Institute of Life Sciences, Bhubaneswar, Odisha, India; Manipal University, Manipal, Karnataka, India.
HCG Panda Cancer Centre, Cuttack, Odisha, India; Acharya Harihar Regional Cancer Centre, Cuttack, Odisha, India.
Adv Cancer Res. 2018;137:37-75. doi: 10.1016/bs.acr.2017.11.001. Epub 2017 Dec 6.
Cancer is a daunting global problem confronting the world's population. The most frequent therapeutic approaches include surgery, chemotherapy, radiotherapy, and more recently immunotherapy. In the case of chemotherapy, patients ultimately develop resistance to both single and multiple chemotherapeutic agents, which can culminate in metastatic disease which is a major cause of patient death from solid tumors. Chemoresistance, a primary cause of treatment failure, is attributed to multiple factors including decreased drug accumulation, reduced drug-target interactions, increased populations of cancer stem cells, enhanced autophagy activity, and reduced apoptosis in cancer cells. Reprogramming tumor cells to undergo drug-induced apoptosis provides a promising and powerful strategy for treating resistant and recurrent neoplastic diseases. This can be achieved by downregulating dysregulated antiapoptotic factors or activation of proapoptotic factors in tumor cells. A major target of dysregulation in cancer cells that can occur during chemoresistance involves altered expression of Bcl-2 family members. Bcl-2 antiapoptotic molecules (Bcl-2, Bcl-xL, and Mcl-1) are frequently upregulated in acquired chemoresistant cancer cells, which block drug-induced apoptosis. We presently overview the potential role of Bcl-2 antiapoptotic proteins in the development of cancer chemoresistance and overview the clinical approaches that use Bcl-2 inhibitors to restore cell death in chemoresistant and recurrent tumors.
癌症是全球面临的一个令人畏惧的问题。最常见的治疗方法包括手术、化疗、放疗,以及最近的免疫疗法。在化疗的情况下,患者最终会对单一和多种化疗药物产生耐药性,这可能导致转移性疾病,这是实体瘤患者死亡的主要原因。化疗耐药性是治疗失败的主要原因,归因于多种因素,包括药物积累减少、药物靶标相互作用减少、癌症干细胞群体增加、自噬活性增强以及癌细胞凋亡减少。将肿瘤细胞重新编程为药物诱导的凋亡,为治疗耐药性和复发性肿瘤疾病提供了一种有前途和强大的策略。这可以通过下调肿瘤细胞中失调的抗凋亡因子或激活促凋亡因子来实现。在化疗耐药性过程中,癌细胞中发生的一个主要失调靶点涉及 Bcl-2 家族成员的表达改变。Bcl-2 抗凋亡分子(Bcl-2、Bcl-xL 和 Mcl-1)在获得性化疗耐药癌细胞中经常上调,阻止药物诱导的细胞凋亡。我们目前概述了 Bcl-2 抗凋亡蛋白在癌症化疗耐药性发展中的潜在作用,并概述了使用 Bcl-2 抑制剂恢复化疗耐药和复发性肿瘤细胞死亡的临床方法。