1 604 171 BEYOND BROODING ON ONCOMETABOLIC HAVOC IN IDH-MUTANT GLIOMAS AND AML: CURRENT AND FUTURE THERAPEUTIC STRATEGIES. ISOCITRATE DEHYDROGENASES 1 AND 2 (IDH1,2), THE KEY KREBS CYCLE ENZYMES THAT GENERATE NADPH REDUCING EQUIVALENTS, UNDERGO HETEROZYGOUS MUTATIONS IN >70% OF LOW- TO MID-GRADE GLIOMAS AND ~20% OF ACUTE MYELOID LEUKEMIAS (AMLS) AND GAIN AN UNUSUAL NEW ACTIVITY OF REDUCING THE ALPHA-KETOGLUTARATE (ALPHA-KG) TO D-2 HYDROXYGLUTARATE (D-2HG) IN A NADPH-CONSUMING REACTION. THE ONCOMETABOLITE D-2HG, WHICH ACCUMULATES >35 MM, IS WIDELY ACCEPTED TO DRIVE A PROGRESSIVE ONCOGENESIS BESIDES EXACERBATING THE ALREADY INCREASED OXIDATIVE STRESS IN THESE CANCERS. MORE IMPORTANTLY, D-2HG COMPETES WITH ALPHA-KG AND INHIBITS A LARGE NUMBER OF ALPHA-KG-DEPENDENT DIOXYGENASES SUCH AS TET (TEN-ELEVEN TRANSLOCATION), JMJC DOMAIN-CONTAINING KDMS (HISTONE LYSINE DEMETHYLASES), AND THE ALKBH DNA REPAIR PROTEINS THAT ULTIMATELY LEAD TO HYPERMETHYLATION OF THE CPG ISLANDS IN THE GENOME. THE RESULTING CPG ISLAND METHYLATOR PHENOTYPE (CIMP) ACCOUNTS FOR MAJOR GENE EXPRESSION CHANGES INCLUDING THE SILENCING OF THE MGMT (O(6)-METHYLGUANINE DNA METHYLTRANSFERASE) REPAIR PROTEIN IN GLIOMAS. GLIOMA PATIENTS WITH IDH1 MUTATIONS ALSO SHOW BETTER THERAPEUTIC RESPONSES AND LONGER SURVIVAL, THE REASONS FOR WHICH ARE YET UNCLEAR. THERE HAS BEEN A GREAT SURGE IN DRUG DISCOVERY FOR CURTAILING THE MUTANT IDH ACTIVITIES, AND ARRESTING TUMOR PROLIFERATION; HOWEVER, GIVEN THE UNIQUE AND CHRONIC METABOLIC EFFECTS OF D-2HG, THE PROMISE OF THESE COMPOUNDS FOR GLIOMA TREATMENT IS UNCERTAIN. THIS COMPREHENSIVE REVIEW DISCUSSES THE BIOLOGY, CURRENT DRUG DESIGN AND OPPORTUNITIES FOR IMPROVED THERAPIES THROUGH EXPLOITABLE SYNTHETIC LETHALITY PATHWAYS, AND AN INTRIGUING ONCOMETABOLITE-INSPIRED STRATEGY FOR PRIMARY GLIOBLASTOMA. 2018 2 1445 25 DIFFUSE PEDIATRIC-TYPE HIGH-GRADE GLIOMA ARISING IN AN OVARIAN MATURE CYSTIC TERATOMA. IMMATURE NEUROECTODERMAL TISSUE CAN BE FOUND IN THE OVARY AS PART OF AN IMMATURE TERATOMA OR AS PART OF A TERATOMA WITH MALIGNANT NEUROECTODERMAL TRANSFORMATION. SUCH LESIONS MAY CLOSELY RESEMBLE CENTRAL NERVOUS SYSTEM TUMORS, BUT THEIR BIOLOGIC SIMILARITY IS UNCLEAR. WE DESCRIBE AN 18-YR-OLD FEMALE WHO PRESENTED WITH ABDOMINAL PAIN CAUSED BY AN OVARIAN MASS WITH WIDESPREAD METASTASES. HISTOLOGY SHOWED A PRIMITIVE, HIGH-GRADE TUMOR ARISING IN THE BACKGROUND OF A MATURE TERATOMA. THE TUMOR WAS SOX10 POSITIVE, WITH FOCAL EXPRESSION OF GFAP, S100, NSE, AND SYNAPTOPHYSIN. MOLECULAR ANALYSIS DEMONSTRATED CO-AMPLIFICATION OF PDGFRA AND KIT, ALTERATIONS COMMON IN HIGH-GRADE GLIOMAS. BY WHOLE-GENOME METHYLATION PROFILING, IT CLUSTERED INTO THE "DIFFUSE PEDIATRIC-TYPE HIGH-GRADE GLIOMA, RTK1 SUBTYPE, SUBCLASS C" GROUP. DESPITE PROGRESSING THROUGH 2 LINES OF CHEMOTHERAPY WITH WIDESPREAD METASTATIC DISEASE, SHE ACHIEVED AN EXCELLENT RESPONSE TO CHEMOTHERAPY DIRECTED TOWARD AGGRESSIVE GERM CELL TUMORS. THIS CASE EMPHASIZES THE IMPORTANCE OF IMMUNOHISTOCHEMICAL, GENOMIC, AND EPIGENETIC ANALYSES TO ACCURATELY CLASSIFY THESE EXCEEDINGLY RARE TUMORS AND DETERMINE THE OPTIMAL THERAPY. 2023 3 4261 38 MGMT-METHYLATION IN NON-NEOPLASTIC DISEASES OF THE CENTRAL NERVOUS SYSTEM. QUANTIFYING O(6)-METHYLGUANINE-DNA METHYLTRANSFERASE (MGMT) PROMOTER METHYLATION PLAYS AN ESSENTIAL ROLE IN ASSESSING THE POTENTIAL EFFICACY OF ALKYLATING AGENTS IN THE CHEMOTHERAPY OF MALIGNANT GLIOMAS. MGMT PROMOTER METHYLATION IS CONSIDERED TO BE A CHARACTERISTIC OF SUBGROUPS OF CERTAIN MALIGNANCIES BUT HAS ALSO BEEN DESCRIBED IN VARIOUS PERIPHERAL INFLAMMATORY DISEASES. HOWEVER, MGMT PROMOTER METHYLATION LEVELS HAVE NOT YET BEEN INVESTIGATED IN NON-NEOPLASTIC BRAIN DISEASES. THIS STUDY DEMONSTRATES FOR THE FIRST TIME THAT ONE CAN INDEED DETECT SLIGHTLY ENHANCED MGMT PROMOTER METHYLATION IN INDIVIDUAL CASES OF INFLAMMATORY DEMYELINATING CNS DISEASES SUCH AS MULTIPLE SCLEROSIS AND PROGRESSIVE MULTIFOCAL LEUCENCEPHALOPATHY (PML), AS WELL AS IN OTHER DEMYELINATING DISEASES SUCH AS CENTRAL PONTINE AND EXPTRAPONTINE MYELINOLYSIS, AND DISEASES WITH MYELIN DAMAGE SUCH AS WALLERIAN DEGENERATION. IN THIS CONTEXT, WE IDENTIFIED A REDUCTION IN THE EXPRESSION OF THE DEMETHYLASE TET1 AS A POSSIBLE CAUSE FOR THE ENHANCED MGMT PROMOTER METHYLATION. HENCE, WE SHOW FOR THE FIRST TIME THAT MGMT HYPERMETHYLATION OCCURS IN CHRONIC DISEASES THAT ARE NOT STRICTLY ASSOCIATED TO DISTINCT PATHOGENS, ONCOGENIC VIRUSES OR NEOPLASMS BUT THAT LEAD TO DAMAGE OF THE MYELIN SHEATH IN VARIOUS WAYS. WHILE THIS GIVES NEW INSIGHTS INTO EPIGENETIC AND PATHOPHYSIOLOGICAL PROCESSES INVOLVED IN DE- AND REMYELINATION, WHICH MIGHT OFFER NEW THERAPEUTIC OPPORTUNITIES FOR DEMYELINATING DISEASES IN THE FUTURE, IT ALSO REDUCES THE SPECIFICITY OF MGMT HYPERMETHYLATION AS A TUMOR BIOMARKER. 