Motixafortide

- Reports continued progress in the evaluation of assets for potential pipeline expansion in the areas of oncology and rare disease; transaction targeted for 2025 -- Provides updated and extended cash runway guidance into H1 2027 -- Management to host conference call today, August 14th , at 8:30 am EDT - TEL AVIV, Israel , Aug. 14, 2025 /PRNewswire/ -- BioLineRx Ltd. (NASDAQ: BLRX) (TASE: BLRX), a development stage biopharmaceutical company pursuing life-changing therapies in oncology and rare diseases, today reported its unaudited financial results for the quarter ended June 30, 2025 , and provided a corporate update. "Since our last quarterly update, we have been acutely focused on evaluating a broad range of potential pipeline expansion opportunities where we can leverage our clinical and regulatory expertise, and track record of drug approval success, to drive new innovation in areas of need," said Philip Serlin , Chief Executive Officer of BioLineRx . "Today, I am pleased to report that discussions with potential partners continue to progress. Our balance sheet is strong, our organization is lean, and we are seeing promising opportunities that fit well within our criteria - most notably a clear and efficient development pathway. I remain confident that we could potentially execute a transaction this year that will expand our pipeline and provide fresh opportunities for clinical success and long-term value creation." Financial Updates With $28.2 million on its balance sheet as of June 30, 2025 , BioLineRx is guiding to a cash runway into the first half of 2027. This represents an improvement as compared to the Company's previous cash runway guidance into the second half of 2026. Clinical Updates Motixafortide Pancreatic Ductal Adenocarcinoma (mPDAC) Enrollment activities continue in the CheMo4METPANC Phase 2b clinical trial, which is being led by Columbia University , and supported by both Regeneron and BioLineRx . The CheMo4METPANC trial is evaluating motixafortide in combination with the PD-1 inhibitor cemiplimab and standard chemotherapy (gemcitabine and nab-paclitaxel). A prespecified interim analysis is planned when 40% of progression-free survival (PFS) events are observed. An abstract featuring updated data from the pilot phase of the ongoing CheMo4METPANC clinical trial was presented at the 2025 ASCO Annual Meeting in May. Key highlights include: - Four of 11 patients remained progression-free after more than one year.- Two patients underwent definitive treatment for metastatic pancreatic cancer: one had complete resolution of all radiologically detected liver lesions and underwent radiation to the primary pancreatic tumor, and one had a sustained partial response and underwent pancreaticoduodenectomy with pathology demonstrating a complete response.- An analysis of pre- and on-treatment biopsies revealed that CD8+ T-cell tumor infiltration increased across all eleven patients treated with the motixafortide combination. Sickle Cell Disease (SCD) & Gene Therapy Ongoing Phase 1 clinical trial evaluating motixafortide as monotherapy and in combination with natalizumab for stem cell mobilization for gene therapies in sickle cell disease continues to progress. The trial is sponsored by Washington University School of Medicine in St. Louis , and results are anticipated in the second half