中药逆转肿瘤多药耐药的研究进展

目的综述逆转肿瘤多药耐药(MDR)的研究进展。方法检索中药提取物或中药单体联合化疗药物逆转肿瘤MDR的研究。结果一些中药提取物或中药单体能使耐药株对化疗药物变得敏感,使耐药蛋白的转运活性下降。结论中药具有逆转肿瘤MDR的活性,其作用机制大多是与耐药相关蛋白相关的。     

肿瘤多药耐药机制及其逆转方案的研究

肿瘤细胞产生的多药耐药(multidrug resistance,MDR)是临床上肿瘤化学治疗失败的主要原因之一。MDR产生机制非常复杂,对肿瘤多药耐药机制的研究以及寻找高效、低毒、作用靶点广泛的逆转肿瘤耐药的药物,已成为肿瘤治疗亟待解决的关键性问题。本文就肿瘤多药耐药产生的可能途径和逆转策略进行综述,为临床医师针对肿瘤患者制定个体化化疗方案,达到减少耐药性、提高临床疗效的目的提供参考资料。     

白血病细胞多药耐药逆转方法的研究进展

白血病细胞耐药的产生是药物治疗中的一大阻碍,耐药细胞过表达的跨膜转运蛋白（主要为P-糖蛋白）导致胞内药物浓度降低是产生耐药的主要原因。此外,凋亡基因的异常表达、药物作用靶点的改变也产生多药耐药（MDR）。针对这些特点寻找合适的药品与化疗药合用以增加肿瘤细胞对化疗药的敏感性,或者利用高分子材料改变释药系统,以及开发新型药物是逆转白血病细胞耐药的主要手段。通过对逆转白血病MDR的方法进行探讨,旨在为白血病治疗提供新思路。     

中药逆转肿瘤多药耐药非经典机制的研究进展

目前认为,由肿瘤多药耐药(MDR)基因编码的P-糖蛋白(P-gp)过度表达介导的药物外排是产生MDR的经典机制[1]。除此外,MDR还与多药耐药相关蛋白(MRP)、谷光甘肽-S-转移酶(GST)、拓扑异构酶Ⅱ(TopoⅡ)、细胞凋亡等多种非经典机制密切相关。由于中药不同于一般的化学制剂只有单一的逆转作用靶点,一种中药单体就是一个复杂的化学分子复合体,往往同时具有数种逆转机制,故从中药中筛选有效的MDR逆转剂已成为近年的研究热点。然而,中药逆转肿瘤MDR研究现存的主要问题是无论何种剂型,其研究机制偏于单一,大多数的研究主要集中在经典机制上。…     

中药逆转肺癌多药耐药的研究新进展

肺癌发病率和死亡率居全球恶性肿瘤首位,作为治疗主导方向的化疗,药物推陈出新,方案不断优化,疗效却已达“平台期”,究其原因,肺癌细胞的多药耐药(MDR)不容忽视。寻找肺癌化疗耐药逆转剂,逆转MDR 是肿瘤领域的研究热点。中药活性广泛而显著,高效小毒,多靶点逆转MDR,临床药效逐步得到肯定,但明确的逆转机制尚待研究。     

黄酮类化合物逆转肿瘤多药耐药的研究进展

肿瘤多药耐药(multidrug resistance,MDR)是临床上导致化疗失败的重要原因。采用化疗药物与多药耐药逆转剂联合给药是逆转多药耐药的非常具有前景的策略。目前黄酮类化合物在逆转多药耐药上显示出较大潜力。黄酮类化合物可以通过抑制外排蛋白、诱导凋亡、调节细胞周期以及调节细胞内氧化应激等发挥逆转耐药的作用。黄酮类化合物可以单独给药或与化疗药物等联合给药用于逆转肿瘤多药耐药。本文就黄酮类化合物逆转MDR的机制及应用研究进展进行综述。     

肿瘤多药耐药逆转药物的研究进展

化疗是目前治疗肿瘤主要手段之一,而在治疗过程中产生的多药耐药（multidrug resistance,MDR）现象却是造成化疗失败的主要因素。多药耐药是指肿瘤对一种抗肿瘤药物出现耐药的同时,对其他许多结构各异、作用机制不同的抗肿瘤药物亦产生交叉耐药现象。因此,研究MDR产生的机制、寻求有效的耐药逆转剂及逆转措施,克服MDR现象已成为国内外的研究热点。     

活血化瘀类中药逆转多药耐药作用的研究概况

肿瘤的多药耐药（multidrug resistance,MDR）是肿瘤化疗失败的主要原因之一。中草药以其多成分,多作用机制的优势在我国肿瘤临床治疗方面获得了广泛的应用,其中活血化瘀类中药是常用的一类药物,目前已经发现该类中药对肿瘤细胞的多药耐药具有逆转作用。现就MDR的发生机制和活血化瘀类中药制剂逆转MDR的研究作一综述。     