2021 4 329 38 ALPHA-OXOGLUTARATE INHIBITS THE PROLIFERATION OF IMMORTALIZED NORMAL BLADDER EPITHELIAL CELLS VIA AN EPIGENETIC SWITCH INVOLVING ARID1A. INTERSTITIAL CYSTITIS (IC) IS A CHRONIC URINARY TRACT DISEASE THAT IS CHARACTERIZED BY UNPLEASANT SENSATIONS, SUCH AS PERSISTENT PELVIC PAIN, IN THE ABSENCE OF INFECTION OR OTHER IDENTIFIABLE CAUSES. WE PREVIOUSLY PERFORMED COMPREHENSIVE METABOLOMICS PROFILING OF URINE SAMPLES FROM IC PATIENTS USING NUCLEAR MAGNETIC RESONANCE AND GAS-CHROMATOGRAPHY/MASS SPECTROMETRY AND FOUND THAT URINARY ALPHA-OXOGLUTARATE (ALPHA-OG), WAS SIGNIFICANTLY ELEVATED. ALPHA-OG, A TRICARBOXYLIC ACID (TCA) CYCLE INTERMEDIATE, REPORTEDLY FUNCTIONS TO SUPPRESS THE PROLIFERATION OF IMMORTALIZED NORMAL HUMAN BLADDER EPITHELIAL CELLS. HERE, WE IDENTIFIED AT-RICH INTERACTIVE DOMAIN 1 A (ARID1A), A KEY CHROMATIN REMODELER, AS BEING HYPOMETHYLATED AND UPREGULATED BY ALPHA-OG TREATMENT. THIS WAS DONE THROUGH EPIC DNA METHYLATION PROFILING AND SUBSEQUENT BIOCHEMICAL APPROACHES, INCLUDING QUANTITATIVE RT-PCR AND WESTERN BLOT ANALYSES. FURTHERMORE, WE FOUND THAT ALPHA-OG ALMOST COMPLETELY SUPPRESSES TEN-ELEVEN TRANSLOCATION (TET) ACTIVITY, BUT DOES NOT AFFECT DNA METHYLTRANSFERASE (DNMT) ACTIVITY. ALTOGETHER, OUR STUDIES REVEAL THE POTENTIAL ROLE OF ALPHA-OG IN EPIGENETIC REMODELING THROUGH ITS EFFECTS ON ARID1A AND TET EXPRESSION IN THE BLADDER. THIS MAY PROVIDE A NEW POSSIBLE THERAPEUTIC STRATEGY IN TREATING IC. 2018 5 3115 35 GEROMETABOLITES: THE PSEUDOHYPOXIC AGING SIDE OF CANCER ONCOMETABOLITES. ONCOMETABOLITES ARE DEFINED AS SMALL-MOLECULE COMPONENTS (OR ENANTIOMERS) OF NORMAL METABOLISM WHOSE ACCUMULATION CAUSES SIGNALING DYSREGULATION TO ESTABLISH A MILIEU THAT INITIATES CARCINOGENESIS. IN A SIMILAR MANNER, WE PROPOSE THE TERM "GEROMETABOLITES" TO REFER TO SMALL-MOLECULE COMPONENTS OF NORMAL METABOLISM WHOSE DEPLETION CAUSES SIGNALING DYSREGULATION TO ESTABLISH A MILIEU THAT DRIVES AGING. IN AN INVESTIGATION OF THE PATHOGENIC ACTIVITIES OF THE CURRENTLY RECOGNIZED ONCOMETABOLITES R(-)-2-HYDROXYGLUTARATE (2-HG), FUMARATE, AND SUCCINATE, WHICH ACCUMULATE DUE TO MUTATIONS IN ISOCITRATE DEHYDROGENASES (IDH), FUMARATE HYDRATASE (FH), AND SUCCINATE DEHYDROGENASE (SDH), RESPECTIVELY, WE ILLUSTRATE THE FACT THAT METABOLIC PSEUDOHYPOXIA, THE ACCUMULATION OF HYPOXIA-INDUCIBLE FACTOR (HIFALPHA) UNDER NORMOXIC CONDITIONS, AND THE SUBSEQUENT WARBURG-LIKE REPROGRAMMING THAT SHIFTS GLUCOSE METABOLISM FROM THE OXIDATIVE PATHWAY TO AEROBIC GLYCOLYSIS ARE THE SAME MECHANISMS THROUGH WHICH THE DECLINE OF THE "GEROMETABOLITE" NICOTINAMIDE ADENINE DINUCLEOTIDE (NAD)(+) REVERSIBLY DISRUPTS NUCLEAR-MITOCHONDRIAL COMMUNICATION AND CONTRIBUTES TO THE DECLINE IN MITOCHONDRIAL FUNCTION WITH AGE. FROM AN EVOLUTIONARY PERSPECTIVE, IT IS REASONABLE TO VIEW NAD(+)-DRIVEN MITOCHONDRIAL HOMEOSTASIS AS A CONSERVED RESPONSE TO CHANGES IN ENERGY SUPPLIES AND OXYGEN LEVELS. SIMILARLY, THE NATURAL ABILITY OF 2-HG TO SIGNIFICANTLY ALTER EPIGENETICS MIGHT REFLECT AN EVOLUTIONARILY ANCIENT ROLE OF CERTAIN METABOLITES TO SIGNAL FOR ELEVATED GLUTAMINE/GLUTAMATE METABOLISM AND/OR OXYGEN DEFICIENCY. HOWEVER, WHEN CHRONICALLY ALTERED, THESE RESPONSES BECOME CONSERVED CAUSES OF AGING AND CANCER. BECAUSE HIFALPHA-DRIVEN PSEUDOHYPOXIA MIGHT DRIVE THE OVERPRODUCTION OF 2-HG, THE INTRIGUING POSSIBILITY EXISTS THAT THE DECLINE OF GEROMETABOLITES SUCH AS NAD(+) COULD PROMOTE THE CHRONIC ACCUMULATION OF ONCOMETABOLITES IN NORMAL CELLS DURING AGING. IF THE SOLE ACTIVATION OF A WARBURG-LIKE METABOLIC REPROGRAMMING IN NORMAL TISSUES MIGHT BE ABLE TO SIGNIFICANTLY INCREASE THE ENDOGENOUS PRODUCTION OF BONA FIDE ETIOLOGICAL DETERMINANTS IN CANCER, SUCH AS ONCOMETABOLITES, THIS UNDESIRABLE TRADE-OFF BETWEEN MITOCHONDRIAL DYSFUNCTION AND ACTIVATION OF ONCOMETABOLITES PRODUCTION MIGHT THEN PAVE THE WAY FOR THE EPIGENETIC INITIATION OF CARCINOGENESIS IN A STRICTLY METABOLIC-DEPENDENT MANNER. PERHAPS IT IS TIME TO DEFINITELY ADOPT THE VIEW THAT AGING AND AGING DISEASES INCLUDING CANCER ARE GOVERNED BY A PIVOTAL REGULATORY ROLE OF METABOLIC REPROGRAMMING IN CELL FATE DECISIONS. 