摘要
前列腺癌是成年男性最常见的肿瘤之一,而热休克蛋白(HSPs)作为广泛参与多种肿瘤发病机制、诊断、治疗和预后的分子伴侣,在前列腺癌中发挥着重要的生物学功能,并且HSP27被认为是与前列腺特异性膜抗原类似的生物标志物。其中,热休克蛋白家族成员HSP27的表达增加与前列腺癌去势抵抗有关,并且能够促进肿瘤耐药、侵袭与骨转移,从而使前列腺癌更加难以治疗。因此,靶向前列腺癌中的HSP27可以作为一种有前景的肿瘤治疗策略。本文就HSP27的结构与功能、前列腺癌中HSP27介导的去势抵抗及以HSP27为靶点的抗肿瘤治疗研究进行综述,以期为临床中前列腺癌治疗方案提供新的理论依据。
热休克蛋白(heat shock proteins,HSPs)是一类受热休克或其他应激源诱导激活并参与蛋白折叠和成熟的大家族蛋白,包括HSP27、HSP40、HSP60、HSP70、HSP90和大型HSP
前列腺癌(prostate cancer,PCa)是男性高危肿瘤之一,在老年男性当中具有较高的发病风险。先前有研究表明西方国家的前列腺癌发病率最高,但最近的报告指出包括中国在内的许多世界其他国家及地区前列腺癌发病率也在不断增
前列腺癌中的HSP27是肿瘤进展的关键调节者,可促进雄激素受体折叠和核内运输,并且可作为确定PCa分期状态的有效预后工具。患者群体的异质性和预后状态是高危疾病治疗的关键因素,如有的PCa患者具有致死表型,而有的可能在肿瘤发展的初级阶段就能治愈,故将HSP27作为预后诊断工具具有十分重要的临床价值。本文综述了HSP27在前列腺癌中的作用,包括HSP27受诱导产生的机制、抗凋亡能力及其在肿瘤进展与耐药中的具体功能。此外,本文总结了靶向HSP27治疗的研究成果,并将其作为治疗CRPC的一种有效策略。
HSPs一般根据相对分子质量进行分类,其中大多数属于HSP27、HSP40、HSP60、HSP70、HSP90和大型HSPs (HSP110和葡萄糖抑制蛋白170、GRP170)。大部分HSP蛋白是具有ATP酶活性的ATP依赖性蛋白,而HSP27属于ATP非依赖性蛋

Figure 1 Structure of human HSP27
与大多数小型热休克蛋白相似,HSP27能够形成相对分子质量接近800 kD~1 000 kD的同质或异质低聚复合物。位于N端区域的3个丝氨酸残基(Ser15、Ser78和Ser82)的磷酸化是影响HSP27寡聚状态和伴侣功能的关键翻译后修饰过程,而磷酸化位点Thr143位于α-crystallin
正常细胞具有独特的细胞保护机制,以承受各种压力条件。非应激细胞表达足以维持蛋白质组和细胞稳态的基础水平的热休克蛋白,而应激细胞表达更高水平的热休克蛋白从而保护重要蛋白免受毒性物质的伤害。HSP27在很多肿瘤细胞中高表达,帮助折叠癌蛋白并维持其稳定性,抑制其在肿瘤微环境中的聚集或水解,从而成为代谢调节的必要元
HSP27在调控肿瘤的发生、发展、转移、细胞凋亡、耐药等方面具有重要作用,可作为疾病预后不良的指标。抑制HSP27可以逆转上皮-间质转化(EMT)、降低基质金属蛋白酶(MMP)活性并抑制肿瘤细胞的增殖、迁移和侵
研究发现HSP27在肿瘤细胞中可通过抑制p53介导的p21表达,调控p53信号通路,从而抑制细胞衰
HSP27在人类肿瘤中的表达水平已经得到了深入的研究,其异常表达与肿瘤的侵袭性、化疗的耐药性以及患者预后不良有关。然而,在肿瘤中对HSP27磷酸化作用的相关研究报道较少。事实上,各种刺激物可以诱导HSP27中丝氨酸残基15、78和82的磷酸化,这种翻译后修饰影响了HSP27的一些细胞功
Yin
HSP27在PCa细胞中的一个重要作用是其能帮助折叠和支持雄激素受体(AR)运输。AR是睾酮和双氢睾酮的甾类受体转录因子,在前列腺癌,尤其是在去势抵抗性前列腺癌中起重要作
在前列腺癌细胞中AR是一种客体蛋白,可与HSP90、HSP70和HSP40(

Figure 2 Proposed roles of HSP proteins in the regulation of AR signaling
除经典途径外,研究结果还表明:雄激素及其他类固醇激素刺激能够使AR定位于膜脂质筏的微区并与AKT相互作用,激活AKT信号传
HSP27磷酸化后会形成伴侣分子寡聚物调节多种细胞存活相关信号通路, HSP27能够与细胞色素c结合并抑制caspase活化和细胞凋
临床研究发现在进行雄激素剥夺或化学药物治疗后,前列腺癌细胞中HSP27表达显著增加并作为细胞保护性伴侣分子发挥作用,使细胞具有耐药
HSP27的表达增加与前列腺癌发展为易转移扩散的CRPC有关。有研究报道HSP27能通过翻译控制PCa中的相关肿瘤蛋白(如TCTP)表达,从而促进肿瘤恶性发
虽然HSP27在各种肿瘤类型中都有表达,但许多研究认为HSP27是PCa的一个独特而重要的标志物。HSP27在PCa细胞中的表达增加间接反映了肿瘤的转移趋势以及不良的预后状态。最近的蛋白组学研究表明,HSP27、ALDH6A1与抗增殖蛋白可作为3种生物标志物来监测前列腺肿瘤早期和晚期的状态变
与HSP90和HSP70不同,HSP27由于其结构中缺少ATP结合域,不适合作为小分子抑制剂的直接作用靶点。其他靶向机制,如Dong
Nappi
HSP27作为伴侣分子协助前列腺癌中AR的核转位与功能激活,并促进AKT的磷酸化,而AR与AKT信号网络在前列腺癌糖酵解作用中发挥着重要作
近年来,靶向HSP27寡聚化方法的出现使以HSP27为靶点的治疗有更多的选择,像zerumbone (ZER)这样的小分子通过其半胱氨酸残基的交联导致HSP27的二聚改变,从而抑制HSP27低聚化,增加肿瘤细胞对放疗的敏感
HSP27在肿瘤发生中发挥重要作用,并且与前列腺癌转移以及去势耐药相关,可作为潜在的临床生物标志物,用于前列腺癌患者的诊断和预后标记。此外,HSP27还可作为前列腺癌治疗的潜在靶点,有助于新型化疗药物的开发。
然而,现阶段研究还没有完全解释清楚肿瘤细胞和正常细胞对HSP的不同需求,而进一步的研究可以为开发更有效、毒性更小的新型抗肿瘤HSP27抑制剂找到一个治疗窗口。现研究开发的一些HSP抑制剂缺乏令人满意的抗肿瘤活性,且具有一定的器官毒性,而对一种HSP的抑制可能会刺激其他HSP过度表达,从而减弱单一HSP抑制剂的抑制作用。例如,HSP27的抑制会刺激热休克反应,导致其他HSPs的过表达。因此,联合使用不同的HSPs抑制剂可能是提高肿瘤治疗疗效的一种良好策略,而进一步了解HSP27的功能和分子机制对于提高前列腺癌诊断的准确性和开发更有效的化疗药物具有十分重要的意义。
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