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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.
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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。
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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
, 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 |
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