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P53 – Tumor Suppressor Gene:
Understanding P53 – Based
Anticancer Therapies Utilizing
Dietary Agents
by Serge Jurasunas,N.D., M.D. (Hom)
www.sergejurasunas.com
Lisbon, Portugal
1
P53 – Tumor Suppressor Gene: Understanding P53 –
Based Anticancer Therapies Utilizing Dietary Agents
(At the end of this paper we made an announcement
concerning the “20th
World Congress on Advances in
Oncology – 18th
International Symposium of Molecular
Medicine”, featuring a program presenting several topics
related to our therapies.)
Abstract
The P53 tumor suppressor gene which has been dubbed both the “Guardian of
the Genome” (Lane 1992) and Science “Molecule of the Year”, is directly
involved in the initiation of apoptosis and programmed cell death, to prevent
an accumulation of abnormal cells. However apoptosis evasion is a
characteristic feature of human cancers that promote tumor formation and
progression (1). Presently, P53 is known to play a key role in practically all
types of human cancers, and the mutation or loss of P53 gene function, can
be identified in more than 50% of all human cancer cases worldwide (2).
Frequency of P53 mutations
70% in lung cancer
60% in cancers of colon, head, neck, ovary, bladder
45% in stomach cancer
35% - 40% in breast cancer
Recent data has shown in addition to losing transcriptional function, mutant
P53 gains oncogenic functions termed GOF (Gain of Function) that drive cell
migration, invasion, and metastases (3-4). The notion for mutant P53 GOF
theory is supported by recent studies using mutated P53-blocked mice which
display a broader tumor spectrum, increased aggressiveness and metastatic
potential as compared with their P53–null counterparts (5-6). Similarly in
human cancers mutant P53 expression has been linked with a poor prognosis
(7).
Therefore mutant P53 function raises the possibility that the mutant protein
may be a good target for designing novel therapies.
The P53 pathway seems to play a critical role in therapeutic response and
both as a diagnostic and marker in the prognosis of therapeutic treatment
effects.
The inability of most cancers to undergo apoptosis in response to appropriate
stimuli is a key cause of treatment failure, presenting one of the major, yet
unsolved problems in Oncology (8).
2
Introduction
Programmed cell death, called apoptosis is a fundamentally important process
that prevents an accumulation of genetically abnormal cells. Apoptosis
Induction often appears to be related to the production process of P53
protein. This follows the activation of the tumor suppressor gene as a stress
response to any DNA damage within a cell nucleus (9). In normal, unstressed
cells, P53 is expressed at a very low level; the half-life of the protein does not
exceed 20 minutes.
Active P53 binds to target DNA and determines the choice between trigger cell
cycle arrests at a check point to allow DNA repair or can activate a special
molecular pathway leading to the self-destruction of a cell through apoptosis.
Both alternatives provide any organism with genetic stability.
P53 – Apoptosis pathway
Transcriptional upregulation of pro-
apoptotic genes.
Pro-apoptotic BCL-2 members
BAX, Puma, Noxa
Initiating cyto C Release.
P53 expressed at very low levels in
normal cells
accumulated if cell is damaged by
genotoxic stress
Oren M. (2003) decision making by P53 – Life, death and cancer – Cell death Differ 10 – 431-442
Stress
Damaged
Chemotherapy
P53
P21
Cell cycle
arrest
Apoptosis
DNA repair
Angiogenesis
inhibition
Tumor inhibition
Loss of P53 pathway function can contribute not only to
aggressive tumor behaviour but also to therapeutic
resistance
Figure 1
The critical role of P53 is made evident by the fact that it is mutated in
approximately 50% to 70% of all human cancers. In fact, P53 is the most
commonly mutated gene in human cancer. In human malignancies, very often
there are mutations or a loss of alleles in the gene located on the
chromosome 17P. More than 500 mutations in the P53 gene have been
discovered, although they are not equal in terms of biological activity.
The mutated gene in transformed cells leads to protein confirmation changes
and the accumulation of very stable mutant forms of P53 in the nucleus. All
3
types of mutated P53 are likely to be ineffective in maintaining a non-
tumorigenic cellular phenotype when compared to a wild type P53.
Wild Type P53, which is a nuclear phosphoprotein, has been shown to be a
sequence specific transcription factor which induces the expression of P21,
WAF1/C1P1/Sdi-1, leading to a G1 arrest checkpoint to step up repair before
DNA replication and contributes to normal cell proliferation (10) unless DNA
replication is successful, the cells will be induced to undergo apoptosis.
However during a stress response from its P53 gene to any damage, recent
findings suggest that P53 induces apoptosis by trans-activating expression of
the BAX gene MRna (11) to increase BAX protein and simultaneously inhibit the
function of BCL2. RNA proteins are homologs, through BAX acts as an
accelerator of apoptosis while BCL2 serves to prolong life survival (12).
This suggests that P53 mutation not only serves to inactivate the pro-
apoptotic P53 pathway, but that may also play an additional role in tumor
progression. Mutant P53 itself provides a selective advantage to tumor cells
and promotes tumor growth. Recent data suggests that expression of mutant
P53 is not the equivalent of P53 loss, where mutant P53 can acquire new
functions.
BCL2 activity up-regulates in many types of cancer and correlates with cancer
cell resistance to a wide spectrum of chemotherapy agents (13). Over-
expression of the anti-apoptotic BCL2 proteins blocks cytochrome C release in
mitochondria in response to a variety of stimuli, whereas the pro-apoptotic
BAX protein releases cytochrome C that in turn activates an apoptotic
cascade, while the loss of BAX associates with tumor progression and with
shorter survival in metastatic breast cancer (14).
Figure 2
4
BAX was the first identified P53–regulated, pro-apoptotic BCL2 family
member. P53–responsive elements have been unequivocally identified in the
BAX gene (15). BAX is specifically required for Puma mediated apoptosis, and
it also participates in the death response as an indirect target of P53 through
Puma (16) and Noxa, both implicated in P53–dependent apoptosis.
Some studies show that the loss of BAX is responsible for nearly half of the
accelerated tumor growth in brain tumors that are related to loss of P53
function (17). BAX is inactive in approximately one third of invasive breast
cancers, where in a study of 119 women with metastatic breast cancer, it was
found that patients whose tumors had lost BAX activity, had poor responses to
combination chemotherapy, faster time to tumor progression, and shorter
overall survival (18).
This may suggest that turning on this pro-apoptotic gene may be important for
chemotherapy response, where one of the factors that can regulate BAX gene
activity is the P53 tumor suppressor gene, which also simultaneously inhibits
BCL2 during the process of apoptosis. Nevertheless because BAX proteins
antagonize BCL2 anti-apoptotic function, it is likely that the BCL2/BAX
balance ratio determines both the susceptibility of a cell to apoptosis as well
as therapeutic response to apoptosis stimuli (19).
If apoptosis signaling is not initiated by nuclear P53 and/or the presence of a
mutated P53 gene, loss of BAX and over-expressed BCL2, this allows some
cancer cells to divide unchecked after radiation or chemotherapy treatment;
associating with cancer cell resistance, increased rate of tumor recurrence,
and shorter patient survival (20).
