Article(id=1198652618965873640, tenantId=1146029695717560320, journalId=1189982191388893191, issueId=1198652605778985059, articleNumber=null, orderNo=null, doi=10.16438/j.0513-4870.2022-1053, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1662998400000, receivedDateStr=2022-09-13, revisedDate=1664899200000, revisedDateStr=2022-10-05, acceptedDate=null, acceptedDateStr=null, onlineDate=1763710654249, onlineDateStr=2025-11-21, pubDate=1691769600000, pubDateStr=2023-08-12, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1763710654249, onlineIssueDateStr=2025-11-21, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1763710654249, creator=13701087609, updateTime=1763710654249, updator=13701087609, issue=Issue{id=1198652605778985059, tenantId=1146029695717560320, journalId=1189982191388893191, year='2023', volume='58', issue='8', pageStart='0', pageEnd='2540', issueExtLink='null', onlineDate='null', pubDate='1691769600000', pubDateStr='2023-08-12', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1763710651106, creator='13701087609', updateTime=1763710739504, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1198652976601596347, tenantId=1146029695717560320, journalId=1189982191388893191, issueId=1198652605778985059, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1198652976601596348, tenantId=1146029695717560320, journalId=1189982191388893191, issueId=1198652605778985059, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2341, endPage=2352, ext={EN=ArticleExt(id=1198652619636961302, articleId=1198652618965873640, tenantId=1146029695717560320, journalId=1189982191388893191, language=EN, title=Peptide-drug conjugates for tumor targeted diagnosis and treatment, columnId=null, journalTitle=Acta Pharmaceutica Sinica, columnName=null, runingTitle=null, highlight=null, articleAbstract=

Cancer is still one of the major diseases threatening human life and health. At present, how to achieve precise diagnosis and treatment of tumors is the biggest challenge in cancer treatment. Prodrugs use the tumor specificity of targeting molecules to deliver anticancer drugs to tumor sites, which can effectively improve drug bioavailability, therapeutic efficacy and safety, and are currently a hot spot in the research and development of anticancer drugs. The targeting molecules of prodrugs mainly include nucleic acid aptamers, polymers, antibodies, polypeptides, etc. Among them, polypeptides have the advantages of good biocompatibility, controllable degradation performance, high in vivo responsiveness, and simple and easy preparation methods, and are widely used. It is used to construct peptide-drug conjugates (PDC) prodrugs to achieve targeted therapy of tumors. In recent years, with the development of phage peptide library technology and peptide standard solid-phase synthesis technology, more and more targeted peptides have been discovered and effectively synthesized and modified, providing strong support for the development of PDC. This review briefly introduces the types and functions of functional peptides and linkers in PDC, and discusses the application of PDC in chemotherapy, immunotherapy and photodynamic therapy in tumor targeted diagnosis and treatment, and finally summarizes the difficulties faced by PDC drug development.

, authors=null, authorsList=Ying CHEN, Rong-rong ZHENG, Shi-ying LI, authorCompany=null, correspAuthors=Shi-ying LI, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2023 Acta Pharmaceutica Sinica. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1198652622744940805, articleId=1198652618965873640, tenantId=1146029695717560320, journalId=1189982191388893191, language=CN, title=多肽-药物键合物用于肿瘤靶向诊疗, columnId=1190335349655180086, journalTitle=药学学报, columnName=综述, runingTitle=null, highlight=null, articleAbstract=

癌症仍是威胁人类生命和健康的主要疾病之一。目前, 如何实现肿瘤精准诊疗是癌症治疗的最大挑战。前体药物利用靶向分子的肿瘤特异性将抗癌药物靶向递送至肿瘤部位, 能够有效提高药物生物利用度、治疗效果和安全性, 是当前抗癌药物的研发热点。前药的靶向分子主要有核酸适体、聚合物、抗体、多肽等, 其中多肽具有生物相容性好、降解性能可控、生物体内响应性高和制备方法简单易行等优点, 被广泛用来构建多肽-药物键合物(peptide-drug conjugates, PDC)前药, 实现对肿瘤的靶向治疗。近年来, 随着噬菌体肽库技术和多肽标准固相合成技术的发展, 越来越多的靶向多肽被发现和有效合成修饰, 为PDC的发展提供了有力支持。本文简要介绍了PDC中功能型多肽和连接子的种类及功能, 并详细论述了PDC在化学疗法、免疫疗法和光动力疗法在肿瘤靶向诊疗中的应用, 最后总结了PDC药物开发所面临的困难。

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*李仕颖, Tel: 86-20-37103274, E-mail:
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Future Oncol, 2020, 16: 631-641., articleTitle=OCEAN: a randomized phase Ⅲ study of melflufen + dexamethasone to treat relapsed refractory multiple myeloma, refAbstract=null)], funds=[Fund(id=1198960100074418929, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1198652618965873640, awardId=2021YFD1800600, language=CN, fundingSource=国家重点研发计划项目(2021YFD1800600), fundOrder=null, country=null), Fund(id=1198960100200248064, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1198652618965873640, awardId=2021B1515020043, language=CN, fundingSource=广东省自然科学基金项目(2021B1515020043), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1198960094223364270, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1198652618965873640, xref=null, ext=[AuthorCompanyExt(id=1198960094240141488, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1198652618965873640, companyId=1198960094223364270, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Pharmacy, Guangzhou Medical University, Guangzhou 511436, China), AuthorCompanyExt(id=1198960094248530096, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1198652618965873640, companyId=1198960094223364270, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=广州医科大学药学院, 广东 广州 511436)])], figs=[ArticleFig(id=1198960097843048962, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1198652618965873640, language=EN, label=null, caption=null, figureFileSmall=LeH7v5GmBbi46ogrv7a9tQ==, figureFileBig=G5AzKbTzvdX5YCbTpgVXfw==, tableContent=null), ArticleFig(id=1198960097981461011, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1198652618965873640, language=CN, label=Figure 