Attacking cancer's Achilles heel: antagonism of anti-apoptotic BCL-2 family members

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Abstract

Malignant cells routinely violate cellular checkpoints that should initiate cell death in normal cells by triggering pro-apoptotic members of the BCL-2 family of proteins. To escape such death inducing signals, cancer cells often select for upregulation of anti-apoptotic BCL-2 family members including BCL-2, BCL-XL, BFL-1, BCL-W and MCL-1. These family members prevent death by sequestering pro-apoptotic molecules. To counter this resistance mechanism, small molecule inhibitors of anti-apoptotic BCL-2 family members have been under development. These molecules have shown promise in pre-clinical and clinical testing to overcome apoptotic resistance, prompting cancer cells to undergo apoptosis. Alternatively, other strategies have taken advantage of the normal regulatory machinery controlling anti-apoptotic molecules and have used inhibitors of signaling pathways to down-modulate the expression of anti-apoptotic molecules, thus tilting the balance in cancer cells to cell death. This review explores recent developments and strategies aimed at antagonizing anti-apoptotic BCL-2 family member action to promote the induction of cell death in cancer therapy.

Cancer cells select for expression of anti-apoptotic BCL-2 molecules. To counter this resistance, small molecule inhibitors of anti-apoptotic proteins are showing promise in pre-clinical and clinical testing to induce cancer cells apoptosis. Alternatively, attenuating anti-apoptotic molecule expression is also being evaluated to promote cancer cell death. This review explores methods to antagonizing anti-apoptotic BCL-2 proteins action to promote cell death in cancer therapy.

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