Role of stem cells and gap junctional intercellular communication in human carcinogenesis.

Epidemiological data, experimental animal bioassays, studies of in vitro neoplastic transformation, and molecular oncology studies have implicated a multistage, multimechanism process in human carcinogenesis. From animal carcinogenesis studies, the operational concept of a single normal cell being irreversibly altered during the first step in carcinogenesis is called initiation. The subsequent interruptible or reversible clonal expansion of these initiated cells by non-cytotoxic mitogenic stimuli, compensatory hyperplasia due to cell death by necrosis, or inhibition of apoptosis is referred to as the promotion phase. Last, when one of these clonally expanded, initiated cells acquires sufficient genetic/epigenetic alterations to become neoplastically transformed and acquire the phenotypes of promoter independence, invasiveness and metastasis, it is referred to as the progression step of carcinogenesis. This report hypothesizes that the single normal cell that is initiated is a pluripotent stem cell. By assuming that the normal pluripotent stem cell is immortal and becomes mortal when induced to terminally differentiate, initiation would be viewed as the irreversible process by which a stable alteration in a finite number of proto-oncogenes and/or tumor suppressor genes could block terminal differentiation or "mortalization". Promotion would involve the reversible inhibition of gap junctional intercellular communication (GJIC) and while progression occurs with the stable down-regulation of GJIC.