Saturday, October 10, 2009

Telomerase and Wnt signaling

Now that research into telomeres and telomerase has (finally) garnered a Nobel Prize, it's a good time to write about recent research on the subject.

Seminal work on telomeres by Elizabeth Blackburn, one of the Nobel winners, was published way back in 1978, and active studies have been going on ever since. So perhaps it's not surprising that the rate of new findings is not so rapid as occurs in newer areas – such as stem cells.

But fascinating new results on telomeres and telomerase do still appear, and one of them connects with more recent research areas – such as Wnt signaling and... stem cells.

Here's the press release:

Discovery pinpoints new connection between cancer cells, stem cells (7/1/09)
A molecule called telomerase, best known for enabling unlimited cell division of stem cells and cancer cells, has a surprising additional role in the expression of genes in an important stem cell regulatory pathway, say researchers at the Stanford University School of Medicine. The unexpected finding may lead to new anticancer therapies and a greater understanding of how adult and embryonic stem cells divide and specialize.

Don't bother getting excited about the "new anticancer therapies" bit. That's just boilerplate that about 77.3% of all press releases dealing with cell biology contain, presumably to impress the rubes. If you need something to get excited about, you might recall that telomerase is also being investigated intensively in connection with issues of aging and longevity, independently from cancer. However, while it's possible that something of medical significance may come from this research, that's probably way down the road.

Before discussing the new research, let's review some of the background on telomeres, telomerase, and Wnt signaling.

To begin with, a telomere is a series of short repeated segments of DNA found at the ends of chromosomes in all eukaryotic cells. In cells of vertebrate animals the repeated segment is TTAGGG (where the letters represent nucleobases: T=thymine, A=adenine, G=guanine).

The total number of nucleotides in these repeated segments varies a great deal from species to species, but in humans it is (initially) about 10,000 nucleotides (or ~1700 complete segments). I say "initially", because part of the telomere is lost every time a cell divides – perhaps 50 to 200 nucleotides per division. Obviously, this means that an adult cell newly derived from a stem cell can divide at most 50-200 times before the telomere is all gone. In practice, the number is a lot less than the maximum, perhaps 40 to 60 times, which is called the Hayflick limit. Cells are programmed to stop dividing on reaching this limit, since otherwise useful DNA would be lost or damaged upon further division.

Why does this loss occur? It seems to be somewhat of an accident of the nitty-gritty details of how DNA replication occurs during cell division. I won't go into that, since it's best explained with some diagrams; you can read about it at Wikipedia. In fact, in the early days of molecular biology (around 1972), what happens at the end of chromosomes during DNA replication was rather puzzling, and the puzzle was called the "end replication problem". Now it's pretty well understood, though somewhat messy.

In any case, the loss of DNA from the telomeres during cell division is a fact, and it conveniently explains the existence of the Hayflick limit, which had been recognized since 1965. What happens when the teleomere is all used up and the limit is reached? Cells that have reached the limit don't necessarily die (though they might), but they do stop dividing, and they enter a static phase of cell life known as senescence.

If you think about it, senescence can be a problem, especially in certain tissues that need to continually replenish their cells, such as skin and the lining of the intestines, as well as hair, fingernails, etc. How is senescence circumvented in such tissues? The answer is (adult) stem cells. It turns out that stem cells are not subject to the Hayflick limit. It's not clear whether they are subject to limits at all.

Like any other cell type, stem cells also divide (by the process technically known as mitosis). But there is one difference from the way "ordinary" cells divide. Stem cells can divide asymmetrically, where one daughter cell is another stem cell, but the other daughter is a "progenitor cell", which is close to a normal, fully-differentiated adult cell of a fixed tissue type. Progenitor cells differentiate further into the final form when they divide, and they are able to divide only a limited number of times.

So how is it that stem cells are able to escape the Hayflick limit, dividing an indefinite number of times, even though they are also subject to the same loss of telomere nucleotides with each division? The answer is the enzyme telomerase, which is able to rebuild shortened teleomeres. It's fortunate for the longevity of complex organisms that telomerase exists, otherwise stem cells would not be able to divide often enough to allow tissues exposed to harsh conditions (such as skin and intestinal lining) to be replenished.

In order to explain the results of the research to be described here we need to say more about telomerase, but first let's summarize the function of telomeres. At first it may seem that all they do is compensate for the sloppy way that DNA replication works, by providing long stretches of expendable DNA at the ends of chromosomes. But there is one other notable function: teleomeres are a useful "cap" at the end of a chromosome that is recognizable to cellular mechanisms responsible for detecting DNA damage. If it weren't for the telomeres, the ends of chromosomes would be indistinguishable from DNA damage, which can result from errors in the replication process, as well as damage due to external agents such as ionizing radiation or harmful chemicals. Cells have various mechanisms for repairing many kinds of damage, but even if repair isn't possible, other mechanisms exist that recognize the damage and prevent further cell division or cause programmed cell death (apoptosis).

