The adenosine A2A receptor in triple-negative breast cancer: molecular mechanisms and therapeutic implications
摘要
Triple-negative breast cancer (TNBC) has been well-recognized as one of the most aggressive subtypes of breast cancer. TNBC lacks the expression of the estrogen receptor (ER), progesterone receptor (PR), or human epidermal growth factor receptor 2 (HER2), due to which TNBC cannot be treated using traditional therapies available for other subtypes of breast cancer. As a result, TNBC remains heavily dependent on cytotoxic chemotherapy and, more recently, immune-checkpoint inhibitors, although the latter provide durable responses in a limited number of patients. Emerging research has underscored the role of tumor immunometabolism in immune evasion and therapy-refractive behavior. One of the most promising mechanisms involves the extracellular adenosine (eADO) axis created by the action of ectonucleotidases CD39/CD73 and gets transduced by the adenosine A2A receptor (A2AR). Because the A2AR is stimulated by an increase in eADO concentration, the metabolism of the immune cells is shifted from a pro-inflammatory, glycolytic state to a more immunosuppressive, anti-inflammatory, oxidative state. This change in the immune cell metabolism represses T-lymphocyte and natural killer (NK)-cell-dependent cytotoxicity and drives myeloid cells, particularly macrophages, to adopt an M2-like protumorigenic phenotype. In TNBC, hypoxia as well as oxidative stress upregulates adenosinergic signaling and, as a result, further propagates immune system dysfunction. This review focuses on the mechanistic roles of the A2AR, while contextualizing its function within tumor biology. It aims to explain A2AR regulation across distinct tumor microenvironment (TME) compartments, and a critical analysis of its crosstalk with glycolytic metabolic checkpoints, which include hypoxia-inducible factor 1-alpha (HIF-1α) and AMP-activated protein kinase (AMPK). This provides insight into its potential for therapeutic targeting.