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结合绕过p53的药物来治疗TP53突变白血病
Sudipta Biswas1, Zeinab Albadry M Zahran1,2, Xiaorong Gu1
1Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.
使用特里弗卢诺米德向皮里米丁合成,可以规避TP53突变AML中对低甲基化剂的耐药性. 定时,间歇的DHODH和DNMT1抑制方案为治疗耐药AML提供了一种非细胞毒性方法.
科学领域:
- 血液学 血液学 血液学
- 癌症生物学 癌症生物学
- 药理学 药理学是指药理学的学科.
背景情况:
- 患有TP53突变的急性髓性白血病 (AML) 往往会对低甲基化剂 (HMA) 发展出快速的耐药性,如德西他和5-阿扎丁.
- HMA耐药性与内源性pyrimidines的增加和CAD的上调有关,这是de novo pyrimidine合成中的关键酶.
- 由于基线CAD水平较高,TP53突变的AML表现出对HMA耐药性的倾向.
研究的目的:
- 研究新的治疗策略,以克服TP53突变AML中的HMA耐药性.
- 评估向金二胺合成的疗效,特别是通过DHODH与teriflunomide的抑制,作为恢复HMA敏感性的手段.
- 为了确定Terriflunomide和HMA组合治疗的最佳剂量计划.
主要方法:
- 评估了 teriflunomide 对 HMA 抵抗性 TP53 突变 AML 细胞中的金字素水平, DNMT1 枯竭和细胞活力的影响.
- 研究了BCL2抑制剂venetoclax的作用及其在TP53突变AML中的有限疗效.
- 利用TP53突变AML的小鼠模型来比较不同的特里弗卢诺米德-HMA组合方案.
- 检查了慢性特里弗卢诺米德暴露对皮里米丁代谢和HMA敏感性的影响.
主要成果:
- 泰里弗卢诺米德有效降低了胺水平,恢复了DNMT1的枯竭,并诱导了HMA耐药AML细胞的终端分化,绕过了p53/apoptosis通路.
- 这种DHODH抑制保留了正常的造血干细胞和原生细胞 (NHSPCs).
- 当Teriflunomide在HMA前一天服用时,可以获得最佳的疗效,证明了时间表依赖的协同作用.
- 长期暴露于特里弗卢诺米德导致了补偿性皮里米丁救援,可能导致对HMA的抗性.
结论:
- 用特里弗卢诺米德向二罗酸脱酶 (DHODH) 是一种有前途的策略,用于克服TP53突变AML中的HMA耐药性.
- 定时,间歇 (计量学) 的DNMT1和DHODH抑制剂可以规避遗传和适应性耐药机制.
- 这种方法提供了一种非细胞毒性治疗选择,可以节省正常的造血干细胞/原始细胞 (HSPC).
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