肾癌中调节性细胞死亡的新动向和未来展望

肾癌是泌尿系统常见的恶性肿瘤之一。近年来,我国肾癌的发病率呈逐年上升的趋势,严重威胁着人们的健康。调节性细胞死亡是由一种细胞主动有序的死亡方式,普遍存在于生命活动过程中,在维系生命活动的平衡中发挥着至关重要的作用。近期Science杂志上报道了一种新的调节性细胞死亡方式即铜死亡,进一步强化了生命体中细胞死亡的重要性。随着对调节性细胞死亡认识的不断深入,越来越多的研究显示不同的调节性细胞死亡（如铁死亡、焦亡、自噬等）均与肾癌的发生、发展密切相关。如诱导细胞铁死亡将显著抑制肾癌的侵袭和转移、并与肾癌患者的更好预后密切相关;细胞焦亡不仅可以诱导肾癌细胞死亡还可以激活抗肾癌的免疫应答;自噬在肾癌中具有“双向”作用,增强自噬可抑制肾癌细胞生长,但也可能减弱联合用药治疗的效果;抑制细胞凋亡和坏死性凋亡可以显著促进肾癌细胞的增殖、侵袭等。本文将综述铁死亡、细胞焦亡、自噬、细胞凋亡和坏死性凋亡的分子机制和在肾癌发生、发展中作用的研究进展并进行展望,为探索肾癌的发病机制和潜在的治疗靶点提供新的视角。     

Molecular regulatory mechanism of ferroptosis and its role in gastrointestinal oncology: Progress and updates

Gastrointestinal (GI) tumors, including liver, pancreatic, gastric, and colorectal cancers, have a high incidence rate and low survival rate due to the lack of effective therapeutic methods and frequent relapses. Surgery and postoperative chemoradiotherapy have largely reduced the fatality rates for most GI tumors, but these therapeutic approaches result in poor prognoses due to severe adverse reactions and the development of drug resistance. Recent studies have shown that ferroptosis plays an important role in the onset and progression of GI tumors. Ferroptosis is a new non-apoptotic form of cell death, which is iron-dependent, non-apoptotic cell death characterized by the accumulation of lipid reactive oxygen species (ROS). The activation of ferroptosis can lead to tumor cell death. Thus, regulating ferroptosis in tumor cells may become a new therapeutic approach for tumors, making it become a research hotspot. Current studies suggest that ferroptosis is mainly triggered by the accumulation of lipid ROS. Furthermore, several studies have indicated that ferroptosis may be a new approach for the treatment of GI tumors. Here, we review current research progress on the mechanism of ferroptosis, current inducers and inhibitors of ferroptosis, and the role of ferroptosis in GI tumors to propose new methods for the treatment of such tumors.     

铁死亡在泌尿系肿瘤治疗中的研究进展

铁死亡是一种不同于凋亡、自噬、坏死的程序性细胞死亡方式,已有研究表明铁死亡与退行性疾病、缺血-再灌注损伤、肾损伤、肿瘤等疾病相关。泌尿系肿瘤发病率逐年递增,而治疗效果不佳。因此,探究铁死亡在泌尿系肿瘤中的潜在治疗效果可能作为一种新的治疗方式。本文主要总结了铁死亡发展历程、核心机制以及在泌尿系肿瘤中的研究现状。将铁死亡和现有的肿瘤治疗方式结合有助于增加其抗肿瘤治疗和克服肿瘤的耐药性。但铁死亡在泌尿系肿瘤中的研究相对较少,深入探究其作用机制有助于将其应用于临床抗肿瘤治疗。     

Role of ferroptosis in colorectal cancer

Colorectal cancer (CRC) is the second deadliest cancer and the third-most common malignancy in the world. Surgery, chemotherapy, and targeted therapy have been widely used to treat CRC, but some patients still develop resistance to these treatments. Ferroptosis is a novel non-apoptotic form of cell death. It is an iron-dependent non-apoptotic cell death characterized by the accumulation of lipid reactive oxygen species and has been suggested to play a role in reversing resistance to anticancer drugs. This review summarizes recent advances in the prognostic role of ferroptosis in CRC and the mechanism of action in CRC.     

