癌症发生和肿瘤进展过程中对缺氧和酸中毒的适应
Adaptation to hypoxia and acidosis in carcinogenesis and tumor progression.
作者信息
Fang Jennifer S, Gillies Robert D, Gatenby Robert A
机构信息
Department of Physiology, University of Arizona, Tucson, AZ, USA.
出版信息
Semin Cancer Biol. 2008 Oct;18(5):330-7. doi: 10.1016/j.semcancer.2008.03.011. Epub 2008 Mar 26.
Carcinogenesis is a complex, multistep, multipath process often described as "somatic evolution". Conventional models of cancer progression are typically based on the genetic and epigenetic changes observed in malignant and premalignant tumors. We have explored an alternative approach that emphasizes the selection forces within adaptive landscapes governing growth and evolution in in situ, microinvasive, and metastatic cancers. In each environment, specific barriers to proliferation act as strong selection forces that determine the optimal phenotypic properties that permit tumor growth and invasion. Thus, the phenotypic properties or "hallmarks" of cancer can be viewed as successful adaptations to these microenvironmental selection forces. In turn, these selection pressures are not static but will dynamically change as a result of tumor population growth and evolution. Here, we emphasize the role of hypoxia and acidosis in the progression of tumor from in situ to invasive cancer. This is a consequence of early tumor cell proliferation on epithelial surfaces, which are separated from the underlying blood supply by the intact basement membrane. As tumor cells proliferate further away from the basement membrane, the diffusion-reaction kinetics of substrate and metabolite flow to and from the blood vessels result in regional hypoxia and acidosis. Cellular adaptation to the former include upregulation of glycolysis and to the latter include upregulation of Na+/H+ exchangers (NHE1) and other acid-regulating proteins such as carbonic anhydrase. We propose this phenotype is critical for subsequent malignant growth of primary and metastatic cancers.
致癌作用是一个复杂的、多步骤、多途径的过程,通常被描述为“体细胞进化”。传统的癌症进展模型通常基于在恶性和癌前肿瘤中观察到的基因和表观遗传变化。我们探索了一种替代方法,该方法强调适应性景观中的选择力,这些选择力控制原位癌、微浸润癌和转移性癌的生长和进化。在每种环境中,特定的增殖障碍作为强大的选择力,决定了允许肿瘤生长和侵袭的最佳表型特性。因此,癌症的表型特性或“特征”可被视为对这些微环境选择力的成功适应。反过来,这些选择压力并非一成不变,而是会随着肿瘤群体的生长和进化而动态变化。在这里,我们强调缺氧和酸中毒在肿瘤从原位癌发展为浸润性癌过程中的作用。这是早期肿瘤细胞在上皮表面增殖的结果,上皮表面通过完整的基底膜与下方的血液供应隔开。随着肿瘤细胞进一步远离基底膜增殖,底物和代谢物进出血管的扩散反应动力学导致局部缺氧和酸中毒。细胞对前者的适应包括糖酵解上调,对后者的适应包括钠氢交换体(NHE1)和其他酸调节蛋白(如碳酸酐酶)上调。我们认为这种表型对于原发性和转移性癌症随后的恶性生长至关重要。