Article(id=1202979642878681829, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1202979639087030850, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2379.2022.0412, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1634313600000, receivedDateStr=2021-10-16, revisedDate=null, revisedDateStr=null, acceptedDate=1638460800000, acceptedDateStr=2021-12-03, onlineDate=1764742297143, onlineDateStr=2025-12-03, pubDate=1690473600000, pubDateStr=2023-07-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1764742297143, onlineIssueDateStr=2025-12-03, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1764742297143, creator=13701087609, updateTime=1764742297143, updator=13701087609, issue=Issue{id=1202979639087030850, tenantId=1146029695717560320, journalId=1189873630562394117, year='2023', volume='48', issue='7', pageStart='749', pageEnd='870', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1764742296239, creator=13701087609, updateTime=1764742346610, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1202979850442203282, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1202979639087030850, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1202979850442203283, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1202979639087030850, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=834, endPage=840, ext={EN=ArticleExt(id=1202979643314889478, articleId=1202979642878681829, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Research progress on MAGE-A4 in tumor diagnosis and immunotherapy, columnId=1190243275882729994, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Review, runingTitle=null, highlight=null, articleAbstract=

Immunotherapy has become one of the hopes to ultimately defeat cancer after radiotherapy, chemotherapy and targeted therapy, and tumor-associated antigen is an important target in immunotherapy. As an important member of the melanoma associated antigen-A (MAGE-A) subfamily, MAGE-A4 is highly expressed in various tumor tissues and low expressed in normal tissues except testis and placenta. It is involved in the regulation of cell functions and has important roles in regulating cell cycle, inducing cell differentiation and growth, and participating in epithelial-mesenchymal transformation, which is closely related to the tumorigenesis, progression, metastasis and prognosis. The latest study shows that the phase Ⅱ clinical study of T cell receptor-transgenic T (TCR-T) immunotherapy based on MAGE-A4 target is being carried out. The results of phase Ⅰ study showed that the overall response rate (ORR) was 23.7% and the disease stability was 47.4%, suggesting that TCR-T immunotherapy based on MAGE-A4 target has good clinical application value. This paper summarizes the structure and biological function of MAGE-A4, the latest research progress of various solid tumors and its clinical application, aiming to provide theoretical basis for clinical transformation and immune-targeted therapy of MAGE-A4.

, correspAuthors=Yu-Min Li, authorNote=null, correspAuthorsNote=
* E-mail:
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肿瘤免疫治疗已成为继放化疗、靶向治疗后最终攻克癌症的希望之一,而肿瘤相关性抗原是免疫治疗的重要靶点。黑色素瘤相关抗原-A4(MAGE-A4)作为癌睾丸抗原,是MAGE-A亚家族的重要成员,具有很好的组织学特异性,在多种肿瘤组织中呈高表达,在正常组织(除睾丸、胎盘外)中均呈低表达。MAGE-A4参与细胞功能的调节,具有调控细胞周期、诱导细胞分化和生长、参与上皮-间质转化等重要作用,与肿瘤的发生、发展、转移及预后密切相关。目前,以MAGE-A4为靶点的T细胞受体转基因T细胞(TCR-T)免疫治疗,其Ⅰ期临床试验结果显示总体反应率(ORR)为23.7%、病情稳定率为47.4%,Ⅱ期临床试验正在开展,提示以MAGE-A4为靶点的TCR-T免疫治疗具有较高的临床应用价值。本文总结了MAGE-A4的结构和生物学功能及其在多种实体肿瘤中的最新研究进展和临床应用,旨在为MAGE-A4的临床转化及免疫靶向治疗提供理论基础。

, correspAuthors=李玉民, authorNote=null, correspAuthorsNote=
李玉民,E-mail:
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吴文章,硕士研究生,主要从事消化系统肿瘤免疫治疗方面的研究

