bims-pideca Biomed News
on Class IA PI3K signalling in development and cancer
Issue of 2020‒03‒29
sixteen papers selected by
Ralitsa Radostinova Madsen
University College London Cancer Institute
  1. mTOR signaling at the crossroads of environmental signals and T-cell fate decisions.
  2. Impact of the Activation Status of the Akt/mTOR Signalling Pathway on the Clinical Behaviour of Synovial Sarcoma: Retrospective Analysis of 174 Patients at a Single Institution.
  3. Targeting PI3Kβ alone and in combination with chemotherapy or immunotherapy in tumors with PTEN loss.
  4. Probing the subcellular distribution of phosphatidylinositol reveals a surprising lack at the plasma membrane.
  5. An atlas of human metabolism.
  6. Understanding the Cause and Consequence of Tumor Heterogeneity.
  7. Editorial: The Role of Breast Cancer Stem Cells in Clinical Outcomes.
  8. Increased mTOR activation in idiopathic multicentric Castleman disease.
  9. Broad and thematic remodeling of the surfaceome and glycoproteome on isogenic cells transformed with driving proliferative oncogenes.
  10. DNA-PK, Nuclear mTOR, and the Androgen Pathway in Prostate Cancer.
  11. Effects of PKB/AKT inhibitors on insulin-stimulated lipogenesis and phosphorylation state of lipogenic enzymes in white adipose tissue.
  12. Subpopulation targeting of pyruvate dehydrogenase and GLUT1 decouples metabolic heterogeneity during collective cancer cell invasion.
  13. Regulation of nutrient transporters by metabolic and environmental stresses.
  14. Foundations of ER-phagy regulation.
  15. Fibrinogen Alpha Chain Knockout Promotes Tumor Growth and Metastasis through Integrin-AKT Signaling Pathway in Lung Cancer.
  16. Targeting apoptosis in cancer therapy.
  1. Immunol Rev. 2020 Mar 25.
    mTOR signaling at the crossroads of environmental signals and T-cell fate decisions.
    Hongling Huang, Lingyun Long, Peipei Zhou, Nicole M Chapman, Hongbo Chi.
      The evolutionarily conserved serine/threonine kinase mTOR (mechanistic target of rapamycin) forms the distinct protein complexes mTORC1 and mTORC2 and integrates signals from the environment to coordinate downstream signaling events and various cellular processes. T cells rely on mTOR activity for their development and to establish their homeostasis and functional fitness. Here, we review recent progress in our understanding of the upstream signaling and downstream targets of mTOR. We also provide an updated overview of the roles of mTOR in T-cell development, homeostasis, activation, and effector-cell fate decisions, as well as its important impacts on the suppressive activity of regulatory T cells. Moreover, we summarize the emerging roles of mTOR in T-cell exhaustion and transdifferentiation. A better understanding of the contribution of mTOR to T-cell fate decisions will ultimately aid in the therapeutic targeting of mTOR in human disease.
    Keywords:  T cell; Treg cell; iNKT cell; mTOR; metabolism
    DOI:  https://doi.org/10.1111/imr.12845
  2. Cancer Manag Res. 2020 ;12 1759-1769
    Impact of the Activation Status of the Akt/mTOR Signalling Pathway on the Clinical Behaviour of Synovial Sarcoma: Retrospective Analysis of 174 Patients at a Single Institution.
    Ying-Xue Li, Shan-Shan Ding, Wen-Juan Wen, Lin Han, Hong-Qun Wang, Huai-Yin Shi.
      Purpose: Phosphoinositide 3-kinase (PI3K) and the downstream Akt/mammalian target of rapamycin (mTOR) pathway are central to the control of cell proliferation and survival. Although abnormal activation of this pathway has been well established in a variety of tumours, limited studies are available on synovial sarcoma. The aim of this study was to investigate the expression of several key proteins of those pathways in synovial sarcomas and to correlate the expression of these proteins with clinicopathologic features and prognosis.Patients and Methods: A total of 174 patients with synovial sarcomas were recruited for this study. The phosphorylation status of Akt, mTOR, and eukaryotic translation initiation factor 4E binding protein (4E-BP1) was measured by immunohistochemistry assays in formalin-fixed, paraffin-embedded samples. Correlations between the expression levels of these proteins and clinicopathologic features and prognosis were analysed.
