查看“阿伏西地”的源代码

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            <strong>[[阿伏西地]]</strong>（<strong>[[Alvocidib]]</strong>，研发代码：<strong>[[HMR1275]]</strong>）是全球首个进入临床开发的强效、多靶点<strong>[[细胞周期蛋白依赖性激酶]]</strong>（[[CDK]]）抑制剂。作为一种半合成黄酮类化合物，其核心机制在于通过竞争性抑制<strong>[[CDK9]]</strong>来阻断<strong>[[正转录延伸因子b]]</strong>（[[P-TEFb]]）复合物的活性。阿伏西地能够迅速下调具有极短半衰期的抗凋亡蛋白<strong>[[MCL-1]]</strong>的转录，从而诱导肿瘤细胞发生线粒体途径凋亡。在血液学肿瘤领域，特别是<strong>[[急性髓系白血病]]</strong>（[[AML]]）和[[慢性淋巴细胞白血病]]（[[CLL]]）的治疗中，阿伏西地被视为克服[[BCL-2]]抑制剂耐药及针对高危遗传学特征人群的重要精准治疗药物。
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            <div style="font-size: 1.2em; font-weight: bold; letter-spacing: 1.2px;">[[阿伏西地]]</div>
            <div style="font-size: 0.75em; opacity: 0.85; margin-top: 4px;">[[Alvocidib]] / [[Flavopiridol]] · 点击展开</div>
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                <div style="font-size: 0.8em; color: #64748b; margin-top: 12px; font-weight: 600;">核心靶点：[[CDK9]] / [[Pan-CDK]]</div>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0; width: 45%;">[[CAS]]登记号</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">146426-40-6</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">[[Entrez]]ID</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">1022([[CDK9]])</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">药物类型</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #1e40af;">[[小分子激酶抑制剂]]</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">分子式</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">C21H20ClNO5</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">给药途径</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">[[静脉滴注]]</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569;">开发公司</th>
                    <td style="padding: 12px; color: #0f172a;">[[Tolero Pharmaceuticals]]</td>
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    <h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">分子机制：转录暂停与凋亡重启</h2>
    
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        阿伏西地的药理活性主要源于对[[转录延伸]]阶段的物理拦截：
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        <li style="margin-bottom: 12px;"><strong>抑制P-TEFb复合物：</strong> 阿伏西地以纳摩尔级别的亲和力结合[[CDK9]]。该酶是[[P-TEFb]]的核心，负责对<strong>[[RNA聚合酶II]]</strong>的[[C-末端结构域]]（[[CTD]]）进行磷酸化，从而启动转录延伸。</li>
        <li style="margin-bottom: 12px;"><strong>剥夺抗凋亡信号：</strong> 某些关键癌基因（如[[MCL-1]]、[[MYC]]、[[Cyclin D1]]）对转录暂停极其敏感。抑制[[CDK9]]会导致[[MCL-1]]的[[mRNA]]合成迅速停止，打破[[BCL-2家族]]成员之间的平衡。</li>
        <li style="margin-bottom: 12px;"><strong>细胞周期双重拦截：</strong> 作为[[Pan-CDK]]抑制剂，它还能同时抑制[[CDK1]]、[[CDK2]]和[[CDK4]]，分别将细胞拦截在[[G1/S]]期和[[G2/M]]期，实现增殖抑制与诱导凋亡的双重打击。</li>
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    <h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">核心临床应用图谱</h2>

