PDAC, Pancreatic ductal adenocarcinoma

PDAC,胰腺导管腺癌
  • 文章类型: Journal Article
    内皮细胞(ECs)在肿瘤进展中起重要作用。目前,抗血管生成治疗的主要靶点是血管内皮生长因子(VEGF)通路。一些患者确实从抗VEGF/VEGFR治疗中获益;然而,大量患者在治疗后没有反应或获得耐药性。此外,抗VEGF/VEGFR治疗可能由于其对正常ECs的作用而导致肾毒性和心血管相关的副作用。因此,有必要确定对肿瘤ECs具有特异性并可应用于各种癌症类型的靶标。我们整合了来自六种癌症类型的单细胞RNA测序数据,并构建了一个多癌症EC图谱以解码肿瘤EC的特征。我们发现尖端样ECs主要存在于肿瘤组织中,而在正常组织中几乎不存在。提示样ECs参与促进肿瘤血管生成和抑制抗肿瘤免疫反应。此外,肿瘤细胞,骨髓细胞,周细胞是促血管生成因子的主要来源。高比例的尖端样ECs与多种癌症类型的不良预后相关。我们还发现,前列腺特异性膜抗原(PSMA)是我们研究的所有癌症类型中尖端样ECs的特异性标志物。总之,我们证明,尖端样EC是肿瘤和正常组织之间的主要差异EC亚簇。头端样ECs可通过促进血管生成同时抑制抗肿瘤免疫应答来促进肿瘤进展。PSMA是尖端状ECs的特异性标记,可作为诊断和治疗非前列腺癌的潜在靶点。
    Endothelial cells (ECs) play an important role in tumor progression. Currently, the main target of anti-angiogenic therapy is the vascular endothelial growth factor (VEGF) pathway. Some patients do benefit from anti-VEGF/VEGFR therapy; however, a large number of patients do not have response or acquire drug resistance after treatment. Moreover, anti-VEGF/VEGFR therapy may lead to nephrotoxicity and cardiovascular-related side effects due to its action on normal ECs. Therefore, it is necessary to identify targets that are specific to tumor ECs and could be applied to various cancer types. We integrated single-cell RNA sequencing data from six cancer types and constructed a multi-cancer EC atlas to decode the characteristic of tumor ECs. We found that tip-like ECs mainly exist in tumor tissues but barely exist in normal tissues. Tip-like ECs are involved in the promotion of tumor angiogenesis and inhibition on anti-tumor immune responses. Moreover, tumor cells, myeloid cells, and pericytes are the main sources of pro-angiogenic factors. High proportion of tip-like ECs is associated with poor prognosis in multiple cancer types. We also identified that prostate-specific membrane antigen (PSMA) is a specific marker for tip-like ECs in all the cancer types we studied. In summary, we demonstrate that tip-like ECs are the main differential EC subcluster between tumors and normal tissues. Tip-like ECs may promote tumor progression through promoting angiogenesis while inhibiting anti-tumor immune responses. PSMA was a specific marker for tip-like ECs, which could be used as a potential target for the diagnosis and treatment of non-prostate cancers.
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  • 文章类型: Journal Article
    未经证实:基质靶向治疗对肿瘤免疫抑制的影响在很大程度上尚未被研究。RNA寡核苷酸,STNM01已显示抑制负责肿瘤蛋白聚糖合成和基质重塑的碳水化合物磺基转移酶15(CHST15)。这项I/IIa期研究旨在评估STNM01在不可切除的胰腺导管腺癌(PDAC)患者中的安全性和有效性。
    未经批准:这是一个开放标签,STNM01作为吉西他滨联合nab-紫杉醇难治性PDAC二线治疗的剂量递增研究.一个周期包括三次2周内窥镜超声引导的局部注射STNM01,剂量为250、1,000、2,500或10,000nM,与S-1组合(每天两次80-120mg,每3周14天)。主要结果是剂量-剂量毒性(DLT)的发生率。次要结局包括总生存期(OS),肿瘤反应,肿瘤微环境的变化对免疫组织病理学的影响,和安全性(jRCT2031190055)。
    未经批准:共纳入22例患者,最多重复3个循环;未观察到DLT。中位OS为7.8个月。疾病控制率为77.3%;1例患者显示胰腺和肿瘤引流淋巴结可见病变完全消失。较高的肿瘤CHST15表达与基线时较差的CD3+和CD8+T细胞浸润相关。STNM01导致CHST15的显着减少,并在第1周期结束时与S-1组合的肿瘤浸润性CD3和CD8T细胞增加。CD3+T细胞中更高的倍数增加与更长的OS相关。有8个3级不良事件。
    UNASSIGNED:局部注射STNM01作为联合二线治疗的不可切除PDAC患者的耐受性良好。它通过增强肿瘤微环境中的T细胞浸润来延长存活。
    UNASSIGNED:本研究得到了日本医学研究与发展机构(AMED)的支持。
    UNASSIGNED: The impact of stroma-targeting therapy on tumor immune suppression is largely unexplored. An RNA oligonucleotide, STNM01, has been shown to repress carbohydrate sulfotransferase 15 (CHST15) responsible for tumor proteoglycan synthesis and matrix remodeling. This phase I/IIa study aimed to evaluate the safety and efficacy of STNM01 in patients with unresectable pancreatic ductal adenocarcinoma (PDAC).