of 2025. A second study, sponsored by St. Jude Children's Research Hospital , continues to enroll patients. The study is a multi-center Phase 1 clinical trial evaluating motixafortide for the mobilization of CD34+ hematopoietic stem cells (HSCs) used in the development of gene therapies for patients with Sickle Cell Disease (SCD). APHEXDA Performance Update APHEXDA generated sales of $1.7 million in the second quarter of 2025, providing royalty revenue to the Company of $0.3 million . Financial Results for the Quarter Ended June 30, 2025 Total revenues for the second quarter of 2025 were $0.3 million , reflecting the royalties paid by Ayrmid from the commercialization of APHEXDA in stem cell mobilization in the U.S. Total revenues in 2025 are not comparable to the same period in 2024, which included direct commercial sales by BioLineRx prior to the Ayrmid transaction in November 2024 . Cost of revenues for the second quarter of 2025 was immaterial, compared to cost of revenues of $0.9 million for the second quarter of 2024. Cost of revenues in 2025 are not comparable to the same period in 2024, which included cost of sales from direct commercial sales by BioLineRx prior to the Ayrmid transaction in November 2024 . Research and development expenses for the second quarter of 2025 were $2.3 million , compared to $2.2 million for the second quarter of 2024. The increase resulted primarily from certain one-time costs associated with the PDAC study at Columbia University , offset by lower expenses related to motixafortide due to the out-licensing of U.S. rights to Ayrmid, as well as a decrease in payroll and share-based compensation, primarily due to a decrease in headcount. There were no sales and marketing expenses for the second quarter of 2025, compared to $6.4 million for the second quarter of 2024. The decrease resulted primarily from the shutdown of U.S. commercial operations in the fourth quarter of 2024 following the Ayrmid transaction. General and administrative expenses for the second quarter of 2025 were $0.2 million , compared to $1.6 million for the second quarter of 2024. The decrease resulted primarily from the reversal of a provision for doubtful accounts following receipt of an overdue milestone payment from Gloria, a decrease in payroll and share-based compensation, primarily due to a decrease in headcount, as well as small decreases in a number of general and administrative expenses. Net non-operating expenses for the second quarter of 2025 were $1.9 million , compared to net non-operating income of $7.8 million for the second quarter of 2024. Non-operating income (expenses) for both periods primarily relate to fair-value adjustments of warrant liabilities on the balance sheet, as a result of changes in the Company's share price Net financial income for the second quarter of 2025 was $0.2 million , compared to net financial expenses of $1.6 million for the second quarter of 2024. Net financial income (expenses) for both periods primarily relate to loan interest paid, partially offset by investment income earned on bank deposits and gains on foreign currency (primarily NIS) cash balances due to the strengthening of the NIS during the period. The significant decrease in financial expenses in the 2025 period results from a substantial paydown of the BlackRock loan balance in November 2024 , following