title: Epigenetic therapy of cancer with 5-aza-2'-deoxycytidine (decitabine).
abstract: Epigenetic events, such as aberrant DNA methylation, have been demonstrated to silence the expression of many genes that suppress malignancy. Since the event is reversible, it is an interesting target for intervention with specific inhibitors of DNA methylation, such as 5-aza-2'-deoxycytidine (5-AZA-CdR, decitabine). 5-AZA-CdR is a prodrug that requires activation via phosphorylation by deoxcytidine kinase. The nucleotide analog is incorporated into DNA, where it produces an irreversible inactivation of DNA methyltransferase. 5-AZA-CdR is an S-phase-specific agent. The demethylation of DNA by this analog in neoplastic cells can lead to the reactivation of silent tumor-suppressor genes, induction of differentiation or senescence, growth inhibition, and loss of clonogenicity. 5-AZA-CdR was demonstrated to be a potent antineoplastic agent against leukemia and tumors in animal models. Preliminary clinical trials of 5-AZA-CdR using different dose-schedules have shown interesting antineoplastic activity in patients with leukemia, myelodysplastic syndrome (MDS), and non-small cell lung cancer (NSCLC). Pharmacokinetic studies have shown that 5-AZA-CdR has a short in vivo half-life of 15 to 25 minutes. The major toxicity produced by this analog is granulocytopenia. To exploit the full chemotherapeutic potential of 5-AZA-CdR for the treatment of cancer, its optimal dose-schedule has to be found. This will require a good understanding of the pharmacology of this analog and its action on both normal and neoplastic cells.
authors.affiliation: Département de pharmacologie, Université de Montréal and Centre de recherche pédiatrique, Hõpital Ste-Justine, 3175 Côte Sainte-Catherine, Montréal, Québec H3T 1C5, Canada. Richard.l.momparler@umontreal.ca
authors.forename: Richard L
authors.initials: RL
authors.lastname: Momparler
mesh_terms: D000483:Alleles; D000818:Animals; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001374:Azacitidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D045744:Cell Line, Tumor; D016922:Cellular Senescence; D002986:Clinical Trials as Topic; D004247:DNA / Q000737:chemistry; D019175:DNA Methylation; D000077209:Decitabine; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D044127:Epigenesis, Genetic; D020868:Gene Silencing; D016147:Genes, Tumor Suppressor; D006801:Humans; D008954:Models, Biological; D008956:Models, Chemical; D009369:Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000628:therapy; D010641:Phenotype; D010766:Phosphorylation; D011355:Prodrugs; D016196:S Phase; D013997:Time Factors
chemical_list: D000964:Antimetabolites, Antineoplastic; D011355:Prodrugs; D000077209:Decitabine; D004247:DNA; D001374:Azacitidine