孫 曉 夏 蕾 何流漾 戚春建
(南京醫(yī)科大學(xué)附屬常州市第二人民醫(yī)院中心實(shí)驗(yàn)室腫瘤研究所,常州 213000)
中性粒細(xì)胞是存在于腫瘤微環(huán)境中的免疫細(xì)胞之一,腫瘤的發(fā)生與發(fā)展,與腫瘤微環(huán)境密切相關(guān)。近年來越來越多的研究表明,中性粒細(xì)胞具有抗腫瘤和促腫瘤的雙重作用,腫瘤微環(huán)境中的中性粒細(xì)胞可以分泌多種蛋白酶、活性氧及細(xì)胞因子,在腫瘤的發(fā)生發(fā)展、增殖、轉(zhuǎn)移和血管生成等幾個(gè)方面發(fā)揮著重要的作用。本文就近幾年來中性粒細(xì)胞在腫瘤免疫中的作用、相關(guān)機(jī)制和研究進(jìn)展進(jìn)行綜述。
中性粒細(xì)胞(Neutrophil)又被稱之為多形核細(xì)胞(Polymorphonuclear leukocytes,PMNs),是機(jī)體中最多的白細(xì)胞,約占外周血白細(xì)胞總數(shù)的50% ~ 70%。作為機(jī)體固有免疫系統(tǒng)的重要組成部分,中性粒細(xì)胞是保護(hù)機(jī)體免受微生物感染、消除病原體的主要免疫細(xì)胞[1],是機(jī)體免于感染或炎癥的首道防線[2]。中性粒細(xì)胞來源于骨髓中的造血干細(xì)胞,在骨髓中分化發(fā)育后進(jìn)入血液或組織。中性粒細(xì)胞的主要功能表現(xiàn)為非特異性細(xì)胞免疫[3]。CD11b/LY6G是小鼠成熟中性粒細(xì)胞的生物學(xué)標(biāo)記[4],當(dāng)機(jī)體發(fā)生感染時(shí),血液中的中性粒細(xì)胞在病原微生物的刺激下,局部釋放細(xì)胞因子和趨化因子,使其聚集在炎癥部位,發(fā)生脫顆粒,并釋放出多種水解酶類,同時(shí)快速上調(diào)CD11b、CD16和CD45等膜受體[5],起到抗感染的效應(yīng)。
越來越多的證據(jù)表明,在腫瘤發(fā)展的不同時(shí)期,中性粒細(xì)胞的表型和功能可以發(fā)生不同的極化(Polarization)。腫瘤發(fā)生的早期階段,在不同細(xì)胞因子的作用下,腫瘤內(nèi)中性粒細(xì)胞顯示出抗腫瘤表型(N1型),其通過分泌細(xì)胞因子(IL-1β、TNF-α、IL-6和IL-12等)和免疫活化作用(作用于受損細(xì)胞的活性氧來產(chǎn)生炎癥),非特異性的殺傷腫瘤細(xì)胞,從而抑制腫瘤的發(fā)生和發(fā)展[6,7]。如果在腫瘤早期使用抗LY6G的單克隆抗體清除腫瘤微環(huán)境中性粒細(xì)胞,可促進(jìn)腫瘤細(xì)胞生長,抗體介導(dǎo)腫瘤免疫治療的療效顯著降低[8];隨著腫瘤進(jìn)展,在腫瘤發(fā)生的中晚期階段,中性粒細(xì)胞聚集于腫瘤基質(zhì),在腫瘤微環(huán)境細(xì)胞產(chǎn)生的生長因子作用下,發(fā)生表型和功能的改變,表現(xiàn)為促進(jìn)腫瘤細(xì)胞增殖、遷移、侵襲和血管生成[9]。轉(zhuǎn)化生長因子β (Transforming growth factor-β,TGF-β) 通過上調(diào)精氨酸酶1(Arginase1,ARG1)、趨化因子配體2[Chemokine (C-C motif)2,CCL2]、趨化因子配體5[Chemokine(C-C motif)5,CCL5]等表達(dá),抑制其殺傷腫瘤細(xì)胞的效應(yīng),可以誘導(dǎo)腫瘤微環(huán)境中抗腫瘤的N1型中性粒細(xì)胞向N2 型極化,促進(jìn)腫瘤生長及轉(zhuǎn)移[10]。