Not all DNA damage can be repaired or compensated for by apoptosis or cessation of cell division. Unrepaired DNA damage (however it occurs) is the main cause of cancer (though not the only one). So the existence of the Hayflick limit as a result of teleomere shortening acts as one defense against cancer. Cancer can be defined as the uncontrolled proliferation of cells as a result of DNA damage (affecting existing mechanisms that normally control proliferation) or other causes. So fixed limits on the number of times a cell can divide is one of a number of mechanisms organisms have to guard against cancer.

Before moving on, here's a quick summary of the functions served by telomeres: (1) compensate for the chromosome "end replication problem"; (2) make it possible for cells to distinguish chromosome ends from damaged chromosomes; (3) provide natural limits to the number of times ordinary cells can divide, as protection against cancer.

As noted above, the third of these functions is a problem for stem cells that do need the ability to divide an indefinite number of times. Repair of tissues exposed to harsh conditions is not the only circumstance this ability is needed. Another very important case is that of embryonic development. Multicellular, sexually-reproducing organisms start from a single cell (zygote). Yet there are close to 1014 cells in an adult human.

It is true that a single cell that underwent 47 cycles of cell division could theoretically produce that many cells. But that's really pushing the limits, since some cell types are needed in much larger numbers than others. The bottom line is that embryonic development is the other main circumstance when limits on cell division need to be overcome.

Telomerase is what makes this overcoming of telomere limits possible. And it does it in a pretty straightforward way. Telomerase is a complex molecule with three distinct parts. Two of these are proteins: Telomerase Reverse Transcriptase (TERT) and dyskernin, which are coded for by distinct genes. TERT does most of the work. The other part is a short piece of RNA, called the telomerase RNA component (TERC), which contains and is somewhat longer than the repeat unit (TTAGGG in vertebrates). Like any other reverse transcriptase enzyme (other examples of which occur in RNA viruses such as HIV), TERT simply translates a piece of RNA into DNA and inserts it into a chromosome. In the case of telomerase, the RNA is carried inside the enzyme complex itself. Telomerase does its job simply by replacing the telomere DNA that is lost from chromosomes during mitosis.

So telomerase performs the function of rebuilding telomeres, and this is essential in tissues where cells must proliferate rapidly, such as in embryonic development and tissue regeneration. But as we noted above, if the restriction on cell division is circumvented, the risk of cancer goes up. Although telomerase serves an essential purpose in specialized contexts, it also makes it possible for cells to become cancerous. Consequently, telomerase is not expressed in most adult body cells. However, telomerase is expressed in about 90% of tumor cells.

It might seem as though one approach to controlling or even destroying cancer could involve either inhibiting telomerase or developing a vaccine using telomerase to induce an immune response against telomerase-rich cancer cells. There are in fact various clinical trials exploring both techniques. But this is tricky and rather risky, because as we've observed, telomerase is needed in stem cells required for tissue regneration, at least once the cells have begun proliferating. Those cells need to be protected while they are simply doing their job – replenishing skin and intestinal linings, for example. We need to understand how such cells are controlled so that they work without leading to cancer.

Anyhow, TERT is a protein that is an essential component of telomerase, which plays an important role in cell proliferation. The new research we're finally almost ready to discuss shows that, surprisingly, TERT also plays a role in a completely different aspect of cell proliferation having nothing to do with telomeres. That's where Wnt signaling comes in.

Wnt signaling is a subject we've looked at several times before. Some of the relevant articles are here, here, here, and here. Wnt was first noticed in connection with embryonic development and tissue regeneration. This article has many examples. The name Wnt alludes to a gene called "wingless", because the gene causes fruit flies to lack wings when the gene is mutated.

Recently Wnt's importance in stem cells has also received a lot of attention. Some of our discussion of that may be found here, here, here, and here. Wnt's relevance to cancer and cancer stem cells is often touched on in most of all the articles listed.

Basically, Wnt is the name of a family of proteins that play an important role in signals promoting cell proliferation, especially in the context of embryonic development and tissue renewal (skin, intestines, hair, and immune system cells). Since Wnt proteins promote proliferation, they also play a role in cancer.

The fact, then, that new research shows teleomerase can enhance Wnt signaling is signficant as a second, entirely separate route through which it plays a role in both normal stem cell function and cancer.

