Journal
THERANOSTICS
Volume 11, Issue 13, Pages 6251-6277Publisher
IVYSPRING INT PUBL
DOI: 10.7150/thno.57689
Keywords
radioactive iodine refractory thyroid cancer; redifferentiation; signaling pathways; sodium iodide symporter; membrane targeting
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Funding
- Biomedical Research Institute grant, Kyungpook National University Hospital (2020)
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Advanced, metastatic differentiated thyroid cancers often have a poor prognosis due to decreased NIS expression and RAI refractoriness caused by genetic aberrations such as BRAF, RAS, and RET/PTC rearrangements. These genetic abnormalities activate MAPK and PI3K/AKT signaling pathways leading to dedifferentiation of DTCs. Research in recent years has focused on strategies to restore NIS expression and RAI uptake.
The advanced, metastatic differentiated thyroid cancers (DTCs) have a poor prognosis mainly owing to radioactive iodine (RAI) refractoriness caused by decreased expression of sodium iodide symporter (NIS), diminished targeting of NIS to the cell membrane, or both, thereby decreasing the efficacy of RAI therapy. Genetic aberrations (such as BRAF, RAS, and RET/PTC rearrangements) have been reported to be prominently responsible for the onset, progression, and dedifferentiation of DTCs, mainly through the activation of mitogen-activated protein kinase (MAPK) and phosphoinositide 3-kinase (PI3K)/AKT signaling pathways. Eventually, these alterations result in a lack of NIS and disabling of RAI uptake, leading to the development of resistance to RAI therapy. Over the past decade, promising approaches with various targets have been reported to restore NIS expression and RAI uptake in preclinical studies. In this review, we summarized comprehensive molecular mechanisms underlying the dedifferentiation in RAI-refractory DTCs and reviews strategies for restoring RAI avidity by tackling the mechanisms.
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