Clinical use of PI3K inhibitors in B-cell lymphoid malignancies: today and tomorrow

Introduction: PI3K inhibitors are an important new therapeutic option for the treatment of relapsed and refractory B-cell lymphoid malignancies. Idelalisib is a PI3Kδ inhibitor that has been approved for the treatment of lymphoma and chronic lymphocytic leukemia in the relapsed/refractory setting, and several other PI3K inhibitors are being developed targeting other isoforms of the PI3K enzyme, which results in distinct toxicities and variable efficacy in the clinical setting.

Areas covered: We provide a general overview of PI3K inhibitors, recommended applications, and the mechanism and management of toxicities. We further review trials, ongoing and completed, leading to the approval of idelalisib as well other PI3K inhibitors currently in development. Articles were obtained from PubMed, and abstracts were searched for the past 5 years from the websites for ASCO, ASH, EHA, and ICML/Lugano.

Expert commentary: PI3K inhibitors provide an important and powerful pharmacologic tool in the armamentarium against hematologic malignancies, especially for relapsed/refractory B-cell lymphoid malignancies. Unique toxicities are associated with inhibition of different isoforms of the PI3K enzyme, as demonstrated with the infectious and autoimmune toxicities associated with the PI3Kδ inhibitor, idelalisib. Due to these unique toxicities, PI3K inhibitors should only be used in formally approved combinations and settings.     

The PI3K pathway: clinical inhibition in chronic lymphocytic leukemia

Constitutive or mutational activation of the phosphatidylinositol 3 kinase, or PI3K, has been implicated in many cancers, including chronic lymphocytic leukemia (CLL). The δ isoform of the p110 catalytic subunit of PI3K has its primary physiologic function in B cells and appears to be the predominant mediator of most PI3K signals in CLL cells. Idelalisib is a first-in-class inhibitor of the PI3K delta isoform that shows near complete inhibition of AKT phosphorylation in CLL cells in vitro and in vivo. Idelalisib shows the classic pattern of response to BCR inhibition in CLL, with rapid nodal response and transient increase in lymphocytosis. The phase I study established the recommended dose as 150 mg twice per day. Subsequent registration trials have focused predominantly on antibody combinations, leading to the US Food and Drug Administration (FDA) approval of idelalisib with rituximab for relapsed CLL patients for whom rituximab is appropriate therapy in summer 2014. The median progression-free survival (PFS) of idelalisib–rituximab in this heavily pretreated CLL population with multiple comorbidities and frequent 17p deletion was an impressive 19.4 months. The success of idelalisib has paved the way for the development of other PI3K inhibitors in CLL, including duvelisib and TGR-1202, which are in or moving toward registration trials.     

芹菜素通过 PI3K/Akt 信号通路诱导 Hela 细胞凋亡

目的：初探芹菜素（Apigenin）对人宫颈癌细胞 Hela 的抑制机制。方法：MTT 法检测 Apigenin 对 Hela细胞的增殖抑制作用,实时无标记细胞分析技术测量 Apigenin 对 Hela 细胞生长曲线的影响。Western blot 检测 Apigenin 对 Hela 细胞中 PI3K/ Akt 信号通路的影响。结果：与阴性对照组相比,Apigenin 能显著抑制 Hela细胞的增殖（P <0.01）,当药物浓度为20μmol/ L 时抑制率达到（80.5±5.3）%,IC50值为（6.8±0.8）μmol/ L。细胞生长曲线反映,Apigenin 减缓了 Hela 细胞的增殖,对数期细胞经20μmol/ L Apigenin 处理后,细胞数量迅速下降。Western blot 结果显示,Apigenin 能显著抵抗 IGF -1引起的 Akt 激活但并不能降低 PI3K 的磷酸化水平。同时 Apigenin 还能降低 Bcl -2/ Bax 比例,提高 Caspase -3活性,启动细胞线粒体凋亡。结论：Apigenin可以通过 PI3K/ Akt 信号通路促进 Hela 细胞的凋亡。     

