Saleh F, Renno W, Klepacek I, Ibrahim G, Dashti H, Asfar S, Behbehani A, Al-Sayer H, Dashti A
Faculty of Medicine, Health Sciences Centre, Department of Anatomy, Kuwait University, and Department of Surgery, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait.
Curr Pharm Des. 2005;11(27):3531-43. doi: 10.2174/138161205774414556.
To develop an effective pharmaceutical treatment for a disease, we need to fully understand the biological behavior of that disease, especially when dealing with cancer. The current available treatment for cancer may help in lessening the burden of the disease or, on certain occasions, in increasing the survival of the patient. However, a total eradication of cancer remains the researchers' hope. Some of the discoveries in the field of medicine relied on observations of natural events. Among these events is the spontaneous regression of cancer. It has been argued that such regression could be immunologically-mediated, but no direct evidence has been shown to support such an argument. We, hereby, provide compelling evidence that spontaneous cancer regression in humans is immunologically-mediated, hoping that the results from this study would stimulate the pharmaceutical industry to focus more on cancer vaccine immunotherapy. Our results showed that patients with >3 primary melanomas (very rare group among cancer patients) develop significant histopathological spontaneous regression of further melanomas that they could acquire during their life (P=0.0080) as compared to patients with single primary melanoma where the phenomenon of spontaneous regression is absent or minimal. It seems that such regression resulted from the repeated exposure to the tumor which mimics a self-immunization process. Analysis of the regressing tumors revealed heavy infiltration by T lymphocytes as compared to non-regressing tumors (P<0.0001), the predominant of which were T cytotoxic rather than T helper. Mature dendritic cells were also found in significant number (P<0.0001) in the regressing tumors as compared to the non regressing ones, which demonstrate an active involvement of the different arms of the immune system in the multiple primary melanoma patients in the process of tumor regression. Also, MHC expression was significantly higher in the regressing versus the non-regressing tumors (P <0.0001), which reflects a proper tumor antigen expression. Associated with tumor regression was also loss of the melanoma common tumor antigen Melan A/ MART-1 in the multiple primary melanoma patients as compared to the single primary ones (P=0.0041). Furthermore, loss of Melan A/ MART-1 in the regressing tumors significantly correlated with the presence of Melan A/ MART-1-specific CTLs in the peripheral blood of these patients (P=0.03), which adds to the evidence that the phenomenon of regression seen in these patients was immunologically-mediated and tumor-specific. Such correlation was also seen in another rare group of melanoma patients, namely those with occult primary melanoma. The lesson that we could learn from nature in this study is that inducing cancer regression using the different arms of the immune system is possible. Also, developing a novel cancer vaccine is not out of reach.
为开发针对某种疾病的有效药物治疗方法,我们需要充分了解该疾病的生物学行为,尤其是在治疗癌症时。目前可用的癌症治疗方法可能有助于减轻疾病负担,或在某些情况下提高患者的生存率。然而,彻底根除癌症仍是研究人员的期望。医学领域的一些发现依赖于对自然事件的观察。这些事件中包括癌症的自发消退。有人认为这种消退可能是由免疫介导的,但尚未有直接证据支持这一观点。在此,我们提供了令人信服的证据,证明人类癌症的自发消退是由免疫介导的,希望本研究结果能促使制药行业更加关注癌症疫苗免疫疗法。我们的研究结果表明,与单发原发性黑色素瘤患者(自发消退现象不存在或很轻微)相比,患有>3处原发性黑色素瘤的患者(在癌症患者中属于非常罕见的群体)在其生命过程中可能获得的进一步黑色素瘤会出现显著的组织病理学自发消退(P = 0.0080)。似乎这种消退是由于反复接触肿瘤,这类似于自身免疫过程。对消退肿瘤的分析显示,与未消退肿瘤相比,T淋巴细胞大量浸润(P <0.0001),其中主要是细胞毒性T细胞而非辅助性T细胞。与未消退肿瘤相比,在消退肿瘤中还发现大量成熟的树突状细胞(P <0.0001),这表明免疫系统的不同分支积极参与了多原发性黑色素瘤患者的肿瘤消退过程。此外,消退肿瘤中的MHC表达显著高于未消退肿瘤(P <0.0001),这反映了肿瘤抗原的适当表达。与肿瘤消退相关的是,与单发原发性黑色素瘤患者相比,多原发性黑色素瘤患者中黑色素瘤常见肿瘤抗原Melan A/MART-1也有所缺失(P = 0.0041)。此外,消退肿瘤中Melan A/MART-1的缺失与这些患者外周血中Melan A/MART-1特异性CTL的存在显著相关(P = 0.03),这进一步证明这些患者中观察到的消退现象是由免疫介导的且具有肿瘤特异性。在另一组罕见的黑色素瘤患者,即隐匿性原发性黑色素瘤患者中也观察到了这种相关性。我们从本研究中可以从自然中学到的经验是,利用免疫系统的不同分支诱导癌症消退是可能的。而且,开发一种新型癌症疫苗并非遥不可及。
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