食管癌多药耐药机制的研究进展

化疗是食管癌治疗的主要方法之一,而多药耐药(MDR)现象是目前食管癌化疗过程中遇到的最大障碍。肿瘤MDR是指肿瘤患者经过某种化疗药物长期治疗后,除了对该化疗药物产生耐药性,对其他多种结构和功能不同的抗肿瘤药物亦产生耐药。肿瘤MDR是一个多阶段、多因素参与的复杂过程,包括药物转运蛋白的外排作用、靶酶的变化以及其他参与因素的改变等,主要对食管癌多药耐药机制及其逆转剂的研究进展进行综述。     

P-糖蛋白介导的多药耐药及其逆转剂的研究进展

多药耐药(multidrug resistance,MDR)[1]是指肿瘤细胞对1种抗肿瘤药物产生耐药性的同时,对结构和作用机制完全不同的其他多种抗肿瘤药物产生交叉耐药性,是一种独特的广谱耐药现象[2].MDR由多种途径诱导,可分为经典和非经典MDR两大机制.MDR是肿瘤化疗的一个主要的障碍.抗肿瘤药物在肿瘤细胞积累的下降,可被几种膜蛋白质调节,这些膜蛋白质属于ATP结合的盒式(ATP binding cassette,ABC)运输蛋白家族成员,P-糖蛋白(P-gp)属于这个蛋白家族.P-gp是一种ATP依赖性的跨膜外流泵,它可通过细胞膜转运多种抗肿瘤药,从而限制这些抗肿瘤药进入细胞而导致肿瘤细胞耐药.据此,研究学者着力于寻找抑制P-gp的分子,以逆转肿瘤化疗药的耐药性.近年来由于中药资源丰富,作用靶点多,可针对MDR机制复杂的特点,有学者开始开发逆转肿瘤MDR的中药.     

The role of ABC transporters in drug resistance, metabolism and toxicity

ATP Binding Cassette (ABC) transporters form a special family of membrane proteins, characterized by homologous ATP-binding, and large, multispanning transmembrane domains. Several members of this family are primary active transporters, which significantly modulate the absorption, metabolism, cellular effectivity and toxicity of pharmacological agents. This review provides a general overview of the human ABC transporters, their expression, localization and basic mechanism of action. Then we shortly deal with the human ABC transporters as targets of therapeutic interventions in medicine, including cancer drug resistance, lipid and other metabolic disorders, and even gene therapy applications. We place a special emphasis on the three major groups of ABC transporters involved in cancer multidrug resistance (MDR). These are the classical P-glycoprotein (MDR1, ABCB1), the multidrug resistance associated proteins (MRPs, in the ABCC subfamily), and the ABCG2 protein, an ABC half-transporter. All these proteins catalyze an ATP-dependent active transport of chemically unrelated compounds, including anticancer drugs. MDR1 (P-glycoprotein) and ABCG2 preferentially extrude large hydrophobic, positively charged molecules, while the members of the MRP family can extrude both hydrophobic uncharged molecules and water-soluble anionic compounds. Based on the physiological expression and role of these transporters, we provide examples for their role in Absorption-Distribution-Metabolism-Excretion (ADME) and toxicology, and describe several basic assays which can be applied for screening drug interactions with ABC transporters in the course of drug research and development.     

Molecular mechanisms for tumour resistance to chemotherapy

Chemotherapy is one of the prevailing methods used to treat malignant tumours, but the outcome and prognosis of tumour patients are not optimistic. Cancer cells gradually generate resistance to almost all chemotherapeutic drugs via a variety of distinct mechanisms and pathways. Chemotherapeutic resistance, either intrinsic or acquired, is caused and sustained by reduced drug accumulation and increased drug export, alterations in drug targets and signalling transduction molecules, increased repair of drug‐induced DNA damage, and evasion of apoptosis. In order to better understand the mechanisms of chemoresistance, this review highlights our current knowledge of the role of altered drug metabolism and transport and deregulation of apoptosis and autophagy in the development of tumour chemoresistance. Reduced intracellular activation of prodrugs (e.g. thiotepa and tegafur) or enhanced drug inactivation by Phase I and II enzymes contributes to the development of chemoresistance. Both primary and acquired resistance can be caused by alterations in the transport of anticancer drugs which is mediated by a variety of drug transporters such as P‐glycoprotein (P‐gp), multidrug resistance associated proteins, and breast cancer resistance protein. Presently there is a line of evidence indicating that deregulation of programmed cell death including apoptosis and autophagy is also an important mechanism for tumour resistance to anticancer drugs. Reversal of chemoresistance is likely via pharmacological and biological approaches. Further studies are warranted to grasp the full picture of how each type of cancer cells develop resistance to anticancer drugs and to identify novel strategies to overcome it.     