    UNASSIGNED: This was an open-label, dose-escalation study of STNM01 as second-line therapy in gemcitabine plus nab-paclitaxel-refractory PDAC. A cycle comprised three 2-weekly endoscopic ultrasound-guided locoregional injections of STNM01 at doses of 250, 1,000, 2,500, or 10,000 nM in combination with S-1 (80-120 mg twice a day for 14 days every 3 weeks). The primary outcome was the incidence of dose-liming toxicity (DLT). The secondary outcomes included overall survival (OS), tumor response, changes in tumor microenvironment on immunohistopathology, and safety (jRCT2031190055).
    UNASSIGNED: A total of 22 patients were enrolled, and 3 cycles were repeated at maximum; no DLT was observed. The median OS was 7.8 months. The disease control rate was 77.3%; 1 patient showed complete disappearance of visible lesions in the pancreas and tumor-draining lymph nodes. Higher tumoral CHST15 expression was associated with poor CD3+ and CD8+ T cell infiltration at baseline. STNM01 led to a significant reduction in CHST15, and increased tumor-infiltrating CD3+ and CD8+ T cells in combination with S-1 at the end of cycle 1. Higher fold increase in CD3+ T cells correlated with longer OS. There were 8 grade 3 adverse events.
    UNASSIGNED: Locoregional injection of STNM01 was well tolerated in patients with unresectable PDAC as combined second-line therapy. It prolonged survival by enhancing T cell infiltration in tumor microenvironment.
    UNASSIGNED: The present study was supported by the Japan Agency for Medical Research and Development (AMED).
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    瞬时受体电位(TRP)通道是钙(Ca2+)通透性通道的主要类型,这些相关的跨膜和细胞内TRP通道以前被认为主要与心血管和神经元系统的调节有关。如今,然而,越来越多的证据表明,这些TRP通道也负责肿瘤发生和发展,诱导肿瘤侵袭和转移。然而,TRP通道在恶性肿瘤中的总体潜在机制和可能的信号转导途径可能仍然难以捉摸.因此,在这次审查中,我们专注于TRP通道与肿瘤的显着特征之间的联系,例如多药耐药(MDR),转移,凋亡,扩散,逃避免疫监视,以及相关肿瘤微环境的改变。此外,我们还讨论了相关TRP通道在各种形式癌症中的表达和相关抑制剂的疗效。还介绍了各种作用机制的抗癌药物的化学敏感性和潜在的临床应用。此外,对于这种类型的钙通道的干预,提供可能的新的治疗方法来对抗恶性肿瘤将是有启发性的。
    Transient receptor potential (TRP) channels are one primary type of calcium (Ca2+) permeable channels, and those relevant transmembrane and intracellular TRP channels were previously thought to be mainly associated with the regulation of cardiovascular and neuronal systems. Nowadays, however, accumulating evidence shows that those TRP channels are also responsible for tumorigenesis and progression, inducing tumor invasion and metastasis. However, the overall underlying mechanisms and possible signaling transduction pathways that TRP channels in malignant tumors might still remain elusive. Therefore, in this review, we focus on the linkage between TRP channels and the significant characteristics of tumors such as multi-drug resistance (MDR), metastasis, apoptosis, proliferation, immune surveillance evasion, and the alterations of relevant tumor micro-environment. Moreover, we also have discussed the expression of relevant TRP channels in various forms of cancer and the relevant inhibitors\' efficacy. The chemo-sensitivity of the anti-cancer drugs of various acting mechanisms and the potential clinical applications are also presented. Furthermore, it would be enlightening to provide possible novel therapeutic approaches to counteract malignant tumors regarding the intervention of calcium channels of this type.