Here's the research abstract:

Telomerase modulates Wnt signalling by association with target gene chromatin (7/2/09)
Stem cells are controlled, in part, by genetic pathways frequently dysregulated during human tumorigenesis. Either stimulation of Wnt/β-catenin signalling or overexpression of telomerase is sufficient to activate quiescent epidermal stem cells in vivo, although the mechanisms by which telomerase exerts these effects are not understood. Here we show that telomerase directly modulates Wnt/β-catenin signalling by serving as a cofactor in a β-catenin transcriptional complex. The telomerase protein component TERT (telomerase reverse transcriptase) interacts with BRG1 (also called SMARCA4), a SWI/SNF-related chromatin remodelling protein, and activates Wnt-dependent reporters in cultured cells and in vivo. TERT serves an essential role in formation of the anterior–posterior axis in Xenopus laevis embryos, and this defect in Wnt signalling manifests as homeotic transformations in the vertebrae of Tert-/- mice. Chromatin immunoprecipitation of the endogenous TERT protein from mouse gastrointestinal tract shows that TERT physically occupies gene promoters of Wnt-dependent genes. These data reveal an unanticipated role for telomerase as a transcriptional modulator of the Wnt/β-catenin signalling pathway.

That's a pretty good summary of the paper, but I imagine most people would like a bit more explanation of what's going on.

Previous research had disclosed some interesting "coincidences" involving stems cells and embryonic development, in which both telomerase and Wnt signaling seemed to have similar effects, even though no obvious connection was known. For example, epidermal (skin) stem cells spend most of their time in a quiescent (non-dividing) state. The main function of Wnt proteins is to carry signals between cells that inform target cells of a need to start dividing, for example during various stages of embryonic development or to heal wounds. The curious thing is that telomerase was known to have a similar effect as Wnt signaling on some stem cells. This coincidence is enough to motivate looking for a connection.

If you are really into this sort of thing, you might want to refer to this diagram of various cell signaling pathways, including that of Wnt. One of the things it illustrates is the position of β-catenin in the Wnt pathway. β-catenin operates at the end of the pathway, where it becomes a part of a protein complex that includes transcription factors (known as TCF/LEF), and the complex causes expression of a variety of Wnt-regulated genes, which go on to enable cell proliferation.

One of the main findings of the research is that TERT interacts with another protein called BRG1 (or SMARCA4), and together these become important parts ("cofactors") of the gene-regulating protein complex. It was also determined that TERT is the only component of telomerase that is involved with Wnt signaling.

Apparently TERT is more important for some instances of Wnt signaling than for others. For example, low levels of TERT in embryos of the frog Xenopus laevis resulted in very abnormal development of the frog embryos (in terms for the anterior-posterior axis of the body). But low levels of TERT at a later stage of development caused only somewhat more subtle defects in formation of ribs in the embryo. Similar somewhat minor effects also occured with low levels of TERT in mouse embryos, and these defects were much like the effects of low levels of β-catenin.

So what, then, is so interesting about this research? It's satisfying to know the reasons for what were previously just observed coincidences, such as the fact that telomerase is not only very important for the ability of stem cells to divide freely (during embryonic development and tissue regeneration) but that it also can help stimulate stem cell division.

But what makes this research especially significant is the importance of the biological processes in which both telomerase and Wnt signaling play major roles – namely embryonic development, tissue regeneration and repair, and cancer. The latter two processes are especially important for medical reasons, although we're still a long way from being able to use this knowledge about telomerase and Wnt signaling for therapeutic purposes.

As far as cancer is concerned, we need to understand much more about how telomerase and Wnt signaling work in various types of stem cells, given that stem cells may play a big role in some types of cancer (though not in others).

But tissue regeneration and repair are also of significant medical interest, since it is the eventual inability of various types of tissues to replenish themselves in old age that is responsible for the many debilities that appear in old age. Many people have speculated that telomerase could help alleviate this problem – provided it does not also lead to facilitating the development of cancer.

Finally, we are left with the puzzle of how it is that TERT happens to play important – yet quite distinct – roles in two very separate processes that are, neverthelesss, both important for cell proliferation. We don't know the answer to this, but we can speculate. Perhaps it's because TERT has to be around anyway for stem cells during embryogenesis and tissue regeneration. That being the case, perhaps at some point in evolution, TERT also happened to help boost Wnt signaling a little. The effect of amplifying Wnt signaling in the same contexts that telomerase was needed would be advantageous and worth conserving. This kind of double duty should lead to more efficient use of cell resources.



