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当守护者沉睡时:癌症中 p53 通路的再激活。

When the guardian sleeps: Reactivation of the p53 pathway in cancer.

机构信息

Department of Clinical Pathology, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.

Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Laboratory of Immunological and Molecular Cancer Research Laboratory of Immunological and Molecular Cancer Research, Paracelsus Medical University, Salzburg, Austria.

出版信息

Mutat Res Rev Mutat Res. 2017 Jul;773:1-13. doi: 10.1016/j.mrrev.2017.02.003. Epub 2017 Feb 17.

Abstract

The p53 tumor suppressor is inactivated in most cancers, thus suggesting that loss of p53 is a prerequisite for tumor growth. Therefore, its reintroduction through different means bears great clinical potential. After a brief introduction to current knowledge of p53 and its regulation by the ubiquitin-ligases MDM2/MDMX and post-translational modifications, we will discuss small molecules that are able to reactivate specific, frequently observed mutant forms of p53 and their applicability for clinical purposes. Many malignancies display amplification of MDM genes encoding negative regulators of p53 and therefore much effort to date has concentrated on the development of molecules that inhibit MDM2, the most advanced of which are being tested in clinical trials for sarcoma, glioblastoma, bladder cancer and lung adenocarcinoma. These will be discussed as will recent findings of MDMX inhibitors: these are of special importance as it has been shown that cancers that become resistant to MDM2 inhibitors often amplify MDM4. Finally, we will also touch on gene therapy and vaccination approaches; the former of which aims to replace mutated TP53 and the latter whose goal is to activate the body's immune system toward mutant p53 expressing cells. Besides the obvious importance of MDM2 and MDMX expression for regulation of p53, other regulatory factors should not be underestimated and are also described. Despite the beauty of the concept, the past years have shown that many obstacles have to be overcome to bring p53 reactivation to the clinic on a broad scale, and it is likely that in most cases it will be part of a combined therapeutic approach. However, improving current p53 targeted molecules and finding the best therapy partners will clearly impact the future of cancer therapy.

摘要

p53 肿瘤抑制因子在大多数癌症中失活,这表明 p53 的丧失是肿瘤生长的前提。因此,通过不同的方法重新引入 p53 具有巨大的临床潜力。在简要介绍了 p53 的现有知识及其被泛素连接酶 MDM2/MDMX 和翻译后修饰的调控后,我们将讨论能够重新激活特定的、常见的突变型 p53 的小分子及其在临床应用中的适用性。许多恶性肿瘤显示出编码 p53 负调控因子的 MDM 基因的扩增,因此迄今为止,许多努力都集中在开发抑制 MDM2 的分子上,其中最先进的分子正在肉瘤、胶质母细胞瘤、膀胱癌和肺腺癌的临床试验中进行测试。我们将讨论 MDMX 抑制剂的最新发现:这些抑制剂非常重要,因为已经表明,对 MDM2 抑制剂产生耐药性的癌症通常会扩增 MDM4。最后,我们还将讨论基因治疗和疫苗接种方法;前者旨在替代突变的 TP53,后者的目标是激活机体的免疫系统对表达突变型 p53 的细胞。除了 MDM2 和 MDMX 表达对 p53 调控的明显重要性外,还不能低估其他调控因子,并对其进行了描述。尽管这一概念非常美妙,但过去几年的研究表明,要将 p53 重新激活广泛应用于临床,还需要克服许多障碍,而且在大多数情况下,它可能是联合治疗方法的一部分。然而,改善现有的 p53 靶向分子并找到最佳的治疗伙伴将明显影响癌症治疗的未来。

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