1 1978 119 EPIGENETIC ALTERATIONS IN CHOLANGIOCARCINOMA-SUSTAINED IL-6/STAT3 SIGNALING IN CHOLANGIO- CARCINOMA DUE TO SOCS3 EPIGENETIC SILENCING. CHOLANGIOCARCINOMA (CCA) IS A HIGHLY LETHAL MALIGNANT TUMOR ARISING FROM THE BILIARY TRACT EPITHELIUM, CHARACTERIZED BY ITS TYPICALLY LATE CLINICAL PRESENTATION AND LACK OF EFFECTIVE THERAPEUTIC MODALITIES. CHRONIC INFLAMMATORY CONDITIONS, INCLUDING PRIMARY SCLEROSING CHOLANGITIS, LIVER FLUKE INFESTATION AND HEPATOLITHIASIS, ARE LISTED IN THE RISK FACTORS, BUT FOR MOST CASES OF CCA THE CAUSE IS UNKNOWN. RECENT ADVANCES IN MOLECULAR PATHOGENESIS HAVE HIGHLIGHTED THE IMPORTANCE OF EPIGENETIC ALTERATIONS INCLUDING PROMOTER HYPERMETHYLATION AND HISTONE DEACETYLATION IN ADDITION TO GENETIC CHANGES IN THE PROCESS OF CHOLANGIOCARCINOGENESIS. THIS REVIEW PROVIDES A COMPREHENSIVE OVERVIEW OF THE GENES HYPERMETHYLATED IN CCA TO DATE AND THEIR PUTATIVE ROLES IN CHOLANGIOCARCINOGENESIS. AMONG GENES HYPERMETHYLATED, WE FOUND THE CPG ISLAND HYPERMETHYLATION IN SUPPRESSOR OF CYTOKINE SIGNALING 3 (SOCS3) GENE PROMOTER IN CCA. INTERLEUKIN-6 (IL-6)-MEDIATED SIGNAL TRANSDUCERS AND ACTIVATORS OF TRANSCRIPTION 3 (STAT3) ACTIVATION ARE ABERRANTLY SUSTAINED IN CCA CELLS, RESULTING IN RESISTANCE TO APOPTOSIS. SOCS3 CONTROLS THE IL-6/STAT3 SIGNALING PATHWAY BY A CLASSIC FEEDBACK LOOP. INDEED, SOCS3 EPIGENETIC SILENCING IS RESPONSIBLE FOR SUSTAINED IL-6/STAT3 SIGNALING IN CCA. THESE FINDINGS PROVIDE NEW PERSPECTIVES FOR EPIGENETIC THERAPY TO RESTORE SOCS3 IN THIS CANCER. 2009 2 1972 61 EPIGENETIC ALTERATIONS ASSOCIATED WITH CHOLANGIOCARCINOMA (REVIEW). CHOLANGIOCARCINOMA (CCA) IS A HIGHLY LETHAL MALIGNANT TUMOR ARISING FROM THE BILIARY TRACT EPITHELIUM. CHRONIC INFLAMMATORY CONDITIONS, INCLUDING PRIMARY SCLEROSING CHOLANGITIS, LIVER FLUKE INFESTATION, AND HEPATOLITHIASIS, ARE CONSIDERED RISK FACTORS, BUT THE CAUSE IS STILL UNKNOWN IN MOST CASES. RECENT ADVANCES IN MOLECULAR PATHOGENESIS HAVE HIGHLIGHTED THE IMPORTANCE OF EPIGENETIC ALTERATIONS, INCLUDING PROMOTER HYPERMETHYLATION AND HISTONE DEACETYLATION, IN THE PROCESS OF CHOLANGIOCARCINOGENESIS. MORE RECENTLY, RESEARCH INTEREST HAS BEEN FOCUSING ON MICRORNA (MIR), A MAJOR SUBTYPE OF NON-CODING RNA. MIR IS HIGHLY CONSERVED AMONG SPECIES AND REGULATES THE EXPRESSION OF SPECIFIC TARGET GENES BY BINDING TO THE 3'-UNTRANSLATED REGIONS OF MESSENGER RNA. THE NUMBER OF STUDIES ON A POSSIBLE LINK BETWEEN MIR AND VARIOUS CANCERS IS GROWING. THIS REVIEW PROVIDES A COMPREHENSIVE OVERVIEW OF THE GENES CURRENTLY KNOWN TO BE HYPERMETHYLATED IN CCA AND THEIR PUTATIVE ROLES IN CHOLANGIOCARCINOGENESIS. THE EPIGENETIC ROLE OF MIR IN THE PATHOGENESIS OF CCA IS ALSO DISCUSSED. 2009 3 1435 40 DIFFERENTIAL METHYLATION LANDSCAPE OF PANCREATIC DUCTAL ADENOCARCINOMA AND ITS PRECANCEROUS LESIONS. BACKGROUND: PANCREATIC CANCER IS ONE OF THE MOST LETHAL DISEASES WITH AN INCIDENCE ALMOST EQUAL TO THE MORTALITY. IN ADDITION TO HAVING GENETIC CAUSES, CANCER CAN ALSO BE CONSIDERED AN EPIGENETIC DISEASE. DNA METHYLATION IS THE PREMIER EPIGENETIC MODIFICATION AND PATTERNS OF ABERRANT DNA METHYLATION ARE RECOGNIZED TO BE A COMMON HALLMARK OF HUMAN TUMOR. IN THE MULTISTAGE CARCINOGENESIS OF PANCREAS STARTING FROM PRECANCEROUS LESIONS TO PANCREATIC DUCTAL ADENOCARCINOMA (PDAC), THE EPIGENETIC CHANGES PLAY A SIGNIFICANT ROLE. DATA SOURCES: RELEVANT STUDIES FOR THIS REVIEW WERE DERIVED VIA AN EXTENSIVE LITERATURE SEARCH IN PUBMED VIA USING VARIOUS KEYWORDS SUCH AS PANCREATIC DUCTAL ADENOCARCINOMA, PRECANCEROUS LESIONS, METHYLATION PROFILE, EPIGENETIC BIOMARKERS THAT ARE RELEVANT DIRECTLY OR CLOSELY ASSOCIATED WITH THE CONCERNED AREA OF OUR INTEREST. THE LITERATURE SEARCH WAS INTENSIVELY DONE CONSIDERING A TIME FRAME OF 20 YEARS (1998-2018). RESULT: IN THIS REVIEW WE HAVE HIGHLIGHTED THE HYPERMETHYLATION AND HYPOMETHYLATION OF THE PRECANCEROUS PDAC LESIONS (PANCREATIC INTRA-EPITHELIAL NEOPLASIA, INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM, MUCINOUS