1 5083 168 PICKING A BONE WITH WISP1 (CCN4): NEW STRATEGIES AGAINST DEGENERATIVE JOINT DISEASE. AS THE WORLD'S POPULATION CONTINUES TO AGE, IT IS ESTIMATED THAT DEGENERATIVE JOINT DISEASE DISORDERS SUCH AS OSTEOARTHRITIS WILL IMPACT AT LEAST 130 MILLION INDIVIDUALS THROUGHOUT THE GLOBE BY THE YEAR 2050. ADVANCED AGE, OBESITY, GENETICS, GENDER, BONE DENSITY, TRAUMA, AND A POOR LEVEL OF PHYSICAL ACTIVITY CAN LEAD TO THE ONSET AND PROGRESSION OF OSTEOARTHRITIS. HOWEVER, FACTORS THAT LEAD TO DEGENERATIVE JOINT DISEASE AND INVOLVE GENDER, GENETICS, EPIGENETIC MECHANISMS, AND ADVANCED AGE ARE NOT WITHIN THE CONTROL OF AN INDIVIDUAL. FURTHERMORE, CURRENT THERAPIES INCLUDING PAIN MANAGEMENT, IMPROVED NUTRITION, AND REGULAR PROGRAMS FOR EXERCISE DO NOT LEAD TO THE RESOLUTION OF OSTEOARTHRITIS. AS A RESULT, NEW AVENUES FOR TARGETING THE TREATMENT OF OSTEOARTHRITIS ARE DESPERATELY NEEDED. WNT1 INDUCIBLE SIGNALING PATHWAY PROTEIN 1 (WISP1), A MATRICELLULAR PROTEIN AND A DOWNSTREAM TARGET OF THE WINGLESS PATHWAY WNT1, IS ONE SUCH TARGET TO CONSIDER THAT GOVERNS CELLULAR PROTECTION, STEM CELL PROLIFERATION, AND TISSUE REGENERATION IN A NUMBER OF DISORDERS INCLUDING BONE DEGENERATION. HOWEVER, INCREASED WISP1 EXPRESSION ALSO HAS BEEN ASSOCIATED WITH THE PROGRESSION OF OSTEOARTHRITIS. WISP1 HAS AN INTRICATE RELATIONSHIP WITH A NUMBER OF PROLIFERATIVE AND PROTECTIVE PATHWAYS THAT INCLUDE PHOSPHOINOSITIDE 3-KINASE (PI 3-K), PROTEIN KINASE B (AKT), NUCLEAR FACTOR KAPPA-LIGHT-CHAIN-ENHANCER OF ACTIVATED B CELLS (NF-KAPPAB), INTERLEUKIN -6 (IL-6), TRANSFORMING GROWTH FACTOR-BETA, MATRIX METALLOPROTEINASE, SMALL NON-CODING RIBONUCLEIC ACIDS (RNAS), SIRTUIN SILENT MATING TYPE INFORMATION REGULATION 2 HOMOLOG 1 (SACCHAROMYCES CEREVISIAE) (SIRT1), AND THE MECHANISTIC TARGET OF RAPAMYCIN (MTOR). TAKEN TOGETHER, THIS COMPLEX ASSOCIATION WISP1 HOLDS WITH THESE SIGNALING PATHWAYS NECESSITATES A FINE BIOLOGICAL REGULATION OF WISP1 ACTIVITY THAT CAN OFFSET THE PROGRESSION OF DEGENERATIVE JOINT DISEASE, BUT NOT LIMIT THE CELLULAR PROTECTIVE CAPABILITIES OF THE WISP1 PATHWAY. 2016 2 1900 41 ENERGY SENSING PATHWAYS: BRIDGING TYPE 2 DIABETES AND COLORECTAL CANCER? THE RECENTLY RAPID INCREASE OF OBESITY AND TYPE 2 DIABETES MELLITUS HAS CAUSED GREAT BURDEN TO OUR SOCIETY. A POSITIVE ASSOCIATION BETWEEN TYPE 2 DIABETES AND RISK OF COLORECTAL CANCER HAS BEEN REPORTED BY INCREASING EPIDEMIOLOGICAL STUDIES. THE MOLECULAR MECHANISM OF THIS CONNECTION REMAINS ELUSIVE. HOWEVER, TYPE 2 DIABETES MAY RESULT IN ABNORMAL CARBOHYDRATE AND LIPID METABOLISM, HIGH LEVELS OF CIRCULATING INSULIN, INSULIN GROWTH FACTOR-1, AND ADIPOCYTOKINES, AS WELL AS CHRONIC INFLAMMATION. ALL THESE FACTORS COULD LEAD TO THE ALTERATION OF ENERGY SENSING PATHWAYS SUCH AS THE AMP ACTIVATED KINASE (PRKA), MECHANISTIC (MAMMALIAN) TARGET OF RAPAMYCIN (MTOR), SIRT1, AND AUTOPHAGY SIGNALING PATHWAYS. THE RESULTED IMPAIRED SIRT1 AND AUTOPHAGY SIGNALING PATHWAY COULD INCREASE THE RISK OF GENE MUTATION AND CANCER GENESIS BY DECREASING GENETIC STABILITY AND DNA MISMATCH REPAIR. THE DYSREGULATED MTOR AND PRKA PATHWAY COULD REMODEL CELL METABOLISM DURING THE GROWTH AND METASTASIS OF CANCER IN ORDER FOR THE CANCER CELL TO SURVIVE THE UNFAVORABLE MICROENVIRONMENT SUCH AS HYPOXIA AND LOW BLOOD SUPPLY. MOREOVER, THESE PATHWAYS MAY BE COUPLING METABOLIC AND EPIGENETIC ALTERATIONS THAT ARE CENTRAL TO ONCOGENIC TRANSFORMATION. FURTHER RESEARCHES INCLUDING MOLECULAR PATHOLOGIC EPIDEMIOLOGIC STUDIES ARE WARRANTED TO BETTER ADDRESS THE PRECISE LINKS BETWEEN THESE TWO IMPORTANT DISEASES. 