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Moon DO. NADPH Dynamics: Linking Insulin Resistance and β-Cells Ferroptosis in Diabetes Mellitus. Int J Mol Sci 2023; 25:342. [PMID: 38203517 PMCID: PMC10779351 DOI: 10.3390/ijms25010342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
This review offers an in-depth exploration of Nicotinamide Adenine Dinucleotide Phosphate (NADPH) in metabolic health. It delves into how NADPH affects insulin secretion, influences insulin resistance, and plays a role in ferroptosis. NADPH, a critical cofactor in cellular antioxidant systems and lipid synthesis, plays a central role in maintaining metabolic homeostasis. In adipocytes and skeletal muscle, NADPH influences the pathophysiology of insulin resistance, a hallmark of metabolic disorders such as type 2 diabetes and obesity. The review explores the mechanisms by which NADPH contributes to or mitigates insulin resistance, including its role in lipid and reactive oxygen species (ROS) metabolism. Parallelly, the paper investigates the dual nature of NADPH in the context of pancreatic β-cell health, particularly in its relation to ferroptosis, an iron-dependent form of programmed cell death. While NADPH's antioxidative properties are crucial for preventing oxidative damage in β-cells, its involvement in lipid metabolism can potentiate ferroptotic pathways under certain pathological conditions. This complex relationship underscores the delicate balance of NADPH homeostasis in pancreatic health and diabetes pathogenesis. By integrating findings from recent studies, this review aims to illuminate the nuanced roles of NADPH in different tissues and its potential as a therapeutic target. Understanding these dynamics offers vital insights into the development of more effective strategies for managing insulin resistance and preserving pancreatic β-cell function, thereby advancing the treatment of metabolic diseases.
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Affiliation(s)
- Dong-Oh Moon
- Department of Biology Education, Daegu University, 201 Daegudae-ro, Gyeongsan-si 38453, Gyeongsangbuk-do, Republic of Korea
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2
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Stadler G, de Almeida Veiga A, Rita Corso C, Bach de Assis C, de Toledo Nogueira B, Regina Rocha Martins L, Cruz Bonk B, Lada Degaut Pontes F, Cavalcante de Figueiredo B, Mera de Souza L. Two-dimensional chromatography for enantiomeric analysis of mitotane and its metabolite o,p'-DDA in patients with adrenocortical carcinoma indicates enantioselective metabolism. Bioorg Chem 2023; 141:106835. [PMID: 37713949 DOI: 10.1016/j.bioorg.2023.106835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/21/2023] [Accepted: 09/02/2023] [Indexed: 09/17/2023]
Abstract
Mitotane is a chiral drug used to treat adrenocortical carcinoma, being metabolized to the o,p'-dichlorodiphenyl acetic acid (o,p'-DDA), also a chiral compound. Despite of its therapeutic significance, the overall ratios and enantiomers have not been known. In this study, we analyzed the enantiomers of mitotane and o,p'-DDA in the plasma of patients by a newly developed chiral-phase method employed in two-dimensional chromatography. Important differences were observed in the ratio of (S)/(R)-mitotane, which varied substantially from 1:1.2 to 1:10 whereas the (S)/(R)-o,p'-DDA ratio was relatively conserved, at approximately 2:1. These findings provide evidence for the enantioselective metabolism and provide a method for further analyses of mitotane and metabolites, which can explain the variation in the therapeutic response.
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Affiliation(s)
- Gabriela Stadler
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba 80250-060, Brazil; Faculdades Pequeno Príncipe, Curitiba 80230-020, Brazil
| | - Alan de Almeida Veiga
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba 80250-060, Brazil; Faculdades Pequeno Príncipe, Curitiba 80230-020, Brazil
| | - Claudia Rita Corso
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba 80250-060, Brazil; Faculdades Pequeno Príncipe, Curitiba 80230-020, Brazil
| | - Camila Bach de Assis
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba 80250-060, Brazil; Faculdades Pequeno Príncipe, Curitiba 80230-020, Brazil
| | - Beatriz de Toledo Nogueira
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba 80250-060, Brazil; Faculdades Pequeno Príncipe, Curitiba 80230-020, Brazil
| | | | - Beatriz Cruz Bonk
- Universidade Tecnológica Federal do Paraná, Curitiba 81280-340, Brazil
| | - Flávia Lada Degaut Pontes
- Departamento de Bioquímica e Biologia Molecular, Universidade Federal do Paraná, Curitiba 81531-990, Brazil
| | - Bonald Cavalcante de Figueiredo
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba 80250-060, Brazil; Faculdades Pequeno Príncipe, Curitiba 80230-020, Brazil
| | - Lauro Mera de Souza
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba 80250-060, Brazil; Faculdades Pequeno Príncipe, Curitiba 80230-020, Brazil.
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3
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Bach C, Corso CR, Veiga ADA, Paraizo MM, de Souza LM. Effects of o,p'-DDE, a Mitotane Metabolite, in an Adrenocortical Carcinoma Cell Line. Pharmaceuticals (Basel) 2022; 15:ph15121486. [PMID: 36558937 PMCID: PMC9784234 DOI: 10.3390/ph15121486] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022] Open
Abstract
In South Brazil, the incidence of pediatric adrenocortical carcinoma (ACC) is higher than in other regions and countries worldwide. The ACC treatment includes therapy with mitotane, the only adrenolytic drug approved by the FDA. The mitotane metabolism occurs via two main reactions: the β-hydroxylation, which yields the final product o,p'-DDA, and the α-hydroxylation, which will give the final product o,p'-DDE. It is speculated that o,p'-DDE may be an active metabolite since it has a cytotoxic effect on adrenocortical carcinoma cells (H295R). No further studies have been conducted to confirm this hypothesis; however, it was found that mitotane and its metabolites are present at significantly different concentrations in the plasma of the patients. Our study aimed to assess the in vitro effects of o,p'-DDE and o,p'-DDD in cell death pathways, oxidative parameters, and interaction with adrenal CYP's involved in the steroidogenic process in the H295R cell line. It was found that o,p'-DDE had a different effect than the o,p'-DDD on apoptosis, inhibiting this cell death pathway, but it promotes cell necrosis at higher concentrations. In contrast to o,p'-DDD, the o,p'-DDE did not have effects on the different oxidative parameters evaluated, but exhibited stimulatory interactions with steroidogenic CYP's, at intermediate concentrations. Therefore, we demonstrated important cell effects of o,p'-DDE; its plasma levels during mitotane therapy should be monitored as an important therapeutic parameter.
