伊曲康唑柔性脂质体的制备及体外性能研究

摘要：目的:制备伊曲康唑柔性脂质体,并考察其体外透皮性能。方法:以大豆卵磷脂为成膜材料和聚山梨酯80为边缘活化剂,薄膜分散法制备伊曲康唑柔性脂质体,考察粒径、Zeta电位、包封率、载药量及稳定性。采用Franz扩散池,以大鼠皮肤为透皮屏障,考察伊曲康唑柔性脂质体及其溶液的体外透皮性能差异。结果:伊曲康唑柔性脂质体平均粒径为（222.5±15.34） nm,多分散系数（PDI）为（0.226±0.09）,Zeta电位为（-5.09±1.52） m V,平均包封率为（83.80±2.18）%。体外透皮实验表明,伊曲康唑脂质体中伊曲康唑12 h的累积渗透量(Q12)是伊曲康唑溶液的2.21倍;渗透速率(Jss)是伊曲康唑溶液的2.20倍;皮肤滞留量（Qs）是伊曲康唑溶液的6.2倍。结论:伊曲康唑柔性脂质体可显著提高伊曲康唑的体外累积透皮量和皮肤滞留量,有望成为新型局部给药制剂。     

RGD修饰的多柔比星脂质体的制备及荷瘤动物活体成像研究

目的制备精氨酸-甘氨酸-天冬氨酸环状三肽(arginine-glycin-aspartic acid,RGD)序列修饰的多柔比星(doxorubicin,DOX)脂质体(RGD-DOX-LP),考察其粒径、zeta电位、包封率,并探究其肿瘤细胞摄取率及在荷瘤裸鼠中的靶向分布情况。方法采用薄膜分散法制备RGD-DOX-LP及多柔比星脂质体(DOX-LP)。荧光分光光度法研究SUP-M2细胞对RGD-DOX-LP,DOX-LP及DOX溶液的摄取效率。以Cyp790为染料,采用近红外小动物活体成像仪研究比较Cyp靶向脂质体(Cyp-RGDDOXLP)与Cyp常规脂质体(Cyp-DOX-LP)在荷瘤裸鼠体内的分布情况。结果 RGD-DOX-LP粒径为(117±1.8)nm,zeta电位为(-12.46±0.86)mv。细胞摄取实验结果显示,SUP-M2细胞对RGDDOXLP的摄取率是DOX-LP的2.8倍,差异有统计学意义(P<0.05)。在荷瘤裸鼠中,Cyp-RGDDOXLP组在肿瘤部位的荧光强度显著高于Cyp-DOX-LP组,荧光持续时间也显著延长。结论 RGD修饰载多柔比星的脂质体能够高效、靶向性地富集于肿瘤组织,是一种有效的抗肿瘤给药系统。     

靶向肿瘤新生血管的阿霉素阳离子脂质体的体外研究

本研究采用3β-［N-(N′,N′-二甲基胺乙基)胺基甲酰胺基］胆固醇(DC-Chol)和二棕榈酰磷脂酰胆碱为脂材制备了各种DC-Chol含量不同的阿霉素阳离子脂质体，考察了阿霉素阳离子脂质体的体外性质，同时以大鼠主动脉内皮细胞为模型，考察它们对不同阳离子脂质体的摄取情况，并采用静脉注射FITC-Dextran(M_r 500 000)标记体内肿瘤新生血管，为体内靶向肿瘤血管提供依据。结果表明阿霉素阳离子脂质体包封率均在90%以上，粒径在100~200 nm。随着DC-Chol含量的增加，zeta电位升高，但PEG的加入会降低zeta电位。DC-Chol含量的增加会增大阿霉素的释放量，同时也促进脂质体被内皮细胞的摄取，加快摄取速度。因此在进行体内靶向肿瘤血管考察时应充分关注这些体外实验结果。FITC-Dextran标记法可以显影体内新生血管，为体内肿瘤血管靶向实验提供直观的观察方法。     

