Tu1919 Diagnostic Accuracy of Carcinoembryonic Antigen (CEA) in Cyst Fluid Analysis in Histologically Confirmed Pancreatic Cysts: Results From a Large, Multicenter Cohort Study

Abstract

Background: The phosphatidylinositol 3-kinase (PI3K)/Akt/mTORC1/S6K pathway plays a pivotal role in the proliferation and survival of pancreatic ductal adenocarcinoma (PDAC) cells and is aberrantly activated in pancreatic cancer tissues. In addition to growth-promoting signaling, mTORC1/S6K also mediates negative feedback loops that restrain upstream signaling via insulin/IGF receptor and other tyrosine kinase receptors. Suppression of these feedback loops by selective mTORC1 inhibitors, e.g. by rapamycin and its analogs, unleashes overactivation of the PI3K/Akt pathway that potentially oppose the anti-proliferative effects of mTOR inhibitors. This prompted the development of active-site mTORC1/2 kinase inhibitors (TOR-KIs) and dual PI3K and mTOR inhibitors (PI3K/TOR-KIs). Recently, we reported that TOR-KIs induce an unexpected increase in the activity of the ERK pathway in PDAC cells through a PI3K-independent pathway. Here, we examined whether PI3K/TOR-KIs also induce ERK pathway over-activation in PDAC cells. Results: To determine the effect of dual PI3K/TOR inhibition on ERK activation, we treated serum-starved cultures of PDAC cells (MiaPaca-2 and PANC-1) with increasing concentrations of the dual PI3K/TOR-KI NPVBEZ235 for 2 h followed by stimulation with insulin and neurotensin, a potent mitogenic combination for these cells. As expected, prior exposure to NPV-BEZ235 potently blocked mTORC1 activation (scored by S6 phosphorylation at Ser-240/244) and mTORC2-mediated Akt phosphorylation at Ser-473, in a concentration-dependent manner. Strikingly, we also demonstrate, for the first time that exposure to NPV-BEZ235 markedly enhanced the increase in the phosphorylation of ERK at Thr-202 and Tyr-204. Maximal ERK over-activation coincided with complete inhibition of Akt phosphorylation at Ser-473 (produced at 100500 ηM NPV-BEZ235). ERK over-activation was also seen when PDAC cells were stimulated with 2% fetal bovine serum instead of insulin and neurotensin and when a different PI3K/ TOR-KI (PKI-587) was used instead of NPV-BEZ235. Treatment with the MEK inhibitors U126 or PD0325901 (1-5 μM) prevented ERK over-activation induced by PI3K/TOR-KIs. In order to examine whether the over-activation of the ERK pathway counterbalances the growth-suppressive effect of PI3K/TOR-KIs, PDAC cells were treated with NPV-BEZ235, PD0325901 or a combination of NPV-BEZ235 and PD0325901. The combination of these drugs caused a more pronounced inhibition of cell growth than that produced by each inhibitor added individually. Conclusion: Collectively, our results highlight the importance of discovering novel signaling crosstalk to anticipate mechanisms of tumor resistance to new drugs. The capability of predicting drug resistance can assist in developing rational and effective strategies for developing combination therapies in PDAC.