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Int J Mol Sci, 2021, 22(10): 5208., articleTitle=MAGEA4 coated extracellular vesicles are stable and can be assembled in vitro, refAbstract=null)], funds=[Fund(id=1203005081751872503, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979642878681829, awardId=20ZD7FA003, language=EN, fundingSource=Key Science and Technology Project of Gansu Province(20ZD7FA003), fundOrder=null, country=null), Fund(id=1203005081856730113, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979642878681829, awardId=20ZD7FA003, language=CN, fundingSource=甘肃省重大科技项目(20ZD7FA003), fundOrder=null, country=null), Fund(id=1203005081982558217, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979642878681829, awardId=CYXZ2021-24, language=EN, fundingSource=Cuiying Student Scientific Research Cultivation Program of Lanzhou University Second Hospital(CYXZ2021-24), fundOrder=null, country=null), Fund(id=1203005082087415824, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979642878681829, awardId=CYXZ2021-24, language=CN, fundingSource=兰州大学第二医院“翠英学子科研培育”计划项目(CYXZ2021-24), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1203005078409011990, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979642878681829, xref=1, ext=[AuthorCompanyExt(id=1203005078417400599, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979642878681829, companyId=1203005078409011990, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu 730030, China), AuthorCompanyExt(id=1203005078425789208, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979642878681829, companyId=1203005078409011990, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1兰州大学第二医院普外科,兰州 730030)]), AuthorCompany(id=1203005078518063901, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979642878681829, xref=2, ext=[AuthorCompanyExt(id=1203005078526452511, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979642878681829, companyId=1203005078518063901, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Gansu Provincial Key Laboratory of Digestive System Cancer, Lanzhou, Gansu 730030, China), AuthorCompanyExt(id=1203005078539035425, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979642878681829, companyId=1203005078518063901, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2甘肃省消化系统肿瘤重点实验室,兰州 730030)])], figs=[ArticleFig(id=1203005081110143958, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979642878681829, language=EN, label=Fig. 1, caption=Mechanism of MAGE-A4 in inducing cell differentiation and proliferation and promoting EMT, figureFileSmall=1QLEtFfGavMqcBxXFg6R+Q==, figureFileBig=1XlRBMkwu0thDXVATOHZlw==, tableContent=null), ArticleFig(id=1203005081219195869, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979642878681829, language=CN, label=图1, caption=MAGE-A4在诱导细胞分化、增殖以及促进EMT过程中的作用机制

Nocth由Nocth1配体诱导产生胞外区(notch extracellular domain,NEC)和跨膜片段(notch transmembrane fragment,NTM)2个亚基,NEC与NTM以二硫键连接形成异二聚体形式的Notch受体,再由γ-分泌酶裂解Notch受体位点,产生NICD(Notch蛋白活化形式)并进入细胞核内,与C蛋白结合因子(CSL)和转录激活子蛋白家族(mastermind-like,MAML)形成NICD-MAML-CSL三聚体转录因子复合物,随后该复合物作用于细胞核内的靶基因TWIST1并促进其表达,TWIST1与MAGE-A4的E-boxes启动子结合诱导EMT,同时促进MAGE-A4表达上调,然后TWIST1与MAGE-A4由细胞核进入细胞质中,与相关基因协同激活下游多个肿瘤信号通路(NF-κB、Akt、HIF-1),从而导致细胞无限增殖并抑制其凋亡,最终导致肿瘤的发生和发展。HIF-1. 缺氧诱导因子-1;Akt/PKB. 蛋白激酶B;PI3K. 磷脂酰肌醇-3激酶;NF-κB. 核因子κB;MAPK. 丝裂原活化蛋白激酶;CK2. 酪蛋白激酶2;FBLX14. F-box和亮氨酸重复蛋白14

, figureFileSmall=1QLEtFfGavMqcBxXFg6R+Q==, figureFileBig=1XlRBMkwu0thDXVATOHZlw==, tableContent=null), ArticleFig(id=1203005081370190823, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979642878681829, language=EN, label=Tab. 1, caption=

Clinical trial targeting MAGE-A4

, figureFileSmall=null, figureFileBig=null, tableContent=
序号状态研究题目疾病干预措施项目地点
1启动TACTIC-TAA特异性细胞毒性T淋巴细胞治疗乳腺癌患者乳腺癌TAA特异性CTLs美国
2启动TAA特异性细胞毒性T淋巴细胞治疗胰腺癌患者胰腺癌多种TAA特异性T细胞美国
3招募中TCR工程T细胞用于实体肿瘤实体肿瘤IMA201产品美国
4招募中肿瘤相关的特异性抗原细胞毒性T淋巴细胞治疗多发性骨髓瘤多发性骨髓瘤TAA特异性CTLs美国
5招募中PDC*肺01肿瘤疫苗在非小细胞肺癌中的安全性、免疫原性及初步临床活性研究非小细胞肺癌PDC*肺01疫苗比利时
6启动TAA特异性CTLs治疗实体肿瘤横纹肌肉瘤TAA特异性的CTLs美国
7招募中TAA特异性CTLs的管理;霍奇金淋巴瘤或非霍奇金淋巴瘤;TACTAL淋巴瘤TAA特异性的CTLs美国
), ArticleFig(id=1203005081542157291, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979642878681829, language=CN, label=表1, caption=

