Ultimate precision: targeting cancer but not normal self-replication

V Velcheti, D Schrump, Y Saunthararajah - Lung Cancer: New …, 2021 - Springer
Lung Cancer: New Understandings and Therapies, 2021Springer
Self-replication is the engine that drives all biological evolution, including neoplastic
evolution. A key oncotherapy challenge is to target this, the heart of malignancy, while
sparing the normal self-replication mandatory for health and life. Self-replication can be
demystified: it is an activation of replication, the most ancient of cell programs, uncoupled
from activation of lineage-differentiation, metazoan programs more recent in origin. The
uncoupling can be physiologic, as in normal tissue stem cells, or pathologic, as in cancer …
Abstract
Self-replication is the engine that drives all biological evolution, including neoplastic evolution. A key oncotherapy challenge is to target this, the heart of malignancy, while sparing the normal self-replication mandatory for health and life. Self-replication can be demystified: it is an activation of replication, the most ancient of cell programs, uncoupled from activation of lineage-differentiation, metazoan programs more recent in origin. The uncoupling can be physiologic, as in normal tissue stem cells, or pathologic, as in cancer. Neoplastic evolution selects to disengage replication from forward-differentiation where intrinsic replication rates are the highest – in committed progenitors that have division times measured in hours versus weeks for tissue stem cells - via partial loss-of-function in master transcription factors that activate terminal-differentiation programs (e.g., GATA4) or in the coactivators they use for this purpose (e.g., ARID1A). These loss-of-function mutations bias master transcription factor circuits, which normally regulate corepressor versus coactivator recruitment, towards corepressors (e.g., DNMT1) that repress rather than activate terminal-differentiation genes. Pharmacologic inhibition of the corepressors re-balances to coactivator function, activating lineage-differentiation genes that dominantly antagonize MYC (the master transcription factor coordinator of replication) to terminate malignant self-replication. Physiologic self-replication continues because the master transcription factors in tissue stem cells activate stem cell, not terminal-differentiation, programs. Druggable corepressor proteins are thus the barriers between self-replicating cancer cells and the terminal-differentiation fates intended by their master transcription factor content. This final common pathway to oncogenic self-replication, being separate and distinct from the normal, offers the favorable therapeutic indices needed for clinical progress.
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