Актуальные вопросы канцерогенеза

И.В. Высоцкая1, В.П. Летягин2, М.А. Шабанов2, В.Ю. Кирсанов1, Е.А. Ким1, Н.В. Левкина1

1 ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России, ул. Трубецкая, д. 8, стр. 2, Москва, Российская Федерация, 119991

2 ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России, Каширское ш., д. 24, Москва, Российская Федерация, 115478

Для переписки: Ирина Викторовна Высоцкая, д-р мед. наук, профессор, ул. Трубецкая, д. 8, стр. 2, Москва, Российская Федерация, 119991; e-mail: vysotskaya.irina@mail.ru

Для цитирования: Высоцкая И.В., Летягин В.П., Шабанов М.А. и др. Актуальные вопросы канцерогенеза. Клиническая онкогематология. 2019;12(1):101–6.

DOI: 10.21320/2500-2139-2019-12-1-101-106


РЕФЕРАТ

В обзоре приведены современные данные об основных патогенетических механизмах, обусловливающих неконтролируемый рост и метастазирование опухоли, развитие ее резистентности к традиционным методам терапии. Генетическая нестабильность клетки, связанная с накоплением мутаций в генах контроля клеточного роста и дифференцировки, является ключевым моментом опухолевой прогрессии. Понимание и детальное изучение процессов канцерогенеза лежит в основе создания новых противоопухолевых препаратов, что, в свою очередь, позволяет оптимизировать и индивидуализировать лечение пациентов с онкологическими заболеваниями.

Ключевые слова: канцерогенез, инициация, промоция, репарация, протоонкогены, гены-супрессоры, Ras, TP53, таргетная терапия.

Получено: 27 июня 2018 г.

Принято в печать: 20 декабря 2018 г.

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Клиническое и прогностическое значение молекулярных маркеров диффузной В-крупноклеточной лимфомы

С.М. Расторгуев1, Д.А. Королева2, Е.С. Булыгина1, С.В. Цыганкова1, Н.Г. Гончаров1, О.С. Нарайкин1, Н.Г. Габеева2, Е.Е. Звонков2, А.В. Недолужко1

1 ФГБУ «НИЦ “Курчатовский институт”», пл. Академика Курчатова, д. 1, Москва, Российская Федерация, 123182

2 ФГБУ «НМИЦ гематологии» Минздрава России, Новый Зыковский пр-д, д. 4а, Москва, Российская Федерация, 125167

Для переписки: Артем Валерьевич Недолужко, канд. биол. наук, пл. Академика Курчатова, д. 1, Москва, Российская Федерация, 123182; тел.: +7(916)670-55-95; e-mail: nedoluzhko@gmail.com

Для цитирования: Расторгуев С.М., Королева Д.А., Булыгина Е.С. и др. Клиническое и прогностическое значение молекулярных маркеров диффузной В-крупноклеточной лимфомы. Клиническая онкогематология. 2019:12(1):95–100.

DOI: 10.21320/2500-2139-2019-12-1-95-100


РЕФЕРАТ

Диффузная В-крупноклеточная лимфома (ДВКЛ) — наиболее распространенная лимфатическая опухоль взрослых, она составляет примерно 30–40 % всех неходжкинских лимфом. К критериям диагноза относятся диффузный рост крупных анаплазированных опухолевых клеток, экспрессия В-клеточных маркеров и высокий индекс пролиферативной активности. Благодаря совершенствованию молекулярно-генетических технологий стало очевидно, что в основе клинического разнообразия лежит огромное количество генетических поломок, определяющих эпигенетическую модификацию экспрессии генов, вариабельность активации определенных сигнальных путей и иммунологические особенности опухолевых клеток. Исследование и систематизация молекулярных маркеров являются важным направлением в области диагностики и лечения ДВКЛ. В настоящем обзоре мы описываем данные о наиболее значимых молекулярных маркерах и современные представления об их клиническом значении.

Ключевые слова: лимфома, ДВКЛ, В-клетки, транскриптомика, экспрессия генов, эпигеномика, геномика.

Получено: 3 июля 2018 г.

Принято в печать: 10 декабря 2018 г.

Читать статью в PDF 


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Роль иммунологического синапса в биологии хронического лимфолейкоза

Д.С. Бадмажапова, И.В. Гальцева, Е.Е. Звонков

ФГБУ «НМИЦ гематологии» Минздрава России, Новый Зыковский пр-д, д. 4, Москва, Российская Федерация, 125167

Для переписки: Дарима Сэмункоевна Бадмажапова, Новый Зыковский пр-д, д. 4, Москва, Российская Федерация, 125167; тел.: +7(929)562-93-41; e-mail: badmazhapova-darima@mail.ru

Для цитирования: Бадмажапова Д.С., Гальцева И.В., Звонков Е.Е. Роль иммунологического синапса в биологии хронического лимфолейкоза. Клиническая онкогематология. 2018;11(4):313–8.

