Mathew Deepthi Maria, Gopalakrishnan Abilash Valsala
Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology, Tamil Nadu, Vellore, 632014, India.
Med Oncol. 2025 Sep 1;42(10):460. doi: 10.1007/s12032-025-03012-9.
Acute myeloid leukemia (AML) is an aggressive hematologic malignancy characterized by the clonal expansion of primitive hematopoietic stem cells. Despite therapeutic advances, including chemotherapy, hypomethylating agents, and FLT3 inhibitors, resistance and relapse remain major clinical challenges. One of the contributors to chemoresistance in AML is the nuclear factor erythroid 2-related factor 2 (Nrf2), a transcription factor that regulates redox homeostasis and promotes cell survival under oxidative stress. Under normal conditions, Kelch-like ECH-associated protein 1 (KEAP1) inhibits Nrf2. In response to oxidative stress, KEAP1 becomes inactivated, allowing Nrf2 to be activated. Nrf2 is then transported to the nucleus, where it facilitates the transcription of genes that protect cells from oxidative stress. Although vital for protecting cells from oxidative damage, recent studies have also proved the dual role of Nrf2 in cancer progression. The persistent activation of Nrf2 is associated with many cancer types, including AML. This review provides a brief discussion of the molecular mechanisms by which Nrf2 contributes to therapy resistance in AML, with a focus on its regulation of miRNAs, HO-1 1upregulation, and metabolic reprogramming via the pentose phosphate pathway (PPP). We also summarize the pathways involved in Nrf2 activation in AML and the limitations of current treatments that trigger oxidative stress, thereby leading to Nrf2-driven resistance. For AML treatment, recent research has placed a greater emphasis on combination therapy approaches that include Nrf2 inhibitors, in addition to traditional chemotherapeutic medicines such as doxorubicin, or targeted therapies like the BCL-2 inhibitor venetoclax. This review also analyses these studies to determine whether a combination strategy would be an appropriate method for treating AML.
急性髓系白血病(AML)是一种侵袭性血液系统恶性肿瘤,其特征是原始造血干细胞的克隆性扩增。尽管在治疗方面取得了进展,包括化疗、去甲基化药物和FLT3抑制剂,但耐药性和复发仍然是主要的临床挑战。AML化疗耐药的原因之一是核因子红细胞2相关因子2(Nrf2),它是一种转录因子,可调节氧化还原稳态并在氧化应激下促进细胞存活。在正常情况下, Kelch样ECH相关蛋白1(KEAP1)抑制Nrf2。响应氧化应激时,KEAP1失活,使Nrf2被激活。然后Nrf2被转运到细胞核,在那里它促进保护细胞免受氧化应激的基因的转录。尽管Nrf2对保护细胞免受氧化损伤至关重要,但最近的研究也证明了Nrf2在癌症进展中的双重作用。Nrf2的持续激活与包括AML在内的多种癌症类型相关。本综述简要讨论了Nrf2导致AML治疗耐药的分子机制,重点关注其对miRNA的调节、HO-1上调以及通过磷酸戊糖途径(PPP)进行的代谢重编程。我们还总结了AML中Nrf2激活所涉及的途径以及当前引发氧化应激从而导致Nrf2驱动的耐药性的治疗方法的局限性。对于AML治疗,最近的研究更加强调联合治疗方法,除了阿霉素等传统化疗药物或BCL-2抑制剂维奈托克等靶向治疗外,还包括Nrf2抑制剂。本综述还分析了这些研究,以确定联合策略是否是治疗AML的合适方法。
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