癌癥十大特征PPT醫(yī)學(xué)課件

1、Paper sharing:Hanahan D, Weinberg R. Hallmarks of Cancer: The Next Generation.Cell, 2011,144( 5): 646-674.Dept. Medical Oncology, 1st Affiliated Hospital*University1Six hallmarks of cancer proposed in 20002Emerging hallmarks 3Sustaining Proliferative SignalingThe most fundamental trait of cancer cel

2、ls involves their ability to sustain chronic proliferationNormal tissues ensuring a homeostasis by carefully control thing the production and release of growth-promoting signals Cancer cells, by deregulating these signals, become masters of their own destinies.4The enabling signals are conveyed in l

3、arge part by growth factors that bind cell-surface receptors Cancer cells can acquire the capability to sustain proliferative signaling in a number of alternative ways5Cancer cells can produce growth factor ligands Send signals to stimulate normal cells within the supporting tumor-associated stromaE

4、levating the levels of receptor proteins displayed at the cancer cell surfaceStructural alterations in the receptor molecules Somatic mutations activate additional downstream pathways. EGFR mutation in NSCLC, B-Raf mutation in melanoma.67Disruptions of negative-feedback mechanisms that attenuate pro

5、liferative signalingExcessive proliferative signaling can trigger cell senescence: RAS,MYC.8Evading Growth SuppressorsCancer cells must circumvent powerful programs that negatively regulate cell proliferationMany of these programs depend on the actions of tumor suppressor genesTwo prototypical tumor

6、 suppressors encode the RB and TP53 proteinsTo remove contact Inhibition Corruption of the TGF-b Pathway Promotes Malignancy, more elaborate than simple shutdown of its antiproliferative signaling circuitry activate EMT 9The RB protein integrates signals from diverse extracellular and intracellular

7、sources and, in response, decides whether or not a cell should proceed through its growth-and-division cycleCancer cells with defects in RB pathway function are missing the services of a critical gatekeeper of cell-cycle progression whose absence permits persistent cell proliferation. 10TP53 receive

8、s inputs from stress and abnormality sensors If the degree of damage to the genome is excessive, or if the levels of nucleotide pools, growth-promoting signals, glucose, or oxygenation are suboptimal, TP53 can call a halt to further cell-cycle progression until these conditions have been normalized.

9、 Alternatively, in the face of alarm signals indicating overwhelming or irreparable damage to such cellular subsystems, TP53 can trigger apoptosis. 11Contact Inhibition the cell-to- cell contacts formed by dense populations of normal cells propagated in two-dimensional culture operate to suppress fu

10、rther cell proliferation, yielding conuent cellmonolayers. “contact inhibition” is abolished in various types of cancer cells in culture, suggesting that contact inhibition is an in vitro surrogate of a mechanism that operates in vivo to ensure normal tissue homeostasis 12Mechanisms of Contact Inhib

11、ition the NF2 gene Merlin, the cytoplasmic gene product, orchestrates contact inhibition via coupling cell-surface adhesion molecules .Merlin strengthens the adhesivity of cadherin-mediated cell-to-cell attachments, by sequestering growth factor receptors, Merlin limits their ability to efciently em

12、it mitogenic signals LKB1 epithelial polarity protein which organizes epithelial structure and helps maintain tissue integrity overrule the mitogenic effects of the powerful Myc oncogene LKB1 expression is suppressed, epithelial integrity is destabilized, and epithelial cells become susceptible to M

13、yc-induced transformation13Resisting Cell DeathApoptosisAutophagy Necrosis14ApoptosisThe concept that apoptosis serves as a natural barrier to cancer development has been established over the last two decadesApoptosis is attenuated in those tumors that succeed in progressing to states of high-grade

14、malignancy and resistance to therapy15The apoptotic machinery is composed of both upstream regulators and downstream effector components The regulators are divided into two major circuits, one receiving and processing extracellular death-inducing signals (the extrinsic apoptotic program, for example

15、 the Fas ligand/Fas receptor) The other sensing and integrating a variety of signals of intracellular origin (the intrinsic program). 16Apoptosis signaling pathways 17Apoptosis-triggering mechanismsTP53 induces in response to substantial levels of DNA breaks and other chromosomal abnormalities.insuf

