Multiple myeloma: the bone marrow microenvironment and its relation to treatment.

Multiple myeloma is the most common haematological malignancy yet currently it remains incurable. For decades the mainstay in therapy has been non-targeted approaches including genotoxic agents and immunosuppressants. With myeloma predominantly affecting an elderly population, who are vulnerable to aggressive therapy, these non-specific approaches have resulted in poor survival. However, in recent years an explosion of collaborative research into myeloma has identified molecular interactions between myeloma cells and the bone marrow microenvironment as promoting myeloma development and associated complications such as bone lesions due to osteolysis. At the same time, a better understanding of the adhesion molecules, cytokines and signalling pathways involved in myeloma has led to the development of new targeted therapies, which are improving the quality of life for patients and significantly extending median patient survival. This review explores the current understanding of molecular pathways that promote myeloma progression and lead to bone destruction, with particular reference to the influence of interactions with the bone marrow microenvironment. It describes molecular targets for therapy with reference to the new therapeutics and their improved efficacy. While the outlook for myeloma patients has improved in recent years as a result of these new approaches, drug resistance remains a problem and future therapies will also need to address the molecular mechanisms of resistance in order to improve further the outcome for patients with this disease.

DNA damage repair and tolerance: a role in chemotherapeutic drug resistance.

A significant barrier to effective cancer therapy is the development of resistance to the drugs utilised. Standard chemotherapeutic regimens typically contain genotoxic agents, designed to damage DNA of existing tumour cells as well as prevent the synthesis of new DNA during proliferation. DNA damage in normal cells can be repaired efficiently or tolerated to preserve cellular and organ functionality. The mechanisms of DNA repair and tolerance are distinct for different types of lesion, but can be predicted if the mechanism of interaction of the drug with the DNA is known. There is now evidence in solid tumours to suggest that increased repair or tolerance of DNA lesions may contribute to the ability of the cancer cell to survive in high genotoxic stress environments afforded by the therapy. This review will explore the current understanding of drug resistance mechanisms to chemotherapy, but will focus on the new evidence for tolerance and repair, including some new data from the authors' laboratory on the haematological malignancy multiple myeloma. The review will focus particularly on the role of the 'specialised polymerases' which have flexible active sites capable of accommodating DNA lesions, allowing replication past the lesion by translesion synthesis and tolerance of the damage, which ultimately results in a phenotype of drug resistance.

Toxicity testing: the search for an in vitro alternative to animal testing.

Prior to introduction to the clinic, pharmaceuticals must undergo rigorous toxicity testing to ensure their safety. Traditionally, this has been achieved using in vivo animal models. However, besides ethical reasons, there is a continual drive to reduce the number of animals used for this purpose due to concerns such as the lack of concordance seen between animal models and toxic effects in humans. Adequate testing to ensure any toxic metabolites are detected can be further complicated if the agent is administered in a prodrug form, requiring a source of cytochrome P450 enzymes for metabolism. A number of sources of metabolic enzymes have been utilised in in vitro models, including cell lines, primary human tissue and liver extracts such as S9. This review examines current and new in vitro models for toxicity testing, including a new model developed within the authors' laboratory utilising HepG2 liver spheroids within a co-culture system to examine the effects of chemotherapeutic agents on other cell types.

Induced heteroduplex genotyping of TNF-alpha, IL-1beta, IL-6 and IL-10 polymorphisms associated with transcriptional regulation.

We describe the construction and use of 7 induced heteroduplex generators, reagents for the rapid and unequivocal genotyping of nucleotide sequence polymorphism in TNF-alpha, IL-1beta, IL-6 and IL-10. Polymorphisms detected are those previously associated with regulation of gene transcription: TNF-alpha positions -308 and -238; IL-1beta position +3953; IL-6 position -174; and IL-10 positions -1082, -819 and -592. The reagents were used for analysis of allele and haplotype frequencies in a population of healthy Caucasian volunteer blood donors.

The identification and repair of DNA adducts induced by waterborne benzo[a]pyrene in developing Xenopus laevis larvae.

We report on the formation and subsequent repair of benzo[a]pyrene-induced DNA adducts in Xenopus laevis larvae in vivo, as monitored by 32P-post labelling. In vivo benzo[a]pyrene is metabolized by the cytochrome P450 family of enzymes to metabolites, of which the 7,8-diol-9,10-epoxides have been implicated as causing potentially tumourigenic lesions. Larvae were exposed to waterborne benzo[a]pyrene (0.01, 0.05 and 0.1 mg/l) for 24 h at stages 38, 45 and 50 of development (24 h, 5 days and 2 weeks post-hatching, respectively) and allowed to recover for up to 6 days. A wide range of adduct lesions were observed at stage 50, three of which were observed at all stages investigated. Adduct repair was biphasic, with an initial rapid repair over the first 24 h post exposure, followed by a much slower decline, resulting in persistence of adducts for at least 6 days post exposure. The individual lesions were repaired at different rates, with some being almost completely repaired after 6 days recovery, whereas one of the main adducts showed restricted repair at stage 50 and another no repair at all. Identification of some adducts has been achieved, by the inclusion of isomeric standards of (+)- or (-)-anti-benzo[a]pyrene diol epoxide reacted with deoxyguanosine and adenosine 3'-monophosphates prepared in vitro. The non-repairable lesion at stage 50 has been shown to be the (+)-trans-anti-benzo[a]pyrene diol epoxide-N2-guanine adduct. This adduct was observed at all stages, but was only maximally repaired at stages 38 and 45.