Genetic and Epigenetic Alterations As Hallmarks of the Intricate Road to Cancer
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Oncogene (2003) 22, 6472–6478 & 2003 Nature Publishing Group All rights reserved 0950-9232/03 $25.00 www.nature.com/onc Genetic and epigenetic alterations as hallmarks of the intricate road to cancer Marcella Macaluso1,2, Marco G Paggi3,1 and Antonio Giordano*,1 1Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, PA, USA; 2Department of Oncology Section of Molecular Oncology, Regional Reference Center for the Biomolecular Characterization of Neoplasm and Genetic Screening of Hereditary Tumors, University of Palermo, Palermo, Italy; 3Regina Elena Cancer Institute, Center for Experimental Research, Rome, Italy Despite the clonal origin of most tumors, their tremendous Basically, two major classes of mutations can be heterogeneity suggests that cancer progression springs considered:(a) ‘gatekeeper’ mutations, which compro- from the combined forces of both genetic and epigenetic mise the control of cell proliferation, and (b) ‘caretaker’ events, which produce variant clonal populations, together mutations, responsible for genetic instability (Cairns, with the selective pressures of the microenvironment, 1975; Kinzler and Vogelstein, 1997; Frank, 2003; Russo which promote growth and, perhaps, dissemination of et al., 2003). Alterations in these cancer susceptibility variants with a specific set of characteristics. Although the genes may result through either genetic or epigenetic importance of genetic mutations in cancer has long been mechanisms; while the genetic abnormalities are asso- recognized, the role of epigenetic events has been ciated with changes in DNA sequence, the epigenetic suggested more recently. This review focuses on the events may lead to changes in gene expression without genetic and epigenetic molecular mechanisms involved in changes in DNA sequence through different mechan- cancer onset and progression, and discusses the possibility isms. Methylation of DNA and remodeling of chroma- of new strategies in the development of anticancer tin via histone proteins, are believed to be the most treatments. important epigenetic changes, whose role in cancer has Oncogene (2003) 22, 6472–6478. doi:10.1038/sj.onc.1206955 been recently underscored. This review focuses on the genetic and epigenetic Keywords: cell transformation; cancer development and molecular mechanisms involved in cancer formation and progression progression; moreover, the possibility of new strategies in the development of anticancer treatments is discussed. From the normal control of the cell cycle to tumorigenesis Introduction Cancer is intimately related to the process of develop- Human cancer is widely recognized as an intricate ment and growth. Every gene implicated in the multistep process that involves malfunction in proto- progression to a cancerous phenotype plays a funda- oncogenes, tumor suppressor genes, and other key mental role, during embryo growth and development. cellular genes implicated in cell proliferation, differen- Genes that regulate these processes are thus important tiation, survival, and genome integrity (Hahn et al., targets of research to understand differences in the 1999; Hahn and Weinberg, 2002). Perhaps surprisingly, control of gene expression between normal and cancer the whole process of cell transformation has been shown cells and to identify new candidates for anticancer drug to be not so easy to achieve, due to the intrinsic development. resistance to transformation at both cellular and The cell cycle is a very finely tuned process and organismic levels; in fact, it may take decades to be responds to the specific needs of any specific tissue or accomplished through subsequent rounds of clonal cell (Hartwell and Kastan, 1994). Normally, in an adult selection. Owing to this peculiar mechanism, several tissue, we observe a delicate balance between pro- different combinations of gene inactivations can be grammed cell death (apoptosis) and proliferation (cell found in the genome of morphologically similar human division) which is responsible for the dynamic steady cancers, and this phenomenon is possibly responsible for state. Disruption of this equilibrium by loss of cell cycle the enormous heterogeneity in outcomes of patients with control may lead to hyperplasia and eventually to tumor the same clinical diagnosis. development (Hanahan and Weinberg, 2000). Mutations in oncogenes and tumor suppressor genes and alterations in their signaling pathways have been *Correspondence:A Giordano; E-mail:[email protected] identified to be involved in the uncoupling of the cell Genetic and epigenetic causes of cancer M Macaluso et al 6473 cycle from its normal regulatory parameters (Gan et al., pRb/p16INK4/cyclin