1, caption= Composition of the three parts of the peptide-drug conjugates (PDC) , figureFileSmall=LeH7v5GmBbi46ogrv7a9tQ==, figureFileBig=G5AzKbTzvdX5YCbTpgVXfw==, tableContent=null), ArticleFig(id=1198960098145038884, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1198652618965873640, language=EN, label=null, caption=null, figureFileSmall=/U2k9skaVqMunm063cMfJA==, figureFileBig=ErvZI/CEcUhhIuKCZKtIDQ==, tableContent=null), ArticleFig(id=1198960098283450925, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1198652618965873640, language=CN, label=Figure 2, caption= Tumor-specific and pro-apoptotic peptide-drug nanoparticles of drug-drug nanoparticles (DD-NPs) for synergistic pro-apoptotic/chemotherapy. A: Peptides and hydrophobic doxorubicin (DOX) can form stable nanoparticles through hydrophobic interactions and amphiphilic intermolecular <i>π-π</i> stacking, resulting in DD-NPs; B: The DD-NPs highly accumulates in the targeted tumor tissues <i>via</i> enhanced permeability and retention effect; C: DD-NPs are specifically cleaved into pro-apoptotic Ala-Val-Pro-Ile-Ala-Gln (SMAC) and cytotoxic DOX in cathepsin B-overexpressing cancer cells, and then synergistically induce apoptosis in drug-resistant cells through chemotherapy and inhibitor of apoptosis protein (IAP) inhibition. Adapted from Ref. 63 with permission. Copyright © 2020 Elsevier , figureFileSmall=/U2k9skaVqMunm063cMfJA==, figureFileBig=ErvZI/CEcUhhIuKCZKtIDQ==, tableContent=null), ArticleFig(id=1198960098451223096, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1198652618965873640, language=EN, label=null, caption=null, figureFileSmall=rsTMgdtMy8RxY/64XxQm4w==, figureFileBig=RcfKHPF6u5NXHBaiFtNVuA==, tableContent=null), ArticleFig(id=1198960098585440835, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1198652618965873640, language=CN, label=Figure 3, caption= Induction of tolerant dendritic cells and regulatory T cells by peptide-vitamin conjugates. MHC: Major histocompatibility complex; TCR: T cell receptor; tDC: Tolerogenic dendritic cells; T<sub>reg</sub>: Regulatory cell; CD: Antigen differentiation cluster. Adapted from Ref. 67 with permission. Copyright © 2020 Wiley , figureFileSmall=rsTMgdtMy8RxY/64XxQm4w==, figureFileBig=RcfKHPF6u5NXHBaiFtNVuA==, tableContent=null), ArticleFig(id=1198960098732241493, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1198652618965873640, language=EN, label=null, caption=null, figureFileSmall=vgPX/BhXfc0bmTZssY2N4Q==, figureFileBig=A8SX7CpRYxgN6xnte9m0zA==, tableContent=null), ArticleFig(id=1198960098962928223, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1198652618965873640, language=CN, label=Figure 4, caption= ACPP-PpIX for diagnostic imaging and photodynamic therapy. A: MMP-2 triggered structure transformation of ACPP-PpIX; B: Schematic illustration of the mechanism of action of ACPP-PpIX. ACPP-PpIX: Activatable cell-penetrating peptide protoporphyrin IX conjugate; CPP-PpIX: Cell penetrating peptide protoporphyrin IX conjugate; GLAGE8: Polyanionic peptide E8; <sup>3</sup>O<sub>2</sub>: Triplet oxygen; <sup>1</sup>O<sub>2</sub>: Singlet oxygen. Adapted from Ref. 70 with permission. Copyright © 2015 American Chemical Society , figureFileSmall=vgPX/BhXfc0bmTZssY2N4Q==, figureFileBig=A8SX7CpRYxgN6xnte9m0zA==, tableContent=null), ArticleFig(id=1198960099118117489, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1198652618965873640, language=EN, label=null, caption=null, figureFileSmall=XSVYROtTf0+KWlggab6lFw==, figureFileBig=urHxixjrnQWOHew5N6nSdQ==, tableContent=null), ArticleFig(id=1198960099281695362, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1198652618965873640, language=CN, label=Figure 5, caption= Schematic illustration of the structure and proposed mechanism of M-ChiP for tumor-targeted synergistic photodynamic therapy. A: Chemical structure of PpIX-KrFxrFxrFxr-PEG8; B: Self-assembly of PpIX-KrFxrFxrFxr-PEG8 into M-ChiP; C: Intravenous injection of M-ChiP into tumor bearing mouse; D: Accumulation of M-ChiP on tumor site <i>via</i> EPR effect; E: Insertion of M-ChiP into the plasma membrane of tumor cells; F: The production of <sup>1</sup>O<sub>2</sub> under irradiation and the rupture of plasma membrane; G: The endocytosis and the mitochondria target delivery of M-ChiP; H: The production of <sup>1</sup>O<sub>2</sub> under irradiation and the destruction of mitochondria; I: The synergistic therapeutic effects to induce tumor cell death. M-ChiP: Single-agent self-delivery chimeric peptide based nanoparticle; EPR: Enhanced permeability and retention effect. Adapted from Ref. 71 with permission. Copyright © 2019 Elsevier , figureFileSmall=XSVYROtTf0+KWlggab6lFw==, figureFileBig=urHxixjrnQWOHew5N6nSdQ==, tableContent=null), ArticleFig(id=1198960099411718808, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1198652618965873640, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
Type Name Sequence Target
Tumor cell targeting peptide GE11 YHWYGYTPQNVI EGFR[16]
AHNP FCDGFYACYKDV HER2[17]
1-D03 MEGPSKCCYSLALSH ErbB2[18]
3-G03 SGTKSKCCYSLRRSS ErbB2[18]
JB3 D-CSKAPKLPAAYC IGF-IR[19]
Tumor vascular endothelial cell targeting peptide RGD RGD Integrin αvβ3[20]
NGR NGR CD13[21]
GEBP11 CTKNSYLMC HUVECs[22]
CS-1 peptide EILDVPST Integrin α4β1[23]
CS-5 peptide GEEIQIGHIPREDVDYHLP Integrin α4β1[24]
CSDSWHYC CSDSWHYWC VEGFR-3[25]
Tumor
microenvironment sensitive peptide
Ac-GPLGIAQ Ac-GPLGIAGQ MMP-2[26]
GQ8 GPLGIAGQ-NH2 MMP-2, MMP-9[27]
PLGVRKLVFF PLGVRKLVFF MMP-2[28]
pHLIP ACEQNPIYWARY pH sensitivity[29]
GFLG GFLG Cathepsin B[30]
Cell-penetrating peptide TAT YGRKKRRQRRR[30] /
iRGD CRGDK/RGPD/EC NRP-1, integrin αvβ3[31]
