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台大農藝系 遺傳學 601
20000
Chapter 22 slide 1
Tumor Genetics
MGL-12
July 21st 2013
Mohammed El-Khateeb
2
Cellular Basis of Cancer
• Cancer is a collection of diseases characterized
by abnormal and uncontrolled growth
• Cancer arises from a loss of normal growth
control
• In normal tissues, the rates of new cell growth
and old cell death are kept in balance
• In cancer, this balance is disrupted
• This disruption can result from
1) uncontrolled cell growth or
2) loss of a cell's ability to undergo apoptosis
3
Cancer Cell Do Not Grow Faster
Than Normal Cells
Rather, Their Growth is Just
Uncontrolled
4
Proliferation Differentiation Death
Transit
Proliferating
Exiting
Renewing
Cellular equilibrium
5Proliferation Differentiation Death
Cancer: disruption of
cellular equilibrium
6
Post mitoticStem cell
DifferentiatedNormal
senescent
differentiated
cell
Benign tumor
Grade 2
malignancy
Grade 3 or 4
malignancy
Stem cells as the target of carcinogens
CELL GROWTH
• Cells in the body are "programmed" to:
To develop
To grow
To differentiate
To die
• in response to a complex system
of biochemical signals.
Cancer results from the emergence of a clone of cells
freed of these developmental programming constraints
and capable of inappropriate proliferation
Cancer is a Disease of the Cell Cycle
Response to the
Environmental Signals
• SIGNALS RESPONSE
Growth Factors Differentiation
Steroids
Cell to Cell Interaction
Growth and Death
Mitosis
Fig. 18.2, Regulation of cell division by signal transduction.
10
Class I: Growth Factors
Class II: Receptors for Growth Factors and Hormones
Class III: Intracellular Signal Transducers
Class IV: Nuclear Transcription Factors
Class V: Cell-Cycle Control Proteins
Five types of proteins encoded by proto-oncogenes participate in control
of cell growth:
Types of Growth Factors
for Differentiation
1.Growth Factors
2.TM GF R (TKase)
3. Integral MR
4. Ras GTPase
5. Cytoplasmic
Oncogenes
6. Nuclear Oncogene
Oncogenes and Proto-Oncogenes
Products
Cancer cells have acquired the ability to
proliferate in the absence of appropriate
signals
Cancer: General Etiology
and Pathogenesis
• Etiologic agents: Environmental (chemical, physical, and biological)
Hereditary (familial cancer syndromes)
• General mechanisms: Acquired capabilities (Self-maintained replication,
longer survival, genetic instability, neoangiogenesis, invasion and metastasis)
Activation of oncogenes, inactivation of TSG, non-effective DNA repair
Caretaker and gatekeeper pathways
15
Cause Damage Cancer Risk Signals
Physical
UVSkin Ca,
MelanomaP53 (CC-TT)
RadiationThyroid Ca.,
LeucemiaTranslokation
Chemical
Benzopren Lung Ca. p53 (G-T)
Aflatoxin Liver Ca. p53 (249 G-T)
Oxidative
StressGeriatric Ca P53 (C-T)
Biological HBV Liver Ca.Virus DNA
Integration
THE CAUSES OF GENOMIC CHANGES
IN CANCER : Somatic Changes
Chemical Signals that Control the Cell
Cycle
1. Cyclin and Kinase
proteins that initiate mitosis
requires buildup of cyclin to pair with kinase
2. Hormones
chemical signals from specialized glands that stimulate mitosis
3. Growth Factors
chemical factors produced locally that stimulate mitosis
Cell cycle and cancer:
Cell differentiation occurs as cells proliferate to form
tissues.
• Cell differentiation correlates with loss of ability to
proliferate; highly specialized cells are terminally
differentiated.
• Terminally differentiated cells have a finite life
span, and are replaced with new cells produced
from stem cells.
• Stem cells are capable of self-renewal; cells
divide without undergoing terminal differentiation.
Cell Cycle Checkpoints
G1S
G2
cytoplasm
doubles
chromosomes
replicate
assembly of
components
for divisioncytokinesis
PM
A
T
Mitosis
DNA Damage
Checkpoints
DNA Damage
Checkpoint
Apoptosis
Checkpoint
Spindle
Assembly
Checkpoint
The Cell CycleThe Cell Cycle
MM
(mitosis)(mitosis)
GG11
(cell growth)(cell growth)
REPAIRS
AHEAD
S (synthesis)S (synthesis)
GG00 (resting) (resting)
OncogenesOncogenes
Tumor suppressor genesTumor suppressor genes
GG22
DNA repairDNA repair
genesgenes
ASCO
Normal cell cycle is controlled by
signal transduction:
• Growth factors bind to surface receptors on the cell;
transmembrane proteins relay signals into the cell.