D1 pathway 2003). Gatekeeper genes function by directly controlling cell growth, thus inhibiting proliferation, leading to Cancer cells acquire a growth advantage by evading apoptosis and/or promoting terminal differentiation antigrowth signals. pRb/p16INK4a/Cdk4–6/D-type cyclins (Russo et al., 2003). These genes are frequently mutated constitute a G1 regulatory pathway commonly targeted in both sporadic and hereditary tumors, and their in many tumors, particularly in virtually all human functional loss is rate limiting for tumor growth of a melanomas (Bartkova et al., 1996; Mælandsmo et al., specific tissue type. Alteration of a particular gatekeeper 1996). gene can lead to the development of a particular form of Many of the antiproliferative signals that regulate the predisposition to cancer (Kinzler and Vogelstein, 1997). cell cycle clock are funneled through the retinoblastoma Caretaker genes are involved in the maintenance of protein (pRb) and its related proteins, p107 and pRb2/ genomic stability by reducing the mutation rates in p130 (Cinti and Giordano, 2000). At least two opposing gatekeepers and oncogenes. Mutations in these genes enzymatic reactions control the activity of pRb family are frequently found in hereditary tumors (Kinzler members:phosphorylation and dephosphorylation and Vogelstein, 1997). Consequently, an altered (Cinti and Giordano, 2000). The overall mechanism of gatekeeper gene could affect mainly tumor initiation, tumor formation seems to consist of inhibitory effects while a caretaker gene could accelerate the tumor on the pRb pathway controlling the G1–S transition and progression, even if in certain cases their functions it is also accomplished by alterations in other regulatory may partly overlap; as such the same gene may act either components of this pathway resulting in decreased as a gatekeeper or as a caretaker (Frank, 2003). tumor suppression. Mutations and deletions of the Rb gene have been reported in several human tumors, and Alteration of cell cycle checkpoints inherited allelic loss of Rb confers increased suscept- ibility to cancer formation (Yamasaki, 2003). The genetic evolution of normal cells into cancer cells is Nevertheless, the Rb-related Rb2/p130 gene plays a largely determined by the fidelity of DNA replication, pivotal role in the negative control of the cell cycle and repair, and division. The switch between phases is a in tumor progression as well (Paggi and Giordano, hallmark of the cell cycle, and the control mechanisms 2001). that restrain cell cycle transition or induce apoptotic Loss-of-function mutations in p16INK4a, a cell cycle signaling pathways after cell stress are known as cell regulatory protein involved in tumor suppression in the cycle checkpoints (Sherr, 2000). Intrinsic and extrinsic pRb pathway, occur frequently in human cancers (Ruas mechanisms act to control and regulate the cell cycle. and Peters, 1998; Sherr, 2000). p16INK4a blocks cell cycle The intrinsic mechanisms appear at every cycle and the progression by binding Cdk4–6 and inhibiting the action extrinsic mechanisms only act when defects are detected of D-type cyclins. Moreover, by inhibiting pRb phos- (Sandal, 2002). Loss of these control mechanisms by phorylation, p16INK4a can promote the formation of a genetic and epigenetic events results in genomic pRb/E2F-repressive complex that blocks the G1–S instability, accumulation of DNA damage, uncontrolled progression of the cell cycle (Zhang et al., 1999). In cell proliferation, and eventually tumor development. fact, it has been reported that both cyclin D1 over- Cyclin-dependent kinases (Cdks), cyclins, Cdk inhibi- expression and p16INK4a protein alteration produce tors (CKIs), Cdk activator kinases (CAKs), tumor persistent hyperphorylation of pRb, resulting in evasion suppressor genes (gatekeepers, caretakers, and of cell cycle arrest (Beasley et al., 2003). landscapers), and oncogenes are the main players in Small homozygous deletions are the major mechan- the mammalian cell cycle. ism of p16INK4a inactivation in various primary tumors Cells escape growth control and evade cell death by such as glial tumors and mesotheliomas, while muta- targeting key oncogenes and tumor suppressor genes in tions are not commonly reported (Jen et al., 1994; Ohta molecular pathways. The pRb (pRb/p16INK4a/cyclin D1) et al., 1994; Cairns et al., 1995; Zhang et al., 1998). and p53 (p14ARF/mdm2/p53) pathways are the two main Moreover, aberrant methylation of p16INK4a has been cell cycle control pathways frequently targeted in shown in cancer of the lung, breast, bladder, head and tumorigenesis, and the alterations occurring in each neck, colon, and esophagus (Gonzales-Zulueta et al., pathway depend on the tumor type (Giaccia and 1995; Woodwock et al., 1999; Esteller et al., 2001).