Chapter
Induction of bone formation by cancer cells in bone
Suppression of bone formation
The bone microenvironment support cancer cell growth
Chapter 3 - Stem cell niches in the bone–bone marrow organ and their significance for hematopoietic and non-hematopoietic cancer
Niche and microenvironment
Osteoblastic and endothelial niches
Bone marrow stromal cells and the niche
The heterotopic transplantation system
Modeling the niche and probing its significance in disease
The niche in early metastatic growth
Chapter 4 - Deregulation of osteoblast differentiation in primary bone cancers
Normal osteoblastogenesis: general process and major regulatory mechanisms
Deregulated genes in bone tumors
Deregulated signaling pathways in bone tumors
Bone morphogenetic protein BMP and transforming growth factor-β (TGF-β) signaling
Receptor tyrosine kinase signaling
Intracellular signaling pathways
Deregulation of local regulatory mechanisms in bone tumors
Microenvironmental factors
Conclusions and perspectives
Chapter 5 - Contribution of osteoclasts to the bone–tumor niche
The vicious cycle of tumor–bone metastases
Tumor-derived factors stimulating osteoclasts
Bone-derived factors stimulating tumor cells
Other ways osteoclasts contribute to the bone-tumor niche
Chapter 6 - Involvement of osteocytes in cancer bone niche
Osteocytes: A multifunctional bone cell
Short overview of RANK/RANKL/osteoprotegerin and canonical Wnt signaling pathways
Central role of osteocytes in bone remodeling through RANKL and sclerostin regulation
Deregulation of RANK/RANKL and Wnt pathways in malignancy
Is there a direct link between malignant cells and osteocytes?
Conclusions and perspectives
Chapter 7 - Role of mesenchymal stem cells in bone cancer; initiation, propagation and metastasis
Introduction to the mesenchymal stem cell
Initiation: MSCs as progenitors of bone tumors
Propagation: Cancer stem cells in bone sarcoma
Metastasis: MSCs prepare the road for metastasis
Seed and soil and exosomes
Chapter 8 - Gap junction in bone remodeling and in primary bone tumors: osteosarcoma and Ewing sarcoma
Regulation of intercellular communication
Regulation of unitary conductance
Regulation of the channel number
Role of gap junctions in bone remodeling
Connexin and bone remodeling
Gap junction in primary bone cancers
Gap junction and primary bone tumors: osteosarcoma and Ewing sarcoma
Conclusion and perspectives
Chapter 9 - Macrophages and pathophysiology of bone cancers
Macrophage differentiation, polarization and activation status
Tumor associated macrophages
Macrophages in intravasation
Macrophages in extravasation
Macrophages in metastasis formation
Therapeutic interests on macrophages in bone cancer
Strategies interfering with cancer cell/TAM crosstalk
TAM depletion or polarization modulation strategies
Chapter 10 - Cytokines and bone cancers
Clinical observational studies on cytokines and bone cancer development
Cytokines in cancer cell metastasis to bone
The first steps of tumor invasion in bone
Cancer-induced bone disease
Cytokines and primary bone cancers
Conclusions and perspectives
Chapter 11 - Technical aspects: how do we best prepare bone samples for proper histological analysis?
Bone biopsy in humans or large animals
Microcomputed tomography (MicroCT)
Dehydration and infiltration
Preparation of accelerated MMA medium for infiltration and embedding
Fast infiltration and embedding method
Osteoid tissue and calcified bone
Argentophilic proteins (AgNOR method)
Histoenzymatic identification of osteoclast by TRAcP staining
Mast cell identification in mastocytosis
Living osteocytes in the bone matrix
Section 3 - Markers of bone cancer(cells, genes and proteins)
Chapter 12 - Bone remodeling markers and bone cancer
Monitoring of anti-tumor therapy
Conclusions and perspectives
Chapter 13 - Cancer stem cells in representative bone tumors: osteosarcoma, Ewing sarcoma and metastases from breast and prostat...
