Exémestane-évérolimus dans les cancers du sein métastatiques de la femme ménopausée,HER2-négatifs,exprimant les récepteurs hormonaux et résistants aux inhibiteurs de l’aromatase non stéroïdiens : une nouvelle option thérapeutique

Phosphatidylinositol-3-kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR) pathway is commonly deregulated in breast cancer and has been involved in resistance to endocrine therapy. In the BOLERO-2 study, the addition of everolimus, a selective inhibitor of mTOR protein, to exemestane was associated with a significant improvement in progression-free survival, compared to exemestane plus placebo, in patients with hormone receptor-positive, HER2-negative metastatic breast cancer, and resistant to non-steroidal aromatase inhibitor therapy. However, adverse events and treatment stops were more often observed with the combination therapy, suggesting the need for a careful benefit/risk evaluation before initiating this new combination. This review aims at synthesizing the biological basis of the everolimus-exemestane association, presenting the main validated and ongoing therapeutic trials, interests and limits, as well as the multiple potential therapeutic perspectives.     

PI3K-AKT-mTOR信号通路在伯基特淋巴瘤中的活化

目的 探讨PI3K-AKT-mTOR信号通路在伯基特淋巴瘤中的活化情况.方法 收集13例伯基特淋巴瘤患者淋巴瘤组织及14例患者淋巴结反应性增生组织病理切片,采用免疫组织化学方法检测AKT、mTOR、RPS6磷酸化情况.结果 伯基特淋巴瘤组织中p-AKT、p-mTOR、p-RPS6表达率分别为84.6％(11/13)、100.0％(13/13)、100.0％(13/13),反应性淋巴结增生为64.2 ％(9/14)、71.4％(10/14)、78.6 ％(11/14),阳性表达率差异均具有统计学意义(均P＜0.05).结论 PI3K-AKT-mTOR信号通路在伯基特淋巴瘤中存在异常活化.     

骨唾液酸蛋白对乳腺癌 MDA-MB-231 细胞 PI3K-AKT 信号通路的影响

目的:探讨骨唾液酸蛋白(bone sialoprotein,BSP)对乳腺癌MDA-MB-231细胞PI3K-AKT信号通路的影响。方法:BSP基因沉默的乳腺癌MDA-MB-231细胞(简称231BO-BSP27)经重组人BSP(recombinant human BSP,rhBSP)和PI3K-AKT抑制剂LY294002处理后,Western blotting检测磷酸化AKT水平的变化,实时定量PCR检测caspase-3、cyclin D1 mRNA表达水平,MTT法检测细胞增殖能力。结果:与BSP基因未沉默的对照组231BO-Scrambled细胞相比,BSP基因沉默的231BO-BSP27细胞BSP蛋白表达明显下调(74.32±2.18)%(P<0.01);AKT磷酸化水平明显下降(33.30±2.61)%(P<0.01),而caspase-3和cyclin D1 mRNA表达分别上升和下降(1.000±0.000 vs 1.733±0.039,1.000±0.000 vs 0.370±0.012;均P<0.01);231BO-BSP27细胞增殖能力显著下降(P<0.05)。外源添加rhBSP蛋白分别上调231BO-Scrambled和231BO-BSP27细胞AKT磷酸化水平(17.86±2.27)%和(33.78±1.51)%(均P<0.01),231BO-BSP27细胞caspase-3 mRNA表达降低(1.000±0.039 vs 0.541±0.091,P<0.01)、cyclin D1 mRNA表达升高(1.000±0.000 vs 2.921±0.032,P<0.01),促进231BO-Scrambled和231BO-BSP27细胞的增殖(均P<0.01)。LY294002则能逆转rhBSP对231BO-Scrambled和231BO-BSP27细胞AKT磷酸化激活作用(P<0.05),使231BO-BSP27细胞caspase-3 mRNA表达升高(P<0.01)、cyclin D1 mRNA表达降低(P<0.01),使该两种细胞增殖能力下降(均P<0.01)。结论:BSP通过PI3K-AKT信号通路调控乳腺癌MDA-MB-231细胞caspase-3和cyclin D1的表达,并影响细胞的增殖。     

m-TOR inhibitors: biology and use in the treatment of haematological diseases

Mammalian target of rapamycyin (mTOR) is a downstream serine/threonine kinase of the PI3K/AKT pathway that integrates signals from the microenvironment such as cytokines, growth factors, and nutriments to regulate multiple cellular processes, including mRNA translation, autophagy, metabolism, growth and survival. mTOR operates in two distinct multi-protein complexes: mTORC1 and mTORC2; sharing mTOR kinase as a common catalytic subunit, mTORC1 controls cell growth and mTORC2 modulates cell survival and drug resistance. mTOR signalling pathway has been found to be deregulated in many haematological malignancies, and has been designed as an attractive anti-tumor target. Thereby, mTOR inhibition with rapamycin (sirolimus) or its derivates (rapalogs) represents promising treatments, either alone or in combination with strategies to target other pathways that may overcome resistance. At present time, numerous clinical trials with mTOR inhibitors are ongoing for treatment of haematological diseases with modest or promising results. The aim of this review is to present the rationale for using mTOR inhibitors in haematology, first via biological explanations and secondly, by focusing on each haematological malignancies with new perspective of treatment.     

