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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5247_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Preface
- •Contents
- •1.1 Introduction
- •1.5 Prostate Cancer
- •References
- •2.3.1 Smoking
- •2.3.2 Height
- •2.3.3 Physical Activity
- •2.1 Introduction
- •2.2.1 Incidence
- •2.2.2 Survival
- •2.2.3 Mortality
- •2.3.4 Coffee
- •References
- •3.1 Introduction
- •References
- •4.1 Introduction
- •4.2 Autophagy Flux
- •4.4 Apoptosis Mechanism
- •4.4.1 Intrinsic Pathway
- •4.4.2 Extrinsic Pathway
- •4.4.3 Perforin/Granzyme Pathway
- •4.6 Ferroptosis Machinery
- •References
- •5.1 Introduction
- •References
- •6.1 Introduction
- •6.8 Conclusion
- •References
- •7.1 Introduction
- •7.2.2 EZH2 Action Modes
- •References
- •8.1 Introduction
- •References
- •9.1 Introduction
- •9.4.1 Oncogenic lncRNAs
- •9.4.2 Tumor-Suppressive lncRNAs
- •References
- •10.1 Introduction
- •10.4 Prostate Cancer TME
- •10.7 Conclusion
- •References
- •11.1 Introduction
- •11.3 Chemoresistant Mediated by AR Axis
- •11.10 Conclusion
- •References
- •12.1 Introduction
- •12.2 Curcumin
- •12.3 Epigallocatechin Gallate (EGCG)
- •12.4 Emodin
- •12.5 Thymoquinone (TQ)
- •12.6 Genistein
- •12.7 Parthenolide
- •12.8 Conclusion
- •References
- •13.1 Introduction
- •13.7 Conclusion
- •References
- •14.1 Introduction
- •14.3.1 Polymer-Based Nanoparticles
- •14.3.2 Liposomes
- •14.3.3 Gold Nanoparticles
- •14.3.4 Quantum Dots (QDs)
- •14.3.5 Magnetic Nanoparticles (MNPs)
- •14.3.6 Mesoporous Silica Nanoparticles (MSNs)
- •14.3.7 Dendritic Polymers
- •14.4 Micelles
- •14.6 Conclusion
- •References

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target cell tropism, restricted capacity for packaging nucleic acids, and difculties
in the production process [36, 37]. Novel gene therapy vectors that are not dependent on viral mechanisms have been created with the aim of addressing or surpassing these constraints. Non-viral vectors refer to articially created carriers that are
specically intended for the transportation of nucleic acids and genes. In a broad
sense, these vectors possess the capacity to transport bigger genetic payloads and
encounter less signicant obstacles in terms of production compared to viral vectors. Furthermore, it should be noted that they exhibit decreased immunogenicity,
resulting in a considerable reduction in the likelihood of adverse effects [36].
Despite the persistent challenges afliated with the effective delivery of payloads to
specic target cells, the use of non-viral vectors in cancer therapy has been a subject
of considerable investigation. Preliminary investigations using these gene therapy
methods in the treatment of PCa have provided fundamental insights that have laid
the groundwork for further advancements in this area of research.
In a study conducted in 2007, it was shown that the introduction of a degradable
polymer (poly (butane diol diacrylate co amino pentanol) (C32)) combined with a
diphtheria toxin suicide gene controlled by prostate-specic antigen expression
directly into the prostates of mice with tumors led to a decrease in size by 33% or
complete elimination by 13% of the injected prostatic lobes. This outcome was
compared to the results of injecting naked diphtheria toxin gene DNA, which
resulted in a reduction of 17% and no complete elimination in a TRAMP mouse
model [38]. It is worth mentioning that the introduction of naked DNA through
injection did not lead to apoptosis. In contrast, when the vector was combined with
the diphtheria toxin suicide gene and injected at the initial site, tumor death was
observed in 80% of cells. On the other hand, the administration of naked diphtheria
toxin gene DNA resulted in less than 5% apoptotic cell death [38]. It is substantial
to note that this vector is currently not utilized.
Lipid-based non-viral vectors have been widely recognized and utilized as a
viable approach for facilitating gene transfer. In a research conducted in 1987, lipoplexes, which are lipid complexes used for the encapsulation of DNA, were recognized as promising non-viral vectors for transferring genes [39]. Previous
investigations have revealed the effectiveness of lipid-based cationic particles in
delivering DNA to human PCa cell lines and a nasopharyngeal cancer cell line [40].
