Sørensen Mia Dahl, Fosmark Sigurd, Hellwege Sofie, Beier Dagmar, Kristensen Bjarne Winther, Beier Christoph Patrick
Department of Pathology, Odense University Hospital, Odense C, Denmark.
Adv Exp Med Biol. 2015;853:111-38. doi: 10.1007/978-3-319-16537-0_7.
Glioblastoma remains a tumor with a dismal prognosis because of failure of current treatment. Glioblastoma cells with stem cell (GSC) properties survive chemotherapy and give rise to tumor recurrences that invariably result in the death of the patients. Here we summarize the current knowledge on chemoresistance of malignant glioma with a strong focus on GSC. Chemoresistant GSC are the most likely cause of tumor recurrence, but it remains controversial if GSC and under which conditions GSC are more chemoresistant than non-GSC within the tumor. Regardless of this uncertainty, the chemoresistance varies and it is mainly mediated by intrinsic factors. O6-methyl-guanidine methyltransferase (MGMT) remains the most potent mediator of chemoresistance, but disturbed mismatch repair system and multidrug resistance proteins contribute substantially. However, the intrinsic resistance by MGMT expression is regulated by extrinsic factors like hypoxia increasing MGMT expression and thereby resistance to alkylating chemotherapy. The search of new biomarkers helping to predict the tumor response to chemotherapy is ongoing and will complement the already known markers like MGMT.
由于目前的治疗效果不佳,胶质母细胞瘤仍然是一种预后很差的肿瘤。具有干细胞(GSC)特性的胶质母细胞瘤细胞能在化疗中存活,并导致肿瘤复发,最终 invariably 导致患者死亡。在这里,我们总结了目前关于恶性胶质瘤化疗耐药性的知识,重点关注 GSC。化疗耐药的 GSC 是肿瘤复发最可能的原因,但 GSC 是否以及在何种情况下比肿瘤内的非 GSC 更具化疗耐药性仍存在争议。尽管存在这种不确定性,但化疗耐药性各不相同,主要由内在因素介导。O6-甲基鸟嘌呤甲基转移酶(MGMT)仍然是化疗耐药性最有效的介导因子,但错配修复系统紊乱和多药耐药蛋白也起了很大作用。然而,MGMT 表达引起的内在耐药性受缺氧等外在因素调节,缺氧会增加 MGMT 表达,从而导致对烷化剂化疗的耐药性。寻找有助于预测肿瘤对化疗反应的新生物标志物的工作正在进行中,这将补充像 MGMT 这样已知的标志物。