Antp RQIKIWFQNRRMKWKK[32] /
pVEC LLIILRRRIRKQAHAHSK[33] /
Organelle targeting peptide NLS CGYGPKKKRKVGG Nucleus[34]
NTP RIFIHFRIGC Nucleus[35]
KLA KLAKLAKKLA Mitochondria[36]
SS31 HDDAPL-NH2 Mitochondria[37]
12-mer peptide RDVFTKGYGFGL Mitochondria[38]
Therapeutic peptide RGDS RGDS Caspase-8/9[39]
DEVD DEVD Caspase-3[40]
AARAVFLAL AARAVFLAL T lymphocytes[41]
YRPRPRRY YRPRPRRY T lymphocytes[42]
TPP-1 SGQYASYHCWCWRDPGGSK PD-L1[43]
), ArticleFig(id=1198960099541742247, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1198652618965873640, language=CN, label=Table 1, caption=

Various functional polypeptides in PDC. EGFR: Epithelial growth factor receptor; HER2: Human epidermal growth factor receptor 2; ErbB2: Tyrosine kinase receptor 2; IGF-IR: Insulin-like growth factor receptor; CD13: Aminopeptidase N; HUVECs: Human umbilical vein endothelial cells; VEGFR-3: Vascular endothelial growth factor receptor-3; MMP: Matrix metalloproteinase; NRP-1: Neuropilin-1; Caspase: Cysteinyl aspartate specific proteinase; PD-L1: Programmed cell death 1 ligand 1

, figureFileSmall=null, figureFileBig=null, tableContent=
Type Name Sequence Target
Tumor cell targeting peptide GE11 YHWYGYTPQNVI EGFR[16]
AHNP FCDGFYACYKDV HER2[17]
1-D03 MEGPSKCCYSLALSH ErbB2[18]
3-G03 SGTKSKCCYSLRRSS ErbB2[18]
JB3 D-CSKAPKLPAAYC IGF-IR[19]
Tumor vascular endothelial cell targeting peptide RGD RGD Integrin αvβ3[20]
NGR NGR CD13[21]
GEBP11 CTKNSYLMC HUVECs[22]
CS-1 peptide EILDVPST Integrin α4β1[23]
CS-5 peptide GEEIQIGHIPREDVDYHLP Integrin α4β1[24]
CSDSWHYC CSDSWHYWC VEGFR-3[25]
Tumor
microenvironment sensitive peptide
Ac-GPLGIAQ Ac-GPLGIAGQ MMP-2[26]
GQ8 GPLGIAGQ-NH2 MMP-2, MMP-9[27]
PLGVRKLVFF PLGVRKLVFF MMP-2[28]
pHLIP ACEQNPIYWARY pH sensitivity[29]
GFLG GFLG Cathepsin B[30]
Cell-penetrating peptide TAT YGRKKRRQRRR[30] /
iRGD CRGDK/RGPD/EC NRP-1, integrin αvβ3[31]
Antp RQIKIWFQNRRMKWKK[32] /
pVEC LLIILRRRIRKQAHAHSK[33] /
Organelle targeting peptide NLS CGYGPKKKRKVGG Nucleus[34]
NTP RIFIHFRIGC Nucleus[35]
KLA KLAKLAKKLA Mitochondria[36]
SS31 HDDAPL-NH2 Mitochondria[37]
12-mer peptide RDVFTKGYGFGL Mitochondria[38]
Therapeutic peptide RGDS RGDS Caspase-8/9[39]
DEVD DEVD Caspase-3[40]
AARAVFLAL AARAVFLAL T lymphocytes[41]
YRPRPRRY YRPRPRRY T lymphocytes[42]
TPP-1 SGQYASYHCWCWRDPGGSK PD-L1[43]
), ArticleFig(id=1198960099701125821, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1198652618965873640, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
Type Name
Non-cleavable Oxime bond[54]
Triazole bond[54]
γ-Aminobutyric acid[54]
Thioether bond[55]
Amide bond[55]
Cleavable
Enzyme sensitive KCLPRTGCK[56]
GAGRRAAG[57]
Reduction sensitive Disulfide bond[58]
pH sensitive Hydrazine bond[59]
Imine[60]
Hydrazone bond[61]
), ArticleFig(id=1198960099818566347, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1198652618965873640, language=CN, label=Table 2, caption=

Various commonly used linkers in PDC

, figureFileSmall=null, figureFileBig=null, tableContent=
Type Name
Non-cleavable Oxime bond[54]
Triazole bond[54]
γ-Aminobutyric acid[54]
Thioether bond[55]
Amide bond[55]
Cleavable
Enzyme sensitive KCLPRTGCK[56]
GAGRRAAG[57]
Reduction sensitive Disulfide bond[58]
pH sensitive Hydrazine bond[59]
Imine[60]
Hydrazone bond[61]
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多肽-药物键合物用于肿瘤靶向诊疗
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陈颖 , 郑蓉蓉 , 李仕颖 *
药学学报 | 综述 2023,58(8): 2341-2352
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多肽-药物键合物用于肿瘤靶向诊疗
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陈颖, 郑蓉蓉, 李仕颖*
作者信息
  • 广州医科大学药学院, 广东 广州 511436
通讯作者:
*李仕颖, Tel: 86-20-37103274, E-mail:
Peptide-drug conjugates for tumor targeted diagnosis and treatment
Ying CHEN, Rong-rong ZHENG, Shi-ying LI*
Affiliations
  • School of Pharmacy, Guangzhou Medical University, Guangzhou 511436, China
出版时间: 2023-08-12 doi: 10.16438/j.0513-4870.2022-1053
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癌症仍是威胁人类生命和健康的主要疾病之一。目前, 如何实现肿瘤精准诊疗是癌症治疗的最大挑战。前体药物利用靶向分子的肿瘤特异性将抗癌药物靶向递送至肿瘤部位, 能够有效提高药物生物利用度、治疗效果和安全性, 是当前抗癌药物的研发热点。前药的靶向分子主要有核酸适体、聚合物、抗体、多肽等, 其中多肽具有生物相容性好、降解性能可控、生物体内响应性高和制备方法简单易行等优点, 被广泛用来构建多肽-药物键合物(peptide-drug conjugates, PDC)前药, 实现对肿瘤的靶向治疗。近年来, 随着噬菌体肽库技术和多肽标准固相合成技术的发展, 越来越多的靶向多肽被发现和有效合成修饰, 为PDC的发展提供了有力支持。本文简要介绍了PDC中功能型多肽和连接子的种类及功能, 并详细论述了PDC在化学疗法、免疫疗法和光动力疗法在肿瘤靶向诊疗中的应用, 最后总结了PDC药物开发所面临的困难。

多肽  /  连接子  /  抗肿瘤药物  /  肿瘤靶向  /  药物递送系统

Cancer is still one of the major diseases threatening human life and health. At present, how to achieve precise diagnosis and treatment of tumors is the biggest challenge in cancer treatment. Prodrugs use the tumor specificity of targeting molecules to deliver anticancer drugs to tumor sites, which can effectively improve drug bioavailability, therapeutic efficacy and safety, and are currently a hot spot in the research and development of anticancer drugs. The targeting molecules of prodrugs mainly include nucleic acid aptamers, polymers, antibodies, polypeptides, etc. Among them, polypeptides have the advantages of good biocompatibility, controllable degradation performance, high in vivo responsiveness, and simple and easy preparation methods, and are widely used. It is used to construct peptide-drug conjugates (PDC) prodrugs to achieve targeted therapy of tumors. In recent years, with the development of phage peptide library technology and peptide standard solid-phase synthesis technology, more and more targeted peptides have been discovered and effectively synthesized and modified, providing strong support for the development of PDC. This review briefly introduces the types and functions of functional peptides and linkers in PDC, and discusses the application of PDC in chemotherapy, immunotherapy and photodynamic therapy in tumor targeted diagnosis and treatment, and finally summarizes the difficulties faced by PDC drug development.