以MAGE-A4为靶点的临床试验

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序号状态研究题目疾病干预措施项目地点
1启动TACTIC-TAA特异性细胞毒性T淋巴细胞治疗乳腺癌患者乳腺癌TAA特异性CTLs美国
2启动TAA特异性细胞毒性T淋巴细胞治疗胰腺癌患者胰腺癌多种TAA特异性T细胞美国
3招募中TCR工程T细胞用于实体肿瘤实体肿瘤IMA201产品美国
4招募中肿瘤相关的特异性抗原细胞毒性T淋巴细胞治疗多发性骨髓瘤多发性骨髓瘤TAA特异性CTLs美国
5招募中PDC*肺01肿瘤疫苗在非小细胞肺癌中的安全性、免疫原性及初步临床活性研究非小细胞肺癌PDC*肺01疫苗比利时
6启动TAA特异性CTLs治疗实体肿瘤横纹肌肉瘤TAA特异性的CTLs美国
7招募中TAA特异性CTLs的管理;霍奇金淋巴瘤或非霍奇金淋巴瘤;TACTAL淋巴瘤TAA特异性的CTLs美国
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MAGE-A4在肿瘤诊断与免疫治疗中的作用研究进展
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吴文章 1 , 张凡 1 , 贾祺 1 , 李玉民 1, 2, *
解放军医学杂志 | 综述 2023,48(7): 834-840
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解放军医学杂志 | 综述 2023, 48(7): 834-840
MAGE-A4在肿瘤诊断与免疫治疗中的作用研究进展
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吴文章1, 张凡1, 贾祺1, 李玉民1, 2, *
作者信息
  • 1兰州大学第二医院普外科,兰州 730030
  • 2甘肃省消化系统肿瘤重点实验室,兰州 730030
  • 吴文章,硕士研究生,主要从事消化系统肿瘤免疫治疗方面的研究

通讯作者:

李玉民,E-mail:
Research progress on MAGE-A4 in tumor diagnosis and immunotherapy
Wen-Zhang Wu1, Fan Zhang1, Qi Jia1, Yu-Min Li1, 2, *
Affiliations
  • 1Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu 730030, China
  • 2Gansu Provincial Key Laboratory of Digestive System Cancer, Lanzhou, Gansu 730030, China
出版时间: 2023-07-28 doi: 10.11855/j.issn.0577-7402.2379.2022.0412
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肿瘤免疫治疗已成为继放化疗、靶向治疗后最终攻克癌症的希望之一,而肿瘤相关性抗原是免疫治疗的重要靶点。黑色素瘤相关抗原-A4(MAGE-A4)作为癌睾丸抗原,是MAGE-A亚家族的重要成员,具有很好的组织学特异性,在多种肿瘤组织中呈高表达,在正常组织(除睾丸、胎盘外)中均呈低表达。MAGE-A4参与细胞功能的调节,具有调控细胞周期、诱导细胞分化和生长、参与上皮-间质转化等重要作用,与肿瘤的发生、发展、转移及预后密切相关。目前,以MAGE-A4为靶点的T细胞受体转基因T细胞(TCR-T)免疫治疗,其Ⅰ期临床试验结果显示总体反应率(ORR)为23.7%、病情稳定率为47.4%,Ⅱ期临床试验正在开展,提示以MAGE-A4为靶点的TCR-T免疫治疗具有较高的临床应用价值。本文总结了MAGE-A4的结构和生物学功能及其在多种实体肿瘤中的最新研究进展和临床应用,旨在为MAGE-A4的临床转化及免疫靶向治疗提供理论基础。