DOI: 10.21320/2500-2139-2018-11-4-313-318


РЕФЕРАТ

Хронический лимфолейкоз (ХЛЛ) — злокачественное лимфопролиферативное заболевание, которое проявляется накоплением опухолевых В-лимфоцитов с характерным иммунофенотипом (CD19+CD5+CD23+) в костном мозге, периферической крови и вторичных лимфоидных органах. По клиническому течению ХЛЛ является гетерогенным заболеванием. Это самый частый вид лейкоза у лиц старшей возрастной группы. Несмотря на применение новых лекарственных средств, остаются рефрактерные формы заболевания. Последние открытия в иммунологии позволили понять некоторые механизмы уклонения опухолевых клеток от иммунного надзора. Взаимодействие клеток иммунной системы друг с другом осуществляется за счет формирования иммунологического синапса, в котором основная роль отводится семейству молекул CD28/В7, так называемым иммунным контрольным точкам, регулирующим активационные и ингибирующие механизмы регуляции клеток. Приобретение клетками опухолевого фенотипа — многоступенчатый процесс, в котором клетка приобретает уникальные биологические свойства, в т. ч. и возможность быть невидимой для иммунитета. В отличие от солидных опухолей при лимфопролиферативных заболеваниях опухолевые В-лимфоциты способны экспрессировать главный комплекс гистосовместимости II класса и костимулирующие молекулы CD80 и CD86. Это свидетельствует о том, что они могут быть антигенпрезентирующими клетками для Т-клеток. Наличие коингибирующих молекул на поверхности опухолевых клеток может служить одним из факторов ингибирования иммунного ответа. В настоящем обзоре рассматриваются современные представления о биологических особенностях и иммунологических взаимодействиях клеток ХЛЛ с клетками микроокружения.

Ключевые слова: хронический лимфолейкоз, иммунологический синапс, иммунитет.

Получено: 15 марта 2018 г.

Принято в печать: 29 июня 2018 г.

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Ингибиторы иммунных контрольных точек в терапии лимфом

К.В. Лепик

НИИ детской онкологии, гематологии и трансплантологии им. Р.М. Горбачевой, ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова», ул. Льва Толстого, д. 6/8, Санкт-Петербург, Российская Федерация, 197022

Для переписки: Кирилл Викторович Лепик, ул. Льва Толстого, д. 6/8, Санкт-Петербург, Российская Федерация, 197022; e-mail: lepikkv@gmail.com

Для цитирования: Лепик К.В. Ингибиторы иммунных контрольных точек в терапии лимфом. Клиническая онкогематология. 2018;11(4):303–12.

DOI: 10.21320/2500-2139-2018-11-4-303-312


РЕФЕРАТ

Рецепторы и лиганды программируемой клеточной гибели (PD-1 и PD-L1) — наиболее изученные представители семейства иммунных контрольных точек (ИКТ), представляют собой ключевой элемент регуляции иммунного ответа. Способность злокачественных клеток воздействовать на рецепторы ИКТ является одним из важнейших механизмов подавления противоопухолевого иммунитета. Создание препаратов — ингибиторов ИКТ предоставляет возможность контроля и активации иммунного ответа, открывая новые перспективы иммунотерапии злокачественных новообразований, в т. ч. лимфом. В данном обзоре освещаются биологические основы применения ингибиторов ИКТ при классической лимфоме Ходжкина и неходжкинских лимфомах, а также представлен опыт их использования в клинике. Кроме того, обозначены новые подходы к созданию комбинированных режимов с включением ИКТ.

Ключевые слова: иммунные контрольные точки (ИКТ), PD-1, PD-L1, классическая лимфома Ходжкина, неходжкинские лимфомы, ингибиторы ИКТ.

Получено: 25 марта 2018 г.

Принято в печать: 23 июля 2018 г.

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Теория и практика иммунотерапии, направленной против антигена PRAME

В.А. Мисюрин

ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России, Каширское ш., д. 24, Москва, Российская Федерация, 115478

Для переписки: Всеволод Андреевич Мисюрин, канд. биол. наук, Каширское ш., д. 24, Moсква, Российская Федерация, 115478; тел.: +7(985)436-30-19; e-mail: vsevolod.misyurin@gmail.com

Для цитирования: Мисюрин В.А. Теория и практика иммунотерапии, направленной против антигена PRAME. Клиническая онкогематология. 2018;11(2):138-49.

