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Zhang J, Fan J, Zeng X, Nie M, Luan J, Wang Y, Ju D, Yin K. Hedgehog signaling in gastrointestinal carcinogenesis and the gastrointestinal tumor microenvironment. Acta Pharm Sin B 2021; 11:609-620. [PMID: 33777671 PMCID: PMC7982428 DOI: 10.1016/j.apsb.2020.10.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/29/2020] [Accepted: 08/21/2020] [Indexed: 12/16/2022] Open
Abstract
The Hedgehog (HH) signaling pathway plays important roles in gastrointestinal carcinogenesis and the gastrointestinal tumor microenvironment (TME). Aberrant HH signaling activation may accelerate the growth of gastrointestinal tumors and lead to tumor immune tolerance and drug resistance. The interaction between HH signaling and the TME is intimately involved in these processes, for example, tumor growth, tumor immune tolerance, inflammation, and drug resistance. Evidence indicates that inflammatory factors in the TME, such as interleukin 6 (IL-6) and interferon-γ (IFN-γ), macrophages, and T cell-dependent immune responses, play a vital role in tumor growth by affecting the HH signaling pathway. Moreover, inhibition of proliferating cancer-associated fibroblasts (CAFs) and inflammatory factors can normalize the TME by suppressing HH signaling. Furthermore, aberrant HH signaling activation is favorable to both the proliferation of cancer stem cells (CSCs) and the drug resistance of gastrointestinal tumors. This review discusses the current understanding of the role and mechanism of aberrant HH signaling activation in gastrointestinal carcinogenesis, the gastrointestinal TME, tumor immune tolerance and drug resistance and highlights the underlying therapeutic opportunities.
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Key Words
- 5-Fu, 5-fluorouracil
- ALK5, TGF-β receptor I kinase
- ATO, arsenic trioxide
- BCC, basal cell carcinoma
- BCL-2, B cell lymphoma 2
- BMI-1, B cell-specific moloney murine leukemia virus insertion region-1
- CAFs, cancer-associated fibroblasts
- CSCs, cancer stem cells
- Cancer stem cells
- Carcinogenesis
- DHH, Desert Hedgehog
- Drug resistance
- EGF, epidermal growth factor
- FOLFOX, oxaliplatin
- G protein coupled receptor kinase 2, HH
- Gastrointestinal cancer
- Hedgehog
- Hedgehog, HIF-1α
- IHH, Indian Hedgehog
- IL-10/6, interleukin 10/6
- ITCH, itchy E3 ubiquitin ligase
- MDSCs, myeloid-derived suppressor cells
- NK, natural killer
- NOX4, NADPH Oxidase 4
- PD-1, programmed cell death-1
- PD-L1, programmed cell death ligand-1
- PKA, protein kinase A
- PTCH, Patched
- ROS, reactive oxygen species
- SHH, Sonic Hedgehog
- SMAD3, mothers against decapentaplegic homolog 3
- SMO, Smoothened
- SNF5, sucrose non-fermenting 5
- STAT3, signal transducer and activator of transcription 3
- SUFU, Suppressor of Fused
- TAMs, tumor-related macrophages
- TGF-β, transforming growth factor β
- TME, tumor microenvironment
- Tumor microenvironment
- VEGF, vascular endothelial growth factor
- WNT, Wingless/Integrated
- and leucovorin, GLI
- ch5E1, chimeric monoclonal antibody 5E1
- glioma-associated oncogene homologue, GRK2
- hypoxia-inducible factor 1α, IFN-γ: interferon-γ
- βArr2, β-arrestin2
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Affiliation(s)
- Jinghui Zhang
- Department of Gastrointestinal Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
- Department of Biological Medicines, Fudan University School of Pharmacy, Shanghai 201203, China
| | - Jiajun Fan
- Department of Biological Medicines, Fudan University School of Pharmacy, Shanghai 201203, China
- Shanghai Engineering Research Center of Immunotherapeutics, Shanghai 201203, China
| | - Xian Zeng
- Department of Biological Medicines, Fudan University School of Pharmacy, Shanghai 201203, China
- Shanghai Engineering Research Center of Immunotherapeutics, Shanghai 201203, China
| | - Mingming Nie
- Department of Gastrointestinal Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Jingyun Luan
- Department of Biological Medicines, Fudan University School of Pharmacy, Shanghai 201203, China
- Shanghai Engineering Research Center of Immunotherapeutics, Shanghai 201203, China
| | - Yichen Wang
- Department of Biological Medicines, Fudan University School of Pharmacy, Shanghai 201203, China
- Shanghai Engineering Research Center of Immunotherapeutics, Shanghai 201203, China
| | - Dianwen Ju
- Department of Biological Medicines, Fudan University School of Pharmacy, Shanghai 201203, China
- Shanghai Engineering Research Center of Immunotherapeutics, Shanghai 201203, China
- Corresponding authors. Tel./fax: +86 21 65349106 (Kai Yin); Tel.: +86 21 5198 0037; Fax +86 21 5198 0036 (Dianwen Ju).
