title: Activation of Akt is increased in the dysplasia-carcinoma sequence in Barrett's oesophagus and contributes to increased proliferation and inhibition of apoptosis: a histopathological and functional study.
abstract: BACKGROUND
  The incidence of oesophageal adenocarcinoma is increasing rapidly in the developed world. The serine-threonine protein kinase and proto-oncogene Akt has been reported to regulate proliferation and apoptosis in several tissues but there are no data on the involvement of Akt in oesophageal carcinogenesis. Therefore we have examined the activation of Akt in Barrett's oesophagus and oesophageal adenocarcinoma and the functional effects of Akt activation in vitro.
  
  
  METHODS
  Expression of total and active (phosphorylated) Akt were determined in endoscopic biopsies and surgical resection specimens using immunohistochemistry. The functional effects of Akt were examined using Barrett's adenocarcinoma cells in culture.
  
  
  RESULTS
  In normal squamous oesophagus, erosive oesophagitis and non-dysplastic Barrett's oesophagus, phospho-Akt was limited to the basal 1/3 of the mucosa. Image analysis confirmed that Akt activation was significantly increased in non-dysplastic Barrett's oesophagus compared to squamous epithelium and further significantly increased in high-grade dysplasia and adenocarcinoma. In all cases of high grade dysplasia and adenocarcinoma Akt was activated in the luminal 1/3 of the epithelium. Transient acid exposure and the obesity hormone leptin activated Akt, stimulated proliferation and inhibited apoptosis: the combination of acid and leptin was synergistic. Inhibition of Akt phosphorylation with LY294002 increased apoptosis and blocked the effects of acid and leptin both alone and in combination. Activation of Akt was associated with downstream phosphorylation and deactivation of the pro-apoptotic protein Bad and phosphorylation of the Forkhead family transcription factor FOXO1.
  
  
  CONCLUSIONS
  Akt is abnormally activated in Barrett's oesophagus, high grade dysplasia and adenocarcinoma. Akt activation promotes proliferation and inhibits apoptosis in Barrett's adenocarcinoma cells and both transient acid exposure and leptin stimulate Akt phosphorylation. Downstream targets of Akt include Bad and Forkhead transcription factors. Activation of Akt in obesity and by reflux of gastric acid may be important in the pathogenesis of Barrett's adenocarcinoma.
authors.affiliation: Gastroenterology Unit, Norfolk and Norwich University Hospital, Norwich, UK. ian.beales@nnuh.nhs.uk
authors.forename: Ian L P
authors.initials: IL
authors.lastname: Beales
authors.forename: Olorunseun
authors.initials: O
authors.lastname: Ogunwobi
authors.forename: Ewen
authors.initials: E
authors.lastname: Cameron
authors.forename: Khalid
authors.initials: K
authors.lastname: El-Amin
authors.forename: Gabriel
authors.initials: G
authors.lastname: Mutungi
authors.forename: Mark
authors.initials: M
authors.lastname: Wilkinson
mesh_terms: D000230:Adenocarcinoma / Q000201:enzymology* / Q000473:pathology; D017209:Apoptosis; D001471:Barrett Esophagus / Q000201:enzymology* / Q000473:pathology; D049109:Cell Proliferation; D002471:Cell Transformation, Neoplastic / Q000378:metabolism*; D004789:Enzyme Activation / Q000502:physiology*; D004938:Esophageal Neoplasms / Q000201:enzymology* / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007150:Immunohistochemistry; D011230:Precancerous Conditions / Q000201:enzymology / Q000473:pathology; D000090063:Proto-Oncogene Mas; D051057:Proto-Oncogene Proteins c-akt / Q000378:metabolism*
chemical_list: C000715470:MAS1 protein, human; D000090063:Proto-Oncogene Mas; D051057:Proto-Oncogene Proteins c-akt