Clocking In With Cancer Treatment

I always hesitate to say things like ‘you may recall’ as, from much undergraduate teaching, I’ve learned that blithe throwaways like ‘you’ll remember this from last Monday’s lecture’ tend to be met with blank stares and trying ‘you met this idea in the first year’ on second year classes will draw forth outright mirth blending with mutinous howls. So let’s just start by noting that three weeks ago in Our Inner Self we had a march-past of our intestinal army of bacteria and saw that it is in continuous flux, its make-up oscillating in time to our biological clock – the daily variation that governs most of our bodily functions including the sleep-wake cycle. That’s amazing stuff but a sharp bit of lateral thinking raises interesting questions. If most of the important things in our bodies tick to circadian rhythms, is cell proliferation one of them – after all, the process of cells making more of themselves is at the heart of life. Answer ‘yes.’ But, as abnormal cell proliferation – i.e. something going wrong – is a perfectly adequate three-word definition of cancer, a small step extends the question to ‘do tumours also have rhythm?’ Answer, again, ‘yes.’ A little background before we explain.

Turning back to the clock

In Twenty more winks we saw that there’s a connection between sleep (or rather lack of it) and cancer and showed how two pairs of genes (CRY/PER and CLOCK/BMAL1) lie at the core of circadian timekeeping. They control the sleep-wake cycle and much else. The proteins they make form an orchestrated feedback loop, synchronised by light-induced signalling. That is, the expression of each pair oscillates with a period of roughly 24 hours, but the pairs are out of step to the tune of about 12 hours. The proteins encoded by these genes regulate the expression of many other genes that ensure the cells and tissues of the body beat to an appropriate rhythm. Many messengers spread circadian oscillations around the body via the blood of which, in humans, cortisol (made by the adrenal glands) is perhaps the most familiar (it’s a steroid hormone: the medication dexamethasone is cortisol with two small, extra bits that make it 25 times more potent). You can fairly easily measure cortisol concentration in blood and you’d expect to find that at nine in the morning you’d have roughly double your midnight amount. In other words cortisol is part of your wake-up call. It turns on your appetite, gets you geared up for physical activity and it also activates anti-stress and anti-inflammatory signal pathways. EGFR & cortisol Cross-talk between EGFR and cortisol during the active phase (right: high cortisol) and the resting phase (left: low cortisol). (from Lauriola et al., 2014).

Getting the message across

Taking the memory-prodding risk yet again, in Mission Impossible? we described how biological signals from the outside world bind to receptors (proteins) to convey their message (I’m here, do something!) to the interior of cells. So the picture is: cells receive many signals from messengers that, one way or another, talk to the nucleus, switching on genes that drive proliferation. Most external messengers are proteins themselves – one example is a potent growth promoter called epidermal growth factor (EGF) that works by switching on the EGF receptor (EGFR). Cortisol isn’t a protein: as we’ve noted, it’s a steroid – which means it can diffuse across membranes – but, once inside a cell it works in essentially the same way, by binding to its specific receptor. The upshot of all this is that messengers transmit information from outside the cell to the nucleus – where DNA lives, the cells’ repository of genetic material – so that genes become activated to produce proteins.

Oscillating signals: cellular chattering

The picture of multiple, linear signalling pathways co-existing within cells invites the idea that their protein components might be unable to resist tapping in to their neighbours’ conversations – and so it has turned out. However, for pathways like the EGFR that signal cell growth, cross-talk with cortisol signalling is more than merely listening in. Proteins activated by the steroid hormone can actually interfere with the relays in the EGFR pathway so that EGF signals are suppressed during the active phase (day-time in us, night-time in rodents) but enhanced during the resting phase.

The meaning for life

So growth signaling is under circadian control – by and large our cells do their multiplying when we are at rest. Interesting although perhaps not unexpected. But, as The Bonzo Dog Doo-Dah Band warbled, ‘here comes the twist’ (Urban Spaceman, 1968 if you’re struggling). These pathways are the very ones that are hyper-activated (i.e. mutated) to drive cancer cells to make more of themselves and they are, accordingly, the targets for many anti-cancer drugs. However, chemotherapy is usually administered as single bursts, at daily or longer intervals, and drugs are progressively removed by metabolism thereafter. This means that much of the impact may be lost if, when the drug concentration is at its highest, the target pathway is already suppressed by high glucocorticoids . There’s evidence consistent with this idea from animals bearing EGFR-driven tumours treated with specific inhibitors that are more effective if administered in the resting phase rather than in the active phase.

It’s all in the timing

So two new messages are now making themselves heard in the world of cancer biology. The first is beginning to tell the full story of clock complexity. The second takes up this theme by pointing out that a circadian clock-based model in cancer therapy may offer improved methods for prevention and treatment.


Lauriola, M. et al. Diurnal suppression of EGFR signalling by glucocorticoids and implications for tumour progression and treatment. Nat. Commun. 5:5073 doi: 10.1038/ncomms6073 (2014).