Cracking the Genetic Code of Glioblastoma: The Hidden Role of HOX Genes

What if the same genes that shaped us during early development were also driving one of the most lethal brain cancers?
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HOX gene dysregulation in glioblastoma: a narrative review of current advances - Discover Oncology

HOX (homeobox) genes are virtually absent in healthy adult brains but are detected in malignant brain tumors, particularly gliomas. In 2021, the World Health Organization (WHO) classified adult-type diffuse gliomas into three distinct categories: astrocytomas (isocitrate dehydrogenase [IDH]-mutated), oligodendrogliomas (IDH-mutated and 1p/19q-deleted), and glioblastomas, IDH-wildtype (GBM). GBM is the most common and aggressive primary malignant tumor of the Central Nervous System (CNS), characterized by its high recurrence rate and rapid growth. Dysregulation of HOX genes is a well-established phenomenon in both solid and liquid malignancies, playing crucial roles in various fundamental characteristics of cancer, including GBM. In recent years, HOX genes have gained recognition not only as key regulators of tumor progression but also as potential biomarkers for predicting disease outcomes and as promising therapeutic targets for GBM. This review compiles the latest research on HOX genes in GBM, encompassing studies published before and after the 2021 WHO classification of CNS tumors. Our goal is to provide a comprehensive overview of key findings on the role of HOX gene clusters, which are groups of genes involved in regulating the development of the body plan along the anterior–posterior axis, in GBM initiation, progression, prognosis, and treatment response.

🔬 Why HOX Genes?

HOX (Homeobox) genes are essential during embryonic development. Like master architects, they determine where the head, tail, arms, and legs form. These genes are highly conserved across species and play a crucial role in organizing the body’s structure along the anterior-posterior axis.

But in recent years, researchers have discovered that HOX genes can be reactivated or dysregulated in cancer—and not just any cancer. In glioblastoma (GBM), one of the deadliest forms of brain tumor, abnormal HOX gene expression has been linked to:

  • Tumor growth

  • Therapeutic resistance

  • Poor survival outcomes

This unexpected connection between developmental biology and cancer progression caught our attention. 

The genomic architecture of the HOX family is present in each of the four loci. Humans have four loci of HOX genes: HOXA contains 11 genes, located in chromosome 7p15.2; HOXB contains 10 genes, located in chromosome 17q21.3; HOXC contains 9 genes, located in chromosome 12q13.3; HOXD contains 9 genes, located in the chromosome 2q31 (p represent the short arm of the chromosome, q represent the long arm of the chromosome). During embryonic development, HOX genes are expressed sequentially in partially overlapping zones along the anterior-posterior axis.

🧠 The Glioblastoma Challenge

Glioblastoma is an aggressive, fast-growing tumor with a notoriously poor prognosis. Despite surgery, radiation, and chemotherapy, the average survival time remains just 12–15 months after diagnosis.

We wondered—could HOX genes be one of the hidden drivers behind glioblastoma’s resistance and rapid progression?


🧾 What We Did?

We conducted an in-depth review of the scientific literature to answer this question. Our article:

  • Summarizes the current knowledge about HOX gene expression in GBM

  • Highlights specific HOX genes (like HOXA9, HOXA10, and HOXD10) that are linked to treatment resistance

  • Explores the connection between HOX gene activity and glioma stem cells, tumor microenvironment, and immune evasion

  • Discusses the implications of HOX genes as biomarkers and therapeutic targets

This is the first narrative review focused specifically on HOX gene dysregulation in GBM.

🚀 Why It Matters

Our findings suggest that HOX genes are more than developmental relics—they may be active participants in the progression and treatment resistance of glioblastoma.

Understanding how and why these genes become dysregulated could lead to:

  • Improved diagnostic tools

  • Personalized treatment strategies

  • New targets for drug development


📖 Behind the Scenes

This project brought together my passion for computational genomics and my fascination with developmental biology. It reminded me how genes that build life can also contribute to its breakdown, depending on the context.

Writing this review wasn’t just an academic task—it was an effort to bridge two fields and encourage researchers to see cancer through a broader genetic lens.

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Brain Cancer
Life Sciences > Biological Sciences > Neuroscience > Neurological Disorders > CNS Cancer > Brain Cancer
Genetics
Life Sciences > Biological Sciences > Genetics and Genomics > Genetics
  • Discover Oncology Discover Oncology

    This is a fully open access general oncology journal that aims to provide a unified forum for researchers and clinicians. The journal spans from basic and translational science, to preclinical, clinical, and epidemiology, and welcomes content that interfaces at all levels of cancer research.

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