| | - Kai Yin
- Department of Gastrointestinal Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
- Corresponding authors. Tel./fax: +86 21 65349106 (Kai Yin); Tel.: +86 21 5198 0037; Fax +86 21 5198 0036 (Dianwen Ju).
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Abstract
Since its initial discovery in Drosophila, Hedgehog (HH) signaling has long been associated with foregut development. The mammalian genome expresses 3 HH ligands, with sonic hedgehog (SHH) levels highest in the mucosa of the embryonic foregut. More recently, interest in the pathway has shifted to improving our understanding of its role in gastrointestinal cancers. The use of reporter mice proved instrumental in our ability to probe the expression pattern of SHH ligand and the cell types responding to canonical HH signaling during homeostasis, inflammation, and neoplastic transformation. SHH is highly expressed in parietal cells and is required for these cells to produce gastric acid. Furthermore, myofibroblasts are the predominant cell type responding to HH ligand in the uninfected stomach. Chronic infection caused by Helicobacter pylori and associated inflammation induces parietal cell atrophy and the expansion of metaplastic cell types, a precursor to gastric cancer in human subjects. During Helicobacter infection in mice, canonical HH signaling is required for inflammatory cells to be recruited from the bone marrow to the stomach and for metaplastic development. Specifically, polarization of the invading myeloid cells to myeloid-derived suppressor cells requires the HH-regulated transcription factor GLI1, thereby creating a microenvironment favoring wound healing and neoplastic transformation. In mice, GLI1 mediates the phenotypic shift to gastric myeloid-derived suppressor cells by directly inducing Schlafen 4 (slfn4). However, the human homologs of SLFN4, designated SLFN5 and SLFN12L, also correlate with intestinal metaplasia and could be used as biomarkers to predict the subset of individuals who might progress to gastric cancer and benefit from treatment with HH antagonists.
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Key Words
- ATPase, adenosine triphosphatase
- DAMP, damage-associated molecular pattern
- DAMPs
- GLI, glioma-associated protein
- GLI1
- Gr-MDSC, granulocytic myeloid-derived suppressor cell
- HH, hedgehog
- HHIP, hedgehog-interacting protein
- IFN, interferon
- IL, interleukin
- MDSC, myeloid-derived suppressor cell
- MDSCs
- Metaplasia
- Mo-MDSC, monocytic myeloid-derived suppressor cell
- PTCH, Patched
- SHH
- SHH, sonic hedgehog
- SLFN4, Schlafen 4
- SMO, Smoothened
- SP, spasmolytic polypeptide
- SPEM
- SPEM, spasmolytic polypeptide–expressing mucosa
- SST, somatostatin
- TLR, Toll-like receptor
- mRNA, messenger RNA
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Affiliation(s)
- Juanita L. Merchant
- Department of Internal Medicine-Gastroenterology, University of Michigan, Ann Arbor, Michigan,Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan,Correspondence Address correspondence to: Juanita L. Merchant, MD, PhD, University of Michigan, 109 Zina Pitcher Place, Ann Arbor, Michigan 48109-2200. fax: (734) 763-4686.University of Michigan109 Zina Pitcher PlaceAnn ArborMichigan 48109-2200
| | - Lin Ding
- Department of Internal Medicine-Gastroenterology, University of Michigan, Ann Arbor, Michigan
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