1 4850 145 OPIOIDS AND OPIOID RECEPTORS; UNDERSTANDING PHARMACOLOGICAL MECHANISMS AS A KEY TO THERAPEUTIC ADVANCES AND MITIGATION OF THE MISUSE CRISIS. OPIOIDS ARE A MAINSTAY IN ACUTE PAIN MANAGEMENT AND PRODUCE THEIR EFFECTS AND SIDE EFFECTS (E.G., TOLERANCE, OPIOID-USE DISORDER AND IMMUNE SUPPRESSION) BY INTERACTION WITH OPIOID RECEPTORS. I WILL DISCUSS OPIOID PHARMACOLOGY IN SOME CONTROVERSIAL AREAS OF ENQUIRY OF ANAESTHETIC RELEVANCE. THE MAIN OPIOID TARGET IS THE MICRO (MU,MOP) RECEPTOR BUT OTHER MEMBERS OF THE OPIOID RECEPTOR FAMILY, DELTA (DELTA; DOP) AND KAPPA (KAPPA; KOP) OPIOID RECEPTORS ALSO PRODUCE ANALGESIC ACTIONS. THESE ARE NALOXONE-SENSITIVE. THERE IS IMPORTANT CLINICAL DEVELOPMENT RELATING TO THE NOCICEPTIN/ORPHANIN FQ (NOP) RECEPTOR, AN OPIOID RECEPTOR THAT IS NOT NALOXONE-SENSITIVE. BETTER UNDERSTANDING OF THE DRIVERS FOR OPIOID EFFECTS AND SIDE EFFECTS MAY FACILITATE SEPARATION OF SIDE EFFECTS AND PRODUCTION OF SAFER DRUGS. OPIOIDS BIND TO THE RECEPTOR ORTHOSTERIC SITE TO PRODUCE THEIR EFFECTS AND CAN ENGAGE MONOMER OR HOMO-, HETERODIMER RECEPTORS. SOME LIGANDS CAN DRIVE ONE INTRACELLULAR PATHWAY OVER ANOTHER. THIS IS THE BASIS OF BIASED AGONISM (OR FUNCTIONAL SELECTIVITY). OPIOID ACTIONS AT THE ORTHOSTERIC SITE CAN BE MODULATED ALLOSTERICALLY AND POSITIVE ALLOSTERIC MODULATORS THAT ENHANCE OPIOID ACTION ARE IN DEVELOPMENT. AS WELL AS TARGETING LIGAND-RECEPTOR INTERACTION AND TRANSDUCTION, MODULATING RECEPTOR EXPRESSION AND HENCE FUNCTION IS ALSO TRACTABLE. THERE IS EVIDENCE FOR EPIGENETIC ASSOCIATIONS WITH DIFFERENT TYPES OF PAIN AND ALSO SUBSTANCE MISUSE. AS LONG AS THE OPIOID NARRATIVE IS DEFINED BY THE 'OPIOID CRISIS' THE DRIVE TO REMOVE THEM COULD GATHER PACE. THIS WILL DENY USE WHERE THEY ARE EFFECTIVE, AND ACCESS TO MORPHINE FOR PAIN RELIEF IN LOW INCOME COUNTRIES. 2023 2 2883 32 G9A INHIBITS CREB-TRIGGERED EXPRESSION OF MU OPIOID RECEPTOR IN PRIMARY SENSORY NEURONS FOLLOWING PERIPHERAL NERVE INJURY. NEUROPATHIC PAIN, A DISTRESSING AND DEBILITATING DISORDER, IS STILL POORLY MANAGED IN CLINIC. OPIOIDS, LIKE MORPHINE, REMAIN THE MAINSTAY OF PRESCRIBED MEDICATIONS IN THE TREATMENT OF THIS DISORDER, BUT THEIR ANALGESIC EFFECTS ARE HIGHLY UNSATISFACTORY IN PART DUE TO NERVE INJURY-INDUCED REDUCTION OF OPIOID RECEPTORS IN THE FIRST-ORDER SENSORY NEURONS OF DORSAL ROOT GANGLIA. G9A IS A REPRESSOR OF GENE EXPRESSION. WE FOUND THAT NERVE INJURY-INDUCED INCREASES IN G9A AND ITS CATALYZED REPRESSIVE MARKER H3K9M2 ARE RESPONSIBLE FOR EPIGENETIC SILENCING OF OPRM1, OPRK1, AND OPRD1 GENES IN THE INJURED DORSAL ROOT GANGLIA. BLOCKING THESE INCREASES RESCUED DORSAL ROOT GANGLIA OPRM1, OPRK1, AND OPRD1 GENE EXPRESSION AND MORPHINE OR LOPERAMIDE ANALGESIA AND PREVENTED THE DEVELOPMENT OF MORPHINE OR LOPERAMIDE-INDUCED ANALGESIC TOLERANCE UNDER NEUROPATHIC PAIN CONDITIONS. CONVERSELY, MIMICKING THESE INCREASES REDUCED THE EXPRESSION OF THREE OPIOID RECEPTORS AND PROMOTED THE MU OPIOID RECEPTOR-GATED RELEASE OF PRIMARY AFFERENT NEUROTRANSMITTERS. MECHANISTICALLY, NERVE INJURY-INDUCED INCREASES IN THE BINDING ACTIVITY OF G9A AND H3K9ME2 TO THE OPRM1 GENE WERE ASSOCIATED WITH THE REDUCED BINDING OF CYCLIC AMP RESPONSE ELEMENT BINDING PROTEIN TO THE OPRM1 GENE. THESE FINDINGS SUGGEST THAT G9A PARTICIPATES IN THE NERVE INJURY-INDUCED REDUCTION OF THE OPRM1 GENE LIKELY THROUGH G9A-TRIGGERED BLOCKAGE IN THE ACCESS OF CYCLIC AMP RESPONSE ELEMENT BINDING PROTEIN TO THIS GENE. 2016 3 5284 24 PROPOSALS FOR CLINICAL TRIALS IN CHRONIC MYELOMONOCYTIC LEUKEMIA. CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML) IS A CLONAL HEMATOLOGIC MALIGNANCY OF MOSTLY OLDER INDIVIDUALS THAT EXHIBITS BOTH MYELODYSPLASTIC AND MYELOPROLIFERATIVE FEATURES. CMML PRESENTATION AND OUTCOME ARE VARIABLE, REFLECTING GENETIC AND CLINICAL HETEROGENEITY. HYPOMETHYLATING AGENTS ARE THE MAINSTAY OF THERAPY BUT INDUCE COMPLETE REMISSIONS IN LESS THAN 20% OF PATIENTS AND DO NOT PROLONG SURVIVAL COMPARED TO HYDROXYUREA. ALLOGENEIC STEM CELL TRANSPLANT (ASCT) IS POTENTIALLY