T7肽修饰共载多柔比星与miRNA脂质体的制备及其对结肠癌细胞的增殖抑制作用

目的 制备T7肽修饰共载多柔比星(DOX)与MIFsiRNA脂质体(T7-LPs-DOX/RNA),研究其对人源结肠癌细胞(RKO)的靶向抑制作用.方法 薄膜分散法制备脂质体,透射电镜观察其形态.流式细胞仪检测RKO细胞对不同脂质体的摄取效率和摄取机制.细胞克隆形成实验检测不同脂质体对RKO细胞存活率的影响.构建RKO细胞肿瘤球模型,观察T7-LPs-DOX/RNA对实体肿瘤球的穿透能力.结果 RKO细胞对T7-LPs的摄取效率显著强于普通脂质体,T7-LPs-DOX/RNA对RKO细胞增殖抑制作用强于其他脂质体(P＜0.05).经过T7肽修饰后,脂质体对肿瘤球的穿透能力显著增强.结论 T7-LPs-DOX/RNA是一种有效的结肠癌靶向给药系统.     

LHRHa与八聚精氨酸共修饰载氟尿嘧啶靶向脂质体的构建及其抗前列腺癌作用

目的 构建促黄体激素释放激素类似物(LHRHa)与八聚精氨酸(R8)共修饰载氟尿嘧啶(5-FU)脂质体(LHRHa/R8-LP-5-FU),对其前列腺癌靶向性以及治疗效果进行初步研究.方法 采用薄膜分散法制备LHRHa/R8-LP-5-FU,考察其形态、粒径、电位,并通过PC-3前列腺癌细胞定性和定量摄取实验考察其前列腺癌细胞靶向性.采用噻唑蓝(MTT)实验以及肿瘤球实验考察LHRHa/R8-LP-5-FU对PC-3细胞增殖抑制率.结果 所制备LHRHa/R8-LP-5-FU粒径为(115.0±15.2) nm,电位为(11.00±2.15) mV,5-FU的包封率(84.5±5.1)％.体外细胞摄取实验表明,PC-3细胞对LHRHa/R8-LP摄取效率分别是R8修饰脂质体(R8-LP)和LHRHa修饰脂质体(LHRHa-LP) 2.8和3.2倍(P＜0.01).细胞毒性实验结果显示,以0.9％氯化钠溶液为对照,LP-5-FU、R8-LP-5-FU、LHRHa-LP-5-FU和LHRHa/R8-LP-5-FU对PC-3细胞的增殖抑制率分别为(26.4±4.5)％,(39.5±4.2)％,(48.6±3.5)％和(82.5±4.3)％(P＜0.01).LHRHa/R8-LP-5-FU对肿瘤球的生长抑制作用明显高于其他脂质体.细胞毒性实验结果与细胞摄取实验结果一致.结论 LHRHa与细胞穿膜肽共修饰载5-FU脂质体具有良好的前列腺肿瘤细胞靶向性和抗肿瘤作用,是一种潜在的治疗前列腺癌的高效给药系统.     