• Two types of growth factors:
1. Growth factors stimulate cell division.
2. Growth-inhibiting factors inhibit cell division
• Healthy cells divide only when growth factor and growth-
inhibiting factor balance favors cell division.
• Cancer cells divide without constraint
(e.g., mutations in growth and growth-inhibiting factor
genes).
Genetic Mechanisms of
Tumors• Gene deletions / amplifications
• Mutations
Inserstional
Point Mutations
• Genetic Instability
Microsatellite Instability (MSI)
Chromosomal Instability (CIN)
EXAMPLES
Environmental vs.
Hereditary Cancer
Familial Clustering of Cancer
• Epidemiological studies show an
increased relative risk of cancer in
individuals with a family history of cancer
• This is probably due to a mixture of rare
highly penetrant genes, commoner lower
penetrance genes and environmental
effects
Cancer Inheritance
MULTIPLE HITS PROCESS
• The first hit it could be embryonic as in Retinoplastoma
• The others could be due to: Point mutation
Loss of reduplication
Deletion
Mutation of normal gene
Somatic recombination
Inherited Cancer Genes
• Neurofibromatosis type-1
• P53 gene
• Familial Polyposis Gene (APC)
• Hereditary nonpolyposis colon cancer (HNCC)
• Breast Cancer Genes (BRCAI, BRCA2)
• P16 Familial Melanoma
• RET proto-oncogene and multiple endocrine neoplasia
SOLID TUMORS SARCOMAS
• In addition to leukemias and lymphomas
some sarcomas also have specific
chromosomal abnormalities
•One example is t(11;22) seen in Ewing’s
sarcoma in which the DNA binding domain
of a transcription factor FLI1 is fused with
the transactivation domain of EWSR1
gene
RECURRENT ABNORMALITIES
EPITHELIAL TUMORS
• Small cell ca of the lung del(3)(p14-
p24)
• Wilm’s tumor del(11)(p13)
• Breast Her-2/neu amplification
• Mostly multiple abnormalities
Ovarian Cancer• > 400 cases karyotyped
• 2 cytogenetic pathways 1: +7,+8q and +12 2: 6q- and 1q-
• 3 phases of karyotypic evolution 1. step wise changes 2. Increased chromosome instability 3. Triploidization with 6q- and 1q-
• CGH reveal multiple changes in the malignant and fewer changes in borderline tumors
Uterine leiomyomas and
leiomyosarcomas• Benign tumors such as leiomyomas also
show recurrent chromosomal abnormalities such as t(12;14) and deletion of 7q
• 40% of leiomyomas show abnormal karyotypes
• Leiomyosarcomas show complex chromosomal rearrangements
COPY NUMBER CHANGES IN
LEIOMYOSARCOMA
LOSS
• 13q (59%)
• 10q(59%)
• 2q(35%)
• 16q(29%)
GAIN
• 5p(35%)
• 6p amplification
• 17p amplification
The Familial Polyposis Gene (A PC),
• The familial polyposis gene (APC), which strikingly predisposes to colon cancer, was ultimately identified by mutations in patients.
• The inherited gene is also involved in the great majority of sporadic cases of colon polyps and colon cancer.
• This tumor suppressor gene has been shown to function as a major regulator of the Wntpathway, a signaling system that is well characterized both biochemically and developmentally
Moderate Colorectal Cancer
Risk
• Two first-degree relatives affected
(0.4% population)
• One first-degree relative
diagnosed <45y (0.2% population)
• Suggest colonoscopy at 35y (2%
risk of polyp) and 55y (17-21% risk
of polyp)
Morphological and Molecular Changes in Adenoma and Carcinoma Sequence
The Hereditary Nonpolyposis Colon
Cancer Genes
• HNPCC is an inherited form of
colorectal cancer that is caused by
mutations in any of several genes
involved in DNA mismatch repair.
• It represents an example of a cancer
syndrome caused by genomic
instability
Hereditary Non-Polyposis
Colon Cancer
• 80% lifetime risk of colorectal cancer (males)
• 60% lifetime risk of endometrial cancer
• 10% risk of ovarian cancer
• Surveillance 1-2 yearly colonoscopies from 25y
• Consider endometrial screening by ultrasound and endometrial pipelle biopsy
• Consider ovarian screening by transvaginal ultrasound
Cancer and repair: HNPCC
Normal epithelium
Adenoma Carcinoma Metastasis
Accumulation of mutations in multiple genes
Oncogenes:(gain of function)=increased proli-feration, etc.
Tumor supressors:(loss of function)=loss of control: apoptosis, etc.
