Taxanes

紫杉烷
  • 文章类型: Journal Article
    背景:SLC2A1增强紫杉烷类对非小细胞肺癌(NSCLC)的化学抗性的机制仍然是一个谜。
    方法:对不同数据集的SLC2A1表达模式和预后进行调查,以及我们内部收集的样本,进行了。此外,通过体外实验进一步研究了SLC2A1的生物学功能。该研究还使用CCK-8,膜联蛋白-V检查了NSCLC对紫杉烷的化学抗性,和caspase-3测定。此外,紫杉烷类对SLC2A1表达的影响通过蛋白质印迹分析确定.通过流式细胞术和代谢组学技术检查SLC2A1对CSC形成的影响。最后,使用单细胞测序和细胞聊天分析了SLC2A1对肿瘤微环境的影响.
    结果:在本调查中,观察到SLC2A1在NSCLC肿瘤组织中的表达升高,表现出与预后较差的显着关联。SLC2A1过表达促进NSCLC细胞增殖,入侵,迁移,化学抗性,CD90+和EpCAM+CSCs的形成。基于SLC2A1和EpCAM表达对NSCLC细胞进行分类。SLC2A1highEpCAM+CSC对紫杉烷类具有更高的化学抗性。SLC2A1和EpCAM高表达的NSCLC患者预后较差。机械上,SLC2A1通过激活糖酵解促进CD90+和EpCAM+CSC的形成。最后,SLC2A1低肿瘤细胞通过HLA-A促进CD8+T细胞功能,B,C,通过HLA-E抑制NK细胞功能
    结论:一起,SLC2A1在增强紫杉烷类对NSCLC的化学抗性中起重要作用。
    BACKGROUND: The mechanisms by which SLC2A1 enhances chemo-resistance of taxanes to non-small cell lung cancer (NSCLC) remains enigmatic.
    METHODS: An investigation into the SLC2A1 expression pattern and prognosis across diverse datasets, as well as our internally collected samples, was undertaken. Additionally, the biological function of SLC2A1 was further delved into through in vitro experiments. The study also examined the chemo-resistance of NSCLC to taxanes using CCK-8, Annexin-V, and caspase-3 assays. Furthermore, the impact of taxanes on SLC2A1 expression was determined via western blot analysis. The effects of SLC2A1 on the formation of CSCs was examined via flow cytometry and metabolomics techniques. Finally, the impact of SLC2A1 on the tumor microenvironment was analyzed using single-cell sequencing and cellchat.
    RESULTS: In the present investigation, it was observed that there was an elevated expression of SLC2A1 in NSCLC tumor tissues, which exhibited a significant association with a poorer prognosis. SLC2A1 overexpression in vitro promoted NSCLC cell proliferation, invasion, migration, chemo-resistance, and the formation of CD90+ and EpCAM+ CSCs. NSCLC cells were categorized based on SLC2A1 and EpCAM expression. SLC2A1highEpCAM+ CSCs were more chemo-resistance to taxanes. NSCLC patients with high SLC2A1 and EpCAM expression had poorer prognosis. Mechanically, SLC2A1 promoted the formation of CD90+ and EpCAM+ CSCs via activating glycolysis. Finally, SLC2A1low tumor cells promoted CD8+T cell function via HLA-A, B, C, and suppressed NK cell function via HLA-E.
    CONCLUSIONS: Together, SLC2A1 plays an important role in enhancing chemo-resistance of taxanes to NSCLC.