16、cient survival factor signaling , interleukin-3, IGF-1Hyperactive signaling by certain oncoproteins, such as Myc18Strategies developed by cancer cells to circumvent apoptosisMost common is the loss of TP53 tumor suppressor functionIncreasing expression of antiapoptotic regulators (Bcl-2, Bcl-xL) or

17、of survival signalsDownregulating proapoptotic factors (Bax, Bim, Puma), or by short-circuiting the extrinsic ligand-induced death pathway19AutophagyCan be strongly induced in certain states of cellular stress, the most obvious of which is nutrient deciency In this fashion, low-molecular-weight meta

18、bolites are generated that support survival in the stressed, nutrient-limited environments experienced by many cancer cells20Autophagy is cytoprotective for cancer cellsNutrient starvation, radiotherapy, and certain cytotoxic drugs can induce elevated levels of autophagySeverely stressed cancer cell

19、s have been shown to shrink via autophagy to a state of reversible dormancyThis survival response may enable the persistence and eventual regrowth of some late stage tumors following treatment with potent anticancer agents.21Necrosis Has Proinflammatory and Tumor-Promoting PotentialNecrotic cells re

20、leasing their contents into the local tissue microenvironmentImmune inflammatory cells can be actively tumor promoting, given that such cells are capable of fostering angiogenesis, cancer cell proliferation, and invasivenessNecrotic cells can release bioactive regulatory factors, such as IL-1a22Enab

21、ling Replicative ImmortalityMost normal cell lineages are able to pass through only a limited number of successive cell growth-and-division cycles. This limitation has been associated with two distinct barriers to proliferation senescence, a typically irreversible entrance into a nonproliferative bu

22、t viable state, crisis, in which the great majority of cells in the population die.Cancer cells :able to proliferate in culture without evidence of either senes- cence or crisis (immortalization)Telomeres protecting the ends of chromosomes are centrally involved in the capability for unlimited proli

23、feration23The telomeres, composed of multiple tandem hexanucleotide repeats, shorten progressively in nonimmortalized cells propagated in culture, eventually losing the ability to protect the ends of chromosomal DNAs from end-to-end fusions2425Telomerase, the specialized DNA polymerase that adds tel

24、omere repeat segments to the ends of telomeric DNA, is almost absent in nonimmortalized cells but expressed at functionally significant levels in the vast majority (90%) of immortalized cells, including human cancer cellsExpression of the enzyme is correlated with a resistance to induction of both s

25、enescence and crisis/apoptosisSuppression of telomerase activity leads to telomere shortening and to activation of one or the other of proliferative barriers.26 Delayed Activation of Telomerase May Both Limitand Foster Neoplastic ProgressionClones of incipient cancer cells often experience telomere

26、loss-induced crisis relatively early during the course of multistep tumor progression due to their inability to express signficant levels of telomerase. The absence of TP53-mediated surveillance of genomic integrity may permit other incipient neoplasias to survive initial telomere erosion and attend

27、ant chromosomal breakage-fusion-bridge (BFB) cycles.27Overt carcinomas exhibited telomerase expression concordantly with the reconstruction of longer telomeres and the fixation of the aberrant karyotypes .The delayed acquisition of telomerase function serves to generate tumor-promoting mutations, wh

28、ereas its subsequent activation stabilizes the mutant genome and confers the unlimited replicative capacity28Inducing Angiogenesis Tumors require sustenance in the form of nutrients and oxygen as well as an ability to evacuate metabolic wastes and carbon dioxide. The process of angiogenesis, address

29、es these needs. The normal vasculature becomes largely quiescent. In the adult, as part of physiologic processes such as wound healing and female reproductive cycling, angiogenesis is turned on, but only transiently29angiogenesisprecocious capillary sprouting convoluted and excessive vessel branchin

30、g, distorted and enlarged vessels, erratic blood flow, microhemorrhaging, leakiness, abnormal levels of endothelial cell proliferation and apoptosis30During tumor progression, an “angiogenic switch” is almost always activated and remains on, causing normally quiescent vasculature to continually spro

31、ut new vessels that help sustain expanding neoplastic growthsThe angiogenic switch is governed by countervailing factors that either induce or oppose angiogenesis31 VEGF-Athree receptor tyrosine kinases(VEGFR-13)hypoxia and oncogene extracellular matrix( release and activation by extracellular matri

32、x-degrading proteases )other proangiogenic signals(such as FGF)32 angiogenesis inhibitorsTSP-1 binds transmembrane receptors displayed by endothelial cells and thereby evokes suppressive signals that can counteract proangiogenic stimuli 33AngiostatinProteolytic cleavage of structural proteinsEndosta

