Immunotherapies

免疫疗法
  • 文章类型: Journal Article
    肝癌是一个全球性的健康挑战,造成重大的社会经济负担。肝细胞癌(HCC)是原发性肝癌的主要类型,在分子和细胞特征方面是高度异质的。早期或小肿瘤通常用手术或消融治疗。目前,化疗和免疫疗法是不可切除肿瘤或晚期HCC的最佳治疗方法。然而,药物反应和获得性耐药是不可预测的与现有的系统指南有关的突变模式和分子生物标志物,导致许多非典型分子谱患者的治疗结局不佳。凭借先进的技术平台,有价值的信息,如肿瘤遗传改变,表观遗传数据,和肿瘤微环境可以从液体活检获得。说明了肝癌的肿瘤间和肿瘤内异质性,这些数据为治疗方案的决策过程提供了坚实的证据.本文回顾了目前对HCC检测方法的理解,旨在更新使用液体活检进行HCC监测的发展。最近在分子基础上的重要发现,表观遗传概况,循环肿瘤细胞,循环DNA,和组学研究详细阐述了肝癌的诊断。此外,讨论了与治疗选择相关的生物标志物。还强调了一些最近关于靶向治疗的值得注意的临床试验。提供见解,将知识转化为潜在的生物标志物,用于检测和诊断。预后,治疗反应,以及在临床实践中的耐药指标。
    Liver cancer is a global health challenge, causing a significant social-economic burden. Hepatocellular carcinoma (HCC) is the predominant type of primary liver cancer, which is highly heterogeneous in terms of molecular and cellular signatures. Early-stage or small tumors are typically treated with surgery or ablation. Currently, chemotherapies and immunotherapies are the best treatments for unresectable tumors or advanced HCC. However, drug response and acquired resistance are not predictable with the existing systematic guidelines regarding mutation patterns and molecular biomarkers, resulting in sub-optimal treatment outcomes for many patients with atypical molecular profiles. With advanced technological platforms, valuable information such as tumor genetic alterations, epigenetic data, and tumor microenvironments can be obtained from liquid biopsy. The inter- and intra-tumoral heterogeneity of HCC are illustrated, and these collective data provide solid evidence in the decision-making process of treatment regimens. This article reviews the current understanding of HCC detection methods and aims to update the development of HCC surveillance using liquid biopsy. Recent critical findings on the molecular basis, epigenetic profiles, circulating tumor cells, circulating DNAs, and omics studies are elaborated for HCC diagnosis. Besides, biomarkers related to the choice of therapeutic options are discussed. Some notable recent clinical trials working on targeted therapies are also highlighted. Insights are provided to translate the knowledge into potential biomarkers for detection and diagnosis, prognosis, treatment response, and drug resistance indicators in clinical practice.
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  • 文章类型: English Abstract
    Acute lymphoblastic leukemia (ALL) is one of the most common acute leukemias, with rapid onset and progression. The standardized application of chemotherapy and transplantation have improved the prognosis of patients, while the unmet therapeutic needs still exist. Recently novel immunotherapies including Bispecific T cell Engager develop rapidly, offering more options for ALL treatment and also demanding higher requirements for clinical diagnosis and treatment management. Based on the evidence of domestic and international medical evidence and clinical experience, the expert panel updated Chinese consensus for the Bispeific T cell Engager in the treatment of B-cell acute lymphoblastic leukemia (2022) and formulated this edition of the Chinese expert consensus.
    急性淋巴细胞白血病(acute lymphoblastic leukemia, ALL)是最常见的急性白血病之一,发病急、进展快,化疗和移植的规范化应用已极大改善患者预后,但仍存在未满足的治疗需求。近年以双特异性T细胞衔接器(Bispecific T cell Engager,BiTE)为代表的免疫治疗发展迅速,为ALL治疗提供了更多选择,同时也对临床诊疗管理提出了更高的要求。专家组基于国内外最新循证医学证据、相关指南和临床实践,对2022年版《双特异性T细胞衔接器治疗急性淋巴细胞白血病指导原则》进行更新,制定了该版中国专家共识。.
