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Spinocerebellar ataxia 4 is a devastating progressive movement disease that can begin as early as the late teens. Now, a multinational research team has conclusively identified the genetic difference that causes the disease, bringing answers to families and opening the door to future treatments. Spinocerebellar ataxia 4 is a devastating progressive movement disease that can begin as early as the late teens. Now, a multinational research team led by University of Utah researchers has conclusively identified the genetic difference that causes the disease, bringing answers to families and opening the door to future treatments. Some families call it a trial of faith. Others just call it a curse. The progressive neurological disease known as spinocerebellar ataxia 4 (SCA4) is a rare condition, but its effects on patients and their families can be severe. For most people, the first sign is difficulty walking and balancing, which gets worse as time progresses. The symptoms usually start in a person's forties or fifties but can begin as early as the late teens. There is no known cure. And, until now, there was no known cause. Now, after 25 years of uncertainty, a multinational study led by Stefan Pulst, M.D., Dr. med., professor and chair of neurology, and K. Pattie Figueroa, a project manager in neurology, both in the Spencer Fox Eccles School of Medicine at University of Utah, has conclusively identified the genetic difference that causes SCA4, bringing answers to families and opening the door to future treatments. Their results are published in the peer-reviewed journal Nature Genetics. Solving a genetic enigma SCA4's pattern of inheritance had long made it clear that the disease was genetic, and previous research had located the gene responsible to a specific region of one chromosome. But that region proved extraordinarily difficult for researchers to analyze: full of repeated segments that look like parts of other chromosomes, and with an unusual chemical makeup that makes most genetic tests fail. To pinpoint the change that causes SCA4, Figueroa and Pulst, along with the rest of the research team, used a recently developed advanced sequencing technology. By comparing DNA from affected and unaffected people from several Utah families, they found that in SCA4 patients, a section in a gene called ZFHX3 is much longer than it should be, containing an extra-long string of repetitive DNA. Isolated human cells that have the extra-long version of ZFHX3 show signs of being sick -- they don't seem able to recycle proteins as well as they should, and some of them contain clumps of stuck-together protein. "This mutation is a toxic expanded repeat and we think that it actually jams up how a cell deals with unfolded or misfolded proteins," says Pulst, the last author on the study. Healthy cells need to constantly break down non-functional proteins. Using cells from SCA4 patients, the group showed that the SCA4-causing mutation gums up the works of cells' protein-recycling machinery in a way that could poison nerve cells. Hope for the future Intriguingly, something similar seems to be happening in another form of ataxia, SCA2, which also interferes with protein recycling. The researchers are currently testing a potential therapy for SCA2 in clinical trials, and the similarities between the two conditions raise the possibility that the treatment might benefit patients with SCA4 as well. Finding the genetic change that leads to SCA4 is essential to develop better treatments, Pulst says. "The only step to really improve the life of patients with inherited disease is to find out what the primary cause is. We now can attack the effects of this mutation potentially at multiple levels." But while treatments will take a long time to develop, simply knowing the cause of the disease can be incredibly valuable for families affected by SCA4, says Figueroa, the first author on the study. People in affected families can learn whether they have the disease-causing genetic change or not, which can help inform life decisions such as family planning. "They can come and get tested and they can have an answer, for better or for worse," Figueroa says. The researchers emphasize that their discoveries would not have been possible without the generosity of SCA4 patients and their families, whose sharing of family records and biological samples allowed them to compare the DNA of affected and unaffected individuals. "Different branches of the family opened up not just their homes but their history to us," Figueroa says. Family records were complete enough that the researchers were able to trace the origins of the disease in Utah back through history to a pioneer couple who moved to Salt Lake Valley in the 1840s. Since meeting so many families with the disease, studying SCA4 has become a personal quest, Figueroa adds. "I've been working on SCA4 directly since 2010 when the first family approached me, and once you go to their homes and get to know them, they're no longer the number on the DNA vial. These are people you see every day… You can't walk away. This is not just science. This is somebody's life." This work was performed in collaboration with researchers from University of Tübingen, University of Lübeck and Kiel University, University Hospital Hamburg-Eppendorf, and Veterans Administration Medical Center, Albany, NY. The study was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award number R35127253 and the DFG-funded INST 37/1049-1.