2017 3 5581 39 ROLE OF NF-KAPPAB IN AGEING AND AGE-RELATED DISEASES: LESSONS FROM GENETICALLY MODIFIED MOUSE MODELS. AGEING IS A COMPLEX PROCESS, INDUCED BY MULTIFACETED INTERACTION OF GENETIC, EPIGENETIC, AND ENVIRONMENTAL FACTORS. IT IS MANIFESTED BY A DECLINE IN THE PHYSIOLOGICAL FUNCTIONS OF ORGANISMS AND ASSOCIATED TO THE DEVELOPMENT OF AGE-RELATED CHRONIC DISEASES AND CANCER DEVELOPMENT. IT IS CONSIDERED THAT AGEING FOLLOWS A STRICTLY-REGULATED PROGRAM, IN WHICH SOME SIGNALING PATHWAYS CRITICALLY CONTRIBUTE TO THE ESTABLISHMENT AND MAINTENANCE OF THE AGED STATE. CHRONIC INFLAMMATION IS A MAJOR MECHANISM THAT PROMOTES THE BIOLOGICAL AGEING PROCESS AND COMORBIDITY, WITH THE TRANSCRIPTION FACTOR NF-KAPPAB (NUCLEAR FACTOR KAPPA-LIGHT-CHAIN-ENHANCER OF ACTIVATED B CELLS) AS A CRUCIAL MEDIATOR OF INFLAMMATORY RESPONSES. THIS, TOGETHER WITH THE FINDING THAT THE ACTIVATION OR INHIBITION OF NF-KAPPAB CAN INDUCE OR REVERSE RESPECTIVELY THE MAIN FEATURES OF AGED ORGANISMS, HAS BROUGHT IT UNDER CONSIDERATION AS A KEY TRANSCRIPTION FACTOR THAT ACTS AS A DRIVER OF AGEING. IN THIS REVIEW, WE FOCUSED ON THE DATA OBTAINED ENTIRELY THROUGH THE GENERATION OF KNOCKOUT AND TRANSGENIC MOUSE MODELS OF EITHER PROTEIN INVOLVED IN THE NF-KAPPAB SIGNALING PATHWAY THAT HAVE PROVIDED RELEVANT INFORMATION ABOUT THE INTRICATE PROCESSES OR MOLECULAR MECHANISMS THAT CONTROL AGEING. WE HAVE REVIEWED THE RELATIONSHIP OF NF-KAPPAB AND PREMATURE AGEING; THE DEVELOPMENT OF CANCER ASSOCIATED WITH AGEING AND THE IMPLICATION OF NF-KAPPAB ACTIVATION IN THE DEVELOPMENT OF AGE-RELATED DISEASES, SOME OF WHICH GREATLY INCREASE THE RISK OF DEVELOPING CANCER. 2021 4 4679 42 NEW MOLECULAR TARGETS FOR THE TREATMENT OF OSTEOARTHRITIS. OSTEOARTHRITIS (OA) IS A CHRONIC DEGENERATIVE JOINT DISORDER CHARACTERIZED BY DESTRUCTION OF THE ARTICULAR CARTILAGE, SUBCHONDRAL BONE ALTERATIONS AND SYNOVITIS. CURRENT TREATMENTS ARE FOCUSED ON SYMPTOMATIC RELIEF BUT THEY LACK EFFICACY TO CONTROL THE PROGRESSION OF THIS DISEASE WHICH IS A LEADING CAUSE OF DISABILITY. THEREFORE, THE DEVELOPMENT OF EFFECTIVE DISEASE-MODIFYING DRUGS IS URGENTLY NEEDED. DIFFERENT INITIATIVES ARE IN PROGRESS TO DEFINE THE MOLECULAR MECHANISMS INVOLVED IN THE INITIATION AND PROGRESSION OF OA. THESE STUDIES SUPPORT THE THERAPEUTIC POTENTIAL OF PATHWAYS RELEVANT IN JOINT METABOLISM SUCH AS WNT/BETA-CATENIN, DISCOIDIN DOMAIN RECEPTOR 2 OR PROTEINASE-ACTIVATED RECEPTOR 2. THE DYSREGULATION IN CARTILAGE CATABOLISM AND SUBCHONDRAL BONE REMODELING COULD BE IMPROVED BY SELECTIVE INHIBITORS OF MATRIX METALLOPROTEINASES, AGGRECANASES AND OTHER PROTEASES. ANOTHER APPROACH WOULD FAVOR THE ACTIVITY OF ANABOLIC PROCESSES BY USING GROWTH FACTORS OR REGULATORY MOLECULES. RECENT STUDIES HAVE ALSO REVEALED THE ROLE OF OXIDATIVE STRESS AND SYNOVITIS IN THE PROGRESSION OF THIS DISEASE, SUPPORTING THE DEVELOPMENT OF A NUMBER OF INHIBITORY STRATEGIES. NOVEL TARGETS IN OA ARE REPRESENTED BY GENES INVOLVED IN OA PATHOPHYSIOLOGY DISCOVERED USING GENE NETWORK, EPIGENETIC AND MICRORNA APPROACHES. FURTHER INSIGHTS INTO THE MOLECULAR MECHANISMS INVOLVED IN OA INITIATION AND PROGRESSION MAY LEAD TO THE DEVELOPMENT OF NEW THERAPIES ABLE TO CONTROL JOINT DESTRUCTION AND REPAIR. 2010 5 2416 30 EPIGENETIC SIGNALING OF CANCER STEM CELLS DURING INFLAMMATION. MALIGNANT TUMORS POSE A GREAT CHALLENGE TO HUMAN HEALTH, WHICH HAS LED TO MANY STUDIES INCREASINGLY ELUCIDATING THE TUMORIGENIC PROCESS. CANCER STEM CELLS (CSCS) HAVE PROFOUND IMPACTS ON TUMORIGENESIS AND DEVELOPMENT OF DRUG RESISTANCE. RECENTLY, THERE HAS BEEN INCREASED INTEREST IN THE RELATIONSHIP BETWEEN INFLAMMATION AND CSCS BUT THE MECHANISM UNDERLYING THIS RELATIONSHIP HAS NOT BEEN FULLY ELUCIDATED. INFLAMMATORY CYTOKINES PRODUCED DURING CHRONIC INFLAMMATION ACTIVATE SIGNALING PATHWAYS THAT REGULATE THE GENERATION OF CSCS THROUGH EPIGENETIC MECHANISMS. IN THIS REVIEW, WE FOCUS ON THE EFFECTS OF INFLAMMATION ON CANCER STEM CELLS, PARTICULARLY THE ROLE OF SIGNALING PATHWAYS SUCH AS NF-KAPPAB PATHWAY, STAT3 PATHWAY AND SMAD PATHWAY INVOLVED IN REGULATING EPIGENETIC CHANGES. WE HOPE TO PROVIDE A NOVEL PERSPECTIVE FOR IMPROVING STRATEGIES FOR TUMOR TREATMENT. 