5
Figure 3
Another profound feature of malignant cells is their ability to induce
angiogenesis necessary for tumor growth. Again, there is a clear correlation
between mutant P53 GOF that facilitates angiogenesis by increasing the
expression of VEGF (21), via interaction with E2F1 that induces the expression
of ID4, which in turn promotes the expression of pro-angiogenic factors such
IL and GROa, thus eventually leading to increasing angiogenesis in cancerous
tissues (22). Other novel functions of mutant P53 GOF are shown through the
activation of specific target genes EGFR/1, RAS, Myc, and interference with
the TGFB growth arrest control pathway, down-regulation of the E-Cadherin
cell-cell adhesion molecules to enhance motility and tumor cell migration and
invasion (23).
We have new clues and important conceptualizations that indicate tumors
cannot be viewed simply as an uncontrolled proliferative mass, but rather as a
cellular community, interacting with a microenvironment (24-25). This is why
targeting mutant P53 remains an urgent need to improve cancer treatment by
increasing a cancer cell’s sensitivity to apoptosis.
Therapeutic Strategy
Targeting mutant P53 and restoring the wild type function of P53 tumor
suppressor gene in tumor cells would be of potential therapeutic benefit and
an attractive strategy for anticancer treatments (26-27). Upon restoration of
P53 transcriptional activity, the apoptosis pathway would predominate.
Many cancer cells escape apoptosis and become resistant to chemotherapy
radiation or from destruction by the immune cells by endogenous cytotoxic T-
cells and natural killer cells (NK). If the oncogene BCL2 is highly expressed it
confers greater resistance to cancer cells from attacking immune cells,
increasing the urgent need for effective cancer therapies.
Furthermore some of the P53 apoptosis targets such as BAX, Puma, Noxa, and
P21 could potentially be used as targets for gene therapy to increase the
effectiveness of chemotherapy.
Dietary Agents that Induce Apoptosis with Chemo
Preventive Effects
A large number of dietary agents can exert effects on the human genome
either directly or indirectly to modulate gene expression. Extensive research
during the last half century demonstrated that numerous agents identified
from fruits and vegetables can interfere with several signaling pathways, and
were validated as apoptosis inducers in research experiments.
6
Figure 4
These dietary agents include well known, well documented substances
recommended for cancer prevention and therapy, such as curcumin (tumeric)
(28-29) resveratrol (grapes) (30) genistan (soybean) (31) capsaicin (red chili)
(32) ellagic acid (pomegranate) (33) caffeic acid and phenyl ester (propolis),
polyphenols (green tea), (34) catechin (green tea) (35), and índole-3-carbinol
(cruciferous vegetables) (36).
They have all clearly accumulated evidence demonstrating their efficacy to
induce apoptosis by modulation of the P53 independent pathway, BAX, BAK,
targeting the anti-apoptotic proteins, BCL2, and Survivin gene so as to
potentialize a chemotherapy/radiation regimen. Curcumin, for instance, has
been found to inhibit the activity of NF-KB, BCL2, and increase P53 activity as
well as sensitize cancer cells to Cisplatin and Taxol–induced apoptosis (37).
The combination of 5-Fu and genistein enhances therapeutic effects in colon
cancer through the COX2 pathway (38). Genistein combined with docetaxel or
Gemicitabine significantly inhibited BCL2 – BCL–XL, Survivin and induced P21
WAF1, suggesting that combination treatment regulates the important
molecules in the apoptotic pathway (39-40). Green tea and black tea cause
induction of apoptosis accompanied with up regulation in BAX and a decrease
in BCL2 proteins in prostate cancer cells (41). Capsaicin caused apoptosis in
prostate cancer cells show an increase of P53, P21 and BAX (42). Curcumin
down-regulates the apoptosis suppressor proteins BCL2 and BCL–XL in several
cancer cell lines, thus increasing apoptosis overall. (43).
7
In human breast cancer cells curcumin, induces apoptosis through P53
dependent BAX induction (44) curcumin resveratrol and green tea polyphenols
are also known to down-regulate the expression of apoptosis suppressor
proteins, such as BCL2 and BCL-X in several cancer cell lines.
In human prostate carcinoma, LNCaP cells, treatment with EGGG induced
apoptosis, was associated with stabilization of P53, with an accompanying
down regulation of NF.KB activity resulting in a decreased expression of the
anti-apoptotic BCL2. Overall dietary agents synergise with chemotherapeutic
drugs, thereby reducing the toxicity of chemotherapeutic agents. (45)
Numerous studies continue to report that resveratrol exerts its anticancer
effects by causing cell cycle arrest and inducing apoptosis in many different
cancers (46). These include colon adenocarcinoma cells (Caco-2), esophageal
carcinoma cells, medulloblastoma cells, the highly invasive and metastatic
breast cancer cell line MDA-MB-231, melanoma cells, pancreatic carcinoma
cells, esophageal squamous carcinoma cells, as well as lung cancer cells.
A complete document concerning the modulation of apoptosis by active
compounds for cancer therapy and their synergy with chemotherapeutic agent
is available at www.sergejurasunas.com .
Conclusion
Deregulation of P53 has enormous influence on carcinogenesis as mutant P53,
which can induce an increased epigenetic instability of tumor cells,
facilitating and accelerating tumor evolution.
Increasing body of investigation has shown that inhibitor of apoptosis protein
(IAP’s) as BCL2, Survivin, etc. is now seen as diagnostic markers for early-
stage malignancy and novel prognostic markers (47). In addition these
molecules have been validated as therapeutic targets. Accumulated evidence
clearly indicates that dietary agents may play a critical role by targeting P53
and IAP’s and improve chemotherapy regimen. Despite significant advances in
cancer diagnosis and therapy, there is still little progress in the treatment of
advanced disease.
Most modern medicines currently available for treating cancer are very
expensive, toxic, and less effective in treating the disease. Therefore new
effective ways to treat cancer have become a priority. Thus, one must
investigate further in detail, dietary agents derived from natural sources
without toxicity. Hopefully they will find a place in the clinical management
of patients with malignancy.
Case Reports
We have been measuring the activity of P53 pathway, BAX, BCL2, Survivin and
P21 gene expression with a large number, variety, and grades of cancer
patients, developing a targeting therapy that could restore mutant P53 to a
normal wild type function as a first step after gaining results to modulate
8
BAX, inhibit the BCL-2 and Survivin anti-apoptotic proteins. The targeting
therapy includes dietary agents such as curcumin and other compounds
empirically experimented upon by the author. It includes an extract of fish
oils rich in oligopeptide, that contain short-chain of amino acids shown to
have efficiency to target mutant P53 (48), fermented chlorella in tablets rich
in vitamins, minerals and nucleic acids. The fermenting process increases the
level of nutrients and absorptive power. Finally an antioxidant compound was
derived from modified vegetables and seeds, with low molecular weight
having an S.O.D. - like activity (49).
This targeting therapy is known as PSJ-53 therapy, had been first utilized in
experiments to restore mutant P53, and were proven by P53 gene expression
and P53 protein testing. Later experimentation in modulating BAX gene
expression and targeting BCL2 and Survivin anti-apoptotic proteins (50), were
shown to potentialize the efficiency of chemotherapy and radiation. Survivin,
a unique member of the IAP’S inhibits Caspase 7-9 and promotes both cell
proliferation and angiogenesis (51). Measuring and targeting Survivin remains
a major goal in response to antineoplasic agents (52).
We present three cancer cases with blood analysis reports of P53 gene
expression and mutated protein levels before and after the treatment, along
with two cases with complete figures of the pro-apoptotic and anti-apoptotic
genes before and after treatment.