结肠癌靶向米托蒽醌脂质体的制备及其抗肿瘤活性研究

目的:比较透明质酸(HA)修饰的脂质体(HA-LP)与普通脂质体(LP)的抗转移及抗肿瘤活性。方法:采用薄膜水化法制备空白脂质体,通过透明质酸上的羧基与膜材中DSPE的氨基反应将HA连接在脂质体上,运用硫酸铵梯度法包载模型药物米托蒽醌;通过透射电镜表征脂质体形态;免疫荧光法检测结肠癌细胞(CT26 cells)中透明质酸受体CD44表达情况;高内涵扫描仪检测结肠癌细胞对脂质体的摄取情况;划痕实验考察2组脂质体抑制细胞转移的能力;体内抗肿瘤实验考察2组脂质体的抑瘤效果。结果:所制备的脂质体形态均一,包封率均大于95%。免疫荧光结果显示,结肠癌细胞中CD44受体高度表达。相同的药物浓度下,HA-LP相较于未修饰的脂质体具有明显增加的细胞摄取。划痕实验结果表明,HA可能与受体CD44存在某种相互作用,抑制了结肠癌细胞的转移,表现出HA-LP具有更强的抗转移活性。体内抗肿瘤结果显示,HA-LP对小鼠荷结肠癌实体瘤的抑瘤率为62.1%,显著高于普通脂质体组(46.6%,P<0.05)。结论:HA-LP与细胞膜上的受体CD44作用,显著增加了其细胞摄取,并抑制了结肠癌细胞的转移,体内抑瘤结果同样显示,具有肿瘤靶向功能的HA-LP具有更强的抑制肿瘤生长的能力。     

DSPE-PEG,Tween80和Brij35对伊文思蓝脂质体包封率和体内分布的影响

目的寻找与DSPE．PEG功能相似的表面活性剂，以增加脂质体的稳定性，改善其体内分布，提高靶向性。方法制备了伊文思蓝脂质体，考察了胆固醇与磷脂的比例对伊文思蓝脂质体包封率的影响；比较了用DSPE-PEG、Tween80和Brij35修饰后的伊文思蓝脂质体包封率和在大鼠体内分布状况的变化。结果伊文思蓝脂质体的包封率最高为25．30％。用DSPE-PEG、Tween80和Brij35修饰后使伊文思蓝脂质体的包封率略有下降，但差别不显著；体内分布实验结果显示：修饰后的脂质体在肝、脾和肾中伊文思蓝的浓度均有不同程度的降低，脑中伊文思蓝的浓度有所提高，而且以Tween80修饰组最显著。结论DSPE-PEG、Trween80和Brij35对伊文思蓝脂质体的包封率影响较小。Brij35对伊文思蓝脂质体的作用与DSPE-PEG相似，能提高脂质体逃避网状内皮系统吞噬的能力；Tween80主要能增加伊文思蓝脂质体在大鼠脑组织中的分布，为脑靶向脂质体的研究提供了有益信息。     

不同表面活性剂对伊文思蓝脂质体体内外性质的影响

目的　寻找与二硬脂酰磷脂酰乙醇胺 聚乙二醇 (DSPE PEG)功能相似的表面活性剂 ,以增加脂质体的稳定性 ,改善其体内分布 ,提高靶向性。方法　制备伊文思蓝 (EB)脂质体 ,考察胆固醇与磷脂的比例对伊文思蓝脂质体包封率的影响 ;比较用DSPE PEG、吐温 80 (Tween 80 )和苄泽 3 5 (Brij 3 5 )修饰后的EB脂质体的包封率和在大鼠体内组织分布状况的变化。结果　EB脂质体的包封率最高为 2 5 3 0 %。用DSPE PEG、Tween 80和Brij 3 5修饰后使EB脂质体的包封率略有下降 ,但差别不显著 ;体内分布实验结果显示 :修饰后的脂质体在肝、脾和肾中EB的浓度均有不同程度的降低 ,脑中EB的浓度有所提高 ,而且以Tween 80修饰组最显著。结论　DSPE PEG、Tween 80和Brij 3 5对EB脂质体的包封率影响较小。Brij 3 5对EB脂质体的作用与DSPE PEG相似 ,能提高脂质体逃避网状内皮系统吞噬的能力 ;Tween 80主要能增加EB脂质体在大鼠脑组织中的分布 ,为脑靶向脂质体的研究提供了有益信息     

