Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Molecular Targets for Therapy

AMP-dependent kinase/mammalian target of rapamycin complex 1 signaling in T-cell acute lymphoblastic leukemia: therapeutic implications

Abstract

The mammalian target of rapamycin (mTOR) serine/threonine kinase is the catalytic subunit of two multi-protein complexes, referred to as mTORC1 and mTORC2. Signaling downstream of mTORC1 has a critical role in leukemic cell biology by controlling mRNA translation of genes involved in both cell survival and proliferation. mTORC1 activity can be downmodulated by upregulating the liver kinase B1/AMP-activated protein kinase (LKB1/AMPK) pathway. Here, we have explored the therapeutic potential of the anti-diabetic drug, metformin (an LKB1/AMPK activator), against both T-cell acute lymphoblastic leukemia (T-ALL) cell lines and primary samples from T-ALL patients displaying mTORC1 activation. Metformin affected T-ALL cell viability by inducing autophagy and apoptosis. However, it was much less toxic against proliferating CD4+ T-lymphocytes from healthy donors. Western blot analysis demonstrated dephosphorylation of mTORC1 downstream targets. Unlike rapamycin, we found a marked inhibition of mRNA translation in T-ALL cells treated with metformin. Remarkably, metformin targeted the side population of T-ALL cell lines as well as a putative leukemia-initiating cell subpopulation (CD34+/CD7/CD4) in patient samples. In conclusion, metformin displayed a remarkable anti-leukemic activity, which emphasizes future development of LKB1/AMPK activators as clinical candidates for therapy in T-ALL.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6

Similar content being viewed by others

References

  1. Pui CH, Robison LL, Look AT . Acute lymphoblastic leukaemia. Lancet 2008; 371: 1030–1043.

    CAS  Google Scholar 

  2. Kox C, Zimmermann M, Stanulla M, Leible S, Schrappe M, Ludwig WD et al. The favorable effect of activating NOTCH1 receptor mutations on long-term outcome in T-ALL patients treated on the ALL-BFM 2000 protocol can be separated from FBXW7 loss of function. Leukemia 2010; 24: 2005–2013.

    Article  CAS  Google Scholar 

  3. Zhao WL . Targeted therapy in T-cell malignancies: dysregulation of the cellular signaling pathways. Leukemia 2010; 24: 13–21.

    Article  CAS  Google Scholar 

  4. Biagi C, Astolfi A, Masetti R, Serravalle S, Franzoni M, Chiarini F et al. Pediatric early T-cell precursor leukemia with NF1 deletion and high-sensitivity in vitro to tipifarnib. Leukemia 2010; 24: 1230–1233.

    Article  CAS  Google Scholar 

  5. Masiero M, Minuzzo S, Pusceddu I, Moserle L, Persano L, Agnusdei V et al. Notch3-mediated regulation of MKP-1 levels promotes survival of T acute lymphoblastic leukemia cells. Leukemia 2011; 25: 588–598.

    Article  CAS  Google Scholar 

  6. Steelman LS, Franklin RA, Abrams SL, Chappell W, Kempf CR, Basecke J et al. Roles of the Ras/Raf/MEK/ERK pathway in leukemia therapy. Leukemia 2011; 25: 1080–1094.

    Article  CAS  Google Scholar 

  7. Silva A, Yunes JA, Cardoso BA, Martins LR, Jotta PY, Abecasis M et al. PTEN posttranslational inactivation and hyperactivation of the PI3K/Akt pathway sustain primary T cell leukemia viability. J Clin Invest 2008; 118: 3762–3774.

    Article  CAS  Google Scholar 

  8. Cardoso BA, Martins LR, Santos CI, Nadler LM, Boussiotis VA, Cardoso AA et al. Interleukin-4 stimulates proliferation and growth of T-cell acute lymphoblastic leukemia cells by activating mTOR signaling. Leukemia 2009; 23: 206–208.