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  • 文章类型: Journal Article
    胰腺癌(PC)是全球最致命的癌症之一,生存率低,预后差。PC的治疗环境充满了障碍,包括耐药性,缺乏有效的靶向治疗和免疫抑制肿瘤微环境(TME)。PC对现有免疫疗法的抵抗力凸显了对创新方法的需求,随着TME成为一个有前途的治疗靶点。在了解巨噬细胞的作用方面的最新进展,这一背景突出了它们对肿瘤发展和进展的显著影响.存在两种重要类型的巨噬细胞:M1和M2,其在TME中起关键作用。治疗策略包括,肿瘤相关巨噬细胞(TAMs)的消耗,重新编程TAM以促进抗肿瘤活性,靶向巨噬细胞募集可以带来有希望的结果。靶向巨噬细胞相关途径可能为调节免疫反应提供新策略。抑制血管生成,克服PC治疗中对化疗的耐药性。
    Pancreatic cancer (PC) is one of the deadliest cancers worldwide with low survival rates and poor outcomes. The treatment landscape for PC is fraught with obstacles, including drug resistance, lack of effective targeted therapies and the immunosuppressive tumor microenvironment (TME). The resistance of PC to existing immunotherapies highlights the need for innovative approaches, with the TME emerging as a promising therapeutic target. The recent advancements in understanding the role of macrophages, this context highlight their significant impact on tumor development and progression. There are two important types of macrophages: M1 and M2, which play critical roles in the TME. Therapeutics strategies including, depletion of tumor-associated macrophages (TAMs), reprogramming TAMs to promote anti-tumor activity, and targeting macrophage recruitment can lead to promising outcomes. Targeting macrophage-related pathways may offer novel strategies for modulating immune responses, inhibiting angiogenesis, and overcoming resistance to chemotherapy in PC treatment.
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  • 文章类型: Journal Article
    自然杀伤(NK)细胞是先天免疫效应,其功能依赖于受体结合细胞因子,识别自我分子,或检测病毒感染或肿瘤细胞表达的危险信号。强大的细胞毒性潜力使NK细胞有望用于癌症免疫疗法。增强其活性的策略包括细胞因子给药,封锁免疫检查站,以及基于抗体的NK细胞接合器(NKCEs)的设计。NKCE代表了癌症治疗的前沿方法:它们增强了NK与靶细胞的相互作用,并优化了肿瘤杀伤。可能克服免疫抑制肿瘤微环境。NK细胞属于先天性淋巴细胞(ILC),被分为不同的亚群,也包括具有记忆样表型的细胞:这种复杂性需要在癌症免疫疗法的背景下进行探索。特别是在设计NKCE时。可以采用两种策略来增强癌症患者中的NK细胞活性:激活患者自身的NK细胞与离体激活的NK细胞的过继转移。此外,NKCEs激活γδT细胞的能力在免疫治疗中可能具有显著的协同作用。
    Natural killer (NK) cells are innate immune effectors whose functions rely on receptors binding cytokines, recognizing self-molecules, or detecting danger signals expressed by virus-infected or tumor cells. The potent cytotoxic potential makes NK cells promising candidates for cancer immunotherapy. To enhance their activity strategies include cytokine administration, blocking of immune checkpoints, and designing of antibody-based NK cell engagers (NKCEs). NKCEs represent a cutting-edge approach to cancer therapy: they strengthen the NK-to-target cell interactions and optimize tumor killing, possibly overcoming the immunosuppressive tumor microenvironment. NK cells belong to the innate lymphoid cells (ILCs) and are categorized into different subsets also including cells with a memory-like phenotype: this complexity needs to be explored in the context of cancer immunotherapy, particularly when designing NKCEs. Two strategies to enhance NK cell activity in cancer patients can be adopted: activating patients\' own NK cells versus the adoptive transfer of ex vivo activated NK cells. Furthermore, the capability of NKCEs to activate γδ T cells could have a significant synergistic effect in immunotherapy.