    Results: The positive rates of phosphorylated (p)Akt, pmTOR, p4E-BP1, and CyclinD1 were 62.7%, 55.6%, 47.1%, and 52.6%, respectively. The positive results of pmTOR, pAkt, and downstream p4E-BP1 were correlated with each other. The positive pAkt, pmTOR, p4E-BP1, and CyclinD1 results were more highly expressed in head and neck and visceral tumours, and positive p4E-BP1 results were correlated with larger size and larger areas of necrosis. In multivariate analysis of clinicopathologic factors, head and neck and visceral location, large tumour size, larger areas of necrosis and frequent mitosis were confirmed as risk factors for shorter overall survival. Positive pAkt, pmTOR and p4E-BP1 results were correlated significantly with shorter overall survival, and CyclinD1 was not in the univariate analysis. The positive pmTOR, pAkt, p4E-BP1, and CyclinD1 results were significantly poor prognostic factors for overall survival, and only positive p4E-BP1 results were significantly associated with shorter event-free survival in multivariate analysis.
    Conclusion: This study demonstrated the high expression of pAkt, pmTOR, and p4E-BP1 associated with aggressive clinical behaviour in synovial sarcomas and provided evidence for prognostic evaluation and targeted therapy.
    Keywords:  clinicopathologic features; p4E-BP1; pAkt; pmTOR; prognosis; synovial sarcoma
    DOI:  https://doi.org/10.2147/CMAR.S228578
  3. Oncotarget. 2020 Mar 17. 11(11): 969-981
    Targeting PI3Kβ alone and in combination with chemotherapy or immunotherapy in tumors with PTEN loss.
    Nicci Owusu-Brackett, Ming Zhao, Argun Akcakanat, Kurt W Evans, Erkan Yuca, Ecaterina Ileana Dumbrava, Filip Janku, Funda Meric-Bernstam.
      Background: PTEN-deficient tumors are dependent on PI3Kβ activity, making PI3Kβ a compelling target. We evaluated the efficacy of PI3Kβ inhibitor AZD8186 on tumors with PTEN loss. Results: In vitro cell viability assay and immunoblotting demonstrated that PTEN loss was significantly correlated with AZD8186 sensitivity in triple negative breast cancer (TNBC) cell lines. Colony formation assay confirmed sensitivity of PTEN-deficient cell lines to AZD8186. AZD8186 inhibited PI3K signaling in PTEN loss TNBC cells. AZD8186 in combination with paclitaxel, eribulin had synergistic effects on growth inhibition in PTEN loss cells. AZD8186 promoted apoptosis in PTEN loss cells which was synergized by paclitaxel. In vivo, AZD8186 had limited activity as a single agent, but enhanced antitumor activity when combined with paclitaxel in MDA-MB-436 and MDA-MB-468 cell-line xenografts. AZD8186 significantly enhanced antitumor efficacy of anti-PD1 antibodies in the PTEN-deficient BP murine melanoma xenograft model, but not in the PTEN-wild-type CT26 xenograft model. Methods: In vitro, cell proliferation and colony formation assays were performed to determine cell sensitivity to AZD8186. Immunoblotting was performed to assess PTEN expression and PI3K signaling activity. FACS was performed to evaluate apoptosis. In vivo, antitumor efficacy of AZD8186 and its combinations were evaluated. Conclusions: AZD8186 has single agent efficacy in PTEN-deficient TNBC cell lines in vitro, but has limited single agent efficacy in vivo. However, AZD8186 has enhanced efficacy when combined with paclitaxel and anti-PD1 in vivo. Further study is needed to determine optimal combination therapies for PTEN-deficient solid tumors.
    Keywords:  AZD8186; PI3Kβ; PTEN loss; chemotherapy; immunotherapy
    DOI:  https://doi.org/10.18632/oncotarget.27503
  4. J Cell Biol. 2020 Mar 02. 219(3):
    Probing the subcellular distribution of phosphatidylinositol reveals a surprising lack at the plasma membrane.
    James P Zewe, April M Miller, Sahana Sangappa, Rachel C Wills, Brady D Goulden, Gerald R V Hammond.