白花蛇舌草通过PI3K/Akt信号通路抑制人非霍奇金淋巴瘤Raji细胞增殖

目的:探讨白花蛇舌草对人非霍奇金淋巴瘤Raji细胞增殖及PI3K/Akt信号通路的影响。方法:将人非霍奇金淋巴瘤细胞Raji分为对照组、白花蛇舌草组、LY294002组、白花蛇舌草+LY294002组,采用CCK-8法检测各组Raji细胞培养12 h、24 h、48 h、72 h时细胞增殖情况,流式细胞仪检测各组细胞周期分布情况,Western blot检测培养48 h时各组细胞CyclinD1、CyclinD3、CDK4、PAK2、p-PI3K、p-Akt蛋白水平。结果:白花蛇舌草组、LY294002组、白花蛇舌草+LY294002组Raji细胞增殖抑制率随着处理时间延长而增加,在相同时间点时,白花蛇舌草+LY294002组Raji细胞增殖抑制率均高于白花蛇舌草组、LY294002组（P＜0.05）;细胞周期检测结果显示:与对照组相比,白花蛇舌草组、LY294002组、白花蛇舌草+LY294002组G0/G1期细胞比例增多、S期细胞比例降低（P＜0.05）,而白花蛇舌草组、LY294002组G0/G1期、S期细胞比较差异无统计学意义（P＞0.05）,白花蛇舌草+LY294002组G0/G1期、S期细胞均低于白花蛇舌草组、LY294002组（P＜0.05）;Western blot检测结果显示:白花蛇舌草组、LY294002组、白花蛇舌草+LY294002组CyclinD1、CyclinD3、CDK4、PAK2、p-PI3K、p-Akt蛋白水平均低于对照组（P＜0.05）,白花蛇舌草+LY294002组CyclinD1、CyclinD3、CDK4、PAK2、p-PI3K、p-Akt蛋白水平均低于白花蛇舌草组、LY294002组（P＜0.05）,白花蛇舌草组、LY294002组各种蛋白水平比较差异无统计学意义（P＞0.05）。结论:白花蛇舌草对Raji细胞增殖有抑制作用,可能与抑制PI3K/Akt信号通路活化有关。     

ＰＩ３Ｋ／Ａｋｔ信号传导通路及其在结直肠癌中的研究进展

结直肠癌是常见的恶性肿瘤之一,近十年来,结直肠癌在我国的发病率呈逐年上升的趋势。已有研究表明,ＰＩ３Ｋ／Ａｋｔ信号传导通路是与细胞增殖和细胞凋亡关系最密切的信号传导通路之一。随着ＰＩ３Ｋ／ＡＫｔ信号通路在结直肠癌发生、发展中的研究不断深入,该通路对结直肠癌发生、发展及治疗药物的研发具有十分重要的价值。本文就ＰＩ３Ｋ／Ａｋｔ信号传导通路在结直肠癌发生、发展和治疗中的作用以及机制的研究进展作一综述。     

PI3K/Akt途径在朊蛋白介导胃癌耐药中的作用研究

目的:探讨PI3K/Akt途径在朊蛋白(PrPc)介导胃癌耐药中的作用.方法:脂质体基因转染法建立高表达PrPc的胃癌细胞亚系.Western印迹检测转染细胞中Akt蛋白的表达.噻唑蓝(MTT) 比色法测定单独或联用PI3K抑制剂LY294002时转染细胞对化疗药物的敏感性.流式细胞仪检测单独或联用LY294002时转染细胞内阿霉素蓄积和潴留.结果:将PrPc正义载体pcDNA-PrP转入SGC7901,成功建立PrPc高表达胃癌细胞亚系并命名为PS;空载体转染细胞命名为BS.Western-Blot显示磷酸化Akt在PS中的表达较BS及SGC7901增高,而三者的总Akt则无差别.未经LY294002处理时,在阿霉素或长春新碱的作用下,PS的存活率分别为91.4%±3.4%和89.4%±3.8%,较BS(79.2%±4.3%和75.9%±2.1%)明显增高(均 ),PS细胞内阿霉素蓄积量和潴留量分别为4.4±0.3和4.2±0.4,明显低于BS(8.2±0.5和8.0±0.3)(均 );当联合LY294002处理后,PS在两种药物作用下的存活率均随着LY294002浓度的增加逐渐降低,并均在LY294002为30μmol/L时接近BS(均 ),PS细胞内阿霉素蓄积量和潴留量逐渐增高,并均在LY294002为30μmol/L时接近BS(均 ).结论:PrPc介导的胃癌耐药与PI3K/ Akt途径活性密切相关,抑制PI3K/ Akt途径活性可逆转PrPc介导的胃癌耐药.     

