Much work over the last two decades has firmly established that
loss of cell cycle checkpoint regulation, and resultant unabated
cellular proliferation, is an inherent characteristic of cancer.
This loss may occur through aberration in any single component
involved in signal transduction pathways that orchestrate
checkpoint regulation, which may manifest through either a failure
to activate the checkpoint or a failure to respond to the activated
checkpoint. In normal cells, checkpoint pathways are activated when
genetic or cellular homeostasis is compromised, and signals are
then transduced to re-stabilize homeostasis, and, failing this, to
activate the apoptotic machinery to induce a cellular suicidal
response. This implies that both survival and cell death pathways
are induced following checkpoint activation, and that the final
decision is dependant on the net result of integrating the two sets
of signals.
It is intriguing that checkpoint pathways are also critical in
cancer therapy to provide an apoptotic stimulus when cellular
damage induced by the therapeutic agent is detected by the sensor
system. Therefore, it is not surprising that failure in
pro-survival checkpoint response will render tumor cells
hypersensitive to cytotoxics and, conversely, failure in
pro-apoptotic checkpoint response will induce genetic instability
and/or therapeutic resistance. Understanding the intricacies of
checkpoint response is, therefore, central to the design of
therapeutic regimen that will enhance antitumor effects. Although
early versions of this design entail combination of cytotoxic
agents with cell cycle or checkpoint inhibitors, a greater
understanding of the concepts could make such combinations
clinically more effective. The contributions in this book will
consolidate the current state of knowledge on checkpoint responses
that may lay the foundation for hypothesis-driven rational
approaches in advancing the management of cancer.
The immediate attraction of the book to the scientific community
is that it represents a timely opportunity to build upon existing
concepts of checkpoints to expand our understanding of the inner
workings of the critical checkpoint machinery. The present
understanding has provided ample appreciation that response to
checkpoint activation is manifested through coordinated inhibition
of cyclin-dependent kinase (CDK) complexes in G1, S and/or the G2
phase in order to arrest the cell cycle. Kinase inhibition can
occur through several mechanisms, including inhibitory
phosphorylation of CDK, destruction of the cognate cyclins, and
recruitment of CDK inhibitors from the INK and WAF1/CIP1 families.
However, the wealth of information from recent discoveries needs to
be examined critically to consolidate our conceptual knowledge of
checkpoints. At the same time, there is acute awareness in the
diversity of checkpoint response between cytotoxic agents, and this
serves as a reminder of the magnitude of complexity that is
inherent in checkpoint regulation. This volume is intended to bring
the cancer research community closer toward an improved
understanding of this regulation, how checkpoint abnormalities can
impact negatively on cancer therapy, and emerging strategies to
target checkpoint response as a therapeutic end-point.
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