Finding an effective treatment for acute myeloid leukemia (AML) remains a challenge, and all cellular processes that are deregulated in AML cells should be considered in the design of targeted therapies. We show in our current study that the LKB1/AMPK/TSC tumor suppressor axis is functional in AML and can be activated by the biguanide molecule metformin, resulting in a specific inhibition of mammalian target of rapamycin (mTOR) catalytic activity. This induces a multisite dephosphorylation of the key translation regulator, 4E-BP1, which markedly inhibits the initiation step of mRNA translation. Consequently, metformin reduces the recruitment of mRNA molecules encoding oncogenic proteins to the polysomes,
IntroductionIn acute myeloid leukemia (AML), the oncogenic deregulation of mRNA translation markedly contributes to the malignant phenotype. However, the efficacy of clinically available therapies that target this process, such as rapamycin, remains moderate due to the induction of multiple resistance mechanisms, 1 and new approach should be considered to bypass these processes.The liver kinase B1 (LKB1) serine/threonine kinase is encoded by the tumor-suppressor gene, STK11, which harbors germ-line mutations in the inherited cancer predisposition, Peutz-Jeghers syndrome, and somatic mutations in sporadic cancers. 2 The search for substrates of LKB1 that mediate its tumor-suppressor function led to the identification of the LKB1/AMPK/TSC adenosine monophosphate-activated protein kinase (AMPK) as a direct LKB1 substrate. 3 AMPK is a heterotrimeric complex comprising a catalytic ␣-and 2 regulatory -and ␥-subunits, and LKB1 enhances AMPK activity through the phosphorylation of the ␣-subunit at T 172 . 4 AMPK is allosterically activated by the accumulation of AMP molecules, due to metabolic stresses that inhibit adenosine triphosphate (ATP) production (eg, hypoxia, glucose deprivation) or stimulate ATP consumption 5 and is also activated by drugs used to treat type 2 diabetes, including metformin. 6 AMPK is therefore the main cellular energy sensor, acting as a central negative regulator of metabolic pathways, such as fatty acid oxidation and glucose consumption. 7 The LKB1/AMPK pathway also regulates the protein synthesis rate through the control of the serine/threonine kinase mammalian target of rapamycin (mTOR), 8 a process that is consistently deregulated in AML cells. 9 When activated, AMPK stimulates tuberous sclerosis complex 1/2 (TSC 1/2 ), which comprises the TSC1/hamartin and TSC2/tuberin proteins, through AMPK-mediated TSC2 phosphorylation at the T 1227 and S 1345 residues. 10 This stimulates the GTPase-activating protein (GAP) function of TSC2 toward the small G-protein Rheb (Ras homolog enriched in brain), and increases the pool of guanosine diphosphate (GDP)-bound Rheb molecules. Although the molecular mechanism underlying mTOR activation by Rheb-guanosine triphosphate (GTP) is still under debate, [11][12][13] it is well established that TSC2 activation switches off Rheb, resulting in the inhibition o...