      The polyphosphoinositides (PPIn) are central regulatory lipids that direct membrane function in eukaryotic cells. Understanding how their synthesis is regulated is crucial to revealing these lipids' role in health and disease. PPIn are derived from the major structural lipid, phosphatidylinositol (PI). However, although the distribution of most PPIn has been characterized, the subcellular localization of PI available for PPIn synthesis is not known. Here, we used several orthogonal approaches to map the subcellular distribution of PI, including localizing exogenous fluorescent PI, as well as detecting lipid conversion products of endogenous PI after acute chemogenetic activation of PI-specific phospholipase and 4-kinase. We report that PI is broadly distributed throughout intracellular membrane compartments. However, there is a surprising lack of PI in the plasma membrane compared with the PPIn. These experiments implicate regulation of PI supply to the plasma membrane, as opposed to regulation of PPIn-kinases, as crucial to the control of PPIn synthesis and function at the PM.
    DOI:  https://doi.org/10.1083/jcb.201906127
  5. Sci Signal. 2020 Mar 24. pii: eaaz1482. [Epub ahead of print]13(624):
    An atlas of human metabolism.
    Jonathan L Robinson, Pınar Kocabaş, Hao Wang, Pierre-Etienne Cholley, Daniel Cook, Avlant Nilsson, Mihail Anton, Raphael Ferreira, Iván Domenzain, Virinchi Billa, Angelo Limeta, Alex Hedin, Johan Gustafsson, Eduard J Kerkhoven, L Thomas Svensson, Bernhard O Palsson, Adil Mardinoglu, Lena Hansson, Mathias Uhlén, Jens Nielsen.
      Genome-scale metabolic models (GEMs) are valuable tools to study metabolism and provide a scaffold for the integrative analysis of omics data. Researchers have developed increasingly comprehensive human GEMs, but the disconnect among different model sources and versions impedes further progress. We therefore integrated and extensively curated the most recent human metabolic models to construct a consensus GEM, Human1. We demonstrated the versatility of Human1 through the generation and analysis of cell- and tissue-specific models using transcriptomic, proteomic, and kinetic data. We also present an accompanying web portal, Metabolic Atlas (https://www.metabolicatlas.org/), which facilitates further exploration and visualization of Human1 content. Human1 was created using a version-controlled, open-source model development framework to enable community-driven curation and refinement. This framework allows Human1 to be an evolving shared resource for future studies of human health and disease.
    DOI:  https://doi.org/10.1126/scisignal.aaz1482
  6. Trends Cancer. 2020 Apr;pii: S2405-8033(20)30026-1. [Epub ahead of print]6(4): 267-271
    Understanding the Cause and Consequence of Tumor Heterogeneity.
    Subreen Khatib, Yotsawat Pomyen, Hien Dang, Xin Wei Wang.
      Tumor heterogeneity is a large conundrum in cancer medicine, making most therapeutic interventions palliative rather than curative. Here we discuss the implications of how molecularly targeted therapies in solid malignancies that promote limited cancer cell death may in fact make tumors more heterogeneous, increase aggressive phenotypes, and thus worsen patient outcomes.
    Keywords:  biodiversity; cell death; heterogeneity; tumor evolution
    DOI:  https://doi.org/10.1016/j.trecan.2020.01.010
  7. Front Oncol. 2020 ;10 299
    Editorial: The Role of Breast Cancer Stem Cells in Clinical Outcomes.
    Dayanidhi Raman, Amit K Tiwari, Venkataswarup Tiriveedhi, Julie A Rhoades Sterling.
      
    Keywords:  BCSC niche; breast cancer stemness; chemoresistance; immunotherapy; metabolic plasticity; tumor heterogeneity; tumor microenvironment
    DOI:  https://doi.org/10.3389/fonc.2020.00299
  8. Blood. 2020 Mar 23. pii: blood.2019002792. [Epub ahead of print]
    Increased mTOR activation in idiopathic multicentric Castleman disease.
    Daniel J Arenas, Katherine Floess, Dale Kobrin, Ruth-Anne Langan Pai, Maya Blanka Srkalovic, Mark-Avery Tamakloe, Rozena Rasheed, Jasira Ziglar, Johnson Khor, Sophia A T Parente, Sheila K Pierson, Daniel Martinez, Gerald B Wertheim, Taku Kambayashi, Joseph Baur, David T Teachey, David C Fajgenbaum.
