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浙江大学学报（医学版）
浙江大学学报（医学版）  2021, Vol. 50 Issue (1): 32-40    DOI: 10.3724/zdxbyxb-2021-0040
专题报道     
谷氨酰胺代谢途径在肿瘤化疗耐药中的功能机制
胡鑫暘(),金洪传,朱丽媛()
浙江大学医学院附属邵逸夫医院 浙江省生物治疗重点实验室，浙江 杭州 310016
Effect of glutamine metabolism on chemoresistance and its mechanism in tumors
HU Xinyang(),JIN Hongchuan,ZHU Liyuan()
Zhejiang Provincial Key Laboratory of Biotherapy，Sir Run Run Shaw Hospital，Zhejiang University School of Medicine，Hangzhou 310016，China
 全文: PDF(2996 KB)   HTML( 19 )
摘要：

肿瘤细胞代谢重编程表现为对谷氨酰胺等营养物质摄取增加，而谷氨酰胺代谢可为在肿瘤细胞中过度激活的糖酵解和氧化磷酸化反应提供所需的原料，还可通过影响糖、脂质、蛋白质代谢的稳态平衡直接诱发肿瘤细胞对化疗药物的抵抗。针对谷氨酰胺代谢途径不同环节的抑制剂联合常规化疗药物在多种耐药肿瘤中取得了较好的临床治疗效果。谷氨酰胺代谢途径主要通过以下几种方式在肿瘤细胞耐药中发挥作用：谷氨酰胺转运体活性动态变化直接影响细胞内谷氨酰胺含量而影响细胞耐药性；肿瘤微环境中脂肪细胞、成纤维细胞及微环境代谢物通过免疫应答等方式介导耐药发生；谷氨酰胺代谢途径关键酶的表达及活性改变对肿瘤细胞耐药性的产生也至关重要。本文从转运体、肿瘤微环境及代谢酶等层面总结了谷氨酰胺代谢途径在肿瘤细胞产生化疗药物抵抗过程中的调控功能及其作用方式，以期为今后提高耐药性肿瘤的临床治疗效果提供新的思路。
关键词： 谷氨酰胺;  细胞代谢;  肿瘤;  耐药性;  综述    
Abstract:

The metabolic reprogramming of tumor cells is characterized by increased uptake of various nutrients including glutamine. Glutamine metabolism provides the required substances for glycolysis and oxidative phosphorylation and affects the homeostasis of carbohydrate，fat and protein metabolism to induce the chemoresistance of tumor cells. Combination of chemotherapeutic agents with inhibitors specific to different components of glutamine metabolic pathway has obtained favorable clinical results on various tumors. Glutamine metabolic pathway plays a role in drug resistance of tumor cells in various ways. Firstly，the dynamic change of glutamine transporters can directly affect intracellular glutamine content thereby causing drug resistance; secondly，tumor stromal cells including adipocyte，fibroblast and metabolite from tumor microenvironment would give rise to immune-mediated drug resistance; thirdly，the expression and activity of key enzymes in glutamine metabolism also has a critical role in drug resistance of tumors. This article reviews the effects of glutamine metabolic pathway in the development of tumor chemoresistance，in terms of transporters，tumor microenvironment and metabolic enzymes，to provide insight for improving the therapeutic efficacy for drug-resistant tumors.
Key words: Glutamine    Cell metabolism    Tumor    Drug resistance    Review
收稿日期: 2020-11-25 出版日期: 2021-05-15
CLC:  R730.23  
基金资助: 国家自然科学基金（81903061）
通讯作者: 朱丽媛     E-mail: 21918520@zju.edu.cn;zly_smile@126.com
作者简介: 胡鑫暘，硕士研究生，主要从事肿瘤代谢重编程过程及其蛋白修饰的功能机制研究；E-mail：21918520@zju.edu.cn；https://orcid.org/0000-0001-8988-4866
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胡鑫暘
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引用本文:

胡鑫暘,金洪传,朱丽媛. 谷氨酰胺代谢途径在肿瘤化疗耐药中的功能机制[J]. 浙江大学学报（医学版）, 2021, 50(1): 32-40.

