葡萄糖饥饿模拟药物aldometanib通过重塑肿瘤免疫微环境使肝癌小鼠存活至正常寿命

时间:2025年11月26日
来源:Cell Research

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本研究针对肝癌免疫抑制微环境这一治疗难题,发现特异性靶向溶酶体醛缩酶的葡萄糖饥饿模拟药物aldometanib可通过激活AMPK通路,重塑肿瘤免疫微环境,促进CD8+ T细胞浸润,从而抑制肝癌发展。该研究首次证明代谢干预可使癌症成为终身可控疾病,为肝癌治疗开辟了新途径。

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在肝癌治疗领域,免疫抑制微环境一直是制约治疗效果的关键瓶颈。尽管代谢异常被广泛认为是肿瘤发生发展的重要特征,但针对代谢途径的干预策略却始终未能取得突破性进展。肝细胞癌(Hepatocellular Carcinoma, HCC)作为全球范围内常见的恶性肿瘤,其发生发展与代谢紊乱密切相关,特别是糖代谢异常在肿瘤微环境(Tumor Microenvironment, TME)的免疫抑制中扮演重要角色。
近年来,AMP活化蛋白激酶(AMP-activated protein kinase, AMPK)作为代谢稳态的主调控因子受到广泛关注。然而,传统的AMPK激活剂由于非特异性激活所有亚细胞区域的AMPK池,往往产生严重副作用,限制了其临床应用。这促使研究人员寻找更精准的AMPK调控策略。
厦门大学林圣彩教授团队长期致力于葡萄糖感知-AMPK通路的研究,他们发现了一条通过溶酶体途径特异性激活AMPK的新机制。基于这一理论基础,研究团队开发了特异性靶向醛缩酶的抑制剂aldometanib,该药物能够模拟葡萄糖饥饿状态,选择性激活溶酶体AMPK,而不影响能量水平。
为验证aldometanib的抗肿瘤效果,研究人员构建了多种肝癌模型,包括DEN-HFD诱导的小鼠肝癌模型、MYC;Trp53-/- 基因工程小鼠模型以及原位移植瘤模型。令人惊喜的是,aldometanib治疗不仅显著抑制了肝癌的发展,还使荷瘤小鼠的生存期延长至正常寿命。更为重要的是,这种抗肿瘤效应完全依赖于宿主体内完整的免疫系统,特别是在免疫缺陷小鼠中aldometanib失去了治疗效果。
机制研究表明,aldometanib通过激活AMPK,重塑了肿瘤免疫微环境,显著增加了CD8+ T细胞在肿瘤组织中的浸润。这些CD8+ T细胞表现出高度的活化和肿瘤杀伤能力,表现为颗粒酶B(granzyme B)和干扰素-γ(IFN-γ)表达上调。值得注意的是,aldometanib本身并不直接杀伤肿瘤细胞,而是通过调节免疫微环境,间接发挥抗肿瘤作用。
研究还发现,AMPK在非癌性宿主肝组织中的表达对aldometanib的抗肿瘤效果至关重要。即使在AMPK缺失的肝癌细胞中,只要宿主肝组织AMPK正常,aldometanib仍能有效抑制肿瘤生长。这一发现揭示了代谢调控在肿瘤免疫中的新作用机制。
此外,aldometanib还能增强肝癌对免疫检查点抑制剂(如抗PD-1抗体)的敏感性,为联合治疗提供了新思路。研究还证实,aldometanib治疗不仅改善了葡萄糖耐受性,还降低了肝脏脂质沉积,体现了其多方面的代谢调节作用。
主要技术方法包括:建立DEN-HFD诱导、MYC;Trp53-/- 基因工程及原位移植等多种肝癌小鼠模型;利用流式细胞术分析肿瘤免疫细胞浸润;通过免疫组化、Western blotting等技术检测蛋白表达和活化;采用高效液相色谱-质谱联用技术测定代谢物浓度;使用小动物MRI进行肿瘤监测;开展体外细胞共培养实验验证免疫细胞杀伤功能。其中患者来源的肝癌组织来自福建癌症医院和厦门大学附属中山医院。
Aldometanib治疗使HCC小鼠存活至正常年龄
研究显示,aldometanib治疗能显著延长DEN-HFD诱导的肝癌小鼠的生存期,中位生存时间达到805天,与健康小鼠相当。在不同剂量实验中,aldometanib表现出剂量依赖性的肿瘤抑制效果,即使晚期开始治疗也能有效抑制肿瘤进展。血清ALT和AST水平显著降低,表明肝功能得到改善。
9mm tumors(lower panel; shown as means±SEM,n values indicate the number of mice used for each condition and are labeled in each panel; P values were calculated by two-way ANOVA followed by Tukey's test).c Aldometanib effectively inhibits late-stage HCC. Mice were induced to develop HCC using DEN and HFD as in a. Aldometanib at 100 mg/L was administered in drinking water starting at 12 weeks, 24 weeks, or 35 weeks of age(depicted in the upper panel). Numbers of tumors in each size/diameter category for each entry time of aldometanib are shown(lower panel; shown as means±SEM, n values represent the number of mice for each starting age and are labeled in each panel, with P values calculated by two-way ANOVA followed by Tukey's test).d Aldometanib suppresses AFP levels in DEN-HFD mice. HCC tissues from aldometanib-treated and untreated DEN-HFD mice, prepared as in b,were subjected to immunohistochemistry(IHC) staining for AFP. Representative images at different magnifications are shown in the upper panel, and the percentages of AFP-positive area in the HCC tissues were calculated and are shown in the lower panel(means±SEM, n= 4(vehicle) or 5(aldometanib) mice for each treatment, with P values calculated by two-sided Student's t-test).e