Abstract
Simple SummaryDiabetic people have an increased risk of developing several types of cancers, particularly pancreatic cancer. The higher availability of glucose and/or lipids that characterizes diabetes and obesity is responsible for the increased production of highly reactive carbonyl compounds, a condition referred to as “carbonyl stress”. Also known as glycotoxins and lipotoxins, these compounds react quickly and damage various molecules in cells forming final products termed AGEs (advanced glycation end-products). AGEs were shown to markedly accelerate tumor development in an experimental model of pancreatic cancer and AGE inhibition prevented the tumor-promoting effect of diabetes. In humans, carbonyl stress has been associated with the risk of pancreatic cancer and recognized as a possible contributor to other cancers, including breast and colorectal cancer. These findings suggest that carbonyl stress is involved in cancer development and growth and may be the mechanistic link between diabetes and pancreatic cancer, thus representing a potential drug target.Both type 2 (T2DM) and type 1 (T1DM) diabetes mellitus confer an increased risk of pancreatic cancer in humans. The magnitude and temporal trajectory of the risk conferred by the two forms of diabetes are similar, suggesting a common mechanism. Carbonyl stress is a hallmark of hyperglycemia and dyslipidemia, which accompanies T2DM, prediabetes, and obesity. Accumulating evidence demonstrates that diabetes promotes pancreatic ductal adenocarcinoma (PDAC) in experimental models of T2DM, a finding recently confirmed in a T1DM model. The carbonyl stress markers advanced glycation end-products (AGEs), the levels of which are increased in diabetes, were shown to markedly accelerate tumor development in a mouse model of Kras-driven PDAC. Consistently, inhibition of AGE formation by trapping their carbonyl precursors (i.e., reactive carbonyl species, RCS) prevented the PDAC-promoting effect of diabetes. Considering the growing attention on carbonyl stress in the onset and progression of several cancers, including breast, lung and colorectal cancer, this review discusses the mechanisms by which glucose and lipid imbalances induce a status of carbonyl stress, the oncogenic pathways activated by AGEs and their precursors RCS, and the potential use of carbonyl-scavenging agents and AGE inhibitors in PDAC prevention and treatment, particularly in high-risk diabetic individuals.
Highlights
Pancreatic cancer is a highly fatal malignancy with very poor overall survival rates.Pancreatic ductal adenocarcinoma (PDAC) is by far the most common and most lethal type of pancreatic cancer, representing over 90% of the pancreatic malignancies [1]
Based on the observation that excessive energy intake, elevated body mass index, and central obesity have been reported to increase the risk of both pancreatic ductal adenocarcinoma (PDAC) [48] and diabetes [49,50], it cannot be excluded that T2DM and PDAC share common pathogenic mechanisms related to insulin resistance/hyperinsulinemia and/or chronic metabolic inflammation
PDAC, and the efficacy of therapeutic targeting of receptor for AGEs (RAGE) in delaying PDAC development in naïve mice, these findings argue against the utility of RAGE blockade/inhibition as a therapeutic option in conditions characterized by increased circulating advanced glycation end-products (AGEs) levels, such as diabetes
Summary
Pancreatic cancer is a highly fatal malignancy with very poor overall survival rates. Known as juvenile-onset diabetes or insulin-dependent diabetes, Type 1 diabetes mellitus (T1DM) accounts for less than 10% of diabetic patients and is characterized by an absolute deficiency of insulin secretion due to immune-mediated destruction of the insulin-producing β-cells of pancreatic islets [10] In addition to these etiological distinctions, important metabolic differences exist between T1DM and T2DM, as dyslipidemia and hypertension often pre-date diagnosis and accompany T2DM, but usually not T1DM. Its consequences are shared by the two forms of diabetes, as chronic complications such as cardiovascular and kidney disease, vision loss, and neurological deficits affect both T1DM and T2DM patients in the long run [12] Both T2DM and T1DM have been increasingly recognized as risk factors for the development of various cancers, including PDAC [6,13,14,15,16].
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