      Idiopathic multicentric Castleman disease (iMCD) is a rare and poorly-understood hematologic disorder characterized by lymphadenopathy, systemic inflammation, cytopenias, and life-threatening multi-organ dysfunction. Interleukin-6 (IL-6) inhibition effectively treats approximately one-third of patients. Limited options exist for non-responders, because the etiology, dysregulated cell types, and signaling pathways are unknown. We previously reported three anti-IL-6 non-responders with increased mTOR activation who responded to mTOR inhibition with sirolimus. We investigated mTOR signaling in tissue and serum proteomes from iMCD patients and controls. mTOR activation was increased in the interfollicular space of iMCD lymph nodes (N=26) compared to control lymph nodes by immunohistochemistry (IHC) for pS6, p4EBP1, and p70S6K, known effectors and read-outs of mTORC1 activation. IHC for pS6 also revealed increased mTOR activation in iMCD compared to Hodgkin lymphoma, systemic lupus erythematosus, and reactive lymph nodes, suggesting that the mTOR activation in iMCD is not just a product of lymphoproliferation/inflammatory lymphadenopathy. Further, the degree of mTOR activation in iMCD was comparable to autoimmune lymphoproliferative syndrome, a disease driven by mTOR hyperactivation that responds to sirolimus treatment. Geneset enrichment analysis of serum proteomic data from iMCD patients (n=88) and controls (n=42) showed significantly enriched mTORC1 signaling. Finally, functional studies revealed increased baseline mTOR pathway activation in peripheral monocytes and T-cells from iMCD remission samples compared to healthy controls. IL-6 stimulation augmented mTOR activation in iMCD patients, which was abrogated with JAK1/2 inhibition. These findings support mTOR activation as a novel therapeutic target for iMCD, which is being investigated through a trial of sirolimus (NCT03933904).
    DOI:  https://doi.org/10.1182/blood.2019002792
  9. Proc Natl Acad Sci U S A. 2020 Mar 23. pii: 201917947. [Epub ahead of print]
    Broad and thematic remodeling of the surfaceome and glycoproteome on isogenic cells transformed with driving proliferative oncogenes.
    Kevin K Leung, Gary M Wilson, Lisa L Kirkemo, Nicholas M Riley, Joshua J Coon, James A Wells.
      The cell surface proteome, the surfaceome, is the interface for engaging the extracellular space in normal and cancer cells. Here we apply quantitative proteomics of N-linked glycoproteins to reveal how a collection of some 700 surface proteins is dramatically remodeled in an isogenic breast epithelial cell line stably expressing any of six of the most prominent proliferative oncogenes, including the receptor tyrosine kinases, EGFR and HER2, and downstream signaling partners such as KRAS, BRAF, MEK, and AKT. We find that each oncogene has somewhat different surfaceomes, but the functions of these proteins are harmonized by common biological themes including up-regulation of nutrient transporters, down-regulation of adhesion molecules and tumor suppressing phosphatases, and alteration in immune modulators. Addition of a potent MEK inhibitor that blocks MAPK signaling brings each oncogene-induced surfaceome back to a common state reflecting the strong dependence of the oncogene on the MAPK pathway to propagate signaling. Cell surface protein capture is mediated by covalent tagging of surface glycans, yet current methods do not afford sequencing of intact glycopeptides. Thus, we complement the surfaceome data with whole cell glycoproteomics enabled by a recently developed technique called activated ion electron transfer dissociation (AI-ETD). We found massive oncogene-induced changes to the glycoproteome and differential increases in complex hybrid glycans, especially for KRAS and HER2 oncogenes. Overall, these studies provide a broad systems-level view of how specific driver oncogenes remodel the surfaceome and the glycoproteome in a cell autologous fashion, and suggest possible surface targets, and combinations thereof, for drug and biomarker discovery.
    Keywords:  MAPK signaling pathway; glycoproteomics; oncogenes; surfaceome
    DOI:  https://doi.org/10.1073/pnas.1917947117
  10. Trends Cancer. 2020 Apr;pii: S2405-8033(20)30031-5. [Epub ahead of print]6(4): 337-347
    DNA-PK, Nuclear mTOR, and the Androgen Pathway in Prostate Cancer.
    Vincent Giguère.
      Androgen and its receptor (AR) are major drivers of prostate cancer (PCa), a leading cause of mortality in aging men. Thus, understanding the numerous mechanisms by which AR can promote the growth and proliferation of PCa cells and enable their escape from hormone-dependent therapies, eventually leading to metastasis and death of the patient, is essential to discover alternative therapeutic approaches. Recently, two structurally related members of the phosphatidylinositol 3-kinase-like protein kinase (PIKK) family, DNA-dependent protein kinase (DNA-PK) and mammalian target of rapamycin (mTOR), were shown to have a direct role in modulating AR activity on chromatin of PCa cells. In this review, the common features of DNA-PK and mTOR and the similarities in their noncanonical roles as transcription coregulators of the AR are highlighted. An outlook on how these findings could be translated into new approaches to manage and treat PCa is provided.
    Keywords:  DNA repair; FOXA1; HOXB13; androgen receptor; coregulator; nuclear receptor; transcription
    DOI:  https://doi.org/10.1016/j.trecan.2020.01.015
  11. Biochem J. 2020 Mar 26. pii: BCJ20190788. [Epub ahead of print]
    Effects of PKB/AKT inhibitors on insulin-stimulated lipogenesis and phosphorylation state of lipogenic enzymes in white adipose tissue.
    Nusrat Hussain, Sheng-Ju Chuang, Manuel Johanns, Didier Vertommen, Gregory R Steinberg, Bruce Kemp, Mark H Rider.
      We investigated acute effects of two allosteric protein kinase B (PKB) inhibitors, MK-2206 and Akti-1/2, on insulin-stimulated lipogenesis in rat epididymal adipocytes incubated with fructose as carbohydrate substrate. In parallel, the phosphorylation state of lipogenic enzymes in adipocytes and incubated epidiymal fat pads was monitored by immunoblotting. Preincubation of rat epididymal adipocytes with PKB inhibitors dose-dependently inhibited the following: insulin-stimulated lipogenesis, increased PKB Ser473 phosphorylation, increased PKB activity and decreased acetyl-CoA carboxylase (ACC) Ser79 phosphorylation. By contrast, the effect of insulin to decrease the phosphorylation of pyruvate dehydrogenase (PDH) at Ser293 and Ser300 was not abolished by PKB inhibition. Insulin treatment also induced ATP-citrate lyase (ACL) Ser454 phosphorylation, but this effect was less sensitive to PKB inhibitors than ACC dephosphorylation by insulin. In incubated rat epididymal fat pads, Akti-1/2 treatment reversed insulin-induced ACC dephosphorylation, while ACL phosphorylation by insulin was maintained. ACL and ACC purified from white adipose tissue were poor substrates for PKBa in vitro. However, effects of wortmannin and torin, along with Akti-1/2 and MK-2206, on recognized PKB target phosphorylation by insulin were similar to their effects on insulin-induced ACL phosphorylation, suggesting that PKB could be the physiological kinase for ACL phosphorylation by insulin. In incubated epididymal fat pads from wild-type versus ACC1/2 S79A/S212A knockin mice, effects of insulin to increase lipogenesis from radioactive fructose or from radioactive acetate were reduced but not abolished. Together, the results support a key role for PKB in mediating insulin-stimulated lipogenesis by decreasing ACC phosphorylation, but not by decreasing PDH phosphorylation.
    Keywords:  ACC; ACL; Insulin; Lipogenesis; PDH; PKB inhibitors
    DOI:  https://doi.org/10.1042/BCJ20190788
  12. Nat Commun. 2020 Mar 24. 11(1): 1533
    Subpopulation targeting of pyruvate dehydrogenase and GLUT1 decouples metabolic heterogeneity during collective cancer cell invasion.
    R Commander, C Wei, A Sharma, J K Mouw, L J Burton, E Summerbell, D Mahboubi, R J Peterson, J Konen, W Zhou, Y Du, H Fu, M Shanmugam, A I Marcus.
      Phenotypic heterogeneity exists within collectively invading packs of tumor cells, suggesting that cellular subtypes cooperate to drive invasion and metastasis. Here, we take a chemical biology approach to probe cell:cell cooperation within the collective invasion pack. These data reveal metabolic heterogeneity within invasive chains, in which leader cells preferentially utilize mitochondrial respiration and trailing follower cells rely on elevated glucose uptake. We define a pyruvate dehydrogenase (PDH) dependency in leader cells that can be therapeutically exploited with the mitochondria-targeting compound alexidine dihydrochloride. In contrast, follower cells highly express glucose transporter 1 (GLUT1), which sustains an elevated level of glucose uptake required to maintain proliferation. Co-targeting of both leader and follower cells with PDH and GLUT1 inhibitors, respectively, inhibits cell growth and collective invasion. Taken together, our work reveals metabolic heterogeneity within the lung cancer collective invasion pack and provides rationale for co-targeting PDH and GLUT1 to inhibit collective invasion.
    DOI:  https://doi.org/10.1038/s41467-020-15219-7
  13. Curr Opin Cell Biol. 2020 Mar 19. pii: S0955-0674(20)30032-6. [Epub ahead of print]65 35-41
    Regulation of nutrient transporters by metabolic and environmental stresses.
    Markus Babst.
      The yeast plasma membrane is a selective barrier between an erratic environment and the cell's metabolism. Nutrient transporters are the gatekeepers that control the import of molecules feeding into the metabolic pathways. Nutrient import adjusts rapidly to changes in metabolism and the environment, which is accomplished by regulating the surface expression of transporters. Recent studies indicate that the lipid environment in which transporters function regulates ubiquitination efficiency and endocytosis of these proteins. Changes in the lipid environment are caused by lateral movements of the transporters between different membrane domains and by the influence of the extracellular environment on the fluidity of the plasma membrane.
    Keywords:  Alpha-arrestin; Eisosome; Membrane tension; Metabolism; Nutrient transporter; TORC2
    DOI:  https://doi.org/10.1016/j.ceb.2020.02.009
  14. Nat Rev Mol Cell Biol. 2020 Mar 17.
    Foundations of ER-phagy regulation.
    Paulina Strzyz.
      
    DOI:  https://doi.org/10.1038/s41580-020-0238-8
  15. Mol Cancer Res. 2020 Mar 23. pii: molcanres.1033.2019. [Epub ahead of print]
    Fibrinogen Alpha Chain Knockout Promotes Tumor Growth and Metastasis through Integrin-AKT Signaling Pathway in Lung Cancer.
    Meng Wang, Guangxin Zhang, Yue Zhang, Xuelian Cui, Shuaibin Wang, Song Gao, Yicun Wang, Ying Liu, Jeeyoo Hope Bae, Wei-Hsiung Yang, Lei S Qi, Lizhong Wang, Runhua Liu.
      Fibrinogen is an extracellular matrix protein composed of three polypeptide chains with fibrinogen alpha (FGA), beta (FGB) and gamma (FGG). While fibrinogen and its related fragments are involved in tumor angiogenesis and metastasis, their functional roles are incompatible. A recent genome-scale screening reveals that loss of FGA affects the acceleration of tumor growth and metastasis of lung cancer, but the mechanism remains elusive. We used CRISPR/Cas9 genome editing to knockout (KO) FGA in human lung adenocarcinoma (LUAD) cell lines A549 and H1299. By colony formation, transwell migration and matrix invasion assays, FGA KO increased cell proliferation, migration, and invasion but decreased the expressions of epithelial-mesenchymal transition marker E-cadherin and cytokeratin 5/8 in A549 and H1299 cells. However, administration of FGA inhibited cell proliferation and migration but induced apoptosis in A549 cells. Of note, FGA KO cells indirectly co-cultured by transwells with FGA wild-type cells increased FGA in the culture medium, leading to decreased migration of FGA KO cells. Furthermore, our functional analysis identified a direct interaction of FGA with integrin α5 as well as FGA-integrin signaling that regulated the AKT-mTOR signaling pathway in A549 cells. In addition, we validated that FGA KO increased tumor growth and metastasis through activation of AKT signaling in an A549 xenograft model. Implications: These findings demonstrate that that loss of FGA facilities tumor growth and metastasis through integrin-AKT signaling pathway in lung cancer.
    DOI:  https://doi.org/10.1158/1541-7786.MCR-19-1033
  16. Nat Rev Clin Oncol. 2020 Mar 23.
    Targeting apoptosis in cancer therapy.
    Benedito A Carneiro, Wafik S El-Deiry.
      For over three decades, a mainstay and goal of clinical oncology has been the development of therapies promoting the effective elimination of cancer cells by apoptosis. This programmed cell death process is mediated by several signalling pathways (referred to as intrinsic and extrinsic) triggered by multiple factors, including cellular stress, DNA damage and immune surveillance. The interaction of apoptosis pathways with other signalling mechanisms can also affect cell death. The clinical translation of effective pro-apoptotic agents involves drug discovery studies (addressing the bioavailability, stability, tumour penetration, toxicity profile in non-malignant tissues, drug interactions and off-target effects) as well as an understanding of tumour biology (including heterogeneity and evolution of resistant clones). While tumour cell death can result in response to therapy, the selection, growth and dissemination of resistant cells can ultimately be fatal. In this Review, we present the main apoptosis pathways and other signalling pathways that interact with them, and discuss actionable molecular targets, therapeutic agents in clinical translation and known mechanisms of resistance to these agents.
    DOI:  https://doi.org/10.1038/s41571-020-0341-y
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