有研究發(fā)現(xiàn)小鼠肺癌模型中,敲除TGF-β組相較對照組,N1型中性粒細(xì)胞大量浸潤腫瘤組織,腫瘤生長緩慢,活化細(xì)胞毒性T淋巴細(xì)胞(Cytotoxic T lymphocytes,CTLs),抗腫瘤效應(yīng)明顯,表現(xiàn)為抗腫瘤的N1型[11]。中性粒細(xì)胞分泌髓過氧化物酶(Myeloperoxidase,MPO)和活性氧(Reactive oxygen species,ROS)、次氯酸(Hypochlorous acid,HOCl)等一些具有細(xì)胞毒性作用的介質(zhì)[12],可直接殺傷腫瘤細(xì)胞。中性粒細(xì)胞也是抗體介導(dǎo)的腫瘤免疫治療的重要效應(yīng)細(xì)胞[13],抗體Fc段能與中性粒細(xì)胞表面的Fc受體(Fc receptor,F(xiàn)cR)相結(jié)合,誘導(dǎo)中性粒細(xì)胞釋放細(xì)胞毒性介質(zhì),起到殺傷腫瘤細(xì)胞的作用[14]。在肺癌術(shù)后患者中,從癌旁組織分離的腫瘤相關(guān)中性粒細(xì)胞刺激T細(xì)胞增殖和干擾素-γ(Interferon-γ,IFN-γ)釋放,中性粒細(xì)胞和活化T細(xì)胞之間的作用導(dǎo)致前者表面上的CD54、CD86、OX40L和4-1BBL共刺激分子顯著上調(diào),這一正反饋回路中增強(qiáng)了T細(xì)胞增殖,進(jìn)而抑制腫瘤細(xì)胞的生存[15]。中性粒細(xì)胞可以與不同的細(xì)胞群體相互作用,通過直接的細(xì)胞毒活性針對腫瘤細(xì)胞發(fā)揮抗腫瘤活性,并通過廣泛的釋放介質(zhì)(例如細(xì)胞因子、趨化因子和生長因子)募集和激活細(xì)胞適應(yīng)性免疫系統(tǒng),也可通過誘導(dǎo)單核細(xì)胞來源的樹突狀細(xì)胞(Dendritic cells,DC)和自然殺傷細(xì)胞(Natural killer cell,NK)的成熟,增強(qiáng)免疫應(yīng)答[16]。綜上所述,N1型中性粒細(xì)胞能夠減弱腫瘤細(xì)胞的侵襲能力,減少腫瘤細(xì)胞的增殖作用[17],從而控制腫瘤生長和轉(zhuǎn)移[18]。
近年來研究發(fā)現(xiàn),中性粒細(xì)胞可以參與致癌過程的不同階段,包括增強(qiáng)腫瘤細(xì)胞的增殖、遷移和侵襲[19],促進(jìn)腫瘤血栓形成、介導(dǎo)腫瘤免疫抑制。表現(xiàn)為促腫瘤的N2型。
目前推測腫瘤微環(huán)境中N2型中性粒細(xì)胞促進(jìn)腫瘤相關(guān)進(jìn)展的可能機(jī)制包括以下幾個(gè)方面。
4.1N2型中性粒細(xì)胞參與腫瘤的發(fā)生發(fā)展 N2型中性粒細(xì)胞可以通過釋放活性氮(Reactive nitrogen species,RNS)、ROS或蛋白酶等促進(jìn)腫瘤的發(fā)生[20]。彈性蛋白酶(Neutrophil elastase,NE)是N2型中性粒細(xì)胞顆粒蛋白分泌的一種絲氨酸蛋白酶。正常狀態(tài)下,中性粒細(xì)胞釋放的NE較少;當(dāng)機(jī)體受到感染時(shí),一氧化氮合酶(inducible nitric oxide synthase,iNOS)、TNF-α、IL-8等一些細(xì)胞因子可刺激中性粒細(xì)胞大量釋放NE[21]。另外,鈣調(diào)蛋白(Cadherin) 也可增強(qiáng)脂多糖(Lipopolysaccharide,LPS)誘導(dǎo)的NE釋放,進(jìn)而促進(jìn)癌癥的發(fā)生[22]。