ResearchBlogging.org
Park, J., Venteicher, A., Hong, J., Choi, J., Jun, S., Shkreli, M., Chang, W., Meng, Z., Cheung, P., Ji, H., McLaughlin, M., Veenstra, T., Nusse, R., McCrea, P., & Artandi, S. (2009). Telomerase modulates Wnt signalling by association with target gene chromatin Nature, 460 (7251), 66-72 DOI: 10.1038/nature08137


Further reading:

Cell biology: The not-so-odd couple (7/2/09) – expository article in Nature about the telomerase-Wnt research

Nobel in medicine honors discoveries of telomeres and telomerase (10/5/09) – news article in Science News

Nobel for insights into ageing and cancer (10/5/09) – news article in New Scientist

Chromosome protection scoops Nobel (10/5/09) – news article in Nature

Three Americans Win Physiology or Medicine Nobel (10/5/09) – news article at ScienceNOW.com

Work on Telomeres Wins Nobel Prize in Physiology or Medicine for 3 U.S. Genetic Researchers (10/5/09) – news article in Scientific American

Nobel Winners Isolate Protein Behind Immortality, Cancer (10/5/09) – news article at Wired.com

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Sunday, July 05, 2009

New targeted therapy finds and eliminates deadly leukemia stem cells

Insecure people who are derisive or dismissive of technical scientific terminology (which they affectedly disdain as "jargon") can miss a lot of significant meaning.

Consider the medical term "leukemia", which is familiar to the public as referring to a form of blood cancer. It's related to the less familiar term "leukocyte", which refers to various kinds of white blood cells. (The prefix "leuko-" is derived from Greek leukos, meaning "white". The suffix, "-cyte" is also Greek: kytos, meaning "cell".)

Leukocytes were originally recognized as distinct from other types of cells in the blood, especially "red" blood cells, which derive their color from iron-containing hemoglobin. There are actually a number of different types of leukocytes – and different types of corresponding leukemias. One common subtype of leukemia involves myeloid cells (myelocytes), which are normally found in bone marrow and occur as precursors to several types of blood cells. Acute myeloid leukemia (AML, also known as acute myelogenous leukemia) is the most common example, and has several subtypes itself.

Leukocytes of many types are derived from myeloid cells, which are thus a type of stem cell. When such cells develop certain types of abnormalities they harmfully overproduce derived cells, effectively making them cancer (specifically, leukemia) stem cells. The most common type of abnormality is a type of cell surface receptor known as CD123. A receptor is simply a protein found on a cell surface which binds to external cell signaling proteins called cytokines. (There's the "cyto-" again. The "-kine" part is from Greek kinos, which refers to motion, as in "kinetic".)

Cytokines are often interpreted by cells as signals to divide and proliferate, usually in a helpful way, as normal with immune system cells. Certain immune-system cytokines are called interleukins, because they facilitate signaling among immune system leukocytes. CD123 receptors, in particular, are receptors for interleukin-3. Thus CD123 receptors have another name: interleukin-3 receptor, alpha.

CD123 is essential for the normal communication between immune system cells such as T cells. It must exist on the surfaces of cells that need to respond to interleukin-3, in order to have a proper immune system response to infection. You do not, however, want CD123 on stem cells, whose excessive proliferation results in leukemia.

And so it is that one promising treatment for acute myeloid leukemia involves the development of a novel antibody, called 7G3, that can block CD123 receptors without triggering proliferation. Of course, that might interfere with immune system function – but such interference is preferable to leukemia.

New Targeted Therapy Finds And Eliminates Deadly Leukemia Stem Cells (7/2/09)
Associate Professor Lock [senior study author] and colleagues exploited the fact that the molecule CD123 is expressed at very high levels on LSCs but not on normal blood cells. CD123 is part of the interleukin-3 receptor, a protein that interacts with a growth factor (called a cytokine) that influences cell survival and proliferation. The researchers created a therapeutic antibody that recognized and bound to CD123 with the hope that this antibody would selectively interfere with AML-LSC survival.

When AML-LSCs from human patients were transplanted into mice treated with the antibody, called 7G3, cytokine signaling in the tumor cells was blocked. Further, 7G3 impaired migration of the AML-LSCs to bone marrow and activated the innate immune system of the host mouse to destroy the AML-LSCs. Overall, treatment with 7G3 substantially improved mouse survival when compared with control groups. The researchers go on to report that a CD123-targeting antibody is currently being used in phase 1 clinical trials of advanced AML and that there are no signs of treatment-related toxicity.
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Update, 8/14/09: Here's another research effort that's targeting CD123 in AML: New discovery points to a new treatment avenue for acute myeloid leukemia (7/6/09)

Further reading:

New Drug Hits Leukemia Early (7/2/09) – Science News article

Monoclonal Antibody-Mediated Targeting of CD123, IL-3 Receptor α Chain, Eliminates Human Acute Myeloid Leukemic Stem CellsCell Stem Cell research article

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Saturday, May 17, 2008

Cancer stem cells II

Since we've just had a discussion of generalities about cancer stem cells (here), it seems like it would be fun to have a summary of research on CSCs that was presented at the recent meeting of the American Association for Cancer Research in San Diego, or reported since then. So here it is.

