tumour angiogenesis Flashcards

1
Q

What are some characteristics of malignant tumour?

A
  1. growth - unlimited growth (not self-limited like in benign)
  2. invasiveness - migration of tumour to cells into the surrounding stroma.
  3. metastasis- spread of tumour from primary site to form secondary tumours at other sites.
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2
Q

What are key steps in cancer progression-sequential process of metastasis?

A
  1. Transformation : extensive mutagenic and epigentic changes followed by clonal selection
  2. Angiogenesis: new blood vessel formation (overcomes limitations imposed by hypoxia, lack of O2 would have killed the tumour)
  3. Motility and invasion: epithelial to mesenchymal transition (invasive properties allowing intravasation into circulation and extravasation from circulation to tissue)
  4. Metastasis: colonisation of target organs (ability to expand from micrometastases)
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3
Q

What is tumour angiogenesis?

A

-angiogenesis = formation of new blood vessels from pre existing vessels.

  • -small tumour eventually gets large and demands for O2 and nutrients increases
  • tumour switches on expression of angiogenic factors that initiate blood vessels growth
  • growth of new vessels around tumours, allow transport of O2 need for tumour to grow are called tumour angiogenesis.
  • it can shred and travel in blood to metastasis.
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4
Q

What is vasculogenesis?

A

formation of new blood vessels from progenitor cells.

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5
Q

What are good and bad types of angiogenesis?

A

Good

  1. developmental/ vasculogenesis
    - organ growth
  2. normal angiogenesis
    - wound repair
    - placenta during pregnancy

Bad

  1. pathological angiogenesis
    - tumour angiogenesis
    - ocular(eyes)
    - inflammatory disorders
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6
Q

How does hypoxia occur?

A
  • hypoxia is a strong stimulus for tumour angiogenesis
  • hypoxia <1% O2
  • increase with increasing distance from capillaries
  • activates transcription of genes involved in angiogenesis, tumour cell migration and metastasis
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7
Q

What are some angiogenic factors?

A
  1. Vascular endothelial growth factors (VEGF)
  2. fibroblast growth factor 2 (FGF 2)
  3. placental growth factor (PIGF)
  4. angiopoietin 2 (Ang 2)

these factors are secreted by tumour cells upon hypoxia
enzymes called matrix metalloproteinases also stimulate angiogenesis.

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8
Q

outline the vascular endothelial growth factor (VEGF)signalling?

A
  1. VEGF binds to its receptor on endothelial cells
  2. VEGF/VEGF -R2 dimerizes at the plasma membrane and recruits cofactors
  3. subsequently activate 3 major signal transduction pathways
  4. ultimately through these pathways VEGF activates cell survival, vascular permability, gene expression and cell proliferation
  5. all of these are essential for angiogenesis

++PIP2 for cell proliferation, PKB for cell survival and Ras/Raf for gene cell expression.

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9
Q

What is EMT?

A
  • epithelial to mesenchymal transition
  • EMT is a process by which epithelial cells

Lose:

  • epithelial shape and cell polarity (beta catnin, claudin-1)
  • cytokeratin intermediate filament expression
  • epithelial adherens junctions (E-cadherin)

Gain migratory and invasive properties:

  • fibroblast- like shape and motility
  • invasiveness
  • vimentin intermediate filament expression
  • mesenchymal gene expression (fibronectin, PDGF receptor, avb6 integrins)
  • protease secretion (MMP-2, MMP-9)
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10
Q

What are 3 epithelial markers essential for their structure, shape and cell polarity?

A
  1. E-cadherin
  2. beta -catenin
    3.claudin-1
    When these factors are down regulated , switch from epithelial -> mesenchymal
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11
Q

what are 3 mesenchymal markers?

A
  1. N-cadherin
    2.Vimentin
  2. fibronectin
    these factors are upregulated , swithc from epithelial ->mesenchymal
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12
Q

How do E-cadherins maintain cell adhesion and polarity of typical epithelial cells?

