IMR Press / FBL / Volume 27 / Issue 7 / DOI: 10.31083/j.fbl2707223
Open Access Review
Potential Mechanisms by which Glucocorticoids Induce Breast Carcinogenesis through Nrf2 Inhibition
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1 Animal Facility, Istituto Nazionale Tumori - “Fondazione G. Pascale" - IRCCS, 80131 Naples, Italy
2 Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Salerno, Italy
3 Department of Radiological, Oncological and Anatomo-Pathological Science, University of Rome “Sapienza”, 00161 Rome, Italy
4 Hematology Service, San Luca Hospital, ASL Salerno, 84124 Salerno, Italy
5 Anesthesia and Intensive Care Unit, “Immacolata di Sapri" Hospital– ASL Salerno, 84073 Salerno, Italy
6 Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
*Correspondence: a.giudice@istitutotumori.na.it; aldo.giudice@libero.it (Aldo Giudice); sialiberti@unisa.it (Silvana Mirella Aliberti)
These authors contributed equally.
Academic Editor: Graham Pawelec
Front. Biosci. (Landmark Ed) 2022, 27(7), 223; https://doi.org/10.31083/j.fbl2707223
Submitted: 27 May 2022 | Revised: 20 June 2022 | Accepted: 30 June 2022 | Published: 14 July 2022
(This article belongs to the Special Issue New Insights against Cancer Progression and Metastasis)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Breast cancer is the most common malignancy among women worldwide. Several studies indicate that, in addition to established risk factors for breast cancer, other factors such as cortisol release related to psychological stress and drug treatment with high levels of glucocorticoids may also contribute significantly to the initiation of breast cancer. There are several possible mechanisms by which glucocorticoids might promote neoplastic transformation of breast tissue. Among these, the least known and studied is the inhibition of the nuclear erythroid factor 2-related (Nrf2)-antioxidant/electrophile response element (ARE/EpRE) pathway by high levels of glucocorticoids. Specifically, Nrf2 is a potent transcriptional activator that plays a central role in the basal and inducible expression of many cytoprotective genes that effectively protect mammalian cells from various forms of stress and reduce the propensity of tissues and organisms to develop disease or malignancy including breast cancer. Consequently, a loss of Nrf2 in response to high levels of gluco-corticoids may lead to a decrease in cellular defense against oxidative stress, which plays an important role in the initiation of human mammary carcinogenesis. In the present review, we provide a comprehensive overview of the current state of knowledge of the cellular mechanisms by which both glucocorticoid pharmacotherapy and endogenous GCs (cortisol in humans and corticosterone in rodents) may contribute to breast cancer development through inhibition of the Nrf2-ARE/EpRE pathway and the protective role of melatonin against glucocorticoid-induced apoptosis in the immune system.

Keywords
breast carcinogenesis
glucocorticoids (GCs)
glucocorticoid receptor (GR)
glucocor-ticoid response element (GRE)
nuclear factor erythroid 2-related factor 2 (Nrf2)
antioxidant/electrophile response element (ARE/EpRE)
melatonin (MLT)
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