Introduction: the cancer stem cell theory and isolation assays
CSC evidence and origin in osteosarcoma
Stem cell features in Ewing tumor of bone
Bone metastasis stem cells
Conclusion: Limits of CSC evidence and therapeutic implications
Chapter 14 - Homeobox genes from the Dlx family and bone cancers
Chromosomic organization and structure of Dlx homeobox genes
Dlx homeobox gene transcripts
Biochemical peculiarities of DLX homeoproteins
Binding with other proteins
Dlx homeobox gene expressions and functions in skeleton
Embryonic development – morphogenesis
Bone growth – histogenesis
Dlx and osteoblast differentiation in membranous bones
Dlx and chondroblast differentiation in endochondral bones
Dlx and osteoclastogenesis
Dlx homeobox genes and cancers
Dlx expression in non-osseous cancers
Dlx expression in bone tumors
Bone metastasis: secondary bone tumors
Chapter 15 - MicroRNA implication in therapeutic resistance and metastatic dissemination of bone-associated tumors
MicroRNAs and chemoresistance
MicroRNAs and efflux pumps
MicroRNAs and apoptotic pathways
MicroRNAs, cell cycle control and proliferation
MicroRNAs as predictive treatment biomarkers
Conclusion and perspectives
Chapter 16 - Hypoxia and angiogenesis: from primary tumor to bone metastasis
Vascular endothelial growth factor
Hypoxia inducible factors
Hypoxia and tumor progression
Angiogenesis and tumor progression
Angiogenesis in metastatic bone cancer
Models to study angiogenesis
Anti-angiogenic treatments for bone cancer
Conclusion and perspectives
Part II - Primary bone tumors
Section 1 - Specific biological aspects
Chapter 17 - Modeling osteosarcoma: in vitro and in vivo approaches
Spontaneous disease models
Genetically engineered mouse models (GEMM)
Additional models to consider
Chapter 18 - Stemness markers of osteosarcoma
Stemness markers of osteosarcoma
Chapter 19 - Molecular pathology of osteosarcoma
Genomic instability and genetic changes
Alternative length of telomeres (ALT)
Tumor suppressor gene dysfunction in osteosarcoma
Oncogenes in osteosarcoma
Genes involved in osteosarcoma metastasis
Molecular insights into therapeutics
Chapter 20 - Gene and proteomic profiling of osteosarcoma
Genetic alterations: classical oncogenes and tumor suppressors
Other oncogenic alterations
Classical signaling pathways
Markers of disease progression
Factors contributing to chemoresistance
Factors contributing to OS metastasis
Markers derived from proteomics
Other markers influencing the phenotype
Conclusions and future perspectives
Chapter 21 - Ewing sarcoma family of tumors
Clinical features and pathogenesis
Morphology and pathogenesis
Staging and prognostic indicators
Recurrent and metastatic disease
Therapeutic targets for Ewing sarcoma
EWSR1-FLI1 fusion proteins
Chapter 22 - Biology of Ewing sarcoma
Ewing sarcoma’s oncogenes
The cell of origin of Ewing sarcoma
EWS-ETS modulated pathways
Interaction with microenvironment
Understanding metastatic disease
Chapter 23 - Osteoclast-rich lesions of bone: a clinical and molecular overview
Osteoclast-rich neoplasms of bone
Sites of involvement and imaging
New therapeutic approaches
Multicentric giant cell tumors
Metastatic giant cell tumors
Malignant transformation of giant cell tumors
The cherubism phenotype: cherubism, noonan-like/multiple giant cell lesion of the jaw and neurofibromatosis
Chapter 24 - Markers for bone sarcomas
Markers for osteogenic sarcomas
Markers in high-grade osteosarcomas
High-grade conventional osteosarcomas
Telangiectatic osteosarcoma
Markers in low-grade osteosarcomas
Markers for chondrogenic sarcomas
Markers in central and periosteal chondrosarcomas
Markers in peripheral chondrosarcomas
Markers in clear cell chondrosarcomas
Markers for Ewing family sarcomas and small blue cell tumors
Differential diagnosis between ESFT and mesenchymal chondrosarcoma
Differential diagnosis between ESFT and small cell osteosarcoma
Markers in other primary bone sarcomas
Markers in notochordal tumors
Epithelioid bone hemangioendothelioma
Chapter 25 - Margins and bone tumors – what are we talking about?
Margins, a mainstay in bone tumor management
Characterization of margins
What is an adequate margin?