peptide  /  linker  /  anti-cancer agent  /  tumor targeting  /  drug delivery system
陈颖, 郑蓉蓉, 李仕颖. 多肽-药物键合物用于肿瘤靶向诊疗. 药学学报, 2023 , 58 (8) : 2341 -2352 . DOI: 10.16438/j.0513-4870.2022-1053
Ying CHEN, Rong-rong ZHENG, Shi-ying LI. Peptide-drug conjugates for tumor targeted diagnosis and treatment[J]. Acta Pharmaceutica Sinica, 2023 , 58 (8) : 2341 -2352 . DOI: 10.16438/j.0513-4870.2022-1053
多肽是一类由几个或几十个氨基酸按一定顺序通过酰胺键连接的功能性片段, 具有特殊生理功能, 能被机体吸收并参与细胞代谢。虽然组成多肽的天然氨基酸只有20种, 但通过分子设计和氨基酸不同排列组合依然能产生许多种功能型多肽, 能在细胞水平上调控人体的各种生理功能[1, 2]。相比于传统的生物医用载体, 多肽具有肿瘤细胞靶向功能、细胞渗透功能、促凋亡功能、肿瘤微环境响应性高等优点[3-6]。值得注意的是, 由于多肽链段上氨基酸残基具有不同的化学结构, 多肽可利用其肽键间氢键作用及氨基酸残基之间的疏水性作用、静电作用、氢键作用及π-π堆积作用等有效实现分子自组装, 形成有序的超分子拓扑结构, 如纳米管、纤维、囊泡、片层等[7], 展现出单分子或分子低聚体所没有的特性。此外, 多肽具有生物相容性好、生物体内响应性高的特性, 基于多肽自身的结构特点和化学修饰引入特殊功能基团所设计的载体材料具有独特的生理功能, 如pH响应性、酶响应性等。因此, 各种功能型多肽被研究者广泛用于构建多肽-药物键合物(peptide-drug conjugates, PDC), 实现对肿瘤的靶向治疗[8-10]
PDC由功能多肽、连接子、细胞毒性药物3个模块组成, 其组成与作用机制均与抗体偶联药物(antibody drug conjugates, ADC) 相似。此前, 已有大量基于抗体的ADC药物分子得到了广泛研究和临床应用发展, 但基于多肽的PDC药物分子显示出了更大优势。由于ADC的大分子尺寸, 基于抗体的ADC药物分子在肿瘤组织中的穿透性、通透性和滞留效应(enhanced permeability and retention effect, EPR)、免疫原性和体循环稳定性等方面往往不如人意。相比于ADC或其他大分子聚合药物, PDC分子体积小, 在肿瘤穿透、EPR效应等方面有更大优势, 并且部分靶向多肽可改变入胞机制, 克服肿瘤细胞的多药耐药性, 实现对耐药肿瘤的有效凋亡[11]。目前, 众多的研究者热衷于使用化学疗法、免疫疗法、光动力疗法(photodynamic therapy, PDT) 甚至两种方法协同作用治疗肿瘤。无论是哪一种疗法, 如何将药物精准递送至肿瘤部位, 减少药物在非肿瘤部位的过早释放都是重中之重。基于多肽的肿瘤细胞靶向性、刺激响应性、可控自组装等特性, PDC在实现肿瘤精准诊疗上有巨大潜力。本文将综述用于构建PDC的多肽和连接子的种类与功能, 具体论述PDC在肿瘤的化疗、免疫疗法、PDT的研究进展(图 1), 并对PDC用于肿瘤精准治疗的前景进行了展望。
研究表明[12], 肿瘤细胞和肿瘤血管内皮细胞表面的各种受体表达状态与正常细胞相比有不同程度的差异。并且肿瘤微环境在有氧呼吸、血管生成及代谢状态等方面与正常组织相比有显著不同, 具体表现为酸中毒、谷胱甘肽(glutathione, GSH) 表达异常、基质金属蛋白酶(matrix metalloproteinase, MMP) 表达异常等[13]。因此, 肿瘤细胞表面、肿瘤血管内皮细胞表面和肿瘤微环境高表达受体的配体多肽具有对肿瘤组织的天然靶向性。此外, 许多多肽对细胞中的各种亚细胞器也具有靶向性, 如核定位信号肽[14]、线粒体靶向肽[15]等。当细胞毒性药物与这些靶向肽结合时, 可被靶向递送至肿瘤组织, 提高药物生物利用度和治疗效果, 有效避免药物对正常细胞的损伤, 降低药物的全身系统毒性。
在肿瘤细胞凋亡过程中, 肿瘤治疗肽起着必不可少的作用, 如半胱天冬蛋白酶(cysteinyl aspartate specific proteinase, caspase) 家族可通过破坏多种抗凋亡的因素发挥作用, 被激活后可切断与其特异性识别的靶蛋白多肽, 导致程序性细胞死亡; 肿瘤抗原衍生的肽能通过细胞表面被称为人类白细胞抗原(human leukocyte antigen, HLA) 的特殊分子呈递给免疫系统, 引起免疫应答导致肿瘤细胞凋亡。其中, 表 1[16-43]总结了被应用于PDC研究的各类靶向肽。
靶向肿瘤细胞多肽的受体往往会在肿瘤细胞表面呈现高表达状态, 如胰岛素样生长因子受体(IGF-IR)、表皮生长因子受体(EGFR)、促性腺激素释放激素受体(gonadotropin-releasing hormone receptor, GnRHR) 等。以靶向肿瘤细胞表面受体的靶向肽通过化学修饰构建载体材料, 包载药物制备得到的PDC将具有对肿瘤细胞最直接的靶向性, 能有效提高细胞毒性药物的临床治疗效果和安全性, 增强患者对药物的适应性。Pham等[44]利用转肽酶A和一种蛋白连接酶OaAEP1 (Oldenlandia affinis asparaginyl endopeptidase 1) 在人类红细胞外囊泡(red blood cell extracellular vesicles, RBCEVs) 与EGFR靶向肽间建立共价键进行偶联, 促进了EGFR阳性肺癌细胞在体内对RBCEVs的特异性摄取。更进一步地, 作者将包载紫杉醇(paclitaxel, PTX) 的胞外囊泡与EGFR靶向肽偶联, 显著增强药物抑制EGFR阳性肿瘤生长的疗效。
肿瘤细胞在遗传上存在不稳定性, 常常会对细胞毒性药物产生耐受性, 是癌症治疗失败的主要原因之一。在以肿瘤细胞为靶标筛选靶向肽时, 体外培养的肿瘤细胞会丢失一些肿瘤细胞特异性分子或产生肿瘤细胞中并不存在的分子, 不利于靶向肽的筛选。相反, 肿瘤血管内皮细胞在遗传上很稳定, 不易引起耐药性, 是靶向肽筛选的理想目标。在众多的肿瘤血管靶向肽中, 研究最多的就是含精氨酸-甘氨酸-天冬氨酸序列的多肽(Arg-Gly-Asp, RGD) 和含天冬酰胺-甘氨酸-精氨酸序列的多肽(Asn-Gly-Arg, NGR)。其中, RGD肽可被整合素αvβ3受体识别, 可用来靶向肿瘤血管整合素受体。整合素αvβ3在肿瘤细胞和肿瘤血管内皮细胞处有高表达, 对肿瘤的侵袭转移、血管生成起着重要作用, 因此整合素αvβ3成为许多抗肿瘤药物的绝佳靶点。NGR肽识别并结合的受体为肿瘤血管内皮细胞中过表达的CD13酶, 具有较好的肿瘤血管靶向性。CD13是一种跨膜蛋白酶, 在大部分肿瘤细胞和肿瘤血管内皮细胞中过量表达, 是影响肿瘤血管生成的重要因素。肿瘤的生长增殖、侵袭转移对营养物质的需求量极大, 导致肿瘤血管结构与功能与正常血管差异较大。因此, 通过靶向肿瘤血管内皮细胞来递送药物至肿瘤组织, 有效避免对正常组织的损伤, 也是一种具有极大潜力的肿瘤靶向治疗策略。
