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PI3King the Lock: Targeting the PI3K/Akt/mTOR Pathway as a Novel Therapeutic Strategy in Neuroblastoma
Abstract
Neuroblastoma is the most common extracranial cancer in childhood. High-risk neuroblastoma continues to have a poor prognosis and there is an urgent need to design biologically based therapies that specifically target the pathways responsible for malignant transformation and progression. One such pathway is the PI3K/Akt/mTOR pathway. In this article we outline the evidence for aberrant activation of the PI3K/Akt/mTOR pathway in neuroblastoma and discuss the possible mechanisms which mediate it. We also discuss the development of treatments targeting this pathway in neuroblastoma and the challenges that must be overcome before such treatments can enter routine clinical practice.
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“ROS are known to hyperactivate PI3K/Akt/mTOR (Phosphoinositide 3-Kinases/Protein kinase B/mammalian Target Of Rapamycin), an intracellular pathway playing an important role in cell cycle regulation, specifically proliferation, cancer, and longevity (King et al. 2015).”
From Reactive Oxygen Species, Toxicity, Oxidative Stress, and Antioxidants: Chronic Diseases and Aging (2023) · cites this paper as King et al. 2015
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“8 Arch Med Sci Therapeutic methods targeting PI3K/AKT are widely used in the treatment of human cancers such as prostate cancer [23], osteosarcoma [24] and neuroblastoma [25].”
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“In addition, TRAF6 recruits and induces activity of the receptor tyrosine kinase Protooncogene tyrosine-protein kinase (c-Src) via integrin αVβ3, leading to cytoskeletal reorganization, required for osteoclast-mediated bone resorption (4,10), as well as downstream activation of phosphoinositide 3-kinase (PI3K), and pr…”
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“Further, PI3K-AKT pathway regulates intracellular signalling and controls cell survival, proliferation, cell cycle, growth and cancer in response to extracellular signals (King et al., 2015; Zhang et al., 2018).”
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“A major player in the PI3K-AKT cascade is the AKT serine-threonine kinase, which, upon activation, modulates the function of several downstream targets, including proteins essential for proliferation, protein synthesis, and metabolism (King et al., 2015).”
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“PI3K/Akt/mTOR signaling is an intracellular pathway that regulates the cell cycle, making it directly associated with cell proliferation, cellular quiescence, cancer and longevity (23).”
BackgroundA Tale of Two: When Neural Stem Cells Encounter Hypoxia
Fan, Y., Li, J., & Fang, B. (2022) · Cellular and Molecular Neurobiology · doi:10.1007/s10571-022-01293-6 · Cited by 14
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Regulation of Phosphoinositide Signaling by Scaffolds at Cytoplasmic Membranes
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“Active Akt in turn phosphorylates and inhibits the mTOR complex 1 (mTORC1) inhibitors TSC1/2 [57].”
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“Activation of PI3K can phosphorylate and activate AKT, localizing it in the plasma membrane (33).”
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“PI3K activation phosphorylates AKT and active AKT can lead to a number of downstream effects including the activation of mTOR, also in the form of phosphorylates mTOR, which in turn directly impacts cell growth and survival [41-43].”
BackgroundPhase I study of perifosine monotherapy in patients with recurrent or refractory neuroblastoma
Matsumoto, K., Shichino, H., Kawamoto, H., et al. (2017) · Pediatric Blood & Cancer · doi:10.1002/pbc.26623 · Cited by 12
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“Phosphoinositide 3-kinase (PI3K) is a crucial protein activated by receptor tyrosine kinases, and it in turn activates AKT which is a key signaling protein kinase involved in PI3K/AKT/mTOR and other pathways [134, 135].”
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The PI3K-AKT-mTOR pathway activates recovery from general anesthesia
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“com/oncotarget cycle and may be associated with cellular proliferation, migration, adhesion, metabolism, invasion, and survival [11, 12].”
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“PI3K activation facilities Akt phosphorylation and activation, localizes it at the plasma membrane, and thereby genetically and epigenetically affects its downstream target genes (31-34).”
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“Regarding upstream signaling pathways, the PI3K/AKT signaling pathway plays an important role in regulating the development and progression of malignancies, and in common cancers, this pathway is overactive or aberrantly dysregulated, including in cervical cancer [27,28,54–57].”
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“The PI3K/Akt pathway and Myc gene are involved in this process (King et al., 2015; Yu and Cui, 2016).”
BackgroundPromising Molecular Targets and Novel Therapeutic Approaches in Neuroblastoma
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“In addition, the inhibition of pro-apoptotic factors such as Bad and FOXO transcription factors decreased apoptotic changes.(25) The above-mentioned factors are thought to participate in different cell activities (Fig.”
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“Through western blot analysis, we also determine if the PI3K/AKT/mTOR pathway, which has been widely reported to regulate cell cycle and consequently involved in the proliferation and progression of cancer cells [17], is involved in the progression of the PDGF-BBinduced ASMCs.”
