[细胞凋亡、紫外线辐射、癌前病变与皮肤肿瘤]
[Apoptosis, UV-radiation, precancerosis and skin tumors].
作者信息
Tomas Davor
机构信息
Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital, Zagreb, Croatia.
出版信息
Acta Med Croatica. 2009 Oct;63 Suppl 2:53-8.
Apoptosis plays an important role in regulating skin development and homeostasis, as well as carcinogenesis. Apoptosis balances epidermal proliferation to maintain epidermal thickness and may eliminate mutated, premalignant cells. Skin carcinomas are the most common cancers in Western population. The risk is closely related to UV exposure and the relation between exposure to UV radiation and development of skin cancer has been well established. Apoptosis and carcinogenesis in skin can be triggered by UV irradiation, and tumor suppressor gene p53 plays the most important role in these two processes. The p53 gene is involved in the cell cycle arrest and activation of apoptosis. It has been shown that p53 could protect skin cells from DNA-damage due to UVB exposure. UV-induced DNA damage activates the mechanisms for removal of DNA damage, delay in cell cycle progression, DNA repair, or apoptosis by transcriptional activation of p-53 related genes, such as p21 and bax. Several studies have shown that UVB also induces mutations in p53 gene.The induced mutations are unique (C toT and CC to TT transition) for UVB radiation and are not commonly induced by other carcinogens. Mutations in the p53 gene have been detected in 50% of all human cancers and in the majority of skin carcinomas. A high frequency of p53 mutation was reported in pre-malignant actinic keratosis lesions that is considered to be pre-squamous cell carcinoma, and in Bowen's disease that is considered to be in situ squamous cell carcinoma (SCC) of the skin. The majority of these mutations were characteristic UVB mutations and these findings suggested that p53 mutations might be involved in the malignant conversion of precancerous lesions to SCC. Several studies have demonstrated the continued and discontinued regimens of chronic UVB treatment to ultimately result in skin tumor development with 100% incidence, although the kinetics of tumor occurrence is delayed in the latter. Thus, these studies suggest that skin cancer development can be delayed but not stopped with further avoidance of UV exposure. More recent studies have shown that besides UVB, UVA component of solar irradiation could also be an important carcinogen but in the stem cell compartment of the skin. This knowledge will lead to development of new apoptosis-based therapeutics; several have recently been tested in SCC. It can be expected that new apoptosis-based drugs are to be introduced soon to the daily medical practice; however, prevention of excessive UVB exposure remains the main curative factor against skin cancer.
细胞凋亡在调节皮肤发育、稳态以及肿瘤发生过程中发挥着重要作用。细胞凋亡平衡表皮增殖以维持表皮厚度,并可能清除突变的癌前细胞。皮肤癌是西方人群中最常见的癌症。其风险与紫外线暴露密切相关,紫外线辐射与皮肤癌发生之间的关系已得到充分证实。皮肤中的细胞凋亡和肿瘤发生可由紫外线照射引发,而肿瘤抑制基因p53在这两个过程中起着最重要的作用。p53基因参与细胞周期阻滞和细胞凋亡的激活。研究表明,p53可以保护皮肤细胞免受紫外线B(UVB)暴露导致的DNA损伤。紫外线诱导的DNA损伤通过激活p53相关基因(如p21和bax)的转录来激活DNA损伤清除机制、延迟细胞周期进程、进行DNA修复或诱导细胞凋亡。多项研究表明,UVB还可诱导p53基因发生突变。这些诱导突变是UVB辐射特有的(从C到T以及从CC到TT的转变),通常不会由其他致癌物诱导产生。在所有人类癌症的50%以及大多数皮肤癌中都检测到了p53基因的突变。在被认为是鳞状细胞癌前病变的光化性角化病前期病变以及被认为是皮肤原位鳞状细胞癌(SCC)的鲍恩病中,均报告了高频率的p53突变。这些突变中的大多数是典型的UVB突变,这些发现表明p53突变可能参与癌前病变向SCC的恶性转化。多项研究表明,持续和间断的慢性UVB治疗方案最终都会导致皮肤肿瘤发生,发生率达100%,尽管后者肿瘤发生的动力学过程有所延迟。因此,这些研究表明,进一步避免紫外线暴露虽可延迟但无法阻止皮肤癌的发生。最近的研究表明,除了UVB外,太阳辐射中的UVA成分也可能是一种重要的致癌物,但作用于皮肤的干细胞区室。这一认识将推动基于细胞凋亡的新疗法的开发;最近已有几种在SCC中进行了测试。预计不久将有基于细胞凋亡的新药应用于日常医疗实践;然而,预防过度的UVB暴露仍然是预防皮肤癌的主要治疗因素。