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- FIGURE 6-10. Model of multistep tumor progression incorporating
- current concepts of genetic changes occurring during tumorigenesis
- Genetic changes such as loss of pRb function and overexpressed c-myc
- lead to increased cell proliferation; however, these changes also lead
- to increased apoptotis and thus no significant net increase in cell
- number. The viral gene products, E1A from adenovirus, T antigen from
- SV40, and E7 from human papilloma virus, appear to have similar
- effects on the cell by virtue of binding to pRb. However, subsequent
- genetic changes which decrease apoptosis tendencies can occur, such as
- loss of p53 function or overexpression of bcl-2, and would lead to
- increases in tissue cell number. Viral gene products, such as
- adenoviral E1b, SV40 large T antigen, and HPV E6, appear to exert this
- effect by binding to p53 protein. Subsequent genetic changes can lead
- to further alterations in phenotype, such as invasiveness and
- metastasis. Though the order of events may vary in different
- tumorigenesis settings, the concept that both increased proliferation
- signals and decreased cell death signals contribute to this
- progression probably applies to most tumor types. (Concept adapted
- from Symonds and colleagues. Cell 1994;78:703)
-