CYSTIC NEOPLASM AND CHRONIC PANCREATITIS) AND PDAC ALONG WITH THE POTENTIAL BIOMARKERS. WE HAVE ALSO ACHIEVED THE EARLY EPIGENETIC DRIVER THAT LEADS TO PROGRESSION FROM PRECANCEROUS LESIONS TO PDAC. A BUNCH OF EPIGENETIC DRIVER GENES LEADS TO PROGRESSION OF PRECANCEROUS LESIONS TO PDAC (PPENK, APC, P14/5/16/17, HMLH1 AND MGMT) ARE ALSO DOCUMENTED. WE SUMMARIZED THE IMPORTANCE OF THESE OBSERVATIONS IN THERAPEUTICS AND DIAGNOSIS OF PDAC HENCE IDENTIFYING THE POTENTIAL USE OF EPIGENETIC BIOMARKERS IN EPIGENETIC TARGETED THERAPY. EPIGENETIC INACTIVATION OCCURS BY HYPERMETHYLATION OF CPG ISLANDS IN THE PROMOTER REGIONS OF TUMOR SUPPRESSOR GENES. WE LISTED ALL HYPER- AND HYPOMETHYLATION OF CPG ISLANDS OF SEVERAL GENES IN PDAC INCLUDING ITS PRECANCEROUS LESIONS. CONCLUSIONS: THE CONCEPT OF THE REVIEW WOULD HELP TO UNDERSTAND THEIR BIOLOGICAL EFFECTS, AND TO DETERMINE WHETHER THEY MAY BE SUCCESSFULLY COMBINED WITH OTHER EPIGENETIC DRUGS. HOWEVER, WE NEED TO CONTINUE OUR RESEARCH TO DEVELOP MORE SPECIFIC DNA-DEMETHYLATING AGENTS, WHICH ARE THE TARGETS FOR HYPERMETHYLATED CPG METHYLATION SITES. 2020 4 4951 35 PATHOGENESIS OF CHOLANGIOCARCINOMA: FROM GENETICS TO SIGNALLING PATHWAYS. CHOLANGIOCARCINOMA (CCA) IS A MALIGNANT TUMOUR OF BILE DUCT EPITHELIAL CELLS WITH DISMAL PROGNOSIS AND RISING INCIDENCE. CHRONIC INFLAMMATION RESULTING FROM LIVER FLUKE INFECTION, HEPATITIS AND OTHER INFLAMMATORY BOWEL DISEASES IS A MAJOR CONTRIBUTING FACTOR TO CHOLANGIOCARCINOGENESIS, LIKELY THROUGH ACCUMULATION OF SERIAL GENETIC AND EPIGENETIC ALTERATIONS RESULTING IN ABERRATION OF ONCOGENES AND TUMOUR SUPPRESSORS. RECENT STUDIES MAKING USE OF ADVANCES IN HIGH-THROUGHPUT GENOMICS HAVE REVEALED THE GENETIC LANDSCAPE OF CCA, GREATLY INCREASING OUR UNDERSTANDING OF ITS UNDERLYING BIOLOGY. A SERIES OF HIGHLY RECURRENT MUTATIONS IN GENES SUCH AS TP53, KRAS, SMAD4, BRAF, MLL3, ARID1A, PBRM1 AND BAP1, WHICH ARE KNOWN TO BE INVOLVED IN CELL CYCLE CONTROL, CELL SIGNALLING PATHWAYS AND CHROMATIN DYNAMICS, HAVE LED TO INVESTIGATIONS OF THEIR ROLES, THROUGH MOLECULAR TO MOUSE MODELLING STUDIES, IN CHOLANGIOCARCINOGENESIS. THIS REVIEW FOCUSES ON THE LANDSCAPE GENETIC ALTERATIONS IN CCA AND ITS FUNCTIONAL RELEVANCE TO THE FORMATION AND PROGRESSION OF CCA. 2015 5 1304 28 DEFECTS IN SPLICEOSOMAL MACHINERY: A NEW PATHWAY OF LEUKAEMOGENESIS. PROPER SPLICING OF PRE-MRNA IS REQUIRED FOR PROTEIN SYNTHESIS AND THEREFORE IS A FUNDAMENTAL CELLULAR FUNCTION. THE DISCOVERY OF A VARIETY OF SOMATIC SPLICEOSOMAL MUTATIONS IN HAEMATOLOGICAL MALIGNANCIES, INCLUDING MYELOID NEOPLASMS AND CHRONIC LYMPHOCYTIC LEUKAEMIA HAS POINTED TO A NEW LEUKAEMOGENIC PATHWAY INVOLVING SPLICEOSOMAL DYSFUNCTION. THEORETICALLY, SPLICEOSOMAL MUTATIONS CAN LEAD TO ACTIVATION OF INCORRECT SPLICE SITES, INTRON RETENTION OR ABERRANT ALTERNATIVE SPLICING OCCURRING IN PATTERNS GENERATED BY MUTATIONS OF INDIVIDUAL SPLICEOSOMAL PROTEINS. SUCH EVENTS CAN PRODUCE A DEFECTIVE BALANCE BETWEEN PROTEIN ISOFORMS LEADING TO FUNCTIONAL CONSEQUENCES INCLUDING DEFECTIVE REGULATION OF PROLIFERATION AND DIFFERENTIATION. THE OBSERVED PATTERN OF OCCURRENCE OF HIGHLY SPECIFIC MISSENSE MUTATIONS, COUPLED WITH THE LACK OF NONSENSE MUTATIONS AND DELETIONS, IMPLIES A GAIN-OF-FUNCTION OR BETTER GAIN-OF-DYSFUNCTION MECHANISM. INCORRECT SPLICING OF DOWNSTREAM GENES, SUCH AS TUMOUR SUPPRESSOR GENES, MAY RESULT IN HAPLOINSUFFICIENT EXPRESSION THROUGH NONSENSE-MEDIATED MRNA DECAY. THUS, SPLICEOSOMAL MUTATIONS MAY, DEPENDING ON THE PATTERN OF AFFECTED PROTEINS, LEAD TO SIMILAR FUNCTIONAL EFFECTS ON TUMOUR SUPPRESSOR GENES AS CHROMOSOMAL DELETIONS, EPIGENETIC SILENCING OR INACTIVATING/HYPOMORPHIC MUTATIONS. THE PROGNOSTIC VALUE OF THE MOST COMMON MUTATIONS AND THEIR PHENOTYPIC ASSOCIATION IN THE CLINICAL SETTING IS CURRENTLY UNDER INVESTIGATION. IT IS LIKELY THAT SPLICEOSOMAL MUTATIONS MAY INDICATE SENSITIVITY TO SPLICEOSOME INHIBITORS APPLIED IN THE FORM OF A SYNTHETIC LETHAL APPROACH. THIS REVIEW DISCUSSES THE MOST CURRENT ASPECTS OF SPLICEOSOMAL RESEARCH IN THE CONTEXT OF HAEMATOLOGICAL MALIGNANCIES. 