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  • 文章类型: Journal Article
    未经证实:EUS引导的胆囊引流(EUS-GBD)正在成为不适合手术的急性胆囊炎(AC)患者的一种有价值的治疗方法。当使用管腔贴壁金属支架时,大口径的胆囊通道允许随后的直接经口内镜胆囊镜检查(POEC)和最终的胆囊切开取石术(CL),为虚弱的患者提供潜在的“治愈”解决方案。本系列的目的是评估这些手术在经历AC的肿瘤患者中的结果,特别关注化疗的连续性。
    UNASSIGNED:在2020年12月至2021年4月期间在SanRaffaele研究所进行的所有连续治疗性EUS程序的前瞻性登记中,搜索了在化疗候选物中进行的EUS-GBD+POEC-CL。临床和技术变量进行了前瞻性登记,化疗延迟天数和术后结局也是如此.
    UNASSIGNED:连续3例诊断为恶性肿瘤(2例胰腺癌和1例严重骨髓增殖性疾病伴骨骼病变)的患者出现AC,主要接受EUS-GBD治疗。4周后,他们被系统地安排用于POEC-CL和腔贴壁金属支架更换为双尾纤塑料支架。所有程序和修订都是成功的,临床快速改善。使用抓钳清除所有胆囊中3至15毫米的食物残渣和结石,息肉切除圈套,Dormia篮子,和机械碎石术。在POEC-CL期间记录了一个没有任何临床后果的轻度不良事件。修订不会干扰化疗方案。技术变量(例如,讨论了胃与十二指肠引流或是否需要同轴双尾纤塑料支架)。
    UNASSIGNED:EUS-GBD和随后的POEC-CL为AC提供了一种高效且微创的解决方案。这些初步经验促进了对所有不希望进行手术干预的个人的这种方法的进一步评估。如肿瘤患者的预后取决于化疗的连续性,尽管应该在这种情况下进行进一步的前瞻性确认。
    UNASSIGNED: EUS-guided gallbladder drainage (EUS-GBD) is emerging as a valuable treatment for acute cholecystitis (AC) in patients unfit for surgery. When lumen-apposing metal stents are used, large-caliber access to the gallbladder allows for subsequent direct peroral endoscopic cholecystoscopy (POEC) and eventual cholecystolithotomy (CL), offering a potentially \"curative\" solution for frailer patients. The aim of this series was to evaluate the outcome of these procedures in oncologic patients experiencing AC, with a specific focus on chemotherapy continuity.
    UNASSIGNED: A prospective registry of all consecutive therapeutic EUS procedures performed in the San Raffaele Institute between December 2020 and April 2021 was searched for EUS-GBD + POEC-CL performed in chemotherapy candidates. Clinical and technical variables were prospectively registered, as were days of chemotherapy delay and postprocedural outcomes.
    UNASSIGNED: Three consecutive patients with a diagnosis of a malignancy (2 pancreatic cancers and 1 severe myeloproliferative disease with skeletal lesions) experienced AC and were primarily treated by EUS-GBD. After 4 weeks, they were systematically scheduled for POEC-CL and lumen-apposing metal stent exchange for a double-pigtail plastic stent. All procedures and revisions were successful, with rapid clinical improvement. All gallbladders were cleared of food debris and stones between 3 and 15 mm using grasping forceps, polypectomy snares, Dormia baskets, and mechanical lithotripsy. One mild adverse event without any clinical consequence was registered during POEC-CL. Revisions did not interfere with the chemotherapy schedule. Technical variables (eg, gastric vs duodenal drainage or need for coaxial double-pigtail plastic stent) are discussed.
    UNASSIGNED: EUS-GBD and subsequent POEC-CL allows a highly effective and minimally invasive solution for AC. These initial experiences promote further evaluation of this approach for all those individuals in whom surgical interventions are undesirable, such as oncologic patients whose prognosis depends on chemotherapy continuity, although further prospective confirmation in this setting should be pursued.
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  • 文章类型: Journal Article
    外泌体是细胞衍生的纳米囊泡,直径为30至150nm,多囊泡体与细胞表面融合后释放。它们可以运输核酸,蛋白质,和脂质用于细胞间通讯并激活靶细胞中的信号通路。在癌症中,外泌体可能通过调节免疫反应参与肿瘤的生长和转移,阻断上皮-间质转化,促进血管生成。它们还参与对化疗药物的抗性的发展。液体活检中的外泌体可用作非侵入性生物标志物,用于癌症的早期检测和诊断。由于它们的两亲结构,外泌体是用于癌症治疗的天然药物递送载体。
    Exosomes are cell-derived nanovesicles with diameters from 30 to 150 nm, released upon fusion of multivesicular bodies with the cell surface. They can transport nucleic acids, proteins, and lipids for intercellular communication and activate signaling pathways in target cells. In cancers, exosomes may participate in growth and metastasis of tumors by regulating the immune response, blocking the epithelial-mesenchymal transition, and promoting angiogenesis. They are also involved in the development of resistance to chemotherapeutic drugs. Exosomes in liquid biopsies can be used as non-invasive biomarkers for early detection and diagnosis of cancers. Because of their amphipathic structure, exosomes are natural drug delivery vehicles for cancer therapy.