1 – A case of multi-cancer recurrence.
2 – Remission of breast cancer
3 – Pancreatic cancer
4 – Recurrence of colon cancer
5 – Lung cancer
6 - Glioma
Methodology
P53 pathway activity and other pro-apoptotic and anti-apoptotic genes were
evaluated by measuring protein concentration and the level of P53 gene
expression, BCL2, BAX, Survivin , and P21 in the same peripheral venous blood
obtained from patients in the clinic.
The enzyme-link immunosorbent assay (Elisa) was used together with the
Polymer chain reaction (PCR) for the evaluation of the level of P53, BAX,
Survivin, P21 gene expression and for the qualitative detection of P53 protein.
Blood samples were collected in sterile tubes and sent to a laboratory
specializing in molecular marker tests, which offers complete reports and
discussion about each test.
9
Table 1 - Effects of PSJ-53 Therapy on the Tumor Suppressor P53 Pathway
M – Case of Multiple Cancer Recurrence
P53 protein level units/ml
of plasma
No
Date of
blood
sample
collection
Wild P53
Ref.range*
<0.33
units/ml of
plasma
Mutated P53
Ref.range
N.D.**
P53 gene (wild
expression level
Ref.range * <106
copies/ml of
plasma
Comments
1 2 Feb 2009 N.D.** 26.1 2.7 x 105
The blood sample was
collected prior to PSJ-53
therapy
2 18 May 2009 16.8 N.D.** 8.9 x 1011
The blood sample was
collected after a 3 month
course of PSJ-53 therapy
3 21 Sep 2009 156.0 N.D.** 1.5 x 1013
The blood sample was
collected 4 months after
completion of the PSJ-53
therapy during which time no
further treatment was given.
Table 2 – F – 48 years old: Breast Cancer – Breast Cancer in Remission 2009
P53 protein level units/ml
of plasma
No
Date of
blood
sample
collection
Wild P53
Ref.range*
<0.33
units/ml of
plasma
Mutated P53
Ref.range
N.D.**
P53 gene (wild
expression level
Ref.range * <106
copies/ml of
plasma
Comments
1 2 Feb 2010 N.D.** 52.5 52.245 The blood sample was
collected prior to PSJ-53
therapy
2 19 Apr 2010 10.99 N.D.** 170.000 The blood sample was
collected after a 2 month after
completion of the PSJ-53
therapy
The results clearly show the presence of mutated P53 prior to PSJ-53 therapy.
However after 2 months of the treatment we reversed the mutant P53 to a
normal wild type function, associated with an increase of the P53 gene
expression and protein level during this period of time.
10
Table 3 – F – 56 years old – Pancreatic Cancer – 5 Years of Remission
P53 protein level units/ml
of plasma
No
Date of
blood
sample
collection
Wild P53
Ref.range*
<0.33
units/ml of
plasma
Mutated P53
Ref.range
N.D.**
P53 gene (wild
expression level
Ref.range * <106
copies/ml of
plasma
Comments
1 4 May 2009 N.D.** 52.5 52.245 The blood sample was
collected prior to PSJ-53
therapy
2 4 July 2009 10.99 N.D.** 170.000 The blood sample was
collected after a 2 month
after completion of the
PSJ-53 therapy
3 17 Nov 2009 67.4 N.D.** 1.2 x 106
The blood sample was
collected after a 4 month
after completion of the
PSJ-53 therapy
The results clearly show the presence of mutated P53 prior to the PSJ-53
therapy. However after 2 months of therapy followed by 4 months of
treatment, we reversed the mutant P53 to a normal wild type function and
gradually the P53 wild protein production had risen to a high level leading to
increased self-destruction of cancer cells.
Table 4 – M – 81 years old – Recurrence of Colon Cancer – Liver Metastases
The patient refused chemotherapy but agreed to take some radiation therapy.
He was sent by his medical doctor to take molecular markers testing to first
check if radiotherapy will be efficient or not. P53, BAX or either P21 should
be active, sensitive to radiation and increase self-destruction of cancer cells.
New Reference range: P53 protein level wild – 0.10 – 1.00 units/ml of plasma
P53 gene expression – 10-50 units/ml of plasma
BCL2 gene expression - 10 units
BAX gene expression - 10 – 100 units
Survivin gene expression - 10 units
P21 gene expression - 10 – 50 units
11
P53 protein level
units/ml of plasma
No
Date of
blood
sample
collection
Wild P53
Ref.range*
<0.33
units/ml of
plasma
Mutated
P53
Ref.range
N.D.**
P53 gene
(wild
expression
level
Ref.range *
<106
copies/ml of
plasma
BCL-2 BAX Survivin P21
1 1 Mar 2011 N.D.** 10.88 N.D.** 390 N.D.** 129 N.D.**
2 11Jul 2011 N.D.** N.D.** 1.180 N.D.** 409 N.D.** N.D.**
The results clearly show after 4 months of treatment a significant
improvement and reversal of the mutant P-53 tumor suppressor gene.
However the P53 gene didn’t induce the level of normal protein (Often
because of a blockage of Puma). BAX gene expression is now active as a
pathway to destroy cancer cells and the Oncogene BCL2 and Survivin are not
active due to the applied treatment. Therefore the new pattern showed that
cancer cells were destroyed and that radiotherapy would be efficient,
increasing the destruction of cancer cells. The first report showed BCL2 and
Survivin were slightly active (at risk) but after the treatment, were totally
inhibited which contributed to increase the efficiency of
chemotherapy/radiation regimen.
After radiation therapy and further treatment with natural compounds, the
patient was free from liver metastases.
Table 5 – M – 50 years old – Lung Cancer
P53 protein level
units/ml of plasma
No
Date of
blood
sample
collection
Wild P53
Ref.range*
<0.33
units/ml of
plasma
Mutated
P53
Ref.range
N.D.**
P53 gene
(wild
expression
level
Ref.range *
<106
copies/ml of
plasma
BCL-2 BAX Survivin P21
1 7Jan 2013 N.D.** 16.26 N.D.** 340 330 1.028 552
2 11Mar2013 0.1 N.D.** 3 2 5 5 4.527
12
Ratio of the 1st
Analysis – BCL/BAX - 0.89
- Survivin/P21 – 0.53
Ratio of the 2nd Analysis – BCL/BAX – 2.5
- Survivin/P21 – 905.4 – Too high to make a ratio
The results clearly show after 2 months with PSJ-53 therapy that we reversed
mutant P53 to a wild type function, however P53 protein was produced only
to a certain extent. However we have targeted BCL2 and especially the high
expression of Survivin to a normal range and eliminated resistance in some
population of cancer cells and increased the self-destruction of cancer cells
through chemotherapy/radiation with a resultant decrease in lung nodule
size. P21 gene expression is very highly active (4.527) and promotes the self-
destruction of cancer cells. P21 is a P53-independent channel to apoptosis and
can be independent of P53 activated by another channel such as the TGF-B.
P21 is very sensitive to radiation in destroying cancer cells.
Table 6 – F – 8 years old – Glioma
Postponed Chemotherapy after 3 surgeries with poor results.