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                <th style="padding: 10px; border: 1px solid #cbd5e1; color: #0f172a; width: 25%;">适应症领域</th>
                <th style="padding: 10px; border: 1px solid #cbd5e1; color: #475569;">研究方案</th>
                <th style="padding: 10px; border: 1px solid #cbd5e1; color: #1e40af;">当前临床价值</th>
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                <td style="padding: 8px; border: 1px solid #cbd5e1; font-weight: 600;">[[急性髓系白血病]]</td>
                <td style="padding: 8px; border: 1px solid #cbd5e1;">联合[[阿糖胞苷]]及[[柔红霉素]]</td>
                <td style="padding: 8px; border: 1px solid #cbd5e1;">在[[MCL-1]]高度依赖的AML亚群中展现了优异的[[完全缓解]]（[[CR]]）率。</td>
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                <td style="padding: 8px; border: 1px solid #cbd5e1; font-weight: 600;">[[慢性淋巴细胞白血病]]</td>
                <td style="padding: 8px; border: 1px solid #cbd5e1;">序贯[[Venetoclax]]</td>
                <td style="padding: 8px; border: 1px solid #cbd5e1;">作为“引物”降低MCL-1水平，显著增强肿瘤对[[BCL-2]]抑制剂的敏感性。</td>
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                <td style="padding: 8px; border: 1px solid #cbd5e1; font-weight: 600;">[[复发难治实体瘤]]</td>
                <td style="padding: 8px; border: 1px solid #cbd5e1;">[[MYC]]扩增相关瘤种</td>
                <td style="padding: 8px; border: 1px solid #cbd5e1;">正探索其在靶向[[MYC]]转录上游的临床潜力。</td>
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    <h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">诊疗策略：风险管理与精准预警</h2>
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        阿伏西地的临床应用遵循高度个体化的管理逻辑，其安全性监控优于常规化疗：
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        <li style="margin-bottom: 12px;"><strong>[[肿瘤溶解综合征]]（TLS）预防：</strong> 由于其极强的诱导凋亡能力，应用前必须进行充分的[[水化]]及[[降尿酸]]预处理，并严密监测[[电解质]]变化。</li>
        <li style="margin-bottom: 12px;"><strong>[[生物标志物]]分层：</strong> 目前临床倾向于通过[[BH3谱图]]或[[MCL-1表达]]检测来识别获益人群，即所谓的“[[MCL-1依赖]]”表型。</li>
        <li style="margin-bottom: 12px;"><strong>[[时间药理学]]给药：</strong> 采用[[推注]]（[[Bolus]]）后跟随[[长期输注]]的模式，旨在克服血浆蛋白结合的干扰，使药物有效占据[[CDK9]]口袋。</li>
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            <li style="margin-bottom: 8px;"><strong>[[CDK9]]：</strong> 控制mRNA转录延伸的关键激酶，阿伏西地最为核心的治疗靶位。</li>
            <li style="margin-bottom: 8px;"><strong>[[MCL-1]]：</strong> 促生存蛋白，其快速耗竭是白血病细胞发生凋亡的核心触发点。</li>
            <li style="margin-bottom: 8px;"><strong>[[P-TEFb]]：</strong> 正转录延伸因子b，是协调RNA聚合酶由起始转向延伸的分子开关。</li>
            <li style="margin-bottom: 8px;"><strong>[[Venetoclax]]：</strong> 靶向[[BCL-2]]，常与阿伏西地联合应用以解决复杂的抗凋亡防御网络。</li>
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        <span style="color: #0f172a; font-weight: bold; font-size: 1.05em; display: inline-block; margin-bottom: 15px;">学术参考文献与权威点评</span>
        
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            [1] <strong>Zeidner JF, et al. (2015).</strong> <em>Alvocidib (flavopiridol) followed by 7+3 chemotherapy in newly diagnosed AML patients with poor-risk genetics.</em> <strong>[[Blood]]</strong>.[Academic Review]<br>
            <span style="color: #475569;">[权威点评]：确立了阿伏西地在针对高危AML遗传学特征（如17p缺失）人群中的重要补充地位。</span>
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            [2] <strong>Lin TS, et al. (2009).</strong> <em>Flavopiridol given as a 30-minute bolus followed by 4-hour continuous infusion in chronic lymphocytic leukemia.</em> <strong>[[Journal of Clinical Oncology]]</strong>.<br>
            <span style="color: #475569;">[核心价值]：该研究优化的给药模式显著降低了毒性并提升了CLL患者的治疗深度。</span>
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            [[阿伏西地]] ([[Alvocidib]]) 诊疗生态 · 知识图谱
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                <td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">关联靶点</td>
                <td style="padding: 10px 15px; color: #334155;">[[CDK9]]•[[MCL-1]]•[[RNA Pol II]]•[[MYC]]•[[BCL-2]]</td>
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                <td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">同类/竞争</td>
                <td style="padding: 10px 15px; color: #334155;">[[Dinaciclib]]•[[Voruciclib]]•[[AZD4573]]•[[VIP152]]</td>
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                <td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">战略实体</td>
                <td style="padding: 10px 15px; color: #334155;">[[Tolero Pharmaceuticals]]•[[NCI]]•[[FDA]]•[[Sumitomo Pharma]]</td>
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                <td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">研究前沿</td>
                <td style="padding: 10px 15px; color: #334155;">[[克服BCL-2抑制剂获得性耐药]]•[[针对转录成瘾肿瘤的精准治疗]]•[[基于AI的TLS早期预警模型]]</td>
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