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  • 文章类型: Journal Article
    骨是癌症转移的优先靶器官之一。骨转移与各种并发症有关,其中骨痛最常见,使人衰弱。癌症相关骨痛(CABP)是由于神经发生增加而引起的。响应于骨骼中产生的肿瘤微环境,感觉神经(SNs)的重编程和轴突发生与SNs的敏化和激发相协调。重要的是,CABP与死亡率增加有关,其中精确的细胞和分子机制仍然知之甚少。骨骼由自主神经(AN)(交感神经和副交感神经)和SN密集支配。最近的研究表明,支配肿瘤微环境的神经与肿瘤建立了密切的联系,为肿瘤的发展和传播产生各种刺激。在这次审查中,我们目前对SNs支配骨在CABP病理生理学中的作用的理解将被概述。然后,将结合我们最近的发现讨论SNs促进骨癌进展的假设,即SNs不仅在CABP的诱导中起重要作用,而且在使用CABP的临床前模型的骨转移进展中起重要作用。建议SN是骨骼微环境的关键组成部分,其驱动骨骼与癌症之间的恶性循环以进行骨转移。抑制骨神经支配SNs的活性可能对骨转移的进展和CABP的诱导具有潜在的治疗作用。
    Bone is one of the preferential target organs of cancer metastasis. Bone metastasis is associated with various complications, of which bone pain is most common and debilitating. The cancer-associated bone pain (CABP) is induced as a consequence of increased neurogenesis, reprogramming and axonogenesis of sensory nerves (SNs) in harmony with sensitization and excitation of SNs in response to the tumor microenvironment created in bone. Importantly, CABP is associated with increased mortality, of which precise cellular and molecular mechanism remains poorly understood. Bone is densely innervated by autonomic nerves (ANs) (sympathetic and parasympathetic nerves) and SNs. Recent studies have shown that the nerves innervating the tumor microenvironment establish intimate communications with tumors, producing various stimuli for tumors to progress and disseminate. In this review, our current understanding of the role of SNs innervating bone in the pathophysiology of CABP will be overviewed. Then the hypothesis that SNs facilitate cancer progression in bone will be discussed in conjunction with our recent findings that SNs play an important role not only in the induction of CABP but also the progression of bone metastasis using a preclinical model of CABP. It is suggested that SNs are a critical component of the bone microenvironment that drives the vicious cycle between bone and cancer to progress bone metastasis. Suppression of the activity of bone-innervating SNs may have potential therapeutic effects on the progression of bone metastasis and induction of CABP.
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  • 文章类型: Journal Article
    环状RNA(circularRNAs,circRNAs)是一类非常令人感兴趣的保守单链RNA分子,其通过前体mRNA反向剪接衍生自外显子或内含子序列。与典型的线性RNA不同,circRNAs形成共价闭合,连续的稳定环,没有5'端盖和3'末端聚(A)尾部,因此对外切核酸酶消化有抗性。大多数circRNAs是高度丰富的,并在不同物种中保守,具有组织或发育阶段特异性表达。circRNAs已被证明作为microRNA海绵发挥重要作用,基因剪接和转录的调节因子,RNA结合蛋白海绵和蛋白/肽翻译。新的证据表明,circRNAs在各种人类疾病中起作用,特别是癌症,并可能作为癌症治疗更好的预测生物标志物和治疗靶点。考虑到它们潜在的临床相关性,circRNAs已成为肿瘤病理领域新的研究热点。在本研究中,目前对生物发生的理解,特点,数据库,研究方法,生物学功能亚细胞分布,表观遗传调控,讨论了circRNAs的细胞外运输和降解。特别是,首先总结了circRNA研究中涉及的多个数据库和方法,以及确定circRNAs在肿瘤生长中潜在作用的最新进展,移民和入侵,这使得circRNAs更好的预测生物标志物,被描述。此外,提出了circRNAs在癌症患者管理中的临床应用的未来观点,这可以为将来的circRNAs提供新的见解。
    Circular RNAs (circRNAs) are a very interesting class of conserved single-stranded RNA molecules derived from exonic or intronic sequences by precursor mRNA back-splicing. Unlike canonical linear RNAs, circRNAs form covalently closed, continuous stable loops without a 5\'end cap and 3\'end poly(A) tail, and therefore are resistant to exonuclease digestion. The majority of circRNAs are highly abundant, and conserved across different species with a tissue or developmental-stage-specific expression. circRNAs have been shown to play important roles as microRNA sponges, regulators of gene splicing and transcription, RNA-binding protein sponges and protein/peptide translators. Emerging evidence reveals that circRNAs function in various human diseases, particularly cancers, and may function as better predictive biomarkers and therapeutic targets for cancer treatment. In consideration of their potential clinical relevance, circRNAs have become a new research hotspot in the field of tumor pathology. In the present study, the current understanding of the biogenesis, characteristics, databases, research methods, biological functions subcellular distribution, epigenetic regulation, extracellular transport and degradation of circRNAs was discussed. In particular, the multiple databases and methods involved in circRNA research were first summarized, and the recent advances in determining the potential roles of circRNAs in tumor growth, migration and invasion, which render circRNAs better predictive biomarkers, were described. Furthermore, future perspectives for the clinical application of circRNAs in the management of patients with cancer were proposed, which could provide new insights into circRNAs in the future.