P53 protein level
units/ml of plasma
No
Date of
blood
sample
collection
Wild P53
Ref.range*
<0.33
units/ml of
plasma
Mutated
P53
Ref.range
N.D.**
P53 gene
(wild
expression
level
Ref.range *
<106
copies/ml of
plasma
BCL-2 BAX Survivin P21
1 6Jan 2013 0.2 N.D.** 1.344 2.066 1.714 1.734 2.192
2 11Mar2013 16.4 N.D.** 820 131 N.D.** N.D.** 229
We have clearly demonstrated that mutant P53 can be targeted together with
other pro-apoptotic and anti-apoptotic genes using dietary compounds, which
for many patients has been proven with many scientific examples. This is only
one example and not the publication of cancer cases followed under 1 or 2
year period as we have done with many patients (This child has now been
treated for over 2 years with excellent results, and has taken 5 blood
analyses,
Which each time indicated what treatment should be done. However, my last
article in the Townsend Letter 2014 (p.68-74) showed complete cases relative
to breast cancer with molecular markers testing done over a one year period
13
and more. Step by step it showed improvement and the normal balance
between the pro-apoptotic and anti-apoptotic genes (pp.68-74).
New avenues are now focusing on targeting apoptosis in cancer, which include
Oncogenes, BCL2, and Survivin that increases cancer cell resistance to
chemotherapy/radiation regimen while scientific literature today has already
accumulated thousands of articles on laboratory reports, theories, and
studies.
We urgently need to put into clinical practice what we have discovered and
learned. Targeting P53 and other genes remain one of the greatest challenges
in the treatment of cancer. We have been working now for over 8 years with
molecular markers as a diagnostic, prognosis, and follow up to treatment,
selected the appropriate bioactive dietary compounds or anticancer agents,
exceeding 1000 cases, blood tests, and successes. This may be an incentive
for more doctors to venture into this new direction in order to achieve more
beneficial results with their patient treatment, especially in cases where we
can verify the ones who would be refractory to chemotherapy and have a poor
response. It is always best to first check through patient testing, to determine
whether or not chemotherapy would be beneficial.
20th
World Congress on Advances in Oncology
18th
International Symposium of Molecular Medicine – October 8-10, 2015
Metropolitan Hotel – Athens – Greece
Participants from nearly 36 countries
In October we will participate in this important event that focuses on
molecular medicine and opens the door to a new conception of future
diagnostics and personalized treatment that predicts outcome in advance. The
purpose of the Congress is to offer a significant opportunity to share the
knowledge that cancer cells are “addicted” to certain altered genes, a
vulnerability that can be exploited therapeutically. These driver genes
correspond to Oncogenes or tumor suppressor genes causing the tumor to
grow and proliferate. Oncogenes as BCL2 or Survivin are two anti-apoptotic
genes mostly expressed in cancer. The program includes at least 2 lectures on
BCL-2.
The preliminary presentation includes new Biomarkers for molecular
medicine, the role of angiogenesis, the Japanese Kampa Medicine, lecture on
herbal extract including curcuma which is a real opening in a Congress of
Oncology.
It is now more than 8 years since I have been involved with the study and
clinical practice of Molecular Markers and cancer, including P53 mutation and
we are able to modulate treatment of patients according to the results of the
test and predict better how patients react to chemotherapy.
14
This Congress is a real opportunity for M.D., N.D.'s that are looking for a
better way to treat patients and enter now in the future which has now
arrived.
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expression and angiogenesis in the absence of an intact P21 – Rb pathway –
Cell death and differentiation (2013) 20.888.897.
22 – Fontemaggi G. Dell Orsos Triscinoglo D. et al – The execution of the
transcriptional axis mutant P53, E2F1 and LD4 promotes tumor angiogenesis –
Nature Struct Mol Biol, 2009, 16, 086-1093.
23 – Patricia A.J. Muller, Karen H., Vousden and Jim C. Norman – P53 its
mutants in tumor cell migration and invasion – JBC Home – January 2011, Vol.
2209.218.
16
24 – Allinen M., Berouklim R., Car L., Brennan C., Lahti-Domenici J. Huaqng,
Hu M. Clin, Richardson A., Schnitt S., Sellers W.R., Polyak K. – Molecular
characterization of the microenvironment in breast cancer cell – 2004, 6, 17-
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25 – Howlett A.R., Bissell M.J. – The influence of tissue microenvironment
(stroma and extracellular matrix) on the development and function of
mammary epithelium – Epithelium cell biol, 1993, 2, 79 – 89.
26 – Ling Bai and Wer Guo Zhu – P53 structure, functions and therapeutic
applications – Journal of cancer molecules, 2006, 2 (4), 141-153.
27 – Aaron D. Schimmer – Inhibitor of apoptosis proteins: Translating Basic
knowledge into clinical practice - Cancer Research, October 15 – 2004, 64,
7183–7190.
28 – Aggarwal B.B., Kumar A., Bharti A.C. – Anticancer potential of curcumin:
preclinical and clinical studies – Anticancer Res. 2003: 23-363-398.
29 – Dorai Y. C. Cao, B, Dorai R., Buttyan and A.E. Katz – Therapeutic potential
of curcumin in prostate cancer III – Curcumin inhibits proliferation, induces
apoptosis and inhibits angiogenesis of LNCAP prostate cancer cells in vivo –
Prostate, 2001, 47, 293-303.
30 – Aggarvwal B.B., Bhardway A., Aggarwal R.S., Seeram N.P., Shishodia S.,
Takada Y. – Role of resveratrol in prevention and therapy of cancer: preclinical
and clinical studies – Anticancer Research, 2004, 24 (5A) 2783-840.
31 - Li M., Zhang Z., Hill D.L., Chen X., Wang H., Zhang R. – Genistein a
dietary isoflavone down-regulates the MDM2 oncogene at both transcriptional
and posttranslational levels – Cancer Res. 2500, 65 (18), 8200 – 8.
32 – Oyagbemi A.A., Saba A.B., Azeez O.I. – Capsaicin: a novel
chemopreventive molecule and its underlying molecular mechanism of action
– Indian J. cancer, Jan/March 2010, 47 (1) 53-8.
33 – Bhagavathi A, Narayana, Otto Geoffray, Mark C., Willingham, Gian G. Ree,
Daniel W. Nixon – P53/P2 (WAF1/C1P1) expression and its possible role in G1
arrest and apoptosis in ellagic acid treated cancer cells – Cancer Letters,
March 1999, Vol.136, issue 2 – P 215-221.
34 – K. Natarajan, Sanjaya Singh, Terrence R., Burke Jr., Deizder Grimberger
and Bharat B. Aggarwal – Caffeic acid phenetlyl ester is a potent and specific
inhibitor of activation of nuclear transcription factor NF.KB – Proc. Nath Acad
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1927 – 2005.
17
36 – Hee-Sook Choi, Min-Chul Cho Hee Gu Lee, Do-Young Yoan. – Indole-3-
Carbinol induces apoptosis through P53 activation of caspases 8 – pathway in
lung cancer – A 5 49 – cells. – Food and chemical toxicology, March 2010,
vol.48, issue 88, pages 883–890.
37 – Han S.S., Chung S.T., Robertson D.A., Ranjan D., Bondada S. – Curcumin
causes the growth arrest and apoptosis of B-cell lymphoma by down regulation
of egr/1 – C-myc, bcl-xl, NF Kappa B and P53, BAX – Clin Immunol, 1999, 93
(2), 152-61
38 - Li Y., Bhuiyan M., Sarkar F. – Induction of apoptosis in breast cancer cells
MDA-MB-231 by genistein. – Oncogene 18: 3166-3172 - 1999.