前言肿瘤是一个复杂的生态系统，其中癌症细胞和多种宿主细胞之间的相互作用影响疾病的进展和治疗反应。在肿瘤进展过程中，癌症细胞采用多种途径来逃避免疫攻击，例如下调抗原提呈机制或诱导抑制性免疫检查点分子，而免疫压力在肿瘤的发展和转移扩散过程中促进克隆进化。同时，癌症细胞劫持免疫细胞，如中性粒细胞、巨噬细胞和调节性T细胞（Treg），以协调免疫抑制性肿瘤微环境（TME）。这反过来促进免疫逃逸，促进血管和细胞外基质的重塑，并支持癌症进展和治疗抵抗。异常免疫反应被广泛认为是癌症的标志，并为癌症治疗提供了有吸引力的靶点。因此，我们有必要深入了解癌症细胞的内在特征，包括遗传变异、信号通路调节和代谢改变，它们在协调免疫景观的组成和功能状态方面发挥关键作用，并影响免疫调节策略的治疗效益。遗传改变癌基因、抑癌基因或DNA损伤修复基因中的特定癌症细胞固有遗传改变有助于调节癌症免疫状况。癌基因癌症细胞中不同的致癌基因通过不同的机制调节免疫行为，这些机制因癌症类型、癌症分期和癌症部位而异。例如，KRAS突变通过IL-8诱导的炎症、IL-6介导的巨噬细胞和Treg细胞浸润、GM-CSF诱导的Gr1+CD11b+髓系细胞的扩增、IL-10和TGF-β介导的CD4+CD25−T细胞向Treg细胞的转化、以及抑制干扰素调节因子2（IRF2）和随后产生的CXCL3，从而导致CD8+T细胞抑制，髓系衍生抑制细胞（MDSCs）的迁移增强。MYC通过增强CD47和PD-L1表达来抑制抗肿瘤免疫，从而削弱巨噬细胞和T细胞的募集。此外通过分泌IL-1β，阻断细胞毒性T细胞、NK细胞和树突状细胞的浸润，并增强支持肿瘤的巨噬细胞和中性粒细胞的浸润。KRAS突变和MYC还通过与MYC相互作用的锌指蛋白1（MIZ1）产生协同作用，介导IFN-β的抑制以及CCL9和IL-23的分泌，增强PD-L1+巨噬细胞浸润，抑制B细胞、T细胞和NK淋巴细胞驱动免疫逃避。此外，突变的表皮生长因子受体（EGFR）通过降低PD-L1表达来驱动免疫逃逸，通过IRF1介导的CXCL10下调阻碍CD8+T细胞募集，并通过CD73依赖性腺苷生成或JNK–JUN介导的CCL2上调促进Treg细胞浸润。人表皮生长因子受体2（HER2）扩增导致主要组织相容性复合物I类（MHC-I）的下调和TANK结合激酶1（TBK1）的磷酸化，其抑制下游cGAS–STING信号传导和IFNβ产生，导致免疫逃避。抑癌基因抑癌基因通过不同的环境依赖机制调节免疫。例如，研究发现Trp53的缺失通过WNT配体介导的巨噬细胞极化和IL-1β的产生驱动免疫抑制，导致中性粒细胞的全身聚集，从而CD8+T细胞的抑制和CXCL17、CCL3、CCL11、CXCL5和M-CSF介导的巨噬细胞和Treg细胞的募集。TP53的突变与PD-L1表达相关，并通过CXCL2分泌调节免疫抑制中性粒细胞的募集，通过NF-κB介导的IL-8调节慢性炎症，并且结合TBK1抑制下游cGAS–STING–IRF3信号传导和IFN-β1的产生，其减少T细胞和NK细胞浸润并增强巨噬细胞极化。相反，TP53的功能增益突变与新抗原表达，以及IFN-γ和CXCL9表达相关，这支持抗肿瘤免疫。在KRAS突变肿瘤中，丝氨酸/苏氨酸激酶11（STK11）的失活通过粒细胞集落刺激因子（G-CSF）、IL-6和CXCL7的表达刺激免疫抑制中性粒细胞的积聚。此外，KRAS和STK11突变肿瘤中PD-L1的表达会导致对免疫检查点阻断（ICB）的抵抗。最后，PTEN丢失通过CCL2和VEGF的分泌减少CD8+T细胞浸润，并激活PI3K信号增强PD-L1的表达，以及NF-κB介导的CCL20、CXCL1、IL-6和IL-23分泌增强Treg细胞和髓系细胞浸润，并通过IL-1β和M-CSF驱动局部MDSC扩增。DNA损伤修复机制的遗传改变癌症细胞中的错配修复（MMR）缺陷会导致突变、新抗原和细胞中DNA的积累，从而触发cGAS–STING依赖性的T细胞浸润，免疫检查点分子如PD-1、PDL1、CTLA-4和LAG-3在浸润免疫细胞上的表达增强。