CURATIVE, BUT FEW PATIENTS QUALIFY DUE TO ADVANCED AGE AND/OR COMORBIDITIES. WORK OF THE PAST SEVERAL YEARS HAS IDENTIFIED KEY MOLECULAR PATHWAYS THAT DRIVE DISEASE PROLIFERATION AND TRANSFORMATION TO ACUTE LEUKEMIA, INCLUDING JAK/STAT AND MAPK SIGNALING AND EPIGENETIC DYSREGULATION. THERE IS INCREASINGLY COMPELLING EVIDENCE THAT INFLAMMATION IS A MAJOR DRIVER OF CMML PROGRESSION. THUS FAR HOWEVER, THIS MECHANISTIC KNOWLEDGE HAS NOT YET BEEN TRANSLATED INTO IMPROVED OUTCOMES, SUGGESTING THAT FUNDAMENTALLY NEW APPROACHES ARE REQUIRED. IN THIS REVIEW, WE DISCUSS THE DISEASE COURSE, NEW CLASSIFICATIONS, AND CURRENT TREATMENT LANDSCAPE OF CMML. WE REVIEW ONGOING CLINICAL STUDIES AND DISCUSS OPTIONS FOR RATIONALLY BASED FUTURE CLINICAL TRIALS. 2023 4 1160 24 CONTINUING WAR ON PAIN: A PERSONALIZED APPROACH TO THE THERAPY WITH NONSTEROIDAL ANTI-INFLAMMATORY DRUGS AND OPIOIDS. SUCCESSFUL PAIN MANAGEMENT REQUIRES THE DELIVERY OF ANALGESIA WITH MINIMAL RISK OF ADVERSE DRUG REACTIONS. NONSTEROIDAL ANTI-INFLAMMATORY DRUGS AND OPIOIDS REMAIN THE MAINSTAY OF TREATMENT FOR THE MAJORITY OF PATIENTS. UNFORTUNATELY, ALMOST 50% OF ALL PATIENTS EXPERIENCE INADEQUATE PAIN RELIEF AND SERIOUS SIDE EFFECTS. ALLELIC VARIANTS IN GENES CODING FOR TARGET PROTEINS, TRANSPORTERS AND ENZYMES, WHICH GOVERN ANALGESIC DRUGS ACTION AND THEIR FATE IN THE ORGANISM, MIGHT EXPLAIN INTER-INDIVIDUAL VARIABILITY IN PAIN SEVERITY AND IN DRUG-INDUCED PAIN RELIEF AND TOXICITIES. ADDITIONALLY, IT SEEMS THAT EPIGENETIC CHANGES CONTRIBUTE TO THE HIGHLY VARIABLE RESPONSE TO PAIN TREATMENT. THEREFORE, PHARMACOGENOMIC TESTING MIGHT BE A VALUABLE TOOL FOR PERSONALIZATION OF PAIN TREATMENT, WITH A MULTIDISCIPLINARY TEAM APPROACH INVOLVED. 2019 5 2582 24 EPIGENETICS OF MYELODYSPLASTIC SYNDROMES. MYELODYSPLASTIC SYNDROMES (MDS) ARE CLONAL DISEASES OF THE ELDERLY CHARACTERIZED BY CHRONIC CYTOPENIAS, DYSPLASIA AND A VARIABLE RISK OF PROGRESSION TO ACUTE MYELOID LEUKEMIA (AML). ABERRANT METHYLATION OF TUMOR-SUPPRESSOR GENE PROMOTERS HAS BEEN ESTABLISHED FOR MANY YEARS AND RECENTLY TRACKED TO THE MOST IMMATURE CELLS OF MDS, SUGGESTING THAT THESE ALTERATIONS ARE DRIVERS OF MDS PATHOGENESIS. IN RECENT YEARS, RECURRENT SOMATIC MUTATIONS IN GENES ENCODING PROTEINS INVOLVED IN DNA METHYLATION AND DEMETHYLATION AND IN COVALENT HISTONE MODIFICATIONS HAVE BEEN REPORTED IN MYELOID MALIGNANCIES, INCLUDING MDS. WHOLE-GENOME EPIGENETIC PROFILES OF MDS ARE ALSO EMERGING. IN PARALLEL WITH THESE ADVANCES IN THE MOLECULAR PATHOGENESIS OF MDS, CLINICAL TRIALS HAVE ESTABLISHED HYPOMETHYLATING AGENTS (HMAS) AS THE MAINSTAY OF THERAPY IN THE ADVANCED FORMS OF THE DISEASE. IN THIS REVIEW, WE SUMMARIZE THE CURRENT UNDERSTANDING OF THE MOLECULAR MACHINERY INVOLVED IN EPIGENETIC REGULATION, DISCUSS HOW EPIGENETIC ALTERATIONS ARISE IN MDS AND CONTRIBUTE TO ITS PATHOGENESIS AND THEN DISCUSS THE MODE OF ACTION OF HMAS IN MDS. 2014 6 6442 21 THERAPEUTIC APPROACHES IN MYELOFIBROSIS AND MYELODYSPLASTIC/MYELOPROLIFERATIVE OVERLAP SYNDROMES. THE DISCOVERY OF JAK2 (V617F) A DECADE AGO LED TO OPTIMISM FOR A RAPIDLY DEVELOPING TREATMENT REVOLUTION IN PH(-) MYELOPROLIFERATIVE NEOPLASMS. UNLIKE BCR-ABL, HOWEVER, JAK2 WAS FOUND TO HAVE A MORE HETEROGENEOUS ROLE IN CARCINOGENESIS. THEREFORE, FOR YEARS, DEVELOPMENT OF NEW THERAPIES WAS SLOW, DESPITE STANDARD TREATMENT OPTIONS THAT DID NOT ADDRESS THE OVERWHELMING SYMPTOM BURDEN IN PATIENTS WITH PRIMARY MYELOFIBROSIS (MF), POST-ESSENTIAL THROMBOCYTHEMIA MF, POST-POLYCYTHEMIA VERA MF, AND MYELODYSPLASTIC SYNDROME (MDS)/MYELOPROLIFERATIVE NEOPLASM (MPN) SYNDROMES. JAK-STAT INHIBITORS HAVE CHANGED THIS, DRASTICALLY AMELIORATING SYMPTOMS AND ULTIMATELY BEGINNING TO SHOW EVIDENCE OF IMPACT ON SURVIVAL. NOW, THE GENETIC FOUNDATIONS OF MYELOFIBROSIS AND MDS/MPN ARE RAPIDLY BEING ELUCIDATED AND CONTRIBUTING TO TARGETED THERAPY DEVELOPMENT. THIS HAS BEEN EMPOWERED THROUGH UPDATED RESPONSE CRITERIA FOR MDS/MPN AND REFINED PROGNOSTIC SCORING SYSTEMS IN THESE DISEASES. THE AIM OF THIS ARTICLE IS TO SUMMARIZE CONCISELY THE CURRENT AND RATIONALLY DESIGNED INVESTIGATIONAL THERAPEUTICS DIRECTED AT JAK-STAT, HEDGEHOG, PI3K-AKT, BONE MARROW FIBROSIS, TELOMERASE, AND ROGUE EPIGENETIC SIGNALING. THE REVOLUTION IN IMMUNOTHERAPY AND NOVEL TREATMENTS AIMED AT PREVIOUSLY UNTARGETED SIGNALING PATHWAYS PROVIDES HOPE FOR CONSIDERABLE ADVANCEMENT IN THERAPY OPTIONS FOR THOSE WITH CHRONIC MYELOID DISEASE. 