黑色素瘤相关抗原-A4  /  结构  /  功能  /  恶性肿瘤  /  免疫治疗

Immunotherapy has become one of the hopes to ultimately defeat cancer after radiotherapy, chemotherapy and targeted therapy, and tumor-associated antigen is an important target in immunotherapy. As an important member of the melanoma associated antigen-A (MAGE-A) subfamily, MAGE-A4 is highly expressed in various tumor tissues and low expressed in normal tissues except testis and placenta. It is involved in the regulation of cell functions and has important roles in regulating cell cycle, inducing cell differentiation and growth, and participating in epithelial-mesenchymal transformation, which is closely related to the tumorigenesis, progression, metastasis and prognosis. The latest study shows that the phase Ⅱ clinical study of T cell receptor-transgenic T (TCR-T) immunotherapy based on MAGE-A4 target is being carried out. The results of phase Ⅰ study showed that the overall response rate (ORR) was 23.7% and the disease stability was 47.4%, suggesting that TCR-T immunotherapy based on MAGE-A4 target has good clinical application value. This paper summarizes the structure and biological function of MAGE-A4, the latest research progress of various solid tumors and its clinical application, aiming to provide theoretical basis for clinical transformation and immune-targeted therapy of MAGE-A4.

melanoma associated antigen-A4  /  structure  /  function  /  malignant tumor  /  immunotherapy
吴文章, 张凡, 贾祺, 李玉民. MAGE-A4在肿瘤诊断与免疫治疗中的作用研究进展. 解放军医学杂志, 2023 , 48 (7) : 834 -840 . DOI: 10.11855/j.issn.0577-7402.2379.2022.0412
Wen-Zhang Wu, Fan Zhang, Qi Jia, Yu-Min Li. Research progress on MAGE-A4 in tumor diagnosis and immunotherapy[J]. Medical Journal of Chinese People’s Liberation Army, 2023 , 48 (7) : 834 -840 . DOI: 10.11855/j.issn.0577-7402.2379.2022.0412