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  • 文章类型: Journal Article
    这里,我们揭示了卡巴他赛(CBZ)诱导的PC-3去势耐药转移性前列腺癌细胞(mCRPC)凋亡的可逆性。通过膜联蛋白V评估在不同恢复期去除CBZ后PC-3细胞从凋亡中的恢复,DNA损伤,氧化损伤,线粒体膜去极化,和半胱天冬酶激活。我们的结果表明,CBZ的给药导致PC-3细胞凋亡72h。然而,恢复的细胞表现出减少的核损伤,质膜破裂,ROS水平,在PC-3细胞中去除特别是1nMCBZ持续24小时恢复期后,释放细胞色素c水平和caspase-3激活,上调Bcl-2表达。我们的研究表明,CBZ处理的PC-3细胞可以在凋亡细胞死亡后恢复。然而,高级分子分析应阐明PC-3mCRPC细胞中恢复的分子机制与紫杉烷反应或抗性之间的关系。
    Here, we revealed the reversibility of cabazitaxel (CBZ)-induced apoptosis in PC-3 castration resistant metastatic prostate cancer cells (mCRPC) through the hallmarks of apoptosis. The recovery of PC-3 cells from apoptosis upon removal of CBZ at different recovery periods was evaluated by Annexin V, DNA damage, oxidative damage, mitochondrial membrane depolarization, and caspase activation. Our results showed that the administration of CBZ caused apoptosis for 72 h in PC-3 cells. However, recovered cells exhibited decreased nuclear damage, plasma membrane disruption, ROS level, release cytochrome c level and caspase-3 activation with upregulation of Bcl-2 expression upon removal of especially 1 nM CBZ for 24 h recovery period in PC-3 cells. Our study indicates that CBZ treated PC-3 cells can recover after apoptotic cell death. However, advanced molecular analysis should elucidate the relationship between the molecular mechanisms of recovery and taxane response or resistance in PC-3 mCRPC cells.
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  • 文章类型: Case Reports
    紫杉烷相关性黄斑囊样水肿(CME)是紫杉烷类药物的罕见并发症,化疗药物.我们报告了一名47岁的汉族男子,他将我们的眼科中心转诊为视力下降,双眼视觉畸变持续两周。两周前,他接受了六个月化疗的最后一个周期,包括用于下咽恶性肿瘤的紫杉醇。最佳矫正视力(BCVA)为0.4OD和0.1OS。黄斑光学相干断层扫描显示显著的双侧CME,荧光素血管造影术(FA)显示荧光素在晚期聚集而无泄漏。玻璃体内注射700μg地塞米松(DEX)植入物施用于左眼,13天后施用于右眼。两个月后,黄斑形态恢复正常。第一次访问一年后,在OCT上,BCVA为1.0OD和0.8OS,标准黄斑。总之,玻璃体内DEX植入可能是紫杉烷相关CME的有效辅助治疗.
    Taxane-related cystoid macular edema (CME) is a rare complication of the taxoid medication, a chemotherapeutic drug. We report a 47-year-old Han Chinese man referred to our Eye Center for decreased vision with visual distortion in both eyes for two weeks. Two weeks prior, he received the last cycle of his six-monthly chemotherapy, including paclitaxel for hypopharyngeal malignancy. The best-corrected visual acuity (BCVA) was 0.4 OD and 0.1 OS. Macular optical coherence tomography showed significant bilateral CME, and fluorescein angiography (FA) revealed the fluorescein pooling at the late phase without leakage. Intravitreal 700 μg dexamethasone (DEX) implant was applied to the left eye and 13 days after to the right eye. Two months later, the macular morphology recovered to normal. One year after the first visit, the BCVA was 1.0 OD and 0.8 OS with standard macula on OCT. In conclusion, the intravitreal DEX implant might be an effective adjuvant treatment for taxane-related CME.
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  • 文章类型: Journal Article
    目的:该研究调查了冷冻疗法在减轻化疗引起的周围神经病变(CIPN)中的疗效,化疗的不良反应,通常导致剂量减少或治疗中断。
    方法:本研究注册于PROSPERO(CRD42023428936)。使用PubMed进行了文献检索,Embase,和Cochrane图书馆数据库。纳入研究冷冻疗法对CIPN影响的随机和非随机对照试验进行系统评价和荟萃分析。预防的主要结果是CIPN的发生率。
    结果:我们确定了17项试验,涉及2,851例患者。总的来说,11项试验比较了冷冻治疗组和对照组的CIPN发生率。观察到化疗中点和结束时CIPN的发生率存在显着差异,风险比(RR)为0.23(95%置信区间[CI]=0.13至0.43)和0.54(95%CI=0.33至0.88),分别。冷冻疗法也显著降低了感觉CIPN的发生率,RR为0.67(95%CI=0.49至0.92)。此外,冷冻治疗显示妇科癌症患者CIPN的发生率显著降低(RR=0.24,95%CI=0.14~0.41).化疗后的整体生活质量评分明显良好(标准化平均差=1.43;95%CI=0.50至2.36),冷冻治疗可缓解神经性症状。
    结论:冷冻疗法对CIPN的发展具有明显的预防作用,为接受化疗的患者提供实质性的症状缓解和生活质量改善。通过使用冷冻手套和袜子进行冷冻治疗,或连续流冷却系统,最佳在化疗前15分钟开始,并在化疗后15分钟结束,被推荐用于实现最大的治疗效果。
    OBJECTIVE: The study investigates cryotherapy\'s efficacy in mitigating Chemotherapy-induced peripheral neuropathy (CIPN), an adverse effect of chemotherapy that often leads to dosage reduction or treatment discontinuation.
