Abstract
The prevalence of obesity continues to increase to the extent that it became a worldwide
pandemic. An accumulating body of evidence has associated obesity with the development of different
types of cancer, including colorectal cancer, which is a notorious disease with a high mortality
rate. At the molecular level, colorectal cancer is a heterogenous disease characterized by a myriad
of genetic and epigenetic alterations associated with various forms of genomic instability (detailed
in Supplementary Materials). Recently, the microenvironment has emerged as a major factor
in carcinogenesis. Our aim is to define the different molecular alterations leading to the development
of colorectal cancer in obese patients with a focus on the role of the microenvironment in carcinogenesis.
We also highlight all existent molecules in clinical trials that target the activated pathways
in obesity-associated colorectal cancer, whether used as single treatments or in combination.
Obesity predisposes to colorectal cancer via creating a state of chronic inflammation with dysregulated
adipokines, inflammatory mediators, and other factors such as immune cell infiltration. A unifying
theme in obesity-mediated colorectal cancer is the activation of the PI3K/AKT,
mTOR/MAPK, and STAT3 signaling pathways. Different inhibitory molecules towards these pathways
exist, increasing the therapeutic choice of obesity-associated colon cancer. However, obese
patients are more likely to suffer from chemotherapy overdosing. Preventing obesity through maintaining
a healthy and active lifestyle remains to be the best remedy.
Keywords:
Chemotherapy, chronic inflammation, colorectal cancer, microenvironment, obesity, STAT3 signaling pathway.
Graphical Abstract
[10]
Zierle-Ghosh, A.; Jan, A. Physiology, body mass index. StatPearls. Treasure Island (FL). 2021.
[26]
Thorsson, V.; Gibbs, D.L.; Brown, S.D.; Wolf, D.; Bortone, D.S.; Ou Yang, T.H.; Porta-Pardo, E.; Gao, G.F.; Plaisier, C.L.; Eddy, J.A.; Ziv, E.; Culhane, A.C.; Paull, E.O.; Sivakumar, I.K.A.; Gentles, A.J.; Malhotra, R.; Farshidfar, F.; Colaprico, A.; Parker, J.S.; Mose, L.E.; Vo, N.S.; Liu, J.; Liu, Y.; Rader, J.; Dhankani, V.; Reynolds, S.M.; Bowlby, R.; Califano, A.; Cherniack, A.D.; Anastassiou, D.; Bedognetti, D.; Mokrab, Y.; Newman, A.M.; Rao, A.; Chen, K.; Krasnitz, A.; Hu, H.; Malta, T.M.; Noushmehr, H.; Pedamallu, C.S.; Bullman, S.; Ojesina, A.I.; Lamb, A.; Zhou, W.; Shen, H.; Choueiri, T.K.; Weinstein, J.N.; Guinney, J.; Saltz, J.; Holt, R.A.; Rabkin, C.S.; Lazar, A.J.; Serody, J.S.; Demicco, E.G.; Disis, M.L.; Vincent, B.G.; Shmulevich, I. The immune landscape of cancer.
Immunity, 2018,
48(4), 812-830.e14.
[
http://dx.doi.org/10.1016/j.immuni.2018.03.023] [PMID:
29628290]
[27]
Thorsson, V.; Gibbs, D.L.; Brown, S.D.; Wolf, D.; Bortone, D.S.; Ou Yang, T.H.; Porta-Pardo, E.; Gao, G.F.; Plaisier, C.L.; Eddy, J.A.; Ziv, E.; Culhane, A.C.; Paull, E.O.; Sivakumar, I.K.A.; Gentles, A.J.; Malhotra, R.; Farshidfar, F.; Colaprico, A.; Parker, J.S.; Mose, L.E.; Vo, N.S.; Liu, J.; Liu, Y.; Rader, J.; Dhankani, V.; Reynolds, S.M.; Bowlby, R.; Califano, A.; Cherniack, A.D.; Anastassiou, D.; Bedognetti, D.; Mokrab, Y.; Newman, A.M.; Rao, A.; Chen, K.; Krasnitz, A.; Hu, H.; Malta, T.M.; Noushmehr, H.; Pedamallu, C.S.; Bullman, S.; Ojesina, A.I.; Lamb, A.; Zhou, W.; Shen, H.; Choueiri, T.K.; Weinstein, J.N.; Guinney, J.; Saltz, J.; Holt, R.A.; Rabkin, C.S.; Lazar, A.J.; Serody, J.S.; Demicco, E.G.; Disis, M.L.; Vincent, B.G.; Shmulevich, I. The immune landscape of cancer.
Immunity, 2019,
51(2), 411-412.
[
http://dx.doi.org/10.1016/j.immuni.2019.08.004] [PMID:
31433971]
[151]
Muller, T.D.; Nogueiras, R.; Andermann, M.L.; Andrews, Z.B.; Anker, S.D.; Argente, J.; Batterham, R.L.; Benoit, S.C.; Bowers, C.Y.; Broglio, F.; Casanueva, F.F.; D’Alessio, D.; Depoortere, I.; Geliebter, A.; Ghigo, E.; Cole, P.A.; Cowley, M.; Cummings, D.E.; Dagher, A.; Diano, S.; Dickson, S.L.; Diéguez, C.; Granata, R.; Grill, H.J.; Grove, K.; Habegger, K.M.; Heppner, K.; Heiman, M.L.; Holsen, L.; Holst, B.; Inui, A.; Jansson, J.O.; Kirchner, H.; Korbonits, M.; Laferrere, B.; LeRoux, C.W.; Lopez, M.; Morin, S.; Nakazato, M.; Nass, R.; Perez-Tilve, D.; Pfluger, P.T.; Schwartz, T.W.; Seeley, R.J.; Sleeman, M.; Sun, Y.; Sussel, L.; Tong, J.; Thorner, M.O.; van der Lely, A.J.; van der Ploeg, L.H.; Zigman, J.M.; Kojima, M.; Kangawa, K.; Smith, R.G.; Horvath, T.; Tschop, M.H. Ghrelin.
Mol. Metab., 2015,
4(6), 437-460.
[
http://dx.doi.org/10.1016/j.molmet.2015.03.005] [PMID:
26042199]
[190]
Parikh, A.; Thevenin, C. Physiology, gastrointestinal hormonal control. In: StatPearls; Treasure Island, FL, 2021.