PI3K inhibitors in trastuzumab-resistant HER2-positive breast cancer cells with PI3K pathway alterations

The activation of the PI3K signaling pathway resulting from genetic alterations induces carcinogenesis and resistance to anticancer therapies. Breast cancer is a major malignancy that is associated with dysregulation of the PI3K signaling pathway. PIK3CA mutations and PTEN loss occur in every subtype of breast cancer. PI3K inhibitors are being evaluated in breast cancer after the success of an alpha isoform-specific PI3K inhibitor in estrogen receptor (ER)-positive/HER2-negative metastatic breast cancer. Some preclinical data indicate the potential for PI3K/mTOR targeting in combination with trastuzumab for HER2-positive breast cancer with or without expression of the estrogen receptor. However, the role of this therapy in HER2-positive breast cancer with PIK3CA mutations and/or PTEN loss remains unclear. We examined three HER2-positive, ER-negative breast cancer cell lines to determine the efficacy of a novel alpha isoform-specific PI3K inhibitor in combination with trastuzumab. The results indicated that this combination was effective in PIK3CA-mutant or PTEN-deficient breast cancer cells by inducing apoptosis and inhibiting the expression of downstream proteins. PTEN loss by siRNA modulation in parental HER2-positive cancer cells with PI3K signaling pathway alterations could not confer resistance to alpelisib or GDC-0077 plus trastuzumab. We selected the CK-MB-1 cell line without alterations in the PI3K pathway to demonstrate that PI3K inhibitors plus trastuzumab represented a biomarker-specific treatment. In vivo effects of alpelisib plus trastuzumab were tested and confirmed in a mouse model, showing the combination strategy offered the best opportunity to achieve tumor volume reduction. With known safety profiles, this cytotoxic chemotherapy-free regimen warrants further attention as a biomarker-driven strategy for treating HER2-positive breast cancer.     

PI3K/AKT signaling pathway as a critical regulator of Cisplatin response in tumor cells

Chemotherapy is one of the main therapeutic modalities for cancer patients. Cisplatin (CDDP), as one of thefirst-line drugs, is of great importance in the chemotherapy of various tumors. However, a significant percentage of cancerpatients are resistant to CDDP treatment. Due to the CDDP side effects on normal tissues, the diagnosis of CDDPresistance is required to suggest the most efficient therapeutic strategies for cancer patients. Several molecularmechanisms and signaling pathways are associated with CDDP response. The PI3K/AKT signaling pathway has apivotal role in the transmission of extracellular signals into the cells to regulate various pathophysiological processessuch as cell proliferation, migration, and drug resistance. In the present review, we summarized all of the studieswhich have been reported on the role of PI3K/AKT pathway in regulation of CDDP response. It was shown that thePI3K/AKT pathway is mainly involved in CDDP response in lung, ovarian, and gastrointestinal cancers. It was alsoobserved that the non-coding RNAs have a key role in CDDP response by regulation of PI3K/AKT pathway. Thisreview paves the way for suggesting a PI3K/AKT-related panel marker for the prediction of CDDP response indifferent cancer patients.     

Phase II study of palliative low-dose local radiotherapy in disseminated indolent non-Hodgkin's lymphoma and chronic lymphocytic leukemia

: Indolent non-Hodgkin’s lymphoma (INHL) and chronic lymphocytic leukemia (CLL) are highly sensitive to radiotherapy (RT). Previous retrospective studies have shown high response rates after local palliative RT of 4 Gy in 2 fractions, which prompted this prospective Phase II trial of the palliative effect of this regimen in patients with disseminated INHL or CLL.

: Twenty-two patients (11 men, 11 women, median age 62 years, range 30–89) with disseminated INHL (n = 15) or CLL (n = 7) were treated with local low-dose RT, 2 Gy × 2 within 3 days, with the aim of achieving palliation from localized lymphoma masses. The patients were treated to a total of 31 different sites. Seventeen patients had previously been treated with chemotherapy. The median observation time after the start of RT was 8 months (range 3–26).

: All patients and all irradiated sites were assessable for response. Of the 22 patients, 18 responded to the treatment, corresponding to an overall response rate (RR) of 82%; 12 patients (55%) achieved a complete response (CR), 5 patients (22%) a partial response (PR), and 1 patient had a CR at three sites and a PR at one site. Of the 31 irradiated sites, 27 responded to treatment, corresponding to an overall RR of 87%; in 20 sites (65%) a CR was achieved and in 7 sites (22%) a PR. Patients with disseminated INHL had an overall RR of 87% (74% CR, 13% PR); patients with CLL had an overall RR of 71% (29% CR, 42% PR). The median duration of response was estimated at 22 months. None of the patients had significant side effects from the treatment.

