Abstract
Genetic and epigenetic events within a cell which promote a block in normal development or differentiation coupled with unregulated proliferation are hallmarks of neoplastic transformation. Differentiation therapy involves the use of agents with the ability to induce differentiation in cells that have lost this ability, i.e. cancer cells. The promise of differentiation-based therapy as a viable treatment modality is perhaps best characterized by the addition of retinoids in the treatment of acute promyelocytic leukemia (APML) revolutionizing the management of APML and dramatically improving survival. However, interest and application of differentiationbased therapy for the treatment of solid malignancies have lagged due to deficiencies in our understanding of differentiation pathways in solid malignancies. Over the past decade, a differentiation-based developmental model for solid tumors has emerged providing insights into the biology of various solid tumors as well as identification of targetable pathways capable of re-activating blocked terminal differentiation programs. Furthermore, a variety of agents including retinoids, histone deacetylase inhibitors (HDACI), PPARγ agonists, and others, currently in use for a variety of malignancies, have been shown to induce differentiation in solid tumors. Herein we discuss the relevancy of differentiation-based therapies in solid tumors, using soft tissue sarcomas (STS) as a biologic and clinical model, and review the preclinical data to support its role as a promising modality of therapy for the treatment of solid tumors.
Highlights
Differentiation therapy is a therapeutic modality aimed at re-activating endogenous differentiation programs in cancer cells with subsequent tumor cellular maturation and concurrent loss of the tumor phenotype
The algorithm proposed successfully classified: (1) the AML subtypes in accord with the FAB classification schema (e.g. M0 subtype was arrayed closest to stem cells); (2) breast carcinoma based on estrogen receptor (ER) status; and (3) confirmed our initial findings in liposarcomas as described above
We have previously shown that mesenchymal stem cells (MSCs) are the progenitors of malignant www.impactjournals.com/oncotarget fibrous histiocytoma (MFH; termed high grade undifferentiated pleomorphic sarcoma [HGUPS], a commonly diagnosed mesenchymal tumor) and that increased levels of DKK1, a Wnt developmental pathway inhibitor, mediate the transition from the MSC state to the MFH state [18]
Summary
Differentiation therapy is a therapeutic modality aimed at re-activating endogenous differentiation programs in cancer cells with subsequent tumor cellular maturation and concurrent loss of the tumor phenotype. Our analysis of differentially expressed genes identified genes marking discrete stages of adipocytic differentiation and discriminating these genes from markers that may be involved in malignant transformation and potentially amenable to therapeutic targeting Picking up on this theme, and using significantly advanced computational methodologies, Riester and colleagues recently developed a statistical algorithm utilizing gene expression data from different cancers (including AML, breast carcinoma and liposarcoma) to construct phylogenetic trees which objectively and systematically categorized cancer subtypes based on degrees of maturation and relative to their corresponding cells of origin (e.g. hMSC for liposarcomas) [17]. The algorithm proposed successfully classified: (1) the AML subtypes in accord with the FAB classification schema (e.g. M0 subtype was arrayed closest to stem cells); (2) breast carcinoma based on estrogen receptor (ER) status; and (3) confirmed our initial findings in liposarcomas as described above This developmentalbased approach represents a new method for reclassifying solid tumors, and provides fundamental insight into solid tumor etiology
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