在BRCA1突变的肿瘤中，双链DNA积聚在细胞中，并引发与CD8+T细胞浸润相关的cGAS–STING介导的炎症反应。cGAS–STING还促进免疫抑制性髓系细胞、巨噬细胞、Treg细胞和耗竭的PD1+T细胞的募集，以及VEGF的上调。DNA传感基因和下游介质（如IFN-β或CCL5）的遗传缺失或表观遗传沉默可介导BRCA1突变肿瘤的免疫逃逸，以及PD-L1的表达增强。相反，BRCA2突变肿瘤显示cGAS–STING介导的各种T细胞群的富集。表观遗传修饰除了遗传改变外，表观遗传改变也是癌症细胞的一个共同特征，在核结构和基因转录中起着至关重要的作用。癌症表观基因组会发生各种变化，包括DNA甲基化、组蛋白修饰、染色质重塑和非编码RNA的失调。越来越多的证据表明，癌症细胞中发生的表观遗传变化也会影响与免疫系统的串扰。DNA甲基化由于超级增强子（SE）的形成，炎症基因的DNA去甲基化导致CXC趋化因子配体（CXCL）介导的中性粒细胞募集，而总体低甲基化与PD-L1、IL-6和VEGF的表达增强相关。而DNA（超）甲基化可降低编码PD-L1的基因CD274和编码MHC-I的HLA基因的表达，而编码cGAS–STING的基因通过启动子甲基化的转录抑制增强MHC-I表达和T细胞识别。异柠檬酸脱氢酶1（IDH1）或IDH2的突变通过将α-酮戊二酸转化为（R）-2-羟基戊二酸（2HG）来诱导全局超甲基化。而编码PD-L1、CXCL9和CXCL10免疫相关基因的转录抑制会损害IDH突变肿瘤中CD8+T细胞的浸润，G-CSF的转录激活会增强非抑制性中性粒细胞和前中性粒细胞的浸润。组蛋白甲基化组蛋白H3在Lys27发生三甲基化（H3K27me3），在DNA低甲基化的背景下，抑制编码MHC-I、CXCL9和CXCL10的基因，并减少CD8+T细胞浸润。癌症细胞中的多梳抑制复合物2（PRC2）活性介导H3K27me3，抑制G-CSF和IL-6的表达并诱导性一氧化氮合成酶阳性（iNOS+）巨噬细胞、中性粒细胞和T细胞的招募。ARID1A是SWI/SNF复合物的DNA结合亚基, ARID1A的遗传突变会抑制IFN-γ诱导基因转录和CXCL9、CXCL10和CXCL11的表达，从而抑制T细胞浸润。组蛋白乙酰化组蛋白乙酰化通过组蛋白乙酰转移酶1（HAT1）调节免疫应答，HAT1介导CD274和组蛋白去乙酰化酶（HDACs）的表达，HDACs抑制编码PD-L1和PD-L2的基因的表达，以及CCL5、CXCL9和CXCL10的表达，从而损害T细胞浸润。细胞内信号通路癌症细胞的一个关键特征是异常信号传导，这是由编码或非编码DNA区域的遗传或表观遗传改变以及生长因子和代谢等外部信号驱动的。WNT–β-catenin通路激活的癌症细胞内固有WNT–β-catenin信号与免疫排斥相关，但其潜在机制仍不明确。WNT–β-catenin通过诱导ATF3表达阻断CD103+树突状细胞的募集和T细胞启动，并抑制CCL4或CCL5分泌。TGF-β通路淋巴细胞抗原LY6K和LY6E在癌症细胞中的过表达激活TGF-β信号转导和SMAD2/3磷酸化，导致NK细胞活性降低和Treg细胞浸润增强。αVβ6整合素的上调通过激活TGF-β和SMAD2/3磷酸化来调节SOX4的表达，SOX4抑制多种I型干扰素诱导基因和编码MHC-I的基因，同时增强PD-L1表达，这会损害细胞毒性T细胞介导的免疫。此外，癌症细胞衍生的TGF-β介导CD4+T细胞向Treg细胞的转化。而SMAD4的敲除会导致肿瘤细胞中TGF-β信号的失活，这增强了CCL9的表达和未成熟髓系细胞的募集。NF-κB信号通路PD-L1的表达受癌症细胞内NF-κB信号转导的转录调控，其途径是通过MUC1-c与CD274启动子上的NF-κB亚基p65的直接结合，或通过TGF-β介导的MRTFA的表达。MUC1-C和p65还驱动ZEB1转录，这导致编码CCL2、IFN-γ、GM-CSF和TLR9的基因受到抑制，CD8+T细胞浸润受损。