6Mezibuněčná signalizace volné signální molekuly vs Mezibuněčná signalizace volné signální molekuly vs. membránové receptory
7Signaling molecules Intra- and extracellular Extracellular signaling molecules bind to either cell-surface receptors or intracellular receptors.Most signaling molecules are hydrophilic –- unable to cross the plasma membrane –- bind to cellsurface receptors- generate signals inside the target cell.Small signaling molecules diffuse acrossthe plasma membrane and bind to receptorsinside the target celleither in the cytosol orin the nucleus.Many of these small signaling moleculesare hydrophobic and nearly insoluble in aqueoussolutions - transported bound to carrier proteins- dissociate before entering the target cell.
8Signaling mediated by secreted molecules Many of the same types of signaling molecules are used in paracrine, synaptic, and endocrine signaling. The crucial differences lie in the speed and selectivity with which the signals are delivered to their targets.
9The contrast between endocrine and synaptic signaling. Endocrine cells and nerve cells work together to coordinate the diverse activities of the billions of cells in a higher animal.Endocrine cells secrete many different hormones into the blood to signal specific target cells. The target cells have receptors for binding specific hormones and thereby "pull" the appropriate hormones from the extracellular fluid.In synaptic signaling the specificity arises from the contacts between nerve processes and the specific target cells they signal: usually only a target cell that is in synaptic contact with a nerve cell is exposed to the neurotransmitter released from the nerve terminal.Whereas different endocrine cells must use different hormones in order to communicate specifically with their target cells, many nerve cells can use the same neurotransmitter and still communicate in a specific manner.
10The same signaling molecule can induce different responses in different target cells In some cases this is because the signaling molecule binds to different receptor proteins, as illustrated in (A) and (B).In other cases the signaling molecule binds to identical receptor proteins that activate different response pathways in different cells, as illustrated in (B) and (C).In all of the cases shown the signaling molecule is acetylcholine (D).
11Signaling molecules binding to intracellular receptors Note that all of them are small and hydrophobic. The active, hydroxylated form of vitamin D3is shown.
12Intracellular receptor superfamily A model of an intracellular receptor protein. In its inactive state the receptor is bound to an inhibitory protein complex that contains a heat-shock protein called Hsp90. The binding of ligand to the receptor causes the inhibitory complex to dissociate, thereby activating the receptor by exposing its DNA-binding site.The model shown is basedon the receptor for cortisol,but all of the receptors inthis superfamily have arelated structure.
13Early primary response and delayed secondary response - intracellular receptor protein activation The response to a steroid hormone is illustrated, but the same principles apply for all ligands that activate this family of receptor proteins.Some of the primary-response proteins turn on secondary-response genes, whereas others turn off the primary-response genes.
15Two major intracellular signaling mechanisms share common features In both cases a signaling protein is activated by the addition of a phosphate group and inactivated by the removal of the phosphate.In (A) the phosphate is added covalently to the signaling protein by a protein kinase; in (B) a signaling protein is induced to exchange its bound GDP for GTP.To emphasize the similarity in the two mechanisms, ATP is shown as APP , ADP as APP, GTP as GPP , and GDP as GPP.
16Signaling via G-Protein-linked Cell-Surface Receptors
17A schematic drawing of a G-protein-linked receptor Receptors that bind protein ligands have a largeextracellular ligand-binding domain formed bythe part of the polypeptide chain.Receptors for small ligands such as adrenalinehave small extracellular domains, and theligand-binding site is usually deep withinthe plane of the membrane.The parts of the intracellular domains that aremainly responsible for binding to trimeric G proteinsare shown in orange,while those that becomephosphorylated during receptor desensitizationare shown in red.
18Two major pathways by which G-protein-linked cell-surface receptors generate small intracellular mediatorsIn both cases the binding of an extracellular ligand alters the conformation of the cytoplasmic domain of the receptor, causing it to bind to a G protein that activates (or inactivates) a plasma membrane enzyme.In the cyclic AMP (cAMP) pathway the enzyme directly produces cyclic AMP.In the Ca2+ pathway the enzyme produces a soluble mediator (inositol trisphosphate) that releases Ca2+ from the endoplasmic reticulum.Like other small intracellular mediators, both cyclic AMP and Ca2+ relay the signal by acting as allosteric effectors: they bind to specific proteins in the cell, altering their conformation and thereby their activity.