DOI: 10.21320/2500-2139-2018-11-2-138-149


РЕФЕРАТ

Антиген PRAME, представляющий собой значимую мишень для моноклональных антител, является онкоспецифическим маркером, который активен на всех стадиях дифференцировки опухолевых клеток, и вызывает спонтанный T-клеточный ответ. Поскольку белок PRAME экспрессируется примерно у каждого второго больного с солидными опухолями и онкогематологическими заболеваниями, иммунотерапия против данного антигена имеет значительные перспективы. В настоящем обзоре обсуждается механизм развития спонтанного иммунного ответа против PRAME и роль данного антигена в иммунном надзоре. Рассматривается процесс развития PRAME-специфических T-клеток. Оцениваются риски применения иммунотерапии против PRAME-экспрессирующей клетки. Обсуждаются достоинства и недостатки различных подходов в иммунотерапии, в т. ч. использование дендритноклеточных вакцин, вакцинирование антигеном PRAME, выведение специфических T-клеток и разработка специфических моноклональных антител. Объяснены возможные причины неудач некоторых видов иммунотерапии, представлены пути их преодоления. Поиск литературы, на которой основан данный обзор, проводился в базах данных Pubmed, Scopus и eLibrary по ключевому слову «PRAME». Рассмотрены только те публикации, в которых изучались различные аспекты или создавались средства иммунотерапии, направленной против антигена PRAME.

Ключевые слова: PRAME, иммунотерапия, дендритноклеточные вакцины, пептидные вакцины, T-клеточные вакцины, терапевтические антитела.

Получено: 19 декабря 2017 г.

Принято в печать: 5 февраля 2018 г.

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Клиническое значение экспрессии гена PRAME при онкогематологических заболеваниях

В.А. Мисюрин

ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России, Москва, Каширское ш., д. 24, 115478

Для переписки: Всеволод Андреевич Мисюрин, канд. биол. наук, Каширское ш., д. 24, Moсква, Российская Федерация, 115478; тел. +7(985)436-30-19; e-mail: vsevolod.misyurin@gmail.com

Для цитирования: Мисюрин В.А. Клиническое значение экспрессии гена PRAME при онкогематологических заболеваниях. Клиническая онкогематология. 2018;11(1):26–33.

DOI: 10.21320/2500-2139-2018-11-1-26-33


РЕФЕРАТ

Хотя и активность PRAME была впервые установлена при солидных опухолях, данный ген чрезвычайно часто экспрессируется при онкогематологических заболеваниях. Ген PRAME может быть использован как надежный биомаркер наличия опухолевых клеток. Определение транскриптов PRAME используется при мониторинге минимальной остаточной болезни и диагностике молекулярного рецидива. При проведении экспериментов с PRAME-экспрессирующими линиями лейкозных клеток получены противоречивые результаты. По этой причине объяснить наблюдаемое влияние экспрессии PRAME на прогноз очень сложно. Тем не менее при хронических миелопролиферативных заболеваниях и хроническом миелоидном лейкозе активность PRAME связана с худшим прогнозом, а при острых лейкозах лимфоидной и миелоидной направленности — с лучшим. Несмотря на большой объем клинических наблюдений, при некоторых нозологических формах влияние экспрессии PRAME на прогноз остается неизвестным. В настоящем обзоре литературы широко представлены известные данные об экспрессии гена PRAME при онкогематологических заболеваниях.

Ключевые слова: PRAME, лейкозы, лимфомы, прогноз.

Получено: 14 сентября 2017 г.

Принято в печать: 2 декабря 2017 г.

Читать статью в PDF 

ЛИТЕРАТУРА

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Новые возможности лечения рецидивов и рефрактерной множественной миеломы (обзор литературы)

О.М. Вотякова

ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России, Каширское ш., д. 24, Москва, Российская Федерация, 115478

Для переписки: Ольга Михайловна Вотякова, канд. мед. наук, Каширское ш., д. 24, Москва, Российская Федерация, 115478; тел.: 8(499)324-92-09; e-mail: omvtk@yandex.ru

Для цитирования: Вотякова О.М. Новые возможности лечения рецидивов и рефрактерной множественной миеломы (обзор литературы). Клиническая онкогематология. 2017;10(4):425–34.