2014 6 3294 30 HIGH INCIDENCE OF MGMT AND RARBETA PROMOTER METHYLATION IN PRIMARY GLIOBLASTOMAS: ASSOCIATION WITH HISTOPATHOLOGICAL CHARACTERISTICS, INFLAMMATORY MEDIATORS AND CLINICAL OUTCOME. GLIOBLASTOMAS, THE MOST FREQUENT PRIMARY BRAIN TUMORS IN ADULTS, ARE CHARACTERIZED BY A HIGHLY AGGRESSIVE, INFLAMMATORY AND ANGIOGENIC PHENOTYPE. METHYLATION OF CPG ISLANDS IN CANCER-RELATED GENES MAY SERVE AS AN EPIGENETIC BIOMARKER FOR GLIOBLASTOMA DIAGNOSIS AND PROGNOSIS. THE AIM OF THIS STUDY WAS TO ANALYZE THE METHYLATION STATUS OF FOUR CRITICAL TUMOR-ASSOCIATED GENES (MGMT, RARBETA, RASSF1A, CDH13), AND INVESTIGATE POSSIBLE LINKS WITH INFLAMMATORY (INTERLEUKIN [IL]-6, IL-8) AND ANGIOGENIC MEDIATORS (VASCULAR ENDOTHELIAL GROWTH FACTOR [VEGF], CYCLOOXYGENASE [COX]-2) AND CLINICAL OUTCOME IN 23 GLIOMA SAMPLES (6 GRADE II ASTROCYTOMAS, 17 GRADE IV GLIOBLASTOMAS). RARBETA AND MGMT GENES WERE MORE FREQUENTLY METHYLATED IN 70.58% AND 58.8% OF GLIOBLASTOMAS, RESPECTIVELY. RASSF1A AND CDH13 DISPLAYED A SIMILAR METHYLATION FREQUENCY (23.52%) IN GLIOBLASTOMAS. NO GENE METHYLATION WAS OBSERVED IN GRADE II ASTROCYTOMAS. TUMOR GRADE CORRELATED POSITIVELY WITH MGMT AND RARBETA METHYLATION (P = 0.005 AND P = 0.019, RESPECTIVELY) AND THE EXTENT OF NECROSIS (P = 0.001 AND P = 0.003). INTERESTINGLY, THE MARKER OF CHRONIC INFLAMMATION, IL-6, WAS POSITIVELY ASSOCIATED WITH METHYLATION OF MGMT (P = 0.004), RARBETA (P = 0.002), AND RASSF1A (P = 0.0081) AS WELL AS THE TOTAL NUMBER OF METHYLATED GENES (P < 0.0001), INDICATING THE IMPORTANT ROLE OF IL-6 IN MAINTAINING PROMOTER METHYLATION OF THESE GENES. VEGF EXPRESSION CORRELATED POSITIVELY WITH MGMT AND RARBETA METHYLATION ALTHOUGH THESE RELATIONSHIPS WERE OF MARGINAL SIGNIFICANCE (P = 0.0679 AND P = 0.0757). KAPLAN-MEIER UNIVARIATE SURVIVAL ANALYSIS INDICATED AN UNFAVORABLE SURVIVAL PERIOD IN PATIENTS WITH MGMT METHYLATION COMPARED WITH THOSE WITHOUT METHYLATION (P = 0.0474). OUR STUDY HIGHLIGHTS THE IMPLICATION OF MGMT AND RARBETA METHYLATION IN THE AGGRESSIVE PHENOTYPE OF PRIMARY GLIOBLASTOMAS. THE ASSOCIATION OF MGMT METHYLATION WITH CLINICAL OUTCOME INDICATES ITS POTENTIAL PROGNOSTIC VALUE. 2010 7 926 33 CHRONIC INFLAMMATION PATHWAY NF-KAPPAB COOPERATES WITH EPIGENETIC REPROGRAMMING TO DRIVE THE MALIGNANT PROGRESSION OF GLIOBLASTOMA. WITHOUT AN EFFECTIVE STRATEGY FOR TARGETED THERAPY, GLIOBLASTOMA IS STILL INCURABLE WITH A MEDIAN SURVIVAL OF ONLY 15 MONTHS. BOTH CHRONIC INFLAMMATION AND EPIGENETIC REPROGRAMMING ARE HALLMARKS OF CANCER. HOWEVER, THE MECHANISMS AND CONSEQUENCES OF THEIR COOPERATION IN GLIOBLASTOMA REMAIN UNKNOWN. HERE, WE DISCOVER THAT CHRONIC INFLAMMATION GOVERNS H3K27ME3 REPROGRAMMING IN GLIOBLASTOMA THROUGH THE CANONICAL NF-KAPPAB PATHWAY TO TARGET EZH2. BEING A CRUCIAL MEDIATOR OF CHRONIC INFLAMMATION, THE CANONICAL NF-KAPPAB SIGNALLING SPECIFICALLY DIRECTS THE EXPRESSION AND REDISTRIBUTION OF H3K27ME3 BUT NOT H3K4ME3, H3K9ME3 AND H3K36ME3. USING RNA-SEQ SCREENING TO FOCUS ON GENES ENCODING METHYLTRANSFERASES AND DEMETHYLASES OF HISTONE, WE IDENTIFY EZH2 AS A KEY METHYLTRANSFERASE TO CONTROL INFLAMMATION-TRIGGERED EPIGENETIC REPROGRAMMING IN GLIOMAGENESIS. MECHANISTICALLY, NF-KAPPAB SELECTIVELY DRIVES THE EXPRESSION OF EZH2 BY ACTIVATING ITS TRANSCRIPTION, CONSEQUENTLY RESULTING IN A GLOBAL CHANGE IN H3K27ME3 EXPRESSION AND DISTRIBUTION. FURTHERMORE, WE FIND THAT CO-ACTIVATION OF NF-KAPPAB AND EZH2 CONFERS THE POOREST CLINICAL OUTCOME, AND THAT THE RISK FOR GLIOBLASTOMA CAN BE ACCURATELY MOLECULARLY STRATIFIED BY NF-KAPPAB AND EZH2. IT IS NOTABLE THAT NF-KAPPAB CAN POTENTIALLY COOPERATE WITH EZH2 IN MORE THAN ONE WAY, AND MOST IMPORTANTLY, WE DEMONSTRATE A SYNERGISTIC EFFECT OF CANCER CELLS INDUCED BY COMBINATORY INHIBITION OF NF-KAPPAB AND EZH2, WHICH BOTH ARE FREQUENTLY OVER-ACTIVATED IN GLIOBLASTOMA. IN SUMMARY, WE UNCOVER A FUNCTIONAL COOPERATION BETWEEN CHRONIC INFLAMMATION AND EPIGENETIC REPROGRAMMING IN GLIOBLASTOMA, COMBINED TARGETING OF WHICH BY INHIBITORS GUARANTEED IN SAFETY AND AVAILABILITY FURNISHES A POTENT STRATEGY FOR EFFECTIVE TREATMENT OF THIS FATAL DISEASE. 