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Affiliation(s)
- Camila Bach
- Instituto de Pesquisa Pelé Pequeno Príncipe, Av. Silva Jardim, 1632-Água Verde, Curitiba CEP 80250-060, PR, Brazil
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333-Rebouças, Curitiba CEP 80230-020, PR, Brazil
| | - Claudia Rita Corso
- Instituto de Pesquisa Pelé Pequeno Príncipe, Av. Silva Jardim, 1632-Água Verde, Curitiba CEP 80250-060, PR, Brazil
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333-Rebouças, Curitiba CEP 80230-020, PR, Brazil
| | - Alan de Almeida Veiga
- Instituto de Pesquisa Pelé Pequeno Príncipe, Av. Silva Jardim, 1632-Água Verde, Curitiba CEP 80250-060, PR, Brazil
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333-Rebouças, Curitiba CEP 80230-020, PR, Brazil
| | - Mariana Martins Paraizo
- Instituto de Pesquisa Pelé Pequeno Príncipe, Av. Silva Jardim, 1632-Água Verde, Curitiba CEP 80250-060, PR, Brazil
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333-Rebouças, Curitiba CEP 80230-020, PR, Brazil
| | - Lauro Mera de Souza
- Instituto de Pesquisa Pelé Pequeno Príncipe, Av. Silva Jardim, 1632-Água Verde, Curitiba CEP 80250-060, PR, Brazil
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333-Rebouças, Curitiba CEP 80230-020, PR, Brazil
- Correspondence: ; Tel.: +55-41-3310-1035
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Stelcer E, Komarowska H, Jopek K, Żok A, Iżycki D, Malińska A, Szczepaniak B, Komekbai Z, Karczewski M, Wierzbicki T, Suchorska W, Ruchała M, Ruciński M. Biological response of adrenal carcinoma and melanoma cells to mitotane treatment. Oncol Lett 2022; 23:120. [PMID: 35261634 PMCID: PMC8855164 DOI: 10.3892/ol.2022.13240] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/02/2021] [Indexed: 11/09/2022] Open
Abstract
A previous case report described an adrenal incidentaloma initially misdiagnosed as adrenocortical carcinoma (ACC), which was treated with mitotane. The final diagnosis was metastatic melanoma of unknown primary origin. However, the patient developed rapid disease progression after mitotane withdrawal, suggesting a protective role for mitotane in a non-adrenal-derived tumor. The aim of the present study was to determine the biological response of primary melanoma cells obtained from that patient, and that of other established melanoma and ACC cell lines, to mitotane treatment using a proliferation assay, flow cytometry, quantitative PCR and microarrays. Although mitotane inhibited the proliferation of both ACC and melanoma cells, its role in melanoma treatment appears to be limited. Flow cytometry analysis and transcriptomic studies indicated that the ACC cell line was highly responsive to mitotane treatment, while the primary melanoma cells showed a moderate response in vitro. Mitotane modified the activity of several key biological processes, including ‘mitotic nuclear division’, ‘DNA repair’, ‘angiogenesis’ and ‘negative regulation of ERK1 and ERK2 cascade’. Mitotane administration led to elevated levels of DNA double-strand breaks, necrosis and apoptosis. The present study provides a comprehensive insight into the biological response of mitotane-treated cells at the molecular level. Notably, the present findings offer new knowledge on the effects of mitotane on ACC and melanoma cells.
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Affiliation(s)
- Ewelina Stelcer
- Department of Histology and Embryology, Poznan University of Medical Sciences, 61‑001 Poznan, Poland
| | - Hanna Komarowska
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 60‑355 Poznan, Poland
| | - Karol Jopek
- Department of Histology and Embryology, Poznan University of Medical Sciences, 61‑001 Poznan, Poland
| | - Agnieszka Żok
- Division of Philosophy of Medicine and Bioethics, Department of Social Sciences and Humanities, Poznan University of Medical Sciences, 60‑806 Poznan, Poland
| | - Dariusz Iżycki
- Department of Cancer Immunology, Poznan University of Medical Sciences, 61‑866 Poznan, Poland
| | - Agnieszka Malińska
- Department of Histology and Embryology, Poznan University of Medical Sciences, 61‑001 Poznan, Poland
| | - Beata Szczepaniak
- Department of Histology and Embryology, Poznan University of Medical Sciences, 61‑001 Poznan, Poland
| | - Zhanat Komekbai
- Department of Histology, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan
| | - Marek Karczewski
- Department of General and Transplantation Surgery, Poznan University of Medical Sciences, 60‑355 Poznan, Poland
| | - Tomasz Wierzbicki
- Department of General, Endocrinological and Gastroenterological Surgery, Poznan University of Medical Sciences, 60‑355 Poznan, Poland
| | - Wiktoria Suchorska
- Radiobiology Laboratory, Greater Poland Cancer Centre, 61‑866 Poznan, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 60‑355 Poznan, Poland
| | - Marcin Ruciński
- Department of Histology and Embryology, Poznan University of Medical Sciences, 61‑001 Poznan, Poland
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5
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Altieri B, Lalli E, Faggiano A. Mitotane treatment in adrenocortical carcinoma: mechanisms of action and predictive markers of response to therapy. Minerva Endocrinol (Torino) 2021; 47:203-214. [PMID: 34881855 DOI: 10.23736/s2724-6507.21.03601-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Adrenocortical carcinoma (ACC) is a rare malignancy with a high risk of recurrence even in cases with complete surgical tumor resection. Mitotane represents the cornerstone of the adjuvant therapy as well as the first line of medical treatment in advanced cases. However, evidence on mitotane efficacy is mostly based on retrospective studies and the use of mitotane continues to represent a clinical challenge. EVIDENCE ACQUISITION Mitotane causes selective damage to adrenocortical cells, causing an increase of cell apoptosis through a disruption of mitochondria and the induction of the endoplasmic reticulum stress. Different clinical and molecular markers predicting response to mitotane have been proposed with uncertain results. Attainment of mitotane plasma levels within the target range of 14 to 20 mg/L represent the strongest predictor of mitotane effectiveness both in adjuvant and advanced tumor setting. The occurrence of late recurrence after primary ACC diagnosis and changes in metabolic activity on FDG-PET are only weakly associated with mitotane response. Among the proposed molecular markers associated with mitotane efficacy, the investigation of the CYP2W1*6 and CYP2B6*6 single nucleotide polymorphisms appears to be currently the most promising predictive molecular markers of mitotane therapy. However, none of the evaluated markers has been validated for clinical use. CONCLUSIONS In the era of precision medicine, a better insight into mitotane molecular mechanisms as well as the potential use in the daily clinical practice of clinical parameters and molecular markers predicting the individual response to mitotane are urgently needed.