來自N2型中性粒細(xì)胞的NE與胰島素受體底物-1(Insulin receptor substrate-1,IRS-1)結(jié)合后被內(nèi)吞到肺癌細(xì)胞中,NE能夠降解磷脂酰肌醇3-激酶(Phosphatidylinositol 3-kinase,PI3K)的抑制劑IRS-1,與PI3K 的調(diào)節(jié)亞基p85相結(jié)合激活PI3K,促進(jìn)AKT磷酸化,激活該信號通路,進(jìn)一步促進(jìn)腫瘤細(xì)胞的增殖與生存[23]。N2型中性粒細(xì)胞可分泌趨化因子IL-8,IL-8通過募集中性粒細(xì)胞脫顆粒進(jìn)入腫瘤微環(huán)境,誘導(dǎo)信號級聯(lián)反應(yīng)導(dǎo)致CD8+T細(xì)胞抗腫瘤效應(yīng)降低[24-26]。N2型中性粒細(xì)胞還能通過產(chǎn)生ROS破壞DNA引起腫瘤細(xì)胞的無限增殖,中性粒細(xì)胞衍生的氧和氮衍生物負(fù)責(zé)DNA點(diǎn)突變并促進(jìn)遺傳不穩(wěn)定性[27],來自中性粒細(xì)胞的髓過氧化物酶(Myeloperoxidase,MPO)催化氯離子和H2O2形成次氯酸(HOCl)激活基質(zhì)金屬蛋白酶(Matrix metalloproteinase,MMP)并滅活金屬蛋白酶組織抑制劑(Tissue inhibitor of metalloproteinase,TIMP),導(dǎo)致肺上皮細(xì)胞DNA 損傷和突變,從而促進(jìn)胞外基質(zhì)(Extracellular matrix,ECM)重塑以及肺癌的發(fā)生[28]。
4.2N2型中性粒細(xì)胞參與腫瘤細(xì)胞的轉(zhuǎn)移 N2型中性粒細(xì)胞分泌的趨化因子IL-8與腫瘤細(xì)胞表面的C-X-C 趨化因子受體2(C-X-C motif chemokine receptor 2,CXCR2)結(jié)合后,既能募集中性粒細(xì)胞進(jìn)入腫瘤微環(huán)境,又能夠促進(jìn)腫瘤血管生成[29]。在小鼠肺微環(huán)境中移植具有不同肺轉(zhuǎn)移潛力的人腎細(xì)胞癌(Renal cell carcinoma,RCC)細(xì)胞后,小鼠肺間質(zhì)隔室的基因表達(dá)譜顯示出富集中性粒細(xì)胞特異性功能的特征。該實(shí)驗(yàn)結(jié)果表明腫瘤微環(huán)境中,中性粒細(xì)胞分泌趨化因子募集中性粒細(xì)胞至肺組織,N2型中性粒細(xì)胞可促進(jìn)肺組織中腫瘤細(xì)胞轉(zhuǎn)移的發(fā)生[18]。體外實(shí)驗(yàn)表明,在頭頸鱗癌(Head and neck cancer,HNSCC)模型中,磷酸化皮層蛋白(Cortactin)釋放可溶性因子,募集N2型中性粒細(xì)胞到達(dá)腫瘤細(xì)胞中并促進(jìn)其遷移。中性粒細(xì)胞浸潤與Cortactin的表達(dá)相關(guān),Cortactin是一種與細(xì)胞遷移和侵襲有關(guān)的肌動(dòng)蛋白結(jié)合蛋白,Cortactin磷酸化也與來自喉癌患者腫瘤組織中的中性粒細(xì)胞浸潤顯著相關(guān)[30]。另有文章指出[31],通過延時(shí)視頻顯微鏡觀察N2型中性粒細(xì)胞對體外生長的胰島素的胰腺癌細(xì)胞,顯示中性粒細(xì)胞誘導(dǎo)胰腺腫瘤細(xì)胞的黏附。這種黏附是由于中性粒細(xì)胞釋放的NE 能夠介導(dǎo)E-鈣黏蛋白(E-cadherin,E-cad)的降解,下調(diào)細(xì)胞中特異性siRNA的表達(dá),顯著增加了胰腺腫瘤細(xì)胞的遷移能力,導(dǎo)致中性粒細(xì)胞有助于侵襲性腫瘤生長。在對卵巢癌組織的檢測中,也得到類似的結(jié)果,即NE誘導(dǎo)E-cad 蛋白表達(dá)下調(diào),中性粒細(xì)胞促進(jìn)腫瘤侵襲[32]。