In the 1990s, Semenza identified genes that turned on, when oxygen levels were low to increase levels of erythropoietin (EPO), a protein that increases the oxygen carrying RBCs in blood.
Of course, his paper was rejected from numerous top journals.
“They didn’t find it to be of sufficient interest to warrant publication,” Semenza said.
…
The world took a quarter of a century to recognize his contribution and reward him finally the 2019 Nobel.
…
One of the biggest challenges facing cancer patients and oncologists is that the cells at the center of a tumor are not killed by our available therapy. They have *adapted to a low-oxygen environment*.
Traditional chemotherapy or radiation treatments mostly kill the tumor cells on the periphery.
The cells at the heart of the tumour have become that extra hardy. They survive and spread to other parts ( Metastasis) leading to spread of cancer even after extensive surgery, radiation and chemotherapy has cleared 95% of cancer cells.
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The basic question is how the cancer cells can survive the lack-of-oxygen condition.
When we are deprived of oxygen, we die. In heart attack, our heart cells die due to lack of oxygen supply. In brain stroke, lack of oxygen kills a part of brain leading to paralysis. In drowning, chocking, hanging or poisonous gas, lack of oxygen kills.
But the cancer cells, inspite of our best effort survive the lack of oxygen and spread. ( Metastasis)
The Nobel was awarded to the discovery of a molecular machinery – A switch that ensures that the cancer cells at the most interior part of the tumor always has the right level of oxygen- An Oxygen Rheostat.
Dr Ramakanta's Ideas 