20 - World Journal of Gastroenterology

Online Submissions: http://www.wjgnet.com/esps/wjg@wjgnet.comdoi:10.3748/wjg.v19.i20.2997World J Gastroenterol 2013 May 28; 19(20): 2997-3006ISSN 1007-9327 (print) ISSN 2219-2840 (online)© 2013 Baishideng. All rights reserved.REVIEWColon cancer stem cells: Controversies and perspectivesMaria Ausiliatrice Puglisi, Valentina Tesori, Wanda Lattanzi, Giovanni Battista Gasbarrini, Antonio GasbarriniMaria Ausiliatrice Puglisi, Valentina Tesori, Antonio Gasbarrini,Department of Internal Medicine and Gastroenterology, GemelliHospital, 00168 Rome, ItalyWanda Lattanzi, Institute of Anatomy and Cell Biology, UniversitàCattolica del Sacro Cuore, 00168 Rome, ItalyGiovanni Battista Gasbarrini, Fondazione Ricerca in MedicinaONLUS, 40123 Bologna, ItalyAuthor contributions: Puglisi MA and Tesori V contributedequally to this work; Puglisi MA, Tesori V and Gasbarrini A contributedto the article design, writing and revision; Lattanzi W andGasbarrini GB contributed to the literature research and revision;all authors approved the version to be published.Correspondence to: Maria Ausiliatrice Puglisi, PhD, Departmentof Internal Medicine and Gastroenterology, Gemelli Hospital,Largo A. Gemelli 8, 00197 Rome,Italy. ausiliapuglisi@yahoo.itTelephone: +39-6-30156018 Fax: +39-6-30157249Received: January 12, 2013 Revised: March 25, 2013Accepted: April 3, 2013Published online: May 28, 2013Core tip: According to the “cancer stem cell” (CSC) theory,tumor growth and spread are driven by a minorityof cancer cells which exhibit characteristics similar tonormal stem cells. Although CSCs have been implicatedin colon carcinogenesis, due to the complexity of theirbiology and unsolved technical issues, an unequivocallyapproved identification and isolation strategy is still amatter of debate. Several markers have been used toidentify colon CSCs but the function of these proteinsin CSC biology has not yet been clarified. Moreover, thepossibility that CSCs might contribute to the failure ofexisting chemotherapies to eradicate malignant tumors,indicate that targeting of CSCs may represent a promisingstrategy to eradicate chemoresistant cancers. Aimof this review was to acquire more information on thebiology of human colon CSCs and shed light on the roleof this cells in the onset and the maintenance of coloncancer.AbstractTumors have long been viewed as a population inwhich all cells have the equal propensity to form newtumors, the so called conventional stochastic model.The cutting-edge theory on tumor origin and progression,tends to consider cancer as a stem cell disease.Stem cells are actively involved in the onset andmaintenance of colon cancer. This review is intendedto examine the state of the art on colon cancer stemcells (CSCs), with regard to the recent achievements ofbasic research and to the corresponding translationalconsequences. Specific prominence is given to thehypothesized origin of CSCs and to the methods fortheir identification. The growing understanding of CSCbiology is driving the optimization of novel anti-cancertargeted drugs.© 2013 Baishideng. All rights reserved.Key words: Colon cancer stem cells; Colorectal cancer;CD133; Therapy; ChemoresistancePuglisi MA, Tesori V, Lattanzi W, Gasbarrini GB, Gasbarrini A.Colon cancer stem cells: Controversies and perspectives. WorldJ Gastroenterol 2013; 19(20): 2997-3006 Available from: URL:http://www.wjgnet.com/1007-9327/full/v19/i20/2997.htm DOI:http://dx.doi.org/10.3748/wjg.v19.i20.2997INTRODUCTIONThe intestine epithelium is subjected to a rapid and continuousregeneration, supported by crypt intestinal stemcells (ISCs). This feature severely increases the risk formalignant conversion [1] . Indeed, colorectal cancer (CRC)is one of the most common type of neoplasm worldwide,representing the second leading cause of morbidityand mortality from cancer in both Europe and the UnitedStates. This means that CRC can also be considered oneof the main national emergencies, both in terms of morbidityand in terms of social and economic costs [2] .Studies on CRC pathogenesis have been originallyfocusing on the clonal selection process, a model of carcinogenesispostulated in 1975 [3] . The characterizationWJG|www.wjgnet.com2997 May 28, 2013|Volume 19|Issue 20|