2012 6 778 25 CELL-FREE DNA METHYLATION: THE NEW FRONTIERS OF PANCREATIC CANCER BIOMARKERS' DISCOVERY. PANCREATIC DUCTAL ADENOCARCINOMA (PDAC) IS AMONG THE MOST LETHAL CANCER TYPES WORLD-WIDE. ITS HIGH MORTALITY IS RELATED TO THE DIFFICULTY IN THE DIAGNOSIS, WHICH OFTEN OCCURS WHEN THE DISEASE IS ALREADY ADVANCED. AS OF TODAY, NO EARLY DIAGNOSTIC TESTS ARE AVAILABLE, WHILE ONLY A LIMITED NUMBER OF PROGNOSTIC TESTS HAVE REACHED CLINICAL PRACTICE. THE MAIN REASON IS THE LACK OF RELIABLE BIOMARKERS THAT ARE ABLE TO CAPTURE THE EARLY DEVELOPMENT OR THE PROGRESSION OF THE DISEASE. HENCE, THE DISCOVERY OF BIOMARKERS FOR EARLY DIAGNOSIS OR PROGNOSIS OF PDAC REMAINS, DE FACTO, AN UNMET NEED. AN INCREASING NUMBER OF STUDIES HAS SHOWN THAT CELL-FREE DNA (CFDNA) METHYLATION ANALYSIS REPRESENTS A PROMISING NON-INVASIVE APPROACH FOR THE DISCOVERY OF BIOMARKERS WITH DIAGNOSTIC OR PROGNOSTIC POTENTIAL. IN PARTICULAR, CFDNA METHYLATION COULD BE UTILIZED FOR THE IDENTIFICATION OF DISEASE-SPECIFIC SIGNATURES IN PRE-NEOPLASTIC LESIONS OR CHRONIC PANCREATITIS (CP), REPRESENTING A SENSITIVE AND NON-INVASIVE METHOD OF EARLY DIAGNOSIS OF PDAC. IN THIS REVIEW, WE WILL DISCUSS THE ADVANTAGES AND PITFALLS OF CFDNA METHYLATION STUDIES. FURTHER, WE WILL PRESENT THE CURRENT ADVANCES IN THE DISCOVERY OF PANCREATIC CANCER BIOMARKERS WITH EARLY DIAGNOSTIC OR PROGNOSTIC POTENTIAL, FOCUSING ON PANCREAS-SPECIFIC (E.G., CUX2 OR REG1A) OR ABNORMAL (E.G., ADAMTS1 OR BNC1) CFDNA METHYLATION SIGNATURES IN HIGH RISK PRE-NEOPLASTIC CONDITIONS AND PDAC. 2019 7 1184 21 COOPERATIVE EPIGENETIC REMODELING BY TET2 LOSS AND NRAS MUTATION DRIVES MYELOID TRANSFORMATION AND MEK INHIBITOR SENSITIVITY. MUTATIONS IN EPIGENETIC MODIFIERS AND SIGNALING FACTORS OFTEN CO-OCCUR IN MYELOID MALIGNANCIES, INCLUDING TET2 AND NRAS MUTATIONS. CONCURRENT TET2 LOSS AND NRAS(G12D) EXPRESSION IN HEMATOPOIETIC CELLS INDUCED MYELOID TRANSFORMATION, WITH A FULLY PENETRANT, LETHAL CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML), WHICH WAS SERIALLY TRANSPLANTABLE. TET2 LOSS AND NRAS MUTATION COOPERATIVELY LED TO DECREASE IN NEGATIVE REGULATORS OF MITOGEN-ACTIVATED PROTEIN KINASE (MAPK) ACTIVATION, INCLUDING SPRY2, THEREBY CAUSING SYNERGISTIC ACTIVATION OF MAPK SIGNALING BY EPIGENETIC SILENCING. TET2/NRAS DOUBLE-MUTANT LEUKEMIA SHOWED PREFERENTIAL SENSITIVITY TO MAPK KINASE (MEK) INHIBITION IN BOTH MOUSE MODEL AND PATIENT SAMPLES. THESE DATA PROVIDE INSIGHTS INTO HOW EPIGENETIC AND SIGNALING MUTATIONS COOPERATE IN MYELOID TRANSFORMATION AND PROVIDE A RATIONALE FOR MECHANISM-BASED THERAPY IN CMML PATIENTS WITH THESE HIGH-RISK GENETIC LESIONS. 2018 8 2936 44 GENETIC AND EPIGENETIC ABNORMALITIES IN PRIMARY SCLEROSING CHOLANGITIS-ASSOCIATED CHOLANGIOCARCINOMA. PRIMARY SCLEROSING CHOLANGITIS (PSC) IS A CHOLESTATIC LIVER DISEASE OF UNKNOWN ETIOLOGY, CHARACTERIZED BY CHRONIC INFLAMMATION OF THE BILIARY TREE WITH SUBSEQUENT FIBROSIS AND CIRRHOSIS OF THE LIVER. PATIENTS WITH PSC ARE AT INCREASED RISK FOR THE DEVELOPMENT OF CHOLANGIOCARCINOMA (CCA), A HIGHLY MALIGNANT EPITHELIAL TUMOR ARISING FROM THE INTRAHEPATIC AND EXTRAHEPATIC BILE DUCTS. CURRENTLY, ORTHOTOPIC LIVER TRANSPLANTATION IS THE ONLY CURATIVE TREATMENT. THE LACK OF EFFICIENT DIAGNOSTIC METHODS FOR EARLY DETECTION AND THE LIMITED THERAPEUTIC OPTIONS FOR CCA ARE MAJOR PROBLEMS AND ARE ASSOCIATED WITH POOR SURVIVAL. THE PATHOGENESIS OF PSC-ASSOCIATED CCA IS COMPLEX AND POORLY UNDERSTOOD. IT SEEMS THAT PRO-INFLAMMATORY CYTOKINES PLAY AN IMPORTANT ROLE IN GENETIC AND EPIGENETIC CHANGES THAT CONTRIBUTE TO THE CARCINOGENIC PROCESS. THE MAPPING OF GENETIC ALTERATIONS MAY ELUCIDATE MOLECULAR TARGETS THAT MAY BE APPLIED AS BIOMARKERS TO FACILITATE EARLY DIAGNOSIS OF MALIGNANT DEGENERATION TO IMPROVE PATIENT OUTCOME. IN THE LAST DECADE, THE INTRODUCTION OF SEVERAL NOVEL MOLECULAR TECHNIQUES AVAILABLE FOR GENOME-WIDE SCREENING HAS ADVANCED OUR KNOWLEDGE ON MANY OF THE GENETIC ABNORMALITIES THAT ARE PREVALENT IN CCA AND PSC-ASSOCIATED CCA. THIS REVIEW SUMMARIZES GENETIC AND EPIGENETIC ABNORMALITIES, WHICH HAVE IMPORTANT POTENTIAL FOR CLINICAL APPLICATION. 