Potential Mechanisms by which Glucocorticoids Induce Breast Carcinogenesis through Nrf2 Inhibition.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
high levels of glucocorticoids | increase | breast cancer | women | - | may also contribute significantly to the initiation | #1 |
high levels of glucocorticoids | decrease | nuclear erythroid factor 2-related (Nrf2)-antioxidant/electrophile response element (ARE/EpRE) pathway | - | - | inhibition | #2 |
Nrf2 | increase | many cytoprotective genes | mammalian cells | - | plays a central role in the basal and inducible expression | #3 |
Nrf2 | decrease | mammalian cells from various forms of stress | mammalian cells | - | effectively protect | #4 |
Nrf2 | decrease | tissues and organisms to develop disease or malignancy including breast cancer | tissues and organisms | - | reduce the propensity | #5 |
high levels of glucocorticoids | decrease | Nrf2 | - | - | loss | #6 |
loss of Nrf2 | decrease | cellular defense against oxidative stress | - | - | may lead to a decrease | #7 |
decrease in cellular defense against oxidative stress | increase | human mammary carcinogenesis | human | - | plays an important role in the initiation | #8 |
glucocorticoid pharmacotherapy and endogenous GCs (cortisol in humans and corticosterone in rodents) | increase | Nrf2-ARE/EpRE pathway | humans and rodents | - | may contribute to breast cancer development through inhibition | #9 |
melatonin | decrease | immune system | - | - | protective role against glucocorticoid-induced apoptosis | #10 |
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.