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Mechanisms of disease 2 COLLEGE AANTEKENINGEN Thema 1

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THEME 1A – CANCER BIOLOGY AND GENETICS

LECTURE 2 – CANCER BIOLOGY: THE HALLMARKS OF CANCER
Characteristics of cancer tissue:
- Chaos / not organised
- Resistance to cell death
- Unlimited proliferation
- Angiogenesis (promotion of formation of blood vessels)
- Metastasis

Hallmarks of cancer:




Sustaining proliferative signalling:
- Overexpression of growthfactors
- Overexpression of cell-surface receptors for growthfactors
 Activating mutation also possible
- Therefore: overexpression of intracellular signaling molecules
 Activating mutation
- Therefore: overexpression of transcriptionfactors
Genes which stimulate cancer development are named proto-oncogenes. In case
of activating mutations, a cause for the acticvation is not needed anymore.

Activating mutations often occur in EGFR. (receptorgene). The mutation often occur in a specific part
of the gene, because only part of the gene has functional impact. A mutation in a non-functional part
of the gene does not have this effect.
Amplification of ERBB2, also HER2, is very common in breast cancer. Also a
receptor gene (HER2 receptor).
Extracellular targets are more easy to treat, like heroseptin, which is an
antibody targeting HER2. Intracellular activating mutations are more difficult to
treat.

Evading growth suppressors:
- In a healthy cell: growth suppressors are dominant
- In a cancer cell: growth promotors are dominant
 The balance is disturbed
Start checkpoint: entering of the S-phase of the cell cycle.
To check wether a molecule is a tumor suppressor or an proto-onco molecule, look
at the ‘normal’ function in the cell. (figure) retinoblastoma is a tumor suppressor.

,Growth inhibitors: TGFB receptor, p16 (loss-of-function)
Growth stimulators: cyclin D, CDK4 (gain-of-function)

TP53 = major tumor suppressor
reason: very important protein in the human cell. In every
case of a problem  p53 is used.

Senescence = ‘fall asleep’, handbreak of the cell




- Mutated in > 50% of tumors
- Pathways affected in > 90% of the cases
- Loss of p53  loss of cell cycle checkpoints  proliferation of cells with DNA damage
- Heriditary mutation: Li Fraumeni syndrome (multiple tumors at young age), dominant
inheritance.

APC complex: destruction of B-catenin  no signalling to the nucleus.
In case of WNT stimulation  APC complex will not form  B-catenin can signal to the
nucleus, stimulating proliferation. APC is a main tumor suppressor in colorectal cancer.

Avoiding immune destruction:
- Less production of MHC-I molecules, to prevent presentation of antigens to immune cells.

Enabling replicative immortality:
- In healthy cells: limited proliferative capacity
- In cancer cells: telomerase activation




Most malignant characteristic: ability to spread to other organs, metastasis
- Loosening of the tumor cells (inactivation of E-cadherin)
- Degradation of ECM (expression of proteolytic enzymes)
- Epithelial tumors: lose epithelial differentiation
Very inefficient process! Millions of cells might be released, only a few are able to metastasize

Ability to induce angiogenesis:
- Growth of tissue leads to increase in nutrients needed
- Selective pressure leads to the ability to promote angiogenesis

Ability to resist cell death:

, - Reduction of pro-apoptic factors (BAX, BAK)
- Increase of anti-apoptotic factors (BCL, MCL)
- Increase of inhibition of apoptosis

Deregulation of cellular energetics:
- The Warburg effect: switch from oxidative fosforylisation to lactation to form building blocks
to form more cells
- This way, more lactate forms, which stimulates angiogenesis.

Enablers: tumor-promoting inflammation
- ..

*osmosis: oncogenes and tumor suppressive genes

LECTURE 3 – CANCER GENETICS
Hallmarks: need to be acquired by a healthy cell to develop into a malignant cell. Mutations are
needed for this. Takes time  can take years to develop cancer.
So, cancer is driven by the accumulation of mutations.

Linear vs branched models of cancer evolution




Mutation = permanent alteration in a parental DNA sequence, needed in both strands
- Chromosome mutations
 May affect expression of many genes
 Loss or gain
 Translocation
 Multi-locus deletion
 Leads to loss of function of the alleles
- Gene mutations
 May affect expression of a few genes
 Deletions
 Insertions
 Substitutions

Deletion of a coding sequence that does not affect the reading frame, part of the protein may be
intact, it can be functional or partially functional. Example:
EGFR mutation: structural comformation is changed, leading to activation, but not to loss of function.

In or out-frame mutations:
- Intron; non coding, no effect
- Promotor; may affect transcription efficiency
- Splice site; may affect process of splicing
- Exon; may affect protein composition

, Substitution leads to a frameshift, leading to (partial) loss of function.

Silent mutations: mutations that translate to the same amino acid as before.




Mutation in KRAS prevent the removal of GTP by GAP, leading to continuous activation. The
mutation often occurs in a specific aminoacid.
Mutation in BRAF also causes continuous acitation.

Gene amplification:
- MYC gene  neuroblastomas
- HER2  breast, ovarian, gastric etc.
Detection of amplification:
- Complementary sequence that will bind the strand you are looking for
- Staining  visible under microscope

In 85% of Burkitt lymphoma cases: chromosomal translocation:
- Proto-oncogene location becomes after a promotor of a very expressive protein
- In case of Burkitt lymphoma: MYC gene after the immunoglobulin promotor  increased
expression

MYC: transcriptionfactor which promotes proliferation, onco-gene

Activating mutations typically affect one allele = enough for an acitvating effect

Epigenetic alteration of genes: methylation of DNA, leading to change in histone structure 
inactivates the gene by making it more difficult to reach.

Dominant negative mutations: 1 mutation in 1 allele completely destroys the function of the
protein, generally missense mutations

There are mutation patterns in oncogenes, with mutation hotspots.

Driver genes (functional relevance for tumorformation)
- Frequent and functionally relevant mutation
Passenger genes (no functional relevance for cancer fitness)
- Random, functionally irrelevant mutations
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