: Low-dose RT (4 Gy in 2 fractions) is a highly effective palliative treatment of localized lymphoma masses in patients with disseminated INHL and CLL. The treatment has minimal side effects.     

Down-regulation of the PI3K/Akt signaling pathway and induction of apoptosis in CA46 Burkitt lymphoma cells by baicalin

Background

Baicalin, a flavone present in Scutellaria baicalensis Georgi, inhibits the growth of human leukemia and myeloma cells through induction of apoptosis.

Methods

The present study was undertaken to ascertain whether cultured Burkitt lymphoma cells undergo apoptosis when treated with baicalin. Growth rates were measured using MTT and colony formation assays, and induction of apoptosis was quantified using Annexin V and DNA fragmentation assays. Mechanisms underlying observed growth suppression were examined using Western blotting.

Results

Treatment of CA46 Burkitt lymphoma cells with baicalin for 48 h markedly decreased the rate of cell proliferation; an IC₅₀ value of 10 μM was obtained. Colony formation was almost fully suppressed at 10 μM baicalin. CA46 cells underwent apoptosis in response to baicalin treatment as evidenced by an increase in the percentage of cells stainable with Annexin V, by increased DNA fragmentation, and by activation of the intrinsic (mitochondrial) pathway for cell death as characterized by increased expression of the cleaved forms of caspase-9, caspase-3, and poly (ADP-ribose) polymerase. Additionally, baicalin was found to down-regulate anti-apoptotic and up-regulate apoptotic components of the phosphatidylinositide-3-kinase (PI3K)/serine/threonine kinase (Akt) signaling pathway.

Conclusions

The concentrations at which baicalin altered expression of components of the PI3K/Akt pathway in CA46 cells were comparable to those that suppressed growth and induced apoptosis, supporting the hypothesis that the observed growth-inhibitory and apoptosis-inducing actions of baicalin in these cells are mediated by down-regulation of this pathway.     

红花多糖抑制PI3K/Akt信号通路诱导人胃癌细胞凋亡的研究

目的 探讨红花多糖通过抑制PI3K/Akt信号通路调控胃癌细胞凋亡的机制。方法 MTT比色法观察SPS对人胃癌SGC-7901细胞体外增殖的抑制作用,流式细胞仪(FCM)分析细胞凋亡,实时荧光定量RT-PCR法和Western Blot法检测蛋白激酶B(Akt)基因及蛋白的表达情况。结果 红花多糖在一定范围内以剂量依赖方式和时间依赖方式抑制SGC-7901胃癌细胞生长。流式细胞仪检测,SGC-7901细胞经红花多糖处理24 h,其早期凋亡率、细胞坏死或晚期凋亡率显著增加,呈现明显的剂量依赖性。Real-time PCR和Western Blot检测发现,SPS处理的细胞Akt基因及蛋白表达量明显下降。结论 红花多糖对人胃癌SGC-7901细胞体外增殖具有明显的抑制作用,该抑制作用具有一定的时间依赖性和剂量依赖性;红花多糖能够下调Akt mRNA表达,降低Akt和p-Akt蛋白的表达量,抑制Akt通路发挥抗肿瘤作用。     

LRRC3B对食管癌细胞Eca109迁移、侵袭及PI3K/Akt信号通路的影响

背景与目的:先前的研究已经证实富含亮氨酸重复序列3B蛋白(leucine-rich repeat-containing 3B,LRRC3B)在多种癌症中低表达,并且与癌细胞的迁移侵袭密切相关.该研究旨在探讨LRRC3B在食管癌发展中的作用机制.方法:免疫组织化学染色检测LRRC3B在60例食管癌组织及60例癌旁组织中的表达情况,采用实时荧光定量聚合酶链反应(real-time fluorescent quantitative polymerase chain reaction,RTFQ-PCR)和蛋白[质]印迹法(Western blot)分别检测食管癌细胞Eca109和食管正常上皮细胞系HEEC中LRRC3B的mRNA和蛋白表达.处理食管癌细胞Eca109并分3组:正常对照组、阴性对照组(转染对照空pCMV6质粒)和过表达LRRC3B组(转染pCMV6-LRRC3B过表达质粒).采用Transwell法检测各组Eca109细胞迁移和侵袭的变化.采用Western blot检测各组细胞中上皮间质转化(epithelial-mesenchymal transition,EMT)相关蛋白E-cadherin、N-cadherin和Vimentin表达以及p-Akt蛋白水平.结果:LRRC3B在食管癌组织和细胞中的表达明显低于癌旁组织和食管正常上皮细胞.过表达LRRC3B明显抑制Eca109细胞的迁移和侵袭能力,上调上皮因子E-cadherin表达,抑制间质标志物N-cadherin和Vimentin表达,同时降低细胞内p-Akt水平.结论:LRRC3B在食管癌中低表达,上调LRRC3B能够抑制食管癌细胞的EMT过程,可能与抑制PI3K/Akt信号通路有关.     

