2. Neoplasia V insensitivity to growth inhibition and escape from senescence : TUMOR SUPPRESSOR GENES

3. Internal controls of cell cycle - “CHECKPOINTS”
1. G1/S checkpoint : checks for DNA damage ,prevents replication of cells that have defects in DNA ; cell cycle arrest mediated through p53
2. G2/M checkpoint : monitors completion of DNA replication ; cell cycle arrest by p53- dependent & p53-independent mechanisms
Defects in cell cycle checkpoints are major cause of genetic instability
in cancer cells

4. TUMOR SUPPRESSOR GENES
Products of tumor suppressor genes apply “brakes” to cell proliferation – network of check points
Tumor suppressors like RB & p53 , are part of regulatory network that recognize genotoxic stress and respond by shutting down prolif
Another set of tumor suppressors involved in cell differentiation causing cells to enter postmitotic differentiated pool without replicative potential

5. Selected Tumor Suppressor Genes Involved in Human Neoplasms

6. rb gene RB - The 1st and prototypic tumor suppressor gene
60% retinoblastomas are sporadic
Familial Retinoblastoma inherited as an autosomal dominant trait.
Patients with familial retinoblastoma are also at greatly increased risk of developing osteosarcoma and other soft-tissue sarcomas.
“two-hit” hypothesis of oncogenesis proposed by Knudson

7. Knudson's hypothesis can be stated as follows :
 Two mutations (hits) involving both alleles of RB at chromosome locus 13q14, are required to produce retinoblastoma
In familial cases, children inherit one defective copy of the RB gene in the germ line (one hit ) ; the other copy is normal. .

8. Knudson's hypothesis :
 Retinoblastoma develops when the normal RB allele is mutated in retinoblasts as a result of spontaneous somatic mutation (second hit).
In sporadic cases both normal RB alleles must undergo somatic mutation in the same retinoblast (two hits). A retinal cell that has completely lost RB function becomes cancerous. .

9. pathogenesis of retinoblastoma

10. Role or rb in regulating G1/S TRANSITION
RB (RB protein) – product of Rb gene is nuclear phosphoprotein.
Active form – hypophosphorylated in quiescent cells
Inactive form – hyperphosphrylated in G1/S transition
Key role in G1/S checkpoint ; if RB is absent as a result of gene mutation the “molecular brakes” on cell cycle are released

11. Role or rb in regulating G1/S TRANSITION
Initiation of DNA replication requires activity of cyclinE – CDK2 ; expression of cyclin E is dependent on E2F family of transcription factors
In its active form RB binds to E2F & blocks E2F mediated transcription of cyclin E
RB couples control of cell cycle progression at G1 with diferentiation ; diff is associated with exit from cell cycle

12. Role of RB in checking G 1- S checkpoint of cell cycle

13. p 53 – guardian of the genome
p53 gene is located on chromosome 17p
Most common target for genetic alteration over 50% of human tumors contain mutations in this gene
Homozygous loss of p53 occurs in virtually every type of cancer, including CA lung, colon breast—the three leading causes of CA death
P53 protein functions as a transcription factor

14. p 53 – guardian of the genome
In response to DNA damage, p53 is phosphorylated by genes that sense the damage & are involved in DNA repair.
p53 links cell damage with DNA repair, cell cycle arrest, and apoptosis.
Assists in DNA repair by causing G1 arrest and inducing DNA-repair genes.
A cell with DNA damage beyond repair is directed to undergo apoptosis.

15. p 53 – guardian of the genome
In view of these activities, p53 has been rightfully called a “guardian of the genome.”
With loss of function of p53, DNA damage goes unrepaired, mutations accumulate in dividing cells, and the cell marches along a one-way street leading to malignant transformation.

16. The role of p53 in maintaining the integrity of the genome.

17. p53 prevents neoplastic transformation by three interlocking mechanisms:
activation of temporary cell cycle arrest (quiescence)
induction of permanent cell cycle arrest (senescence) or
triggering of programmed cell death (apoptosis)

18. Li – Fraumeni syndrome :
individuals who inherit one mutant allele of p53
have a 25 fold greater chance of developing malignant tumor by age 50 than general population

19. APC/β – CATENIN PATHWAY
Adenomatous polyposis coli genes (APC) is a tumor suppressor ; down-regulate growth-promoting signals.
Germ-line mutations at the APC (5q21) loci are associated with familial adenomatous polyposis
Almost invariably, one or more of these polyps undergoes malignant transfor- mation, giving rise to colon cancer.