2013 9 4038 26 MACROPHAGE IMPLICATION IN IPF: UPDATES ON IMMUNE, EPIGENETIC, AND METABOLIC PATHWAYS. IDIOPATHIC PULMONARY FIBROSIS (IPF) IS A LETHAL INTERSTITIAL LUNG DISEASE OF UNKNOWN ETIOLOGY WITH A POOR PROGNOSIS. IT IS A CHRONIC AND PROGRESSIVE DISEASE THAT HAS A DISTINCT RADIOLOGICAL AND PATHOLOGICAL PATTERN FROM COMMON INTERSTITIAL PNEUMONIA. THE USE OF IMMUNOSUPPRESSIVE MEDICATION WAS SHOWN TO BE COMPLETELY INEFFECTIVE IN CLINICAL TRIALS, RESULTING IN YEARS OF NEGLECT OF THE IMMUNE COMPONENT. HOWEVER, RECENT DEVELOPMENTS IN FUNDAMENTAL AND TRANSLATIONAL SCIENCE DEMONSTRATE THAT IMMUNE CELLS PLAY A SIGNIFICANT REGULATORY ROLE IN IPF, AND MACROPHAGES APPEAR TO BE AMONG THE MOST CRUCIAL. THESE HIGHLY PLASTIC CELLS GENERATE MULTIPLE GROWTH FACTORS AND MEDIATORS THAT HIGHLY AFFECT THE INITIATION AND PROGRESSION OF IPF. IN THIS REVIEW, WE WILL PROVIDE AN UPDATE ON THE ROLE OF MACROPHAGES IN IPF THROUGH A SYSTEMIC DISCUSSION OF VARIOUS REGULATORY MECHANISMS INVOLVING IMMUNE RECEPTORS, CYTOKINES, METABOLISM, AND EPIGENETICS. 2023 10 4566 19 MYELOID SOMATIC MUTATION PANEL TESTING IN MYELOPROLIFERATIVE NEOPLASMS. MYELOPROLIFERATIVE NEOPLASMS ARE CHARACTERISED BY SOMATIC MUTATIONS IN PATHWAYS THAT REGULATE CELL PROLIFERATION, EPIGENETIC MODIFICATIONS, RNA SPLICING OR DNA REPAIR. ASSESSMENT OF THE MUTATIONAL PROFILE ASSISTS DIAGNOSIS AND CLASSIFICATION, BUT ALSO AIDS ASSESSMENT OF PROGNOSIS, AND MAY GUIDE THE USE OF EMERGING TARGETED THERAPIES. THE MOST PRACTICAL WAY TO PROVIDE INFORMATION ON NUMEROUS GENETIC VARIANTS IS BY USING MASSIVELY PARALLEL SEQUENCING, COMMONLY IN THE FORM OF DISEASE SPECIFIC NEXT GENERATION SEQUENCING (NGS) PANELS. THIS REVIEW SUMMARISES THE DIAGNOSTIC AND PROGNOSTIC VALUE OF SOMATIC MUTATION TESTING IN PHILADELPHIA-NEGATIVE MYELOPROLIFERATIVE NEOPLASMS: POLYCYTHAEMIA VERA, ESSENTIAL THROMBOCYTHAEMIA, PRIMARY MYELOFIBROSIS, CHRONIC NEUTROPHILIC LEUKAEMIA, SYSTEMIC MASTOCYTOSIS, AND CHRONIC EOSINOPHILIC LEUKAEMIA. NGS PANEL TESTING IS INCREASING IN ROUTINE PRACTICE AND PROMISES TO IMPROVE THE ACCURACY AND EFFICIENCY OF PATHOLOGICAL DIAGNOSIS AND PROGNOSIS. 2021 11 6068 35 THE DIET AS A CAUSE OF HUMAN PROSTATE CANCER. ASYMPTOMATIC PROSTATE INFLAMMATION AND PROSTATE CANCER HAVE REACHED EPIDEMIC PROPORTIONS AMONG MEN IN THE DEVELOPED WORLD. ANIMAL MODEL STUDIES IMPLICATE DIETARY CARCINOGENS, SUCH AS THE HETEROCYCLIC AMINES FROM OVER-COOKED MEATS AND SEX STEROID HORMONES, PARTICULARLY ESTROGENS, AS CANDIDATE ETIOLOGIES FOR PROSTATE CANCER. EACH ACTS BY CAUSING EPITHELIAL CELL DAMAGE, TRIGGERING AN INFLAMMATORY RESPONSE THAT CAN EVOLVE INTO A CHRONIC OR RECURRENT CONDITION. THIS MILIEU APPEARS TO SPAWN PROLIFERATIVE INFLAMMATORY ATROPHY (PIA) LESIONS, A TYPE OF FOCAL ATROPHY THAT REPRESENTS THE EARLIEST OF PROSTATE CANCER PRECURSOR LESIONS. RARE PIA LESIONS CONTAIN CELLS WHICH EXHIBIT HIGH C-MYC EXPRESSION, SHORTENED TELOMERE SEGMENTS, AND EPIGENETIC SILENCING OF GENES SUCH AS GSTP1, ENCODING THE PI-CLASS GLUTATHIONE S-TRANSFERASE, ALL CHARACTERISTIC OF PROSTATIC INTRAEPITHELIAL NEOPLASIA (PIN) AND PROSTATE CANCER. SUBSEQUENT GENETIC CHANGES, SUCH AS THE GENE TRANSLOCATIONS/DELETIONS THAT GENERATE FUSION TRANSCRIPTS BETWEEN ANDROGEN-REGULATED GENES (SUCH AS TMPRSS2) AND GENES ENCODING ETS FAMILY TRANSCRIPTION FACTORS (SUCH AS ERG1), ARISE IN PIN LESIONS AND MAY PROMOTE INVASIVENESS CHARACTERISTIC OF PROSTATIC ADENOCARCINOMA CELLS. LETHAL PROSTATE CANCERS CONTAIN MARKEDLY CORRUPTED GENOMES AND EPIGENOMES. EPIGENETIC SILENCING, WHICH SEEMS TO ARISE IN RESPONSE TO THE INFLAMED MICROENVIRONMENT GENERATED BY DIETARY CARCINOGENS AND/OR ESTROGENS AS PART OF AN EPIGENETIC "CATASTROPHE" AFFECTING