As general background, keep in mind that cell surface proteins CD44 and CD24 are considered to be markers of cancer stem cells in various (but not necessarily all) types of cancer. Also, certain cell signaling pathways are thought to be especially important in the activity of cancer stem cells. The list includes Wnt, Sonic hedgehog, Notch, and Bmi1.


Stem Cell-Like Cancer Cells Resistant To Standard Therapy, Responsive To Targeted Therapy (4/29/08)
Previous research had identified a subset of cells in breast tumors that have the ability to form colonies in culture and give rise to tumors in mouse models. Such cells are thought to be cancer stem cells. They express the cell surface glycoprotein CD44, but not CD24, and they appear to be resistant to standard chemotherapeutic agents. However, the drug lapatinib, which inhibits the HER2 pathway, seems to selectively kill these cells.

Getting To The Roots Of Breast Cancer (4/29/08)
This is another report on the research described in the previous item. It provides additional details on the research protocol.

Stem Cell Type Supposed To Be Crucial For Angiogenesis And Cancer Growth Does Not Exist? (4/22/08)
This study casts doubt on the existence of a certain type of bone-marrow derived stem cell that has been suspected of circulating in the blood and acting as a precursor to endothelial cells that make up blood vessel walls. Such cells, if they existed, would be an important target for inhibiting angiogenesis in tumors. The researchers showed, using advanced techniques with mouse models, that endothelial differentiation is not a typical function of bone-marrow derived stem cells.

Ovarian Cancer Stem Cells Identified, Characterized (4/17/08)
Researchers have identified, characterized and cloned ovarian cancer stem cells and have shown that these stem cells may be the source of ovarian cancer's recurrence and its resistance to chemotherapy. They isolated cells from samples of either peritoneal fluid or solid tumors. The cancer stem cells that were identified had traditional cancer stem cell markers including CD44 and MyD88 (which interacts with toll-like receptors to activate NF-κB).
The cells also showed a high capacity for repair and self-renewal. Such cells, when isolated, were capable of forming tumors 100 percent of the time. Within those tumors, 10 percent of the cells were CD44 positive, while 90 percent were CD44 negative, indicating that some cancer stem cells had undergone differentiation.

Stem Cells: The Role Of Cancer-initiating Cells In Diagnosis And Treatment (4/15/08)
This press release describes research presented at the AACR meeting related to stem cells and pancreatic, bladder, ovarian, and breast cancer, and glioma.

Research in pancreatic cancer found that in addition to CD44 and CD24, the enzyme aldehyde dehydrogenase was expressed in a small population of tumor cells. Cells expressing aldehyde dehydrogenase had greater growth capacity than those that didn't, and they were also associated with poorer overall survival.

In a study of breast cancer and glioma, surface markers were not found be sufficient as markers of stem cell activity. However, cells with low proteasome activity did have notably greater capacity for self-renewal and tumor production capacity. (Proteasomes are large protein complexes that degrade unneeded or damaged proteins.)

Researchers studying bladder transitional cell carcinomas found, in 40% of cases, CD44+ cells with other stem cell self-renewal patterns. In these cells, 85% had active Gli1, a part of the Hedgehog pathway, originally discovered in human glioblastoma. A relatively small percentage had active Bmi1, Stat3, or β-catenin (part of the Wnt pathway). None had active Oct4 or Nanog (pluripotent stem cells markers).

The research on ovarian cancer (noted above) involving CD44 and MyD88 markers is referenced again here.

Stem Cell Marker Controls Two Key Cancer Pathways (4/14/08)
Research into breast cancer stem cells has identified, for the first time, another gene that may be involved, Msi1. The investigators showed that Msi1 activated Wnt and Notch signaling. Other studies have shown that Msi1 is a marker of human adult stem cells in general because it has been found in human breast, colon, brain, skin, and other cells. Msi1 was found to affects mammary cells to influence whether they develop into muscle, milk duct linings, etc. Further, Msi1 was found to be expressed in particularly aggressive tumors.

Stem Cells And Cancer: Scientists Investigate A Fine Balancing Act (4/11/08)
This is a report of a general talk about how the mechanisms normally involved in balancing different functions of stem cells may also contribute to cancer. For example, research shows that Bmi1 is important for maintaining stocks of stem cells, and without it stocks of stem cells are depleted. But also Bmi1 is overactive in various cancers including brain tumors.