晚期肾癌分子靶向治疗新进展

肾癌是泌尿系最常见的恶性肿瘤,透明细胞癌是常见病理类型,约占全部肾癌的 85 %～90 %。既往主要以化疗、白介素及干扰素药物等治疗肾癌。近年来随着肿瘤诊治水平的提高,对肾癌的认识和诊治取得重要突破,特别是分子靶向治疗为患者提供了新的治疗手段。以索拉非尼、舒尼替尼、帕唑帕尼、贝伐珠单抗、替西罗莫司、依维莫司、阿西替尼和卡博替尼等分子靶向治疗多种药物已应用于临床,为患者带来明显生存获益且耐受性较好。本文主要对晚期肾癌分子靶向治疗方面的最新进展进行综述。      

Cross-link between ferroptosis and nasopharyngeal carcinoma: New approach to radiotherapy sensitization

Ferroptosis is a recently discovered special type of regulated cell death that is strongly associated with both homeostasis maintenance and cancer development. Previous studies have indicated that a number of small-molecular agents inducing ferroptosis have great potential in the treatment of different types of cancer, including breast, pancreatic, prostate and head and neck cancer. However, the role of ferroptosis in nasopharyngeal carcinoma (NPC) has remained to be fully determined. To the best of our knowledge, no review of the currently available studies on this subject has been published to date. The metabolism and expression of specific genes that regulate ferroptosis may represent a promising radiosensitization target in cancer treatment. The aim of the present review was to describe the cross-link between ferroptosis and NPC and to discuss the potential value of regulators and the possible mechanism underlying the role of ferroptosis in the radiosensitization of NPC, in the hope that linking the mechanism of ferroptosis with the development of NPC will accelerate the development of novel ferroptosis-based targets and radiotherapy strategies in NPC.     

Novel perspective in pancreatic cancer therapy: Targeting ferroptosis pathway

Pancreatic cancer is a highly lethal malignancy with low resection and survival rates and is not sensitive to radiotherapy and chemotherapy. Ferroptosis is a novel form of nonapoptotic regulated cell death characterized by the accumulation of lipid peroxides and reactive oxygen species involved in iron metabolism. Ferroptosis has a significant role in the occurrence and development of various tumors. Previous studies have shown that regulating ferroptosis-induced cell death inhibited tumor growth in pancreatic cancer and was synergistic with other antitumor drugs to improve treatment sensitivity. Herein, we discuss the mechanism, inducers, and developments of ferroptosis in pancreatic cancer to provide new strategies for the treatment of the malignancy.     

Necroptosis: A new way of dying?

This review embarks upon a cell death journey from the discovery of apoptosis and necrosis through to the coalescence of these: necroptosis. The mechanisms of 2 emerging necrotic cell death pathways, pyroptosis and ferroptosis, will be explored before delving into apoptotic and necroptotic signaling cascades, highlighting the complex interplay between molecular players. The involvement of the ripoptosome, interferon signaling and DNA damage in necroptosis will be discussed briefly. The major focus is on necroptosis initiation by tumor necrosis factor-α (TNFα) and its cognate receptor TNFR1, caspase-independent RIP1/RIP3/MLKL necrosome activation and cell death propagation by damage-associated molecular pattern (DAMP) release. Finally, the implications of a complex cell death signaling network will be revealed in the context of cancer biology and therapy. The clinical contribution of the discovery of necroptosis as an unequivocally new way of dying is monumental and could drastically alter cancer therapy strategies in the future.     

铁死亡在消化系统肿瘤中的研究进展

铁死亡是一种新近发现的程序性细胞死亡形式,其过程主要表现为铁依赖的膜结构脂质过氧化损伤,进而导致细胞的完整性破坏并崩解死亡。铁死亡参与了包括肿瘤、缺血再灌注损伤、急性肾损伤和神经系统疾病等在内的多种疾病过程。铁死亡在肿瘤的发生发展中发挥重要作用,尤其对消化系统肿瘤存在较大的潜在临床转化研究意义。本文对铁死亡的发生机制以及其在消化系统肿瘤中的相关进展进行系统综述。      

Tumour stem cell-targeted treatment: elimination or differentiation.