N2型中性粒細(xì)胞與胰腺癌和乳腺癌細(xì)胞-細(xì)胞的直接相互作用已被證明涉及腫瘤細(xì)胞上的細(xì)胞表面細(xì)胞間黏附分子-1(Intercellular adhesion molecule-1,ICAM-1)和中性粒細(xì)胞上的β-2-整聯(lián)蛋白,中性粒細(xì)胞結(jié)合腫瘤細(xì)胞相關(guān)整合素并誘導(dǎo)腫瘤細(xì)胞上的ICAM-1聚集,激活腫瘤細(xì)胞遷移至肝臟[33]。在黑色素瘤模型中,亦發(fā)現(xiàn)N2型中性粒細(xì)胞上調(diào)表達(dá)β-2-整聯(lián)蛋白,其與黑素瘤細(xì)胞表面表達(dá)的ICAM-1相互作用,通過中性粒細(xì)胞將腫瘤細(xì)胞攜帶到轉(zhuǎn)移部位[34]。
4.3N2型中性粒細(xì)胞參與腫瘤血管生成 N2型中性粒細(xì)胞在腫瘤血管生成中具有重要作用[35],其介導(dǎo)多種血管生成因子的表達(dá),如血管內(nèi)皮生長因子-A(Vascular endothelial growth factor-A,VEGF-A)、前動(dòng)力蛋白-2(Prokineticin-2,PROK-2)和MMP-9等[9]。有實(shí)驗(yàn)證實(shí),肝癌相關(guān)中性粒細(xì)胞釋放的MMP-9通過活化從ECM中釋放VEGF-A,繼而促進(jìn)腫瘤新生血管形成[36]。N2型中性粒細(xì)胞分泌的趨化因子IL-8參與腫瘤血管的形成,促進(jìn)腫瘤生長[18],在纖維肉瘤和前列腺癌的鼠模型中,阻斷CXCL8/IL-8募集N2型中性粒細(xì)胞顯著減少腫瘤血管生成、抑制腫瘤生長。腫瘤異種移植鼠模型中,在腫瘤細(xì)胞和基質(zhì)細(xì)胞G-CSF影響下,N2型中性粒細(xì)胞釋放的促血管生成分子Bv8能明顯促進(jìn)受損血管生成和腫瘤生長[37]。Galdiero等[37]還發(fā)現(xiàn)肝癌細(xì)胞刺激N2型中性粒細(xì)胞分泌肝細(xì)胞生長因子(HGF),HGF修飾腫瘤微環(huán)境,參與腫瘤血管生成,使腫瘤細(xì)胞變得更具侵襲性[7]。
圖1 中性粒細(xì)胞在腫瘤免疫中的作用Fig.1 Role of neutrophils in tumor immunology
中性粒細(xì)胞在腫瘤微環(huán)境中具有雙重作用。N1型中性粒細(xì)胞具有細(xì)胞毒性作用,產(chǎn)生抗腫瘤效應(yīng);N2型中性粒細(xì)胞可通過分泌各種細(xì)胞因子和趨化因子、NE、MMP-9及ROS等生物活性物質(zhì)來促進(jìn)腫瘤細(xì)胞發(fā)生發(fā)展,參與血管生成,增強(qiáng)腫瘤細(xì)胞侵襲與轉(zhuǎn)移能力,產(chǎn)生促腫瘤效應(yīng)(圖1)。由于目前越來越多的研究表明中性粒細(xì)胞在腫瘤發(fā)生過程中具有兩面性,但其具體的機(jī)制尚不清楚。更全面認(rèn)識中性粒細(xì)胞可塑性的分子機(jī)制及兩種類型的功能和標(biāo)志,可以為抗腫瘤免疫和分子診療提供新靶標(biāo)??傊?,中性粒細(xì)胞是腫瘤發(fā)生發(fā)展的參與者,隨著研究的不斷深入,中性粒細(xì)胞及其相關(guān)因子有望為腫瘤治療提供新的思路和方法。
參考文獻(xiàn):
[1] Jani PK,Schwaner E,Kajdacsi E,etal.Complement MASP-1 enhances adhesion between endothelial cells and neutrophils by up-regulating E-selectin expression [J].Mol Immunol,2016,75:38-47.