HUNDREDS OF GENES, PERSISTS TO DRIVE CLONAL EVOLUTION THROUGH METASTATIC DISSEMINATION. THE CAUSE OF THE INITIAL EPIGENETIC "CATASTROPHE" HAS NOT BEEN DETERMINED BUT LIKELY INVOLVES DEFECTIVE CHROMATIN STRUCTURE MAINTENANCE BY OVER-EXUBERANT DNA METHYLATION OR HISTONE MODIFICATION. WITH DIETARY CARCINOGENS AND ESTROGENS DRIVING PRO-CARCINOGENIC INFLAMMATION IN THE DEVELOPED WORLD, IT IS TEMPTING TO SPECULATE THAT DIETARY COMPONENTS ASSOCIATED WITH DECREASED PROSTATE CANCER RISK, SUCH AS INTAKE OF FRUITS AND VEGETABLES, ESPECIALLY TOMATOES AND CRUCIFERS, MIGHT ACT TO ATTENUATE THE RAVAGES OF THE CHRONIC OR RECURRENT INFLAMMATORY PROCESSES. SPECIFICALLY, NUTRITIONAL AGENTS MIGHT PREVENT PIA LESIONS OR REDUCE THE PROPENSITY OF PIA LESIONS TO SUFFER "CATASTROPHIC" EPIGENOME CORRUPTION. 2014 12 3575 31 IMPACT OF MOLECULAR PROFILING ON THE MANAGEMENT OF PATIENTS WITH MYELOFIBROSIS. MYELOFIBROSIS (MF) IS A CHRONIC MYELOPROLIFERATIVE NEOPLASM (MPN) CHARACTERIZED BY A HIGHLY HETEROGENEOUS CLINICAL COURSE, WHICH CAN BE COMPLICATED BY SEVERE CONSTITUTIONAL SYMPTOMS, MASSIVE SPLENOMEGALY, PROGRESSIVE BONE MARROW FAILURE, CARDIOVASCULAR EVENTS, AND DEVELOPMENT OF ACUTE LEUKEMIA. CONSTITUTIVE SIGNALING THROUGH THE JAK-STAT PATHWAY PLAYS A FUNDAMENTAL ROLE IN ITS PATHOGENESIS, GENERALLY DUE TO ACTIVATING MUTATIONS OF JAK2, CALR AND MPL GENES (I.E., THE MPN DRIVER MUTATIONS), PRESENT IN MOST MF PATIENTS. NEXT GENERATION SEQUENCING (NGS) PANEL TESTING HAS SHOWN THAT ADDITIONAL SOMATIC MUTATIONS CAN ALREADY BE DETECTED AT THE TIME OF DIAGNOSIS IN MORE THAN HALF OF PATIENTS, AND THAT THEY ACCUMULATE ALONG THE DISEASE COURSE. THESE MUTATIONS, MOSTLY AFFECTING EPIGENETIC MODIFIERS OR SPLICEOSOME COMPONENTS, MAY COOPERATE WITH MPN DRIVERS TO FAVOR CLONAL DOMINANCE OR INFLUENCE THE CLINICAL PHENOTYPE, AND SOME, SUCH AS HIGH MOLECULAR RISK MUTATIONS, CORRELATE WITH A MORE AGGRESSIVE CLINICAL COURSE WITH POOR TREATMENT RESPONSE. THE CURRENT MAIN ROLE OF MOLECULAR PROFILING IN CLINICAL PRACTICE IS PROGNOSTICATION, PRINCIPALLY FOR SELECTING HIGH-RISK PATIENTS WHO MAY BE CANDIDATES FOR TRANSPLANTATION, THE ONLY CURATIVE TREATMENT FOR MF TO DATE. TO THIS END, CONTEMPORARY PROGNOSTIC MODELS INCORPORATING MOLECULAR DATA ARE USEFUL TOOLS TO DISCRIMINATE DIFFERENT RISK CATEGORIES. ASIDE FROM CERTAIN CLINICAL SITUATIONS, DECISIONS REGARDING MEDICAL TREATMENT ARE NOT BASED ON PATIENT MOLECULAR PROFILING, YET THIS APPROACH MAY BECOME MORE RELEVANT IN NOVEL TREATMENT STRATEGIES, SUCH AS THE USE OF VACCINES AGAINST THE MUTANT FORMS OF JAK2 OR CALR, OR DRUGS DIRECTED AGAINST ACTIONABLE MOLECULAR TARGETS. 2022 13 5026 32 PERSONALIZED MEDICINE IN IDIOPATHIC PULMONARY FIBROSIS: FACTS AND PROMISES. PURPOSE OF REVIEW: IN THIS ARTICLE, WE SUMMARIZE AND DISCUSS THE MOST RECENT LITERATURE ON PERSONALIZED MEDICINE IN IDIOPATHIC PULMONARY FIBROSIS (IPF), A CHRONIC PROGRESSIVE AND ALMOST INVARIABLY LETHAL DISEASE OF UNKNOWN CAUSE. THIS REVIEW IS TIMELY AS MAJOR ADVANCES IN OUR UNDERSTANDING OF DISEASE PATHOBIOLOGY AND IMPROVEMENTS IN MOLECULAR TECHNIQUES HAVE RECENTLY LED TO THE IDENTIFICATION OF POTENTIAL SURROGATES OF DIAGNOSIS, PROGNOSIS AND RESPONSE TO TREATMENT. RECENT FINDINGS: THE MOST PROMISING AND ADVANCED CANDIDATE BIOMARKERS ARE PRESENTED BASED ON THEIR PROPOSED MECHANISTIC PATHWAYS (E.G. ALVEOLAR EPITHELIAL CELL DYSFUNCTION, IMMUNE DYSREGULATION, MICROBIOME, EXTRACELLULAR MATRIX REMODELING AND FIBROPROLIFERATION, EPIGENETIC MARKERS AND METABOLOMICS). RECENT DATA SUGGEST THAT COMPONENTS OF THE IMMUNE SYSTEM MAY CONTRIBUTE TO THE DEVELOPMENT OF IPF. A POTENTIAL ROLE FOR INFECTIONS AS A COFACTOR IN DISEASE DEVELOPMENT AND PROGRESSION OR AS A TRIGGER IN DISEASE EXACERBATION HAS ALSO RECENTLY BEEN PROPOSED. SUMMARY: CLINICAL MANAGEMENT OF IPF IS UNSATISFACTORY BECAUSE OF LIMITED AVAILABILITY OF TRULY EFFECTIVE THERAPIES, LACK OF ACCURATE PREDICTORS OF DISEASE BEHAVIOR AND ABSENCE OF SIMPLE SHORT-TERM MEASURES OF THERAPEUTIC RESPONSE. A NUMBER OF PUTATIVE BIOMARKERS HAVE BEEN IDENTIFIED IN PATIENTS WITH IPF, ALTHOUGH NONE HAS BEEN VALIDATED TO THE STANDARD NECESSARY FOR THEIR USE IN EITHER THERAPEUTIC TRIALS OR CLINICAL PRACTICE. CURRENTLY, ONGOING PROSPECTIVE LONGITUDINAL STUDIES WILL HOPEFULLY PERMIT SUCH VALIDATION. 