Genomic analyses have become an important tool to identify new avenues for therapy. This is especially true for cancer types with extremely poor outcomes, since our lack of effective therapies offers no tangible clinical starting point to build upon. The highly malignant brain tumor glioblastoma (GBM) exemplifies such a refractory cancer, with only 15 month average patient survival. Analyses of several hundred GBM samples compiled by the TCGA (The Cancer Genome Atlas) have produced an extensive transcriptomic map, identified prevalent chromosomal alterations, and defined important driver mutations. Unfortunately, clinical trials based on these results have not yet delivered an improvement on outcome. It is, therefore, necessary to characterize other regulatory routes known for playing a role in tumor relapse and response to treatment. Alternative splicing affects more than 90% of the human coding genes and it is an important source for transcript variation and gene regulation. Mutations and alterations in splicing factors are highly prevalent in multiple cancers, demonstrating the potential for splicing to act as a tumor driver. As a result, numerous genes are expressed as cancer-specific splicing isoforms that are functionally distinct from the canonical isoforms found in normal tissue. These include genes that regulate cancer-critical pathways such as apoptosis, DNA repair, cell proliferation, and migration. Splicing defects can even induce genomic instability, a common characteristic of cancer, and a driver of tumor evolution. Importantly, components of the splicing machinery are targetable; multiple drugs can inhibit splicing factors or promote changes in splicing which could be exploited to begin improving clinical outcomes. Here, we review the current literature and present a case for exploring RNA processing as therapeutic route for the treatment of GBM.

译文

基因组分析已成为识别治疗新途径的重要工具。对于结局极差的癌症类型尤其如此,因为我们缺乏有效的治疗方法,无法提供任何切实可行的临床起点。高度恶性的脑肿瘤胶质母细胞瘤(GBM)就是这种难治性癌症的例证,患者平均存活仅15个月。由TCGA(癌症基因组图谱)汇编的数百个GBM样品的分析已产生了广泛的转录组图谱,确定了普遍的染色体改变,并定义了重要的驱动程序突变。不幸的是,基于这些结果的临床试验尚未改善预后。因此,必须表征已知在肿瘤复发和对治疗的反应中起作用的其他调节途径。选择性剪接影响超过90%的人类编码基因,它是转录本变异和基因调控的重要来源。剪接因子的突变和改变在多种癌症中非常普遍,证明了剪接作为肿瘤驱动因子的潜力。结果,许多基因被表达为癌症特异性剪接同工型,其功能与正常组织中发现的典型同工型不同。这些基因包括调控癌症关键通路的基因,例如凋亡,DNA修复,细胞增殖和迁移。剪接缺陷甚至可能导致基因组不稳定,这是癌症的共同特征,也是肿瘤发展的驱动力。重要的是,拼接机的组件是可定位的;多种药物可抑制剪接因子或促进剪接变化,这些变化可被用来开始改善临床结果。在这里,我们回顾当前的文献,并提出了探索RNA加工作为治疗GBM的治疗途径的案例。

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