多发性骨髓瘤中的异常DNA甲基化:主要障碍还是机遇?
Aberrant DNA methylation in multiple myeloma: A major obstacle or an opportunity?
作者信息
Muylaert Catharina, Van Hemelrijck Lien Ann, Maes Anke, De Veirman Kim, Menu Eline, Vanderkerken Karin, De Bruyne Elke
机构信息
Department of Hematology and Immunology-Myeloma Center Brussels, Vrije Universiteit Brussel, Brussels, Belgium.
出版信息
Front Oncol. 2022 Aug 18;12:979569. doi: 10.3389/fonc.2022.979569. eCollection 2022.
Drug resistance (DR) of cancer cells leading to relapse is a huge problem nowadays to achieve long-lasting cures for cancer patients. This also holds true for the incurable hematological malignancy multiple myeloma (MM), which is characterized by the accumulation of malignant plasma cells in the bone marrow (BM). Although new treatment approaches combining immunomodulatory drugs, corticosteroids, proteasome inhibitors, alkylating agents, and monoclonal antibodies have significantly improved median life expectancy, MM remains incurable due to the development of DR, with the underlying mechanisms remaining largely ill-defined. It is well-known that MM is a heterogeneous disease, encompassing both genetic and epigenetic aberrations. In normal circumstances, epigenetic modifications, including DNA methylation and posttranslational histone modifications, play an important role in proper chromatin structure and transcriptional regulation. However, in MM, numerous epigenetic defects or so-called 'epimutations' have been observed and this especially at the level of DNA methylation. These include genome-wide DNA hypomethylation, locus specific hypermethylation and somatic mutations, copy number variations and/or deregulated expression patterns in DNA methylation modifiers and regulators. The aberrant DNA methylation patterns lead to reduced gene expression of tumor suppressor genes, genomic instability, DR, disease progression, and high-risk disease. In addition, the frequency of somatic mutations in the DNA methylation modifiers seems increased in relapsed patients, again suggesting a role in DR and relapse. In this review, we discuss the recent advances in understanding the involvement of aberrant DNA methylation patterns and/or DNA methylation modifiers in MM development, progression, and relapse. In addition, we discuss their involvement in MM cell plasticity, driving myeloma cells to a cancer stem cell state characterized by a more immature and drug-resistant phenotype. Finally, we briefly touch upon the potential of DNA methyltransferase inhibitors to prevent relapse after treatment with the current standard of care agents and/or new, promising (immuno) therapies.
癌细胞的耐药性导致复发是目前实现癌症患者长期治愈的一个巨大问题。对于无法治愈的血液系统恶性肿瘤多发性骨髓瘤(MM)来说也是如此,其特征是恶性浆细胞在骨髓(BM)中积聚。尽管将免疫调节药物、皮质类固醇、蛋白酶体抑制剂、烷化剂和单克隆抗体联合使用的新治疗方法显著提高了中位预期寿命,但由于耐药性的产生,MM仍然无法治愈,其潜在机制在很大程度上仍不明确。众所周知,MM是一种异质性疾病,包括遗传和表观遗传异常。在正常情况下,表观遗传修饰,包括DNA甲基化和翻译后组蛋白修饰,在适当的染色质结构和转录调控中起重要作用。然而,在MM中,已经观察到许多表观遗传缺陷或所谓的“表观突变”,尤其是在DNA甲基化水平。这些包括全基因组DNA低甲基化、基因座特异性高甲基化和体细胞突变、拷贝数变异和/或DNA甲基化修饰剂和调节剂的表达模式失调。异常的DNA甲基化模式导致肿瘤抑制基因的基因表达降低、基因组不稳定、耐药性、疾病进展和高危疾病。此外,复发患者中DNA甲基化修饰剂的体细胞突变频率似乎增加,这再次表明其在耐药性和复发中的作用。在这篇综述中,我们讨论了在理解异常DNA甲基化模式和/或DNA甲基化修饰剂在MM发生、进展和复发中的作用方面的最新进展。此外,我们还讨论了它们在MM细胞可塑性中的作用,促使骨髓瘤细胞进入以更不成熟和耐药表型为特征的癌症干细胞状态。最后,我们简要提及DNA甲基转移酶抑制剂在使用当前标准护理药物和/或新的、有前景的(免疫)疗法治疗后预防复发的潜力。