2015 14 1674 22 DRIVER MUTATIONS IN LEUKEMIA PROMOTE DISEASE PATHOGENESIS THROUGH A COMBINATION OF CELL-AUTONOMOUS AND NICHE MODULATION. STUDIES OF PATIENTS WITH ACUTE MYELOID LEUKEMIA (AML) HAVE LED TO THE IDENTIFICATION OF MUTATIONS THAT AFFECT DIFFERENT CELLULAR PATHWAYS. SOME OF THESE HAVE BEEN CLASSIFIED AS PRELEUKEMIC, AND A STEPWISE EVOLUTION PROGRAM WHEREBY CELLS ACQUIRE ADDITIONAL MUTATIONS HAS BEEN PROPOSED IN THE DEVELOPMENT OF AML. HOW THE TIMING OF ACQUISITION OF THESE MUTATIONS AND THEIR IMPACT ON TRANSFORMATION AND THE BONE MARROW (BM) MICROENVIRONMENT OCCURS HAS ONLY RECENTLY BEGUN TO BE INVESTIGATED. WE SHOW THAT CONSTITUTIVE AND EARLY LOSS OF THE EPIGENETIC REGULATOR, TET2, WHEN COMBINED WITH CONSTITUTIVE ACTIVATION OF FLT3, RESULTS IN TRANSFORMATION OF CHRONIC MYELOMONOCYTIC LEUKEMIA-LIKE OR MYELOPROLIFERATIVE NEOPLASM-LIKE PHENOTYPE TO AML, WHICH IS MORE PRONOUNCED IN DOUBLE-MUTANT MICE RELATIVE TO MICE CARRYING MUTATIONS IN SINGLE GENES. FURTHERMORE, WE SHOW THAT IN PRELEUKEMIC AND LEUKEMIC MICE THERE ARE ALTERATIONS IN THE BM NICHE AND SECRETED CYTOKINES, WHICH CREATES A PERMISSIVE ENVIRONMENT FOR THE GROWTH OF MUTATION-BEARING CELLS RELATIVE TO NORMAL CELLS. 2020 15 2540 32 EPIGENETICS IN IDIOPATHIC PULMONARY FIBROSIS. IDIOPATHIC PULMONARY FIBROSIS (IPF) IS A LETHAL CHRONIC LUNG DISORDER WITH NO EFFECTIVE TREATMENT AND A PROGNOSIS WORSE THAN THAT OF LUNG CANCER. DESPITE EXTENSIVE RESEARCH EFFORTS, ITS ETIOLOGY AND PATHOGENESIS STILL REMAIN LARGELY UNKNOWN. CURRENT EXPERIMENTAL EVIDENCE HAS SHIFTED THE DISEASE PARADIGM FROM CHRONIC INFLAMMATION TOWARDS THE PREMISE OF ABNORMAL EPITHELIAL WOUND REPAIR IN RESPONSE TO REPEATED EPIGENETIC INJURIOUS STIMULI IN GENETICALLY PREDISPOSED INDIVIDUALS. EPIGENETICS IS DEFINED AS THE STUDY OF HERITABLE CHANGES IN GENE FUNCTION BY FACTORS OTHER THAN AN INDIVIDUAL'S DNA SEQUENCE, PROVIDING VALUABLE INFORMATION REGARDING ADAPTION OF GENES TO ENVIRONMENTAL CHANGES. ALTHOUGH CANCER IS THE MOST STUDIED DISEASE WITH RELEVANCE TO EPIGENETIC MODIFICATIONS, RECENT DATA SUPPORT THE IDEA THAT EPIGENOMIC ALTERATIONS MAY LEAD TO VARIABLE DISEASE PHENOTYPES, INCLUDING FIBROPROLIFERATIVE LUNG DISORDERS SUCH AS IPF. THIS REVIEW ARTICLE SUMMARIZES THE LATEST EXPERIMENTAL AND TRANSLATIONAL EPIGENETIC STUDIES IN THE RESEARCH FIELD OF CHRONIC LUNG DISORDERS, MAINLY FOCUSING ON IPF, HIGHLIGHTS CURRENT METHODOLOGY LIMITATIONS, AND UNDERLINES FUTURE DIRECTIONS AND PERSPECTIVES. 2015 16 620 38 BIOCHEMISTRY AND MOLECULAR BIOLOGY OF GELATINASE B OR MATRIX METALLOPROTEINASE-9 (MMP-9): THE NEXT DECADE. RESEARCH ON MATRIX METALLOPROTEINASES (MMPS) AND IN PARTICULAR ON GELATINASE B, ALIAS MMP-9, HAS GROWN EXPONENTIALLY IN THE DECADE 2003-2012. STRUCTURAL DETAILS ABOUT FLEXIBILITY OF MMP-9 MONOMERS, TOGETHER WITH GLYCOSYLATION, OLIGOMERIZATION, HETEROGENEITY AND INSTABILITY OF THE WILDTYPE ENZYME EXPLAIN WHY CRYSTALLOGRAPHY EXPERIMENTS HAVE NOT YET BEEN SUCCESSFUL FOR THE INTACT ENZYME. MMP-9 MAY BE VIEWED AS A MULTIDOMAIN ENZYME IN WHICH THE HEMOPEXIN, THE O-GLYCOSYLATED AND THE CATALYTIC DOMAINS YIELD SUPPORT FOR ATTACHMENT, ARTICULATION AND CATALYSIS, RESPECTIVELY. THE STEPWISE PROTEOLYTIC ACTIVATION OF THE INACTIVE ZYMOGEN INTO A CATALYTICALLY ACTIVE FORM BECOMES GRADUALLY BETTER UNDERSTOOD. PRIMING OF ACTIVATION BY MMP-3 MAY BE EXECUTED BY MEPRINS THAT DESTABILIZE THE INTERACTION OF THE AMINOTERMINUS WITH THE THIRD FIBRONECTIN REPEAT. ALTERNATIVELY, AUTOCATALYTIC ACTIVATION MAY OCCUR IN THE PRESENCE OF MOLECULES THAT TIGHTLY BIND TO THE CATALYTIC SITE AND THAT PUSH THE CYSTEIN RESIDUE IN THE PRODOMAIN AWAY FROM THE CATALYTIC ZINC ION. THANKS TO THE