Guevara-Aguirre Jaime, Peña Gabriela, Pazmiño Gabriel, Acosta William, Saavedra Jannette, Lescano Daniela, Guevara Alexandra, Gavilanes Antonio W D
Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Diego de Robles s/n y Pampite, Cumbayá, Quito, Ecuador.
Instituto de Endocrinología IEMYR, Quito, Ecuador.
Endocr Relat Cancer. 2023 May 11;30(6). doi: 10.1530/ERC-22-0389. Print 2023 Jun 1.
Meta-analyses from 2018-2022 have shown that obesity increases the risk of various cancers such as acute myeloid lymphoma, chronic myeloid lymphoma, diffuse beta cell lymphoma, Hodgkin's lymphoma, leukemia, multiple myeloma, non-Hodgkin's lymphoma, bladder, breast, cholangiocarcinoma, colorectal, ovarian, esophageal, kidney, liver, prostate, thyroid, and uterus. Contextually, obesity, and its comorbidities, is the largest, most lethal pandemics in the history of mankind; hence, identification of underlying mechanisms is needed to adequately address this global health threat. Herein, we present the metabolic and hormonal mechanisms linked to obesity that might etiologically contribute to neoplasia, including hyperinsulinemia and putative places in the insulin-signaling pathway. Excess insulin, acting as a growth factor, might contribute to tumorigenesis, while abundant ATP and GDP supply the additional energy needed for proliferation of rapidly dividing cells. Our observations in the Ecuadorian cohort of subjects with Laron syndrome (ELS) prove that obesity does not always associate with increased cancer risk. Indeed, despite excess body fat from birth to death, these individuals display a diminished incidence of cancer when compared to their age- and sex-matched relatives. Furthermore, in cell cultures exposed to potent oxidizing agents, addition of ELS serum induces less DNA damage as well as increased apoptosis. ELS individuals have absent growth hormone (GH) counter-regulatory effects in carbohydrate metabolism due to a defective GH receptor. The corresponding biochemical phenotype includes extremely low basal serum concentrations of insulin and insulin-like growth factor-I, lower basal glucose and triglyceride (TG) levels, and diminished glucose, TG, and insulin responses to orally administered glucose or to a mixed meal.
2018年至2022年的荟萃分析表明,肥胖会增加患多种癌症的风险,如急性髓系淋巴瘤、慢性髓系淋巴瘤、弥漫性β细胞淋巴瘤、霍奇金淋巴瘤、白血病、多发性骨髓瘤、非霍奇金淋巴瘤、膀胱癌、乳腺癌、胆管癌、结直肠癌、卵巢癌、食管癌、肾癌、肝癌、前列腺癌、甲状腺癌和子宫癌。从背景来看,肥胖及其合并症是人类历史上最大、最致命的流行病;因此,需要确定潜在机制以充分应对这一全球健康威胁。在此,我们介绍与肥胖相关的代谢和激素机制,这些机制可能在病因上导致肿瘤形成,包括高胰岛素血症以及胰岛素信号通路中的假定位点。过量的胰岛素作为一种生长因子,可能有助于肿瘤发生,而丰富的ATP和GDP为快速分裂细胞的增殖提供所需的额外能量。我们在厄瓜多尔患有拉龙综合征(ELS)的受试者队列中的观察结果证明,肥胖并不总是与癌症风险增加相关。事实上,尽管这些个体从出生到死亡都有多余的体脂,但与年龄和性别匹配的亲属相比,他们患癌症的发生率较低。此外,在暴露于强氧化剂的细胞培养物中,添加ELS血清会减少DNA损伤并增加细胞凋亡。由于生长激素(GH)受体缺陷,ELS个体在碳水化合物代谢中没有GH的反调节作用。相应的生化表型包括基础血清胰岛素和胰岛素样生长因子-I浓度极低、基础葡萄糖和甘油三酯(TG)水平较低,以及口服葡萄糖或混合餐后葡萄糖、TG和胰岛素反应减弱。