|
1
|
Argentieri MA, Nagarajan S, Seddighzadeh B, Baccarelli AA, Shields AE. Epigenetic Pathways in Human Disease: The Impact of DNA Methylation on Stress-Related Pathogenesis and Current Challenges in Biomarker Development. EBioMedicine 2017; 18:327-350. [PMID: 28434943 PMCID: PMC5405197 DOI: 10.1016/j.ebiom.2017.03.044] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/06/2017] [Accepted: 03/28/2017] [Indexed: 01/30/2023] Open
Abstract
HPA axis genes implicated in glucocorticoid regulation play an important role in regulating the physiological impact of social and environmental stress, and have become a focal point for investigating the role of glucocorticoid regulation in the etiology of disease. We conducted a systematic review to critically assess the full range of clinical associations that have been reported in relation to DNA methylation of CRH, CRH-R1/2, CRH-BP, AVP, POMC, ACTH, ACTH-R, NR3C1, FKBP5, and HSD11β1/2 genes in adults. A total of 32 studies were identified. There is prospective evidence for an association between HSD11β2 methylation and hypertension, and functional evidence of an association between NR3C1 methylation and both small cell lung cancer (SCLC) and breast cancer. Strong associations have been reported between FKBP5 and NR3C1 methylation and PTSD, and biologically-plausible associations have been reported between FKBP5 methylation and Alzheimer's Disease. Mixed associations between NR3C1 methylation and mental health outcomes have been reported according to different social and environmental exposures, and according to varying gene regions investigated. We conclude by highlighting key challenges and future research directions that will need to be addressed in order to develop both clinically meaningful prognostic biomarkers and an evidence base that can inform public policy practice.
Collapse
Affiliation(s)
- M Austin Argentieri
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Suite 901, Boston, MA 02114, USA
| | - Sairaman Nagarajan
- Department of Pediatrics, State University of New York Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11218, USA
| | - Bobak Seddighzadeh
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Suite 901, Boston, MA 02114, USA
| | - Andrea A Baccarelli
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Suite 901, Boston, MA 02114, USA; Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W. 168th St., 11th Floor, New York, NY 10032, USA
| | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Suite 901, Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
| |
Collapse
|
|
2
|
Abstract
PURPOSE OF REVIEW This review will discuss issues arising along with the expanding use of hypomethylating treatment (HMT) in the management of acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS). RECENT FINDINGS HMT has been shown to induce responses in MDS and AML, and azacitidine (Vidaza, Celgene) has been shown to prolong survival in higher-risk MDS. Recent studies have supported the idea that disease stability may also be a treatment goal, whereas treatment interruption in responding patients is associated with rapid disease relapse and death. In AML, a modest but significant survival advantage has been shown for HMT by censoring patients at the time of subsequent AML therapy, but the major limitation remains the short duration of responses. Unfortunately, some of the strategies to overcome these limitations have failed, including the combination of HMT to histone-deacetylase inhibitors, which has not definitively shown to significantly prolong survival. Molecules interfering with other pathways impacting the survival and proliferation of blasts, used alone or in combination, including guadecitabine, selinexor, or inhibitors of IDH2 mutations, are more promising approaches. SUMMARY Hypomethylating drugs are the first successful treatment for elderly patients with higher-risk MDS and are effective for some AML subtypes. Translational studies will hopefully identify patients with a favorable profile of response to these drugs, and help to identify newer targets for combination treatments.
Collapse
|