由于抑制C终端Src激酶而导致的易布鲁替尼心房动
Ling Xiao1, Joe-Elie Salem2,3,4, Sebastian Clauss1,5,6
1Cardiovascular Research Center (L.X., S.C., A.H., A.B., J.T., M.N., P.T.E., D.J.M.), Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Circulation
|October 23, 2020
概括
易布鲁替尼通过抑制C端Src激酶 (CSK) 引起心房动,这是一种非目标效应. 这一发现解释了这种B细胞癌症药物的关键副作用.
科学领域:
- 心脏病学
- 癌症学
- 药理学
背景情况:
- 易布鲁替尼是一种布鲁顿氨酸激酶抑制剂,对B细胞癌症有效,但会增加心房动 (AF) 的风险.
- 伊布鲁替尼诱导的AF背后的机制尚不清楚.
研究的目的:
- 研究ibrutinib在小鼠中的电生理作用.
- 确定因易布鲁替尼诱导的肌肉炎的分子点.
- 在人类药物监测数据中确认已识别的目标和AF之间的关联.
主要方法:
- 在接受ibrutinib治疗的小鼠中进行电生理学研究.
- 化学蛋白质分析以确定易布鲁替尼的心脏点.
- 基因小鼠模型 (布鲁顿氨酸激酶淘汰,心脏特异性Csk淘汰) 和药理实验.
- 对VigiBase药监数据库的分析
主要成果:
- 在小鼠中,易布鲁替尼治疗引发了AF,左心房扩大,纤维化和炎症.
- 易布鲁替尼的AF诱导独立于布鲁顿氨酸激酶,但与非位抑制有关.
- 鉴定出C终端Src激酶 (CSK) 是主要的非向激酶,可导致IBRUTINIB诱导的AF.
- 针对心脏特异性Csk淘汰赛小鼠的复制 ibrutinib 治疗效应.
- 在VigiBase分析中,CSK抑制剂与AF报告增加之间存在显著的关联 (OR=8. 0).
结论:
- 抑制CSK是驱动易布鲁替尼诱导的AF的机制.
- 这一发现确定了显著临床副作用的特定分子途径.
- 了解这种机制可能有助于在接受ibrutinib或类似激酶抑制剂治疗的患者中减轻AF风险.
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