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Eric Monsalves Institute of Medical Science

Department of Medical Biophysics University of Toronto, Toronto, Ontario, Canada

Division of Neurosurgery Toronto Western Hospital, 399 Bathurst Street, 4W-439, Toronto, Ontario, Canada M5T 2S8

Ontario Cancer Institute Princess Margaret Hospital, Toronto, Ontario, Canada

Endocrine Oncology Site Group Princess Margaret Hospital, Toronto, Ontario, Canada

Department of Laboratory Medicine and Pathobiology University of Toronto, Toronto, Ontario, Canada
Institute of Medical Science

Department of Medical Biophysics University of Toronto, Toronto, Ontario, Canada

Division of Neurosurgery Toronto Western Hospital, 399 Bathurst Street, 4W-439, Toronto, Ontario, Canada M5T 2S8

Ontario Cancer Institute Princess Margaret Hospital, Toronto, Ontario, Canada

Endocrine Oncology Site Group Princess Margaret Hospital, Toronto, Ontario, Canada

Department of Laboratory Medicine and Pathobiology University of Toronto, Toronto, Ontario, Canada

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Kyle Juraschka Institute of Medical Science

Department of Medical Biophysics University of Toronto, Toronto, Ontario, Canada

Division of Neurosurgery Toronto Western Hospital, 399 Bathurst Street, 4W-439, Toronto, Ontario, Canada M5T 2S8

Ontario Cancer Institute Princess Margaret Hospital, Toronto, Ontario, Canada

Endocrine Oncology Site Group Princess Margaret Hospital, Toronto, Ontario, Canada

Department of Laboratory Medicine and Pathobiology University of Toronto, Toronto, Ontario, Canada

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Toru Tateno Institute of Medical Science

Department of Medical Biophysics University of Toronto, Toronto, Ontario, Canada

Division of Neurosurgery Toronto Western Hospital, 399 Bathurst Street, 4W-439, Toronto, Ontario, Canada M5T 2S8

Ontario Cancer Institute Princess Margaret Hospital, Toronto, Ontario, Canada

Endocrine Oncology Site Group Princess Margaret Hospital, Toronto, Ontario, Canada

Department of Laboratory Medicine and Pathobiology University of Toronto, Toronto, Ontario, Canada

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Sameer Agnihotri Institute of Medical Science

Department of Medical Biophysics University of Toronto, Toronto, Ontario, Canada

Division of Neurosurgery Toronto Western Hospital, 399 Bathurst Street, 4W-439, Toronto, Ontario, Canada M5T 2S8

Ontario Cancer Institute Princess Margaret Hospital, Toronto, Ontario, Canada

Endocrine Oncology Site Group Princess Margaret Hospital, Toronto, Ontario, Canada

Department of Laboratory Medicine and Pathobiology University of Toronto, Toronto, Ontario, Canada

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Sylvia L Asa Institute of Medical Science

Department of Medical Biophysics University of Toronto, Toronto, Ontario, Canada

Division of Neurosurgery Toronto Western Hospital, 399 Bathurst Street, 4W-439, Toronto, Ontario, Canada M5T 2S8

Ontario Cancer Institute Princess Margaret Hospital, Toronto, Ontario, Canada

Endocrine Oncology Site Group Princess Margaret Hospital, Toronto, Ontario, Canada

Department of Laboratory Medicine and Pathobiology University of Toronto, Toronto, Ontario, Canada

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Shereen Ezzat Institute of Medical Science

Department of Medical Biophysics University of Toronto, Toronto, Ontario, Canada

Division of Neurosurgery Toronto Western Hospital, 399 Bathurst Street, 4W-439, Toronto, Ontario, Canada M5T 2S8

Ontario Cancer Institute Princess Margaret Hospital, Toronto, Ontario, Canada

Endocrine Oncology Site Group Princess Margaret Hospital, Toronto, Ontario, Canada

Department of Laboratory Medicine and Pathobiology University of Toronto, Toronto, Ontario, Canada
Institute of Medical Science

Department of Medical Biophysics University of Toronto, Toronto, Ontario, Canada

Division of Neurosurgery Toronto Western Hospital, 399 Bathurst Street, 4W-439, Toronto, Ontario, Canada M5T 2S8