    METHODS: The study was registered with PROSPERO (CRD42023428936). A literature search was conducted using the PubMed, Embase, and Cochrane Library databases. Randomized and nonrandomized controlled trials that investigated the effects of cryotherapy on CIPN were included for systematic review and meta-analysis. The primary outcome for prevention was the incidence of CIPN.
    RESULTS: We identified 17 trials involving 2,851 patients. In total, 11 trials compared the incidence of CIPN between cryotherapy and control groups. Significant differences in the incidence of CIPN at the midpoint and end of chemotherapy were observed, with risk ratios (RRs) of 0.23 (95% confidence interval [CI] = 0.13 to 0.43) and 0.54 (95% CI = 0.33 to 0.88), respectively. Cryotherapy also significantly reduced the incidence of sensory CIPN, with an RR of 0.67 (95% CI = 0.49 to 0.92). Additionally, cryotherapy demonstrated a significant reduction in the incidence of CIPN in patients with gynecological cancers (RR = 0.24, 95% CI = 0.14 to 0.41). Significantly favorable global quality of life scores following chemotherapy (standardized mean difference = 1.43; 95% CI = 0.50 to 2.36) and relieved neuropathic symptoms were found with cryotherapy.
    CONCLUSIONS: Cryotherapy demonstrates a pronounced preventive effect against the development of CIPN, providing substantial symptomatic relief and quality of life improvements for patients undergoing chemotherapy. The administration of cryotherapy through the use of frozen gloves and socks, or continuous-flow cooling systems, optimally initiated 15 min prior to and concluded 15 min following chemotherapy, is recommended for achieving maximum therapeutic efficacy.
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  • 文章类型: Journal Article
    近年来,非小细胞肺癌(NSCLC)的治疗前景取得了重大进展,标志着向靶向药物和免疫检查点抑制剂(ICIs)的转变。然而,化疗仍然是治疗的基石,单独或组合。微管靶向剂,如紫杉烷和长春花生物碱,在早期和晚期NSCLC的临床实践中起着至关重要的作用。
    这篇综述概述了行动机制,现在的意义,以及微管靶向剂(MTA)的前瞻性进展,在第三阶段试验的新组合上有一个特别的亮点。在线数据库PubMed,WebofScience,科克伦图书馆,和ClinicalTrials.gov使用术语“微管靶向剂”和“非小细胞肺癌”或同义词进行搜索,特别关注过去5年的出版物。
    尽管出现了免疫疗法,MTA仍然至关重要,通常与免疫疗法同时或之后使用,尤其是鳞状细胞肺癌。下一代测序扩展了治疗选择,但是缺乏可靠的免疫疗法生物标志物。虽然抗体-药物缀合物(ADC)显示出希望,管理毒性仍然至关重要。在早期阶段,MTA,可能是ICIs,是标准的,而ADC可能在晚期取代传统化疗。然而,MTA在后续生产线或有禁忌症的患者中仍然是必不可少的。
    UNASSIGNED: The treatment landscape of non-small cell lung cancer (NSCLC) has seen significant advancements in recent years, marked by a shift toward target agents and immune checkpoint inhibitors (ICIs). However, chemotherapy remains a cornerstone of treatment, alone or in combination. Microtubule-targeting agents, such as taxanes and vinca alkaloids, play a crucial role in clinical practice in both early and advanced settings in NSCLC.
    UNASSIGNED: This review outlines the mechanisms of action, present significance, and prospective advancements of microtubule-targeting agents (MTAs), with a special highlight on new combinations in phase 3 trials. The online databases PubMed, Web of Science, Cochrane Library, and ClinicalTrials.gov were searched using the terms \'Microtubule-targeting agents\' and \'non-small cell lung cancer\' or synonyms, with a special focus over the last 5 years of publications.