2022 8 6456 26 THYMOSIN BETA4 PREVENTS OXIDATIVE STRESS, INFLAMMATION, AND FIBROSIS IN ETHANOL- AND LPS-INDUCED LIVER INJURY IN MICE. THYMOSIN BETA 4 (TBETA4), AN ACTIN-SEQUESTERING PROTEIN, IS INVOLVED IN TISSUE DEVELOPMENT AND REGENERATION. IT PREVENTS INFLAMMATION AND FIBROSIS IN SEVERAL TISSUES. WE INVESTIGATED THE ROLE OF TBETA4 IN CHRONIC ETHANOL- AND ACUTE LIPOPOLYSACCHARIDE- (LPS-) INDUCED MOUSE LIVER INJURY. C57BL/6 MICE WERE FED 5% ETHANOL IN LIQUID DIET FOR 4 WEEKS PLUS BINGE ETHANOL (5 G/KG, GAVAGE) WITH OR WITHOUT LPS (2 MG/KG, INTRAPERITONEAL) FOR 6 HOURS. TBETA4 (1 MG/KG, INTRAPERITONEAL) WAS ADMINISTERED FOR 1 WEEK. WE DEMONSTRATED THAT TBETA4 PREVENTED ETHANOL- AND LPS-MEDIATED INCREASE IN LIVER INJURY MARKERS AS WELL AS CHANGES IN LIVER PATHOLOGY. IT ALSO PREVENTED ETHANOL- AND LPS-MEDIATED INCREASE IN OXIDATIVE STRESS BY DECREASING ROS AND LIPID PEROXIDATION AND INCREASING THE ANTIOXIDANTS, REDUCED GLUTATHIONE AND MANGANESE-DEPENDENT SUPEROXIDE DISMUTASE. IT ALSO PREVENTED THE ACTIVATION OF NUCLEAR FACTOR KAPPA B BY BLOCKING THE PHOSPHORYLATION OF THE INHIBITORY PROTEIN, IKAPPAB, THEREBY PREVENTED PROINFLAMMATORY CYTOKINE PRODUCTION. MOREOVER, TBETA4 PREVENTED FIBROGENESIS BY SUPPRESSING THE EPIGENETIC REPRESSOR, METHYL-CPG-BINDING PROTEIN 2, THAT COORDINATELY REVERSED THE EXPRESSION OF PEROXISOME PROLIFERATOR-ACTIVATED RECEPTOR-GAMMA AND DOWNREGULATED FIBROGENIC GENES, PLATELET-DERIVED GROWTH FACTOR-BETA RECEPTOR, ALPHA-SMOOTH MUSCLE ACTIN, COLLAGEN 1, AND FIBRONECTIN, RESULTING IN REDUCED FIBROSIS. OUR DATA SUGGEST THAT TBETA4 HAS ANTIOXIDANT, ANTI-INFLAMMATORY, AND ANTIFIBROTIC POTENTIAL DURING ALCOHOLIC LIVER INJURY. 2018 9 6813 25 [EPILEPSY-ASSOCIATED TUMORS OF THE CENTRAL NERVOUS SYSTEM: EPILEPSY SURGERY AND ONCOLOGICAL ASPECTS]. BACKGROUND: AMONG THE TUMORS ASSOCIATED WITH CHRONIC EPILEPSY, DYSEMBRYOPLASTIC NEUROEPITHELIAL TUMOR AND GANGLIOGLIOMA ARE THE MOST COMMON BESIDES ANGIOCENTRIC GLIOMA, PLEOMORPHIC XANTHOASTROCYTOMA AND PILOCYTIC ASTROCYTOMA. THESE TUMORS ARE USUALLY CONSIDERED AS BEING BENIGN. OBJECTIVE: TO DETERMINE THE BEST CONSERVATIVE AND SURGICAL TREATMENT OF TUMORS ASSOCIATED WITH EPILEPSY. MATERIAL AND METHODS: THIS ARTICLE PRESENTS CASE REPORTS OF MALIGNANT TRANSFORMATION OF A DYSEMBRYOPLASTIC NEUROEPITHELIAL TUMOR AND OF A TUMOR INITIALLY DIAGNOSED AS A GANGLIOGLIOMA BASED ON MAGNETIC RESONANCE IMAGING (MRI) CRITERIA. DESCRIPTION OF REFERENCES IN THE LITERATURE ON EPILEPSY SURGERY AND THE NEURO-ONCOLOGY OF EPILEPSY-ASSOCIATED TUMORS. RESULTS: IN THE CASE OF THE INITIALLY HISTOPATHOLOGICALLY DIAGNOSED DYSEMBRYOPLASTIC NEUROEPITHELIAL TUMOR, A MALIGNANT TRANSFORMATION OCCURRED 5 YEARS AFTER INCOMPLETE RESECTION. THE DIFFERENTIATION FROM A GLIOBLASTOMA WAS POSSIBLE THROUGH THE ANALYSIS OF THE METHYLATION PROFILE. IN ANOTHER CASE A TUMOR ASSUMED TO BE A GANGLIOGLIOMA SHOWED AN INCREASE IN SIZE AFTER 6 YEARS. INITIAL HISTOPATHOLOGICAL RESULTS REVEALED A GLIOBLASTOMA. THE ANALYSIS OF THE METHYLATION PROFILE SUGGESTED THE DIAGNOSIS OF AN ANAPLASTIC PLEOMORPHIC XANTHOASTROCYTOMA AND AS A DIFFERENTIAL DIAGNOSIS AN ANAPLASTIC GANGLIOGLIOMA. TUMOR PROGRESS CORRELATED WITH THE WORSENING OF SEIZURES. CONCLUSION: RECENT STUDIES HAVE SHOWN THAT IN THE TREATMENT OF PREDOMINANTLY BENIGN EPILEPSY-ASSOCIATED TUMORS NEURO-ONCOLOGICAL ASPECTS SHOULD ALSO BE TAKEN INTO ACCOUNT IN ADDITION TO THE EPILEPTOLOGICAL CONSIDERATIONS. IN THE CASE OF MALIGNANT TRANSFORMATION EPIGENETIC SCREENING (METHYLATION PROFILES) CAN HELP TO CLASSIFY THE TUMOR ENTITY MORE PRECISELY. 