国际妇产科学杂志, 2025, 52(5): 486-491 doi: 10.12280/gjfckx.20241179

妇科肿瘤研究: 综述

胰高血糖素样肽-1受体激动剂在子宫内膜癌中的研究进展

姜昊哲, 尚丹丹, 王山, 万金良,

256603 滨州医学院第一临床医学院(姜昊哲);滨州医学院附属医院妇科(尚丹丹),肿瘤科(王山,万金良)

Research Progress of Glucagon-Like Peptide-1 Receptor Agonist in Endometrial Cancer

JIANG Hao-zhe, SHANG Dan-dan, WANG Shan, WAN Jin-liang,

The First Clinical Medical College of Binzhou Medical College, Binzhou 256603, Shandong Province, China (JIANG Hao-zhe); Department of Gynecology (SHANG Dan-dan), Department of Oncology (WANG Shan, WAN Jin-liang), Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China

通讯作者: 万金良,E-mail:wanjinliang01@163.com

审校者

本文编辑: 王昕

收稿日期: 2024-12-25  

Corresponding authors: WAN Jin-liang, E-mail:wanjinliang01@163.com

Received: 2024-12-25  

摘要

子宫内膜癌(endometrial cancer,EC)是女性生殖系统最常见的恶性肿瘤之一,其发病率在全球范围内呈上升趋势。胰高血糖素样肽-1受体激动剂(glucagon-like peptide-1 receptor agonist,GLP-1RA)作为降糖药物,在EC治疗中的潜在作用逐渐受到关注。现有研究已经初步证明GLP-1RA可通过激活腺苷酸活化蛋白激酶(AMP-activated protein kinase,AMPK)/哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin,mTOR)、环磷酸腺苷(cyclic adenosine monophosphate,cAMP)/蛋白激酶A(protein kinase A,PKA)等多条信号通路调控EC的生理活动,进而影响EC细胞的凋亡、自噬、铁死亡及细胞周期阻滞,并在高血糖环境中显示出克服顺铂化疗耐药的潜力,从而抑制EC细胞的存活、迁移和侵袭能力。此外,GLP-1RA还可上调胰高血糖素样肽-1受体(glucagon-like peptide-1 receptor,GLP-1R)的表达,且在正常组织和EC组织中均可检测到GLP-1R表达水平的变化。因此,GLP-1RA在EC的治疗中具有潜在的应用价值。从关键靶点、生理机制和作用效果的角度综述GLP-1RA在EC发生、发展中的最新研究进展,旨在为未来的研究提供参考。

关键词: 子宫内膜肿瘤; 细胞凋亡; 自噬; 铁死亡; 抗药性,肿瘤; 胰高血糖素样肽-1受体激动剂

Abstract

Endometrial cancer (EC) is one of the most common malignant tumors in the female reproductive system, and its incidence is on the rise globally. Glucagon-like peptide-1 receptor agonist (GLP-1RA) as hypoglycemic drug, has gradually attracted attention for their potential role in the treatment of EC. Existing studies have preliminarily demonstrated that GLP-1RA can regulate the physiological activities of EC by activating multiple signaling pathways such as AMP- activated protein kinase (AMPK)/mammalian target of rapamycin (mTOR) and cyclic adenosine monophosphate (cAMP)/protein kinase A(PKA). This further affects apoptosis, autophagy, ferroptosis, and cell cycle arrest of EC cells, and shows the potential to overcome cisplatin chemotherapy resistance in a hyperglycemic environment, thereby inhibiting the survival, migration, and invasion abilities of EC cells. In addition, GLP-1RA can upregulate the expression of glucagon-like peptide-1 receptor (GLP-1R), and changes in the expression level of GLP-1R can be detected in both normal tissues and EC tissues. Therefore, GLP-1RA has potential application value in the treatment of EC. This review summarizes the latest research progress of GLP-1RA in the occurrence and development of EC from the perspectives of key targets, physiological mechanisms, and effects, aiming to provide reference for future research.