    UNASSIGNED: Despite the emergence of immunotherapy, MTA remains crucial, often used alongside or after immunotherapy, especially in squamous cell lung cancer. Next-generation sequencing expands treatment options, but reliable biomarkers for immunotherapy are lacking. While antibody-drug conjugates (ADCs) show promise, managing toxicities remain vital. In the early stages, MTAs, possibly with ICIs, are standard, while ADCs may replace traditional chemotherapy in the advanced stages. Nevertheless, MTAs remain essential in subsequent lines or for patients with contraindications.
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  • 文章类型: Journal Article
    紫杉烷类是一类具有重要生物活性的二萜,例如紫杉醇(taxol®)是一种优良的天然广谱抗癌药物。生物合成紫杉烷的尝试取得了有限的成功,主要是由于效率低的催化元件的瓶颈。在这项研究中,我们开发了一种人工合成系统,通过生物和化学耦合方法从甲羟戊酸(MVA)生产紫杉烷,它包括体外多酶催化模块,化学催化模块和酵母细胞催化模块。通过优化体外多酶催化体系,在8h内,紫杉二烯的产量从MVA增加到946.7mg/L,生产率比微生物发酵高14.2倍。通过引入钯催化,Taxa-4(20)的转化率,11(12)-二烯-5α-乙酸酯(T5α-AC)达到48%,有效解决了T5αOH产品混杂和产率低的问题。最后,我们优化了T10βOH在酵母中的表达,导致Taxa-4的生物合成(20),11(12)-二烯-5α-乙酰氧基-10β-醇(T5α-AC-10β-醇),产量为15.8mg/L,比共培养发酵策略产生的高2000倍以上。这些技术为紫杉烷的有效合成提供了一种有前途的新方法。
    Taxanes are kinds of diterpenoids with important bioactivities, such as paclitaxel (taxol®) is an excellent natural broad-spectrum anticancer drug. Attempts to biosynthesize taxanes have made with limited success, mainly due to the bottleneck of the low efficiency catalytic elements. In this study, we developed an artificial synthetic system to produce taxanes from mevalonate (MVA) by coupling biological and chemical methods, which comprises in vitro multi-enzyme catalytic module, chemical catalytic module and yeast cell catalytic module. Through optimizing in vitro multienzyme catalytic system, the yield of taxadiene was increased to 946.7 mg/L from MVA within 8 h and the productivity was 14.2-fold higher than microbial fermentation. By incorporating palladium catalysis, the conversion rate of Taxa-4(20),11(12)-dien-5α-yl acetate (T5α-AC) reached 48 %, effectively addressing the product promiscuity and the low yield rate of T5αOH. Finally, we optimized the expression of T10βOH in yeast resulting in the biosynthesis of Taxa-4(20),11(12)-dien-5α-acetoxy-10β-ol(T5α-AC-10β-ol) at a production of 15.8 mg/L, which displayed more than 2000-fold higher than that produced by co-culture fermentation strategy. These technologies offered a promising new approach for efficient synthesis of taxanes.
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  • 文章类型: Journal Article
    Alternariaalternata真菌是一种从Corylusavellana中分离出的有效的紫杉醇生产者。主要挑战是缺乏用于内生真菌生产力的优化培养基。为了使A.alternata最大限度地生产紫杉烷,几种发酵条件,包括pH(pH4.0-7.0),不同类型和浓度的碳(果糖,葡萄糖,蔗糖,甘露醇,山梨醇,和麦芽提取物),和氮(尿素,硝酸铵,硝酸钾,磷酸铵,和硫酸铵)逐步应用。根据结果,A.alternata在含有蔗糖5%(w/v)和2.5mM磷酸铵在pH6.0的培养基中显示出快速和可持续的生长速率,紫杉醇产量最高(94.8µggFW-1与对照中的2.8µggFW-1),和氨基酸的最大含量。此外,果胶对真菌的影响进行了评估,和收获的菌丝体。在第21天,果胶显着提高了生长和紫杉烷产量(分别为第7天相应的171%和116%)。结果也通过数学建模进行检验。因此,这些发现表明低成本,环保,和易于生产的方法,具有优异的生物技术潜力,用于工业制造紫杉烷。
    Alternaria alternata fungus is a potent paclitaxel producer isolated from Corylus avellana. The major challenge is the lack of optimized media for endophytic fungi productivity. In the effort to maximize the production of taxoids by A. alternata, several fermentation conditions, including pH (pH 4.0-7.0), different types and concentrations of carbon (fructose, glucose, sucrose, mannitol, sorbitol, and malt extract), and nitrogen (urea, ammonium nitrate, potassium nitrate, ammonium phosphate, and ammonium sulfate) were applied step by step. Based on the results, A. alternata in a medium containing sucrose 5% (w/v) and ammonium phosphate 2.5 mM at pH 6.0 showed a rapid and sustainable growth rate, the highest paclitaxel yield (94.8 µg gFW-1 vs 2.8 µg gFW-1 in controls), and the maximum content of amino acids. Additionally, the effect of pectin was evaluated on fungus, and mycelia harvested. Pectin significantly enhanced the growth and taxoid yield on day 21 (respectively 171% and 116% of their corresponding on day 7). The results were checked out by mathematical modeling as well. Accordingly, these findings suggest a low-cost, eco-friendly, and easy-to-produce approach with excellent biotechnological potential for the industrial manufacture of taxoids.