the transaction with Ayrmid. Net loss for the second quarter of 2025 was $3.9 million , compared to net income of $0.5 million for the second quarter of 2024. As of June 30, 2025 , the Company had cash, cash equivalents, and short-term bank deposits of $28.2 million , sufficient to fund operations, as currently planned, into the first half of 2027. Conference Call and Webcast Information To access the conference call, please dial +1-888-281-1167 from the U.S. or +972-3-918-0685 internationally. A live webcast and a replay of the call can be accessed through the event page on the Company's website. Please allow extra time prior to the call to visit the site and download any necessary software to listen to the live broadcast. The call replay will be available approximately two hours after completion of the live conference call. A dial-in replay of the call will be available until August 16, 2025; please dial +1-888-295-2634 from the US or +972-3-925-5904 internationally. About BioLineRx BioLineRx Ltd. (NASDAQ/TASE: BLRX) is a biopharmaceutical company pursuing life-changing therapies in oncology and rare diseases. The Company's first approved product, APHEXDA® (motixafortide), is indicated in the U.S. for stem cell mobilization for autologous transplantation in multiple myeloma, and is being commercialized by Ayrmid Ltd. (globally, except Asia ) and Gloria Biosciences (in Asia). BioLineRx has retained the rights to develop motixafortide in metastatic pancreatic cancer (PDAC), and has a Phase 2b PDAC trial currently ongoing under a collaboration with Columbia University . In addition, BioLineRx is in discussions to expand its pipeline in the areas of oncology and/or rare diseases, where the Company can utilize its end-to-end expertise in drug development, regulatory affairs and manufacturing to bring life-changing innovation from bench to bedside. Learn more about who we are, what we do, and how we do it at www.biolinerx.com, or on Twitter and LinkedIn.  Forward Looking Statement Various statements in this release concerning BioLineRx's future expectations constitute "forward-looking statements" within the meaning of the Private Securities Litigation Reform Act of 1995. These statements include words such as "anticipates," "believes," "could," "estimates," "expects," "intends," "may," "plans," "potential," "predicts," "projects," "should," "will," and "would," and describe opinions about future events. These include statements regarding management's expectations, beliefs and intentions regarding, among other things, expectations regarding pipeline expansion, the expected cash runway, and BioLineRx's business strategy. These forward-looking statements involve known and unknown risks, uncertainties and other factors that may cause the actual results, performance or achievements of BioLineRx to be materially different from any future results, performance or achievements expressed or implied by such forward-looking statements. Factors that could cause BioLineRx's actual results to differ materially from those expressed or implied in such forward-looking statements include, but are not limited to: the clinical development, commercialization and market acceptance of BioLineRx's therapeutic candidates, including the degree and pace of market uptake of APHEXDA for the mobilization of hematopoietic stem cells for autologous