DEVELOPMENT OF DEGRADOMICS TECHNOLOGIES, SUBSTRATE REPERTOIRES OF MMP-9 HAVE BEEN DEFINED, BUT IT REMAINS A CHALLENGE TO DETERMINE AND PROVE WHICH SUBSTRATES ARE BIOLOGICALLY RELEVANT. THE SUBSTRATE REPERTOIRE HAS BEEN ENLARGED FROM EXTRACELLULAR TO MEMBRANE-BOUND AND EFFICIENT INTRACELLULAR SUBSTRATES, SUCH AS CRYSTALLINS, TUBULINS AND ACTINS. BIOLOGICAL STUDIES OF MMP-9 HAVE TUNED THE FIELD FROM BEING PRIMARILY CANCER-ORIENTED TOWARDS VASCULAR AND INFLAMMATORY RESEARCH. IN TUMOR BIOLOGY, IT HAS BEEN INCREASINGLY APPRECIATED THAT MMP-9 FROM INFLAMMATORY CELLS, PARTICULARLY NEUTROPHILS, CO-DETERMINES PROGNOSIS AND OUTCOME. ASIDE FROM THE CATALYTIC FUNCTIONS EXECUTED BY AMINOTERMINAL DOMAINS OF MMP-9, THE CARBOXYTERMINAL HEMOPEXIN (PEX) DOMAIN OF GELATINASE B EXERTS NON-CATALYTIC ANTI-APOPTOTIC SIGNALING EFFECTS. THE RECOGNITION THAT GELATINASE B IS INDUCED BY MANY PRO-INFLAMMATORY CYTOKINES, WHEREAS ITS INHIBITORS ARE INCREASED BY ANTI-INFLAMMATORY CYTOKINES, HAS GENERATED INTEREST TO TARGET MMP-9 IN ACUTE LETHAL CONDITIONS, SUCH AS BACTERIAL MENINGITIS, SEPSIS AND ENDOTOXIN SHOCK, AND IN ACUTE EXACERBATIONS OF CHRONIC DISEASES. PREVIOUSLY DESCRIBED TRANSCRIPTIONAL REGULATION OF MMP-9 IS COMPLEMENTED BY EPIGENETIC CHECKPOINTS, INCLUDING HISTONE MODIFICATIONS AND MICRORNAS. BECAUSE ACTIVATION OF PROMMP-9 MAY BE EXECUTED BY OTHER MMPS, THE THERAPEUTIC DOGMA THAT MMP INHIBITORS NEED TO BE HIGHLY SELECTIVE MAY BE KEYED DOWN FOR THE TREATMENT OF LIFE-THREATENING CONDITIONS. WHEN INFLAMMATION AND MMP-9 FULFILL BENEFICIAL FUNCTIONS TO CLEAR DAMAGING PROTEIN COMPLEXES, SUCH AS IN SYSTEMIC AUTOIMMUNE DISEASES, THERAPEUTIC MMP INHIBITION HAS TO BE AVOIDED. IN MMP9 GENE KNOCKOUT MICE, SPECIFIC SPONTANEOUS PHENOTYPES EMERGED WITH EFFECTS ON THE SKELETAL, REPRODUCTIVE AND NERVOUS SYSTEMS. THESE FINDINGS NOT ONLY HAVE CLINICAL CORRELATES IN BONE GROWTH AND FERTILITY, BUT ALSO STIMULATE RESEARCH ON THE ROLES OF MMPS AND MMP-9 IN ENDOCRINOLOGY, IMMUNOLOGY AND THE NEUROSCIENCES. MMP9-DEFICIENT MICE ARE VALUABLE TOOLS TO DEFINE MMP-9 SUBSTRATES IN VIVO AND TO STUDY THE ROLE OF THIS ENZYME IN ANIMAL MODELS OF INFLAMMATORY, VASCULAR, NEOPLASTIC AND DEGENERATIVE DISEASES. FUTURE CHALLENGES INCLUDE SOLVING THE CRYSTAL STRUCTURE, DEFINITION OF THE FUNCTIONS OF COVALENT OLIGOMERS AND HETEROMERS IN BIOLOGY AND PATHOLOGY, LIFE-IMAGING OF MMP-9 ACTIVITY, SUBSTRATE DETERMINATION IN SITU AND THE STUDY OF INHIBITOR EFFECTS ON FERTILITY, CANCER AND INFLAMMATION AND IN NEUROBIOLOGY AND REGENERATIVE MEDICINE. SUCH STUDIES WILL BETTER DEFINE CONDITIONS IN WHICH INHIBITION OF MMP-9 IS BENEFICIAL OR HAS TO BE AVOIDED. 2013 17 3628 26 INACTIVATION OF NUCLEAR HISTONE DEACETYLASES BY EP300 DISRUPTS THE MICEE COMPLEX IN IDIOPATHIC PULMONARY FIBROSIS. IDIOPATHIC PULMONARY FIBROSIS (IPF) IS A CHRONIC, PROGRESSIVE, AND HIGHLY LETHAL LUNG DISEASE WITH UNKNOWN ETIOLOGY AND POOR PROGNOSIS. IPF PATIENTS DIE WITHIN 2 YEARS AFTER DIAGNOSIS MOSTLY DUE TO RESPIRATORY FAILURE. CURRENT TREATMENTS AGAINST IPF AIM TO AMELIORATE PATIENT SYMPTOMS AND TO DELAY DISEASE PROGRESSION. UNFORTUNATELY, THERAPIES TARGETING THE CAUSES OF OR REVERTING IPF HAVE NOT YET BEEN DEVELOPED. HERE WE SHOW THAT REDUCED LEVELS OF MIRNA LETHAL 7D (MIRLET7D) IN IPF COMPROMISE EPIGENETIC GENE SILENCING MEDIATED BY THE RIBONUCLEOPROTEIN COMPLEX MICEE. IN ADDITION, WE FIND THAT HYPERACTIVE EP300 REDUCES NUCLEAR HDAC ACTIVITY AND INTERFERES WITH MICEE FUNCTION IN IPF. REMARKABLY, EP300 INHIBITION REDUCES FIBROTIC HALLMARKS OF IN VITRO (PATIENT-DERIVED PRIMARY FIBROBLAST), IN VIVO (BLEOMYCIN MOUSE MODEL), AND EX VIVO (PRECISION-CUT LUNG SLICES, PCLS) IPF MODELS. OUR WORK PROVIDES THE MOLECULAR BASIS FOR THERAPIES AGAINST IPF USING EP300 INHIBITION. 