    Article  CAS  Google Scholar 

  9. Jotta PY, Ganazza MA, Silva A, Viana MB, da Silva MJ, Zambaldi LJ et al. Negative prognostic impact of PTEN mutation in pediatric T-cell acute lymphoblastic leukemia. Leukemia 2010; 24: 239–242.

    Article  CAS  Google Scholar 

  10. Chapuis N, Tamburini J, Green AS, Willems L, Bardet V, Park S et al. Perspectives on inhibiting mTOR as a future treatment strategy for hematological malignancies. Leukemia 2010; 24: 1686–1699.

    Article  CAS  Google Scholar 

  11. Hsieh AC, Costa M, Zollo O, Davis C, Feldman ME, Testa JR et al. Genetic dissection of the oncogenic mTOR pathway reveals druggable addiction to translational control via 4EBP-eIF4E. Cancer Cell 2010; 17: 249–261.

    Article  CAS  Google Scholar 

  12. Evangelisti C, Ricci F, Tazzari P, Tabellini G, Battistelli M, Falcieri E et al. Targeted inhibition of mTORC1 and mTORC2 by active-site mTOR inhibitors has cytotoxic effects in T-cell acute lymphoblastic leukemia. Leukemia 2011; 25: 781–791.

    Article  CAS  Google Scholar 

  13. Hemminki A, Markie D, Tomlinson I, Avizienyte E, Roth S, Loukola A et al. A serine/threonine kinase gene defective in Peutz-Jeghers syndrome. Nature 1998; 391: 184–187.

    Article  CAS  Google Scholar 

  14. Hezel AF, Bardeesy N . LKB1; linking cell structure and tumor suppression. Oncogene 2008; 27: 6908–6919.

    Article  CAS  Google Scholar 

  15. Shackelford DB, Shaw RJ . The LKB1-AMPK pathway: metabolism and growth control in tumour suppression. Nat Rev Cancer 2009; 9: 563–575.

    Article  CAS  Google Scholar 

  16. Inoki K, Zhu T, Guan KL . TSC2 mediates cellular energy response to control cell growth and survival. Cell 2003; 115: 577–590.

    Article  CAS  Google Scholar 

  17. Gwinn DM, Shackelford DB, Egan DF, Mihaylova MM, Mery A, Vasquez DS et al. AMPK phosphorylation of raptor mediates a metabolic checkpoint. Mol Cell 2008; 30: 214–226.

    Article  CAS  Google Scholar 

  18. Li D . Metformin as an antitumor agent in cancer prevention and treatment. J Diabetes 2001 (in press), doi: 10.1111/j.1753-0407.2011.00119.

  19. Guppy A, Jamal-Hanjani M, Pickering L . Anticancer effects of metformin and its potential use as a therapeutic agent for breast cancer. Future Oncol 2011; 7: 727–736.

    Article  CAS  Google Scholar 

  20. Green AS, Chapuis N, Maciel TT, Willems L, Lambert M, Arnoult C et al. The LKB1/AMPK signaling pathway has tumor suppressor activity in acute myeloid leukemia through the repression of mTOR-dependent oncogenic mRNA translation. Blood 2010; 116: 4262–4273.

    Article  CAS  Google Scholar 

  21. Chiarini F, Del Sole M, Mongiorgi S, Gaboardi GC, Cappellini A, Mantovani I et al. The novel Akt inhibitor, perifosine, induces caspase-dependent apoptosis and downregulates P-glycoprotein expression in multidrug-resistant human T-acute leukemia cells by a JNK-dependent mechanism. Leukemia 2008; 22: 1106–1116.

    Article  CAS  Google Scholar 

  22. Papa V, Tazzari PL, Chiarini F, Cappellini A, Ricci F, Billi AM et al. Proapoptotic activity and chemosensitizing effect of the novel Akt inhibitor perifosine in acute myelogenous leukemia cells. Leukemia 2008; 22: 147–160.