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Affiliation(s)
- Barbara Altieri
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany -
| | - Enzo Lalli
- Institut de Pharmacologie Moléculaire et Cellulaire CNRS UMR 7275, Valbonne, France.,Université Côte d'Azur, Valbonne, France.,INSERM, Valbonne, France
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Lo Iacono M, Puglisi S, Perotti P, Saba L, Petiti J, Giachino C, Reimondo G, Terzolo M. Molecular Mechanisms of Mitotane Action in Adrenocortical Cancer Based on In Vitro Studies. Cancers (Basel) 2021; 13:cancers13215255. [PMID: 34771418 PMCID: PMC8582505 DOI: 10.3390/cancers13215255] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/16/2021] [Accepted: 10/16/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Mitotane is the only approved drug for the treatment of advanced adrenocortical carcinoma and for postoperative adjuvant therapy. It is known that mitotane destroys the adrenal cortex impairing steroidogenesis, although its exact molecular mechanism is still unclear. However, confounding factors affecting in vitro experiments could reduce the relevance of the studies. In this review, we explore in vitro studies on mitotane effects, highlighting how different experimental conditions might contribute to the controversial findings. On this basis, it may be necessary to re-evaluate the experiments taking into account their potential confounding factors such as cell strains, culture serum, lipoprotein concentration, and culture passages, which could hide important molecular results. As a consequence, the identification of novel pharmacological molecular pathways might be used in the future to implement personalized therapy, maximizing the benefit of mitotane treatment while minimizing its toxicity. Abstract Mitotane is the only approved drug for the treatment of advanced adrenocortical carcinoma and is increasingly used for postoperative adjuvant therapy. Mitotane action involves the deregulation of cytochromes P450 enzymes, depolarization of mitochondrial membranes, and accumulation of free cholesterol, leading to cell death. Although it is known that mitotane destroys the adrenal cortex and impairs steroidogenesis, its exact mechanism of action is still unclear. The most used cell models are H295-derived cell strains and SW13 cell lines. The diverging results obtained in presumably identical cell lines highlight the need for a stable in vitro model and/or a standard methodology to perform experiments on H295 strains. The presence of several enzymatic targets responsive to mitotane in mitochondria and mitochondria-associated membranes causes progressive alteration in mitochondrial structure when cells were exposed to mitotane. Confounding factors of culture affecting in vitro experiments could reduce the significance of any molecular mechanism identified in vitro. To ensure experimental reproducibility, particular care should be taken in the choice of culture conditions: aspects such as cell strains, culture serum, lipoproteins concentration, and culture passages should be carefully considered and explicated in the presentation of results. We aimed to review in vitro studies on mitotane effects, highlighting how different experimental conditions might contribute to the controversial findings. If the concerns pointed out in this review will be overcome, the new insights into mitotane mechanism of action observed in-vitro could allow the identification of novel pharmacological molecular pathways to be used to implement personalized therapy.
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The Challenging Pharmacokinetics of Mitotane: An Old Drug in Need of New Packaging. Eur J Drug Metab Pharmacokinet 2021; 46:575-593. [PMID: 34287806 PMCID: PMC8397669 DOI: 10.1007/s13318-021-00700-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 01/10/2023]
Abstract
Adrenocortical carcinoma (ACC) is a malignant tumor originating from the adrenal gland cortex with a heterogeneous but overall dismal prognosis in advanced stages. For more than 50 years, mitotane has remained a cornerstone for the treatment of ACC as adjuvant and palliative therapy. It has a very poor aqueous solubility of 0.1 mg/l and high partition coefficient in octanol/water (log P) value of 6. The commercially available dosage form is 500 mg tablets (Lysodren®). Even at doses up to 6 g/day (12 tablets in divided doses) for several months, > 50% patients do not achieve therapeutic plasma concentration > 14 mg/l due to poor water solubility, large volume of distribution and inter/intra-individual variability in bioavailability. This article aims to give a concise update of the clinical challenges associated with the administration of high-dose mitotane oral therapy which encompass the issues of poor bioavailability, difficult-to-predict pharmacokinetics and associated adverse events. Moreover, we present recent efforts to improve mitotane formulations. Their success has been limited, and we therefore propose an injectable mitotane formulation instead of oral administration, which could bypass many of the main issues associated with high-dose oral mitotane therapy. A parenteral administration of mitotane could not only help to alleviate the adverse effects but also circumvent the variable oral absorption, give better control over therapeutic plasma mitotane concentration and potentially shorten the time to achieve therapeutic drug plasma concentrations considerably. Mitotane as tablet form is currently the standard treatment for adrenocortical carcinoma. It has been used for 5 decades but suffers from highly variable responses in patients, subsequent adverse effects and overall lower response rate. This can be fundamentally linked to the exceedingly poor water solubility of mitotane itself. In terms of enhancing water solubility, a few research groups have attempted to develop better formulations of mitotane to overcome the issues associated with tablet dosage form. However, the success rate was limited, and these formulations did not make it into the clinics. In this article, we have comprehensively reviewed the properties of these formulations and discuss the reasons for their limited utility. Furthermore, we discuss a recently developed mitotane nanoformulation that led us to propose a novel approach to mitotane therapy, where intravenous delivery supplements the standard oral administration. With this article, we combine the current state of knowledge as a single piece of information about the various problems associated with the use of mitotane tablets, and herein we postulate the development of a new injectable mitotane formulation, which can potentially circumvent the major problems associated to mitotane's poor water solubility.
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Corso CR, Acco A, Bach C, Bonatto SJR, de Figueiredo BC, de Souza LM. Pharmacological profile and effects of mitotane in adrenocortical carcinoma. Br J Clin Pharmacol 2021; 87:2698-2710. [PMID: 33382119 DOI: 10.1111/bcp.14721] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 12/20/2022] Open
Abstract
Mitotane is the only adrenolytic drug approved by the Food and Drug Administration for treating adrenocortical carcinoma (ACC). This drug has cytotoxic effects on tumour tissues; it induces cell death and antisecretory effects on adrenal cells by inhibiting the synthesis of adrenocortical steroids, which are involved in the pathogenesis of ACC. However, high doses of mitotane are usually necessary to reach the therapeutic plasma concentration, which may result in several adverse effects. This suggests that important pharmacological processes, such as first pass metabolism, tissue accumulation and extensive time for drug elimination, are associated with mitotane administration. Few studies have reported the pharmacological aspects and therapeutic effects of mitotane. Therefore, the aim of this review was to summarize the chemistry, pharmacokinetics and pharmacodynamics, and therapeutic and toxic effects of mitotane. This review also discusses new perspectives of mitotane formulation that are currently under investigation. Understanding the pharmacological profile of mitotane can improve the monitoring and efficacy of this drug in ACC treatment and can provide useful information for the development of new drugs with specific action against ACC with fewer adverse effects.