The multidrug resistance mechanisms and their interactions with the radiopharmaceutical probes used for an in vivo detection

The resistance of human malignancy to multiple chemotherapeutic agents ts remains a major obstacle in cancer therapy. This resistance phenomenon is called "multiple" because when cells are resistant they fail to respond to any of a wide range of anticancer agents. This leads to a complete ineffectiveness of any treatment and has dramatic consequences for the patients. This chemoresistance can be intrinsic--when tumour cells do not respond initially to the treatment--or acquired--when resistance appear during the therapy. Our understanding of the mechanisms responsible of the drug resistance has increased over the past few years. The tumour resistance is able to develop several strategies to inactivate the chemotherapeutic agents such as activation of the detoxification process, and overexpression of efflux pump proteins. The phenotype resistance of the cell is mainly characterised by an increased expression of membrane transport proteins such as the P-glycoprotein and the Multidrug Resistance Protein--MRPI--that act as real efflux pump to anticancer agent and contribute to physiological alterations i.e. intracellular pH and plasma membrane potentials. The detoxification procedure is also implicated with the Glutathione S transferase enzymes and the major anti oxidant of the cells the glutathione (GSH). More recently a newly reported transporter called "Breast Resistance Cancer Protein" has appeared. The role of all these transporters and the link with the detoxification systems in the clinical outcome of cancer chemotherapy is the subject of intense research. Particularly, one way of interest concerned in vivo investigations with radiolabelled compounds used in nuclear medicine. The understanding of how the radiolabelled compounds could interact with the phenotype resistance of the cells had a key role for further exploration of molecular imaging of the MDR phenotype.     

Pluronic block copolymers for overcoming drug resistance in cancer

Pluronic block copolymers have been used extensively in a variety of pharmaceutical formulations including delivery of low molecular mass drugs and polypeptides. This review describes novel applications of Pluronic block copolymers in the treatment of drug-resistant tumors. It has been discovered that Pluronic block copolymers interact with multidrug-resistant cancer (MDR) tumors resulting in drastic sensitization of these tumors with respect to various anticancer agents, particularly, anthracycline antibiotics. Furthermore, Pluronic affects several distinct drug resistance mechanisms including inhibition of drug efflux transporters, abolishing drug sequestration in acidic vesicles as well as inhibiting the glutathione/glutathione S-transferase detoxification system. All these mechanisms of drug resistance are energy-dependent and therefore ATP depletion induced by Pluronic block copolymers in MDR cells is considered as one potential reason for chemosensitization of these cells. Following validation using in vitro and in vivo models, a formulation containing doxorubicin and Pluronic mixture (L61 and F127), SP1049C, has been evaluated in phase I clinical trials. Further mechanistic studies and clinical evaluations of these systems are in progress.     

Nanoparticles for delivery of chemotherapeutic agents to tumors

Despite decades of research, progress in cancer chemotherapy is relatively slow, hampered, in part, by the lack of appropriate mechanisms to deliver anticancer drugs selectively to tumor tissues. This is a challenging task, as various cellular, anatomical and physiological barriers impede effective delivery of drugs to tumors. Systemic or oral administration can cause severe toxicity, which limits the therapeutic potential of anticancer drugs. Therefore, the most important goal of drug delivery is to minimize the exposure of normal tissues to these drugs while maintaining their therapeutic concentration in tumors. Furthermore, the risk of subtherapeutic dosing of anticancer drugs is significant as tumors may develop drug resistance as a result of biochemical changes, drug export mechanisms, or limitations in mechanisms of cellular drug importation. As the field of cancer nanomedicine advances, it is anticipated that many drug delivery-related issues concerning cancer chemotherapeutics will be resolved. This review discusses the current status of nanoparticle-mediated cancer drug delivery, challenges to its utilization, and potential implications of its use in cancer therapy.     

An update on overcoming MDR1-mediated multidrug resistance in cancer chemotherapy

The intrinsic or acquired resistance to anticancer drugs remains one of the most significant factors impeding the progress of cancer chemotherapy. This phenomenon often involves simultaneous resistance to other anticancer drugs that differ in their chemical structure and mode of action and are not even used in chemotherapy. This phenotype has been called multidrug resistance (MDR). Although the cellular basis underlying MDR is not fully understood, several factors mediating therapy resistance in tumors have been proposed. One of the mechanisms leading to chemoresistance of tumor cells is the increased activity of transporter proteins. The best-characterized transporter protein is MDR1/P-glycoprotein, and a number of clinical investigations have suggested that its intrinsic or acquired overexpression resulted in a poor clinical outcome of chemotherapy. Various types of compounds and techniques for the reversal of MDR1/P-glycoprotein-mediated MDR have been developed, and efforts have concentrated on the inhibition of function and suppression of expression. This review summarizes the current state of knowledge of MDR1/P-glycoprotein and the modulation of MDR by targeting MDR1/P-glycoprotein.