相反，免疫疗法和化疗诱导的NF-κB和p300–CBP的活化增强了MHC-I抗原呈递和CD8+T细胞识别。HIF信号通路缺氧诱导的缺氧诱导因子1α（HIF1α）信号通路通过增强CD274的表达和抑制编码CCL2和CCL5的基因来驱动免疫逃避，这会损害NK细胞和CD8+T细胞的浸润，而HIF2α诱导CXCL1的表达并促进肿瘤的中性粒细胞募集。代谢改变在肿瘤的发生和进展过程中，癌症细胞及其TME不断暴露在恶劣的条件和压力下。为了生存和维持生长，需要细胞适应和代谢重编程。癌症代谢重编程与免疫抑制和逃避有关。肿瘤细胞消耗大量葡萄糖，这与T细胞浸润不良有关。高葡萄糖消耗导致乳酸的产生并分泌到肿瘤微环境中，乳酸在肿瘤微环境中以免疫抑制的方式起作用，降低NK细胞的细胞溶解活性，并增强PD-1表达和Treg细胞的免疫抑制能力。此外，乳酸增加了肿瘤和脾脏中MDSC的频率，并在肿瘤相关巨噬细胞中诱导“M2样”极化。此外，癌症细胞中谷氨酰胺的消耗降低CD8+T细胞的活化和浸润，并通过增加G-CSF的分泌增强MDSC的募集。小结近年来，关于癌症细胞-免疫细胞串扰的研究大幅增长。跨越式发展的技术进步，包括单细胞多组学技术，基于人工智能的系统生物学方法以及体内体细胞基因编辑策略，有望加速这些研究的深入，并最终形成针对个体患者的新型免疫干预策略。展望未来，个性化免疫干预策略将需要综合多组学肿瘤表征、免疫分析、液体活检样本的动态监测以评估基于血液的生物标志物、计算数据分析和转化，以及临床相关体外和体内模型的机制研究。有关癌症细胞内在和癌症细胞外部特征的知识体系将共同决定局部和系统免疫状况，以指导临床决策，并为针对患者个性化新型治疗方法开辟道路。参考文献：1.Mechanisms driving the immunoregulatory function of cancer cells. Nat Rev Cancer.2023 Jan 30.封面图来源：pixabay版权声明/免责声明本文为授权转载文章。本文仅作信息交流之目的，不提供任何商用、医用、投资用建议。文中图片、视频、字体、音乐等素材或为药时代购买的授权正版作品，或来自微信公共图片库，或取自公司官网/网络，部分素材根据CC0协议使用，版权归拥有者，药时代尽力注明来源。如有任何问题，请与我们联系。衷心感谢!药时代官方网站:www.drugtimes.cn联系方式:电话:13651980212微信:27674131邮箱:contact@drugtimes.cn股价大涨270%！涨的是所有GLP-1“弯道超车”的机会3个月减重近30斤，股价翻倍，Viking已被礼来看中？14.6亿美元！诺和诺德又有新交易点击这里，欣赏更多精彩内容！

异柠檬酸脱氢酶野生型高级别胶质瘤（isocitrate dehydrogenase wild type glioma, IDH-WT glioma）具有高度侵袭性，患者预后差。目前治疗胶质瘤的标准疗法包括手术切除、放疗和化疗，但这些传统疗法很少能治愈这种疾病。高级别胶质瘤肿瘤免疫微环境（tumor microenvironment, TME）中通常缺乏肿瘤浸润淋巴细胞（tumor-infiltrating lymphocytes）以及具备有大量的免疫抑制性髓样细胞（immunosuppressive myeloid cells），被认为是一种免疫冷肿瘤，这样的免疫抑制微环境组成使得当前新兴的肿瘤免疫治疗策略在胶质瘤治疗上也难以发挥良好的作用。因此，准确且全面地揭示肿瘤免疫微环境并检测其中的免疫细胞状态和基因表达的动态变化，将为胶质瘤免疫治疗提供新的靶点和策略。近年来，随着单细胞测序技术的飞速发展，已经能实现对于复杂肿瘤微环境中的免疫细胞状态鉴定以及基因表达的动态变化检测。基于此项技术，多个研究团队已对胶质瘤中不同的肿瘤细胞亚型或是浸润的免疫细胞类型进行了初步分类鉴定。然而，大多数研究都集中在肿瘤细胞与免疫细胞之间的相互作用和影响上，而缺失了不同免疫细胞类型之间的细胞间相互作用所带来的影响。