transplantation in multiple myeloma patients; the initiation, timing, progress and results of BioLineRx's preclinical studies, clinical trials, and other therapeutic candidate development efforts; BioLineRx's ability to advance its therapeutic candidates into clinical trials or to successfully complete its preclinical studies or clinical trials, whether the clinical trial results for APHEXDA will be predictive of real-world results; BioLineRx's receipt of regulatory approvals for its therapeutic candidates, and the timing of other regulatory filings and approvals; whether access to APHEXDA is achieved in a commercially viable manner and whether APHEXDA receives adequate reimbursement from third-party payors; BioLineRx's ability to establish, manage, and maintain corporate collaborations, as well as the ability of BioLineRx's collaborators to execute on their development and commercialization plans; BioLineRx's ability to integrate new therapeutic candidates and new personnel as well as new collaborations; the interpretation of the properties and characteristics of BioLineRx's therapeutic candidates and of the results obtained with its therapeutic candidates in preclinical studies or clinical trials; the implementation of BioLineRx's business model and strategic plans for its business and therapeutic candidates; the scope of protection BioLineRx is able to establish and maintain for intellectual property rights covering its therapeutic candidates and its ability to operate its business without infringing the intellectual property rights of others; estimates of BioLineRx's expenses, future revenues, capital requirements and its needs for and ability to access sufficient additional financing; risks related to changes in healthcare laws, rules and regulations in the United States or elsewhere; competitive companies, technologies and BioLineRx's industry; BioLineRx's ability to maintain the listing of its ADSs on Nasdaq; and statements as to the impact of the political and security situation in Israel on BioLineRx's business, which may exacerbate the magnitude of the factors discussed above. These and other factors are more fully discussed in the "Risk Factors" section of BioLineRx's most recent annual report on Form 20-F filed with the Securities and Exchange Commission on March 31, 2025 . In addition, any forward-looking statements represent BioLineRx's views only as of the date of this release and should not be relied upon as representing its views as of any subsequent date. BioLineRx does not assume any obligation to update any forward-looking statements unless required by law. Contacts: United States Irina Koffler LifeSci Advisors , LLC IR@biolinerx.com Israel Moran Meir LifeSci Advisors , LLC moran@lifesciadvisors.com CONDENSED CONSOLIDATED INTERIM STATEMENTS OF FINANCIAL POSITION (UNAUDITED) December 31 , June 30 , 2024 2025 in USD thousands Assets CURRENT ASSETS Cash and cash equivalents 10,436 7,189 Short-term bank deposits 9,126 20,970 Trade receivables 2,476 78 Prepaid expenses 443 572 Other receivables 1,478 203 Inventory 3,145 2,850 Total current assets 27,104 31,862 NON-CURRENT ASSETS Property and equipment, net 386 197 Right-of-use assets, net 967 800 Intangible assets, net 10,449 10,408 Total non-current assets 11,802 11,405 Total assets 38,906 43,267 Liabilities and equity CURRENT LIABILITIES