Multipoint targeting of the PI3K/mTOR pathway in mesothelioma

Background:

Mesothelioma is a notoriously chemotherapy-resistant neoplasm, as is evident in the dismal overall survival for patients with those of asbestos-associated disease. We previously demonstrated co-activation of multiple receptor tyrosine kinases (RTKs), including epidermal growth factor receptor (EGFR), MET, and AXL in mesothelioma cell lines, suggesting that these kinases could serve as novel therapeutic targets. Although clinical trials have not shown activity for EGFR inhibitors in mesothelioma, concurrent inhibition of various activated RTKs has pro-apoptotic and anti-proliferative effects in mesothelioma cell lines. Thus, we hypothesised that a coordinated network of multi-RTK activation contributes to mesothelioma tumorigenesis.

Methods:

Activation of PI3K/AKT/mTOR, Raf/MAPK, and co-activation of RTKs were evaluated in mesotheliomas. Effects of RTK and downstream inhibitors/shRNAs were assessed by measuring mesothelioma cell viability/growth, apoptosis, activation of signalling intermediates, expression of cell-cycle checkpoints, and cell-cycle alterations.

Results:

We demonstrate activation of the PI3K/AKT/p70S6K and RAF/MEK/MAPK pathways in mesothelioma, but not in non-neoplastic mesothelial cells. The AKT activation, but not MAPK activation, was dependent on coordinated activation of RTKs EGFR, MET, and AXL. In addition, PI3K/AKT/mTOR pathway inhibition recapitulated the anti-proliferative effects of concurrent inhibition of EGFR, MET, and AXL. Dual targeting of PI3K/mTOR by BEZ235 or a combination of RAD001 and AKT knockdown had a greater effect on mesothelioma proliferation and viability than inhibition of individual activated RTKs or downstream signalling intermediates. Inhibition of PI3K/AKT was also associated with MDM2-p53 cell-cycle regulation.

Conclusions:

These findings show that PI3K/AKT/mTOR is a crucial survival pathway downstream of multiple activated RTKs in mesothelioma, underscoring that PI3K/mTOR is a compelling target for therapeutic intervention.     

PI3K/Akt信号通路与肿瘤血管新生的研究进展

PI3K/Akt信号通路在多种细胞中活化,参与细胞的增殖、分化、凋亡、血管新生等病理、生理过程。血管的生成需要PI3K/Akt信号通路的激活,PI3K/Akt活化后可以广泛诱导鸡胚尿囊膜血管的生成。PI3K/Akt信号通路与其下游信号分子mTOR及多种促血管新生因子,如VEGF、HIF等相互作用,从而促进肿瘤血管新生。PI3K/Akt信号通路抑制剂能够抑制其血管新生作用,因此靶向PI3K/Akt信号通路为恶性肿瘤靶向治疗提供了新方法。     

PI3K/Akt/mTOR通路抑制剂对白血病细胞株增殖及其PHLPP表达的影响

目的:观察PI3K/Akt/mTOR通路抑制剂wortmannin或rapamycin对白血病细胞株增殖及其PHLPP(PH domainleucine-rich repeat protein phosphatase)蛋白表达的影响。方法:以不同浓度的wortmannin或rapamycin分别作用于人类髓细胞白血病细胞系K562、HL-60,采用WST-1法检测细胞的增殖活性,AnnexinⅤ-FITC双染流式细胞术检测细胞凋亡,Westernblotting法检测细胞中p-Akt、Akt、PHLPP蛋白的表达。结果:Wortmannin以时间以及剂量依赖方式抑制K562、HL-60细胞的增殖(P<0.05),48 h的IC50值分别为(187.6±48.4)、(185.5±48.1)nmol/L。100 nmol/L wortmannin作用于K562细胞、50nmol/L wortmannin作用于HL-60细胞12和24 h后,细胞凋亡率均较对照细胞显著升高[(12.4±0.7)%、(17.6±2.3)%vs(5.0±0.6)%,P<0.05;(11.0±0.2)%、(17.9±1.6)%vs(6.8±0.4)%,P<0.05]。Wortmannin分别作用于K562、HL-60细胞12、24、36 h后,p-Akt、PHLPP的蛋白表达水平明显降低;rapamycin同样可使K562、HL-60细胞中PHLPP蛋白的表达水平降低。结论:PI3K/Akt/mTOR信号通路抑制剂抑制白血病细胞株增殖的同时降低其PHLPP蛋白的表达。     