2016 10 6531 34 TRANSCRIPTIONAL REGULATION OF BRAIN-DERIVED NEUROTROPHIC FACTOR (BDNF) BY METHYL CPG BINDING PROTEIN 2 (MECP2): A NOVEL MECHANISM FOR RE-MYELINATION AND/OR MYELIN REPAIR INVOLVED IN THE TREATMENT OF MULTIPLE SCLEROSIS (MS). MULTIPLE SCLEROSIS (MS) IS A CHRONIC PROGRESSIVE, NEUROLOGICAL DISEASE CHARACTERIZED BY THE TARGETED IMMUNE SYSTEM-MEDIATED DESTRUCTION OF CENTRAL NERVOUS SYSTEM (CNS) MYELIN. AUTOREACTIVE CD4+ T HELPER CELLS HAVE A KEY ROLE IN ORCHESTRATING MS-INDUCED MYELIN DAMAGE. ONCE ACTIVATED, CIRCULATING TH1-CELLS SECRETE A VARIETY OF INFLAMMATORY CYTOKINES THAT FOSTER THE BREAKDOWN OF BLOOD-BRAIN BARRIER (BBB) EVENTUALLY INFILTRATING INTO THE CNS. INSIDE THE CNS, THEY BECOME REACTIVATED UPON EXPOSURE TO THE MYELIN STRUCTURAL PROTEINS AND CONTINUE TO PRODUCE INFLAMMATORY CYTOKINES SUCH AS TUMOR NECROSIS FACTOR ALPHA (TNFALPHA) THAT LEADS TO DIRECT ACTIVATION OF ANTIBODIES AND MACROPHAGES THAT ARE INVOLVED IN THE PHAGOCYTOSIS OF MYELIN. PROLIFERATING OLIGODENDROCYTE PRECURSORS (OPS) MIGRATING TO THE LESION SITES ARE CAPABLE OF ACUTE REMYELINATION BUT UNABLE TO COMPLETELY REPAIR OR RESTORE THE IMMUNE SYSTEM-MEDIATED MYELIN DAMAGE. THIS RESULTS IN VARIOUS PERMANENT CLINICAL NEUROLOGICAL DISABILITIES SUCH AS COGNITIVE DYSFUNCTION, FATIGUE, BOWEL/BLADDER ABNORMALITIES, AND NEUROPATHIC PAIN. AT PRESENT, THERE IS NO CURE FOR MS. RECENT REMYELINATION AND/OR MYELIN REPAIR STRATEGIES HAVE FOCUSED ON THE ROLE OF THE NEUROTROPHIN BRAIN-DERIVED NEUROTROPHIC FACTOR (BDNF) AND ITS UPSTREAM TRANSCRIPTIONAL REPRESSOR METHYL CPG BINDING PROTEIN (MECP2). RESEARCH IN THE FIELD OF EPIGENETIC THERAPEUTICS INVOLVING HISTONE DEACETYLASE (HDAC) INHIBITORS AND LYSINE ACETYL TRANSFERASE (KAT) INHIBITORS IS BEING EXPLORED TO REPRESS THE DETRIMENTAL EFFECTS OF MECP2. THIS REVIEW WILL ADDRESS THE ROLE OF MECP2 AND BDNF IN REMYELINATION AND/OR MYELIN REPAIR AND THE POTENTIAL OF HDAC AND KAT INHIBITORS AS NOVEL THERAPEUTIC INTERVENTIONS FOR MS. 2016 11 6574 27 TREATMENT OF CHRONIC MYELOMONOCYTIC LEUKEMIA WITH 5-AZACYTIDINE: CASE REPORTS. EPIGENETIC THERAPY WITH HYPOMETHYLATING AGENT (5-AZACYTIDINE; AZA) IS COMMON IN THE MANAGEMENT OF SPECIFIC SUBTYPES OF MYELODYSPLASTIC SYNDROME (MDS), BUT THERE ARE ONLY FEW STUDIES IN CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML) PATIENTS. IN THIS PAPER OUR EXPERIENCE WITH 3 CMML PATIENTS TREATED WITH AZA IS DESCRIBED. IN ONE PATIENT TRANSFUSION INDEPENDENCY WAS OBSERVED AFTER 4 TREATMENT CYCLES; IN ONE CASE A PARTIAL RESPONSE WAS RECORDED, BUT A PROGRESSION TO ACUTE MYELOID LEUKEMIA (AML) AFTER 13 AZA CYCLES HAS APPEARED. IN ONE PATIENT, AZA IN REDUCED DOSAGE WAS ADMINISTERED AS A BRIDGING TREATMENT BEFORE ALLOGENEIC STEM CELL TRANSPLANTATION (ASCT), BUT IN THE CONTROL BONE MARROW ASPIRATE (BEFORE ASCT) A PROGRESSION TO AML WAS RECORDED. FUTURE STUDIES ARE MANDATORY FOR EVALUATION OF NEW MOLECULAR AND CLINICAL FEATURES WHICH COULD PREDICT THE EFFICIENCY OF HYPOMETHYLATING AGENTS IN CMML THERAPY WITH RESPECT TO OVERALL SURVIVAL, EVENT-FREE SURVIVAL, QUALITY-ADJUSTED LIFE YEAR, AND PHARMACOECONOMY. 2012 12 5408 24 REGULATION AND SIGNALING OF THE GPR17 RECEPTOR IN OLIGODENDROGLIAL CELLS. REMYELINATION, NAMELY, THE FORMATION OF NEW MYELIN SHEATHS AROUND DENUDED AXONS, COUNTERACTS AXONAL DEGENERATION AND RESTORES NEURONAL FUNCTION. CONSIDERABLE ADVANCES HAVE BEEN MADE IN UNDERSTANDING THIS REGENERATIVE PROCESS THAT OFTEN FAILS IN DISEASES LIKE MULTIPLE SCLEROSIS, LEAVING AXONS DEMYELINATED AND VULNERABLE TO DAMAGE, THUS CONTRIBUTING TO DISEASE PROGRESSION. THE IDENTIFICATION OF THE MEMBRANE RECEPTOR GPR17 ON A SUBSET OF OLIGODENDROCYTE PRECURSOR CELLS (OPCS), WHICH MEDIATE REMYELINATION IN THE ADULT CENTRAL NERVOUS SYSTEM (CNS), HAS LED TO A HUGE AMOUNT OF EVIDENCE THAT VALIDATED THIS RECEPTOR AS A NEW ATTRACTIVE TARGET FOR REMYELINATING THERAPIES. HERE, WE SUMMARIZE THE ROLE OF GPR17 IN OPC FUNCTION, MYELINATION AND REMYELINATION, DESCRIBING ITS ATYPICAL PHARMACOLOGY, ITS DOWNSTREAM SIGNALING, AND THE GENETIC AND EPIGENETIC FACTORS MODULATING ITS ACTIVITY. WE ALSO HIGHLIGHT CRUCIAL INSIGHTS INTO GPR17 PATHOPHYSIOLOGY COMING FROM THE DEMONSTRATION THAT OLIGODENDROCYTE INJURY, ASSOCIATED WITH INFLAMMATION IN CHRONIC NEURODEGENERATIVE CONDITIONS, IS INVARIABLY CHARACTERIZED BY ABNORMAL AND PERSISTENT GPR17 UPREGULATION, WHICH, IN TURN, IS ACCOMPANIED BY A BLOCK OF OPCS AT IMMATURE PREMYELINATING STAGES. FINALLY, WE DISCUSS THE CURRENT LITERATURE IN LIGHT OF THE POTENTIAL EXPLOITMENT OF GPR17 AS A THERAPEUTIC TARGET TO PROMOTE REMYELINATION. 