Additionally, in vitro experiments using folate-linked lipid-based nanoparticles
have shown a signicant increase in transfection efciency (~100-fold) compared to
the commercially available vector Tfx20 in luciferase gene transfer assays. The
study established the efcacy of using a folate-linked nanoparticle for the delivery
of herpes simplex virus thymidine kinase (HSV-TK) by direct tumor injections, followed by the administration of ganciclovir (GCV). This treatment approach caused
a signicant decrease (>50%) in tumor volume, indicating the successful suppression of prostate cancer xenograft development [41]. In an alternative methodology,
the implementation of systemic therapy with a cationic liposome-p53 gene complex
targeted by human transferrin, in conjunction with radiation, resulted in the total
regression of PCa xenograft tumors. Notably, no indications of tumor reversion
were seen during the six-month treatment period, with statistical signicance proven

13 Gene Therapy asaNew Emerging Strategy forProstate Cancer
263
(P < 0.001) [42]. Various lipid formulations and targeting strategies have been
explored in the laboratory for the delivery of macromolecules, such as DNA, to
cancer cells using liposomes. These strategies include the use of pH-sensitive polymers like N-isopropylacrylamide copolymers and succinylated PEG, as well as
fusogenic peptides and proteins like GALA peptide [41, 43, 44]. Nevertheless, there
is a lack of clinical investigation about the usage of these techniques in PCa. In
contrast, the utilization of a plasmid DNA expression vector harboring IL2 complexed with a cationic lipid vector known as leuvectin has been observed to facilitate invivo transfection in phase I/II clinical trials conducted on patients with renal
cell carcinoma. However, the clinical response to this approach has been varied,
suggesting that its efcacy in treating kidney cancer or its translation to patients
with prostate cancer is improbable [45]. Lipid-based non-viral vectors are now
undergoing active development and continuous improvement in the realm of smallmolecule medication delivery for cancer-related purposes. The ongoing progress in
this eld of study is likely to generate heightened attention toward the application of
these delivery methods based on the idea of gene therapy applications for PCa.
Peptide-based vectors used for the delivery of gene consequences contain polyarginine, a cationic cell-penetrating peptide that has revealed effective transportation
of plasmid DNA to PCa cell lines [46]. The transfection efcacy of the nal plasmid
DNA complex was enhanced fourfold with the incorporation of poly- arginine, as
compared to the control samples. Moreover, the synergistic use of aspartic acid and
poly-arginine shows promising prospects for selective afnity toward hydroxyapatite, the predominant constituent of rigid connective tissue. This combination has
promise as a viable bone-targeting vector [46]. Given the potential therapeutic benet of delivering prostate transmembrane protein androgen induced 1 (PMEPA1),
which has been linked to reduced tumor invasion and bone metastasis, making use
of this vector in the context of metastasis is worth considering [46]. While the potential of poly-arginine is encouraging, it is considerable to note that alternative peptide-based vectors have not shown any discernible benets in prostate cancer models,
as far as our current understanding is concerned.
TA-MCs are truncated versions of plasmids that do not include prokaryotic elements and, if preferred, do not include antibiotic-resistance genes, resulting in the
retention of only eukaryotic machinery [47]. In the year 2019, it was shown that a
transcription activator-mediator complex has the capability to induce the expression
of a reporter gene that is not naturally occurring inside an organism. This reporter
gene has the potential to serve as a biomarker when detected in plasma samples
[48]. The transfection effectiveness of TA-MCs is enhanced in comparison to plasmids, mostly due to decreased transcriptional silencing and their smaller size [49,
50]. Subsequent investigations employed the promoter region of survivin, a protein
that exhibits heightened expression in various types of cancer (such as lung, prostate, and breast). This protein demonstrates low expression in normal prostate tissue
but expands with the grade of PCa tumors. To induce the expression of embryonic
alkaline phosphatase, a synthetically modied variant of human placental phosphatase, the aforementioned promoter region was utilized. The successful transfection
of TA-MCs into various PCa cell lines resulted in the induction of detectable

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alkaline phosphatase expression in the blood of mouse models with subcutaneous
PCa tumors. This expression was discovered to be correlated positively with survivin expression, recommending that alkaline phosphatase could serve as a potential marker for assessing the aggressiveness of PCa [48]. Despite being in its rst
phases of research, this technique has the potential to provide innovative approaches
for estimating disease aggressiveness and may nd use in screening for prostate
cancer or other conditions characterized by high survivin expression. In conclusion,
the administration of oligonucleotide antisense compounds by systemic injection
represents a promising strategy for the control of gene products. Specically, investigation attempts have been directed at suppressing the expression of STAT3, which
has revealed potential in altering immunosuppressive myeloid cells in the context of
PCa [51, 52].
