BACKGROUND & AIMS:
:Colorectal carcinoma (CRC) is the second leading cause of cancer-related death in the United States in the general population (men and women combined). Epidemiologic data obtained over the last several decades shows convincing evidence for the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) in the reduction of risk of CRC through the inhibition of cycloxygenase (COX). Recent research has also demonstrated that prostaglandin E2 (PGE2), a predominant product of COX, plays a critical role in tumorigenesis of CRCs through its guanine nucleotide-binding protein (G protein)-coupled receptors (GPCRs), EP2, and EP4. Molecular analysis of CRC and its precursor lesions have shown that mutation of Adenomatous Polyposis Coli (APC), a gene involved in the wingless type signaling pathway, is an early event during the neoplastic progression in the majority of sporadic CRCs. The fundamental questions are: why is wild type APC so important in adult colorectal tissues in preventing this tumorigenesis, and what are the mechanisms by which NSAIDs prevent colorectal tumorigenesis? We reviewed the recent literature concerning the PGE2-GPCR signaling pathway and the APC-beta-catenin (wingless type) pathway in CRC cells and propose a unifying schema regarding the tumorigenesis of CRC. Colorectal epithelia are continuously exposed to various extracellular agonists (including low levels of PGE2). The binding of these agonists to their corresponding GPCRs leads to formation of activated Galphas, which in turn activates beta-catenin. In normal colorectal epithelia, wild type APC blocks the Galphas-induced activation of beta-catenin, and therefore maintains homeostasis and prevents tumorigenesis. In contrast, in the absence of functional APC, continuous formation of activated Galphas by the binding of various extracellular agonists to their receptors leads to the activation and nuclear accumulation of beta-catenin. This elevated nuclear beta-catenin in turn increases transcription of many genes (COX-2, C-myc, Cyclin D1, vascular endothelial growth factor, T cell factor, etc.) involved in tumorigenesis. Increased transcription of COX-2 also leads to excessive production of PGE2 that in turn forms a stimulatory loop with many biologic functions (proliferation, migration, invasion, angiogenesis, and inhibition of apoptosis), which may result in the development of CRC. Because NSAIDs inhibit COX and decrease the production of PGE2, interruption of the cycle helps prevent colorectal tumorigenesis.
背景与目标:
大肠癌(CRC)是美国普通人群(男性和女性合计)中与癌症相关的死亡的第二大主要原因。在过去的几十年中获得的流行病学数据表明,非甾体类抗炎药(NSAIDs)通过抑制环氧合酶(COX)降低CRC风险的功效令人信服。最近的研究还表明,COX的主要产物前列腺素E2(PGE2)通过鸟嘌呤核苷酸结合蛋白(G蛋白)偶联受体(GPCR),EP2和EP4在CRC的肿瘤发生中起关键作用。对CRC及其前体病变的分子分析表明,在大多数散发性CRC中,腺瘤性息肉病(APC)的突变是无翼型信号传导途径中的一个基因,是肿瘤发展过程中的早期事件。基本的问题是:为什么野生型APC在成人结直肠组织中如此重要,以防止这种肿瘤发生,以及NSAIDs预防结直肠肿瘤发生的机制是什么?我们回顾了有关CRC细胞中PGE2-GPCR信号通路和APC-β-catenin(无翼型)通路的最新文献,并提出了关于CRC肿瘤发生的统一方案。大肠上皮细胞不断暴露于各种细胞外激动剂(包括低水平的PGE2)。这些激动剂与其相应的GPCR结合会导致形成活化的Galpha,进而激活β-catenin。在正常的结直肠上皮细胞中,野生型APC阻断了Galphas诱导的β-catenin活化,因此保持体内平衡并防止了肿瘤的发生。相反,在不存在功能性APC的情况下,通过各种细胞外激动剂与其受体的结合而连续形成活化的Galpha,会导致β-catenin的活化和核蓄积。这种升高的核β-catenin反过来又增加了参与肿瘤发生的许多基因(COX-2,C-myc,Cyclin D1,血管内皮生长因子,T细胞因子等)的转录。 COX-2转录的增加还导致PGE2的过量产生,进而形成具有许多生物学功能(增殖,迁移,侵袭,血管生成和细胞凋亡抑制)的刺激环,这可能导致CRC的发展。由于NSAIDs抑制COX并减少PGE2的产生,因此周期的中断有助于预防结直肠癌的发生。