title: O6-Methylguanine-DNA methyltransferase inactivation and chemotherapy.
abstract: BACKGROUND
  Alkylating agents are frequently used in the chemotherapy of many types of cancer. This group of drugs mediates cell death by damaging DNA and therefore, understandably, cellular DNA repair mechanisms can influence both their antitumour efficacy and their dose-limiting toxicities.
  
  
  METHODS
  This review focuses on the mechanism of action of the DNA repair protein, O(6)-methylguanine-DNA methyltransferase (MGMT) and its exploitation in cancer therapy and reviews the current literature.
  
  
  RESULTS
  MGMT can provide resistance to alkylating agents by DNA damage reversal. Inhibition of tumour MGMT by pseudosubstrates to overcome tumour resistance is under clinical evaluation. In addition, MGMT overexpression in haematopoietic stem cells has been shown in animal models to protect normal cells against the myelosuppressive effects of chemotherapy: this strategy has also entered clinical trials.
  
  
  RESULTS
  MGMT inhibitors enhance the myelotoxic effect of O(6)-alkylating drugs and therefore reduce the maximum-tolerated dose of these agents. Retroviral vectors used for chemoprotective gene therapy are associated with insertional mutagenesis and leukaemia development.
  
  
  CONCLUSIONS
  The results of ongoing preclinical and clinical research involving various aspects of MGMT modulation should provide new prospects for the treatment of glioma, melanoma and other cancer types.
  
  
  CONCLUSIONS
  Tissue- and tumour-specific approaches to the modulation of MGMT together with other DNA repair functions and in combination with immuno- or radiotherapy are promising strategies to improve alkylating agent therapy.
authors.affiliation: Cancer Research UK Carcinogenesis Group, Paterson Institute for Cancer Research, University of Manchester, Wilmslow Road, Manchester M20 4BX, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Verbeek
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Southgate
authors.forename: David E
authors.initials: DE
authors.lastname: Gilham
authors.forename: Geoffrey P
authors.initials: GP
authors.lastname: Margison
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000494:pharmacology*; D004249:DNA Damage; D045643:DNA Repair Enzymes / Q000235:genetics / Q000378:metabolism*; D019008:Drug Resistance, Neoplasm; D015316:Genetic Therapy / Q000379:methods*; D006801:Humans; D019853:O(6)-Methylguanine-DNA Methyltransferase / Q000037:antagonists & inhibitors* / Q000502:physiology
chemical_list: D018906:Antineoplastic Agents, Alkylating; D019853:O(6)-Methylguanine-DNA Methyltransferase; D045643:DNA Repair Enzymes