Secrets of cellular signaling shed light on new cancer stem cell therapies (4/10/08)
Researchers are beginning to study inhibition of signaling pathways that seem to be active in tumors fed by cancer stem cells. In this case, inhibition of the Notch pathway is being investigated as part of a treatment, together with chemotherapy, for metastatic breast cancer. An important question is whether cancer stem cells are sufficiently different from normal adult stem cells so that inhibition of Notch signaling is not harmful. Results of testing in mice indicate that Notch signals are not required for the maintenance of blood-forming stem cells in adult mice.

Stem cells and cancer: cancer pathways that also control the adult stem cell population (4/10/08)
Apc (adenomatosis polyposis coli) is a tumor-suppressing protein that controls β-catenin and hence affects Wnt signaling. When intestinal crypts are damaged and need to be regenerated, Wnt signaling directs stem cells to generate replacement cells. Apc normally turns off Wnt signaling of stem cells when it is no longer needed. The research here showed that if Apc is lost or damaged, Wnt signaling may continue and result in tumor formation

Cancer Stem Cells Created With New Technique (4/9/08)
One of the most important unresolved questions about cancer stem cells is how they originate to begin with. For instance, are they mutations of existing stem cells, or instead precancerous cells that have acquired stem-cell-like capabilities? The research here supports the latter scenario. Starting with normal skin cells, the researchers activated three genes associated with embryonic stem cells. The result closely resembled known cancer stem cells. And they also had more resemblance to normal embryonic stem cells than to normal adult stem cells. One of the genes was Myc, which has also been used to create pluripotent stem cells from skin cells. In addition to the scientific significance of this work, it should also facilitate study of cancer stem cells, which are otherwise hard to locate.

Module Map Links Embryonic Stem Cells And Cancer Stem Cells (4/9/08)
The researchers involved in the work described in the preceding report have additional related findings. They systematically compared gene expression patterns between embryonic stem cells and multiple types of human cancer cells. Gene expression patterns in diverse human epithelial cancers were much like patterns in embronic stem cells. Further, presence of these patterns in cancer cells strongly predicted metastasis and death. On the other hand, normal adult tissue stem cells had an opposite pattern, which was repressed in various human cancers compared to normal tissues. The researchers additionally demonstrated that c-Myc, but not other oncogenes, was sufficient to reactivate the ESC-like program in normal and cancer cells.


And here's some earlier research that features the Nanog and Bmi1 proteins:

To Evade Chemotherapy, Some Cancer Cells Mimic Stem Cells (9/19/07)
Anti-cancer treatments often effectively shrink the size of tumors, but some might have an opposite effect, actually expanding the small population of cancer stem cells believed to drive the disease, according to new findings.

"Our experiments suggest that some treatments could be producing more cancer stem cells that then are capable of metastasizing, because these cells are trying to find a way to survive the therapy," said one of the study's investigators, Vasyl Vasko.

When the researchers applied various anti-cancer drugs to experimental cancer cells, they found that surviving cells expressed more Nanog and Bmi1:
They selected a rare form of cancer, mesenchymal chondrosarcoma (MCS), which has not been well described and for which there is no effective treatment. The researchers first determined that Nanog and BMI1 stem cell markers were more highly expressed in metastatic tumors compared to primary tumors. ...

They then applied various therapies - from VEGF inhibitors such as Avastin to the proteasome inhibitor Velcade - in mice implanted with human MSC, and analyzed the effects on tumors. Some of the treatments seemed to work, because they led to a dramatic decrease in the size of the tumors, Dr. Vasko said. But analysis of stem cell expression before and after treatment revealed that even as some anti-cancer treatments shrank tumors, they increased expression of Nanog and BMI1. "These treatments were not enough to completely inhibit tumor growth, and the cancer stem cell markers were still present," Dr. Vasko said.


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Sunday, May 11, 2008

Cancer stem cells

Cancer stem cells (CSCs) have been mentioned here before in passing – recently here, for example. But it's now time to direct particular attention to them.

One reason is that a number of new experimental results concerning CSCs were presented last month at the American Association for Cancer Research meeting in San Diego.

Another reason is that CSCs, like other stem cells, happen to utilize a number of the signaling pathways that are very interesting in connection with cancer, embryonic development, and various other cellular processes. The list includes Myc, Nanog, Notch, Sonic hedgehog (Shh), TOR, and Wnt. This is a rapidly developing field of research, and CSCs are right in the thick of things.