反相高效液相色谱法测定伊曲康唑脂质体药物含量及包封率

目的:建立测定伊曲康唑脂质体药物含量及包封率的 RP-HPLC 法。方法:采用 Diamonsil C_(18)柱(250 mm×4.6 mm,5μm);流动相:甲醇-0.5%醋酸铵-乙醚(15:4:1);流速:1.0 mL·min~(-1);紫外检测波长:262 nm;进样量:20 μL;柱温:35℃。采用 Sephadex G-50分离伊曲康唑脂质体中的游离药物。结果:在本色谱条件下伊曲康唑与辅料及溶剂峰分离良好,伊曲康唑浓度在1.2～48.0μg·mL~(-1)范围内线性关系良好(r=0.9999,n=7),回收率在98.0%～101.0%之间,日内及日间RSD 均小于2%(n=5)。结论:该方法准确可靠、简单快速,可用于伊曲康唑脂质体含量及包封率的测定。     

支链淀粉修饰双嘧达莫脂质体的制备及其在小鼠体内的组织分布

目的研究支链淀粉修饰双嘧达莫(DIP)脂质体的制备方法并考察其在小鼠体内的组织分布。方法 采用薄膜-分散法制备普通DIP脂质体；合成两亲性的棕榈酰化支链淀粉并用其修饰DIP脂质体；比较修饰前后包封率、zeta电位、平均粒径和径距的变化；采用反相高效液相法测定小鼠组织中的DIP浓度。结果修饰后DIP脂质体的包封率降低，zeta电位增加，平均粒径和径距无明显变化；普通脂质体可以增强DIP在肺部、肝脏和脾脏的分布，而较之普通脂质体，支链淀粉修饰的脂质体可以进一步增加肺部DIP水平，同时减少DIP在肝脏和脾脏的分布，并延长在肺部的滞留时间。结论与普通脂质体和注射液比较，支链淀粉修饰的脂质体可以改变DIP在小鼠体内的组织分布，具有显著的肺靶向性。     

The role of EGFR tyrosine kinase inhibitors in the first-line treatment of advanced non small cell lung cancer patients harboring EGFR mutation

Lung cancer continues to be the leading cause of cancer death worldwide. Among lung cancers, 80% are classified as nonsmall- cell lung cancer (NSCLC) and are mostly diagnosed at an advanced stage (either locally advanced or metastatic disease). In the last years, the discovery of the pivotal role in tumorigenesis of the Epidermal Growth Factor Receptor (EGFR) has provided a new class of targeted therapeutic agents: the EGFR tyrosine kinase inhibitors (EGFR-TKIs). Since the first reports of an association between somatic mutations in EGFR exons 19 and 21 and response to EGFR-TKIs, treatment of advanced NSCLC has changed dramatically. Histologic profile, clinical characteristics, and mutational profile of lung carcinoma have all been reported as predictive factors of response to EGFR-TKIs and other targeted therapies. In advanced NSCLC patients harboring EGFR mutations, the use of EGFR TKIs in first-line treatment has provided an unusually large progression-free survival (PFS) benefit with a negligible toxicity when compared with cytotoxic chemotherapy in phase III randomized trials. Considering the findings regarding the excellent benefit and better safety profile of EGFR TKIs in EGFR mutation positive patients, these targeted therapeutic agents can be now considered as first-line treatment in this setting of patients. This review will discuss the new evidences in the role of EGFR-TKIs in the first-line treatment of advanced NSCLC and their implication in the current clinical decision-making.     

Recent understanding of the molecular mechanisms for the efficacy and resistance of EGF receptor-specific tyrosine kinase inhibitors in non-small cell lung cancer