本课题组前期研究发现[45], 以RGD肽作为靶向分子, 与caspase-3响应性多肽DEVD、光敏剂原卟啉(protoporphyrin IX, PpIX) 和一个荧光共振能量转移荧光团对构建了一种肿瘤靶向荧光探针P-PpIX。归功于RGD的靶向作用, 荧光探针可富集于整合素αvβ3过表达的肿瘤组织。对肿瘤区域进行光照可触发PpIX的PDT诱导肿瘤细胞凋亡, 进而激活caspase酶。被激活的caspase-3能进一步切割DEVD, 使荧光共振能量转移过程终止, 从而恢复荧光信号。该方法有效提高了肿瘤PDT的疗效并为肿瘤细胞凋亡过程提供实时反馈。
由肿瘤细胞、免疫细胞、基质细胞和细胞外间质组成的肿瘤微环境, 在有氧呼吸、血管生成及代谢状态等方面与正常组织相比有显著不同。肿瘤组织微环境主要生理特性有微酸性、细胞内外巯基物质浓度差异、部分酶过量表达、低氧等。因此, 肿瘤微环境与正常细胞的明显差异为肿瘤靶向治疗提供了更多的有效靶点选择。在众多肿瘤微环境响应肽中, 酶敏感肽、pH敏感肽[46]和还原敏感肽被研究者广泛应用。例如, MMP家族参与人体重要的生理和病理过程, 在人体正常组织中仅少量存在, 但在肿瘤微环境中过度表达, 对肿瘤细胞侵袭转移起至关重要的作用。Qiu等[47]利用含有MMP-2敏感多肽GPLGLAG的可活化细胞穿膜肽(activatable cell-penetrating peptide, ACPP) 作为桥梁将PpIX修饰到金纳米棒(gold nanorods, GNRs) 表面, 得到GNR-ACPP-PpIX纳米递药体系。由于ACPP独特的U型结构和GNRs的强近红外区光吸收, PpIX的光活性被抑制。当该纳米体系到达肿瘤组织后, 嵌合肽中的GPLGLAG多肽序列被MMP-2降解, 聚乙二醇(polyethylene glycol, PEG) 外壳脱落, 细胞穿膜肽暴露, PpIX的光活性恢复, 有利于光敏剂在MMP-2过表达肿瘤细胞的富集。
多肽药物键合物在肿瘤治疗中未达到预期效果时, 其原因往往是因为肿瘤细胞对偶联物的内化效率较低。虽然PDC的分子体积在2~20 kDa, 与其他大分子递药系统相比有较好的肿瘤穿透效果, 但这种仅依靠降低分子体积来提高肿瘤组织渗透率的效果有限, 还需加大偶联物剂量才能实现在肿瘤部位达到有效药物浓度富集。为改善上述缺陷, 研究者提出, 细胞穿膜肽(cell-penetrating peptide, CPP) 具有穿透细胞膜往细胞内运送各种生物活性物质的特性, 能使PDC具备主动渗透能力, 进一步提升偶联物在肿瘤组织处的渗透效率, 增强靶向药物的抗肿瘤效果。根据CPP是否具有靶向性, 可将其分为无靶向穿膜肽和靶向穿膜肽。众多无靶向穿膜肽中, 蛋白转导肽TAT [YGRKKRRQRRR] 最具代表性, 不仅能在包括蛋白质、多肽及核酸等多种外源生物大分子的跨膜转导过程中发挥重要作用, 而且能携带这些外源生物大分子穿透活体细胞的各种生物膜性结构(细胞膜和血脑屏障等) 进入胞内并发挥生理功能。然而以TAT肽为代表的穿膜肽缺少肿瘤靶向性, 因此常将其与具有靶向性的肽段连接形成靶向穿透双功能肽如PEGA-pVEC[48]、gHo-pVEC[49]等。Zhang等[50]以pH敏感穿膜肽TH [AGYLLGHINLHHLAHL (Aib) HHIL-Cys] 修饰负载有免疫佐剂α-半乳糖神经酰胺的脂质体(TH modified liposome loaded with alpha-galactosylceramides, aGC-TH-Lip) 用于肿瘤免疫治疗。测定TH修饰的脂质体(TH peptidemodified liposome, TH-Lip) 在体外被小鼠树突状细胞(dendritic cell, DC) 的摄取状况, 结果显示, TH-Lip在体外被DC2.4细胞的摄取量是聚乙二醇修饰的脂质体(polyethylene glycols modified liposome, PEG-Lip) 的1.48倍。荷瘤小鼠给予aGC-TH-Lip后, 其体内自然杀伤性T细胞、成熟DC细胞和细胞毒性T淋巴细胞数量较游离aGC组均有明显差异。结果表明, 基于TH肽的递送系统能有效地将药物富集到肿瘤细胞, 增强负载药物疗效。
在靶向穿膜肽中, 以CendR肽为基础所构建的多肽受到广泛关注。CendR是氨基酸C-端序列为R/KXXR/K的短肽, 能与肿瘤组织内高表达的NRP-1 (neuropilin-1) 特异性结合。CendR多肽和NRP-1的相互作用是药物克服生理屏障, 促使其在组织内穿透的最关键因素。例如iRGD (CRGDK/RGPD/EC) 肽既含有肿瘤血管内皮细胞靶向肽RGD序列又具备CendR肽链序列, 与肿瘤细胞的亲和性高, 能有效靶向渗透入肿瘤组织和肿瘤细胞内。
细胞器独特的生理功能在肿瘤细胞的生长增殖、侵袭转移中发挥着关键作用, 因此细胞器如细胞核、线粒体等可作为肿瘤治疗的靶点。细胞核是真核细胞内重要的细胞结构, 是细胞遗传与代谢的调控中心。药物靶向至细胞核能克服耐药细胞的细胞外排作用, 有效破坏肿瘤细胞细胞核的结构与功能, 使肿瘤细胞生理功能紊乱并致其凋亡。然而细胞核外的核膜阻碍了细胞核与细胞质的物质运输, 大分子活性物质需借助核靶向分子才能完成入核过程。细胞核靶向肽能很好地将细胞毒性药物运输至细胞核, 被广泛用于协助药物入核。
线粒体是细胞进行有氧呼吸、提供细胞代谢所需能量的主要场所。传统的线粒体靶向肿瘤治疗通常将亲脂性阳离子(如三苯基) 作为线粒体靶向基团以将细胞毒性物质递送至线粒体, 然而由于传统线粒体靶向递药系统对肿瘤细胞选择性低、肿瘤细胞富集少、全身系统毒性较高等缺点削弱了肿瘤治疗效果。为克服上述缺陷, 线粒体靶向肽通常含有带正电荷和疏水性的氨基酸, 如线粒体穿膜肽、Szeto-Schiller肽、线粒体靶向序列等[51], 被提出作为线粒体靶向分子的亲脂性阳离子的替代品。受损的线粒体产生活性氧、细胞色素C等信号激活caspase家族蛋白来启动细胞凋亡。因此, 线粒体成为了最适合肿瘤PDT触发细胞凋亡的细胞器。Sun等[52]以RGD肽和KLA肽开发了一种多阶段肿瘤靶向脂质体(RGD/KLA-modified liposome, RGD-KLA-Lip) 负载PTX, RGD-KLA-Lip具有对肿瘤细胞和肿瘤血管内皮细胞线粒体的靶向运输作用, 促进了线粒体介导的细胞凋亡并有效降低了细胞毒性药物的全身系统毒性。
