急性早幼粒细胞白血病的新型治疗方法:三氧化二砷、维甲酸及类视黄醇药理学

Novel treatment of acute promyelocytic leukemia: As₂O₃, retinoic acid and retinoid pharmacology.

作者信息

Zhu George

出版信息

Curr Pharm Biotechnol. 2013;14(9):849-58. doi: 10.2174/1389201015666140113095812.

Abstract

Acute promyelocytic leukemia(APL), a specific characteristic of t(15;17) chromosome translocation, represents 5% to 15% of cases of acute nonlymphocytic leukemia. An alternative approach is to consider retinoic acid(all-trans RA, ATRA or 13-cis RA or 9-cis RA) plus chemotherapy or RA plus As₂O₃ regimens as now novel therapy. Molecular gene analyses are conclusive in vivo evidence that oncogenic PML/RARa plays a crucial role in APL leukemogenesis. As a novel approach to APL treatment, one possible the action of RA, A consense sequence (5'-TCAGGTCATGACCTGA-3') has been postulated for the thyroid hormone (TRE) and retinoic acid responsive element (RARE) containing half palindromes, which located in the promoter region of target genes. High dose (100-fold) of RA-RARE-PML/RARa complex in intracellular localization appears to relieve repressor from DNA binding, including corepressors N-CoR, SMRT and HDACs, release PML/RARa- mediated transcriptional repression, and release histone deacetylase activity from PMLRARa. The resulting PML/RARa oncoprotein proteolytic degradation through the autophagy-lysosome pathway and the ubiquitin SUMO-proteasome system (UPS), as well as caspase 3 (cleavage site Asp522 within a-helics region of PML component of the fusion protein) or neutrophil elastase, or lysosomal protease enzyme induction. PML protein relocalizes into the wild-type nuclear body (PML-NB) configuration or/and wild-type RARa upregulated. An effect to relieve the blockade (inhibition) of PML/RARA-mediated RA dependent promyelocytic differentiation, and retinoic acid in APL therapy (see Figure in the full text, George Zhu, 1991). Here, like v-erbA, PML/RARa is a (strong) transcriptional repressor of the RA receptor (RAR) complex, and PML/RARa fusion receptor gene act as conditional oncogenic receptor (translocated chimeric retinoic acid a signaling) or oncogenic PML/RARa may participate in leukemogenesis of APL through blocking RA-mediated promyelocytic differentiation. This is first described in eukaryotes.

摘要

急性早幼粒细胞白血病(APL)是t(15;17)染色体易位的一个特定特征,占急性非淋巴细胞白血病病例的5%至15%。另一种方法是将维甲酸(全反式维甲酸、ATRA或13 - 顺式维甲酸或9 - 顺式维甲酸)加化疗或维甲酸加三氧化二砷方案视为新型疗法。分子基因分析是致癌性PML/RARα在APL白血病发生中起关键作用的决定性体内证据。作为APL治疗的一种新方法,维甲酸的一种可能作用是,已假定甲状腺激素(TRE)和维甲酸反应元件(RARE)的共有序列(5'-TCAGGTCATGACCTGA-3')包含位于靶基因启动子区域的半回文结构。细胞内定位的高剂量(100倍)维甲酸 - RARE - PML/RARα复合物似乎能使阻遏物从DNA结合中释放出来,包括共阻遏物N - CoR、SMRT和组蛋白去乙酰化酶,解除PML/RARα介导的转录抑制,并从PMLRARα释放组蛋白去乙酰化酶活性。由此产生的PML/RARα癌蛋白通过自噬 - 溶酶体途径和泛素SUMO - 蛋白酶体系统(UPS)进行蛋白水解降解,以及通过半胱天冬酶3(融合蛋白PML组分α螺旋区域内的切割位点Asp522)或中性粒细胞弹性蛋白酶或溶酶体蛋白酶诱导。PML蛋白重新定位到野生型核体(PML - NB)构型或/和野生型RARα上调。这一效应解除了PML/RARA介导的维甲酸依赖性早幼粒细胞分化的阻断(抑制),以及维甲酸在APL治疗中的作用(见全文中的图,George Zhu,1991)。在此,与v - erbA一样,PML/RARα是维甲酸受体(RAR)复合物的(强)转录阻遏物,PML/RARα融合受体基因作为条件致癌受体(易位嵌合维甲酸α信号传导),或者致癌性PML/RARα可能通过阻断维甲酸介导的早幼粒细胞分化参与APL的白血病发生。这是在真核生物中首次描述的。

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