Dithmer M, Kirsch A M, Gräfenstein L, Wang F, Schmidt H, Coupland S E, Fuchs S, Roider J, Klettner A K
Augenklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel.
Klinik für Unfallchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel.
Klin Monbl Augenheilkd. 2019 Mar;236(3):295-307. doi: 10.1055/s-0043-103002. Epub 2017 Apr 4.
The role of oxidative stress in cancer is complex. While the pathological alterations induced by oxidative stress may be involved in the induction of tumours, in the late stages of tumour development, it can facilitate the loss of tumour cells and might even prevent metastasis. Tumour cells show metabolic alterations, often inducing an increased production of reactive oxygen species, which makes these cells particularly vulnerable to additional oxidative stress. This is an important mode of action in the use of many chemotherapeutics and in the application of ionizing radiation. Uveal melanoma is the most frequent primary tumour in the adult eye. For metastasis of this tumour, which affects about 50 % of the patients, no appropriate treatment is currently available. However, the primary tumour can efficiently be treated with ionizing radiation. A frequent side effect of this treatment is radiation retinopathy, which is treated with vascular endothelial growth factor (VEGF) antagonists. A therapy of the primary tumour with VEGF antagonists is under discussion. So far, little data is available on this subject, however, a paradoxical worsening of the situation has been found in a mouse model of uveal melanoma treated with bevacizumab.
We have investigated the effect of VEGF and of the VEGF-antagonist bevacizumab on the survival of five different melanoma cell lines under oxidative stress treatment with hydrogen peroxide. In addition, we investigated the expression of relevant proteins and the effect of bevacizumab on the proliferation of the cells as well as its effect on the angiogenic behaviour of endothelial cells, co-cultured with uveal melanoma cells.
Our study showed that not only VEGF but also, paradoxically, the VEGF-antagonist bevacizumab is able to protect uveal melanoma cells from oxidative stress-induced cell death. Bevacizumab did not influence the proliferation of the cells and showed only limited effectiveness to reduce angiogenic structures.
Considering that oxidative stress is the mode of action for ionizing radiation to induce cell death, a protective effect of bevacizumab on uveal melanoma cells against oxidative stress is worrisome and argues against the use of VEGF in uveal melanoma.
氧化应激在癌症中的作用很复杂。虽然氧化应激诱导的病理改变可能参与肿瘤的诱导,但在肿瘤发展的后期,它可促进肿瘤细胞的丢失,甚至可能阻止转移。肿瘤细胞表现出代谢改变,常导致活性氧生成增加,这使得这些细胞特别容易受到额外氧化应激的影响。这是许多化疗药物和电离辐射应用中的一种重要作用方式。葡萄膜黑色素瘤是成人眼部最常见的原发性肿瘤。对于约50%的患者发生转移的这种肿瘤,目前尚无合适的治疗方法。然而,原发性肿瘤可用电离辐射有效治疗。这种治疗的常见副作用是放射性视网膜病变,可用血管内皮生长因子(VEGF)拮抗剂治疗。用VEGF拮抗剂治疗原发性肿瘤正在讨论中。到目前为止,关于这个问题的数据很少,然而,在用贝伐单抗治疗的葡萄膜黑色素瘤小鼠模型中发现了矛盾的病情恶化情况。
我们研究了VEGF和VEGF拮抗剂贝伐单抗在过氧化氢氧化应激处理下对五种不同黑色素瘤细胞系存活的影响。此外,我们研究了相关蛋白的表达以及贝伐单抗对细胞增殖的影响及其对与葡萄膜黑色素瘤细胞共培养的内皮细胞血管生成行为的影响。
我们的研究表明,不仅VEGF,而且矛盾的是,VEGF拮抗剂贝伐单抗也能够保护葡萄膜黑色素瘤细胞免受氧化应激诱导的细胞死亡。贝伐单抗不影响细胞增殖,并且在减少血管生成结构方面仅显示出有限的效果。
考虑到氧化应激是电离辐射诱导细胞死亡的作用方式,贝伐单抗对葡萄膜黑色素瘤细胞的氧化应激保护作用令人担忧,反对在葡萄膜黑色素瘤中使用VEGF。