2021 6 4745 36 NOVEL INSIGHTS OF EZH2-MEDIATED EPIGENETIC MODIFICATIONS IN DEGENERATIVE MUSCULOSKELETAL DISEASES. DEGENERATIVE MUSCULOSKELETAL DISEASES (OSTEOPOROSIS, OSTEOARTHRITIS, DEGENERATIVE SPINAL DISEASE AND SARCOPENIA) ARE PATHOLOGICAL CONDITIONS THAT AFFECT THE FUNCTION AND PAIN OF TISSUES SUCH AS BONE, CARTILAGE, AND MUSCLES, AND ARE CLOSELY ASSOCIATED WITH AGEING AND LONG-TERM DEGENERATION. ENHANCER OF ZESTE HOMOLOG 2 (EZH2), AN IMPORTANT EPIGENETIC REGULATOR, REGULATES GENE EXPRESSION MAINLY THROUGH THE PRC2-DEPENDENT TRIMETHYLATION OF HISTONE H3 AT LYSINE 27 (H3K27ME3). INCREASING EVIDENCE SUGGESTS THAT EZH2 IS INVOLVED IN SEVERAL BIOLOGICAL PROCESSES CLOSELY RELATED TO DEGENERATIVE MUSCULOSKELETAL DISEASES, SUCH AS OSTEOGENIC-ADIPOGENIC DIFFERENTIATION OF BONE MARROW MESENCHYMAL STEM CELLS, OSTEOCLAST ACTIVATION, CHONDROCYTE FUNCTIONAL STATUS, AND SATELLITE CELL PROLIFERATION AND DIFFERENTIATION, MAINLY THROUGH EPIGENETIC REGULATION (H3K27ME3). THEREFORE, THE SYNTHESIS AND ELUCIDATION OF THE ROLE OF EZH2 IN DEGENERATIVE MUSCULOSKELETAL DISEASES HAVE ATTRACTED INCREASING ATTENTION. IN ADDITION, ALTHOUGH EZH2 INHIBITORS HAVE BEEN APPROVED FOR CLINICAL USE, WHETHER THEY CAN BE REPURPOSED FOR THE TREATMENT OF DEGENERATIVE MUSCULOSKELETAL DISEASES NEEDS TO BE CONSIDERED. HERE, WE REVIEWED THE ROLE OF EZH2 IN THE DEVELOPMENT OF DEGENERATIVE MUSCULOSKELETAL DISEASES AND BROUGHT FORWARD PROSPECTS OF ITS PHARMACOLOGICAL INHIBITORS IN THE IMPROVEMENT OF THE TREATMENT OF THE DISEASES. 2023 7 2309 42 EPIGENETIC REGULATION OF CHONDROCYTES AND SUBCHONDRAL BONE IN OSTEOARTHRITIS. THE AIM OF THIS REVIEW IS TO PROVIDE AN UPDATED REVIEW OF THE EPIGENETIC FACTORS INVOLVED IN THE ONSET AND DEVELOPMENT OF OSTEOARTHRITIS (OA). OA IS A PREVALENT DEGENERATIVE JOINT DISEASE CHARACTERIZED BY CHRONIC INFLAMMATION, ECTOPIC BONE FORMATION WITHIN THE JOINT, AND PHYSICAL AND PROTEOLYTIC CARTILAGE DEGRADATION WHICH RESULT IN CHRONIC PAIN AND LOSS OF MOBILITY. AT PRESENT, NO DISEASE-MODIFYING THERAPEUTICS EXIST FOR THE PREVENTION OR TREATMENT OF THE DISEASE. RESEARCH HAS IDENTIFIED SEVERAL OA RISK FACTORS INCLUDING MECHANICAL STRESSORS, PHYSICAL ACTIVITY, OBESITY, TRAUMATIC JOINT INJURY, GENETIC PREDISPOSITION, AND AGE. RECENTLY, THERE HAS BEEN INCREASED INTEREST IN IDENTIFYING EPIGENETIC FACTORS INVOLVED IN THE PATHOGENESIS OF OA. IN THIS REVIEW, WE DETAIL SEVERAL OF THESE EPIGENETIC MODIFICATIONS WITH KNOWN FUNCTIONS IN THE ONSET AND PROGRESSION OF THE DISEASE. WE ALSO REVIEW CURRENT THERAPEUTICS TARGETING ABERRANT EPIGENETIC REGULATION AS POTENTIAL OPTIONS FOR PREVENTIVE OR THERAPEUTIC TREATMENT. 2022 8 1150 34 CONNECTION BETWEEN INFLAMMATION AND CARCINOGENESIS IN GASTROINTESTINAL TRACT: FOCUS ON TGF-BETA SIGNALING. INFLAMMATION IS A PRIMARY DEFENSE PROCESS AGAINST VARIOUS EXTRACELLULAR STIMULI, SUCH AS VIRUSES, PATHOGENS, FOODS, AND ENVIRONMENTAL POLLUTANTS. WHEN CELLS RESPOND TO STIMULI FOR SHORT PERIODS OF TIME, IT RESULTS IN ACUTE OR PHYSIOLOGICAL INFLAMMATION. HOWEVER, IF THE STIMULATION IS SUSTAINED FOR LONGER TIME OR A PATHOLOGICAL STATE OCCURS, IT IS KNOWN AS CHRONIC OR PATHOLOGICAL INFLAMMATION. SEVERAL STUDIES HAVE SHOWN THAT TUMORIGENESIS IN THE GASTROINTESTINAL (GI) TRACT IS CLOSELY ASSOCIATED WITH CHRONIC INFLAMMATION, FOR WHICH ABNORMAL CELLULAR ALTERATIONS THAT ACCOMPANY CHRONIC INFLAMMATION SUCH AS OXIDATIVE STRESSES, GENE MUTATIONS, EPIGENETIC CHANGES, AND INFLAMMATORY CYTOKINES, ARE SHARED WITH CARCINOGENIC PROCESSES, WHICH FORMS A CRITICAL CROSS-LINK BETWEEN CHRONIC INFLAMMATION AND CARCINOGENESIS. TRANSFORMING GROWTH FACTOR (TGF)-BETA IS A MULTI-POTENT CYTOKINE THAT PLAYS AN IMPORTANT ROLE IN REGULATION OF CELL GROWTH, APOPTOSIS AND DIFFERENTIATION. MOST IMPORTANTLY, TGF-BETA IS A STRONG ANTI-INFLAMMATORY CYTOKINE THAT REGULATES THE DEVELOPMENT OF EFFECTOR CELLS. TGF-BETA HAS A SUPPRESSIVE EFFECT ON CARCINOGENESIS UNDER NORMAL CONDITIONS BY INHIBITING ABNORMAL CELL GROWTH, BUT ON THE OTHER HAND, MANY GI CANCERS ORIGINATE FROM UNCONTROLLED CELL GROWTH AND DIFFERENTIATION BY GENETIC LOSS OF TGF-BETA SIGNALING MOLECULES OR PERTURBATION OF TGF-BETA ADAPTORS. ONCE A TUMOR HAS DEVELOPED, TGF-BETA EXERTS A PROMOTING EFFECT ON THE TUMOR ITSELF AND STROMAL CELLS TO ENHANCE CELL GROWTH, ALTER THE RESPONSIVENESS OF TUMOR CELLS TO STIMULATE INVASION AND METASTASIS, AND INHIBITED IMMUNE SURVEILLANCE. THEREFORE, NOVEL DEVELOPMENT OF THERAPEUTIC AGENTS TO INHIBIT TGF-BETA-INDUCED PROGRESSION OF TUMOR AND TO RETAIN ITS GROWTH INHIBITORY ACTIVITIES, IN ADDITION TO ANTI-INFLAMMATORY ACTIONS, COULD BE USEFUL IN ONCOLOGY. IN THIS REVIEW, WE DISCUSS THE ROLE OF TGF-BETA IN INFLAMMATION AND CARCINOGENESIS OF THE GI TRACT RELATED TO ABNORMAL TGF-BETA SIGNALING. 