2016 7 4532 37 MULTIMODAL ANALGESIA FOR PERIOPERATIVE MANAGEMENT OF PATIENTS PRESENTING FOR SPINAL SURGERY. MULTIMODAL, NON-OPIOID BASED ANALGESIA HAS BECOME THE CORNERSTONE OF ERAS PROTOCOLS FOR EFFECTIVE ANALGESIA AFTER SPINAL SURGERY. OPIOID SIDE EFFECTS, DEPENDENCE AND LEGISLATION RESTRICTING LONG TERM OPIOID USE HAS LED TO A RESURGENCE IN INTEREST IN OPIOID SPARING TECHNIQUES. THE INCREASING ARRAY OF MULTIMODAL OPIOID SPARING ANALGESICS AVAILABLE FOR SPINAL SURGERY TARGETING NOVEL RECEPTORS, TRANSMITTERS, AND ALTERING EPIGENETICS CAN HELP PROVIDE AN OPTIMAL PERIOPERATIVE EXPERIENCE WITH LESS OPIOID SIDE EFFECTS AND LONG-TERM DEPENDENCE. EPIGENETIC MECHANISMS OF PAIN MAY ENHANCE OR SUPPRESS GENE EXPRESSION, WITHOUT ALTERING THE GENOME ITSELF. SUCH MECHANISMS ARE COMPLEX, DYNAMIC AND RESPONSIVE TO ENVIRONMENT. ALTERATIONS THAT OCCUR CAN AFFECT THE PATHOPHYSIOLOGY OF PAIN MANAGEMENT AT A DNA LEVEL, MODIFYING PERCEIVED PAIN RELIEF. IN THIS REVIEW, WE PROVIDE A BRIEF OVERVIEW OF EPIGENETICS OF PAIN, SYSTEMIC LOCAL ANESTHETICS AND NEURAXIAL TECHNIQUES THAT CONTINUE TO REMAIN USEFUL FOR SPINAL SURGERY, NEUROPATHIC AGENTS, AS WELL AS OTHER COMMON AND LESS COMMON TARGET RECEPTORS FOR A TRULY MULTIMODAL APPROACH TO PERIOPERATIVE PAIN MANAGEMENT. 2019 8 255 25 ADVANCES IN MYELOFIBROSIS: A CLINICAL CASE APPROACH. PRIMARY MYELOFIBROSIS IS A MEMBER OF THE MYELOPROLIFERATIVE NEOPLASMS, A DIVERSE GROUP OF BONE MARROW MALIGNANCIES. SYMPTOMS OF MYELOFIBROSIS, PARTICULARLY THOSE ASSOCIATED WITH SPLENOMEGALY (ABDOMINAL DISTENTION AND PAIN, EARLY SATIETY, DYSPNEA, AND DIARRHEA) AND CONSTITUTIONAL SYMPTOMS, REPRESENT A SUBSTANTIAL BURDEN TO PATIENTS. MOST PATIENTS EVENTUALLY DIE FROM THE DISEASE, WITH A MEDIAN SURVIVAL RANGING FROM APPROXIMATELY 5-7 YEARS. MUTATIONS IN JANUS KINASE 2 (JAK2), A KINASE THAT IS ESSENTIAL FOR THE NORMAL DEVELOPMENT OF ERYTHROCYTES, GRANULOCYTES, AND PLATELETS, NOTABLY THE V617F MUTATION, HAVE BEEN IDENTIFIED IN APPROXIMATELY 50% OF PATIENTS WITH MYELOFIBROSIS. THE APPROVAL OF A JAK2 INHIBITOR IN 2011 HAS IMPROVED THE OUTLOOK OF MANY PATIENTS WITH MYELOFIBROSIS AND HAS CHANGED THE TREATMENT LANDSCAPE. THIS ARTICLE FOCUSES ON SOME OF THE IMPORTANT ISSUES IN CURRENT MYELOFIBROSIS TREATMENT MANAGEMENT, INCLUDING DIFFERENTIATION OF MYELOFIBROSIS FROM ESSENTIAL THROMBOCYTHEMIA AND POLYCYTHEMIA VERA, UP-DATED DATA ON THE RESULTS OF JAK2 INHIBITOR THERAPY, THE ROLE OF EPIGENETIC MECHANISMS IN MYELOFIBROSIS PATHOGENESIS, INVESTIGATIONAL THERAPIES FOR MYELOFIBROSIS, AND ADVANCES IN HEMATOPOIETIC STEM CELL TRANSPLANT. THREE MYELOFIBROSIS CASES ARE INCLUDED TO UNDERSCORE THE ISSUES IN DIAGNOSING AND TREATING THIS COMPLEX DISEASE. 2013 9 4759 28 NOVEL TREATMENTS FOR MYELOFIBROSIS: BEYOND JAK INHIBITORS. MYELOFIBROSIS IS A CHRONIC HEMATOLOGIC MALIGNANCY CHARACTERIZED BY CONSTITUTIONAL SYMPTOMS, BONE MARROW FIBROSIS, EXTRAMEDULLARY HEMATOPOIESIS RESULTING IN SPLENOMEGALY AND A PROPENSITY TOWARD LEUKEMIC PROGRESSION. GIVEN THE CENTRAL ROLE OF THE JAK-STAT PATHWAY IN THE PATHOBIOLOGY OF MYELOFIBROSIS, JAK INHIBITORS ARE THE MAINSTAY OF CURRENT PHARMACOLOGIC MANAGEMENT. ALTHOUGH THESE THERAPIES HAVE PRODUCED MEANINGFUL IMPROVEMENTS IN SPLENOMEGALY AND SYMPTOM BURDEN, JAK INHIBITORS DO NOT SIGNIFICANTLY IMPACT DISEASE PROGRESSION. IN ADDITION, MANY PATIENTS ARE INELIGIBLE BECAUSE OF DISEASE-RELATED CYTOPENIAS, WHICH ARE EXACERBATED BY JAK INHIBITORS. THEREFORE, THERE IS A CONTINUED EFFORT TO IDENTIFY TARGETS OUTSIDE THE JAK-STAT PATHWAY. IN THIS REVIEW, WE DISCUSS NOVEL THERAPIES IN DEVELOPMENT FOR MYELOFIBROSIS. WE FOCUS ON THE PRECLINICAL RATIONALE, EFFICACY AND SAFETY DATA FOR NON-JAK INHIBITOR THERAPIES THAT HAVE PUBLISHED OR PRESENTED CLINICAL DATA. SPECIFICALLY, WE DISCUSS AGENTS THAT TARGET EPIGENETIC MODIFICATION (PELABRESIB, BOMEDEMSTAT), APOPTOSIS (NAVITOCLAX, NAVTEMDALIN), SIGNALING PATHWAYS (PARSACLISIB), BONE MARROW FIBROSIS (AVID200, PRM-151), IN ADDITION TO OTHER TARGETS INCLUDING TELOMERASE (IMETELSTAT), SELECTIVE INHIBITOR OF NUCLEAR TRANSPORT (SELINEXOR), CD123 (TAGRAXOFUSP) AND ERYTHROID MATURATION (LUSPATERCEPT). WE END BY PROVIDING COMMENTARY ON THE ONGOING AND FUTURE THERAPEUTIC DEVELOPMENT IN MYELOFIBROSIS. 