DOI: 10.21320/2500-2139-2017-10-4-425-434


РЕФЕРАТ

Несмотря на улучшение результатов лечения больных с впервые диагностированной множественной миеломой (ММ) благодаря внедрению в клиническую практику новых лекарственных препаратов и высокодозной химиотерапии с аутологичной трансплантацией гемопоэтических стволовых клеток, рецидивы неизбежно наступают у всех больных. Применение иммуномодулирующих препаратов (талидомида, леналидомида) и ингибитора протеасом бортезомиба позволило улучшить результаты лечения рецидивов ММ. Тем не менее развиваются повторные рецидивы и рефрактерность болезни к этим препаратам. Для этой категории больных необходимы новые лечебные стратегии, включая разработку более эффективных агентов среди существующих классов противомиеломных препаратов, исследование рациональной комбинации новых и традиционных лекарственных средств, а также поиск новых мишеней для препаратов, эффективных при ММ. В обзоре представлены основные клинические данные по эффективности и безопасности наиболее перспективных новых ингибиторов протеасом (карфилзомиба, иксазомиба), иммуномодулирующего препарата следующего поколения помалидомида, моноклональных антител (даратумумаба и элотузумаба).

Ключевые слова: ингибиторы протеасом, иммуномодулирующие препараты, моноклональные антитела, множественная миелома.

Получено: 14 марта 2017 г.

Принято в печать: 20 июня 2017 г.

Читать статью в PDF 

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Нарушенный метаболизм метионина в злокачественных клетках — потенциальная мишень для противоопухолевой терапии

В.С. Покровский1, Д.Ж. Давыдов1, Н.В. Ануфриева2, Д.Д. Жданов3, Е.М. Трещалина1, Т.В. Демидкина2, Е.А. Морозова2

1 ФГБУ «Российский онкологический научный центр им. Н.Н. Блохина» Минздрава России, лаборатория комбинированной терапии опухолей, Каширское ш., д. 24, Москва, Российская Федерация, 154478

2 ФГБУН «Институт молекулярной биологии им. В.А. Энгельгардта» РАН, ул. Вавилова, д. 32, Москва, Российская Федерация, 119991

3 ФГБУ «НИИ биомедицинской химии им. В.Н. Ореховича», Погодинская ул., д. 10, стр. 8, Москва, Российская Федерация, 119121

Для переписки: Вадим Сергеевич Покровский, д-р мед. наук, Каширское ш., д. 24, Москва, Российская Федерация, 154478; тел.: 8(499)324-14-09; e-mail: vadimpokrovsky@yandex.ru

Для цитирования: Покровский В.С., Давыдов Д.Ж., Ануфриева Н.В. и др. Нарушенный метаболизм метионина в злокачественных клетках — потенциальная мишень для противоопухолевой терапии. Клиническая онкогематология. 2017;10(3):324–32.

DOI: 10.21320/2500-2139-2017-10-3-324-332


РЕФЕРАТ

В обзоре представлены особенности клеточного метаболизма метионина, а также известные данные о механизмах развития метиониновой зависимости в злокачественных клетках. Рассмотрены возможности использования безметиониновой диеты для контроля опухолевого роста у больных с различными формами рака. Сгруппированы и обобщены новейшие сведения о метионин-γ-лиазе — ферменте, обеспечивающем элиминацию метионина из плазмы. Раскрыта его роль в качестве потенциального противоопухолевого фермента. Обобщены сведения о продуцентах метионин-γ-лиазы, активности данного фермента, полученного из различных источников, и сведения о моделях опухолей и клеточных культурах, проявляющих метиониновую зависимость.

Ключевые слова: метионин-γ-лиаза, метионин, метиониновая зависимость, злокачественные клетки, рак, противоопухолевые ферменты, противоопухолевая терапия.

Получено: 16 декабря 2016 г.

Принято в печать: 6 марта 2017 г.

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Цитогенетические и молекулярно-генетические факторы прогноза острых лимфобластных лейкозов

А.В. Мисюрин

ФГБУ «Российский онкологический научный центр им. Н.Н. Блохина» Минздрава России, Каширское ш., д. 24, Москва, Российская Федерация, 115478

Для переписки: Андрей Витальевич Мисюрин, канд. биол. наук, Каширское ш., д. 24, Moсква, Российская Федерация, 115478; e-mail: and@genetechnology.ru

Для цитирования: Мисюрин А.В. Цитогенетические и молекулярно-генетические факторы прогноза острых лимфобластных лейкозов. Клиническая онкогематология. 2017;10(3):317–23.