2010 9 2704 30 EXERCISE AND COLORECTAL CANCER: PREVENTION AND MOLECULAR MECHANISMS. EXERCISE AND PHYSICAL ACTIVITY HAVE BEEN SHOWN TO BE STRONGLY ASSOCIATED WITH A DECREASED INCIDENCE RATE OF VARIOUS CHRONIC DISEASES ESPECIALLY NUMEROUS HUMAN MALIGNANCIES. A HUGE NUMBER OF CLINICAL TRIALS AND META-ANALYSIS HAVE DEMONSTRATED THAT EXERCISE IS SIGNIFICANTLY EFFECTIVE IN LOWERING THE RISK OF COLORECTAL CANCER. IN ADDITION, IT IS SUGGESTED AS AN EFFECTIVE THERAPEUTIC MODALITY AGAINST THIS CANCER TYPE. THEREFORE, IN THIS REVIEW, WE WILL REVIEW COMPREHENSIBLY THE EFFECTS OF EXERCISE IN PREVENTING, TREATING, AND ALLEVIATING THE ADVERSE EFFECTS OF CONVENTIONAL THERAPEUTIC OPTIONS IN COLORECTAL CANCER. MOREOVER, THE POSSIBLE MECHANISMS UNDERLYING THE POSITIVE EFFECTS OF EXERCISE AND PHYSICAL ACTIVITY IN COLORECTAL CANCER, INCLUDING REGULATION OF INFLAMMATION, APOPTOSIS, GROWTH FACTOR AXIS, IMMUNITY, EPIGENETIC, ETC. WILL BE ALSO DISCUSSED. 2022 10 2232 35 EPIGENETIC MODIFICATIONS OF MIRNAS IN OSTEOARTHRITIS: A SYSTEMATIC REVIEW ON THEIR METHYLATION LEVELS AND EFFECTS ON CHONDROCYTES, EXTRACELLULAR MATRIX AND JOINT INFLAMMATION. OSTEOARTHRITIS (OA) IS A JOINT DISORDER CHARACTERIZED BY PROGRESSIVE DEGENERATION OF CARTILAGE EXTRACELLULAR MATRIX (ECM), CHONDROCYTE HYPERTROPHY AND APOPTOSIS AND INFLAMMATION. THE CURRENT TREATMENTS MAINLY CONCERN PAIN CONTROL AND REDUCTION OF INFLAMMATION, BUT NO THERAPEUTIC STRATEGY HAS BEEN IDENTIFIED AS A DISEASE-MODIFYING TREATMENT. THEREFORE, IDENTIFYING SPECIFIC BIOMARKERS USEFUL TO PREVENT, TREAT OR DISTINGUISH THE STAGES OF OA DISEASE HAS BECOME AN IMMEDIATE NEED OF CLINICAL PRACTICE. THE ROLE OF MICRORNAS (MIRNAS) IN OA HAS BEEN INVESTIGATED IN THE LAST DECADE, AND INCREASING EVIDENCE HAS EMERGED THAT THE INFLUENCE OF THE ENVIRONMENT ON GENE EXPRESSION THROUGH EPIGENETIC PROCESSES CONTRIBUTES TO THE DEVELOPMENT, PROGRESSION AND AGGRESSIVENESS OF OA, IN PARTICULAR ACTING ON THE MICROENVIRONMENT MODULATIONS. THE EFFECTS OF EPIGENETIC REGULATION, PARTICULARLY DIFFERENT MIRNA METHYLATION DURING OA DISEASE, WERE HIGHLIGHTED IN THE PRESENT SYSTEMATIC REVIEW. THE EVIDENCE ARISING FROM THIS STUDY OF THE LITERATURE CONDUCTED IN THREE DATABASES (PUBMED, SCOPUS, WEB OF SCIENCE) SUGGESTED THAT MIRNA METHYLATION STATE ALREADY STRONGLY IMPACTS OA PROGRESSION, DRIVING CHONDROCYTES AND SYNOVIOCYTE PROLIFERATION, APOPTOSIS, INFLAMMATION AND ECM DEPOSITION. HOWEVER, THE POSSIBILITY OF UNDERSTANDING THE MECHANISM BY WHICH DIFFERENT EPIGENETIC MODIFICATIONS OF MIRNA OR PRE-MIRNA SEQUENCES DRIVE THE AGGRESSIVENESS OF OA COULD BE THE NEW FOCUS OF FUTURE INVESTIGATIONS. 2023 11 3921 38 LINKING INFLAMMATION TO CELL CYCLE PROGRESSION. RISK OF GASTROINTESTINAL CANCERS IS CLOSELY RELATED TO INCREASED LEVELS OF OXIDANTS IN THE BALANCE BETWEEN OXIDANT AND ANTI-OXIDANT AGENTS. A POSSIBLE EXPLANATION OF THIS EPIDEMIOLOGICAL OBSERVATION IS THE LOCAL LOSS OF THE EPITHELIAL BARRIER FUNCTION WITH A FOCAL INFLAMMATORY RESPONSE. ACCORDINGLY, CHRONIC INFLAMMATORY DISEASES REPRESENT WELL-KNOWN RISK FACTORS FOR CANCER AND, ON THE OTHER HAND, IT IS KNOWN THAT ANTI-INFLAMMATORY AGENTS, DEMULCENTS AND ANTIOXIDANTS MARKEDLY INHIBIT THE DEVELOPMENT OF COLON CANCER IN ANIMAL MODELS AS WELL IN HUMANS. AT MOLECULAR LEVEL A KEY ROLE IN THE PROCESS THAT LINK INFLAMMATION TO CELLULAR TRANSFORMATION SEEMS TO BE PLAYED BY ACTIVATION OF CYCLOOXYGENASE-2 (COX-2) TOGETHER WITH PRODUCTION OF REACTIVE OXYGEN INTERMEDIATE (ROI). BOTH THESE EVENTS HAVE BEEN STRICTLY LINKED WITH CELL PROLIFERATION AND TRANSFORMATION, ALTHOUGH THE INTRACELLULAR PATHWAYS INVOLVED IN THESE PROCESSES ARE STILL NOT COMPLETELY UNDERSTOOD. THE UNCONTROLLED PROLIFERATION, WHICH IS A LANDMARK OF CELLULAR TRANSFORMATION, IS ACCOMPANIED BY THE DEREGULATION OF PROTEINS INVOLVED IN THE CONTROL OF CELL