39 – David J.N., Shingh B., Bhuiyan M., Sharkar F.H. - Genistein – induced up-
regulation of P21/WAF1, down-regulation of cyclin B and induction of
apoptosis in prostate cancer cells – Nutr. Cancer, 1998, 32-123-31.
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increased antitumor activity of gemicitabine by genistein in vitro and in vivo
using an orthotropic model of pancreatic cancer – Cancer Res., 2005, 65, 9064
– 9072.
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tea component, catechin, induce apoptosis of human malignant B cells via
production of reactive oxygen species – Clin cancer res, 2005, 7-79-09-11 (16)
6049-9.
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Chen – Capasaicin induces cell cycle arrest and apoptosis in human KB cancer
cells – BMC Complementary and Alternative Medicine, 2013, 13, 46 dor:10-
1186/1472-6882 – 13-46.
43 – Zhi-Dong Lu, Xiang-Ping Liu and Bin Kong – Curcumin induces apoptosis in
breast cancer cells and inhibits tumor growth in vitro in vivo. – Int. Journal of
clinical x experimental pathology 2014 7 (6): 2818.2824.
44 – Choudhuri, Pal S., Agwarwal M.L., Das T., SA G. – Curcumin induced
apoptosis in human breast cancer cells through P53 – dependent BAX induction
– FEBS Letter Feb 13-512 (1-3): 334-40.
45 – Bharat B. Aggarwal, Shishir Shishodia – Molecular targets of dietary agents
for prevention and therapy of cancer – Bioch. Pharma 71 (2006) 1397-1421
46 – Ahmand N., Adhami VM, Afaq F., Feyes DK., Mukhtar H. – Resveratrol
causes WAF-1/P21 – mediated G (1) – phase arrest of cell cycle and induction
of apoptosis in human epidermoid carcinoma A 431 cells Clin Cancer Res.
2001: 7 (5): 1466-73.
18
47 – Xiaoynan C., Longhang C., Jinghua W. et al – Survivin: a potential
prognostic marker and chemoradiotherapeutic target for colorectal cancer
HR. J. Med Sc 2010 – 174-327.35.
48 – Jurasunas S., Galkina Taylor O. – How to target mutant P53 in a case of
multiple cancer recurrence – Townsend Letter, August/Sept 2010, issue 325/26
p. 68-71.
49 – Jurasunas S. – Therapeutic application of a new low molecular antioxidant
compound: Int Symposium on ROS and Nitrogen Species: Diagnostic,
Preventive and Therapeutic value, 2002 – July 8-12 – St. Petersburg , Russia.
50 – Jurasunas Serge – Complementary approach to breast cancer targeting
BCL2, BAX and Survivin gene expression – Townsend Letter August/Sept 2014
68-72.
51 – Shin S., Sung B.J., Cho Y.S., et al – Anti-apoptotic protein human surviving
is a direct inhibitor of caspase 3 and 7 – 2001 – Biochemistry 40: 1117-23.
52 – Mita AC., Mita MM., Nawrocki ST., Giles FJ. – Survivin: Key regulator of
mitosis and apoptosis and novel target for cancer therapeutics – Clin. Cancer
Res. 2008: 14.5000.5.
Author Contact Information:
Professor Serge Jurasunas, N.D., M.D. (Hom)
Holiterapias
Rua da Misericordia, 137 – 1º
1200-272 Lisboa -Portugal
Email: info@sergejurasunas.com
www.sergejurasunas.com
19

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P53 Tumor Suppressor Gene: Understanding P53 Based Dietary Anti Cancer Therapies Utilizing Dietary Agents

  • 1. P53 – Tumor Suppressor Gene: Understanding P53 – Based Anticancer Therapies Utilizing Dietary Agents by Serge Jurasunas,N.D., M.D. (Hom) www.sergejurasunas.com Lisbon, Portugal 1
  • 2. P53 – Tumor Suppressor Gene: Understanding P53 – Based Anticancer Therapies Utilizing Dietary Agents (At the end of this paper we made an announcement concerning the “20th World Congress on Advances in Oncology – 18th International Symposium of Molecular Medicine”, featuring a program presenting several topics related to our therapies.) Abstract The P53 tumor suppressor gene which has been dubbed both the “Guardian of the Genome” (Lane 1992) and Science “Molecule of the Year”, is directly involved in the initiation of apoptosis and programmed cell death, to prevent an accumulation of abnormal cells. However apoptosis evasion is a characteristic feature of human cancers that promote tumor formation and progression (1). Presently, P53 is known to play a key role in practically all types of human cancers, and the mutation or loss of P53 gene function, can be identified in more than 50% of all human cancer cases worldwide (2). Frequency of P53 mutations 70% in lung cancer 60% in cancers of colon, head, neck, ovary, bladder 45% in stomach cancer 35% - 40% in breast cancer Recent data has shown in addition to losing transcriptional function, mutant P53 gains oncogenic functions termed GOF (Gain of Function) that drive cell migration, invasion, and metastases (3-4). The notion for mutant P53 GOF theory is supported by recent studies using mutated P53-blocked mice which display a broader tumor spectrum, increased aggressiveness and metastatic potential as compared with their P53–null counterparts (5-6). Similarly in human cancers mutant P53 expression has been linked with a poor prognosis (7). Therefore mutant P53 function raises the possibility that the mutant protein may be a good target for designing novel therapies. The P53 pathway seems to play a critical role in therapeutic response and both as a diagnostic and marker in the prognosis of therapeutic treatment effects. The inability of most cancers to undergo apoptosis in response to appropriate stimuli is a key cause of treatment failure, presenting one of the major, yet unsolved problems in Oncology (8). 2
  • 3. Introduction Programmed cell death, called apoptosis is a fundamentally important process that prevents an accumulation of genetically abnormal cells. Apoptosis Induction often appears to be related to the production process of P53 protein. This follows the activation of the tumor suppressor gene as a stress response to any DNA damage within a cell nucleus (9). In normal, unstressed cells, P53 is expressed at a very low level; the half-life of the protein does not exceed 20 minutes. Active P53 binds to target DNA and determines the choice between trigger cell cycle arrests at a check point to allow DNA repair or can activate a special molecular pathway leading to the self-destruction of a cell through apoptosis. Both alternatives provide any organism with genetic stability. P53 – Apoptosis pathway Transcriptional upregulation of pro- apoptotic genes. Pro-apoptotic BCL-2 members BAX, Puma, Noxa Initiating cyto C Release. P53 expressed at very low levels in normal cells accumulated if cell is damaged by genotoxic stress Oren M. (2003) decision making by P53 – Life, death and cancer – Cell death Differ 10 – 431-442 Stress Damaged Chemotherapy P53 P21 Cell cycle arrest Apoptosis DNA repair Angiogenesis inhibition Tumor inhibition Loss of P53 pathway function can contribute not only to aggressive tumor behaviour but also to therapeutic resistance Figure 1 The critical role of P53 is made evident by the fact that it is mutated in approximately 50% to 70% of all human cancers. In fact, P53 is the most commonly mutated gene in human cancer. In human malignancies, very often there are mutations or a loss of alleles in the gene located on the chromosome 17P. More than 500 mutations in the P53 gene have been discovered, although they are not equal in terms of biological activity. The mutated gene in transformed cells leads to protein confirmation changes and the accumulation of very stable mutant forms of P53 in the nucleus. All 3