PI3K/AKT/mTOR信号通路抑制剂在淋巴瘤中的研究进展*

磷脂酰肌醇-3 激酶（phosphatidylinositol 3-kinase,PI 3K）- 蛋白激酶B（protein kinaseB ,PKB ,又称AKT ）- 雷帕霉素靶蛋白（mammalian target of  rapamycin,mTOR）信号通路与细胞的生长、增殖、分化、凋亡、代谢等密切相关,在多种实体肿瘤中已发现该信号通路的异常。近年来,以抑制该通路特定位点的靶向治疗已成为抗肿瘤的研究热点。许多该位点新型抑制剂也已进入淋巴瘤的临床试验中,本文就该通路在淋巴瘤中的活化状态及各个分子靶点抑制剂的研究进展做一综述。     

抑制PI3K/Akt信号转导通路提高化疗效果的实验研究

目的:探讨通过抑制PI3K/Akt信号转导通路提高抗癌药物对恶性肿瘤细胞的杀伤作用。方法:采用噻唑蓝(MTT)比色法检测塞莱昔布、顺铂及多西紫杉醇单独或联合PI3K抑制剂LY294002对人宫颈癌HeLa细胞和人乳腺癌MCF7细胞的抑制率;采用流式细胞技术检测药物单独或联合作用对HeLa细胞和MCF7细胞凋亡的影响。结果:①联合LY294002能够显著提高塞莱昔布、顺铂及多西紫杉醇对HeLa细胞和MCF7细胞抑制率(P<0.05)。②LY294002与塞莱昔布、顺铂及多西紫杉醇的协同治疗指数均小于1,具有协同治疗作用。③联合LY294002能够增加HeLa细胞和MCF7细胞的凋亡水平。结论:抑制PI3K/Akt信号转导通路能够显著提高塞莱昔布、顺铂及多西紫杉醇对HeLa细胞和MCF7细胞的杀伤作用。     

Current clinical development of PI3K pathway inhibitors in glioblastoma

Glioblastoma (GBM) is the most common and lethal primary malignant tumor of the central nervous system, and effective therapeutic options are lacking. The phosphatidylinositol 3-kinase (PI3K) pathway is frequently dysregulated in many human cancers, including GBM. Agents inhibiting PI3K and its effectors have demonstrated preliminary activity in various tumor types and have the potential to change the clinical treatment landscape of patients with solid tumors. In this review, we describe the activation of the PI3K pathway in GBM, explore why inhibition of this pathway may be a compelling therapeutic target for this disease, and provide an update of the data on PI3K inhibitors in clinical trials and from earlier investigation.     

Role of aberrant PI3K pathway activation in gallbladder tumorigenesis

The PI3K/AKT pathway governs a plethora of cellular processes, including cell growth, proliferation, and metabolism, in response to growth factors and cytokines. By acting as a unique lipid phosphatase converting phosphatidylinositol-3,4,5,-trisphosphate (PIP3) to phosphatidylinositol-4,5,-bisphosphate (PIP2), phosphatase and tensin homolog (PTEN) acts as the major cellular suppressor of PI3K signaling and AKT activation. Recently, PI3K mutations and loss/mutation of PTEN have been characterized in human gallbladder tumors; whether aberrant PTEN/PI3K pathway plays a causal role in gallbladder carcinogenesis, however, remains unknown. Herein we show that in mice, deregulation of PI3K/AKT signaling is sufficient to transform gallbladder epithelial cells and trigger fully penetrant, highly proliferative gallbladder tumors characterized by high levels of phospho-AKT. Histopathologically, these mouse tumors faithfully resemble human adenomatous gallbladder lesions. The identification of PI3K pathway deregulation as both an early event in the neoplastic transformation of the gallbladder epithelium and a main mechanism of tumor growth in Pten heterozygous and Pten mutant mouse models provides a new framework for studying in vivo the efficacy of target therapies directed against the PI3K pathway, as advanced metastatic tumors are often addicted to “trunkular” mutations.