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  • 文章类型: Journal Article
    代谢功能障碍相关的脂肪变性肝病(MASLD)是一种进行性病理状况,其特征是肝细胞内甘油三酯的积累导致组织学变化,which,从长远来看,可能会损害肝功能。MASLD倾向于代谢功能障碍相关脂肪性肝炎(MASH),其中炎症反应的持续存在使组织损伤持续存在并诱导细胞外基质的改变,导致肝纤维化和肝硬化。此外,这些过程也是肝细胞癌(HCC)发展的沃土。在后一方面,越来越多的证据表明,慢性炎症不仅是肝细胞恶性转化的主要刺激因素,细胞增殖和癌细胞进展,但也重塑了免疫景观,诱导免疫系统耗竭,有利于癌症免疫监视的丧失。因此,彻底了解协调肝脏炎症反应的细胞和分子机制可能为微调治疗干预措施开辟道路,从一侧,抵消MASLD进展,另一个,有效治疗HCC。
    Metabolic dysfunction associated steatotic liver disease (MASLD) is a progressive pathological condition characterized by the accumulation of triglycerides within hepatocytes that causes histological changes, which, in the long run, might compromise liver functional capacities. MASLD predisposes to metabolic dysfunction-associated steatohepatitis (MASH), in which the persistence of inflammatory reactions perpetuates tissue injury and induces alterations of the extracellular matrix, leading to liver fibrosis and cirrhosis. Furthermore, these processes are also fertile ground for the development of hepatocellular carcinoma (HCC). In this latter respect, growing evidence suggests that chronic inflammation not only acts as the primary stimulus for hepatocellular malignant transformation, cell proliferation and cancer cell progression but also reshapes the immune landscape, inducing immune system exhaustion and favoring the loss of cancer immune surveillance. Therefore, a thorough understanding of the cellular and molecular mechanisms orchestrating hepatic inflammatory responses may open the way for fine-tuning therapeutic interventions that could, from one side, counteract MASLD progression and, on the other one, effectively treat HCCs.
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  • 文章类型: Journal Article
    外泌体被认为具有临床应用的转化潜力。基于外泌体的液体活检为早期癌症检测和实时疾病监测提供了一种非侵入性方法。临床试验正在进行中,以验证外泌体生物标志物在提高诊断准确性和预测治疗反应方面的功效。此外,工程外泌体正在被开发为靶向药物递送系统,可以引导血流将治疗剂递送到肿瘤部位,从而提高治疗效果,同时最大限度地减少全身毒性。外泌体还表现出免疫调节特性,它们被用来增强抗肿瘤免疫反应。在这次审查中,我们详细介绍了临床试验和研究的最新进展,强调外泌体彻底改变癌症护理的潜力。
    Exosomes are regarded as having transformative potential for clinical applications. Exosome-based liquid biopsies offer a noninvasive method for early cancer detection and real-time disease monitoring. Clinical trials are underway to validate the efficacy of exosomal biomarkers for enhancing diagnostic accuracy and predicting treatment responses. Additionally, engineered exosomes are being developed as targeted drug delivery systems that can navigate the bloodstream to deliver therapeutic agents to tumor sites, thus enhancing treatment efficacy while minimizing systemic toxicity. Exosomes also exhibit immunomodulatory properties, which are being harnessed to boost antitumor immune responses. In this review, we detail the latest advances in clinical trials and research studies, underscoring the potential of exosomes to revolutionize cancer care.