    Article  CAS  Google Scholar 

  23. Martelli AM, Papa V, Tazzari PL, Ricci F, Evangelisti C, Chiarini F et al. Erucylphosphohomocholine, the first intravenously applicable alkylphosphocholine, is cytotoxic to acute myelogenous leukemia cells through JNK- and PP2A-dependent mechanisms. Leukemia 2010; 24: 687–698.

    Article  CAS  Google Scholar 

  24. Altman JK, Sassano A, Kaur S, Glaser H, Kroczynska B, Redig AJ et al. Dual mTORC2/mTORC1 Targeting Results in Potent Suppressive Effects on Acute Myeloid Leukemia (AML) Progenitors. Clin Cancer Res 2011; 17: 4378–4388.

    Article  CAS  Google Scholar 

  25. Chiarini F, Grimaldi C, Ricci F, Tazzari PL, Evangelisti C, Ognibene A et al. Activity of the novel dual phosphatidylinositol 3-kinase/mammalian target of rapamycin inhibitor NVP-BEZ235 against T-cell acute lymphoblastic leukemia. Cancer Res 2010; 70: 8097–8107.

    Article  CAS  Google Scholar 

  26. Memmott RM, Dennis PA . LKB1 and mammalian target of rapamycin as predictive factors for the anticancer efficacy of metformin. J Clin Oncol 2009; 27: e226.

    Article  Google Scholar 

  27. Tamburini J, Chapuis N, Bardet V, Park S, Sujobert P, Willems L et al. Mammalian target of rapamycin (mTOR) inhibition activates phosphatidylinositol 3-kinase/Akt by up-regulating insulin-like growth factor-1 receptor signaling in acute myeloid leukemia: rationale for therapeutic inhibition of both pathways. Blood 2008; 111: 379–382.

    Article  CAS  Google Scholar 

  28. Janku F, McConkey DJ, Hong DS, Kurzrock R . Autophagy as a target for anticancer therapy. Nat Rev Clin Oncol 2011; 8: 528–539.

    Article  CAS  Google Scholar 

  29. Barth S, Glick D, Macleod KF . Autophagy: assays and artifacts. J Pathol 2010; 221: 117–124.

    Article  CAS  Google Scholar 

  30. Hagner PR, Schneider A, Gartenhaus RB . Targeting the translational machinery as a novel treatment strategy for hematologic malignancies. Blood 2010; 115: 2127–2135.

    Article  CAS  Google Scholar 

  31. Bleau AM, Hambardzumyan D, Ozawa T, Fomchenko EI, Huse JT, Brennan CW et al. PTEN/PI3K/Akt pathway regulates the side population phenotype and ABCG2 activity in glioma tumor stem-like cells. Cell Stem Cell 2009; 4: 226–235.

    Article  CAS  Google Scholar 

  32. Moshaver B, van Rhenen A, Kelder A, van der Pol M, Terwijn M, Bachas C et al. Identification of a small subpopulation of candidate leukemia-initiating cells in the side population of patients with acute myeloid leukemia. Stem Cells 2008; 26: 3059–3067.

    Article  Google Scholar 

  33. Jakubikova J, Adamia S, Kost-Alimova M, Klippel S, Cervi D, Daley JF et al. Lenalidomide targets clonogenic side population in multiple myeloma: pathophysiologic and clinical implications. Blood 2011; 117: 4409–4419.

    Article  CAS  Google Scholar 

  34. Yamazaki J, Mizukami T, Takizawa K, Kuramitsu M, Momose H, Masumi A et al. Identification of cancer stem cells in a Tax-transgenic (Tax-Tg) mouse model of adult T-cell leukemia/lymphoma. Blood 2009; 114: 2709–2720.

    Article  CAS  Google Scholar 

  35. Cox CV, Martin HM, Kearns PR, Virgo P, Evely RS, Blair A . Characterization of a progenitor cell population in childhood T-cell acute lymphoblastic leukemia. Blood 2007; 109: 674–682.