Chapter 26 - Cytogenetics of bone tumors
Ewing sarcoma/primitive neuroectodermal tumor
Myogenic, lipogenic, neuronal, and epithelial tumors
Tumors of undefined neoplastic nature
Chapter 27 - Genetic aspects of bone tumors
Conventional chondrosarcoma
Dedifferentiated chondrosarcoma
Giant cell tumors of the bone
Conclusion and perspectives
Chapter 28 - Cytogenetic and molecular genetic alterations in bone tumors
Techniques for detecting genetic alterations in bone tumors
Genetic alterations in bone tumor entities
Central and periosteal chondrogenic tumors
Peripheral chondrogenic tumors
Mesenchymal chondrosarcoma
Other chondrogenic tumors
Epithelioid hemangioendothelioma
Undifferentiated high-grade pleomorphic sarcoma
Conclusions and perspectives
Chapter 29 - Genetics of giant cell tumors of bone
Cytogenetic analyses of GCT
Molecular analysis of GCT
Section 2 - Pre-clinical and clinicalaspects
Chapter 30 - Mammalian models of bone sarcomas
Importance of animal models of bone sarcoma
Criteria for a representative bone sarcoma model
Types of animal models and modes of tumor induction
Syngeneic and xenogeneic models
Syngeneic: K7, K12 and K7M2
Xenogeneic: SAOS-2 and SAOS-LM-sublines (SAOS-LM2 to SAOS-LM7)
Genetically engineered models of osteosarcoma
Rat models of osteosarcoma
Chapter 31 - Zebrafish models for studying bone cancers: mutants, transgenic fish and embryos
Advantages of zebrafish models for cancer research
Chapter 32 - Imaging of bone sarcomas
Magnetic resonance imaging
Nuclear medicine: bone scintigraphy and PET/CT (positron emission tomography/computed tomography)
Imaging characteristics and considerations of specific sarcoma types
Telangiectatic osteosarcoma
Low-grade central osteosarcoma (LGCOS)
Dedifferentiated chondrosarcoma
Chapter 33 - New therapeutic targets in Ewing sarcoma: from pre-clinical proof-of-concept to clinical trials
Therapeutic options for Ewing sarcoma
Inhibition of growth factor signaling pathways
IGF-1R/PI3K/AKT/mTOR signaling pathway
Targeting tumor microenvironment
Inhibition of angiogenesis
Targeting the pro-inflammatory microenvironment
Targeting the bone microenvironment
Hedgehog pathway inhibitors (SHH/PATCH/Smo/GLI)
Chapter 34 - Therapeutic approaches for bone sarcomas
Computer-assisted navigation
Therapeutic approaches for primary metastatic and recurrent disease
Conflict of Interest Statement
Chapter 35 - Chondrosarcoma of bone: diagnosis and therapy
Classic chondrosarcoma (grade I–III)
Dedifferentiated chondrosarcoma (ddCS)
Mesenchymal chondrosarcoma
Clear cell chondrosarcoma
Difficulties in making the diagnosis of chondrosarcoma
Diagnosis of low-grade chondrosarcoma
High-grade chondrosarcoma
Chemotherapy/radiotherapy
Therapy low-grade chondrosarcoma
Outlook for new therapeutic approaches
Chapter 36 - Apoptosis and drug resistance in malignant bone tumors
The Fas/Fas ligand pathway
Histone deacetylase inhibitors
Inhibition of glutathione S-transferase P1 (GSTP)
Apoptosis-relevant genes as prognostic markers
Apoptosis in Ewing sarcoma
The Fas/Fas ligand pathway
Apoptosis-relevant genes as prognostic markers
Apoptosis in chondrosarcoma
Chapter 37 - Giant cell tumors of bone
RANKL and GCTB: how understanding of pathogenesis drove development of highly active targeted therapy
Clinical studies of RANKL inhibitors
Part III - Bone metastases
Section 1 - Specific biological aspects
Chapter 38 - EMT process in bone metastasis
EMT in physiological processes and cancer
EMT in primary tumor and metastatic dissemination
EMT and metastasis to the bone
EMT and cancer stem cells
EMT, circulating tumor cells (CTCs) and disseminated tumor cells (DTCs) in the bone marrow
MET and outgrowth of metastasis
Bone marrow-derived cells in EMT and MET regulation
Therapeutic targets in bone metastasis and EMT
Chapter 39 - Histopathology of skeletal metastases
Several primary tumors with a predilection for skeletal metastasis