CYCLE CHECKPOINTS. ALTERED EXPRESSION AND FUNCTION OF CYCLOOXYGENASE AND NITRIC OXIDE SYNTHASE SEEM TO INFLUENCE, AMONG OTHERS, THE EXPRESSION OF PROTEINS INVOLVED IN THE REGULATION OF CELL CYCLE PROGRESSION. SIMILARLY, ANTI-INFLAMMATORY AND ANTIOXIDANT AGENTS MAY ALSO ACT ON THE EXPRESSION AND FUNCTION OF SEVERAL CELL CYCLE REGULATING PROTEINS. UNDERSTANDING THE MECHANISMS BY WHICH CHRONIC INFLAMMATION CONTRIBUTES TO GENETIC AND EPIGENETIC CHANGES INVOLVED IN THE REGULATION OF CRITICAL CELL CYCLE CHECKPOINTS MAY HELP TO DEVELOP MORE AND MORE SPECIFIC TREATMENT STRATEGIES FOR REDUCING MALIGNANT TRANSFORMATION OF THESE INFLAMMATORY DISEASES. 2004 12 797 38 CELLULAR SENESCENCE IN OSTEOARTHRITIS PATHOLOGY. CELLULAR SENESCENCE IS A STATE OF STABLE PROLIFERATION ARREST OF CELLS. THE SENESCENCE PATHWAY HAS MANY BENEFICIAL EFFECTS AND IS SEEN TO BE ACTIVATED IN DAMAGED/STRESSED CELLS, AS WELL AS DURING EMBRYONIC DEVELOPMENT AND WOUND HEALING. HOWEVER, THE PERSISTENCE AND ACCUMULATION OF SENESCENT CELLS IN VARIOUS TISSUES CAN ALSO IMPAIR FUNCTION AND HAVE BEEN IMPLICATED IN THE PATHOGENESIS OF MANY AGE-RELATED DISEASES. OSTEOARTHRITIS (OA), A SEVERELY DEBILITATING CHRONIC CONDITION CHARACTERIZED BY PROGRESSIVE TISSUE REMODELING AND LOSS OF JOINT FUNCTION, IS THE MOST PREVALENT DISEASE OF THE SYNOVIAL JOINTS, AND INCREASING AGE IS THE PRIMARY OA RISK FACTOR. THE PROFILE OF INFLAMMATORY AND CATABOLIC MEDIATORS PRESENT DURING THE PATHOGENESIS OF OA IS STRIKINGLY SIMILAR TO THE SECRETORY PROFILE OBSERVED IN 'CLASSICAL' SENESCENT CELLS. DURING OA, CHONDROCYTES (THE SOLE CELL TYPE PRESENT WITHIN ARTICULAR CARTILAGE) EXHIBIT INCREASED LEVELS OF VARIOUS SENESCENCE MARKERS, SUCH AS SENESCENCE-ASSOCIATED BETA-GALACTOSIDASE (SABETAGAL) ACTIVITY, TELOMERE ATTRITION, AND ACCUMULATION OF P16INK4A. THIS SUGGESTS THE HYPOTHESIS THAT SENESCENCE OF CELLS WITHIN JOINT TISSUES MAY PLAY A PATHOLOGICAL ROLE IN THE CAUSATION OF OA. IN THIS REVIEW, WE DISCUSS THE MECHANISMS BY WHICH SENESCENT CELLS MAY PREDISPOSE SYNOVIAL JOINTS TO THE DEVELOPMENT AND/OR PROGRESSION OF OA, AS WELL AS TOUCHING UPON VARIOUS EPIGENETIC ALTERATIONS ASSOCIATED WITH BOTH OA AND SENESCENCE. 2017 13 6399 38 THE ROLES AND MECHANISMS OF ACTIONS OF VITAMIN C IN BONE: NEW DEVELOPMENTS. VITAMIN C IS AN IMPORTANT ANTIOXIDANT AND COFACTOR THAT IS INVOLVED IN THE REGULATION OF DEVELOPMENT, FUNCTION, AND MAINTENANCE OF SEVERAL CELL TYPES IN THE BODY. DEFICIENCIES IN VITAMIN C CAN LEAD TO CONDITIONS SUCH AS SCURVY, WHICH, AMONG OTHER AILMENTS, CAUSES GINGIVIA, BONE PAIN, AND IMPAIRED WOUND HEALING. THIS REVIEW EXAMINES THE FUNCTIONAL IMPORTANCE OF VITAMIN C AS IT RELATES TO THE DEVELOPMENT AND MAINTENANCE OF BONE TISSUES. ANALYSIS OF SEVERAL EPIDEMIOLOGICAL STUDIES AND GENETIC MOUSE MODELS REGARDING THE EFFECT OF VITAMIN C SHOWS A POSITIVE EFFECT ON BONE HEALTH. OVERALL, VITAMIN C EXERTS A POSITIVE EFFECT ON TRABECULAR BONE FORMATION BY INFLUENCING EXPRESSION OF BONE MATRIX GENES IN OSTEOBLASTS. RECENT STUDIES ON THE MOLECULAR PATHWAY FOR VITAMIN C ACTIONS THAT INCLUDE DIRECT EFFECTS OF VITAMIN C ON TRANSCRIPTIONAL REGULATION OF TARGET GENES BY INFLUENCING THE ACTIVITY OF TRANSCRIPTION FACTORS AND BY EPIGENETIC MODIFICATION OF KEY GENES INVOLVED IN SKELETAL DEVELOPMENT AND MAINTENANCE ARE DISCUSSED. WITH AN UNDERSTANDING OF MECHANISMS INVOLVED IN THE UPTAKE AND METABOLISM OF VITAMIN C AND KNOWLEDGE OF PRECISE MOLECULAR PATHWAYS FOR VITAMIN C ACTIONS IN BONE CELLS, IT IS POSSIBLE THAT NOVEL THERAPEUTIC STRATEGIES CAN BE DEVELOPED OR EXISTING THERAPIES CAN BE MODIFIED FOR THE TREATMENT OF OSTEOPOROTIC FRACTURES. 