A
  • homotypic adhesion molecule (adhesion of cells with same cadherin) form dimers between cells.
  • calcium dependent
  • binds beta catenin
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13
Q

how does contact inhibition maintain monolayer in normal cells?

A

Normal cells:

  • when E cadherins bind two cells
  • contact inhibition prevents proliferation to maintain monolayer of normal cell.

Loss of E cadherin due to mutation:

  • loss of cadherin = loss of adhesion properties
  • distupted cell-cell adhesion/ contact
  • no contact inhibition
  • cells grow on top of each other.
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14
Q

How do stromal cell contribute to tumour progression?

A
  1. factors released by stromal cells (macrophages. mast cells, fibroblasts) include angiogenic factors, growth factors, cytokines, proteases.
  2. protease uPA factor activated by tumour cells converts plasminogen to plasmin
  3. plasmin activates matrix metalloproteinases (converts pro MMPs -> MMPs ), MMPs degrade extra cellular matrix (ECM) and release matrix -bound and angiogenic factors such as transforming growth factor -beta 1 (TGF- beta 1)
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15
Q

What is an example of protease factor released from stromal cells?

A

Urokinase-type plasminogen activator(uPA);

  • activated by tumour cells
  • resulting in plasmin production
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16
Q

what are steps involved in cancer dissemination?

A
  1. primary tumour formation
  2. localised invasion
  3. intravastion
  4. transport through circulation
  5. arrest in micro-vessels of various organs
  6. arrest in microvessels of various organs
  7. extravasation
  8. formation of a micrometastasis
  9. colonization - formation of a macrometastasis

=>The overall process is highly inefficient
-tumour cells can extravasate successfully (>80%)
but the last two steps are very inefficient (<0.2% of cells actually form micrometastases)

17
Q

What are common sites of metastasis?

A
  • breast cancer to liver, lung, brain , bone
  • colorectal cancer to colon
  • Gastric cancer to stomach and oesophagus
  • Lung (non-small cell) to adrenal gland
  • pancreatic to pancreas
  • prostate to prosatate
18
Q

What determines the pattern of tumour spread- mechanical hypothesis?

A

Mechanical hypothesis:
-anatomical consideration: blood and lymphatic systems entrapment in capillary beds (20- 30 micrometer carcinoma cell , 8 micrometer capillary bed)

19
Q

What determines the pattern of tumour spread- seed and soil hypothesis?

A
  • specific adhesions between tumour cells and endothelial cells in the target organ, creating a favourable environment in target organ for colonisation.
    Genetic alterations acquired during progression allow tumour spread.
20
Q

How can we use tumour angiogenesis, cell motility & invasion to inhibit cancer?

A
  1. tumour angiogenesis
    => success with targeted therapy to angiogenic factors like vascular endothelial growth factor
  2. cell motility
    => no success with targetting cell-cell adhesion molecules
  3. invasion
    =>all clinical trials with matrix metalloproteinases have been unsuccessful in reducing tumour burden

so only tumour angiogenesis therapy been successful

21
Q

What is the angiogenesis hypothesis of inhbiting tumour?

A
  • 1971- Judah Folkman
  • paradigm shift from targeting tumour itself to targeting vessels surrounding it.
  • both tumour and microvascular compartments (vessels around it) are therapeutic targets.
22
Q

What is an example of pathological angiogenesis?

A
  • kidney cancer

- renal cell carcinoma is a highly angiogenic and metastatic tumour

23
Q

What was first anti-angiogenic drug?

A

=> Avastin (Nepoleone Ferrara, 2013)
-aka bevacizumab
approved for corectal, lung, kidney and ovarian cancers and eye disease too.

24
Q

What is the mechanism of action of bevacizumab/avastin

A
  • Avastin is a monoclonal antibody that binds to VEGF
  • VEGF secreted by tumour binds to anti-VEGF antibody
  • this prevents VEGF binding to ligand binding site on receptor of endothelium cell
  • no downstream phosphorylation of receptor and downstream reactions
  • VEGF -signal transmission inhibited
  • so angiogenesis, progression, metastasis , survival inhibited.