2020 13 1620 33 DNA METHYLTRANSFERASE-MEDIATED TRANSCRIPTIONAL SILENCING IN MALIGNANT GLIOMA: A COMBINED WHOLE-GENOME MICROARRAY AND PROMOTER ARRAY ANALYSIS. EPIGENETIC INACTIVATION OF TUMOR SUPPRESSOR GENES IS A COMMON FEATURE IN HUMAN CANCER. PROMOTER HYPERMETHYLATION AND HISTONE DEACETYLATION ARE REVERSIBLE EPIGENETIC MECHANISMS ASSOCIATED WITH TRANSCRIPTIONAL REGULATION. DNA METHYLTRANSFERASES (DNMT1 AND DNMT3B) REGULATE AND MAINTAIN PROMOTER METHYLATION AND ARE OVEREXPRESSED IN HUMAN CANCER. WE PERFORMED WHOLE-GENOME MICROARRAY ANALYSIS TO IDENTIFY GENES WITH ALTERED EXPRESSION AFTER RNAI-INDUCED SUPPRESSION OF DNMT IN A GLIOBLASTOMA MULTIFORME (GBM) CELL LINE. WE THEN IDENTIFIED GENES WITH BOTH DECREASED EXPRESSION AND EVIDENCE OF PROMOTER CPG ISLAND HYPERMETHYLATION IN GBM TISSUE SAMPLES USING A COMBINED WHOLE-GENOME MICROARRAY TRANSCRIPTOME ANALYSIS IN CONJUNCTION WITH A PROMOTER ARRAY ANALYSIS AFTER DNA IMMUNOPRECIPITATION WITH ANTI-5-METHYLCYTIDINE. DNMT1 AND 3B KNOCKDOWN RESULTED IN THE RESTORED EXPRESSION OF 308 GENES THAT ALSO CONTAINED PROMOTER REGION HYPERMETHYLATION. OF THESE, 43 WERE ALSO FOUND TO BE DOWNREGULATED IN GBM TISSUE SAMPLES. THREE DOWNREGULATED GENES WITH HYPERMETHYLATED PROMOTERS AND RESTORED EXPRESSION IN RESPONSE TO ACUTE DNMT SUPPRESSION WERE ASSAYED FOR METHYLATION CHANGES USING BISULFITE SEQUENCE ANALYSIS OF THE PROMOTER REGION AFTER CHRONIC DNMT SUPPRESSION. RESTORATION OF GENE EXPRESSION WAS NOT ASSOCIATED WITH CHANGES IN PROMOTER REGION METHYLATION, BUT RATHER WITH CHANGES IN HISTONE METHYLATION AND CHROMATIN CONFORMATION. TWO OF THE IDENTIFIED GENES EXHIBITED GROWTH SUPPRESSIVE ACTIVITY IN IN VITRO ASSAYS. COMBINING TARGETED GENETIC MANIPULATIONS WITH COMPREHENSIVE GENOMIC AND EXPRESSION ANALYSES PROVIDES A POTENTIALLY POWERFUL NEW APPROACH FOR IDENTIFYING EPIGENETICALLY REGULATED GENES IN GBM. 2009 14 3571 35 IMPACT OF LOCAL ANESTHETICS ON EPIGENETICS IN CANCER. DEFECTIVE SILENCING OF TUMOR SUPPRESSOR GENES THROUGH EPIGENETIC ALTERATIONS CONTRIBUTES TO ONCOGENESIS BY PERTURBING CELL CYCLE REGULATION, DNA REPAIR OR CELL DEATH MECHANISMS. REVERSAL OF SUCH EPIGENETIC CHANGES INCLUDING DNA HYPERMETHYLATION PROVIDES A PROMISING ANTICANCER STRATEGY. UNTIL NOW, THE NUCLEOSIDE DERIVATIVES 5-AZACYTIDINE AND DECITABINE ARE THE SOLE DNA METHYLTRANSFERASE (DNMT) INHIBITORS APPROVED BY THE FDA FOR THE TREATMENT OF SPECIFIC HEMATOLOGICAL CANCERS. NEVERTHELESS, DUE TO THEIR NUCLEOSIDE STRUCTURE, THESE INHIBITORS DIRECTLY INCORPORATE INTO DNA, WHICH LEADS TO SEVERE SIDE EFFECTS AND COMPROMISES GENOMIC STABILITY. MUCH EMPHASIS HAS BEEN PLACED ON THE DEVELOPMENT OF LESS TOXIC EPIGENETIC MODIFIERS. RECENTLY, SEVERAL PRECLINICAL STUDIES DEMONSTRATED THE POTENT EPIGENETIC EFFECTS OF LOCAL ANESTHETICS, WHICH ARE ROUTINELY USED DURING PRIMARY TUMOR RESECTION TO RELIEF SURGICAL PAIN. THESE NON-NUCLEOSIDE MOLECULES INHIBIT DNMT ACTIVITY, AFFECT THE EXPRESSION OF MICRO-RNAS AND REPRESS HISTONE ACETYLATION, THUS EXERTING CYTOTOXIC EFFECTS ON MALIGNANT CELLS. THE IN-DEPTH MECHANISTIC COMPREHENSION OF THESE EPIGENETIC EFFECTS MIGHT PROMOTE THE USE OF LOCAL ANESTHETICS AS ANTICANCER DRUGS. 2022 15 3175 23 H2AX PHOSPHORYLATION REGULATED BY P38 IS INVOLVED IN BIM EXPRESSION AND APOPTOSIS IN CHRONIC MYELOGENOUS LEUKEMIA CELLS INDUCED BY IMATINIB. INCREASING EVIDENCE SUGGESTS THAT HISTONE H2AX PLAYS A CRITICAL ROLE IN REGULATION OF TUMOR CELL APOPTOSIS AND ACTS AS A NOVEL HUMAN TUMOR SUPPRESSOR PROTEIN. HOWEVER, THE ACTION OF H2AX IN CHRONIC MYELOGENOUS LEUKEMIA (CML) CELLS IS UNKNOWN. THE DETAILED MECHANISM AND EPIGENETIC REGULATION BY H2AX REMAIN ELUSIVE IN CANCER CELLS. HERE, WE REPORT THAT H2AX WAS INVOLVED IN APOPTOSIS OF CML CELLS. OVEREXPRESSION OF H2AX INCREASED APOPTOTIC SENSITIVITY OF CML CELLS (K562) INDUCED BY IMATINIB. HOWEVER, OVEREXPRESSION OF SER139-MUTATED H2AX (BLOCKING PHOSPHORYLATION) DECREASED SENSITIVITY OF K562 CELLS TO APOPTOSIS. SIMILARLY, KNOCKDOWN OF H2AX MADE K562 CELLS RESISTANT TO APOPTOTIC INDUCTION. THESE RESULTS REVEALED THAT THE FUNCTION OF H2AX INVOLVED IN APOPTOSIS IS STRICTLY RELATED TO ITS PHOSPHORYLATION (SER139). OUR DATA FURTHER INDICATED THAT IMATINIB MAY STIMULATE MITOGEN-ACTIVATED PROTEIN KINASE (MAPK) FAMILY MEMBER P38, AND H2AX PHOSPHORYLATION FOLLOWED A SIMILAR TIME COURSE, SUGGESTING A