2015 14 4987 38 PATTERNS OF CALCIUM SIGNALING: A LINK BETWEEN CHRONIC EMOTIONS AND CANCER. INTRA AND INTER-CELLULAR CALCIUM SIGNALING IS PRESENT IN ALL TYPES OF CELLS AND BODY TISSUES. IN THE HUMAN BRAIN, CALCIUM CURRENTS AND WAVES ARE RELATED TO MENTAL ACTIVITIES, INCLUDING EMOTIONS. WE PRESENT A THEORETICAL INTERPRETATION OF THESE PHENOMENA SUGGESTING THEIR INVOLVEMENT IN CHRONIC EMOTIONAL PATTERNS AND IN THE PATHOLOGY OF CANCER. RECENT DEVELOPMENTS ON BIOPHYSICS, TRANSLATIONAL BIOLOGY AND PSYCHONEUROENDOCRINOIMMUNOLOGY (PNEI) CAN SUPPORT EXPLANATORY HYPOTHESES ABOUT THE LINK BETWEEN EMOTIONAL STRESSES AND THE ORIGIN AND DEVELOPMENT OF DIFFERENT TYPES OF TUMOR CELLS. CHRONIC STRESSES MAY CAUSE PERTURBATIONS OF RHYTHMS OF THE PNEI SYSTEM, EXCESSIVE ACTIVATION OF HPA AXIS AND ABNORMAL ACTIVATION OF CALCIUM SIGNALS IN SOMATIC TISSUES, WITH DELETERIOUS EFFECTS ON DIFFERENT PARTS OF THE BODY. THE INCREASING OF CALCIUM SIGNALING INSIDE CELLS MAY LEAD TO A DEREGULATION OF DIFFERENT PATHWAYS AND EPIGENETIC SYSTEMS THAT PROMOTE THE PRODUCTION OF GENOMIC MUTATIONS IN A SECOND PHASE. IN PARTICULAR, THE HYPERACTIVATION OF THE TRANSCRIPTION NUCLEAR FACTOR KAPPAB (NF-KAPPAB), IF IS NOT COUNTERBALANCED BY THE FOLLOWING ACTIVATION OF THE NUCLEAR FACTOR (ERYTHROID-DERIVED 2)-LIKE 2 (NFE2L2 OR NRF2), INCREASES THE PRODUCTION OF OXIDATIVE CATABOLITES, AS THE ADVANCED GLYCATION END PRODUCTS (AGE), WHICH PLAY A KEY ROLE IN THE PROGRESSION OF DIFFERENT TYPES OF CANCER AND OTHER DEGENERATIVE DISEASES. CORTISOL BINDING TO GLUCOCORTICOID RECEPTOR (GR) REDUCES THE ACTIVITY OF BOTH NF-KAPPAB AND NRF2 INSIDE THE CELLS BUT INHIBITS THE CELLULAR IMMUNITY AND THE ANABOLIC PROCESSES OF TISSUE REGENERATION. THE TISSUE ATROPHY AND THE DEFECTIVE ANTI-AGEING MECHANISMS PROMOTES THE TUMORAL CELLS GROWTH AND THEIR ESCAPE FROM THE IMMUNE-SURVEILLANCE. 2017 15 4526 36 MULTIFUNCTIONAL TARGETS OF DIETARY POLYPHENOLS IN DISEASE: A CASE FOR THE CHEMOKINE NETWORK AND ENERGY METABOLISM. CHRONIC, NON-ACUTE INFLAMMATION IS BEHIND CONDITIONS THAT REPRESENT MOST OF THE DISEASE BURDEN IN HUMANS AND IS CLEARLY LINKED TO IMMUNE AND METABOLIC MECHANISMS. THE CONVERGENCE OF PATHWAYS INVOLVING THE IMMUNE RESPONSE, OXIDATIVE STRESS, INCREASED CIRCULATING LIPIDS AND ABERRANT INSULIN SIGNALING RESULTS IN CCL2-ASSOCIATED MACROPHAGE RECRUITMENT AND ALTERED ENERGY METABOLISM. THE CCL2/CCR2 PATHWAY AND THE ENERGY SENSOR AMP-ACTIVATED PROTEIN KINASE (AMPK) ARE ATTRACTIVE THERAPEUTIC TARGETS AS A PART OF PREVENTIVE MANAGEMENT OF DISEASE. SEVERAL EFFECTS OF POLYPHENOLS ARE USEFUL IN THIS SCENARIO, INCLUDING A REDUCTION IN THE ACTIVITIES OF CYTOKINES AND MODULATION OF CELLULAR METABOLISM THROUGH HISTONE DEACETYLASE INHIBITORS, AMPK ACTIVATORS, CALORIE-RESTRICTION MIMETICS OR EPIGENETIC REGULATORS. RESEARCH IS CURRENTLY UNDERWAY TO DEVELOP ORALLY ACTIVE DRUGS WITH THESE EFFECTS, BUT IT IS CONVENIENT TO EXAMINE MORE CLOSELY WHAT WE ARE EATING. IF A LACK OF RELEVANCE IN TERMS OF TOXICITY AND SUBSTANTIAL EFFECTIVENESS ARE CONFIRMED, PLANT-DERIVED COMPONENTS MAY PROVIDE USEFUL DRUGGABLE COMPONENTS AND DIETARY SUPPLEMENTS. WE CONSIDER THERAPEUTIC ACTIONS AS A COMBINATION OF SYNERGISTIC AND/OR ANTAGONISTIC INTERACTIONS IN A MULTI-TARGET STRATEGY. HENCE, IMPROVEMENT IN FOOD THROUGH ENRICHMENT WITH POLYPHENOLS WITH DEMONSTRATED ACTIVITY MAY REPRESENT A MAJOR ADVANCE IN THE DESIGN OF DIETS WITH BOTH INDUSTRIAL AND SANITARY VALUE. 2013 16 5162 34 PRECISION MEDICINE DRIVEN BY CANCER SYSTEMS BIOLOGY. MOLECULAR INSIGHTS FROM GENOME AND SYSTEMS BIOLOGY ARE INFLUENCING HOW CANCER IS DIAGNOSED AND TREATED. WE CRITICALLY EVALUATE BIG DATA CHALLENGES IN PRECISION MEDICINE. THE MELANOMA RESEARCH COMMUNITY HAS IDENTIFIED DISTINCT SUBTYPES INVOLVING CHRONIC SUN-INDUCED DAMAGE AND THE MITOGEN-ACTIVATED PROTEIN KINASE DRIVER PATHWAY. IN ADDITION, DESPITE LOW MUTATION BURDEN, NON-GENOMIC MITOGEN-ACTIVATED PROTEIN KINASE MELANOMA DRIVERS ARE FOUND IN MEMBRANE RECEPTORS, METABOLISM, OR EPIGENETIC SIGNALING WITH THE ABILITY TO BYPASS CENTRAL MITOGEN-ACTIVATED PROTEIN KINASE MOLECULES AND ACTIVATING A SIMILAR PROGRAM OF MITOGENIC EFFECTORS. MUTATION HOTSPOTS, STRUCTURAL MODELING, UV SIGNATURE, AND GENOMIC AS WELL AS NON-GENOMIC MECHANISMS OF DISEASE INITIATION AND PROGRESSION ARE TAKEN INTO CONSIDERATION TO IDENTIFY RESISTANCE MUTATIONS AND NOVEL DRUG TARGETS. A COMPREHENSIVE PRECISION MEDICINE PROFILE OF A MALIGNANT MELANOMA PATIENT ILLUSTRATES FUTURE RATIONAL DRUG TARGETING STRATEGIES. NETWORK ANALYSIS EMPHASIZES AN IMPORTANT ROLE OF