Ontario Cancer Institute Princess Margaret Hospital, Toronto, Ontario, Canada

Endocrine Oncology Site Group Princess Margaret Hospital, Toronto, Ontario, Canada

Department of Laboratory Medicine and Pathobiology University of Toronto, Toronto, Ontario, Canada
Institute of Medical Science

Department of Medical Biophysics University of Toronto, Toronto, Ontario, Canada

Division of Neurosurgery Toronto Western Hospital, 399 Bathurst Street, 4W-439, Toronto, Ontario, Canada M5T 2S8

Ontario Cancer Institute Princess Margaret Hospital, Toronto, Ontario, Canada

Endocrine Oncology Site Group Princess Margaret Hospital, Toronto, Ontario, Canada

Department of Laboratory Medicine and Pathobiology University of Toronto, Toronto, Ontario, Canada

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Gelareh Zadeh Institute of Medical Science

Department of Medical Biophysics University of Toronto, Toronto, Ontario, Canada

Division of Neurosurgery Toronto Western Hospital, 399 Bathurst Street, 4W-439, Toronto, Ontario, Canada M5T 2S8

Ontario Cancer Institute Princess Margaret Hospital, Toronto, Ontario, Canada

Endocrine Oncology Site Group Princess Margaret Hospital, Toronto, Ontario, Canada

Department of Laboratory Medicine and Pathobiology University of Toronto, Toronto, Ontario, Canada
Institute of Medical Science

Department of Medical Biophysics University of Toronto, Toronto, Ontario, Canada

Division of Neurosurgery Toronto Western Hospital, 399 Bathurst Street, 4W-439, Toronto, Ontario, Canada M5T 2S8

Ontario Cancer Institute Princess Margaret Hospital, Toronto, Ontario, Canada

Endocrine Oncology Site Group Princess Margaret Hospital, Toronto, Ontario, Canada

Department of Laboratory Medicine and Pathobiology University of Toronto, Toronto, Ontario, Canada

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pathogenesis will help to identify novel treatment targets ( Asa & Ezzat 2009 ). One such pathway that has been implicated in PAs is the phophotidylinositide-3-kinase (PI3K)/AKT/mTOR pathway. This pathway is involved in numerous crucial cell functions including

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Kristen Wong Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York, USA

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Francesca Di Cristofano Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York, USA

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Michela Ranieri Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York, USA

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Daniela De Martino Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York, USA

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Antonio Di Cristofano Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York, USA

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. Drug treatments and cell proliferation assay The CDK4/6 inhibitor palbociclib was provided by Pfizer and prepared in 50 mM lactate. The PI3K/mTOR inhibitor, omipalisib, and the MEK inhibitor, trametinib, were purchased from Selleck Chemicals (Houston

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Rhonda L Bitting Divisions of Medical Oncology and Urology, Duke Cancer Institute, Duke University, DUMC Box 102002, Durham, North Carolina 27710, USA

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Andrew J Armstrong Divisions of Medical Oncology and Urology, Duke Cancer Institute, Duke University, DUMC Box 102002, Durham, North Carolina 27710, USA

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with metastatic CRPC, the survival rate of patients with metastatic CRPC remains poor and additional therapeutic approaches are needed. The phosphatidylinositol 3-kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR) pathway is a key oncogenic

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Matti L Gild Human Oncology and Pathogenesis Program, Department of Medicine, Department of Pathology

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Iñigo Landa Human Oncology and Pathogenesis Program, Department of Medicine, Department of Pathology

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Mabel Ryder Human Oncology and Pathogenesis Program, Department of Medicine, Department of Pathology
Human Oncology and Pathogenesis Program, Department of Medicine, Department of Pathology

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Ronald A Ghossein Human Oncology and Pathogenesis Program, Department of Medicine, Department of Pathology

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Jeffrey A Knauf Human Oncology and Pathogenesis Program, Department of Medicine, Department of Pathology

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James A Fagin Human Oncology and Pathogenesis Program, Department of Medicine, Department of Pathology
Human Oncology and Pathogenesis Program, Department of Medicine, Department of Pathology

