Gastric cancer (GC) is the fourth most common type of malignity and the second leading cause of cancer death worldwide. Infectious agents such as Helicobacter pylori (H.pylori) and Epstein-Barr virus (EBV) play important role in the etiology in GC. EBV is a double-stranded DNA virus, approximality 184 kb in size, included in Herpes virus family and is the first virus determined in human neoplastic cell. EBV associated gastric cancer (EBVaGC) constitutes approximately 10% of whole GC in wordlwide. DNA hypermethylation in promotor region of tumor supressor genes is seen frequently in the genetic basis of EBCaGC. It is not a clear subject how EBV infection induce the methylation. In this review, the current literature about the gene promotor region hypermethylation in EBVaGCs will be revised.
Keywords:Gastric cancer, Epstein-Barr virus, DNA hypermethylation
IntroductionGastric cancer (GC) is a malignancy that is in fourth place in the world in terms of incidence and in second place in cancer-related deaths (1, 2). GC, which is a malignancy having a multifactorial etiology, shows a heterogeneous behavior in biological and genetic aspects (3). The main reason for the pathogenesis is chronic Helicobacter pylori (H. pylori) infection. The International Cancer Research Agency accepted H. pylori as a class 1 carcinogen in 1994. This classification was updated and approved again in 2009 (3). The other infectious agent associated with gastric carcinogenesis is Epstein-Barr virus (EBV).Though early diagnosis in recent years, improved surgical techniques, and improvements in perioperative care conditions have influenced the clinical course of GC in a positive way, GC is still a major problem because of its high prevalence, poor prognosis, and limited treatment options (2). Due to the advanced stage of disease at diagnosis, 5-year survival is only 20%-30% (4). The fatality rate of GC is higher than colon, breast, and prostate cancers that are common.The prognosis of gastric cancer depends on its stage at diagnosis and the selection of appropriate treatment strategies. The identification of new molecular markers in the early diagnosis of cancers and the therapeutic strategy will positively affect the clinical course of the disease. This will be possible only with the understanding of the biological behavior of the tumor. In this compilation, recent literature will be reviewed about the relationship between DNA hypermethylation observed in EBV and in GC.
DNA methylationCancer occurs by the accumulation of genetic and epigenetic changes over a long period. DNA methylation is common in cancer and is divided into two categories: "whole genome hypomethylation" and "regional hypermethylation" (5).Genome hypomethylation is evaluated as the decrease in 5-methylcytosine content in the entire genome (5). This is particularly seen in repeat sequences, which constitute more than 40% of the genome and are quite methyl under normal conditions. Genome hypomethylation seen in almost all cancers increases the progression of cancer by causing g...