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Chapter 781 Another Way

AQP4 protein is a very interesting protein.

Although it is abundantly expressed in the human nervous system, the study of the mechanism of action of this protein has revealed a somewhat surprising situation—it seems to have more negative effects than positive effects on the human body.

During hydrocephalus, the AQP4 protein causes excessive edema of interstitial cells and nerve cells.The cytotoxicity produced after edema is the main reason for the sequelae of cerebral edema.

In brain tumors, AQP4 also plays a "less glamorous" role.In brain tumors, the expression of AQP4 protein far exceeds that of normal cells.A large amount of water enters the tumor and the area near the tumor, resulting in peritumoral edema.At the same time, the AQP4 protein also promotes the migration of astrocytes, which in fact promotes the invasion of surrounding brain tissue by glioblastomas.

The paper discovered by Yuan Pingan puts forward a more exciting conclusion - AQP4 protein is very important for maintaining the survival of glioma stem cells.

In the experiment, the glioma stem cells whose AQP4 protein was knocked down became worse and even died in large numbers.At the same time, their ability to self-renew is weakened and their ability to proliferate is also reduced.More importantly, the migration ability of glioma stem cells whose expression of AQP4 protein was knocked down was also greatly inhibited.

It is clear that the author of the article himself is aware of this.He emphasized at the end of the article that AQP4 is likely to be a very valuable therapeutic target for glioma, and may even provide a new direction for the treatment of glioma.But the author is obviously not good at fantasizing. He didn't expect that there are still individuals with insufficient expression of AQP4 protein in the world.

After reading a series of papers quickly, Sun Li'en felt a lot more at ease.Moreover, he soon realized a key point - the immune system in Tang Min's body was probably not very active. Insufficient expression of AQP4 protein is the main reason for the slow growth of tumors and even their disappearance.

A genetic disease that may have killed Tang Min protected Tang Min from the attack of brain cell glioma.This seems to be a vivid example of God's will in the dark.

After the AQP4 protein was knocked down, the glioma was weakened by several grades.The example of Tang Min shows that this kind of tumor can't even grow as fast as under normal circumstances. In fact, most patients with glioma have no symptoms in the early stage, and glioblastoma expands rapidly, and causes epilepsy and other symptoms. Many other symptoms within.Once diagnosed, they survive a median of just three months without treatment.Even with treatment, the median survival is less than two years.The five-year survival rate is as low as single digits.

However, Tang Min's gliomas did not show signs of rapid growth—they did not even grow into "tumors".After only a small area of ​​low signal, the glioma collapsed on its own due to the insufficient expression of AQP4 protein.What's even better is that the transfer of nervous system gliomas to other systems is itself an extremely rare situation-of course, this may be partly due to statistical errors due to the high lethality of nervous system gliomas-and AQP4 Insufficient protein expression actually limits the differentiation ability of glioma stem cells.This weakens the possibility of transsystemic metastasis of glioma on the basis of being extremely rare.

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The Oncology Department of the Fourth Hospital also saw such a case for the first time.But after reading the papers that Yuan Pingan found, they quickly gave their own suggestions.

"First of all, the existing lateral ventricle shunt in the patient must be pulled out." The first suggestion of the oncology department has little to do with the tumor itself. "Dr. Sun, you have no problem with the general direction of your treatment. We still need to try our best to prevent tumor metastasis." Speaking of this, Chen Haitao, the deputy director of the oncology department, couldn't help laughing, "This is the first time we have dealt with such brain cell glue." Gynecoma... just because it was found so early is worth a paper."

The gossip that Dr. Sun Li'en's real identity might be a "scattered essay boy" has been circulating inside the Fourth Hospital.And Chen Haitao felt that he might soon become another main force behind the spread of this gossip.

After calming down for a while, Director Chen continued, "Trans-organ metastasis of brain cell glioma is very rare. This is because it is not easy for nerve cell tumors to survive in other organs. Before the metastasis, it is the first to lead to the death of the patient. However, the probability of the cerebrospinal fluid spreading the nervous system tumor is relatively high." He pondered for a moment and said, "There is about 4~6%. However, since the brain cells have begun to suspect glial If there is a tumor, then it is better to stop the shunt as soon as possible. She is in a relatively stable condition now, and she should be able to remove the tube now, right?"