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  • 文章类型: Journal Article
    含有蛋白酪氨酸磷酸酶2(SHP2)的Src同源性代表了各种疾病的值得注意的靶标,在癌症中作为一种众所周知的致癌磷酸酶。由于细胞渗透性低和生物利用度差,靶向蛋白酪氨酸磷酸催化位点的传统抑制剂通常具有不令人满意的应用功效。最近,已经鉴定出特别大量的对SHP2具有惊人抑制效力的变构抑制剂。特别是,很少有临床试验通过使用SHP2变构抑制剂治疗实体瘤取得重大进展.本文综述了用于肿瘤治疗的小分子SHP2抑制剂的发展和构效关系研究。为了帮助未来开发具有改进选择性的SHP2抑制剂,更高的口服生物利用度和更好的理化性质。
    Src homology containing protein tyrosine phosphatase 2 (SHP2) represents a noteworthy target for various diseases, serving as a well-known oncogenic phosphatase in cancers. As a result of the low cell permeability and poor bioavailability, the traditional inhibitors targeting the protein tyrosine phosphate catalytic sites are generally suffered from unsatisfactory applied efficacy. Recently, a particularly large number of allosteric inhibitors with striking inhibitory potency on SHP2 have been identified. In particular, few clinical trials conducted have made significant progress on solid tumors by using SHP2 allosteric inhibitors. This review summarizes the development and structure-activity relationship studies of the small-molecule SHP2 inhibitors for tumor therapies, with the purpose of assisting the future development of SHP2 inhibitors with improved selectivity, higher oral bioavailability and better physicochemical properties.
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  • 文章类型: Journal Article
    UNASSIGNED: Margin-negative (R0) resection is the only potentially curative treatment for patients with pancreatic ductal adenocarcinoma (PDAC). Pre-operative multi-agent chemotherapy alone (MAC) or MAC followed by pre-operative radiotherapy (MAC + RT) may be used to improve resectability and potentially survival. However, the optimal pre-operative regimen is unknown.
    UNASSIGNED: Patients with non-metastatic PDAC from 2006 to 2016 who received pre-operative MAC or MAC + RT before oncologic resection were identified in the National Cancer Database. Univariable and multivariable (MVA) associates with R0 resection were identified with logistic regression, and survival was analyzed secondarily with the Kaplan Meier method and Cox regression analysis.
    UNASSIGNED: 4,599 patients were identified (MAC: 3,109, MAC + RT: 1,490). Compared to those receiving MAC, patients receiving MAC + RT were more likely to have cT3-4 disease (76% vs 64%, p < 0.001) and cN + disease (33% vs 29%, p = 0.010), but were less likely to have ypT3-4 disease (59% vs 74%, p < 0.001) and ypN + disease (32% vs 55%, p < 0.001) and more likely to have a pathologic complete response (5% vs 2%, p < 0.001) and R0 resection (86% vs 80%, p < 0.001). On MVA, MAC + RT (OR 1.58, 95% CI 1.33-1.89, p < 0.001), evaluation at an academic center (OR 1.33, 95% CI 1.14-1.56, p < 0.001), and female sex (OR 1.43, 95% CI 1.23-1.67, p < 0.001) were associated with higher odds of R0 resection, while cT3-4 disease (OR 0.81, 95% CI 0.68-0.96, p = 0.013) was associated with lower odds of R0 resection.
    UNASSIGNED: For patients with localized PDAC who receive pre-operative MAC, the addition of pre-operative RT was associated with improved rates of R0 resection and pathologic response.
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