  • 4. types of mutated P53 are likely to be ineffective in maintaining a non- tumorigenic cellular phenotype when compared to a wild type P53. Wild Type P53, which is a nuclear phosphoprotein, has been shown to be a sequence specific transcription factor which induces the expression of P21, WAF1/C1P1/Sdi-1, leading to a G1 arrest checkpoint to step up repair before DNA replication and contributes to normal cell proliferation (10) unless DNA replication is successful, the cells will be induced to undergo apoptosis. However during a stress response from its P53 gene to any damage, recent findings suggest that P53 induces apoptosis by trans-activating expression of the BAX gene MRna (11) to increase BAX protein and simultaneously inhibit the function of BCL2. RNA proteins are homologs, through BAX acts as an accelerator of apoptosis while BCL2 serves to prolong life survival (12). This suggests that P53 mutation not only serves to inactivate the pro- apoptotic P53 pathway, but that may also play an additional role in tumor progression. Mutant P53 itself provides a selective advantage to tumor cells and promotes tumor growth. Recent data suggests that expression of mutant P53 is not the equivalent of P53 loss, where mutant P53 can acquire new functions. BCL2 activity up-regulates in many types of cancer and correlates with cancer cell resistance to a wide spectrum of chemotherapy agents (13). Over- expression of the anti-apoptotic BCL2 proteins blocks cytochrome C release in mitochondria in response to a variety of stimuli, whereas the pro-apoptotic BAX protein releases cytochrome C that in turn activates an apoptotic cascade, while the loss of BAX associates with tumor progression and with shorter survival in metastatic breast cancer (14). Figure 2 4
  • 5. BAX was the first identified P53–regulated, pro-apoptotic BCL2 family member. P53–responsive elements have been unequivocally identified in the BAX gene (15). BAX is specifically required for Puma mediated apoptosis, and it also participates in the death response as an indirect target of P53 through Puma (16) and Noxa, both implicated in P53–dependent apoptosis. Some studies show that the loss of BAX is responsible for nearly half of the accelerated tumor growth in brain tumors that are related to loss of P53 function (17). BAX is inactive in approximately one third of invasive breast cancers, where in a study of 119 women with metastatic breast cancer, it was found that patients whose tumors had lost BAX activity, had poor responses to combination chemotherapy, faster time to tumor progression, and shorter overall survival (18). This may suggest that turning on this pro-apoptotic gene may be important for chemotherapy response, where one of the factors that can regulate BAX gene activity is the P53 tumor suppressor gene, which also simultaneously inhibits BCL2 during the process of apoptosis. Nevertheless because BAX proteins antagonize BCL2 anti-apoptotic function, it is likely that the BCL2/BAX balance ratio determines both the susceptibility of a cell to apoptosis as well as therapeutic response to apoptosis stimuli (19). If apoptosis signaling is not initiated by nuclear P53 and/or the presence of a mutated P53 gene, loss of BAX and over-expressed BCL2, this allows some cancer cells to divide unchecked after radiation or chemotherapy treatment; associating with cancer cell resistance, increased rate of tumor recurrence, and shorter patient survival (20). 5
  • 6. Figure 3 Another profound feature of malignant cells is their ability to induce angiogenesis necessary for tumor growth. Again, there is a clear correlation between mutant P53 GOF that facilitates angiogenesis by increasing the expression of VEGF (21), via interaction with E2F1 that induces the expression of ID4, which in turn promotes the expression of pro-angiogenic factors such IL and GROa, thus eventually leading to increasing angiogenesis in cancerous tissues (22). Other novel functions of mutant P53 GOF are shown through the activation of specific target genes EGFR/1, RAS, Myc, and interference with the TGFB growth arrest control pathway, down-regulation of the E-Cadherin cell-cell adhesion molecules to enhance motility and tumor cell migration and invasion (23). We have new clues and important conceptualizations that indicate tumors cannot be viewed simply as an uncontrolled proliferative mass, but rather as a cellular community, interacting with a microenvironment (24-25). This is why targeting mutant P53 remains an urgent need to improve cancer treatment by increasing a cancer cell’s sensitivity to apoptosis. Therapeutic Strategy Targeting mutant P53 and restoring the wild type function of P53 tumor suppressor gene in tumor cells would be of potential therapeutic benefit and an attractive strategy for anticancer treatments (26-27). Upon restoration of P53 transcriptional activity, the apoptosis pathway would predominate. Many cancer cells escape apoptosis and become resistant to chemotherapy radiation or from destruction by the immune cells by endogenous cytotoxic T- cells and natural killer cells (NK). If the oncogene BCL2 is highly expressed it confers greater resistance to cancer cells from attacking immune cells, increasing the urgent need for effective cancer therapies. Furthermore some of the P53 apoptosis targets such as BAX, Puma, Noxa, and P21 could potentially be used as targets for gene therapy to increase the effectiveness of chemotherapy. Dietary Agents that Induce Apoptosis with Chemo Preventive Effects A large number of dietary agents can exert effects on the human genome either directly or indirectly to modulate gene expression. Extensive research during the last half century demonstrated that numerous agents identified from fruits and vegetables can interfere with several signaling pathways, and were validated as apoptosis inducers in research experiments. 6
  • 7. Figure 4 These dietary agents include well known, well documented substances recommended for cancer prevention and therapy, such as curcumin (tumeric) (28-29) resveratrol (grapes) (30) genistan (soybean) (31) capsaicin (red chili) (32) ellagic acid (pomegranate) (33) caffeic acid and phenyl ester (propolis), polyphenols (green tea), (34) catechin (green tea) (35), and índole-3-carbinol (cruciferous vegetables) (36). They have all clearly accumulated evidence demonstrating their efficacy to induce apoptosis by modulation of the P53 independent pathway, BAX, BAK, targeting the anti-apoptotic proteins, BCL2, and Survivin gene so as to potentialize a chemotherapy/radiation regimen. Curcumin, for instance, has been found to inhibit the activity of NF-KB, BCL2, and increase P53 activity as well as sensitize cancer cells to Cisplatin and Taxol–induced apoptosis (37). The combination of 5-Fu and genistein enhances therapeutic effects in colon cancer through the COX2 pathway (38). Genistein combined with docetaxel or Gemicitabine significantly inhibited BCL2 – BCL–XL, Survivin and induced P21 WAF1, suggesting that combination treatment regulates the important molecules in the apoptotic pathway (39-40). Green tea and black tea cause induction of apoptosis accompanied with up regulation in BAX and a decrease in BCL2 proteins in prostate cancer cells (41). Capsaicin caused apoptosis in prostate cancer cells show an increase of P53, P21 and BAX (42). Curcumin down-regulates the apoptosis suppressor proteins BCL2 and BCL–XL in several cancer cell lines, thus increasing apoptosis overall. (43). 7