Sun Li'en nodded. The reason why Shanghai Yuanhai Hospital performed lateral ventricle drainage on Tang Min was because she had an unexplained increase in intracranial pressure and a cerebellar tonsillar hernia.Now that it is clear that her increased intracranial pressure is caused by insufficient expression of AQP4, the existence of this tube is of little significance.What's more, it may become a channel for cancer cells to transfer to the peritoneal cavity.

"I'll arrange a surgical operation first to remove this tube." Sun Lien made the arrangement, "What about other treatments? Do you need to start chemotherapy now?"

"I think...you can think about it again." Regarding the issue of chemotherapy, Director Chen was more conservative than Sun Lien. "Most of the other patients who need chemotherapy are to improve the quality of life or prolong the progression-free period. In essence, these treatments are not much different from palliative care. Specifically in this case... I suggest stimulating her first." immune system."

Stimulating the immune system is a less common cancer treatment option.After all, after most cancer patients are found to have cancer, the tumor often progresses to the point where the body cannot handle it by itself.For them, stimulating the immune system not only failed to solve the tumor, but also caused a severe immune response.

But Tang Min's situation is completely different from other cancer patients.Due to her birth defect, the tumor had difficulty growing in her brain.The fact that neural tumors are difficult to survive in other tissues also limits the metastasis of her tumors in other tissues.

Under the constraints of multiple conditions, oncology doctors naturally consider stimulating the immune system rather than intervening in the disease with chemotherapy drugs with broad cytotoxicity.

"If it's just to improve immunity...Thymopentin for injection is fine." Director Chen thought over and over again, and gave his opinion cautiously. "However, Dr. Sun, you have cooperated with the co-worker on this case, right?"

Sun Li'en nodded, this cooperation is not a secret in the Fourth Court.

"Then it will be easy." Director Chen continued, "The Hematology Department of Tongxie is currently engaged in the third phase clinical trial of NKT cell therapy, and Tang Min can be admitted into the group - this should be the safest treatment plan at present."

NKT cell therapy is a variant of CAR-T cell therapy.As one of the most advanced and seemingly successful "fourth cancer treatment options", NKT cell therapy can make full use of the body's own immune system to attack tumor cells.Moreover, compared with PD-1 and traditional CAR-T cell therapy, NKT cell therapy has fewer adverse reactions and has a more "broad-spectrum" anti-cancer effect-it can treat almost all types of cancer.

Currently, only the Ministry of Health, Labor and Welfare of Japan has granted clinical approval for NKT cell therapy.NKT therapy in other countries is still in the clinical trial stage.The first NKT cell therapy experiment started in China in 10. At present, hundreds of experiments have been carried out. Most of these experimental cases belong to patients with terminal stage and extremely high recurrence rate.Among them, 27 patients with extremely relapsed tumors received three years of NKT treatment, and 25 of them did not relapse. In 44 patients with liver and lung metastases, the effective rate was close to 70% after one year of NKT treatment for patients with a single lesion size less than one centimeter.

It can be said that the effect of NKT cell therapy is remarkable, and its comprehensive effective rate is much higher than conventional chemotherapy drugs and chemotherapy drug combinations.Since NKT cells cannot exist in the human body for a long time, its therapeutic stability is also better than that of CAR-T and PD-1, which "catalyze the human body's response" treatment.Except for the need for long-term infusion therapy, almost all aspects are better than or the same as existing immunotherapy methods.

However, Tang Min's condition is special. Compared with other end-stage patients included in the group, the time required for NKT treatment is bound to be shorter.

"This is a way." Sun Lien took out the phone from his pocket and said excitedly, "I'll contact Professor Zhu right now!"

　The papers mentioned in this article are from

　　The role of AQP4 in the development of glioblastoma, a master's thesis of Liu Tingting of Anhui University

　　This article was published in May 2016.

　　
　
(End of this chapter)