PARALLEL RESPONSE. H2AX PHOSPHORYLATION CAN BE BLOCKED BY P38 SIRNA OR ITS INHIBITOR. THESE DATA DEMONSTRATED THAT H2AX PHOSPHORYLATION WAS REGULATED BY P38 MAPK PATHWAY IN K562 CELLS. HOWEVER, THE P38 MAPK DOWNSTREAM, MITOGEN- AND STRESS-ACTIVATED PROTEIN KINASE-1 AND -2, WHICH PHOSPHORYLATED HISTONE H3, WERE NOT REQUIRED FOR H2AX PHOSPHORYLATION DURING APOPTOSIS. FINALLY, WE PROVIDED EPIGENETIC EVIDENCE THAT H2AX PHOSPHORYLATION REGULATED APOPTOSIS-RELATED GENE BIM EXPRESSION. BLOCKING OF H2AX PHOSPHORYLATION INHIBITED BIM GENE EXPRESSION. TAKEN TOGETHER, THESE DATA DEMONSTRATED THAT H2AX PHOSPHORYLATION REGULATED BY P38 IS INVOLVED IN BIM EXPRESSION AND APOPTOSIS IN CML CELLS INDUCED BY IMATINIB. 2014 16 4565 28 MYELOID MALIGNANCIES: MUTATIONS, MODELS AND MANAGEMENT. MYELOID MALIGNANT DISEASES COMPRISE CHRONIC (INCLUDING MYELODYSPLASTIC SYNDROMES, MYELOPROLIFERATIVE NEOPLASMS AND CHRONIC MYELOMONOCYTIC LEUKEMIA) AND ACUTE (ACUTE MYELOID LEUKEMIA) STAGES. THEY ARE CLONAL DISEASES ARISING IN HEMATOPOIETIC STEM OR PROGENITOR CELLS. MUTATIONS RESPONSIBLE FOR THESE DISEASES OCCUR IN SEVERAL GENES WHOSE ENCODED PROTEINS BELONG PRINCIPALLY TO FIVE CLASSES: SIGNALING PATHWAYS PROTEINS (E.G. CBL, FLT3, JAK2, RAS), TRANSCRIPTION FACTORS (E.G. CEBPA, ETV6, RUNX1), EPIGENETIC REGULATORS (E.G. ASXL1, DNMT3A, EZH2, IDH1, IDH2, SUZ12, TET2, UTX), TUMOR SUPPRESSORS (E.G. TP53), AND COMPONENTS OF THE SPLICEOSOME (E.G. SF3B1, SRSF2). LARGE-SCALE SEQUENCING EFFORTS WILL SOON LEAD TO THE ESTABLISHMENT OF A COMPREHENSIVE REPERTOIRE OF THESE MUTATIONS, ALLOWING FOR A BETTER DEFINITION AND CLASSIFICATION OF MYELOID MALIGNANCIES, THE IDENTIFICATION OF NEW PROGNOSTIC MARKERS AND THERAPEUTIC TARGETS, AND THE DEVELOPMENT OF NOVEL THERAPIES. GIVEN THE IMPORTANCE OF EPIGENETIC DEREGULATION IN MYELOID DISEASES, THE USE OF DRUGS TARGETING EPIGENETIC REGULATORS APPEARS AS A MOST PROMISING THERAPEUTIC APPROACH. 2012 17 5971 43 TET PROTEINS AND 5-METHYLCYTOSINE OXIDATION IN HEMATOLOGICAL CANCERS. DNA METHYLATION HAS PIVOTAL REGULATORY ROLES IN MAMMALIAN DEVELOPMENT, RETROTRANSPOSON SILENCING, GENOMIC IMPRINTING, AND X-CHROMOSOME INACTIVATION. CANCER CELLS DISPLAY HIGHLY DYSREGULATED DNA METHYLATION PROFILES CHARACTERIZED BY GLOBAL HYPOMETHYLATION IN CONJUNCTION WITH HYPERMETHYLATION OF PROMOTER CPG ISLANDS THAT PRESUMABLY LEAD TO GENOME INSTABILITY AND ABERRANT EXPRESSION OF TUMOR SUPPRESSOR GENES OR ONCOGENES. THE RECENT DISCOVERY OF TEN-ELEVEN-TRANSLOCATION (TET) FAMILY DIOXYGENASES THAT OXIDIZE 5MC TO 5-HYDROXYMETHYLCYTOSINE (5HMC), 5-FORMYLCYTOSINE (5FC), AND 5-CARBOXYLCYTOSINE (5CAC) IN DNA HAS LED TO PROFOUND PROGRESS IN UNDERSTANDING THE MECHANISM UNDERLYING DNA DEMETHYLATION. AMONG THE THREE TET GENES, TET2 RECURRENTLY UNDERGOES INACTIVATING MUTATIONS IN A WIDE RANGE OF MYELOID AND LYMPHOID MALIGNANCIES. TET2 FUNCTIONS AS A BONA FIDE TUMOR SUPPRESSOR PARTICULARLY IN THE PATHOGENESIS OF MYELOID MALIGNANCIES RESEMBLING CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML) AND MYELODYSPLASTIC SYNDROMES (MDS) IN HUMAN. HERE WE REVIEW DIVERSE FUNCTIONS OF TET PROTEINS AND THE NOVEL EPIGENETIC MARKS THAT THEY GENERATE IN DNA METHYLATION/DEMETHYLATION DYNAMICS AND NORMAL AND MALIGNANT HEMATOPOIETIC DIFFERENTIATION. THE IMPACT OF TET2 INACTIVATION IN HEMATOPOIESIS AND VARIOUS MECHANISMS MODULATING THE EXPRESSION OR ACTIVITY OF TET PROTEINS ARE ALSO DISCUSSED. FURTHERMORE, WE ALSO PRESENT EVIDENCE THAT TET2 AND TET3 COLLABORATE TO SUPPRESS ABERRANT HEMATOPOIESIS AND HEMATOPOIETIC TRANSFORMATION. A DETAILED UNDERSTANDING OF THE NORMAL AND PATHOLOGICAL FUNCTIONS OF TET PROTEINS MAY PROVIDE NEW AVENUES TO DEVELOP NOVEL EPIGENETIC THERAPIES FOR TREATING HEMATOLOGICAL MALIGNANCIES. 