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  • 文章类型: Journal Article
    Taxanes,如紫杉醇和多西他赛,改变了乳腺癌治疗的前景,在早期和晚期/转移性疾病的化疗方案中发挥关键作用。虽然这些药物在提高患者预后方面表现出显著疗效,它们还与一系列可能影响治疗耐受性和生活质量的不良反应有关.这篇全面的综述为紫杉烷治疗乳腺癌提供了深入的探索,重点关注临床观点和毒性特征。我们描述了紫杉烷的作用机制,它们在各种乳腺癌亚型中的临床有效性,以及临床实践中常见的不良反应。此外,我们根据个体患者特征和治疗目标,研究减轻紫杉烷相关毒性并优化治疗选择和排序的策略.最后,我们强调未来研究和发展的领域,包括开发新的配方,识别治疗反应的预测性生物标志物,以及探索联合疗法以增强治疗效果。通过合并现有证据和临床见解,这篇综述旨在让临床医师和研究者了解紫杉烷治疗乳腺癌的现状,并指导进一步加强患者护理和预后的努力.
    Taxanes, such as paclitaxel and docetaxel, have transformed the landscape of breast cancer treatment, playing pivotal roles in chemotherapy protocols for both early-stage and advanced/metastatic diseases. While these agents have demonstrated remarkable efficacy in enhancing patient outcomes, they are also linked to a range of adverse effects that can impact treatment tolerability and quality of life. This comprehensive review offers an in-depth exploration of taxane therapy in breast cancer, with a focus on clinical perspectives and toxicity profiles. We delineate the mechanisms of action of taxanes, their clinical effectiveness across various breast cancer subtypes, and the prevalent adverse effects encountered in clinical practice. Moreover, we deliberate on strategies for mitigating taxane-associated toxicity and optimizing treatment selection and sequencing based on individual patient characteristics and therapeutic objectives. Finally, we underscore areas for future research and advancement, encompassing the development of novel formulations, the identification of predictive biomarkers for treatment response, and the exploration of combination therapies to bolster therapeutic outcomes. By amalgamating existing evidence and clinical insights, this review aims to apprise clinicians and researchers of the current status of taxane treatment in breast cancer and steer endeavors toward further enhancing patient care and outcomes.