Caspase家族是一种调节细胞程序性凋亡、炎症等生理功能的蛋白酶家族, 细胞凋亡的过程实际上是caspase被活化并发生凋亡蛋白酶的级联反应。在细胞凋亡过程中, caspase蛋白酶被激活可切断对其特异性识别的多肽。这种caspase蛋白酶刺激响应型多肽常用作构建荧光探针来实现对肿瘤细胞凋亡过程中的实时检测, 或用于设计caspase蛋白酶响应型纳米递药系统实现细胞毒性药物对肿瘤的靶向治疗。
肿瘤抗原可使免疫系统将正常细胞与肿瘤细胞区分开, 一方面肿瘤抗原衍生肽能通过HLA呈递给免疫系统, 另一方面抗原递呈细胞(antigen presenting cells, APC) 能摄取、加工处理肿瘤抗原, 并将抗原递呈给T淋巴细胞的一类免疫细胞, 引起机体的免疫应答。因此, 肿瘤抗原多肽尤其是只在肿瘤细胞表达的肿瘤特异性表达抗原肽均可作为免疫治疗肽, 在以APC和T淋巴细胞为靶点对肿瘤细胞进行免疫治疗方面有着巨大潜力。Boël等[53]报道了编码肿瘤抗原的新基因BAGE基因, 其编码的ARAVFLAL肽可被T淋巴细胞识别。BAGE基因在正常组织中是沉默的, 而在肿瘤部位特异性表达, 编码的抗原可作为对细胞毒性T淋巴细胞的靶向肽, 触发免疫系统对肿瘤的免疫应答。
PDC的多肽分子和细胞毒性药物通过连接子共价偶联。作为一种前药, PDC须满足在体循环过程中无过早释药, 仅在肿瘤部位释放药物的条件。其中, 连接子的选择至关重要, 需考虑很多因素: 多肽类型与功能、细胞毒性药物、肿瘤微环境特性等。合适的连接子不仅能保证PDC在体循环过程中的稳定性, 还能提高细胞毒性药物杀伤肿瘤细胞效率。根据连接子在体循环中的稳定性和肿瘤组织处的断裂机制, 可将其分为不可裂解型连接子和可裂解型连接子。可裂解型连接子中, 根据其在肿瘤组织中触发裂解机制又可分为酶敏感性连接子、还原敏感型连接子和pH敏感型连接子。表 2[54-61]中列举了一些常用的连接子。
不可裂解型化学物质如肟、硫醚、三唑和γ-氨基丁酸等[54], 可用于结合细胞毒性药物连接到靶向多肽。与可裂解型连接子相比, 以不可裂解型连接子为中间体的PDC优势在于良好的体循环稳定性、更少的过早释药和更低的系统毒性。但是当连接的靶向肽与细胞毒性分子相同时, 不可裂解型连接子构建的PDC相比于可裂解型连接子往往表现出更低的抗肿瘤效果[62]
Yu等[55]将一种细胞穿膜肽KRP与多柔比星(doxorubicin hydrochloride, DOX) 通过硫醚键和酰胺键连接得到KRP-DOX偶联物。KRP-DOX静脉注射移植骨肉瘤小鼠后, 在血液循环中几乎没有释放游离DOX, 并表现出了良好的肿瘤组织选择性富集和肿瘤细胞内化效率, 这归功于偶联物中稳定的共价键避免了药物在血液中的过早释放, 使大部分DOX通过KRP进入肿瘤细胞。
酶敏感型连接子常用形式有酯键、特定氨基酸序列的短肽等, 能被肿瘤细胞的专属性或过表达蛋白酶特异性识别, 广泛用于肿瘤微环境异常表达酶触发释药。由于血浆中pH过高, 肿瘤组织中某些特定蛋白酶在血浆中的活性低, 因此酶响应型连接子在体循环中能保持良好稳定性。其中, 蛋白酶特异性响应短肽在PDC研究中受到广泛关注。肿瘤组织中高表达的蛋白酶有MMP、半胱氨酸组织蛋白酶、激肽释放酶等。
还原敏感型连接子是基于细胞质中GSH等还原性物质的浓度比血浆中浓度高近1 000倍。并且, 由于肿瘤微环境的氧化应激和缺氧, 肿瘤细胞内的GSH浓度比正常细胞更高, 促进二硫键在细胞内的断裂。因此, 二硫键被广泛用于靶向给药。以二硫键为中间体构建的PDC在血液中具有良好稳定性, 而在肿瘤细胞中能被还原分解释放出细胞毒性分子。Qian等[58]利用一种靶向MMP-2的多肽MMP1 (CCKIGLFRWR) 通过还原敏感性二硫键与DOX连接。MMP1肽和DOX间的二硫键通过高浓度GSH还原而断裂。DOX可有效地进入肿瘤细胞。同时, MMP1肽选择性地抑制MMP-2活性, 有效抑制肿瘤转移。
与正常细胞通过氧化磷酸化获取能量的方式不同, 肿瘤细胞因为脉管系统分布不均匀(也称瓦氏效应), 供氧量不足, 所以只能利用无氧糖酵解产生的能量。因此, 肿瘤细胞会产生大量的乳酸、氢离子及二氧化碳, 从而导致肿瘤微环境酸化(pH值为6.2~6.8)。溶酶体中的pH值为4.5~6.0, 与人体生理pH 7.4差异更大。pH敏感型连接子中, 最常用的连接子是肼键[59], 其在中性环境中稳定, 但在弱酸性环境中易水解。此外, 亚胺[60]、缩醛等都是pH敏感型连接子常用形式。Ding等[61]利用PEG的水合壳功能和腙键的酸敏感性, 构建了一种CPP修饰的pH敏感性PEG化脂质体, 以提高多肽对肿瘤靶向的选择性。高效液相色谱和流式细胞术表明, 酸可降解腙键, 在正常中性条件下是稳定的, PEG可从脂质体表面完全切割, 在肿瘤酸性环境下暴露出CPP, 增强肿瘤细胞对PEG链的摄取。
PDC的功能多肽为偶联物提供了肿瘤靶向、细胞穿透、蛋白酶响应等功能; 连接子起着中间体和刺激响应释药作用; 而细胞毒性药物则是PDC的核心, 对肿瘤细胞具有杀伤作用。细胞毒性药物是指能诱导细胞凋亡的治疗活性分子, 包括化疗药物、光敏剂、放射性核素、肿瘤抗原、免疫检查点阻断剂甚至是显像剂、造影剂等。然而, 细胞毒性药物单独使用对肿瘤细胞无选择性, 无差别杀伤正常细胞, 导致全身系统毒性。此外, 给药后肿瘤细胞细胞膜上过度表达外排抗肿瘤药物蛋白引起多药耐药性, 削弱了细胞毒性药物在临床治疗中的疗效。虽然传统的前药载体能让药物具有较好的缓释作用, 但仍存在制备复杂、生物降解性差、对肿瘤细胞选择性差等缺陷。以功能多肽为载体的PDC前药系统可有效提高细胞毒性药物靶向性, 解决其全身系统毒性、多药耐药等问题, 并且多肽载体在体内生物降解可控, 不会产生积累毒性, 为肿瘤诊疗开辟新途径。
化疗是肿瘤传统三大疗法之一, 由于化疗药物自身靶向能力差、生物利用度低等原因, 为化疗带来了严重的不良反应, 削弱了其在临床治疗中的疗效。PDC前药系统是解决化疗药物此类普遍性问题的重要手段。
Shim等[63]利用促凋亡肽(Ala-Val-Pro-Ile-Ala-Gln, SMAC) 和组织蛋白酶B裂解肽(Phe-Arg-Arg, FRRG) 与DOX偶联, 自组装得到纳米粒(SMAC-FRRG-DOX nanoparticles)。如图 2所示, DD-NPs (drug-drug nanoparticles) 仅在组织蛋白酶B高表达的癌细胞中被切割释放出促凋亡药物与DOX, 诱导了促凋亡作用与化疗的协同治疗。在乳腺瘤小鼠实验中, DD-NPs通过EPR作用在肿瘤组织处高度积累, 并通过SMAC肽和FRRG肽的双重递送增强了DOX介导的化疗。因此, 它们可阻止耐药性的发展, 并有效、安全地抑制肿瘤的生长和转移, 且使常规化疗的毒副作用最小。
