1. MICROTEACHING
Sanjeev Sharma

2. Cancer cell and Chemotherapy
In which phase of cell cycle DNA replication occurs ?
What is the mechanism of action of cytarabine ?
How bortezomib acts?

3. PHASES OF CELL CYCLE
G0 phase (resting stage)- The cell has not yet started to divide. Cells spend much of their lives in this phase . Depending on the type of cell, G0 can last for a few hours to a few years. When the cell is signalled to reproduce, it moves into the G1 phase
G1 phase- During this phase, the cell starts making more proteins and growing larger, so the new cells will be of normal size. This phase lasts about 18 to 30 hours.

4. S phase – In this phase, the chromosomes containing the genetic code (DNA) are copied so that both of the new cells formed will have matching strands of DNA. This phase lasts about 18 to 20 hrs.

5. G2 phase- In this phase, the cell checks the DNA and prepares to start splitting into cells. It lasts from 2 to 10 hrs.
M-phase-In this phase, which lasts only 30 to 60 mins, the cell actually splits into 2 new cells.

6. Topoisomerases- catalyze transient breaks in DNA molecule and unwind the double helix
DNA polymerases- carry out the discontinuous replication of DNA strands

7. The Ubiquitin-Proteasome Pathway

8. Tumor Growth Patterns Tumors grow exponentially at first
As tumors get larger, the growth rate slows due to lack of oxygen and nutrients
As tumors get very large, many cells are not proliferating, and some have died due to lack of oxygen and nutrients

9. Characteristics of cancer cell division
Growth fraction - at any particular time some cells are going through the cell cycle whereas other cells are resting.
The ratio of proliferating cells to cells in G0, is called the growth fraction.
A tissue with a large percentage of proliferating cells & few cells in G0 has a high growth fraction.
Conversely, a tissue composed of mostly of cells in G0 has a low growth fraction.

10. Chemotherapy Effect on Cellular Reproduction

11. CLASSIFICATION OF CANCER CHEMOTHERAPY
Alkylating agents- Cyclophosphamide, Ifosfamide, Chlorambucil Antimetabolites- Folate antagonists- Methotrexate Purine antagonists- 6 MP Pyrimidine antagonists- Cytarabine Vinca alkaloids- Vincristine, Vinblastine Epipodophyllotoxins- Etoposide Antibiotics- Daunorubicin,Doxorubicin, Mitoxantrone Hormonal- Steroids Miscellaneous/Others- Hydroxyurea, L-Asparaginase,Rituximab, Imatinib, ATRA

12. Classification on the basis of effect on cell cycle
Cell cycle active, phase specific
Cell cycle active, phase non-specific
Non cell cycle active
S phase- Methtrexate, 6MP, Cytarabine M phase- VCR Alkylating agents, anthracyclines Steroids, Asparaginase

13. Mechanism of action of chemotherapeutic agents

14. Alkylating agents
Alkylating agents (cyclophosphamide) works by 3 different mechanisms- 1) It attaches alkyl groups to DNA bases. This alteration causes DNA fragmentation by repair enzymes
Cyclophosphamide
Bases alkylated
DNA fragmented

15. Alkylating agents contd…
3) Induction of mispairing of nucleotides leading to mutations
2) Formation of cross-bridges,which prevent DNA from being separated for synthesis or transcription
Cross bridge formed
Mispairing

16. Methotrexate
MTX prevents the formation of THF, causing an intracellular deficiency of folate coenzymes and accumulation of the toxic inhibitory substrate, DHF polyglutamate
The one carbon transfer reactions for purine and thymidylate synthesis cease, interrupting DNA and RNA synthesis

17. Cytarabine
Ara-C
Cytarabine is converted to its triphosphate form which acts by two ways-
1) Inhibition of DNA polymerase
2) Is incoporporated into the DNA, where it terminates strand elongation-DNA synthesis stops in S phase
Ara-C

18. Vinca Alkaloids M phase specific
Binds to the microtubular protein tubulin and terminates assembly of the mitotic spindle- interference with chromosome segregation resulting in mitotic arrest at metaphase .
M phase specific

19. Anthracyclines DNA-Drug interaction Doxorubicin
1) Intercalation: Doxorubicin intercalates between adjacent nucleotides along the DNA forming a tight DNA-drug interaction. This interaction disrupts DNA synthesis and transcription.
2) Enzyme inhibition: Doxorubicin binds and inhibits topoisomerase II,a key enzyme involved in DNA synthesis.
3) Oxygen free radicals are also produced which damage DNA and prevent DNA synthesis.
DNA-Drug interaction
Doxorubicin

20. Asparaginase
Causes catabolic depletion of serum asparagine to aspartic acid and ammonia
Resulting in reduced blood asparagine levels and inhibition of protein synthesis

21. Imatinib
Imatinib (STI571) occupies the ATP-binding site (also known as the phosphate- or P-loop) of BCR-ABL complex. ATP is displaced and substrate is not phosphorylated.

22. ATRA
The fusion protein complexes(PML-RARA) are not activated by physiological concentrations of RA so the corepressors are not dissociated and transcription does not occur.
The high dosage of RA is enough to bind to the PML-RARα fusion protein and dissociate the SMRT/HDAC complex so that repression no longer occurs

23. Bortezomib
NF-kB is an important regulatory protein that promotes the transcription of a variety of growth promoting and angiogenic factors
In normal cells NF-kB exists in an inactivated state bound to inhibitor IkB.
In MM increased proteasomal degradation of IkB increases NF-kB
Bortezomib blocks proteasome, elevates IkB, which inactivates NF-kB, promoting tumor cell apoptosis

24. Rituximab
Anti CD-20 monoclonal antibody (Rituximab) binds to CD-20 on malignant cells and leads to Apoptosis by –
Antibody dependent cell mediated cytotoxicity(ADCC)
And
Complement dependent cytotoxicity(CDC)

25. COMBINATION CHEMOTHERAPY
Advantages of combination therapy:
1. Suppression of drug resistance - less chance of a cell developing resistance to multi drugs than to single drug.
2. Increased cancer cell kill - administration of drugs with different mechanisms of action.
3. Reduced injury to normal cells - by using a combination of drugs that do not have overlapping toxicities, we can achieve a greater anticancer effect than we could by using any one agent alone.

26. Summary

27. THANKS