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Affiliation(s)
- Claudia Rita Corso
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil.,Faculdades Pequeno Príncipe, Curitiba, Brazil
| | - Alexandra Acco
- Pharmacology Department, Federal University of Paraná, Curitiba, Brazil
| | - Camila Bach
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil.,Faculdades Pequeno Príncipe, Curitiba, Brazil
| | - Sandro José Ribeiro Bonatto
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil.,Faculdades Pequeno Príncipe, Curitiba, Brazil
| | | | - Lauro Mera de Souza
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil.,Faculdades Pequeno Príncipe, Curitiba, Brazil
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Paragliola RM, Corsello A, Locantore P, Papi G, Pontecorvi A, Corsello SM. Medical Approaches in Adrenocortical Carcinoma. Biomedicines 2020; 8:biomedicines8120551. [PMID: 33260476 PMCID: PMC7760807 DOI: 10.3390/biomedicines8120551] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/15/2020] [Accepted: 11/27/2020] [Indexed: 12/15/2022] Open
Abstract
Adrenocortical carcinoma (ACC) represents one of the most aggressive endocrine tumors. In spite of a correct therapeutic strategy based on a multidisciplinary approach between endocrinologist, surgeon and oncologist, the prognosis is often poor. Surgery is the mainstay treatment in ACC. Mitotane, a dichloro-diphenyl-trichloro-ethane derivate, represents the main medical treatment of ACC in consideration of its adrenocytolitic activity and it is mainly employed as adjuvant treatment after complete surgical resection and for the treatment of advanced ACC. However, the use of mitotane as adjuvant therapy is still controversial, also in consideration of the retrospective nature of several studies. The recurrence of disease is frequent, especially in advanced disease at the diagnosis. Therefore, in these contexts, conventional chemotherapy must be considered in association with mitotane, being the combination etoposide, doxorubicin and cisplatin (EDP) the standard of care in this setting. A more modern therapeutic approach, based on the need of a salvage therapy for advanced ACC that progresses through first-line EDP, is focused on molecular-targeted therapies. However, robust clinical trials are necessary to assess the real efficacy of these treatments.
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10
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NADPH homeostasis in cancer: functions, mechanisms and therapeutic implications. Signal Transduct Target Ther 2020; 5:231. [PMID: 33028807 PMCID: PMC7542157 DOI: 10.1038/s41392-020-00326-0] [Citation(s) in RCA: 213] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/09/2020] [Accepted: 09/14/2020] [Indexed: 02/08/2023] Open
Abstract
Nicotinamide adenine dinucleotide phosphate (NADPH) is an essential electron donor in all organisms, and provides the reducing power for anabolic reactions and redox balance. NADPH homeostasis is regulated by varied signaling pathways and several metabolic enzymes that undergo adaptive alteration in cancer cells. The metabolic reprogramming of NADPH renders cancer cells both highly dependent on this metabolic network for antioxidant capacity and more susceptible to oxidative stress. Modulating the unique NADPH homeostasis of cancer cells might be an effective strategy to eliminate these cells. In this review, we summarize the current existing literatures on NADPH homeostasis, including its biological functions, regulatory mechanisms and the corresponding therapeutic interventions in human cancers, providing insights into therapeutic implications of targeting NADPH metabolism and the associated mechanism for cancer therapy.
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11
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Weigand I, Altieri B, Lacombe AMF, Basile V, Kircher S, Landwehr LS, Schreiner J, Zerbini MCN, Ronchi CL, Megerle F, Berruti A, Canu L, Volante M, Paiva I, Della Casa S, Sbiera S, Fassnacht M, Fragoso MCBV, Terzolo M, Kroiss M. Expression of SOAT1 in Adrenocortical Carcinoma and Response to Mitotane Monotherapy: An ENSAT Multicenter Study. J Clin Endocrinol Metab 2020; 105:5843694. [PMID: 32449514 DOI: 10.1210/clinem/dgaa293] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/20/2020] [Indexed: 12/18/2022]
Abstract
CONTEXT Objective response rate to mitotane in advanced adrenocortical carcinoma (ACC) is approximately 20%, and adverse drug effects are frequent. To date, there is no marker established that predicts treatment response. Mitotane has been shown to inhibit sterol-O-acyl transferase 1 (SOAT1), which leads to endoplasmic reticulum stress and cell death in ACC cells. OBJECTIVE To investigate SOAT1 protein expression as a marker of treatment response to mitotane. PATIENTS A total of 231 ACC patients treated with single-agent mitotane as adjuvant (n = 158) or advanced disease therapy (n = 73) from 12 ENSAT centers were included. SOAT1 protein expression was determined by immunohistochemistry on formalin-fixed paraffin-embedded specimens. SETTING Retrospective study at 12 ACC referral centers. MAIN OUTCOME MEASURE Recurrence-free survival (RFS), progression-free survival (PFS), and disease-specific survival (DSS). RESULTS Sixty-one of 135 patients (45%) with adjuvant mitotane treatment had recurrences and 45/68 patients (66%) with mitotane treatment for advanced disease had progressive disease. After multivariate adjustment for sex, age, hormone secretion, tumor stage, and Ki67 index, RFS (hazard ratio [HR] = 1.07; 95% confidence interval [CI], 0.61-1.85; P = 0.82), and DSS (HR = 1.30; 95% CI, 0.58-2.93; P = 0.53) in adjuvantly treated ACC patients did not differ significantly between tumors with high and low SOAT1 expression. Similarly, in the advanced stage setting, PFS (HR = 1.34; 95% CI, 0.63-2.84; P = 0.45) and DSS (HR = 0.72; 95% CI, 0.31-1.70; P = 0.45) were comparable and response rates not significantly different. CONCLUSIONS SOAT1 expression was not correlated with clinical endpoints RFS, PFS, and DSS in ACC patients with mitotane monotherapy. Other factors appear to be relevant for mitotane treatment response and ACC patient survival.
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Affiliation(s)
- Isabel Weigand
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Barbara Altieri
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Amanda M F Lacombe
- Unidade de Suprarrenal, Laboratório de Hormônios e Genética Molecular LIM42, Serviço de Endocrinologia e Metabologia, Hospital de Clínicas; Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Brazil, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vittoria Basile
- Department of Clinical and Biological Sciences, University of Turin at San Luigi Hospital, Orbassano, Italy
| | - Stefan Kircher
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Laura-Sophie Landwehr
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Jochen Schreiner
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Maria C N Zerbini
- Unidade de Suprarrenal, Laboratório de Hormônios e Genética Molecular LIM42, Serviço de Endocrinologia e Metabologia, Hospital de Clínicas; Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Brazil, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Cristina L Ronchi
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
- Institute of Metabolism and System Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Felix Megerle
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Letizia Canu
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Marco Volante
- Department of Oncology, University of Turin, Orbassano, Turin, Italy
| | - Isabel Paiva
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário of Coimbra, Coimbra, Portugal
| | - Silvia Della Casa
- Division of Endocrinology and Metabolism, Fondazione Policlinico Gemelli, Catholic University, Rome, Italy
| | - Silviu Sbiera
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Maria Candida B V Fragoso
- Unidade de Suprarrenal, Laboratório de Hormônios e Genética Molecular LIM42, Serviço de Endocrinologia e Metabologia, Hospital de Clínicas; Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Brazil, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Massimo Terzolo
- Department of Clinical and Biological Sciences, University of Turin at San Luigi Hospital, Orbassano, Italy
| | - Matthias Kroiss
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
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12
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Puglisi S, Calabrese A, Basile V, Pia A, Reimondo G, Perotti P, Terzolo M. New perspectives for mitotane treatment of adrenocortical carcinoma. Best Pract Res Clin Endocrinol Metab 2020; 34:101415. [PMID: 32179008 DOI: 10.1016/j.beem.2020.101415] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Adrenocortical carcinoma (ACC) is an aggressive cancer characterized by poor survival. Apart from radical surgery, there is a limited range of therapeutic options and mitotane remains the cornerstone of medical treatment of ACC in either adjuvant or palliative settings. The aim of adjuvant mitotane therapy is to reduce the risk of ACC recurrence following surgical removal of the tumor. Use of mitotane in an adjuvant setting is off-label, but the recent guidelines endorsed by the European Society of Endocrinology (ESE) and the European Network for the Study of Adrenal Tumors (ENSAT) recommend it in ACC patients at high risk of recurrence. The palliative use of mitotane for treatment of advanced ACC aims at controlling tumor progression and, when present, hormone secretion. In this clinical setting, mitotane is used in association with chemotherapy to treat the more aggressive forms, while mitotane monotherapy is reserved for less progressive ACC. Many years after its introduction in clinical practice, there are still uncertainties surrounding the use of this old drug and the derived benefits. Moreover, physicians who use mitotane should recognize and manage the systemic effects of the drug that need a complex supporting therapy.