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also has effects on mammalian target of rapamycin (mTOR), has been shown to inhibit growth and induce apoptosis of the MTC cell line TT ( Kunnimalaiyaan et al . 2006 , Ball et al . 2007 ). Recently, novel natural compounds called withanolides have

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Maria Cristina De Martino
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Richard A Feelders
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Wouter W de Herder
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Peter M van Koetsveld
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Fadime Dogan
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Joseph A M J L Janssen
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A Marlijn Waaijers
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Claudia Pivonello Department of Internal Medicine Division of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands

Dipartimento di Medicina Clinica e Chirurgia Sezione di Endocrinologia, Università Federico II, Naples, Italy

Department of Pathology Erasmus Medical Center, Rotterdam and Reinier de Graaf Gasthuis, Delft, The Netherlands

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Steven W J Lamberts
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Annamaria Colao Department of Internal Medicine Division of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands

Dipartimento di Medicina Clinica e Chirurgia Sezione di Endocrinologia, Università Federico II, Naples, Italy

Department of Pathology Erasmus Medical Center, Rotterdam and Reinier de Graaf Gasthuis, Delft, The Netherlands

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Ronald R de Krijger Department of Internal Medicine Division of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands

Dipartimento di Medicina Clinica e Chirurgia Sezione di Endocrinologia, Università Federico II, Naples, Italy

Department of Pathology Erasmus Medical Center, Rotterdam and Reinier de Graaf Gasthuis, Delft, The Netherlands

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Rosario Pivonello Department of Internal Medicine Division of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands

Dipartimento di Medicina Clinica e Chirurgia Sezione di Endocrinologia, Università Federico II, Naples, Italy

Department of Pathology Erasmus Medical Center, Rotterdam and Reinier de Graaf Gasthuis, Delft, The Netherlands

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Leo J Hofland
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factor may be mTOR, which is a protein kinase of the phosphatidylinositol 3-kinase (PI3K)/Akt signaling pathway, playing a pivotal role in cell growth, metabolism, and proliferation ( Guertin & Sabatini 2007 ). Activation of the mTOR pathway leads to the

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Yuanzhong Wang Department of Cancer Biology, Beckman Research Institute of the City of Hope, Duarte, California, USA

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Yen-Dun Tony Tzeng Department of Cancer Biology, Beckman Research Institute of the City of Hope, Duarte, California, USA
Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan, Republic of China

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Gregory Chang Department of Cancer Biology, Beckman Research Institute of the City of Hope, Duarte, California, USA

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Xiaoqiang Wang Department of Cancer Biology, Beckman Research Institute of the City of Hope, Duarte, California, USA

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Shiuan Chen Department of Cancer Biology, Beckman Research Institute of the City of Hope, Duarte, California, USA

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. Luciferase activity was normalized to protein concentration. * P < 0.05 vs siRNA NC, n = 3. AREG sustains ERα signaling by activation of PI3K/Akt/mTOR signaling and upregulation of FoxM1 and SGK3 expression To investigate the mechanism

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Simona Falletta Department of Medical Science, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy

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Stefano Partelli Pancreatic Surgery Unit, Pancreas Translational and Research Institute, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy

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Corrado Rubini Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy

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Dominik Nann Institut fur Pathologie, University of Bern, Bern, Switzerland

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Andrea Doria Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy

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Ilaria Marinoni Institut fur Pathologie, University of Bern, Bern, Switzerland

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Vanessa Polenta Pancreatic Surgery Unit, Pancreas Translational and Research Institute, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy

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Carmelina Di Pasquale Department of Medical Science, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy

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Ettore degli Uberti Department of Medical Science, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy

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Aurel Perren Institut fur Pathologie, University of Bern, Bern, Switzerland

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Massimo Falconi Pancreatic Surgery Unit, Pancreas Translational and Research Institute, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy

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Maria Chiara Zatelli Department of Medical Science, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy

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-NET growth by recent guidelines ( Pavel et al . 2016 ). The mammalian target of rapamycin (mTOR) is a serine threonine kinase located downstream the PI3K/AKT signaling pathway that plays a crucial role in mediating basic cellular functions ( Jiang & Liu

