Department of Biological Sciences, Birla Institute of Technology and Science (BITS), Pilani, Rajasthan, India.
Department of Biological Sciences, Birla Institute of Technology and Science (BITS), Pilani, Rajasthan, India.
Adv Cancer Res. 2023;158:293-335. doi: 10.1016/bs.acr.2022.12.006. Epub 2023 Jan 13.
Traditional chemotherapy against cancer is often severely hampered by acquired resistance to the drug. Epigenetic alterations and other mechanisms like drug efflux, drug metabolism, and engagement of survival pathways are crucial in evading drug pressure. Herein, growing evidence suggests that a subpopulation of tumor cells can often tolerate drug onslaught by entering a "persister" state with minimal proliferation. The molecular features of these persister cells are gradually unraveling. Notably, the "persisters" act as a cache of cells that can eventually re-populate the tumor post-withdrawal drug pressure and contribute to acquiring stable drug-resistant features. This underlines the clinical significance of the tolerant cells. Accumulating evidence highlights the importance of modulation of the epigenome as a critical adaptive strategy for evading drug pressure. Chromatin remodeling, altered DNA methylation, and de-regulation of non-coding RNA expression and function contribute significantly to this persister state. No wonder targeting adaptive epigenetic modifications is increasingly recognized as an appropriate therapeutic strategy to sensitize them and restore drug sensitivity. Furthermore, manipulating the tumor microenvironment and "drug holiday" is also explored to maneuver the epigenome. However, heterogeneity in adaptive strategies and lack of targeted therapies have significantly hindered the translation of epigenetic therapy to the clinics. In this review, we comprehensively analyze the epigenetic alterations adapted by the drug-tolerant cells, the therapeutic strategies employed to date, and their limitations and future prospects.
传统的癌症化疗常常受到药物获得性耐药的严重阻碍。表观遗传改变和其他机制,如药物外排、药物代谢和生存途径的参与,在逃避药物压力方面至关重要。在这里,越来越多的证据表明,肿瘤细胞的一个亚群可以通过进入增殖最小的“持久细胞”状态来耐受药物的冲击。这些持久细胞的分子特征正在逐渐被揭示。值得注意的是,“持久细胞”充当了一个细胞库,这些细胞可以在药物压力消除后重新填充肿瘤,并有助于获得稳定的耐药特征。这凸显了耐受细胞的临床意义。越来越多的证据强调了修饰表观基因组作为逃避药物压力的关键适应性策略的重要性。染色质重塑、DNA 甲基化改变以及非编码 RNA 表达和功能的失调对这种持久状态有重要贡献。难怪靶向适应性表观遗传修饰越来越被认为是一种敏感化和恢复药物敏感性的适当治疗策略。此外,还探索了操纵肿瘤微环境和“药物假期”来操纵表观基因组。然而,适应性策略的异质性和缺乏靶向治疗极大地阻碍了表观遗传学治疗向临床的转化。在这篇综述中,我们全面分析了耐受药物的细胞所适应的表观遗传改变、迄今为止所采用的治疗策略及其局限性和未来前景。
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