2022 10 4615 30 NERVE INJURY DIMINISHES OPIOID ANALGESIA THROUGH LYSINE METHYLTRANSFERASE-MEDIATED TRANSCRIPTIONAL REPRESSION OF MU-OPIOID RECEPTORS IN PRIMARY SENSORY NEURONS. THE MU-OPIOID RECEPTOR (MOR, ENCODED BY OPRM1) AGONISTS ARE THE MAINSTAY ANALGESICS FOR TREATING MODERATE TO SEVERE PAIN. NERVE INJURY CAUSES DOWN-REGULATION OF MORS IN THE DORSAL ROOT GANGLION (DRG) AND DIMINISHES THE OPIOID EFFECT ON NEUROPATHIC PAIN. HOWEVER, THE EPIGENETIC MECHANISMS UNDERLYING THE DIMINISHED MOR EXPRESSION CAUSED BY NERVE INJURY ARE NOT CLEAR. G9A (ENCODED BY EHMT2), A HISTONE 3 AT LYSINE 9 METHYLTRANSFERASE, IS A KEY CHROMATIN REGULATOR RESPONSIBLE FOR GENE SILENCING. IN THIS STUDY, WE DETERMINED THE ROLE OF G9A IN DIMINISHED MOR EXPRESSION AND OPIOID ANALGESIC EFFECTS IN ANIMAL MODELS OF NEUROPATHIC PAIN. WE FOUND THAT NERVE INJURY IN RATS INDUCED A LONG-LASTING REDUCTION IN THE EXPRESSION LEVEL OF MORS IN THE DRG BUT NOT IN THE SPINAL CORD. NERVE INJURY CONSISTENTLY INCREASED THE ENRICHMENT OF THE G9A PRODUCT HISTONE 3 AT LYSINE 9 DIMETHYLATION IN THE PROMOTER OF OPRM1 IN THE DRG. G9A INHIBITION OR SIRNA KNOCKDOWN FULLY REVERSED MOR EXPRESSION IN THE INJURED DRG AND POTENTIATED THE MORPHINE EFFECT ON PAIN HYPERSENSITIVITY INDUCED BY NERVE INJURY. IN MICE LACKING EHMT2 IN DRG NEURONS, NERVE INJURY FAILED TO REDUCE THE EXPRESSION LEVEL OF MORS AND THE MORPHINE EFFECT. IN ADDITION, G9A INHIBITION OR EHMT2 KNOCKOUT IN DRG NEURONS NORMALIZED NERVE INJURY-INDUCED REDUCTION IN THE INHIBITORY EFFECT OF THE OPIOID ON SYNAPTIC GLUTAMATE RELEASE FROM PRIMARY AFFERENT NERVES. OUR FINDINGS INDICATE THAT G9A CONTRIBUTES CRITICALLY TO TRANSCRIPTIONAL REPRESSION OF MORS IN PRIMARY SENSORY NEURONS IN NEUROPATHIC PAIN. G9A INHIBITORS MAY BE USED TO ENHANCE THE OPIOID ANALGESIC EFFECT IN THE TREATMENT OF CHRONIC NEUROPATHIC PAIN. 2016 11 4681 21 NEW OPTIONS IN THE TREATMENT OF MYELODYSPLASTIC SYNDROME. MYELODYSPLASTIC SYNDROME (MDS) IS A HETEROGENEOUS GROUP OF PROGRESSIVE CHRONIC HEMATOPOIETIC DISORDERS, USUALLY PRESENTING AS REFRACTORY ANEMIA OR CYTOPENIA, WITH AN APPROXIMATELY 25% RISK OF PROGRESSION TOWARD ACUTE MYELOID LEUKAEIMA (AML), AND NO PROVEN CURATIVE TREATMENT. NOVEL BIOLOGICAL TREATMENT STRATEGIES TARGETING BOTH THE MALIGNANT BLOOD CELL AND ITS MICROENVIRONMENT CAN OVERCOME RESISTANCE TO CURRENT THERAPIES, AND REPRESENT A PROMISING TREATMENT PARADIGM FOR IMPROVING PATIENT OUTCOME. MANY OF THESE AGENTS HAVE MULTIPLE BIOLOGIC ACTIVITIES. THE OBJECTIVE OF THIS ARTICLE IS TO PRESENT A COMPARATIVE REVIEW OF CLASSIFICATION SYSTEMS IN MDS AND TO DISCUSS THE EVOLVING TRENDS IN THE TREATMENT OF MDS (IMMUNOSUPPRESIVE THERAPY, IMMUNOMODULATORY DRUGS, ARSENIC TRIOXIDE, PROTEASOME INHIBITORS, EPIGENETIC THERAPY). 2005 12 958 25 CHRONIC MYELOMONOCYTIC LEUKEMIA - A REVIEW. INTRODUCTION: CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML) IS A CLONAL MYELOID NEOPLASM, DENOTED BY OVERLAPPING MYELODYSPLASTIC AND MYELOPROLIFERATIVE FEATURES, WITH POOR OVERALL SURVIVAL AND HIGH TRANSFORMATION RATE TO ACUTE MYELOID LEUKEMIA. AREAS COVERED: THIS REVIEW, FOLLOWING A THOROUGH MEDLINE SEARCH OF PERTINENT PUBLISHED LITERATURE, DISCUSSES THE DIAGNOSTIC CRITERIA, THE PATHOGENESIS, AND THE COMPLEX GENETIC LANDSCAPE OF THE DISEASE. PROGNOSTICATION, RESPONSE CRITERIA, THERAPEUTIC MANAGEMENT OF PATIENTS, EFFICACY OF ESTABLISHED AND NOVEL TREATMENT MODALITIES ARE THOROUGHLY REVIEWED. EXPERT OPINION: CYTOGENETIC ABNORMALITIES AND MUTATIONS IN GENES INVOLVED IN EPIGENETIC AND TRANSCRIPTIONAL REGULATION, AND CELL-SIGNALING ARE ABUNDANT IN CMML AND IMPLICATED IN ITS COMPLEX PATHOGENESIS. AS PRESENCE OF THESE MUTATIONS CARRY A PROGNOSTIC IMPACT, THEY ARE INCREASINGLY INCORPORATED IN RISK-STRATIFICATION SCHEMES. NOVEL RESPONSE CRITERIA HAVE BEEN PROPOSED, CONSIDERING THE UNIQUE FEATURES OF THE DISEASE. ALTHOUGH ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION REMAINS THE ONLY TREATMENT WITH CURATIVE INTENT, IT IS RESERVED FOR A MINORITY OF PATIENTS; THEREFORE, THERE IS AN UNMET NEED FOR OPTIMIZING TREATMENT MODALITIES, SUCH AS HYPOMETHYLATING AGENTS, AND INTRODUCING NOVEL AGENTS, WHICH COULD SUBSTANTIALLY IMPROVE SURVIVAL AND QUALITY OF LIFE OF CMML PATIENTS. CLINICAL TRIALS DEDICATED SPECIFICALLY TO CMML ARE NEEDED TO EXPLORE THE EFFICACY AND SAFETY OF NOVEL TREATMENT MODALITIES. 2021 13 5039 40 PHARMACOGENETICS OF CHRONIC PAIN MANAGEMENT. OBJECTIVE: THE EXPERIENCE OF CHRONIC PAIN IS ONE OF THE COMMONEST REASONS INDIVIDUALS SEEK MEDICAL ATTENTION, MAKING THE MANAGEMENT OF CHRONIC PAIN A MAJOR ISSUE IN CLINICAL PRACTICE. DRUG METABOLISM AND RESPONSES ARE AFFECTED BY MANY FACTORS, WITH GENETIC VARIATIONS OFFERING ONLY A PARTIAL EXPLANATION OF AN INDIVIDUAL'S RESPONSE. THERE IS A PAUCITY OF EVIDENCE FOR THE BENEFITS OF PHARMACOGENETIC TESTING IN THE CONTEXT OF PAIN MANAGEMENT. DESIGN AND METHODS: WE REVIEWED THE LITERATURE BETWEEN 2000 AND 2013, AND REFERENCES CITED THEREIN, USING VARIOUS KEYWORDS RELATED TO PAIN MANAGEMENT, PHARMACOLOGY AND PHARMACOGENETICS. RESULTS: OPIOIDS CONTINUE TO BE THE MAINSTAY OF CHRONIC PAIN MANAGEMENT. SEVERAL NON-OPIOID BASED THERAPIES, SUCH AS TREATMENT WITH CANNABINOIDS, GENE THERAPY AND EPIGENETIC-BASED APPROACHES ARE NOW AVAILABLE FOR THESE PATIENTS. ADJUVANT THERAPIES WITH ANTIDEPRESSANTS, BENZODIAZEPINES OR ANTICONVULSANTS CAN ALSO BE USEFUL IN MANAGING PAIN. CURRENTLY, LABORATORY MONITORING OF PAIN MANAGEMENT PATIENTS, IF PERFORMED, IS LARGELY THROUGH URINE DRUG MEASUREMENTS. CONCLUSIONS: DRUG HALF-LIFE CALCULATIONS CAN BE USED AS FUNCTIONAL MARKERS OF THE CUMULATIVE EFFECT OF PHARMACOGENETICS AND DRUG-DRUG INTERACTIONS. ASSESSMENT OF HALF-LIFE AND THERAPEUTIC EFFECTS MAY BE MORE USEFUL THAN GENETIC TESTING IN PREVENTING ADVERSE DRUG REACTIONS TO PAIN MEDICATIONS, WHILE ENSURING EFFECTIVE ANALGESIA. DEFINITIVE, MASS SPECTROMETRY-BASED METHODS, CAPABLE OF MEASURING PARENT DRUG AND METABOLITE LEVELS, ARE THE MOST USEFUL ASSAYS FOR THIS PURPOSE. URINE DRUG MEASUREMENTS DO NOT NECESSARILY CORRELATE WITH SERUM DRUG CONCENTRATIONS OR THERAPEUTIC EFFECTS. THEREFORE, THEY ARE LIMITED IN THEIR USE IN MONITORING EFFICACY AND TOXICITY. 2014 14 2363 37 EPIGENETIC REGULATION OF SPINAL CORD GENE EXPRESSION CONTRIBUTES TO ENHANCED POSTOPERATIVE PAIN AND ANALGESIC TOLERANCE SUBSEQUENT TO CONTINUOUS OPIOID EXPOSURE. BACKGROUND: OPIOIDS HAVE BECOME THE MAINSTAY FOR TREATMENT OF MODERATE TO SEVERE PAIN AND ARE COMMONLY USED TO TREAT SURGICAL PAIN. WHILE OPIOID ADMINISTRATION HAS BEEN SHOWN TO CAUSE OPIOID-INDUCED HYPERALGESIA AND TOLERANCE, INTERACTIONS BETWEEN OPIOID ADMINISTRATION AND SURGERY WITH RESPECT TO THESE PROBLEMATIC ADAPTATIONS HAVE SCARCELY BEEN ADDRESSED. ACCUMULATING EVIDENCE SUGGESTS OPIOIDS AND NOCICEPTIVE SIGNALING MAY CONVERGE ON EPIGENETIC MECHANISMS IN SPINAL CORD TO ENHANCE OR PROLONG NEUROPLASTIC CHANGES. EPIGENETIC REGULATION OF BDNF (BRAIN-DERIVED NEUROTROPHIC FACTOR) AND PDYN (PRODYNORPHIN) GENES MAY BE INVOLVED. RESULTS: FOUR DAYS OF ASCENDING DOSES OF MORPHINE TREATMENT CAUSED OPIOID-INDUCED HYPERALGESIA AND REDUCED OPIOID ANALGESIC EFFICACY IN MICE. BOTH OPIOID-INDUCED HYPERALGESIA AND THE REDUCED OPIOID ANALGESIC EFFICACY WERE ENHANCED IN MICE THAT RECEIVED HINDPAW INCISIONS. THE EXPRESSION OF BDNF AND PDYN (QPCR) WAS INCREASED AFTER MORPHINE TREATMENT AND INCISION. CHROMATIN IMMUNOPRECIPITATION ASSAYS DEMONSTRATED THAT THE PDYN AND BDNF PROMOTERS WERE MORE STRONGLY ASSOCIATED WITH ACETYLATED