[2] Ling MR,Chapple IL,Matthews JB.Peripheral blood neutrophil cytokine hyper-reactivity in chronic periodontitis [J].Innate Immun,2015,21(7):714-725.
[3] Ella K,Csepanyi-Komi R,Kaldi K.Circadian regulation of human peripheral neutrophils [J].Brain Behav Immun,2016,57:209-221.
[4] Carlsen ED,Jie Z,Liang Y,etal.Interactions between neutrophils and leishmania braziliensis amastigotes facilitate cell activation and parasite clearance [J].J Innate Immun,2015,7(4):354-363.
[5] Vernon PJ,Paredes RM,Sooter AJ,etal.Severe hemorrhagic shock induces acute activation and expansion of IL-8+/IL-10+neutrophils with enhanced oxidative reactivity in non-human primates [J].Shock,2016,46(3 Suppl 1):129-136.
[6] 劉義慶,盧冰如,張炳昌,等.中性粒細(xì)胞的功能及其與自身免疫性疾病關(guān)聯(lián)性研究進(jìn)展 [J].中國免疫學(xué)雜志,2014,30(5):712-716.
Liu YQ,Lu BR,Zhang BC,etal.Research progresses of functions of neutrophils and the relationship between neutrophils and autoimmune diseases[J].Chin J Immunol,2014,30(5):712-716.
[7] Uribe-Querol E,Rosales C.Neutrophils in cancer:two sides of the same coin [J].J Immunol Res,2015,2015:983698.
[8] Albanesi M,Mancardi DA,Jonsson F,etal.Neutrophils mediate antibody-induced antitumor effects in mice [J].Blood,2013,122(18):3160-3164.
[9] Mishalian I,Bayuh R,Levy L,etal.Tumor-associated neutrophils (TAN) develop pro-tumorigenic properties during tumor progression [J].Cancer Immunol Immunother,2013,62(11):1745-1756.
[10] Piccard H,Muschel RJ,Opdenakker G.On the dual roles and polarized phenotypes of neutrophils in tumor development and progression [J].Crit Rev Oncol Hematol,2012,82(3):296-309.
[11] Fridlender ZG,Sun J,Kim S,etal.Polarization of tumor-associated neutrophil phenotype by TGF-beta:"N1" versus "N2" TAN [J].Cancer Cell,2009,16(3):183-194.
[12] Kadota K,Nitadori JI,Ujiie H,etal.Prognostic impact of immune microenvironment in lung squamous cell carcinoma:tumor-infiltrating CD10+Neutrophil/CD20+lymphocyte ratio as an independent prognostic factor [J].J Thorac Oncol,2015,10(9):1301-1310.
[13] Ning C,Li YY,Wang Y,etal.Complement activation promotes colitis-associated carcinogenesis through activating intestinal IL-1beta/IL-17A axis [J].Mucosal Immunol,2015,8(6):1275-1284.
[14] Wang W,Erbe AK,Hank JA,etal.NK cell-mediated antibody-dependent cellular cytotoxicity in cancer immunotherapy [J].Front Immunol,2015,6:368.
[15] Eruslanov EB,Bhojnagarwala PS,Quatromoni JG,etal.Tumor-associated neutrophils stimulate T cell responses in early-stage human lung cancer [J].J Clin Invest,2014,124(12):5466-5480.
[16] Sceneay J,Chow MT,Chen A,etal.Primary tumor hypoxia recruits CD11b+/Ly6Cmed/Ly6G+immune suppressor cells and compromises NK cell cytotoxicity in the premetastatic niche [J].Cancer Res,2012,72(16):3906-3911.
[17] Abe H,Morikawa T,Saito R,etal.In Epstein-Barr virus-associated gastric carcinoma a high density of CD66b-positive tumor-associated neutrophils is associated with intestinal-type histology and low frequency of lymph node metastasis [J].Virchows Arch,2016,468(5):539-548.
[18] Lopez-Lago MA,Posner S,Thodima VJ,etal.Neutrophil chemokines secreted by tumor cells mount a lung antimetastatic response during renal cell carcinoma progression [J].Oncogene,2013,32(14):1752-1760.