Targeting the PI3K-AKT-mTOR signaling network in cancer

The phosphoinositide 3-kinase-AKT-mammalian target of rapamycin (PI3K-AKT-mTOR) pathway is a frequently hyperactivated pathway in cancer and is important for tumor cell growth and survival. The development of targeted therapies against mTOR, a vital substrate along this pathway, led to the approval of allosteric inhibitors, including everolimus and temsirolimus, for the treatment of breast, renal, and pancreatic cancers. However, the suboptimal duration of response in unselected patients remains an unresolved issue. Numerous novel therapies against critical nodes of this pathway are therefore being actively investigated in the clinic in multiple tumour types. In this review, we focus on the progress of these agents in clinical development along with their biological rationale, the need of predictive biomarkers and various combination strategies, which will be useful in counteracting the mechanisms of resistance to this class of drugs.     

PI3K/AKT/mTOR通路及其抑制剂在乳腺癌中的应用现状

磷脂酰肌醇3-激酶（phosphoinositide 3-kinase,PI3K）/蛋白激酶B（protein kinase B,AKT）/哺乳动物雷帕霉素靶蛋白（mammalian target of rapamycin,mTOR）信号转导通路在多种肿瘤中异常激活,参与肿瘤细胞增殖、分化和凋亡等生命过程的调控,是抗肿瘤药物研发的重要靶点。对目前已应用于乳腺癌临床或处于临床试验阶段的PI3K/AKT/mTOR信号通路抑制剂进行归纳,并综述该通路抑制剂的联合用药策略,以期为不同亚型乳腺癌提供个体化靶向治疗方案。     

A novel imidazopyridine derivative,HS-106, induces apoptosis of breast cancer cells and represses angiogenesis by targeting the PI3K/mTOR pathway

Abnormal activation of the phosphatidylinositol 3-kinase (PI3K)/Akt pathway is an essential step for the formation and growth of tumors in humans. HS-106 is an imidazopyridine derivative that inhibits the kinase activity of PI3K by binding to the ATP-binding cleft. We found that this compound suppressed breast cancer cell proliferation and induced apoptosis by specifically inhibiting the activity of target proteins in the PI3K/Akt/mTOR signaling pathway. Cell cycle analysis revealed that treatment with HS-106 resulted in cell cycle arrest at the G₂/M phase due to up-regulation of p-cdc25 and down-regulation of cyclin B1. Also, HS-106 induced apoptosis by increasing the levels of cleaved caspase-3 and cleaved PARP. In addition, chromatin condensation and apoptotic bodies were detected in HS-106-treated breast cancer cells. Furthermore, HS-106 decreased the expression of hypoxia-inducible factor 1α (HIF-1α), and inhibited tube formation and migration of human umbilical vein endothelial cells (HUVECs) in vitro and blood vessel formation in an in vivo Matrigel plug assay. These results show that HS-106 may be an effective novel therapeutic candidate in clinical trials as a potential treatment for human breast cancers or other advanced malignancies with aberrant PI3K/Akt/mTOR signaling.     

Inhibition of PI3K/Akt/mTOR signaling pathway enhances the sensitivity of the SKOV3/DDP ovarian cancer cell line to cisplatin in vitro

The activation of the PI3K/AKT/m TOR pathway plays a key role in ovarian cancer tumorigenesis, progression and chemotherapy resistance. This study aimed to explore the possible mechanism that PI-103, a dual inhibitor of phosphatidylinositide 3-kinase and m TOR, enhances the sensitivity of SKOV3/DDP ovarian cancer cell line to cisplatin chemotherapy. The results showed that PI-103 could significantly increase the sensitivity of SKVO3/DDP cells to cisplatin through inhibiting the activation of PI3K/Akt/m TOR signaling pathway and inducing cell cycle arrest and apoptosis.     