  • 8. In human breast cancer cells curcumin, induces apoptosis through P53 dependent BAX induction (44) curcumin resveratrol and green tea polyphenols are also known to down-regulate the expression of apoptosis suppressor proteins, such as BCL2 and BCL-X in several cancer cell lines. In human prostate carcinoma, LNCaP cells, treatment with EGGG induced apoptosis, was associated with stabilization of P53, with an accompanying down regulation of NF.KB activity resulting in a decreased expression of the anti-apoptotic BCL2. Overall dietary agents synergise with chemotherapeutic drugs, thereby reducing the toxicity of chemotherapeutic agents. (45) Numerous studies continue to report that resveratrol exerts its anticancer effects by causing cell cycle arrest and inducing apoptosis in many different cancers (46). These include colon adenocarcinoma cells (Caco-2), esophageal carcinoma cells, medulloblastoma cells, the highly invasive and metastatic breast cancer cell line MDA-MB-231, melanoma cells, pancreatic carcinoma cells, esophageal squamous carcinoma cells, as well as lung cancer cells. A complete document concerning the modulation of apoptosis by active compounds for cancer therapy and their synergy with chemotherapeutic agent is available at www.sergejurasunas.com . Conclusion Deregulation of P53 has enormous influence on carcinogenesis as mutant P53, which can induce an increased epigenetic instability of tumor cells, facilitating and accelerating tumor evolution. Increasing body of investigation has shown that inhibitor of apoptosis protein (IAP’s) as BCL2, Survivin, etc. is now seen as diagnostic markers for early- stage malignancy and novel prognostic markers (47). In addition these molecules have been validated as therapeutic targets. Accumulated evidence clearly indicates that dietary agents may play a critical role by targeting P53 and IAP’s and improve chemotherapy regimen. Despite significant advances in cancer diagnosis and therapy, there is still little progress in the treatment of advanced disease. Most modern medicines currently available for treating cancer are very expensive, toxic, and less effective in treating the disease. Therefore new effective ways to treat cancer have become a priority. Thus, one must investigate further in detail, dietary agents derived from natural sources without toxicity. Hopefully they will find a place in the clinical management of patients with malignancy. Case Reports We have been measuring the activity of P53 pathway, BAX, BCL2, Survivin and P21 gene expression with a large number, variety, and grades of cancer patients, developing a targeting therapy that could restore mutant P53 to a normal wild type function as a first step after gaining results to modulate 8
  • 9. BAX, inhibit the BCL-2 and Survivin anti-apoptotic proteins. The targeting therapy includes dietary agents such as curcumin and other compounds empirically experimented upon by the author. It includes an extract of fish oils rich in oligopeptide, that contain short-chain of amino acids shown to have efficiency to target mutant P53 (48), fermented chlorella in tablets rich in vitamins, minerals and nucleic acids. The fermenting process increases the level of nutrients and absorptive power. Finally an antioxidant compound was derived from modified vegetables and seeds, with low molecular weight having an S.O.D. - like activity (49). This targeting therapy is known as PSJ-53 therapy, had been first utilized in experiments to restore mutant P53, and were proven by P53 gene expression and P53 protein testing. Later experimentation in modulating BAX gene expression and targeting BCL2 and Survivin anti-apoptotic proteins (50), were shown to potentialize the efficiency of chemotherapy and radiation. Survivin, a unique member of the IAP’S inhibits Caspase 7-9 and promotes both cell proliferation and angiogenesis (51). Measuring and targeting Survivin remains a major goal in response to antineoplasic agents (52). We present three cancer cases with blood analysis reports of P53 gene expression and mutated protein levels before and after the treatment, along with two cases with complete figures of the pro-apoptotic and anti-apoptotic genes before and after treatment. 1 – A case of multi-cancer recurrence. 2 – Remission of breast cancer 3 – Pancreatic cancer 4 – Recurrence of colon cancer 5 – Lung cancer 6 - Glioma Methodology P53 pathway activity and other pro-apoptotic and anti-apoptotic genes were evaluated by measuring protein concentration and the level of P53 gene expression, BCL2, BAX, Survivin , and P21 in the same peripheral venous blood obtained from patients in the clinic. The enzyme-link immunosorbent assay (Elisa) was used together with the Polymer chain reaction (PCR) for the evaluation of the level of P53, BAX, Survivin, P21 gene expression and for the qualitative detection of P53 protein. Blood samples were collected in sterile tubes and sent to a laboratory specializing in molecular marker tests, which offers complete reports and discussion about each test. 9
  • 10. Table 1 - Effects of PSJ-53 Therapy on the Tumor Suppressor P53 Pathway M – Case of Multiple Cancer Recurrence P53 protein level units/ml of plasma No Date of blood sample collection Wild P53 Ref.range* <0.33 units/ml of plasma Mutated P53 Ref.range N.D.** P53 gene (wild expression level Ref.range * <106 copies/ml of plasma Comments 1 2 Feb 2009 N.D.** 26.1 2.7 x 105 The blood sample was collected prior to PSJ-53 therapy 2 18 May 2009 16.8 N.D.** 8.9 x 1011 The blood sample was collected after a 3 month course of PSJ-53 therapy 3 21 Sep 2009 156.0 N.D.** 1.5 x 1013 The blood sample was collected 4 months after completion of the PSJ-53 therapy during which time no further treatment was given. Table 2 – F – 48 years old: Breast Cancer – Breast Cancer in Remission 2009 P53 protein level units/ml of plasma No Date of blood sample collection Wild P53 Ref.range* <0.33 units/ml of plasma Mutated P53 Ref.range N.D.** P53 gene (wild expression level Ref.range * <106 copies/ml of plasma Comments 1 2 Feb 2010 N.D.** 52.5 52.245 The blood sample was collected prior to PSJ-53 therapy 2 19 Apr 2010 10.99 N.D.** 170.000 The blood sample was collected after a 2 month after completion of the PSJ-53 therapy The results clearly show the presence of mutated P53 prior to PSJ-53 therapy. However after 2 months of the treatment we reversed the mutant P53 to a normal wild type function, associated with an increase of the P53 gene expression and protein level during this period of time. 10
  • 11. Table 3 – F – 56 years old – Pancreatic Cancer – 5 Years of Remission P53 protein level units/ml of plasma No Date of blood sample collection Wild P53 Ref.range* <0.33 units/ml of plasma Mutated P53 Ref.range N.D.** P53 gene (wild expression level Ref.range * <106 copies/ml of plasma Comments 1 4 May 2009 N.D.** 52.5 52.245 The blood sample was collected prior to PSJ-53 therapy 2 4 July 2009 10.99 N.D.** 170.000 The blood sample was collected after a 2 month after completion of the PSJ-53 therapy 3 17 Nov 2009 67.4 N.D.** 1.2 x 106 The blood sample was collected after a 4 month after completion of the PSJ-53 therapy The results clearly show the presence of mutated P53 prior to the PSJ-53 therapy. However after 2 months of therapy followed by 4 months of treatment, we reversed the mutant P53 to a normal wild type function and gradually the P53 wild protein production had risen to a high level leading to increased self-destruction of cancer cells. Table 4 – M – 81 years old – Recurrence of Colon Cancer – Liver Metastases The patient refused chemotherapy but agreed to take some radiation therapy. He was sent by his medical doctor to take molecular markers testing to first check if radiotherapy will be efficient or not. P53, BAX or either P21 should be active, sensitive to radiation and increase self-destruction of cancer cells. New Reference range: P53 protein level wild – 0.10 – 1.00 units/ml of plasma P53 gene expression – 10-50 units/ml of plasma BCL2 gene expression - 10 units BAX gene expression - 10 – 100 units Survivin gene expression - 10 units P21 gene expression - 10 – 50 units 11
