Abstract
The intrinsic and acquired resistance of ovarian cancer to conventional platinum/taxane chemotherapy is approximately 80-85%, with a high recurrence rate, making it one of the most lethal gynecological cancers. Epigenetic dysregulation, a key factor in tumor growth and chemoresistance, includes abnormal DNA methylation and 5-hydroxymethylcytosine (5hmC) loss. The ten-eleven translocation (TET) family of dioxygenases (TET1/TET2/TET3) mediates DNA demethylation, causing oxidation of 5-methylcytosine to 5hmC, potentially altering gene expression due to cancer cell plasticity and impacting treatment responses. This review discusses the multiple effects of TETs in ovarian cancer, highlighting the regulation of epithelial mesenchymal transition (EMT), cancer stem cells (CSCs), and the Wnt/β-catenin and TGF-β signaling pathways by TET enzymes. TET1 plays a dual role, promoting chemoresistance via CSC enrichment and suppressing tumors by replenishing Wnt antagonists. TET2, primarily a tumor suppressor, reduces 5hmC; TET2 loss is associated with poor therapeutic results. Elevated expression of TET3, which controls EMT and miRNA expression, is linked to a worse prognosis. In addition, we reviewed the potential resensitization of resistant tumors to multiple modalities of treatment by reactivating/modulating TET activity and function via cofactors and epigenetic treatment. Regulation of the TET-5hmc axis appears promising to overcome chemoresistance and improve therapeutic outcomes.