The epidermal growth factor receptor (EGFR) and its ligands figure prominently in the biology of gliomas, the most common tumors of the central nervous system (CNS). Although their histologic classification seems to be straightforward, these tumors constitute a heterogeneous class of related neoplasms. They are associated with a variety of molecular abnormalities affecting signal transduction, transcription factors, apoptosis, angiogensesis, and the extracellular matrix. Under normal conditions, these same interacting factors drive CNS growth and development. We are now recognizing the diverse molecular genetic heterogeneity that underlies tumors classified histologically into three distinct grades. This recognition is leading to new therapeutic strategies targeted directly at specific molecular subtypes. In this article, we will review the role of EGFR and related molecular pathways in the genesis of the normal CNS and their relationship to glial tumorigenesis. We will discuss barriers to effective treatment as they relate to anatomic specialization of the CNS. We will also consider the ways in which specific EGFR alterations common to glioma reflect outcomes following treatment with targeted therapies, all with an eye towards applying this understanding to improved patient outcomes.
Epidermal growth factor (EGF) was identified by embryologistStanley Cohen in the early 1960s and its receptor (EGFR) was identified a decade later (1, 2). During that time and in the decades that followed, a family of related factors and their receptors were identified. The complex intracellular effects that follow activation of these receptors were subsequently elaborated. Together, this would prove to be of critical importance in our understanding of both normal growth and development and neoplastic transformation. This review will focus on the role of these receptor-ligand interactions in primary brain tumor biology. We will briefly discuss their importance in the development of normal brain and the implication of those roles for tumorigenesis. Following a review of specific abnormalities in brain tumors, we will conclude with a summary of brain tumor therapies that include EGFR-mediated signaling in their rationale.
Receptor-Ligand InteractionsThe EGFR was the first of the human EGF receptor (HER) family members to be discovered. The HER family proteins are members of the receptor tyrosine kinase (RTK) superfamily. The platelet-derived growth factor receptor (PDGFR), another RTK family member, is also important in brain tumor biology. The ligands for the HER family receptors are also diverse. They include the EGF family and the structurally related neuregulin family. Both are produced by many cell types, including neurons and glia. All of the ligands function via autocrine and/ or paracrine signaling. The EGF family includes EGF, transforming growth factor-a (TGF-a), heparin-binding EGF, amphiregulin, betacellulin, and epiregulin (3).The neuregulin (NRG) family consists of the protein products derived from the alternat...