13.5 CRISPR–Cas9 andCAR T inPCa Gene Therapy
The use of CRISPR and the CRISPR–Cas9 technology has signicantly transformed the eld of biological research [53]. In summary, this method allows accurate modications of certain DNA sequences at any location inside the target DNA
by inducing double-strand breaks [53]. The binding of a guide RNA to Cas9 facilitates its targeting to a complementary target sequence, resulting in the formation of
a double-strand break [54]. Therefore, this technique facilitates genetic alteration by
introducing single-stranded or double-stranded nucleotides into specic sites. The
eld of prostate cancer disease biology, along with other types of malignancies, has
seen a signicant transformation due to the advent of CRISPR–Cas9 technology.
This breakthrough has paved the way for the emergence of a revolutionary therapeutic approach known as CAR T cell therapy.
The usage of CRISPR–Cas9 technology enables the expeditious and effective
execution of many scientic procedures. The generation of activating and detrimental mutations in less time when compared to transgenic mice enables the production
of novel genetic models for cancer. In previous studies, the targeted removal of
phospholipase receptor A2 receptor 1 [55], the androgen receptor [56], and metabolically signicant kinases [57] has been successfully achieved by the use of
CRISPR–Cas9 technology in both PCa cell lines and xenograft models. The use of
CRISPR–Cas9 technology allows for the generation of mouse models via the process of deletions, as shown by the production of a PTEN-knockout mouse [58].
Furthermore, the use of CRISPR technology has enabled the targeted removal of
single-nucleotide polymorphisms linked to the risk of prostate cancer. This has provided valuable knowledge on the possible functional impacts of mutations in these
specic risk alleles [59, 60]. The induction of phenotypes may be achieved by the
use of a modied Cas9 protein in conjunction with a transcription-activating
domain. This approach has been shown in research where the expression of RNA
target genes, including DKK3, was raised in cell lines associated with prostate cancer [61]. In recent studies, researchers have successfully integrated CRISPR–Cas9

13 Gene Therapy asaNew Emerging Strategy forProstate Cancer
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with other delivery mechanisms, including liposomes paired with an RNA aptamer
targeting PSMA.This innovative approach enables the targeted delivery of precise
genome-editing tools specically to cancerous PCa cells in laboratory settings (in
vitro) [62]. This work effectively demonstrated the specic targeting of PSMAexpressing PCa cell lines and xenograft models by the method. Furthermore, the
editing of PLK1 mRNA levels resulted in disrupted proliferation of both cell lines
and tumors.
The use of CRISPR–Cas9 may also facilitate the conduction of high-throughput
screenings targeting biological components that play a crucial role in the proliferation of cancer cells [63]. From a methodological perspective, the construction of a
gene library consisting of single-guide sequences facilitates the targeted suppression of a substantial number of genes within a single experimental setup. The gene
library was subjected to incubation together with the required equipment, leading to
the integration of the single-guide sequences into the cells and the targeted suppression of a signicant percentage of them. After a phase of expansion, the procedure
of DNA sequencing is carried out for the purpose of ascertaining the proportional
occurrence of sequences that match those present in the sequence library. In contrast
to the baseline controls, a reduction in the abundance of a certain gene sequence
signies genes that have undergone negative selection and are hence crucial for the
survival of cells [63]. Numerous research endeavors using this technological
approach have explored a wide range of gene-associated results, including medication resistance [64], cancer metastasis [65], and immune response [66]. A comprehensive screening of the LNCaP cell line has been conducted in the context of
prostate cancer, using a single-guide RNA library that specically targets over
19,000 genes. The ndings from this study, in conjunction with further mechanistic
investigations, have shown that a cluster of genes encoding RNA-binding proteins,
including those involved in alternative splicing and the regulation of the androgen
receptor, plays a crucial role in the proliferation of LNCaP PCa cells [67]. In addition, a recent study using a CRISPR screen identied novel pathways of resistance
to inhibition of PARP, which may have implications for the therapy of metastatic
PCa [68].
CAR T cells are a kind of genetically modied receptors that have the ability to
attach to particular antigens and also activate T cells [69]. Over the course of many
generations, CAR T cells have undergone engineering that incorporates double or
multiple costimulatory signals. These modications have been aimed at enhancing
the immune response by promoting the activation of cytotoxic T cells [69]. CAR T
cells are created by the manipulation of T cells obtained from patients, wherein a
virus, often lentiviral in nature, is used as a means of introducing the desired genetic
information. Signicantly, CAR T cell technology exhibits independence from the
major histocompatibility complex, hence allowing CAR T cells to recognize antigens in individuals with any human leukocyte antigen (HLA) lineage or in tumors
where the major histocompatibility complex has been downregulated [69]. The efcacy of CAR T cell technology has been proven for the management of hematological malignancies [70], but its effectiveness in solid tumors has yet to be established.