最新数据显示,2020年全球新发癌症病例1929万例,其中,中国457万例,占23.7%;死亡996万例,其中中国300万例,占30%,位居全球第一[1]。恶性肿瘤的发生、侵蚀、转移是一个动态的、连续的过程,尽管随着免疫学和分子生物学的发展,特别是人类基因组的解密,针对基因和受体的靶向治疗[2]、新生血管抑制剂[3]、诱导细胞分化和凋亡[4]等作用机制的药物已经或正在进入临床,但驱动肿瘤进展的具体分子机制精密复杂,深入研究肿瘤发生发展过程中的关键机制对提高肿瘤治疗效果、控制转移及扩散并最终预防死亡具有重要意义。近年来,免疫疗法已用于许多晚期癌症患者,通过特定的肿瘤抗原诱导细胞和体液免疫反应,可有效杀伤肿瘤细胞并提高安全性及有效性。癌睾丸抗原(cancer-testis antigen,CTA)具有很强的免疫原性,主要包括黑色素瘤相关抗原(melanoma-associated antigen,MAGE)、白细胞介素-13受体α链(interleukin-13 receptor,IL-13Rα)、食管癌肿瘤共享抗原1(New York esophageal squamous cell carcinoma 1,NY-ESO-1)等,在肿瘤组织和部分生殖细胞中特异性表达,其作为肿瘤标志物具有较高的识别特异性,且可作为肿瘤免疫治疗的重要靶点[5]
黑色素瘤相关抗原-A4(melanoma-associated antigen-A4,MAGE-A4)作为MAGE-A家族的重要成员,在多种癌症(如黑色素瘤、乳腺癌、肺癌、肾细胞癌、结直肠癌、胃癌[6-9]等)组织及睾丸、胎盘中高表达,而在其他正常组织中呈低表达[10],可通过与磷脂酰肌醇3-激酶(phosphoinositide 3-kinase,PI3K)结合及细胞黏附蛋白质复合物与核苷酸受体相互作用,从而在肿瘤中发挥相应的生物学功能[11]。此外,MAGE-A4可通过Notch信号通路促进肿瘤细胞的分化与增殖,引起细胞、体液免疫应答,从而影响预后[12-13]。有研究显示,MAGE-A4通过干扰T细胞的功能参与了肿瘤细胞逃离免疫系统杀伤的过程[14-16],还可与上皮-间质转化(epithelial-mesenchymal transition,EMT)诱导转录因子TWIST协同作用,增强细胞增殖、迁移和侵袭的能力[17]。2020年美国临床肿瘤学会公布了一项包括滑膜肉瘤、头颈癌和肺癌等多种实体瘤患者的研究,此项以MAGE-A4为靶点的T细胞受体转基因T细胞(T cell receptor-transgenic T,TCR-T)免疫治疗Ⅰ期临床试验结果显示,患者中位反应时间和中位无进展生存期分别为28周、20周,总体反应率(OR)和病情稳定率分别为23.7%、47.4%[18]。基于此,相关的Ⅱ期临床试验和靶向MAGE-A4的下一代T细胞疗法ADP-A2M4CD8的Ⅰ期临床试验已经开展。本文系统回顾相关文献,对MAGE-A4在肿瘤中的作用机制及其临床应用价值进行综述,旨在为MAGE-A4的临床应用转化及免疫靶向治疗提供理论基础。
MAGE-A4基因位于人类X染色体q28,大小约12 kb,可编码约300个氨基酸的蛋白质。核磁共振(nuclear magnetic resonance,NMR)和质谱分析均表明,MAGE-A4蛋白具有紧凑的折叠结构和失序区域,主要包含N端转录激活区、DNA结合区、C端四聚化功能区及C端非特异结合功能调控区等功能结构域。MAGE-A4蛋白N端由100个氨基酸残基构成,富含Pro、Arg等大量失序结构域;C端由两个串联翼螺旋结构域WH-A和WH-B构成,这两个结构域与其他高度保守的氨基酸共同组成MAGE同源域(MAGE homology domain,MHD)。尽管MAGE-A4与该家族其他成员编码的蛋白质具有50%~80%的序列一致性,但MAGE家族不同成员的结构和功能略有差异,主要原因是WH-A和WH-B会发生构象变化,并与不同的蛋白质结构域相互作用。MAGE-A家族成员众多,主要包括MAGE-A 1-12,其中MAGE-A5、MAGE-A7是假基因,不表达任何功能[19]
MAGE-A4的羧基末端片段可通过抑制病毒和转录因子Miz-1与p21启动子的结合而抑制p21的上调,进而抑制细胞周期阻滞,促进肿瘤细胞凋亡[20]。研究发现,MAGE-A4及其相关共表达基因主要富集在Notch信号通路和遗传物质输出代谢通路,而Notch信号主要影响细胞凋亡、增殖及细胞边界的形成,介导多能祖细胞形态演化的多个过程[11]。Notch信号通路主要形成Notch活化蛋白-转录激活子蛋白家族-C蛋白结合因子[Notch intracellular domain-mastermind-like-C promoter binding factor 1-/Su(H)/Lag1,NICD-MAML-CSL]三聚体转录因子复合物,随后该复合物作用于细胞核内的MAGE-A4并与相关基因协同激活下游核因子κB(nuclear factor κB,NF-κB)、蛋白激酶B(protein kinase B,Akt)、缺氧诱导因子-1(hypoxia inducible factor-1,HIF-1)等多个肿瘤信号通路,进而激活细胞无限增殖和抗凋亡的潜能,最终诱发癌变。