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FOXO3a is a major target of inactivation by PI3K/AKT signaling in aggressive neuroblastoma
Evan E Santo1, Peter Stroeken, Peter V Sluis
1Department of Oncogenomics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Abstract:
Neuroblastoma is a pediatric tumor of the peripheral sympathetic nervous system with a highly variable prognosis. Activation of the phosphoinositide 3-kinase (PI3K)/AKT pathway in neuroblastoma is correlated with poor patient prognosis, but the precise downstream effectors mediating this effect have not been determined. Here we identify the forkhead transcription factor FOXO3a as a key target of the PI3K/AKT pathway in neuroblastoma. FOXO3a expression was elevated in low-stage neuroblastoma tumors and normal embryonal neuroblasts, but reduced in late-stage neuroblastoma. Inactivation of FOXO3a by AKT was essential for neuroblastoma cell survival. Treatment of neuroblastoma cells with the dual PI3K/mTOR inhibitor PI-103 activated FOXO3a and triggered apoptosis. This effect was rescued by FOXO3a silencing. Conversely, apoptosis induced by PI-103 or the AKT inhibitor MK-2206 was potentiated by FOXO3a overexpression. Furthermore, levels of total or phosphorylated FOXO3a correlated closely with apoptotic sensitivity to MK-2206. In clinical specimens, there was an inverse relationship between gene expression signatures regulated by PI3K signaling and FOXO3a transcriptional activity. Moreover, high PI3K activity and low FOXO3a activity were each associated with an extremely poor prognosis. Our work indicates that expression of FOXO3a and its targets offer useful prognostic markers as well as biomarkers for PI3K/AKT inhibitor efficacy in neuroblastoma.
Insights
The phosphoinositide 3-kinase (PI3K)/AKT pathway drives neuroblastoma growth by inactivating the FOXO3a transcription factor. Restoring FOXO3a function induces apoptosis, offering a potential therapeutic strategy for this pediatric cancer.
Area of Science:
- Oncology
- Molecular Biology
- Genetics
Background:
- Neuroblastoma is a pediatric cancer with unpredictable outcomes.
- The PI3K/AKT pathway is frequently activated in neuroblastoma, correlating with poor prognosis.
- Downstream targets of PI3K/AKT in neuroblastoma remain largely unknown.
Purpose of the Study:
- To identify key downstream effectors of the PI3K/AKT pathway in neuroblastoma.
- To investigate the role of the transcription factor FOXO3a in neuroblastoma.
- To evaluate FOXO3a as a prognostic marker and a predictive biomarker for PI3K/AKT inhibitors.
Main Methods:
- Analysis of FOXO3a expression in neuroblastoma cell lines and clinical specimens.
- Investigating the effect of PI3K/AKT pathway inhibitors (PI-103, MK-2206) on FOXO3a activity and apoptosis.
- Gene expression analysis to correlate PI3K signaling and FOXO3a activity with patient prognosis.
Main Results:
- FOXO3a expression is inversely correlated with neuroblastoma stage and PI3K/AKT pathway activation.
- AKT-mediated inactivation of FOXO3a is crucial for neuroblastoma cell survival.
- PI3K/AKT inhibition activates FOXO3a, leading to apoptosis, which can be modulated by FOXO3a levels.
- High PI3K activity and low FOXO3a activity are associated with poor prognosis in neuroblastoma patients.
Conclusions:
- FOXO3a is a critical downstream target of the PI3K/AKT pathway in neuroblastoma.
- FOXO3a expression serves as a prognostic indicator and a potential biomarker for predicting response to PI3K/AKT inhibitors.
- Targeting the PI3K/AKT/FOXO3a axis presents a promising therapeutic avenue for neuroblastoma.
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