EPIGENETIC AND METABOLIC MASTER REGULATORS IN ONCOGENESIS. CO-OCCURRENCE OF DRIVER MUTATIONS IN SIGNALING, METABOLIC, AND EPIGENETIC FACTORS HIGHLIGHTS HOW CUMULATIVE ALTERATIONS OF OUR GENOMES AND EPIGENOMES PROGRESSIVELY LEAD TO UNCONTROLLED CELL PROLIFERATION. PRECISION INSIGHTS HAVE THE ABILITY TO IDENTIFY INDEPENDENT MOLECULAR PATHWAYS SUITABLE FOR DRUG TARGETING. SYNERGISTIC TREATMENT COMBINATIONS OF ORTHOGONAL MODALITIES INCLUDING IMMUNOTHERAPY, MITOGEN-ACTIVATED PROTEIN KINASE INHIBITORS, EPIGENETIC INHIBITORS, AND METABOLIC INHIBITORS HAVE THE POTENTIAL TO OVERCOME IMMUNE EVASION, SIDE EFFECTS, AND DRUG RESISTANCE. 2017 17 3038 37 GENOME ENGINEERING FOR OSTEOARTHRITIS: FROM DESIGNER CELLS TO DISEASE-MODIFYING DRUGS. BACKGROUND: OSTEOARTHRITIS (OA) IS A HIGHLY PREVALENT DEGENERATIVE JOINT DISEASE INVOLVING JOINT CARTILAGE AND ITS SURROUNDING TISSUES. OA IS THE LEADING CAUSE OF PAIN AND DISABILITY WORLDWIDE. AT PRESENT, THERE ARE NO DISEASE-MODIFYING OA DRUGS, AND THE PRIMARY THERAPIES INCLUDE EXERCISE AND NONSTEROIDAL ANTI-INFLAMMATORY DRUGS UNTIL TOTAL JOINT REPLACEMENT AT THE END-STAGE OF THE DISEASE. METHODS: IN THIS REVIEW, WE SUMMARIZED THE CURRENT STATE OF KNOWLEDGE IN GENETIC AND EPIGENETIC ASSOCIATIONS AND RISK FACTORS FOR OA AND THEIR POTENTIAL DIAGNOSTIC AND THERAPEUTIC APPLICATIONS. RESULTS: GENOME-WIDE ASSOCIATION STUDIES AND ANALYSIS OF EPIGENETIC MODIFICATIONS (SUCH AS MIRNA EXPRESSION, DNA METHYLATION AND HISTONE MODIFICATIONS) CONDUCTED ACROSS VARIOUS POPULATIONS SUPPORT THE NOTION THAT THERE IS A GENETIC BASIS FOR CERTAIN SUBSETS OF OA PATHOGENESIS. CONCLUSION: WITH RECENT ADVANCES IN THE DEVELOPMENT OF GENOME EDITING TECHNOLOGIES SUCH AS THE CRISPR-CAS9 SYSTEM, THESE GENETIC AND EPIGENETIC ALTERNATIONS IN OA CAN BE USED AS PLATFORMS FROM WHICH POTENTIAL BIOMARKERS FOR THE DIAGNOSIS, PROGNOSIS, DRUG RESPONSE, AND DEVELOPMENT OF POTENTIAL PERSONALIZED THERAPEUTIC TARGETS FOR OA CAN BE APPROACHED. FURTHERMORE, GENOME EDITING HAS ALLOWED THE DEVELOPMENT OF "DESIGNER" CELLS, WHEREBY THE RECEPTORS, GENE REGULATORY NETWORKS, OR TRANSGENES CAN BE MODIFIED AS A BASIS FOR NEW CELL-BASED THERAPIES. 2019 18 2508 25 EPIGENETICS AND OSTEOARTHRITIS. OSTEOARTHRITIS (OA) IS THE MOST COMMON FORM OF JOINT DISEASE AND THE LEADING CAUSE OF CHRONIC DISABILITY IN MIDDLE-AGED AND OLDER POPULATIONS. THE DEVELOPMENT OF DISEASE-MODIFYING THERAPY FOR OA CURRENTLY FACES MAJOR OBSTACLES LARGELY BECAUSE THE REGULATORY MECHANISMS FOR THE FUNCTION OF JOINT TISSUE CELLS REMAIN UNCLEAR. PREVIOUS STUDIES HAVE FOUND THAT THE ALTERATIONS IN GENE EXPRESSION OF SPECIFIC TRANSCRIPTION FACTORS (TFS), PRO- OR ANTI-INFLAMMATORY CYTOKINES, MATRIX PROTEINASES AND EXTRACELLULAR MATRIX (ECM) PROTEINS IN ARTICULAR CARTILAGE MAY BE INVOLVED IN THE DEVELOPMENT OF OA. HOWEVER, THE REGULATORY MECHANISMS FOR THE EXPRESSION OF THOSE GENES IN OA CHONDROCYTES ARE LARGELY UNKNOWN. THE RECENT ADVANCES IN EPIGENETIC STUDIES HAVE SHED LIGHTS ON THE IMPORTANCE OF EPIGENETIC REGULATION OF GENE EXPRESSION IN THE DEVELOPMENT OF OA. IN THIS REVIEW, WE SUMMARIZE AND DISCUSS THE RECENT STUDIES ON THE REGULATORY ROLES OF VARIOUS EPIGENETIC MECHANISMS IN THE EXPRESSION OF GENES FOR SPECIFIC TFS, CYTOKINES, ECM PROTEINS AND MATRIX PROTEINASES, AS WELL THE SIGNIFICANCE OF THESE EPIGENETIC MECHANISMS IN THE PATHOGENESIS OF OA. 2015 19 4738 33 NOVEL FIBROBLAST PHENOTYPES IN HOMEOSTASIS AND CHRONIC INFLAMMATION: FROM FUNCTIONS TO POTENTIAL REGULATORS. FIBROBLASTS ARE ESSENTIAL COMPONENTS OF THE STROMA, SUSTAINING A VARIETY OF TISSUES AND BEING KEY TO THE PROCESS OF TISSUE REPAIR AFTER INJURY. THEIR ROLE IN TISSUE REPAIR HAS BEEN ATTRIBUTED TO THEIR ABILITY TO ACQUIRE A CONTRACTILE, EXTRACELLULAR MATRIX-PRODUCING PHENOTYPE KNOWN AS MYOFIBROBLASTS. THIS PROPERTY IS PRIMARILY DEPENDENT ON THEIR RESPONSE TO THE PLEIOTROPIC CYTOKINE TRANSFORMING GROWTH FACTOR-BETA1. UNTIL RECENTLY, THE POTENTIAL ROLE OF FIBROBLASTS IN OTHER HOMEOSTATIC AND DISEASE-RELATED PROCESSES WAS LESS WELL UNDERSTOOD. ALTHOUGH IN VITRO STUDIES INDICATED THAT FIBROBLASTS