A wide range of studies suggest that most cancers are clonal and may represent the progeny of a single cell, a cancer stem cell (CSC) endowed with the capacity to maintain tumour growth. The concept of a cancer stem cell emerged decades ago, and the haematopoietic system is where it has mostly gained ground. More recently, CSC have been described in breast cancer and brain tumours. Growing evidence suggests that pathways regulating normal stem cell self-renewal and differentiation are also present in cancer cells and CSC. Malignant tumours can be viewed as an abnormal organ in which a small population of tumourigenic cancer stem cells have escaped the normal limits of self-renewal giving rise to abnormally differentiated cancer cells that contribute to tumour progression and growth. This new model has important implications for the study and treatment of cancer. Understanding the molecular circuitry which contributes to the maintenance of stem cells may provide an insight into the molecular mechanisms of cancer and thus new approaches for elimination or differentiation therapy. Therapies targeting CSC should focus on pathways such as Wnt, Shh and Notch which are required for the maintenance of cancer stem cells, but also on the ABC transporter family and other specific properties of cancer stem cells.     

铁死亡在泌尿系统肿瘤中的作用及其机制研究进展

铁死亡是近年来新发现的一种不同于凋亡、坏死和自噬的程序性细胞死亡。细胞内谷胱甘肽及谷胱甘肽过氧化物酶抗氧化防御系统调控异常及铁离子依赖性膜结构脂质过氧化的蓄积是铁死亡发生的主要病理生理改变。铁死亡参与包括肿瘤、缺血再灌注损伤及神经系统疾病等多种疾病的发生发展过程。近年来研究发现铁死亡与泌尿系统肿瘤密切相关,本文概述了铁死亡在泌尿系统肿瘤发生及进展中作用的相关调控分子机制,旨在为泌尿系统肿瘤的临床治疗提供新的方向。     

Harnessing the cell death pathway for targeted cancer treatment

Genotoxic agents have long targeted apoptotic cell death as a primary means of treating cancer. However, the presence of cellular defects in many cancers has contributed to an acquired resistance to apoptotic cell death, lowering the effectiveness of chemo- and radiotherapies. The mechanisms by which cells achieve this resistance to treatment are still being investigated, but an alternative approach is the study of cell death pathways that are mechanistically distinct from apoptosis. These pathways, including autophagy and necrosis, have arisen as attractive targets for cancer therapy. This review will discuss apoptosis, autophagy, and necrosis in the context of tumorigenesis and drug resistance, as well as provide an up-to-date preclinical and clinical review of inhibitors targeting these cell death pathways for multiple cancer types. The goal of these studies is to identify molecular targets that will enhance the efficacy and specificity of current cancer therapies.     

铁死亡与乳腺癌治疗相关性的研究进展

铁死亡是近年来新发现的一种程序性细胞死亡形式，其特征是脂质活性氧的铁依赖性堆积，并在乳腺癌等疾病中起着重要的作用。乳腺癌是女性常见的恶性肿瘤之一，虽其病因及发病机制尚未阐明，但通过激活铁死亡途径能抑制乳腺癌细胞增殖，改善对化疗药物的耐药性，增强对放疗的敏感性及抑制癌细胞远处转移，可作为乳腺癌患者治疗的潜在新靶点。本文将对铁死亡发生机制及在乳腺癌治疗中的作用进行综述。      

Fumarate hydratase inactivation in hereditary leiomyomatosis and renal cell cancer is synthetic lethal with ferroptosis induction

Hereditary leiomyomatosis and renal cell cancer (HLRCC) is a hereditary cancer syndrome characterized by inactivation of the Krebs cycle enzyme fumarate hydratase (FH). HLRCC patients are at high risk of developing kidney cancer of type 2 papillary morphology that is refractory to current radiotherapy, immunotherapy and chemotherapy. Hence, an effective therapy for this deadly form of cancer is urgently needed. Here, we show that FH inactivation (FH^?/?) proves synthetic lethal with inducers of ferroptosis, an iron‐dependent and nonapoptotic form of cell death. Specifically, we identified gene signatures for compound sensitivities based on drug responses for 9 different drug classes against the NCI‐60 cell lines. These signatures predicted that ferroptosis inducers would be selectively toxic to FH^?/? cell line UOK262. Preferential cell death against UOK262‐FH^?/? was confirmed with 4 different ferroptosis inducers. Mechanistically, the FH^?/? sensitivity to ferroptosis is attributed to dysfunctional GPX4, the primary cellular defender against ferroptosis. We identified that C93 of GPX4 is readily post‐translationally modified by fumarates that accumulate in conditions of FH^?/?, and that C93 modification represses GPX4 activity. Induction of ferroptosis in FH‐inactivated tumors represents an opportunity for synthetic lethality in cancer.     

