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白细胞介素-6诱导肾细胞癌产生耐药性。

Interleukin-6 induces drug resistance in renal cell carcinoma.

作者信息

Ishibashi Kei, Koguchi Tomoyuki, Matsuoka Kanako, Onagi Akifumi, Tanji Ryo, Takinami-Honda Ruriko, Hoshi Seiji, Onoda Mitsutaka, Kurimura Yoshimasa, Hata Junya, Sato Yuichi, Kataoka Masao, Ogawsa Soichiro, Haga Nobuhiro, Kojima Yoshiyuki

机构信息

Department of Urology, Fukushima Medical University School of Medicine.

出版信息

Fukushima J Med Sci. 2018 Dec 8;64(3):103-110. doi: 10.5387/fms.2018-15. Epub 2018 Oct 23.

Abstract

Metastatic renal cell carcinoma (mRCC) is a tumor entity with poor prognosis due to limited therapy options. Tyrosine kinase inhibitors (TKIs), the novel targeted agents have been used for the treatment of mRCC and have shown efficacy. Interferon (IFN)-α is also one of the most frequently used agents in immunotherapy. However, drug resistance needs to be overcome to achieve a sufficiently positive effect. Interleukin-6 (IL-6), which induce suppressor of cytokine signaling-3 (SOCS3) expression, is one of the factors associated with poor prognosis of patients with renal cell carcinoma (RCC). To analyze the influence of IL-6 in drug resistance of RCC, anti-IL-6 receptor antibody was used in combination with IFN or TKIs. The SOCS3 mRNA expression level was significantly increased by IFN-α stimulation in 786-O RCC cells which were resistant to IFN, but not in ACHN cells that were sensitive to IFN. The overexpression of SOCS3 by gene transfection in ACHN significantly inhibited the growth-inhibitory effect of IFN-α. An in vivo study demonstrated that co-administration of SOCS3-targeted siRNA promoted INF-α-induced cell death and growth suppression in 786-O cell xenograft. SOCS3 could be a key component in the resistance to interferon treatment of renal cell carcinoma. Because SOCS3 is rapidly up-regulated by IL-6 and a negative regulator of cytokine signaling, IL-6 expression on RCC cells was also analyzed and the 786-O cells showed the high level of IL-6 mRNA expression under the condition of interferon stimulation. IL-6R antibody, tocilizumab, significantly suppressed cell proliferation in 786-O cells by interferon stimulation accompanied with phosphorylation of STAT1 and inhibited SOCS3 expression. The in vivo effects of combination therapy with tocilizumab and interferon showed significant suppression of 786-O tumor growth in a xenograft model. We also hypothesized that TKI resistance and IL-6 secretion are causally connected. And we found that 786-O RCC cells secrete high IL-6 levels after low dose stimulation with the TKIs sorafenib, sunitinib and pazopanib, inducing activation of AKT-mTOR pathway, NFκB, HIF-2α and VEGF expression. Tocilizumab neutralizes the AKT-mTOR pathway activation and results in reduced proliferation. A combination therapy with tocilizumab and TKI suppresses 786-O tumor growth and inhibits angiogenesis in vivo more efficient than TKI alone. Our findings suggest that IL-6 could induce drug resistance on RCC, and combination therapy of IL-6R inhibitors and IFN/TKIs may represent a novel therapeutic approach for RCC treatment.

摘要

转移性肾细胞癌(mRCC)是一种由于治疗选择有限而预后较差的肿瘤实体。酪氨酸激酶抑制剂(TKIs)作为新型靶向药物已被用于治疗mRCC并显示出疗效。干扰素(IFN)-α也是免疫治疗中最常用的药物之一。然而,需要克服耐药性才能取得足够积极的效果。诱导细胞因子信号传导抑制因子-3(SOCS3)表达的白细胞介素-6(IL-6)是与肾细胞癌(RCC)患者预后不良相关的因素之一。为了分析IL-6对RCC耐药性的影响,将抗IL-6受体抗体与IFN或TKIs联合使用。在对IFN耐药的786-O RCC细胞中,IFN-α刺激可显著提高SOCS3 mRNA表达水平,但在对IFN敏感的ACHN细胞中则不然。通过基因转染在ACHN中过表达SOCS3可显著抑制IFN-α的生长抑制作用。一项体内研究表明,联合给予靶向SOCS3的小干扰RNA可促进IFN-α诱导的786-O细胞异种移植中的细胞死亡和生长抑制。SOCS3可能是肾细胞癌对干扰素治疗耐药的关键组成部分。由于SOCS3可被IL-6迅速上调且是细胞因子信号传导的负调节因子,因此还分析了RCC细胞上的IL-6表达,结果显示786-O细胞在干扰素刺激条件下IL-6 mRNA表达水平较高。IL-6R抗体托珠单抗在干扰素刺激下可显著抑制786-O细胞的增殖,同时伴有STAT1的磷酸化并抑制SOCS3表达。托珠单抗与干扰素联合治疗在异种移植模型中显示出对786-O肿瘤生长的显著抑制作用。我们还假设TKI耐药性与IL-6分泌存在因果关系。我们发现,786-O RCC细胞在用索拉非尼、舒尼替尼和帕唑帕尼等TKIs低剂量刺激后会分泌高水平的IL-6,从而诱导AKT-mTOR通路激活、NFκB、HIF-2α和VEGF表达。托珠单抗可中和AKT-mTOR通路的激活并导致增殖减少。托珠单抗与TKI联合治疗在体内比单独使用TKI更有效地抑制786-O肿瘤生长并抑制血管生成。我们的研究结果表明,IL-6可诱导RCC产生耐药性,IL-6R抑制剂与IFN/TKIs联合治疗可能代表一种治疗RCC的新方法。

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