19Cyclic AMP The synthesis and degradation of cyclic AMP (cAMP). It is shown as a formula, a ball-and-stick model, and as a space-filling model.
20A current model of how Gs couples receptor activation to adenylyl cyclase activation As long as the extracellular signaling ligand remains bound, the receptor protein can continue to activate molecules of Gs protein, thereby amplifying the response.More important, an as can remain active and continue to stimulate a cyclase molecule for many seconds after the signaling ligand dissociates from the receptor, providing even greater amplification.
21The activation of cyclic-AMP-dependent protein kinase (A-kinase) The binding of cyclic AMP to the regulatory subunits induces a conformational change, causing these subunits to dissociate from the complex, thereby activating the catalytic subunits.Each regulatory subunit has two cyclic-AMP-binding sites, and the release of the catalytic subunits requires the binding of more than two cyclic AMP molecules to the tetramer. This greatly sharpens the response of the kinase to changes in cyclic AMP concentration.There are at least two types of A-kinase in most mammalian cells:type I is mainly in the cytosol, whereas type II is bound via its regulatory subunit to the plasma membrane,nuclear membrane, and microtubules.In both cases, however, once the catalyticsubunits are freed and active, they canmigrate into the nucleus (where they canphosphorylate gene regulatory proteins),while the regulatory subunits remainin the cytoplasm.
22The stimulation of glycogen breakdown by cyclic AMP in skeletal muscle cells. The binding of cyclic AMP to A-kinase activates this enzyme to phosphorylate and thereby activate phosphorylase kinase, which in turn phosphorylates and activates glycogen phosphorylase, the enzyme that breaks down glycogen.
23The role of protein phosphatase-I in the regulation of glycogen metabolism by cyclic AMP Cyclic AMP inhibits protein phosphatase-I, which would otherwise oppose the phosphorylation reactions stimulated by cyclic AMP. It does so by activating A-kinase to phosphorylate a phosphatase inhibitor protein, which then binds to and inhibits protein phosphatase-I.
24Some Hormone-induced Cellular Responses Mediated by Cyclic AMP Target Tissue Hormone Major ResponseThyroid gland thyroid-stimulating hormone (TSH) thyroid hormone synthesis and secretionAdrenal cortex adrenocorticotropic hormone (ACTH) cortisol secretionOvary luteinizing hormone (LH) progesterone secretionMuscle adrenaline glycogen breakdownBone parathormone bone resorptionHeart adrenaline increase in heart rate and force of contractionLiver glucagon glycogen breakdownKidney vasopressin water resorptionFat adrenaline, ACTH, glucagon, TSH triglyceride breakdownPart III. Internal Organization of the Cell Chapter 15. Cell Signaling Signaling via G-Protein-linked Cell-Surface Receptors 11Figure Adenylyl cyclase. In vertebrates the enzyme usually contains about 1100 amino acid residues and is thought tohave two clusters of six transmembrane segments separating two similar cytoplasmic catalytic domains. There are at least sixtypes of this form of adenylyl cyclase in mammals (types I-VI). All of them are stimulated by Gs, but type I, which is foundmainly in the brain, is also stimulated by complexes of Ca2+ bound to the Ca2+-binding protein calmodulin (discussed later).Figure Adrenaline. This hormone (also called epinephrine) is made from tyrosine and is secreted by the adrenal glandwhen a mammal is stressed.Some Hormone-induced Cellular Responses Mediated by Cyclic AMPTarget Tissue Hormone Major ResponseThyroid gland thyroid-stimulating h. (TSH) thyroid h synthesis and secretionAdrenal cortex adrenocorticotropic h. (ACTH) cortisol secretionOvary luteinizing h. (LH) progesterone secretionMuscle adrenaline glycogen breakdownBone parathormone bone resorptionHeart adrenaline heart rate and forceLiver glucagon glycogen breakdownKidney vasopressin water resorptionFat adrenaline, ACTH, glucagon, TSH triglyceride breakdown
25Inositol phospholipid pathway The activated receptor binds to a specific trimeric G protein (Gq), causing the a subunit to dissociate and activate phospholipase C-b, which cleaves PIP2 to generate IP3 and diacylglycerol.The diacylglycerol activates C-kinase. Both phospholipase C-b and C-kinase are water-soluble enzymes that translocate from the cytosol to the inner face of the plasma membrane in the process of being activated.
