Tumor development follows an evolutionary pattern of "mutation-selection-adaptation", characterized by exogenous oncogenic induction and endogenous replicative stress. The fragile histidine triad (FHIT) is a tumor suppressor. Tumor suppressor genes with regular expression inhibit cell proliferation and tumorigenesis. Decreased FHIT expression leads to the malignant transformation of affected cells and promotes the evolutionary development of cancer. Aberrant transcripts or decreases in the transcription and translation of the FHIT are present in at least 50% of preneoplastic lesions and human cancers, especially in esophageal, lung, liver, stomach, pancreatic, kidney, skin, breast, and cervical cancers. Abnormal expression of the FHIT is also evident in hyperplastic lesions, suggesting that the inactivation of the FHIT plays a vital role in inhibiting the formation of early preneoplastic and premalignant lesions. There are three basic pathways leading to the aberrant expression of the FHIT: replication stress, loss of heterozygous (LOH), and CpG methylation at the promoter region.
1. Introduction
Over the past few decades, cancer has become the second leading cause of human death
[1], leading to enormous economic and medical burden. Cancer development represents an evolutionary process. Many attempts have been made to identify possible causes and evolutionary factors for cancer
[2]. Cancers of most histological types result from persistent stimulation of both exogenous and endogenous carcinogenic factors. The endogenous contributors of carcinogenesis mainly includes ageing, genetic predisposition, metabolic syndrome, and non-resolving inflammation
[3], while the exogenous contributors includes tobacco smoking, air pollution, radiation, toxins such as aflatoxin, and chronic infection with viruses and bacteria. Usually, exogenous oncogenic factors induce carcinogenesis via activating endogenous factors such as apolipoprotein B mRNA-editing enzyme catalytic polypeptide-like (APOBEC) family members and/or inactivating another group of endogenous factors including the fragile histidine triad (FHIT). Interaction of exogenous contributors and endogenous contributors should be important in understanding the mechanisms of carcinogenesis. For instance, hepatitis B virus (HBV)-induced hepatocarcinogenesis is significantly associated with genetic predisposition-determined immune selection of some HBV mutations, HBV integration into human genome, and non-resolving inflammation caused by HBV replication
[4][5]. A cancer evolutionary theory presented by Henry Heng states that due to either exogenous oncogenic factors such as viral/bacterial infections, exposures to carcinogens and other stressors, and/or endogenous factors such as tissue/organs constrains or chromosomal instability, genomic chaos appears in a cell, leading to genomic disorganization, aneuploidy, and polyploid giant cancer cells. This is called the macroscopic stage of cancer evolution, or macroevolution, a discontinuous and rapid process causing the entire cell karyotype to be reorganized. This process is followed by a slower phase of continuous microevolution, or stepwise Darwinian clonal evolution, and a process of adaptation and selection then passes on new karyotypes in a gradual, slow and continuous manner, eventually evolving into cancer
[6][7]. During this microevolutionary stage, the positive selection of cancer gene mutations and epigenetic factors can contribute to mutated cell growth
[8]. Continuous cycling between macroevolution and microevolution via the polyploid and diploid genomes creates a highly dynamic evolving system for malignant transformation in response to endogenous and exogenous stresses
[9]. The process of tumorigenesis follows an evolutionary pattern of “mutation-selection-adaptation” in affected cells
[5][10]. Typically, mutations in acute inflammation are quickly cleared or repaired and do not drive cancer development
[11]. In persistent external stimuli or chronic unresolved inflammation, proinflammatory molecules such as interleukin-6 (IL-6) may
trans-activate the expression levels and/or alter the expression patterns of corresponding mutation-promoting genes including activation-induced deaminase (AID)/APOBEC3 family members and epigenetic modifying genes such as histone deacetylases (HDAC) within normal cells, resulting in multiple somatic mutations and epigenetic changes in cell cycle- and metabolism-related genes that can accumulate in the affected cells
[5]. Endogenous APOBEC3 cytosine deaminases generate prevalent mutational signatures in human cancer cells
[12][13]. During HBV-induced hepatocarcinogenesis, a large number of HCC-risk HBV mutations, aneuploidy, and somatic mutations emerge, which facilitates the evolutionary development of hepatocellular carcinoma (HCC). The affected cells might transform surrounding fibroblasts into cancer-associated fibroblasts (CAFs) via secreting some proinflammatory cytokines. CAFs recruit some immune inhibiting cells including M2 macrophage, myeloid derived suppressor cell, neutrophil, regulatory T (Treg) cells, and endothelial to establish the tumor microenvironment (TME)
