KRAS突变型胰腺癌相关性肌肉减少症的研究进展

Research progress of KRAS‑mutant pancreatic cancer‑related sarcopenia

  • 摘要: 恶性肿瘤相关性肌肉减少症主要表现为分解代谢引起的蛋白质降解和肌肉消耗,导致骨骼肌的质量、力量与功能下降。胰腺癌是肌肉减少症发生率最高的恶性肿瘤。超过80%胰腺癌患者存在Kirsten大鼠肉瘤病毒癌基因同源物(KRAS)基因驱动突变,会促进肌肉减少症的进展。笔者系统阐述KRAS突变型胰腺癌与肌肉减少症的相互作用机制,主要体现在4个方面:(1)KRAS驱动的代谢重编程会引起肌肉能量储备的耗竭,影响肌纤维能量的重新分配,导致能量单向流动供给肿瘤细胞增殖。(2)肿瘤细胞通过改变细胞因子谱,激活泛素‑蛋白酶体系统和自噬‑溶酶体途径,促进肌管降解和抑制肌肉再生,破坏肌肉稳态,导致营养物质单向流动支持肿瘤生长。(3)肿瘤细胞引起的氧化应激损伤骨骼肌。(4)肿瘤细胞诱导骨骼肌的免疫细胞重塑。同时,笔者回顾KRAS突变型胰腺癌相关性肌肉减少症的治疗进展。随着KRAS突变胰腺癌相关性肌肉减少症研究的深入,靶向治疗和个性化干预有望成为改善患者预后、提高生命质量的重要手段。

     

    Abstract: Cancer‑related sarcopenia is mainly characterized by protein degradation and muscle depletion caused by catabolism, leading to a decrease in the quality, strength, and function of skeletal muscles. Pancreatic cancer has the highest incidence of cancer‑associated sarcopenia. More than 80% of pancreatic cancer patients have the Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations, which promote the progress of sarcopenia. The authors systematically elaborate the interaction mechanism between KRAS‑mutant pancreatic cancer and sarcopenia, mainly in four aspects: (1) KRAS driven metabolic reprogramming leads to depletion of muscle energy reserves, affecting the redistribution of muscle fiber energy and resulting in unidirectional energy flow for cancer cell proliferation. (2) By altering the cytokine profile, activating the ubiquitin protease system and the autophagy lysosome pathway, the cancer cells promote myotube degradation, inhibit muscle regeneration, disrupt muscle homeostasis, and lead to unidirectional flow of nutrients to support tumor growth. (3) Oxidative stress caused by cancer cells damages skeletal muscles. (4) Cancer cells induce immune cell remodeling in skeletal muscle. Meanwhile, the authors review the treatment progress of KRAS‑mutant pancreatic cancer‑related sarcopenia. With the deepening research of KRAS‑mutant pancreatic cancer‑related sarcopenia, targeted therapy and personalized intervention are expected to become important means to improve the prognosis and quality of life of patients.

     

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