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  • 文章类型: Preprint
    前列腺癌(PCa)是美国男性癌症相关死亡的第二大原因。激素治疗后复发的PCa,称为抗去势PCA(CRPC),经常表现为转移瘤(mCRPC),这是死亡的主要原因。用于mCRPC患者的少数可用疗法包括紫杉烷类多西他赛(DTX)和卡巴他赛(CBZ)。然而,耐药性的发展限制了其临床应用。机械上,耐药性是通过多药耐药(MDR)蛋白如MDR1/ABCB1的上调而产生的,这使得ABCB1成为有吸引力的治疗靶点.然而,由于低特异性和毒性问题,ABCB1抑制剂未能在临床上有用。为了研究紫杉烷的抗性,我们产生了CBZ抗性C4-2B细胞(RC4-2B),并在细胞培养和3D前列腺球环境中记录了对CBZ和DTX的抗性.RNAseq鉴定了ABCB1在RC4-2B中的表达增加,免疫印迹和免疫荧光分析证实了这一点。ABCB1特异性抑制剂elacridar逆转RC4-2B细胞中的CBZ和DTX抗性,证实ABCB1介导的抗性机制。在使用FDA批准的细胞毒性药物精选库的基于细胞的筛选中,我们发现DNA损伤化合物喜树碱(CPT)和阿糖胞苷(Ara-C)克服了抗性,如在亲本C4-2B和抗性RC4-2B中相似的细胞毒性所见。Further,这些化合物对具有高ABCB1表达的紫杉烷抗性的多种PC细胞具有细胞毒性,因此,可用于征服PCa中紫杉烷的获得性抗性。最后,用小分子抑制剂(CDK4/6i)抑制CDK4/6激酶可增强亲本和抗性细胞中CPT或Ara-C的细胞毒性作用。总的来说,我们的发现表明,DNA损伤剂CPT和Ara-C单独或与CDK4/6i联合可作为CRPC患者的新治疗方案,包括那些抗紫杉烷的。
    Prostate cancer (PCa) is the second leading cause of cancer-related death in American men. PCa that relapses after hormonal therapies, referred to as castration resistant PCa (CRPC), often presents with metastases (mCRPC) that are the major cause of mortality. The few available therapies for mCRPC patients include taxanes docetaxel (DTX) and cabazitaxel (CBZ). However, development of resistance limits their clinical use. Mechanistically, resistance arises through upregulation of multidrug resistance (MDR) proteins such as MDR1/ABCB1, making ABCB1 an attractive therapeutic target. Yet, ABCB1 inhibitors failed to be clinically useful due to low specificity and toxicity issues. To study taxanes resistance, we produced CBZ resistant C4-2B cells (RC4-2B) and documented resistance to both CBZ and DTX in cell culture and in 3D prostaspheres settings. RNAseq identified increased expression of ABCB1 in RC4-2B, that was confirmed by immunoblotting and immunofluorescent analysis. ABCB1-specific inhibitor elacridar reversed CBZ and DTX resistance in RC4-2B cells, confirming ABCB1-mediated resistance mechanism. In a cell-based screen using a curated library of FDA-approved cytotoxic drugs, we found that DNA damaging compounds Camptothecin (CPT) and Cytarabine (Ara-C) overcame resistance as seen by similar cytotoxicity in parental C4-2B and resistant RC4-2B. Further, these compounds were cytotoxic to multiple PC cells resistant to taxanes with high ABCB1 expression and, therefore, can be used to conquer the acquired resistance to taxanes in PCa. Finally, inhibition of CDK4/6 kinases with small molecule inhibitors (CDK4/6i) potentiated cytotoxic effect of CPT or Ara-C in both parental and resistant cells. Overall, our findings indicate that DNA damaging agents CPT and Ara-C alone or in combination with CDK4/6i can be suggested as a new treatment regimen in CRPC patients, including those that are resistant to taxanes.
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  • 文章类型: Journal Article
    卵巢癌是一种高度致命的妇科癌症。这种疾病通常直到晚期才被发现,导致高发病率和死亡率。不幸的是,由于耐药性的出现,许多患者经历了复发和屈服于疾病,这极大地限制了目前可用的肿瘤治疗的有效性。这里,我们讨论了卡铂耐药的分子机制,紫杉醇,聚二磷酸腺苷核糖聚合酶抑制剂,和贝伐单抗治疗卵巢癌。我们对最广泛研究的抗性机制进行了详细分析,包括药物灭活,药物靶标改变,增强型药物外排泵,增加DNA损伤修复能力,和减少药物吸收/积累。深入了解与耐药性相关的分子机制对于揭示能够预测和监测疾病进展过程中的动力学并发现新的治疗靶标的新生物标志物至关重要。
    Ovarian cancer is a highly lethal form of gynecological cancer. This disease often goes undetected until advanced stages, resulting in high morbidity and mortality rates. Unfortunately, many patients experience relapse and succumb to the disease due to the emergence of drug resistance that significantly limits the effectiveness of currently available oncological treatments. Here, we discuss the molecular mechanisms responsible for resistance to carboplatin, paclitaxel, polyadenosine diphosphate ribose polymerase inhibitors, and bevacizumab in ovarian cancer. We present a detailed analysis of the most extensively investigated resistance mechanisms, including drug inactivation, drug target alterations, enhanced drug efflux pumps, increased DNA damage repair capacity, and reduced drug absorption/accumulation. The in-depth understanding of the molecular mechanisms associated with drug resistance is crucial to unveil new biomarkers capable of predicting and monitoring the kinetics during disease progression and discovering new therapeutic targets.
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