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Affiliation(s)
- S Puglisi
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - A Calabrese
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - V Basile
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - A Pia
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - G Reimondo
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - P Perotti
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - M Terzolo
- Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy.
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13
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Ruggiero C, Doghman-Bouguerra M, Ronco C, Benhida R, Rocchi S, Lalli E. The GRP78/BiP inhibitor HA15 synergizes with mitotane action against adrenocortical carcinoma cells through convergent activation of ER stress pathways. Mol Cell Endocrinol 2018; 474:57-64. [PMID: 29474877 DOI: 10.1016/j.mce.2018.02.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/10/2018] [Accepted: 02/18/2018] [Indexed: 01/28/2023]
Abstract
Many types of cancer cells present constitutively activated ER stress pathways because of their significant burden of misfolded proteins coded by mutated and rearranged genes. Further increase of ER stress by pharmacological intervention may shift the balance towards cell death and can be exploited therapeutically. Recent studies have shown that an important component in the mechanism of action of mitotane, the only approved drug for the medical treatment of adrenocortical carcinoma (ACC), is represented by activation of ER stress through inhibition of the SOAT1 enzyme and accumulation of toxic lipids. Here we show that HA15, a novel inhibitor of the essential ER chaperone GRP78/BiP, inhibits ACC H295R cell proliferation and steroidogenesis and is able to synergize with mitotane action. These results suggest that convergent activation of ER stress pathways by drugs acting via different mechanisms represents a valuable therapeutic option for ACC.
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Affiliation(s)
- Carmen Ruggiero
- Université Côte d'Azur, Valbonne, 06560, France; CNRS UMR 7275, Sophia Antipolis, Valbonne, 06560, France; NEOGENEX CNRS International Associated Laboratory, Valbonne, 06560, France; Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, 06560, France
| | - Mabrouka Doghman-Bouguerra
- Université Côte d'Azur, Valbonne, 06560, France; CNRS UMR 7275, Sophia Antipolis, Valbonne, 06560, France; NEOGENEX CNRS International Associated Laboratory, Valbonne, 06560, France; Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, 06560, France
| | - Cyril Ronco
- Université Côte d'Azur, Valbonne, 06560, France; Faculté des Sciences, Institut de Chimie de Nice (ICN) - CNRS UMR 7272, 28, Avenue de Valrose, Nice, 06108, France
| | - Rachid Benhida
- Université Côte d'Azur, Valbonne, 06560, France; Faculté des Sciences, Institut de Chimie de Nice (ICN) - CNRS UMR 7272, 28, Avenue de Valrose, Nice, 06108, France
| | - Stéphane Rocchi
- Université Côte d'Azur, Valbonne, 06560, France; INSERM U1065 - Equipe 12, Centre Méditerranéen de Médecine Moléculaire (C3M), Nice, 06200, France
| | - Enzo Lalli
- Université Côte d'Azur, Valbonne, 06560, France; CNRS UMR 7275, Sophia Antipolis, Valbonne, 06560, France; NEOGENEX CNRS International Associated Laboratory, Valbonne, 06560, France; Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, 06560, France.
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14
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Krupenko SA, Krupenko NI. ALDH1L1 and ALDH1L2 Folate Regulatory Enzymes in Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1032:127-143. [PMID: 30362096 DOI: 10.1007/978-3-319-98788-0_10] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Epidemiological studies implicate excess ethanol ingestion as a risk factor for several cancers and support the concept of a synergistic effect of chronic alcohol consumption and folate deficiency on carcinogenesis. Alcohol consumption affects folate-related genes and enzymes including two major folate-metabolizing enzymes, ALDH1L1 and ALDH1L2. ALDH1L1 (cytosolic 10-formyltetrahydrofolate dehydrogenase) is a regulatory enzyme in folate metabolism that controls the overall flux of one-carbon groups in folate-dependent biosynthetic pathways. It is strongly and ubiquitously down-regulated in malignant tumors via promoter methylation, and recent studies underscored this enzyme as a candidate tumor suppressor and potential marker of aggressive cancers. A related enzyme, ALDH1L2, is the mitochondrial homolog of ALDH1L1 encoded by a separate gene. In contrast to its cytosolic counterpart, ALDH1L2 is expressed in malignant tumors and cancer cell lines and was implicated in metastasis regulation. This review discusses the link between folate and cancer, modifying effects of alcohol consumption on folate-associated carcinogenesis, and putative roles of ALDH1L1 and ALDH1L2 in this process.
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Affiliation(s)
- Sergey A Krupenko
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA. .,UNC Nutrition Research Institute, Chapel Hill, NC, USA.
| | - Natalia I Krupenko
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA.,UNC Nutrition Research Institute, Chapel Hill, NC, USA
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15
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Udhane SS, Legeza B, Marti N, Hertig D, Diserens G, Nuoffer JM, Vermathen P, Flück CE. Combined transcriptome and metabolome analyses of metformin effects reveal novel links between metabolic networks in steroidogenic systems. Sci Rep 2017; 7:8652. [PMID: 28819133 PMCID: PMC5561186 DOI: 10.1038/s41598-017-09189-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 07/24/2017] [Indexed: 12/11/2022] Open
Abstract
Metformin is an antidiabetic drug, which inhibits mitochondrial respiratory-chain-complex I and thereby seems to affect the cellular metabolism in many ways. It is also used for the treatment of the polycystic ovary syndrome (PCOS), the most common endocrine disorder in women. In addition, metformin possesses antineoplastic properties. Although metformin promotes insulin-sensitivity and ameliorates reproductive abnormalities in PCOS, its exact mechanisms of action remain elusive. Therefore, we studied the transcriptome and the metabolome of metformin in human adrenal H295R cells. Microarray analysis revealed changes in 693 genes after metformin treatment. Using high resolution magic angle spinning nuclear magnetic resonance spectroscopy (HR-MAS-NMR), we determined 38 intracellular metabolites. With bioinformatic tools we created an integrated pathway analysis to understand different intracellular processes targeted by metformin. Combined metabolomics and transcriptomics data analysis showed that metformin affects a broad range of cellular processes centered on the mitochondrium. Data confirmed several known effects of metformin on glucose and androgen metabolism, which had been identified in clinical and basic studies previously. But more importantly, novel links between the energy metabolism, sex steroid biosynthesis, the cell cycle and the immune system were identified. These omics studies shed light on a complex interplay between metabolic pathways in steroidogenic systems.