此外,不同肿瘤类型中MAGE-A4的作用机制略有不同。Sakurai等[20]和Bhan等[21]利用生物还原法和荧光分光光度法证实,MAGE-A4/p53通路能够诱导肺癌细胞凋亡,MAGE-A4作为一种肿瘤抑制蛋白起到抑制肿瘤细胞增殖的作用。MAGE-A4可与肝癌中的Gankyrin蛋白作用,并与p16和周期蛋白依赖性激酶结合,促进视网膜母细胞瘤蛋白的磷酸化和降解,从而抑制肿瘤细胞的抗凋亡能力[22]。食管癌相关研究证实,MAGE-A4可通过降低基质金属蛋白酶2(matrix metalloproteinase 2,MMP2)和NF-κB2的表达而抑制食管癌细胞的增殖[23]
T细胞的功能决定了肿瘤免疫治疗的效果[24]。基于淋巴瘤和多发性骨髓瘤患者的临床研究显示,构建MAGE-A4肿瘤抗原疫苗能够有效激活患者的T细胞活性,从而激活抗肿瘤免疫,抑制肿瘤进展,并防止免疫逃逸[25-26]。T细胞介导的免疫调节主要受T细胞受体(T cell receptor,TCR)对肽-人白细胞抗原(peptide-human leukocyte antigen,pHLA)复合物的识别,而HLA表面与TCR编码的互补决定区(complementarity-determining region,CDR)环1和2之间的相互作用决定了识别的稳定性,在此基础上通过CDR环3的直接引导功能选择合适的多肽激活T细胞,进而发挥免疫监视及免疫防御功能。Coles等[27]鉴定的A2-GVY结构(HLA-A*02:01限制性MAGE-A4肽复合物)与TCR特异识别后能有效调节T细胞的抗原识别能力,进而影响其功能。
TWIST1作为一种碱性-螺旋-环-螺旋(basic-helix-loop-helix,bHLH)转录因子,可与MAGE-A4的E-boxes启动子结合,通过转录调控诱导EMT,并能正反馈促进MAGE-A4、TWIST1的表达,致使肿瘤细胞黏附能力下降并从原发灶脱落,造成肿瘤细胞的远处播散[28]。核内转录、翻译生成的TWIST1被释放进入细胞质,从而激活蛋白激酶B(protein kinase B,PKB)、丝裂原活化蛋白激酶(mitogen-activated protein kinases,MAPK)、酪蛋白激酶2(casein kinase 2,CK2)、F-box和亮氨酸重复蛋白14(F-box and leucine rich repeat protein 14,FBLX14)信号通路,介导肿瘤细胞的远处转移和扩散[1729]。与此同时,大量协同表达的MAGE-A4通过载体蛋白由细胞核进入细胞质及胞外区,进一步激活和调控Notch受体、NICD,从而介导EMT,使上皮和间质特性反转[30]。MAGE-A4在诱导细胞分化、增殖以及促进EMT过程中的作用机制如图1所示。
Forghanifard等[31]从食管鳞状上皮癌(esophageal squamous cell carcinoma,ESCC)样本中检测到MAGE-A4蛋白过表达率为90.2%,且肿瘤组织中MAGE-A4 mRNA含量明显高于癌旁组织,结合患者临床资料,MAGE-A4 mRNA高表达的肿瘤患者TNM分期更晚、预后更差(P<0.05)[31]。Iura等[32]发现,108例滑膜肉瘤样本中,MAGE-A4阳性表达率为82%(89/108),且MAGE-A4高表达与临床分期明显相关。Hussein等[33]采用RT-PCR进行检测发现,67例乳腺癌组织的MAGE-A4阳性表达率较癌旁组织明显升高,且与不良预后相关[34]。Bandić等[35]发现,MAGE-A4是乳腺癌患者的独立危险因素,MAGE-A4阳性患者的生存期明显长于阴性患者。分析原因可能是MAGE-A4基因与参与DNA修复的肿瘤抑制基因BRCA1/BRCA2在染色体水平上相互作用,从而增加了BRCA1/BRCA2种系突变的风险[36]。另外,MAGE-A4在口腔鳞状细胞癌和膀胱癌中均呈高表达,且其表达与淋巴结转移及肌层浸润明显相关(P<0.05)[37-38]。MAGE-A4在非小细胞肺癌(non-small-cell lung cancer,NSCLC)中的表达水平也明显升高,其在鳞状细胞癌和腺癌中的高表达率分别为58.0%、95.0%,且MAGE-A4高表达患者的复发和转移风险较低表达患者高,生存时间较低表达患者短[39]。为进一步探究MAGE-A4表达与人类白细胞抗原(human leukocyte antigen,HLA)缺失之间的关系,Baba等[40]对363例行治愈性手术的NSCLC患者进行分析,发现MAGE-A4阳性患者HLA表达缺失比例明显高于MAGE-A4阴性者,提示MAGE-A4高表达与预后不良相关。以上研究结果表明,MAGE-A4可作为多种肿瘤诊断及预后判断的生物标志物。