Current maturities of long-term loan 4,479 4,479 Accounts payable and accruals: Trade 5,583 3,465 Other 3,131 2,767 Current maturities of lease liabilities 522 408 Warrants 1,691 4,360 Total current liabilities 15,406 15,479 NON-CURRENT LIABILITIES Long-term loan, net of current maturities 8,958 6,718 Lease liabilities 1,081 998 Total non-current liabilities 10,039 7,716 COMMITMENTS AND CONTINGENT LIABILITIES Total liabilities 25,445 23,195 EQUITY Ordinary shares 38,097 71,819 Share premium 353,693 327,475 Warrants 5,367 3,686 Capital reserve 17,547 17,148 Other comprehensive loss (1,416) (1,416) Accumulated deficit (399,827) (398,640) Total equity 13,461 20,072 Total liabilities and equity 38,906 43,267 CONDENSED CONSOLIDATED INTERIM STATEMENTS OF COMPREHENSIVE INCOME (LOSS) (UNAUDITED) Three months ended June 30 , Six months ended June 30 , 2024 2025 2024 2025 in USD thousands In USD thousands REVENUES: License revenues 3,550 304 9,481 559 Product sales, net 1,843 - 2,767 - Total revenues 5,393 304 12,248 559 COST OF REVENUES (897) (72) (2,352) (106) GROSS PROFIT 4,496 232 9,896 453 RESEARCH AND DEVELOPMENT EXPENSES (2,225) (2,326) (4,719) (3,949) SALES AND MARKETING EXPENSES (6,415) - (12,757) - GENERAL AND ADMINISTRATIVE EXPENSES (1,629) (209) (3,015) (1,198) OPERATING LOSS (5,773) (2,303) (10,595) (4,694) NON-OPERATING INCOME (EXPENSES), NET 7,807 (1,851) 12,297 5,793 FINANCIAL INCOME 535 490 1,100 784 FINANCIAL EXPENSES (2,085) (276) (3,014) (696) NET INCOME (LOSS) AND COMPREHENSIVE INCOME (LOSS) 484 (3,940) (212) 1,187 in USD In USD EARNINGS )LOSS( PER ORDINARY SHARE - BASIC AND DILUTED 0.00 (0.00) (0.00) 0.00 WEIGHTED AVERAGE NUMBER OF SHARES USED INCALCULATION OF EARNINGS )LOSS( PER ORDINARY SHARE 1,197,582,901 2,369,687,536 1,142,221,033 2,294,127,662 CONDENSED CONSOLIDATED INTERIM STATEMENTS OF CHANGES IN EQUITY (UNAUDITED) Ordinary shares Share premium Warrants Capital reserve Other comprehensive loss Accumulated deficit Total in USD thousands BALANCE AT JANUARY 1, 2024 CHANGES FOR SIX MONTHS ENDED JUNE 30, 2024: 31,355 355,482 1,408 17,000 (1,416) (390,606) 13,223 Issuance of share capital and warrants, net 3,056 (3,056) - - - - - Employee stock options expired - - - (66) - - (66) Share-based compensation - - - 1,036 - - 1,036 Comprehensive loss for the period - - - - - (212) (212) BALANCE AT JUNE 30, 2024 34,411 352,426 1,408 17,970 (1,416) (390,818) 13,891 Ordinary shares Share premium Warrants Capital reserve Other comprehensive loss Accumulated deficit Total in USD thousands BALANCE AT JANUARY 1, 2025 CHANGES FOR SIX MONTHS ENDED JUNE 30, 2025 : 38,097 353,693 5,367 17,547 (1,416) (399,827) 13,461 Issuance of share capital, pre-funded warrants and warrants, net 25,664 (20,988) 501 - - - 5,177 Pre-funded warrants exercised 8,058 (5,876) (2,182) - - - - Employee stock options expired - 646 - (646) - - - Share-based compensation - - - 247 - - 247 Comprehensive income for the period - - - - - 1,187 1,187 BALANCE AT JUNE 30, 2025 71,819 327,475 3,686 17,148 (1,416) (398,640) 20,072 BioLineRx Ltd. CONDENSED CONSOLIDATED INTERIM CASH FLOW STATEMENTS (UNAUDITED) Six months ended June 30 , 2024 2025 in USD thousands CASH FLOWS - OPERATING ACTIVITIES Comprehensive income (loss) for the period (212) 1,187 Adjustments required to reflect net cash used in operating activities (see appendix below) (25,226) (3,955) Net