其在肺癌中的研究进展

细胞焦亡是不同于坏死与凋亡的一种新的程序性细胞死亡方式,炎性小体、Caspase和GASDERMIN家族在焦亡过程中发挥重要作用。细胞焦亡参与肿瘤的发生发展,影响肿瘤细胞的增殖、侵袭与转移,诱导细胞焦亡成为一种潜在的抗肿瘤治疗策略。全文将从GSDMD和Caspase家族探讨焦亡的分子调节机制以及焦亡在肺癌发生发展、治疗中的作用,探索潜在的诊断标志物和治疗靶点,以期为肺癌的诊疗提供新方向与新思路。     

焦亡在肿瘤治疗中作用的研究进展

细胞焦亡是一种伴随炎症反应的程序性细胞死亡,主要通过激活炎性半胱氨酸蛋白酶Caspase-1/4/5/11切割GSDMD或激活凋亡半胱氨酸蛋白酶Caspase-3切割GSDME两种途径被触发。细胞焦亡参与多种疾病的发生发展。近年来,焦亡在肿瘤治疗中的意义得到了广泛关注,积累了诸多新成果,形成了一些新见解。本文谨就此进行简要综述,以期为拓展细胞死亡方式与肿瘤治疗之间的研究提供参考。     

GSDME引起的细胞焦亡在肿瘤治疗中的研究进展

细胞焦亡是由Gasdermin家族蛋白介导的程序性死亡方式,并伴随炎症及免疫反应。Gasdermin含有一个功能性的N端结构域、C端结构域,以及 一个被激活的炎性半胱天冬酶（caspases）识别和裂解的连接子,此结构可在膜上穿孔,导致膜肿胀和破裂。Gasdermin家族蛋白均可诱导细胞发生焦亡,但只 有Gasdermin E(GSDME)启动子甲基化存在于多数肿瘤中,使其有可能成为新的预测肿瘤和化疗药物选择的因子,并且其诱导的焦亡常与自然杀伤细胞有密切联 系。除此以外,GSDME引起的细胞焦亡也与其他类型疾病有密切联系,如嵌合抗原受体(CAR)T细胞治疗癌症的疗效和糖尿病性肾病（DKD）等。本文将对GSDME蛋 白在各种疾病中的研究现状进行综述,以期对临床肿瘤及其他类型疾病的治疗有所帮助。     

PD-1/PD-L1抑制剂在前列腺癌免疫治疗中的研究进展

前列腺癌（prostate cancer,PCa）发病率呈逐年上升趋势,前列腺癌免疫治疗已成为继外科、放疗、化疗之后的第四种治疗方法。作为当今肿瘤免疫治疗领域最具有研究前景的免疫检查点抑制剂中的程序性死亡受体-1（programmed cell death-1,PD-1）/程序性死亡配体-1（programmed cell death-ligand1,PD-L1）抑制剂,通过阻断PD-1与其配体PD-L1结合,从而终止T细胞的负性调控信号,使T细胞的活性恢复,进而逆转肿瘤免疫逃逸机制,恢复自身免疫应答,最后起到抑制和杀伤肿瘤的作用。本文就目前应用于前列腺癌临床试验的PD-1/PD-L1抑制剂的现况和临床疗效研究进展进行综述。      

细胞焦亡在胃癌中的生物学作用研究进展

细胞焦亡是依赖于Gasdermin家族蛋白诱导细胞质膜形成膜孔的可调控的细胞死亡,以质膜孔隙形成和促IL-18、IL-1炎症因子生成释放为表现。随着研究的深入,细胞焦亡在癌症中的生物学作用日益凸显。细胞焦亡各关键组分尤其是Gasdermin家族在癌症的发生发展中显示出关键作用。细胞焦亡与胃癌的关系复杂,一方面细胞焦亡可以抑制肿瘤的发生和发展;另一方面细胞焦亡作为促炎性死亡的一种,可以为肿瘤细胞的生长形成适宜的肿瘤微环境,从而促进胃癌的发生发展。因此,本文就细胞焦亡的分子机制、胃癌与细胞焦亡的相关研究探讨该生物学过程在胃癌中的作用,以期为胃癌的诊疗提供新的思路。      