H3K9 AFTER MORPHINE PLUS INCISION THAN IN THE MORPHINE OR INCISION ALONE GROUPS. SELECTIVE TROPOMYOSIN-RELATED KINASE B (ANA-12) AND KAPPA-OPIOID RECEPTOR (NOR-BINALTORPHIMINE) ANTAGONISTS WERE ADMINISTERED INTRATHECALLY, BOTH REDUCED HYPERALGESIA ONE OR THREE DAYS AFTER SURGERY. ADMINISTRATION OF ANA-12 OR NOR-BINALTORPHIMINE ATTENUATED THE DECREASED MORPHINE ANALGESIC EFFICACY ON DAY 1, BUT ONLY NOR-BINALTORPHIMINE WAS EFFECTIVE ON DAY 3 AFTER INCISION IN OPIOID-EXPOSED GROUP. COADMINISTRATION OF HISTONE ACETYLTRANSFERASE INHIBITOR ANACARDIC ACID DAILY WITH MORPHINE BLOCKED THE DEVELOPMENT OF OPIOID-INDUCED HYPERALGESIA AND ATTENUATED INCISION-ENHANCED HYPERALGESIA IN MORPHINE-TREATED MICE. ANACARDIC ACID HAD SIMILAR EFFECTS ON ANALGESIC TOLERANCE, SHOWING THE INVOLVEMENT OF HISTONE ACETYLATION IN THE INTERACTIONS DETECTED. CONCLUSIONS: SPINAL EPIGENETIC CHANGES INVOLVING BDNF AND PDYN MAY CONTRIBUTE TO THE ENHANCED POSTOPERATIVE NOCICEPTIVE SENSITIZATION AND ANALGESIC TOLERANCE OBSERVED AFTER CONTINUOUS OPIOID EXPOSURE. TREATMENTS BLOCKING THE EPIGENETICALLY MEDIATED UP-REGULATION OF THESE GENES OR ADMINISTRATION OF TRKB OR KAPPA-OPIOID RECEPTOR ANTAGONISTS MAY IMPROVE THE CLINICAL UTILITY OF OPIOIDS, PARTICULARLY AFTER SURGERY. 2016 15 1242 33 CURRENT AND NOVEL THERAPEUTIC APPROACHES IN MYELODYSPLASTIC SYNDROMES. MYELODYSPLASTIC SYNDROMES (MDS) ARE A HETEROGENEOUS GROUP OF HEMATOLOGIC NEOPLASMS WITH AN ANNUAL INCIDENCE OF 4.1 CASES PER 100,000 AMERICANS. PATIENTS WITH MDS SUFFER FROM CHRONIC CYTOPENIAS THAT MAY LEAD TO RECURRENT TRANSFUSIONS, INFECTIONS, AND INCREASED RISK FOR BLEEDING. THEY ARE ALSO AT RISK FOR PROGRESSION TO ACUTE MYELOID LEUKEMIA. ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION IS THE ONLY POTENTIALLY CURATIVE TREATMENT FOR MDS, ALTHOUGH 3 DRUGS HAVE BEEN APPROVED BY THE US FOOD AND DRUG ADMINISTRATION FOR ITS TREATMENT: LENALIDOMIDE, 5-AZACITIDINE, AND DECITABINE. THESE THERAPIES CAN BE EFFECTIVE IN THE RELIEF OF CYTOPENIAS, ACHIEVEMENT OF CYTOGENETIC REMISSIONS, AND REDUCTION IN BONE MARROW BLASTS. 5-AZACITIDINE HAS ALSO BEEN SHOWN TO IMPROVE OVERALL SURVIVAL. HOWEVER, THERE REMAIN MANY UNMET NEEDS IN THE TREATMENT OF MDS. BREAKTHROUGHS IN OUR UNDERSTANDING OF THE COMPLEX PATHOGENESIS OF MDS THROUGH EPIGENETIC, GENETIC, IMMUNOLOGIC, AND OTHER BIOLOGICAL MECHANISMS HAVE ALLOWED US TO DEVELOP NEW THERAPEUTIC STRATEGIES THAT CAN LEAD TO IMPROVEMENTS IN OUTCOMES IN MDS. IN THIS REVIEW, WE AIM TO PROVIDE AN OVERVIEW OF THE EVOLUTION IN CLASSIFCATION AND RISK STRATIFCATION IN MDS AND TO ILLUSTRATE HOW WE CAN USE THIS TO GUIDE US IN TAILORING THERAPEUTIC CHOICES IN THIS DISEASE. RESPONSES AND OUTCOMES RELATED TO COM MONLY USED MDS THERAPIES WILL BE DISCUSSED TOGETHER WITH NOVEL THERAPIES THAT HAVE EVOLVED WITH THE IMPROVED UNDERSTANDING OF MDS PATHOPHYSIOLOGY. 2014 16 1744 31 EARLY LIFE ADVERSE ENVIRONMENTAL EXPOSURES INCREASE THE RISK OF UTERINE FIBROID DEVELOPMENT: ROLE OF EPIGENETIC REGULATION. UTERINE FIBROIDS [UF(S), AKA: LEIOMYOMA] ARE THE MOST IMPORTANT BENIGN NEOPLASTIC THREAT TO WOMEN'S HEALTH. THEY ARE THE MOST COMMON CAUSE OF HYSTERECTOMY IMPOSING UNTOLD PERSONAL CONSEQUENCES AND 100S OF BILLIONS OF HEALTHCARE DOLLARS, WORLDWIDE. CURRENTLY, THERE IS NO LONG TERM EFFECTIVE FDA-APPROVED MEDICAL TREATMENT AVAILABLE, AND SURGERY IS THE MAINSTAY. THE ETIOLOGY OF UFS IS NOT FULLY UNDERSTOOD. IN THIS REGARD, WE AND OTHERS HAVE RECENTLY REPORTED THAT SOMATIC MUTATIONS IN THE GENE ENCODING THE TRANSCRIPTIONAL MEDIATOR SUBUNIT MED12 ARE FOUND TO OCCUR AT A HIGH FREQUENCY ( APPROXIMATELY 85%) IN UFS. UFS LIKELY ORIGINATE WHEN A MED12 MUTATION OCCURS IN A MYOMETRIAL STEM CELL CONVERTING IT INTO A TUMOR-FORMING STEM CELL LEADING TO A CLONAL FIBROID LESION. ALTHOUGH THE MOLECULAR ATTRIBUTES UNDERLYING THE MECHANISTIC FORMATION OF UFS IS LARGELY UNKNOWN, A GROWING BODY OF LITERATURE IMPLICATES UNFAVORABLE EARLY LIFE ENVIRONMENTAL EXPOSURES AS POTENTIALLY IMPORTANT CONTRIBUTORS. EARLY LIFE EXPOSURE TO EDCS DURING