Duan等[64]合成并评估了两种紫衫醇-细胞穿透肽偶联物(paclitaxel-cell penetrating peptide conjugates, PTX-CPPs)。与游离PTX相比, 两种PTX-CPPs在癌细胞中均显示出显著增强的细胞摄取、细胞毒性升高、细胞凋亡增加及线粒体膜电位降低。PTX-CPPs在抑制荷瘤小鼠肿瘤生长方面比游离PTX更有效, 这表明其在体内抗肿瘤疗效更好, 有效改善了PTX水溶性低、细胞多药耐药性等问题。
Saghaeidehkordi等[65]设计了一种靶向于乳腺癌细胞受体角蛋白1的靶向肽, 与DOX通过酸敏感性腙键连接构建了受体角蛋白1靶向肽-DOX偶联物。在三阴性乳腺癌小鼠模型中对偶联物进行了体内评估, 第35天时用PDC处理的小鼠肿瘤生长显著减少, 约为游离DOX治疗小鼠肿瘤生长体积的65%。更值得注意的是, 由于靶向肽的靶向作用, PDC药物处理组小鼠肿瘤内DOX水平是游离DOX组的1.4倍。相反, 在其他器官处, PDC药物处理组显示出更低的DOX水平, 仅为游离DOX组的45%~77%, 说明靶向肽能显著增强药物在肿瘤组织处的富集, 减少化疗药物的不良反应。
化疗药物结合各种功能型多肽构建PDC, 克服了化疗药物肿瘤靶向性低、毒副作用严重的缺陷, 并且增强了药物的肿瘤穿透能力, 能在病灶处实现有效富集, 进一步增强疗效。然而, 体循环中PDC的多肽与连接子可被蛋白酶或化学刺激裂解, 造成药物过早释放, 出现不希望的毒副作用。因此, 为提高PDC在血循环中的稳定性, 还需对PDC的载体构建开发新材料和新技术。
抗肿瘤免疫反应可分为3个步骤[66]: ①肿瘤抗原加工与递呈; ② APCs启动肿瘤抗原特异性T细胞; ③肿瘤部位的效应T细胞杀灭癌细胞。然而, 肿瘤细胞能采用不同策略来抑制免疫系统, 逃避机体正常的抗肿瘤免疫反应, 出现免疫逃逸。
肿瘤逃逸免疫系统的主要机制是通过抑制抗原呈递。APC尤其是DC细胞本应促进抗肿瘤免疫。然而, 肿瘤源性因子(白介素-6、白介素-10、血管内皮生长因子等) 创造的环境会阻碍DC的成熟, 维持在不成熟状态, 最终损害其作为抗原递呈细胞的功能, 从而使这些细胞不能诱导抗肿瘤T细胞反应。Yuzuriha等[67]设计了一种抗原肽SIINFEKL与全反式维甲素(all-trans retinoic acid, ATRA)、维生素D3的偶联物, 以有效地诱导对抗肿瘤特异性免疫耐受(图 3)。ATRA与维生素D3作为DC细胞的诱导剂, 能有效抑制巨噬细胞和DC细胞的炎症反应, 促进DC细胞对抗原的呈递, 进而诱导T淋巴细胞对肿瘤的免疫治疗。这种以APC为靶标的多肽药物键合物前药体系将有助于增强APC对肿瘤抗原的识别与处理, 促进对抗肿瘤特异性免疫耐受。
肿瘤免疫治疗中, 免疫检查点表达于免疫及相关细胞, 与肿瘤细胞上的受体结合后通过抑制免疫细胞的活性和增殖能力来抑制免疫应答, 从而诱导免疫逃逸。免疫检查点及其配体是肿瘤成像及靶向治疗的优良靶标, 筛选及制备出的一些分子可与免疫检查点或其配体特异性结合, 通过阻断其相互作用而使免疫细胞发挥正常功能, 这类化合物被称为免疫检查点阻断剂。其中, 靶向细胞毒性T淋巴细胞相关分子-4 (cytotoxic T-lymphocyte-associated protein 4, CTLA-4)、程序性细胞死亡受体-1 (programmed cell death receptor 1, PD-1) 和PD-L1 (programmed cell death 1 ligand 1) 的药物是最广泛研究和认可的。多肽也能成为免疫检查点阻断药物。Li等[68]使用T细胞活化测定和混合淋巴细胞反应, 证实多肽TPP-1 (SGQYASYHCWCWRDPGGSK) 会干扰PD-1/PD-L1的相互作用。为了检测TPP-1对体内肿瘤生长的抑制作用, 建立了使用H460细胞的异种移植小鼠模型。TPP-1或PD-L1抗体治疗小鼠的肿瘤块生长率分别比对照肽治疗小鼠低56%或71%, 表明TPP-1抑制或至少延缓肿瘤生长, 这归功于TPP-1减弱了PD-L1对T细胞的抑制作用, T细胞重新激活。更进一步的是, Meng等[69]将超顺磁性氧化铁纳米粒(superparamagnetic iron oxide nanoparticles, SPIO NPs) 被H460肺癌细胞膜包封得到SPIO NP@M, 并将PD-L1抑制肽TPP1和MMP-2敏感肽PLGLLG偶联到肺癌细胞膜上得到SPIO NP@M-P纳米粒。H460肺癌细胞膜作为仿生载体延长了PDC药物的半衰期, 并以MMP-2敏感肽作为靶向分子使其在肿瘤组织中实现有效积累。更值得注意的是, PDC药物递送系统中将PD-L1抑制肽TPP1作为了细胞毒性药物, 增强了肿瘤免疫治疗疗效。
除上述的抗原呈递抑制和肿瘤检查点外, 肿瘤免疫逃逸与免疫抑制肿瘤微环境息息相关, 例如吲哚胺2, 3-双加氧酶抑制、异常氧化还原状态、肿瘤相关巨噬细胞等, 使得免疫疗法在肿瘤治疗中的疗效降低。然而, 以多肽为基础的PDC药物可充分利用肿瘤微环境响应来设计药物靶向递送系统。由于肿瘤微环境与正常组织间的巨大差异, 使肿瘤微环境敏感肽、pH敏感肽等对肿瘤微环境具有靶向能力, 同时, pH敏感型连接子、还原敏感型连接子亦可利用肿瘤微环境实现药物的可控释放。随着对肿瘤微环境的不断研究, PDC可在肿瘤免疫疗法领域取得更大进步。
PDT是基于光敏剂在局部或全身的作用, 由于其选择性好、患者耐受性高, 在癌症治疗中有很好的应用前景。PDT的分子机制是基于3种无毒成分, 仅通过相互作用在病理组织内产生预期效果。这3种必需分子分别为光敏剂、具有适当波长的光、在细胞中溶解的氧气。光敏剂进入细胞后吸收适当波长的光, 启动激活过程, 产生具有细胞毒性的单态氧等活性氧物质。高活性氧会引起肿瘤组织内的蛋白质、脂肪和其他分子的光损伤, 能导致肿瘤细胞在凋亡或坏死过程中直接死亡。值得注意的是, 光敏剂在细胞内的位置不同决定了细胞死亡的机制不同, 例如线粒体的损伤可导致细胞凋亡、细胞膜的破坏和完整性的丧失可引起坏死、溶酶体或内质网的损伤可引起自噬。