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  • 文章类型: Journal Article
    在过去的十年中,免疫疗法的出现彻底改变了实体和血液癌症的治疗。激活免疫系统以靶向癌细胞的许可疗法可大致分为两类。第一类是抑制免疫检查点信号的抗体,称为免疫检查点抑制剂(ICIs)。第二类是基于细胞的免疫疗法,包括嵌合抗原受体T淋巴细胞(CAR-T)细胞疗法,自然杀伤(NK)细胞疗法,和肿瘤浸润淋巴细胞(TIL)疗法。所有这些治疗的临床疗效通常超过风险,但免疫相关不良事件(irAE)的发生率很高,从轻度(例如皮疹)到严重甚至致命(例如心肌炎,细胞因子释放综合征)和可逆至永久性(例如内分泌疾病)。在不同的irAE并发症和综合征中,支持irAE病理学的机制各不相同,反映了观察到的广泛的临床表型和不同个体免疫反应的变异性,总体上了解得很少。免疫相关的心血管毒性已经出现,我们的理解已经从最初关注罕见但致命的ICI相关性心肌炎伴心源性休克发展到更常见的并发症,包括不太严重的ICI相关性心肌炎,心包炎,心律失常,包括传导系统疾病和心脏传导阻滞,非炎性心力衰竭,Takotsubo综合征和冠状动脉疾病。在这份关于癌症免疫疗法心血管毒性的科学声明中,我们总结了病理生理学,流行病学,诊断,以及ICI,CAR-T的管理,NK,和TIL疗法。我们还强调了文献中的差距以及未来研究应该关注的地方。
    The advent of immunological therapies has revolutionized the treatment of solid and haematological cancers over the last decade. Licensed therapies which activate the immune system to target cancer cells can be broadly divided into two classes. The first class are antibodies that inhibit immune checkpoint signalling, known as immune checkpoint inhibitors (ICIs). The second class are cell-based immune therapies including chimeric antigen receptor T lymphocyte (CAR-T) cell therapies, natural killer (NK) cell therapies, and tumour infiltrating lymphocyte (TIL) therapies. The clinical efficacy of all these treatments generally outweighs the risks, but there is a high rate of immune-related adverse events (irAEs), which are often unpredictable in timing with clinical sequalae ranging from mild (e.g. rash) to severe or even fatal (e.g. myocarditis, cytokine release syndrome) and reversible to permanent (e.g. endocrinopathies).The mechanisms underpinning irAE pathology vary across different irAE complications and syndromes, reflecting the broad clinical phenotypes observed and the variability of different individual immune responses, and are poorly understood overall. Immune-related cardiovascular toxicities have emerged, and our understanding has evolved from focussing initially on rare but fatal ICI-related myocarditis with cardiogenic shock to more common complications including less severe ICI-related myocarditis, pericarditis, arrhythmias, including conduction system disease and heart block, non-inflammatory heart failure, takotsubo syndrome and coronary artery disease. In this scientific statement on the cardiovascular toxicities of immune therapies for cancer, we summarize the pathophysiology, epidemiology, diagnosis, and management of ICI, CAR-T, NK, and TIL therapies. We also highlight gaps in the literature and where future research should focus.
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  • 文章类型: Review
    多年来,免疫疗法已明显改善了癌症治疗领域。然而,实现结直肠癌(CRC)患者的长期生存仍然是一个重要的未满足的需求。结合靶向药物如MEK或多激酶抑制剂的联合免疫疗法提供了一些姑息益处。然而,目前CRC的治疗性医疗设备仍存在很大差距。近年来,人们对探索新的治疗策略的兴趣激增,包括光激活药物与光学设备的结合应用。这种方法有望实现细胞毒性剂的局部和靶向递送。如微管靶向药物,直接进入结肠内的癌细胞。
    Over the years immunotherapy has demonstrably improved the field of cancer treatment. However, achieving long-term survival for colorectal cancer (CRC) patients remains a significant unmet need. Combination immunotherapies incorporating targeted drugs like MEK or multi-kinase inhibitors have offered some palliative benefit. Nevertheless, substantial gaps remain in the current therapeutic armamentarium for CRC. In recent years, there has been a surge of interest in exploring novel treatment strategies, including the application of light-activated drugs in conjunction with optical devices. This approach holds promise for achieving localized and targeted delivery of cytotoxic agents, such as microtubule-targeting drugs, directly to cancerous cells within the colon.
