Dougall William C, Holen Ingunn, González Suárez Eva
Therapeutic Innovation Unit, Amgen Inc , Seattle, WA, USA.
Academic Unit of Clinical Oncology, Medical School, University of Sheffield , Sheffield, England.
Bonekey Rep. 2014 Apr 9;3:519. doi: 10.1038/bonekey.2014.14. eCollection 2014.
Acting through its cognate receptor, receptor activator of nuclear factor-κB (RANK), RANK ligand (RANKL) is an essential mediator of osteoclast function and survival. Preclinical data have now firmly established that blockade of tumor-induced osteoclastogenesis by RANKL inhibition will not only protect against bone destruction but will also inhibit the progression of established bone metastases and delay the formation of de novo bone metastases in cancer models. In patients with bone metastases, skeletal complications are driven by increased osteoclastic activity and may result in pathological fractures, spinal cord compression and the need for radiotherapy to the bone or orthopedic surgery (collectively known as skeletal-related events (SREs)). Denosumab, a fully human monoclonal antibody against RANKL, has been demonstrated to prevent or delay SREs in patients with solid tumors that have metastasized to bone. In addition to its central role in tumor-induced osteolysis, bone destruction and skeletal tumor progression, there is emerging evidence for direct pro-metastatic effects of RANKL, independent of osteoclasts. For example, RANKL also stimulates metastasis via activity on RANK-expressing cancer cells, resulting in increased invasion and migration. Pharmacological inhibition of RANKL may also reduce bone and lung metastasis through blockade of the direct action of RANKL on metastatic cells. This review describes these distinct but potentially overlapping mechanisms by which RANKL may promote metastases.
通过其同源受体核因子κB受体激活剂(RANK)发挥作用,RANK配体(RANKL)是破骨细胞功能和存活的重要介质。临床前数据现已确凿地证实,通过抑制RANKL来阻断肿瘤诱导的破骨细胞生成,不仅可以预防骨破坏,还能抑制已形成的骨转移进展,并延缓癌症模型中新生骨转移的形成。在骨转移患者中,骨骼并发症是由破骨细胞活性增加所致,可能导致病理性骨折、脊髓压迫以及需要对骨骼进行放射治疗或进行骨科手术(统称为骨相关事件(SREs))。地诺单抗是一种针对RANKL的全人单克隆抗体,已被证明可预防或延缓已发生骨转移的实体瘤患者发生SREs。除了在肿瘤诱导的骨溶解、骨破坏和骨骼肿瘤进展中起核心作用外,越来越多的证据表明RANKL具有独立于破骨细胞的直接促转移作用。例如,RANKL还通过作用于表达RANK的癌细胞来刺激转移,导致侵袭和迁移增加。对RANKL的药理抑制作用也可能通过阻断RANKL对转移细胞的直接作用来减少骨转移和肺转移。本综述描述了RANKL可能促进转移的这些不同但可能重叠的机制。