cash used in operating activities (25,438) (2,768) CASH FLOWS - INVESTING ACTIVITIES Investments in short-term deposits (20,559) (24,818) Maturities of short-term deposits 28,660 12,926 Sale (purchase) of property and equipment (59) 11 Net cash provided by (used in) investing activities 8,042 (11,881) CASH FLOWS - FINANCING ACTIVITIES Issuance of share capital and warrants, net of issuance costs 5,565 13,554 Net proceeds from loan 19,223 - Repayments of loan (1,547) (2,240) Repayments of lease liabilities (256) (262) Net cash provided by financing activities 22,985 11,052 INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS 5,589 (3,597) CASH AND CASH EQUIVALENTS – BEGINNING OF PERIOD 4,255 10,436 EXCHANGE DIFFERENCES ON CASH AND CASH EQUIVALENTS (221) 350 CASH AND CASH EQUIVALENTS - END OF PERIOD 9,623 7,189 BioLineRx Ltd. APPENDIX TO CONDENSED CONSOLIDATED INTERIM CASH FLOW STATEMENTS (UNAUDITED) Six months ended June 30 , 2024 2025 in USD thousands Adjustments required to reflect net cash used in operating activities: Income and expenses not involving cash flows: Depreciation and amortization 1,373 341 Exchange differences on cash and cash equivalents 221 (350) Fair value adjustments of warrants (12,845) (6,410) Warrant issuance costs 642 702 Share-based compensation 970 247 Interest on short-term deposits 201 48 Interest on loan 1,997 - Exchange differences on lease liabilities 189 110 (7,252) (5,312) Changes in operating asset and liability items: Decrease (increase) in trade receivables (2,821) 2,398 Decrease (increase) in prepaid expenses and other receivables (359) 1,146 Decrease (increase) in inventory (1,681) 295 Decrease in accounts payable and accruals (5,633) (2,482) Decrease in contract liabilities (7,480) - (17,974) 1,357 (25,226) (3,955) Supplemental information on interest received in cash 931 583 Supplemental information on interest paid in cash 971 694 Supplemental information on non-cash transactions: Changes in right-of-use asset and lease liabilities 58 45 Warrant issuance costs 207 - Logo - https://mma.prnewswire.com/media/2154863/BioLineRx_Ltd_Logo.jpg View original content:https://www.prnewswire.com/news-releases/biolinerx-reports-second-quarter-2025-financial-results-and-provides-corporate-update-302530015.html SOURCE BioLineRx Ltd. +972-8-6429100

1CXCR4的分子结构与信号通路CXCR4的分子结构CXCR4作为G蛋白偶联受体(GPCR)，由352个氨基酸组成，具有典型的七跨膜α螺旋拓扑结构，属于CXC趋化因子受体家族成员，又称CD184。图1 CXCR4的结构示意图CXCR4的表达调控CXCR4的表达受表观遗传(如启动子低甲基化、组蛋白乙酰化)、非编码RNA(如miR-340-5p、miR-588)及转录因子(如NF-κB、HIF-1α)的调控。CXCR4的结合配体CXCR4主要结合天然配体CXCL12(又称SDF-1)，有α、β、γ等多种亚型，二者结合后调控细胞迁移、免疫应答和神经可塑性。其中，α亚型在骨髓干细胞归巢和神经系统发育中起关键作用；β亚型与血管生成相关；γ亚型与癌细胞的转移密切相关。图2 CXCR4/CXCL12生物轴中的信号通路CXCR4的信号传导CXCR4与CXCL12结合后，通过G蛋白亚基(如Gαi、Gα12/13、Gβ/Gγ)激活下游通路：● PI3K/Akt通路：调控细胞存活、增殖和代谢。● PLC通路：参与细胞内钙动员和蛋白激酶C(PKC)激活。● JAK/STAT通路：调节基因转录，影响细胞增殖和免疫应答。● MAPK/ERK通路：控制细胞生长、分化和凋亡。● β-抑制蛋白(β-arrestin)通路：参与受体脱敏和内吞作用，调控信号持续时间。2CXCR4的生物学功能与病理作用CXCR4的生理功能● 免疫系统调控①免疫细胞迁移：CXCR4表达于T/B细胞、树突状细胞等表面，介导免疫细胞向感染或炎症部位的趋化运动。②HIV共受体：作为人类免疫缺陷病毒(HIV)感染免疫细胞的共受体，与CD4协同促进病毒进入细胞。● 造血与组织修复①造血干细胞(HSC)归巢：在骨髓微环境中，CXCR4/CXCL12轴维持HSC的滞留和自我更新，调控血细胞生成。②组织再生：CXCR4参与心血管和消化系统的稳态维持、伤口愈合及血管生成(如内皮细胞迁移和新生血管形成)。● 神经系统作用①神经发育：CXCR4在神经元突触前/后膜均有分布，调控神经元和神经胶质细胞的迁移，参与血脑屏障形成。②神经保护：在神经炎症(如多发性硬化)中，CXCR4信号可减轻神经损伤，促进轴突修复和神经元干细胞分化。图3 CXCR4的生理功能CXCR4的病理功能● 肿瘤进展与转移①癌症干细胞(CSCs)标记：CXCR4+细胞具有干细胞特性(自我更新、肿瘤起始能力)，与肿瘤的侵袭性密切相关。