SENSITIVE WINDOWS OF DEVELOPMENT CAN REPROGRAM NORMAL PHYSIOLOGICAL RESPONSES AND ALTER DISEASE SUSCEPTIBILITY LATER IN LIFE. NEONATAL EXPOSURE TO THE EDCS SUCH AS DIETHYLSTILBESTROL (DES) AND GENISTEIN DURING REPRODUCTIVE TRACT DEVELOPMENT HAS BEEN SHOWN TO INCREASE THE INCIDENCE, MULTIPLICITY AND OVERALL SIZE OF UFS IN THE EKER RAT MODEL, CONCOMITANTLY REPROGRAMMING ESTROGEN-RESPONSIVE GENE EXPRESSION. IMPORTANTLY, EDC EXPOSURE REPRESSES ENHANCER OF ZESTE 2 (EZH2) AND REDUCES LEVELS OF HISTONE 3 LYSINE 27 TRIMETHYLATION (H3K27ME3) REPRESSIVE MARK THROUGH ESTROGEN RECEPTOR/PHOSPHATIDYLINOSITIDE 3-KINASES/PROTEIN KINASE B NON-GENOMIC SIGNALING IN THE DEVELOPING UTERUS. CONSIDERING THE FACT THAT DISTINCT MEDIATOR COMPLEX SUBUNIT 12 (MED12) MUTATIONS ARE DETECTED IN DIFFERENT FIBROID LESIONS IN THE SAME UTERUS, THE EMERGENCE OF EACH MED12 MUTATION IS LIKELY AN INDEPENDENT EVENT IN AN ALTERED MYOMETRIAL STEM CELL. IT IS THEREFORE POSSIBLE THAT A CHRONIC REDUCTION IN DNA REPAIR CAPACITY EVENTUALLY CAUSES THE EMERGENCE OF MUTATIONS SUCH AS MED12 IN MYOMETRIAL STEM CELLS CONVERTING THEM INTO FIBROID TUMOR-FORMING STEM CELLS, AND THEREBY LEADS TO THE DEVELOPMENT OF UFS. ADVANCING OUR UNDERSTANDING OF THE MECHANISTIC ROLE EPIGENETIC REGULATION OF STEM CELLS PLAYS IN MEDIATING RISK AND TUMORIGENESIS WILL HELP IN POINTING THE WAY TOWARD THE DEVELOPMENT OF NOVEL THERAPEUTIC OPTIONS. 2016 17 5799 23 STEPPING OUT OF ANTIQUITY: AN UPDATE ON EMERGING DRUGS FOR THE TREATMENT OF POLYCYTHEMIA VERA. INTRODUCTION: POLYCYTHEMIA VERA IS A CHRONIC HEMATOLOGIC MALIGNANCY FREQUENTLY PRESENTED WITH CONSTITUTIONAL SYMPTOMS AND ASSOCIATED WITH AN INCREASED RISK OF THROMBOSIS, HEMORRHAGE, AND PROGRESSION TO MYELOFIBROSIS OR ACUTE MYELOID LEUKEMIA. CURRENT TREATMENT STRATEGIES REDUCE THROMBOHEMORRHAGIC RISK BY CONTROLLING BLOOD COUNTS AND INHIBITING PLATELETS, BUT OFTEN FAIL TO ADDRESS DISEASE-RELATED SYMPTOMS OR BIOLOGICALLY MODIFY THE DISEASE.AREAS COVERED: WE REVIEW THE CURRENT PARADIGM FOR TREATING POLYCYTHEMIA VERA, HIGHLIGHT AREAS OF UNMET NEED, REVIEW THERAPEUTIC AGENTS IN LATE STAGE CLINICAL DEVELOPMENT, AND PROVIDE AN OVERARCHING VIEW OF HOW THESE EMERGING AGENT MAY FIT INTO THE FUTURE ARMAMENTARIUM OF POLYCYTHEMIA VERA TREATMENTS.EXPERT OPINION: THE SHIFT FROM FOCUSING SOLELY ON SECONDARY PREVENTION OF THROMBOHEMORRHAGIC EVENTS TO A COMPREHENSIVE TREATMENT STRATEGY THAT ADDITIONALLY AIMS TO IMPROVE QUALITY OF LIFE AND PREVENT DISEASE PROGRESSION HAS RESULTED IN A RAPIDLY EVOLVING THERAPEUTIC LANDSCAPE THAT PROMISES TO MOVE THE TREATMENT OF POLYCYTHEMIA VERA OUT OF ANTIQUITY INTO THE MODERN AGE. 2021 18 5249 30 PROGRAMMED CELL DEATH-1 PATHWAY INHIBITION IN MYELOID MALIGNANCIES: IMPLICATIONS FOR MYELOPROLIFERATIVE NEOPLASMS. MYELOPROLIFERATIVE NEOPLASMS (MPNS) ARE CLONAL HEMATOPOIETIC DISEASES THAT BELONG TO THE SPECTRUM OF MYELOID MALIGNANCIES (MYMS), WHICH ALSO INCLUDE MYELODYSPLASTIC SYNDROMES (MDS), ACUTE MYELOID LEUKEMIA (AML), AND CHRONIC MYELOGENOUS LEUKEMIA (CML). WHILE HEMATOPOIETIC STEM CELL TRANSPLANTATION (HSCT) IS A POTENTIALLY CURATIVE THERAPEUTIC APPROACH TO MANY MYMS, THE ASSOCIATED MORBIDITY AND MORTALITY HAVE NECESSITATED THE DEVELOPMENT OF NON-HSCT THERAPEUTICS FOR SYMPTOM MANAGEMENT AND DISEASE COURSE MODIFICATION. IMMUNE CHECKPOINT INHIBITION, IN PARTICULAR ALONG THE PROGRAMMED CELL DEATH PROTEIN 1 (PD-1)/B7-H1 (PD-L1) AXIS, IS AN ESTABLISHED STRATEGY IN SOLID TUMORS WITH POTENTIAL AS AN ADJUNCTIVE THERAPY IN HEMATOLOGIC MALIGNANCIES. SEMINAL STUDIES SUGGEST THAT THE PRO-INFLAMMATORY MICROENVIRONMENT OF MYMS CAN SUPPRESS T LYMPHOCYTE-MEDIATED IMMUNITY VIA PD-1 SIGNALING AND THAT RESPONSE TO MAINSTAY EPIGENETIC THERAPIES FOR MYMS MAY BE GOVERNED BY PD-1 GENE REGULATION. ALTHOUGH THE ROLE OF PD-1 SIGNALING IN MPN PATHOGENESIS AND PROGRESSION IS AS YET UNCLEAR, RESEARCH IN MPN PATIENTS HAS REVEALED EXPANSION OF MYELOID-DERIVED SUPPRESSOR CELLS (MDSCS), WHICH MAY EFFECT HOST IMMUNE TOLERANCE OF TUMOR VIA TEMPORALLY AND SPATIALLY SPECIFIC ACTIVATION OF PD-1/PD-L1 SIGNALING. THE CURRENT UNDERSTANDING OF IMMUNE DYSFUNCTION IN MPNS AND ANALOGOUS MYMS OFFERS A COMPELLING RATIONALE TO STUDY PD-1/PD-L1 INHIBITION IN PATIENTS AS A NOVEL TREATMENT OPTION. 