PDF file - 232KB, Figure S1: FoxO subcellular localization under NVP-BEZ235, BKM120, or MK-2206 treatment. Figure S2: Quantified ratios of AKT phosphorylation levels to total AKT levels in FoxO WT and KO cells after 50 nM NVP-BEZ235 treatment. Figure S3: The effect of high dosage NVP-BEZ235 on cell proliferation in FoxO WT and KO cells. Figure S4: Rictor knockdown potentiates cell proliferation suppression and cell death induction in response to NVP-BEZ235 treatment in RCC cells. Figure S5: The expression levels of p27 and Bim in FoxO deficient cells under NVPBEZ235 treatment.
ARTICLE ABSTRACT
The PI3K–AKT pathway is hyperactivated in many human cancers, and several drugs to inhibit this pathway, including the PI3K/mTOR dual inhibitor NVP-BEZ235, are currently being tested in various preclinical and clinical trials. It has been shown that pharmacologic inhibition of the PI3K–AKT pathway results in feedback activation of other oncogenic signaling pathways, which likely will limit the clinical utilization of these inhibitors in cancer treatment. However, the underlying mechanisms of such feedback regulation remain incompletely understood. The PI3K–AKT pathway is a validated therapeutic target in renal cell carcinoma (RCC). Here, we show that FoxO transcription factors serve to promote AKT phosphorylation at Ser473 in response to NVP-BEZ235 treatment in renal cancer cells. Inactivation of FoxO attenuated NVP-BEZ235–induced AKT Ser473 phosphorylation and rendered renal cancer cells more susceptible to NVP-BEZ235–mediated cell growth suppression in vitro and tumor shrinkage in vivo. Mechanistically, we showed that FoxOs upregulated the expression of Rictor, an essential component of MTOR complex 2, in response to NVP-BEZ235 treatment and revealed that Rictor is a key downstream target of FoxOs in NVP-BEZ235–mediated feedback regulation. Finally, we show that FoxOs similarly modulate the feedback response on AKT Ser473 phosphorylation and renal tumor growth by other phosphoinositide 3-kinase (PI3K) or AKT inhibitor treatment. Together, our study reveals a novel mechanism of PI3K–AKT inhibition-mediated feedback regulation and may identify FoxO as a novel biomarker to stratify patients with RCC for PI3K or AKT inhibitor treatment, or a novel therapeutic target to synergize with PI3K–AKT inhibition in RCC treatment. Cancer Res; 74(6); 1682–93. ©2014 AACR.