[5][10]. During HBV-induced hepatocarcinogenesis, the HBV mutations in the HBx gene and the large S gene, which are generated by incompetent immunity during the chronic infection, in turn promote the generation of pro-inflammatory TME via secreting plasminogen activator inhibitor-1 and activating STAT3 signaling pathways, respectively
[14][15]. Under selection pressures of TME and accompanying hypoxia, a small number of viral or somatic mutations conferring “stemness” and survival advantage to the mutated cells are selected out. High-grade tumor development is remarkably similar to pre-embryogenic development
[9]. Retro-differentiation or reverse development, which is in contrast to embryogenic development, is common in cancer development. When positive selection outweighs negative selection, some driver mutations accumulate, leading to cancer development, recurrence, and metastasis
[16][17]. Finally, these cells gain stemness and strong clonal capacity through reverse differentiation and/or epithelial–mesenchymal transition (EMT), adapting to the TME
[5][10][18][19]. Based on evidence obtained in HBV-induced hepatocarcinogenesis and other research,
rwe
searchers proposed a novel theory of cancer development, namely Cancer Evo-Dev
[5][10].
Throughout the process, the APOBEC3 signature mutation is a key to the signature mutation of most cancer types
[12][13][20]. Aberrant expression of APOBEC3B can generate several C>U or C>T mutations in the genome that drive cancer development
[21][22]. APOBEC3B mutations prefer to induce mutation in single-stranded DNA (ssDNA)
[23]. Therefore, genes that promote the rise of ssDNA in the genome are critical in cancer evolution. Decreased FHIT expression, especially FHIT deletion, increases double-bond breaks in the genome and increases levels of ssDNA
[24][25]. As ssDNA is an optimal substrate for the AID/APOBEC3 cytidine deaminases, the FHIT facilitates the mutagenic effect of AID/APOBEC3s. Thus, the FHIT might bridge macroevolution and microevolution, the two sequential forms of cancer evolution. As discussed late
in this article, FHIT loss facilitates the development of the EMT. Thus, the role of the FHIT is indispensable in Cancer Evo-Dev.
The
FHIT gene, located on chromosome 3p14.2, was identified in 1996 through exon capture
[26]. The FHIT is a histidine triplet protein superfamily member, a diadenosine 59,5–P1, P3-triphosphate (Ap3A) hydrolase. The
FHIT gene consists of ten exons, of which exons one to four and ten are involved only in transcription. Exons five to nine are protein codons that form an open reading frame (ORF), encoding a small protein of 147 amino acids
[25]. The 5′ end contains a noncoding region, and the 3′ untranslated region has a poly-A consensus sequence and a poly-A tail. The FHIT functions as a tumor suppressor. The tumorigenicity of the FHIT-transfected cells is significantly reduced in vivo
[25][27].
2. The Fragile Histidine TriadIT/FRA3B Is Sensitive to Replication Pressure
The FHIT gene spans a 2-Mb genome and contains one of the most common fragile sites (CFSs), FRA3B
[28]. FRA3B deletions are frequently observed in cancer cells due to endogenous or exogenous damage. The corresponding deletion of the FHIT protein after FRA3B deletion may predict malignant tumor formation
[29][30]. Studies show that the changes in the FHIT expression are associated with FRA3B deletion
[31]. CFSs are preferentially unstable in pre-cancerous lesions or preneoplastic stages, leading to altered gene function during tumorigenesis or progression
[32]. CFSs are genomic loci prone to the formation of breaks or gaps on metaphase chromosomes, which are characterized by AT-rich sequences, complex replication, and transcriptional repression due to late replication timing and large transcription units
[33]. The completion of replication at CFS occurs very late in the cell cycle at mitosis through a process termed mitotic DNA synthesis (MiDAS)
[34]. The transcriptional process of oversized genes often extends well beyond one cell cycle and even into the next, leading to simultaneous replication and transcription and creating "fragility"
[35]. Typically, CFSs are stabilized by relaxing the DNA superhelix and restricting the formation of R-loops to resolve transcription–replication collision
[32][36][37]. CFSs are hypersensitive to replication stress. When stimulated by exogenous or endogenous factors, they are highly susceptible to breakage
[38]. Early pre-cancerous lesions create a continuous environment of replication stress. FRA3B is one of the most common CFSs, and exposure to constant stress predisposes it to more breakage due to replication–transcription conflicts.
