1. Molecular Basis of Cancer Carcinogenesis Dr. Raid Jastania

2. Molecular Basis of Cancer Tumors are monoclonal proliferation Tumors carry genetic defect that are not lethal (inherited or acquired) Transformed cells acquire gene defects that allow them to form tumor

3. What are the genes involved in Cancer? A lot of genes! Like what? Genes promote growth eg. RAS Genes inhibit growth eg. P53 Genes control apoptosis eg. Bcl-2 Genes of DNA repair And others….

4. Molecular Basis of Cancer Targeted genes: –1. Proto-oncogenes (oncogenes) –2. Tumor suppressor genes –3. Genes controlling apoptosis –4. Genes regulating DNA repair Other genes involved: –Genes regulating angiogenesis –Genes enhancing invasion and metastasis Carcinogenesis is a multistep process –At both genetic and phenotypic levels –Progression results from accumulation of genetic defects

5. Molecular Basis of Cancer What does a cell need to be “cancer”? –Independent growth (growth autonomy) –Insensitive to inhibition of growth –Resistant to apoptosis –No aging (continuous dividing) –Sustained angiogenesis –Ability to invade and metastsize

6. Independent Growth (Growth Autonomy) By the action of oncogenes (from protooncogenes) Promote growth, no control Normal growth (dividing) –Growth factor – Growth factor receptor – Signal transduction – Transcription factors – Entry of the cell cycle by cyclins and CDK’s

7. Independent Growth Growth Autonomy by Oncogenes Growth factors –PDGF in Glioblastoma multiforme –TGF-alpha in Sacroma Growth factor receptors –EGF (epidermal growth factor) ERBB1 in squamous cell carcinoma of lung ERBB2 in breast cancer

8. Independent Growth (Growth Autonomy) Signal transducing proteins –RAS: colon cancer, pancreatic cancer –ABL: (BCR-ABL) in Chronic myologenous leukemia (CML) –Gleevec is a drug used to inhibit ABL action and used in the treatment of CML

9. Independent Growth (Growth Autonomy) Transcription factors: –MYC: in Burkitt lymphoma Cyclins and CDK: –Cyclin D: in breast cancer, liver cancer, lymphoma

10. Insensitivity to growth Inhibition Retinoblastoma gene RB –Two-hit hypothesis (Knudson) –Mutated in many cancer including retinoblastoma TGF-beta pathway –Act through RB –Mutated in colon cancer, stomach and endometrial cancer

11. Insensitivity to growth Inhibition APC – beta catenin pathway –APC in cytoplasmic protein that regulates the level of beta-catenin –Beta-catenin activates cell proliferation –APC binds to Beta-catenin and enhance degradation –Inherited mutation of APC in FAP (familial adenomatous polyposis) –2 nd hit occurs and adenoma appear –With time more adenoma 100’s and 1000’s –Cancer develop when other genes affected eg. RAS, P53

13. Insensitivity to growth Inhibition P53: –Common in human cancer 70% –Tumor suppressor gene –DNA damage – P53 activation by release from MDM2 P53 results in arresting the cell cycle by increasing P21. P53 enhance repair of the DNA damage by GADD45 P53 induces apoptosis by increasing level of Bax –Li-Fraumeni Syndrome: inherited mutated P53

14. Resistance to Apoptosis Bcl-2 family Level of Bcl-2 vs. BAX, BAD Bcl-2 prevents apoptosis by preventing the release of cytochrome C Bcl-2 overexpressed in lymphoma

15. No Aging (continuous dividing) Normal cells have 60-70 replication possible, then the cells cannot divide (aging) This is done by shortening of Telomere Tumors have telomerase activity and prevent cell aging

16. Angiogenesis Tumors cannot grow more than 2 mm with no vascular supply Hypoxia induces angiogenesis Tumor associated angiogenic factors –VEGF –bFGF P53 inhibits angiogenesis

17. Ability to invade and metastasize 1. Loosening of intercellular junction E-cadherin mutation 2. Attachment to matrix Cancer cells have high number of receptors to ECM like laminin receptor 3. Degradation of ECM By secreting metalloproteinases 4. Migration By the action of cytokines and chemokines 5. Homing Expression of adhesion molecules

18. Genomic Instability DNA mismatch repair genes: hereditary non-polyposis colon cancer DNA excision repair gene: Xeroderma pigmentosum Ataxia telangiectasia (ATM) gene senses the DNA damage BRCA1, BRCA2: involved in DNA repair

19. Multistep Carcinogenesis Colon Cancer: –APC – RAS – P53 –Hyperplasia – Adenoma – Carcinoma Tumor progression and heterogeneity

28. Etiology of Cancer Genetic Damage –1. Chemicals –2. Radiation –3. Microbes

29. Etiology of Cancer Heredity: –Inherited cancer syndromes –Familial cancer –Autosomal recessive syndromes of defective DNA repair

30. Etiology of Cancer Heredity: –Inherited cancer syndromes Autosomal dominant Eg. Familial Adenomatous Polyposis (FAP) Retinoblastoma, MEN, Neurofibromatosis, von Hipple-Lindau –Familial cancer Not clear transmission pattern Cancer at early age, multiple, affecting relatives BRCA1, BRCA2 –Autosomal recessive syndromes of defective DNA repair: Xeroderma pigmentosum, ataxia telangiectasia

31. Etiology of Cancer Chemicals: –Scrotal cancer in chimney sweepers –Direct or indirect action –Natural or synthetic –Alkylating agents, hydrocarbons, smoking, Azo dyes, Aflatoxin B1 –Mechanism: mutation of genes (promoters and initiators)

32. Etiology of Cancer Carcinogens –Smoking: causes lung cancer, pancreatic cancer, bladder cancer –Asbestos: found in construction, roofing papers, fire- resistant textile, causes lung cancer, mesothelioma, GI cancer –Benzene: found in light oil, printing, paint rubber, dry cleaning, adhesive, causes leukemia and lymphoma –Cadmium: found in batteries, metal plating, causes prostate cancer –Vinyl chrolride: found in refrigerant, adhesive, causes liver cancer

34. Etiology of Cancer Radiation: –Ultraviolet sun light, x-ray, nuclear radiation –Chromosome breakage, translocation, mutation, genomic instability –Ultraviolet light causes skin cancer, common in Australia.

35. Etiology of Cancer Viruses and microbes –Acute transforming viruses contain viral oncogenes –Slow transforming viruses cause insertional mutation HTLV-1 causes T-cell lymphoma HPV: cervical cancer EBV: lymphoma HBV: Liver cancer Helicobacter pylori: gastric cancer