Metastatic carcinoma of unknown primary site
Chapter 40 - Disseminated tumor cells in bone marrow of cancer patients
Molecular determinants of metastatic spread
Clinical relevance of DTC in bone marrow
Chapter 41 - MicroRNA-mediated regulation of bone metastasis formation: from primary tumors to skeleton
Development of skeletal metastases
Cancer cells escape the primary tumor
Cancer cells colonize the bone marrow
Cancer cells alter bone remodeling to promote skeletal lesions
Deregulation of microRNA expression modulates multiple steps of the metastatic cascade
Experimental evidence for the involvement of microRNAs in the metastatic cascade leading to bone metastasis formation
Involvement of microRNAs in the early stage of metastatic dissemination to bone
miR-335, miR-126, miR-206
Involvement of microRNAs in the tumor cell homing and colonization of bone marrow
miR-204, miR-211, miR-379
Chapter 42 - Myeloma and osteoclast relationship
Osteoclastogenesis: molecular mechanisms
Pathophysiology of MM-induced osteoclastogenesis
Role of RANKL/RANK/OPG system
Role of chemokines in MM-induced bone destruction
Other factors involved in MM-induced OC activation
Role of osteocytes in the activation of OCs in MM
OCs support MM cell survival: the vicious loop
Section 2 - Pre-clinical andclinical aspects
Chapter 43 - In vivo models used in studies of bone metastases
Models used in the studies of breast cancer bone metastases
Mechanisms of bone metastasis formation
Mechanisms of bone metastasis formation
Intraosseous implantation
Mechanisms of bone metastasis formation
Mechanisms of bone metastasis formation
Mechanisms of bone metastasis formation
In vivo models of prostate cancer bone metastases
Mechanisms of bone metastasis formation
Bone metastasis from subcutaneous tumors
Models used in the studies of multiple myeloma bone disease
Tumor homing, colonization and development
Tumor homing, colonization and development
Tumor homing, colonization and development
Tumor homing, colonization and development
Tumor homing, colonization and development
Chapter 44 - Interventional radiologic techniques in management of bone tumors
Embolization of metastatic bone lesions
Embolization of non-metastatic bone lesions
Complications and post-embolization scenarios
Variations of vertebroplasty
Chapter 45 - Diagnosis of bone metastases in urological malignancies – an update
Serum and bone markers for bone metastases
Newer markers not yet in clinical practice
Procollagen extension peptides
Tartrate-resistant acid phosphatase
Fasting urinary calcium and hydroxyproline
Positron emission tomography
Magnetic resonance imaging
Urological malignancies – recommendations
Chapter 46 - Pre-clinical molecular imaging of “the seed and the soil” in bone metastasis
Clinical Need for Improved Imaging Modalities
Pre-clinical models to study tumor progression and metastasis
Small animal imaging modalities
Magnetic resonance imaging (MRI)
Micro-computed tomography (mCT)
Multispectral optoacoustic tomography (MSOT)
Micro-positron emission tomography (PET) and single photon emission computed tomography (SPECT)
Conclusions and future perspectives
Chapter 47 - Mechanisms and management of bone cancer pain
Epidemiology of bone cancer pain
Models of bone cancer pain
Nervous system reorganization in response to cancer-related bone pain
Pain management strategies
Cytokines and growth factors
Chapter 48 - Bone cancer: current opinion in palliative care
Development of murine model of bone cancer
Unique sensory innervation of bone
Tumor induced acidosis, bone pain, and fracture
Tumor associated stromal cells
Sensory and sympathetic nerve injury and sprouting in the tumor-bearing bone
Bone cancer-induced central sensitization
Chapter 49 - Involvement of sympathetic nerves in bone metastasis
The vicious cycle of bone destruction
What primes the vicious cycle?