  • 12. P53 protein level units/ml of plasma No Date of blood sample collection Wild P53 Ref.range* <0.33 units/ml of plasma Mutated P53 Ref.range N.D.** P53 gene (wild expression level Ref.range * <106 copies/ml of plasma BCL-2 BAX Survivin P21 1 1 Mar 2011 N.D.** 10.88 N.D.** 390 N.D.** 129 N.D.** 2 11Jul 2011 N.D.** N.D.** 1.180 N.D.** 409 N.D.** N.D.** The results clearly show after 4 months of treatment a significant improvement and reversal of the mutant P-53 tumor suppressor gene. However the P53 gene didn’t induce the level of normal protein (Often because of a blockage of Puma). BAX gene expression is now active as a pathway to destroy cancer cells and the Oncogene BCL2 and Survivin are not active due to the applied treatment. Therefore the new pattern showed that cancer cells were destroyed and that radiotherapy would be efficient, increasing the destruction of cancer cells. The first report showed BCL2 and Survivin were slightly active (at risk) but after the treatment, were totally inhibited which contributed to increase the efficiency of chemotherapy/radiation regimen. After radiation therapy and further treatment with natural compounds, the patient was free from liver metastases. Table 5 – M – 50 years old – Lung Cancer P53 protein level units/ml of plasma No Date of blood sample collection Wild P53 Ref.range* <0.33 units/ml of plasma Mutated P53 Ref.range N.D.** P53 gene (wild expression level Ref.range * <106 copies/ml of plasma BCL-2 BAX Survivin P21 1 7Jan 2013 N.D.** 16.26 N.D.** 340 330 1.028 552 2 11Mar2013 0.1 N.D.** 3 2 5 5 4.527 12
  • 13. Ratio of the 1st Analysis – BCL/BAX - 0.89 - Survivin/P21 – 0.53 Ratio of the 2nd Analysis – BCL/BAX – 2.5 - Survivin/P21 – 905.4 – Too high to make a ratio The results clearly show after 2 months with PSJ-53 therapy that we reversed mutant P53 to a wild type function, however P53 protein was produced only to a certain extent. However we have targeted BCL2 and especially the high expression of Survivin to a normal range and eliminated resistance in some population of cancer cells and increased the self-destruction of cancer cells through chemotherapy/radiation with a resultant decrease in lung nodule size. P21 gene expression is very highly active (4.527) and promotes the self- destruction of cancer cells. P21 is a P53-independent channel to apoptosis and can be independent of P53 activated by another channel such as the TGF-B. P21 is very sensitive to radiation in destroying cancer cells. Table 6 – F – 8 years old – Glioma Postponed Chemotherapy after 3 surgeries with poor results. P53 protein level units/ml of plasma No Date of blood sample collection Wild P53 Ref.range* <0.33 units/ml of plasma Mutated P53 Ref.range N.D.** P53 gene (wild expression level Ref.range * <106 copies/ml of plasma BCL-2 BAX Survivin P21 1 6Jan 2013 0.2 N.D.** 1.344 2.066 1.714 1.734 2.192 2 11Mar2013 16.4 N.D.** 820 131 N.D.** N.D.** 229 We have clearly demonstrated that mutant P53 can be targeted together with other pro-apoptotic and anti-apoptotic genes using dietary compounds, which for many patients has been proven with many scientific examples. This is only one example and not the publication of cancer cases followed under 1 or 2 year period as we have done with many patients (This child has now been treated for over 2 years with excellent results, and has taken 5 blood analyses, Which each time indicated what treatment should be done. However, my last article in the Townsend Letter 2014 (p.68-74) showed complete cases relative to breast cancer with molecular markers testing done over a one year period 13
  • 14. and more. Step by step it showed improvement and the normal balance between the pro-apoptotic and anti-apoptotic genes (pp.68-74). New avenues are now focusing on targeting apoptosis in cancer, which include Oncogenes, BCL2, and Survivin that increases cancer cell resistance to chemotherapy/radiation regimen while scientific literature today has already accumulated thousands of articles on laboratory reports, theories, and studies. We urgently need to put into clinical practice what we have discovered and learned. Targeting P53 and other genes remain one of the greatest challenges in the treatment of cancer. We have been working now for over 8 years with molecular markers as a diagnostic, prognosis, and follow up to treatment, selected the appropriate bioactive dietary compounds or anticancer agents, exceeding 1000 cases, blood tests, and successes. This may be an incentive for more doctors to venture into this new direction in order to achieve more beneficial results with their patient treatment, especially in cases where we can verify the ones who would be refractory to chemotherapy and have a poor response. It is always best to first check through patient testing, to determine whether or not chemotherapy would be beneficial. 20th World Congress on Advances in Oncology 18th International Symposium of Molecular Medicine – October 8-10, 2015 Metropolitan Hotel – Athens – Greece Participants from nearly 36 countries In October we will participate in this important event that focuses on molecular medicine and opens the door to a new conception of future diagnostics and personalized treatment that predicts outcome in advance. The purpose of the Congress is to offer a significant opportunity to share the knowledge that cancer cells are “addicted” to certain altered genes, a vulnerability that can be exploited therapeutically. These driver genes correspond to Oncogenes or tumor suppressor genes causing the tumor to grow and proliferate. Oncogenes as BCL2 or Survivin are two anti-apoptotic genes mostly expressed in cancer. The program includes at least 2 lectures on BCL-2. The preliminary presentation includes new Biomarkers for molecular medicine, the role of angiogenesis, the Japanese Kampa Medicine, lecture on herbal extract including curcuma which is a real opening in a Congress of Oncology. It is now more than 8 years since I have been involved with the study and clinical practice of Molecular Markers and cancer, including P53 mutation and we are able to modulate treatment of patients according to the results of the test and predict better how patients react to chemotherapy. 14
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  • 19. 47 – Xiaoynan C., Longhang C., Jinghua W. et al – Survivin: a potential prognostic marker and chemoradiotherapeutic target for colorectal cancer HR. J. Med Sc 2010 – 174-327.35. 48 – Jurasunas S., Galkina Taylor O. – How to target mutant P53 in a case of multiple cancer recurrence – Townsend Letter, August/Sept 2010, issue 325/26 p. 68-71. 49 – Jurasunas S. – Therapeutic application of a new low molecular antioxidant compound: Int Symposium on ROS and Nitrogen Species: Diagnostic, Preventive and Therapeutic value, 2002 – July 8-12 – St. Petersburg , Russia. 50 – Jurasunas Serge – Complementary approach to breast cancer targeting BCL2, BAX and Survivin gene expression – Townsend Letter August/Sept 2014 68-72. 51 – Shin S., Sung B.J., Cho Y.S., et al – Anti-apoptotic protein human surviving is a direct inhibitor of caspase 3 and 7 – 2001 – Biochemistry 40: 1117-23. 52 – Mita AC., Mita MM., Nawrocki ST., Giles FJ. – Survivin: Key regulator of mitosis and apoptosis and novel target for cancer therapeutics – Clin. Cancer Res. 2008: 14.5000.5. Author Contact Information: Professor Serge Jurasunas, N.D., M.D. (Hom) Holiterapias Rua da Misericordia, 137 – 1º 1200-272 Lisboa -Portugal Email: info@sergejurasunas.com www.sergejurasunas.com 19