3. Repeated Breakages and Repairs Cause Loss of Heterozygosity in the Fragile Histidine ITriad
After DNA damage, DNA repair is performed by the flanking, long interspersed nuclear element 1. Aphidicolin blocks replication forks in replicating S-phase cells, resulting in DNA double-strand breaks (DSBs). The extent of DNA end excision is the primary factor determining whether repair proceeds via non-homologous end joining (NHEJ) or homologous recombination. NHEJ occurs at any time throughout the cell cycle, unlike homologous recombination, which occurs mainly in the S/G2 phase
[33][39]. Prolonged and repeated breaks and repairs cause improper segregation of chromosomes during mitosis, resulting in LOH
[40][41]. LOH is evident at the FHIT in more than 90% of lung tumors, and at least one allele of three markers (D3S1300, D3S1312, or D3S1313) is lost in the primary tumor and the corresponding bronchoalveolar lavage fluid
[42]. There are 11 recurring breakpoint/repair regions, and deletions occur mainly between intron three (near exon four) and intron five (150 kb distal to exon five)
[43]. In addition, splicing events also affect the FHIT expression, usually appearing as exon 4–6 deletions caused by aberrant splicing in exons 3–7 and exon 4–8 deletions caused by aberrant splicing in exons 3–9. 82% of colorectal adenocarcinomas have the FHIT deletions, fragment insertions, point mutations, or alternative splicing in exon ten
[44]. Notably, partial deletion of the FRA3B sequence does not reduce the occurrence of breakages and instability within the remaining sequences at the FHIT gene, with the highest frequency of chromosomal breaks and gaps occurring in the 300-kb interval between exon four and D3S1300
[45]. Depletion of FHIT neither activate the DNA damage response nor cause cell cycle arrest, allowing continued cell proliferation and ongoing chromosomal instability. LOH can be fatal in inactivating the function of the FHIT, which prevents the FHIT from acting as a “gene caretaker”, leading to a significant increase in genomic instability.
4. CpG Methylation at the Fragile Histidine TriadIT Promoter Region
Methylation at the FHIT gene promoter is also an essential mechanism of the promoter inactivation. The methylation tends to suppress the expression of the FHIT, allowing the generation and accumulation of mutations in tumors that drive the evolutionary development of cancer
[29]. In locally advanced lung cancer, FHIT mRNA expression is frequently absent via the CpG methylation
[46]. For Asian populations, aberrant methylation of the FHIT can be used as a potential diagnostic biomarker for non-small cell lung cancer
[46]. The FHIT
low/pHER2
high signature is associated with the higher size of tumors, lymph node involvement, and late TNM stages, serving as an independent predictor of poor prognosis in lung adenocarcinoma whilst also being predictive of a poor response to immune checkpoint inhibitors in advanced lung cancer
[47]. Double allelic inactivation of the FHIT gene and its complete silencing of the FHIT gene by heterozygous deletion has also been found in breast cancer
[48]. Exposure to ambient air pollution throughout life may be associated with DNA methylation of some tumor suppressor genes such as FHIT in breast tumor tissue
[49]. In esophageal cancer, variations in the FHIT gene mainly arise from a loss of exon five or eight or hypermethylation of the FHIT promoter
[50]. Nevertheless, it remains unknown how the CpG methylation is induced. Because inactivation is often observed at the early stages of pre-cancerous lesions, it is likely to be caused by chronic inflammation or activated oncogenes.