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Selective Killing: How Chemotherapy Harms Cancer Cells More Than Normal Cells

1The Selectivity Problem: Why Preferential Killing Is Possible but Imperfect2Proliferation as the Primary Vulnerability: Cell-Cycle Dependence3Antimetabolites and the S-Phase Trap4Microtubule Poisons and Mitotic Arrest5DNA-Damaging Agents: Alkylators, Crosslinkers, and Topoisomerase Poisons6The DNA-Damage Response and the Decision to Die7Why Selectivity Fails: Normal-Tissue Toxicity and the Limits of the Window8Resistance: How Tumors Escape and What It Reveals About Selectivity9Widening the Window: Clinical Strategies That Exploit Selectivity
Proliferation as the Primary Vulnerability: Cell-Cycle Dependence

The Cell Cycle and Its Checkpoints

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Think of the cell cycle as a production line with four stations. In G1 the cell grows and checks whether conditions are right to commit to division. In S phase it copies all its DNA. In G2 it verifies the copy is complete and builds the machinery for division. In M phase it separates the chromosomes and splits in two. Cells that leave the line sit in G0. Checkpoints are the quality-control gates: the G1/S checkpoint asks whether the DNA is intact before replication begins, the G2/M checkpoint asks whether replication finished cleanly, and the spindle checkpoint asks whether every chromosome is attached before separation. Antimetabolites block S phase because that is when DNA building blocks are needed. Microtubule poisons block M phase because that is when the spindle must function. Notice that a cell must pass through the sensitive phase while the drug is present for the drug to act — this is why timing matters.
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The cell cycle is the ordered sequence of events by which a cell duplicates its contents and divides into two daughter cells. It has four main phases. G1 (first gap) is a growth phase in which the cell increases in size and prepares for DNA synthesis. S phase is when DNA replication occurs; each chromosome is copied to produce two sister chromatids. G2 (second gap) is a further growth and preparation phase in which the cell checks that replication is complete and assembles the machinery for division. M phase (mitosis) is when the duplicated chromosomes are segregated and the cell divides. Cells that are not actively dividing exit the cycle into G0, a quiescent state that can be temporary or permanent.

Progression through the cycle is controlled by checkpoints — surveillance mechanisms that verify the previous phase is complete before allowing the next to begin. The G1/S checkpoint (the restriction point in mammalian cells) asks whether the cell has sufficient size, nutrients, and undamaged DNA to commit to replication. The G2/M checkpoint asks whether DNA replication is complete and whether any damage remains unrepaired before the cell enters mitosis. The spindle assembly checkpoint, which operates during M phase, asks whether every chromosome is properly attached to the mitotic spindle before anaphase begins. If a checkpoint detects a problem, it halts progression and either allows time for repair or triggers apoptosis.

Different classes of chemotherapy drugs act at specific points in this cycle. Antimetabolites (such as methotrexate and 5-fluorouracil) interfere with DNA synthesis and therefore act during S phase. Microtubule poisons (such as vincristine and paclitaxel) disrupt the mitotic spindle and therefore act during M phase. Alkylating agents and topoisomerase poisons damage DNA and can act in any phase, though their lethal effects are often expressed when the damaged DNA is replicated in S phase. This is the basis for the phase-specific versus phase-nonspecific classification.

References

  1. [1]The Cell Cycle — NCBI Bookshelfncbi.nlm.nih.gov
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