26Inositol phospholipids (phosphoinositides) The polyphosphoinositides (PIP and PIP2) are produced by the phosphorylation of phosphatidylinositol (PI). Although all three inositol phospholipids may be broken down in the signaling response, it is the breakdown of PIP2 that is most critical, even though it is the least abundant, constituting less than 10% of the total inositol lipids and less than 1% of the total phospholipids.
27The hydrolysis of PIP2.Two intracellular mediators are produced when PIP2 is hydrolyzed:inositoltrisphosphate (IP3), which diffuses through the cytosol and releases Ca2+ from the ER, and diacylglycerol, which remains in the membrane and helps activate the enzyme proteinkinase C.There are at least three classes of phospholipase C - b, g, and delta - and it is the b class that is activated by G-protein-linked receptors.
28Two intracellular pathways by which activated C-kinase can activate the transcription of specific genesIn one ( red arrows) C-kinase activates a phosphorylation cascade that leads to the phosphorylation of a pivotal protein kinase called MAP-kinase, which in turn phosphorylates and activates the gene regulatory protein Elk-1. Elk-1 is bound to a short DNA sequence (called serum response element, SRE) in association with another DNA-binding protein (calledserum response factor, SRF) .In the other pathway ( green arrows) C-kinase activation leads to the phosphorylation of Ik-B, which releases the gene regulatory protein NF-kB so that it can migrate into the nucleus and activate the transcription of specific genes.
29Some Cellular Responses Mediated by G-Protein-linked Receptors Coupled to the Inositol-Phospholipid Signaling PathwayTarget Tissue Signaling Molecule Major ResponseLiver vasopressin glycogen breakdownPancreas acetylcholine amylase secretionSmooth muscle acetylcholine contractionMast cells antigen histamine secretionBlood platelets thrombin aggregation
30Signaling via Enzyme-linked Cell-Surface Receptors
31Six subfamilies of receptor tyrosine kinases Only one or two members of each subfamily are indicated. Note that the tyrosine kinase domain is interrupted by a "kinase insert region" in some of the subfamilies. The functional significance of the cysteine-rich and immunoglobulinlike domains is unknown.
32The serine/threonine phosphorylation cascade activated by Ras and C-kinase In the pathway activated by receptor tyrosine kinases via Ras, the MAP-kinase-kinase-kinase is often a serine/threonine kinase called Raf, which is thought to be activated by the binding of activated Ras.In the pathway activated by G-protein-linked receptors via C-kinase, the MAPkinase-kinase-kinase can either be Raf or a different serine/threonine kinase.Receptor tyrosine kinases may also activate a more direct signaling pathway to the nucleus by directly phosphorylating, and thereby activating, gene regulatory proteins that contain SH2domains.
33Growth Factors and Tumor Growth and Metastasis Mutations inHER familyVEGFMMPsrasp53COX-2Tumor effectsmetastasisproliferationloss of apoptosisinfinite replicationangiogenesisinvasionCancer arises from the cumulative effects of multiple mutations in genes critical for cellular growth control, leading to aberrant cell growth. These mutations can result in:increased activity of oncogenesdecreased activity of tumor suppressor genesdysregulation of growth factors or their receptors, such as the HER family and its ligands, leading to abnormal signal transductiondysregulation of cell-cycle regulatory proteins, such as p53.These deleterious mutations accumulate in the cell, overwhelming the usual controls, and allowing the tumor to evade the body’s defenses.Such mutations result in various abnormal properties, including the ability to divide indefinitely (cell immortality), insensitivity to apoptotic signals (absence of programmed cell death), stimulation of angiogenesis (establishing a tumor-supporting vascular network), and the capacity to invade other tissues (metastasis). These processes combine to drive uncontrolled cellular proliferation, and tumor growth and spread.Hanahan D, Weinberg RA. Cell. 2000;100:57-70.Primary tumorHanahan D, Weinberg RA. Cell. 2000;100:57-70.