TCR-T疗法是指提取靶向肿瘤细胞特异性抗原的TCR,然后通过基因编辑等技术改造T细胞并回输至患者体内,继而激发T细胞免疫杀伤肿瘤细胞。相较其他过继性T细胞疗法如嵌合抗原受体T细胞免疫疗法(chimeric antigen receptor T-cell immunotherapy,CAR-T),TCR-T疗法能有效克服实体肿瘤周围肿瘤微环境的抑制,更有效地杀伤肿瘤细胞[41]
2006年有学者首次对黑色素瘤患者使用表达黑色素细胞分化抗原(MART-1)的特异性TCR-T细胞疗法进行治疗,经评估后20例患者中6例部分缓解[42]。随后一项针对NY-ESO-1抗原编辑的T细胞TCR-T临床研究迅速开展,Ⅰ期临床试验结果显示部分缓解率为67%(4/6),Ⅱ期临床试验结果显示,18例中10例部分缓解,1例达到完全缓解,客观缓解率为61%(11/18)[43]。一项采用NY-ESO-1/LAGE-1抗原设计的TCR-T治疗多发性骨髓瘤的临床试验显示,20例患者中16例临床治疗效果明显,无进展生存期为19.1个月[44]。截至目前,ClinicalTrials.gov网站注册的靶向实体肿瘤的TCR-T临床试验共43项,诸多试验数据尚未公布,未来随着新研究成果的不断涌现,TCR-T过继免疫治疗将为难治性肿瘤患者带来新的希望。尽管TCR-T的临床疗效毋庸置疑,但其靶标毒性及脱靶毒性是目前面临的主要挑战,不仅能杀伤肿瘤细胞,还会损伤正常组织(如皮肤、眼球等)。因此,抗原选择至关重要,也是T细胞发挥功能的重要因素之一。依据上述已公布的临床试验及最新登记在册的项目可知,TCR-T靶向抗原主要有三类:肿瘤相关性抗原、病毒抗原、肿瘤新抗原。MAGE-A4、MAGE-A3、NY-ESO-1等属于肿瘤相关性抗原,具有很强的组织特异性及免疫原性。构建识别此类抗原的TCR-T细胞,不仅能显著提高TCR-T对肿瘤的杀伤能力,且能最大程度减少免疫治疗的不良反应。
Tang等[45]基于MAGE-A4构建TCR-T细胞并移植至MAGE-A4阳性的ESCC患者体内,治疗后2个月7例出现肿瘤进展,3例生存时间超过27个月,研究发现这些T细胞保持了体外抗原特异性肿瘤反应性,能够有效杀伤肿瘤细胞,改善患者预后。一项纳入20例晚期食管癌、胃癌和肺癌患者的临床研究中,在4例高表达MAGE-A4的患者中观察到特异性体液免疫反应,检测发现这4例在接种MAGE-A4疫苗后能够特异性诱导产生CD8+T细胞,且治疗后高表达MAGE-A4患者的总生存期明显长于低表达者(P=0.009)[14]。因此,MAGE-A4可能是抑制ESCC侵袭性的候选治疗靶点[1645-46],其原理为利用MAGE-A4-TCR来识别肿瘤细胞表面的肽-主要组织相容性复合体,从而杀伤肿瘤细胞[47]
一项纳入16例患者的CHP-MAGE-A4癌症疫苗Ⅰ期和Ⅱ期临床试验结果显示,与基线(中位数为10.28%)相比,接种疫苗后7周癌症患者的Tregs/CD4淋巴细胞比例较低,且与良好的预后相关[48]。一项基于子宫平滑肌肉瘤的MAGE-A4 siTCR基因修饰的过继T细胞研究中,利用人外周血单个核细胞(peripheral blood mononuclear cells,PBMCs)制备MAGE-A4 siTCR基因修饰的T细胞,随后的体外和体内实验结果均显示,其对MAGE-A4和HLA-A*2402阳性肿瘤细胞具有特异性杀伤作用,表明MAGE-A4 siTCR过继细胞疗法是治疗MAGE-A4阳性肿瘤患者的一种有前途的策略[49]。最新的临床研究进一步证实了以上观点,ADP-A2M4疗法(针对MAGE-A4抗原的TCR-T技术)的Ⅰ期临床数据显示,入组的16例滑膜肉瘤患者的客观缓解率为43.8%,疾病控制率达到90%以上[18]