Keywords: Endometrial neoplasms; Apoptosis; Autophagy; Ferroptosis; Drug resistance, neoplasm; Glucagon-like peptide-1 receptor agonists

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本文引用格式

姜昊哲, 尚丹丹, 王山, 万金良. 胰高血糖素样肽-1受体激动剂在子宫内膜癌中的研究进展[J]. 国际妇产科学杂志, 2025, 52(5): 486-491 doi:10.12280/gjfckx.20241179

JIANG Hao-zhe, SHANG Dan-dan, WANG Shan, WAN Jin-liang. Research Progress of Glucagon-Like Peptide-1 Receptor Agonist in Endometrial Cancer[J]. Journal of International Obstetrics and Gynecology, 2025, 52(5): 486-491 doi:10.12280/gjfckx.20241179

子宫内膜癌(endometrial cancer,EC)是女性生殖系统最常见的恶性肿瘤之一。全球EC的发病率和死亡率呈上升趋势,而发病年龄呈下降趋势[1]。近年研究显示,高血糖是EC发生的独立危险因素,糖尿病患者发生EC的风险是非糖尿病患者的2倍[2],且高血糖EC患者的死亡率显著高于血糖正常者[3]。鉴于糖尿病与EC之间密切关联,控制血糖水平已成为预防及治疗EC的关键策略之一[2]。胰高血糖素样肽-1受体激动剂(glucagon-like peptide-1 receptor agonist,GLP-1RA)作为2型糖尿病的二线治疗药物,通过模拟胰高血糖素样肽-1(glucagon-like peptide-1,GLP-1)的生理作用,能够有效降低糖尿病患者的血糖水平[4]

由于高血糖是EC的危险因素,而GLP-1RA在控制血糖方面具有显著效果,这为探索GLP-1RA在EC治疗中的潜在作用提供了理论基础。因此,深入研究GLP-1RA对EC的作用及其机制,不仅对EC的治疗具有重要意义,也为拓展GLP-1RA的临床应用提供了新的方向。现对GLP-1RA在干预EC的效果、作用机制和靶点等方面的最新进展进行综述,以期为临床治疗提供依据。

1 GLP-1RA的生物学功能

GLP-1是一种由肠道分泌的激素,其天然形式在循环系统中2~3 min内即被降解[5]。为了延长其作用效果,研究者开发了多种GLP-1RA,其中包括艾塞那肽(Exenatide)、阿必鲁肽(Albiglutide)和利拉鲁肽(Liraglutide)等,这些药物已被广泛应用于临床。

GLP-1RA主要通过激活胰高血糖素样肽-1受体(glucagon-like peptide-1 receptor,GLP-1R)调控人体生理功能,具体作用如下。①降低血糖:GLP-1RA能够促进胰岛素分泌、减缓胃排空速度以及抑制胰高血糖素的释放,有效降低糖尿病患者的血糖水平[4]。②治疗肥胖:GLP-1RA能通过影响中枢神经系统抑制食欲,从而控制食物摄入量并改变对食物的偏好,降低对高脂肪食物的喜好,以达到减重的目的[6]。③治疗精神疾病:GLP-1RA在精神疾病的治疗领域也显示出潜力,包括预防阿尔茨海默病、延缓帕金森病进展以及缓解焦虑和抑郁症状[7-8]。④治疗心血管疾病:GLP-1RA能够预防和改善动脉粥样硬化、心力衰竭、高血压等疾病,其心血管保护作用可能与抗炎和抗氧化特性有关[9],并且GLP-1RA已成为合并心血管疾病的2型糖尿病患者的一线治疗药物。⑤抗肿瘤:GLP-1RA与降低多种肥胖相关癌症的患病风险显著相关,包括EC、食管癌、结直肠癌、肾癌、胰腺癌、胆囊癌、卵巢癌、肝癌、脑膜瘤和多发性骨髓瘤,这提示GLP-1RA可能对此类癌症的发生有预防作用[10]。尽管有研究表明GLP-1RA对多种疾病有防治效果,但是其疗效、应用方式等问题尚未完全明晰,因此目前GLP-1RA仅应用于单纯糖尿病以及合并上述其他疾病的糖尿病患者。

2 GLP-1RA在EC中的相关作用机制

GLP-1RA可用于治疗糖尿病[4],高血糖水平又与EC的发病风险、预后以及特异性生存率之间存在显著相关性[3],因此,GLP-1RA与EC之间可能存在紧密联系。近年基础研究揭示了GLP-1RA对EC的抗肿瘤作用,包括抑制EC细胞的生长和增殖,GLP-1RA的潜在靶向调控机制主要包括诱导细胞凋亡、促进细胞自噬、影响细胞铁死亡以及调节细胞周期[11-17],见表1