Chronic stress reduces survival rate in patients with breast cancer
Influence of sympathetic nerves on the bone microenvironment
Effect of chronic stress on bone metastasis
Beta-blockers for the prevention of breast cancer metastasis
Implications for other types of solid and blood cancers
Chapter 50 - Pain control with palliative radiotherapy in patients with bone metastases
Principles of palliative radiation therapy
Mechanism of action in relief of painful bone metastases
Assessment of quality of life
Local field radiation therapy: clinical trials
Wide field radiation therapy: clinical trials
Side effects of local field radiotherapy
Radiotherapy-induced nausea and vomiting
Side effects of wide field radiotherapy
Post-operative radiotherapy
Complications of bone metastases
Impending fracture and risk prediction
Malignant spinal cord compression
Other treatment modalities and their Integration with external beam radiotherapy
Radiotherapy and minimally invasive surgical techniques
Stereotactic body radiotherapy
Radiotherapy and radiopharmaceuticals
Local radiotherapy, hemi-body irradiation and radionuclides: a comparison
Radiotherapy and bone-modifying agents
Perspectives and conclusions
Chapter 51 - Cellular and molecular actions of bisphosphonates
Simple BPs are converted to toxic metabolites
Nitrogen-containing BPs inhibit FPP synthase
N-BPs prevent the prenylation of small GTPase proteins
Inhibition of FPP synthase causes accumulation of IPP and the formation of ApppI
Anti-tumor actions of bisphosphonates
Conclusions and perspectives
Chapter 52 - The use of nitrogen-bisphosphonates to capture the potent anti-tumor arsenal of human peripheral blood γδ T cells for the t...
γδ T cells: lymphocytes intrinsically engineered for cancer immunotherapy
A fortuitous happenstance: when nitrogen-bisphosphonates and human peripheral blood γδ T cells met
Turning potential into practice: γδ T cells and nitrogen-bisphosphonates for cancer immunotherapy
In Summary: moving bone cancer management forward with the support of γδ T cells
Chapter 53 - Systemic treatment of bone metastases in castration-resistant prostate cancer (CRPC): pre-clinical to clinical poin...
Pathophysiology and pre-clinical advances
Cellular and molecular aspects of bone metastases development
New therapeutic approaches to treat bone metastases
Clinical complications and treatments
Health and economic burden of bone metastases in PCa
SREs: a serious complication of bone metastases
Current teatment options for preventing or delaying SREs
Adverse events of zoledronic acid and denosumab
Radionuclide therapy in the pain caused SREs
Novel promising bone-targeting agents on the horizon in clinic
Chapter 54 - A multi-targeted approach to treating bone metastases
A model for successful cancer metastasis to bone
Targeting osteoclast function
Targeting osteoblast function
Targeting endothelial cell function
Enhancing immune response
Targeting tumor associated macrophages
Targeting hematopoietic progenitor cells
Chapter 55 - Bone metastases in prostate cancer: pathophysiology, clinical complications, actual treatment, and future directions
Mechanisms of bone metastasis
Role of radiation therapy in the management of painful bone metastasis
Malignant spinal cord compression
Role for systemic corticosteroids
Indications for RT in the management of MSCC
Role of denosumab and zoledronic acid
Systemic treatment options
Chapter 56 - Bone-targeted agents and skeletal-related events in breast cancer patients with bone metastases
Incidence, prevalence and survival
Diagnosis and types of bone metastases
Clinical consequences of bone metastases
Response to treatment in bone metastases
Predicting bone metastases
Bone physiology and turnover
Pathophysiology of bone metastases
Treatment of bone metastases
General principles of management
Bisphosphonates and new bone active agents
Clinical trials and use of bisphosphonates and bone active agents in breast cancer
Reduction of skeletal complications
Chapter 57 - Bone metastases – current status of bone-targeted treatments
Multidisciplinary management of bone metastases
Bone-targeted agents in oncology
Prevention of skeletal morbidity in metastatic bone disease
Practical recommendations on use of bone-targeted agents in advanced cancer patients
Chapter 58 - Bone metastases, clinical trials II: zoledronic acid and denosumab in the prevention of bone metastases
Introduction and background
Z-FAST, ZO-FAST, and E-ZO-FAST
Adjuvant denosumab trials
Conclusion and perspectives