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Affiliation(s)
- Sameer S Udhane
- Pediatric Endocrinology and Diabetology of the Department of Pediatrics and the Department of Clinical Research, University of Bern, 3010, Bern, Switzerland
| | - Balazs Legeza
- Pediatric Endocrinology and Diabetology of the Department of Pediatrics and the Department of Clinical Research, University of Bern, 3010, Bern, Switzerland
| | - Nesa Marti
- Pediatric Endocrinology and Diabetology of the Department of Pediatrics and the Department of Clinical Research, University of Bern, 3010, Bern, Switzerland
| | - Damian Hertig
- Departments of Clinical Research and Radiology, University of Bern, Bern, Switzerland.,University Institute of Clinical Chemistry, University of Bern, Bern, Switzerland
| | - Gaëlle Diserens
- Departments of Clinical Research and Radiology, University of Bern, Bern, Switzerland
| | - Jean-Marc Nuoffer
- University Institute of Clinical Chemistry, University of Bern, Bern, Switzerland
| | - Peter Vermathen
- Departments of Clinical Research and Radiology, University of Bern, Bern, Switzerland
| | - Christa E Flück
- Pediatric Endocrinology and Diabetology of the Department of Pediatrics and the Department of Clinical Research, University of Bern, 3010, Bern, Switzerland.
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16
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Sbiera S, Leich E, Liebisch G, Sbiera I, Schirbel A, Wiemer L, Matysik S, Eckhardt C, Gardill F, Gehl A, Kendl S, Weigand I, Bala M, Ronchi CL, Deutschbein T, Schmitz G, Rosenwald A, Allolio B, Fassnacht M, Kroiss M. Mitotane Inhibits Sterol-O-Acyl Transferase 1 Triggering Lipid-Mediated Endoplasmic Reticulum Stress and Apoptosis in Adrenocortical Carcinoma Cells. Endocrinology 2015; 156:3895-908. [PMID: 26305886 DOI: 10.1210/en.2015-1367] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Adrenocortical carcinoma (ACC) is a rare malignancy that harbors a dismal prognosis in advanced stages. Mitotane is approved as an orphan drug for treatment of ACC and counteracts tumor growth and steroid hormone production. Despite serious adverse effects, mitotane has been clinically used for decades. Elucidation of its unknown molecular mechanism of action seems essential to develop better ACC therapies. Here, we set out to identify the molecular target of mitotane and altered downstream mechanisms by combining expression genomics and mass spectrometry technology in the NCI-H295 ACC model cell line. Pathway analyses of expression genomics data demonstrated activation of endoplasmic reticulum (ER) stress and profound alteration of lipid-related genes caused by mitotane treatment. ER stress marker CHOP was strongly induced and the two upstream ER stress signalling events XBP1-mRNA splicing and eukaryotic initiation factor 2 A (eIF2α) phosphorylation were activated by mitotane in NCI-H295 cells but to a much lesser extent in four nonsteroidogenic cell lines. Lipid mass spectrometry revealed mitotane-induced increase of free cholesterol, oxysterols, and fatty acids specifically in NCI-H295 cells as cause of ER stress. We demonstrate that mitotane is an inhibitor of sterol-O-acyl-transferase 1 (SOAT1) leading to accumulation of these toxic lipids. In ACC tissue samples we show variable SOAT1 expression correlating with the response to mitotane treatment. In conclusion, mitotane confers adrenal-specific cytotoxicity and down-regulates steroidogenesis by inhibition of SOAT1 leading to lipid-induced ER stress. Targeting of cancer-specific lipid metabolism opens new avenues for treatment of ACC and potentially other types of cancer.
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Affiliation(s)
- Silviu Sbiera
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
| | - Ellen Leich
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
| | - Gerhard Liebisch
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
| | - Iuliu Sbiera
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
| | - Andreas Schirbel
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
| | - Laura Wiemer
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
| | - Silke Matysik
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
| | - Carolin Eckhardt
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
| | - Felix Gardill
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
| | - Annemarie Gehl
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
| | - Sabine Kendl
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
| | - Isabel Weigand
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
| | - Margarita Bala
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
| | - Cristina L Ronchi
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
| | - Timo Deutschbein
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
| | - Gerd Schmitz
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
| | - Andreas Rosenwald
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
| | - Bruno Allolio
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
| | - Martin Fassnacht
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
| | - Matthias Kroiss
- Department of Internal Medicine I, Endocrinology and Diabetes Unit (S.S., I.S., E.C., F.G., A.G., I.W., M.B., C.L.R., T.D., B.A., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany; Comprehensive Cancer Center Mainfranken (S.S., A.R., M.F., M.K.), 97080 Würzburg, Germany; Institute of Pathology (E.L., A.R.), University of Würzburg, 97080 Würzburg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (S.M., G.L., G.S.), University Hospital Regensburg, 93053 Regensburg, Germany; Department of Nuclear Medicine (A.S.), University Hospital Würzburg, 97080 Würzburg, Germany; and Clinical Chemistry and Laboratory Medicine (S.K., M.F.), University Hospital Würzburg, 97080 Würzburg, Germany
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17
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Terzolo M, Zaggia B, Allasino B, De Francia S. Practical treatment using mitotane for adrenocortical carcinoma. Curr Opin Endocrinol Diabetes Obes 2014; 21:159-65. [PMID: 24732405 DOI: 10.1097/med.0000000000000056] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Description of novel findings about the mechanism of action of mitotane and its activity as an adjunctive postoperative measure, or for treatment of advanced adrenocortical carcinoma. RECENT FINDINGS Several in-vitro studies have shown that mitotane suppresses gene transcription of different enzymatic steps of the steroidogenetic pathway. Moreover, mitotane induces CYP3A4 expression, thus accelerating the metabolic clearance of a variety of drugs including steroids. Retrospective studies provided evidence that adjunctive mitotane can prolong recurrence-free survival of treated patients. The concept of a therapeutic window of mitotane plasma concentrations was confirmed also for adjunctive treatment, but the relationship between mitotane concentration and given dose is loose. Genetic variability of the P450-dependent enzymes metabolizing mitotane may explain individual differences. SUMMARY Mitotane concentration of 14-20 mg/l should be reached and maintained during treatment also in an adjunctive setting. In advanced adrenocortical carcinoma, a high-dose starting regimen should be employed when mitotane is used as monotherapy. The combination of mitotane with other drugs should consider the possibility of pharmacologic interactions due to mitotane-induced activation of drug metabolism. This concept applies also to steroid replacement in mitotane-treated patients, who need higher doses to adjust for increased steroid metabolism.