There is also some overlap with the recent active work going on with induced pluripotent stem cells (IPSCs). For example, Myc and Nanog turn up in IPSC research.

Finally, CSCs are also controversial (as is to be expected of any field that's in rapid flux) – and controversies are inherently interesting to read about.

One of the controversies concerns whether CSCs really exist and are important to the extent their principal investigators tend to believe. A reason to be skeptical of their importance is that there are some indications that CSCs should not be too rare, and that they should also be largely resistant to standard chemotherapy drugs. Yet in many cancers, chemotherapy can kill at least 99% of tumor cells, which would therefore include most CSCs. But this reasoning, too, is controversial.

But let's go back to first principles and explain just what a CSC is. Even that is tricky, since there are several models hypothesized for CSC behavior. In most general terms, however, a CSC is much like other adult stem cells, in that when a CSC divides, one daughter cell is an essentially similar CSC, while the other daughter is a more ordinary tumor cell, which does not have as much ability to proliferate by repeated division.

This is already somewhat different from the older picture of cancer. In that picture, one "renegade" cell first acquires somehow a mutation of its DNA which defeats one of the numerous cellular safeguards against uncontrolled cell proliferation. As time goes on, descendants of that cell accumulate further mutations that defeat other safeguards. Eventually, a significant population of cells exists which have a similar set of mutations that can evade most of the safeguards, and at that point, a dangerous tumor starts to grow. In effect, most of the cells of the tumor are stem cells, which continually produce more of their kind, without serious inhibition.

But it is gradually became clear that such a naive picture couldn't be generally correct. The main reason is that many cancerous cells stop dividing after awhile, and they are not capable of seeding a new tumor if (for instance) they are introduced into another part of an experimental animal having the tumor, or into a tumor-free animal. Most cells cannot divide an arbitrarily large number of times. There is a limit to the number of cell divisions, called the Hayflick limit. This limit, typically, is about 52 divisions. When the limit is reached, a cell does not necessarily die, but it does enter a new phase of life called the senescence phase, in which it ceases to divide.

The main reason for the Hayflick limit is a structure, called a telomere, found at the ends of all chromosomes. Telomeres consist of repeated short segments of DNA and protect the chromosome from damage during cell division. But a telomere shortens each time a cell divides, and once it becomes too short, the cell becomes senescent. This is because the mechanisms that protect a cell's DNA normally do not permit the cell cycle to function when telomeres are too short. Even if these mechanisms could be evaded, the cell's DNA would be damaged in the division process, and the resulting malfunctions would likely cause the cell to die.

However, stem cells need to be able to divide far beyond the Hayflick limit. Embryonic stem cells need this ability in order for an embryo to grow from a single cell into an organism with trillions of cells. Adult stem cells also need this ability to be able to replace cells in certain tissues that must be frequently renewed, such as in the skin and the lining of the intestines. In order to make this possible, stem cells express an enzyme, called telomerase, which has the specific function of rebuilding shortened telomeres.

Many, but not all, cancer cells also express telomerase. Only those that do are capable of indefinitely dividing. So such cancer cells have the production of telomerase in common with stem cells. That still doesn't mean that they are CSCs, because they may lack other attributes of stem cells. In particular, they may not be able to produce at least one exact copy of themselves when dividing. Instead, both daughter cells may be more differentiated and specialized than the mother cell, and (among other things) lose the ability to produce telomerase. Once that happens, the daughter cells' fate is eventual senescence, at best.

There are several possible ways in which CSCs might arise. One possibility is that all mutations necessary for a growing cancer occur, over a period of time, in a population of actual stem cells. (Once the mutations first occur, they of course are inherited by all descendants.) Another possibility is that only some of the mutations occur in the stem cell phase, while other mutations necessary for cancer occur after the full "stemness" is lost (but while the cells are still capable of repeated division). Perhaps a late stage of cancer development is that cells with enough oncogenic mutations to become cancerous reacquire an ability to divide repeatedly, if that was lost along the way.

In fact, there is evidence that both of these models, and possibly others, actually occur. It all boils down to the time sequence of mutation events in a particular type of cancer, and the sequence is likely to be different in different types of cancer. In any case, one of the main tasks of cancer research now is to figure out not only what mutations occur in a particular type of cancer, but also the order in which they typically occur. The hope is that sufficient knowledge of this process will make it possible to devise ways to stop it.

Here are some other things to read for additional background:


Update, 5/17/08: I've written up some summaries of recent research on cancer stem cells here.