表1   GLP-1RA作用于EC的效果及机制

文献处理方式研究类型正常EC组织中的表达靶点/通路作用机制作用效果
Zhang等[11]艾塞那肽动物实验+
体外实验
-AMPK/mTOR上调p-AMPK,p-AMPK抑制mTOR磷酸化,再通过mTOR上调caspase-3促进EC细胞凋亡,抑制肿瘤生长
Kanda等[12]利拉鲁肽体外实验-AMPK上调AMPK、p-AMPK和LC3,下调p62促进细胞凋亡、自噬,抑制癌细胞的生长,阻滞细胞周期
Zhu等[13]利拉鲁肽体外实验-AMPK、PR、
p-P70S6K
上调AMPK、PR,下调p-P70S6K上调孕酮受体表达;与孕酮协同抑制癌细胞增殖
Zhang等[14]艾塞那肽体外实验-AMPK、ROS、LDH上调AMPK、ROS、LDH减弱高血糖诱导的化疗耐药性;增强凋亡、调控细胞周期效果和细胞毒性
李武等[15]①艾塞那肽
②敲低GLP-
1R基因
体外实验上调--①艾塞那肽促进EC细胞增殖;②敲低GLP-1R基因可抑制EC细胞活力
Li等[16]过表达GLP-
1R
动物实验+
体外实验
下调cAMP/PKA上调cAMP、PKA抑制EC细胞的增殖,促进其凋亡;动物实验中肿瘤体积和质量减小
Li等[17]①敲除GLP-
1R基因
②艾塞那肽
体外实验上调ROS、SLC7A11、FTH1、GPX4下调ROS、SLC7A11、FTH1,上调GPX4(应用艾塞那肽则效果相反)①下调GLP-1R使EC细胞活力、迁移和侵袭能力显著降低,诱导细胞周期阻滞、细胞凋亡和铁死亡;②艾塞那肽上调GLP-1R表达

注:AMPK 腺苷酸活化蛋白激酶,mTOR 哺乳动物雷帕霉素靶蛋白,p-AMPK 磷酸化腺苷酸活化蛋白激酶,caspase-3 胱天蛋白酶-3,LC3 微管相关蛋白1轻链3,PR 孕激素受体,p-P70S6K 磷酸化p70核糖体蛋白S6激酶,ROS 活性氧,LDH 乳酸脱氢酶,cAMP 环磷酸腺苷,PKA 蛋白激酶A,SLC7A11 溶质转运第7家族的第11个成员,FTH1 铁蛋白重链1,GPX4 谷胱甘肽过氧化物酶4;- 文献中未提及

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2.1 诱导细胞凋亡

细胞凋亡是一种程序性细胞死亡方式,在维持组织稳态、清除异常细胞以及预防肿瘤发生中发挥着关键作用[18]。近年研究表明,GLP-1RA可能通过诱导细胞凋亡途径抑制EC细胞增殖,其分子机制主要涉及腺苷酸活化蛋白激酶(AMP-activated protein kinase,AMPK)/哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin,mTOR)和环磷酸腺苷(cyclic adenosine monophosphate,cAMP)/蛋白激酶A(protein kinase A,PKA)信号通路的调控。Zhang等[11]研究表明,艾塞那肽可通过上调EC细胞中磷酸化AMPK(phospho-AMPK,p-AMPK)蛋白和下调磷酸化mTOR的表达,进而增强胱天蛋白酶-3(caspase-3)的活性,提示其通过AMPK信号通路调控EC细胞凋亡过程。Kanda等[12]进一步证实,利拉鲁肽能以剂量依赖的方式促进EC细胞早期凋亡,其作用机制同样涉及AMPK通路的激活,且当利拉鲁肽与AMPK激活剂AICAR(5-Aminoimidazole-4-carboxamide1-β-D-ribofuranoside)联合使用时可产生协同效应。此外,GLP-1RA不仅能直接诱导EC细胞凋亡,还能增强顺铂的促凋亡作用。Zhang等[14]的研究表明,高血糖环境可抑制顺铂诱导的EC细胞凋亡,而艾塞那肽可有效逆转这种抑制作用。