The interplay of oncogenic signaling,oxidative stress and ferroptosis in cancer

Oncogene-induced hyper-proliferation in cancer cells is accompanied by the onset of different stresses, including DNA-replication stress, metabolic stress and oxidative stress. Excessive accumulation of reactive oxygen species (ROS) plays a pivotal and contradictory role in tumor progression. ROS dictates a multitude of cell signaling pathways to facilitate the malignant transformation of tumor cells. In the meantime, oxidative burden in tumor cells mandates reinforcing antioxidant capacity to mitigate detrimental damages. The addiction to oxidative stress and increased iron demands in cancer cells also impinges on the sensitivity of ferroptosis. Targeting redox homeostasis and ferroptosis to overcome drug resistance in cancer treatment has become an attractive research topic. However, the roles of oncogenic signaling in redox regulation and ferroptosis have not been comprehensively discussed. In this review, we summarize current knowledge regarding the interplay between redox regulation and ferroptosis in the context of cancer biology. We emphasize the implication of oncogenic signaling in redox homeostasis and ferroptosis regulation. We also provide an overview of strategies targeting oxidative stress and ferroptosis in cancer treatment.     

Double and multiple primary cancers in an adult head and neck radiation therapy clinic

The records of 321 consecutive patients referred to the Radiation Oncology Center between January 1, 1980, and December 30, 1982, for head and neck cancers were reviewed to determine the incidence of other cancers. Two hundred sixty-two patients have had a single primary cancer in the head and neck region. Fifty-nine patients (18%) have had more than one cancer. These 59 patients have had 68 other cancers. While other head and neck cancers lead the list of second primaries, second cancers also occurred in the esophagus, lung, genitourinary system and elsewhere. Twenty cancers had occurred prior to the patient developing head and neck cancer. Thirty-two cancers were synchronous with the head and neck cancer; 16 have been metachronous. These numbers emphasize that patients with head and neck cancers are in a cancer-prone group that develops a variety of other cancers. These findings have important implications in work-up, radiation treatment planning, treatment goals and follow-up programs.     

自噬在细胞铁死亡发生中作用机制的研究进展

铁死亡（ferroptosis）是近年来新发现的一种非凋亡性细胞程序性死亡方式,以铁依赖性和脂质活性氧(lipid reactive oxygen species,L-ROS)累积为特征。自噬是真核生物中的高度保守的生物代谢过程,广泛参与机体生物调节。研究发现细胞铁死亡与自噬在肿瘤发生发展中关系密切,自噬调控基因及相关信号通路与铁死亡过程发生交互调节,影响细胞死亡进程。本文将概述铁死亡与自噬的发生及调节机制,综述自噬在铁死亡发生过程中的作用,展望利用自噬与铁死亡的相互作用对肿瘤治疗的意义。     

Burden of metastatic bone disease from genitourinary malignancies

Bone metastases are common among patients with stage IV genitourinary cancers. Most patients with bone metastases develop at least one debilitating and potentially life-limiting skeletal-related event. These events are associated with increased medical expenses and decreased quality of life. Current guidelines recommend screening for bone metastases in men with high-risk prostate cancer, but guidance for screening and treatment of bone metastases from genitourinary cancers varies by country and setting. Several bisphosphonates have been evaluated in the advanced genitourinary cancer setting. Zoledronic acid has demonstrated efficacy in significantly reducing the risk of skeletal-related events in patients with bone metastases from a broad range of solid tumors including prostate, renal and bladder cancers, and is recommended for preserving bone health.