33、tinPhysiologic regulators that modulate transitory angiogenesis during tissue remodeling and wound healing34Pericytes is important for the maintenance of a functional tumor neovasculatureA variety of bone marrow-derived cells contribute to tumor angiogenesis macrophages, neutrophils, mast cells, and

34、 myeloid progenitors, the peri-tumoral inflammatory cells Help to trip the angiogenic switch in previously quiescent tissue Sustain ongoing angiogenesis Protect the vasculature from the effects of drugs targeting therapy35Activating Invasion and Metastasisinvasion-metastasis cascade36E-cadherin, a k

35、ey cell-to-cell adhesion moleculeE-cadherin helps to assemble epithelial cell sheets and maintain the quiescence of the cells within these sheets. Increased expression of E-cadherin was well established as an antagonist of invasion and metastasisIncreased expression of E-cadherin was well establishe

36、d as an antagonist of invasion and metastasis,； reduction of its expression was known to potentiate these phenotypeFrequently observed down regulation and occasional mutational inactivation of E-cadherin in human carcinomas provided strong support for its role as a key suppressor of this hallmark ca

37、pability37The epithelial-mesenchymal transition( EMT) Broadly Regulates Invasion and MetastasisMotilityInasivenessResistance to apoptosis 38EMT：transformed epithelial cells can acquire the abilities to invade, to resist apoptosis, and to disseminateEmbryonic morphogenesis and wound healingCarcinoma

38、cells can concomitantly acquire multiple attributes that enable invasion and metastasis.EMT are able to orchestrate most steps of the invasion-metastasis cascade3940mesenchymal-epithelial transition (MET) MET results in the formation of new tumor colonies of carcinoma cells exhibiting a histopatholo

39、gy similar to those of carcinoma cells in the primary tumor41Contributions of Stromal Cells to Invasionand MetastasisCrosstalk between cancer cells and cells of the neoplastic stroma is involved in the acquired capability for invasive growth and metastasisMesenchymal stem cells (MSCs) present in the

40、 tumor stroma have been found to secrete CCL5/RANTES in response to signals released by cancer cells; CCL5 then acts reciprocally on the cancer cells to stimulate invasive behaviorMacrophages at the tumor periphery can foster local invasion by supplying matrix-degrading enzymes such as metalloprotei

41、nases and cysteine cathepsin proteases 42Emerging hallmarks43Genome Instability and MutationGene disordersMultiple hallmarks depends in large part on a succession of alterations in the genomes of neoplastic cells.Multistep tumor progression can be portrayed as a succession of clonal expansions, each

42、 of which is triggered by the acquisition of an enabling mutant genotype.4445Cancer cells often increase the rates of mutationThe accumulation of mutations can be accelerated by compromising the surveillance systems that normally monitor genomic integrity and force genetically damaged cells into eit

43、her senescence or apoptosisThe role of TP53 is central guardian of the genome46A diverse array of defects of theDNA-maintenance machinery-caretakers of the genomeDetect-ing DNA damage and activating the repair machineryDirectly repairing damaged DNA Inactivating or intercepting mutagenic molecules b

44、efore they have damaged the DNA47Tumor-Promoting InflammationVirtually every neoplastic lesion contains immune cellsHistorically, such immune responses were largely thought to reflect an attempt by the immune system to eradicate tumors Antitumoral responses48By 2000, there were already clues that th

45、e tumor-associated inflammatory response had the unanticipated, paradoxical effect of enhancing tumorigenesis and progression49Contribution of inflammation to cancer cellsSupplying bioactive molecules to the tumor microenvironment :growth factors; survival factors ; proangiogenic factors,et al.Is de

46、monstrably capable of fostering the development of incipient neoplasias into full-blown cancers Release chemicals, notably reactive oxygen species, that are actively mutagenic for nearby cancer cells, accelerating their genetic evolution toward states of heightened malignancy5051Reprogramming Energy

47、 MetabolismUnder aerobic conditions, normal cells process glucose,first to pyruvate via glycolysis in the cytosol and thereafter to carbon dioxide in the mitochondria; under anaerobic conditions, glycolysis is favored 52Cancer cells can reprogram their glucose metabolism “aerobic glycolysis” Upregulating glucose tra