Epigenetic regulation in bladder cancer: development of new prognostic targets and therapeutic implications

Epigenetic and genetic alterations contribute to cancer initiation and progression. Epigenetics refers to heritable alterations in gene expression without DNA sequence changes. Epigenetic changes include reversible alterations in DNA methylation, chromatin modification, nucleosome positioning, and non-coding RNA profiles. In bladder cancer, many epigenetic changes have been reported to exhibit correlation with cancer progression and malignances. In particular, both DNA hypermethylation and hypomethylation have been reported to be associated with higher bladder cancer rates or advanced tumor stages. The association of changes in histone modifying enzyme expression with bladder cancer stages has been extensively studied. MicroRNA (miRNA) expression also has been studied in bladder cancer diagnosis and disease progression. The use of epigenetics for the diagnosis of and therapeutic target screening in bladder cancer is an emerging and rapidly evolving field. The reversible nature of epigenetic changes may facilitate additional therapeutic options in the future.