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Fundamentals of Cancer Medicine |
David S. Goodsell, Ph.D., The Scripps Research Institute, Department of Molecular Biology, 10550 North Torrey Pines Road, La Jolla, California 92037, USA. Telephone: 858-784-2839; Fax: 858-784-2860; e-mail: goodsell{at}scripps.edu WorldWideWeb http://www.scripps.edu/pub/goodsell
Imagine preventing cancer before it even starts. Of course, cancer prevention starts at home. We can stay away from smoke, solvents, and sunlight, avoiding unnecessary risks to our cells. We can also eat healthy foods like fruits and vegetables that are filled with protective antioxidants and cleansing fiber. But researchers are now looking to chemistry to provide new compounds to reduce the risk of cancer. The goal is to create a long-term preventive therapy that blocks the early steps of cancer formation and progression, providing extra protection for susceptible individuals.
Surprisingly, a drug that is probably already in your medicine cabinet may be a candidate. Evidence is mounting that regular doses of aspirin, or other nonsteroidal anti-inflammatory drugs, can decrease the risk of cancer, in particular, of colon cancer. Aspirin is a true wonder drug: an effective painkiller, a tool in the fight against heart disease and stroke, and now, a potential new weapon in the arsenal against cancer.
As one might expect from a drug with such profound and manifold effects, aspirin acts at a central point of communication in the body, attacking the messages that are delivered by prostaglandins. Smooth muscle contraction, pain signaling, and inflammation are all modulated by prostaglandin molecules. Aspirin attacks the first step in the synthesis of these important messengers. Arachidonic acid (a fatty acid, more snakelike than spidery, which is clipped from membrane lipids) is converted into prostaglandins by the enzyme cyclooxygenase (COX), also known as prostaglandin H2 synthase. This enzyme actually contains two active sites, a cyclooxygenase and a peroxidase, performing the first two chemical reactions of prostaglandin synthesis (Fig. 1
). Aspirin arrests the first reaction, insinuating itself into the deep cyclooxygenase active site and bonding directly to a serine amino acid. This glues the drug in place, effectively blocking the entry of arachidonic acid.
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The search is on for effective drugs to block COX-2, while leaving the essential COX-1 enzymes untouched. Aspirin is too harsh for long-term use in chemoprevention. It blocks COX-1 as well as COX-2, disrupting stomach and kidney function as the normal levels of prostaglandins are disturbed. Subtle differences between the two enzymes are currently being explored, and oddly-shaped molecules created to favor the contours of the proper target.
ADDITIONAL READING
Kurumbail RG, Stevens AM, Gierse JK et al. Structural basis for selective inhibition of cyclooxygenase-2 by anti-inflammatory agents. Nature 1996;384:644-648.
Smith WL. Prostanoid biosynthesis and mechanisms of action. Am J Physiol 1992;263:F181-F191.
Versteeg HH, van Bergen en Henegouwen PM, van Deventer SJH et al. Cyclooxygenase-dependent signaling: molecular events and consequences. FEBS Lett 1999;445:1-5.
Wattenberg LW. Prevention-therapy-basic science and the resolution of the cancer problem: presidential address. Cancer Res 1993;53:5890-5896.
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