PI3K/AKT/mTOR通路抑制剂在膀胱癌中的研究进展

磷脂酰肌醇3-激酶(PI3K)/AKT/哺乳动物雷帕霉素靶标(mTOR)通路在人类肿瘤的恶性转化及其随后的生长、增殖和转移中起重要作用。临床前研究表明,PI3K/AKT/mTOR通路在膀胱癌中经常被激活。因此,这一通路被认为是膀胱癌治疗干预的候选通路,针对该通路不同成分的抑制剂正处于临床开发的不同阶段。在这里,重点介绍我们对PI3K/AKT/mTOR通路的最新研究进展,并讨论以该通路为靶点的治疗药物作为膀胱癌治疗药物的发展障碍及发展潜力。     

PI3K-AKT-mTOR信号通路抑制剂与肿瘤免疫治疗

磷脂酰肌醇3-蛋白激酶B-哺乳动物雷帕霉素靶蛋白（PI3K-AKT-mTOR）信号通路的上游通路主要包括表皮生长因子受体(EGFR)、人类表皮生长因子受体2(HER2)、肝细胞生长因子受体(MET)和成纤维细胞生长因子受体(FGFR)等各类受体的酪氨酸激酶,其受体的突变、扩增常会导致PI3K-AKT-mTOR信号通路的失调,引起肿瘤发生发展。该通路异常激活常伴随着下游关键分子的改变包括PIK3CA、AKT1、PTEN 的基因突变,PIK3CA、AKT1、AKT2 的基因扩增,肿瘤抑制基因PTEN 的缺失等。PI3K-AKT-mTOR信号通路抑制剂主要包括PI3K抑制剂、AKT抑制剂、mTOR抑制剂和双重抑制剂等。PI3K-AKT-mTOR抑制剂对肿瘤免疫微环境、免疫细胞均有显著影响。PI3K-AKT-mTOR抑制剂单药治疗肿瘤具有一定局限性,如联合DC疫苗、免疫检查点抑制剂和CAR-T细胞等免疫疗法可增强抗肿瘤疗效。     

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.     

Chemoresistance in breast cancer: PI3K/Akt pathway inhibitors vs the current chemotherapy

Breast cancer is the most prevalent type of cancer among women. Several types of drugs, targeting the specific proteins expressed on the breast cancer cell surface (such as receptor tyrosine kinases and immune checkpoint regulators) and proteins involved in cell cycle and motility (including cyclin-dependent kinases, DNA stabilisers, and cytoskeleton modulators) are approved for different subtypes of breast cancer. However, breast cancer also has a poor response to conventional chemotherapy due to intrinsic and acquired resistance, and an Akt fingerprint is detectable in most drug-resistant cases. Overactivation of Akt and its upstream and downstream regulators in resistant breast cancer cells is considered a major potential target for novel anti-cancer therapies, suggesting that Akt signalling acts as a cellular mechanism against chemotherapy. The present review has shown that sustained activation of Akt results in resistance to different types of chemotherapy. Akt signalling plays a cellular defence role against chemotherapy and (1) enhances multi-drug resistance, (2) increases reactive oxygen species at breast tumor microenvironment, (3) enhances anaerobic metabolism, (4) inhibits the tricarboxylic cycle, (5) promotes PD-L1 upregulation, (6) inhibits apoptosis, (7) increases glucose uptake, and more importantly (8) recruits and interconnects the plasma membrane, nucleus, endoplasmic reticulum, and mitochondria to hijack breast cancer cells and rescue these cells from chemotherapy. Therefore, Akt signalling is considered a cellular defence mechanism employed against chemotherapeutic effects. In addition, interfering roles of PI3K/Akt signalling on the current cytotoxic and molecularly targeted therapy as well as immunotherapy of breast cancer are discussed with a clinical approach. Although, alpelisib, a PIK3CA inhibitor, is the only PI3K/Akt pathway inhibitor approved for breast cancer, we also highlight well-evaluated inhibitors of PI3K/Akt signalling based on different subtypes of breast cancer, which are under clinical trials whether as monotherapy or in combination with other types of chemotherapy.     

PI3K/Akt/mTOR信号传导通路与恶性肿瘤浸润和转移的研究进展

PI3K/Akt/mTOR信号通路作为细胞内重要信号传导通路之一,通过影响下游多种效应分子的活化状态,在细胞内发挥着抑制凋亡、促进增殖的关键作用,它与人类多种肿瘤的发生发展密切相关.本文综述了PI3K/Akt/mTOR信号通路的组成与功能、调节以及其抗肿瘤细胞凋亡作用机理等方面的研究进展,并就其抗细胞凋亡作用在肿瘤治疗中的应用作了评述,期待为以PI3K/Akt/mTOR信号通路中关键分子为靶点的肿瘤治疗研究提供参考.     

