FLT3^-的AML细胞对PKC412体外敏感性的初步研究

目的:探索PKC412(midostaurin,米哚妥林)在FLT3^-AM L患者治疗中的价值。方法:无菌采集21例FLT3^-的初治AML患者骨髓血或外周血肝素抗凝,应用密度梯度离心法分离单个核细胞,采用三磷酸腺苷生物荧光肿瘤体外药敏检测技术(ATP bioluminescence-tumor chemosensitivity assay,ATP-TCA)测定白血病细胞体外对8种浓度PKC412的敏感性,并分析其体外药敏结果、危险度分层及临床疗效三者之间的关系。结果:21例AML患者的白血病细胞在体外对PKC412的反应不相同,体外敏感率为42.9%,体外敏感浓度为1-5μmol/L。PKC412体外药敏结果与患者危险度分层之间无相关性,与临床疗效之间也无相关性。低、中危组患者的存活率著优于高危组患者(P=0.015)。结论:PKC412可能是FLT3^-初治AML的有效治疗手段之一;白血病细胞对PKC412的敏感性有可能成为判断PKC421疗效的独立预测指标。

米哚妥林对急性白血病细胞株HL-60细胞抑制效应的研究

目的:探讨蛋白激酶C(PKC)抑制剂米哚妥林(PKC412)对HL-60细胞株增殖和凋亡的影响及作用机制。方法:采用CCK-8法检测不同浓度PKC412对HL-60细胞增殖的影响;瑞士吉姆萨染色法鉴定PKC412对HL-60细胞凋亡的影响;qRT-PCR检测BCL-2、P53基因的mRNA表达,Western blot检测BCL-2、P53蛋白的表达;以尾静脉注射HL-60细胞构建急性白血病小鼠模型,以PKC41231.25nmol/kg尾静脉给药,生理盐水组作为对照组,研究PKC412在小鼠体内对HL-60细胞的抑制;ELISA法检测PKC412对肿瘤小鼠细胞因子TNF-α和TGF-β分泌的影响。结果:PKC412抑制HL-60细胞株细胞增殖,呈剂量依赖性(r=0.9973),其中IC50=0.31μmol/L;并能诱导HL-60细胞凋亡。PKC412作用HL-60细胞株48 h后,与对照组比较BCL-2基因mRNA表达下调(0.417±0.044 vs 0.933±0.033,t=9.347,P<0.001),P53基因mRNA表达上调(1.533±0.145 vs 1.050±0.161,t=2.231,P>0.05);BCL-2蛋白表达量下降,P53蛋白表达量升高。PKC412在体内可抑制HL-60肿瘤细胞生长,给药后小鼠生存率为50%,与对照组比较体重增加(18.02±0.403 g vs 16.44±0.562 g,t=2.272,P=0.0356)。PKC412组血清及脾细胞中TNF-α和TGF-β细胞因子较对照组分泌明显减少(P<0.05)。结论:PKC412能通过抑制BCL-2基因表达水平诱导HL-60细胞凋亡,体内给药可抑制肿瘤的生长。

上海交通大学医学院附属瑞金医院感染科与美国密歇根大学共同研究发现肝损伤治疗“新选择”

上海交通大学医学院附属瑞金医院感染科与美国密歇根大学Bishr Omary教授的实验室共同研究发现肝损伤治疗“新选择”——PKC412。该研究首次为角蛋白相关性肝损伤提供了治疗选择，从而为急慢性肝损伤提供了全新的研究思路。

Compassionate Use of Midostaurin in Myeloid and Lymphoid Neoplasia with FGFR1 Abnormality

Background: Patients with stem cell myeloproliferative disorders have a particularly poor prognosis and limited treatment options, i.e. mainly aggressive chemotherapy or allogeneic stem cell transplantation. In 2004, Chen et al. reported a patient presenting a t(8;13) (p11;q12) cytogenic anomaly who responded positively to treatment with PKC412 (midostaurin), an oral multi-targeted tyrosine kinase inhibitor. Here, we report a second case treated with the above-mentioned drug. Patient: A 71-year-old woman was diagnosed as having chronic myelogenous leukaemia with eosinophilia secondary to t(8;13) with FGFR1 involvement. Due to her age, an allogeneic stem cell transplantation was not possible. Treatment: A treatment combining aggressive chemotherapy and midostaurin was explored. The patient received one cycle of hyper-CVAD chemotherapy followed by maintenance therapy with midostaurin. A relapse occurred after six months, and she was treated with four more cycles of hyper-CVAD chemotherapy. The patient entered a complete clinical, haematological and cytogenetic remission. A maintenance therapy with midostaurin continued for four months until she developed a chemoresistant relapse followed by acute leukaemia. Conclusion: This is the second case of a t(8;13) myeloid and lymphoid neoplasm with FGFR1 abnormalities treated successfully with midostaurin. Midostaurin is administered orally, allows for outpatient care and in this case showed only occasional and minimal side effects. The combination of hyper-CVAD and midostaurin extended survival by 21 months without allogeneic transplantation. This case further supports the possibility of using midostaurin for the treatment of other diseases with FGFR1 dysregulations;however, specific clinical trials are needed to confirm this hypothesis.

米哚妥林衍生物5'''-methoxyfradcarbazole A对小鼠白血病CB3细胞的作用及机制研究

目的研究米哚妥林衍生物5'''-methoxyfradcarbazole A对小鼠白血病细胞CB3生长抑制的作用机制。方法四甲基偶氮唑蓝(MTT)法检测化合物5'''-methoxyfradcarbazole A对小鼠白血病细胞CB3细胞增殖的影响,并测定其生长抑制曲线;利用流式细胞术测定细胞凋亡、周期和分化的结果;Western blot分析5'''-methoxyfradcarbazole A对细胞周期、凋亡相关蛋白的影响。结果化合物5'''-methoxyfradcarbazole A对小鼠白血病细胞具有显著的生长抑制作用,其IC50值为(0.587±0.135)μmol·L-1;5'''-methoxyfradcarbazole A能够诱导CB3细胞产生早期凋亡和晚期凋亡,并表现出时间和浓度的依赖性;其还能影响CB3的细胞周期,明显增高G2期比例;5'''-methoxyfradcarbazole A促进血小板分化标志物CD41和红细胞分化标志物Ter119表达的增加;此外,5'''-methoxyfradcarbazole A作用CB3细胞后显著增加凋亡相关蛋白Bim、PARP1和细胞周期蛋白P21的表达,降低磷酸化ERK蛋白的表达。结论5'''-methoxyfradcarbazole A通过促进凋亡蛋白Bim的表达增加小鼠白血病细胞CB3的凋亡,通过增加细胞周期蛋白P21的表达使CB3细胞发生G2期阻滞;此外,PARP1及磷酸化的ERK蛋白表达水平变化也在一定程度上解释了5'''-methoxyfradcarbazole A对CB3细胞的生长抑制作用。