免疫检查点在乳腺癌中的研究进展

免疫检查点对于维持自身免疫耐受、避免免疫系统对正常组织进行攻击发挥着至关重要的作用。肿瘤细胞能够利用免疫检查点通路的激活逃避免疫系统的识别。目前最重要的免疫检查点为细胞毒T淋巴细胞相关抗原-4（CTLA-4）、程序性死亡受体-1（PD-1）及程序性死亡受体配体-1（PD-L1）。肿瘤细胞PD-L1通过与活化的T细胞的PD-1结合,能够通过诱导T细胞的凋亡降低肿瘤免疫反应。免疫检查点抑制剂的应用能够延长肿瘤患者的生存时间。尽管目前对于免疫检查点认识有限,但免疫检查点抑制剂作为新的治疗方法有望改变乳腺癌的治疗模式。本篇综述将介绍乳腺癌中免疫检查点的研究进展。     

Commensal microbiota contributes to predicting the response to immune checkpoint inhibitors in non-small-cell lung cancer patients

Immunotherapy against cancer, through immune checkpoint inhibitors targeting the programmed cell death-1/programmed cell death-ligand 1 axis, is particularly successful in tumors by relieving the immune escape. However, interindividual responses to immunotherapy are often heterogeneous. Therefore, it is essential to screen out predictive tumor biomarkers. In this study, we analyzed the commensal microbiota in stool samples and paired sputum samples from 75 metastatic non-small-cell lung cancer (NSCLC) patients at baseline and during treatment with immune checkpoint inhibitors. Results showed distinct microbes’ signatures between the gut microbiota and paired respiratory microbiota. The alpha diversity between the gut and respiratory microbiota was uncorrelated, and only the gut microbiota alpha diversity was associated with anti-programmed cell death-1 response. Higher gut microbiota alpha diversity indicated better response and more prolonged progression-free survival. Comparison of bacterial communities between responders and nonresponders showed some favorable/unfavorable microbes enriched in responders/nonresponders, indicating that commensal microbiota had potential predictive value for the response to immune checkpoint inhibitors. Generally, some rare low abundance gut microbes and high abundance respiratory microbes lead to discrepancies in microbial composition between responders and nonresponders. A significant positive correlation was observed between the abundance of Streptococcus and CD8⁺ T cells. These results highlighted the intimate relationship between commensal microbiota and the response to immunotherapy in NSCLC patients. Gut microbiota and respiratory microbiota are promising biomarkers to screen suitable candidates who are likely to benefit from immune checkpoint inhibitor-based immunotherapy.     

PD-1/PD-L1抑制剂治疗淋巴瘤的研究进展

免疫检查点抑制剂已被批准用于多种难治性实体肿瘤的治疗,如恶性黑色素瘤、肺癌、胰腺癌、肾癌等。其在复发/难治性淋巴瘤的治疗方面也展现出广阔的应用前景。程序性死亡受体-1及其配体(PD-1/PD-L1)通路是免疫检查点抑制治疗(checkpoint blockade therapy,CBT)的关键性通路之一。肿瘤细胞可通过PD-1/PD-L1通路抑制T细胞活性,阻断免疫应答,从而实现免疫逃逸,最终促进肿瘤的发生、发展。新近研究发现PD-1/PD-L1通路在复发/难治性霍奇金淋巴瘤（Hodgkin lymphoma,HL）和部分非霍奇金淋巴瘤（non-Hodgkin lymphoma,NHL）中也发挥着重要作用。本文将简单介绍PD-1/PD-L1通路的生物学活性,总结针对该通路的免疫疗法在恶性淋巴瘤治疗中的研究进展。     

Immunotherapy in Hodgkin and non-Hodgkin lymphoma: Innate,adaptive and targeted immunological strategies

Since the clinical introduction of anti-CD20 monoclonal antibodies into lymphoma treatment, immunologic approaches in lymphoma have made substantial progress. Advances in our understanding of tumor immunology have led to the development of strategies to overcome immunologic barriers responsible for an ineffective immune response. Specifically, therapeutic agents have been developed and tested against molecules that are responsible for T-cell exhaustion. The use of monoclonal antibodies against immune checkpoints in the adaptive immune system, such as programmed cell death-1 and cytotoxic T-lymphocyte-associated protein 4, has changed the landscape of cancer therapy including the treatment of lymphoma. This achievement has recently been accompanied by the development of novel immune checkpoint inhibitors targeting the innate immune system, including the CD47-SIRPα signaling pathway, and this approach has yielded promising results. To overcome impaired antigen presentation, antibody-based cytotoxic strategies, namely antibody-drug conjugates (polatuzumab vedotin and brentuximab vedotin) and bispecific T-cell or NK-cell engagers (blinatumomab, REGN1979, RG6206, and AFM13), have rapidly evolved with promising clinical activity. As additional tools become available for lymphoma treatment, formulation of safe, rational combination strategies to combine them with standard therapy will be of paramount importance. A successful approach to the treatment of lymphoma may require both an optimized anti-tumor immune response as well as effective depletion of malignant lymphoid cells.     