Mismatch repair defects
Retinoblastoma
• Deletions 13q14 or mutations of the RB1
gene
• Cell cycle regulatory protein that inhibits G1
to S phase transition
• 80% de novo mutations
• High rate of loss of heterozygosity in tumor
tissue
Retinoplastoma Inheritance
• Inheritance of RB1 heterozygous
• Second hit occurs during embryonic life due to Point mutation
Loss of reduplication
Deletion
Mutation of normal gene
Somatic recombination
The Development of Hereditary Cancer
1 damaged gene
1 normal gene
Tumordevelops
2 normal genes 2 damaged genes
In hereditary cancer, one damaged gene is inherited.
1 damaged gene1 normal gene
Tumordevelops2 damaged genes
Sporadic and Familial (Mendelian) forms
of Cancer Knudson’s Two-Hit Hypothesis
SporadicNormal
tumor
suppressor
gene
Single tumors,
unilateral,
later-onset
Somatic
mutation
in one allele
Somatic
mutation
in other allele
• two mutations (two hits) are required for loss of tumor suppressor function
Sporadic and Familial (Mendelian) Forms of Cancer
Knudson’s two-hit hypothesis
Familial
Tumor suppressor gene
containing a germline
mutation in one allele -
heterozygous for the
mutation
Multiple tumors,
bilateral,
early-onset
Somatic
mutation
in other allele
• two mutations (two hits) are required for loss of tumor suppressor function
• the first “hit” is inherited and the second “hit” is somatic
Neurofibromatosis Type 1
• The gene responsible for NFl chro. 17q
• GAP Protein, and a similar role in signal transduction.
BRCA1 and BRCA2
• High (60-80%) lifetime risk of breast
cancer, both genes.
• Increased ovarian cancer risk
(BRCA1>BRCA2)
• Surveillance for both indicated;
mammography, MRI, TV ultrasound
• Consider prophylactic surgery
The Inherited Breast Cancer Genes:
BRCA 1 and BRCA2
• Mutations in BRCA 1 and BRCA2 are responsible for a large proportion of inherited breast cancer cases.
• These mutations usually result in a truncated protein product and loss of function.
• The protein products of both of these genes interact with RAD51, a DNA repair protein.
BRCA1-Linked Hereditary
Breast and Ovarian Cancer
Noncarrier
BRCA1-mutation carrier
Affected with cancer
Breast, dx
45
d. 89
92 86
73 68 Ovary, dx 59
d. 62
Breast
, dx
59
Breast,
dx 36
36
71
p16 and Familial Melanoma
• Can be aused by loss-of-function
mutations in the p 16 tumor
suppressor gene or by gain-of-
function mutations in the target of
p16, the CDK4 proto-oncogene.
• Both mutations result in a loss of cell
cycle control via the pRI pathway.
7/21/2013 MSK/UJ/GL2 52
CHROMOSOMAL
ABNORMALITIES
IN MALIGNANCIES
Three classes of error lead to
aneuploidy in tumor cells
Chronic Myelogenous Leukemia
• Invariably fatal
• The Philadelphia Chromosome
– Reciprocal Translocation
– long arm of HAS 22 < > small part of HSA 9
• 2 chromosomal changes
– Translocation causes oncogene activation
MOST FREQUENT CLONAL CHROMOSOME
ABNORMALITIES IN HEMATOLOGIC
MALIGNANCIES
DIAGNOSIS: ABNORMALITY:
CML, ALL t(9;22)(q34;q11.2)
AML t(8;21)(q22;q22)
APL t(15;17)(q22;q12~21)
AML with EO inv(16)(p13q22)
MDS /AML 5q-, -7, 7q-,+8, 20q-
CLL del(13q), +12
ALL t(1;19)(q23;p13)
t(4;11)(q21;q23)
Burkitt’s Lymphoma t(8;14)(q24;q32)
Follicular Lymphoma t(14;18)(q32;q21)
Mantle Cell Lymphoma t(11;14)(q13;q32)
Chromosomal Rearrangements
or Translocations
Neoplasm Translocation Proto-oncogene
Burkitt lymphoma t(8;14) 80% of cases c-myc1
t(8;22) 15% of cases
t(2;8) 5% of cases
Chronic myelogenous t(9;22) 90-95% of cases bcr-abl2
leukemia
Acute lymphocytic t(9;22) 10-15% of cases bcr-abl2
leukemia
1c-myc is translocated to the IgG locus, which results in its activated expression2bcr-abl fusion protein is produced, which results in a constitutively active abl kinase
Examples of Chromosomal Regions That
Show Loss of Heterozygosity in Tumors
Chormosome
Region Disorder(s) Associated TSG
lq Breast carcinoma Unknown
3p Small~celllung carcinoma Unknown
5q Familial polyposis coli;
colorectal carcinoma MCC
11 p Wilms tumor; rhabdomyosarcoma WTl
13q Retinoblastoma; breast carcinoma;
osteosarcomas RB 1
17p Colorectal carcinoma; breast cancer TP53
18q Colorectal carcinoma DCC
22 Neurofibromatosis, type 2 Unknown
Cancer: General Etiology and Pathogenesis