    Article  CAS  Google Scholar 

  36. Zuurbier L, Homminga I, Calvert V, te Winkel ML, Buijs-Gladdines JG, Kooi C et al. NOTCH1 and/or FBXW7 mutations predict for initial good prednisone response but not for improved outcome in pediatric T-cell acute lymphoblastic leukemia patients treated on DCOG or COALL protocols. Leukemia 2010; 24: 2014–2022.

    Article  CAS  Google Scholar 

  37. Clappier E, Collette S, Grardel N, Girard S, Suarez L, Brunie G et al. NOTCH1 and FBXW7 mutations have a favorable impact on early response to treatment, but not on outcome, in children with T-cell acute lymphoblastic leukemia (T-ALL) treated on EORTC trials 58881 and 58951. Leukemia 2010; 24: 2023–2031.

    Article  CAS  Google Scholar 

  38. Renneville A, Kaltenbach S, Clappier E, Collette S, Micol JB, Nelken B et al. Wilms tumor 1 (WT1) gene mutations in pediatric T-cell malignancies. Leukemia 2010; 24: 476–480.

    Article  CAS  Google Scholar 

  39. Yu L, Slovak ML, Mannoor K, Chen C, Hunger SP, Carroll AJ et al. Microarray detection of multiple recurring submicroscopic chromosomal aberrations in pediatric T-cell acute lymphoblastic leukemia. Leukemia 2011; 25: 1042–1046.

    Article  CAS  Google Scholar 

  40. Silva A, Girio A, Cebola I, Santos CI, Antunes F, Barata JT . Intracellular reactive oxygen species are essential for PI3K/Akt/mTOR-dependent IL-7-mediated viability of T-cell acute lymphoblastic leukemia cells. Leukemia 2011; 25: 960–967.

    Article  CAS  Google Scholar 

  41. Chiarini F, Fala F, Tazzari PL, Ricci F, Astolfi A, Pession A et al. Dual inhibition of class IA phosphatidylinositol 3-kinase and mammalian target of rapamycin as a new therapeutic option for T-cell acute lymphoblastic leukemia. Cancer Res 2009; 69: 3520–3528.

    Article  CAS  Google Scholar 

  42. Campas C, Lopez JM, Santidrian AF, Barragan M, Bellosillo B, Colomer D et al. Acadesine activates AMPK and induces apoptosis in B-cell chronic lymphocytic leukemia cells but not in T lymphocytes. Blood 2003; 101: 3674–3680.

    Article  CAS  Google Scholar 

  43. Jung CH, Jun CB, Ro SH, Kim YM, Otto NM, Cao J et al. ULK-Atg13-FIP200 complexes mediate mTOR signaling to the autophagy machinery. Mol Biol Cell 2009; 20: 1992–2003.

    Article  CAS  Google Scholar 

  44. Separovic D, Kelekar A, Nayak AK, Tarca AL, Hanada K, Pierce JS et al. Increased ceramide accumulation correlates with downregulation of the autophagy protein ATG-7 in MCF-7 cells sensitized to photodamage. Arch Biochem Biophys 2010; 494: 101–105.

    Article  CAS  Google Scholar 

  45. An D, Kewalramani G, Chan JK, Qi D, Ghosh S, Pulinikunnil T et al. Metformin infuences cell death by pathways that are dependent and independent of caspase-3. Diabetologia 2006; 49: 2174–2184.

    Article  CAS  Google Scholar 

  46. Zakikhani M, Blouin MJ, Piura E, Pollak MN . Metformin and rapamycin have distinct effects on the AKT pathway and proliferation in breast cancer cells. Breast Cancer Res Treat 2010; 123: 271–279.

    Article  CAS  Google Scholar 

  47. Tamburini J, Green AS, Bardet V, Chapuis N, Park S, Willems L et al. Protein synthesis is resistant to rapamycin and constitutes a promising therapeutic target in acute myeloid leukemia. Blood 2009; 114: 1618–1627.