DOI: 10.21320/2500-2139-2017-10-3-317-323


РЕФЕРАТ

В обзоре представлены характерные и воспроизводимые при острых лимфобластных лейкозах (ОЛЛ) перестройки хромосом, которые можно обнаружить при стандартном цитогенетическом исследовании (окраска на G-полосы) или методом FISH. Более тонкие генетические изменения, недоступные для наблюдения цитогенетиков, выявляются с помощью современных методов молекулярно-биологической диагностики. Показано прогностическое значение цитогенетических и молекулярно-генетических маркеров ОЛЛ. Представлен минимальный набор клинически значимых молекулярных маркеров, которые целесообразно исследовать при ОЛЛ.

Ключевые слова: острый лимфобластный лейкоз, хромосомная аномалия, химерный онкоген, экспрессия гена, мутация гена.

Получено: 3 декабря 2016 г.

Принято в печать: 8 марта 2017 г.

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Молекулярно-генетические нарушения в патогенезе опухолей системы крови и соответствующие им изменения сигнальных систем клетки

Л.Р. Тилова1, А.В. Савинкова1, Е.М. Жидкова1,2, О.И. Борисова1,3, Т.И. Фетисов1,4, К.А. Кузин1, О.А. Власова1, А.С. Антипова3, О.Ю. Баранова3, К.И. Кирсанов1, Г.А. Белицкий1, М.Г. Якубовская1, Е.А. Лесовая1,5

1 НИИ канцерогенеза, ФГБУ «Российский онкологический научный центр им. Н.Н. Блохина» Минздрава России, Каширское ш., д. 24, Moсква, Российская Федерация, 115478

2 Московский технологический университет, пр-т Вернадского, д. 78, Москва, Российская Федерация, 119454

3 НИИ клинической онкологии, ФГБУ «Российский онкологический научный центр им. Н.Н. Блохина» Минздрава России, Каширское ш., д. 23, Moсква, Российская Федерация, 115478

4 Первый Московский государственный медицинский университет им. И.М. Сеченова, ул. Трубецкая, д. 8, корп. 2, Москва, Российская Федерация, 119991

5 Рязанский государственный медицинский университет им. И.П. Павлова, ул. Высоковольтная, д. 9, Рязань, Российская Федерация, 390026

Для переписки: Екатерина Андреевна Лесовая, канд. биол. наук, Каширское ш., д. 24, стр. 15, Moсква, Российская Федерация, 115478; тел.: 8(910)471-41-28; e-mail: lesovenok@yandex.ru

Для цитирования: Тилова Л.Р., Савинкова А.В., Жидкова Е.М. и др. Молекулярно-генетические нарушения в патогенезе опухолей системы крови и соответствующие им изменения сигнальных систем клетки. Клиническая онкогематология. 2017;10(2):235–49.

DOI: 10.21320/2500-2139-2017-10-2-235-249


РЕФЕРАТ

Заболевания системы крови включают широкую группу злокачественных опухолей кроветворной и лимфоидной тканей, в основе патогенеза которых лежат генетические изменения, специфические для каждой отдельной разновидности нозологий. Одной из характерных особенностей онкогематологических заболеваний является высокая частота хромосомных аномалий (делеции, транслокации, инсерции). Кроме того, наблюдаются также мутации отдельных генов или блокирование нормальной регуляции функционирования генов в связи с эпигеномными событиями. Прогрессирование онкогематологических заболеваний может быть обусловлено накоплением различных генетических нарушений. Современная классификация опухолей кроветворной и лимфоидной тканей основана на анализе клинических данных, морфологических и функциональных признаков опухолевых клеток и выявлении специфических цитогенетических и молекулярно-генетических нарушений. К настоящему времени установлено большое количество генетических нарушений, характерных для конкретных типов злокачественных новообразований системы крови. Это позволяет оптимизировать лечебную тактику, а также разрабатывать, тестировать и вводить в клиническое использование ряд таргетных препаратов. К ним относятся препараты на основе моноклональных антител (ритуксимаб, алемтузумаб и др.), низкомолекулярные соединения (иматиниб, бортезомиб, карфилзомиб). Для разработки новых таргетных молекул или же перепрофилирования уже известных химиопрепаратов не только полезна информация об аномалиях при каждом типе гематологической опухоли, но и понимание изменений в эфферентных путях передачи сигнала в клетке, которые затрагивают данное нарушение. В настоящем обзоре рассматриваются генетические нарушения при заболеваниях, обозначенных в международной классификации ВОЗ опухолей кроветворной и лимфоидной тканей 2008 г. и дополненной в 2016 г., и соответствующие изменения в сигнальных путях, связанные со злокачественной трансформацией клеток кроветворной системы.

Ключевые слова: опухоли кроветворной и лимфоидной тканей, хромосомные аномалии, нарушения сигнальных путей, классификация ВОЗ.

Получено: 29 сентября 2016 г.

Принято в печать: 16 января 2017 г.

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