此外,GLP-1RA对EC细胞凋亡的促进作用还与GLP-1R的表达密切相关,GLP-1RA功能的发挥需要与GLP-1R结合。但GLP-1R在EC细胞凋亡中的作用目前尚存在争议。Li等[16]的研究从GLP-1R表达水平的角度探讨了EC细胞凋亡的机制,发现与正常子宫内膜细胞相比,EC细胞中GLP-1R的表达水平显著降低,而高表达的GLP-1R可能通过激活cAMP/PKA信号通路上调cAMP和p-PKA的表达,从而促进EC细胞凋亡,并抑制其增殖、迁移和侵袭。这表明EC细胞可能通过主动下调GLP-1R来抑制细胞凋亡。然而,其另外两项研究得出了相反的结论,研究通过对EC组织和正常子宫内膜组织的GLP-1R表达水平进行比较,发现EC组织中GLP-1R的mRNA和蛋白表达水平均显著升高,提示EC细胞可能通过上调GLP-1R表达来抑制细胞凋亡而发挥促癌作用[15,17]。这种差异可能源于研究样本来源、检测方法或EC分子亚型的不同,需要进一步扩大样本量进行验证。

总之,诱导细胞凋亡是GLP-1RA抗EC治疗的重要机制之一。当前研究普遍认为多种GLP-1RA均可通过调节AMPK/mTOR和cAMP/PKA信号通路促进EC细胞凋亡,抑制肿瘤生长和转移。然而,关于GLP-1R在EC中的表达水平及其对EC细胞凋亡的调控作用存在争议,未来需要开展大规模临床研究,深入探讨GLP-1RA在不同EC亚型中的凋亡诱导机制,为其临床应用提供更充分的依据。

2.2 诱导细胞自噬

细胞自噬是一种高度保守的细胞内降解系统,细胞内受损的细胞器和错误折叠的蛋白质等组分在溶酶体酶的作用下被降解并重新利用。自噬及其相关过程在癌症的发生发展中有重要作用,这为基于调控自噬的抗癌治疗策略提供了理论依据[19]。自噬在正常子宫内膜生理过程中发挥着关键调控作用,而且在诸如子宫内膜增生和EC等病理状态下,细胞自噬对子宫内膜的影响同样显著[20],此外,一些化疗药物能够通过诱导过度自噬来促进癌细胞死亡[21],提示细胞自噬可能成为治疗EC的有效机制。

已有研究证实GLP-1RA在多种组织细胞中能够诱导自噬过程:利拉鲁肽可以通过激活磷脂酰肌醇3激酶(phosphoinositide 3-kinase,PI3K)/蛋白激酶B(protein kinase B,Akt)/mTOR通路,在抑制肝癌细胞增殖的同时诱导自噬和衰老[22];京尼平苷(Geniposide)通过激活GLP-1R/AMPK/mTOR信号通路促进骨关节炎软骨细胞自噬[23]。这些发现为GLP-1RA调控EC细胞自噬提供了理论基础。已知微管相关蛋白1轻链3(microtubule-associated protein 1 light chain 3,LC3)和p62的蛋白水平分别与自噬呈正相关和负相关,Kanda等[12]研究发现,采用利拉鲁肽处理EC细胞后,其以剂量依赖的方式上调GLP-1R、AMPK、p-AMPK和LC3蛋白的表达,同时下调了p62蛋白表达;为进一步证明AMPK通路的作用,联合使用AMPK激活剂AICAR和利拉鲁肽处理EC细胞,观察到两者对EC细胞自噬的协同作用。这些结果表明,利拉鲁肽可能以剂量依赖的方式显著促进LC3表达,降低p62表达,并通过AMPK信号通路刺激EC细胞自噬。

然而,目前关于GLP-1RA调控EC细胞自噬的研究仍存在诸多局限,现有研究主要限于体外细胞实验,GLP-1RA在体内的作用尚不明确,且对利拉鲁肽以外的GLP-1RA研究也亟待进行。尽管如此,GLP-1RA靶向EC细胞的自噬仍然是EC治疗具有潜在应用价值的一种新策略。

2.3 抑制细胞铁死亡

铁死亡是一种铁依赖性、磷脂过氧化作用驱动的调节性细胞死亡形式,受多种细胞代谢途径调控,如氧化还原稳态、铁代谢、线粒体活性以及氨基酸、脂质和糖的代谢等,并与多种疾病相关的信号通路有关[24]。作为一种天然的抗肿瘤机制,铁死亡通过与肿瘤抑制基因的相互作用发挥抗肿瘤作用,并能增强免疫治疗应答,逆转肿瘤耐药性[25]。这些特性使铁死亡调控成为癌症治疗的新兴策略。