INTRODUCTION: The epidermal growth factor receptor (EGFR) and its family members are involved in many aspects of tumor biological processes. Aberrant activation of the EGFR tyrosine kinase by mutations or protein overexpression is observed in various types of human cancer, including lung cancer. EGFR tyrosine kinase inhibitors (EGFR-TKIs), such as gefitinib and erlotinib, are highly effective in lung cancer patients who harbor active mutations in the EGFR gene. However, patients who are initially sensitive to EGFR-TKIs eventually relapse within few years. AREAS COVERED: Non-small cell lung cancer (NSCLC) is the most common type of lung cancer and is associated with a high frequency of EGFR mutations. This review describes the EGFR mutations that determine the sensitivity to EGFR-TKIs and the current understanding of the molecular mechanisms of acquired resistance to EGFR-TKIs in NSCLC. Furthermore, the authors describe recent strategies developed to overcome acquired resistance using second-generation EGFR-TKIs and combination therapies with several molecular-targeting drugs. EXPERT OPINION: Although recent findings have contributed to our understanding of the mechanism of acquired resistance and helped the development of novel strategies to overcome such resistance, the underlying mechanisms are complex and additional research is necessary to develop effective therapeutic strategies for individual patients with lung cancer.     

EGFR基因靶向治疗非小细胞肺癌的研究进展

非小细胞肺癌(Non-small cell lung cancer,NSCLC)是现阶段临床发现的肺癌患者中发病率最高的一种类型,治疗手段匮乏,效果不甚理想,目前临床中研究热点是EGFR基因在NSCLC靶向治疗中的作用。表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)是基于EGFR基因作用而开发出来,用于治疗EGFR基因突变阳性的NSCLC患者。本文综述了EGFR基因靶向治疗非小细胞肺癌的研究进展。     

Small-molecule EGFR tyrosine kinase inhibitors for the treatment of cancer

Introduction: EGFR has been implicated in various malignancies such as NSCLC, breast, head and neck, and pancreatic cancer. Numerous drugs have been developed in order to target the tyrosine domain of EGFR as an approach in cancer treatment.

Areas covered: This article focuses on the different generations of EGFR tyrosine kinase inhibitors (TKIs). This spans from the emergence of the first-generation EGFR-TKIs to overcoming drug resistance using second-generation EGFR-TKIs and to reducing adverse effect (AE) using mutant-selective third-generation EGFR-TKIs.

Expert opinion: Current TKI treatment is frequently accompanied by drug resistance and/or serious AEs. There has been the promise of advancements in second-generation EGFR-TKIs that could overcome drug resistance, acting as second- or third-line salvage treatment, but this promise has yet to be met. That being said, both issues are currently being addressed with mutant-selective EGFR-TKIs with the expectation of bringing more EGFR-targeted therapy into the next phase of cancer therapy in the future.     

Osimertinib for EGFR T790M mutation-positive non-small cell lung cancer

Introduction: Significant advances have been made since the development of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) targeting EGFR mutations in non-small-cell lung cancer (NSCLC), however, lung cancer cells eventually acquire resistance to those agents. Osimertinib (AZD9291) has been developed as 3^rd generation EGFR-TKI with activities against sensitizing mutations and T790 M resistance mutation, which account for about 50% of the mechanisms of acquired resistance to 1^st or 2^nd generation EGFR-TKIs. A recent phase I/II clinical trial with osimertinib for advanced NSCLC patients with known sensitizing EGFR mutations and documented disease progression on prior EGFR-TKIs revealed promising effect with acceptable toxicities.

Areas covered: This article summarizes current understanding and available preclinical and clinical data on osimertinib and also discusses future directions. The literature search included PubMed and the latest articles from international conferences.

Expert commentary: The development of osimertinib has provided new therapeutic options for NSCLC patients harboring T790 M. Compared with other EGFR-TKIs including rociletinib, osimertinib seems to possess an advantage with respect to the effect and safety profile among existing EGFR-TKIs. However, tumor progression still occurs even when treating with osimertinib. A further understanding of the mechanisms of resistance is eagerly anticipated in order to develop next generation EGFR-TKIs.     