②增殖：通过CXCR4PI3K/AKT、JAK/STAT、MAPK等通路促进肿瘤细胞增殖。③血管生成：诱导VEGF表达、招募内皮祖细胞，激活血管生成相关基因，并通过激活Rac1和MMP-2/MMP-14蛋白酶，增强肿瘤细胞侵袭和血管内渗能力。④转移：促进上皮-间质转化(EMT)、细胞黏附(如整合素表达)和基质金属蛋白酶(MMPs)分泌，介导肿瘤细胞向高表达CXCL12的器官(如肺、骨髓、淋巴结)迁移，形成转移灶。● 治疗抵抗与免疫逃逸①耐药性：激活PI3K/Akt和JAK/STAT通路，上调抗凋亡蛋白(如Bcl-2)，降低化疗和放疗敏感性。②免疫抑制微环境：肿瘤相关成纤维细胞(CAFs)分泌CXCL12，与癌细胞表面CXCR4结合，通过招募调节性T细胞(Tregs)、肿瘤相关巨噬细胞(TAMs)和髓源性抑制细胞(MDSCs)，抑制抗肿瘤免疫应答。● 预后价值CXCR4在超20种癌症(如非小细胞肺癌、乳腺癌、胰腺癌、白血病等)中高表达，与肿瘤的恶性程度、转移和预后不良显著相关，包括更高的转移率、化疗抵抗和更短的生存期。图4 CXCR4的病理功能3CXCR4靶向药物类型及临床进展CXCR4靶向治疗的核心策略● 阻断CXCR4/CXCL12相互作用：通过拮抗剂阻止配体结合，抑制下游PI3K/Akt、MAPK等促癌通路，减少肿瘤细胞增殖、迁移和耐药性。● 诱导受体内吞与降解：部分抗体(如Ulocuplumab)通过促进CXCR4内吞，降低细胞表面受体水平，阻断信号传导。● 癌症干细胞(CSCs)靶向：选择性清除CSCs，减少肿瘤复发和转移。例如，肽类拮抗剂Motixafortide通过结合CXCR4，抑制CSCs的归巢和存活。图5 不同CXCR4抑制剂的作用机制小分子拮抗剂● Plerixafor(AMD3100)：首个FDA批准的CXCR4拮抗剂，双环胺衍生物，竞争性结合CXCR4，阻断CXCL12信号，用于干细胞动员。联合化疗或免疫疗法(如抗PD-1抗体)用于血液肿瘤和实体瘤。● Mavorixafor(X4P-001)：提高口服生物利用度高，可增强CD8+细胞浸润，调节肿瘤微环境免疫细胞浸润，减少心脏毒性。FDA批准用于治疗WHIM综合征，联合免疫检查点抑制剂用于肾细胞癌、黑色素瘤等。● 其他药物：Burixafor(亲和力高于Plerixafor，用于干细胞动员)、GMI-1359(双重抑制CXCR4和E-selectin，用于乳腺癌)。表1 靶向CXCR4/CXCL12轴的小分子肽类拮抗剂● T22及其衍生物：如T140、Motixafortide(BL-8040)，源自马蹄蟹蛋白，通过β-折叠结构结合CXCR4。其中，Motixafortide联合G-CSF已获批用于MM的干细胞动员，并联合免疫疗法用于胰腺癌。● POL系列：如Balixafortide(POL6326)，环肽类，用于乳腺癌、前列腺癌的临床研究，可增强化疗敏感性。单克隆抗体● Ulocuplumab(BMS-936564)：人源化IgG4抗体，通过活性氧(ROS)诱导凋亡，不依赖补体或ADCC效应。用于MM和AML，联合疗法显示响应率提升。● PF-06747143：IgG1抗体，兼具ADCC/CDC效应及细胞动员作用，用于AML、NHL。其他● 纳米抗体：如ALX-0651，双位点结合CXCR4，用于干细胞动员。● 天然产物：①海洋黄酮Penicillixanthone-A：双重抑制CXCR4/CCR5，抗HIV和肿瘤。②柴胡皂苷A：通过下调CXCR4表达，抑制乳腺癌转移。③清热活血方(QRHX)：通过抑制CXCL12/CXCR4/JAK2/STAT3通路，调控肿瘤相关巨噬细胞，用于肺癌模型。④Turmeric(姜黄)：通过下调CXCR4和STAT3，抑制多种肿瘤的增殖和转移。⑤Sinomenine(青藤碱)：通过抑制CXCR4/STAT3通路诱导骨肉瘤细胞周期阻滞和凋亡。● 适配体：NOX-A12(Spiegelmer适配体)，靶向CXCL12/CXCR4轴，用于血液肿瘤。● 抗体-药物偶联物(ADCs)：抗CXCR4抗体偶联Auristatin，选择性杀灭CXCR4+肿瘤细胞，减少对正常干细胞的毒性。● 放射性核素：如⁷⁷Lu/⁹⁰Y标记Pentixather，用于多发性骨髓瘤的内放射治疗，联合化疗显著降低肿瘤负荷。表2 CXCR4的特异性配体目录包括受体激动剂和拮抗剂联合治疗● 化疗增敏：CXCR4抑制剂与化疗药物联用，逆转肿瘤细胞对紫杉醇、阿糖胞苷等的耐药性(如Plerixafor联合化疗用于AML)。● 免疫治疗协同：通过重塑免疫微环境(如减少Tregs和MDSCs浸润)，增强PD-1抑制剂等免疫疗法的响应率(如Mavorixafor联合Nivolumab用于肾细胞癌)。靶向药物递送系统利用CXCR4介导的内吞作用，设计靶向载体，实现化疗药物或siRNA的肿瘤选择性递送。● 脂质纳米颗粒：表面修饰CXCR4配体(如SDF1α、AMD3100)，递送化疗药物(如阿霉素)、siRNA或光热剂(IR780)，用于乳腺癌、肝癌等，兼具靶向性与信号阻断双重作用。● 聚合物纳米颗粒：如PLGA纳米粒结合LFC131肽，递送索拉非尼或p53mRNA，逆转耐药并调节免疫微环境；氧化还原响应型胶束结合T22肽，共递送Venetoclax和索拉非尼，用于AML治疗。● 蛋白纳米颗粒：如T22肽修饰的多价蛋白纳米颗粒，递送化疗药物(如5-FdU、Ara-C)、毒素(如PE24、蓖麻毒素)或促凋亡蛋白，诱导肿瘤选择性焦亡，用于结直肠癌和AML的选择性杀伤。● 无机纳米粒：如金纳米粒结合抗CXCR4抗体，增强放疗敏感性。表3 CXCR4靶向药物递送系统CXCR4的诊断与预后价值CXCR4过表达与肿瘤分期、转移负荷及不良预后相关，可作为分子标志物指导患者分层和治疗监测。● ⁶⁸Ga-Pentixafor(诊断性放射性药物)：高亲和力结合CXCR4，通过PET成像可视化受体分布，肾排泄快，背景积累低。①血液系统肿瘤：对多发性骨髓瘤(MM)的诊断灵敏度远高于¹⁸F-FDGPET(93.3%vs.53.3%)，定量指标与肿瘤分期和生物标志物高度相关。在弥漫大B细胞淋巴瘤、边缘区淋巴瘤中，可提高分期准确性并指导治疗策略调整。②实体瘤：在小细胞肺癌(SCLC)、肾上腺皮质癌中摄取显著，卵巢癌、胆管癌中肿瘤/背景比(TBR)较高，但在多数实体瘤中表达异质性限制其广泛应用。③其他疾病：可用于心血管疾病(如心肌梗死)和炎症性疾病的CXCR4表达评估。● ¹⁷⁷Lu/⁹⁰Y-Pentixather(治疗性放射性药物)：通过放射性核素(如¹⁷⁷Lu、⁹⁰Y)标记CXCR4拮抗剂，精准递送辐射至肿瘤细胞，诱导凋亡并抑制微环境支持。①血液系统肿瘤：在复发难治性急性髓系白血病(AML)中，联合异基因造血干细胞移植(HSCT)可实现完全缓解；在MM中，单药治疗部分患者出现部分缓解，但总体生存率未显著提升。②实体瘤：初步研究显示对SCLC、肾上腺皮质癌有效，但因实体瘤异质性和骨髓抑制毒性，应用受限。● AMD3100衍生物：如⁶⁴Cu-AMD3465，用于CXCR4表达可视化，但肝、肾摄取较高需优化。● 荧光成像：如Cy5标记Pentixafor，用于Barrett食管的荧光内镜检测。图6 在癌症诊断和治疗中靶向趋化因子受体CXCR44CXCL12/CXCR4轴在不同疾病中的应用肿瘤● 黑色素瘤：CXCL12/CXCR4通过激活PI3K-AKT、MAPK、NF-κB等下游信号通路，促进肿瘤细胞增殖、迁移、血管生成及免疫逃逸，同时通过β1整合素增强肿瘤细胞与血管内皮细胞黏附，引导肿瘤细胞向CXCL12富集的淋巴结、肝、骨等器官迁移，形成转移灶。图7 CXCL12/CXCR4在黑色素瘤中的作用机制● 白血病：CXCL12/CXCR4维持骨髓微环境黏附，在急性T细胞淋巴细胞白血病(T-ALL)中，CXCL12诱导H3K9甲基化，改变染色质构象，增强白血病细胞的核变形能力和迁移性；慢性淋巴细胞白血病(CLL)中，CXCL12/STAT3通路促进IL-10表达，抑制T细胞功能，介导免疫逃逸。