    Article  CAS  Google Scholar 

  48. Misaghian N, Ligresti G, Steelman LS, Bertrand FE, Basecke J, Libra M et al. Targeting the leukemic stem cell: the Holy Grail of leukemia therapy. Leukemia 2009; 23: 25–42.

    Article  CAS  Google Scholar 

  49. Gerby B, Clappier E, Armstrong F, Deswarte C, Calvo J, Poglio S et al. Expression of CD34 and CD7 on human T-cell acute lymphoblastic leukemia discriminates functionally heterogeneous cell populations. Leukemia 2011; 25: 1249–1258.

    Article  CAS  Google Scholar 

  50. Chiu PP, Jiang H, Dick JE . Leukemia-initiating cells in human T-lymphoblastic leukemia exhibit glucocorticoid resistance. Blood 2010; 116: 5268–5279.

    Article  CAS  Google Scholar 

  51. Hirsch HA, Iliopoulos D, Tsichlis PN, Struhl K . Metformin selectively targets cancer stem cells, and acts together with chemotherapy to block tumor growth and prolong remission. Cancer Res 2009; 69: 7507–7511.

    Article  CAS  Google Scholar 

  52. Sengupta TK, Leclerc GM, Hsieh-Kinser TT, Leclerc GJ, Singh I, Barredo JC . Cytotoxic effect of 5-aminoimidazole-4-carboxamide-1-beta-4-ribofuranoside (AICAR) on childhood acute lymphoblastic leukemia (ALL) cells: implication for targeted therapy. Mol Cancer 2007; 6: 46.

    Article  Google Scholar 

  53. Leclerc GM, Leclerc GJ, Fu G, Barredo JC . AMPK-induced activation of Akt by AICAR is mediated by IGF-1R dependent and independent mechanisms in acute lymphoblastic leukemia. J Mol Signal 2010; 5: 15.

    Article  Google Scholar 

  54. Kuznetsov JN, Leclerc GJ, Leclerc GM, Barredo JC . AMPK and Akt determine apoptotic cell death following perturbations of one-carbon metabolism by regulating ER stress in acute lymphoblastic leukemia. Mol Cancer Ther 2011; 10: 437–447.

    Article  CAS  Google Scholar 

  55. Bailey CJ, Turner RC . Metformin. N Engl J Med 1996; 334: 574–579.

    Article  CAS  Google Scholar 

  56. Carvalho C, Correia S, Santos MS, Seica R, Oliveira CR, Moreira PI . Metformin promotes isolated rat liver mitochondria impairment. Mol Cell Biochem 2008; 308: 75–83.

    Article  CAS  Google Scholar 

  57. Wilcock C, Bailey CJ . Accumulation of metformin by tissues of the normal and diabetic mouse. Xenobiotica 1994; 24: 49–57.

    Article  CAS  Google Scholar 

  58. Mavrakis KJ, Wolfe AL, Oricchio E, Palomero T, de Keersmaecker K, McJunkin K et al. Genome-wide RNA-mediated interference screen identifies miR-19 targets in Notch-induced T-cell acute lymphoblastic leukaemia. Nat Cell Biol 2010; 12: 372–379.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study was supported by grants from MinSan 2008 ‘Molecular therapy in pediatric sarcomas and leukemias against IGF-IR system: new drugs, best drug–drug interactions, mechanisms of resistance and indicators of efficacy’, MIUR PRIN 2008 (2008THTNLC) and MIUR FIRB 2010 (RBAP10447J_003) to AMM.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A M Martelli.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Grimaldi, C., Chiarini, F., Tabellini, G. et al. AMP-dependent kinase/mammalian target of rapamycin complex 1 signaling in T-cell acute lymphoblastic leukemia: therapeutic implications. Leukemia 26, 91–100 (2012). https://doi.org/10.1038/leu.2011.269

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/leu.2011.269

Keywords

This article is cited by

Search

Quick links