本课题组的前期研究中[70], 合成了一种MMP-2敏感激活的细胞穿透肽ACPP [R9GPLGLAGE8] 与PpIX的偶联物(ACPP-PpIX), 用于肿瘤靶向PDT (图 4)。ACPP由聚阳离子穿膜肽R9 (RRRRRRRRR)、MMP-2敏感寡肽和聚阴离子肽E8 (EEEEEEEE) 组成。在正常组织中, R9肽的细胞穿透功能会通过分子内静电吸引被E8肽阻断。一旦偶联物进入MMP-2过表达的肿瘤细胞, R9肽和E8肽之间的寡肽连接子被蛋白水解将分离抑制性聚阴离子, 释放CPP-PpIX用于PDT, 这有效地解决了显正电荷的细胞穿透肽在血液循环中不稳定和对肿瘤组织具有非特异性导致毒副作用严重的缺陷。结果发现, 在尾静脉注射后, ACPP-PpIX偶联物可通过荧光增强有效地聚集在肿瘤部位, 有利于肿瘤诊断和图像引导下的PDT。
由于富含氧的细胞环境可产生活性氧, 线粒体可能是最适合PDT触发细胞凋亡的细胞器。Cheng等[71]开发了一种单药自递送嵌合肽基纳米粒, 用于线粒体和质膜双靶向光动力肿瘤治疗(图 5)。嵌合肽由光敏剂PpIX、一种具有双重靶向功能的生物活性肽RFXRFXRFXR和亲水PEG链组成。实验表明, 肿瘤质膜定位嵌合肽可增强光照射下的膜通透性, 提高纳米粒的细胞传递。更重要的是, 线粒体和质膜双靶向系统实现了光敏剂的线粒体有效定位, 从而实现线粒体部位的PDT, 最大限度增强了光敏剂诱导PDT的疗效。
上述文献[70, 71]证明了两肽结合能有效提高PDC在体内的稳定性, 并且将光敏剂靶向线粒体的PDT效果更佳。Xu等[72]以活性中性粒细胞封装了RGD肽和线粒体破坏肽KLA (KLAKLAKKLAKLAL) 修饰的光敏剂Ce6, 既赋予了PDC体内长循环能力、对肿瘤组织的靶向性, 又能主动进入肿瘤细胞积聚在线粒体处触发PDT。同时多肽KLA诱导线粒体膜破坏, 达到协同治疗目的。
PDC前药策略不仅能将光敏剂成功靶向至肿瘤组织, 增强其肿瘤细胞穿透能力, 而且能利用细胞器靶向肽如线粒体靶向肽、质膜靶向肽、内质网靶向肽等将光敏剂定向递送至亚细胞器, 以不同的机制引起肿瘤细胞凋亡, 发挥PDT的最大疗效。
与ADC或其他大分子聚合药物相比, PDC药物分子体积小, 具有更强的肿瘤组织穿透能力和EPR效应, 这是PDC药物的一大优势。然而, PDC分子质量小亦使其易透过肾小球滤过膜而被快速清除, 是PDC分子生物半衰期短的一个重要原因。此外, 由于血浆中存在各种蛋白酶或多肽酶, PDC在体循环中易被降解, 是造成PDC在体内不稳定、生物半衰期短的另一重大因素。为了让PDC具有长时间的持续给药能力, 使细胞毒性药物在病灶部位实现有效富集, 研究者通常对PDC进行化学修饰或采用仿生载体策略。Wang等[73]将PDC接枝于PEG和第4代聚酰胺基胺树枝状大分子所构建的载体上, 大大增强了PDC在小鼠体内的长循环能力。Fan等[74]采用仿生载体策略, 利用大鼠胶质瘤细胞的细胞膜(rat glioma cell membrane, CCM) 包裹紫杉醇纳米悬浮液[paclitaxel nano suspension, (PTX) NS], 并进一步将血脑肿瘤屏障穿透肽WSM (SYPGWSW) 通过插入法修饰到肿瘤细胞膜表面, 使PDC既具有了肿瘤穿透能力, 又提高了其PDC在体循环中稳定性。但值得注意的是, 化学修饰、仿生载体策略等方法在一定程度上限制了PDC分子体积小所带来的肿瘤穿透能力强和载药率高等优势。因此, 在开发设计PDC药物分子结构时, 需综合考虑多方因素。
世界上首个被FDA批准的抗癌PDC药物Pepaxto在验证性临床试验中出现了逐步增高的死亡率, 其临床试验均被终止并撤出市场。作为一种新型PDC药物, Pepaxto靶向于肿瘤细胞中的CD13酶, 被用于治疗CD13高表达的多发性骨髓瘤。在氨肽酶敏感性裂解后, Pepaxto的亲水性烷基化代谢物马法兰积聚在骨髓瘤细胞中, 与细胞中的生物活性成分发生烷化作用, 造成细胞凋亡。Schjesvold等[75]对Pepaxto做了详细研究, 称Pepaxto是由于该药物的高亲脂性通过被动转运进入细胞内, 并迅速在肿瘤细胞中使药物富集到有效浓度, 这是Pepaxto的一大优势。但也正因其高亲脂性, Pepaxto也能进入到正常细胞中, 出现不良反应, 这与其在临床试验研究中总生存期下降可能有关。
本综述对多肽、连接子进行了详细分析, 并论述了PDC在肿瘤治疗中的各种应用, 为构建PDC前药递送系统提供了有力支持。具有良好生物活性的多肽本身或经过化学修饰后, 能实现长循环可控释放、肿瘤细胞靶向、细胞穿透等功能。在PDC的构建中, 常用的多肽主要包括肿瘤细胞靶向肽、肿瘤血管内皮细胞靶向肽、肿瘤微环境敏感肽、细胞穿膜肽、细胞器靶向肽和治疗肽。针对不同类型肿瘤, 靶向肽的选择对药物的治疗效果影响深远。此外, 发挥中间体作用的连接子对PDC的药效也至关重要, 具有PDC稳定性及响应性控制释药的作用, 有利于药物在肿瘤组织中的富集。从目前研究看, PDC前药递送系统在肿瘤的化学疗法、免疫疗法和PDT中展现出了巨大应用潜力。相信随着多肽合成和筛选技术的不断发展, 肿瘤靶标的不断发现, 将更有利于PDC在肿瘤诊疗中的应用。
作者贡献: 陈颖负责文献检索和全文撰写; 郑蓉蓉负责文章修订和复核; 李仕颖负责选题和思路指导。
利益冲突: 所有作者和文章所涉及内容均不存在潜在的利益冲突。
  • 国家重点研发计划项目(2021YFD1800600)
  • 广东省自然科学基金项目(2021B1515020043)
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2023年第58卷第8期
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doi: 10.16438/j.0513-4870.2022-1053
  • 接收时间:2022-09-13
  • 首发时间:2025-11-21
  • 出版时间:2023-08-12
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  • 收稿日期:2022-09-13
  • 修回日期:2022-10-05
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国家重点研发计划项目(2021YFD1800600)
广东省自然科学基金项目(2021B1515020043)
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    广州医科大学药学院, 广东 广州 511436

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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
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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