此外，CXCL12/CXCR4轴通过激活STAT3，保护肿瘤细胞免受化疗诱导的凋亡。● 乳腺癌：CXCL12/CXCR4可间接诱导CyclinD1和VEGF表达，促进肿瘤增殖和血管生成。临床样本中，CXCR4与磷酸化STAT3(p-STAT3)的共表达与肿瘤大小、淋巴结转移及组织学分级呈正相关。● 肺癌：CXCL12/CXCR4通过JAK2/STAT3通路抑制顺铂诱导的肺癌细胞凋亡，临床样本中CXCL12与p-STAT3表达呈正相关，且与恶性进展相关。● 膀胱癌：癌症相关成纤维细胞(CAFs)分泌的CXCL12通过JAK2/STAT3通路诱导p62蛋白积累，抑制PD-L1的自噬降解，促进免疫逃逸。表4 癌症中针对CXCR4的治疗干预(临床试验)神经退行性疾病● 阿尔茨海默病(AD)：CXCL12/CXCR4激活NF-κB通路，促进小胶质细胞释放TNF-α，加速Aβ聚集和tau过度磷酸化，导致突触丢失，损害神经祖细胞(NPC)增殖和记忆形成。● 帕金森病(PD)：α-synuclein通过TLR4激活CXCL12/CXCR4信号，招募微胶质细胞并释放IL-1β，损伤黑质多巴胺能神经元。低浓度CXCL12通过CXCR4促进多巴胺释放(神经保护)，高浓度则通过Rac1通路诱导神经元凋亡。执行功能障碍与前额叶CXCL12/CXCR4介导的小胶质细胞活化相关。● 多发性硬化(MS)：CXCL12在MS斑块处异常分布，吸引CXCR4+免疫细胞穿越血脑屏障(BBB)，加剧脱髓鞘和轴突损伤。信息处理速度下降与CXCL12/CXCR4轴激活相关，CSF中CXCL12水平可作为疾病严重程度的生物标志物。● 肌萎缩侧索硬化(ALS)：CXCL12/CXCR4在脊髓前角运动神经元中上调，参与TDP-43蛋白聚集和应激颗粒形成，加速神经元死亡。约1/3患者伴前额叶认知障碍，与运动皮层微胶质细胞活化和CXCL12/CXCR4信号增强相关。图8 神经炎症和认知障碍图9 干细胞在神经炎症和再生中的作用和功能其他疾病● 银屑病：皮损中CXCL12和CXCR4表达升高，CXCL12+成纤维细胞招募CXCR4高表达中性粒细胞和T细胞，促进IL-17依赖性炎症和表皮增生。CXCR4阻断可改善咪喹莫特诱导的银屑病样病变，但角质形成细胞中CXCR4缺失反而加剧炎症，提示细胞类型特异性机制。● 脑损伤(弓形虫感染)：CXCL12与STAT3的mRNA表达升高，协同调控先天免疫和T细胞介导的保护性免疫，控制脑内弓形虫感染。● 心肌缺血：心脏干细胞通过旁分泌CXCL12激活STAT3，促进血管再生和心肌修复；miR-135a-5p/CXCL12/JAK-STAT轴则通过调控炎症和凋亡，减轻心肌梗死损伤。● 动脉损伤：JAK/STAT3通路诱导血管内皮细胞表达CXCL12，促进血管重塑过程中的增殖反应。● 皮肤疾病：CXCL12通过CXCR4激活真皮乳头层和外根鞘细胞的STAT3/STAT5，抑制毛发生长；在伤口愈合中，IL-10通过STAT3促进成纤维细胞合成透明质9178和VEGF，加速组织再生。● 胃炎(幽门螺杆菌感染)：cagA蛋白激活STAT3，后者与转录因子BHLHE40结合，上调CXCL12表达，促进胃黏膜CD4+T细胞浸润，加剧炎症反应。● 肾纤维化：CXCL12α/CXCR4通过JAK2/STAT3/GSK3β/β-catenin通路，抑制GSK3β活性，促进β-catenin核转位，诱导肾小管细胞纤维化；糖尿病肾病中，该轴还通过STAT3介导DPP4诱导的线粒体功能障碍。● 肝纤维化：CAFs分泌的CXCL12通过ACKR3/STAT3通路增强基质金属蛋白酶(MMP2)和VEGF表达，促进肿瘤内皮细胞迁移和血管生成。图10 CXCL12/CXCR4与STAT3通路表5 靶向CXCL12/STAT3通路的治疗药物纲要疼痛● 神经病理性疼痛：在多种神经病理性疼痛模型中，如坐骨神经损伤、糖尿病神经病变、HIV相关神经痛等，CXCL12/CXCR4轴的表达均上调。它通过激活下游信号通路、促进炎症因子(TNF-α、IL-1β)释放等机制，增强神经元兴奋性(如Nav1.8钠通道表达增加)，导致痛觉过敏和异常疼痛行为。在坐骨神经损伤模型中，损伤后CXCL12和CXCR4在背根神经节(DRG)和脊髓背角的表达上调，参与了神经病理性疼痛的发展和维持。● 炎症性疼痛：在CFA诱导的炎症性疼痛中，CXCR4基因启动子去甲基化，导致其表达升高，激活NF-κB和ERK通路，引发机械性痛敏。在慢性胰腺炎疼痛中，TLR4与CXCL12/CXCR4相互作用形成正反馈，激活星形胶质细胞和小胶质细胞，释放炎症因子，加重疼痛。● 癌症相关疼痛：在骨癌痛中，肿瘤细胞植入会诱导脊髓CXCL12表达，激活RhoA/ROCK2和CaMKII/CREB通路，增强神经元敏感性。在胰腺癌中，早期肿瘤通过CXCL12吸引施万细胞形成神经微环境，可能抑制疼痛，但晚期促进神经病理性疼痛。● 术后疼痛：以足底切口模型为例，术后脊髓背角CXCL12/CXCR4激活NF-κB和Akt，介导机械痛敏。抑制CXCR4可减少细胞外信号调节激酶(ERK)磷酸化，从而缓解疼痛。● 阿片类药物诱导的痛觉过敏(OIH)：CXCL12通过NMDAR(NR2B亚基)增强神经元兴奋性，导致痛觉过敏。使用CXCR4拮抗剂(如AMD3100)可降低NMDAR磷酸化，减轻痛觉过敏症状。● 复杂性区域疼痛综合征(CRPS-I)：在CRPS-I的慢性缺血疼痛(CPIP)模型中，脊髓背角CXCL12/CXCR4轴激活ERK通路，参与疼痛信号的传递。阻断CXCR4可减少c-Fos阳性染色细胞，降低胶质细胞激活，缓解机械性异常性疼痛。图11 慢性疼痛中的CXCL12/CXCR4轴的作用机制5挑战与未来方向现有挑战● 毒性与脱靶效应：小分子及抗体药物对正常组织(如肝、肾、骨髓等)的影响需通过优化靶向特异性解决(如纳米载体靶向)。● 实体瘤渗透限制：CXCR4⁺肿瘤细胞常位于基质丰富区域，纳米药物递送效率受限，需结合超声成像或微泡技术增强渗透。● 耐药性机制：长期治疗可能诱导CXCR4表达上调或信号通路代偿，需联合多靶点抑制剂(如同时阻断PI3K和CXCR4)。未来方向● 精准医学：通过⁶⁸Ga-PentixaforPET成像量化CXCR4表达，筛选高表达患者开展“篮子试验”(跨癌种治疗)。● 联合治疗策略：①免疫-靶向联合：CXCR4拮抗剂与化疗、免疫检查点抑制剂(如PD-1抗体)、TLR激动剂或、CAR-T细胞疗法或放疗联用，增强抗肿瘤免疫和敏感性，克服耐药。②双特异性分子：开发同时靶向CXCR4和其他CSC标记(如CD44、LGR5)的双抗或纳米颗粒，克服异质性。● 新型递送技术：①仿生纳米载体：模拟巨噬细胞膜的CXCR4靶向纳米囊泡，递送化疗药物并重塑免疫微环境。②智能响应型系统：pH或酶响应性纳米颗粒，在肿瘤微环境中释放药物，减少正常组织暴露。抗体发现服务 & 产品1羊驼免疫&骆驼免疫—自建现代化养殖农场2万亿级天然抗体库产品—轻松DIY科研抗体3配套产品—助您轻松搭建基因工程抗体平台关于仁域生物成都仁域生物成立于2019年1月，是一家专注基因工程抗体技术和天然抗体库开发的公司，拥有优化的噬菌体展示抗体库技术和现代化的骆驼/羊驼养殖免疫基地。可为客户提供14天、100%成功率的先导抗体分子发现服务，彻底解决传统抗体定制的周期长、失败率高、成本高三大难题。目前已经成功完成300+靶点抗体筛选项目！protocol 获取 / 产品咨询邮箱｜find@renyubio.com电话｜19136178673地址｜成都市经开区科技产业孵化园关注我们，小编将持续更新相关内容～参考文献Rueda A, Serna N, Mangues R, Villaverde A, Unzueta U. 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