Several potential antigen targets for CAR T cell therapy in PCa have been

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discovered, including PSA, PAP, PSMA, and PSCA [71]. The research conducted in
2014 examined the effectiveness of several generations of anti-PSMA CAR T cells
in an invivo model that expressed PSMA [72]. One of the generations used CD28
as a costimulatory molecule, and it exhibited signicant activity. A further investigation has shown that the manipulation of PD1, together with CD28 co-stimulation,
successfully eradicates cancerous cells in animal models exhibiting various malignancies, such as prostate cancer [73]. In addition, a further investigation utilizing
PCa cell lines and mouse models of PCa demonstrated that the inclusion of an
intracellular 4-1BB costimulatory domain resulted in enhanced specicity toward
PSCA+ tumor cells when compared to CAR T cells including a CD28 costimulatory domain [74]. Recent research conducted on patient-derived mCRPC cells has
provided evidence suggesting that chimeric antigen receptor (CAR) T cells directed
against PSMA might potentially exhibit efcacy when used in conjunction with the
dominant-negative transforming growth factor beta (TGF-β) type II receptor. The
aforementioned combination elicited a response in CD8+ T cells, causing them to
exhibit reactivity toward PSMA and insensitivity toward TGF-β, which is a recognized consequence of resistance to CAR T cell treatment. To ensure safety, the T
cell construct was engineered to be regulated by HSV-1-TK, enabling the elimination of cells with the administration of GCV.The invitro use of GCV injection led
to the successful eradication of castration-resistant cell lines [75].
Therefore, CAR T cells have potential in the management of metastatic PCa and,
perhaps, non-metastatic PCa. Nevertheless, the presence of an immunosuppressive
tumor microenvironment and the difculty associated with directing cells to bone
metastases are obstacles that still need to be addressed [76]. Patients with hematological malignancies who have undergone CAR T cell treatment have had adverse
effects, including cytokine release syndrome and neurotoxicity [77]. Additionally,
studies conducted on solid malignancies have shown modest response rates so far.
The safety, practicality, and effectiveness of this intriguing technique will be determined via ongoing experiments.
13.6 Perspective ofGene Therapy inPCa
While gene therapy has demonstrated promise as an emerging modality for addressing PCa, the limited number of therapies available in clinical settings may be attributed to the underwhelming outcomes seen in early clinical studies with vector-based
systems. The absence of achievement may be attributed to several factors. In investigations pertaining to direct injection therapies, it has been regularly shown that
both replication-incompetent and replication-competent vectors have not been successful in achieving comprehensive eradication of tumors. Despite the promising
substantiation of tumor cell death and immune response, the overarching objective
of preventing cancer has yet to be achieved. Similar to previous endeavors in focal
therapy utilizing ablation devices, which have persistently demonstrated a high
recurrence rate beyond the targeted treatment area [78], direct injection therapy is

13 Gene Therapy asaNew Emerging Strategy forProstate Cancer
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additionally hindered by the prevalent heterogeneity observed inlocalized prostate
cancer [79]. This heterogeneity poses a challenge to direct oncolytic injection treatments, as they are vulnerable to potential inadequacy beyond the intended treatment
zone, particularly when the objective is the complete eradication of cancer.
The emergence of the CRISPR–Cas9 system, CAR T cell treatment, and advancements in laboratory research have stimulated a renewed enthusiasm for the function
of gene therapy in the management of PCa. The promise of gene editing in the
context of PCa treatment seems to be vast, and the enthusiasm around the clinical
implementation of these strategies is well-founded. Nevertheless, despite the
increasing impetus, the development of new or enhanced treatments will encounter
similar challenges as those encountered in the past when attempting to translate
promising oncolytic and vaccine-based ndings into outcomes that are clinically
signicant. The efcacy of presently promising medicines in signicantly ameliorating the trajectory of disease development in males diagnosed with prostate cancer
has to be determined and will be revealed over time [13].
13.7 Conclusion
Prostate cancer possesses favorable characteristics for the application of gene therapy as a treatment modality. These include its physiological availability for biopsy
and treatment, the relatively protracted disease progression observed in men with
both localized and metastatic forms of the disease, and the extensive prior research
conducted on therapies using both immune-incompetent and immune-competent
models. Nevertheless, regardless of the promising outcomes shown in preclinical
studies including immune material administration by direct injection and vaccinebased approaches, gene therapy has not yet been included in the therapy protocol for
individuals diagnosed with PCa. Future research endeavors exploring the potential
of gene therapy-based approaches, in conjunction with other therapeutic modalities,
as well as innovative strategies for gene delivery and immune activation, hold promise in enhancing the longevity and overall well-being of those aficted with
PCa [13].
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