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  • 文章类型: Journal Article
    肝癌,主要是肝细胞癌(HCC),是全球癌症相关死亡的第二大原因。它的典型特征是快速进展,预后不良,和高死亡率。鉴于这些挑战,寻找有助于早期诊断和靶向治疗的分子靶标仍然势在必行.Glypican3(GPC3),一种细胞表面糖蛋白,作为解决HCC组织中过表达的HCC的有希望的候选者;GPC3是用于肝癌诊断的可靠的免疫组织化学标记物,并且是通过血清中可溶性GPC3进行液体活检的潜在标记物。已经开发了针对GPC3的各种免疫疗法,包括疫苗,抗GPC3免疫毒素,和嵌合抗原受体修饰的细胞。这次审查全面涵盖了结构,物理化学性质,生物学功能,以及GPC3的临床应用。它探讨了以GPC3为中心的诊断和治疗策略,为在具有挑战性的HCC中改善早期检测和靶向治疗提供了希望。
    Liver cancer, primarily hepatocellular carcinoma (HCC), is the second leading cause of cancer-related deaths globally. It is typically characterized by rapid progression, poor prognosis, and high mortality rates. Given these challenges, the search for molecular targets aiding early diagnosis and targeted therapy remains imperative. Glypican 3 (GPC3), a cell-surface glycoprotein, emerges as a promising candidate for addressing HCC Overexpressed in HCC tissues; GPC3 is a credible immunohistochemical marker for liver cancer diagnosis and a potential marker for liquid biopsy through soluble GPC3 in serum. Various immunotherapies targeting GPC3 have been developed, including vaccines, anti-GPC3 immunotoxins, and chimeric antigen receptor-modified cells. This review comprehensively covers the structure, physicochemical properties, biological functions, and clinical applications of GPC3. It explores diagnostic and treatment strategies centered around GPC3, offering hope for improved early detection and targeted therapies in the challenging landscape of HCC.
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  • 文章类型: Journal Article
    泛素化,蛋白质的关键翻译后修饰,在调节蛋白质的稳定性中起着至关重要的作用。泛素化酶和去泛素化酶的失调是各种癌症的共同特征,强调必须研究泛素连接酶和去泛素化酶(DUB),以了解致癌过程和治疗干预措施的发展。在这次审查中,我们讨论了泛素-蛋白酶体系统(UPS)在癌症的所有标志和药物发现的进展中的贡献。我们深入研究了UPS在肿瘤学中的多种功能,包括它对多种癌症相关途径的调节,它在代谢重编程中的作用,它参与肿瘤免疫反应,它在表型可塑性和多态微生物组中的功能,和其他基本的细胞功能。此外,我们全面概述了利用UPS的新型抗癌策略,包括蛋白水解靶向嵌合体(PROTACs)和分子胶的开发和应用。
    Ubiquitination, a pivotal posttranslational modification of proteins, plays a fundamental role in regulating protein stability. The dysregulation of ubiquitinating and deubiquitinating enzymes is a common feature in various cancers, underscoring the imperative to investigate ubiquitin ligases and deubiquitinases (DUBs) for insights into oncogenic processes and the development of therapeutic interventions. In this review, we discuss the contributions of the ubiquitin-proteasome system (UPS) in all hallmarks of cancer and progress in drug discovery. We delve into the multiple functions of the UPS in oncology, including its regulation of multiple cancer-associated pathways, its role in metabolic reprogramming, its engagement with tumor immune responses, its function in phenotypic plasticity and polymorphic microbiomes, and other essential cellular functions. Furthermore, we provide a comprehensive overview of novel anticancer strategies that leverage the UPS, including the development and application of proteolysis targeting chimeras (PROTACs) and molecular glues.
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