Additional links:

The Cancer Stem Cells Project

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Sunday, April 27, 2008

TOR signaling and cancer

Another recent development pertinent to the discussion of TOR signaling and cancer (see here), is the announcement of preclinical findings about a potential anti-cancer drug that may act against ovarian cancer. The drug works by inhibiting the mTOR signaling pathway. (mTOR is the mammalian form of TOR.)

This is not at all the first anti-cancer drug that's come along with a similar mechanism of action. But it's still interesting, because any drug that affects TOR signaling has the potential of also causing unwanted side effects, since TOR signaling is involved in so many cell processes. Presumably some effort has been made to find reasons why the effect of the drug should be limited to cancer cells.

The drug is called NV-128, and has been developed by an Australian biotech company called Novogen. Since the drug hasn't yet entered clinical trials in humans, it could take a decade or so (as usual) to perform enough testing to determine that NV-128 is actually effective, and relatively safe.

Anyhow, here's the news release:

Drug Compound Leads To Death Of Ovarian Cancer Cells Resistant To Chemotherapy (4/17/08)
In a discovery that may be useful for maintaining remission in chemo-resistant ovarian cancer, Yale scientists report that pre-clinical studies have shown the drug compound NV-128 can induce the death of ovarian cancer cells by halting the activation of a protein pathway called mTOR.

Many traditional cancer drugs work by triggering cell death via apoptosis. Unfortunately, apoptosis needs enzymes called caspases to work, as explained here. And cancer cells may develop a circumvention of this mechanism by turning down the production of caspases, which are needed to allow mitochondria to respond to apoptosis signals. NV-128, however, is able to overcome this problem by triggering caspase-independent cell death.
In cancer cells, mTOR signals enhance tumor growth and may be associated with resistance to conventional therapies. Inhibition of mTOR could shut down many of these survival pathways, including proteins that protect the mitochondria of cancer cells.

Here's the Novogen press release:

Novogen’s NV-128 shown to target the akt-mTOR receptor in chemoresistant cancer cells (4/15/08)
NV-128 is unique in that it does not induce caspase-mediated apoptosis which can be non-functional in chemoresistant cancer cells due to accumulated mutations in tumour suppressor/promoter genes and over-expression of anti-apoptotic proteins. Rather, NV-128 uncouples the akt-mTOR­P70S6K signal transduction cascade which has a key role in driving protein translation and uncontrolled cancer cell proliferation. Further, NV-128 induces mitochondrial depolarization via a novel pathway involving the autophagy protein Beclin-1 and Bcl-2, thereby resulting in endonuclease G translocation to the nucleus and cell death.

The same research group that presented the findings just mentioned has also done work on ovarian cancer itself, and been able to locate cancer stem cells for this type of cancer:

Ovarian Cancer Stem Cells Identified, Characterized (4/17/08)
Researchers at Yale School of Medicine have identified, characterized and cloned ovarian cancer stem cells and have shown that these stem cells may be the source of ovarian cancer's recurrence and its resistance to chemotherapy.

As already mentioned, NV-128 is not the only drug under investigation for attacking cancer by targeting the TOR pathway. In fact, almost a year ago, the first anti-cancer mTOR-inhibitor received FDA approval. It's Toricel (temsirolimus), an intravenous drug from Wyeth Pharmaceuticals, for kidney cancer. Novartis has an oral drug (everolimus) for kidney cancer in Phase III trials. (It's already been approved by the FDA as an immunosuppressant to prevent rejection of organ transplants.) Interestingly, and unsurprisingly, everolimus is a derivative of Rapamycin (sirolimus) – an anti-fungal and immunosuppressive compound – which led to the original discovery of mTOR. Everolimus works similarly to Rapamycin as an mTOR inhibitor.

The American biotech company Ariad Pharmaceuticals has a small molecule anti-cancer mTOR inhibitor called deforolimus in intermediate clinical trials for a variety of solid cancers, such as sarcomas, endometrial, prostate, breast and non-small cell lung cancers. The company describes the drug as "a novel small-molecule inhibitor of the protein mTOR, a “master switch” in cancer cells. Blocking mTOR creates a starvation-like effect in cancer cells by interfering with cell growth, division, metabolism, and angiogenesis." Last summer Ariad entered into a major partnership with Merck to develop and test the drug, so this is an indication that the drug has definite promise.

Ariad has a nice video you can download, which explains a bit about how their drug works, and about TOR signaling in general. I highly recommend having a look at it, since it covers upstream signals that activate mTOR (growth factors, amino acids, oxygen, energy), downstream effects (synthesis of proteins for cell growth, cell division, metabolism, and angiogenesis). It notes that certain other signaling proteins (PTEN, Akt, PI3K) cause overactivation of mTOR, and it points out that mTOR stimulates the production of the cyclin D cell division protein.

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