In gene therapy to treat cancer, typically only a fraction of the tumor cells can be successfully transfected with a gene. However, in the case of brain tumor therapy with the thymidine kinase gene from herpes simplex virus (HSV-tk), not only the cells transfected with the gene but also neighboring others can be killed in the presence of ganciclovir. Such a "bystander" effect is reminiscent of our previous observation that the effect of certain therapeutic agents may be enhanced by their diffusion through gap junctional intercellular communication (GJIC). Herein, we present the evidence, from in vitro studies, that gap junctions could indeed be responsible for such a gene therapy bystander effect. We used HeLa cells for this purpose, since they show very little, if any, ability to communicate through gap junctions. When HeLa cells were transfected with HSV-tk gene and cocultured with nontransfected cells, only HSV-tk-transfected HeLa cells (tk+) were killed by ganciclovir. However, when HeLa cells transfected with a gene encoding for the gap junction protein, connexin 43 (Cx43), were used, not only tk+ cells, but also tk- cells were killed, presumably due to the transfer, via Cx43-mediated GJIC, of toxic ganciclovir molecules phosphorylated by HSV-tk to the tk- cells. Such bystander effect was not observed when tk+ and tk- cells were cocultured without direct cell-cell contact between those two types of cells. Thus, our results give strong evidence that the bystander effect seen in HSV-tk gene therapy may be due to Cx-mediated GJIC.

Gap junctions comprise arrays of intercellular channels formed by connexin proteins and provide for the direct communication between adjacent cells. This type of intercellular communication permits the coordination of cellular activities and plays key roles in the control of cell growth and differentiation and in the maintenance of tissue homoeostasis. After more than 50 years, deciphering the links among connexins, gap junctions and cancer, researchers are now beginning to translate this knowledge to the clinic. The emergence of new strategies for connexin targeting, combined with an improved understanding of the molecular bases underlying the dysregulation of connexins during cancer development, offers novel opportunities for clinical applications. However, different connexin isoforms have diverse channel-dependent and -independent functions that are tissue and stage specific. This can elicit both pro- and anti-tumorigenic effects that engender significant challenges in the path towards personalised medicine. Here, we review the current understanding of the role of connexins and gap junctions in cancer, with particular focus on the recent progress made in determining their prognostic and therapeutic potential.

Cancer was one of the first pathologies to be associated with gap-junction defect. Despite the evidence accumulated over the last 40-year period, the molecular involvement of gap junctions and their structural proteins (connexins) in cancer has not been elucidated. The lack of a satisfying explanation may come from the complexity of the disease, evolving through various stages during tumor progression, with cancer cells exhibiting different phenotypes. Here, the question of the involvement of gap junctions has been readdressed by considering the connexin expression/function level at different fundamental stages of carcinogenesis (cell proliferation, cell invasion, and cancer cell dissemination). By performing this analysis, it becomes clear that gap junctions are probably differently involved, depending on the stage of the cancer progression considered. In particular, the most recent data suggest that connexins may act on cell growth by controlling gene expression through a variety of processes (independent of or dependent on the gap-junctional communication capacity). During invasion, connexins have been demonstrated to enhance adherence of cancer cells to the stroma, migration, and probably their dissemination by establishing communication with the endothelial barrier. All these data present a complex picture of connexins in various functions, depending on the cell phenotype.