2017 19 4618 34 NERVE INJURY-INDUCED EPIGENETIC SILENCING OF OPIOID RECEPTORS CONTROLLED BY DNMT3A IN PRIMARY AFFERENT NEURONS. OPIOIDS ARE THE GOLD STANDARD FOR PHARMACOLOGICAL TREATMENT OF NEUROPATHIC PAIN, BUT THEIR ANALGESIC EFFECTS ARE UNSATISFACTORY IN PART DUE TO NERVE INJURY-INDUCED DOWNREGULATION OF OPIOID RECEPTORS IN DORSAL ROOT GANGLIA (DRG) NEURONS. HOW NERVE INJURY DRIVES SUCH DOWNREGULATION REMAINS ELUSIVE. DNA METHYLTRANSFERASE (DNMT)-TRIGGERED DNA METHYLATION REPRESSES GENE EXPRESSION. WE SHOW HERE THAT BLOCKING THE NERVE INJURY-INDUCED INCREASE IN DRG DNMT3A (A DE NOVO DNMT) RESCUED THE EXPRESSION OF OPRM1 AND OPRK1 MRNAS AND THEIR RESPECTIVE ENCODING MU-OPIOID RECEPTOR (MOR) AND KAPPA-OPIOID RECEPTOR (KOR) PROTEINS IN THE INJURED DRG. BLOCKING THIS INCREASE ALSO PREVENTED THE NERVE INJURY-INDUCED INCREASE IN DNA METHYLATION IN THE PROMOTER AND 5'-UNTRANSLATED REGION OF THE OPRM1 GENE IN THE INJURED DRG, RESTORED MORPHINE OR LOPERAMIDE (A PERIPHERAL ACTING MOR PREFERRING AGONIST) ANALGESIC EFFECTS, AND ATTENUATED THE DEVELOPMENT OF THEIR ANALGESIC TOLERANCE UNDER NEUROPATHIC PAIN CONDITIONS. MIMICKING THIS INCREASE REDUCED THE EXPRESSION OF OPRM1 AND OPRK1 MRNAS AND THEIR CODING MOR AND KOR IN DRG AND AUGMENTED MOR-GATED NEUROTRANSMITTER RELEASE FROM THE PRIMARY AFFERENTS. MECHANISTICALLY, DNMT3A REGULATION OF OPRM1 GENE EXPRESSION REQUIRED THE METHYL-CPG-BINDING PROTEIN 1, MBD1, AS MBD1 KNOCKOUT RESULTED IN THE DECREASED BINDING OF DNMT3A TO THE OPRM1 GENE PROMOTER AND BLOCKED THE DNMT3A-TRIGGERED REPRESSION OF OPRM1 GENE EXPRESSION IN DRG NEURONS. THESE DATA SUGGEST THAT DNMT3A IS REQUIRED FOR NERVE INJURY-INDUCED AND MBD1-MEDIATED EPIGENETIC SILENCING OF THE MOR AND KOR IN THE INJURED DRG. DNMT3A INHIBITION MAY SERVE AS A PROMISING ADJUVANT THERAPY FOR OPIOID USE IN NEUROPATHIC PAIN MANAGEMENT. 2017 20 1311 27 DEFINITIONS, BIOLOGY, AND CURRENT THERAPEUTIC LANDSCAPE OF MYELODYSPLASTIC/MYELOPROLIFERATIVE NEOPLASMS. MYELODYSPLASTIC/MYELOPROLIFERATIVE NEOPLASMS (MDS/MPN) ARE HEMATOLOGICAL DISORDERS CHARACTERIZED BY BOTH PROLIFERATIVE AND DYSPLASTIC FEATURES. ACCORDING TO THE 2022 INTERNATIONAL CONSENSUS CLASSIFICATION (ICC), MDS/MPN CONSISTS OF CLONAL MONOCYTOSIS OF UNDETERMINED SIGNIFICANCE (CMUS), CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML), ATYPICAL CHRONIC MYELOID LEUKEMIA (ACML), MDS/MPN WITH SF3B1 MUTATION (MDS/MPN-T-SF3B1), MDS/MPN WITH RING SIDEROBLASTS AND THROMBOCYTOSIS NOT OTHERWISE SPECIFIED (MDS/MPN-RS-T-NOS), AND MDS/MPN-NOS. THESE DISORDERS EXHIBIT A DIVERSE RANGE OF GENETIC ALTERATIONS INVOLVING VARIOUS TRANSCRIPTION FACTORS (E.G., RUNX1), SIGNALING MOLECULES (E.G., NRAS, JAK2), SPLICING FACTORS (E.G., SF3B, SRSF2), AND EPIGENETIC REGULATORS (E.G., TET2, ASXL1, DNMT3A), AS WELL AS SPECIFIC CYTOGENETIC ABNORMALITIES (E.G., 8 TRISOMIES, 7 DELETIONS/MONOSOMIES). CLINICAL STUDIES EXPLORING THERAPEUTIC OPTIONS FOR HIGHER-RISK MDS/MPN OVERLAP SYNDROMES MOSTLY INVOLVE HYPOMETHYLATING AGENTS, BUT OTHER TREATMENTS SUCH AS LENALIDOMIDE AND TARGETED AGENTS SUCH AS JAK INHIBITORS AND INHIBITORS TARGETING PARP, HISTONE DEACETYLASES, AND THE RAS PATHWAY ARE UNDER INVESTIGATION. WHILE THESE TREATMENT MODALITIES CAN PROVIDE PARTIAL DISEASE CONTROL, ALLOGENEIC BONE MARROW TRANSPLANTATION (ALLO-BMT) IS THE ONLY POTENTIALLY CURATIVE OPTION FOR PATIENTS. IMPORTANT PROGNOSTIC FACTORS CORRELATING WITH OUTCOMES AFTER ALLO-BMT INCLUDE COMORBIDITIES, SPLENOMEGALY, KARYOTYPE ALTERATIONS, AND THE BONE MARROW BLASTS PERCENTAGE AT THE TIME OF TRANSPLANTATION. FUTURE RESEARCH IS IMPERATIVE TO OPTIMIZING THERAPEUTIC STRATEGIES AND ENHANCING PATIENT OUTCOMES IN MDS/MPN NEOPLASMS. IN THIS REVIEW, WE SUMMARIZE MDS/MPN DIAGNOSTIC CRITERIA, BIOLOGY, AND CURRENT AND FUTURE TREATMENT OPTIONS, INCLUDING BONE MARROW TRANSPLANTATION. 2023