Pyroptosis impacts the prognosis and treatment response in gastric cancer via immune system modulation

Pyroptosis plays a vital role in the development of cancers; however, its role in regulating immune cell infiltration in tumor microenvironment (TME) and pyroptosis-related molecular subtypes remain unclear. Herein, we comprehensively analyzed the molecular subtypes mediated by the pyroptosis-related genes (PRGs) in gastric cancer (GC). Three pyroptosis patterns were determined with distinct TME cell-infiltrating characteristics and prognosis. Principal component analysis was performed to establish the pyroptosis score. The high pyroptosis score group was featured by increased activated CD4+ T cell infiltration, better prognosis, elevated tumor mutation burden, higher immune and stromal scores, and enhanced response to immunotherapy. However, the low pyroptosis score group was characterized by poorer survival, decreased immune infiltration, and glycerolipid and histidine metabolism pathways. Additionally, high pyroptosis score was confirmed as an independent favorable prognostic factor for overall survival. Three cohorts designed to analyze the response to immunotherapy verified that patients with higher pyroptosis score showed treatment benefit. In summary, our study demonstrated that pyroptosis regulates the complex TME. Assessing the pyroptosis patterns will advance our understanding on TME features and tumor immunology and provide the rationale for designing personalized immunotherapy strategies.     

肿瘤免疫检查点治疗中的疾病暴发性进展及其应对策略

[摘要] 以PD-1/PD-L1 等免疫检查点为靶点,应用单克隆抗体加以阻断,从而达到激活免疫系统杀灭肿瘤的目的,是当今肿瘤生物治疗的重要手段。在部分肿瘤患者,免疫检查点抑制剂（ICIs）治疗可完全治愈或者有效抑制肿瘤,显著延长生存期;但是在部分肿瘤患者,ICIs 治疗导致病情加重,出现暴发性进展（HPD）的现象,即免疫检查点治疗后肿瘤发生反常的加速生长,首次评效时肿瘤生长速率（TGR）比治疗前增加大于50%（△TGR>50%）。本文重点讨论ICIs 治疗中HPD的相关问题,如HPD的发现过程、潜在的病理生理机制,以及未来如何应对这一挑战。     

PD-1/PD-L1在非小细胞肺癌中的临床研究进展

近年来,免疫治疗在癌症研究中取得了突飞猛进的发展。以程序性死亡受体-1（programmed cell death-1,PD-1）及其配体程序性死亡配体-1（programmed cell death-ligand 1,PD-L1）为靶点的免疫治疗药物在非小细胞肺癌（non-small cell lung cancer,NSCLC）的治疗中显示出了良好的疗效和耐受性,治疗前景值得期待。本文对PD-1/PD-L1治疗NSCLC的临床研究现状进行综述。      

Clinical significance and therapeutic potential of the programmed death-1 ligand/programmed death-1 pathway in human pancreatic cancer.

PURPOSE: The programmed death-1 ligand/programmed death-1 (PD-L/PD-1) pathway has been recently suggested to play a pivotal role in the immune evasion of tumors from host immune system. In this study, we tried to reveal the clinical importance and therapeutic potential of the PD-L/PD-1 pathway in pancreatic cancer, which is one of the most aggressive and intractable malignant tumors. EXPERIMENTAL DESIGN: We used immunohistochemistry to investigate PD-L expression in 51 patients with pancreatic cancer who underwent surgery and explored the therapeutic efficacy of blocking the PD-L1/PD-1 pathway in murine pancreatic cancer in vivo. RESULTS: PD-L1-positive patients had a significantly poorer prognosis than the PD-L1-negative patients, whereas there was no significant correlation of tumor PD-L2 expression with patient survival. PD-L1 expression was inversely correlated with tumor-infiltrating T lymphocytes, particularly CD8(+) T cells. These clinical data have suggested that the PD-L1/PD-1 pathway may be a critical regulator in human pancreatic cancer. Monoclonal antibodies against PD-L1 or PD-1 induced a substantial antitumor effect on murine pancreatic cancer in vivo. PD-L1 blockade promoted CD8(+) T-cell infiltration into the tumor and induced local immune activation. Furthermore, the combination of anti-PD-L1 monoclonal antibody and gemcitabine exhibited a significant synergistic effect on murine pancreatic cancer and resulted in complete response without overt toxicity. CONCLUSION: Our data suggest for the first time that PD-L1 status may be a new predictor of prognosis for patients with pancreatic cancer and provide the rationale for developing a novel therapy of targeting the PD-L/PD-1 pathway against this fatal disease.     