ARE ABLE TO RESPOND TO AND SECRETE INFLAMMATORY MEDIATORS, DEFINITIVE EVIDENCE OF THEIR CONTRIBUTION TO CHRONIC INFLAMMATION WAS LIMITED. HOWEVER, THE EMERGENCE OF TECHNIQUES THAT ALLOW EXPLORATION OF TISSUES AT THE SINGLE CELL LEVEL HAS CHALLENGED THE PREVIOUS PARADIGMS ON FIBROBLAST IDENTITY AND FUNCTIONS, AND HAS LED TO THE DISCOVERY OF SIGNIFICANT DIVERSITY, SHOWING THE PRESENCE OF FIBROBLASTS WITH ALTERNATE TRANSCRIPTIONAL PROFILES IN A VARIETY OF TISSUES. THESE STUDIES HAVE ALSO SUGGESTED POTENTIAL ROLES OF NOVEL FIBROBLAST SUBTYPES AS REGULATORS OF EPITHELIAL HOMEOSTASIS AND RENEWAL, INFLAMMATORY CELL INFILTRATION AND ACTIVATION, AND ANTIGEN PRESENTATION. HERE, WE PROVIDE A COMPREHENSIVE REVIEW OF THE RECENT LITERATURE ON FIBROBLAST DIVERSITY IN THE DIGESTIVE TRACT, SKIN, LUNGS AND JOINTS. WE ALSO REVIEW EVIDENCE OF THEIR CONTRIBUTION TO THE REGULATION OF HOMEOSTASIS AND CHRONIC INFLAMMATION, AS WELL AS THEIR INTERACTIONS WITH OTHER CELLS IN VARIOUS TISSUE COMPARTMENTS. WE DISCUSS EVIDENCE OF DIFFERENT FACTORS INVOLVED IN THE CONTROL OF FIBROBLAST FUNCTION, ADDRESSING THE ROLE OF VARIOUS CYTOKINES, TRANSCRIPTION FACTORS AND EPIGENETIC CHANGES, AS WELL AS MICROENVIRONMENTAL FACTORS, INCLUDING EXTRACELLULAR MATRIX STIFFNESS, HYPOXIA, AND METABOLIC SHIFTS. 2023 20 6449 46 THERAPEUTIC TARGETING OF TELOMERASE. TELOMERE LENGTH AND CELL FUNCTION CAN BE PRESERVED BY THE HUMAN REVERSE TRANSCRIPTASE TELOMERASE (HTERT), WHICH SYNTHESIZES THE NEW TELOMERIC DNA FROM A RNA TEMPLATE, BUT IS NORMALLY RESTRICTED TO CELLS NEEDING A HIGH PROLIFERATIVE CAPACITY, SUCH AS STEM CELLS. CONSEQUENTLY, TELOMERASE-BASED THERAPIES TO ELONGATE SHORT TELOMERES ARE DEVELOPED, SOME OF WHICH HAVE SUCCESSFULLY REACHED THE STAGE I IN CLINICAL TRIALS. TELOMERASE IS ALSO PERMISSIVE FOR TUMORIGENESIS AND 90% OF ALL MALIGNANT TUMORS USE TELOMERASE TO OBTAIN IMMORTALITY. THUS, REVERSAL OF TELOMERASE UPREGULATION IN TUMOR CELLS IS A POTENTIAL STRATEGY TO TREAT CANCER. NATURAL AND SMALL-MOLECULE TELOMERASE INHIBITORS, IMMUNOTHERAPEUTIC APPROACHES, OLIGONUCLEOTIDE INHIBITORS, AND TELOMERASE-DIRECTED GENE THERAPY ARE USEFUL TREATMENT STRATEGIES. TELOMERASE IS MORE WIDELY EXPRESSED THAN ANY OTHER TUMOR MARKER. THE LOW EXPRESSION IN NORMAL TISSUES, TOGETHER WITH THE LONGER TELOMERES IN NORMAL STEM CELLS VERSUS CANCER CELLS, PROVIDES SOME DEGREE OF SPECIFICITY WITH LOW RISK OF TOXICITY. HOWEVER, LONG TERM TELOMERASE INHIBITION MAY ELICIT NEGATIVE EFFECTS IN HIGHLY-PROLIFERATIVE CELLS WHICH NEED TELOMERASE FOR SURVIVAL, AND IT MAY INTERFERE WITH TELOMERE-INDEPENDENT PHYSIOLOGICAL FUNCTIONS. MOREOVER, ONLY A FEW HTERT MOLECULES ARE REQUIRED TO OVERCOME SENESCENCE IN CANCER CELLS, AND TELOMERASE INHIBITION REQUIRES PROLIFERATING CELLS OVER A SUFFICIENT NUMBER OF POPULATION DOUBLINGS TO INDUCE TUMOR SUPPRESSIVE SENESCENCE. THESE LIMITATIONS MAY EXPLAIN THE MODERATE SUCCESS RATES IN MANY CLINICAL STUDIES. DESPITE EXTENSIVE STUDIES, ONLY ONE VACCINE AND ONE TELOMERASE ANTAGONIST ARE ROUTINELY USED IN CLINICAL WORK. FOR COMPLETE ERADICATION OF ALL SUBPOPULATIONS OF CANCER CELLS A SIMULTANEOUS TARGETING OF SEVERAL MECHANISMS WILL LIKELY BE NEEDED. POSSIBLE TECHNICAL IMPROVEMENTS HAVE BEEN PROPOSED INCLUDING THE DEVELOPMENT OF MORE SPECIFIC INHIBITORS, METHODS TO INCREASE THE EFFICACY OF VACCINATION METHODS, AND PERSONALIZED APPROACHES. TELOMERASE ACTIVATION AND CELL REJUVENATION IS SUCCESSFULLY USED IN REGENERATIVE MEDICINE FOR TISSUE ENGINEERING AND RECONSTRUCTIVE SURGERY. HOWEVER, THERE ARE ALSO A NUMBER OF PITFALLS IN THE TREATMENT WITH TELOMERASE ACTIVATING PROCEDURES FOR THE WHOLE ORGANISM AND FOR LONGER PERIODS OF TIME. EXTENDED CELL LIFESPAN MAY ACCUMULATE RARE GENETIC AND EPIGENETIC ABERRATIONS THAT CAN CONTRIBUTE TO MALIGNANT TRANSFORMATION. THEREFORE, NOVEL VECTOR SYSTEMS HAVE BEEN DEVELOPED FOR A 'MILD' INTEGRATION OF TELOMERASE INTO THE HOST GENOME AND LOSS OF THE VECTOR IN RAPIDLY-PROLIFERATING CELLS. IT IS CURRENTLY UNCLEAR IF THIS TECHNIQUE CAN ALSO BE USED IN HUMAN BEINGS TO TREAT CHRONIC DISEASES, SUCH AS ATHEROSCLEROSIS. 2016