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Affiliation(s)
- Massimo Terzolo
- aInternal Medicine I bPharmacology, Department of Clinical and Biological Sciences, University of Turin, Italy
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18
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Szabó DR, Baghy K, Szabó PM, Zsippai A, Marczell I, Nagy Z, Varga V, Éder K, Tóth S, Buzás EI, Falus A, Kovalszky I, Patócs A, Rácz K, Igaz P. Antitumoral effects of 9-cis retinoic acid in adrenocortical cancer. Cell Mol Life Sci 2014; 71:917-32. [PMID: 23807211 PMCID: PMC11113805 DOI: 10.1007/s00018-013-1408-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/10/2013] [Accepted: 06/11/2013] [Indexed: 01/08/2023]
Abstract
The currently available medical treatment options of adrenocortical cancer (ACC) are limited. In our previous meta-analysis of adrenocortical tumor genomics data, ACC was associated with reduced retinoic acid production and retinoid X receptor-mediated signaling. Our objective has been to study the potential antitumoral effects of 9-cis retinoic acid (9-cisRA) on the ACC cell line NCI-H295R and in a xenograft model. Cell proliferation, hormone secretion, and gene expression have been studied in the NCI-H295R cell line. A complex bioinformatics approach involving pathway and network analysis has been performed. Selected genes have been validated by real-time qRT-PCR. Athymic nude mice xenografted with NCI-H295R have been used in a pilot in vivo xenograft model. 9-cisRA significantly decreased cell viability and steroid hormone secretion in a concentration- and time-dependent manner in the NCI-H295R cell line. Four major molecular pathways have been identified by the analysis of gene expression data. Ten genes have been successfully validated involved in: (1) steroid hormone secretion (HSD3B1, HSD3B2), (2) retinoic acid signaling (ABCA1, ABCG1, HMGCR), (3) cell-cycle damage (GADD45A, CCNE2, UHRF1), and the (4) immune response (MAP2K6, IL1R2). 9-cisRA appears to directly regulate the cell cycle by network analysis. 9-cisRA also reduced tumor growth in the in vivo xenograft model. In conclusion, 9-cisRA might represent a promising new candidate in the treatment of hormone-secreting adrenal tumors and adrenocortical cancer.
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Affiliation(s)
- Diana Rita Szabó
- 2nd Department of Medicine, Faculty of Medicine, Semmelweis University, Szentkirályi Str. 46, Budapest, 1088 Hungary
| | - Kornélia Baghy
- 1st Department of Pathology and Experimental Cancer Research, Faculty of Medicine, Semmelweis University, Üllői Str. 26, Budapest, 1088 Hungary
| | - Peter M. Szabó
- Molecular Medicine Research Group, Hungarian Academy of Sciences and Semmelweis University, Szentkirályi Str. 46, Budapest, 1088 Hungary
| | - Adrienn Zsippai
- 2nd Department of Medicine, Faculty of Medicine, Semmelweis University, Szentkirályi Str. 46, Budapest, 1088 Hungary
| | - István Marczell
- 2nd Department of Medicine, Faculty of Medicine, Semmelweis University, Szentkirályi Str. 46, Budapest, 1088 Hungary
| | - Zoltán Nagy
- 2nd Department of Medicine, Faculty of Medicine, Semmelweis University, Szentkirályi Str. 46, Budapest, 1088 Hungary
| | - Vivien Varga
- 2nd Department of Medicine, Faculty of Medicine, Semmelweis University, Szentkirályi Str. 46, Budapest, 1088 Hungary
| | - Katalin Éder
- Department of Genetics, Cell- and Immunobiology, Faculty of Medicine, Semmelweis University, Nagyvárad Sq. 4, Budapest, 1089 Hungary
| | - Sára Tóth
- Department of Genetics, Cell- and Immunobiology, Faculty of Medicine, Semmelweis University, Nagyvárad Sq. 4, Budapest, 1089 Hungary
| | - Edit I. Buzás
- Department of Genetics, Cell- and Immunobiology, Faculty of Medicine, Semmelweis University, Nagyvárad Sq. 4, Budapest, 1089 Hungary
| | - András Falus
- Department of Genetics, Cell- and Immunobiology, Faculty of Medicine, Semmelweis University, Nagyvárad Sq. 4, Budapest, 1089 Hungary
| | - Ilona Kovalszky
- 1st Department of Pathology and Experimental Cancer Research, Faculty of Medicine, Semmelweis University, Üllői Str. 26, Budapest, 1088 Hungary
| | - Attila Patócs
- Molecular Medicine Research Group, Hungarian Academy of Sciences and Semmelweis University, Szentkirályi Str. 46, Budapest, 1088 Hungary
| | - Károly Rácz
- 2nd Department of Medicine, Faculty of Medicine, Semmelweis University, Szentkirályi Str. 46, Budapest, 1088 Hungary
| | - Peter Igaz
- 2nd Department of Medicine, Faculty of Medicine, Semmelweis University, Szentkirályi Str. 46, Budapest, 1088 Hungary
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19
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Gentilin E, Molè D, Gagliano T, Minoia M, Ambrosio MR, Degli Uberti EC, Zatelli MC. Inhibitory effects of mitotane on viability and secretory activity in mouse gonadotroph cell lines. Reprod Toxicol 2014; 45:71-6. [PMID: 24486453 DOI: 10.1016/j.reprotox.2014.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/09/2014] [Accepted: 01/20/2014] [Indexed: 01/03/2023]
Abstract
Mitotane represents the mainstay medical treatment for metastatic, inoperable or recurrent adrenocortical carcinoma. Besides the well-known adverse events, mitotane therapy is associated also with endocrinological effects, including sexual and reproductive dysfunction. The majority of male patients undergoing adjuvant mitotane therapy show a picture of hypogonadism, characterized by low free testosterone and high sex hormone binding globulin levels and unmodified LH concentrations. Since mitotane has been shown to have direct pituitary effects, we investigated whether mitotane may influence both cell viability and function of gonadotroph cells in the settings of two pituitary cell lines. We found that mitotane reduces cell viability, induces apoptosis, modifies cell cycle phase distribution and secretion of gonadotroph cells. The present data strengthen previous evidence showing a direct mitotane effect at pituitary level and represent a possible explanation of the lack of LH increase following decrease in free testosterone in patients undergoing adjuvant mitotane therapy.