基于SNP芯片研究PI3K/Akt/mTOR通路上自噬相关基因SNPs与胃癌的关联

目的： 探讨与胃癌发生相关的PI3K/Akt/mTOR通路上新的与自噬相关基因单核苷酸多态性位点（SNPs），为寻找有价值的胃癌发生相关的分子标志物提供新的依据。方法： 采用1：1配对病例-对照研究的方法。通过KEGG pathway网站和Gene Ontology、Ensemble数据库及HaploView、STRING、Cytoscape软件联合SNP芯片筛选目标SNPs，采用基质辅助激光解吸电离飞行时间质谱（MALDI-TOF-MS）对筛检出来的SNPs位点在来自福建省仙游县的622例胃癌患者和622例健康人群基因组中进行验证。结果： SNP芯片及生物信息学分析筛选出IRS1 rs10205233、PIK3CD rs3934934、PIK3R1 rs706711、PIK3R1 rs706714和AKT1 rs35285446为候选位点。扩大样本验证发现IRS1 rs10205233的多态性变异（C > T）显著降低了胃癌的发病风险[共显性模型、显性模型的OR（95% CI）分别为0.761（0.595，0.975）、0.764（0.601，0.973）]。进一步分层分析，该位点显性模型、隐形模型、共显性模型以及等位基因在贲门癌和非贲门癌人群中均未见统计学差异（P > 0.05）。并未见其他位点与患胃癌风险的关联有统计学意义。对PIK3R1基因2个位点（rs706711、rs706714）的单体型分析也未见统计学差异。结论： IRS1 rs10205233位点与福建省胃癌高发区仙游县的胃癌发生存在关联，T等位基因可能是胃癌发生的一个遗传保护因素。     

基于SNP芯片研究PI3K/Akt/mTOR通路上自噬相关基因SNPs与胃癌的关联

目的： 探讨与胃癌发生相关的PI3K/Akt/mTOR通路上新的与自噬相关基因单核苷酸多态性位点（SNPs）,为寻找有价值的胃癌发生相关的分子标志物提供新的依据。方法： 采用1：1配对病例-对照研究的方法。通过KEGG pathway网站和Gene Ontology、Ensemble数据库及HaploView、STRING、Cytoscape软件联合SNP芯片筛选目标SNPs,采用基质辅助激光解吸电离飞行时间质谱（MALDI-TOF-MS）对筛检出来的SNPs位点在来自福建省仙游县的622例胃癌患者和622例健康人群基因组中进行验证。结果： SNP芯片及生物信息学分析筛选出IRS1 rs10205233、PIK3CD rs3934934、PIK3R1 rs706711、PIK3R1 rs706714和AKT1 rs35285446为候选位点。扩大样本验证发现IRS1 rs10205233的多态性变异（C > T）显著降低了胃癌的发病风险[共显性模型、显性模型的OR（95% CI）分别为0.761（0.595,0.975）、0.764（0.601,0.973）]。进一步分层分析,该位点显性模型、隐形模型、共显性模型以及等位基因在贲门癌和非贲门癌人群中均未见统计学差异（P > 0.05）。并未见其他位点与患胃癌风险的关联有统计学意义。对PIK3R1基因2个位点（rs706711、rs706714）的单体型分析也未见统计学差异。结论： IRS1 rs10205233位点与福建省胃癌高发区仙游县的胃癌发生存在关联,T等位基因可能是胃癌发生的一个遗传保护因素。     

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。     

Targeting the PI3K pathway and DNA damage response as a therapeutic strategy in ovarian cancer

Ovarian cancer is the most lethal gynecological malignancy worldwide although exponential progress has been made in its treatment over the last decade. New agents and novel combination treatments are on the horizon. Among many new drugs, a series of PI3K/AKT/mTOR pathway (referred to as the PI3K pathway) inhibitors are under development or already in clinical testing. The PI3K pathway is frequently upregulated in ovarian cancer and activated PI3K signaling contributes to increased cell survival and chemoresistance. However, no significant clinical success has been achieved with the PI3K pathway inhibitor(s) to date, reflecting the complex biology and also highlighting the need for combination treatment strategies. DNA damage repair pathways have been active therapeutic targets in ovarian cancer. Emerging data suggest the PI3K pathway is also involved in DNA replication and genome stability, making DNA damage response (DDR) inhibitors as an attractive combination treatment for PI3K pathway blockades. This review describes an expanded role for the PI3K pathway in the context of DDR and cell cycle regulation. We also present the novel treatment strategies combining PI3K pathway inhibitors with DDR blockades to improve the efficacy of these inhibitors for ovarian cancer.