Metastasis, responsible for 90% of cancer patient deaths, is an inefficient process because many tumor cells die. The survival of metastatic tumor cells should be considered as a critical therapeutic target. This review provides a new perspective regarding the role of AKT in tumor survival, and the rationale to target AKT in anti-metastasis therapies.J. Cell. Physiol. 218: 451-454, 2009. ß 2008 Wiley-Liss, Inc.
The Drives and Operatives of Metastasis ContinuumMetastasis is the spread of cancer cells from their primary location to other parts of the body. Once cancer becomes metastatic, it cannot be effectively treated by surgical and radiation therapies. Metastasis is the predominant cause of cancer-related mortality. In order to develop therapies, we need to better understand the cellular and molecular basis of clinical and phenotypic effects that convert tumor cells to metastases. Major cellular events involved in tumor metastasis are relaxed proliferation controls, diminished cell-cell adhesion, altered cell interaction with extracellular matrix (ECM), increased activity of stromal fibroblasts and immune cells (Arya et al., 2006), increased hypoxia and nutritional deprivation, and production of an adequate blood supply (angiogenesis), entrance into (intravasation) and exit from (extravasation) blood or lymph, and implantation and proliferation at metastatic sites. Metastasis is an inefficient process because many tumor cells die (Weiss, 1990). In fact, death can be triggered at every step: immune surveillance, disruption of cell-cell contacts, changes of the matrix ligands of the epithelial cell surface integrin receptors, lack of oxygen and nutrients, and physical trauma as tumor cells force their path of migration through the endothelial tissue barrier. Tumor cells must be equipped with at least three essential operatives that can evolve to overcome barriers posed by constantly changing microenviroment (Fig. 1A). One operative, by which malignant cells escape the surrounding matrix and become migratory and invasive, is to adopt the phenotypes of mesenchymal cells known as the epithelial-to-mesenchymal transition (EMT). A second mechanism must arise to resist apoptosis. A third stimulates neovascularization to sustain the local supply of oxygen and nutrients. The sustaining power of tumor cells driving them toward an open-ended continuum of metastatic operation is their unique mutator phenotype, which also confers increased plasticity of epigenetic regulation. At the center of metastatic drive is the combination of the tumor cells' limitless replicative potential and their increased ability to survive.One of the key tumor survival mechanisms is the AKT signaling pathway (Franke et al., 1995). Three homologous AKT isoforms (AKT1, AKT2, and AKT3) are members of the AGC kinase family (Woodgett, 2005). The biological and biochemical characteristics of AKTs have been extensively reviewed. Briefly, in response to survival signals, activated phosphatidylinositol 3-OH kinase (PI3K) phosphorylates phosphatidylinosito...