Beliakoff Jason, Whitesell Luke
Department of Urology, Stanford University School of Medicine, CA, USA.
Anticancer Drugs. 2004 Aug;15(7):651-62. doi: 10.1097/01.cad.0000136876.11928.be.
Rapidly evolving insights into the specific molecular genetic abnormalities that drive the growth and metastasis of breast cancer have led to the development of targeted therapeutics that do not rely on the generalized disruption of DNA metabolism and cell division for activity. Of particular interest are inhibitors of cellular signal transduction pathways involving tyrosine kinases as well as selective modulators of steroid hormone signaling, histone acetylation, angiogenesis and tumor cell apoptosis. Unique within this array of promising new agents, however, are compounds that target heat shock protein 90 (Hsp90). This molecular chaperone associates with a distinct, but surprisingly diverse, set of proteins that are referred to as Hsp90 client proteins. Hsp90 binds to these clients, and plays a key role in regulating their stability and function. Many of the proteins chaperoned by Hsp90 are involved in breast cancer progression and resistance to therapy, including the estrogen receptor, receptor tyrosine kinases of the erbB family, Akt, and mutant p53. Several small molecule inhibitors of Hsp90 have been identified that can deplete cellular levels of multiple oncogenic client proteins simultaneously by enhancing their ubiquitination and proteasome-mediated degradation. The activity of Hsp90 inhibitors has been well validated in preclinical breast cancer models, both in single-agent studies and in combination with conventional chemotherapy. One of these inhibitors, 17-allylamino, 17-demethoxygeldanamycin (17-AAG, NSC 330507) has recently completed phase I testing. The agent was well tolerated at drug exposures that were shown to cause modulation of Hsp90 client protein levels. Given the redundancy and complexity of the molecular abnormalities present in most breast cancers, the ability of Hsp90 inhibitors to alter the activity of multiple oncogenic targets may prove of unique therapeutic benefit.
对驱动乳腺癌生长和转移的特定分子遗传异常的深入了解迅速发展,催生了不依赖于DNA代谢和细胞分裂的普遍破坏来发挥作用的靶向疗法。特别令人感兴趣的是涉及酪氨酸激酶的细胞信号转导途径抑制剂以及类固醇激素信号传导、组蛋白乙酰化、血管生成和肿瘤细胞凋亡的选择性调节剂。然而,在这一系列有前景的新药物中,独特的是靶向热休克蛋白90(Hsp90)的化合物。这种分子伴侣与一组独特但令人惊讶地多样化的蛋白质相关联,这些蛋白质被称为Hsp90客户蛋白。Hsp90与这些客户蛋白结合,并在调节它们的稳定性和功能方面发挥关键作用。由Hsp90伴侣的许多蛋白质都参与乳腺癌的进展和对治疗的抗性,包括雌激素受体、erbB家族的受体酪氨酸激酶、Akt和突变型p53。已经鉴定出几种Hsp90的小分子抑制剂,它们可以通过增强其泛素化和蛋白酶体介导的降解同时消耗多种致癌客户蛋白的细胞水平。Hsp90抑制剂的活性在临床前乳腺癌模型中已得到充分验证,无论是在单药研究还是与传统化疗联合使用中。其中一种抑制剂,17-烯丙基氨基,17-去甲氧基格尔德霉素(17-AAG,NSC 330507)最近完成了I期试验。在显示可导致Hsp90客户蛋白水平调节的药物暴露下,该药物耐受性良好。鉴于大多数乳腺癌中存在的分子异常的冗余性和复杂性,Hsp90抑制剂改变多个致癌靶点活性的能力可能证明具有独特的治疗益处。