2019 18 1113 26 COMMON PATHWAYS IN IDIOPATHIC PULMONARY FIBROSIS AND CANCER. IDIOPATHIC PULMONARY FIBROSIS (IPF) IS MARKED BY A VERY DISAPPOINTING SURVIVAL RATE AND STILL REPRESENTS A CLINICAL DILEMMA. ACCORDING TO THE CURRENT PATHOGENIC HYPOTHESIS, CHRONIC DAMAGE OF THE ALVEOLAR EPITHELIUM IS FOLLOWED BY ABNORMAL TISSUE REPAIR AND IMPAIRMENT OF THE ALVEOLAR STRUCTURE. THIS PROCESS IS DRIVEN BY PATHOGENIC EVENTS VERY SIMILAR TO CANCER, INCLUDING EPIGENETIC AND GENETIC CHANGES, ALTERED RESPONSE TO REGULATORY SIGNALS, ABNORMAL EXPRESSION OF MICRORNAS AND ACTIVATION OF SPECIFIC SIGNALLING PATHWAYS. IPF ALSO RESEMBLES CANCER WITH REGARD TO ITS POOR RESPONSE TO MEDICAL TREATMENT AND PROGNOSIS, WHICH IS VERY OFTEN WORSE THAN MANY CANCERS. WE HAVE HYPOTHESISED THAT IPF MIGHT BE ASSIMILATED TO A NEOPROLIFERATIVE DISORDER OF THE LUNG. VIEWING IPF AS A CANCER-LIKE DISEASE MAY SATISFY THE NEED FOR A BETTER UNDERSTANDING OF THE PATHOGENESIS OF IPF BY EXPLOITING THE LARGE AMOUNT OF KNOWLEDGE THAT CANCER BIOLOGY EVOKES. THE RECOGNITION OF COMMON PATHOGENIC PATHWAYS BETWEEN THE TWO DISEASES MAY STIMULATE NEW CLINICAL TRIALS WITH CANCER DRUGS, DIFFERENT DRUG COMBINATIONS AND DIFFERENT LINES OF DRUGS, AS ALREADY EXPERIMENTED IN ONCOLOGY. MOREOVER, THE CONCEPT OF IPF AS A CANCER-LIKE DISORDER MAY IMPROVE THE ATTENTION GIVEN TO THIS DREADFUL DISEASE ON A PUBLIC, POLITICAL AND HEALTHCARE LEVEL. 2013 19 4450 25 MOLECULAR MECHANISMS AND CELLULAR CONTRIBUTION FROM LUNG FIBROSIS TO LUNG CANCER DEVELOPMENT. IDIOPATHIC PULMONARY FIBROSIS (IPF) IS A CHRONIC, PROGRESSIVE, FIBROSING INTERSTITIAL LUNG DISEASE (ILD) OF UNKNOWN AETIOLOGY, WITH A MEDIAN SURVIVAL OF 2-4 YEARS FROM THE TIME OF DIAGNOSIS. ALTHOUGH IPF HAS UNKNOWN AETIOLOGY BY DEFINITION, THERE HAVE BEEN IDENTIFIED SEVERAL RISKS FACTORS INCREASING THE PROBABILITY OF THE ONSET AND PROGRESSION OF THE DISEASE IN IPF PATIENTS SUCH AS CIGARETTE SMOKING AND ENVIRONMENTAL RISK FACTORS ASSOCIATED WITH DOMESTIC AND OCCUPATIONAL EXPOSURE. AMONG THEM, CIGARETTE SMOKING TOGETHER WITH CONCOMITANT EMPHYSEMA MIGHT PREDISPOSE IPF PATIENTS TO LUNG CANCER (LC), MOSTLY TO NON-SMALL CELL LUNG CANCER (NSCLC), INCREASING THE RISK OF LUNG CANCER DEVELOPMENT. TO THIS PURPOSE, IPF AND LC SHARE SEVERAL CELLULAR AND MOLECULAR PROCESSES DRIVING THE PROGRESSION OF BOTH PATHOLOGIES SUCH AS FIBROBLAST TRANSITION PROLIFERATION AND ACTIVATION, ENDOPLASMIC RETICULUM STRESS, OXIDATIVE STRESS, AND MANY GENETIC AND EPIGENETIC MARKERS THAT PREDISPOSE IPF PATIENTS TO LC DEVELOPMENT. NINTEDANIB, A TYROSINE-KINASE INHIBITOR, WAS FIRSTLY DEVELOPED AS AN ANTICANCER DRUG AND THEN RECOGNIZED AS AN ANTI-FIBROTIC AGENT BASED ON THE COMMON TARGET MOLECULAR PATHWAY. IN THIS REVIEW OUR AIM IS TO DESCRIBE THE UPDATED STUDIES ON COMMON CELLULAR AND MOLECULAR MECHANISMS BETWEEN IPF AND LUNG CANCER, KNOWLEDGE OF WHICH MIGHT HELP TO FIND NOVEL THERAPEUTIC TARGETS FOR THIS DISEASE COMBINATION. 2021 20 3811 28 INTRATUMORAL HETEROGENEITY: CLONAL COOPERATION IN EPITHELIAL-TO-MESENCHYMAL TRANSITION AND METASTASIS. ALTHOUGH PHENOTYPIC INTRATUMORAL HETEROGENEITY WAS FIRST DESCRIBED MANY DECADES AGO, THE ADVENT OF NEXT-GENERATION SEQUENCING HAS PROVIDED CONCLUSIVE EVIDENCE THAT IN ADDITION TO PHENOTYPIC DIVERSITY, SIGNIFICANT GENOTYPIC DIVERSITY EXISTS WITHIN TUMORS. TUMOR HETEROGENEITY LIKELY ARISES BOTH FROM CLONAL EXPANSIONS, AS WELL AS FROM DIFFERENTIATION HIERARCHIES EXISTENT IN THE TUMOR, SUCH AS THAT ESTABLISHED BY CANCER STEM CELLS (CSCS) AND NON-CSCS. THESE DIFFERENTIATION HIERARCHIES MAY ARISE DUE TO GENETIC MUTATIONS, EPIGENETIC ALTERATIONS, OR MICROENVIRONMENTAL INFLUENCES. AN ADDITIONAL DIFFERENTIATION HIERARCHY WITHIN EPITHELIAL TUMORS MAY ARISE WHEN ONLY A FEW TUMOR CELLS TRANS-DIFFERENTIATE INTO MESENCHYMAL-LIKE CELLS, A PROCESS KNOWN AS EPITHELIAL-TO-MESENCHYMAL TRANSITION (EMT). AGAIN, THIS PROCESS CAN BE INFLUENCED BY BOTH GENETIC AND NON-GENETIC FACTORS. IN THIS REVIEW WE DISCUSS THE EVIDENCE FOR CLONAL INTERACTION AND COOPERATION FOR TUMOR MAINTENANCE AND PROGRESSION, PARTICULARLY WITH RESPECT TO EMT, AND FURTHER ADDRESS THE FAR-REACHING EFFECTS THAT TUMOR HETEROGENEITY MAY HAVE ON CANCER THERAPY. 2015