阿美替尼治疗非小细胞肺癌的研究进展

肺癌是全球癌症相关死亡的最常见原因,其中85%为非小细胞肺癌(non-small-cell lung cancer,NSCLC),表皮生长因子受体(epidermal growth factor receptor,EGFR)是治疗晚期NSCLC最重要的靶点之一。第一、二代EGFR酪氨酸激酶抑制剂(EGFR-tyrosine kinase inhibitor,EGFR-TKI)一直是晚期EGFR突变NSCLC患者的标准治疗方法,但获得性耐药几乎不可避免,主要耐药原因为T790M突变。阿美替尼是中国首个自主研发的第三代EGFR-TKI,对包括L858R和19号外显子缺失在内的EGFR敏感突变,以及T790M耐药突变均具有活性,同时保留野生型EGFR,克服了第一、二代EGFR-TKI的耐药性和选择性问题,其临床前和临床研究均显示出良好的有效性与安全性,为我国NSCLC患者提供了新的用药选择。本综述对阿美替尼的结构、作用机制、临床前研究、药动学,在NSCLC治疗中的临床疗效、安全性,以及与其他第三代EGFR-TKI的比较进行了总结,为该药的临床使用及未来的探索研究提供参考。     

EGFR-TKIs在NSCLC中的耐药机制及治疗策略研究进展

表皮生长因子受体（EGFR）抑制剂是目前临床治疗非小细胞肺癌（NSCLC）的一线小分子靶向药物,随着EGFR酪氨酸激酶抑制剂（EGFR-TKI）的广泛使用,其耐药现象也日趋明显,已成为其治疗NSCLC的巨大挑战。本文总结了EGFR-TKIs在NSCLC中的主要耐药机制,并对相关逆转策略的研究进展进行综述。     

表皮生长因子受体-酪氨酸激酶抑制剂分子耐药机制研究

以表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKI)为靶点的治疗近年逐渐引起关注。但部分患者在服用EGFR-TKI初期即出现原发和获得性耐药。本文综述EGFR-TKI分子耐药机制的研究现状,探讨EGFR-TKI分子耐药机制重要的临床意义。     

Pharmacotherapy targeting the EGFR oncogene in NSCLC

Introduction: The EGFR plays a central role in regulating cancer cell growth and survival, representing an attractive therapeutic target in NSCLC.

Areas covered: For the purpose of this review article, data from Phase II and III trials with anti-EGFR agents, including EGFR-tyrosine kinase inhibitors (TKIs) and mAbs, were collected and analysed.

Expert opinion: Eight large Phase III trials demonstrated that EGFR-TKIs are the best option we can offer today as front-line therapy exclusively in EGFR mutant NSCLC. In patients with EGFR wild type or unknown lung cancer, platinum-based chemotherapy remains the standard of care, with no consistent benefit produced by the addition of an anti-EGFR treatment. In pretreated NSCLC, EGFR-TKIs are considered more effective than standard monotherapy with cytotoxics in presence of classical EGFR mutations, whereas in the EGFR wild-type population, a similar efficacy with docetaxel or pemetrexed in terms of survival has been demonstrated. New agents targeting EGFR are under investigation, particularly in individuals with squamous cell histology and those with acquired resistance to EGFR-TKIs.     

miR-340 与Nrf2 在非小细胞肺癌患者靶向治疗耐药中的表达及相关性分析

目的探究miR-340与Nrf2在非小细胞肺癌患者靶向治疗耐药中的表达及意义。方法选取2016年1月—2019年12月我院收治的EGFR基因突变非小细胞肺癌表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)耐药患者42例作为观察组,同期于我院治疗的非耐药患者42例为对照组,检测并比较两组患者miR-340、Nrf2表达水平,同时探究miR-340水平与Nrf2的相关性。结果观察组患者血清miR-340水平显著高于对照组(P<0.05),Nrf2水平显著低于对照组(P<0.05);miR-340与Nrf2水平呈负相关(P<0.05);进一步Logistic分析显示,miR-340表达上调及Nrf2表达下调是非小细胞肺癌患者EGFR-TKIs耐药发生的独立危险因素。结论miR-340可通过影响体内Nrf2水平参与EGFR-TKIs耐药的发生,为提高肺腺癌的诊治提供了新的理论依据及潜在干预靶点。