Immune escape to PD-L1/PD-1 blockade: seven steps to success (or failure)

The emergence of programmed death-ligand 1 (PD-L1)/programmed death-1 (PD-1)–targeted therapy has demonstrated the importance of the PD-L1: PD-1 interaction in inhibiting anticancer T-cell immunity in multiple human cancers, generating durable responses and extended overall survival. However, not all patients treated with PD-L1/PD-1–targeted therapy experience tumor shrinkage, durable responses, or prolonged survival. To extend such benefits to more cancer patients, it is necessary to understand why some patients experience primary or secondary immune escape, in which the immune response is incapable of eradicating all cancer cells. Understanding immune escape from PD-L1/PD-1–targeted therapy will be important to the development of rational immune-combination therapy and predictive diagnostics and to the identification of novel immune targets. Factors that likely relate to immune escape include the lack of strong cancer antigens or epitopes recognized by T cells, minimal activation of cancer-specific T cells, poor infiltration of T cells into tumors, downregulation of the major histocompatibility complex on cancer cells, and immunosuppressive factors and cells in the tumor microenvironment. Precisely identifying and understanding these mechanisms of immune escape in individual cancer patients will allow for personalized cancer immunotherapy, in which monotherapy and combination immunotherapy are chosen based on the presence of specific immune biology. This approach may enable treatment with immunotherapy without inducing immune escape, resulting in a larger proportion of patients obtaining clinical benefit.     

免疫检查点Tim-3和LAG-3在肺癌中的研究进展

近年来肺癌的免疫治疗取得了重大突破,随着免疫检查点抑制剂的出现,阻断体内抑制性分子可以使免疫系统重新激活以抵抗肿瘤,改善了一线和二线治疗中的总生存率。目前细胞程序死亡受体 1（PD-1）及其配体（PD-L1）抑制剂为肺癌患者提供了新的治疗方法。尽管检查点阻断改善了肺癌患者的治疗前景,但单药治疗方法仅对一部分患者有效且可能产生耐药性,仍需我们不断探索新的抑制途径。本文主要对免疫检查点T细胞免疫球蛋白黏蛋白分子-3（Tim-3）和淋巴细胞活化基因-3（LAG-3）在肺癌中的研究进展作一综述。     

Methods for monitoring cancer cell pyroptosis

Pyroptosis is a form of proinflammatory cell death that depends on the gasdermin family of proteins. The main features of pyroptosis are altered membrane permeability, cell swelling, membrane rupture, and the ability to mobilize a strong immune response. The relationship between pyroptosis and cancer has become a popular topic in immunological research. Multiple strategies for inducing pyroptosis in cancer cells have been developed for cancer therapy, including chemotherapy, small molecule drugs, and nanomedicines. In this review, we systematically discuss recent advances in research on the mechanisms of pyroptosis, and compare pyroptosis with apoptosis and necroptosis from several aspects. The development of various experimental systems has accompanied rapid progress in this field, but little consensus on monitoring pyroptosis is currently available. We focus on techniques commonly used to monitor pyroptosis, and describe future techniques that may be used to increase our knowledge in this field. Overall, the advancement of pyroptosis detection methods will help researchers to better investigate the relationships between pyroptosis and various cancers, and should provide insights into the use of these promising tools for cancer treatments.     

PD-L1和PD-1作为治疗结直肠癌的免疫检查新靶点的研究进展

免疫抗癌疗法是一种新的治疗实体肿瘤的方法。在这个新的领域，免疫系统里作为负向调节因子的免疫检查位点，在抗肿瘤免疫反应领域中起着重要的作用。因此，诸如抗细胞毒性T淋巴细胞相关抗原4(CTLA-4)、程序性细胞死亡蛋白（PD-1）、程序性细胞死亡蛋白配体1（PD-L1），现在已经研发出了针对前述这三者免疫检查位点的阻断因子，用于抗肿瘤的药物，在临床前期研究和临床研究中有着可喜的成果。本文综述关于在结直肠癌中免疫检查位点阻断剂的生物背景和临床研发最新进展。关于阻断PD-1和PD-L1的临床前期试验结果的前景令人充满希望，尤其是在带有微卫星不稳定性（MSI）的结直肠癌患者中更加明显。接下来进一步深入开展的临床试验将证实这些初步结果，并且评估这二者联合治疗方法的可行性和确认这两个生物标记物作为免疫检查位点阻断剂的效应在哪些人群中更有可能受益或更加抵抗。