近期EC研究发现,铁死亡诱导剂可通过促进细胞铁死亡和提高细胞对药物的敏感性来抑制EC的发展。例如,新型铁死亡诱导剂胡桃醌(Juglone)可通过诱导EC细胞铁死亡,有效抑制肿瘤细胞的迁移和侵袭[26]。Ras选择性致死小分子3(Ras-selective lethalsmall molecule 3,RSL3)等铁死亡诱导剂可改善EC细胞对醋酸甲羟孕酮(medroxyprogesterone acetate,MPA)的耐药性,增强疗效[27]。这些发现为基于铁死亡调控的EC治疗提供了重要依据,并且已有研究表明GLP-1R能够调节细胞铁死亡的过程,从而影响EC的发展。Li等[17]研究发现GLP-1R在EC组织中表现出自发性上调,可能是潜在的致癌靶点。当EC细胞中的GLP-1R表达被抑制时,细胞活力、迁移和侵袭能力显著降低,同时伴随铁死亡过程的激活。该研究还发现经艾塞那肽处理后,可上调GLP-1R表达,导致EC细胞中活性氧(reactive oxygen species,ROS)上调,谷胱甘肽过氧化物酶4(glutathione peroxidase 4,GPX4)下调,这些变化与抑制细胞铁死亡密切相关。鉴于GLP-1RA可通过AMPK信号通路调控EC细胞的多种生物学行为[11-14],且艾塞那肽抑制肾小管细胞铁死亡的作用也依赖于AMPK信号通路的激活[28],推测GLP-1RA可能通过激活AMPK信号通路来抑制EC细胞的铁死亡,而过表达GLP-1R或使用GLP-1RA可能会抑制铁死亡,从而加速癌症进展。

GLP-1RA对EC的作用是多种机制综合作用的结果,尚未有研究明确解释GLP-1R与EC细胞铁死亡之间的关联机制,需要通过进一步的探索来完善。因此,如果想要将GLP-1RA投入EC治疗,需要多方面考虑其对细胞铁死亡过程的影响。

2.4 调控细胞周期

细胞周期变化是影响肿瘤进展的关键因素,细胞周期阻滞可延长细胞周期持续时间,进而影响肿瘤细胞的增殖能力[29]。近期研究显示,GLP-1R及GLP-1RA在阻滞EC细胞周期中发挥着重要作用。GLP-1R能够调控EC细胞周期,进而影响其生长、增殖。GLP-1R的表达下调能够诱导EC细胞G0/G1期阻滞,而其激活则减少这种阻滞[17]。下调EC细胞GLP-1R的表达可以使G1期、G0期细胞数量显著增加,S期细胞数量显著减少。此外,在EC细胞中可检测到GLP-1R自发性表达上调,提示GLP-1R可能在EC细胞中起到维持恶性表型的持续增殖和自我更新的作用[17]。在经利拉鲁肽处理的EC细胞中,S期阻滞的细胞比例显著增加[12],这与利拉鲁肽在乳腺癌细胞诱导G0/G1期阻滞的效果不完全相同[30],表明GLP-1RA在不同癌症类型中对细胞周期的影响可能存在差异。艾塞那肽能增强顺铂在高血糖EC组织中的S期细胞阻滞效果,从而克服高血糖诱导的EC细胞对顺铂的耐药性[14]。这些研究揭示了GLP-1R与EC细胞周期的调控密切相关,GLP-1RA有望成为治疗EC的新型药物或化疗辅助剂。

2.5 GLP-1RA潜在作用机制和靶点

在EC以外的癌症研究中,学者们发现了GLP-1RA干预肿瘤进展的其他机制,利拉鲁肽能通过降低小鼠肺癌和肝癌模型中的中性粒细胞固有免疫杀伤能力提高程序性死亡受体配体1(programmed death-ligand 1,PD-L1)抑制剂的抗肿瘤效果[31]。利拉鲁肽还可以作用于结直肠癌细胞,通过抑制PI3K/Akt/mTOR信号通路阻滞细胞周期,抑制细胞增殖、迁移、侵袭,促进细胞凋亡[32]。这些作用途径和靶点可能也适用于EC治疗,但还需通过实验验证以更全面地解释GLP-1RA干预EC进展的内在机制。

3 GLP-1RA在EC化疗耐药中的研究进展

化疗是目前治疗早期高危、晚期和复发性EC的重要手段。铂类药物作为EC化疗的一线选择,其耐药性仍是临床治疗中亟待解决的难题,常导致肿瘤复发和转移。因此,深入研究EC耐药的分子机制,探寻新的治疗靶点以提高化疗效果,对降低EC的复发率和死亡率至关重要[33]