34Biologic Control of Tumor Growth Normal cellsReceptorsAutocrine factorsParacrine factorsAt a cellular level, tumor development, growth, and progression are determined by a complex interplay of factors.These include the activation and stimulation of tumor cell-surface receptors by autocrine factors released from the tumor cells (the so-called autocrine feedback loop) as well as by circulating paracrine factors released from stromal epithelial cells elsewhere in the body, in response to tumor-secreted paracrine factors.So, tumor cells drive their own uncontrolled growth, both directly and indirectly, via chemical messengers that trigger receptor-initiated cell signaling.Growth factors (or ligands) that bind to cell-surface receptors are important regulators of cell growth and division. Dysregulation of growth factors and/or their receptors provides a stimulus for the uncontrolled cell growth that is a primary characteristic of cancer.Examples of important growth factors are:epidermal growth factor (EGF)transforming growth factor alpha (TGF-a)heregulininsulin-like growth factor.Hoststromal epitheliumTumorcell
35The HER Family of Receptors EGFTGF-aAmphiregulinBetacellulinHB-EGFEpiregulinLigands:NRG2NRG3HeregulinsBetacellulinHeregulinsCysteine-richdomainsThe HER family comprises four closely related transmembrane receptors: HER1/EGFR (erbB1), HER2 (erbB2 or neu), HER3 (erbB3), and HER4 (erbB4), of which HER1/EGFR and HER2 are the most studied.Each HER family receptor has a similar morphology, with an external (extracellular) ligand-binding domain, an anchoring (transmembrane) region, and an internal (cytoplasmic) domain with tyrosine-kinase (TK) activity (except for HER3 which lacks intrinsic TK).HER1/EGFR and HER2 are involved in the growth and differentiation of normal cells (although no ligand has been identified for HER2 yet), and importantly, they are dysregulated in many human cancers, suggesting a pivotal role in tumorigenesis.1,2As a result, these receptors are a focal point for the development of novel targeted anticancer therapies.1. Salomon D, Brandt R, Ciardiello F, et al. Crit Rev Oncol Hematol ;19:2. Woodburn J. Pharmacol Ther. 1999;82:HER2erbB2neuHER1/EGFRerbB1HER3erbB3HER4erbB4Tyrosine-kinasedomainsSalomon D, Brandt R, Ciardiello F, et al. Crit Rev Oncol Hematol. 1995;19:Woodburn J. Pharmacol Ther. 1999;82:
36HER1/EGFR Dimerization HER1 homodimerHER1-HER1Three HER1-containing heterodimersHER1-HER2HER1-HER3HER1-HER4Like all members of the HER family, individual HER1/EGFRs exist as monomers when inactive.Ligand binding causes either homodimerization (between monomers of the same receptor, for example HER1-HER1), or heterodimerization between the bound receptor and another member of the HER family (for example, HER1- HER2). Dimerization activates receptor TK via phosphorylation, triggering downstream signaling.HER2 is the most common heterodimerization partner for the HER family,1,2 possibly because, having no known ligand, it requires heterodimerization to activate its TK.HER3 has no intrinsic TK activity and must associate with another HER-family receptor to trigger signaling.1. Pinkas-Kramarski R, Soussan L, Waterman H, et al. EMBO J. 1996;15:2. Klapper LN, Glathe S, Vaisman N, et al. Proc Natl Acad Sci USA. 1999;96:Pinkas-Kramarski R, Soussan L, Waterman H, et al. EMBO J. 1996;15:Klapper LN, Glathe S, Vaisman N, et al. Proc Natl Acad Sci USA. 1999;96:
37Effects of HER1/EGFR Activation ExtracellularIntracellularTransactivationPPSrc PLCg GAP Grb2 Shc Nck Vav Grb7 CrkPKCRasAfter HER1/EGFR ligand binding, dimerization, and TK phosphorylation, a complex signaling cascade involving many molecules begins.HER1/EGFR activation can produce a range of effects in tumor cells depending on the ligand involved and the dimer formed. Although not fully understood, certain signal transduction pathways are associated with specific cellular effects.The cellular effects of activation include increased cellular proliferation, invasion, metastasis, angiogenesis, and inhibition of apoptosis.1There is evidence that somatic mutations in the TK domain of the HER1/EGFR gene increase activation in response to ligand binding.2Finally, tumor cells driven by a HER1/EGFR pathway, particularly one involving an autocrine feedback loop, can become resistant to radiotherapy, chemotherapeutic agents or hormones, so making them resistant to conventional therapy.3,41. Woodburn J. Pharmacol Ther. 1999;82:2. Lynch TJ, Bell DW, Sordella R, et al. New Engl J Med. 2004;350.3. Knowlden JM, Hutcheson IR, Jones HE, et al. Endocrinology 2003;144:4. Chakravarti A, Chakladar A, Delaney MA, et al. Cancer Res. 2002;62:JNKAblPI3K AktMAPKProliferation, invasion, metastasis, angiogenesis, and inhibition of apoptosisWoodburn J. Pharmacol Ther. 1999;82: ; Lynch TJ, Bell DW, Sordella R, et al. New Engl J Med ;350; Knowlden JM, Hutcheson IR, Jones HE, et al. Endocrinology 2003;144: ; Chakravarti A, Chakladar A, Delaney MA, et al. Cancer Res. 2002;62:
38HER1/EGFR Dysregulation in Tumors Ligand overproduction(autocrine loop)Mutationsconferringconstitutive activationDefectiveinternalization or downregulationOverexpressionPPPPPPPPPPPPHER1/EGFR dysregulation takes several forms, one or all of which can be active in tumors, increasing receptor phosphorylation and, therefore, activation.Arguably the most important mechanism of HER1/EGFR dysregulation in tumor cells is the over-production of HER1/EGFR ligands, most often EGF and TGF-.HER1/EGFR overexpression as a result of gene amplification and/or protein over-production can increase receptor activation.Ligands can be over-produced by cells with dysregulated HER1/EGFR, producing an autocrine activation loop. This phenomenon is thought to be a vital step in the development of hormone-resistant tumors, particularly of the breast and prostate.1,2HER1/EGFR mutations, most commonly EGFRvIII, result in ligand- independent, constitutive activity. There is evidence that EGFRvIII is associated with more aggressive tumors.3Somatic mutations in the TK domain of the HER1/EGFR gene have been reported recently. Preliminary data suggest these mutations may cause enhanced receptor activation in response to ligand binding.4,5Defective internalization or downregulation of the receptor can also cause abnormal signaling.61. De Miguel P, Royuela, Bethencourt R, et al. Cytokine. 1999;11:2. Normanno N, Kim N, Wen D, et al. Breast Cancer Res Treat. 1995;35:3. Lal A, Glazer CA, Martinson HM, et al. Cancer Res. 2002;62:4. Lynch TJ, Bell DW, Sordella R, et al. New Engl J Med. 2004;350.5. Paez JG, Janne PA, Lee JC, et al. Science, 29 April 2004 ( /science ).6. Yang H, Jiang D, Li W, et al. Oncogene 2000;19:EGFRvII/IIIEGFRvIP = phosphateDe Miguel P, Royuela, Bethencourt R, et al. Cytokine. 1999;11: ; Normanno N, Kim N, Wen D, et al. Breast Cancer Res Treat. 1995;35: ; Lal A, Glazer CA, Martinson HM, et al. Cancer Res. 2002;62: ; Lynch TJ, Bell DW, Sordella R, et al. New Engl J Med. 2004;350; Paez JG, Janne PA, Lee JC, et al. Science, 29 April 2004 ( /science ); Yang H, Jiang D, Li W, et al. Oncogene 2000;19:
39Tumors with HER1/EGFR Dysregulation GliomaHead and neckBreastLungEsophagusRenalGastricColorectalOvarianPancreaticMany solid tumors have dysregulated HER1/EGFR.1This association of HER1/EGFR and tumor development has been shown in hormone-sensitive tumors (breast and prostate), and also in tumors that are not hormone-dependent (e.g. head and neck, NSCLC, colon, ovarian, and glioma).2HER1/EGFR dysregulation is associated with advanced disease and poor prognosis.1. Salomon DS, Brandt R, Ciardiello F, et al. Crit Rev Oncol Hematol. 1995;19:2. Woodburn JR. Pharmacol Ther. 1999;82:BladderCervicalProstateSalomon DS, Brandt R, Ciardiello F, et al. Crit Rev Oncol Hematol. 1995;19: Woodburn JR. Pharmacol Ther. 1999;82:
40Common Approaches to Targeting HER1/EGFR Various approaches are being investigated to target members of the HER family, particularly HER1/EGFR and HER2.These include receptor sub-type specific monoclonal antibodies (MAbs) and small-molecule TK inhibitors (TKIs), which target the HER axis either outside or inside the tumor cell, respectively.MAbs block the extracellular ligand-binding region of the receptor. Several MAbs are specific for either HER1/EGFR or HER2.1 Different antibody- based approaches use MAbs or HER ligands conjugated with cellular toxins.2Small-molecule TKIs act at an intracellular level, inhibiting TK phosphorylation and preventing downstream receptor signaling. There are agents that inhibit HER1/EGFR specifically, HER1/EGFR and HER2, or all members of the HER family (pan HER-TK inhibitors).3-5Agents are being developed to interfere with HER activity at a nuclear level by blocking signal transduction and/or translation. The most promising methods are antisense oligonucleotides, ribozyme-mediated DNA inhibition, and gene therapy.61. Slamon DJ, Leyland-Jones B, Shak S, et al. N Engl J Med. 2001;344:2. Mendelsohn J, Baselga J. Oncogene. 2000;19:3. Noonberg SB, Benz CC. Drugs. 2000;59:4. Raymond E, Faivre S, Arman JP. Drugs. 2000;60(Suppl 1):15-23.5. Arteaga C. J Clin Oncol. 2001;19:32s-40s.6. Pedersen MW, Meltom M, Damstrup L, et al. Ann Oncol. 2001;12:PPTKinhibitorsPAnti-ligand-blockingantibodiesLigand–toxinconjugatesPAntibody–toxinconjugatesAnti-HER1/EGFR- blocking antibodiesSlamon DJ, Leyland-Jones B, Shak S, et al. N Engl J Med. 2001;344: ; Mendelsohn J, Baselga J. Oncogene. 2000;19: ; Noonberg SB, Benz CC. Drugs. 2000;59: ; Raymond E, Faivre S, Armann JP. Drugs. 2000;60(Suppl 1):15-23; Arteaga C. J Clin Oncol. 2001;19:32s-40s; Pedersen MW, Meltom M, Damstrup L, et al. Ann Oncol. 2001;12:
41EGFR inhibitory K-ras Monoklonální protilátky Tyrosinkinázové inhibitory¯ ProliferationK-ras Apoptosis Sensitivity to radiotherapy¯ InvasionAnti-HER1/EGFR monoclonal antibodies prevent ligand binding and subsequent receptor activation.1 Small-molecule TKIs inhibit the binding of ATP to the intracellular TK domain of the target receptor, blocking receptor phosphorylation and associated downstream signaling.2Receptor inhibition using TKIs or antibodies inhibits cellular processes promoting tumor growth and progression, such as proliferation, angiogenesis, and metastasis, and normal control mechanisms, like apoptosis, are restored.1,2HER1/EGFR inhibition also prevents tumor cells from evading damage by radiotherapy, so restoring or enhancing their sensitivity to this treatment.31. Etessami A, Bourhis J. Drugs Fut. 2000;25:2. Moyer J, Barbacci EG, Iwata KK, et al. Cancer Res. 1997;57:3. Harari PM, Huang SM. Semin Radiat Oncol. 2002;12(Suppl 2):21-26.¯ Metastasis¯ Adhesion¯ AngiogenesisEtessami A, Bourhis J. Drugs Fut. 2000;25:Moyer J, Barbacci EG, Iwata KK, et al. Cancer Res. 1997;57: Harari PM, Huang SM. Semin Radiat Oncol. 2002;12(Suppl 2):21-26.
