Rôle des voies de signalisation AMPc/PKA et Wnt/bêta-caténine dans la formation des systèmes de régulation aberrants au sein de la corticosurrénale

Abstract : In most cases, cortisol hypersecretion (Cushing’s syndrome; CS) results from ACTH-producing pituitary adenoma (Cushing’s disease). Occasionally, CS is the consequence of a unilateral adrenal adenoma or a bilateral macronodular adrenal hyperplasia (BMAH) producing cortisol. In these conditions, hypercortisolism is referred to as “ACTH-independent” owing to suppressed plasma ACTH levels. The molecular mechanisms underlying the maintenance of cortisol hypersecretion by adrenocortical adenomas and BMAHs in the absence of circulating ACTH has long remained unknown. However, major advances have been made during the past recent years in the comprehension of the pathophysiology of primary adrenal CS. Two main types of molecular defects have been shown to favor cortisol hypersecretion by adrenocortical neoplasms: somatic mutations responsible for activation of intracellular signaling pathways and abnormally expressed (or illegitimate) membrane receptors by tumor cells. In the human adrenal gland, serotonin (5-HT), released by subcapsular mast cells stimulates corticosteroid secretion through activation of its type 4 receptor (5-HT4R). The 5-HT4R is principally expressed in zona glomerulosa cells but weakly expressed in zona fasciculata cells explaining why 5-HT strongly stimulates aldosterone production. Interestingly, in primary pigmented nodular adrenocortical disease (PPNAD) cells, activation of the cAMP/PKA pathway by PRKAR1A mutations triggers upregulation of the 5-HT synthesizing enzyme tryptophan hydroxylase (TPH) type 2 together with the 5-HT4, 5-HT6 and 5-HT7 receptors, positively coupled to cAMP/PKA signaling pathway. 5-HT strongly stimulates cortisol production and inhibition of TPH reduced corticosteroidogenesis in cultured PPNAD cells. In human, cortisol secretion is normally stimulated by ACTH also through activation of the cAMP/PKA signaling pathway. Patients suffering from Cushing’s disease, paraneoplastic Cushing’s syndrome (paraCS), 21-hydroxylase deficiency or BMAH display high plasma or intraadrenal ACTH levels. In these patients, we show that chronic stimulation of cAMP/PKA pathway by ACTH induces TPH type 1 and 5-HT4/6/7 receptors overexpression in steroidogenic cells. In primary cultured adrenocortical cells originating from a patient with paraCS, 5-HT and 5-HT4/7 receptors agonists were able to activate cortisol secretion. On the other hand, the role of Wnt/-catenin signaling pathway in the emergence of illegitimate receptors is still debated. We therefore evaluated 5-HT4, 5-HT6, 5-HT7, LH/hCG and GIP receptors expression in an adrenocortical tumor with APC germline mutation and two experimental models of constitutive activation of β-catenin in adrenocortical cells, namely genetically modified mice and human transfected adrenocortical cells. Our results indicate that Wnt/-catenin pathway activation promotes significant overexpression of LH/hCG receptor in the 3 models investigated. Globally, our data show that activation of intracellular signaling pathways such as the cAMP/PKA pathway by ACTH or Wnt/-catenin by genetic mutations favors the emergence of abnormal regulatory systems in the adrenal cortex. Our results also demonstrate that intraadrenal 5-HT is involved in corticosteroids hypersecretion related to different diseases including Cushing’s disease, paraneoplastic Cushing’s syndrome, 21-hydroxylase deficiency and BMAH. TPH inhibitors may thus represent a new therapeutic approach of corticosteroid excess in patients suffering from these disorders.
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Julie Le Mestre. Rôle des voies de signalisation AMPc/PKA et Wnt/bêta-caténine dans la formation des systèmes de régulation aberrants au sein de la corticosurrénale. Endocrinologie et métabolisme. Normandie Université, 2018. Français. ⟨NNT : 2018NORMR055⟩. ⟨tel-02293792⟩

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