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“Oral squamous cell carcinoma (OSCC) is the eighth most common cancer type, accounting for 90%–95% of all oral malignancies worldwide [1, 2].”
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“It may be considered a novel therapeutic strategy in NB [26, 27].”
BackgroundWenhua Juanbi Recipe Attenuates Rheumatoid Arthritis via Inhibiting miRNA‐146a‐Mediated Autophagy
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“The PI3K/AKT/mTOR pathway is a signi fi cant intracellular signaling pathway regulating the cell cycle and is closely associated with cell proliferation and lifespan [32, 33].”
Knockdown of Mediator Complex Subunit 19 Suppresses the Growth and Invasion of Prostate Cancer Cells
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SYK Inhibition Potentiates the Effect of Chemotherapeutic Drugs on Neuroblastoma Cells In Vitro
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“Neuroblastoma, a pediatric cancer of the peripheral sympathetic nervous system, is frequently diagnosed at the advanced stage of disease and treated with various strategies, including chemotherapy, radiotherapy, autologous stem cell transplantation, and surgery [15,17].”
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“PI3K induced generation of phosphatidylinositol-3,4,5-trisphosphate recruits Akt to the inner plasma membrane and allows the activation of Akt, resulting in activation of a panel of downstream intracellular proteins [17–19].”
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“This pathway can serve as a therapeutic target for NB 62,63 .”
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“The PI3K/AKT/mTOR pathway is an intracellular signaling pathway which affects cell cycle regulation as it is directly linked to cellular quiescence, proliferation and cancer [14].”
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“We then assessed the impact of low-frequency rMS on the JNK/p38/ERK and PI3K/AKT/ mTOR pathways, which are related to unlimited cell proliferation, dedifferentiation, and a lack of tumor apoptosis [36,37].”
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“The phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) pathway has been investigated extensively to determine its role in drug resistance and driving malignancy processes in solid cancer patients [39–43].”
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“For example, inhibition of MAPK signaling or mTOR signaling can effectively reduce cerebral ischemia reperfusion injury (Dennis et al., 2001; Sovan, 2013; Johansson et al., 2014; King et al., 2015; Yang et al., 2016).”
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“These include the PI3K-Akt, RAS-RAF-MEK-ERK, SRC, JAK-STAT signaling pathways (59).”
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“This way, clinical data appear to converge on the following feasible molecular targets: the tropomyosin kinase receptor homologs A, B and C (Trk) which control the spatiotemporal regulation of growth, differentiation, and survival of central and peripheral neurons [10]; the mammalian target of rapamycin (mTOR), a seri…”
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Applications and prospects of targeted therapy for neuroblastoma
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Liu, J., Zhang, M.-Y., Kan, Y., Wang, W., Liu, J., Gong, J.-H., & Yang, J.-G. (2021) · Frontiers in Cell and Developmental Biology · doi:10.3389/fcell.2020.622793 · Cited by 5
“Knockdown of Nuclear Factor-κB Activating Protein Inhibited the Phosphatidylinositol 3-Kinase/Protein Kinase B Signaling Pathway in SK-N-SH Cells The PI3K/AKT signaling pathway is an important signaling pathway involved in various malignant tumors, including NB (King et al., 2015).”
MethodSorteberg, A. L., Halipi, V., Wickström, M., & Fard, S. S. (2022) · Frontiers in Oncology · doi:10.3389/fonc.2022.906194 · Cited by 5
Sriramulu, S., Nandy, S. K., Ganesan, H., et al. (2021) · Computational Biology and Chemistry · doi:10.1016/j.compbiolchem.2021.107478 · Cited by 5
Molecular mechanisms and signaling pathways involved in immunopathological events of COVID-19
Peyvandi, A. A., Niknazar, S., Mehrjerdi, F. Z., Abbaszadeh, H., Khoshsirat, S., & Peyvandi, M. (2021) · Physiology and Pharmacology · doi:10.52547/ppj.25.3.193 · Cited by 5
Chen, J., Cai, H., Xie, Y., et al. (2017) · PubMed · Cited by 4
Koçoğlu, S. S., Sunay, F. B., & Akkaya, P. N. (2023) · Antibiotics · doi:10.3390/antibiotics12060995 · Cited by 4
“examined activation of the PI3K pathway in 39 samples from patients with high-risk neuroblastoma and showed that expression of PI3Kp110 and PI3Kp85 could be detected in the cytoplasm of 54% of cases, and phosphorylated AKT was present in the cytoplasm in almost all cases [29].”
MethodFan, X.-P., Wang, J., Chen, S.-Y., Li, X., Cao, J., Wang, H., Ding, L., Che, T., & Li, Y. (2025) · Scientific Reports · doi:10.1038/s41598-025-89217-4 · Cited by 5
“AKT, a crucial serine/threonine kinase and pivotal component of the PI3K signaling pathway, is essential for functions like cell growth, programmed cell death, movement, glucose regulation, and gene expression 54 .”