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Affiliation(s)
- Erica Gentilin
- Section of Endocrinology, Department of Medical Sciences, University of Ferrara, Italy; Laboratorio in Rete del Tecnopolo Tecnologie delle Terapie Avanzate (LTTA), University of Ferrara, Italy
| | - Daniela Molè
- Section of Endocrinology, Department of Medical Sciences, University of Ferrara, Italy
| | - Teresa Gagliano
- Section of Endocrinology, Department of Medical Sciences, University of Ferrara, Italy
| | - Mariella Minoia
- Section of Endocrinology, Department of Medical Sciences, University of Ferrara, Italy
| | | | - Ettore C Degli Uberti
- Section of Endocrinology, Department of Medical Sciences, University of Ferrara, Italy; Laboratorio in Rete del Tecnopolo Tecnologie delle Terapie Avanzate (LTTA), University of Ferrara, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology, Department of Medical Sciences, University of Ferrara, Italy; Laboratorio in Rete del Tecnopolo Tecnologie delle Terapie Avanzate (LTTA), University of Ferrara, Italy.
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20
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Abstract
Adrenocortical carcinoma (ACC) is an orphan malignancy that has attracted increasing attention during the last decade. Here we provide an update on advances in the field since our last review published in this journal in 2006. The Wnt/β-catenin pathway and IGF-2 signaling have been confirmed as frequently altered signaling pathways in ACC, but recent data suggest that they are probably not sufficient for malignant transformation. Thus, major players in the pathogenesis are still unknown. For diagnostic workup, comprehensive hormonal assessment and detailed imaging are required because in most ACCs, evidence for autonomous steroid secretion can be found and computed tomography or magnetic resonance imaging (if necessary, combined with functional imaging) can differentiate benign from malignant adrenocortical tumors. Surgery is potentially curative in localized tumors. Thus, we recommend a complete resection including lymphadenectomy by an expert surgeon. The pathology report should demonstrate the adrenocortical origin of the lesion (eg, by steroidogenic factor 1 staining) and provide Weiss score, resection status, and quantitation of the proliferation marker Ki67 to guide further treatment. Even after complete surgery, recurrence is frequent and adjuvant mitotane treatment improves outcome, but uncertainty exists as to whether all patients benefit from this therapy. In advanced ACC, mitotane is still the standard of care. Based on the FIRM-ACT trial, mitotane plus etoposide, doxorubicin, and cisplatin is now the established first-line cytotoxic therapy. However, most patients will experience progress and require salvage therapies. Thus, new treatment concepts are urgently needed. The ongoing international efforts including comprehensive "-omic approaches" and next-generation sequencing will improve our understanding of the pathogenesis and hopefully lead to better therapies.
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Affiliation(s)
- Martin Fassnacht
- Department of Internal Medicine IV, Hospital of the University of Munich, Ziemssenstrasse 1, 80336 München, Germany.
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21
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Hescot S, Slama A, Lombès A, Paci A, Remy H, Leboulleux S, Chadarevian R, Trabado S, Amazit L, Young J, Baudin E, Lombès M. Mitotane alters mitochondrial respiratory chain activity by inducing cytochrome c oxidase defect in human adrenocortical cells. Endocr Relat Cancer 2013; 20:371-81. [PMID: 23696597 DOI: 10.1530/erc-12-0368] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mitotane, 1,1-dichloro-2-(o-chlorophenyl)-2-(p-chlorophenyl)ethane is the most effective medical therapy for adrenocortical carcinoma, but its molecular mechanism of action remains poorly understood. Although mitotane is known to have mitochondrial (mt) effects, a direct link to mt dysfunction has never been established. We examined the functional consequences of mitotane exposure on proliferation, steroidogenesis, and mt respiratory chain, biogenesis and morphology, in two human adrenocortical cell lines, the steroid-secreting H295R line and the non-secreting SW13 line. Mitotane inhibited cell proliferation in a dose- and a time-dependent manner. At the concentration of 50 μM (14 mg/l), which corresponds to the threshold for therapeutic efficacy, mitotane drastically reduced cortisol and 17-hydroxyprogesterone secretions by 70%. This was accompanied by significant decreases in the expression of genes encoding mt proteins involved in steroidogenesis (STAR, CYP11B1, and CYP11B2). In both H295R and SW13 cells, 50 μM mitotane significantly inhibited (50%) the maximum velocity of the activity of the respiratory chain complex IV (cytochrome c oxidase (COX)). This effect was associated with a drastic reduction in steady-state levels of the whole COX complex as revealed by blue native PAGE and reduced mRNA expression of both mtDNA-encoded COX2 (MT-CO2) and nuclear DNA-encoded COX4 (COX4I1) subunits. In contrast, the activity and expression of respiratory chain complexes II and III were unaffected by mitotane treatment. Lastly, mitotane exposure enhanced mt biogenesis (increase in mtDNA content and PGC1α (PPARGC1A) expression) and triggered fragmentation of the mt network. Altogether, our results provide first evidence that mitotane induced a mt respiratory chain defect in human adrenocortical cells.
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Affiliation(s)
- Ségolène Hescot
- INSERM U693, Fac Med Paris Sud, Rue Gabriel Péri, Le Kremlin-Bicêtre F-94276, France
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Dai ZJ, Gao J, Kang HF, Ma YG, Ma XB, Lu WF, Lin S, Ma HB, Wang XJ, Wu WY. Targeted inhibition of mammalian target of rapamycin (mTOR) enhances radiosensitivity in pancreatic carcinoma cells. DRUG DESIGN DEVELOPMENT AND THERAPY 2013; 7:149-59. [PMID: 23662044 PMCID: PMC3610438 DOI: 10.2147/dddt.s42390] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The mammalian target of rapamycin (mTOR) is a protein kinase that regulates protein translation, cell growth, and apoptosis. Rapamycin (RPM), a specific inhibitor of mTOR, exhibits potent and broad in vitro and in vivo antitumor activity against leukemia, breast cancer, and melanoma. Recent studies showing that RPM sensitizes cancers to chemotherapy and radiation therapy have attracted considerable attention. This study aimed to examine the radiosensitizing effect of RPM in vitro, as well as its mechanism of action. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and colony formation assay showed that 10 nmol/L to 15 nmol/L of RPM had a radiosensitizing effects on pancreatic carcinoma cells in vitro. Furthermore, a low dose of RPM induced autophagy and reduced the number of S-phase cells. When radiation treatment was combined with RPM, the PC-2 cell cycle arrested in the G2/M phase of the cell cycle. Complementary DNA (cDNA) microarray and reverse transcription polymerase chain reaction (RT-PCR) revealed that the expression of DDB1, RAD51, and XRCC5 were downregulated, whereas the expression of PCNA and ABCC4 were upregulated in PC-2 cells. The results demonstrated that RPM effectively enhanced the radiosensitivity of pancreatic carcinoma cells.
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Affiliation(s)
- Zhi-Jun Dai
- Department of Oncology, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, People's Republic of China.
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