Aldometanib inhibits HCC in MYC;Trp53-/- mice. Wild-type BALB/c mice(12 weeks old) were hydrodynamically injected via the tail vein with plasmids carrying sgRNAs targeting Trp53 for knockout, along with a plasmid for Myc overexpression. One week later, mice were intraperitoneally injected with CCl4 twice a week for 3 weeks(depicted in the upper panel). Aldometanib was administered at 100 mg/L in drinking water starting at 16 weeks of age. At week 18, mice were euthanized, and the numbers of tumors in each size/diameter category are shown(lower panel; shown as means±SEM, n numbers are labeled in each panel, with P values calculated by two-way ANOVA followed by Sidak's test). f Aldometanib reduces the size of orthotopic allografts derived from Hepa1-6 hepatoma cells. Hepa1-6 cells were transplanted into the left liver lobe of C57BL/6 mice to form orthotopic allografts. At day 2 post-transplantation, the mice were treated with aldometanib in drinking water for 15 days(depicted in the upper panel). On day 17, mice were euthanized, and the weights of the orthotopic allografts were determined(lower panel; shown as means±SEM, n values represent the number of mice and are labeled in each panel, with P values calculated by two-sided Student's t-test). g Aldometanib treatment increases the median lifespan of mice bearing Hepa1-6 allografts. Wild-type C57BL/6 mice were transplanted with Hepa1-6 cells as in f, and then treated with aldometanib in drinking water on day 2 post-transplantation(depicted in the upper panel). The lifespans of the mice were determined and are shown as Kaplan-Meier curves(see also statistical analyses in Supplementary information, Table S2). Experiments in this figure were performed three times.'>
非癌性宿主肝中AMPK在aldometanib抑制HCC中起主导作用
通过肝脏特异性AMPKα敲除(AMPKα-LKO)小鼠实验,研究人员发现aldometanib的抗肿瘤效果完全依赖于AMPK的激活。特别有趣的是,当将AMPKα-/- Hepa1-6细胞移植到野生型小鼠肝脏时,aldometanib仍能有效抑制肿瘤生长;反之,如果将野生型Hepa1-6细胞移植到AMPKα-LKO小鼠肝脏,aldometanib的抑瘤效果显著减弱。这表明非癌性宿主肝组织中的AMPK在aldometanib介导的肿瘤抑制中起主导作用。
Aldometanib不具细胞毒性
令人意外的是,aldometanib在体外实验中并不直接诱导肝癌细胞凋亡或坏死,甚至在较高浓度下还能抑制细胞死亡。然而在体内实验中,aldometanib治疗却显著增加了肝癌组织中的TUNEL阳性信号和凋亡标志物水平,包括caspase-7裂解和PUMA蛋白表达上调。这种差异表明aldometanib通过间接机制在体内诱导肿瘤细胞死亡。
Aldometanib诱导CD8+ T细胞浸润肿瘤
研究发现,aldometanib治疗能显著促进CD8+ T细胞在肝癌组织中的浸润,这些细胞表现出效应记忆表型(CD62L-CD44+)和强大的肿瘤杀伤能力。同时,aldometanib还减少了中性粒细胞和肿瘤相关巨噬细胞(Tumor-Associated Macrophages, TAMs)等免疫抑制细胞的数量,改善了肿瘤免疫微环境。当使用中和抗体清除CD8+ T细胞后,aldometanib的抗肿瘤效果明显减弱,证实了CD8+ T细胞在其作用机制中的关键地位。
本研究的重要发现在于,代谢干预可以通过重塑肿瘤免疫微环境,使癌症转变为终身可控的疾病状态。aldometanib作为首个能够模拟葡萄糖饥饿状态并特异性激活溶酶体AMPK的药物,不仅为肝癌治疗提供了新策略,更重要的是开创了"代谢免疫"治疗的新范式。该研究证实,通过精准调控代谢通路,可以打破肿瘤的免疫抑制屏障,为免疫细胞发挥杀伤作用创造有利条件。
值得注意的是,aldometanib的作用机制不依赖于传统的细胞因子信号通路,如CXCL9、CXCL10和CXCL11等趋化因子,而是通过整体改善肿瘤代谢微环境来实现免疫细胞的重编程。这种独特的机制使得aldometanib可能对多种病因和亚型的肝癌都具有治疗潜力,克服了当前免疫疗法对特定肝癌类型的局限性。
此外,aldometanib与现有免疫检查点抑制剂的协同作用,为肝癌联合治疗提供了新的可能性。研究还提示,代谢重编程可能成为增强肿瘤免疫治疗效果的重要途径,具有广阔的临床应用前景。
这项发表于《Cell Research》的研究不仅深化了对AMPK在肿瘤免疫中作用机制的理解,更重要的是提出了"代谢干预可使癌症成为终身可控疾病"的创新理念,为癌症治疗开辟了全新方向,有望引领肿瘤治疗进入新的时代。

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