20. APC /β –C ATENIN PATHWAY
Both copies of the APC gene must be lost / mutated for tumor to arise
APC (& β-catenin ) are component of the WNT signaling pathway, which has a major role in controlling cell fate, adhesion, and cell polarity during embryonic development
An important function of the APC protein is to down-regulate β-catenin
Cells with loss of APC behave as if they are under continuous WNT signaling

21. A, The role of APC in regulating the stability and function of β-catenin. APC and β-catenin are components of the WNT signaling pathway. In resting cells (not exposed to WNT), β-catenin forms a macromolecular complex containing the APC protein. This complex leads to the destruction of β-catenin, and intracellular levels of β-catenin are low.
B, When cells are stimulated by WNT molecules, the destruction complex is deactivated, β-catenin degradation does not occur, and cytoplasmic levels increase. β-catenin translocates to the nucleus, where it binds to TCF, a transcription factor that activates genes involved in cell cycle progression.
C, When APC is mutated or absent, the destruction of β-catenin cannot occur. β-catenin translocates to the nucleus and coactivates genes that promote entry into the cell cycle, and cells behave as if they are under constant stimulation by the WNT pathway.

22. EVASION OF APOPTOSIS
Accumulation of neoplastic cells may also result from mutations in the genes that regulate apoptosis.
Apoptosis represents a barrier that must be surmounted for cancer to occur.
In the adult, cell death by apoptosis is a physiologic response to several pathologic conditions that might contribute to malignancy if the cells remained viable.

23. EVASION OF APOPTOSIS
CD95 receptor- induced (extrinsic pathway) and DNA damage–triggered (intrinsic) pathways of apoptosis & mechanisms used by tumor cells to evade cell death.
Reduced CD95/Fas (death receptors) level.
Inactivation of death-induced signaling complex by FLICE protein (caspase 8)
Reduced egress of cytochrome c from mitochondrion as a result of up-regulation of BCL2.
Reduced levels of pro-apoptotic BAX resulting from loss of p53.
Loss of apoptotic peptidase activating factor 1 (APAF1).
Up-regulation of inhibitors of apoptosis (IAP).

24. LIMITLESS REPLICATIVE POTENTIAL: TELOMERASE
Most normal human cells have a capacity of 60 to 70 doublings only, then become senescent due to progressive shortening of telomeres
Short telomeres are recognized by the DNA-repair machinery as double - stranded DNA breaks, and this leads to cell cycle arrest mediated by p53 and RB.
In cells in which the checkpoints are disabled by p53 or RB1 mutations, the nonhomologous end-joining pathway is activated to save the cell, joining the shortened ends of two chromosomes

25. LIMITLESS REPLICATIVE POTENTIAL: TELOMERASE
At mitosis the dicentric chromosomes are pulled apart, generating random double-stranded breaks, activating DNA-repair pathways, leading to the random association of double-stranded ends and the formation, again, of dicentric chromosomes
Genomic instability from the repeated “bridge-fusion-breakage cycles” eventually produces mitotic catastrophe, characterized by massive cell death.
For tumors to grow indefinitely tumor cells must Reactivate / Re-expression of telomerase
Re-expression of telomerase allows the cells to escape the bridge-fusion-breakage cycle

26. Sequence of events in the development of limitless replicative potential.
Replication of somatic cells, which do not express telomerase, leads to shortened telomeres.
In the presence of competent checkpoints, cells undergo arrest and enter nonreplicative senescence.
In the absence of checkpoints, DNA-repair pathways are inappropriately activated, leading to the formation of dicentric chromosomes.

27. ANGIOGENESIS
Solid tumors cannot enlarge beyond 1 to 2 mm in diameter unless they are vascularized
Cancer cells can stimulate neoangiogenesis or in some cases vasculogenesis
Tumor angiogenesis is controlled by the balance between angiogenesis promoters and inhibitors (e.g p53)
Tumor vasculature is abnormal, vessels are leaky , dilated and have a haphazard pattern of connection

28. ANGIOGENESIS
Most human tumors do not induce angiogenesis early remain small /in situ, possibly for years, until the angiogenic switch terminates this stage
The molecular basis of the angiogenic switch involves increased production of angiogenic factors and/or loss of angiogenic inhibitors
These factors may be produced directly by the tumor cells ,or by inflammatory cells (e.g., macrophages) or stromal cells

29. ANGIOGENESIS Neovascularization has a dual effect on tumor growth:
1. Perfusion - supplies needed nutrients & O2
2. Endothelial cells secrete growth factors (IGFs, PDGF, GMCSF) promoting growth of adjacent tumor cells
Angiogenesis is required also for access to the vasculature and hence for metastasis.
Angiogenesis is thus a necessary biologic correlate of malignancy