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Josefine Bostner Department of Clinical and Experimental Medicine, Department of Clinical and Experimental Medicine, Department of Oncology, Department of Oncology

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Elin Karlsson Department of Clinical and Experimental Medicine, Department of Clinical and Experimental Medicine, Department of Oncology, Department of Oncology

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Cecilia Bivik Eding Department of Clinical and Experimental Medicine, Department of Clinical and Experimental Medicine, Department of Oncology, Department of Oncology

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Gizeh Perez-Tenorio Department of Clinical and Experimental Medicine, Department of Clinical and Experimental Medicine, Department of Oncology, Department of Oncology

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Hanna Franzén Department of Clinical and Experimental Medicine, Department of Clinical and Experimental Medicine, Department of Oncology, Department of Oncology

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Aelita Konstantinell Department of Clinical and Experimental Medicine, Department of Clinical and Experimental Medicine, Department of Oncology, Department of Oncology

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Tommy Fornander Department of Clinical and Experimental Medicine, Department of Clinical and Experimental Medicine, Department of Oncology, Department of Oncology

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Bo Nordenskjöld Department of Clinical and Experimental Medicine, Department of Clinical and Experimental Medicine, Department of Oncology, Department of Oncology

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Olle Stål Department of Clinical and Experimental Medicine, Department of Clinical and Experimental Medicine, Department of Oncology, Department of Oncology

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/mammalian target of rapamycin (PI3K/mTOR) cascade is a characterized mechanism of endocrine resistance, with aberrant stimulation promoting estrogen receptor (ER) α (ESR1) activation and tumor growth, despite estrogen antagonizing- or estrogen restriction

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Teresa Gagliano Section of Endocrinology, Laboratorio in Rete del Tecnopolo ‘Tecnologie delle Terapie Avanzate’ (LTTA), Department of Cardiological, Department of Morphology, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy

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Mariaenrica Bellio Section of Endocrinology, Laboratorio in Rete del Tecnopolo ‘Tecnologie delle Terapie Avanzate’ (LTTA), Department of Cardiological, Department of Morphology, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy

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Erica Gentilin Section of Endocrinology, Laboratorio in Rete del Tecnopolo ‘Tecnologie delle Terapie Avanzate’ (LTTA), Department of Cardiological, Department of Morphology, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy
Section of Endocrinology, Laboratorio in Rete del Tecnopolo ‘Tecnologie delle Terapie Avanzate’ (LTTA), Department of Cardiological, Department of Morphology, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy

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Daniela Molè Section of Endocrinology, Laboratorio in Rete del Tecnopolo ‘Tecnologie delle Terapie Avanzate’ (LTTA), Department of Cardiological, Department of Morphology, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy

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Federico Tagliati Section of Endocrinology, Laboratorio in Rete del Tecnopolo ‘Tecnologie delle Terapie Avanzate’ (LTTA), Department of Cardiological, Department of Morphology, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy

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Marco Schiavon Section of Endocrinology, Laboratorio in Rete del Tecnopolo ‘Tecnologie delle Terapie Avanzate’ (LTTA), Department of Cardiological, Department of Morphology, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy

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Narciso Giorgio Cavallesco Section of Endocrinology, Laboratorio in Rete del Tecnopolo ‘Tecnologie delle Terapie Avanzate’ (LTTA), Department of Cardiological, Department of Morphology, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy

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Luigi Gaetano Andriolo Section of Endocrinology, Laboratorio in Rete del Tecnopolo ‘Tecnologie delle Terapie Avanzate’ (LTTA), Department of Cardiological, Department of Morphology, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy

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Maria Rosaria Ambrosio Section of Endocrinology, Laboratorio in Rete del Tecnopolo ‘Tecnologie delle Terapie Avanzate’ (LTTA), Department of Cardiological, Department of Morphology, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy

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Federico Rea Section of Endocrinology, Laboratorio in Rete del Tecnopolo ‘Tecnologie delle Terapie Avanzate’ (LTTA), Department of Cardiological, Department of Morphology, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy

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Ettore degli Uberti Section of Endocrinology, Laboratorio in Rete del Tecnopolo ‘Tecnologie delle Terapie Avanzate’ (LTTA), Department of Cardiological, Department of Morphology, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy
Section of Endocrinology, Laboratorio in Rete del Tecnopolo ‘Tecnologie delle Terapie Avanzate’ (LTTA), Department of Cardiological, Department of Morphology, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy

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Maria Chiara Zatelli Section of Endocrinology, Laboratorio in Rete del Tecnopolo ‘Tecnologie delle Terapie Avanzate’ (LTTA), Department of Cardiological, Department of Morphology, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy
Section of Endocrinology, Laboratorio in Rete del Tecnopolo ‘Tecnologie delle Terapie Avanzate’ (LTTA), Department of Cardiological, Department of Morphology, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy

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mainly represented by chemotherapy and radiation ( Bertino et al . 2009 ) in the attempt to reduce tumor mass, while somatostatin analogs are employed for symptomatic control ( Srirajaskanthan et al . 2009 ). The mammalian target of rapamycin (mTOR

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Atsuko Kasajima Institute of Pathology, Department of Internal Medicine, Department of Pathology, Institute of Pathology, Institute of Pathology, Institute of Pathology, Charité Universitätsmedizin, Berlin, Germany
Institute of Pathology, Department of Internal Medicine, Department of Pathology, Institute of Pathology, Institute of Pathology, Institute of Pathology, Charité Universitätsmedizin, Berlin, Germany

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Marianne Pavel Institute of Pathology, Department of Internal Medicine, Department of Pathology, Institute of Pathology, Institute of Pathology, Institute of Pathology, Charité Universitätsmedizin, Berlin, Germany

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Silvia Darb-Esfahani Institute of Pathology, Department of Internal Medicine, Department of Pathology, Institute of Pathology, Institute of Pathology, Institute of Pathology, Charité Universitätsmedizin, Berlin, Germany

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Aurelia Noske Institute of Pathology, Department of Internal Medicine, Department of Pathology, Institute of Pathology, Institute of Pathology, Institute of Pathology, Charité Universitätsmedizin, Berlin, Germany

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Albrecht Stenzinger Institute of Pathology, Department of Internal Medicine, Department of Pathology, Institute of Pathology, Institute of Pathology, Institute of Pathology, Charité Universitätsmedizin, Berlin, Germany
Institute of Pathology, Department of Internal Medicine, Department of Pathology, Institute of Pathology, Institute of Pathology, Institute of Pathology, Charité Universitätsmedizin, Berlin, Germany

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Hironobu Sasano Institute of Pathology, Department of Internal Medicine, Department of Pathology, Institute of Pathology, Institute of Pathology, Institute of Pathology, Charité Universitätsmedizin, Berlin, Germany

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Manfred Dietel Institute of Pathology, Department of Internal Medicine, Department of Pathology, Institute of Pathology, Institute of Pathology, Institute of Pathology, Charité Universitätsmedizin, Berlin, Germany

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Carsten Denkert Institute of Pathology, Department of Internal Medicine, Department of Pathology, Institute of Pathology, Institute of Pathology, Institute of Pathology, Charité Universitätsmedizin, Berlin, Germany

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Christoph Röcken Institute of Pathology, Department of Internal Medicine, Department of Pathology, Institute of Pathology, Institute of Pathology, Institute of Pathology, Charité Universitätsmedizin, Berlin, Germany

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Bertram Wiedenmann Institute of Pathology, Department of Internal Medicine, Department of Pathology, Institute of Pathology, Institute of Pathology, Institute of Pathology, Charité Universitätsmedizin, Berlin, Germany

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Wilko Weichert Institute of Pathology, Department of Internal Medicine, Department of Pathology, Institute of Pathology, Institute of Pathology, Institute of Pathology, Charité Universitätsmedizin, Berlin, Germany
Institute of Pathology, Department of Internal Medicine, Department of Pathology, Institute of Pathology, Institute of Pathology, Institute of Pathology, Charité Universitätsmedizin, Berlin, Germany

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( Modlin et al . 2008 ), therefore novel treatment strategies for these tumours are still urgently needed. Recently, the mammalian target of rapamycin (mTOR) inhibitors temsirolimus ( Rini 2008 ) and everolimus ( Sánchez-Fructuoso 2008 ) have entered late

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