2015 18 1616 31 DNA METHYLTRANSFERASE AND HISTONE DEACETYLASE INHIBITORS IN THE TREATMENT OF MYELODYSPLASTIC SYNDROMES. THE RECENTLY APPROVED DRUGS 5-AZACITIDINE (5AC) AND 5-AZA-2'-DEOXYAZACYTIDINE (DAC) ARE IN WIDE CLINICAL USE FOR THE TREATMENT OF MYELODYSPLASTIC SYNDROME (MDS) OF ALL TYPES AND CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML). THESE AGENTS WERE DEVELOPED BASED UPON AN UNDERSTANDING OF THE IMPORTANCE OF EPIGENETIC CHANGES IN MALIGNANCY, AND THEY HAVE BEEN EVALUATED IN RANDOMIZED CLINICAL TRIALS, WHICH DEMONSTRATE RESPONSE RATES BETWEEN 20% AND 40% IN PATIENTS FOR WHOM NO PREVIOUS STANDARD OF CARE WAS AVAILABLE. AS UNDERSTANDING OF THE EPIGENETIC CHANGES CHARACTERISTIC OF THE MALIGNANT PHENOTYPE IMPROVES, WE ARE ABLE TO TARGET OTHER REGULATORS OF CHROMATIN CONFORMATION THAT CONTRIBUTE TO ABERRANT GENE TRANSCRIPTION AND DYSREGULATED CELL GROWTH. THE HISTONE DEACETYLASE (HDAC) INHIBITORS BELONG TO ONE CLASS OF THERAPEUTICS DEVELOPED USING THIS PARADIGM. ALTHOUGH RESPONSES USING HDAC INHIBITORS ALONE IN MDS HAVE BEEN MODEST, ROBUST PRECLINICAL DATA DRIVE CLINICAL TRIALS IN WHICH THEY ARE UTILIZED IN COMBINATION WITH DNA METHYLTRANSFERASE (DNMT) INHIBITORS. COMBINATION THERAPY OFFERS THE POSSIBILITY OF HEMATOLOGIC IMPROVEMENT AND REMISSION TO MYELODYSPLASTIC PATIENTS WITH PREVIOUSLY UNTREATABLE DISEASE. 2008 19 5917 37 TARGETING BCL-2 IN B-CELL MALIGNANCIES AND OVERCOMING THERAPEUTIC RESISTANCE. DEFECTS IN APOPTOSIS CAN PROMOTE TUMORIGENESIS AND IMPAIR RESPONSES OF MALIGNANT B CELLS TO CHEMOTHERAPEUTICS. MEMBERS OF THE B-CELL LEUKEMIA/LYMPHOMA-2 (BCL-2) FAMILY OF PROTEINS ARE KEY REGULATORS OF THE INTRINSIC, MITOCHONDRIAL APOPTOTIC PATHWAY. OVEREXPRESSION OF ANTIAPOPTOTIC BCL-2 FAMILY PROTEINS IS ASSOCIATED WITH TREATMENT RESISTANCE AND POOR PROGNOSIS. THUS, INHIBITION OF BCL-2 FAMILY PROTEINS IS A RATIONAL THERAPEUTIC OPTION FOR MALIGNANCIES THAT ARE DEPENDENT ON ANTIAPOPTOTIC BCL-2 FAMILY PROTEINS. VENETOCLAX (ABT-199, GDC-0199) IS A HIGHLY SELECTIVE BCL-2 INHIBITOR THAT REPRESENTS THE FIRST APPROVED AGENT OF THIS CLASS AND IS CURRENTLY WIDELY USED IN THE TREATMENT OF CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) AS WELL AS ACUTE MYELOID LEUKEMIA (AML). DESPITE IMPRESSIVE CLINICAL ACTIVITY, VENETOCLAX MONOTHERAPY FOR A PROLONGED DURATION CAN LEAD TO DRUG RESISTANCE OR LOSS OF DEPENDENCE ON THE TARGETED PROTEIN. IN THIS REVIEW, WE PROVIDE AN OVERVIEW OF THE MECHANISM OF ACTION OF BCL-2 INHIBITION AND THE ROLE OF THIS APPROACH IN THE CURRENT TREATMENT PARADIGM OF B-CELL MALIGNANCIES. WE SUMMARIZE THE DRIVERS OF DE NOVO AND ACQUIRED RESISTANCE TO VENETOCLAX THAT ARE CLOSELY ASSOCIATED WITH COMPLEX CLONAL SHIFTS, INTERPLAY OF EXPRESSION AND INTERACTIONS OF BCL-2 FAMILY MEMBERS, TRANSCRIPTIONAL REGULATORS, AND METABOLIC MODULATORS. WE ALSO EXAMINE HOW TUMORS INITIALLY RESISTANT TO VENETOCLAX BECOME RESPONSIVE TO IT FOLLOWING PRIOR THERAPIES. HERE, WE SUMMARIZE PRECLINICAL DATA PROVIDING A RATIONALE FOR EFFICACIOUS COMBINATION STRATEGIES OF VENETOCLAX TO OVERCOME THERAPEUTIC RESISTANCE BY A TARGETED APPROACH DIRECTED AGAINST ALTERNATIVE ANTIAPOPTOTIC BCL-2 FAMILY PROTEINS (MCL-1, BCL-XL), COMPENSATORY PROSURVIVAL PATHWAYS, EPIGENETIC MODIFIERS, AND DYSREGULATED CELLULAR METABOLISM/ENERGETICS FOR DURABLE CLINICAL REMISSIONS. 2020 20 5499 31 REVIEW: RECENT CLINICAL TRIALS IN EPIGENETIC THERAPY. EPIGENETIC FACTORS SUCH AS DNA METHYLATION AND HISTONE DEACETYLATION ARE KNOWN TO CONTRIBUTE TO THE MALIGNANT TRANSFORMATION OF CELLS BY SILENCING CRITICAL GENES. DRUGS THAT INHIBIT DNA METHYLTRANSFERASES OR HISTONE DEACETYLASES WERE SHOWN TO HAVE THE POTENTIAL TO REACTIVATE SILENCED GENES AND INDUCE DIFFERENTIATION OR APOPTOSIS OF MALIGNANT CELLS. THE MOST INTENSIVELY STUDIED CLASS OF SUCH AGENTS IS DNA METHYLTRANSFERASE INHIBITORS, INCLUDING 5-AZACYTIDINE (AZACITIDINE) AND 5-AZA-2'-DEOXYCYTIDINE (DECITABINE). IN 2004, AZACITIDINE WAS APPROVED FOR THE TREATMENT OF MYELODYSPLASTIC SYNDROME ON THE BASIS OF PHASE II AND III STUDIES THAT SHOWED A RESPONSE RATE (COMPLETE AND PARTIAL RESPONSES) OF 15%. AZACITIDINE IS ALSO BEING EVALUATED IN CLINICAL TRIALS FOR OTHER MALIGNANT DISEASES. DECITABINE HAS RESPONSE RATES OF 17-49% IN MYELODYSPLASTIC SYNDROME IN MULTIPLE PHASE II AND III STUDIES AND ALSO ACTIVITY IN ACUTE AND CHRONIC MYELOGENOUS LEUKEMIA. HISTONE DEACETYLASE INHIBITORS BELONG TO ANOTHER CLASS OF EPIGENETIC MODIFYING AGENTS THAT INCLUDE DEPSIPEPTIDE, BUTYRATE DERIVATIVES, SUBEROYLANILIDE HYDROXAMIC ACID AND VALPROIC ACID. NO AGENT IN THIS CLASS HAS BEEN STUDIED IN A PHASE III TRIAL, BUT SEVERAL AGENTS HAVE BEEN OR ARE BEING STUDIED IN PHASE II TRIALS. FURTHER RESEARCH IS NEEDED TO DETERMINE THE APPROPRIATE PATIENT SELECTION AND DOSING SCHEDULES. 2006