[19] Swierczak A,Mouchemore KA,Hamilton JA,etal.Neutrophils:important contributors to tumor progression and metastasis [J].Cancer Metastasis Rev,2015,34(4):735-751.
[20] Antonio N,Bonnelykke-Behrndtz ML,Ward LC,etal.The wound inflammatory response exacerbates growth of pre-neoplastic cells and progression to cancer [J].Embo J,2015,34(17):2219-2236.
[21] Tanaka Y,Ito S,Isobe K.Vancomycin-sensitive bacteria trigger development of colitis-associated colon cancer by attracting neutrophils [J].Sci Rep,2016,6:23920.
[22] Liang W,Ferrara N.The complex role of neutrophils in tumor angiogenesis and metastasis [J].Cancer Immunol Res,2016,4(2):83-91.
[23] Houghton AM,Rzymkiewicz DM,Ji H,etal.Neutrophil elastase-mediated degradation of IRS-1 accelerates lung tumor growth [J].Nat Med,2010,16(2):219-223.
[24] Zea AH,Rodriguez PC,Atkins MB,etal.Arginase-producing myeloid suppressor cells in renal cell carcinoma patients:a mechanism of tumor evasion [J].Cancer Res,2005,65(8):3044-3048.
[25] Rodriguez PC,Zea AH,Culotta KS,etal.Regulation of T cell receptor CD3zeta chain expression by L-arginine [J].J Biol Chem,2002,277(24):21123-21129.
[26] Rotondo R,Barisione G,Mastracci L,etal.IL-8 induces exocytosis of arginase 1 by neutrophil polymorphonuclears in nonsmall cell lung cancer [J].Int J Cancer,2009,125(4):887-893.
[27] Gungor N,Knaapen AM,Munnia A,etal.Genotoxic effects of neutrophils and hypochlorous acid [J].Mutagenesis,2010,25(2):149-154.
[28] Satpathy SR,Jala VR,Bodduluri SR,etal.Crystalline silica-induced leukotriene B4-dependent inflammation promotes lung tumour growth [J].Nat Commun,2015,6:7064.
[29] 王 健,韓忠燕,周 娜.CXCL8及其受體CXCR1、CXCR2在慢性乙肝患者外周血PMNs中的表達(dá) [J].中國免疫學(xué)雜志,2015,31(3):375-379.
Wang J,Han ZY,Zhou N. Expression of CXCL8 and its receptors (CXCR1 and CXCR2) in peripheral blood neutrophils of chronic hepatitis B[J].Chin J Immunol,2015,31(3):375-379.
[30] Dumitru CA,Bankfalvi A,Gu X,etal.Neutrophils activate tumoral CORTACTIN to enhance progression of orohypopharynx carcinoma [J].Front Immunol,2013,4:33.
[31] Gaida MM,Steffen TG,Gunther F,etal.Polymorphonuclear neutrophils promote dyshesion of tumor cells and elastase-mediated degradation of E-cadherin in pancreatic tumors [J].Eur J Immunol,2012,42(12):3369-3380.
[32] Mayer C,Darb-Esfahani S,Meyer AS,etal.Neutrophil granulocytes in ovarian cancer-induction of epithelial-to-mesenchymal-transition and tumor cell migration [J].J Cancer,2016,7(5):546-554.
[33] Strell C,Lang K,Niggemann B,etal.Neutrophil granulocytes promote the migratory activity of MDA-MB-468 human breast carcinoma cells via ICAM-1 [J].Exp Cell Res,2010,316(1):138-148.
[34] Huh SJ,Liang S,Sharma A,etal.Transiently entrapped circulating tumor cells interact with neutrophils to facilitate lung metastasis development [J].Cancer Res,2010,70(14):6071-6082.
[35] Tazzyman S,Niaz H,Murdoch C.Neutrophil-mediated tumour angiogenesis:subversion of immune responses to promote tumour growth [J].Semin Cancer Biol,2013,23(3):149-158.
[36] Deryugina EI,Zajac E,Juncker-Jensen A,etal.Tissue-infiltrating neutrophils constitute the major in vivo source of angiogenesis-inducing MMP-9 in the tumor microenvironment [J].Neoplasia,2014,16(10):771-788.
[37] Galdiero MR,Garlanda C,Jaillon S,etal.Tumor associated macrophages and neutrophils in tumor progression [J].J Cell Physiol,2013,228(7):1404-1412.