Cytotoxic lycorine alkaloids of the plant family Amaryllidaceae
Nair, J. J., & Staden, J. V. (2025) · Bioorganic Chemistry · doi:10.1016/j.bioorg.2025.108619 · Cited by 4
Malik, S. K., Paracha, R. Z., Khalid, M., et al. (2018) · IET Systems Biology · doi:10.1049/iet-syb.2018.5040 · Cited by 4
Yi, X.-X., Zhou, H., He, Y. T., Yang, C., Yu, L., Wan, H., & Chen, J. (2023) · Medicine · doi:10.1097/md.0000000000033276 · Cited by 4
Characteristic Mutational Damages in Gastric and Colorectal Adenocarcinomas
Yermekova, S., Orazgaliyeva, M., Goncharova, T., Rakhimbekova, F., Kaidarova, D. R., & Shatkovskaya, O. (2023) · Asian Pacific Journal of Cancer Prevention · doi:10.31557/apjcp.2023.24.11.3939 · Cited by 4
“Another RAS-activated signalling pathway is the PI3K/AKT/mTOR pathway, which stimulates protein synthesis, cell growth, and inhibits apoptosis (King et al., 2015).”
BackgroundWang, K., Liao, P.-Y., Chang, W., Yang, C.-R., Su, Y., Wu, P., Wu, Y., Hung, Y., Akhtar, N., Lai, H., et al. (2024) · Frontiers in Pharmacology · doi:10.3389/fphar.2023.1281067 · Cited by 4
Unravelling the novel insights between miR-7 and Parkinson’s disease (PD)
Kushwaha, S., Lakhanpal, V., Elangovan, A., Iyer, M., Kinoshita, M., Narayanasamy, A., HariKrishnaReddy, D., Siama, Z., Yadav, M. K., & Vellingiri, B. (2026) · Neurological Sciences · doi:10.1007/s10072-026-08834-7 · Cited by 3
“When PI3K is activated, AKT is phosphorylated and activated, and then it localizes to the cellular membrane [93].”
Association of PI3K/AKT/mTOR Pathway with Cancer and Its Therapeutic Implications
Saleem, S., Bashir, I., Khan, M. S., & Ahanger, M. S. (2025) · Springer eBooks · doi:10.1007/978-981-96-2763-9_3 · Cited by 3
Li, Y., Iida, H., Kimata, K., Zhuo, L., Ota, A., Kimura, S. H., Yin, X., Deie, M., & Ushida, T. (2019) · Molecular Pain · doi:10.1177/1744806919892389 · Cited by 3
“In many cancers, this pathway is overactive, which reduces apoptosis and allows cell proliferation.(40) However, this pathway is important to promote growth and proliferation over differentiation of adult stem cells, specifically neural stem cells.”
BackgroundThe Importance of RTK Signaling Genes and their Inhibitors in Breast Cancer
Rahimi, M., Kakroodi, S. T., & Tajvidi, M. (2022) · Journal of Obstetrics Gynecology and Cancer Research · doi:10.30699/jogcr.7.4.258 · Cited by 3
“This pathway is vital in the cell processes, such as cell division, growth, survival, and angiogenesis (11, 12).”
BackgroundBahmad, H. F., Chalhoub, R., Harati, H., Bou-Gharios, J., Ballout, F., Monzer, A., Msheik, H., Assi, S., Araji, T., Elajami, M. K., et al. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.02.18.953596 · Cited by 3
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Metadata
- Authors
- King, D., Yeomanson, D., & Bryant, H. E.
- Affiliations
- Sheffield Children's Hospital (GB)
- Venue
- Journal of Pediatric Hematology/Oncology
- Published
- 2015-05
- Volume
- 37
- Issue
- 4
- Pages
- 245-251
- ISSN
- 1077-4114 (ISSN-L)
- OpenAlex
- W1974245465
- Cited by
- 248
- References
- 52
- Citations by year
- 2026: 10 · 2025: 19 · 2024: 31 · 2023: 24 · 2022: 26 · 2021: 29 · 2020: 29 · 2019: 25 · 2018: 22 · 2017: 22 · 2016: 11
- FWCI
- 2.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Pediatric Hematology/Oncology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Neuroblastoma Research and Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › PI3K/AKT/mTOR signaling in cancer
- Health Sciences › Medicine › Clinical Neurology › Neurofibromatosis and Schwannoma Cases
- Keywords
- neuroblastoma, PI3K/AKT/mTOR pathway, high-risk neuroblastoma, PI3K inhibitors, AKT inhibitors, mTOR inhibitors, targeted therapy, childhood cancer
- MeSH terms
- Mechanistic Target of Rapamycin Complex 1, Mechanistic Target of Rapamycin Complex 2, Phosphoinositide-3 Kinase Inhibitors, Animals, Humans, Neuroblastoma, Signal Transduction, Phosphatidylinositol 3-Kinases, Multiprotein Complexes, Protein Kinase Inhibitors, Proto-Oncogene Proteins c-akt, TOR Serine-Threonine Kinases
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