此外，因缺乏相应病人自体的非肿瘤环境中的免疫细胞作为对照组，现存研究也难以细致准确的评估肿瘤细胞特异的免疫调控作用。近日，西湖大学生命科学学院谢琦研究员，联合浙二医院神经外科祝向东主任、华山医院神经外科秦智勇主任，在Cancer Immunology Research上发表题为“Single-cell transcriptomics reveals the heterogeneity of the immune landscape of IDH-wildtype high-grade gliomas”的研究论文，利用单细胞转录组测序技术，对IDH-野生型高级别胶质瘤肿瘤浸润的免疫细胞和配对的外周血单核细胞（peripheral blood mononuclear cells, PBMC）的免疫景观进行了深入的分析，并且发现了胶质瘤免疫治疗的潜在靶点。该项研究整合了九对来自肿瘤组织浸润的免疫细胞及相匹配PBMC的单细胞转录组图景，确定了肿瘤中具备高促瘤发生特征的两个肿瘤相关巨噬细胞（tumor-associated macrophages, TAM）的亚群，以及通过T cell轨迹分析以及体内体外实验验证确定芳基烃受体（aryl hydrocarbon receptor, AHR）是T cell功能障碍的调节因子，并对肿瘤微环境相较于PBMC中存在的独特免疫细胞配体-受体相互作用介导的细胞间通讯进行了鉴定。该研究对九对高级别IDH-野生型胶质瘤患者的肿瘤组织浸润的免疫细胞以及相匹配的PBMC细胞进行了单细胞转录组测序，分别获得了53,843个肿瘤浸润的免疫细胞和53,229个PBMC单细胞。通过单细胞数据分析，识别了多种淋巴细胞和髓系细胞亚群。通过GBM肿瘤与PBMC的各个细胞类型的比例计算，该研究揭示了Macrophage和DC在肿瘤浸润的免疫细胞中的比例较高，而T cell, B cell和NK cell的比例则占比较低（图1）。图1.肿瘤浸润的免疫细胞及其配对PBMC的免疫细胞图谱该研究进一步对于肿瘤内浸润的两个主要的TAM群体单核细胞来源的巨噬细胞（monocyte-derived macrophages, MDMs）和脑内小胶质细胞（brain-resident microglia, MG）进行分析。MDMs和MG可进一步聚类为三个亚群，其中MDM-1高表达干扰素相关基因（IFITM3、ISG1、TNF和LY6E），MDM-2高表达抗原呈递相关基因（HLA-DMA、HLA-DMB和HLA_DQA2），而MDM-3高表达缺氧反应基因（MIF、ENO1、ALDOA、LDHA和EPAS1）；MG-1高表达趋化因子相关基因（CCL4、CCL4L2、CCL3、CCL3L1和SPP1)、MG-2高表达应激反应基因（HSPA6、HAPA1A、HSPA1B和DNAJB1）和MG-3则高表达干扰素相关基因（IFI27、IFI6、MIX1和IFI44L）。通过在不同的TAMs亚群中评估血管生成和吞噬基因表达，该研究发现MDM-3和MG-1中表现出较强的血管生成特征，而MDM-1和MG-3中表现出较高的吞噬作用特征。图2.TAMs的亚群分类以及功能通路富集基于对于肿瘤内浸润的CD8+T cell的轨迹分析，该研究发现转录因子AHR在CD8_Stress态和CD8_Exhaustion 俩终末端状态中均高度表达。该研究进一步通过在CRISPR/Cas9 技术敲除CAR T细胞中的AHR，体内和体外实验验证了敲除AHR可以抑制T细胞的耗竭，上调IFNγ分泌，从而增加其对于胶质瘤的杀伤能力，延长菏瘤小鼠的中位生存期，提示AHR可以作为改进胶质瘤的CAR T疗法的潜在靶点。图3.AHR敲除促进T cell的抗肿瘤能力综上所述，该研究描绘了IDH野生型高级别胶质瘤浸润的免疫细胞和其配对的PBMC的免疫景观的异质性，为改进胶质瘤的免疫治疗策略提供了新的线索。本文仅用于学术分享，转载请注明出处。若有侵权，请联系微信：bioonSir 删除或修改！