近年多项研究表明,EC的患病风险和预后与糖尿病有密切关系,同时高血糖还是化疗耐药的影响因素之一,高血糖可以诱导多种癌症的化疗耐药性,包括EC[14]、乳腺癌[34]、胰腺癌[35]、结直肠癌[36]和慢性髓系白血病[37]等。这些发现提示,高血糖可能通过某种共同机制介导了多种癌症的化疗耐药性。Zhang等[14]的研究发现,在正常血糖条件下,顺铂能够更显著地下调抗凋亡蛋白B细胞淋巴瘤-2(B-cell lymphoma-2,Bcl-2)和Bcl-XL的表达,同时上调促凋亡蛋白Bcl-2相关X蛋白(Bcl-2 associated X protein,Bax)、细胞色素C以及裂解的多腺苷二磷酸核糖聚合酶[poly(ADP-ribose) polymerase,PARP],从而发挥其抗肿瘤作用,显著诱导S期细胞凋亡、细胞周期阻滞以及细胞活力降低。然而,顺铂的抗癌效果会被高血糖环境显著削弱。该研究进一步发现,高血糖引起的顺铂耐药性可以被艾塞那肽抑制,从而提高顺铂的抗癌功效。应用艾塞那肽增加了EC细胞中p-AMPK/AMPK比值和乙酰化p53的水平,可能通过激活AMPK信号通路逆转高血糖诱导的EC化疗耐药,GLP-1RA有望成为EC化疗的辅助治疗药物。

4 结语与展望

随着GLP-1RA在糖尿病治疗中的应用,其多种潜在的治疗效果引起了广泛关注。EC的发展与血糖水平密切相关,现已有研究初步证明GLP-1RA能够通过多种机制直接调控EC生理活动,包括影响EC细胞凋亡、自噬、铁死亡,以及阻滞细胞周期,从而干预EC的进展,并显示出克服化疗耐药的潜力。

GLP-1RA的作用靶点包括AMPK/mTOR、cAMP/PKA等信号通路,其中AMPK信号通路在调控EC方面的作用最为显著。GLP-1RA通过激活AMPK信号通路,抑制癌细胞生长和增殖,促进细胞凋亡和自噬,并减轻高血糖诱导的化疗耐药。基于此,从联合用药的角度出发,GLP-1RA与AMPK激动剂AICAR的联合使用有望更有效地抑制EC进展,为提高疗效提供新的思路。

然而,当前研究仍存在局限性。首先,尽管GLP-1RA的种类不断增加,但目前其临床应用主要集中在糖尿病的治疗。在针对EC的基础研究中,常用的药物多为艾塞那肽和利拉鲁肽,缺乏对其他GLP-1RA的系统性研究。其次,目前的研究多集中于体外细胞实验,缺乏体内实验数据的支持,其具体的作用信号通路、关键作用分子和调控机制仍需进一步阐明。

总之,GLP-1RA在EC研究中已取得阶段性进展,现有研究结果普遍支持其对EC的潜在治疗作用。然而,GLP-1RA能否实际应用于EC治疗及其作用机制,仍有待进一步研究证实。未来研究需充分阐明GLP-1RA在EC中的作用及其内在调控机制,为其临床应用提供更坚实的理论和实验基础。

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There is a strong association between hyperglycemia, oxidative stress, inflammation and the onset and progression of diabetes which causes a higher risk of cancer. This study investigated, the effect of concomitant use of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) with iron supplements in hyper-glucose conditions on the K-562 cell line.The effects of iron, ω-3 PUFAs, and a combination of both on K-562 cells were investigated under normal and high glucose conditions. The impact of these treatments was evaluated using multiple methodologies, including the MTT assay for cell viability, quantification of oxidative stress markers [total antioxidant capacity (TAC) and malondialdehyde (MDA)], and analysis of the cell cycle. Furthermore, the expression levels of TNFα and p53 mRNA were measured using Real-time PCR.The co-treatment of ω-3 PUFAs and iron in the presence of high glucose had notable effects, as evidenced by an increase in cell survival, resistance to imatinib chemotherapy, TNFαmRNA expression levels, MDA levels, and percentage of cells in the G2/S phase. Additionally, there was a decrease in the mRNA expression of p53 and TAC levels compared to treatment in the normal-glucose condition.Hyperglycemic conditions in conjunction with the combined treatment of theω-3 PUFAs and iron, led to reduced anticancer capacity, chemosensitivity, anti-inflammatory and antioxidant properties of the K-562 cells. These effects were found to be mediated by oxidative stress.© 2023. The Author(s), under exclusive licence to Springer Nature B.V.

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