HU Xinyang,JIN Hongchuan,ZHU Liyuan. Effect of glutamine metabolism on chemoresistance and its mechanism in tumors. J Zhejiang Univ (Med Sci), 2021, 50(1): 32-40.

链接本文:

http://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0040    或    http://www.zjujournals.com/med/CN/Y2021/V50/I1/32

图 1  谷氨酰胺代谢途径示意图 RAG：大鼠肉瘤癌基因相关GTP结合蛋白；ARF1：二磷酸腺苷核糖基化因子1；mTOR：哺乳动物雷帕霉素靶蛋白；SLC1A5：溶质载体家族1成员5；SLC7A11：溶质载体家族7成员11；SLC38A9：溶质载体家族38成员9；NADPH：还原型烟酰胺腺嘌呤二核苷酸磷酸.

谷氨酰胺代谢相关靶点

促进肿瘤耐药机制

耐药癌种

耐受药物

参考文献序号

转运体

?

溶质载体家族1成员5

促进谷氨酰胺进入线粒体，促进谷胱甘肽合成

胰腺癌

吉西他滨

28

通过AMPK-AKT信号通路抑制氧化磷酸化途径

结肠癌

二甲双胍

30

溶质载体家族1成员5抑制剂联合CB-839减少耐药细胞内谷胱甘肽产生，促进活性氧积累

肝癌

CB-839

45

溶质载体家族7成员8

激活mTOR通路，促进溶质载体家族7成员8的稳定，形成正反馈，促进耐药细胞摄取更多谷氨酰胺

胰腺癌

吉西他滨

29

溶质载体家族25成员22

促进三羧酸循环中谷氨酰胺代谢物琥珀酸的积累，促进DNA甲基化以及Wnt 信号通路激活

结肠癌

5-氟尿嘧啶

48

肿瘤微环境

?

肿瘤间质脂肪细胞

分泌大量谷氨酰胺，帮助白血病细胞抵抗左旋天冬酰胺酶的作用

急性淋巴细胞白血病

左旋天冬酰胺酶

34

肿瘤间质成纤维细胞

微囊蛋白1表达下降，自噬水平升高，促进谷氨酰胺向肿瘤实质细胞转移

乳腺癌

他莫昔芬

37

谷氨酰胺代谢酶

?

谷氨酰胺酶

表达增加，细胞对谷氨酰胺代谢依赖度增加，α酮戊二酸水平增高

黑色素瘤

BRAF抑制剂

39

多形性胶质母细胞瘤

雷帕霉素、PP242

40

谷氨酸脱氢酶、谷氨酰胺酶

ADI-PEG20诱导耐药细胞短期内C-MYC表达，进而促进谷氨酸脱氢酶和谷氨酰胺酶表达，提高谷氨酰胺代谢通路的活性

黑色素瘤

ADI-PEG20

41

谷氨酸脱氢酶

低氧情况下缺氧诱导因子1α蛋白水平升高，促进谷氨酸脱氢酶表达，使得肿瘤细胞对谷氨酰胺的摄取和利用增加

肺癌

顺铂

42

调控氧化磷酸化

 ?

PPARδ

促进耐药细胞对谷氨酰胺依赖，并调节氧化还原稳态，促进耐药细胞增殖

肝癌

索拉菲尼

43

其他途径

 ?

MYC

表达上调，调节谷氨酰胺诱导的未折叠蛋白反应，使得肿瘤细胞对低糖环境的耐受增加

乳腺癌

他莫昔芬、氟维司群

46

谷氨酰胺代谢通路多靶点

耐药细胞依赖谷氨酰胺代谢提供的氮源来维持蛋白质的异常糖基化，同时维持还原性稳态

胰腺癌

吉西他滨

47

α酮戊二酸

肿瘤细胞DNA损伤修复酶ALKBH的活性发挥依赖于细胞内α酮戊二酸水平

黑色素瘤、结肠癌

甲磺酸甲酯

49
表 1  谷氨酰胺代谢通路靶点与肿瘤化疗药物抵抗机制汇总
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