42EGFR inhibitory vs. mutace K-ras Monoklonální protilátkyTyrosinkinázové inhibitory¯ ProliferationK-ras Apoptosis Sensitivity to radiotherapy¯ InvasionAnti-HER1/EGFR monoclonal antibodies prevent ligand binding and subsequent receptor activation.1 Small-molecule TKIs inhibit the binding of ATP to the intracellular TK domain of the target receptor, blocking receptor phosphorylation and associated downstream signaling.2Receptor inhibition using TKIs or antibodies inhibits cellular processes promoting tumor growth and progression, such as proliferation, angiogenesis, and metastasis, and normal control mechanisms, like apoptosis, are restored.1,2HER1/EGFR inhibition also prevents tumor cells from evading damage by radiotherapy, so restoring or enhancing their sensitivity to this treatment.31. Etessami A, Bourhis J. Drugs Fut. 2000;25:2. Moyer J, Barbacci EG, Iwata KK, et al. Cancer Res. 1997;57:3. Harari PM, Huang SM. Semin Radiat Oncol. 2002;12(Suppl 2):21-26.¯ Metastasis¯ Adhesion¯ AngiogenesisEtessami A, Bourhis J. Drugs Fut. 2000;25:Moyer J, Barbacci EG, Iwata KK, et al. Cancer Res. 1997;57: Harari PM, Huang SM. Semin Radiat Oncol. 2002;12(Suppl 2):21-26.
43Onkogen K-ras Onkogen z rodiny ras – K-ras, N-ras, H-ras Umístění na 12 chromosomu v pozici 12.1Protein s GTPázovou aktivitou o velikosti 21 kDaSoučást MAPK signální dráhy - účastní se přenosu signálu z vnějšího prostředí buňky do jádra a za fyziologických podmínek je aktivovaný receptorovými tyrosinkinázami, např. EGFR1
44K-ras v onkologiiAktivační mutace K-ras genu v kodonu 12 a 13Nová moderní cílená protinádorová léčivaEGFR inhibitorynízkomolekulární inhibitory tyrosinkináz (Gefitinib, Erlotinib)anti-EGFR monoklonální protilátky (Cetuximab, Vectibix)Nemalobuněčný karcinom plic (NSCLC), skvamocelulární karcinom hlavy a krku (HNSCC) a metastazující kolorektální karcinom (CrC)Kompletní či parciální remise je zaznamenána jen u relativně malého počtu pacientů (přibližně 10 %)Individualizace terapie – „Správnému pacientovi, správná léčba“
45Biologická léčbaCílená individualizovaná léčba – targeting therapy – zasahuje specifický cíl – často signální molekuly nebo receptory zodpovědné za vznik onemocnění – důležitá znalost signálních drah – základní výzkum je předpokladem pro objevování novějších a účinnějších léčiv.Prediktivní faktory – negativní a pozitivní – predikují účinnost zvoleného léčiva u konkrétního pacienta.
46Molecular Biology of the Cell, Fourth Edition Bruce Alberts, Alexander Johnson, Julian Lewis,Martin Raff, Keith Roberts, Peter Walter28/02/ pagesMUDr. Josef SrovnalLaboratoř experimentální medicíny DK FN a LF UP OlomoucTel: