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Autophagy in Endocrine Tumors 22:4 R205–R218 Review A Weckman et al. Autophagy in endocrine tumors 22:4 R205–R218 Review Autophagy in endocrine tumors Andrea Weckman1, Fabio Rotondo2, Antonio Di Ieva1, Luis V Syro3, Henriett Butz2, Michael D Cusimano1 and Kalman Kovacs2 Correspondence should be addressed 1Division of Neurosurgery, Department of Surgery, and 2Division of Pathology, Department of Laboratory Medicine, to F Rotondo St Michael’s Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8 Canada Email 3Department of Neurosurgery, Hospital Pablo Tobon Uribe and Clı´nica Medellin, Medellin, Colombia [email protected] Abstract Autophagy is an important intracellular process involving the degradation of cytoplasmic Key Words components. It is involved in both physiological and pathological conditions, including " autophagy cancer. The role of autophagy in cancer is described as a ‘double-edged sword,’ a term that " autophagy modulation reflects its known participation in tumor suppression, tumor survival and tumor cell " endocrine disease proliferation. Available research regarding autophagy in endocrine cancer supports this " neoplasia concept. Autophagy shows promise as a novel therapeutic target in different types of " therapeutic potential endocrine cancer, inhibiting or increasing treatment efficacy in a context- and cell-type- dependent manner. At present, however, there is very little research concerning autophagy in endocrine tumors. No research was reported connecting autophagy to some of the tumors of the endocrine glands such as the pancreas and ovary. This review aims to elucidate the roles of autophagy in different types of endocrine cancer and highlight the need for increased research in the field. Endocrine-Related Cancer (2015) 22, R205–R218 Endocrine-Related Cancer Introduction The word ‘autophagy’ derives from the Greek roots ‘auto,’ in both tumor progression and tumor suppression (White or self, and ‘phagy,’ to eat (Levine & Klionsky 2004)–in & DiPaola 2009). other words, self-cannibalism or self-eating. Autophagy is Relative to other types of neoplasia, endocrine tumors a genetically programmed and evolutionarily conserved occur more rarely (Table 1). Endocrine tumors are defined intracellular process. Different types of autophagy, such as neoplasia of the hormone-secreting cells of the classic as macroautophagy, microautophagy and chaperone- endocrine glands, including the pituitary, thyroid, para- mediated autophagy, have been described, each with thyroid and adrenal glands, as well as the ovaries and different specific functions and slightly different mechan- testes. The apparent rareness of endocrine tumors is partly isms. All types of autophagy, however, share the end result due to the fact that many pituitary, adrenal, parathyroid of lysosome-mediated degradation of cytoplasmic com- and thyroid tumors remain undiagnosed (Nicholson ponents (Weckman et al. 2014). The ubiquitous cellular 2008).However,sincemoreandmoreevidenceis process of autophagy has been explored in a wide array emerging on the importance of autophagy in cancer, its of different contexts, including both physiological and role must be investigated in endocrine cancers as well. Our pathological conditions. More recently, autophagy has paper aims to review the function of autophagy in been implicated in the pathogenesis of cancer and is oncogenesis and consolidate existing research regarding commonly referred to as a ‘double-edged sword’ for its role the role of autophagy in endocrine tumors. http://erc.endocrinology-journals.org q 2015 Society for Endocrinology Published by Bioscientifica Ltd. DOI: 10.1530/ERC-15-0042 Printed in Great Britain Downloaded from Bioscientifica.com at 10/03/2021 10:22:46PM via free access Review A Weckman et al. Autophagy in endocrine tumors 22:4 R206 Table 1 Epidemiology of endocrine cancers. The inconsistency otherwise damaged proteins and organelles. During in format and relative lack of epidemiological data reflect the periods of metabolic stress (i.e., nutrient deprivation, rarity of endocrine neoplasms and resulting lack of motivation hypoxic conditions and/or lack of growth factors), to study them autophagy breaks down proteins into the basic amino acids essential to survival. These amino acids are then used Tumor type Epidemiological data in various crucial processes such as synthesizing proteins Pituitary 10–15% of intracranial neoplasmsa important for the cell to adapt to stress, or the Krebs cycle Adrenal Adrenal cortical adenomas: incidence to produce ATP for cellular energy (Mizushima 2007, unknowna Adrenal cortical carcinomas: 1/million Levine & Kroemer 2008)(Fig. 1B). Autophagy has also per yeara been implicated in protecting the genome from genetic Pheochromocytomas: 2–9/million instability and DNA mutations that ultimately result per yearb Thyroid Most common endocrine neoplasm: in tumor development (Mathew et al. 2007a, Levine & 1% of all cancera Kroemer 2008). Paradoxically to its cell-survival-oriented a 0.8–5.0/100 000 per year (male) functions, autophagy is also involved in type II pro- 1.9–19.4/100 000 per year (female)a Parathyroid Primary hyperparathyroidism: 17.7 grammed cell death. Type II programmed cell death is cases/million per yeara distinguishable from type I programmed cell death Parathyroid carcinoma: 0.005% of all (apoptosis) partly by the accretion of autophagic vacuoles, cancersb Endocrine pancreas 1–2% of pancreatic neoplasmsa as well as the use of endogenous lysosomal enzymes for 4–12/million per yearb degradation of the dying cell, rather than lysosomal c Endocrine ovary 1% of ovarian cancers enzymes from phagocytes (Shintani & Klionsky 2004). Endocrine testis 1% of testicular cancersc Interestingly, both the cell survival and cell death features aDeLellis (2004). of autophagic function have been implicated in the bSturgeon (2009). development, progression and treatment efficacy in cRies et al. (2007). cancer cases. Autophagy Autophagy and cancer The discovery of the involvement of autophagy in a wide The function of autophagy in cancer has been extensively Endocrine-Related Cancer array of both physiological and pathological conditions reviewed over the past decade (Kondo et al. 2005, Hippert such as cardiac, pulmonary and liver diseases, neuro- et al. 2006, Jin & White 2007, Mathew et al. 2007b, Morselli degeneration, infection, immunity and cancer (Shintani & et al. 2009, White & DiPaola 2009, Kimmelman 2011, Klionsky 2004, Levine & Kroemer 2008, Mizushima et al. Yang et al. 2011, White 2012, Kubisch et al. 2013, Lu & 2008, Choi et al. 2013) has led to a recent increase in Harrison-Findik 2013). Autophagy plays a dual, context- interest in the multifaceted role of autophagy in humans. dependent role in tumor suppression and tumor survival, Consequently, the precise mechanisms and molecular a paradox that is widely accepted while its mechanism players in mammalian autophagy have been extensively remains largely unexplained. reviewed (Levine & Klionsky 2004, Mizushima 2007, Yang The role of autophagy as a cellular housekeeper is & Klionsky 2010, Tanida 2011)(Fig. 1A). The autophagic linked to its proposed role as a tumor suppressor. The process, most commonly stimulated by nutrient depri- importance of autophagy in tumor suppression was C K vation (Mizushima 2007), initiates with the engulfment suggested after the observation that beclin 1 / (a gene of specific cytoplasmic components by a phagophore or linked to autophagy) mice had increased rates of tumor isolation membrane to form a double-membraned autop- development (Qu et al. 2003, Yue et al. 2003). Moreover, hagosome. The autophagosome proceeds to fuse with a monoallelic loss of beclin 1 is prevalent in human lysosome in order to expose its contents to the lysosomal prostate, ovarian and breast cancers (Aita et al. 1999, degradative enzymes and break down the engulfed Liang et al. 1999) and restoring expression of beclin 1, cytoplasmic constituents. in human breast carcinoma cells results in inhibition of Autophagy has various physiological functions. in vitro tumorigenesis and cellular proliferation (Liang Under normal conditions, autophagy plays a cellular et al. 1999). Although this is the most well known tumor ‘housekeeping’ role, responsible for removing detrimental suppressor gene associated with autophagy activation, substances such as long-lived, misfolded, aggregated or there are many others that have also been reported in the http://erc.endocrinology-journals.org q 2015 Society for Endocrinology Published by Bioscientifica Ltd. DOI: 10.1530/ERC-15-0042 Printed in Great Britain Downloaded from Bioscientifica.com at 10/03/2021 10:22:46PM via free access Review A Weckman et al. Autophagy in endocrine tumors 22:4 R207 A Growth factor Starvation/hypoxia receptors Class I P13K Ras PKB/Akt nuclear TSC1/TSC2 AMPK p53 Raf/MEK/ERK Rheb mTOR DRAM Antiapoptotic cytosolic ULK comp exes Bcl-2, Bcl-XL p53 Autophagy B Isolation membrane Autophagosome Autolysosome Mitochondria Endoplasmic reticulum Protein Endocrine-Related Cancer Bacteria Viruses Free amino acids, fatty-acids Bulk or selective autophagy • Starvation/nutrient deprivation • Lack of growth factors • Detrimental substance removing misfolded/aggregated/damaged proteins damaged cell organelles Protein synthesis Lysosome • Type II programmed cell death energy production • Microbes Figure 1 The process of autophagy in mammalian cells. (A) In this complex process, a autophagosome proceeds to fuse with lysosome. The contents within the series of protein complexes and autophagy-related proteins are involved in autophagosome
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