第1个人工合成的MAGE-A4-H/K-HELP多肽疫苗应用于结肠癌肺转移患者,该疫苗能够特异性诱导Th1和Tc1免疫应答,并产生IgG抗体,随访观察发现肿瘤生长减缓,且癌胚抗原等肿瘤标志物的水平明显下降[50]。基于MAGE-A4特异性TCR的过继T细胞疗法在淋巴瘤[25]、多发性骨髓瘤[26]、子宫平滑肌瘤[51]、黑色素瘤[52]、滑膜肉瘤[53]的临床研究中也获得了丰硕的成果,目前已开展的临床试验如表1所示。最近,过继性T细胞疗法ADP-A2M4的主要研究者David Hong教授评估了ADP-A2M4在表达MAGE-A4的晚期实体瘤(滑膜肉瘤、卵巢癌、头颈癌、胃癌、蕈样/圆细胞脂肪肉瘤、非小细胞肺癌、膀胱癌、食管癌和黑色素瘤)患者中的安全性、耐受性和抗肿瘤活性[18]:共38例患者接受治疗,其中9例(23.7%)瘤体体积较治疗前缩小,18例(47.4%)肿瘤体积未见明显增加及转移,且所有患者均未见明显不良反应。此外有研究发现,MAGE-A4参与了肿瘤耐药的形成。Peikert等[54]利用Western blotting、免疫组化、免疫细胞化学检测证实,在细胞核内积累的外源性MAGE-A4与p53关联,从而诱导了Caspase介导的细胞凋亡,并使非小细胞肺癌对化疗药物敏感,而只在细胞质中积累的外源性MAGE-A4可使肺癌细胞对顺铂不敏感,分析原因可能是肿瘤异质性所致,即细胞系经过多次分裂增殖,其子细胞呈现出分子生物学或基因方面的改变,从而使肿瘤的生长速度、侵袭能力、对药物的敏感性、预后等各方面产生差异[55]。目前MAGE-A4协调p53基因介导肿瘤细胞参与耐药的具体机制尚未明确。Gao等[56]在黑色素瘤中发现MAGE-A4可与E3泛素连接酶RAD18结合,从而招募Y家族DNA聚合酶到DNA复制叉位点,进而激活跨损伤DNA合成(translesion DNA synthesis,TLS)过程,增强了肿瘤细胞对化疗/放疗的耐受性[57]
综上所述,MAGE-A4作为具有高识别特异性的肿瘤标志物,可作为肿瘤免疫治疗的重要靶点。在疫苗设计过程中可能存在肿瘤特异性的TCR意外脱靶,与非肿瘤限制表位结合,导致T细胞不能有效清除肿瘤细胞并产生严重的临床毒性。细胞外囊泡(extracellular vesicles,EVs)被认为参与了肿瘤的发展和转移,Reinsalu等[58]发现,MAGE-A4-EVs作为一种肿瘤诊断及治疗的创新手段具有巨大的潜力,有望增加T细胞及其他肿瘤疫苗的靶向特异性。
免疫治疗为复发、转移及部分晚期肿瘤患者带来了新的希望,其中抗原选择是药物发挥作用的关键。MAGE-A4作为肿瘤特异性抗原,与其他肿瘤相关性抗原相比能更有效地提高特异性杀伤肿瘤细胞的能力,从而避免脱靶效应。因此,未来可构建以MAGE-A4为主的多抗原复合体,并将其与CAR-T、树突状细胞(dendritic cells,DC)疫苗结合,进一步探究其治疗肿瘤的潜力及与其他免疫治疗、抗肿瘤药物(PD-1,PD-L1等)的协同作用。以MAGE-A4为靶点的Ⅰ期临床试验在治疗滑膜肉瘤、头部肿瘤、宫颈癌和肺癌中颇有成效,随着Ⅱ期临床试验的开展,MAGE-A4在其他恶性肿瘤中的研究更加深入,可拓宽肿瘤免疫治疗的临床手段。随着研究的不断深入,MAGE-A4作为肿瘤免疫治疗的重要靶点将显示出强大的临床转化潜力。
  • 甘肃省重大科技项目(20ZD7FA003)
  • 兰州大学第二医院“翠英学子科研培育”计划项目(CYXZ2021-24)
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2023年第48卷第7期
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doi: 10.11855/j.issn.0577-7402.2379.2022.0412
  • 接收时间:2021-10-16
  • 首发时间:2025-12-03
  • 出版时间:2023-07-28
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  • 收稿日期:2021-10-16
  • 录用日期:2021-12-03
基金
Key Science and Technology Project of Gansu Province(20ZD7FA003)
甘肃省重大科技项目(20ZD7FA003)
Cuiying Student Scientific Research Cultivation Program of Lanzhou University Second Hospital(CYXZ2021-24)
兰州大学第二医院“翠英学子科研培育”计划项目(CYXZ2021-24)
作者信息
    1兰州大学第二医院普外科,兰州 730030
    2甘肃省消化系统肿瘤重点实验室,兰州 730030

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2种不同金属材料的力学参数

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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